[Federal Register Volume 69, Number 150 (Thursday, August 5, 2004)]
[Proposed Rules]
[Pages 47488-47730]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 04-17312]
[[Page 47487]]
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Part II
Department of Health and Human Services
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Centers for Medicare and Medicaid Services
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42 CFR Parts 405, 410, 411, et al.
Medicare Program; Revisions to Payment Policies Under the Physician Fee
Schedule for Calendar Year 2005; Proposed Rule
Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 /
Proposed Rules
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 405, 410, 411, 414, 418, 424, 484, and 486
[CMS-1429-P]
RIN 0938-AM90
Medicare Program; Revisions to Payment Policies Under the
Physician Fee Schedule for Calendar Year 2005
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Proposed rule.
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SUMMARY: This proposed rule would refine the resource-based practice
expense relative value units (RVUs) and make other changes to Medicare
Part B payment policy. The proposed policy changes concern:
supplemental survey data for practice expense, updated geographic
practice cost indices for physician work and practice expense, updated
malpractice RVUs, revised requirements for supervision of therapy
assistants, revised payment rules for low osmolar contrast media,
changes to payment policies for physicians and practitioners managing
dialysis patients, clarification of care plan oversight requirements,
revised requirements for supervision of diagnostic psychological
testing services, clarifications to the policies affecting therapy
services, revised requirements for assignment of Medicare claims,
addition to the list of telehealth services, and several coding issues.
We are proposing these changes to ensure that our payment systems
are updated to reflect changes in medical practice and the relative
value of services. We solicit comments on these proposed policy
changes.
This proposed rule also addresses the following provisions of the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003
(MMA): coverage of an initial preventive physical examination; coverage
of cardiovascular screening blood tests; coverage of diabetes screening
tests; incentive payment improvements for physicians in shortage areas;
payment for covered outpatient drugs and biologicals; payment for renal
dialysis services; coverage of routine costs associated with certain
clinical trials of category A devices as defined by the Food and Drug
Administration; hospice consultation service; indexing the Part B
deductible to inflation; extension of coverage of intravenous immune
globulin (IVIG) for the treatment in the home of primary immune
deficiency diseases; revisions to reassignment provisions; clinical
conditions for payment of covered items of durable medical equipment;
and payment for diagnostic mammograms.
In addition, we discuss physicians' services associated with drug
administration services and payment for set-up of portable x-ray
equipment.
DATES: To be assured consideration, comments must be received at one of
the addresses provided below, no later than 5 p.m. on September 24,
2004.
ADDRESSES: In commenting, please refer to file code CMS-1429-P. Because
of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
You may submit comments in one of three ways (no duplicates,
please):
1. Electronically. You may submit electronic comments on specific
issues in this regulation to http://www.cms.hhs.gov/regulations/
ecomments. (Attachments should be in Microsoft Word, WordPerfect, or
Excel; however, we prefer Microsoft Word.)
2. By mail. You may mail written comments (one original and two
copies) to the following address ONLY:
Centers for Medicare & Medicaid Services, Department of Health and
Human Services, Attention: CMS-1429-P, P.O. Box 8012, Baltimore, MD
21244-8012.
Please allow sufficient time for mailed comments to be received before
the close of the comment period.
3. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments (one original and two copies) before the
close of the comment period to one of the following addresses. If you
intend to deliver your comments to the Baltimore address, please call
telephone number (410) 786-7197 in advance to schedule your arrival
with one of our staff members.
Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW.,
Washington, DC 20201; or 7500 Security Boulevard, Baltimore, MD 21244-
1850.
(Because access to the interior of the HHH Building is not readily
available to persons without Federal Government identification,
commenters are encouraged to leave their comments in the CMS drop slots
located in the main lobby of the building. A stamp-in clock is
available for persons wishing to retain a proof of filing by stamping
in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
Submission of comments on paperwork requirements. You may submit
comments on this document's paperwork requirements by mailing your
comments to the addresses provided at the end of the ``Collection of
Information Requirements'' section in this document.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
Pam West (410) 786-2302 (for issues related to Practice Expense,
Respiratory Therapy Coding, and Therapy Supervision).
Rick Ensor (410) 786-5617 (for issues related to Geographic Practice
Cost Index (GPCI) and malpractice RVUs).
Craig Dobyski (410) 786-4584 (for issues related to list of telehealth
services or payments for physicians and practitioners managing dialysis
patients).
Bill Larson or Tiffany Sanders (410) 786-7176 (for issues related to
coverage of an initial preventive physical examination).
Cathleen Scally (410) 786-5714 (for issues related to payment of an
initial preventive physical examination).
Joyce Eng (410) 786-7176 (for issues related to coverage of
cardiovascular screening tests).
Betty Shaw (410) 786-7176 (for issues related to coverage of diabetes
screening tests).
Anita Greenberg (410) 786-0548 (for issues related to payment of
cardiovascular and diabetes screening tests).
David Worgo (410) 786-5919, (for issues related to incentive payment
improvements for physicians practicing in shortage areas).
Angela Mason or Jennifer Fan (410) 786-0548 (for issues related to
payment for covered outpatient drugs and biologicals).
David Walczak (410) 786-4475 (for issues related to reassignment
provisions).
Henry Richter (410) 786-4562 (for issues related to payments for ESRD
facilities).
Steve Berkowitz (410) 786-7176 (for issues related to coverage of
routine costs associated with certain clinical trials of category A
devices).
Terri Deutsch (410) 786-9462 (for issues related to hospice
consultation services).
Karen Daily (410) 786-7176 (for issues related to clinical conditions
for payment of covered items of durable medical equipment).
[[Page 47489]]
Dorothy Shannon (410) 786-3396 (for issues related to outpatient
therapy services performed ``incident to'' physicians' services).
Roberta Epps (410) 786-5919 (for issues related to low osmolar contrast
media or supervision of diagnostic psychological testing services).
Gail Addis (410) 786-4522 (for issues related to care plan oversight).
Diane Milstead (410) 786-3355 or Gaysha Brooks (410) 786-9649 (for all
other issues).
SUPPLEMENTARY INFORMATION:
Submitting Comments: We welcome comments from the public on all
issues set forth in this rule to assist us in fully considering issues
and developing policies. You can assist us by referencing the file code
CMS-1429-P and the specific ``issue identifier'' that precedes the
section on which you choose to comment.
Inspection of Public Comments: Comments received timely will be
available for public inspection as they are processed, generally
beginning approximately 3 weeks after publication of a document, at the
headquarters of the Centers for Medicare & Medicaid Services, 7500
Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of
each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view
public comments, phone (410) 786-7197.
Copies: To order copies of the Federal Register containing this
document, send your request to: New Orders, Superintendent of
Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date
of the issue requested and enclose a check or money order payable to
the Superintendent of Documents, or enclose your Visa or Master Card
number and expiration date. Credit card orders can also be placed by
calling the order desk at (202) 512-1800 (or toll-free at 1-888-293-
6498) or by faxing to (202) 512-2250. The cost for each copy is $10. As
an alternative, you can view and photocopy the Federal Register
document at most libraries designated as Federal Depository Libraries
and at many other public and academic libraries throughout the country
that receive the Federal Register.
This Federal Register document is also available from the Federal
Register online database through GPO Access, a service of the U.S.
Government Printing Office. The web site address is: http://
www.access.gpo.gov/nara/index.html.
Information on the physician fee schedule can be found on the CMS
homepage. You can access this data by using the following directions:
1. Go to the CMS homepage (http://www.cms.hhs.gov).
2. Place your cursor over the word ``Professionals'' in the blue
area near the top of the page. Select ``physicians'' from the drop-down
menu.
3. Under ``Policies/Regulations'' select ``Physician Fee
Schedule.''
To assist readers in referencing sections contained in this
preamble, we are providing the following table of contents. Some of the
issues discussed in this preamble affect the payment policies but do
not require changes to the regulations in the Code of Federal
Regulations. Information on the regulation's impact appears throughout
the preamble and is not exclusively in section VII.
Table of Contents
I. Background
A. Legislative History
B. Published Changes to the Fee Schedule
II. Provisions of the Proposed Regulation Related to the Physician
Fee Schedule
A. Resource-Based Practice Expense Relative Value Units (RVUs)
B. Geographic Practice Cost Indices (GPCIs)
C. Malpractice Work RVUs
D. Coding Issues
III. Provisions Related to the Medicare Modernization Act of 2003
A. Section 611--Preventive Physical Examination
B. Section 613--Diabetes Screening
C. Section 612--Cardiovascular Screening
D. Section 413--Incentive Payment for Physician Scarcity
E. Section 303--Payment for Covered Outpatient Drugs and
Biologicals
F. Section 952--Revision to Reassignment Provisions
G. Section 642--Extension of Coverage of IVIG for the Treatment
in the Home of Primary Immune Deficiency Diseases
H. Section 623--Payment for Renal Dialysis Services
I. Section 731--Coverage of Routine Costs for Category A
Clinical Trials
J. Section 629--Part B Deductible
K. Section 512--Hospice Consultation Service
L. Section 302--Clinical Conditions for Coverage of Durable
Medical Equipment (DME)
M. Section 614--Payment for Certain Mammography Services
N. Section 305--Payment for Inhalation Drugs
IV. Other Issues
A. Provisions Related to Therapy Services
1. Outpatient Therapy Services Performed ``Incident to''
Physicians'' Services
2. Supervision Requirements for Therapy Assistants in Private
Practice
3. Other Technical Revisions
B. Low Osmolar Contrast Media
C. Payments for Physicians and Practitioners Managing Dialysis
Patients
D. Technical Revision--Sec. 411.404
E. Supervision of Clinical Psychological Testing
F. Care Plan Oversight
G. Assignment of Medicare Claims--Payment to the Supplier
V. Collection of Information Requirements
VI. Response to Comments
VII. Regulatory Impact Analysis
Addendum A--Explanation and Use of Addendum B.
Addendum B--2005 Relative Value Units and Related Information Used
in Determining Medicare Payments for 2005.
Addendum C--Codes for Which We Received PEAC Recommendations on
Practice Expense Direct Cost Inputs.
Addendum D--Proposed Changes to Practice Expense Equipment
Description and Pricing.
Addendum E--Revised 2005 Office Rental Index Versus Current Office
Rental Index by 2004 Fee Schedule Area
Addendum F--Current Geographic Practice Cost Indices by Medicare
Carrier and Locality
Addendum G--Proposed 2005 Geographic Practice Cost Indices by
Medicare Carrier and Locality
Addendum H--Proposed 2006 Geographic Practice Cost Indices by
Medicare Carrier and Locality
Addendum I--Comparison of Current 2004 Geographic Adjustment Factors
(GAFs) to Proposed 2005 GAFS
Addendum J--Comparison of Current 2004 GAFs to Proposed 2006 GAFs
In addition, because of the many organizations and terms to which
we refer by acronym in this proposed rule, we are listing these
acronyms and their corresponding terms in alphabetical order below:
ACC American College of Cardiology
ACR American College of Radiology
AMA American Medical Association
APA American Psychological Association
ASP Average Sales Price
ATA American Telemedicine Association
BBA Balanced Budget Act of 1997
BBRA Balanced Budget Refinement Act of 1999
BIPA Benefits Improvement and Protection Act of 2000
BLS Bureau of Labor Statistics
CAH Critical Access Hospital
CF Conversion factor
CFR Code of Federal Regulations
CMS Centers for Medicare & Medicaid Services
CNS Clinical Nurse Specialist
CPT [Physicians'] Current Procedural Terminology [4th Edition, 2002,
copyrighted by the American Medical Association]
CPEP Clinical Practice Expert Panel
CY Calendar Year
E/M Evaluation and management
ESRD End-Stage Renal Disease
FMR Fair market rental
FY Fiscal Year
GAF Geographic adjustment factor
GPCI Geographic practice cost index
HCPCS Healthcare Common Procedure Coding System
HHA Home health agency
HHS [Department of] Health and Human Services
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HOCM High osmolar contrast media
HPSA Health Professional Shortage Area
HRSA Health Resources and Services Administration
IDTFs Independent Diagnostic Testing Facilities
IPPS Inpatient prospective payment system
IOM Internet Only Manual
ISO Insurance Services Office
LOCM Low osmolar contrast media
MCM Medicare Carrier Manual
MCP Monthly Capitation Payment
MedPAC Medicare Payment Advisory Commission
MEI Medicare Economic Index
MGMA Medical Group Management Association
MMA Medicare Prescription Drug, Improvement, and Modernization Act
of 2003
MPFS Medicare Physician Fee Schedule
MSA Metropolitan Statistical Area
NAMCS National Ambulatory Medical Care Survey
NP Nurse Practitioner
OBRA Omnibus Budget Reconciliation Act
OMB Office of Management and Budget
OPPS Outpatient prospective payment system
PA Physician Assistant
PC Professional component
PCF Patient compensation fund
PEAC Practice Expense Advisory Committee
PET Positron Emission Tomography
PHSA Public Health Services Act
PPS Prospective payment system
PSA Physician Scarcity Area
RN Registered Nurse
RUC [AMA's Specialty Society] Relative [Value] Update Committee
RUCA Rural-Urban Commuting Area
RVU Relative value unit
SCHIP State Child Health Insurance Program
SGR Sustainable growth rate
SLP Speech language pathology
SMS [AMA's] Socioeconomic Monitoring System
TC Technical component
USPSTF U.S. Preventive Services Task Force
I. Background
A. Legislative History
Since January 1, 1992, Medicare has paid for physicians' services
under section 1848 of the Social Security Act (the Act), ``Payment for
Physicians' Services.'' The Act requires that payments under the fee
schedule be based on national uniform relative value units (RVUs) based
on the resources used in furnishing a service. Section 1848(c) of the
Act requires that national RVUs be established for physician work,
practice expense, and malpractice expense. Section
1848(c)(2)(B)(ii)(II) of the Act provides that adjustments in RVUs may
not cause total physician fee schedule payments to differ by more than
$20 million from what they would have been had the adjustments not been
made. If adjustments to RVUs cause expenditures to change by more than
$20 million, we must make adjustments to ensure that they do not
increase or decrease by more than $20 million.
B. Published Changes to the Fee Schedule
The July 2000 and August 2003 proposed rules ((65 FR 44177) and (68
FR 49030), respectively), include a summary of the final physician fee
schedule rules published through February 2003.
In the November 7, 2003 final rule, we refined the resource-based
practice expense RVUs and made other changes to Medicare Part B payment
policy. The specific policy changes concerned: The Medicare Economic
Index; practice expense for professional component services; definition
of diabetes for diabetes self-management training; supplemental survey
data for practice expense; geographic practice cost indices; and
several coding issues. In addition, this rule updated the codes subject
to the physician self-referral prohibition. We also made revisions to
the sustainable growth rate, the anesthesia conversion factor and
finalized the CY 2003 interim RVUs and issued interim RVUs for new and
revised procedure codes for CY 2004.
As required by the statute, we announced that the physician fee
schedule update for CY 2004 would be -4.5 percent; the initial estimate
of the sustainable growth rate for CY 2004 was 7.4 percent; and the
conversion factor for CY 2004 was $35.1339.
Subsequent to the November 7, 2003 final rule, the Congress enacted
the MMA (Pub. L. 108-17). On January 7, 2004, an interim final rule was
published to implement provisions of the MMA applicable in 2004 to
Medicare payment for covered drugs and physician fee schedule services.
These provisions included--
Revising the current payment methodology for Part B
covered drugs and biologicals that are not paid on a cost or
prospective payment basis;
Making changes to Medicare payment for furnishing or
administering drugs and biologicals;
Revising the geographic practice cost indices;
Changing the physician fee schedule conversion factor. The
2004 physician fee schedule conversion factor is $37.3374; and
Extending the ``opt-out'' provisions of section
1802(b)(5)(3) of the Act to dentists, podiatrists, and optometrists.
The information contained in the January 7, 2004 interim final rule
concerning payment under the physician fee schedule superceded
information contained in the November 7, 2003 final rule to the extent
that the two are inconsistent.
II. Provisions of the Proposed Rule
This proposed rule would affect the regulations set forth at Part
405, Federal Health Insurance for the Aged and Disabled; Part 410,
Supplementary Medical Insurance (SMI) Benefits; Part 411, Exclusions
from Medicare and Limitations on Medicare Payment; Part 414, Payment
for Part B Medical and Other Health Services; Part 418, Hospice Care;
Part 424, Conditions for Medicare Payment; Part 484, Home Health
Services; and Part 486, Conditions for Coverage of Specialized Services
Furnished by Suppliers.
A. Resource-Based Practice Expense Relative Value Units
[If you choose to comment on issues in this section, please include the
caption ``Practice Expense'' at the beginning of your comments.]
1. Resource-Based Practice Expense Legislation
Section 121 of the Social Security Act Amendments of 1994 (Pub. L.
103-432), enacted on October 31, 1994, amended section
1848(c)(2)(C)(ii) of the Social Security Act and required us to develop
a methodology for a resource-based system for determining practice
expense RVUs for each physician's service beginning in 1998. Until that
time, physicians' practice expenses were established based on
historical allowed charges.
In developing the methodology, we were to consider the staff,
equipment, and supplies used in providing medical and surgical services
in various settings. The legislation specifically required that, in
implementing the new system of practice expense RVUs, we apply the same
budget-neutrality provisions that we apply to other adjustments under
the physician fee schedule.
Section 4505(a) of the Balanced Budget Act of 1997 (BBA) (Pub. L.
105-33), enacted on August 5, 1997, amended section 1848(c)(2)(C)(ii)
of the Act and delayed the effective date of the resource-based
practice expense RVU system until January 1, 1999. In addition, section
4505(b) of the BBA provided for a 4-year transition period from charge-
based practice expense RVUs to resource-based RVUs.
Further legislation affecting resource-based practice expense RVUs
was included in the Medicare, Medicaid and State Child Health Insurance
Program (SCHIP) Balanced Budget Refinement Act of 1999 (BBRA) (Pub. L.
106-113)
[[Page 47491]]
enacted on November 29, 1999. Section 212 of the BBRA amended section
1848(c)(2)(C)(ii) of the Act by directing us to establish a process
under which we accept and use, to the maximum extent practicable and
consistent with sound data practices, data collected or developed by
entities and organizations. These data would supplement the data we
normally collect in determining the practice expense component of the
physician fee schedule for payments in CY 2001 and CY 2002. (The 1999
and 2003 final rules (64 FR 59380 and 68 FR 63196, respectively,
extended the period during which we would accept supplemental data.)
2. Current Methodology for Computing the Practice Expense Relative
Value Unit System
In the November 2, 1998 final rule (63 FR 58910), effective with
services furnished on or after January 1, 1999, we established at 42
CFR 414.22(b)(5) a new methodology for computing resource-based
practice expense RVUs that used the two significant sources of actual
practice expense data we have available--the Clinical Practice Expert
Panel (CPEP) data and the American Medical Association's (AMA)
Socioeconomic Monitoring System (SMS) data. The CPEP data were
collected from panels of physicians, practice administrators, and
nonphysicians (for example registered nurses) nominated by physician
specialty societies and other groups. The CPEP panels identified the
direct inputs required for each physician service in both the office
setting and out-of-office setting. The AMA's SMS data provided
aggregate specialty-specific information on hours worked and practice
expenses. The methodology was based on an assumption that current
aggregate specialty practice costs are a reasonable way to establish
initial estimates of relative resource costs for physicians' services
across specialties. The methodology allocated these aggregate specialty
practice costs to specific procedures and, thus, can be seen as a
``top-down'' approach.
Also in the November 2, 1998 final rule, in response to comments,
we discussed the establishment of the Practice Expense Advisory
Committee (PEAC) of the AMA's Specialty Society Relative Value Update
Committee (RUC), which would review code-specific CPEP data during the
refinement period. This committee would include representatives from
all major specialty societies and would make recommendations to us on
suggested changes to the CPEP data.
As directed by the BBRA, we also established a process (see 65 FR
65380) under which we would accept and use, to the maximum extent
practicable and consistent with sound data practices, data collected by
entities and organizations to supplement the data we normally collect
in determining the practice expense component of the physician fee
schedule.
a. Major Steps
A brief discussion of the major steps involved in the determination
of the practice expense RVUs follows.
(Please see the November 1, 2001 final rule (66 FR 55249) for a more
detailed explanation of the top-down methodology.)
Step 1--Determine the specialty specific practice expense
per hour of physician direct patient care. We used the AMA's SMS survey
of actual aggregate cost data by specialty to determine the practice
expenses per hour for each specialty. We calculated the practice
expenses per hour for the specialty by dividing the aggregate practice
expenses for the specialty by the total number of hours spent in
patient care activities.
Step 2--Create a specialty-specific practice expense pool
of practice expense costs for treating Medicare patients. To calculate
the total number of hours spent treating Medicare patients for each
specialty, we used the physician time assigned to each procedure code
and the Medicare utilization data. The primary sources for the
physician time data were surveys submitted to the AMA's RUC and surveys
done by Harvard for the establishment of the work RVUs. We then
multiplied the physician time assigned per procedure code by the number
of times that code was billed by each specialty, and summed the
products for each code, by specialty, to get the total physician hours
spent treating Medicare patients for that specialty. We then calculated
the specialty specific practice expense pools by multiplying the
specialty practice expenses per hour (from step 1) by the total
Medicare physician hours for the specialty.
Step 3--Allocate the specialty specific practice expense
pool to the specific services (procedure codes) performed by each
specialty. For each specialty, we divided the practice expense pool
into two groups based on whether direct or indirect costs were involved
and used a different allocation basis for each group.
(i) Direct costs--For direct costs (which include clinical labor,
medical supplies, and medical equipment), we used the procedure-
specific CPEP data on the staff time, supplies, and equipment as the
allocation basis. For the separate practice expense pool for services
without physician work RVUs, we have used, on an interim basis, 1998
practice expense RVUs to allocate the direct cost pools.
(ii) Indirect costs--To allocate the cost pools for indirect costs,
including administrative labor, office expenses, and all other
expenses, we used the total direct costs, or the 1998 practice expense
RVUs, in combination with the physician fee schedule work RVUs. We
converted the work RVUs to dollars using the Medicare CF (expressed in
1995 dollars for consistency with the SMS survey years).
Step 4--The direct and indirect costs are then added
together to attain the practice expense for each procedure, by
specialty. For procedures performed by more than one specialty, the
final practice expense allocation was a weighted average of practice
expense allocations for the specialties that perform the procedure,
based on the frequency with which each specialty performs the procedure
on Medicare patients.
b. Other Methodological Issues
i. Nonphysician Work Pool
As an interim measure, until we could further analyze the effect of
the top-down methodology on the Medicare payment for services with
physician work RVUs equal to zero (including the technical components
of radiology services and other diagnostic tests), we created a
separate practice expense pool. We first used the average clinical
staff time from the CPEP data and the ``all physicians'' practice
expense per hour to create the pool. In the December 2002 final rule,
we changed this policy and now use the total clinical staff time and
the weighted average specialty-specific practice expense per hour for
specialties with services in this pool. In the next step, we used the
adjusted 1998 practice expense RVUs to allocate this pool to each
service. Also, for all radiology services that are assigned physician
work RVUs, we used the adjusted 1998 practice expense RVUs for
radiology services as an interim measure to allocate the direct
practice expense cost pool for radiology.
A specialty society may request that its services be removed from
the nonphysician workpool. We have removed services from the
nonphysician work pool if the requesting specialty predominates
utilization of the service.
[[Page 47492]]
ii. Crosswalks for Specialties Without Practice Expense Survey Data
Since many specialties identified in our claims data did not
correspond exactly to the specialties included in the SMS survey data,
it was necessary to crosswalk these specialties to the most appropriate
SMS specialty.
iii. Physical Therapy Services
Because we believe that most physical therapy services furnished in
physicians' offices are performed by physical therapists, we
crosswalked all utilization for therapy services in the CPT 97000
series to the physical and occupational therapy practice expense pool.
3. Practice Expense Proposals for Calendar Year 2005
a. Supplemental Practice Expense Surveys
i. Survey Criteria and Submission Dates
As required by the BBRA, we established criteria to evaluate survey
data collected by organizations to supplement the SMS survey data
normally used in the calculation of the practice expense component of
the physician fee schedule. By regulation (see 68 FR 63200), we
provided that, beginning this year, supplemental survey data must be
submitted by March 1 to be considered for use in computing practice
expense RVUs for the following year. This allows us to publish our
decisions regarding survey data in the proposed rule and provides the
opportunity for public comment on these results before implementation.
To continue to ensure the maximum opportunity for specialties to
submit supplemental practice expense data, we extended until 2005 the
period that we would accept survey data that meet the criteria set
forth in the November 2000 final rule. We will no longer accept
supplemental practice expense data after that point. The deadline for
submission of supplemental data to be considered in CY 2006 is March 1,
2005.
ii. Survey by the College of American Pathologists (CAP)
In the June 28, 2002 Federal Register (67 FR 43849), we proposed a
technical change to the practice expense methodology that calculated
the technical component as the difference between the global and
professional component RVUs for services not included in the
nonphysician work pool. In the December 31, 2002 final rule (67 FR
79979), we established a 1-year moratorium on the technical change for
pathology services to allow CAP to do a survey of independent
laboratories. Consistent with last year's rules, CAP submitted its
supplemental survey by August 1, 2003 for use in determining the 2004
practice expense RVUs. Our contractor, The Lewin Group, evaluated the
data and recommended that we accept the survey to supplement the data
on PE. However, because we changed the survey deadline to March 1, CAP
requested that we delay incorporation of the survey data until this
year's proposed rule. CAP also requested that we extend the moratorium
on calculating the technical component as the difference between the
global and professional component RVUs for pathology services for one
additional year to allow us to evaluate in a proposed rule the combined
effects of the use of the new survey data along with other proposed
technical changes. In the November 7, 2003 final rule, in response to
the CAP comment, we agreed to extend the moratorium by an additional
year. In this proposed rule, we propose to incorporate the CAP survey
data into the practice expense methodology and to end the moratorium on
calculating the technical component as the difference between the
global and professional component RVUs for pathology services. We
propose to use the following practice expense per hour figures for
specialty 69--Independent Laboratory.
Table 1.--Practice Expense Per Hour Figures for Specialty 69--Independent Laboratory
--------------------------------------------------------------------------------------------------------------------------------------------------------
Clinical Office Medical Medical
Specialty staff Admin. staff expense supplies equipment Other Total
--------------------------------------------------------------------------------------------------------------------------------------------------------
Independent Laboratory................................ $39.7 $37.5 $40.1 $19.3 $11.1 $16.1 $163.8
--------------------------------------------------------------------------------------------------------------------------------------------------------
iii. Submission of Supplemental Surveys
We received surveys from the American College of Cardiology (ACC),
the American College of Radiology (ACR), and the American Society for
Therapeutic Radiation Oncology (ASTRO). Our contractor, The Lewin
Group, evaluated the data and made recommendations to us regarding use
of the data in a report on May 26, 2004. We have made The Lewin Group
report available on the CMS Web site at http://www.cms.hhs.gov/
physicians/ pfs/. The Lewin Group is recommending that we accept the
data from ACC and ACR but indicated that the survey from ASTRO does not
meet the precision criteria we have established for supplemental
surveys. As a result, The Lewin Group is not recommending that we use
the ASTRO survey results at this time. We agree with this
recommendation and are proposing not using the ASTRO survey data at
this time.
Many of the procedures that are performed by radiology, cardiology,
and radiation oncology are affected by the nonphysician work pool
calculations. We created the nonphysician work pool as an interim
measure because of a concern that the top-down methodology was having a
large adverse impact on payment for services that do not have physician
work RVUs. As we stated in the December 31, 2002 final rule (67 FR
79979), we believe a relatively low practice expense per hour explains
the adverse impact on diagnostic and other services that would occur
from eliminating the nonphysician work pool. The ACR, ACC, and ASTRO
began undertaking surveys in 2003 following our analysis of options for
eliminating the nonphysician work pool in the December 31, 2002 final
rule. CMS' interest is in using the supplemental survey data to
eliminate the nonphysician work pool and use a single methodology to
establish payments for all physician fee schedule services.
We appreciate the efforts of these three specialties to undertake
surveys and assist CMS in finding a permanent resolution of issues
related to the nonphysician work pool. While the radiology survey data
do meet the criteria we have established for use of supplemental
surveys, the ACR has written to us asking that we not use the data
until we have a stable and global solution that is workable for all
specialties that are currently paid using the nonphysician work pool.
The ACC also requested that we use the supplemental survey for services
that are in the cardiology pool. However, ACC also indicated if CMS
determines that it would only be appropriate to use the survey data if
cardiology services are removed from the nonphysician work pool or if
the nonphysician work pool
[[Page 47493]]
is eliminated, we should delay using the data until the issues involved
can be discussed further.
At this time, we are not proposing to eliminate the nonphysician
work pool or to remove selected radiology and cardiology codes from it.
Since our interest is in using supplemental data in conjunction with
pricing all services under the top-down methodology, we agree with the
request from ACR to delay use of its supplemental survey until issues
related to the nonphysician work pool can be addressed. Furthermore, we
believe the high practice expense per hour for cardiology from the
supplemental survey results from the inclusion of practices that do
very high cost office-based cardiology services. Because the RVUs for
these office-based cardiology services are currently determined using
the nonphysician work pool methodology, we believe the ACC supplemental
survey data should only be used in conjunction with removing cardiology
services from the nonphysician work pool. For this reason, we are also
delaying use of the ACC survey data as we continue to analyze
elimination of the nonphysician work pool in conjunction with using
supplemental survey data. As we complete our analysis, we look forward
to working with the medical community to find a permanent resolution of
this issue.
b. Practice Expense Advisory Committee (PEAC) Recommendations on CPEP
Inputs for 2005
Since 1999, the PEAC, an advisory committee of the RUC, has been
providing us with recommendations for refining the direct practice
expense inputs (clinical staff, supplies, and equipment) for existing
CPT codes. As we did last year, we are including our proposals
regarding the PEAC recommendations in the proposed rule, to enable
specialty groups to assess the impact of the proposed changes on their
services and to make comments on them before the final rule.
These PEAC recommendations are the result of meetings held in March
and August 2003 and January and March 2004, and account for over 2,200
codes from many specialties. (A list of these codes can be found in
Addendum C.)
The PEAC held its last meeting in March 2004, and these are the
last recommendations we will be receiving from the committee. The AMA
established the PEAC to assist the RUC in refining the direct input
data used in calculating the practice expense RVUs for established
codes. Since its inception, the PEAC has provided recommendations on
over 7,600 codes, which leaves only a few hundred physician fee
schedule codes that we believe are still unrefined. The PEAC has also
recommended standard times for many clinical staff activities and has
established several supply and equipment packages that can be applied
across wide ranges of codes. This has helped us ensure that the CPEP
inputs have been assigned equitably across procedures performed by
different specialties. The work of the PEAC has, therefore, contributed
greatly to the refinement of the practice expense inputs, and we
appreciate the 5 years of hard work by the specialty societies and the
AMA that helped make the PEAC so successful. Future practice expense
issues, including the refinement of the remaining codes not addressed
by the PEAC, will be handled by the RUC. We anticipate the RUC will
formulate the specific process at a future meeting, possibly as soon as
October 2004. If possible, additional information on this process will
be included in the final fee schedule rule.
We have reviewed the PEAC-submitted recommendations and propose to
adopt nearly all of them. We have worked with the PEAC staff to correct
any typographical errors and to make certain that the recommendations
are in line with previously accepted standards. In addition, in order
to prevent rank order anomalies, we reviewed those codes that are
currently unrefined or that were refined early in the PEAC process to
apply some of the major PEAC-agreed standards. For the unrefined 10-day
global services, we are proposing to substitute for the original CPEP
times the PEAC-agreed standard post-service office visit clinical staff
times used for all 90-day and refined 10-day global services. We also
are proposing to eliminate the discharge management clinical staff time
from all but the 10 and 90-day global codes, substituting one post-
service phone call if not already in the earlier data. Lastly, we are
proposing to delete any extra clinical staff time for post-visit phone
calls because that time is already included in the time allotted for
the visits.
The complete PEAC recommendations and the revised practice expense
database can be found on our web site. (See the ``Supplementary
Information'' section of this proposed rule for directions on accessing
our website.)
We disagree with the PEAC recommendation for clinical labor time
for CPT 99183, Hyperbaric oxygen (HBO) therapy. During last year's
rulemaking, we assigned, on an interim basis, 135 minutes of total
clinical labor. The PEAC however, recommended 42 minutes of total
clinical labor time, which allows for 20 minutes for the HBO chamber
treatment (intra) time. We believe that 90 minutes is a more
appropriate estimation of the clinical staff time actually needed for
the intra time because, according to our data, a typical HBO treatment
session billed under the outpatient prospective payment system is 90
minutes and the clinical staff is in constant attendance. Therefore, we
are proposing a total clinical labor time of 112 minutes for this
service.
The PEAC recommendations for CPT codes 91011 and 91052 included a
supply input for methacholine chloride as the injected stimulant for
these two services. In discussions with representatives from the
gastroenterology specialty subsequent to receipt of the PEAC
recommendations, we learned this is incorrect, since an injected form
of methacholine chloride is not currently available. For CPT 91011,
esophageal motility study, we are proposing to include edrophonium, 1
ml, as the drug typically used in this procedure. For CPT 91052,
gastric analysis study, we were unable to identify the single drug that
is most typically used with this procedure. We have added the
edrophonium to the list of supplies where we need information from the
specialty in order to price appropriately (see Table 3). We are also
requesting that commenters, particularly the specialty organizations,
provide us with information on the drug that is most typically used for
CPT 91052, including drug dosage and price, so that it can be included
in the practice expense database.
In last year's final rule, we indicated that we would not go
forward with the 2003 PEAC recommendations on eight E/M codes for
nursing home services, CPT codes 99301 through 99316 and on two E/M
codes for home visits, CPT codes 99348 and 99350, to allow the PEAC to
reconsider the clinical staff time for these codes based on the
specific input from the representatives of the nursing home and home
visit specialties. This year's PEAC recommendations for the E/M nursing
home services included the views of the long-term care physicians and
represent an overall decrease in clinical labor inputs for these codes.
However, the home care physicians subsequently withdrew these codes
from further PEAC consideration, which leaves the 2003 PEAC
recommendation for these services unchanged. Therefore, we are
proposing to adopt the direct practice expense input recommendations
from
[[Page 47494]]
the March 2003 PEAC meeting for CPT codes 99348 and 99350.
c. Repricing of Clinical Practice Expense Inputs--Equipment
We use the practice expense inputs (the clinical staff, supplies,
and equipment assigned to each procedure) to allocate the specialty-
specific practice expense cost pools to the procedures performed by
each specialty. The costs of the original equipment inputs assigned by
the CPEP panels were determined in 1997 by our contractor, Abt
Associates, based primarily on list prices from equipment suppliers.
Subsequent to the CPEP panels, equipment has also been added to the
CPEP data, with the costs of the inputs provided by the relevant
specialty society. We only include equipment with costs equal to or
exceeding $500 in our practice expense database because the cost per
use for equipment costing less than $500 would be negligible. We also
considered the useful life of the equipment in establishing an
equipment cost per minute of use. This was discussed in our proposed
rule published June 18, 1997 (62 FR 33164). The primary source of this
information was the ``Estimated Useful Lives of Depreciable Hospital
Assets'' (1993 edition) from the American Hospital Association (AHA).
We proposed updates and revisions to the clinical staff salary data
and supply inputs and finalized these in the rules published November
1, 2001 (66 FR 55255) and November 7, 2003 (68 FR 63196), respectively.
We also indicated that, in future rulemaking, we would be proposing
updates to the equipment inputs that are used in the CPEP database.
We contracted with a consultant to assist us in obtaining the
current price for each equipment item in our CPEP database. The
consultant has been able to determine the current prices for most of
the equipment inputs and, to ensure that accurate information was
obtained, has submitted documentation from vendor catalogs or websites
for nearly 600 equipment items.
Our contractor also clarified the specific composition of each of
the various packaged and standardized rooms or ophthalmology ``lanes''
currently identified in the equipment practice expense database (for
example, ``mammography room'' or ``exam lane''). We are proposing to
delete the current ``room'' designation for the radiopharmaceutical
receiving area and, in its place, list separately the equipment
necessary for each procedure as individual line items because there
does not appear to be a standard configuration for such a room across
the nuclear medicine codes.
Although individual equipment items valued under $500 are not
included in the equipment database, we do include instrument packs or
surgical trays that are maintained, stored, and used as a unit, where
the aggregate cost of individual items equals or exceeds $500. We have
adopted the PEAC recommendation based on consensus among specialties to
establish two generic instrument packages rather than list a myriad of
different packages for each specialty. The basic instrument pack,
assigned a value of $500, includes instrument aggregate costs ranging
from $500 to $1,499. The medium pack was assigned $1,500, for
instrument packages priced at or above $1,500. We are proposing to
replace all surgical packs and trays in the practice expense database
with the appropriate standardized packs described above.
Our consultant worked closely with the specialty societies to
obtain accurate information to identify equipment and applicable
prices. The useful life for each equipment item has also been reviewed
and updated as necessary. This update is primarily based on the AHA's
``Estimated Useful Lives of Depreciable Hospital Assets'' (1998
edition) by direct association with a listed item in the publication or
by crosswalking from a reasonably similar item. We understand that AHA
will publish updated guidelines this summer, and we plan to reflect any
updates in our final rule.
Addendum D lists the proposed new prices for equipment items,
instrument packs, and rooms/lanes, as well as new descriptions when
needed. A more detailed spreadsheet can be found on our website, http:/
/www.cms.hhs.gov/physicians/pfs. This spreadsheet contains additional
information regarding the sources used to price each equipment item.
Additionally, there are specific equipment items for which a source
has not yet been identified or for which pricing information has not
yet been found and documented. These are included in Table 2 below. In
this table, we have identified the equipment code (if assigned), the
existing description for the equipment item and current price, the
procedures or specialties associated with the item, as well as the
proposed new description and standardized life for the equipment's use,
where this could be identified. We have also identified equipment for
deletion from the database, such as equipment items less than $500 and
items that have become obsolete. We are requesting that commenters,
particularly the relevant specialty groups, provide us with the needed
pricing information, including appropriate documentation. Whenever
possible, commenters should provide multiple sources of documentation
so that a typical price can be determined. If we are not able to obtain
any verified pricing information for an item, we may eliminate it from
the database.
Table 2.--Equipment Items Needing Specialty Input for Pricing and Proposed Deletions
----------------------------------------------------------------------------------------------------------------
Primary
specialties *CPT code(s)
Code 2005 description Price associated with associated with Status of item
item item
----------------------------------------------------------------------------------------------------------------
Ambulatory blood 3,000.00 Cardiology....... 93784, 93786, See Note A.
pressure monitor. 93788.
Biofeedback .............. Psychology....... 90875............ See Note A.
equipment.
CAD processor unit 210,000.00 Radiology........ 76082, 76083, See Note A (Need
(mammography). 76085. system
components).
E53005............. Camera system, 675,000.00 Anesthesia, IM, 78414............ See Note A.
cardiac, nuclear. cardiology.
E53026............. Collimator, 29,990.00 Radiology........ 78206, 78607, See Note A.
cardiofocal set. 78647, 78803,
78807.
E71013............. Computer and VDT 9,000.00 Ophthalmology, 92060, 92065..... See Notes A and
and software. optometry. C.
Computer software, 60,000.00 Radiation 77301............ See Note A.
MR/PET/CT fusion. oncology.
E51022............. Computer system, 60,000.00 Radiation 77418............ See Note A.
record and verify. oncology.
[[Page 47495]]
E51050............. Computer 221,500.00 Radiation 77300, 77305, See Note A.
workstation, 3D oncology. 77310, 77315,
teletherapy 77321, 77331.
treatment
planning.
Computer .............. Radiology........ 71555, 72159, See Note A.
workstation, MRA 72198, 73225,
post processing. 73725, 74185.
Computer, server.. .............. Radiation 77301............ See Note A. (Need
oncology. system
components).
Cortical bipolar- .............. Neurosurgery, 95961, 95962..... See Note A.
biphasic neurology.
stimulating
equipment.
CPAP/BiPAP remote .............. Pulmonary 95811............ See Note A.
clinical unit. disease,
neurology.
Cryo-thermal unit. .............. Anesthesia....... 64620............ See Notes A and
C.
E53034............. Densitometry unit, 65,000.00 Radiology........ 78351............ See Notes A and
whole body, DPA. C.
E53032............. Densitometry unit, 22,500.00 Radiology........ 78350............ See Notes A and
whole body, SPA. C.
E53036............. Detector (Probe).. 14,000.00 Radiology, 78455............ See Notes A and
cardiology. C.
Dialysis access 10,000.00 Nephrology....... 90940............ See Note A.
flow monitor.
Diathermy, .............. Anesthesia, GP, 97020............ See Notes A and
microwave. podiatry. C.
DNA image analyzer 200,000.00 Lab, pathology... 88358, 88361..... See Note A.
(ACIS).
Drill, .............. Ophthalmology.... 65125............ See Note A.
ophthalmology.
E55035............. ECG signal 8,250.00 Cardiology, IM... 93278............ See Note A.
averaging system.
EEG monitor, .............. 95953............ Neurology........ See Note A.
digital, portable.
E54008............. EEG recorder, 6,940.00 Neurology........ 95950............ See Note A.
ambulatory.
E54009............. EEG review 44,950.00 Neurology........ 95950............ See Note A.
station,
ambulatory.
Electroconvulsive .............. Psychiatry....... 90870............ See Note A.
therapy machine.
Electromagnetic 25,000.00 Physical therapy. G0329............ See Note A.
therapy machine.
E54012............. EMG botox......... 1,500.00 Critical care, 92265............ See Note A.
pulmonary,
ophthalmology.
E52002............. Fetal monitor 35,000.00 Ob-gyn, radiology 76818, 76819..... See Note A.
software.
Film alternator 27,500.00 Radiology........ 329 codes........ See Note B.
(motorized film
viewbox).
Generator, 950.00 Neurology, NP.... 95923............ See Note A.
constant current.
E51072............. HDR Afterload 375,000.00 Radiation 77781-84......... See Note A.
System, oncology.
Nucletron--Oldelf
t.
Hyperbaric chamber 125,000.00 FP, IM, EM....... 99183............ See Note A.
Hyperthermia 360,000.00 Radiation 77600............ See Note A.
system, oncology.
ultrasound,
external.
Hyperthermia 250,000.00 Radiation 77620............ See Note A.
system, oncology.
ultrasound,
intracavitary.
Hysteroscopy 19,500.00 Ob-gyn........... 58563............ See Note A.
ablation system.
E13652............. image analyzer 92,000.00 Pathology, 88355, 88356..... See Note A.
(CAS system). neurology.
IMRT physics tools 55,485.00 Radiation 77301, 77418..... See Note A.
oncology.
E91008............. IVAC Injection 2,500.00 Radiology........ 78206, 78607, See Note A.
Automatic Pump. 78647, 78803,
78807.
Mammography .............. Radiology........ 76090, 76091, See Note A.
reporting 76092.
software.
E12002............. Neurobehavioral 717.00 Psychology, IM... 96115, 96117..... See Note A.
status instrument-
average.
Orthovoltage 140,000.00 Radiation 77401............ See Note A.
radiotherapy oncology.
system.
OSHA ventilated 5,000.00 Radiation 77334............ See Note B.
hood. oncology.
E91011............. Plasma pheresis 37,900.00 Radiology, 36481, 36510, See Note A.
machine w/UV dermatology. 36522.
light source.
E55013............. Programmer, 10,000.00 Cardiology, 33200-01, 33206- See Note A.
pacemaker. cardiothoracic 08, 33212-18,
surgery, general 33220, 33222,
surgery. 33240, 33245-46,
33249, 33282.
[[Page 47496]]
Pulse oxymetry 3,660.00 Pulmonary 94762............ See Note A.
recording disease, IM.
software
(prolonged
monitoring).
Radiation 550,670.00 Radiation 774XX............ See Note B.
treatment vault. oncology.
Radiation virtual .............. Radiation 77280, 77285, See Note A.
simulation system. oncology. 77290, 77402-16.
Remote monitoring 9,500.00 Neurology........ 95955............ See Note A.
service
(neurodiagnostics
).
E54010............. Review master..... 23,500.00 Pulmonary 95805, 95807-11, See Note A.
disease, 95816, 95822,
neurology. 95955-56.
E51004............. Room, basic 150,000.00 Radiology........ 103 codes........ See Note A.
radiology.
E51016............. Room, mammography. 130,000.00 Radiology........ 19030, 19290-91, See Note A.
19295, 76086-92,
76096.
E51005............. Room, radiographic- 475,000.00 ................. 123 codes........ See Note A.
fluoroscopic.
Source, 10 Ci Ir 22,000.00 Radiation 77781-84......... See Note A.
192. oncology.
Strontium-90 8,599.00 Radiation 77789............ See Note A.
applicator. oncology.
Table, cystoscopy. .............. urology.......... 52204-24, 52265- See Note A.
75 52310-17,
52327-32.
E52001............. Ultrasound color 155,000.00 Ob-gyn........... 59070, 59074, See Note A.
doppler, 76818-19.
transducers and
vaginal probe.
E52007............. Ultrasound, 29,900.00 Ob-gyn, 76825-28, 93303- See Note A.
echocardiography cardiology, 12, 93314,
digital pediatrics. 93320, 93325,
acquisition (Novo 93350.
Microsonics,
TomTec).
Vacuum cart....... .............. Anesthesia....... 64620............ See Notes A and
C.
E13635............. Video camera...... 1,000.00 Radiation 77418............ See Note A.
oncology.
Water chiller 28,000.00 Radiation 77402-16......... See Note B.
(radiation oncology.
treatment).
E51076............. Well counter...... .............. Radiology........ 78160-72, 78282.. See Note A.
----------------------------------------------------------------------------------------------------------------
*CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS apply.
Notes:
A. Additional information required. Need detailed description (including system components as specified),
source, and current pricing information.
B. Proposed deletion as indirect expense.
C. Item may no longer be available.
In addition to reviewing and updating the cost information for
equipment items in the database, our contractor also recommended the
following revisions to provide uniformity and consistency in the CPEP
equipment database. All of the following recommendations are noted in
Addendum D:
Assignment of equipment categories. In the original CPEP data, a
number was assigned to each item of equipment. The contractor has
recommended that each equipment item also be assigned a ``category'' to
allow for easier identification and sorting of items. We agree and are
proposing that equipment be assigned to one of the following six
categories: documentation, laboratory, scopes, radiology, furniture,
rooms-lanes, and other equipment.
These categories could also be used to establish a new numbering
system for equipment that would more clearly identify them for practice
expense purposes. We would assign a letter to each category and use
this in conjunction with a number (000 through 999) to identify each
item of equipment. This would enable specialty groups to identify more
easily whether an item of equipment has already been included in the
practice expense database and would help avoid duplication of
references to the same item of equipment under different descriptions.
If we proceed in the final rule with this proposed method for
categorizing equipment, we will assign new identifying numbers to each
equipment input item and these will be available on our website.
Consolidation/standardization of item descriptions.
When items appear to be duplicative, we are proposing to combine
the items. For example, for two cervical endoscopy procedures, our
contractor identified that the price of the LEEP system includes a
smoke evacuation system but that system is also listed separately. We
propose to merge these two line items and reflect both prices in the
price of the LEEP system. All proposed changes are specifically
referenced in Addendum D.
We welcome any comments on the proposed pricing and all other
proposed revisions. To help us evaluate the information provided,
comments should include documentation from more than one source, where
available, such as information from a vendor catalog or website or from
a current invoice.
d. Miscellaneous Practice Expense Issues
i. Pricing for Seldinger Needle
We received comments from a specialty organization on our November
7, 2003 rule stating that the $72.90 price assigned to the Seldinger
needle, which is used in certain radiological procedures, is too high.
The organization estimated that the cost is actually closer to $7.00;
however, documentation was not provided to
[[Page 47497]]
support this price estimate. Our contractor was able to confirm pricing
information from two sources, including a price of $3.50 from a
hospital supplier and a price of $6.85 from a cardiology supplier.
Based on this pricing variability, we are proposing to average the two
prices of this supply item to reflect a cost of $5.175. If a commenter
disagrees with this proposed change in price, the comment should
provide documentation to support the recommended price, as well as the
specific type of needle that is most commonly used.
ii. Hysteroscopic Endometrial Ablation
We received requests from a manufacturer and physicians to price
CPT code 56853, Hysteroscopy with endometrial ablation, in the office
setting so that physicians providing this service in the nonfacility
setting could receive an appropriate payment. (This service is
currently valued only in the facility setting.) We have worked with the
specialty society, the American College of Obstetricians and
Gynecologists, to identify the required resources based on the typical
practice. We propose to assign on an interim basis, the following
direct practice expense inputs in the nonfacility setting for this
service.
Clinical Staff: RN/LPN/MTA--72 minutes (18 pre-service and
54 service)
Supplies: PEAC multispecialty visit supply package, Post-
op incision care kit, pelvic exam package, irrigation tubing, sterile
impervious gown, surgical cap, shoe cover, surgical mask with face
shield, 3x3 sterile gauze (20), cotton tip applicator, cotton balls
(4), irrigation 0.9 percent sodium chloride 500-1000ml(3), maxi-pad,
mini-pad, 3-pack betadine swab (4), Monsel's solution (10ml), lidocaine
jelly (1000ml), disposable speculum, spinal needle, 18-24g needle, 20
ml syringe, bupivicaine 0.25 percent (10ml), 1 percent xylocaine
(20ml), cidex (10ml), Polaroid film-type 667 (2), endosheath, and
hysteroscopic ablation device kit.
Equipment: power table, fiberoptic exam light, endoscopic-
rigid hysteroscope, endoscopy video system, and hysteroscopic ablation
system.
We will request that the RUC review these inputs along with inputs
of other codes still in need of refinement. iii. Photopheresis
We received a request from a supplier to review the direct practice
expense inputs currently in our database for the photopheresis service,
CPT code 36522. These inputs are based on the original CPEP panel
recommendations and the supplier does not believe they are reflective
of the resources now being used. This service was not reviewed by the
PEAC during the refinement process, and we agree that the direct inputs
need to be revised for this service. We propose to assign, on an
interim basis, the following nonfacility practice expense inputs, and
we will request that the RUC review them as part of the practice
expense refinement process.
Clinical Staff: RN--223 minutes (treatment is for
approximately 4 hours)
Supplies: multispecialty visit supply package,
photopheresis procedural kit, blood filter (filter iv set), IV blood
administration set, 0.9 percent irrigation sodium chloride 500-1000 ml
(2), heparin 1,000 units-ml (10), povidone solution-betadine,
methoxsalen (UVADEX) sterile solution-10 ml vial, 1 percent-2 percent
lidocaine-xylocaine, paper surgical tape (12), 2x3 underpad (chux),
nonsterile drapesheet 40 inches x 60 inches, nonsterile Kling bandage,
bandage strip, 3x3 sterile gauze, 4x4 sterile gauze, alcohol swab pad
(3), impervious staff gown, 19-25 g butterfly needle, 14-24g
angiocatheter, 18-27 g needle, 20 ml syringe, 10-12 ml syringe, 1 ml
syringe, 22-26 g syringe needle-3 ml.
Equipment: plasma pheresis machine with ultraviolet light
source, medical recliner.
iv. Pricing of New Supply Items
As part of last year's rulemaking process, we reviewed and updated
the prices for supply items in our practice expense database. During
subsequent meetings of both the PEAC and the RUC, supply items were
added that were not included in the supply pricing update. The
following table, Proposed Practice Expense Supply Item Additions for
2005, lists these additional supply items and the proposed associated
prices that we will use in the practice expense calculation.
Table 3.--Proposed Practice Expense Supply Item Additions for 2004
--------------------------------------------------------------------------------------------------------------------------------------------------------
* CPT code(s)
Supply description Unit price * Unit associated with item Supply category
--------------------------------------------------------------------------------------------------------------------------------------------------------
Acrylic tray-base material.......... 1.775 oz.......................... 21421, 21452........... Lab.
Adapter, luer lock.................. 1.249 Item........................ 36515.................. Hypodermic, IV.
Adapter, spike (for syringe)........ 4.558 Item........................ 36515.................. Hypodermic, IV.
Adhesive, conductive (silver, 3.000 gm.......................... 88349.................. Lab.
liquid).
Adhesive, cyanoacrylate (2ml 28.988 Item........................ 65286.................. Pharmacy, Rx.
uou).doc.
Airway adapter...................... 12.500 Item........................ 94770.................. Accessory, Procedure.
Albuterol inhal soln (3ml vial)..... 0.436 Item........................ 95070.................. Pharmacy, Rx.
Alcohol ethyl 100%.................. 0.028 ml.......................... 88348.................. Lab.
Applicator, cotton-tipped, sterile, 0.056 Item........................ 127 codes.............. Wound Care, Dressings.
6in.
Applicator, wood, 6.5in............. 0.008 Item........................ 99348-49............... Lab.
Bag system, 1000ml (for angiography 8.925 Item........................ 93501, 93505-10........ Accessory, Procedure.
waste fluids).
Balanced salt soln (BSS) (15ml uou). 1.600 Item........................ 59 codes............... Pharmacy, Rx.
Battery, AA......................... 0.450 Item........................ 95250.................. Office Supply, Grocery.
Blade, surgical, super-sharp........ 4.167 Item........................ 14 codes............... Cutters, Closures, Cautery.
Blade, urethrotome.................. 85.030 Item........................ 52270.................. Cutters, Closures, Cautery.
Blood collection tube holder........ 0.163 Item........................ 78110-11, 78120-22, Hypodermic, IV.
78130, 78191, 78725.
Blood collection tube needle........ 0.142 Item........................ 36514-16, 78110-11, Hypodermic, IV.
78120-22, 78130,
78191, 78725.
Blood pressure recording form, 0.310 Item........................ 93784, 93786, 93788.... Office Supply, Grocery.
average.
Brush, protected airway specimen.... 13.000 Item........................ 31623, 31717........... Accessory, Procedure.
Bur, surgical, sterile (drill)...... 4.792 Item........................ 28289.................. Accessory, Procedure.
Canned air (Dust-Off)............... 1.021 oz.......................... 88348.................. Office Supply, Grocery.
Cannula, anterior chamber, 18-27g... 2.688 Item........................ 65815, 66020, 66030, Accessory, Procedure.
66250.
[[Page 47498]]
Catheter percutaneous fastener 12.745 Item........................ 32201, 44901, 47525, Accessory, Procedure.
(Percu-Stay). 47530, 48511, 49021,
49041, 49061, 49423,
49424, 50021, 58823.
Catheter, (Glide)................... 62.000 Item........................ 36218, 36248........... Accessory, Procedure.
Catheter, (SIM2F1).................. 17.000 Item........................ 36011-15, 36215-17, Accessory, Procedure.
36245-47.
Catheter, angiographic.............. 16.200 Item........................ 93508, 93510, 93526.... Hypodermic, IV.
Catheter, balloon inflation device.. 24.900 Item........................ 35470-76............... Accessory, Procedure.
Catheter, balloon ureteral (Dowd)... 65.000 Item........................ 52330.................. Accessory, Procedure.
Catheter, balloon, low profile PTA.. 431.500 Item........................ 35470, 35471, 35474.... Accessory, Procedure.
Catheter, balloon, PTA.............. 243.500 Item........................ 35472-73, 35475-76..... Accessory, Procedure.
Catheter, curved.................... 17.775 Item........................ 36218.................. Accessory, Produce.
Catheter, hyperthermia, closed-end.. .............. Item........................ 77600-20............... Hypodermic, IV.
Catheter, hyperthermia, open-end.... .............. Item........................ 77600.................. Hypodermic, IV.
Catheter, microcatheter (selective 337.880 Item........................ 36217, 36247........... Accessory, Procedure.
3rd order).
Catheter, Swan Ganz................. 65.000 Item........................ 93501, 93526........... Accessory, Procedure.
Catheter, ureteral, acorn tip....... 9.550 Item........................ 52007, 52010, 52327, Accessory, Procedure.
52330.
Clamp, circumcision................. 7.500 Item........................ 54150.................. Cutters, Closures, Cautery.
Collagen, dermal implant (2.5ml uou) 317.000 Item........................ 52327, 52330........... Pharmacy, Rx.
(Contigen).
Conformer, sterile, acrylic......... 20.000 Item........................ 68340.................. Accessory, Procedure.
Contact lens (hard) care kit........ 7.950 Item........................ 92325-26............... Pharmacy, NonRx.
Contact lens (hard) extra strength 0.158 ml.......................... 92325-26............... Pharmacy, NonRx.
cleaning solution.
Contact lends (RGP) polishing soln 0.077 ml.......................... 92325.................. Pharmacy, NonRx.
(Silo2 Care).
Container, 2000ml, transfer pack.... 7.120 Item........................ 36515.................. Accessory, Procedure.
Container, 600ml, transfer pack..... 3.360 Item........................ 36515.................. Accessory Procedure.
Cotton balls, sterile............... 0.022 Item........................ 115 codes.............. Wound Care, Dressings.
Cup, sterile, 12-16 oz.............. 0.760 Item........................ 32201, 44901, 48511, Lab.
49021, 49041, 49061,
50021, 58823, 93501,
93505, 93508, 93510,
93526.
Cup, sterile, 8 oz.................. 0.542 Item........................ 32201, 44901, 48511, Lab.
49021, 49041, 49061,
50021, 58823.
Cuvette, whole blood oximeter....... 115.000 Item........................ 93501, 93526........... Hypodermic, IV.
Diamond knife cleaning rod.......... 1.000 Item........................ 99348.................. Lab.
Drainage catheter, all purpose...... 88.430 Item........................ 44901, 47525, 47530, Accessory, Procedure.
48511, 49021, 49041,
49061, 49423, 50021,
50398, 58823.
Drainage catheter, chest............ 88.890 Item........................ 32201.................. Accessory, Procedure.
Drainage pouch, nephrostomy-biliary. 13.250 Item........................ 32201, 44901, 47525, Accessory, Procedure.
47530, 48511, 49021,
49041, 49061, 49423,
50021, 50398, 58823.
Drape, sterile, incise, ophthalmic.. 4,900 ............................ 67025, 67028, 67110, Gown, Drape.
67120.
Drape, sterile, split-sheet......... 10,243 Item........................ 212 codes.............. Gown, Drape.
Drape, sterile, table 44 in x 76 in. 5.250 Item........................ 93501-10, 93526........ Gown, Drape.
Electrode, Bugbee................... 115.000 Item........................ 52204, 52214, 52224, Accessory, Procedure.
52265, 52275, 55200,
55250.
Electrode, EEG (single)............. 1.638 Item........................ 95961, 95816........... Accessory, Procedure.
Electrode, EGG (single)............. 2.917 Item........................ 91132, 95925-27, 95930. Accessory, Procedure.
Endoscopic deflecting brush......... 73.500 Item........................ 52007.................. Accessory, Procedure.
Film, x-ray, laser print............ 1.437 Item........................ 146 codes.............. Office Supply, Grocery.
Floxin 0.3% otic soln............... 2.354 ml.......................... 69145, 69620........... Pharmacy, Rx.
Forceps, endomyocardial biopsy...... 250.000 Item........................ 93505.................. Accessory, Procedure.
Forceps, Kelly...................... 2.335 Item........................ 93501-10, 93526........ Accessory, Procedure.
Gas, nitrogen....................... 2.708 cu ft....................... 88348-49............... Lab.
Glass knife boat.................... 0.200 Item........................ 88348.................. Lab.
Grid storage box (holds 50 grids)... 3.750 Item........................ 88348.................. Lab.
Guidewire bowl w-lid, sterile....... 3.000 Item........................ 93501-10, 93526........ Accessory, Procedure.
Guidewire, cerebral (Bentson)....... 14.500 Item........................ 36011-15, 36215-17, Accessory, Procedure.
36245-47.
Guidewire, low profile (SpartaCore). 101.250 Item........................ 35470-71, 35474........ Accessory, Procedure.
Guidewire, steerable (Hi-Torque).... 90.000 Item........................ 35470-76, 37203........ Accessory, Procedure.
Guidewire, steerable (Transcend).... 180.000 Item........................ 36217, 32647........... Accessory, Procedure.
Guidewire, torque................... 41.000 Item........................ 35470-76............... Accessory, Procedure.
Heparin 5,000 units-mi inj.......... 0.509 ml.......................... 36514-15............... Pharmacy, Rx.
Hyaluronic acid viscoelastic inj 61.000 Item........................ 65286, 65815, 66250.... Pharmacy, Rx.
(Amvisc, 0.5ml uou.
Hysteroscope ablation device........ 1,146.000 Item........................ 58563.................. Accessory, Procedure.
Jessner's soln...................... 0.240 ml.......................... 15788-89, 15792-93..... Pharmacy, Rx.
Kenalog 40 inj...................... 1.830 ml.......................... 31830.................. Pharmacy, Rx.
[[Page 47499]]
Kit, AccuStick II Introducer system 82.620 Kit......................... 26 codes............... Kit, Pack, Tray.
with RO Marker.
Kit, apheresis treatment............ 140.000 Kit......................... 36515.................. Kit, Pack, Tray.
Kit, barium enema................... 9.466 Kit......................... 75270, 74283........... Kit, Pack, Tray.
Kit, BCR/ABL DNA probe.............. 42.650 Kit......................... 88365.................. Kit, Pack, Tray.
Kit, slit catheter (for compartment 73.750 Kit......................... 20950.................. Kit, Pack, Tray.
pressure monitor).
Kit, vasotomy....................... .............. Kit......................... 55200, 55250........... Kit, Pack, Tray.
Lacrimal duct stent-tube set........ 74.000 Item........................ 68815.................. Accessory, Procedure.
Lead citrate........................ 0.510 gm.......................... 88348.................. Lab.
Manifold (for angiography).......... 6.682 Item........................ 93501, 93508, 93510, Accessory, procedure.
93526.
Marker, gold, for radiosurgery- 29.667 Item........................ 77761-63............... Accessory, Procedure.
radiotherapy.
Mask, CPR (RespAide)................ 16.950 Item........................ 92950.................. Accessory, Procedure.
Methoxsalen, sterile solution 49.500 ml.......................... 36522.................. Pharmacy, Rx.
(UVADEX), 10ml vial.
Microsponge, cellulose (10 pack uou) 3.620 Item........................ 22 codes............... Wound Care, Dressings.
Mount, carbon spectro-pure (for SEM) 0.500 Item........................ 88349.................. Lab.
Nasal tip, olive.................... 0.340 Item........................ 92512.................. Accessory, Procedure.
Nebulizer medication cup............ 0.140 Item........................ 95070.................. Accessory, Procedure.
Needle, arterial, percutaneous...... 3.150 Item........................ 93501, 93505, 93508, Hypodermic, IV.
93510, 93526.
Needle, bone biopsy................. 65.000 Item........................ 20225.................. Hypodermic, IV.
Needle, flexi, hyperthermia......... 12.000 Item........................ 77600-20............... Hypodermic, IV.
Needle, micropigmentation (tattoo).. 12.000 Item........................ 11920-21............... Hypodermic, IV.
Needle, OSHA compliant (SafetyGlide) 0.454 Item........................ 37 codes............... Hypodermic, IV.
Needle, retrobulbar (Atkinson)...... 1.825 Item........................ 67120, 67141........... Hypodermic, IV.
Omnipaque 350mg (125ml uou)......... 29.530 Item........................ 93508, 93510, 93526.... Pharmacy, Rx.
Omnipaque 350mg (50ml uou).......... 12.498 Item........................ 42550, 70370........... Pharmacy, Rx.
Osmometer sample tip and cleaner.... 0.534 Item........................ 88348.................. Lab.
Osmometer std, 50 mOsm-kg, 2ml amp.. 17.000 ml.......................... 88348.................. Lab.
Osmometer std, 850 mOsm-kg, 2ml amp. 17.000 ml.......................... 88348.................. Lab.
Pack, drapes, ortho, large.......... 40.646 Pack........................ 102 codes.............. Kit, Pack, Tray.
Pack, drapes, ortho, small.......... 1.128 Pack........................ 37 codes............... Kit, Pack, Tray.
Pack, ophthalmology visit (w- 1.997 Pack........................ 65272-73, 65280-85, Kit, Pack, Tray.
dilation). 65290, 65810-015,
65855-60, 66130, 66625-
35, 67031, 68130.
Pack, protective, ortho, large...... 9.182 Pack........................ 99 codes............... Kit, Pack, Tray.
Pack, protective, ortho, small...... 4.441 Pack........................ 38 codes............... Kit, Pack, Tray.
Paper, weighing (glassine).......... 0.021 Item........................ 88348.................. Lab.
Phenol, liquified, USP.............. 0.135 ml.......................... 15788-93............... Pharmacy, Rx.
Photo-Flo soln...................... 0.021 ml.......................... 88348.................. Office Supply, Grocery.
Pipette bulb........................ 0.271 Item........................ 88348-49............... Lab.
Pipette 9inch....................... 0.054 Item........................ 88348-89............... Lab.
Plasma antibody adsorption column 1,150.000 Item........................ 36515.................. Accessory, Procedure.
(Prosorba).
Plasma LDL adsorption column 1,300.000 Item........................ 36516.................. Accessory, Procedure.
(Liposorber).
Plasma leukocyte filter............. 49.719 Item........................ 36515.................. Accessory, Procedure.
Plasma separator (Liposorber)....... 100.000 Item........................ 36516.................. Accessory, Procedure.
Plate, surgical, mini-compression, 4 226.000 Item........................ 21208.................. Accessory, Procedure.
hole.
Plate, surgical, mini-i, 16mm....... 147.000 Item........................ 21210.................. Accessory, Procedure.
Plate, surgical, reconstruction, 719.000 Item........................ 21125-27, 21215........ Accessory, Procedure.
left, 5 x 16 hole.
Plate, surgical, reconstruction, 50.000 Item........................ 21125-27, 21215........ Accessory, Procedure.
template, 5 x 16 hole.
Plate, surgical, rigid comminuted 389,000 item........................ 21461, 21462........... Accessory, Procedure.
fracture.
Plate, surgical, rigid comminuted 29.000 Item........................ 21461, 21462........... Accessory, Procedure.
fracture, template.
Pressure bag........................ .............. Item........................ 93501, 93508-10, 93526. Hypodermic, IV.
Prosthesis, voice button (Blom- 48.000 Item........................ 31611.................. Accessory, Procedure.
Singer).
Scalpel, safety, surgical, with 2.143 Item........................ 54150, 54160, 54162.... Cutters, Closures, Cautery.
blade (10-20).
Screw, surgical, auto-drive, 2.0mm x 37.000 Item........................ 2120................... Accessory, Procedure.
4mm.
[[Page 47500]]
Screw, surgical, Carroll-Girard, 9cm 92.000 Item........................ 21401.................. Accessory, Procedure.
x 3.75in.
Screw, surgical, lag, 2.4mm x 26mm.. 66.000 Item........................ 21461-62............... Accessory, Procedure.
Screw, surgical, locking, 2.4mm x 74.000 Item........................ 21127, 21208, 21215.... Accessory, Procedure.
16mm.
Screw, surgical, self-tapping, 1.5- 27.000 Item........................ 21100, 21452........... Accessory, Procedure.
2.0 mm.
Screw, surgical, standard, 2.4mm x 42.000 Item........................ 21125.................. Accessory, Procedure.
14mm.
Screw, surgical, standard, 2.7mm x 47.000 Item........................ 21125-27, 21208, 21215, Accessory, Procedure.
12mm. 21461-62.
Sea salt............................ 0.004 gm.......................... 15810-11............... Office Supply, Grocery.
Sensor, manometry................... 25.000 Item........................ 91010-12, 91122........ Accessory, Procedure.
Sheath, peel away................... 68.990 Item........................ 47530.................. Accessory, Procedure.
Skin refrigerant-anesthetic spray 5.000 oz.......................... 15780-86, 15788-93..... Pharmacy, Rx.
(Frigiderm).
Sodium acetate...................... 0.064 gm.......................... 88348.................. Lab.
Sodium barbital..................... 0.315 gm.......................... 88348.................. Lab.
Specimen block storage box.......... 0.625 Item........................ 88348.................. Lab.
Splint, finger (metal-foam)......... 1.655 Item........................ 26700-05, 26720-25, Wound Care, Dressings.
26740-42, 26750-55,
26770-75.
Sucrose, reagent.................... 0.037 gm.......................... 88348.................. Lab.
Suture device for vessel closure 225.000 Item........................ 35470-75............... Accessory, Procedure.
(Perclose A-T).
Suture, monocryl, 3-0 to 6-0, p, ps. 9.887 Item........................ 15050, 15200, 15220, Cutters, Closures, Cautery.
15240, 15260.
Suture, nylon, 8-0 to 9-0........... 15.320 Item........................ 65270-72, 65275, 65420- Cutters, Closures, Cautery.
26, 66130, 66250,
68115-30, 68320,
68330, 68340, 68360.
Suture, plain, gut, 2-0 to 6-0...... 4.262 Item........................ 41872.................. Cutters, Closures, Cautery.
Suture, polyester, 0 to 3-0 3.895 Item........................ 40840-45............... Cutters, Closures, Cautery.
(Mersilene).
Suture, vicryl, 7-0................. 21.773 Item........................ 67120.................. Cutters, Closures, Cautery.
Syringe 12ml, coronary control...... 7.000 Item........................ 93508-10, 93526........ Hypodermic, IV.
Syringe filter...................... 2.040 Item........................ 88348.................. Hypodermic, IV.
Tape, foam, elastic, 2in (Microfoam) 0.003 Inch........................ 21120-23, 21315, 21355- Wound Care, Dressings.
56, 31820-25.
Toluidine Blue O (for microscopy)... 0.580 gm.......................... 88348.................. Lab.
Towel clamp, plastic................ 0.556 Item........................ 93501-10, 93526........ Accessory, Procedure.
Tracheostomy collar-neckband........ 3.235 Item........................ 31580-84, 31588, 31610. Wound Care, Dressings.
Tracheostomy dressing............... 3.240 Item........................ 31580-84, 31588, 31610. Wound Care, Dressings.
Tracheostomy tube................... 20.934 Item........................ 31370-82, 31580-84, Accessory, Procedure.
31588, 31610, 31613-
14, 31750, 41140,
41145.
Transducer, pressure monitoring (for 9.520 Item........................ 93501, 93508, 93510, Accessory, Procedure.
angiography). 93526.
Tray, bronchogram................... .............. Tray........................ 31708.................. Kit, Pack, Tray.
Tray, central line dressing change.. 2.430 Tray........................ 36514-16............... Kit, Pack, Tray.
Tray, circumcision.................. 25.173 Tray........................ 54150, 54160-62........ Kit, Pack, Tray.
Tray, surgical skin prep, sterile... 6.765 Tray........................ 134 codes.............. Kit, Pack, Tray.
Trichloroacetic acid 90% (sat soln). 0.855 ml.......................... 46900.................. Pharmacy, Rx.
Tubing set (Liposorber)............. 50.000 Item........................ 36516.................. Hypodermic, IV.
Tubing set, blood warmer............ 7.396 Item........................ 36514-16............... Hypodermic, IV.
Tubing set, plasma exchange......... 173.333 Item........................ 36514.................. Hypodermic, IV.
Tubing set, plasma transfer......... 1.680 Item........................ 36515.................. Hypodermic, IV.
Tubing set, Y-type blood recipient.. 5.750 Item........................ 36515.................. Hypodermic, IV.
Tubing, pressure injection line 3.170 Item........................ 93508, 93510, 93526.... Accessory, Procedure.
(angiography).
Tubing, sterile, connecting (fluid 1.950 Item........................ 93510, 93526........... Accessory, Procedure.
administration).
Tubing, sterile, non-vented (fluid .............. Item........................ 93501, 93508, 93510, Accessory, Procedure.
administration). 93526.
Tubing, suction, non-latex (2ft) 7.557 Item........................ 99 codes............... Accessory, Procedure.
with Frazier tip (1).
Underpad 2ft x 2ft (lab bench)...... 0.377 Item........................ 88348-49............... Lab.
Vial, specimen-sample, 4ml.......... 0.550 Item........................ 88348-49............... Lab.
Wax sheet........................... 0.285 Item........................ 88348.................. Lab.
--------------------------------------------------------------------------------------------------------------------------------------------------------
* CPT codes and descriptions only are copyright.
2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
[[Page 47501]]
We have identified certain supply items for which we were unable to
verify the pricing information (see Table 4, Supply Items Needing
Specialty Input for Pricing). Therefore, we are requesting commenters,
particularly specialty organizations, to provide pricing information on
items in this table along with documentation to support the recommended
price. In addition, we are seeking information on the specific contents
of the listed kits, so that we do not duplicate any supply items.
Table 4.--Supply Items Needing Specialty Input for Pricing
--------------------------------------------------------------------------------------------------------------------------------------------------------
Primary specialties *CPT code(s)
Code 2005 Description Unit Unit price associated with item associated with item Status of item
--------------------------------------------------------------------------------------------------------------------------------------------------------
SL008................. Antibodies--detection Slide................. 30.90 Lab, pathology...... 88365............... See Note A.
Blood pressure Item.................. 0.31 Cardiology.......... 93784, 93786, 93788. See Note A.
recording form,
average.
Catheter, Item.................. .............. Radiation oncology.. 77600-20............ See Note A.
hyperthermia, closed-
end.
Catheter, Item.................. .............. Radiation oncology.. 77600............... See Note A.
hyperthermia, open-
end.
Edrophonium.......... ml.................... 4.67 Gastroenterology.... 91011............... See Note A
Hysteroscope, Item.................. 1,146.00 Ob-gyn.............. 58563............... See Note A
ablation device.
Kit, BCR/ABL DNA Kit................... 42.65 Pathology........... 88365............... See Note A.
probe.
SA013................. Kit, detection....... Slide................. 8.50 Pathology, neurology 88355, 88356........ See Note A.
SA024................. Kit, photopheresis Kit................... 809.00 Dermatology, ob-gyn. 36522............... See Note A.
procedure.
Kit, vasotomy........ Kit................... .............. Urology............. 55200, 55250........ See Note A.
Methoxsalen, sterile ml.................... 49.50 Dermatology, 36522............... See Note A.
solution (UVADEX) 10 radiation oncology.
ml vial.
Pressure bag......... Item.................. .............. Cardiology.......... 93501, 93508, 93510, See Note A.
93526.
SL114................. Primary antibodies... Slide................. 3.52 Pathology, neurology 88355, 88356, 88358. See Note A.
Tray, bronchogram.... Tray.................. .............. Pulmonary disease... 31708............... See Note A.
Tubing, sterile, non- Item.................. .............. Cardiology.......... 93501, 93508, 93510, See Note A.
vented (fluid 93526.
administration).
--------------------------------------------------------------------------------------------------------------------------------------------------------
*CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply.
Note A. Additional information required. Need detailed description (including kit contents), source, and current pricing information.
v. Addition of Supply Item to CPT 88365, Tissue In Situ Hybridization
We received a request from a pathology society to add a DNA probe
to the CPEP database for CPT 88365, tissue in situ hybridization. The
society specified that 1.5 DNA probes are typically used in this
service and the cost of one probe is $42.65. Documentation supporting
this price was also provided. We are proposing to add, on an interim
basis, this supply to the practice expense database with the
understanding that the inclusion of the item will be subject to
forthcoming RUC review.
vi. Ophthalmology Equipment
In the CPEP equipment data for many of the ophthalmology
procedures, there is a duplication of time assigned to the screening
lane and exam lane. In a majority of these identified procedures, the
same timeframe was assigned to both the screening and exam lanes. While
some of the procedures had not been refined by the PEAC, others were
refined early on in the PEAC process before the PEAC agreed to assign
only one equipment lane to each procedure because a patient can be in
only one room at a time. In cases where both the screening and exam
lanes are included, we are proposing to adjust the lane assignment by
defaulting to the exam lane and, thus, we will delete the screening
lane from these procedures. For all of the above services where a lane
change was made, time values were assigned to the exam lane in
accordance with our established standard procedure. We are asking
commenters, in particular, organizations representing ophthalmology, to
review these proposed changes and submit specific comments on the
appropriateness of the exam lane default.
vii. Other Practice Expense Issues
Parathyroid Imaging, CPT 78070
We received comments from the RUC and the specialty society
representing nuclear medicine that the practice expenses for CPT 78070,
parathyroid imaging, which is valued in the nonphysician work pool, are
too low. Because this procedure involves multiple imaging sessions, the
organizations have requested that a different crosswalk of charge-based
RVUs be used to more appropriately value the practice expenses involved
with CPT 78070. We agree and are proposing to crosswalk the charge-
based RVUs from CPT 78306, whole body imaging, to this procedure.
B. Geographic Practice Cost Indices (GPCIs)
[If you choose to comment on issues in this section, please include the
caption ``GPCI'' at the beginning of your comments.]
1. Background
The Social Security Act (the Act) requires that payments vary among
physician fee schedule areas according to the extent that resource
costs vary as measured by the Geographic Practice Cost Indices (GPCIs).
In general, the fee schedule areas that existed under the prior
reasonable charge system were retained under the physician fee schedule
from calendar years 1992 to 1996. We implemented a comprehensive
revision in the physician fee schedule payment areas (localities) in
1997, reducing the number of localities from 210 to 89. A detailed
discussion of physician fee schedule areas can be found in the July 2,
1996 proposed rule (61 FR 34615) and the November 22, 1996 final rule
(61 FR 59494).
[[Page 47502]]
We are required by section 1848(e)(1)(A) of the Act to develop
separate GPCIs to measure resource cost differences among localities
compared to the national average for each of the three fee schedule
components. While requiring that the practice expense and malpractice
GPCIs reflect the full relative cost differences, section
1848(e)(1)(A)(iii) of the Act requires that the physician work GPCIs
reflect only one-quarter of the relative cost differences compared to
the national average.
Section 1848(e)(1)(C) of the Act requires us to review and, if
necessary, to adjust the GPCIs at least every 3 years. This section of
the Act also requires us to phase-in the adjustment over 2 years and
implement only one-half of any adjustment if more than 1 year has
elapsed since the last GPCI revision. The GPCIs were first implemented
in 1992. The first review and revision was implemented in 1995, the
second review was implemented in 1998, and the third review was
implemented in 2001. This constitutes the fourth review of the work and
practice expense GPCIs.
The malpractice GPCIs were reviewed and revised as part of the
November 7, 2003 (68 FR 63196) physician fee schedule final rule. At
the time of the publication of the November 2003 final rule, the U.S.
Census data upon which the work and practice expense GPCIs are based
were not yet available.
Section 412 of MMA amends section 1848(e)(1) of the Act and
establishes a floor of 1.0 for the work GPCI for any locality where the
GPCI would otherwise fall below 1.0. This 1.0 work GPCI floor will be
used for purposes of payment for services furnished on or after January
1, 2004 and before January 1, 2007. In addition, section 602 of MMA
further amended section 1848(e)(1) of the Act for purposes of payment
for services furnished in Alaska under the physician fee schedule on or
after January 1, 2004 and before January 1, 2006, and sets the work,
practice expense, and malpractice expense GPCIs at 1.67 if any GPCI
would otherwise be less than 1.67.
Based on these MMA provisions, we revised the addenda published in
the November 7, 2003 final rule (68 FR 63196) that reflected both the
transitional 2004 and 2005 malpractice GPCIs, as well as the work and
practice expense GPCIs that were not updated (Addendum D and Addendum
E, respectively) in an interim final rule with comment period entitled,
``Changes to Medicare Payment for Drugs and Physician Fee Schedule
Payments for Calendar Year 2004,'' published January 7, 2004 (69 FR
1084). Due to the MMA provisions, no locality in these revised addenda
has a work GPCI of less than 1.00. Additionally, the work, practice
expense, and malpractice GPCIs for Alaska are set at 1.67.
We are proposing to revise the work and practice expense GPCIs
beginning in 2005 based on updated U.S. Census data and Department of
Housing and Urban Development fair market rent data.
2. Development of the Geographic Practice Cost Indices
The GPCIs were developed by a joint effort of the Urban Institute
and the Center for Health Economics Research under contract to us.
Indices were developed that measured the relative physician resource
cost differences among areas compared to the national average in a
``market basket'' of goods. The market basket consists of the resources
involved with operating a private medical practice. The resource inputs
are--
Physician work or net income (used to construct the
physician work GPCI);
Employee wages, office rents, medical equipment, supplies,
and other miscellaneous expenses used to comprise the practice expense
GPCI; and
Professional liability insurance premiums (used to
construct the malpractice GPCI).
The resource inputs and their respective weights for the resource
costs associated with the work, practice expense, and malpractice
expense associated with providing a physician service, were obtained
from the 2003 AMA Physician Socioeconomic Characteristics publication
(2003 Patient Care Physician Survey data) which measures physicians'
earnings and overall practice expenses for 2000.
The weights for the 2004 GPCIs, as well as the proposed 2005
through 2007 GPCI revisions, are from the 2003 AMA survey and were used
in the Medicare Economic Index (MEI) revision discussed in the November
2003 physician fee schedule final rule (68 FR 63245). Table 5 below
shows the weights of the resource inputs, as defined by the MEI, those
used for the original GPCIs, as well as the weights for the first,
second, and third GPCI revisions. The MEI weights associated with the
first and second GPCI updates (1995-2000 GPCIs) were not revised. In
addition, the MEI weights for the proposed fourth GPCI revision are
also shown.
Table 5.--Historical View of MEI Weights
----------------------------------------------------------------------------------------------------------------
Percentage of practice cost indices
---------------------------------------------------
Input component 1992-1994 1995-2000 2001-2003 2004-2006
GPCIs GPCIs GPCIs GPCI
----------------------------------------------------------------------------------------------------------------
Physician Work.............................................. 54.2 54.2 54.5 52.5
Practice Expense............................................ 40.2 41.0 42.3 43.7
Employee Wages.............................................. 15.7 16.3 16.8 18.7
Rent........................................................ 11.1 10.3 11.6 12.2
Miscellaneous............................................... 13.4 14.4 13.9 12.8
Malpractice................................................. 5.6 4.8 3.2 3.9
Total................................................... 100.0 100.0 100.0 100.0
----------------------------------------------------------------------------------------------------------------
a. Work Geographic Practice Cost Indices
As in previous GPCI updates, the median hourly earnings component
is based on a 20 percent sample of U.S. Census data from workers in
seven professional occupations. The actual reported earnings of
physicians were not used to establish the GPCIs because Medicare
payments (which are based on the GPCIs) are in part determinants of the
earnings. Including physician wages in the physician work GPCI could,
in effect, make the index dependent upon Medicare payments. Based upon
analysis performed by Health Economics Research, we believe that in the
majority of instances, the earnings of physicians will vary among areas
to the same degree that the earnings of other professionals vary.
[[Page 47503]]
Data from the 2000 decennial U.S. Census by county of seven
professional occupations (architecture and engineering; computer,
mathematical, and natural sciences; social scientist, social workers,
lawyers; education, library, training; registered nurses; pharmacists;
writers, artists, editors) were utilized in the development of the
proposed work GPCIs.
Table 6.--Specific Occupation Categories Used in Development of
Physician Work GPCI
------------------------------------------------------------------------
Census 2000
Categories occupation
code
------------------------------------------------------------------------
Architecture and Engineering.............................. 130-156
Computer, Mathematical, and Natural Sciences.............. 100-124
160-176
Social Scientists, Social Workers, Lawyers................ 180-215
Education, Training, and Library.......................... 220-255
Registered Nurses......................................... 313
Pharmacists............................................... 305
Writers, Artists, and Editors............................. 260-296
------------------------------------------------------------------------
The Census Bureau has very specific criteria that tabulations must
meet in order to be released to the public. To maximize the accuracy
and availability of the data collection, the nonphysician professional
wage data were aggregated into three geographic area categories:
1. By Individual Counties--The tabulations were requested for each
county in a Consolidated Metropolitan Statistical Area (CMSA).
2. By Metropolitan Statistical Area (MSA)--The tabulations were
requested by MSA for all counties that fall within an MSA.
3. By Rest of State--The tabulations were requested by rest of
State for counties that are not in a CMSA or MSA.
The nonphysician professional wage data were subsequently assigned
to each respective county within the MSA or Rest of State aggregations
(or, in the case of CMSAs, the data were already at the county level),
and a median wage by county was calculated for each occupational
category. These median wages were then weighted by the total RVUs
associated with a given county to ultimately arrive at locality-
specific work GPCIs. This geographic aggregation of Census data is the
same methodology that was utilized in previous updates to the GPCIs.
The work GPCIs reflect one-fourth of the relative cost differences,
as required by statute, with the exception of those areas where MMA
requires that the GPCI be set at no lower than 1.00 and that the Alaska
GPCIs be set at 1.67.
b. Practice Expense GPCIs
As in the past, we are proposing that the practice expense GPCI
would be comprised of several factors that represent the major expenses
incurred in operating a physician practice. The factors and the data
sources we propose to use are detailed below. The impact of each
individual factor on the calculation of the practice expense GPCI is
based on the relative weight for that factor consistent with the
calculation of the MEI.
Employee Wage Indices--The employee wage index is based on special
tabulations of 2000 census data, which are generated from the Long Form
Questionnaire. These special tabulations provided by the Census Bureau
are designed to capture the median wage by county of the professional
labor force. The Employee Wage Index uses the median wages of four
labor categories that are most commonly present in a physician's
private practice (administrative support, registered nurses, licensed
practical nurses, and health technicians). Median wages for these
occupations were provided by the U.S. Census Bureau using the same set
of geographic aggregation rules discussed previously in the physician
work GPCI section.
Table 7.--Specific Occupations Used in Creating Employee Wage Index
Update
------------------------------------------------------------------------
Categories Census 2000 occupation code
------------------------------------------------------------------------
Administrative Support................. 500-593
Registered Nurses...................... 313
Licensed Practical Nurses.............. 350
Health Technicians..................... 330, 332, 341, 351-354, 365
------------------------------------------------------------------------
Office Rent Indices-- Since no national data are readily available
for physician office rents, some proxy must be used for this portion of
the practice expense index. To construct the practice expense GPCIs, we
need data that are widely and consistently available across all fee
schedule areas. Although we searched for alternative commercial rental
data that were both widely and consistently available across all fee
schedule areas, we were unable to identify any reliable sources of
commercial rental data.
As with the current practice expense GPCIs, the Department of
Housing and Urban Development (HUD) Fair Market Rental (FMR) data for
the residential rents were again used as the proxy for physician office
rents. The proposed 2005 through 2007 practice expense GPCIs reflect
the final fiscal year 2004 HUD FMR data. See Addendum E for a more
detailed illustration of the actual office rent indices.
We believe that the FMR data remain the best available source for
constructing the office rent index. The FMR data are available for all
areas, are updated annually, and retain consistency from area-to-area
and from year-to-year. Additionally, physicians frequently locate their
offices in areas that are residential, rather than commercial, in
nature. Residential rates may, in fact, be a better measure of the
differences among areas in the physician office market than a general
commercial rental index. In developing FMRs for metropolitan areas, HUD
assumes that all counties within an MSA have the same rent. However, we
believe that the rents in the New York City MSA vary too widely and
propose that the FMR for this metropolitan area should be adjusted to
account for this variation. For the New York City MSA, we used median
gross rent from the 2000 Census to adjust the individual rents within
counties in this MSA.
A reduction in an area's rent index does not necessarily mean that
rents have gone down in that area since the last GPCI update. Since the
GPCIs measure area costs compared to the national average, a decrease
in an area's rent index means that that area's rental costs are lower
relative to the national average rental costs. Addendum E illustrates
the changes in the rental index based upon the new FMR data.
Medical Equipment, Supplies, and other Miscellaneous Expenses--The
GPCIs assume that items such as medical equipment and supplies have a
national market and that input prices do not vary among geographic
areas. We were again unable to find any data sources that demonstrated
price differences by geographic areas. As mentioned in previous
updates, some price differences might exist, but these differences are
more likely to be based on volume discounts rather than on geographic
areas. The medical equipment, supplies, and miscellaneous expense
portion of the practice expense geographic index will continue to be
1.000 for all areas in the proposed GPCIs, except for Alaska which will
have an overall practice expense GPCI set at 1.67 for 2004 and 2005.
c. Malpractice Expense GPCIs
The malpractice GPCIs were reviewed and revised as part of the
November 7, 2003 (68 FR 63196) physician fee schedule final rule.
Please refer to that
[[Page 47504]]
final rule for a detailed discussion of the update to the malpractice
GPCIs.
4. Calculation and Effect of the Proposed 2005 Through 2007 Work and
Practice Expense GPCIs
All three of the indices for a specific fee schedule locality are
based on the indices for the individual counties within the respective
fee schedule localities. As has been done in the past, fee schedule
RVUs would again be used to weight the county indices (to reflect
volumes of services within counties) when mapping to fee schedule areas
and in constructing the national average indices. However, we propose
to use more recent data, 2002 versus 1998 RVUs, in the county,
locality, and national mapping in the proposed GPCIs. The payment
effect associated with the use of these revised RVUs would generally be
negligible, in most cases resulting in changes at the third decimal
point, if at all.
Fee schedule payments are the product of the RVUs, the GPCIs, and
the conversion factor. Updating the GPCIs changes the relative position
of fee schedule areas compared to the national average. Since the
changes represented by the proposed GPCIs could result in total
payments either greater than or less than what would have been paid if
the GPCIs were not updated, it would be necessary to apply scaling
factors to the proposed GPCIs to ensure budget neutrality (prior to
applying the provisions of MMA that change the work GPCIs to a minimum
of 1.0 and increase the Alaska GPCIs to 1.67 because these provisions
are exempted from budget neutrality). We determined that the proposed
work and practice expense GPCIs would have resulted in slightly higher
total national payments. Since the law requires that each individual
component of the fee schedule--work, practice expense, and malpractice
expense--is separately adjusted by its respective GPCI, we propose to
scale each of the GPCIs separately. To ensure budget neutrality prior
to applying the MMA provisions, it would be necessary to--
Decrease the proposed work GPCI by 0.9965;
Decrease the proposed practice expense GPCI by 0.9930; and
Increase the malpractice GPCIs that were published in the
November 7, 2003 final rule by 1.0021.
As all geographic payment areas would receive the same percentage
adjustments, the adjustments do not change the new relative positions
among areas indicated by the proposed GPCIs. After the appropriate
scaling factors are applied, the MMA provision setting a 1.0 floor
would be applied to all work GPCIs falling below 1.0. Additionally, the
GPCIs for Alaska would all be set to 1.67 in accordance with MMA.
The locality specific effect of these proposed revisions to the
work and practice expense GPCIs, as well as the revisions to the
malpractice GPCIs published in the November 7, 2003 final rule, and the
MMA provisions enacted December 8, 2003, are shown in Addendum F
through Addendum H. Addendum F reflects the current GPCIs that were
effective on January 1, 2004. Addendum F can be utilized as a baseline
for purposes of comparison to the proposed GPCIs. Addendum H
illustrates the proposed fully implemented 2006 GPCIs. Addendum G
illustrates the proposed transitional 2005 GPCIs, which are one-half of
the effect of the proposed fully implemented GPCI revisions as required
by section 1848(e)(1)(C) of the Act.
Because the three GPCIs have different weights, the overall effect
of the proposed changes cannot be achieved by summing the individual
effects of the revisions on the work, practice expense, and malpractice
expense GPCIs. The overall effect of all three revised GPCI components
on an area can be estimated by a comparison of the area's geographic
adjustment factors (GAFs). The GAF for a specific payment area is the
weighted composite of the three separate components. The GAF
illustrates an estimate of the general effect on total payments across
a specific fee schedule locality. The effects on individual physicians
would vary depending on each physician's mix and volume of services.
