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Annex 2. List of Procedure Case Rates (Revision 2.0)

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ANNEX 2. LIST OF PROCEDURE CASE RATES (REVISION 2.0) FIRST CASE RATE RVS CODE DESCRIPTION Health Care Case Rate Professional Fee Institution Fee Integumentary System Skin, Subcutaneous and Accessory Structures Incision and Drainage Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, 10060 3,640 840 2,800 cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia) 10080 Incision and drainage of pilonidal cyst 3,640 840 2,800 10120 Incision and removal of foreign body, subcutaneous tissues 3,640 840 2,800 10140 Incision and drainage of hematoma, seroma, or fluid collection 3,640 840 2,800 10160 Puncture aspiration of abscess, hematoma, bulla, or cyst 3,640 840 2,800 10180 Incision and drainage, complex, postoperative wound infection 5,560 1,260 4,300 Excision - Debridement 11000 Debridement of extensive eczematous or infected skin 10,540 5,040 5,500 Debridement including removal of foreign material associated w/ open 11010 10,540 5,040 5,500 fracture(s) and/or dislocation(s); skin and subcutaneous tissues Debridement including removal of foreign material associated w/ open 11011 fracture(s) and/or dislocation(s); skin, subcutaneous tissue, muscle fascia, 11,980 5,880 6,100 and muscle Debridement including removal of foreign material associated w/ open 11012 fracture(s) and/or dislocation(s); skin, subcutaneous tissue, muscle fascia, 12,120 6,720 5,400 muscle, and bone 11040 Debridement; skin, partial thickness 3,640 840 2,800 11041 Debridement; skin, full thickness 3,640 840 2,800 11042 Debridement; skin, and subcutaneous tissue 5,680 1,680 4,000 11043 Debridement; skin, subcutaneous tissue, and muscle 8,020 2,520 5,500 11044 Debridement; skin, subcutaneous tissue, muscle, and bone 8,020 2,520 5,500 Pairing or Curettement Paring or curettement of benign hyperkeratotic skin lesion w/ or w/o 11050 chemical cauterization (such as verrucae or clavi) not extending through the N/A N/A N/A stratum corneum (e.g., callus or wart) w/ or w/o local anesthesia; single lesion Paring or curettement of benign hyperkeratotic skin lesion w/ or w/o 11051 chemical cauterization (such as verrucae or clavi) not extending through the N/A N/A N/A stratum corneum (e.g., callus or wart) w/ or w/o local anesthesia; two to four lesions Paring or curettement of benign hyperkeratotic skin lesion w/ or w/o 11052 chemical cauterization (such as verrucae or clavi) not extending through the N/A N/A N/A stratum corneum (e.g., callus or wart) w/ or w/o local anesthesia; more than four lesions Biopsy Biopsy of skin, subcutaneous tissue and/or mucous membrane (including 11100 3,640 840 2,800 simple closure), unless otherwise listed; single or multiple lesion Shaving of Epidermal or Dermal Lesions Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; 11300 5,560 1,260 4,300 lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; 11301 3,700 1,344 2,356 lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; 11302 8,020 2,520 5,500 lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; 11303 8,440 2,940 5,500 lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, 11305 5,560 1,260 4,300 genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, 11306 3,700 1,344 2,356 genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, 11307 8,020 2,520 5,500 genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, 11308 8,440 2,940 5,500 genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose 11310 3,700 1,344 2,356 ,lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose 11311 8,020 2,520 5,500 ,lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose 11312 8,440 2,940 5,500 ,lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose 11313 8,260 3,360 4,900 ,lips, mucous membrane; lesion diameter over 2.0 cm Excision-Benign Lesions Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms 11400 3,640 840 2,800 or legs; lesion diameter 0.5 cm or less Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms 11401 3,640 840 2,800 or legs; lesion diameter 0.6 to 1.0 cm Page 1 of 113 ANNEX 2. LIST OF PROCEDURE CASE RATES (REVISION 2.0) FIRST CASE RATE RVS CODE DESCRIPTION Health Care Case Rate Professional Fee Institution Fee Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms 11402 3,640 840 2,800 or legs; lesion diameter 1.1 to 2.0 cm Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms 11403 3,640 840 2,800 or legs; lesion diameter 2.1 to 3.0 cm Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms 11404 3,640 840 2,800 or legs; lesion diameter 3.1 to 4.0 cm Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms 11406 3,640 840 2,800 or legs; lesion diameter over 4.0 cm Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, 11420 3,640 840 2,800 hands, feet, genitalia; lesion diameter 0.5 cm or less Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, 11421 3,640 840 2,800 hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, 11422 3,640 840 2,800 hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, 11423 3,640 840 2,800 hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, 11424 3,640 840 2,800 hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, 11426 3,640 840 2,800 hands, feet, genitalia; lesion diameter over 4.0 cm Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, 11440 4,108 1,008 3,100 nose, lips, mucous membrane; lesion diameter 0.5 cm or less Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, 11441 4,108 1,008 3,100 nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, 11442 4,108 1,008 3,100 nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, 11443 4,108 1,008 3,100 nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, 11444 4,108 1,008 3,100 nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, 11446 4,108 1,008 3,100 nose, lips, mucous membrane; lesion diameter over 4.0 cm 11450 Excision of skin and subcutaneous tissue for hidradenitis, axillary 8,020 2,520 5,500 11462 Excision of skin and subcutaneous tissue for hidradenitis, inguinal 8,020 2,520 5,500 Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal 11470 8,020 2,520 5,500 or umbilical Excision - Malignant Lesions Excision, malignant lesion, trunk, arms, or legs; lesion diameter 0.5 cm or 11600 5,560 1,260 4,300 less 11601 Excision, malignant lesion, trunk, arms, or legs; lesion diameter 0.6 to 1.0 cm 5,560 1,260 4,300 11602 Excision, malignant lesion, trunk, arms, or legs; lesion diameter 1.1 to 2.0 cm 5,560 1,260 4,300 11603 Excision, malignant lesion, trunk, arms, or legs; lesion diameter 2.1 to 3.0 cm 5,560 1,260 4,300 11604 Excision, malignant lesion, trunk, arms, or legs; lesion diameter 3.1 to 4.0 cm 5,560 1,260 4,300 11606 Excision, malignant lesion, trunk, arms, or legs; lesion diameter over 4.0 cm 5,560 1,260 4,300 Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion 11620 5,680 1,680 4,000 diameter 0.5 cm or less Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion 11621 5,680 1,680 4,000 diameter 0.6 to 1.0 cm Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion 11622 5,680 1,680 4,000 diameter 1.1 to 2.0 cm Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion 11623 5,680 1,680 4,000 diameter 2.1 to 3.0 cm Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion 11624 5,680 1,680 4,000 diameter 3.1 to 4.0 cm Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion 11626 5,680 1,680 4,000 diameter over 4.0 cm Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 0.5 11640 5,680 1,680 4,000 cm or less Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 0.6 11641 5,680 1,680 4,000 to 1.0 cm Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 1.1 11642 5,680 1,680 4,000 to 2.0 cm Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 2.1 11643 5,680 1,680 4,000 to 3.0 cm Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 3.1 11644 5,680 1,680 4,000 to 4.0 cm Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 11646 5,680 1,680 4,000 over 4.0 cm Nails Page 2 of 113 ANNEX 2.
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