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 21.12 01996 HOSP MANAGE CONT DRUG ADMIN 63.36 0359T BEHAVIORAL ID ASSESSMENT 70.19 0360T OBSERV BEHAV ASSESSMENT 70.19 0361T OBSERV BEHAV ASSESS ADDL 70.19 0362T EXPOSE BEHAV ASSESSMENT 70.19 0363T EXPOSE BEHAV ASSESS ADDL 70.19 0364T ADAPTIVE BEHAVIOR TREATMENT 60.20 0365T ADAPTIVE BEHAVIOR TX ADDL 60.20 0366T GROUP BEHAVIOR TREATMENT 42.84 0367T GROUP BEHAV TREATMENT ADDL 42.84 0368T BEHAVIOR TREATMENT MODIFIED 60.20 0369T BEHAV TREATMENT MODIFY ADDL 60.20 0370T FAM BEHAV TREATMENT GUIDANCE 84.68 0372T SOCIAL SKILLS TRAINING GROUP 42.84 0373T EXPOSURE BEHAVIOR TREATMENT 76.28 0374T EXPOSE BEHAV TREATMENT ADDL 76.28 10021 FNA W/O IMAGE 70.92 10022 FNA W/IMAGE 65.39 10030 Guide cathet fluid drainage 154.73 10040 ACNE SURGERY 87.47 10060 DRAINAGE OF SKIN ABSCESS 95.60 10061 DRAINAGE OF SKIN ABSCESS 178.04 10080 DRAINAGE OF PILONIDAL CYST 103.29 Proc Code Description Mod Rate 10081 DRAINAGE OF PILONIDAL CYST 172.45 10120 REMOVE FOREIGN BODY 103.22 10121 REMOVE FOREIGN BODY 185.58 10140 DRAINAGE OF HEMATOMA/FLUID 118.06 10160 PUNCTURE DRAINAGE OF LESION 95.62 10180 COMPLEX DRAINAGE WOUND 178.97 11000 DEBRIDE INFECTED SKIN 28.42 11001 DEBRIDE INFECTED SKIN ADD-ON 14.22 11004 DEBRIDE GENITALIA & PERINEUM 579.35 11005 DEBRIDE ABDOM WALL 781.65 11006 DEBRIDE GENIT/PER/ABDOM WALL 702.26 11008 REMOVE MESH FROM ABD WALL 274.06 11010 DEBRIDE SKIN AT FX SITE 278.30 11011 DEBRIDE SKIN MUSC AT FX SITE 301.71 11012 DEB SKIN BONE AT FX SITE 426.17 11042 DEB SUBQ TISSUE 20 SQ CM/< 61.54 11043 DEB MUSC/FASCIA 20 SQ CM/< 157.36 11044 DEB BONE 20 SQ CM/< 234.59 11045 DEB SUBQ TISSUE ADD-ON 27.63 11046 DEB MUSC/FASCIA ADD-ON 56.21 11047 DEB BONE ADD-ON 100.66 11055 TRIM SKIN LESION 15.90 11056 TRIM SKIN LESIONS 2 TO 4 22.47 11057 TRIM SKIN LESIONS OVER 4 29.39 11100 BIOPSY SKIN LESION 48.61 11101 BIOPSY SKIN ADD-ON 24.46 11200 REMOVAL OF SKIN TAGS <W/15 73.00 11201 REMOVE SKIN TAGS ADD-ON 16.77 11300 SHAVE SKIN LESION 0.5 CM/< 34.94 11301 SHAVE SKIN LESION 0.6-1.0 CM 53.11 11302 SHAVE SKIN LESION 1.1-2.0 CM 62.20 11303 SHAVE SKIN LESION >2.0 CM 74.11 11305 SHAVE SKIN LESION 