To illustrate a comparison of the overall effect of the current and
proposed GPCIs, Addendum J contains a comparison of the current 2004
GAFs to the proposed fully-implemented 2006 GAFs. Addendum I contains a
comparison of the proposed transitional GAFs (2005) to the current 2004
GAFs. Both Addenda I and J are sorted in descending order of change. As
Addendum J shows, no fee schedule area would experience a total
decrease in its respective GAF by more than 3.5 percent, or increase by
more than 7 percent, if the proposed GPCI revisions are fully
implemented in 2006. The majority of payment areas would change by
considerably less than these amounts. Nearly 75 percent of payment
areas would change by less than 2 percent with the majority of these
payment areas changing by less than 1 percent. Consequently, as
illustrated by Addendum I, no fee schedule area would experience a
total decrease in its respective GAF of more than 1.6 percent, or an
increase of more than 3.5 percent, in the transition year (2005).
The GPCIs measure relative cost differences among payment areas
compared to the national average. The national average cost is
represented by a value of about 1.000. A proposed GPCI revision showing
a decrease from the current value does not necessarily mean that
absolute costs in a payment area have decreased, only that the average
costs of a payment area have decreased as compared to the national
average costs.
5. Payment Localities
In the August 15, 2003 proposed rule, we requested comments on the
composition of the current 89 Medicare physician payment localities to
which the GPCIs are applied. In the November 7, 2003 final rule, we
indicated that we received comments from various parties requesting
that specific counties be removed from their current locality. We
further indicated that we are continuing to examine alternatives for
reconfiguring the current locality structure.
While we have considered alternatives, we have not yet been able to
come up with a policy and criteria that would satisfactorily apply to
all situations. Any policy that we would propose would have to apply to
all States and payment localities. For example, if we were to establish
a policy that if adjacent county geographic indices exceeded a
threshold amount, the lower county could be moved to the higher county
or a separate locality could be created, that approach would cause
redistributions within a State.
Locality changes are budget-neutral with respect to the aggregate
amount of Medicare money in a State. That is, reconfigurations of
localities within a State do not result in any more Medicare money for
the State in the aggregate, but only redistributions of money within a
State. Since there will be both winners and losers in any locality
reconfiguration, the State medical associations should be the impetus
behind these changes. Since 1996, we have moved to Statewide areas in
several States after receiving resolutions from State medical societies
including support from physicians in losing areas, and after going
through Notice and Comment rulemaking. The support of State medical
associations has been the basis for previous changes to Statewide
areas, and continues to be equally important in our consideration of
other future locality changes.
[[Page 47505]]
C. Malpractice Relative Value Units (RVUs)
[If you choose to comment on issues in this section, please include the
caption ``Malpractice RVUs'' at the beginning of your comments.]
1. History of Relative Value Unit System
Section 1848(c)(2)(C) of the Act requires that each service paid
under the physician fee schedule be comprised of three components:
work, practice expense, and malpractice.
From 1992 to 1999, malpractice RVUs were charge-based, using
weighted specialty-specific malpractice expense percentages and 1991
average allowed charges. Malpractice RVUs for new codes after 1991 were
extrapolated from similar existing codes or as a percentage of the
corresponding work RVU. Section 4505(f) of the BBA required us to
implement resource-based malpractice RVUs for services furnished
beginning in 2000. With the implementation of resource-based
malpractice RVUs in 2000 and the full implementation of resource-based
practice expense RVUs in 2002, all physician fee schedule RVUs were
resource-based, eliminating the last vestiges of charged-based payment.
2. Proposed Methodology for the Revision of Resource-based Malpractice
RVUs
The methodology used in calculating the proposed resource-based
malpractice RVUs is the same methodology that was used in the initial
development of resource-based RVUs, the only difference being the use
of more current data. The proposed resource-based malpractice expense
RVUs are based upon:
Actual 2001 and 2002 malpractice premium data;
Projected 2003 premium data; and
2002 Medicare payment data on allowed services and
charges.
As was done in the initial development of resource-based
malpractice expense RVUs in the November 2, 1999 final rule, we are
proposing to revise resource-based malpractice expense RVUs using
specialty-specific malpractice premium data because they represent the
actual malpractice expense to the physician. In addition, malpractice
premium data are widely available. We propose to use actual 2001 and
2002 malpractice premium data and projected 2003 malpractice premium
data for three reasons:
These are the most current data available.
These data capture the highly publicized and most recent
trends in the specialty-specific costs of professional liability
insurance.
These are the same malpractice premium data that were
utilized in the development of revised malpractice GPCIs in the
November 7, 2003 final rule.
We were unable to obtain a nationally representative sample of 2003
malpractice premium data for two reasons: (1) The premium data that we
collected from the private insurance companies had to ``match'' the
market share data that were provided by the respective State
Departments of Insurance. Because none of the State Departments of
Insurance had 2003 market share information at the time of this data
collection, 2003 premium data were not usable; and (2) the majority of
private insurers were not amicable to releasing premium data to us. In
the majority of instances, the private insurance companies would
release their premium data only to the State Departments of Insurance.
Discussions with the industry lead us to conclude that the primary
determinants of malpractice liability costs remain physician specialty,
level of surgical involvement, and the physician's malpractice history.
Malpractice premium data were collected for the top 20 Medicare
physician specialties measured by total payments. Premiums were for a
$1 million/$3 million mature claims-made policy (a policy covering
claims made, rather than services provided during the policy term). We
attempted to collect premium data from all 50 States, Washington, DC,
and Puerto Rico. Data were collected from commercial and physician-
owned insurers and from joint underwriting associations (JUAs). A JUA
is a State government-administered risk pooling insurance arrangement
in areas where commercial insurers have left the market. Adjustments
were made to reflect mandatory patient compensation funds (PCFs) (funds
to pay for any claim beyond the statutory amount, thereby limiting an
individual physician's liability in cases of a large suit) surcharges
in States where PCF participation is mandatory. The premium data
collected represent at least 50 percent of physician malpractice
premiums paid in each State.
For 2001, we were able to collect premium data from 48 States (for
purposes of this discussion, State counts include Washington, DC and
Puerto Rico). We were unable to obtain premium data from Kentucky, New
Hampshire, New Mexico, and Washington DC. To calculate a proxy for the
malpractice premium data for these four areas in 2001, we began with
the most current malpractice premium data collected for these areas,
1996 through 1998 (the last premium data collection that was
undertaken). An average premium price was calculated (using 1996
through 1998 data) for all States except Kentucky, New Hampshire, New
Mexico, and Washington, DC. Similarly, an average premium price was
calculated for the 1999 through 2001 period for all States except
Kentucky, New Hampshire, New Mexico, and Washington, DC. The percentage
change in these premium prices was calculated as the percent difference
between the 1999 to 2001 calculated average premium price and the 1996
to 1998 calculated average premium price. This percentage change was
then applied to the weighted average 1996 to 1998 malpractice premium
price for these four areas to arrive at a comparable 1999 to 2001
average premium price.
For 2002, we were able to obtain malpractice premium data from 33
States. Many State Departments of Insurance had not yet obtained
premium data from the primary insurers within their State at the time
of this data collection. For those States for which we were unable to
obtain malpractice premium data, we calculated a national average rate
of growth for 2002 and applied this national rate of growth to the
weighted average premium for 2001 to obtain an average premium for 2002
for each county for which we were unable to obtain malpractice premium
data for 2002.
We projected premium values for 2003 based on the average of
historical year-to-year changes for each locality (when locality level
data were available) or by State (when only Statewide premium data
projections were available). First, we calculated the percentage
changes in the premiums from the 1999 through 2000, 2000 through 2001,
and 2001 through 2002 periods for each payment locality. Next, we
calculated the geometric mean of these three percentages and applied
the mean to the 2002 premium to obtain the forecasted 2003 malpractice
premium. We used the geometric mean to calculate the forecasted 2003
premium data because the geometric mean is commonly used to derive the
mean of a series of values that represent rates of change. Because the
geometric mean is based on the logarithmic scale, it is less impacted
by outlying data.
Malpractice insurers generally use five-digit codes developed by
the Insurance Services Office (ISO), an advisory body serving property
and casualty insurers, to classify physician
[[Page 47506]]
specialties into different risk classes for premium rating purposes.
ISO codes classify physicians not only by specialty, but in many cases
also by whether or not the specialty performs surgical procedures. A
given specialty could thus have two ISO codes, one for use in rating a
member of that specialty who performs surgical procedures and another
for rating a member who does not perform surgery. Medicare uses its own
system of specialty classification for payment and data purposes. It
was therefore necessary to map Medicare specialties to ISO codes and
insurer risk classes. Different insurers, while using ISO codes, have
their own risk class categories. To ensure consistency, we used the
risk classes of St. Paul Companies, one of the oldest and largest
malpractice insurers. Table 8 crosswalks Medicare specialties to ISO
codes and to the St. Paul risk classes used.
Table 8.--Crosswalk of Medicare Specialties to IOS Codes and to the St. Paul Risk Classes Used
----------------------------------------------------------------------------------------------------------------
ISO code Risk class
Medicare code Medicare ---------------------------------------------------- St. Paul's
description Surgery Other Surgery Other description
----------------------------------------------------------------------------------------------------------------
1.................... General practice.. 80117 80420 4 1 Family/Gen.
Practitioners--N
o Obstetrical.
2.................... General surgery... 80143 80143 5 5 Surgery, General.
3.................... Allergy/ 80254 80254 1A 1A Allergy.
Immunology.
4.................... Otolaryngology.... 80159 80265 3 1 Otarhinolaryngolo
gy.
5.................... Anesthesiology.... 80151 80151 5A 5A Anesthesiology.
6.................... Cardiology........ 80281 80255 2 1 Cardiovascular
Disease.
7.................... Dermatology....... 80472 80256 5 1A Dermatology.
8.................... Family practice... 80117 80420 4 1 Family/Gen.
Practitioners--N
o Obstetrical.
10................... Gastroenterology.. 80104 80241 3 1 Gastroenterology.
11................... Internal medicine. 80284 80257 2 1 Internal
medicine.
13................... Neurology......... 80288 80261 2 2 Neurology.
14................... Neurosurgery...... 80152 80152 8 8 Surgery,
Neurology.
16................... Obstetrics/ 80167 80244 4 1 Gynecology.
Gynecology.
18................... Ophthalmology..... 80114 80263 2 1 Ophthalmology.
20................... Orthopedic surgery 80501 80501 5 5 Surgery,
Orthopedic--excl
uding Spinal
Surgery.
20................... Orthopedic surgery 80154 80154 6 6 Surgery,
Orthopedic--incl
uding Spinal
Surgery.
22................... Pathology......... 80292 80266 2 1A Pathology.
24................... Plastic and 80156 80156 5 5 Surgery, Plastic.
reconstructive
surgery.
25................... Physical medicine 80235 80235 1 1 Physical medicine
and rehab. and rehab.
26................... Psychiatry*....... 80492, 80249 2 1A Psychiatry.
80431
28................... Colorectal surgery 80115 80115 3 3 Surgery, Colon
and Rectal.
29................... Pulmonary Disease. 80269 80269 1 1 Pulmonary
Disease.
30................... Diagnostic 80280 80253 2 2 Radiology.
radiology **.
33................... Thoracic surgery.. 80144 80144 6 6 Surgery,
Thoracic.
34................... Urology........... 80145 80145 2 2 Surgery,
Urological.
36................... Nuclear medicine.. 80262 80262 1 1 Nuclear medicine.
37................... Pediatric medicine 80293 80267 2 1 Pediatrics.
38................... Geriatric 80276 80243 2 1 Geriatrics.
medicine***.
39................... Nephrology***..... 80287 80260 2 1 Nephrology.
40................... Hand surgery...... 80169 80169 5 5 Surgery, Hand.
44................... Infectious disease 80279 80246 2 1 Infectious
disease.
46................... Endocrinology***.. 80272 80238 2 1 Endocrinology.
65................... Physical therapist 80235 80235 1 1 Physical medicine
(independent). and rehab.
66................... Rheumatology...... 80252 80252 1 1 Rheumatology.
67................... Occupational 80235 80235 1 1 Occupational
therapist Medicine.
(independent).
77................... Vascular surgery.. 80146 80146 6 6 Surgery,
Vascular.
78................... Cardiac surgery... 80141 80141 6 6 Surgery, Cardiac.
82................... Hematology........ 80278 80245 2 1 Hematology.
83................... Hematology/ 80473 80473 1 1 Oncology.
oncology.
84................... Preventive 80231 80231 1 1 General
medicine. Preventive
Medicine.
92................... Radiation 80425 80425 2 2 Radiation
Oncology****. Therapy.
93................... Emergency medicine 80157 80102 5 4 Emergency
Medicine.
98................... Gynecologist/ 80167 80244 4 1 Gynecology.
oncologist.
----------------------------------------------------------------------------------------------------------------
Note: For specialties with multiple risk classifications depending on the level of surgical involvement, the
highest level of surgery for each specialty was selected for the ``surgery'' ISO and risk class; and the
lowest level of surgery was selected for the ``nonsurgery'' ISO and risk class.
Note: If a specialty has only one risk classification, the same classification was used for both surgery and
nonsurgery.
* The ISO codes for surgery for Psychiatry represents Psychiatry--shock therapy.
** St. Paul's is the only one of the five companies that has a ``major invasive'' procedures ISO Code for
Radiology; therefore, the ``minor invasive procedures'' ISO Code is being used as the highest level of
surgery.
*** St. Paul's is the only one of the five companies that has a ``major surgery'' ISO Code for Geriatrics,
Nephrology, and Endocrinology; therefore, the minor surgery'' ISO Code is being used as the highest level of
surgery.
**** Medical Protective's Description was used, as St. Paul's does not provide specific medical malpractice
insurance for Radiation Therapy.
[[Page 47507]]
Some physician specialties, nonphysician practitioners, and other
entities (for example, independent diagnostic testing facilities) paid
under the physician fee schedule could not be assigned an ISO code. We
crosswalked these specialties to similar physician specialties assigned
an ISO code and a risk class. The unassigned specialties and the
specialty to which they were assigned are shown in Table 9.
Table 9.--Crosswalk of Specialties to Similar Physician Specialties Assigned an ISO Code and a Risk Class
----------------------------------------------------------------------------------------------------------------
Unassigned Medicare
Medicare code specialty Crosswalk specialty
----------------------------------------------------------------------------------------------------------------
12.......................................... Osteopathic Family Practice.
Manipulative Therapy.
32.......................................... Anesthesiologist Anesthesiology.
Assistant.
35.......................................... Chiropractic......... Physical medicine and rehab.
41.......................................... Optometry............ Ophthalmology.
43.......................................... Certified Registered All Physicians.
Nurse Assistant.
47.......................................... Physiological All Physicians.
Laboratory
(independent).
48.......................................... Podiatry............. All Physicians.
50.......................................... Nurse Practitioner... All Physicians.
62.......................................... Psychologist......... Psychiatry.
68.......................................... Clinical Psychologist Psychiatry.
69.......................................... Clinical Laboratory.. All Physicians.
70.......................................... Multi-Specialty All Physicians.
Clinic or Group
Practice.
74.......................................... Radiation Therapy Radiation Oncology.
Center.
76.......................................... Peripheral Vascular Vascular Surgery.
Disease.
79.......................................... Addiction Medicine... Psychiatry.
80.......................................... Licensed Clinical Psychiatry.
Social Worker.
81.......................................... Critical Care All Physicians.
(Intensivists).
85.......................................... Maxillofacial Surgery Plastic Surgery.
86.......................................... Neuropsychiatry...... Psychiatry.
89.......................................... Certified Clinical All Physicians.
Nurse Specialist.
90.......................................... Medical Oncology..... Internal Medicine.
91.......................................... Surgical Oncology.... General Surgery.
94.......................................... Interventional Radiology.
Radiology.
96.......................................... Optician............. Ophthalmology.
97.......................................... Physician Assistant.. All Physicians.
----------------------------------------------------------------------------------------------------------------
In the development of the proposed resource-based malpractice RVU
methodology, we considered two malpractice premium-based alternatives
for resource-based malpractice RVUs, the dominant specialty approach
and the specialty-weighted approach.
Dominant Specialty Approach
The dominant specialty approach bases the malpractice RVUs upon the
risk factor of only the dominant specialty performing a given service
as long as the dominant specialty accounted for at least 51 percent of
the total utilization for a given service. When 51 percent of the total
utilization does not comprise the dominant specialty, this approach
uses a modified specialty-weighted approach. In this modified
specialty-weighted approach, two or more specialties are collectively
defined as the dominant specialty. Starting with the specialty with the
largest percentage of allowed services, the modified specialty-weighted
approach successively adds the next highest specialty in terms of
percentage of allowed services until a 50 percent threshold is
achieved. The next step is to sum the risk factors of those specialties
(weighted by utilization) in order to achieve at least 50 percent of
the total utilization of a given service and then use the factors in
the calculation of the final malpractice RVU.
The dominant specialty approach produces modest increases for some
specialties and modest decreases for other specialties. The largest
increase for any given specialty, over the specialty-weighted approach,
is less than 1.5 percent of total RVUs, while the largest decrease for
any given specialty is less than 0.5 percent of total RVUs.
Specialty-Weighted Approach
The approach that we adopted in the November 1999 final rule and
are proposing to use in this proposed rule, bases the final malpractice
RVUs upon a weighted average of the risk factors of all specialties
performing a given service. The specialty-weighted approach ensures
that all specialties performing a given service are accounted for in
the calculation of the final malpractice RVU. Our proposed methodology
is as follows:
(1) Compute a national average premium for each specialty.
Insurance rating area malpractice premiums for each specialty were
mapped to the county level. The specialty premium for each county is
then multiplied by the total county RVUs (as defined by Medicare claims
data), which had been divided by the malpractice GPCI applicable to
each county to standardize the relative values for geographic
variations. If the malpractice RVUs were not normalized for geographic
variation, the locality cost differences (as reflected by the GPCIs)
would be counted twice. The product of the malpractice premiums and
standardized RVUs is then summed across specialties for each county.
This calculation is then divided by the total RVUs for all counties,
for each specialty, to yield a national average premium for each
specialty.
Table 10 shows the national average premiums for the years 1999
through 2003 for the 20 specialties for which we collected premium
data. As stated previously, we used an average of the 3 most current
years, 2001 to projected 2003 malpractice premiums, in our calculation
of the proposed malpractice RVUs.
[[Page 47508]]
Table 10.--National Average Premiums for the Years 1999 Through 2003 for the 20 Specialties for Which We Collected Premium Data
--------------------------------------------------------------------------------------------------------------------------------------------------------
Annual
2001 2002 2003 1996-1998 2001-2003 trend \2\ Specialty Normalized Risk
ISO Specialty average average average average average \1\ MGPCI \3\ 2001-2003 factor
(percent) premium \4\ \5\
--------------------------------------------------------------------------------------------------------------------------------------------------------
80269................ Pulmonary disease..... 12,574 13,456 14,541 9,508 13,524 7.30 1.027 13,168 2.14
80280................ Diagnostic radiology.. 15,807 16,783 17,997 12,372 16,862 6.39 0.997 16,913 2.75
80284................ Internal medicine..... 14,395 15,714 16,985 11,836 15,698 5.81 1.028 15,270 2.48
80274................ Gastroenterology...... 14,347 15,398 16,643 11,745 15,463 5.65 1.017 15,204 2.47
80143................ General surgery....... 33,163 36,004 39,059 27,825 36,075 5.33 0.957 37,696 6.13
80423................ General practice...... 13,325 14,479 15,731 11,234 14,512 5.25 0.943 15,389 2.50
80288................ Neurology............. 16,206 17,330 18,629 13,726 17,388 4.84 1.032 16,849 2.74
80114................ Ophthalmology......... 13,064 14,103 15,317 11,209 14,161 4.79 0.997 14,204 2.31
80152................ Neurosurgery.......... 64,724 70,125 76,060 57,701 70,303 4.03 0.952 73,848 12.00
80281................ Cardiology............ 14,798 15,836 17,085 13,204 15,906 3.79 1.021 15,579 2.53
80145................ Urology............... 18,701 20,253 21,931 16,958 20,295 3.66 0.999 20,315 3.30
80159................ Otolaryngology........ 21,720 23,127 24,794 19,990 23,214 3.04 0.997 23,284 3.78
80154................ Orthopedic w/spinal... 40,384 43,758 47,321 38,584 43,821 2.58 0.955 45,886 7.46
80144................ Thoracic surgery...... 39,538 43,200 47,249 38,812 43,329 2.23 1.020 42,479 6.91
80282................ Dermatology........... 11,046 11,549 12,375 10,650 11,657 1.82 1.020 11,428 1.86
80260................ Nephrology \6\........ 8,408 9,290 10,142 n/a 9,280 n/a 0.999 9,289 1.51
80146................ Vascular surgery...... 39,391 42,660 46,211 n/a 42,754 n/a 1.014 42,164 6.85
80141................ Cardiac surgery....... 37,802 40,498 43,722 n/a 40,674 n/a 0.921 44,163 7.18
80425................ Radiation oncology.... 13,800 14,755 15,976 n/a 14,844 n/a 0.995 14,918 2.43
80102................ Emergency medicine.... 20,671 22,672 24,733 n/a 22,692 n/a 0.974 23,298 3.79
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ A simple average of figures for 2001, 2002, and 2003.
\2\ Percent annualized average growth rate between 1996-1998 and 2001-2003.
\3\ An average of locality malpractice GPCIs using specialty-specific malpractice RVUs as weights.
\4\ 2001-2003 premium divided by specialty MGPCI.
\5\ (Normalized 2001-2003 Premium, .9289) x 1.51.
\6\ Nephrology is set to 1.51 to be consistent with the risk factor taken from the rating manuals. n/a signifies that the premium data were not
available.
(2) Calculate a risk factor for each specialty. Differences among
specialties in malpractice premiums are a direct reflection of the
malpractice risk associated with the services performed by a given
specialty. The relative differences in national average premiums
between various specialties can be expressed as a specialty risk
factor. These risk factors are an index calculated by dividing the
national average premium for each specialty by the national average
premium for the specialty with the lowest average premium, nephrology.
Table 11 shows the risk factors, surgical and nonsurgical, by
specialty.
Table 11.--Risk Factors, Surgical and Nonsurgical, by Specialty
----------------------------------------------------------------------------------------------------------------
Nonsurgical Surgical risk
Medicare code Medicare description risk factor factor
----------------------------------------------------------------------------------------------------------------
01............................................ General practice................ 1.79 4.26
02............................................ General surgery................. 6.13 6.13
03............................................ Allergy/Immunology.............. 1.00 1.00
04............................................ Otolaryngology.................. 1.45 3.78
05............................................ Anesthesiology.................. 2.84 2.84
06............................................ Cardiology...................... 1.45 2.53
07............................................ Dermatology..................... 1.00 3.90
08............................................ Family practice................. 1.79 4.26
10............................................ Gastroenterology................ 2.05 3.49
11............................................ Internal medicine............... 2.05 2.48
12............................................ Osteopathic Manipulative Therapy 1.79 4.26
13............................................ Neurology....................... 2.52 2.74
14............................................ Neurosurgery.................... 12.00 12.00
16............................................ Obstetrics/Gynecology........... 2.15 5.63
18............................................ Ophthalmology................... 1.24 2.31
20............................................ Orthopedic surgery w/o Spinal... 8.06 8.06
20............................................ Orthopedic surgery with Spinal.. 7.46 7.46
22............................................ Pathology....................... 1.72 2.09
24............................................ Plastic Surgery................. 6.92 6.92
25............................................ Physical Med & Rehab............ 1.26 1.26
26............................................ Psychiatry...................... 1.11 3.08
28............................................ Colorectal surgery.............. 4.08 4.08
29............................................ Pulmonary disease............... 2.14 2.14
30............................................ Diagnostic radiology............ 2.07 2.75
32............................................ Anesthesiologist Assistant...... 2.84 2.84
33............................................ Thoracic surgery................ 6.91 6.91
34............................................ Urology......................... 3.30 3.30
35............................................ Chiropractic.................... 1.26 1.26
36............................................ Nuclear medicine................ 1.66 1.66
37............................................ Pediatric medicine.............. 1.76 2.42
38............................................ Geriatric medicine.............. 1.35 2.17
39............................................ Nephrology...................... 1.51 1.96
[[Page 47509]]
40............................................ Hand surgery.................... 4.71 4.71
41............................................ Optometry....................... 1.24 2.31
43............................................ Certified Registered Nurse 3.04 3.71
Assistant.
44............................................ Infectious disease.............. 1.55 2.09
46............................................ Endocrinology................... 2.03 2.09
47............................................ Physiological Laboratory 3.04 3.71
(independent).
48............................................ Podiatry........................ 3.04 3.71
50............................................ Nurse Practitioner.............. 3.04 3.71
62............................................ Psychologist.................... 1.11 3.08
65............................................ Physical therapist (independent) 1.26 1.26
66............................................ Rheumatology.................... 2.11 2.11
67............................................ Occupational therapist.......... 1.11 1.11
68............................................ Clinical Psychologist........... 1.11 3.08
69............................................ Clinical Laboratory............. 3.04 3.71
70............................................ Multi-Specialty Clinic or Group 3.04 3.71
Practice.
74............................................ Radiation Therapy Center........ 2.43 2.43
76............................................ Peripheral Vascular Disease..... 6.85 6.85
77............................................ Vascular surgery................ 6.85 6.85
78............................................ Cardiac surgery................. 7.18 7.18
79............................................ Addiction Medicine.............. 1.11 3.08
80............................................ Licensed Clinical Social Worker. 1.11 3.08
81............................................ Critical Care (Intensivists).... 3.04 3.71
82............................................ Hematology...................... 1.77 2.26
83............................................ Hematology/oncology............. 2.05 2.11
84............................................ Preventive medicine............. 1.26 1.26
85............................................ Maxillofacial Surgery........... 6.92 6.92
86............................................ Neuropsychiatry................. 1.11 3.08
89............................................ Certified Clinical Nurse 3.04 3.71
Specialist.
90............................................ Medical Oncology................ 2.05 2.48
91............................................ Surgical Oncology............... 6.13 6.13
92............................................ *Radiation oncology/therapy..... 2.43 2.43
93............................................ Emergency medicine.............. 3.79 4.55
94............................................ Interventional Radiology........ 2.07 2.75
96............................................ Optician........................ 1.24 2.31
97............................................ Physician Assistant............. 3.04 3.71
98............................................ Gynecologist/oncologist......... 2.15 5.63
----------------------------------------------------------------------------------------------------------------
Note: If a specialty has only one risk classification, the same classification was used for both surgery and
nonsurgery.
Note: For specialties with multiple risk classifications depending on the level of surgical involvement, the
highest level of surgery was selected for surgery risk factor and the lowest level of surgery was selected for
nonsurgery risk factor.
(3) Calculate malpractice RVUs for each code. Resource-based
malpractice RVUs were calculated for each procedure. The first step was
to identify the percentage of services performed by each specialty for
each respective procedure code. This percentage was then multiplied by
each respective specialty's risk factor as calculated in Step 2. The
products for all specialties for the procedure were then summed,
yielding a specialty-weighted malpractice RVU reflecting the weighted
malpractice costs across all specialties for that procedure. This
number was then multiplied by the procedure's work RVUs to account for
differences in risk-of-service. Since we were unable to find an
acceptable source of data to be used in determining risk-of-service,
work RVUs were used. We would welcome any suggestions for alternative
data sources to be used in determining risk-of-service.
As mentioned above, certain specialties may have more than one ISO
rating class and risk factor. The surgical risk factor for a specialty
was used for surgical services and the nonsurgical risk factor for
evaluation and management services. Also, for obstetrics/gynecology,
the lower gynecology risk factor was used for all codes except those
obviously surgical services, in which case the higher, surgical risk
factor was used.
Certain codes have no physician work RVUs. The overwhelming
majority of these codes are the technical components (TCs) of
diagnostic tests, such as x-rays and cardiac catheterization, which
have a distinctly separate technical component (the taking of an x-ray
by a technician) and professional component (the interpretation of the
x-ray by a physician). Examples of other codes with no work RVUs are
audiology tests and injections. These services are usually furnished by
nonphysicians, in this example, audiologists and nurses, respectively.
In many cases, the nonphysician or entity furnishing the TC is distinct
and separate from the physician ordering and interpreting the test. We
believe it is appropriate for the malpractice RVUs assigned to TCs to
be based on the malpractice costs of the nonphysician or entity, not
the professional liability of the physician.
Our proposed methodology, however, would result in zero malpractice
RVUs for codes with no physician work, since we propose the use of
physician work RVUs to adjust for risk-of-service. We believe that zero
malpractice RVUs would be inappropriate because nonphysician health
practitioners and entities such as independent diagnostic testing
facilities (IDTFs) also have malpractice liability and carry
malpractice insurance. Therefore, we are proposing to retain the
current charge-based malpractice RVUs for all services with zero work
RVUs. We are open to comments and suggestions for constructing
resource-based malpractice RVUs for codes with no physician work.
[[Page 47510]]
(4) Rescale for budget neutrality. The law requires that changes to
fee schedule RVUs be budget neutral. The current resource-based
malpractice RVUs and the proposed resource-based malpractice RVUs were
constructed using entirely different malpractice premium data. Thus,
the last step is to adjust for budget neutrality by rescaling the
proposed malpractice RVUs so that the total proposed resource-based
malpractice RVUs equal the total current resource-based malpractice
RVUs. The proposed resource-based malpractice RVUs for each procedure
were multiplied by the frequency count for that procedure to determine
the total resource-based malpractice RVUs for each procedure. This was
summed for all procedures to determine the total fee schedule proposed
resource-based malpractice RVUs. This was compared to the total current
resource-based malpractice RVUs, using the same calculation and cases.
The total current and proposed malpractice RVUs were equal, and
therefore budget neutral. Thus, no adjustments were needed to ensure
that expenditures remained constant for the malpractice RVU portion of
the physician fee schedule payment.
The proposed resource-based malpractice RVUs are shown in Addendum
B. These values have been adjusted for budget neutrality on the basis
of the most recent available data. The values do not reflect the final
budget-neutrality adjustment, which we will make in the final rule
based upon the more current Medicare claims data. We do not believe,
however, that the values will change significantly as a result of the
final budget-neutrality adjustment.
Because of the differences in the sizes of the three fee schedule
components, implementation of the proposed resource-based malpractice
RVUs will have a smaller payment effect than the previous
implementation of resource-based practice expense RVUs. On average,
work represents about 52.5 percent of the total payment for a
procedure, practice expense about 43.6 percent of the total payment,
and malpractice expense about 3.9 percent of the total payment. Thus, a
20 percent change in practice expense or work RVUs would yield a change
in payment of about 8 to 11 percent. In contrast, a corresponding 20
percent change in malpractice values would yield a change in payment of
only about 0.6 percent. Estimates of the effects on payment by
specialty and selected high-volume procedures can be found in the
impact section of this rule.
We are requesting comments on our proposed methodology and
resource-based malpractice RVUs.
D. Coding Issues
1. Change in Global Period for CPT Code 77427, Radiation Treatment
Management, Five Treatments
[If you choose to comment on issues in this section, please include the
caption ``CODING-GLOBAL PERIOD'' at the beginning of your comments.]
This code was included in the November 2, 1999 physician fee
schedule final rule and was effective for services beginning January 1,
2000. In that rule, and subsequent rules, we have applied a global
indicator of ``xxx'' to this code, meaning that the global concept does
not apply. It has been brought to our attention that this global
indicator is incorrect. The global indicator should be 090 since the
RUC valuation of this service reflected a global period of 90 days and
we accepted this valuation. Therefore, we would correct the global
indicator for this service to reflect a global period of 90 days (090).
2. Requests for Adding Services to the List of Medicare Telehealth
Services
[If you choose to comment on issues in this section, please include the
caption ``CODING--TELEHEALTH'' at the beginning of your comments.]
a. Background
Section 1834(m) of the Act defines telehealth services as
professional consultations, office and other outpatient visits, and
office psychiatry services identified as of July 1, 2000 by CPT codes
99241 through 99275, 99201 through 99215, 90804 through 90809, and
90862. In addition, the statute required us to establish a process for
adding services to or deleting services from the list of telehealth
services on an annual basis. In the CY 2003 final rule, we established
a process for adding or deleting services to the list of Medicare
telehealth services. This process provides the public an opportunity on
an ongoing basis to submit requests for adding a service. For more
information on submitting a request for addition to the list of
Medicare telehealth services, visit our Web site at www.cms.hhs.gov/
physicians/telehealth.
b. Submitted Requests for Addition to the List of Telehealth Services
Requests for adding services to the list of Medicare telehealth
services must be submitted and received no later than December 31st of
each calendar year to be considered for the next proposed rule. For
example, requests submitted in CY 2003 are considered for the CY 2005
proposed rule.
We received the following public requests for addition in CY 2003:
Inpatient hospital care, emergency department visits, hospital
observation services, inpatient psychotherapy, monthly management of
patients with end-stage renal disease (ESRD), speech and audiologist
services, case management, and care plan oversight.
Requests for additions submitted in CY 2003 are discussed below.
Inpatient hospital care, emergency department visits, hospital
observation services, and inpatient psychotherapy
The American Telemedicine Association (ATA) and an individual
practitioner submitted a request to add initial and subsequent
inpatient hospital care as represented by CPT codes 99221 through 99223
and 99231 through 99233; hospital observation services (CPT codes
99217, 99218 through 99220); and individual psychotherapy furnished in
an inpatient, partial hospitalization, or residential care facility
setting (as defined by CPT codes 90816 through 90822). The requestors
argue that the addition of hospital observation services, inpatient
hospital care, and inpatient psychotherapy will reduce transfers from
remote facilities to tertiary care facilities, decrease length of stay,
improve diagnostic accuracy, plan of care strategies and patient
outcomes, and also stabilize local health care systems. The requestors
emphasize that adding individual psychotherapy in the inpatient and
partial hospitalization setting is crucial for providing access to
mental health services for the rural population. Additionally, the
requestors believe that no current Medicare telehealth service can be
billed when a patient is in observation status or is admitted as an
inpatient. They also noted that the current psychiatry services paid
for as telehealth services are not appropriate for mental health
patients in the hospital, partial hospital, or residential facility
settings.
The University of Kansas Medical Center requested that we add
emergency department visits as defined by CPT codes 99281 through 99285
as telehealth services. The requestor stated that, for many rural
hospitals, the attending physician in emergency cases is a local
primary care or family physician who may not have sufficient experience
with the complexities of emergent care. The requestor believes that
adding emergency department visits will provide quicker access to an
expert trauma or emergency physician and that the time saved could be
life-saving for the patient.
[[Page 47511]]
CMS Review
As discussed in the June 28, 2002 Federal Register (67 FR 43862),
we assign requests to one of two categories for review. Category 1 is
comprised of services, which are similar in nature to an office or
other outpatient visit, consultation, or office psychiatry. We review
category 1 services to ensure that the roles of, and interaction among,
the patient, physician, or practitioner at the distant site and
telepresenter (if necessary) are similar to the current telehealth
services.
Category 2 services would include services that are not similar to
an office or other outpatient visit, consultation, or office
psychiatry. Because of the potential acuity of the patient in the
hospital setting, we consider inpatient hospital care, emergency
department visits, hospital observation services, and inpatient
psychotherapy to fall into the second category of requests. As
discussed on our website, for category 2 services, requestors must
provide evidence indicating that the use of a telecommunications system
produces similar diagnostic findings or therapeutic interventions as
would face-to-face delivery of the same service.
For inpatient hospital care, hospital observation services, and
inpatient psychotherapy, the requestors did not submit evidence
indicating that the use of a telecommunications system does not affect
the diagnosis or treatment plan as compared to the face-to-face
delivery of the service. The requestors instead submitted various
studies and articles regarding: the psychiatric diagnostic interview
examination; school-based pediatric acute care to children; child and
adolescent psychotherapy in clinics and schools; the use of telehealth
technology to simplify case management and prior authorization;
consultation on neurology cases; and nursing care to reduce
hospitalization for heart failure.
These data are not directly relevant to the services that the
requesters wanted to have added. They do not address whether the use of
a telecommunications system produces similar diagnoses or therapeutic
interventions by physicians or practitioners, as would the face-to-face
delivery of inpatient hospital care, hospital observation services, and
inpatient psychotherapy. With respect to emergency department visits,
the requestor submitted a comparison study between emergency department
telemedicine and face-to-face emergency department visits. However,
this study did not take into account complex emergent care. Study
participants were pre-selected based on cases with limited clinical
intervention, for example, animal bites with no skin laceration or
puncture wounds, insect bites without evidence of wheezing or airway
compromise, sore throat, first degree burns--less than 5 percent, and
nonurgent medical problems requiring a referral.
In the absence of sufficient, well-designed comparison studies
showing that the use of a telecommunications system produces similar
diagnoses or therapeutic interventions as would the face-to-face
delivery of the requested services, we are proposing not to add these
services to the list of telehealth services.
We believe that the current list of Medicare telehealth services is
appropriate for hospital inpatients, emergency room cases, and patients
designated as observation status. If guidance or advice is needed in
these settings, a consultation could be requested from an appropriate
source.
End Stage Renal Disease--Monthly Management of Patients on Dialysis
The ATA and an individual practitioner submitted a request that we
add the monthly management of patients on dialysis, as represented by
HCPCS codes G0308 through G0319, to the list of Medicare telehealth
services. Under these codes, Medicare pays an increased monthly
capitated payment amount for additional visits during the month (up to
four). The requestors noted the shortage of nephrologists and the
difficulty they have in visiting face-to-face with all patients on
dialysis. Additionally, the requestors stated that many States,
including Alaska, Hawaii, Montana, and Wisconsin, have remote
community-based dialysis centers with underserved populations located a
considerable distance from a nephrologist. To address this issue,
consultations and patient care conferences are currently being provided
using a telecommunications system to manage patients on dialysis
located in communities that do not have a nephrologist, including
communities in Texas, where dialysis consultations and assessments
using telecommunications are paid under the State's Medicaid program.
Given the claims of a shortage of nephrologists and the new face-to-
face visit requirements for physicians managing patients on dialysis,
the requestors believe that permitting the management of dialysis
patients through telehealth services is crucial.
CMS Review
The MCP G codes represent a range of services provided during a
month, including a complete assessment of the patient and subsequent
visits to monitor the patient's condition. We believe the types of
services provided as part of the subsequent visits included in the
codes are similar to the office and other outpatient visits currently
on the list of Medicare telehealth services. Therefore, we believe
these services would meet the criteria set forth in Category 1 of the
process for adding services described above. However, we do not believe
the complete assessment aspect of the MCP G codes is similar to
existing telehealth services. For example, one aspect of a complete
assessment would involve examination of the vascular access site. This
is a specific clinical examination that is not similar to other
services on the list.
Therefore, we consider the request for addition of the complete
assessment to the list of telehealth services to be a Category 2
request, requiring comparative analyses. In submitting their requests
for addition to the list of Medicare telehealth services, the
requestors included summaries of many studies related to renal dialysis
patient monitoring. However, we do not believe the requestor provided
comparative analyses illustrating that the use of a telecommunications
system is an adequate substitute for the clinical examination of the
vascular access site. We do not believe that the use of a
telecommunications system is an adequate method for conducting a
complete assessment of the ESRD beneficiary. We believe that a clinical
examination of the vascular access site can be adequately performed
only with a face-to-face, ``hands on'' examination of the patient.
However, we do believe the subsequent visits meet the criteria for
approving a Category 1 request. That is, we believe the roles and
interactions between the patient and the physician (or practitioner)
are similar to those of office and other outpatient visits currently on
the telehealth list. This presents a unique scenario, wherein a portion
of the services represented by the MCP G codes are eligible to add to
the list, but one service (the complete assessment) is not. To address
this issue, we propose to add the ESRD-related services with 2 or 3
visits per month and ESRD-related services with 4 or more visits per
month as described by G0308, G0309, G0311, G0312, G0314, G0315, G0317,
G0318 to the list of Medicare telehealth services. However, the
complete assessment of the ESRD
[[Page 47512]]
beneficiary would not be permitted through the use of a
telecommunications system. A comprehensive visit including a clinical
examination of the vascular access site must be furnished face-to-face
``hands on'' by a physician, clinical nurse specialist, nurse
practitioner, or physician's assistant. An interactive
telecommunications system may be used for providing additional visits
required under the 2-to-3 visit MCP and the 4-or-more visit MCP.
As noted previously, the MCP G codes are unique in that they
reflect the ongoing care provided to ESRD patients by the physician or
practitioner, on a monthly basis. These codes also reflect a range of
services, from a monthly comprehensive assessment to monitoring the
patient's overall condition and addressing individual issues and
concerns as they arise during the month. We believe these codes are
distinguishable from other codes by the scope of services and the
ongoing nature of the services provided. Therefore, we believe that it
would be appropriate to permit the use of a telecommunications system
for providing some of the visits required under the ESRD MCP and to add
these codes to the list of Medicare telehealth services.
The MCP physician, for example, the physician or practitioner who
provided the complete assessment, and other practitioners within the
same group practice or employed by the same employer/entity, may
furnish ESRD-related visits through a telecommunications system.
However, the physician or practitioner who performs the complete
assessment and establishes the plan of care should bill for the MCP in
any given month.
Clinical Criteria--The complete assessment visit must be conducted
face-to-face. For subsequent visits, the physician or practitioner at
the distant site is required, at a minimum, to use an interactive audio
and video telecommunications system that allows the physician or
practitioner to provide medical management services for a maintenance
dialysis beneficiary. For example, an ESRD visit conducted via
telecommunications system must permit the physician or practitioner at
the distant site to perform an assessment of whether the dialysis is
working effectively and whether the patient is tolerating the procedure
well (physiologically and psychologically). During this assessment, the
physician or practitioner at the distant site must be able to determine
whether alteration in any aspect of the beneficiary's prescription is
indicated, due to such changes as the estimate of the patient's dry
weight.
Clarification on originating sites--The statute currently defines a
telehealth originating site as a physician's or practitioner's office,
hospital, critical access hospital, rural health clinic, or Federally-
qualified health center. ESRD facilities are not originating sites
(dialysis facilities are not defined in the statute as originating
sites). Subsequent visits (other than the comprehensive assessment) in
any of the statutorily-covered settings could be provided via
telecommunications equipment, including a physician's satellite office
within a dialysis center. Adding dialysis facilities to the list of
Medicare telehealth originating sites would require a legislative
change.
Speech and Audiologist Services
The American Speech-Language Hearing Association (ASHA) requested
that we add 36 audiology services (CPT code range 92541 through 92596)
and 30 speech language pathology (SLP) services (CPT code range 31575
through 97703) to the list of Medicare telehealth services. The ASHA
believes the cognitive nature of these services makes them well-suited
for telehealth and noted several telehealth programs that have been
successful at providing SLP and audiology services. For example,
existing telehealth networks were cited as successfully providing
diagnosis, treatment, and management recommendations for patients with
speech language and hearing disorders.
CMS Review
Speech language pathologists and audiologists are not permitted
under current law to provide and receive payment for Medicare
telehealth services at the distant site. The statute permits only a
physician, as defined by section 1861(r) of the Act or a practitioner
as described in section 1842(b)(18)(C) of the Act (clinical nurse
specialist, nurse practitioner, physician assistant, nurse midwife,
clinical psychologist, and clinical social worker), to furnish Medicare
telehealth services. We are exploring this issue as part of a report to
Congress (required by section 223(d) of BIPA) on additional sites and
settings, geographic areas, and practitioners that may be reimbursed
for the provision of telehealth services. At this time, we are not
adding speech and audiology services to the list of Medicare telehealth
services.
Case Management and Care Plan Oversight (Team Conferences and Physician
Supervision)
Two requests were submitted asking that we add medical team
conferences as identified by CPT codes 99361 and 99362 and physician
supervision (CPT codes 99374 and 99375) as telehealth services.
Requestors stated that for these services, the use of a
telecommunications system provides interdisciplinary medical teams
serving remote underserved populations better access to the clinical
expertise and decision making of specialty physicians. The requestors
note that the current list of Medicare telehealth services, for
example, consultations or office visits, cannot be used for case
management and care plan oversight services because the patient is not
typically present.
CMS Review
Medical team conferences and monthly physician supervision are
already covered Medicare services and do not require a face-to-face
encounter with the beneficiary. Under the Medicare program, the use of
a telecommunications system in furnishing a telehealth service is a
substitution for the face-to-face requirements of a service. Since
medical team conferences and monthly physician supervision do not
require a face-to-face encounter with the patient, we cannot add these
services to the list of Medicare telehealth services.
Review Summary
For the reasons stated above, we propose to add ESRD-related
services as described by G0308, G0309, G0311, G0312, G0314, G0315,
G0317 and G0318 to the list of Medicare telehealth services.
Moreover, we would add the term ``ESRD-related visits'' to the
definition of Medicare telehealth services at CFR 410.78 and 414.65 as
appropriate.
We do not propose to add any additional services discussed above to
the list of Medicare telehealth services for CY 2005.
3. National Pricing of G0238 and G0239 Respiratory Therapy Service
Codes
[If you choose to comment on issues in this section, please include the
caption ``CODING--RESPIRATORY THERAPY'' at the beginning of your
comments.]
In the 2001 final rule, we created three G codes for respiratory
therapy services: G0237 Therapeutic procedures to increase strength or
endurance of respiratory muscles, face-to-face, one-on-one, each 15
minutes (includes monitoring), G0238 Therapeutic procedures to improve
[[Page 47513]]
respiratory function, other than ones described by G0237, one-on-one,
face-to-face, per 15 minutes (includes monitoring) and G0239
Therapeutic procedures to improve respiratory function or increase
strength or endurance of respiratory muscles, two or more individuals
(includes monitoring).
We assigned RVUs to one of the codes (G0237), and indicated that
the other two codes (G0238 and G0239) would be carrier-priced. Since
the services represented by these codes are frequently being performed
in comprehensive outpatient rehabilitation facilities, and paid under
the physician fee schedule through fiscal intermediaries, there has
been some uncertainty surrounding the payment for the carrier-priced
services. We believe assigning RVUs to G0238 and G0239 would alleviate
some of this uncertainty. Since these services are typically performed
by respiratory therapists, no physician work was assigned to G0237, and
we are not proposing work RVUs for either G0238 or G0239.
Therefore, we are proposing to value these services using the
nonphysician workpool.
We propose practice expense RVUS for G0238 equal to those for
G0237. While these codes represent two different types of activities
(G0237 involves therapeutic procedures specifically targeted at
improving the strength and endurance of respiratory muscles such as
pursed-lip breathing, diaphragmatic breathing, and paced breathing, and
G0238 involves other activities such as teaching patients strategies
for performing tasks with less respiratory effort and the performance
of graded activity programs to increase endurance and strength of upper
and lower extremities), we believe that the practice expense involved
is substantially the same for both services and thus, propose to
crosswalk the practice expense RVUs for G0237 to G0238.
G0239 represents situations in which two or more individuals are
receiving services simultaneously (such as those described above in
G0237 or G0238) during the same time period. Although the practitioner
must be in constant attendance, he or she need not be providing one-on-
one patient contact. For G0239, we believe a typical group session to
be 30 minutes in length and to consist of 3 patients. Therefore, for
the practice expense RVUs for G0239, we will use the practice expense
RVUs of G0237 reduced by one-third to account for the fact that the
service is being provided to more than one patient simultaneously and
each patient in a group can be billed for the services of G0239.
We also propose a malpractice RVU of 0.02, the malpractice RVU
assigned to G0237, for these two G codes.
4. Bone Marrow Aspiration and Biopsy Through the Same Incision on the
Same Date of Service
[If you choose to comment on issues in this section, please include the
caption ``CODING--BONE MARROW ASPIRATION'' at the beginning of your
comments.]
In the physician fee schedule final rule published on June 28, 2002
(67 FR 43864), we proposed creation of a new G-code that reflects a
bone marrow biopsy and aspiration procedure performed on the same date,
at the same encounter, through the same incision. While some commenters
were supportive of this proposal, other commenters felt that creation
of a G-code was unnecessary and that any concerns with respect to
payment could be addressed through application of the multiple
procedure payment rules. In a final rule published on December 31, 2002
(67 FR 79992), we agreed that the code should go through the CPT
process and did not make our proposal final.
To date, CPT has not addressed the issue. Therefore, we are
proposing to create a G-code for this service in 2005. We believe that
there is minimal incremental work associated with performing the second
procedure through the same incision during a single encounter and are
proposing an add-on G-code to reflect the additional physician work and
practice expense. As we had stated in our previous proposal, if the two
procedures, aspiration and biopsy, are performed at different sites
(for example, contralateral iliac crests, sternum/iliac crest or two
separate incisions on the same iliac crest), the -59 modifier, which
denotes a distinct procedural service, would be appropriate to use and
Medicare's multiple procedure rules would apply. In this instance, the
CPT codes for aspiration and biopsy would each be used.
G0XX1: Bone Marrow Aspiration Performed With Bone Marrow Biopsy Through
Same Incision on Same Date of Service, Add-On
The code would be used when a bone marrow aspiration and a bone
marrow biopsy are performed on the same day through a single incision.
The physician would use the CPT code for bone marrow biopsy (38221) and
G0XX1 for the second procedure (bone marrow aspiration).
Based on our estimation that the time associated with this G-code
is approximately 5 minutes and based on a comparison to CPT code 38220
which has 34 minutes of intraservice time and a work RVU of 1.08 work,
we are proposing 0.16 work RVUs for this proposed G-code. The proposed
malpractice RVUs are 0.04 which are the current malpractice RVUS
assigned to CPT code 38220. We are proposing the following practice
expense inputs:
--Clinical staff time: Registered nurse--5 minutes
Lab technician--2 minutes
--Equipment: Exam table
We are also proposing a ZZZ global period for this add-on code
since this code is related to another service and is included in the
global period of the other service.
5. Q Code for the Set-Up of Portable X-Ray Equipment
The Q-code for the set-up of portable x-ray equipment, Q0092, is
currently paid under the physician fee schedule and is assigned an RVU
of 0.33. In 2004, this produces a national payment of $12.32. This set-
up code encompasses only a portion of the resources required to provide
a portable x-ray service to patients. In 2003, portable x-ray suppliers
received total Medicare payments of approximately $208 million. More
than half of these payments (approximately $116 million) were for
portable x-ray transportation (codes R0070 and R0075). The portable x-
ray set-up code (Q0092) generated approximately $19 million in
payments. The remainder of the Medicare payments for portable x-ray
services (approximately $73 million) were for the actual x-ray services
themselves.
Between 2002 and 2004, the Medicare carriers increased the average
amount paid for portable x-ray transportation across the country from
about $89 to $112, an increase of about 25 percent (transportation is
carrier-priced). Nonetheless, the Conference Report accompanying the
Consolidated Appropriations Bill, HR 2673 (Pub. L. 108-199, enacted
January 23, 2004), urged the Secretary to review and update the RVUs
for Q0092 utilizing existing data.
In 2002, the National Association of Portable X-ray Providers had
requested that we use their cost data to develop practice expense RVUs
for the physician fee schedule services they provide. We asked the
Lewin Group to evaluate the data using the same standards of review
applied to other specialty survey data. The Lewin Group found that the
data as presented were not adequately detailed
[[Page 47514]]
to calculate a practice expense per hour based on the current practice
expense methodology. Therefore, we did not use the data. However, in
response to ongoing requests from the portable x-ray industry that we
reexamine payments for this code, we have reevaluated this code.
This code is currently priced in the nonphysician work pool.
Removing this code from the nonphysician work pool has an overall
negative impact on payments to portable x-ray suppliers (as a result of
decreases to radiology codes that remain in the nonphysician work pool)
and has a negative impact on many of the codes remaining in the
nonphysician workpool. An alternative to national pricing of portable
x-ray set-up would be to require Medicare carriers to develop local
pricing as they do currently for portable x-ray transportation. In
2002, we received a comment from a supplier of portable x-rays stating
that the practice costs associated with set-up of portable x-ray
equipment are not included in the Socioeconomic Monitoring System (SMS)
and that there are sufficient differences among geographic regions in
the performance of this procedure that warrant reclassifying this
service as carrier-priced. We are interested in public comments on
whether we should pursue national pricing for portable x-ray set-up
outside of the nonphysician work pool or local carrier pricing for 2005
or whether we should continue to price the service in the nonphysician
workpool.
6. Venous Mapping for Hemodialysis
We are proposing to create a new G-code (G0XX3: Venous mapping for
hemodialysis access placement (Service to be performed by operating
surgeon for preoperative venous mapping prior to creation of a
hemodialysis access conduit using an autogenous graft). Autogenous
grafts have longer patency rates, a lower incidence of infection and
greater durability than prosthetic grafts. Use of autogenous grafts can
also result in a decrease in hospitalizations and morbidity related to
vascular access complications. Creation of this G-code will enable us
to distinguish between CPT code 93971 (Duplex scan of extremity veins
including responses to compression and other maneuvers; unilateral or
limited study) and G0XX3. This new code will allow us to track use of
venous mapping for quality improvement purposes.
This G code would only be billed by the operating surgeon in
conjunction with the following CPT codes: 36819, 36821, 36825, and
36832. Because CPT code 93971 and the new G-code would be used to
describe a similar service, we would propose that we not permit payment
for CPT code 93971 when this G-code is billed, unless code 93971 were
being performed for a separately identifiable clinical indication in a
different anatomic region.
The physician work, practice expense and professional liability
expense for this new G code would be the same as those for CPT code
93971. Thus, we propose to crosswalk the RVUs for the new G-code from
those of CPT code 93971. We would also assign this new G-code a global
period of ``XXX'', which means that the global concept does not apply.
III. Provisions of the Medicare Modernization Act of 2003
A. Section 611--Initial Preventive Physical Examination
[If you choose to comment on issues in this section, please include the
caption ``Section 611'' at the beginning of your comments.]
1. Coverage of Initial Preventive Physical Examinations
Section 611 of the MMA provides for coverage under Part B of an
initial preventive physical examination for new beneficiaries,
effective for services furnished on or after January 1, 2005, subject
to certain eligibility and other limitations.
Previously, Medicare law had not allowed for payment for routine
physical examinations or checkups. Section 1862(a)(7) of the Act states
that routine physical checkups are excluded services. This exclusion is
described in Sec. 411.15(a) (Particular services excluded from
coverage). In addition, we have interpreted section 1862(a)(1)(A) of
the Act to exclude coverage for preventive physical examinations. This
section provides that items and services must be reasonable and
necessary for the diagnosis or treatment of illness or injury or to
improve the functioning of a malformed body member as stated in Sec.
411.15(k). Since preventive services are not provided for diagnosis or
treatment of illness, injury, or malformation, we determined that these
services are not reasonable and necessary within the meaning of the
statute.
To conform the regulations to the MMA, we are specifying an
exception to the list of examples of routine physical examinations
excluded from coverage in Sec. 411.15(a)(1) and Sec. 411.15(k)(11)
for initial preventive physical examinations that meet the eligibility
limitation and the conditions for coverage that we are specifying under
Sec. 410.16--Initial Preventive Physical Examinations.
Coverage of initial preventive physical examinations is provided
under Medicare Part B only. The MMA permits payment for one initial
preventive physical examination within the first 6 months after the
effective date of the beneficiary's first Part B coverage period, but
only if that coverage period begins on or after January 1, 2005.
We are proposing to add Sec. 410.16(b), Condition for Coverage of
Initial Preventive Physical Examinations, and Sec. 410.16(c),
Limitation on Coverage of Initial Preventive Physical Examinations, to
provide for coverage of the various initial preventive physical
examination services specified in the statute.
We are proposing to define several terms, as described specifically
in Sec. 410.16, that would be used in implementing the statutory
provisions, including definitions of the following terms--
(1) Eligible beneficiary;
(2) An initial preventive physical examination;
(3) Medical history;
(4) Physician;
(5) Qualified nonphysician practitioner.
(6) Social history;
(7) Review of the individual's functional ability and level of
safety;
Section 611 of the MMA defines an ``initial preventive physical
examination'' to mean physicians' and certain qualified nonphysician
practitioners' services consisting of--
(1) A physical examination (including measurement of height,
weight, blood pressure, and an electrocardiogram, but excluding
clinical laboratory tests) with the goal of health promotion and
disease detection; and
(2) Education, counseling, and referral with respect to screening
and other covered preventive benefits separately authorized under
Medicare Part B.
Specifically, section 611(b) of the MMA provides that the
education, counseling, and referral of the individual by the physician
or other qualified nonphysician practitioner should be with respect to
the following statutory screening and other preventive services
authorized under Medicare Part B:
(1) Pneumococcal, influenza, and hepatitis B vaccine and their
administration.
(2) Screening mammography.
(3) Screening pap smear and screening pelvic exam services.
(4) Prostate cancer screening services.
(5) Colorectal cancer screening tests.
(6) Diabetes outpatient self-management training services;
[[Page 47515]]
(7) Bone mass measurements.
(8) Screening for glaucoma.
(9) Medical nutrition therapy services for individuals with
diabetes or renal disease.
(10) Cardiovascular screening blood tests.
(11) Diabetes screening tests.
Based on the language of the statute, our review of the medical
literature, current clinical practice guidelines, and United States
Preventive Services Task Force recommendations, we are proposing to
interpret the term, ``initial preventive physical examination,'' for
purposes of this new benefit to include all of the following:
(1) Review of the individual's comprehensive medical and social
history, as those terms are defined in paragraph (a) of proposed Sec.
410.16.
(2) Review of the individual's potential (risk factors) for
depression (including past experiences with depression or other mood
disorders) based on the use of an appropriate screening instrument
which the physician or other qualified nonphysician practitioner may
select from various available standardized screening tests for this
purpose, unless the appropriate screening instrument is defined through
the national coverage determination (NCD) process.
(3) Review of the individual's functional ability and level of
safety, as described in paragraph (a) of proposed Sec. 410.16, (that
is, at a minimum, a review of the following areas: hearing impairment,
activities of daily living, falls risk, and home safety), based on the
use of an appropriate screening instrument, which the physician or
other qualified nonphysician practitioner may select from various
available standardized screening tests for this purpose, unless the
appropriate screening instrument is further defined through the NCD
process.
(4) An examination to include measurement of the individual's
height, weight, blood pressure, a visual acuity screen, and other
factors as deemed appropriate by the physician or qualified
nonphysician practitioner, based on the individual's comprehensive
medical and social history and current clinical standards.
(5) Performance and interpretation of an electrocardiogram.
(6) Education, counseling, and referral, as appropriate, based on
the results of the previous five elements of the initial preventive
physical examination.
(7) Education, counseling, and referral, including a written plan
provided to the individual for obtaining the appropriate screening and
other preventive services, which are separately covered under Medicare
Part B benefits; that is, pneumococcal, influenza, and hepatitis B
vaccines and their administration, screening mammography, screening pap
smear and screening pelvic exams, prostate cancer screening tests,
diabetes outpatient self-management training services, bone mass
measurements, screening for glaucoma, medical nutrition therapy
services, cardiovascular screening blood tests, and diabetes screening
tests.
We are requesting public comments on the definition of the term
``initial preventive physical examination.'' For example, we have
chosen not to define the term, ``appropriate screening instrument,''
for screening individuals for depression, functional ability, and level
of safety, as specified in the proposed rule, because we anticipate
that the examining physician or qualified nonphysician practitioner
will want to use the test of his or her choice, based on current
clinical practice guidelines. We believe that any standardized
screening test for depression, functional ability, and level of safety
recognized by the American Academy of Family Physicians, the American
College of Physicians-American Society of Internal Medicine, the
American College of Preventive Medicine, the American Geriatrics
Society, the American Psychiatric Association, or the United States
Preventive Services Task Force, or other recognized medical
professional group, would be acceptable for purposes of meeting the
``appropriate screening instrument'' provision. We ask that commenters
making specific recommendations on this or any related issue provide
documentation from the medical literature, current clinical practice
guidelines, or the United States Preventive Services Task Force
recommendations.
We recognize that the NCD process could be used to define more
specifically the type or types of appropriate screening instruments for
depression, functional ability, or level of safety and propose to
include in Sec. 410.16(a) in elements (2) and (3) of the definition of
an initial preventive physical examination a reference that would allow
us to define these screening instruments more specifically through the
national coverage determination (``NCD'') process. The NCD process
would include an opportunity for public comment on the medical and
scientific issues related to the coverage of the new tests that may be
brought to our attention in the future. Use of an NCD to establish a
change in the scope of benefits is authorized by section 1871(a)(2) of
the Act.
2. Payment for Initial Preventive Physical Examination
There is no current CPT code that contains the specific elements
included in the initial preventive examination. Therefore, we are
proposing to establish the following new HCPCS code, G0XX2, Initial
preventive physical examination, to be used for billing for the initial
preventive examination. As required by the statute, this code includes
an electrocardiogram, but does not include the other previously
mentioned preventive services that are currently separately covered and
paid under the Medicare Part B screening benefits. When these other
preventive services are performed, they should be identified using the
existing appropriate codes.
a. Basis for Payment
Payment for this new HCPCS code will be based on the following:
1. Work RVUs--We are proposing a work value of 1.51 RVUs for G0XX2.
This value is based on our determination that this new service has
equivalent resources and work intensity to those contained in CPT E/M
code 99203, new patient, office or other outpatient visit, and CPT code
93000 electrocardiogram, complete. CPT code 99203 has a work RVU of
1.34 and requires a detailed history, detailed examination, and medical
decision making of low complexity, which we believe to be
representative of the elements contained in the initial preventive
health examination. CPT code 93000, which is for a routine ECG with the
interpretation and report, has a work RVU of 0.17.
2. Malpractice RVUs--For the malpractice component of G0XX2, we are
proposing malpractice RVUs of 0.13 in the nonfacility setting based on
the malpractice RVUs currently assigned to CPT code 99203 (0.10) and
CPT code 93000 (0.03). In the facility setting, we are proposing
malpractice RVUs of 0.11 based on the current malpractice RVUs assigned
to CPT code 99203 (0.10) and 93010 (an EKG interpretation with a value
of 0.01).
3. Practice Expense RVUs--For the practice expense component of
G0XX2, we are proposing practice expense RVUs of 1.65 in the
nonfacility setting based on the practice RVUs assigned to CPT code
99203 (1.14) and CPT code 93000 (0.51). In the facility setting, we are
proposing practice expense RVUs of 0.54 based on the practice RVUs
assigned to CPT code 99203 (0.48) and 93010 (0.06).
[[Page 47516]]
b. Evaluation and Management (E/M) Service
Since some of the components for a medically necessary E/M visit
are reflected in this new HCPCS code, we are also proposing, when it is
appropriate, to allow a medically necessary E/M service no greater than
a level 2 to be reported at the same visit as the initial preventive
physical examination. That portion of the visit must be medically
necessary to treat the patient's illness or injury or to improve the
function of a malformed body member and should be reported with
modifier -25. The physician or qualified nonphysician practitioner
could also bill for the screening and other preventive services
currently covered and paid by Medicare Part B under separate provisions
of section 1861 of the Act, if provided during this initial preventive
physical examination.
c. Coinsurance and Part B Deductible
MMA did not make any provision for the waiver of the Medicare
coinsurance and Part B deductible for the initial preventive physical
examination. Payment for this service would be applied to the required
deductible, which is $110 for CY 2005, if the deductible has not been
met, and the usual coinsurance provisions would apply.
B. Section 613--Diabetes Screening Tests
[If you choose to comment on issues in this section, please include the
caption ``Section 613'' at the beginning of your comments.]
Section 613 of the MMA adds section 1861(yy) to the Act and
mandates coverage of diabetes screening tests.
The term ``diabetes screening tests'' is defined in section 613 as
testing furnished to an individual at risk for diabetes including a
fasting plasma glucose test and such other tests, and modifications to
tests, as the Secretary determines appropriate, in consultation with
appropriate organizations. In compliance with this directive, we
consulted with the American Diabetes Association, the American
Association of Clinical Endocrinologists, and the National Institute
for Diabetes and Digestive and Kidney Diseases.
1. Coverage
We are proposing in Sec. 410.18 that Medicare cover--
A fasting plasma glucose test; and
Post-glucose challenge tests; either an oral glucose
tolerance test with a glucose challenge of 75 grams of glucose for
nonpregnant adults, or a 2-hour post-glucose challenge test alone.
We would not include a random serum or plasma glucose for persons
with symptoms of uncontrolled diabetes such as excessive thirst or
frequent urination in this benefit because it is already covered as a
diagnostic service. This language is not intended to exclude other
post-glucose challenge tests that may be developed in the future,
including panels that may be created to include new diabetes and lipid
screening tests. We also would include language that would allow
Medicare to cover other diabetes screening tests, subject to a NCD
process. We are requesting comments regarding the specific tests,
definitions, and eligibility criteria. The comments that we receive
will also be used to create the list of billing codes for covered tests
and diagnosis codes that would be published in instructions for
Medicare contractors.
The statutory provision describes an ``individual at risk for
diabetes'' as having any of the following risk factors:
1. Hypertension.
2. Dyslipidemia.
3. Obesity, defined as a body mass index greater than or equal to
30 kg/m2.
4. Previous identification of an elevated impaired fasting glucose.
5. Previous identification of impaired glucose tolerance.
6. A risk factor consisting of at least two of the following
characteristics:
(a) Overweight, defined as a body mass index greater than 25 kg/m2,
but less than 30.
(b) A family history of diabetes.
(c) A history of gestational diabetes mellitus or delivery of a
baby weighing greater than 9 pounds.
(d) 65 years of age or older.
The statutory language directs the Secretary to establish standards
regarding the frequency of diabetes screening tests that will be
covered and limits the frequency to no more than twice within the 12-
month period following the date of the most recent diabetes screening
test of that individual.
We are proposing that Medicare beneficiaries diagnosed with ``pre-
diabetes'' be eligible for the maximum frequency allowed by the
statute, that is, 2 screening tests per 12 month period. We propose to
define ``pre-diabetes'' as a previous fasting glucose level of 100-125
mg/dL, or a 2-hour post-glucose challenge of 140-199 mg/dL. This
definition of ``pre-diabetes'' was developed with the assistance of the
American Association of Clinical Endocrinologists and complements the
definition of diabetes that we published November 7, 2003 (68 FR
63195). We are specifically asking for comments regarding our new
definition of ``pre-diabetes.'' We are also requesting suggestions for
the definition of ``a family history of diabetes.''
For individuals not meeting the ``pre-diabetes'' criteria, we are
proposing that one diabetes screening test be covered per individual
per year.
2. Payment
We are proposing to pay for the screening diabetes tests at the
same amounts paid for these tests when performed to diagnose an
individual with signs and symptoms of diabetes. We would pay for these
tests under the clinical laboratory fee schedule. We propose to pay for
these tests under CPT code 82947 Glucose; quantitative, blood (except
reagent strip) and CPT code 82951 Glucose; tolerance test (GTT), three
specimens (includes glucose). To indicate that the purpose of the test
is for diabetes screening, we would require that the laboratory include
a screening diagnosis code in the diagnosis section of the claim. We
propose V77.1 Special screening for diabetes mellitus as the applicable
ICD-9--CM code for this purpose. Because laboratories are required and
accustomed to submitting diagnosis codes when requesting payment for
testing, we believe including a screening diagnosis code is appropriate
for this benefit.
C. Section 612--Cardiovascular Screening Blood Tests
[If you choose to comment on issues in this section, please include the
caption ``Section 612'' at the beginning of your comments.]
Section 612 of the MMA provides for Medicare coverage of cardiovascular
screening blood tests for the early detection of cardiovascular disease
or abnormalities associated with an elevated risk for that disease
effective on or after January 1, 2005.
1. Coverage
The Act requires coverage of tests for cholesterol and other lipid
or trigylcerides levels for this purpose. It also authorizes the
Secretary to approve coverage of other screening tests for other
indications associated with cardiovascular disease or an elevated risk
for that disease, including indications measured by noninvasive
testing, if the United States Preventive Services Task Force (USPSTF)
recommended a blood test for that indication.
We invited comments about the types of tests from the American
College of Physicians/ American Society of Internal Medicine, the
American College of Cardiology, American Academy of
[[Page 47517]]
Family Physicians, American Heart Association, College of American
Pathologists, American Society for Clinical Laboratory Science,
American Society for Clinical Pathologists, American Association for
Clinical Chemistry, and the American Clinical Laboratory Association.
Comments were received from the American Heart Association, American
Academy of Family Physicians, the American Association for Clinical
Chemistry, American Society for Clinical Laboratory Science, the
National Kidney Foundation, and the Vascular Disease Foundation,
regarding the coverage of a number of cardiovascular screening tests in
addition to the required blood lipid tests; for example, high
sensitivity C-Reactive Protein (CRP), homocysteine, or Beta Naturetic
Protein (BNP), electrocardiograms, Doppler and noninvasive vascular
tests, and a skin reflectance test.
We also reviewed the following 2001 recommendations of the USPSTF
regarding screening for lipid disorders that are associated with
cardiovascular disease:
a. Clinicians should routinely screen men aged 35 years and older
and women aged 45 years and older for lipid disorders and treat
abnormal lipids in people who are at increased risk.
b. Clinicians should routinely screen younger adults (men aged 20
to 35 and women aged 20 to 45) for lipid disorders if they have other
risk factors for coronary heart disease.
c. No recommendation was made for or against routine screening for
lipid disorders in younger adults (men aged 20 to 35 or women aged 20
to 45) in the absence of known risk factors for coronary heart disease.
d. Screening for lipid disorders should include measurement of
total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-
C).
e. Evidence is insufficient to recommend for or against
trigylcerides measurement as a part of routine screening for lipid
disorders.
Based on the statutory language and our review of the scientific
literature, expert opinion, and the USPSTF recommendations, we are
proposing coverage of the following three screening blood tests for
conditions associated with cardiovascular disease:
(1) A total cholesterol test.
(2) A cholesterol test for high density lipoproteins.
(3) A triglycerides test.
These tests should be performed as part of a panel and should be
done after a 12-hour fast. We are also proposing coverage of each of
these tests once every 5 years. The statute provides that the Secretary
shall establish frequency standards for the coverage of cardiovascular
screening blood tests, provided the frequency is no more often than
once every 2 years. However, the scientific literature shows that
cholesterol levels are fairly stable and do not fluctuate drastically
for those older than age 65. The USPSTF clinical considerations
indicate that, while screening may be appropriate in older people,
repeated screening is less important because lipid levels are less
likely to increase after age 65. Under the USPSTF recommendations,
routine measurement of total cholesterol and HDL cholesterol every 5
years is recommended by the National Cholesterol Education program
Adult Treatment Panel II (ATP II), sponsored by the National Institutes
of Health, and endorsed by the American Heart Association. In addition,
the most recent Report of the Adult Treatment Panel (ATP III) includes
similar recommendations. In all adults aged 20 years or older, a
fasting lipoprotein profile (total cholesterol, LDL cholesterol, high
density lipoprotein (HDL) cholesterol, and triglyceride) should be
obtained once every 5 years. Since the LDL cholesterol can be
calculated, the remaining tests, which are part of the lipid panel, are
the tests we are proposing for coverage under this new benefit at a 5-
year screening interval. We do not believe the evidence justifies or
the statute allows for coverage of other cardiovascular screening blood
tests at this time.
To facilitate our consideration of future coverage of other new
types of cardiovascular screening blood tests, we have decided to add a
provision to this proposed regulation that, in addition to the specific
cardiovascular screening blood tests proposed for coverage in this
proposed rule, would provide that other types of these tests may be
covered under this new screening benefit, if we determine that this is
appropriate through a National Coverage Determination (NCD). This
provision would allow us to conduct a more timely assessment of other
new types of cardiovascular screening blood tests that may have been
approved for marketing by the Food and Drug Administration and
recommended by the USPSTF than is possible under the standard
rulemaking process. We intend to use the NCD process, which includes an
opportunity for public comments, for evaluating the medical and
scientific issues relating to the coverage of additional tests that may
be brought to our attention in the future. Use of an NCD to establish a
change in the scope of benefits is authorized by section 1871(a)(2) of
the Act. These proposed coverage requirements are set forth in new
section Sec. 410.17.
2. Payment
Section 612 of the MMA provides for Medicare coverage of
cardiovascular screening blood tests for the early detection of
cardiovascular disease or abnormalities associated with an elevated
risk for cardiovascular disease. The coverage is effective on or after
January 1, 2005. We are proposing to pay for the screening
cardiovascular disease tests at the same amounts paid for these tests
when they are performed to diagnose an individual with signs and
symptoms of cardiovascular disease. Medicare would pay for the tests
under the clinical laboratory fee schedule. We propose to use the
following CPT codes:
82465 Cholesterol, serum or whole blood, total.
83718 Lipoprotein, direct measurement; high density
cholesterol (HDL cholesterol).
84478 Triglycerides.
80061 Lipid Panel.
To indicate that the purpose of the test is for cardiovascular
screening, we propose that the laboratory include in the diagnosis
section of the claim the diagnosis code that provides the highest
degree of accuracy and completeness in describing the diagnosis. We
propose that the applicable ICD-9-CM codes for cardiovascular screening
blood tests be selected from the following:
V81.0 Special screening for ischemic heart disease.
V81.1 Special screening for Hypertension.
V81.2 Special screening for other and unspecified
cardiovascular conditions.
Because laboratories are required and accustomed to submitting
diagnosis codes when requesting payment for testing, we believe
including a screening diagnosis code for this purpose will not be
unduly burdensome to them.
D. Section 413--Physician Scarcity Areas and Health Professional
Shortage Areas Incentive Payments
[If you choose to comment on issues in this section, please include the
caption ``Section 413'' at the beginning of your comments.]
1. Background
Section 4043 of the Omnibus Budget Reconciliation Act (OBRA) of
1987 added section 1833(m) to the Act to provide incentive payments to
physicians who furnish services to
[[Page 47518]]
Medicare beneficiaries in Health Professional Shortage Areas (HPSAs).
Under section 1833(m) of the Act, a 5 percent payment was added,
beginning January 1, 1989, to the amounts otherwise payable under the
physician fee schedule to doctors who furnish covered services to
Medicare patients in designated HPSAs. Section 6102 of OBRA 1989
further amended section 1833 of the Act to raise the amount of this
incentive payment from 5 percent to 10 percent for services furnished
after December 31, 1990. The OBRA 1989 amendment also increased
eligible service areas to include both rural and urban HPSAs. The
Congress established the HPSA incentive payments as incentives to
attract new physicians to medically underserved communities and to
encourage physicians in those areas to remain there.
Eligibility for receiving the 10 percent incentive payment is based
on whether the specific location at which the service is furnished is
within an area that is designated (under section 332(a)(1)(A) of the
Public Health Service Act (PHS)) as a HPSA. The Health Resources and
Services Administration of the Department of Health and Human Services
(HRSA) is responsible for designating shortage areas. HRSA designates
several types of HPSAs. Some HPSAs are areas with shortages of primary
care physicians, dentists, or psychiatrists. These shortage
designations are referred to as geographic-based HPSAs. Also, there are
HPSA designations based on underserved populations within an area,
which are referred to as population-based HPSAs.
Section 1833(m) of the Act provides incentive payments for
physicians who furnish services in areas designated as HPSAs under
section 332(a)(1)(A) of the PHS Act. These include all three types of
geographic-based HPSAs (primary medical care, dental, and mental
health). Consequently, physicians, including psychiatrists, furnishing
services in a primary medical care HPSA are eligible to receive bonus
payments. Medicare HPSA bonus payments apply to all physicians who
perform covered services within a primary medical care HPSA, regardless
of specialty. In addition, psychiatrists furnishing services in mental
health HPSAs are eligible to receive incentive payments. We do not
recognize dental HPSAs for the Medicare HPSA payment program because
Medicare does not cover general dental services for its beneficiaries.
Since the inception of the Medicare HPSA incentive payment program,
physicians have been responsible for indicating their eligibility for
the incentive payment on the Medicare billing form. To facilitate the
verification of eligibility, physicians have been notified by their
Medicare carriers when changes (withdrawals, revisions, or
replacements) occur in HPSA designations. Using this information from
carriers, physicians have been required to verify their eligibility and
correctly code their Medicare claims using modifiers (QB for rural
HPSAs and QU for urban HPSAs) to receive incentive payments.
2. New Legislation
a. Physician Scarcity Areas
Section 413(a) of the MMA, provides a new 5 percent incentive
payment to physicians furnishing services in physician scarcity areas.
The MMA adds a new section 1833(u) of the Act which provides for paying
primary care physicians furnishing services in a primary care scarcity
county and specialty physicians furnishing services in a specialist
care scarcity county, an additional amount equal to 5 percent of the
amount paid for these services. Eligible physicians furnishing services
in an area qualified as a physician scarcity area (PSA) and HPSA would
be entitled to receive both incentive payments, that is, a 15 percent
bonus payment. Eligibility for receiving both incentive payments is
time limited (January 1, 2005 to January 1, 2008) because the 5 percent
PSA bonus is scheduled to sunset on December 31, 2007.
The Congress created the new 5 percent incentive payment program to
make it easier to recruit and retain both primary and specialist care
physicians for furnishing services to Medicare beneficiaries in PSAs.
The two measures of physician scarcity are defined by the statute
as follows:
1. The primary care scarcity areas are determined by the ratio of
primary care physicians to Medicare beneficiaries.
2. The specialist care scarcity areas are determined by the ratio
of specialty care physicians to Medicare beneficiaries.
i. Primary Care
Consistent with section 1833(u) of the Act, we would identify
eligible primary care scarcity counties by ranking each county by its
ratio of primary care physicians to Medicare beneficiaries. From the
list of primary care scarcity counties, only those counties with the
lowest primary care ratios that represent 20 percent of the total
number of Medicare beneficiaries residing in the counties will be
considered eligible for the 5 percent incentive payment. For
calculating the ratios, section 1833(u)(6) of the Act, as added by the
MMA, defines a primary care physician as a general practitioner, family
practice practitioner, general internist, obstetrician, or
gynecologist. All other physicians will be considered specialists for
purposes of the 5 percent incentive payment. Section 1833(u) of the
Act, as added by the MMA, specifically defines ``physician'' as one
described in section 1861(r)(1) of the Act. This statutory provision
does not include dentists, podiatrists, optometrists, and
chiropractors.
ii. Specialist Care
To identify eligible specialist care scarcity areas, we would rank
each county by its ratio of specialty physicians to Medicare
beneficiaries. From the list of specialist care scarcity counties, only
those counties with the lowest ratios that represent 20 percent of the
total number of Medicare beneficiaries residing in the counties will be
considered eligible for the 5 percent incentive payment.
iii. The Goldsmith Modification
For purposes of counties identified as having a shortage of primary
care or specialty care physicians, section 1833(u)(5) of the Act also
requires that, to the extent feasible, we treat a rural census tract of
a metropolitan statistical area (as determined under the most recent
modification of the Goldsmith Modification) as an equivalent area. The
Goldsmith modification evolved from an outreach grant program sponsored
by the Office of Rural Health Policy of HRSA. This program was created
to establish an operational definition of rural populations lacking
easy access to health services in Large Area Metropolitan Counties
(LAMCs). Dr. Harold F. Goldsmith and his associates created a
methodology for identifying rural census tracts located within a large
metropolitan county of at least 1,225 square miles. Using a combination
of data on population density and commuting patterns, census tracts
were identified as being so isolated by distance or physical features
that they are more rural than urban in character.
iv. Rural-Urban Commuting Area
The original Goldsmith Modification was developed using data from
the 1980 census. In order to more accurately reflect current
demographic and geographic characteristics of the nation, the Office of
Rural Health Policy, in partnership with the Department of
Agriculture's Economic Research
[[Page 47519]]
Service and the University of Washington, developed the Rural-Urban
Commuting Area codes (RUCAs). Rather than being limited to LAMCs, RUCAs
use urbanization, population density, and daily commuting data to
categorize every census tract in the country. RUCAs are the updated
version of the Goldsmith Modification and are used to identify rural
census tracts in all metropolitan counties.
Once all the full county PSAs are determined, we would identify,
consistent with section 1833(u)(4)(C)of the Act, eligible PSAs by their
5-digit zip code area for the purpose of automatically providing the 5
percent incentive payment to eligible physicians. The zip code of the
place of service is the only data element reported on the Medicare
claim form that would allow automation. For zip codes that cross county
boundaries, the statute specifically requires the use of the dominant
county of the postal zip code (as determined by the U.S. Postal
Service) if the Secretary uses the 5-digit postal zip code to identify
areas eligible to receive the 5 percent payment. The statute also
requires us to publish a list of eligible areas as part of the proposed
and final physician fee schedule rules for the years for which PSAs are
identified or revised and to post a list of PSAs on the CMS Website.
Lastly, the statute provides no administrative or judicial review under
sections 1869 or 1878 of the Act or otherwise, regarding the
identification of a county or area, the assignment of a specialty of
any physician, the assignment of a physician to a county, or the
assignment of a postal ZIP Code to a county or other area.
b. Improvement to Medicare HPSA Incentive Payment Program
In addition to the creation of the 5 percent PSA incentive payment,
section 413 of MMA amended section 1833(m) of the Act to mandate that
we automate payment of the 10 percent HPSA incentive payment to
eligible physicians for full county HPSAs without a requirement for the
physician to identify the HPSA involved. When automation is not
feasible, consistent with section 1833(m) of the Act as amended by
section 413(b) of MMA, we plan to post a list of HPSAs on our website.
When automation is not feasible, the billing of modifiers would still
be required.
The statute provides for no administrative or judicial review of
the identification of a county or area, the assignment of the
individual physician's specialty, the assignment of a physician to a
county or the assignment of a zip code to a county or area.
3. Provisions Related to Physician Scarcity Areas and HPSA Incentive
Payment Program
a. Determination of Physician Scarcity Areas
As the statute prescribes, PSAs for primary care would be
determined by the ratio of primary care physicians to the Medicare
beneficiaries residing in that county or area. A primary care physician
is defined by statute as a general practitioner, family practice
practitioner, general internist, obstetrician, or gynecologist. The
physician definition for determining primary care PSAs will be based on
HRSA's physician designations for primary medical care HPSAs, which
include all of the above physicians. In other words, the PSA definition
for primary care will be identical to HRSA's, except for pediatricians.
Furthermore, the statute provides that the primary care ratio include
only primary care doctors in the active practice of medicine.
Physicians whose practice is exclusively for the Federal Government or
who provide only administrative services would not be included in the
physician tally. PSAs for specialty care would be determined by the
ratio of physicians who are not primary care physicians to the Medicare
beneficiaries residing in that county or area. The specialist care PSA
ratio would include all physicians other than primary care physicians
as defined in the statute. To the extent feasible, we also plan to
include rural census tracts of metropolitan statistical areas (as
determined under the most recent modification of the Goldsmith
Modification), as identified at the zip code level, with sufficiently
low physician-to-Medicare population ratios as equivalent to qualified
full county scarcity areas. The calculation of physician scarcity
ratios is being made by the North Carolina Rural Research and Policy
Analysis Center using the most current Medicare beneficiary and
physician data available. At this time, the North Carolina Rural
Research and Policy Analysis Center can only determine physician
scarcity for Goldsmith areas at the zip code level due to the fact that
Medicare beneficiary data is currently unavailable at the census tract
level.
As previously discussed, section 1833(u) of the Act requires the
automation of incentive payments for all PSAs, which we can only
achieve by assigning zip codes to eligible areas. We propose the
identification of qualified PSAs by zip code for automatic payment as
follows:
For zip codes that fall within a full county PSA, the
bonus would be paid automatically.
For full county PSAs, the dominant county of the 5-digit
zip code, as determined by the U.S. Postal Service, would be used when
the zip code area is not entirely located within the county. In some
cases, a service may be provided in a county that is considered to be a
PSA, but the zip code is not considered to be dominant for that area,
which would not permit automation of the bonus payment. In order to
receive the bonus for those areas, physicians would need to include a
new physician scarcity modifier on the claim. We plan to establish and
implement the new modifier through the Medicare Claims Processing
Manual.
For partial county PSAs (Goldsmith Modification), all zip
code areas that are entirely located within the qualified Goldsmith
area and all zip code areas that are partially located within a
qualified Goldsmith area as long as the majority (51 percent) of the
population located within the zip code area resides in the qualified
Goldsmith area would be able to receive automatic payment.
Due to the complex nature of processing available physician and
Medicare beneficiary data into a usable format to identify counties and
areas with the lowest ratios, we cannot make available a list of PSAs
within this proposed rule. We are working closely with HRSA and its
contractors to publish these lists in the physician fee schedule final
rule.
b. Incentive Payments for Physician Scarcity Areas
Similar to the Medicare HPSA bonus payment program, eligibility for
receiving the 5 percent bonus payment would be based on whether the
specific location at which the service is furnished is within an area
that is designated as a PSA. Furthermore, the statute requires us to
restrict eligibility for receiving the incentive payments for
physicians' services furnished within primary care PSAs to general
practitioners, family practice practitioners, general internists,
obstetricians, or gynecologists. Also prescribed by statute, dentists,
podiatrists, optometrists, and chiropractors are not eligible to
receive incentive payments for PSAs. Section 1833(u) of the Act
specifically defines a physician as one described in section 1861(r)(1)
of the Act, which does not include dentists, podiatrists, optometrists,
and chiropractors.
[[Page 47520]]
To conform our regulations to the statute, we are proposing to add
Sec. 414.66 to provide a 5 percent incentive payment to eligible
physicians furnishing covered services in eligible PSAs. We propose to
add Sec. 414.66(a)(1) to specify that primary care physicians
furnishing services in primary care PSAs are entitled to an additional
5 percent incentive payment above the amount paid under the physician
fee schedule for their professional services furnished on or after
January 1, 2005, and before January 1, 2008. The new incentive payment
would apply to the professional services performed by physicians,
including evaluation and management, surgery, consultation, and home,
office and institutional visits. The technical component of physicians'
services is not eligible because this component is not included in the
definition of physicians' services at section 1861(q) of the Act as
applied by the MMA. We are also proposing to add Sec. 414.66(b) to
specify that physicians, other than primary care physicians, dentists,
podiatrists, optometrists, and chiropractors, furnishing services in
specialist care PSAs are entitled to an additional 5 percent payment
above the amount paid under the physician fee schedule for their
professional services furnished on or after January 1, 2005, and before
January 1, 2008.
c. Improvement to Medicare HPSA Incentive Payment Program
As of January 1, 2005, most physicians eligible for the 10 percent
HPSA incentive payment would no longer be required to determine whether
their service areas are eligible for incentive payments and to modify
their claims to receive those payments. The MMA requires us to automate
bonus payments for physicians' services furnished in full county HPSAs.
Automation of full county HPSA incentive payments involves the same
issues of automation as PSA incentive payments: the zip code of the
place of service is the only data element reported on the claim form
that would allow automation. Similarly, zip codes need to be cross-
walked to full county HPSAs. The statute allows use of the same method
of automation of incentive payments for full county HPSAs as for full
county PSAs. We are proposing the identification of HPSAs by zip code
for automatic payment as follows:
For zip codes that fall entirely within a full or partial
county HPSA, the bonus would be paid automatically.
When the zip code area is not entirely located within the
full county HPSA, only the dominant county of the 5-digit zip code as
determined by the U.S. Postal Service would be used for automatically
paying the HPSA incentive payment.
For all other zip code areas that are not entirely, but
are to some extent, located within a designated HPSA (full county or
partial), we would require physicians furnishing services in these
areas to bill for the incentive payments by using the appropriate
modifier on their Medicare claims. We propose to post on our website,
prior to January 1, 2005, a list of zip codes that fully fall within a
designated HPSA and a list of zip codes that partially fall within a
designated HPSA, so that physicians can determine whether they would
need to bill using a modifier.
Determination of zip codes eligible for automatic HPSA bonus
payment would be made on an annual basis, and there would not be any
mid-year updates. We would effectuate mid-year revisions made to
designations by HRSA the following year for automatic bonus payment
purposes.
d. Medicare HPSA Incentive Payments
The Medicare HPSA Incentive Payment program, which the Congress
established under OBRA 1987, was implemented through the Medicare
Claims Processing Manual. This proposed rule would create Sec. 414.67
to conform the regulations to the law, as amended by OBRA 1987 and
1989.
We propose in Sec. 414.67 to provide a 10 percent incentive
payment to eligible physicians furnishing covered services in eligible
HPSAs. Section 414.67(a) would specify that physicians, regardless of
specialty, furnishing services in a primary medical care HPSA are
entitled to a 10 percent incentive payment above the amount paid for
their professional services under the physician fee schedule. We would
also create Sec. 414.67(c) to specify that psychiatrists furnishing
services in a mental health HPSA are entitled to a 10 percent incentive
payment above the amount paid for their professional services under the
physician fee schedule. Psychiatrists furnishing services in mental
health HPSAs that do not overlap with primary care HPSAs are the only
physicians eligible to receive the 10 percent incentive payment in
those areas. In other words, these stand-alone mental health HPSAs are
eligible areas for psychiatrists only to receive incentive payments.
E. Section 303--Payment Reform for Covered Outpatient Drugs and
Biologicals
[If you choose to comment on issues in this section, please include the
caption ``Section 303'' at the beginning of your comments.]
1. Average Sales Price (ASP) Payment Methodology
a. Background
Medicare Part B covers a limited number of prescription drugs and
biologicals. For the purposes of this proposed rule, the term ``drugs''
will hereafter refer to both drugs and biologicals. Medicare Part B
covered drugs generally fall into the following three categories:
Drugs furnished incident to a physician's service.
Durable medical equipment (DME) drugs.
Drugs specifically covered by statute (for example,
immunosuppressive drugs).
Section 303(c) of the MMA revises the payment methodology for Part
B covered drugs that are not paid on a cost or prospective payment
basis. In particular, section 303(c) of the MMA amends Title XVIII of
the Act by adding section 1847A. Beginning in 2005, section 1847A of
the Act establishes a new ASP drug payment system. In 2005, almost all
Medicare Part B drugs not paid on a cost or prospective payment basis
will be paid under this system.
The new ASP drug payment system is based on data submitted to us
quarterly by manufacturers. For calendar quarters beginning on or after
January 1, 2004, the statute requires manufacturers to report their ASP
data to us for almost all Medicare Part B drugs not paid on a cost or
prospective payment basis. Manufacturers' submissions are due to us not
later than 30 days after the last day of each calendar quarter.
For further information on the submission of manufacturers' ASP
data, see the interim final rule titled ``Manufacturer Submission of
Manufacturer's Average Sales Price (ASP) Data for Medicare Part B Drugs
and Biologicals' published in the Federal Register on April 6, 2004 (69
FR 17935). It is accessible on the CMS Web site at http://
www.cms.hhs.gov/providers/drugs/default.asp.
The methodology for developing Medicare drug payment allowances
based on the manufacturer's submitted ASP data is described in this
proposed rule and reflected in proposed revisions to the regulations at
Sec. 405.517 and new Subpart K in part 414.
b. Provisions of the Proposed Rule
i. The ASP Methodology
Beginning in 2005, section 1847A of the Act establishes an ASP
payment system for certain drugs and biologicals
[[Page 47521]]
not paid on a cost or prospective payment basis furnished on or after
January 1, 2005. The most notable exceptions are described below in
sections III.E.1.c through III.E.1.e.
ii. Calculation of ASP
As described in section 1847A(b)(3)(A) of the Act for multiple
source drugs and section 1847A(b)(4)(A) for single source drugs, the
ASP for all drug products included within the same billing and payment
code [or HCPCS code] is the volume-weighted average of the
manufacturer's average sales prices reported to us across all the NDCs
assigned to the HCPCS code. Specifically, section 1847A(b)(3)(A) of the
Act and section 1847A(b)(4)(A) of the Act require that this amount be
determined by--
Computing the sum of the products (for each National Drug
Code assigned to those drug products) of the manufacturer's average
sales price and the total number of units sold; and
Dividing that sum by the sum of the total number of units
sold for all NDCs assigned to those drug products.
