Provider Type 20 Physician, MD., Osteopath Reimbursement Rates

Updated: July 1, 2015

The information contained in the schedule is made available to provide information and is not a guarantee by the State or the Department or its employees as to the present accuracy of the information contained herein. For example, coverage as well as an actual rate may have been revised or updated and may no longer be the same as posted on the website.

Note: Procedure codes with a rate of $0.00 are reimbursed at 62% of Usual and Customary charges unless noted otherwise in Nevada Medicaid policy. CPT codes, descriptions and other data only are copyright © 2008 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. CPT is a registered trademark ® of the American Medical Association. Current Dental Terminology, fourth edition (CDT) (including procedure codes, definitions (descriptors) and other data) is copyrighted by the American Dental Association. © 2008 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

Proc Code Description Mod Rate 01953 ANESTH BURN EACH 9 PERCENT 21.12 01996 HOSP MANAGE CONT DRUG ADMIN 63.36 0359T BEHAVIORAL ID ASSESSMENT 70.19 0360T OBSERV BEHAV ASSESSMENT 70.19 0361T OBSERV BEHAV ASSESS ADDL 70.19 0362T EXPOSE BEHAV ASSESSMENT 70.19 0363T EXPOSE BEHAV ASSESS ADDL 70.19 0364T ADAPTIVE BEHAVIOR TREATMENT 60.20 0365T ADAPTIVE BEHAVIOR TX ADDL 60.20 0366T GROUP BEHAVIOR TREATMENT 42.84 0367T GROUP BEHAV TREATMENT ADDL 42.84 0368T BEHAVIOR TREATMENT MODIFIED 60.20 0369T BEHAV TREATMENT MODIFY ADDL 60.20 0370T FAM BEHAV TREATMENT GUIDANCE 84.68 0372T SOCIAL SKILLS TRAINING GROUP 42.84 0373T EXPOSURE BEHAVIOR TREATMENT 76.28 0374T EXPOSE BEHAV TREATMENT ADDL 76.28 10021 FNA W/O IMAGE 70.92 10022 FNA W/IMAGE 65.39 10030 Guide cathet fluid drainage 154.73 10040 ACNE SURGERY 87.47 10060 DRAINAGE OF SKIN ABSCESS 95.60 10061 DRAINAGE OF SKIN ABSCESS 178.04 10080 DRAINAGE OF PILONIDAL CYST 103.29 Proc Code Description Mod Rate 10081 DRAINAGE OF PILONIDAL CYST 172.45 10120 REMOVE FOREIGN BODY 103.22 10121 REMOVE FOREIGN BODY 185.58 10140 DRAINAGE OF HEMATOMA/FLUID 118.06 10160 PUNCTURE DRAINAGE OF LESION 95.62 10180 COMPLEX DRAINAGE WOUND 178.97 11000 DEBRIDE INFECTED SKIN 28.42 11001 DEBRIDE INFECTED SKIN ADD-ON 14.22 11004 DEBRIDE GENITALIA & PERINEUM 579.35 11005 DEBRIDE ABDOM WALL 781.65 11006 DEBRIDE GENIT/PER/ABDOM WALL 702.26 11008 REMOVE MESH FROM ABD WALL 274.06 11010 DEBRIDE SKIN AT FX SITE 278.30 11011 DEBRIDE SKIN MUSC AT FX SITE 301.71 11012 DEB SKIN BONE AT FX SITE 426.17 11042 DEB SUBQ TISSUE 20 SQ CM/< 61.54 11043 DEB MUSC/FASCIA 20 SQ CM/< 157.36 11044 DEB BONE 20 SQ CM/< 234.59 11045 DEB SUBQ TISSUE ADD-ON 27.63 11046 DEB MUSC/FASCIA ADD-ON 56.21 11047 DEB BONE ADD-ON 100.66 11055 TRIM SKIN LESION 15.90 11056 TRIM SKIN LESIONS 2 TO 4 22.47 11057 TRIM SKIN LESIONS OVER 4 29.39 11100 BIOPSY SKIN LESION 48.61 11101 BIOPSY SKIN ADD-ON 24.46 11200 REMOVAL OF SKIN TAGS 2.0 CM 74.11 11305 SHAVE SKIN LESION 0.5 CM/< 38.48 11306 SHAVE SKIN LESION 0.6-1.0 CM 51.56 11307 SHAVE SKIN LESION 1.1-2.0 CM 66.25 11308 SHAVE SKIN LESION >2.0 CM 72.94 11310 SHAVE SKIN LESION 0.5 CM/< 47.19 11311 SHAVE SKIN LESION 0.6-1.0 CM 65.00 11312 SHAVE SKIN LESION 1.1-2.0 CM 78.37 11313 SHAVE SKIN LESION >2.0 CM 100.38 11400 EXC TR-EXT B9+MARG 0.5 CM< 79.32 11401 EXC TR-EXT B9+MARG 0.6-1 CM 103.18 11402 EXC TR-EXT B9+MARG 1.1-2 CM 113.71 11403 EXC TR-EXT B9+MARG 2.1-3CM/< 146.50 11404 EXC TR-EXT B9+MARG 3.1-4 CM 160.82 11406 EXC TR-EXT B9+MARG >4.0 CM 244.91 Proc Code Description Mod Rate 11420 EXC H-F-NK-SP B9+MARG 0.5/< 81.23 11421 EXC H-F-NK-SP B9+MARG 0.6-1 110.40 11422 EXC H-F-NK-SP B9+MARG 1.1-2 134.86 11423 EXC H-F-NK-SP B9+MARG 2.1-3 156.55 11424 EXC H-F-NK-SP B9+MARG 3.1-4 178.52 11426 EXC H-F-NK-SP B9+MARG >4 CM 273.01 11440 EXC FACE-MM B9+MARG 0.5 CM/< 103.53 11441 EXC FACE-MM B9+MARG 0.6-1 CM 131.15 11442 EXC FACE-MM B9+MARG 1.1-2 CM 145.52 11443 EXC FACE-MM B9+MARG 2.1-3 CM 177.64 11444 EXC FACE-MM B9+MARG 3.1-4 CM 226.95 11446 EXC FACE-MM B9+MARG >4 CM 326.08 11450 REMOVAL SWEAT GLAND LESION 250.45 11451 REMOVAL SWEAT GLAND LESION 323.33 11462 REMOVAL SWEAT GLAND LESION 239.27 11463 REMOVAL SWEAT GLAND LESION 326.52 11470 REMOVAL SWEAT GLAND LESION 281.55 11471 REMOVAL SWEAT GLAND LESION 352.30 11600 EXC TR-EXT MAL+MARG 0.5 CM/< 119.51 11601 EXC TR-EXT MAL+MARG 0.6-1 CM 148.23 11602 EXC TR-EXT MAL+MARG 1.1-2 CM 162.64 11603 EXC TR-EXT MAL+MARG 2.1-3 CM 194.07 11604 EXC TR-EXT MAL+MARG 3.1-4 CM 214.78 11606 EXC TR-EXT MAL+MARG >4 CM 319.34 11620 EXC H-F-NK-SP MAL+MARG 0.5/< 121.29 11621 EXC S/N/H/F/G MAL+MRG 0.6-1 148.93 11622 EXC S/N/H/F/G MAL+MRG 1.1-2 170.68 11623 EXC S/N/H/F/G MAL+MRG 2.1-3 211.61 11624 EXC S/N/H/F/G MAL+MRG 3.1-4 239.93 11626 EXC S/N/H/F/G MAL+MRG >4 CM 294.83 11640 EXC F/E/E/N/L MAL+MRG 0.5CM< 125.18 11641 EXC F/E/E/N/L MAL+MRG 0.6-1 155.98 11642 EXC F/E/E/N/L MAL+MRG 1.1-2 183.25 11643 EXC F/E/E/N/L MAL+MRG 2.1-3 230.87 11644 EXC F/E/E/N/L MAL+MRG 3.1-4 285.84 11646 EXC F/E/E/N/L MAL+MRG >4 CM 397.05 11719 TRIM NAIL(S) ANY NUMBER 7.60 11720 DEBRIDE NAIL 1-5 14.90 11721 DEBRIDE NAIL 6 OR MORE 24.56 11730 REMOVAL OF NAIL PLATE 50.53 11732 REMOVE NAIL PLATE ADD-ON 20.06 11740 DRAIN BLOOD FROM UNDER NAIL 32.76 11750 REMOVAL OF NAIL BED 173.14 11752 REMOVE NAIL BED/TIP 259.66 11755 BIOPSY NAIL UNIT 78.21 11760 REPAIR OF NAIL BED 133.87 Proc Code Description Mod Rate 11762 RECONSTRUCTION OF NAIL BED 185.05 11765 EXCISION OF NAIL FOLD TOE 93.04 11770 REMOVE PILONIDAL CYST SIMPLE 183.77 11771 REMOVE PILONIDAL CYST EXTEN 431.80 11772 REMOVE PILONIDAL CYST COMPL 573.13 11900 INJECT SKIN LESIONS 7 48.63 11950 TX CONTOUR DEFECTS 1 CC/< 53.20 11951 TX CONTOUR DEFECTS 1.1-5.0CC 76.48 11952 TX CONTOUR DEFECTS 5.1-10CC 100.70 11954 TX CONTOUR DEFECTS >10.0 CC 116.38 11960 INSERT TISSUE EXPANDER(S) 934.51 11970 REPLACE TISSUE EXPANDER 616.24 11971 REMOVE TISSUE EXPANDER(S) 322.25 11976 REMOVE CONTRACEPTIVE CAPSULE 97.05 11980 IMPLANT HORMONE PELLET(S) 79.88 11981 INSERT DRUG IMPLANT DEVICE 81.34 11982 REMOVE DRUG IMPLANT DEVICE 97.30 11983 REMOVE/INSERT DRUG IMPLANT 168.65 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< 45.00 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM 59.25 12004 RPR S/N/AX/GEN/TRK7.6-12.5CM 73.87 12005 RPR S/N/A/GEN/TRK12.6-20.0CM 99.98 12006 RPR S/N/A/GEN/TRK20.1-30.0CM 121.24 12007 RPR S/N/AX/GEN/TRNK >30.0 CM 150.62 12011 RPR F/E/E/N/L/M 2.5 CM/< 56.15 12013 RPR F/E/E/N/L/M 2.6-5.0 CM 62.72 12014 RPR F/E/E/N/L/M 5.1-7.5 CM 79.77 12015 RPR F/E/E/N/L/M 7.6-12.5 CM 99.25 12016 RPR FE/E/EN/L/M 12.6-20.0 CM 134.79 12017 RPR FE/E/EN/L/M 20.1-30.0 CM 154.16 12018 RPR F/E/E/N/L/M >30.0 CM 174.32 12020 CLOSURE OF SPLIT WOUND 190.75 12021 CLOSURE OF SPLIT WOUND 141.38 12031 INTMD RPR S/A/T/EXT 2.5 CM/< 152.69 12032 INTMD RPR S/A/T/EXT 2.6-7.5 193.83 12034 INTMD RPR S/TR/EXT 7.6-12.5 206.50 12035 INTMD RPR S/A/T/EXT 12.6-20 242.75 12036 INTMD RPR S/A/T/EXT 20.1-30 281.53 12037 INTMD RPR S/TR/EXT >30.0 CM 329.21 12041 INTMD RPR N-HF/GENIT 2.5CM/< 156.10 12042 INTMD RPR N-HF/GENIT2.6-7.5 199.13 12044 INTMD RPR N-HF/GENIT7.6-12.5 215.46 12045 INTMD RPR N-HF/GENIT12.6-20 270.64 12046 INTMD RPR N-HF/GENIT20.1-30 307.30 12047 INTMD RPR N-HF/GENIT >30.0CM 342.23 Proc Code Description Mod Rate 12051 INTMD RPR FACE/MM 2.5 CM/< 171.16 12052 INTMD RPR FACE/MM 2.6-5.0 CM 202.59 12053 INTMD RPR FACE/MM 5.1-7.5 CM 217.62 12054 INTMD RPR FACE/MM 7.6-12.5CM 229.00 12055 INTMD RPR FACE/MM 12.6-20 CM 304.25 12056 INTMD RPR FACE/MM 20.1-30.0 378.07 12057 INTMD RPR FACE/MM >30.0 CM 380.17 13100 CMPLX RPR TRUNK 1.1-2.5 CM 205.67 13101 CMPLX RPR TRUNK 2.6-7.5 CM 253.35 13102 CMPLX RPR TRUNK ADDL 5CM/< 74.94 13120 CMPLX RPR S/A/L 1.1-2.5 CM 236.18 13121 CMPLX RPR S/A/L 2.6-7.5 CM 266.90 13122 CMPLX RPR S/A/L ADDL 5 CM/> 86.11 13131 CMPLX RPR F/C/C/M/N/AX/G/H/F 250.46 13132 CMPLX RPR F/C/C/M/N/AX/G/H/F 314.11 13133 CMPLX RPR F/C/C/M/N/AX/G/H/F 131.55 13151 CMPLX RPR E/N/E/L 1.1-2.5 CM 287.17 13152 CMPLX RPR E/N/E/L 2.6-7.5 CM 348.07 13153 CMPLX RPR E/N/E/L ADDL 5CM/< 142.39 13160 LATE CLOSURE OF WOUND 812.08 14000 TIS TRNFR TRUNK 10 SQ CM/< 503.62 14001 TIS TRNFR TRUNK 10.1-30SQCM 653.91 14020 TIS TRNFR S/A/L 10 SQ CM/< 570.41 14021 TIS TRNFR S/A/L 10.1-30 SQCM 718.98 14040 TIS TRNFR F/C/C/M/N/A/G/H/F 634.12 14041 TIS TRNFR F/C/C/M/N/A/G/H/F 777.02 14060 TIS TRNFR E/N/E/L 10 SQ CM/< 675.50 14061 TIS TRNFR E/N/E/L10.1-30SQCM 831.27 14301 TIS TRNFR ANY 30.1-60 SQ CM 885.86 14302 TIS TRNFR ADDL 30 SQ CM/< 222.91 14350 FILLETED FINGER/TOE FLAP 710.79 15002 WOUND PREP TRK/ARM/LEG 228.12 15003 WOUND PREP ADDL 100 CM 45.82 15004 WOUND PREP F/N/HF/G 273.12 15005 WND PREP F/N/HF/G ADDL CM 92.01 15040 HARVEST CULTURED SKIN GRAFT 127.99 15050 SKIN PINCH GRAFT 447.97 15100 SKIN SPLT GRFT TRNK/ARM/LEG 721.11 15101 SKIN SPLT GRFT T/A/L ADD-ON 111.59 15110 EPIDRM AUTOGRFT TRNK/ARM/LEG 755.76 15111 EPIDRM AUTOGRFT T/A/L ADD-ON 102.43 15115 EPIDRM A-GRFT FACE/NCK/HF/G 760.07 15116 EPIDRM A-GRFT F/N/HF/G ADDL 135.54 15120 SKN SPLT A-GRFT FAC/NCK/HF/G 704.54 15121 SKN SPLT A-GRFT F/N/HF/G ADD 132.65 15130 DERM AUTOGRAFT TRNK/ARM/LEG 572.46 Proc Code Description Mod Rate 15131 DERM AUTOGRAFT T/A/L ADD-ON 93.99 15135 DERM AUTOGRAFT FACE/NCK/HF/G 751.60 15136 DERM AUTOGRAFT F/N/HF/G ADD 85.38 15150 CULT SKIN GRFT T/ARM/LEG 628.41 15151 CULT SKIN GRFT T/A/L ADDL 109.41 15152 CULT SKIN GRAFT T/A/L +% 141.28 15155 CULT SKIN GRAFT F/N/HF/G 643.99 15156 CULT SKIN GRFT F/N/HFG ADD 150.68 15157 CULT EPIDERM GRFT F/N/HFG +% 151.39 15200 SKIN FULL GRAFT TRUNK 676.40 15201 SKIN FULL GRAFT TRUNK ADD-ON 80.59 15220 SKIN FULL GRAFT SCLP/ARM/LEG 617.95 15221 SKIN FULL GRAFT ADD-ON 72.52 15240 SKIN FULL GRFT FACE/GENIT/HF 804.14 15241 SKIN FULL GRAFT ADD-ON 113.11 15260 SKIN FULL GRAFT EEN & LIPS 861.95 15261 SKIN FULL GRAFT ADD-ON 141.57 15271 Skin sub graft trnk/arm/leg 86.34 15272 SKIN SUB GRAFT T/A/L ADD-ON 17.05 15273 Skin sub grft t/arm/lg child 202.49 15274 SKN SUB GRFT T/A/L CHILD ADD 43.94 15275 Skin sub graft face/nk/hf/g 100.21 15276 SKIN SUB GRAFT F/N/HF/G ADDL 25.03 15277 Skn sub grft f/n/hf/g child 220.54 15278 SKN SUB GRFT F/N/HF/G CH ADD 54.74 15570 SKIN PEDICLE FLAP TRUNK 744.45 15572 SKIN PEDICLE FLAP ARMS/LEGS 749.58 15574 PEDCLE FH/CH/CH/M/N/AX/G/H/F 773.29 15576 PEDICLE E/N/E/L/NTRORAL 679.03 15600 DELAY FLAP TRUNK 207.69 15610 DELAY FLAP ARMS/LEGS 241.70 15620 DELAY FLAP F/C/C/N/AX/G/H/F 328.03 15630 DELAY FLAP EYE/NOS/EAR/LIP 347.96 15650 TRANSFER SKIN PEDICLE FLAP 386.06 15731 FOREHEAD FLAP W/VASC PEDICLE 1020.27 15732 MUSCLE-SKIN GRAFT HEAD/NECK 1147.42 15734 MUSCLE-SKIN GRAFT TRUNK 1331.00 15736 MUSCLE-SKIN GRAFT ARM 1154.86 15738 MUSCLE-SKIN GRAFT LEG 1252.48 15740 ISLAND PEDICLE FLAP GRAFT 854.11 15750 NEUROVASCULAR PEDICLE FLAP 919.29 15756 FREE MYO/SKIN FLAP MICROVASC 2356.30 15757 FREE SKIN FLAP MICROVASC 2323.21 15758 FREE FASCIAL FLAP MICROVASC 2325.11 15760 COMPOSITE SKIN GRAFT 714.82 15770 DERMA-FAT-FASCIA GRAFT 683.17 Proc Code Description Mod Rate 15777 ACELLULAR DERM MATRIX IMPLT 214.33 15786 ABRASION LESION SINGLE 138.92 15787 ABRASION LESIONS ADD-ON 17.77 15792 CHEMICAL PEEL NONFACIAL 260.98 15793 CHEMICAL PEEL NONFACIAL 363.84 15820 REVISION OF LOWER EYELID 534.87 15821 REVISION OF LOWER EYELID 567.00 15822 REVISION OF UPPER EYELID 401.47 15823 REVISION OF UPPER EYELID 567.31 15830 EXC SKIN ABD 1181.00 15840 NERVE PALSY FASCIAL GRAFT 1028.85 15841 NERVE PALSY MUSCLE GRAFT 1609.83 15842 NERVE PALSY MICROSURG GRAFT 2661.87 15845 SKIN AND MUSCLE REPAIR FACE 1026.97 15847 EXC SKIN ABD ADD-ON 412.57 15850 REMOVE SUTURES SAME SURGEON 39.22 15851 REMOVE SUTURES DIFF SURGEON 46.36 15852 DRESSING CHANGE NOT FOR BURN 46.76 15860 TEST FOR BLOOD FLOW IN GRAFT 111.94 15920 REMOVAL OF TAIL BONE ULCER 608.79 15922 REMOVAL OF TAIL BONE ULCER 791.10 15931 REMOVE SACRUM PRESSURE SORE 684.75 15933 REMOVE SACRUM PRESSURE SORE 855.61 15934 REMOVE SACRUM PRESSURE SORE 925.62 15935 REMOVE SACRUM PRESSURE SORE 1096.92 15936 REMOVE SACRUM PRESSURE SORE 899.09 15937 REMOVE SACRUM PRESSURE SORE 1048.00 15940 REMOVE HIP PRESSURE SORE 702.46 15941 REMOVE HIP PRESSURE SORE 909.85 15944 REMOVE HIP PRESSURE SORE 895.82 15945 REMOVE HIP PRESSURE SORE 986.45 15946 REMOVE HIP PRESSURE SORE 1654.52 15950 REMOVE THIGH PRESSURE SORE 593.26 15951 REMOVE THIGH PRESSURE SORE 890.19 15952 REMOVE THIGH PRESSURE SORE 923.94 15953 REMOVE THIGH PRESSURE SORE 1007.84 15956 REMOVE THIGH PRESSURE SORE 1170.51 15958 REMOVE THIGH PRESSURE SORE 1185.97 16000 INITIAL TREATMENT OF BURN(S) 45.95 16020 DRESS/DEBRID P-THICK BURN S 54.52 16025 DRESS/DEBRID P-THICK BURN M 112.54 16030 DRESS/DEBRID P-THICK BURN L 136.10 16035 INCISION OF BURN SCAB INITI 198.83 16036 ESCHAROTOMY ADDL INCISION 82.07 17000 DESTRUCT PREMALG LESION 52.51 17003 DESTRUCT PREMALG LES 2-14 2.45 Proc Code Description Mod Rate 17004 DESTROY PREMAL LESIONS 15/> 99.06 17106 DESTRUCTION OF SKIN LESIONS 271.65 17107 DESTRUCTION OF SKIN LESIONS 348.95 17108 DESTRUCTION OF SKIN LESIONS 521.97 17110 DESTRUCT B9 LESION 1-14 68.86 17111 DESTRUCT LESION 15 OR MORE 84.58 17250 CHEMICAL CAUTERY TISSUE 37.26 17260 DESTRUCTION OF SKIN LESIONS 68.80 17261 DESTRUCTION OF SKIN LESIONS 91.04 17262 DESTRUCTION OF SKIN LESIONS 115.51 17263 DESTRUCTION OF SKIN LESIONS 128.10 17264 DESTRUCTION OF SKIN LESIONS 137.22 17266 DESTRUCTION OF SKIN LESIONS 160.62 17270 DESTRUCTION OF SKIN LESIONS 99.42 17271 DESTRUCTION OF SKIN LESIONS 110.65 17272 DESTRUCTION OF SKIN LESIONS 127.06 17273 DESTRUCTION OF SKIN LESIONS 144.21 17274 DESTRUCTION OF SKIN LESIONS 174.92 17276 DESTRUCTION OF SKIN LESIONS 211.33 17280 DESTRUCTION OF SKIN LESIONS 90.33 17281 DESTRUCTION OF SKIN LESIONS 124.28 17282 DESTRUCTION OF SKIN LESIONS 143.51 17283 DESTRUCTION OF SKIN LESIONS 178.44 17284 DESTRUCTION OF SKIN LESIONS 208.48 17286 DESTRUCTION OF SKIN LESIONS 281.20 17311 MOHS 1 STAGE H/N/HF/G 374.95 17312 MOHS ADDL STAGE 198.98 17313 MOHS 1 STAGE T/A/L 336.50 17314 MOHS ADDL STAGE T/A/L 184.65 17315 MOHS SURG ADDL BLOCK 52.09 17340 CRYOTHERAPY OF SKIN 49.02 19000 DRAINAGE OF BREAST LESION 43.88 19001 DRAIN BREAST LESION ADD-ON 21.57 19020 INCISION OF BREAST LESION 303.77 19030 INJECTION FOR BREAST X-RAY 77.12 19081 Bx breast 1st lesion strtctc 183.02 19082 Bx breast add lesion strtctc 86.79 19083 Bx breast 1st lesion us imag 171.39 19084 Bx breast add lesion us imag 81.55 19085 Bx breast 1st lesion mr imag 200.00 19086 Bx breast add lesion mr imag 88.31 19100 BX BREAST PERCUT W/O IMAGE 69.19 19101 BIOPSY OF BREAST OPEN 219.59 19105 CRYOSURG ABLATE FA EACH 189.90 19110 NIPPLE EXPLORATION 339.52 19112 EXCISE BREAST DUCT FISTULA 310.66 Proc Code Description Mod Rate 19120 REMOVAL OF BREAST LESION 410.59 19125 EXCISION BREAST LESION 455.77 19126 EXCISION ADDL BREAST LESION 160.83 19260 REMOVAL OF CHEST WALL LESION 1208.03 19271 REVISION OF CHEST WALL 1626.86 19272 EXTENSIVE CHEST WALL SURGERY 1817.52 19281 Perq device breast 1st imag 101.85 19282 Perq device breast ea imag 48.48 19283 Perq dev breast 1st strtctc 102.93 19284 Perq dev breast add strtctc 48.83 19285 Perq dev breast 1st us imag 87.27 19286 Perq dev breast add us imag 41.93 19287 Perq dev breast 1st mr guide 142.77 19288 Perq dev breast add mr guide 62.70 19296 PLACE PO BREAST CATH FOR RAD 208.91 19297 PLACE BREAST CATH FOR RAD 93.64 19298 PLACE BREAST RAD TUBE/CATHS 322.73 19300 REMOVAL OF BREAST TISSUE 410.06 19301 PARTIAL MASTECTOMY 647.80 19302 P-MASTECTOMY W/LN REMOVAL 891.99 19303 MAST SIMPLE COMPLETE 1003.06 19304 MAST SUBQ 568.06 19305 MAST RADICAL 1123.49 19306 MAST RAD URBAN TYPE 1191.07 19307 MAST MOD RAD 1188.01 19316 SUSPENSION OF BREAST 777.50 19318 REDUCTION OF LARGE BREAST 1120.12 19324 ENLARGE BREAST 487.24 19325 ENLARGE BREAST WITH IMPLANT 652.99 19328 REMOVAL OF BREAST IMPLANT 501.15 19330 REMOVAL OF IMPLANT MATERIAL 640.56 19340 IMMEDIATE BREAST PROSTHESIS 1018.34 19342 DELAYED BREAST PROSTHESIS 935.58 19350 BREAST RECONSTRUCTION 682.07 19355 CORRECT INVERTED NIPPLE(S) 566.54 19357 BREAST RECONSTRUCTION 1525.30 19361 BREAST RECONSTR W/LAT FLAP 1601.69 19364 BREAST RECONSTRUCTION 2804.03 19366 BREAST RECONSTRUCTION 1419.71 19367 BREAST RECONSTRUCTION 1822.69 19368 BREAST RECONSTRUCTION 2241.78 19369 BREAST RECONSTRUCTION 2080.14 19370 SURGERY OF BREAST CAPSULE 694.56 19371 REMOVAL OF BREAST CAPSULE 795.04 19380 REVISE BREAST RECONSTRUCTION 783.15 19396 DESIGN CUSTOM BREAST IMPLANT 149.72 Proc Code Description Mod Rate 20005 I&D ABSCESS SUBFASCIAL 234.24 20100 EXPLORE WOUND NECK 605.72 20101 EXPLORE WOUND CHEST 207.42 20102 EXPLORE WOUND ABDOMEN 255.06 20103 EXPLORE WOUND EXTREMITY 350.18 20150 EXCISE EPIPHYSEAL BAR 914.92 20200 MUSCLE BIOPSY 95.54 20205 DEEP MUSCLE BIOPSY 155.33 20206 NEEDLE BIOPSY MUSCLE 59.75 20220 BONE BIOPSY TROCAR/NEEDLE 72.89 20225 BONE BIOPSY TROCAR/NEEDLE 111.12 20240 BONE BIOPSY EXCISIONAL 220.33 20245 BONE BIOPSY EXCISIONAL 623.63 20250 OPEN BONE BIOPSY 389.62 20251 OPEN BONE BIOPSY 423.99 20500 INJECTION OF SINUS TRACT 84.36 20501 INJECT SINUS TRACT FOR X-RAY 38.22 20520 REMOVAL OF FOREIGN BODY 147.09 20525 REMOVAL OF FOREIGN BODY 249.12 20526 THER INJECTION CARP TUNNEL 56.66 20527 INJ DUPUYTREN CORD W/ENZYME 65.19 20550 INJ TENDON SHEATH/LIGAMENT 41.48 20551 INJ TENDON ORIGIN/INSERTION 42.56 20552 INJ TRIGGER POINT 1/2 MUSCL 38.04 20553 INJECT TRIGGER POINTS 3/> 42.90 20555 Place ndl musc/tis for rt 332.58 20600 DRAIN/INJ JOINT/BURSA W/O US 35.53 20604 Drain/inj joint/bursa w/us 44.80 20605 DRAIN/INJ JOINT/BURSA W/O US 37.30 20606 Drain/inj joint/bursa w/us 50.70 20610 DRAIN/INJ JOINT/BURSA W/O US 46.13 20611 Drain/inj joint/bursa w/us 59.92 20612 ASPIRATE/INJ GANGLION CYST 41.58 20615 TREATMENT OF BONE CYST 163.16 20650 INSERT AND REMOVE BONE PIN 154.63 20660 APPLY REM FIXATION DEVICE 243.31 20661 APPLICATION OF HEAD BRACE 507.62 20662 APPLICATION OF PELVIS BRACE 437.73 20663 APPLICATION OF THIGH BRACE 452.02 20664 APPLICATION OF HALO 873.71 20665 REMOVAL OF FIXATION DEVICE 89.96 20670 REMOVAL OF SUPPORT IMPLANT 148.01 20680 REMOVAL OF SUPPORT IMPLANT 427.06 20690 APPLY BONE FIXATION DEVICE 594.09 20692 APPLY BONE FIXATION DEVICE 1122.31 20693 ADJUST BONE FIXATION DEVICE 451.32 Proc Code Description Mod Rate 20694 REMOVE BONE FIXATION DEVICE 339.17 20696 COMP MULTIPLANE EXT FIXATION 1128.81 20697 COMP EXT FIXATE STRUT CHANGE 1864.48 20802 REPLANTATION ARM COMPLETE 2309.03 20805 REPLANT FOREARM COMPLETE 3066.65 20808 REPLANTATION HAND COMPLETE 3984.08 20816 REPLANTATION DIGIT COMPLETE 1990.23 20822 REPLANTATION DIGIT COMPLETE 1834.08 20824 REPLANTATION THUMB COMPLETE 2148.50 20827 REPLANTATION THUMB COMPLETE 1828.87 20838 REPLANTATION FOOT COMPLETE 2604.41 20900 REMOVAL OF BONE FOR GRAFT 192.55 20902 REMOVAL OF BONE FOR GRAFT 288.17 20910 REMOVE CARTILAGE FOR GRAFT 412.54 20912 REMOVE CARTILAGE FOR GRAFT 485.48 20920 REMOVAL OF FASCIA FOR GRAFT 397.10 20922 REMOVAL OF FASCIA FOR GRAFT 502.12 20924 REMOVAL OF TENDON FOR GRAFT 506.40 20926 REMOVAL OF TISSUE FOR GRAFT 441.21 20930 SP BONE ALGRFT MORSEL ADD-ON 95.56 20931 SP BONE ALGRFT STRUCT ADD-ON 113.59 20936 SP BONE AGRFT LOCAL ADD-ON 100.63 20937 SP BONE AGRFT MORSEL ADD-ON 169.07 20938 SP BONE AGRFT STRUCT ADD-ON 185.41 20950 FLUID PRESSURE MUSCLE 91.42 20955 FIBULA BONE GRAFT MICROVASC 2531.68 20956 ILIAC BONE GRAFT MICROVASC 2660.26 20957 MT BONE GRAFT MICROVASC 2292.26 20962 OTHER BONE GRAFT MICROVASC 2199.34 20969 BONE/SKIN GRAFT MICROVASC 2803.66 20970 BONE/SKIN GRAFT ILIAC CREST 2878.50 20972 BONE/SKIN GRAFT METATARSAL 2189.87 20973 BONE/SKIN GRAFT GREAT TOE 2818.76 20974 ELECTRICAL BONE STIMULATION 49.67 20975 ELECTRICAL BONE STIMULATION 177.52 20979 US BONE STIMULATION 32.75 20982 ABLATE BONE TUMOR(S) PERQ 380.42 20983 Ablate bone tumor(s) perq 397.62 20985 CPTR-ASST DIR MS PX 148.10 21010 INCISION OF JAW JOINT 750.81 21011 EXC FACE LES SC <2 CM 257.00 21012 EXC FACE LES SBQ 2 CM/> 335.20 21013 EXC FACE TUM DEEP < 2 CM 397.84 21014 EXC FACE TUM DEEP 2 CM/> 518.07 21015 RESECT FACE/SCALP TUM < 2 CM 715.60 21016 RESECT FACE/SCALP TUM 2 CM/> 1042.13 Proc Code Description Mod Rate 21025 EXCISION OF BONE LOWER JAW 759.16 21026 EXCISION OF FACIAL BONE(S) 505.05 21029 CONTOUR OF FACE BONE LESION 657.33 21030 EXCISE MAX/ZYGOMA B9 TUMOR 424.90 21031 REMOVE EXOSTOSIS MANDIBLE 296.93 21032 REMOVE EXOSTOSIS MAXILLA 294.00 21034 EXCISE MAX/ZYGOMA MAL TUMOR 1169.56 21040 EXCISE MANDIBLE LESION 425.60 21044 REMOVAL OF JAW BONE LESION 888.91 21045 EXTENSIVE JAW SURGERY 1235.02 21046 REMOVE MANDIBLE CYST COMPLEX 1122.28 21047 EXCISE LWR JAW CYST W/REPAIR 1314.24 21048 REMOVE MAXILLA CYST COMPLEX 1152.72 21049 EXCIS UPPR JAW CYST W/REPAIR 1224.19 21050 REMOVAL OF JAW JOINT 873.04 21060 REMOVE JAW JOINT CARTILAGE 838.12 21070 REMOVE CORONOID PROCESS 618.63 21073 Mnpj of tmj w/anesth 260.49 21076 PREPARE FACE/ORAL PROSTHESIS 838.86 21077 PREPARE FACE/ORAL PROSTHESIS 2122.21 21079 PREPARE FACE/ORAL PROSTHESIS 1399.98 21080 PREPARE FACE/ORAL PROSTHESIS 1562.50 21081 PREPARE FACE/ORAL PROSTHESIS 1436.83 21082 PREPARE FACE/ORAL PROSTHESIS 1354.95 21083 PREPARE FACE/ORAL PROSTHESIS 1218.85 21084 PREPARE FACE/ORAL PROSTHESIS 1453.22 21085 PREPARE FACE/ORAL PROSTHESIS 650.12 21086 PREPARE FACE/ORAL PROSTHESIS 1565.29 21087 PREPARE FACE/ORAL PROSTHESIS 1565.29 21088 PREPARE FACE/ORAL PROSTHESIS 1110.25 21100 MAXILLOFACIAL FIXATION 383.01 21110 INTERDENTAL FIXATION 682.14 21116 INJECTION JAW JOINT X-RAY 42.76 21120 RECONSTRUCTION OF CHIN 536.99 21121 RECONSTRUCTION OF CHIN 637.85 21122 RECONSTRUCTION OF CHIN 696.62 21123 RECONSTRUCTION OF CHIN 880.62 21125 AUGMENTATION LOWER JAW BONE 816.02 21127 AUGMENTATION LOWER JAW BONE 870.59 21137 REDUCTION OF FOREHEAD 764.38 21138 REDUCTION OF FOREHEAD 919.73 21139 REDUCTION OF FOREHEAD 1077.85 21141 LEFORT I-1 PIECE W/O GRAFT 1383.70 21142 LEFORT I-2 PIECE W/O GRAFT 1423.23 21143 LEFORT I-3/> PIECE W/O GRAFT 1442.38 21145 LEFORT I-1 PIECE W/ GRAFT 1516.36 Proc Code Description Mod Rate 21146 LEFORT I-2 PIECE W/ GRAFT 1760.27 21147 LEFORT I-3/> PIECE W/ GRAFT 1515.26 21150 LEFORT II ANTERIOR INTRUSION 1812.33 21151 LEFORT II W/BONE GRAFTS 2054.07 21154 LEFORT III W/O LEFORT I 2237.04 21155 LEFORT III W/ LEFORT I 2252.76 21159 LEFORT III W/FHDW/O LEFORT I 2503.99 21160 LEFORT III W/FHD W/ LEFORT I 2619.61 21172 RECONSTRUCT ORBIT/FOREHEAD 1885.18 21175 RECONSTRUCT ORBIT/FOREHEAD 2164.94 21179 RECONSTRUCT ENTIRE FOREHEAD 1572.25 21180 RECONSTRUCT ENTIRE FOREHEAD 1541.18 21181 CONTOUR CRANIAL BONE LESION 727.23 21182 RECONSTRUCT CRANIAL BONE 1927.27 21183 RECONSTRUCT CRANIAL BONE 2406.72 21184 RECONSTRUCT CRANIAL BONE 2228.97 21188 RECONSTRUCTION OF MIDFACE 1582.46 21193 RECONST LWR JAW W/O GRAFT 1310.93 21194 RECONST LWR JAW W/GRAFT 1373.85 21195 RECONST LWR JAW W/O FIXATION 1344.74 21196 RECONST LWR JAW W/FIXATION 1491.76 21198 RECONSTR LWR JAW SEGMENT 1173.98 21199 RECONSTR LWR JAW W/ADVANCE 1057.18 21206 RECONSTRUCT UPPER JAW BONE 1218.12 21208 AUGMENTATION OF FACIAL BONES 869.99 21209 REDUCTION OF FACIAL BONES 644.54 21210 FACE BONE GRAFT 867.87 21215 LOWER JAW BONE GRAFT 932.67 21230 RIB CARTILAGE GRAFT 743.24 21235 EAR CARTILAGE GRAFT 572.58 21240 RECONSTRUCTION OF JAW JOINT 1111.69 21242 RECONSTRUCTION OF JAW JOINT 1019.72 21243 RECONSTRUCTION OF JAW JOINT 1688.65 21244 RECONSTRUCTION OF LOWER JAW 1081.55 21245 RECONSTRUCTION OF JAW 894.25 21246 RECONSTRUCTION OF JAW 826.73 21247 RECONSTRUCT LOWER JAW BONE 1599.49 21248 RECONSTRUCTION OF JAW 909.24 21249 RECONSTRUCTION OF JAW 1296.20 21255 RECONSTRUCT LOWER JAW BONE 1398.65 21256 RECONSTRUCTION OF ORBIT 1239.11 21260 REVISE EYE SOCKETS 1348.65 21261 REVISE EYE SOCKETS 2191.29 21263 REVISE EYE SOCKETS 1881.56 21267 REVISE EYE SOCKETS 1679.67 21268 REVISE EYE SOCKETS 1806.16 Proc Code Description Mod Rate 21270 AUGMENTATION CHEEK BONE 737.70 21275 REVISION ORBITOFACIAL BONES 851.50 21280 REVISION OF EYELID 594.95 21282 REVISION OF EYELID 391.64 21295 REVISION OF JAW MUSCLE/BONE 207.16 21296 REVISION OF JAW MUSCLE/BONE 467.60 21310 CLOSED TX NOSE FX W/O MANJ 27.83 21315 CLOSED TX NOSE FX W/O STABLJ 154.03 21320 CLOSED TX NOSE FX W/ STABLJ 136.31 21325 OPEN TX NOSE FX UNCOMPLICATD 476.35 21330 OPEN TX NOSE FX W/SKELE FIXJ 567.56 21335 OPEN TX NOSE & SEPTAL FX 735.87 21336 OPEN TX SEPTAL FX W/WO STABJ 652.23 21337 CLOSED TX SEPTAL&NOSE FX 299.11 21338 OPEN NASOETHMOID FX W/O FIXJ 727.49 21339 OPEN NASOETHMOID FX W/ FIXJ 783.53 21340 PERQ TX NASOETHMOID FX 754.75 21343 OPEN TX DPRSD FRONT SINUS FX 1233.30 21344 OPEN TX COMPL FRONT SINUS FX 1577.61 21345 CLOSED TX NOSE/JAW FX 627.28 21346 OPN TX NASOMAX FX W/FIXJ 917.47 21347 OPN TX NASOMAX FX MULTPLE 1114.73 21348 OPN TX NASOMAX FX W/GRAFT 1188.01 21355 PERQ TX MALAR FRACTURE 324.16 21356 OPN TX DPRSD ZYGOMATIC ARCH 380.80 21360 OPN TX DPRSD MALAR FRACTURE 539.08 21365 OPN TX COMPLX MALAR FX 1128.57 21366 OPN TX COMPLX MALAR W/GRFT 1199.92 21385 OPN TX ORBIT FX TRANSANTRAL 688.90 21386 OPN TX ORBIT FX PERIORBITAL 708.33 21387 OPN TX ORBIT FX COMBINED 742.66 21390 OPN TX ORBIT PERIORBTL IMPLT 815.88 21395 OPN TX ORBIT PERIORBT W/GRFT 990.80 21400 CLOSED TX ORBIT W/O MANIPULJ 157.83 21401 CLOSED TX ORBIT W/MANIPULJ 313.28 21406 OPN TX ORBIT FX W/O IMPLANT 517.19 21407 OPN TX ORBIT FX W/IMPLANT 662.89 21408 OPN TX ORBIT FX W/BONE GRFT 916.78 21421 TREAT MOUTH ROOF FRACTURE 658.38 21422 TREAT MOUTH ROOF FRACTURE 673.41 21423 TREAT MOUTH ROOF FRACTURE 838.90 21431 TREAT CRANIOFACIAL FRACTURE 732.73 21432 TREAT CRANIOFACIAL FRACTURE 665.26 21433 TREAT CRANIOFACIAL FRACTURE 1775.02 21435 TREAT CRANIOFACIAL FRACTURE 1271.90 21436 TREAT CRANIOFACIAL FRACTURE 2082.77 Proc Code Description Mod Rate 21440 TREAT DENTAL RIDGE FRACTURE 483.45 21445 TREAT DENTAL RIDGE FRACTURE 635.76 21450 TREAT LOWER JAW FRACTURE 499.79 21451 TREAT LOWER JAW FRACTURE 651.10 21452 TREAT LOWER JAW FRACTURE 376.26 21453 TREAT LOWER JAW FRACTURE 797.75 21454 TREAT LOWER JAW FRACTURE 593.38 21461 TREAT LOWER JAW FRACTURE 960.03 21462 TREAT LOWER JAW FRACTURE 1057.48 21465 TREAT LOWER JAW FRACTURE 995.26 21470 TREAT LOWER JAW FRACTURE 1230.00 21480 RESET DISLOCATED JAW 32.08 21485 RESET DISLOCATED JAW 597.23 21490 REPAIR DISLOCATED JAW 945.97 21495 TREAT HYOID BONE FRACTURE 719.24 21497 INTERDENTAL WIRING 625.25 21501 DRAIN NECK/CHEST LESION 323.91 21502 DRAIN CHEST LESION 533.86 21510 DRAINAGE OF BONE LESION 447.77 21550 BIOPSY OF NECK/CHEST 158.55 21552 EXC NECK LES SC 3 CM/> 444.05 21554 EXC NECK TUM DEEP 5 CM/> 728.42 21555 EXC NECK LES SC < 3 CM 307.48 21556 EXC NECK TUM DEEP < 5 CM 534.81 21557 RESECT NECK THORAX TUMOR<5CM 964.60 21558 RESECT NECK TUMOR 5 CM/> 1349.88 21600 PARTIAL REMOVAL OF RIB 565.92 21610 PARTIAL REMOVAL OF RIB 1206.90 21615 REMOVAL OF RIB 636.96 21616 REMOVAL OF RIB AND NERVES 858.59 21620 PARTIAL REMOVAL OF STERNUM 512.47 21627 STERNAL DEBRIDEMENT 547.31 21630 EXTENSIVE STERNUM SURGERY 1225.33 21632 EXTENSIVE STERNUM SURGERY 1225.93 21685 HYOID MYOTOMY & SUSPENSION 1009.28 21700 REVISION OF NECK MUSCLE 374.02 21705 REVISION OF NECK MUSCLE/RIB 558.39 21720 REVISION OF NECK MUSCLE 489.74 21725 REVISION OF NECK MUSCLE 472.09 21740 RECONSTRUCTION OF STERNUM 1023.76 21742 REPAIR STERN/NUSS W/O SCOPE 890.88 21743 REPAIR STERNUM/NUSS W/SCOPE 1172.51 21750 REPAIR OF STERNUM SEPARATION 694.87 21805 TREATMENT OF RIB FRACTURE 276.24 21811 Optx of rib fx w/fixj scope 547.77 21812 Treatment of rib fracture 651.41 Proc Code Description Mod Rate 21813 Treatment of rib fracture 878.82 21820 TREAT STERNUM FRACTURE 146.94 21825 TREAT STERNUM FRACTURE 552.50 21899 NECK/CHEST SURGERY PROCEDURE 0.00 21920 BIOPSY SOFT TISSUE OF BACK 162.58 21925 BIOPSY SOFT TISSUE OF BACK 353.89 21930 EXC BACK LES SC < 3 CM 364.97 21931 EXC BACK LES SC 3 CM/> 468.71 21932 EXC BACK TUM DEEP < 5 CM 659.38 21933 EXC BACK TUM DEEP 5 CM/> 734.26 21935 RESECT BACK TUM < 5 CM 1028.51 21936 RESECT BACK TUM 5 CM/> 1411.81 22010 I&D P-SPINE C/T/CERV-THOR 955.12 22015 I&D ABSCESS P-SPINE L/S/LS 902.91 22100 REMOVE PART OF NECK VERTEBRA 883.35 22101 REMOVE PART THORAX VERTEBRA 898.30 22102 REMOVE PART LUMBAR VERTEBRA 822.13 22103 REMOVE EXTRA SPINE SEGMENT 143.62 22110 REMOVE PART OF NECK VERTEBRA 1094.73 22112 REMOVE PART THORAX VERTEBRA 1080.61 22114 REMOVE PART LUMBAR VERTEBRA 998.86 22116 REMOVE EXTRA SPINE SEGMENT 141.07 22206 INCIS SPINE 3 COLUMN THORAC 2369.69 22207 INCIS SPINE 3 COLUMN LUMBAR 2408.98 22208 INCIS SPINE 3 COLUMN ADL SEG 593.40 22210 INCIS 1 VERTEBRAL SEG CERV 1782.58 22212 INCIS 1 VERTEBRAL SEG THORAC 1481.00 22214 INCIS 1 VERTEBRAL SEG LUMBAR 1492.34 22216 INCIS ADDL SPINE SEGMENT 366.65 22220 INCIS W/DISCECTOMY CERVICAL 1628.52 22222 INCIS W/DISCECTOMY THORACIC 1570.14 22224 INCIS W/DISCECTOMY LUMBAR 1597.77 22226 REVISE EXTRA SPINE SEGMENT 368.21 22305 CLOSED TX SPINE PROCESS FX 173.42 22310 CLOSED TX VERT FX W/O MANJ 283.20 22315 CLOSED TX VERT FX W/MANJ 777.76 22318 TREAT ODONTOID FX W/O GRAFT 1645.77 22319 TREAT ODONTOID FX W/GRAFT 1837.99 22325 TREAT SPINE FRACTURE 1451.61 22326 TREAT NECK SPINE FRACTURE 1498.24 22327 TREAT THORAX SPINE FRACTURE 1496.86 22328 TREAT EACH ADD SPINE FX 285.38 22505 MANIPULATION OF SPINE 122.72 22510 Perq cervicothoracic inject 442.43 22511 Perq lumbosacral injection 414.68 22512 Vertebroplasty addl inject 201.03 Proc Code Description Mod Rate 22513 Perq vertebral augmentation 505.30 22514 Perq vertebral augmentation 472.34 22515 Perq vertebral augmentation 210.38 22526 IDET SINGLE LEVEL 341.20 22527 IDET 1 OR MORE LEVELS 153.53 22532 LAT THORAX SPINE FUSION 1804.74 22533 LAT LUMBAR SPINE FUSION 1688.24 22534 LAT THOR/LUMB ADDL SEG 365.79 22548 NECK SPINE FUSION 1974.80 22551 NECK SPINE FUSE&REMOV BEL C2 1729.36 22552 ADDL NECK SPINE FUSION ARTHR 397.84 22554 NECK SPINE FUSION 1281.83 22556 THORAX SPINE FUSION 1680.57 22558 LUMBAR SPINE FUSION 1550.74 22585 ADDITIONAL SPINAL FUSION 338.29 22586 PRESCRL FUSE W/ INSTR L5-S1 1889.92 22590 SPINE & SKULL SPINAL FUSION 1592.25 22595 NECK SPINAL FUSION 1515.95 22600 NECK SPINE FUSION 1299.71 22610 THORAX SPINE FUSION 1271.14 22612 LUMBAR SPINE FUSION 1607.37 22614 SPINE FUSION EXTRA SEGMENT 395.08 22630 LUMBAR SPINE FUSION 1563.05 22632 SPINE FUSION EXTRA SEGMENT 322.17 22633 LUMBAR SPINE FUSION COMBINED 1859.29 22634 SPINE FUSION EXTRA SEGMENT 501.15 22800 POST FUSION VERT SEG 2430.04 22808 ANT FUSION 2-3 VERT SEG 1838.77 22810 ANT FUSION 4-7 VERT SEG 2058.02 22812 ANT FUSION 8/> VERT SEG 2258.51 22818 KYPHECTOMY 1-2 SEGMENTS 2185.12 22819 KYPHECTOMY 3 OR MORE 2763.16 22830 EXPLORATION OF SPINAL FUSION 818.31 22840 INSERT SPINE FIXATION DEVICE 770.60 22841 INSERT SPINE FIXATION DEVICE 246.52 22842 INSERT SPINE FIXATION DEVICE 771.17 22843 INSERT SPINE FIXATION DEVICE 819.93 22844 INSERT SPINE FIXATION DEVICE 985.67 22845 INSERT SPINE FIXATION DEVICE 744.68 22846 INSERT SPINE FIXATION DEVICE 772.75 22847 INSERT SPINE FIXATION DEVICE 890.32 22848 INSERT PELV FIXATION DEVICE 360.79 22849 REINSERT SPINAL FIXATION 1312.67 22850 REMOVE SPINE FIXATION DEVICE 729.21 Proc Code Description Mod Rate 22851 APPLY SPINE PROSTH DEVICE 412.75 22852 REMOVE SPINE FIXATION DEVICE 697.02 22855 REMOVE SPINE FIXATION DEVICE 1128.51 22856 CERV ARTIFIC DISKECTOMY 1673.17 22857 LUMBAR ARTIF DISKECTOMY 1839.11 22858 Second level cer diskectomy 670.62 22861 REVISE CERV ARTIFIC DISC 2221.42 22862 REVISE LUMBAR ARTIF DISC 2143.16 22864 REMOVE CERV ARTIF DISC 1998.89 22865 REMOVE LUMB ARTIF DISC 2061.56 22900 EXC ABDL TUM DEEP < 5 CM 561.70 22901 EXC ABDL TUM DEEP 5 CM/> 659.96 22902 EXC ABD LES SC < 3 CM 323.03 22903 EXC ABD LES SC 3 CM/> 431.56 22904 RADICAL RESECT ABD TUMOR<5CM 1047.04 22905 RAD RESECT ABD TUMOR 5 CM/> 1333.53 23000 REMOVAL OF CALCIUM DEPOSITS 371.28 23020 RELEASE SHOULDER JOINT 690.98 23030 DRAIN SHOULDER LESION 255.79 23031 DRAIN SHOULDER BURSA 219.81 23035 DRAIN SHOULDER BONE LESION 685.60 23040 EXPLORATORY SHOULDER SURGERY 720.62 23044 EXPLORATORY SHOULDER SURGERY 568.42 23065 BIOPSY SHOULDER TISSUES 167.66 23066 BIOPSY SHOULDER TISSUES 356.13 23071 EXC SHOULDER LES SC 3 CM/> 418.08 23073 EXC SHOULDER TUM DEEP 5 CM/> 691.05 23075 EXC SHOULDER LES SC < 3 CM 326.17 23076 EXC SHOULDER TUM DEEP < 5 CM 538.97 23077 RESECT SHOULDER TUMOR < 5 CM 1145.50 23078 RESECT SHOULDER TUMOR 5 CM/> 1446.29 23100 BIOPSY OF SHOULDER JOINT 500.86 23101 SHOULDER JOINT SURGERY 456.34 23105 REMOVE SHOULDER JOINT LINING 639.59 23106 INCISION OF COLLARBONE JOINT 496.66 23107 EXPLORE TREAT SHOULDER JOINT 663.02 23120 PARTIAL REMOVAL COLLAR BONE 587.04 23125 REMOVAL OF COLLAR BONE 709.30 23130 REMOVE SHOULDER BONE PART 609.77 23140 REMOVAL OF BONE LESION 530.02 23145 REMOVAL OF BONE LESION 695.66 23146 REMOVAL OF BONE LESION 621.17 23150 REMOVAL OF HUMERUS LESION 660.79 23155 REMOVAL OF HUMERUS LESION 794.01 23156 REMOVAL OF HUMERUS LESION 678.51 23170 REMOVE COLLAR BONE LESION 560.73 Proc Code Description Mod Rate 23172 REMOVE SHOULDER BLADE LESION 567.44 23174 REMOVE HUMERUS LESION 758.57 23180 REMOVE COLLAR BONE LESION 667.26 23182 REMOVE SHOULDER BLADE LESION 662.38 23184 REMOVE HUMERUS LESION 735.78 23190 PARTIAL REMOVAL OF SCAPULA 571.13 23195 REMOVAL OF HEAD OF HUMERUS 755.95 23200 RESECT CLAVICLE TUMOR 1521.53 23210 RESECT SCAPULA TUMOR 1788.71 23220 RESECT PROX HUMERUS TUMOR 1961.56 23330 REMOVE SHOULDER FOREIGN BODY 151.47 23333 Remove shoulder fb deep 458.05 23334 Shoulder prosthesis removal 1079.24 23335 Shoulder prosthesis removal 1286.14 23350 INJECTION FOR SHOULDER X-RAY 51.47 23395 MUSCLE TRANSFER SHOULDER/ARM 1291.08 23397 MUSCLE TRANSFERS 1144.18 23400 FIXATION OF SHOULDER BLADE 972.95 23405 INCISION OF TENDON & MUSCLE 630.86 23406 INCISE TENDON(S) & MUSCLE(S) 773.66 23410 REPAIR ROTATOR CUFF ACUTE 824.03 23412 REPAIR ROTATOR CUFF CHRONIC 855.51 23415 RELEASE OF SHOULDER LIGAMENT 697.70 23420 REPAIR OF SHOULDER 972.32 23430 REPAIR BICEPS TENDON 750.45 23440 REMOVE/TRANSPLANT TENDON 758.38 23450 REPAIR SHOULDER CAPSULE 950.23 23455 REPAIR SHOULDER CAPSULE 1005.80 23460 REPAIR SHOULDER CAPSULE 1092.45 23462 REPAIR SHOULDER CAPSULE 1075.38 23465 REPAIR SHOULDER CAPSULE 1120.43 23466 REPAIR SHOULDER CAPSULE 1125.86 23470 RECONSTRUCT SHOULDER JOINT 1211.73 23472 RECONSTRUCT SHOULDER JOINT 1469.19 23473 Revis reconst shoulder joint 1637.93 23474 Revis reconst shoulder joint 1770.40 23480 REVISION OF COLLAR BONE 821.67 23485 REVISION OF COLLAR BONE 958.12 23490 REINFORCE CLAVICLE 863.87 23491 REINFORCE SHOULDER BONES 1016.45 23500 TREAT CLAVICLE FRACTURE 222.46 23505 TREAT CLAVICLE FRACTURE 333.11 23515 TREAT CLAVICLE FRACTURE 723.56 23520 TREAT CLAVICLE DISLOCATION 233.85 23525 TREAT CLAVICLE DISLOCATION 354.38 23530 TREAT CLAVICLE DISLOCATION 572.91 Proc Code Description Mod Rate 23532 TREAT CLAVICLE DISLOCATION 624.22 23540 TREAT CLAVICLE DISLOCATION 227.58 23545 TREAT CLAVICLE DISLOCATION 309.57 23550 TREAT CLAVICLE DISLOCATION 573.77 23552 TREAT CLAVICLE DISLOCATION 656.63 23570 TREAT SHOULDER BLADE FX 238.39 23575 TREAT SHOULDER BLADE FX 374.55 23585 TREAT SCAPULA FRACTURE 984.17 23600 TREAT HUMERUS FRACTURE 308.17 23605 TREAT HUMERUS FRACTURE 425.71 23615 TREAT HUMERUS FRACTURE 888.38 23616 TREAT HUMERUS FRACTURE 1247.22 23620 TREAT HUMERUS FRACTURE 256.44 23625 TREAT HUMERUS FRACTURE 353.90 23630 TREAT HUMERUS FRACTURE 785.44 23650 TREAT SHOULDER DISLOCATION 287.51 23655 TREAT SHOULDER DISLOCATION 399.16 23660 TREAT SHOULDER DISLOCATION 584.80 23665 TREAT DISLOCATION/FRACTURE 396.47 23670 TREAT DISLOCATION/FRACTURE 880.88 23675 TREAT DISLOCATION/FRACTURE 500.34 23680 TREAT DISLOCATION/FRACTURE 931.98 23700 FIXATION OF SHOULDER 195.73 23800 FUSION OF SHOULDER JOINT 1028.77 23802 FUSION OF SHOULDER JOINT 1287.05 23900 AMPUTATION OF ARM & GIRDLE 1392.78 23920 AMPUTATION AT SHOULDER JOINT 1129.88 23921 AMPUTATION FOLLOW-UP SURGERY 476.48 23930 DRAINAGE OF ARM LESION 215.26 23931 DRAINAGE OF ARM BURSA 160.92 23935 DRAIN ARM/ELBOW BONE LESION 509.90 24000 EXPLORATORY ELBOW SURGERY 477.65 24006 RELEASE ELBOW JOINT 712.58 24065 BIOPSY ARM/ELBOW SOFT TISSUE 167.92 24066 BIOPSY ARM/ELBOW SOFT TISSUE 412.06 24071 EXC ARM/ELBOW LES SC 3 CM/> 405.45 24073 EX ARM/ELBOW TUM DEEP 5 CM/> 690.28 24075 EXC ARM/ELBOW LES SC < 3 CM 329.32 24076 EX ARM/ELBOW TUM DEEP < 5 CM 543.24 24077 RESECT ARM/ELBOW TUM < 5 CM 1038.15 24079 RESECT ARM/ELBOW TUM 5 CM/> 1329.20 24100 BIOPSY ELBOW JOINT LINING 418.21 24101 EXPLORE/TREAT ELBOW JOINT 499.94 24102 REMOVE ELBOW JOINT LINING 616.46 24105 REMOVAL OF ELBOW BURSA 349.71 24110 REMOVE HUMERUS LESION 588.18 Proc Code Description Mod Rate 24115 REMOVE/GRAFT BONE LESION 738.01 24116 REMOVE/GRAFT BONE LESION 863.02 24120 REMOVE ELBOW LESION 528.91 24125 REMOVE/GRAFT BONE LESION 620.34 24126 REMOVE/GRAFT BONE LESION 649.44 24130 REMOVAL OF HEAD OF RADIUS 507.60 24134 REMOVAL OF ARM BONE LESION 747.54 24136 REMOVE RADIUS BONE LESION 637.56 24138 REMOVE ELBOW BONE LESION 674.74 24140 PARTIAL REMOVAL OF ARM BONE 699.57 24145 PARTIAL REMOVAL OF RADIUS 592.14 24147 PARTIAL REMOVAL OF ELBOW 622.55 24149 RADICAL RESECTION OF ELBOW 1175.48 24150 RESECT DISTAL HUMERUS TUMOR 1562.42 24152 RESECT RADIUS TUMOR 1381.63 24155 REMOVAL OF ELBOW JOINT 854.98 24160 REMOVE ELBOW JOINT IMPLANT 1263.78 24164 REMOVE RADIUS HEAD IMPLANT 730.26 24200 REMOVAL OF ARM FOREIGN BODY 139.38 24201 REMOVAL OF ARM FOREIGN BODY 369.20 24220 INJECTION FOR ELBOW X-RAY 68.51 24300 MANIPULATE ELBOW W/ANESTH 412.78 24301 MUSCLE/TENDON TRANSFER 754.12 24305 ARM TENDON LENGTHENING 576.39 24310 REVISION OF ARM TENDON 476.16 24320 REPAIR OF ARM TENDON 781.80 24330 REVISION OF ARM MUSCLES 718.05 24331 REVISION OF ARM MUSCLES 787.41 24332 TENOLYSIS TRICEPS 612.80 24340 REPAIR OF BICEPS TENDON 616.13 24341 REPAIR ARM TENDON/MUSCLE 749.35 24342 REPAIR OF RUPTURED TENDON 778.44 24343 REPR ELBOW LAT LIGMNT W/TISS 706.22 24344 RECONSTRUCT ELBOW LAT LIGMNT 1100.92 24345 REPR ELBW MED LIGMNT W/TISSU 702.27 24346 RECONSTRUCT ELBOW MED LIGMNT 1100.92 24357 REPAIR ELBOW PERC 440.90 24358 REPAIR ELBOW W/DEB OPEN 523.40 24359 REPAIR ELBOW DEB/ATTCH OPEN 660.59 24360 RECONSTRUCT ELBOW JOINT 900.03 24361 RECONSTRUCT ELBOW JOINT 1008.40 24362 RECONSTRUCT ELBOW JOINT 1063.07 24363 REPLACE ELBOW JOINT 1463.30 24365 RECONSTRUCT HEAD OF RADIUS 639.39 24366 RECONSTRUCT HEAD OF RADIUS 681.95 24370 Revise reconst elbow joint 1548.55 Proc Code Description Mod Rate 24371 Revise reconst elbow joint 1788.11 24400 REVISION OF HUMERUS 819.78 24410 REVISION OF HUMERUS 1059.42 24420 REVISION OF HUMERUS 995.41 24430 REPAIR OF HUMERUS 1061.96 24435 REPAIR HUMERUS WITH GRAFT 1082.15 24470 REVISION OF ELBOW JOINT 585.80 24495 DECOMPRESSION OF FOREARM 651.08 24498 REINFORCE HUMERUS 869.75 24500 TREAT HUMERUS FRACTURE 325.12 24505 TREAT HUMERUS FRACTURE 451.42 24515 TREAT HUMERUS FRACTURE 878.91 24516 TREAT HUMERUS FRACTURE 863.06 24530 TREAT HUMERUS FRACTURE 343.36 24535 TREAT HUMERUS FRACTURE 568.73 24538 TREAT HUMERUS FRACTURE 743.58 24545 TREAT HUMERUS FRACTURE 933.04 24546 TREAT HUMERUS FRACTURE 1044.19 24560 TREAT HUMERUS FRACTURE 288.45 24565 TREAT HUMERUS FRACTURE 488.21 24566 TREAT HUMERUS FRACTURE 718.10 24575 TREAT HUMERUS FRACTURE 736.08 24576 TREAT HUMERUS FRACTURE 305.21 24577 TREAT HUMERUS FRACTURE 501.86 24579 TREAT HUMERUS FRACTURE 837.19 24582 TREAT HUMERUS FRACTURE 809.07 24586 TREAT ELBOW FRACTURE 1088.45 24587 TREAT ELBOW FRACTURE 1085.35 24600 TREAT ELBOW DISLOCATION 334.34 24605 TREAT ELBOW DISLOCATION 469.35 24615 TREAT ELBOW DISLOCATION 712.09 24620 TREAT ELBOW FRACTURE 553.79 24635 TREAT ELBOW FRACTURE 674.56 24640 TREAT ELBOW DISLOCATION 94.67 24650 TREAT RADIUS FRACTURE 240.24 24655 TREAT RADIUS FRACTURE 399.38 24665 TREAT RADIUS FRACTURE 652.61 24666 TREAT RADIUS FRACTURE 733.97 24670 TREAT ULNAR FRACTURE 262.66 24675 TREAT ULNAR FRACTURE 414.41 24685 TREAT ULNAR FRACTURE 655.88 24800 FUSION OF ELBOW JOINT 830.51 24802 FUSION/GRAFT OF ELBOW JOINT 1003.52 24900 AMPUTATION OF UPPER ARM 736.14 24920 AMPUTATION OF UPPER ARM 732.97 24925 AMPUTATION FOLLOW-UP SURGERY 565.99 Proc Code Description Mod Rate 24930 AMPUTATION FOLLOW-UP SURGERY 775.03 24931 AMPUTATE UPPER ARM & IMPLANT 769.65 24935 REVISION OF AMPUTATION 1045.53 24940 REVISION OF UPPER ARM 1143.92 25000 INCISION OF TENDON SHEATH 334.91 25001 INCISE FLEXOR CARPI RADIALIS 342.07 25020 DECOMPRESS FOREARM 1 SPACE 572.64 25023 DECOMPRESS FOREARM 1 SPACE 1104.79 25024 DECOMPRESS FOREARM 2 SPACES 777.22 25025 DECOMPRESS FOREARM 2 SPACES 1216.00 25028 DRAINAGE OF FOREARM LESION 522.13 25031 DRAINAGE OF FOREARM BURSA 363.73 25035 TREAT FOREARM BONE LESION 580.50 25040 EXPLORE/TREAT WRIST JOINT 561.17 25065 BIOPSY FOREARM SOFT TISSUES 163.76 25066 BIOPSY FOREARM SOFT TISSUES 356.49 25071 EXC FOREARM LES SC 3 CM/> 424.47 25073 EXC FOREARM TUM DEEP 3 CM/> 530.26 25075 EXC FOREARM LES SC < 3 CM 316.42 25076 EXC FOREARM TUM DEEP < 3 CM 516.83 25077 RESECT FOREARM/WRIST TUM<3CM 885.42 25078 RESECT FORARM/WRIST TUM 3CM> 1171.97 25085 INCISION OF WRIST CAPSULE 449.97 25100 BIOPSY OF WRIST JOINT 345.79 25101 EXPLORE/TREAT WRIST JOINT 403.38 25105 REMOVE WRIST JOINT LINING 482.31 25107 REMOVE WRIST JOINT CARTILAGE 615.02 25109 EXCISE TENDON FOREARM/WRIST 537.59 25110 REMOVE WRIST TENDON LESION 339.59 25111 REMOVE WRIST TENDON LESION 319.57 25112 REREMOVE WRIST TENDON LESION 386.02 25115 REMOVE WRIST/FOREARM LESION 757.50 25116 REMOVE WRIST/FOREARM LESION 598.71 25118 EXCISE WRIST TENDON SHEATH 379.75 25119 PARTIAL REMOVAL OF ULNA 497.25 25120 REMOVAL OF FOREARM LESION 497.05 25125 REMOVE/GRAFT FOREARM LESION 592.70 25126 REMOVE/GRAFT FOREARM LESION 596.90 25130 REMOVAL OF WRIST LESION 446.95 25135 REMOVE & GRAFT WRIST LESION 557.69 25136 REMOVE & GRAFT WRIST LESION 493.05 25145 REMOVE FOREARM BONE LESION 516.48 25150 PARTIAL REMOVAL OF ULNA 563.91 25151 PARTIAL REMOVAL OF RADIUS 584.07 25170 RESECT RADIUS/ULNAR TUMOR 1483.50 25210 REMOVAL OF WRIST BONE 486.76 Proc Code Description Mod Rate 25215 REMOVAL OF WRIST BONES 614.64 25230 PARTIAL REMOVAL OF RADIUS 428.23 25240 PARTIAL REMOVAL OF ULNA 426.57 25246 INJECTION FOR WRIST X-RAY 74.75 25248 REMOVE FOREARM FOREIGN BODY 414.23 25250 REMOVAL OF WRIST PROSTHESIS 533.00 25251 REMOVAL OF WRIST PROSTHESIS 719.81 25259 MANIPULATE WRIST W/ANESTHES 415.30 25260 REPAIR FOREARM TENDON/MUSCLE 630.76 25263 REPAIR FOREARM TENDON/MUSCLE 625.18 25265 REPAIR FOREARM TENDON/MUSCLE 748.07 25270 REPAIR FOREARM TENDON/MUSCLE 491.47 25272 REPAIR FOREARM TENDON/MUSCLE 552.66 25274 REPAIR FOREARM TENDON/MUSCLE 670.52 25275 REPAIR FOREARM TENDON SHEATH 672.63 25280 REVISE WRIST/FOREARM TENDON 561.23 25290 INCISE WRIST/FOREARM TENDON 435.45 25295 RELEASE WRIST/FOREARM TENDON 521.37 25300 FUSION OF TENDONS AT WRIST 686.18 25301 FUSION OF TENDONS AT WRIST 641.74 25310 TRANSPLANT FOREARM TENDON 616.89 25312 TRANSPLANT FOREARM TENDON 715.59 25315 REVISE PALSY HAND TENDON(S) 770.93 25316 REVISE PALSY HAND TENDON(S) 881.27 25320 REPAIR/REVISE WRIST JOINT 984.25 25332 REVISE WRIST JOINT 843.78 25335 REALIGNMENT OF HAND 883.20 25337 RECONSTRUCT ULNA/RADIOULNAR 884.45 25350 REVISION OF RADIUS 672.85 25355 REVISION OF RADIUS 766.48 25360 REVISION OF ULNA 655.25 25365 REVISE RADIUS & ULNA 915.87 25370 REVISE RADIUS OR ULNA 1007.78 25375 REVISE RADIUS & ULNA 891.88 25390 SHORTEN RADIUS OR ULNA 766.93 25391 LENGTHEN RADIUS OR ULNA 997.85 25392 SHORTEN RADIUS & ULNA 1015.71 25393 LENGTHEN RADIUS & ULNA 1132.64 25394 REPAIR CARPAL BONE SHORTEN 784.69 25400 REPAIR RADIUS OR ULNA 802.09 25405 REPAIR/GRAFT RADIUS OR ULNA 1036.20 25415 REPAIR RADIUS & ULNA 968.37 25420 REPAIR/GRAFT RADIUS & ULNA 1170.34 25425 REPAIR/GRAFT RADIUS OR ULNA 963.84 25426 REPAIR/GRAFT RADIUS & ULNA 1125.60 25430 VASC GRAFT INTO CARPAL BONE 706.22 Proc Code Description Mod Rate 25431 REPAIR NONUNION CARPAL BONE 789.66 25440 REPAIR/GRAFT WRIST BONE 766.98 25441 RECONSTRUCT WRIST JOINT 917.24 25442 RECONSTRUCT WRIST JOINT 784.71 25443 RECONSTRUCT WRIST JOINT 781.38 25444 RECONSTRUCT WRIST JOINT 774.55 25445 RECONSTRUCT WRIST JOINT 719.11 25446 WRIST REPLACEMENT 1169.49 25447 REPAIR WRIST JOINTS 825.84 25449 REMOVE WRIST JOINT IMPLANT 1040.99 25450 REVISION OF WRIST JOINT 615.45 25455 REVISION OF WRIST JOINT 680.90 25490 REINFORCE RADIUS 695.13 25491 REINFORCE ULNA 739.39 25492 REINFORCE RADIUS AND ULNA 904.36 25500 TREAT FRACTURE OF RADIUS 249.81 25505 TREAT FRACTURE OF RADIUS 459.55 25515 TREAT FRACTURE OF RADIUS 669.90 25520 TREAT FRACTURE OF RADIUS 537.02 25525 TREAT FRACTURE OF RADIUS 786.45 25526 TREAT FRACTURE OF RADIUS 956.09 25530 TREAT FRACTURE OF ULNA 236.76 25535 TREAT FRACTURE OF ULNA 452.16 25545 TREAT FRACTURE OF ULNA 623.44 25560 TREAT FRACTURE RADIUS & ULNA 251.68 25565 TREAT FRACTURE RADIUS & ULNA 470.05 25574 TREAT FRACTURE RADIUS & ULNA 673.90 25575 TREAT FRACTURE RADIUS/ULNA 901.94 25600 TREAT FRACTURE RADIUS/ULNA 310.28 25605 TREAT FRACTURE RADIUS/ULNA 515.81 25606 TREAT FX DISTAL RADIAL 662.43 25607 TREAT FX RAD EXTRA-ARTICUL 735.53 25608 TREAT FX RAD INTRA-ARTICUL 824.37 25609 TREAT FX RADIAL 3+ FRAG 1048.04 25622 TREAT WRIST BONE FRACTURE 277.24 25624 TREAT WRIST BONE FRACTURE 432.53 25628 TREAT WRIST BONE FRACTURE 719.75 25630 TREAT WRIST BONE FRACTURE 280.10 25635 TREAT WRIST BONE FRACTURE 394.80 25645 TREAT WRIST BONE FRACTURE 569.05 25650 TREAT WRIST BONE FRACTURE 301.32 25651 PIN ULNAR STYLOID FRACTURE 484.83 25652 TREAT FRACTURE ULNAR STYLOID 622.09 25660 TREAT WRIST DISLOCATION 404.18 25670 TREAT WRIST DISLOCATION 605.56 25671 PIN RADIOULNAR DISLOCATION 529.53 Proc Code Description Mod Rate 25675 TREAT WRIST DISLOCATION 398.19 25676 TREAT WRIST DISLOCATION 628.24 25680 TREAT WRIST FRACTURE 471.83 25685 TREAT WRIST FRACTURE 735.16 25690 TREAT WRIST DISLOCATION 480.42 25695 TREAT WRIST DISLOCATION 633.07 25800 FUSION OF WRIST JOINT 730.98 25805 FUSION/GRAFT OF WRIST JOINT 845.09 25810 FUSION/GRAFT OF WRIST JOINT 867.00 25820 FUSION OF HAND BONES 613.71 25825 FUSE HAND BONES WITH GRAFT 756.26 25830 FUSION RADIOULNAR JNT/ULNA 951.24 25900 AMPUTATION OF FOREARM 708.15 25905 AMPUTATION OF FOREARM 634.71 25907 AMPUTATION FOLLOW-UP SURGERY 612.54 25909 AMPUTATION FOLLOW-UP SURGERY 685.40 25915 AMPUTATION OF FOREARM 1040.09 25920 AMPUTATE HAND AT WRIST 696.58 25922 AMPUTATE HAND AT WRIST 490.56 25924 AMPUTATION FOLLOW-UP SURGERY 612.86 25927 AMPUTATION OF HAND 811.39 25929 AMPUTATION FOLLOW-UP SURGERY 596.43 25931 AMPUTATION FOLLOW-UP SURGERY 672.42 26010 DRAINAGE OF FINGER ABSCESS 138.27 26011 DRAINAGE OF FINGER ABSCESS 184.67 26020 DRAIN HAND TENDON SHEATH 432.41 26025 DRAINAGE OF PALM BURSA 419.81 26030 DRAINAGE OF PALM BURSAS 492.40 26034 TREAT HAND BONE LESION 534.54 26035 DECOMPRESS FINGERS/HAND 866.81 26037 DECOMPRESS FINGERS/HAND 567.29 26040 RELEASE PALM CONTRACTURE 309.11 26045 RELEASE PALM CONTRACTURE 467.74 26055 INCISE FINGER TENDON SHEATH 309.39 26060 INCISION OF FINGER TENDON 264.48 26070 EXPLORE/TREAT HAND JOINT 313.27 26075 EXPLORE/TREAT FINGER JOINT 328.56 26080 EXPLORE/TREAT FINGER JOINT 389.12 26100 BIOPSY HAND JOINT LINING 334.27 26105 BIOPSY FINGER JOINT LINING 333.52 26110 BIOPSY FINGER JOINT LINING 320.01 26111 EXC HAND LES SC 1.5 CM/> 416.09 26113 EXC HAND TUM DEEP 1.5 CM/> 547.31 26115 EXC HAND LES SC < 1.5 CM 331.77 26116 EXC HAND TUM DEEP < 1.5 CM 525.32 26117 RAD RESECT HAND TUMOR < 3 CM 746.02 Proc Code Description Mod Rate 26118 RAD RESECT HAND TUMOR 3 CM/> 1055.93 26121 RELEASE PALM CONTRACTURE 595.65 26123 RELEASE PALM CONTRACTURE 831.30 26125 RELEASE PALM CONTRACTURE 274.40 26130 REMOVE WRIST JOINT LINING 460.41 26135 REVISE FINGER JOINT EACH 549.13 26140 REVISE FINGER JOINT EACH 502.61 26145 TENDON EXCISION PALM/FINGER 509.95 26160 REMOVE TENDON SHEATH LESION 332.38 26170 REMOVAL OF PALM TENDON EACH 404.95 26180 REMOVAL OF FINGER TENDON 441.20 26185 REMOVE FINGER BONE 550.98 26200 REMOVE HAND BONE LESION 449.13 26205 REMOVE/GRAFT BONE LESION 602.02 26210 REMOVAL OF FINGER LESION 440.26 26215 REMOVE/GRAFT FINGER LESION 563.17 26230 PARTIAL REMOVAL OF HAND BONE 497.69 26235 PARTIAL REMOVAL FINGER BONE 491.43 26236 PARTIAL REMOVAL FINGER BONE 439.70 26250 EXTENSIVE HAND SURGERY 1095.53 26260 RESECT PROX FINGER TUMOR 818.30 26262 RESECT DISTAL FINGER TUMOR 639.51 26320 REMOVAL OF IMPLANT FROM HAND 344.80 26340 MANIPULATE FINGER W/ANESTH 333.23 26341 MANIPULAT PALM CORD POST INJ 73.59 26350 REPAIR FINGER/HAND TENDON 700.66 26352 REPAIR/GRAFT HAND TENDON 807.47 26356 REPAIR FINGER/HAND TENDON 1080.94 26357 REPAIR FINGER/HAND TENDON 860.67 26358 REPAIR/GRAFT HAND TENDON 908.28 26370 REPAIR FINGER/HAND TENDON 748.27 26372 REPAIR/GRAFT HAND TENDON 875.41 26373 REPAIR FINGER/HAND TENDON 839.68 26390 REVISE HAND/FINGER TENDON 827.39 26392 REPAIR/GRAFT HAND TENDON 963.65 26410 REPAIR HAND TENDON 556.38 26412 REPAIR/GRAFT HAND TENDON 670.06 26415 EXCISION HAND/FINGER TENDON 786.27 26416 GRAFT HAND OR FINGER TENDON 750.35 26418 REPAIR FINGER TENDON 569.41 26420 REPAIR/GRAFT FINGER TENDON 701.52 26426 REPAIR FINGER/HAND TENDON 499.78 26428 REPAIR/GRAFT FINGER TENDON 748.61 26432 REPAIR FINGER TENDON 490.49 26433 REPAIR FINGER TENDON 522.74 26434 REPAIR/GRAFT FINGER TENDON 639.73 Proc Code Description Mod Rate 26437 REALIGNMENT OF TENDONS 611.51 26440 RELEASE PALM/FINGER TENDON 608.14 26442 RELEASE PALM & FINGER TENDON 951.18 26445 RELEASE HAND/FINGER TENDON 566.88 26449 RELEASE FOREARM/HAND TENDON 691.54 26450 INCISION OF PALM TENDON 400.97 26455 INCISION OF FINGER TENDON 397.81 26460 INCISE HAND/FINGER TENDON 388.34 26471 FUSION OF FINGER TENDONS 605.57 26474 FUSION OF FINGER TENDONS 593.47 26476 TENDON LENGTHENING 576.10 26477 TENDON SHORTENING 574.31 26478 LENGTHENING OF HAND TENDON 612.35 26479 SHORTENING OF HAND TENDON 610.45 26480 TRANSPLANT HAND TENDON 741.54 26483 TRANSPLANT/GRAFT HAND TENDON 831.87 26485 TRANSPLANT PALM TENDON 793.18 26489 TRANSPLANT/GRAFT PALM TENDON 919.36 26490 REVISE THUMB TENDON 783.04 26492 TENDON TRANSFER WITH GRAFT 870.20 26494 HAND TENDON/MUSCLE TRANSFER 790.11 26496 REVISE THUMB TENDON 827.83 26497 FINGER TENDON TRANSFER 855.97 26498 FINGER TENDON TRANSFER 1132.20 26499 REVISION OF FINGER 820.96 26500 HAND TENDON RECONSTRUCTION 614.30 26502 HAND TENDON RECONSTRUCTION 697.05 26508 RELEASE THUMB CONTRACTURE 630.29 26510 THUMB TENDON TRANSFER 588.80 26516 FUSION OF KNUCKLE JOINT 689.19 26517 FUSION OF KNUCKLE JOINTS 816.08 26518 FUSION OF KNUCKLE JOINTS 824.02 26520 RELEASE KNUCKLE CONTRACTURE 640.40 26525 RELEASE FINGER CONTRACTURE 639.55 26530 REVISE KNUCKLE JOINT 535.15 26531 REVISE KNUCKLE WITH IMPLANT 621.10 26535 REVISE FINGER JOINT 416.91 26536 REVISE/IMPLANT FINGER JOINT 701.82 26540 REPAIR HAND JOINT 647.98 26541 REPAIR HAND JOINT WITH GRAFT 787.38 26542 REPAIR HAND JOINT WITH GRAFT 671.15 26545 RECONSTRUCT FINGER JOINT 682.01 26546 REPAIR NONUNION HAND 977.75 26548 RECONSTRUCT FINGER JOINT 752.16 26550 CONSTRUCT THUMB REPLACEMENT 1632.20 26551 GREAT TOE-HAND TRANSFER 2941.51 Proc Code Description Mod Rate 26553 SINGLE TRANSFER TOE-HAND 3050.21 26554 DOUBLE TRANSFER TOE-HAND 3163.56 26555 POSITIONAL CHANGE OF FINGER 1364.14 26556 TOE JOINT TRANSFER 2712.51 26560 REPAIR OF WEB FINGER 564.35 26561 REPAIR OF WEB FINGER 936.45 26562 REPAIR OF WEB FINGER 1262.79 26565 CORRECT METACARPAL FLAW 672.12 26567 CORRECT FINGER DEFORMITY 670.70 26568 LENGTHEN METACARPAL/FINGER 890.45 26580 REPAIR HAND DEFORMITY 1514.85 26587 RECONSTRUCT EXTRA FINGER 939.72 26590 REPAIR FINGER DEFORMITY 1398.03 26591 REPAIR MUSCLES OF HAND 429.60 26593 RELEASE MUSCLES OF HAND 587.82 26596 EXCISION CONSTRICTING TISSUE 757.82 26600 TREAT METACARPAL FRACTURE 277.15 26605 TREAT METACARPAL FRACTURE 292.66 26607 TREAT METACARPAL FRACTURE 455.22 26608 TREAT METACARPAL FRACTURE 476.24 26615 TREAT METACARPAL FRACTURE 574.40 26641 TREAT THUMB DISLOCATION 339.38 26645 TREAT THUMB FRACTURE 390.52 26650 TREAT THUMB FRACTURE 476.95 26665 TREAT THUMB FRACTURE 628.42 26670 TREAT HAND DISLOCATION 307.53 26675 TREAT HAND DISLOCATION 416.75 26676 PIN HAND DISLOCATION 499.63 26685 TREAT HAND DISLOCATION 579.97 26686 TREAT HAND DISLOCATION 623.56 26700 TREAT KNUCKLE DISLOCATION 304.98 26705 TREAT KNUCKLE DISLOCATION 378.21 26706 PIN KNUCKLE DISLOCATION 438.84 26715 TREAT KNUCKLE DISLOCATION 573.08 26720 TREAT FINGER FRACTURE EACH 184.74 26725 TREAT FINGER FRACTURE EACH 303.81 26727 TREAT FINGER FRACTURE EACH 467.79 26735 TREAT FINGER FRACTURE EACH 595.80 26740 TREAT FINGER FRACTURE EACH 214.35 26742 TREAT FINGER FRACTURE EACH 333.89 26746 TREAT FINGER FRACTURE EACH 740.04 26750 TREAT FINGER FRACTURE EACH 185.03 26755 TREAT FINGER FRACTURE EACH 273.66 26756 PIN FINGER FRACTURE EACH 416.28 26765 TREAT FINGER FRACTURE EACH 501.25 26770 TREAT FINGER DISLOCATION 255.79 Proc Code Description Mod Rate 26775 TREAT FINGER DISLOCATION 344.41 26776 PIN FINGER DISLOCATION 441.16 26785 TREAT FINGER DISLOCATION 546.06 26820 THUMB FUSION WITH GRAFT 778.59 26841 FUSION OF THUMB 718.76 26842 THUMB FUSION WITH GRAFT 778.16 26843 FUSION OF HAND JOINT 729.70 26844 FUSION/GRAFT OF HAND JOINT 806.89 26850 FUSION OF KNUCKLE 681.20 26852 FUSION OF KNUCKLE WITH GRAFT 781.74 26860 FUSION OF FINGER JOINT 553.61 26861 FUSION OF FINGER JNT ADD-ON 103.96 26862 FUSION/GRAFT OF FINGER JOINT 712.49 26863 FUSE/GRAFT ADDED JOINT 230.01 26910 AMPUTATE METACARPAL BONE 708.43 26951 AMPUTATION OF FINGER/THUMB 644.98 26952 AMPUTATION OF FINGER/THUMB 637.48 26990 DRAINAGE OF PELVIS LESION 623.55 26991 DRAINAGE OF PELVIS BURSA 523.98 26992 DRAINAGE OF BONE LESION 965.64 27000 INCISION OF HIP TENDON 421.03 27001 INCISION OF HIP TENDON 542.52 27003 INCISION OF HIP TENDON 596.09 27005 INCISION OF HIP TENDON 728.38 27006 INCISION OF HIP TENDONS 737.26 27025 INCISION OF HIP/THIGH FASCIA 919.89 27027 BUTTOCK FASCIOTOMY 845.72 27030 DRAINAGE OF HIP JOINT 919.37 27033 EXPLORATION OF HIP JOINT 977.25 27035 DENERVATION OF HIP JOINT 1180.23 27036 EXCISION OF HIP JOINT/MUSCLE 1014.82 27040 BIOPSY OF SOFT TISSUES 201.53 27041 BIOPSY OF SOFT TISSUES 689.13 27043 EXC HIP PELVIS LES SC 3 CM/> 467.27 27045 EXC HIP/PELV TUM DEEP 5 CM/> 748.82 27047 EXC HIP/PELVIS LES SC < 3 CM 363.17 27048 EXC HIP/PELV TUM DEEP < 5 CM 609.72 27049 RESECT HIP/PELV TUM < 5 CM 1367.59 27050 BIOPSY OF SACROILIAC JOINT 401.80 27052 BIOPSY OF HIP JOINT 578.75 27054 REMOVAL OF HIP JOINT LINING 687.32 27057 BUTTOCK FASCIOTOMY W/DBRDMT 948.80 27059 RESECT HIP/PELV TUM 5 CM/> 1809.18 27060 REMOVAL OF ISCHIAL BURSA 465.47 27062 REMOVE FEMUR LESION/BURSA 456.29 27065 REMOVE HIP BONE LES SUPER 513.95 Proc Code Description Mod Rate 27066 REMOVE HIP BONE LES DEEP 815.01 27067 REMOVE/GRAFT HIP BONE LESION 1036.65 27070 PART REMOVE HIP BONE SUPER 853.61 27071 PART REMOVAL HIP BONE DEEP 920.22 27075 RESECT HIP TUMOR 2110.37 27076 RESECT HIP TUM INCL ACETABUL 2536.41 27077 RESECT HIP TUM W/INNOM BONE 2851.65 27078 RSECT HIP TUM INCL FEMUR 2080.60 27080 REMOVAL OF TAIL BONE 512.49 27086 REMOVE HIP FOREIGN BODY 165.74 27087 REMOVE HIP FOREIGN BODY 628.96 27090 REMOVAL OF HIP PROSTHESIS 830.79 27091 REMOVAL OF HIP PROSTHESIS 1608.82 27093 INJECTION FOR HIP X-RAY 70.36 27095 INJECTION FOR HIP X-RAY 82.27 27096 INJECT SACROILIAC JOINT 84.73 27097 REVISION OF HIP TENDON 682.56 27098 TRANSFER TENDON TO PELVIS 694.72 27100 TRANSFER OF ABDOMINAL MUSCLE 820.17 27105 TRANSFER OF SPINAL MUSCLE 867.23 27110 TRANSFER OF ILIOPSOAS MUSCLE 970.58 27111 TRANSFER OF ILIOPSOAS MUSCLE 900.13 27120 RECONSTRUCTION OF HIP SOCKET 1304.14 27122 RECONSTRUCTION OF HIP SOCKET 1103.86 27125 PARTIAL HIP REPLACEMENT 1139.32 27130 TOTAL HIP ARTHROPLASTY 1366.90 27132 TOTAL HIP ARTHROPLASTY 1688.66 27134 REVISE HIP JOINT REPLACEMENT 1932.00 27137 REVISE HIP JOINT REPLACEMENT 1483.83 27138 REVISE HIP JOINT REPLACEMENT 1542.67 27140 TRANSPLANT FEMUR RIDGE 896.31 27146 INCISION OF HIP BONE 1289.93 27147 REVISION OF HIP BONE 1475.44 27151 INCISION OF HIP BONES 1597.69 27156 REVISION OF HIP BONES 1722.30 27158 REVISION OF PELVIS 1407.00 27161 INCISION OF NECK OF FEMUR 1222.14 27165 INCISION/FIXATION OF FEMUR 1385.14 27170 REPAIR/GRAFT FEMUR HEAD/NECK 1182.38 27175 TREAT SLIPPED EPIPHYSIS 590.14 27176 TREAT SLIPPED EPIPHYSIS 920.54 27177 TREAT SLIPPED EPIPHYSIS 1116.80 27178 TREAT SLIPPED EPIPHYSIS 920.54 27179 REVISE HEAD/NECK OF FEMUR 978.17 27181 TREAT SLIPPED EPIPHYSIS 1021.54 27185 REVISION OF FEMUR EPIPHYSIS 585.63 Proc Code Description Mod Rate 27187 REINFORCE HIP BONES 996.45 27193 TREAT PELVIC RING FRACTURE 478.41 27194 TREAT PELVIC RING FRACTURE 701.41 27200 TREAT TAIL BONE FRACTURE 187.70 27202 TREAT TAIL BONE FRACTURE 534.05 27215 TREAT PELVIC FRACTURE(S) 599.21 27216 TREAT PELVIC RING FRACTURE 888.89 27217 TREAT PELVIC RING FRACTURE 834.37 27218 TREAT PELVIC RING FRACTURE 1151.03 27220 TREAT HIP SOCKET FRACTURE 526.81 27222 TREAT HIP SOCKET FRACTURE 977.93 27226 TREAT HIP WALL FRACTURE 1064.12 27227 TREAT HIP FRACTURE(S) 1670.78 27228 TREAT HIP FRACTURE(S) 1902.92 27230 TREAT THIGH FRACTURE 472.35 27232 TREAT THIGH FRACTURE 762.80 27235 TREAT THIGH FRACTURE 912.49 27236 TREAT THIGH FRACTURE 1203.56 27238 TREAT THIGH FRACTURE 460.60 27240 TREAT THIGH FRACTURE 959.33 27244 TREAT THIGH FRACTURE 1237.14 27245 TREAT THIGH FRACTURE 1237.50 27246 TREAT THIGH FRACTURE 386.91 27248 TREAT THIGH FRACTURE 746.72 27250 TREAT HIP DISLOCATION 182.96 27252 TREAT HIP DISLOCATION 761.38 27253 TREAT HIP DISLOCATION 946.07 27254 TREAT HIP DISLOCATION 1272.65 27256 TREAT HIP DISLOCATION 235.39 27257 TREAT HIP DISLOCATION 361.58 27258 TREAT HIP DISLOCATION 1113.45 27259 TREAT HIP DISLOCATION 1558.02 27265 TREAT HIP DISLOCATION 400.52 27266 TREAT HIP DISLOCATION 582.11 27267 Cltx thigh fx 438.37 27268 Cltx thigh fx w/mnpj 538.60 27269 Optx thigh fx 1250.42 27275 MANIPULATION OF HIP JOINT 181.65 27279 Arthrodesis sacroiliac joint 560.88 27280 FUSION OF SACROILIAC JOINT 1046.01 27282 FUSION OF PUBIC BONES 855.66 27284 FUSION OF HIP JOINT 1626.08 27286 FUSION OF HIP JOINT 1660.02 27290 AMPUTATION OF LEG AT HIP 1631.16 27295 AMPUTATION OF LEG AT HIP 1270.71 27301 DRAIN THIGH/KNEE LESION 495.73 Proc Code Description Mod Rate 27303 DRAINAGE OF BONE LESION 640.09 27305 INCISE THIGH TENDON & FASCIA 485.10 27306 INCISION OF THIGH TENDON 370.56 27307 INCISION OF THIGH TENDONS 480.26 27310 EXPLORATION OF KNEE JOINT 733.15 27323 BIOPSY THIGH SOFT TISSUES 178.43 27324 BIOPSY THIGH SOFT TISSUES 395.70 27325 NEURECTOMY HAMSTRING 557.52 27326 NEURECTOMY POPLITEAL 513.72 27327 EXC THIGH/KNEE LES SC < 3 CM 313.98 27328 EXC THIGH/KNEE TUM DEEP <5CM 619.41 27329 RESECT THIGH/KNEE TUM < 5 CM 1041.02 27330 BIOPSY KNEE JOINT LINING 418.03 27331 EXPLORE/TREAT KNEE JOINT 476.70 27332 REMOVAL OF KNEE CARTILAGE 641.40 27333 REMOVAL OF KNEE CARTILAGE 586.08 27334 REMOVE KNEE JOINT LINING 685.93 27335 REMOVE KNEE JOINT LINING 766.45 27337 EXC THIGH/KNEE LES SC 3 CM/> 417.36 27339 EXC THIGH/KNEE TUM DEP 5CM/> 749.90 27340 REMOVAL OF KNEECAP BURSA 371.89 27345 REMOVAL OF KNEE CYST 481.64 27347 REMOVE KNEE CYST 529.84 27350 REMOVAL OF KNEECAP 655.11 27355 REMOVE FEMUR LESION 604.43 27356 REMOVE FEMUR LESION/GRAFT 