FSH Chrgmaster 12-2018
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Description Q Code CPTCode Rev Code Cost Markup Flatfee Markup% Billable Billable Fee 300-399 MG/ML IODINE CONCENTRATE Q9967 Q9967 320 50.00 100.00 50.00 ABDOMINO-VAGINAL VESICAL NECK SUSPENSION, WITH OR WITHOUT ENDOSCOPIC 51845 51845 360 100.00 0.00 CONTROL (EG, STAMEY, RAZ, MODIFIED PEREYRA) ABLATION, ONE OR MORE LIVER TUMOR(S), 47382 47382 360 100.00 0.00 PERCUTANEOUS, RADIOFREQUENCY ABLATION, OPEN, OF ONE OR MORE LIVER 47381 47381 360 100.00 0.00 TUMOR(S); CRYOSURGICAL ABLATION, OPEN, OF ONE OR MORE LIVER 47380 47380 360 100.00 0.00 TUMOR(S); RADIOFREQUENCY ABRASION; EACH ADDITIONAL FOUR LESIONS OR LESS (LIST SEPARATELY IN ADDITION TO 15787 15787 360 100.00 0.00 CODE FOR PRIMARY PROCEDURE) ABRASION; SINGLE LESION (EG, KERATOSIS, 15786 15786 360 100.00 0.00 SCAR) ACETABULOPLASTY; (EG, WHITMAN, COLONNA, 27120 27120 360 100.00 0.00 HAYGROVES, OR CUP TYPE) ACETABULOPLASTY; RESECTION, FEMORAL 27122 27122 360 100.00 0.00 HEAD (EG, GIRDLESTONE PROCEDURE) ACETONE OTHER KETONE BODIES 82009 82009 301 60.00 100.00 60.00 ACROMIOPLASTY OR ACROMIONECTOMY, PARTIAL, WITH OR WITHOUT 23130 23130 360 17,250.00 100.00 17,250.00 CORACOACROMIAL LIGAMENT RELEASE ACTH 82024 82024 301 300.00 100.00 300.00 ACUTE HEPATITIS PANEL 80074 80074 300 1,210.00 100.00 1,210.00 ADAPT/EXT, PACING OR NEUROSTIMULATOR C1883-G C1883 278 700.00 0.00 LEAD IMPLANTABLE ADAPTER/EXT, PACING OR NEUROSTIMULATOR C1883-W C1883 278 100.00 0.00 LEAD IMPLANTABLE ADENOIDECTOMY, PRIMARY; AGE 12 OR OVER 42831 42831 360 8,900.00 100.00 8,900.00 ADENOIDECTOMY, PRIMARY; UNDER AGE 12 42830 42830 360 17,100.00 100.00 17,100.00 Description Q Code CPTCode Rev Code Cost Markup Flatfee Markup% Billable Billable Fee ADENOIDECTOMY, SECONDARY; AGE 12 OR 42836 42836 360 8,900.00 100.00 8,900.00 OVER ADENOIDECTOMY, SECONDARY; UNDER AGE 12 42835 42835 360 8,900.00 100.00 8,900.00 ADHESION BARRIER C1765-W C1765 278 100.00 0.00 ADHESION BARRIER C1765-G C1765 278 700.00 0.00 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; DEFECT 30.1 SQ 14301 14301 360 15,400.00 100.00 15,400.00 CM TO 60.0 SQ CM ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; EACH ADDITIONAL 30.0 SQ CM, OR PART THEREOF 14302 14302 360 13,540.00 100.00 13,540.00 (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS 14060 14060 360 10,160.00 100.00 10,160.00 AND/OR LIPS; DEFECT 10 SQ CM OR LESS ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS 14061 14061 360 13,540.00 100.00 13,540.00 AND/OR LIPS; DEFECT 10.1 SQ CM TO 30.0 SQ CM ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, 14040 14040 360 8,470.00 100.00 8,470.00 MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10 SQ CM OR LESS ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, 14041 14041 360 13,630.00 100.00 13,630.00 MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10.1 SQ CM TO 30.0 SQ CM ADJACENT TISSUE TRANSFER OR REARRANGEMENT, MORE THAN 30 SQ CM, 14300 14300 360 100.00 0.00 UNUSUAL OR COMPLICATED, ANY AREA ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; 14020 14020 360 6,770.00 100.00 6,770.00 DEFECT 10 SQ CM OR LESS Description Q