Provider Type 20 Physician, MD., Osteopath Reimbursement Rates Updated: July 1, 2015 The information contained in the schedule is made available to provide information and is not a guarantee by the State or the Department or its employees as to the present accuracy of the information contained herein. For example, coverage as well as an actual rate may have been revised or updated and may no longer be the same as posted on the website. Note: Procedure codes with a rate of $0.00 are reimbursed at 62% of Usual and Customary charges unless noted otherwise in Nevada Medicaid policy. CPT codes, descriptions and other data only are copyright © 2008 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. CPT is a registered trademark ® of the American Medical Association. Current Dental Terminology, fourth edition (CDT) (including procedure codes, definitions (descriptors) and other data) is copyrighted by the American Dental Association. © 2008 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. Proc Code Description Mod Rate 01953 ANESTH BURN EACH 9 PERCENT 0001 21.12 01996 HOSP MANAGE CONT DRUG ADMIN 0001 63.36 10021 FNA W/O IMAGE 0001 70.92 10022 FNA W/IMAGE 0001 65.39 10030 Guide cathet fluid drainage 0001 154.73 10040 ACNE SURGERY 0001 87.47 10060 DRAINAGE OF SKIN ABSCESS 0001 95.60 10061 DRAINAGE OF SKIN ABSCESS 0001 178.04 10080 DRAINAGE OF PILONIDAL CYST 0001 103.29 10081 DRAINAGE OF PILONIDAL CYST 0001 172.45 10120 REMOVE FOREIGN BODY 0001 103.22 10121 REMOVE FOREIGN BODY 0001 185.58 10140 DRAINAGE OF HEMATOMA/FLUID 0001 118.06 10160 PUNCTURE DRAINAGE OF LESION 0001 95.62 10180 COMPLEX DRAINAGE WOUND 0001 178.97 11000 DEBRIDE INFECTED SKIN 0001 28.42 11001 DEBRIDE INFECTED SKIN ADD-ON 0001 14.22 11004 DEBRIDE GENITALIA & PERINEUM 0001 579.35 11005 DEBRIDE ABDOM WALL 0001 781.65 11006 DEBRIDE GENIT/PER/ABDOM WALL 0001 702.26 11008 REMOVE MESH FROM ABD WALL 0001 274.06 11010 DEBRIDE SKIN AT FX SITE 0001 278.30 11011 DEBRIDE SKIN MUSC AT FX SITE 0001 301.71 11012 DEB SKIN BONE AT FX SITE 0001 426.17 Proc Code Description Mod Rate 11042 DEB SUBQ TISSUE 20 SQ CM/< 0001 61.54 11043 DEB MUSC/FASCIA 20 SQ CM/< 0001 157.36 11044 DEB BONE 20 SQ CM/< 0001 234.59 11045 DEB SUBQ TISSUE ADD-ON 0001 27.63 11046 DEB MUSC/FASCIA ADD-ON 0001 56.21 11047 DEB BONE ADD-ON 0001 100.66 11055 TRIM SKIN LESION 0001 15.90 11056 TRIM SKIN LESIONS 2 TO 4 0001 22.47 11057 TRIM