739.47 27357 REMOVE FEMUR LESION/GRAFT 815.80 27358 REMOVE FEMUR LESION/FIXATION 279.71 27360 PARTIAL REMOVAL LEG BONE(S) 854.85 27364 RESECT THIGH/KNEE TUM 5 CM/> 1568.28 27365 RESECT FEMUR/KNEE TUMOR 2080.99 27370 INJECTION FOR KNEE X-RAY 51.92 27372 REMOVAL OF FOREIGN BODY 405.78 27380 REPAIR OF KNEECAP TENDON 596.28 27381 REPAIR/GRAFT KNEECAP TENDON 802.05 27385 REPAIR OF THIGH MUSCLE 576.94 27386 REPAIR/GRAFT OF THIGH MUSCLE 833.07 27390 INCISION OF THIGH TENDON 448.36 27391 INCISION OF THIGH TENDONS 577.20 27392 INCISION OF THIGH TENDONS 712.54 27393 LENGTHENING OF THIGH TENDON 509.94 27394 LENGTHENING OF THIGH TENDONS 653.09 27395 LENGTHENING OF THIGH TENDONS 879.52 27396 TRANSPLANT OF THIGH TENDON 616.41 27397 TRANSPLANTS OF THIGH TENDONS 917.64 27400 REVISE THIGH MUSCLES/TENDONS 695.06 Proc Code Description Mod Rate 27403 REPAIR OF KNEE CARTILAGE 641.86 27405 REPAIR OF KNEE LIGAMENT 678.57 27407 REPAIR OF KNEE LIGAMENT 793.31 27409 REPAIR OF KNEE LIGAMENTS 967.09 27412 AUTOCHONDROCYTE IMPLANT KNEE 1661.40 27415 OSTEOCHONDRAL KNEE ALLOGRAFT 1379.46 27416 Osteochondral knee autograft 982.92 27418 REPAIR DEGENERATED KNEECAP 833.41 27420 REVISION OF UNSTABLE KNEECAP 736.70 27422 REVISION OF UNSTABLE KNEECAP 745.75 27424 REVISION/REMOVAL OF KNEECAP 748.22 27425 LAT RETINACULAR RELEASE OPEN 447.85 27427 RECONSTRUCTION KNEE 716.97 27428 RECONSTRUCTION KNEE 1117.25 27429 RECONSTRUCTION KNEE 1256.47 27430 REVISION OF THIGH MUSCLES 742.97 27435 INCISION OF KNEE JOINT 812.66 27437 REVISE KNEECAP 661.20 27438 REVISE KNEECAP WITH IMPLANT 845.57 27440 REVISION OF KNEE JOINT 798.66 27441 REVISION OF KNEE JOINT 825.26 27442 REVISION OF KNEE JOINT 873.55 27443 REVISION OF KNEE JOINT 817.94 27445 REVISION OF KNEE JOINT 1259.46 27446 REVISION OF KNEE JOINT 1168.58 27447 TOTAL KNEE ARTHROPLASTY 1366.16 27448 INCISION OF THIGH 810.13 27450 INCISION OF THIGH 1017.09 27454 REALIGNMENT OF THIGH BONE 1303.89 27455 REALIGNMENT OF KNEE 944.27 27457 REALIGNMENT OF KNEE 960.12 27465 SHORTENING OF THIGH BONE 1258.12 27466 LENGTHENING OF THIGH BONE 1183.25 27468 SHORTEN/LENGTHEN THIGHS 1206.10 27470 REPAIR OF THIGH 1182.74 27472 REPAIR/GRAFT OF THIGH 1270.84 27475 SURGERY TO STOP LEG GROWTH 662.64 27477 SURGERY TO STOP LEG GROWTH 733.31 27479 SURGERY TO STOP LEG GROWTH 862.40 27485 SURGERY TO STOP LEG GROWTH 671.67 27486 REVISE/REPLACE KNEE JOINT 1417.63 27487 REVISE/REPLACE KNEE JOINT 1773.06 27488 REMOVAL OF KNEE PROSTHESIS 1208.96 27495 REINFORCE THIGH 1133.35 27496 DECOMPRESSION OF THIGH/KNEE 543.77 27497 DECOMPRESSION OF THIGH/KNEE 582.84 Proc Code Description Mod Rate 27498 DECOMPRESSION OF THIGH/KNEE 655.11 27499 DECOMPRESSION OF THIGH/KNEE 701.01 27500 TREATMENT OF THIGH FRACTURE 479.49 27501 TREATMENT OF THIGH FRACTURE 499.39 27502 TREATMENT OF THIGH FRACTURE 773.05 27503 TREATMENT OF THIGH FRACTURE 804.83 27506 TREATMENT OF THIGH FRACTURE 1345.53 27507 TREATMENT OF THIGH FRACTURE 978.50 27508 TREATMENT OF THIGH FRACTURE 496.16 27509 TREATMENT OF THIGH FRACTURE 645.84 27510 TREATMENT OF THIGH FRACTURE 687.08 27511 TREATMENT OF THIGH FRACTURE 1003.03 27513 TREATMENT OF THIGH FRACTURE 1248.13 27514 TREATMENT OF THIGH FRACTURE 971.82 27516 TREAT THIGH FX GROWTH PLATE 476.99 27517 TREAT THIGH FX GROWTH PLATE 686.04 27519 TREAT THIGH FX GROWTH PLATE 893.81 27520 TREAT KNEECAP FRACTURE 295.55 27524 TREAT KNEECAP FRACTURE 754.86 27530 TREAT KNEE FRACTURE 280.71 27532 TREAT KNEE FRACTURE 578.17 27535 TREAT KNEE FRACTURE 901.81 27536 TREAT KNEE FRACTURE 1197.43 27538 TREAT KNEE FRACTURE(S) 443.99 27540 TREAT KNEE FRACTURE 815.94 27550 TREAT KNEE DISLOCATION 470.89 27552 TREAT KNEE DISLOCATION 627.13 27556 TREAT KNEE DISLOCATION 876.25 27557 TREAT KNEE DISLOCATION 1051.39 27558 TREAT KNEE DISLOCATION 1198.42 27560 TREAT KNEECAP DISLOCATION 334.32 27562 TREAT KNEECAP DISLOCATION 483.60 27566 TREAT KNEECAP DISLOCATION 894.61 27570 FIXATION OF KNEE JOINT 150.96 27580 FUSION OF KNEE 1443.52 27590 AMPUTATE LEG AT THIGH 817.50 27591 AMPUTATE LEG AT THIGH 974.54 27592 AMPUTATE LEG AT THIGH 691.80 27594 AMPUTATION FOLLOW-UP SURGERY 515.92 27596 AMPUTATION FOLLOW-UP SURGERY 735.49 27598 AMPUTATE LOWER LEG AT KNEE 737.29 27599 LEG SURGERY PROCEDURE 0.00 27600 DECOMPRESSION OF LOWER LEG 417.59 27601 DECOMPRESSION OF LOWER LEG 444.84 27602 DECOMPRESSION OF LOWER LEG 504.49 27603 DRAIN LOWER LEG LESION 390.27 Proc Code Description Mod Rate 27604 DRAIN LOWER LEG BURSA 333.25 27605 INCISION OF ACHILLES TENDON 185.86 27606 INCISION OF ACHILLES TENDON 286.87 27607 TREAT LOWER LEG BONE LESION 613.34 27610 EXPLORE/TREAT ANKLE JOINT 657.01 27612 EXPLORATION OF ANKLE JOINT 566.46 27613 BIOPSY LOWER LEG SOFT TISSUE 163.40 27614 BIOPSY LOWER LEG SOFT TISSUE 408.64 27615 RESECT LEG/ANKLE TUM < 5 CM 1026.95 27616 RESECT LEG/ANKLE TUM 5 CM/> 1270.24 27618 EXC LEG/ANKLE TUM < 3 CM 306.32 27619 EXC LEG/ANKLE TUM DEEP <5 CM 473.34 27620 EXPLORE/TREAT ANKLE JOINT 456.85 27625 REMOVE ANKLE JOINT LINING 581.45 27626 REMOVE ANKLE JOINT LINING 628.51 27630 REMOVAL OF TENDON LESION 369.59 27632 EXC LEG/ANKLE LES SC 3 CM/> 413.63 27634 EXC LEG/ANKLE TUM DEP 5 CM/> 683.46 27635 REMOVE LOWER LEG BONE LESION 592.38 27637 REMOVE/GRAFT LEG BONE LESION 755.65 27638 REMOVE/GRAFT LEG BONE LESION 773.70 27640 PARTIAL REMOVAL OF TIBIA 836.80 27641 PARTIAL REMOVAL OF FIBULA 671.93 27645 RESECT TIBIA TUMOR 1788.71 27646 RESECT FIBULA TUMOR 1550.93 27647 RESECT TALUS/CALCANEUS TUM 1041.50 27648 INJECTION FOR ANKLE X-RAY 52.28 27650 REPAIR ACHILLES TENDON 666.71 27652 REPAIR/GRAFT ACHILLES TENDON 691.11 27654 REPAIR OF ACHILLES TENDON 710.95 27656 REPAIR LEG FASCIA DEFECT 396.07 27658 REPAIR OF LEG TENDON EACH 375.72 27659 REPAIR OF LEG TENDON EACH 488.76 27664 REPAIR OF LEG TENDON EACH 363.10 27665 REPAIR OF LEG TENDON EACH 416.34 27675 REPAIR LOWER LEG TENDONS 487.28 27676 REPAIR LOWER LEG TENDONS 618.02 27680 RELEASE OF LOWER LEG TENDON 430.67 27681 RELEASE OF LOWER LEG TENDONS 546.97 27685 REVISION OF LOWER LEG TENDON 467.83 27686 REVISE LOWER LEG TENDONS 554.84 27687 REVISION OF CALF TENDON 457.00 27690 REVISE LOWER LEG TENDON 634.51 27691 REVISE LOWER LEG TENDON 757.16 27692 REVISE ADDITIONAL LEG TENDON 106.65 27695 REPAIR OF ANKLE LIGAMENT 481.74 Proc Code Description Mod Rate 27696 REPAIR OF ANKLE LIGAMENTS 562.80 27698 REPAIR OF ANKLE LIGAMENT 644.43 27700 REVISION OF ANKLE JOINT 593.92 27702 RECONSTRUCT ANKLE JOINT 976.81 27703 RECONSTRUCTION ANKLE JOINT 1127.10 27704 REMOVAL OF ANKLE IMPLANT 579.74 27705 INCISION OF TIBIA 762.18 27707 INCISION OF FIBULA 405.98 27709 INCISION OF TIBIA & FIBULA 1174.56 27712 REALIGNMENT OF LOWER LEG 1108.89 27715 REVISION OF LOWER LEG 1074.30 27720 REPAIR OF TIBIA 880.01 27722 REPAIR/GRAFT OF TIBIA 891.75 27724 REPAIR/GRAFT OF TIBIA 1276.02 27725 REPAIR OF LOWER LEG 1224.34 27726 Repair fibula nonunion 974.67 27727 REPAIR OF LOWER LEG 922.31 27730 REPAIR OF TIBIA EPIPHYSIS 586.56 27732 REPAIR OF FIBULA EPIPHYSIS 383.13 27734 REPAIR LOWER LEG EPIPHYSES 616.73 27740 REPAIR OF LEG EPIPHYSES 621.03 27742 REPAIR OF LEG EPIPHYSES 683.38 27745 REINFORCE TIBIA 760.04 27750 TREATMENT OF TIBIA FRACTURE 318.73 27752 TREATMENT OF TIBIA FRACTURE 496.76 27756 TREATMENT OF TIBIA FRACTURE 576.52 27758 TREATMENT OF TIBIA FRACTURE 894.83 27759 TREATMENT OF TIBIA FRACTURE 1003.65 27760 CLTX MEDIAL ANKLE FX 306.37 27762 CLTX MED ANKLE FX W/MNPJ 437.94 27766 OPTX MEDIAL ANKLE FX 612.04 27767 Cltx post ankle fx 285.37 27768 Cltx post ankle fx w/mnpj 440.72 27769 Optx post ankle fx 732.59 27780 TREATMENT OF FIBULA FRACTURE 279.69 27781 TREATMENT OF FIBULA FRACTURE 388.68 27784 TREATMENT OF FIBULA FRACTURE 720.71 27786 TREATMENT OF ANKLE FRACTURE 287.26 27788 TREATMENT OF ANKLE FRACTURE 385.31 27792 TREATMENT OF ANKLE FRACTURE 656.69 27808 TREATMENT OF ANKLE FRACTURE 302.00 27810 TREATMENT OF ANKLE FRACTURE 426.73 27814 TREATMENT OF ANKLE FRACTURE 776.68 27816 TREATMENT OF ANKLE FRACTURE 286.81 27818 TREATMENT OF ANKLE FRACTURE 436.51 27822 TREATMENT OF ANKLE FRACTURE 846.89 Proc Code Description Mod Rate 27823 TREATMENT OF ANKLE FRACTURE 961.01 27824 TREAT LOWER LEG FRACTURE 305.86 27825 TREAT LOWER LEG FRACTURE 495.38 27826 TREAT LOWER LEG FRACTURE 843.11 27827 TREAT LOWER LEG FRACTURE 1090.00 27828 TREAT LOWER LEG FRACTURE 1303.85 27829 TREAT LOWER LEG JOINT 689.32 27830 TREAT LOWER LEG DISLOCATION 354.12 27831 TREAT LOWER LEG DISLOCATION 399.27 27832 TREAT LOWER LEG DISLOCATION 757.31 27840 TREAT ANKLE DISLOCATION 371.41 27842 TREAT ANKLE DISLOCATION 495.70 27846 TREAT ANKLE DISLOCATION 735.49 27848 TREAT ANKLE DISLOCATION 820.32 27860 FIXATION OF ANKLE JOINT 178.29 27870 FUSION OF ANKLE JOINT OPEN 1041.31 27871 FUSION OF TIBIOFIBULAR JOINT 691.82 27880 AMPUTATION OF LOWER LEG 932.39 27881 AMPUTATION OF LOWER LEG 890.13 27882 AMPUTATION OF LOWER LEG 613.60 27884 AMPUTATION FOLLOW-UP SURGERY 584.12 27886 AMPUTATION FOLLOW-UP SURGERY 668.45 27888 AMPUTATION OF FOOT AT ANKLE 680.02 27889 AMPUTATION OF FOOT AT ANKLE 671.66 27892 DECOMPRESSION OF LEG 558.67 27893 DECOMPRESSION OF LEG 614.82 27894 DECOMPRESSION OF LEG 863.37 28001 DRAINAGE OF BURSA OF FOOT 169.41 28002 TREATMENT OF FOOT INFECTION 322.94 28003 TREATMENT OF FOOT INFECTION 573.95 28005 TREAT FOOT BONE LESION 583.25 28008 INCISION OF FOOT FASCIA 293.84 28010 INCISION OF TOE TENDON 210.78 28011 INCISION OF TOE TENDONS 291.68 28020 EXPLORATION OF FOOT JOINT 363.98 28022 EXPLORATION OF FOOT JOINT 326.25 28024 EXPLORATION OF TOE JOINT 305.12 28035 DECOMPRESSION OF TIBIA NERVE 359.85 28039 EXC FOOT/TOE TUM SC 1.5 CM/> 351.78 28041 EXC FOOT/TOE TUM DEP 1.5CM/> 461.70 28043 EXC FOOT/TOE TUM SC < 1.5 CM 263.01 28045 EXC FOOT/TOE TUM DEEP <1.5CM 350.33 28046 RESECT FOOT/TOE TUMOR < 3 CM 738.70 28047 RESECT FOOT/TOE TUMOR 3 CM/> 1028.61 28050 BIOPSY OF FOOT JOINT LINING 282.68 28052 BIOPSY OF FOOT JOINT LINING 283.11 Proc Code Description Mod Rate 28054 BIOPSY OF TOE JOINT LINING 236.24 28055 NEURECTOMY FOOT 377.81 28060 PARTIAL REMOVAL FOOT FASCIA 357.21 28062 REMOVAL OF FOOT FASCIA 408.06 28070 REMOVAL OF FOOT JOINT LINING 355.74 28072 REMOVAL OF FOOT JOINT LINING 336.00 28080 REMOVAL OF FOOT LESION 367.79 28086 EXCISE FOOT TENDON SHEATH 363.06 28088 EXCISE FOOT TENDON SHEATH 295.55 28090 REMOVAL OF FOOT LESION 309.47 28092 REMOVAL OF TOE LESIONS 270.16 28100 REMOVAL OF ANKLE/HEEL LESION 412.80 28102 REMOVE/GRAFT FOOT LESION 573.13 28103 REMOVE/GRAFT FOOT LESION 392.14 28104 REMOVAL OF FOOT LESION 351.72 28106 REMOVE/GRAFT FOOT LESION 446.65 28107 REMOVE/GRAFT FOOT LESION 366.80 28108 REMOVAL OF TOE LESIONS 289.65 28110 PART REMOVAL OF METATARSAL 289.85 28111 PART REMOVAL OF METATARSAL 329.75 28112 PART REMOVAL OF METATARSAL 315.14 28113 PART REMOVAL OF METATARSAL 428.21 28114 REMOVAL OF METATARSAL HEADS 842.42 28116 REVISION OF FOOT 565.37 28118 REMOVAL OF HEEL BONE 411.87 28119 REMOVAL OF HEEL SPUR 362.28 28120 PART REMOVAL OF ANKLE/HEEL 502.06 28122 PARTIAL REMOVAL OF FOOT BONE 442.25 28124 PARTIAL REMOVAL OF TOE 330.80 28126 PARTIAL REMOVAL OF TOE 250.24 28130 REMOVAL OF ANKLE BONE 668.93 28140 REMOVAL OF METATARSAL 444.37 28150 REMOVAL OF TOE 282.31 28153 PARTIAL REMOVAL OF TOE 266.14 28160 PARTIAL REMOVAL OF TOE 270.68 28171 RESECT TARSAL TUMOR 848.72 28173 RESECT METATARSAL TUMOR 773.68 28175 RESECT PHALANX OF TOE TUMOR 489.49 28190 REMOVAL OF FOOT FOREIGN BODY 134.51 28192 REMOVAL OF FOOT FOREIGN BODY 315.89 28193 REMOVAL OF FOOT FOREIGN BODY 371.76 28200 REPAIR OF FOOT TENDON 319.48 28202 REPAIR/GRAFT OF FOOT TENDON 426.82 28208 REPAIR OF FOOT TENDON 312.80 28210 REPAIR/GRAFT OF FOOT TENDON 404.49 28220 RELEASE OF FOOT TENDON 301.23 Proc Code Description Mod Rate 28222 RELEASE OF FOOT TENDONS 351.09 28225 RELEASE OF FOOT TENDON 259.32 28226 RELEASE OF FOOT TENDONS 373.65 28230 INCISION OF FOOT TENDON(S) 284.53 28232 INCISION OF TOE TENDON 245.09 28234 INCISION OF FOOT TENDON 264.79 28238 REVISION OF FOOT TENDON 490.18 28240 RELEASE OF BIG TOE 290.50 28250 REVISION OF FOOT FASCIA 405.55 28260 RELEASE OF MIDFOOT JOINT 511.60 28261 REVISION OF FOOT TENDON 766.14 28262 REVISION OF FOOT AND ANKLE 1175.87 28264 RELEASE OF MIDFOOT JOINT 724.29 28270 RELEASE OF FOOT CONTRACTURE 335.38 28272 RELEASE OF TOE JOINT EACH 254.70 28280 FUSION OF TOES 353.83 28285 REPAIR OF HAMMERTOE 377.97 28286 REPAIR OF HAMMERTOE 301.14 28288 PARTIAL REMOVAL OF FOOT BONE 432.04 28289 REPAIR HALLUX RIGIDUS 551.20 28290 CORRECTION OF BUNION 395.80 28292 CORRECTION OF BUNION 604.17 28293 CORRECTION OF BUNION 712.22 28294 CORRECTION OF BUNION 536.25 28296 CORRECTION OF BUNION 521.98 28297 CORRECTION OF BUNION 587.12 28298 CORRECTION OF BUNION 507.12 28299 CORRECTION OF BUNION 675.75 28300 INCISION OF HEEL BONE 659.46 28302 INCISION OF ANKLE BONE 716.70 28304 INCISION OF MIDFOOT BONES 599.42 28305 INCISE/GRAFT MIDFOOT BONES 638.26 28306 INCISION OF METATARSAL 407.56 28307 INCISION OF METATARSAL 468.80 28308 INCISION OF METATARSAL 376.91 28309 INCISION OF METATARSALS 899.53 28310 REVISION OF BIG TOE 356.18 28312 REVISION OF TOE 321.82 28313 REPAIR DEFORMITY OF TOE 363.30 28315 REMOVAL OF SESAMOID BONE 325.18 28320 REPAIR OF FOOT BONES 622.41 28322 REPAIR OF METATARSALS 584.68 28340 RESECT ENLARGED TOE TISSUE 413.95 28341 RESECT ENLARGED TOE 493.14 28344 REPAIR EXTRA TOE(S) 287.62 28345 REPAIR WEBBED TOE(S) 365.11 Proc Code Description Mod Rate 28360 RECONSTRUCT CLEFT FOOT 892.77 28400 TREATMENT OF HEEL FRACTURE 229.38 28405 TREATMENT OF HEEL FRACTURE 353.93 28406 TREATMENT OF HEEL FRACTURE 532.06 28415 TREAT HEEL FRACTURE 1116.05 28420 TREAT/GRAFT HEEL FRACTURE 1259.00 28430 TREATMENT OF ANKLE FRACTURE 210.48 28435 TREATMENT OF ANKLE FRACTURE 293.37 28436 TREATMENT OF ANKLE FRACTURE 451.14 28445 TREAT ANKLE FRACTURE 1066.84 28446 Osteochondral talus autogrft 1229.28 28450 TREAT MIDFOOT FRACTURE EACH 193.89 28455 TREAT MIDFOOT FRACTURE EACH 269.45 28456 TREAT MIDFOOT FRACTURE 320.26 28465 TREAT MIDFOOT FRACTURE EACH 628.99 28470 TREAT METATARSAL FRACTURE 207.58 28475 TREAT METATARSAL FRACTURE 227.75 28476 TREAT METATARSAL FRACTURE 351.88 28485 TREAT METATARSAL FRACTURE 527.20 28490 TREAT BIG TOE FRACTURE 125.57 28495 TREAT BIG TOE FRACTURE 149.83 28496 TREAT BIG TOE FRACTURE 234.42 28505 TREAT BIG TOE FRACTURE 498.44 28510 TREATMENT OF TOE FRACTURE 120.51 28515 TREATMENT OF TOE FRACTURE 142.48 28525 TREAT TOE FRACTURE 403.40 28530 TREAT SESAMOID BONE FRACTURE 102.27 28531 TREAT SESAMOID BONE FRACTURE 193.95 28540 TREAT FOOT DISLOCATION 184.83 28545 TREAT FOOT DISLOCATION 262.83 28546 TREAT FOOT DISLOCATION 340.63 28555 REPAIR FOOT DISLOCATION 664.28 28570 TREAT FOOT DISLOCATION 183.29 28575 TREAT FOOT DISLOCATION 330.43 28576 TREAT FOOT DISLOCATION 396.62 28585 REPAIR FOOT DISLOCATION 685.33 28600 TREAT FOOT DISLOCATION 190.30 28605 TREAT FOOT DISLOCATION 295.43 28606 TREAT FOOT DISLOCATION 401.36 28615 REPAIR FOOT DISLOCATION 794.74 28630 TREAT TOE DISLOCATION 109.91 28635 TREAT TOE DISLOCATION 132.84 28636 TREAT TOE DISLOCATION 174.00 28645 REPAIR TOE DISLOCATION 485.67 28660 TREAT TOE DISLOCATION 89.53 28665 TREAT TOE DISLOCATION 131.78 Proc Code Description Mod Rate 28666 TREAT TOE DISLOCATION 190.95 28675 REPAIR OF TOE DISLOCATION 404.19 28705 FUSION OF FOOT BONES 1276.81 28715 FUSION OF FOOT BONES 942.12 28725 FUSION OF FOOT BONES 777.56 28730 FUSION OF FOOT BONES 739.97 28735 FUSION OF FOOT BONES 786.56 28737 REVISION OF FOOT BONES 692.77 28740 FUSION OF FOOT BONES 631.84 28750 FUSION OF BIG TOE JOINT 598.61 28755 FUSION OF BIG TOE JOINT 332.28 28760 FUSION OF BIG TOE JOINT 575.58 28800 AMPUTATION OF MIDFOOT 549.38 28805 AMPUTATION THRU METATARSAL 750.39 28810 AMPUTATION TOE & METATARSAL 440.38 28820 AMPUTATION OF TOE 402.54 28825 PARTIAL AMPUTATION OF TOE 377.00 28890 HI ENRGY ESWT PLANTAR FASCIA 226.53 28899 FOOT/TOES SURGERY PROCEDURE 0.00 29000 APPLICATION OF BODY CAST 167.78 29010 APPLICATION OF BODY CAST 151.25 29015 APPLICATION OF BODY CAST 175.77 29035 APPLICATION OF BODY CAST 136.63 29040 APPLICATION OF BODY CAST 187.99 29044 APPLICATION OF BODY CAST 160.87 29046 APPLICATION OF BODY CAST 175.54 29049 APPLICATION OF FIGURE EIGHT 70.47 29055 APPLICATION OF SHOULDER CAST 138.77 29058 APPLICATION OF SHOULDER CAST 94.20 29065 APPLICATION OF LONG ARM CAST 68.67 29075 APPLICATION OF FOREARM CAST 62.72 29085 APPLY HAND/WRIST CAST 67.56 29086 APPLY FINGER CAST 51.42 29105 APPLY LONG ARM SPLINT 59.66 29125 APPLY FOREARM SPLINT 39.79 29126 APPLY FOREARM SPLINT 48.83 29130 APPLICATION OF FINGER SPLINT 28.64 29131 APPLICATION OF FINGER SPLINT 33.23 29200 STRAPPING OF CHEST 39.46 29240 STRAPPING OF SHOULDER 43.30 29260 STRAPPING OF ELBOW OR WRIST 36.77 29280 STRAPPING OF HAND OR FINGER 35.75 29305 APPLICATION OF HIP CAST 159.56 29325 APPLICATION OF HIP CASTS 179.24 29345 APPLICATION OF LONG LEG CAST 102.00 29355 APPLICATION OF LONG LEG CAST 108.26 Proc Code Description Mod Rate 29358 APPLY LONG LEG CAST BRACE 104.85 29365 APPLICATION OF LONG LEG CAST 88.69 29405 APPLY SHORT LEG CAST 60.11 29425 APPLY SHORT LEG CAST 56.87 29435 APPLY SHORT LEG CAST 83.31 29440 ADDITION OF WALKER TO CAST 30.33 29445 APPLY RIGID LEG CAST 105.56 29450 APPLICATION OF LEG CAST 111.79 29505 APPLICATION LONG LEG SPLINT 50.26 29515 APPLICATION LOWER LEG SPLINT 50.17 29520 STRAPPING OF HIP 34.62 29530 STRAPPING OF KNEE 36.73 29540 STRAPPING OF ANKLE AND/OR FT 25.90 29550 STRAPPING OF TOES 19.30 29580 APPLICATION OF PASTE BOOT 35.73 29581 APPLY MULTLAY COMPRS LWR LEG 12.48 29582 Apply multlay comprs upr leg 15.53 29583 Apply multlay comprs upr arm 11.04 29584 Appl multlay comprs arm/hand 15.53 29700 REMOVAL/REVISION OF CAST 33.95 29705 REMOVAL/REVISION OF CAST 46.90 29710 REMOVAL/REVISION OF CAST 81.65 29720 REPAIR OF BODY CAST 43.82 29730 WINDOWING OF CAST 45.13 29740 WEDGING OF CAST 68.97 29750 WEDGING OF CLUBFOOT CAST 66.34 29800 JAW ARTHROSCOPY/SURGERY 523.20 29804 JAW ARTHROSCOPY/SURGERY 659.10 29805 SHOULDER ARTHROSCOPY DX 473.46 29806 SHOULDER ARTHROSCOPY/SURGERY 1066.17 29807 SHOULDER ARTHROSCOPY/SURGERY 1038.83 29819 SHOULDER ARTHROSCOPY/SURGERY 588.19 29820 SHOULDER ARTHROSCOPY/SURGERY 542.75 29821 SHOULDER ARTHROSCOPY/SURGERY 593.45 29822 SHOULDER ARTHROSCOPY/SURGERY 577.37 29823 SHOULDER ARTHROSCOPY/SURGERY 630.06 29824 SHOULDER ARTHROSCOPY/SURGERY 680.50 29825 SHOULDER ARTHROSCOPY/SURGERY 588.55 29826 SHOULDER ARTHROSCOPY/SURGERY 177.50 29827 ARTHROSCOP ROTATOR CUFF REPR 1080.24 29828 Arthroscopy biceps tenodesis 929.13 29830 ELBOW ARTHROSCOPY 456.84 29834 ELBOW ARTHROSCOPY/SURGERY 492.56 29835 ELBOW ARTHROSCOPY/SURGERY 508.45 29836 ELBOW ARTHROSCOPY/SURGERY 579.70 29837 ELBOW ARTHROSCOPY/SURGERY 530.84 Proc Code Description Mod Rate 29838 ELBOW ARTHROSCOPY/SURGERY 590.50 29840 WRIST ARTHROSCOPY 453.54 29843 WRIST ARTHROSCOPY/SURGERY 485.14 29844 WRIST ARTHROSCOPY/SURGERY 499.14 29845 WRIST ARTHROSCOPY/SURGERY 579.51 29846 WRIST ARTHROSCOPY/SURGERY 521.49 29847 WRIST ARTHROSCOPY/SURGERY 546.35 29848 WRIST ENDOSCOPY/SURGERY 510.83 29850 KNEE ARTHROSCOPY/SURGERY 625.54 29851 KNEE ARTHROSCOPY/SURGERY 935.44 29855 TIBIAL ARTHROSCOPY/SURGERY 790.92 29856 TIBIAL ARTHROSCOPY/SURGERY 1000.72 29860 HIP ARTHROSCOPY DX 669.35 29861 HIP ARTHRO W/FB REMOVAL 729.04 29862 HIP ARTHR0 W/DEBRIDEMENT 820.79 29863 HIP ARTHR0 W/SYNOVECTOMY 823.32 29866 AUTGRFT IMPLNT KNEE W/SCOPE 1053.62 29867 ALLGRFT IMPLNT KNEE W/SCOPE 1283.87 29868 MENISCAL TRNSPL KNEE W/SCPE 1682.01 29870 KNEE ARTHROSCOPY DX 414.42 29871 KNEE ARTHROSCOPY/DRAINAGE 516.26 29873 KNEE ARTHROSCOPY/SURGERY 526.99 29874 KNEE ARTHROSCOPY/SURGERY 540.27 29875 KNEE ARTHROSCOPY/SURGERY 497.60 29876 KNEE ARTHROSCOPY/SURGERY 659.82 29877 KNEE ARTHROSCOPY/SURGERY 626.21 29879 KNEE ARTHROSCOPY/SURGERY 666.83 29880 KNEE ARTHROSCOPY/SURGERY 566.56 29881 KNEE ARTHROSCOPY/SURGERY 544.82 29882 KNEE ARTHROSCOPY/SURGERY 703.62 29883 KNEE ARTHROSCOPY/SURGERY 847.17 29884 KNEE ARTHROSCOPY/SURGERY 623.37 29885 KNEE ARTHROSCOPY/SURGERY 755.10 29886 KNEE ARTHROSCOPY/SURGERY 638.49 29887 KNEE ARTHROSCOPY/SURGERY 751.94 29888 KNEE ARTHROSCOPY/SURGERY 994.17 29889 KNEE ARTHROSCOPY/SURGERY 1227.89 29891 ANKLE ARTHROSCOPY/SURGERY 690.88 29892 ANKLE ARTHROSCOPY/SURGERY 623.60 29893 SCOPE PLANTAR FASCIOTOMY 427.97 29894 ANKLE ARTHROSCOPY/SURGERY 511.31 29895 ANKLE ARTHROSCOPY/SURGERY 477.09 29897 ANKLE ARTHROSCOPY/SURGERY 514.63 29898 ANKLE ARTHROSCOPY/SURGERY 568.20 29899 ANKLE ARTHROSCOPY/SURGERY 1041.42 29900 MCP JOINT ARTHROSCOPY DX 469.91 Proc Code Description Mod Rate 29901 MCP JOINT ARTHROSCOPY SURG 534.36 29902 MCP JOINT ARTHROSCOPY SURG 613.76 29904 Subtalar arthro w/fb rmvl 639.69 29905 Subtalar arthro w/exc 692.41 29906 Subtalar arthro w/deb 729.02 29907 Subtalar arthro w/fusion 879.63 29914 HIP ARTHRO W/FEMOROPLASTY ARTHR 1015.92 29915 HIP ARTHRO ACETABULOPLASTY ARTHR 1036.57 29916 HIP ARTHRO W/LABRAL REPAIR ARTHR 1036.93 30000 DRAINAGE OF NOSE LESION 120.44 30020 DRAINAGE OF NOSE LESION 120.04 30100 INTRANASAL BIOPSY 69.19 30110 REMOVAL OF NOSE POLYP(S) 131.58 30115 REMOVAL OF NOSE POLYP(S) 432.61 30117 REMOVAL OF INTRANASAL LESION 339.73 30118 REMOVAL OF INTRANASAL LESION 771.34 30120 REVISION OF NOSE 438.14 30124 REMOVAL OF NOSE LESION 287.78 30125 REMOVAL OF NOSE LESION 611.44 30130 EXCISE INFERIOR TURBINATE 382.12 30140 RESECT INFERIOR TURBINATE 444.42 30150 PARTIAL REMOVAL OF NOSE 775.44 30160 REMOVAL OF NOSE 776.90 30200 INJECTION TREATMENT OF NOSE 60.49 30210 NASAL SINUS THERAPY 100.47 30220 INSERT NASAL SEPTAL BUTTON 126.34 30300 REMOVE NASAL FOREIGN BODY 127.83 30310 REMOVE NASAL FOREIGN BODY 209.29 30320 REMOVE NASAL FOREIGN BODY 454.55 30400 RECONSTRUCTION OF NOSE 1014.61 30410 RECONSTRUCTION OF NOSE 1189.05 30420 RECONSTRUCTION OF NOSE 1379.34 30430 REVISION OF NOSE 979.25 30435 REVISION OF NOSE 1118.58 30450 REVISION OF NOSE 1502.28 30460 REVISION OF NOSE 755.63 30462 REVISION OF NOSE 1579.41 30465 REPAIR NASAL STENOSIS 988.75 30520 REPAIR OF NASAL SEPTUM 628.43 30540 REPAIR NASAL DEFECT 691.24 30545 REPAIR NASAL DEFECT 920.69 30560 RELEASE OF NASAL ADHESIONS 139.35 30580 REPAIR UPPER JAW FISTULA 508.70 30600 REPAIR MOUTH/NOSE FISTULA 442.74 30620 INTRANASAL RECONSTRUCTION 630.32 30630 REPAIR NASAL SEPTUM DEFECT 630.59 Proc Code Description Mod Rate 30801 ABLATE INF TURBINATE SUPERF 138.51 30802 ABLATE INF TURBINATE SUBMUC 191.95 30901 CONTROL OF NOSEBLEED 56.76 30903 CONTROL OF NOSEBLEED 79.77 30905 CONTROL OF NOSEBLEED 101.37 30906 REPEAT CONTROL OF NOSEBLEED 131.77 30915 LIGATION NASAL SINUS ARTERY 580.41 30920 LIGATION UPPER JAW ARTERY 839.73 30930 THER FX NASAL INF TURBINATE 124.99 30999 NASAL SURGERY PROCEDURE 0.00 31000 IRRIGATION MAXILLARY SINUS 105.73 31002 IRRIGATION SPHENOID SINUS 202.92 31020 EXPLORATION MAXILLARY SINUS 360.50 31030 EXPLORATION MAXILLARY SINUS 528.78 31032 EXPLORE SINUS REMOVE POLYPS 575.83 31040 EXPLORATION BEHIND UPPER JAW 767.81 31050 EXPLORATION SPHENOID SINUS 486.38 31051 SPHENOID SINUS SURGERY 647.40 31070 EXPLORATION OF FRONTAL SINUS 442.41 31075 EXPLORATION OF FRONTAL SINUS 784.16 31080 REMOVAL OF FRONTAL SINUS 1033.47 31081 REMOVAL OF FRONTAL SINUS 1498.38 31084 REMOVAL OF FRONTAL SINUS 1156.28 31085 REMOVAL OF FRONTAL SINUS 1591.38 31086 REMOVAL OF FRONTAL SINUS 1123.49 31087 REMOVAL OF FRONTAL SINUS 1082.91 31090 EXPLORATION OF SINUSES 1033.93 31200 REMOVAL OF ETHMOID SINUS 577.73 31201 REMOVAL OF ETHMOID SINUS 745.84 31205 REMOVAL OF ETHMOID SINUS 914.94 31225 REMOVAL OF UPPER JAW 1878.12 31230 REMOVAL OF UPPER JAW 2080.57 31231 NASAL ENDOSCOPY DX 64.59 31233 NASAL/SINUS ENDOSCOPY DX 138.30 31235 NASAL/SINUS ENDOSCOPY DX 163.02 31237 NASAL/SINUS ENDOSCOPY SURG 162.73 31238 NASAL/SINUS ENDOSCOPY SURG 170.03 31239 NASAL/SINUS ENDOSCOPY SURG 626.29 31240 NASAL/SINUS ENDOSCOPY SURG 162.37 31254 REVISION OF ETHMOID SINUS 274.32 31255 REMOVAL OF ETHMOID SINUS 401.60 31256 EXPLORATION MAXILLARY SINUS 198.57 31267 ENDOSCOPY MAXILLARY SINUS 318.59 31276 SINUS ENDOSCOPY SURGICAL 507.00 31287 NASAL/SINUS ENDOSCOPY SURG 233.49 31288 NASAL/SINUS ENDOSCOPY SURG 270.50 Proc Code Description Mod Rate 31290 NASAL/SINUS ENDOSCOPY SURG 1163.32 31291 NASAL/SINUS ENDOSCOPY SURG 1236.39 31292 NASAL/SINUS ENDOSCOPY SURG 1003.58 31293 NASAL/SINUS ENDOSCOPY SURG 1088.61 31294 NASAL/SINUS ENDOSCOPY SURG 1246.33 31295 SINUS ENDO W/BALLOON DIL NASAL 167.95 31296 SINUS ENDO W/BALLOON DIL NASAL 200.74 31297 SINUS ENDO W/BALLOON DIL NASAL 165.19 31299 SINUS SURGERY PROCEDURE 0.00 31300 REMOVAL OF LARYNX LESION 1264.92 31320 DIAGNOSTIC INCISION LARYNX 661.36 31360 REMOVAL OF LARYNX 2090.07 31365 REMOVAL OF LARYNX 2583.71 31367 PARTIAL REMOVAL OF LARYNX 2212.46 31368 PARTIAL REMOVAL OF LARYNX 2451.71 31370 PARTIAL REMOVAL OF LARYNX 2079.37 31375 PARTIAL REMOVAL OF LARYNX 1974.10 31380 PARTIAL REMOVAL OF LARYNX 1946.19 31382 PARTIAL REMOVAL OF LARYNX 2135.59 31390 REMOVAL OF LARYNX & PHARYNX 2877.26 31395 RECONSTRUCT LARYNX & PHARYNX 3016.36 31400 REVISION OF LARYNX 1000.86 31420 REMOVAL OF EPIGLOTTIS 838.86 31500 INSERT EMERGENCY AIRWAY 110.42 31502 CHANGE OF WINDPIPE AIRWAY 35.19 31505 DIAGNOSTIC LARYNGOSCOPY 49.62 31510 LARYNGOSCOPY WITH BIOPSY 122.21 31511 REMOVE FOREIGN BODY LARYNX 131.19 31512 REMOVAL OF LARYNX LESION 131.65 31513 INJECTION INTO VOCAL CORD 133.75 31515 LARYNGOSCOPY FOR ASPIRATION 112.34 31520 DX LARYNGOSCOPY NEWBORN 159.22 31525 DX LARYNGOSCOPY EXCL NB 161.98 31526 DX LARYNGOSCOPY W/OPER SCOPE 159.56 31527 LARYNGOSCOPY FOR TREATMENT 197.53 31528 LARYNGOSCOPY AND DILATION 146.61 31529 LARYNGOSCOPY AND DILATION 164.04 31530 LARYNGOSCOPY W/FB REMOVAL 199.89 31531 LARYNGOSCOPY W/FB & OP SCOPE 214.98 31535 LARYNGOSCOPY W/BIOPSY 191.63 31536 LARYNGOSCOPY W/BX & OP SCOPE 213.24 31540 LARYNGOSCOPY W/EXC OF TUMOR 245.01 31541 LARYNSCOP W/TUMR EXC + SCOPE 267.34 31545 REMOVE VC LESION W/SCOPE 367.48 31546 REMOVE VC LESION SCOPE/GRAFT 557.97 31560 LARYNGOSCOP W/ARYTENOIDECTOM 316.79 Proc Code Description Mod Rate 31561 LARYNSCOP REMVE CART + SCOP 347.16 31570 LARYNGOSCOPE W/VC INJ 232.20 31571 LARYNGOSCOP W/VC INJ + SCOPE 252.67 31575 DIAGNOSTIC LARYNGOSCOPY 76.44 31576 LARYNGOSCOPY WITH BIOPSY 124.96 31577 REMOVE FOREIGN BODY LARYNX 151.12 31578 REMOVAL OF LARYNX LESION 173.08 31579 DIAGNOSTIC LARYNGOSCOPY 143.20 31580 REVISION OF LARYNX 1226.40 31582 REVISION OF LARYNX 1901.17 31584 TREAT LARYNX FRACTURE 1514.27 31587 REVISION OF LARYNX 1006.73 31588 REVISION OF LARYNX 1147.61 31590 REINNERVATE LARYNX 894.94 31595 LARYNX NERVE SURGERY 767.30 31600 INCISION OF WINDPIPE 398.62 31601 INCISION OF WINDPIPE 260.99 31603 INCISION OF WINDPIPE 226.21 31605 INCISION OF WINDPIPE 185.14 31610 INCISION OF WINDPIPE 719.93 31611 SURGERY/SPEECH PROSTHESIS 544.97 31612 PUNCTURE/CLEAR WINDPIPE 47.71 31613 REPAIR WINDPIPE OPENING 459.66 31614 REPAIR WINDPIPE OPENING 764.52 31615 VISUALIZATION OF WINDPIPE 129.80 31620 ENDOBRONCHIAL US ADD-ON 67.27 31622 DX BRONCHOSCOPE/WASH 147.34 31623 DX BRONCHOSCOPE/BRUSH 147.02 31624 DX BRONCHOSCOPE/LAVAGE 148.09 31625 BRONCHOSCOPY W/BIOPSY(S) 171.00 31626 BRONCHOSCOPY W/MARKERS 206.51 31627 NAVIGATIONAL BRONCHOSCOPY 94.57 31628 BRONCHOSCOPY/LUNG BX EACH 189.92 31629 BRONCHOSCOPY/NEEDLE BX EACH 204.53 31630 BRONCHOSCOPY DILATE/FX REPR 202.06 31631 BRONCHOSCOPY DILATE W/STENT 231.39 31632 BRONCHOSCOPY/LUNG BX ADDL 48.85 31633 BRONCHOSCOPY/NEEDLE BX ADDL 63.09 31634 BRONCH W/BALLOON OCCLUSION BRONC 200.73 31635 BRONCHOSCOPY W/FB REMOVAL 188.86 31636 BRONCHOSCOPY BRONCH STENTS 223.19 31637 BRONCHOSCOPY STENT ADD-ON 73.76 31638 BRONCHOSCOPY REVISE STENT 256.37 31640 BRONCHOSCOPY W/TUMOR EXCISE 256.62 31641 BRONCHOSCOPY TREAT BLOCKAGE 259.60 31643 DIAG BRONCHOSCOPE/CATHETER 176.47 Proc Code Description Mod Rate 31645 BRONCHOSCOPY CLEAR AIRWAYS 161.99 31646 BRONCHOSCOPY RECLEAR AIRWAY 140.49 31647 Bronchial valve init insert 221.23 31648 BRONCHIAL VALVE REMOV INIT 211.88 31649 BRONCHIAL VALVE REMOV ADDL 68.26 31651 BRONCHIAL VALVE ADDL INSERT 79.50 31660 Bronch thermoplsty 1 lobe 211.42 31661 Bronch thermoplsty 2/> lobes 222.87 31717 BRONCHIAL BRUSH BIOPSY 108.74 31720 CLEARANCE OF AIRWAYS 50.97 31725 CLEARANCE OF AIRWAYS 91.51 31730 INTRO WINDPIPE WIRE/TUBE 146.67 31750 REPAIR OF WINDPIPE 1379.73 31755 REPAIR OF WINDPIPE 1736.22 31760 REPAIR OF WINDPIPE 1388.61 31766 RECONSTRUCTION OF WINDPIPE 1800.84 31770 REPAIR/GRAFT OF BRONCHUS 1349.04 31775 RECONSTRUCT BRONCHUS 1375.92 31780 RECONSTRUCT WINDPIPE 1187.92 31781 RECONSTRUCT WINDPIPE 1555.05 31785 REMOVE WINDPIPE LESION 1088.73 31786 REMOVE WINDPIPE LESION 1461.26 31800 REPAIR OF WINDPIPE INJURY 717.37 31805 REPAIR OF WINDPIPE INJURY 826.20 31820 CLOSURE OF WINDPIPE LESION 332.25 31825 REPAIR OF WINDPIPE DEFECT 485.23 31830 REVISE WINDPIPE SCAR 344.92 32035 THORACOSTOMY W/RIB RESECTION 725.01 32036 THORACOSTOMY W/FLAP DRAINAGE 787.97 32096 Open wedge/bx lung infiltr 817.44 32097 Open wedge/bx lung nodule 817.80 32098 Open biopsy of lung pleura 771.96 32100 EXPLORATION OF CHEST 827.15 32110 EXPLORE/REPAIR CHEST 1473.71 32120 RE-EXPLORATION OF CHEST 884.07 32124 EXPLORE CHEST FREE ADHESIONS 941.82 32140 REMOVAL OF LUNG LESION(S) 1005.67 32141 REMOVE/TREAT LUNG LESIONS 1552.12 32150 REMOVAL OF LUNG LESION(S) 1018.37 32151 REMOVE LUNG FOREIGN BODY 1014.99 32160 OPEN CHEST HEART MASSAGE 797.43 32200 DRAIN OPEN LUNG LESION 1149.48 32215 TREAT CHEST LINING 811.27 32220 RELEASE OF LUNG 1608.92 32225 PARTIAL RELEASE OF LUNG 1008.79 32310 REMOVAL OF CHEST LINING 930.91 Proc Code Description Mod Rate 32320 FREE/REMOVE CHEST LINING 1619.36 32400 NEEDLE BIOPSY CHEST LINING 87.90 32405 PERCUT BX LUNG/MEDIASTINUM 104.46 32440 REMOVE LUNG PNEUMONECTOMY 1588.12 32442 SLEEVE PNEUMONECTOMY 3259.02 32445 REMOVAL OF LUNG EXTRAPLEURAL 3583.40 32480 PARTIAL REMOVAL OF LUNG 1500.19 32482 BILOBECTOMY 1606.96 32484 SEGMENTECTOMY 1454.78 32486 SLEEVE LOBECTOMY 2381.23 32488 COMPLETION PNEUMONECTOMY 2434.83 32491 LUNG VOLUME REDUCTION 1491.61 32501 REPAIR BRONCHUS ADD-ON 248.51 32503 RESECT APICAL LUNG TUMOR 1841.44 32504 RESECT APICAL LUNG TUM/CHEST 2099.32 32505 Wedge resect of lung initial 943.68 32506 Wedge resect of lung add-on 159.76 32507 Wedge resect of lung diag 159.76 32540 REMOVAL OF LUNG LESION 1760.38 32550 Insert pleural cath 226.15 32551 INSERTION OF CHEST TUBE 179.37 32552 REMOVE LUNG CATHETER 168.33 32553 INS MARK THOR FOR RT PERQ 214.23 32554 Aspirate pleura w/o imaging 90.28 32555 Aspirate pleura w/ imaging 113.62 32556 Insert cath pleura w/o image 124.72 32557 Insert cath pleura w/ image 167.41 32560 TREAT PLEURODESIS W/AGENT 79.48 32561 LYSE CHEST FIBRIN INIT DAY 71.81 32562 LYSE CHEST FIBRIN SUBQ DAY 64.17 32601 THORACOSCOPY DIAGNOSTIC 313.38 32604 THORACOSCOPY WBX SAC 487.82 32606 THORACOSCOPY W/BX MED SPACE 468.60 32607 Thoracoscopy w/bx infiltrate 313.74 32608 Thoracoscopy w/bx nodule 385.07 32609 Thoracoscopy w/bx pleura 265.96 32650 THORACOSCOPY W/PLEURODESIS 674.71 32651 THORACOSCOPY REMOVE CORTEX 1107.68 32652 THORACOSCOPY REM TOTL CORTEX 1681.92 32653 THORACOSCOPY REMOV FB/FIBRIN 1070.78 32654 THORACOSCOPY CONTRL BLEEDING 1188.72 32655 THORACOSCOPY RESECT BULLAE 968.32 32656 THORACOSCOPY W/PLEURECTOMY 808.66 32658 THORACOSCOPY W/SAC FB REMOVE 723.82 32659 THORACOSCOPY W/SAC DRAINAGE 741.43 32661 THORACOSCOPY W/PERICARD EXC 809.44 Proc Code Description Mod Rate 32662 THORACOSCOPY W/MEDIAST EXC 906.48 32663 THORACOSCOPY W/LOBECTOMY 1419.95 32664 THORACOSCOPY W/ TH NRV EXC 860.14 32665 THORACOSCOP W/ESOPH MUSC EXC 1234.17 32666 Thoracoscopy w/wedge resect 882.77 32667 Thoracoscopy w/w resect addl 160.12 32668 Thoracoscopy w/w resect diag 160.16 32669 Thoracoscopy remove segment 1364.46 32670 Thoracoscopy bilobectomy 1619.96 32671 Thoracoscopy pneumonectomy 1805.63 32672 Thoracoscopy for lvrs 1548.43 32673 Thoracoscopy w/thymus resect 1222.54 32674 Thoracoscopy lymph node exc 218.81 32701 Thorax stereo rad targetw/tx 223.86 32800 REPAIR LUNG HERNIA 956.46 32810 CLOSE CHEST AFTER DRAINAGE 914.47 32815 CLOSE BRONCHIAL FISTULA 2853.60 32820 RECONSTRUCT INJURED CHEST 1349.13 32900 REMOVAL OF RIB(S) 1424.27 32905 REVISE & REPAIR CHEST WALL 1354.78 32906 REVISE & REPAIR CHEST WALL 1674.32 32940 REVISION OF LUNG 1252.44 32960 THERAPEUTIC PNEUMOTHORAX 104.31 32997 TOTAL LUNG LAVAGE 354.67 32998 PERQ RF ABLATE TX PUL TUMOR 288.92 32999 CHEST SURGERY PROCEDURE 0.00 33010 DRAINAGE OF HEART SAC 119.79 33011 REPEAT DRAINAGE OF HEART SAC 121.65 33015 INCISION OF HEART SAC 512.44 33020 INCISION OF HEART SAC 890.05 33025 INCISION OF HEART SAC 812.56 33030 PARTIAL REMOVAL OF HEART SAC 2036.45 33031 PARTIAL REMOVAL OF HEART SAC 2526.42 33050 RESECT HEART SAC LESION 1014.94 33120 REMOVAL OF HEART LESION 2140.76 33130 REMOVAL OF HEART LESION 1415.94 33140 HEART REVASCULARIZE (TMR) 1608.58 33141 HEART TMR W/OTHER PROCEDURE 134.94 33202 INSERT EPICARD ELTRD OPEN 786.75 33203 INSERT EPICARD ELTRD ENDO 817.51 33206 INSERT HEART PM ATRIAL 462.01 33207 INSERT HEART PM VENTRICULAR 492.28 33208 INSRT HEART PM ATRIAL & VENT 532.87 33210 INSERT ELECTRD/PM CATH SNGL 180.04 33211 INSERT CARD ELECTRODES DUAL 184.97 33212 INSERT PULSE GEN SNGL LEAD 334.08 Proc Code Description Mod Rate 33213 INSERT PULSE GEN DUAL LEADS 349.14 33214 UPGRADE OF PACEMAKER SYSTEM 491.84 33215 REPOSITION PACING-DEFIB LEAD 309.44 33216 INSERT 1 ELECTRODE PM-DEFIB 382.35 33217 INSERT 2 ELECTRODE PM-DEFIB 376.67 33218 REPAIR LEAD PACE-DEFIB ONE 399.65 33220 REPAIR LEAD PACE-DEFIB DUAL 402.39 33221 Insert pulse gen mult leads 371.37 33222 RELOCATION POCKET PACEMAKER 350.15 33223 RELOCATE POCKET FOR DEFIB 421.28 33224 INSERT PACING LEAD & CONNECT 514.88 33225 L VENTRIC PACING LEAD ADD-ON 466.72 33226 REPOSITION L VENTRIC LEAD 494.24 33227 Remove&replace pm gen singl 352.09 33228 Remv&replc pm gen dual lead 366.76 33229 Remv&replc pm gen mult leads 385.04 33230 Insrt pulse gen w/dual leads 400.07 33231 Insrt pulse gen w/mult leads 412.60 33233 REMOVAL OF PM GENERATOR 242.02 33234 REMOVAL OF PACEMAKER SYSTEM 496.07 33235 REMOVAL PACEMAKER ELECTRODE 647.56 33236 REMOVE ELECTRODE/THORACOTOMY 800.94 33237 REMOVE ELECTRODE/THORACOTOMY 852.14 33238 REMOVE ELECTRODE/THORACOTOMY 954.87 33240 INSRT PULSE GEN W/SINGL LEAD 379.99 33241 REMOVE PULSE GENERATOR 227.81 33243 REMOVE ELTRD/THORACOTOMY 1390.04 33244 REMOVE ELCTRD TRANSVENOUSLY 869.93 33249 INSJ/RPLCMT DEFIB W/LEAD(S) 925.58 33250 ABLATE HEART DYSRHYTHM FOCUS 1499.64 33251 ABLATE HEART DYSRHYTHM FOCUS 1659.45 33254 ABLATE ATRIA LMTD 1393.24 33255 ABLATE ATRIA W/O BYPASS EXT 1694.46 33256 ABLATE ATRIA W/BYPASS EXTEN 2001.47 33257 ABLATE ATRIA LMTD ADD-ON 594.77 33258 ABLATE ATRIA X10SV ADD-ON 668.20 33259 Ablate atria w/bypass add-on 864.11 33261 ABLATE HEART DYSRHYTHM FOCUS 1681.36 33262 RMVL& REPLC PULSE GEN 1 LEAD 385.72 33263 RMVL & RPLCMT DFB GEN 2 LEAD 401.13 33264 RMVL & RPLCMT DFB GEN MLT LD 417.97 33265 ABLATE ATRIA LMTD ENDO 1390.63 33266 ABLATE ATRIA X10SV ENDO 1886.90 33270 Ins/rep subq defibrillator 648.01 33271 Insj subq impltbl dfb elctrd 489.34 33272 Rmvl of subq defibrillator 441.79 Proc Code Description Mod Rate 33273 Repos prev impltbl subq dfb 393.15 33282 IMPLANT PAT-ACTIVE HT RECORD 238.66 33284 REMOVE PAT-ACTIVE HT RECORD 210.64 33300 REPAIR OF HEART WOUND 2491.13 33305 REPAIR OF HEART WOUND 4179.92 33310 EXPLORATORY HEART SURGERY 1182.31 33315 EXPLORATORY HEART SURGERY 1956.90 33320 REPAIR MAJOR BLOOD VESSEL(S) 1084.05 33321 REPAIR MAJOR VESSEL 1218.00 33322 REPAIR MAJOR BLOOD VESSEL(S) 1416.26 33330 INSERT MAJOR VESSEL GRAFT 1467.86 33335 INSERT MAJOR VESSEL GRAFT 1920.10 33361 Replace aortic valve perq 1369.99 33362 Replace aortic valve open 1498.27 33363 Replace aortic valve open 1550.70 33364 Replace aortic valve open 1631.46 33365 Replace aortic valve open 1800.13 33366 Trcath replace aortic valve 1948.05 33367 Replace aortic valve w/byp 628.16 33368 Replace aortic valve w/byp 761.37 33369 Replace aortic valve w/byp 1004.64 33400 REPAIR OF AORTIC VALVE 2332.71 33401 VALVULOPLASTY OPEN 1447.37 33403 VALVULOPLASTY W/CP BYPASS 1518.74 33404 PREPARE HEART-AORTA CONDUIT 1784.77 33405 REPLACEMENT OF AORTIC VALVE 2320.89 33406 REPLACEMENT OF AORTIC VALVE 2941.04 33410 REPLACEMENT OF AORTIC VALVE 2595.81 33411 REPLACEMENT OF AORTIC VALVE 3431.53 33412 REPLACEMENT OF AORTIC VALVE 3253.78 33413 REPLACEMENT OF AORTIC VALVE 3293.65 33414 REPAIR OF AORTIC VALVE 2197.95 33415 REVISION SUBVALVULAR TISSUE 2068.54 33416 REVISE VENTRICLE MUSCLE 2077.52 33417 REPAIR OF AORTIC VALVE 1696.09 33418 Repair tcat mitral valve 1815.44 33419 Repair tcat mitral valve 566.53 33420 REVISION OF MITRAL VALVE 1482.70 33422 REVISION OF MITRAL VALVE 1723.65 33425 REPAIR OF MITRAL VALVE 2793.57 33426 REPAIR OF MITRAL VALVE 2436.24 33427 REPAIR OF MITRAL VALVE 2500.44 33430 REPLACEMENT OF MITRAL VALVE 2861.53 33460 REVISION OF TRICUSPID VALVE 2492.71 33463 VALVULOPLASTY TRICUSPID 3158.72 33464 VALVULOPLASTY TRICUSPID 2502.19 Proc Code Description Mod Rate 33465 REPLACE TRICUSPID VALVE 2818.88 33468 REVISION OF TRICUSPID VALVE 2506.51 33470 REVISION OF PULMONARY VALVE 1312.10 33471 VALVOTOMY PULMONARY VALVE 1416.25 33474 REVISION OF PULMONARY VALVE 2215.18 33475 REPLACEMENT PULMONARY VALVE 2398.33 33476 REVISION OF HEART CHAMBER 1563.34 33478 REVISION OF HEART CHAMBER 1606.50 33496 REPAIR PROSTH VALVE CLOT 1699.37 33500 REPAIR HEART VESSEL FISTULA 1617.41 33501 REPAIR HEART VESSEL FISTULA 1156.16 33502 CORONARY ARTERY CORRECTION 1304.69 33503 CORONARY ARTERY GRAFT 1337.04 33504 CORONARY ARTERY GRAFT 1505.30 33505 REPAIR ARTERY W/TUNNEL 2119.98 33506 REPAIR ARTERY TRANSLOCATION 2089.60 33507 REPAIR ART INTRAMURAL 1744.16 33508 ENDOSCOPIC VEIN HARVEST 16.42 33510 CABG VEIN SINGLE 1978.12 33511 CABG VEIN TWO 2172.08 33512 CABG VEIN THREE 2469.38 33513 CABG VEIN FOUR 2540.69 33514 CABG VEIN FIVE 2679.94 33516 CABG VEIN SIX OR MORE 2789.30 33517 CABG ARTERY-VEIN SINGLE 191.56 33518 CABG ARTERY-VEIN TWO 421.66 33519 CABG ARTERY-VEIN THREE 557.28 33521 CABG ARTERY-VEIN FOUR 669.58 33522 CABG ARTERY-VEIN FIVE 751.38 33523 CABG ART-VEIN SIX OR MORE 851.96 33530 CORONARY ARTERY BYPASS/REOP 537.66 33533 CABG ARTERIAL SINGLE 1912.05 33534 CABG ARTERIAL TWO 2247.56 33535 CABG ARTERIAL THREE 2505.20 33536 CABG ARTERIAL FOUR OR MORE 2689.61 33542 REMOVAL OF HEART LESION 2685.60 33545 REPAIR OF HEART DAMAGE 3159.28 33548 RESTORE/REMODEL VENTRICLE 3040.90 33572 OPEN CORONARY ENDARTERECTOMY 236.37 33600 CLOSURE OF VALVE 1737.44 33602 CLOSURE OF VALVE 1673.92 33606 ANASTOMOSIS/ARTERY-AORTA 1784.15 33608 REPAIR ANOMALY W/CONDUIT 1820.29 33610 REPAIR BY ENLARGEMENT 1795.50 33611 REPAIR DOUBLE VENTRICLE 1995.82 33612 REPAIR DOUBLE VENTRICLE 2017.56 Proc Code Description Mod Rate 33615 REPAIR MODIFIED FONTAN 2052.57 33617 REPAIR SINGLE VENTRICLE 2188.70 33619 REPAIR SINGLE VENTRICLE 2905.39 33620 APPLY R&L PULM ART BANDS APPLI 1487.76 33621 TRANSTHOR CATH FOR STENT TRANS 892.89 33622 REDO COMPL CARDIAC ANOMALY RECON 3513.16 33641 REPAIR HEART SEPTUM DEFECT 1671.72 33645 REVISION OF HEART VEINS 1769.19 33647 REPAIR HEART SEPTUM DEFECTS 1868.40 33660 REPAIR OF HEART DEFECTS 1796.45 33665 REPAIR OF HEART DEFECTS 1968.52 33670 REPAIR OF HEART CHAMBERS 2028.80 33675 CLOSE MULT VSD 2016.81 33676 CLOSE MULT VSD W/RESECTION 2192.25 33677 CL MULT VSD W/REM PUL BAND 2277.75 33681 REPAIR HEART SEPTUM DEFECT 1873.88 33684 REPAIR HEART SEPTUM DEFECT 1931.45 33688 REPAIR HEART SEPTUM DEFECT 1927.70 33690 REINFORCE PULMONARY ARTERY 1213.25 33692 REPAIR OF HEART DEFECTS 2122.21 33694 REPAIR OF HEART DEFECTS 2006.23 33697 REPAIR OF HEART DEFECTS 2103.68 33702 REPAIR OF HEART DEFECTS 1579.62 33710 REPAIR OF HEART DEFECTS 2155.80 33720 REPAIR OF HEART DEFECT 1573.83 33722 REPAIR OF HEART DEFECT 1670.17 33724 REPAIR VENOUS ANOMALY 1566.10 33726 REPAIR PUL VENOUS STENOSIS 2122.86 33730 REPAIR HEART-VEIN DEFECT(S) 2049.60 33732 REPAIR HEART-VEIN DEFECT 1779.32 33735 REVISION OF HEART CHAMBER 1324.34 33736 REVISION OF HEART CHAMBER 1435.81 33737 REVISION OF HEART CHAMBER 1375.39 33750 MAJOR VESSEL SHUNT 1376.49 33755 MAJOR VESSEL SHUNT 1379.97 33762 MAJOR VESSEL SHUNT 1378.09 33764 MAJOR VESSEL SHUNT & GRAFT 1323.07 33766 MAJOR VESSEL SHUNT 1403.30 33767 MAJOR VESSEL SHUNT 1461.38 33768 CAVOPULMONARY SHUNTING 454.32 33770 REPAIR GREAT VESSELS DEFECT 2270.96 33771 REPAIR GREAT VESSELS DEFECT 2369.87 33774 REPAIR GREAT VESSELS DEFECT 1848.28 33775 REPAIR GREAT VESSELS DEFECT 1993.79 33776 REPAIR GREAT VESSELS DEFECT 2003.49 33777 REPAIR GREAT VESSELS DEFECT 2041.34 Proc Code Description Mod Rate 33778 REPAIR GREAT VESSELS DEFECT 2542.44 33779 REPAIR GREAT VESSELS DEFECT 2247.38 33780 REPAIR GREAT VESSELS DEFECT 2428.43 33781 REPAIR GREAT VESSELS DEFECT 2517.77 33782 NIKAIDOH PROC 3359.77 33783 NIKAIDOH PROC W/OSTIA IMPLT 3749.28 33786 REPAIR ARTERIAL TRUNK 2344.01 33788 REVISION OF PULMONARY ARTERY 1575.09 33800 AORTIC SUSPENSION 933.07 33802 REPAIR VESSEL DEFECT 1113.60 33803 REPAIR VESSEL DEFECT 1234.71 33813 REPAIR SEPTAL DEFECT 1261.74 33814 REPAIR SEPTAL DEFECT 1556.16 33820 REVISE MAJOR VESSEL 996.06 33822 REVISE MAJOR VESSEL 1051.01 33824 REVISE MAJOR VESSEL 1193.35 33840 REMOVE AORTA CONSTRICTION 1323.74 33845 REMOVE AORTA CONSTRICTION 1362.04 33851 REMOVE AORTA CONSTRICTION 1359.41 33852 REPAIR SEPTAL DEFECT 1436.77 33853 REPAIR SEPTAL DEFECT 1883.11 33860 ASCENDING AORTIC GRAFT 3283.66 33863 ASCENDING AORTIC GRAFT 3219.25 33864 ASCENDING AORTIC GRAFT 3282.99 33870 TRANSVERSE AORTIC ARCH GRAFT 2574.66 33875 THORACIC AORTIC GRAFT 2813.57 33877 THORACOABDOMINAL GRAFT 3728.48 33880 ENDOVASC TAA REPR INCL SUBCL 1849.87 33881 ENDOVASC TAA REPR W/O SUBCL 1591.48 33883 INSERT ENDOVASC PROSTH TAA 1153.28 33884 ENDOVASC PROSTH TAA ADD-ON 422.47 33886 ENDOVASC PROSTH DELAYED 1003.73 33889 ARTERY TRANSPOSE/ENDOVAS TAA 821.93 33891 CAR-CAR BP GRFT/ENDOVAS TAA 1004.93 33910 REMOVE LUNG ARTERY EMBOLI 2712.49 33915 REMOVE LUNG ARTERY EMBOLI 1295.00 33916 SURGERY OF GREAT VESSEL 4304.32 33917 REPAIR PULMONARY ARTERY 1473.97 33920 REPAIR PULMONARY ATRESIA 1859.06 33922 TRANSECT PULMONARY ARTERY 1427.02 33924 REMOVE PULMONARY SHUNT 288.99 33925 RPR PUL ART UNIFOCAL W/O CPB 1738.54 33926 REPR PUL ART UNIFOCAL W/CPB 2471.83 33946 Ecmo/ecls initiation venous 319.77 33947 Ecmo/ecls initiation artery 348.05 33948 Ecmo/ecls daily mgmt-venous 243.56 Proc Code Description Mod Rate 33949 Ecmo/ecls daily mgmt artery 237.69 33951 Ecmo/ecls insj prph cannula 388.49 33952 Ecmo/ecls insj prph cannula 377.35 33953 Ecmo/ecls insj prph cannula 432.68 33954 Ecmo/ecls insj prph cannula 420.11 33955 Ecmo/ecls insj ctr cannula 903.41 33956 Ecmo/ecls insj ctr cannula 852.42 33957 Ecmo/ecls repos perph cnula 306.30 33958 Ecmo/ecls repos perph cnula 300.20 33959 Ecmo/ecls repos perph cnula 352.29 33962 Ecmo/ecls repos perph cnula 335.78 33963 Ecmo/ecls repos perph cnula 568.72 33964 Ecmo/ecls repos perph cnula 575.70 33965 Ecmo/ecls rmvl perph cannula 309.54 33966 Ecmo/ecls rmvl prph cannula 340.75 33967 INSERT I-AORT PERCUT DEVICE 262.20 33968 REMOVE AORTIC ASSIST DEVICE 34.23 33969 Ecmo/ecls rmvl perph cannula 348.70 33970 AORTIC CIRCULATION ASSIST 361.15 33971 AORTIC CIRCULATION ASSIST 723.39 33973 INSERT BALLOON DEVICE 523.73 33974 REMOVE INTRA-AORTIC BALLOON 909.74 33975 IMPLANT VENTRICULAR DEVICE 1355.02 33976 IMPLANT VENTRICULAR DEVICE 1650.40 33977 REMOVE VENTRICULAR DEVICE 1152.71 33978 REMOVE VENTRICULAR DEVICE 1375.66 33979 INSERT INTRACORPOREAL DEVICE 1995.65 33980 REMOVE INTRACORPOREAL DEVICE 1824.83 33981 REPLACE VAD PUMP EXT 857.90 33982 REPLACE VAD INTRA W/O BP 2002.67 33983 REPLACE VAD INTRA W/BP 2360.03 33984 Ecmo/ecls rmvl prph cannula 340.00 33985 Ecmo/ecls rmvl ctr cannula 646.29 33986 Ecmo/ecls rmvl ctr cannula 614.85 33987 Artery expos/graft artery 261.06 33988 Insertion of left heart vent 744.29 33989 Removal of left heart vent 498.23 33990 Insert vad artery access 442.99 33991 Insert vad art&vein access 645.78 33992 Remove vad different session 209.21 33993 Reposition vad diff session 183.72 34001 REMOVAL OF ARTERY CLOT 990.09 34051 REMOVAL OF ARTERY CLOT 1018.23 34101 REMOVAL OF ARTERY CLOT 620.99 34111 REMOVAL OF ARM ARTERY CLOT 620.60 34151 REMOVAL OF ARTERY CLOT 1448.84 Proc Code Description Mod Rate 34201 REMOVAL OF ARTERY CLOT 1067.54 34203 REMOVAL OF LEG ARTERY CLOT 990.91 34401 REMOVAL OF VEIN CLOT 1496.42 34421 REMOVAL OF VEIN CLOT 750.94 34451 REMOVAL OF VEIN CLOT 1496.43 34471 REMOVAL OF VEIN CLOT 1105.15 34490 REMOVAL OF VEIN CLOT 624.91 34501 REPAIR VALVE FEMORAL VEIN 1019.88 34502 RECONSTRUCT VENA CAVA 1557.15 34510 TRANSPOSITION OF VEIN VALVE 1197.39 34520 CROSS-OVER VEIN GRAFT 1030.16 34530 LEG VEIN FUSION 1113.08 34800 ENDOVAS AAA REPR W/SM TUBE 1160.14 34802 ENDOVAS AAA REPR W/2-P PART 1281.83 34803 ENDOVAS AAA REPR W/3-P PART 1326.32 34804 ENDOVAS AAA REPR W/1-P PART 1280.48 34805 ENDOVAS AAA REPR W/LONG TUBE 1231.02 34806 ANEURYSM PRESS SENSOR ADD-ON 102.17 34808 ENDOVAS ILIAC A DEVICE ADDON 211.52 34812 XPOSE FOR ENDOPROSTH FEMORL 347.83 34813 FEMORAL ENDOVAS GRAFT ADD-ON 244.73 34820 XPOSE FOR ENDOPROSTH ILIAC 505.30 34825 ENDOVASC EXTEND PROSTH INIT 718.22 34826 ENDOVASC EXTEN PROSTH ADDL 210.77 34830 OPEN AORTIC TUBE PROSTH REPR 1836.12 34831 OPEN AORTOILIAC PROSTH REPR 1974.73 34832 OPEN AORTOFEMOR PROSTH REPR 1974.73 34833 XPOSE FOR ENDOPROSTH ILIAC 630.40 34834 XPOSE ENDOPROSTH BRACHIAL 282.75 34839 Plnning pt spec fenest graft 0.00 34841 Endovasc visc aorta 1 graft 0.00 34842 Endovasc visc aorta 2 graft 0.00 34843 Endovasc visc aorta 3 graft 0.00 34844 Endovasc visc aorta 4 graft 0.00 34845 Visc & infraren abd 1 prosth 0.00 34846 Visc & infraren abd 2 prosth 0.00 34847 Visc & infraren abd 3 prosth 0.00 34848 Visc & infraren abd 4+ prost 0.00 34900 ENDOVASC ILIAC REPR W/GRAFT 917.91 35001 REPAIR DEFECT OF ARTERY 1161.19 35002 REPAIR ARTERY RUPTURE NECK 1163.84 35005 REPAIR DEFECT OF ARTERY 1184.38 35011 REPAIR DEFECT OF ARTERY 1031.43 35013 REPAIR ARTERY RUPTURE ARM 1293.23 35021 REPAIR DEFECT OF ARTERY 1281.75 35022 REPAIR ARTERY RUPTURE CHEST 1475.93 Proc Code Description Mod Rate 35045 REPAIR DEFECT OF ARM ARTERY 1027.80 35081 REPAIR DEFECT OF ARTERY 1812.04 35082 REPAIR ARTERY RUPTURE AORTA 2266.97 35091 REPAIR DEFECT OF ARTERY 1858.95 35092 REPAIR ARTERY RUPTURE AORTA 2705.21 35102 REPAIR DEFECT OF ARTERY 1963.50 35103 REPAIR ARTERY RUPTURE AORTA 2329.70 35111 REPAIR DEFECT OF ARTERY 1545.60 35112 REPAIR ARTERY RUPTURE SPLEEN 1894.98 35121 REPAIR DEFECT OF ARTERY 1692.06 35122 REPAIR ARTERY RUPTURE BELLY 2186.21 35131 REPAIR DEFECT OF ARTERY 1435.99 35132 REPAIR ARTERY RUPTURE GROIN 1692.26 35141 REPAIR DEFECT OF ARTERY 1145.58 35142 REPAIR ARTERY RUPTURE THIGH 1372.75 35151 REPAIR DEFECT OF ARTERY 1288.34 35152 REPAIR RUPTD POPLITEAL ART 1456.01 35180 REPAIR BLOOD VESSEL LESION 938.35 35182 REPAIR BLOOD VESSEL LESION 1782.79 35184 REPAIR BLOOD VESSEL LESION 1062.57 35188 REPAIR BLOOD VESSEL LESION 1222.51 35189 REPAIR BLOOD VESSEL LESION 1586.53 35190 REPAIR BLOOD VESSEL LESION 780.09 35201 REPAIR BLOOD VESSEL LESION 973.73 35206 REPAIR BLOOD VESSEL LESION 796.91 35207 REPAIR BLOOD VESSEL LESION 756.52 35211 REPAIR BLOOD VESSEL LESION 1417.83 35216 REPAIR BLOOD VESSEL LESION 2104.05 35221 REPAIR BLOOD VESSEL LESION 1479.66 35226 REPAIR BLOOD VESSEL LESION 861.78 35231 REPAIR BLOOD VESSEL LESION 1243.08 35236 REPAIR BLOOD VESSEL LESION 1010.53 35241 REPAIR BLOOD VESSEL LESION 1469.07 35246 REPAIR BLOOD VESSEL LESION 1599.17 35251 REPAIR BLOOD VESSEL LESION 1726.10 35256 REPAIR BLOOD VESSEL LESION 1055.55 35261 REPAIR BLOOD VESSEL LESION 1094.99 35266 REPAIR BLOOD VESSEL LESION 897.59 35271 REPAIR BLOOD VESSEL LESION 1416.43 35276 REPAIR BLOOD VESSEL LESION 1483.98 35281 REPAIR BLOOD VESSEL LESION 1674.22 35286 REPAIR BLOOD VESSEL LESION 970.71 35301 RECHANNELING OF ARTERY 1172.57 35302 RECHANNELING OF ARTERY 1169.70 35303 RECHANNELING OF ARTERY 1291.36 35304 RECHANNELING OF ARTERY 1335.49 Proc Code Description Mod Rate 35305 RECHANNELING OF ARTERY 1282.39 35306 RECHANNELING OF ARTERY 478.57 35311 RECHANNELING OF ARTERY 1486.47 35321 RECHANNELING OF ARTERY 915.49 35331 RECHANNELING OF ARTERY 1503.44 35341 RECHANNELING OF ARTERY 1427.67 35351 RECHANNELING OF ARTERY 1329.37 35355 RECHANNELING OF ARTERY 1077.04 35361 RECHANNELING OF ARTERY 1586.25 35363 RECHANNELING OF ARTERY 1801.66 35371 RECHANNELING OF ARTERY 850.99 35372 RECHANNELING OF ARTERY 1017.12 35390 REOPERATION CAROTID ADD-ON 164.48 35400 ANGIOSCOPY 153.61 35450 REPAIR ARTERIAL BLOCKAGE 528.19 35452 REPAIR ARTERIAL BLOCKAGE 352.61 35458 REPAIR ARTERIAL BLOCKAGE 506.08 35460 REPAIR VENOUS BLOCKAGE 320.38 35471 REPAIR ARTERIAL BLOCKAGE 534.21 35472 REPAIR ARTERIAL BLOCKAGE 364.95 35475 REPAIR ARTERIAL BLOCKAGE 345.82 35476 REPAIR VENOUS BLOCKAGE 275.09 35500 HARVEST VEIN FOR BYPASS 330.70 35501 ART BYP GRFT IPSILAT CAROTID 1549.84 35506 ART BYP GRFT SUBCLAV-CAROTID 1329.05 35508 ART BYP GRFT CAROTID-VERTBRL 1397.43 35509 ART BYP GRFT CONTRAL CAROTID 1474.43 35510 ART BYP GRFT CAROTID-BRCHIAL 1282.26 35511 ART BYP GRFT SUBCLAV-SUBCLAV 1321.69 35512 ART BYP GRFT SUBCLAV-BRCHIAL 1257.86 35515 ART BYP GRFT SUBCLAV-VERTBRL 1385.38 35516 ART BYP GRFT SUBCLAV-AXILARY 1272.10 35518 ART BYP GRFT AXILLARY-AXILRY 1191.07 35521 ART BYP GRFT AXILL-FEMORAL 1278.70 35522 ART BYP GRFT AXILL-BRACHIAL 1259.25 35523 ART BYP GRFT BRCHL-ULNR-RDL 1330.33 35525 ART BYP GRFT BRACHIAL-BRCHL 1178.61 35526 ART BYP GRFT AOR/CAROT/INNOM 1784.65 35531 ART BYP GRFT AORCEL/AORMESEN 2095.25 35533 ART BYP GRFT AXILL/FEM/FEM 1569.81 35535 ART BYP GRFT HEPATORENAL 1754.81 35536 ART BYP GRFT SPLENORENAL 1761.47 35537 ART BYP GRFT AORTOILIAC 2173.05 35538 ART BYP GRFT AORTOBI-ILIAC 2432.76 35539 ART BYP GRFT AORTOFEMORAL 2285.47 35540 ART BYP GRFT AORTBIFEMORAL 2534.05 Proc Code Description Mod Rate 35556 ART BYP GRFT FEM-POPLITEAL 1457.68 35558 ART BYP GRFT FEM-FEMORAL 1284.19 35560 ART BYP GRFT AORTORENAL 1776.11 35563 ART BYP GRFT ILIOILIAC 1378.50 35565 ART BYP GRFT ILIOFEMORAL 1366.99 35566 ART BYP FEM-ANT-POST TIB/PRL 1739.43 35570 ART BYP TIBIAL-TIB/PERONEAL 1407.97 35571 ART BYP POP-TIBL-PRL-OTHER 1383.40 35572 HARVEST FEMOROPOPLITEAL VEIN 356.74 35583 VEIN BYP GRFT FEM-POPLITEAL 1503.60 35585 VEIN BYP FEM-TIBIAL PERONEAL 1743.58 35587 VEIN BYP POP-TIBL PERONEAL 1423.33 35600 HARVEST ART FOR CABG ADD-ON 263.66 35601 ART BYP COMMON IPSI CAROTID 1457.75 35606 ART BYP CAROTID-SUBCLAVIAN 1220.99 35612 ART BYP SUBCLAV-SUBCLAVIAN 1088.82 35616 ART BYP SUBCLAV-AXILLARY 1129.96 35621 ART BYP AXILLARY-FEMORAL 1142.56 35623 ART BYP AXILLARY-POP-TIBIAL 1368.01 35626 ART BYP AORSUBCL/CAROT/INNOM 1632.80 35631 ART BYP AOR-CELIAC-MSN-RENAL 1923.79 35632 ART BYP ILIO-CELIAC 1666.70 35633 ART BYP ILIO-MESENTERIC 1863.36 35634 ART BYP ILIORENAL 1630.71 35636 ART BYP SPENORENAL 1661.61 35637 ART BYP AORTOILIAC 1798.72 35638 ART BYP AORTOBI-ILIAC 1834.64 35642 ART BYP CAROTID-VERTEBRAL 1028.34 35645 ART BYP SUBCLAV-VERTEBRL 1080.11 35646 ART BYP AORTOBIFEMORAL 1784.39 35647 ART BYP AORTOFEMORAL 1619.01 35650 ART BYP AXILLARY-AXILLARY 1116.77 35654 ART BYP AXILL-FEM-FEMORAL 1425.75 35656 ART BYP FEMORAL-POPLITEAL 1127.51 35661 ART BYP FEMORAL-FEMORAL 1128.43 35663 ART BYP ILIOILIAC 1305.55 35665 ART BYP ILIOFEMORAL 1222.78 35666 ART BYP FEM-ANT-POST TIB/PRL 1321.79 35671 ART BYP POP-TIBL-PRL-OTHER 1167.29 35681 COMPOSITE BYP GRFT PROS&VEIN 82.77 35682 COMPOSITE BYP GRFT 2 VEINS 367.30 35683 COMPOSITE BYP GRFT 3/> SEGMT 425.79 35685 BYPASS GRAFT PATENCY/PATCH 207.05 35686 BYPASS GRAFT/AV FIST PATENCY 166.39 35691 ART TRNSPOSJ VERTBRL CAROTID 984.96 35693 ART TRNSPOSJ SUBCLAVIAN 870.34 Proc Code Description Mod Rate 35694 ART TRNSPOSJ SUBCLAV CAROTID 1028.22 35695 ART TRNSPOSJ CAROTID SUBCLAV 1067.67 35697 REIMPLANT ARTERY EACH 153.27 35700 REOPERATION BYPASS GRAFT 158.54 35701 EXPLORATION CAROTID ARTERY 583.94 35721 EXPLORATION FEMORAL ARTERY 467.70 35741 EXPLORATION POPLITEAL ARTERY 530.16 35761 EXPLORATION OF ARTERY/VEIN 400.93 35800 EXPLORE NECK VESSELS 735.12 35820 EXPLORE CHEST VESSELS 2057.18 35840 EXPLORE ABDOMINAL VESSELS 1204.84 35860 EXPLORE LIMB VESSELS 870.78 35870 REPAIR VESSEL GRAFT DEFECT 1296.83 35875 REMOVAL OF CLOT IN GRAFT 615.24 35876 REMOVAL OF CLOT IN GRAFT 980.52 35879 REVISE GRAFT W/VEIN 961.76 35881 REVISE GRAFT W/VEIN 1060.98 35883 REVISE GRAFT W/NONAUTO GRAFT 1256.15 35884 REVISE GRAFT W/VEIN 1292.64 35901 EXCISION GRAFT NECK 489.04 35903 EXCISION GRAFT EXTREMITY 585.00 35905 EXCISION GRAFT THORAX 1750.26 35907 EXCISION GRAFT ABDOMEN 1979.60 36000 PLACE NEEDLE IN VEIN 9.77 36002 PSEUDOANEURYSM INJECTION TRT 108.92 36005 INJECTION EXT VENOGRAPHY 48.74 36010 PLACE CATHETER IN VEIN 122.49 36011 PLACE CATHETER IN VEIN 158.69 36012 PLACE CATHETER IN VEIN 178.97 36013 PLACE CATHETER IN ARTERY 132.20 36014 PLACE CATHETER IN ARTERY 150.47 36015 PLACE CATHETER IN ARTERY 174.40 36100 ESTABLISH ACCESS TO ARTERY 161.81 36120 ESTABLISH ACCESS TO ARTERY 101.35 36140 ESTABLISH ACCESS TO ARTERY 104.31 36147 ACCESS AV DIAL GRFT FOR EVAL 188.96 36148 ACCESS AV DIAL GRFT FOR PROC 49.33 36160 ESTABLISH ACCESS TO AORTA 129.92 36200 PLACE CATHETER IN AORTA 154.86 36215 PLACE CATHETER IN ARTERY 245.55 36216 PLACE CATHETER IN ARTERY 280.55 36217 PLACE CATHETER IN ARTERY 336.33 36218 PLACE CATHETER IN ARTERY 53.34 36221 Place cath thoracic aorta 217.41 36222 Place cath carotid/inom art 295.60 36223 Place cath carotid/inom art 318.91 Proc Code Description Mod Rate 36224 Place cath carotd art 348.94 36225 Place cath subclavian art 317.46 36226 Place cath vertebral art 350.02 36227 Place cath xtrnl carotid 110.89 36228 Place cath intracranial art 225.25 36245 INS CATH ABD/L-EXT ART 1ST 259.65 36246 INS CATH ABD/L-EXT ART 2ND 272.74 36247 INS CATH ABD/L-EXT ART 3RD 326.13 36248 INS CATH ABD/L-EXT ART ADDL 51.90 36251 Ins cath ren art 1st unilat 284.47 36252 Ins cath ren art 1st bilat 372.43 36253 Ins cath ren art 2nd+ unilat 398.89 36254 Ins cath ren art 2nd+ bilat 432.79 36260 INSERTION OF INFUSION PUMP 625.17 36261 REVISION OF INFUSION PUMP 364.21 36262 REMOVAL OF INFUSION PUMP 306.27 36400 BL DRAW < 3 YRS FEM/JUGULAR 20.57 36405 BL DRAW <3 YRS SCALP VEIN 17.11 36406 BL DRAW <3 YRS OTHER VEIN 9.41 36410 NON-ROUTINE BL DRAW 3/> YRS 9.77 36415 ROUTINE VENIPUNCTURE 3.98 36416 CAPILLARY BLOOD DRAW 4.34 36420 VEIN ACCESS CUTDOWN < 1 YR 48.60 36425 VEIN ACCESS CUTDOWN > 1 YR 40.44 36430 BLOOD TRANSFUSION SERVICE 34.12 36440 BL PUSH TRANSFUSE 2 YR/< 58.11 36450 BL EXCHANGE/TRANSFUSE NB 107.39 36455 BL EXCHANGE/TRANSFUSE NON-NB 112.45 36460 TRANSFUSION SERVICE FETAL 368.34 36468 INJECTION(S) SPIDER VEINS 25.70 36470 INJECTION THERAPY OF VEIN 86.31 36471 INJECTION THERAPY OF VEINS 102.73 36475 ENDOVENOUS RF 1ST VEIN 361.65 36476 ENDOVENOUS RF VEIN ADD-ON 177.39 36478 ENDOVENOUS LASER 1ST VEIN 357.89 36479 ENDOVENOUS LASER VEIN ADDON 176.19 36481 INSERTION OF CATHETER VEIN 359.18 36500 INSERTION OF CATHETER VEIN 182.22 36510 INSERTION OF CATHETER VEIN 62.67 36511 APHERESIS WBC 95.63 36512 APHERESIS RBC 94.00 36513 APHERESIS PLATELETS 100.07 36514 APHERESIS PLASMA 94.91 36515 APHERESIS ADSORP/REINFUSE 87.68 36516 APHERESIS SELECTIVE 71.58 36522 PHOTOPHERESIS 102.03 Proc Code Description Mod Rate 36555 INSERT NON-TUNNEL CV CATH 117.51 36556 INSERT NON-TUNNEL CV CATH 121.95 36557 INSERT TUNNELED CV CATH 329.88 36558 INSERT TUNNELED CV CATH 282.42 36560 INSERT TUNNELED CV CATH 365.69 36561 INSERT TUNNELED CV CATH 360.56 36563 INSERT TUNNELED CV CATH 382.80 36565 INSERT TUNNELED CV CATH 355.13 36566 INSERT TUNNELED CV CATH 389.36 36568 INSERT PICC CATH 98.73 36569 INSERT PICC CATH 92.45 36570 INSERT PICVAD CATH 311.95 36571 INSERT PICVAD CATH 327.25 36575 REPAIR TUNNELED CV CATH 35.92 36576 REPAIR TUNNELED CV CATH 198.93 36578 REPLACE TUNNELED CV CATH 219.15 36580 REPLACE CVAD CATH 67.86 36581 REPLACE TUNNELED CV CATH 199.35 36582 REPLACE TUNNELED CV CATH 310.32 36583 REPLACE TUNNELED CV CATH 339.03 36584 REPLACE PICC CATH 67.28 36585 REPLACE PICVAD CATH 284.85 36589 REMOVAL TUNNELED CV CATH 140.40 36590 REMOVAL TUNNELED CV CATH 208.17 36591 Draw blood off venous device 23.35 36592 Collect blood from picc 26.22 36593 Declot vascular device 30.89 36595 MECH REMOV TUNNELED CV CATH 186.49 36596 MECH REMOV TUNNELED CV CATH 45.83 36597 REPOSITION VENOUS CATHETER 61.52 36598 INJ W/FLUOR EVAL CV DEVICE 37.18 36600 WITHDRAWAL OF ARTERIAL BLOOD 15.62 36620 INSERTION CATHETER ARTERY 50.84 36625 INSERTION CATHETER ARTERY 107.05 36640 INSERTION CATHETER ARTERY 131.48 36660 INSERTION CATHETER ARTERY 68.74 36680 INSERT NEEDLE BONE CAVITY 60.27 36800 INSERTION OF CANNULA 126.57 36810 INSERTION OF CANNULA 220.51 36815 INSERTION OF CANNULA 149.08 36818 AV FUSE UPPR ARM CEPHALIC 687.76 36819 AV FUSE UPPR ARM BASILIC 755.05 36820 AV FUSION/FOREARM VEIN 825.49 36821 AV FUSION DIRECT ANY SITE 711.16 36823 INSERTION OF CANNULA(S) 1357.50 36825 ARTERY-VEIN AUTOGRAFT 816.58 Proc Code Description Mod Rate 36830 ARTERY-VEIN NONAUTOGRAFT 673.61 36831 OPEN THROMBECT AV FISTULA 465.78 36832 AV FISTULA REVISION OPEN 593.89 36833 AV FISTULA REVISION 673.31 36835 ARTERY TO VEIN SHUNT 512.67 36838 DIST REVAS LIGATION HEMO 1183.10 36860 EXTERNAL CANNULA DECLOTTING 114.87 36861 CANNULA DECLOTTING 132.61 36870 PERCUT THROMBECT AV FISTULA 305.38 37140 REVISION OF CIRCULATION 2308.04 37145 REVISION OF CIRCULATION 2146.90 37160 REVISION OF CIRCULATION 2199.36 37180 REVISION OF CIRCULATION 2115.76 37181 SPLICE SPLEEN/KIDNEY VEINS 2307.66 37182 INSERT HEPATIC SHUNT (TIPS) 848.67 37183 REMOVE HEPATIC SHUNT (TIPS) 399.08 37184 PRIM ART MECH THROMBECTOMY 460.91 37185 PRIM ART M-THROMBECT ADD-ON 169.48 37186 SEC ART M-THROMBECT ADD-ON 256.45 37187 VENOUS MECH THROMBECTOMY 410.45 37188 VENOUS M-THROMBECTOMY ADD-ON 294.41 37191 Ins endovas vena cava filtr 242.75 37192 Redo endovas vena cava filtr 365.66 37193 Rem endovas vena cava filter 373.91 37195 THROMBOLYTIC THERAPY STROKE 304.44 37197 Remove intrvas foreign body 306.80 37200 TRANSCATHETER BIOPSY 223.92 37202 TRANSCATHETER THERAPY INFUSE 306.45 37211 Thrombolytic art therapy 407.72 37212 Thrombolytic venous therapy 359.99 37213 Thromblytic art/ven therapy 250.78 37214 CESSJ THERAPY CATH REMOVAL 148.36 37215 TRANSCATH STENT CCA W/EPS 1100.81 37216 TRANSCATH STENT CCA W/O EPS 1019.39 37217 Stent placemt retro carotid 1136.75 37218 Stent placemt ante carotid 878.29 37220 ILIAC REVASC REVAS 424.08 37221 ILIAC REVASC W/STENT REVAS 516.55 37222 ILIAC REVASC ADD-ON 190.82 37223 ILIAC REVASC W/STENT ADD-ON 218.36 37224 FEM/POPL REVAS W/TLA REVAS 469.06 37225 FEM/POPL REVAS W/ATHER REVAS 633.14 37226 FEM/POPL REVASC W/STENT REVAS 517.14 37227 FEM/POPL REVASC STNT & ATHER REVAS 762.65 37228 TIB/PER REVASC W/TLA REVAS 572.06 37229 TIB/PER REVASC W/ATHER REVAS 740.37 Proc Code Description Mod Rate 37230 TIB/PER REVASC W/STENT REVAS 716.87 37231 TIB/PER REVASC STENT & ATHER REVAS 785.43 37232 TIB/PER REVASC ADD-ON 207.29 37233 TIBPER REVASC W/ATHER ADD-ON 338.99 37234 REVSC OPN/PRQ TIB/PERO STENT 287.21 37235 TIB/PER REVASC STNT & ATHER 416.97 37236 Open/perq place stent 1st 469.58 37237 OPEN/PERQ PLACE STENT EA