Physician Fee Schedule Provider Specialty 075 Rural Health Clinic Medicaid Maximum Allowable NON- EFFECTIVE CODE MOD TOS DESCRIPTION FACILITY FACILITY DATE 10021 3 FINE NEEDLE ASPIRATION; WITHOUT IMAGING GUIDANCE 59.91 114.35 3/1/2007 10022 3 FINE NEEDLE ASPIRATION: WITH IMAGING GUIDANCE 56.14 122.86 3/1/2007 10040 3 ACNE SURGERY (EG, MARSUPIALIZATION, OPENING OR REMOVAL OF 67.54 75.84 3/1/2007 10060 3 DRAINAGE OF ABSCESS 73.44 84.07 3/1/2007 10061 3 DRAINAGE OF ABSCESS 134.51 147.12 3/1/2007 10080 3 INCISION AND DRAINAGE OF PILONIDAL CYST; 77.86 140.27 3/1/2007 10081 3 INCISION AND DRAINAGE OF PILONIDAL CYST; 134.83 215.49 3/1/2007 10120 3 INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; 74.88 113.06 3/1/2007 10121 3 INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; 153.42 211.84 3/1/2007 10140 3 DRAINAGE OF BLOOD EFFUSION 97.17 117.09 3/1/2007 10160 3 PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST 78.63 97.88 3/1/2007 10180 3 INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE WOUND INFECTION 145.78 182.96 3/1/2007 11000 3 SURGICAL CLEANSING OF SKIN 28.00 41.61 3/1/2007 11001 3 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; EACH ADDITIONAL 10% OF 13.95 18.26 3/1/2007 11004 3 DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING 488.60 488.60 3/1/2007 11005 3 DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING 656.57 656.57 3/1/2007 11006 3 DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING 605.51 605.51 3/1/2007 11008 3 REMOVAL OF PROSTHETIC MATERIAL OR MESH, ABDOMINAL WALL FOR NECROTIZING SOFT 237.59 237.59 3/1/2007 11040 3 DEBRIDEMENT; 24.20 36.15 3/1/2007 11041 3 DEBRIDEMENT; 31.67 44.28 3/1/2007 11042 3 DEBRIDEMENT; 41.82 61.07 3/1/2007 11043 3 DEBRIDEMENT; 178.62 204.93 7/1/2006 11044 3 DEBRIDEMENT; 244.27 267.58 7/1/2006 11055 3 PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); SINGLE 20.49 35.18 3/1/2007 11056 3 PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); TWO TO 28.69 44.63 3/1/2007 11057 3 PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); MORE 37.12 54.72 3/1/2007 11100 3 BIOPSY OF SKIN LESION 39.58 71.26 3/1/2007 11101 3 BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLU 20.41 25.39 3/1/2007 11200 3 REMOVAL OF SKIN TAGS 53.02 62.65 3/1/2007 11201 3 REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; EACH ADDITIONAL 13.80 15.13 3/1/2007 11300 3 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; 24.21 51.76 3/1/2007 11301 3 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; 40.88 68.29 3/1/2007 11302 3 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; 50.58 82.01 3/1/2007 11303 3 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; 59.50 98.01 3/1/2007 11305 3 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, 31.82 53.40 3/1/2007 11306 3 SHAVING OF LESION SCALP/NECK/HAND/ETC .6- 1.0 CM 47.24 72.80 3/1/2007 11307 3 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, 54.94 85.14 3/1/2007 11308 3 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, 67.92 99.46 3/1/2007 11310 3 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, 35.29 63.84 3/1/2007 11311 3 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, 51.24 79.46 3/1/2007 11312 3 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, 58.83 91.62 3/1/2007 11313 3 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, 79.06 117.90 3/1/2007 11400 3 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED 59.32 94.50 3/1/2007 11401 3 REMOVAL OF SKIN LESION 77.45 111.64 3/1/2007 11402 3 REMOVAL OF SKIN LESION 85.88 124.05 3/1/2007 11403 3 REMOVAL SKIN LESION 108.35 143.20 3/1/2007 11404 3 AMB SURG EXC BEN LESIONS TRUNK ARM LEGS 3.0 TO 4.0 120.55 163.04 3/1/2007 11406 3 AMB SURG EXC BEN LESION TRUNK ARM LEG OVER 4.0 CM 161.39 208.43 7/1/2006 11420 3 EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED 65.31 93.53 3/1/2007 11421 3 REMOVAL OF SKIN LESION 87.26 