Code CPTCode Rev Code Cost Markup Flatfee Markup% Billable Billable Fee ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; 14021 14021 360 10,900.00 100.00 10,900.00 DEFECT 10.1 SQ CM TO 30.0 SQ CM ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM 14000 14000 360 6,770.00 100.00 6,770.00 OR LESS ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM 14001 14001 360 10,160.00 100.00 10,160.00 TO 30.0 SQ CM ADJUSTMENT OR REVISION OF EXTERNAL FIXATION SYSTEM REQUIRING ANESTHESIA (EG, 20693 20693 360 7,500.00 100.00 7,500.00 NEW PIN(S) OR WIRE(S) AND/OR NEW RING(S) OR BAR(S)) ADRENALECTOMY, PARTIAL OR COMPLETE, OR EXPLORATION OF ADRENAL GLAND WITH OR 60540 60540 360 100.00 0.00 WITHOUT BIOPSY, TRANSABDOMINAL, LUMBAR OR DORSAL (SEPARATE PROCEDURE); ADRENALECTOMY, PARTIAL OR COMPLETE, OR EXPLORATION OF ADRENAL GLAND WITH OR 60545 60545 360 100.00 0.00 WITHOUT BIOPSY, TRANSABDOMINAL, LUMBAR OR DORSAL (SEPARATE PROCEDURE); WIT ADVERSE REACTION WORKUP 86078 86900 305 850.00 100.00 850.00 AEROBIC CULTURE, QUANTITATIVE 87071 87071 306 180.00 100.00 180.00 AEROSOL INHALATION PENTAMIDIN 94642 94642 460 800.00 100.00 800.00 AFB STAIN-ACID FAST BACILLUS 87206 87206 306 120.00 100.00 120.00 AFP FRACT ISOFORM/TOT AFP 82107 82107 301 450.00 100.00 450.00 ALBUMIN 82040 82040 301 50.00 100.00 50.00 Albumin; urine or other source, quantitative, each 82042 82042 307 50.00 100.00 50.00 specimen ALCOHOL-ASSAY OF ETHANOL 82055 82055 301 220.00 100.00 220.00 ALK PHOS 84075 84075 301 50.00 100.00 50.00 ALLERGEN SPECIFIC IGE 86003 86003 302 80.00 100.00 80.00 ALLERGEN SPECIFIC IGG 86001 86001 302 60.00 100.00 60.00 ALLOGRAFT FOR SPINE SURGERY ONLY; 20930 20930 360 5,500.00 100.00 5,500.00 MORSELIZED Description Q Code CPTCode Rev Code Cost Markup Flatfee Markup% Billable Billable Fee ALLOGRAFT FOR SPINE SURGERY ONLY; 20931 20931 360 100.00 0.00 STRUCTURAL ALPHA FETOPROTEIN SERUM 82105 82105 301 340.00 100.00 340.00 ALPHA-1 ANTITRYPSIN PHENO 82104 82104 301 410.00 100.00 410.00 ALT SGPT 84460 84460 301 50.00 100.00 50.00 ALVEOLECTOMY, INCLUDING CURETTAGE OF 41830 41830 360 100.00 0.00 OSTEITIS OR SEQUESTRECTOMY ALVEOLOPLASTY, EACH QUADRANT (SPECIFY) 41874 41874 360 100.00 0.00 AMINO ACIDS, MULTIPLE QUALITATIVE, EACH 82128 82128 301 119.91 100.00 119.91 SPECIMEN AMMONIA 82140 82140 180.00 100.00 180.00 AmnioBand or Guardian, per sq cm Q4151-G Q4151 636 700.00 0.00 AmnioBand or Guardian, per sq cm - W Q4151-W Q4151 636 100.00 0.00 Amnioband, 1 mg Q4168-G Q4168 636 700.00 0.00 Amnioband, 1 mg- W Q4168-W Q4168 278 700.00 0.00 AmnioMatrix or BioDMatrix, injectable 1 cc Q4139-W Q4139 278 100.00 0.00 AmnioMatrix or BioDMatrix, injectable, 1 cc Q4139 Q4139 636 700.00 0.00 Amniotic membrane for surgical reconstruction, per V2790-G V2790 278 700.00 0.00 procedure ( Amniotic membrane ) Amniotic membrane for surgical reconstruction, per V2790-W V2790 278 100.00 0.00 procedure ( Amniotic membrane )- W AMPUTATION OF PENIS, RADICAL; IN CONTINUITY WITH BILATERAL PELVIC 54135 54135 360 100.00 0.00 LYMPHADENECTOMY, INCLUDING EXTERNAL ILIAC, HYPOGASTRIC AND OBTURATOR NODES AMPUTATION OF PENIS, RADICAL; WITH BILATERAL INGUINOFEMORAL 54130 54130 360 100.00 