ADD 219.43 37238 Open/perq place stent same 329.00 37239 OPEN/PERQ PLACE STENT EA ADD 153.14 37241 VASC EMBOLIZE/OCCLUDE VENOUS 450.26 37242 Vasc embolize/occlude artery 502.78 37243 Vasc embolize/occlude organ 599.43 37244 Vasc embolize/occlude bleed 699.19 37250 IV US FIRST VESSEL ADD-ON 109.27 37251 IV US EACH ADD VESSEL ADD-ON 81.65 37500 ENDOSCOPY LIGATE PERF VEINS 777.91 37565 LIGATION OF NECK VEIN 745.15 37600 LIGATION OF NECK ARTERY 726.13 37605 LIGATION OF NECK ARTERY 820.34 37606 LIGATION OF NECK ARTERY 581.19 37607 LIGATION OF A-V FISTULA 386.84 37609 TEMPORAL ARTERY PROCEDURE 211.25 37615 LIGATION OF NECK ARTERY 539.22 37616 LIGATION OF CHEST ARTERY 1107.27 37617 LIGATION OF ABDOMEN ARTERY 1353.51 37618 LIGATION OF EXTREMITY ARTERY 395.77 37619 Ligation of inf vena cava 1672.35 37650 REVISION OF MAJOR VEIN 521.82 37660 REVISION OF MAJOR VEIN 1152.62 37700 REVISE LEG VEIN 257.56 37718 LIGATE/STRIP SHORT LEG VEIN 446.60 37722 LIGATE/STRIP LONG LEG VEIN 493.94 37735 REMOVAL OF LEG VEINS/LESION 698.51 37760 LIGATE LEG VEINS RADICAL 629.60 37761 LIGATE LEG VEINS OPEN 564.57 37765 STAB PHLEB VEINS XTR 10-20 460.97 37766 PHLEB VEINS - EXTREM 20+ 566.92 37780 REVISION OF LEG VEIN 262.42 37785 LIGATE/DIVIDE/EXCISE VEIN 268.17 37788 REVASCULARIZATION PENIS 1345.67 37790 PENILE VENOUS OCCLUSION 481.71 37799 VASCULAR SURGERY PROCEDURE 0.00 38100 REMOVAL OF SPLEEN TOTAL 1150.76 38101 REMOVAL OF SPLEEN PARTIAL 1159.87 38102 REMOVAL OF SPLEEN TOTAL 261.79 Proc Code Description Mod Rate 38115 REPAIR OF RUPTURED SPLEEN 1266.03 38120 LAPAROSCOPY SPLENECTOMY 1051.11 38200 INJECTION FOR SPLEEN X-RAY 133.00 38204 BL DONOR SEARCH MANAGEMENT 100.67 38205 HARVEST ALLOGENEIC STEM CELL 80.68 38206 HARVEST AUTO STEM CELLS 82.17 38207 CRYOPRESERVE STEM CELLS 44.40 38208 THAW PRESERVED STEM CELLS 28.48 38209 WASH HARVEST STEM CELLS 11.78 38210 T-CELL DEPLETION OF HARVEST 78.79 38211 TUMOR CELL DEPLETE OF HARVST 71.88 38212 RBC DEPLETION OF HARVEST 46.83 38213 PLATELET DEPLETE OF HARVEST 11.78 38214 VOLUME DEPLETE OF HARVEST 40.60 38215 HARVEST STEM CELL CONCENTRTE 46.83 38220 BONE MARROW ASPIRATION 60.68 38221 BONE MARROW BIOPSY 74.81 38230 BONE MARROW HARVEST ALLOGEN 211.41 38232 Bone marrow harvest autolog 209.61 38240 TRANSPLT ALLO HCT/DONOR 224.34 38241 TRANSPLT AUTOL HCT/DONOR 167.50 38242 TRANSPLT ALLO LYMPHOCYTES 116.95 38243 Transplj hematopoietic boost 117.99 38300 DRAINAGE LYMPH NODE LESION 183.76 38305 DRAINAGE LYMPH NODE LESION 477.53 38308 INCISION OF LYMPH CHANNELS 448.44 38380 THORACIC DUCT PROCEDURE 576.90 38381 THORACIC DUCT PROCEDURE 810.80 38382 THORACIC DUCT PROCEDURE 602.14 38500 BIOPSY/REMOVAL LYMPH NODES 253.58 38505 NEEDLE BIOPSY LYMPH NODES 72.06 38510 BIOPSY/REMOVAL LYMPH NODES 422.66 38520 BIOPSY/REMOVAL LYMPH NODES 467.72 38525 BIOPSY/REMOVAL LYMPH NODES 434.96 38530 BIOPSY/REMOVAL LYMPH NODES 553.23 38542 EXPLORE DEEP NODE(S) NECK 524.03 38550 REMOVAL NECK/ARMPIT LESION 506.50 38555 REMOVAL NECK/ARMPIT LESION 1002.77 38562 REMOVAL PELVIC LYMPH NODES 699.61 38564 REMOVAL ABDOMEN LYMPH NODES 700.24 38570 LAPAROSCOPY LYMPH NODE BIOP 531.60 38571 LAPAROSCOPY LYMPHADENECTOMY 783.21 38572 LAPAROSCOPY LYMPHADENECTOMY 956.69 38700 REMOVAL OF LYMPH NODES NECK 814.56 38720 REMOVAL OF LYMPH NODES NECK 1360.60 38724 REMOVAL OF LYMPH NODES NECK 1469.59 Proc Code Description Mod Rate 38740 REMOVE ARMPIT LYMPH NODES 691.81 38745 REMOVE ARMPIT LYMPH NODES 873.85 38746 REMOVE THORACIC LYMPH NODES 218.81 38747 REMOVE ABDOMINAL LYMPH NODES 266.00 38760 REMOVE GROIN LYMPH NODES 841.73 38765 REMOVE GROIN LYMPH NODES 1287.07 38770 REMOVE PELVIS LYMPH NODES 797.18 38780 REMOVE ABDOMEN LYMPH NODES 1023.41 38790 INJECT FOR LYMPHATIC X-RAY 84.56 38792 RA TRACER ID OF SENTINL NODE 40.83 38794 ACCESS THORACIC LYMPH DUCT 299.90 38900 IO MAP OF SENT LYMPH NODE INTRA 137.40 39000 EXPLORATION OF CHEST 504.13 39010 EXPLORATION OF CHEST 801.08 39200 RESECT MEDIASTINAL CYST 887.70 39220 RESECT MEDIASTINAL TUMOR 1160.35 39400 MEDIASTINOSCOPY INCL BIOPSY 514.01 39501 REPAIR DIAPHRAGM LACERATION 853.18 39503 REPAIR OF DIAPHRAGM HERNIA 6122.98 39540 REPAIR OF DIAPHRAGM HERNIA 867.46 39541 REPAIR OF DIAPHRAGM HERNIA 945.12 39545 REVISION OF DIAPHRAGM 905.49 39560 RESECT DIAPHRAGM SIMPLE 801.83 39561 RESECT DIAPHRAGM COMPLEX 1251.35 40490 BIOPSY OF LIP 73.81 40500 PARTIAL EXCISION OF LIP 369.54 40510 PARTIAL EXCISION OF LIP 362.86 40520 PARTIAL EXCISION OF LIP 365.14 40525 RECONSTRUCT LIP WITH FLAP 562.76 40527 RECONSTRUCT LIP WITH FLAP 627.21 40530 PARTIAL REMOVAL OF LIP 408.82 40650 REPAIR LIP 304.35 40652 REPAIR LIP 356.13 40654 REPAIR LIP 430.96 40700 REPAIR CLEFT LIP/NASAL 915.55 40701 REPAIR CLEFT LIP/NASAL 1017.91 40702 REPAIR CLEFT LIP/NASAL 897.15 40720 REPAIR CLEFT LIP/NASAL 1053.17 40761 REPAIR CLEFT LIP/NASAL 1111.08 40800 DRAINAGE OF MOUTH LESION 135.55 40801 DRAINAGE OF MOUTH LESION 227.00 40804 REMOVAL FOREIGN BODY MOUTH 137.18 40805 REMOVAL FOREIGN BODY MOUTH 241.03 40806 INCISION OF LIP FOLD 36.12 40808 BIOPSY OF MOUTH LESION 110.71 40810 EXCISION OF MOUTH LESION 131.36 Proc Code Description Mod Rate 40812 EXCISE/REPAIR MOUTH LESION 202.26 40814 EXCISE/REPAIR MOUTH LESION 314.24 40816 EXCISION OF MOUTH LESION 326.78 40818 EXCISE ORAL MUCOSA FOR GRAFT 280.49 40819 EXCISE LIP OR CHEEK FOLD 242.96 40820 TREATMENT OF MOUTH LESION 177.35 40830 REPAIR MOUTH LACERATION 171.31 40831 REPAIR MOUTH LACERATION 231.87 40840 RECONSTRUCTION OF MOUTH 633.95 40842 RECONSTRUCTION OF MOUTH 611.33 40843 RECONSTRUCTION OF MOUTH 898.81 40844 RECONSTRUCTION OF MOUTH 1105.69 40845 RECONSTRUCTION OF MOUTH 1237.08 41000 DRAINAGE OF MOUTH LESION 114.86 41005 DRAINAGE OF MOUTH LESION 128.90 41006 DRAINAGE OF MOUTH LESION 257.38 41007 DRAINAGE OF MOUTH LESION 250.08 41008 DRAINAGE OF MOUTH LESION 275.86 41009 DRAINAGE OF MOUTH LESION 298.45 41010 INCISION OF TONGUE FOLD 111.64 41015 DRAINAGE OF MOUTH LESION 354.93 41016 DRAINAGE OF MOUTH LESION 358.69 41017 DRAINAGE OF MOUTH LESION 360.49 41018 DRAINAGE OF MOUTH LESION 419.14 41019 Place needles h&n for rt 465.36 41100 BIOPSY OF TONGUE 110.82 41105 BIOPSY OF TONGUE 114.32 41108 BIOPSY OF FLOOR OF MOUTH 92.63 41110 EXCISION OF TONGUE LESION 135.73 41112 EXCISION OF TONGUE LESION 260.02 41113 EXCISION OF TONGUE LESION 286.91 41114 EXCISION OF TONGUE LESION 647.83 41115 EXCISION OF TONGUE FOLD 156.51 41116 EXCISION OF MOUTH LESION 227.17 41120 PARTIAL REMOVAL OF TONGUE 1067.04 41130 PARTIAL REMOVAL OF TONGUE 1319.53 41135 TONGUE AND NECK SURGERY 2185.35 41140 REMOVAL OF TONGUE 2205.38 41145 TONGUE REMOVAL NECK SURGERY 2787.47 41150 TONGUE MOUTH JAW SURGERY 2215.90 41153 TONGUE MOUTH NECK SURGERY 2407.27 41155 TONGUE JAW & NECK SURGERY 3032.81 41250 REPAIR TONGUE LACERATION 158.52 41251 REPAIR TONGUE LACERATION 184.02 41252 REPAIR TONGUE LACERATION 215.71 41500 FIXATION OF TONGUE 381.24 Proc Code Description Mod Rate 41510 TONGUE TO LIP SURGERY 451.34 41512 TONGUE SUSPENSION 634.12 41520 RECONSTRUCTION TONGUE FOLD 263.94 41530 TONGUE BASE VOL REDUCTION 412.67 41800 DRAINAGE OF GUM LESION 151.70 41805 REMOVAL FOREIGN BODY GUM 180.58 41806 REMOVAL FOREIGN BODY JAWBONE 274.40 41820 EXCISION GUM EACH QUADRANT 196.56 41821 EXCISION OF GUM FLAP 44.52 41822 EXCISION OF GUM LESION 188.18 41823 EXCISION OF GUM LESION 332.81 41825 EXCISION OF GUM LESION 125.92 41826 EXCISION OF GUM LESION 217.98 41827 EXCISION OF GUM LESION 313.69 41828 EXCISION OF GUM LESION 217.84 41830 REMOVAL OF GUM TISSUE 291.68 41850 TREATMENT OF GUM LESION 98.46 41870 GUM GRAFT 245.79 41872 REPAIR GUM 265.82 41874 REPAIR TOOTH SOCKET 260.83 42000 DRAINAGE MOUTH ROOF LESION 105.62 42100 BIOPSY ROOF OF MOUTH 112.33 42104 EXCISION LESION MOUTH ROOF 143.05 42106 EXCISION LESION MOUTH ROOF 183.24 42107 EXCISION LESION MOUTH ROOF 354.15 42120 REMOVE PALATE/LESION 1011.28 42140 EXCISION OF UVULA 159.54 42145 REPAIR PALATE PHARYNX/UVULA 717.29 42160 TREATMENT MOUTH ROOF LESION 150.67 42180 REPAIR PALATE 187.96 42182 REPAIR PALATE 260.48 42200 RECONSTRUCT CLEFT PALATE 865.07 42205 RECONSTRUCT CLEFT PALATE 902.40 42210 RECONSTRUCT CLEFT PALATE 1041.58 42215 RECONSTRUCT CLEFT PALATE 679.42 42220 RECONSTRUCT CLEFT PALATE 526.60 42225 RECONSTRUCT CLEFT PALATE 893.96 42226 LENGTHENING OF PALATE 908.79 42227 LENGTHENING OF PALATE 852.45 42235 REPAIR PALATE 747.82 42260 REPAIR NOSE TO LIP FISTULA 670.26 42280 PREPARATION PALATE MOLD 116.14 42281 INSERTION PALATE PROSTHESIS 154.77 42300 DRAINAGE OF SALIVARY GLAND 156.23 42305 DRAINAGE OF SALIVARY GLAND 437.92 42310 DRAINAGE OF SALIVARY GLAND 127.38 Proc Code Description Mod Rate 42320 DRAINAGE OF SALIVARY GLAND 179.58 42330 REMOVAL OF SALIVARY STONE 168.69 42335 REMOVAL OF SALIVARY STONE 263.35 42340 REMOVAL OF SALIVARY STONE 342.76 42400 BIOPSY OF SALIVARY GLAND 56.15 42405 BIOPSY OF SALIVARY GLAND 229.73 42408 EXCISION OF SALIVARY CYST 332.45 42409 DRAINAGE OF SALIVARY CYST 226.84 42410 EXCISE PAROTID GLAND/LESION 632.19 42415 EXCISE PAROTID GLAND/LESION 1070.62 42420 EXCISE PAROTID GLAND/LESION 1201.49 42425 EXCISE PAROTID GLAND/LESION 848.39 42426 EXCISE PAROTID GLAND/LESION 1368.17 42440 EXCISE SUBMAXILLARY GLAND 418.78 42450 EXCISE SUBLINGUAL GLAND 367.20 42500 REPAIR SALIVARY DUCT 351.56 42505 REPAIR SALIVARY DUCT 464.03 42507 PAROTID DUCT DIVERSION 524.83 42509 PAROTID DUCT DIVERSION 890.27 42510 PAROTID DUCT DIVERSION 640.99 42550 INJECTION FOR SALIVARY X-RAY 63.24 42600 CLOSURE OF SALIVARY FISTULA 354.98 42650 DILATION OF SALIVARY DUCT 60.51 42660 DILATION OF SALIVARY DUCT 84.68 42665 LIGATION OF SALIVARY DUCT 211.88 42699 SALIVARY SURGERY PROCEDURE 0.00 42700 DRAINAGE OF TONSIL ABSCESS 139.49 42720 DRAINAGE OF THROAT ABSCESS 398.02 42725 DRAINAGE OF THROAT ABSCESS 824.33 42800 BIOPSY OF THROAT 115.09 42804 BIOPSY OF UPPER NOSE/THROAT 115.65 42806 BIOPSY OF UPPER NOSE/THROAT 134.88 42808 EXCISE PHARYNX LESION 164.94 42809 REMOVE PHARYNX FOREIGN BODY 135.27 42810 EXCISION OF NECK CYST 296.44 42815 EXCISION OF NECK CYST 569.91 42820 REMOVE TONSILS AND ADENOIDS 295.09 42821 REMOVE TONSILS AND ADENOIDS 306.73 42825 REMOVAL OF TONSILS 266.79 42826 REMOVAL OF TONSILS 256.13 42830 REMOVAL OF ADENOIDS 212.21 42831 REMOVAL OF ADENOIDS 228.07 42835 REMOVAL OF ADENOIDS 181.76 42836 REMOVAL OF ADENOIDS 245.30 42842 EXTENSIVE SURGERY OF THROAT 1012.06 42844 EXTENSIVE SURGERY OF THROAT 1387.55 Proc Code Description Mod Rate 42845 EXTENSIVE SURGERY OF THROAT 2246.49 42860 EXCISION OF TONSIL TAGS 192.67 42870 EXCISION OF LINGUAL TONSIL 591.00 42890 PARTIAL REMOVAL OF PHARYNX 1436.48 42892 REVISION OF PHARYNGEAL WALLS 1907.14 42894 REVISION OF PHARYNGEAL WALLS 2395.91 42900 REPAIR THROAT WOUND 344.35 42950 RECONSTRUCTION OF THROAT 809.63 42953 REPAIR THROAT ESOPHAGUS 968.95 42955 SURGICAL OPENING OF THROAT 767.21 42960 CONTROL THROAT BLEEDING 173.51 42961 CONTROL THROAT BLEEDING 429.73 42962 CONTROL THROAT BLEEDING 526.92 42970 CONTROL NOSE/THROAT BLEEDING 418.68 42971 CONTROL NOSE/THROAT BLEEDING 465.36 42972 CONTROL NOSE/THROAT BLEEDING 520.88 43020 INCISION OF ESOPHAGUS 500.08 43030 THROAT MUSCLE SURGERY 526.92 43045 INCISION OF ESOPHAGUS 1320.22 43100 EXCISION OF ESOPHAGUS LESION 636.71 43101 EXCISION OF ESOPHAGUS LESION 1021.27 43107 REMOVAL OF ESOPHAGUS 2566.87 43108 REMOVAL OF ESOPHAGUS 4681.85 43112 REMOVAL OF ESOPHAGUS 2714.92 43116 PARTIAL REMOVAL OF ESOPHAGUS 5283.65 43117 PARTIAL REMOVAL OF ESOPHAGUS 2491.01 43118 PARTIAL REMOVAL OF ESOPHAGUS 3637.06 43121 PARTIAL REMOVAL OF ESOPHAGUS 2901.87 43122 PARTIAL REMOVAL OF ESOPHAGUS 2579.05 43123 PARTIAL REMOVAL OF ESOPHAGUS 4744.65 43124 REMOVAL OF ESOPHAGUS 3867.37 43130 REMOVAL OF ESOPHAGUS POUCH 800.36 43135 REMOVAL OF ESOPHAGUS POUCH 1512.32 43180 Esophagoscopy rigid trnso 587.38 43191 Esophagoscopy rigid trnso dx 127.38 43192 Esophagoscp rig trnso inject 151.77 43193 Esophagoscp rig trnso biopsy 180.67 43194 ESOPHAGOSCP RIG TRNSO REM FB 163.44 43195 Esophagoscopy rigid balloon 181.03 43196 Esophagoscp guide wire dilat 198.61 43197 Esophagoscopy flex dx brush 80.48 43198 ESOPHAGOSC FLEX TRNSN BIOPSY 95.78 43200 ESOPHAGOSCOPY FLEXIBLE BRUSH 94.91 43201 ESOPH SCOPE W/SUBMUCOUS INJ 111.30 43202 ESOPHAGOSCOPY FLEX BIOPSY 111.70 43204 ESOPH SCOPE W/SCLEROSIS INJ 147.02 Proc Code Description Mod Rate 43205 ESOPHAGUS ENDOSCOPY/LIGATION 151.82 43206 ESOPH OPTICAL ENDOMICROSCOPY 145.19 43211 Esophagoscop mucosal resect 246.74 43212 Esophagoscop stent placement 194.74 43213 Esophagoscopy retro balloon 274.33 43214 Esophagosc dilate balloon 30 198.56 43215 ESOPHAGOSCOPY FLEX REMOVE FB 150.08 43216 ESOPHAGOSCOPY LESION REMOVAL 145.89 43217 ESOPHAGOSCOPY SNARE LES REMV 173.94 43220 ESOPHAGOSCOPY BALLOON <30MM 128.07 43226 ESOPH ENDOSCOPY DILATION 141.00 43227 ESOPHAGOSCOPY CONTROL BLEED 178.37 43229 Esophagoscopy lesion ablate 209.87 43231 ESOPHAGOSCOP ULTRASOUND EXAM 173.85 43232 ESOPHAGOSCOPY W/US NEEDLE BX 206.98 43233 Egd balloon dil esoph30 mm/> 235.55 43235 EGD DIAGNOSTIC BRUSH WASH 133.02 43236 UPPR GI SCOPE W/SUBMUC INJ 149.37 43237 ENDOSCOPIC US EXAM ESOPH 210.13 43238 EGD US FINE NEEDLE BX/ASPIR 239.77 43239 EGD BIOPSY SINGLE/MULTIPLE 148.65 43240 EGD W/TRANSMURAL DRAIN CYST 417.20 43241 EGD TUBE/CATH INSERTION 153.87 43242 EGD US FINE NEEDLE BX/ASPIR 273.33 43243 EGD INJECTION VARICES 253.36 43244 EGD VARICES LIGATION 262.46 43245 EGD DILATE STRICTURE 188.16 43246 EGD PLACE GASTROSTOMY TUBE 215.93 43247 EGD REMOVE FOREIGN BODY 188.50 43248 EGD GUIDE WIRE INSERTION 179.37 43249 ESOPH EGD DILATION <30 MM 165.40 43250 EGD CAUTERY TUMOR POLYP 182.26 43251 EGD REMOVE LESION SNARE 210.85 43252 EGD OPTICAL ENDOMICROSCOPY 181.45 43253 Egd us transmural injxn/mark 273.33 43254 Egd endo mucosal resection 283.82 43255 EGD CONTROL BLEEDING ANY 216.07 43257 EGD W/THRML TXMNT GERD 241.54 43259 EGD US EXAM DUODENUM/JEJUNUM 242.57 43260 ERCP W/SPECIMEN COLLECTION 343.82 43261 ENDO CHOLANGIOPANCREATOGRAPH 360.57 43262 ENDO CHOLANGIOPANCREATOGRAPH 380.50 43263 ERCP SPHINCTER PRESSURE MEAS 380.88 43264 ERCP REMOVE DUCT CALCULI 387.84 43265 ERCP LITHOTRIPSY CALCULI 460.46 43266 Egd endoscopic stent place 234.88 Proc Code Description Mod Rate 43270 Egd lesion ablation 246.80 43273 ENDOSCOPIC PANCREATOSCOPY 125.34 43274 Ercp duct stent placement 485.95 43275 Ercp remove forgn body duct 400.77 43276 Ercp stent exchange w/dilate 505.47 43277 Ercp ea duct/ampulla dilate 403.21 43278 Ercp lesion ablate w/dilate 458.36 43279 LAP MYOTOMY HELLER 1289.67 43280 LAPAROSCOPY FUNDOPLASTY 1080.51 43281 LAP PARAESOPHAG HERN REPAIR 1541.51 43282 LAP PARAESOPH HER RPR W/MESH 1733.05 43283 LAP ESOPH LENGTHENING LAPAR 156.79 43289 LAPAROSCOPE PROC ESOPH 0.00 43300 REPAIR OF ESOPHAGUS 625.40 43305 REPAIR ESOPHAGUS AND FISTULA 1105.55 43310 REPAIR OF ESOPHAGUS 1505.25 43312 REPAIR ESOPHAGUS AND FISTULA 1621.26 43313 ESOPHAGOPLASTY CONGENITAL 2915.89 43314 TRACHEO-ESOPHAGOPLASTY CONG 2930.75 43320 FUSE ESOPHAGUS & STOMACH 1391.31 43325 REVISE ESOPHAGUS & STOMACH 1342.46 43327 ESOPH FUNDOPLASTY LAP ESOPH 820.41 43328 ESOPH FUNDOPLASTY THOR ESOPH 1167.41 43330 ESOPHAGOMYOTOMY ABDOMINAL 1331.63 43331 ESOPHAGOMYOTOMY THORACIC 1360.88 43332 TRANSAB ESOPH HIAT HERN RPR REPAI 1161.22 43333 TRANSAB ESOPH HIAT HERN RPR REPAI 1263.29 43334 TRANSTHOR DIAPHRAG HERN RPR REPAI 1252.29 43335 TRANSTHOR DIAPHRAG HERN RPR REPAI 1341.44 43336 THORABD DIAPHR HERN REPAIR REPAI 1523.18 43337 THORABD DIAPHR HERN REPAIR REPAI 1644.75 43338 ESOPH LENGTHENING ESOPH 117.42 43340 FUSE ESOPHAGUS & INTESTINE 1373.82 43341 FUSE ESOPHAGUS & INTESTINE 1415.21 43351 SURGICAL OPENING ESOPHAGUS 1335.76 43352 SURGICAL OPENING ESOPHAGUS 1082.65 43360 GASTROINTESTINAL REPAIR 2405.88 43361 GASTROINTESTINAL REPAIR 2552.75 43400 LIGATE ESOPHAGUS VEINS 1540.16 43401 ESOPHAGUS SURGERY FOR VEINS 1560.01 43405 LIGATE/STAPLE ESOPHAGUS 1459.58 43410 REPAIR ESOPHAGUS WOUND 1063.49 43415 REPAIR ESOPHAGUS WOUND 2606.43 43420 REPAIR ESOPHAGUS OPENING 1031.60 43425 REPAIR ESOPHAGUS OPENING 1447.64 43450 DILATE ESOPHAGUS 1/MULT PASS 89.03 Proc Code Description Mod Rate 43453 DILATE ESOPHAGUS 95.98 43460 PRESSURE TREATMENT ESOPHAGUS 222.65 43496 FREE JEJUNUM FLAP MICROVASC 5602.67 43500 SURGICAL OPENING OF STOMACH 786.75 43501 SURGICAL REPAIR OF STOMACH 1344.52 43502 SURGICAL REPAIR OF STOMACH 1518.81 43510 SURGICAL OPENING OF STOMACH 905.46 43520 INCISION OF PYLORIC MUSCLE 687.54 43605 BIOPSY OF STOMACH 829.82 43610 EXCISION OF STOMACH LESION 979.32 43611 EXCISION OF STOMACH LESION 1219.25 43620 REMOVAL OF STOMACH 1959.22 43621 REMOVAL OF STOMACH 2261.30 43622 REMOVAL OF STOMACH 2304.07 43631 REMOVAL OF STOMACH PARTIAL 1446.92 43632 REMOVAL OF STOMACH PARTIAL 2024.99 43633 REMOVAL OF STOMACH PARTIAL 1913.77 43634 REMOVAL OF STOMACH PARTIAL 2118.04 43635 REMOVAL OF STOMACH PARTIAL 111.45 43640 VAGOTOMY & PYLORUS REPAIR 1178.45 43641 VAGOTOMY & PYLORUS REPAIR 1197.56 43644 LAP GASTRIC BYPASS/ROUX-EN-Y 1728.69 43645 LAP GASTR BYPASS INCL SMLL I 1848.09 43651 LAPAROSCOPY VAGUS NERVE 652.85 43652 LAPAROSCOPY VAGUS NERVE 762.27 43653 LAPAROSCOPY GASTROSTOMY 572.34 43659 LAPAROSCOPE PROC STOM 0.00 43752 NASAL/OROGASTRIC W/TUBE PLMT 41.01 43753 TX GASTRO INTUB W/ASP 20.76 43754 DX GASTR INTUB W/ASP SPEC 33.35 43755 DX GASTR INTUB W/ASP SPECS GASTR 58.01 43756 DX DUOD INTUB W/ASP SPEC DUODE 51.09 43757 DX DUOD INTUB W/ASP SPECS DUODE 77.17 43760 CHANGE GASTROSTOMY TUBE 47.76 43761 REPOSITION GASTROSTOMY TUBE 104.42 43770 LAP PLACE GASTR ADJ DEVICE 1115.09 43771 LAP REVISE GASTR ADJ DEVICE 1274.40 43772 LAP RMVL GASTR ADJ DEVICE 952.32 43773 LAP REPLACE GASTR ADJ DEVICE 1267.94 43774 LAP RMVL GASTR ADJ ALL PARTS 959.39 43775 LAP SLEEVE GASTRECTOMY 1318.38 43800 RECONSTRUCTION OF PYLORUS 929.41 43810 FUSION OF STOMACH AND BOWEL 1013.73 43820 FUSION OF STOMACH AND BOWEL 1338.15 43825 FUSION OF STOMACH AND BOWEL 1304.55 43830 PLACE GASTROSTOMY TUBE 697.94 Proc Code Description Mod Rate 43831 PLACE GASTROSTOMY TUBE 593.86 43832 PLACE GASTROSTOMY TUBE 1040.51 43840 REPAIR OF STOMACH LESION 1355.66 43842 V-BAND GASTROPLASTY 1149.05 43845 GASTROPLASTY DUODENAL SWITCH 1954.15 43846 GASTRIC BYPASS FOR OBESITY 1608.13 43850 REVISE STOMACH-BOWEL FUSION 1622.30 43855 REVISE STOMACH-BOWEL FUSION 1682.76 43860 REVISE STOMACH-BOWEL FUSION 1632.50 43865 REVISE STOMACH-BOWEL FUSION 1702.71 43870 REPAIR STOMACH OPENING 710.00 43880 REPAIR STOMACH-BOWEL FISTULA 1595.09 43886 REVISE GASTRIC PORT OPEN 363.67 43887 REMOVE GASTRIC PORT OPEN 326.42 43888 CHANGE GASTRIC PORT OPEN 460.09 44005 FREEING OF BOWEL ADHESION 1091.32 44010 INCISION OF SMALL BOWEL 871.44 44015 INSERT NEEDLE CATH BOWEL 142.62 44020 EXPLORE SMALL INTESTINE 969.74 44021 DECOMPRESS SMALL BOWEL 980.06 44025 INCISION OF LARGE BOWEL 988.65 44050 REDUCE BOWEL OBSTRUCTION 933.79 44055 CORRECT MALROTATION OF BOWEL 1492.98 44100 BIOPSY OF BOWEL 112.80 44110 EXCISE INTESTINE LESION(S) 851.55 44111 EXCISION OF BOWEL LESION(S) 985.06 44120 REMOVAL OF SMALL INTESTINE 1221.37 44121 REMOVAL OF SMALL INTESTINE 241.45 44125 REMOVAL OF SMALL INTESTINE 1181.09 44126 ENTERECTOMY W/O TAPER CONG 2457.33 44127 ENTERECTOMY W/TAPER CONG 2840.74 44128 ENTERECTOMY CONG ADD-ON 242.58 44130 BOWEL TO BOWEL FUSION 1312.74 44137 REMOVE INTESTINAL ALLOGRAFT 381.97 44139 MOBILIZATION OF COLON 120.87 44140 PARTIAL REMOVAL OF COLON 1340.00 44141 PARTIAL REMOVAL OF COLON 1827.13 44143 PARTIAL REMOVAL OF COLON 1664.77 44144 PARTIAL REMOVAL OF COLON 1771.48 44145 PARTIAL REMOVAL OF COLON 1661.38 44146 PARTIAL REMOVAL OF COLON 2123.57 44147 PARTIAL REMOVAL OF COLON 1946.50 44150 REMOVAL OF COLON 1876.44 44151 REMOVAL OF COLON/ILEOSTOMY 2150.38 44155 REMOVAL OF COLON/ILEOSTOMY 2091.83 44156 REMOVAL OF COLON/ILEOSTOMY 2308.63 Proc Code Description Mod Rate 44157 COLECTOMY W/ILEOANAL ANAST 2184.07 44158 COLECTOMY W/NEO-RECTUM POUCH 2251.52 44160 REMOVAL OF COLON 1241.58 44180 LAP ENTEROLYSIS 917.96 44186 LAP JEJUNOSTOMY 651.40 44187 LAP ILEO/JEJUNO-STOMY 1114.28 44188 LAP COLOSTOMY 1231.50 44202 LAP ENTERECTOMY 1386.64 44203 LAP RESECT S/INTESTINE ADDL 241.86 44204 LAPARO PARTIAL COLECTOMY 1543.27 44205 LAP COLECTOMY PART W/ILEUM 1343.04 44206 LAP PART COLECTOMY W/STOMA 1761.10 44207 L COLECTOMY/COLOPROCTOSTOMY 1834.57 44208 L COLECTOMY/COLOPROCTOSTOMY 1997.73 44210 LAPARO TOTAL PROCTOCOLECTOMY 1808.95 44211 LAP COLECTOMY W/PROCTECTOMY 2254.56 44212 LAPARO TOTAL PROCTOCOLECTOMY 2082.04 44213 LAP MOBIL SPLENIC FL ADD-ON 189.29 44227 LAP CLOSE ENTEROSTOMY 1671.30 44300 OPEN BOWEL TO SKIN 841.69 44310 ILEOSTOMY/JEJUNOSTOMY 1046.32 44312 REVISION OF ILEOSTOMY 590.18 44314 REVISION OF ILEOSTOMY 1010.03 44316 DEVISE BOWEL POUCH 1409.57 44320 COLOSTOMY 1204.29 44322 COLOSTOMY WITH BIOPSIES 1001.78 44340 REVISION OF COLOSTOMY 626.28 44345 REVISION OF COLOSTOMY 1055.58 44346 REVISION OF COLOSTOMY 1185.82 44360 SMALL BOWEL ENDOSCOPY 156.36 44361 SMALL BOWEL ENDOSCOPY/BIOPSY 171.70 44363 SMALL BOWEL ENDOSCOPY 205.58 44364 SMALL BOWEL ENDOSCOPY 219.17 44365 SMALL BOWEL ENDOSCOPY 194.73 44366 SMALL BOWEL ENDOSCOPY 257.24 44369 SMALL BOWEL ENDOSCOPY 263.52 44370 SMALL BOWEL ENDOSCOPY/STENT 284.25 44372 SMALL BOWEL ENDOSCOPY 256.25 44373 SMALL BOWEL ENDOSCOPY 204.88 44376 SMALL BOWEL ENDOSCOPY 303.01 44377 SMALL BOWEL ENDOSCOPY/BIOPSY 319.03 44378 SMALL BOWEL ENDOSCOPY 409.47 44379 S BOWEL ENDOSCOPE W/STENT 435.12 44380 SMALL BOWEL ENDOSCOPY BR/WA 67.95 44381 Small bowel endoscopy br/wa 72.44 44382 SMALL BOWEL ENDOSCOPY 82.01 Proc Code Description Mod Rate 44384 Small bowel endoscopy 168.47 44385 ENDOSCOPY OF BOWEL POUCH 108.03 44386 ENDOSCOPY BOWEL POUCH/BIOP 128.43 44388 COLONOSCOPY THRU STOMA SPX 166.83 44389 COLONOSCOPY WITH BIOPSY 185.00 44390 COLONOSCOPY FOR FOREIGN BODY 225.15 44391 COLONOSCOPY FOR BLEEDING 250.96 44392 COLONOSCOPY & POLYPECTOMY 220.61 44394 COLONOSCOPY W/SNARE 256.57 44403 Colonoscopy w/resection 176.39 44404 Colonoscopy w/injection 176.39 44405 Colonoscopy w/dilation 176.39 44406 Colonoscopy w/ultrasound 176.39 44407 Colonoscopy w/ndl aspir/bx 176.39 44408 Colonoscopy w/decompression 176.39 44500 INTRO GASTROINTESTINAL TUBE 24.66 44602 SUTURE SMALL INTESTINE 1409.39 44603 SUTURE SMALL INTESTINE 1616.01 44604 SUTURE LARGE INTESTINE 1055.77 44605 REPAIR OF BOWEL LESION 1306.33 44615 INTESTINAL STRICTUROPLASTY 1076.61 44620 REPAIR BOWEL OPENING 870.11 44625 REPAIR BOWEL OPENING 1023.38 44626 REPAIR BOWEL OPENING 1605.97 44640 REPAIR BOWEL-SKIN FISTULA 1404.25 44650 REPAIR BOWEL FISTULA 1451.67 44660 REPAIR BOWEL-BLADDER FISTULA 1330.85 44661 REPAIR BOWEL-BLADDER FISTULA 1553.92 44680 SURGICAL REVISION INTESTINE 1069.26 44700 SUSPEND BOWEL W/PROSTHESIS 1023.56 44701 INTRAOP COLON LAVAGE ADD-ON 167.27 44800 EXCISION OF BOWEL POUCH 762.51 44820 EXCISION OF MESENTERY LESION 840.88 44850 REPAIR OF MESENTERY 749.62 44899 BOWEL SURGERY PROCEDURE 0.00 44900 DRAIN APPENDIX ABSCESS OPEN 773.38 44950 APPENDECTOMY 640.24 44955 APPENDECTOMY ADD-ON 83.88 44960 APPENDECTOMY 872.20 44970 LAPAROSCOPY APPENDECTOMY 598.47 45000 DRAINAGE OF PELVIC ABSCESS 427.20 45005 DRAINAGE OF RECTAL ABSCESS 157.77 45020 DRAINAGE OF RECTAL ABSCESS 570.80 45100 BIOPSY OF RECTUM 301.48 45108 REMOVAL OF ANORECTAL LESION 368.33 45110 REMOVAL OF RECTUM 1861.97 Proc Code Description Mod Rate 45111 PARTIAL REMOVAL OF RECTUM 1093.80 45112 REMOVAL OF RECTUM 1894.91 45113 PARTIAL PROCTECTOMY 2005.32 45114 PARTIAL REMOVAL OF RECTUM 1810.73 45116 PARTIAL REMOVAL OF RECTUM 1572.13 45119 REMOVE RECTUM W/RESERVOIR 1965.09 45120 REMOVAL OF RECTUM 1593.17 45121 REMOVAL OF RECTUM AND COLON 1731.38 45123 PARTIAL PROCTECTOMY 1126.79 45126 PELVIC EXENTERATION 2883.76 45130 EXCISION OF RECTAL PROLAPSE 1100.45 45135 EXCISION OF RECTAL PROLAPSE 1372.21 45136 EXCISE ILEOANAL RESERVIOR 1836.83 45150 EXCISION OF RECTAL STRICTURE 396.71 45160 EXCISION OF RECTAL LESION 1019.23 45171 EXC RECT TUM TRANSANAL PART 604.06 45172 EXC RECT TUM TRANSANAL FULL 818.38 45190 DESTRUCTION RECTAL TUMOR 698.83 45300 PROCTOSIGMOIDOSCOPY DX 54.37 45303 PROCTOSIGMOIDOSCOPY DILATE 92.82 45305 PROCTOSIGMOIDOSCOPY W/BX 79.95 45307 PROCTOSIGMOIDOSCOPY FB 104.79 45308 PROCTOSIGMOIDOSCOPY REMOVAL 88.34 45309 PROCTOSIGMOIDOSCOPY REMOVAL 93.20 45315 PROCTOSIGMOIDOSCOPY REMOVAL 112.50 45317 PROCTOSIGMOIDOSCOPY BLEED 119.68 45320 PROCTOSIGMOIDOSCOPY ABLATE 107.84 45321 PROCTOSIGMOIDOSCOPY VOLVUL 108.65 45327 PROCTOSIGMOIDOSCOPY W/STENT 121.97 45330 DIAGNOSTIC SIGMOIDOSCOPY 63.45 45331 SIGMOIDOSCOPY AND BIOPSY 75.73 45332 SIGMOIDOSCOPY W/FB REMOVAL 111.73 45333 SIGMOIDOSCOPY & POLYPECTOMY 110.66 45334 SIGMOIDOSCOPY FOR BLEEDING 162.94 45335 SIGMOIDOSCOPY W/SUBMUC INJ 92.49 45337 SIGMOIDOSCOPY & DECOMPRESS 142.78 45338 SIGMOIDOSCOPY W/TUMR REMOVE 141.33 45340 SIG W/TNDSC BALLOON DILATION 116.23 45341 SIGMOIDOSCOPY W/ULTRASOUND 156.34 45342 SIGMOIDOSCOPY W/US GUIDE BX 237.70 45378 DIAGNOSTIC COLONOSCOPY 216.45 45379 COLONOSCOPY W/FB REMOVAL 271.59 45380 COLONOSCOPY AND BIOPSY 258.31 45381 COLONOSCOPY SUBMUCOUS NJX 245.04 45382 COLONOSCOPY W/CONTROL BLEED 328.11 45384 COLONOSCOPY W/LESION REMOVAL 270.51 Proc Code Description Mod Rate 45385 COLONOSCOPY W/LESION REMOVAL 306.85 45386 COLONOSCOPY W/BALLOON DILAT 265.68 45391 COLONOSCOPY W/ENDOSCOPE US 293.83 45392 COLONOSCOPY W/ENDOSCOPIC FNB 378.19 45395 LAP REMOVAL OF RECTUM 1999.22 45397 LAP REMOVE RECTUM W/POUCH 2167.33 45400 LAPAROSCOPIC PROC 1160.50 45402 LAP PROCTOPEXY W/SIG RESECT 1542.06 45500 REPAIR OF RECTUM 532.86 45505 REPAIR OF RECTUM 595.38 45520 TREATMENT OF RECTAL PROLAPSE 41.12 45540 CORRECT RECTAL PROLAPSE 1064.51 45541 CORRECT RECTAL PROLAPSE 931.77 45550 REPAIR RECTUM/REMOVE SIGMOID 1475.68 45560 REPAIR OF RECTOCELE 701.05 45562 EXPLORATION/REPAIR OF RECTUM 1119.78 45563 EXPLORATION/REPAIR OF RECTUM 1641.68 45800 REPAIR RECT/BLADDER FISTULA 1201.33 45805 REPAIR FISTULA W/COLOSTOMY 1456.27 45820 REPAIR RECTOURETHRAL FISTULA 1175.46 45825 REPAIR FISTULA W/COLOSTOMY 1382.13 45900 REDUCTION OF RECTAL PROLAPSE 204.77 45905 DILATION OF ANAL SPHINCTER 169.42 45910 DILATION OF RECTAL NARROWING 196.27 45915 REMOVE RECTAL OBSTRUCTION 227.31 45990 SURG DX EXAM ANORECTAL 107.80 46020 PLACEMENT OF SETON 235.95 46030 REMOVAL OF RECTAL MARKER 91.42 46040 INCISION OF RECTAL ABSCESS 413.40 46045 INCISION OF RECTAL ABSCESS 433.16 46050 INCISION OF ANAL ABSCESS 98.65 46060 INCISION OF RECTAL ABSCESS 476.78 46070 INCISION OF ANAL SEPTUM 240.78 46080 INCISION OF ANAL SPHINCTER 160.27 46083 INCISE EXTERNAL HEMORRHOID 106.88 46200 REMOVAL OF ANAL FISSURE 325.85 46220 EXCISE ANAL EXT TAG/PAPILLA 119.98 46221 LIGATION OF HEMORRHOID(S) 192.38 46230 REMOVAL OF ANAL TAGS 174.43 46250 REMOVE EXT HEM GROUPS 2+ 314.54 46255 REMOVE INT/EXT HEM 1 GROUP 353.68 46257 REMOVE IN/EX HEM GRP & FISS 421.00 46258 REMOVE IN/EX HEM GRP W/FISTU 464.46 46260 REMOVE IN/EX HEM GROUPS 2+ 474.82 46261 REMOVE IN/EX HEM GRPS & FISS 525.92 46262 REMOVE IN/EX HEM GRPS W/FIST 554.10 Proc Code Description Mod Rate 46270 REMOVE ANAL FIST SUBQ 392.58 46275 REMOVE ANAL FIST INTER 416.08 46280 REMOVE ANAL FIST COMPLEX 471.63 46285 REMOVE ANAL FIST 2 STAGE 415.23 46288 REPAIR ANAL FISTULA 551.57 46320 REMOVAL OF HEMORRHOID CLOT 112.03 46500 INJECTION INTO HEMORRHOID(S) 130.95 46505 CHEMODENERVATION ANAL MUSC 242.16 46600 DIAGNOSTIC ANOSCOPY SPX 41.13 46604 ANOSCOPY AND DILATION 66.94 46606 ANOSCOPY AND BIOPSY 77.88 46607 Diagnostic anoscopy & biopsy 0.00 46608 ANOSCOPY REMOVE FOR BODY 80.95 46610 ANOSCOPY REMOVE LESION 81.35 46611 ANOSCOPY 82.73 46612 ANOSCOPY REMOVE LESIONS 94.71 46614 ANOSCOPY CONTROL BLEEDING 64.45 46615 ANOSCOPY 94.31 46700 REPAIR OF ANAL STRICTURE 657.56 46705 REPAIR OF ANAL STRICTURE 483.41 46706 REPR OF ANAL FISTULA W/GLUE 170.71 46707 REPAIR ANORECTAL FIST W/PLUG 463.34 46710 REPR PER/VAG POUCH SNGL PROC 1102.07 46712 REPR PER/VAG POUCH DBL PROC 2042.06 46715 REP PERF ANOPER FISTU 497.80 46716 REP PERF ANOPER/VESTIB FISTU 1071.02 46730 CONSTRUCTION OF ABSENT ANUS 1757.24 46735 CONSTRUCTION OF ABSENT ANUS 2033.97 46740 CONSTRUCTION OF ABSENT ANUS 2138.60 46742 REPAIR OF IMPERFORATED ANUS 2441.39 46744 REPAIR OF CLOACAL ANOMALY 3353.73 46746 REPAIR OF CLOACAL ANOMALY 3514.91 46748 REPAIR OF CLOACAL ANOMALY 3816.67 46750 REPAIR OF ANAL SPHINCTER 766.56 46751 REPAIR OF ANAL SPHINCTER 608.12 46753 RECONSTRUCTION OF ANUS 591.54 46754 REMOVAL OF SUTURE FROM ANUS 227.83 46760 REPAIR OF ANAL SPHINCTER 1104.51 46761 REPAIR OF ANAL SPHINCTER 935.68 46762 IMPLANT ARTIFICIAL SPHINCTER 932.10 46900 DESTRUCTION ANAL LESION(S) 138.82 46910 DESTRUCTION ANAL LESION(S) 136.02 46916 CRYOSURGERY ANAL LESION(S) 142.71 46917 LASER SURGERY ANAL LESIONS 134.92 46922 EXCISION OF ANAL LESION(S) 136.02 46924 DESTRUCTION ANAL LESION(S) 185.16 Proc Code Description Mod Rate 46930 DESTROY INTERNAL HEMORRHOIDS 148.27 46940 TREATMENT OF ANAL FISSURE 147.45 46942 TREATMENT OF ANAL FISSURE 133.55 46945 REMOVE BY LIGAT INT HEM GRP 224.92 46946 REMOVE BY LIGAT INT HEM GRPS 224.97 46947 HEMORRHOIDOPEXY BY STAPLING 382.95 47000 NEEDLE BIOPSY OF LIVER 104.55 47001 NEEDLE BIOPSY LIVER ADD-ON 102.70 47010 OPEN DRAINAGE LIVER LESION 1201.46 47015 INJECT/ASPIRATE LIVER CYST 1146.33 47100 WEDGE BIOPSY OF LIVER 841.78 47120 PARTIAL REMOVAL OF LIVER 2320.17 47122 EXTENSIVE REMOVAL OF LIVER 3416.26 47125 PARTIAL REMOVAL OF LIVER 3060.51 47130 PARTIAL REMOVAL OF LIVER 3287.67 47135 TRANSPLANTATION OF LIVER 4876.53 47136 TRANSPLANTATION OF LIVER 4179.17 47140 PARTIAL REMOVAL DONOR LIVER 3554.68 47141 PARTIAL REMOVAL DONOR LIVER 3881.51 47142 PARTIAL REMOVAL DONOR LIVER 4681.51 47146 PREP DONOR LIVER/VENOUS 327.90 47147 PREP DONOR LIVER/ARTERIAL 382.43 47300 SURGERY FOR LIVER LESION 1124.93 47350 REPAIR LIVER WOUND 1367.20 47360 REPAIR LIVER WOUND 1859.14 47361 REPAIR LIVER WOUND 3001.95 47362 REPAIR LIVER WOUND 1441.79 47370 LAPARO ABLATE LIVER TUMOR RF 1235.23 47371 LAPARO ABLATE LIVER CRYOSURG 1223.76 47379 LAPAROSCOPE PROCEDURE LIVER 0.00 47380 OPEN ABLATE LIVER TUMOR RF 1435.99 47381 OPEN ABLATE LIVER TUMOR CRYO 1448.23 47382 PERCUT ABLATE LIVER RF 781.65 47383 Perq abltj lvr cryoablation 503.87 47400 INCISION OF LIVER DUCT 2145.71 47420 INCISION OF BILE DUCT 1338.93 47425 INCISION OF BILE DUCT 1362.25 47460 INCISE BILE DUCT SPHINCTER 1264.00 47480 INCISION OF GALLBLADDER 873.58 47490 INCISION OF GALLBLADDER 335.59 47500 INJECTION FOR LIVER X-RAYS 97.62 47505 INJECTION FOR LIVER X-RAYS 37.86 47510 INSERT CATHETER BILE DUCT 474.89 47511 INSERT BILE DUCT DRAIN 581.16 47525 CHANGE BILE DUCT CATHETER 85.00 47530 REVISE/REINSERT BILE TUBE 352.89 Proc Code Description Mod Rate 47550 BILE DUCT ENDOSCOPY ADD-ON 164.61 47552 BILIARY ENDO PERQ DX W/SPECI 317.06 47553 BILIARY ENDOSCOPY THRU SKIN 314.69 47554 BILIARY ENDOSCOPY THRU SKIN 490.35 47555 BILIARY ENDOSCOPY THRU SKIN 373.29 47556 BILIARY ENDOSCOPY THRU SKIN 424.03 47560 LAPAROSCOPY W/CHOLANGIO 266.74 47561 LAPARO W/CHOLANGIO/BIOPSY 292.86 47562 LAPAROSCOPIC CHOLECYSTECTOMY 655.52 47563 LAPARO CHOLECYSTECTOMY/GRAPH 712.22 47564 LAPARO CHOLECYSTECTOMY/EXPLR 1110.47 47570 LAPARO CHOLECYSTOENTEROSTOMY 772.02 47600 REMOVAL OF GALLBLADDER 1065.60 47605 REMOVAL OF GALLBLADDER 1121.24 47610 REMOVAL OF GALLBLADDER 1250.12 47612 REMOVAL OF GALLBLADDER 1265.46 47620 REMOVAL OF GALLBLADDER 1374.08 47630 REMOVE BILE DUCT STONE 546.20 47700 EXPLORATION OF BILE DUCTS 1049.15 47701 BILE DUCT REVISION 1727.57 47711 EXCISION OF BILE DUCT TUMOR 1555.78 47712 EXCISION OF BILE DUCT TUMOR 1991.69 47715 EXCISION OF BILE DUCT CYST 1326.05 47720 FUSE GALLBLADDER & BOWEL 1149.05 47721 FUSE UPPER GI STRUCTURES 1350.17 47740 FUSE GALLBLADDER & BOWEL 1308.18 47741 FUSE GALLBLADDER & BOWEL 1470.74 47760 FUSE BILE DUCTS AND BOWEL 2248.30 47765 FUSE LIVER DUCTS & BOWEL 3027.12 47780 FUSE BILE DUCTS AND BOWEL 2466.10 47785 FUSE BILE DUCTS AND BOWEL 3239.89 47800 RECONSTRUCTION OF BILE DUCTS 1577.38 47801 PLACEMENT BILE DUCT SUPPORT 1010.82 47802 FUSE LIVER DUCT & INTESTINE 1521.04 47900 SUTURE BILE DUCT INJURY 1367.69 48000 DRAINAGE OF ABDOMEN 1848.16 48001 PLACEMENT OF DRAIN PANCREAS 2300.62 48020 REMOVAL OF PANCREATIC STONE 1173.50 48100 BIOPSY OF PANCREAS OPEN 885.04 48102 NEEDLE BIOPSY PANCREAS 244.14 48105 RESECT/DEBRIDE PANCREAS 2838.67 48120 REMOVAL OF PANCREAS LESION 1105.53 48140 PARTIAL REMOVAL OF PANCREAS 1558.06 48145 PARTIAL REMOVAL OF PANCREAS 1626.89 48146 PANCREATECTOMY 1873.12 48148 REMOVAL OF PANCREATIC DUCT 1244.08 Proc Code Description Mod Rate 48150 PARTIAL REMOVAL OF PANCREAS 3098.27 48152 PANCREATECTOMY 2876.19 48153 PANCREATECTOMY 3087.20 48154 PANCREATECTOMY 2888.41 48155 REMOVAL OF PANCREAS 1812.34 48160 PANCREAS REMOVAL/TRANSPLANT 2507.57 48400 INJECTION INTRAOP ADD-ON 109.64 48500 SURGERY OF PANCREATIC CYST 1147.57 48510 DRAIN PANCREATIC PSEUDOCYST 1087.84 48520 FUSE PANCREAS CYST AND BOWEL 1088.65 48540 FUSE PANCREAS CYST AND BOWEL 1305.71 48545 PANCREATORRHAPHY 1340.84 48547 DUODENAL EXCLUSION 1785.82 48548 FUSE PANCREAS AND BOWEL 1659.22 48999 PANCREAS SURGERY PROCEDURE 0.00 49000 EXPLORATION OF ABDOMEN 770.10 49002 REOPENING OF ABDOMEN 1045.15 49010 EXPLORATION BEHIND ABDOMEN 934.16 49020 DRAINAGE ABDOM ABSCESS OPEN 1586.93 49040 DRAIN OPEN ABDOM ABSCESS 998.26 49060 DRAIN OPEN RETROPERI ABSCESS 1099.56 49062 DRAIN TO PERITONEAL CAVITY 732.80 49082 Abd paracentesis 74.03 49083 Abd paracentesis w/imaging 109.36 49084 Peritoneal lavage 100.74 49180 BIOPSY ABDOMINAL MASS 86.48 49203 Exc abd tum 5 cm or less 1195.40 49204 Exc abd tum over 5 cm 1526.32 49205 Exc abd tum over 10 cm 1754.31 49215 EXCISE SACRAL SPINE TUMOR 2220.62 49220 MULTIPLE SURGERY ABDOMEN 953.64 49250 EXCISION OF UMBILICUS 582.55 49255 REMOVAL OF OMENTUM 792.65 49320 DIAG LAPARO SEPARATE PROC 328.00 49321 LAPAROSCOPY BIOPSY 347.35 49322 LAPAROSCOPY ASPIRATION 371.13 49323 LAPARO DRAIN LYMPHOCELE 645.80 49324 LAP INSERT TUNNEL IP CATH 391.31 49325 LAP REVISION PERM IP CATH 419.36 49326 LAP W/OMENTOPEXY ADD-ON 188.68 49327 LAP INS DEVICE FOR RT 129.28 49329 LAPARO PROC ABDM/PER/OMENT 0.00 49400 AIR INJECTION INTO ABDOMEN 95.32 49402 REMOVE FOREIGN BODY ADBOMEN 852.89 49405 Image cath fluid colxn visc 213.65 49406 Image cath fluid peri/retro 214.00 Proc Code Description Mod Rate 49407 Image cath fluid trns/vgnl 227.96 49411 INS MARK ABD/PEL FOR RT PERQ 198.57 49412 INS DEVICE FOR RT GUIDE OPEN PLACE 81.41 49418 INSERT TUN IP CATH PERC INSER 227.41 49419 INSERT TUN IP CATH W/PORT 443.59 49421 INS TUN IP CATH FOR DIAL OPN 229.18 49422 REMOVE TUNNELED IP CATH 380.52 49423 EXCHANGE DRAINAGE CATHETER 72.54 49424 ASSESS CYST CONTRAST INJECT 38.93 49425 INSERT ABDOMEN-VENOUS DRAIN 751.10 49426 REVISE ABDOMEN-VENOUS SHUNT 617.35 49427 INJECTION ABDOMINAL SHUNT 45.57 49428 LIGATION OF SHUNT 430.76 49429 REMOVAL OF SHUNT 457.55 49435 INSERT SUBQ EXTEN TO IP CATH 119.41 49436 EMBEDDED IP CATH EXIT-SITE 186.63 49440 Place gastrostomy tube perc 226.86 49441 Place duod/jej tube perc 257.48 49442 Place cecostomy tube perc 222.69 49446 Change g-tube to g-j perc 164.63 49450 Replace g/c tube perc 67.34 49451 Replace duod/jej tube perc 92.45 49452 Replace g-j tube perc 142.04 49460 Fix g/colon tube w/device 48.67 49465 FLUORO EXAM OF G/COLON TUBE 30.90 49491 RPR HERN PREEMIE REDUC 790.03 49492 RPR ING HERN PREMIE BLOCKED 940.50 49495 RPR ING HERNIA BABY REDUC 397.62 49496 RPR ING HERNIA BABY BLOCKED 608.97 49500 RPR ING HERNIA INIT REDUCE 379.13 49501 RPR ING HERNIA INIT BLOCKED 602.26 49505 PRP I/HERN INIT REDUC >5 YR 518.47 49507 PRP I/HERN INIT BLOCK >5 YR 583.62 49520 REREPAIR ING HERNIA REDUCE 628.94 49521 REREPAIR ING HERNIA BLOCKED 712.53 49525 REPAIR ING HERNIA SLIDING 570.52 49540 REPAIR LUMBAR HERNIA 670.19 49550 RPR REM HERNIA INIT REDUCE 572.62 49553 RPR FEM HERNIA INIT BLOCKED 629.07 49555 REREPAIR FEM HERNIA REDUCE 592.83 49557 REREPAIR FEM HERNIA BLOCKED 720.24 49560 RPR VENTRAL HERN INIT REDUC 734.46 49561 RPR VENTRAL HERN INIT BLOCK 926.86 49565 REREPAIR VENTRL HERN REDUCE 766.88 49566 REREPAIR VENTRL HERN BLOCK 937.09 49568 HERNIA REPAIR W/MESH 266.72 Proc Code Description Mod Rate 49570 RPR EPIGASTRIC HERN REDUCE 415.77 49572 RPR EPIGASTRIC HERN BLOCKED 513.95 49580 RPR UMBIL HERN REDUC < 5 YR 331.96 49582 RPR UMBIL HERN BLOCK < 5 YR 480.98 49585 RPR UMBIL HERN REDUC > 5 YR 442.94 49587 RPR UMBIL HERN BLOCK > 5 YR 474.19 49590 REPAIR SPIGELIAN HERNIA 571.69 49600 REPAIR UMBILICAL LESION 726.83 49605 REPAIR UMBILICAL LESION 4913.67 49606 REPAIR UMBILICAL LESION 1127.32 49610 REPAIR UMBILICAL LESION 683.97 49611 REPAIR UMBILICAL LESION 554.43 49650 LAP ING HERNIA REPAIR INIT 427.14 49651 LAP ING HERNIA REPAIR RECUR 555.60 49652 LAP VENT/ABD HERNIA REPAIR 681.04 49653 LAP VENT/ABD HERN PROC COMP 850.75 49654 LAP INC HERNIA REPAIR 773.41 49655 LAP INC HERN REPAIR COMP 944.41 49656 LAP INC HERNIA REPAIR RECUR 839.74 49657 LAP INC HERN RECUR COMP 1204.63 49659 LAPARO PROC HERNIA REPAIR 0.00 49900 REPAIR OF ABDOMINAL WALL 814.47 49904 OMENTAL FLAP EXTRA-ABDOM 1449.77 49905 OMENTAL FLAP INTRA-ABDOM 352.35 49906 FREE OMENTAL FLAP MICROVASC 3585.61 49999 ABDOMEN SURGERY PROCEDURE 0.00 50010 EXPLORATION OF KIDNEY 737.32 50020 RENAL ABSCESS OPEN DRAIN 1023.17 50040 DRAINAGE OF KIDNEY 915.75 50045 EXPLORATION OF KIDNEY 920.40 50060 REMOVAL OF KIDNEY STONE 1124.93 50065 INCISION OF KIDNEY 1194.13 50070 INCISION OF KIDNEY 1170.86 50075 REMOVAL OF KIDNEY STONE 1439.99 50080 REMOVAL OF KIDNEY STONE 859.78 50081 REMOVAL OF KIDNEY STONE 1261.50 50100 REVISE KIDNEY BLOOD VESSELS 1074.32 50120 EXPLORATION OF KIDNEY 937.34 50125 EXPLORE AND DRAIN KIDNEY 970.06 50130 REMOVAL OF KIDNEY STONE 1019.74 50135 EXPLORATION OF KIDNEY 1107.61 50200 RENAL BIOPSY PERQ 144.69 50205 RENAL BIOPSY OPEN 751.25 50220 REMOVE KIDNEY OPEN 1034.37 50225 REMOVAL KIDNEY OPEN COMPLEX 1185.61 50230 REMOVAL KIDNEY OPEN RADICAL 1265.83 Proc Code Description Mod Rate 50234 REMOVAL OF KIDNEY & URETER 1285.12 50236 REMOVAL OF KIDNEY & URETER 1447.81 50240 PARTIAL REMOVAL OF KIDNEY 1308.12 50250 CRYOABLATE RENAL MASS OPEN 1201.87 50280 REMOVAL OF KIDNEY LESION 944.36 50290 REMOVAL OF KIDNEY LESION 887.43 50300 REMOVE CADAVER DONOR KIDNEY 1541.58 50320 REMOVE KIDNEY LIVING DONOR 1420.15 50323 PREP CADAVER RENAL ALLOGRAFT 0.00 50325 PREP DONOR RENAL GRAFT 0.00 50327 PREP RENAL GRAFT/VENOUS 214.78 50328 PREP RENAL GRAFT/ARTERIAL 188.21 50329 PREP RENAL GRAFT/URETERAL 173.47 50340 REMOVAL OF KIDNEY 945.45 50360 TRANSPLANTATION OF KIDNEY 2405.17 50365 TRANSPLANTATION OF KIDNEY 2825.69 50370 REMOVE TRANSPLANTED KIDNEY 1193.46 50380 REIMPLANTATION OF KIDNEY 1994.82 50382 CHANGE URETER STENT PERCUT 272.97 50384 REMOVE URETER STENT PERCUT 249.77 50385 Change stent via transureth 230.58 50386 Remove stent via transureth 175.06 50387 CHANGE EXT/INT URETER STENT 99.34 50389 REMOVE RENAL TUBE W/FLUORO 54.88 50390 DRAINAGE OF KIDNEY LESION 97.22 50391 INSTLL RX AGNT INTO RNAL TUB 97.62 50392 INSERT KIDNEY DRAIN 179.95 50393 INSERT URETERAL TUBE 218.12 50394 INJECTION FOR KIDNEY X-RAY 50.42 50395 CREATE PASSAGE TO KIDNEY 180.35 50396 MEASURE KIDNEY PRESSURE 118.56 50398 CHANGE KIDNEY TUBE 72.90 50400 REVISION OF KIDNEY/URETER 1143.17 50405 REVISION OF KIDNEY/URETER 1378.12 50500 REPAIR OF KIDNEY WOUND 1279.84 50520 CLOSE KIDNEY-SKIN FISTULA 1073.52 50525 REPAIR RENAL-ABDOMEN FISTULA 1469.04 50526 REPAIR RENAL-ABDOMEN FISTULA 1423.96 50540 REVISION OF HORSESHOE KIDNEY 1132.59 50541 LAPARO ABLATE RENAL CYST 909.69 50542 LAPARO ABLATE RENAL MASS 1152.34 50543 LAPARO PARTIAL NEPHRECTOMY 1471.14 50544 LAPAROSCOPY PYELOPLASTY 1230.86 50545 LAPARO RADICAL NEPHRECTOMY 1326.18 50546 LAPAROSCOPIC NEPHRECTOMY 1188.36 50548 LAPARO REMOVE W/URETER 1330.93 Proc Code Description Mod Rate 50551 KIDNEY ENDOSCOPY 291.51 50553 KIDNEY ENDOSCOPY 311.80 50555 KIDNEY ENDOSCOPY & BIOPSY 337.70 50557 KIDNEY ENDOSCOPY & TREATMENT 341.86 50561 KIDNEY ENDOSCOPY & TREATMENT 390.89 50562 RENAL SCOPE W/TUMOR RESECT 574.88 50570 KIDNEY ENDOSCOPY 485.59 50572 KIDNEY ENDOSCOPY 526.31 50574 KIDNEY ENDOSCOPY & BIOPSY 559.65 50575 KIDNEY ENDOSCOPY 706.92 50576 KIDNEY ENDOSCOPY & TREATMENT 557.51 50580 KIDNEY ENDOSCOPY & TREATMENT 602.05 50590 FRAGMENTING OF KIDNEY STONE 561.34 50592 PERC RF ABLATE RENAL TUMOR 364.85 50593 Perc cryo ablate renal tum 482.65 50600 EXPLORATION OF URETER 927.36 50605 INSERT URETERAL SUPPORT 968.86 50610 REMOVAL OF URETER STONE 933.68 50620 REMOVAL OF URETER STONE 893.05 50630 REMOVAL OF URETER STONE 881.93 50650 REMOVAL OF URETER 1023.10 50660 REMOVAL OF URETER 1129.15 50684 INJECTION FOR URETER X-RAY 50.42 50686 MEASURE URETER PRESSURE 93.81 50688 CHANGE OF URETER TUBE/STENT 80.20 50690 INJECTION FOR URETER X-RAY 70.57 50700 REVISION OF URETER 917.76 50715 RELEASE OF URETER 1197.21 50722 RELEASE OF URETER 1056.10 50725 RELEASE/REVISE URETER 1088.15 50727 REVISE URETER 500.33 50728 REVISE URETER 690.14 50740 FUSION OF URETER & KIDNEY 1217.65 50750 FUSION OF URETER & KIDNEY 1138.85 50760 FUSION OF URETERS 1119.41 50770 SPLICING OF URETERS 1138.85 50780 REIMPLANT URETER IN BLADDER 1096.41 50782 REIMPLANT URETER IN BLADDER 1040.52 50783 REIMPLANT URETER IN BLADDER 1113.17 50785 REIMPLANT URETER IN BLADDER 1195.87 50800 IMPLANT URETER IN BOWEL 915.60 50810 FUSION OF URETER & BOWEL 1328.44 50815 URINE SHUNT TO INTESTINE 1207.88 50820 CONSTRUCT BOWEL BLADDER 1303.74 50825 CONSTRUCT BOWEL BLADDER 1637.51 50830 REVISE URINE FLOW 1780.69 Proc Code Description Mod Rate 50840 REPLACE URETER BY BOWEL 1214.12 50845 APPENDICO-VESICOSTOMY 1233.74 50860 TRANSPLANT URETER TO SKIN 933.61 50900 REPAIR OF URETER 840.84 50920 CLOSURE URETER/SKIN FISTULA 870.77 50930 CLOSURE URETER/BOWEL FISTULA 1223.55 50940 RELEASE OF URETER 876.67 50945 LAPAROSCOPY URETEROLITHOTOMY 961.20 50947 LAPARO NEW URETER/BLADDER 1370.01 50948 LAPARO NEW URETER/BLADDER 1259.10 50951 ENDOSCOPY OF URETER 303.31 50953 ENDOSCOPY OF URETER 322.76 50955 URETER ENDOSCOPY & BIOPSY 348.82 50957 URETER ENDOSCOPY & TREATMENT 350.54 50961 URETER ENDOSCOPY & TREATMENT 313.73 50970 URETER ENDOSCOPY 366.46 50972 URETER ENDOSCOPY & CATHETER 354.34 50974 URETER ENDOSCOPY & BIOPSY 467.55 50976 URETER ENDOSCOPY & TREATMENT 460.95 50980 URETER ENDOSCOPY & TREATMENT 351.86 51020 INCISE & TREAT BLADDER 465.06 51030 INCISE & TREAT BLADDER 465.15 51040 INCISE & DRAIN BLADDER 285.82 51045 INCISE BLADDER/DRAIN URETER 487.56 51050 REMOVAL OF BLADDER STONE 467.06 51060 REMOVAL OF URETER STONE 574.70 51065 REMOVE URETER CALCULUS 571.83 51080 DRAINAGE OF BLADDER ABSCESS 403.80 51100 Drain bladder by needle 38.91 51101 Drain bladder by trocar/cath 52.17 51102 Drain bl w/cath insertion 144.89 51500 REMOVAL OF BLADDER CYST 628.85 51520 REMOVAL OF BLADDER LESION 586.81 51525 REMOVAL OF BLADDER LESION 850.35 51530 REMOVAL OF BLADDER LESION 785.42 51535 REPAIR OF URETER LESION 769.09 51550 PARTIAL REMOVAL OF BLADDER 958.23 51555 PARTIAL REMOVAL OF BLADDER 1256.12 51565 REVISE BLADDER & URETER(S) 1278.22 51570 REMOVAL OF BLADDER 1461.50 51575 REMOVAL OF BLADDER & NODES 1797.61 51580 REMOVE BLADDER/REVISE TRACT 1872.42 51585 REMOVAL OF BLADDER & NODES 2084.27 51590 REMOVE BLADDER/REVISE TRACT 1910.54 51595 REMOVE BLADDER/REVISE TRACT 2163.49 51596 REMOVE BLADDER/CREATE POUCH 2322.91 Proc Code Description Mod Rate 51597 REMOVAL OF PELVIC STRUCTURES 2273.74 51600 INJECTION FOR BLADDER X-RAY 44.12 51605 PREPARATION FOR BLADDER XRAY 37.68 51610 INJECTION FOR BLADDER X-RAY 64.30 51700 IRRIGATION OF BLADDER 44.12 51701 INSERT BLADDER CATHETER 27.53 51702 INSERT TEMP BLADDER CATH 30.04 51703 INSERT BLADDER CATH COMPLEX 80.46 51705 CHANGE OF BLADDER TUBE 51.64 51710 CHANGE OF BLADDER TUBE 78.49 51715 ENDOSCOPIC INJECTION/IMPLANT 198.44 51720 TREATMENT OF BLADDER LESION 78.97 51725 SIMPLE CYSTOMETROGRAM TC 109.52 51725 SIMPLE CYSTOMETROGRAM 26 75.33 51725 SIMPLE CYSTOMETROGRAM 184.85 51726 COMPLEX CYSTOMETROGRAM TC 176.33 51726 COMPLEX CYSTOMETROGRAM 26 84.69 51726 COMPLEX CYSTOMETROGRAM 261.03 51727 CYSTOMETROGRAM W/UP TC 203.23 51727 CYSTOMETROGRAM W/UP 26 107.79 51727 CYSTOMETROGRAM W/UP 311.02 51728 CYSTOMETROGRAM W/VP TC 207.18 51728 CYSTOMETROGRAM W/VP 26 104.49 51728 CYSTOMETROGRAM W/VP 311.67 51729 CYSTOMETROGRAM W/VP&UP TC 211.12 51729 CYSTOMETROGRAM W/VP&UP 26 126.84 51729 CYSTOMETROGRAM W/VP&UP 337.97 51736 URINE FLOW MEASUREMENT TC 6.83 51736 URINE FLOW MEASUREMENT 26 8.32 51736 URINE FLOW MEASUREMENT 15.16 51741 ELECTRO-UROFLOWMETRY FIRST TC 7.19 51741 ELECTRO-UROFLOWMETRY FIRST 26 8.32 51741 ELECTRO-UROFLOWMETRY FIRST 15.52 51784 ANAL/URINARY MUSCLE STUDY TC 113.83 51784 ANAL/URINARY MUSCLE STUDY 26 76.01 51784 ANAL/URINARY MUSCLE STUDY 189.84 51785 ANAL/URINARY MUSCLE STUDY TC 175.94 51785 ANAL/URINARY MUSCLE STUDY 26 78.88 51785 ANAL/URINARY MUSCLE STUDY 254.82 51792 URINARY REFLEX STUDY TC 154.04 51792 URINARY REFLEX STUDY 26 55.24 51792 URINARY REFLEX STUDY 209.28 51797 INTRAABDOMINAL PRESSURE TEST TC 71.10 51797 INTRAABDOMINAL PRESSURE TEST 26 39.18 51797 INTRAABDOMINAL PRESSURE TEST 110.29 51798 US URINE CAPACITY MEASURE 19.04 Proc Code Description Mod Rate 51800 REVISION OF BLADDER/URETHRA 1031.31 51820 REVISION OF URINARY TRACT 1069.43 51840 ATTACH BLADDER/URETHRA 660.58 51841 ATTACH BLADDER/URETHRA 784.36 51845 REPAIR BLADDER NECK 587.63 51860 REPAIR OF BLADDER WOUND 745.79 51865 REPAIR OF BLADDER WOUND 889.03 51880 REPAIR OF BLADDER OPENING 467.60 51900 REPAIR BLADDER/VAGINA LESION 821.04 51920 CLOSE BLADDER-UTERUS FISTULA 800.07 51925 HYSTERECTOMY/BLADDER REPAIR 1049.55 51940 CORRECTION OF BLADDER DEFECT 1609.23 51960 REVISION OF BLADDER & BOWEL 1377.41 51980 CONSTRUCT BLADDER OPENING 704.57 51990 LAPARO URETHRAL SUSPENSION 758.26 51992 LAPARO SLING OPERATION 856.43 52000 CYSTOSCOPY 125.18 52001 CYSTOSCOPY REMOVAL OF CLOTS 284.23 52005 CYSTOSCOPY & URETER CATHETER 132.12 52007 CYSTOSCOPY AND BIOPSY 164.42 52010 CYSTOSCOPY & DUCT CATHETER 164.42 52204 CYSTOSCOPY W/BIOPSY(S) 140.37 52214 CYSTOSCOPY AND TREATMENT 174.01 52224 CYSTOSCOPY AND TREATMENT 201.82 52234 CYSTOSCOPY AND TREATMENT 242.85 52235 CYSTOSCOPY AND TREATMENT 285.31 52240 CYSTOSCOPY AND TREATMENT 387.77 52250 CYSTOSCOPY AND RADIOTRACER 237.37 52260 CYSTOSCOPY AND TREATMENT 208.53 52265 CYSTOSCOPY AND TREATMENT 163.20 52270 CYSTOSCOPY & REVISE URETHRA 180.37 52275 CYSTOSCOPY & REVISE URETHRA 245.62 52276 CYSTOSCOPY AND TREATMENT 262.01 52277 CYSTOSCOPY AND TREATMENT 319.64 52281 CYSTOSCOPY AND TREATMENT 151.62 52282 CYSTOSCOPY IMPLANT STENT 333.30 52283 CYSTOSCOPY AND TREATMENT 199.49 52285 CYSTOSCOPY AND TREATMENT 194.34 52287 Cystoscopy chemodenervation 167.74 52290 CYSTOSCOPY AND TREATMENT 241.13 52300 CYSTOSCOPY AND TREATMENT 279.87 52301 CYSTOSCOPY AND TREATMENT 286.99 52305 CYSTOSCOPY AND TREATMENT 275.85 52310 CYSTOSCOPY AND TREATMENT 150.43 52315 CYSTOSCOPY AND TREATMENT 270.98 52317 REMOVE BLADDER STONE 343.49 Proc Code Description Mod Rate 52318 REMOVE BLADDER STONE 467.87 52320 CYSTOSCOPY AND TREATMENT 243.46 52325 CYSTOSCOPY STONE REMOVAL 316.78 52327 CYSTOSCOPY INJECT MATERIAL 259.20 52330 CYSTOSCOPY AND TREATMENT 260.86 52332 CYSTOSCOPY AND TREATMENT 154.34 52334 CREATE PASSAGE TO KIDNEY 253.69 52341 CYSTO W/URETER STRICTURE TX 280.79 52342 CYSTO W/UP STRICTURE TX 305.43 52343 CYSTO W/RENAL STRICTURE TX 340.53 52344 CYSTO/URETERO STRICTURE TX 365.18 52345 CYSTO/URETERO W/UP STRICTURE 389.82 52346 CYSTOURETERO W/RENAL STRICT 441.60 52351 CYSTOURETERO & OR PYELOSCOPE 299.14 52352 CYSTOURETERO W/STONE REMOVE 350.61 52353 CYSTOURETERO W/LITHOTRIPSY 387.40 52354 CYSTOURETERO W/BIOPSY 412.42 52355 CYSTOURETERO W/EXCISE TUMOR 462.46 52356 Cysto/uretero w/lithotripsy 411.34 52400 CYSTOURETERO W/CONGEN REPR 472.29 52402 CYSTOURETHRO CUT EJACUL DUCT 263.31 52441 Cystourethro w/implant 234.99 52442 Cystourethro w/addl implant 82.71 52450 INCISION OF PROSTATE 464.49 52500 REVISION OF BLADDER NECK 482.55 52601 PROSTATECTOMY (TURP) 835.45 52630 REMOVE PROSTATE REGROWTH 395.82 52640 RELIEVE BLADDER CONTRACTURE 311.49 52647 LASER SURGERY OF PROSTATE 639.56 52648 LASER SURGERY OF PROSTATE 682.69 52649 PROSTATE LASER ENUCLEATION 812.54 52700 DRAINAGE OF PROSTATE ABSCESS 435.53 53000 INCISION OF URETHRA 146.91 53010 INCISION OF URETHRA 290.88 53020 INCISION OF URETHRA 96.14 53025 INCISION OF URETHRA 66.62 53040 DRAINAGE OF URETHRA ABSCESS 388.28 53060 DRAINAGE OF URETHRA ABSCESS 169.23 53080 DRAINAGE OF URINARY LEAKAGE 415.30 53085 DRAINAGE OF URINARY LEAKAGE 654.76 53200 BIOPSY OF URETHRA 140.75 53210 REMOVAL OF URETHRA 760.06 53215 REMOVAL OF URETHRA 916.77 53220 TREATMENT OF URETHRA LESION 447.85 53230 REMOVAL OF URETHRA LESION 603.20 53235 REMOVAL OF URETHRA LESION 624.62 Proc Code Description Mod Rate 53240 SURGERY FOR URETHRA POUCH 419.69 53250 REMOVAL OF URETHRA GLAND 419.47 53260 TREATMENT OF URETHRA LESION 179.55 53265 TREATMENT OF URETHRA LESION 184.68 53270 REMOVAL OF URETHRA GLAND 189.36 53275 REPAIR OF URETHRA DEFECT 259.48 53400 REVISE URETHRA STAGE 1 792.52 53405 REVISE URETHRA STAGE 2 862.75 53410 RECONSTRUCTION OF URETHRA 967.80 53415 RECONSTRUCTION OF URETHRA 1116.83 53420 RECONSTRUCT URETHRA STAGE 1 830.93 53425 RECONSTRUCT URETHRA STAGE 2 925.02 53430 RECONSTRUCTION OF URETHRA 961.87 53431 RECONSTRUCT URETHRA/BLADDER 1139.28 53440 MALE SLING PROCEDURE 743.83 53442 REMOVE/REVISE MALE SLING 773.04 53444 INSERT TANDEM CUFF 782.99 53445 INSERT URO/VES NCK SPHINCTER 744.44 53446 REMOVE URO SPHINCTER 634.67 53447 REMOVE/REPLACE UR SPHINCTER 799.03 53448 REMOV/REPLC UR SPHINCTR COMP 1264.03 53449 REPAIR URO SPHINCTER 604.56 53450 REVISION OF URETHRA 403.69 53460 REVISION OF URETHRA 451.94 53500 URETHRLYS TRANSVAG W/ SCOPE 745.89 53502 REPAIR OF URETHRA INJURY 481.29 53505 REPAIR OF URETHRA INJURY 480.57 53510 REPAIR OF URETHRA INJURY 623.23 53515 REPAIR OF URETHRA INJURY 785.44 53520 REPAIR OF URETHRA DEFECT 549.59 53600 DILATE URETHRA STRICTURE 62.95 53601 DILATE URETHRA STRICTURE 52.55 53605 DILATE URETHRA STRICTURE 63.54 53620 DILATE URETHRA STRICTURE 86.32 53621 DILATE URETHRA STRICTURE 70.59 53660 DILATION OF URETHRA 41.18 53661 DILATION OF URETHRA 40.08 53665 DILATION OF URETHRA 38.59 53850 PROSTATIC MICROWAVE THERMOTX 600.33 53852 PROSTATIC RF THERMOTX 614.86 53855 INSERT PROST URETHRAL STENT 81.62 53860 TRANSURETHRAL RF TREATMENT TRANS 234.04 54000 SLITTING OF PREPUCE 106.45 54001 SLITTING OF PREPUCE 137.73 54015 DRAIN PENIS LESION 305.97 54050 DESTRUCTION PENIS LESION(S) 103.80 Proc Code Description Mod Rate 54055 DESTRUCTION PENIS LESION(S) 90.92 54056 CRYOSURGERY PENIS LESION(S) 110.66 54057 LASER SURG PENIS LESION(S) 93.32 54060 EXCISION OF PENIS LESION(S) 129.21 54065 DESTRUCTION PENIS LESION(S) 172.63 54100 BIOPSY OF PENIS 124.37 54105 BIOPSY OF PENIS 210.57 54110 TREATMENT OF PENIS LESION 616.49 54111 TREAT PENIS LESION GRAFT 790.87 54112 TREAT PENIS LESION GRAFT 925.86 54115 TREATMENT OF PENIS LESION 419.20 54120 PARTIAL REMOVAL OF PENIS 624.63 54125 REMOVAL OF PENIS 803.32 54130 REMOVE PENIS & NODES 1178.78 54135 REMOVE PENIS & NODES 1493.12 54150 CIRCUMCISION W/REGIONL BLOCK 97.78 54160 CIRCUMCISION NEONATE 142.24 54161 CIRCUM 28 DAYS OR OLDER 194.82 54162 LYSIS PENIL CIRCUMIC LESION 196.96 54163 REPAIR OF CIRCUMCISION 216.34 54164 FRENULOTOMY OF PENIS 192.06 54200 TREATMENT OF PENIS LESION 83.22 54205 TREATMENT OF PENIS LESION 525.67 54220 TREATMENT OF PENIS LESION 132.78 54230 PREPARE PENIS STUDY 78.51 54231 DYNAMIC CAVERNOSOMETRY 115.06 54235 PENILE INJECTION 73.04 54240 PENIS STUDY TC 34.84 54240 PENIS STUDY 26 63.43 54240 PENIS STUDY 98.28 54250 PENIS STUDY TC 10.78 54250 PENIS STUDY 26 107.45 54250 PENIS STUDY 118.23 54300 REVISION OF PENIS 633.26 54304 REVISION OF PENIS 740.34 54308 RECONSTRUCTION OF URETHRA 706.64 54312 RECONSTRUCTION OF URETHRA 808.30 54316 RECONSTRUCTION OF URETHRA 985.47 54318 RECONSTRUCTION OF URETHRA 690.23 54322 RECONSTRUCTION OF URETHRA 771.51 54324 RECONSTRUCTION OF URETHRA 956.88 54326 RECONSTRUCTION OF URETHRA 934.44 54328 REVISE PENIS/URETHRA 928.18 54332 REVISE PENIS/URETHRA 1001.47 54336 REVISE PENIS/URETHRA 1175.20 54340 SECONDARY URETHRAL SURGERY 562.85 Proc Code Description Mod Rate 54344 SECONDARY URETHRAL SURGERY 986.43 54348 SECONDARY URETHRAL SURGERY 983.85 54352 RECONSTRUCT URETHRA/PENIS 1399.97 54360 PENIS PLASTIC SURGERY 712.48 54380 REPAIR PENIS 789.47 54385 REPAIR PENIS 981.10 54390 REPAIR PENIS AND BLADDER 1270.55 54400 INSERT SEMI-RIGID PROSTHESIS 522.82 54401 INSERT SELF-CONTD PROSTHESIS 648.93 54405 INSERT MULTI-COMP PENIS PROS 798.98 54406 REMOVE MUTI-COMP PENIS PROS 721.27 54408 REPAIR MULTI-COMP PENIS PROS 780.99 54410 REMOVE/REPLACE PENIS PROSTH 849.58 54411 REMOV/REPLC PENIS PROS COMP 1013.35 54415 REMOVE SELF-CONTD PENIS PROS 522.24 54416 REMV/REPL PENIS CONTAIN PROS 702.17 54417 REMV/REPLC PENIS PROS COMPL 888.24 54420 REVISION OF PENIS 696.63 54430 REVISION OF PENIS 632.78 54435 REVISION OF PENIS 411.88 54440 REPAIR OF PENIS 623.36 54450 PREPUTIAL STRETCHING 56.64 54500 BIOPSY OF TESTIS 73.54 54505 BIOPSY OF TESTIS 207.41 54512 EXCISE LESION TESTIS 533.75 54520 REMOVAL OF TESTIS 323.75 54522 ORCHIECTOMY PARTIAL 596.11 54530 REMOVAL OF TESTIS 500.77 54535 EXTENSIVE TESTIS SURGERY 735.12 54550 EXPLORATION FOR TESTIS 486.41 54560 EXPLORATION FOR TESTIS 678.80 54600 REDUCE TESTIS TORSION 447.83 54620 SUSPENSION OF TESTIS 296.09 54640 SUSPENSION OF TESTIS 474.11 54650 ORCHIOPEXY (FOWLER-STEPHENS) 703.45 54660 REVISION OF TESTIS 352.99 54670 REPAIR TESTIS INJURY 400.67 54680 RELOCATION OF TESTIS(ES) 777.50 54690 LAPAROSCOPY ORCHIECTOMY 735.22 54692 LAPAROSCOPY ORCHIOPEXY 788.03 54700 DRAINAGE OF SCROTUM 211.49 54800 BIOPSY OF EPIDIDYMIS 128.40 54830 REMOVE EPIDIDYMIS LESION 369.15 54840 REMOVE EPIDIDYMIS LESION 317.92 54860 REMOVAL OF EPIDIDYMIS 414.19 54861 REMOVAL OF EPIDIDYMIS 558.92 Proc Code Description Mod Rate 54865 EXPLORE EPIDIDYMIS 355.13 54900 FUSION OF SPERMATIC DUCTS 778.07 54901 FUSION OF SPERMATIC DUCTS 1064.76 55000 DRAINAGE OF HYDROCELE 83.77 55040 REMOVAL OF HYDROCELE 336.04 55041 REMOVAL OF HYDROCELES 505.35 55060 REPAIR OF HYDROCELE 377.94 55100 DRAINAGE OF SCROTUM ABSCESS 166.19 55110 EXPLORE SCROTUM 384.81 55120 REMOVAL OF SCROTUM LESION 355.65 55150 REMOVAL OF SCROTUM 487.70 55175 REVISION OF SCROTUM 359.30 55180 REVISION OF SCROTUM 688.90 55200 INCISION OF SPERM DUCT 277.09 55250 REMOVAL OF SPERM DUCT(S) 225.23 55300 PREPARE SPERM DUCT X-RAY 185.51 55400 REPAIR OF SPERM DUCT 525.56 55450 LIGATION OF SPERM DUCT 253.94 55500 REMOVAL OF HYDROCELE 395.40 55520 REMOVAL OF SPERM CORD LESION 452.49 55530 REVISE SPERMATIC CORD VEINS 349.88 55535 REVISE SPERMATIC CORD VEINS 425.25 55540 REVISE HERNIA & SPERM VEINS 540.09 55550 LAPARO LIGATE SPERMATIC VEIN 423.44 55600 INCISE SPERM DUCT POUCH 416.95 55605 INCISE SPERM DUCT POUCH 536.07 55650 REMOVE SPERM DUCT POUCH 709.09 55680 REMOVE SPERM POUCH LESION 342.35 55700 BIOPSY OF PROSTATE 138.23 55705 BIOPSY OF PROSTATE 262.64 55706 PROSTATE SATURATION SAMPLING 362.95 55720 DRAINAGE OF PROSTATE ABSCESS 446.23 55725 DRAINAGE OF PROSTATE ABSCESS 586.73 55801 REMOVAL OF PROSTATE 1080.23 55810 EXTENSIVE PROSTATE SURGERY 1301.98 55812 EXTENSIVE PROSTATE SURGERY 1589.33 55815 EXTENSIVE PROSTATE SURGERY 1741.46 55821 REMOVAL OF PROSTATE 863.70 55831 REMOVAL OF PROSTATE 933.79 55840 EXTENSIVE PROSTATE SURGERY 1321.34 55842 EXTENSIVE PROSTATE SURGERY 1415.19 55845 EXTENSIVE PROSTATE SURGERY 1615.42 55860 SURGICAL EXPOSURE PROSTATE 863.86 55862 EXTENSIVE PROSTATE SURGERY 1083.04 55865 EXTENSIVE PROSTATE SURGERY 1317.82 55866 LAPARO RADICAL PROSTATECTOMY 1715.78 Proc Code Description Mod Rate 55870 ELECTROEJACULATION 141.10 55873 CRYOABLATE PROSTATE 756.77 55875 TRANSPERI NEEDLE PLACE PROS 754.03 55876 PLACE RT DEVICE/MARKER PROS 99.41 55920 Place needles pelvic for rt 443.50 56405 I & D OF VULVA/PERINEUM 110.08 56420 DRAINAGE OF GLAND ABSCESS 92.54 56440 SURGERY FOR VULVA LESION 185.09 56441 LYSIS OF LABIAL LESION(S) 139.31 56442 HYMENOTOMY 48.85 56501 DESTROY VULVA LESIONS SIM 116.39 56515 DESTROY VULVA LESION/S COMPL 201.99 56605 BIOPSY OF VULVA/PERINEUM 61.11 56606 BIOPSY OF VULVA/PERINEUM 29.64 56620 PARTIAL REMOVAL OF VULVA 516.08 56625 COMPLETE REMOVAL OF VULVA 619.00 56630 EXTENSIVE VULVA SURGERY 912.78 56631 EXTENSIVE VULVA SURGERY 1160.73 56632 EXTENSIVE VULVA SURGERY 1347.29 56633 EXTENSIVE VULVA SURGERY 1189.19 56634 EXTENSIVE VULVA SURGERY 1264.07 56637 EXTENSIVE VULVA SURGERY 1474.56 56640 EXTENSIVE VULVA SURGERY 1477.02 56700 PARTIAL REMOVAL OF HYMEN 189.83 56740 REMOVE VAGINA GLAND LESION 302.27 56800 REPAIR OF VAGINA 242.66 56805 REPAIR CLITORIS 1164.40 56810 REPAIR OF PERINEUM 262.55 56820 EXAM OF VULVA W/SCOPE 87.08 56821 EXAM/BIOPSY OF VULVA W/SCOPE 116.73 57000 EXPLORATION OF VAGINA 191.69 57010 DRAINAGE OF PELVIC ABSCESS 441.05 57020 DRAINAGE OF PELVIC FLUID 83.13 57022 I & D VAGINAL HEMATOMA PP 175.26 57023 I & D VAG HEMATOMA NON-OB 315.08 57061 DESTROY VAG LESIONS SIMPLE 99.58 57065 DESTROY VAG LESIONS COMPLEX 174.29 57100 BIOPSY OF VAGINA 67.06 57105 BIOPSY OF VAGINA 126.90 57106 REMOVE VAGINA WALL PARTIAL 490.91 57107 REMOVE VAGINA TISSUE PART 1439.67 57109 VAGINECTOMY PARTIAL W/NODES 1689.34 57110 REMOVE VAGINA WALL COMPLETE 910.14 57111 REMOVE VAGINA TISSUE COMPL 1630.82 57112 VAGINECTOMY W/NODES COMPL 1709.42 57120 CLOSURE OF VAGINA 517.01 Proc Code Description Mod Rate 57130 REMOVE VAGINA LESION 160.96 57135 REMOVE VAGINA LESION 174.22 57150 TREAT VAGINA INFECTION 29.64 57155 INSERT UTERI TANDEM/OVOIDS 285.65 57156 INS VAG BRACHYTX DEVICE INSER 144.80 57160 INSERT PESSARY/OTHER DEVICE 47.78 57170 FITTING OF DIAPHRAGM/CAP 48.82 57180 TREAT VAGINAL BLEEDING 106.97 57200 REPAIR OF VAGINA 302.56 57210 REPAIR VAGINA/PERINEUM 370.54 57220 REVISION OF URETHRA 323.47 57230 REPAIR OF URETHRAL LESION 400.94 57240 REPAIR BLADDER & VAGINA 673.12 57250 REPAIR RECTUM & VAGINA 685.36 57260 REPAIR OF VAGINA 844.49 57265 EXTENSIVE REPAIR OF VAGINA 924.70 57267 INSERT MESH/PELVIC FLR ADDON 258.65 57268 REPAIR OF BOWEL BULGE 488.29 57270 REPAIR OF BOWEL POUCH 810.56 57280 SUSPENSION OF VAGINA 964.25 57282 COLPOPEXY EXTRAPERITONEAL 505.54 57283 COLPOPEXY INTRAPERITONEAL 699.17 57284 REPAIR PARAVAG DEFECT OPEN 823.93 57285 REPAIR PARAVAG DEFECT VAG 680.04 57287 REVISE/REMOVE SLING REPAIR 679.60 57288 REPAIR BLADDER DEFECT 714.26 57289 REPAIR BLADDER & VAGINA 719.98 57291 CONSTRUCTION OF VAGINA 632.16 57292 CONSTRUCT VAGINA WITH GRAFT 829.48 57295 REVISE VAG GRAFT VIA VAGINA 482.41 57296 REVISE VAG GRAFT OPEN ABD 964.50 57300 REPAIR RECTUM-VAGINA FISTULA 564.60 57305 REPAIR RECTUM-VAGINA FISTULA 937.95 57307 FISTULA REPAIR & COLOSTOMY 1066.48 57308 FISTULA REPAIR TRANSPERINE 674.00 57310 REPAIR URETHROVAGINAL LESION 454.64 57311 REPAIR URETHROVAGINAL LESION 517.52 57320 REPAIR BLADDER-VAGINA LESION 529.74 57330 REPAIR BLADDER-VAGINA LESION 729.70 57335 REPAIR VAGINA 1139.39 57400 DILATION OF VAGINA 135.77 57410 PELVIC EXAMINATION 108.93 57415 REMOVE VAGINAL FOREIGN BODY 160.84 57420 EXAM OF VAGINA W/SCOPE 91.92 57421 EXAM/BIOPSY OF VAG W/SCOPE 125.11 57423 REPAIR PARAVAG DEFECT LAP 930.79 Proc Code Description Mod Rate 57425 LAPAROSCOPY SURG COLPOPEXY 981.02 57426 REVISE PROSTH VAG GRAFT LAP 859.21 57452 EXAM OF