Note that in the following discussions, the term ``manufacturer's
ASP'' refers to the ASP data submitted to us by manufacturers at the
NDC level and the term ``ASP'' used in isolation refers to the weighted
average sales price for all drug products included within the HCPCS
[billing and payment] code.
Section 1847A(b)(5) of the Act requires that the ASP be determined
without regard to any special packaging, labeling, or identifiers on
the dosage form or product or package.
iii. Medicare Payment Allowances for Multiple Source Drugs
Section 1847A(b)(1)(A) of the Act requires that the Medicare
payment allowance for a multiple source drug included within the same
HCPCS code be equal to 106 percent of the ASP for the HCPCS code. This
payment allowance is subject to applicable deductible and coinsurance.
The payment limit is also subject to the two limitations described
below in section III.E.1.b.v of this preamble concerning widely
available market prices and average manufacturer prices in the Medicaid
drug rebate program. As described in section 1847A(e) of the Act, the
payment limit may also be adjusted in response to a public health
emergency under section 319 of the Public Health Service Act in which
there is a documented inability to access drugs and a concomitant
increase in the price of the drug which is not reflected in the
manufacturer's average sales price.
iv. Medicare Payment Allowances for Single Source Drugs
Section 1847A(b)(1)(B) of the Act requires that the Medicare
payment allowance for a single source drug HCPCS code be equal to the
lesser of 106 percent of the average sales price for the HCPCS code or
106 percent of the wholesale acquisition cost of the HCPCS code. This
payment allowance is subject to applicable deductible and coinsurance.
The payment limit is also subject to the two limitations described
below in section III.E.1.b.v concerning widely available market prices
and average manufacturer prices in the Medicaid drug rebate program. As
described in section 1847A(e) of the Act, the payment limit may also be
adjusted in response to a public health emergency under section 319 of
the Public Health Service Act.
It has been brought to our attention that some physicians have
concerns about their ability to purchase drugs at the Medicare payment
amount of 106 percent of the ASP as these physicians believe that they
are small purchasers of the Medicare Part B drugs subject to this
proposed rule and do not have access to the average discounts. It is
our understanding that many physicians are members of purchasing
groups, which do obtain discounts on drugs. We encourage physicians to
consider participating in such groups in order to achieve advantageous
prices. We are interested in comments regarding the extent to which
physicians can become members of such buying groups and the possible
effects of doing so.
v. Limitations on ASP
Section 1847A(d)(1) of the Act states that ``The Inspector General
of the Department of Health and Human Services shall conduct studies,
which may include surveys, to determine the widely available market
prices of drugs and biologicals to which this section applies, as the
Inspector General, in consultation with the Secretary, determines to be
appropriate.'' Section 1847A(d)(2) of the Act states that ``Based upon
such studies and other data for drugs and biologicals, the Inspector
General shall compare the average sales price under this section for
drugs and biologicals with--
The widely available market price for such drugs and
biologicals (if any); and
The average manufacturer price (as determined under
section 1927(k)(1)) for such drugs and biologicals.''
Section 1847A(d)(3) of the Act states that ``The Secretary may
disregard the average sales price for a drug or biological that exceeds
the widely available market price or the average manufacturer price for
such drug or biological by the applicable threshold percentage (as
defined in subparagraph (B)).'' Section 1847A(d)(3)(B) states that
``the term `applicable threshold percentage' means--
In 2005, in the case of an average sales price for a drug
or biological that exceeds widely available market price or the average
manufacturer price, 5 percent; and
In 2006 and subsequent years, the percentage applied under
this subparagraph subject to such adjustment as the Secretary may
specify for the widely available market price or the average
manufacturer price, or both.''
Section 1847A(d)(3)(C) of the Act states that ``If the Inspector
General finds that the average sales price for a drug or biological
exceeds such widely available market price or average manufacturer
price for such drug or biological by the applicable threshold
percentage, the Inspector General shall inform the Secretary (at such
times as the Secretary may specify to carry out this subparagraph) and
the Secretary shall, effective as of the next quarter, substitute for
the amount of payment otherwise determined under this section for such
drug or biological the lesser of--
The widely available market price for the drug or
biological (if any); or
103 percent of the average manufacturer price (as
determined under section 1927(k)(1)) for the drug or biological.''
vi. Payment Methodology in Cases Where the Average Sales Price During
the First Quarter of Sales Is Unavailable
Section 1847A(c)(4) of the Act states that ``In the case of a drug
or biological during an initial period (not to exceed a full calendar
quarter) in which data on the prices for sales for the drug or
biological is not sufficiently available from the manufacturer to
compute an average sales price for the drug or biological, the
Secretary may determine the amount payable under this section for the
drug or biological based on--
The wholesale acquisition cost; or
The methodologies in effect under this part on November 1,
2003, to determine payment amounts for drugs or biologicals.''
[[Page 47522]]
c. Payment for Influenza, Pneumococcal, and Hepatitis B Vaccines
Section 1841(o)(1)(A)(iv) of the Act requires that influenza,
pneumococcal, and hepatitis B vaccines described in subparagraph (A) or
(B) of section 1861(s)(10) of the Act be paid based on 95 percent of
the average wholesale price (AWP) of the drug. These AWP payments,
which will be updated quarterly, have not been revised by the ASP
provisions.
d. Payment for Drugs Furnished During 2005 in Connection With the
Furnishing of Renal Dialysis Services if Separately Billed by Renal
Dialysis Facilities.
Section 1881(b)(13)(A)(ii) of the Act indicates that payment for a
drug furnished during 2005 in connection with the furnishing of renal
dialysis services, if separately billed by renal dialysis facilities,
will be based on the acquisition cost of the drug as determined by the
Inspector General (IG) report to the Secretary required by section
623(c) of the MMA or, insofar as the IG has not determined the
acquisition cost with respect to a drug, the Secretary shall determine
the payment amount for the drug. In the report, ``Medicare
Reimbursement for Existing End-Stage Renal Disease Drugs,'' the IG
found that, on average, in 2003 the four largest chains had drug
acquisition costs that were 6 percent lower than the ASP of 10 of the
top drugs, including erythropoietin. A sample of the remaining
independent facilities had acquisition costs that were 4 percent above
the ASP. Based on this information, the overall weighted average drug
acquisition cost for renal dialysis facilities is 3 percent lower than
the ASP. Therefore, payment for a drug or biological furnished during
2005 in connection with renal dialysis services and separately billed
by renal dialysis facilities will be based on the ASP of the drug minus
3 percent. This will be updated quarterly based on the ASP reported to
us by drug manufacturers.
e. Payment for Infusion Drugs Furnished Through an Item of DME
In 2005, section 1841(o)(1)(D)(i) of the Act requires an infusion
drug furnished through an item of DME covered under section 1861(n) of
the Act be paid 95 percent of the average wholesale price for that drug
in effect on October 1, 2003.
2. Provisions for Appropriate Reporting and Billing for Physicians'
Services Associated With the Administration of Covered Outpatient Drugs
Section 1848(c)(2)(J) of the Act (as added by section 303(a) of the
MMA) requires the Secretary to promptly evaluate existing drug
administration codes for physicians' services to ensure accurate
reporting and billing for those services, taking into account levels of
complexity of the administration and resource consumption. According to
section 1848(c)(2)(B)(iv) of the Act (also as amended by section 303(a)
of the MMA), any changes in expenditures in 2005 or 2006 resulting from
this review are exempt from the budget neutrality requirement of
section 1848(c)(2)(B)(ii) of the Act. The statute further indicates
that the Secretary shall use existing processes for the consideration
of coding changes and, to the extent changes are made, shall use those
processes to establish relative values for those services. The
Secretary is also required to consult with physician specialties
affected by the provisions that change Medicare payments for drugs and
drug administration.
In the January 7, 2004 interim final rule with comment (69 FR
1094), we indicated that the Physicians Regulatory Issues Team (PRIT)
will review Medicare payment policy for drug administration and that we
plan to consult with the AMA's CPT Editorial Panel and physician
specialties affected by changes in payment for drugs and drug
administration. We requested that the CPT Editorial Panel review all
codes related to the administration of drugs and consider whether any
revisions or additional codes are needed. At its February 2004 meeting,
the CPT Editorial Panel established a workgroup, with representatives
from affected specialties, to make recommendations on drug
administration coding to the full Panel. In addition, the workgroup
will be reviewing issues related to drug administration that were
identified in the public comments on the January 7, 2004 Physician Fee
Schedule rule. These comments raised the following two major issues:
1. Can the current coding distinction between chemotherapy and
nonchemotherapy infusions allow for recognition of the resources needed
to administer drugs with high toxicity or potential for serious side
effects for diagnoses other than cancer? If not, are code revisions or
new codes needed?
2. Does the current coding for chemotherapy administration capture
all the support services provided by oncology practices for
chemotherapy patients? If not, are code revisions or new codes such as
a cancer management code needed?
There were also a number of specific comments on individual codes
raised by some specialties such as urology and ophthalmology. On June
21, 2004, the workgroup held a public meeting to receive input and
comments about drug administration code changes under consideration.
The workgroup is expected to report to the full CPT Editorial Panel on
all these issues at its August 2004 meeting. Once we review the CPT
Editorial Panel's work on this issue, we will consider whether it is
necessary for us to make coding changes effective January 1, 2005
through the use of G codes, since the 2005 CPT book will already have
been published. While the CPT Editorial Panel's work on this issue is
important to us, we finally determine coding policy for Medicare; we
also would welcome public comments on these issues. We would also
welcome comments concerning any alternative methods of allocating
practice expenses to the drug administration codes. (See section
II.A.2. of this proposed rule for a discussion of allocation of
practice expenses.) If coding changes are to be made for next year, we
would announce them in the physician fee schedule final rule effective
January 1, 2005.
We also plan to analyze any shift or change in utilization patterns
once the payment changes for drugs and drug administration required by
MMA go into effect. While we do not believe the changes will result in
access problems, we plan to continue studying this issue. We also note
that the MMA requires the Medicare Payment Advisory Commission (MedPAC)
to study items and services furnished by oncologists and drug
administration services furnished by other specialties.
3. Blood Clotting Factor--Section 303(e)(1)--Items and Services
Relating to Furnishing of Blood Clotting Factors
For clotting factors furnished on or after January 1, 2005, we
propose to establish a separate payment of $0.05 per unit to hemophilia
treatment centers and homecare companies for the items and services
associated with the furnishing of blood clotting factor.
Section 303(e)(1) of the MMA requires the Secretary, after review
of the January 2003 report to the Congress by the Comptroller General
of the United States, to establish a separate payment to hemophilia
treatment centers and homecare companies for the items and services
associated with the furnishing of blood clotting factor. In the
proposed rule, Payment Reform for Part B Drugs
[[Page 47523]]
(68 FR 50440), published in the Federal Register on August 20, 2003, we
indicated that we are proposing to create a payment of $0.05 per unit
of clotting factor provided to Medicare beneficiaries by hemophilia
treatment centers and homecare companies to appropriately pay for the
administrative costs associated with furnishing the clotting factor. We
did not propose the creation of separate payment for furnishing the
clotting factor for individuals or entities other than hemophilia
treatment centers and homecare companies.
We received comments from hemophilia organizations and specialty
pharmacy providers of blood clotting factor. Most comments questioned
our position to create a separate payment of $0.05 per unit, stating
that this amount would jeopardize the ability of these facilities to
adequately supply the clotting factor. Commenters were concerned that
the $0.05 amount was too low and would cause many entities to
discontinue providing the clotting factors and severely impact
beneficiaries' access to clotting factor.
Based on a review of the General Accounting Office (GAO) report and
data received from various clotting factor providers, we believe a
separate payment amount of $0.05 per unit would cover the
administrative costs associated with supplying the clotting factor. As
outlined in the MMA, any separate payment amount established may
include the mixing and delivery of factors, including special inventory
management and storage requirements, as well as ancillary supplies and
patient training necessary for the self-administration of these
factors. The MMA states that, in determining the separate payment, the
total amount of payments and these separate payments shall not exceed
the total amount of payments that would have been made for the factors
if the amendments in section 303 of the MMA had not been enacted. As
indicated in the GAO report, ``[w]hen Medicare's payment for clotting
factor more closely reflects acquisition costs, we recommend that the
Administrator establish a separate payment for providers based on the
costs of delivering clotting factor to Medicare beneficiaries.
Effective January 1, 2005, payment for blood clotting factors will more
closely reflect acquisition costs as payment will be based on the
average sales price as reported by drug manufacturers plus 6 percent.''
Therefore, in the absence of additional data, we believe that a
separate payment amount of $0.05 per unit for the cost of delivering
clotting factor is an appropriate amount beginning CY 2005 and we are
proposing revisions to Sec. 410.63 to reflect this amount. However, we
are also seeking updated data and comments on the GAO report, as well
as information on the fixed and variable costs of furnishing clotting
factor. We recognize that there may be alternatives to a fee, which
varies entirely based on the number of units of clotting factor
furnished. We will closely examine all data and information submitted
in order to make a final determination with respect to the
appropriateness of the $0.05 per unit amount. That information will
enable us to effectively determine the appropriateness of the $0.05 per
unit amount.
4. Supplying Fee
Section 1842(o)(6) of the Act, as added by section 303(e)(2) of the
MMA, requires the Secretary to pay a supplying fee (less applicable
deductible and coinsurance) to pharmacies for certain Medicare Part B
drugs and biologicals, as determined appropriate by the Secretary. The
types of Medicare Part B drugs and biologicals eligible for a supplying
fee are immunosuppressive drugs described in section 1861(s)(2)(J) of
the Act, oral anticancer chemotherapeutic drugs described in section
1861(s)(2)(Q) of the Act, and oral anti-emetic drugs used as part of an
anticancer chemotherapeutic regimen described in section 1861(s)(2)(T)
of the Act. As discussed in the interim final rule published on January
7, 2004 (69 FR 1084), we considered this fee to be bundled into the
current payment for these drugs for 2004 where payment is based on the
Average Wholesale Price (AWP).
We propose to establish a separately billable supplying fee,
effective January 1, 2005, when Medicare implements a different payment
system for these drugs. We believe that a separately billable supplying
fee of $10 per prescription is an appropriate level, beginning CY 2005.
We received data suggesting various amounts for the supplying fee.
Retail chain pharmacies suggested a supplying fee of $12 to $15 per
prescription. These pharmacies stated that on average it cost between
$10 to $12 to dispense a prescription to a Medicare beneficiary.
However, when supplying immunosuppressive and oral anti-cancer drugs to
Medicare beneficiaries, they argued that costs increase due to factors
such as coordination of benefits activities. The specialty pharmacies
that exclusively or largely furnish immunosuppressive drugs submitted
data indicating that they believe a supplying fee of $44 (weighted
average) to $56 (unweighted average) was appropriate. Pharmacies have
pointed to the additional Medicare billing requirements as additional
costs they had to incur, in the form of extra staff and time required
to fulfill the billing requirements. We believe that a supplying fee of
$10 per prescription is appropriate, especially when combined with the
savings the pharmacy will experience with the clarification and
elimination of the billing and shipping requirements, as described
below.
We point out that if we were to establish a supplying fee of $44,
then we expect that Medicare would be spending more money in 2005 on
the supplying fees and immunosuppressive drugs than Medicare would have
paid for immunosuppressive drugs in 2005 under the former system at 95
percent of AWP, when the supplying fee was bundled into payment for the
drug.
Our goal is to assure that each beneficiary who needs covered oral
drugs has access to those medications. We seek comments about the
appropriateness of our proposed supplying fee amount as well as the
components of a supplying fee that would assure beneficiary access to
oral drugs. We believe that a supplying fee is intended to cover a
pharmacy's activities to get oral drugs to beneficiaries. We seek data
and information on the additional services these pharmacies provide to
Medicare beneficiaries, the extent to which oral drugs can be furnished
without these additional services and the extent to which such services
are covered under Medicare. We seek comment about whether the supplying
fee should be somewhat higher during the initial month following a
Medicare beneficiary's transplant to the extent that additional
resources are required for example, due to more frequent changes in
prescriptions for immunosuppressive drugs.
5. Billing Requirements
We propose to clarify or eliminate the following billing
requirements in an effort to reduce a pharmacy's costs of supplying
covered immunosuppressive and oral drugs to Medicare beneficiaries:
Original signed order. We wish to clarify Medicare's
policy regarding the necessity of an original signed order prior to the
filling of a prescription. According to the Medicare Program Integrity
Manual (section 5.1 of Chapter 5), which addresses the ordering
requirement for durable medical equipment, prosthetics, orthotics and
supplies (DMEPOS), including drugs, most DMEPOS items can be dispensed
[[Page 47524]]
based on a verbal order from a physician. A written order must be
obtained before submitting a claim, but that written order may be
faxed, photocopied, electronic, or pen and ink. The order for the drug
must specify the name of the drug, the concentration (if applicable),
the dosage, and the frequency of administration. We hope that
clarification of this requirement would reduce a pharmacy's costs of
supplying covered immunosuppressive and oral drugs to Medicare
beneficiaries to the extent that pharmacies are currently applying an
original signed prescription requirement.
Assignment of Benefits Form. Currently, pharmacies must
obtain a completed Assignment of Benefits form in order to receive
payment from Medicare. Other payors do not impose this requirement.
This requirement increases a pharmacy's cost of supplying covered drugs
to Medicare beneficiaries. Section 1842(o)(3) of the Act requires that
payment for drugs under Part B of Medicare can only be made on an
assignment related basis. However, Sec. 424.55(a) implies that if a
beneficiary does not sign an assignment of benefits form, then Medicare
will not make payment to the supplier. It has been pointed out that
this requirement increases costs to suppliers that are not reimbursed
by Medicare. We believe that it is not necessary for an assignment of
benefit form to be filled out for drugs covered under Part B since
payment for them can only be made on an assignment-related basis. We
propose to eliminate use of the Assignment of Benefits form for Part B
covered oral drugs as a means of reducing a pharmacy's costs of
supplying such drugs to Medicare beneficiaries. (Additional discussion
on assignment of Medicare claims is in section IV.G of this preamble.)
DMERC Information Form (DIF). The DIF is a form created by
the DMERC Medical Directors that contains information regarding the
dates of the beneficiary's transplant and other diagnosis information.
Pharmacies must have a completed DIF in order to receive payment. This
requirement increases a pharmacy's cost of supplying covered drugs to
Medicare beneficiaries. The DIF is a one-time requirement that was
established to facilitate implementation of the immunosuppressive drug
benefit when Medicare covered the drugs for different periods of time
to distinguish between transplant and non-transplant uses for
immunosuppressive drugs. Since section 1861(s)(2)(J) of the Act no
longer imposes limits on the period of time for coverage of
immunosuppressive drugs, we believe that the information on transplant
diagnosis can be captured through other means (for example, diagnosis
codes on the Part B claim form). In light of this statutory revision,
we have had discussions with the DMERCs about their elimination of the
use of this form when billing DMERC drugs. The DMERCs plan to eliminate
the use of this form effective October 1, 2004. We believe that a
pharmacy's costs of supplying Part B covered oral drugs to Medicare
beneficiaries would be reduced with this change.
6. Shipping Time Frame
It has been suggested that Medicare guidelines for refill
prescriptions allowed too short of a window between shipping the next
month's prescription and the end of the current month. It has been
argued that, as a result, a pharmacy ``effectively'' had to ship the
product to a beneficiary using an overnight delivery service.
As indicated in section III.N of this preamble, on January 2, 2004,
we revised the guidelines (effective February 2, 2004) regarding the
time frame for subsequent deliveries of refills of DMEPOS products to
occur no sooner than ``approximately 5 days prior to the end of the
usage for the current product'' (see section 4.26.1 of Chapter 4--
Benefit Integrity of the Medicare Program Integrity Manual). This
change allows shipping of refills on ``approximately'' the 25th day of
the month in the case of a month's supply. We emphasize the word
``approximately'; while we believe that normal ground service shipping
would allow delivery in 5 days, if there were circumstances where
ground service could not occur in 5 days, the guideline would still be
met if the shipment occurs in 6 or 7 days. (``Days'' refers to business
days or shipping days applicable to the shipper, that is, a 6-day week
in the case of the U.S. Postal Service.) We believe that this change
eliminates the need for suppliers to use overnight shipping methods and
allows shipping of drugs by less expensive ground service.
F. Section 952--Revisions to Reassignment Provisions--Section 952 of
the MMA
[If you choose to comment on issues in this section, please include the
caption ``Section 952'' at the beginning of your comments.]
Section 1842(b)(6) of the Act requires that payment may only be
made to the physician or other person who furnished a service, or to
the beneficiary for whom services were furnished, unless certain
specified exceptions are met. Prior to the enactment of section 952 of
the MMA, Medicare did not permit the reassignment of payments for
services provided by an independent contractor physician or
nonphysician practitioner unless the services were performed on the
premises of the facility or health care delivery system that submitted
the bill. Therefore, if the services were furnished offsite,
reassignment was prohibited (see section 1842(b)(6)(A)(ii) of the Act).
Section 1842(b)(6)(A)(ii) of the Act, as amended by section 952 of
the MMA, allows a physician or nonphysician practitioner to reassign
payment for Medicare-covered services, regardless of the site of
service, as long as there is a contractual arrangement between the
physician and nonphysician practitioner and the entity through which
the entity submits the bill for those services. Thus, the services may
be provided on or off the premises of the entity receiving the
reassigned payments. The MMA Conference Agreement states that entities
that retain independent contractors may enroll in the Medicare program.
We note that the expanded exception created by section 952 applies to
those situations when an entity seeks to obtain the medical services of
a physician or nonphysician practitioner.
Section 952 states that reassignment is permissible if the
contractual arrangement between the entity that submits the bill for
the service and the physician or nonphysician practitioner who performs
the service ``meets such program integrity and other safeguards as the
Secretary may determine to be appropriate.'' The Conference Agreement
supports appropriate program integrity efforts for entities with
independent contractors that bill the Medicare program, including joint
and several liability (that is, both the entity accepting reassignment
and the physician or nonphysician practitioner providing a service are
both liable for any Medicare overpayments). The Conference Agreement
also recommends that physician or nonphysician practitioners have
unrestricted access to the billings submitted on their behalf by
entities with which they contract. We incorporated these recommended
safeguards in a change to the Medicare Manual, implementing section 952
of the MMA that was published on February 27, 2004. We are proposing to
revise Sec. 424.71 and Sec. 424.80 to reflect these safeguards, as
well as the expanded exception established by section 952.
Given the myriad relationships and financial arrangements
potentially permitted by section 952, the purpose of
[[Page 47525]]
joint and several liability is to encourage both parties to the
contractual arrangement to exercise oversight of billings submitted to
the Medicare program by holding them each fully accountable. Since
physician or nonphysician practitioners will be subject to liability
for claims that are submitted to the Medicare program by entities to
which they have reassigned payments, it follows that a physician or
nonphysician practitioners should have access to the billings submitted
on their behalf.
We note that section 952 of the MMA revises only the statutory
reassignment exceptions relevant to services provided in facilities and
clinics (section 1842(b)(6)(A)(ii) of the Act). Arrangements involving
reassignment must not violate any other applicable Medicare laws or
regulations governing billing or claims submission, including, but not
limited to, those regarding ``incident to'' services, payment for
purchased diagnostic tests, and payment for purchased test
interpretations.
In addition, physician group practices should be mindful that
compliance with the in-office ancillary services exception to the
physician self-referral prohibition requires that a physician who is
engaged by a group practice on an independent contractor basis must
provide services to the group practice's patients in the group's
facilities. As noted in the Phase I physician self-referral final rule
(66 FR 887), ``[w]e consider an independent contractor physician to be
``in the group practice'' if (1) he or she has a contractual
arrangement to provide services to the group's patients in the group
practice's facilities, (2) the contract contains compensation terms
that are the same as those that apply to group members under section
1877(h)(4)(iv) of the Act or the contract fits in the personal services
exception, and (3) the contract complies with the reassignment rules *
* * .'' See also 66 FR 886. This test is codified at Sec. 411.351 in
the definition of ``physician in the group practice.''
We are aware that the changes in the reassignment rules based on
section 952 of the MMA may create new fraud and abuse vulnerabilities,
which may not become apparent until the program has experience with the
new contractual arrangements addressed in section 952 of the MMA.
Parties should be mindful that contractual arrangements involving
reassignment may not be used to camouflage inappropriate fee-splitting
arrangements or payments for referrals. We are soliciting public
comment on potential program vulnerabilities and on possible additional
program integrity safeguards to guard against such vulnerabilities. We
intend to monitor reassignment arrangements for potential program
abuse.
G. Section 642--Extension of Coverage of IVIG for the Treatment of
Primary Immune Deficiency Diseases in the Home
[If you choose to comment on issues in this section, please include the
caption ``Section 642'' at the beginning of your comments.]
Beginning for dates of service on or after January 1, 2004,
Medicare pays for intravenous immune globulin administered in the home.
This benefit is for the drug and not for the items or services related
to the administration of the drug when administered in the home, if
deemed medically appropriate. Manual instructions implementing this MMA
provision have been issued and can be found at http://www.cms.hhs.gov/
manuals/pm_trans/R6BP.pdf and http://www.cms.hhs.gov/manuals/pm_
trans/R74CP.pdf. We are also proposing to revise Sec. 410.10 to
address this statutory change.
H. Section 623--Payment for Renal Dialysis Services
[If you choose to comment on issues in this section, please include the
caption ``Section 623'' at the beginning of your comments.]
1. Background
We are proposing changes affecting payments to ESRD facilities that
result from enactment of the MMA and would be effective January 1,
2005. Section 1881(b) of the Act, as amended by section 623 of the MMA,
directed the Secretary to revise the current composite rate payment
system. The statute has several major provisions that require the
development of revised composite payment rates, as follows:
An update of 1.6 percent.
An add-on to the composite rate for the difference between
current payments for separately billable drugs and biologicals and
payments based on the revised drug pricing methodology using
acquisition costs.
Case-mix adjustments for a limited number of patient
characteristics.
Application of a budget neutrality adjustment. The statute
also allows the Secretary to adjust the payment rates by a geographic
index as the Secretary determines to be appropriate which would be
phased-in over a multiyear period.
By January 1, 2005, we plan to implement the proposed revisions
affecting the composite payment rate which would include the following:
An increase of 1.6 percent to the basic composite payment
rate.
Proposed revisions to the pricing of separately billable
drugs and biologicals.
A drug add-on to the composite rate to reflect the
difference between current payments for separately billable drugs and
biologicals, and payment based on the revised drug pricing methodology
using acquisition costs.
We propose to implement the patient characteristics adjustments and
the related budget neutrality adjustments by April 1, 2005. (See
detailed discussion later in this section.)
2. Legislative History
Section 2991 of the Social Security Amendments of 1972 (Pub. L. 92-
603), established Medicare's End Stage Renal Disease (ESRD) Program.
This law extended Medicare coverage to individuals who have permanent
kidney failure, require either dialysis or transplantation, and meet
certain other eligibility requirements. The End Stage Renal Disease
Program Amendments of 1978 (Pub. L. 95-292) added section 1881(b)(2)(B)
to title XVIII of the Act.
That legislation provided for the establishment of a prospective
reimbursement methodology for the payment of dialysis treatments
provided by renal dialysis facilities. Further changes to the ESRD
payment system were made by section 2145 of Pub. L. 97-35, which
amended section 1881 of the Act, requiring the development of a
prospective reimbursement system for outpatient maintenance dialysis
that promotes home dialysis. The payment system required either the
reimbursement of home dialysis and in-facility dialysis under
``composite'' rates, or the use of some other more efficient method
determined to promote home dialysis more effectively.
On February 12, 1982, we published a proposed rule on reimbursement
for outpatient maintenance dialysis services (47 FR 6556) and we
published the final rule on May 13, 1983 (48 FR 21254). This regulation
implemented section 1881 of the Act, as amended by section 2145 of Pub.
L. 97-35, and provided that each ESRD facility will receive a fixed
composite payment rate per dialysis treatment, adjusted for geographic
differences in area wage levels. Payment for in-facility and home
dialysis treatments was established using a composite payment rate
reflecting the costs of both modalities. Separate composite payment
rates were established for hospital-based and independent dialysis
facilities. The regulation also included a process under which
facilities could obtain exceptions
[[Page 47526]]
to their composite payment rates under specified circumstances.
The average composite payment rate per treatment, effective on
August 1, 1983, was $123 for independent ESRD facilities and $127 for
hospital-based facilities. The composite rate was designed to provide
payment for a package of goods and services needed to furnish dialysis
treatments that included certain routinely provided drugs, laboratory
tests, supplies, and equipment. Unless specifically included in the
composite payment rate, other injectable drugs and laboratory tests
medically necessary for the care of the dialysis patient are separately
billable.
Prior to January 1, 2004, drugs not paid on a cost or prospective
payment basis were paid based on the lower of the actual charge or 95
percent of the AWP (section 1842(o)(1) of the Act, as added by section
4556 of the BBA of 1997 (Pub. L. 105-33)). Sections 303 through 305 of
the MMA make revisions to payment methodology for Part B covered drugs
that are not paid on a cost or prospective payment basis. For CY 2004,
the MMA provides that drugs not paid on a cost or prospective payment
basis will be paid at 85 percent of the AWP determined as of April 1,
2003. However, there are several exceptions to this general rule,
including payment of ESRD drugs and biologicals. In CY 2004, drugs and
biologicals furnished in connection with the furnishing of renal
dialysis services if separately billed by renal dialysis facilities are
paid at 95 percent of AWP. We note that hospital-based ESRD facilities
are paid reasonable costs for separately billable drugs, except for
Erythropoietin/Epoietin (EPO).
EPO is an anti-anemia drug administered to certain patients with
ESRD. Medicare Part B pays for EPO and its administration if it is
furnished by an approved ESRD facility as part of an outpatient
dialysis service or by a supplier of home dialysis equipment and
supplies to ESRD patients in their homes as part of home dialysis
services. Most dialysis is furnished to ESRD patients on an outpatient
basis or is self-administered in the home.
Section 1881(b)(11) of the Act expressly excludes payment for EPO
furnished to ESRD patients from the composite rate for dialysis
services. The costs of EPO are, therefore, billed separately by an ESRD
facility or by a supplier of home dialysis equipment and supplies and
are paid in addition to the facility's composite rate. Any EPO-related
costs, such as the cost of its administration or overhead costs
associated with its storage, however, are subsumed in the facility's
composite rate.
Section 413.174(f)(3) requires that we prospectively determine the
EPO amount pursuant to section 1881(b)(11)(B)(ii) of the Act. Section
4201(c) of the Omnibus Budget Reconciliation Act of 1990 (OBRA 90)
(Pub. L. 101-508), however, amended section 1881(b)(11) of the Act to
establish a new EPO payment methodology. OBRA 90 directed, effective
January 1, 1991, that payment for EPO furnished to ESRD patients by
Medicare-approved dialysis facilities or suppliers of home dialysis
equipment and supplies for home use be made on a per-unit basis. OBRA
90 also established a maximum payment amount of $11 per 1,000 unit
doses rounded to the nearest 100 units. Subsequently, section
13556(a)(2) of OBRA 93 was enacted, which further amended section
1881(11)(b)(B)(ii) of the Act to reduce the maximum payment level to
$10 per 1,000 units effective January 1, 1994. Although we have the
authority to revise the rate, we continue to pay at the rate of $10 per
1,000 units.
Section 9335(a) of Pub. L. 99-509 required the Secretary to reduce
the initially established composite payment rates by $2.00 per
treatment effective October 1, 1986. This reduction was partially
reversed as a result of the enactment of section 4201(a)(2) of Pub. L.
101-508, which increased the composite payment rates in effect as of
September 30, 1990 by $1.00 per treatment, but effectively froze the
methodology for their calculation, including the data and definitions
used, as of that date. Section 222 of Pub. L. 106-113, provided for a
1.2 percent increase to the payment rates effective January 1, 2000,
and also provided for another 1.2 percent increase effective January 1,
2001. Section 422(a)(1) of Pub. L. 106-554, raised the amount of the
January 1, 2001 payment increase by another 1.2 percent for a total
increase of 2.4 percent effective January 1, 2001.
Section 422 of Pub. L. 106-554 also directed the Secretary to
develop a Prospective Payment System (PPS) that expanded the bundle of
routine services reflected in the composite rate to include separately
billable laboratory tests and drugs ``to the maximum extent feasible''.
In addition, section 422(a) of Pub. L. 106-554 prohibited the granting
of new composite rate payment exceptions for services furnished after
December 31, 2000. Because a bundled ESRD payment system must be
periodically updated, section 422(b) of Pub. L. 106-554 also required
the development of an ESRD market basket to account for changes in
price inflation, with discretionary consideration of other factors
known to affect costs. Section 422(c) of Pub. L. 106-554 mandated the
submission of a report to the Congress on the bundled payment system
and ESRD market basket.
On May 12, 2003, the Secretary submitted the required report to the
Congress. The report explained the major issues that must be addressed
before a bundled ESRD PPS can be implemented, presented an ESRD
composite rate market basket, and discussed the results from the first
phase of our sponsored research to develop a bundled payment system.
The report presented the following three major findings that are
relevant to our efforts to revise the composite rate payment system:
Current data sources are adequate for proceeding to
develop a bundled ESRD PPS.
Case-mix may be an important variable for risk adjusting
payments, based on preliminary analysis.
Current data provide a sound basis for monitoring patient
outcomes in a revised ESRD payment system.
3. Summary of Section 623 of MMA
The following provisions in section 623 of the MMA, effective
January 1, 2005, affect the composite payment rate methodology, as well
as the pricing methodology for separately billable drugs and
biologicals furnished by ESRD facilities:
a. Section 623(a)--The last sentence of section 1881(b)(7) of the
Act, as amended by MMA, provides for an increase in the current
composite payment rate of 1.6 percent.
b. Section 623(d)(1)--Section 1881(b)(13) of the Act, as added by
MMA section 623(d)(1), provides for a revision to the current AWP
pricing of separately billable drugs and biologicals; payment will be
based on acquisition costs as determined by the OIG's study mandated
under section 623(c) of the MMA. Insofar, as the OIG has not determined
the acquisition costs, with respect to a drug or biological, the
Secretary shall determine the payment amount for such drug or
biological.
c. Section 623(d)(1)--Section 1881(b)(12) of the Act, as added by
MMA section 623(d)(1), also requires the establishment of a basic case-
mix adjusted composite payment rate that applies certain adjustments to
the composite payment rate as follows:
Adjustments for a limited number of patient
characteristics.
An adjustment that reflects the difference between current
payments for
[[Page 47527]]
separately billed drugs and biologicals and the revised pricing based
on acquisition costs or other method as determined by the Secretary.
A geographic adjustment, if the Secretary determines such
an adjustment is appropriate with the possibility of a phase-in.
A budget neutrality adjustment, so that aggregate payments
under the basic case-mix adjusted composite payment rates for 2005
equal the aggregate payments that would have been made for the same
period if section 1881(b)(12) of the Act did not apply.
4. Provisions of the Proposed Rule
a. Composite Rate Increase
The current composite payment rates applicable to urban and rural
hospital-based and independent ESRD facilities were effective January
1, 2002. The current wage-adjusted rates for each urban and rural area
were published in Tables III and IV of Program Memorandum A-01-19
issued February 1, 2001 and are applicable through the end of 2004.
Section 623(a)(3) of the MMA requires that the composite rates in
effect on December 31, 2004 be increased by 1.6 percent. We are
publishing revised wage-adjusted composite rates that reflect the
statutorily required 1.6 percent increase. Those rates are set forth in
Tables I and II at the end of this section. These tables reflect the
updated hospital-based and independent facility composite rate of
$132.40 and $128.35, respectively, adjusted by the current wage index.
The rates will be effective January 1, 2005. The rates shown in the
tables do not include any of the basic case-mix adjustments required
under section 623 of the MMA.
b. Revised Pricing Methodology for Separately Billable Drugs and
Biologicals Furnished by ESRD Facilities
Section 623(d) of the MMA requires the Secretary to establish a
basic case-mix adjusted PPS for dialysis services that are furnished
beginning on January 1, 2005 by providers of services and renal
dialysis facilities to individuals in a facility and to individuals at
home. This system will include services comprising the composite rate
as well as the difference between payment amounts for separately billed
drugs and biologicals (including erythropoietin) furnished by ESRD
facilities and acquisition costs of such drugs and biologicals as
determined by the OIG reports from the studies mandated by section
623(c) of the MMA.
For 2004, the payment amounts for separately billed drugs and
biologicals (other than erythropoietin) furnished by ESRD facilities
are determined by 95 percent of AWP. For 2005, the payment amounts for
separately billed drugs and biologicals (including erythropoietin)
furnished by ESRD facilities are described in section III.E of the
NRPM. Insofar as the acquisition cost has not been determined by the
OIG, then the Secretary shall determine the payment amount of the drug
and biological.
For 2005 and subsequent years, the payment amounts for separately
billed drugs and biologicals (including erythropoietin) furnished by
ESRD facilities will be the acquisition cost or the amount that is
derived from the ASP methodology in section 1847A of the Act, as the
Secretary may specify.
See section III.E.1.d. of this proposed rule for further
explanation of payment for separately billable drugs and biologicals
furnished by renal dialysis facilities.
c. Composite Rate Adjustment to Account for Changes in Pricing of
Separately Billable Drugs and Biologicals
Section 1881(b)(12) of the Act, as added by section 623(d) of the
MMA, contains two provisions that specify how the drug add-on
adjustment is to be handled in the revised ESRD payment system. First,
subparagraph (B)(ii) of such section requires an adjustment to the
composite payment rates to account for the difference between payment
amounts for separately billed drugs (including erythropoietin) under
the current payment system and acquisition costs as determined by the
OIG. Second, subparagraph (E)(i) requires that the drug add-on
adjustment be budget-neutral, that is, that it be designed to result in
the same aggregate amount of expenditures as would have been made
without the statutory policy change.
We need to determine the composite rate adjustment for drug add-on
amount that simultaneously deals with both statutory requirements. That
is, the aggregate amount of the composite rate adjustment for drug add-
on amount needs to equal the aggregate amount of the drug spread (the
difference between drug payments under the old system and acquisition
costs).
In order to ensure that we satisfy both constraints, it is
necessary to consider the proposed drug pricing in developing the
adjustment to the composite rates. As discussed in section III.E.1.d.
of this proposed rule, we are proposing to pay for separately billable
ESRD drugs using ASP minus 3 percent based on the average relationship
of acquisition costs to average sales prices from the drug
manufacturers as outlined in the OIG report. We have developed the
proposed drug add-on adjustment using the ASP minus 3 percent drug
prices. Section 2 below discusses the details of the calculation of the
drug add-on adjustment. An alternative approach would be to use the
2003 acquisition prices from the OIG report, calculate the aggregate
difference between such prices and payments for drugs under the AWP
system, update this difference to 2005 and then apply the budget
neutrality adjustment. Because the same budget-neutrality adjustment
would be used in both calculations, we believe that the drug add-on
adjustment for the drug spread would be the same with both approaches.
Therefore, we are proposing to use the ASP minus 3 percent prices as
the basis for developing the drug add-on adjustment to the composite
rate.
1. Options for Applying the Drug Add-On Adjustment to the Composite
Payment Rate
Currently, separately billable ESRD drugs are paid differently to
hospital-based and independent ESRD facilities. EPO is currently the
only drug for which payment is uniform across ESRD facilities; EPO is
paid at the current rate of $10 per 1000 units. All other separately
billed ESRD drugs provided by independent ESRD facilities are currently
paid 95 percent of AWP prices. However, hospital based ESRD facilities
are paid their reasonable cost for the other separately billed drugs
they provide. Because they are paid on cost, hospital-based facilities
have not made the profits from drug payment that independent facilities
have enjoyed.
The statutory language describing the add-on adjustment to the
composite rate does not specifically differentiate between hospital-
based and independent facility composite rate adjustments. However, the
drug add-on provision is included with the other provisions related to
the basic case-mix adjusted composite rate system; thus, it could be
argued that the drug add-on provision was intended to address ESRD
industry concerns about the inadequacy of the composite payment rate.
We believe these concerns apply equally to hospital-based facilities
and independent facilities. Therefore, we are proposing a single
adjustment to the composite payment rates for both hospital based and
independent facilities.
An alternative option would be to develop a separate adjustment for
hospital-based facilities for EPO and one for independent facilities
for all of their separately billed drugs. The IG's report provided the
acquisition costs we are
[[Page 47528]]
using; it did not provide different acquisition costs for hospital-
based and independent facilities. We believe that it would not be
appropriate for us to use these data to create two separate
adjustments. The following discussion outlines the development of the
drug add-on adjustment under both options--a single factor and separate
factors.
2. Computation of Drug Add-On Adjustment to the ESRD Composite Payment
Rate
i. Data
To develop the drug add-on adjustment we used historical total
aggregate payments for separately billed ESRD drugs for half of 2000
and all of 2001 and 2002. For EPO, these payments were broken down
according to type of ESRD facility (hospital-based versus independent).
We also used the number of dialysis treatments performed by these two
types of facilities over the same period.
ii. ASP Minus 3 Percent
We updated the ASP minus 3 percent prices, for the first quarter of
2004, to represent 2005 prices. We used the projected annual price
growth factor for National Health Expenditure prescription drugs of
3.39 percent.
TABLE 12
------------------------------------------------------------------------
First quarter
2004 average Quarter 2005
Drugs sales price average sales
first minus 3 price minus 3
percent percent
------------------------------------------------------------------------
Epogen.................................. $8.74 $9.04
Calcitriol.............................. 0.66 0.68
Doxercalciferol......................... 2.55 2.64
Iron--dextran........................... 9.22 9.54
Iron--sucrose........................... 0.34 0.35
Levocarnitine........................... 7.15 7.39
Paricalcitol............................ 3.86 3.99
Sodium--ferric--glut.................... 4.15 4.29
Alteplase, Recombinant.................. 27.74 28.68
Vancomycin.............................. 3.40 3.52
------------------------------------------------------------------------
iii. Current Medicare Reimbursement
We updated the first quarter 2004 Medicare payment amounts (95
percent of AWP), based on the January 2004 Single Drug Pricer, for
drugs other than EPO, to estimate 2005 payment amounts by using an
estimated AWP growth of 3 percent. These growth factors are based on
historical trends of AWPs. We did not increase the price for Epogen
since payment was maintained at $10.00 per thousand units prior to MMA.
TABLE 13
------------------------------------------------------------------------
Current medicare
Drugs reimbursement
prices for 2005
------------------------------------------------------------------------
Epogen................................................ $10.00
Calcitriol............................................ 1.42
Doxercalciferol....................................... 5.67
Iron--dextran......................................... 18.45
Iron--sucrose......................................... 0.68
Levocarnitine......................................... 35.23
Paricalcitol.......................................... 5.49
Sodium--ferric--glut.................................. 8.42
Alteplase, Recombinant................................ 37.80
Vancomycin............................................ 7.24
------------------------------------------------------------------------
iv. Dialysis Treatments
We updated the number of dialysis treatments by actuarial projected
growth in the number of ESRD beneficiaries. Since Medicare covers a
maximum of three treatments per week, utilization growth is limited,
and therefore any increase in the number of treatments should be due to
enrollment. In 2005, we project there will be a total of 36.5 million
treatments performed (5.1 million treatments will be performed by
hospital-based facilities and 31.4 million treatments by independent
facilities).
v. Drug Payments
We updated the total aggregate Epogen drug payments for each
hospital-based and independent facilities using historical trend
factors. For 2003 through 2005, the 2002 payment level was increased
each year by trend factors of 2.8 percent for hospital-based facilities
and by 9.4 percent for independent facilities.
Using drug growth factors for drugs paid for by Medicare Part B
carriers, which were calculated from historical data, we updated the
aggregate spending for separately billable drugs, other than EPO, for
independent facilities. We used 24.7 percent for 2003, 23.3 percent for
2004, and 21.4 percent for 2005 as factors because historical growth of
ESRD drugs is similar to that for drugs paid for by Part B carriers.
These factors are projected to approach the level of National Health
Expenditure prescription drug growth. For 2005, we estimate that
spending will reach $185 million for Epogen provided in hospital-based
facilities, and $2,664 million for drugs provided in independent
facilities ($1,568 million for Epogen and $1,096 million for other
drugs).
vi. Add-On Calculation and Budget Neutrality
For each of the ten drugs, we calculated the percent by which ASP
minus 3 percent prices are projected to be less than reimbursement
amounts under the current system for 2005. For Epogen, this amount is
10 percent. We applied this 10 percent figure to the total aggregate
drug payments for Epogen in hospital-based facilities, resulting in a
difference of $18 million. We then calculated a weighted average of the
percentages by which ASP minus 3 percent would be below current
Medicare reimbursement prices for the top 10 ESRD drugs. We weighted
these percentages by using the 2002 Medicare reimbursement values
contained in the OIG report for the ten drugs. This procedure resulted
in a weighted average of 19 percent. Since these ten drugs represented
98 percent of drugs payments, we applied the weighted average to 100
percent or all of aggregate drug spending projections for independent
facilities, producing a projected difference of $516 million.
Combining the 2005 figures of $18 million and $516 million, for a
total of $534 million and then distributing this over a total projected
36.5 million treatments would result in a single add-on to the per
treatment composite rate
[[Page 47529]]
of 11.3 percent. By making this adjustment to the composite rate, we
estimate that the aggregate payments to ESRD facilities would be budget
neutral with respect to drug payments.
Alternatively, we could produce separate drug add-on adjustments
for hospital-based and independent facilities using the same
methodology. Under this option, we could distribute the $18 million
difference in EPO payments to hospital-based facilities based on data
projecting 5.1 million treatments resulting in a hospital-based
facility drug add-on adjustment of 2.7 percent. We would distribute the
$516 million difference in drug payments (including EPO) to independent
facilities using projected treatments of 31.4 million, resulting in a
drug add-on adjustment of 12.8 percent for independent facilities.
Drug prices used in the computation of the proposed drug add-on
adjustment to the ESRD composite payment rate, may be revised based on
later data and will be reflected in the final rule.
3. Composite Rate Effect of Proposed Drug Add-On Adjustment
We used a single drug add-on adjustment for both hospital-based and
independent ESRD facilities, the proposed adjustment to the composite
rate would be 1.113. Separate adjustments would provide a 1.128
adjustment for independent facilities and 1.027 for hospital-based
facilities. The following table illustrates the effect on the composite
payment rates under the two potential drug add-on options. (Case-mix
budget neutrality adjustments are not reflected in this table).
Table 14
------------------------------------------------------------------------
CY 2005 Separate Single add-
Facility type base rate add-on on
------------------------------------------------------------------------
Independent...................... $128.35 $144.78 $142.85
Hospital Based................... 132.41 135.99 147.37
------------------------------------------------------------------------
Under the single add-on, the proportionately higher rate for
hospital-based facilities would be consistent with section 1881(b)(7)
which requires that our payment methods differentiate between hospital-
based facilities and others. Separate add-on adjustments would result
in a significantly higher composite payment rate for independent
facilities, than hospital-based facilities, that is, $8.79 higher per
treatment.
d. Patient Characteristic Adjustments
1. Statutory Authority
The current ESRD composite payment rates do not adjust for
variation in patient characteristics or case mix. Section
1881(b)(12)(A) of the Act, as added by section 623(d)(1) of the MMA,
requires that the outpatient dialysis services included in the
composite rate be case-mix adjusted. Specifically, the statute states
that ``The Secretary shall establish a basic case-mix adjusted
prospective payment system for dialysis services furnished by providers
of services and renal dialysis facilities in a year to individuals in a
facility and to individuals at home. The case-mix under the system
would be for a limited number of patient characteristics.'' In the
following sections, we describe the development of the methodology for
the proposed patient characteristic case-mix adjusters required under
the MMA.
2. Background
Case-mix measures utilizing patient characteristics have been used
in a number of prospective payment systems. Use of a case-mix measure
permits targeting of greater payments to facilities that treat more
costly resource-intensive patients. However, the legislative mandate to
establish a case-mix adjustment for services included in the composite
rate based on a limited number of patient characteristics presents a
unique challenge.
The composite rate represents payment for a fixed bundle of routine
services provided to ESRD patients as part of a dialysis treatment.
Generally, the items and services needed to provide a dialysis
treatment do not vary significantly across patients. Moreover, the
bills for composite payment rate services furnished to ESRD patients,
which are generally submitted monthly, do not identify the specific
items and services provided on a case-by-case basis. In addition, the
Medicare cost reports identify only aggregate costs for composite rate
services at the facility level. Therefore, any case-mix adjustment
based on patient characteristics obtained from the bills for outpatient
ESRD services and applied to the composite rate will reflect only
variation in composite rate costs at the facility level.
Earlier research by Hirth (1999) and Dor (1992) found that if case-
mix adjustments applied only to composite rate items and services the
adjustments played a limited role in predicting variation in costs per
treatment because case-mix and dialysis treatment patterns are very
similar across facilities. However, more recent analyses conducted
under our contract with the University of Michigan, Kidney,
Epidemiology and Cost Center (KECC) found that patient level case-mix
adjustment would be more relevant in a bundled payment system that
includes both composite rate and separately billable items and
services. KECC's research studies relied on an extensive set of
variables to define patient case-mix. These variables included patient
characteristics, a large number of specific comorbidities and clinical
measures (including primary diagnosis) and other (non-Medicare)
insurance coverage, as well as the duration of ESRD. We relied on
linear regression analyses used in the studies to assess the
relationship of patient characteristics and comorbidity measures to per
session cost and Medicare payments to facilities. These studies relied
on data from our administrative files.
We are continuing and expanding the research project in support of
the development of a fully bundled case-mix adjusted system. We are
continuing to explore alternative models and options with more detailed
analysis of patient characteristics as part of the legislatively
mandated report to the Congress in the fall of 2005.
Despite the difficulty in developing a patient characteristic case-
mix adjustment, we were able to develop case-mix adjustment factors for
a limited number of patient characteristics, consistent with the
legislative mandate. As expected, these adjusters are only modest
predictors of variation in average costs for composite services. In
developing the proposed patient characteristic adjustments, we used our
available administrative data. Because facilities do not list
individual composite rate items and services on the dialysis bill,
billing data do not identify resources used by each patient. In
[[Page 47530]]
addition, facilities can underreport or not report comorbid conditions.
Therefore, these bills are not useful for deriving average facility
input costs. Since there are not any current requirements to list
comorbid conditions on the dialysis bill, we used a combination of data
sources to determine co-morbidities for ESRD patients on maintenance
dialysis. These include the Medicare claims history file as well as the
CMS Form 2728 (ESRD Medical Evidence Report) which provides information
on the cause of ESRD and lists 20 possible co-morbidities present at
the onset of a patient's ESRD. The Form 2728 is completed only at the
initiation of dialysis treatment. It is not updated to reflect more
recent medical conditions.
Nonetheless, we found selected variables from the Form 2728 to be
valid predictors of cost per treatment for the proposed case-mix
adjustment, and the Form 2728 was also useful in developing our
proposed case-mix adjustments. As discussed below, the Form 2728
variables were supplemented by additional information we obtained from
billing records.
3. Development of the Proposed Adjustments for Patient Characteristics
We are proposing a methodology to establish a basic case-mix
adjusted composite rate system using a limited number of patient
characteristic variables developed from existing our administrative
files. We analyzed a number of patient level variables including age,
gender, alcohol and drug dependence, inability to ambulate/transfer,
current smoker, number of years since ESRD onset, weight, height, mean
BUN, and mean creatinine clearance, as well as a number of
comorbidities.
As a means to estimate how average cost variations among facilities
are influenced by selected patient characteristics, extensive analyses
were performed to develop a proposed ``basic case-mix adjusted PPS, for
a limited number of patient characteristics,'' as specified in the
statute. We analyzed the average cost per dialysis session (including
both hemodialysis and Method I peritoneal dialysis converted to
equivalent 3 times per week hemodialysis sessions) from national data
gathered for the years 2000, 2001, and 2002.
A stepwise regression was used to select a limited set of variables
that were predictive of average facility cost per treatment. We used
data pooled over a three-year period because we found the regression
coefficients to reflect a consistent pattern over three years. We used
data pooled over a three-year period to minimize the potential for
volatility in the regressive coefficients. The analysis controlled for
selected variables that influence facility costs, but are not case-mix
related. These variables included wage index, the natural log of the
number of dialysis sessions provided annually by the facility, type of
facility, chain affiliation, and percentage of patients with urea
reduction ratio (URR) as a measure of dialysis dose equal to or greater
than 65 percent. The proposed model is based not only on the predictive
power of these measures, but also upon objectivity (for example,
discrete variables: age/gender), clinical plausibility, and
practicality (that is, availability) of data collection. The variables
used were assessed for their clinical plausibility by clinicians from
the University of Michigan and CMS. Physicians assessed a proposed list
to determine relationship of the proposed comorbidities to ESRD
patients, and clinical practice/patterns.
In addition to exploring a number of potential case-mix variables,
we examined two methods, that is, linear and log linear models of the
composite rate costs. We selected the log linear model in order to
yield patient specific case-mix adjustments which can be multiplied by
a dialysis facility's otherwise applicable composite rate payment. In
this proposed rule, we provide a detailed example of the calculation of
the proposed case-mix adjusted composite rate payments.
4. Proposed Patient Characteristic Adjustments
As discussed in the background section above, the basic case-mix
system is constrained by the composite rate and the data available for
these adjustments. While we analyzed a number of variables, four
patient characteristic variables were found to be modest predictors of
cost variation among ESRD facilities. These patient characteristic
variables include gender, age, and two comorbidities (AIDs and PVD)
(See table 3 for specific ICD 9 codes for these comorbidities). Each of
the gender categories was also divided into three age categories so
that one adjustment factor could be developed to encompass both gender
and age. The proposed patient characteristic adjustments are discussed
below.
i. Gender and Age
We are proposing adjustments for both gender and age. We found that
gender and age were strong predictors of facility cost variations. In
addition, data on gender and age are readily available, and are
objective measures. After examining a number of options for age, we are
proposing under 65, 65-79, and over 80 as the three categories for age.
We attempted to develop a case-mix adjuster specific to the under 18
age group. However, the population in that age group that was included
in the data used to develop the case-mix adjustments was too small, and
was generally concentrated in a very small number of facilities.
While we recognize that pediatric patients are more costly to
treat, those patients are generally treated in specialized pediatric
facilities. As provided in MMA, those facilities can request
adjustments to their composite payment rates through the exceptions
process. This process will enable pediatric facilities to obtain
payments that specifically recognize the higher cost associated with
treating these patients. In developing the age adjustments, data for
those patients were grouped into the under 65 age category. We note
that adjustments for both gender and age are consistent with the MA
risk adjustment models for ESRD patients.
ii. Proposed Comorbidity Adjustments
As discussed above, the effect of the costs of dialysis for a
number of conditions were analyzed. These included several
comorbidities that did not have a statistically significant
relationship to facility costs. In other cases, the lack of data
precluded inclusion of a comorbid condition in the proposed patient
characteristic adjustments. That is, we are unable to propose any
adjustments based on data that cannot be routinely reported, (for
example, some data elements that are reported only on the Form 2728).
For the reasons discussed above, the Form 2728 is not an appropriate
source of information since it is not updated after a patient enters
the ESRD program. Two variables not currently available on the Medicare
bill are weight and height. Weight and height are used to compute a
patient's body mass index (BMI). Our analysis indicates that patients
with extremely low or high BMI are costly to treat. Since BMI is
directly related to a patient's dialysis prescription, we believe this
factor could be an important measure of resource consumption related to
the composite payment rate. We also believe that the length of time a
patient is dialyzed could directly affect composite rate costs. We are
currently exploring the feasibility of developing a mechanism to
collect these data on the ESRD bill. In addition, we are soliciting
comments on other data elements that could be added to the bill
[[Page 47531]]
that could be relevant predictors of composite rate costs.
We also examined whether having cancer was predictive of higher
resource used. We examined all cancers reported within the last 3 to 10
years as reported on our claims history file or the Form 2728. While a
patient's history of cancer was associated with higher costs, we found
this measure to be too broad to be clinically meaningful. We will
continue to evaluate this condition as a potential variable for
refinement purposes. As ESRD facilities begin reporting patient
comorbidities, we expect that we will be in a better position to
identify the specific cancer diagnoses that may be related to increased
composite rate costs.
We also explored whether diabetes as a comorbidity is predictive of
high resource use. We found that the predictive power of diabetes was
dependent on whether PVD was part of the model. PVD was always
statistically significant, when accounted for, while most measures of
diabetes were not strongly associated with facility costs. Therefore,
we are proposing a case-mix adjustment for PVD diagnoses. We believe
this adjustment appropriately addresses the higher costs associated
with sicker diabetic patients. We note that about 73 percent of
diabetes patients included in our data also had PVD. Another comorbid
condition that was found to be a significant predictor of facility cost
is AIDs. This diagnosis is currently coded as part of the claims data.
Another Form 2728 variable we examined was the presence of a
substance (alcohol and drugs) dependence diagnosis. While the presence
of substance abuse was found to be predictive of higher facility level
costs, we are not proposing an adjustment for this comorbidity at this
time since the substance abuse diagnosis is underreported on the
claims. We are soliciting comments on the variables included in the
proposed patient characteristic adjustment as well as recommendations
for the inclusion of other potential variables that may affect the
costs of dialysis.
In summary, we are proposing to use a limited number of patient
characteristics that do explain variation in reported costs for
composite rate services consistent with the legislative requirement.
The proposed adjustment factors are as follows:
Table 15
------------------------------------------------------------------------
------------------------------------------------------------------------
Female........................ age <65 years.................. 1.11
age 65-79 years................ 1.00
age >79 years.................. 1.16
Male.......................... age <65 years.................. 1.21
age 65-79 years................ 1.17
age >79 years.................. 1.23
AIDS.......................... ............................... 1.15
PVD........................... ............................... 1.07
------------------------------------------------------------------------
While the magnitude of some of the patient specific case-mix
adjustments appears to be significant, facility variation in the case-
mix is limited. This is because of the overall similarity of the
distribution of patients among the eight case-mix classification
categories across facility classification groups. This is reflected by
the average case-mix adjustment based on 2002 data for the various
types of ESRD facilities shown in the table below.
Table 16
------------------------------------------------------------------------
Average case
Facility type mix adjustment
------------------------------------------------------------------------
All..................................................... 1.1919
Independent............................................. 1.1917
Hospital Based.......................................... 1.1936
Urban................................................... 1.1931
Rural................................................... 1.1865
Small (<5k treatments/yr.).............................. 1.1911
Medium (5-10k treatments/yr.)........................... 1.1910
Large (>10k treatments/yr.)............................. 1.1924
Non-profit.............................................. 1.1924
For-profit.............................................. 1.1918
------------------------------------------------------------------------
As illustrated from this table, regardless of the type of provider,
the average case-mix adjustments for patient characteristics do not
vary significantly. We are continuing research to develop a more fully
bundled proposed model that is not constrained by the existing
composite rate. We will continue to study the predictive value of
comorbidities and facility and patient level variables as part of the
ongoing research. In addition, we are aware that by limiting the number
of variables for the patient characteristics adjustment applicable to
the composite payment rate, we are limiting the predictive power of the
model. We are planning to consider additional variables to refine and
update the proposed patient characteristics. Once we have implemented
this basic case-mix system, we will continue to analyze comorbidities
(on the reported claims file) and will consider expanding the list of
variables used in the patient classification adjustment. In addition,
we will be working with our fiscal intermediaries to improve the
reporting of comorbidities on claims.
5. Technical Description of Model Used To Develop the Proposed Patient
Characteristic Adjustments
Both facility and patient level variables were used for the
development of the proposed case-mix adjustment. Facility costs are
based on Medicare allowable costs reported by facilities for dialysis
and related services for which they are reimbursed through the
composite rate. The sources of the cost data are the Medicare
Independent Renal Dialysis Facility Cost Reports (Form CMS 265-94) and
the Medicare Hospital Cost Reports (Form CMS 2552-96). We used the most
current set of facility cost reports available (cost reports updated
through December 2003 and made publicly available in March 2004).
All cost reports spanning any part of calendar years 2000, 2001 or
2002 were included in the development of the case mix adjusters. While
for most facilities, especially independent facilities, a single cost
report encompasses the entire calendar year; data for some facilities,
most notably those whose reporting period spans two calendar years (for
example, October through September rather than January through
December) were pro-rated to calculate the average treatment cost during
a calendar year. The resulting numbers of cost reports used in the
analyses are shown in the table below by facility type and year. Note
that currently there are fewer cost reports available for analysis in
2002 because many facilities have not yet submitted cost reports for
that year. The final version of this regulation will contain the most
recent data available.
Table 17
------------------------------------------------------------------------
2000 2001 2002
------------------------------------------------------------------------
Independent facilities....................... 3,027 3,034 2,508
Hospital-based facilities.................... 477 466 456
------------------------------------------------------------------------
The average treatment cost per dialysis session for each facility
was calculated by dividing the total reported cost for dialysis and
related services by the total number of dialysis treatments. The source
of the reported cost for independent facilities was Worksheet B from
Form CMS 265-94 and, for hospital-based facilities, Worksheet I-2 (Form
CMS 2552-96). The source for the total number of dialysis treatments
for independent facilities was worksheet Form CMS265-94 and, for
hospital-based facilities, worksheet I-4 (Form CMS 2552-96). Note that,
for CMS Form 2552-96 and CMS Form 265-94, values
[[Page 47532]]
in the fields for renal dialysis and home program dialysis were used in
the cost and treatment calculations. For the CMS Form 265-94 and the
CMS Form 2552-96 (Worksheet C, and worksheet I-4, respectively) values
in the field home program CAPD and home program CCPD were stated in
terms of patient weeks, rather than the number of treatments. These
cells were multiplied by three to make them comparable to the number of
hemodialysis sessions per week. The method used was consistent with the
research (Dor, Held, Pauley 1992, Hirth, et.al., 1999, Griffiths,
et.al., 1994, and Ozgen and Ozcan, 2002).
This method created an average Medicare allowable cost per dialysis
treatment for each facility year of observation. Using the facility's
Medicare billing number, cost report data were linked to claims data.
For some facilities more than one billing number appears on claims and
a list of correspondence among billing was used to link the claims to
the cost report facility identifiers. This linkage was somewhat
ambiguous for hospital facilities with satellite centers.
Patient level data was obtained from the Medicare claims data, and
the Medical Evidence Form (CMS 2728). ESRD patients were identified
using the Renal Beneficiary and Utilization System (REBUS), Medical
Evidence and Master Patient File Records. Dialysis-related services
(for example, the number of dialysis sessions) were identified for ESRD
patients by Billing source (72x: renal dialysis facility bills),
revenue center codes and the Healthcare Common Procedure Coding System
(HCPCS).
6. Study Sample
Regression models for the average cost per session were used to
estimate the typical cost per session. The average cost per session can
be influenced by facilities with exceptional costs or with exceptional
case-mix measures. To insure that the sample would characterize the
patterns across the majority of facilities rather than being influenced
by a few exceptional, non-representative facilities, the following
facilities were excluded:
Facilities with missing data from the cost reports or
claims data. Twelve percent of the facilities lacked reported data.
Facilities with high or low average costs.
Facilities with exceptions.
Facilities with extremely high or low proportions of
patients with relevant medical cormorbidities.
Small facilities.
Facilities with high or low average costs were determined based
upon their composite rate. Facilities, having values for the log of the
ratio of average costs to the composite rate of less than minus 0.5 or
greater than 1.0 were excluded. This excluded less than 1 percent of
facilities. Some facilities, that is, those with extremely high or low
values based on selected patient characteristics (for example, percent
of patients having a specific comorbidities such as AIDs, HIV, or
alcohol and drug dependence) and selected facility characteristics (for
example, facility size or URR). As with average costs, facilities with
extreme variables did not represent the normal distribution of patient
characteristics across facilities. This excluded 1.6 percent of the
facilities. In addition, we excluded small facilities with less than 20
full patient years of dialysis during the year because it was difficult
to assess the relationship between case-mix and facility costs based on
the experience of a small number of patients. Facilities treating a
small number of patients represented approximately 6.9 percent of the
total facilities.
The sample excluded facilities with exceptional reimbursement
levels. These included facilities with exceptions, facilities with
higher than average payments, for example, with $3.00 or greater than
the predicted composite rate payments. We excluded facilities based on
our list of exceptions granted from November 1993 to July 2001. Some
facilities were not included within the sample because their average
payments were greater than the calculated (predicted) composite rate
for the individual facility. While for the majority of the facilities,
average composite rate payments were exactly as predicted, for some
facilities, the payments were $3.00 greater than the predicted rate.
These facilities were excluded because they were likely to be
facilities with errors in reporting or facilities with exceptions. Of
all of the facilities in the sample, 7.5 of the facilities were
excluded from the sample.
7. Developing Case-Mix Measures at Each Facility Based on Patient-
Specific Data
Facility-level case-mix measures were defined using certain
demographic and comorbidity indicators for the Medicare dialysis
patients in each facility for CYs 2000 to 2002. In aggregating patient
data by facility, case-mix measures for each patient were weighted by
the number of hemodialysis-equivalent dialysis sessions received in
each facility. This process gives approximately 12 times as much weight
to the characteristics of patients receiving a full year of dialysis
care at a particular facility as compared to a patient receiving only
one month of care at that facility. The resulting facility-level case-
mix measures reflect how case-mix is distributed across individual
treatments provided in the facility for Medicare dialysis patients. The
number of dialysis sessions for each patient in each facility was
obtained from Medicare outpatient institutional dialysis claims. The
number of peritoneal dialysis patient days reported on each claim was
multiplied by 3/7 to yield the number of hemodialysis-equivalent
dialysis sessions provided during the time period covered by each
claim. (For additional information see Phase I KECC Report, dated
August 2002, p. 43).
8. Statistical Models
We explored a number of statistical methods to model the
relationship between composite rate costs and patient/facility
characteristics. We explored both linear and log-linear ordinary least
squares regression models for each year from 2000 to 2002 to predict
the natural log of the ratio of each facility's composite rate costs
divided by that facility's composite payment rate (without regard to
exception payments).
i. Choice of Estimation Method
We are proposing to use the log linear model in the methodology
explained below in order to yield an easily administered case-mix
adjuster which can be multiplied by the patient's otherwise applicable
composite payment rate. This case-mix adjustment system also controls
for selected variables.
We used the cost to payment ratio (that is, the natural log of the
ratio of reported costs compared to the composite rate calculated for
each facility) as the dependent variable in the models. The analysis
that supports our decision is described in detailed below. In order to
determine how reimbursement levels could be adjusted to reflect the
costs of treating different patients, estimates of how the cost of
providing dialysis services (that is, the composite rate) varies
according to the patient characteristics (for example, age gender and
comorbidities) were completed. Because the reported cost per treatment
for each facility, in part, reflects the level of reimbursement (for
example, Medicare payments) that the facility received, the measure of
facility costs used is defined as the ratio relative to the current
standard reimbursement level for each facility. For the purposes
[[Page 47533]]
of these analyses, the standard Medicare reimbursement payments for
composite rate services (excluding those facilities with payment
exceptions) were used. These currently vary across facilities based on
the application of the area wage index used to develop the patient
characteristics adjustment. This wage index (that is, labor costs) was
used to account for regional differences in labor costs, and includes
an adjustment for hospital based versus independent facility status.
As we have indicated, the costs of treatment varies from the
composite rate payment for a number of reasons, including differences
in the patient case-mix. The ratio of average reported costs at each
facility were compared with the calculated composite rate payment in
order to measure any variation in costs (that is, facility costs) from
the composite rate. This cost to payment ratio measures the extent to
which costs at a facility are higher or lower than the payment that
would be expected based on their labor costs and facility type.
Regression analysis was used to determine the extent to which the ratio
varied with the average case-mix for each facility.
The analysis indicated that a log transformation of this cost to
payment ratio was less skewed and a better fit (that is, the predicted
variables were closer to the actual values using the log
transformation).
ii. Control Variables
Apart from patient clinical and demographic characteristics, the
proposed model also controls for selected other variables. These
selected control variables include the wage index, the natural log of
facility size (number of annual treatments), hospital-based/independent
status, chain affiliation, and percent of patients with urea reduction
ratios (URRs) greater than or equal to 65 percent. These control
variables were included in the proposed model in order to account for
the separate effect of facility variables and one readily available
outcome variable on composite rate costs. These control variables were
included in order to reduce potential distortion in the patient
specific case-mix adjustors attributable to facility characteristics.
We included the wage index to account for differences among facilities
in area wage levels. We used facility size as a control factor because
larger facilities, on average, have lower per treatment costs than
smaller facilities. The hospital-based/independent classification was
used because hospital based providers tend to have higher self-reported
costs. Chain ownership is included in the model to account for
differences among chains due to reporting conventions, as well as
reflect similarities among facilities within chains. The URR was
included as a control variable to account for a quality of care outcome
measure at each facility, thereby mitigating any potential bias between
composite rate costs and quality of care on the model's coefficients.
iii. The Log-Linear Model for Facility Costs
We identified a limited number of comorbidities that are strong
predictors of composite rate costs and developed an estimated
adjustment factor for each of these comorbidities. In order to yield an
adjustor that can be multiplied with the composite rate payment, the
model was used to estimate the facility's reported composite rate costs
per treatment, divided by the composite payment rate calculated for
each facility. The resulting ratio was modeled using case-mix and
control variables. Analysis indicated that a log transformation of this
ratio was less skewed and was better fit by the model (that is,
predicted values were closer to actual values using the log
transformation, especially for high cost facilities).
For facility j, the case-mix is measured by a vector of values,
denoted by Xj. These values include both control variables
and case-mix measures. The log of the ratio of cost per session
(Cj) to composite rate (Rj) is denoted by
Yj=log(Cj/Rj). The multiple
observations for three years are not indicated explicitly. The model
equation is Yj = Xj [beta] + [egr]j,
where [beta] is the vector of coefficients for the predictor variables
and [egr]j is an error term. This model is equivalent to the
following model for cost for patient i, with a vector of individual
characteristics Xij, at facility j: Cij =
Rj eXij[beta].
9. Identifying Factors for Case-Mix Adjustment
An evaluation of individual case-mix factors as potential risk
adjusters was performed using several criteria to explain variation in
facility costs. Consideration was also given to the validity of these
potential case adjustors to costs based on clinical judgment, the
stability of this relationship over time, the objectivity and accuracy
of the data used to compute the factors, the reliability of information
reported by different providers, and the feasibility of including them
as risk adjusters.
Case-mix factors that explained statistically significant variation
in facility costs were identified based on a regression model that used
a stepwise selection method. Unless otherwise specified, case-mix
measures represent the fraction of dialysis sessions in each facility
that were provided to patients having the relevant characteristic or
comorbidity. Case-mix measures that were considered for selection in
the model included age/gender groups (ages <65, 65-79 and 80+ years,
separately for females and males), less than one year of treatment for
ESRD, average weight among adult dialysis patients (ages>=20), low body
mass index among adult dialysis patients (BMI<18.5 kg/m\2\) and the
presence of individual comorbidities that were previously described
that were developed from a combination of data from the Medicare claims
history file and the CMS Form 2728.
10. Using the Model To Apply a Patient-Specific Case-Mix Adjustment to
the Composite Rate
The regression coefficients that are estimated using facility cost
model we discuss above can be used to apply a patient-specific case mix
adjustment to the composite rate. This is accomplished by re-
transforming the estimated coefficients to obtain relative factors for
case mix adjustment. Based on a facility level cost model, where
Xn is the proportion of patients in a facility having a
specific characteristic (for example, a specific comorbidity), a one
unit change in Xn can be used to characterize the difference
between having and not having a specific patient characteristic. The
coefficient for Xn,[beta]n, then estimates the
change in the dependent variable (the natural log of the ratio of
average composite rate costs to the composite rate) corresponding to
whether or not a patient has that characteristic. The estimated
coefficients can be re-transformed as e Xin[beta]tv to
obtain relative factors for n=1 to N case-mix measures included in the
model.
The relative factors can then be applied multiplicatively to the
composite rate in order to derive a case mix adjusted composite rate.
Since these relative factors were all estimated to have values of 1.00
or greater, an adjustment to the composite rate based on these factors
would necessarily lead to higher payments by Medicare. However, the MMA
provision requires that the modification to the composite rate payment
system be budget neutral. For the purpose of this example only, a
budget neutrality factor that is less than 1.00 must, therefore, also
be applied, with the same factor being applied to all patients and all
facilities.
For patient i in facility j, a case-mix adjusted composite rate,
ARij is
[[Page 47534]]
calculated as a function of the current composite rate, Rij,
the estimated budget neutrality factor, N (to be determined), and an
overall relative factor for case mix adjustment, Aij, where
ARij = Rj * N * Aij, Rj =
([rho]BjWj + (1-[rho])Bj, and
Aij = eXij[beta].
In the above equations, [rho] is the fraction of costs attributed
to labor and therefore subject to an adjustment for geographic
differences in wages, 1-[rho] is the fraction of costs attributed to
non-labor inputs, Bj is the base rate for facility j,
Wj is the CMS/BLS wage index for facility j (with 0.9 and
1.3 representing the minimum and maximum values for Wj,
respectively), Xij is a vector of case-mix measures for
patient i at facility j, and B is the vector of coefficients estimated
by the regression model. Parameters Pj and Bj
vary according to whether facilities are independent or hospital-based
and may also vary over time, while Wj is determined either
by the MSA in which each facility is located or by the state location
for facilities not in an MSA.
As suggested by the equations above, the coefficients estimated by
the cost model can be used to derive an aggregate relative adjustment
factor for each patient (Aij) based on their individual
characteristics (Xi). By applying this factor in a
multiplicative fashion to the composite rate, it is also being applied
multiplicatively to the wage index, so that the dollar effect of the
case-mix adjustment also varies across facilities according to regional
differences in labor costs. That is, the case-mix adjustment will be
larger in magnitude for facilities that face relatively high labor
costs. This is appropriate if we expect the higher level of care that
may be necessary for certain types of patients, such as those with PVD,
to require additional staff time or more highly trained staff in
locales with differential wage levels. An overall relative case-mix
adjustment factor for patient i, Ai, can be calculated based
on the model as Ai = eXi[beta] =
eX1i[beta]\1\ + X2i[beta]\2\ + +
Xpi[beta]\p\.
However, since this is equivalent to Ai =
eXi[ballot] =
eX1i[ballot]\1\*eX2i[ballot]
\2\* . . . *eXni[ballot]\n\, the overall relative
case-mix adjustment factor, or patient multiplier, can be calculated by
multiplying together the relative adjustment factors for each case-mix
measure. For every n=1 to p, Xpi corresponds to a 1 if that
characteristic is present and a 0 if that characteristic is not
present. For any characteristic that is not present, Xpi=0
and eXpi[ballot]\p\=1, such that the equation can
be simplified by including only those terms that are relevant for each
patient. For characteristics that are present, Xpi=1, and
the equation can be further simplified by dropping Xpi.
Where the individual factors for case-mix adjustment are age/
gender, PVD and AIDS, the equation used to calculate the relative
factor for case mix adjustment can then be expressed as Ai
=e[beta] = e[beta]\AS\*e[beta]\PVD\*e[beta]\AIDS\ where e[beta]\AS\ is
the relative factor for the appropriate age and sex category (one of
six age/sex groups), e[beta]\PVD\ is the relative factor for the
relevant PVD category (whether PVD is present or absent) and
e[beta]\AIDS\ is the relative factor for the appropriate AIDS category
(whether AIDS is present or absent).
11. Example
To illustrate, the proposed adjustment factors in section 4. above
were used to derive a case-mix multiplier for a 7-year old male who has
been diagnosed with PVD, but not AIDS. Using the proposed adjustment
factors that correspond to males between the ages of 65 and 79 years
and the presence of PVD, the overall case-mix multiplier for this
patient is calculated as A = e\Xb\ = e[beta]\AS\*e[beta]\PVD\ = 1.17 x
1.07 = 1.2519.
A detailed example of the computation of the adjusted composite
payment rate that includes the patient characteristics adjustments, as
well as the applicable adjustments related to the ESRD drug payment
revisions and budget neutrality, is provided later in this section I.
below.
e. Geographic Index
Section 623(d)(1) of the MMA provides that the Secretary shall
adjust the payment rates under this section by a geographic index as
the Secretary determines to be appropriate. This section also specifies
that, if the Secretary revises the current geographic adjustments
applied to the composite payment rate, the revised adjustments must be
phased in over a period of time. The current geographic adjustment
(wage index) is a blend of two wage indexes, one based on hospital wage
data collected by us from fiscal year 1986 and the other developed from
1980 hospital wage and employment data from the Bureau of Labor
Statistics (BLS). The hospital and BLS proportions of the blended wage
index are 40 percent and 60 percent. The actual wage index values and
MSA/non-MSA designations currently used in connection with the
composite rates were published in the August 15, 1986 Federal Register
(51 FR 29412-29417). For the reasons discussed below, we have decided
not to propose any changes to the current wage index adjustments at
this time.
On June 6, 2003, OMB issued Bulletin 03-04 that announced new MSAs
and two new sets of statistical areas, Micropolitan Statistical Areas
and Combined Statistical Areas (CSAs). We recognize that the new OMB
definitions will have implications for the various payment systems we
administer that reflect payment distinctions based on geographic
location. Any changes adopted will not only result in payment
redistributions among ESRD facilities, but will also affect hospitals,
home health agencies, skilled nursing facilities, and rehabilitation
providers.
Therefore, it is essential that we evaluate any proposals to revise
the area definitions and assess the impact of changes in geographical
areas on those payment systems that incorporate adjusters for area wage
levels among urban and rural locations.
Although the MMA gives the Secretary discretion to revise the
outdated wage indexes used in the composite rates, we believe that we
should take no action to replace them with revised measures pending
completion of our assessments.
Therefore, we are proposing to take no action at this time to
revise the current set of composite rate wage indexes and the urban and
rural definitions used to develop them. Once revisions to the urban and
rural definitions are adopted, we may be in a better position to
propose revisions to the geographic adjustments applied to the case-mix
adjusted composite payment rates.
For purposes of applying the required geographic adjustments to the
case-mix adjusted composite rate payment system, we are proposing to
continue using the wage index values and urban and rural designations
that are currently applied to the composite payment rates.
Section 1881(b)(12)(E)(i) of the Act, as added by section 623(d)(1)
of the MMA, requires that the basic case-mix adjusted composite rate
system be designed to result in the same aggregate amount of
expenditure for such services, as estimated by the Secretary, as would
have been made for 2005 if that paragraph did not apply. Therefore, the
drug add-on adjustment and the patient characteristics case-mix
adjustment required by section 623(d)(1) of the MMA must result in the
same aggregate expenditures for 2005 as if these adjustments were not
made.
With respect to the drug payment add-on adjustment the total
estimated difference between the current drug payment based on 95
percent of AWP and the payment amount generated from payment based on
ASP minus 3 percent is reflected in the proposed adjustment which is
designed so that aggregate
[[Page 47535]]
payments are budget neutral. (See section H.4.c.2. of this proposed
rule for more detailed explanation of drug add-on adjustment).
In order to account for the payment effect related to the case-mix
adjustment, we standardized the composite rate by dividing the rate by
the average case-mix modifier of 1.1919. (See section 4.ii Proposed
Cormorbidity Adjustments). The resulting adjustment to the composite
rate is .8390. However, we were not able to simulate the case-mix
effects from the ESRD billing file because comorbidities are generally
not included on the ESRD bill. (See section H.3. of this proposed rule
for the discussion of the data issues.) We propose to refine our
adjustments for case-mix once we have more complete data on the ESRD
bill.
F. Payment Exceptions and the Revised Composite Payment Rates
Before the enactment of BIPA, an ESRD facility could apply for and
receive prospective adjustments or exceptions to its otherwise
applicable composite payment rate under specified circumstances.
Section 1881(b)(7) of the Act and Sec. 413.182 contain the statutory
and regulatory authorities for the provision of exceptions to the
composite payment rates. Section 422(a)(2) of BIPA prohibited the
granting of new exceptions to the composite payment rates on or after
December 31, 2000, except under very limited circumstances, which
expired July 1, 2001. That prohibition remains in effect, with one
exception. Section 623(b) of the MMA amended section 422(a)(2) of BIPA
to afford pediatric facilities the opportunity to seek exceptions
provided they did not have an exception rate in effect as of October 1,
2002. The statute defines a pediatric facility as a renal facility, 50
percent of whose patients are under age 18. On April 1, 2004, we opened
an exception window for pediatric facilities. The exception window
closes September 27, 2004.
Section 422(a)(2)(C) of BIPA provided that any ESRD composite rate
exception in effect on December 31, 2000 would continue as long as the
exception rate exceeds the applicable composite payment rate. The MMA
did not revise that provision. Comparisons of a provider's exception
rate and the standard composite payment rate are straightforward,
because each payment rate was applied on a facility specific basis,
without any adjustments for case-mix. However, in this proposed rule,
we are proposing revised composite payment rates that are case-mix
adjusted. The wage adjusted composite payment rates listed for each
urban and rural area noted in Tables I and II at the end of this
section, although applied on a per treatment basis, are subject to case
mix adjustments in accordance with section 623(d)(1) of the MMA. The
proposed methodology for applying patient characteristic adjusters
applicable to each treatment will determine the case-mix adjustment
which will vary for each patient. Thus, an ESRD facility's average
composite rate per treatment will depend on its unique case mix.
Our policy was not to increase any ESRD facility's exception rate
when there has been a congressionally mandated update to the ESRD
composite payment rates. When computing an exception amount, we take
into consideration the ESRD facility's patient population and the
higher costs relating to the patient mix. Since ESRD facilities can
maintain their current exception rates, we would expect them to compare
the exception rate to the basic case-mix adjusted composite rate to
determine the best payment rate for their facility. We are proposing to
allow each dialysis facility the option of continuing to be paid at its
exception rate or at the basic case-mix adjusted composite rate (which
includes all the MMA 623 payment adjustments). If the facility retains
its exception rate, it would not be subject to any of the adjustments
specified in section 623 of the MMA. Whether a provider's exception
rate in effect on December 31, 2000 will exceed its average case-mix
adjusted composite payment rate is impossible for us to accurately
determine. We believe that projections as to whether an ESRD facility's
exception rate per treatment will exceed its average case-mix adjusted
composite rate per treatment are best left to the entities affected.
Therefore, we are proposing that each ESRD facility with composite rate
exceptions currently in effect, and each pediatric ESRD facility
granted an exception, must notify its fiscal intermediary in writing if
it wishes to withdraw its exception and be subject to the basic case-
mix adjusted composite payment rate methodology set forth in this
notice.
We are proposing to allow an ESRD facility to notify its fiscal
intermediary at any time if it wishes to give up its exception rate.
Once a facility has notified its fiscal intermediary of its election to
give up its exception rate, it would lose that exception rate,
regardless of basis or amount, and be subject to the proposed case-mix
adjusted composite payment rates beginning 30 days after the
intermediary's receipt of the facility's notification letter.
Facilities with exception rates will be required to notify their fiscal
intermediaries only if they wish to forego their exceptions. ESRD
facilities electing to retain their exceptions do not need to notify
their intermediaries. ESRD facilities without exceptions, of course,
will be subject to the composite payment rates determined using the
basic case-mix methodology described in this notice beginning January
1, 2005.
G. Summary of Composite Rate Revisions and Proposed Implementation
As set forth in this proposed rule, we will increase the ESRD
composite payment rates by 1.6 percent effective January 1, 2005 in
accordance with section 623(a) of the MMA. Also, the composite payment
rates will be increased to reflect revisions to the drug pricing
methodology for separately billable drugs, as discussed in section
H.4.b. of this proposed rule. That increase represents the spread or
difference between the payment amounts for separately billable drugs
and biologicals and their acquisition costs based on the OIG's May 2004
report to the Secretary. The development and computation of the drug
add-on adjustment are described in section H.4.c of this proposed rule.
We have also proposed a basic case-mix methodology for adjusting the
composite payment rates based on a limited number of patient
characteristics, as prescribed in section 623(d) of the MMA. The
development and application of the case-mix adjusters are explained in
section H.4.d.4 of this proposed rule. The MMA requires that the basic
case-mix adjusted composite payment rates be effective for services
furnished beginning January 1, 2005. Despite the law's specificity with
respect to effective date, the systems and operational changes
necessary to apply the case-mix adjusters cannot be completed in time
for a prospective January 1, 2005 effective date.
The 1.6 percent statutory increase and 11.3 drug add-on for
independent and hospital-based facilities for separately billable drugs
will be applied to the composite rates for all ESRD facilities
beginning January 1, 2005. However, the computation of the case mix
adjusters depends on age, sex, and specific comorbidities which must be
obtained from the bills for each ESRD facility. Therefore, the
combination of case-mix adjusters used to increase a provider's
otherwise applicable composite payment rate depends on a provider's
unique patient profile and is facility-specific. The correct
computation of these facility-specific case-mix adjusters will require
numerous programming,
[[Page 47536]]
systems, billing, and instructional changes by us, fiscal
intermediaries, and system maintainers. In addition, providers and
their fiscal intermediaries will require education and training not
only on the basic features of the new ESRD PPS, but also on the proper
reporting of patient and clinical information on the bills, essential
for an accurate case mix adjustment in connection with each patient's
claims.
Given these requirements, the lead time necessary for systems
changes, and the anticipated time necessary for providers and their
fiscal intermediaries to familiarize themselves with and correctly
apply the basic case-mix adjustments, we are proposing an April 1, 2005
effective date.
As an alternative to an April 1, 2005 effective date for the
patient characteristic case mix adjustments, we considered two options
for an April 1, 2005 prospective implementation date that would
effectively comply with the MMA's January 1, 2005 effective date. Under
the first option, we would implement the patient characteristic
adjustments on April 1, 2005 and reprocess bills and adjust payments to
January 1, 2005. Under this option, the budget neutrality adjustment
related to the patient characteristic factors would not be applied to
the composite rate until bills are reprocessed.
The second option that we considered was to make payment to
facilities starting January 1, 2005, at the budget neutralized
composite rate, until the systems changes for the case-mix adjustment
can be implemented, April 1, 2005. Payment at this rate would avoid
overpayments, and thus, the need to recoup moneys that may occur when
we retroactively process the claims for case-mix adjustments on April
1, 2005. Under this option, facilities would receive approximately 16
percent less than they would otherwise be entitled to on January 1,
2005.
We rejected both of these alternatives. Both options require the
reprocessing and adjustment of bills for the first quarter of 2005. In
addition, because of the likelihood of payment error due to the
complexity of the process and costly implementation and potential
disruption of payment to ESRD facilities, we believe that these options
are problematic. Given that the expected impact of the patient
characteristic adjustments on ESRD facility payments will, for the most
part, be minimal, we believe that applying the adjustments
prospectively from April 1, 2005 provides a smoother transition to the
new payment methodology.
Finally, this notice provides for a budget neutrality reduction of
.8390 percent to the case-mix adjusted composite payment rates. Our
budget neutrality methodology is explained in section H.4.f. of this
proposed rule. Because section 623(d) of the MMA requires that budget
neutrality be applied in the context of implementing the case-mix
adjusted composite rate payment system, we are proposing that the
effective date of the budget neutrality adjustment should also be April
1, 2005. If we applied the budget neutrality adjustment in January,
rather than when the case-mix adjustment is applied in April, the
result would be that all the composite rates would go down.
We are specifically soliciting comments on these options of the
proposed rule. However, the 1.6 percent statutory increase to the
composite payment rates, and the drug add-on for separately billable
drugs, will be effective January 1, 2005, as these adjustments are
easily implemented prospectively.
IV. Example of Payment Calculation Under the Proposed Case-Mix Adjusted
Composite Rate System
The following example presents 2 patients dialyzing at Neighbor
Dialysis, an independent facility in Baltimore, MD. Patient 1,
John Smith, is a 71-year old male who has been diagnosed with PVD and
AIDS. Patient 2, Jane Doe, is a 59-year old female who has
been diagnosed with PVD.