0.00 LYMPHADENECTOMY AMPUTATION OF PENIS; COMPLETE 54125 54125 360 100.00 0.00 AMPUTATION OF PENIS; PARTIAL 54120 54120 360 100.00 0.00 AMPUTATION, ANKLE, THROUGH MALLEOLI OF TIBIA AND FIBULA (EG, SYME, PIROGOFF TYPE 27888 27888 360 100.00 0.00 PROCEDURES), WITH PLASTIC CLOSURE AND RESECTION OF NERVES Description Q Code CPTCode Rev Code Cost Markup Flatfee Markup% Billable Billable Fee AMPUTATION, ARM THROUGH HUMERUS; OPEN, 24920 24920 360 100.00 0.00 CIRCULAR (GUILLOTINE) AMPUTATION, ARM THROUGH HUMERUS; RE- 24930 24930 360 100.00 0.00 AMPUTATION AMPUTATION, ARM THROUGH HUMERUS; 24925 24925 360 100.00 0.00 SECONDARY CLOSURE OR SCAR REVISION AMPUTATION, ARM THROUGH HUMERUS; WITH 24931 24931 360 100.00 0.00 IMPLANT AMPUTATION, ARM THROUGH HUMERUS; WITH 24900 24900 360 100.00 0.00 PRIMARY CLOSURE AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, 26951 26951 360 6,380.00 100.00 6,380.00 INCLUDING NEURECTOMIES; WITH DIRECT CLOSURE AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, 26952 26952 360 7,440.00 100.00 7,440.00 INCLUDING NEURECTOMIES; WITH LOCAL ADVANCEMENT FLAPS (V-Y, HOOD) AMPUTATION, FOOT; MIDTARSAL (EG, CHOPART 28800 28800 360 100.00 0.00 TYPE PROCEDURE) AMPUTATION, FOOT; TRANSMETATARSAL 28805 28805 360 10,030.00 100.00 10,030.00 AMPUTATION, FOREARM, THROUGH RADIUS 25900 25900 360 100.00 0.00 AND ULNA; AMPUTATION, FOREARM, THROUGH RADIUS 25905 25905 360 100.00 0.00 AND ULNA; OPEN, CIRCULAR (GUILLOTINE) AMPUTATION, FOREARM, THROUGH RADIUS 25909 25909 360 100.00 0.00 AND ULNA; RE-AMPUTATION AMPUTATION, FOREARM, THROUGH RADIUS AND ULNA; SECONDARY CLOSURE OR SCAR 25907 25907 360 100.00 0.00 REVISION AMPUTATION, LEG, THROUGH TIBIA AND 27880 27880 360 21,800.00 100.00 21,800.00 FIBULA; AMPUTATION, LEG, THROUGH TIBIA AND 27882 27882 360 100.00 0.00 FIBULA; OPEN, CIRCULAR (GUILLOTINE) AMPUTATION, LEG, THROUGH TIBIA AND 27886 27886 360 21,800.00 100.00 21,800.00 FIBULA; RE-AMPUTATION Description Q Code CPTCode Rev Code Cost Markup Flatfee Markup% Billable Billable Fee AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; SECONDARY CLOSURE OR SCAR 27884 27884 360 100.00 0.00 REVISION AMPUTATION, LEG, THROUGH TIBIA AND FIBULA; WITH IMMEDIATE FITTING TECHNIQUE 27881 27881 360 100.00 0.00 INCLUDING APPLICATION OF FIRST CAST AMPUTATION, METACARPAL, WITH FINGER OR THUMB (RAY AMPUTATION), SINGLE, WITH OR 26910 26910 360 10,150.00 100.00 10,150.00 WITHOUT INTEROSSEOUS TRANSFER AMPUTATION, METATARSAL, WITH TOE, SINGLE 28810 28810 360 8,000.00 100.00 8,000.00 AMPUTATION, THIGH, THROUGH FEMUR, ANY 27590 27590 360 100.00 0.00 LEVEL; AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; IMMEDIATE FITTING TECHNIQUE 27591 27591 360 100.00 0.00 INCLUDING FIRST CAST AMPUTATION, THIGH, THROUGH FEMUR, ANY 27592 27592 360 100.00 0.00 LEVEL; OPEN, CIRCULAR (GUILLOTINE) AMPUTATION, THIGH, THROUGH FEMUR, ANY 27596 27596 360 100.00 0.00 LEVEL; RE-AMPUTATION AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; SECONDARY CLOSURE OR SCAR 27594 27594 360 100.00 0.00 REVISION AMPUTATION, TOE; INTERPHALANGEAL JOINT 28825 28825 360 8,000.00 100.00 8,000.00 AMPUTATION, TOE; METATARSOPHALANGEAL 28820 28820 360 8,000.00 100.00