CERVIX W/SCOPE 93.15 57454 BX/CURETT OF CERVIX W/SCOPE 138.17 57455 BIOPSY OF CERVIX W/SCOPE 112.87 57456 ENDOCERV CURETTAGE W/SCOPE 105.20 57460 BX OF CERVIX W/SCOPE LEEP 166.15 57461 CONZ OF CERVIX W/SCOPE LEEP 191.43 57500 BIOPSY OF CERVIX 77.11 57505 ENDOCERVICAL CURETTAGE 92.93 57510 CAUTERIZATION OF CERVIX 117.67 57511 CRYOCAUTERY OF CERVIX 134.49 57513 LASER SURGERY OF CERVIX 135.21 57520 CONIZATION OF CERVIX 276.51 57522 CONIZATION OF CERVIX 246.71 57530 REMOVAL OF CERVIX 349.02 57531 REMOVAL OF CERVIX RADICAL 1783.88 57540 REMOVAL OF RESIDUAL CERVIX 790.76 57545 REMOVE CERVIX/REPAIR PELVIS 834.36 57550 REMOVAL OF RESIDUAL CERVIX 413.83 57555 REMOVE CERVIX/REPAIR VAGINA 609.62 57556 REMOVE CERVIX REPAIR BOWEL 573.37 57558 D&C OF CERVICAL STUMP 115.45 57700 REVISION OF CERVIX 314.56 57720 REVISION OF CERVIX 311.28 57800 DILATION OF CERVICAL CANAL 49.04 58100 BIOPSY OF UTERUS LINING 89.54 58110 BX DONE W/COLPOSCOPY ADD-ON 41.50 58120 DILATION AND CURETTAGE 221.33 58140 MYOMECTOMY ABDOM METHOD 933.98 58145 MYOMECTOMY VAG METHOD 552.35 58146 MYOMECTOMY ABDOM COMPLEX 1172.28 58150 TOTAL HYSTERECTOMY 1016.87 58152 TOTAL HYSTERECTOMY 1265.14 58180 PARTIAL HYSTERECTOMY 973.78 58200 EXTENSIVE HYSTERECTOMY 1348.56 58210 EXTENSIVE HYSTERECTOMY 1810.11 58240 REMOVAL OF PELVIS CONTENTS 2875.06 58260 VAGINAL HYSTERECTOMY 839.71 58262 VAG HYST INCLUDING T/O 936.74 58263 VAG HYST W/T/O & VAG REPAIR 1005.83 58267 VAG HYST W/URINARY REPAIR 1071.61 58270 VAG HYST W/ENTEROCELE REPAIR 895.36 58275 HYSTERECTOMY/REVISE VAGINA 999.36 58280 HYSTERECTOMY/REVISE VAGINA 1068.02 58285 EXTENSIVE HYSTERECTOMY 1331.60 Proc Code Description Mod Rate 58290 VAG HYST COMPLEX 1169.16 58291 VAG HYST INCL T/O COMPLEX 1265.83 58292 VAG HYST T/O & REPAIR COMPL 1335.25 58293 VAG HYST W/URO REPAIR COMPL 1389.04 58294 VAG HYST W/ENTEROCELE COMPL 1238.28 58300 INSERT INTRAUTERINE DEVICE 51.04 58301 REMOVE INTRAUTERINE DEVICE 69.12 58340 CATHETER FOR HYSTEROGRAPHY 58.17 58345 REOPEN FALLOPIAN TUBE 282.78 58346 INSERT HEYMAN UTERI CAPSULE 439.55 58350 REOPEN FALLOPIAN TUBE 79.49 58353 ENDOMETR ABLATE THERMAL 222.39 58356 ENDOMETRIAL CRYOABLATION 351.59 58400 SUSPENSION OF UTERUS 443.23 58410 SUSPENSION OF UTERUS 816.17 58520 REPAIR OF RUPTURED UTERUS 837.86 58540 REVISION OF UTERUS 922.73 58541 LSH UTERUS 250 G OR LESS 876.52 58542 LSH W/T/O UT 250 G OR LESS 979.96 58543 LSH UTERUS ABOVE 250 G 994.93 58544 LSH W/T/O UTERUS ABOVE 250 G 1080.92 58545 LAPAROSCOPIC MYOMECTOMY 910.14 58546 LAPARO-MYOMECTOMY COMPLEX 1144.20 58548 LAP RADICAL HYST 1862.01 58550 LAPARO-ASST VAG HYSTERECTOMY 896.79 58552 LAPARO-VAG HYST INCL T/O 996.66 58553 LAPARO-VAG HYST COMPLEX 1153.34 58554 LAPARO-VAG HYST W/T/O COMPL 1339.28 58555 HYSTEROSCOPY DX SEP PROC 193.38 58558 HYSTEROSCOPY BIOPSY 270.90 58559 HYSTEROSCOPY LYSIS 347.68 58560 HYSTEROSCOPY RESECT SEPTUM 393.06 58561 HYSTEROSCOPY REMOVE MYOMA 556.05 58562 HYSTEROSCOPY REMOVE FB 294.21 58563 HYSTEROSCOPY ABLATION 348.04 58565 HYSTEROSCOPY STERILIZATION 440.25 58570 TLH UTERUS 250 G OR LESS 943.67 58571 Tlh w/t/o 250 g or less 1056.87 58572 TLH UTERUS OVER 250 G 1175.90 58573 Tlh w/t/o uterus over 250 g 1354.65 58600 DIVISION OF FALLOPIAN TUBE 370.35 58605 DIVISION OF FALLOPIAN TUBE 333.94 58611 LIGATE OVIDUCT(S) ADD-ON 78.88 58615 OCCLUDE FALLOPIAN TUBE(S) 247.37 58660 LAPAROSCOPY LYSIS 682.26 58661 LAPAROSCOPY REMOVE ADNEXA 654.16 Proc Code Description Mod Rate 58662 LAPAROSCOPY EXCISE LESIONS 716.11 58670 LAPAROSCOPY TUBAL CAUTERY 370.71 58671 LAPAROSCOPY TUBAL BLOCK 371.07 58672 LAPAROSCOPY FIMBRIOPLASTY 746.85 58673 LAPAROSCOPY SALPINGOSTOMY 811.85 58700 REMOVAL OF FALLOPIAN TUBE 786.30 58720 REMOVAL OF OVARY/TUBE(S) 736.70 58740 ADHESIOLYSIS TUBE OVARY 887.94 58750 REPAIR OVIDUCT 928.23 58752 REVISE OVARIAN TUBE(S) 860.28 58760 FIMBRIOPLASTY 822.09 58770 CREATE NEW TUBAL OPENING 877.86 58800 DRAINAGE OF OVARIAN CYST(S) 301.92 58805 DRAINAGE OF OVARIAN CYST(S) 410.47 58820 DRAIN OVARY ABSCESS OPEN 316.53 58822 DRAIN OVARY ABSCESS PERCUT 749.45 58825 TRANSPOSITION OVARY(S) 704.77 58900 BIOPSY OF OVARY(S) 452.69 58920 PARTIAL REMOVAL OF OVARY(S) 726.05 58925 REMOVAL OF OVARIAN CYST(S) 751.41 58940 REMOVAL OF OVARY(S) 527.12 58943 REMOVAL OF OVARY(S) 1163.16 58950 RESECT OVARIAN MALIGNANCY 1113.47 58951 RESECT OVARIAN MALIGNANCY 1428.43 58952 RESECT OVARIAN MALIGNANCY 1613.01 58953 TAH RAD DISSECT FOR DEBULK 1994.43 58954 TAH RAD DEBULK/LYMPH REMOVE 2162.79 58956 BSO OMENTECTOMY W/TAH 1362.93 58957 RESECT RECURRENT GYN MAL 1564.10 58958 RESECT RECUR GYN MAL W/LYM 1714.63 58960 EXPLORATION OF ABDOMEN 954.38 58999 GENITAL SURGERY PROCEDURE 0.00 59000 AMNIOCENTESIS DIAGNOSTIC 127.48 59001 AMNIOCENTESIS THERAPEUTIC 184.78 59012 FETAL CORD PUNCTURE PRENATAL 208.98 59015 CHORION BIOPSY 159.30 59020 FETAL CONTRACT STRESS TEST TC 33.76 59020 FETAL CONTRACT STRESS TEST 26 37.46 59020 FETAL CONTRACT STRESS TEST 71.23 59025 FETAL NON-STRESS TEST TC 18.32 59025 FETAL NON-STRESS TEST 26 29.73 59025 FETAL NON-STRESS TEST 48.06 59030 FETAL SCALP BLOOD SAMPLE 99.58 59050 FETAL MONITOR W/REPORT 52.30 59051 FETAL MONITOR/INTERPRET ONLY 43.53 59070 TRANSABDOM AMNIOINFUS W/US 418.73 Proc Code Description Mod Rate 59072 UMBILICAL CORD OCCLUD W/US 538.26 59074 FETAL FLUID DRAINAGE W/US 397.90 59076 FETAL SHUNT PLACEMENT W/US 540.42 59100 REMOVE UTERUS LESION 856.17 59120 TREAT ECTOPIC PREGNANCY 815.86 59121 TREAT ECTOPIC PREGNANCY 816.11 59130 TREAT ECTOPIC PREGNANCY 835.79 59135 TREAT ECTOPIC PREGNANCY 828.86 59136 TREAT ECTOPIC PREGNANCY 906.33 59140 TREAT ECTOPIC PREGNANCY 378.60 59150 TREAT ECTOPIC PREGNANCY 790.16 59151 TREAT ECTOPIC PREGNANCY 768.48 59160 D & C AFTER DELIVERY 207.72 59200 INSERT CERVICAL DILATOR 73.61 59300 EPISIOTOMY OR VAGINAL REPAIR 196.34 59320 REVISION OF CERVIX 156.38 59325 REVISION OF CERVIX 218.14 59350 REPAIR OF UTERUS 288.09 59400 OBSTETRICAL CARE 2144.73 59409 OBSTETRICAL CARE 840.57 59410 OBSTETRICAL CARE 1070.75 59412 ANTEPARTUM MANIPULATION 106.47 59414 DELIVER PLACENTA 94.40 59425 ANTEPARTUM CARE ONLY 465.62 59426 ANTEPARTUM CARE ONLY 832.98 59430 CARE AFTER DELIVERY 188.31 59510 CESAREAN DELIVERY 2371.93 59514 CESAREAN DELIVERY ONLY 945.68 59515 CESAREAN DELIVERY 1297.11 59525 REMOVE UTERUS AFTER CESAREAN 499.71 59610 VBAC DELIVERY 2249.19 59612 VBAC DELIVERY ONLY 943.69 59614 VBAC CARE AFTER DELIVERY 1173.20 59618 ATTEMPTED VBAC DELIVERY 2404.43 59620 ATTEMPTED VBAC DELIVERY ONLY 977.03 59622 ATTEMPTED VBAC AFTER CARE 1332.81 59812 TREATMENT OF MISCARRIAGE 324.63 59820 CARE OF MISCARRIAGE 386.96 59821 TREATMENT OF MISCARRIAGE 390.59 59830 TREAT UTERUS INFECTION 447.06 59840 ABORTION 219.50 59841 ABORTION 390.88 59850 ABORTION 343.13 59851 ABORTION 408.10 59852 ABORTION 502.87 59855 ABORTION 425.74 Proc Code Description Mod Rate 59856 ABORTION 499.99 59857 ABORTION 513.88 59866 ABORTION (MPR) 216.12 59870 EVACUATE MOLE OF UTERUS 482.64 59871 REMOVE CERCLAGE SUTURE 137.49 60000 DRAIN THYROID/TONGUE CYST 156.13 60100 BIOPSY OF THYROID 79.25 60200 REMOVE THYROID LESION 663.40 60210 PARTIAL THYROID EXCISION 709.19 60212 PARTIAL THYROID EXCISION 1010.44 60220 PARTIAL REMOVAL OF THYROID 712.64 60225 PARTIAL REMOVAL OF THYROID 934.46 60240 REMOVAL OF THYROID 923.41 60252 REMOVAL OF THYROID 1322.90 60254 EXTENSIVE THYROID SURGERY 1671.97 60260 REPEAT THYROID SURGERY 1098.38 60270 REMOVAL OF THYROID 1371.83 60271 REMOVAL OF THYROID 1060.23 60280 REMOVE THYROID DUCT LESION 446.78 60281 REMOVE THYROID DUCT LESION 594.64 60300 Aspir/inj thyroid cyst 50.11 60500 EXPLORE PARATHYROID GLANDS 968.08 60502 RE-EXPLORE PARATHYROIDS 1289.40 60505 EXPLORE PARATHYROID GLANDS 1389.95 60512 AUTOTRANSPLANT PARATHYROID 243.12 60520 REMOVAL OF THYMUS GLAND 1042.82 60521 REMOVAL OF THYMUS GLAND 1138.91 60522 REMOVAL OF THYMUS GLAND 1379.24 60540 EXPLORE ADRENAL GLAND 1054.16 60545 EXPLORE ADRENAL GLAND 1212.91 60600 REMOVE CAROTID BODY LESION 1434.20 60605 REMOVE CAROTID BODY LESION 1581.82 60650 LAPAROSCOPY ADRENALECTOMY 1187.51 61000 REMOVE CRANIAL CAVITY FLUID 88.52 61001 REMOVE CRANIAL CAVITY FLUID 109.10 61020 REMOVE BRAIN CAVITY FLUID 106.50 61026 INJECTION INTO BRAIN CANAL 107.75 61050 REMOVE BRAIN CANAL FLUID 85.74 61055 INJECTION INTO BRAIN CANAL 118.34 61070 BRAIN CANAL SHUNT PROCEDURE 60.09 61105 TWIST DRILL HOLE 467.16 61107 DRILL SKULL FOR IMPLANTATION 318.40 61108 DRILL SKULL FOR DRAINAGE 916.23 61120 BURR HOLE FOR PUNCTURE 754.75 61140 PIERCE SKULL FOR BIOPSY 1272.98 61150 PIERCE SKULL FOR DRAINAGE 1365.83 Proc Code Description Mod Rate 61151 PIERCE SKULL FOR DRAINAGE 1003.07 61154 PIERCE SKULL & REMOVE CLOT 1283.31 61156 PIERCE SKULL FOR DRAINAGE 1253.82 61210 PIERCE SKULL IMPLANT DEVICE 371.94 61215 INSERT BRAIN-FLUID DEVICE 509.40 61250 PIERCE SKULL & EXPLORE 874.82 61253 PIERCE SKULL & EXPLORE 824.71 61304 OPEN SKULL FOR EXPLORATION 1653.91 61305 OPEN SKULL FOR EXPLORATION 2026.33 61312 OPEN SKULL FOR DRAINAGE 2099.78 61313 OPEN SKULL FOR DRAINAGE 2002.14 61314 OPEN SKULL FOR DRAINAGE 1847.28 61315 OPEN SKULL FOR DRAINAGE 2089.74 61316 IMPLT CRAN BONE FLAP TO ABDO 88.75 61320 OPEN SKULL FOR DRAINAGE 1920.59 61321 OPEN SKULL FOR DRAINAGE 2147.53 61322 DECOMPRESSIVE CRANIOTOMY 2395.96 61323 DECOMPRESSIVE LOBECTOMY 2404.18 61330 DECOMPRESS EYE SOCKET 1874.63 61332 EXPLORE/BIOPSY EYE SOCKET 2092.43 61333 EXPLORE ORBIT/REMOVE LESION 2139.74 61340 SUBTEMPORAL DECOMPRESSION 1458.44 61343 INCISE SKULL (PRESS RELIEF) 2218.97 61345 RELIEVE CRANIAL PRESSURE 2056.48 61450 INCISE SKULL FOR SURGERY 1938.83 61458 INCISE SKULL FOR BRAIN WOUND 2025.19 61460 INCISE SKULL FOR SURGERY 2121.30 61480 INCISE SKULL FOR SURGERY 1491.31 61500 REMOVAL OF SKULL LESION 1344.97 61501 REMOVE INFECTED SKULL BONE 1165.18 61510 REMOVAL OF BRAIN LESION 2207.73 61512 REMOVE BRAIN LINING LESION 2573.73 61514 REMOVAL OF BRAIN ABSCESS 1925.30 61516 REMOVAL OF BRAIN LESION 1876.12 61517 IMPLT BRAIN CHEMOTX ADD-ON 88.05 61518 REMOVAL OF BRAIN LESION 2786.91 61519 REMOVE BRAIN LINING LESION 2977.00 61520 REMOVAL OF BRAIN LESION 3773.63 61521 REMOVAL OF BRAIN LESION 3209.38 61522 REMOVAL OF BRAIN ABSCESS 2204.80 61524 REMOVAL OF BRAIN LESION 2099.49 61526 REMOVAL OF BRAIN LESION 3679.26 61530 REMOVAL OF BRAIN LESION 3102.03 61531 IMPLANT BRAIN ELECTRODES 1232.83 61533 IMPLANT BRAIN ELECTRODES 1535.72 61534 REMOVAL OF BRAIN LESION 1658.79 Proc Code Description Mod Rate 61535 REMOVE BRAIN ELECTRODES 1008.49 61536 REMOVAL OF BRAIN LESION 2600.03 61537 REMOVAL OF BRAIN TISSUE 2485.50 61538 REMOVAL OF BRAIN TISSUE 2691.64 61539 REMOVAL OF BRAIN TISSUE 2379.85 61540 REMOVAL OF BRAIN TISSUE 2200.63 61541 INCISION OF BRAIN TISSUE 2166.04 61543 REMOVAL OF BRAIN TISSUE 2189.63 61544 REMOVE & TREAT BRAIN LESION 1918.06 61545 EXCISION OF BRAIN TUMOR 3210.07 61546 REMOVAL OF PITUITARY GLAND 2325.95 61548 REMOVAL OF PITUITARY GLAND 1567.48 61550 RELEASE OF SKULL SEAMS 881.56 61552 RELEASE OF SKULL SEAMS 1119.64 61556 INCISE SKULL/SUTURES 1718.15 61557 INCISE SKULL/SUTURES 1694.68 61558 EXCISION OF SKULL/SUTURES 1706.54 61559 EXCISION OF SKULL/SUTURES 1751.08 61563 EXCISION OF SKULL TUMOR 1996.06 61564 EXCISION OF SKULL TUMOR 2425.59 61566 REMOVAL OF BRAIN TISSUE 2265.77 61567 INCISION OF BRAIN TISSUE 2584.07 61570 REMOVE FOREIGN BODY BRAIN 1882.45 61571 INCISE SKULL FOR BRAIN WOUND 2004.68 61575 SKULL BASE/BRAINSTEM SURGERY 2433.07 61576 SKULL BASE/BRAINSTEM SURGERY 3450.80 61580 CRANIOFACIAL APPROACH SKULL 2502.86 61581 CRANIOFACIAL APPROACH SKULL 2705.49 61582 CRANIOFACIAL APPROACH SKULL 2974.82 61583 CRANIOFACIAL APPROACH SKULL 2930.76 61584 ORBITOCRANIAL APPROACH/SKULL 2880.85 61585 ORBITOCRANIAL APPROACH/SKULL 3266.53 61586 RESECT NASOPHARYNX SKULL 2471.18 61590 INFRATEMPORAL APPROACH/SKULL 3075.14 61591 INFRATEMPORAL APPROACH/SKULL 3127.03 61592 ORBITOCRANIAL APPROACH/SKULL 3205.78 61595 TRANSTEMPORAL APPROACH/SKULL 2390.09 61596 TRANSCOCHLEAR APPROACH/SKULL 2475.55 61597 TRANSCONDYLAR APPROACH/SKULL 2875.56 61598 TRANSPETROSAL APPROACH/SKULL 2861.44 61600 RESECT/EXCISE CRANIAL LESION 2162.00 61601 RESECT/EXCISE CRANIAL LESION 2434.09 61605 RESECT/EXCISE CRANIAL LESION 2204.32 61606 RESECT/EXCISE CRANIAL LESION 3029.25 61607 RESECT/EXCISE CRANIAL LESION 2915.62 61608 RESECT/EXCISE CRANIAL LESION 3270.94 Proc Code Description Mod Rate 61610 TRANSECT ARTERY SINUS 1776.32 61611 TRANSECT ARTERY SINUS 395.13 61612 TRANSECT ARTERY SINUS 1401.92 61613 REMOVE ANEURYSM SINUS 3310.90 61615 RESECT/EXCISE LESION SKULL 2278.64 61616 RESECT/EXCISE LESION SKULL 3355.05 61618 REPAIR DURA 1315.31 61619 REPAIR DURA 1493.11 61623 ENDOVASC TEMPORY VESSEL OCCL 556.42 61624 TRANSCATH OCCLUSION CNS 1110.78 61626 TRANSCATH OCCLUSION NON-CNS 859.21 61630 INTRACRANIAL ANGIOPLASTY 1279.50 61635 INTRACRAN ANGIOPLSTY W/STENT 1395.88 61640 DILATE IC VASOSPASM INIT 620.78 61641 DILATE IC VASOSPASM ADD-ON 218.40 61642 DILATE IC VASOSPASM ADD-ON 436.05 61680 INTRACRANIAL VESSEL SURGERY 2272.12 61682 INTRACRANIAL VESSEL SURGERY 4216.04 61684 INTRACRANIAL VESSEL SURGERY 2867.71 61686 INTRACRANIAL VESSEL SURGERY 4538.10 61690 INTRACRANIAL VESSEL SURGERY 2204.35 61692 INTRACRANIAL VESSEL SURGERY 3691.56 61697 BRAIN ANEURYSM REPR COMPLX 4258.37 61698 BRAIN ANEURYSM REPR COMPLX 4674.04 61700 BRAIN ANEURYSM REPR SIMPLE 3446.37 61702 INNER SKULL VESSEL SURGERY 4060.39 61703 CLAMP NECK ARTERY 1370.29 61705 REVISE CIRCULATION TO HEAD 2624.34 61708 REVISE CIRCULATION TO HEAD 1953.55 61710 REVISE CIRCULATION TO HEAD 1999.31 61711 FUSION OF SKULL ARTERIES 2629.56 61720 INCISE SKULL/BRAIN SURGERY 1280.54 61735 INCISE SKULL/BRAIN SURGERY 1602.87 61750 INCISE SKULL/BRAIN BIOPSY 1418.10 61751 BRAIN BIOPSY W/CT/MR GUIDE 1386.73 61760 IMPLANT BRAIN ELECTRODES 1593.12 61770 INCISE SKULL FOR TREATMENT 1632.13 61781 SCAN PROC CRANIAL INTRA STERE 236.14 61782 SCAN PROC CRANIAL EXTRA STERE 193.09 61783 SCAN PROC SPINAL STERE 236.86 61790 TREAT TRIGEMINAL NERVE 881.71 61791 TREAT TRIGEMINAL TRACT 1121.84 61796 SRS CRANIAL LESION SIMPLE 1011.59 61797 SRS CRAN LES SIMPLE ADDL 219.60 61798 SRS CRANIAL LESION COMPLEX 1381.38 61799 SRS CRAN LES COMPLEX ADDL 302.61 Proc Code Description Mod Rate 61800 APPLY SRS HEADFRAME ADD-ON 153.64 61850 IMPLANT NEUROELECTRODES 990.33 61860 IMPLANT NEUROELECTRODES 1577.49 61863 IMPLANT NEUROELECTRODE 1516.52 61864 IMPLANT NEUROELECTRDE ADDL 287.08 61867 IMPLANT NEUROELECTRODE 2300.57 61868 IMPLANT NEUROELECTRDE ADDL 505.49 61870 IMPLANT NEUROELECTRODES 1193.43 61880 REVISE/REMOVE NEUROELECTRODE 577.68 61885 INSRT/REDO NEUROSTIM 1 ARRAY 523.03 61886 IMPLANT NEUROSTIM ARRAYS 854.42 61888 REVISE/REMOVE NEURORECEIVER 394.69 62000 TREAT SKULL FRACTURE 1039.51 62005 TREAT SKULL FRACTURE 1281.24 62010 TREATMENT OF HEAD INJURY 1544.03 62100 REPAIR BRAIN FLUID LEAKAGE 1623.17 62115 REDUCTION OF SKULL DEFECT 1261.78 62117 REDUCTION OF SKULL DEFECT 1567.95 62120 REPAIR SKULL CAVITY LESION 1685.33 62121 INCISE SKULL REPAIR 1722.68 62140 REPAIR OF SKULL DEFECT 1047.62 62141 REPAIR OF SKULL DEFECT 1152.78 62142 REMOVE SKULL PLATE/FLAP 896.74 62143 REPLACE SKULL PLATE/FLAP 1051.67 62145 REPAIR OF SKULL & BRAIN 1435.84 62146 REPAIR OF SKULL WITH GRAFT 1259.07 62147 REPAIR OF SKULL WITH GRAFT 1468.48 62148 RETR BONE FLAP TO FIX SKULL 127.85 62160 NEUROENDOSCOPY ADD-ON 191.98 62161 DISSECT BRAIN W/SCOPE 1530.65 62162 REMOVE COLLOID CYST W/SCOPE 1905.43 62163 ZNEUROENDOSCOPY W/FB REMOVAL 1234.10 62164 REMOVE BRAIN TUMOR W/SCOPE 2106.88 62165 REMOVE PITUIT TUMOR W/SCOPE 1561.12 62180 ESTABLISH BRAIN CAVITY SHUNT 1614.45 62190 ESTABLISH BRAIN CAVITY SHUNT 932.16 62192 ESTABLISH BRAIN CAVITY SHUNT 983.57 62194 REPLACE/IRRIGATE CATHETER 432.46 62200 ESTABLISH BRAIN CAVITY SHUNT 1387.64 62201 BRAIN CAVITY SHUNT W/SCOPE 1212.78 62220 ESTABLISH BRAIN CAVITY SHUNT 1028.84 62223 ESTABLISH BRAIN CAVITY SHUNT 1063.44 62225 REPLACE/IRRIGATE CATHETER 528.37 62230 REPLACE/REVISE BRAIN SHUNT 850.63 62252 CSF SHUNT REPROGRAM TC 39.15 62252 CSF SHUNT REPROGRAM 26 46.43 Proc Code Description Mod Rate 62252 CSF SHUNT REPROGRAM 85.59 62256 REMOVE BRAIN CAVITY SHUNT 605.92 62258 REPLACE BRAIN CAVITY SHUNT 1136.53 62263 EPIDURAL LYSIS MULT SESSIONS 353.03 62264 EPIDURAL LYSIS ON SINGLE DAY 238.75 62267 INTERDISCAL PERQ ASPIR DX 161.23 62268 DRAIN SPINAL CORD CYST 262.42 62269 NEEDLE BIOPSY SPINAL CORD 268.92 62270 SPINAL FLUID TAP DIAGNOSTIC 79.37 62272 DRAIN CEREBRO SPINAL FLUID 86.04 62273 INJECT EPIDURAL PATCH 113.78 62280 TREAT SPINAL CORD LESION 173.73 62281 TREAT SPINAL CORD LESION 160.36 62282 TREAT SPINAL CANAL LESION 145.57 62284 INJECTION FOR MYELOGRAM 86.87 62287 PERCUTANEOUS DISKECTOMY 564.62 62290 INJECT FOR SPINE DISK X-RAY 174.87 62291 INJECT FOR SPINE DISK X-RAY 171.03 62292 INJECTION INTO DISK LESION 586.39 62294 INJECTION INTO SPINAL ARTERY 717.69 62302 Myelography lumbar injection 122.48 62303 Myelography lumbar injection 124.27 62304 Myelography lumbar injection 120.40 62305 Myelography lumbar injection 125.60 62310 INJECT SPINE CERV/THORACIC 72.32 62311 INJECT SPINE LUMBAR/SACRAL 70.89 62318 INJECT SPINE W/CATH CRV/THRC 77.07 62319 INJECT SPINE W/CATH LMB/SCRL 78.95 62350 IMPLANT SPINAL CANAL CATH 404.97 62351 IMPLANT SPINAL CANAL CATH 885.48 62355 REMOVE SPINAL CANAL CATHETER 268.06 62360 INSERT SPINE INFUSION DEVICE 314.84 62361 IMPLANT SPINE INFUSION PUMP 351.85 62362 IMPLANT SPINE INFUSION PUMP 389.41 62365 REMOVE SPINE INFUSION DEVICE 294.90 62367 ANALYZE SPINE INFUS PUMP 25.41 62368 ANALYZE SP INF PUMP W/REPROG 34.38 62369 Anal sp inf pmp w/reprg&fill 35.10 62370 ANL SP INF PMP W/MDREPRG&FIL 46.20 63001 REMOVE SPINE LAMINA 1/2 CRVL 1248.96 63003 REMOVE SPINE LAMINA 1/2 THRC 1247.54 63005 REMOVE SPINE LAMINA 1/2 LMBR 1194.45 63011 REMOVE SPINE LAMINA 1/2 SCRL 1101.31 63012 REMOVE LAMINA/FACETS LUMBAR 1203.77 63015 REMOVE SPINE LAMINA >2 CRVCL 1498.35 63016 REMOVE SPINE LAMINA >2 THRC 1530.62 Proc Code Description Mod Rate 63017 REMOVE SPINE LAMINA >2 LMBR 1261.84 63020 NECK SPINE DISK SURGERY 1182.27 63030 LOW BACK DISK SURGERY 980.44 63035 SPINAL DISK SURGERY ADD-ON 194.24 63040 LAMINOTOMY SINGLE CERVICAL 1420.91 63042 LAMINOTOMY SINGLE LUMBAR 1313.15 63043 LAMINOTOMY ADDL CERVICAL 535.76 63044 LAMINOTOMY ADDL LUMBAR 508.97 63045 REMOVE SPINE LAMINA 1 CRVL 1285.38 63046 REMOVE SPINE LAMINA 1 THRC 1223.21 63047 REMOVE SPINE LAMINA 1 LMBR 1113.76 63048 REMOVE SPINAL LAMINA ADD-ON 215.42 63050 CERVICAL LAMINOPLSTY 2/> SEG 1575.65 63051 C-LAMINOPLASTY W/GRAFT/PLATE 1731.09 63055 DECOMPRESS SPINAL CORD THRC 1642.43 63056 DECOMPRESS SPINAL CORD LMBR 1494.76 63057 DECOMPRESS SPINE CORD ADD-ON 324.64 63064 DECOMPRESS SPINAL CORD THRC 1789.15 63066 DECOMPRESS SPINE CORD ADD-ON 208.89 63075 NECK SPINE DISK SURGERY 1381.36 63076 NECK SPINE DISK SURGERY 251.76 63077 SPINE DISK SURGERY THORAX 1508.49 63078 SPINE DISK SURGERY THORAX 196.30 63081 REMOVE VERT BODY DCMPRN CRVL 1788.21 63082 REMOVE VERTEBRAL BODY ADD-ON 271.01 63085 REMOVE VERT BODY DCMPRN THRC 1915.63 63086 REMOVE VERTEBRAL BODY ADD-ON 191.99 63087 REMOV VERTBR DCMPRN THRCLMBR 2410.47 63088 REMOVE VERTEBRAL BODY ADD-ON 259.17 63090 REMOVE VERT BODY DCMPRN LMBR 1982.09 63091 REMOVE VERTEBRAL BODY ADD-ON 179.76 63101 REMOVE VERT BODY DCMPRN THRC 2341.47 63102 REMOVE VERT BODY DCMPRN LMBR 2261.18 63103 REMOVE VERTEBRAL BODY ADD-ON 294.18 63170 INCISE SPINAL CORD TRACT(S) 1605.93 63172 DRAINAGE OF SPINAL CYST 1422.93 63173 DRAINAGE OF SPINAL CYST 1741.25 63180 REVISE SPINAL CORD LIGAMENTS 1498.47 63182 REVISE SPINAL CORD LIGAMENTS 1476.63 63185 INCISE SPINE NRV HALF SEGMNT 1210.48 63190 INCISE SPINE NRV >2 SEGMNTS 1275.83 63191 INCISE SPINE ACCESSORY NERVE 1280.24 63194 INCISE SPINE & CORD CERVICAL 1255.64 63195 INCISE SPINE & CORD THORACIC 1549.89 63196 INCISE SPINE&CORD 2 TRX CRVL 1360.78 63197 INCISE SPINE&CORD 2 TRX THRC 1554.09 Proc Code Description Mod Rate 63198 INCISE SPIN&CORD 2 STGS CRVL 1602.35 63199 INCISE SPIN&CORD 2 STGS THRC 1681.14 63200 RELEASE SPINAL CORD LUMBAR 1553.89 63250 REVISE SPINAL CORD VSLS CRVL 2992.81 63251 REVISE SPINAL CORD VSLS THRC 3059.71 63252 REVISE SPINE CORD VSL THRLMB 3059.01 63265 EXCISE INTRASPINL LESION CRV 1686.80 63266 EXCISE INTRSPINL LESION THRC 1741.04 63267 EXCISE INTRSPINL LESION LMBR 1390.88 63268 EXCISE INTRSPINL LESION SCRL 1467.88 63270 EXCISE INTRSPINL LESION CRVL 2093.50 63271 EXCISE INTRSPINL LESION THRC 2091.26 63272 EXCISE INTRSPINL LESION LMBR 1923.66 63273 EXCISE INTRSPINL LESION SCRL 1880.37 63275 BX/EXC XDRL SPINE LESN CRVL 1820.01 63276 BX/EXC XDRL SPINE LESN THRC 1802.55 63277 BX/EXC XDRL SPINE LESN LMBR 1567.67 63278 BX/EXC XDRL SPINE LESN SCRL 1602.09 63280 BX/EXC IDRL SPINE LESN CRVL 2136.97 63281 BX/EXC IDRL SPINE LESN THRC 2110.31 63282 BX/EXC IDRL SPINE LESN LMBR 1994.73 63283 BX/EXC IDRL SPINE LESN SCRL 1915.54 63285 BX/EXC IDRL IMED LESN CERVL 2637.68 63286 BX/EXC IDRL IMED LESN THRC 2597.12 63287 BX/EXC IDRL IMED LESN THRLMB 2768.41 63290 BX/EXC XDRL/IDRL LSN ANY LVL 2810.57 63295 REPAIR LAMINECTOMY DEFECT 335.69 63300 REMOVE VERT XDRL BODY CRVCL 1855.39 63301 REMOVE VERT XDRL BODY THRC 2223.43 63302 REMOVE VERT XDRL BODY THRLMB 2195.92 63303 REMOV VERT XDRL BDY LMBR/SAC 2332.62 63304 REMOVE VERT IDRL BODY CRVCL 2368.89 63305 REMOVE VERT IDRL BODY THRC 2522.14 63306 REMOV VERT IDRL BDY THRCLMBR 2184.80 63307 REMOV VERT IDRL BDY LMBR/SAC 2426.80 63308 REMOVE VERTEBRAL BODY ADD-ON 323.69 63600 REMOVE SPINAL CORD LESION 915.55 63610 STIMULATION OF SPINAL CORD 388.67 63615 REMOVE LESION OF SPINAL CORD 1247.50 63620 SRS SPINAL LESION 1115.37 63621 SRS SPINAL LESION ADDL 251.58 63650 IMPLANT NEUROELECTRODES 416.26 63655 IMPLANT NEUROELECTRODES 834.83 63661 REMOVE SPINE ELTRD PERQ ARAY 322.17 63662 REMOVE SPINE ELTRD PLATE 775.86 63663 REVISE SPINE ELTRD PERQ ARAY 462.95 Proc Code Description Mod Rate 63664 REVISE SPINE ELTRD PLATE 803.02 63685 INSRT/REDO SPINE N GENERATOR 366.16 63688 REVISE/REMOVE NEURORECEIVER 370.03 63700 REPAIR OF SPINAL HERNIATION 1276.76 63702 REPAIR OF SPINAL HERNIATION 1403.65 63704 REPAIR OF SPINAL HERNIATION 1662.72 63706 REPAIR OF SPINAL HERNIATION 1817.51 63707 REPAIR SPINAL FLUID LEAKAGE 924.06 63709 REPAIR SPINAL FLUID LEAKAGE 1112.67 63710 GRAFT REPAIR OF SPINE DEFECT 1116.27 63740 INSTALL SPINAL SHUNT 953.38 63741 INSTALL SPINAL SHUNT 656.53 63744 REVISION OF SPINAL SHUNT 690.30 63746 REMOVAL OF SPINAL SHUNT 605.65 64400 N BLOCK INJ TRIGEMINAL 69.34 64402 N BLOCK INJ FACIAL 74.83 64405 N BLOCK INJ OCCIPITAL 63.21 64408 N BLOCK INJ VAGUS 73.43 64410 N BLOCK INJ PHRENIC 76.20 64412 N BLOCK INJ SPINAL ACCESSOR 73.20 64413 N BLOCK INJ CERVICAL PLEXUS 81.05 64415 N BLOCK INJ BRACHIAL PLEXUS 64.61 64416 N BLOCK CONT INFUSE B PLEX 78.04 64417 N BLOCK INJ AXILLARY 70.07 64418 N BLOCK INJ SUPRASCAPULAR 75.32 64420 N BLOCK INJ INTERCOST SNG 68.75 64421 N BLOCK INJ INTERCOST MLT 94.54 64425 N BLOCK INJ ILIO-ING/HYPOGI 94.77 64430 N BLOCK INJ PUDENDAL 81.91 64435 N BLOCK INJ PARACERVICAL 85.34 64445 N BLOCK INJ SCIATIC SNG 71.86 64446 N BLK INJ SCIATIC CONT INF 78.40 64447 N BLOCK INJ FEM SINGLE 65.29 64448 N BLOCK INJ FEM CONT INF 70.08 64449 N BLOCK INJ LUMBAR PLEXUS 81.99 64450 N BLOCK OTHER PERIPHERAL 45.76 64455 N BLOCK INJ PLANTAR DIGIT 35.38 64479 INJ FORAMEN EPIDURAL C/T 135.91 64480 INJ FORAMEN EPIDURAL ADD-ON 65.95 64483 INJ FORAMEN EPIDURAL L/S 113.45 64484 INJ FORAMEN EPIDURAL ADD-ON 52.51 64486 Tap block unil by injection 63.20 64487 Tap block uni by infusion 72.52 64488 Tap block bi injection 78.39 64489 Tap block bi by infusion 87.38 64490 INJ PARAVERT F JNT C/T 1 LEV 109.01 Proc Code Description Mod Rate 64491 INJ PARAVERT F JNT C/T 2 LEV 61.25 64492 INJ PARAVERT F JNT C/T 3 LEV 61.97 64493 INJ PARAVERT F JNT L/S 1 LEV 92.22 64494 INJ PARAVERT F JNT L/S 2 LEV 52.15 64495 INJ PARAVERT F JNT L/S 3 LEV 52.87 64505 N BLOCK SPENOPALATINE GANGL 86.00 64508 N BLOCK CAROTID SINUS S/P 78.77 64510 N BLOCK STELLATE GANGLION 74.05 64517 N BLOCK INJ HYPOGAS PLXS 120.12 64520 N BLOCK LUMBAR/THORACIC 80.65 64530 N BLOCK INJ CELIAC PELUS 92.82 64550 APPLY NEUROSTIMULATOR 9.02 64553 IMPLANT NEUROELECTRODES 156.07 64555 IMPLANT NEUROELECTRODES 150.20 64561 IMPLANT NEUROELECTRODES 396.76 64565 IMPLANT NEUROELECTRODES 131.35 64566 NEUROELTRD STIM POST TIBIAL POSTE 29.86 64568 INC FOR VAGUS N ELECT IMPL INCIS 614.97 64569 REVISE/REPL VAGUS N ELTRD REVIS 785.77 64570 REMOVE VAGUS N ELTRD REMOV 698.98 64575 IMPLANT NEUROELECTRODES 308.21 64580 IMPLANT NEUROELECTRODES 298.60 64581 IMPLANT NEUROELECTRODES 666.00 64585 REVISE/REMOVE NEUROELECTRODE 143.78 64590 INSRT/REDO PN/GASTR STIMUL 159.71 64595 REVISE/RMV PN/GASTR STIMUL 126.35 64600 INJECTION TREATMENT OF NERVE 215.29 64605 INJECTION TREATMENT OF NERVE 365.55 64610 INJECTION TREATMENT OF NERVE 488.03 64611 CHEMODENERV SALIV GLANDS CHEMO 99.13 64612 DESTROY NERVE FACE MUSCLE 124.20 64615 Chemodenerv musc migraine 127.57 64616 Chemodenerv musc neck dyston 108.17 64617 Chemodener muscle larynx emg 113.96 64620 INJECTION TREATMENT OF NERVE 173.62 64630 INJECTION TREATMENT OF NERVE 189.21 64632 N BLOCK INJ COMMON DIGIT 69.36 64633 Destroy cerv/thor facet jnt 229.75 64634 DESTROY C/TH FACET JNT ADDL 69.21 64635 Destroy lumb/sac facet jnt 226.25 64636 DESTROY L/S FACET JNT ADDL 60.49 64640 INJECTION TREATMENT OF NERVE 94.15 64642 Chemodenerv 1 extremity 1-4 107.38 64643 Chemodenerv 1 extrem 1-4 ea 71.74 64644 Chemodenerv 1 extrem 5/> mus 117.15 64645 Chemodenerv 1 extrem 5/> ea 82.27 Proc Code Description Mod Rate 64646 Chemodenerv trunk musc 1-5 116.11 64647 Chemodenerv trunk musc 6/> 133.94 64650 CHEMODENERV ECCRINE GLANDS 41.27 64653 CHEMODENERV ECCRINE GLANDS 54.44 64680 INJECTION TREATMENT OF NERVE 169.01 64681 INJECTION TREATMENT OF NERVE 189.24 64702 REVISE FINGER/TOE NERVE 497.59 64704 REVISE HAND/FOOT NERVE 319.02 64708 REVISE ARM/LEG NERVE 496.87 64712 REVISION OF SCIATIC NERVE 563.66 64713 REVISION OF ARM NERVE(S) 727.65 64714 REVISE LOW BACK NERVE(S) 634.80 64716 REVISION OF CRANIAL NERVE 542.69 64718 REVISE ULNAR NERVE AT ELBOW 594.86 64719 REVISE ULNAR NERVE AT WRIST 399.22 64721 CARPAL TUNNEL SURGERY 426.60 64722 RELIEVE PRESSURE ON NERVE(S) 368.82 64726 RELEASE FOOT/TOE NERVE 271.77 64727 INTERNAL NERVE REVISION 184.16 64732 INCISION OF BROW NERVE 415.86 64734 INCISION OF CHEEK NERVE 389.53 64736 INCISION OF CHIN NERVE 440.57 64738 INCISION OF JAW NERVE 486.54 64740 INCISION OF TONGUE NERVE 461.70 64742 INCISION OF FACIAL NERVE 505.88 64744 INCISE NERVE BACK OF HEAD 496.30 64746 INCISE DIAPHRAGM NERVE 435.74 64755 INCISION OF STOMACH NERVES 914.85 64760 INCISION OF VAGUS NERVE 511.53 64763 INCISE HIP/THIGH NERVE 506.55 64766 INCISE HIP/THIGH NERVE 560.38 64771 SEVER CRANIAL NERVE 586.73 64772 INCISION OF SPINAL NERVE 561.31 64774 REMOVE SKIN NERVE LESION 418.00 64776 REMOVE DIGIT NERVE LESION 392.52 64778 DIGIT NERVE SURGERY ADD-ON 155.08 64782 REMOVE LIMB NERVE LESION 451.36 64783 LIMB NERVE SURGERY ADD-ON 216.90 64784 REMOVE NERVE LESION 739.63 64786 REMOVE SCIATIC NERVE LESION 1085.70 64787 IMPLANT NERVE END 243.51 64788 REMOVE SKIN NERVE LESION 398.97 64790 REMOVAL OF NERVE LESION 829.02 64792 REMOVAL OF NERVE LESION 1198.68 64795 BIOPSY OF NERVE 195.47 64802 SYMPATHECTOMY CERVICAL 677.41 Proc Code Description Mod Rate 64804 REMOVE SYMPATHETIC NERVES 1030.61 64809 REMOVE SYMPATHETIC NERVES 712.04 64818 REMOVE SYMPATHETIC NERVES 646.15 64820 SYMPATHECTOMY DIGITAL ARTERY 729.57 64821 REMOVE SYMPATHETIC NERVES 701.88 64822 REMOVE SYMPATHETIC NERVES 701.88 64823 SYMPATHECTOMY SUPFC PALMAR 800.34 64831 REPAIR OF DIGIT NERVE 686.76 64832 REPAIR NERVE ADD-ON 339.95 64834 REPAIR OF HAND OR FOOT NERVE 744.41 64835 REPAIR OF HAND OR FOOT NERVE 816.73 64836 REPAIR OF HAND OR FOOT NERVE 816.73 64837 REPAIR NERVE ADD-ON 365.71 64840 REPAIR OF LEG NERVE 927.85 64856 REPAIR/TRANSPOSE NERVE 1014.00 64857 REPAIR ARM/LEG NERVE 1061.56 64858 REPAIR SCIATIC NERVE 1073.63 64859 NERVE SURGERY 259.63 64861 REPAIR OF ARM NERVES 1376.71 64862 REPAIR OF LOW BACK NERVES 1371.41 64864 REPAIR OF FACIAL NERVE 877.98 64865 REPAIR OF FACIAL NERVE 1122.07 64866 FUSION OF FACIAL/OTHER NERVE 1164.00 64868 FUSION OF FACIAL/OTHER NERVE 1027.82 64872 SUBSEQUENT REPAIR OF NERVE 119.57 64874 REPAIR & REVISE NERVE ADD-ON 168.91 64876 REPAIR NERVE/SHORTEN BONE 184.83 64885 NERVE GRAFT HEAD/NECK 4 CM 1306.16 64890 NERVE GRAFT HAND/FOOT 4 CM 1190.32 64892 NERVE GRAFT ARM/LEG <4 CM 1086.48 64893 NERVE GRAFT ARM/LEG >4 CM 1160.55 64895 NERVE GRAFT HAND/FOOT 4 CM 1600.50 64897 NERVE GRAFT ARM/LEG 4 CM 1381.62 64901 NERVE GRAFT ADD-ON 589.96 64902 NERVE GRAFT ADD-ON 682.68 64905 NERVE PEDICLE TRANSFER 1046.83 64907 NERVE PEDICLE TRANSFER 1218.26 64910 NERVE REPAIR W/ALLOGRAFT 827.56 64911 NEURORRAPHY W/VEIN AUTOGRAFT 1036.08 64999 NERVOUS SYSTEM SURGERY 0.00 65091 REVISE EYE 663.36 65093 REVISE EYE WITH IMPLANT 654.70 Proc Code Description Mod Rate 65101 REMOVAL OF EYE 768.76 65103 REMOVE EYE/INSERT IMPLANT 802.77 65105 REMOVE EYE/ATTACH IMPLANT 886.57 65110 REMOVAL OF EYE 1242.63 65112 REMOVE EYE/REVISE SOCKET 1441.64 65114 REMOVE EYE/REVISE SOCKET 1512.35 65125 REVISE OCULAR IMPLANT 305.27 65130 INSERT OCULAR IMPLANT 763.91 65135 INSERT OCULAR IMPLANT 775.10 65140 ATTACH OCULAR IMPLANT 820.51 65150 REVISE OCULAR IMPLANT 572.73 65155 REINSERT OCULAR IMPLANT 883.78 65175 REMOVAL OF OCULAR IMPLANT 667.30 65205 REMOVE FOREIGN BODY FROM EYE 45.90 65210 REMOVE FOREIGN BODY FROM EYE 55.01 65220 REMOVE FOREIGN BODY FROM EYE 43.05 65222 REMOVE FOREIGN BODY FROM EYE 54.67 65235 REMOVE FOREIGN BODY FROM EYE 724.08 65260 REMOVE FOREIGN BODY FROM EYE 949.98 65265 REMOVE FOREIGN BODY FROM EYE 1145.36 65270 REPAIR OF EYE WOUND 144.43 65272 REPAIR OF EYE WOUND 348.95 65273 REPAIR OF EYE WOUND 377.81 65275 REPAIR OF EYE WOUND 473.51 65280 REPAIR OF EYE WOUND 707.97 65285 REPAIR OF EYE WOUND 1158.29 65286 REPAIR OF EYE WOUND 507.78 65290 REPAIR OF EYE SOCKET WOUND 515.78 65400 REMOVAL OF EYE LESION 616.99 65410 BIOPSY OF CORNEA 111.28 65420 REMOVAL OF EYE LESION 380.34 65426 REMOVAL OF EYE LESION 489.69 65430 CORNEAL SMEAR 107.17 65435 CURETTE/TREAT CORNEA 72.53 65436 CURETTE/TREAT CORNEA 386.77 65450 TREATMENT OF CORNEAL LESION 328.33 65600 REVISION OF CORNEA 352.32 65710 CORNEAL TRANSPLANT 1131.42 65730 CORNEAL TRANSPLANT 1255.83 65750 CORNEAL TRANSPLANT 1259.02 65755 CORNEAL TRANSPLANT 1256.92 65756 CORNEAL TRNSPL ENDOTHELIAL 1174.92 65757 PREP CORNEAL ENDO ALLOGRAFT 0.00 65760 REVISION OF CORNEA 1291.97 65765 REVISION OF CORNEA 1498.68 65767 CORNEAL TISSUE TRANSPLANT 1394.78 Proc Code Description Mod Rate 65770 REVISE CORNEA WITH IMPLANT 1599.25 65771 RADIAL KERATOTOMY 759.47 65772 CORRECTION OF ASTIGMATISM 413.96 65775 CORRECTION OF ASTIGMATISM 547.50 65778 COVER EYE W/MEMBRANE 73.87 65779 COVER EYE W/MEMBRANE SUTURE 292.10 65780 OCULAR RECONST TRANSPLANT 906.07 65781 OCULAR RECONST TRANSPLANT 1322.74 65782 OCULAR RECONST TRANSPLANT 1212.62 65800 DRAINAGE OF EYE 94.85 65810 DRAINAGE OF EYE 476.85 65815 DRAINAGE OF EYE 496.99 65820 RELIEVE INNER EYE PRESSURE 744.04 65850 INCISION OF EYE 876.06 65855 LASER SURGERY OF EYE 307.88 65860 INCISE INNER EYE ADHESIONS 289.68 65865 INCISE INNER EYE ADHESIONS 468.64 65870 INCISE INNER EYE ADHESIONS 614.39 65875 INCISE INNER EYE ADHESIONS 644.14 65880 INCISE INNER EYE ADHESIONS 658.47 65900 REMOVE EYE LESION 955.78 65920 REMOVE IMPLANT OF EYE 803.49 65930 REMOVE BLOOD CLOT FROM EYE 664.23 66020 INJECTION TREATMENT OF EYE 130.38 66030 INJECTION TREATMENT OF EYE 112.80 66130 REMOVE EYE LESION 604.52 66150 GLAUCOMA SURGERY 869.77 66155 GLAUCOMA SURGERY 869.07 66160 GLAUCOMA SURGERY 980.40 66170 GLAUCOMA SURGERY 1222.93 66172 INCISION OF EYE 1541.97 66174 TRANSLUM DIL EYE CANAL TRANS 988.39 66175 TRNSLUM DIL EYE CANAL W/STNT TRANS 1125.34 66179 Aqueous shunt eye w/o graft 1073.69 66180 AQUEOUS SHUNT EYE W/GRAFT 1190.40 66183 Insert ant drainage device 1071.83 66184 Revision of aqueous shunt 784.00 66185 REVISE AQUEOUS SHUNT EYE 780.48 66220 REPAIR EYE LESION 761.08 66225 REPAIR/GRAFT EYE LESION 981.61 66250 FOLLOW-UP SURGERY OF EYE 586.03 66500 INCISION OF IRIS 351.73 66505 INCISION OF IRIS 385.54 66600 REMOVE IRIS AND LESION 828.21 66605 REMOVAL OF IRIS 1048.39 66625 REMOVAL OF IRIS 438.83 Proc Code Description Mod Rate 66630 REMOVAL OF IRIS 590.79 66635 REMOVAL OF IRIS 570.77 66680 REPAIR IRIS & CILIARY BODY 546.34 66682 REPAIR IRIS & CILIARY BODY 667.22 66700 DESTRUCTION CILIARY BODY 394.94 66710 CILIARY TRANSSLERAL THERAPY 414.15 66711 CILIARY ENDOSCOPIC ABLATION 638.02 66720 DESTRUCTION CILIARY BODY 429.62 66740 DESTRUCTION CILIARY BODY 389.66 66761 REVISION OF IRIS 242.62 66762 REVISION OF IRIS 433.59 66770 REMOVAL OF INNER EYE LESION 479.88 66820 INCISION SECONDARY CATARACT 404.85 66821 AFTER CATARACT LASER SURGERY 319.90 66825 REPOSITION INTRAOCULAR LENS 773.86 66830 REMOVAL OF LENS LESION 707.18 66840 REMOVAL OF LENS MATERIAL 733.34 66850 REMOVAL OF LENS MATERIAL 812.45 66852 REMOVAL OF LENS MATERIAL 881.07 66920 EXTRACTION OF LENS 748.04 66930 EXTRACTION OF LENS 849.98 66940 EXTRACTION OF LENS 812.53 66982 CATARACT SURGERY COMPLEX 822.32 66983 CATARACT SURG W/IOL 1 STAGE 743.38 66984 CATARACT SURG W/IOL 1 STAGE 661.23 66985 INSERT LENS PROSTHESIS 785.91 66986 EXCHANGE LENS PROSTHESIS 926.53 66990 OPHTHALMIC ENDOSCOPE ADD-ON 89.67 66999 EYE SURGERY PROCEDURE 0.00 67005 PARTIAL REMOVAL OF EYE FLUID 499.33 67010 PARTIAL REMOVAL OF EYE FLUID 555.96 67015 RELEASE OF EYE FLUID 593.53 67025 REPLACE EYE FLUID 659.29 67027 IMPLANT EYE DRUG SYSTEM 888.99 67028 INJECTION EYE DRUG 102.88 67030 INCISE INNER EYE STRANDS 528.38 67031 LASER SURGERY EYE STRANDS 363.65 67036 REMOVAL OF INNER EYE FLUID 982.45 67039 LASER TREATMENT OF RETINA 1287.96 67040 LASER TREATMENT OF RETINA 1454.19 67041 Vit for macular pucker 1358.90 67042 Vit for macular hole 1553.19 67043 Vit for membrane dissect 1665.33 67101 REPAIR DETACHED RETINA 702.36 67105 REPAIR DETACHED RETINA 659.85 67107 REPAIR DETACHED RETINA 1268.95 Proc Code Description Mod Rate 67108 REPAIR DETACHED RETINA 1645.67 67110 REPAIR DETACHED RETINA 790.12 67112 REREPAIR DETACHED RETINA 1359.71 67113 REPAIR RETINAL DETACH CPLX 1790.02 67115 RELEASE ENCIRCLING MATERIAL 508.54 67120 REMOVE EYE IMPLANT MATERIAL 587.11 67121 REMOVE EYE IMPLANT MATERIAL 948.02 67141 TREATMENT OF RETINA 507.90 67145 TREATMENT OF RETINA 509.35 67208 TREATMENT OF RETINAL LESION 573.86 67210 TREATMENT OF RETINAL LESION 514.45 67218 TREATMENT OF RETINAL LESION 1371.75 67220 TREATMENT OF CHOROID LESION 521.23 67221 OCULAR PHOTODYNAMIC THER 220.30 67225 EYE PHOTODYNAMIC THER ADD-ON 27.91 67227 TREATMENT OF RETINAL LESION 566.90 67228 TREATMENT OF RETINAL LESION 979.86 67229 Tr retinal les preterm inf 1099.75 67250 REINFORCE EYE WALL 809.06 67255 REINFORCE/GRAFT EYE WALL 881.18 67311 REVISE EYE MUSCLE 621.26 67312 REVISE TWO EYE MUSCLES 750.94 67314 REVISE EYE MUSCLE 699.04 67316 REVISE TWO EYE MUSCLES 844.16 67318 REVISE EYE MUSCLE(S) 699.87 67320 REVISE EYE MUSCLE(S) ADD-ON 319.22 67331 EYE SURGERY FOLLOW-UP ADD-ON 321.25 67332 REREVISE EYE MUSCLES ADD-ON 348.95 67334 REVISE EYE MUSCLE W/SUTURE 298.99 67335 EYE SUTURE DURING SURGERY 156.24 67340 REVISE EYE MUSCLE ADD-ON 355.53 67343 RELEASE EYE TISSUE 686.64 67345 DESTROY NERVE OF EYE MUSCLE 231.35 67346 BIOPSY EYE MUSCLE 207.22 67400 EXPLORE/BIOPSY EYE SOCKET 968.11 67405 EXPLORE/DRAIN EYE SOCKET 803.69 67412 EXPLORE/TREAT EYE SOCKET 883.96 67413 EXPLORE/TREAT EYE SOCKET 890.76 67414 EXPLR/DECOMPRESS EYE SOCKET 1349.23 67415 ASPIRATION ORBITAL CONTENTS 107.75 67420 EXPLORE/TREAT EYE SOCKET 1692.97 67430 EXPLORE/TREAT EYE SOCKET 1237.54 67440 EXPLORE/DRAIN EYE SOCKET 1227.55 67445 EXPLR/DECOMPRESS EYE SOCKET 1472.37 67450 EXPLORE/BIOPSY EYE SOCKET 1268.60 67500 INJECT/TREAT EYE SOCKET 71.50 Proc Code Description Mod Rate 67505 INJECT/TREAT EYE SOCKET 87.14 67515 INJECT/TREAT EYE SOCKET 94.44 67550 INSERT EYE SOCKET IMPLANT 1004.07 67560 REVISE EYE SOCKET IMPLANT 1004.23 67570 DECOMPRESS OPTIC NERVE 1278.73 67700 DRAINAGE OF EYELID ABSCESS 119.88 67710 INCISION OF EYELID 102.16 67715 INCISION OF EYELID FOLD 113.71 67800 REMOVE EYELID LESION 108.03 67801 REMOVE EYELID LESIONS 140.72 67805 REMOVE EYELID LESIONS 173.21 67808 REMOVE EYELID LESION(S) 385.85 67810 BIOPSY EYELID & LID MARGIN 72.09 67820 REVISE EYELASHES 55.61 67825 REVISE EYELASHES 126.72 67830 REVISE EYELASHES 144.57 67835 REVISE EYELASHES 461.77 67840 REMOVE EYELID LESION 163.69 67850 TREAT EYELID LESION 136.51 67875 CLOSURE OF EYELID BY SUTURE 101.68 67880 REVISION OF EYELID 382.83 67882 REVISION OF EYELID 495.73 67900 REPAIR BROW DEFECT 529.16 67901 REPAIR EYELID DEFECT 605.40 67902 REPAIR EYELID DEFECT 760.38 67903 REPAIR EYELID DEFECT 507.90 67904 REPAIR EYELID DEFECT 625.92 67906 REPAIR EYELID DEFECT 504.38 67908 REPAIR EYELID DEFECT 445.48 67909 REVISE EYELID DEFECT 458.00 67911 REVISE EYELID DEFECT 588.53 67912 CORRECTION EYELID W/IMPLANT 500.79 67914 REPAIR EYELID DEFECT 339.64 67915 REPAIR EYELID DEFECT 201.75 67916 REPAIR EYELID DEFECT 447.15 67917 REPAIR EYELID DEFECT 478.90 67921 REPAIR EYELID DEFECT 324.36 67922 REPAIR EYELID DEFECT 201.37 67923 REPAIR EYELID DEFECT 450.15 67924 REPAIR EYELID DEFECT 479.65 67930 REPAIR EYELID WOUND 252.28 67935 REPAIR EYELID WOUND 464.36 67938 REMOVE EYELID FOREIGN BODY 119.18 67950 REVISION OF EYELID 482.36 67961 REVISION OF EYELID 475.42 67966 REVISION OF EYELID 689.38 Proc Code Description Mod Rate 67971 RECONSTRUCTION OF EYELID 761.50 67973 RECONSTRUCTION OF EYELID 981.24 67974 RECONSTRUCTION OF EYELID 980.22 67975 RECONSTRUCTION OF EYELID 719.79 68020 INCISE/DRAIN EYELID LINING 113.69 68040 TREATMENT OF EYELID LESIONS 55.43 68100 BIOPSY OF EYELID LINING 100.18 68110 REMOVE EYELID LINING LESION 155.57 68115 REMOVE EYELID LINING LESION 187.82 68130 REMOVE EYELID LINING LESION 408.76 68135 REMOVE EYELID LINING LESION 154.58 68200 TREAT EYELID BY INJECTION 36.22 68320 REVISE/GRAFT EYELID LINING 564.78 68325 REVISE/GRAFT EYELID LINING 691.79 68326 REVISE/GRAFT EYELID LINING 678.46 68328 REVISE/GRAFT EYELID LINING 744.42 68330 REVISE EYELID LINING 483.90 68335 REVISE/GRAFT EYELID LINING 681.27 68340 SEPARATE EYELID ADHESIONS 419.43 68360 REVISE EYELID LINING 432.04 68362 REVISE EYELID LINING 691.10 68371 HARVEST EYE TISSUE ALOGRAFT 409.50 68400 INCISE/DRAIN TEAR GLAND 138.48 68420 INCISE/DRAIN TEAR SAC 171.76 68440 INCISE TEAR DUCT OPENING 102.99 68500 REMOVAL OF TEAR GLAND 1043.25 68505 PARTIAL REMOVAL TEAR GLAND 1020.27 68510 BIOPSY OF TEAR GLAND 311.89 68520 REMOVAL OF TEAR SAC 699.91 68525 BIOPSY OF TEAR SAC 280.91 68530 CLEARANCE OF TEAR DUCT 271.95 68540 REMOVE TEAR GLAND LESION 947.50 68550 REMOVE TEAR GLAND LESION 1160.94 68700 REPAIR TEAR DUCTS 634.39 68705 REVISE TEAR DUCT OPENING 174.17 68720 CREATE TEAR SAC DRAIN 784.43 68745 CREATE TEAR DUCT DRAIN 799.38 68750 CREATE TEAR DUCT DRAIN 824.18 68760 CLOSE TEAR DUCT OPENING 153.13 68761 CLOSE TEAR DUCT OPENING 123.08 68770 CLOSE TEAR SYSTEM FISTULA 661.41 68801 DILATE TEAR DUCT OPENING 110.08 68810 PROBE NASOLACRIMAL DUCT 194.53 68811 PROBE NASOLACRIMAL DUCT 215.68 68815 PROBE NASOLACRIMAL DUCT 268.15 68816 Probe nl duct w/balloon 261.78 Proc Code Description Mod Rate 68840 EXPLORE/IRRIGATE TEAR DUCTS 121.88 68850 INJECTION FOR TEAR SAC X-RAY 55.02 69000 DRAIN EXTERNAL EAR LESION 121.12 69005 DRAIN EXTERNAL EAR LESION 158.80 69020 DRAIN OUTER EAR CANAL LESION 144.36 69100 BIOPSY OF EXTERNAL EAR 48.97 69105 BIOPSY OF EXTERNAL EAR CANAL 64.31 69110 REMOVE EXTERNAL EAR PARTIAL 326.52 69120 REMOVAL OF EXTERNAL EAR 411.67 69140 REMOVE EAR CANAL LESION(S) 888.34 69145 REMOVE EAR CANAL LESION(S) 253.76 69150 EXTENSIVE EAR CANAL SURGERY 1060.40 69155 EXTENSIVE EAR/NECK SURGERY 1685.54 69200 CLEAR OUTER EAR CANAL 58.72 69205 CLEAR OUTER EAR CANAL 102.87 69210 REMOVE IMPACTED EAR WAX UNI 33.11 69220 CLEAN OUT MASTOID CAVITY 62.91 69222 CLEAN OUT MASTOID CAVITY 138.73 69300 REVISE EXTERNAL EAR 480.67 69310 REBUILD OUTER EAR CANAL 1104.26 69320 REBUILD OUTER EAR CANAL 1543.99 69420 INCISION OF EARDRUM 122.34 69421 INCISION OF EARDRUM 150.78 69424 REMOVE VENTILATING TUBE 62.88 69433 CREATE EARDRUM OPENING 134.99 69436 CREATE EARDRUM OPENING 162.62 69440 EXPLORATION OF MIDDLE EAR 701.27 69450 EARDRUM REVISION 553.72 69501 MASTOIDECTOMY 742.63 69502 MASTOIDECTOMY 986.51 69505 REMOVE MASTOID STRUCTURES 1217.70 69511 EXTENSIVE MASTOID SURGERY 1246.99 69530 EXTENSIVE MASTOID SURGERY 1669.51 69535 REMOVE PART OF TEMPORAL BONE 2708.95 69540 REMOVE EAR LESION 129.01 69550 REMOVE EAR LESION 1053.66 69552 REMOVE EAR LESION 1585.36 69554 REMOVE EAR LESION 2543.26 69601 MASTOID SURGERY REVISION 1061.39 69602 MASTOID SURGERY REVISION 1104.35 69603 MASTOID SURGERY REVISION 1274.17 69604 MASTOID SURGERY REVISION 1128.40 69605 MASTOID SURGERY REVISION 1576.04 69610 REPAIR OF EARDRUM 294.36 69620 REPAIR OF EARDRUM 493.57 69631 REPAIR EARDRUM STRUCTURES 898.52 Proc Code Description Mod Rate 69632 REBUILD EARDRUM STRUCTURES 1095.23 69633 REBUILD EARDRUM STRUCTURES 1059.68 69635 REPAIR EARDRUM STRUCTURES 1246.93 69636 REBUILD EARDRUM STRUCTURES 1394.95 69637 REBUILD EARDRUM STRUCTURES 1390.53 69641 REVISE MIDDLE EAR & MASTOID 1057.32 69642 REVISE MIDDLE EAR & MASTOID 1356.42 69643 REVISE MIDDLE EAR & MASTOID 1241.76 69644 REVISE MIDDLE EAR & MASTOID 1494.03 69645 REVISE MIDDLE EAR & MASTOID 1469.78 69646 REVISE MIDDLE EAR & MASTOID 1558.58 69650 RELEASE MIDDLE EAR BONE 815.99 69660 REVISE MIDDLE EAR BONE 939.49 69661 REVISE MIDDLE EAR BONE 1223.20 69662 REVISE MIDDLE EAR BONE 1170.65 69666 REPAIR MIDDLE EAR STRUCTURES 820.89 69667 REPAIR MIDDLE EAR STRUCTURES 822.31 69670 REMOVE MASTOID AIR CELLS 957.92 69676 REMOVE MIDDLE EAR NERVE 844.90 69700 CLOSE MASTOID FISTULA 696.25 69710 IMPLANT/REPLACE HEARING AID 2758.07 69711 REMOVE/REPAIR HEARING AID 875.34 69714 IMPLANT TEMPLE BONE W/STIMUL 1090.31 69715 TEMPLE BNE IMPLNT W/STIMULAT 1344.70 69717 TEMPLE BONE IMPLANT REVISION 1143.98 69718 REVISE TEMPLE BONE IMPLANT 1358.65 69720 RELEASE FACIAL NERVE 1211.60 69725 RELEASE FACIAL NERVE 1902.60 69740 REPAIR FACIAL NERVE 1182.48 69745 REPAIR FACIAL NERVE 1258.10 69801 INCISE INNER EAR 127.36 69805 EXPLORE INNER EAR 1067.99 69806 EXPLORE INNER EAR 960.07 69820 ESTABLISH INNER EAR WINDOW 870.49 69840 REVISE INNER EAR WINDOW 898.66 69905 REMOVE INNER EAR 932.50 69910 REMOVE INNER EAR & MASTOID 1031.24 69915 INCISE INNER EAR NERVE 1558.36 69930 IMPLANT COCHLEAR DEVICE 1239.36 69950 INCISE INNER EAR NERVE 1801.37 69955 RELEASE FACIAL NERVE 2001.68 69960 RELEASE INNER EAR CANAL 1946.03 69970 REMOVE INNER EAR LESION 2167.03 69990 MICROSURGERY ADD-ON 218.56 70010 CONTRAST X-RAY OF BRAIN 67.62 70015 CONTRAST X-RAY OF BRAIN TC 99.03 Proc Code Description Mod Rate 70015 CONTRAST X-RAY OF BRAIN 26 62.07 70015 CONTRAST X-RAY OF BRAIN 161.11 70030 X-RAY EYE FOR FOREIGN BODY TC 22.69 70030 X-RAY EYE FOR FOREIGN BODY 26 8.76 70030 X-RAY EYE FOR FOREIGN BODY 31.45 70100 X-RAY EXAM OF JAW <4VIEWS TC 27.60 70100 X-RAY EXAM OF JAW <4VIEWS 26 9.49 70100 X-RAY EXAM OF JAW <4VIEWS 37.10 70110 X-RAY EXAM OF JAW 4/> VIEWS TC 29.49 70110 X-RAY EXAM OF JAW 4/> VIEWS 26 13.14 70110 X-RAY EXAM OF JAW 4/> VIEWS 42.63 70120 X-RAY EXAM OF MASTOIDS TC 29.11 70120 X-RAY EXAM OF MASTOIDS 26 9.49 70120 X-RAY EXAM OF MASTOIDS 38.61 70130 X-RAY EXAM OF MASTOIDS TC 44.23 70130 X-RAY EXAM OF MASTOIDS 26 17.50 70130 X-RAY EXAM OF MASTOIDS 61.73 70134 X-RAY EXAM OF MIDDLE EAR TC 40.45 70134 X-RAY EXAM OF MIDDLE EAR 26 18.63 70134 X-RAY EXAM OF MIDDLE EAR 59.09 70140 X-RAY EXAM OF FACIAL BONES TC 21.56 70140 X-RAY EXAM OF FACIAL BONES 26 10.61 70140 X-RAY EXAM OF FACIAL BONES 32.17 70150 X-RAY EXAM OF FACIAL BONES TC 32.14 70150 X-RAY EXAM OF FACIAL BONES 26 13.49 70150 X-RAY EXAM OF FACIAL BONES 45.64 70160 X-RAY EXAM OF NASAL BONES TC 27.22 70160 X-RAY EXAM OF NASAL BONES 26 9.13 70160 X-RAY EXAM OF NASAL BONES 36.36 70170 X-RAY EXAM OF TEAR DUCT TC 36.20 70170 X-RAY EXAM OF TEAR DUCT 26 16.10 70170 X-RAY EXAM OF TEAR DUCT 51.40 70190 X-RAY EXAM OF EYE SOCKETS TC 27.60 70190 X-RAY EXAM OF EYE SOCKETS 26 11.32 70190 X-RAY EXAM OF EYE SOCKETS 38.93 70200 X-RAY EXAM OF EYE SOCKETS TC 32.14 70200 X-RAY EXAM OF EYE SOCKETS 26 14.59 70200 X-RAY EXAM OF EYE SOCKETS 46.73 70210 X-RAY EXAM OF SINUSES TC 23.82 70210 X-RAY EXAM OF SINUSES 26 9.13 70210 X-RAY EXAM OF SINUSES 32.96 70220 X-RAY EXAM OF SINUSES TC 28.36 70220 X-RAY EXAM OF SINUSES 26 13.14 70220 X-RAY EXAM OF SINUSES 41.50 70240 X-RAY EXAM PITUITARY SADDLE TC 22.69 70240 X-RAY EXAM PITUITARY SADDLE 26 10.23 Proc Code Description Mod Rate 70240 X-RAY EXAM PITUITARY SADDLE 32.92 70250 X-RAY EXAM OF SKULL TC 26.85 70250 X-RAY EXAM OF SKULL 26 13.15 70250 X-RAY EXAM OF SKULL 40.01 70260 X-RAY EXAM OF SKULL TC 32.89 70260 X-RAY EXAM OF SKULL 26 17.87 70260 X-RAY EXAM OF SKULL 50.77 70300 X-RAY EXAM OF TEETH TC 9.84 70300 X-RAY EXAM OF TEETH 26 6.25 70300 X-RAY EXAM OF TEETH 16.09 70310 X-RAY EXAM OF TEETH TC 32.52 70310 X-RAY EXAM OF TEETH 26 8.40 70310 X-RAY EXAM OF TEETH 40.92 70320 FULL MOUTH X-RAY OF TEETH TC 44.23 70320 FULL MOUTH X-RAY OF TEETH 26 12.44 70320 FULL MOUTH X-RAY OF TEETH 56.67 70328 X-RAY EXAM OF JAW JOINT TC 24.20 70328 X-RAY EXAM OF JAW JOINT 26 9.87 70328 X-RAY EXAM OF JAW JOINT 34.08 70330 X-RAY EXAM OF JAW JOINTS TC 39.32 70330 X-RAY EXAM OF JAW JOINTS 26 13.15 70330 X-RAY EXAM OF JAW JOINTS 52.48 70332 X-RAY EXAM OF JAW JOINT TC 56.33 70332 X-RAY EXAM OF JAW JOINT 26 32.26 70332 X-RAY EXAM OF JAW JOINT 88.59 70336 MAGNETIC IMAGE JAW JOINT TC 266.45 70336 MAGNETIC IMAGE JAW JOINT 26 76.27 70336 MAGNETIC IMAGE JAW JOINT 342.73 70350 X-RAY HEAD FOR ORTHODONTIA TC 12.49 70350 X-RAY HEAD FOR ORTHODONTIA 26 10.27 70350 X-RAY HEAD FOR ORTHODONTIA 22.76 70355 PANORAMIC X-RAY OF JAWS TC 10.60 70355 PANORAMIC X-RAY OF JAWS 26 11.34 70355 PANORAMIC X-RAY OF JAWS 21.94 70360 X-RAY EXAM OF NECK TC 22.31 70360 X-RAY EXAM OF NECK 26 8.76 70360 X-RAY EXAM OF NECK 31.07 70370 THROAT X-RAY & FLUOROSCOPY TC 69.93 70370 THROAT X-RAY & FLUOROSCOPY 26 16.02 70370 THROAT X-RAY & FLUOROSCOPY 85.96 70371 SPEECH EVALUATION COMPLEX TC 53.68 70371 SPEECH EVALUATION COMPLEX 26 44.16 70371 SPEECH EVALUATION COMPLEX 97.84 70373 CONTRAST X-RAY OF LARYNX TC 69.55 70373 CONTRAST X-RAY OF LARYNX 26 22.97 70373 CONTRAST X-RAY OF LARYNX 92.53 Proc Code Description Mod Rate 70380 X-RAY EXAM OF SALIVARY GLAND TC 31.38 70380 X-RAY EXAM OF SALIVARY GLAND 26 9.51 70380 X-RAY EXAM OF SALIVARY GLAND 40.90 70390 X-RAY EXAM OF SALIVARY DUCT TC 88.07 70390 X-RAY EXAM OF SALIVARY DUCT 26 20.10 70390 X-RAY EXAM OF SALIVARY DUCT 108.18 70450 CT HEAD/BRAIN W/O DYE TC 86.56 70450 CT HEAD/BRAIN W/O DYE 26 43.78 70450 CT HEAD/BRAIN W/O DYE 130.34 70460 CT HEAD/BRAIN W/DYE TC 119.82 70460 CT HEAD/BRAIN W/DYE 26 58.37 70460 CT HEAD/BRAIN W/DYE 178.19 70470 CT HEAD/BRAIN W/O & W/DYE TC 148.16 70470 CT HEAD/BRAIN W/O & W/DYE 26 66.07 70470 CT HEAD/BRAIN W/O & W/DYE 214.24 70480 CT ORBIT/EAR/FOSSA W/O DYE TC 198.81 70480 CT ORBIT/EAR/FOSSA W/O DYE 26 66.43 70480 CT ORBIT/EAR/FOSSA W/O DYE 265.24 70481 CT ORBIT/EAR/FOSSA W/DYE TC 237.35 70481 CT ORBIT/EAR/FOSSA W/DYE 26 71.93 70481 CT ORBIT/EAR/FOSSA W/DYE 309.29 70482 CT ORBIT/EAR/FOSSA W/O&W/DYE TC 266.83 70482 CT ORBIT/EAR/FOSSA W/O&W/DYE 26 75.19 70482 CT ORBIT/EAR/FOSSA W/O&W/DYE 342.03 70486 CT MAXILLOFACIAL W/O DYE TC 159.12 70486 CT MAXILLOFACIAL W/O DYE 26 59.11 70486 CT MAXILLOFACIAL W/O DYE 218.24 70487 CT MAXILLOFACIAL W/DYE TC 196.92 70487 CT MAXILLOFACIAL W/DYE 26 67.53 70487 CT MAXILLOFACIAL W/DYE 264.45 70488 CT MAXILLOFACIAL W/O & W/DYE TC 243.02 70488 CT MAXILLOFACIAL W/O & W/DYE 26 73.74 70488 CT MAXILLOFACIAL W/O & W/DYE 316.77 70490 CT SOFT TISSUE NECK W/O DYE TC 149.30 70490 CT SOFT TISSUE NECK W/O DYE 26 66.43 70490 CT SOFT TISSUE NECK W/O DYE 215.73 70491 CT SOFT TISSUE NECK W/DYE TC 187.47 70491 CT SOFT TISSUE NECK W/DYE 26 71.53 70491 CT SOFT TISSUE NECK W/DYE 259.00 70492 CT SFT TSUE NCK W/O & W/DYE TC 232.82 70492 CT SFT TSUE NCK W/O & W/DYE 26 75.19 70492 CT SFT TSUE NCK W/O & W/DYE 308.02 70496 CT ANGIOGRAPHY HEAD TC 381.72 70496 CT ANGIOGRAPHY HEAD 26 90.90 70496 CT ANGIOGRAPHY HEAD 472.63 70498 CT ANGIOGRAPHY NECK TC 400.24 Proc Code Description Mod Rate 70498 CT ANGIOGRAPHY NECK 26 90.52 70498 CT ANGIOGRAPHY NECK 490.77 70540 MRI ORBIT/FACE/NECK W/O DYE TC 312.56 70540 MRI ORBIT/FACE/NECK W/O DYE 26 70.10 70540 MRI ORBIT/FACE/NECK W/O DYE 382.66 70542 MRI ORBIT/FACE/NECK W/DYE TC 352.62 70542 MRI ORBIT/FACE/NECK W/DYE 26 84.35 70542 MRI ORBIT/FACE/NECK W/DYE 436.98 70543 MRI ORBT/FAC/NCK W/O &W/DYE TC 423.67 70543 MRI ORBT/FAC/NCK W/O &W/DYE 26 110.93 70543 MRI ORBT/FAC/NCK W/O &W/DYE 534.61 70544 MR ANGIOGRAPHY HEAD W/O DYE TC 366.98 70544 MR ANGIOGRAPHY HEAD W/O DYE 26 62.43 70544 MR ANGIOGRAPHY HEAD W/O DYE 429.42 70545 MR ANGIOGRAPHY HEAD W/DYE TC 360.94 70545 MR ANGIOGRAPHY HEAD W/DYE 26 62.43 70545 MR ANGIOGRAPHY HEAD W/DYE 423.37 70546 MR ANGIOGRAPH HEAD W/O&W/DYE TC 551.79 70546 MR ANGIOGRAPH HEAD W/O&W/DYE 26 93.85 70546 MR ANGIOGRAPH HEAD W/O&W/DYE 645.64 70547 MR ANGIOGRAPHY NECK W/O DYE TC 368.12 70547 MR ANGIOGRAPHY NECK W/O DYE 26 62.43 70547 MR ANGIOGRAPHY NECK W/O DYE 430.55 70548 MR ANGIOGRAPHY NECK W/DYE TC 389.66 70548 MR ANGIOGRAPHY NECK W/DYE 26 62.43 70548 MR ANGIOGRAPHY NECK W/DYE 452.10 70549 MR ANGIOGRAPH NECK W/O&W/DYE TC 556.33 70549 MR ANGIOGRAPH NECK W/O&W/DYE 26 93.45 70549 MR ANGIOGRAPH NECK W/O&W/DYE 649.78 70551 MRI BRAIN STEM W/O DYE TC 181.80 70551 MRI BRAIN STEM W/O DYE 26 76.65 70551 MRI BRAIN STEM W/O DYE 258.45 70552 MRI BRAIN STEM W/DYE TC 258.90 70552 MRI BRAIN STEM W/DYE 26 93.13 70552 MRI BRAIN STEM W/DYE 352.03 70553 MRI BRAIN STEM W/O & W/DYE TC 295.93 70553 MRI BRAIN STEM W/O & W/DYE 26 119.01 70553 MRI BRAIN STEM W/O & W/DYE 414.95 71010 CHEST X-RAY 1 VIEW FRONTAL TC 15.51 71010 CHEST X-RAY 1 VIEW FRONTAL 26 9.49 71010 CHEST X-RAY 1 VIEW FRONTAL 25.01 71015 CHEST X-RAY STEREO FRONTAL TC 21.18 71015 CHEST X-RAY STEREO FRONTAL 26 10.95 71015 CHEST X-RAY STEREO FRONTAL 32.13 71020 CHEST X-RAY 2VW FRONTAL&LATL TC 21.18 71020 CHEST X-RAY 2VW FRONTAL&LATL 26 11.30 Proc Code Description Mod Rate 71020 CHEST X-RAY 2VW FRONTAL&LATL 32.49 71021 CHEST X-RAY FRNT LAT LORDOTC TC 25.71 71021 CHEST X-RAY FRNT LAT LORDOTC 26 14.23 71021 CHEST X-RAY FRNT LAT LORDOTC 39.95 71022 CHEST X-RAY FRNT LAT OBLIQUE TC 32.52 71022 CHEST X-RAY FRNT LAT OBLIQUE 26 17.18 71022 CHEST X-RAY FRNT LAT OBLIQUE 49.70 71023 CHEST X-RAY AND FLUOROSCOPY TC 51.03 71023 CHEST X-RAY AND FLUOROSCOPY 26 19.31 71023 CHEST X-RAY AND FLUOROSCOPY 70.35 71030 CHEST X-RAY 4/> VIEWS TC 33.65 71030 CHEST X-RAY 4/> VIEWS 26 15.66 71030 CHEST X-RAY 4/> VIEWS 49.32 71034 CHEST X-RAY&FLUORO 4/> VIEWS TC 69.55 71034 CHEST X-RAY&FLUORO 4/> VIEWS 26 23.31 71034 CHEST X-RAY&FLUORO 4/> VIEWS 92.87 71035 CHEST X-RAY SPECIAL VIEWS TC 29.49 71035 CHEST X-RAY SPECIAL VIEWS 26 9.49 71035 CHEST X-RAY SPECIAL VIEWS 38.99 71100 X-RAY EXAM RIBS UNI 2 VIEWS TC 23.45 71100 X-RAY EXAM RIBS UNI 2 VIEWS 26 11.68 71100 X-RAY EXAM RIBS UNI 2 VIEWS 35.13 71101 X-RAY EXAM UNILAT RIBS/CHEST TC 28.74 71101 X-RAY EXAM UNILAT RIBS/CHEST 26 13.85 71101 X-RAY EXAM UNILAT RIBS/CHEST 42.59 71110 X-RAY EXAM RIBS BIL 3 VIEWS TC 29.49 71110 X-RAY EXAM RIBS BIL 3 VIEWS 26 14.23 71110 X-RAY EXAM RIBS BIL 3 VIEWS 43.73 71111 X-RAY EXAM RIBS/CHEST4/> VWS TC 40.45 71111 X-RAY EXAM RIBS/CHEST4/> VWS 26 16.78 71111 X-RAY EXAM RIBS/CHEST4/> VWS 57.24 71120 X-RAY EXAM BREASTBONE 2/>VWS TC 23.45 71120 X-RAY EXAM BREASTBONE 2/>VWS 26 10.59 71120 X-RAY EXAM BREASTBONE 2/>VWS 34.04 71130 X-RAY STRENOCLAVIC JT 3/>VWS TC 28.36 71130 X-RAY STRENOCLAVIC JT 3/>VWS 26 11.68 71130 X-RAY STRENOCLAVIC JT 3/>VWS 40.05 71250 CT THORAX W/O DYE TC 149.30 71250 CT THORAX W/O DYE 26 52.54 71250 CT THORAX W/O DYE 201.84 71260 CT THORAX W/DYE TC 188.22 71260 CT THORAX W/DYE 26 64.62 71260 CT THORAX W/DYE 252.85 71270 CT THORAX W/O & W/DYE TC 233.95 71270 CT THORAX W/O & W/DYE 26 71.15 71270 CT THORAX W/O & W/DYE 305.11 Proc Code Description Mod Rate 71275 CT ANGIOGRAPHY CHEST TC 294.80 71275 CT ANGIOGRAPHY CHEST 26 99.66 71275 CT ANGIOGRAPHY CHEST 394.47 71550 MRI CHEST W/O DYE TC 365.09 71550 MRI CHEST W/O DYE 26 75.55 71550 MRI CHEST W/O DYE 440.65 71551 MRI CHEST W/DYE TC 408.56 71551 MRI CHEST W/DYE 26 89.81 71551 MRI CHEST W/DYE 498.37 71552 MRI CHEST W/O & W/DYE TC 510.22 71552 MRI CHEST W/O & W/DYE 26 116.77 71552 MRI CHEST W/O & W/DYE 626.99 71555 MRI ANGIO CHEST W OR W/O DYE TC 345.82 71555 MRI ANGIO CHEST W OR W/O DYE 26 93.43 71555 MRI ANGIO CHEST W OR W/O DYE 439.26 72010 X-RAY EXAM SPINE AP&LAT TC 60.10 72010 X-RAY EXAM SPINE AP&LAT 26 24.50 72010 X-RAY EXAM SPINE AP&LAT 84.61 72020 X-RAY EXAM OF SPINE 1 VIEW TC 16.64 72020 X-RAY EXAM OF SPINE 1 VIEW 26 8.04 72020 X-RAY EXAM OF SPINE 1 VIEW 24.69 72040 X-RAY EXAM NECK SPINE 2-3 VW TC 26.09 72040 X-RAY EXAM NECK SPINE 2-3 VW 26 12.47 72040 X-RAY EXAM NECK SPINE 2-3 VW 38.57 72050 X-RAY EXAM NECK SPINE 4/5VWS TC 35.16 72050 X-RAY EXAM NECK SPINE 4/5VWS 26 16.84 72050 X-RAY EXAM NECK SPINE 4/5VWS 52.00 72052 X-RAY EXAM NECK SPINE 6/>VWS TC 47.25 72052 X-RAY EXAM NECK SPINE 6/>VWS 26 19.38 72052 X-RAY EXAM NECK SPINE 6/>VWS 66.64 72069 X-RAY EXAM TRUNK SPINE STAND TC 28.74 72069 X-RAY EXAM TRUNK SPINE STAND 26 12.47 72069 X-RAY EXAM TRUNK SPINE STAND 41.22 72070 X-RAY EXAM THORAC SPINE 2VWS TC 24.20 72070 X-RAY EXAM THORAC SPINE 2VWS 26 11.68 72070 X-RAY EXAM THORAC SPINE 2VWS 35.89 72072 X-RAY EXAM THORAC SPINE 3VWS TC 28.74 72072 X-RAY EXAM THORAC SPINE 3VWS 26 11.30 72072 X-RAY EXAM THORAC SPINE 3VWS 40.05 72074 X-RAY EXAM THORAC SPINE4/>VW TC 36.29 72074 X-RAY EXAM THORAC SPINE4/>VW 26 11.30 72074 X-RAY EXAM THORAC SPINE4/>VW 47.60 72080 X-RAY EXAM TRUNK SPINE 2 VWS TC 26.47 72080 X-RAY EXAM TRUNK SPINE 2 VWS 26 12.47 72080 X-RAY EXAM TRUNK SPINE 2 VWS 38.95 72090 X-RAY EXAM SCLOIOSIS ERECT TC 39.70 Proc Code Description Mod Rate 72090 X-RAY EXAM SCLOIOSIS ERECT 26 16.16 72090 X-RAY EXAM SCLOIOSIS ERECT 55.86 72100 X-RAY EXAM L-S SPINE 2/3 VWS TC 26.09 72100 X-RAY EXAM L-S SPINE 2/3 VWS 26 12.47 72100 X-RAY EXAM L-S SPINE 2/3 VWS 38.57 72110 X-RAY EXAM L-2 SPINE 4/>VWS TC 35.92 72110 X-RAY EXAM L-2 SPINE 4/>VWS 26 16.84 72110 X-RAY EXAM L-2 SPINE 4/>VWS 52.76 72114 X-RAY EXAM L-S SPINE BENDING TC 51.03 72114 X-RAY EXAM L-S SPINE BENDING 26 17.97 72114 X-RAY EXAM L-S SPINE BENDING 69.01 72120 X-RAY BEND ONLY L-S SPINE TC 31.00 72120 X-RAY BEND ONLY L-S SPINE 26 12.47 72120 X-RAY BEND ONLY L-S SPINE 43.48 72125 CT NECK SPINE W/O DYE TC 151.19 72125 CT NECK SPINE W/O DYE 26 55.09 72125 CT NECK SPINE W/O DYE 206.28 72126 CT NECK SPINE W/DYE TC 189.36 72126 CT NECK SPINE W/DYE 26 63.53 72126 CT NECK SPINE W/DYE 252.89 72127 CT NECK SPINE W/O & W/DYE TC 235.46 72127 CT NECK SPINE W/O & W/DYE 26 65.70 72127 CT NECK SPINE W/O & W/DYE 301.17 72128 CT CHEST SPINE W/O DYE TC 150.43 72128 CT CHEST SPINE W/O DYE 26 51.82 72128 CT CHEST SPINE W/O DYE 202.25 72129 CT CHEST SPINE W/DYE TC 189.36 72129 CT CHEST SPINE W/DYE 26 63.53 72129 CT CHEST SPINE W/DYE 252.89 72130 CT CHEST SPINE W/O & W/DYE TC 238.87 72130 CT CHEST SPINE W/O & W/DYE 26 65.70 72130 CT CHEST SPINE W/O & W/DYE 304.57 72131 CT LUMBAR SPINE W/O DYE TC 149.67 72131 CT LUMBAR SPINE W/O DYE 26 51.82 72131 CT LUMBAR SPINE W/O DYE 201.50 72132 CT LUMBAR SPINE W/DYE TC 188.60 72132 CT LUMBAR SPINE W/DYE 26 63.53 72132 CT LUMBAR SPINE W/DYE 252.13 72133 CT LUMBAR SPINE W/O & W/DYE TC 235.84 72133 CT LUMBAR SPINE W/O & W/DYE 26 65.70 72133 CT LUMBAR SPINE W/O & W/DYE 301.54 72141 MRI NECK SPINE W/O DYE TC 179.15 72141 MRI NECK SPINE W/O DYE 26 77.42 72141 MRI NECK SPINE W/O DYE 256.58 72142 MRI NECK SPINE W/DYE TC 260.41 72142 MRI NECK SPINE W/DYE 26 92.73 Proc Code Description Mod Rate 72142 MRI NECK SPINE W/DYE 353.15 72146 MRI CHEST SPINE W/O DYE TC 179.15 72146 MRI CHEST SPINE W/O DYE 26 77.42 72146 MRI CHEST SPINE W/O DYE 256.58 72147 MRI CHEST SPINE W/DYE TC 257.01 72147 MRI CHEST SPINE W/DYE 26 92.73 72147 MRI CHEST SPINE W/DYE 349.74 72148 MRI LUMBAR SPINE W/O DYE TC 179.15 72148 MRI LUMBAR SPINE W/O DYE 26 77.82 72148 MRI LUMBAR SPINE W/O DYE 256.98 72149 MRI LUMBAR SPINE W/DYE TC 255.49 72149 MRI LUMBAR SPINE W/DYE 26 93.13 72149 MRI LUMBAR SPINE W/DYE 348.63 72156 MRI NECK SPINE W/O & W/DYE TC 296.31 72156 MRI NECK SPINE W/O & W/DYE 26 119.01 72156 MRI NECK SPINE W/O & W/DYE 415.33 72157 MRI CHEST SPINE W/O & W/DYE TC 296.69 72157 MRI CHEST SPINE W/O & W/DYE 26 119.01 72157 MRI CHEST SPINE W/O & W/DYE 415.71 72158 MRI LUMBAR SPINE W/O & W/DYE TC 294.42 72158 MRI LUMBAR SPINE W/O & W/DYE 26 119.81 72158 MRI LUMBAR SPINE W/O & W/DYE 414.23 72159 MR ANGIO SPINE W/O&W/DYE TC 365.09 72159 MR ANGIO SPINE W/O&W/DYE 26 92.64 72159 MR ANGIO SPINE W/O&W/DYE 457.74 72170 X-RAY EXAM OF PELVIS TC 21.18 72170 X-RAY EXAM OF PELVIS 26 9.93 72170 X-RAY EXAM OF PELVIS 31.11 72190 X-RAY EXAM OF PELVIS TC 34.03 72190 X-RAY EXAM OF PELVIS 26 12.12 72190 X-RAY EXAM OF PELVIS 46.15 72191 CT ANGIOGRAPH PELV W/O&W/DYE TC 316.72 72191 CT ANGIOGRAPH PELV W/O&W/DYE 26 93.83 72191 CT ANGIOGRAPH PELV W/O&W/DYE 410.55 72192 CT PELVIS W/O DYE TC 102.81 72192 CT PELVIS W/O DYE 26 56.18 72192 CT PELVIS W/O DYE 159.00 72193 CT PELVIS W/DYE TC 188.22 72193 CT PELVIS W/DYE 26 60.62 72193 CT PELVIS W/DYE 248.85 72194 CT PELVIS W/O & W/DYE TC 228.28 72194 CT PELVIS W/O & W/DYE 26 63.15 72194 CT PELVIS W/O & W/DYE 291.44 72195 MRI PELVIS W/O DYE TC 323.52 72195 MRI PELVIS W/O DYE 26 76.72 72195 MRI PELVIS W/O DYE 400.25 Proc Code Description Mod Rate 72196 MRI PELVIS W/DYE TC 358.67 72196 MRI PELVIS W/DYE 26 90.18 72196 MRI PELVIS W/DYE 448.86 72197 MRI PELVIS W/O & W/DYE TC 430.85 72197 MRI PELVIS W/O & W/DYE 26 116.77 72197 MRI PELVIS W/O & W/DYE 547.63 72198 MR ANGIO PELVIS W/O & W/DYE TC 351.87 72198 MR ANGIO PELVIS W/O & W/DYE 26 92.69 72198 MR ANGIO PELVIS W/O & W/DYE 444.57 72200 X-RAY EXAM SI JOINTS TC 22.69 72200 X-RAY EXAM SI JOINTS 26 9.13 72200 X-RAY EXAM SI JOINTS 31.83 72202 X-RAY EXAM SI JOINTS 3/> VWS TC 27.60 72202 X-RAY EXAM SI JOINTS 3/> VWS 26 9.85 72202 X-RAY EXAM SI JOINTS 3/> VWS 37.46 72220 X-RAY EXAM SACRUM TAILBONE TC 21.93 72220 X-RAY EXAM SACRUM TAILBONE 26 9.13 72220 X-RAY EXAM SACRUM TAILBONE 31.07 72240 MYELOGRAPHY NECK SPINE TC 90.34 72240 MYELOGRAPHY NECK SPINE 26 47.08 72240 MYELOGRAPHY NECK SPINE 137.42 72255 MYELOGRAPHY THORACIC SPINE TC 83.16 72255 MYELOGRAPHY THORACIC SPINE 26 47.44 72255 MYELOGRAPHY THORACIC SPINE 130.60 72265 MYELOGRAPHY L-S SPINE TC 91.09 72265 MYELOGRAPHY L-S SPINE 26 43.06 72265 MYELOGRAPHY L-S SPINE 134.16 72270 MYELOGPHY 2/> SPINE REGIONS TC 139.47 72270 MYELOGPHY 2/> SPINE REGIONS 26 68.98 72270 MYELOGPHY 2/> SPINE REGIONS 208.46 72275 EPIDUROGRAPHY TC 82.02 72275 EPIDUROGRAPHY 26 41.31 72275 EPIDUROGRAPHY 123.34 72285 DISCOGRAPHY CERV/THOR SPINE TC 57.84 72285 DISCOGRAPHY CERV/THOR SPINE 26 63.23 72285 DISCOGRAPHY CERV/THOR SPINE 121.07 72295 X-RAY OF LOWER SPINE DISK TC 60.10 72295 X-RAY OF LOWER SPINE DISK 26 44.95 72295 X-RAY OF LOWER SPINE DISK 