0.5 CM/< 38.48 11306 SHAVE SKIN LESION 0.6-1.0 CM 51.56 11307 SHAVE SKIN LESION 1.1-2.0 CM 66.25 11308 SHAVE SKIN LESION >2.0 CM 72.94 11310 SHAVE SKIN LESION 0.5 CM/< 47.19 11311 SHAVE SKIN LESION 0.6-1.0 CM 65.00 11312 SHAVE SKIN LESION 1.1-2.0 CM 78.37 11313 SHAVE SKIN LESION >2.0 CM 100.38 11400 EXC TR-EXT B9+MARG 0.5 CM< 79.32 11401 EXC TR-EXT B9+MARG 0.6-1 CM 103.18 11402 EXC TR-EXT B9+MARG 1.1-2 CM 113.71 11403 EXC TR-EXT B9+MARG 2.1-3CM/< 146.50 11404 EXC TR-EXT B9+MARG 3.1-4 CM 160.82 11406 EXC TR-EXT B9+MARG >4.0 CM 244.91 Proc Code Description Mod Rate 11420 EXC H-F-NK-SP B9+MARG 0.5/< 81.23 11421 EXC H-F-NK-SP B9+MARG 0.6-1 110.40 11422 EXC H-F-NK-SP B9+MARG 1.1-2 134.86 11423 EXC H-F-NK-SP B9+MARG 2.1-3 156.55 11424 EXC H-F-NK-SP B9+MARG 3.1-4 178.52 11426 EXC H-F-NK-SP B9+MARG >4 CM 273.01 11440 EXC FACE-MM B9+MARG 0.5 CM/< 103.53 11441 EXC FACE-MM B9+MARG 0.6-1 CM 131.15 11442 EXC FACE-MM B9+MARG 1.1-2 CM 145.52 11443 EXC FACE-MM B9+MARG 2.1-3 CM 177.64 11444 EXC FACE-MM B9+MARG 3.1-4 CM 226.95 11446 EXC FACE-MM B9+MARG >4 CM 326.08 11450 REMOVAL SWEAT GLAND LESION 250.45 11451 REMOVAL SWEAT GLAND LESION 323.33 11462 REMOVAL SWEAT GLAND LESION 239.27 11463 REMOVAL SWEAT GLAND LESION 326.52 11470 REMOVAL SWEAT GLAND LESION 281.55 11471 REMOVAL SWEAT GLAND LESION 352.30 11600 EXC TR-EXT MAL+MARG 0.5 CM/< 119.51 11601 EXC TR-EXT MAL+MARG 0.6-1 CM 148.23 11602 EXC TR-EXT MAL+MARG 1.1-2 CM 162.64 11603 EXC TR-EXT MAL+MARG 2.1-3 CM 194.07 11604 EXC TR-EXT MAL+MARG 3.1-4 CM 214.78 11606 EXC TR-EXT MAL+MARG >4 CM 319.34 11620 EXC H-F-NK-SP MAL+MARG 0.5/< 121.29 11621 EXC S/N/H/F/G MAL+MRG 0.6-1 148.93 11622 EXC S/N/H/F/G MAL+MRG 1.1-2 170.68 11623 EXC S/N/H/F/G MAL+MRG 2.1-3 211.61 11624 EXC S/N/H/F/G MAL+MRG 3.1-4 239.93 11626 EXC S/N/H/F/G MAL+MRG >4 CM 294.83 11640 EXC F/E/E/N/L MAL+MRG 0.5CM< 125.18 11641 EXC F/E/E/N/L MAL+MRG 0.6-1 155.98 11642 EXC F/E/E/N/L MAL+MRG 1.1-2 183.25 11643 EXC F/E/E/N/L MAL+MRG 2.1-3 230.87 11644 EXC F/E/E/N/L MAL+MRG 3.1-4 285.84 11646 EXC F/E/E/N/L MAL+MRG >4 CM 397.05 11719 TRIM NAIL(S) ANY NUMBER 7.60 11720 DEBRIDE NAIL 1-5 14.90 11721 DEBRIDE NAIL 6 OR MORE 24.56 