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Division of Health Care Financing & Policy SB 278 Section 16

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Division of Health Care Financing & Policy SB 278 Section 16 Division of Health Care Financing & Policy SB 278 Section 16 - Physician Rates Reporting Facility & Non-Facility Rate Comparison Nevada 2016 2016 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 70.92 128.90 72.80 (57.98) (1.88) 10022 Fna w/image 65.39 148.21 68.38 (82.82) (2.99) 10030 Guide cathet fluid drainage 154.73 827.01 176.71 (672.28) (21.98) 10035 Perq dev soft tiss 1st imag 86.35 568.38 90.92 (482.03) (4.57) 10036 Perq dev soft tiss add imag 43.52 495.42 45.82 (451.90) (2.30) 10040 Acne surgery 87.47 106.03 92.10 (18.56) (4.63) 10060 Drainage of skin abscess 95.60 122.68 101.60 (27.08) (6.00) 10061 Drainage of skin abscess 178.04 215.50 188.01 (37.46) (9.97) 10080 Drainage of pilonidal cyst 103.29 188.83 107.87 (85.54) (4.58) 10081 Drainage of pilonidal cyst 172.45 281.57 177.64 (109.12) (5.19) 10120 Remove foreign body 103.22 159.56 108.73 (56.34) (5.51) 10121 Remove foreign body 185.58 287.08 194.44 (101.50) (8.86) 10140 Drainage of hematoma/fluid 118.06 170.87 124.18 (52.81) (6.12) 10160 Puncture drainage of lesion 95.62 136.49 100.72 (40.87) (5.10) 10180 Complex drainage wound 178.97 258.94 188.14 (79.97) (9.17) 11000 Debride infected skin 28.42 56.88 29.76 (28.46) (1.34) 11001 Debride infected skin add-on 14.22 22.40 14.87 (8.18) (0.65) 11004 Debride genitalia & perineum 579.35 608.28 608.28 (28.93) (28.93) 11005 Debride abdom wall 781.65 822.97 822.97 (41.32) (41.32) 11006 Debride genit/per/abdom wall 702.26 738.09 738.09 (35.83) (35.83) 11008 Remove mesh from abd wall 274.06 289.40 289.40 (15.34) (15.34) 11010 Debride skin at fx site 278.30 518.01 293.96 (239.71) (15.66) 11011 Debride skin musc at fx site 301.71 562.17 314.02 (260.46) (12.31) 11012 Deb skin bone at fx site 426.17 750.34 448.73 (324.17) (22.56) 11042 Deb subq tissue 20 sq cm/< 61.54 122.30 64.69 (60.76) (3.15) 11043 Deb musc/fascia 20 sq cm/< 157.36 238.94 162.88 (81.58) (5.52) 11044 Deb bone 20 sq cm/< 234.59 329.00 242.39 (94.41) (7.80) 11045 Deb subq tissue add-on 27.63 42.68 27.24 (15.05) 0.39 11046 Deb musc/fascia add-on 56.21 76.56 58.48 (20.35) (2.27) 11047 Deb bone add-on 100.66 129.49 104.26 (28.83) (3.60) 11055 Trim skin lesion 15.90 49.83 16.70 (33.93) (0.80) 11056 TRIM SKIN LESIONS 2 TO 4 22.47 60.86 23.58 (38.39) (1.11) 11057 Trim skin lesions over 4 29.39 68.49 30.84 (39.10) (1.45) 11100 Biopsy skin lesion 48.61 108.35 51.11 (59.74) (2.50) 11101 Biopsy skin add-on 24.46 34.20 26.29 (9.74) (1.83) 11200 Removal of skin tags <w/15 73.00 92.14 77.08 (19.14) (4.08) 11201 Remove skin tags add-on 16.77 19.76 17.50 (2.99) (0.73) 11300 SHAVE SKIN LESION 0.5 CM/< 34.94 101.99 36.85 (67.05) (1.91) 11301 SHAVE SKIN LESION 0.6-1.0 CM 53.11 125.49 56.21 (72.38) (3.10) 11302 SHAVE SKIN LESION 1.1-2.0 CM 62.20 147.77 66.05 (85.57) (3.85) 11303 SHAVE SKIN LESION >2.0 CM 74.11 163.18 78.08 (89.07) (3.97) 11305 Shave skin lesion 0.5 cm/< 38.48 103.94 41.06 (65.46) (2.58) 11306 SHAVE SKIN LESION 0.6-1.0 CM 51.56 127.68 54.25 (76.12) (2.69) 11307 Shave skin lesion 1.1-2.0 cm 66.25 