OUTPATIENT SURGERY FEE SCHEDULE PROC DESCRIPTION 2010 Rate 2011 Rate 2012 Rate 10021 FINE NEEDLE ASPIRATION;W/O IMAGING GUIDE $27.11 $27.11 $27.11 10022 FINE NEEDLE ASPIREATION;W/IMAGING GUIDE $36.34 $36.34 $36.34 10040 ACNE SURG(E.G.MARSUPIALIZATION)OPN-REMOV $822.23 $822.23 $822.23 10060 INCIS&DRAIN ABCESS/CYST, SIMPLE/SINGLE $822.23 $822.23 $822.23 10061 INCIS&DRAIN CYST/ABSESS COMPLICA/MULTIPL $822.23 $822.23 $822.23 10080 I&D PILONIDAL CYST SIMPLE $822.23 $822.23 $822.23 10081 I&D PILONIDAL CYST COMPLICATED $822.23 $822.23 $822.23 10120 INC REMOVAL FOREIGN BODY SURG SIMPLE $822.23 $822.23 $822.23 10121 INC REMOVAL FOREIGN BODY SURG COMPLICAT $822.23 $822.23 $822.23 10140 I&D HEMATOMA, SEROMA OR FLUID COLLECTION $822.23 $822.23 $822.23 10160 PUNCT ASPLE ABSCESS HEMATOMA BULLA CYST $125.00 $125.00 $125.00 10180 INCISION/DRAINAGE,COMPLEX,POSTOP WOUND. $822.23 $822.23 $822.23 11000 DEBRI EXTEN ECZEMA OR INFECT SKIN 10% $570.00 $570.00 $570.00 11004 DEBRI SKIN,SUBCUT TIS,EXT GENTALIA&PERIN $822.23 $822.23 $822.23 11005 DEBRIDE SKIN,SUBCUTAN TIS,ABDOMINAL WALL $822.23 $822.23 $822.23 11006 DEBR SKN,SUBCUT TIS,EXT GENTAL,PERIN&ABD $822.23 $822.23 $822.23 11008 REMV PROSTH MATR'L/MESH,ABD WALL/ADD-ON $125.00 $125.00 $125.00 11010 DEBRID/OPEN FRACT-DISLOC;SKIN&SUBCU TISS $822.23 $822.23 $822.23 11011 DEBRID/OPN FRA&DISL;SKN,SUBCU,MUSCLE FAS $822.23 $822.23 $822.23 11012 DEBRID/OPN FRA&DISL;SKN,SUBC,MUS FAS,BON $822.23 $822.23 $822.23 11040 DEBRIDEMENT SKIN PARTIAL THICKNESS $1,339.05 D D 11041 DEBRIDEMENT SKIN FULL THICKNESS $1,339.05 D D 11042 DEBRIDEMENT SKIN AND SUBCUTANEOUS TISSUE $1,339.05 $1,339.05 $1,339.05 11043 DEBRIDEMENT SKIN SUBCUTAN TISSU MUSCLE $1,339.05 $1,339.05 $1,339.05 11044 DEBRIDEMENT SKIN SUBCUTAN TISS MUSC BONE $1,339.05 $1,339.05 $1,339.05 11045 DEBRIDEMNT,SUBCUT TISSUE;EA ADD 20 SQ Not Valid $1,339.05 $1,339.05 11046 DEBRID,MUSCL/FASC (EPID,DERMIS,SUBCU Not Valid $1,339.05 $1,339.05 11047 DEBRIDEMENT, BONE; EACH ADD'L 20 SQ CM Not Valid $1,339.05 $1,339.05 11055 PARING/CUT BEN HYPERKERATOTIC LESI;SINGL $822.23 $822.23 $822.23 11056 PARING/CUT BEN HYPERKERATOTIC LESI; 20R4 $822.23 $822.23 $822.23 11057 PARING/CUT BEN HYPERKERATOTIC LESINOS;4+ $822.23 $822.23 $822.23 11100 BIOPSY SKN SQ TSSUE MUCOS MEMBRANE 1 LES $822.23 $822.23 $822.23 11200 REMOV SKN TAGS MULT FIBROCUT 15 OR < LES $822.23 $822.23 $822.23 11300 SHVG EPID/DERML LESION SGL