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Home , Ankle replacement, Hernia repair, Mediastinoscopy

U.S. DEPARTMENT OF LABOR, OFFICE OF WORKERS' COMPENSATION PROGRAMS OWCP MEDICAL FEE SCHEDULE -- Effective August 14, 2015 Procedure Code Base Units Effective Date: August 14, 2015

Formula for calculating maximum allowable: (Time Units + Base Units) x Conversion Factor = Max Allowable

BASE © CPT SHORT DESCRIPTION (Refer to AMA CPT ) UNIT Add-on Code 00100 Anest for proced on integ sys - head/or saliv glands 5 00102 Anesthesia for plastic repair of cleft lip 6 00103 Anesthesia for bepharoplasty 5 00104 Anesthesia for electroconvulsive therapy 4 00120 Anest; proc-esternal/middle/inner ear, inc nos 5 00124 Anesthesia for otoscopy 4 00126 Anesthesia for tympanotomy 4 00140 Anesthesia for procedures on eye; nos 5 00142 Anesthesia for procedures on eye; lens 4 00144 Anest; procedures on eye; corneal transplant 6 00145 Anesthesia for procedures on eye; vitrectomy 6 00147 Anesthesia for iridectomy 4 00148 Anesthesia for procedures on eye; opthalmoscopy 4 00160 Anest; proc-nose and accessory sinuses; nos 5 00162 Anest; proced-nose/accesory sinuses; rad surg 7 00164 Anesth-proced on nose & access sinuses; biop/soft tis 4 00170 Anesthesia for intraoral procedures, incl biopsy; nos 5 00172 Anesth-intraoral proced, w/biop; repair-cleft palate 6 00174 Anest; intraoral pro-w/biop-ex/retropharyngeal tumor 6 00176 Anesth-intraoral proced, w/biopsy; rad surg 7 00190 Anesthesia for procedures on facial ; nos 5 00192 Anest - proced on facial bones; rad surg 7 00210 Anesthesia for intracranial proacedures nos 11 00211 Anesth, cran surg, hemotoma 10 00212 Anest; intracranial procedures; subdural taps 5 00214 Anesthesia for intracranial procedures; burr holes 9 00215 Anesthesia for skull fracture 9 00216 Anesthesia-intracranial proced; vascular 15 00218 Anesth-intracranial proced, in sitting position 13 00220 Anest - intracranial proced; spinal fluid shunting proc 10 00222 Anest - intracranial proc; electrocoag-cranial nerve 6 00300 Anest; proc-integ sys of neck, incl subcu tissue 5 00320 Anest-proced: esoph/thy/lar/trac/lymph nos 6 00322 Anest proced on neck: needle biopsy of thyroid 3 00350 Anesth; proc-on major vessels of neck; nos 10 00352 Anesth-proc on maj vessels of neck; simple ligation 5 00400 Anesth; proc on ant integ sys-chest a/subcu tise 3 00402 Anest; proc-ant integ sys of chest; reconstr on breast 5 00404 Anest; proc-ant integ sys of chest; radical/mod rad; breast 5 00406 Anest; ant integ sys chest; rad/mod rad proc; breast w/node disse 13 00410 Anest; proc ant integ chest; elec convers of arrhythmias 4 00450 Anest; proc-on clavicle and scapula; nos 5 00452 Anest; proc-clavicle & scapula; rad surg 6 00454 Anesthesia for procedures on clavicle, biopsy 3 00470 Anesthesia for partial rib resection nos 6 00472 Anest; partial rib resection, thoracoplasty (any type) 10 00474 Anesthesia for partial rib resection, radical proced 13 00500 Anesthesia for all procedures on 15 00520 Anest for closed chest proc nos 6 00522 Anest - closed chest proced; needle biopsy-pleura 4 00524 Anest for closed chest procedure; pneumocentesis 4 00528 Anest for closed chest procedure; mediastinoscopy 8 00529 Anest, closed chest procedure; medi 11 00530 Anesthesia for permanent transvenous pacemaker insertion 4 00532 Anesthesia for accesss to central venous circula 4 00534 Anest-transven insert/replace-cardioverter/debfib 7 00537 Anest for cardiac electrophysiologic procedures 7 00539 Anest; tracheobronchial reconstruction 18 00540 Anest; thoracot proced-/pleura/dia/media nos 12 00541 Anest; thoracot proced; one ventilation 15 00542 Anest; procedure - 15 00546 Anesth-thoracot; pul resection w/thoracoplasty 15 00548 Anesth-thoracotomy; repair-trauma to /bronchi 17 00550 Anesthesia for sternal