Calculation of Basic Composite Rate for Neighbor Dialysis
Wage adjusted Composite Rate for independent facilities in Baltimore,
Md. (Table I): $134.93
Wage adjusted Composite Rate increased by proposed drug add-on
adjustment ($134.93 x 1.113): $150.18
Adjusted Facility Composite Rate after budget neutrality (150.18 x
.8490): $126.00
Calculation of Case-mix Adjusted Payments
Patient 1--John Smith:
Male age 65-79 years: 1.17
AIDS: 1.15
PVD: 1.07
Case-mix adjusted rate for John Smith ($126.00 x 1.17 x 1.15 x 1.07):
$181.40
Patient 2--Jane Doe:
Female age < 65 years: 1.11
PVD: 1.07
Case-mix adjusted rate for Jane Doe ($126.00 x 1.11 x 1.07): $149.65
Table 18.--Composite Payment Rates Effective January 1, 2005
[For urban renal facilities]
----------------------------------------------------------------------------------------------------------------
MSA code Name of MSA State Hospital Independent
----------------------------------------------------------------------------------------------------------------
0040....................... ABILENE.................... TX.................... 127.58 123.18
0060....................... AGUADILLA.................. PR.................... 127.57 123.18
0080....................... AKRON...................... OH.................... 137.39 133.68
0120....................... ALBANY..................... GA.................... 127.57 123.18
0160....................... ALBANY-SCHENECTADY-TROY.... NY.................... 129.93 125.70
0200....................... ALBUQUERQUE................ NM.................... 135.60 131.77
0220....................... ALEXANDRIA................. LA.................... 129.70 125.46
0240....................... ALLENTOWN-BETHLEHEM........ PA-NJ................. 134.75 130.87
0280....................... ALTOONA.................... PA.................... 133.79 129.84
0320....................... AMARILLO................... TX.................... 130.03 125.80
0360....................... ANAHEIM-SANTA ANA.......... CA.................... 145.72 142.64
0380....................... ANCHORAGE.................. AK.................... 146.35 146.35
0400....................... ANDERSON................... IN.................... 131.74 127.63
0405....................... ANDERSON................... SC.................... 127.57 123.18
0440....................... ANN ARBOR.................. MI.................... 145.80 142.71
0450....................... ANNISTON................... AL.................... 127.57 123.18
0460....................... APPLETON-OSHKOSH-NEENAH.... WI.................... 132.60 128.56
0470....................... ARECIBO.................... PR.................... 127.57 123.18
0480....................... ASHEVILLE.................. NC.................... 130.57 126.39
0500....................... ATHENS..................... GA.................... 127.57 123.18
[[Page 47537]]
0520....................... ATLANTA.................... GA.................... 130.07 125.84
0560....................... ATLANTIC CITY.............. NJ.................... 134.72 130.82
0600....................... AUGUSTA.................... GA-SC................. 130.08 125.85
0620....................... AURORA-ELGIN............... IL.................... 140.21 136.70
0640....................... AUSTIN..................... TX.................... 135.14 131.29
0680....................... BAKERSFIELD................ CA.................... 141.64 138.25
0720....................... BALTIMORE.................. MD.................... 138.55 134.93
0733....................... BANGOR..................... ME.................... 129.34 125.09
0760....................... BATON ROUGE................ LA.................... 131.80 127.71
0780....................... BATTLE CREEK............... MI.................... 134.05 130.11
0840....................... BEAUMONT-PORT ARTHUR....... TX.................... 130.85 126.67
0845....................... BEAVER COUNTY.............. PA.................... 138.52 134.89
0860....................... BELLINGHAM................. WA.................... 132.87 128.85
0870....................... BENTON HARBOR.............. MI.................... 127.57 123.18
0875....................... BERGEN-PASSAIC............. NJ.................... 142.22 140.71
0880....................... BILLINGS................... MT.................... 132.16 128.08
0920....................... BILOXI-GULFPORT............ MS.................... 127.57 123.18
0960....................... BINGHAMTON................. NY.................... 130.00 125.77
1000....................... BIRMINGHAM................. AL.................... 131.83 127.73
1010....................... BISMARCK................... ND.................... 130.64 126.47
1020....................... BLOOMINGTON................ IN.................... 129.78 125.54
1040....................... BLOOMINGTON-NORMAL......... IL.................... 129.69 125.45
1080....................... BOISE CITY................. ID.................... 135.23 131.39
1123....................... BOSTON-SALEM-BROCKTON...... MA.................... 139.45 135.89
1125....................... BOULDER-LONGMONT........... CO.................... 140.62 137.15
1140....................... BRADENTON.................. FL.................... 128.79 124.47
1145....................... BRAZORIA................... TX.................... 134.02 130.08
1150....................... BREMERTON.................. WA.................... 129.14 124.87
1163....................... BRIDGEPORT-NORWALK-DANBURY. CT.................... 141.49 138.08
1240....................... BROWNSVILLE-HARLINGEN...... TX.................... 129.79 125.56
1260....................... BRYAN-COLLEGE STATION...... TX.................... 128.68 124.37
1280....................... BUFFALO.................... NY.................... 133.55 129.59
1300....................... BURLINGTON................. NC.................... 127.57 123.18
1303....................... BURLINGTON................. VT.................... 131.37 127.24
1310....................... CAGUAS..................... PR.................... 127.57 123.18
1320....................... CANTON..................... OH.................... 131.51 127.40
1350....................... CASPER..................... WY.................... 136.29 132.52
1360....................... CEDAR RAPIDS............... IA.................... 131.05 126.92
1400....................... CHAMPAIGN-URBANA-RANTOUL... IL.................... 133.39 129.39
1440....................... CHARLESTON................. SC.................... 131.44 127.33
1480....................... CHARLESTON................. WVA................... 135.86 132.06
1520....................... CHARLOTTE-ROCK HILL........ NC-SC................. 129.79 125.57
1540....................... CHARLOTTESVILLE............ VA.................... 133.15 129.15
1560....................... CHATTANOOGA................ TN-GA................. 132.45 128.39
1580....................... CHEYENNE................... WY.................... 131.21 127.06
1600....................... CHICAGO.................... IL.................... 142.79 139.48
1620....................... CHICO...................... CA.................... 139.53 135.98
1640....................... CINCINNATI................. OH-KY-IN.............. 137.22 133.50
1660....................... CLARKSVILLE-HOPKINSVILLE... TN-KY................. 127.57 123.18
1680....................... CLEVELAND.................. OH.................... 141.66 138.27
11720...................... COLORADO SPRINGS........... CO.................... 135.83 132.03
1740....................... COLUMBIA................... MO.................... 140.08 136.56
1760....................... COLUMBIA................... SC.................... 130.43 126.24
1800....................... COLUMBUS................... GA-AL................. 128.15 123.79
1840....................... COLUMBUS................... OH.................... 134.12 130.19
1880....................... CORPUS CHRISTI............. TX.................... 131.52 127.41
1900....................... CUMBERLAND................. MD-WVA................ 128.22 123.87
1920....................... DALLAS..................... TX.................... 134.47 130.56
1950....................... DANVILLE................... VA.................... 127.57 123.18
1960....................... DAVENPORT-MOLINE........... IA-IL................. 133.12 129.11
2000....................... DAYTON-SPRINGFIELD......... OH.................... 137.82 134.14
2020....................... DAYTONA BEACH.............. FL.................... 127.85 123.47
2030....................... DECATUR.................... AL.................... 127.57 123.18
2040....................... DECATUR.................... IL.................... 131.69 127.57
2080....................... DENVER..................... CO.................... 143.60 140.35
2120....................... DES MOINES................. IA.................... 135.21 131.36
2160....................... DETROIT.................... MI.................... 143.03 139.73
2180....................... DOTHAN..................... AL.................... 127.57 123.18
2200....................... DUBUQUE.................... IA.................... 132.63 128.61
2240....................... DULUTH..................... MN-WI................. 130.10 125.88
2290....................... EAU CLAIRE................. WI.................... 128.84 124.53
[[Page 47538]]
2320....................... EL PASO.................... TX.................... 128.41 124.08
2330....................... ELKHART-GOSHEN............. IN.................... 129.30 125.01
2335....................... ELMIRA..................... NY.................... 132.63 128.60
2340....................... ENID....................... OK.................... 129.51 125.24
2360....................... ERIE....................... PA.................... 131.82 127.74
2400....................... EUGENE-SPRINGFIELD......... OR.................... 133.37 129.37
2440....................... EVANSVILLE................. IN-KY................. 134.10 130.16
2520....................... FARGO-MOORHEAD............. ND-MN................. 133.83 129.88
2560....................... FAYETTEVILLE............... NC.................... 127.57 123.18
2580....................... FAYETTEVILLE-SPRINGDALE.... AR.................... 127.57 123.18
2640....................... FLINT...................... MI.................... 141.83 138.45
2650....................... FLORENCE................... AL.................... 127.57 123.18
2655....................... FLORENCE................... SC.................... 127.57 123.18
2670....................... FORT COLLINS-LOVELAND...... CO.................... 131.49 127.38
2680....................... FT LAUDERDALE-POMPANO BEACH FL.................... 137.23 133.51
2700....................... FORT MYERS-CAPE CORAL...... FL.................... 129.73 125.49
2710....................... FORT PIERCE................ FL.................... 130.09 125.87
2720....................... FORT SMITH................. AR-OK................. 128.97 124.67
2750....................... FORT WALTON BEACH.......... FL.................... 127.57 123.18
2760....................... FORT WAYNE................. IN.................... 129.32 125.05
2800....................... FORT WORTH-ARLINGTON....... TX.................... 133.06 129.04
2840....................... FRESNO..................... CA.................... 142.09 138.72
2880....................... GADSDEN.................... AL.................... 128.48 124.17
2900....................... GAINESVILLE................ FL.................... 130.25 126.06
2920....................... GALVESTON-TEXAS CITY....... TX.................... 137.86 134.20
2960....................... GARY-HAMMOND............... IN.................... 138.47 134.85
2975....................... GLENS FALLS................ NY.................... 128.98 124.68
2985....................... GRAND FORKS................ ND.................... 129.26 124.98
3000....................... GRAND RAPIDS............... MI.................... 133.41 129.44
3040....................... GREAT FALLS................ MT.................... 132.09 128.01
3060....................... GREELEY.................... CO.................... 134.34 130.43
3080....................... GREEN BAY.................. WI.................... 133.34 129.33
3120....................... GREENSBORO-WINSTON SALEM- NC.................... 129.67 125.42
HIGH PT.
3160....................... GREENVILLE-SPARTANBURG..... SC.................... 130.15 125.95
3180....................... HAGERSTOWN................. MD.................... 132.79 128.78
3200....................... HAMILTON-MIDDLETOWN........ OH.................... 134.87 130.98
3240....................... HARRISBURG-LEBANON-CARLISLE PA.................... 133.92 129.97
3283....................... HARTFORD-NEW BRITAIN- CT.................... 140.38 136.90
BRISTOL.
3290....................... HICKORY.................... NC.................... 127.57 123.18
3320....................... HONOLULU................... HI.................... 141.73 138.34
3350....................... HOUMA-THIBODAUX............ LA.................... 128.02 123.66
3360....................... HOUSTON.................... TX.................... 137.24 133.53
3400....................... HUNTINGTON-ASHLAND......... WVA-KY-OH............. 130.11 125.88
3440....................... HUNTSVILLE................. AL.................... 127.57 123.18
3480....................... INDIANAPOLIS............... IN.................... 135.16 131.30
3500....................... IOWA CITY.................. IA.................... 143.23 140.37
3520....................... JACKSON.................... MI.................... 134.43 130.53
3560....................... JACKSON.................... MS.................... 128.82 124.51
3580....................... JACKSON.................... TN.................... 127.57 123.18
3600....................... JACKSONVILLE............... FL.................... 130.77 126.58
3605....................... JACKSONVILLE............... NC.................... 127.75 123.37
3620....................... JANESVILLE-BELOIT.......... WI.................... 128.39 124.05
3640....................... JERSEY CITY................ NJ.................... 138.46 134.84
3660....................... JOHNSON CITY-BRISTOL....... TN-VA................. 127.57 123.18
3680....................... JOHNSTOWN.................. PA.................... 133.36 129.36
3690....................... JOLIET..................... IL.................... 140.66 137.19
3710....................... JOPLIN..................... MO.................... 127.97 123.61
3720....................... KALAMAZOO.................. MI.................... 143.25 139.98
3740....................... KANKAKEE................... IL.................... 130.84 126.66
3760....................... KANSAS CITY................ MO-KS................. 133.22 129.21
3800....................... KENOSHA.................... WI.................... 137.39 133.69
3810....................... KILLEEN-TEMPLE............. TX.................... 128.12 123.75
3840....................... KNOXVILLE.................. TN.................... 127.83 123.45
3850....................... KOKOMO..................... IN.................... 132.39 128.34
3870....................... LA CROSSE.................. WI.................... 131.00 126.87
3880....................... LAFAYETTE.................. LA.................... 132.84 128.83
3920....................... LAFAYETTE.................. IN.................... 128.65 124.33
3960....................... LAKE CHARLES............... LA.................... 130.17 125.97
3965....................... LAKE COUNTY................ IL.................... 141.41 137.98
3980....................... LAKELAND-WINTER HAVEN...... FL.................... 127.57 123.18
4000....................... LANCASTER.................. PA.................... 135.38 131.54
[[Page 47539]]
4040....................... LANSING-EAST LANSING....... MI.................... 135.98 132.18
4080....................... LAREDO..................... TX.................... 127.57 123.18
4100....................... LAS CRUCES................. NM.................... 127.57 123.18
4120....................... LAS VEGAS.................. NV.................... 141.01 137.58
4150....................... LAWRENCE................... KS.................... 131.82 127.73
4200....................... LAWTON..................... OK.................... 130.27 126.08
4243....................... LEWISTON-AUBURN............ ME.................... 128.39 124.06
4280....................... LEXINGTON-FAYETTE.......... KY.................... 130.21 126.01
4320....................... LIMA....................... OH.................... 133.29 129.29
4360....................... LINCOLN.................... NE.................... 129.96 125.72
4400....................... LITTLE ROCK-N LITTLE ROCK.. AR.................... 135.96 132.17
4420....................... LONGVIEW-MARSHALL.......... TX.................... 127.57 123.18
4440....................... LORAIN-ELYRIA.............. OH.................... 134.22 130.30
4480....................... LOS ANGELES-LONG BEACH..... CA.................... 146.35 145.02
4520....................... LOUISVILLE................. KY-IN................. 134.40 130.50
4600....................... LUBBOCK.................... TX.................... 129.87 125.63
4640....................... LYNCHBURG.................. VA.................... 128.00 123.63
4680....................... MACON-WARNER ROBINS........ GA.................... 129.46 125.19
4720....................... MADISON.................... WI.................... 135.45 131.63
4763....................... MANCHESTER-NASHUA.......... NH.................... 131.20 127.04
4800....................... MANSFIELD.................. OH.................... 130.40 126.20
4840....................... MAYAGUEZ................... PR.................... 127.57 123.18
4880....................... MCALLEN-EDINBURG-MISSION... TX.................... 127.57 123.18
4890....................... MEDFORD.................... OR.................... 133.00 128.99
4900....................... MELBOURNE-TITUSVILLE....... FL.................... 130.19 125.99
4920....................... MEMPHIS.................... TN-AR-MS.............. 135.10 131.23
4940....................... MERCED..................... CA.................... 138.45 134.83
5000....................... MIAMI-HIALEAH.............. FL.................... 138.47 134.85
5015....................... MIDDLESEX-HUNTERDON........ NJ.................... 134.87 130.99
5040....................... MIDLAND.................... TX.................... 135.10 131.24
5080....................... MILWAUKEE.................. WI.................... 136.75 133.02
5120....................... MINNEAPOLIS-ST PAUL........ MN-WI................. 136.11 132.33
5160....................... MOBILE..................... AL.................... 129.00 124.70
5170....................... MODESTO.................... CA.................... 138.05 134.41
5190....................... MONMOUTH-OCEAN............. NJ.................... 133.08 129.06
5200....................... MONROE..................... LA.................... 129.18 124.90
5240....................... MONTGOMERY................. AL.................... 130.14 125.92
5280....................... MUNCIE..................... IN.................... 131.36 127.22
5320....................... MUSKEGON................... MI.................... 131.68 127.57
5345....................... NAPLES..................... FL.................... 130.55 126.35
5360....................... NASHVILLE.................. TN.................... 132.71 128.70
5380....................... NASSAU-SUFFOLK............. NY.................... 146.35 144.35
5403....................... NEW BEDFORD-FALL RIVER- MA.................... 131.79 127.70
ATTELBORO.
5483....................... NEW HAVEN-WATERBURY-MERIDEN CT.................... 137.50 133.80
5523....................... NEW LONDON-NORWICH......... CT.................... 137.24 133.52
5560....................... NEW ORLEANS................ LA.................... 130.68 126.50
5600....................... NEW YORK................... NY.................... 146.35 146.35
5640....................... NEWARK..................... NJ.................... 141.09 137.67
5700....................... NIAGARA FALLS.............. NY.................... 130.31 126.11
5720....................... NORFOLK-NEWPORT NEWS....... VA.................... 129.67 125.42
5775....................... OAKLAND.................... CA.................... 146.35 145.92
5790....................... OCALA...................... FL.................... 128.79 124.48
5800....................... ODESSA..................... TX.................... 129.63 125.38
5880....................... OKLAHOMA CITY.............. OK.................... 134.67 130.78
5910....................... OLYMPIA.................... WA.................... 135.49 131.66
5920....................... OMAHA...................... NE-IA................. 132.99 128.98
5950....................... ORANGE COUNTY.............. NY.................... 132.46 128.39
5960....................... ORLANDO.................... FL.................... 132.46 128.39
5990....................... OWENSBORO.................. KY.................... 127.57 123.18
6000....................... OXNARD-VENTURA............. CA.................... 146.28 145.05
6015....................... PANAMA CITY................ FL.................... 127.57 123.18
6020....................... PARKERSBURG-MARIETTA....... WVA-OH................ 130.89 126.73
6025....................... PASCAGOULA................. MS.................... 135.50 131.67
6080....................... PENSACOLA.................. FL.................... 128.26 123.91
6120....................... PEORIA..................... IL.................... 136.83 133.10
6160....................... PHILADELPHIA............... PA-NJ................. 141.48 138.07
6200....................... PHOENIX.................... AZ.................... 137.96 134.32
6240....................... PINE BLUFF................. AR.................... 127.57 123.18
6280....................... PITTSBURGH................. PA.................... 138.69 135.09
6323....................... PITTSFIELD................. MA.................... 133.87 129.91
6360....................... PONCE...................... PR.................... 127.57 123.18
[[Page 47540]]
6403....................... PORTLAND................... ME.................... 132.96 128.94
6440....................... PORTLAND................... OR.................... 139.91 136.40
6453....................... PORTSMOUTH-DOVER-ROCHESTER. NH-ME................. 128.29 123.95
6460....................... POUGHKEEPSIE............... NY.................... 135.84 132.03
6483....................... PROVIDENCE-PAWTUCKET- RI.................... 134.58 130.69
WOONSOCKET.
6520....................... PROVO-OREM................. UT.................... 130.42 126.22
6560....................... PUEBLO..................... CO.................... 137.23 133.52
6600....................... RACINE..................... WI.................... 129.52 125.26
6640....................... RALEIGH-DURHAM............. NC.................... 132.93 128.90
6660....................... RAPID CITY................. SD.................... 128.78 124.47
6680....................... READING.................... PA.................... 133.16 129.15
6690....................... REDDING.................... CA.................... 138.98 135.39
6720....................... RENO....................... NV.................... 144.32 142.52
6740....................... RICHLAND-KENNEWICK......... WA.................... 131.96 127.89
6760....................... RICHMOND-PETERSBURG........ VA.................... 129.76 125.53
6780....................... RIVERSIDE-SAN BERNARDINO... CA.................... 143.65 140.40
6800....................... ROANOKE.................... VA.................... 130.33 126.13
6820....................... ROCHESTER.................. MN.................... 134.23 130.31
6840....................... ROCHESTER.................. NY.................... 134.50 130.60
6880....................... ROCKFORD................... IL.................... 136.62 132.85
6920....................... SACRAMENTO................. CA.................... 144.16 141.12
6960....................... SAGINAW-BAY CITY-MIDLAND... MI.................... 138.22 134.57
6980....................... ST CLOUD................... MN.................... 129.55 125.29
7000....................... ST JOSEPH.................. MO.................... 132.19 128.12
7040....................... ST LOUIS................... MO-IL................. 135.07 131.21
7080....................... SALEM...................... OR.................... 136.70 132.96
7120....................... SALINAS-SEASIDE-MONTEREY... CA.................... 144.09 140.88
7160....................... SALT LAKE CITY-OGDEN....... UT.................... 131.27 127.13
7200....................... SAN ANGELO................. TX.................... 127.57 123.18
7240....................... SAN ANTONIO................ TX.................... 129.30 125.03
7320....................... SAN DIEGO.................. CA.................... 144.75 142.04
7360....................... SAN FRANCISCO.............. CA.................... 146.35 145.92
7400....................... SAN JOSE................... CA.................... 146.35 145.68
7440....................... SAN JUAN................... PR.................... 127.57 123.18
7480....................... SANTA BARBARA-LOMPOC....... CA.................... 139.14 135.58
7485....................... SANTA CRUZ................. CA.................... 140.64 137.18
7490....................... SANTA FE................... NM.................... 129.81 125.59
7500....................... SANTA ROSA-PETALUMA........ CA.................... 146.35 145.59
7510....................... SARASOTA................... FL.................... 131.98 127.90
7520....................... SAVANNAH................... GA.................... 129.72 125.48
7560....................... SCRANTON-WILKES BARRE...... PA.................... 133.66 129.70
7600....................... SEATTLE.................... WA.................... 136.87 133.14
7610....................... SHARON..................... PA.................... 132.08 128.00
7620....................... SHEBOYGAN.................. WI.................... 129.28 125.01
7640....................... SHERMAN-DENISON............ TX.................... 127.57 123.18
7680....................... SHREVEPORT................. LA.................... 133.23 129.23
7720....................... SIOUX CITY................. IA-NE................. 132.47 128.40
7760....................... SIOUX FALLS................ SD.................... 130.62 126.44
7800....................... SOUTH BEND-MISHAWAKA....... IN.................... 130.13 125.92
7840....................... SPOKANE.................... WA.................... 138.38 134.75
7880....................... SPRINGFIELD................ IL.................... 137.27 133.56
7920....................... SPRINGFIELD................ MO.................... 129.48 125.21
8003....................... SPRINGFIELD................ MA.................... 133.39 129.39
8050....................... STATE COLLEGE.............. PA.................... 137.91 134.25
8080....................... STEUBENVILLE-WEIRTON....... OH-WVA................ 131.46 127.35
8120....................... STOCKTON................... CA.................... 146.35 145.06
8160....................... SYRACUSE................... NY.................... 141.36 139.77
8200....................... TACOMA..................... WA.................... 136.53 132.76
8240....................... TALLAHASSE................. FL.................... 129.91 125.67
8280....................... TAMPA-ST PETERSBURG- FL.................... 132.27 128.21
CLEARWATER.
8320....................... TERRE HAUTE................ IN.................... 127.57 123.18
8360....................... TEXARKANA.................. TX-AR................. 135.59 131.75
8400....................... TOLEDO..................... OH.................... 140.91 137.45
8440....................... TOPEKA..................... KS.................... 135.89 132.10
8480....................... TRENTON.................... NJ.................... 135.66 131.82
8520....................... TUCSON..................... AZ.................... 134.02 130.07
8560....................... TULSA...................... OK.................... 133.31 129.30
8600....................... TUSCALOOSA................. AL.................... 133.86 129.91
8640....................... TYLER...................... TX.................... 132.17 128.09
8680....................... UTICA-ROME................. NY.................... 130.41 126.22
8720....................... VALLEJO-FAIRFIELD-NAPA..... CA.................... 146.35 146.18
[[Page 47541]]
8725....................... VANCOUVER.................. WA.................... 139.12 135.53
8750....................... VICTORIA................... TX.................... 127.57 123.18
8760....................... VINELAND-MILLVILLE- NJ.................... 132.48 128.41
BRIDGETON.
8780....................... VISALIA-PORTERVILLE........ CA.................... 142.02 140.48
8800....................... WACO....................... TX.................... 127.81 123.43
8840....................... WASHINGTON................. DC-MD-VA.............. 141.74 138.35
8920....................... WATERLOO-CEDAR FALLS....... IA.................... 129.50 125.24
8940....................... WAUSAU..................... WI.................... 130.90 126.74
8960....................... WEST PALM & DELRAY BEACH... FL.................... 131.84 127.75
9000....................... WHEELING................... WVA-OH................ 131.83 127.74
9040....................... WICHITA.................... KS.................... 136.67 132.93
9080....................... WICHITA FALLS.............. TX.................... 127.57 123.18
9140....................... WILLIAMSPORT............... PA.................... 130.24 126.04
9160....................... WILMINGTON................. DE-NJ-MD.............. 136.71 132.97
9200....................... WILMINGTON................. NC.................... 128.74 124.42
9243....................... WORCESTER-LEOMINSTER....... MA.................... 132.43 128.37
9260....................... YAKIMA..................... WA.................... 132.24 128.18
9280....................... YORK....................... PA.................... 132.45 128.39
9320....................... YOUNGSTOWN-WARREN.......... OH.................... 137.25 133.54
9340....................... YUBA CITY.................. CA.................... 137.02 133.29
----------------------------------------------------------------------------------------------------------------
Table 19.--Composite Payment Rates Effective January 1, 2005
[For rural renal facilities]
----------------------------------------------------------------------------------------------------------------
MSA Code Name of MSA State Hospital Independent
----------------------------------------------------------------------------------------------------------------
AL......................... ALABAMA.................... AL.................... 127.57 123.18
AK......................... ALASKA..................... AK.................... 146.35 146.35
AZ......................... ARIZONA.................... AZ.................... 128.68 124.35
AR......................... ARKANSAS................... AR.................... 127.57 123.18
CA......................... CALIFORNIA................. CA.................... 137.00 133.27
CO......................... COLORADO................... CO.................... 128.21 123.86
CT......................... CONNECTICUT................ CT.................... 136.02 132.22
DE......................... DELAWARE................... DE.................... 128.76 124.44
FL......................... FLORIDA.................... FL.................... 127.75 123.37
GA......................... GEORGIA.................... GA.................... 127.57 123.18
HI......................... HAWAII..................... HI.................... 140.40 136.92
ID......................... IDAHO...................... ID.................... 127.83 123.45
IL......................... ILLINOIS................... IL.................... 127.57 123.18
IN......................... INDIANA.................... IN.................... 127.57 123.18
IA......................... IOWA....................... IA.................... 127.57 123.18
KS......................... KANSAS..................... KS.................... 127.57 123.18
KY......................... KENTUCKY................... KY.................... 127.57 123.18
LA......................... LOUISIANA.................. LA.................... 127.57 123.18
ME......................... MAINE...................... ME.................... 127.57 123.18
MD......................... MARYLAND................... MD.................... 130.27 126.08
MA......................... MASSACHUSETTS.............. MA.................... 135.99 132.19
MI......................... MICHIGAN................... MI.................... 132.98 128.97
MN......................... MINNESOTA.................. MN.................... 127.57 123.18
MS......................... MISSISSIPPI................ MS.................... 127.57 123.18
MO......................... MISSOURI................... MO.................... 127.57 123.18
MT......................... MONTANA.................... MT.................... 127.87 123.50
NE......................... NEBRASKA................... NE.................... 127.57 123.18
NV......................... NEVADA..................... NV.................... 133.20 129.20
NH......................... NEW HAMPSHIRE.............. NH.................... 132.24 128.18
NM......................... NEW MEXICO................. NM.................... 128.68 124.36
NY......................... NEW YORK................... NY.................... 127.78 123.40
NC......................... NORTH CAROLINA............. NC.................... 127.57 123.18
ND......................... NORTH DAKOTA............... ND.................... 127.70 123.31
OH......................... OHIO....................... OH.................... 128.66 124.34
OK......................... OKLAHOMA................... OK.................... 127.57 123.18
OR......................... OREGON..................... OR.................... 132.66 128.64
PA......................... PENNSYLVANIA............... PA.................... 132.54 128.48
PR......................... PUERTO RICO................ PR.................... 127.57 123.18
RI......................... RHODE ISLAND............... RI.................... 130.86 126.69
SC......................... SOUTH CAROLINA............. SC.................... 127.57 123.18
SD......................... SOUTH DAKOTA............... SD.................... 127.57 123.18
TN......................... TENNESSEE.................. TN.................... 127.57 123.18
TX......................... TEXAS...................... TX.................... 127.57 123.18
[[Page 47542]]
UT......................... UTAH....................... UT.................... 128.56 124.24
VT......................... VERMONT.................... VT.................... 127.57 123.18
VA......................... VIRGINIA................... VA.................... 127.57 123.18
WA......................... WASHINGTON................. WA.................... 131.35 127.21
WV......................... WEST VIRGINIA.............. WV.................... 128.43 124.09
WI......................... WISCONSIN.................. WI.................... 127.57 123.18
WY......................... WYOMING.................... WY.................... 131.29 127.15
----------------------------------------------------------------------------------------------------------------
Table 20.--Comorbidities
------------------------------------------------------------------------
------------------------------------------------------------------------
AIDS
042...................... Human immunodeficiency disease
Peripheral vascular disease
0400..................... Gas gangrene
4151..................... Pulmonary embolism and infarction
41511.................... Pulmonary embolism and infarction,
iatrogenic pulmonary embolism and
infarction
440...................... Atherosclerosis
4400..................... Atherosclerosis of aorta
4401..................... Atherosclerosis of renal artery
4402..................... Atherosclerosis of native arteries of the
extremities
44020.................... Atherosclerosis of native arteries of the
extremities, unspecified
44021.................... Atherosclerosis of native arteries of the
extremities, with intermittent
claudication
44022.................... Atherosclerosis of native arteries of the
extremities, with rest pain
44023.................... Atherosclerosis of the extremities with
ulceration
44024.................... Atherosclerosis of the extremities with
gangrene
44029.................... Atherosclerosis of native arteries of the
extremities, with ulceration
4403..................... Atherosclerosis of bypass graft of the
extremities
44030.................... Atherosclerosis of bypass graft of the
extremities of unspecified graft
44031.................... Atherosclerosis of bypass graft of the
extremities of autologous vein bypass
graft
44032.................... Atherosclerosis of bypass graft of the
extremities of nonautologous biological
bypass graft
441...................... Aortic aneurysm and dissection
4410..................... Aortic aneurysm and dissection,
dissection of aorta
44100.................... Aortic aneurysm and dissection,
dissection of aorta, unspecified site
44101.................... Aortic aneurysm and dissection,
dissection of aorta, thoracic
44102.................... Aortic aneurysm and dissection,
dissection of aorta, abdominal
44103.................... Aortic aneurysm and dissection,
dissection of aorta, thoracoabdominal
4411..................... Thoracic aneurysm, ruptured
4412..................... Thoracic aneurysm without mention of
rupture
4413..................... Abdominal aneurysm, ruptured
4414..................... Abdominal aneurysm without mention of
rupture
4415..................... Aortic aneurysm of unspecified site,
ruptured
4416..................... Thoracoabdominal aneurysm, ruptured
4417..................... Thoracoabdominal aneurysm without mention
of rupture
4419..................... Aortic aneurysm and dissection of
unspecified site without mention of
rupture
442...................... Other aneurysm
4420..................... Other aneurysm of artery of upper
extremity
4421..................... Other aneurysm of renal artery
4422..................... Other aneurysm of iliac artery
4423..................... Other aneurysm of artery of lower
extremity
4428..................... Other aneurysm of other specified artery
44281.................... Other aneurysm of other specified artery,
artery of neck
44282.................... Other aneurysm of other specified artery,
subclavian artery
44283.................... Other aneurysm of other specified artery,
splenic artery
44284.................... Other aneurysm of other specified artery,
other visceral artery
44289.................... Other aneurysm of other specified artery,
other
4429..................... Other aneurysm of unspecified site
443...................... Other peripheral vascular disease
4430..................... Other peripheral vascular disease,
Raynaud's syndrome
4431..................... Other peripheral vascular disease,
thromboangiitis obliterans [Buerger's
disease]
4432..................... Other peripherovascular diseases, other
arterial dissection
44321.................... Other peripherovascular diseases, other
arterial dissection, dissection of
carotid artery
44322.................... Other peripherovascular diseases, other
arterial dissection, dissection of iliac
artery
44323.................... Other peripherovascular diseases, other
arterial dissection, dissection of renal
artery
44324.................... Other peripherovascular diseases, other
arterial dissection, dissection of
vertebral artery
44329.................... Other peripherovascular diseases, other
arterial dissection, dissection of other
artery
4438..................... Other peripheral vascular disease, other
specified peripheral vascular disease
44381.................... Other peripheral vascular disease, other
specified peripheral vascular disease,
peripheral angiopathy in diseases
classified elsewhere
44389.................... Other peripheral vascular disease, other
specified peripheral vascular disease,
other
4439..................... Peripheral vascular disease, unspecified
[[Page 47543]]
444...................... Arterial embolism and thrombosis
4440..................... Arterial embolism and thrombosis, of
abdominal aorta
4441..................... Arterial embolism and thrombosis, of
thoracic aorta
4442..................... Arterial embolism and thrombosis, of
arteries of the extremities
44421.................... Arterial embolism and thrombosis, of
arteries of the extremities, upper
extremity
44422.................... Arterial embolism and thrombosis, of
arteries of the extremities, lower
extremity
4448..................... Arterial embolism and thrombosis, of
other specified artery
44481.................... Arterial embolism and thrombosis, of
other specified artery, upper extremity
44489.................... Arterial embolism and thrombosis, of
other specified artery, lower extremity
449...................... Arterial embolism and thrombosis, of
unspecified artery
4450..................... Atheroembolism, of extremities
44501.................... Atheroembolism, of extremities, upper
extremity
44502.................... Atheroembolism, of extremities, lower
extremity
446...................... Polyarteritis nodosa and allied
conditions
4460..................... Polyarteritis nodosa and allied
conditions, polyarteritis nodosa
451...................... Phlebitis and thrombophlebitis
4510..................... Phlebitis and thrombophlebitis of
superficial vessels of lower extremities
4511..................... Phlebitis and thrombophlebitis, of deep
vessels of lower extremities
45111.................... Phlebitis and thrombophlebitis, of deep
vessels of lower extremities, femoral
vein
45119.................... Phlebitis and thrombophlebitis, of deep
vessels of lower extremities, other
4512..................... Phlebitis and thrombophlebitis, of lower
extremities, unspecified
45181.................... Phlebitis and thrombophlebitis, of other
sites, iliac vein
45182.................... Phlebitis and thrombophlebitis, of other
sites, of superficial veins of upper
extremities
45183.................... Phlebitis and thrombophlebitis, of other
sites, of deep veins of upper
extremities
45184.................... Phlebitis and thrombophlebitis, of upper
extremities, unspecified
45189.................... Phlebitis and thrombophlebitis, other
4519..................... Phlebitis and thrombophlebitis,
unspecified
453...................... Other venous embolism and thrombosis
4530..................... Other venous embolism and thrombosis,
Budd-Chiari syndrome
4531..................... Other venous embolism and thrombosis,
Thrombophlebitis migrans
4532..................... Other venous embolism and thrombosis of
vena cava
4533..................... Other venous embolism and thrombosis of
renal vein
4538..................... Other venous embolism and thrombosis of
other specified sites
4539..................... Other venous embolism and thrombosis of
unspecified site
------------------------------------------------------------------------
I. Section 731(b)--Coverage for Routine Costs of Category A Clinical
Trials
[If you choose to comment on issues in this section, please include the
caption ``Section 731(b)'' at the beginning of your comments.]
Section 1862(m) of the Act, as added by Section 731(b) of the MMA,
prohibits the Secretary from excluding payment for the routine costs of
care furnished to a Medicare beneficiary participating in a clinical
trial of a Category A device based on a determination that such care is
not ``reasonable and necessary'' under section 1862(a)(1). In effect,
this section authorizes Medicare to cover the routine costs of clinical
trials involving Category A devices. Category A (experimental/
investigational) devices are defined in Sec. 405.201 as innovative
medical devices about which the Food and Drug Administration (FDA) has
major questions about safety and effectiveness.
For a trial to qualify for payment of routine costs, it must meet
certain criteria established by the Secretary to ensure that the trial
conforms to appropriate scientific and ethical standards. Current
criteria are established in the National Coverage Determination Manual
(CMS Pub. 100-3, Manual section 310.1).
In addition, the MMA established additional criteria for trials
initiated before January 1, 2010 to ensure that the devices involved in
these trials be intended for use in the diagnosis, monitoring, or
treatment of an immediately life-threatening disease or condition.
Guidelines for determining if a device meets this requirement will be
defined through the NCD process.
Section 411.15(o) currently precludes Medicare payment for Category
A devices. We would not revise this section because the MMA does not
require Medicare to pay for the cost of the Category A device (as
opposed to the cost of routine care associated with the trial of a
Category A device).
We are proposing changes to Sec. 405.207. As currently written,
this section precludes coverage of services related to a noncovered
device. Since the Category A device is noncovered, we would amend this
section to allow coverage of routine care services related to a
noncovered Category A device. In addition, we propose language to
cross-reference Sec. 405.201 concerning coverage of Category B
(nonexperimental/investigational) devices. We would not be changing
coverage of Category B devices, but providing consistency by placing
information on Category A and Category B devices in the same section.
J. Section 629--Part B Deductible
[If you choose to comment on issues in this section, please include the
caption ``Section 629'' at the beginning of your comments.]
Section 629 of the MMA provides for regular updates to the Medicare
Part B deductible in consideration of inflationary changes in the
nation's economy. Since 1991, the Medicare Part B deductible has been
$100 per year. The MMA stipulates that the Medicare Part B deductible
will be $110 for calendar year 2005, and, for a subsequent year, the
deductible will be the previous year's deductible increased by the
annual percentage increase in the monthly actuarial rate under section
1839(a)(1) of the Act, ending with that subsequent year (rounded to the
nearest dollar). Section 1839(a)(1) of the Act requires the Secretary
of Health and Human Services to calculate the monthly actuarial rate
for Medicare enrollees age 65 and over.
We propose to update Sec. 410.160(f), ``Amount of the Part B
annual deductible,'' to conform to the MMA and to reflect that the
Medicare Part B deductible is $100 for calendar years
[[Page 47544]]
1991 through 2004. Finally, we plan to publish an annual notification
in the Federal Register, announcing each upcoming year's Part B
deductible. This notification for the Part B deductible will be
included as part of the annual notice we currently publish announcing
Medicare's Part B premiums and actuarial rates.
K. Section 512--Hospice Consultation
[If you choose to comment on issues in this section, please include the
caption ``Section 512'' at the beginning of your comments.]
1. Coverage of Hospice Consultation Services
Effective January 1, 2005, section 512 of the MMA provides for
payment to be made to a hospice for specified services furnished by a
physician who is either the medical director of or employee of a
hospice agency. Payment will be made on behalf of a beneficiary who is
terminally ill (which is defined as having a prognosis of 6 months or
less if the disease or illness runs its normal course), has not made a
hospice election, and has not previously received the pre-election
hospice services specified in section 1812(a)(1)(5) of the Act as added
by section 512 of the MMA. These services comprise an evaluation of an
individual's need for pain and symptom management, counseling the
individual regarding hospice and other care options, and may include
advising the individual regarding advanced care planning.
The decision to elect hospice services is a personal choice and is
generally a decision made between the individual and his or her
physician (probably the physician making the terminal diagnosis).
Therefore, we believe that most individuals will seek this type of
service from their own physician. Thus, we do not expect that the
services of a hospice physician would be necessary for all individuals
who elect hospice. However, a beneficiary, or his/her physician may
seek the expertise of a hospice medical director or physician employee
of a hospice to assure that a beneficiary's end-of-life options for
care and pain management are discussed and evaluated.
Currently, beneficiaries are able to receive this evaluation, pain
management, counseling, and advice through other Medicare benefits. For
example, physicians, typically those who determine the beneficiary's
terminal diagnoses, can provide for these evaluation and management
services as well as for pain and symptom management under the physician
fee schedule. Beneficiaries may also obtain assistance with decisions
pertaining to end-of life issues through discharge planning in
hospitals and through services of social workers, case managers, and
other health care professionals. To the extent that beneficiaries have
already received Medicare-covered evaluation and counseling with
respect to end-of-life care, the hospice evaluation and counseling
would seem duplicative. We intend to monitor data regarding these
services to assess whether Medicare is paying for duplicative services.
We are proposing to cover the services described above for a
terminally ill beneficiary, at the request of the beneficiary or the
beneficiary's physician. The service would, in accordance with the
statute, be available on a one-time basis to a beneficiary who has not
elected or previously used the hospice benefit, but who might benefit
from evaluation and counseling with a hospice physician regarding the
beneficiary's decision-making process or to provide recommendations for
pain and symptom management. Since the beneficiary or his/her physician
decides to obtain this service from the hospice medical director or
physician employee, the evaluation and counseling service may not be
initiated by the hospice, that is, the entity receiving payment for the
service.
The statute specifies that payment will be made to the hospice when
the physician providing the service is an employee physician or medical
director of a hospice. Therefore, other hospice personnel, such as
nurse practitioners, nurses, or social workers, cannot furnish the
services. The statute requires the physicians to be employed by a
hospice; therefore, the service cannot be furnished by a physician
under contractual arrangements with the hospice or by the beneficiary's
physician, if that physician is not an employee of the hospice.
Moreover, if the beneficiary's physician is also the medical director
or physician employee of a hospice, that physician already possesses
the expertise necessary to furnish end-of-life evaluation, management,
and counseling services and is providing these services to the
beneficiary and is receiving payment for these services through the use
of evaluation and management (E&M) codes.
In the event that the individual's physician initiates the request
for services of the hospice medical director or physician, we would
expect that appropriate documentation guidelines would be followed. The
request or referral would be in writing, and the hospice medical
director or employee physician would be expected to provide a written
note on the patient's medical chart. The hospice employee physician
providing these services would be required to maintain a written record
of this service. If the beneficiary initiates the services, we would
expect that the hospice agency would maintain a written record of the
service and that communication between the hospice medical director or
physician and the beneficiary's physician would occur, with the
beneficiary's permission, to the extent necessary to ensure continuity
of care.
We propose to add new Sec. 418.205 and Sec. 418.304(d) to
implement section 512 of the MMA.
2. Payment for Hospice Consultation Services
Section 512(b) of the MMA amends section 1414(i) of the Act and
establishes payment for this service at an amount ``equal to an amount
established for an office or other outpatient visit for evaluation and
management associated with presenting problems of moderate severity and
requiring medical decision-making of low complexity under the physician
fee schedule, other than the portion of such amount attributable to the
practice expense component.'' No existing CPT or HCPCS code
specifically represents these services. We are proposing to establish a
new HCPCS code, G0xx4 Hospice--evaluation and counseling services, pre-
election. The hospice would use this HCPCS code to submit claims to the
Regional Home Health Intermediary (RHHI) for payment for these
services. Utilization of this code would allow us to provide payment
for this service as well as enable us to monitor the frequency with
which the code is used and to assess whether the code is used
appropriately. Payments by hospices to physicians or others in a
position to refer patients for services furnished under this provision
may implicate the Federal anti-kickback statute.
In accordance with the statute, we are proposing that the payment
amount for this service would be based on the work and malpractice
expense RVUs for CPT code 99203 multiplied by the CF (1.34 Work RVU +
0.10 Malpractice RVU)* (CF). This CPT code for an office or outpatient
visit for the evaluation and management of a new patient represents a
detailed history, detailed examination and medical decision making of
low complexity, which, we believe, is quite similar to the components
of this new service provided by a medical director or physician
employed by the hospice
[[Page 47545]]
agency. Assuming that there are no changes in RVUs for CPT code 99203
and that the CY 2005 update to the physician fee schedule is the 1.5
percent specified in the MMA, the national payment amount for this
service would be $54.57 for this service (1.44 * 37.8975).
L. Section 302--Clinical Conditions for Coverage of Durable Medical
Equipment (DME)
[If you choose to comment on issues in this section, please include the
caption ``Section 302'' at the beginning of your comments.]
1. Legislative Requirement
Section 1832(a)(1)(E) of the Act, as added by section 302(a)(2) of
the MMA, requires the Secretary to establish clinical conditions for
payment of covered items of durable medical equipment (DME). The law
requires the Secretary to establish types or classes of covered items
that require a face-to-face examination of the individual by a
physician or practitioner and also require a prescription for these
items.
Covered items of durable medical equipment, prosthetics, orthotics,
and supplies (DMEPOS) have already been divided into classes of covered
items, as established by the local medical review policies (LMRP) and
local coverage determinations (LCD) issued by the durable medical
equipment regional carriers (DMERCs). For example, the contractors have
developed policies on long term home oxygen therapy, canes, crutches,
wheelchairs, hospital beds, urological supplies, spinal orthoses,
surgical dressing, and enteral and parenteral nutrition therapy. These
and other policies for each of the four DMERCs are entered into the
Medicare Coverage Database at http://www.cms.hhs.gov/coverage.
These policies are developed based on clinical evidence and after
discussion with clinical experts in the area. There are already a
number of local coverage determinations and national coverage
determinations that outline the clinical conditions for which these
items are covered. These determinations outline the conditions for
coverage, payment, and the documentation or testing necessary to
establish medical necessity. We propose to continue developing these
clinical conditions of coverage through the local and national coverage
determination process.
We are also proposing to expand the requirement for clinical
conditions of coverage to medical supplies, appliances and devices
defined in 42 CFR 410.36. These are commonly referred to as
prosthetics, orthotics and supplies (POS). We believe items of POS
require the same level of medical intervention and skill as DME. As
with DME, there are already a number of local and national coverage
determinations outlining appropriate clinical conditions for coverage
and propose to continue this process.
From a clinical perspective, we believe that it is appropriate for
beneficiaries requiring DMEPOS to be under the care of a physician and
for DMEPOS orders to occur in the context of routine clinical care. We
believe it is good clinical practice for the beneficiary to be seen by
the physician for their medical condition and the physician to decide
whether or not an item of DMEPOS is appropriate during the face-to-face
examination of the beneficiary. Since we expect a beneficiary to be
seen by their physician for a specific medical condition, we do not
believe that a requirement for a face-to-face examination for initial
orders and at the time of the prescription renewals for items of
continued need (those DMEPOS items where an order is good for only a
certain period of time and requires a follow-up examination by the
physician) would place a burden on the physician or beneficiary, as it
would be part of a necessary examination. We believe this to be the
current practice in most cases.
Our goal is to encourage quality care, to mitigate any
proliferation of use of these products and ensure that only patients
that need items of DMEPOS receive them. To comply with the requirements
of section 302(a)(2) of the MMA and to enhance quality and reduce
fraud, we would establish basic requirements that apply to all items of
durable medical equipment, prosthetics, orthotics, and supplies. We
have identified a proliferation of use for some items of DMEPOS and we
believe that engaging the physician or practitioner early in the
process of ordering DMEPOS will assist us in mitigating any unnecessary
proliferation of use.
This regulation proposes to make a face-to-face exam by the
physician to determine the medical necessity and ordering an item of
DMEPOS an explicit requirement for all initial orders of DMEPOS and at
the time of prescription renewal for all DMEPOS continued need items.
However, we seek specific comments about whether specific items of
DMEPOS should be exempt from the face-to-face examination requirement.
In order for us to verify the medical necessity for an item, the
prescribing physician's or practitioner's records must document the
need at the time the physician or practitioner examines the
beneficiary. For example, a letter to the supplier or to us dated
months after the date the examination was conducted and the order was
written would not be sufficient verification.
2. Provisions Related to DMEPOS
To implement the provisions of the MMA, we would--
Establish a requirement for a face-to-face examination by
a physician, physician assistant (PA), clinical nurse specialist (CNS),
or nurse practitioner (NP), as they are defined in the Act (the
prescribing physician or practitioner) to determine the medical
necessity of durable medical equipment, orthotics and prosthetics.
Require that the prescribing physician or practitioner be
independent from the DMEPOS supplier and may not be a contractor or an
employee of the supplier.
Establish a requirement that the face-to-face examination
should be for the purpose of evaluating and treating the patient's
medical condition and not for the sole purpose of obtaining the
prescribing physician's or practitioner's order for the DMEPOS. We
expect the prescribing physician or practitioner to conduct a
sufficient examination of the patient's medical condition to ascertain
the appropriate overall treatment plan and to order the DMEPOS as only
one aspect of that treatment plan.
Require an order prior to delivery for all items of
durable medical equipment, prosthetics, or orthotics.
Require that the order be dated and signed within 30 days
after the face-to-face examination and include verification of the
examination. We are soliciting comments on the appropriate verification
process.
Require the prescribing physician or practitioner to
maintain appropriate and timely documentation in the medical records
that support the need for all DMEPOS ordered.
Provide that we would promulgate through contractor
instructions other criteria required for payment, such as for
prescription renewal requirements, repair, minor revisions and
replacement. We are interested in comments on whether the Agency should
establish national renewal requirements or permit contractor
discretion.
Provide that we would promulgate through the national
coverage determination process or through the local coverage
determination process additional clinical conditions for items of
DMEPOS.
We propose to revise language in Sec. 410.36 and Sec. 410.38 to
implement section 302(a)(2) of the MMA.
[[Page 47546]]
M. Section 614--Payment for Certain Mammography Services
[If you choose to comment on issues in this section, please include the
caption ``Section 614'' at the beginning of your comments.]
Medicare covers an annual screening mammogram for all beneficiaries
who are women age 40 and older, and one baseline mammogram for
beneficiaries who are women age 35 through 39. Medicare also covers
medically necessary diagnostic mammograms. Payment for screening
mammography, regardless of setting, is paid under the physician fee
schedule, but diagnostic mammography performed in the hospital
outpatient department is currently paid under the hospital outpatient
prospective payment system (OPPS).
Section 614 of the MMA amended section 1833(t)(1)(B)(iv) of the Act
to exclude payment for screening and diagnostic mammograms from the
OPPS. In the OPPS proposed rule, we will discuss our proposal for
payment for diagnostic mammograms using the payments established under
the physician fee schedule. This proposal will parallel the current
practice used for the payment of screening mammography services
provided in the OPPS setting and will be effective January 1, 2005.
N. Section 305--Payment for Inhalation Drugs
[If you choose to comment on issues in this section, please include the
caption ``Section 305'' at the beginning of your comments.]
1. Background
Lung diseases such as chronic obstructive pulmonary disease (COPD)
affect large numbers of Medicare beneficiaries. COPD is the fourth
largest cause of death in America behind heart disease, certain
cancers, and stroke. We hope to reduce the number of new COPD cases by
educating Americans about the disease, its causes, and ways to prevent
it. We hope to improve the lives of Medicare beneficiaries and improve
beneficiary access to treatment for those who already suffer from these
conditions.
Depending on an individual's age and health, a number of steps can
be taken to treat or prevent this. Because approximately 85 percent of
those with COPD are smokers, the first step to avoid the disease is to
stop smoking. Smoking has been linked to a large number of health
problems and is a leading cause of cancer and pulmonary disease. The
Department of Health and Human Services (HHS) has been actively
encouraging Americans to quit smoking through its smoking cessation
initiatives. Americans who quit smoking will enjoy longer, healthier
lives and avoid diseases such as COPD.
We have also recently approved services to address the needs of
Americans suffering from COPD, including lung-volume reduction surgery,
which, performed in more serious cases, removes the diseased lung
tissue, allowing the rest of the lung to function better. Specifically,
effective January 1, 2004, Medicare expanded coverage of lung volume
reduction surgery to include patients, who are not high-risk surgical
patients, who either have severe, upper-lobe emphysema, or have severe,
non-upper-lobe emphysema with low exercise capacity.
A number of drugs are available to treat the persons with asthma or
who develop COPD. These include agents, often inhaled, that expand the
bronchial tubes, allowing the patient to breathe more freely. Access to
these drugs for Medicare beneficiaries has been expanded by the MMA.
Nebulizers and metered dose inhalers (MDIs) are two different
delivery methods to administer inhalation drugs to a beneficiary. A
nebulizer works by aerosolizing liquefied inhalation drugs so that the
medication can be more easily inhaled into the lungs. For about 10 to
30 minutes, a beneficiary breathes the mist via compressor tubing
hooked up to the nebulizer. An MDI consists of a canister of
pressurized medication that is propelled directly into the airways of
the lungs when a beneficiary presses on the inhaler and breathes in
through the mouth, thereby allowing the medicine to take effect
quickly.
Medicare Part B currently pays for nebulizers and inhalation drugs.
However, Medicare Part B does not cover MDIs and, therefore, does not
pay for inhalation drugs delivered by an MDI. An MDI is considered to
be an item of disposable medical equipment (for which there is no
current Part B benefit category) while a nebulizer is considered to be
an item of DME.
The Part D drug benefit improves beneficiary access to inhalation
therapy by covering MDIs (including the inhalation drugs they furnish)
beginning January 1, 2006. In addition, the prescription drug discount
card began offering discounts on MDIs effective June 1, 2004.
Since Medicare currently covers inhalation drugs provided through
nebulizers, but not alternative forms of inhalation therapy, there are
strong financial incentives toward use of the former compared to
alternatives. Our review of the literature over the past decade did not
find that bronchodilators delivered via nebulizers were more effective
than bronchodilators delivered via metered dose inhalers.
Since one delivery method is not clinically superior to the other,
when Medicare covers both methods of delivery of inhalation therapy,
the decision to prescribe one over the other will be made by the
physician and beneficiary based on beneficiary needs and preferences
consistent with applicable standards of medical practice. It would not
be unlikely for many beneficiaries to choose the convenience of MDIs
over nebulizers once the Medicare coverage imbalance is removed in
2006. Since MDIs are less expensive, very portable, and easier to use,
it is likely there will be a substantial shift of Medicare
beneficiaries from nebulizers to MDIs beginning in 2006, even absent
the Medicare payment changes for nebulizers and inhalation drugs in
2005.
2. What Medicare Part B Currently Covers
Medicare Part B currently covers and pays for five separate items
related to nebulizers. All of the items are subject to the standard
Part B deductible and coinsurance.
a. Nebulizers
Medicare Part B currently covers the rental of nebulizers.
Nebulizers are in the ``capped rental'' category of DME for payment
purposes. Payment is made on a monthly basis during the period of
medical need. Medicare pays 10 percent of the payment amount during the
first three months and 7.5 percent during the next 12 months. Section
1834(a) of the Act specifies that the payment amount is equal to the
amount paid for purchase of the nebulizer in 1986, indexed to current
levels by the cumulative DME update factor specified in this
subsection. Thus, Medicare will pay up to a cumulative total of 120
percent of the payment amount for 15 months of renting a nebulizer.
If the beneficiary needs a nebulizer for more than 15 months, and
continues to rent it, Medicare makes no further payment for the
equipment because the equipment has already been paid for. Medicare
does continue to pay for maintenance and servicing of the nebulizer, as
well as the inhalation drugs, but the supplier retains title to the
equipment.
During the 10th month of continuous rental of a nebulizer, the
supplier is required to offer the beneficiary a purchase option, and if
the beneficiary accepts the offer and exercises the
[[Page 47547]]
purchase option, the supplier transfers title to the nebulizer in the
13th month. In this case, Medicare would make its final monthly rental
payment in the 13th month, and the title then would transfer to the
beneficiary. About 3 percent of beneficiaries exercise the purchase
option.
In 2003, the average Medicare monthly rental payment for nebulizers
was $19.07 for the first three months and $14.30 for the fourth through
fifteenth month. Thus, Medicare would pay $228.81 for a nebulizer if
the beneficiary's period of medical need were 15 months. There are
various types of nebulizers (compressor, ultrasonic, portable,
disposable) and nebulizer accessories (breathing circuits, air filters,
tubing extensions, mouthpieces, spare battery packs, DC adapters)
available. Internet prices for compressor nebulizers range from $50 to
$100, and prices for portable nebulizers range from $100 to $200,
depending on the specific features of the nebulizer. The Medicare
payment amount includes payment for delivery of the equipment.
(Shipping costs for nebulizers available for purchase on the Internet
range from free shipping up to $25).
b. Maintenance and Servicing of Nebulizers
Medicare Part B makes an additional separate payment to the
supplier for maintenance and servicing of the equipment (for parts and
labor not covered by the supplier's or manufacturer's warranty). For
nebulizers that are not purchased, but are used for more than 21
months, the servicing fee covers six-month periods beginning after the
21st month of use. As required by section 1834(a)(7) of the Act,
Medicare's payment for maintenance and servicing is equal to the lesser
of a reasonable and necessary maintenance and servicing fee, or 10
percent of the total purchase price of the equipment. For nebulizers
that are purchased, Medicare may make a payment to the supplier for any
necessary maintenance and servicing that is performed.
In 2003, the average service fee for nebulizers was $19.07 per six-
month period. Other than routine cleaning of the unit (that is,
cleaning and changing filters, cleaning and disinfecting nebulizers,
tubing, and mouthpieces), very little maintenance is required to
maintain a nebulizer's peak performance. There is usually no scheduled
maintenance for the nebulizer. Medicare pays for the usual frequency
for replacement of accessories. Maintenance kits and replacement parts
are available through online suppliers for approximately $5 to $15.
c. Inhalation Drugs
Medicare Part B pays for drugs that the nebulizer furnishes to a
beneficiary. Unlike nebulizers, inhalation drugs are not an explicit
benefit covered by statute. However, there was an administrative
decision made early in the program's history to cover inhalation drugs
as a supply so that the nebulizer could work. Without the inhalation
drugs, the nebulizer would not be effective for a beneficiary.
The two most common inhalation drugs used by beneficiaries are
albuterol sulfate (a beta-adrenergic bronchodilator) and ipratropium
bromide (an anticholinergic bronchodilator). A beneficiary may use one
or the other of these inhalation drugs, and they are frequently
prescribed together. Both albuterol sulfate and ipratropium bromide are
manufactured in powder form, but are generally liquefied and furnished
to beneficiaries in liquid form for use in a nebulizer. The beneficiary
may use a solution of one drug, or a combination of both drugs, in
addition to saline if necessary, with the nebulizer. The beneficiary
may mix the solution, or the supplier may furnish the drug in a pre-
mixed form (either commercially pre-mixed or pharmacy compounded). The
shelf life of these drugs is at least 18 to 24 months, and they do not
require any special storage arrangements such as refrigeration.
Medicare also pays for other inhalation drugs, such as budesonide
(an inhaled corticosteroid), which are used in conjunction with
albuterol sulfate and ipratropium bromide. These drugs can also be
administered using a nebulizer or an MDI.
d. Dispensing Fee
Medicare has paid a monthly $5 dispensing fee for each covered
inhalation drug or combination of drugs used in a nebulizer. The
dispensing fee is paid for each drug dispensed, not the number of unit
dose vials provided to the beneficiaries. Additionally, if two or more
drugs are combined in single unit dose vials, only one dispensing fee
will be paid per drug combination per month. A dispensing fee for
saline is not separately billable or payable. Inhalation drugs are the
only drugs for which Medicare Part B currently pays a separate
dispensing fee.
e. Beneficiary Training.
In 2003, CPT code 94664 was revised to include beneficiary training
by a physician or physician's staff regarding use of a nebulizer, MDI,
aerosol generator, or intermittent positive pressure breathing (IPPB)
machine. The narrative terminology for the code currently is--
Demonstration and/or evaluation of patient utilization of an aerosol
generator, nebulizer, metered dose inhaler or IPPB machine.'' The 2004
Medicare physician fee schedule payment for this service is $13.44.
This service has no physician work relative value units reflecting that
the training is typically performed by physician office staff. In 2004,
this service has 0.32 practice expense relative value units (RVUs) and
0.04 malpractice RVUs. Additionally, the supplier of the nebulizer,
under Sec. 424.57(c)(12), must ``document that it or another qualified
party has at an appropriate time, provided beneficiaries with necessary
information and instructions on how to use Medicare covered-items
safely and effectively.'' Beneficiary training by a physician or
physician's staff regarding use of a nebulizer would meet the
definition of ``another qualified party'' for purposes of this supplier
requirement.
3. Medicare Spending for Nebulizers and Inhalation Drugs
In 2003, Medicare spent about $1.6 billion for nebulizers and
inhalation drugs. This amount includes--
(a) About $130 million for nebulizers (both rental and purchase)
and nebulizer related accessories and supplies;
(b) About $13 million for servicing/maintenance fees;
(c) About $1.3 billion for albuterol sulfate and ipratropium
bromide and another $120 million for other inhalation drugs for a total
of approximately $1.4 billion. (This represents about 88 percent of
Medicare spending for inhalation therapy.);
(d) About $35.5 million for 7.1 million dispensing fees; and
(e) About $4.5 million for beneficiary training under CPT code
94664 (though this figure also includes training for other items as
well as nebulizers).
Medicare spending for inhalation drugs has grown rapidly.
Preliminary data indicate that between 2001 and 2003, Medicare spending
increased by 77 percent for albuterol sulfate and ipratropium bromide.
4. Inspector General and General Accounting Office Studies
The HHS IG issued 10 reports between February 1996 and January 2004
about Medicare payments for albuterol sulfate and ipratropium bromide
in excess of acquisition costs. In a report issued in September 2001,
[[Page 47548]]
the General Accounting Office (GAO) also concluded that Medicare
payment for these drugs was in excess of acquisition costs.
Table 1 of the Interim Final Rule regarding Changes to Medicare
Payment for Drugs and Physician Fee Schedule Payments for Calendar Year
2004, published in the January 7, 2004 Federal Register (69 FR 1084),
showed that the acquisition cost (averaging IG and GAO results) was 34
percent of the Average Wholesale Price (AWP) for ipratropium bromide
and 17 percent for albuterol sulfate. Prior to 2004, Medicare paid 95
percent of the AWP for each of these drugs and beneficiary coinsurance
was 20 percent of the Medicare payment amount. In the case of albuterol
sulfate, the beneficiary coinsurance was more than the actual
acquisition cost for the drug. During 2004, Medicare payment is 80
percent of the AWP for each of these drugs. Beginning with 2005,
Medicare payment will be 106 percent of the Average Sales Price (ASP).
The IG report issued in January 2004 again concluded that Medicare
payments were far in excess of acquisition costs for both albuterol
sulfate and ipratropium bromide. The IG found that the Medicare 2004
payment (and payment in prior years) was a multiple of the actual
acquisition costs for both drugs based on a comparison to the median
price that the drug was available through wholesalers/distributors and
group purchasing organizations (GPOs) and comparison to the
manufacturer-reported Wholesale Acquisition Cost (WAC).
5. Inhalation Drug Spread
In 2003, ipratropium bromide and albuterol sulfate were the third
and seventh largest drugs in terms of Medicare spending for carrier
paid drugs. The differences between Medicare's payment amount and
acquisition costs (that is, spread) for albuterol sulfate and
ipratropium bromide are among the largest spreads for drugs studied by
the IG and GAO. Based on the actual acquisition costs determined by IG
and GAO studies, in 2003, Medicare paid an estimated nearly $900
million in excess of acquisition costs for albuterol sulfate and
ipratropium bromide.
The IG and GAO findings of large differences between Medicare
payment amounts and acquisition costs for inhalation drugs provided the
foundation for Congressional enactment of section 305 of the MMA. This
section of the MMA sets Medicare payment for inhalation drugs at 106
percent of the ASP. (The Congressional Budget Office's November 20,
2003 pricing of the MMA estimated section 305 as having savings of $4.2
billion over 10 years.)
Suppliers argue that inhalation drug spread has allowed them to
fund activities related to care for beneficiaries with asthma or COPD
that otherwise do not have a Medicare Part B benefit category. These
other activities may include the following:
Respiratory therapists on staff or in networks available
on-call for home visits or telephone consultations.
On-call pharmacists.
Monthly calls to schedule medication refills.
Continuous education on disease states, including monthly
follow-ups.
24-hour support lines.
On-call and/or monthly home delivery of medication and
supplies.
Quality improvement programs.
6. Nebulizers vs. MDIs
Medicare Part B currently covers only one type of inhalation
therapy, nebulizers and inhalation drugs. Although Medicare Part B does
not cover MDIs and the inhalation drugs they furnish, the new Part D
benefit beginning in 2006 will cover these alternative hand-held
inhalation therapy devices (MDIs). In addition, the discount card and
$600 transitional assistance payment for low-income beneficiaries will
help seniors buy inhalers in 2004 and 2005, helping to bridge the gap
until 2006 when coverage begins.
MDIs are the quickest and easiest way to take inhalation medication
for most asthmatics and patients with COPD. The medication is propelled
directly into the lungs, allowing it to take effect more quickly, and
with fewer medication side effects. An MDI contains a specific number
of ``metered inhalations,'' and is made to deliver the prescribed
amount of medication for the labeled number of doses (typically 200
doses, which is 8 doses per day for 25 days). Inhalation accessory
devices, such as holding chambers and spacers, are used to improve the
direction and deposition of medication delivered by MDIs, making it
easier for beneficiaries to use an MDI and making the MDI more
effective in delivering the medicine to the lungs.
Since Medicare currently covers nebulizers and inhalation drugs,
but not alternative forms of inhalation therapy, there are strong
financial incentives toward use of the former compared to alternatives.
Our review of the literature over the past decade, including two meta-
analyses and over two dozen individual studies applicable to adults,
did not find that bronchodilators delivered via nebulizer were more
effective than when delivered via metered dose inhaler.
Since one delivery method is not clinically superior to the other,
when Medicare covers both methods of delivery of inhalation therapy,
the decision to prescribe one over the other will be made by the
physician and beneficiary based on beneficiary needs and preferences
consistent with applicable standards of medical practice. It would not
be unlikely for many beneficiaries to choose the convenience of MDIs
over nebulizers once the Medicare coverage imbalance is removed in
2006. Since MDIs are less expensive, very portable, and easier to use,
it is likely there will be a substantial shift of Medicare
beneficiaries from nebulizers to MDIs beginning in 2006, even absent
the Medicare payment changes for nebulizers and inhalation drugs in
2005.
Some claim that beneficiaries cannot use MDIs because they do not
have the dexterity to use them. Use of an MDI requires proper
inhalation techniques in order to receive the full benefit possible
from the amount of medication included in each dose. Spacers and
holding chambers extend the mouthpiece of the inhaler and increase the
air volume into which the medication is atomized, allowing more time
for the patient to breathe the medication and avoid misdirecting the
medication onto the soft tissues inside the mouth where it will have
little effect on lung function.
A nebulizer may also require a certain level of dexterity (that is,
operating, maintaining, and cleaning the nebulizer correctly). There
may also be beneficiaries who do not have the dexterity to use either
an MDI or nebulizer, which would require the availability of
alternative therapies, such as an IPPB machine to aid in the delivery
of aerosol medication by increasing the depth of breathing more than
the patient alone can achieve.
7. Payments Beginning in 2005 Including Provisions of the Proposed Rule
Our goal is to assure that each beneficiary who needs inhalation
therapy has access to the most appropriate medication and delivery
method. We expect that the combined changes to cover MDIs, adjust
payments for inhalation drugs, and provide for an appropriate
dispensing fee will improve beneficiary access and choice. We seek
comments about an appropriate amount for a dispensing fee that would
assure beneficiary access to inhalation medications provided through
nebulizers.
[[Page 47549]]
We believe that a dispensing fee is intended to cover a pharmacy's
activities to get inhalation drugs to beneficiaries. We seek data and
information on the additional services these pharmacies provide to
Medicare beneficiaries, the extent to which inhalation drugs can be
furnished without these additional services and the extent to which
such services are covered under Medicare. We are concerned about
significant shifts in beneficiary access to inhalation therapy prior to
implementation of the Part D drug benefit in light of the reduction in
Medicare payment for inhalation drugs beginning in 2005, and also seek
comments about whether the dispensing fee should include a somewhat
higher, transitional payment.
Below we discuss, changes in payment for inhalation drugs and
nebulizers beginning in 2005.
a. Nebulizers
Section 1834(a)(21) of the Act, as amended by section 302(c)(2) of
the MMA, requires a reduction in Medicare payment, beginning with 2005,
for specified items of DME, including nebulizers paid under code E0570.
The reduction is the difference in payment amounts under Medicare and
the median Federal Employees Health Benefits (FEHB) plan, as identified
in IG testimony before the Senate Committee of Appropriations on June
12, 2002. Other codes for nebulizers and related equipment are not
affected by the payment reduction.
b. Maintenance and Servicing of Nebulizers
Since the maintenance and servicing fee is equal to the first
month's rental payment, the maintenance and servicing fee for
nebulizers will also be reduced in 2005.
c. Inhalation Drugs
As discussed in the ASP payment section of this proposed rule, for
the first quarter of 2005, the Medicare payment at ASP plus 6 percent
is estimated to be $0.04 per milligram for albuterol sulfate and $0.30
per milligram for ipratropium bromide. While these figures represent
estimated reductions from 2004 payment levels of about 90 percent, they
are not necessarily the actual payment amounts for the first quarter of
2005. The actual payment amounts will be based on ASP's calculated from
the manufacturer ASP to be submitted for the third quarter of 2004.
Both albuterol sulfate and ipratropium bromide are generic drugs
that have multiple manufacturers. Since these ASPs are average figures
across all manufacturers, a pharmacy should be able to acquire
albuterol sulfate and ipratropium bromide at these prices. Moreover, to
the extent there is price variation among manufacturers, there will be
some manufacturers with lower prices than others. In this case, a
pharmacy might be able to obtain albuterol sulfate and ipratropium
bromide at a price below the average.
The Medicare payment amount includes a 6 percent add-on. Assuming
that ASP remains constant between the first and third quarters of 2004,
the 6 percent add-on would be about $1.00 for a typical month's supply
of 450 milligrams of albuterol sulfate and about $3.00 for a 90-day
supply. Similarly, the 6 percent add-on would be about $1.60 for a
typical month's supply of 93 milligrams of ipratropium bromide and
about $4.80 for a 90-day supply. Because albuterol sulfate and
ipratropium bromide are often prescribed together, Medicare payment at
106 percent of ASP would include, as additional payments above the
acquisition cost of the drugs, a total payment to the supplier of about
$2.60 for a 30-day supply and about $7.80 for a 90-day supply of both
drugs.
d. Dispensing Fee
Given the overall reduction in payment for inhalation drugs, we are
concerned about beneficiary access to these drugs. Because shipping,
handling, compounding, and other pharmacy activities would usually
exceed the 6 percent payment above the drug acquisition cost, we
believe that it is appropriate for Medicare to continue to pay a
separate dispensing fee to pharmacies that furnish inhalation drugs to
beneficiaries.
We propose to establish a separate dispensing fee for inhalation
drugs. This separate dispensing fee will be in addition to the
difference between the supplier's acquisition cost and the Medicare
payment for the drug. For example, if a supplier is acquiring albuterol
and ipratropium bromide for the average sales price, the supplier would
receive a separate dispensing fee amount plus their acquisition cost
plus $7.80 for a 90-day supply. The $7.80 is the amount included in the
payment for the drug itself since Medicare pays 6 percent above the
average sales price.
As noted above, Medicare has paid a $5 monthly dispensing fee for
each covered inhalation drug or combination of drugs used in a
nebulizer. Dispensing fees are paid by Medicaid and private insurers;
we seek information about these dispensing fees for inhalation drugs
and their applicability to Medicare. In addition, we seek comments
about an appropriate dispensing fee amount to cover the shipping,
handling, compounding, and other pharmacy activities required to get
these inhalation medications to Medicare beneficiaries. We seek data
and information that explains the direct labor and non-labor costs as
well as indirect costs of overhead for these pharmacy activities as
they relate to dispensing of inhalation drugs.
Consideration of dispensing fees needs to be viewed in the context
of several important changes and clarifications in Medicare policy and
billing requirements.
First, we are proposing to allow a prescription for inhalation
drugs covering a 90-day period to be written by a physician and filled
by a pharmacy. Current guidelines are that a pharmacy generally should
not fill a prescription for inhalation drugs for more than a month's
supply for a beneficiary. We believe that this requirement needs
revision in the case of inhalation drugs for two key reasons. Most
beneficiaries who use inhalation drugs use them for extended periods of
time and often use them for the rest of their lives. In addition, we
understand that many inhalation drugs are delivered to a beneficiary
through the mail. We understand that a mail-order prescription drug
model works well for a 90-day prescription. We believe that there will
be significant savings in shipping for a 90-day prescription rather
than a monthly prescription.
We would expect that reasonableness would govern filling a monthly
vs. a 90-day prescription with a physician writing and a pharmacy
filling a monthly or a 90-day prescription depending on the
circumstances of the beneficiary. For example, it would be reasonable
to expect that the first time a beneficiary receives a prescription for
a nebulizer and inhalation drugs that the prescription would be for a
month. Similarly, it would be reasonable to expect that refill
prescriptions for beneficiaries would be for a 90-day period. Carriers
would continue to assess claims for dispensed quantities greater than
what would be reasonable based on usual dosing guidelines. We would
expect that the bulk of prescriptions would be for 90-day periods.
Second, we recently revised the guidelines regarding the time frame
for delivery of refills of DMEPOS products to occur no sooner than
``approximately 5 days prior to the end of the usage for the current
product''. As previously noted, inhalation drugs are often furnished to
a beneficiary by mail. It has
[[Page 47550]]
been suggested that Medicare guidelines for refill prescriptions
allowed too short of a window between shipping the next month's
prescription and the end of the current month. It was argued that as a
result, a pharmacy ``effectively'' had to ship the product to a
beneficiary using an overnight delivery service.
On January 2, 2004, we revised the guidelines (effective February
2, 2004) regarding the time frame for subsequent deliveries of refills
of DMEPOS products to occur no sooner than ``approximately 5 days prior
to the end of the usage for the current product'' (see section 4.26.1
of Chapter 4--Benefit Integrity of the Medicare Program Integrity
Manual). This change allows shipping of inhalation drugs on
``approximately'' the 25th day of the month in the case of a month's
supply, and on ``approximately'' the 85th day in the case of a 90-day
supply. We emphasize the word ``approximately''; while we believe that
normal ground service shipping would allow delivery in 5 days, if there
were circumstances where ground service could not occur in 5 days, the
guideline would still be met if the shipment occurs in 6 or 7 days.
(``Days'' refers to business days or shipping days applicable to the
shipper, that is, a 6 day week in the case of the U.S. Postal
Service.). We believe that this change eliminates the need for
suppliers to use overnight shipping methods and allows shipping of
inhalation drugs by less expensive ground service.
Third, we understand that some pharmacies believe that Medicare has
a requirement that a pharmacy must obtain an original signed
prescription before each prescription is dispensed. The Program
Integrity Manual (section 5.1 of Chapter 5) addresses the ordering
requirement for DMEPOS items. The Manual indicates that most DMEPOS
items, including drugs, can be dispensed based on a verbal order from a
physician. The Manual further indicates that a written order must be
obtained before submitting a claim, but that such written order may be
faxed, photocopied, electronic or pen and ink. The order for inhalation
drugs must specify the name of the drug, the concentration (if
applicable), dosage, and frequency of administration. We hope that
clarification of this requirement would reduce a pharmacy's costs of
supplying covered inhalation drugs to Medicare beneficiaries to the
extent that pharmacies are currently applying an original signed
prescription requirement.
Fourth, Medicare regulations (Sec. 424.57) specify the
requirements a DMEPOS supplier must meet in order to receive payment
for a Medicare covered item. Section 424.57(c)(12) contains the proof
of delivery requirement and indicates that a ``supplier must be
responsible for the delivery of Medicare covered items to beneficiaries
and maintain proof of delivery.'' We recently revised the Program
Integrity Manual (section 4.26 of Chapter 4) to address proof of
delivery requirements for suppliers. As discussed in the Manual, the
burden of proving delivery is left to the supplier. The Manual provides
examples of the types of proof that are reasonable and acceptable, but
it does not provide an all-inclusive list. Other acceptable proof-of-
delivery methods may exist and may be employed by suppliers. This
documentation is normally only requested by the contractor when a
complaint is received that the item was not provided or received. The
documentation is necessary to investigate the allegation. We believe
that the current provisions on proof of delivery are adequate and
appropriate for inhalation drugs.
Fifth, in section IV.H (Assignment of Medicare Claims--Payment to
the Supplier) of this proposed rule, we propose to change current
regulations at Sec. 424.55 to eliminate the requirement that
beneficiaries assign claims to suppliers in situations where suppliers
are required by section 1842(o)(3) of the Act to accept assignment.
This change would eliminate the need for suppliers to have a signed
Assignment of Benefits (AOB) form from a beneficiary in order for
Medicare to make payment. Because such section of the Act requires
Medicare to make payment for drugs only on an assigned basis, this
change would eliminate a billing requirement for drugs, including
inhalation drugs. We believe that this change would reduce a pharmacy's
costs of supplying covered inhalation drugs to Medicare beneficiaries
to the extent that pharmacies are requiring a signed AOB form before
submitting a claim.
We believe that the amount of dispensing fee needs to be considered
in conjunction with--
(1) Our proposal to allow 90-day prescriptions;
(2) Our recent revision to allow the next month's refill
prescription to be shipped approximately 5 business days prior to the
end of usage for the product, that is, to allow shipping on the 25th of
the month for a month's supply, and shipping or 85th day in the case of
a 90-day period;
(3) Our policy clarification regarding signed original orders
before a prescription is filled;
(4) Our proof of delivery requirement revisions; and
(5) Our proposed change regarding the Assignment of Benefits form.
e. Beneficiary Training
Medicare Part B will continue to pay for beneficiary training by a
physician's staff regarding use of a nebulizer, MDI, aerosol generator,
or IPPB machine. Section 424.57(c)(12) specifies that ``The supplier
must document that it or another qualified party has at an appropriate
time, provided beneficiaries with necessary information and
instructions on how to use Medicare covered-items safely and
effectively.'' Beneficiary training by a physician or physician's staff
regarding use of a nebulizer would meet the definition of ``another
qualified party'' for purposes of this supplier requirement.
IV. Other Issues
A. Proposals Related to Therapy Services
1. Outpatient Therapy Services Performed ``Incident To'' Physicians'
Services
[If you choose to comment on issues in this section, please include the
caption ``Therapy--Incident To'' at the beginning of your comments.]
In last year's proposed rule, we requested comments on clarifying
that the personnel qualifications of therapists in home health settings
at Sec. 484.4 apply consistently to all therapy settings, including
the offices of physical and occupational therapists, physicians, and
nonphysician practitioners. We received comments from therapists,
physicians, nontherapist health care providers and their representative
organizations. After consideration of all comments, we now propose to
revise 42 CFR 410.26, 410.59, 410.60 and 410.62 to reflect that
physical therapy, occupational therapy, and speech-language pathology
services provided incident to a physician's professional services are
subject to certain limitations as described at section 1862(a)(20) of
the Act.
Regulations in 42 CFR 485.705 specify that, in almost all settings,
outpatient rehabilitative therapy services, (physical therapy (PT),
occupational therapy (OT), or speech-language pathology (SLP)) can be
furnished only by the following individuals meeting the qualifications
in Sec. 484.4: physical therapists, occupational therapists,
appropriately supervised physical therapist assistants, appropriately
supervised occupational therapy assistants, and speech-language
pathologists. Some States permit licensed physicians, physician
assistants, clinical nurse specialists, and nurse practitioners to
furnish PT, OT,
[[Page 47551]]
and SLP services also. Therapy services, and those who provide therapy
services, must also meet the standards and conditions as specified in
Medicare manuals.
Section 1862(a)(20) of the Act permits payment for therapy services
furnished incident to a physician's professional services only if the
practitioner meets the standards and conditions that would apply to
such therapy services if they were furnished by a therapist, with the
exception of the licensing requirement. We are proposing to amend the
regulations to include the statutory requirement that only individuals
meeting the existing qualification and training standards for
therapists (with the exception of licensure) consistent with Sec.
484.4 qualify to provide therapy services incident to physicians'
services.
Section 1862(a)(20) of the Act refers only to PT, OT, and SLP
services and not to any other type of therapy or service. This section
applies to services of the type described in section 1861(p), 1861(g)
and 1861(ll) of the Act; it does not, for example, apply to therapy
provided by qualified clinical psychologists. This section also does
not apply to services that are not covered either as therapy or as
evaluation and management services provided incident to a physician or
nonphysician practitioner such as recreational therapy, relaxation
therapy, athletic training, exercise physiology, kinesiology, or
massage therapy services.
2. Qualification Standards and Supervision Requirements in Therapy
Private Practice Settings
[If you choose to comment on issues in this section, please include the
caption ``Therapy Standards and Requirements'' at the beginning of your
comments.]
Section 1861(p) includes services furnished to individuals by
physical and occupational therapists meeting licensing and other
standards prescribed by the Secretary if the services meet the
necessary conditions for standards for health and safety. These
services include those furnished in the therapist's office or the
individual's home. By regulation, we have defined therapists under this
provision as physical or occupational therapists in private practice
(PTPPs and OTPPs).
Under Medicare Part B, outpatient therapy services, including
physical and occupational therapy services, are generally covered when
reasonable and necessary and when provided by physical and occupational
therapists meeting the qualifications set forth at Sec. 484.4.
Services provided by qualified therapy assistants, including physical
therapist assistants (PTAs) and occupational therapy assistants (OTAs),
may also be covered by Medicare when furnished under the specified
level of therapist supervision that is required for the setting in
which the services are provided (institutions and private practice
therapist offices). For PTPPs and OTPPs, the regulations specify that
the PT or OT meets only State licensure or certification standards and
do not currently refer to the professional qualification requirements
at Sec. 484.4.
Since 1999, when therapy services are provided by PTAs and OTAs in
the PT or OT private practice setting, the services must be personally
supervised by the PTPP or OTPP. In response to a requirement to report
to Congress on State standards for supervision of PTAs, CMS contracted
with the Urban Institute. The Urban Institute found that no State has
the strict, full-time ``personal'' supervision requirement, for any
setting, that Medicare places on PTAs in PTPPs (the report only
examined PTAs, which are more heavily regulated than OTAs). The Urban
Institute study found that only 7 States require any ``personal'' PTA
supervision by the PT, and all 7 required this level of supervision
only periodically, every 14, 30 or 60 days. The remaining States and
Washington, DC all have less stringent PTA supervision requirements,
including: 7 States and Washington, DC require full-time on-site
supervision, which corresponds to Medicare's direct supervision level;
16 States require the equivalent of Medicare's general supervision
level, which does not require the PT to be on site, but requires the PT
to be in contact via telecommunication; and another 16 States have
rules for periodic on-site PT visits. Most States permit a supervision
level similar to the Medicare ``general'' supervision requirement for
physical therapy services delivered in institutional settings. To
provide a consistent therapy assistant supervision policy, we are
proposing to revise the regulations at 410.59 and 410.60 to require
direct supervision of PTAs and OTAs when therapy services are provided
by PTs or OTs in private practice. This proposed change would no longer
require the personal presence of the PTPP or OTPP when their PTAs or
OTAs provide services in the private practice setting. We are
particularly interested in receiving comments regarding the proposed
PTA supervision change, from personal to direct, for the private
practice setting as whether or not it will have implications for the
quality of services provided, or for Medicare spending, either through
increased capacity to provide these services, or, alternatively, in the
event that the Congress again extends the moratorium on the
implementation of the limits on Medicare reimbursement for therapy
services imposed by the Balanced Budget Act of 1997.
Currently, the OTPP or PTPP regulations at Sec. 410.59(c) and
Sec. 410.60(c) do not reference qualification requirements for therapy
assistants, or other staff, working for PTs and OTs in private
practices. These qualification requirements were removed during 1998
rulemaking--when the coverage conditions requiring survey and
certification, at Sec. 486 Subpart D, for independently practicing PTs
and OTs were replaced with a simplified carrier enrollment process for
PTPPs and OTPPs. In our 1998 rule, at 63 FR 58868, we deleted the
references at Sec. 410.59 and Sec. 410.60 to the requirements at
Sec. 484.4 for PTs and OTs in private practice. At that time, the
qualifications for the staff of the PTPP and OTPP, including PTAs and
OTAs, were inadvertently removed because the coverage conditions at
Sec. 486 Subpart D were no longer applicable. In order to provide a
consistent policy regarding requirements for therapists and therapy
assistants, we are proposing to restore the qualifications by adding at
Sec. 410.59 and Sec. 410.60 the cross-reference to the qualifications
at Sec. 484.4 for privately practicing therapists and their therapy
assistants.
3. Other Technical Revisions
[If you choose to comment on issues in this section, please include the
caption ``Therapy Technical Revisions'' at the beginning of your
comments.]
We are making technical corrections to Sec. 410.62 to refer
consistently to speech-language pathology in this section (currently
the terms ``speech pathology'' and ``speech-language pathology'' are
used interchangeably) and are revising Sec. 410.62(a)(2)(iii) to
appropriately reference Sec. 410.61 (the current reference is to Sec.
410.63).
We are also removing subpart D, Conditions for Coverage: Outpatient
Physical Therapy Services Furnished by Physical Therapists, from part
486. Our November 1998 rule (63 FR 58868) discussed replacing this
subpart with a simplified carrier enrollment process for physical or
occupational therapists in private practice; however, the conforming
regulatory change to remove Subpart D was never made.
In addition, we are making a technical change at Sec. 484.4 to
correct the title ``physical therapy assistant'' to ``physical
therapist assistant.''
[[Page 47552]]
We are also amending Sec. 410.59(e) and Sec. 410.60(e) to include
a reference to the 2-year moratorium on the therapy caps established by
section 624 of the MMA.
B. Low Osmolar Contrast Media
[If you choose to comment on issues in this section, please include the
caption ``LOW OSMOLAR CONTRAST MEDIA'' at the beginning of your
comments.]
Contrast media are used to enhance the images produced by various
types of diagnostic radiological procedures. High osmolar contrast
media (HOCM), initially developed for use with these procedures, was
relatively inexpensive and payment for HOCM is subsumed in the payment
for the technical component of these procedures. When the more
expensive low osmolar contrast media (LOCM) were developed, estimates
showed that if all radiologic studies requiring contrast media were to
use LOCM, the costs to the Medicare program would have been
substantial. At that time, there were no definitive studies showing
that the benefits of using LOCM justified the very high additional
costs.
When the Medicare physician fee schedule was established, findings
of studies of patients receiving both types of contrast media had been
published, and the American College of Radiology (ACR) had adopted
criteria for the use of LOCM. We determined that the older, less
expensive contrast media (HOCM) could be used safely in a large
percentage of the Medicare population. However, we also decided that
separate payment for LOCM should be made for patients with certain
medical characteristics. We adopted the ACR criteria, with some
modification, as the basis for a policy that separate payments be made
for the use of LOCM in radiological procedures for patients meeting
certain criteria. These criteria were established at Sec. 414.38.
Specifically, separate payment is made for all intrathecal,
intravenous, and intra-arterial injections of LOCM, when it is used for
nonhospital patients who have one or more of the following five medical
conditions--
A history of previous adverse reactions to contrast media,
with the exception of a sensation of heat, flushing, or a single
episode of nausea or vomiting;
A history of asthma or allergy;
Significant cardiac dysfunction, including recent or
imminent cardiac decompensation, severe arrhythmias, unstable angina
pectoris, recent myocardial infarction, and pulmonary hypertension;
Generalized debilitation;
Sickle cell disease.
Under these conditions, we pay for LOCM, utilizing HCPCS codes A4644
through A4646. The payment amount for LOCM is calculated according to
the rules applicable to drugs provided incident to a physician's
service. The amount is reduced by 8 percent to account for the
allowance for contrast media already included in the technical
component of the service.
ACR has requested that we allow further separate payment for LOCM
by either expanding or eliminating the conditions. According to ACR,
use of LOCM has become the standard in most radiology practices and
benefits both physicians and patients. The benefits of uniform use of
LOCM would include--
The reduction of patient discomfort arising when HOCM is
used instead of LOCM; and
A reduction in physician resources now required to screen
for high-risk patients.
The price differential between HOCM and LOCM is also decreasing.
Universal use of LOCM, along with declining prices, will result in an
efficient, and safer alternative to HOCM.
We are proposing to revise the regulations at Sec. 414.38 to
eliminate the restrictive criteria for the payment of LOCM. This
proposal would make Medicare payment for LOCM consistent across
settings. Before January 1, 2003, the criteria in Sec. 414.38 were
also used to determine payment in the hospital setting. However, as
instructed in our Program Memorandum A-02-120, issued November 22,
2002, hospitals that are subject to the outpatient prospective payment
system (OPPS) no longer use these criteria. Instead, payment for both
ionic and non-ionic contrast media (including LOCM) is packaged into
the APC payment for the procedure. Under OPPS there is no longer a
payment difference between LOCM and other contrast materials.
Effective January 1, 2005, payment for LOCM would be made on the
basis of the average sales price plus six percent in accordance with
the standard methodology for drug pricing established by the MMA.
However, because the technical portions of radiology services are
currently valued in the nonphysician workpool and the CPEP inputs for
these services are not used in calculating payment, we will continue to
reduce payment for LOCM by eight percent to avoid any duplicate payment
for contrast media.
C. Payments for Physicians and Practitioners Managing Patients on
Dialysis
[If you choose to comment on issues in this section, please include the
caption ``MANAGING PATIENTS ON DIALYSIS'' at the beginning of your
comments.]
1. ESRD-Related Services Provided to Patients in Observation Settings
In response to comments received on billing procedures when the
patient is hospitalized during the month, we stated in the November 7,
2003 Federal Register (68 FR 63220) that the physician may bill the
code that reflects the number of visits during the month on days when
the patient was not in the hospital (either admitted as an inpatient or
in observation status). (We refer to Medicare's payment amount below as
the monthly capitation payment or MCP and the patient's normal
attending physician for ESRD-related services as the MCP physician).
In comments on the August 15, 2003 proposed rule, the Renal
Physicians Association (RPA) indicated that the observation area is not
an uncommon setting for outpatient face-to-face encounters to occur and
the observation area should be an approved site-of-service for
physician-dialysis patient encounters that count toward the MCP visit
total. We indicated in the final rule, however, that observation
services would not be counted as a visit under the MCP, but would be
paid separately. Prior to this, long-standing Medicare policy had
subsumed ESRD-related observation visits within the MCP.
Upon further review of this issue, we now agree with RPA's comment
and propose that ESRD-related visits provided to patients by the MCP
physician in an observation setting would be counted as visits for
purposes of billing the MCP codes.
2. Payment for Outpatient ESRD-Related Services for Partial Month
Scenarios
Since changing our payments for managing patients on dialysis, we
have received a number of comments from the nephrology community
requesting guidance on billing for outpatient ESRD-related services
provided to transient patients and in partial month scenarios where the
comprehensive visit may not have been furnished: for example, when the
patient is hospitalized during the month, or receives a kidney
transplant before the monthly comprehensive visit is furnished. To
address this issue, we propose to change the description of the G codes
for ESRD-related home dialysis services, less than full month, as
[[Page 47553]]
identified by G0324 through G0327. The new descriptor would include
other partial month scenarios, in addition to patients dialyzing at
home. The proposed descriptors for G0324 through G0327 are as follows:
``G0324: End stage renal disease (ESRD) related services for
dialysis less than a full month of service, per day; for patients under
two years of age.''
``G0325: End stage renal disease (ESRD) related services for
dialysis less than a full month of service, per day; for patients
between two and eleven years of age.''
``G0326: End stage renal disease (ESRD) related services for
dialysis less than a full month of service, per day; for patients
between twelve and nineteen years of age.''
``G0327: End stage renal disease (ESRD) related services for
dialysis less than a full month of service, per day; for patients
twenty years of age and over.''
The G codes G0324 through G0327 would be used to bill for
outpatient ESRD-related services provided in the following scenarios:
Transient patients--Patients traveling away from home
(less than full month);
Home Dialysis Patients (less than full month);
Partial month where there was one or more face-to-face
visits without the comprehensive visit and either the patient was
hospitalized before a complete assessment was furnished, dialysis
stopped due to death, or the patient had a transplant.
We believe that modifying the definition of the per diem G codes
(as identified by G0324 through G0327) would provide a consistent way
to bill for these partial month scenarios. However, this proposed
change to the descriptions of G0324 through G0327 is intended to
accommodate unusual circumstances when the outpatient ESRD-related
services would not be paid for under the MCP. Use of these per diem
codes would be limited to the scenarios listed above. Physicians who
have an on-going formal agreement with the MCP physician to provide
cursory visits during the month (for example ``rounding physicians'')
may not use the per diem codes.
Clarification on Billing for Transient Patients
For transient patients who are away from their home dialysis site,
and at another site for fewer than 30 consecutive days, the revised per
diem G codes (G0324 through G0327) would be billed by the physician or
practitioner responsible for the transient patient's ESRD-related care.
Only the physician or practitioner responsible for the traveling ESRD
patient's care would be permitted to bill for ESRD-related services
using the per diem G codes (G0324 through G0327).
If the transient patient is under the care of a physician or
practitioner other than his or her regular MCP physician for a complete
month, the physician or practitioner responsible for the transient
patient's ESRD-related care cannot bill using the per diem codes. In
this case the transient physician or practitioner treating the patient
must furnish a complete assessment and bill for ESRD-related services
under the MCP.
We are currently evaluating the criteria for defining a transient
patient and welcome comments on when a patient should be considered
transient.
D. Technical Revision
[If you choose to comment on issues in this section, please include the
caption ``TECHNICAL REVISION'' at the beginning of your comments.]
In Sec. 411.404, Medicare noncoverage of all obesity-related
services is used as an example. Since we are currently revising this
coverage policy, we are proposing to omit this example.
E. Diagnostic Psychological Tests
[If you choose to comment on issues in this section, please include the
caption ``DIAGNOSTIC PSYCHOLOGICAL TESTS'' at the beginning of your
comments.]
All diagnostic tests covered under section 1861(s)(3) of the Act
and payable under the physician fee schedule must be furnished under
the appropriate level of supervision by a physician as defined in
section 1861(r) of the Act. Additionally, the physician or nonphysician
practitioner who is treating the patient must order all diagnostic
tests in order for these tests to be considered reasonable and
necessary. These tests must be furnished under at least a general level
of physician supervision, that is, the test is furnished under the
physician's overall direction and control, but the physician's presence
is not required during the performance of the procedure.
