ANNEX 6. LIST OF PROCEDURE CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES Professional Health Care RVS CODE DESCRIPTION Case Rate Fee Institution Fee Incision and drainage of abscess (e.g., carbuncle, 10060 suppurative hidradenitis, cutaneous or 2,548 588 1,960 subcutaneous abscess, cyst, furuncle, or paronychia) 10080 Incision and drainage of pilonidal cyst 2,548 588 1,960 Incision and removal of foreign body, subcutaneous 10120 2,548 588 1,960 tissues Incision and drainage of hematoma, seroma, or fluid 10140 2,548 588 1,960 collection Puncture aspiration of abscess, hematoma, bulla, or 10160 2,548 588 1,960 cyst Incision and drainage, complex, postoperative 10180 3,892 882 3,010 wound infection 11040 Debridement; skin, partial thickness 2,548 588 1,960 11041 Debridement; skin, full thickness 2,548 588 1,960 11042 Debridement; skin, and subcutaneous tissue 3,976 1,176 2,800 11043 Debridement; skin, subcutaneous tissue, and muscle 5,614 1,764 3,850 Debridement; skin, subcutaneous tissue, muscle, 11044 5,614 1,764 3,850 and bone Paring or curettement of benign hyperkeratotic skin lesion w/ or w/o chemical cauterization (such as 11050 verrucae or clavi) not extending through the 2,548 588 1,960 stratum corneum (e.g., callus or wart) w/ or w/o local anesthesia; single lesion Paring or curettement of benign hyperkeratotic skin lesion w/ or w/o chemical cauterization (such as 11051 verrucae or clavi) not extending through the 3,892 882 3,010 stratum corneum (e.g., callus or wart) w/ or w/o local anesthesia; two to four lesions Paring or curettement of benign hyperkeratotic skin lesion w/ or w/o chemical cauterization (such as 11052 verrucae or clavi) not extending through the 3,976 1,176 2,800 stratum corneum (e.g., callus or wart) w/ or w/o local anesthesia; more than four lesions Biopsy of skin, subcutaneous tissue and/or mucous 11100 membrane (including simple closure), unless 2,548 588 1,960 otherwise listed; single or multiple lesion Shaving of epidermal or dermal lesion, single lesion, 11300 3,892 882 3,010 trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, 11301 2,590 941 1,649 trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, 11302 5,614 1,764 3,850 trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Page 1 of 22 ANNEX 6. LIST OF PROCEDURE CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES Professional Health Care RVS CODE DESCRIPTION Case Rate Fee Institution Fee Shaving of epidermal or dermal lesion, single lesion, 11305 scalp, neck, hands, feet, genitalia; lesion diameter 3,892 882 3,010 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, 11306 scalp, neck, hands, feet, genitalia; lesion diameter 2,590 941 1,649 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, 11307 scalp, neck, hands, feet, genitalia; lesion diameter 5,614 1,764 3,850 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, 11310 face, ears, eyelids, nose ,lips, mucous membrane; 2,590 941 1,649 lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, 11311 face, ears, eyelids, nose ,lips, mucous membrane; 5,614 1,764 3,850 lesion diameter 0.6 to 1.0 cm Excision, benign lesion, except skin tag (unless listed 11400 elsewhere), trunk, arms or legs; lesion diameter 0.5 2,548 588 1,960 cm or less Excision, benign lesion, except skin tag (unless listed 11401 elsewhere), trunk, arms or legs; lesion diameter 0.6 2,548 588 1,960 to 1.0 cm Excision, benign lesion, except skin tag (unless listed 11402 elsewhere), trunk, arms or legs; lesion diameter 1.1 2,548 588 1,960 to 2.0 cm Excision, benign lesion, except skin tag (unless listed 11403 elsewhere), trunk, arms or legs; lesion diameter 2.1 2,548 588 1,960 to 3.0 cm Excision, benign lesion, except skin tag (unless listed 11404 elsewhere), trunk, arms or legs; lesion diameter 3.1 2,548 588 1,960 to 4.0 cm Excision, benign lesion, except skin tag (unless listed 11406 elsewhere), trunk, arms or legs; lesion diameter 2,548 588 1,960 over 4.0 cm Excision, benign lesion, except skin tag (unless listed 11420 elsewhere), scalp, neck, hands, feet, genitalia; lesion 2,548 588 1,960 diameter 0.5 cm or less Excision, benign lesion, except skin tag (unless listed 11421 elsewhere), scalp, neck, hands, feet, genitalia; lesion 2,548 588 1,960 diameter 0.6 to 1.0 cm Excision, benign lesion, except skin tag (unless listed 11422 elsewhere), scalp, neck, hands, feet, genitalia; lesion 2,548 588 1,960 diameter 1.1 to 2.0 cm Excision, benign lesion, except skin tag (unless listed 11423 elsewhere), scalp, neck, hands, feet, genitalia; lesion 2,548 588 1,960 diameter 2.1 to 3.0 cm Excision, benign lesion, except skin tag (unless listed 11424 elsewhere), scalp, neck, hands, feet, genitalia; lesion 