105.06 73000 X-RAY EXAM OF COLLAR BONE TC 22.31 73000 X-RAY EXAM OF COLLAR BONE 26 8.77 73000 X-RAY EXAM OF COLLAR BONE 31.09 73010 X-RAY EXAM OF SHOULDER BLADE TC 24.20 73010 X-RAY EXAM OF SHOULDER BLADE 26 10.30 73010 X-RAY EXAM OF SHOULDER BLADE 34.51 73020 X-RAY EXAM OF SHOULDER TC 17.40 Proc Code Description Mod Rate 73020 X-RAY EXAM OF SHOULDER 26 8.04 73020 X-RAY EXAM OF SHOULDER 25.44 73030 X-RAY EXAM OF SHOULDER TC 22.69 73030 X-RAY EXAM OF SHOULDER 26 10.66 73030 X-RAY EXAM OF SHOULDER 33.36 73040 CONTRAST X-RAY OF SHOULDER TC 83.54 73040 CONTRAST X-RAY OF SHOULDER 26 28.88 73040 CONTRAST X-RAY OF SHOULDER 112.42 73050 X-RAY EXAM OF SHOULDERS TC 31.00 73050 X-RAY EXAM OF SHOULDERS 26 11.76 73050 X-RAY EXAM OF SHOULDERS 42.77 73060 X-RAY EXAM OF HUMERUS TC 21.93 73060 X-RAY EXAM OF HUMERUS 26 9.13 73060 X-RAY EXAM OF HUMERUS 31.07 73070 X-RAY EXAM OF ELBOW TC 21.93 73070 X-RAY EXAM OF ELBOW 26 8.42 73070 X-RAY EXAM OF ELBOW 30.35 73080 X-RAY EXAM OF ELBOW TC 26.85 73080 X-RAY EXAM OF ELBOW 26 9.13 73080 X-RAY EXAM OF ELBOW 35.98 73085 CONTRAST X-RAY OF ELBOW TC 78.62 73085 CONTRAST X-RAY OF ELBOW 26 30.00 73085 CONTRAST X-RAY OF ELBOW 108.62 73090 X-RAY EXAM OF FOREARM TC 21.18 73090 X-RAY EXAM OF FOREARM 26 8.77 73090 X-RAY EXAM OF FOREARM 29.96 73092 X-RAY EXAM OF ARM INFANT TC 21.93 73092 X-RAY EXAM OF ARM INFANT 26 8.40 73092 X-RAY EXAM OF ARM INFANT 30.34 73100 X-RAY EXAM OF WRIST TC 24.20 73100 X-RAY EXAM OF WRIST 26 9.57 73100 X-RAY EXAM OF WRIST 33.77 73110 X-RAY EXAM OF WRIST TC 31.38 73110 X-RAY EXAM OF WRIST 26 9.13 73110 X-RAY EXAM OF WRIST 40.52 73115 CONTRAST X-RAY OF WRIST TC 88.83 73115 CONTRAST X-RAY OF WRIST 26 29.64 73115 CONTRAST X-RAY OF WRIST 118.47 73120 X-RAY EXAM OF HAND TC 20.80 73120 X-RAY EXAM OF HAND 26 8.77 73120 X-RAY EXAM OF HAND 29.58 73130 X-RAY EXAM OF HAND TC 26.09 73130 X-RAY EXAM OF HAND 26 9.13 73130 X-RAY EXAM OF HAND 35.23 73140 X-RAY EXAM OF FINGER(S) TC 28.36 73140 X-RAY EXAM OF FINGER(S) 26 7.32 Proc Code Description Mod Rate 73140 X-RAY EXAM OF FINGER(S) 35.68 73200 CT UPPER EXTREMITY W/O DYE TC 149.30 73200 CT UPPER EXTREMITY W/O DYE 26 52.61 73200 CT UPPER EXTREMITY W/O DYE 201.91 73201 CT UPPER EXTREMITY W/DYE TC 186.33 73201 CT UPPER EXTREMITY W/DYE 26 60.62 73201 CT UPPER EXTREMITY W/DYE 246.96 73202 CT UPPR EXTREMITY W/O&W/DYE TC 252.09 73202 CT UPPR EXTREMITY W/O&W/DYE 26 63.15 73202 CT UPPR EXTREMITY W/O&W/DYE 315.25 73206 CT ANGIO UPR EXTRM W/O&W/DYE TC 261.16 73206 CT ANGIO UPR EXTRM W/O&W/DYE 26 92.64 73206 CT ANGIO UPR EXTRM W/O&W/DYE 353.81 73218 MRI UPPER EXTREMITY W/O DYE TC 318.99 73218 MRI UPPER EXTREMITY W/O DYE 26 70.08 73218 MRI UPPER EXTREMITY W/O DYE 389.07 73219 MRI UPPER EXTREMITY W/DYE TC 357.54 73219 MRI UPPER EXTREMITY W/DYE 26 84.73 73219 MRI UPPER EXTREMITY W/DYE 442.27 73220 MRI UPPR EXTREMITY W/O&W/DYE TC 430.85 73220 MRI UPPR EXTREMITY W/O&W/DYE 26 111.31 73220 MRI UPPR EXTREMITY W/O&W/DYE 542.17 73221 MRI JOINT UPR EXTREM W/O DYE TC 197.29 73221 MRI JOINT UPR EXTREM W/O DYE 26 71.64 73221 MRI JOINT UPR EXTREM W/O DYE 268.94 73222 MRI JOINT UPR EXTREM W/DYE TC 328.06 73222 MRI JOINT UPR EXTREM W/DYE 26 84.73 73222 MRI JOINT UPR EXTREM W/DYE 412.79 73223 MRI JOINT UPR EXTR W/O&W/DYE TC 399.86 73223 MRI JOINT UPR EXTR W/O&W/DYE 26 111.31 73223 MRI JOINT UPR EXTR W/O&W/DYE 511.18 73225 MR ANGIO UPR EXTR W/O&W/DYE TC 362.83 73225 MR ANGIO UPR EXTR W/O&W/DYE 26 88.62 73225 MR ANGIO UPR EXTR W/O&W/DYE 451.45 73500 X-RAY EXAM OF HIP TC 19.29 73500 X-RAY EXAM OF HIP 26 9.93 73500 X-RAY EXAM OF HIP 29.22 73510 X-RAY EXAM OF HIP TC 30.25 73510 X-RAY EXAM OF HIP 26 12.12 73510 X-RAY EXAM OF HIP 42.37 73520 X-RAY EXAM OF HIPS TC 29.87 73520 X-RAY EXAM OF HIPS 26 14.67 73520 X-RAY EXAM OF HIPS 44.54 73525 CONTRAST X-RAY OF HIP TC 80.13 73525 CONTRAST X-RAY OF HIP 26 30.02 73525 CONTRAST X-RAY OF HIP 110.16 Proc Code Description Mod Rate 73530 X-RAY EXAM OF HIP TC 19.54 73530 X-RAY EXAM OF HIP 26 15.74 73530 X-RAY EXAM OF HIP 34.39 73540 X-RAY EXAM OF PELVIS & HIPS TC 35.16 73540 X-RAY EXAM OF PELVIS & HIPS 26 11.38 73540 X-RAY EXAM OF PELVIS & HIPS 46.55 73550 X-RAY EXAM OF THIGH TC 20.80 73550 X-RAY EXAM OF THIGH 26 9.93 73550 X-RAY EXAM OF THIGH 30.73 73560 X-RAY EXAM OF KNEE 1 OR 2 TC 23.07 73560 X-RAY EXAM OF KNEE 1 OR 2 26 9.93 73560 X-RAY EXAM OF KNEE 1 OR 2 33.00 73562 X-RAY EXAM OF KNEE 3 TC 29.49 73562 X-RAY EXAM OF KNEE 3 26 10.66 73562 X-RAY EXAM OF KNEE 3 40.16 73564 X-RAY EXAM KNEE 4 OR MORE TC 34.03 73564 X-RAY EXAM KNEE 4 OR MORE 26 12.47 73564 X-RAY EXAM KNEE 4 OR MORE 46.51 73565 X-RAY EXAM OF KNEES TC 27.98 73565 X-RAY EXAM OF KNEES 26 10.30 73565 X-RAY EXAM OF KNEES 38.29 73580 CONTRAST X-RAY OF KNEE JOINT TC 105.08 73580 CONTRAST X-RAY OF KNEE JOINT 26 30.41 73580 CONTRAST X-RAY OF KNEE JOINT 135.50 73590 X-RAY EXAM OF LOWER LEG TC 20.42 73590 X-RAY EXAM OF LOWER LEG 26 9.13 73590 X-RAY EXAM OF LOWER LEG 29.56 73592 X-RAY EXAM OF LEG INFANT TC 21.93 73592 X-RAY EXAM OF LEG INFANT 26 8.40 73592 X-RAY EXAM OF LEG INFANT 30.34 73600 X-RAY EXAM OF ANKLE TC 21.93 73600 X-RAY EXAM OF ANKLE 26 8.77 73600 X-RAY EXAM OF ANKLE 30.71 73610 X-RAY EXAM OF ANKLE TC 26.85 73610 X-RAY EXAM OF ANKLE 26 9.13 73610 X-RAY EXAM OF ANKLE 35.98 73615 CONTRAST X-RAY OF ANKLE TC 80.13 73615 CONTRAST X-RAY OF ANKLE 26 30.02 73615 CONTRAST X-RAY OF ANKLE 110.16 73620 X-RAY EXAM OF FOOT TC 21.18 73620 X-RAY EXAM OF FOOT 26 8.02 73620 X-RAY EXAM OF FOOT 29.20 73630 X-RAY EXAM OF FOOT TC 24.96 73630 X-RAY EXAM OF FOOT 26 8.76 73630 X-RAY EXAM OF FOOT 33.72 73650 X-RAY EXAM OF HEEL TC 21.93 Proc Code Description Mod Rate 73650 X-RAY EXAM OF HEEL 26 8.40 73650 X-RAY EXAM OF HEEL 30.34 73660 X-RAY EXAM OF TOE(S) TC 25.71 73660 X-RAY EXAM OF TOE(S) 26 6.94 73660 X-RAY EXAM OF TOE(S) 32.66 73700 CT LOWER EXTREMITY W/O DYE TC 149.30 73700 CT LOWER EXTREMITY W/O DYE 26 52.61 73700 CT LOWER EXTREMITY W/O DYE 201.91 73701 CT LOWER EXTREMITY W/DYE TC 189.36 73701 CT LOWER EXTREMITY W/DYE 26 60.62 73701 CT LOWER EXTREMITY W/DYE 249.98 73702 CT LWR EXTREMITY W/O&W/DYE TC 249.45 73702 CT LWR EXTREMITY W/O&W/DYE 26 63.15 73702 CT LWR EXTREMITY W/O&W/DYE 312.60 73706 CT ANGIO LWR EXTR W/O&W/DYE TC 295.56 73706 CT ANGIO LWR EXTR W/O&W/DYE 26 98.19 73706 CT ANGIO LWR EXTR W/O&W/DYE 393.75 73718 MRI LOWER EXTREMITY W/O DYE TC 318.99 73718 MRI LOWER EXTREMITY W/O DYE 26 70.10 73718 MRI LOWER EXTREMITY W/O DYE 389.09 73719 MRI LOWER EXTREMITY W/DYE TC 359.05 73719 MRI LOWER EXTREMITY W/DYE 26 84.73 73719 MRI LOWER EXTREMITY W/DYE 443.78 73720 MRI LWR EXTREMITY W/O&W/DYE TC 434.26 73720 MRI LWR EXTREMITY W/O&W/DYE 26 110.93 73720 MRI LWR EXTREMITY W/O&W/DYE 545.19 73721 MRI JNT OF LWR EXTRE W/O DYE TC 197.67 73721 MRI JNT OF LWR EXTRE W/O DYE 26 71.64 73721 MRI JNT OF LWR EXTRE W/O DYE 269.32 73722 MRI JOINT OF LWR EXTR W/DYE TC 333.35 73722 MRI JOINT OF LWR EXTR W/DYE 26 85.12 73722 MRI JOINT OF LWR EXTR W/DYE 418.48 73723 MRI JOINT LWR EXTR W/O&W/DYE TC 401.38 73723 MRI JOINT LWR EXTR W/O&W/DYE 26 111.31 73723 MRI JOINT LWR EXTR W/O&W/DYE 512.69 73725 MR ANG LWR EXT W OR W/O DYE TC 351.87 73725 MR ANG LWR EXT W OR W/O DYE 26 93.79 73725 MR ANG LWR EXT W OR W/O DYE 445.66 74000 X-RAY EXAM OF ABDOMEN TC 16.64 74000 X-RAY EXAM OF ABDOMEN 26 9.49 74000 X-RAY EXAM OF ABDOMEN 26.14 74010 X-RAY EXAM OF ABDOMEN TC 29.49 74010 X-RAY EXAM OF ABDOMEN 26 12.04 74010 X-RAY EXAM OF ABDOMEN 41.54 74020 X-RAY EXAM OF ABDOMEN TC 29.49 74020 X-RAY EXAM OF ABDOMEN 26 13.85 Proc Code Description Mod Rate 74020 X-RAY EXAM OF ABDOMEN 43.35 74022 X-RAY EXAM SERIES ABDOMEN TC 35.92 74022 X-RAY EXAM SERIES ABDOMEN 26 16.40 74022 X-RAY EXAM SERIES ABDOMEN 52.32 74150 CT ABDOMEN W/O DYE TC 100.54 74150 CT ABDOMEN W/O DYE 26 62.07 74150 CT ABDOMEN W/O DYE 162.62 74160 CT ABDOMEN W/DYE TC 187.47 74160 CT ABDOMEN W/DYE 26 66.07 74160 CT ABDOMEN W/DYE 253.55 74170 CT ABDOMEN W/O & W/DYE TC 220.35 74170 CT ABDOMEN W/O & W/DYE 26 72.64 74170 CT ABDOMEN W/O & W/DYE 293.00 74174 Ct angio abd&pelv w/o&w/dye TC 460.71 74174 Ct angio abd&pelv w/o&w/dye 26 113.90 74174 Ct angio abd&pelv w/o&w/dye 574.61 74175 CT ANGIO ABDOM W/O & W/DYE TC 309.92 74175 CT ANGIO ABDOM W/O & W/DYE 26 98.57 74175 CT ANGIO ABDOM W/O & W/DYE 408.49 74176 CT ABD & PELVIS W/O CONTRAST TC 137.20 74176 CT ABD & PELVIS W/O CONTRAST 26 90.54 74176 CT ABD & PELVIS W/O CONTRAST 227.75 74177 CT ABD & PELV W/CONTRAST TC 247.56 74177 CT ABD & PELV W/CONTRAST 26 94.54 74177 CT ABD & PELV W/CONTRAST 342.11 74178 CT ABD & PELV 1/> REGNS TC 294.04 74178 CT ABD & PELV 1/> REGNS 26 104.40 74178 CT ABD & PELV 1/> REGNS 398.45 74181 MRI ABDOMEN W/O DYE TC 280.82 74181 MRI ABDOMEN W/O DYE 26 75.55 74181 MRI ABDOMEN W/O DYE 356.37 74182 MRI ABDOMEN W/DYE TC 401.75 74182 MRI ABDOMEN W/DYE 26 89.81 74182 MRI ABDOMEN W/DYE 491.56 74183 MRI ABDOMEN W/O & W/DYE TC 432.74 74183 MRI ABDOMEN W/O & W/DYE 26 116.77 74183 MRI ABDOMEN W/O & W/DYE 549.51 74185 MRI ANGIO ABDOM W ORW/O DYE TC 352.62 74185 MRI ANGIO ABDOM W ORW/O DYE 26 93.07 74185 MRI ANGIO ABDOM W ORW/O DYE 445.70 74190 X-RAY EXAM OF PERITONEUM TC 49.23 74190 X-RAY EXAM OF PERITONEUM 26 24.84 74190 X-RAY EXAM OF PERITONEUM 73.84 74210 CONTRST X-RAY EXAM OF THROAT TC 65.77 74210 CONTRST X-RAY EXAM OF THROAT 26 18.21 74210 CONTRST X-RAY EXAM OF THROAT 83.99 Proc Code Description Mod Rate 74220 CONTRAST X-RAY ESOPHAGUS TC 74.09 74220 CONTRAST X-RAY ESOPHAGUS 26 24.10 74220 CONTRAST X-RAY ESOPHAGUS 98.20 74230 CINE/VID X-RAY THROAT/ESOPH TC 70.31 74230 CINE/VID X-RAY THROAT/ESOPH 26 27.75 74230 CINE/VID X-RAY THROAT/ESOPH 98.06 74235 REMOVE ESOPHAGUS OBSTRUCTION TC 98.82 74235 REMOVE ESOPHAGUS OBSTRUCTION 26 59.86 74235 REMOVE ESOPHAGUS OBSTRUCTION 159.64 74240 X-RAY UPPER GI DELAY W/O KUB TC 86.56 74240 X-RAY UPPER GI DELAY W/O KUB 26 36.15 74240 X-RAY UPPER GI DELAY W/O KUB 122.71 74241 X-RAYUPPER GI DELAY W/KUB TC 92.23 74241 X-RAYUPPER GI DELAY W/KUB 26 35.38 74241 X-RAYUPPER GI DELAY W/KUB 127.61 74245 X-RAY UPPER GI&SMALL INTEST TC 144.01 74245 X-RAY UPPER GI&SMALL INTEST 26 47.08 74245 X-RAY UPPER GI&SMALL INTEST 191.09 74246 CONTRST X-RAY UPPR GI TRACT TC 102.43 74246 CONTRST X-RAY UPPR GI TRACT 26 35.77 74246 CONTRST X-RAY UPPR GI TRACT 138.21 74247 CONTRST X-RAY UPPR GI TRACT TC 117.93 74247 CONTRST X-RAY UPPR GI TRACT 26 35.77 74247 CONTRST X-RAY UPPR GI TRACT 153.70 74249 CONTRST X-RAY UPPR GI TRACT TC 159.12 74249 CONTRST X-RAY UPPR GI TRACT 26 47.08 74249 CONTRST X-RAY UPPR GI TRACT 206.21 74250 X-RAY EXAM OF SMALL BOWEL TC 91.85 74250 X-RAY EXAM OF SMALL BOWEL 26 24.46 74250 X-RAY EXAM OF SMALL BOWEL 116.32 74251 X-RAY EXAM OF SMALL BOWEL TC 410.07 74251 X-RAY EXAM OF SMALL BOWEL 26 35.77 74251 X-RAY EXAM OF SMALL BOWEL 445.85 74260 X-RAY EXAM OF SMALL BOWEL TC 343.93 74260 X-RAY EXAM OF SMALL BOWEL 26 25.92 74260 X-RAY EXAM OF SMALL BOWEL 369.85 74261 CT COLONOGRAPHY DX TC 383.61 74261 CT COLONOGRAPHY DX 26 124.05 74261 CT COLONOGRAPHY DX 507.67 74262 CT COLONOGRAPHY DX W/DYE TC 428.59 74262 CT COLONOGRAPHY DX W/DYE 26 129.19 74262 CT COLONOGRAPHY DX W/DYE 557.78 74270 CONTRAST X-RAY EXAM OF COLON TC 133.42 74270 CONTRAST X-RAY EXAM OF COLON 26 35.77 74270 CONTRAST X-RAY EXAM OF COLON 169.20 74280 CONTRAST X-RAY EXAM OF COLON TC 185.20 Proc Code Description Mod Rate 74280 CONTRAST X-RAY EXAM OF COLON 26 51.08 74280 CONTRAST X-RAY EXAM OF COLON 236.29 74283 CONTRAST X-RAY EXAM OF COLON TC 113.01 74283 CONTRAST X-RAY EXAM OF COLON 26 102.38 74283 CONTRAST X-RAY EXAM OF COLON 215.40 74290 CONTRAST X-RAY GALLBLADDER TC 58.59 74290 CONTRAST X-RAY GALLBLADDER 26 16.40 74290 CONTRAST X-RAY GALLBLADDER 75.00 74300 X-RAY BILE DUCTS/PANCREAS TC 34.39 74300 X-RAY BILE DUCTS/PANCREAS 26 19.01 74300 X-RAY BILE DUCTS/PANCREAS 52.85 74301 X-RAYS AT SURGERY ADD-ON TC 19.91 74301 X-RAYS AT SURGERY ADD-ON 26 11.36 74301 X-RAYS AT SURGERY ADD-ON 30.77 74305 X-RAY BILE DUCTS/PANCREAS TC 29.68 74305 X-RAY BILE DUCTS/PANCREAS 26 21.93 74305 X-RAY BILE DUCTS/PANCREAS 51.40 74320 CONTRAST X-RAY OF BILE DUCTS TC 76.36 74320 CONTRAST X-RAY OF BILE DUCTS 26 27.35 74320 CONTRAST X-RAY OF BILE DUCTS 103.71 74327 X-RAY BILE STONE REMOVAL TC 110.75 74327 X-RAY BILE STONE REMOVAL 26 38.53 74327 X-RAY BILE STONE REMOVAL 149.28 74328 X-RAY BILE DUCT ENDOSCOPY TC 118.73 74328 X-RAY BILE DUCT ENDOSCOPY 26 37.28 74328 X-RAY BILE DUCT ENDOSCOPY 154.93 74329 X-RAY FOR PANCREAS ENDOSCOPY TC 118.73 74329 X-RAY FOR PANCREAS ENDOSCOPY 26 37.66 74329 X-RAY FOR PANCREAS ENDOSCOPY 154.93 74330 X-RAY BILE/PANC ENDOSCOPY TC 118.73 74330 X-RAY BILE/PANC ENDOSCOPY 26 48.27 74330 X-RAY BILE/PANC ENDOSCOPY 165.07 74340 X-RAY GUIDE FOR GI TUBE TC 98.82 74340 X-RAY GUIDE FOR GI TUBE 26 28.50 74340 X-RAY GUIDE FOR GI TUBE 126.70 74355 X-RAY GUIDE INTESTINAL TUBE TC 98.82 74355 X-RAY GUIDE INTESTINAL TUBE 26 40.23 74355 X-RAY GUIDE INTESTINAL TUBE 137.56 74360 X-RAY GUIDE GI DILATION TC 118.73 74360 X-RAY GUIDE GI DILATION 26 29.26 74360 X-RAY GUIDE GI DILATION 146.24 74363 X-RAY BILE DUCT DILATION TC 229.50 74363 X-RAY BILE DUCT DILATION 26 46.06 74363 X-RAY BILE DUCT DILATION 275.12 74400 CONTRST X-RAY URINARY TRACT TC 95.63 74400 CONTRST X-RAY URINARY TRACT 26 25.56 Proc Code Description Mod Rate 74400 CONTRST X-RAY URINARY TRACT 121.19 74410 CONTRST X-RAY URINARY TRACT TC 93.74 74410 CONTRST X-RAY URINARY TRACT 26 25.18 74410 CONTRST X-RAY URINARY TRACT 118.93 74415 CONTRST X-RAY URINARY TRACT TC 122.46 74415 CONTRST X-RAY URINARY TRACT 26 25.56 74415 CONTRST X-RAY URINARY TRACT 148.03 74420 CONTRST X-RAY URINARY TRACT TC 98.82 74420 CONTRST X-RAY URINARY TRACT 26 19.01 74420 CONTRST X-RAY URINARY TRACT 117.65 74425 CONTRST X-RAY URINARY TRACT TC 49.23 74425 CONTRST X-RAY URINARY TRACT 26 18.63 74425 CONTRST X-RAY URINARY TRACT 68.05 74430 CONTRAST X-RAY BLADDER TC 27.60 74430 CONTRAST X-RAY BLADDER 43.63 74440 X-RAY MALE GENITAL TRACT TC 68.04 74440 X-RAY MALE GENITAL TRACT 26 19.72 74440 X-RAY MALE GENITAL TRACT 87.77 74445 X-RAY EXAM OF PENIS TC 42.35 74445 X-RAY EXAM OF PENIS 26 59.58 74445 X-RAY EXAM OF PENIS 100.63 74450 X-RAY URETHRA/BLADDER TC 55.38 74450 X-RAY URETHRA/BLADDER 26 17.55 74450 X-RAY URETHRA/BLADDER 72.76 74455 X-RAY URETHRA/BLADDER TC 72.58 74455 X-RAY URETHRA/BLADDER 26 16.76 74455 X-RAY URETHRA/BLADDER 89.34 74470 X-RAY EXAM OF KIDNEY LESION TC 47.06 74470 X-RAY EXAM OF KIDNEY LESION 26 27.75 74470 X-RAY EXAM OF KIDNEY LESION 74.57 74475 X-RAY CONTROL CATH INSERT TC 75.22 74475 X-RAY CONTROL CATH INSERT 26 27.73 74475 X-RAY CONTROL CATH INSERT 102.96 74480 X-RAY CONTROL CATH INSERT TC 75.22 74480 X-RAY CONTROL CATH INSERT 26 27.73 74480 X-RAY CONTROL CATH INSERT 102.96 74485 X-RAY GUIDE GU DILATION TC 75.22 74485 X-RAY GUIDE GU DILATION 26 27.35 74485 X-RAY GUIDE GU DILATION 102.58 74710 X-RAY MEASUREMENT OF PELVIS TC 21.93 74710 X-RAY MEASUREMENT OF PELVIS 26 17.50 74710 X-RAY MEASUREMENT OF PELVIS 39.44 74740 X-RAY FEMALE GENITAL TRACT TC 63.13 74740 X-RAY FEMALE GENITAL TRACT 26 19.31 74740 X-RAY FEMALE GENITAL TRACT 82.44 74742 X-RAY FALLOPIAN TUBE TC 118.73 Proc Code Description Mod Rate 74742 X-RAY FALLOPIAN TUBE 26 32.54 74742 X-RAY FALLOPIAN TUBE 150.59 74775 X-RAY EXAM OF PERINEUM TC 55.38 74775 X-RAY EXAM OF PERINEUM 26 32.52 74775 X-RAY EXAM OF PERINEUM 87.96 75557 Cardiac mri for morph TC 225.64 75557 Cardiac mri for morph 26 119.97 75557 Cardiac mri for morph 345.62 75559 Cardiac mri w/stress img TC 319.36 75559 Cardiac mri w/stress img 26 148.31 75559 Cardiac mri w/stress img 467.68 75561 Cardiac mri for morph w/dye TC 323.90 75561 Cardiac mri for morph w/dye 26 132.36 75561 Cardiac mri for morph w/dye 456.26 75563 Card mri w/stress img & dye TC 386.64 75563 Card mri w/stress img & dye 26 151.62 75563 Card mri w/stress img & dye 538.26 75565 CARD MRI VELOC FLOW MAPPING TC 46.12 75565 CARD MRI VELOC FLOW MAPPING 26 12.76 75565 CARD MRI VELOC FLOW MAPPING 58.88 75571 CT HRT W/O DYE W/CA TEST TC 82.40 75571 CT HRT W/O DYE W/CA TEST 26 28.75 75571 CT HRT W/O DYE W/CA TEST 111.16 75572 CT HRT W/3D IMAGE TC 215.06 75572 CT HRT W/3D IMAGE 26 88.16 75572 CT HRT W/3D IMAGE 303.22 75573 CT HRT W/3D IMAGE CONGEN TC 287.62 75573 CT HRT W/3D IMAGE CONGEN 26 128.62 75573 CT HRT W/3D IMAGE CONGEN 416.24 75574 CT ANGIO HRT W/3D IMAGE TC 321.25 75574 CT ANGIO HRT W/3D IMAGE 26 121.35 75574 CT ANGIO HRT W/3D IMAGE 442.61 75600 CONTRAST EXAM THORACIC AORTA TC 198.05 75600 CONTRAST EXAM THORACIC AORTA 26 24.80 75600 CONTRAST EXAM THORACIC AORTA 222.86 75605 CONTRAST EXAM THORACIC AORTA TC 102.43 75605 CONTRAST EXAM THORACIC AORTA 26 57.26 75605 CONTRAST EXAM THORACIC AORTA 159.69 75625 CONTRAST EXAM ABDOMINL AORTA TC 101.68 75625 CONTRAST EXAM ABDOMINL AORTA 26 57.69 75625 CONTRAST EXAM ABDOMINL AORTA 159.37 75630 X-RAY AORTA LEG ARTERIES TC 100.92 75630 X-RAY AORTA LEG ARTERIES 26 89.31 75630 X-RAY AORTA LEG ARTERIES 190.24 75635 CT ANGIO ABDOMINAL ARTERIES TC 318.27 75635 CT ANGIO ABDOMINAL ARTERIES 26 122.54 Proc Code Description Mod Rate 75635 CT ANGIO ABDOMINAL ARTERIES 440.82 75658 ARTERY X-RAYS ARM TC 121.33 75658 ARTERY X-RAYS ARM 26 64.13 75658 ARTERY X-RAYS ARM 185.46 75705 ARTERY X-RAYS SPINE TC 147.78 75705 ARTERY X-RAYS SPINE 26 111.56 75705 ARTERY X-RAYS SPINE 259.34 75710 ARTERY X-RAYS ARM/LEG TC 128.13 75710 ARTERY X-RAYS ARM/LEG 26 56.08 75710 ARTERY X-RAYS ARM/LEG 184.22 75716 ARTERY X-RAYS ARMS/LEGS TC 154.62 75716 ARTERY X-RAYS ARMS/LEGS 26 66.05 75716 ARTERY X-RAYS ARMS/LEGS 220.68 75726 ARTERY X-RAYS ABDOMEN TC 114.15 75726 ARTERY X-RAYS ABDOMEN 26 58.03 75726 ARTERY X-RAYS ABDOMEN 172.18 75731 ARTERY X-RAYS ADRENAL GLAND TC 132.67 75731 ARTERY X-RAYS ADRENAL GLAND 26 58.33 75731 ARTERY X-RAYS ADRENAL GLAND 191.01 75733 ARTERY X-RAYS ADRENALS TC 148.20 75733 ARTERY X-RAYS ADRENALS 26 65.56 75733 ARTERY X-RAYS ADRENALS 213.77 75736 ARTERY X-RAYS PELVIS TC 125.11 75736 ARTERY X-RAYS PELVIS 26 56.08 75736 ARTERY X-RAYS PELVIS 181.20 75741 ARTERY X-RAYS LUNG TC 103.94 75741 ARTERY X-RAYS LUNG 26 66.39 75741 ARTERY X-RAYS LUNG 170.34 75743 ARTERY X-RAYS LUNGS TC 113.39 75743 ARTERY X-RAYS LUNGS 26 83.52 75743 ARTERY X-RAYS LUNGS 196.91 75746 ARTERY X-RAYS LUNG TC 118.31 75746 ARTERY X-RAYS LUNG 26 58.77 75746 ARTERY X-RAYS LUNG 177.08 75756 ARTERY X-RAYS CHEST TC 131.91 75756 ARTERY X-RAYS CHEST 26 61.67 75756 ARTERY X-RAYS CHEST 193.59 75774 ARTERY X-RAY EACH VESSEL TC 85.80 75774 ARTERY X-RAY EACH VESSEL 26 18.25 75774 ARTERY X-RAY EACH VESSEL 104.06 75791 AV DIALYSIS SHUNT IMAGING TC 261.54 75791 AV DIALYSIS SHUNT IMAGING 26 84.93 75791 AV DIALYSIS SHUNT IMAGING 346.48 75801 LYMPH VESSEL X-RAY ARM/LEG TC 203.80 75801 LYMPH VESSEL X-RAY ARM/LEG 26 46.74 75801 LYMPH VESSEL X-RAY ARM/LEG 246.16 Proc Code Description Mod Rate 75803 LYMPH VESSEL X-RAY ARMS/LEGS TC 203.80 75803 LYMPH VESSEL X-RAY ARMS/LEGS 26 62.17 75803 LYMPH VESSEL X-RAY ARMS/LEGS 263.89 75805 LYMPH VESSEL X-RAY TRUNK TC 229.50 75805 LYMPH VESSEL X-RAY TRUNK 26 43.15 75805 LYMPH VESSEL X-RAY TRUNK 271.86 75807 LYMPH VESSEL X-RAY TRUNK TC 229.50 75807 LYMPH VESSEL X-RAY TRUNK 26 62.17 75807 LYMPH VESSEL X-RAY TRUNK 289.60 75809 NONVASCULAR SHUNT X-RAY TC 84.67 75809 NONVASCULAR SHUNT X-RAY 26 24.84 75809 NONVASCULAR SHUNT X-RAY 109.52 75810 VEIN X-RAY SPLEEN/LIVER TC 473.49 75810 VEIN X-RAY SPLEEN/LIVER 26 60.71 75810 VEIN X-RAY SPLEEN/LIVER 532.50 75820 VEIN X-RAY ARM/LEG TC 96.01 75820 VEIN X-RAY ARM/LEG 26 35.75 75820 VEIN X-RAY ARM/LEG 131.77 75822 VEIN X-RAY ARMS/LEGS TC 109.99 75822 VEIN X-RAY ARMS/LEGS 26 54.01 75822 VEIN X-RAY ARMS/LEGS 164.01 75825 VEIN X-RAY TRUNK TC 96.39 75825 VEIN X-RAY TRUNK 26 57.27 75825 VEIN X-RAY TRUNK 153.66 75827 VEIN X-RAY CHEST TC 99.03 75827 VEIN X-RAY CHEST 26 56.50 75827 VEIN X-RAY CHEST 155.54 75831 VEIN X-RAY KIDNEY TC 103.19 75831 VEIN X-RAY KIDNEY 26 63.22 75831 VEIN X-RAY KIDNEY 166.42 75833 VEIN X-RAY KIDNEYS TC 116.42 75833 VEIN X-RAY KIDNEYS 26 72.09 75833 VEIN X-RAY KIDNEYS 188.51 75840 VEIN X-RAY ADRENAL GLAND TC 106.59 75840 VEIN X-RAY ADRENAL GLAND 26 65.87 75840 VEIN X-RAY ADRENAL GLAND 172.46 75842 VEIN X-RAY ADRENAL GLANDS TC 128.13 75842 VEIN X-RAY ADRENAL GLANDS 26 77.38 75842 VEIN X-RAY ADRENAL GLANDS 205.52 75860 VEIN X-RAY NECK TC 103.57 75860 VEIN X-RAY NECK 26 58.03 75860 VEIN X-RAY NECK 161.60 75870 VEIN X-RAY SKULL TC 105.83 75870 VEIN X-RAY SKULL 26 59.52 75870 VEIN X-RAY SKULL 165.36 75872 VEIN X-RAY SKULL EPIDURAL TC 105.46 Proc Code Description Mod Rate 75872 VEIN X-RAY SKULL EPIDURAL 26 53.10 75872 VEIN X-RAY SKULL EPIDURAL 158.56 75880 VEIN X-RAY EYE SOCKET TC 106.97 75880 VEIN X-RAY EYE SOCKET 26 36.51 75880 VEIN X-RAY EYE SOCKET 143.48 75885 VEIN X-RAY LIVER W/HEMODYNAM TC 104.70 75885 VEIN X-RAY LIVER W/HEMODYNAM 26 72.94 75885 VEIN X-RAY LIVER W/HEMODYNAM 177.65 75887 VEIN X-RAY LIVER W/O HEMODYN TC 104.70 75887 VEIN X-RAY LIVER W/O HEMODYN 26 71.75 75887 VEIN X-RAY LIVER W/O HEMODYN 176.46 75889 VEIN X-RAY LIVER W/HEMODYNAM TC 105.46 75889 VEIN X-RAY LIVER W/HEMODYNAM 26 58.01 75889 VEIN X-RAY LIVER W/HEMODYNAM 163.47 75891 VEIN X-RAY LIVER TC 105.83 75891 VEIN X-RAY LIVER 26 58.77 75891 VEIN X-RAY LIVER 164.61 75893 VENOUS SAMPLING BY CATHETER TC 106.59 75893 VENOUS SAMPLING BY CATHETER 26 27.31 75893 VENOUS SAMPLING BY CATHETER 133.91 75894 X-RAYS TRANSCATH THERAPY TC 907.89 75894 X-RAYS TRANSCATH THERAPY 26 69.17 75894 X-RAYS TRANSCATH THERAPY 975.95 75896 X-RAYS TRANSCATH THERAPY TC 789.88 75896 X-RAYS TRANSCATH THERAPY 26 68.41 75896 X-RAYS TRANSCATH THERAPY 858.30 75898 FOLLOW-UP ANGIOGRAPHY TC 39.82 75898 FOLLOW-UP ANGIOGRAPHY 26 87.86 75898 FOLLOW-UP ANGIOGRAPHY 125.61 75901 REMOVE CVA DEVICE OBSTRUCT TC 163.28 75901 REMOVE CVA DEVICE OBSTRUCT 26 24.80 75901 REMOVE CVA DEVICE OBSTRUCT 188.09 75902 REMOVE CVA LUMEN OBSTRUCT TC 59.35 75902 REMOVE CVA LUMEN OBSTRUCT 26 20.10 75902 REMOVE CVA LUMEN OBSTRUCT 79.45 75945 INTRAVASCULAR US TC 171.58 75945 INTRAVASCULAR US 26 20.48 75945 INTRAVASCULAR US 192.94 75946 INTRAVASCULAR US ADD-ON TC 86.88 75946 INTRAVASCULAR US ADD-ON 26 20.89 75946 INTRAVASCULAR US ADD-ON 107.87 75952 ENDOVASC REPAIR ABDOM AORTA TC 2333.81 75952 ENDOVASC REPAIR ABDOM AORTA 26 238.87 75952 ENDOVASC REPAIR ABDOM AORTA 2593.00 75953 ABDOM ANEURYSM ENDOVAS RPR TC 892.69 75953 ABDOM ANEURYSM ENDOVAS RPR 26 72.68 Proc Code Description Mod Rate 75953 ABDOM ANEURYSM ENDOVAS RPR 991.88 75954 ILIAC ANEURYSM ENDOVAS RPR TC 875.61 75954 ILIAC ANEURYSM ENDOVAS RPR 26 118.44 75954 ILIAC ANEURYSM ENDOVAS RPR 973.05 75956 XRAY ENDOVASC THOR AO REPR 26 374.51 75957 XRAY ENDOVASC THOR AO REPR 26 320.48 75958 XRAY PLACE PROX EXT THOR AO 26 213.29 75959 XRAY PLACE DIST EXT THOR AO 26 190.09 75962 REPAIR ARTERIAL BLOCKAGE TC 127.38 75962 REPAIR ARTERIAL BLOCKAGE 26 26.97 75962 REPAIR ARTERIAL BLOCKAGE 154.35 75964 REPAIR ARTERY BLOCKAGE EACH TC 80.51 75964 REPAIR ARTERY BLOCKAGE EACH 26 18.65 75964 REPAIR ARTERY BLOCKAGE EACH 99.17 75966 REPAIR ARTERIAL BLOCKAGE TC 117.93 75966 REPAIR ARTERIAL BLOCKAGE 26 64.86 75966 REPAIR ARTERIAL BLOCKAGE 182.80 75968 REPAIR ARTERY BLOCKAGE EACH TC 74.84 75968 REPAIR ARTERY BLOCKAGE EACH 26 17.84 75968 REPAIR ARTERY BLOCKAGE EACH 92.68 75970 VASCULAR BIOPSY TC 434.03 75970 VASCULAR BIOPSY 26 42.74 75970 VASCULAR BIOPSY 477.47 75978 REPAIR VENOUS BLOCKAGE TC 125.49 75978 REPAIR VENOUS BLOCKAGE 26 26.97 75978 REPAIR VENOUS BLOCKAGE 152.46 75980 CONTRAST XRAY EXAM BILE DUCT TC 203.80 75980 CONTRAST XRAY EXAM BILE DUCT 26 74.51 75980 CONTRAST XRAY EXAM BILE DUCT 277.65 75982 CONTRAST XRAY EXAM BILE DUCT TC 229.50 75982 CONTRAST XRAY EXAM BILE DUCT 26 74.13 75982 CONTRAST XRAY EXAM BILE DUCT 303.35 75984 XRAY CONTROL CATHETER CHANGE TC 80.89 75984 XRAY CONTROL CATHETER CHANGE 26 36.47 75984 XRAY CONTROL CATHETER CHANGE 117.37 75989 ABSCESS DRAINAGE UNDER X-RAY TC 71.44 75989 ABSCESS DRAINAGE UNDER X-RAY 26 60.14 75989 ABSCESS DRAINAGE UNDER X-RAY 131.59 76000 FLUOROSCOPE EXAMINATION TC 44.99 76000 FLUOROSCOPE EXAMINATION 26 8.76 76000 FLUOROSCOPE EXAMINATION 53.75 76001 FLUOROSCOPE EXAM EXTENSIVE TC 98.82 76001 FLUOROSCOPE EXAM EXTENSIVE 26 37.40 76001 FLUOROSCOPE EXAM EXTENSIVE 133.57 76010 X-RAY NOSE TO RECTUM TC 19.67 76010 X-RAY NOSE TO RECTUM 26 9.49 Proc Code Description Mod Rate 76010 X-RAY NOSE TO RECTUM 29.16 76080 X-RAY EXAM OF FISTULA TC 36.67 76080 X-RAY EXAM OF FISTULA 26 27.35 76080 X-RAY EXAM OF FISTULA 64.03 76098 X-RAY EXAM BREAST SPECIMEN TC 11.73 76098 X-RAY EXAM BREAST SPECIMEN 26 8.40 76098 X-RAY EXAM BREAST SPECIMEN 20.13 76100 X-RAY EXAM OF BODY SECTION TC 74.09 76100 X-RAY EXAM OF BODY SECTION 26 32.98 76100 X-RAY EXAM OF BODY SECTION 107.07 76101 COMPLEX BODY SECTION X-RAY TC 122.09 76101 COMPLEX BODY SECTION X-RAY 26 37.57 76101 COMPLEX BODY SECTION X-RAY 159.66 76102 COMPLEX BODY SECTION X-RAYS TC 175.75 76102 COMPLEX BODY SECTION X-RAYS 26 38.36 76102 COMPLEX BODY SECTION X-RAYS 214.12 76120 CINE/VIDEO X-RAYS TC 78.25 76120 CINE/VIDEO X-RAYS 26 20.48 76120 CINE/VIDEO X-RAYS 98.73 76125 CINE/VIDEO X-RAYS ADD-ON TC 29.68 76125 CINE/VIDEO X-RAYS ADD-ON 26 15.02 76125 CINE/VIDEO X-RAYS ADD-ON 43.44 76140 X-RAY CONSULTATION 69.86 76376 3D RENDER W/INTRP POSTPROCES TC 20.04 76376 3D RENDER W/INTRP POSTPROCES 26 10.21 76376 3D RENDER W/INTRP POSTPROCES 30.26 76377 3D RENDER W/INTRP POSTPROCES TC 46.50 76377 3D RENDER W/INTRP POSTPROCES 26 40.87 76377 3D RENDER W/INTRP POSTPROCES 87.37 76380 CAT SCAN FOLLOW-UP STUDY TC 109.24 76380 CAT SCAN FOLLOW-UP STUDY 26 50.33 76380 CAT SCAN FOLLOW-UP STUDY 159.57 76390 MR SPECTROSCOPY TC 397.22 76390 MR SPECTROSCOPY 26 72.59 76390 MR SPECTROSCOPY 469.81 76497 CT PROCEDURE TC 0.00 76497 CT PROCEDURE 26 0.00 76497 CT PROCEDURE 0.00 76499 RADIOGRAPHIC PROCEDURE TC 0.00 76499 RADIOGRAPHIC PROCEDURE 26 0.00 76499 RADIOGRAPHIC PROCEDURE 0.00 76506 ECHO EXAM OF HEAD TC 97.90 76506 ECHO EXAM OF HEAD 26 32.86 76506 ECHO EXAM OF HEAD 130.77 76510 OPHTH US B & QUANT A TC 85.43 76510 OPHTH US B & QUANT A 26 102.15 Proc Code Description Mod Rate 76510 OPHTH US B & QUANT A 187.58 76511 OPHTH US QUANT A ONLY TC 51.79 76511 OPHTH US QUANT A ONLY 26 55.64 76511 OPHTH US QUANT A ONLY 107.44 76512 OPHTH US B W/NON-QUANT A TC 41.96 76512 OPHTH US B W/NON-QUANT A 26 56.45 76512 OPHTH US B W/NON-QUANT A 98.42 76513 ECHO EXAM OF EYE WATER BATH TC 63.51 76513 ECHO EXAM OF EYE WATER BATH 26 37.66 76513 ECHO EXAM OF EYE WATER BATH 101.17 76514 ECHO EXAM OF EYE THICKNESS TC 5.68 76514 ECHO EXAM OF EYE THICKNESS 26 10.27 76514 ECHO EXAM OF EYE THICKNESS 15.95 76516 ECHO EXAM OF EYE TC 50.28 76516 ECHO EXAM OF EYE 26 32.23 76516 ECHO EXAM OF EYE 82.51 76519 ECHO EXAM OF EYE TC 55.95 76519 ECHO EXAM OF EYE 26 33.40 76519 ECHO EXAM OF EYE 89.35 76529 ECHO EXAM OF EYE TC 49.52 76529 ECHO EXAM OF EYE 26 34.85 76529 ECHO EXAM OF EYE 84.38 76536 US EXAM OF HEAD AND NECK TC 100.17 76536 US EXAM OF HEAD AND NECK 26 29.20 76536 US EXAM OF HEAD AND NECK 129.37 76604 US EXAM CHEST TC 65.40 76604 US EXAM CHEST 26 28.09 76604 US EXAM CHEST 93.49 76641 Ultrasound breast complete 26 37.54 76641 Ultrasound breast complete 112.77 76642 Ultrasound breast limited 26 34.96 76642 Ultrasound breast limited 92.46 76700 US EXAM ABDOM COMPLETE TC 107.35 76700 US EXAM ABDOM COMPLETE 26 41.96 76700 US EXAM ABDOM COMPLETE 149.32 76705 ECHO EXAM OF ABDOMEN TC 84.67 76705 ECHO EXAM OF ABDOMEN 26 30.28 76705 ECHO EXAM OF ABDOMEN 114.95 76770 US EXAM ABDO BACK WALL COMP TC 102.43 76770 US EXAM ABDO BACK WALL COMP 26 38.32 76770 US EXAM ABDO BACK WALL COMP 140.76 76775 US EXAM ABDO BACK WALL LIM TC 38.94 76775 US EXAM ABDO BACK WALL LIM 26 29.92 76775 US EXAM ABDO BACK WALL LIM 68.86 76776 US EXAM K TRANSPL W/DOPPLER TC 124.35 76776 US EXAM K TRANSPL W/DOPPLER 26 39.42 Proc Code Description Mod Rate 76776 US EXAM K TRANSPL W/DOPPLER 163.77 76800 US EXAM SPINAL CANAL TC 87.69 76800 US EXAM SPINAL CANAL 26 58.35 76800 US EXAM SPINAL CANAL 146.05 76801 OB US < 14 WKS SINGLE FETUS TC 82.40 76801 OB US < 14 WKS SINGLE FETUS 26 50.67 76801 OB US < 14 WKS SINGLE FETUS 133.08 76802 OB US < 14 WKS ADDL FETUS TC 27.22 76802 OB US < 14 WKS ADDL FETUS 26 43.04 76802 OB US < 14 WKS ADDL FETUS 70.27 76805 OB US >/= 14 WKS SNGL FETUS TC 103.19 76805 OB US >/= 14 WKS SNGL FETUS 26 51.05 76805 OB US >/= 14 WKS SNGL FETUS 154.24 76810 OB US >/= 14 WKS ADDL FETUS TC 51.03 76810 OB US >/= 14 WKS ADDL FETUS 26 50.69 76810 OB US >/= 14 WKS ADDL FETUS 101.73 76811 OB US DETAILED SNGL FETUS TC 95.63 76811 OB US DETAILED SNGL FETUS 26 98.45 76811 OB US DETAILED SNGL FETUS 194.09 76812 OB US DETAILED ADDL FETUS TC 128.13 76812 OB US DETAILED ADDL FETUS 26 92.64 76812 OB US DETAILED ADDL FETUS 220.78 76813 OB US NUCHAL MEAS 1 GEST TC 65.77 76813 OB US NUCHAL MEAS 1 GEST 26 61.28 76813 OB US NUCHAL MEAS 1 GEST 127.06 76814 OB US NUCHAL MEAS ADD-ON TC 31.76 76814 OB US NUCHAL MEAS ADD-ON 26 51.42 76814 OB US NUCHAL MEAS ADD-ON 83.19 76815 OB US LIMITED FETUS(S) TC 61.99 76815 OB US LIMITED FETUS(S) 26 33.15 76815 OB US LIMITED FETUS(S) 95.15 76816 OB US FOLLOW-UP PER FETUS TC 78.62 76816 OB US FOLLOW-UP PER FETUS 26 44.14 76816 OB US FOLLOW-UP PER FETUS 122.76 76817 TRANSVAGINAL US OBSTETRIC TC 68.04 76817 TRANSVAGINAL US OBSTETRIC 26 39.04 76817 TRANSVAGINAL US OBSTETRIC 107.08 76818 FETAL BIOPHYS PROFILE W/NST TC 73.71 76818 FETAL BIOPHYS PROFILE W/NST 26 54.71 76818 FETAL BIOPHYS PROFILE W/NST 128.42 76819 FETAL BIOPHYS PROFIL W/O NST TC 54.06 76819 FETAL BIOPHYS PROFIL W/O NST 26 40.13 76819 FETAL BIOPHYS PROFIL W/O NST 94.20 76820 UMBILICAL ARTERY ECHO TC 25.33 76820 UMBILICAL ARTERY ECHO 26 25.88 76820 UMBILICAL ARTERY ECHO 51.22 Proc Code Description Mod Rate 76821 MIDDLE CEREBRAL ARTERY ECHO TC 62.37 76821 MIDDLE CEREBRAL ARTERY ECHO 26 36.87 76821 MIDDLE CEREBRAL ARTERY ECHO 99.24 76825 ECHO EXAM OF FETAL HEART TC 203.72 76825 ECHO EXAM OF FETAL HEART 26 85.27 76825 ECHO EXAM OF FETAL HEART 289.00 76826 ECHO EXAM OF FETAL HEART TC 130.78 76826 ECHO EXAM OF FETAL HEART 26 42.66 76826 ECHO EXAM OF FETAL HEART 173.45 76827 ECHO EXAM OF FETAL HEART TC 49.90 76827 ECHO EXAM OF FETAL HEART 26 29.50 76827 ECHO EXAM OF FETAL HEART 79.41 76828 ECHO EXAM OF FETAL HEART TC 26.47 76828 ECHO EXAM OF FETAL HEART 26 28.79 76828 ECHO EXAM OF FETAL HEART 55.26 76830 TRANSVAGINAL US NON-OB TC 97.90 76830 TRANSVAGINAL US NON-OB 26 35.75 76830 TRANSVAGINAL US NON-OB 133.66 76831 ECHO EXAM UTERUS TC 93.36 76831 ECHO EXAM UTERUS 26 37.58 76831 ECHO EXAM UTERUS 130.95 76856 US EXAM PELVIC COMPLETE TC 96.01 76856 US EXAM PELVIC COMPLETE 26 35.38 76856 US EXAM PELVIC COMPLETE 131.39 76857 US EXAM PELVIC LIMITED TC 37.05 76857 US EXAM PELVIC LIMITED 26 19.72 76857 US EXAM PELVIC LIMITED 56.78 76870 US EXAM SCROTUM TC 44.61 76870 US EXAM SCROTUM 26 33.22 76870 US EXAM SCROTUM 77.84 76872 US TRANSRECTAL TC 62.37 76872 US TRANSRECTAL 26 35.39 76872 US TRANSRECTAL 97.77 76873 ECHOGRAP TRANS R PROS STUDY TC 99.41 76873 ECHOGRAP TRANS R PROS STUDY 26 81.05 76873 ECHOGRAP TRANS R PROS STUDY 180.46 76881 US XTR NON-VASC COMPLETE ULTRA TC 92.61 76881 US XTR NON-VASC COMPLETE ULTRA 26 32.86 76881 US XTR NON-VASC COMPLETE ULTRA 125.48 76882 US XTR NON-VASC LMTD TC 11.73 76882 US XTR NON-VASC LMTD 26 25.58 76882 US XTR NON-VASC LMTD 37.31 76885 US EXAM INFANT HIPS DYNAMIC TC 119.06 76885 US EXAM INFANT HIPS DYNAMIC 26 38.32 76885 US EXAM INFANT HIPS DYNAMIC 157.39 76886 US EXAM INFANT HIPS STATIC TC 81.65 Proc Code Description Mod Rate 76886 US EXAM INFANT HIPS STATIC 26 31.32 76886 US EXAM INFANT HIPS STATIC 112.97 76930 ECHO GUIDE CARDIOCENTESIS TC 54.81 76930 ECHO GUIDE CARDIOCENTESIS 26 33.11 76930 ECHO GUIDE CARDIOCENTESIS 87.93 76932 ECHO GUIDE FOR HEART BIOPSY TC 57.55 76932 ECHO GUIDE FOR HEART BIOPSY 26 34.30 76932 ECHO GUIDE FOR HEART BIOPSY 93.03 76936 ECHO GUIDE FOR ARTERY REPAIR TC 185.96 76936 ECHO GUIDE FOR ARTERY REPAIR 26 100.86 76936 ECHO GUIDE FOR ARTERY REPAIR 286.82 76937 US GUIDE VASCULAR ACCESS TC 22.31 76937 US GUIDE VASCULAR ACCESS 26 15.72 76937 US GUIDE VASCULAR ACCESS 38.04 76940 US GUIDE TISSUE ABLATION TC 71.29 76940 US GUIDE TISSUE ABLATION 26 108.89 76940 US GUIDE TISSUE ABLATION 177.08 76941 ECHO GUIDE FOR TRANSFUSION TC 57.55 76941 ECHO GUIDE FOR TRANSFUSION 26 72.44 76941 ECHO GUIDE FOR TRANSFUSION 128.87 76942 ECHO GUIDE FOR BIOPSY TC 42.34 76942 ECHO GUIDE FOR BIOPSY 26 34.68 76942 ECHO GUIDE FOR BIOPSY 77.02 76945 ECHO GUIDE VILLUS SAMPLING TC 57.55 76945 ECHO GUIDE VILLUS SAMPLING 26 35.81 76945 ECHO GUIDE VILLUS SAMPLING 92.31 76946 ECHO GUIDE FOR AMNIOCENTESIS TC 14.00 76946 ECHO GUIDE FOR AMNIOCENTESIS 26 19.69 76946 ECHO GUIDE FOR AMNIOCENTESIS 33.69 76948 ECHO GUIDE OVA ASPIRATION TC 14.00 76948 ECHO GUIDE OVA ASPIRATION 26 20.48 76948 ECHO GUIDE OVA ASPIRATION 34.48 76965 ECHO GUIDANCE RADIOTHERAPY TC 24.96 76965 ECHO GUIDANCE RADIOTHERAPY 26 69.74 76965 ECHO GUIDANCE RADIOTHERAPY 94.70 76970 ULTRASOUND EXAM FOLLOW-UP TC 79.00 76970 ULTRASOUND EXAM FOLLOW-UP 26 21.22 76970 ULTRASOUND EXAM FOLLOW-UP 100.22 76975 GI ENDOSCOPIC ULTRASOUND TC 57.55 76975 GI ENDOSCOPIC ULTRASOUND 26 45.06 76975 GI ENDOSCOPIC ULTRASOUND 99.18 76977 US BONE DENSITY MEASURE TC 4.55 76977 US BONE DENSITY MEASURE 26 2.94 76977 US BONE DENSITY MEASURE 7.49 76998 US GUIDE INTRAOP 26 67.68 76999 ECHO EXAMINATION PROCEDURE TC 0.00 Proc Code Description Mod Rate 76999 ECHO EXAMINATION PROCEDURE 0.00 77001 FLUOROGUIDE FOR VEIN DEVICE TC 63.88 77001 FLUOROGUIDE FOR VEIN DEVICE 26 19.72 77001 FLUOROGUIDE FOR VEIN DEVICE 83.61 77002 NEEDLE LOCALIZATION BY XRAY TC 79.00 77002 NEEDLE LOCALIZATION BY XRAY 26 28.86 77002 NEEDLE LOCALIZATION BY XRAY 107.87 77003 FLUOROGUIDE FOR SPINE INJECT TC 63.51 77003 FLUOROGUIDE FOR SPINE INJECT 26 31.39 77003 FLUOROGUIDE FOR SPINE INJECT 94.90 77011 CT SCAN FOR LOCALIZATION TC 172.73 77011 CT SCAN FOR LOCALIZATION 26 63.49 77011 CT SCAN FOR LOCALIZATION 236.22 77012 CT SCAN FOR NEEDLE BIOPSY TC 75.60 77012 CT SCAN FOR NEEDLE BIOPSY 26 58.67 77012 CT SCAN FOR NEEDLE BIOPSY 134.28 77013 CT GUIDE FOR TISSUE ABLATION TC 428.10 77013 CT GUIDE FOR TISSUE ABLATION 26 208.35 77013 CT GUIDE FOR TISSUE ABLATION 652.83 77014 CT SCAN FOR THERAPY GUIDE TC 84.29 77014 CT SCAN FOR THERAPY GUIDE 26 44.91 77014 CT SCAN FOR THERAPY GUIDE 129.21 77021 MR GUIDANCE FOR NEEDLE PLACE TC 339.77 77021 MR GUIDANCE FOR NEEDLE PLACE 26 78.93 77021 MR GUIDANCE FOR NEEDLE PLACE 418.71 77022 MRI FOR TISSUE ABLATION TC 739.86 77022 MRI FOR TISSUE ABLATION 26 221.49 77022 MRI FOR TISSUE ABLATION 799.67 77051 COMPUTER DX MAMMOGRAM ADD-ON TC 7.57 77051 COMPUTER DX MAMMOGRAM ADD-ON 26 3.30 77051 COMPUTER DX MAMMOGRAM ADD-ON 10.88 77052 COMP SCREEN MAMMOGRAM ADD-ON TC 7.57 77052 COMP SCREEN MAMMOGRAM ADD-ON 26 3.30 77052 COMP SCREEN MAMMOGRAM ADD-ON 10.88 77053 X-RAY OF MAMMARY DUCT TC 44.61 77053 X-RAY OF MAMMARY DUCT 26 18.21 77053 X-RAY OF MAMMARY DUCT 62.83 77054 X-RAY OF MAMMARY DUCTS TC 61.24 77054 X-RAY OF MAMMARY DUCTS 26 23.75 77054 X-RAY OF MAMMARY DUCTS 84.99 77055 MAMMOGRAM ONE BREAST TC 57.46 77055 MAMMOGRAM ONE BREAST 26 36.51 77055 MAMMOGRAM ONE BREAST 93.97 77056 MAMMOGRAM BOTH BREASTS TC 75.60 77056 MAMMOGRAM BOTH BREASTS 26 45.27 77056 MAMMOGRAM BOTH BREASTS 120.87 Proc Code Description Mod Rate 77057 MAMMOGRAM SCREENING TC 49.52 77057 MAMMOGRAM SCREENING 26 36.51 77057 MAMMOGRAM SCREENING 86.04 77058 MRI ONE BREAST TC 496.61 77058 MRI ONE BREAST 26 84.71 77058 MRI ONE BREAST 581.33 77059 MRI BOTH BREASTS TC 494.35 77059 MRI BOTH BREASTS 26 84.71 77059 MRI BOTH BREASTS 579.06 77063 Breast tomosynthesis bi 26 31.62 77063 Breast tomosynthesis bi 58.64 77071 X-RAY STRESS VIEW 53.75 77072 X-RAYS FOR BONE AGE TC 15.13 77072 X-RAYS FOR BONE AGE 26 9.85 77072 X-RAYS FOR BONE AGE 24.99 77073 X-RAYS BONE LENGTH STUDIES TC 24.58 77073 X-RAYS BONE LENGTH STUDIES 26 15.80 77073 X-RAYS BONE LENGTH STUDIES 40.38 77074 X-RAYS BONE SURVEY LIMITED TC 51.79 77074 X-RAYS BONE SURVEY LIMITED 26 23.75 77074 X-RAYS BONE SURVEY LIMITED 75.54 77075 X-RAYS BONE SURVEY COMPLETE TC 85.05 77075 X-RAYS BONE SURVEY COMPLETE 26 28.11 77075 X-RAYS BONE SURVEY COMPLETE 113.16 77076 X-RAYS BONE SURVEY INFANT TC 77.11 77076 X-RAYS BONE SURVEY INFANT 26 36.51 77076 X-RAYS BONE SURVEY INFANT 113.62 77077 JOINT SURVEY SINGLE VIEW TC 24.96 77077 JOINT SURVEY SINGLE VIEW 26 17.61 77077 JOINT SURVEY SINGLE VIEW 42.57 77078 CT BONE DENSITY AXIAL TC 107.35 77078 CT BONE DENSITY AXIAL 26 12.76 77078 CT BONE DENSITY AXIAL 120.11 77080 DXA BONE DENSITY AXIAL TC 41.21 77080 DXA BONE DENSITY AXIAL 26 10.59 77080 DXA BONE DENSITY AXIAL 51.80 77081 DXA BONE DENSITY/PERIPHERAL TC 17.78 77081 DXA BONE DENSITY/PERIPHERAL 26 11.30 77081 DXA BONE DENSITY/PERIPHERAL 29.09 77084 MAGNETIC IMAGE BONE MARROW TC 332.97 77084 MAGNETIC IMAGE BONE MARROW 26 83.63 77084 MAGNETIC IMAGE BONE MARROW 416.61 77085 Dxa bone density study 26 15.83 77085 Dxa bone density study 59.16 77086 Fracture assessment via dxa 37.50 77261 RADIATION THERAPY PLANNING 76.86 Proc Code Description Mod Rate 77262 RADIATION THERAPY PLANNING 115.28 77263 RADIATION THERAPY PLANNING 170.12 77280 SET RADIATION THERAPY FIELD TC 248.31 77280 SET RADIATION THERAPY FIELD 26 36.87 77280 SET RADIATION THERAPY FIELD 285.19 77285 SET RADIATION THERAPY FIELD TC 388.90 77285 SET RADIATION THERAPY FIELD 26 55.50 77285 SET RADIATION THERAPY FIELD 444.41 77290 SET RADIATION THERAPY FIELD TC 449.75 77290 SET RADIATION THERAPY FIELD 26 82.52 77290 SET RADIATION THERAPY FIELD 532.28 77293 Respirator motion mgmt simul 26 105.91 77293 Respirator motion mgmt simul 452.49 77295 3-D RADIOTHERAPY PLAN TC 276.71 77295 3-D RADIOTHERAPY PLAN 26 227.16 77295 3-D RADIOTHERAPY PLAN 503.88 77300 RADIATION THERAPY DOSE PLAN TC 37.05 77300 RADIATION THERAPY DOSE PLAN 26 32.87 77300 RADIATION THERAPY DOSE PLAN 69.92 77301 RADIOTHERAPY DOSE PLAN IMRT TC 1630.40 77301 RADIOTHERAPY DOSE PLAN IMRT 26 422.91 77301 RADIOTHERAPY DOSE PLAN IMRT 2053.31 77306 Telethx isodose plan simple 149.65 77307 Telethx isodose plan cplx 26 151.41 77307 Telethx isodose plan cplx 291.55 77316 Brachytx isodose plan simple 192.75 77317 Brachytx isodose intermed 252.43 77318 Brachytx isodose complex 363.39 77321 SPECIAL TELETX PORT PLAN TC 44.99 77321 SPECIAL TELETX PORT PLAN 26 50.01 77321 SPECIAL TELETX PORT PLAN 95.00 77331 SPECIAL RADIATION DOSIMETRY TC 19.67 77331 SPECIAL RADIATION DOSIMETRY 26 46.01 77331 SPECIAL RADIATION DOSIMETRY 65.68 77332 RADIATION TREATMENT AID(S) TC 55.19 77332 RADIATION TREATMENT AID(S) 26 28.86 77332 RADIATION TREATMENT AID(S) 84.06 77333 RADIATION TREATMENT AID(S) TC 9.84 77333 RADIATION TREATMENT AID(S) 26 44.55 77333 RADIATION TREATMENT AID(S) 54.40 77334 RADIATION TREATMENT AID(S) TC 91.09 77334 RADIATION TREATMENT AID(S) 26 65.34 77334 RADIATION TREATMENT AID(S) 156.44 77336 RADIATION PHYSICS CONSULT 79.00 77338 DESIGN MLC DEVICE FOR IMRT TC 294.10 77338 DESIGN MLC DEVICE FOR IMRT 26 227.56 Proc Code Description Mod Rate 77338 DESIGN MLC DEVICE FOR IMRT 521.66 77370 RADIATION PHYSICS CONSULT 121.01 77371 SRS MULTISOURCE 1149.24 77372 SRS LINEAR BASED 1102.89 77373 SBRT DELIVERY 1320.61 77401 RADIATION TREATMENT DELIVERY 21.18 77402 RADIATION TREATMENT DELIVERY 147.78 77407 RADIATION TREATMENT DELIVERY 268.34 77412 RADIATION TREATMENT DELIVERY 254.74 77417 RADIOLOGY PORT FILM(S) 14.75 77422 NEUTRON BEAM TX SIMPLE 44.23 77423 NEUTRON BEAM TX COMPLEX 52.55 77424 Io rad tx delivery by x-ray 0.00 77425 Io rad tx deliver by elctrns 0.00 77427 RADIATION TX MANAGEMENT X5 190.48 77431 RADIATION THERAPY MANAGEMENT 104.45 77432 STEREOTACTIC RADIATION TRMT 428.39 77435 SBRT MANAGEMENT 647.36 77469 Io radiation tx management 320.40 77470 SPECIAL RADIATION TREATMENT TC 49.14 77470 SPECIAL RADIATION TREATMENT 26 110.65 77470 SPECIAL RADIATION TREATMENT 159.80 77520 PROTON TRMT SIMPLE W/O COMP 0.00 77522 PROTON TRMT SIMPLE W/COMP 0.00 77523 PROTON TRMT INTERMEDIATE 0.00 77525 PROTON TREATMENT COMPLEX 0.00 77600 HYPERTHERMIA TREATMENT TC 334.52 77600 HYPERTHERMIA TREATMENT 26 82.52 77600 HYPERTHERMIA TREATMENT 417.04 77605 HYPERTHERMIA TREATMENT TC 638.75 77605 HYPERTHERMIA TREATMENT 26 120.21 77605 HYPERTHERMIA TREATMENT 758.96 77610 HYPERTHERMIA TREATMENT TC 969.44 77610 HYPERTHERMIA TREATMENT 26 80.25 77610 HYPERTHERMIA TREATMENT 1049.70 77615 HYPERTHERMIA TREATMENT TC 938.53 77615 HYPERTHERMIA TREATMENT 26 110.65 77615 HYPERTHERMIA TREATMENT 1049.18 77620 HYPERTHERMIA TREATMENT TC 301.28 77620 HYPERTHERMIA TREATMENT 26 81.33 77620 HYPERTHERMIA TREATMENT 382.62 77750 INFUSE RADIOACTIVE MATERIALS TC 115.70 77750 INFUSE RADIOACTIVE MATERIALS 26 264.41 77750 INFUSE RADIOACTIVE MATERIALS 380.11 77761 APPLY INTRCAV RADIAT SIMPLE TC 199.62 77761 APPLY INTRCAV RADIAT SIMPLE 26 201.90 Proc Code Description Mod Rate 77761 APPLY INTRCAV RADIAT SIMPLE 401.52 77762 APPLY INTRCAV RADIAT INTERM TC 226.47 77762 APPLY INTRCAV RADIAT INTERM 26 303.83 77762 APPLY INTRCAV RADIAT INTERM 530.30 77763 APPLY INTRCAV RADIAT COMPL TC 293.02 77763 APPLY INTRCAV RADIAT COMPL 26 458.33 77763 APPLY INTRCAV RADIAT COMPL 751.35 77776 APPLY INTERSTIT RADIAT SIMPL TC 198.88 77776 APPLY INTERSTIT RADIAT SIMPL 26 251.48 77776 APPLY INTERSTIT RADIAT SIMPL 450.36 77777 APPLY INTERSTIT RADIAT INTER TC 203.41 77777 APPLY INTERSTIT RADIAT INTER 26 402.05 77777 APPLY INTERSTIT RADIAT INTER 605.47 77778 APPLY INTERSTIT RADIAT COMPL TC 300.60 77778 APPLY INTERSTIT RADIAT COMPL 26 598.21 77778 APPLY INTERSTIT RADIAT COMPL 898.81 77785 HDR BRACHYTX 1 CHANNEL TC 172.77 77785 HDR BRACHYTX 1 CHANNEL 26 75.23 77785 HDR BRACHYTX 1 CHANNEL 248.00 77786 HDR BRACHYTX 2-12 CHANNEL TC 333.42 77786 HDR BRACHYTX 2-12 CHANNEL 26 171.99 77786 HDR BRACHYTX 2-12 CHANNEL 505.42 77787 HDR BRACHYTX OVER 12 CHAN TC 546.25 77787 HDR BRACHYTX OVER 12 CHAN 26 259.33 77787 HDR BRACHYTX OVER 12 CHAN 805.59 77789 APPLY SURFACE RADIATION TC 62.37 77789 APPLY SURFACE RADIATION 26 60.24 77789 APPLY SURFACE RADIATION 122.62 77790 RADIATION HANDLING TC 44.61 77790 RADIATION HANDLING 26 54.73 77790 RADIATION HANDLING 99.34 78012 Thyroid uptake measurement TC 72.95 78012 Thyroid uptake measurement 26 9.47 78012 Thyroid uptake measurement 82.43 78013 Thyroid imaging w/blood flow TC 189.39 78013 Thyroid imaging w/blood flow 26 18.57 78013 Thyroid imaging w/blood flow 207.97 78014 Thyroid imaging w/blood flow TC 226.43 78014 Thyroid imaging w/blood flow 26 25.54 78014 Thyroid imaging w/blood flow 251.98 78015 THYROID MET IMAGING TC 199.22 78015 THYROID MET IMAGING 26 34.30 78015 THYROID MET IMAGING 233.52 78016 THYROID MET IMAGING/STUDIES TC 264.98 78016 THYROID MET IMAGING/STUDIES 26 35.88 78016 THYROID MET IMAGING/STUDIES 300.86 Proc Code Description Mod Rate 78018 THYROID MET IMAGING BODY TC 292.95 78018 THYROID MET IMAGING BODY 26 42.62 78018 THYROID MET IMAGING BODY 335.58 78020 THYROID MET UPTAKE TC 59.35 78020 THYROID MET UPTAKE 26 28.75 78020 THYROID MET UPTAKE 88.10 78070 PARATHYROID PLANAR IMAGING TC 278.96 78070 PARATHYROID PLANAR IMAGING 26 40.47 78070 PARATHYROID PLANAR IMAGING 319.44 78071 Parathyrd planar w/wo subtrj TC 314.11 78071 Parathyrd planar w/wo subtrj 26 60.52 78071 Parathyrd planar w/wo subtrj 374.64 78072 Parathyrd planar w/spect&ct TC 386.30 78072 Parathyrd planar w/spect&ct 26 81.63 78072 Parathyrd planar w/spect&ct 467.93 78075 ADRENAL CORTEX & MEDULLA IMG TC 420.33 78075 ADRENAL CORTEX & MEDULLA IMG 26 36.43 78075 ADRENAL CORTEX & MEDULLA IMG 456.76 78102 BONE MARROW IMAGING LTD TC 153.87 78102 BONE MARROW IMAGING LTD 26 27.33 78102 BONE MARROW IMAGING LTD 181.21 78103 BONE MARROW IMAGING MULT TC 202.62 78103 BONE MARROW IMAGING MULT 26 37.92 78103 BONE MARROW IMAGING MULT 240.55 78104 BONE MARROW IMAGING BODY TC 220.76 78104 BONE MARROW IMAGING BODY 26 39.34 78104 BONE MARROW IMAGING BODY 260.11 78110 PLASMA VOLUME SINGLE TC 91.13 78110 PLASMA VOLUME SINGLE 26 9.85 78110 PLASMA VOLUME SINGLE 100.99 78111 PLASMA VOLUME MULTIPLE TC 94.53 78111 PLASMA VOLUME MULTIPLE 26 11.30 78111 PLASMA VOLUME MULTIPLE 105.84 78120 RED CELL MASS SINGLE TC 90.00 78120 RED CELL MASS SINGLE 26 12.04 78120 RED CELL MASS SINGLE 102.04 78121 RED CELL MASS MULTIPLE TC 91.13 78121 RED CELL MASS MULTIPLE 26 16.40 78121 RED CELL MASS MULTIPLE 107.54 78122 BLOOD VOLUME TC 83.20 78122 BLOOD VOLUME 26 21.82 78122 BLOOD VOLUME 105.02 78130 RED CELL SURVIVAL STUDY TC 150.11 78130 RED CELL SURVIVAL STUDY 26 32.15 78130 RED CELL SURVIVAL STUDY 182.26 78135 RED CELL SURVIVAL KINETICS TC 342.46 Proc Code Description Mod Rate 78135 RED CELL SURVIVAL KINETICS 26 33.60 78135 RED CELL SURVIVAL KINETICS 376.06 78140 RED CELL SEQUESTRATION TC 113.05 78140 RED CELL SEQUESTRATION 26 32.15 78140 RED CELL SEQUESTRATION 145.20 78185 SPLEEN IMAGING TC 205.65 78185 SPLEEN IMAGING 26 20.40 78185 SPLEEN IMAGING 226.05 78190 PLATELET SURVIVAL KINETICS TC 368.53 78190 PLATELET SURVIVAL KINETICS 26 56.54 78190 PLATELET SURVIVAL KINETICS 425.08 78191 PLATELET SURVIVAL TC 150.11 78191 PLATELET SURVIVAL 26 32.15 78191 PLATELET SURVIVAL 182.26 78195 LYMPH SYSTEM IMAGING TC 321.29 78195 LYMPH SYSTEM IMAGING 26 60.92 78195 LYMPH SYSTEM IMAGING 382.22 78201 LIVER IMAGING TC 178.43 78201 LIVER IMAGING 26 22.27 78201 LIVER IMAGING 200.71 78202 LIVER IMAGING WITH FLOW TC 193.17 78202 LIVER IMAGING WITH FLOW 26 24.35 78202 LIVER IMAGING WITH FLOW 217.53 78205 LIVER IMAGING (3D) TC 193.17 78205 LIVER IMAGING (3D) 26 35.36 78205 LIVER IMAGING (3D) 228.53 78206 LIVER IMAGE (3D) WITH FLOW TC 316.00 78206 LIVER IMAGE (3D) WITH FLOW 26 47.72 78206 LIVER IMAGE (3D) WITH FLOW 363.73 78215 LIVER AND SPLEEN IMAGING TC 183.73 78215 LIVER AND SPLEEN IMAGING 26 25.18 78215 LIVER AND SPLEEN IMAGING 208.91 78216 LIVER & SPLEEN IMAGE/FLOW TC 103.23 78216 LIVER & SPLEEN IMAGE/FLOW 26 28.05 78216 LIVER & SPLEEN IMAGE/FLOW 131.28 78226 Hepatobiliary system imaging TC 317.89 78226 Hepatobiliary system imaging 26 37.94 78226 Hepatobiliary system imaging 355.84 78227 Hepatobil syst image w/drug TC 436.20 78227 Hepatobil syst image w/drug 26 45.95 78227 Hepatobil syst image w/drug 482.15 78230 SALIVARY GLAND IMAGING TC 126.66 78230 SALIVARY GLAND IMAGING 26 19.97 78230 SALIVARY GLAND IMAGING 146.63 78231 SERIAL SALIVARY IMAGING TC 111.92 78231 SERIAL SALIVARY IMAGING 26 26.22 Proc Code Description Mod Rate 78231 SERIAL SALIVARY IMAGING 138.14 78232 SALIVARY GLAND FUNCTION EXAM TC 85.09 78232 SALIVARY GLAND FUNCTION EXAM 26 21.06 78232 SALIVARY GLAND FUNCTION EXAM 106.15 78258 ESOPHAGEAL MOTILITY STUDY TC 199.60 78258 ESOPHAGEAL MOTILITY STUDY 26 37.17 78258 ESOPHAGEAL MOTILITY STUDY 236.77 78261 GASTRIC MUCOSA IMAGING TC 235.12 78261 GASTRIC MUCOSA IMAGING 26 36.15 78261 GASTRIC MUCOSA IMAGING 271.28 78262 GASTROESOPHAGEAL REFLUX EXAM TC 227.94 78262 GASTROESOPHAGEAL REFLUX EXAM 26 33.47 78262 GASTROESOPHAGEAL REFLUX EXAM 261.42 78264 GASTRIC EMPTYING STUDY TC 268.00 78264 GASTRIC EMPTYING STUDY 26 40.85 78264 GASTRIC EMPTYING STUDY 308.86 78267 BREATH TST ATTAIN/ANAL C-14 11.94 78268 BREATH TEST ANALYSIS C-14 102.44 78270 VIT B-12 ABSORPTION EXAM TC 85.80 78270 VIT B-12 ABSORPTION EXAM 26 10.59 78270 VIT B-12 ABSORPTION EXAM 96.40 78271 VIT B-12 ABSRP EXAM INT FAC TC 85.80 78271 VIT B-12 ABSRP EXAM INT FAC 26 10.59 78271 VIT B-12 ABSRP EXAM INT FAC 96.40 78272 VIT B-12 ABSORP COMBINED TC 95.29 78272 VIT B-12 ABSORP COMBINED 26 14.23 78272 VIT B-12 ABSORP COMBINED 109.53 78278 ACUTE GI BLOOD LOSS IMAGING TC 323.94 78278 ACUTE GI BLOOD LOSS IMAGING 26 50.33 78278 ACUTE GI BLOOD LOSS IMAGING 374.27 78282 GI PROTEIN LOSS EXAM TC 59.73 78282 GI PROTEIN LOSS EXAM 26 20.10 78282 GI PROTEIN LOSS EXAM 79.64 78290 MECKELS DIVERT EXAM TC 323.94 78290 MECKELS DIVERT EXAM 26 35.04 78290 MECKELS DIVERT EXAM 358.98 78291 LEVEEN/SHUNT PATENCY EXAM TC 224.92 78291 LEVEEN/SHUNT PATENCY EXAM 26 44.12 78291 LEVEEN/SHUNT PATENCY EXAM 269.04 78300 BONE IMAGING LIMITED AREA TC 161.81 78300 BONE IMAGING LIMITED AREA 26 32.11 78300 BONE IMAGING LIMITED AREA 193.92 78305 BONE IMAGING MULTIPLE AREAS TC 204.89 78305 BONE IMAGING MULTIPLE AREAS 26 42.30 78305 BONE IMAGING MULTIPLE AREAS 247.20 78306 BONE IMAGING WHOLE BODY TC 225.30 Proc Code Description Mod Rate 78306 BONE IMAGING WHOLE BODY 26 43.76 78306 BONE IMAGING WHOLE BODY 269.06 78315 BONE IMAGING 3 PHASE TC 321.67 78315 BONE IMAGING 3 PHASE 26 51.78 78315 BONE IMAGING 3 PHASE 373.46 78320 BONE IMAGING (3D) TC 191.66 78320 BONE IMAGING (3D) 26 51.74 78320 BONE IMAGING (3D) 243.41 78350 BONE MINERAL SINGLE PHOTON TC 23.07 78350 BONE MINERAL SINGLE PHOTON 26 11.30 78350 BONE MINERAL SINGLE PHOTON 34.38 78351 BONE MINERAL DUAL PHOTON 15.68 78414 NON-IMAGING HEART FUNCTION TC 54.30 78414 NON-IMAGING HEART FUNCTION 26 23.37 78414 NON-IMAGING HEART FUNCTION 77.46 78428 CARDIAC SHUNT IMAGING TC 156.51 78428 CARDIAC SHUNT IMAGING 26 38.98 78428 CARDIAC SHUNT IMAGING 195.50 78445 VASCULAR FLOW IMAGING TC 160.67 78445 VASCULAR FLOW IMAGING 26 23.25 78445 VASCULAR FLOW IMAGING 183.93 78451 HT MUSCLE IMAGE SPECT SING TC 298.24 78451 HT MUSCLE IMAGE SPECT SING 26 69.23 78451 HT MUSCLE IMAGE SPECT SING 367.47 78452 HT MUSCLE IMAGE SPECT MULT TC 429.02 78452 HT MUSCLE IMAGE SPECT MULT 26 81.23 78452 HT MUSCLE IMAGE SPECT MULT 510.26 78453 HT MUSCLE IMAGE PLANAR SING TC 277.07 78453 HT MUSCLE IMAGE PLANAR SING 26 51.44 78453 HT MUSCLE IMAGE PLANAR SING 328.52 78454 HT MUSC IMAGE PLANAR MULT TC 399.54 78454 HT MUSC IMAGE PLANAR MULT 26 68.17 78454 HT MUSC IMAGE PLANAR MULT 467.72 78456 ACUTE VENOUS THROMBUS IMAGE TC 292.95 78456 ACUTE VENOUS THROMBUS IMAGE 26 50.27 78456 ACUTE VENOUS THROMBUS IMAGE 343.22 78457 VENOUS THROMBOSIS IMAGING TC 169.36 78457 VENOUS THROMBOSIS IMAGING 26 39.02 78457 VENOUS THROMBOSIS IMAGING 208.39 78458 VEN THROMBOSIS IMAGES BILAT TC 133.84 78458 VEN THROMBOSIS IMAGES BILAT 26 39.54 78458 VEN THROMBOSIS IMAGES BILAT 173.38 78459 HEART MUSCLE IMAGING (PET) TC 183.17 78459 HEART MUSCLE IMAGING (PET) 26 75.13 78459 HEART MUSCLE IMAGING (PET) 261.72 78466 HEART INFARCT IMAGE TC 159.92 Proc Code Description Mod Rate 78466 HEART INFARCT IMAGE 26 35.75 78466 HEART INFARCT IMAGE 195.67 78468 HEART INFARCT IMAGE (EF) TC 170.12 78468 HEART INFARCT IMAGE (EF) 26 40.45 78468 HEART INFARCT IMAGE (EF) 210.58 78469 HEART INFARCT IMAGE (3D) TC 194.31 78469 HEART INFARCT IMAGE (3D) 26 47.02 78469 HEART INFARCT IMAGE (3D) 241.34 78472 GATED HEART PLANAR SINGLE TC 196.57 78472 GATED HEART PLANAR SINGLE 26 49.19 78472 GATED HEART PLANAR SINGLE 245.77 78473 GATED HEART MULTIPLE TC 236.64 78473 GATED HEART MULTIPLE 26 73.59 78473 GATED HEART MULTIPLE 310.23 78481 HEART FIRST PASS SINGLE TC 139.47 78481 HEART FIRST PASS SINGLE 26 48.80 78481 HEART FIRST PASS SINGLE 188.27 78483 HEART FIRST PASS MULTIPLE TC 182.59 78483 HEART FIRST PASS MULTIPLE 26 73.96 78483 HEART FIRST PASS MULTIPLE 256.56 78491 HEART IMAGE (PET) SINGLE TC 185.34 78491 HEART IMAGE (PET) SINGLE 26 75.89 78491 HEART IMAGE (PET) SINGLE 264.62 78492 HEART IMAGE (PET) MULTIPLE TC 230.59 78492 HEART IMAGE (PET) MULTIPLE 26 94.09 78492 HEART IMAGE (PET) MULTIPLE 329.42 78494 HEART IMAGE SPECT TC 182.59 78494 HEART IMAGE SPECT 26 59.75 78494 HEART IMAGE SPECT 242.34 78496 HEART FIRST PASS ADD-ON TC 21.93 78496 HEART FIRST PASS ADD-ON 26 25.12 78496 HEART FIRST PASS ADD-ON 47.06 78579 Lung ventilation imaging TC 175.39 78579 Lung ventilation imaging 26 24.80 78579 Lung ventilation imaging 200.20 78580 LUNG PERFUSION IMAGING TC 218.87 78580 LUNG PERFUSION IMAGING 26 37.55 78580 LUNG PERFUSION IMAGING 256.42 78582 Lung ventilat&perfus imaging TC 305.42 78582 Lung ventilat&perfus imaging 26 54.33 78582 Lung ventilat&perfus imaging 359.75 78597 Lung perfusion differential TC 179.93 78597 Lung perfusion differential 26 36.37 78597 Lung perfusion differential 216.31 78598 Lung perf&ventilat diferentl TC 287.28 78598 Lung perf&ventilat diferentl 26 42.25 Proc Code Description Mod Rate 78598 Lung perf&ventilat diferentl 329.53 78600 BRAIN IMAGE < 4 VIEWS TC 174.28 78600 BRAIN IMAGE < 4 VIEWS 26 22.22 78600 BRAIN IMAGE < 4 VIEWS 196.50 78601 BRAIN IMAGE W/FLOW < 4 VIEWS TC 206.02 78601 BRAIN IMAGE W/FLOW < 4 VIEWS 26 26.28 78601 BRAIN IMAGE W/FLOW < 4 VIEWS 232.30 78605 BRAIN IMAGE 4+ VIEWS TC 184.86 78605 BRAIN IMAGE 4+ VIEWS 26 27.75 78605 BRAIN IMAGE 4+ VIEWS 212.61 78606 BRAIN IMAGE W/FLOW 4 + VIEWS TC 322.05 78606 BRAIN IMAGE W/FLOW 4 + VIEWS 26 31.66 78606 BRAIN IMAGE W/FLOW 4 + VIEWS 353.71 78607 BRAIN IMAGING (3D) TC 312.98 78607 BRAIN IMAGING (3D) 26 60.45 78607 BRAIN IMAGING (3D) 373.43 78608 BRAIN IMAGING (PET) TC 1218.13 78608 BRAIN IMAGING (PET) 26 75.91 78608 BRAIN IMAGING (PET) 1740.13 78609 BRAIN IMAGING (PET) TC 1425.19 78609 BRAIN IMAGING (PET) 26 79.67 78609 BRAIN IMAGING (PET) 79.67 78610 BRAIN FLOW IMAGING ONLY TC 172.01 78610 BRAIN FLOW IMAGING ONLY 26 15.31 78610 BRAIN FLOW IMAGING ONLY 187.32 78630 CEREBROSPINAL FLUID SCAN TC 328.09 78630 CEREBROSPINAL FLUID SCAN 26 34.64 78630 CEREBROSPINAL FLUID SCAN 362.74 78635 CSF VENTRICULOGRAPHY TC 333.01 78635 CSF VENTRICULOGRAPHY 26 30.96 78635 CSF VENTRICULOGRAPHY 363.97 78645 CSF SHUNT EVALUATION TC 318.65 78645 CSF SHUNT EVALUATION 26 28.43 78645 CSF SHUNT EVALUATION 347.08 78647 CEREBROSPINAL FLUID SCAN TC 329.23 78647 CEREBROSPINAL FLUID SCAN 26 46.72 78647 CEREBROSPINAL FLUID SCAN 375.96 78650 CSF LEAKAGE IMAGING TC 329.61 78650 CSF LEAKAGE IMAGING 26 31.39 78650 CSF LEAKAGE IMAGING 361.00 78660 NUCLEAR EXAM OF TEAR FLOW TC 171.63 78660 NUCLEAR EXAM OF TEAR FLOW 26 28.13 78660 NUCLEAR EXAM OF TEAR FLOW 199.76 78700 KIDNEY IMAGING MORPHOL TC 163.69 78700 KIDNEY IMAGING MORPHOL 26 22.99 78700 KIDNEY IMAGING MORPHOL 186.69 Proc Code Description Mod Rate 78701 KIDNEY IMAGING WITH FLOW TC 204.51 78701 KIDNEY IMAGING WITH FLOW 26 25.18 78701 KIDNEY IMAGING WITH FLOW 229.70 78707 K FLOW/FUNCT IMAGE W/O DRUG TC 199.60 78707 K FLOW/FUNCT IMAGE W/O DRUG 26 48.10 78707 K FLOW/FUNCT IMAGE W/O DRUG 247.70 78708 K FLOW/FUNCT IMAGE W/DRUG TC 123.26 78708 K FLOW/FUNCT IMAGE W/DRUG 26 60.86 78708 K FLOW/FUNCT IMAGE W/DRUG 184.12 78709 K FLOW/FUNCT IMAGE MULTIPLE TC 320.91 78709 K FLOW/FUNCT IMAGE MULTIPLE 26 70.72 78709 K FLOW/FUNCT IMAGE MULTIPLE 391.64 78710 KIDNEY IMAGING (3D) TC 182.59 78710 KIDNEY IMAGING (3D) 26 30.48 78710 KIDNEY IMAGING (3D) 213.08 78725 KIDNEY FUNCTION STUDY TC 97.93 78725 KIDNEY FUNCTION STUDY 26 18.55 78725 KIDNEY FUNCTION STUDY 116.49 78730 URINARY BLADDER RETENTION TC 73.33 78730 URINARY BLADDER RETENTION 26 8.04 78730 URINARY BLADDER RETENTION 81.38 78740 URETERAL REFLUX STUDY TC 207.16 78740 URETERAL REFLUX STUDY 26 28.80 78740 URETERAL REFLUX STUDY 235.97 78761 TESTICULAR IMAGING W/FLOW TC 188.64 78761 TESTICULAR IMAGING W/FLOW 26 36.87 78761 TESTICULAR IMAGING W/FLOW 225.51 78800 TUMOR IMAGING LIMITED AREA TC 169.74 78800 TUMOR IMAGING LIMITED AREA 26 34.32 78800 TUMOR IMAGING LIMITED AREA 204.06 78801 TUMOR IMAGING MULT AREAS TC 227.94 78801 TUMOR IMAGING MULT AREAS 26 40.49 78801 TUMOR IMAGING MULT AREAS 268.44 78802 TUMOR IMAGING WHOLE BODY TC 302.40 78802 TUMOR IMAGING WHOLE BODY 26 43.00 78802 TUMOR IMAGING WHOLE BODY 345.40 78803 TUMOR IMAGING (3D) TC 310.33 78803 TUMOR IMAGING (3D) 26 53.54 78803 TUMOR IMAGING (3D) 363.87 78804 TUMOR IMAGING WHOLE BODY TC 555.65 78804 TUMOR IMAGING WHOLE BODY 26 53.57 78804 TUMOR IMAGING WHOLE BODY 609.23 78805 ABSCESS IMAGING LTD AREA TC 158.40 78805 ABSCESS IMAGING LTD AREA 26 37.21 78805 ABSCESS IMAGING LTD AREA 195.62 78806 ABSCESS IMAGING WHOLE BODY TC 311.47 Proc Code Description Mod Rate 78806 ABSCESS IMAGING WHOLE BODY 26 43.00 78806 ABSCESS IMAGING WHOLE BODY 354.47 78807 NUCLEAR LOCALIZATION/ABSCESS TC 309.20 78807 NUCLEAR LOCALIZATION/ABSCESS 26 53.14 78807 NUCLEAR LOCALIZATION/ABSCESS 362.34 78808 IV INJ RA DRUG DX STUDY 49.59 78811 PET IMAGE LTD AREA TC 608.94 78811 PET IMAGE LTD AREA 26 82.74 78811 PET IMAGE LTD AREA 690.65 78812 PET IMAGE SKULL-THIGH TC 756.42 78812 PET IMAGE SKULL-THIGH 26 99.34 78812 PET IMAGE SKULL-THIGH 857.85 78813 PET IMAGE FULL BODY TC 783.97 78813 PET IMAGE FULL BODY 26 104.53 78813 PET IMAGE FULL BODY 889.05 78814 PET IMAGE W/CT LMTD TC 857.71 78814 PET IMAGE W/CT LMTD 26 115.14 78814 PET IMAGE W/CT LMTD 972.65 78815 PET IMAGE W/CT SKULL-THIGH TC 947.84 78815 PET IMAGE W/CT SKULL-THIGH 26 126.81 78815 PET IMAGE W/CT SKULL-THIGH 1074.82 78816 PET IMAGE W/CT FULL BODY TC 972.44 78816 PET IMAGE W/CT FULL BODY 26 127.83 78816 PET IMAGE W/CT FULL BODY 1102.71 78999 NUCLEAR DIAGNOSTIC EXAM TC 0.00 78999 NUCLEAR DIAGNOSTIC EXAM 26 0.00 78999 NUCLEAR DIAGNOSTIC EXAM 0.00 79005 NUCLEAR RX ORAL ADMIN TC 51.41 79005 NUCLEAR RX ORAL ADMIN 26 90.37 79005 NUCLEAR RX ORAL ADMIN 141.79 79101 NUCLEAR RX IV ADMIN TC 52.17 79101 NUCLEAR RX IV ADMIN 26 97.62 79101 NUCLEAR RX IV ADMIN 149.79 79200 NUCLEAR RX INTRACAV ADMIN TC 58.97 79200 NUCLEAR RX INTRACAV ADMIN 26 105.95 79200 NUCLEAR RX INTRACAV ADMIN 164.93 79300 NUCLR RX INTERSTIT COLLOID TC 55.74 79300 NUCLR RX INTERSTIT COLLOID 26 84.82 79300 NUCLR RX INTERSTIT COLLOID 139.37 79403 HEMATOPOIETIC NUCLEAR TX TC 85.84 79403 HEMATOPOIETIC NUCLEAR TX 26 116.41 79403 HEMATOPOIETIC NUCLEAR TX 202.25 79440 NUCLEAR RX INTRA-ARTICULAR TC 50.28 79440 NUCLEAR RX INTRA-ARTICULAR 26 101.30 79440 NUCLEAR RX INTRA-ARTICULAR 151.59 79445 NUCLEAR RX INTRA-ARTERIAL TC 104.92 Proc Code Description Mod Rate 79445 NUCLEAR RX INTRA-ARTERIAL 26 121.18 79445 NUCLEAR RX INTRA-ARTERIAL 227.68 80047 METABOLIC PANEL IONIZED CA 10.96 80048 METABOLIC PANEL TOTAL CA 10.96 80050 GENERAL HEALTH PANEL 24.56 80051 ELECTROLYTE PANEL 9.09 80053 COMPREHEN METABOLIC PANEL 13.68 80055 OBSTETRIC PANEL 49.38 80061 LIPID PANEL 17.35 80069 RENAL FUNCTION PANEL 11.25 80074 ACUTE HEPATITIS PANEL 61.74 80076 HEPATIC FUNCTION PANEL 10.58 80150 ASSAY OF AMIKACIN 19.53 80156 ASSAY CARBAMAZEPINE TOTAL 18.87 80157 ASSAY CARBAMAZEPINE FREE 17.18 80158 ASSAY OF CYCLOSPORINE 23.39 80162 ASSAY OF DIGOXIN TOTAL 17.21 80164 ASSAY DIPROPYLACETIC ACD TOT 17.56 80168 ASSAY OF ETHOSUXIMIDE 21.18 80170 ASSAY OF GENTAMICIN 21.24 80173 ASSAY OF HALOPERIDOL 18.87 80176 ASSAY OF LIDOCAINE 19.03 80178 ASSAY OF LITHIUM 8.56 80184 ASSAY OF PHENOBARBITAL 14.83 80185 ASSAY OF PHENYTOIN TOTAL 17.18 80186 ASSAY OF PHENYTOIN FREE 17.84 80188 ASSAY OF PRIMIDONE 21.47 80190 ASSAY OF PROCAINAMIDE 21.70 80192 ASSAY OF PROCAINAMIDE 21.70 80194 ASSAY OF QUINIDINE 18.92 80195 ASSAY OF SIROLIMUS 17.79 80197 ASSAY OF TACROLIMUS 17.79 80198 ASSAY OF THEOPHYLLINE 18.33 80200 ASSAY OF TOBRAMYCIN 20.89 80201 ASSAY OF TOPIRAMATE 15.45 80202 ASSAY OF VANCOMYCIN 17.56 80299 QUANTITATIVE ASSAY DRUG 17.74 80400 ACTH STIMULATION PANEL 42.27 80402 ACTH STIMULATION PANEL 112.69 80406 ACTH STIMULATION PANEL 101.42 80408 ALDOSTERONE SUPPRESSION EVAL 162.64 80410 CALCITONIN STIMUL PANEL 104.12 80412 CRH STIMULATION PANEL 427.20 80414 TESTOSTERONE RESPONSE 66.92 80415 ESTRADIOL RESPONSE PANEL 72.42 80416 RENIN STIMULATION PANEL 171.02 Proc Code Description Mod Rate 80417 RENIN STIMULATION PANEL 57.00 80418 PITUITARY EVALUATION PANEL 751.18 80420 DEXAMETHASONE PANEL 93.37 80422 GLUCAGON TOLERANCE PANEL 59.71 80424 GLUCAGON TOLERANCE PANEL 65.44 80426 GONADOTROPIN HORMONE