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123-16 Report Detailing the Medicaid and Children's Health Insurance

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123-16 Report Detailing the Medicaid and Children's Health Insurance 123-16 Division of Health Care Financing & Policy SB 278 Section 16 - Physician Rates Reporting Facility & Non-Facility Rate Comparison Nevada 2015 2015 Medicaid Medicaid Medicaid Medicare Medicare vs. vs. Procedure Code & Description Rates (1) Non-Facility Facility Medicare Medicare Rates for Rates for Non-Facility Facility 10021 FNA W/O IMAGE 70.92 156.25048 72.718169 (85.33) (1.80) 10022 FNA W/IMAGE 65.39 148.42288 69.029561 (83.03) (3.64) 10030 Guide cathet fluid drainage 154.73 830.4244 167.43373 (675.69) (12.70) 10040 ACNE SURGERY 87.47 105.60202 92.056241 (18.13) (4.59) 10060 DRAINAGE OF SKIN ABSCESS 95.6 122.24032 101.1691 (26.64) (5.57) 10061 DRAINAGE OF SKIN ABSCESS 178.04 214.99146 187.52363 (36.95) (9.48) 10080 DRAINAGE OF PILONIDAL CYST 103.29 189.06846 108.54632 (85.78) (5.26) 10081 DRAINAGE OF PILONIDAL CYST 172.45 281.03412 176.80687 (108.58) (4.36) 10120 REMOVE FOREIGN BODY 103.22 159.79337 108.62043 (56.57) (5.40) 10121 REMOVE FOREIGN BODY 185.58 286.15943 193.22033 (100.58) (7.64) 10140 DRAINAGE OF HEMATOMA/FLUID 118.06 170.74141 124.08373 (52.68) (6.02) 10160 PUNCTURE DRAINAGE OF LESION 95.62 136.01415 100.64461 (40.39) (5.02) 10180 COMPLEX DRAINAGE WOUND 178.97 258.01567 187.2766 (79.05) (8.31) 11000 DEBRIDE INFECTED SKIN 28.42 56.834206 29.742646 (28.41) (1.32) 11001 DEBRIDE INFECTED SKIN ADD-ON 14.22 21.656564 14.507403 (7.44) (0.29) 11004 DEBRIDE GENITALIA & PERINEUM 579.35 605.04269 605.04269 (25.69) (25.69) 11005 DEBRIDE ABDOM WALL 781.65 816.37812 816.37812 (34.73) (34.73) 11006 DEBRIDE GENIT/PER/ABDOM WALL 702.26 732.5909 732.5909 (30.33) (30.33) 11008 REMOVE MESH FROM ABD WALL 274.06 287.08024 287.08024 (13.02) (13.02) 11010 DEBRIDE SKIN AT FX SITE 278.3 515.0912 292.71465 (236.79) (14.41) 11011 DEBRIDE SKIN MUSC AT FX SITE 301.71 551.43955 309.87314 (249.73) (8.16) 11012 DEB SKIN BONE AT FX SITE 426.17 742.88485 444.50142 (316.71) (18.33) 11042 DEB SUBQ TISSUE 20 SQ CM/< 61.54 122.23459 64.288752 (60.69) (2.75) 11043 DEB MUSC/FASCIA 20 SQ CM/< 157.36 237.33469 161.70409 (79.97) (4.34) 11044 DEB BONE 20 SQ CM/< 234.59 328.07846 241.53598 (93.49) (6.95) 11045 DEB SUBQ TISSUE ADD-ON 27.63 42.651163 27.224025 (15.02) 0.41 11046 DEB MUSC/FASCIA ADD-ON 56.21 76.123588 58.43882 (19.91) (2.23) 11047 DEB BONE ADD-ON 100.66 128.31651 103.10631 (27.66) (2.45) 11055 TRIM SKIN