2,548 588 1,960 diameter 3.1 to 4.0 cm Excision, benign lesion, except skin tag (unless listed 11426 elsewhere), scalp, neck, hands, feet, genitalia; lesion 2,548 588 1,960 diameter over 4.0 cm Page 2 of 22 ANNEX 6. LIST OF PROCEDURE CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES Professional Health Care RVS CODE DESCRIPTION Case Rate Fee Institution Fee Excision, other benign lesion (unless listed 11440 elsewhere), face, ears, eyelids, nose, lips, mucous 2,876 706 2,170 membrane; lesion diameter 0.5 cm or less Excision, other benign lesion (unless listed 11441 elsewhere), face, ears, eyelids, nose, lips, mucous 2,876 706 2,170 membrane; lesion diameter 0.6 to 1.0 cm Excision, other benign lesion (unless listed 11442 elsewhere), face, ears, eyelids, nose, lips, mucous 2,876 706 2,170 membrane; lesion diameter 1.1 to 2.0 cm Excision, other benign lesion (unless listed 11443 elsewhere), face, ears, eyelids, nose, lips, mucous 2,876 706 2,170 membrane; lesion diameter 2.1 to 3.0 cm Excision, other benign lesion (unless listed 11444 elsewhere), face, ears, eyelids, nose, lips, mucous 2,876 706 2,170 membrane; lesion diameter 3.1 to 4.0 cm Excision, other benign lesion (unless listed 11446 elsewhere), face, ears, eyelids, nose, lips, mucous 2,876 706 2,170 membrane; lesion diameter over 4.0 cm Excision of skin and subcutaneous tissue for 11450 5,614 1,764 3,850 hidradenitis, axillary Excision of skin and subcutaneous tissue for 11462 5,614 1,764 3,850 hidradenitis, inguinal Excision of skin and subcutaneous tissue for 11470 5,614 1,764 3,850 hidradenitis, perianal, perineal or umbilical Excision, malignant lesion, trunk, arms, or legs; 11600 3,892 882 3,010 lesion diameter 0.5 cm or less Excision, malignant lesion, trunk, arms, or legs; 11601 3,892 882 3,010 lesion diameter 0.6 to 1.0 cm Excision, malignant lesion, trunk, arms, or legs; 11602 3,892 882 3,010 lesion diameter 1.1 to 2.0 cm Excision, malignant lesion, trunk, arms, or legs; 11603 3,892 882 3,010 lesion diameter 2.1 to 3.0 cm Excision, malignant lesion, trunk, arms, or legs; 11604 3,892 882 3,010 lesion diameter 3.1 to 4.0 cm Excision, malignant lesion, trunk, arms, or legs; 11606 3,892 882 3,010 lesion diameter over 4.0 cm Excision, malignant lesion, scalp, neck, hands, feet, 11620 3,976 1,176 2,800 genitalia; lesion diameter 0.5 cm or less Excision, malignant lesion, scalp, neck, hands, feet, 11621 3,976 1,176 2,800 genitalia; lesion diameter 0.6 to 1.0 cm Excision, malignant lesion, scalp, neck, hands, feet, 11622 3,976 1,176 2,800 genitalia; lesion diameter 1.1 to 2.0 cm Excision, malignant lesion, scalp, neck, hands, feet, 11623 3,976 1,176 2,800 genitalia; lesion diameter 2.1 to 3.0 cm Excision, malignant lesion, scalp, neck, hands, feet, 11624 3,976 1,176 2,800 genitalia; lesion diameter 3.1 to 4.0 cm Page 3 of 22 ANNEX 6. LIST OF PROCEDURE CASE RATES FOR PRIMARY CARE FACILITIES - INFIRMARIES/ DISPENSARIES Professional Health Care RVS CODE DESCRIPTION Case Rate Fee Institution Fee Excision, malignant lesion, scalp, neck, hands, feet, 11626 3,976 1,176 2,800 genitalia; lesion diameter over 4.0 cm Excision, malignant lesion, face, ears, eyelids, nose, 11640 3,976 1,176 2,800 lips; lesion diameter 0.5 cm or less Excision, malignant lesion, face, ears, eyelids, nose, 11641 3,976 1,176 2,800 lips; lesion diameter 0.6 to 1.0 cm Excision, malignant lesion, face, ears, eyelids, nose, 11642 3,976 1,176 2,800 lips; lesion diameter 1.1 to 2.0 cm Excision, malignant lesion, face, ears, eyelids, nose, 11643 3,976 1,176 2,800 lips; lesion diameter 2.1 to 3.0 cm Excision, malignant lesion, face, ears, eyelids, nose, 11644 3,976 1,176 2,800 lips; lesion diameter 3.1 to 4.0 cm Excision, malignant lesion, face, ears, eyelids, nose, 11646 3,976 1,176 2,800 lips; lesion diameter over 4.0 cm 11720 Debridement of nail(s) by any method(s); one to five 2,548 588 1,960 Debridement of nail(s) by any method(s); six or 11721 3,892 882 3,010 more 11730 Avulsion of nail plate, partial or complete 2,548 588 1,960 11740 Evacuation of subungual hematoma 2,548 588 1,960 Excision of nail and nail matrix, partial or complete 11750 (e.g., ingrown or deformed nail) for permanent 2,548 588 1,960 removal Excision of nail and nail matrix, partial or complete 11752 (e.g., ingrown or deformed nail) for permanent 6,510 1,470 5,040 removal w/ amputation of tuft of distal phalanx Biopsy of nail unit, any method (e.g., plate, bed, 11755 matrix, hyponychium, proximal and lateral nail 2,548 588 1,960 folds) 11760 Repair of nail bed 3,892 882 3,010 11762 Reconstruction of nail bed w/ graft 6,510 1,470 5,040 Wedge excision of skin of nail fold (e.g., for ingrown 11765 2,548 588 1,960 toenail)