TK/AM/LG .5C< $822.23 $822.23 $822.23 11301 SHAVE SKIN LESION, DIA 6.5 TO 1.0 CM $822.23 $822.23 $822.23 11302 SHVG EPID/DRM LESION SGL TK/AM/LG 1.1-2C $822.23 $822.23 $822.23 11303 SHVG EPID/DERM LESION SGL TK/AM/LG 2.0>C $822.23 $822.23 $822.23 11305 SHV EPD/DRL LSN SGL SCL/NK/HD/FT/GT .5C< $822.23 $822.23 $822.23 11306 SHV EPD/DRM LSN SGL SCL/NK/HD/FT/G .6-1C $822.23 $822.23 $822.23 11307 SHV EPD/DRM LSN SGL SCL/NK/HD/F/G 1.1-2G $822.23 $822.23 $822.23 11308 SHV EPD/DRL LSN SGL SCL/NK/HD/FT/G 2.0C> $822.23 $822.23 $822.23 11310 SHV EPD/DRM LESION SGL F/E/E/N/L/MM .5C< $822.23 $822.23 $822.23 11311 SHV EPD/DRM LESN SGL F/E/E/N/L/MM .6-1C $822.23 $822.23 $822.23 11312 SHV EPD/DRM LSN SGL F/E/E/N/L/MM 1.1-2CM $822.23 $822.23 $822.23 11313 SHV EPD/DRM LSN SGL F/E/E/N/L/MM DIA 2C> $822.23 $822.23 $822.23 11400 EXC BENGN LES INCL MARG,T-A-L,<= 0.5 CM $822.23 $822.23 $822.23 07/27/12 Page 1 of 90 PROC DESCRIPTION 2010 Rate 2011 Rate 2012 Rate 11401 EXC BENGN LES INCL MARGIN,T-A-L,0.6-1 CM $822.23 $822.23 $822.23 11402 EXC BENGN LES INCL MARGIN,T-A-L,1.1-2 CM $822.23 $822.23 $822.23 11403 EXC BENGN LES INCL MARGIN,T-A-L,2.1-3 CM $822.23 $822.23 $822.23 11404 EXC BENGN LES INCL MARGIN,T-A-L,3.1-4 CM $822.23 $822.23 $822.23 11406 EXC BENGN LES INCL MARGIN,T-A-L, > 4.0CM $822.23 $822.23 $822.23 11420 EXC BENGN LES INCL MARG H-F-NK-SP 0.5 < $822.23 $822.23 $822.23 11421 EXC BENGN LES INCL MARG H-F-NK-SP 0.6-1 $822.23 $822.23 $822.23 11422 EXC BENGN LES INCL MARG H-F-NK-SP 1.1-2 $822.23 $822.23 $822.23 11423 EXC BENGN LES INCL MARG H-F-NK-SP 2.1-3 $822.23 $822.23 $822.23 11424 EXC BENGN LES INCL MARG H-F-NK-SP 3.1-4 $822.23 $822.23 $822.23 11426 EXC BENGN LES INCL MARG H-F-NK-SP > 4 CM $822.23 $822.23 $822.23 11440 EXC BEGN LES INCL MARG FACE 0.5 < CM $822.23 $822.23 $822.23 11441 EXC BEGN LES INCL MARG FACE 0.6-1 CM $822.23 $822.23 $822.23 11442 EXC BEGN LES INCL MARG FACE 1.1-2 CM $822.23 $822.23 $822.23 11443 EXC BEGN LES INCL MARG FACE 2.1-3 CM $822.23 $822.23 $822.23 11444 EXC BEGN LES INCL MARG FACE 3.1-4 CM $822.23 $822.23 $822.23 11446 EXC BEGN LES INCL MARG FACE > 4 CM $822.23 $822.23 $822.23 11450 EXC SKN SUBQ HIDRADENITIS AX SIM/INT REP $822.23 $822.23 $822.23 11451 EXC SKN SUBQ HIDRADENITIS AX COMPLEX REP $822.23 $822.23 $822.23 11462 EXC SKN SUBQ HIDRADENITIS ING SIM/INT RE $822.23 $822.23 $822.23 11463 EXC SKN SUBQ HIDRADENITIS ING COMPLEX RE $822.23 $822.23 $822.23 11470 EXCIS SKIN-SUBQ HIDRADENTIS PERI/NAL/NEA $822.23 $822.23 $822.23 11471 EXCIS SKIN-SUBQ HIDRADENITIS PERI/NAL/NE $822.23 $822.23 $822.23 11600 EXC MALGN LES INC MARG,TRNK-ARM-LG .5<CM $822.23 $822.23 $822.23 11601 EXC MALG LES INC MARG,TRNK-ARM-LG .6-1CM $822.23 $822.23 $822.23 11602 EXC MAL LES INC MAR,TRNK-ARM-LG 1.1-2 CM $822.23 $822.23 $822.23 11603 EXC MAL LES INC MAR,TRNK-ARM-LG 2.1-3 CM $822.23 $822.23 $822.23 11604 EXC MAL LES INC MAR,TRNK-ARM-LG 3.1-4 CM $822.23 $822.23 $822.23 11606 EXC MALG LES INC MAR,TRNK-ARM-LEG > 4CM $822.23 $822.23 $822.23 11620 EXC,MAL LES INC MAR,HND-FT-NK-SP 0.5 < $822.23 $822.23 $822.23 11621 EXC,MAL LES INC MAR,HND-FT-NK-SP 0.6-1 $822.23 $822.23 $822.23 11622 EXC,MAL LES INC MAR,HND-FT-NK-SP 1.1-2 $822.23 $822.23 $822.23 11623 EXC,MAL LES INC MAR,HND-FT-NK-SP 2.1-3 $822.23 $822.23 $822.23 11624 EXC,MAL LES INC MAR,HND-FT-NK-SP 3.1-4 $822.23 $822.23 $822.23 11626 EXC,MAL LES INC MAR,HND-FT-NK-SP > 4 CM $822.23 $822.23 $822.23 11640 EXCISE,MALIG LESION INCL MARG,FACE 0.5 < $822.23 $822.23 $822.23 11641 EXCISE,MALG LESION INCL MARG, FACE 0.6-1 $822.23 $822.23 $822.23 11642 EXCISE,MALG LESION INCL MARG, FACE 1.1-2 $822.23 $822.23 $822.23 11643 EXCISE,MALG LESION INCL MARG, FACE 2.1-3 $822.23 $822.23 $822.23 11644 EXCISE,MALG LESION INCL MARG, FACE 3.1-4 $822.23 $822.23 $822.23 11646 EXCISE,MALG LESION INCL MARG,FACE > 4 CM $822.23 $822.23 $822.23 11720 DEBRID NAILS/ANY METHOD(S);ONE TO FIVE $293.65 $293.65 $293.65 11721 DEBRID NAILS BY ANY METHOD(S); 6 OR MORE $293.65 $293.65 $293.65 11730 EXC AVULSIO NAIL PLAPART COM SIMP SINGLE $822.23 $822.23 $822.23 11740 EVACUATION SUBUNGWAL HEMATOMA $822.23 $822.23 $822.23 11750 EXC OF NAIL & NAIL MATRIX $822.23 $822.23 $822.23 11752 EXCIS NAIL/MATX PART/COMP W AMPU DIST TU $822.23 $822.23 $822.23 11755 BIOPSY OF NAIL UNIT (SEPARATE PROCEDURE) $822.23 $822.23 $822.23 07/27/12 Page 2 of 90 PROC DESCRIPTION 2010 Rate 2011 Rate 2012 Rate 11760 RECONSTRUCTION NAIL BEO SIMPLE $822.23 $822.23 $822.23 11762 RECONSTRUCTION NAIL BED COMPLICATED $822.23 $822.23 $822.23 11765 WEDGE EXCIS OF SKIN OF NAIL FOLD(IN-GROW $822.23 $822.23 $822.23 11770 EXC PILONIDAL CYST OR SINUS SIMPLE $1,339.05 $1,339.05 $1,339.05 11771 EXC PILONIDAL CYST OR SINUS EXTENSIVE $1,339.05 $1,339.05 $1,339.05 11772 EXC PILONIDAL CYST OR SINUS COMPLICATED $1,339.05 $1,339.05 $1,339.05 11900 INJECT INTRALESIONAL