LESION 15.9 49.794596 16.68269 (33.89) (0.78) 11056 TRIM SKIN LESIONS 2 TO 4 22.47 60.811014 23.56012 (38.34) (1.09) 11057 TRIM SKIN LESIONS OVER 4 29.39 68.440987 30.813821 (39.05) (1.42) 11100 BIOPSY SKIN LESION 48.61 107.5625 50.369207 (58.95) (1.76) 11101 BIOPSY SKIN ADD-ON 24.46 33.818266 25.916561 (9.36) (1.46) 11200 REMOVAL OF SKIN TAGS <W/15 73 91.742621 76.315483 (18.74) (3.32) 11201 REMOVE SKIN TAGS ADD-ON 16.77 19.3907 17.13307 (2.62) (0.36) 11300 SHAVE SKIN LESION 0.5 CM/< 34.94 101.9374 36.46613 (67.00) (1.53) 11301 SHAVE SKIN LESION 0.6-1.0 CM 53.11 124.69808 55.46409 (71.59) (2.35) 11302 SHAVE SKIN LESION 1.1-2.0 CM 62.2 146.97794 64.950718 (84.78) (2.75) 11303 SHAVE SKIN LESION >2.0 CM 74.11 163.08101 77.66734 (88.97) (3.56) 11305 SHAVE SKIN LESION 0.5 CM/< 38.48 103.13782 40.300449 (64.66) (1.82) 11306 SHAVE SKIN LESION 0.6-1.0 CM 51.56 126.8816 53.508623 (75.32) (1.95) 11307 SHAVE SKIN LESION 1.1-2.0 CM 66.25 148.98854 68.466406 (82.74) (2.22) 11308 SHAVE SKIN LESION >2.0 CM 72.94 156.46206 75.939927 (83.52) (3.00) 11310 SHAVE SKIN LESION 0.5 CM/< 47.19 118.49085 48.880589 (71.30) (1.69) 11311 SHAVE SKIN LESION 0.6-1.0 CM 65 116.34348 68.933255 (51.34) (3.93) 11312 SHAVE SKIN LESION 1.1-2.0 CM 78.37 167.13765 81.347714 (88.77) (2.98) 11313 SHAVE SKIN LESION >2.0 CM 100.38 193.10362 104.30351 (92.72) (3.92) 11400 EXC TR-EXT B9+MARG 0.5 CM< 79.32 129.5649 84.036033 (50.24) (4.72) 11401 EXC TR-EXT B9+MARG 0.6-1 CM 103.18 155.85774 108.82378 (52.68) (5.64) 11402 EXC TR-EXT B9+MARG 1.1-2 CM 113.71 173.16373 119.35688 (59.45) (5.65) 11403 EXC TR-EXT B9+MARG 2.1-3CM/< 146.5 199.81636 153.91122 (53.32) (7.41) 11404 EXC TR-EXT B9+MARG 3.1-4 CM 160.82 226.69133 169.12176 (65.87) (8.30) 11406 EXC TR-EXT B9+MARG >4.0 CM 244.91 326.27622 257.79478 (81.37) (12.88) 11420 EXC H-F-NK-SP B9+MARG 0.5/< 81.23 127.87043 84.97546 (46.64) (3.75) 11421 EXC H-F-NK-SP B9+MARG 0.6-1 110.4 163.79811 115.25906 (53.40) (4.86) 11422 EXC H-F-NK-SP B9+MARG 1.1-2 134.86 183.27115 142.25754 (48.41) (7.40) 11423 EXC H-F-NK-SP B9+MARG 2.1-3 156.55 211.06907 164.78766 (54.52) (8.24) 11424 EXC H-F-NK-SP B9+MARG 3.1-4 178.52 244.37108 189.05915 (65.85) (10.54) 11426 EXC H-F-NK-SP B9+MARG >4 CM 273.01 346.68618 287.23526 (73.68) (14.23) 11440 EXC FACE-MM B9+MARG 0.5 CM/< 103.53 140.60603 107.87039 (37.08) (4.34) 11441 EXC FACE-MM B9+MARG 0.6-1 CM 131.15 175.31431 137.68715 (44.16) (6.54) 11442 EXC FACE-MM B9+MARG 1.1-2 CM 145.52 195.89147 152.24395 (50.37) (6.72) 11443 EXC FACE-MM B9+MARG 2.1-3 CM 177.64 233.11014 186.07618 (55.47) (8.44) 11444 EXC FACE-MM