11730 REMOVAL OF NAIL PLATE 50.53 11732 REMOVE NAIL PLATE ADD-ON 20.06 11740 DRAIN BLOOD FROM UNDER NAIL 32.76 11750 REMOVAL OF NAIL BED 173.14 11752 REMOVE NAIL BED/TIP 259.66 11755 BIOPSY NAIL UNIT 78.21 11760 REPAIR OF NAIL BED 133.87 Proc Code Description Mod Rate 11762 RECONSTRUCTION OF NAIL BED 185.05 11765 EXCISION OF NAIL FOLD TOE 93.04 11770 REMOVE PILONIDAL CYST SIMPLE 183.77 11771 REMOVE PILONIDAL CYST EXTEN 431.80 11772 REMOVE PILONIDAL CYST COMPL 573.13 11900 INJECT SKIN LESIONS </W 7 31.12 11901 INJECT SKIN LESIONS >7 48.63 11950 TX CONTOUR DEFECTS 1 CC/< 53.20 11951 TX CONTOUR DEFECTS 1.1-5.0CC 76.48 11952 TX CONTOUR DEFECTS 5.1-10CC 100.70 11954 TX CONTOUR DEFECTS >10.0 CC 116.38 11960 INSERT TISSUE EXPANDER(S) 934.51 11970 REPLACE TISSUE EXPANDER 616.24 11971 REMOVE TISSUE EXPANDER(S) 322.25 11976 REMOVE CONTRACEPTIVE CAPSULE 97.05 11980 IMPLANT HORMONE PELLET(S) 79.88 11981 INSERT DRUG IMPLANT DEVICE 81.34 11982 REMOVE DRUG IMPLANT DEVICE 97.30 11983 REMOVE/INSERT DRUG IMPLANT 168.65 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< 45.00 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM 59.25 12004 RPR S/N/AX/GEN/TRK7.6-12.5CM 73.87 12005 RPR S/N/A/GEN/TRK12.6-20.0CM 99.98 12006 RPR S/N/A/GEN/TRK20.1-30.0CM 121.24 12007 RPR S/N/AX/GEN/TRNK >30.0 CM 150.62 12011 RPR F/E/E/N/L/M 2.5 CM/< 56.15 12013 RPR F/E/E/N/L/M 2.6-5.0 CM 62.72 12014 RPR F/E/E/N/L/M 5.1-7.5 CM 79.77 12015 RPR F/E/E/N/L/M 7.6-12.5 CM 99.25 12016 RPR FE/E/EN/L/M 12.6-20.0 CM 134.79 12017 RPR FE/E/EN/L/M 20.1-30.0 CM 154.16 12018 RPR F/E/E/N/L/M >30.0 CM 174.32 12020 CLOSURE OF SPLIT WOUND 190.75 12021 CLOSURE OF SPLIT WOUND 141.38 12031 INTMD RPR S/A/T/EXT 2.5 CM/< 152.69 12032 INTMD RPR S/A/T/EXT 2.6-7.5 193.83 12034 INTMD RPR S/TR/EXT 7.6-12.5 206.50 12035 INTMD RPR S/A/T/EXT 12.6-20 242.75 12036 INTMD RPR S/A/T/EXT 20.1-30 281.53 12037 INTMD RPR S/TR/EXT >30.0 CM 329.21 12041 INTMD RPR N-HF/GENIT 2.5CM/< 156.10 12042 INTMD RPR N-HF/GENIT2.6-7.5 199.13 12044 INTMD RPR N-HF/GENIT7.6-12.5 215.46 12045 INTMD RPR N-HF/GENIT12.6-20 270.64 12046 INTMD RPR N-HF/GENIT20.1-30 307.30 12047 INTMD RPR N-HF/GENIT >30.0CM 