150.53 69.95 (84.28) (3.70) 11308 SHAVE SKIN LESION >2.0 CM 72.94 157.66 77.08 (84.72) (4.14) 11310 Shave skin lesion 0.5 cm/< 47.19 118.91 49.62 (71.72) (2.43) 11311 Shave skin lesion 0.6-1.0 cm 65.00 116.41 68.96 (51.41) (3.96) 11312 Shave skin lesion 1.1-2.0 cm 78.37 167.97 82.11 (89.60) (3.74) 11313 Shave skin lesion >2.0 cm 100.38 194.30 105.44 (93.92) (5.06) 11400 Exc tr-ext b9+marg 0.5 cm< 79.32 129.99 84.43 (50.67) (5.11) 11401 Exc tr-ext b9+marg 0.6-1 cm 103.18 155.95 108.88 (52.77) (5.70) 11402 Exc tr-ext b9+marg 1.1-2 cm 113.71 173.27 119.80 (59.56) (6.09) 11403 Exc tr-ext b9+marg 2.1-3cm/< 146.50 200.64 155.08 (54.14) (8.58) 11404 Exc tr-ext b9+marg 3.1-4 cm 160.82 227.89 170.65 (67.07) (9.83) 11406 Exc tr-ext b9+marg >4.0 cm 244.91 327.57 259.04 (82.66) (14.13) 11420 Exc h-f-nk-sp b9+marg 0.5/< 81.23 128.29 85.74 (47.06) (4.51) 11421 Exc h-f-nk-sp b9+marg 0.6-1 110.40 163.90 115.32 (53.50) (4.92) 11422 Exc h-f-nk-sp b9+marg 1.1-2 134.86 183.38 142.34 (48.52) (7.48) 11423 Exc h-f-nk-sp b9+marg 2.1-3 156.55 211.18 165.24 (54.63) (8.69) 11424 Exc h-f-nk-sp b9+marg 3.1-4 178.52 244.15 188.80 (65.63) (10.28) 11426 Exc h-f-nk-sp b9+marg >4 cm 273.01 348.00 288.50 (74.99) (15.49) 11440 Exc face-mm b9+marg 0.5 cm/< 103.53 141.41 108.65 (37.88) (5.12) 11441 Exc face-mm b9+marg 0.6-1 cm 131.15 175.77 138.49 (44.62) (7.34) 11442 Exc face-mm b9+marg 1.1-2 cm 145.52 196.72 153.04 (51.20) (7.52) 11443 Exc face-mm b9+marg 2.1-3 cm 177.64 234.31 187.62 (56.67) (9.98) 11444 Exc face-mm b9+marg 3.1-4 cm 226.95 293.94 238.59 (66.99) (11.64) 11446 Exc face-mm b9+marg >4 cm 326.08 407.76 341.86 (81.68) (15.78) 11450 Removal sweat gland lesion 250.45 400.01 265.21 (149.56) (14.76) 11451 Removal sweat gland lesion 323.33 509.26 341.32 (185.93) (17.99) 11462 Removal sweat gland lesion 239.27 390.76 253.32 (151.49) (14.05) 11463 Removal sweat gland lesion 326.52 515.36 342.52 (188.84) (16.00) 11470 Removal sweat gland lesion 281.55 433.65 295.83 (152.10) (14.28) 11471 Removal sweat gland lesion 352.30 534.96 367.02 (182.66) (14.72) 11600 Exc tr-ext mal+marg 0.5 cm/< 119.51 201.59 125.15 (82.08) (5.64) 11601 Exc tr-ext mal+marg 0.6-1 cm 148.23 239.45 156.61 (91.22) (8.38) 11602 Exc tr-ext mal+marg 1.1-2 cm 162.64 259.76 172.02 (97.12) (9.38) 11603 Exc tr-ext mal+marg 2.1-3 cm 194.07 296.64 205.89 (102.57) (11.82) 11604 Exc tr-ext mal+marg 3.1-4 cm 214.78 329.75 226.58 (114.97) (11.80) 11606 Exc tr-ext mal+marg >4 cm 319.34 471.46 336.66 (152.12) (17.32) 11620 Exc h-f-nk-sp mal+marg 0.5/< 121.29 203.78 126.97 (82.49) (5.68) 11621 Exc s/n/h/f/g mal+mrg 0.6-1 148.93 240.92 158.07 (91.99) (9.14) 11622 Exc s/n/h/f/g mal+mrg 1.1-2 170.68 268.49 180.75 (97.81) (10.07) 11623 Exc s/n/h/f/g mal+mrg 2.1-3 211.61 314.84 223.71 (103.23) (12.10) 11624 Exc s/n/h/f/g mal+mrg 3.1-4 239.93 354.79 253.12 (114.86) (13.19) 11626 Exc s/n/h/f/g mal+mrg >4 cm 294.83 427.17 310.07 (132.34) (15.24) 11640 Exc f/e/e/n/l mal+mrg 0.5cm< 125.18 210.13 131.44 (84.95) (6.26) 11641 Exc f/e/e/n/l mal+mrg 0.6-1 155.98 249.40 164.68 (93.42) (8.70) 11642 Exc f/e/e/n/l mal+mrg 1.1-2 183.25 284.61 194.24 (101.36) (10.99) 11643 Exc f/e/e/n/l mal+mrg 2.1-3 230.87 334.94 242.68 (104.07) (11.81) 11644 Exc f/e/e/n/l mal+mrg 3.1-4 285.84 412.85 300.27 (127.01) (14.43) 11646 Exc f/e/e/n/l mal+mrg >4 cm 397.05 538.76 416.76 (141.71) (19.71) 11719 Trim nail(s) any number 7.60 14.38 7.98 (6.78) (0.38) 11720 Debride nail 1-5 14.90 33.69 15.24 (18.79) (0.34) 11721 Debride nail 6 or more 24.56 46.83 25.75 (22.27) (1.19) 11730 REMOVAL OF NAIL PLATE 50.53 103.42 52.97 (52.89) (2.44) 11732 Remove nail plate add-on 20.06 37.23 21.04 (17.17) (0.98) 11740 Drain blood from under nail 32.76 52.03 34.34 (19.27) (1.58) 11750 Removal of nail bed 173.14 189.52 148.10 (16.38) 25.04 11755 Biopsy nail unit 78.21 139.93 81.56 (61.72) (3.35) 11760 Repair of nail bed 133.87 203.92 122.59 (70.05) 11.28 11762 Reconstruction of nail bed 185.05 293.47 192.55 (108.42) (7.50) 11765 EXCISION OF NAIL FOLD TOE 93.04 175.88 98.68 (82.84) (5.64) 11770 Remove pilonidal cyst simple 183.77 291.31 194.53 (107.54) (10.76) 11771 Remove pilonidal cyst exten 431.80 600.73 456.14 (168.93) (24.34) 11772 Remove pilonidal cyst compl 573.13 728.65 606.65 (155.52) (33.52) 11900 Inject skin lesions </w 7 31.12 58.09 32.86 (26.97) (1.74) 11901 Inject skin lesions >7 48.63 72.97 50.75 (24.34) (2.12) 11950 Tx contour defects 1 cc/< 53.20 76.77 53.42 (23.57) (0.22) 11951 Tx contour defects 1.1-5.0cc 76.48 101.45 75.09 (24.97) 1.39 11952 Tx contour defects 5.1-10cc 100.70 136.30 101.28 (35.60) (0.58) 11954 Tx contour defects >10.0 cc 116.38 164.50 120.07 (48.12) (3.69) 11960 Insert tissue expander(s) 934.51 994.84 994.84 (60.33) (60.33) 11970 Replace tissue expander 616.24 640.09 640.09 (23.85) (23.85) 11971 Remove tissue expander(s) 322.25 493.78 336.01 (171.53) (13.76) 11976 Remove contraceptive capsule 97.05 148.67 97.84 (51.62) (0.79) 11980 Implant hormone pellet(s) 79.88 98.05 58.52 (18.17) 21.36 11981 Insert drug implant device 81.34 146.79 86.16 (65.45) (4.82) 11982 Remove drug implant device 97.30 166.50 104.75 (69.20) (7.45) 11983 Remove/insert drug implant 168.65 231.08 181.37 (62.43) (12.72) 12001 Rpr s/n/ax/gen/trnk 2.5cm/< 45.00 93.23 46.17 (48.23) (1.17) 12002 Rpr s/n/ax/gen/trnk2.6-7.5cm 59.25 113.35 60.63 (54.10) (1.38) 12004 Rpr s/n/ax/gen/trk7.6-12.5cm 73.87 133.44 75.83 (59.57) (1.96) 12005 Rpr s/n/a/gen/trk12.6-20.0cm 99.98 168.14 98.48 (68.16) 1.50 12006 Rpr s/n/a/gen/trk20.1-30.0cm 121.24 199.29 120.96 (78.05) 0.28 12007 Rpr s/n/ax/gen/trnk >30.0 cm 150.62 232.42 152.96 (81.80) (2.34) 12011 Rpr f/e/e/n/l/m 2.5 cm/< 56.15 114.22 57.36 (58.07) (1.21) 12013 Rpr f/e/e/n/l/m 2.6-5.0 cm 62.72 119.20 60.08 (56.48) 2.64 12014 Rpr f/e/e/n/l/m 5.1-7.5 cm 79.77 139.21 77.45 (59.44) 2.32 12015 Rpr f/e/e/n/l/m 7.6-12.5 cm 99.25 168.51 97.34 (69.26) 1.91 12016 Rpr fe/e/en/l/m 12.6-20.0 cm 134.79 213.77 133.19 (78.98) 1.60 12017 Rpr fe/e/en/l/m 20.1-30.0 cm 154.16 159.56 159.56 (5.40) (5.40) 12018 Rpr f/e/e/n/l/m >30.0 cm 174.32 180.92 180.92 (6.60) (6.60) 12020 Closure of split wound 190.75 304.14 204.73 (113.39) (13.98) 12021 Closure of split wound 141.38 174.91 148.55 (33.53) (7.17) 12031 Intmd rpr s/a/t/ext 2.5 cm/< 152.69 248.23 161.24 (95.54) (8.55) 12032 Intmd rpr s/a/t/ext 2.6-7.5 193.83 317.99 205.78 (124.16) (11.95) 12034 Intmd rpr s/tr/ext 7.6-12.5 206.50 326.04 217.59 (119.54) (11.09) 12035 Intmd rpr s/a/t/ext 12.6-20
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