PANEL 192.34 80428 GROWTH HORMONE PANEL 86.45 80430 GROWTH HORMONE PANEL 101.71 80432 INSULIN SUPPRESSION PANEL 175.09 80434 INSULIN TOLERANCE PANEL 131.12 80435 INSULIN TOLERANCE PANEL 133.51 80436 METYRAPONE PANEL 118.15 80438 TRH STIMULATION PANEL 65.33 80439 TRH STIMULATION PANEL 87.11 80500 LAB PATHOLOGY CONSULTATION 20.55 80502 LAB PATHOLOGY CONSULTATION 66.25 81000 URINALYSIS NONAUTO W/SCOPE 4.10 81001 URINALYSIS AUTO W/SCOPE 4.10 81002 URINALYSIS NONAUTO W/O SCOPE 3.31 81003 URINALYSIS AUTO W/O SCOPE 2.90 81005 URINALYSIS 2.81 81007 URINE SCREEN FOR BACTERIA 1.25 81015 MICROSCOPIC EXAM OF URINE 3.94 81020 URINALYSIS GLASS TEST 4.77 81025 URINE PREGNANCY TEST 8.19 81050 URINALYSIS VOLUME MEASURE 3.88 82009 TEST FOR ACETONE/KETONES 5.85 82010 ACETONE ASSAY 10.59 82013 ACETYLCHOLINESTERASE ASSAY 14.47 82016 ACYLCARNITINES QUAL 17.96 82017 ACYLCARNITINES QUANT 21.85 82024 ASSAY OF ACTH 50.06 82030 ASSAY OF ADP & AMP 33.43 82040 ASSAY OF SERUM ALBUMIN 6.41 82042 ASSAY OF URINE ALBUMIN 6.70 82043 MICROALBUMIN QUANTITATIVE 7.49 82044 MICROALBUMIN SEMIQUANT 5.92 82045 ALBUMIN ISCHEMIA MODIFIED 43.99 82075 ASSAY OF BREATH ETHANOL 15.61 82085 ASSAY OF ALDOLASE 12.57 82088 ASSAY OF ALDOSTERONE 52.82 82103 ALPHA-1-ANTITRYPSIN TOTAL 17.41 82104 ALPHA-1-ANTITRYPSIN PHENO 18.74 82105 ALPHA-FETOPROTEIN SERUM 21.69 82106 ALPHA-FETOPROTEIN AMNIOTIC 21.69 82107 ALPHA-FETOPROTEIN L3 48.15 Proc Code Description Mod Rate 82108 ASSAY OF ALUMINUM 33.02 82120 AMINES VAGINAL FLUID QUAL 4.88 82127 AMINO ACID SINGLE QUAL 17.96 82128 AMINO ACIDS MULT QUAL 17.96 82131 AMINO ACIDS SINGLE QUANT 21.85 82135 ASSAY AMINOLEVULINIC ACID 21.32 82136 AMINO ACIDS QUANT 2-5 21.85 82139 AMINO ACIDS QUAN 6 OR MORE 21.85 82140 ASSAY OF AMMONIA 18.88 82143 AMNIOTIC FLUID SCAN 8.90 82150 ASSAY OF AMYLASE 8.39 82154 ANDROSTANEDIOL GLUCURONIDE 37.37 82157 ASSAY OF ANDROSTENEDIONE 37.94 82160 ASSAY OF ANDROSTERONE 32.40 82163 ASSAY OF ANGIOTENSIN II 26.59 82164 ANGIOTENSIN I ENZYME TEST 18.92 82172 ASSAY OF APOLIPOPROTEIN 20.08 82175 ASSAY OF ARSENIC 24.59 82180 ASSAY OF ASCORBIC ACID 12.80 82190 ATOMIC ABSORPTION 19.32 82232 ASSAY OF BETA-2 PROTEIN 20.96 82239 BILE ACIDS TOTAL 22.20 82240 BILE ACIDS CHOLYLGLYCINE 34.44 82247 BILIRUBIN TOTAL 6.49 82248 BILIRUBIN DIRECT 6.49 82252 FECAL BILIRUBIN TEST 5.89 82261 ASSAY OF BIOTINIDASE 21.85 82270 OCCULT BLOOD FECES 4.21 82271 OCCULT BLOOD OTHER SOURCES 4.21 82272 OCCULT BLD FECES 1-3 TESTS 4.21 82274 ASSAY TEST FOR BLOOD FECAL 20.61 82286 ASSAY OF BRADYKININ 8.93 82300 ASSAY OF CADMIUM 30.00 82306 VITAMIN D 25 HYDROXY 37.99 82308 ASSAY OF CALCITONIN 34.71 82310 ASSAY OF CALCIUM 6.68 82330 ASSAY OF CALCIUM 17.71 82331 CALCIUM INFUSION TEST 6.70 82340 ASSAY OF CALCIUM IN URINE 7.81 82355 CALCULUS ANALYSIS QUAL 15.00 82360 CALCULUS ASSAY QUANT 16.68 82365 CALCULUS SPECTROSCOPY 16.71 82370 X-RAY ASSAY CALCULUS 16.23 82373 ASSAY C-D TRANSFER MEASURE 23.39 82374 ASSAY BLOOD CARBON DIOXIDE 6.33 82375 ASSAY CARBOXYHB QUANT 15.96 Proc Code Description Mod Rate 82376 ASSAY CARBOXYHB QUAL 7.59 82378 CARCINOEMBRYONIC ANTIGEN 24.58 82379 ASSAY OF CARNITINE 21.85 82380 ASSAY OF CAROTENE 11.95 82382 ASSAY URINE CATECHOLAMINES 22.28 82383 ASSAY BLOOD CATECHOLAMINES 32.48 82384 ASSAY THREE CATECHOLAMINES 32.72 82387 ASSAY OF CATHEPSIN-D 26.97 82390 ASSAY OF CERULOPLASMIN 13.91 82397 CHEMILUMINESCENT ASSAY 18.30 82415 ASSAY OF CHLORAMPHENICOL 16.42 82435 ASSAY OF BLOOD CHLORIDE 5.95 82436 ASSAY OF URINE CHLORIDE 6.51 82438 ASSAY OTHER FLUID CHLORIDES 6.33 82441 TEST FOR CHLOROHYDROCARBONS 7.78 82465 ASSAY BLD/SERUM CHOLESTEROL 5.63 82480 ASSAY SERUM CHOLINESTERASE 10.21 82482 ASSAY RBC CHOLINESTERASE 9.95 82485 ASSAY CHONDROITIN SULFATE 26.76 82486 GAS/LIQUID CHROMATOGRAPHY 23.39 82487 PAPER CHROMATOGRAPHY 20.70 82488 PAPER CHROMATOGRAPHY 27.69 82489 THIN LAYER CHROMATOGRAPHY 23.96 82491 CHROMOTOGRAPHY QUANT SING 23.39 82492 CHROMOTOGRAPHY QUANT MULT 23.39 82495 ASSAY OF CHROMIUM 26.28 82507 ASSAY OF CITRATE 36.03 82523 COLLAGEN CROSSLINKS 24.22 82525 ASSAY OF COPPER 16.08 82528 ASSAY OF CORTICOSTERONE 29.18 82530 CORTISOL FREE 21.66 82533 TOTAL CORTISOL 21.12 82540 ASSAY OF CREATINE 6.00 82541 COLUMN CHROMOTOGRAPHY QUAL 23.39 82542 COLUMN CHROMOTOGRAPHY QUANT 23.39 82543 COLUMN CHROMOTOGRAPH/ISOTOPE 23.39 82544 COLUMN CHROMOTOGRAPH/ISOTOPE 23.39 82550 ASSAY OF CK (CPK) 8.43 82552 ASSAY OF CPK IN BLOOD 17.36 82553 CREATINE MB FRACTION 14.96 82554 CREATINE ISOFORMS 15.38 82565 ASSAY OF CREATININE 6.64 82570 ASSAY OF URINE CREATININE 6.70 82575 CREATININE CLEARANCE TEST 12.24 82585 ASSAY OF CRYOFIBRINOGEN 11.12 82595 ASSAY OF CRYOGLOBULIN 8.38 Proc Code Description Mod Rate 82600 ASSAY OF CYANIDE 25.13 82607 VITAMIN B-12 19.53 82608 B-12 BINDING CAPACITY 18.56 82610 Cystatin c 17.61 82615 TEST FOR URINE CYSTINES 10.58 82626 DEHYDROEPIANDROSTERONE 32.75 82627 DEHYDROEPIANDROSTERONE 28.81 82633 DESOXYCORTICOSTERONE 40.14 82634 DEOXYCORTISOL 37.94 82638 ASSAY OF DIBUCAINE NUMBER 15.87 82652 VIT D 1 25-DIHYDROXY 49.90 82656 PANCREATIC ELASTASE FECAL 14.95 82657 ENZYME CELL ACTIVITY 23.39 82658 ENZYME CELL ACTIVITY RA 23.39 82664 ELECTROPHORETIC TEST 44.52 82668 ASSAY OF ERYTHROPOIETIN 24.36 82670 ASSAY OF ESTRADIOL 36.21 82671 ASSAY OF ESTROGENS 41.86 82672 ASSAY OF ESTROGEN 28.12 82677 ASSAY OF ESTRIOL 31.34 82679 ASSAY OF ESTRONE 32.34 82693 ASSAY OF ETHYLENE GLYCOL 19.30 82696 ASSAY OF ETIOCHOLANOLONE 30.57 82705 FATS/LIPIDS FECES QUAL 6.59 82710 FATS/LIPIDS FECES QUANT 21.78 82715 ASSAY OF FECAL FAT 22.30 82725 ASSAY OF BLOOD FATTY ACIDS 17.25 82726 LONG CHAIN FATTY ACIDS 23.39 82728 ASSAY OF FERRITIN 17.66 82731 ASSAY OF FETAL FIBRONECTIN 48.15 82735 ASSAY OF FLUORIDE 24.02 82746 ASSAY OF FOLIC ACID SERUM 19.05 82747 ASSAY OF FOLIC ACID RBC 22.44 82759 ASSAY OF RBC GALACTOKINASE 27.84 82760 ASSAY OF GALACTOSE 14.50 82775 ASSAY GALACTOSE TRANSFERASE 27.30 82776 GALACTOSE TRANSFERASE TEST 10.86 82784 ASSAY IGA/IGD/IGG/IGM EACH 8.67 82785 ASSAY OF IGE 21.34 82787 IGG 1 2 3 OR 4 EACH 10.39 82800 BLOOD PH 10.96 82803 BLOOD GASES ANY COMBINATION 25.08 82805 BLOOD GASES W/O2 SATURATION 36.77 82810 BLOOD GASES O2 SAT ONLY 11.31 82820 HEMOGLOBIN-OXYGEN AFFINITY 12.29 82930 GASTRIC ANALY W/PH EA SPEC GASTR 6.90 Proc Code Description Mod Rate 82938 GASTRIN TEST 22.93 82941 ASSAY OF GASTRIN 22.85 82943 ASSAY OF GLUCAGON 18.51 82945 GLUCOSE OTHER FLUID 5.09 82946 GLUCAGON TOLERANCE TEST 19.53 82947 ASSAY GLUCOSE BLOOD QUANT 5.09 82948 REAGENT STRIP/BLOOD GLUCOSE 4.10 82950 GLUCOSE TEST 6.15 82951 GLUCOSE TOLERANCE TEST (GTT) 13.50 82952 GTT-ADDED SAMPLES 5.08 82955 ASSAY OF G6PD ENZYME 12.55 82960 TEST FOR G6PD ENZYME 7.84 82962 GLUCOSE BLOOD TEST 2.33 82963 ASSAY OF GLUCOSIDASE 27.84 82965 ASSAY OF GDH ENZYME 10.02 82977 ASSAY OF GGT 9.32 82978 ASSAY OF GLUTATHIONE 18.47 82979 ASSAY RBC GLUTATHIONE 8.93 82985 ASSAY OF GLYCATED PROTEIN 19.53 83001 ASSAY OF GONADOTROPIN (FSH) 24.08 83002 ASSAY OF GONADOTROPIN (LH) 23.99 83003 ASSAY GROWTH HORMONE (HGH) 21.62 83009 H PYLORI (C-13) BLOOD 87.29 83010 ASSAY OF HAPTOGLOBIN QUANT 16.30 83012 ASSAY OF HAPTOGLOBINS 22.28 83013 H PYLORI (C-13) BREATH 87.29 83014 H PYLORI DRUG ADMIN 10.19 83015 HEAVY METAL SCREEN 24.40 83018 QUANTITATIVE SCREEN METALS 28.46 83020 HEMOGLOBIN ELECTROPHORESIS 26 18.76 83020 HEMOGLOBIN ELECTROPHORESIS 16.68 83021 HEMOGLOBIN CHROMOTOGRAPHY 23.39 83026 HEMOGLOBIN COPPER SULFATE 3.06 83030 FETAL HEMOGLOBIN CHEMICAL 10.71 83033 FETAL HEMOGLOBIN ASSAY QUAL 7.72 83036 GLYCOSYLATED HEMOGLOBIN TEST 12.57 83037 GLYCOSYLATED HB HOME DEVICE 12.57 83045 BLOOD METHEMOGLOBIN TEST 6.42 83050 BLOOD METHEMOGLOBIN ASSAY 9.50 83051 ASSAY OF PLASMA HEMOGLOBIN 9.48 83060 BLOOD SULFHEMOGLOBIN ASSAY 10.71 83065 ASSAY OF HEMOGLOBIN HEAT 8.93 83068 HEMOGLOBIN STABILITY SCREEN 10.96 83069 ASSAY OF URINE HEMOGLOBIN 5.12 83070 ASSAY OF HEMOSIDERIN QUAL 6.15 83080 ASSAY OF B HEXOSAMINIDASE 21.85 Proc Code Description Mod Rate 83088 ASSAY OF HISTAMINE 38.27 83090 ASSAY OF HOMOCYSTINE 21.85 83150 ASSAY OF HOMOVANILLIC ACID 25.08 83491 ASSAY OF CORTICOSTEROIDS 17 22.70 83497 ASSAY OF 5-HIAA 16.71 83498 ASSAY OF PROGESTERONE 17-D 35.21 83499 ASSAY OF PROGESTERONE 20- 32.68 83500 ASSAY FREE HYDROXYPROLINE 29.35 83505 ASSAY TOTAL HYDROXYPROLINE 31.51 83516 IMMUNOASSAY NONANTIBODY 14.95 83518 IMMUNOASSAY DIPSTICK 10.98 83519 RIA NONANTIBODY 17.50 83520 IMMUNOASSAY QUANT NOS NONAB 16.77 83525 ASSAY OF INSULIN 14.81 83527 ASSAY OF INSULIN 16.78 83528 ASSAY OF INTRINSIC FACTOR 20.61 83540 ASSAY OF IRON 7.38 83550 IRON BINDING TEST 9.07 83570 ASSAY OF IDH ENZYME 11.46 83582 ASSAY OF KETOGENIC STEROIDS 18.37 83586 ASSAY 17- KETOSTEROIDS 16.59 83593 FRACTIONATION KETOSTEROIDS 34.08 83605 ASSAY OF LACTIC ACID 13.84 83615 LACTATE (LD) (LDH) ENZYME 7.81 83625 ASSAY OF LDH ENZYMES 16.58 83630 LACTOFERRIN FECAL (QUAL) 25.44 83631 LACTOFERRIN FECAL (QUANT) 25.44 83632 PLACENTAL LACTOGEN 26.20 83633 TEST URINE FOR LACTOSE 7.12 83655 ASSAY OF LEAD 15.69 83661 L/S RATIO FETAL LUNG 28.49 83662 FOAM STABILITY FETAL LUNG 24.51 83663 FLUORO POLARIZE FETAL LUNG 24.51 83664 LAMELLAR BDY FETAL LUNG 24.51 83670 ASSAY OF LAP ENZYME 11.86 83690 ASSAY OF LIPASE 8.93 83695 ASSAY OF LIPOPROTEIN(A) 16.77 83698 ASSAY LIPOPROTEIN PLA2 43.99 83700 LIPOPRO BLD ELECTROPHORETIC 14.59 83701 LIPOPROTEIN BLD HR FRACTION 32.16 83704 LIPOPROTEIN BLD BY NMR 40.88 83718 ASSAY OF LIPOPROTEIN 10.61 83719 ASSAY OF BLOOD LIPOPROTEIN 15.07 83721 ASSAY OF BLOOD LIPOPROTEIN 12.36 83727 ASSAY OF LRH HORMONE 22.28 83735 ASSAY OF MAGNESIUM 8.68 Proc Code Description Mod Rate 83775 ASSAY MALATE DEHYDROGENASE 9.55 83785 ASSAY OF MANGANESE 31.87 83788 MASS SPECTROMETRY QUAL 23.39 83789 MASS SPECTROMETRY QUANT 23.39 83825 ASSAY OF MERCURY 21.07 83835 ASSAY OF METANEPHRINES 21.95 83857 ASSAY OF METHEMALBUMIN 13.91 83861 MICROFLUID ANALY TEARS MICRO 21.41 83864 MUCOPOLYSACCHARIDES 25.81 83872 ASSAY SYNOVIAL FLUID MUCIN 7.59 83873 ASSAY OF CSF PROTEIN 22.29 83874 ASSAY OF MYOGLOBIN 16.73 83876 ASSAY MYELOPEROXIDASE 43.99 83880 ASSAY OF NATRIURETIC PEPTIDE 43.99 83883 ASSAY NEPHELOMETRY NOT SPEC 17.61 83885 ASSAY OF NICKEL 31.75 83915 ASSAY OF NUCLEOTIDASE 14.44 83916 OLIGOCLONAL BANDS 26.05 83918 ORGANIC ACIDS TOTAL QUANT 21.32 83919 ORGANIC ACIDS QUAL EACH 21.32 83921 ORGANIC ACID SINGLE QUANT 21.32 83930 ASSAY OF BLOOD OSMOLALITY 8.56 83935 ASSAY OF URINE OSMOLALITY 8.83 83937 ASSAY OF OSTEOCALCIN 38.68 83945 ASSAY OF OXALATE 16.68 83950 ONCOPROTEIN HER-2/NEU 48.15 83951 ONCOPROTEIN DCP 48.15 83970 ASSAY OF PARATHORMONE 53.49 83986 ASSAY PH BODY FLUID NOS 4.63 83992 ASSAY FOR PHENCYCLIDINE 16.53 83993 Assay for calprotectin fecal 25.44 84030 ASSAY OF BLOOD PKU 7.12 84035 ASSAY OF PHENYLKETONES 4.75 84060 ASSAY ACID PHOSPHATASE 9.57 84061 PHOSPHATASE FORENSIC EXAM 10.25 84066 ASSAY PROSTATE PHOSPHATASE 12.52 84075 ASSAY ALKALINE PHOSPHATASE 6.70 84078 ASSAY ALKALINE PHOSPHATASE 8.67 84080 ASSAY ALKALINE PHOSPHATASES 19.16 84081 ASSAY PHOSPHATIDYLGLYCEROL 21.41 84085 ASSAY OF RBC PG6D ENZYME 8.74 84087 ASSAY PHOSPHOHEXOSE ENZYMES 13.38 84100 ASSAY OF PHOSPHORUS 6.13 84105 ASSAY OF URINE PHOSPHORUS 6.70 84106 TEST FOR PORPHOBILINOGEN 5.54 84110 ASSAY OF PORPHOBILINOGEN 10.93 Proc Code Description Mod Rate 84112 EVAL AMNIOTIC FLUID PROTEIN 48.15 84119 TEST URINE FOR PORPHYRINS 11.16 84120 ASSAY OF URINE PORPHYRINS 19.06 84126 ASSAY OF FECES PORPHYRINS 33.01 84132 ASSAY OF SERUM POTASSIUM 5.95 84133 ASSAY OF URINE POTASSIUM 5.57 84134 ASSAY OF PREALBUMIN 18.89 84135 ASSAY OF PREGNANEDIOL 24.79 84138 ASSAY OF PREGNANETRIOL 24.53 84140 ASSAY OF PREGNENOLONE 26.79 84143 ASSAY OF 17-HYDROXYPREGNENO 29.57 84144 ASSAY OF PROGESTERONE 27.03 84146 ASSAY OF PROLACTIN 25.11 84150 ASSAY OF PROSTAGLANDIN 32.34 84152 ASSAY OF PSA COMPLEXED 23.83 84153 ASSAY OF PSA TOTAL 23.83 84154 ASSAY OF PSA FREE 23.83 84155 ASSAY OF PROTEIN SERUM 4.75 84156 ASSAY OF PROTEIN URINE 4.75 84157 ASSAY OF PROTEIN OTHER 4.75 84160 ASSAY OF PROTEIN ANY SOURCE 6.70 84163 PAPPA SERUM 18.20 84165 PROTEIN E-PHORESIS SERUM 26 18.76 84165 PROTEIN E-PHORESIS SERUM 13.91 84166 PROTEIN E-PHORESIS/URINE/CSF 26 18.76 84166 PROTEIN E-PHORESIS/URINE/CSF 23.11 84181 WESTERN BLOT TEST 26 18.76 84181 WESTERN BLOT TEST 22.07 84182 PROTEIN WESTERN BLOT TEST 26 18.76 84182 PROTEIN WESTERN BLOT TEST 23.32 84202 ASSAY RBC PROTOPORPHYRIN 18.59 84203 TEST RBC PROTOPORPHYRIN 11.15 84206 ASSAY OF PROINSULIN 23.08 84207 ASSAY OF VITAMIN B-6 36.41 84210 ASSAY OF PYRUVATE 14.06 84220 ASSAY OF PYRUVATE KINASE 12.23 84228 ASSAY OF QUININE 15.07 84233 ASSAY OF ESTROGEN 48.15 84234 ASSAY OF PROGESTERONE 40.60 84235 ASSAY OF ENDOCRINE HORMONE 67.83 84238 ASSAY NONENDOCRINE RECEPTOR 47.39 84244 ASSAY OF RENIN 28.50 84252 ASSAY OF VITAMIN B-2 26.22 84255 ASSAY OF SELENIUM 33.08 84260 ASSAY OF SEROTONIN 40.14 84270 ASSAY OF SEX HORMONE GLOBUL 28.16 Proc Code Description Mod Rate 84275 ASSAY OF SIALIC ACID 17.41 84285 ASSAY OF SILICA 30.51 84295 ASSAY OF SERUM SODIUM 6.23 84300 ASSAY OF URINE SODIUM 6.30 84302 ASSAY OF SWEAT SODIUM 6.30 84305 ASSAY OF SOMATOMEDIN 27.55 84307 ASSAY OF SOMATOSTATIN 23.69 84311 SPECTROPHOTOMETRY 9.06 84315 BODY FLUID SPECIFIC GRAVITY 3.25 84375 CHROMATOGRAM ASSAY SUGARS 25.41 84376 SUGARS SINGLE QUAL 7.12 84377 SUGARS MULTIPLE QUAL 7.12 84378 SUGARS SINGLE QUANT 14.94 84379 SUGARS MULTIPLE QUANT 14.94 84392 ASSAY OF URINE SULFATE 6.15 84402 ASSAY OF FREE TESTOSTERONE 33.00 84403 ASSAY OF TOTAL TESTOSTERONE 33.45 84425 ASSAY OF VITAMIN B-1 27.51 84430 ASSAY OF THIOCYANATE 15.07 84432 ASSAY OF THYROGLOBULIN 20.81 84436 ASSAY OF TOTAL THYROXINE 8.90 84437 ASSAY OF NEONATAL THYROXINE 8.38 84439 ASSAY OF FREE THYROXINE 11.68 84442 ASSAY OF THYROID ACTIVITY 19.16 84443 ASSAY THYROID STIM HORMONE 21.78 84445 ASSAY OF TSI GLOBULIN 65.91 84446 ASSAY OF VITAMIN E 18.37 84449 ASSAY OF TRANSCORTIN 23.32 84450 TRANSFERASE (AST) (SGOT) 6.70 84460 ALANINE AMINO (ALT) (SGPT) 6.85 84466 ASSAY OF TRANSFERRIN 16.54 84478 ASSAY OF TRIGLYCERIDES 7.44 84479 ASSAY OF THYROID (T3 OR T4) 8.38 84480 ASSAY TRIIODOTHYRONINE (T3) 18.37 84481 FREE ASSAY (FT-3) 21.95 84482 T3 REVERSE 20.42 84484 ASSAY OF TROPONIN QUANT 12.74 84485 ASSAY DUODENAL FLUID TRYPSIN 9.73 84488 TEST FECES FOR TRYPSIN 9.46 84490 ASSAY OF FECES FOR TRYPSIN 9.85 84510 ASSAY OF TYROSINE 13.48 84512 ASSAY OF TROPONIN QUAL 9.98 84520 ASSAY OF UREA NITROGEN 5.12 84525 UREA NITROGEN SEMI-QUANT 4.88 84540 ASSAY OF URINE/UREA-N 6.15 84545 UREA-N CLEARANCE TEST 8.55 Proc Code Description Mod Rate 84550 ASSAY OF BLOOD/URIC ACID 5.85 84560 ASSAY OF URINE/URIC ACID 6.15 84577 ASSAY OF FECES/UROBILINOGEN 16.17 84578 TEST URINE UROBILINOGEN 4.20 84580 ASSAY OF URINE UROBILINOGEN 9.19 84583 ASSAY OF URINE UROBILINOGEN 6.51 84585 ASSAY OF URINE VMA 20.08 84586 ASSAY OF VIP 45.79 84588 ASSAY OF VASOPRESSIN 43.99 84590 ASSAY OF VITAMIN A 15.03 84591 ASSAY OF NOS VITAMIN 15.03 84597 ASSAY OF VITAMIN K 17.77 84600 ASSAY OF VOLATILES 20.83 84620 XYLOSE TOLERANCE TEST 15.35 84630 ASSAY OF ZINC 14.75 84681 ASSAY OF C-PEPTIDE 26.97 84702 CHORIONIC GONADOTROPIN TEST 18.20 84703 CHORIONIC GONADOTROPIN ASSAY 9.74 84704 HCG FREE BETACHAIN TEST 18.20 84830 OVULATION TESTS 12.99 85002 BLEEDING TIME TEST 5.84 85004 AUTOMATED DIFF WBC COUNT 8.38 85007 BL SMEAR W/DIFF WBC COUNT 4.45 85008 BL SMEAR W/O DIFF WBC COUNT 4.45 85009 MANUAL DIFF WBC COUNT B-COAT 4.82 85013 SPUN MICROHEMATOCRIT 3.06 85014 HEMATOCRIT 3.06 85018 HEMOGLOBIN 3.06 85025 COMPLETE CBC W/AUTO DIFF WBC 10.07 85027 COMPLETE CBC AUTOMATED 8.38 85032 MANUAL CELL COUNT EACH 5.57 85041 AUTOMATED RBC COUNT 3.90 85044 MANUAL RETICULOCYTE COUNT 5.57 85045 AUTOMATED RETICULOCYTE COUNT 5.17 85046 RETICYTE/HGB CONCENTRATE 7.22 85048 AUTOMATED LEUKOCYTE COUNT 3.28 85049 AUTOMATED PLATELET COUNT 5.80 85055 RETICULATED PLATELET ASSAY 23.45 85060 BLOOD SMEAR INTERPRETATION 23.99 85097 BONE MARROW INTERPRETATION 84.88 85130 CHROMOGENIC SUBSTRATE ASSAY 15.40 85170 BLOOD CLOT RETRACTION 4.69 85175 BLOOD CLOT LYSIS TIME 5.89 85210 CLOT FACTOR II PROTHROM SPEC 16.83 85220 BLOOC CLOT FACTOR V TEST 22.86 85230 CLOT FACTOR VII PROCONVERTIN 23.20 Proc Code Description Mod Rate 85240 CLOT FACTOR VIII AHG 1 STAGE 23.20 85244 CLOT FACTOR VIII RELTD ANTGN 26.45 85245 CLOT FACTOR VIII VW RISTOCTN 29.73 85246 CLOT FACTOR VIII VW ANTIGEN 29.73 85247 CLOT FACTOR VIII MULTIMETRIC 29.73 85250 CLOT FACTOR IX PTC/CHRSTMAS 24.67 85260 CLOT FACTOR X STUART-POWER 23.20 85270 CLOT FACTOR XI PTA 23.20 85280 CLOT FACTOR XII HAGEMAN 25.08 85290 CLOT FACTOR XIII FIBRIN STAB 21.18 85291 CLOT FACTOR XIII FIBRIN SCRN 11.53 85292 CLOT FACTOR FLETCHER FACT 24.54 85293 CLOT FACTOR WGHT KININOGEN 24.54 85300 ANTITHROMBIN III ACTIVITY 15.36 85301 ANTITHROMBIN III ANTIGEN 14.01 85302 CLOT INHIBIT PROT C ANTIGEN 15.58 85303 CLOT INHIBIT PROT C ACTIVITY 17.92 85305 CLOT INHIBIT PROT S TOTAL 15.03 85306 CLOT INHIBIT PROT S FREE 19.86 85307 ASSAY ACTIVATED PROTEIN C 19.86 85335 FACTOR INHIBITOR TEST 16.68 85337 THROMBOMODULIN 9.16 85345 COAGULATION TIME LEE & WHITE 5.57 85347 COAGULATION TIME ACTIVATED 5.51 85348 COAGULATION TIME OTR METHOD 4.82 85360 EUGLOBULIN LYSIS 10.88 85362 FIBRIN DEGRADATION PRODUCTS 7.36 85366 FIBRINOGEN TEST 10.86 85370 FIBRINOGEN TEST 14.71 85378 FIBRIN DEGRADE SEMIQUANT 9.24 85379 FIBRIN DEGRADATION QUANT 13.19 85384 FIBRINOGEN ACTIVITY 11.00 85385 FIBRINOGEN ANTIGEN 11.00 85390 FIBRINOLYSINS SCREEN I&R 26 18.76 85390 FIBRINOLYSINS SCREEN I&R 6.69 85396 CLOTTING ASSAY WHOLE BLOOD 19.83 85397 CLOTTING FUNCT ACTIVITY 29.73 85400 FIBRINOLYTIC PLASMIN 11.46 85410 FIBRINOLYTIC ANTIPLASMIN 9.99 85415 FIBRINOLYTIC PLASMINOGEN 22.28 85420 FIBRINOLYTIC PLASMINOGEN 8.47 85421 FIBRINOLYTIC PLASMINOGEN 13.20 85441 HEINZ BODIES DIRECT 5.45 85445 HEINZ BODIES INDUCED 8.83 85460 HEMOGLOBIN FETAL 10.03 85461 HEMOGLOBIN FETAL 8.59 Proc Code Description Mod Rate 85475 HEMOLYSIN ACID 11.50 85520 HEPARIN ASSAY 16.96 85525 HEPARIN NEUTRALIZATION 15.35 85530 HEPARIN-PROTAMINE TOLERANCE 18.37 85536 IRON STAIN PERIPHERAL BLOOD 8.38 85540 WBC ALKALINE PHOSPHATASE 11.15 85547 RBC MECHANICAL FRAGILITY 11.15 85549 MURAMIDASE 24.31 85555 RBC OSMOTIC FRAGILITY 8.66 85557 RBC OSMOTIC FRAGILITY 17.31 85576 BLOOD PLATELET AGGREGATION 26 18.76 85576 BLOOD PLATELET AGGREGATION 27.84 85597 PHOSPHOLIPID PLTLT NEUTRALIZ 23.29 85598 HEXAGNAL PHOSPH PLTLT NEUTRL PHOSP 23.29 85610 PROTHROMBIN TIME 5.10 85611 PROTHROMBIN TEST 5.11 85612 VIPER VENOM PROTHROMBIN TIME 12.40 85613 RUSSELL VIPER VENOM DILUTED 12.40 85635 REPTILASE TEST 12.75 85651 RBC SED RATE NONAUTOMATED 4.59 85652 RBC SED RATE AUTOMATED 3.50 85660 RBC SICKLE CELL TEST 7.15 85670 THROMBIN TIME PLASMA 7.47 85675 THROMBIN TIME TITER 8.87 85705 THROMBOPLASTIN INHIBITION 12.47 85730 THROMBOPLASTIN TIME PARTIAL 7.78 85732 THROMBOPLASTIN TIME PARTIAL 8.38 85810 BLOOD VISCOSITY EXAMINATION 15.12 86000 AGGLUTININS FEBRILE ANTIGEN 9.04 86001 ALLERGEN SPECIFIC IGG 6.76 86003 ALLERGEN SPECIFIC IGE 6.76 86005 ALLERGEN SPECIFIC IGE 10.33 86021 WBC ANTIBODY IDENTIFICATION 14.69 86022 PLATELET ANTIBODIES 23.80 86023 IMMUNOGLOBULIN ASSAY 10.26 86038 ANTINUCLEAR ANTIBODIES 15.66 86039 ANTINUCLEAR ANTIBODIES (ANA) 14.46 86060 ANTISTREPTOLYSIN O TITER 9.46 86063 ANTISTREPTOLYSIN O SCREEN 7.47 86077 PHYS BLOOD BANK SERV XMATCH 53.29 86078 PHYS BLOOD BANK SERV REACTJ 53.29 86140 C-REACTIVE PROTEIN 6.70 86141 C-REACTIVE PROTEIN HS 16.77 86146 BETA-2 GLYCOPROTEIN ANTIBODY 32.97 86147 CARDIOLIPIN ANTIBODY EA IG 32.97 86148 ANTI-PHOSPHOLIPID ANTIBODY 20.82 Proc Code Description Mod Rate 86155 CHEMOTAXIS ASSAY 20.71 86156 COLD AGGLUTININ SCREEN 8.68 86157 COLD AGGLUTININ TITER 10.45 86160 COMPLEMENT ANTIGEN 15.56 86161 COMPLEMENT/FUNCTION ACTIVITY 15.56 86162 COMPLEMENT TOTAL (CH50) 26.33 86171 COMPLEMENT FIXATION EACH 12.97 86185 COUNTERIMMUNOELECTROPHORESIS 11.59 86200 CCP ANTIBODY 16.77 86215 DEOXYRIBONUCLEASE ANTIBODY 17.17 86225 DNA ANTIBODY NATIVE 17.80 86226 DNA ANTIBODY SINGLE STRAND 15.69 86235 NUCLEAR ANTIGEN ANTIBODY 21.69 86243 FC RECEPTOR 26.59 86255 FLUORESCENT ANTIBODY SCREEN 26 18.76 86255 FLUORESCENT ANTIBODY SCREEN 15.61 86256 FLUORESCENT ANTIBODY TITER 26 18.00 86256 FLUORESCENT ANTIBODY TITER 15.61 86277 GROWTH HORMONE ANTIBODY 20.39 86280 HEMAGGLUTINATION INHIBITION 10.61 86294 IMMUNOASSAY TUMOR QUAL 25.43 86300 IMMUNOASSAY TUMOR CA 15-3 26.97 86301 IMMUNOASSAY TUMOR CA 19-9 26.97 86304 IMMUNOASSAY TUMOR CA 125 26.97 86308 HETEROPHILE ANTIBODY SCREEN 6.70 86309 HETEROPHILE ANTIBODY TITER 8.38 86310 HETEROPHILE ANTIBODY ABSRBJ 9.55 86316 IMMUNOASSAY TUMOR OTHER 26.97 86317 IMMUNOASSAY INFECTIOUS AGENT 19.42 86318 IMMUNOASSAY INFECTIOUS AGENT 16.77 86320 SERUM IMMUNOELECTROPHORESIS 26 18.00 86320 SERUM IMMUNOELECTROPHORESIS 29.05 86325 OTHER IMMUNOELECTROPHORESIS 26 18.00 86325 OTHER IMMUNOELECTROPHORESIS 28.98 86327 IMMUNOELECTROPHORESIS ASSAY 26 21.18 86327 IMMUNOELECTROPHORESIS ASSAY 29.40 86329 IMMUNODIFFUSION NES 18.19 86331 IMMUNODIFFUSION OUCHTERLONY 15.53 86332 IMMUNE COMPLEX ASSAY 31.58 86334 IMMUNOFIX E-PHORESIS SERUM 26 18.76 86334 IMMUNOFIX E-PHORESIS SERUM 28.95 86335 IMMUNFIX E-PHORSIS/URINE/CSF 26 18.76 86335 IMMUNFIX E-PHORSIS/URINE/CSF 38.03 86336 INHIBIN A 16.78 86337 INSULIN ANTIBODIES 27.74 86340 INTRINSIC FACTOR ANTIBODY 19.53 Proc Code Description Mod Rate 86341 ISLET CELL ANTIBODY 25.64 86343 LEUKOCYTE HISTAMINE RELEASE 16.15 86344 LEUKOCYTE PHAGOCYTOSIS 10.35 86353 LYMPHOCYTE TRANSFORMATION 63.54 86355 B CELLS TOTAL COUNT 48.88 86356 Mononuclear cell antigen 23.45 86357 NK CELLS TOTAL COUNT 48.88 86359 T CELLS TOTAL COUNT 48.88 86360 T CELL ABSOLUTE COUNT/RATIO 60.89 86361 T CELL ABSOLUTE COUNT 23.45 86367 STEM CELLS TOTAL COUNT 48.88 86376 MICROSOMAL ANTIBODY EACH 18.85 86378 MIGRATION INHIBITORY FACTOR 25.51 86382 NEUTRALIZATION TEST VIRAL 21.91 86384 NITROBLUE TETRAZOLIUM DYE 14.75 86403 PARTICLE AGGLUT ANTBDY SCRN 13.20 86406 PARTICLE AGGLUT ANTBDY TITR 13.78 86430 RHEUMATOID FACTOR TEST QUAL 7.35 86431 RHEUMATOID FACTOR QUANT 7.35 86480 TB TEST CELL IMMUN MEASURE 80.33 86481 TB AG RESPONSE T-CELL SUSP TUBER 97.10 86485 SKIN TEST CANDIDA 10.52 86490 COCCIDIOIDOMYCOSIS SKIN TEST 5.04 86510 HISTOPLASMOSIS SKIN TEST 6.48 86580 TB INTRADERMAL TEST 7.91 86590 STREPTOKINASE ANTIBODY 14.31 86592 SYPHILIS TEST NON-TREP QUAL 5.52 86593 SYPHILIS TEST NON-TREP QUANT 5.70 86602 ANTINOMYCES ANTIBODY 13.19 86603 ADENOVIRUS ANTIBODY 16.67 86606 ASPERGILLUS ANTIBODY 19.51 86609 BACTERIUM ANTIBODY 16.70 86611 BARTONELLA ANTIBODY 13.19 86612 BLASTOMYCES ANTIBODY 16.72 86615 BORDETELLA ANTIBODY 17.10 86617 LYME DISEASE ANTIBODY 20.07 86618 LYME DISEASE ANTIBODY 22.07 86619 BORRELIA ANTIBODY 17.33 86622 BRUCELLA ANTIBODY 11.58 86625 CAMPYLOBACTER ANTIBODY 17.00 86628 CANDIDA ANTIBODY 15.56 86631 CHLAMYDIA ANTIBODY 15.32 86632 CHLAMYDIA IGM ANTIBODY 16.44 86635 COCCIDIOIDES ANTIBODY 14.86 86638 Q FEVER ANTIBODY 15.71 86641 CRYPTOCOCCUS ANTIBODY 18.67 Proc Code Description Mod Rate 86644 CMV ANTIBODY 18.65 86645 CMV ANTIBODY IGM 21.83 86648 DIPHTHERIA ANTIBODY 19.71 86651 ENCEPHALITIS CALIFORN ANTBDY 17.10 86652 ENCEPHALTIS EAST EQNE ANBDY 17.10 86653 ENCEPHALTIS ST LOUIS ANTBODY 17.10 86654 ENCEPHALTIS WEST EQNE ANTBDY 17.10 86658 ENTEROVIRUS ANTIBODY 16.88 86663 EPSTEIN-BARR ANTIBODY 17.00 86664 EPSTEIN-BARR NUCLEAR ANTIGEN 19.82 86665 EPSTEIN-BARR CAPSID VCA 23.51 86666 EHRLICHIA ANTIBODY 13.19 86668 FRANCISELLA TULARENSIS 13.48 86671 FUNGUS NES ANTIBODY 15.88 86674 GIARDIA LAMBLIA ANTIBODY 19.07 86677 HELICOBACTER PYLORI ANTIBODY 18.81 86682 HELMINTH ANTIBODY 16.86 86684 HEMOPHILUS INFLUENZA ANTIBDY 20.52 86687 HTLV-I ANTIBODY 10.87 86688 HTLV-II ANTIBODY 18.15 86689 HTLV/HIV CONFIRMJ ANTIBODY 25.08 86692 HEPATITIS DELTA AGENT ANTBDY 22.23 86694 HERPES SIMPLEX NES ANTBDY 18.65 86695 HERPES SIMPLEX TYPE 1 TEST 17.10 86696 HERPES SIMPLEX TYPE 2 TEST 25.08 86698 HISTOPLASMA ANTIBODY 16.19 86701 HIV-1ANTIBODY 11.51 86702 HIV-2 ANTIBODY 17.51 86703 HIV-1/HIV-2 1 RESULT ANTBDY 17.76 86704 HEP B CORE ANTIBODY TOTAL 15.61 86705 HEP B CORE ANTIBODY IGM 15.26 86706 HEP B SURFACE ANTIBODY 13.91 86707 HEPATITIS BE ANTIBODY 14.99 86708 HEPATITIS A TOTAL ANTIBODY 16.05 86709 HEPATITIS A IGM ANTIBODY 14.59 86710 INFLUENZA VIRUS ANTIBODY 17.56 86713 LEGIONELLA ANTIBODY 19.83 86717 LEISHMANIA ANTIBODY 15.87 86720 LEPTOSPIRA ANTIBODY 17.10 86723 LISTERIA MONOCYTOGENES 17.10 86727 LYMPH CHORIOMENINGITIS AB 16.67 86729 LYMPHO VENEREUM ANTIBODY 15.48 86732 MUCORMYCOSIS ANTIBODY 17.10 86735 MUMPS ANTIBODY 16.91 86738 MYCOPLASMA ANTIBODY 17.16 86741 NEISSERIA MENINGITIDIS 17.10 Proc Code Description Mod Rate 86744 NOCARDIA ANTIBODY 17.10 86747 PARVOVIRUS ANTIBODY 19.48 86750 MALARIA ANTIBODY 17.10 86753 PROTOZOA ANTIBODY NOS 16.05 86756 RESPIRATORY VIRUS ANTIBODY 16.70 86757 RICKETTSIA ANTIBODY 25.08 86759 ROTAVIRUS ANTIBODY 17.10 86762 RUBELLA ANTIBODY 18.65 86765 RUBEOLA ANTIBODY 16.70 86768 SALMONELLA ANTIBODY 17.10 86771 SHIGELLA ANTIBODY 17.10 86774 TETANUS ANTIBODY 19.18 86777 TOXOPLASMA ANTIBODY 18.65 86778 TOXOPLASMA ANTIBODY IGM 18.66 86784 TRICHINELLA ANTIBODY 16.28 86787 VARICELLA-ZOSTER ANTIBODY 16.70 86788 WEST NILE VIRUS AB IGM 21.83 86789 WEST NILE VIRUS ANTIBODY 18.65 86790 VIRUS ANTIBODY NOS 16.70 86793 YERSINIA ANTIBODY 17.10 86800 THYROGLOBULIN ANTIBODY 20.61 86803 HEPATITIS C AB TEST 18.49 86804 HEP C AB TEST CONFIRM 20.07 86805 LYMPHOCYTOTOXICITY ASSAY 67.77 86806 LYMPHOCYTOTOXICITY ASSAY 61.68 86807 CYTOTOXIC ANTIBODY SCREENING 33.15 86808 CYTOTOXIC ANTIBODY SCREENING 33.15 86812 HLA TYPING A B OR C 33.44 86813 HLA TYPING A B OR C 54.25 86816 HLA TYPING DR/DQ 36.10 86817 HLA TYPING DR/DQ 54.25 86821 LYMPHOCYTE CULTURE MIXED 54.25 86822 LYMPHOCYTE CULTURE PRIMED 47.38 86850 RBC ANTIBODY SCREEN 12.36 86860 RBC ANTIBODY ELUTION 30.90 86870 RBC ANTIBODY IDENTIFICATION 25.75 86880 COOMBS TEST DIRECT 6.97 86885 COOMBS TEST INDIRECT QUAL 7.41 86886 COOMBS TEST INDIRECT TITER 6.70 86890 AUTOLOGOUS BLOOD PROCESS 51.50 86891 AUTOLOGOUS BLOOD OP SALVAGE 111.33 86900 BLOOD TYPING SEROLOGIC ABO 3.86 86901 BLOOD TYPING SEROLOGIC RH(D) 3.86 86902 BLOOD TYPE ANTIGEN DONOR EA BLOOD 4.95 86904 BLOOD TYPING PATIENT SERUM 12.32 86905 BLOOD TYPING RBC ANTIGENS 4.95 Proc Code Description Mod Rate 86906 BLD TYPING SEROLOGIC RH PHNT 10.04 86920 COMPATIBILITY TEST SPIN 20.60 86923 COMPATIBILITY TEST ELECTRIC 19.50 86927 PLASMA FRESH FROZEN 12.36 86930 FROZEN BLOOD PREP 36.05 86931 FROZEN BLOOD THAW 46.35 86932 FROZEN BLOOD FREEZE/THAW 46.35 86940 HEMOLYSINS/AGGLUTININS AUTO 10.63 86941 HEMOLYSINS/AGGLUTININS 15.69 86945 BLOOD PRODUCT/IRRADIATION 5.15 86950 LEUKACYTE TRANSFUSION 48.89 86960 VOL REDUCTION OF BLOOD/PROD 25.93 86965 POOLING BLOOD PLATELETS 12.32 86970 RBC PRETX INCUBATJ W/CHEMICL 6.18 86971 RBC PRETX INCUBATJ W/ENZYMES 6.18 86972 RBC PRETX INCUBATJ W/DENSITY 6.18 86975 RBC SERUM PRETX INCUBJ DRUGS 6.18 86976 RBC SERUM PRETX ID DILUTION 6.18 86977 RBC SERUM PRETX INCUBJ/INHIB 6.18 86978 RBC PRETREATMENT SERUM 6.18 86985 SPLIT BLOOD OR PRODUCTS 5.15 87003 SMALL ANIMAL INOCULATION 21.82 87015 SPECIMEN INFECT AGNT CONCNTJ 8.65 87040 BLOOD CULTURE FOR BACTERIA 13.38 87045 FECES CULTURE AEROBIC BACT 12.23 87046 STOOL CULTR AEROBIC BACT EA 12.23 87070 CULTURE OTHR SPECIMN AEROBIC 11.16 87071 CULTURE AEROBIC QUANT OTHER 12.23 87073 CULTURE BACTERIA ANAEROBIC 12.23 87075 CULTR BACTERIA EXCEPT BLOOD 12.26 87076 CULTURE ANAEROBE IDENT EACH 10.47 87077 CULTURE AEROBIC IDENTIFY 10.47 87081 CULTURE SCREEN ONLY 8.59 87084 CULTURE OF SPECIMEN BY KIT 11.16 87086 URINE CULTURE/COLONY COUNT 10.45 87088 URINE BACTERIA CULTURE 10.49 87101 SKIN FUNGI CULTURE 9.99 87102 FUNGUS ISOLATION CULTURE 10.88 87103 BLOOD FUNGUS CULTURE 11.68 87106 FUNGI IDENTIFICATION YEAST 13.38 87107 FUNGI IDENTIFICATION MOLD 13.38 87109 MYCOPLASMA 19.94 87110 CHLAMYDIA CULTURE 25.39 87116 MYCOBACTERIA CULTURE 14.00 87118 MYCOBACTERIC IDENTIFICATION 14.18 87140 CULTURE TYPE IMMUNOFLUORESC 7.22 Proc Code Description Mod Rate 87143 CULTURE TYPING GLC/HPLC 16.23 87147 CULTURE TYPE IMMUNOLOGIC 6.51 87149 DNA/RNA DIRECT PROBE 25.99 87152 CULTURE TYPE PULSE FIELD GEL 6.77 87158 CULTURE TYPING ADDED METHOD 6.77 87164 DARK FIELD EXAMINATION 26 18.76 87164 DARK FIELD EXAMINATION 13.91 87166 DARK FIELD EXAMINATION 14.63 87168 MACROSCOPIC EXAM ARTHROPOD 5.52 87169 MACROSCOPIC EXAM PARASITE 5.52 87172 PINWORM EXAM 5.52 87176 TISSUE HOMOGENIZATION CULTR 7.62 87177 OVA AND PARASITES SMEARS 11.53 87181 MICROBE SUSCEPTIBLE DIFFUSE 2.17 87184 MICROBE SUSCEPTIBLE DISK 8.93 87185 MICROBE SUSCEPTIBLE ENZYME 2.17 87186 MICROBE SUSCEPTIBLE MIC 11.21 87187 MICROBE SUSCEPTIBLE MLC 13.43 87188 MICROBE SUSCEPT MACROBROTH 8.60 87190 MICROBE SUSCEPT MYCOBACTERI 6.51 87197 BACTERICIDAL LEVEL SERUM 19.47 87205 SMEAR GRAM STAIN 5.52 87206 SMEAR FLUORESCENT/ACID STAI 6.97 87207 SMEAR SPECIAL STAIN 26 18.76 87207 SMEAR SPECIAL STAIN 7.77 87209 SMEAR COMPLEX STAIN 23.29 87210 SMEAR WET MOUNT SALINE/INK 5.52 87220 TISSUE EXAM FOR FUNGI 5.52 87230 ASSAY TOXIN OR ANTITOXIN 25.59 87250 VIRUS INOCULATE EGGS/ANIMAL 25.34 87252 VIRUS INOCULATION TISSUE 33.78 87253 VIRUS INOCULATE TISSUE ADDL 26.18 87254 VIRUS INOCULATION SHELL VIA 25.34 87255 GENET VIRUS ISOLATE HSV 43.89 87260 ADENOVIRUS AG IF 15.54 87265 PERTUSSIS AG IF 15.54 87269 GIARDIA AG IF 15.54 87270 CHLAMYDIA TRACHOMATIS AG IF 15.54 87271 CYTOMEGALOVIRUS DFA 15.54 87272 CRYPTOSPORIDIUM AG IF 15.54 87273 HERPES SIMPLEX 2 AG IF 15.54 87274 HERPES SIMPLEX 1 AG IF 15.54 87275 INFLUENZA B AG IF 15.54 87276 INFLUENZA A AG IF 15.54 87277 LEGIONELLA MICDADEI AG IF 15.54 87278 LEGION PNEUMOPHILIA AG IF 15.54 Proc Code Description Mod Rate 87279 PARAINFLUENZA AG IF 15.54 87280 RESPIRATORY SYNCYTIAL AG IF 15.54 87281 PNEUMOCYSTIS CARINII AG IF 15.54 87283 RUBEOLA AG IF 15.54 87285 TREPONEMA PALLIDUM AG IF 15.54 87290 VARICELLA ZOSTER AG IF 15.54 87299 ANTIBODY DETECTION NOS IF 15.54 87300 AG DETECTION POLYVAL IF 15.54 87301 ADENOVIRUS AG EIA 15.54 87305 ASPERGILLUS AG EIA 15.54 87320 CHYLMD TRACH AG EIA 15.54 87324 CLOSTRIDIUM AG EIA 15.54 87327 CRYPTOCOCCUS NEOFORM AG EIA 15.54 87328 CRYPTOSPORIDIUM AG EIA 15.54 87329 GIARDIA AG EIA 15.54 87332 CYTOMEGALOVIRUS AG EIA 15.54 87335 E COLI 0157 AG EIA 15.54 87336 ENTAMOEB HIST DISPR AG EIA 15.54 87337 ENTAMOEB HIST GROUP AG EIA 15.54 87338 HPYLORI STOOL EIA 15.55 87339 H PYLORI AG EIA 15.54 87340 HEPATITIS B SURFACE AG EIA 13.39 87341 HEPATITIS B SURFACE AG EIA 13.39 87350 HEPATITIS BE AG EIA 14.94 87380 HEPATITIS DELTA AG EIA 21.27 87385 HISTOPLASMA CAPSUL AG EIA 15.54 87390 HIV-1 AG EIA 22.85 87391 HIV-2 AG EIA 22.85 87400 INFLUENZA A/B AG EIA 15.54 87420 RESP SYNCYTIAL AG EIA 15.54 87425 ROTAVIRUS AG EIA 15.54 87427 SHIGA-LIKE TOXIN AG EIA 15.54 87430 STREP A AG EIA 15.54 87449 AG DETECT NOS EIA MULT 15.54 87450 AG DETECT NOS EIA SINGLE 12.42 87451 AG DETECT POLYVAL EIA MULT 12.42 87470 BARTONELLA DNA DIR PROBE 25.99 87471 BARTONELLA DNA AMP PROBE 45.47 87472 BARTONELLA DNA QUANT 55.51 87475 LYME DIS DNA DIR PROBE 25.99 87476 LYME DIS DNA AMP PROBE 45.47 87477 LYME DIS DNA QUANT 55.51 87480 CANDIDA DNA DIR PROBE 25.99 87481 CANDIDA DNA AMP PROBE 45.47 87482 CANDIDA DNA QUANT 54.11 87485 CHYLMD PNEUM DNA DIR PROBE 25.99 Proc Code Description Mod Rate 87486 CHYLMD PNEUM DNA AMP PROBE 45.47 87487 CHYLMD PNEUM DNA QUANT 55.51 87490 CHYLMD TRACH DNA DIR PROBE 25.99 87491 CHYLMD TRACH DNA AMP PROBE 45.47 87492 CHYLMD TRACH DNA QUANT 45.30 87495 CYTOMEG DNA DIR PROBE 25.99 87496 CYTOMEG DNA AMP PROBE 45.47 87497 CYTOMEG DNA QUANT 55.51 87498 ENTEROVIRUS PROBE&REVRS TRNS 45.47 87500 VANOMYCIN DNA AMP PROBE 45.47 87501 INFLUENZA DNA AMP PROB 1+ 66.50 87502 INFLUENZA DNA AMP PROBE 110.28 87503 INFLUENZA DNA AMP PROB ADDL INFEC 26.91 87510 GARDNER VAG DNA DIR PROBE 25.99 87511 GARDNER VAG DNA AMP PROBE 45.47 87512 GARDNER VAG DNA QUANT 54.11 87515 HEPATITIS B DNA DIR PROBE 25.99 87516 HEPATITIS B DNA AMP PROBE 45.47 87517 HEPATITIS B DNA QUANT 55.51 87520 HEPATITIS C RNA DIR PROBE 25.99 87521 HEPATITIS C PROBE&RVRS TRNSC 45.47 87522 HEPATITIS C REVRS TRNSCRPJ 55.51 87525 HEPATITIS G DNA DIR PROBE 25.99 87526 HEPATITIS G DNA AMP PROBE 45.47 87527 HEPATITIS G DNA QUANT 54.11 87528 HSV DNA DIR PROBE 25.99 87529 HSV DNA AMP PROBE 45.47 87530 HSV DNA QUANT 55.51 87531 HHV-6 DNA DIR PROBE 25.99 87532 HHV-6 DNA AMP PROBE 45.47 87533 HHV-6 DNA QUANT 54.11 87534 HIV-1 DNA DIR PROBE 25.99 87535 HIV-1 PROBE&REVERSE TRNSCRPJ 45.47 87536 HIV-1 QUANT&REVRSE TRNSCRPJ 110.28 87537 HIV-2 DNA DIR PROBE 25.99 87538 HIV-2 PROBE&REVRSE TRNSCRIPJ 45.47 87539 HIV-2 QUANT&REVRSE TRNSCRIPJ 55.51 87540 LEGION PNEUMO DNA DIR PROB 25.99 87541 LEGION PNEUMO DNA AMP PROB 45.47 87542 LEGION PNEUMO DNA QUANT 54.11 87550 MYCOBACTERIA DNA DIR PROBE 25.99 87551 MYCOBACTERIA DNA AMP PROBE 45.47 87552 MYCOBACTERIA DNA QUANT 55.51 87555 M.TUBERCULO DNA DIR PROBE 25.99 87556 M.TUBERCULO DNA AMP PROBE 45.47 87557 M.TUBERCULO DNA QUANT 55.51 Proc Code Description Mod Rate 87560 M.AVIUM-INTRA DNA DIR PROB 25.99 87561 M.AVIUM-INTRA DNA AMP PROB 45.47 87562 M.AVIUM-INTRA DNA QUANT 55.51 87580 M.PNEUMON DNA DIR PROBE 25.99 87581 M.PNEUMON DNA AMP PROBE 45.47 87582 M.PNEUMON DNA QUANT 54.11 87590 N.GONORRHOEAE DNA DIR PROB 25.99 87591 N.GONORRHOEAE DNA AMP PROB 45.47 87592 N.GONORRHOEAE DNA QUANT 55.51 87623 HPV LOW-RISK TYPES 24.53 87624 HPV HIGH-RISK TYPES 24.53 87625 HPV TYPES 16 & 18 ONLY 24.53 87640 STAPH A DNA AMP PROBE 45.47 87641 MR-STAPH DNA AMP PROBE 45.47 87650 STREP A DNA DIR PROBE 25.99 87651 STREP A DNA AMP PROBE 45.47 87652 STREP A DNA QUANT 54.11 87653 STREP B DNA AMP PROBE 45.47 87660 TRICHOMONAS VAGIN DIR PROBE 25.99 87797 DETECT AGENT NOS DNA DIR 25.99 87798 DETECT AGENT NOS DNA AMP 45.47 87799 DETECT AGENT NOS DNA QUANT 55.51 87800 DETECT AGNT MULT DNA DIREC 51.98 87801 DETECT AGNT MULT DNA AMPLI 90.97 87802 STREP B ASSAY W/OPTIC 15.54 87803 CLOSTRIDIUM TOXIN A W/OPTIC 15.54 87804 INFLUENZA ASSAY W/OPTIC 15.54 87807 RSV ASSAY W/OPTIC 15.54 87808 TRICHOMONAS ASSAY W/OPTIC 15.54 87809 Adenovirus assay w/optic 15.54 87810 CHYLMD TRACH ASSAY W/OPTIC 15.54 87850 N. GONORRHOEAE ASSAY W/OPTIC 15.54 87880 STREP A ASSAY W/OPTIC 15.54 87899 AGENT NOS ASSAY W/OPTIC 15.54 87900 PHENOTYPE INFECT AGENT DRUG 168.92 87901 GENOTYPE DNA HIV REVERSE T 333.65 87902 GENOTYPE DNA/RNA HEP C 333.65 87903 PHENOTYPE DNA HIV W/CULTURE 633.30 87904 PHENOTYPE DNA HIV W/CLT ADD 33.78 87905 SIALIDASE ENZYME ASSAY 15.83 87906 GENOTYPE DNA/RNA HIV 166.83 88104 CYTOPATH FL NONGYN SMEARS TC 44.89 88104 CYTOPATH FL NONGYN SMEARS 26 28.42 88104 CYTOPATH FL NONGYN SMEARS 73.32 88106 CYTOPATH FL NONGYN FILTER TC 65.00 88106 CYTOPATH FL NONGYN FILTER 26 19.08 Proc Code Description Mod Rate 88106 CYTOPATH FL NONGYN FILTER 84.08 88108 CYTOPATH CONCENTRATE TECH TC 56.02 88108 CYTOPATH CONCENTRATE TECH 26 22.18 88108 CYTOPATH CONCENTRATE TECH 78.21 88112 CYTOPATH CELL ENHANCE TECH TC 34.84 88112 CYTOPATH CELL ENHANCE TECH 26 27.35 88112 CYTOPATH CELL ENHANCE TECH 62.19 88120 CYTP URNE 3-5 PROBES EA SPEC CYTOP TC 560.86 88120 CYTP URNE 3-5 PROBES EA SPEC CYTOP 26 57.08 88120 CYTP URNE 3-5 PROBES EA SPEC CYTOP 617.95 88121 CYTP URINE 3-5 PROBES CMPTR CYTOP TC 485.43 88121 CYTP URINE 3-5 PROBES CMPTR CYTOP 26 49.19 88121 CYTP URINE 3-5 PROBES CMPTR CYTOP 534.62 88125 FORENSIC CYTOPATHOLOGY TC 8.99 88125 FORENSIC CYTOPATHOLOGY 26 12.82 88125 FORENSIC CYTOPATHOLOGY 21.81 88130 SEX CHROMATIN IDENTIFICATION 19.51 88140 SEX CHROMATIN IDENTIFICATION 10.36 88141 CYTOPATH C/V INTERPRET 31.23 88142 CYTOPATH C/V THIN LAYER 26.25 88143 CYTOPATH C/V THIN LAYER REDO 26.25 88147 CYTOPATH C/V AUTOMATED 14.75 88148 CYTOPATH C/V AUTO RESCREEN 19.69 88150 CYTOPATH C/V MANUAL 13.69 88152 CYTOPATH C/V AUTO REDO 13.69 88153 CYTOPATH C/V REDO 13.69 88154 CYTOPATH C/V SELECT 13.69 88155 CYTOPATH C/V INDEX ADD-ON 7.77 88160 CYTOPATH SMEAR OTHER SOURCE TC 38.07 88160 CYTOPATH SMEAR OTHER SOURCE 26 25.66 88160 CYTOPATH SMEAR OTHER SOURCE 63.74 88161 CYTOPATH SMEAR OTHER SOURCE TC 33.40 88161 CYTOPATH SMEAR OTHER SOURCE 26 24.59 88161 CYTOPATH SMEAR OTHER SOURCE 57.99 88162 CYTOPATH SMEAR OTHER SOURCE TC 56.02 88162 CYTOPATH SMEAR OTHER SOURCE 26 39.22 88162 CYTOPATH SMEAR OTHER SOURCE 95.25 88164 CYTOPATH TBS C/V MANUAL 13.69 88165 CYTOPATH TBS C/V REDO 13.69 88166 CYTOPATH TBS C/V AUTO REDO 13.69 88167 CYTOPATH TBS C/V SELECT 13.69 88172 CYTP DX EVAL FNA 1ST EA SITE TC 18.32 88172 CYTP DX EVAL FNA 1ST EA SITE 26 35.01 88172 CYTP DX EVAL FNA 1ST EA SITE 53.34 88173 CYTOPATH EVAL FNA REPORT TC 75.05 88173 CYTOPATH EVAL FNA REPORT 26 69.68 Proc Code Description Mod Rate 88173 CYTOPATH EVAL FNA REPORT 144.73 88174 CYTOPATH C/V AUTO IN FLUID 27.69 88175 CYTOPATH C/V AUTO FLUID REDO 34.33 88177 CYTP FNA EVAL EA ADDL TC 7.55 88177 CYTP FNA EVAL EA ADDL 26 21.50 88177 CYTP FNA EVAL EA ADDL 29.06 88182 CELL MARKER STUDY TC 73.29 88182 CELL MARKER STUDY 26 35.61 88182 CELL MARKER STUDY 108.91 88184 FLOWCYTOMETRY/ TC 1 MARKER 87.98 88185 FLOWCYTOMETRY/TC ADD-ON 53.87 88187 FLOWCYTOMETRY/READ 2-8 69.44 88188 FLOWCYTOMETRY/READ 9-15 87.54 88189 FLOWCYTOMETRY/READ 16 & > 107.03 88230 TISSUE CULTURE LYMPHOCYTE 150.99 88233 TISSUE CULTURE SKIN/BIOPSY 182.39 88235 TISSUE CULTURE PLACENTA 190.85 88237 TISSUE CULTURE BONE MARROW 163.70 88239 TISSUE CULTURE TUMOR 191.19 88240 CELL CRYOPRESERVE/STORAGE 13.09 88241 FROZEN CELL PREPARATION 13.09 88245 CHROMOSOME ANALYSIS 20-25 192.93 88248 CHROMOSOME ANALYSIS 50-100 224.44 88249 CHROMOSOME ANALYSIS 100 224.44 88261 CHROMOSOME ANALYSIS 5 229.05 88262 CHROMOSOME ANALYSIS 15-20 161.53 88263 CHROMOSOME ANALYSIS 45 194.77 88264 CHROMOSOME ANALYSIS 20-25 161.53 88267 CHROMOSOME ANALYS PLACENTA 232.99 88269 CHROMOSOME ANALYS AMNIOTIC 215.56 88271 CYTOGENETICS DNA PROBE 27.75 88272 CYTOGENETICS 3-5 34.70 88273 CYTOGENETICS 10-30 41.64 88274 CYTOGENETICS 25-99 45.11 88275 CYTOGENETICS 100-300 52.05 88280 CHROMOSOME KARYOTYPE STUDY 32.52 88283 CHROMOSOME BANDING STUDY 64.94 88285 CHROMOSOME COUNT ADDITIONAL 24.62 88289 CHROMOSOME STUDY ADDITIONAL 18.54 88291 CYTO/MOLECULAR REPORT 30.33 88300 SURGICAL PATH GROSS TC 10.07 88300 SURGICAL PATH GROSS 26 4.53 88300 SURGICAL PATH GROSS 14.60 88302 TISSUE EXAM BY PATHOLOGIST TC 22.99 88302 TISSUE EXAM BY PATHOLOGIST 26 6.95 88302 TISSUE EXAM BY PATHOLOGIST 29.95 Proc Code Description Mod Rate 88304 TISSUE EXAM BY PATHOLOGIST TC 31.97 88304 TISSUE EXAM BY PATHOLOGIST 26 11.10 88304 TISSUE EXAM BY PATHOLOGIST 43.07 88305 TISSUE EXAM BY PATHOLOGIST TC 32.33 88305 TISSUE EXAM BY PATHOLOGIST 26 37.05 88305 TISSUE EXAM BY PATHOLOGIST 69.38 88307 TISSUE EXAM BY PATHOLOGIST TC 204.66 88307 TISSUE EXAM BY PATHOLOGIST 26 81.52 88307 TISSUE EXAM BY PATHOLOGIST 286.18 88309 TISSUE EXAM BY PATHOLOGIST TC 290.51 88309 TISSUE EXAM BY PATHOLOGIST 26 144.35 88309 TISSUE EXAM BY PATHOLOGIST 434.86 88311 DECALCIFY TISSUE TC 7.91 88311 DECALCIFY TISSUE 26 12.14 88311 DECALCIFY TISSUE 20.05 88312 SPECIAL STAINS GROUP 1 TC 67.15 88312 SPECIAL STAINS GROUP 1 26 26.67 88312 SPECIAL STAINS GROUP 1 93.82 88313 SPECIAL STAINS GROUP 2 TC 53.87 88313 SPECIAL STAINS GROUP 2 26 11.78 88313 SPECIAL STAINS GROUP 2 65.65 88314 HISTOCHEMICAL STAINS ADD-ON TC 55.30 88314 HISTOCHEMICAL STAINS ADD-ON 26 22.16 88314 HISTOCHEMICAL STAINS ADD-ON 77.47 88319 ENZYME HISTOCHEMISTRY TC 57.82 88319 ENZYME HISTOCHEMISTRY 26 27.44 88319 ENZYME HISTOCHEMISTRY 85.26 88321 MICROSLIDE CONSULTATION 92.68 88323 MICROSLIDE CONSULTATION TC 59.61 88323 MICROSLIDE CONSULTATION 26 85.03 88323 MICROSLIDE CONSULTATION 144.64 88325 COMPREHENSIVE REVIEW OF DATA 208.86 88329 PATH CONSULT INTROP 56.28 88331 PATH CONSULT INTRAOP 1 BLOC TC 36.28 88331 PATH CONSULT INTRAOP 1 BLOC 26 60.66 88331 PATH CONSULT INTRAOP 1 BLOC 96.94 88332 PATH CONSULT INTRAOP ADDL TC 12.58 88332 PATH CONSULT INTRAOP ADDL 26 30.16 88332 PATH CONSULT INTRAOP ADDL 42.75 88333 INTRAOP CYTO PATH CONSULT 1 TC 40.94 88333 INTRAOP CYTO PATH CONSULT 1 26 61.77 88333 INTRAOP CYTO PATH CONSULT 1 102.72 88334 INTRAOP CYTO PATH CONSULT 2 TC 25.86 88334 INTRAOP CYTO PATH CONSULT 2 26 38.20 88334 INTRAOP CYTO PATH CONSULT 2 64.07 88341 Immunohisto antibody slide 26 22.48 Proc Code Description Mod Rate 88341 Immunohisto antibody slide 70.77 88342 IMMUNOHISTOCHEMISTRY TC 13.95 88342 IMMUNOHISTOCHEMISTRY 26 55.80 88342 IMMUNOHISTOCHEMISTRY 69.75 88344 Immunohisto antibody slide 123.07 88346 IMMUNOFLUORESCENT STUDY TC 63.56 88346 IMMUNOFLUORESCENT STUDY 26 41.52 88346 IMMUNOFLUORESCENT STUDY 105.08 88347 IMMUNOFLUORESCENT STUDY TC 47.05 88347 IMMUNOFLUORESCENT STUDY 26 40.44 88347 IMMUNOFLUORESCENT STUDY 87.49 88348 ELECTRON MICROSCOPY TC 627.37 88348 ELECTRON MICROSCOPY 26 74.12 88348 ELECTRON MICROSCOPY 701.50 88355 ANALYSIS SKELETAL MUSCLE TC 91.93 88355 ANALYSIS SKELETAL MUSCLE 26 81.42 88355 ANALYSIS SKELETAL MUSCLE 173.35 88356 ANALYSIS NERVE TC 146.19 88356 ANALYSIS NERVE 26 128.95 88356 ANALYSIS NERVE 275.15 88358 ANALYSIS TUMOR TC 38.07 88358 ANALYSIS TUMOR 26 43.90 88358 ANALYSIS TUMOR 81.97 88360 TUMOR IMMUNOHISTOCHEM/MANUAL TC 75.41 88360 TUMOR IMMUNOHISTOCHEM/MANUAL 26 52.96 88360 TUMOR IMMUNOHISTOCHEM/MANUAL 128.37 88361 TUMOR IMMUNOHISTOCHEM/COMPUT TC 98.75 88361 TUMOR IMMUNOHISTOCHEM/COMPUT 26 57.50 88361 TUMOR IMMUNOHISTOCHEM/COMPUT 156.25 88362 NERVE TEASING PREPARATIONS TC 195.02 88362 NERVE TEASING PREPARATIONS 26 110.00 88362 NERVE TEASING PREPARATIONS 305.02 88363 XM ARCHIVE TISSUE MOLEC ANAL EXAMI 21.63 88364 Insitu hybridization (fish) 102.55 88365 INSITU HYBRIDIZATION (FISH) TC 117.42 88365 INSITU HYBRIDIZATION (FISH) 26 58.16 88365 INSITU HYBRIDIZATION (FISH) 175.58 88366 Insitu hybridization (fish) 156.53 88367 INSITU HYBRIDIZATION AUTO TC 193.53 88367 INSITU HYBRIDIZATION AUTO 26 60.53 88367 INSITU HYBRIDIZATION AUTO 254.06 88368 INSITU HYBRIDIZATION MANUAL TC 168.04 88368 INSITU HYBRIDIZATION MANUAL 26 62.48 88368 INSITU HYBRIDIZATION MANUAL 230.52 88369 M/phmtrc alysishquant/semiq 77.44 88371 PROTEIN WESTERN BLOT TISSUE 26 18.76 Proc Code Description Mod Rate 88371 PROTEIN WESTERN BLOT TISSUE 19.13 88372 PROTEIN ANALYSIS W/PROBE 26 18.76 88372 PROTEIN ANALYSIS W/PROBE 29.47 88373 M/phmtrc alys ishquant/semiq 63.15 88374 M/phmtrc alys ishquant/semiq 216.40 88375 Optical endomicroscpy interp 0.00 88377 M/phmtrc alys ishquant/semiq 225.51 88381 MICRODISSECTION MANUAL TC 105.93 88381 MICRODISSECTION MANUAL 26 53.17 88381 MICRODISSECTION MANUAL 159.10 88387 TISS EXAM MOLECULAR STUDY TC 6.48 88387 TISS EXAM MOLECULAR STUDY 26 28.31 88387 TISS EXAM MOLECULAR STUDY 34.79 88388 TISS EX MOLECUL STUDY ADD-ON TC 8.99 88388 TISS EX MOLECUL STUDY ADD-ON 26 23.24 88388 TISS EX MOLECUL STUDY ADD-ON 32.23 88720 BILIRUBIN TOTAL TRANSCUT 6.49 88740 TRANSCUTANEOUS CARBOXYHB 6.49 88741 TRANSCUTANEOUS METHB 6.49 89050 BODY FLUID CELL COUNT 6.12 89051 BODY FLUID CELL COUNT 7.13 89055 LEUKOCYTE ASSESSMENT FECAL 5.52 89060 EXAM SYNOVIAL FLUID CRYSTALS 26 18.76 89060 EXAM SYNOVIAL FLUID CRYSTALS 9.27 89125 SPECIMEN FAT STAIN 4.47 89160 EXAM FECES FOR MEAT FIBERS 4.77 89190 NASAL SMEAR FOR EOSINOPHILS 6.15 89220 SPUTUM SPECIMEN COLLECTION 17.25 89230 COLLECT SWEAT FOR TEST 5.04 89240 PATHOLOGY LAB PROCEDURE 0.00 89310 SEMEN ANALYSIS W/COUNT 11.15 90460 IM ADMIN 1ST/ONLY COMPONENT 22.22 90471 IMMUNIZATION ADMIN 22.22 90472 IMMUNIZATION ADMIN EACH ADD 11.01 90473 IMMUNE ADMIN ORAL/NASAL 22.22 90474 IMMUNE ADMIN ORAL/NASAL ADDL 11.01 90476 ADENOVIRUS VACCINE TYPE 4 0.00 90477 ADENOVIRUS VACCINE TYPE 7 0.00 90581 ANTHRAX VACCINE SC OR IM 113.17 90585 BCG VACCINE PERCUT 161.54 90586 BCG VACCINE INTRAVESICAL 148.66 90632 HEP A VACCINE ADULT IM 56.31 90633 HEP A VACC PED/ADOL 2 DOSE 27.39 90634 HEP A VACC PED/ADOL 3 DOSE 27.39 90636 HEP A/HEP B VACC ADULT IM 62.71 90645 HIB VACCINE HBOC IM 22.46 Proc Code Description Mod Rate 90646 HIB VACCINE PRP-D IM 18.94 90647 HIB VACCINE PRP-OMP IM 20.92 90648 HIB VACCINE PRP-T IM 21.10 90649 HPV VACCINE 4 VALENT IM 124.80 90650 HPV VACCINE 2 VALENT IM 124.80 90654 FLU VACC IIV3 NO PRESERV ID 18.60 90655 FLU VAC NO PRSV 3 VAL 6-35 M 17.46 90656 FLU VACCINE NO PRESERV 3 & > 13.48 90657 FLU VACCINE 3 YRS IM 7.03 90658 FLU VACCINE 3 YRS & > IM 13.74 90660 FLU VACCINE NASAL 9.34 90669 PNEUMOCOCCAL VACC 7 VAL IM 16.30 90670 PNEUMOCOCCAL VACC 13 VAL IM 139.49 90672 FLU VACCINE 4 VALENT NASAL 9.34 90673 Flu vacc riv3 no preserv 33.11 90675 RABIES VACCINE IM 129.23 90676 RABIES VACCINE ID 67.39 90680 ROTOVIRUS VACC 3 DOSE ORAL 55.71 90681 ROTAVIRUS VACC 2 DOSE ORAL 49.23 90685 FLU VAC NO PRSV 4 VAL 6-35 M 15.15 90686 FLU VAC NO PRSV 4 VAL 3 YRS+ 15.15 90687 FLU VACCINE 4 VAL 6-35 MO IM 13.74 90688 FLU VACC 4 VAL 3 YRS PLUS IM 13.74 90690 TYPHOID VACCINE ORAL 27.08 90691 TYPHOID VACCINE IM 37.85 90692 TYPHOID VACCINE H-P SC/ID 2.09 90693 TYPHOID VACCINE AKD SC 0.00 90696 DTAP-IPV VACC 4-6 YR IM 0.00 90698 DTAP-HIB-IP VACCINE IM 55.71 90700 DTAP VACCINE < 7 YRS IM 12.75 90702 DT VACCINE < 7 YRS IM 8.62 90703 TETANUS VACCINE IM 7.69 90704 MUMPS VACCINE SC 16.62 90705 MEASLES VACCINE SC 12.92 90706 RUBELLA VACCINE SC 14.77 90707 MMR VACCINE SC 33.23 90708 MEASLES-RUBELLA VACCINE SC 22.07 90710 MMRV VACCINE SC 99.16 90712 ORAL POLIOVIRUS VACCINE 17.85 90713 POLIOVIRUS IPV SC/IM 9.96 90714 TD VACCINE NO PRSRV 7/> IM 20.43 90715 TDAP VACCINE 7 YRS/> IM 35.65 90716 CHICKEN POX VACCINE SC 57.23 90717 YELLOW FEVER VACCINE SC 52.92 90719 DIPHTHERIA VACCINE IM 0.00 90720 DTP/HIB VACCINE IM 34.77 Proc Code Description Mod Rate 90721 DTAP/HIB VACCINE IM 23.40 90723 DTAP-HEP B-IPV VACCINE IM 32.75 90725 CHOLERA VACCINE INJECTABLE 8.65 90727 PLAGUE VACCINE IM 0.00 90732 PNEUMOCOCCAL VACC 23 VAL IM 11.12 90733 MENINGOCOCCAL VACCINE SC 60.62 90734 MENINGOCOCCAL VACCINE IM 70.57 90735 ENCEPHALITIS VACCINE SC 71.69 90736 ZOSTER VACC SC 117.01 90740 HEPB VACC ILL PAT 3 DOSE IM 102.77 90743 HEP B VACC ADOL 2 DOSE IM 22.46 90744 HEPB VACC PED/ADOL 3 DOSE IM 22.46 90746 HEP B VACC ADULT 3 DOSE IM 51.08 90747 HEPB VACC ILL PAT 4 DOSE IM 102.77 90748 HEP B/HIB VACCINE IM 45.54 90785 Psytx complex interactive 12.32 90791 Psych diagnostic evaluation 115.38 90792 Psych diag eval w/med srvcs 124.29 90832 Psytx pt&/family 30 minutes 55.77 90833 Psytx pt&/fam w/e&m 30 min 57.05 90834 Psytx pt&/family 45 minutes 73.93 90836 Psytx pt&/fam w/e&m 45 min 72.15 90837 Psytx pt&/family 60 minutes 110.56 90838 Psytx pt&/fam w/e&m 60 min 95.31 90839 Psytx crisis initial 60 min 115.49 90840 Psytx crisis ea addl 30 min 55.45 90845 PSYCHOANALYSIS 79.87 90847 FAMILY PSYTX W/PATIENT 92.40 90853 GROUP PSYCHOTHERAPY 22.84 90863 Pharmacologic mgmt w/psytx 44.31 90867 TCRANIAL MAGN STIM TX PLAN 353.92 90868 TCRANIAL MAGN STIM TX DELI 172.76 90869 Tcran magn stim redetemine 439.37 90870 ELECTROCONVULSIVE THERAPY 156.04 90875 PSYCHOPHYSIOLOGICAL THERAPY 54.37 90876 PSYCHOPHYSIOLOGICAL THERAPY 94.70 90901 BIOFEEDBACK TRAIN ANY METH 35.32 90911 BIOFEEDBACK PERI/URO/RECTAL 75.42 90935 HEMODIALYSIS ONE EVALUATION 63.54 90937 HEMODIALYSIS REPEATED EVAL 91.14 90940 HEMODIALYSIS ACCESS STUDY 70.97 90945 DIALYSIS ONE EVALUATION 75.30 90947 DIALYSIS REPEATED EVAL 108.83 90951 ESRD SERV 4 VISITS P MO <2YR 816.70 90952 ESRD SERV 2-3 VSTS P MO <2YR 617.16 90953 ESRD SERV 1 VISIT P MO <2YRS 411.33 Proc Code Description Mod Rate 90954 ESRD SERV 4 VSTS P MO 2-11 708.80 90955 ESRD SRV 2-3 VSTS P MO 2-11 400.04 90956 ESRD SRV 1 VISIT P MO 2-11 278.89 90957 ESRD SRV 4 VSTS P MO 12-19 564.20 90958 ESRD SRV 2-3 VSTS P MO 12-19 381.82 90959 ESRD SERV 1 VST P MO 12-19 258.70 90960 ESRD SRV 4 VISITS P MO 20+ 249.27 90961 ESRD SRV 2-3 VSTS P MO 20+ 209.90 90962 ESRD SERV 1 VISIT P MO 20+ 162.16 90963 ESRD HOME PT SERV P MO <2YRS 478.25 90964 ESRD HOME PT SERV P MO 2-11 416.86 90965 ESRD HOME PT SERV P MO 12-19 395.39 90966 ESRD HOME PT SERV P MO 20+ 209.58 90967 ESRD HOME PT SERV P DAY <2 15.50 90968 ESRD HOME PT SRV P DAY 2-11 13.33 90969 ESRD HOME PT SRV P DAY 12-19 13.03 90970 ESRD HOME PT SERV P DAY 20+ 6.85 90989 DIALYSIS TRAINING COMPLETE 462.17 90993 DIALYSIS TRAINING INCOMPL 78.16 90997 HEMOPERFUSION 80.97 91010 ESOPHAGUS MOTILITY STUDY TC 97.67 91010 ESOPHAGUS MOTILITY STUDY 26 60.00 91010 ESOPHAGUS MOTILITY STUDY 157.67 91013 ESOPHGL MOTIL W/STIM/PERFUS TC 12.86 91013 ESOPHGL MOTIL W/STIM/PERFUS 26 8.39 91013 ESOPHGL MOTIL W/STIM/PERFUS 21.25 91020 GASTRIC MOTILITY STUDIES TC 142.32 91020 GASTRIC MOTILITY STUDIES 26 67.45 91020 GASTRIC MOTILITY STUDIES 209.77 91022 DUODENAL MOTILITY STUDY TC 83.85 91022 DUODENAL MOTILITY STUDY 26 66.77 91022 DUODENAL MOTILITY STUDY 150.63 91030 ACID PERFUSION OF ESOPHAGUS TC 80.64 91030 ACID PERFUSION OF ESOPHAGUS 26 42.57 91030 ACID PERFUSION OF ESOPHAGUS 123.22 91034 GASTROESOPHAGEAL REFLUX TEST TC 124.97 91034 GASTROESOPHAGEAL REFLUX TEST 26 45.04 91034 GASTROESOPHAGEAL REFLUX TEST 170.02 91035 G-ESOPH REFLX TST W/ELECTROD TC 360.12 91035 G-ESOPH REFLX TST W/ELECTROD 26 73.63 91035 G-ESOPH REFLX TST W/ELECTROD 433.75 91037 ESOPH IMPED FUNCTION TEST TC 98.95 91037 ESOPH IMPED FUNCTION TEST 26 46.05 91037 ESOPH IMPED FUNCTION TEST 145.01 91038 ESOPH IMPED FUNCT TEST > 1HR TC 355.95 91038 ESOPH IMPED FUNCT TEST > 1HR 26 51.27 Proc Code Description Mod Rate 91038 ESOPH IMPED FUNCT TEST > 1HR 407.22 91040 ESOPH BALLOON DISTENSION TST TC 316.43 91040 ESOPH BALLOON DISTENSION TST 26 43.74 91040 ESOPH BALLOON DISTENSION TST 360.18 91065 BREATH HYDROGEN/METHANE TEST TC 64.90 91065 BREATH HYDROGEN/METHANE TEST 26 9.32 91065 BREATH HYDROGEN/METHANE TEST 74.23 91110 GI TRACT CAPSULE ENDOSCOPY TC 631.25 91110 GI TRACT CAPSULE ENDOSCOPY 26 169.97 91110 GI TRACT CAPSULE ENDOSCOPY 801.22 91111 ESOPHAGEAL CAPSULE ENDOSCOPY TC 611.97 91111 ESOPHAGEAL CAPSULE ENDOSCOPY 26 46.60 91111 ESOPHAGEAL CAPSULE ENDOSCOPY 658.58 91112 Gi wireless capsule measure TC 869.29 91112 Gi wireless capsule measure 26 98.20 91112 Gi wireless capsule measure 967.49 91117 COLON MOTILITY 6 HR STUDY COLON 132.42 91120 RECTAL SENSATION TEST TC 314.83 91120 RECTAL SENSATION TEST 26 45.11 91120 RECTAL SENSATION TEST 359.94 91122 ANAL PRESSURE RECORD TC 118.87 91122 ANAL PRESSURE RECORD 26 79.16 91122 ANAL PRESSURE RECORD 198.03 91200 Liver elastography 32.31 92002 EYE EXAM NEW PATIENT 73.19 92004 EYE EXAM NEW PATIENT 132.74 92012 EYE EXAM ESTABLISH PATIENT 76.65 92014 EYE EXAM&TX ESTAB PT 1/>VST 110.90 92015 DETERMINE REFRACTIVE STATE 17.73 92018 NEW EYE EXAM & TREATMENT 131.04 92019 EYE EXAM & TREATMENT 63.49 92020 SPECIAL EYE EVALUATION 24.49 92025 CORNEAL TOPOGRAPHY TC 16.07 92025 CORNEAL TOPOGRAPHY 26 17.75 92025 CORNEAL TOPOGRAPHY 33.82 92060 SPECIAL EYE EVALUATION TC 23.78 92060 SPECIAL EYE EVALUATION 26 34.57 92060 SPECIAL EYE EVALUATION 58.35 92065 ORTHOPTIC/PLEOPTIC TRAINING TC 31.81 92065 ORTHOPTIC/PLEOPTIC TRAINING 26 15.79 92065 ORTHOPTIC/PLEOPTIC TRAINING 47.60 92071 Contact lens fitting for tx 33.73 92072 Fit contac lens for managmnt 122.21 92081 VISUAL FIELD EXAMINATION(S) TC 15.75 92081 VISUAL FIELD EXAMINATION(S) 26 14.97 92081 VISUAL FIELD EXAMINATION(S) 30.73 Proc Code Description Mod Rate 92082 VISUAL FIELD EXAMINATION(S) TC 23.78 92082 VISUAL FIELD EXAMINATION(S) 26 20.28 92082 VISUAL FIELD EXAMINATION(S) 44.07 92083 VISUAL FIELD EXAMINATION(S) TC 32.46 92083 VISUAL FIELD EXAMINATION(S) 26 25.24 92083 VISUAL FIELD EXAMINATION(S) 57.70 92100 SERIAL TONOMETRY EXAM(S) 71.64 92132 CMPTR OPHTH DX IMG ANT SEGMT SCANN TC 14.15 92132 CMPTR OPHTH DX IMG ANT SEGMT SCANN 26 17.78 92132 CMPTR OPHTH DX IMG ANT SEGMT SCANN 31.93 92133 CMPTR OPHTH IMG OPTIC NERVE SCANN TC 14.47 92133 CMPTR OPHTH IMG OPTIC NERVE SCANN 26 25.24 92133 CMPTR OPHTH IMG OPTIC NERVE SCANN 39.71 92134 CPTR OPHTH DX IMG POST SEGMT SCANN TC 14.47 92134 CPTR OPHTH DX IMG POST SEGMT SCANN 26 26.20 92134 CPTR OPHTH DX IMG POST SEGMT SCANN 40.68 92136 OPHTHALMIC BIOMETRY TC 52.69 92136 OPHTHALMIC BIOMETRY 26 27.71 92136 OPHTHALMIC BIOMETRY 80.41 92140 GLAUCOMA PROVOCATIVE TESTS 56.40 92145 Corneal hysteresis deter 13.88 92225 SPECIAL EYE EXAM INITIAL 24.47 92226 SPECIAL EYE EXAM SUBSEQUENT 21.96 92227 REMOTE DX RETINAL IMAGING REMOT 12.86 92228 REMOTE RETINAL IMAGING MGMT REMOT TC 12.22 92228 REMOTE RETINAL IMAGING MGMT REMOT 26 19.00 92228 REMOTE RETINAL IMAGING MGMT REMOT 31.22 92230 EYE EXAM WITH PHOTOS 52.72 92235 EYE EXAM WITH PHOTOS TC 55.91 92235 EYE EXAM WITH PHOTOS 26 42.08 92235 EYE EXAM WITH PHOTOS 97.99 92240 ICG ANGIOGRAPHY TC 170.59 92240 ICG ANGIOGRAPHY 26 57.02 92240 ICG ANGIOGRAPHY 227.62 92250 EYE EXAM WITH PHOTOS TC 49.16 92250 EYE EXAM WITH PHOTOS 26 21.13 92250 EYE EXAM WITH PHOTOS 70.30 92260 OPHTHALMOSCOPY/DYNAMOMETRY 16.71 92265 EYE MUSCLE EVALUATION TC 31.49 92265 EYE MUSCLE EVALUATION 26 36.59 92265 EYE MUSCLE EVALUATION 68.08 92270 ELECTRO-OCULOGRAPHY TC 44.02 92270 ELECTRO-OCULOGRAPHY 26 36.30 92270 ELECTRO-OCULOGRAPHY 80.32 92275 ELECTRORETINOGRAPHY TC 89.96 92275 ELECTRORETINOGRAPHY 26 52.37 Proc Code Description Mod Rate 92275 ELECTRORETINOGRAPHY 142.33 92283 COLOR VISION EXAMINATION TC 41.13 92283 COLOR VISION EXAMINATION 26 8.40 92283 COLOR VISION EXAMINATION 49.54 92284 DARK ADAPTATION EYE EXAM TC 43.38 92284 DARK ADAPTATION EYE EXAM 26 10.86 92284 DARK ADAPTATION EYE EXAM 54.24 92285 EYE PHOTOGRAPHY TC 15.75 92285 EYE PHOTOGRAPHY 26 2.82 92285 EYE PHOTOGRAPHY 18.58 92286 INTERNAL EYE PHOTOGRAPHY TC 14.47 92286 INTERNAL EYE PHOTOGRAPHY 26 19.59 92286 INTERNAL EYE PHOTOGRAPHY 34.06 92287 INTERNAL EYE PHOTOGRAPHY 123.05 92310 CONTACT LENS FITTING 84.93 92311 CONTACT LENS FITTING 91.18 92312 CONTACT LENS FITTING 102.73 92313 CONTACT LENS FITTING 87.55 92314 PRESCRIPTION OF CONTACT LENS 70.56 92315 RX CNTACT LENS APHAKIA 1 EYE 65.82 92316 RX CNTACT LENS APHAKIA 2 EYE 81.82 92317 RX CORNEOSCLERAL CNTACT LENS 67.70 92325 MODIFICATION OF CONTACT LENS 37.27 92326 REPLACEMENT OF CONTACT LENS 32.13 92340 FIT SPECTACLES MONOFOCAL 31.56 92341 FIT SPECTACLES BIFOCAL 35.89 92342 FIT SPECTACLES MULTIFOCAL 38.70 92352 FIT APHAKIA SPECTCL MONOFOCL 36.06 92353 FIT APHAKIA SPECTCL MULTIFOC 41.62 92354 FIT SPECTACLES SINGLE SYSTEM 12.22 92355 FIT SPECTACLES COMPOUND LENS 18.64 92358 APHAKIA PROSTH SERVICE TEMP 10.29 92370 REPAIR & ADJUST SPECTACLES 27.46 92371 REPAIR & ADJUST SPECTACLES 10.29 92502 EAR AND THROAT EXAMINATION 85.96 92504 EAR MICROSCOPY EXAMINATION 27.02 92507 SPEECH/HEARING THERAPY 70.25 92508 SPEECH/HEARING THERAPY 20.67 92511 NASOPHARYNGOSCOPY 123.04 92512 NASAL FUNCTION STUDIES 54.39 92516 FACIAL NERVE FUNCTION TEST 62.62 92520 LARYNGEAL FUNCTION STUDIES 66.29 92521 Evaluation of speech fluency 99.66 92522 Evaluate speech production 80.78 92523 Speech sound lang comprehen 168.00 92524 Behavral qualit analys voice 84.39 Proc Code Description Mod Rate 92531 SPONTANEOUS NYSTAGMUS STUDY 24.31 92532 POSITIONAL NYSTAGMUS TEST 28.00 92533 CALORIC VESTIBULAR TEST 44.62 92534 OPTOKINETIC NYSTAGMUS TEST 19.69 92540 BASIC VESTIBULAR EVALUATION TC 19.61 92540 BASIC VESTIBULAR EVALUATION 26 69.87 92540 BASIC VESTIBULAR EVALUATION 89.48 92541 SPONTANEOUS NYSTAGMUS TEST TC 8.68 92541 SPONTANEOUS NYSTAGMUS TEST 26 18.31 92541 SPONTANEOUS NYSTAGMUS TEST 27.00 92542 POSITIONAL NYSTAGMUS TEST TC 8.04 92542 POSITIONAL NYSTAGMUS TEST 26 15.21 92542 POSITIONAL NYSTAGMUS TEST 23.26 92543 CALORIC VESTIBULAR TEST TC 9.33 92543 CALORIC VESTIBULAR TEST 26 4.99 92543 CALORIC VESTIBULAR TEST 14.32 92544 OPTOKINETIC NYSTAGMUS TEST TC 9.01 92544 OPTOKINETIC NYSTAGMUS TEST 26 12.11 92544 OPTOKINETIC NYSTAGMUS TEST 21.12 92545 OSCILLATING TRACKING TEST TC 7.72 92545 OSCILLATING TRACKING TEST 26 10.55 92545 OSCILLATING TRACKING TEST 18.28 92546 SINUSOIDAL ROTATIONAL TEST TC 79.04 92546 SINUSOIDAL ROTATIONAL TEST 26 13.35 92546 SINUSOIDAL ROTATIONAL TEST 92.39 92547 SUPPLEMENTAL ELECTRICAL TEST 5.47 92548 POSTUROGRAPHY TC 70.36 92548 POSTUROGRAPHY 26 22.64 92548 POSTUROGRAPHY 93.01 92550 TYMPANOMETRY & REFLEX THRESH 18.39 92551 PURE TONE HEARING TEST AIR 10.61 92552 PURE TONE AUDIOMETRY AIR 27.64 92553 AUDIOMETRY AIR & BONE 33.10 92555 SPEECH THRESHOLD AUDIOMETRY 20.57 92556 SPEECH AUDIOMETRY COMPLETE 32.78 92557 COMPREHENSIVE HEARING TEST 33.11 92559 GROUP AUDIOMETRIC TESTING 27.69 92560 BEKESY AUDIOMETRY SCREEN 16.62 92561 BEKESY AUDIOMETRY DIAGNOSIS 33.74 92562 LOUDNESS BALANCE TEST 41.45 92563 TONE DECAY HEARING TEST 27.32 92564 SISI HEARING TEST 25.39 92565 STENGER TEST PURE TONE 14.79 92567 TYMPANOMETRY 12.85 92568 ACOUSTIC REFL THRESHOLD TST 13.67 92570 ACOUSTIC IMMITANCE TESTING 28.37 Proc Code Description Mod Rate 92571 FILTERED SPEECH HEARING TEST 24.10 92572 STAGGERED SPONDAIC WORD TEST 45.95 92575 SENSORINEURAL ACUITY TEST 67.15 92576 SYNTHETIC SENTENCE TEST 31.17 92577 STENGER TEST SPEECH 17.36 92579 VISUAL AUDIOMETRY (VRA) 37.12 92582 CONDITIONING PLAY AUDIOMETRY 61.37 92583 SELECT PICTURE AUDIOMETRY 46.59 92584 ELECTROCOCHLEOGRAPHY 63.30 92585 AUDITOR EVOKE POTENT COMPRE TC 93.81 92585 AUDITOR EVOKE POTENT COMPRE 26 23.28 92585 AUDITOR EVOKE POTENT COMPRE 117.10 92586 AUDITOR EVOKE POTENT LIMIT 75.50 92587 EVOKED AUDITORY TEST LIMITED TC 2.58 92587 EVOKED AUDITORY TEST LIMITED 26 16.81 92587 EVOKED AUDITORY TEST LIMITED 19.40 92588 EVOKED AUDITORY TST COMPLETE TC 3.54 92588 EVOKED AUDITORY TST COMPLETE 26 25.79 92588 EVOKED AUDITORY TST COMPLETE 29.33 92590 HEARING AID EXAM ONE EAR 33.23 92591 HEARING AID EXAM BOTH EARS 48.92 92592 HEARING AID CHECK ONE EAR 15.08 92593 HEARING AID CHECK BOTH EARS 21.54 92594 ELECTRO HEARNG AID TEST ONE 16.00 92595 ELECTRO HEARNG AID TST BOTH 24.31 92596 EAR PROTECTOR EVALUATION 38.24 92597 ORAL SPEECH DEVICE EVAL 63.89 92601 COCHLEAR IMPLT F/UP EXAM <7 122.64 92602 REPROGRAM COCHLEAR IMPLT 7/> 72.50 92603 COCHLEAR IMPLT F/UP EXAM 7/> 129.78 92604 REPROGRAM COCHLEAR IMPLT 7/> 78.33 92605 EX FOR NONSPEECH DEVICE RX 81.75 92606 NON-SPEECH DEVICE SERVICE 72.65 92607 EX FOR SPEECH DEVICE RX 1HR 113.72 92608 EX FOR SPEECH DEVICE RX ADDL 47.09 92609 USE OF SPEECH DEVICE SERVICE 98.51 92610 EVALUATE SWALLOWING FUNCTION 75.07 92611 MOTION FLUOROSCOPY/SWALLOW 80.48 92612 ENDOSCOPY SWALLOW TST (FEES) 158.64 92613 ENDOSCOPY SWALLOW TST (FEES) 33.26 92614 LARYNGOSCOPIC SENSORY TEST 133.90 92615 EVAL LARYNGOSCOPY SENSE TST 29.85 92616 FEES W/LARYNGEAL SENSE TEST 188.52 92617 INTERPRT FEES/LARYNGEAL TEST 36.99 92620 AUDITORY FUNCTION 60 MIN 82.77 92621 AUDITORY FUNCTION + 15 MIN 19.67 Proc Code Description Mod Rate 92625 TINNITUS ASSESSMENT 61.47 92920 Prq cardiac angioplast 1 art 490.08 92921 Prq cardiac angio addl art 0.00 92924 Prq card angio/athrect 1 art 583.03 92925 Prq card angio/athrect addl 0.00 92928 Prq card stent w/angio 1 vsl 544.23 92929 Prq card stent w/angio addl 0.00 92933 Prq card stent/ath/angio 608.98 92934 Prq card stent/ath/angio 0.00 92937 Prq revasc byp graft 1 vsl 543.92 92938 Prq revasc byp graft addl 0.00 92941 PRQ CARD REVASC MI 1 VSL 610.25 92943 Prq card revasc chronic 1vsl 610.25 92944 Prq card revasc chronic addl 0.00 92950 HEART/LUNG RESUSCITATION CPR 267.61 92953 TEMPORARY EXTERNAL PACING 9.59 92960 CARDIOVERSION ELECTRIC EXT 181.21 92961 CARDIOVERSION ELECTRIC INT 215.09 92970 CARDIOASSIST INTERNAL 154.89 92971 CARDIOASSIST EXTERNAL 81.75 92973 PRQ CORONARY MECH THROMBECT 159.19 92974 CATH PLACE CARDIO BRACHYTX 145.42 92975 DISSOLVE CLOT HEART VESSEL 351.23 92977 DISSOLVE CLOT HEART VESSEL 113.76 92978 INTRAVASC US HEART ADD-ON TC 145.85 92978 INTRAVASC US HEART ADD-ON 26 78.48 92978 INTRAVASC US HEART ADD-ON 228.01 92979 INTRAVASC US HEART ADD-ON TC 73.85 92979 INTRAVASC US HEART ADD-ON 26 63.32 92979 INTRAVASC US HEART ADD-ON 138.47 92986 REVISION OF AORTIC VALVE 1199.03 92987 REVISION OF MITRAL VALVE 1238.15 92990 REVISION OF PULMONARY VALVE 974.10 92992 REVISION OF HEART CHAMBER 953.87 92993 REVISION OF HEART CHAMBER 668.02 92997 PUL ART BALLOON REPR PERCUT 586.90 92998 PUL ART BALLOON REPR PERCUT 290.24 93000 ELECTROCARDIOGRAM COMPLETE 14.85 93005 ELECTROCARDIOGRAM TRACING 7.40 93010 ELECTROCARDIOGRAM REPORT 7.44 93015 CARDIOVASCULAR STRESS TEST 66.91 93016 CARDIOVASCULAR STRESS TEST 19.19 93017 CARDIOVASCULAR STRESS TEST 35.03 93018 CARDIOVASCULAR STRESS TEST 12.69 93024 CARDIAC DRUG STRESS TEST TC 48.52 93024 CARDIAC DRUG STRESS TEST 26 50.18 Proc Code Description Mod Rate 93024 CARDIAC DRUG STRESS TEST 98.70 93025 MICROVOLT T-WAVE ASSESS 146.27 93040 RHYTHM ECG WITH REPORT 11.34 93041 RHYTHM ECG TRACING 5.15 93042 RHYTHM ECG REPORT 6.19 93224 ECG MONIT/REPRT UP TO 48 HRS 81.43 93225 ECG MONIT/REPRT UP TO 48 HRS 24.10 93226 ECG MONIT/REPRT UP TO 48 HRS 34.06 93227 ECG MONIT/REPRT UP TO 48 HRS 23.25 93228 REMOTE 30 DAY ECG REV/REPORT 22.96 93229 REMOTE 30 DAY ECG TECH SUPP 600.09 93260 Prgrmg dev eval impltbl sys 58.08 93261 Interrogate subq defib 53.13 93268 ECG RECORD/REVIEW 183.26 93270 REMOTE 30 DAY ECG REV/REPORT 8.36 93271 ECG/MONITORING AND ANALYSIS 152.92 93272 ECG/REVIEW INTERPRET ONLY 21.96 93278 ECG/SIGNAL-AVERAGED TC 16.07 93278 ECG/SIGNAL-AVERAGED 26 10.84 93278 ECG/SIGNAL-AVERAGED 26.92 93279 PM DEVICE PROGR EVAL SNGL TC 15.43 93279 PM DEVICE PROGR EVAL SNGL 26 28.53 93279 PM DEVICE PROGR EVAL SNGL 43.96 93280 PM DEVICE PROGR EVAL DUAL TC 17.68 93280 PM DEVICE PROGR EVAL DUAL 26 33.79 93280 PM DEVICE PROGR EVAL DUAL 51.48 93281 PM DEVICE PROGR EVAL MULTI TC 20.57 93281 PM DEVICE PROGR EVAL MULTI 26 39.36 93281 PM DEVICE PROGR EVAL MULTI 59.94 93282 PRGRMG EVAL IMPLANTABLE DFB TC 18.00 93282 PRGRMG EVAL IMPLANTABLE DFB 26 37.19 93282 PRGRMG EVAL IMPLANTABLE DFB 55.20 93283 PRGRMG EVAL IMPLANTABLE DFB TC 21.21 93283 PRGRMG EVAL IMPLANTABLE DFB 26 50.53 93283 PRGRMG EVAL IMPLANTABLE DFB 71.75 93284 PRGRMG EVAL IMPLANTABLE DFB TC 24.10 93284 PRGRMG EVAL IMPLANTABLE DFB 26 54.86 93284 PRGRMG EVAL IMPLANTABLE DFB 78.97 93285 ILR DEVICE EVAL PROGR TC 14.15 93285 ILR DEVICE EVAL PROGR 26 22.61 93285 ILR DEVICE EVAL PROGR 36.76 93286 PERI-PX PACEMAKER DEVICE EVL TC 10.61 93286 PERI-PX PACEMAKER DEVICE EVL 26 13.33 93286 PERI-PX PACEMAKER DEVICE EVL 23.95 93287 PERI-PX DEVICE EVAL & PRGR TC 11.58 93287 PERI-PX DEVICE EVAL & PRGR 26 19.83 Proc Code Description Mod Rate 93287 PERI-PX DEVICE EVAL & PRGR 31.41 93288 PM DEVICE EVAL IN PERSON TC 14.15 93288 PM DEVICE EVAL IN PERSON 26 18.26 93288 PM DEVICE EVAL IN PERSON 32.41 93289 INTERROG DEVICE EVAL HEART TC 17.36 93289 INTERROG DEVICE EVAL HEART 26 39.97 93289 INTERROG DEVICE EVAL HEART 57.33 93290 ICM DEVICE EVAL TC 8.36 93290 ICM DEVICE EVAL 26 18.58 93290 ICM DEVICE EVAL 26.95 93291 ILR DEVICE INTERROGATE TC 13.18 93291 ILR DEVICE INTERROGATE 26 18.58 93291 ILR DEVICE INTERROGATE 31.76 93292 WCD DEVICE INTERROGATE TC 9.65 93292 WCD DEVICE INTERROGATE 26 18.26 93292 WCD DEVICE INTERROGATE 27.91 93293 PM PHONE R-STRIP DEVICE EVAL TC 33.74 93293 PM PHONE R-STRIP DEVICE EVAL 26 13.94 93293 PM PHONE R-STRIP DEVICE EVAL 47.69 93294 PM DEVICE INTERROGATE REMOTE 29.51 93295 DEV INTERROG REMOTE 1/2/MLT 58.72 93296 PM/ICD REMOTE TECH SERV 23.14 93297 ICM DEVICE INTERROGAT REMOTE 22.96 93298 ILR DEVICE INTERROGAT REMOTE 23.28 93303 ECHO TRANSTHORACIC TC 156.78 93303 ECHO TRANSTHORACIC 26 55.74 93303 ECHO TRANSTHORACIC 212.53 93304 ECHO TRANSTHORACIC TC 108.91 93304 ECHO TRANSTHORACIC 26 32.22 93304 ECHO TRANSTHORACIC 141.13 93306 TTE W/DOPPLER COMPLETE TC 147.78 93306 TTE W/DOPPLER COMPLETE 26 55.74 93306 TTE W/DOPPLER COMPLETE 203.53 93307 TTE W/O DOPPLER COMPLETE TC 77.75 93307 TTE W/O DOPPLER COMPLETE 26 39.65 93307 TTE W/O DOPPLER COMPLETE 117.40 93308 TTE F-UP OR LMTD TC 87.71 93308 TTE F-UP OR LMTD 26 22.27 93308 TTE F-UP OR LMTD 109.98 93312 ECHO TRANSESOPHAGEAL TC 204.03 93312 ECHO TRANSESOPHAGEAL 26 91.58 93312 ECHO TRANSESOPHAGEAL 295.61 93313 ECHO TRANSESOPHAGEAL 36.77 93314 ECHO TRANSESOPHAGEAL TC 222.98 93314 ECHO TRANSESOPHAGEAL 26 52.29 93314 ECHO TRANSESOPHAGEAL 275.28 Proc Code Description Mod Rate 93315 ECHO TRANSESOPHAGEAL TC 123.70 93315 ECHO TRANSESOPHAGEAL 26 121.70 93315 ECHO TRANSESOPHAGEAL 248.93 93316 ECHO TRANSESOPHAGEAL 37.41 93317 ECHO TRANSESOPHAGEAL TC 123.70 93317 ECHO TRANSESOPHAGEAL 26 82.78 93317 ECHO TRANSESOPHAGEAL 205.54 93318 ECHO TRANSESOPHAGEAL INTRAOP TC 104.93 93318 ECHO TRANSESOPHAGEAL INTRAOP 26 99.01 93318 ECHO TRANSESOPHAGEAL INTRAOP 322.78 93320 DOPPLER ECHO EXAM HEART TC 32.46 93320 DOPPLER ECHO EXAM HEART 26 16.09 93320 DOPPLER ECHO EXAM HEART 48.55 93321 DOPPLER ECHO EXAM HEART TC 21.21 93321 DOPPLER ECHO EXAM HEART 26 6.51 93321 DOPPLER ECHO EXAM HEART 27.73 93325 DOPPLER COLOR FLOW ADD-ON TC 20.25 93325 DOPPLER COLOR FLOW ADD-ON 26 3.11 93325 DOPPLER COLOR FLOW ADD-ON 23.36 93350 STRESS TTE ONLY TC 152.28 93350 STRESS TTE ONLY 26 62.56 93350 STRESS TTE ONLY 214.85 93351 STRESS TTE COMPLETE 249.74 93352 ADMIN ECG CONTRAST AGENT 29.90 93355 Echo transesophageal (tee) 198.21 93451 RIGHT HEART CATH RIGHT TC 572.49 93451 RIGHT HEART CATH RIGHT 26 131.97 93451 RIGHT HEART CATH RIGHT 704.47 93452 LEFT HRT CATH W/VENTRCLGRPHY LEFT TC 557.40 93452 LEFT HRT CATH W/VENTRCLGRPHY LEFT 26 231.50 93452 LEFT HRT CATH W/VENTRCLGRPHY LEFT 788.90 93453 R&L HRT CATH W/VENTRICLGRPHY COMBI TC 718.67 93453 R&L HRT CATH W/VENTRICLGRPHY COMBI 26 303.41 93453 R&L HRT CATH W/VENTRICLGRPHY COMBI 1022.09 93454 CORONARY ARTERY ANGIO S&I CATHE TC 570.89 93454 CORONARY ARTERY ANGIO S&I CATHE 26 233.04 93454 CORONARY ARTERY ANGIO S&I CATHE 803.94 93455 CORONARY ART/GRFT ANGIO S&I CATHE TC 666.95 93455 CORONARY ART/GRFT ANGIO S&I CATHE 26 268.99 93455 CORONARY ART/GRFT ANGIO S&I CATHE 935.95 93456 R HRT CORONARY ARTERY ANGIO CATHE TC 709.04 93456 R HRT CORONARY ARTERY ANGIO CATHE 26 298.04 93456 R HRT CORONARY ARTERY ANGIO CATHE 1007.08 93457 R HRT ART/GRFT ANGIO CATHE TC 804.12 93457 R HRT ART/GRFT ANGIO CATHE 26 334.34 93457 R HRT ART/GRFT ANGIO CATHE 1138.47 Proc Code Description Mod Rate 93458 L HRT ARTERY/VENTRICLE ANGIO CATHE TC 679.80 93458 L HRT ARTERY/VENTRICLE ANGIO CATHE 26 284.33 93458 L HRT ARTERY/VENTRICLE ANGIO CATHE 964.14 93459 L HRT ART/GRFT ANGIO CATHE TC 744.37 93459 L HRT ART/GRFT ANGIO CATHE 26 320.26 93459 L HRT ART/GRFT ANGIO CATHE 1064.64 93460 R&L HRT ART/VENTRICLE ANGIO CATHE TC 784.85 93460 R&L HRT ART/VENTRICLE ANGIO CATHE 26 356.53 93460 R&L HRT ART/VENTRICLE ANGIO CATHE 1141.39 93461 R&L HRT ART/VENTRICLE ANGIO CATHE TC 912.72 93461 R&L HRT ART/VENTRICLE ANGIO CATHE 26 393.47 93461 R&L HRT ART/VENTRICLE ANGIO CATHE 1306.20 93462 L HRT CATH TRNSPTL PUNCTURE LEFT 187.50