342.23 Proc Code Description Mod Rate 12051 INTMD RPR FACE/MM 2.5 CM/< 171.16 12052 INTMD RPR FACE/MM 2.6-5.0 CM 202.59 12053 INTMD RPR FACE/MM 5.1-7.5 CM 217.62 12054 INTMD RPR FACE/MM 7.6-12.5CM 229.00 12055 INTMD RPR FACE/MM 12.6-20 CM 304.25 12056 INTMD RPR FACE/MM 20.1-30.0 378.07 12057 INTMD RPR FACE/MM >30.0 CM 380.17 13100 CMPLX RPR TRUNK 1.1-2.5 CM 205.67 13101 CMPLX RPR TRUNK 2.6-7.5 CM 253.35 13102 CMPLX RPR TRUNK ADDL 5CM/< 74.94 13120 CMPLX RPR S/A/L 1.1-2.5 CM 236.18 13121 CMPLX RPR S/A/L 2.6-7.5 CM 266.90 13122 CMPLX RPR S/A/L ADDL 5 CM/> 86.11 13131 CMPLX RPR F/C/C/M/N/AX/G/H/F 250.46 13132 CMPLX RPR F/C/C/M/N/AX/G/H/F 314.11 13133 CMPLX RPR F/C/C/M/N/AX/G/H/F 131.55 13151 CMPLX RPR E/N/E/L 1.1-2.5 CM 287.17 13152 CMPLX RPR E/N/E/L 2.6-7.5 CM 348.07 13153 CMPLX RPR E/N/E/L ADDL 5CM/< 142.39 13160 LATE CLOSURE OF WOUND 812.08 14000 TIS TRNFR TRUNK 10 SQ CM/< 503.62 14001 TIS TRNFR TRUNK 10.1-30SQCM 653.91 14020 TIS TRNFR S/A/L 10 SQ CM/< 570.41 14021 TIS TRNFR S/A/L 10.1-30 SQCM 718.98 14040 TIS TRNFR F/C/C/M/N/A/G/H/F 634.12 14041 TIS TRNFR F/C/C/M/N/A/G/H/F 777.02 14060 TIS TRNFR E/N/E/L 10 SQ CM/< 675.50 14061 TIS TRNFR E/N/E/L10.1-30SQCM 831.27 14301 TIS TRNFR ANY 30.1-60 SQ CM 885.86 14302 TIS TRNFR ADDL 30 SQ CM/< 222.91 14350 FILLETED FINGER/TOE FLAP 710.79 15002 WOUND PREP TRK/ARM/LEG 228.12 15003 WOUND PREP ADDL 100 CM 45.82 15004 WOUND PREP F/N/HF/G 273.12 15005 WND PREP F/N/HF/G ADDL CM 92.01 15040 HARVEST CULTURED SKIN GRAFT 127.99 15050 SKIN PINCH GRAFT 447.97 15100 SKIN SPLT GRFT TRNK/ARM/LEG 721.11 15101 SKIN SPLT GRFT T/A/L ADD-ON 111.59 15110 EPIDRM AUTOGRFT TRNK/ARM/LEG 755.76 15111 EPIDRM AUTOGRFT T/A/L ADD-ON 102.43 15115 EPIDRM A-GRFT FACE/NCK/HF/G 760.07 15116 EPIDRM A-GRFT F/N/HF/G ADDL 135.54 15120 SKN SPLT A-GRFT FAC/NCK/HF/G 704.54 15121 SKN SPLT A-GRFT F/N/HF/G ADD 132.65 15130 DERM AUTOGRAFT TRNK/ARM/LEG 572.46 Proc Code Description Mod Rate 15131 DERM AUTOGRAFT T/A/L ADD-ON 93.99 15135 DERM AUTOGRAFT FACE/NCK/HF/G 751.60 15136 DERM AUTOGRAFT F/N/HF/G ADD 85.38 15150 CULT SKIN GRFT T/ARM/LEG 628.41 15151 CULT SKIN GRFT T/A/L ADDL 109.41 15152 CULT SKIN GRAFT T/A/L