However, certain diagnostic tests require either direct or personal
supervision. Direct supervision in the office setting means the
physician must be present in the office suite and immediately available
to furnish assistance and direction throughout the performance of the
procedure. It does not mean that the physician must be present in the
room when the procedure is performed. Personal supervision means the
physician must be in attendance in the room during the performance of
the procedure. Physician supervision at the specified level is required
throughout the performance of the test. Services furnished without the
required level of supervision are not reasonable and necessary, and
Medicare payment is precluded.
Section 410.32(b)(2)(iii) does permit an exception to these
physician supervision level requirements for clinical psychologists and
independently practicing psychologists (who are not clinical
psychologists) to personally perform diagnostic psychological testing
services without physician supervision. However, diagnostic
psychological tests performed by anyone other than a clinical
psychologist or independently practicing psychologist must be provided
under the general supervision of a physician as defined above.
Accordingly, clinical psychologists and independently practicing
psychologists have not been permitted to supervise others in the
administration of diagnostic psychological tests.
In Sec. 410.71(d), we require a clinical psychologist who
furnishes diagnostic, assessment, preventive, and therapeutic services
directly to individuals to hold a doctoral degree in psychology and to
be licensed or certified, on the basis of the doctoral degree in
psychology, by the State in which he or she practices. Program
instructions define an independently practicing psychologist as an
individual who is not a clinical psychologist and practices
independently of an institution, agency, or physician's office.
Examples include, but are not limited to, educational psychologists and
counseling psychologists. Any psychologist who is licensed or certified
to practice psychology in the State or jurisdiction where he or she is
furnishing services may qualify as an independent psychologist. It is
our understanding that all States, the District of Columbia, and Puerto
Rico license psychologists, but that some trust territories do not. In
the jurisdictions that do not issue licenses, an independently
practicing psychologist may be any practicing psychologist.
The American Psychological Association (APA) requested that we re-
evaluate our regulations regarding clinical psychologists' supervision
of diagnostic psychological tests. The APA also provided additional
information concerning provision of these services.
According to the APA, clinical psychologists generally have seven
years of graduate education in the study of human behavior and are
highly trained in the selection, administration,
[[Page 47554]]
and interpretation of psychological tests. In addition, according to
our payment data, the majority of health care practitioners, other than
physicians, performing psychological and neuropsychological testing
services under the central nervous system codes (CPT codes 96100
through 96117) are psychologists. We agree that clinical psychologists
possess core knowledge in test measurement and development,
psychometric theory, specialized psychological assessment techniques,
statistics, and the psychology of behavior that uniquely qualifies them
to direct test selection and interpret test data.
Therefore, we are proposing to change the supervision requirements
regarding who can supervise diagnostic psychological testing services.
Having ancillary staff supervised by clinical psychologists would
enable these practitioners with a higher level of expertise to oversee
psychological testing. It could also potentially relieve burdens on
physicians and healthcare facilities.
Additionally, in rural areas, we anticipate that permitting
psychologists to supervise diagnostic psychological testing services
would reduce delays in testing, diagnosis, and treatment that could
result from the unavailability of physicians to supervise the tests.
We propose that the appropriate level of supervision of diagnostic
psychological tests by clinical psychologists be general supervision,
the level required of physicians supervising the same services.
We are proposing to revise the regulations at Sec.
410.32(b)(2)(iii) to permit clinical psychologists to supervise the
performance of diagnostic psychological and neuropsychological testing
services. This proposal extends solely to clinical psychologists, and
it does not include independently practicing psychologists.
F. Care Plan Oversight
[If you choose to comment on issues in this section, please include the
caption ``CARE PLAN OVERSIGHT'' at the beginning of your comments.]
Care Plan Oversight (CPO) refers to the supervision of patients
under Medicare-covered home health or hospice care requiring complex
multi-disciplinary care modalities, including regular development and
review of plans of care. In the December 8, 1994 physician fee schedule
final rule (59 FR 63423), we established separate payment for CPO when
performed by physicians. The Balanced Budget Act (BBA) of 1997 extended
to nonphysician practitioners (NPPs) the right to receive payment for
Medicare physicians' services that fall within their scope of practice
under State law. In the November 1, 2000 final rule (65 FR 65407), we
created HCPCS codes G0181 and G0182 for reporting home health and
hospice CPO, respectively. We also clarified in that rule that services
of NPPs, practicing within the scope of State law applicable to their
services, could be billed as CPO services.
To certify a patient for home health services, a physician must
review the patient records and sign the plan of care. Our policy has
been that the physician who bills for CPO must be the same physician
who signs the plan of care and that, according to the statute,
(sections 1814(a)(2)(C) and 1835(a)(2)(A) of the Act), only a physician
can sign the plan of care for home health services. The effect of these
two provisions, both of which were in place prior to the BBA of 1997,
created a problem with respect to an NPP billing for CPO in the home
health setting.
We propose to revise Sec. 414.39 to clarify that NPPs can perform
home health CPO even though they cannot certify a patient for home
health services and sign the plan of care. However, we are also
proposing the conditions under which NPP services may be billed for
CPO; we established these conditions in consultation with our
contractor medical directors and CMS medical staff. In general, the
proposed conditions are meant to ensure that the NPP has seen and
examined the patient and that the appropriate and established
relationship exists between the physician who certifies the patient for
home health services and the NPP who will provide the home health CPO.
G. Assignment of Medicare Claims--Payment to the Supplier
[If you choose to comment on issues in this section, please include the
caption ``Assignment'' at the beginning of your comments.]
Current regulations require the beneficiary (or the person
authorized to request payment on the beneficiary's behalf) to assign a
claim to the supplier for an assignment to be effective. Over time,
however, the Act has been amended in various sections to require
suppliers, in some instances, to accept assignment for a Medicare
covered service regardless of whether or not the beneficiary actually
assigns the claim to the supplier. (This would include situations in
which services are furnished by a participating physician or supplier.)
In these instances, the requirement in our current regulations at Sec.
424.55(a) that the beneficiary assign the claim to the supplier is now
unnecessary. Therefore, we are proposing to create an exception to the
general rule in Sec. 424.55(a). New Sec. 424.55(c) would eliminate
the requirement that beneficiaries assign claims to suppliers in
situations where suppliers are required by statute to accept
assignment.
We believe the creation of this exception to the requirement for
beneficiaries to assign benefits in situations where benefits can by
statute only be paid on an assigned basis will reduce the paperwork
burden on beneficiaries and suppliers.
V. Collection of Information Requirements
Under the Paperwork Reduction Act of 1995 (PRA), we are required to
provide 60-day notice in the Federal Register and solicit public
comment before a collection of information requirement is submitted to
the Office of Management and Budget (OMB) for review and approval. In
order to fairly evaluate whether OMB should approve an information
collection, section 3506(c)(2)(A) of the PRA requires that we solicit
comment on the following issues:
The need for the information collection and its usefulness
in carrying out the proper functions of our agency.
The accuracy of our estimate of the information collection
burden.
The quality, utility, and clarity of the information to be
collected.
Recommendations to minimize the information collection
burden on the affected public, including automated collection
techniques.
Section 410.16 requires the furnishing of education, counseling,
and referral services as part of an initial preventive physical
examination, a written plan for obtaining the appropriate screening and
other preventive services which are also covered as separate Medicare B
Part services.
The burden associated with this requirement is the time required of
the physician or practitioner to provide beneficiaries with education,
counseling, and referral services and to develop and provide a written
plan for obtaining screening and other preventive services.
While these requirements are subject to the PRA, we believe the
burden associated with these requirements to be reasonable and
customary business practice; therefore, the burden for this collection
requirement is exempt under 5 CFR 1320.3(b)(2)&(3).
Section 411.404 requires that written notice must be given to a
beneficiary, or someone acting on his or her behalf, that
[[Page 47555]]
the services were not covered because they did not meet Medicare
coverage guidelines.
Although this section is subject to the PRA, the burden associated
with this requirement is currently captured and accounted for in two
currently approved information collections under OMB numbers 0938-0566
and 0938-0781.
Sections 410.36 and 410.38 require that the physician must document
in the medical records the need for the prosthetic, orthotic, durable
medical equipment, and/or supplies being ordered.
While these information collection requirements are subject to the
PRA, the burden associated with them is exempt as defined in 5 CFR
1320.3(b)(2).
If you comment on these information collection and recordkeeping
requirements, please mail copies directly to the following:
Centers for Medicare & Medicaid Services, Office of Strategic
Operations and Regulatory Affairs, Attn: Melissa Musotto (CMS-1429-P),
Room C5-13-28, 7500 Security Boulevard, Baltimore, MD 21244-1850; and
Office of Information and Regulatory Affairs, Office of Management and
Budget, Room 10235, New Executive Office Building, Washington, DC
20503, Attn: Christopher Martin, CMS Desk Officer (CMS-1429-P),
Christopher--Martin@omb.eop.gov. FAX (202) 395-6974.
VI. Response to Comments
Because of the large number of public comments we normally receive
on Federal Register documents, we are not able to acknowledge or
respond to them individually. We will consider all comments we receive
by the date and time specified in the DATES section of this preamble,
and, when we proceed with a subsequent document, we will respond to the
comments in the preamble to that document.
VII. Regulatory Impact Analysis
[If you choose to comment on issues in this section, please include
the caption ``IMPACT'' at the beginning of your comments.]
We have examined the impact of this rule as required by Executive
Order 12866 (September 1993, Regulatory Planning and Review), the
Regulatory Flexibility Act (RFA) (September 16, 1980 Pub. L. 96-354),
section 1102(b) of the Social Security Act, the Unfunded Mandates
Reform Act of 1995 (Pub.L. 104-4), and Executive Order 13132.
Executive Order 12866 (as amended by Executive Order 13258, which
merely reassigns responsibilities of duties) directs agencies to assess
all costs and benefits of available regulatory alternatives and, when
regulation is necessary, to select regulatory approaches that maximize
net benefits (including potential economic, environmental, public
health and safety effects, distributive impacts, and equity). A
regulatory impact analysis must be prepared for proposed rules with
economically significant effects (that is, a proposed rule that would
have an annual effect on the economy of $100 million or more in any 1
year, or would adversely affect in a material way the economy, a sector
of the economy, productivity, competition, jobs, the environment,
public health or safety, or State, local, or tribal governments or
communities). As indicated in more detail below, we estimate that the
physician fee schedule provisions included in this proposed rule will
redistribute more than $100 million in 1 year. We are also estimating
that the combined effect of several provisions of the MMA implemented
in this proposed rule will increase spending by more than $100 million.
Other MMA provisions implemented in this proposed rule are estimated to
reduce spending by more than $100 million. We are considering this
proposed rule to be economically significant because its provisions are
estimated to result in an increase, decrease or aggregate
redistribution of Medicare spending that will exceed $100 million.
Therefore, this proposed rule is a major rule and we have prepared a
regulatory impact analysis.
The RFA requires that we analyze regulatory options for small
businesses and other entities. We prepare a regulatory flexibility
analysis unless we certify that a rule would not have a significant
economic impact on a substantial number of small entities. The analysis
must include a justification concerning the reason action is being
taken, the kinds and number of small entities the rule affects, and an
explanation of any meaningful options that achieve the objectives with
less significant adverse economic impact on the small entities.
Section 1102(b) of the Act requires us to prepare a regulatory
impact analysis for any proposed rule that may have a significant
impact on the operations of a substantial number of small rural
hospitals. This analysis must conform to the provisions of section 603
of the RFA. For purposes of section 1102(b) of the Act, we define a
small rural hospital as a hospital that is located outside a
Metropolitan Statistical Area and has fewer than 100 beds. We have
determined that this proposed rule would have minimal impact on small
hospitals located in rural areas. Of 431 hospital-based ESRD facilities
located in rural areas, only 40 are affiliated with hospitals with
fewer than 100 beds.
For purposes of the RFA, physicians, nonphysician practitioners,
and suppliers are considered small businesses if they generate revenues
of $6 million or less. Approximately 95 percent of physicians are
considered to be small entities. There are about 875,000 physicians,
other practitioners and medical suppliers that receive Medicare payment
under the physician fee schedule. There are in excess of 20,000
physicians and other practitioners that receive Medicare payment for
drugs. (As noted previously in this proposed rule and described further
below, we are proposing significant changes to the payments for drugs.)
These physicians are concentrated in the specialties of oncology,
urology, and rheumatology. Of the physicians in these specialties,
approximately 40 percent are in oncology and 45 percent in urology.
For purposes of the RFA, approximately 98 percent of suppliers of
durable medical equipment (DME) and prosthetic devices are considered
small businesses according to the Small Business Administration's (SBA)
size standards. We estimate that 106,000 entities bill Medicare for
durable medical equipment, prosthetics, orthotics, and supplies
(DMEPOS) each year. Total annual estimated Medicare revenues for DME
suppliers exceed approximately $4.0 billion. Of this amount,
approximately $1.6 billion are for DME drugs.
In addition, most ESRD facilities are considered small entities,
either based on nonprofit status, or by having revenues of $29 million
or less in any year. We consider a substantial number of entities to be
affected if the proposed rule is estimated to impact more than 5
percent of the total number of small entities. Based on our analysis of
the 697 nonprofit ESRD facilities considered small entities in
accordance with the above definitions, we estimate that the combined
impact of the proposed changes to payment for renal dialysis services
included in this rule would have a 1.6 percent increase in payments
relative to current composite rate payments.
The analysis and discussion provided in this section, as well as
elsewhere in this proposed rule, complies with the RFA requirements.
Section 202 of the Unfunded Mandates Reform Act of 1995 also requires
that agencies assess anticipated costs and benefits before issuing any
rule that may result in expenditures in any year by State, local,
[[Page 47556]]
or tribal governments, in the aggregate, or by the private sector, of
$110 million. Medicare beneficiaries are considered to be part of the
private sector for this purpose. The net impact of the provisions of
this rule, including those related to the MMA, are estimated to result
in a savings to beneficiaries of nearly $270 million for FY 2005. The
specific effects of the provisions being implemented in this proposed
rule are explained in greater detail below.
We have examined this proposed rule in accordance with Executive
Order 13132 and have determined that this regulation would not have any
significant impact on the rights, roles, or responsibilities of State,
local, or tribal governments.
We have prepared the following analysis, which, together with the
information provided in the rest of this preamble, meets all assessment
requirements. It explains the rationale for and purposes of the rule;
details the costs and benefits of the rule; analyzes alternatives; and
presents the measures we propose to use to minimize the burden on small
entities. As indicated elsewhere in this proposed rule, we propose to
refine resource-based practice expense RVUs and make a variety of other
changes to our regulations, payments, or payment policy to ensure that
our payment systems are updated to reflect changes in medical practice
and the relative value of services. We are also proposing several
changes resulting from the MMA, including changes to Medicare payment
rates for outpatient drugs, changes to the payment for renal dialysis
services, creating new preventive health care benefits and creating
incentive payment program improvements for physician scarcity.
We are providing information for each of the policy changes in the
relevant sections of this proposed rule. We are unaware of any relevant
Federal rules that duplicate, overlap or conflict with this proposed
rule. The relevant sections of this proposed rule contain a description
of significant alternatives if applicable.
A. Resource-Based Practice Expense and Malpractice Relative Value Units
Under section 1848(c)(2) of the Act, adjustments to RVUs may not
cause the amount of expenditures to differ by more than $20 million
from the amount of expenditures that would have resulted without such
adjustments. We are proposing several changes that would result in a
change in expenditures that would exceed $20 million if we made no
offsetting adjustments to either the conversion factor or RVUs.
With respect to practice expense, our policy has been to meet the
budget-neutrality requirements in the statute by incorporating a
rescaling adjustment in the practice expense methodologies. That is, we
estimate the aggregate number of practice expense RVUs that will be
paid under current and proposed policy in CY 2005. We apply a uniform
adjustment factor to make the aggregate number of proposed practice
expense RVUs equal the number estimated that would be paid under
current policy.
Table 21 shows the specialty level impact on payment of changes
being proposed for CY 2005. Our estimates of changes in Medicare
revenues for physician fee schedule services compare payment rates for
2005 with payment rates for 2004 using 2003 Medicare utilization for
both years. We are using 2003 Medicare claims processed and paid
through June 30, 2004 that we estimate are 96.7 complete and have
adjusted the figures to reflect a full year of data. Thus, because we
are using a single year of utilization, the estimated changes in
revenues reflect payment changes only between 2004 and 2005. To the
extent that there are year-to-year changes in the volume and mix of
services provided by physicians, the actual impact on total Medicare
revenues will be different than those shown here. The payment impacts
reflect averages for each specialty based on Medicare utilization. The
payment impact for an individual physician would be different from the
average, based on the mix of services the physician provides. The
average change in total revenues would be less than the impact
displayed here because physicians furnish services to both Medicare and
non-Medicare patients and specialties may receive substantial Medicare
revenues for services that are not paid under the physician fee
schedule. For instance, independent laboratories receive approximately
80 percent of their Medicare revenues from clinical laboratory services
that are not paid under the physician fee schedule. The table shows
only the payment impact on physician fee schedule services.
We modeled the impact of changes to the practice expense
methodology and illustrated the effect in table 21 below. The column
labeled ``Practice Expense RVU Refinements'' shows the effect of the
refinements we are making to the practice expense methodology for 2005.
For instance, we are incorporating refined practice expense inputs
recommended by the PEAC into the methodology as well as updating the
prices of medical equipment. We are also adding 2003 utilization data
for codes that did not exist in the 1997 through 2002 period.
In general, updating the methodology with 2003 utilization data has
little or no impact on total payments to a specialty but the practice
expense values for specific services may change. In general, the
largest changes to a practice expense RVU will occur when a code was
established after 2002 and we did not have any Medicare utilization
data to determine the specialty that performs the service. In these
cases, we either assigned the code to a specialty cost pool based on
the specialty most likely to do the service or we used the ``all
physician'' scaling factors to determine the code's practice expense
RVUs. While we are trying to minimize instability in the practice
expense RVUs for new services by assigning the specialty that is most
likely to perform the service when we have no utilization data, the
addition of utilization to the methodology may still result in some
change to the practice expense RVUs during the first few years a code
is in existence.
The practice expense refinements will reduce payments to
audiologists by approximately 4 percent. Virtually all of the reduction
in payment is due to the refinement of procedure code 92547. We
accepted the PEAC recommendation to reduce the clinical staff time of
the audiologist involved in this add-on service from 71 minutes to 1
minute. The refinement of clinical staff and equipment resulted in a
reduction from 1.15 to 0.08 practice expense RVUs producing the nearly
4 percent reduction in payments shown in table 21.
Payments to vascular surgeons will increase approximately 3 percent
as a result of the refinements. The increase in payment is attributed
to the repricing of medical equipment used in performing noninvasive
vascular diagnostic tests that will increase the practice expense RVUs
for procedure codes 93880, 93923, 93925, 93970 and other codes in that
family. The estimated 2 percent increase in payment from the practice
expense refinements for interventional radiology is primarily due to
the establishment of nonfacility pricing for procedure codes 35470 to
35476. The 3 percent increase in payment to oral and maxillofacial
surgeons is largely attributed to the refinement of medical supplies
for procedure codes 21210 and 21215. The 1 percent decrease in payment
to nurse practitioners and geriatricians is attributed to the
refinement of the nonfacility practice expense RVUs for
[[Page 47557]]
nursing facility visits (procedure codes 99301 through 99316). As
stated in the November 7, 2003 Federal Register (68 FR 63204), the
changes to the nonfacility practice expense RVUs for these codes were
delayed by 1 year to allow the PEAC to reconsider its earlier
recommendation to us to reflect input from representatives of
specialties that provide these services in nursing homes. The PEAC
reconsidered its recommendations with input from these specialties. Our
acceptance of the PEAC recommendations is resulting in a decrease in
the nonfacility practice expense RVUs for the nursing facility visit
codes.
The column labeled ``Survey Data'' shows the impact on payment from
using the supplemental practice expense survey from the College of
American Pathologists (CAP). Using this survey together with making the
technical component practice expense RVUs equal to the difference
between the global and professional component practice expense RVUs and
the other practice expense refinements will increase payments to
pathologists by approximately 2 percent and independent laboratories by
more than 6 percent. As we indicated above, independent laboratories
receive approximately 20 percent of their total Medicare revenues from
physician fee schedule services. The remaining 80 percent of their
Medicare revenues are from clinical diagnostic laboratory services that
will be unchanged by use of the CAP survey data. Thus, total Medicare
revenues to independent laboratories as a result of using the CAP
survey will increase by slightly more than 1 percent (or 20 percent of
the 6 percent increase in physician fee schedule revenues). There will
be little or no impact on all other specialties from use of the CAP
survey.
The column labeled ``Total'' in Table 21 below shows the payment
impact by specialty of all the changes described above. If we change
any of these proposals following our consideration of comments, these
figures may change.
Table 21.--Impact of Practice Expense RVU Changes on Total Medicare Allowed Charges by Physician, Practitioner
and Supplier Subcategory
----------------------------------------------------------------------------------------------------------------
Medicare Practice
allowed expense RVU Survey data Total
Specialty charges ($ in refinements (percent) (percent)
millions) (percent)
----------------------------------------------------------------------------------------------------------------
Physicians:
ALLERGY/IMMUNOLOGY.......................... 161 -1 0 -1
ANESTHESIOLOGY.............................. 1,416 0 0 0
CARDIAC SURGERY............................. 359 0 0 0
CARDIOLOGY.................................. 6,583 0 0 0
COLON AND RECTAL SURGERY.................... 111 0 0 0
CRITICAL CARE............................... 130 0 0 0
DERMATOLOGY................................. 1,870 0 0 0
EMERGENCY MEDICINE.......................... 1,672 0 0 0
ENDOCRINOLOGY............................... 280 0 0 0
FAMILY PRACTICE............................. 4,448 0 0 0
GASTROENTEROLOGY............................ 1,636 0 0 0
GENERAL PRACTICE............................ 998 0 0 0
GENERAL SURGERY............................. 2,258 0 0 0
GERIATRICS.................................. 117 -1 0 -1
HAND SURGERY................................ 57 1 0 1
HEMATOLOGY/ONCOLOGY......................... 1,753 0 0 0
INFECTIOUS DISEASE.......................... 401 0 0 0
INTERNAL MEDICINE........................... 8,846 0 0 0
INTERVENTIONAL RADIOLOGY.................... 190 2 0 2
NEPHROLOGY.................................. 1,248 1 0 1
NEUROLOGY................................... 1,200 0 0 0
NEUROSURGERY................................ 490 0 0 0
NUCLEAR MEDICINE............................ 85 0 0 0
OBSTETRICS/GYNECOLOGY....................... 582 0 0 0
OPHTHALMOLOGY............................... 4,583 -1 0 -1
ORTHOPEDIC SURGERY.......................... 2,902 0 0 0
OTOLARNGOLOGY............................... 815 0 0 0
PATHOLOGY................................... 869 -1 3 2
PEDIATRICS.................................. 59 -1 0 -1
PHYSICAL MEDICINE........................... 677 0 0 0
PLASTIC SURGERY............................. 281 0 0 0
PSYCHIATRY.................................. 1,093 0 0 0
PULMONARY DISEASE........................... 1,446 0 0 0
RADIATION ONCOLOGY.......................... 1,164 0 0 0
RADIOLOGY................................... 4,690 0 0 0
RHEUMATOLOGY................................ 413 0 0 0
THORACIC SURGERY............................ 463 0 0 0
UROLOGY..................................... 1,699 0 0 0
VASCULAR SURGERY............................ 487 3 0 3
Practitioners:
AUDIOLOGIST................................. 28 -4 0 -4
CHIROPRACTOR................................ 656 0 0 0
CLINICAL PSYCHOLOGIST....................... 490 0 0 0
CLINICAL SOCIAL WORKER...................... 313 0 0 0
NURSE ANESTHETIST........................... 481 0 0 0
[[Page 47558]]
NURSE PRACTITIONER.......................... 552 -1 0 -1
OPTOMETRY................................... 664 0 0 0
ORAL/MAXILLOFACIAL SURGERY.................. 36 3 0 3
PHYSICAL/OCCUPATIONAL THERAPY............... 990 -1 0 -1
PHYSICIAN ASSISTANT......................... 410 0 0 0
PODIATRY.................................... 1,383 0 0 0
Suppliers:
DIAGNOSTIC TESTING FACILITY................. 876 1 0 1
INDEPENDENT LABORATORY...................... 530 0 6 6
PORTABLE X-RAY SUPPLIER..................... 91 0 0 0
Other:
ALL OTHER................................... 93 0 2 2
ALL PHYSICIAN FEE SCHEDULE.................. 66,395 0 0 0
----------------------------------------------------------------------------------------------------------------
As discussed in Section II.C of this rule, we are proposing changes
to the malpractice RVUs based on more current malpractice premium data.
As anticipated from past revisions to the malpractice RVUs, use of more
current malpractice premium data results in minimal proposed impacts on
the specialty level payments. See Table 22, ``Specialty Impact of
Malpractice RVUs Revisions'', for a breakdown of the impacts of these
revisions on individual specialties. Of the 54 specialties shown, 15
specialties (representing a total of 40 percent of Medicare allowed
charges) experience no estimated change. Total Medicare payments for an
additional 32 specialties are estimated to increase or decrease between
0.1 percent and 0.5 percent. We estimate that 7 specialties will
experience a total payment increase or decrease of more than 0.5
percent as a result of the malpractice RVU changes. If we change any of
these proposals following our consideration of comments, these figures
may change.
Table 22.--Specialty Impact of Malpractice RVU Revisions
----------------------------------------------------------------------------------------------------------------
Allowed charges Percent of Percent change
Specialty \1\ total charges \2\
----------------------------------------------------------------------------------------------------------------
DERMATOLOGY.................................................. 1,870,318,730 2.8 0.7
PLASTIC SURGERY.............................................. 280,508,065 0.4 0.6
ORAL/MAXILLOFACIAL SURGERY................................... 35,598,814 0.1 0.6
COLON AND RECTAL SURGERY..................................... 110,683,908 0.2 0.6
GASTROENTEROLOGY............................................. 1,635,616,057 2.5 0.5
GENERAL SURGERY.............................................. 2,257,836,035 3.4 0.5
CRITICAL CARE................................................ 130,256,300 0.2 0.5
INFECTIOUS DISEASE........................................... 395,195,230 0.6 0.4
GERIATRICS................................................... 116,547,182 0.2 0.3
PSYCHIATRY................................................... 1,092,801,668 1.7 0.3
PULMONARY DISEASE............................................ 1,445,180,432 2.2 0.3
NURSE PRACTITIONER........................................... 549,723,060 0.8 0.2
PATHOLOGY.................................................... 868,617,850 1.3 0.2
NEUROLOGY.................................................... 1,199,069,489 1.8 0.2
PHYSICAL MEDICINE............................................ 676,516,230 1.0 0.2
INDEPENDENT LABORATORY....................................... 529,571,661 0.8 0.2
OPTOMETRY.................................................... 664,163,601 1.0 0.2
NEPHROLOGY................................................... 1,247,164,211 1.9 0.1
VASCULAR SURGERY............................................. 486,263,563 0.7 0.1
OBSTETRICS/GYNECOLOGY........................................ 578,322,768 0.9 0.1
INTERNAL MEDICINE............................................ 8,821,789,552 13.4 0.1
ENDOCRINOLOGY................................................ 279,359,088 0.4 0.1
ANESTHESIOLOGY............................................... 1,415,251,017 2.1 0.0
HEMATOLOGY/ONCOLOGY.......................................... 1,553,937,401 2.4 0.0
CARDIOLOGY................................................... 6,580,625,617 10.0 0.0
OPHTHALMOLOGY................................................ 4,583,221,470 7.0 0.0
NURSE ANESTHETIST............................................ 481,060,016 0.7 0.0
THORACIC SURGERY............................................. 463,428,857 0.7 0.0
RADIATION ONCOLOGY........................................... 1,162,754,357 1.8 0.0
ALL OTHER.................................................... 92,826,859 0.1 0.0
CLINICAL SOCIAL WORKER....................................... 313,327,455 0.5 0.0
GENERAL PRACTICE............................................. 995,188,403 1.5 0.0
UROLOGY...................................................... 1,689,047,785 2.6 0.0
INTERVENTIONAL RADIOLOGY..................................... 189,980,663 0.3 0.0
EMERGENCY MEDICINE........................................... 1,671,773,516 2.5 0.0
FAMILY PRACTICE.............................................. 4,442,795,644 6.7 0.0
DIAGNOSTIC TESTING FACILITY.................................. 876,242,174 1.3 0.0
[[Page 47559]]
PHYSICIANS ASSISTANT......................................... 409,700,298 0.6 -0.1
PEDIATRICS................................................... 58,880,964 0.1 -0.1
AUDIOLOGIST.................................................. 27,930,180 0.0 -0.1
CLINICAL PSYCHOLOGIST........................................ 490,006,176 0.7 -0.1
CARDIAC SURGERY.............................................. 359,324,850 0.5 -0.1
PORTABLE X-RAY SUPPLIER...................................... 91,026,934 0.1 -0.1
HAND SURGERY................................................. 56,595,222 0.1 -0.1
OTOLARNGOLOGY................................................ 814,914,443 1.2 -0.1
RHEUMATOLOGY................................................. 405,622,764 0.6 -0.1
NUCLEAR MEDICINE............................................. 85,239,821 0.1 -0.1
CHIROPRACTOR................................................. 656,312,519 1.0 -0.2
RADIOLOGY.................................................... 4,689,652,801 7.1 -0.3
PODIATRY..................................................... 1,382,552,109 2.1 -0.4
ORTHOPEDIC SURGERY........................................... 2,902,084,841 4.4 -0.4
NEUROSURGERY................................................. 489,366,546 0.7 -0.6
ALLERGY/IMMUNOLOGY........................................... 160,728,139 0.2 -0.9
PHYSICAL/OCCUPATIONAL THERAPY................................ 990,284,755 1.5 -1.3
----------------------------------------------------------------------------------------------------------------
\1\ 2003 Allowed Charges
\2\ Percent change based upon percent change in total payment.
Section 1848(d) and (f) of the Act requires the Secretary to set
the physician fee schedule update under the sustainable growth rate
(SGR) system. For 2004 and 2005, the statute requires the update to be
no less than 1.5 percent. We believe it is highly likely that the
statutory formula in section 1848(d)(4) will produce an update of less
than 1.5 percent for 2005. Therefore, we estimate that the physician
fee schedule update for 2005 will be 1.5 percent. We are currently
forecasting payment reductions under the SGR system for 2006 and later
years. As in the past, we will include a complete discussion of our
methodology for calculating the SGR in the final rule.
Table 23 below shows the estimated change in average payments by
specialty resulting from changes to the practice expense and
malpractice RVUs and the 2005 physician fee schedule update. (Please
note that the table does not include the specialties of Hematology/
Oncology, Urology, Rheumatology and Obstetrics/Gynecology. There are
unique issues related to drug administration that will further affect
these specialties that are presented in detail below).
Table 23.--Impact of Practice Expense and Malpractice RVU Changes and Physician Fee Schedule Update on Total
Medicare Allowed Charges by Physician, Practitioner and Supplier Subcategory
----------------------------------------------------------------------------------------------------------------
Practice
Medicare expenses & Physician fee
Speciality allowed malpractice schedule Total
charges ($ in RVU changes update (percent)
Millions) (percent) (percent)
----------------------------------------------------------------------------------------------------------------
Physicians:
ALLERGY/IMMUNOLOGY.......................... 161 -2 1.5 0
ANESTHESIOLOGY.............................. 1,416 0 1.5 2
CARDIAC SURGERY............................. 359 0 1.5 1
CARDIOLOGY.................................. 6,583 0 1.5 2
COLON AND RECTAL SURGERY.................... 111 1 1.5 2
CRITICAL CARE............................... 130 0 1.5 2
DERMATOLOGY................................. 1,870 1 1.5 3
EMERGENCY MEDICINE.......................... 1,672 0 1.5 2
ENDOCRINOLOGY............................... 280 0 1.5 2
FAMILY PRACTICE............................. 4,448 0 1.5 1
GASTROENTEROLOGY............................ 1,636 0 1.5 2
GENERAL PRACTICE............................ 998 0 1.5 1
GENERAL SURGERY............................. 2,258 1 1.5 2
GERIATRICS.................................. 117 -1 1.5 1
HAND SURGERY................................ 57 0 1.5 2
INFECTIOUS DISEASE.......................... 401 0 1.5 2
INTERNAL MEDICINE........................... 8,846 0 1.5 1
INTERVENTIONAL RADIOLOGY.................... 190 2 1.5 4
NEPHROLOGY.................................. 1,248 1 1.5 2
NEUROLOGY................................... 1,200 0 1.5 2
NEUROSURGERY................................ 490 -1 1.5 1
NUCLEAR MEDICINE............................ 85 0 1.5 1
OPHTHALMOLOGY............................... 4,583 -1 1.5 0
ORTHOPEDIC SURGERY.......................... 2,902 0 1.5 1
OTOLARNGOLOGY............................... 815 0 1.5 2
PATHOLOGY................................... 869 2 1.5 4
[[Page 47560]]
PEDIATRICS.................................. 59 -1 1.5 1
PHYSICAL MEDICINE........................... 677 0 1.5 2
PLASTIC SURGERY............................. 281 1 1.5 2
PSYCHIATRY.................................. 1,093 0 1.5 2
PULMONARY DISEASE........................... 1,446 0 1.5 2
RADIATION ONCOLOGY.......................... 1,164 0 1.5 1
RADIOLOGY................................... 4,690 0 1.5 1
THORACIC SURGERY............................ 463 0 1.5 2
VASCULAR SURGERY............................ 487 3 1.5 4
Practitioners:
AUDIOLOGIST................................. 28 -4 1.5 -2
CHIROPRACTOR................................ 656 -1 1.5 1
CLINICAL PSYCHOLOGIST....................... 490 0 1.5 1
CLINICAL SOCIAL WORKER...................... 313 0 1.5 1
NURSE ANESTHETIST........................... 481 0 1.5 2
NURSE PRACTITIONER.......................... 552 -1 1.5 0
OPTOMETRY................................... 664 0 1.5 1
ORAL/MAXILLOFACIAL SURGERY.................. 36 4 1.5 5
PHYSICAL/OCCUPATIONAL THERAPY............... 990 -2 1.5 -1
PHYSICIAN ASSISTANT......................... 410 0 1.5 1
PODIATRY.................................... 1,383 -1 1.5 1
Suppliers:
DIAGNOSTIC TESTING FACILITY................. 876 1 1.5 3
INDEPENDENT LABORATORY...................... 530 6 1.5 8
PORTABLE X-RAY SUPPLIER..................... 91 0 1.5 1
Other:
ALL OTHER................................... 93 2 1.5 3
ALL PHYSICIAN FEE SCHEDULE.................. 66,395 0 1.5 2
----------------------------------------------------------------------------------------------------------------
Table 24 shows the impact on payments for selected high-volume
procedures of all of the changes previously discussed. We selected
these procedures because they are the most commonly provided procedures
by a broad spectrum of physician specialties, or they are of particular
interest to the physician community (for example, the preventive office
visit, G0XX2). This table shows the combined impact of the change in
the practice expense and malpractice RVUs and the estimated physician
fee schedule update on total payment for the procedure. There are
separate columns that show the change in the facility rates and the
nonfacility rates. For an explanation of facility and nonfacility
practice expense refer to Sec. 414.22(b)(5)(i). The table shows the
estimated change in payment rates based on provisions of this proposed
rule and the estimated physician fee schedule update. If we change any
of the provisions following the consideration of public comments, these
figures may change.
Table 24.--Impact of Proposed Rule and Physician Fee Schedule Update on Medicare Payment for Selected Procedures
--------------------------------------------------------------------------------------------------------------------------------------------------------
Non-facility Facility
-----------------------------------------------------------------------
CODE MOD Description Percent Percent
Old New change Old New change
--------------------------------------------------------------------------------------------------------------------------------------------------------
11721.............................. ........ Debride nail, 6 or more.......... $ 38.08 $ 38.28 1 $ 29.87 $ 29.94 0
17000.............................. ........ Destroy benign/premlg lesion..... 60.49 61.39 1 35.84 45.48 27
27130.............................. ........ Total hip arthroplasty........... N/A N/A N/A 1,370.28 1,382.50 1
27236.............................. ........ Treat thigh fracture............. N/A N/A N/A 1,088.01 1,103.20 1
27244.............................. ........ Treat thigh fracture............. N/A N/A N/A 1,115.27 1,133.51 2
27447.............................. ........ Total knee arthroplasty.......... N/A N/A N/A 1,475.95 1,492.02 1
33533.............................. ........ CABG, arterial, single........... N/A N/A N/A 1,882.18 1,905.49 1
35301.............................. ........ Rechanneling of artery........... N/A N/A N/A 1,114.89 1,122.90 1
43239.............................. ........ Upper GI endoscopy, biopsy....... 321.85 336.15 4 159.43 162.58 2
45385.............................. ........ Lesion removal colonoscopy....... 497.71 514.65 3 288.24 293.71 2
66821.............................. ........ After cataract laser surgery..... 240.83 237.62 -1 237.09 230.80 -3
66984.............................. ........ Cataract surg w/iol, 1 stage..... N/A N/A N/A 684.39 683.67 0
67210.............................. ........ Treatment of retinal lesion...... 577.98 599.92 4 560.81 573.01 2
71010.............................. 26 Chest x-ray...................... 9.33 9.47 2 9.33 9.47 2
71020.............................. 26 Chest x-ray...................... 11.20 11.37 2 11.20 11.37 2
76091.............................. 26 Mammogram, both breasts.......... 96.33 97.40 1 N/A N/A N/A
76091.............................. ........ Mammogram, both breasts.......... 44.80 45.10 1 44.80 45.10 1
[[Page 47561]]
76092.............................. 26 Mammogram, screening............. 84.76 85.27 1 N/A N/A N/A
76092.............................. ........ Mammogram, screening............. 36.22 36.38 0 36.22 36.38 0
77427.............................. ........ Radiation tx management, x5...... 169.14 172.05 2 169.14 172.05 2
78465.............................. 26 Heart image (3d), multiple....... 76.17 77.31 1 76.17 77.31 1
88305.............................. 26 Tissue exam by pathologist....... 41.44 42.07 2 41.44 42.07 2
90801.............................. ........ Psy dx interview................. 150.84 153.48 2 142.26 144.39 1
90806.............................. ........ Psytx, off, 45-50 min............ 97.45 98.91 1 93.72 95.12 1
90807.............................. ........ Psytx, off, 45-50 min w/e&m...... 103.80 104.98 1 101.18 102.32 1
90862.............................. ........ Medication management............ 51.15 52.30 2 48.17 49.27 2
90935.............................. ........ Hemodialysis, one evaluation..... N/A N/A N/A 72.06 73.14 1
92004.............................. ........ Eye exam, new patient............ 126.57 129.61 2 89.24 90.58 2
92012.............................. ........ Eye exam established pat......... 63.47 65.18 3 36.22 37.14 3
92014.............................. ........ Eye exam & treatment............. 93.34 96.26 3 58.99 60.64 3
92980.............................. ........ Insert intracoronary stent....... N/A N/A N/A 812.09 829.58 2
92982.............................. ........ Coronary artery dilation......... N/A N/A N/A 602.63 615.83 2
93000.............................. ........ Electrocardiogram, complete...... 26.51 26.91 2 N/A N/A N/A
93010.............................. ........ Electrocardiogram report......... 8.96 9.10 2 8.96 9.10 2
93015.............................. ........ Cardiovascular stress test....... 106.78 108.01 1 N/A N/A N/A
93307.............................. 26 Echo exam of heart............... 49.29 49.27 0 49.29 49.27 0
93510.............................. 26 Left heart catheterization....... 252.77 257.32 2 252.77 257.32 2
98941.............................. ........ Chiropractic manipulation........ 36.22 36.76 1 31.74 31.83 0
99203.............................. ........ Office/outpatient visit, new..... 95.96 97.40 2 71.69 72.38 1
99204.............................. ........ Office/outpatient visit, new..... 135.53 137.57 2 105.66 107.25 2
99205.............................. ........ Office/outpatient visit, new..... 172.13 174.71 1 140.39 142.49 1
99211.............................. ........ Office/outpatient visit, est..... 21.28 21.98 3 8.96 9.10 2
99212.............................. ........ Office/outpatient visit, est..... 37.71 38.66 3 23.52 24.25 3
99213.............................. ........ Office/outpatient visit, est..... 52.65 53.06 1 35.47 35.24 -1
99214.............................. ........ Office/outpatient visit, est..... 82.14 83.00 1 57.87 58.74 2
99215.............................. ........ Office/outpatient visit, est..... 119.11 121.27 2 93.34 95.12 2
99221.............................. ........ Initial hospital care............ N/A N/A N/A 66.83 68.22 2
99222.............................. ........ Initial hospital care............ N/A N/A N/A 111.27 112.93 1
99223.............................. ........ Initial hospital care............ N/A N/A N/A 154.95 157.27 1
99231.............................. ........ Subsequent hospital care......... N/A N/A N/A 33.23 34.11 3
99232.............................. ........ Subsequent hospital care......... N/A N/A N/A 54.89 56.09 2
99233.............................. ........ Subsequent hospital care......... N/A N/A N/A 78.04 79.58 2
99236.............................. ........ Observ/hosp same date............ N/A N/A N/A 226.26 223.60 -1
99238.............................. ........ Hospital discharge day........... N/A N/A N/A 69.82 70.87 2
99239.............................. ........ Hospital discharge day........... N/A N/A N/A 95.21 91.71 -4
99241.............................. ........ Office consultation.............. 50.03 50.40 1 33.98 34.49 2
99242.............................. ........ Office consultation.............. 91.48 92.47 1 69.45 70.11 1
99243.............................. ........ Office consultation.............. 120.60 122.79 2 92.22 93.99 2
99244.............................. ........ Office consultation.............. 170.63 172.81 1 136.65 138.70 2
99245.............................. ........ Office consultation.............. 220.29 224.35 2 181.09 184.56 2
99251.............................. ........ Initial inpatient consult........ N/A N/A N/A 35.84 36.00 0
99252.............................. ........ Initial inpatient consult........ N/A N/A N/A 71.69 72.76 1
99253.............................. ........ Initial inpatient consult........ N/A N/A N/A 97.45 98.91 1
99254.............................. ........ Initial inpatient consult........ N/A N/A N/A 140.39 142.12 1
99255.............................. ........ Initial inpatient consult........ N/A N/A N/A 193.03 195.55 1
99261.............................. ........ Follow-up inpatient consult...... N/A N/A N/A 22.40 22.36 0
99262.............................. ........ Follow-up inpatient consult...... N/A N/A N/A 44.80 45.48 2
99263.............................. ........ Follow-up inpatient consult...... N/A N/A N/A 66.09 67.46 2
99282.............................. ........ Emergency dept visit............. N/A N/A N/A 27.63 27.67 0
99283.............................. ........ Emergency dept visit............. N/A N/A N/A 61.61 62.15 1
99284.............................. ........ Emergency dept visit............. N/A N/A N/A 95.58 7.02 2
99285.............................. ........ Emergency dept visit............. N/A N/A N/A 149.72 151.97 2
99291.............................. ........ Critical care, first hour........ 242.69 257.32 6 203.12 207.68 2
99292.............................. ........ Critical care, add'l 30 min...... 107.91 114.45 6 101.56 103.84 2
99301.............................. ........ Nursing facility care............ 71.69 66.32 -7 61.61 66.32 8
99302.............................. ........ Nursing facility care............ 97.82 87.92 -10 82.52 87.92 7
99303.............................. ........ Nursing facility care............ 120.97 108.39 -10 102.68 108.39 6
99311.............................. ........ Nursing fac care, subseq......... 40.70 34.49 -15 30.62 34.49 13
99312.............................. ........ Nursing fac care, subseq......... 63.10 56.85 -10 51.53 56.85 10
99313.............................. ........ Nursing fac care, subseq......... 86.25 79.96 -7 72.43 79.96 10
99348.............................. ........ Home visit, est patient.......... 75.42 72.01 -5 N/A N/A N/A
99350.............................. ........ Home visit, est patient.......... 169.89 165.23 -3 N/A N/A N/A
G0317.............................. ........ ESRDrelsvc 4+/mo;20+yr........... 303.18 307.73 2 303.18 307.73 2
G0318.............................. ........ ESRDrelsvc 2-3/mo;20+yr.......... 252.40 256.19 2 252.40 256.19 2
G0319.............................. ........ ESRDrelsvc 1/mo;20+yr............ 201.62 204.65 2 201.62 204.65 2
[[Page 47562]]
G0XX2.............................. ........ Preventive Office Visit.......... N/A 124.30 N/A N/A 82.24 N/A
--------------------------------------------------------------------------------------------------------------------------------------------------------
Section 303(a)(1) of the MMA amended section 1848(c)(2) of the Act
to require increased work and practice expense RVUs for drug
administration services. Section 303(a)(4) of the MMA required an
additional temporary increase in payment to specific drug
administration services (procedure codes 90780 through 90788, 96400,
96408 through 96425, 96520, and 96530) of 32 percent for 2004 and 3
percent for 2005. Table 25 shows the payment amounts for selected high-
volume drug administration CPT codes from 2002 to 2006 including the
effect of the transition adjustment of 32 percent required for 2004 and
3 percent for 2005 and 0 percent for 2006. The amounts shown in the
table include the effect of the 1.5 percent update for 2004 and 2005.
The 2006 payment amount shown in the table reflects the 2005 conversion
factor because the 2006 physician fee schedule update is currently
unknown.
With the exception of procedure code 96412 declining by 17 percent
(which occurred because resource-based pricing replaced the use of
charge-based RVUs when the services were removed from the nonphysician
work pool), the MMA permanently increases payment for all of these
services from a low of 17 percent for procedure code 90781 to 321
percent for procedure code 90782. The volume-weighted average permanent
increase in payment among these drug administration services is
approximately 105 percent (109 percent for oncologists and 94 percent
for other physicians). Including the effect of the transition makes the
volume-weighted increase in payment for these codes more than 170
percent from 2003 to 2004 and 110 percent from 2003 to 2005. The
payment amount for procedure code 96400 in 2002 was $5.07. Payment for
this code increased substantially to $37.52 in 2003 when, at the
request of the American Urological Association (see 67 FR 79981
published on December 31, 2002), we removed this code from the
nonphysician work pool. Including the effect of the additional changes
required by MMA, we expect payment for this code to be $49.65 by 2006.
Thus, the payment increase for procedure code 96400 between 2002 and
2006 is 879 percent. As indicated earlier, we are continuing to
consider coding and RVU changes for drug administration services for
2005 based on the results of the CPT review and our consideration of
public comments. If we change any of the RVUs for these codes as a
result of CPT's review or the consideration of public comments, these
figures may change.
Table 25.--Impact of Proposed Rule and Physician Fee Schedule Update on Medicare Payment for Selected Drug Administration Services
--------------------------------------------------------------------------------------------------------------------------------------------------------
Non-facility payment
------------------------------------------------------------------------------------------
2005 2006
Code Description 2002 2003 2004 Payment * Payment * Percent Percent
Payment Payment Payment w/Current w/Current change 2003 change 2002
PE RVUs PE RVUs to 2006 to 2006
--------------------------------------------------------------------------------------------------------------------------------------------------------
90780 IV infusion therapy, 1 hour............................ $40.54 $42.67 $117.79 $92.90 $90.20 111 122
90781 IV infusion, additional hour........................... 20.27 21.70 33.02 26.15 25.39 17 25
90782 Injection, sc/im....................................... 3.98 4.41 24.64 19.13 18.57 321 367
96400 Chemotherapy, sc/im.................................... 5.07 37.52 64.07 51.14 49.65 32 879
96408 Chemotherapy, push technique........................... 35.11 37.52 154.76 122.96 119.38 218 240
96410 Chemotherapy,infusion method........................... 55.75 59.22 217.35 171.75 166.75 182 199
96412 Chemo, infuse method add-on............................ 41.63 44.14 48.30 37.86 36.76 -17 -12
--------------------------------------------------------------------------------------------------------------------------------------------------------
* Payment amounts reflect the current practice expense RVUs and a 1.5 percent update for 2005. The 2006 update is currently unknown. The payment amounts
for 2006 were calculated using the 2005 conversion factor. If we were to make further revisions to the practice expense RVUs following the
consideration of public comments and/or the CPT coding process, the payment amounts will be different.
Table 26 below shows the impact of the drug and physician fee
schedule changes for selected specialties that receive a significant
portion of their total Medicare revenues from drugs. Table 27 shows the
combined payment impact of the drug and physician fee schedule payment
changes on combined Medicare revenues. The first column (``Estimated
Medicare Drug Revenues'') shows estimated 2004 Medicare Drug Revenues
using 2003 utilization adjusted for drug payment changes required in
2004 by the MMA. The next column (``% Change Medicare Drug Revenues'')
shows the payment impact of the adoption of the average sales price
plus 6 percent (ASP+6) drug payment methodology in 2005 relative to
2004 on specialty drug payments. The payment impacts are based on ASP
submissions from the 1st quarter of 2004. The ASP prices that will be
used to determine payment in 2005 will begin with the 3rd quarter 2004
ASP submission and will be updated quarterly. To model the impact
illustrated, we assumed an average increase in ASP prices of 3.39
percent (the national health expenditure prescription drug price growth
factor) from the 1st quarter 2004 submission to the prices that will be
used to determine 2005 payments. Table xxxxxxx follows table xxxxxx and
shows the drug prices we used to determine the payment impact. The drug
payment impacts are based on those high volume drugs where we have
validated the ASP price submission that represent the following
percentages of 2003 drug payments: 72 percent for Hematology/Oncology,
94
[[Page 47563]]
percent for Urology, 97 percent for Rheumatology and 73 percent for
Obstetrics/Gynecology. For drugs in which we did not complete our
validation of the ASP submission before completing the proposed rule,
we used the average payment change for other drugs provided by the
specialty unless a special circumstance applied. (that is, for
Hematology/Oncology and Obstetrics/Gynecology, we calculated the
average reduction in payment for drugs excluding J9265, J2430, and
J9390, three drugs having an unusually large reduction in payment as a
result of coming off patent. We do not believe these reductions will be
typical of other drugs furnished by oncologists and obstetrician/
gynecologists).
Our estimates of changes in Medicare revenues for drugs and
physician fee schedule services compare payment rates for 2005 with
payment rates for 2004 using 2003 Medicare utilization for both years.
We are using 2003 Medicare claims processed and paid through June 30,
2004 that we estimate are 96.7 complete and have adjusted the figures
to reflect a full year of data. Thus, because we are using a single
year of utilization, the estimated changes in revenues reflect payment
changes only between 2004 and 2005. To the extent that there are year-
to-year changes in the volume and mix of drugs and physician fee
schedule services provided by physicians, the actual impact on total
Medicare revenues will be different than those shown here.
Assuming no change in utilization, we estimate that Medicare drug
revenues for oncologists would decline by less than 8 percent as a
result of policies adopted in this proposed rule. Oncologists
administer a number of drugs that are changing in payments by different
amounts. For instance, oncologists' highest Medicare revenue drug,
Q0136 (EPOGEN; PROCRIT), would decline in payment by 7 percent while
its second highest revenue drug, J9310 (RITUXAN), would increase in
payment by 7 percent. Three drugs supplied by oncologists, J9265 (ONXOL
TAXOL), J2430 (PAMIDRONATE DISODIUM), and J9390 (NAVELBINE), are coming
off patent and their price would decline respectively by 81 percent, 71
percent, and 12 percent. The 2004 Medicare payment amounts for these
three drugs respectively were equal to 81, 85 and 81 percent of the
April 1, 2003 average wholesale price levels that applied or did not
decrease proportionally after the drugs came off patent. These three
drugs are estimated to account for only 7 percent of oncologists
adjusted 2004 Medicare drug revenues but contribute more than 5 percent
of the approximate 8 percent total reduction in Medicare drug revenues
that oncologists would experience as a result of adopting the ASP+6
payment methodology. While Medicare revenues to oncologists would
decline from the reductions in payment for these three drugs, the cost
to acquire these drugs has already declined. Thus, Medicare's payment,
as with all other drugs experiencing payment changes, will be much
closer to the cost the physician pays to acquire the drug.
Adoption of ASP+6 prices would reduce Medicare drug revenues for
urologists by approximately 36 percent. This large reduction can be
attributed to a 35 percent reduction in payment for two drugs: J9202
(ZOLADEX) and J9217 (LUPRON DEPOT-PED). While we estimate an even
larger reduction in the ASP+6 price for J9217, our payment impact
assumes that nearly all Medicare carriers are using the ``least costly
alternative'' pricing and paying code J9217 at the J9202 price.
We estimate a 6 percent reduction in Medicare drug revenues for
rheumatology. Nearly all of this reduction can be attributed to a 6
percent reduction in Medicare payment for J1745 (REMICADE).
We estimate less than an 18 percent decrease in Medicare drug
revenues for obstetrics/gynecology. However, much of this revenue
reduction can be attributed to an 81 percent reduction in payment for
J9265 (ONXOL TAXOL) coming off patent. Even though this one drug is
estimated to account for only 16 percent of obstetrics/gynecology
adjusted 2004 Medicare drug revenues, it contributes 13 percent of the
approximate 18 percent total reduction in Medicare drug revenues that
obstetrics/gynecologists would experience as a result of adopting the
ASP+6 payment methodology. As explained above, while Medicare revenues
to obstetrics/gynecology would decline as a result of the price
reduction for this code, Medicare's payment will be much closer to the
price physicians pay to acquire the drug. We are estimating an average
approximate reduction of 6 percent across other drugs supplied by
obstetrics/gynecology.
The remaining columns of Table 26 show the potential impact on
physician fee schedule services of changes being contemplated for 2005
for the specialties shown. The column labeled ``Practice Expense and
Malpractice RVU Changes'' show the combined impact of the changes
previously illustrated for these specialties in Tables 21 and 22. The
column labeled ``Drug Administration Payment Changes'' shows a range of
potential physician fee schedule impacts for 2005. The left side of
this column shows the impact of the changes required in payment by
section 303(a)(4) of the MMA (that is, the change in the transition
payment from 2004 to 2005) if we were to make no further changes to the
payments or codes for drug administration services. However, because we
are considering further changes to the payments or codes for drug
administration once the AMA's CPT Panel review of this issue is
complete, the right hand side of the column labeled ``Drug
Administration Payment Changes'' reflects the amount that physician fee
schedule payments would have to increase to make the net reduction
across all Medicare revenues for these specialties equal to 2 percent.
The next column shows the physician fee schedule update of 1.5 percent
and the final column labeled ``Total Physician Fee Schedule'' Changes''
shows the combined effect of all of the changes previously described.
The left hand side of the column shows the combined effect of (1) the
practice expense and malpractice RVU changes, (2) the maximum reduction
in payment that could occur if we made no further changes to payments
for drug administration and (3) the physician fee schedule update. The
right hand side of the column shows the combined effect of (1) the
practice expense and malpractice RVU changes, (2) the amount physician
fee schedule revenues would have to increase to make the reduction in
total revenues equal to 2 percent and (3) the physician fee schedule
update.
If we made no further changes to drug administration, physician fee
schedule revenues would decline by 9 percent for oncology, be unchanged
for urology and rheumatology, and increase by 1 percent for obstetrics/
gynecology. Physician fee schedule revenues would have to increase by
12 percent for oncology, 19 percent for urology, 2 percent for
rheumatology and 1 percent for obstetrics/gynecology for total revenues
to these specialties to decline by 2 percent from adoption of the ASP+6
percent drug payment methodology.
Table 27 shows the combined impact of changes we are making to
Medicare drug and physician fee schedule payments for the same
specialties shown in table 26. The column labeled ``% of Total Medicare
Revenues from Drugs'' shows the proportion of total Medicare revenues
received from drugs, while the next column shows the payment impact
from adoption of the ASP+6 drug payment methodology. The following
columns show the proportion of total Medicare revenues received
[[Page 47564]]
from physician fee schedule services and the payment impact from
physician fee schedule changes. All of the payment impacts are the same
as those shown in Table 26. We note that these impacts and percentages
represent averages for each specialty or supplier. The percentages and
impacts for any individual physician are dependent on the mix of drugs
and physician fee schedule services they provide to Medicare
beneficiaries. These tables are intended to illustrate, assuming
constant utilization, the combined impact of payment changes from 2004
to 2005 across all of the services that these specialties perform using
the most recent data available to us. Thus, the last 3 columns show
combined Medicare revenues from all sources and the combined Medicare
payment impact from the earlier described changes being proposed or
considered for 2005.
For example, as indicated in the Table 27, we estimate that
approximately 70 percent of total 2004 Medicare revenues for
oncologists are attributed to drugs. We estimate that Medicare revenues
from drugs will decline by approximately 8 percent for oncology as a
result of policies adopted in this proposed rule. Physician fee
schedule services account for approximately 28 percent of oncology's
2004 Medicare revenues. If we made no other changes to the RVUs or
codes for drug administration services and if there is no change in the
utilization of services, we estimate that physician fee schedule
payments to oncology would decline by approximately 9 percent from 2004
to 2005. In this scenario, combined Medicare payments to oncology would
decline approximately 8 percent. However, if we were to make further
changes to physician fee schedule payments so they increased by 12
percent, we estimate the combined revenue reduction to oncology would
be 2 percent.
We estimate that urology receives approximately 37 percent of their
2004 total revenues from drugs and 60 percent from physician fee
schedule services. Because urology and other physician specialties
receive a smaller share of their total Medicare revenues from drug
administration services than oncology, they are less affected than
oncology by the reduction in the drug administration transition payment
percentage from 32 to 3 percent from 2004 to 2005. If we made no other
changes to the RVUs or codes for drug administration services, we
estimate that physician fee schedule revenues for urologists would
increase by approximately 1 percent from 2004 to 2005. (While the
reduction in payment for drug administration alone would slightly
reduce urologists' physician fee schedule revenues, we estimate that
any reduction would be offset by the physician fee schedule update). In
this scenario, combined Medicare payments to urologists would decline
approximately 13 percent. However, if we were to make further changes
to physician fee schedule payments so that they increased by 19
percent, we estimate the combined revenue reduction to urology would be
2 percent.
Rheumatology revenues from drugs are estimated to account for
approximately 46 percent of their total revenues and would decline
approximately 6 percent from adoption of the ASP+6 drug payment
methodology. If we made no other changes to the RVUs or codes for drug
administration services, we estimate that physician fee schedule
revenues would be either unchanged or decline slightly in the aggregate
and estimate a reduction in total Medicare revenues to rheumatology of
approximately 3 percent. However, if we were to make further changes to
physician fee schedule payments so they increased by 2 percent, we
estimate the combined revenue reduction to rheumatologists would be 2
percent.
Medicare drug revenues represent 13 percent of total Medicare
revenues for obstetrics/gynecology while physician fee schedule
revenues account for 85 percent. We estimate that Medicare drug
revenues for obstetrics/gynecology would decline by 18 percent and
physician fee schedule revenues would increase 1 percent if we make no
further changes to the RVUs or codes for drug administration services.
In this scenario, obstetrics/gynecology's combined Medicare revenues
would decline by 2 percent. Any change to the drug administration codes
that increases their payments would make the net revenue reduction
equal to or less than 2 percent for obstetrics/gynecology.
[[Page 47565]]
Table 26.--Impact of Drug and Physician Fee Schedule Payment Changes on Total Medicare Allowed Charges for Selected Specialties
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Drugs Physician fee schedule
----------------------------------------------------------------------------------------------------------------------------------------------------------
Estimated Practice expense
Specialty medicare drug Percent change Medicare allowed & malpractice RVU Drug administration payment Physician fee Total physician fee schedule
revenues ($ in medicare drug charges ($ in changes changes schedule update changes
millions) revenues millions) (percent) (percent)
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
HEMATOLOGY/ONCOLOGY.................. $4,363 -8 $1,753 0 -10 to 10................... 1.5 -9% to 12%
UROLOGY.............................. 1,061 -36 1,699 0 -1% to 17%.................. 1.5 0% to 19%
RHEUMATOLOGY......................... 373 -6 413 0 -2% to 0%................... 1.5 0% to 2%
OBSTETRICS/GYNECOLOGY................ 88 -18 582 0 -1% to -1%.................. 1.5 1% to 1%
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
The amounts shown on the left-hand side of the column labeled ``Drug Administration Payment Changes'' offset a part of the increase these specialties received in 2004 as shown in the January
7, 2004 Federal Register (69 FR 1100). We estimate the 2003-2005 increase in physician fee schedule payments to these specialties (before application of the physician fee schedule update) to
be 28 percent for oncology, 2 percent for obstetrics/gynecology, 4 percent for rheumatology and 2 percent for urology. Urology received an additional 2 percent increase in total physician
fee schedule payments (again, before application of the update) from 2002 to 2003 (see 67 FR 80035-80036 published on December 31, 2002) as a result of the large increase in payment for CPT
code 96400 making the 2002-2005 payment increase exceed 4 percent.
[[Page 47566]]
Table 27.--Combined Payment Impact Drug and Physician Fee Schedule Payment Changes for Selected Specialties
--------------------------------------------------------------------------------------------------------------------------------------------------------
Drugs Physician fee schedule All revenues
-------------------------------------------------------------------------------------------------------------------------
Combined medicare
Specialty Percent of total Percent change Percent of total Percent change revenues all Combined percent
medicare revenues medicare drug medicare revenues physician fee sources ($ in change all medicare
from drugs revenues from fee schedule schedule revenues millions) revenues
--------------------------------------------------------------------------------------------------------------------------------------------------------
HEMATOLOGY/ONCOLOGY........... 70 -8 28 -9% to 12%........... $6,251 -8% to -2%
UROLOGY....................... 37 -36 60 0% to 19%............ 2,842 -13% to -2%
RHEUMATOLOGY.................. 46 -6 51 0% to 2%............. 818 -3% to -2%
OBSTETRICS/GYNECOLOGY......... 13 -18 85 1% to 1%............. 684 -2% to -2%
--------------------------------------------------------------------------------------------------------------------------------------------------------
The above tables show those specialties that receive significant
revenues from drugs and physician fee schedule services that could be
further affected by the review of drug administration coding currently
undertaken by the CPT Editorial Panel and any changes we may make after
further consideration of this effort and public comments.
Although infectious disease physicians do receive significant
revenues from drugs and drug administration, we are not showing them in
this table because we have validated only drug payment data accounting
for 27 percent of their allowed charges for drugs. Based on these data,
we estimate an 11 percent reduction in their Medicare drug payments
that account for approximately 6 percent of their total Medicare
revenues. If total drug payment were to decline by 11 percent, we
estimate that net revenues to infectious disease physicians will remain
unchanged, absent any further changes in drug and drug administration
coding. We are not showing DME and Other Medical Suppliers in the above
table because they do not receive significant revenues for physician
fee schedule services and will be unaffected by any further changes
made to drug administration coding or RVUs because they do not bill for
these services. However, they do receive a substantial portion of their
total Medicare revenues from drugs that are affected by the change to
ASP+6 pricing. For DME/Other Medical Suppliers, 40 and 60 percent of
Medicare revenues respectively are received from drugs and DME fee
schedule services. These suppliers would receive an approximate
reduction of 70 percent in their Medicare drug revenues from the
adoption of ASP+6 drug prices due to the large reduction in payment for
two high volume inhalation drugs (J7619 and J7644). These impacts will
be reduced somewhat by the dispensing fee we are proposing for
inhalation drugs. We estimate the total reduction in payment across all
of the services provided by DME suppliers as a result of provisions of
this proposed rule would be approximately 28 percent.
Table 28.--Drug Pricing Table Used for Payment Impacts
----------------------------------------------------------------------------------------------------------------
Estimated
CY 2004 Pay CY 2005 Percent
Code Short description Trade name allowance allowance change
limit limit 6%)
----------------------------------------------------------------------------------------------------------------
J0152.................. Adenosine injection.... ADENOSCAN.............. $66.56 $69.78 5%
J0585.................. Botulinum toxin a per BOTOX.................. 4.43 4.69 6
unit.
J0880.................. Darbepoetin alfa ARANESP................ 21.20 18.10 -15
injection.
J1441.................. Filgrastim 480 mcg NEUPOGEN............... 267.79 267.04 0
injection.
J1745.................. Infliximab injection... REMICADE............... 58.79 53.32 -9
J2430.................. Pamidronate disodium/30 AREDIA, PAMIDRONATE 237.88 67.27 -72
MG. DISODIUM,.
J2505.................. Injection, NEULASTA............... 2,507.50 2,260.77 -10
pegfilgrastim 6mg.
J2792.................. Rho(D) immune globulin WINRHO................. 18.39 13.04 -29
h, sd.
J3395.................. Verteporfin injection.. VISUDYNE............... 1,404.26 1,368.79 -3
J3487.................. Zoledronic acid........ ZOMETA................. 194.54 202.50 4
J7192.................. Factor viii recombinant KOGENATE, HELIXATE, 1.29 0.92 -29
RECOMBINATE, REFACTO,
BIOCLATE,.
J7317.................. Sodium hyaluronate HYALGAN, SUPARTZ, 124.11 110.07 -11
injection. ORTHOVISC.
J7320.................. Hylan G-F 20 injection. SYNVISC................ 204.03 188.88 -7
J7507.................. Tacrolimus oral per 1 PROGRAF................ 3.13 3.19 2
MG.
J7517.................. Mycophenolate mofetil CELLCEPT............... 2.55 2.54 0
oral.
J7619.................. Albuterol inh sol u d. PROVENTIL, ALBUTEROL 0.39 0.04 -89
SULFATE, VENTOLIN.
J7626.................. Budesonide inhalation PULMICORT.............. 4.04 3.91 -3
sol.
J7644.................. Ipratropium brom inh IPRATROPIUM BROMIDE.... 2.82 0.30 -89
sol u d.
J9045.................. Carboplatin injection.. PARAPLATIN............. 137.54 131.77 -4
J9170.................. Docetaxel.............. TAXOTERE............... 301.40 287.59 -5
J9201.................. Gemcitabine HCl........ GEMZAR................. 111.33 107.46 -3
J9202.................. Goserelin acetate ZOLADEX................ 375.99 234.28 -38
implant.
J9206.................. Irinotecan injection... CAMPTOSAR.............. 130.24 123.86 -5
J9217*................. Leuprolide acetate LUPRON DEPOT, ELIGARD, 500.58 234.28 -53
suspnsion. LUPRON DEPOT-PED.
[[Page 47567]]
J9219.................. Leuprolide acetate VIADUR................. 4,831.40 2,190.71 -55
implant.
J9265.................. Paclitaxel injection... TAXOL, ONXOL, NOV-ONXOL 138.28 25.84 -81
J9310.................. Rituximab cancer RITUXAN................ 427.28 438.38 3
treatment.
J9350.................. Topotecan.............. HYCAMTIN............... 706.17 731.46 4
J9355.................. Trastuzumab............ HERCEPTIN.............. 52.01 50.84 -2
J9390.................. Vinorelbine tartrate/10 NAVELBINE.............. 76.19 64.67 -15
mg.
Q0136.................. Non esrd epoetin alpha PROCRIT................ 11.62 10.37 -11
inj.
**Unlisted............. ....................... ALOXI.................. 307.80 202.51 -34
----------------------------------------------------------------------------------------------------------------
*The figures here for J9217 reflect the ASP prices submitted by the drug manufacturer. However, we assumed that
Medicare carriers are applying ``least costly alternative'' pricing and are using the J9202 price for J9217.
**Aloxi is the brand name for an antiemetic that is paid in 2004 at 95% of AWP using an unlisted code because
the drug was approved by the FDA in the fall of 2003. Even though we do not have a code or volume for this
drug from 2003 like we do for the other drugs shown in the table, we are showing it here because it is the
highest growth injectable antiemetic drug currently on the market.
B. Geographic Practice Cost Indices
As discussed in section II.B, in this rule, we are proposing
changes to the work and practice expense GPCIs based on new census
data. The resulting geographic redistributions would not result in an
overall increase in the current geographic adjustment indices by more
than 3.5 percent or a decrease by more than 1.6 percent for any given
locality in 2005. These geographic redistributions would not result in
an overall increase in the current geographic adjustment indices by
more than 7 percent or a decrease by more than 3.5 percent for any
given locality in 2006. Addenda E and F illustrate the locality
specific overall impact of this proposal. The GAF, as displayed in
addenda E and F is a weighted composite index of the individual
proposed revisions to the work, practice expense, and malpractice
expense GPCIs, respectively. The malpractice GPCI was updated as part
of the November 7, 2003 final rule, and the MMA provisions were
addressed in the final rule published on January 7, 2004.
C. Coding Issues
1. Revisions to Global Period
In section II.D.1, we are proposing a change in the global period
for procedure code 77427, Radiation treatment management, five
treatments from a global indicator of ``xxx'' (meaning that the global
concept does not apply) to ``090'' (meaning that there is a 90-day
global period). We are not changing any of the RVUs for procedure code
77427 because this service was valued to reflect a global period of 90
days. The implication of this change is that any visit services
provided in the 90-day global period that are related to procedure code
77427 will no longer be paid separately. We reviewed Medicare data and
found that physicians rarely bill for services during the 90-day period
following the date-of-service for procedure code 77427. Therefore, we
believe this proposal will have little effect on Medicare program
expenditures and our payments to physicians.
2. Additions to the List of Medicare Telehealth Services
In section II.D.2, we are proposing to add end stage renal disease
(ESRD) services, as represented by HCPCS codes G0308, G0309, G0311,
G0312, G0314, G0315, G0317, G03178 to the list of telehealth services.
We believe that this change will have little effect on Medicare
expenditures.
3. National Pricing of G0238/G0239 (Respiratory Therapy Service Codes)
As discussed earlier in the preamble, we are proposing to use the
nonphysician workpool to value two respiratory therapy service codes
(G0238 and G0239) that are currently carrier priced. We believe that
this proposed change will eliminate the uncertainty surrounding payment
of these codes when performed in comprehensive outpatient
rehabilitation facilities that are paid under the physician fee
schedule through fiscal intermediaries. We do not anticipate that
nationally pricing these services would have a significant impact on
Medicare expenditures.
4. New HCPCS Code for Bone Marrow Aspiration
We are proposing a new HCPCS code for instances when a bone marrow
aspiration and a bone marrow biopsy are performed on the same day
through a single incision. Currently, we do not allow payment for both
of these procedures on the same day. While this coding change will
allow for a small additional payment for the second procedure performed
through a single incision on the same day, we anticipate that the costs
will be insignificant.
5. New HCPCS Code for Venous Mapping
As stated earlier in the preamble, we are proposing a new HCPCS
code for venous mapping for hemodialysis access placement. The primary
reason for this new code is to enable us to track the use of venous
mapping for quality improvement purposes. Since pricing for this
service is not changing, there will be no impact on Medicare
expenditures.
D. MMA Provisions
1. Section 611--Preventive Physical Examination
As discussed earlier in this preamble, the MMA authorizes coverage
of an initial preventive physical examination effective January 1,
2005, subject to certain eligibility and other limitations. We estimate
that this new benefit will result in an increase in Medicare
expenditures. These new payments will be made to physicians and other
practitioners who provide these examinations and for any medically
necessary follow-up tests, counseling, or treatment that may be
required as a result of the coverage of these examinations. The impact
of this provision is shown in the following table.
[[Page 47568]]
TABLE 29.--Medicare Cost Estimates for MMA Provision 611
(in millions)
----------------------------------------------------------------------------------------------------------------
MMA provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009
----------------------------------------------------------------------------------------------------------------
Sec. 611.................................. 65 75 75 75 75
----------------------------------------------------------------------------------------------------------------
2. Section 613--Diabetes Screening
Section 613 of the MMA adds subsection (yy) to section 1861 of the
Social Security Act and mandates coverage of diabetes screening tests,
effective on or after January 1, 2005. We estimate that this change in
coverage for certain beneficiaries will result in an increase in
Medicare payments. These payments will be made to physicians' office
laboratories and other laboratory suppliers who perform these tests as
a result of the increased frequency of coverage of these tests. The
impact of this provision is shown in Table 30 that follows.
3. Section 612--Cardiovascular Screening
Section 612 of the MMA provides for Medicare coverage for
cholesterol and other lipid or triglyceride levels of cardiovascular
screening blood tests for the early detection of abnormalities
associated with an elevated risk for such diseases effective on or
after January 1, 2005. We estimate that this change in coverage for
certain beneficiaries will result in an increase in Medicare payments.
These payments will be made to physician office laboratories and other
laboratory suppliers who perform these tests as a result of the
increased frequency of coverage of these tests. Increased Medicare
program expenditures for this provision are shown in Table 30 below.
TABLE 30.--Medicare Cost Estimates for MMA Provisions 612 and 613
(in millions)
----------------------------------------------------------------------------------------------------------------
MMA provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009
----------------------------------------------------------------------------------------------------------------
Sec. 612 Cholesterol and Blood Lipid........... 50 80 90 90 100
Sec. 613 Diabetes Screening.................... 20 40 50 60 80
----------------------------------------------------------------------------------------------------------------
4. Section 413--Incentive Payment for Physician Scarcity
a. Physician Scarcity Areas
Section 413(a) of the MMA provides a new 5-percent incentive
payment to physicians who furnish services in physician scarcity areas.
The MMA provides for paying primary care physicians furnishing services
in a primary care scarcity area, and specialty physicians furnishing
services in a specialist care scarcity county, an additional amount
equal to 5 percent of the amount paid for their professional services
under the fee schedule from January 1, 2005 to December 31, 2007. We
estimate that this new incentive payment for physician services will
result in an increase in Medicare payments that are shown in Table 31.
b. Improvement to Medicare HPSA Incentive Payment Program
Section 413(b) of the MMA amended section 1833(m) of the Act to
mandate that we automate payment of the 10 percent HPSA incentive
payment to eligible physicians. Since the inception of the HPSA
incentive payment program, physicians have been required to determine
their eligibility and correctly code their Medicare claims using
modifiers. We estimate that this change to the HPSA incentive payment
program to provide for automation of payment will result in an increase
in Medicare payments because many eligible physicians are not applying
for bonuses due to the burden of verifying eligibility. The impact of
this provision is shown in Table 31.
TABLE 31.--Medicare Cost Estimates for MMA Provisions
(in millions)
----------------------------------------------------------------------------------------------------------------
MMA provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009
----------------------------------------------------------------------------------------------------------------
Sec. 413(a) Physician Scarcity Areas........... 30 50 50 20 0
Sec. 413(b) Improvement to HPSA................ 20 30 30 30 30
----------------------------------------------------------------------------------------------------------------
5. Sections 303-304--Payment for Covered Outpatient Drugs and
Biologicals and Section 305--Payment for Inhalation Drugs
Sections 303 and 304 of the MMA make changes to Medicare payment
for covered outpatient drugs and biologicals and changes to the
administration of those drugs. Section 305 makes changes to payment for
inhalation drugs. We implemented provisions of sections 303 through 305
changing payments in 2004 for drugs and their administration in the
January 7, 2004 Federal Register (69 FR 1084). In this proposed rule,
we are making further changes to Medicare's payment for drugs and drug
administration for 2005 required by sections 303 through 305 of the
MMA. We estimate that adoption of the ASP+6 payment methodology will
result in Medicare savings for FY 2005 of $180 million for section 303
of the MMA, $140 million for section 304 of the MMA, and $210 million
for section 305 of the MMA. If we were to make no further changes to
the coding or payment for drug administration services, we estimate
Medicare savings of $90 million for section 303 of the MMA and $40
million for section 304 of the MMA. In addition, we are also proposing
to pay a supplying fee of $10 per Medicare Part B oral drug
prescription. We estimate this proposal will increase Medicare
expenditures by $52 million from FY 2005 through FY 2009, assuming an
average of two prescriptions per month. We are also
[[Page 47569]]
proposing to pay a furnishing fee of $0.05 per unit off clotting
factor. This proposal is estimated to cost $13 million from FY 2005
through FY 2009.
6. Section 952--Reassignment
The reassignment provisions discussed in section III.F is currently
estimated to have no significant impact on Medicare expenditures.
7. Section 623--Payment for Renal Dialysis Services
a. Effects on the Medicare Program (Budgetary Effect)
Because the proposed basic case mix adjusted composite payment rate
and the revised payment for ESRD drugs must be budget neutral in
accordance with section 623(d)(1) of the MMA, except for the
statutorily required 1.6 percent increase set forth in section 623(a),
we estimate that there would be no budgetary impact for the Medicare
program beyond this increase. The impact of this provision (net of
beneficiary liability) is shown in the following table.
TABLE 32.--Medicare Cost Estimates for MMA Provision 623
(in millions)
----------------------------------------------------------------------------------------------------------------
MMA provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009
----------------------------------------------------------------------------------------------------------------
Section 623............................... 40 50 50 60 60
----------------------------------------------------------------------------------------------------------------
b. Impact on ESRD Providers
In order to understand the impact of the proposed changes affecting
payments to ESRD facilities that result from enactment of the MMA on
different categories of ESRD facilities, it is necessary to compare
estimated payments under the current payment system (current payments)
to estimated payments under the proposed revisions to the composite
rate payment system as set forth in this proposed rule (proposed
payments). To estimate the impact among various classes of ESRD
facilities, it is imperative that the estimates of current payments and
proposed payments contain similar inputs. Therefore, we simulated
proposed payments only for those ESRD facilities for which we are able
to calculate both current payment and proposed payment.
Due to data limitations, we are unable estimate current and
proposed payments for 592 facilities that bill for ESRD drugs. Of these
592 facilities, 174 are hospital based and 418 are independent.
Therefore, 29 percent of hospital-based facilities and 11 percent of
independent facilities are not shown in the impact table. ESRD
providers were grouped into the categories based on characteristics
provided in the Online Survey and Certification and Reporting (OSCAR)
file and the most recent cost report data from HCRIS. We also used the
December 2003 update of CY 2003 Standard Analytical File (SAF) claims
as a basis for Medicare dialysis treatments and separately billable
drugs and biologicals. While the December 2003 update of the 2003 SAF
file is not complete, we wanted to use the most recent data available,
and plan to use an updated version of the 2003 SAF file for the final
rule.
Table 33.--Impact of MMA Section 623 Payments to Hospital Based and Independent ESRD Facilities (Includes Drug and Composite Rate Payments)
[Percent change in total payments to ESRD facilities (both program and beneficiaries)]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Effect of 1.6%
Number of Effect of composite
Number of dialysis changes in rate update Effect of Overall effect
facilities treatments drug payments on total case mix 3/ 4/
(in millions) 1/ payments 2/
--------------------------------------------------------------------------------------------------------------------------------------------------------
All..................................................... 3,671 29.2 0.0 1.0 0.0 1.0
Independent............................................. 3,240 26.1 -0.6 1.0 -0.0 0.4
Hospital Based.......................................... 431 3.1 5.7 1.1 0.1 7.0
Size: .............. .............. .............. .............. .............. ..............
Small <5000 treatment per year...................... 1,313 4.0 -0.6 1.0 -0.1 0.3
Medium 5000-10000 treatments per yr................. 1,414 10.2 -0.7 1.0 -0.1 0.2
Large > 10000 treatments per year................... 944 15.0 0.6 1.0 0.0 1.7
Type of Ownership: .............. .............. .............. .............. .............. ..............
Not-for-profit...................................... 697 5.2 2.9 1.1 0.0 4.1
For-profit.......................................... 2,710 21.9 -0.6 1.0 -0.0 0.4
Other............................................... 264 2.1 -0.1 1.0 0.0 1.0
Urban............................................... 2,701 23.6 0.1 1.0 0.1 1.2
Rural............................................... 970 5.6 -0.5 1.0 -0.5 -0.0
Region: .............. .............. .............. .............. .............. ..............
New England......................................... 125 1.2 1.3 1.1 0.1 2.4
Middle Atlantic..................................... 475 4.0 0.5 1.0 0.9 2.4
East North Central.................................. 540 4.5 0.4 1.0 -0.1 1.3
West North Central.................................. 255 1.7 1.4 1.1 -0.5 2.0
South Atlantic...................................... 886 6.9 -1.0 1.0 0.0 0.0
East South Central.................................. 309 2.2 -1.0 1.0 -0.7 -0.7
West South Central.................................. 522 4.1 -1.0 1.0 -0.2 -0.1
Mountain............................................ 194 1.3 0.6 1.1 -0.5 1.1
Pacific............................................. 339 3.0 1.4 1.1 -0.2 2.3
[[Page 47570]]
Puerto Rico......................................... 26 0.4 0.8 1.0 1.4 3.3
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ This column shows the effect of the changes in drug payments to ESRD providers. These include changes in payment for separately billable drugs and
the 11.3% drug add-on.
\2\ This column shows the effect of the 1.6% update to the composite rate on total payments to ESRD providers. Note that ESRD providers receive an
average of 36% of their total revenues from separately billable drugs which results in an average net increase of 1.0%.
\3\ This column shows impact of case-mix adjustments only.
\4\ This column shows percent change between the proposed and current payments to ESRD facilities. The proposed payments includes the 1.6% increase, the
11.3% drug add-on, and the case-mix adjustments times treatments plus proposed payment for separately billable drugs. The current payment to ESRD
facilities includes the current composite rate times treatments plus current drug payments for separately billable drugs.
Table 33 shows the impact of MMA Section 623 on hospital based and
independent facilities. We have included both composite rate payments
as well as payments for separately billable drugs and biologicals
because both are effected by Section 623. The first column of Table 33
identifies the type of ESRD provider, the second column indicates the
number of ESRD facilities for each type, and the third column indicates
the number of dialysis treatments.
The fourth column shows the effect of the changes in drug payments
to ESRD providers. The overall effect of changes in drug payments is
budget-neutral as required by MMA. The drug add-on adjustment is
designed to result in the same aggregate amount of expenditures as
would have been made without the statutory policy change.
Current payments for drugs represent 2005 Medicare reimbursement
using 95 percent of AWP prices for the top ten drugs. Medicare spending
for drugs other than EPO is estimated using 2004 AWP prices updated by
a 3 percent inflation factor times actual drug utilization from 2003
claims. EPO is priced $10 per 1000 units (EPO units are estimated using
payments because the units field on bills represents the number of EPO
administrations rather than the number EPO units). Spending under the
proposed change is 2004 ASP minus 3 percent for the top ten drugs plus
3.39 percent inflation factor times actual drug utilization from 2003
claims.
Proposed payment for drugs under MMA also includes the 11.3 percent
drug add-on to the composite rate. This amount is computed by
multiplying the composite rate for each provider (with the 1.6 percent
increase) times dialysis treatments from 2003 claims. Column 4 is
computed by comparing spending under the proposed payment for drugs
including the 11.3 percent drug add-on amount to spending under current
payments for drugs. In order to make column 4 comparable with rest of
Table 33, current composite rate payments to ESRD facilities were
included in both current and proposed spending calculations.
Column 5 shows the effect of the 1.6 percent increase to the
composite rate on total payments to ESRD providers. While all ESRD
providers will get a 1.6 percent increase to their composite rate, this
table shows the net effect of this increase on ESRD providers total
Medicare revenues (both drug and composite rate payments combined), and
therefore does not show a 1.6 percent increase.
On average, ESRD providers receive an average of 36 percent of
their total revenues from separately billable drugs and 64 percent of
their total revenues from composite rate payment. Since the 1.6 percent
increase is applied to the 64 percent portion of their total Medicare
revenues, the 1.6 percent composite rate increase is also
arithmetically equal to a 1.0 percent increase in ESRD providers' total
Medicare revenues. Column 5 is computed by combining proposed payment
for drugs (including the 11.3 percent drug add-on amount) with: (1)
Current composite rate times dialysis treatments from 2003 claims or
(2) composite rate with 1.6 percent increase times dialysis treatments
from 2003 claims. The difference between these two combinations is the
net effect of the 1.6 percent increase on total payments to ESRD
providers. In order to isolate the effect of the 1.6 percent increase,
the computation in Column 5 assumes that drug payments to ESRD
providers remain constant.
Column 6 shows the impact of the case-mix adjustments as described
in section H.4.d of this proposed rule. Because MMA requires this
adjustment be budget-neutral in the aggregate, there is no overall
impact to the ESRD providers as a whole. While the case-mix adjustment
will have an impact within the various provider types, Column 6 shows
that the effect between provider groupings is minimal. Column 6 is
computed as the difference between proposed payments to ESRD providers
with the case-mix adjustments compared to payments to providers without
the case-mix adjustments. As described in section H.4.f, we
standardized the composite rate to meet the MMA requirement that
payment be budget-neutral with respect to aggregate payments.
Therefore, there is no change for ESRD providers in aggregate. We note
that when applying the case-mix adjustments, we did so at the summary
level as shown in Table 33.
Column 7 shows the overall effect of all changes in drug and
composite rate payments to ESRD providers. The overall effect measured
as the difference between proposed payment with all MMA changes as
proposed in this rule and current payment. Proposed payment is computed
by multiplying the composite rate for each provider (with both 1.6
percent increase and the 11.3 percent add-on) times dialysis treatments
from 2003 claims times the appropriate case-mix adjustment by provider
category. In addition, proposed payment includes payments for
separately billable drugs under the revised pricing methodology as
described in section III-E-Section 303-Payment Reform for Outpatient
Drugs and Biologicals, Subsection 1.d. Current payment is the current
composite rate for each provider times dialysis treatments from 2003
claims plus current drug payments for separately billable drugs.
The overall impact to ESRD providers in aggregate is 1.0 percent.
Among the three separately shown effects, the effect
[[Page 47571]]
of changes in drug payments has the most variation among provider type
and contributes most to the overall effect. Separately billable ESRD
drugs are paid differently to hospital-based and independent ESRD
providers. As discussed in section H.4.c, we are proposing a single
drug add-on to the composite rates for both hospital based and
independent facilities. The 7.0 percent increase in payments to
hospital-based providers is largely due to the proposed single drug
add-on to the composite rate. Many hospital based providers are not-
for-profit, which may explain the larger than average increase in
payments.
8. Section 731--Coverage of Routine Costs for Category A Clinical
Trials
The coverage of routine costs associated with certain Category A
clinical trials as discussed in MMA section 731(b) has no significant
impact on Medicare expenditures.
9. Section 629--Part B Deductible
As explained earlier in the preamble, section 629 of the MMA
provides for annual updates to the Medicare Part B deductible. The MMA
stipulates that the Medicare Part B deductible will be $110 for
calendar year 2005, and, for subsequent years, the deductible will be
the previous year's deductible increased by the annual percentage
increase in the monthly actuarial rate under section 1839(a)(1) of the
Act, ending with that subsequent year (rounded to the nearest dollar).
We note that while this MMA provision results in a savings to the
Medicare program, it also increases beneficiary costs by an equal
amount.
Table 34.--Estimated Medicare Savings for MMA Provision 629
[in millions]
----------------------------------------------------------------------------------------------------------------
MMA provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009
----------------------------------------------------------------------------------------------------------------
Sec. 629.................................. 110 290 440 590 770
----------------------------------------------------------------------------------------------------------------
10. Section 512--Hospice Consultation Service
As explained in section III.K, effective January 1, 2005, section
512 of the MMA provides for payment to be made to a hospice for
specified services furnished by a physician who is either the medical
director of, or an employee of, a hospice agency. We estimate that this
MMA provision will increase Medicare expenditures by $10 million per
year beginning in 2005.
11. Section 302--Clinical Conditions for Coverage of Durable Medical
Equipment (DME)
As explained earlier in the preamble, to comply with the
requirements of section 302 of the MMA and to enhance quality and
reduce fraud, we are proposing to establish basic requirements that
apply to all items of durable medical equipment, prosthetics,
orthotics, and supplies (DMEPOS). The impact to the Medicare program
will be to improve quality of care because we are involving the
physician early in the process when determining the medical necessity
for items of DMEPOS. The physician community has stated that they are
often asked to order an item of DMEPOS for their patient when they do
not think the item is reasonable and necessary. We believe these
requirements will result in no costs or savings to Medicare because if
any additional spending from more physician visits occur it will be
offset by savings from Medicare paying for less DMEPOS. However, we
expect to continue evaluating this issue.
E. Other Issues
1. Outpatient Therapy Services Performed ``Incident to'' Physicians''
Services
As discussed in section IV.A, we are proposing to amend the
regulations to include the statutory requirement that only individuals
meeting the existing qualification and training standards for
therapists (with the exception of licensure) consistent with Sec.
484.4 qualify to provide therapy services incident to physicians'
services. We believe that while this will have little impact on
Medicare expenditures, it will assist in ensuring the quality of
services provided to beneficiaries.
2. Supervision Requirements for Therapy Assistants in Private Practice
As discussed earlier in section IV.A.2, we are proposing to revise
the regulations at Sec. 410.59 and Sec. 410.60 to replace a
requirement to provide personal supervision and instead require direct
supervision of physical therapist assistants and occupational therapy
assistants when therapy services are provided by physical therapists or
occupational therapists in private practice. This proposed policy
change would provide beneficiaries access to medically necessary
therapy services, under a physician-certified plan of care. We believe
that this change would result in a 5 percent increase in therapy
billing in therapy private practice settings with an estimated cost of
$9 million for FY 2005. Projected costs for FY 2006 are $17 million
while each subsequent year would only increase by $1 million each year,
assuming the therapy caps are applied.
3. Low Osmolar Contrast Media
As discussed earlier in the preamble, we are proposing to revise
the regulations at Sec. 414.38 to eliminate the restrictive criteria
for the payment of LOCM. This proposal will make payment for LOCM
consistent across Medicare payment systems. By identifying contrast-
enhanced procedures that most commonly use LOCM, the typical ranges of
LOCM amounts used by modality, and the cost ranges for LOCM in the
marketplace, we estimate program costs as shown in the following table:
Table 35
----------------------------------------------------------------------------------------------------------------
Regulatory Provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009
----------------------------------------------------------------------------------------------------------------
LOCM...................................... 20 30 30 30 30
----------------------------------------------------------------------------------------------------------------
[[Page 47572]]
4. Payments for Physicians and Practitioners Managing Patients on
Dialysis
We believe that the proposals with respect to ESRD-related services
furnished to patients in observation settings and payment for
outpatient ESRD-related services for partial month scenarios discussed
earlier in section 1V. E. provide clarification of current policy
surrounding these issues. We do not believe these proposals would have
a significant impact on Medicare expenditures.
5. Supervision of Clinical Psychological Testing
We are proposing to change the supervision requirements regarding
who can supervise diagnostic psychological testing services. As
previously discussed, having ancillary staff supervised by clinical
psychologists would enable these practitioners with a higher level of
expertise to oversee psychological testing and potentially relieve
burdens on physicians and healthcare facilities.
Additionally, in rural areas, we anticipate that permitting
psychologists to supervise diagnostic psychological testing services
would reduce delays in testing, diagnosis, and treatment that could
result from the unavailability of physicians to supervise the tests. We
believe that this proposal will have little impact on Medicare
expenditures.
6. Care Plan Oversight
As discussed in section IV.G, we are proposing to revise Sec.
414.39 to clarify that NPPs can perform home health care plan oversight
even though they cannot certify a patient for home health services and
sign the plan of care. We do not expect that this proposal would have
an impact on Medicare expenditures, since it is only clarifying that an
NPP or a physician can provide care plan oversight for home health
care.
7. Assignment of Medicare Claims
The proposed changes with respect to assignment of Medicare claims
are currently estimated to have no significant impact on Medicare
expenditures. However, as stated earlier in this preamble at section
IV.H, we believe the proposed changes will reduce the paperwork burden
on beneficiaries and suppliers.