SKIN LESIONS OVER 4 0001 29.39 11100 BIOPSY SKIN LESION 0001 48.61 11101 BIOPSY SKIN ADD-ON 0001 24.46 11200 REMOVAL OF SKIN TAGS <W/15 0001 73.00 11201 REMOVE SKIN TAGS ADD-ON 0001 16.77 11300 SHAVE SKIN LESION 0.5 CM/< 0001 34.94 11301 SHAVE SKIN LESION 0.6-1.0 CM 0001 53.11 11302 SHAVE SKIN LESION 1.1-2.0 CM 0001 62.20 11303 SHAVE SKIN LESION >2.0 CM 0001 74.11 11305 SHAVE SKIN LESION 0.5 CM/< 0001 38.48 11306 SHAVE SKIN LESION 0.6-1.0 CM 0001 51.56 11307 SHAVE SKIN LESION 1.1-2.0 CM 0001 66.25 11308 SHAVE SKIN LESION >2.0 CM 0001 72.94 11310 SHAVE SKIN LESION 0.5 CM/< 0001 47.19 11311 SHAVE SKIN LESION 0.6-1.0 CM 0001 65.00 11312 SHAVE SKIN LESION 1.1-2.0 CM 0001 78.37 11313 SHAVE SKIN LESION >2.0 CM 0001 100.38 11400 EXC TR-EXT B9+MARG 0.5 CM< 0001 79.32 11401 EXC TR-EXT B9+MARG 0.6-1 CM 0001 103.18 11402 EXC TR-EXT B9+MARG 1.1-2 CM 0001 113.71 11403 EXC TR-EXT B9+MARG 2.1-3CM/< 0001 146.50 11404 EXC TR-EXT B9+MARG 3.1-4 CM 0001 160.82 11406 EXC TR-EXT B9+MARG >4.0 CM 0001 244.91 11420 EXC H-F-NK-SP B9+MARG 0.5/< 0001 81.23 11421 EXC H-F-NK-SP B9+MARG 0.6-1 0001 110.40 11422 EXC H-F-NK-SP B9+MARG 1.1-2 0001 134.86 11423 EXC H-F-NK-SP B9+MARG 2.1-3 0001 156.55 11424 EXC H-F-NK-SP B9+MARG 3.1-4 0001 178.52 11426 EXC H-F-NK-SP B9+MARG >4 CM 0001 273.01 11440 EXC FACE-MM B9+MARG 0.5 CM/< 0001 103.53 11441 EXC FACE-MM B9+MARG 0.6-1 CM 0001 131.15 11442 EXC FACE-MM B9+MARG 1.1-2 CM 0001 145.52 11443 EXC FACE-MM B9+MARG 2.1-3 CM 0001 177.64 11444 EXC FACE-MM B9+MARG 3.1-4 CM 0001 226.95 11446 EXC FACE-MM B9+MARG >4 CM 0001 326.08 11450 REMOVAL SWEAT GLAND LESION 0001 250.45 11451 REMOVAL SWEAT GLAND LESION 0001 323.33 11462 REMOVAL SWEAT GLAND LESION 0001 239.27 Proc Code Description Mod Rate 11463 REMOVAL SWEAT GLAND LESION 0001 326.52 11470 REMOVAL SWEAT GLAND LESION 0001 281.55 11471 REMOVAL SWEAT GLAND LESION 0001 352.30 11600 EXC TR-EXT MAL+MARG 0.5 CM/< 0001 119.51 11601 EXC TR-EXT MAL+MARG 0.6-1 CM 0001 148.23 11602 EXC TR-EXT MAL+MARG 1.1-2 CM 0001 162.64 11603 EXC TR-EXT MAL+MARG 2.1-3 CM 0001 194.07 11604 EXC TR-EXT MAL+MARG 3.1-4 CM 0001 214.78 11606 EXC TR-EXT MAL+MARG >4 CM 0001 319.34 11620 EXC H-F-NK-SP MAL+MARG 0.5/< 0001 121.29 11621 EXC S/N/H/F/G MAL+MRG 0.6-1 0001 148.93 11622 EXC S/N/H/F/G MAL+MRG 1.1-2 0001 170.68 11623 EXC S/N/H/F/G MAL+MRG 2.1-3 0001 211.61 11624 EXC S/N/H/F/G MAL+MRG 3.1-4 0001 239.93 11626 EXC S/N/H/F/G MAL+MRG >4 CM 