UP TO 7 LESIONS $822.23 $822.23 $822.23 11901 INJECT INTRALESIONAL MO THAN 7 LESIONS $822.23 $822.23 $822.23 11960 INSERTION OF TISSUE EXPANDERS $293.65 $293.65 $293.65 11970 REPLACE TISSUE EXPANDER WITH PERM PROSTH $822.23 $822.23 $822.23 11971 REMOV TISSU EXPANDER(S) WO INSERT PROSTH $293.65 $293.65 $293.65 11981 INSERT NON-BIODEGRADE DRUG DELIV IMPLANT $822.23 $822.23 $822.23 11982 REMOVE NON-BIODEGRADE DRUG DELIV IMPLANT $822.23 $822.23 $822.23 11983 RMOVE/REINSRT NON-BIO DRUG DELIV IMPLANT $822.23 $822.23 $822.23 12001 SIMPLE REPAIR (AREA) 2.5 OR LESS $293.65 $293.65 $293.65 12002 SIMPLE REPAIR (AREA) 2.6 TO 7.5 CM $293.65 $293.65 $293.65 12004 SIMPLE REPAIR (AREA) 7.6 TO 12.5 CM $125.00 $125.00 $125.00 12005 SIMPLE REPAIR (AREA) 12.6 TO 20.0 CM $822.23 $822.23 $822.23 12006 SIMPLE REPAIR (AREA) 20.1 TO 30.0 CM $822.23 $822.23 $822.23 12007 SIMPLE REPAIR WD SCALP ETC OVER 30CM $822.23 $822.23 $822.23 12011 SIMPLE REPAIR (AREA) 2.5 OR LESS $293.65 $293.65 $293.65 12013 SIMPLE REPAIR (AREA) 2.6 TO 5.0 CM $293.65 $293.65 $293.65 12014 SIMPLE REPAIR (AREA) 5.1 TO 7.5 CM $293.65 $293.65 $293.65 12015 SIMPLE REPAIR (AREA) 7.6 TO 12.5 CM $293.65 $293.65 $293.65 12016 SIMPLE REPAIR (AREA) 12.6 TO 20.0 CM $293.65 $293.65 $293.65 12017 SIMPLE REPAIR (AREA) 20.1 TO 30.0 CM $293.65 $293.65 $293.65 12018 SIMPLE REPAIR WD FACE ETC OVER 30CM $293.65 $293.65 $293.65 12020 TREATMENT SUPERFICIAL WOUND DEHISCENCE $293.65 $293.65 $293.65 12021 TREAT SUPERFICIAL WOUND DEHIS CF W/PACKI $293.65 $293.65 $293.65 12031 LAYER CLOSUR(AREA) 2.5 CM OR LESS $293.65 $293.65 $293.65 12032 LAYER CLOSURE(AREA) 2.6 CM TO 7.5 CM $293.65 $293.65 $293.65 12034 LAYER CLOSURE(AREA) 7.6 CM TO 12.5 CM $822.23 $822.23 $822.23 12035 LAYER CLOSURE(AREA) 12.6 CM TO 20.0 CM $822.23 $822.23 $822.23 12036 LAYER CLOSURE(AREA) 20.1 CM TO 30.0 CM $822.23 $822.23 $822.23 12037 LAYER CLOS SCALP/AX/TRUNK/EXTREM OVER 30 $822.23 $822.23 $822.23 12041 LAYER CLOSURE(AREA) 2.5 CM OR LESS $822.23 $822.23 $822.23 12042 LAYER CLOSURE (AREA) 2.6 CM TO 7.5 CM 75 $822.23 $822.23 $822.23 12044 LAYER CLOS (AREA) 7.6 CM TO 12.5 CM $822.23 $822.23 $822.23 12045 LAYER CLOS (AREA) 12.6 CM TO 20.0 CM $822.23 $822.23 $822.23 12046 LAYER CLOSURE (AREA) 20.1 CM TO 30.00 CM $822.23 $822.23 $822.23 12047 LAYER CLOS NEK/HAN/FET/EX GENIT OVER 30C $822.23 $822.23 $822.23 12051 LAYER CLOSURE (AREA) 2.5 CM OR LESS $293.65 $293.65 $293.65