TABLE G. — PHYSICIAN AND OTHER PROFESSIONAL SERVICES RELATIVE VALUE UNITS (RVUs) BY CPT/HCPCS CODE PAGE 1 of 135 Non- Facility CPT/ Conversion Status/ Work Facility Total Practice Charge HCPCS Modifier 1 CPT/HCPCS Code Description Factor/GAAF Usage Expense Practice Expense Expense Methodology 3 Code Category Indicator 2 RVUs Expense RVUs RVUs RVUs 01996 DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN Anesthesia 2.62 Anesthesia 10021 FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE Surgery 1.27 0.55 2.78 RBRVS 10022 FINE NEEDLE ASPIRATION WITH IMAGING GUIDANCE Surgery 1.27 0.48 2.60 RBRVS 10030 IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE Surgery 3.00 1.17 18.76 RBRVS 10035 PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE Surgery 1.70 0.63 13.31 RBRVS 10036 PERQ SFT TISS LOC DEVICE PLMT ADD LES W/GDNCE Surgery 0.85 0.32 12.25 RBRVS 10040 ACNE SURGERY Surgery 1.21 1.14 1.50 RBRVS 10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE Surgery 1.22 1.42 1.97 RBRVS 10061 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE Surgery 2.45 2.38 3.10 RBRVS 10080 INCISION & DRAINAGE PILONIDAL CYST SIMPLE Surgery 1.22 1.55 3.68 RBRVS 10081 INCISION & DRAINAGE PILONIDAL CYST COMPLICATED Surgery 2.50 2.01 4.76 RBRVS 10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE Surgery 1.22 1.59 2.95 RBRVS 10121 INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL Surgery 2.74 2.17 4.61 RBRVS 10140 I&D HEMATOMA SEROMA/FLUID COLLECTION Surgery 1.58 1.61 2.85 RBRVS 10160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST Surgery 1.25 1.33 2.28 RBRVS 10180 INCISION & DRAINAGE COMPLEX PO WOUND INFECTION Surgery 2.30 2.33 4.19 RBRVS 11000 DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF Surgery 0.60 0.17 0.89 RBRVS 11001 DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10% BDY SURF Surgery 0.30 0.08 0.27 RBRVS 11004 DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT&PR Surgery 10.80 3.91 3.91 RBRVS 11005 DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL Surgery 14.24 5.21 5.21 RBRVS 11006 DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT/ABDL Surgery 13.10 4.68 4.68 RBRVS 11008 REMOVAL PROSTHETIC MATRL ABDL WALL FOR INFECTION Surgery 5.00 1.83 1.83 RBRVS 11010 DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS Surgery 4.19 3.11 9.01 RBRVS 11011 DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC Surgery 4.94 2.68 9.10 RBRVS 11012 DBRDMT FX&/DISLC SUBQ T/M/F BONE Surgery 6.87 3.99 11.93 RBRVS 11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< Surgery 1.01 0.64 2.18 RBRVS 11043 DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/< Surgery 2.70 1.37 3.38 RBRVS 11044 DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/< Surgery 4.10 1.91 4.19 RBRVS 11045 DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM Surgery 0.50 0.18 0.60 RBRVS 11046 DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM Surgery 1.03 0.40 0.87 RBRVS 11047 DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM Surgery 1.80 0.72 1.39 RBRVS 11055 PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 Surgery 0.35 0.09 0.98 RBRVS 11056 PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4 Surgery 0.50 0.12 1.12 RBRVS 11057 PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4 Surgery 0.65 0.16 1.16 RBRVS 11100 BX SKIN SUBCUTANEOUS&/MUCOUS MEMBRANE 1 LESION Surgery 0.81 0.48 2.01 RBRVS 11101 BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN Surgery 0.41 0.25 0.46 RBRVS 11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 Surgery 0.82 1.17 1.57 RBRVS 11201 REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10 Surgery 0.29 0.15 0.21 RBRVS 11300 SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/< Surgery 0.60 0.33 2.07 RBRVS 11301 SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM Surgery 0.90 0.52 2.37 RBRVS 11302 SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM Surgery 1.05 0.61 2.79 RBRVS 11303 SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM Surgery 1.25 0.71 2.98 RBRVS 11305 SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/< Surgery 0.80 0.25 1.92 RBRVS 11306 SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM Surgery 0.96 0.42 2.37 RBRVS 11307 SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM Surgery 1.20 0.56 2.71 RBRVS 11308 SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM Surgery 1.46 0.51 2.66 RBRVS 11310 SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/< Surgery 0.80 0.45 2.30 RBRVS 11311 SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM Surgery 1.10 0.64 1.90 RBRVS 11312 SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM Surgery 1.30 0.76 3.05 RBRVS 11313 SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM Surgery 1.68 0.96 3.32 RBRVS 11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/< Surgery 0.90 1.27 2.49 RBRVS 11401 EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM Surgery 1.28 1.50 2.75 RBRVS 11402 EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM Surgery 1.45 1.59 3.01 RBRVS 11403 EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM/< Surgery 1.84 2.07 3.27 RBRVS 11404 EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM Surgery 2.11 