93463 DRUG ADMIN & HEMODYNMIC MEAS PHARM 95.27 93464 EXERCISE W/HEMODYNAMIC MEAS PHYSI TC 166.73 93464 EXERCISE W/HEMODYNAMIC MEAS PHYSI 26 85.90 93464 EXERCISE W/HEMODYNAMIC MEAS PHYSI 252.64 93503 INSERT/PLACE HEART CATHETER 115.12 93505 BIOPSY OF HEART LINING TC 471.30 93505 BIOPSY OF HEART LINING 26 208.33 93505 BIOPSY OF HEART LINING 679.64 93530 RT HEART CATH CONGENITAL TC 543.71 93530 RT HEART CATH CONGENITAL 26 205.17 93530 RT HEART CATH CONGENITAL 734.48 93531 R & L HEART CATH CONGENITAL TC 1553.27 93531 R & L HEART CATH CONGENITAL 26 404.40 93531 R & L HEART CATH CONGENITAL 1932.36 93532 R & L HEART CATH CONGENITAL TC 1511.73 93532 R & L HEART CATH CONGENITAL 26 484.79 93532 R & L HEART CATH CONGENITAL 1972.05 93533 R & L HEART CATH CONGENITAL TC 1511.73 93533 R & L HEART CATH CONGENITAL 26 325.00 93533 R & L HEART CATH CONGENITAL 1816.35 93561 CARDIAC OUTPUT MEASUREMENT TC 18.15 93561 CARDIAC OUTPUT MEASUREMENT 26 21.40 93561 CARDIAC OUTPUT MEASUREMENT 39.39 93562 CARD OUTPUT MEASURE SUBSQ TC 10.46 93562 CARD OUTPUT MEASURE SUBSQ 26 6.82 93562 CARD OUTPUT MEASURE SUBSQ 17.23 93563 INJECT CONGENITAL CARD CATH INJEC 49.41 93564 INJECT HRT CONGNTL ART/GRFT INJEC 50.67 93565 INJECT L VENTR/ATRIAL ANGIO INJEC 38.54 93566 INJECT R VENTR/ATRIAL ANGIO INJEC 153.55 93567 INJECT SUPRVLV AORTOGRAPHY INJEC 126.06 93568 INJECT PULM ART HRT CATH INJEC 137.13 Proc Code Description Mod Rate 93571 HEART FLOW RESERVE MEASURE TC 145.85 93571 HEART FLOW RESERVE MEASURE 26 78.48 93571 HEART FLOW RESERVE MEASURE 228.93 93572 HEART FLOW RESERVE MEASURE TC 73.85 93572 HEART FLOW RESERVE MEASURE 26 63.66 93572 HEART FLOW RESERVE MEASURE 141.23 93580 TRANSCATH CLOSURE OF ASD 883.57 93581 TRANSCATH CLOSURE OF VSD 1192.84 93582 Perq transcath closure pda 608.95 93583 Perq transcath septal reduxn 677.73 93600 BUNDLE OF HIS RECORDING TC 63.39 93600 BUNDLE OF HIS RECORDING 26 107.05 93600 BUNDLE OF HIS RECORDING 161.23 93602 INTRA-ATRIAL RECORDING TC 36.00 93602 INTRA-ATRIAL RECORDING 26 105.77 93602 INTRA-ATRIAL RECORDING 134.16 93603 RIGHT VENTRICULAR RECORDING TC 54.46 93603 RIGHT VENTRICULAR RECORDING 26 105.13 93603 RIGHT VENTRICULAR RECORDING 151.70 93609 MAP TACHYCARDIA ADD-ON TC 87.69 93609 MAP TACHYCARDIA ADD-ON 26 250.43 93609 MAP TACHYCARDIA ADD-ON 320.01 93610 INTRA-ATRIAL PACING TC 44.31 93610 INTRA-ATRIAL PACING 26 149.89 93610 INTRA-ATRIAL PACING 183.39 93612 INTRAVENTRICULAR PACING TC 52.31 93612 INTRAVENTRICULAR PACING 26 148.60 93612 INTRAVENTRICULAR PACING 191.39 93613 ELECTROPHYS MAP 3D ADD-ON 352.19 93615 ESOPHAGEAL RECORDING TC 10.46 93615 ESOPHAGEAL RECORDING 26 46.63 93615 ESOPHAGEAL RECORDING 53.54 93616 ESOPHAGEAL RECORDING TC 10.46 93616 ESOPHAGEAL RECORDING 26 57.47 93616 ESOPHAGEAL RECORDING 74.77 93618 HEART RHYTHM PACING TC 127.70 93618 HEART RHYTHM PACING 26 214.76 93618 HEART RHYTHM PACING 324.62 93619 ELECTROPHYSIOLOGY EVALUATION TC 248.62 93619 ELECTROPHYSIOLOGY EVALUATION 26 366.23 93619 ELECTROPHYSIOLOGY EVALUATION 584.94 93620 ELECTROPHYSIOLOGY EVALUATION TC 288.31 93620 ELECTROPHYSIOLOGY EVALUATION 26 582.29 93620 ELECTROPHYSIOLOGY EVALUATION 823.41 93621 ELECTROPHYSIOLOGY EVALUATION TC 79.69 93621 ELECTROPHYSIOLOGY EVALUATION 26 105.48 Proc Code Description Mod Rate 93621 ELECTROPHYSIOLOGY EVALUATION 177.24 93622 ELECTROPHYSIOLOGY EVALUATION TC 131.39 93622 ELECTROPHYSIOLOGY EVALUATION 26 154.93 93622 ELECTROPHYSIOLOGY EVALUATION 291.39 93623 STIMULATION PACING HEART TC 105.85 93623 STIMULATION PACING HEART 26 143.71 93623 STIMULATION PACING HEART 235.70 93624 ELECTROPHYSIOLOGIC STUDY TC 64.31 93624 ELECTROPHYSIOLOGIC STUDY 26 235.90 93624 ELECTROPHYSIOLOGIC STUDY 285.85 93631 HEART PACING MAPPING TC 205.54 93631 HEART PACING MAPPING 26 366.11 93631 HEART PACING MAPPING 555.09 93640 EVALUATION HEART DEVICE TC 230.78 93640 EVALUATION HEART DEVICE 26 173.35 93640 EVALUATION HEART DEVICE 392.93 93641 ELECTROPHYSIOLOGY EVALUATION TC 230.78 93641 ELECTROPHYSIOLOGY EVALUATION 26 295.78 93641 ELECTROPHYSIOLOGY EVALUATION 504.63 93642 ELECTROPHYSIOLOGY EVALUATION TC 134.64 93642 ELECTROPHYSIOLOGY EVALUATION 26 216.47 93642 ELECTROPHYSIOLOGY EVALUATION 351.11 93644 Electrophysiology evaluation 276.27 93650 ABLATE HEART DYSRHYTHM FOCUS 538.40 93653 EP & ABLATE SUPRAVENT ARRHYT 756.08 93654 EP & ABLATE VENTRIC TACHY 1006.82 93655 Ablate arrhythmia add on 377.87 93656 TX ATRIAL FIB PULM VEIN ISOL 1008.08 93657 Tx l/r atrial fib addl 378.21 93660 TILT TABLE EVALUATION TC 55.91 93660 TILT TABLE EVALUATION 26 82.77 93660 TILT TABLE EVALUATION 138.68 93662 INTRACARDIAC ECG (ICE) TC 111.70 93662 INTRACARDIAC ECG (ICE) 26 127.72 93662 INTRACARDIAC ECG (ICE) 248.01 93701 BIOIMPEDANCE CV ANALYSIS 21.53 93702 Bis xtracell fluid analysis 103.13 93724 ANALYZE PACEMAKER SYSTEM TC 25.07 93724 ANALYZE PACEMAKER SYSTEM 26 212.61 93724 ANALYZE PACEMAKER SYSTEM 237.68 93740 TEMPERATURE GRADIENT STUDIES 7.81 93745 SET-UP CARDIOVERT-DEFIBRILL 0.00 93750 INTERROGATION VAD IN PERSON 47.71 93770 MEASURE VENOUS PRESSURE 7.81 93784 AMBULATORY BP MONITORING 47.93 93786 AMBULATORY BP RECORDING 26.67 Proc Code Description Mod Rate 93788 AMBULATORY BP ANALYSIS 4.83 93790 REVIEW/REPORT BP RECORDING 16.41 93799 CARDIOVASCULAR PROCEDURE TC 0.00 93799 CARDIOVASCULAR PROCEDURE 26 0.00 93799 CARDIOVASCULAR PROCEDURE 0.00 93880 EXTRACRANIAL BILAT STUDY TC 144.89 93880 EXTRACRANIAL BILAT STUDY 26 26.38 93880 EXTRACRANIAL BILAT STUDY 171.27 93882 EXTRACRANIAL UNI/LTD STUDY TC 92.85 93882 EXTRACRANIAL UNI/LTD STUDY 26 18.05 93882 EXTRACRANIAL UNI/LTD STUDY 110.90 93886 INTRACRANIAL COMPLETE STUDY TC 280.13 93886 INTRACRANIAL COMPLETE STUDY 26 42.52 93886 INTRACRANIAL COMPLETE STUDY 322.66 93888 INTRACRANIAL LIMITED STUDY TC 160.95 93888 INTRACRANIAL LIMITED STUDY 26 27.63 93888 INTRACRANIAL LIMITED STUDY 188.59 93890 TCD VASOREACTIVITY STUDY TC 214.92 93890 TCD VASOREACTIVITY STUDY 26 44.67 93890 TCD VASOREACTIVITY STUDY 259.60 93892 TCD EMBOLI DETECT W/O INJ TC 250.58 93892 TCD EMBOLI DETECT W/O INJ 26 51.83 93892 TCD EMBOLI DETECT W/O INJ 302.41 93893 TCD EMBOLI DETECT W/INJ TC 260.22 93893 TCD EMBOLI DETECT W/INJ 26 52.15 93893 TCD EMBOLI DETECT W/INJ 312.37 93922 UPR/L XTREMITY ART 2 LEVELS TC 69.08 93922 UPR/L XTREMITY ART 2 LEVELS 26 10.52 93922 UPR/L XTREMITY ART 2 LEVELS 79.60 93923 UPR/LXTR ART STDY 3+ LVLS TC 105.38 93923 UPR/LXTR ART STDY 3+ LVLS 26 19.56 93923 UPR/LXTR ART STDY 3+ LVLS 124.94 93924 LWR XTR VASC STDY BILAT TC 135.25 93924 LWR XTR VASC STDY BILAT 26 21.72 93924 LWR XTR VASC STDY BILAT 156.98 93925 LOWER EXTREMITY STUDY TC 186.04 93925 LOWER EXTREMITY STUDY 26 35.07 93925 LOWER EXTREMITY STUDY 221.12 93926 LOWER EXTREMITY STUDY TC 104.74 93926 LOWER EXTREMITY STUDY 26 22.08 93926 LOWER EXTREMITY STUDY 126.82 93930 UPPER EXTREMITY STUDY TC 186.65 93930 UPPER EXTREMITY STUDY 26 20.18 93930 UPPER EXTREMITY STUDY 206.84 93931 UPPER EXTREMITY STUDY TC 127.86 93931 UPPER EXTREMITY STUDY 26 13.67 Proc Code Description Mod Rate 93931 UPPER EXTREMITY STUDY 141.54 93965 EXTREMITY STUDY TC 93.17 93965 EXTREMITY STUDY 26 15.53 93965 EXTREMITY STUDY 108.70 93970 EXTREMITY STUDY TC 137.18 93970 EXTREMITY STUDY 26 31.08 93970 EXTREMITY STUDY 168.26 93971 EXTREMITY STUDY TC 82.25 93971 EXTREMITY STUDY 26 19.88 93971 EXTREMITY STUDY 102.13 93975 VASCULAR STUDY TC 242.90 93975 VASCULAR STUDY 26 78.84 93975 VASCULAR STUDY 321.74 93976 VASCULAR STUDY TC 136.22 93976 VASCULAR STUDY 26 53.39 93976 VASCULAR STUDY 189.61 93978 VASCULAR STUDY TC 173.80 93978 VASCULAR STUDY 26 28.59 93978 VASCULAR STUDY 202.40 93979 VASCULAR STUDY TC 121.12 93979 VASCULAR STUDY 26 18.93 93979 VASCULAR STUDY 140.05 93980 PENILE VASCULAR STUDY TC 54.30 93980 PENILE VASCULAR STUDY 26 54.59 93980 PENILE VASCULAR STUDY 108.89 93981 PENILE VASCULAR STUDY TC 47.23 93981 PENILE VASCULAR STUDY 26 19.24 93981 PENILE VASCULAR STUDY 66.47 93982 Aneurysm pressure sens study 38.77 93990 DOPPLER FLOW TESTING TC 164.16 93990 DOPPLER FLOW TESTING 26 11.21 93990 DOPPLER FLOW TESTING 175.38 94002 VENT MGMT INPAT INIT DAY 81.77 94003 VENT MGMT INPAT SUBQ DAY 58.94 94010 BREATHING CAPACITY TEST TC 24.75 94010 BREATHING CAPACITY TEST 26 7.44 94010 BREATHING CAPACITY TEST 32.19 94011 SPIROMETRY UP TO 2 YRS OLD 90.07 94012 SPIRMTRY W/BRNCHDIL INF-2 YR 141.09 94013 MEAS LUNG VOL THRU 2 YRS 27.88 94014 PATIENT RECORDED SPIROMETRY 46.07 94015 PATIENT RECORDED SPIROMETRY 24.10 94016 REVIEW PATIENT SPIROMETRY 21.96 94060 EVALUATION OF WHEEZING TC 42.74 94060 EVALUATION OF WHEEZING 26 11.45 94060 EVALUATION OF WHEEZING 54.19 Proc Code Description Mod Rate 94070 EVALUATION OF WHEEZING TC 27.64 94070 EVALUATION OF WHEEZING 26 25.40 94070 EVALUATION OF WHEEZING 53.04 94150 VITAL CAPACITY TEST TC 19.29 94150 VITAL CAPACITY TEST 26 3.43 94150 VITAL CAPACITY TEST 22.72 94200 LUNG FUNCTION TEST (MBC/MVV) TC 17.04 94200 LUNG FUNCTION TEST (MBC/MVV) 26 4.97 94200 LUNG FUNCTION TEST (MBC/MVV) 22.01 94250 EXPIRED GAS COLLECTION TC 18.64 94250 EXPIRED GAS COLLECTION 26 4.97 94250 EXPIRED GAS COLLECTION 23.62 94375 RESPIRATORY FLOW VOLUME LOOP TC 21.86 94375 RESPIRATORY FLOW VOLUME LOOP 26 12.99 94375 RESPIRATORY FLOW VOLUME LOOP 34.85 94400 CO2 BREATHING RESPONSE CURVE TC 32.78 94400 CO2 BREATHING RESPONSE CURVE 26 17.02 94400 CO2 BREATHING RESPONSE CURVE 49.80 94450 HYPOXIA RESPONSE CURVE TC 43.38 94450 HYPOXIA RESPONSE CURVE 26 17.34 94450 HYPOXIA RESPONSE CURVE 60.73 94452 HAST W/REPORT TC 38.88 94452 HAST W/REPORT 26 12.67 94452 HAST W/REPORT 51.56 94453 HAST W/OXYGEN TITRATE TC 55.26 94453 HAST W/OXYGEN TITRATE 26 16.38 94453 HAST W/OXYGEN TITRATE 71.65 94610 SURFACTANT ADMIN THRU TUBE 52.49 94620 PULMONARY STRESS TEST/SIMPLE TC 22.50 94620 PULMONARY STRESS TEST/SIMPLE 26 26.94 94620 PULMONARY STRESS TEST/SIMPLE 49.44 94621 PULM STRESS TEST/COMPLEX TC 84.82 94621 PULM STRESS TEST/COMPLEX 26 60.70 94621 PULM STRESS TEST/COMPLEX 145.53 94640 AIRWAY INHALATION TREATMENT 16.39 94642 AEROSOL INHALATION TREATMENT 64.92 94644 CBT 1ST HOUR 39.52 94645 CBT EACH ADDL HOUR 12.86 94660 POS AIRWAY PRESSURE CPAP 55.68 94662 NEG PRESS VENTILATION CNP 35.45 94664 EVALUATE PT USE OF INHALER 15.43 94667 CHEST WALL MANIPULATION 22.82 94668 CHEST WALL MANIPULATION 26.35 94669 Mechanical chest wall oscill 31.81 94680 EXHALED AIR ANALYSIS O2 TC 40.49 94680 EXHALED AIR ANALYSIS O2 26 11.15 Proc Code Description Mod Rate 94680 EXHALED AIR ANALYSIS O2 51.64 94681 EXHALED AIR ANALYSIS O2/CO2 TC 36.95 94681 EXHALED AIR ANALYSIS O2/CO2 26 8.68 94681 EXHALED AIR ANALYSIS O2/CO2 45.64 94690 EXHALED AIR ANALYSIS TC 40.49 94690 EXHALED AIR ANALYSIS 26 3.43 94690 EXHALED AIR ANALYSIS 43.92 94726 Pulm funct tst plethysmograp TC 36.65 94726 Pulm funct tst plethysmograp 26 10.83 94726 Pulm funct tst plethysmograp 47.48 94727 Pulm function test by gas TC 26.67 94727 Pulm function test by gas 26 10.83 94727 Pulm function test by gas 37.51 94728 Pulm funct test oscillometry TC 24.75 94728 Pulm funct test oscillometry 26 11.15 94728 Pulm funct test oscillometry 35.90 94729 CO/MEMBANE DIFFUSE CAPACITY TC 40.49 94729 CO/MEMBANE DIFFUSE CAPACITY 26 8.05 94729 CO/MEMBANE DIFFUSE CAPACITY 48.54 94750 PULMONARY COMPLIANCE STUDY TC 62.97 94750 PULMONARY COMPLIANCE STUDY 26 9.91 94750 PULMONARY COMPLIANCE STUDY 72.89 94760 MEASURE BLOOD OXYGEN LEVEL 2.90 94761 MEASURE BLOOD OXYGEN LEVEL 4.51 94762 MEASURE BLOOD OXYGEN LEVEL 22.18 94770 EXHALED CARBON DIOXIDE TEST 7.18 94774 PED HOME APNEA REC COMPL 0.00 94775 PED HOME APNEA REC HK-UP 0.00 94776 PED HOME APNEA REC DOWNLD 0.00 94777 PED HOME APNEA REC REPORT 0.00 94780 Car seat/bed test 60 min 45.83 94781 Car seat/bed test + 30 min 18.04 94799 PULMONARY SERVICE/PROCEDURE TC 0.00 94799 PULMONARY SERVICE/PROCEDURE 26 0.00 94799 PULMONARY SERVICE/PROCEDURE 0.00 95004 PERCUT ALLERGY SKIN TESTS 5.78 95012 EXHALED NITRIC OXIDE MEAS 17.36 95017 Perq & icut allg test venoms 7.28 95018 Perq&ic allg test drugs/biol 17.77 95024 ICUT ALLERGY TEST DRUG/BUG 7.06 95027 ICUT ALLERGY TITRATE-AIRBORN 4.17 95028 ICUT ALLERGY TEST-DELAYED 12.22 95044 ALLERGY PATCH TESTS 4.83 95052 PHOTO PATCH TEST 5.79 95056 PHOTOSENSITIVITY TESTS 38.88 95060 EYE ALLERGY TESTS 30.21 Proc Code Description Mod Rate 95065 NOSE ALLERGY TEST 23.78 95070 BRONCHIAL ALLERGY TESTS 26.35 95071 BRONCHIAL ALLERGY TESTS 31.49 95076 Ingest challenge ini 120 min 102.97 95079 Ingest challenge addl 60 min 73.30 95115 IMMUNOTHERAPY ONE INJECTION 8.04 95117 IMMUNOTHERAPY INJECTIONS 9.33 95120 IMMUNOTHERAPY ONE INJECTION 16.31 95125 IMMUNOTHERAPY 2/> INJECTIONS 20.00 95130 IMMNTX 1 STING INSECT 28.00 95131 IMMNTX 2 STING INSECTS 35.69 95132 IMMNTX 3 STING INSECTS 43.08 95133 IMMNTX 4 STING INSECTS 52.00 95134 IMMNTX 5 STING INSECTS 62.16 95144 ANTIGEN THERAPY SERVICES 11.16 95145 ANTIGEN THERAPY SERVICES 19.51 95146 ANTIGEN THERAPY SERVICES 34.93 95147 ANTIGEN THERAPY SERVICES 31.39 95148 ANTIGEN THERAPY SERVICES 47.13 95149 ANTIGEN THERAPY SERVICES 62.88 95165 ANTIGEN THERAPY SERVICES 11.48 95170 ANTIGEN THERAPY SERVICES 8.59 95180 RAPID DESENSITIZATION 118.23 95250 GLUCOSE MONITORING CONT 141.04 95251 GLUC MONITOR CONT PHYS I&R 38.17 95782 Polysom <6 yrs 4/> paramtrs 916.52 95783 Polysom <6 yrs cpap/bilvl 976.90 95800 SLP STDY UNATTENDED SLEEP TC 113.73 95800 SLP STDY UNATTENDED SLEEP 26 45.55 95800 SLP STDY UNATTENDED SLEEP 159.29 95801 SLP STDY UNATND W/ANAL SLEEP TC 41.13 95801 SLP STDY UNATND W/ANAL SLEEP 26 42.75 95801 SLP STDY UNATND W/ANAL SLEEP 83.88 95805 MULTIPLE SLEEP LATENCY TEST TC 325.48 95805 MULTIPLE SLEEP LATENCY TEST 26 52.05 95805 MULTIPLE SLEEP LATENCY TEST 377.53 95806 SLEEP STUDY UNATT&RESP EFFT TC 99.31 95806 SLEEP STUDY UNATT&RESP EFFT 26 53.91 95806 SLEEP STUDY UNATT&RESP EFFT 153.23 95807 SLEEP STUDY ATTENDED TC 370.87 95807 SLEEP STUDY ATTENDED 26 54.51 95807 SLEEP STUDY ATTENDED 425.38 95808 POLYSOM ANY AGE 1-3> PARAM TC 493.58 95808 POLYSOM ANY AGE 1-3> PARAM 26 76.59 95808 POLYSOM ANY AGE 1-3> PARAM 570.18 95810 POLYSOM 6/> YRS 4/> PARAM TC 446.05 Proc Code Description Mod Rate 95810 POLYSOM 6/> YRS 4/> PARAM 26 107.19 95810 POLYSOM 6/> YRS 4/> PARAM 553.25 95811 POLYSOM 6/>YRS CPAP 4/> PARM TC 468.86 95811 POLYSOM 6/>YRS CPAP 4/> PARM 26 111.54 95811 POLYSOM 6/>YRS CPAP 4/> PARM 580.41 95812 EEG 41-60 MINUTES TC 337.02 95812 EEG 41-60 MINUTES 26 50.32 95812 EEG 41-60 MINUTES 387.35 95813 EEG OVER 1 HOUR TC 371.73 95813 EEG OVER 1 HOUR 26 80.78 95813 EEG OVER 1 HOUR 452.52 95816 EEG AWAKE AND DROWSY TC 265.71 95816 EEG AWAKE AND DROWSY 26 50.66 95816 EEG AWAKE AND DROWSY 316.37 95819 EEG AWAKE AND ASLEEP TC 311.00 95819 EEG AWAKE AND ASLEEP 26 50.32 95819 EEG AWAKE AND ASLEEP 361.33 95822 EEG COMA OR SLEEP ONLY TC 271.49 95822 EEG COMA OR SLEEP ONLY 26 50.32 95822 EEG COMA OR SLEEP ONLY 321.82 95824 EEG CEREBRAL DEATH ONLY TC 52.62 95824 EEG CEREBRAL DEATH ONLY 26 35.48 95824 EEG CEREBRAL DEATH ONLY 87.69 95827 EEG ALL NIGHT RECORDING TC 646.78 95827 EEG ALL NIGHT RECORDING 26 50.66 95827 EEG ALL NIGHT RECORDING 697.45 95829 SURGERY ELECTROCORTICOGRAM TC 1370.49 95829 SURGERY ELECTROCORTICOGRAM 26 285.58 95829 SURGERY ELECTROCORTICOGRAM 1656.07 95830 INSERT ELECTRODES FOR EEG 224.84 95857 CHOLINESTERASE CHALLENGE 48.98 95860 MUSCLE TEST ONE LIMB TC 62.33 95860 MUSCLE TEST ONE LIMB 26 45.37 95860 MUSCLE TEST ONE LIMB 107.70 95861 MUSCLE TEST 2 LIMBS TC 76.47 95861 MUSCLE TEST 2 LIMBS 26 72.39 95861 MUSCLE TEST 2 LIMBS 148.86 95863 MUSCLE TEST 3 LIMBS TC 93.49 95863 MUSCLE TEST 3 LIMBS 26 87.62 95863 MUSCLE TEST 3 LIMBS 181.12 95864 MUSCLE TEST 4 LIMBS TC 115.66 95864 MUSCLE TEST 4 LIMBS 26 93.21 95864 MUSCLE TEST 4 LIMBS 208.87 95865 MUSCLE TEST LARYNX TC 48.20 95865 MUSCLE TEST LARYNX 26 72.33 95865 MUSCLE TEST LARYNX 120.53 Proc Code Description Mod Rate 95866 MUSCLE TEST HEMIDIAPHRAGM TC 57.51 95866 MUSCLE TEST HEMIDIAPHRAGM 26 59.38 95866 MUSCLE TEST HEMIDIAPHRAGM 116.89 95867 MUSCLE TEST CRAN NERV UNILAT TC 45.95 95867 MUSCLE TEST CRAN NERV UNILAT 26 36.97 95867 MUSCLE TEST CRAN NERV UNILAT 82.92 95868 MUSCLE TEST CRAN NERVE BILAT TC 60.40 95868 MUSCLE TEST CRAN NERVE BILAT 26 54.98 95868 MUSCLE TEST CRAN NERVE BILAT 115.39 95869 MUSCLE TEST THOR PARASPINAL TC 50.12 95869 MUSCLE TEST THOR PARASPINAL 26 17.07 95869 MUSCLE TEST THOR PARASPINAL 67.20 95870 MUSCLE TEST NONPARASPINAL TC 61.05 95870 MUSCLE TEST NONPARASPINAL 26 17.39 95870 MUSCLE TEST NONPARASPINAL 78.44 95872 MUSCLE TEST ONE FIBER TC 43.70 95872 MUSCLE TEST ONE FIBER 26 135.82 95872 MUSCLE TEST ONE FIBER 179.52 95873 GUIDE NERV DESTR ELEC STIM TC 48.52 95873 GUIDE NERV DESTR ELEC STIM 26 18.03 95873 GUIDE NERV DESTR ELEC STIM 66.56 95874 GUIDE NERV DESTR NEEDLE EMG TC 46.91 95874 GUIDE NERV DESTR NEEDLE EMG 26 17.39 95874 GUIDE NERV DESTR NEEDLE EMG 64.31 95875 LIMB EXERCISE TEST TC 61.05 95875 LIMB EXERCISE TEST 26 51.59 95875 LIMB EXERCISE TEST 112.64 95885 Musc tst done w/nerv tst lim TC 35.67 95885 Musc tst done w/nerv tst lim 26 16.46 95885 Musc tst done w/nerv tst lim 52.13 95886 Musc test done w/n test comp TC 40.49 95886 Musc test done w/n test comp 26 40.71 95886 Musc test done w/n test comp 81.20 95887 Musc tst done w/n tst nonext TC 43.38 95887 Musc tst done w/n tst nonext 26 33.23 95887 Musc tst done w/n tst nonext 76.62 95905 MOTOR &/ SENS NRVE CNDJ TEST TC 58.80 95905 MOTOR &/ SENS NRVE CNDJ TEST 26 2.50 95905 MOTOR &/ SENS NRVE CNDJ TEST 61.30 95907 NVR CNDJ TST 1-2 STUDIES 83.90 95908 NRV CNDJ TST 3-4 STUDIES 103.42 95909 NRV CNDJ TST 5-6 STUDIES 124.56 95910 NRV CNDJ TEST 7-8 STUDIES 163.62 95911 NRV CNDJ TEST 9-10 STUDIES 198.82 95912 NRV CNDJ TEST 11-12 STUDIES 233.71 95913 NRV CNDJ TEST 13/> STUDIES 270.42 Proc Code Description Mod Rate 95921 AUTONOMIC NRV PARASYM INERVJ TC 38.88 95921 AUTONOMIC NRV PARASYM INERVJ 26 40.34 95921 AUTONOMIC NRV PARASYM INERVJ 79.23 95922 AUTONOMIC NRV ADRENRG INERVJ TC 51.73 95922 AUTONOMIC NRV ADRENRG INERVJ 26 43.45 95922 AUTONOMIC NRV ADRENRG INERVJ 95.19 95923 AUTONOMIC NRV SYST FUNJ TEST TC 143.61 95923 AUTONOMIC NRV SYST FUNJ TEST 26 40.98 95923 AUTONOMIC NRV SYST FUNJ TEST 184.59 95924 Ans parasymp & symp w/tilt 128.68 95925 SOMATOSENSORY TESTING TC 131.08 95925 SOMATOSENSORY TESTING 26 24.50 95925 SOMATOSENSORY TESTING 155.58 95926 SOMATOSENSORY TESTING TC 105.38 95926 SOMATOSENSORY TESTING 26 24.53 95926 SOMATOSENSORY TESTING 129.92 95927 SOMATOSENSORY TESTING TC 120.80 95927 SOMATOSENSORY TESTING 26 24.18 95927 SOMATOSENSORY TESTING 144.98 95928 C MOTOR EVOKED UPPR LIMBS TC 154.88 95928 C MOTOR EVOKED UPPR LIMBS 26 70.56 95928 C MOTOR EVOKED UPPR LIMBS 225.45 95929 C MOTOR EVOKED LWR LIMBS TC 149.74 95929 C MOTOR EVOKED LWR LIMBS 26 69.92 95929 C MOTOR EVOKED LWR LIMBS 219.66 95930 VISUAL EVOKED POTENTIAL TEST TC 103.45 95930 VISUAL EVOKED POTENTIAL TEST 26 16.14 95930 VISUAL EVOKED POTENTIAL TEST 119.60 95933 BLINK REFLEX TEST TC 46.27 95933 BLINK REFLEX TEST 26 27.66 95933 BLINK REFLEX TEST 73.94 95937 NEUROMUSCULAR JUNCTION TEST TC 41.45 95937 NEUROMUSCULAR JUNCTION TEST 26 30.79 95937 NEUROMUSCULAR JUNCTION TEST 72.25 95938 Somatosensory testing TC 261.85 95938 Somatosensory testing 26 40.41 95938 Somatosensory testing 302.26 95939 C motor evoked upr&lwr limbs TC 334.47 95939 C motor evoked upr&lwr limbs 26 105.69 95939 C motor evoked upr&lwr limbs 440.17 95940 Ionm in operatng room 15 min 28.29 95941 Ionm remote/>1 pt or per hr 0.00 95943 Parasymp&symp hrt rate test 0.00 95950 AMBULATORY EEG MONITORING TC 227.48 95950 AMBULATORY EEG MONITORING 26 70.87 95950 AMBULATORY EEG MONITORING 298.35 Proc Code Description Mod Rate 95951 EEG MONITORING/VIDEORECORD TC 1196.95 95951 EEG MONITORING/VIDEORECORD 26 287.70 95951 EEG MONITORING/VIDEORECORD 1476.96 95953 EEG MONITORING/COMPUTER TC 240.65 95953 EEG MONITORING/COMPUTER 26 143.89 95953 EEG MONITORING/COMPUTER 384.54 95954 EEG MONITORING/GIVING DRUGS TC 283.71 95954 EEG MONITORING/GIVING DRUGS 26 107.61 95954 EEG MONITORING/GIVING DRUGS 391.33 95955 EEG DURING SURGERY TC 157.10 95955 EEG DURING SURGERY 26 47.23 95955 EEG DURING SURGERY 204.33 95956 EEG MONITOR TECHNOL ATTENDED TC 1323.10 95956 EEG MONITOR TECHNOL ATTENDED 26 168.41 95956 EEG MONITOR TECHNOL ATTENDED 1491.52 95957 EEG DIGITAL ANALYSIS TC 301.01 95957 EEG DIGITAL ANALYSIS 26 92.95 95957 EEG DIGITAL ANALYSIS 393.97 95958 EEG MONITORING/FUNCTION TEST TC 305.24 95958 EEG MONITORING/FUNCTION TEST 26 197.34 95958 EEG MONITORING/FUNCTION TEST 502.59 95961 ELECTRODE STIMULATION BRAIN TC 115.02 95961 ELECTRODE STIMULATION BRAIN 26 137.95 95961 ELECTRODE STIMULATION BRAIN 252.97 95962 ELECTRODE STIM BRAIN ADD-ON TC 73.25 95962 ELECTRODE STIM BRAIN ADD-ON 26 148.80 95962 ELECTRODE STIM BRAIN ADD-ON 222.06 95965 MEG SPONTANEOUS TC 1433.27 95965 MEG SPONTANEOUS 26 376.85 95965 MEG SPONTANEOUS 1791.74 95966 MEG EVOKED SINGLE TC 715.40 95966 MEG EVOKED SINGLE 26 191.47 95966 MEG EVOKED SINGLE 894.18 95967 MEG EVOKED EACH ADDL TC 626.17 95967 MEG EVOKED EACH ADDL 26 168.17 95967 MEG EVOKED EACH ADDL 752.02 95970 ANALYZE NEUROSTIM NO PROG 61.32 95971 ANALYZE NEUROSTIM SIMPLE 53.43 95972 ANALYZE NEUROSTIM COMPLEX 96.36 95973 ANALYZE NEUROSTIM COMPLEX 55.79 95974 CRANIAL NEUROSTIM COMPLEX 183.06 95975 CRANIAL NEUROSTIM COMPLEX 97.60 95978 ANALYZE NEUROSTIM BRAIN/1H 221.28 95979 ANALYZ NEUROSTIM BRAIN ADDON 95.48 95980 IO ANAL GAST N-STIM INIT 39.71 95981 Io anal gast n-stim subsq 28.46 Proc Code Description Mod Rate 95982 Io ga n-stim subsq w/reprog 45.59 95990 SPIN/BRAIN PUMP REFIL & MAIN 83.24 95991 SPIN/BRAIN PUMP REFIL & MAIN 108.35 95992 CANALITH REPOSITIONING PROC 38.35 96000 MOTION ANALYSIS VIDEO/3D 83.30 96001 MOTION TEST W/FT PRESS MEAS 86.26 96002 DYNAMIC SURFACE EMG 18.64 96003 DYNAMIC FINE WIRE EMG 17.42 96004 PHYS REVIEW OF MOTION TESTS 103.01 96020 FUNCTIONAL BRAIN MAPPING 26 149.99 96101 PSYCHO TESTING BY PSYCH/PHYS 69.65 96102 PSYCHO TESTING BY TECHNICIAN 58.65 96103 PSYCHO TESTING ADMIN BY COMP 24.26 96110 DEVELOPMENTAL SCREEN W/SCORE 7.40 96111 DEVELOPMENTAL TEST EXTEND 112.57 96116 NEUROBEHAVIORAL STATUS EXAM 82.22 96118 NEUROPSYCH TST BY PSYCH/PHYS 86.03 96119 NEUROPSYCH TESTING BY TEC 72.03 96120 NEUROPSYCH TST ADMIN W/COMP 42.25 96125 COGNITIVE TEST BY HC PRO 75.73 96127 Brief emotional/behav assmt 4.82 96150 ASSESS HLTH/BEHAVE INIT 18.46 96151 ASSESS HLTH/BEHAVE SUBSEQ 17.85 96152 INTERVENE HLTH/BEHAVE INDIV 16.92 96153 INTERVENE HLTH/BEHAVE GROUP 4.02 96154 INTERV HLTH/BEHAV FAM W/PT 16.62 96360 HYDRATION IV INFUSION INIT 50.84 96361 HYDRATE IV INFUSION ADD-ON 13.35 96365 THER/PROPH/DIAG IV INF INIT 61.38 96366 THER/PROPH/DIAG IV INF ADDON 16.42 96367 TX/PROPH/DG ADDL SEQ IV INF 26.68 96368 THER/DIAG CONCURRENT INF 18.04 96369 SC THER INFUSION UP TO 1 HR 174.45 96370 SC THER INFUSION ADDL HR 13.53 96371 SC THER INFUSION RESET PUMP 81.61 96372 THER/PROPH/DIAG INJ SC/IM 22.22 96373 THER/PROPH/DIAG INJ IA 17.08 96374 THER/PROPH/DIAG INJ IV PUSH 50.18 96375 TX/PRO/DX INJ NEW DRUG ADDON 19.76 96376 TX/PRO/DX INJ SAME DRUG ADON 11.60 96401 CHEMO ANTI-NEOPL SQ/IM 65.89 96402 CHEMO HORMON ANTINEOPL SQ/IM 28.29 96405 CHEMO INTRALESIONAL UP TO 7 72.11 96406 CHEMO INTRALESIONAL OVER 7 100.58 96409 CHEMO IV PUSH SNGL DRUG 97.34 96411 CHEMO IV PUSH ADDL DRUG 54.65 Proc Code Description Mod Rate 96413 CHEMO IV INFUSION 1 HR 119.12 96415 CHEMO IV INFUSION ADDL HR 24.76 96416 CHEMO PROLONG INFUSE W/PUMP 124.40 96417 CHEMO IV INFUS EACH ADDL SEQ 55.27 96420 CHEMO IA PUSH TECNIQUE 93.32 96422 CHEMO IA INFUSION UP TO 1 HR 150.18 96423 CHEMO IA INFUSE EACH ADDL HR 69.17 96425 CHEMOTHERAPY INFUSION METHOD 161.78 96440 CHEMOTHERAPY INTRACAVITARY 763.40 96446 CHEMOTX ADMN PRTL CAVITY CHEMO 172.97 96450 CHEMOTHERAPY INTO CNS 160.84 96521 REFILL/MAINT PORTABLE PUMP 120.84 96522 REFILL/MAINT PUMP/RESVR SYST 99.31 96523 IRRIG DRUG DELIVERY DEVICE 22.11 96542 CHEMOTHERAPY INJECTION 105.16 96567 PHOTODYNAMIC TX SKIN 118.55 96570 PHOTODYNMC TX 30 MIN ADD-ON 50.50 96571 PHOTODYNAMIC TX ADDL 15 MIN 23.25 96900 ULTRAVIOLET LIGHT THERAPY 18.32 96902 TRICHOGRAM 19.29 96904 WHOLE BODY PHOTOGRAPHY 60.08 96910 PHOTOCHEMOTHERAPY WITH UV-B 62.33 96912 PHOTOCHEMOTHERAPY WITH UV-A 80.32 96913 PHOTOCHEMOTHERAPY UV-A OR B 113.09 96920 LASER TX SKIN < 250 SQ CM 135.66 96921 LASER TX SKIN 250-500 SQ CM 149.55 96922 LASER TX SKIN >500 SQ CM 207.08 97001 PT EVALUATION 66.20 97002 PT RE-EVALUATION 37.28 97003 OT EVALUATION 74.56 97004 OT RE-EVALUATION 46.92 97010 HOT OR COLD PACKS THERAPY 5.37 97022 WHIRLPOOL THERAPY 20.93 97032 ELECTRICAL STIMULATION 16.95 97035 ULTRASOUND THERAPY 11.23 97110 THERAPEUTIC EXERCISES 28.18 97112 NEUROMUSCULAR REEDUCATION 29.47 97116 GAIT TRAINING THERAPY 25.05 97150 GROUP THERAPEUTIC PROCEDURES 15.27 97535 SELF CARE MNGMENT TRAINING 30.75 97597 RMVL DEVITAL TIS 20 CM/< 68.30 97598 RMVL DEVITAL TIS ADDL 20CM/< 22.46 97602 WOUND(S) CARE NON-SELECTIVE 14.46 97605 NEG PRESS WOUND TX 50 CM 40.29 97607 Neg press wnd tx 38.23 99145 MOD SEDAT PHYS/QHP EA 15 MIN 15.16 99148 MOD SED DIFF PHYS/QHP<5 YRS 42.33 99149 MOD SED DIFF PHYS/QHP 5/>YRS 34.12 99150 MOD SED DIFF PHYS/QHP ADD ON 15.16 99170 ANOGENITAL EXAM CHILD W IMAG 153.74 99175 INDUCTION OF VOMITING 15.11 99183 HYPERBARIC OXYGEN THERAPY 189.29 99188 App topical fluoride varnish 12.30 99195 PHLEBOTOMY 88.74 99199 SPECIAL SERVICE/PROC/REPORT 0.00 99201 OFFICE/OUTPATIENT VISIT NEW 42.63 99202 OFFICE/OUTPATIENT VISIT NEW 73.09 99203 OFFICE/OUTPATIENT VISIT NEW 106.04 99204 OFFICE/OUTPATIENT VISIT NEW 162.51 99205 OFFICE/OUTPATIENT VISIT NEW 202.15 99211 OFFICE/OUTPATIENT VISIT EST 19.79 99212 OFFICE/OUTPATIENT VISIT EST 42.99 99213 OFFICE/OUTPATIENT VISIT EST 71.58 99214 OFFICE/OUTPATIENT VISIT EST 105.48 99215 OFFICE/OUTPATIENT VISIT EST 141.04 99217 OBSERVATION CARE DISCHARGE 70.67 99218 INITIAL OBSERVATION CARE 96.47 99219 INITIAL OBSERVATION CARE 131.93 Proc Code Description Mod Rate 99220 INITIAL OBSERVATION CARE 180.56 99221 INITIAL HOSPITAL CARE 99.09 99222 INITIAL HOSPITAL CARE 134.52 99223 INITIAL HOSPITAL CARE 198.05 99224 SUBSEQUENT OBSERVATION CARE 38.92 99225 SUBSEQUENT OBSERVATION CARE 70.45 99226 SUBSEQUENT OBSERVATION CARE 101.71 99231 SUBSEQUENT HOSPITAL CARE 38.18 99232 SUBSEQUENT HOSPITAL CARE 70.11 99233 SUBSEQUENT HOSPITAL CARE 100.99 99234 OBSERV/HOSP SAME DATE 131.74 99235 OBSERV/HOSP SAME DATE 164.59 99236 OBSERV/HOSP SAME DATE 212.50 99238 HOSPITAL DISCHARGE DAY 70.65 99239 HOSPITAL DISCHARGE DAY 104.41 99241 OFFICE CONSULTATION 48.13 99242 OFFICE CONSULTATION 90.03 99243 OFFICE CONSULTATION 122.86 99244 OFFICE CONSULTATION 181.16 99245 OFFICE CONSULTATION 221.55 99251 INPATIENT CONSULTATION 48.19 99252 INPATIENT CONSULTATION 73.91 99253 INPATIENT CONSULTATION 112.76 99254 INPATIENT CONSULTATION 162.64 99255 INPATIENT CONSULTATION 196.62 99281 EMERGENCY DEPT VISIT 20.40 99282 EMERGENCY DEPT VISIT 40.15 99283 EMERGENCY DEPT VISIT 59.82 99284 EMERGENCY DEPT VISIT 114.14 99285 EMERGENCY DEPT VISIT 167.66 99291 CRITICAL CARE FIRST HOUR 267.69 99292 CRITICAL CARE ADDL 30 MIN 119.67 99304 NURSING FACILITY CARE INIT 90.92 99305 NURSING FACILITY CARE INIT 129.57 99306 NURSING FACILITY CARE INIT 163.87 99307 NURSING FAC CARE SUBSEQ 43.55 99308 NURSING FAC CARE SUBSEQ 67.28 99309 NURSING FAC CARE SUBSEQ 88.48 99310 NURSING FAC CARE SUBSEQ 131.62 99315 NURSING FAC DISCHARGE DAY 71.39 99316 NURSING FAC DISCHARGE DAY 102.24 99318 ANNUAL NURSING FAC ASSESSMNT 93.61 99324 DOMICIL/R-HOME VISIT NEW PAT 54.27 99325 DOMICIL/R-HOME VISIT NEW PAT 78.88 99326 DOMICIL/R-HOME VISIT NEW PAT 135.81 99327 DOMICIL/R-HOME VISIT NEW PAT 181.42 Proc Code Description Mod Rate 99328 DOMICIL/R-HOME VISIT NEW PAT 210.10 99334 DOMICIL/R-HOME VISIT EST PAT 59.19 99335 DOMICIL/R-HOME VISIT EST PAT 92.51 99336 DOMICIL/R-HOME VISIT EST PAT 130.34 99337 DOMICIL/R-HOME VISIT EST PAT 188.04 99341 HOME VISIT NEW PATIENT 53.91 99342 HOME VISIT NEW PATIENT 77.82 99343 HOME VISIT NEW PATIENT 127.05 99344 HOME VISIT NEW PATIENT 177.62 99345 HOME VISIT NEW PATIENT 214.09 99347 HOME VISIT EST PATIENT 54.29 99348 HOME VISIT EST PATIENT 82.04 99349 HOME VISIT EST PATIENT 124.12 99350 HOME VISIT EST PATIENT 173.14 99354 PROLONGED SERVICE OFFICE 97.47 99355 PROLONGED SERVICE OFFICE 95.31 99356 PROLONGED SERVICE INPATIENT 89.68 99357 PROLONGED SERVICE INPATIENT 88.96 99360 PHYSICIAN STANDBY SERVICES 60.40 99374 HOME HEALTH CARE SUPERVISION 68.83 99375 HOME HEALTH CARE SUPERVISION 103.28 99377 HOSPICE CARE SUPERVISION 68.83 99378 HOSPICE CARE SUPERVISION 103.28 99379 NURSING FAC CARE SUPERVISION 68.83 99380 NURSING FAC CARE SUPERVISION 103.28 99381 INIT PM E/M NEW PAT INFANT 108.72 99382 INIT PM E/M NEW PAT 1-4 YRS 113.18 99383 PREV VISIT NEW AGE 5-11 118.04 99384 PREV VISIT NEW AGE 12-17 133.32 99385 PREV VISIT NEW AGE 18-39 129.52 99391 PER PM REEVAL EST PAT INFANT 97.81 99392 PREV VISIT EST AGE 1-4 104.41 99393 PREV VISIT EST AGE 5-11 104.05 99394 PREV VISIT EST AGE 12-17 113.73 99395 PREV VISIT EST AGE 18-39 116.16 99420 HEALTH RISK ASSESSMENT TEST 10.78 99460 INIT NB EM PER DAY HOSP 91.75 99461 INIT NB EM PER DAY NON-FAC 96.56 99462 SBSQ NB EM PER DAY HOSP 40.91 99463 SAME DAY NB DISCHARGE 111.53 99464 ATTENDANCE AT DELIVERY 68.81 99465 NB RESUSCITATION 143.62 99466 PED CRIT CARE TRANSPORT 257.89 99467 PED CRIT CARE TRANSPORT ADDL 119.68 99468 NEONATE CRIT CARE INITIAL 907.87 99469 NEONATE CRIT CARE SUBSQ 384.19 Proc Code Description Mod Rate 99471 PED CRITICAL CARE INITIAL 831.62 99472 PED CRITICAL CARE SUBSQ 390.76 99475 PED CRIT CARE AGE 2-5 INIT 560.97 99476 PED CRIT CARE AGE 2-5 SUBSQ 339.25 99477 Init day hosp neonate care 337.11 99478 IC LBW INF < 1500 GM SUBSQ 133.83 99479 IC LBW INF 1500-2500 G SUBSQ 121.33 99480 IC INF PBW 2501-5000 G SUBSQ 116.84 99490 Chron care mgmt srvc 20 min 41.66 99495 TRANS CARE MGMT 14 DAY DISCH 160.79 99496 TRANS CARE MGMT 7 DAY DISCH 227.02 A4206 1 CC STERILE SYRINGE&NEEDLE 0.39 A4207 2 CC STERILE SYRINGE&NEEDLE 0.39 A4208 3 CC STERILE SYRINGE&NEEDLE 0.39 A4209 5+ CC STERILE SYRINGE&NEEDLE 0.40 A4212 NON CORING NEEDLE OR STYLET 6.71 A4213 20+ CC SYRINGE ONLY 0.79 A4215 STERILE NEEDLE 0.25 A4216 STERILE WATER/SALINE, 10 ML 0.45 A4217 STERILE WATER/SALINE, 500 ML 2.66 A4218 STERILE SALINE OR WATER 4.75 A4220 INFUSION PUMP REFILL KIT 32.52 A4221 MAINT DRUG INFUS CATH PER WK 22.26 A4222 INFUSION SUPPLIES WITH PUMP 44.17 A4231 INFUSION INSULIN PUMP NEEDLE 5.10 A4244 ALCOHOL OR PEROXIDE PER PINT 0.79 A4245 ALCOHOL WIPES PER BOX 2.37 A4246 BETADINE/PHISOHEX SOLUTION 2.77 A4247 BETADINE/IODINE SWABS/WIPES 3.95 A4248 CHLORHEXIDINE ANTISEPT 1.73 A4250 URINE REAGENT STRIPS/TABLETS 0.13 A4253 BLOOD GLUCOSE/REAGENT STRIPS NU 33.76 A4255 GLUCOSE MONITOR PLATFORMS 4.11 A4256 CALIBRATOR SOLUTION/CHIPS 9.72 A4257 REPLACE LENSSHIELD CARTRIDGE 12.75 A4258 LANCET DEVICE EACH 17.75 A4259 LANCETS PER BOX 12.74 A4261 CERVICAL CAP CONTRACEPTIVE 46.65 A4262 TEMPORARY TEAR DUCT PLUG 0.39 A4263 PERMANENT TEAR DUCT PLUG 31.96 A4264 INTRATUBAL OCCLUSION DEVICE 1245.00 A4265 PARAFFIN 3.39 A4266 DIAPHRAGM 25.07 A4267 MALE CONDOM 0.38 A4268 FEMALE CONDOM 0.38 A4269 SPERMICIDE 1.13 Proc Code Description Mod Rate A4280 BRST PRSTHS ADHSV ATTCHMNT 4.84 A4281 REPLACEMENT BREASTPUMP TUBE 0.00 A4282 REPLACEMENT BREASTPUMP ADPT 0.00 A4283 REPLACEMENT BREASTPUMP CAP 0.00 A4284 REPLCMNT BREAST PUMP SHIELD 0.00 A4285 REPLCMNT BREAST PUMP BOTTLE 0.00 A4286 REPLCMNT BREASTPUMP LOK RING 0.00 A4290 SACRAL NERVE STIM TEST LEAD 104.86 A4300 CATH IMPL VASC ACCESS PORTAL 0.00 A4301 IMPLANTABLE ACCESS SYST PERC 0.00 A4306 DRUG DELIVERY SYSTEM <=50 ML 18.54 A4310 INSERT TRAY W/O BAG/CATH 7.72 A4311 CATHETER W/O BAG 2-WAY LATEX 14.84 A4312 CATH W/O BAG 2-WAY SILICONE 18.04 A4313 CATHETER W/BAG 3-WAY 18.52 A4314 CATH W/DRAINAGE 2-WAY LATEX 21.50 A4315 CATH W/DRAINAGE 2-WAY SILCNE 26.39 A4316 CATH W/DRAINAGE 3-WAY 28.40 A4320 IRRIGATION TRAY 5.33 A4321 CATH THERAPEUTIC IRRIG AGENT 0.00 A4322 IRRIGATION SYRINGE 3.04 A4326 MALE EXTERNAL CATHETER 10.79 A4327 FEM URINARY COLLECT DEV CUP 42.27 A4328 FEM URINARY COLLECT POUCH 10.45 A4330 STOOL COLLECTION POUCH 7.15 A4331 EXTENSION DRAINAGE TUBING 3.18 A4332 LUBE STERILE PACKET 0.12 A4333 URINARY CATH ANCHOR DEVICE 2.20 A4334 URINARY CATH LEG STRAP 4.93 A4338 INDWELLING CATHETER LATEX 12.26 A4340 INDWELLING CATHETER SPECIAL 26.99 A4344 CATH INDW FOLEY 2 WAY SILICN 16.02 A4346 CATH INDW FOLEY 3 WAY 19.25 A4351 STRAIGHT TIP URINE CATHETER 1.81 A4352 COUDE TIP URINARY CATHETER 6.42 A4353 INTERMITTENT URINARY CATH 7.00 A4354 CATH INSERTION TRAY W/BAG 11.80 A4355 BLADDER IRRIGATION TUBING 7.86 A4356 EXT URETH CLMP OR COMPR DVC 39.33 A4357 BEDSIDE DRAINAGE BAG 9.70 A4358 URINARY LEG OR ABDOMEN BAG 6.63 A4361 OSTOMY FACE PLATE 18.37 A4362 SOLID SKIN BARRIER 3.46 A4363 OSTOMY CLAMP, REPLACEMENT 2.20 A4364 ADHESIVE, LIQUID OR EQUAL 2.93 A4366 OSTOMY VENT 1.30 Proc Code Description Mod Rate A4367 OSTOMY BELT 7.35 A4368 OSTOMY FILTER 0.26 A4369 SKIN BARRIER LIQUID PER OZ 2.06 A4371 SKIN BARRIER POWDER PER OZ 3.60 A4372 SKIN BARRIER SOLID 4X4 EQUIV 4.18 A4373 SKIN BARRIER WITH FLANGE 6.28 A4375 DRAINABLE PLASTIC PCH W FCPL 17.18 A4376 DRAINABLE RUBBER PCH W FCPLT 47.58 A4377 DRAINABLE PLSTIC PCH W/O FP 4.29 A4378 DRAINABLE RUBBER PCH W/O FP 30.75 A4379 URINARY PLASTIC POUCH W FCPL 15.02 A4380 URINARY RUBBER POUCH W FCPLT 37.33 A4381 URINARY PLASTIC POUCH W/O FP 4.61 A4382 URINARY HVY PLSTC PCH W/O FP 24.62 A4383 URINARY RUBBER POUCH W/O FP 28.19 A4384 OSTOMY FACEPLT/SILICONE RING 9.62 A4385 OST SKN BARRIER SLD EXT WEAR 5.10 A4388 DRAINABLE PCH W EX WEAR BARR 4.36 A4389 DRAINABLE PCH W ST WEAR BARR 6.22 A4390 DRAINABLE PCH EX WEAR CONVEX 9.61 A4391 URINARY POUCH W EX WEAR BARR 7.07 A4392 URINARY POUCH W ST WEAR BARR 8.18 A4393 URINE PCH W EX WEAR BAR CONV 9.04 A4394 OSTOMY POUCH LIQ DEODORANT 2.58 A4395 OSTOMY POUCH SOLID DEODORANT 0.05 A4396 PERISTOMAL HERNIA SUPPRT BLT 40.48 A4397 IRRIGATION SUPPLY SLEEVE 4.07 A4398 OSTOMY IRRIGATION BAG 13.81 A4399 OSTOMY IRRIG CONE/CATH W BRS 12.26 A4400 OSTOMY IRRIGATION SET 48.87 A4402 LUBRICANT PER OUNCE 1.60 A4404 OSTOMY RING EACH 1.63 A4405 NONPECTIN BASED OSTOMY PASTE 3.40 A4406 PECTIN BASED OSTOMY PASTE 5.74 A4407 EXT WEAR OST SKN BARR <=4SQ 8.76 A4408 EXT WEAR OST SKN BARR >4SQ 9.87 A4409 OST SKN BARR CONVEX <=4 SQ I 6.22 A4410 OST SKN BARR EXTND >4 SQ 9.04 A4411 OST SKN BARR EXTND =4SQ 5.10 A4412 OST POUCH DRAIN HIGH OUTPUT 2.70 A4413 2 PC DRAINABLE OST POUCH 5.50 A4414 OST SKNBAR W/O CONV<=4 SQ IN 4.93 A4415 OST SKN BARR W/O CONV >4 SQI 6.00 A4416 OST PCH CLSD W BARRIER/FILTR 2.75 A4417 OST PCH W BAR/BLTINCONV/FLTR 3.72 A4418 OST PCH CLSD W/O BAR W FILTR 1.81 Proc Code Description Mod Rate A4419 OST PCH FOR BAR W FLANGE/FLT 1.74 A4420 OST PCH CLSD FOR BAR W LK FL 0.00 A4422 OST POUCH ABSORBENT MATERIAL 0.12 A4423 OST PCH FOR BAR W LK FL/FLTR 1.86 A4424 OST PCH DRAIN W BAR & FILTER 4.75 A4425 OST PCH DRAIN FOR BARRIER FL 3.58 A4426 OST PCH DRAIN 2 PIECE SYSTEM 2.73 A4427 OST PCH DRAIN/BARR LK FLNG/F 2.78 A4428 URINE OST POUCH W FAUCET/TAP 6.51 A4429 URINE OST POUCH W BLTINCONV 8.25 A4430 OST URINE PCH W B/BLTIN CONV 8.52 A4431 OST PCH URINE W BARRIER/TAPV 6.22 A4432 OS PCH URINE W BAR/FANGE/TAP 3.59 A4433 URINE OST PCH BAR W LOCK FLN 3.34 A4434 OST PCH URINE W LOCK FLNG/FT 3.76 A4450 NON-WATERPROOF TAPE 0.09 A4452 WATERPROOF TAPE 0.36 A4455 ADHESIVE REMOVER PER OUNCE 1.22 A4481 TRACHEOSTOMA FILTER 0.38 A4483 MOISTURE EXCHANGER 0.00 A4490 ABOVE KNEE SURGICAL STOCKING 5.93 A4495 THIGH LENGTH SURG STOCKING 5.93 A4500 BELOW KNEE SURGICAL STOCKING 4.35 A4510 FULL LENGTH SURG STOCKING 10.67 A4550 SURGICAL TRAYS 34.14 A4556 ELECTRODES, PAIR 12.14 A4557 LEAD WIRES, PAIR 17.94 A4558 CONDUCTIVE GEL OR PASTE 5.45 A4561 PESSARY RUBBER, ANY TYPE 18.63 A4562 PESSARY, NON RUBBER,ANY TYPE 46.38 A4565 SLINGS 6.32 A4570 SPLINT 20.13 A4580 CAST SUPPLIES (PLASTER) 0.00 A4590 SPECIAL CASTING MATERIAL 45.29 A4595 TENS SUPPL 2 LEAD PER MONTH 28.35 A4604 TUBING WITH HEATING ELEMENT NU 66.81 A4606 OXYGEN PROBE USED W OXIMETER 0.00 A4608 TRANSTRACHEAL OXYGEN CATH 58.15 A4612 BATTERY CABLES UE 60.95 A4612 BATTERY CABLES RR 8.14 A4612 BATTERY CABLES NU 79.93 A4614 HAND-HELD PEFR METER 23.78 A4617 MOUTH PIECE 3.25 A4619 FACE TENT 1.21 A4620 VARIABLE CONCENTRATION MASK 2.37 A4623 TRACHEOSTOMY INNER CANNULA 5.57 Proc Code Description Mod Rate A4624 TRACHEAL SUCTION TUBE NU 2.63 A4625 TRACH CARE KIT FOR NEW TRACH 6.58 A4626 TRACHEOSTOMY CLEANING BRUSH 2.78 A4627 SPACER BAG/RESERVOIR 15.02 A4628 OROPHARYNGEAL SUCTION CATH NU 3.65 A4629 TRACHEOSTOMY CARE KIT 4.61 A4630 REPL BAT T.E.N.S. OWN BY PT NU 6.19 A4633 UVL REPLACEMENT BULB NU 41.04 A4634 REPLACEMENT BULB TH LIGHTBOX 0.00 A4639 INFRARED HT SYS REPLCMNT PAD NU 287.21 A4640 ALTERNATING PRESSURE PAD UE 38.13 A4640 ALTERNATING PRESSURE PAD RR 6.45 A4640 ALTERNATING PRESSURE PAD NU 53.82 A4642 IN111 SATUMOMAB 460.80 A4657 SYRINGE W/WO NEEDLE 0.00 A4660 SPHYG/BP APP W CUFF AND STET 50.00 A4670 AUTOMATIC BP MONITOR, DIAL 50.00 A4673 EXT LINE W EASY LOCK CONNECT 0.00 A4690 DIALYZER, EACH 493.22 A4719 "Y SET" TUBING 0.00 A4722 DIALYS SOL FLD VOL > 1999CC 0.00 A4725 DIALYS SOL FLD VOL > 4999CC 0.00 A4726 DIALYS SOL FLD VOL > 5999CC 0.00 A4750 ART OR VENOUS BLOOD TUBING 9.66 A4760 DIALYSATE SOL TEST KIT, EACH 0.00 A4770 BLOOD COLLECTION TUBE/VACUUM 0.00 A4860 DISPOSABLE CATHETER TIPS 0.00 A4911 DRAIN BAG/BOTTLE 0.00 A5051 POUCH CLSD W BARR ATTACHED 2.07 A5052 CLSD OSTOMY POUCH W/O BARR 1.49 A5053 CLSD OSTOMY POUCH FACEPLATE 1.48 A5054 CLSD OSTOMY POUCH W/FLANGE 1.79 A5055 STOMA CAP 1.44 A5061 POUCH DRAINABLE W BARRIER AT 3.52 A5062 DRNBLE OSTOMY POUCH W/O BARR 2.09 A5063 DRAIN OSTOMY POUCH W/FLANGE 2.17 A5071 URINARY POUCH W/BARRIER 6.01 A5072 URINARY POUCH W/O BARRIER 3.43 A5073 URINARY POUCH ON BARR W/FLNG 3.18 A5081 STOMA PLUG OR SEAL, ANY TYPE 2.81 A5082 CONTINENT STOMA CATHETER 10.11 A5093 OSTOMY ACCESSORY CONVEX INSE 1.95 A5102 BEDSIDE DRAIN BTL W/WO TUBE 20.69 A5105 URINARY SUSPENSORY 40.76 A5112 URINARY LEG BAG 34.62 A5113 LATEX LEG STRAP 4.70 Proc Code Description Mod Rate A5114 FOAM/FABRIC LEG STRAP 8.94 A5120 SKIN BARRIER, WIPE OR SWAB 0.20 A5121 SOLID SKIN BARRIER 6X6 6.72 A5122 SOLID SKIN BARRIER 8X8 12.85 A5126 DISK/FOAM PAD +OR- ADHESIVE 1.32 A5131 APPLIANCE CLEANER 13.76 A5200 PERCUTANEOUS CATHETER ANCHOR 11.29 A5500 DIAB SHOE FOR DENSITY INSERT 59.36 A5501 DIABETIC CUSTOM MOLDED SHOE 178.04 A5503 DIABETIC SHOE W/ROLLER/ROCKR 26.40 A5504 DIABETIC SHOE WITH WEDGE 26.40 A5505 DIAB SHOE W/METATARSAL BAR 26.40 A5506 DIABETIC SHOE W/OFF SET HEEL 26.40 A5507 MODIFICATION DIABETIC SHOE 26.40 A5508 DIABETIC DELUXE SHOE 0.00 A5510 COMPRESSION FORM SHOE INSERT 0.00 A5512 MULTI DEN INSERT DIRECT FORM 24.22 A5513 MULTI DEN INSERT CUSTOM MOLD 36.14 A6010 COLLAGEN BASED WOUND FILLER 30.96 A6011 COLLAGEN GEL/PASTE WOUND FIL 2.28 A6021 COLLAGEN DRESSING <=16 SQ IN 21.02 A6022 COLLAGEN DRSG>16<=48 SQ IN 21.02 A6023 COLLAGEN DRESSING >48 SQ IN 190.30 A6024 COLLAGEN DSG WOUND FILLER 6.19 A6025 SILICONE GEL SHEET, EACH 21.71 A6154 WOUND POUCH EACH 14.36 A6196 ALGINATE DRESSING <=16 SQ IN 7.35 A6197 ALGINATE DRSG >16 <=48 SQ IN 16.44 A6198 ALGINATE DRESSING > 48 SQ IN 0.00 A6199 ALGINATE DRSG WOUND FILLER 5.29 A6203 COMPOSITE DRSG <= 16 SQ IN 3.35 A6204 COMPOSITE DRSG >16<=48 SQ IN 6.23 A6205 COMPOSITE DRSG > 48 SQ IN 0.00 A6206 CONTACT LAYER <= 16 SQ IN 3.34 A6207 CONTACT LAYER >16<= 48 SQ IN 7.34 A6208 CONTACT LAYER > 48 SQ IN 0.00 A6209 FOAM DRSG <=16 SQ IN W/O BDR 7.48 A6210 FOAM DRG >16<=48 SQ IN W/O B 19.92 A6211 FOAM DRG > 48 SQ IN W/O BRDR 29.37 A6212 FOAM DRG <=16 SQ IN W/BORDER 9.70 A6213 FOAM DRG >16<=48 SQ IN W/BDR 15.97 A6214 FOAM DRG > 48 SQ IN W/BORDER 10.29 A6216 NON-STERILE GAUZE<=16 SQ IN 0.05 A6217 NON-STERILE GAUZE>16<=48 SQ 0.00 A6218 NON-STERILE GAUZE > 48 SQ IN 0.37 A6219 GAUZE <= 16 SQ IN W/BORDER 0.95 Proc Code Description Mod Rate A6220 GAUZE >16 <=48 SQ IN W/BORDR 2.58 A6221 GAUZE > 48 SQ IN W/BORDER 0.00 A6222 GAUZE <=16 IN NO W/SAL W/O B 2.13 A6223 GAUZE >16<=48 NO W/SAL W/O B 2.42 A6224 GAUZE > 48 IN NO W/SAL W/O B 3.61 A6229 GAUZE >16<=48 SQ IN WATR/SAL 3.61 A6231 HYDROGEL DSG<=16 SQ IN 4.68 A6232 HYDROGEL DSG>16<=48 SQ IN 6.88 A6233 HYDROGEL DRESSING >48 SQ IN 19.19 A6234 HYDROCOLLD DRG <=16 W/O BDR 6.54 A6235 HYDROCOLLD DRG >16<=48 W/O B 16.82 A6236 HYDROCOLLD DRG > 48 IN W/O B 27.25 A6237 HYDROCOLLD DRG <=16 IN W/BDR 7.91 A6238 HYDROCOLLD DRG >16<=48 W/BDR 22.79 A6240 HYDROCOLLD DRG FILLER PASTE 12.24 A6241 HYDROCOLLOID DRG FILLER DRY 2.57 A6242 HYDROGEL DRG <=16 IN W/O BDR 6.07 A6243 HYDROGEL DRG >16<=48 W/O BDR 12.31 A6244 HYDROGEL DRG >48 IN W/O BDR 39.28 A6245 HYDROGEL DRG <= 16 IN W/BDR 7.27 A6246 HYDROGEL DRG >16<=48 IN W/B 9.92 A6247 HYDROGEL DRG > 48 SQ IN W/B 23.78 A6248 HYDROGEL DRSG GEL FILLER 16.24 A6250 SKIN SEAL PROTECT MOISTURIZR 0.00 A6251 ABSORPT DRG <=16 SQ IN W/O B 1.99 A6252 ABSORPT DRG >16 <=48 W/O BDR 3.25 A6253 ABSORPT DRG > 48 SQ IN W/O B 6.34 A6254 ABSORPT DRG <=16 SQ IN W/BDR 1.21 A6255 ABSORPT DRG >16<=48 IN W/BDR 3.03 A6256 ABSORPT DRG > 48 SQ IN W/BDR 0.00 A6257 TRANSPARENT FILM <= 16 SQ IN 1.53 A6258 TRANSPARENT FILM >16<=48 IN 4.30 A6259 TRANSPARENT FILM > 48 SQ IN 10.94 A6260 WOUND CLEANSER ANY TYPE/SIZE 0.74 A6261 WOUND FILLER GEL/PASTE /OZ 3.56 A6262 WOUND FILLER DRY FORM / GRAM 0.74 A6266 IMPREG GAUZE NO H20/SAL/YARD 1.92 A6402 STERILE GAUZE <= 16 SQ IN 0.12 A6403 STERILE GAUZE>16 <= 48 SQ IN 0.43 A6404 STERILE GAUZE > 48 SQ IN 0.37 A6407 PACKING STRIPS, NON-IMPREG 1.88 A6410 STERILE EYE PAD 0.39 A6412 OCCLUSIVE EYE PATCH 0.37 A6441 PAD BAND W>=3 <5/YD 0.67 A6442 CONFORM BAND N/S W<3/YD 0.17 A6443 CONFORM BAND N/S W>=3<5/YD 0.29 Proc Code Description Mod Rate A6444 CONFORM BAND N/S W>=5/YD 0.56 A6445 CONFORM BAND S W <3/YD 0.32 A6446 CONFORM BAND S W>=3 <5/YD 0.41 A6447 CONFORM BAND S W >=5/YD 0.67 A6448 LT COMPRES BAND <3/YD 1.16 A6449 LT COMPRES BAND >=3 <5/YD 1.75 A6450 LT COMPRES BAND >=5/YD 0.00 A6451 MOD COMPRES BAND W>=3<5/YD 0.00 A6452 HIGH COMPRES BAND W>=3<5YD 5.91 A6453 SELF-ADHER BAND W <3/YD 0.61 A6454 SELF-ADHER BAND W>=3 <5/YD 0.77 A6455 SELF-ADHER BAND >=5/YD 1.39 A6456 ZINC PASTE BAND W >=3>  1.28 A6457 TUBULAR DRESSING 1.14 A6503 COMPRES BURNGARMENT FACEHOOD 0.00 A6504 CMPRSBURNGARMENT GLOVE-WRIST 0.00 A6506 CMPRSBURNGRMNT GLOVE-AXILLA 0.00 A6508 CMPRS BURNGARMENT FOOT-THIGH 0.00 A6509 COMPRES BURN GARMENT JACKET 0.00 A6511 COMPRES BURN GARMENT PANTY 0.00 A6512 COMPRES BURN GARMENT, NOC 0.00 A6530 COMPRESSION STOCKING BK18-30 25.00 A6531 COMPRESSION STOCKING BK30-40 43.27 A6532 COMPRESSION STOCKING BK40-50 60.96 A6533 GC STOCKING THIGHLNGTH 18-30 30.00 A6534 GC STOCKING THIGHLNGTH 30-40 30.00 A6535 GC STOCKING THIGHLNGTH 40-50 30.00 A6536 GC STOCKING FULL LNGTH 18-30 40.00 A6537 GC STOCKING FULL LNGTH 30-40 40.00 A6538 GC STOCKING FULL LNGTH 40-50 40.00 A6539 GC STOCKING WAISTLNGTH 18-30 80.00 A6540 GC STOCKING WAISTLNGTH 30-40 80.00 A6541 GC STOCKING WAISTLNGTH 40-50 80.00 A6544 GC STOCKING GARTER BELT 14.00 A6549 G COMPRESSION STOCKING 0.00 A6550 NEG PRES WOUND THER DRSG SET 27.42 A7000 DISPOSABLE CANISTER FOR PUMP NU 9.54 A7001 NONDISPOSABLE PUMP CANISTER NU 33.08 A7002 TUBING USED W SUCTION PUMP NU 3.83 A7003 NEBULIZER ADMINISTRATION SET NU 2.74 A7004 DISPOSABLE NEBULIZER SML VOL NU 1.80 A7005 NONDISPOSABLE NEBULIZER SET NU 30.83 A7006 FILTERED NEBULIZER ADMIN SET NU 9.54 A7007 LG VOL NEBULIZER DISPOSABLE NU 4.61 A7008 DISPOSABLE NEBULIZER PREFILL NU 11.00 A7009 NEBULIZER RESERVOIR BOTTLE NU 42.04 Proc Code Description Mod Rate A7010 DISPOSABLE CORRUGATED TUBING NU 23.59 A7011 NONDISPOS CORRUGATED TUBING 15.23 A7012 NEBULIZER WATER COLLEC DEVIC NU 3.78 A7013 DISPOSABLE COMPRESSOR FILTER NU 0.83 A7014 COMPRESSOR NONDISPOS FILTER NU 4.49 A7015 AEROSOL MASK USED W NEBULIZE NU 1.88 A7016 NEBULIZER DOME & MOUTHPIECE NU 7.25 A7017 NEBULIZER NOT USED W OXYGEN UE 100.52 A7017 NEBULIZER NOT USED W OXYGEN RR 13.40 A7017 NEBULIZER NOT USED W OXYGEN NU 134.04 A7018 WATER DISTILLED W/NEBULIZER 0.38 A7020 INTERFACE, COUGH STIM DEVICE INTER 2.75 A7025 REPLACE CHEST COMPRESS VEST NU 434.94 A7026 REPLACE CHST CMPRSS SYS HOSE NU 28.75 A7030 CPAP FULL FACE MASK NU 188.64 A7031 REPLACEMENT FACEMASK INTERFA NU 69.77 A7032 REPLACEMENT NASAL CUSHION NU 40.53 A7033 REPLACEMENT NASAL PILLOWS NU 28.41 A7034 NASAL APPLICATION DEVICE NU 117.64 A7035 POS AIRWAY PRESS HEADGEAR NU 39.75 A7036 POS AIRWAY PRESS CHINSTRAP NU 18.20 A7037 POS AIRWAY PRESSURE TUBING NU 41.02 A7038 POS AIRWAY PRESSURE FILTER NU 5.39 A7039 FILTER, NON DISPOSABLE W PAP NU 15.33 A7044 PAP ORAL INTERFACE NU 120.91 A7046 REPL WATER CHAMBER, PAP DEV 19.51 A7501 TRACHEOSTOMA VALVE W DIAPHRA 105.03 A7502 REPLACEMENT DIAPHRAGM/FPLATE 49.91 A7503 HMES FILTER HOLDER OR CAP 11.33 A7504 TRACHEOSTOMA HMES FILTER 0.67 A7505 HMES OR TRACH VALVE HOUSING 4.68 A7506 HMES/TRACHVALVE ADHESIVEDISK 0.33 A7507 INTEGRATED FILTER & HOLDER 2.49 A7508 HOUSING & INTEGRATED ADHESIV 2.87 A7509 HEAT & MOISTURE EXCHANGE SYS 1.41 A7520 TRACH/LARYN TUBE NON-CUFFED 47.48 A7521 TRACH/LARYN TUBE CUFFED 47.05 A7522 TRACH/LARYN TUBE STAINLESS 45.16 A7524 TRACHEOSTOMA STENT/STUD/BTTN 77.40 A7525 TRACHEOSTOMY MASK 2.07 A7526 TRACHEOSTOMY TUBE COLLAR 3.37 A9150 MISC/EXPER NON-PRESCRIPT DRU 0.00 A9270 NON-COVERED ITEM OR SERVICE 0.00 A9300 EXERCISE EQUIPMENT 0.00 A9500 TC99M SESTAMIBI 81.54 A9501 Technetium TC-99m teboroxime 52.55 Proc Code Description Mod Rate A9502 TC99M TETROFOSMIN 72.53 A9503 TC99M MEDRONATE 24.99 A9504 TC99M APCITIDE 24.55 A9505 TL201 THALLIUM 26.76 A9507 IN111 CAPROMAB 901.82 A9508 I131 IODOBENGUATE, DX 20.39 A9509 Iodine I-123 sod iodide mil1 113.90 A9510 TC99M DISOFENIN 53.53 A9512 TC99M PERTECHNETATE 6.28 A9516 IODINE I-123 SOD IODIDE MIC 31.93 A9517 I131 IODIDE CAP, RX 18.12 A9520 Tc99 tilmanocept diag 0.5mci 0.00 A9521 TC99M EXAMETAZIME 432.53 A9524 I131 SERUM ALBUMIN, DX 74.41 A9526 NITROGEN N-13 AMMONIA 164.35 A9527 IODINE I-125 SODIUM IODIDE 11.01 A9528 IODINE I-131 IODIDE CAP, DX 22.91 A9529 I131 IODIDE SOL, DX 20.74 A9530 I131 IODIDE SOL, RX 11.01 A9531 I131 MAX 100UCI 5.61 A9532 I125 SERUM ALBUMIN, DX 64.92 A9536 TC99M DEPREOTIDE 44.35 A9537 TC99M MEBROFENIN 36.19 A9538 TC99M PYROPHOSPHATE 31.87 A9539 TC99M PENTETATE 30.86 A9540 TC99M MAA 24.89 A9541 TC99M SULFUR COLLOID 39.38 A9542 IN111 IBRITUMOMAB, DX 1353.40 A9543 Y90 IBRITUMOMAB, RX 14338.22 A9544 I131 TOSITUMOMAB, DX 1639.32 A9545 I131 TOSITUMOMAB, RX 11436.22 A9546 CO57/58 5.37 A9547 IN111 OXYQUINOLINE 447.29 A9548 IN111 PENTETATE 327.64 A9550 TC99M GLUCEPTATE 38.58 A9551 TC99M SUCCIMER 189.06 A9552 F18 FDG 209.74 A9553 CR51 CHROMATE 273.65 A9554 I125 IOTHALAMATE, DX 50.60 A9555 RB82 RUBIDIUM 176.51 A9556 GA67 GALLIUM 23.27 A9557 TC99M BICISATE 390.61 A9558 XE133 XENON 10MCI 26.28 A9559 CO57 CYANO 4.56 A9560 TC99M LABELED RBC 64.19 A9561 TC99M OXIDRONATE 26.03 Proc Code Description Mod Rate A9562 TC99M MERTIATIDE 121.43 A9563 P32 NA PHOSPHATE 132.45 A9564 P32 CHROMIC PHOSPHATE 608.98 A9566 TC99M FANOLESOMAB 339.80 A9567 TECHNETIUM TC-99M AEROSOL 33.67 A9568 TECHNETIUM TC99M ARCITUMOMAB 18.87 A9569 Technetium TC-99m auto WBC 517.30 A9570 Indium In-111 auto WBC 525.12 A9571 Indium IN-111 auto platelet 797.71 A9572 Indium In-111 pentetreotide 690.43 A9576 Inj prohance multipack 2.34 A9577 Inj multihance 4.11 A9578 Inj multihance multipack 3.97 A9579 Gad-base MR contrast NOS1ml 3.81 A9580 SODIUM FLUORIDE F-18 206.58 A9581 GADOXETATE DISODIUM INJ 13.18 A9582 IODINE I-123 IOBENGUANE 1270.11 A9583 GADOFOSVESET TRISODIUM INJ 16.18 A9600 SR89 STRONTIUM 787.40 A9604 SM 153 LEXIDRONAM 3101.39 A9700 ECHOCARDIOGRAPHY CONTRAST 33.81 A9900 SUPPLY/ACCESSORY/SERVICE 0.00 A9901 DELIVERY/SET UP/DISPENSING 0.00 A9999 DME SUPPLY OR ACCESSORY, NOS 0.00 C1814 RETINAL TAMP, SILICONE OIL 0.00 C1818 INTEGRATED KERATOPROSTHESIS 0.00 C1819 TISSUE LOCALIZATION-EXCISION 0.00 C1884 EMBOLIZATION PROTECT SYST 0.00 C8918 MRA W/CONT, PELVIS 0.00 C8919 MRA W/O CONT, PELVIS 0.00 C8920 MRA W/O FOL W/CONT, PELVIS 0.00 C8929 TTE W OR WO FOL WCON,DOPPLER 0.00 C8930 TTE W OR W/O CONTR, CONT ECG 0.00 C9716 RADIOFREQUENCY ENERGY TO ANU 0.00 D0120 PERIODIC ORAL EVALUATION 33.24 D0140 LIMIT ORAL EVAL PROBLM FOCUS 33.24 D0145 ORAL EVALUATION PT < 3YRS 20.50 D0150 COMPREHENSVE ORAL EVALUATION 33.24 D0160 EXTENSV ORAL EVAL PROB FOCUS 36.89 D0170 RE-EVAL,EST PT,PROBLEM FOCUS 18.44 D0190 Screening of a patient 14.34 D0191 Assessment of a patient 10.24 D0210 INTRAOR COMPLETE FILM SERIES 58.94 D0220 INTRAORAL PERIAPICAL FIRST 18.86 D0230 INTRAORAL PERIAPICAL EA ADD 5.89 D0240 INTRAORAL OCCLUSAL FILM 14.14 Proc Code Description Mod Rate D0270 DENTAL BITEWING SINGLE IMAGE 11.79 D0272 DENTAL BITEWINGS TWO IMAGES 21.21 D0273 BITEWINGS - THREE IMAGES 16.40 D0274 BITEWINGS FOUR IMAGES 23.57 D0277 VERT BITEWINGS 7 TO 8 IMAGES 5.00 D0290 SKULL/FACIAL BONE IMAGE 51.24 D0322 DENTAL TOMOGRAPHIC SURVEY 153.99 D0330 PANORAMIC IMAGE 41.24 D0340 CEPHALOMETRIC IMAGE 40.99 D0350 ORAL/FACIAL PHOTO IMAGES 20.50 D0364 Cone beam ct capt & interp 172.19 D0365 Cone beam ct interprete man 172.19 D0366 Cone beam ct interprete max 172.19 D0367 Cone beam ct interp both jaw 172.19 D0370 Max ultrasound capt & interp 151.69 D0371 Sialoendoscopy capt & interp 0.00 D0380 Cone beam ct capture limited 137.34 D0381 Cone beam ct capt mandible 137.34 D0382 Cone beam ct capt maxilla 137.34 D0383 Cone beam ct both jaws 137.34 D0386 Max ultrasound image capture 81.99 D0391 Imterprete diagnostic image 0.00 D0415 COLLECTION OF MICROORGANISMS 34.85 D0416 VIRAL CULTURE 34.85 D0460 PULP VITALITY TEST 10.25 D0470 DIAGNOSTIC CASTS 25.62 D0486 ACCESS OF TRANSEP CYTOL SAMP 43.05 D0502 OTHER ORAL PATHOLOGY PROCEDU 55.34 D0999 UNSPECIFIED DIAGNOSTIC PROCE 0.00 D1110 DENTAL PROPHYLAXIS ADULT 49.81 D1120 DENTAL PROPHYLAXIS CHILD 57.28 D1206 TOPICAL FLUORIDE VARNISH 53.30 D1208 TOPICAL APP FLUORID EX VRNSH 10.24 D1351 DENTAL SEALANT PER TOOTH 23.57 D1352 PREV RESIN REST, PERM TOOTH PREVE 10.25 D1353 Sealant repair per tooth 16.40 D1510 SPACE MAINTAINER FXD UNILAT 139.09 D1515 FIXED BILAT SPACE MAINTAINER 278.18 D1520 REMOVE UNILAT SPACE MAINTAIN 102.49 D1525 REMOVE BILAT SPACE MAINTAIN 143.50 D1550 RECEMENT SPACE MAINTAINER 22.54 D1555 REMOVE FIX SPACE MAINTAINER 22.54 D2140 AMALGAM ONE SURFACE PERMANEN 64.83 D2150 AMALGAM TWO SURFACES PERMANE 86.04 D2160 AMALGAM THREE SURFACES PERMA 97.83 D2161 AMALGAM 4 OR > SURFACES PERM 117.87 Proc Code Description Mod Rate D2330 RESIN ONE SURFACE-ANTERIOR 56.38 D2331 RESIN TWO SURFACES-ANTERIOR 75.85 D2332 RESIN THREE SURFACES-ANTERIO 83.03 D2335 RESIN 4/> SURF OR W INCIS AN 94.30 D2390 ANT RESIN-BASED CMPST CROWN 57.40 D2391 POST 1 SRFC RESINBASED CMPST 43.05 D2392 POST 2 SRFC RESINBASED CMPST 55.34 D2393 POST 3 SRFC RESINBASED CMPST 63.55 D2394 POST >=4SRFC RESINBASE CMPST 69.69 D2712 CROWN 3/4 RESIN-BASED COMPOS 303.40 D2721 CROWN RESIN W/ BASE METAL 307.50 D2740 CROWN PORCELAIN/CERAMIC SUBS 450.99 D2751 CROWN PORCELAIN FUSED BASE M 327.99 D2781 CROWN 3/4 CAST BASE METAL 266.49 D2791 CROWN FULL CAST BASE METAL 327.99 D2910 RECEMENT INLAY ONLAY OR PART 30.74 D2915 RECEMENT CAST OR PREFAB POST 34.02 D2920 RE-CEMENT OR RE-BOND CROWN 30.74 D2921 Reattach tooth fragment 41.00 D2930 PREFAB STNLSS STEEL CRWN PRI 92.24 D2931 PREFAB STNLSS STEEL CROWN PE 133.25 D2932 PREFABRICATED RESIN CROWN 61.50 D2933 PREFAB STAINLESS STEEL CROWN 112.74 D2940 PROTECTIVE RESTORATION 30.74 D2950 CORE BUILD-UP INCL ANY PINS 123.00 D2951 TOOTH PIN RETENTION 20.50 D2952 POST AND CORE CAST + CROWN 163.99 D2953 EACH ADDTNL CAST POST 133.25 D2954 PREFAB POST/CORE + CROWN 102.49 D2955 POST REMOVAL 82.00 D2957 EACH ADDTNL PREFAB POST 71.75 D2960 LAMINATE LABIAL VENEER 123.00 D2961 LAB LABIAL VENEER RESIN 205.00 D2962 LAB LABIAL VENEER PORCELAIN 205.00 D2970 TEMPORARY CROWN •FRACTURED TOOTHÙ 100.45 D2975 COPING 166.05 D2980 CROWN REPAIR 84.04 D2981 Inlay repair 0.00 D2982 Onlay repair 