F. Alternatives Considered
This proposed rule contains a range of policies, including
proposals related to specific MMA provisions. The preamble provides
descriptions of the statutory provisions that are addressed, identifies
those policies when discretion has been exercised and presents
rationale for our decisions and, when possible, alternatives that were
considered.
The following is a discussion of additional points on the proposed
changes required by section 302 of the MMA involving ordering items of
durable medical equipment, prosthetics, orthotics, and supplies
(DMEPOS).
In developing the proposed changes to implement section 302 of the
MMA, we did consider establishing ``the face-to-face requirement,'' and
``the order prior to delivery'' requirement only for specific items of
DMEPOS for which there has been an identified proliferation of use.
However, we believe it is important that the physician or nonphysician
practitioner determine the medical need for all items of DME. It is
good clinical practice for beneficiaries to be seen by the physician
for their medical condition and at that time the physician will decide
whether an item of DME is appropriate. It is our intent to make
Medicare more consistent with private payers in that beneficiaries be
seen by their physician for their medical condition, who then makes a
diagnosis and orders any supplies needed to address their needs. Since
we expect beneficiaries to be seen by their doctor for a specific
medical condition, we do not believe that this would place a burden on
the physician, as it would be part of a necessary examination.
We also note that in establishing these proposed requirements we do
make exceptions for items of continued need, such as, glucose test
strips or support surfaces. Once the physician has initially
established the need, we do not require additional visits or additional
documentation.
G. Impact on Beneficiaries
There are a number of changes made in this proposed rule that would
have an effect on beneficiaries. In general, we believe these changes
will improve beneficiary access to services that are currently covered
or will expand the Medicare benefit package to include new services. As
explained in more detail below, the MMA or regulatory provisions may
increase beneficiary liability in some cases. Any changes in aggregate
beneficiary liability from a particular provision will be a function of
the coinsurance (20 percent if applicable for the particular provision
after the beneficiary has met the deductible) and the effect of the
aggregate cost (savings) of the provision on the calculation of the
Medicare Part B premium rate (generally 25 percent of the provision's
cost or savings). Taking into account the MMA and regulatory provisions
of this proposed rule, we estimate beneficiary savings in FY 2005 of
$270 million. This figure could be less if we make further changes to
Medicare's drug administration payments.
The MMA provisions that expand Medicare benefits include: section
611, adding a preventive office visit for newly eligible Medicare
beneficiaries; section 612 providing coverage of cardiovascular
screening blood tests; and section 613, providing coverage for diabetes
screening tests for Medicare beneficiaries at risk for diabetes. While
the preventive office visit for newly eligible Medicare beneficiaries
is subject to deductible and coinsurance, we believe Medicare
beneficiaries will continue to benefit from expanded coverage for this
service. We believe many beneficiaries have supplemental insurance
coverage or Medicaid that pays the Medicare deductible on their behalf
and there will be no immediate additional out-of-pocket cost. Further,
even if a beneficiary pays nearly all of the costs of this new benefit,
the preventive office visit will substitute for another service a
beneficiary may need to meet the annual deductible and the beneficiary
will receive more covered benefits at little additional cost. There are
no out-of-pocket costs to the beneficiary for the cardiovascular
screening blood tests and diabetes screening tests.
Other proposals in this rule related to the MMA will also impact
beneficiary liability, with the most significant related to indexing of
the part B deductible (section 629 of the MMA) and the drug
administration payment changes (sections 303 and 305 of the MMA).
Indexing of the Part B deductible will result in an estimated cost to
beneficiaries of $110 million in 2005. MMA provisions that improve
administration of the 10 percent HPSA bonus and provide an additional 5
percent bonus payment to physicians in Medicare scarcity areas will
have no impact on beneficiary liability because the bonus payments are
applied to the amount Medicare pays the physician net of beneficiary
liability. These provisions will also improve access for Medicare
beneficiaries by increasing payments to physicians in areas that
traditionally have had a low ratio of physicians to population.
The implementation of MMA provisions related to drugs and drug
administration will reduce Medicare beneficiary liability for Medicare
covered services. We estimate that implementation of sections 303
through 305 of the MMA will reduce Medicare
[[Page 47573]]
beneficiary liability for drugs by $360 million in FY 2005. If we were
to make no further changes to Medicare's payments for drug
administration, we estimate additional savings to Medicare
beneficiaries of $120 million in FY 2005. Provisions of this proposed
rule that increase the supplying fee for immunosuppressive drugs and
the furnishing fee for the clotting factor are estimated to increase
beneficiary liability by $36 million and $10 million respectively, from
FY 2005 through FY 2009.
We do not believe that the drug and drug administration payment
changes required by the MMA are intended to lessen beneficiary access
to care. By reducing beneficiary liability, we believe it is likely
that beneficiary access to care will be improved. As indicated earlier,
without any further change in payment for drug administration, the MMA
increased payment for drug administration by more than 105 percent from
2003 to 2005 while making payment for drugs at 6 percent more than
their average sales price. Nevertheless, we acknowledge that there is a
concern among physicians and others that the large changes in
Medicare's payments may affect their ability or willingness to continue
making drugs and related services available.
As indicated above, we are considering making further changes to
Medicare payment for drug administration based on the results of CPT's
review of this issue or in response to public comment. Further, we are
gathering Medicare utilization for drugs and drug administration
beginning in 2002 and plan to analyze shifts or changes in utilization
patterns as the information becomes available to us once the payment
changes required by the MMA go into effect. While we do not believe the
payment changes for drugs and drug administration will result in access
problems, we plan to continue studying this issue. We also note that
the MMA requires the Medicare Payment Advisory Commission (MedPAC) to
study related issues. Specifically, section 303(a)(5) of the MMA
requires MedPAC to study items and services furnished by oncologists
and drug administration services furnished by other specialists.
Similarly, section 305(b) requires the General Accounting Office to
study the adequacy of Medicare payments for inhalation therapy.
We are also undertaking several changes using our administrative
authority that will affect Medicare beneficiaries. Our proposal to
remove restrictions that limit Medicare payment for use of low osmolar
contrast material to specific indications would update Medicare's
payment policy to be consistent with the standard practice of medicine
and will improve the quality of care for beneficiaries.
We believe early involvement of the physician in determining the
medical necessity for items of DMEPOS will assist in improving the
accuracy of Medicare program payments and the quality of care. In
addition, it will also reduce out-of-pocket costs for unnecessary
DMEPOS that may have otherwise been provided to Medicare beneficiaries.
In accordance with the provisions of Executive Order 12866, this
regulation was reviewed by the Office of Management and Budget.
List of Subjects
42 CFR Part 405
Administrative practice and procedure, Health facilities, Health
professions, Kidney diseases, Medical devices, Medicare, Reporting and
recordkeeping requirements, Rural areas, X-rays
42 CFR Part 410
Health facilities, Health professions, Kidney diseases,
Laboratories, Medicare, Reporting and recordkeeping requirements, Rural
areas, X-rays
42 CFR Part 411
Kidney diseases, Medicare, Reporting and recordkeeping requirements
42 CFR Part 414
Administrative practice and procedure, Health facilities, Health
professions, Kidney diseases, Medicare, Reporting and recordkeeping
requirements
42 CFR Part 418
Health facilities, Hospice care, Medicare, Reporting and
recordkeeping requirements
42 CFR Part 424
Emergency medical services, Health facilities, Health professions,
Medicare, Reporting and recordkeeping requirements
42 CFR Part 484
Health facilities, Health professions, Medicare, Reporting and
recordkeeping requirements
42 CFR Part 486
Grant programs-health, Health facilities, Medicare, Reporting and
recordkeeping requirements, X-rays
For the reasons set forth in the preamble, the Centers for Medicare
& Medicaid Services proposes to amend 42 CFR chapter IV as follows:
PART 405--FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED
1. The authority citation for part 405 continues to read as
follows:
Authority: Secs. 1102, 1861, 1862(a), 1871, 1874, 1881, and
1886(k) of the Social Security Act (42 U.S.C. 1302, 1395x, 1395y(a),
1395hh, 1395kk, 1395rr, and 1395ww(k)), and sec. 353 of the Public
Health Service Act (42 U.S.C. 263a).
2. Section 405.207 is amended by revising paragraph (b) to read as
follows:
Sec. 405.207 Services related to a noncovered device.
* * * * *
(b) When payment is made. Medicare payment may be made for--
(1) Covered services to treat a condition or complication that
arises due to the use of a noncovered device or a noncovered device-
related service; or
(2) Routine care services related to experimental/investigational
(Category A) devices as defined in Sec. 405.201(b); and furnished in
conjunction with an FDA-approved clinical trial. The trial must meet
criteria established through the national coverage determination
process; and if the trial is initiated before January 1, 2010, the
device must be determined as intended for use in the diagnosis,
monitoring or treatment of an immediate life-threatening disease or
condition.
(3) Routine care services related to a non-experimental/
investigational (Category B) device defined in Sec. 405.201(b) that is
furnished in conjunction with an FDA-approved clinical trial.
3. Section 405.517 is amended by adding a new paragraph (a)(3) to
read as follows:
Sec. 405.517 Payment for drugs and biologicals that are not paid on a
cost or prospective payment basis.
(a) Applicability. * * *
(3) Payment for drugs and biologicals on or after January 1, 2005.
Effective January 1, 2005, payment for drugs and biologicals that are
not paid on a cost or prospective payment basis are paid in accordance
with part 414, subpart K of this chapter.
PART 410--SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS
4. The authority citation for part 410 continues to read as
follows:
[[Page 47574]]
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
5. Section 410.10 is amended by adding new paragraph (y) to read as
follows:
Sec. 410.10 Medical and other health services: Included services.
* * * * *
(y) Intravenous immune globulin administered in the home for the
treatment of primary immune deficiency diseases.
6. Section 410.16 is added to read as follows:
Sec. 410.16 Initial preventive physical examination: Conditions for
and limitations on coverage.
(a) Definitions. As used in this section, the following definitions
apply--
Eligible beneficiary means individuals who receive their initial
preventive physical examinations within 6 months after the effective
date of their first Medicare Part B coverage period, but only if their
first Part B coverage period begins on or after January 1, 2005.
Initial preventive physical examination means all of the following
services furnished to an individual by a physician or other qualified
nonphysician practitioner with the goal of health promotion and disease
detection:
(1) Review of the individual's comprehensive medical and social
history.
(2) Review of the individual's potential (risk factors) for
depression, including past experiences with depression or other mood
disorders, based on the use of an appropriate screening instrument,
which the physician or other qualified nonphysician practitioner may
select unless the appropriate screening instrument is further defined
through a national coverage determination.
(3) Review of the individual's functional ability, and level of
safety, based on the use of an appropriate screening instrument, which
the physician or other qualified nonphysician practitioner may select
unless the appropriate screening instrument is defined through a
national coverage determination.
(4) An examination to include measurement of the individual's
height, weight, blood pressure, a visual acuity screen, and other
factors as deemed appropriate, based on the individual's medical and
social history, and current clinical standards.
(5) Performance and interpretation of an electrocardiogram.
(6) Education, counseling, and referral, as deemed appropriate by
the physician or qualified nonphysician practitioner, based on the
results of the review and evaluation services described in this
section.
(7) Education, counseling, and referral, including a written plan
provided to the individual for obtaining the appropriate screening and
other preventive services for the individual that are covered as
separate Medicare Part B benefits as described in section 1861(s)(10),
section 1861(jj), section 1861(nn), section 1861(oo), section 1861(pp),
section 1861(qq)(1), section 1861(rr), section 1861(uu), section
1861(vv), section 1861(xx)(1), and section 1861(yy) of the Social
Security Act (the Act).
Medical history is defined to include, at a minimum, the following:
(1) Past medical and surgical history, including experiences with
illnesses, hospital stays, operations, allergies, injuries and
treatments.
(2) Current medications and supplements, including calcium and
vitamins.
(3) Family history, including a review of medical events in the
patient's family, including diseases that may be hereditary or place
the individual at risk.
Physician for purposes of this provision means a doctor of medicine
or osteopathy (as defined in section 1861(r)(1) of the Act).
Qualified nonphysician practitioner for purposes of this provision
means a physician assistant, nurse practitioner, or clinical nurse
specialist (as authorized under section 1861(s)(2)(K)(i) and section
1861(s)(2)(K)(ii) of the Act and defined in section 1861(aa)(5) of the
Act, or in regulations at Sec. 410.74, Sec. 410.75, and Sec.
410.76).
Review of the individual's functional ability and level of safety.
Review of the individual's functional ability and level of safety must
include, at a minimum, a review of the following areas:
(1) Hearing impairment.
(2) Activities of daily living.
(3) Falls risk.
(4) Home safety.
Social history is defined to include, at a minimum, the following:
(1) History of alcohol, tobacco, and illicit drug use.
(2) Work and travel history.
(3) Diet.
(4) Social activities.
(5) Physical activities.
(b) Condition for coverage of an initial preventive physical
examination. Medicare Part B pays for an initial preventive physical
examination provided to an eligible beneficiary, as described in
paragraph (a) of this section, if it is furnished by a physician or
other qualified nonphysician practitioner, as defined in paragraphs (a)
of this section.
(c) Limitations on coverage of initial preventive physical
examinations. Payment may not be made for an initial preventive
physical preventive examination that is performed for an individual who
is not an eligible beneficiary as described in paragraph (a) of this
section.
7. A new Sec. 410.17 is added to read as follows:
Sec. 410.17 Cardiovascular disease screening tests.
(a) Definition. For purposes of this subpart, the following
definition applies:
Cardiovascular screening blood test means:
(1) A lipid panel consisting of a total cholesterol, HDL
cholesterol, and triglyceride. The test is performed after a 12-hour
fasting period.
(2) Other blood tests, previously recommended by the U.S.
Preventive Services Task Force (USPSTF), as determined by the Secretary
through a national coverage determination process.
(3) Other non-invasive tests, for indications that have a blood
test recommended by the USPSTF, as determined by the Secretary through
a national coverage determination process.
(b) General conditions of coverage. Medicare Part B covers
cardiovascular disease screening tests when ordered by the physician
who is treating the beneficiary (see Sec. 410.32(a)) for the purpose
of early detection of cardiovascular disease in individuals without
apparent signs or symptoms of cardiovascular disease.
(c) Limitation on coverage of cardiovascular screening tests.
Payment may be made for cardiovascular screening tests performed for an
asymptomatic individual only if the individual has not had the
screening tests paid for by Medicare during the preceding 59 months
following the month in which the last cardiovascular screening tests
were performed.
8. A new Sec. 410.18 is added to read as follows:
Sec. 410.18 Diabetes screening tests.
(a) Definitions. For purposes of this section, the following
definitions apply:
Diabetes means diabetes mellitus, a condition of abnormal glucose
metabolism diagnosed using the following criteria: a fasting blood
sugar
[[Page 47575]]
greater than or equal to 126 mg/dL on two different occasions; a 2-hour
post-glucose challenge greater than or equal to 200 mg/dL on two
different occasions; or a random glucose test over 200 mg/dL for a
person with symptoms of uncontrolled diabetes.
Pre-diabetes means a condition of abnormal glucose metabolism
diagnosed using the following criteria: a fasting glucose level of 100-
125 mg/dL, or a 2-hour post-glucose challenge of 140-199 mg/dL. The
term pre-diabetes includes the following conditions:
(1) Impaired fasting glucose.
(2) Impaired glucose tolerance.
(b) General conditions of coverage. Medicare Part B covers diabetes
screening tests after a referral from a physician or qualified
nonphysician practitioner to an individual at risk for diabetes for the
purpose of early detection of diabetes.
(c) Types of tests covered. The following tests are covered if all
other conditions of this subpart are met:
(1) Fasting plasma glucose test.
(2) Post-glucose challenges including, but not limited to, an oral
glucose tolerance test with a glucose challenge of 75 grams of glucose
for non-pregnant adults, a 2-hour post glucose challenge test alone.
(3) Other tests as determined by the Secretary through a national
coverage determination.
(d) Amount of testing covered. Medicare covers the following for
individuals:
(1) Diagnosed with pre-diabetes Medicare, two screening tests per
calendar year.
(2) Previously tested who were not diagnosed with pre-diabetes, or
who have never been tested before, one screening test per year.
(e) Eligible risk factors. Individuals with the following risk
factors are eligible to receive the benefit:
(1) Hypertension.
(2) Dyslipidemia.
(3) Obesity, defined as a body mass index greater than or equal to
30 kg/m2.
(4) Prior identification of impaired fasting glucose or glucose
intolerance.
(5) Any two of the following characteristics:
(i) Overweight, defined as body mass index greater than 25, but
less than 30, kg/m2.
(ii) A family history of diabetes.
(iii) 65 years of age or older.
(iv) A history of birthing a baby weighing more than 9 pounds.
(f) Individuals not covered. For individuals previously diagnosed
as diabetic, no coverage.
9. Section 410.26 is amended by revising paragraph (c) to read as
follows:
Sec. 410.26 Services and supplies incident to a physician's
professional services: Conditions.
* * * * *
(c) Limitations. (1) Drugs and biologicals are also subject to the
limitations specified in Sec. 410.29.
(2) Physical therapy, occupational therapy and speech-language
pathology services provided incident to a physician's professional
services are subject to the provisions established in Sec.
410.59(a)(3)(iii), Sec. 410.60(a)(3)(iii), and Sec. 410.62(a)(3)(ii).
10. Section 410.32 is amended by revising paragraph (b)(2)(iii) to
read as follows:
Sec. 410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and
other diagnostic tests: Conditions.
* * * * *
(b) * * *
(2) * * *
(iii) Diagnostic psychological testing services when--
(A) Personally furnished by a clinical psychologist or an
independently practicing psychologist as defined in program
instructions; or
(B) Furnished under the general supervision of a physician or a
clinical psychologist.
* * * * *
11. Section 410.36 is amended by--
A. Revising the section heading.
B. Adding to paragraph (a), the paragraph heading ``Condition for
coverage medical supplies, appliances, and devices.''
C. Revising paragraph (b).
D. Adding new paragraphs (c) and (d).
The additions and revisions read as follows:
Sec. 410.36 Medical supplies, appliances, and devices: Conditions for
and limitations on coverage.
(a) Conditions for coverage of medical supplies, appliances, and
medical devices. * * *
(b) Conditions for coverage. Medicare Part B pays for the medical
supplies, appliances, and devices listed in paragraph (a) of this
section when:
(1) The medical supplies, appliances, and devices are ordered by a
physician, physician assistant, clinical nurse specialist, or nurse
practitioner as defined in the Act.
(2) The physician or prescribing practitioner--
(i) Conducts a face-to-face examination to determine the medical
necessity for medical supplies, appliances, and devices.
(ii) Conducts the face-to-face examination only for the initial
order and at the time of the prescription renewal for items of
continued need, such as glucose testing supplies.
(iii) Is independent from the DME supplier and may not be an
employee or contractor of the supplier.
(3) A written order is completed and signed before delivery of
these medical supplies, appliances, and devices to the beneficiary.
(4) The physician's or prescribing practitioner's order is dated
and signed within 30 days after the face-to-face examination and the
beneficiary's medical record includes verification of the face-to-face
examination.
(5) The physician or prescribing practitioner documents in the
beneficiary's medical record the need for the medical supplies,
appliances, and devices being ordered.
(6) CMS may determine other criteria, such as prescription renewal
requirements, repairs, minor revisions and replacement, through
contractor instructions.
(c) Limitation. Medicare does not pay for a face-to-face
examination for the sole purpose of the beneficiary's obtaining the
physician or prescribing practitioner's order for the medical supplies,
appliances, and devices.
(d) Clinical conditions for coverage. Clinical conditions for
coverage, other than those set forth in paragraph (b) of this section,
of medical supplies, appliances, and devices are determined through the
national or local coverage determination process.
12. Section 410.38 is amended by--
A. Revising paragraph (g).
B. Adding paragraphs (h) and (i).
The revision and additions read as follows:
Sec. 410.38 Durable medical equipment: Scope and conditions.
* * * * *
(g) Conditions for coverage. (1) Medicare Part B pays for durable
medical equipment ordered by a physician, physician assistant, clinical
nurse specialist, or nurse practitioner, as defined in the Act.
(2) The physician or prescribing practitioner must--
(i) Conduct a face-to-face examination to determine the medical
necessity of each item of durable medical equipment.
(ii) Conduct the face-to-face examination for the initial order and
at the time of the prescription renewal for items of continued need,
such as infusion pumps or hospital beds.
(iii) Be independent from the DME supplier and cannot be an
employee or contractor of the supplier.
(3) A written order must be completed and signed before delivery of
any
[[Page 47576]]
durable medical equipment to the beneficiary.
(4) The physician's or prescribing practitioner's order must be
dated and signed within 30 days after the face-to-face examination and
the beneficiary's medical record must include verification of the face-
to-face examination.
(5) The physician or prescribing practitioner must document in the
beneficiary's medical record the need for the durable medical equipment
being ordered.
(6) CMS may determine other additional payment criteria, such as
prescription renewal requirements, repairs, minor revisions and
replacement, through contractor instructions.
(h) Limitation. Medicare does not pay for a face-to-face
examination for the sole purpose of the beneficiary's obtaining the
physician's or prescribing practitioner's order for the durable medical
equipment.
(i) Clinical conditions for coverage. Clinical conditions for
coverage, not defined in paragraph (g) of this section, of durable
medical equipment are determined through the national or local coverage
determination process.
13. Section 410.59 is amended by--
A. Revising paragraph (a) introductory text and paragraph
(a)(3)(ii).
B. Adding new paragraph (a)(3)(iii).
C. Revising paragraph (b) heading.
C. Revising paragraph (c)(2).
D. Adding new paragraph (e)(1)(iii).
The additions and revisions read as follows:
Sec. 410.59 Outpatient occupational therapy services: Conditions.
(a) Basic rule. Except as specified in paragraph (a)(3)(iii) of
this section, Medicare Part B pays for outpatient occupational therapy
services only if they are furnished by an individual meeting the
qualifications in Sec. 484.4 for an occupational therapist or by an
appropriately supervised occupational therapy assistant who meets the
following conditions: * * *
(3) * * *
(ii) By, or under the direct supervision of, an occupational
therapist in private practice as described in paragraph (c) of this
section; or
(iii) By, or incident to the service of, a physician, physician
assistant, clinical nurse specialist, or nurse practitioner when those
professionals may perform occupational therapy services within the
scope of their State practice. When an occupational therapy service is
provided incident to the service of a physician, physician assistant,
clinical nurse specialist, or nurse practitioner, the service and the
person who furnishes the service must meet the standards and conditions
that apply to occupational therapy and occupational therapists, except
that a license to practice occupational therapy in the State is not
required.
(b) Conditions for coverage of outpatient therapy services
furnished to certain inpatients of a hospital or a CAH or SNF. * * *
* * * * *
(c) Special provisions for services furnished by occupational
therapists in private practice. * * *
(2) Supervision of occupational therapy services. Occupational
therapy services are performed by, or under the direct supervision of,
an occupational therapist in private practice. All services not
performed personally by the therapist must be performed by employees of
the practice, directly supervised by the therapist, and included in the
fee for the therapist's services.
* * * * *
(e) Annual limitation on incurred expenses.
(1) * * *
(iii) The limitation is not applied for services furnished from
December 8, 2003 through December 31, 2005.
* * * * *
14. Section 410.60 is amended by--
A. Revising paragraph (a) introductory text.
B. Revising paragraph (a)(3)(ii).
C. Adding new paragraph (a)(3)(iii).
D. Revising paragraph (b) heading.
E. Revising paragraph (c)(2).
F. Adding new paragraph (e)(1)(iii).
The additions and revisions read as follows:
Sec. 410.60 Outpatient physical therapy services: Conditions.
(a) Basic rule. Except as specified in paragraph (a)(3)(iii) of
this section, Medicare Part B pays for outpatient physical therapy
services only if they are furnished by an individual meeting the
qualifications in Sec. 484.4 for a physical therapist or by an
appropriately supervised physical therapist assistant who meets the
following conditions:
* * * * *
(3) * * *
(ii) By or under the direct supervision of a physical therapist in
private practice as described in paragraph (c) of this section; or
(iii) By, or incident to, the service of a physician, physician
assistant, clinical nurse specialist, or nurse practitioner when those
professionals may perform physical therapy services within the scope of
their State practice. When a physical therapy service is provided
incident to the service of a physician, physician's assistant, clinical
nurse specialist, or nurse practitioner, the service and person who
furnishes the service must meet the standards and conditions that apply
to physical therapy and physical therapists, except that a license to
practice physical therapy in the State is not required.
(b) Condition for coverage of outpatient physical therapy services
furnished to certain inpatients of a hospital or a CAH or SNF. * * *
(c) Special provisions for services furnished by physical
therapists in private practice. * * *
(2) Supervision of physical therapy services. Physical therapy
services are performed by, or under the direct supervision of, a
physical therapist in private practice. All services not performed
personally by the therapist must be performed by employees of the
practice, directly supervised by the therapist, and included in the fee
for the therapist's services.
* * * * *
(e) Annual limitation on incurred expenses.
(1) * * *
(iii) The limitation is not applied for services furnished from
December 8, 2003 through December 31, 2005.
* * * * *
15. Section 410.62 is amended by--
A. Revising paragraph (a) introductory text and (a)(2)(i),
(a)(2)(iii) and (a)(3).
B. Revising paragraphs (b) and (c).
The revisions read as follows:
Sec. 410.62 Outpatient speech-language pathology services: Conditions
and exclusions.
(a) Basic rule. Except as specified in paragraph (a)(3)(ii) of this
section, Medicare Part B pays for outpatient speech-language pathology
services only if they are furnished by an individual who meets the
qualifications for a speech-language pathologist in Sec. 484.4 of this
chapter if they meet the following conditions: * * *
(2) * * *
(i) Is established by a physician or, effective January 1, 1982, by
either a physician or the speech-language pathologist who provides the
services to the particular individual;
(ii) * * *
(iii) Meets the requirements of Sec. 410.61.
(3) They are furnished--
(i) By a provider as defined in Sec. 489.2 of this chapter, or by
others under arrangements with, and under the supervision of, a
provider; or
(ii) By, or incident to, the service of a physician, physician
assistant, clinical
[[Page 47577]]
nurse specialist, or nurse practitioner when those professionals may
perform speech-language pathology services within the scope of their
State practice. When a speech-language pathology service is provided
incident to the services of a physician, physician's assistant,
clinical nurse specialist, or nurse practitioner, the service and the
person who furnishes the service must meet the standards and conditions
that apply to speech-language pathology and speech-language
pathologists, except that a license to practice speech-language
pathology services in the State is not required.
(b) Condition for coverage of outpatient speech-language pathology
services to certain inpatients of a hospital, CAH, or SNF. Medicare
Part B pays for outpatient speech-language pathology services furnished
to an inpatient of a hospital, CAH, or SNF who requires the services
but has exhausted or is otherwise ineligible for benefit days under
Medicare Part A.
(c) Excluded services. No service is included as an outpatient
speech-language pathology service if it is not included as an inpatient
hospital service if furnished to a hospital or CAH inpatient.
* * * * *
16. Section 410.63 is amended by--
A. Revising paragraph (b) section heading.
B. Adding a new paragraph (c).
The revision and addition reads as follows:
Sec. 410.63 Hepatitis vaccine and blood clotting factors: Conditions.
(b) Blood clotting factors: Conditions. * * *
(c) Blood clotting factors: Separate payment. Effective January 1,
2005, Medicare pays hemophilia treatment centers and homecare companies
that furnish blood clotting factor a separate payment of $0.05 per unit
for the items and services associated with the furnishing of the blood
clotting factor. These items and services include the mixing and
delivery of factors, including special inventory management and storage
requirements, as well as ancillary supplies and patient training
necessary for the self-administration of these factors.
17. Section 410.78 is amended by--
A. Revising paragraph (a)(4).
B. Revising paragraph (b) introductory text.
The revisions read as follows:
Sec. 410.78 Telehealth services.
(a) * * *
(4) Originating site means the location of an eligible Medicare
beneficiary at the time the service being furnished via a
telecommunications system occurs. For asynchronous store and forward
telecommunications technologies, the only originating sites are Federal
telemedicine demonstration programs conducted in Alaska or Hawaii.
(b) General rule. Medicare Part B pays for office and other
outpatient visits, professional consultation, psychiatric diagnostic
interview examination, individual psychotherapy, monthly end stage
renal disease (ESRD) related evaluation and management services and
pharmacologic management furnished by an interactive telecommunications
system if the following conditions are met:
* * * * *
18. Section 410.160 is amended by revising paragraph (f) to read as
follows:
Sec. 410.160 Part B annual deductible.
* * * * *
(f) Amount of the Part B annual deductible. (1) Beginning with
expenses for services furnished during calendar year 2006, and for all
succeeding years, the annual deductible is the previous year's
deductible plus the annual percentage increase in the monthly actuarial
rate for Medicare enrollees age 65 and over, rounded to the nearest
dollar.
(2) For 2005, the deductible is $110.
(3) From 1991 through 2004, the deductible was $100.
(4) From 1982 through 1990, the deductible was $75.
(5) From 1973 through 1981, the deductible was $60.
(6) From 1966 through 1972, the deductible was $50.
* * * * *
PART 411--EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE
PAYMENT
19. The authority citation for part 411 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
20. Section 411.15 is amended by--
A. Revising paragraph (a)(1).
B. Adding paragraph (k)(11).
The revision and addition read as follows:
Sec. 411.15 Particular services excluded from coverage.
* * * * *
(a) * * *
(1) Examinations performed for a purpose other than treatment or
diagnosis of a specific illness, symptoms, complaint, or injury, except
for screening mammography, colorectal cancer screening tests, screening
pelvic exams, prostate cancer screening tests, glaucoma screening
exams, or initial preventive physical examinations that meet the
criteria specified in paragraphs (k)(6) through (k)(11) of this
section.
* * * * *
(k) * * *
(11) In the case of initial preventive physical examinations, with
the goal of health promotion and disease prevention, subject to the
conditions and limitations specified in Sec. 410.16 of this chapter.
* * * * *
21. Section 411.404 is amended by revising paragraph (b) to read as
follows:
Sec. 411.404 Criteria for determining that a beneficiary knew that
services were excluded from coverage as custodial care or as not
reasonable and necessary.
* * * * *
(b) Written notice. Written notice is given to the beneficiary, or
to someone acting on his or her behalf, that the services were not
covered because they did not meet Medicare coverage guidelines. A
notice concerning similar or reasonably comparable services furnished
on a previous occasion also meets this criterion. After a beneficiary
is notified that there is no Medicare payment for a service that is not
covered by Medicare, he or she is presumed to know that there is no
Medicare payment for any form of subsequent treatment for the non-
covered condition.
* * * * *
PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES.
22. The authority citation for part 414 continues to read as
follows:
Authority: Secs. 1102, 1871, and 1881(b)(1) of the Social
Security Act (42 U.S.C. 1302, 1395hh, and 1395rr(b)(1)).
Sec. 414.38 [Removed]
23. Section 414.38 is removed.
24. Section 414.39 is amended by--
A. Revising paragraph (a).
B. Adding paragraph (c).
The revision and addition read as follows:
Sec. 414.39 Special rules for payment of care plan oversight.
(a) General. Except as specified in paragraphs (b) and (c) of this
section, payment for care plan oversight is included in the payment for
visits and other services under the physician fee schedule. For
purposes of this section a nonphysician practitioner (NPP) is a nurse
practitioner, clinical nurse specialist or physician assistant.
* * * * *
[[Page 47578]]
(c) Special rules for payment of care plan oversight provided by
nonphysician practitioners for beneficiaries who receive HHA services
covered by Medicare. (1) An NPP can perform physician care plan
oversight without certifying a patient for home health services (only a
physician can certify a patient for home health care) if the
relationship with the physician who signs the plan of care meets one of
the following conditions:
(i) The physician and NPP are part of the same group practice;
(ii) If the NPP is a nurse practitioner or clinical nurse
specialist, the physician signing the plan of care also has a
collaborative agreement with the NPP;
(iii) If the NPP is a physician assistant, the physician signing
the plan of care is also the physician who provides general supervision
of physician assistant services for the practice; or
(iv) The physician signing the plan of care provides regular
ongoing care under the same plan of care as does the NPP billing for
care plan oversight.
(2) Payment may be made for care plan oversight services furnished
by an NPP when:
(i) The NPP providing the care plan oversight has seen and examined
the patient;
(ii) The NPP providing care plan oversight is not functioning as a
consultant whose participation is limited to a single medical condition
rather than multi-disciplinary coordination of care; or
(iii) The NPP providing care plan oversight integrates his or her
care with that of the physician who signed the plan of care.
25. Section 414.65 is amended by revising paragraph (a)(1) to read
as follows:
Sec. 414.65 Payment for telehealth services.
(a) * * *
(1) The Medicare payment amount for office or other outpatient
visits, consultation, individual psychotherapy, psychiatric diagnostic
interview examination, monthly end stage renal disease (ESRD) related
evaluation and management services and pharmacologic management
furnished via an interactive telecommunications system is equal to the
current fee schedule amount applicable for the service of the physician
or practitioner.
* * * * *
26. Section 414.66 is added to read as follows:
Sec. 414.66 Incentive payments for physicians scarcity areas.
(a) Definition. As used in this section, the following definition
applies--
Primary care physician is defined as a general practitioner, family
practice practitioner, general internist, obstetrician or gynecologist.
(b) Physicians' services furnished to a beneficiary in a Physician
Scarcity Area (PSA) for primary or specialist care are eligible for a 5
percent incentive payment.
(c) Primary care physicians furnishing services in primary care
PSAs are entitled to an additional 5 percent incentive payment above
the amount paid under the physician fee schedule for their professional
services furnished on or after January 1, 2005 and before January 1,
2008.
(d) Physicians (other than dentists, podiatrists, optometrists,
chiropractors, and those identified in paragraph (a) of this section)
furnishing services in specialist care PSAs are entitled to an
additional 5 percent payment above the amount paid under the physician
fee schedule for their professional services furnished on or after
January 1, 2005 and before January 1, 2008.
27. Section 414.67 is added to read as follows:
Sec. 414.67 Incentive payments for Health Professional Shortage
Areas.
(a) Physicians' services furnished to a beneficiary in a
geographic-based Health Professional Shortage Area (HPSA) are eligible
for a 10 percent incentive payment.
(b) Physicians furnishing services in a geographic-based primary
medical care HPSA are entitled to a 10 percent incentive payment above
the amount paid for their professional services under the physician fee
schedule.
(c) Psychiatrists furnishing services in a mental health HPSA are
entitled to a 10 percent incentive payment above the amount paid for
their professional services under the physician fee schedule. (The only
physicians eligible to receive the 10 percent incentive payment in
mental health HPSAs that do not overlap with primary care HPSAs are
psychiatrists.)
28. Part 414 is amended by adding a new subpart K to read as
follows:
Subpart K--Payment for Drugs and Biologicals in 2005
Sec.
414.900 Basis.
414.902 Definitions.
414.904 Basis of Payment.
Subpart K--Payment for Drugs and Biologicals in 2005
Sec. 414.900 Basis.
(a) This subpart implements section 1842(o) of the Social Security
Act by specifying the methodology for determining the payment allowance
limit for drugs and biologicals covered under Medicare Part B that are
not paid on a cost or prospective payment system basis.
(b) Examples of drugs that are subject to the requirements
specified in this subpart are:
(1) Drugs furnished incident to a physician's service; durable
medical equipment (DME) drugs.
(2) Separately billable drugs at independent dialysis facilities
not under the ESRD composite rate.
(3) Statutorily covered drugs, for example--
(i) Influenza
(ii) Pneumococcal and hepatitis vaccines.
(iii) Antigens.
(iv) Hemophilia blood clotting factor.
(v) Immunosuppressive drugs.
(vi) Certain oral anti-cancer drugs.
Sec. 414.902 Definitions.
As used in this subpart, unless the context indicates otherwise--
Drug means both drugs and biologicals.
Manufacturer's average sales price means the price calculated and
reported by a manufacturer under part 414, subpart J of this chapter.
Multiple source drug means a drug described by section
1847A(c)(6)(C) of the Act.
Single source drug means a drug described by section 1847A(c)(6)(D)
of the Act.
Unit is defined as in part 414, subpart J of this chapter.
Wholesale acquisition cost (WAC) means the price described by
section 1847A(c)(6)(B) of the Act.
Sec. 414.904 Basis of payment.
(a) Method of payment. Payment for a drug for calendar year 2005 is
based on the lesser of--
(1) The actual charge on the claim for program benefits; or
(2) 106 percent of the average sales price, subject to the
applicable limitations specified in paragraph (d) of this section or
subject to the exceptions described in paragraph (e) of this section.
(b) Multiple source drugs. (1) Average sales prices. The average
sales price for all drug products included within the same multiple
source drug billing and payment code is the volume-weighted
[[Page 47579]]
average of the manufacturers' average sales prices for those drug
products.
(2) Calculation of the average sales price. The average sales price
is determined by--
(i) Computing the sum of the products (for each National Drug Code
assigned to the drug products) of the manufacturer's average sales
price and the total number of units sold; and
(ii) Dividing that sum by the sum of the total number of units sold
for all NDCs assigned to the drug products.
(c) Single source drugs. (1) Average sales price. The average sales
price is the volume-weighted average of the manufacturers' average
sales prices for all National Drug Codes assigned to the drug or
biological product.
(2) Calculation of the average sales price. The average sales price
is determined by computing--
(i) The sum of the products (for each National Drug Code assigned
to the drug product) of the manufacturer's average sales price and the
total number of units sold; and
(ii) Dividing that sum by the sum of the total number of units sold
for all NDCs assigned to the drug product.
(d) Limitations on the average sales price. (1) Wholesale
acquisition cost for a single source drug. The payment limit for a
single source drug product is the lesser of 106 percent of the average
sales price for the product or 106 percent of the wholesale acquisition
cost for the product.
(2) Payment limit for a drug furnished to an end-stage renal
disease patient. The payment for a drug furnished to an end-stage renal
disease patient that is separately billed by an end stage renal disease
facility, including erythropoietin, cannot exceed 97 percent of the
average sales price.
(3) Widely available market price and average manufacturer price.
If the Inspector General finds that the average sales price exceeds the
widely available market price or the average manufacturer price by 5
percent or more in calendar year 2005, the payment limit in the quarter
following the transmittal of this information to the Secretary is the
lesser of the widely available market price or 103 percent of the
average manufacturer price.
(e) Exceptions to the average sales price. (1) Vaccines. The
payment limits for hepatitis B vaccine furnished to individuals at high
or intermediate risk of contracting hepatitis B (as determined by the
Secretary), pneumococcal vaccine, and influenza vaccine and are
calculated using 95 percent of the average wholesale price.
(2) Infusion drugs furnished through a covered item of durable
medical equipment. The payment limit for an infusion drug furnished
through a covered item of durable medical equipment is calculated using
95 percent of the average wholesale price in effect on October 1, 2003
and is not updated in 2005.
(3) Blood and blood products. In the case of blood and blood
products (other than blood clotting factors), the payment limits are
determined in the same manner as the payment limits were determined on
October 1, 2003.
(4) Payment limit in a case where the average sales price during
the first quarter of sales is unavailable. In the case of a drug during
an initial period (not to exceed a full calendar quarter) in which data
on the prices for sales of the drug are not sufficiently available from
the manufacturer to compute an average sales price for the drug, the
payment limit is based on the wholesale acquisition cost or the
applicable Medicare Part B drug payment methodology in effect on
November 1, 2003.
(f) Except as otherwise specified (see paragraph (e)(2)of this
section) for infusion drugs, the payment limits are updated quarterly.
(g) The payment limit is computed without regard to any special
packaging, labeling, or identifiers on the dosage form or product or
package.
(h) The payment amount is subject to applicable deductible and
coinsurance.
PART 418--HOSPICE CARE
29. The authority citation for part 418 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
30. Section 418.205 is added to read as follows:
Sec. 418.205 Special requirements for hospice pre-election evaluation
and counseling services.
(a) Definition. For purposes of this section, the following
definition applies:
Terminal illness is defined as having a prognosis of 6 months or
less if the disease or illness runs its normal course.
(b) Effective date for payment and requirements. Effective January
1, 2005, payment for hospice pre-election evaluation and counseling
services as specified in Sec. 418.304(d) may be made to a hospice
agency on behalf of a Medicare beneficiary who is terminally ill if the
requirements of this section are met.
(1) The beneficiary: (i) Is certified as having a terminal illness.
(ii) Has not made a hospice election.
(iii) Has not previously received hospice pre-election evaluation
and consultation services specified under this section.
(2) Services provided. The hospice pre-election services include--
(i) An evaluation of an individual's need for pain and symptom
management;
(ii) Counseling regarding hospice and other care options; and
(iii) May include advising the individual regarding advanced care
planning.
(3) Provider of pre-election hospice services. (i) The physician
furnishing these services must be an employee or medical director of
the hospice billing for this service.
(ii) The services cannot be furnished by other hospice personnel,
such as but not limited to nurse practitioners, nurses, or social
workers, physicians under contractual arrangements with the hospice or
by the beneficiary's physician, if that physician is not an employee of
the hospice.
(iii) If the beneficiary's physician is also the medical director
or a physician employee of the hospice, the attending physician is not
required to request or provide this service because that physician
already possesses the expertise necessary to furnish end-of-life
evaluation and management, and counseling services.
(4) Documentation. (i) If the individual's physician initiates the
request for services of the hospice medical director or physician,
appropriate documentation is required.
(ii) The request or referral must be in writing, and the hospice
medical director or physician employee is expected to provide a written
note on the patient's medical record.
(iii) The hospice agency employing the physician providing these
services is required to maintain a written record of the services
rendered.
(iv) If the services are initiated by the beneficiary, the hospice
agency is required to maintain a record of the services and that
communication between the hospice medical director or physician and the
beneficiary's physician occurs, with the beneficiary's permission, to
the extent necessary to ensure continuity of care.
31. Section 418.304 is amended by adding paragraph (d) to read as
follows.
Sec. 418.304 Payment for physician services.
* * * * *
(d) Payment for hospice evaluation and counseling services--pre-
election. The intermediary makes payment for these services established
in Sec. 418.205 to the hospice. As directed by the statute, payment
for this service is set at an amount established for an office or other
outpatient visit for evaluation and
[[Page 47580]]
management associated with presenting problems of moderate severity and
requiring medical decision-making of low complexity under the physician
fee schedule, other than the portion of such amount attributable to the
practice expense component. Payment for this pre-election service is
not calculated towards the hospice cap amount.
PART 424--CONDITIONS FOR MEDICARE PAYMENT
32. The authority citation for part 424 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
33. Section 424.55 is amended by adding new paragraph (c) to read
as follows:
Sec. 424.55 Payment to the supplier.
* * * * *
(c) Exception. In situations when payment under the Act can only be
made on an assignment-related basis or when payment is for services
furnished by a participating physician or supplier, the beneficiary (or
the person authorized to request payment on the beneficiary's behalf)
is not required to assign the claim to the supplier in order for an
assignment to be effective.
34. Section 424.71 is amended as follows:
A. The definition of ``Health care delivery system or system'' is
removed.
B. The definition of the term ``Entity'' is added in alphabetical
order.
The addition reads as follows:
Sec. 424.71 Definitions.
* * * * *
Entity means a person, group, or facility that is enrolled in the
Medicare program.
* * * * *
35. Section 424.80 is amended by--
A. Revising paragraph (b)(2).
B. Removing paragraph (b)(3).
C. Redesignating paragraphs (b)(4) through (6) as paragraphs (b)
(3) through (5), respectively.
D. Revising paragraph (c).
E. Adding a new paragraph (d).
The revisions and addition read as follows:
Sec. 424.80 Prohibition of reassignment of claims by suppliers.
* * * * *
(b) * * *
(1) * * *
(2) Payment to an entity under a contractual arrangement. Medicare
may pay an entity enrolled in the Medicare program if there is a
contractual arrangement between the entity and the supplier under which
the entity bills for the supplier's services, subject to the provisions
of paragraph (d) of this section.
* * * * *
(c) Rules applicable to an employer or entity. An employer or
entity that may receive payment under paragraph (b)(1) or (b)(2) of
this section is considered the supplier of those services for purposes
of subparts C, D, and E of this part, subject to the provisions of
paragraph (d) of this section.
(d) Reassignment to an entity under a contractual arrangement:
Conditions and limitations. (1) Liability of the parties. An entity
enrolled in the Medicare program that receives payment under a
contractual arrangement under paragraph (b)(2) of this section and the
supplier that otherwise receives payment are jointly and severally
responsible for any Medicare overpayment to that entity.
(2) Access to records. The supplier furnishing the service has
unrestricted access to claims submitted by an entity for services
provided by that supplier.
PART 484-HOME HEALTH SERVICES
36. The authority citation for part 484 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395(hh).
Sec. 484.4 [Amended]
37. In Sec. 484.4 in the definition of physical therapy assistant
the term ``physical therapy assistant'' is removed and the term
``physical therapist assistant'' is added in its place wherever it
appears.
PART 486--CONDITIONS FOR COVERAGE OF SPECIALIZED SERVICES FURNISHED
BY SUPPLIERS
38. The authority citation for part 486 continues to read as
follows:
Authority: Sections 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
Subpart D [Removed and Reserved]
39. Part 486 subpart D, consisting of Sec. 486.150 through Sec.
486.163, is removed and reserved.
(Catalog of Federal Domestic Assistance Program No. 93.774,
Medicare--Supplementary Medical Insurance Program)
Dated: July 13, 2004.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
Approved: July 23, 2004.
Tommy G. Thompson,
Secretary.
Note: These addenda will not appear in the Code of Federal
Regulations.
Addendum A--Explanation and Use of Addenda B
The addenda on the following pages provide various data
pertaining to the Medicare fee schedule for physicians' services
furnished in 2005. Addendum B contains the RVUs for work, non-
facility practice expense, facility practice expense, and
malpractice expense, and other information for all services included
in the physician fee schedule.
In previous years, we have listed many services in Addendum B
that are not paid under the physician fee schedule. To avoid
publishing as many pages of codes for these services, we are not
including clinical laboratory codes and most alpha-numeric codes
(Healthcare Common Procedure Coding System (HCPCS) codes not
included in CPT) in Addendum B.
Addendum B--2005 Relative Value Units and Related Information Used in
Determining Medicare Payments for 2005
This addendum contains the following information for each CPT
code and alphanumeric HCPCS code, except for alphanumeric codes
beginning with B (enteral and parenteral therapy), E (durable
medical equipment), K (temporary codes for nonphysicians' services
or items), or L (orthotics), and codes for anesthesiology.
1. CPT/HCPCS code. This is the CPT or alphanumeric HCPCS number
for the service. Alphanumeric HCPCS codes are included at the end of
this addendum.
2. Modifier. A modifier is shown if there is a technical
component (modifier TC) and a professional component (PC) (modifier
-26) for the service. If there is a PC and a TC for the service,
Addendum B contains three entries for the code: One for the global
values (both professional and technical); one for modifier -26 (PC);
and one for modifier TC. The global service is not designated by a
modifier, and physicians must bill using the code without a modifier
if the physician furnishes both the PC and the TC of the service.
Modifier -53 is shown for a discontinued procedure. There will
be RVUs for the code (CPT code 45378) with this modifier.
3. Status indicator. This indicator shows whether the CPT/HCPCS
code is in the physician fee schedule and whether it is separately
payable if the service is covered.
A = Active code. These codes are separately payable under the
fee schedule if covered. There will be RVUs for codes with this
status. The presence of an ``A'' indicator does not mean that
Medicare has made a national decision regarding the coverage of the
service. Carriers remain responsible for coverage decisions in the
absence of a national Medicare policy.
[[Page 47581]]
B = Bundled code. Payment for covered services is always bundled
into payment for other services not specified. If RVUs are shown,
they are not used for Medicare payment. If these services are
covered, payment for them is subsumed by the payment for the
services to which they are incident. (An example is a telephone call
from a hospital nurse regarding care of a patient.)
C = Carrier-priced code. Carriers will establish RVUs and
payment amounts for these services, generally on a case-by-case
basis following review of documentation, such as an operative
report.
D = Deleted code. These codes are deleted effective with the
beginning of the calendar year.
E = Excluded from physician fee schedule by regulation. These
codes are for items or services that we chose to exclude from the
physician fee schedule payment by regulation. No RVUs are shown, and
no payment may be made under the physician fee schedule for these
codes. Payment for them, if they are covered, continues under
reasonable charge or other payment procedures.
F = Deleted/discontinued codes. Code not subject to a 90-day
grace period.
G = Code not valid for Medicare purposes. Medicare does not
recognize codes assigned this status. Medicare uses another code for
reporting of, and payment for, these services.
H = Deleted modifier. Either the TC or PC component shown for
the code has been deleted, and the deleted component is shown in the
data base with the H status indicator. (Code subject to a 90-day
grace period.)
I = Not valid for Medicare purposes. Medicare uses another code
for the reporting of, and the payment for these services. (Code NOT
subject to a 90-day grace period.)
N = Noncovered service. These codes are noncovered services.
Medicare payment may not be made for these codes. If RVUs are shown,
they are not used for Medicare payment.
P = Bundled or excluded code. There are no RVUs for these
services. No separate payment should be made for them under the
physician fee schedule.
--If the item or service is covered as incident to a physician's
service and is furnished on the same day as a physician's service,
payment for it is bundled into the payment for the physician's
service to which it is incident (an example is an elastic bandage
furnished by a physician incident to a physician's service).
--If the item or service is covered as other than incident to a
physician's service, it is excluded from the physician fee schedule
(for example, colostomy supplies) and is paid under the other
payment provisions of the Act.
R = Restricted coverage. Special coverage instructions apply. If
the service is covered and no RVUs are shown, it is carrier-priced.
T = Injections. There are RVUs for these services, but they are
only paid if there are no other services payable under the physician
fee schedule billed on the same date by the same provider. If any
other services payable under the physician fee schedule are billed
on the same date by the same provider, these services are bundled
into the service(s) for which payment is made.
X = Exclusion by law. These codes represent an item or service
that is not within the definition of ``physicians' services'' for
physician fee schedule payment purposes. No RVUs are shown for these
codes, and no payment may be made under the physician fee schedule.
(Examples are ambulance services and clinical diagnostic laboratory
services.)
4. Description of code. This is an abbreviated version of the
narrative description of the code.
5. Physician work RVUs. These are the RVUs for the physician
work for this service in 2005. Codes that are not used for Medicare
payment are identified with a ``+.''
6. Facility practice expense RVUs. These are the fully
implemented resource-based practice expense RVUs for facility
settings.
7. Non-facility practice expense RVUs. These are the fully
implemented resource-based practice expense RVUs for non-facility
settings.
8. Malpractice expense RVUs. These are the RVUs for the
malpractice expense for the service for 2005.
9. Facility total. This is the sum of the work, fully
implemented facility practice expense, and malpractice expense RVUs.
10. Non-facility total. This is the sum of the work, fully
implemented non-facility practice expense, and malpractice expense
RVUs.
11. Global period. This indicator shows the number of days in
the global period for the code (0, 10, or 90 days). An explanation
of the alpha codes follows:
MMM = The code describes a service furnished in uncomplicated
maternity cases including antepartum care, delivery, and postpartum
care. The usual global surgical concept does not apply. See the 1999
Physicians' Current Procedural Terminology for specific definitions.
XXX = The global concept does not apply.
YYY = The global period is to be set by the carrier (for
example, unlisted surgery codes).
ZZZ = Code related to another service that is always included in
the global period of the other service. (Note: Physician work and
practice expense are associated with intra service time and in some
instances the post service time.)
--------------------
\1\ CPT codes and descriptions only are copyright 2004 American Medical
Association. All Rights Reserved. Applicable FARS/DFARS Apply.
\2\ Copyright 2004 American Dental Association. All rights reserved.
\3\ + Indicates RVUs are not used for Medicare Payments.
[[Page 47581]]
Addendum B.--Relative Value Units (RVUS) and Related Information
--------------------------------------------------------------------------------------------------------------------------------------------------------
Physician Non- Mal- Non-
CPT \1\/ HCPCS \2\ MOD Status Description work facility Facility practice facility Facility Global
RVUs \3\ PE RVUs PE RVUs RVUs Total total
--------------------------------------------------------------------------------------------------------------------------------------------------------
10021............... .............. A Fna w/o image........ 1.27 2.16 0.54 0.11 3.54 1.92 XXX
10022............... .............. A Fna w/image.......... 1.27 2.55 0.42 0.08 3.90 1.77 XXX
10040............... .............. A Acne surgery......... 1.18 1.01 0.79 0.10 2.29 2.07 010
10060............... .............. A Drainage of skin 1.17 1.21 0.94 0.10 2.48 2.21 010
abscess.
10061............... .............. A Drainage of skin 2.40 1.82 1.50 0.21 4.43 4.11 010
abscess.
10080............... .............. A Drainage of pilonidal 1.17 3.12 1.12 0.11 4.40 2.40 010
cyst.
10081............... .............. A Drainage of pilonidal 2.45 4.10 1.51 0.26 6.81 4.22 010
cyst.
10120............... .............. A Remove foreign body.. 1.22 2.19 0.99 0.11 3.52 2.32 010
10121............... .............. A Remove foreign body.. 2.69 3.53 1.79 0.30 6.52 4.78 010
10140............... .............. A Drainage of hematoma/ 1.53 1.77 1.29 0.15 3.45 2.97 010
fluid.
10160............... .............. A Puncture drainage of 1.20 1.61 1.09 0.12 2.93 2.41 010
lesion.
10180............... .............. A Complex drainage, 2.25 3.00 1.98 0.32 5.57 4.55 010
wound.
11000............... .............. A Debride infected skin 0.60 0.58 0.21 0.05 1.23 0.86 000
11001............... .............. A Debride infected skin 0.30 0.23 0.11 0.02 0.55 0.43 ZZZ
add-on.
11010............... .............. A Debride skin, fx..... 4.19 6.89 2.62 0.59 11.67 7.40 010
11011............... .............. A Debride skin/muscle, 4.94 8.19 2.33 0.69 13.82 7.96 000
fx.
11012............... .............. A Debride skin/muscle/ 6.87 12.09 3.83 1.11 20.07 11.81 000
bone, fx.
11040............... .............. A Debride skin, partial 0.50 0.52 0.21 0.04 1.06 0.75 000
11041............... .............. A Debride skin, full... 0.82 0.66 0.33 0.07 1.55 1.22 000
11042............... .............. A Debride skin/tissue.. 1.12 0.97 0.44 0.11 2.20 1.67 000
11043............... .............. A Debride tissue/muscle 2.38 3.40 2.59 0.27 6.05 5.24 010
11044............... .............. A Debride tissue/muscle/ 3.06 4.47 3.75 0.38 7.91 7.19 010
bone.
11055............... .............. R Trim skin lesion..... 0.43 0.56 0.17 0.03 1.02 0.63 000
11056............... .............. R Trim skin lesions, 2 0.61 0.63 0.23 0.05 1.29 0.89 000
to 4.
[[Page 47582]]
11057............... .............. R Trim skin lesions, 0.79 0.74 0.30 0.06 1.59 1.15 000
over 4.
11100............... .............. A Biopsy, skin lesion.. 0.81 1.25 0.36 0.07 2.13 1.24 000
11101............... .............. A Biopsy, skin add-on.. 0.41 0.33 0.19 0.03 0.77 0.63 ZZZ
11200............... .............. A Removal of skin tags. 0.77 1.05 0.76 0.07 1.89 1.60 010
11201............... .............. A Remove skin tags add- 0.29 0.16 0.12 0.03 0.48 0.44 ZZZ
on.
11300............... .............. A Shave skin lesion.... 0.51 0.99 0.21 0.04 1.54 0.76 000
11301............... .............. A Shave skin lesion.... 0.85 1.11 0.38 0.07 2.03 1.30 000
11302............... .............. A Shave skin lesion.... 1.05 1.30 0.46 0.09 2.44 1.60 000
11303............... .............. A Shave skin lesion.... 1.24 1.58 0.52 0.11 2.93 1.87 000
11305............... .............. A Shave skin lesion.... 0.67 0.84 0.27 0.06 1.57 1.00 000
11306............... .............. A Shave skin lesion.... 0.99 1.10 0.42 0.08 2.17 1.49 000
11307............... .............. A Shave skin lesion.... 1.14 1.29 0.49 0.10 2.53 1.73 000
11308............... .............. A Shave skin lesion.... 1.41 1.45 0.59 0.12 2.98 2.12 000
11310............... .............. A Shave skin lesion.... 0.73 1.12 0.32 0.07 1.92 1.12 000
11311............... .............. A Shave skin lesion.... 1.05 1.23 0.49 0.09 2.37 1.63 000
11312............... .............. A Shave skin lesion.... 1.20 1.42 0.55 0.11 2.73 1.86 000
11313............... .............. A Shave skin lesion.... 1.62 1.79 0.72 0.15 3.56 2.49 000
11400............... .............. A Exc tr-ext b9+marg 0.85 2.00 0.88 0.09 2.94 1.82 010
0.5 < cm.
11401............... .............. A Exc tr-ext b9+marg 1.23 2.06 1.02 0.13 3.42 2.38 010
0.6-1 cm.
11402............... .............. A Exc tr-ext b9+marg 1.51 2.23 1.08 0.17 3.91 2.76 010
1.1-2 cm.
11403............... .............. A Exc tr-ext b9+marg 1.79 2.40 1.32 0.21 4.40 3.32 010
2.1-3 cm.
11404............... .............. A Exc tr-ext b9+marg 2.06 2.71 1.40 0.25 5.02 3.71 010
3.1-4 cm.
11406............... .............. A Exc tr-ext b9+marg > 2.76 3.07 1.66 0.33 6.16 4.75 010
4.0 cm.
11420............... .............. A Exc h-f-nk-sp b9+marg 0.98 1.76 0.93 0.10 2.84 2.01 010
0.5 <.
11421............... .............. A Exc h-f-nk-sp b9+marg 1.42 2.06 1.11 0.15 3.63 2.68 010
0.6-1.
11422............... .............. A Exc h-f-nk-sp b9+marg 1.63 2.25 1.34 0.18 4.06 3.15 010
1.1-2.
11423............... .............. A Exc h-f-nk-sp b9+marg 2.01 2.58 1.45 0.23 4.82 3.69 010
2.1-3.
11424............... .............. A Exc h-f-nk-sp b9+marg 2.43 2.80 1.60 0.28 5.51 4.31 010
3.1-4.
11426............... .............. A Exc h-f-nk-sp b9+marg 3.77 3.49 2.10 0.44 7.70 6.31 010
> 4 cm.
11440............... .............. A Exc face-mm b9+marg 1.06 2.21 1.31 0.10 3.37 2.47 010
0.5 < cm.
11441............... .............. A Exc face-mm b9+marg 1.48 2.34 1.49 0.16 3.98 3.13 010
0.6-1 cm.
11442............... .............. A Exc face-mm b9+marg 1.72 2.54 1.57 0.20 4.46 3.49 010
1.1-2 cm.
11443............... .............. A Exc face-mm b9+marg 2.29 2.92 1.81 0.26 5.47 4.36 010
2.1-3 cm.
11444............... .............. A Exc face-mm b9+marg 3.14 3.47 2.17 0.35 6.96 5.66 010
3.1-4 cm.
11446............... .............. A Exc face-mm b9+marg > 4.48 4.04 2.76 0.47 8.99 7.71 010
4 cm.
11450............... .............. A Removal, sweat gland 2.73 5.06 2.02 0.35 8.14 5.10 090
lesion.
11451............... .............. A Removal, sweat gland 3.94 6.64 2.54 0.52 11.10 7.00 090
lesion.
11462............... .............. A Removal, sweat gland 2.51 5.14 2.01 0.31 7.96 4.83 090
lesion.
11463............... .............. A Removal, sweat gland 3.94 6.85 2.68 0.51 11.30 7.13 090
lesion.
11470............... .............. A Removal, sweat gland 3.25 5.09 2.26 0.38 8.72 5.89 090
lesion.
11471............... .............. A Removal, sweat gland 4.40 6.74 2.76 0.54 11.68 7.70 090
lesion.
11600............... .............. A Exc tr-ext mlg+marg 1.31 2.64 0.97 0.13 4.08 2.41 010
0.5 < cm.
11601............... .............. A Exc tr-ext mlg+marg 1.80 2.70 1.22 0.18 4.68 3.20 010
0.6-1 cm.
11602............... .............. A Exc tr-ext mlg+marg 1.95 2.83 1.26 0.20 4.98 3.41 010
1.1-2 cm.
11603............... .............. A Exc tr-ext mlg+marg 2.19 3.07 1.33 0.24 5.50 3.76 010
2.1-3 cm.
11604............... .............. A Exc tr-ext mlg+marg 2.40 3.38 1.39 0.28 6.06 4.07 010
3.1-4 cm.
11606............... .............. A Exc tr-ext mlg+marg > 3.42 4.06 1.73 0.40 7.88 5.55 010
4 cm.
11620............... .............. A Exc h-f-nk-sp 1.19 2.60 0.95 0.13 3.92 2.27 010
mlg+marg 0.5 <.
11621............... .............. A Exc h-f-nk-sp 1.76 2.70 1.24 0.19 4.65 3.19 010
mlg+marg 0.6-1.
11622............... .............. A Exc h-f-nk-sp 2.09 2.97 1.38 0.23 5.29 3.70 010
mlg+marg 1.1-2.
11623............... .............. A Exc h-f-nk-sp 2.61 3.33 1.58 0.31 6.25 4.50 010
mlg+marg 2.1-3.
11624............... .............. A Exc h-f-nk-sp 3.06 3.74 1.77 0.38 7.18 5.21 010
mlg+marg 3.1-4.
11626............... .............. A Exc h-f-nk-sp mlg+mar 4.29 4.64 2.38 0.50 9.43 7.17 010
> 4 cm.
11640............... .............. A Exc face-mm 1.35 2.66 1.11 0.15 4.16 2.61 010
malig+marg 0.5 <.
11641............... .............. A Exc face-mm 2.16 3.02 1.52 0.24 5.42 3.92 010
malig+marg 0.6-1.
11642............... .............. A Exc face-mm 2.59 3.40 1.71 0.30 6.29 4.60 010
malig+marg 1.1-2.
11643............... .............. A Exc face-mm 3.10 3.80 1.95 0.37 7.27 5.42 010
malig+marg 2.1-3.
11644............... .............. A Exc face-mm 4.02 4.67 2.44 0.49 9.18 6.95 010
malig+marg 3.1-4.
11646............... .............. A Exc face-mm mlg+marg 5.94 5.74 3.46 0.67 12.35 10.07 010
> 4 cm.
11719............... .............. R Trim nail(s)......... 0.17 0.25 0.07 0.01 0.43 0.25 000
11720............... .............. A Debride nail, 1-5.... 0.32 0.34 0.12 0.03 0.69 0.47 000
11721............... .............. A Debride nail, 6 or 0.54 0.43 0.21 0.04 1.01 0.79 000
more.
11730............... .............. A Removal of nail plate 1.13 1.03 0.43 0.09 2.25 1.65 000
11732............... .............. A Remove nail plate, 0.57 0.44 0.22 0.05 1.06 0.84 ZZZ
add-on.
11740............... .............. A Drain blood from 0.37 0.56 0.36 0.03 0.96 0.76 000
under nail.
11750............... .............. A Removal of nail bed.. 1.86 2.16 1.75 0.15 4.17 3.76 010
11752............... .............. A Remove nail bed/ 2.67 2.99 2.99 0.28 5.94 5.94 010
finger tip.
11755............... .............. A Biopsy, nail unit.... 1.31 1.57 0.77 0.11 2.99 2.19 000
11760............... .............. A Repair of nail bed... 1.58 2.63 1.79 0.18 4.39 3.55 010
11762............... .............. A Reconstruction of 2.89 2.88 2.34 0.27 6.04 5.50 010
nail bed.
11765............... .............. A Excision of nail 0.69 1.78 0.76 0.06 2.53 1.51 010
fold, toe.
11770............... .............. A Removal of pilonidal 2.61 3.50 1.50 0.32 6.43 4.43 010
lesion.
11771............... .............. A Removal of pilonidal 5.73 5.66 3.31 0.72 12.11 9.76 090
lesion.
11772............... .............. A Removal of pilonidal 6.97 7.54 5.08 0.88 15.39 12.93 090
lesion.
11900............... .............. A Injection into skin 0.52 0.65 0.21 0.04 1.21 0.77 000
lesions.
[[Page 47583]]
11901............... .............. A Added skin lesions 0.80 0.66 0.35 0.07 1.53 1.22 000
injection.
11920............... .............. R Correct skin color 1.61 3.69 1.09 0.22 5.52 2.92 000
defects.
11921............... .............. R Correct skin color 1.93 3.95 1.27 0.28 6.16 3.48 000
defects.
11922............... .............. R Correct skin color 0.49 1.13 0.25 0.07 1.69 0.81 ZZZ
defects.
11950............... .............. R Therapy for contour 0.84 1.14 0.39 0.09 2.07 1.32 000
defects.
11951............... .............. R Therapy for contour 1.19 1.49 0.51 0.15 2.83 1.85 000
defects.
11952............... .............. R Therapy for contour 1.69 1.85 0.68 0.24 3.78 2.61 000
defects.
11954............... .............. R Therapy for contour 1.85 2.43 0.90 0.17 4.45 2.92 000
defects.
11960............... .............. A Insert tissue 9.07 NA 10.37 1.23 NA 20.67 090
expander(s).
11970............... .............. A Replace tissue 7.05 NA 6.12 1.04 NA 14.21 090
expander.
11971............... .............. A Remove tissue 2.13 9.13 3.78 0.30 11.56 6.21 090
expander(s).
11976............... .............. R Removal of 1.78 1.73 0.68 0.20 3.71 2.66 000
contraceptive cap.
11980............... .............. A Implant hormone 1.48 1.08 0.54 0.13 2.69 2.15 000
pellet(s).
11981............... .............. A Insert drug implant 1.48 1.70 0.68 0.11 3.29 2.27 XXX
device.
11982............... .............. A Remove drug implant 1.78 1.94 0.83 0.18 3.90 2.79 XXX
device.
11983............... .............. A Remove/insert drug 3.30 2.28 1.46 0.24 5.82 5.00 XXX
implant.
12001............... .............. A Repair superficial 1.70 2.00 0.78 0.15 3.85 2.63 010
wound(s).
12002............... .............. A Repair superficial 1.86 2.06 0.91 0.17 4.09 2.94 010
wound(s).
12004............... .............. A Repair superficial 2.24 2.35 1.02 0.21 4.80 3.47 010
wound(s).
12005............... .............. A Repair superficial 2.86 2.85 1.21 0.27 5.98 4.34 010
wound(s).
12006............... .............. A Repair superficial 3.66 3.42 1.52 0.37 7.45 5.55 010
wound(s).
12007............... .............. A Repair superficial 4.11 3.86 1.82 0.44 8.41 6.37 010
wound(s).
12011............... .............. A Repair superficial 1.76 2.15 0.79 0.16 4.07 2.71 010
wound(s).
12013............... .............. A Repair superficial 1.99 2.30 0.95 0.18 4.47 3.12 010
wound(s).
12014............... .............. A Repair superficial 2.46 2.59 1.07 0.22 5.27 3.75 010
wound(s).
12015............... .............. A Repair superficial 3.19 3.16 1.26 0.29 6.64 4.74 010
wound(s).
12016............... .............. A Repair superficial 3.92 3.59 1.53 0.37 7.88 5.82 010
wound(s).
12017............... .............. A Repair superficial 4.70 NA 1.89 0.48 NA 7.07 010
wound(s).
12018............... .............. A Repair superficial 5.52 NA 2.25 0.58 NA 8.35 010
wound(s).
12020............... .............. A Closure of split 2.62 3.84 1.92 0.30 6.76 4.84 010
wound.
12021............... .............. A Closure of split 1.84 1.83 1.42 0.23 3.90 3.49 010
wound.
12031............... .............. A Layer closure of 2.15 2.28 0.96 0.22 4.65 3.33 010
wound(s).
12032............... .............. A Layer closure of 2.47 3.85 1.81 0.24 6.56 4.52 010
wound(s).
12034............... .............. A Layer closure of 2.92 3.20 1.46 0.31 6.43 4.69 010
wound(s).
12035............... .............. A Layer closure of 3.42 5.22 2.16 0.39 9.03 5.97 010
wound(s).
12036............... .............. A Layer closure of 4.04 5.59 2.55 0.52 10.15 7.11 010
wound(s).
12037............... .............. A Layer closure of 4.66 6.13 2.96 0.61 11.40 8.23 010
wound(s).
12041............... .............. A Layer closure of 2.37 2.54 1.13 0.24 5.15 3.74 010
wound(s).
12042............... .............. A Layer closure of 2.74 3.27 1.47 0.26 6.27 4.47 010
wound(s).
12044............... .............. A Layer closure of 3.14 3.23 1.61 0.32 6.69 5.07 010
wound(s).
12045............... .............. A Layer closure of 3.63 5.30 2.28 0.41 9.34 6.32 010
wound(s).
12046............... .............. A Layer closure of 4.24 6.55 2.75 0.49 11.28 7.48 010
wound(s).
12047............... .............. A Layer closure of 4.64 6.39 3.08 0.57 11.60 8.29 010
wound(s).
12051............... .............. A Layer closure of 2.47 3.27 1.45 0.25 5.99 4.17 010
wound(s).
12052............... .............. A Layer closure of 2.77 3.22 1.44 0.26 6.25 4.47 010
wound(s).
12053............... .............. A Layer closure of 3.12 3.24 1.54 0.30 6.66 4.96 010
wound(s).
12054............... .............. A Layer closure of 3.45 3.56 1.64 0.34 7.35 5.43 010
wound(s).
12055............... .............. A Layer closure of 4.42 4.49 2.12 0.46 9.37 7.00 010
wound(s).
12056............... .............. A Layer closure of 5.23 6.76 3.05 0.53 12.52 8.81 010
wound(s).
12057............... .............. A Layer closure of 5.95 6.16 3.75 0.64 12.75 10.34 010
wound(s).
13100............... .............. A Repair of wound or 3.12 4.05 2.30 0.33 7.50 5.75 010
lesion.
13101............... .............. A Repair of wound or 3.91 4.66 2.68 0.40 8.97 6.99 010
lesion.
13102............... .............. A Repair wound/lesion 1.24 1.17 0.57 0.15 2.56 1.96 ZZZ
add-on.
13120............... .............. A Repair of wound or 3.30 4.14 2.35 0.35 7.79 6.00 010
lesion.
13121............... .............. A Repair of wound or 4.32 4.85 2.79 0.43 9.60 7.54 010
lesion.
13122............... .............. A Repair wound/lesion 1.44 1.51 0.63 0.18 3.13 2.25 ZZZ
add-on.
13131............... .............. A Repair of wound or 3.78 4.36 2.68 0.39 8.53 6.85 010
lesion.
13132............... .............. A Repair of wound or 5.94 5.58 3.80 0.56 12.08 10.30 010
lesion.
13133............... .............. A Repair wound/lesion 2.19 1.66 1.03 0.24 4.09 3.46 ZZZ
add-on.
13150............... .............. A Repair of wound or 3.80 4.87 2.76 0.41 9.08 6.97 010
lesion.
13151............... .............. A Repair of wound or 4.44 4.80 3.14 0.45 9.69 8.03 010
lesion.
13152............... .............. A Repair of wound or 6.32 6.03 4.03 0.62 12.97 10.97 010
lesion.
13153............... .............. A Repair wound/lesion 2.38 1.93 1.14 0.28 4.59 3.80 ZZZ
add-on.
13160............... .............. A Late closure of wound 10.46 NA 7.15 1.48 NA 19.09 090
14000............... .............. A Skin tissue 5.88 7.82 5.43 0.70 14.40 12.01 090
rearrangement.
14001............... .............. A Skin tissue 8.46 9.39 7.03 1.00 18.85 16.49 090
rearrangement.
14020............... .............. A Skin tissue 6.58 8.58 6.48 0.77 15.93 13.83 090
rearrangement.
14021............... .............. A Skin tissue 10.04 9.96 8.23 1.10 21.10 19.37 090
rearrangement.
14040............... .............. A Skin tissue 7.86 8.78 7.16 0.83 17.47 15.85 090
rearrangement.
14041............... .............. A Skin tissue 11.47 10.58 8.64 1.13 23.18 21.24 090
rearrangement.
14060............... .............. A Skin tissue 8.49 8.78 7.41 0.88 18.15 16.78 090
rearrangement.
14061............... .............. A Skin tissue 12.27 11.59 9.46 1.20 25.06 22.93 090
rearrangement.
14300............... .............. A Skin tissue 11.74 11.11 9.13 1.40 24.25 22.27 090
rearrangement.
14350............... .............. A Skin tissue 9.60 NA 7.14 1.22 NA 17.96 090
rearrangement.
15000............... .............. A Skin graft........... 3.99 3.79 2.18 0.47 8.25 6.64 000
[[Page 47584]]
15001............... .............. A Skin graft add-on.... 1.00 1.35 0.41 0.13 2.48 1.54 ZZZ
15050............... .............. A Skin pinch graft..... 4.29 6.92 5.11 0.55 11.76 9.95 090
15100............... .............. A Skin split graft..... 9.04 12.55 7.82 1.24 22.83 18.10 090
15101............... .............. A Skin split graft add- 1.72 3.72 1.17 0.24 5.68 3.13 ZZZ
on.
15120............... .............. A Skin split graft..... 9.82 10.72 7.79 1.19 21.73 18.80 090
15121............... .............. A Skin split graft add- 2.67 4.49 1.84 0.36 7.52 4.87 ZZZ
on.
15200............... .............. A Skin full graft...... 8.02 9.41 6.19 1.02 18.45 15.23 090
15201............... .............. A Skin full graft add- 1.32 2.56 0.62 0.18 4.06 2.12 ZZZ
on.
15220............... .............. A Skin full graft...... 7.86 9.18 6.67 0.97 18.01 15.50 090
15221............... .............. A Skin full graft add- 1.19 2.31 0.56 0.17 3.67 1.92 ZZZ
on.
15240............... .............. A Skin full graft...... 9.03 10.20 7.94 1.08 20.31 18.05 090
15241............... .............. A Skin full graft add- 1.86 2.44 0.91 0.24 4.54 3.01 ZZZ
on.
15260............... .............. A Skin full graft...... 10.04 10.21 8.57 0.97 21.22 19.58 090
15261............... .............. A Skin full graft add- 2.23 2.68 1.40 0.26 5.17 3.89 ZZZ
on.
15342............... .............. A Cultured skin graft, 1.00 1.86 0.55 0.10 2.96 1.65 010
25 cm.
15343............... .............. A Culture skn graft 0.25 0.09 0.09 0.03 0.37 0.37 ZZZ
addl 25 cm.
15350............... .............. A Skin homograft....... 3.99 6.44 3.84 0.48 10.91 8.31 090
15351............... .............. A Skin homograft add-on 1.00 0.36 0.36 0.14 1.50 1.50 ZZZ
15400............... .............. A Skin heterograft..... 3.99 4.01 4.01 0.39 8.39 8.39 090
15401............... .............. A Skin heterograft add- 1.00 1.89 0.44 0.12 3.01 1.56 ZZZ
on.
15570............... .............. A Form skin pedicle 9.20 11.30 6.75 1.30 21.80 17.25 090
flap.
15572............... .............. A Form skin pedicle 9.26 9.49 6.44 1.29 20.04 16.99 090
flap.
15574............... .............. A Form skin pedicle 9.87 10.67 7.77 1.22 21.76 18.86 090
flap.
15576............... .............. A Form skin pedicle 8.68 9.75 6.87 0.95 19.38 16.50 090
flap.
15600............... .............. A Skin graft........... 1.91 7.61 3.06 0.27 9.79 5.24 090
15610............... .............. A Skin graft........... 2.42 4.74 3.42 0.33 7.49 6.17 090
15620............... .............. A Skin graft........... 2.94 7.76 3.87 0.36 11.06 7.17 090
15630............... .............. A Skin graft........... 3.27 7.03 4.14 0.38 10.68 7.79 090
15650............... .............. A Transfer skin pedicle 3.96 7.14 4.20 0.49 11.59 8.65 090
flap.
15732............... .............. A Muscle-skin graft, 17.81 18.03 12.20 1.98 37.82 31.99 090
head/neck.
15734............... .............. A Muscle-skin graft, 17.76 18.12 12.36 2.52 38.40 32.64 090
trunk.
15736............... .............. A Muscle-skin graft, 16.25 18.14 11.20 2.38 36.77 29.83 090
arm.
15738............... .............. A Muscle-skin graft, 17.89 17.91 11.70 2.58 38.38 32.17 090
leg.
15740............... .............. A Island pedicle flap 10.23 10.14 8.25 1.01 21.38 19.49 090
graft.
15750............... .............. A Neurovascular pedicle 11.39 NA 9.02 1.51 NA 21.92 090
graft.
15756............... .............. A Free myo/skin flap 35.18 NA 20.52 4.51 NA 60.21 090
microvasc.
15757............... .............. A Free skin flap, 35.18 NA 21.55 4.05 NA 60.78 090
microvasc.
15758............... .............. A Free fascial flap, 35.05 NA 21.53 3.91 NA 60.49 090
microvasc.
15760............... .............. A Composite skin graft. 8.73 10.02 7.25 0.94 19.69 16.92 090
15770............... .............. A Derma-fat-fascia 7.51 NA 6.67 1.01 NA 15.19 090
graft.
15775............... .............. R Hair transplant punch 3.95 2.97 1.30 0.52 7.44 5.77 000
grafts.
15776............... .............. R Hair transplant punch 5.53 5.33 2.80 0.72 11.58 9.05 000
grafts.
15780............... .............. A Abrasion treatment of 7.28 11.57 8.24 0.75 19.60 16.27 090
skin.
15781............... .............. A Abrasion treatment of 4.84 6.91 5.36 0.47 12.22 10.67 090
skin.
15782............... .............. A Abrasion treatment of 4.31 9.92 6.56 0.35 14.58 11.22 090
skin.
15783............... .............. A Abrasion treatment of 4.28 6.87 4.18 0.42 11.57 8.88 090
skin.
15786............... .............. A Abrasion, lesion, 2.03 3.35 1.32 0.18 5.56 3.53 010
single.
15787............... .............. A Abrasion, lesions, 0.33 1.10 0.16 0.03 1.46 0.52 ZZZ
add-on.
15788............... .............. R Chemical peel, face, 2.09 6.72 3.08 0.19 9.00 5.36 090
epiderm.
15789............... .............. R Chemical peel, face, 4.91 8.09 4.82 0.43 13.43 10.16 090
dermal.
15792............... .............. R Chemical peel, 1.86 7.11 4.45 0.17 9.14 6.48 090
nonfacial.
15793............... .............. A Chemical peel, 3.73 6.29 4.39 0.32 10.34 8.44 090
nonfacial.
15810............... .............. A Salabrasion.......... 4.73 NA 3.90 0.34 NA 8.97 090
15811............... .............. A Salabrasion.......... 5.38 5.47 4.76 0.80 11.65 10.94 090
15819............... .............. A Plastic surgery, neck 9.37 NA 7.17 0.91 NA 17.45 090
15820............... .............. A Revision of lower 5.14 6.93 5.52 0.48 12.55 11.14 090
eyelid.
15821............... .............. A Revision of lower 5.71 7.32 5.68 0.46 13.49 11.85 090
eyelid.
15822............... .............. A Revision of upper 4.44 5.82 4.47 0.39 10.65 9.30 090
eyelid.
15823............... .............. A Revision of upper 7.04 7.84 6.40 0.50 15.38 13.94 090
eyelid.
15831............... .............. A Excise excessive skin 12.38 NA 8.15 1.69 NA 22.22 090
tissue.
15832............... .............. A Excise excessive skin 11.57 NA 8.33 1.63 NA 21.53 090
tissue.
15833............... .............. A Excise excessive skin 10.62 NA 8.20 1.48 NA 20.30 090
tissue.
15834............... .............. A Excise excessive skin 10.83 NA 7.68 1.60 NA 20.11 090
tissue.
15835............... .............. A Excise excessive skin 11.65 NA 7.53 1.63 NA 20.81 090
tissue.
15836............... .............. A Excise excessive skin 9.33 NA 6.77 1.31 NA 17.41 090
tissue.
15837............... .............. A Excise excessive skin 8.42 8.63 7.36 1.19 18.24 16.97 090
tissue.
15838............... .............. A Excise excessive skin 7.12 NA 6.05 0.63 NA 13.80 090
tissue.
15839............... .............. A Excise excessive skin 9.37 8.87 6.39 1.15 19.39 16.91 090
tissue.
15840............... .............. A Graft for face nerve 13.24 NA 9.96 1.39 NA 24.59 090
palsy.
15841............... .............. A Graft for face nerve 23.23 NA 14.98 2.79 NA 41.00 090
palsy.
15842............... .............. A Flap for face nerve 37.90 NA 22.88 2.91 NA 63.69 090
palsy.
15845............... .............. A Skin and muscle 12.55 NA 9.29 0.86 NA 22.70 090
repair, face.
15850............... .............. B Removal of sutures... 0.78 1.57 0.29 0.05 2.40 1.12 XXX
15851............... .............. A Removal of sutures... 0.86 1.70 0.31 0.06 2.62 1.23 000
15852............... .............. A Dressing change not 0.86 1.87 0.33 0.09 2.82 1.28 000
for burn.
[[Page 47585]]
15860............... .............. A Test for blood flow 1.95 0.83 0.78 0.25 3.03 2.98 000
in graft.
15920............... .............. A Removal of tail bone 7.94 NA 5.55 0.97 NA 14.46 090
ulcer.
15922............... .............. A Removal of tail bone 9.89 NA 7.20 1.41 NA 18.50 090
ulcer.
15931............... .............. A Remove sacrum 9.23 NA 5.68 1.23 NA 16.14 090
pressure sore.
15933............... .............. A Remove sacrum 10.83 NA 7.84 1.48 NA 20.15 090
pressure sore.
15934............... .............. A Remove sacrum 12.67 NA 8.03 1.76 NA 22.46 090
pressure sore.
15935............... .............. A Remove sacrum 14.55 NA 10.31 2.06 NA 26.92 090
pressure sore.
15936............... .............. A Remove sacrum 12.36 NA 8.21 1.74 NA 22.31 090
pressure sore.
15937............... .............. A Remove sacrum 14.19 NA 9.80 2.01 NA 26.00 090
pressure sore.
15940............... .............. A Remove hip pressure 9.33 NA 6.17 1.30 NA 16.80 090
sore.
15941............... .............. A Remove hip pressure 11.41 NA 9.43 1.63 NA 22.47 090
sore.
15944............... .............. A Remove hip pressure 11.44 NA 8.59 1.63 NA 21.66 090
sore.
15945............... .............. A Remove hip pressure 12.67 NA 9.63 1.80 NA 24.10 090
sore.
15946............... .............. A Remove hip pressure 21.54 NA 14.34 3.09 NA 38.97 090
sore.
15950............... .............. A Remove thigh pressure 7.53 NA 5.41 1.02 NA 13.96 090
sore.
15951............... .............. A Remove thigh pressure 10.70 NA 7.85 1.48 NA 20.03 090
sore.
15952............... .............. A Remove thigh pressure 11.37 NA 7.74 1.58 NA 20.69 090
sore.
15953............... .............. A Remove thigh pressure 12.61 NA 8.97 1.83 NA 23.41 090
sore.
15956............... .............. A Remove thigh pressure 15.50 NA 10.75 2.18 NA 28.43 090
sore.
15958............... .............. A Remove thigh pressure 15.46 NA 11.02 2.17 NA 28.65 090
sore.
16000............... .............. A Initial treatment of 0.89 0.87 0.26 0.08 1.84 1.23 000
burn(s).
16010............... .............. A Treatment of burn(s). 0.87 0.66 0.63 0.08 1.61 1.58 000
16015............... .............. A Treatment of burn(s). 2.35 NA 1.15 0.30 NA 3.80 000
16020............... .............. A Treatment of burn(s). 0.80 1.31 0.59 0.08 2.19 1.47 000
16025............... .............. A Treatment of burn(s). 1.85 1.77 0.96 0.19 3.81 3.00 000
16030............... .............. A Treatment of burn(s). 2.08 2.18 1.12 0.22 4.48 3.42 000
16035............... .............. A Incision of burn 3.74 NA 1.58 0.42 NA 5.74 090
scab, initi.
16036............... .............. A Escharotomy; add-l 1.50 NA 0.60 0.20 NA 2.30 ZZZ
incision.
17000............... .............. A Destroy benign/premlg 0.60 0.97 0.55 0.05 1.62 1.20 010
lesion.
17003............... .............. A Destroy lesions, 2-14 0.15 0.11 0.07 0.01 0.27 0.23 ZZZ
17004............... .............. A Destroy lesions, 15 2.79 2.30 1.59 0.23 5.32 4.61 010
or more.
17106............... .............. A Destruction of skin 4.58 4.58 3.33 0.44 9.60 8.35 090
lesions.
17107............... .............. A Destruction of skin 9.15 7.17 5.43 0.87 17.19 15.45 090
lesions.
17108............... .............. A Destruction of skin 13.18 9.25 7.64 1.33 23.76 22.15 090
lesions.
17110............... .............. A Destruct lesion, 1-14 0.65 1.63 0.71 0.05 2.33 1.41 010
17111............... .............. A Destruct lesion, 15 0.92 1.68 0.81 0.08 2.68 1.81 010
or more.
17250............... .............. A Chemical cautery, 0.50 1.22 0.34 0.05 1.77 0.89 000
tissue.
17260............... .............. A Destruction of skin 0.91 1.28 0.68 0.08 2.27 1.67 010
lesions.
17261............... .............. A Destruction of skin 1.17 1.61 0.83 0.10 2.88 2.10 010
lesions.
17262............... .............. A Destruction of skin 1.58 1.88 1.02 0.13 3.59 2.73 010
lesions.
17263............... .............. A Destruction of skin 1.79 2.05 1.09 0.15 3.99 3.03 010
lesions.
17264............... .............. A Destruction of skin 1.94 2.22 1.12 0.16 4.32 3.22 010
lesions.
17266............... .............. A Destruction of skin 2.34 2.50 1.22 0.20 5.04 3.76 010
lesions.
17270............... .............. A Destruction of skin 1.32 1.70 0.87 0.11 3.13 2.30 010
lesions.
17271............... .............. A Destruction of skin 1.49 1.77 0.98 0.13 3.39 2.60 010
lesions.
17272............... .............. A Destruction of skin 1.77 1.99 1.11 0.15 3.91 3.03 010
lesions.
17273............... .............. A Destruction of skin 2.05 2.20 1.21 0.17 4.42 3.43 010
lesions.
17274............... .............. A Destruction of skin 2.59 2.56 1.44 0.22 5.37 4.25 010
lesions.
17276............... .............. A Destruction of skin 3.20 2.94 1.68 0.29 6.43 5.17 010
lesions.
17280............... .............. A Destruction of skin 1.17 1.61 0.81 0.10 2.88 2.08 010
lesions.
17281............... .............. A Destruction of skin 1.72 1.90 1.09 0.15 3.77 2.96 010
lesions.
17282............... .............. A Destruction of skin 2.04 2.15 1.24 0.17 4.36 3.45 010
lesions.
17283............... .............. A Destruction of skin 2.64 2.54 1.49 0.22 5.40 4.35 010
lesions.
17284............... .............. A Destruction of skin 3.21 2.92 1.74 0.28 6.41 5.23 010
lesions.
17286............... .............. A Destruction of skin 4.43 3.67 2.43 0.41 8.51 7.27 010
lesions.
17304............... .............. A 1 stage mohs, up to 5 7.59 8.22 3.55 0.64 16.45 11.78 000
spec.
17305............... .............. A 2 stage mohs, up to 5 2.85 3.88 1.34 0.24 6.97 4.43 000
spec.
17306............... .............. A 3 stage mohs, up to 5 2.85 3.90 1.35 0.24 6.99 4.44 000
spec.
17307............... .............. A Mohs addl stage up to 2.85 2.63 1.36 0.24 5.72 4.45 000
5 spec.
17310............... .............. A Mohs any stage > 5 0.95 1.62 0.46 0.09 2.66 1.50 ZZZ
spec each.
17340............... .............. A Cryotherapy of skin.. 0.76 0.37 0.36 0.06 1.19 1.18 010
17360............... .............. A Skin peel therapy.... 1.43 1.44 0.87 0.12 2.99 2.42 010
19000............... .............. A Drainage of breast 0.84 1.98 0.31 0.08 2.90 1.23 000
lesion.
19001............... .............. A Drain breast lesion 0.42 0.25 0.14 0.04 0.71 0.60 ZZZ
add-on.
19020............... .............. A Incision of breast 3.56 6.36 2.68 0.45 10.37 6.69 090
lesion.
19030............... .............. A Injection for breast 1.53 2.88 0.50 0.09 4.50 2.12 000
x-ray.
19100............... .............. A Bx breast percut w/o 1.27 2.08 0.42 0.15 3.50 1.84 000
image.
19101............... .............. A Biopsy of breast, 3.18 4.51 1.91 0.36 8.05 5.45 010
open.
19102............... .............. A Bx breast percut w/ 2.00 3.83 0.66 0.15 5.98 2.81 000
image.
19103............... .............. A Bx breast percut w/ 3.69 11.53 1.23 0.30 15.52 5.22 000
device.
19110............... .............. A Nipple exploration... 4.29 5.82 2.87 0.56 10.67 7.72 090
19112............... .............. A Excise breast duct 3.66 6.11 2.69 0.48 10.25 6.83 090
fistula.
19120............... .............. A Removal of breast 5.55 4.55 3.06 0.72 10.82 9.33 090
lesion.
19125............... .............. A Excision, breast 6.05 4.79 3.28 0.79 11.63 10.12 090
lesion.
19126............... .............. A Excision, addl breast 2.93 NA 1.00 0.38 NA 4.31 ZZZ
lesion.
[[Page 47586]]
19140............... .............. A Removal of breast 5.13 7.18 3.41 0.69 13.00 9.23 090
tissue.
19160............... .............. A Removal of breast 5.98 NA 3.43 0.78 NA 10.19 090
tissue.
19162............... .............. A Remove breast tissue, 13.51 NA 6.34 1.74 NA 21.59 090
nodes.
19180............... .............. A Removal of breast.... 8.79 NA 5.03 1.14 NA 14.96 090
19182............... .............. A Removal of breast.... 7.72 NA 4.77 1.03 NA 13.52 090
19200............... .............. A Removal of breast.... 15.47 NA 7.98 1.82 NA 25.27 090
19220............... .............. A Removal of breast.... 15.70 NA 8.25 1.97 NA 25.92 090
19240............... .............. A Removal of breast.... 15.98 NA 8.23 2.06 NA 26.27 090
19260............... .............. A Removal of chest wall 15.42 NA 11.17 2.01 NA 28.60 090
lesion.
19271............... .............. A Revision of chest 18.87 NA 17.99 2.51 NA 39.37 090
wall.
19272............... .............. A Extensive chest wall 21.52 NA 18.97 3.01 NA 43.50 090
surgery.
19290............... .............. A Place needle wire, 1.27 2.89 0.42 0.08 4.24 1.77 000
breast.
19291............... .............. A Place needle wire, 0.63 1.22 0.21 0.04 1.89 0.88 ZZZ
breast.