119.46 3/1/2007 11422 3 REMOVAL OF SKIN LESION 102.72 132.93 3/1/2007 11423 3 AMB SURG EXC BEN LESION SCALP NECK HAND 2.0 TO 3.0 120.21 156.73 3/1/2007 11424 3 AMB SURG EXC BEN LESION SCALP NECK HAND 3.0 TO 4.0 139.65 179.15 3/1/2007 11426 3 AMB SURG EXC BEN LESION SCALP NECK HAND OVER 4.0 212.37 257.18 3/1/2007 11440 3 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS (UNLESS LISTED ELSEWHERE), 78.42 106.30 3/1/2007 11441 3 REMOVAL OF SKIN LESION 101.68 129.56 3/1/2007 11442 3 EXCISION, OTHER BENIGN LESION INCLUDING MARGINS (UNLESS LISTED ELSEWHERE), 112.57 144.77 3/1/2007 11443 3 AMB SURG EXC BEN LESION FACE EARS NOSE 2.0 TO 3.0 140.29 176.14 3/1/2007 11444 3 AMB SURG EXC BEN LESION FACE EARS NOSE 3.0 TO 4.0 180.75 222.58 3/1/2007 11446 3 EXCISION, OTHER BENIGN LESION (UNLESS LISTED ELSEWHERE), FACE, 254.77 297.92 3/1/2007 11450 3 EXC SKIN FOR HIDRADENITIS PRIMARY SUTURE/AXILLARY. 173.36 273.06 7/1/2006 11451 3 EXC SKIN FOR HIDRADENITIS W OTHER CLOSURE/AXILLARY 238.19 367.89 3/1/2007 11462 3 EXC SKIN FOR HIDRADENITIS W PRIM SUTURE/INGUINAL 164.22 267.33 7/1/2006 11463 3 EXC SKIN FOR HIDRADENITIS W OTH CLOSURE/INGUINAL 242.85 377.74 3/1/2007 Physician Fee Schedule Provider Specialty 075 Rural Health Clinic Medicaid Maximum Allowable NON- EFFECTIVE CODE MOD TOS DESCRIPTION FACILITY FACILITY DATE 11470 3 EXC SKIN FOR HIDRADENITIS W PRIMARY CLOSURE 201.26 294.16 7/1/2006 11471 3 EXC SKIN FOR HIDRADENITIS WITH OTHER CLOSURE 262.65 389.46 3/1/2007 11600 3 REMOVAL OF SKIN LESION 81.60 136.91 7/1/2006 11601 3 REMOVAL OF SKIN LESION 107.98 157.33 7/1/2006 11602 3 REMOVAL OF SKIN LESION 114.70 166.71 7/1/2006 11603 3 EXCISION MALIGNANT LESION TRUCK ARMS OR LEGS DIAME 126.59 184.55 7/1/2006 11604 3 AMB SURG EXCISION MALIGNANT LESION 3.0 TO 4.0 CM 137.05 202.97 7/1/2006 11606 3 AMB SURG EXCISION MALIGNANT LESION OVER 4.0 CM 189.04 266.23 7/1/2006 11620 3 REMOVAL OF SKIN LESION 76.38 131.04 7/1/2006 11621 3 REMOVAL OF SKIN LESION 107.20 155.89 7/1/2006 11622 3 REMOVAL OF SKIN LESION 124.51 176.84 7/1/2006 11623 3 EXCISION MALIGNANT LESION DIAMETER 2 TO 3 CM. 150.91 209.20 7/1/2006 11624 3 AMB SURG EXC MALIGNANT LESION 3.0 TO 4.0 SCALP ETC 175.33 240.60 7/1/2006 11626 3 AMB SURG EXC MALIGNANT LESION 4.0 SCALP NECK 236.82 314.16 3/1/2007 11640 3 REMOVAL OF SKIN LESION 87.87 139.16 7/1/2006 11641 3 REMOVAL OF SKIN LESION 124.18 177.95 3/1/2007 11642 3 REMOVAL OF SKIN LESION 145.57 205.65 3/1/2007 11643 3 AMB SURG EXC MALIGNANT LESION FACE EARS 2.0 TO 3.0 181.37 243.80 3/1/2007 11644 3 AMB SURG EXC MALIGNANT LESION FACE EARS 3.0 TO 4.0 229.02 306.03 3/1/2007 11646 3 AMB SURG EXC MALIGNANT LESION FACE EARS OVER 4.0 327.62 406.95 3/1/2007 11720 3 DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); ONE TO FIVE 15.00 23.63 3/1/2007 11721 3 DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); SIX OR MORE 25.87 34.83 3/1/2007 11730 3 REMOVAL OF NAIL 52.10 75.66 3/1/2007 11732 3 AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH ADDITIONAL NAIL PLATE 26.59 35.55 3/1/2007 11740 3 EVACUATION OF SUBUNGUAL HEMATOMA 25.07 32.46 3/1/2007 11750 3 REMOVAL OF NAIL BED 142.17 161.43 1/1/2007 11752 3 EXC NAIL WITH AMPUTATION OF TUFT OF DISTAL PHALANX 203.56 203.56 7/1/2006 11755 3 BIOPSY OF NAIL UNIT (EG, PLATE, BED, MATRIX, HYPONYCHIUM, PROXIMAL AND LATERAL 71.22 101.76 3/1/2007 11760 3 RECONSTRUCTION OF NAIL BED 113.04 148.74 3/1/2007 11762 3 RECONSTRUCTION OF NAIL BED 175.19 205.39 3/1/2007 11765 3 WEDGE EXCISION OF SKIN OF NAIL FOLD (EG, FOR INGROWN TOENAIL) 51.86 85.96 7/1/2006 11770 3 AMB SURG EXC PILONIDAL CYST/SINUS SIMPLE 142.93 208.33 3/1/2007 11771 3 AMB SURG EXC PILONIDAL CYST/SINUS EXTENSIVE 323.67 406.33 3/1/2007 11772 3 AMB SURG EXC PILONIDAL CYST/SINUS COMPLICATED 426.15 507.15 3/1/2007 11900 3 INJECTION INTO SKIN LESIONS 24.68 40.71 3/1/2007 11901 3 INJECTION, INTRALESIONAL; 38.88 51.35 3/1/2007 11960 3 INSERTION OF TISSUE EXPENDER.