0001 294.83 11640 EXC F/E/E/N/L MAL+MRG 0.5CM< 0001 125.18 11641 EXC F/E/E/N/L MAL+MRG 0.6-1 0001 155.98 11642 EXC F/E/E/N/L MAL+MRG 1.1-2 0001 183.25 11643 EXC F/E/E/N/L MAL+MRG 2.1-3 0001 230.87 11644 EXC F/E/E/N/L MAL+MRG 3.1-4 0001 285.84 11646 EXC F/E/E/N/L MAL+MRG >4 CM 0001 397.05 11719 TRIM NAIL(S) ANY NUMBER 0001 7.60 11720 DEBRIDE NAIL 1-5 0001 14.90 11721 DEBRIDE NAIL 6 OR MORE 0001 24.56 11730 REMOVAL OF NAIL PLATE 0001 50.53 11732 REMOVE NAIL PLATE ADD-ON 0001 20.06 11740 DRAIN BLOOD FROM UNDER NAIL 0001 32.76 11750 REMOVAL OF NAIL BED 0001 173.14 11752 REMOVE NAIL BED/TIP 0001 259.66 11755 BIOPSY NAIL UNIT 0001 78.21 11760 REPAIR OF NAIL BED 0001 133.87 11762 RECONSTRUCTION OF NAIL BED 0001 185.05 11765 EXCISION OF NAIL FOLD TOE 0001 93.04 11770 REMOVE PILONIDAL CYST SIMPLE 0001 183.77 11771 REMOVE PILONIDAL CYST EXTEN 0001 431.80 11772 REMOVE PILONIDAL CYST COMPL 0001 573.13 11900 INJECT SKIN LESIONS </W 7 0001 31.12 11901 INJECT SKIN LESIONS >7 0001 48.63 11950 TX CONTOUR DEFECTS 1 CC/< 0001 53.20 11951 TX CONTOUR DEFECTS 1.1-5.0CC 0001 76.48 11952 TX CONTOUR DEFECTS 5.1-10CC 0001 100.70 11954 TX CONTOUR DEFECTS >10.0 CC 0001 116.38 11960 INSERT TISSUE EXPANDER(S) 0001 934.51 11970 REPLACE TISSUE EXPANDER 0001 616.24 11971 REMOVE TISSUE EXPANDER(S) 0001 322.25 11976 REMOVE CONTRACEPTIVE CAPSULE 0001 97.05 Proc Code Description Mod Rate 11980 IMPLANT HORMONE PELLET(S) 0001 79.88 11981 INSERT DRUG IMPLANT DEVICE 0001 81.34 11982 REMOVE DRUG IMPLANT DEVICE 0001 97.30 11983 REMOVE/INSERT DRUG IMPLANT 0001 168.65 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< 0001 45.00 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM 0001 59.25 12004 RPR S/N/AX/GEN/TRK7.6-12.5CM 0001 73.87 12005 RPR S/N/A/GEN/TRK12.6-20.0CM 0001 99.98 12006 RPR S/N/A/GEN/TRK20.1-30.0CM 0001 121.24 12007 RPR S/N/AX/GEN/TRNK >30.0 CM 0001 150.62 12011 RPR F/E/E/N/L/M 2.5 CM/< 0001 56.15 12013 RPR F/E/E/N/L/M 2.6-5.0 CM 0001 62.72 12014 RPR F/E/E/N/L/M 5.1-7.5 CM 0001 79.77 12015 RPR F/E/E/N/L/M 7.6-12.5 CM 0001 99.25 12016 RPR FE/E/EN/L/M 12.6-20.0 CM 0001 134.79 12017 RPR FE/E/EN/L/M 20.1-30.0 CM 0001 154.16 12018 RPR F/E/E/N/L/M >30.0 CM 0001 174.32 12020 CLOSURE OF SPLIT WOUND 0001 190.75 12021 CLOSURE OF SPLIT WOUND 0001 141.38 12031 INTMD RPR S/A/T/EXT 2.5 CM/< 0001 152.69 12032 INTMD RPR S/A/T/EXT 2.6-7.5 0001 193.83 12034 INTMD RPR S/TR/EXT 7.6-12.5 0001 206.50 