debridement 10 00560 Anesth, heart surg w/o pump 15 00561 Anest-heart/pericard/great ves-chest; w/ pump oxygenator 25 00562 Anest-heart/pericard/great ves-chest; w/pump oxygenator 20 00563 Anest-heart/pericard/great ves-chest; w/pump oxyg w/hypotherm 25 00566 Anest for direct coronary artery bypass graft w/out pump oxyg 25 00567 Anesth, cabg w/pump 18 00580 Anesthesia for heart transplant-heart/lung 20 00600 Anesth for proced on cerv spine/cord; nos 10 00604 Anesth-post cerv laminect-sitting position 13 00620 Anesthesia-proced on thoracic spine/cord; nos 10 00625 Anes spine tranthor w/o vent 13 00626 Anes, spine transthor w/vent 15 00630 Anesthesia for procedures in lumbar region (nos) 8 00632 Anesthesia for lumbar sympathectomy 7 00635 Anesth-procedures in lum region; diag/therapeutic lum puncture 4 00640 Anesth-manip of spine; closed proced on spine 3 00670 Anesth-ext spine/spinal cord proced 13 00700 Anesth-proced on upper ant abdom wall; (nos) 4 00702 Anesthesia for percutaneous biopsy 4 00730 Anesth-procedures on upper post abdominal wall 5 00740 Anesth-upper gastrointestinal endoscopic proced 5 00750 Anesthesia for repairs in upper abdomen; (nos) 4 00752 Anesth-repair lum/ventral /wound dehiscence 6 00754 Anesth-hernia repairs-up abdomen; omphalocele 7 00756 Anesth-transabdominal repair- 7 00770 Anesth-all procedures-major abdominal blood ves 15 00790 Anesth-intraperitoneal proced-up abdo, w/laparos nos 7 00792 Anesth-intraperitoneal proced up abdo-partial 13 00794 Anesth-intraperitoneal pro/up abdo; pancreatect/part/tot 8 00796 Anesth-intraperitoneal pro up abdo, shunts/liver transplant 30 00797 Anesth-intraperitoneal pro up abdo, gastric restrict procedure 11 00800 Anesth-pro low ant abdom wall nos 4 00802 Anesth-pro low ant abdom wall; panniculectomy 5 00810 Anesthesia for intestinal endoscopic procedures 5 00820 Anesth-pro on low post abdominal wall 5 00830 Anesthesia for hernia repairs in lower abdomen; (nos) 4 00832 Anesth-hernia repair, ventral & incisional hernias 6 00840 Anesth-intraperitoneal proced low abdo w/laparos; nos 6 00842 Anesthesia for amniocentesis 4 00844 Anesthesia for abdominoperitoneal resection 7 00846 Anesthesia for radical hysterectomy 8 00848 Anesthesia for pelvic exentration 8 00851 Anesthesia for tubal ligation 6 00860 Anesth-extraperitoneal low abdo, w/urinary tract-nos 6 00862 Anesth-renal proced w/upper 1/3 ureter/donor nephrect 7 00864 Aanesthesia for total cystectomy 8 00865 Anest - extraperitoneal proced-lower abd; rad prostatectomy 7 00866 Anesthesia for adrenalectomy 10 00868 Anesthesia for renal transplant (recipient) 10 00870 Anesthesia for cystolithiotomy 5 00872 Anesth-/extracorp shock wave-w/h20 bath 7 00873 Anesth-lithotripsy/extracorp shock wave-w/o h20 bath 5 00880 Anesth-proced on maj low abdom ves; nos 15 00882 Anesth-proced on maj low abdom ves; infer vena cava liga 10 00902 Anesthesia for anorectal procedures 5 00904 Anesthesia for radical perineal procedure 7 00906 Anesthesia for vulvectomy 4 00908 Anesthesia for perineal prostatectomy 6 00910 Anesthesia for transurethral procedures 3 00912 Anesthesia for transurethral resection of bladder 5 00914 Anesthesia for transurethral resection of prostate 5 00916 Anesthesia for post-transurethral resection bleeding 5 00918 Anesthesia for transurethral procedures,w/fragmenta 5 00920 Anesthesia-proced on male genital ext genitalia, nos 3 00921 Anesthesia-vasectomy, unilat/bilateral 3 00922 Anesthesia for procedures on seminal vesicles 6 00924 Anesth-proced on undescended testis, unilat/bilat 4 00926 Anesthesia for radical orchiectomy, inguinal 4 00928 Anesthesia for radical orchiectomy, abdominal 6 00930 Anesthesia for orchiopexy, unilateral or bilateral 4 00932 Anesthesia for complete amputation of penis 4 00934 Anesth-radical amputat-penis w/bilat ing lymphaden 6 00936 