19295............... .............. A Place breast clip, 0.00 2.70 NA 0.01 2.71 NA ZZZ
percut.
19316............... .............. A Suspension of breast. 10.67 NA 7.52 1.60 NA 19.79 090
19318............... .............. A Reduction of large 15.60 NA 11.12 2.79 NA 29.51 090
breast.
19324............... .............. A Enlarge breast....... 5.84 NA 4.87 0.84 NA 11.55 090
19325............... .............. A Enlarge breast with 8.44 NA 6.53 1.28 NA 16.25 090
implant.
19328............... .............. A Removal of breast 5.67 NA 5.02 0.89 NA 11.58 090
implant.
19330............... .............. A Removal of implant 7.58 NA 6.02 1.24 NA 14.84 090
material.
19340............... .............. A Immediate breast 6.32 NA 3.10 1.03 NA 10.45 ZZZ
prosthesis.
19342............... .............. A Delayed breast 11.18 NA 8.89 1.77 NA 21.84 090
prosthesis.
19350............... .............. A Breast reconstruction 8.91 13.79 7.15 1.38 24.08 17.44 090
19355............... .............. A Correct inverted 7.56 10.25 4.70 1.07 18.88 13.33 090
nipple(s).
19357............... .............. A Breast reconstruction 18.13 NA 13.76 2.79 NA 34.68 090
19361............... .............. A Breast reconstruction 19.23 NA 11.71 2.84 NA 33.78 090
19364............... .............. A Breast reconstruction 40.94 NA 23.49 5.85 NA 70.28 090
19366............... .............. A Breast reconstruction 21.25 NA 11.16 3.07 NA 35.48 090
19367............... .............. A Breast reconstruction 25.69 NA 16.45 3.84 NA 45.98 090
19368............... .............. A Breast reconstruction 32.37 NA 20.12 4.63 NA 57.12 090
19369............... .............. A Breast reconstruction 29.78 NA 19.66 4.29 NA 53.73 090
19370............... .............. A Surgery of breast 8.04 NA 6.87 1.27 NA 16.18 090
capsule.
19371............... .............. A Removal of breast 9.34 NA 7.79 1.65 NA 18.78 090
capsule.
19380............... .............. A Revise breast 9.13 NA 7.67 1.42 NA 18.22 090
reconstruction.
19396............... .............. A Design custom breast 2.17 1.08 0.99 0.26 3.51 3.42 000
implant.
20000............... .............. A Incision of abscess.. 2.12 2.70 1.73 0.19 5.01 4.04 010
20005............... .............. A Incision of deep 3.41 3.50 2.25 0.41 7.32 6.07 010
abscess.
20100............... .............. A Explore wound, neck.. 10.06 NA 4.46 1.19 NA 15.71 010
20101............... .............. A Explore wound, chest. 3.22 5.94 1.62 0.41 9.57 5.25 010
20102............... .............. A Explore wound, 3.93 7.50 1.91 0.50 11.93 6.34 010
abdomen.
20103............... .............. A Explore wound, 5.29 8.60 3.39 0.70 14.59 9.38 010
extremity.
20150............... .............. A Excise epiphyseal bar 13.67 NA 7.04 1.43 NA 22.14 090
20200............... .............. A Muscle biopsy........ 1.46 3.05 0.75 0.22 4.73 2.43 000
20205............... .............. A Deep muscle biopsy... 2.35 4.07 1.19 0.31 6.73 3.85 000
20206............... .............. A Needle biopsy, muscle 0.99 6.63 0.63 0.07 7.69 1.69 000
20220............... .............. A Bone biopsy, trocar/ 1.27 4.89 0.80 0.09 6.25 2.16 000
needle.
20225............... .............. A Bone biopsy, trocar/ 1.87 26.72 1.13 0.18 28.77 3.18 000
needle.
20240............... .............. A Bone biopsy, 3.23 NA 2.56 0.41 NA 6.20 010
excisional.
20245............... .............. A Bone biopsy, 7.77 NA 6.59 1.19 NA 15.55 010
excisional.
20250............... .............. A Open bone biopsy..... 5.02 NA 3.50 0.91 NA 9.43 010
20251............... .............. A Open bone biopsy..... 5.55 NA 4.15 1.05 NA 10.75 010
20500............... .............. A Injection of sinus 1.23 2.27 1.53 0.10 3.60 2.86 010
tract.
20501............... .............. A Inject sinus tract 0.76 2.98 0.25 0.05 3.79 1.06 000
for x-ray.
20520............... .............. A Removal of foreign 1.85 2.93 1.77 0.20 4.98 3.82 010
body.
20525............... .............. A Removal of foreign 3.49 9.14 2.62 0.47 13.10 6.58 010
body.
20526............... .............. A Ther injection, carp 0.94 0.97 0.51 0.10 2.01 1.55 000
tunnel.
20550............... .............. A Inj tendon sheath/ 0.75 0.71 0.23 0.08 1.54 1.06 000
ligament.
20551............... .............. A Inj tendon origin/ 0.75 0.69 0.33 0.08 1.52 1.16 000
insertion.
20552............... .............. A Inj trigger point, 1/ 0.66 0.72 0.20 0.07 1.45 0.93 000
2 muscl.
20553............... .............. A Inject trigger 0.75 0.82 0.22 0.05 1.62 1.02 000
points, =/> 3.
20600............... .............. A Drain/inject, joint/ 0.66 0.65 0.35 0.06 1.37 1.07 000
bursa.
20605............... .............. A Drain/inject, joint/ 0.68 0.76 0.36 0.07 1.51 1.11 000
bursa.
20610............... .............. A Drain/inject, joint/ 0.79 0.95 0.42 0.10 1.84 1.31 000
bursa.
20612............... .............. A Aspirate/inj ganglion 0.70 0.71 0.36 0.07 1.48 1.13 000
cyst.
20615............... .............. A Treatment of bone 2.28 3.53 1.84 0.19 6.00 4.31 010
cyst.
20650............... .............. A Insert and remove 2.23 2.36 1.55 0.25 4.84 4.03 010
bone pin.
20660............... .............. A Apply, rem fixation 2.51 3.05 1.61 0.54 6.10 4.66 000
device.
20661............... .............. A Application of head 4.88 NA 5.06 1.11 NA 11.05 090
brace.
20662............... .............. A Application of pelvis 6.06 NA 5.58 0.53 NA 12.17 090
brace.
20663............... .............. A Application of thigh 5.42 NA 4.89 0.33 NA 10.64 090
brace.
20664............... .............. A Halo brace 8.05 NA 7.15 1.68 NA 16.88 090
application.
20665............... .............. A Removal of fixation 1.31 2.21 1.35 0.19 3.71 2.85 010
device.
20670............... .............. A Removal of support 1.74 11.52 2.09 0.26 13.52 4.09 010
implant.
20680............... .............. A Removal of support 3.34 8.77 3.71 0.52 12.63 7.57 090
implant.
20690............... .............. A Apply bone fixation 3.51 NA 2.54 0.58 NA 6.63 090
device.
[[Page 47587]]
20692............... .............. A Apply bone fixation 6.40 NA 3.77 0.99 NA 11.16 090
device.
20693............... .............. A Adjust bone fixation 5.85 NA 5.73 0.98 NA 12.56 090
device.
20694............... .............. A Remove bone fixation 4.15 7.13 4.04 0.69 11.97 8.88 090
device.
20802............... .............. A Replantation, arm, 41.09 NA 21.49 4.51 NA 67.09 090
complete.
20805............... .............. A Replant forearm, 49.93 NA 35.25 4.64 NA 89.82 090
complete.
20808............... .............. A Replantation hand, 61.56 NA 43.10 5.37 NA 110.03 090
complete.
20816............... .............. A Replantation digit, 30.89 NA 38.46 4.37 NA 73.72 090
complete.
20822............... .............. A Replantation digit, 25.55 NA 35.14 3.46 NA 64.15 090
complete.
20824............... .............. A Replantation thumb, 30.89 NA 37.30 4.15 NA 72.34 090
complete.
20827............... .............. A Replantation thumb, 26.37 NA 37.15 3.73 NA 67.25 090
complete.
20838............... .............. A Replantation foot, 41.35 NA 22.78 10.71 NA 74.84 090
complete.
20900............... .............. A Removal of bone for 5.57 8.44 5.66 0.85 14.86 12.08 090
graft.
20902............... .............. A Removal of bone for 7.54 NA 7.06 1.21 NA 15.81 090
graft.
20910............... .............. A Remove cartilage for 5.33 NA 5.26 0.66 NA 11.25 090
graft.
20912............... .............. A Remove cartilage for 6.34 NA 6.15 0.70 NA 13.19 090
graft.
20920............... .............. A Removal of fascia for 5.30 NA 4.40 0.58 NA 10.28 090
graft.
20922............... .............. A Removal of fascia for 6.60 7.54 4.87 0.68 14.82 12.15 090
graft.
20924............... .............. A Removal of tendon for 6.47 NA 6.06 0.97 NA 13.50 090
graft.
20926............... .............. A Removal of tissue for 5.52 NA 4.99 0.81 NA 11.32 090
graft.
20931............... .............. A Spinal bone allograft 1.81 NA 0.93 0.42 NA 3.16 ZZZ
20937............... .............. A Spinal bone autograft 2.79 NA 1.45 0.49 NA 4.73 ZZZ
20938............... .............. A Spinal bone autograft 3.02 NA 1.55 0.57 NA 5.14 ZZZ
20950............... .............. A Fluid pressure, 1.26 6.83 0.99 0.19 8.28 2.44 000
muscle.
20955............... .............. A Fibula bone graft, 39.15 NA 25.19 4.72 NA 69.06 090
microvasc.
20956............... .............. A Iliac bone graft, 39.21 NA 25.05 7.16 NA 71.42 090
microvasc.
20957............... .............. A Mt bone graft, 40.59 NA 19.21 4.32 NA 64.12 090
microvasc.
20962............... .............. A Other bone graft, 39.21 NA 26.71 6.19 NA 72.11 090
microvasc.
20969............... .............. A Bone/skin graft, 43.85 NA 27.63 4.68 NA 76.16 090
microvasc.
20970............... .............. A Bone/skin graft, 43.00 NA 25.97 6.77 NA 75.74 090
iliac crest.
20972............... .............. A Bone/skin graft, 42.93 NA 20.56 3.44 NA 66.93 090
metatarsal.
20973............... .............. A Bone/skin graft, 45.69 NA 25.46 5.61 NA 76.76 090
great toe.
20974............... .............. A Electrical bone 0.62 0.69 0.54 0.10 1.41 1.26 000
stimulation.
20975............... .............. A Electrical bone 2.60 NA 1.71 0.46 NA 4.77 000
stimulation.
20979............... .............. A Us bone stimulation.. 0.62 0.80 0.33 0.09 1.51 1.04 000
20982............... .............. A Ablate, bone tumor(s) 7.27 109.89 2.97 0.69 117.85 10.93 000
perq.
21010............... .............. A Incision of jaw joint 10.12 NA 7.14 1.02 NA 18.28 090
21015............... .............. A Resection of facial 5.28 NA 5.43 0.70 NA 11.41 090
tumor.
21025............... .............. A Excision of bone, 10.04 12.22 9.35 1.30 23.56 20.69 090
lower jaw.
21026............... .............. A Excision of facial 4.84 7.85 6.31 0.63 13.32 11.78 090
bone(s).
21029............... .............. A Contour of face bone 7.70 9.34 6.99 0.90 17.94 15.59 090
lesion.
21030............... .............. A Excise max/zygoma b9 4.49 6.32 5.03 0.86 11.67 10.38 090
tumor.
21031............... .............. A Remove exostosis, 3.24 5.16 3.62 0.47 8.87 7.33 090
mandible.
21032............... .............. A Remove exostosis, 3.24 5.34 3.51 0.46 9.04 7.21 090
maxilla.
21034............... .............. A Excise max/zygoma mlg 16.15 15.88 12.63 1.74 33.77 30.52 090
tumor.
21040............... .............. A Excise mandible 4.49 6.38 4.72 0.57 11.44 9.78 090
lesion.
21044............... .............. A Removal of jaw bone 11.84 NA 9.37 1.10 NA 22.31 090
lesion.
21045............... .............. A Extensive jaw surgery 16.15 NA 12.34 1.57 NA 30.06 090
21046............... .............. A Remove mandible cyst 12.98 NA 11.86 0.88 NA 25.72 090
complex.
21047............... .............. A Excise lwr jaw cyst w/ 18.72 NA 13.42 0.88 NA 33.02 090
repair.
21048............... .............. A Remove maxilla cyst 13.48 NA 12.08 0.88 NA 26.44 090
complex.
21049............... .............. A Excis uppr jaw cyst w/ 17.97 NA 13.00 0.88 NA 31.85 090
repair.
21050............... .............. A Removal of jaw joint. 10.75 NA 9.43 1.36 NA 21.54 090
21060............... .............. A Remove jaw joint 10.21 NA 8.60 1.51 NA 20.32 090
cartilage.
21070............... .............. A Remove coronoid 8.19 NA 7.10 1.16 NA 16.45 090
process.
21076............... .............. A Prepare face/oral 13.40 12.34 9.99 1.91 27.65 25.30 010
prosthesis.
21077............... .............. A Prepare face/oral 33.70 31.27 25.96 5.03 70.00 64.69 090
prosthesis.
21079............... .............. A Prepare face/oral 22.31 21.46 17.12 3.09 46.86 42.52 090
prosthesis.
21080............... .............. A Prepare face/oral 25.06 24.45 19.33 3.68 53.19 48.07 090
prosthesis.
21081............... .............. A Prepare face/oral 22.85 22.26 17.45 3.10 48.21 43.40 090
prosthesis.
21082............... .............. A Prepare face/oral 20.84 19.30 15.69 2.95 43.09 39.48 090
prosthesis.
21083............... .............. A Prepare face/oral 19.27 18.76 14.41 2.55 40.58 36.23 090
prosthesis.
21084............... .............. A Prepare face/oral 22.48 22.40 17.67 2.28 47.16 42.43 090
prosthesis.
21085............... .............. A Prepare face/oral 8.99 8.27 6.77 1.17 18.43 16.93 010
prosthesis.
21086............... .............. A Prepare face/oral 24.88 23.73 19.39 3.19 51.80 47.46 090
prosthesis.
21087............... .............. A Prepare face/oral 24.88 23.23 19.14 3.58 51.69 47.60 090
prosthesis.
21100............... .............. A Maxillofacial 4.21 11.59 4.76 0.35 16.15 9.32 090
fixation.
21110............... .............. A Interdental fixation. 5.20 9.57 8.35 0.62 15.39 14.17 090
21116............... .............. A Injection, jaw joint 0.81 4.36 0.33 0.06 5.23 1.20 000
x-ray.
21120............... .............. A Reconstruction of 4.92 10.62 7.48 0.49 16.03 12.89 090
chin.
21121............... .............. A Reconstruction of 7.63 9.73 7.81 0.93 18.29 16.37 090
chin.
21122............... .............. A Reconstruction of 8.51 NA 8.62 0.98 NA 18.11 090
chin.
21123............... .............. A Reconstruction of 11.14 NA 10.78 0.91 NA 22.83 090
chin.
21125............... .............. A Augmentation, lower 10.60 55.70 8.31 0.76 67.06 19.67 090
jaw bone.
21127............... .............. A Augmentation, lower 11.10 42.76 9.44 1.66 55.52 22.20 090
jaw bone.
21137............... .............. A Reduction of forehead 9.81 NA 7.71 1.13 NA 18.65 090
[[Page 47588]]
21138............... .............. A Reduction of forehead 12.17 NA 9.50 0.61 NA 22.28 090
21139............... .............. A Reduction of forehead 14.59 NA 11.04 1.68 NA 27.31 090
21141............... .............. A Reconstruct midface, 18.07 NA 13.75 2.41 NA 34.23 090
lefort.
21142............... .............. A Reconstruct midface, 18.78 NA 12.94 2.26 NA 33.98 090
lefort.
21143............... .............. A Reconstruct midface, 19.55 NA 14.30 1.09 NA 34.94 090
lefort.
21145............... .............. A Reconstruct midface, 19.91 NA 14.02 2.58 NA 36.51 090
lefort.
21146............... .............. A Reconstruct midface, 20.68 NA 15.44 3.09 NA 39.21 090
lefort.
21147............... .............. A Reconstruct midface, 21.74 NA 15.13 1.83 NA 38.70 090
lefort.
21150............... .............. A Reconstruct midface, 25.20 NA 16.75 3.04 NA 44.99 090
lefort.
21151............... .............. A Reconstruct midface, 28.26 NA 22.88 4.22 NA 55.36 090
lefort.
21154............... .............. A Reconstruct midface, 30.47 NA 23.07 4.55 NA 58.09 090
lefort.
21155............... .............. A Reconstruct midface, 34.40 NA 23.85 6.61 NA 64.86 090
lefort.
21159............... .............. A Reconstruct midface, 42.32 NA 29.02 6.31 NA 77.65 090
lefort.
21160............... .............. A Reconstruct midface, 46.37 NA 27.46 4.91 NA 78.74 090
lefort.
21172............... .............. A Reconstruct orbit/ 27.76 NA 14.01 2.83 NA 44.60 090
forehead.
21175............... .............. A Reconstruct orbit/ 33.12 NA 18.18 3.43 NA 54.73 090
forehead.
21179............... .............. A Reconstruct entire 22.22 NA 14.72 3.24 NA 40.18 090
forehead.
21180............... .............. A Reconstruct entire 25.15 NA 15.92 3.08 NA 44.15 090
forehead.
21181............... .............. A Contour cranial bone 9.89 NA 7.78 1.37 NA 19.04 090
lesion.
21182............... .............. A Reconstruct cranial 32.14 NA 19.47 3.42 NA 55.03 090
bone.
21183............... .............. A Reconstruct cranial 35.26 NA 21.18 3.51 NA 59.95 090
bone.
21184............... .............. A Reconstruct cranial 38.18 NA 22.37 6.84 NA 67.39 090
bone.
21188............... .............. A Reconstruction of 22.43 NA 18.83 2.97 NA 44.23 090
midface.
21193............... .............. A Reconst lwr jaw w/o 17.12 NA 12.84 2.10 NA 32.06 090
graft.
21194............... .............. A Reconst lwr jaw w/ 19.81 NA 13.91 2.11 NA 35.83 090
graft.
21195............... .............. A Reconst lwr jaw w/o 17.21 NA 14.79 1.22 NA 33.22 090
fixation.
21196............... .............. A Reconst lwr jaw w/ 18.88 NA 15.66 2.03 NA 36.57 090
fixation.
21198............... .............. A Reconstr lwr jaw 14.14 NA 12.69 1.41 NA 28.24 090
segment.
21199............... .............. A Reconstr lwr jaw w/ 15.98 NA 9.15 1.39 NA 26.52 090
advance.
21206............... .............. A Reconstruct upper jaw 14.08 NA 12.62 1.78 NA 28.48 090
bone.
21208............... .............. A Augmentation of 10.21 22.32 9.56 1.11 33.64 20.88 090
facial bones.
21209............... .............. A Reduction of facial 6.71 10.78 8.06 0.90 18.39 15.67 090
bones.
21210............... .............. A Face bone graft...... 10.21 24.84 9.33 1.37 36.42 20.91 090
21215............... .............. A Lower jaw bone graft. 10.75 41.85 9.35 1.51 54.11 21.61 090
21230............... .............. A Rib cartilage graft.. 10.75 NA 8.46 1.20 NA 20.41 090
21235............... .............. A Ear cartilage graft.. 6.71 9.83 6.40 0.68 17.22 13.79 090
21240............... .............. A Reconstruction of jaw 14.03 NA 12.17 2.28 NA 28.48 090
joint.
21242............... .............. A Reconstruction of jaw 12.93 NA 11.66 2.29 NA 26.88 090
joint.
21243............... .............. A Reconstruction of jaw 20.76 NA 17.37 3.05 NA 41.18 090
joint.
21244............... .............. A Reconstruction of 11.84 NA 12.07 1.24 NA 25.15 090
lower jaw.
21245............... .............. A Reconstruction of jaw 11.84 14.35 9.83 1.12 27.31 22.79 090
21246............... .............. A Reconstruction of jaw 12.45 NA 9.03 1.24 NA 22.72 090
21247............... .............. A Reconstruct lower jaw 22.60 NA 17.43 3.23 NA 43.26 090
bone.
21248............... .............. A Reconstruction of jaw 11.46 12.11 9.38 1.67 25.24 22.51 090
21249............... .............. A Reconstruction of jaw 17.49 16.70 12.67 2.02 36.21 32.18 090
21255............... .............. A Reconstruct lower jaw 16.69 NA 16.15 2.57 NA 35.41 090
bone.
21256............... .............. A Reconstruction of 16.17 NA 12.03 1.36 NA 29.56 090
orbit.
21260............... .............. A Revise eye sockets... 16.50 NA 12.75 0.98 NA 30.23 090
21261............... .............. A Revise eye sockets... 31.44 NA 24.21 3.09 NA 58.74 090
21263............... .............. A Revise eye sockets... 28.38 NA 19.17 2.61 NA 50.16 090
21267............... .............. A Revise eye sockets... 18.87 NA 19.72 1.64 NA 40.23 090
21268............... .............. A Revise eye sockets... 24.44 NA 20.22 2.43 NA 47.09 090
21270............... .............. A Augmentation, cheek 10.21 11.66 7.24 1.04 22.91 18.49 090
bone.
21275............... .............. A Revision, 11.22 NA 8.63 1.29 NA 21.14 090
orbitofacial bones.
21280............... .............. A Revision of eyelid... 6.02 NA 5.95 0.46 NA 12.43 090
21282............... .............. A Revision of eyelid... 3.48 NA 4.58 0.27 NA 8.33 090
21295............... .............. A Revision of jaw 1.53 NA 2.54 0.15 NA 4.22 090
muscle/bone.
21296............... .............. A Revision of jaw 4.24 NA 4.90 0.35 NA 9.49 090
muscle/bone.
21300............... .............. A Treatment of skull 0.72 2.39 0.26 0.11 3.22 1.09 000
fracture.
21310............... .............. A Treatment of nose 0.58 2.30 0.15 0.05 2.93 0.78 000
fracture.
21315............... .............. A Treatment of nose 1.51 4.23 1.88 0.14 5.88 3.53 010
fracture.
21320............... .............. A Treatment of nose 1.85 3.91 1.62 0.18 5.94 3.65 010
fracture.
21325............... .............. A Treatment of nose 3.76 NA 8.61 0.34 NA 12.71 090
fracture.
21330............... .............. A Treatment of nose 5.37 NA 9.64 0.61 NA 15.62 090
fracture.
21335............... .............. A Treatment of nose 8.60 NA 9.60 0.75 NA 18.95 090
fracture.
21336............... .............. A Treat nasal septal 5.71 NA 9.57 0.56 NA 15.84 090
fracture.
21337............... .............. A Treat nasal septal 2.70 6.49 3.56 0.27 9.46 6.53 090
fracture.
21338............... .............. A Treat nasoethmoid 6.45 NA 13.90 0.75 NA 21.10 090
fracture.
21339............... .............. A Treat nasoethmoid 8.08 NA 13.77 0.92 NA 22.77 090
fracture.
21340............... .............. A Treatment of nose 10.75 NA 8.59 0.97 NA 20.31 090
fracture.
21343............... .............. A Treatment of sinus 12.93 NA 15.39 1.67 NA 29.99 090
fracture.
21344............... .............. A Treatment of sinus 19.69 NA 16.42 2.45 NA 38.56 090
fracture.
21345............... .............. A Treat nose/jaw 8.15 9.84 7.16 1.11 19.10 16.42 090
fracture.
21346............... .............. A Treat nose/jaw 10.59 NA 12.18 1.22 NA 23.99 090
fracture.
21347............... .............. A Treat nose/jaw 12.67 NA 16.03 1.57 NA 30.27 090
fracture.
[[Page 47589]]
21348............... .............. A Treat nose/jaw 16.66 NA 11.21 1.62 NA 29.49 090
fracture.
21355............... .............. A Treat cheek bone 3.76 6.24 3.49 0.28 10.28 7.53 010
fracture.
21356............... .............. A Treat cheek bone 4.14 7.10 4.53 0.47 11.71 9.14 010
fracture.
21360............... .............. A Treat cheek bone 6.45 NA 5.92 0.71 NA 13.08 090
fracture.
21365............... .............. A Treat cheek bone 14.93 NA 10.79 1.72 NA 27.44 090
fracture.
21366............... .............. A Treat cheek bone 17.74 NA 11.52 1.90 NA 31.16 090
fracture.
21385............... .............. A Treat eye socket 9.15 NA 8.27 0.83 NA 18.25 090
fracture.
21386............... .............. A Treat eye socket 9.15 NA 7.06 1.04 NA 17.25 090
fracture.
21387............... .............. A Treat eye socket 9.69 NA 8.93 0.96 NA 19.58 090
fracture.
21390............... .............. A Treat eye socket 10.11 NA 7.91 0.92 NA 18.94 090
fracture.
21395............... .............. A Treat eye socket 12.66 NA 9.21 1.60 NA 23.47 090
fracture.
21400............... .............. A Treat eye socket 1.40 2.64 1.90 0.14 4.18 3.44 090
fracture.
21401............... .............. A Treat eye socket 3.26 8.05 3.49 0.27 11.58 7.02 090
fracture.
21406............... .............. A Treat eye socket 7.00 NA 6.26 0.82 NA 14.08 090
fracture.
21407............... .............. A Treat eye socket 8.60 NA 7.05 0.94 NA 16.59 090
fracture.
21408............... .............. A Treat eye socket 12.36 NA 9.10 1.39 NA 22.85 090
fracture.
21421............... .............. A Treat mouth roof 5.13 9.33 8.31 0.61 15.07 14.05 090
fracture.
21422............... .............. A Treat mouth roof 8.31 NA 8.06 0.97 NA 17.34 090
fracture.
21423............... .............. A Treat mouth roof 10.38 NA 9.30 1.20 NA 20.88 090
fracture.
21431............... .............. A Treat craniofacial 7.04 NA 9.51 1.05 NA 17.60 090
fracture.
21432............... .............. A Treat craniofacial 8.60 NA 8.05 0.87 NA 17.52 090
fracture.
21433............... .............. A Treat craniofacial 25.31 NA 16.66 3.07 NA 45.04 090
fracture.
21435............... .............. A Treat craniofacial 17.22 NA 12.82 2.81 NA 32.85 090
fracture.
21436............... .............. A Treat craniofacial 28.00 NA 18.25 3.23 NA 49.48 090
fracture.
21440............... .............. A Treat dental ridge 2.70 7.10 6.16 0.35 10.15 9.21 090
fracture.
21445............... .............. A Treat dental ridge 5.37 9.73 8.36 0.68 15.78 14.41 090
fracture.
21450............... .............. A Treat lower jaw 2.97 7.38 6.92 0.37 10.72 10.26 090
fracture.
21451............... .............. A Treat lower jaw 4.86 9.34 8.40 0.65 14.85 13.91 090
fracture.
21452............... .............. A Treat lower jaw 1.98 13.11 4.61 0.20 15.29 6.79 090
fracture.
21453............... .............. A Treat lower jaw 5.53 10.73 10.71 0.71 16.97 16.95 090
fracture.
21454............... .............. A Treat lower jaw 6.45 NA 6.50 0.76 NA 13.71 090
fracture.
21461............... .............. A Treat lower jaw 8.08 24.43 12.64 0.95 33.46 21.67 090
fracture.
21462............... .............. A Treat lower jaw 9.78 27.59 12.69 0.94 38.31 23.41 090
fracture.
21465............... .............. A Treat lower jaw 11.89 NA 9.99 1.63 NA 23.51 090
fracture.
21470............... .............. A Treat lower jaw 15.32 NA 12.18 1.97 NA 29.47 090
fracture.
21480............... .............. A Reset dislocated jaw. 0.61 1.77 0.19 0.06 2.44 0.86 000
21485............... .............. A Reset dislocated jaw. 3.98 8.22 7.67 0.49 12.69 12.14 090
21490............... .............. A Repair dislocated jaw 11.84 NA 9.84 1.79 NA 23.47 090
21493............... .............. A Treat hyoid bone 1.27 NA 0.55 0.07 NA 1.89 090
fracture.
21494............... .............. A Treat hyoid bone 6.27 NA 3.53 0.53 NA 10.33 090
fracture.
21495............... .............. A Treat hyoid bone 5.68 NA 8.41 0.46 NA 14.55 090
fracture.
21497............... .............. A Interdental wiring... 3.85 8.44 7.63 0.44 12.73 11.92 090
21501............... .............. A Drain neck/chest 3.80 6.47 3.83 0.45 10.72 8.08 090
lesion.
21502............... .............. A Drain chest lesion... 7.11 NA 5.67 0.93 NA 13.71 090
21510............... .............. A Drainage of bone 5.73 NA 5.70 0.79 NA 12.22 090
lesion.
21550............... .............. A Biopsy of neck/chest. 2.06 3.59 1.72 0.19 5.84 3.97 010
21555............... .............. A Remove lesion, neck/ 4.34 5.53 3.20 0.54 10.41 8.08 090
chest.
21556............... .............. A Remove lesion, neck/ 5.56 NA 4.08 0.66 NA 10.30 090
chest.
21557............... .............. A Remove tumor, neck/ 8.87 NA 5.41 1.09 NA 15.37 090
chest.
21600............... .............. A Partial removal of 6.88 NA 5.77 0.95 NA 13.60 090
rib.
21610............... .............. A Partial removal of 14.59 NA 9.11 2.49 NA 26.19 090
rib.
21615............... .............. A Removal of rib....... 9.86 NA 6.70 1.39 NA 17.95 090
21616............... .............. A Removal of rib and 12.02 NA 8.04 1.72 NA 21.78 090
nerves.
21620............... .............. A Partial removal of 6.78 NA 6.03 0.93 NA 13.74 090
sternum.
21627............... .............. A Sternal debridement.. 6.80 NA 6.43 0.95 NA 14.18 090
21630............... .............. A Extensive sternum 17.35 NA 11.89 2.45 NA 31.69 090
surgery.
21632............... .............. A Extensive sternum 18.11 NA 11.13 2.45 NA 31.69 090
surgery.
21685............... .............. A Hyoid myotomy & 12.98 NA 9.96 1.05 NA 23.99 090
suspension.
21700............... .............. A Revision of neck 6.18 NA 4.44 0.72 NA 11.34 090
muscle.
21705............... .............. A Revision of neck 9.59 NA 5.60 1.21 NA 16.40 090
muscle/rib.
21720............... .............. A Revision of neck 5.67 2.45 2.45 0.86 8.98 8.98 090
muscle.
21725............... .............. A Revision of neck 6.98 NA 5.63 0.78 NA 13.39 090
muscle.
21740............... .............. A Reconstruction of 16.48 NA 8.56 2.06 NA 27.10 090
sternum.
21750............... .............. A Repair of sternum 10.75 NA 6.11 1.44 NA 18.30 090
separation.
21800............... .............. A Treatment of rib 0.96 NA 1.37 0.09 NA 2.42 090
fracture.
21805............... .............. A Treatment of rib 2.75 NA 3.38 0.35 NA 6.48 090
fracture.
21810............... .............. A Treatment of rib 6.85 NA 5.01 0.93 NA 12.79 090
fracture(s).
21820............... .............. A Treat sternum 1.28 1.84 1.79 0.15 3.27 3.22 090
fracture.
21825............... .............. A Treat sternum 7.40 NA 6.68 0.99 NA 15.07 090
fracture.
21920............... .............. A Biopsy soft tissue of 2.06 3.29 1.48 0.20 5.55 3.74 010
back.
21925............... .............. A Biopsy soft tissue of 4.48 5.20 3.24 0.59 10.27 8.31 090
back.
21930............... .............. A Remove lesion, back 4.99 5.73 3.40 0.63 11.35 9.02 090
or flank.
21935............... .............. A Remove tumor, back... 17.93 NA 10.24 2.46 NA 30.63 090
22100............... .............. A Remove part of neck 9.72 NA 7.73 1.68 NA 19.13 090
vertebra.
22101............... .............. A Remove part, thorax 9.80 NA 7.99 1.80 NA 19.59 090
vertebra.
[[Page 47590]]
22102............... .............. A Remove part, lumbar 9.80 NA 8.25 1.57 NA 19.62 090
vertebra.
22103............... .............. A Remove extra spine 2.34 NA 1.21 0.39 NA 3.94 ZZZ
segment.
22110............... .............. A Remove part of neck 12.72 NA 9.38 2.24 NA 24.34 090
vertebra.
22112............... .............. A Remove part, thorax 12.79 NA 9.46 1.92 NA 24.17 090
vertebra.
22114............... .............. A Remove part, lumbar 12.79 NA 9.45 2.13 NA 24.37 090
vertebra.
22116............... .............. A Remove extra spine 2.32 NA 1.16 0.41 NA 3.89 ZZZ
segment.
22210............... .............. A Revision of neck 23.78 NA 15.63 4.60 NA 44.01 090
spine.
22212............... .............. A Revision of thorax 19.39 NA 13.45 3.12 NA 35.96 090
spine.
22214............... .............. A Revision of lumbar 19.42 NA 13.98 3.10 NA 36.50 090
spine.
22216............... .............. A Revise, extra spine 6.03 NA 3.12 1.05 NA 10.20 ZZZ
segment.
22220............... .............. A Revision of neck 21.34 NA 13.87 3.43 NA 38.64 090
spine.
22222............... .............. A Revision of thorax 21.49 NA 11.74 3.46 NA 36.69 090
spine.
22224............... .............. A Revision of lumbar 21.49 NA 14.40 3.63 NA 39.52 090
spine.
22226............... .............. A Revise, extra spine 6.03 NA 3.08 1.05 NA 10.16 ZZZ
segment.
22305............... .............. A Treat spine process 2.05 2.31 1.92 0.33 4.69 4.30 090
fracture.
22310............... .............. A Treat spine fracture. 2.61 2.79 2.34 0.42 5.82 5.37 090
22315............... .............. A Treat spine fracture. 8.83 9.68 7.32 1.60 20.11 17.75 090
22318............... .............. A Treat odontoid fx w/o 21.47 NA 13.56 4.70 NA 39.73 090
graft.
22319............... .............. A Treat odontoid fx w/ 23.96 NA 14.97 5.38 NA 44.31 090
graft.
22325............... .............. A Treat spine fracture. 18.27 NA 12.26 3.18 NA 33.71 090
22326............... .............. A Treat neck spine 19.56 NA 12.93 3.85 NA 36.34 090
fracture.
22327............... .............. A Treat thorax spine 19.17 NA 12.55 3.21 NA 34.93 090
fracture.
22328............... .............. A Treat each add spine 4.60 NA 2.26 0.78 NA 7.64 ZZZ
fx.
22505............... .............. A Manipulation of spine 1.87 NA 0.94 0.30 NA 3.11 010
22520............... .............. A Percut vertebroplasty 8.90 99.93 5.09 1.43 110.26 15.42 010
thor.
22521............... .............. A Percut vertebroplasty 8.33 90.95 4.94 1.34 100.62 14.61 010
lumb.
22522............... .............. A Percut vertebroplasty 4.30 NA 1.67 0.69 NA 6.66 ZZZ
add-l.
22532............... .............. A Lat thorax spine 23.96 NA 14.84 3.78 NA 42.58 090
fusion.
22533............... .............. A Lat lumbar spine 23.09 NA 13.60 2.80 NA 39.49 090
fusion.
22534............... .............. A Lat thor/lumb, add-l 5.99 NA 3.03 1.04 NA 10.06 ZZZ
seg.
22548............... .............. A Neck spine fusion.... 25.78 NA 15.79 5.15 NA 46.72 090
22554............... .............. A Neck spine fusion.... 18.59 NA 12.33 3.73 NA 34.65 090
22556............... .............. A Thorax spine fusion.. 23.42 NA 14.72 3.78 NA 41.92 090
22558............... .............. A Lumbar spine fusion.. 22.25 NA 13.28 2.80 NA 38.33 090
22585............... .............. A Additional spinal 5.52 NA 2.79 1.04 NA 9.35 ZZZ
fusion.
22590............... .............. A Spine & skull spinal 20.48 NA 13.31 4.31 NA 38.10 090
fusion.
22595............... .............. A Neck spinal fusion... 19.36 NA 12.82 3.88 NA 36.06 090
22600............... .............. A Neck spine fusion.... 16.12 NA 11.18 3.24 NA 30.54 090
22610............... .............. A Thorax spine fusion.. 16.00 NA 11.40 2.95 NA 30.35 090
22612............... .............. A Lumbar spine fusion.. 20.97 NA 14.18 3.55 NA 38.70 090
22614............... .............. A Spine fusion, extra 6.43 NA 3.35 1.14 NA 10.92 ZZZ
segment.
22630............... .............. A Lumbar spine fusion.. 20.81 NA 13.59 3.86 NA 38.26 090
22632............... .............. A Spine fusion, extra 5.22 NA 2.66 0.98 NA 8.86 ZZZ
segment.
22800............... .............. A Fusion of spine...... 18.22 NA 12.74 3.04 NA 34.00 090
22802............... .............. A Fusion of spine...... 30.83 NA 19.55 5.01 NA 55.39 090
22804............... .............. A Fusion of spine...... 36.22 NA 22.65 5.68 NA 64.55 090
22808............... .............. A Fusion of spine...... 26.23 NA 16.28 4.55 NA 47.06 090
22810............... .............. A Fusion of spine...... 30.22 NA 18.33 4.43 NA 52.98 090
22812............... .............. A Fusion of spine...... 32.65 NA 20.03 4.55 NA 57.23 090
22818............... .............. A Kyphectomy, 1-2 31.78 NA 18.85 6.00 NA 56.63 090
segments.
22819............... .............. A Kyphectomy, 3 or more 36.39 NA 20.03 5.64 NA 62.06 090
22830............... .............. A Exploration of spinal 10.83 NA 7.95 1.89 NA 20.67 090
fusion.
22840............... .............. A Insert spine fixation 12.52 NA 6.48 2.19 NA 21.19 ZZZ
device.
22842............... .............. A Insert spine fixation 12.56 NA 6.49 2.21 NA 21.26 ZZZ
device.
22843............... .............. A Insert spine fixation 13.44 NA 6.59 2.37 NA 22.40 ZZZ
device.
22844............... .............. A Insert spine fixation 16.42 NA 8.73 2.63 NA 27.78 ZZZ
device.
22845............... .............. A Insert spine fixation 11.94 NA 6.06 2.39 NA 20.39 ZZZ
device.
22846............... .............. A Insert spine fixation 12.40 NA 6.32 2.47 NA 21.19 ZZZ
device.
22847............... .............. A Insert spine fixation 13.78 NA 7.01 2.37 NA 23.16 ZZZ
device.
22848............... .............. A Insert pelv fixation 5.99 NA 3.18 0.96 NA 10.13 ZZZ
device.
22849............... .............. A Reinsert spinal 18.48 NA 11.86 3.14 NA 33.48 090
fixation.
22850............... .............. A Remove spine fixation 9.51 NA 7.11 1.61 NA 18.23 090
device.
22851............... .............. A Apply spine prosth 6.70 NA 3.35 1.23 NA 11.28 ZZZ
device.
22852............... .............. A Remove spine fixation 9.00 NA 6.90 1.52 NA 17.42 090
device.
22855............... .............. A Remove spine fixation 15.11 NA 9.79 2.90 NA 27.80 090
device.
22900............... .............. A Remove abdominal wall 5.79 NA 3.25 0.74 NA 9.78 090
lesion.
23000............... .............. A Removal of calcium 4.35 8.62 4.42 0.59 13.56 9.36 090
deposits.
23020............... .............. A Release shoulder 8.92 NA 7.79 1.43 NA 18.14 090
joint.
23030............... .............. A Drain shoulder lesion 3.42 7.42 2.90 0.53 11.37 6.85 010
23031............... .............. A Drain shoulder bursa. 2.74 7.91 2.72 0.44 11.09 5.90 010
23035............... .............. A Drain shoulder bone 8.60 NA 8.72 1.38 NA 18.70 090
lesion.
23040............... .............. A Exploratory shoulder 9.19 NA 8.09 1.50 NA 18.78 090
surgery.
23044............... .............. A Exploratory shoulder 7.11 NA 6.71 1.19 NA 15.01 090
surgery.
23065............... .............. A Biopsy shoulder 2.27 2.48 1.62 0.24 4.99 4.13 010
tissues.
23066............... .............. A Biopsy shoulder 4.15 7.70 3.98 0.62 12.47 8.75 090
tissues.
[[Page 47591]]
23075............... .............. A Removal of shoulder 2.39 3.68 1.78 0.33 6.40 4.50 010
lesion.
23076............... .............. A Removal of shoulder 7.62 NA 5.86 1.11 NA 14.59 090
lesion.
23077............... .............. A Remove tumor of 16.07 NA 10.90 2.27 NA 29.24 090
shoulder.
23100............... .............. A Biopsy of shoulder 6.02 NA 5.89 0.96 NA 12.87 090
joint.
23101............... .............. A Shoulder joint 5.57 NA 5.58 0.91 NA 12.06 090
surgery.
23105............... .............. A Remove shoulder joint 8.22 NA 7.39 1.32 NA 16.93 090
lining.
23106............... .............. A Incision of 5.95 NA 5.94 0.83 NA 12.72 090
collarbone joint.
23107............... .............. A Explore treat 8.61 NA 7.60 1.40 NA 17.61 090
shoulder joint.
23120............... .............. A Partial removal, 7.10 NA 6.69 1.13 NA 14.92 090
collar bone.
23125............... .............. A Removal of collar 9.38 NA 7.81 1.45 NA 18.64 090
bone.
23130............... .............. A Remove shoulder bone, 7.54 NA 7.33 1.27 NA 16.14 090
part.
23140............... .............. A Removal of bone 6.88 NA 5.50 0.99 NA 13.37 090
lesion.
23145............... .............. A Removal of bone 9.08 NA 7.79 1.42 NA 18.29 090
lesion.
23146............... .............. A Removal of bone 7.82 NA 7.38 1.13 NA 16.33 090
lesion.
23150............... .............. A Removal of humerus 8.47 NA 7.15 1.24 NA 16.86 090
lesion.
23155............... .............. A Removal of humerus 10.33 NA 8.68 1.48 NA 20.49 090
lesion.
23156............... .............. A Removal of humerus 8.67 NA 7.60 1.36 NA 17.63 090
lesion.
23170............... .............. A Remove collar bone 6.85 NA 6.54 1.10 NA 14.49 090
lesion.
23172............... .............. A Remove shoulder blade 6.89 NA 6.63 0.95 NA 14.47 090
lesion.
23174............... .............. A Remove humerus lesion 9.50 NA 8.63 1.56 NA 19.69 090
23180............... .............. A Remove collar bone 8.52 NA 9.43 1.47 NA 19.42 090
lesion.
23182............... .............. A Remove shoulder blade 8.14 NA 9.09 1.26 NA 18.49 090
lesion.
23184............... .............. A Remove humerus lesion 9.37 NA 9.78 1.50 NA 20.65 090
23190............... .............. A Partial removal of 7.23 NA 6.38 1.18 NA 14.79 090
scapula.
23195............... .............. A Removal of head of 9.80 NA 7.95 1.18 NA 18.93 090
humerus.
23200............... .............. A Removal of collar 12.06 NA 9.14 1.69 NA 22.89 090
bone.
23210............... .............. A Removal of shoulder 12.47 NA 9.49 2.01 NA 23.97 090
blade.
23220............... .............. A Partial removal of 14.54 NA 11.12 2.50 NA 28.16 090
humerus.
23221............... .............. A Partial removal of 17.71 NA 12.01 2.33 NA 32.05 090
humerus.
23222............... .............. A Partial removal of 23.88 NA 16.10 3.90 NA 43.88 090
humerus.
23330............... .............. A Remove shoulder 1.85 3.75 1.88 0.24 5.84 3.97 010
foreign body.
23331............... .............. A Remove shoulder 7.37 NA 7.01 1.14 NA 15.52 090
foreign body.
23332............... .............. A Remove shoulder 11.60 NA 9.53 1.85 NA 22.98 090
foreign body.
23350............... .............. A Injection for 1.00 3.52 0.33 0.06 4.58 1.39 000
shoulder x-ray.
23395............... .............. A Muscle 16.82 NA 12.97 2.56 NA 32.35 090
transfer,shoulder/
arm.
23397............... .............. A Muscle transfers..... 16.11 NA 11.57 2.62 NA 30.30 090
23400............... .............. A Fixation of shoulder 13.52 NA 10.38 2.07 NA 25.97 090
blade.
23405............... .............. A Incision of tendon & 8.36 NA 7.15 1.29 NA 16.80 090
muscle.
23406............... .............. A Incise tendon(s) & 10.77 NA 8.60 1.72 NA 21.09 090
muscle(s).
23410............... .............. A Repair rotator cuff, 12.43 NA 9.61 1.95 NA 23.99 090
acute.
23412............... .............. A Repair rotator cuff, 13.29 NA 10.10 2.08 NA 25.47 090
chronic.
23415............... .............. A Release of shoulder 9.96 NA 8.15 1.70 NA 19.81 090
ligament.
23420............... .............. A Repair of shoulder... 13.28 NA 11.06 2.10 NA 26.44 090
23430............... .............. A Repair biceps tendon. 9.97 NA 8.32 1.57 NA 19.86 090
23440............... .............. A Remove/transplant 10.46 NA 8.49 1.63 NA 20.58 090
tendon.
23450............... .............. A Repair shoulder 13.38 NA 10.06 2.12 NA 25.56 090
capsule.
23455............... .............. A Repair shoulder 14.35 NA 10.65 2.26 NA 27.26 090
capsule.
23460............... .............. A Repair shoulder 15.35 NA 11.58 2.43 NA 29.36 090
capsule.
23462............... .............. A Repair shoulder 15.28 NA 10.97 2.42 NA 28.67 090
capsule.
23465............... .............. A Repair shoulder 15.83 NA 11.52 2.51 NA 29.86 090
capsule.
23466............... .............. A Repair shoulder 14.20 NA 11.53 2.25 NA 27.98 090
capsule.
23470............... .............. A Reconstruct shoulder 17.12 NA 12.23 2.70 NA 32.05 090
joint.
23472............... .............. A Reconstruct shoulder 21.07 NA 14.38 3.29 NA 38.74 090
joint.
23480............... .............. A Revision of collar 11.16 NA 8.98 1.89 NA 22.03 090
bone.
23485............... .............. A Revision of collar 13.41 NA 10.10 2.12 NA 25.63 090
bone.
23490............... .............. A Reinforce clavicle... 11.84 NA 9.04 1.44 NA 22.32 090
23491............... .............. A Reinforce shoulder 14.19 NA 10.91 2.29 NA 27.39 090
bones.
23500............... .............. A Treat clavicle 2.08 2.87 2.54 0.29 5.24 4.91 090
fracture.
23505............... .............. A Treat clavicle 3.68 4.41 3.85 0.58 8.67 8.11 090
fracture.
23515............... .............. A Treat clavicle 7.40 NA 6.70 1.16 NA 15.26 090
fracture.
23520............... .............. A Treat clavicle 2.16 2.86 2.75 0.32 5.34 5.23 090
dislocation.
23525............... .............. A Treat clavicle 3.59 4.57 3.96 0.42 8.58 7.97 090
dislocation.
23530............... .............. A Treat clavicle 7.30 NA 6.12 1.21 NA 14.63 090
dislocation.
23532............... .............. A Treat clavicle 8.00 NA 7.11 1.17 NA 16.28 090
dislocation.
23540............... .............. A Treat clavicle 2.23 2.87 2.41 0.27 5.37 4.91 090
dislocation.
23545............... .............. A Treat clavicle 3.25 4.20 3.39 0.42 7.87 7.06 090
dislocation.
23550............... .............. A Treat clavicle 7.23 NA 6.55 1.14 NA 14.92 090
dislocation.
23552............... .............. A Treat clavicle 8.44 NA 7.46 1.27 NA 17.17 090
dislocation.
23570............... .............. A Treat shoulder blade 2.23 3.01 2.90 0.35 5.59 5.48 090
fx.
23575............... .............. A Treat shoulder blade 4.05 4.88 4.32 0.66 9.59 9.03 090
fx.
23585............... .............. A Treat scapula 8.95 NA 7.80 1.44 NA 18.19 090
fracture.
23600............... .............. A Treat humerus 2.93 4.54 3.57 0.46 7.93 6.96 090
fracture.
23605............... .............. A Treat humerus 4.86 6.14 5.11 0.81 11.81 10.78 090
fracture.
23615............... .............. A Treat humerus 9.34 NA 8.97 1.51 NA 19.82 090
fracture.
23616............... .............. A Treat humerus 21.24 NA 14.28 3.37 NA 38.89 090
fracture.
[[Page 47592]]
23620............... .............. A Treat humerus 2.40 3.61 3.00 0.38 6.39 5.78 090
fracture.
23625............... .............. A Treat humerus 3.92 4.93 4.28 0.64 9.49 8.84 090
fracture.
23630............... .............. A Treat humerus 7.34 NA 6.77 1.18 NA 15.29 090
fracture.
23650............... .............. A Treat shoulder 3.38 3.80 2.81 0.30 7.48 6.49 090
dislocation.
23655............... .............. A Treat shoulder 4.56 NA 4.24 0.62 NA 9.42 090
dislocation.
23660............... .............. A Treat shoulder 7.48 NA 6.53 1.22 NA 15.23 090
dislocation.
23665............... .............. A Treat dislocation/ 4.46 5.33 4.72 0.70 10.49 9.88 090
fracture.
23670............... .............. A Treat dislocation/ 7.89 NA 7.00 1.25 NA 16.14 090
fracture.
23675............... .............. A Treat dislocation/ 6.04 6.83 5.82 0.97 13.84 12.83 090
fracture.
23680............... .............. A Treat dislocation/ 10.04 NA 8.27 1.61 NA 19.92 090
fracture.
23700............... .............. A Fixation of shoulder. 2.52 NA 2.17 0.43 NA 5.12 010
23800............... .............. A Fusion of shoulder 14.14 NA 10.68 2.34 NA 27.16 090
joint.
23802............... .............. A Fusion of shoulder 16.58 NA 10.41 2.45 NA 29.44 090
joint.
23900............... .............. A Amputation of arm & 19.69 NA 12.03 3.04 NA 34.76 090
girdle.
23920............... .............. A Amputation at 14.59 NA 10.26 2.21 NA 27.06 090
shoulder joint.
23921............... .............. A Amputation follow-up 5.48 NA 5.09 0.90 NA 11.47 090
surgery.
23930............... .............. A Drainage of arm 2.94 6.36 2.31 0.41 9.71 5.66 010
lesion.
23931............... .............. A Drainage of arm bursa 1.79 5.93 2.17 0.26 7.98 4.22 010
23935............... .............. A Drain arm/elbow bone 6.08 NA 6.43 0.98 NA 13.49 090
lesion.
24000............... .............. A Exploratory elbow 5.81 NA 5.50 0.93 NA 12.24 090
surgery.
24006............... .............. A Release elbow joint.. 9.30 NA 7.85 1.48 NA 18.63 090
24065............... .............. A Biopsy arm/elbow soft 2.08 3.22 1.75 0.22 5.52 4.05 010
tissue.
24066............... .............. A Biopsy arm/elbow soft 5.20 8.95 4.14 0.77 14.92 10.11 090
tissue.
24075............... .............. A Remove arm/elbow 3.91 7.37 3.41 0.54 11.82 7.86 090
lesion.
24076............... .............. A Remove arm/elbow 6.29 NA 5.17 0.91 NA 12.37 090
lesion.
24077............... .............. A Remove tumor of arm/ 11.74 NA 8.85 1.67 NA 22.26 090
elbow.
24100............... .............. A Biopsy elbow joint 4.92 NA 4.64 0.78 NA 10.34 090
lining.
24101............... .............. A Explore/treat elbow 6.12 NA 6.02 1.01 NA 13.15 090
joint.
24102............... .............. A Remove elbow joint 8.02 NA 6.97 1.27 NA 16.26 090
lining.
24105............... .............. A Removal of elbow 3.60 NA 4.50 0.60 NA 8.70 090
bursa.
24110............... .............. A Remove humerus lesion 7.38 NA 6.93 1.21 NA 15.52 090
24115............... .............. A Remove/graft bone 9.62 NA 7.54 1.36 NA 18.52 090
lesion.
24116............... .............. A Remove/graft bone 11.79 NA 9.31 2.05 NA 23.15 090
lesion.
24120............... .............. A Remove elbow lesion.. 6.64 NA 6.02 1.07 NA 13.73 090
24125............... .............. A Remove/graft bone 7.88 NA 6.27 0.73 NA 14.88 090
lesion.
24126............... .............. A Remove/graft bone 8.30 NA 7.10 1.13 NA 16.53 090
lesion.
24130............... .............. A Removal of head of 6.24 NA 6.11 1.03 NA 13.38 090
radius.
24134............... .............. A Removal of arm bone 9.72 NA 9.38 1.52 NA 20.62 090
lesion.
24136............... .............. A Remove radius bone 7.98 NA 7.41 1.29 NA 16.68 090
lesion.
24138............... .............. A Remove elbow bone 8.04 NA 7.86 1.29 NA 17.19 090
lesion.
24140............... .............. A Partial removal of 9.17 NA 9.76 1.45 NA 20.38 090
arm bone.
24145............... .............. A Partial removal of 7.57 NA 8.27 1.22 NA 17.06 090
radius.
24147............... .............. A Partial removal of 7.53 NA 8.80 1.26 NA 17.59 090
elbow.
24149............... .............. A Radical resection of 14.18 NA 11.65 2.23 NA 28.06 090
elbow.
24150............... .............. A Extensive humerus 13.25 NA 10.35 2.15 NA 25.75 090
surgery.
24151............... .............. A Extensive humerus 15.56 NA 11.94 1.27 NA 28.77 090
surgery.
24152............... .............. A Extensive radius 10.04 NA 7.99 1.01 NA 19.04 090
surgery.
24153............... .............. A Extensive radius 11.52 NA 5.74 0.70 NA 17.96 090
surgery.
24155............... .............. A Removal of elbow 11.71 NA 8.51 1.82 NA 22.04 090
joint.
24160............... .............. A Remove elbow joint 7.82 NA 6.88 1.26 NA 15.96 090
implant.
24164............... .............. A Remove radius head 6.22 NA 5.76 1.01 NA 12.99 090
implant.
24200............... .............. A Removal of arm 1.76 3.45 1.63 0.19 5.40 3.58 010
foreign body.
24201............... .............. A Removal of arm 4.55 9.85 4.23 0.68 15.08 9.46 090
foreign body.
24220............... .............. A Injection for elbow x- 1.31 3.71 0.44 0.08 5.10 1.83 000
ray.
24300............... .............. A Manipulate elbow w/ 3.74 NA 5.62 0.63 NA 9.99 090
anesth.
24301............... .............. A Muscle/tendon 10.18 NA 8.32 1.64 NA 20.14 090
transfer.
24305............... .............. A Arm tendon 7.44 NA 6.83 1.13 NA 15.40 090
lengthening.
24310............... .............. A Revision of arm 5.97 NA 5.91 0.91 NA 12.79 090
tendon.
24320............... .............. A Repair of arm tendon. 10.54 NA 7.93 1.72 NA 20.19 090
24330............... .............. A Revision of arm 9.59 NA 8.02 1.51 NA 19.12 090
muscles.
24331............... .............. A Revision of arm 10.63 NA 8.75 1.33 NA 20.71 090
muscles.
24332............... .............. A Tenolysis, triceps... 7.44 NA 6.70 1.19 NA 15.33 090
24340............... .............. A Repair of biceps 7.88 NA 7.07 1.27 NA 16.22 090
tendon.
24341............... .............. A Repair arm tendon/ 7.89 NA 7.97 1.26 NA 17.12 090
muscle.
24342............... .............. A Repair of ruptured 10.60 NA 8.61 1.69 NA 20.90 090
tendon.
24343............... .............. A Repr elbow lat ligmnt 8.64 NA 8.07 1.39 NA 18.10 090
w/tiss.
24344............... .............. A Reconstruct elbow lat 13.98 NA 11.43 2.25 NA 27.66 090
ligmnt.
24345............... .............. A Repr elbw med ligmnt 8.64 NA 7.95 1.40 NA 17.99 090
w/tissu.
24346............... .............. A Reconstruct elbow med 13.98 NA 11.25 2.04 NA 27.27 090
ligmnt.
24350............... .............. A Repair of tennis 5.24 NA 5.68 0.86 NA 11.78 090
elbow.
24351............... .............. A Repair of tennis 5.90 NA 6.02 0.98 NA 12.90 090
elbow.
24352............... .............. A Repair of tennis 6.42 NA 6.28 1.09 NA 13.79 090
elbow.
24354............... .............. A Repair of tennis 6.47 NA 6.24 1.11 NA 13.82 090
elbow.
24356............... .............. A Revision of tennis 6.67 NA 6.42 1.08 NA 14.17 090
elbow.
24360............... .............. A Reconstruct elbow 12.32 NA 9.46 1.92 NA 23.70 090
joint.
[[Page 47593]]
24361............... .............. A Reconstruct elbow 14.06 NA 10.56 2.10 NA 26.72 090
joint.
24362............... .............. A Reconstruct elbow 14.97 NA 10.04 2.30 NA 27.31 090
joint.
24363............... .............. A Replace elbow joint.. 18.46 NA 13.69 2.84 NA 34.99 090
24365............... .............. A Reconstruct head of 8.38 NA 7.19 1.39 NA 16.96 090
radius.
24366............... .............. A Reconstruct head of 9.12 NA 7.53 1.47 NA 18.12 090
radius.
24400............... .............. A Revision of humerus.. 11.04 NA 9.14 1.82 NA 22.00 090
24410............... .............. A Revision of humerus.. 14.80 NA 10.60 2.57 NA 27.97 090
24420............... .............. A Revision of humerus.. 13.42 NA 10.90 2.07 NA 26.39 090
24430............... .............. A Repair of humerus.... 12.79 NA 9.97 2.04 NA 24.80 090
24435............... .............. A Repair humerus with 13.15 NA 11.12 2.10 NA 26.37 090
graft.
24470............... .............. A Revision of elbow 8.73 NA 7.80 0.77 NA 17.30 090
joint.
24495............... .............. A Decompression of 8.11 NA 8.94 1.18 NA 18.23 090
forearm.
24498............... .............. A Reinforce humerus.... 11.90 NA 9.50 1.93 NA 23.33 090
24500............... .............. A Treat humerus 3.21 4.86 3.71 0.48 8.55 7.40 090
fracture.
24505............... .............. A Treat humerus 5.16 6.59 5.39 0.86 12.61 11.41 090
fracture.
24515............... .............. A Treat humerus 11.63 NA 9.55 1.88 NA 23.06 090
fracture.
24516............... .............. A Treat humerus 11.63 NA 9.31 1.88 NA 22.82 090
fracture.
24530............... .............. A Treat humerus 3.49 5.20 4.05 0.55 9.24 8.09 090
fracture.
24535............... .............. A Treat humerus 6.86 7.83 6.62 1.16 15.85 14.64 090
fracture.
24538............... .............. A Treat humerus 9.42 NA 8.89 1.51 NA 19.82 090
fracture.
24545............... .............. A Treat humerus 10.44 NA 8.60 1.70 NA 20.74 090
fracture.
24546............... .............. A Treat humerus 15.67 NA 11.50 2.52 NA 29.69 090
fracture.
24560............... .............. A Treat humerus 2.80 4.49 3.22 0.39 7.68 6.41 090
fracture.
24565............... .............. A Treat humerus 5.55 6.62 5.52 0.94 13.11 12.01 090
fracture.
24566............... .............. A Treat humerus 7.78 NA 8.34 1.33 NA 17.45 090
fracture.
24575............... .............. A Treat humerus 10.64 NA 8.44 1.70 NA 20.78 090
fracture.
24576............... .............. A Treat humerus 2.86 4.77 3.73 0.42 8.05 7.01 090
fracture.
24577............... .............. A Treat humerus 5.78 6.92 5.83 0.97 13.67 12.58 090
fracture.
24579............... .............. A Treat humerus 11.58 NA 9.02 1.89 NA 22.49 090
fracture.
24582............... .............. A Treat humerus 8.54 NA 9.26 1.48 NA 19.28 090
fracture.
24586............... .............. A Treat elbow fracture. 15.19 NA 11.26 2.45 NA 28.90 090
24587............... .............. A Treat elbow fracture. 15.14 NA 11.05 2.23 NA 28.42 090
24600............... .............. A Treat elbow 4.22 4.86 3.53 0.47 9.55 8.22 090
dislocation.
24605............... .............. A Treat elbow 5.41 NA 5.41 0.87 NA 11.69 090
dislocation.
24615............... .............. A Treat elbow 9.41 NA 7.87 1.53 NA 18.81 090
dislocation.
24620............... .............. A Treat elbow fracture. 6.97 NA 6.27 1.07 NA 14.31 090
24635............... .............. A Treat elbow fracture. 13.17 NA 14.21 2.17 NA 29.55 090
24640............... .............. A Treat elbow 1.20 1.85 0.81 0.13 3.18 2.14 010
dislocation.
24650............... .............. A Treat radius fracture 2.16 3.79 2.78 0.33 6.28 5.27 090
24655............... .............. A Treat radius fracture 4.39 5.95 4.80 0.70 11.04 9.89 090
24665............... .............. A Treat radius fracture 8.13 NA 7.69 1.35 NA 17.17 090
24666............... .............. A Treat radius fracture 9.48 NA 8.25 1.55 NA 19.28 090
24670............... .............. A Treat ulnar fracture. 2.54 4.11 3.09 0.38 7.03 6.01 090
24675............... .............. A Treat ulnar fracture. 4.71 6.00 4.97 0.77 11.48 10.45 090
24685............... .............. A Treat ulnar fracture. 8.79 NA 7.72 1.43 NA 17.94 090
24800............... .............. A Fusion of elbow joint 11.18 NA 8.87 1.63 NA 21.68 090
24802............... .............. A Fusion/graft of elbow 13.67 NA 10.49 2.16 NA 26.32 090
joint.
24900............... .............. A Amputation of upper 9.59 NA 7.49 1.44 NA 18.52 090
arm.
24920............... .............. A Amputation of upper 9.53 NA 7.71 1.48 NA 18.72 090
arm.
24925............... .............. A Amputation follow-up 7.06 NA 6.44 1.12 NA 14.62 090
surgery.
24930............... .............. A Amputation follow-up 10.23 NA 7.66 1.53 NA 19.42 090
surgery.
24931............... .............. A Amputate upper arm & 12.70 NA 6.10 1.88 NA 20.68 090
implant.
24935............... .............. A Revision of 15.54 NA 8.40 2.05 NA 25.99 090
amputation.
25000............... .............. A Incision of tendon 3.37 NA 6.96 0.53 NA 10.86 090
sheath.
25001............... .............. A Incise flexor carpi 3.37 NA 4.16 0.52 NA 8.05 090
radialis.
25020............... .............. A Decompress forearm 1 5.91 NA 9.84 0.95 NA 16.70 090
space.
25023............... .............. A Decompress forearm 1 12.94 NA 15.33 1.91 NA 30.18 090
space.
25024............... .............. A Decompress forearm 2 9.49 NA 7.51 1.10 NA 18.10 090
spaces.
25025............... .............. A Decompress forearm 2 16.52 NA 9.99 1.79 NA 28.30 090
spaces.
25028............... .............. A Drainage of forearm 5.24 NA 8.40 0.78 NA 14.42 090
lesion.
25031............... .............. A Drainage of forearm 4.13 NA 8.21 0.63 NA 12.97 090
bursa.
25035............... .............. A Treat forearm bone 7.35 NA 13.88 1.21 NA 22.44 090
lesion.
25040............... .............. A Explore/treat wrist 7.17 NA 7.40 1.15 NA 15.72 090
joint.
25065............... .............. A Biopsy forearm soft 1.99 3.23 1.90 0.20 5.42 4.09 010
tissues.
25066............... .............. A Biopsy forearm soft 4.12 NA 7.18 0.62 NA 11.92 090
tissues.
25075............... .............. A Removel forearm 3.73 NA 6.06 0.52 NA 10.31 090
lesion subcu.
25076............... .............. A Removel forearm 4.91 NA 9.83 0.74 NA 15.48 090
lesion deep.
25077............... .............. A Remove tumor, forearm/ 9.75 NA 12.53 1.38 NA 23.66 090
wrist.
25085............... .............. A Incision of wrist 5.49 NA 7.40 0.84 NA 13.73 090
capsule.
25100............... .............. A Biopsy of wrist joint 3.89 NA 5.49 0.58 NA 9.96 090
25101............... .............. A Explore/treat wrist 4.68 NA 6.06 0.51 NA 11.25 090
joint.
25105............... .............. A Remove wrist joint 5.84 NA 7.58 0.91 NA 14.33 090
lining.
25107............... .............. A Remove wrist joint 6.42 NA 8.54 0.97 NA 15.93 090
cartilage.
25110............... .............. A Remove wrist tendon 3.91 NA 7.20 0.60 NA 11.71 090
lesion.
25111............... .............. A Remove wrist tendon 3.38 NA 4.89 0.52 NA 8.79 090
lesion.
[[Page 47594]]
25112............... .............. A Reremove wrist tendon 4.52 NA 5.49 0.70 NA 10.71 090
lesion.
25115............... .............. A Remove wrist/forearm 8.81 NA 14.32 1.31 NA 24.44 090
lesion.
25116............... .............. A Remove wrist/forearm 7.10 NA 13.40 1.08 NA 21.58 090
lesion.
25118............... .............. A Excise wrist tendon 4.36 NA 5.97 0.68 NA 11.01 090
sheath.
25119............... .............. A Partial removal of 6.03 NA 7.86 0.90 NA 14.79 090
ulna.
25120............... .............. A Removal of forearm 6.09 NA 12.28 0.99 NA 19.36 090
lesion.
25125............... .............. A Remove/graft forearm 7.47 NA 13.08 1.14 NA 21.69 090
lesion.
25126............... .............. A Remove/graft forearm 7.54 NA 13.15 1.16 NA 21.85 090
lesion.
25130............... .............. A Removal of wrist 5.25 NA 6.61 0.81 NA 12.67 090
lesion.
25135............... .............. A Remove & graft wrist 6.88 NA 7.64 0.93 NA 15.45 090
lesion.
25136............... .............. A Remove & graft wrist 5.96 NA 6.77 0.89 NA 13.62 090
lesion.
25145............... .............. A Remove forearm bone 6.36 NA 12.33 0.91 NA 19.60 090
lesion.
25150............... .............. A Partial removal of 7.08 NA 8.50 1.11 NA 16.69 090
ulna.
25151............... .............. A Partial removal of 7.38 NA 12.93 1.12 NA 21.43 090
radius.
25170............... .............. A Extensive forearm 11.07 NA 15.29 1.69 NA 28.05 090
surgery.
25210............... .............. A Removal of wrist bone 5.94 NA 7.00 0.87 NA 13.81 090
25215............... .............. A Removal of wrist 7.88 NA 9.00 1.20 NA 18.08 090
bones.
25230............... .............. A Partial removal of 5.22 NA 6.31 0.78 NA 12.31 090
radius.
25240............... .............. A Partial removal of 5.16 NA 7.18 0.80 NA 13.14 090
ulna.
25246............... .............. A Injection for wrist x- 1.45 3.48 0.48 0.09 5.02 2.02 000
ray.
25248............... .............. A Remove forearm 5.13 NA 8.64 0.70 NA 14.47 090
foreign body.
25250............... .............. A Removal of wrist 6.59 NA 6.09 0.95 NA 13.63 090
prosthesis.
25251............... .............. A Removal of wrist 9.56 NA 7.91 1.27 NA 18.74 090
prosthesis.
25259............... .............. A Manipulate wrist w/ 3.74 NA 5.62 0.62 NA 9.98 090
anesthes.
25260............... .............. A Repair forearm tendon/ 7.79 NA 13.77 1.17 NA 22.73 090
muscle.
25263............... .............. A Repair forearm tendon/ 7.81 NA 13.67 1.11 NA 22.59 090
muscle.
25265............... .............. A Repair forearm tendon/ 9.87 NA 14.56 1.36 NA 25.79 090
muscle.
25270............... .............. A Repair forearm tendon/ 5.99 NA 12.45 0.92 NA 19.36 090
muscle.
25272............... .............. A Repair forearm tendon/ 7.03 NA 13.15 1.10 NA 21.28 090
muscle.
25274............... .............. A Repair forearm tendon/ 8.74 NA 13.88 1.28 NA 23.90 090
muscle.
25275............... .............. A Repair forearm tendon 8.49 NA 7.49 1.19 NA 17.17 090
sheath.
25280............... .............. A Revise wrist/forearm 7.21 NA 12.88 1.07 NA 21.16 090
tendon.
25290............... .............. A Incise wrist/forearm 5.28 NA 15.12 0.81 NA 21.21 090
tendon.
25295............... .............. A Release wrist/forearm 6.54 NA 12.45 0.95 NA 19.94 090
tendon.
25300............... .............. A Fusion of tendons at 8.79 NA 8.61 1.15 NA 18.55 090
wrist.
25301............... .............. A Fusion of tendons at 8.39 NA 8.26 1.24 NA 17.89 090
wrist.
25310............... .............. A Transplant forearm 8.13 NA 13.29 1.17 NA 22.59 090
tendon.
25312............... .............. A Transplant forearm 9.56 NA 14.17 1.37 NA 25.10 090
tendon.
25315............... .............. A Revise palsy hand 10.18 NA 14.74 1.52 NA 26.44 090
tendon(s).
25316............... .............. A Revise palsy hand 12.31 NA 16.51 2.07 NA 30.89 090
tendon(s).
25320............... .............. A Repair/revise wrist 10.75 NA 11.40 1.58 NA 23.73 090
joint.
25332............... .............. A Revise wrist joint... 11.39 NA 9.15 1.72 NA 22.26 090
25335............... .............. A Realignment of hand.. 12.86 NA 11.80 2.00 NA 26.66 090
25337............... .............. A Reconstruct ulna/ 10.15 NA 11.24 1.57 NA 22.96 090
radioulnar.
25350............... .............. A Revision of radius... 8.77 NA 14.12 1.36 NA 24.25 090
25355............... .............. A Revision of radius... 10.15 NA 14.74 1.39 NA 26.28 090
25360............... .............. A Revision of ulna..... 8.42 NA 14.01 1.36 NA 23.79 090
25365............... .............. A Revise radius & ulna. 12.38 NA 15.77 2.03 NA 30.18 090
25370............... .............. A Revise radius or ulna 13.34 NA 16.19 2.27 NA 31.80 090
25375............... .............. A Revise radius & ulna. 13.02 NA 16.55 2.22 NA 31.79 090
25390............... .............. A Shorten radius or 10.38 NA 14.74 1.55 NA 26.67 090
ulna.
25391............... .............. A Lengthen radius or 13.63 NA 16.70 2.17 NA 32.50 090
ulna.
25392............... .............. A Shorten radius & ulna 13.93 NA 16.09 2.15 NA 32.17 090
25393............... .............. A Lengthen radius & 15.85 NA 17.71 2.76 NA 36.32 090
ulna.
25394............... .............. A Repair carpal bone, 10.38 NA 8.05 1.31 NA 19.74 090
shorten.
25400............... .............. A Repair radius or ulna 10.90 NA 15.32 1.73 NA 27.95 090
25405............... .............. A Repair/graft radius 14.36 NA 17.42 2.27 NA 34.05 090
or ulna.
25415............... .............. A Repair radius & ulna. 13.33 NA 16.64 2.07 NA 32.04 090
25420............... .............. A Repair/graft radius & 16.31 NA 18.41 2.58 NA 37.30 090
ulna.
25425............... .............. A Repair/graft radius 13.19 NA 21.64 1.91 NA 36.74 090
or ulna.
25426............... .............. A Repair/graft radius & 15.80 NA 16.70 1.39 NA 33.89 090
ulna.
25430............... .............. A Vasc graft into 9.24 NA 7.21 1.25 NA 17.70 090
carpal bone.
25431............... .............. A Repair nonunion 10.42 NA 8.33 1.69 NA 20.44 090
carpal bone.
25440............... .............. A Repair/graft wrist 10.42 NA 9.51 1.50 NA 21.43 090
bone.
25441............... .............. A Reconstruct wrist 12.88 NA 9.98 2.06 NA 24.92 090
joint.
25442............... .............. A Reconstruct wrist 10.83 NA 8.86 1.51 NA 21.20 090
joint.
25443............... .............. A Reconstruct wrist 10.37 NA 8.75 1.66 NA 20.78 090
joint.
25444............... .............. A Reconstruct wrist 11.13 NA 9.01 1.53 NA 21.67 090
joint.
25445............... .............. A Reconstruct wrist 9.68 NA 7.97 1.52 NA 19.17 090
joint.
25446............... .............. A Wrist replacement.... 16.53 NA 11.90 2.43 NA 30.86 090
25447............... .............. A Repair wrist joint(s) 10.35 NA 8.63 1.53 NA 20.51 090
25449............... .............. A Remove wrist joint 14.47 NA 10.64 2.08 NA 27.19 090
implant.
25450............... .............. A Revision of wrist 7.86 NA 10.31 1.22 NA 19.39 090
joint.
25455............... .............. A Revision of wrist 9.48 NA 11.25 1.21 NA 21.94 090
joint.
25490............... .............. A Reinforce radius..... 9.53 NA 13.89 1.38 NA 24.80 090
[[Page 47595]]
25491............... .............. A Reinforce ulna....... 9.95 NA 14.66 1.52 NA 26.13 090
25492............... .............. A Reinforce radius and 12.31 NA 15.43 2.14 NA 29.88 090
ulna.
25500............... .............. A Treat fracture of 2.45 3.59 2.74 0.33 6.37 5.52 090
radius.
25505............... .............. A Treat fracture of 5.20 6.54 5.43 0.82 12.56 11.45 090
radius.
25515............... .............. A Treat fracture of 9.17 NA 7.65 1.47 NA 18.29 090
radius.
25520............... .............. A Treat fracture of 6.25 6.86 6.06 1.02 14.13 13.33 090
radius.
25525............... .............. A Treat fracture of 12.22 NA 10.16 1.97 NA 24.35 090
radius.
25526............... .............. A Treat fracture of 12.96 NA 13.63 2.04 NA 28.63 090
radius.
25530............... .............. A Treat fracture of 2.09 3.77 2.88 0.32 6.18 5.29 090
ulna.
25535............... .............. A Treat fracture of 5.13 6.02 5.29 0.83 11.98 11.25 090
ulna.
25545............... .............. A Treat fracture of 8.89 NA 7.85 1.43 NA 18.17 090
ulna.
25560............... .............. A Treat fracture radius 2.44 3.71 2.64 0.33 6.48 5.41 090
& ulna.
25565............... .............. A Treat fracture radius 5.62 6.70 5.43 0.90 13.22 11.95 090
& ulna.
25574............... .............. A Treat fracture radius 7.00 NA 7.37 1.14 NA 15.51 090
& ulna.
25575............... .............. A Treat fracture radius/ 10.43 NA 9.66 1.67 NA 21.76 090
ulna.
25600............... .............. A Treat fracture radius/ 2.63 4.09 2.99 0.39 7.11 6.01 090
ulna.
25605............... .............. A Treat fracture radius/ 5.80 7.22 6.21 0.96 13.98 12.97 090
ulna.
25611............... .............. A Treat fracture radius/ 7.76 NA 9.11 1.32 NA 18.19 090
ulna.
25620............... .............. A Treat fracture radius/ 8.54 NA 7.47 1.35 NA 17.36 090
ulna.
25622............... .............. A Treat wrist bone 2.61 4.27 3.13 0.39 7.27 6.13 090
fracture.
25624............... .............. A Treat wrist bone 4.52 6.30 5.08 0.72 11.54 10.32 090
fracture.
25628............... .............. A Treat wrist bone 8.42 NA 8.04 1.30 NA 17.76 090
fracture.
25630............... .............. A Treat wrist bone 2.88 4.19 2.97 0.43 7.50 6.28 090
fracture.
25635............... .............. A Treat wrist bone 4.38 5.94 3.93 0.65 10.97 8.96 090
fracture.
25645............... .............. A Treat wrist bone 7.24 NA 6.99 1.12 NA 15.35 090
fracture.
25650............... .............. A Treat wrist bone 3.05 4.31 3.21 0.41 7.77 6.67 090
fracture.
25651............... .............. A Pin ulnar styloid 5.35 NA 5.42 0.73 NA 11.50 090
fracture.
25652............... .............. A Treat fracture ulnar 7.59 NA 6.94 1.19 NA 15.72 090
styloid.
25660............... .............. A Treat wrist 4.75 NA 4.76 0.64 NA 10.15 090
dislocation.
25670............... .............. A Treat wrist 7.91 NA 7.27 1.23 NA 16.41 090
dislocation.
25671............... .............. A Pin radioulnar 5.99 NA 6.07 0.93 NA 12.99 090
dislocation.
25675............... .............. A Treat wrist 4.66 5.67 4.67 0.61 10.94 9.94 090
dislocation.
25676............... .............. A Treat wrist 8.03 NA 7.53 1.34 NA 16.90 090
dislocation.
25680............... .............. A Treat wrist fracture. 5.98 NA 4.85 0.73 NA 11.56 090
25685............... .............. A Treat wrist fracture. 9.77 NA 8.05 1.53 NA 19.35 090
25690............... .............. A Treat wrist 5.49 NA 5.57 0.89 NA 11.95 090
dislocation.
25695............... .............. A Treat wrist 8.33 NA 7.38 1.32 NA 17.03 090
dislocation.
25800............... .............. A Fusion of wrist joint 9.75 NA 9.20 1.31 NA 20.26 090
25805............... .............. A Fusion/graft of wrist 11.26 NA 10.35 1.79 NA 23.40 090
joint.
25810............... .............. A Fusion/graft of wrist 10.55 NA 10.01 1.60 NA 22.16 090
joint.
25820............... .............. A Fusion of hand bones. 7.44 NA 7.99 1.11 NA 16.54 090
25825............... .............. A Fuse hand bones with 9.26 NA 9.34 1.34 NA 19.94 090
graft.
25830............... .............. A Fusion, radioulnar 10.04 NA 14.57 1.39 NA 26.00 090
jnt/ulna.
25900............... .............. A Amputation of forearm 9.00 NA 12.73 1.36 NA 23.09 090
25905............... .............. A Amputation of forearm 9.11 NA 12.65 1.28 NA 23.04 090
25907............... .............. A Amputation follow-up 7.79 NA 12.07 1.20 NA 21.06 090
surgery.
25909............... .............. A Amputation follow-up 8.95 NA 12.60 1.21 NA 22.76 090
surgery.
25915............... .............. A Amputation of forearm 17.05 NA 19.33 1.13 NA 37.51 090
25920............... .............. A Amputate hand at 8.67 NA 8.07 1.33 NA 18.07 090
wrist.
25922............... .............. A Amputate hand at 7.41 NA 7.30 1.29 NA 16.00 090
wrist.
25924............... .............. A Amputation follow-up 8.45 NA 8.31 1.47 NA 18.23 090
surgery.
25927............... .............. A Amputation of hand... 8.79 NA 12.00 1.34 NA 22.13 090
25929............... .............. A Amputation follow-up 7.58 NA 6.15 1.27 NA 15.00 090
surgery.
25931............... .............. A Amputation follow-up 7.80 NA 11.93 1.04 NA 20.77 090
surgery.
26010............... .............. A Drainage of finger 1.54 5.60 1.64 0.17 7.31 3.35 010
abscess.
26011............... .............. A Drainage of finger 2.19 8.81 2.32 0.32 11.32 4.83 010
abscess.
26020............... .............. A Drain hand tendon 4.66 NA 5.73 0.72 NA 11.11 090
sheath.
26025............... .............. A Drainage of palm 4.81 NA 5.52 0.74 NA 11.07 090
bursa.
26030............... .............. A Drainage of palm 5.92 NA 6.16 0.92 NA 13.00 090
bursa(s).
26034............... .............. A Treat hand bone 6.22 NA 6.34 0.97 NA 13.53 090
lesion.
26035............... .............. A Decompress fingers/ 9.50 NA 8.28 1.40 NA 19.18 090
hand.
26037............... .............. A Decompress fingers/ 7.24 NA 6.74 1.09 NA 15.07 090
hand.
26040............... .............. A Release palm 3.33 NA 4.04 0.54 NA 7.91 090
contracture.
26045............... .............. A Release palm 5.55 NA 5.63 0.93 NA 12.11 090
contracture.
26055............... .............. A Incise finger tendon 2.69 14.17 3.93 0.43 17.29 7.05 090
sheath.
26060............... .............. A Incision of finger 2.81 NA 3.50 0.44 NA 6.75 090
tendon.
26070............... .............. A Explore/treat hand 3.68 NA 3.38 0.47 NA 7.53 090
joint.
26075............... .............. A Explore/treat finger 3.78 NA 3.79 0.52 NA 8.09 090
joint.
26080............... .............. A Explore/treat finger 4.23 NA 4.85 0.65 NA 9.73 090
joint.
26100............... .............. A Biopsy hand joint 3.66 NA 4.13 0.54 NA 8.33 090
lining.
26105............... .............. A Biopsy finger joint 3.70 NA 4.22 0.58 NA 8.50 090
lining.
26110............... .............. A Biopsy finger joint 3.52 NA 4.03 0.53 NA 8.08 090
lining.
26115............... .............. A Removel hand lesion 3.85 13.01 4.76 0.59 17.45 9.20 090
subcut.
26116............... .............. A Removel hand lesion, 5.52 NA 5.99 0.82 NA 12.33 090
deep.
26117............... .............. A Remove tumor, hand/ 8.54 NA 7.05 1.24 NA 16.83 090
finger.
[[Page 47596]]
26121............... .............. A Release palm 7.53 NA 6.95 1.17 NA 15.65 090
contracture.
26123............... .............. A Release palm 9.28 NA 8.85 1.42 NA 19.55 090
contracture.
26125............... .............. A Release palm 4.60 NA 2.44 0.70 NA 7.74 ZZZ
contracture.
26130............... .............. A Remove wrist joint 5.41 NA 5.33 0.97 NA 11.71 090
lining.
26135............... .............. A Revise finger joint, 6.95 NA 6.45 1.01 NA 14.41 090
each.
26140............... .............. A Revise finger joint, 6.16 NA 6.03 0.92 NA 13.11 090
each.
26145............... .............. A Tendon excision, palm/ 6.31 NA 6.04 0.98 NA 13.33 090
finger.
26160............... .............. A Remove tendon sheath 3.15 12.36 4.12 0.48 15.99 7.75 090
lesion.
26170............... .............. A Removal of palm 4.76 NA 4.93 0.71 NA 10.40 090
tendon, each.
26180............... .............. A Removal of finger 5.17 NA 5.40 0.81 NA 11.38 090
tendon.
26185............... .............. A Remove finger bone... 5.24 NA 6.02 0.72 NA 11.98 090
26200............... .............. A Remove hand bone 5.50 NA 5.35 0.87 NA 11.72 090
lesion.
26205............... .............. A Remove/graft bone 7.69 NA 6.88 1.20 NA 15.77 090
lesion.
26210............... .............. A Removal of finger 5.14 NA 5.41 0.79 NA 11.34 090
lesion.
26215............... .............. A Remove/graft finger 7.09 NA 6.30 1.10 NA 14.49 090
lesion.
26230............... .............. A Partial removal of 6.32 NA 5.90 0.95 NA 13.17 090
hand bone.
26235............... .............. A Partial removal, 6.18 NA 5.80 0.93 NA 12.91 090
finger bone.
26236............... .............. A Partial removal, 5.31 NA 5.32 0.80 NA 11.43 090
finger bone.
26250............... .............. A Extensive hand 7.54 NA 6.42 1.21 NA 15.17 090
surgery.
26255............... .............. A Extensive hand 12.41 NA 9.38 1.47 NA 23.26 090
surgery.
26260............... .............. A Extensive finger 7.02 NA 6.17 1.05 NA 14.24 090
surgery.
26261............... .............. A Extensive finger 9.08 NA 6.20 1.29 NA 16.57 090
surgery.
26262............... .............. A Partial removal of 5.66 NA 5.32 0.85 NA 11.83 090
finger.
26320............... .............. A Removal of implant 3.97 NA 4.31 0.59 NA 8.87 090
from hand.
26340............... .............. A Manipulate finger w/ 2.50 NA 4.87 0.39 NA 7.76 090
anesth.
26350............... .............. A Repair finger/hand 5.98 NA 15.28 0.85 NA 22.11 090
tendon.
26352............... .............. A Repair/graft hand 7.67 NA 15.84 1.19 NA 24.70 090
tendon.
26356............... .............. A Repair finger/hand 8.06 NA 18.75 1.22 NA 28.03 090
tendon.
26357............... .............. A Repair finger/hand 8.57 NA 16.30 1.33 NA 26.20 090
tendon.
26358............... .............. A Repair/graft hand 9.13 NA 17.19 1.34 NA 27.66 090
tendon.
26370............... .............. A Repair finger/hand 7.10 NA 15.70 1.09 NA 23.89 090
tendon.
26372............... .............. A Repair/graft hand 8.75 NA 17.07 1.27 NA 27.09 090
tendon.
26373............... .............. A Repair finger/hand 8.15 NA 16.64 1.30 NA 26.09 090
tendon.
26390............... .............. A Revise hand/finger 9.18 NA 13.77 1.35 NA 24.30 090
tendon.
26392............... .............. A Repair/graft hand 10.24 NA 17.43 1.49 NA 29.16 090
tendon.
26410............... .............. A Repair hand tendon... 4.62 NA 12.40 0.72 NA 17.74 090
26412............... .............. A Repair/graft hand 6.30 NA 13.72 0.98 NA 21.00 090
tendon.
26415............... .............. A Excision, hand/finger 8.33 NA 12.22 1.06 NA 21.61 090
tendon.
26416............... .............. A Graft hand or finger 9.36 NA 15.03 1.18 NA 25.57 090
tendon.
26418............... .............. A Repair finger tendon. 4.24 NA 12.78 0.65 NA 17.67 090
26420............... .............. A Repair/graft finger 6.76 NA 14.05 1.05 NA 21.86 090
tendon.
26426............... .............. A Repair finger/hand 6.14 NA 13.57 0.96 NA 20.67 090
tendon.
26428............... .............. A Repair/graft finger 7.20 NA 14.32 1.10 NA 22.62 090
tendon.
26432............... .............. A Repair finger tendon. 4.01 NA 10.55 0.62 NA 15.18 090
26433............... .............. A Repair finger tendon. 4.55 NA 11.22 0.70 NA 16.47 090
26434............... .............. A Repair/graft finger 6.08 NA 11.92 0.88 NA 18.88 090
tendon.
26437............... .............. A Realignment of 5.81 NA 11.84 0.89 NA 18.54 090
tendons.
26440............... .............. A Release palm/finger 5.01 NA 13.94 0.76 NA 19.71 090
tendon.
26442............... .............. A Release palm & finger 8.15 NA 16.43 1.16 NA 25.74 090
tendon.
26445............... .............. A Release hand/finger 4.30 NA 13.70 0.66 NA 18.66 090
tendon.
26449............... .............. A Release forearm/hand 6.99 NA 16.21 1.03 NA 24.23 090
tendon.
26450............... .............. A Incision of palm 3.66 NA 7.53 0.58 NA 11.77 090
tendon.
26455............... .............. A Incision of finger 3.63 NA 7.46 0.55 NA 11.64 090
tendon.
26460............... .............. A Incise hand/finger 3.45 NA 7.28 0.51 NA 11.24 090
tendon.
26471............... .............. A Fusion of finger 5.72 NA 11.52 0.88 NA 18.12 090
tendons.
26474............... .............. A Fusion of finger 5.31 NA 11.69 0.74 NA 17.74 090
tendons.
26476............... .............. A Tendon lengthening... 5.17 NA 11.23 0.79 NA 17.19 090
26477............... .............. A Tendon shortening.... 5.14 NA 11.40 0.77 NA 17.31 090
26478............... .............. A Lengthening of hand 5.79 NA 12.09 0.94 NA 18.82 090
tendon.
26479............... .............. A Shortening of hand 5.73 NA 11.94 0.90 NA 18.57 090
tendon.
26480............... .............. A Transplant hand 6.68 NA 15.43 1.00 NA 23.11 090
tendon.
26483............... .............. A Transplant/graft hand 8.28 NA 15.89 1.22 NA 25.39 090
tendon.
26485............... .............. A Transplant palm 7.69 NA 15.77 1.09 NA 24.55 090
tendon.
26489............... .............. A Transplant/graft palm 9.54 NA 12.39 1.18 NA 23.11 090
tendon.
26490............... .............. A Revise thumb tendon.. 8.40 NA 13.04 1.17 NA 22.61 090
26492............... .............. A Tendon transfer with 9.61 NA 13.84 1.39 NA 24.84 090
graft.
26494............... .............. A Hand tendon/muscle 8.46 NA 13.47 1.21 NA 23.14 090
transfer.
26496............... .............. A Revise thumb tendon.. 9.58 NA 13.47 1.38 NA 24.43 090
26497............... .............. A Finger tendon 9.56 NA 13.82 1.46 NA 24.84 090
transfer.
26498............... .............. A Finger tendon 13.98 NA 16.40 1.95 NA 32.33 090
transfer.
26499............... .............. A Revision of finger... 8.97 NA 13.40 1.30 NA 23.67 090
26500............... .............. A Hand tendon 5.95 NA 11.98 0.89 NA 18.82 090
reconstruction.
26502............... .............. A Hand tendon 7.13 NA 12.45 1.03 NA 20.61 090
reconstruction.
26504............... .............. A Hand tendon 7.46 NA 12.85 1.18 NA 21.49 090
reconstruction.
26508............... .............. A Release thumb 6.00 NA 11.97 0.94 NA 18.91 090
contracture.
[[Page 47597]]
26510............... .............. A Thumb tendon transfer 5.42 NA 11.65 0.77 NA 17.84 090
26516............... .............. A Fusion of knuckle 7.14 NA 12.50 1.04 NA 20.68 090
joint.
26517............... .............. A Fusion of knuckle 8.82 NA 13.82 1.49 NA 24.13 090
joints.
26518............... .............. A Fusion of knuckle 9.01 NA 13.63 1.52 NA 24.16 090
joints.
26520............... .............. A Release knuckle 5.29 NA 14.38 0.80 NA 20.47 090
contracture.
26525............... .............. A Release finger 5.32 NA 14.49 0.81 NA 20.62 090
contracture.
26530............... .............. A Revise knuckle joint. 6.68 NA 6.13 1.03 NA 13.84 090
26531............... .............. A Revise knuckle with 7.90 NA 7.10 1.15 NA 16.15 090
implant.
26535............... .............. A Revise finger joint.. 5.23 NA 3.74 0.58 NA 9.55 090
26536............... .............. A Revise/implant finger 6.36 NA 9.63 0.89 NA 16.88 090
joint.
26540............... .............. A Repair hand joint.... 6.42 NA 12.22 0.97 NA 19.61 090
26541............... .............. A Repair hand joint 8.61 NA 13.69 1.23 NA 23.53 090
with graft.
26542............... .............. A Repair hand joint 6.77 NA 12.25 0.98 NA 20.00 090
with graft.
26545............... .............. A Reconstruct finger 6.91 NA 12.66 1.01 NA 20.58 090
joint.