12035 INTMD RPR S/A/T/EXT 12.6-20 0001 242.75 12036 INTMD RPR S/A/T/EXT 20.1-30 0001 281.53 12037 INTMD RPR S/TR/EXT >30.0 CM 0001 329.21 12041 INTMD RPR N-HF/GENIT 2.5CM/< 0001 156.10 12042 INTMD RPR N-HF/GENIT2.6-7.5 0001 199.13 12044 INTMD RPR N-HF/GENIT7.6-12.5 0001 215.46 12045 INTMD RPR N-HF/GENIT12.6-20 0001 270.64 12046 INTMD RPR N-HF/GENIT20.1-30 0001 307.30 12047 INTMD RPR N-HF/GENIT >30.0CM 0001 342.23 12051 INTMD RPR FACE/MM 2.5 CM/< 0001 171.16 12052 INTMD RPR FACE/MM 2.6-5.0 CM 0001 202.59 12053 INTMD RPR FACE/MM 5.1-7.5 CM 0001 217.62 12054 INTMD RPR FACE/MM 7.6-12.5CM 0001 229.00 12055 INTMD RPR FACE/MM 12.6-20 CM 0001 304.25 12056 INTMD RPR FACE/MM 20.1-30.0 0001 378.07 12057 INTMD RPR FACE/MM >30.0 CM 0001 380.17 13100 CMPLX RPR TRUNK 1.1-2.5 CM 0001 205.67 13101 CMPLX RPR TRUNK 2.6-7.5 CM 0001 253.35 13102 CMPLX RPR TRUNK ADDL 5CM/< 0001 74.94 13120 CMPLX RPR S/A/L 1.1-2.5 CM 0001 236.18 13121 CMPLX RPR S/A/L 2.6-7.5 CM 0001 266.90 13122 CMPLX RPR S/A/L ADDL 5 CM/> 0001 86.11 13131 CMPLX RPR F/C/C/M/N/AX/G/H/F 0001 250.46 13132 CMPLX RPR F/C/C/M/N/AX/G/H/F 0001 314.11 Proc Code Description Mod Rate 13133 CMPLX RPR F/C/C/M/N/AX/G/H/F 0001 131.55 13151 CMPLX RPR E/N/E/L 1.1-2.5 CM 0001 287.17 13152 CMPLX RPR E/N/E/L 2.6-7.5 CM 0001 348.07 13153 CMPLX RPR E/N/E/L ADDL 5CM/< 0001 142.39 13160 LATE CLOSURE OF WOUND 0001 812.08 14000 TIS TRNFR TRUNK 10 SQ CM/< 0001 503.62 14001 TIS TRNFR TRUNK 10.1-30SQCM 0001 653.91 14020 TIS TRNFR S/A/L 10 SQ CM/< 0001 570.41 14021 TIS TRNFR S/A/L 10.1-30 SQCM 0001 718.98 14040 TIS TRNFR F/C/C/M/N/A/G/H/F 0001 634.12 14041 TIS TRNFR F/C/C/M/N/A/G/H/F 0001 777.02 14060 TIS TRNFR E/N/E/L 10 SQ CM/< 0001 675.50 14061 TIS TRNFR E/N/E/L10.1-30SQCM 0001 831.27 14301 TIS TRNFR ANY 30.1-60 SQ CM 0001 885.86 14302 TIS TRNFR ADDL 30 SQ CM/< 0001 222.91 14350 FILLETED FINGER/TOE FLAP 0001 710.79 15002 WOUND PREP TRK/ARM/LEG 0001 228.12 15003 WOUND PREP ADDL 100 CM 0001 45.82 15004 WOUND PREP F/N/HF/G 0001 273.12 15005 WND PREP F/N/HF/G ADDL CM 0001 92.01 15040 HARVEST CULTURED SKIN GRAFT 0001 127.99 15050 SKIN PINCH GRAFT 0001 447.97 15100 SKIN SPLT GRFT TRNK/ARM/LEG 0001 721.11 15101 SKIN SPLT GRFT T/A/L ADD-ON 0001 111.59 15110 EPIDRM AUTOGRFT TRNK/ARM/LEG 0001 755.76 15111 EPIDRM AUTOGRFT T/A/L ADD-ON 0001 102.43 15115 EPIDRM A-GRFT FACE/NCK/HF/G 0001 760.07 15116 EPIDRM A-GRFT F/N/HF/G ADDL 0001 135.54 15120 SKN