B9+MARG 3.1-4 CM 226.95 293.42459 238.11266 (66.47) (11.16) 11446 EXC FACE-MM B9+MARG >4 CM 326.08 406.42352 340.19971 (80.34) (14.12) 11450 REMOVAL SWEAT GLAND LESION 250.45 401.24737 265.03702 (150.80) (14.59) 11451 REMOVAL SWEAT GLAND LESION 323.33 505.62176 338.55714 (182.29) (15.23) 11462 REMOVAL SWEAT GLAND LESION 239.27 388.26152 251.6749 (148.99) (12.40) 11463 REMOVAL SWEAT GLAND LESION 326.52 515.45423 341.24045 (188.93) (14.72) 11470 REMOVAL SWEAT GLAND LESION 281.55 429.64138 293.05476 (148.09) (11.50) 11471 REMOVAL SWEAT GLAND LESION 352.3 529.79695 361.97978 (177.50) (9.68) 11600 EXC TR-EXT MAL+MARG 0.5 CM/< 119.51 201.46394 125.08079 (81.95) (5.57) 11601 EXC TR-EXT MAL+MARG 0.6-1 CM 148.23 238.59454 155.81478 (90.36) (7.58) 11602 EXC TR-EXT MAL+MARG 1.1-2 CM 162.64 258.15816 170.86314 (95.52) (8.22) 11603 EXC TR-EXT MAL+MARG 2.1-3 CM 194.07 294.30566 204.00046 (100.24) (9.93) 11604 EXC TR-EXT MAL+MARG 3.1-4 CM 214.78 328.12393 225.02549 (113.34) (10.25) 11606 EXC TR-EXT MAL+MARG >4 CM 319.34 468.67625 333.97099 (149.34) (14.63) 11620 EXC H-F-NK-SP MAL+MARG 0.5/< 121.29 203.6557 126.89628 (82.37) (5.61) 11621 EXC S/N/H/F/G MAL+MRG 0.6-1 148.93 239.70689 156.55085 (90.78) (7.62) 11622 EXC S/N/H/F/G MAL+MRG 1.1-2 170.68 266.90872 179.23742 (96.23) (8.56) 11623 EXC S/N/H/F/G MAL+MRG 2.1-3 211.61 313.22128 222.16354 (101.61) (10.55) 11624 EXC S/N/H/F/G MAL+MRG 3.1-4 239.93 352.77169 251.17834 (112.84) (11.25) 11626 EXC S/N/H/F/G MAL+MRG >4 CM 294.83 425.12433 307.72757 (130.29) (12.90) 11640 EXC F/E/E/N/L MAL+MRG 0.5CM< 125.18 209.27507 131.01056 (84.10) (5.83) 11641 EXC F/E/E/N/L MAL+MRG 0.6-1 155.98 248.16351 163.50239 (92.18) (7.52) 11642 EXC F/E/E/N/L MAL+MRG 1.1-2 183.25 282.64375 192.33855 (99.39) (9.09) 11643 EXC F/E/E/N/L MAL+MRG 2.1-3 230.87 333.65845 241.47189 (102.79) (10.60) 11644 EXC F/E/E/N/L MAL+MRG 3.1-4 285.84 410.43828 297.93305 (124.60) (12.09) 11646 EXC F/E/E/N/L MAL+MRG >4 CM 397.05 536.6264 414.33811 (139.58) (17.29) 11719 TRIM NAIL(S) ANY NUMBER 7.6 14.369926 7.9733075 (6.77) (0.37) 11720 DEBRIDE NAIL 1-5 14.9 33.66432 15.227009 (18.76) (0.33) 11721 DEBRIDE NAIL 6 OR MORE 24.56 46.798385 25.727172 (22.24) (1.17) 11730 REMOVAL OF NAIL PLATE 50.53 102.99533 52.198653 (52.47) (1.67) 11732 REMOVE NAIL PLATE ADD-ON 20.06 37.204711 21.025029 (17.14) (0.97) 11740 DRAIN BLOOD FROM UNDER NAIL 32.76 51.994586 34.309818 (19.23) (1.55) 11750 REMOVAL OF NAIL BED 173.14 233.59346 181.2917 (60.45) (8.15) 11752 REMOVE NAIL BED/TIP 259.66 339.15431 275.5644 (79.49) (15.90) 11755 BIOPSY NAIL UNIT 78.21 139.09843 80.776325 (60.89) (2.57) 11760 REPAIR OF NAIL BED 133.87 240.24462 137.89873 (106.37) (4.03) 11762 RECONSTRUCTION OF NAIL BED 185.05 295.48388 193.89053 (110.43) (8.84) 11765 EXCISION OF NAIL FOLD TOE 93.04 175.745 98.609311 (82.71) (5.57) 11770 REMOVE PILONIDAL CYST SIMPLE 183.77 288.93081 192.60527 (105.16) (8.84) 11771 REMOVE PILONIDAL CYST EXTEN 431.8 598.55227 454.06395 (166.75) (22.26) 11772 REMOVE PILONIDAL CYST COMPL 573.13 727.62884 604.21174 (154.50) (31.08) 11900 INJECT SKIN LESIONS </W 7 31.12 57.693795 32.483594 (26.57) (1.36) 11901 INJECT SKIN LESIONS >7 48.63 72.209432 50.009404 (23.58) (1.38) 11950 TX CONTOUR DEFECTS 1 CC/< 53.2 81.402132 56.19193 (28.20) (2.99) 11951 TX CONTOUR DEFECTS 1.1-5.0CC 76.48 110.05141 78.068315 (33.57) (1.59) 11952 TX CONTOUR DEFECTS 5.1-10CC 100.7 133.21055 99.346101 (32.51) 1.35 11954 TX CONTOUR DEFECTS >10.0 CC 116.38 164.78193 120.0056 (48.40) (3.63) 11960 INSERT TISSUE EXPANDER(S) 934.51 989.48027 989.48027 (54.97) (54.97) 11970 REPLACE TISSUE EXPANDER 616.24 637.53272 637.53272 (21.29) (21.29) 11971 REMOVE TISSUE EXPANDER(S) 322.25 494.2194 335.43276 (171.97) (13.18) 11976 REMOVE CONTRACEPTIVE CAPSULE 97.05 148.91515 98.118475 (51.87) (1.07) 11980 IMPLANT HORMONE PELLET(S) 79.88 97.628713 58.120188 (17.75) 21.76 11981 INSERT DRUG IMPLANT DEVICE 81.34 147.05277 86.473028 (65.71) (5.13) 11982 REMOVE DRUG IMPLANT DEVICE 97.3 166.05073 104.34217 (68.75) (7.04) 11983 REMOVE/INSERT DRUG IMPLANT 168.65 230.93056 181.2627 (62.28) (12.61) 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< 45 93.190068 45.779838 (48.19) (0.78) 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM 59.25 113.99528 60.940973 (54.75) (1.69) 12004 RPR S/N/AX/GEN/TRK7.6-12.5CM 73.87 133.72108 75.775242 (59.85) (1.91) 12005 RPR S/N/A/GEN/TRK12.6-20.0CM 99.98 172.56012 102.19732 (72.58) (2.22) 12006 RPR S/N/A/GEN/TRK20.1-30.0CM 121.24 207.06505 124.66156 (85.83) (3.42) 12007 RPR S/N/AX/GEN/TRNK >30.0 CM 150.62 240.54571 155.50832 (89.93) (4.89) 12011 RPR F/E/E/N/L/M 2.5 CM/< 56.15 114.13526 57.318239 (57.99) (1.17) 12013 RPR F/E/E/N/L/M 2.6-5.0 CM 62.72 125.12698 64.547238 (62.41) (1.83) 12014 RPR
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  • Slide Courtesy of Jeff North, MD
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  • Icd-9-Cm (2010)
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  • SKIN GRAFTS and SKIN SUBSTITUTES James F Thornton MD
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  • Pathology Testing with Mohs Micrographic Surgery
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