0.00 D2990 Resin infiltration of lesion 0.00 D2999 DENTAL UNSPEC RESTORATIVE PR 0.00 D3110 PULP CAP DIRECT 25.62 D3120 PULP CAP INDIRECT 20.50 D3220 THERAPEUTIC PULPOTOMY 61.50 D3222 PART PULP FOR APEXOGENESIS 65.59 D3230 PULPAL THERAPY ANTERIOR PRIM 102.49 Proc Code Description Mod Rate D3240 PULPAL THERAPY POSTERIOR PRI 102.49 D3310 END THXPY, ANTERIOR TOOTH 205.00 D3320 END THXPY, BICUSPID TOOTH 246.00 D3330 END THXPY, MOLAR 327.99 D3351 APEXIFICATION/RECALC INITIAL 82.00 D3352 APEXIFICATION/RECALC INTERIM 82.00 D3353 APEXIFICATION/RECALC FINAL 163.99 D3355 Pulpal regeneration initial 0.00 D3356 Pulpal regeneration interim 0.00 D3357 Pulpal regeneration complete 0.00 D3410 APICOECTOMY - ANTERIOR 143.50 D3421 ROOT SURGERY BICUSPID 153.74 D3425 ROOT SURGERY MOLAR 163.99 D3426 ROOT SURGERY EA ADD ROOT 61.50 D3430 RETROGRADE FILLING 61.50 D3450 ROOT AMPUTATION 102.49 D3460 ENDODONTIC ENDOSSEOUS IMPLAN 317.75 D3920 TOOTH SPLITTING 82.00 D3950 CANAL PREP/FITTING OF DOWEL 61.50 D3999 ENDODONTIC PROCEDURE 0.00 D4210 GINGIVECTOMY/PLASTY 4 OR MOR 123.00 D4211 GINGIVECTOMY/PLASTY 1 TO 3 40.99 D4212 Gingivectomy/plasty rest 71.74 D4230 ANA CROWN EXP 4 OR> PER QUAD 188.60 D4231 ANA CROWN EXP 1-3 PER QUAD 166.05 D4240 GINGIVAL FLAP PROC W/ PLANIN 123.00 D4241 GNGVL FLAP W ROOTPLAN 1-3 TH 63.55 D4249 CROWN LENGTHEN HARD TISSUE 209.10 D4260 OSSEOUS SURGERY 4 OR MORE 205.00 D4261 OSSEOUS SURG 1 TO 3 TEETH 163.99 D4263 BONE REPLCE GRAFT FIRST SITE 194.75 D4264 BONE REPLCE GRAFT EACH ADD 159.89 D4265 BIO MTRLS TO AID SOFT/OS REG 96.35 D4266 GUIDED TISS REGEN RESORBLE 284.95 D4267 GUIDED TISS REGEN NONRESORB 327.99 D4270 PEDICLE SOFT TISSUE GRAFT PR 123.00 D4273 SUBEPITHELIAL TISSUE GRAFT 338.24 D4274 DISTAL/PROXIMAL WEDGE PROC 209.10 D4277 Soft tissue graft firsttooth 614.99 D4278 Soft tissue graft addl tooth 204.99 D4320 PROVISION SPLNT INTRACORONAL 20.50 D4321 PROVISIONAL SPLINT EXTRACORO 20.50 D4341 PERIODONTAL SCALING & ROOT 102.91 D4342 PERIODONTAL SCALING 1-3TEETH 55.34 D4355 FULL MOUTH DEBRIDEMENT 74.83 D4381 LOCALIZED DELIVERY ANTIMICRO 69.69 Proc Code Description Mod Rate D4910 PERIODONTAL MAINT PROCEDURES 40.99 D4999 UNSPECIFIED PERIODONTAL PROC 0.00 D5110 DENTURES COMPLETE MAXILLARY 615.00 D5120 DENTURES COMPLETE MANDIBLE 615.00 D5130 DENTURES IMMEDIAT MAXILLARY 666.25 D5140 DENTURES IMMEDIAT MANDIBLE 666.25 D5211 DENTURES MAXILL PART RESIN 205.00 D5212 DENTURES MAND PART RESIN 205.00 D5213 DENTURES MAXILL PART METAL 615.00 D5214 DENTURES MANDIBL PART METAL 615.00 D5281 REMOVABLE PARTIAL DENTURE 410.00 D5410 DENTURES ADJUST CMPLT MAXIL 40.99 D5411 DENTURES ADJUST CMPLT MAND 40.99 D5421 DENTURES ADJUST PART MAXILL 40.99 D5422 DENTURES ADJUST PART MANDBL 40.99 D5510 DENTUR REPR BROKEN COMPL BAS 61.50 D5520 REPLACE DENTURE TEETH COMPLT 40.99 D5610 DENTURES REPAIR RESIN BASE 61.50 D5620 REP PART DENTURE CAST FRAME 123.00 D5630 REP PARTIAL DENTURE CLASP 123.00 D5640 REPLACE PART DENTURE TEETH 61.50 D5650 ADD TOOTH TO PARTIAL DENTURE 61.50 D5660 ADD CLASP TO PARTIAL DENTURE 102.49 D5670 REPLC TTH&ACRLC ON MTL FRMWK 305.44 D5671 REPLC TTH&ACRLC MANDIBULAR 305.44 D5730 DENTURE RELN CMPLT MAXIL CH 123.00 D5731 DENTURE RELN CMPLT MAND CHR 123.00 D5740 DENTURE RELN PART MAXIL CHR 102.49 D5741 DENTURE RELN PART MAND CHR 102.49 D5750 DENTURE RELN CMPLT MAX LAB 189.62 D5751 DENTURE RELN CMPLT MAND LAB 189.62 D5760 DENTURE RELN PART MAXIL LAB 163.99 D5761 DENTURE RELN PART MAND LAB 163.99 D5820 DENTURE INTERM PART MAXILL 205.00 D5821 DENTURE INTERM PART MANDBL 205.00 D5850 DENTURE TISS CONDITN MAXILL 40.99 D5851 DENTURE TISS CONDTIN MANDBL 40.99 D5862 PRECISION ATTACHMENT 182.44 D5899 REMOVABLE PROSTHODONTIC PROC 20.50 D5931 SURGICAL OBTURATOR 656.00 D5932 POSTSURGICAL OBTURATOR 1537.50 D5933 REFITTING OF OBTURATOR 307.50 D5936 TEMP OBTURATOR PROSTHESIS 563.74 D5983 RADIATION APPLICATOR 0.00 D5984 RADIATION SHIELD 0.00 D5985 RADIATION CONE LOCATOR 573.99 Proc Code Description Mod Rate D5988 SURGICAL SPLINT 219.34 D5992 ADJUST MAX PROST APPLIANCE ADJUS 82.00 D5993 MAIN/CLEAN MAX PROSTHESIS MAINT 82.00 D5999 MAXILLOFACIAL PROSTHESIS 0.00 D6930 RECEMENT/BOND PART DENTURE 76.87 D7111 EXTRACTION CORONAL REMNANTS 40.99 D7140 EXTRACTION ERUPTED TOOTH/EXR 45.09 D7210 REM IMP TOOTH W MUCOPER FLP 87.12 D7220 IMPACT TOOTH REMOV SOFT TISS 128.12 D7230 IMPACT TOOTH REMOV PART BONY 122.96 D7240 IMPACT TOOTH REMOV COMP BONY 147.60 D7241 IMPACT TOOTH REM BONY W/COMP 205.00 D7250 TOOTH ROOT REMOVAL 82.00 D7251 CORONECTOMY CORON 61.50 D7260 ORAL ANTRAL FISTULA CLOSURE 246.00 D7261 PRIMARY CLOSURE SINUS PERF 286.99 D7270 TOOTH REIMPLANTATION 102.49 D7280 EXPOSURE IMPACT TOOTH ORTHOD 123.00 D7283 PLACE DEVICE IMPACTED TOOTH 49.20 D7285 BIOPSY OF ORAL TISSUE HARD 92.24 D7286 BIOPSY OF ORAL TISSUE SOFT 82.00 D7287 EXFOLIATIVE CYTOLOG COLLECT 40.18 D7288 BRUSH BIOPSY 47.56 D7290 REPOSITIONING OF TEETH 246.00 D7291 TRANSSEPTAL FIBEROTOMY 77.89 D7292 SCREW RETAINED PLATE 727.75 D7293 TEMP ANCHORAGE DEV W FLAP 533.00 D7294 TEMP ANCHORAGE DEV W/O FLAP 395.64 D7295 BONE HARVEST,AUTO GRAFT PROC HARVE 102.49 D7310 ALVEOPLASTY W/ EXTRACTION 86.10 D7311 ALVEOLOPLASTY W/EXTRACT 1-3 108.65 D7320 ALVEOPLASTY W/O EXTRACTION 108.65 D7321 ALVEOLOPLASTY NOT W/EXTRACTS 157.85 D7410 RAD EXC LESION UP TO 1.25 CM 102.49 D7411 EXCISION BENIGN LESION>1.25C 100.45 D7412 EXCISION BENIGN LESION COMPL 139.39 D7440 MALIG TUMOR EXC TO 1.25 CM 656.00 D7441 MALIG TUMOR > 1.25 CM 327.99 D7450 REM ODONTOGEN CYST TO 1.25CM 205.00 D7451 REM ODONTOGEN CYST > 1.25 CM 327.99 D7460 REM NONODONTO CYST TO 1.25CM 205.00 D7461 REM NONODONTO CYST > 1.25 CM 327.99 D7465 LESION DESTRUCTION 107.63 D7472 REMOVAL OF TORUS PALATINUS 143.50 D7473 REMOVE TORUS MANDIBULARIS 147.60 D7490 MAXILLA OR MANDIBLE RESECTIO 4100.00 Proc Code Description Mod Rate D7510 I&D ABSC INTRAORAL SOFT TISS 82.00 D7511 INCISION/DRAIN ABSCESS INTRA 90.61 D7520 I&D ABSCESS EXTRAORAL 123.00 D7521 INCISION/DRAIN ABSCESS EXTRA 145.96 D7530 REMOVAL FB SKIN/AREOLAR TISS 86.10 D7540 REMOVAL OF FB REACTION 123.00 D7550 REMOVAL OF SLOUGHED OFF BONE 358.75 D7560 MAXILLARY SINUSOTOMY 266.49 D7610 MAXILLA OPEN REDUCT SIMPLE 820.00 D7620 CLSD REDUCT SIMPL MAXILLA FX 717.50 D7630 OPEN RED SIMPL MANDIBLE FX 922.49 D7640 CLSD RED SIMPL MANDIBLE FX 820.00 D7650 OPEN RED SIMP MALAR/ZYGOM FX 512.49 D7660 CLSD RED SIMP MALAR/ZYGOM FX 410.00 D7670 CLOSD RDUCTN SPLINT ALVEOLUS 410.00 D7671 ALVEOLUS OPEN REDUCTION 779.00 D7680 REDUCT SIMPLE FACIAL BONE FX 1025.00 D7710 MAXILLA OPEN REDUCT COMPOUND 1025.00 D7720 CLSD REDUCT COMPD MAXILLA FX 902.00 D7730 OPEN REDUCT COMPD MANDBLE FX 1168.49 D7740 CLSD REDUCT COMPD MANDBLE FX 922.49 D7750 OPEN RED COMP MALAR/ZYGMA FX 645.75 D7760 CLSD RED COMP MALAR/ZYGMA FX 533.00 D7770 OPEN REDUC COMPD ALVEOLUS FX 533.00 D7771 ALVEOLUS CLSD REDUC STBLZ TE 73.79 D7780 REDUCT COMPND FACIAL BONE FX 2500.99 D7810 TMJ OPEN REDUCT-DISLOCATION 1291.50 D7820 CLOSED TMP MANIPULATION 194.75 D7840 REMOVAL OF TMJ CONDYLE 1230.00 D7850 TMJ MENISCECTOMY 615.00 D7852 TMJ REPAIR OF JOINT DISC 737.99 D7854 TMJ EXCISN OF JOINT MEMBRANE 573.99 D7858 TMJ RECONSTRUCTION 2296.00 D7860 TMJ CUTTING INTO JOINT 615.00 D7865 TMJ RESHAPING COMPONENTS 1722.00 D7870 TMJ ASPIRATION JOINT FLUID 82.00 D7872 TMJ DIAGNOSTIC ARTHROSCOPY 533.00 D7873 TMJ ARTHROSCOPY LYSIS ADHESN 584.24 D7874 TMJ ARTHROSCOPY DISC REPOSIT 737.99 D7875 TMJ ARTHROSCOPY SYNOVECTOMY 789.25 D7876 TMJ ARTHROSCOPY DISCECTOMY 820.00 D7877 TMJ ARTHROSCOPY DEBRIDEMENT 758.49 D7880 OCCLUSAL ORTHOTIC APPLIANCE 291.09 D7910 DENT SUTUR RECENT WND TO 5CM 26.64 D7911 DENTAL SUTURE WOUND TO 5 CM 53.30 D7912 SUTURE COMPLICATE WND > 5 CM 10.25 Proc Code Description Mod Rate D7921 Collect & appl blood product 71.74 D7940 RESHAPING BONE ORTHOGNATHIC 1230.00 D7941 BONE CUTTING RAMUS CLOSED 820.00 D7943 CUTTING RAMUS OPEN W/GRAFT 1537.50 D7944 BONE CUTTING SEGMENTED 1025.00 D7945 BONE CUTTING BODY MANDIBLE 1025.00 D7946 RECONSTRUCTION MAXILLA TOTAL 2562.49 D7947 RECONSTRUCT MAXILLA SEGMENT 2562.49 D7948 RECONSTRUCT MIDFACE NO GRAFT 2870.00 D7949 RECONSTRUCT MIDFACE W/GRAFT 4182.00 D7951 SINUS AUG W BONE OR BONE SUB 803.59 D7952 Sinus augmentation vertical 0.00 D7953 BONE REPLACEMENT GRAFT 440.74 D7955 REPAIR MAXILLOFACIAL DEFECTS 922.49 D7960 FRENULECTOMY/FRENECTOMY 123.00 D7963 FRENULOPLASTY 145.54 D7970 EXCISION HYPERPLASTIC TISSUE 246.00 D7971 EXCISION PERICORONAL GINGIVA 123.00 D7980 SIALOLITHOTOMY 246.00 D7981 EXCISION OF SALIVARY GLAND 410.00 D7982 SIALODOCHOPLASTY 584.24 D7983 CLOSURE OF SALIVARY FISTULA 246.00 D7990 EMERGENCY TRACHEOTOMY 512.49 D7991 DENTAL CORONOIDECTOMY 820.00 D7996 IMPLANT MANDIBLE FOR AUGMENT 0.00 D7998 INTRAORAL PLACE OF FIX DEV 596.54 D7999 ORAL SURGERY PROCEDURE 0.00 D8010 LIMITED DENTAL TX PRIMARY 450.99 D8020 LIMITED DENTAL TX TRANSITION 533.00 D8040 LIMITED DENTAL TX ADULT 696.99 D8080 COMPRE DENTAL TX ADOLESCENT 1865.49 D8090 COMPRE DENTAL TX ADULT 1947.50 D8210 ORTHODONTIC REM APPLIANCE TX 243.94 D8220 FIXED APPLIANCE THERAPY HABT 293.15 D8660 PREORTHODONTIC TX VISIT 49.20 D8670 PERIODIC ORTHODONTC TX VISIT 79.94 D8680 ORTHODONTIC RETENTION 117.87 D8691 REPAIR ORTHO APPLIANCE 66.62 D8693 REBOND/RECEMENT RETAINERS 69.69 D8999 ORTHODONTIC PROCEDURE 0.00 D9110 TX DENTAL PAIN MINOR PROC 40.99 D9120 FIX PARTIAL DENTURE SECTION 71.75 D9210 DENT ANESTHESIA W/O SURGERY 10.25 D9212 TRIGEMINAL BLOCK ANESTHESIA 10.25 D9215 LOCAL ANESTHESIA 6.15 D9220 GENERAL ANESTHESIA 112.74 Proc Code Description Mod Rate D9221 GENERAL ANESTHESIA EA AD 15M 40.99 D9230 ANALGESIA 18.44 D9241 INTRAVENOUS SEDATION 123.00 D9242 IV SEDATION EA AD 15 M 46.13 D9248 SEDATION (NON-IV) 91.22 D9310 DENTAL CONSULTATION 61.50 D9410 DENTAL HOUSE CALL 61.50 D9420 HOSPITAL/ASC CALL 40.99 D9440 OFFICE VISIT AFTER HOURS 61.50 D9610 DENT THERAPEUTIC DRUG INJECT 20.50 D9612 THERA PAR DRUGS 2 OR > ADMIN 40.99 D9630 OTHER DRUGS/MEDICAMENTS 10.25 D9930 TREATMENT OF COMPLICATIONS 34.85 D9940 DENTAL OCCLUSAL GUARD 205.00 D9942 REPAIR/RELINE OCCLUSAL GUARD 70.52 D9950 OCCLUSION ANALYSIS 168.09 D9951 LIMITED OCCLUSAL ADJUSTMENT 10.25 D9952 COMPLETE OCCLUSAL ADJUSTMENT 163.99 D9999 ADJUNCTIVE PROCEDURE 0.00 E0110 CRUTCH FOREARM PAIR UE 49.45 E0110 CRUTCH FOREARM PAIR RR 15.99 E0110 CRUTCH FOREARM PAIR NU 65.95 E0111 CRUTCH FOREARM EACH UE 34.94 E0111 CRUTCH FOREARM EACH RR 8.43 E0111 CRUTCH FOREARM EACH NU 45.27 E0112 CRUTCH UNDERARM PAIR WOOD UE 24.85 E0112 CRUTCH UNDERARM PAIR WOOD RR 9.93 E0112 CRUTCH UNDERARM PAIR WOOD NU 33.11 E0113 CRUTCH UNDERARM EACH WOOD UE 13.48 E0113 CRUTCH UNDERARM EACH WOOD RR 5.15 E0113 CRUTCH UNDERARM EACH WOOD NU 17.96 E0114 CRUTCH UNDERARM PAIR NO WOOD UE 30.32 E0114 CRUTCH UNDERARM PAIR NO WOOD RR 8.57 E0114 CRUTCH UNDERARM PAIR NO WOOD NU 40.11 E0116 CRUTCH UNDERARM EACH NO WOOD UE 17.75 E0116 CRUTCH UNDERARM EACH NO WOOD RR 5.40 E0116 CRUTCH UNDERARM EACH NO WOOD NU 23.58 E0117 UNDERARM SPRINGASSIST CRUTCH UE 144.55 E0117 UNDERARM SPRINGASSIST CRUTCH RR 19.26 E0117 UNDERARM SPRINGASSIST CRUTCH NU 192.71 E0118 CRUTCH SUBSTITUTE RR 33.40 E0118 CRUTCH SUBSTITUTE NU 334.00 E0140 WALKER W TRUNK SUPPORT UE 270.54 E0140 WALKER W TRUNK SUPPORT RR 36.08 E0140 WALKER W TRUNK SUPPORT NU 360.71 E0300 ENCLOSED PED CRIB HOSP GRADE UE 2128.96 Proc Code Description Mod Rate E0300 ENCLOSED PED CRIB HOSP GRADE RR 283.86 E0300 ENCLOSED PED CRIB HOSP GRADE NU 2838.62 E0301 HD HOSP BED, 350-600 LBS RR 256.30 E0302 EX HD HOSP BED > 600 LBS RR 715.44 E0303 HOSP BED HVY DTY XTRA WIDE RR 289.52 E0303 HOSP BED HVY DTY XTRA WIDE NU 2895.20 E0304 HOSP BED XTRA HVY DTY X WIDE RR 770.67 E0470 RAD W/O BACKUP NON-INV INTFC RR 218.11 E0471 RAD W/BACKUP NON INV INTRFC RR 642.17 E0471 RAD W/BACKUP NON INV INTRFC NU 6421.70 E0472 RAD W BACKUP INVASIVE INTRFC RR 642.17 E0561 HUMIDIFIER NONHEATED W PAP UE 80.24 E0561 HUMIDIFIER NONHEATED W PAP RR 10.69 E0561 HUMIDIFIER NONHEATED W PAP NU 107.00 E0562 HUMIDIFIER HEATED USED W PAP UE 225.91 E0562 HUMIDIFIER HEATED USED W PAP RR 30.11 E0562 HUMIDIFIER HEATED USED W PAP NU 301.22 E0637 COMBINATION SIT TO STAND SYS UE 1578.72 E0637 COMBINATION SIT TO STAND SYS RR 210.51 E0637 COMBINATION SIT TO STAND SYS NU 2104.97 E0638 STANDING FRAME SYS UE 640.18 E0638 STANDING FRAME SYS RR 85.36 E0638 STANDING FRAME SYS NU 853.57 E0675 PNEUMATIC COMPRESSION DEVICE RR 321.99 E0955 CUSHIONED HEADREST UE 151.63 E0955 CUSHIONED HEADREST RR 20.23 E0955 CUSHIONED HEADREST NU 202.18 E0956 W/C LATERAL TRUNK/HIP SUPPOR UE 73.93 E0956 W/C LATERAL TRUNK/HIP SUPPOR RR 9.87 E0956 W/C LATERAL TRUNK/HIP SUPPOR NU 98.58 E0957 W/C MEDIAL THIGH SUPPORT UE 103.45 E0957 W/C MEDIAL THIGH SUPPORT RR 13.79 E0957 W/C MEDIAL THIGH SUPPORT NU 137.93 E0960 W/C SHOULDER HARNESS/STRAPS UE 68.24 E0960 W/C SHOULDER HARNESS/STRAPS RR 9.10 E0960 W/C SHOULDER HARNESS/STRAPS NU 90.98 E0981 SEAT UPHOLSTERY, REPLACEMENT UE 34.12 E0981 SEAT UPHOLSTERY, REPLACEMENT RR 4.80 E0981 SEAT UPHOLSTERY, REPLACEMENT NU 45.51 E0982 BACK UPHOLSTERY, REPLACEMENT UE 32.84 E0982 BACK UPHOLSTERY, REPLACEMENT RR 5.15 E0982 BACK UPHOLSTERY, REPLACEMENT NU 43.80 E0983 ADD PWR JOYSTICK RR 238.05 E0984 ADD PWR TILLER UE 1417.41 E0984 ADD PWR TILLER RR 177.59 E0984 ADD PWR TILLER NU 1889.92 Proc Code Description Mod Rate E0985 W/C SEAT LIFT MECHANISM UE 152.12 E0985 W/C SEAT LIFT MECHANISM RR 20.30 E0985 W/C SEAT LIFT MECHANISM NU 202.85 E0986 MAN W/C PUSH-RIM POWR SYSTEM UE 3648.20 E0986 MAN W/C PUSH-RIM POWR SYSTEM RR 486.43 E0986 MAN W/C PUSH-RIM POWR SYSTEM NU 4864.24 E1002 PWR SEAT TILT UE 3084.76 E1002 PWR SEAT TILT RR 411.33 E1002 PWR SEAT TILT NU 4113.02 E1003 PWR SEAT RECLINE UE 3293.48 E1003 PWR SEAT RECLINE RR 439.14 E1003 PWR SEAT RECLINE NU 4391.30 E1004 PWR SEAT RECLINE MECH UE 3651.77 E1004 PWR SEAT RECLINE MECH RR 486.90 E1004 PWR SEAT RECLINE MECH NU 4869.05 E1005 PWR SEAT RECLINE PWR UE 3952.78 E1005 PWR SEAT RECLINE PWR RR 527.03 E1005 PWR SEAT RECLINE PWR NU 5270.36 E1006 PWR SEAT COMBO W/O SHEAR UE 4841.78 E1006 PWR SEAT COMBO W/O SHEAR RR 645.55 E1006 PWR SEAT COMBO W/O SHEAR NU 6455.70 E1007 PWR SEAT COMBO W/SHEAR UE 6555.94 E1007 PWR SEAT COMBO W/SHEAR RR 874.13 E1007 PWR SEAT COMBO W/SHEAR NU 8741.27 E1008 PWR SEAT COMBO PWR SHEAR UE 6556.55 E1008 PWR SEAT COMBO PWR SHEAR RR 874.20 E1008 PWR SEAT COMBO PWR SHEAR NU 8742.05 E1009 ADD MECH LEG ELEVATION UE 0.00 E1009 ADD MECH LEG ELEVATION RR 0.00 E1009 ADD MECH LEG ELEVATION NU 0.00 E1010 ADD PWR LEG ELEVATION UE 863.51 E1010 ADD PWR LEG ELEVATION RR 115.13 E1010 ADD PWR LEG ELEVATION NU 1151.36 E1028 W/C MANUAL SWINGAWAY UE 154.89 E1028 W/C MANUAL SWINGAWAY RR 20.65 E1028 W/C MANUAL SWINGAWAY NU 206.54 E1029 W/C VENT TRAY FIXED UE 277.15 E1029 W/C VENT TRAY FIXED RR 36.95 E1029 W/C VENT TRAY FIXED NU 369.54 E1391 OXYGEN CONCENTRATOR, DUAL RR 173.17 E2201 MAN W/CH ACC SEAT W>=20<24 UE 279.83 E2201 MAN W/CH ACC SEAT W>=20<24 RR 37.31 E2201 MAN W/CH ACC SEAT W>=20<24 NU 373.10 E2202 SEAT WIDTH 24-27 IN UE 355.50 E2202 SEAT WIDTH 24-27 IN RR 47.40 E2202 SEAT WIDTH 24-27 IN NU 473.98 Proc Code Description Mod Rate E2203 FRAME DEPTH LESS THAN 22 IN UE 359.28 E2203 FRAME DEPTH LESS THAN 22 IN RR 47.89 E2203 FRAME DEPTH LESS THAN 22 IN NU 479.05 E2204 FRAME DEPTH 22 TO 25 IN UE 610.05 E2204 FRAME DEPTH 22 TO 25 IN RR 81.35 E2204 FRAME DEPTH 22 TO 25 IN NU 813.40 E2310 ELECTRO CONNECT BTW CONTROL UE 877.68 E2310 ELECTRO CONNECT BTW CONTROL RR 117.02 E2310 ELECTRO CONNECT BTW CONTROL NU 1170.24 E2311 ELECTRO CONNECT BTW 2 SYS UE 1776.90 E2311 ELECTRO CONNECT BTW 2 SYS RR 236.93 E2311 ELECTRO CONNECT BTW 2 SYS NU 2369.20 E2321 HAND INTERFACE JOYSTICK UE 1149.68 E2321 HAND INTERFACE JOYSTICK RR 153.28 E2321 HAND INTERFACE JOYSTICK NU 1532.90 E2322 MULT MECH SWITCHES UE 1057.78 E2322 MULT MECH SWITCHES RR 141.03 E2322 MULT MECH SWITCHES NU 1410.36 E2323 SPECIAL JOYSTICK HANDLE UE 48.48 E2323 SPECIAL JOYSTICK HANDLE RR 6.47 E2323 SPECIAL JOYSTICK HANDLE NU 64.64 E2324 CHIN CUP INTERFACE UE 33.37 E2324 CHIN CUP INTERFACE RR 4.45 E2324 CHIN CUP INTERFACE NU 44.49 E2325 SIP AND PUFF INTERFACE UE 1010.13 E2325 SIP AND PUFF INTERFACE RR 134.70 E2325 SIP AND PUFF INTERFACE NU 1346.83 E2326 BREATH TUBE KIT UE 239.72 E2326 BREATH TUBE KIT RR 31.96 E2326 BREATH TUBE KIT NU 319.60 E2327 HEAD CONTROL INTERFACE MECH UE 1729.58 E2327 HEAD CONTROL INTERFACE MECH RR 230.62 E2327 HEAD CONTROL INTERFACE MECH NU 2306.14 E2328 HEAD/EXTREMITY CONTROL INTER UE 2908.01 E2328 HEAD/EXTREMITY CONTROL INTER RR 387.74 E2328 HEAD/EXTREMITY CONTROL INTER NU 3877.32 E2329 HEAD CONTROL NONPROPORTIONAL UE 1297.72 E2329 HEAD CONTROL NONPROPORTIONAL RR 173.04 E2329 HEAD CONTROL NONPROPORTIONAL NU 1730.31 E2330 HEAD CONTROL PROXIMITY SWITC UE 2499.96 E2330 HEAD CONTROL PROXIMITY SWITC RR 333.32 E2330 HEAD CONTROL PROXIMITY SWITC NU 3333.27 E2340 W/C WDTH 20-23 IN SEAT FRAME UE 235.67 E2340 W/C WDTH 20-23 IN SEAT FRAME RR 31.42 E2340 W/C WDTH 20-23 IN SEAT FRAME NU 314.22 E2341 W/C WDTH 24-27 IN SEAT FRAME UE 347.23 Proc Code Description Mod Rate E2341 W/C WDTH 24-27 IN SEAT FRAME RR 46.30 E2341 W/C WDTH 24-27 IN SEAT FRAME NU 462.97 E2342 W/C DPTH 20-21 IN SEAT FRAME UE 336.03 E2342 W/C DPTH 20-21 IN SEAT FRAME RR 44.80 E2342 W/C DPTH 20-21 IN SEAT FRAME NU 448.03 E2343 W/C DPTH 22-25 IN SEAT FRAME UE 194.44 E2343 W/C DPTH 22-25 IN SEAT FRAME RR 25.93 E2343 W/C DPTH 22-25 IN SEAT FRAME NU 259.27 E2351 ELECTRONIC SGD INTERFACE UE 523.96 E2351 ELECTRONIC SGD INTERFACE RR 69.88 E2351 ELECTRONIC SGD INTERFACE NU 698.63 E2360 22NF NONSEALED LEADACID UE 84.26 E2360 22NF NONSEALED LEADACID RR 11.29 E2360 22NF NONSEALED LEADACID NU 112.34 E2361 22NF SEALED LEADACID BATTERY UE 102.86 E2361 22NF SEALED LEADACID BATTERY RR 13.72 E2361 22NF SEALED LEADACID BATTERY NU 137.15 E2362 GR24 NONSEALED LEADACID UE 67.82 E2362 GR24 NONSEALED LEADACID RR 9.04 E2362 GR24 NONSEALED LEADACID NU 90.44 E2363 GR24 SEALED LEADACID BATTERY UE 137.17 E2363 GR24 SEALED LEADACID BATTERY RR 18.30 E2363 GR24 SEALED LEADACID BATTERY NU 182.89 E2364 U1NONSEALED LEADACID BATTERY UE 84.26 E2364 U1NONSEALED LEADACID BATTERY RR 11.29 E2364 U1NONSEALED LEADACID BATTERY NU 112.34 E2365 U1 SEALED LEADACID BATTERY UE 82.75 E2365 U1 SEALED LEADACID BATTERY RR 11.03 E2365 U1 SEALED LEADACID BATTERY NU 110.31 E2366 BATTERY CHARGER, SINGLE MODE UE 168.06 E2366 BATTERY CHARGER, SINGLE MODE RR 22.47 E2366 BATTERY CHARGER, SINGLE MODE NU 224.08 E2367 BATTERY CHARGER, DUAL MODE UE 314.31 E2367 BATTERY CHARGER, DUAL MODE RR 41.91 E2367 BATTERY CHARGER, DUAL MODE NU 419.08 E2402 NEG PRESS WOUND THERAPY PUMP RR 1553.40 G0101 CA SCREEN;PELVIC/BREAST EXAM 35.99 G0102 PROSTATE CA SCREENING; DRE 16.42 G0108 DIAB MANAGE TRN PER INDIV 30.89 G0109 DIAB MANAGE TRN IND/GROUP 17.82 G0166 EXTRNL COUNTERPULSE, PER TX 135.85 G0202 SCREENINGMAMMOGRAPHYDIGITAL TC 103.63 G0202 SCREENINGMAMMOGRAPHYDIGITAL 26 36.91 G0202 SCREENINGMAMMOGRAPHYDIGITAL 140.54 G0204 DIAGNOSTICMAMMOGRAPHYDIGITAL TC 102.05 G0204 DIAGNOSTICMAMMOGRAPHYDIGITAL 26 45.76 Proc Code Description Mod Rate G0204 DIAGNOSTICMAMMOGRAPHYDIGITAL 147.80 G0206 DIAGNOSTICMAMMOGRAPHYDIGITAL TC 82.67 G0206 DIAGNOSTICMAMMOGRAPHYDIGITAL 26 39.61 G0206 DIAGNOSTICMAMMOGRAPHYDIGITAL 119.58 G0235 PET NOT OTHERWISE SPECIFIED 0.00 G0277 Hbot, full body chamber, 30m 42.64 G0279 Tomosynthesis, mammo screen 26 31.62 G0279 Tomosynthesis, mammo screen 58.98 G0306 CBC/DIFFWBC W/O PLATELET 5.68 G0307 CBC WITHOUT PLATELET 4.72 G0364 BONE MARROW ASPIRATE &BIOPSY 10.07 G0365 VESSEL MAPPING HEMO ACCESS TC 163.17 G0365 VESSEL MAPPING HEMO ACCESS 26 13.87 G0365 VESSEL MAPPING HEMO ACCESS 177.04 G0372 MD SERVICE REQUIRED FOR PMD 8.82 G0389 Ultrasound exam AAA screen TC 63.94 G0389 Ultrasound exam AAA screen 26 27.05 G0389 Ultrasound exam AAA screen 90.99 G0398 HOME SLEEP TEST/TYPE 2 PORTA TC 109.22 G0398 HOME SLEEP TEST/TYPE 2 PORTA 26 53.80 G0398 HOME SLEEP TEST/TYPE 2 PORTA 163.02 G0399 HOME SLEEP TEST/TYPE 3 PORTA TC 105.67 G0399 HOME SLEEP TEST/TYPE 3 PORTA 26 52.05 G0399 HOME SLEEP TEST/TYPE 3 PORTA 157.72 G0400 HOME SLEEP TEST/TYPE 4 PORTA TC 102.11 G0400 HOME SLEEP TEST/TYPE 4 PORTA 26 50.30 G0400 HOME SLEEP TEST/TYPE 4 PORTA 152.41 G0412 OPEN TX ILIAC SPINE UNI/BIL 705.87 G0413 PELVIC RING FRACTURE UNI/BIL 1028.00 G0414 PELVIC RING FX TREAT INT FIX 972.03 G0415 OPEN TX POST PELVIC FXCTURE 1329.79 G0416 PROSTATE BIOPSY, ANY MTHD TC 462.65 G0416 PROSTATE BIOPSY, ANY MTHD 26 189.08 G0416 PROSTATE BIOPSY, ANY MTHD 651.73 G0432 EIA HIV-1/HIV-2 SCREEN INFEC 9.64 G0433 ELISA HIV-1/HIV-2 SCREEN INFEC 9.64 G0434 DRUG SCREEN MULTI DRUG CLASS DRUG 10.23 G0435 ORAL HIV-1/HIV-2 SCREEN INFEC 8.43 G0438 ANNUAL WELLNESS FIRST 113.85 G0439 ANNUAL WELLNESS SUBSEQ 68.62 G0442 Annual alcohol screen 15 min 16.33 G0443 Brief alcohol misuse counsel 23.44 G0444 Depression screen annual 16.33 G0445 High inten beh couns STD 30m 23.44 G0446 Intens behave ther cardio dx 23.44 G0447 Behavior counsel obesity 15m 23.44 Proc Code Description Mod Rate G0452 Molecular pathology interpr 0.00 G0453 Cont intraop neuro monitor 28.55 G0454 MD document visit by NPP 9.61 G6001 Echo guidance radiotherapy 26 30.56 G6001 Echo guidance radiotherapy 53.74 G6002 Stereoscopic x-ray guidance 26 20.63 G6002 Stereoscopic x-ray guidance 78.81 G6003 Radiation treatment delivery 172.32 G6004 Radiation treatment delivery 133.13 G6005 Radiation treatment delivery 149.11 G6006 Radiation treatment delivery 148.35 G6007 Radiation treatment delivery 273.90 G6008 Radiation treatment delivery 184.49 G6009 Radiation treatment delivery 204.27 G6010 Radiation treatment delivery 204.27 G6011 Radiation treatment delivery 292.92 G6012 Radiation treatment delivery 242.32 G6013 Radiation treatment delivery 273.14 G6014 Radiation treatment delivery 272.76 G6015 Radiation tx delivery imrt 425.32 G6016 Delivery comp imrt 425.32 G6017 Intrafraction track motion 0.00 G6018 Ileoscopy w/stent 168.47 G6019 Colonoscopy lesion removal 277.25 G6020 Colonoscopy w/stent 275.21 G6022 Sigmoidoscopy w/ablate tumr 186.75 G6023 Sigmoidoscopy w/stent 174.97 G6024 Lesion removal colonoscopy 335.88 G6025 Colonoscopy w/stent 346.47 G6027 Anoscopy hra w/spec collect 0.00 G6028 Anoscopy hra w/biopsy 0.00 H0004 ALCOHOL AND/OR DRUG SERVICES 30.28 H2011 CRISIS INTERVEN SVC, 15 MIN 21.71 J1050 Medroxyprogesterone acetate 0.00 J1741 Ibuprofen injection 0.00 J1930 LANREOTIDE INJECTION 0.00 J3530 NASAL VACCINE INHALATION 0.00 J3570 LAETRILE AMYGDALIN VIT B17 0.00 J7315 OPHTHALMIC MITOMYCIN 0.00 J7316 Inj ocriplasmin 0.125 mg 0.00 J7508 Tacrolimus ex rel oral 0.1mg 0.00 J7665 MANNITOL FOR INHALER 0.00 K0601 REPL BATT SILVER OXIDE 1.5 V NU 1.10 K0602 REPL BATT SILVER OXIDE 3 V NU 6.36 K0603 REPL BATT ALKALINE 1.5 V NU 0.57 K0604 REPL BATT LITHIUM 3.6 V NU 6.09 Proc Code Description Mod Rate K0605 REPL BATT LITHIUM 4.5 V NU 14.60 K0730 CTRL DOSE INH DRUG DELIV SYS RR 172.40 L0112 CRANIAL CERVICAL ORTHOSIS 1099.77 L0113 CRANIAL CERVICAL TORTICOLLIS 0.00 L0120 CERV FLEX N/ADJ FOAM PRE OTS 26.63 L0130 FLEX THERMOPLASTIC COLLAR MO 133.02 L0140 CERVICAL SEMI-RIGID ADJUSTAB 48.19 L0150 CERV SEMI-RIG ADJ MOLDED CHN 108.46 L0160 CERV SR WIRE OCC/MAN PRE OTS 133.06 L0170 CERVICAL COLLAR MOLDED TO PT 641.80 L0172 CERV COL SR FOAM 2PC PRE OTS 119.82 L0174 CERV SR 2PC THOR EXT PRE OTS 275.72 L0180 CER POST COL OCC/MAN SUP ADJ 357.44 L0190 CERV COLLAR SUPP ADJ CERV BA 497.18 L0200 CERV COL SUPP ADJ BAR & THOR 518.30 L0220 THOR RIB BELT CUSTOM FABRICA 92.19 L0450 TLSO FLEX TRUNK/THOR PRE OTS 174.44 L0452 TLSO FLEX CUSTOM FAB THORACI 330.85 L0454 TLSO TRNK SJ-T9 PRE CST 350.83 L0456 TLSO FLEX TRNK SJ-SS PRE CST 350.83 L0458 TLSO 2MOD SYMPHIS-XIPHO PRE 547.13 L0460 TLSO 2 SHL SYMPHYS-STERN CST 547.13 L0462 TLSO 3MOD SACRO-SCAP PRE 547.13 L0464 TLSO 4MOD SACRO-SCAP PRE 547.13 L0466 TLSO R FRAM SOFT ANT PRE CST 374.99 L0468 TLSO RIG FRAM PELVIC PRE CST 454.50 L0470 TLSO RIGID FRAME PRE SUBCLAV 639.90 L0472 TLSO RIGID FRAME HYPEREX PRE 405.83 L0480 TLSO RIGID PLASTIC CUSTOM FA 1217.79 L0482 TLSO RIGID LINED CUSTOM FAB 1388.76 L0484 TLSO RIGID PLASTIC CUST FAB 1562.86 L0486 TLSO RIGIDLINED CUST FAB TWO 1692.61 L0488 TLSO RIGID LINED PRE ONE PIE 1212.41 L0490 TLSO RIGID PLASTIC PRE ONE 1124.43 L0625 LO FLEX L1-BELOW L5 PRE OTS 43.27 L0626 LO SAG RIG PNL STAYS PRE CST 61.25 L0627 LO SAG RI AN/POS PNL PRE CST 322.98 L0628 LSO FLEX NO RI STAYS PRE OTS 65.92 L0630 LSO R POST PNL SJ-T9 PRE CST 127.26 L0631 LSO SAG R AN/POS PNL PRE CST 806.64 L0633 LSO SC R POS/LAT PNL PRE CST 225.31 L0635 LSO SAGIT RIGID PANEL PREFAB 960.72 L0636 LSO SAGITTAL RIGID PANEL CUS 1422.21 L0637 LSO SC R ANT/POS PNL PRE CST 991.52 L0638 LSO SAG-CORONAL PANEL CUSTOM 1036.35 L0639 LSO S/C SHELL/PANEL PREFAB 950.64 Proc Code Description Mod Rate L0640 LSO S/C SHELL/PANEL CUSTOM 822.21 L0700 CTLSO A-P-L CONTROL MOLDED 2029.13 L0710 CTLSO A-P-L CONTROL W/ INTER 2096.18 L0810 HALO CERVICAL INTO JCKT VEST 2588.89 L0820 HALO CERVICAL INTO BODY JACK 2040.86 L0830 HALO CERV INTO MILWAUKEE TYP 3147.31 L0859 MRI COMPATIBLE SYSTEM 917.03 L0861 HALO REPL LINER/INTERFACE 169.36 L0970 TLSO CORSET FRONT 114.71 L0972 LSO CORSET FRONT 103.29 L0974 TLSO FULL CORSET 173.70 L0976 LSO FULL CORSET 122.61 L0978 AXILLARY CRUTCH EXTENSION 193.20 L0980 PERONEAL STRAPS PAIR PRE OTS 13.14 L0982 STOCKING SUP GRIPS 4 PRE OTS 13.03 L0984 PROTECT BODY SOCK EA PRE OTS 51.46 L1000 CTLSO MILWAUKE INITIAL MODEL 2037.70 L1005 TENSION BASED SCOLIOSIS ORTH 2514.93 L1010 CTLSO AXILLA SLING 57.18 L1020 KYPHOSIS PAD 86.75 L1025 KYPHOSIS PAD FLOATING 116.87 L1030 LUMBAR BOLSTER PAD 50.16 L1040 LUMBAR OR LUMBAR RIB PAD 78.30 L1050 STERNAL PAD 83.56 L1060 THORACIC PAD 95.99 L1070 TRAPEZIUS SLING 90.31 L1080 OUTRIGGER 48.04 L1085 OUTRIGGER BIL W/ VERT EXTENS 154.49 L1090 LUMBAR SLING 92.00 L1100 RING FLANGE PLASTIC/LEATHER 159.61 L1110 RING FLANGE PLAS/LEATHER MOL 256.33 L1120 COVERS FOR UPRIGHT EACH 39.86 L1200 FURNSH INITIAL ORTHOSIS ONLY 1572.58 L1210 LATERAL THORACIC EXTENSION 262.62 L1220 ANTERIOR THORACIC EXTENSION 222.35 L1230 MILWAUKEE TYPE SUPERSTRUCTUR 446.81 L1240 LUMBAR DEROTATION PAD 77.93 L1250 ANTERIOR ASIS PAD 61.81 L1260 ANTERIOR THORACIC DEROTATION 67.60 L1270 ABDOMINAL PAD 77.76 L1280 RIB GUSSET (ELASTIC) EACH 86.58 L1290 LATERAL TROCHANTERIC PAD 78.89 L1300 BODY JACKET MOLD TO PATIENT 1676.57 L1310 POST-OPERATIVE BODY JACKET 1575.53 L1499 SPINAL ORTHOSIS NOS 1906.45 L1600 HO FLEX FREJKA W/COV PRE CST 123.26 Proc Code Description Mod Rate L1610 HO FREJKA COV ONLY PRE CST 44.06 L1620 HO FLEX PAVLIK HARNS PRE CST 125.04 L1630 ABDUCT CONTROL HIP SEMI-FLEX 138.76 L1640 PELV BAND/SPREAD BAR THIGH C 347.34 L1650 HO ABDUCTION HIP ADJUSTABLE 203.36 L1652 HO BI THIGHCUFFS W SPRDR BAR 280.10 L1660 HO ABDUCTION STATIC PLASTIC 128.82 L1680 PELVIC & HIP CONTROL THIGH C 1222.90 L1685 POST-OP HIP ABDUCT CUSTOM FA 1193.85 L1686 HO POST-OP HIP ABDUCTION 915.55 L1690 COMBINATION BILATERAL HO 1519.45 L1700 LEG PERTHES ORTH TORONTO TYP 1532.72 L1710 LEGG PERTHES ORTH NEWINGTON 1794.22 L1720 LEGG PERTHES ORTHOSIS TRILAT 1322.56 L1730 LEGG PERTHES ORTH SCOTTISH R 1135.95 L1755 LEGG PERTHES PATTEN BOTTOM T 1580.97 L1810 KO ELASTIC WITH JOINTS 97.80 L1820 KO ELAS W/ CONDYLE PADS & JO 119.08 L1830 KO IMMOB CANVAS LONG PRE OTS 87.80 L1831 KNEE ORTH POS LOCKING JOINT 231.26 L1832 KO ADJ JNT POS R SUP PRE CST 546.47 L1834 KO W/0 JOINT RIGID MOLDED TO 736.39 L1836 KO RIGID W/O JOINTS PRE OTS 104.84 L1840 KO DEROT ANT CRUCIATE CUSTOM 922.86 L1843 KO SINGLE UPRIGHT PRE CST 705.03 L1844 KO W/ADJ JT ROT CNTRL MOLDED 1595.91 L1845 KO DOUBLE UPRIGHT PRE CST 615.27 L1846 KO W ADJ FLEX/EXT ROTAT MOLD 1065.60 L1847 KO DBL UPRIGHT W/AIR PRE CST 451.94 L1850 KO SWEDISH TYPE PRE OTS 288.90 L1860 KO SUPRACONDYLAR SOCKET MOLD 1077.00 L1900 AFO SPRNG WIR DRSFLX CALF BD 229.71 L1902 AFO ANKLE GAUNTLET PRE OTS 68.86 L1904 AFO MOLDED ANKLE GAUNTLET 471.98 L1906 AFO MULTILIG ANK SUP PRE OTS 120.70 L1907 AFO SUPRAMALLEOLAR CUSTOM 442.14 L1910 AFO SING BAR CLASP ATTACH SH 268.41 L1920 AFO SING UPRIGHT W/ ADJUST S 274.43 L1930 AFO PLASTIC 237.44 L1940 AFO MOLDED TO PATIENT PLASTI 496.37 L1945 AFO MOLDED PLAS RIG ANT TIB 929.10 L1950 AFO SPIRAL MOLDED TO PT PLAS 747.58 L1951 AFO SPIRAL PREFABRICATED 659.91 L1960 AFO POS SOLID ANK PLASTIC MO 556.33 L1970 AFO PLASTIC MOLDED W/ANKLE J 581.72 L1971 AFO W/ANKLE JOINT, PREFAB 368.30 Proc Code Description Mod Rate L1980 AFO SING SOLID STIRRUP CALF 368.36 L1990 AFO DOUB SOLID STIRRUP CALF 447.39 L2000 KAFO SING FRE STIRR THI/CALF 1018.01 L2010 KAFO SNG SOLID STIRRUP W/O J 928.01 L2020 KAFO DBL SOLID STIRRUP BAND/ 1171.94 L2030 KAFO DBL SOLID STIRRUP W/O J 1016.77 L2034 KAFO PLA SIN UP W/WO K/A CUS 1574.25 L2035 KAFO PLASTIC PEDIATRIC SIZE 136.11 L2036 KAFO PLAS DOUB FREE KNEE MOL 1669.84 L2037 KAFO PLAS SING FREE KNEE MOL 1671.72 L2038 KAFO W/O JOINT MULTI-AXIS AN 1228.47 L2040 HKAFO TORSION BIL ROT STRAPS 133.65 L2050 HKAFO TORSION CABLE HIP PELV 478.11 L2060 HKAFO TORSION BALL BEARING J 582.72 L2070 HKAFO TORSION UNILAT ROT STR 111.60 L2080 HKAFO UNILAT TORSION CABLE 361.00 L2090 HKAFO UNILAT TORSION BALL BR 440.10 L2106 AFO TIB FX CAST PLASTER MOLD 682.41 L2108 AFO TIB FX CAST MOLDED TO PT 991.76 L2112 AFO TIBIAL FRACTURE SOFT 432.04 L2114 AFO TIB FX SEMI-RIGID 582.57 L2116 AFO TIBIAL FRACTURE RIGID 714.52 L2126 KAFO FEM FX CAST THERMOPLAS 1031.23 L2128 KAFO FEM FX CAST MOLDED TO P 1619.84 L2132 KAFO FEMORAL FX CAST SOFT 625.79 L2134 KAFO FEM FX CAST SEMI-RIGID 970.73 L2136 KAFO FEMORAL FX CAST RIGID 1186.95 L2180 PLAS SHOE INSERT W ANK JOINT 117.53 L2182 DROP LOCK KNEE 80.46 L2184 LIMITED MOTION KNEE JOINT 93.25 L2186 ADJ MOTION KNEE JNT LERMAN T 113.33 L2188 QUADRILATERAL BRIM 225.44 L2190 WAIST BELT 65.74 L2192 PELVIC BAND & BELT THIGH FLA 357.87 L2200 LIMITED ANKLE MOTION EA JNT 47.72 L2210 DORSIFLEXION ASSIST EACH JOI 67.47 L2220 DORSI & PLANTAR FLEX ASS/RES 82.19 L2230 SPLIT FLAT CALIPER STIRR & P 77.01 L2240 ROUND CALIPER AND PLATE ATTA 83.93 L2250 FOOT PLATE MOLDED STIRRUP AT 356.64 L2260 REINFORCED SOLID STIRRUP 201.20 L2265 LONG TONGUE STIRRUP 118.20 L2270 VARUS/VALGUS STRAP PADDED/LI 53.90 L2275 PLASTIC MOD LOW EXT PAD/LINE 117.73 L2280 MOLDED INNER BOOT 454.48 L2300 ABDUCTION BAR JOINTED ADJUST 270.23 Proc Code Description Mod Rate L2310 ABDUCTION BAR-STRAIGHT 123.47 L2320 NON-MOLDED LACER 206.50 L2330 LACER MOLDED TO PATIENT MODE 394.10 L2335 ANTERIOR SWING BAND 228.01 L2340 PRE-TIBIAL SHELL MOLDED TO P 448.58 L2350 PROSTHETIC TYPE SOCKET MOLDE 894.32 L2360 EXTENDED STEEL SHANK 51.36 L2370 PATTEN BOTTOM 257.65 L2375 TORSION ANK & HALF SOLID STI 113.41 L2380 TORSION STRAIGHT KNEE JOINT 123.56 L2385 STRAIGHT KNEE JOINT HEAVY DU 134.43 L2387 ADD LE POLY KNEE CUSTOM KAFO 166.10 L2390 OFFSET KNEE JOINT EACH 109.86 L2395 OFFSET KNEE JOINT HEAVY DUTY 143.93 L2397 SUSPENSION SLEEVE LOWER EXT 99.48 L2405 KNEE JOINT DROP LOCK EA JNT 68.50 L2415 KNEE JOINT CAM LOCK EACH JOI 95.43 L2425 KNEE DISC/DIAL LOCK/ADJ FLEX 112.64 L2430 KNEE JNT RATCHET LOCK EA JNT 112.64 L2492 KNEE LIFT LOOP DROP LOCK RIN 88.98 L2500 THI/GLUT/ISCHIA WGT BEARING 316.63 L2510 TH/WGHT BEAR QUAD-LAT BRIM M 729.05 L2520 TH/WGHT BEAR QUAD-LAT BRIM C 462.37 L2525 TH/WGHT BEAR NAR M-L BRIM MO 1142.09 L2526 TH/WGHT BEAR NAR M-L BRIM CU 637.51 L2530 THIGH/WGHT BEAR LACER NON-MO 235.82 L2540 THIGH/WGHT BEAR LACER MOLDED 424.34 L2550 THIGH/WGHT BEAR HIGH ROLL CU 288.26 L2570 HIP CLEVIS TYPE 2 POSIT JNT 478.06 L2580 PELVIC CONTROL PELVIC SLING 465.81 L2600 HIP CLEVIS/THRUST BEARING FR 206.13 L2610 HIP CLEVIS/THRUST BEARING LO 243.74 L2620 PELVIC CONTROL HIP HEAVY DUT 268.36 L2622 HIP JOINT ADJUSTABLE FLEXION 307.79 L2624 HIP ADJ FLEX EXT ABDUCT CONT 332.36 L2627 PLASTIC MOLD RECIPRO HIP & C 1290.44 L2628 METAL FRAME RECIPRO HIP & CA 1261.16 L2630 PELVIC CONTROL BAND & BELT U 248.53 L2640 PELVIC CONTROL BAND & BELT B 337.29 L2650 PELV & THOR CONTROL GLUTEAL 100.65 L2660 THORACIC CONTROL THORACIC BA 187.06 L2670 THORAC CONT PARASPINAL UPRIG 153.51 L2680 THORAC CONT LAT SUPPORT UPRI 142.52 L2750 PLATING CHROME/NICKEL PR BAR 62.92 L2755 CARBON GRAPHITE LAMINATION 102.68 L2760 EXTENSION PER EXTENSION PER 60.98 Proc Code Description Mod Rate L2768 ORTHO SIDEBAR DISCONNECT 102.38 L2780 NON-CORROSIVE FINISH 67.92 L2785 DROP LOCK RETAINER EACH 31.81 L2795 KNEE CONTROL FULL KNEECAP 85.28 L2800 KNEE CAP MEDIAL OR LATERAL P 107.06 L2810 KNEE CONTROL CONDYLAR PAD 78.39 L2820 SOFT INTERFACE BELOW KNEE SE 87.16 L2830 SOFT INTERFACE ABOVE KNEE SE 94.30 L2840 TIBIAL LENGTH SOCK FX OR EQU 32.89 L2850 FEMORAL LGTH SOCK FX OR EQUA 56.34 L2999 LOWER EXTREMITY ORTHOSIS NOS 0.00 L3140 ABDUCTION ROTATION BAR SHOE 33.00 L3150 ABDUCT ROTATION BAR W/O SHOE 33.00 L3160 SHOE STYLED POSITIONING DEV 11.86 L3170 FOOT PLAS HEEL STABI PRE OTS 39.99 L3260 AMBULATORY SURGICAL BOOT EAC 15.42 L3265 PLASTAZOTE SANDAL EACH 17.00 L3650 SO 8 ABD RESTRAINT PRE OTS 58.25 L3660 SO 8 AB RSTR CAN/WEB PRE OTS 89.62 L3670 SO ACRO/CLAV CAN WEB PRE OTS 111.06 L3671 SO CAP DESIGN W/O JNTS CF 644.37 L3674 SO AIRPLANE W/WO JOINT CF SHOUL 949.77 L3675 SO VEST CANVAS/WEB PRE OTS 125.49 L3677 SO HARD PLAS STABILI PRE CST 67.87 L3702 EO W/O JOINTS CF 206.49 L3710 EO ELAS W/METAL JNTS PRE OTS 101.95 L3720 FOREARM/ARM CUFFS FREE MOTIO 642.40 L3730 FOREARM/ARM CUFFS EXT/FLEX A 885.36 L3740 CUFFS ADJ LOCK W/ ACTIVE CON 1049.67 L3760 EO WITHJOINT, PREFABRICATED 357.62 L3762 EO RIGID W/O JOINTS PRE OTS 76.89 L3763 EWHO RIGID W/O JNTS CF 916.94 L3764 EWHO W/JOINT(S) CF 970.98 L3765 EWHFO RIGID W/O JNTS CF 916.94 L3766 EWHFO W/JOINT(S) CF 970.98 L3806 WHFO W/JOINT(S) CUSTOM FAB 365.35 L3807 WHFO W/O JOINTS PRE CST 178.81 L3808 WHFO RIGID W/O JOINTS 365.79 L3900 HINGE EXTENSION/FLEX WRIST/F 1166.95 L3901 HINGE EXT/FLEX WRIST FINGER 1436.40 L3904 WHFO ELECTRIC CUSTOM FITTED 2876.16 L3905 WHO W/NONTORSION JNT(S) CF 709.19 L3906 WHO W/O JOINTS CF 388.08 L3908 WHO COCK-UP NONMOLDE PRE OTS 58.85 L3912 HFO FLEXION GLOVE PRE OTS 93.14 L3913 HFO W/O JOINTS CF 193.69 Proc Code Description Mod Rate L3915 WHO NONTORSION JNTS PRE CST 427.53 L3916 Who nontorsion jnts pre ots 115.14 L3917 METACARP FX ORTHOSIS PRE CST 75.54 L3918 Metacarp fx orthosis pre ots 76.97 L3919 HO W/O JOINTS CF 193.69 L3921 HFO W/JOINT(S) CF 229.71 L3923 HFO WITHOUT JOINTS PRE CST 27.82 L3924 Hfo without joints pre ots 97.42 L3925 FO PIP DIP JNT/SPRNG PRE OTS 50.31 L3927 FO PIP DIP NO JT SPR PRE OTS 0.00 L3929 HFO NONTORSION JNTS PRE CST 82.24 L3930 Hfo nontorsion jnts pre ots 53.50 L3931 WHFO nontorsion joint prefab 183.67 L3933 FO W/O JOINTS CF 152.58 L3935 FO NONTORSION JOINT CF 157.98 L3956 ADD JOINT UPPER EXT ORTHOSIS 721.81 L3960 SEWHO AIRPLAN DESIG ABDU POS 721.81 L3961 SEWHO CAP DESIGN W/O JNTS CF 1201.47 L3962 SEWHO ERBS PALSEY DESIGN ABD 704.68 L3967 SEWHO AIRPLANE W/O JNTS CF 1595.45 L3971 SEWHO CAP DESIGN W/JNT(S) CF 1514.45 L3973 SEWHO AIRPLANE W/JNT(S) CF 1418.53 L3975 SEWHFO CAP DESIGN W/O JNT CF 1201.47 L3976 SEWHFO AIRPLANE W/O JNTS CF 1201.47 L3977 SEWHFO CAP DESGN W/JNT(S) CF 1346.51 L3978 SEWHFO AIRPLANE W/JNT(S) CF 1418.53 L3980 UP EXT FX ORTHOS HUMERAL NOS 303.63 L3982 UPPER EXT FX ORTHOSIS RAD/UL 366.65 L3984 UPPER EXT FX ORTHOSIS WRIST 338.05 L3995 SOCK FRACTURE OR EQUAL EACH 28.06 L3999 UPPER LIMB ORTHOSIS NOS 1279.73 L4000 REPL GIRDLE MILWAUKEE ORTH 8.00 L4010 REPLACE TRILATERAL SOCKET BR 673.59 L4020 REPLACE QUADLAT SOCKET BRIM 864.49 L4030 REPLACE SOCKET BRIM CUST FIT 506.74 L4040 REPLACE MOLDED THIGH LACER 409.70 L4045 REPLACE NON-MOLDED THIGH LAC 329.24 L4050 REPLACE MOLDED CALF LACER 414.36 L4055 REPLACE NON-MOLDED CALF LACE 268.31 L4060 REPLACE HIGH ROLL CUFF 318.97 L4070 REPLACE PROX & DIST UPRIGHT 282.46 L4080 REPL MET BAND KAFO-AFO PROX 86.99 L4090 REPL MET BAND KAFO-AFO CALF/ 82.84 L4100 REPL LEATH CUFF KAFO PROX TH 104.69 L4110 REPL LEATH CUFF KAFO-AFO CAL 85.11 L4130 REPLACE PRETIBIAL SHELL 497.96 Proc Code Description Mod Rate L4205 ORTHO DVC REPAIR PER 15 MIN 8.00 L4210 ORTH DEV REPAIR/REPL MINOR P 8.00 L4350 ANKLE CONTROL ORTHO PRE OTS 89.72 L4360 PNEUMAT WALKING BOOT PRE CST 243.17 L4370 PNEUM FULL LEG SPLNT PRE OTS 142.11 L4386 NON-PNEUM WALK BOOT PRE CST 124.58 L4392 REPLACE AFO SOFT INTERFACE 18.19 L4394 REPLACE FOOT DROP SPINT 13.25 L4396 STATIC OR DYNAMI AFO PRE CST 129.66 L4398 FOOT DROP SPLINT PRE OTS 59.69 L4631 AFO, WALK BOOT TYPE, CUS FAB ANKLE 1661.65 L5000 SHO INSERT W ARCH TOE FILLER 481.95 L5010 MOLD SOCKET ANK HGT W/ TOE F 1082.00 L5020 TIBIAL TUBERCLE HGT W/ TOE F 2119.07 L5050 ANK SYMES MOLD SCKT SACH FT 2135.36 L5060 SYMES MET FR LEATH SOCKET AR 2953.39 L5100 MOLDED SOCKET SHIN SACH FOOT 2156.06 L5105 PLAST SOCKET JTS/THGH LACER 3714.66 L5150 MOLD SCKT EXT KNEE SHIN SACH 3755.02 L5160 MOLD SOCKET BENT KNEE SHIN S 4084.26 L5200 KNE SING AXIS FRIC SHIN SACH 3218.43 L5210 NO KNEE/ANKLE JOINTS W/ FT B 2374.61 L5220 NO KNEE JOINT WITH ARTIC ALI 2949.37 L5230 FEM FOCAL DEFIC CONSTANT FRI 4067.77 L5250 HIP CANAD SING AXI CONS FRIC 5548.07 L5270 TILT TABLE LOCKING HIP SING 5499.47 L5280 HEMIPELVECT CANAD SING AXIS 5444.47 L5301 BK MOLD SOCKET SACH FT ENDO 0.00 L5321 AK OPEN END SACH 3514.44 L5331 HIP DISART CANADIAN SACH FT 4670.41 L5341 HEMIPELVECTOMY CANADIAN SACH 5404.15 L5400 POSTOP DRESS & 1 CAST CHG BK 1272.55 L5410 POSTOP DSG BK EA ADD CAST CH 335.08 L5420 POSTOP DSG & 1 CAST CHG AK/D 1625.34 L5430 POSTOP DSG AK EA ADD CAST CH 452.99 L5450 POSTOP APP NON-WGT BEAR DSG 326.73 L5460 POSTOP APP NON-WGT BEAR DSG 437.30 L5500 INIT BK PTB PLASTER DIRECT 1367.68 L5505 INIT AK ISCHAL PLSTR DIRECT 1859.84 L5510 PREP BK PTB PLASTER MOLDED 1410.83 L5520 PERP BK PTB THERMOPLS DIRECT 1536.75 L5530 PREP BK PTB THERMOPLS MOLDED 1846.92 L5535 PREP BK PTB OPEN END SOCKET 1813.31 L5540 PREP BK PTB LAMINATED SOCKET 1934.10 L5560 PREP AK ISCHIAL PLAST MOLDED 1885.32 L5570 PREP AK ISCHIAL DIRECT FORM 2066.95 Proc Code Description Mod Rate L5580 PREP AK ISCHIAL THERMO MOLD 2508.74 L5585 PREP AK ISCHIAL OPEN END 2221.79 L5590 PREP AK ISCHIAL LAMINATED 2570.51 L5595 HIP DISARTIC SACH THERMOPLS 4305.50 L5600 HIP DISART SACH LAMINAT MOLD 4754.56 L5610 ABOVE KNEE HYDRACADENCE 1965.23 L5611 AK 4 BAR LINK W/FRIC SWING 1589.32 L5613 AK 4 BAR LING W/HYDRAUL SWIG 2620.51 L5614 4-BAR LINK ABOVE KNEE W/SWNG 1328.51 L5616 AK UNIV MULTIPLEX SYS FRICT 1131.75 L5617 AK/BK SELF-ALIGNING UNIT EA 440.50 L5618 TEST SOCKET SYMES 231.58 L5620 TEST SOCKET BELOW KNEE 234.56 L5622 TEST SOCKET KNEE DISARTICULA 304.02 L5624 TEST SOCKET ABOVE KNEE 333.46 L5626 TEST SOCKET HIP DISARTICULAT 438.06 L5628 TEST SOCKET HEMIPELVECTOMY 387.67 L5629 BELOW KNEE ACRYLIC SOCKET 254.87 L5630 SYME TYP EXPANDABL WALL SCKT 441.86 L5631 AK/KNEE DISARTIC ACRYLIC SOC 352.37 L5632 SYMES TYPE PTB BRIM DESIGN S 189.51 L5634 SYMES TYPE POSTER OPENING SO 325.26 L5636 SYMES TYPE MEDIAL OPENING SO 204.34 L5637 BELOW KNEE TOTAL CONTACT 307.69 L5638 BELOW KNEE LEATHER SOCKET 520.39 L5639 BELOW KNEE WOOD SOCKET 1198.87 L5640 KNEE DISARTICULAT LEATHER SO 622.22 L5642 ABOVE KNEE LEATHER SOCKET 496.87 L5643 HIP FLEX INNER SOCKET EXT FR 1248.22 L5644 ABOVE KNEE WOOD SOCKET 473.68 L5645 BK FLEX INNER SOCKET EXT FRA 724.32 L5646 BELOW KNEE CUSHION SOCKET 439.41 L5647 BELOW KNEE SUCTION SOCKET 850.58 L5648 ABOVE KNEE CUSHION SOCKET 528.00 L5649 ISCH CONTAINMT/NARROW M-L SO 1536.84 L5650 TOT CONTACT AK/KNEE DISART S 522.01 L5651 AK FLEX INNER SOCKET EXT FRA 963.10 L5652 SUCTION SUSP AK/KNEE DISART 349.64 L5653 KNEE DISART EXPAND WALL SOCK 522.47 L5654 SOCKET INSERT SYMES 326.77 L5655 SOCKET INSERT BELOW KNEE 283.62 L5656 SOCKET INSERT KNEE ARTICULAT 396.66 L5658 SOCKET INSERT ABOVE KNEE 301.88 L5661 MULTI-DUROMETER SYMES 603.22 L5665 MULTI-DUROMETER BELOW KNEE 547.51 L5666 BELOW KNEE CUFF SUSPENSION 74.85 Proc Code Description Mod Rate L5668 BK MOLDED DISTAL CUSHION 107.98 L5670 BK MOLDED SUPRACONDYLAR SUSP 290.15 L5671 BK/AK LOCKING MECHANISM 531.87 L5672 BK REMOVABLE MEDIAL BRIM SUS 252.77 L5673 SOCKET INSERT W LOCK MECH 628.41 L5676 BK KNEE JOINTS SINGLE AXIS P 387.48 L5677 BK KNEE JOINTS POLYCENTRIC P 527.22 L5678 BK JOINT COVERS PAIR 42.46 L5679 SOCKET INSERT W/O LOCK MECH 523.67 L5680 BK THIGH LACER NON-MOLDED 255.75 L5681 INTL CUSTM CONG/LATYP INSERT 1035.59 L5682 BK THIGH LACER GLUT/ISCHIA M 668.73 L5683 INITIAL CUSTOM SOCKET INSERT 1035.59 L5684 BK FORK STRAP 51.46 L5686 BK BACK CHECK 49.79 L5688 BK WAIST BELT WEBBING 65.31 L5690 BK WAIST BELT PADDED AND LIN 104.63 L5692 AK PELVIC CONTROL BELT LIGHT 142.08 L5694 AK PELVIC CONTROL BELT PAD/L 193.98 L5695 AK SLEEVE SUSP NEOPRENE/EQUA 174.38 L5696 AK/KNEE DISARTIC PELVIC JOIN 197.84 L5697 AK/KNEE DISARTIC PELVIC BAND 85.84 L5698 AK/KNEE DISARTIC SILESIAN BA 110.02 L5699 SHOULDER HARNESS 199.37 L5700 REPLACE SOCKET BELOW KNEE 2928.30 L5701 REPLACE SOCKET ABOVE KNEE 3635.72 L5702 REPLACE SOCKET HIP 4645.70 L5703 SYMES ANKLE W/O (SACH) FOOT 1930.50 L5704 CUSTOM SHAPE COVER BK 489.05 L5705 CUSTOM SHAPE COVER AK 802.86 L5706 CUSTOM SHAPE CVR KNEE DISART 795.73 L5707 CUSTOM SHAPE CVR HIP DISART 1131.18 L5710 KNE-SHIN EXO SNG AXI MNL LOC 384.58 L5711 KNEE-SHIN EXO MNL LOCK ULTRA 558.34 L5712 KNEE-SHIN EXO FRICT SWG & ST 460.75 L5714 KNEE-SHIN EXO VARIABLE FRICT 400.43 L5716 KNEE-SHIN EXO MECH STANCE PH 779.34 L5718 KNEE-SHIN EXO FRCT SWG & STA 974.09 L5722 KNEE-SHIN PNEUM SWG FRCT EXO 870.17 L5724 KNEE-SHIN EXO FLUID SWING PH 1546.65 L5726 KNEE-SHIN EXT JNTS FLD SWG E 1581.69 L5728 KNEE-SHIN FLUID SWG & STANCE 2544.37 L5780 KNEE-SHIN PNEUM/HYDRA PNEUM 1224.24 L5781 LOWER LIMB PROS VACUUM PUMP 3150.08 L5785 EXOSKELETAL BK ULTRALT MATER 440.52 L5790 EXOSKELETAL AK ULTRA-LIGHT M 709.25 Proc Code Description Mod Rate L5795 EXOSKEL HIP ULTRA-LIGHT MATE 894.98 L5810 ENDOSKEL KNEE-SHIN MNL LOCK 520.60 L5811 ENDO KNEE-SHIN MNL LCK ULTRA 779.85 L5812 ENDO KNEE-SHIN FRCT SWG & ST 604.46 L5814 ENDO KNEE-SHIN HYDRAL SWG PH 2923.91 L5816 ENDO KNEE-SHIN POLYC MCH STA 909.37 L5818 ENDO KNEE-SHIN FRCT SWG & ST 1026.87 L5822 ENDO KNEE-SHIN PNEUM SWG FRC 1365.67 L5824 ENDO KNEE-SHIN FLUID SWING P 1639.82 L5826 MINIATURE KNEE JOINT 2458.64 L5828 ENDO KNEE-SHIN FLUID SWG/STA 2933.64 L5830 ENDO KNEE-SHIN PNEUM/SWG PHA 2029.01 L5840 MULTI-AXIAL KNEE/SHIN SYSTEM 3236.89 L5845 KNEE-SHIN SYS STANCE FLEXION 1411.11 L5848 KNEE-SHIN SYS HYDRAUL STANCE 846.60 L5850 ENDO AK/HIP KNEE EXTENS ASSI 102.59 L5855 MECH HIP EXTENSION ASSIST 330.23 L5858 STANCE PHASE ONLY 14631.97 L5910 ENDO BELOW KNEE ALIGNABLE SY 290.45 L5920 ENDO AK/HIP ALIGNABLE SYSTEM 425.51 L5925 ABOVE KNEE MANUAL LOCK 349.76 L5930 HIGH ACTIVITY KNEE FRAME 2649.95 L5940 ENDO BK ULTRA-LIGHT MATERIAL 427.54 L5950 ENDO AK ULTRA-LIGHT MATERIAL 623.94 L5960 ENDO HIP ULTRA-LIGHT MATERIA 773.13 L5961 ENDO POLY HIP, PNEU/HYD/ROT ADDIT 0.00 L5962 BELOW KNEE FLEX COVER SYSTEM 628.52 L5964 ABOVE KNEE FLEX COVER SYSTEM 904.80 L5966 HIP FLEXIBLE COVER SYSTEM 1173.04 L5968 MULTIAXIAL ANKLE W DORSIFLEX 2860.96 L5970 FOOT EXTERNAL KEEL SACH FOOT 204.90 L5971 SACH FOOT, REPLACEMENT 204.90 L5972 FLEXIBLE KEEL FOOT 376.85 L5974 FOOT SINGLE AXIS ANKLE/FOOT 249.17 L5975 COMBO ANKLE/FOOT PROSTHESIS 364.98 L5976 ENERGY STORING FOOT 598.83 L5978 FT PROSTH MULTIAXIAL ANKL/FT 312.05 L5979 MULTI-AXIAL ANKLE/FT PROSTH 2417.33 L5980 FLEX FOOT SYSTEM 3384.57 L5981 FLEX-WALK SYS LOW EXT PROSTH 2626.94 L5982 EXOSKELETAL AXIAL ROTATION U 618.17 L5984 ENDOSKELETAL AXIAL ROTATION 609.15 L5985 LWR EXT DYNAMIC PROSTH PYLON 222.32 L5986 MULTI-AXIAL ROTATION UNIT 677.59 L5987 SHANK FT W VERT LOAD PYLON 5663.57 L5988 VERTICAL SHOCK REDUCING PYLO 1572.78 Proc Code Description Mod Rate L5990 USER ADJUSTABLE HEEL HEIGHT 1428.31 L5999 LOWR EXTREMITY PROSTHES NOS 1420.76 L6010 PART HAND LITTLE/RING 1581.07 L6020 PART HAND NO FINGERS 1474.10 L6050 WRST MLD SCK FLX HNG TRI PAD 2024.81 L6055 WRST MOLD SOCK W/EXP INTERFA 2596.73 L6100 ELB MOLD SOCK FLEX HINGE PAD 1685.00 L6110 ELBOW MOLD SOCK SUSPENSION T 2182.18 L6120 ELBOW MOLD DOUB SPLT SOC STE 2477.81 L6130 ELBOW STUMP ACTIVATED LOCK H 2768.09 L6200 ELBOW MOLD OUTSID LOCK HINGE 2917.12 L6205 ELBOW MOLDED W/ EXPAND INTER 3560.93 L6250 ELBOW INTER LOC ELBOW FORARM 2871.42 L6300 SHLDER DISART INT LOCK ELBOW 3983.78 L6310 SHOULDER PASSIVE RESTOR COMP 3244.87 L6320 SHOULDER PASSIVE RESTOR CAP 1827.35 L6350 THORACIC INTERN LOCK ELBOW 4156.76 L6360 THORACIC PASSIVE RESTOR COMP 3405.88 L6370 THORACIC PASSIVE RESTOR CAP 2171.81 L6380 POSTOP DSG CAST CHG WRST/ELB 1037.38 L6382 POSTOP DSG CAST CHG ELB DIS/ 1305.03 L6384 POSTOP DSG CAST CHG SHLDER/T 1692.25 L6386 POSTOP EA CAST CHG & REALIGN 429.41 L6388 POSTOP APPLICAT RIGID DSG ON 438.41 L6400 BELOW ELBOW PROSTH TISS SHAP 2481.18 L6450 ELB DISART PROSTH TISS SHAP 3024.44 L6500 ABOVE ELBOW PROSTH TISS SHAP 2749.48 L6550 SHLDR DISAR PROSTH TISS SHAP 4077.47 L6570 SCAP THORAC PROSTH TISS SHAP 4680.15 L6580 WRIST/ELBOW BOWDEN CABLE MOL 1433.23 L6582 WRIST/ELBOW BOWDEN CBL DIR F 1103.75 L6584 ELBOW FAIR LEAD CABLE MOLDED 1791.95 L6586 ELBOW FAIR LEAD CABLE DIR FO 1524.30 L6588 SHDR FAIR LEAD CABLE MOLDED 2593.27 L6590 SHDR FAIR LEAD CABLE DIRECT 2278.38 L6600 POLYCENTRIC HINGE PAIR 200.57 L6605 SINGLE PIVOT HINGE PAIR 198.05 L6610 FLEXIBLE METAL HINGE PAIR 178.02 L6611 ADDITIONAL SWITCH EXT POWER 364.58 L6615 DISCONNECT LOCKING WRIST UNI 146.93 L6616 DISCONNECT INSERT LOCKING WR 52.02 L6620 FLEXION/EXTENSION WRIST UNIT 306.47 L6621 FLEX/EXT WRIST W/WO FRICTION 1800.78 L6623 SPRING-ASS ROT WRST W/ LATCH 514.43 L6624 FLEX/EXT/ROTATION WRIST UNIT 3334.81 L6625 ROTATION WRST W/ CABLE LOCK 568.71 Proc Code Description Mod Rate L6628 QUICK DISCONN HOOK ADAPTER O 384.18 L6629 LAMINATION COLLAR W/ COUPLIN 140.43 L6630 STAINLESS STEEL ANY WRIST 172.84 L6632 LATEX SUSPENSION SLEEVE EACH 52.10 L6635 LIFT ASSIST FOR ELBOW 188.33 L6637 NUDGE CONTROL ELBOW LOCK 343.89 L6638 ELEC LOCK ON MANUAL PW ELBOW 1968.81 L6640 SHOULDER ABDUCTION JOINT PAI 224.64 L6641 EXCURSION AMPLIFIER PULLEY T 161.11 L6642 EXCURSION AMPLIFIER LEVER TY 208.95 L6645 SHOULDER FLEXION-ABDUCTION J 341.35 L6646 MULTIPO LOCKING SHOULDER JNT 2483.11 L6647 SHOULDER LOCK ACTUATOR 408.79 L6648 EXT PWRD SHLDER LOCK/UNLOCK 2560.98 L6650 SHOULDER UNIVERSAL JOINT 361.94 L6655 STANDARD CONTROL CABLE EXTRA 80.32 L6660 HEAVY DUTY CONTROL CABLE 98.15 L6665 TEFLON OR EQUAL CABLE LINING 39.77 L6670 HOOK TO HAND CABLE ADAPTER 51.28 L6672 HARNESS CHEST/SHLDER SADDLE 180.30 L6675 HARNESS FIGURE OF 8 SING CON 122.42 L6676 HARNESS FIGURE OF 8 DUAL CON 129.68 L6677 UE TRIPLE CONTROL HARNESS 233.54 L6680 TEST SOCK WRIST DISART/BEL E 248.09 L6682 TEST SOCK ELBW DISART/ABOVE 247.03 L6684 TEST SOCKET SHLDR DISART/THO 372.73 L6686 SUCTION SOCKET 631.27 L6687 FRAME TYP SOCKET BEL ELBOW/W 467.87 L6688 FRAME TYP SOCK ABOVE ELB/DIS 506.84 L6689 FRAME TYP SOCKET SHOULDER DI 577.97 L6690 FRAME TYP SOCK INTERSCAP-THO 669.54 L6691 REMOVABLE INSERT EACH 368.41 L6692 SILICONE GEL INSERT OR EQUAL 597.98 L6693 LOCKINGELBOW FOREARM CNTRBAL 2235.13 L6703 TERM DEV PASSIVE HAND MITT 300.62 L6704 TERM DEV SPORT/REC/WORK ATT 653.14 L6706 TERM DEV MECH HOOK VOL OPEN 360.99 L6707 TERM DEV MECH HOOK VOL CLOSE 1378.40 L6708 TERM DEV MECH HAND VOL OPEN 932.88 L6709 TERM DEV MECH HAND VOL CLOSE 1351.18 L6711 PED TERM DEV, HOOK, VOL OPEN 595.33 L6712 PED TERM DEV, HOOK, VOL CLOS 1096.10 L6713 PED TERM DEV, HAND, VOL OPEN 1383.40 L6714 PED TERM DEV, HAND, VOL CLOS 1171.74 L6715 "Term device multi art digit" 342.54 L6721 HOOK/HAND, HVY DTY, VOL OPEN 2082.62 Proc Code Description Mod Rate L6722 HOOK/HAND, HVY DTY, VOL CLOS 1795.38 L6805 TERM DEV MODIFIER WRIST UNIT 339.57 L6810 TERM DEV PRECISION PINCH DEV 174.55 L6880 Elec hand ind art digits 494.41 L6881 TERM DEV AUTO GRASP FEATURE 3218.65 L6882 MICROPROCESSOR CONTROL UPLMB 2441.49 L6883 REPLC SOCKT BELOW E/W DISA 1378.59 L6884 REPLC SOCKT ABOVE ELBOW DISA 2387.21 L6885 REPLC SOCKT SHLDR DIS/INTERC 3405.88 L6890 PREFAB GLOVE FOR TERM DEVICE 181.87 L6895 CUSTOM GLOVE FOR TERM DEVICE 447.81 L6900 HAND RESTORAT THUMB/1 FINGER 1608.83 L6905 HAND RESTORATION MULTIPLE FI 1569.94 L6910 HAND RESTORATION NO FINGERS 1529.45 L6915 HAND RESTORATION REPLACMNT G 647.52 L7360 SIX VOLT BAT OTTO BOCK/EQ EA 194.82 L7362 BATTERY CHRGR SIX VOLT OTTO 207.03 L7364 TWELVE VOLT BATTERY UTAH/EQU 380.92 L7366 BATTERY CHRGR 12 VOLT UTAH/E 492.16 L7367 REPLACEMNT LITHIUM IONBATTER 306.51 L7368 LITHIUM ION BATTERY CHARGER 397.34 L7400 ADD UE PROST BE/WD, ULTLITE 241.29 L7401 ADD UE PROST A/E ULTLITE MAT 270.12 L7402 ADD UE PROST S/D ULTLITE MAT 291.72 L7403 ADD UE PROST B/E ACRYLIC 289.93 L7404 ADD UE PROST A/E ACRYLIC 437.58 L7405 ADD UE PROST S/D ACRYLIC 572.30 L7499 UPPER EXTREMITY PROSTHES NOS 426.30 L7510 PROSTHETIC DEVICE REPAIR REP 8.00 L7520 REPAIR PROSTHESIS PER 15 MIN 8.00 L7600 PROSTHETIC DONNING SLEEVE 0.00 L8000 MASTECTOMY BRA 39.04 L8001 BREAST PROSTHESIS BRA & FORM 98.74 L8002 BRST PRSTH BRA & BILAT FORM 129.88 L8010 MASTECTOMY SLEEVE 47.19 L8015 EXT BREASTPROSTHESIS GARMENT 47.19 L8020 MASTECTOMY FORM 167.64 L8030 BREAST PROSTHES W/O ADHESIVE 306.28 L8035 CUSTOM BREAST PROSTHESIS 2884.35 L8039 BREAST PROSTHESIS NOS 0.00 L8040 NASAL PROSTHESIS 2062.29 L8041 MIDFACIAL PROSTHESIS 2485.87 L8042 ORBITAL PROSTHESIS 2793.11 L8043 UPPER FACIAL PROSTHESIS 3128.29 L8044 HEMI-FACIAL PROSTHESIS 3463.45 L8045 AURICULAR PROSTHESIS 2176.85 Proc Code Description Mod Rate L8046 PARTIAL FACIAL PROSTHESIS 2234.49 L8047 NASAL SEPTAL PROSTHESIS 1145.16 L8049 REPAIR MAXILLOFACIAL PROSTH 8.00 L8300 TRUSS SINGLE W/ STANDARD PAD 90.20 L8310 TRUSS DOUBLE W/ STANDARD PAD 142.41 L8320 TRUSS ADDITION TO STD PAD WA 57.16 L8330 TRUSS ADD TO STD PAD SCROTAL 52.79 L8400 SHEATH BELOW KNEE 16.83 L8410 SHEATH ABOVE KNEE 21.72 L8415 SHEATH UPPER LIMB 19.20 L8417 PROS SHEATH/SOCK W GEL CUSHN 59.20 L8420 PROSTHETIC SOCK MULTI PLY BK 20.80 L8430 PROSTHETIC SOCK MULTI PLY AK 22.32 L8435 PROS SOCK MULTI PLY UPPER LM 20.72 L8440 SHRINKER BELOW KNEE 44.72 L8460 SHRINKER ABOVE KNEE 71.27 L8465 SHRINKER UPPER LIMB 39.12 L8470 PROS SOCK SINGLE PLY BK 7.14 L8480 PROS SOCK SINGLE PLY AK 8.51 L8485 PROS SOCK SINGLE PLY UPPER L 11.53 L8499 UNLISTED MISC PROSTHETIC SER 0.00 L8500 ARTIFICIAL LARYNX 529.27 L8501 TRACHEOSTOMY SPEAKING VALVE 96.88 L8507 TRACH-ESOPH VOICE PROS PT IN 32.98 L8509 TRACH-ESOPH VOICE PROS MD IN 85.98 L8600 IMPLANT BREAST SILICONE/EQ 545.82 L8603 COLLAGEN IMP URINARY 2.5 ML 351.66 L8604 DEXTRANMER/HYALURONIC ACID 0.00 L8606 SYNTHETIC IMPLNT URINARY 1ML 182.61 L8610 OCULAR IMPLANT 469.40 L8612 AQUEOUS SHUNT PROSTHESIS 638.02 L8613 OSSICULAR IMPLANT 236.84 L8614 COCHLEAR DEVICE 15819.35 L8619 COCH IMP EXT PROC/CONTR RPLC 6791.15 L8627 CID EXT SPEECH PROCESS REPL 6487.90 L8628 CID EXT CONTROLLER REPL 1150.21 L8629 CID TRANSMIT COIL AND CABLE 0.00 L8630 METACARPOPHALANGEAL IMPLANT 270.19 L8641 METATARSAL JOINT IMPLANT 283.93 L8642 HALLUX IMPLANT 277.80 L8658 INTERPHALANGEAL JOINT SPACER 244.76 L8670 VASCULAR GRAFT, SYNTHETIC 446.41 L8690 AUD OSSEO DEV INT/EXT COMP 3748.14 L8691 OSSEOINTEGRATED SND PROC RPL 2100.96 L8692 NON-OSSEOINTEGRATED SND PROC 0.00 L8693 AUD OSSEO DEV, ABUTMENT AUDIT 1341.32 Proc Code Description Mod Rate L8695 EXTERNAL RECHARG SYS EXTERN 13.67 L9900 O&P SUPPLY/ACCESSORY/SERVICE 0.00 Q0081 INFUSION THER OTHER THAN CHE 52.83 Q0084 CHEMOTHERAPY BY INFUSION 166.41 Q0091 OBTAINING SCREEN PAP SMEAR 19.74 Q2034 AGRIFLU VACCINE 0.00 Q3001 BRACHYTHERAPY RADIOELEMENTS 47.57 Q3014 TELEHEALTH FACILITY FEE 24.24 Q4001 CAST SUP BODY CAST PLASTER 161.73 Q4002 CAST SUP BODY CAST FIBERGLAS 343.60 Q4003 CAST SUP SHOULDER CAST PLSTR 87.70 Q4004 CAST SUP SHOULDER CAST FBRGL 186.17 Q4005 CAST SUP LONG ARM ADULT PLST 48.16 Q4006 CAST SUP LONG ARM ADULT FBRG 102.43 Q4007 CAST SUP LONG ARM PED PLSTER 24.08 Q4008 CAST SUP LONG ARM PED FBRGLS 51.04 Q4009 CAST SUP SHT ARM ADULT PLSTR 37.02 Q4010 CAST SUP SHT ARM ADULT FBRGL 79.43 Q4011 CAST SUP SHT ARM PED PLASTER 18.69 Q4012 CAST SUP SHT ARM PED FBRGLAS 39.54 Q4013 CAST SUP GAUNTLET PLASTER 34.86 Q4014 CAST SUP GAUNTLET FIBERGLASS 74.76 Q4015 CAST SUP GAUNTLET PED PLSTER 17.61 Q4016 CAST SUP GAUNTLET PED FBRGLS 37.38 Q4017 CAST SUP LNG ARM SPLINT PLST 30.55 Q4018 CAST SUP LNG ARM SPLINT FBRG 65.05 Q4019 CAST SUP LNG ARM SPLNT PED P 15.45 Q4020 CAST SUP LNG ARM SPLNT PED F 32.71 Q4021 CAST SUP SHT ARM SPLINT PLST 30.55 Q4022 CAST SUP SHT ARM SPLINT FBRG 65.05 Q4023 CAST SUP SHT ARM SPLNT PED P 15.45 Q4024 CAST SUP SHT ARM SPLNT PED F 32.71 Q4025 CAST SUP HIP SPICA PLASTER 135.86 Q4026 CAST SUP HIP SPICA FIBERGLAS 288.97 Q4027 CAST SUP HIP SPICA PED PLSTR 67.93 Q4028 CAST SUP HIP SPICA PED FBRGL 144.48 Q4029 CAST SUP LONG LEG PLASTER 66.85 Q4030 CAST SUP LONG LEG FIBERGLASS 142.33 Q4031 CAST SUP LNG LEG PED PLASTER 33.43 Q4032 CAST SUP LNG LEG PED FBRGLS 71.16 Q4033 CAST SUP LNG LEG CYLINDER PL 57.15 Q4034 CAST SUP LNG LEG CYLINDER FB 121.12 Q4035 CAST SUP LNGLEG CYLNDR PED P 28.39 Q4036 CAST SUP LNGLEG CYLNDR PED F 60.38 Q4037 CAST SUP SHRT LEG PLASTER 76.55 Q4038 CAST SUP SHRT LEG FIBERGLASS 163.17 Proc Code Description Mod Rate Q4039 CAST SUP SHRT LEG PED PLSTER 38.10 Q4040 CAST SUP SHRT LEG PED FBRGLS 81.59 Q4041 CAST SUP LNG LEG SPLNT PLSTR 43.85 Q4042 CAST SUP LNG LEG SPLNT FBRGL 93.09 Q4043 CAST SUP LNG LEG SPLNT PED P 21.92 Q4044 CAST SUP LNG LEG SPLNT PED F 46.72 Q4045 CAST SUP SHT LEG SPLNT PLSTR 28.39 Q4046 CAST SUP SHT LEG SPLNT FBRGL 60.38 Q4047 CAST SUP SHT LEG SPLNT PED P 14.02 Q4048 CAST SUP SHT LEG SPLNT PED F 30.19 Q4049 FINGER SPLINT, STATIC 37.38 Q4050 CAST SUPPLIES UNLISTED 0.00 Q4051 SPLINT SUPPLIES MISC 0.00 Q4101 APLIGRAF 31.39 Q4102 OASIS WOUND MATRIX 4.35 Q4105 INTEGRA DRT 11.87 Q4106 DERMAGRAFT 38.45 Q4116 ALLODERM 34.30 Q4141 Alloskin ac 1 cm 0.00 Q9951 LOCM >= 400 MG/ML IODINE,1ML 0.55 Q9953 INJ FE-BASED MR CONTRAST,1ML 10.73 Q9954 ORAL MR CONTRAST, 100 ML 10.35 Q9955 INJ PERFLEXANE LIP MICROS,ML 55.27 Q9956 INJ OCTAFLUOROPROPANE MIC,ML 47.89 Q9957 INJ PERFLUTREN LIP MICROS,ML 81.10 Q9958 HOCM <=149 MG/ML IODINE, 1ML 0.37 Q9959 HOCM 150-199MG/ML IODINE,1ML 0.38 Q9960 HOCM 200-249MG/ML IODINE,1ML 0.54 Q9961 HOCM 250-299MG/ML IODINE,1ML 0.47 Q9962 HOCM 300-349MG/ML IODINE,1ML 1.07 Q9963 HOCM 350-399MG/ML IODINE,1ML 0.60 Q9964 HOCM>= 400MG/ML IODINE, 1ML 0.72 Q9965 LOCM 100-199MG/ML IODINE,1ML 1.74 Q9966 LOCM 200-299MG/ML IODINE,1ML 1.08 Q9967 LOCM 300-399MG/ML IODINE,1ML 0.77 S0199 MED ABORTION INC ALL EX DRUG 270.00 S2118 TOTAL HIP RESURFACING 0.00 S2225 MYRINGOTOMY LASER-ASSIST 0.00 S2235 IMPLANT AUDITORY BRAIN IMP 518.00 S3000 BILAT DIL RETINAL EXAM 0.00 S5110 FAMILY HOMECARE TRAINING 15M 9.00 S9455 DIABETIC MANAGEMENT PROGRAM, 32.60 S9465 DIABETIC MANAGEMENT PROGRAM, 55.42 T2003 N-ET; ENCOUNTER/TRIP 51.25 V2020 VISION SVCS FRAMES PURCHASES 67.05 V2100 LENS SPHER SINGLE PLANO 4.00 31.41 Proc Code Description Mod Rate V2101 SINGLE VISN SPHERE 4.12-7.00 42.10 V2102 SINGL VISN SPHERE 7.12-20.00 51.06 V2103 SPHEROCYLINDR 4.00D/12-2.00D 29.99 V2104 SPHEROCYLINDR 4.00D/2.12-4D 31.73 V2105 SPHEROCYLINDER 4.00D/4.25-6D 34.80 V2106 SPHEROCYLINDER 4.00D/>6.00D 41.65 V2107 SPHEROCYLINDER 4.25D/12-2D 44.81 V2108 SPHEROCYLINDER 4.25D/2.12-4D 42.61 V2109 SPHEROCYLINDER 4.25D/4.25-6D 47.88 V2110 SPHEROCYLINDER 4.25D/OVER 6D 41.01 V2111 SPHEROCYLINDR 7.25D/.25-2.25 48.35 V2112 SPHEROCYLINDR 7.25D/2.25-4D 50.73 V2113 SPHEROCYLINDR 7.25D/4.25-6D 50.32 V2114 SPHEROCYLINDER OVER 12.00D 54.51 V2115 LENS LENTICULAR BIFOCAL 75.95 V2116 NONASPHERIC LENS BIFOCAL 70.32 V2117 ASPHERIC LENS BIFOCAL 81.75 V2118 LENS ANISEIKONIC SINGLE 75.83 V2121 LENTICULAR LENS, SINGLE 80.96 V2199 LENS SINGLE VISION NOT OTH C 0.00 V2200 LENS SPHER BIFOC PLANO 4.00D 46.95 V2201 LENS SPHERE BIFOCAL 4.12-7.0 57.14 V2202 LENS SPHERE BIFOCAL 7.12-20. 52.73 V2203 LENS SPHCYL BIFOCAL 4.00D/.1 51.06 V2204 LENS SPHCY BIFOCAL 4.00D/2.1 51.82 V2205 LENS SPHCY BIFOCAL 4.00D/4.2 51.18 V2206 LENS SPHCY BIFOCAL 4.00D/OVE 57.49 V2207 LENS SPHCY BIFOCAL 4.25-7D/. 55.83 V2208 LENS SPHCY BIFOCAL 4.25-7/2. 61.50 V2209 LENS SPHCY BIFOCAL 4.25-7/4. 57.70 V2210 LENS SPHCY BIFOCAL 4.25-7/OV 61.54 V2211 LENS SPHCY BIFO 7.25-12/.25- 74.75 V2212 LENS SPHCYL BIFO 7.25-12/2.2 70.16 V2213 LENS SPHCYL BIFO 7.25-12/4.2 65.35 V2214 LENS SPHCYL BIFOCAL OVER 12. 73.91 V2215 LENS LENTICULAR BIFOCAL 90.89 V2216 LENS LENTICULAR NONASPHERIC 98.43 V2217 LENS LENTICULAR ASPHERIC BIF 93.02 V2218 LENS ANISEIKONIC BIFOCAL 87.26 V2219 LENS BIFOCAL SEG WIDTH OVER 35.71 V2220 LENS BIFOCAL ADD OVER 3.25D 33.75 V2221 LENTICULAR LENS, BIFOCAL 94.45 V2299 LENS BIFOCAL SPECIALITY 0.00 V2300 LENS SPHERE TRIFOCAL 4.00D 58.10 V2301 LENS SPHERE TRIFOCAL 4.12-7. 71.51 V2302 LENS SPHERE TRIFOCAL 7.12-20 65.76 Proc Code Description Mod Rate V2303 LENS SPHCY TRIFOCAL 4.0/.12- 62.65 V2304 LENS SPHCY TRIFOCAL 4.0/2.25 65.01 V2305 LENS SPHCY TRIFOCAL 4.0/4.25 65.19 V2306 LENS SPHCYL TRIFOCAL 4.00/>6 65.73 V2307 LENS SPHCY TRIFOCAL 4.25-7/. 70.40 V2308 LENS SPHC TRIFOCAL 4.25-7/2. 68.68 V2309 LENS SPHC TRIFOCAL 4.25-7/4. 83.14 V2310 LENS SPHC TRIFOCAL 4.25-7/>6 70.23 V2311 LENS SPHC TRIFO 7.25-12/.25- 85.98 V2312 LENS SPHC TRIFO 7.25-12/2.25 95.82 V2313 LENS SPHC TRIFO 7.25-12/4.25 107.01 V2314 LENS SPHCYL TRIFOCAL OVER 12 99.33 V2315 LENS LENTICULAR TRIFOCAL 123.23 V2316 LENS LENTICULAR NONASPHERIC 119.62 V2317 LENS LENTICULAR ASPHERIC TRI 114.40 V2318 LENS ANISEIKONIC TRIFOCAL 156.85 V2319 LENS TRIFOCAL SEG WIDTH > 28 39.82 V2320 LENS TRIFOCAL ADD OVER 3.25D 42.02 V2321 LENTICULAR LENS, TRIFOCAL 116.92 V2399 LENS TRIFOCAL SPECIALITY 0.00 V2410 LENS VARIAB ASPHERICITY SING 95.88 V2430 LENS VARIABLE ASPHERICITY BI 115.55 V2499 VARIABLE ASPHERICITY LENS 0.00 V2500 CONTACT LENS PMMA SPHERICAL 70.52 V2501 CNTCT LENS PMMA-TORIC/PRISM 110.91 V2502 CONTACT LENS PMMA BIFOCAL 162.28 V2503 CNTCT LENS PMMA COLOR VISION 112.65 V2510 CNTCT GAS PERMEABLE SPHERICL 94.80 V2511 CNTCT TORIC PRISM BALLAST 153.22 V2512 CNTCT LENS GAS PERMBL BIFOCL 177.88 V2513 CONTACT LENS EXTENDED WEAR 163.20 V2520 CONTACT LENS HYDROPHILIC 83.64 V2521 CNTCT LENS HYDROPHILIC TORIC 145.61 V2522 CNTCT LENS HYDROPHIL BIFOCL 188.95 V2523 CNTCT LENS HYDROPHIL EXTEND 120.76 V2530 CONTACT LENS GAS IMPERMEABLE 178.86 V2531 CONTACT LENS GAS PERMEABLE 426.30 V2599 CONTACT LENS/ES OTHER TYPE 0.00 V2600 HAND HELD LOW VISION AIDS 0.00 V2610 SINGLE LENS SPECTACLE MOUNT 0.00 V2615 TELESCOP/OTHR COMPOUND LENS 0.00 V2630 ANTER CHAMBER INTRAOCUL LENS 0.00 V2632 POST CHMBR INTRAOCULAR LENS 0.00 V2700 BALANCE LENS 46.85 V2710 GLASS/PLASTIC SLAB OFF PRISM 64.93 V2715 PRISM LENS/ES 12.43 Proc Code Description Mod Rate V2718 FRESNELL PRISM PRESS-ON LENS 30.53 V2730 SPECIAL BASE CURVE 21.91 V2744 TINT PHOTOCHROMATIC LENS/ES 13.16 V2745 TINT, ANY COLOR/SOLID/GRAD 8.52 V2750 ANTI-REFLECTIVE COATING 19.16 V2755 UV LENS/ES 13.32 V2760 SCRATCH RESISTANT COATING 17.13 V2762 POLARIZATION, ANY LENS 46.92 V2770 OCCLUDER LENS/ES 20.87 V2780 OVERSIZE LENS/ES 13.40 V2781 PROGRESSIVE LENS PER LENS 0.00 V2782 LENS, 1.54-1.65 P/1.60-1.79G 50.68 V2783 LENS, >= 1.66 P/>=1.80 G 57.14 V2784 LENS POLYCARB OR EQUAL 37.16 V2785 CORNEAL TISSUE PROCESSING 0.00 V2786 OCCUPATIONAL MULTIFOCAL LENS 0.00 V2790 AMNIOTIC MEMBRANE 0.00 V2797 VIS ITEM/SVC IN OTHER CODE 0.00 V2799 MISC VISION ITEM OR SERVICE 0.00