Anesth-rad amputa-penis w/bilat inguinal/iliac lymphaden 8 00938 Anesth-insertion of penile -perineal ap 4 00940 Anesth-vaginal procedures, nos 3 00942 Anesth-for colpotomy, colpectomy, colporrhaphy 4 00944 Anesthesia for vaginal hysterectomy 6 00948 Anesthesia for cervical cerclage 4 00950 Anesthesia culdoscopy 5 00952 Anesthesia for 4 01112 Anesthesia- marrow aspiration/biopsy, iliac crest 5 01120 Anesthesia for procedures on bony pelvis 6 01130 Anesthesia for body cast application or revision 3 01140 Anesth for interpelviabdom amputation (hindquarter) 15 01150 Anesth-rad proced tumor of pelvis, ex hindqtr amputation 10 01160 Anesth-closed pro, involv symphysis pubis/sacroiliac jnt 4 01170 Anesth-open pro involv symphysis pubis/sacroiliac jnt 8 01173 Anesth-open repair, FX disrupt 12 01180 Anesthesia for obturator neurectomy, extrapelvic 3 01190 Anesthesia for obturator neurectomy, intrapelvic 4 01200 Anesthesia for all closed procedures involving 4 01202 Anesthesia for arthroscopic procedures of hip joint 4 01210 Anesthesia for open procedures involving hip joint; (nos) 6 01212 Anesthesia for hip disarticulation 10 01214 Anesthesia for total or revision 8 01215 Anesthesia for revision of total hip 10 01220 Anesth-all closed proced involv up 2/3 of femur-nos 4 01230 Anesth-all open proced involv up 2/3 of femur nos 6 01232 Anesth-open proced involv up 2/3 of femur; amputation 5 01234 Anesth-open proced involv up 2/3 of femur; rad resect 8 01250 Anesth-all proced nerves/mus/ten/fasc/bur-up leg 4 01260 Anesth-all proced involv veins of up leg incl exploration 3 01270 Anesth-all pro involv art-up leg, w/bypass graft; nos 8 01272 Anesthesia for femoral artery ligation 4 01274 Anesthesia for femoral artery embolectomy 6 01320 Anest-all proc-nerves/mus/ten/fasc/bur-/popliteal area 4 01340 Anesth-for all closed proced on lower 1/3 of femur 4 01360 Anesth-for all open proced on lower 1/3 of femur 5 01380 Anesth-for all closed proced on knee joint 3 01382 Anesth-for diag. arthroscopic proced of knee joint 3 01390 Anesth-all closed proced on up ends of tibia/fibula/patella 3 01392 Anesth-all open proced on up ends of tibia/fibula/patella 4 01400 Anesth-for open or surg arthro proced on knee joint nos 4 01402 Anesthesia for total 7 01404 Anesthesia for disarticulation at knee 5 01420 Anesth-all cast applica, removal/repair involv knee jnt 3 01430 Anesth-proced on veins of knee/popliteal area nos 3 01432 Anesth-proced - veins-knee/popli area; arterioven fistula 6 01440 Anesth-for proced-arteries of knee/popli area nos 8 01442 Anesth-popliteal thromboendarterectomy, w/wo pinch graft 8 01444 Anesth-for popliteal excis/graft/repair for occlu/aneurysm 8 01462 Anesthe-all closed proced on low leg//ft 3 01464 Anesthesia for arthroscopic procedures on ankle/ 3 01470 Anest open proc-nerves/mus/tens/fascia, low leg/ank/ft 3 01472 Anesth-repair of rupt achilles tendon, w/wo graft 5 01474 Anest-pro-nerves/mus/ten/fascia-low leg/ank/ft; gastro recess 5 01480 Anesth for open proced on bones-low leg/ank/ft nos 3 01482 Anesth for open proced on bones-low leg/ank/ft; rad resect 4 01484 Anesth-open proced; /osteoplasty-tibia/fib 4 01486 Anesthesia for open procedures; total ankle replacement 7 01490 Anesthesia for lower leg cast application, removal or repair 3 01500 Anesth-proced on arteries-low leg incl bypass graft nos 8 01502 Anesth; proced-arteries-low leg; embolectomy-direct/cath 6 01520 Anesth for proced on veins of lower leg; nos 3 01522 Anesth; proc veins-low leg; venous thrombect, direct-w/cath 5 01610 Anest; proc-nerves/mus/tend, fascia/bursae-shoulder/axilla 5 01620 Anesth; closed proc-hum head/neck/sternoclavic jnt/shoulder 4 01622 Anesth; diag/arthroscopic procedures of shoulder joint 4 01630 Anest; open/surg proc-hum head-neck/sternoclav/acromi/should jnts 5 01634 Anesthesia for