2.16 3.66 RBRVS 11406 EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM Surgery 3.52 2.85 4.66 RBRVS 11420 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/< Surgery 1.03 1.18 2.32 RBRVS 11421 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM Surgery 1.47 1.48 2.78 RBRVS 11422 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM Surgery 1.68 1.95 3.04 RBRVS 11423 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM Surgery 2.06 2.13 3.34 RBRVS 11424 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM Surgery 2.48 2.27 3.72 RBRVS 11426 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM Surgery 4.09 3.05 4.62 RBRVS 11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< Surgery 1.05 1.76 2.63 RBRVS 11441 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM Surgery 1.53 2.01 3.01 RBRVS 11442 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM Surgery 1.77 2.12 3.27 RBRVS 11443 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM Surgery 2.34 2.40 3.63 RBRVS 11444 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM Surgery 3.19 2.82 4.27 RBRVS 11446 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM Surgery 4.80 3.74 5.51 RBRVS 11450 EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR Surgery 3.22 3.31 6.94 RBRVS 11451 EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR Surgery 4.43 3.91 8.37 RBRVS 11462 EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR Surgery 3.00 3.24 6.88 RBRVS 11463 EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR Surgery 4.43 4.00 8.65 RBRVS 11470 EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR Surgery 3.74 3.52 7.15 RBRVS 11471 EXCISION H/P/P/U COMPLEX REPAIR Surgery 4.89 4.12 8.61 RBRVS 11600 EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/< Surgery 1.63 1.56 3.57 RBRVS NOTE: CPT Codes and descriptions only are copyright 2015 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. 1, 2, 3 - See end of the table for notes regarding these fields. TABLE G. — PHYSICIAN AND OTHER PROFESSIONAL SERVICES RELATIVE VALUE UNITS (RVUs) BY CPT/HCPCS CODE PAGE 2 of 135 Non- Facility CPT/ Conversion Status/ Work Facility Total Practice Charge HCPCS Modifier 1 CPT/HCPCS Code Description Factor/GAAF Usage Expense Practice Expense Expense Methodology 3 Code Category Indicator 2 RVUs Expense RVUs RVUs RVUs 11601 EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM Surgery 2.07 1.90 4.09 RBRVS 11602 EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM Surgery 2.27 2.09 4.40 RBRVS 11603 EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/< Surgery 2.82 2.37 4.76 RBRVS 11604 EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM Surgery 3.17 2.51 5.23 RBRVS 11606 EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM Surgery 5.02 3.28 6.87 RBRVS 11620 EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/< Surgery 1.64 1.58 3.61 RBRVS 11621 EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM Surgery 2.08 1.92 4.11 RBRVS 11622 EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM Surgery 2.41 2.16 4.48 RBRVS 11623 EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/< Surgery 3.11 2.51 4.92 RBRVS 11624 EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM Surgery 3.62 2.70 5.39 RBRVS 11626 EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM Surgery 4.61 3.07 6.17 RBRVS 11640 EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/< Surgery 1.67 1.67 3.74 RBRVS 11641 EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM Surgery 2.17 1.99 4.23 RBRVS 11642 EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM Surgery 2.62 2.28 4.66 RBRVS 11643 EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM Surgery 3.42 2.68 5.11 RBRVS 11644 EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM Surgery 4.34 3.15 6.15 RBRVS 11646 EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM Surgery 6.26 4.09 7.35 RBRVS 11719 TRIMMING NONDYSTROPHIC NAILS ANY NUMBER Surgery 0.17 0.04 0.21 RBRVS 11720 DEBRIDEMENT NAIL ANY METHOD 1-5 Surgery 0.32 0.08 0.57 RBRVS 11721 DEBRIDEMENT NAIL ANY METHOD 6/> Surgery 0.54 0.13 0.69 RBRVS 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 Surgery 1.10 0.27 1.62 RBRVS 11732 AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL Surgery 0.44 0.11 0.54 RBRVS 11740 EVACUATION SUBUNGUAL HEMATOMA Surgery 0.37 0.53 1.00 RBRVS 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL Surgery 2.50 2.26 3.62 RBRVS 11752 EXC NAIL MATRIX PRM RMVL W/AMP TUFT DSTL PHALANX Surgery 3.63 3.45 5.14 RBRVS 11755 BIOPSY NAIL UNIT SEPARATE PROCEDURE Surgery 1.31 0.81 2.36 RBRVS 11760 REPAIR NAIL BED Surgery 1.63 1.91 4.62 RBRVS 11762 RECONSTRUCTION NAIL BED W/GRAFT Surgery 2.94 2.08 4.77 RBRVS 11765 WEDGE EXCISION SKIN NAIL FOLD Surgery 1.22 1.37 3.42 RBRVS 11770 EXCISION PILONIDAL CYST/SINUS SIMPLE Surgery 2.66 2.09 4.63 RBRVS 11771 EXCISION PILONIDAL CYST/SINUS EXTENSIVE Surgery 6.09 5.00 8.86 RBRVS 11772 EXCISION PILONIDAL CYST/SINUS COMPLICATED Surgery 7.35 7.58 10.86 RBRVS 11900 INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS Surgery 0.52 0.31 0.98 RBRVS 11901 INJECTION INTRALESIONAL >7 LESIONS Surgery 0.80 0.48 1.07 RBRVS 11920 TATTOOING INCL MICROPIGMENTATION 6.0 CM/< Surgery