shoulder disarticulation 9 01636 Anesthesia for interthoracoscapular (forquarter) amputation 15 01638 Anesthesia for total shoulder replacment 10 01650 Anesth-proced on arteries-shoulder/axilla nos 6 01652 Anesth-proced on art-should-axilla; axil-brachial aneurysm 10 01654 Anesth-proced-arteries of shoulder/axilla; bypass graft 8 01656 Anesth-proced/art-shoulder/axilla; axillary-fem bypass graft 10 01670 Anesthesia for all procedures on veins of shoulder/axilla 4 01680 Anesthesia for shoulder cast application, repair or removal 3 01682 Anesthesia for shoulder spica 4 01710 Anest; proc-nerves/musc/tend/fascia/bursae-up arm/elbow nos 3 01712 Anesthesia for tenotomy, elbow to shoulder, open 5 01714 Anesthesia for tenoplasty, elbow to shoulder 5 01716 Anesthesia for tenodesis, rupture of long tendon of biceps 5 01730 Anesthesia for all closed procedures on humerus and elbow 3 01732 Anesthesia for diagnostic arth proced, elbow jt 3 01740 Anesthesia, open or surg arth proced on humerus/elbow (nos) 4 01742 Anesthesia for osteotomy of humerus 5 01744 Anesthesia for repair of nonunion or malunion of humerus 5 01756 Anest for radical procedures (closed) on humerus or elbow 6 01758 Anesthesia for excision of cyst or tumor of humerus 5 01760 Anesthesia for total elbow replacement 7 01770 Anesthesia-proced on arteries-upper arm/elbow; nos 6 01772 Anesth-proced on arteries-up arm/elbow; embolectomy 6 01780 Anesthesia for proced on veins of upper arm/elbow; nos 3 01782 Anesth-proced on veins of upper arm/elbow; phleborrhaphy 4 01810 Anest; proc-nerves/musc/tend/fascia/bursae/f-arm/wrist/hand 3 01820 Anesth-all closed proced-radius/ulna/wrist/hand bones 3 01829 Anesth, diag procedures on wrist 3 01830 Anesth-open,surg arth/endosc proced-radius/ulna/wrist/hand jt, nos 3 01832 Anesthesia for total wrist replacement 6 01840 Anesth-proced on arteries of forearm, wrist/hand; nos 6 01842 Anesthesia for embolectomy; forearm, wrist or hand 6 01844 Anesth-for vascular shunt/shunt revision, any type 6 01850 Anesth-proced-on veins of forearm, wrist/hand nos 3 01852 Anesthesia for phleborrhaphy; forearm, wrist or hand 4 01860 Anesth-forearm, wrist/hand cast applica, removal/repair 3 01916 Anesth for arteriograms, needle; carotid/vertebral 5 01920 Anest-cardiac cath w/coronary arterio/ventriculography 7 01922 Anesthesia for cat scanning/mri 7 01924 Anesthesia for ther interv radiol arterial procedure 5 01925 Anesthesia for ther interv radiol arterial procedure 7 01926 Anesthesia for ther interv radiol arterial procedure 8 01930 Anesthesia for ther interv radiol venous procedure 5 01931 Anesthesia for ther interv radiol venous procedure 7 01932 Anesthesia for ther interv radiol venous procedure 6 01933 Anesthesia for ther interv radiol venous procedure 7 01935 Anesthesia for percutaneous img Dx Spinal proc 5 01936 Anesthesia for percutaneous img Tx Spinal proc 5 01951 Anesthesia for 2nd-3rd degree burn excis/debrid <1% body 3 01952 Anesthesia for 2nd-3rd degree burn excis/debrid 1-9% body 5 01953 Anesthesia for 2nd-3rd degree burn; each add'l 9% body 1 + 01958 Anesthesia, external cephalic vesio 5 01960 Anesthesia for vaginal delivery 5 01961 Anesthesia for cesarean delivery 7 01962 Anesthesia for urgent hysterectomy following delivery 8 01963 Anesthesia for cesarean hysterectomy 8 01965 Anesth incompl/missed abortion 4 01967 Neuroaxial labor analgesia/anesthesia 5 01968 Neuroaxial labor analgesia/anesthesia add-on code 2 + 01969 Neuroaxial labor analgesia/anesthesia add-on code 5 + 01990 Physio sup-harvesting-(s) brain-dead patient 7 01991 Anesth diag/therapeutic nerve block, inject, not prone 3 01992 Anesth diag/therapeutic nerve block, inject, prone 5 01995 Regional anesthesia limb 5 01996 Daily hospital mgmt of epidural/subarachoid drug adm 3 01999 Unlisted anesthesia procedure(s) 0 ****** ******