26546............... .............. A Repair nonunion hand. 8.91 NA 15.14 1.33 NA 25.38 090
26548............... .............. A Reconstruct finger 8.02 NA 13.25 1.16 NA 22.43 090
joint.
26550............... .............. A Construct thumb 21.21 NA 18.11 2.98 NA 42.30 090
replacement.
26551............... .............. A Great toe-hand 46.51 NA 33.36 5.65 NA 85.52 090
transfer.
26553............... .............. A Single transfer, toe- 46.20 NA 22.83 3.49 NA 72.52 090
hand.
26554............... .............. A Double transfer, toe- 54.87 NA 37.75 9.36 NA 101.98 090
hand.
26555............... .............. A Positional change of 16.61 NA 18.47 2.26 NA 37.34 090
finger.
26556............... .............. A Toe joint transfer... 47.19 NA 33.81 8.04 NA 89.04 090
26560............... .............. A Repair of web finger. 5.37 NA 10.18 0.76 NA 16.31 090
26561............... .............. A Repair of web finger. 10.90 NA 12.81 1.53 NA 25.24 090
26562............... .............. A Repair of web finger. 14.98 NA 17.46 1.18 NA 33.62 090
26565............... .............. A Correct metacarpal 6.73 NA 12.32 0.96 NA 20.01 090
flaw.
26567............... .............. A Correct finger 6.81 NA 12.25 1.02 NA 20.08 090
deformity.
26568............... .............. A Lengthen metacarpal/ 9.07 NA 15.87 1.34 NA 26.28 090
finger.
26580............... .............. A Repair hand deformity 18.15 NA 14.01 1.88 NA 34.04 090
26587............... .............. A Reconstruct extra 14.03 NA 9.06 1.46 NA 24.55 090
finger.
26590............... .............. A Repair finger 17.93 NA 14.31 1.62 NA 33.86 090
deformity.
26591............... .............. A Repair muscles of 3.25 NA 10.31 0.49 NA 14.05 090
hand.
26593............... .............. A Release muscles of 5.30 NA 11.38 0.77 NA 17.45 090
hand.
26596............... .............. A Excision constricting 8.94 NA 9.00 1.38 NA 19.32 090
tissue.
26600............... .............. A Treat metacarpal 1.96 3.61 2.68 0.29 5.86 4.93 090
fracture.
26605............... .............. A Treat metacarpal 2.85 4.56 3.65 0.45 7.86 6.95 090
fracture.
26607............... .............. A Treat metacarpal 5.35 NA 6.38 0.84 NA 12.57 090
fracture.
26608............... .............. A Treat metacarpal 5.35 NA 6.54 0.88 NA 12.77 090
fracture.
26615............... .............. A Treat metacarpal 5.32 NA 5.73 0.85 NA 11.90 090
fracture.
26641............... .............. A Treat thumb 3.93 4.60 3.58 0.43 8.96 7.94 090
dislocation.
26645............... .............. A Treat thumb fracture. 4.40 5.18 4.20 0.62 10.20 9.22 090
26650............... .............. A Treat thumb fracture. 5.71 NA 6.95 0.94 NA 13.60 090
26665............... .............. A Treat thumb fracture. 7.59 NA 6.99 1.19 NA 15.77 090
26670............... .............. A Treat hand 3.68 4.29 2.99 0.39 8.36 7.06 090
dislocation.
26675............... .............. A Treat hand 4.63 5.48 4.48 0.72 10.83 9.83 090
dislocation.
26676............... .............. A Pin hand dislocation. 5.51 NA 6.99 0.88 NA 13.38 090
26685............... .............. A Treat hand 6.97 NA 6.44 1.05 NA 14.46 090
dislocation.
26686............... .............. A Treat hand 7.93 NA 7.21 1.21 NA 16.35 090
dislocation.
26700............... .............. A Treat knuckle 3.68 3.79 2.91 0.34 7.81 6.93 090
dislocation.
26705............... .............. A Treat knuckle 4.18 5.35 4.31 0.61 10.14 9.10 090
dislocation.
26706............... .............. A Pin knuckle 5.11 NA 5.27 0.77 NA 11.15 090
dislocation.
26715............... .............. A Treat knuckle 5.73 NA 5.91 0.89 NA 12.53 090
dislocation.
26720............... .............. A Treat finger 1.66 2.79 2.09 0.22 4.67 3.97 090
fracture, each.
26725............... .............. A Treat finger 3.33 4.77 3.51 0.50 8.60 7.34 090
fracture, each.
26727............... .............. A Treat finger 5.22 NA 6.60 0.84 NA 12.66 090
fracture, each.
26735............... .............. A Treat finger 5.97 NA 6.06 0.94 NA 12.97 090
fracture, each.
26740............... .............. A Treat finger 1.94 3.14 2.71 0.30 5.38 4.95 090
fracture, each.
26742............... .............. A Treat finger 3.84 4.99 3.89 0.56 9.39 8.29 090
fracture, each.
26746............... .............. A Treat finger 5.80 NA 6.12 0.91 NA 12.83 090
fracture, each.
26750............... .............. A Treat finger 1.70 2.49 2.05 0.20 4.39 3.95 090
fracture, each.
26755............... .............. A Treat finger 3.10 4.43 3.02 0.41 7.94 6.53 090
fracture, each.
26756............... .............. A Pin finger fracture, 4.38 NA 6.23 0.69 NA 11.30 090
each.
26765............... .............. A Treat finger 4.16 NA 4.96 0.62 NA 9.74 090
fracture, each.
26770............... .............. A Treat finger 3.02 3.46 2.46 0.27 6.75 5.75 090
dislocation.
26775............... .............. A Treat finger 3.70 5.20 3.84 0.49 9.39 8.03 090
dislocation.
26776............... .............. A Pin finger 4.79 NA 6.40 0.73 NA 11.92 090
dislocation.
26785............... .............. A Treat finger 4.20 NA 4.99 0.67 NA 9.86 090
dislocation.
26820............... .............. A Thumb fusion with 8.25 NA 13.49 1.36 NA 23.10 090
graft.
26841............... .............. A Fusion of thumb...... 7.12 NA 13.39 1.17 NA 21.68 090
26842............... .............. A Thumb fusion with 8.23 NA 13.57 1.24 NA 23.04 090
graft.
26843............... .............. A Fusion of hand joint. 7.60 NA 12.53 1.21 NA 21.34 090
26844............... .............. A Fusion/graft of hand 8.72 NA 13.55 1.29 NA 23.56 090
joint.
26850............... .............. A Fusion of knuckle.... 6.96 NA 12.41 1.05 NA 20.42 090
26852............... .............. A Fusion of knuckle 8.45 NA 13.14 1.23 NA 22.82 090
with graft.
26860............... .............. A Fusion of finger 4.68 NA 11.42 0.73 NA 16.83 090
joint.
[[Page 47598]]
26861............... .............. A Fusion of finger jnt, 1.74 NA 0.93 0.24 NA 2.91 ZZZ
add-on.
26862............... .............. A Fusion/graft of 7.36 NA 12.63 1.05 NA 21.04 090
finger joint.
26863............... .............. A Fuse/graft added 3.89 NA 2.10 0.56 NA 6.55 ZZZ
joint.
26910............... .............. A Amputate metacarpal 7.59 NA 11.57 1.13 NA 20.29 090
bone.
26951............... .............. A Amputation of finger/ 4.58 NA 10.48 0.70 NA 15.76 090
thumb.
26952............... .............. A Amputation of finger/ 6.30 NA 12.05 0.94 NA 19.29 090
thumb.
26990............... .............. A Drainage of pelvis 7.47 NA 7.75 1.18 NA 16.40 090
lesion.
26991............... .............. A Drainage of pelvis 6.67 11.17 5.43 1.07 18.91 13.17 090
bursa.
26992............... .............. A Drainage of bone 13.00 NA 11.06 2.06 NA 26.12 090
lesion.
27000............... .............. A Incision of hip 5.61 NA 5.46 0.96 NA 12.03 090
tendon.
27001............... .............. A Incision of hip 6.93 NA 6.33 1.16 NA 14.42 090
tendon.
27003............... .............. A Incision of hip 7.33 NA 6.74 1.18 NA 15.25 090
tendon.
27005............... .............. A Incision of hip 9.65 NA 8.04 1.58 NA 19.27 090
tendon.
27006............... .............. A Incision of hip 9.67 NA 8.21 1.56 NA 19.44 090
tendons.
27025............... .............. A Incision of hip/thigh 11.14 NA 8.75 1.75 NA 21.64 090
fascia.
27030............... .............. A Drainage of hip joint 12.99 NA 9.85 2.10 NA 24.94 090
27033............... .............. A Exploration of hip 13.37 NA 10.12 2.20 NA 25.69 090
joint.
27035............... .............. A Denervation of hip 16.66 NA 12.61 2.43 NA 31.70 090
joint.
27036............... .............. A Excision of hip joint/ 12.86 NA 10.28 2.11 NA 25.25 090
muscle.
27040............... .............. A Biopsy of soft 2.87 5.25 2.01 0.30 8.42 5.18 010
tissues.
27041............... .............. A Biopsy of soft 9.88 NA 6.79 1.30 NA 17.97 090
tissues.
27047............... .............. A Remove hip/pelvis 7.44 7.14 4.78 1.00 15.58 13.22 090
lesion.
27048............... .............. A Remove hip/pelvis 6.24 NA 5.12 0.89 NA 12.25 090
lesion.
27049............... .............. A Remove tumor, hip/ 13.64 NA 8.93 1.95 NA 24.52 090
pelvis.
27050............... .............. A Biopsy of sacroiliac 4.35 NA 4.64 0.66 NA 9.65 090
joint.
27052............... .............. A Biopsy of hip joint.. 6.22 NA 6.09 0.98 NA 13.29 090
27054............... .............. A Removal of hip joint 8.53 NA 7.59 1.35 NA 17.47 090
lining.
27060............... .............. A Removal of ischial 5.42 NA 4.94 0.78 NA 11.14 090
bursa.
27062............... .............. A Remove femur lesion/ 5.36 NA 5.40 0.91 NA 11.67 090
bursa.
27065............... .............. A Removal of hip bone 5.89 NA 5.71 0.90 NA 12.50 090
lesion.
27066............... .............. A Removal of hip bone 10.31 NA 8.73 1.60 NA 20.64 090
lesion.
27067............... .............. A Remove/graft hip bone 13.81 NA 10.92 2.25 NA 26.98 090
lesion.
27070............... .............. A Partial removal of 10.70 NA 9.98 1.67 NA 22.35 090
hip bone.
27071............... .............. A Partial removal of 11.44 NA 10.98 1.82 NA 24.24 090
hip bone.
27075............... .............. A Extensive hip surgery 34.95 NA 19.82 5.16 NA 59.93 090
27076............... .............. A Extensive hip surgery 22.09 NA 15.05 3.43 NA 40.57 090
27077............... .............. A Extensive hip surgery 39.94 NA 23.29 5.61 NA 68.84 090
27078............... .............. A Extensive hip surgery 13.42 NA 10.70 2.12 NA 26.24 090
27079............... .............. A Extensive hip surgery 13.73 NA 10.31 2.00 NA 26.04 090
27080............... .............. A Removal of tail bone. 6.38 NA 5.17 0.92 NA 12.47 090
27086............... .............. A Remove hip foreign 1.87 4.57 1.82 0.22 6.66 3.91 010
body.
27087............... .............. A Remove hip foreign 8.53 NA 6.85 1.29 NA 16.67 090
body.
27090............... .............. A Removal of hip 11.13 NA 8.76 1.81 NA 21.70 090
prosthesis.
27091............... .............. A Removal of hip 22.11 NA 13.97 3.49 NA 39.57 090
prosthesis.
27093............... .............. A Injection for hip x- 1.30 4.50 0.48 0.12 5.92 1.90 000
ray.
27095............... .............. A Injection for hip x- 1.50 5.81 0.52 0.13 7.44 2.15 000
ray.
27096............... .............. A Inject sacroiliac 1.40 3.95 0.33 0.10 5.45 1.83 000
joint.
27097............... .............. A Revision of hip 8.79 NA 6.63 1.49 NA 16.91 090
tendon.
27098............... .............. A Transfer tendon to 8.82 NA 7.26 0.91 NA 16.99 090
pelvis.
27100............... .............. A Transfer of abdominal 11.06 NA 8.97 1.76 NA 21.79 090
muscle.
27105............... .............. A Transfer of spinal 11.75 NA 9.41 1.32 NA 22.48 090
muscle.
27110............... .............. A Transfer of iliopsoas 13.24 NA 9.48 1.82 NA 24.54 090
muscle.
27111............... .............. A Transfer of iliopsoas 12.13 NA 9.36 2.11 NA 23.60 090
muscle.
27120............... .............. A Reconstruction of hip 17.98 NA 11.83 2.73 NA 32.54 090
socket.
27122............... .............. A Reconstruction of hip 14.96 NA 11.02 2.42 NA 28.40 090
socket.
27125............... .............. A Partial hip 14.67 NA 10.60 2.32 NA 27.59 090
replacement.
27130............... .............. A Total hip 20.09 NA 13.28 3.11 NA 36.48 090
arthroplasty.
27132............... .............. A Total hip 23.27 NA 15.60 3.64 NA 42.51 090
arthroplasty.
27134............... .............. A Revise hip joint 28.48 NA 17.76 4.44 NA 50.68 090
replacement.
27137............... .............. A Revise hip joint 21.14 NA 13.90 3.35 NA 38.39 090
replacement.
27138............... .............. A Revise hip joint 22.14 NA 14.37 3.51 NA 40.02 090
replacement.
27140............... .............. A Transplant femur 12.22 NA 9.61 1.97 NA 23.80 090
ridge.
27146............... .............. A Incision of hip bone. 17.40 NA 12.49 2.61 NA 32.50 090
27147............... .............. A Revision of hip bone. 20.55 NA 13.51 2.80 NA 36.86 090
27151............... .............. A Incision of hip bones 22.48 NA 8.26 3.57 NA 34.31 090
27156............... .............. A Revision of hip bones 24.59 NA 16.32 3.52 NA 44.43 090
27158............... .............. A Revision of pelvis... 19.71 NA 11.30 3.14 NA 34.15 090
27161............... .............. A Incision of neck of 16.68 NA 12.29 2.77 NA 31.74 090
femur.
27165............... .............. A Incision/fixation of 17.88 NA 13.07 2.82 NA 33.77 090
femur.
27170............... .............. A Repair/graft femur 16.05 NA 11.49 2.56 NA 30.10 090
head/neck.
27175............... .............. A Treat slipped 8.45 NA 6.75 1.47 NA 16.67 090
epiphysis.
27176............... .............. A Treat slipped 12.03 NA 9.14 2.00 NA 23.17 090
epiphysis.
27177............... .............. A Treat slipped 15.06 NA 10.99 2.49 NA 28.54 090
epiphysis.
27178............... .............. A Treat slipped 11.97 NA 8.53 2.08 NA 22.58 090
epiphysis.
27179............... .............. A Revise head/neck of 12.96 NA 10.09 2.25 NA 25.30 090
femur.
[[Page 47599]]
27181............... .............. A Treat slipped 14.66 NA 10.31 2.28 NA 27.25 090
epiphysis.
27185............... .............. A Revision of femur 9.17 NA 7.78 1.59 NA 18.54 090
epiphysis.
27187............... .............. A Reinforce hip bones.. 13.52 NA 10.55 2.16 NA 26.23 090
27193............... .............. A Treat pelvic ring 5.55 5.32 5.17 0.93 11.80 11.65 090
fracture.
27194............... .............. A Treat pelvic ring 9.64 NA 7.64 1.62 NA 18.90 090
fracture.
27200............... .............. A Treat tail bone 1.84 2.23 2.17 0.26 4.33 4.27 090
fracture.
27202............... .............. A Treat tail bone 7.03 NA 17.13 0.93 NA 25.09 090
fracture.
27215............... .............. A Treat pelvic 10.03 NA 7.30 1.78 NA 19.11 090
fracture(s).
27216............... .............. A Treat pelvic ring 15.17 NA 9.91 2.49 NA 27.57 090
fracture.
27217............... .............. A Treat pelvic ring 14.09 NA 10.34 2.23 NA 26.66 090
fracture.
27218............... .............. A Treat pelvic ring 20.12 NA 11.62 3.23 NA 34.97 090
fracture.
27220............... .............. A Treat hip socket 6.17 5.71 5.62 1.05 12.93 12.84 090
fracture.
27222............... .............. A Treat hip socket 12.68 NA 10.04 2.17 NA 24.89 090
fracture.
27226............... .............. A Treat hip wall 14.89 NA 8.03 2.46 NA 25.38 090
fracture.
27227............... .............. A Treat hip fracture(s) 23.41 NA 15.53 3.73 NA 42.67 090
27228............... .............. A Treat hip fracture(s) 27.12 NA 17.75 4.44 NA 49.31 090
27230............... .............. A Treat thigh fracture. 5.49 5.51 5.11 0.90 11.90 11.50 090
27232............... .............. A Treat thigh fracture. 10.66 NA 7.34 1.78 NA 19.78 090
27235............... .............. A Treat thigh fracture. 12.14 NA 9.57 2.08 NA 23.79 090
27236............... .............. A Treat thigh fracture. 15.58 NA 11.04 2.49 NA 29.11 090
27238............... .............. A Treat thigh fracture. 5.51 NA 5.27 0.86 NA 11.64 090
27240............... .............. A Treat thigh fracture. 12.48 NA 9.58 2.06 NA 24.12 090
27244............... .............. A Treat thigh fracture. 15.92 NA 11.42 2.57 NA 29.91 090
27245............... .............. A Treat thigh fracture. 20.28 NA 13.85 3.24 NA 37.37 090
27246............... .............. A Treat thigh fracture. 4.70 4.45 4.42 0.80 9.95 9.92 090
27248............... .............. A Treat thigh fracture. 10.43 NA 8.35 1.68 NA 20.46 090
27250............... .............. A Treat hip dislocation 6.94 NA 4.75 0.61 NA 12.30 090
27252............... .............. A Treat hip dislocation 10.37 NA 7.53 1.58 NA 19.48 090
27253............... .............. A Treat hip dislocation 12.90 NA 9.89 1.91 NA 24.70 090
27254............... .............. A Treat hip dislocation 18.23 NA 12.17 2.97 NA 33.37 090
27256............... .............. A Treat hip dislocation 4.11 3.52 2.09 0.43 8.06 6.63 010
27257............... .............. A Treat hip dislocation 5.21 NA 2.82 0.67 NA 8.70 010
27258............... .............. A Treat hip dislocation 15.41 NA 11.10 2.51 NA 29.02 090
27259............... .............. A Treat hip dislocation 21.52 NA 14.33 3.35 NA 39.20 090
27265............... .............. A Treat hip dislocation 5.04 NA 4.91 0.64 NA 10.59 090
27266............... .............. A Treat hip dislocation 7.48 NA 6.46 1.26 NA 15.20 090
27275............... .............. A Manipulation of hip 2.27 NA 2.10 0.38 NA 4.75 010
joint.
27280............... .............. A Fusion of sacroiliac 13.37 NA 10.55 2.21 NA 26.13 090
joint.
27282............... .............. A Fusion of pubic bones 11.32 NA 8.34 1.26 NA 20.92 090
27284............... .............. A Fusion of hip joint.. 23.41 NA 15.00 3.26 NA 41.67 090
27286............... .............. A Fusion of hip joint.. 23.41 NA 16.02 3.54 NA 42.97 090
27290............... .............. A Amputation of leg at 23.25 NA 14.33 3.33 NA 40.91 090
hip.
27295............... .............. A Amputation of leg at 18.62 NA 11.64 2.77 NA 33.03 090
hip.
27301............... .............. A Drain thigh/knee 6.48 10.12 5.14 1.00 17.60 12.62 090
lesion.
27303............... .............. A Drainage of bone 8.27 NA 7.54 1.35 NA 17.16 090
lesion.
27305............... .............. A Incise thigh tendon & 5.91 NA 5.50 0.92 NA 12.33 090
fascia.
27306............... .............. A Incision of thigh 4.61 NA 4.97 0.79 NA 10.37 090
tendon.
27307............... .............. A Incision of thigh 5.79 NA 5.69 1.01 NA 12.49 090
tendons.
27310............... .............. A Exploration of knee 9.26 NA 7.75 1.51 NA 18.52 090
joint.
27315............... .............. A Partial removal, 6.96 NA 4.91 1.21 NA 13.08 090
thigh nerve.
27320............... .............. A Partial removal, 6.29 NA 5.19 0.94 NA 12.42 090
thigh nerve.
27323............... .............. A Biopsy, thigh soft 2.28 3.52 1.88 0.27 6.07 4.43 010
tissues.
27324............... .............. A Biopsy, thigh soft 4.89 NA 4.45 0.73 NA 10.07 090
tissues.
27327............... .............. A Removal of thigh 4.46 6.01 3.73 0.63 11.10 8.82 090
lesion.
27328............... .............. A Removal of thigh 5.56 NA 4.65 0.83 NA 11.04 090
lesion.
27329............... .............. A Remove tumor, thigh/ 14.12 NA 9.68 2.05 NA 25.85 090
knee.
27330............... .............. A Biopsy, knee joint 4.96 NA 4.72 0.85 NA 10.53 090
lining.
27331............... .............. A Explore/treat knee 5.87 NA 5.68 0.95 NA 12.50 090
joint.
27332............... .............. A Removal of knee 8.26 NA 7.26 1.38 NA 16.90 090
cartilage.
27333............... .............. A Removal of knee 7.29 NA 6.81 1.17 NA 15.27 090
cartilage.
27334............... .............. A Remove knee joint 8.69 NA 7.58 1.41 NA 17.68 090
lining.
27335............... .............. A Remove knee joint 9.99 NA 8.39 1.61 NA 19.99 090
lining.
27340............... .............. A Removal of kneecap 4.17 NA 4.69 0.71 NA 9.57 090
bursa.
27345............... .............. A Removal of knee cyst. 5.91 NA 5.77 0.95 NA 12.63 090
27347............... .............. A Remove knee cyst..... 5.77 NA 5.58 0.94 NA 12.29 090
27350............... .............. A Removal of kneecap... 8.16 NA 7.38 1.31 NA 16.85 090
27355............... .............. A Remove femur lesion.. 7.64 NA 7.03 1.20 NA 15.87 090
27356............... .............. A Remove femur lesion/ 9.47 NA 8.11 1.58 NA 19.16 090
graft.
27357............... .............. A Remove femur lesion/ 10.51 NA 8.94 1.81 NA 21.26 090
graft.
27358............... .............. A Remove femur lesion/ 4.73 NA 2.52 0.76 NA 8.01 ZZZ
fixation.
27360............... .............. A Partial removal, leg 10.48 NA 10.15 1.68 NA 22.31 090
bone(s).
27365............... .............. A Extensive leg surgery 16.25 NA 11.89 2.70 NA 30.84 090
27370............... .............. A Injection for knee x- 0.96 3.76 0.32 0.07 4.79 1.35 000
ray.
27372............... .............. A Removal of foreign 5.06 10.10 4.69 0.77 15.93 10.52 090
body.
27380............... .............. A Repair of kneecap 7.15 NA 7.37 1.16 NA 15.68 090
tendon.
[[Page 47600]]
27381............... .............. A Repair/graft kneecap 10.32 NA 9.17 1.63 NA 21.12 090
tendon.
27385............... .............. A Repair of thigh 7.75 NA 7.71 1.27 NA 16.73 090
muscle.
27386............... .............. A Repair/graft of thigh 10.54 NA 9.61 1.69 NA 21.84 090
muscle.
27390............... .............. A Incision of thigh 5.32 NA 5.43 0.84 NA 11.59 090
tendon.
27391............... .............. A Incision of thigh 7.19 NA 6.83 1.19 NA 15.21 090
tendons.
27392............... .............. A Incision of thigh 9.19 NA 7.94 1.52 NA 18.65 090
tendons.
27393............... .............. A Lengthening of thigh 6.38 NA 6.04 0.98 NA 13.40 090
tendon.
27394............... .............. A Lengthening of thigh 8.49 NA 7.49 1.37 NA 17.35 090
tendons.
27395............... .............. A Lengthening of thigh 11.71 NA 9.63 1.80 NA 23.14 090
tendons.
27396............... .............. A Transplant of thigh 7.85 NA 7.29 1.13 NA 16.27 090
tendon.
27397............... .............. A Transplants of thigh 11.26 NA 9.27 1.50 NA 22.03 090
tendons.
27400............... .............. A Revise thigh muscles/ 9.01 NA 7.52 1.47 NA 18.00 090
tendons.
27403............... .............. A Repair of knee 8.32 NA 7.33 1.34 NA 16.99 090
cartilage.
27405............... .............. A Repair of knee 8.64 NA 7.66 1.41 NA 17.71 090
ligament.
27407............... .............. A Repair of knee 10.26 NA 8.48 1.65 NA 20.39 090
ligament.
27409............... .............. A Repair of knee 12.88 NA 10.10 2.18 NA 25.16 090
ligaments.
27418............... .............. A Repair degenerated 10.83 NA 9.05 1.70 NA 21.58 090
kneecap.
27420............... .............. A Revision of unstable 9.82 NA 8.25 1.55 NA 19.62 090
kneecap.
27422............... .............. A Revision of unstable 9.77 NA 8.25 1.55 NA 19.57 090
kneecap.
27424............... .............. A Revision/removal of 9.80 NA 8.22 1.54 NA 19.56 090
kneecap.
27425............... .............. A Lat retinacular 5.21 NA 5.67 0.89 NA 11.77 090
release open.
27427............... .............. A Reconstruction, knee. 9.35 NA 7.95 1.47 NA 18.77 090
27428............... .............. A Reconstruction, knee. 13.98 NA 11.37 2.30 NA 27.65 090
27429............... .............. A Reconstruction, knee. 15.50 NA 12.61 2.61 NA 30.72 090
27430............... .............. A Revision of thigh 9.66 NA 8.15 1.53 NA 19.34 090
muscles.
27435............... .............. A Incision of knee 9.48 NA 8.59 1.45 NA 19.52 090
joint.
27437............... .............. A Revise kneecap....... 8.45 NA 7.23 1.51 NA 17.19 090
27438............... .............. A Revise kneecap with 11.21 NA 8.52 1.80 NA 21.53 090
implant.
27440............... .............. A Revision of knee 10.41 NA 6.01 1.56 NA 17.98 090
joint.
27441............... .............. A Revision of knee 10.80 NA 6.71 1.66 NA 19.17 090
joint.
27442............... .............. A Revision of knee 11.87 NA 8.90 1.86 NA 22.63 090
joint.
27443............... .............. A Revision of knee 10.91 NA 8.70 1.67 NA 21.28 090
joint.
27445............... .............. A Revision of knee 17.65 NA 12.32 2.80 NA 32.77 090
joint.
27446............... .............. A Revision of knee 15.82 NA 11.25 2.44 NA 29.51 090
joint.
27447............... .............. A Total knee 21.45 NA 14.57 3.35 NA 39.37 090
arthroplasty.
27448............... .............. A Incision of thigh.... 11.04 NA 8.86 1.67 NA 21.57 090
27450............... .............. A Incision of thigh.... 13.96 NA 10.81 2.26 NA 27.03 090
27454............... .............. A Realignment of thigh 17.53 NA 12.73 2.84 NA 33.10 090
bone.
27455............... .............. A Realignment of knee.. 12.80 NA 10.02 2.06 NA 24.88 090
27457............... .............. A Realignment of knee.. 13.43 NA 10.06 2.21 NA 25.70 090
27465............... .............. A Shortening of thigh 13.85 NA 10.55 2.31 NA 26.71 090
bone.
27466............... .............. A Lengthening of thigh 16.31 NA 12.12 2.57 NA 31.00 090
bone.
27468............... .............. A Shorten/lengthen 18.94 NA 12.62 2.90 NA 34.46 090
thighs.
27470............... .............. A Repair of thigh...... 16.05 NA 12.08 2.57 NA 30.70 090
27472............... .............. A Repair/graft of thigh 17.69 NA 12.96 2.85 NA 33.50 090
27475............... .............. A Surgery to stop leg 8.63 NA 7.40 1.50 NA 17.53 090
growth.
27477............... .............. A Surgery to stop leg 9.84 NA 7.90 1.72 NA 19.46 090
growth.
27479............... .............. A Surgery to stop leg 12.78 NA 10.03 2.22 NA 25.03 090
growth.
27485............... .............. A Surgery to stop leg 8.83 NA 7.56 1.71 NA 18.10 090
growth.
27486............... .............. A Revise/replace knee 19.24 NA 13.46 2.99 NA 35.69 090
joint.
27487............... .............. A Revise/replace knee 25.23 NA 16.52 3.90 NA 45.65 090
joint.
27488............... .............. A Removal of knee 15.72 NA 11.68 2.49 NA 29.89 090
prosthesis.
27495............... .............. A Reinforce thigh...... 15.53 NA 11.71 2.52 NA 29.76 090
27496............... .............. A Decompression of 6.10 NA 5.85 0.96 NA 12.91 090
thigh/knee.
27497............... .............. A Decompression of 7.16 NA 5.77 1.00 NA 13.93 090
thigh/knee.
27498............... .............. A Decompression of 7.98 NA 6.16 1.27 NA 15.41 090
thigh/knee.
27499............... .............. A Decompression of 8.99 NA 7.12 1.32 NA 17.43 090
thigh/knee.
27500............... .............. A Treatment of thigh 5.91 6.11 4.99 0.95 12.97 11.85 090
fracture.
27501............... .............. A Treatment of thigh 5.91 6.02 5.38 1.01 12.94 12.30 090
fracture.
27502............... .............. A Treatment of thigh 10.56 NA 8.35 1.73 NA 20.64 090
fracture.
27503............... .............. A Treatment of thigh 10.56 NA 8.52 1.80 NA 20.88 090
fracture.
27506............... .............. A Treatment of thigh 17.42 NA 12.93 2.83 NA 33.18 090
fracture.
27507............... .............. A Treatment of thigh 13.97 NA 10.04 2.24 NA 26.25 090
fracture.
27508............... .............. A Treatment of thigh 5.82 6.45 5.48 0.95 13.22 12.25 090
fracture.
27509............... .............. A Treatment of thigh 7.70 NA 8.03 1.30 NA 17.03 090
fracture.
27510............... .............. A Treatment of thigh 9.12 NA 7.34 1.54 NA 18.00 090
fracture.
27511............... .............. A Treatment of thigh 13.62 NA 11.29 2.20 NA 27.11 090
fracture.
27513............... .............. A Treatment of thigh 17.89 NA 13.95 2.91 NA 34.75 090
fracture.
27514............... .............. A Treatment of thigh 17.27 NA 13.42 2.76 NA 33.45 090
fracture.
27516............... .............. A Treat thigh fx growth 5.36 6.35 5.51 0.89 12.60 11.76 090
plate.
27517............... .............. A Treat thigh fx growth 8.77 NA 7.44 1.28 NA 17.49 090
plate.
27519............... .............. A Treat thigh fx growth 15.00 NA 11.71 2.42 NA 29.13 090
plate.
27520............... .............. A Treat kneecap 2.86 4.54 3.46 0.44 7.84 6.76 090
fracture.
27524............... .............. A Treat kneecap 9.99 NA 8.31 1.62 NA 19.92 090
fracture.
27530............... .............. A Treat knee fracture.. 3.77 5.31 4.43 0.62 9.70 8.82 090
[[Page 47601]]
27532............... .............. A Treat knee fracture.. 7.29 7.35 6.45 1.25 15.89 14.99 090
27535............... .............. A Treat knee fracture.. 11.48 NA 10.20 1.78 NA 23.46 090
27536............... .............. A Treat knee fracture.. 15.63 NA 11.67 2.56 NA 29.86 090
27538............... .............. A Treat knee 4.86 6.13 5.20 0.81 11.80 10.87 090
fracture(s).
27540............... .............. A Treat knee fracture.. 13.08 NA 9.60 2.11 NA 24.79 090
27550............... .............. A Treat knee 5.75 6.02 4.96 0.73 12.50 11.44 090
dislocation.
27552............... .............. A Treat knee 7.89 NA 7.08 1.34 NA 16.31 090
dislocation.
27556............... .............. A Treat knee 14.39 NA 11.79 2.32 NA 28.50 090
dislocation.
27557............... .............. A Treat knee 16.74 NA 13.25 2.83 NA 32.82 090
dislocation.
27558............... .............. A Treat knee 17.69 NA 13.18 2.82 NA 33.69 090
dislocation.
27560............... .............. A Treat kneecap 3.81 4.84 3.24 0.39 9.04 7.44 090
dislocation.
27562............... .............. A Treat kneecap 5.78 NA 4.88 0.75 NA 11.41 090
dislocation.
27566............... .............. A Treat kneecap 12.21 NA 9.41 2.03 NA 23.65 090
dislocation.
27570............... .............. A Fixation of knee 1.74 NA 1.77 0.30 NA 3.81 010
joint.
27580............... .............. A Fusion of knee....... 19.34 NA 14.85 3.09 NA 37.28 090
27590............... .............. A Amputate leg at thigh 12.01 NA 7.08 1.68 NA 20.77 090
27591............... .............. A Amputate leg at thigh 12.66 NA 9.04 1.95 NA 23.65 090
27592............... .............. A Amputate leg at thigh 10.00 NA 6.61 1.41 NA 18.02 090
27594............... .............. A Amputation follow-up 6.91 NA 5.49 1.02 NA 13.42 090
surgery.
27596............... .............. A Amputation follow-up 10.58 NA 7.27 1.55 NA 19.40 090
surgery.
27598............... .............. A Amputate lower leg at 10.51 NA 7.40 1.48 NA 19.39 090
knee.
27600............... .............. A Decompression of 5.64 NA 4.76 0.84 NA 11.24 090
lower leg.
27601............... .............. A Decompression of 5.63 NA 5.09 0.86 NA 11.58 090
lower leg.
27602............... .............. A Decompression of 7.34 NA 5.32 1.06 NA 13.72 090
lower leg.
27603............... .............. A Drain lower leg 4.93 7.53 4.17 0.71 13.17 9.81 090
lesion.
27604............... .............. A Drain lower leg bursa 4.46 6.10 3.96 0.67 11.23 9.09 090
27605............... .............. A Incision of achilles 2.87 7.67 2.32 0.36 10.90 5.55 010
tendon.
27606............... .............. A Incision of achilles 4.13 NA 3.36 0.66 NA 8.15 010
tendon.
27607............... .............. A Treat lower leg bone 7.96 NA 6.89 1.25 NA 16.10 090
lesion.
27610............... .............. A Explore/treat ankle 8.33 NA 7.28 1.34 NA 16.95 090
joint.
27612............... .............. A Exploration of ankle 7.32 NA 6.31 0.97 NA 14.60 090
joint.
27613............... .............. A Biopsy lower leg soft 2.17 3.24 1.80 0.22 5.63 4.19 010
tissue.
27614............... .............. A Biopsy lower leg soft 5.65 7.15 4.44 0.75 13.55 10.84 090
tissue.
27615............... .............. A Remove tumor, lower 12.54 NA 10.73 1.75 NA 25.02 090
leg.
27618............... .............. A Remove lower leg 5.08 6.03 4.00 0.68 11.79 9.76 090
lesion.
27619............... .............. A Remove lower leg 8.39 9.53 5.95 1.16 19.08 15.50 090
lesion.
27620............... .............. A Explore/treat ankle 5.97 NA 5.68 0.87 NA 12.52 090
joint.
27625............... .............. A Remove ankle joint 8.29 NA 6.75 1.14 NA 16.18 090
lining.
27626............... .............. A Remove ankle joint 8.90 NA 7.21 1.33 NA 17.44 090
lining.
27630............... .............. A Removal of tendon 4.79 7.60 4.38 0.67 13.06 9.84 090
lesion.
27635............... .............. A Remove lower leg bone 7.77 NA 7.09 1.25 NA 16.11 090
lesion.
27637............... .............. A Remove/graft leg bone 9.84 NA 8.61 1.61 NA 20.06 090
lesion.
27638............... .............. A Remove/graft leg bone 10.55 NA 8.63 1.70 NA 20.88 090
lesion.
27640............... .............. A Partial removal of 11.35 NA 11.05 1.78 NA 24.18 090
tibia.
27641............... .............. A Partial removal of 9.23 NA 9.03 1.39 NA 19.65 090
fibula.
27645............... .............. A Extensive lower leg 14.15 NA 12.52 2.12 NA 28.79 090
surgery.
27646............... .............. A Extensive lower leg 12.64 NA 11.52 1.83 NA 25.99 090
surgery.
27647............... .............. A Extensive ankle/heel 12.22 NA 8.03 1.23 NA 21.48 090
surgery.
27648............... .............. A Injection for ankle x- 0.96 3.57 0.33 0.07 4.60 1.36 000
ray.
27650............... .............. A Repair achilles 9.68 NA 7.69 1.44 NA 18.81 090
tendon.
27652............... .............. A Repair/graft achilles 10.31 NA 8.20 1.51 NA 20.02 090
tendon.
27654............... .............. A Repair of achilles 10.00 NA 7.43 1.32 NA 18.75 090
tendon.
27656............... .............. A Repair leg fascia 4.56 8.58 3.78 0.62 13.76 8.96 090
defect.
27658............... .............. A Repair of leg tendon, 4.97 NA 4.56 0.70 NA 10.23 090
each.
27659............... .............. A Repair of leg tendon, 6.80 NA 5.64 0.97 NA 13.41 090
each.
27664............... .............. A Repair of leg tendon, 4.58 NA 4.55 0.68 NA 9.81 090
each.
27665............... .............. A Repair of leg tendon, 5.39 NA 4.97 0.82 NA 11.18 090
each.
27675............... .............. A Repair lower leg 7.17 NA 5.97 0.94 NA 14.08 090
tendons.
27676............... .............. A Repair lower leg 8.41 NA 6.96 0.91 NA 16.28 090
tendons.
27680............... .............. A Release of lower leg 5.73 NA 5.37 0.87 NA 11.97 090
tendon.
27681............... .............. A Release of lower leg 6.81 NA 6.15 1.06 NA 14.02 090
tendons.
27685............... .............. A Revision of lower leg 6.49 7.29 5.46 0.82 14.60 12.77 090
tendon.
27686............... .............. A Revise lower leg 7.45 NA 6.48 1.21 NA 15.14 090
tendons.
27687............... .............. A Revision of calf 6.23 NA 5.62 0.89 NA 12.74 090
tendon.
27690............... .............. A Revise lower leg 8.70 NA 6.65 1.16 NA 16.51 090
tendon.
27691............... .............. A Revise lower leg 9.95 NA 8.02 1.46 NA 19.43 090
tendon.
27692............... .............. A Revise additional leg 1.87 NA 0.92 0.28 NA 3.07 ZZZ
tendon.
27695............... .............. A Repair of ankle 6.50 NA 6.14 1.01 NA 13.65 090
ligament.
27696............... .............. A Repair of ankle 8.26 NA 6.71 1.10 NA 16.07 090
ligaments.
27698............... .............. A Repair of ankle 9.35 NA 7.16 1.29 NA 17.80 090
ligament.
27700............... .............. A Revision of ankle 9.28 NA 5.67 1.03 NA 15.98 090
joint.
27702............... .............. A Reconstruct ankle 13.65 NA 10.44 2.15 NA 26.24 090
joint.
27703............... .............. A Reconstruction, ankle 15.85 NA 11.21 2.48 NA 29.54 090
joint.
27704............... .............. A Removal of ankle 7.61 NA 5.59 1.22 NA 14.42 090
implant.
27705............... .............. A Incision of tibia.... 10.36 NA 8.45 1.60 NA 20.41 090
[[Page 47602]]
27707............... .............. A Incision of fibula... 4.36 NA 5.24 0.74 NA 10.34 090
27709............... .............. A Incision of tibia & 9.94 NA 8.39 1.54 NA 19.87 090
fibula.
27712............... .............. A Realignment of lower 14.23 NA 10.97 2.22 NA 27.42 090
leg.
27715............... .............. A Revision of lower leg 14.37 NA 11.09 2.38 NA 27.84 090
27720............... .............. A Repair of tibia...... 11.77 NA 9.71 1.90 NA 23.38 090
27722............... .............. A Repair/graft of tibia 11.80 NA 9.46 1.94 NA 23.20 090
27724............... .............. A Repair/graft of tibia 18.17 NA 12.68 2.93 NA 33.78 090
27725............... .............. A Repair of lower leg.. 15.57 NA 12.18 2.53 NA 30.28 090
27727............... .............. A Repair of lower leg.. 13.99 NA 10.68 2.22 NA 26.89 090
27730............... .............. A Repair of tibia 7.40 NA 6.42 1.29 NA 15.11 090
epiphysis.
27732............... .............. A Repair of fibula 5.31 NA 4.93 0.57 NA 10.81 090
epiphysis.
27734............... .............. A Repair lower leg 8.47 NA 6.61 0.68 NA 15.76 090
epiphyses.
27740............... .............. A Repair of leg 9.29 NA 7.98 1.58 NA 18.85 090
epiphyses.
27742............... .............. A Repair of leg 10.28 3.88 3.88 0.68 14.84 14.84 090
epiphyses.
27745............... .............. A Reinforce tibia...... 10.05 NA 8.44 1.70 NA 20.19 090
27750............... .............. A Treatment of tibia 3.19 4.76 3.86 0.51 8.46 7.56 090
fracture.
27752............... .............. A Treatment of tibia 5.83 6.64 5.66 0.99 13.46 12.48 090
fracture.
27756............... .............. A Treatment of tibia 6.77 NA 6.79 1.09 NA 14.65 090
fracture.
27758............... .............. A Treatment of tibia 11.65 NA 9.41 1.82 NA 22.88 090
fracture.
27759............... .............. A Treatment of tibia 13.74 NA 10.54 2.23 NA 26.51 090
fracture.
27760............... .............. A Treatment of ankle 3.01 4.68 3.62 0.44 8.13 7.07 090
fracture.
27762............... .............. A Treatment of ankle 5.24 6.33 5.27 0.80 12.37 11.31 090
fracture.
27766............... .............. A Treatment of ankle 8.35 NA 7.36 1.41 NA 17.12 090
fracture.
27780............... .............. A Treatment of fibula 2.65 4.19 3.24 0.39 7.23 6.28 090
fracture.
27781............... .............. A Treatment of fibula 4.39 5.49 4.64 0.71 10.59 9.74 090
fracture.
27784............... .............. A Treatment of fibula 7.10 NA 6.65 1.18 NA 14.93 090
fracture.
27786............... .............. A Treatment of ankle 2.84 4.46 3.36 0.43 7.73 6.63 090
fracture.
27788............... .............. A Treatment of ankle 4.44 5.63 4.65 0.71 10.78 9.80 090
fracture.
27792............... .............. A Treatment of ankle 7.65 NA 7.10 1.28 NA 16.03 090
fracture.
27808............... .............. A Treatment of ankle 2.83 4.80 3.71 0.44 8.07 6.98 090
fracture.
27810............... .............. A Treatment of ankle 5.12 6.23 5.15 0.81 12.16 11.08 090
fracture.
27814............... .............. A Treatment of ankle 10.66 NA 8.75 1.71 NA 21.12 090
fracture.
27816............... .............. A Treatment of ankle 2.89 4.39 3.43 0.41 7.69 6.73 090
fracture.
27818............... .............. A Treatment of ankle 5.49 6.37 5.17 0.80 12.66 11.46 090
fracture.
27822............... .............. A Treatment of ankle 10.98 NA 10.80 1.79 NA 23.57 090
fracture.
27823............... .............. A Treatment of ankle 12.98 NA 11.64 2.11 NA 26.73 090
fracture.
27824............... .............. A Treat lower leg 2.89 4.59 3.57 0.44 7.92 6.90 090
fracture.
27825............... .............. A Treat lower leg 6.18 6.59 5.37 1.00 13.77 12.55 090
fracture.
27826............... .............. A Treat lower leg 8.53 NA 9.01 1.36 NA 18.90 090
fracture.
27827............... .............. A Treat lower leg 14.04 NA 12.90 2.31 NA 29.25 090
fracture.
27828............... .............. A Treat lower leg 16.21 NA 14.06 2.65 NA 32.92 090
fracture.
27829............... .............. A Treat lower leg joint 5.48 NA 6.92 0.89 NA 13.29 090
27830............... .............. A Treat lower leg 3.78 4.41 3.87 0.49 8.68 8.14 090
dislocation.
27831............... .............. A Treat lower leg 4.55 NA 4.58 0.75 NA 9.88 090
dislocation.
27832............... .............. A Treat lower leg 6.48 NA 6.36 1.07 NA 13.91 090
dislocation.
27840............... .............. A Treat ankle 4.57 NA 3.91 0.45 NA 8.93 090
dislocation.
27842............... .............. A Treat ankle 6.20 NA 5.18 0.92 NA 12.30 090
dislocation.
27846............... .............. A Treat ankle 9.78 NA 8.12 1.61 NA 19.51 090
dislocation.
27848............... .............. A Treat ankle 11.18 NA 9.84 1.74 NA 22.76 090
dislocation.
27860............... .............. A Fixation of ankle 2.34 NA 1.98 0.37 NA 4.69 010
joint.
27870............... .............. A Fusion of ankle 13.89 NA 10.75 2.04 NA 26.68 090
joint, open.
27871............... .............. A Fusion of 9.16 NA 7.85 1.47 NA 18.48 090
tibiofibular joint.
27880............... .............. A Amputation of lower 11.83 NA 7.48 1.67 NA 20.98 090
leg.
27881............... .............. A Amputation of lower 12.32 NA 9.16 1.89 NA 23.37 090
leg.
27882............... .............. A Amputation of lower 8.93 NA 6.90 1.26 NA 17.09 090
leg.
27884............... .............. A Amputation follow-up 8.20 NA 6.15 1.21 NA 15.56 090
surgery.
27886............... .............. A Amputation follow-up 9.31 NA 6.89 1.38 NA 17.58 090
surgery.
27888............... .............. A Amputation of foot at 9.66 NA 7.76 1.43 NA 18.85 090
ankle.
27889............... .............. A Amputation of foot at 9.97 NA 6.76 1.40 NA 18.13 090
ankle.
27892............... .............. A Decompression of leg. 7.38 NA 5.92 1.01 NA 14.31 090
27893............... .............. A Decompression of leg. 7.34 NA 5.83 1.08 NA 14.25 090
27894............... .............. A Decompression of leg. 10.47 NA 8.01 1.58 NA 20.06 090
28001............... .............. A Drainage of bursa of 2.73 2.98 1.95 0.23 5.94 4.91 010
foot.
28002............... .............. A Treatment of foot 4.61 4.99 3.76 0.51 10.11 8.88 010
infection.
28003............... .............. A Treatment of foot 8.40 6.24 5.22 0.93 15.57 14.55 090
infection.
28005............... .............. A Treat foot bone 8.67 NA 6.57 0.95 NA 16.19 090
lesion.
28008............... .............. A Incision of foot 4.44 4.56 3.21 0.43 9.43 8.08 090
fascia.
28010............... .............. A Incision of toe 2.84 2.38 2.38 0.27 5.49 5.49 090
tendon.
28011............... .............. A Incision of toe 4.13 NA 3.30 0.47 NA 7.90 090
tendons.
28020............... .............. A Exploration of foot 5.00 6.03 4.13 0.64 11.67 9.77 090
joint.
28022............... .............. A Exploration of foot 4.66 5.20 3.85 0.49 10.35 9.00 090
joint.
28024............... .............. A Exploration of toe 4.37 5.22 3.92 0.43 10.02 8.72 090
joint.
28030............... .............. A Removal of foot nerve 6.14 NA 3.61 0.55 NA 10.30 090
28035............... .............. A Decompression of 5.08 5.85 4.09 0.57 11.50 9.74 090
tibia nerve.
28043............... .............. A Excision of foot 3.53 3.82 3.17 0.37 7.72 7.07 090
lesion.
[[Page 47603]]
28045............... .............. A Excision of foot 4.71 5.38 3.60 0.49 10.58 8.80 090
lesion.
28046............... .............. A Resection of tumor, 10.16 8.76 6.47 1.17 20.09 17.80 090
foot.
28050............... .............. A Biopsy of foot joint 4.24 4.89 3.59 0.55 9.68 8.38 090
lining.
28052............... .............. A Biopsy of foot joint 3.93 4.92 3.43 0.42 9.27 7.78 090
lining.
28054............... .............. A Biopsy of toe joint 3.44 4.73 3.22 0.34 8.51 7.00 090
lining.
28060............... .............. A Partial removal, foot 5.22 5.47 3.87 0.53 11.22 9.62 090
fascia.
28062............... .............. A Removal of foot 6.51 6.53 4.01 0.61 13.65 11.13 090
fascia.
28070............... .............. A Removal of foot joint 5.09 5.22 3.81 0.56 10.87 9.46 090
lining.
28072............... .............. A Removal of foot joint 4.57 5.53 4.29 0.63 10.73 9.49 090
lining.
28080............... .............. A Removal of foot 3.57 5.12 3.68 0.35 9.04 7.60 090
lesion.
28086............... .............. A Excise foot tendon 4.77 7.98 4.68 0.69 13.44 10.14 090
sheath.
28088............... .............. A Excise foot tendon 3.85 5.76 3.89 0.51 10.12 8.25 090
sheath.
28090............... .............. A Removal of foot 4.40 5.15 3.44 0.46 10.01 8.30 090
lesion.
28092............... .............. A Removal of toe 3.63 5.22 3.52 0.40 9.25 7.55 090
lesions.
28100............... .............. A Removal of ankle/heel 5.65 7.98 4.69 0.70 14.33 11.04 090
lesion.
28102............... .............. A Remove/graft foot 7.72 NA 6.24 0.88 NA 14.84 090
lesion.
28103............... .............. A Remove/graft foot 6.49 NA 4.61 0.70 NA 11.80 090
lesion.
28104............... .............. A Removal of foot 5.11 5.49 3.92 0.56 11.16 9.59 090
lesion.
28106............... .............. A Remove/graft foot 7.15 NA 4.75 0.64 NA 12.54 090
lesion.
28107............... .............. A Remove/graft foot 5.55 6.54 4.20 0.54 12.63 10.29 090
lesion.
28108............... .............. A Removal of toe 4.15 4.59 3.25 0.37 9.11 7.77 090
lesions.
28110............... .............. A Part removal of 4.07 5.22 3.22 0.41 9.70 7.70 090
metatarsal.
28111............... .............. A Part removal of 5.00 6.28 3.65 0.55 11.83 9.20 090
metatarsal.
28112............... .............. A Part removal of 4.48 5.80 3.56 0.51 10.79 8.55 090
metatarsal.
28113............... .............. A Part removal of 4.78 6.07 4.32 0.49 11.34 9.59 090
metatarsal.
28114............... .............. A Removal of metatarsal 9.78 11.63 8.37 1.23 22.64 19.38 090
heads.
28116............... .............. A Revision of foot..... 7.74 6.80 5.17 0.83 15.37 13.74 090
28118............... .............. A Removal of heel bone. 5.95 6.25 4.34 0.69 12.89 10.98 090
28119............... .............. A Removal of heel spur. 5.38 5.43 3.72 0.52 11.33 9.62 090
28120............... .............. A Part removal of ankle/ 5.39 7.30 4.41 0.66 13.35 10.46 090
heel.
28122............... .............. A Partial removal of 7.28 6.84 5.26 0.76 14.88 13.30 090
foot bone.
28124............... .............. A Partial removal of 4.80 5.00 3.65 0.42 10.22 8.87 090
toe.
28126............... .............. A Partial removal of 3.51 4.21 2.99 0.32 8.04 6.82 090
toe.
28130............... .............. A Removal of ankle bone 8.10 NA 6.92 1.12 NA 16.14 090
28140............... .............. A Removal of metatarsal 6.90 7.22 4.76 0.79 14.91 12.45 090
28150............... .............. A Removal of toe....... 4.08 4.84 3.28 0.41 9.33 7.77 090
28153............... .............. A Partial removal of 3.65 4.31 2.68 0.34 8.30 6.67 090
toe.
28160............... .............. A Partial removal of 3.73 4.57 3.33 0.37 8.67 7.43 090
toe.
28171............... .............. A Extensive foot 9.59 NA 5.86 0.83 NA 16.28 090
surgery.
28173............... .............. A Extensive foot 8.79 7.59 5.19 0.85 17.23 14.83 090
surgery.
28175............... .............. A Extensive foot 6.04 5.70 3.70 0.53 12.27 10.27 090
surgery.
28190............... .............. A Removal of foot 1.96 3.40 1.49 0.17 5.53 3.62 010
foreign body.
28192............... .............. A Removal of foot 4.63 5.49 3.64 0.46 10.58 8.73 090
foreign body.
28193............... .............. A Removal of foot 5.72 5.61 3.93 0.56 11.89 10.21 090
foreign body.
28200............... .............. A Repair of foot tendon 4.59 5.10 3.55 0.48 10.17 8.62 090
28202............... .............. A Repair/graft of foot 6.83 7.40 4.49 0.64 14.87 11.96 090
tendon.
28208............... .............. A Repair of foot tendon 4.36 4.82 3.30 0.42 9.60 8.08 090
28210............... .............. A Repair/graft of foot 6.34 6.22 4.02 0.64 13.20 11.00 090
tendon.
28220............... .............. A Release of foot 4.52 4.67 3.42 0.40 9.59 8.34 090
tendon.
28222............... .............. A Release of foot 5.61 5.24 4.12 0.49 11.34 10.22 090
tendons.
28225............... .............. A Release of foot 3.65 4.28 2.90 0.33 8.26 6.88 090
tendon.
28226............... .............. A Release of foot 4.52 4.80 3.74 0.45 9.77 8.71 090
tendons.
28230............... .............. A Incision of foot 4.23 4.67 3.66 0.42 9.32 8.31 090
tendon(s).
28232............... .............. A Incision of toe 3.38 4.53 3.31 0.34 8.25 7.03 090
tendon.
28234............... .............. A Incision of foot 3.36 4.68 3.35 0.34 8.38 7.05 090
tendon.
28238............... .............. A Revision of foot 7.72 7.25 4.93 0.81 15.78 13.46 090
tendon.
28240............... .............. A Release of big toe... 4.35 4.64 3.48 0.45 9.44 8.28 090
28250............... .............. A Revision of foot 5.91 5.63 4.13 0.68 12.22 10.72 090
fascia.
28260............... .............. A Release of midfoot 7.95 6.34 4.99 0.92 15.21 13.86 090
joint.
28261............... .............. A Revision of foot 11.71 8.62 7.29 1.12 21.45 20.12 090
tendon.
28262............... .............. A Revision of foot and 15.81 13.56 10.90 2.43 31.80 29.14 090
ankle.
28264............... .............. A Release of midfoot 10.33 7.74 7.28 1.28 19.35 18.89 090
joint.
28270............... .............. A Release of foot 4.75 4.89 3.73 0.46 10.10 8.94 090
contracture.
28272............... .............. A Release of toe joint, 3.79 4.18 2.85 0.31 8.28 6.95 090
each.
28280............... .............. A Fusion of toes....... 5.18 6.25 4.48 0.63 12.06 10.29 090
28285............... .............. A Repair of hammertoe.. 4.58 4.87 3.42 0.44 9.89 8.44 090
28286............... .............. A Repair of hammertoe.. 4.55 4.79 3.25 0.41 9.75 8.21 090
28288............... .............. A Partial removal of 4.73 5.94 4.88 0.53 11.20 10.14 090
foot bone.
28289............... .............. A Repair hallux rigidus 7.03 7.98 5.75 0.87 15.88 13.65 090
28290............... .............. A Correction of bunion. 5.65 6.26 4.72 0.69 12.60 11.06 090
28292............... .............. A Correction of bunion. 7.03 7.48 5.54 0.67 15.18 13.24 090
28293............... .............. A Correction of bunion. 9.14 10.63 6.10 0.79 20.56 16.03 090
28294............... .............. A Correction of bunion. 8.55 7.45 4.72 0.81 16.81 14.08 090
28296............... .............. A Correction of bunion. 9.17 8.16 5.41 0.88 18.21 15.46 090
28297............... .............. A Correction of bunion. 9.17 8.95 6.25 1.08 19.20 16.50 090
[[Page 47604]]
28298............... .............. A Correction of bunion. 7.93 7.23 5.00 0.80 15.96 13.73 090
28299............... .............. A Correction of bunion. 10.56 8.77 6.06 1.01 20.34 17.63 090
28300............... .............. A Incision of heel bone 9.53 NA 7.02 1.36 NA 17.91 090
28302............... .............. A Incision of ankle 9.54 NA 6.88 1.59 NA 18.01 090
bone.
28304............... .............. A Incision of midfoot 9.15 8.37 5.93 1.05 18.57 16.13 090
bones.
28305............... .............. A Incise/graft midfoot 10.48 4.63 4.63 0.87 15.98 15.98 090
bones.
28306............... .............. A Incision of 5.85 7.37 4.41 0.69 13.91 10.95 090
metatarsal.
28307............... .............. A Incision of 6.32 11.75 5.49 0.82 18.89 12.63 090
metatarsal.
28308............... .............. A Incision of 5.28 6.27 3.90 0.53 12.08 9.71 090
metatarsal.
28309............... .............. A Incision of 12.76 NA 8.22 1.70 NA 22.68 090
metatarsals.
28310............... .............. A Revision of big toe.. 5.42 6.48 4.13 0.53 12.43 10.08 090
28312............... .............. A Revision of toe...... 4.54 6.21 4.28 0.51 11.26 9.33 090
28313............... .............. A Repair deformity of 5.00 6.67 5.64 0.63 12.30 11.27 090
toe.
28315............... .............. A Removal of sesamoid 4.85 6.03 3.80 0.46 11.34 9.11 090
bone.
28320............... .............. A Repair of foot bones. 9.17 NA 6.93 1.27 NA 17.37 090
28322............... .............. A Repair of metatarsals 8.33 10.27 6.50 1.16 19.76 15.99 090
28340............... .............. A Resect enlarged toe 6.97 7.26 4.56 0.58 14.81 12.11 090
tissue.
28341............... .............. A Resect enlarged toe.. 8.40 7.45 5.10 0.72 16.57 14.22 090
28344............... .............. A Repair extra toe(s).. 4.25 6.93 3.86 0.51 11.69 8.62 090
28345............... .............. A Repair webbed toe(s). 5.91 7.19 4.97 0.54 13.64 11.42 090
28360............... .............. A Reconstruct cleft 13.32 NA 10.75 1.90 NA 25.97 090
foot.
28400............... .............. A Treatment of heel 2.16 3.63 3.06 0.32 6.11 5.54 090
fracture.
28405............... .............. A Treatment of heel 4.56 4.83 4.61 0.71 10.10 9.88 090
fracture.
28406............... .............. A Treatment of heel 6.30 NA 6.98 1.03 NA 14.31 090
fracture.
28415............... .............. A Treat heel fracture.. 15.95 NA 13.42 2.44 NA 31.81 090
28420............... .............. A Treat/graft heel 16.62 NA 13.08 2.65 NA 32.35 090
fracture.
28430............... .............. A Treatment of ankle 2.09 3.39 2.58 0.29 5.77 4.96 090
fracture.
28435............... .............. A Treatment of ankle 3.39 3.90 3.74 0.48 7.77 7.61 090
fracture.
28436............... .............. A Treatment of ankle 4.70 NA 6.10 0.76 NA 11.56 090
fracture.
28445............... .............. A Treat ankle fracture. 15.60 NA 11.26 2.40 NA 29.26 090
28450............... .............. A Treat midfoot 1.90 3.11 2.50 0.25 5.26 4.65 090
fracture, each.
28455............... .............. A Treat midfoot 3.09 3.43 3.43 0.41 6.93 6.93 090
fracture, each.
28456............... .............. A Treat midfoot 2.68 NA 4.38 0.43 NA 7.49 090
fracture.
28465............... .............. A Treat midfoot 7.00 NA 6.48 0.97 NA 14.45 090
fracture, each.
28470............... .............. A Treat metatarsal 1.99 3.12 2.46 0.27 5.38 4.72 090
fracture.
28475............... .............. A Treat metatarsal 2.97 3.33 3.21 0.38 6.68 6.56 090
fracture.
28476............... .............. A Treat metatarsal 3.37 NA 5.18 0.51 NA 9.06 090
fracture.
28485............... .............. A Treat metatarsal 5.70 NA 5.67 0.72 NA 12.09 090
fracture.
28490............... .............. A Treat big toe 1.09 2.01 1.67 0.12 3.22 2.88 090
fracture.
28495............... .............. A Treat big toe 1.58 2.18 2.08 0.16 3.92 3.82 090
fracture.
28496............... .............. A Treat big toe 2.33 9.78 3.77 0.31 12.42 6.41 090
fracture.
28505............... .............. A Treat big toe 3.80 9.77 4.81 0.49 14.06 9.10 090
fracture.
28510............... .............. A Treatment of toe 1.09 1.53 1.53 0.11 2.73 2.73 090
fracture.
28515............... .............. A Treatment of toe 1.46 1.89 1.89 0.14 3.49 3.49 090
fracture.
28525............... .............. A Treat toe fracture... 3.32 9.36 4.36 0.41 13.09 8.09 090
28530............... .............. A Treat sesamoid bone 1.06 1.45 1.45 0.10 2.61 2.61 090
fracture.
28531............... .............. A Treat sesamoid bone 2.35 8.98 2.61 0.23 11.56 5.19 090
fracture.
28540............... .............. A Treat foot 2.04 2.41 2.41 0.19 4.64 4.64 090
dislocation.
28545............... .............. A Treat foot 2.45 2.35 2.35 0.36 5.16 5.16 090
dislocation.
28546............... .............. A Treat foot 3.20 8.03 5.00 0.41 11.64 8.61 090
dislocation.
28555............... .............. A Repair foot 6.29 11.58 6.67 0.90 18.77 13.86 090
dislocation.
28570............... .............. A Treat foot 1.66 2.42 2.34 0.20 4.28 4.20 090
dislocation.
28575............... .............. A Treat foot 3.31 3.74 3.74 0.56 7.61 7.61 090
dislocation.
28576............... .............. A Treat foot 4.16 10.32 5.68 0.59 15.07 10.43 090
dislocation.
28585............... .............. A Repair foot 7.98 8.27 6.65 1.01 17.26 15.64 090
dislocation.
28600............... .............. A Treat foot 1.89 2.82 2.69 0.24 4.95 4.82 090
dislocation.
28605............... .............. A Treat foot 2.71 3.14 3.14 0.39 6.24 6.24 090
dislocation.
28606............... .............. A Treat foot 4.89 15.93 6.18 0.78 21.60 11.85 090
dislocation.
28615............... .............. A Repair foot 7.76 NA 8.16 1.21 NA 17.13 090
dislocation.
28630............... .............. A Treat toe dislocation 1.70 1.57 1.01 0.17 3.44 2.88 010
28635............... .............. A Treat toe dislocation 1.91 2.02 1.53 0.19 4.12 3.63 010
28636............... .............. A Treat toe dislocation 2.77 3.87 2.62 0.38 7.02 5.77 010
28645............... .............. A Repair toe 4.21 5.81 3.59 0.44 10.46 8.24 090
dislocation.
28660............... .............. A Treat toe dislocation 1.23 1.26 0.81 0.12 2.61 2.16 010
28665............... .............. A Treat toe dislocation 1.92 NA 1.43 0.22 NA 3.57 010
28666............... .............. A Treat toe dislocation 2.66 5.90 2.57 0.38 8.94 5.61 010
28675............... .............. A Repair of toe 2.92 8.85 3.88 0.40 12.17 7.20 090
dislocation.
28705............... .............. A Fusion of foot bones. 18.77 NA 12.65 2.77 NA 34.19 090
28715............... .............. A Fusion of foot bones. 13.08 NA 9.98 1.93 NA 24.99 090
28725............... .............. A Fusion of foot bones. 11.59 NA 8.50 1.66 NA 21.75 090
28730............... .............. A Fusion of foot bones. 10.74 NA 8.71 1.44 NA 20.89 090
28735............... .............. A Fusion of foot bones. 10.83 NA 8.08 1.44 NA 20.35 090
28737............... .............. A Revision of foot 9.63 NA 7.07 1.12 NA 17.82 090
bones.
28740............... .............. A Fusion of foot bones. 8.01 11.72 6.66 1.03 20.76 15.70 090
28750............... .............. A Fusion of big toe 7.29 13.06 6.84 1.04 21.39 15.17 090
joint.
[[Page 47605]]
28755............... .............. A Fusion of big toe 4.73 7.02 4.04 0.52 12.27 9.29 090
joint.
28760............... .............. A Fusion of big toe 7.74 8.24 5.81 0.81 16.79 14.36 090
joint.
28800............... .............. A Amputation of midfoot 8.20 NA 6.12 1.04 NA 15.36 090
28805............... .............. A Amputation thru 8.38 NA 5.93 1.10 NA 15.41 090
metatarsal.
28810............... .............. A Amputation toe & 6.20 NA 4.78 0.81 NA 11.79 090
metatarsal.
28820............... .............. A Amputation of toe.... 4.40 8.56 4.15 0.55 13.51 9.10 090
28825............... .............. A Partial amputation of 3.58 8.01 3.87 0.44 12.03 7.89 090
toe.
29000............... .............. A Application of body 2.25 3.00 1.73 0.47 5.72 4.45 000
cast.
29010............... .............. A Application of body 2.06 3.29 1.77 0.36 5.71 4.19 000
cast.
29015............... .............. A Application of body 2.41 2.97 1.60 0.26 5.64 4.27 000
cast.
29020............... .............. A Application of body 2.11 3.19 1.42 0.21 5.51 3.74 000
cast.
29025............... .............. A Application of body 2.40 3.19 1.84 0.44 6.03 4.68 000
cast.
29035............... .............. A Application of body 1.77 3.61 1.58 0.29 5.67 3.64 000
cast.
29040............... .............. A Application of body 2.22 2.49 1.52 0.18 4.89 3.92 000
cast.
29044............... .............. A Application of body 2.12 3.97 1.90 0.37 6.46 4.39 000
cast.
29046............... .............. A Application of body 2.41 3.27 2.08 0.40 6.08 4.89 000
cast.
29049............... .............. A Application of figure 0.89 1.30 0.53 0.11 2.30 1.53 000
eight.
29055............... .............. A Application of 1.78 2.98 1.47 0.28 5.04 3.53 000
shoulder cast.
29058............... .............. A Application of 1.31 1.56 0.73 0.16 3.03 2.20 000
shoulder cast.
29065............... .............. A Application of long 0.87 1.32 0.75 0.14 2.33 1.76 000
arm cast.
29075............... .............. A Application of 0.77 1.26 0.68 0.12 2.15 1.57 000
forearm cast.
29085............... .............. A Apply hand/wrist cast 0.87 1.28 0.63 0.13 2.28 1.63 000
29086............... .............. A Apply finger cast.... 0.62 0.96 0.50 0.08 1.66 1.20 000
29105............... .............. A Apply long arm splint 0.87 1.23 0.51 0.12 2.22 1.50 000
29125............... .............. A Apply forearm splint. 0.59 1.02 0.39 0.07 1.68 1.05 000
29126............... .............. A Apply forearm splint. 0.77 1.21 0.46 0.06 2.04 1.29 000
29130............... .............. A Application of finger 0.50 0.47 0.17 0.06 1.03 0.73 000
splint.
29131............... .............. A Application of finger 0.55 0.74 0.24 0.03 1.32 0.82 000
splint.
29200............... .............. A Strapping of chest... 0.65 0.73 0.35 0.05 1.43 1.05 000
29220............... .............. A Strapping of low back 0.64 0.73 0.39 0.05 1.42 1.08 000
29240............... .............. A Strapping of shoulder 0.71 0.86 0.37 0.06 1.63 1.14 000
29260............... .............. A Strapping of elbow or 0.55 0.75 0.33 0.05 1.35 0.93 000
wrist.
29280............... .............. A Strapping of hand or 0.51 0.81 0.33 0.03 1.35 0.87 000
finger.
29305............... .............. A Application of hip 2.03 3.34 1.76 0.33 5.70 4.12 000
cast.
29325............... .............. A Application of hip 2.32 3.52 1.95 0.39 6.23 4.66 000
casts.
29345............... .............. A Application of long 1.40 1.76 1.06 0.23 3.39 2.69 000
leg cast.
29355............... .............. A Application of long 1.53 1.71 1.12 0.24 3.48 2.89 000
leg cast.
29358............... .............. A Apply long leg cast 1.43 2.06 1.09 0.23 3.72 2.75 000
brace.
29365............... .............. A Application of long 1.18 1.65 0.95 0.20 3.03 2.33 000
leg cast.
29405............... .............. A Apply short leg cast. 0.86 1.22 0.71 0.13 2.21 1.70 000
29425............... .............. A Apply short leg cast. 1.01 1.23 0.74 0.13 2.37 1.88 000
29435............... .............. A Apply short leg cast. 1.18 1.55 0.92 0.19 2.92 2.29 000
29440............... .............. A Addition of walker to 0.57 0.69 0.27 0.08 1.34 0.92 000
cast.
29445............... .............. A Apply rigid leg cast. 1.78 1.80 0.96 0.24 3.82 2.98 000
29450............... .............. A Application of leg 2.08 1.47 1.10 0.19 3.74 3.37 000
cast.
29505............... .............. A Application, long leg 0.69 1.18 0.46 0.07 1.94 1.22 000
splint.
29515............... .............. A Application lower leg 0.73 0.87 0.47 0.08 1.68 1.28 000
splint.
29520............... .............. A Strapping of hip..... 0.54 0.87 0.47 0.02 1.43 1.03 000
29530............... .............. A Strapping of knee.... 0.57 0.79 0.33 0.05 1.41 0.95 000
29540............... .............. A Strapping of ankle 0.51 0.42 0.31 0.04 0.97 0.86 000
and/or ft.
29550............... .............. A Strapping of toes.... 0.47 0.42 0.28 0.04 0.93 0.79 000
29580............... .............. A Application of paste 0.57 0.65 0.36 0.06 1.28 0.99 000
boot.
29590............... .............. A Application of foot 0.76 0.51 0.29 0.06 1.33 1.11 000
splint.
29700............... .............. A Removal/revision of 0.57 0.89 0.28 0.07 1.53 0.92 000
cast.
29705............... .............. A Removal/revision of 0.76 0.82 0.38 0.11 1.69 1.25 000
cast.
29710............... .............. A Removal/revision of 1.34 1.53 0.70 0.20 3.07 2.24 000
cast.
29715............... .............. A Removal/revision of 0.94 1.17 0.40 0.13 2.24 1.47 000
cast.
29720............... .............. A Repair of body cast.. 0.68 1.16 0.39 0.11 1.95 1.18 000
29730............... .............. A Windowing of cast.... 0.75 0.81 0.35 0.11 1.67 1.21 000
29740............... .............. A Wedging of cast...... 1.12 1.15 0.49 0.16 2.43 1.77 000
29750............... .............. A Wedging of clubfoot 1.26 1.06 0.58 0.19 2.51 2.03 000
cast.
29800............... .............. A Jaw arthroscopy/ 6.42 NA 7.06 0.99 NA 14.47 090
surgery.
29804............... .............. A Jaw arthroscopy/ 8.13 NA 7.84 1.30 NA 17.27 090
surgery.
29805............... .............. A Shoulder arthroscopy, 5.88 NA 5.84 1.01 NA 12.73 090
dx.
29806............... .............. A Shoulder arthroscopy/ 14.35 NA 11.08 2.42 NA 27.85 090
surgery.
29807............... .............. A Shoulder arthroscopy/ 13.88 NA 10.91 2.35 NA 27.14 090
surgery.
29819............... .............. A Shoulder arthroscopy/ 7.61 NA 6.77 1.26 NA 15.64 090
surgery.
29820............... .............. A Shoulder arthroscopy/ 7.06 NA 6.21 1.17 NA 14.44 090
surgery.
29821............... .............. A Shoulder arthroscopy/ 7.71 NA 6.79 1.24 NA 15.74 090
surgery.
29822............... .............. A Shoulder arthroscopy/ 7.42 NA 6.67 1.20 NA 15.29 090
surgery.
29823............... .............. A Shoulder arthroscopy/ 8.16 NA 7.21 1.30 NA 16.67 090
surgery.
29824............... .............. A Shoulder arthroscopy/ 8.24 NA 7.47 1.30 NA 17.01 090
surgery.
29825............... .............. A Shoulder arthroscopy/ 7.61 NA 6.75 1.12 NA 15.48 090
surgery.
29826............... .............. A Shoulder arthroscopy/ 8.98 NA 7.52 1.42 NA 17.92 090
surgery.
29827............... .............. A Arthroscop rotator 15.34 NA 11.52 2.08 NA 28.94 090
cuff repr.
[[Page 47606]]
29830............... .............. A Elbow arthroscopy.... 5.75 NA 5.33 0.87 NA 11.95 090
29834............... .............. A Elbow arthroscopy/ 6.27 NA 5.82 1.02 NA 13.11 090
surgery.
29835............... .............. A Elbow arthroscopy/ 6.47 NA 5.87 1.12 NA 13.46 090
surgery.
29836............... .............. A Elbow arthroscopy/ 7.54 NA 6.77 1.08 NA 15.39 090
surgery.
29837............... .............. A Elbow arthroscopy/ 6.86 NA 6.12 1.11 NA 14.09 090
surgery.
29838............... .............. A Elbow arthroscopy/ 7.70 NA 6.87 1.23 NA 15.80 090
surgery.
29840............... .............. A Wrist arthroscopy.... 5.53 NA 5.31 0.82 NA 11.66 090
29843............... .............. A Wrist arthroscopy/ 6.00 NA 5.62 0.90 NA 12.52 090
surgery.
29844............... .............. A Wrist arthroscopy/ 6.36 NA 5.81 0.99 NA 13.16 090
surgery.
29845............... .............. A Wrist arthroscopy/ 7.51 NA 6.47 0.99 NA 14.97 090
surgery.
29846............... .............. A Wrist arthroscopy/ 6.74 NA 6.04 1.04 NA 13.82 090
surgery.
29847............... .............. A Wrist arthroscopy/ 7.07 NA 6.18 1.07 NA 14.32 090
surgery.
29848............... .............. A Wrist endoscopy/ 5.43 NA 5.59 0.87 NA 11.89 090
surgery.
29850............... .............. A Knee arthroscopy/ 8.18 NA 5.06 0.84 NA 14.08 090
surgery.
29851............... .............. A Knee arthroscopy/ 13.08 NA 9.78 2.04 NA 24.90 090
surgery.
29855............... .............. A Tibial arthroscopy/ 10.60 NA 8.75 1.71 NA 21.06 090
surgery.
29856............... .............. A Tibial arthroscopy/ 14.12 NA 10.65 2.46 NA 27.23 090
surgery.
29860............... .............. A Hip arthroscopy, dx.. 8.04 NA 6.94 1.23 NA 16.21 090
29861............... .............. A Hip arthroscopy/ 9.14 NA 7.34 1.45 NA 17.93 090
surgery.
29862............... .............. A Hip arthroscopy/ 9.89 NA 8.55 1.62 NA 20.06 090
surgery.
29863............... .............. A Hip arthroscopy/ 9.89 NA 8.49 1.56 NA 19.94 090
surgery.
29870............... .............. A Knee arthroscopy, dx. 5.06 NA 4.88 0.85 NA 10.79 090
29871............... .............. A Knee arthroscopy/ 6.54 NA 5.86 1.12 NA 13.52 090
drainage.
29873............... .............. A Knee arthroscopy/ 5.99 NA 6.57 0.89 NA 13.45 090
surgery.
29874............... .............. A Knee arthroscopy/ 7.04 NA 6.06 1.10 NA 14.20 090
surgery.
29875............... .............. A Knee arthroscopy/ 6.30 NA 5.84 1.05 NA 13.19 090
surgery.
29876............... .............. A Knee arthroscopy/ 7.91 NA 7.01 1.36 NA 16.28 090
surgery.
29877............... .............. A Knee arthroscopy/ 7.34 NA 6.73 1.25 NA 15.32 090
surgery.
29879............... .............. A Knee arthroscopy/ 8.03 NA 7.10 1.36 NA 16.49 090
surgery.
29880............... .............. A Knee arthroscopy/ 8.49 NA 7.35 1.43 NA 17.27 090
surgery.
29881............... .............. A Knee arthroscopy/ 7.75 NA 6.95 1.31 NA 16.01 090
surgery.
29882............... .............. A Knee arthroscopy/ 8.64 NA 7.23 1.48 NA 17.35 090
surgery.
29883............... .............. A Knee arthroscopy/ 11.03 NA 9.04 1.88 NA 21.95 090
surgery.
29884............... .............. A Knee arthroscopy/ 7.32 NA 6.68 1.21 NA 15.21 090
surgery.
29885............... .............. A Knee arthroscopy/ 9.08 NA 7.95 1.48 NA 18.51 090
surgery.
29886............... .............. A Knee arthroscopy/ 7.53 NA 6.83 1.29 NA 15.65 090
surgery.
29887............... .............. A Knee arthroscopy/ 9.03 NA 7.92 1.51 NA 18.46 090
surgery.
29888............... .............. A Knee arthroscopy/ 13.88 NA 10.18 2.22 NA 26.28 090
surgery.
29889............... .............. A Knee arthroscopy/ 15.98 NA 12.41 2.67 NA 31.06 090
surgery.
29891............... .............. A Ankle arthroscopy/ 8.39 NA 7.50 1.28 NA 17.17 090
surgery.
29892............... .............. A Ankle arthroscopy/ 8.99 NA 7.72 1.16 NA 17.87 090
surgery.
29893............... .............. A Scope, plantar 5.21 6.27 3.98 0.45 11.93 9.64 090
fasciotomy.
29894............... .............. A Ankle arthroscopy/ 7.20 NA 5.46 0.99 NA 13.65 090
surgery.
29895............... .............. A Ankle arthroscopy/ 6.98 NA 5.46 0.96 NA 13.40 090
surgery.
29897............... .............. A Ankle arthroscopy/ 7.17 NA 5.87 1.10 NA 14.14 090
surgery.
29898............... .............. A Ankle arthroscopy/ 8.31 NA 6.18 1.11 NA 15.60 090
surgery.
29899............... .............. A Ankle arthroscopy/ 13.89 NA 10.55 2.04 NA 26.48 090
surgery.
29900............... .............. A Mcp joint 5.41 NA 5.81 0.87 NA 12.09 090
arthroscopy, dx.
29901............... .............. A Mcp joint 6.12 NA 6.20 0.97 NA 13.29 090
arthroscopy, surg.
29902............... .............. A Mcp joint 6.69 NA 6.46 0.84 NA 13.99 090
arthroscopy, surg.
30000............... .............. A Drainage of nose 1.43 4.09 1.40 0.12 5.64 2.95 010
lesion.
30020............... .............. A Drainage of nose 1.43 3.28 1.47 0.12 4.83 3.02 010
lesion.
30100............... .............. A Intranasal biopsy.... 0.94 1.97 0.82 0.08 2.99 1.84 000
30110............... .............. A Removal of nose 1.63 3.24 1.57 0.14 5.01 3.34 010
polyp(s).
30115............... .............. A Removal of nose 4.34 NA 5.76 0.42 NA 10.52 090
polyp(s).
30117............... .............. A Removal of intranasal 3.16 13.13 4.62 0.26 16.55 8.04 090
lesion.
30118............... .............. A Removal of intranasal 9.68 NA 9.19 0.82 NA 19.69 090
lesion.
30120............... .............. A Revision of nose..... 5.26 6.48 5.99 0.56 12.30 11.81 090
30124............... .............. A Removal of nose 3.10 NA 3.62 0.30 NA 7.02 090
lesion.
30125............... .............. A Removal of nose 7.15 NA 8.32 0.58 NA 16.05 090
lesion.
30130............... .............. A Removal of turbinate 3.37 NA 5.58 0.32 NA 9.27 090
bones.
30140............... .............. A Removal of turbinate 3.42 NA 6.19 0.36 NA 9.97 090
bones.
30150............... .............. A Partial removal of 9.13 NA 10.99 0.91 NA 21.03 090
nose.
30160............... .............. A Removal of nose...... 9.57 NA 10.19 0.87 NA 20.63 090
30200............... .............. A Injection treatment 0.78 1.62 0.74 0.06 2.46 1.58 000
of nose.
30210............... .............. A Nasal sinus therapy.. 1.08 2.10 1.31 0.09 3.27 2.48 010
30220............... .............. A Insert nasal septal 1.54 4.23 1.53 0.12 5.89 3.19 010
button.
30300............... .............. A Remove nasal foreign 1.04 4.64 1.93 0.08 5.76 3.05 010
body.
30310............... .............. A Remove nasal foreign 1.96 NA 3.09 0.17 NA 5.22 010
body.
30320............... .............. A Remove nasal foreign 4.51 NA 7.03 0.37 NA 11.91 090
body.
30400............... .............. R Reconstruction of 9.82 NA 15.46 1.02 NA 26.30 090
nose.
30410............... .............. R Reconstruction of 12.96 NA 18.32 1.47 NA 32.75 090
nose.
30420............... .............. R Reconstruction of 15.86 NA 17.87 1.48 NA 35.21 090
nose.
30430............... .............. R Revision of nose..... 7.20 NA 15.95 0.79 NA 23.94 090
30435............... .............. R Revision of nose..... 11.69 NA 19.28 1.33 NA 32.30 090
[[Page 47607]]
30450............... .............. R Revision of nose..... 18.62 NA 21.82 1.89 NA 42.33 090
30460............... .............. A Revision of nose..... 9.95 NA 9.94 0.91 NA 20.80 090
30462............... .............. A Revision of nose..... 19.54 NA 20.20 1.90 NA 41.64 090
30465............... .............. A Repair nasal stenosis 11.62 NA 11.99 1.10 NA 24.71 090
30520............... .............. A Repair of nasal 5.69 NA 6.65 0.47 NA 12.81 090
septum.
30540............... .............. A Repair nasal defect.. 7.74 NA 9.29 0.64 NA 17.67 090
30545............... .............. A Repair nasal defect.. 11.36 NA 11.87 0.81 NA 24.04 090
30560............... .............. A Release of nasal 1.26 4.78 2.13 0.10 6.14 3.49 010
adhesions.
30580............... .............. A Repair upper jaw 6.68 7.76 5.78 0.87 15.31 13.33 090
fistula.
30600............... .............. A Repair mouth/nose 6.01 7.53 5.02 0.61 14.15 11.64 090
fistula.
30620............... .............. A Intranasal 5.96 NA 8.81 0.56 NA 15.33 090
reconstruction.
30630............... .............. A Repair nasal septum 7.11 NA 7.94 0.61 NA 15.66 090
defect.
30801............... .............. A Cauterization, inner 1.09 4.14 1.93 0.09 5.32 3.11 010
nose.
30802............... .............. A Cauterization, inner 2.03 4.61 2.35 0.17 6.81 4.55 010
nose.
30901............... .............. A Control of nosebleed. 1.21 1.36 0.32 0.11 2.68 1.64 000
30903............... .............. A Control of nosebleed. 1.54 2.71 0.50 0.13 4.38 2.17 000
30905............... .............. A Control of nosebleed. 1.97 3.51 0.76 0.17 5.65 2.90 000
30906............... .............. A Repeat control of 2.45 3.89 1.20 0.20 6.54 3.85 000
nosebleed.
30915............... .............. A Ligation, nasal sinus 7.19 NA 6.69 0.60 NA 14.48 090
artery.
30920............... .............. A Ligation, upper jaw 9.82 NA 8.96 0.80 NA 19.58 090
artery.
30930............... .............. A Therapy, fracture of 1.26 NA 1.62 0.12 NA 3.00 010
nose.
31000............... .............. A Irrigation, maxillary 1.15 2.85 1.40 0.10 4.10 2.65 010
sinus.
31002............... .............. A Irrigation, sphenoid 1.91 NA 3.26 0.16 NA 5.33 010
sinus.
31020............... .............. A Exploration, 2.94 8.54 5.18 0.28 11.76 8.40 090
maxillary sinus.
31030............... .............. A Exploration, 5.91 11.51 6.66 0.58 18.00 13.15 090
maxillary sinus.
31032............... .............. A Explore sinus, remove 6.56 NA 7.22 0.61 NA 14.39 090
polyps.
31040............... .............. A Exploration behind 9.41 NA 9.85 0.90 NA 20.16 090
upper jaw.
31050............... .............. A Exploration, sphenoid 5.27 NA 6.35 0.57 NA 12.19 090
sinus.
31051............... .............. A Sphenoid sinus 7.10 NA 8.24 0.69 NA 16.03 090
surgery.
31070............... .............. A Exploration of 4.27 NA 5.93 0.39 NA 10.59 090
frontal sinus.
31075............... .............. A Exploration of 9.15 NA 9.72 0.80 NA 19.67 090
frontal sinus.
31080............... .............. A Removal of frontal 11.40 NA 13.54 1.36 NA 26.30 090
sinus.
31081............... .............. A Removal of frontal 12.73 NA 13.99 2.47 NA 29.19 090
sinus.
31084............... .............. A Removal of frontal 13.49 NA 13.50 1.23 NA 28.22 090
sinus.
31085............... .............. A Removal of frontal 14.18 NA 13.94 1.74 NA 29.86 090
sinus.
31086............... .............. A Removal of frontal 12.84 NA 13.26 1.11 NA 27.21 090
sinus.
31087............... .............. A Removal of frontal 13.08 NA 12.51 1.28 NA 26.87 090
sinus.
31090............... .............. A Exploration of 9.52 NA 12.54 0.94 NA 23.00 090
sinuses.
31200............... .............. A Removal of ethmoid 4.96 NA 9.24 0.31 NA 14.51 090
sinus.
31201............... .............. A Removal of ethmoid 8.36 NA 9.16 0.82 NA 18.34 090
sinus.
31205............... .............. A Removal of ethmoid 10.22 NA 11.89 0.73 NA 22.84 090
sinus.
31225............... .............. A Removal of upper jaw. 19.20 NA 17.81 1.69 NA 38.70 090
31230............... .............. A Removal of upper jaw. 21.91 NA 19.35 1.89 NA 43.15 090
31231............... .............. A Nasal endoscopy, dx.. 1.10 3.38 0.88 0.09 4.57 2.07 000
31233............... .............. A Nasal/sinus 2.18 4.31 1.47 0.19 6.68 3.84 000
endoscopy, dx.
31235............... .............. A Nasal/sinus 2.64 4.91 1.72 0.27 7.82 4.63 000
endoscopy, dx.
31237............... .............. A Nasal/sinus 2.98 5.19 1.88 0.28 8.45 5.14 000
endoscopy, surg.
31238............... .............. A Nasal/sinus 3.26 5.23 2.08 0.27 8.76 5.61 000
endoscopy, surg.
31239............... .............. A Nasal/sinus 8.69 NA 8.01 0.62 NA 17.32 010
endoscopy, surg.
31240............... .............. A Nasal/sinus 2.61 NA 1.73 0.25 NA 4.59 000
endoscopy, surg.
31254............... .............. A Revision of ethmoid 4.64 NA 2.84 0.46 NA 7.94 000
sinus.
31255............... .............. A Removal of ethmoid 6.95 NA 4.10 0.74 NA 11.79 000
sinus.
31256............... .............. A Exploration maxillary 3.29 NA 2.11 0.34 NA 5.74 000
sinus.
31267............... .............. A Endoscopy, maxillary 5.45 NA 3.29 0.56 NA 9.30 000
sinus.
31276............... .............. A Sinus endoscopy, 8.84 NA 5.11 0.92 NA 14.87 000
surgical.
31287............... .............. A Nasal/sinus 3.91 NA 2.45 0.40 NA 6.76 000
endoscopy, surg.
31288............... .............. A Nasal/sinus 4.57 NA 2.80 0.47 NA 7.84 000
endoscopy, surg.
31290............... .............. A Nasal/sinus 17.21 NA 12.04 1.41 NA 30.66 010
endoscopy, surg.
31291............... .............. A Nasal/sinus 18.16 NA 12.46 1.74 NA 32.36 010
endoscopy, surg.
31292............... .............. A Nasal/sinus 14.74 NA 10.60 1.27 NA 26.61 010
endoscopy, surg.
31293............... .............. A Nasal/sinus 16.19 NA 11.37 1.17 NA 28.73 010
endoscopy, surg.
31294............... .............. A Nasal/sinus 19.03 NA 12.86 1.42 NA 33.31 010
endoscopy, surg.
31300............... .............. A Removal of larynx 14.27 NA 14.99 1.21 NA 30.47 090
lesion.
31320............... .............. A Diagnostic incision, 5.25 NA 10.34 0.46 NA 16.05 090
larynx.
31360............... .............. A Removal of larynx.... 17.05 NA 16.72 1.44 NA 35.21 090
31365............... .............. A Removal of larynx.... 24.12 NA 20.35 2.03 NA 46.50 090
31367............... .............. A Partial removal of 21.83 NA 21.88 1.81 NA 45.52 090
larynx.
31368............... .............. A Partial removal of 27.05 NA 25.47 2.26 NA 54.78 090
larynx.
31370............... .............. A Partial removal of 21.35 NA 22.26 1.77 NA 45.38 090
larynx.
31375............... .............. A Partial removal of 20.18 NA 20.41 1.65 NA 42.24 090
larynx.
31380............... .............. A Partial removal of 20.18 NA 20.60 1.64 NA 42.42 090
larynx.
31382............... .............. A Partial removal of 20.49 NA 21.61 1.72 NA 43.82 090
larynx.
31390............... .............. A Removal of larynx & 27.49 NA 24.37 2.32 NA 54.18 090
pharynx.
31395............... .............. A Reconstruct larynx & 31.04 NA 28.28 2.61 NA 61.93 090
pharynx.
31400............... .............. A Revision of larynx... 10.29 NA 13.80 0.84 NA 24.93 090
[[Page 47608]]
31420............... .............. A Removal of epiglottis 10.20 NA 9.54 0.83 NA 20.57 090
31500............... .............. A Insert emergency 2.33 NA 0.55 0.18 NA 3.06 000
airway.
31502............... .............. A Change of windpipe 0.65 0.31 0.28 0.05 1.01 0.98 000
airway.
31505............... .............. A Diagnostic 0.61 1.45 0.62 0.05 2.11 1.28 000
laryngoscopy.
31510............... .............. A Laryngoscopy with 1.92 3.32 1.25 0.17 5.41 3.34 000
biopsy.
31511............... .............. A Remove foreign body, 2.16 3.12 1.06 0.19 5.47 3.41 000
larynx.
31512............... .............. A Removal of larynx 2.07 3.20 1.36 0.17 5.44 3.60 000
lesion.
31513............... .............. A Injection into vocal 2.10 NA 1.46 0.17 NA 3.73 000
cord.
31515............... .............. A Laryngoscopy for 1.80 3.63 1.07 0.14 5.57 3.01 000
aspiration.
31520............... .............. A Diagnostic 2.56 NA 1.56 0.20 NA 4.32 000
laryngoscopy.
31525............... .............. A Diagnostic 2.63 3.65 1.66 0.22 6.50 4.51 000
laryngoscopy.
31526............... .............. A Diagnostic 2.57 NA 1.71 0.21 NA 4.49 000
laryngoscopy.
31527............... .............. A Laryngoscopy for 3.27 NA 1.87 0.27 NA 5.41 000
treatment.
31528............... .............. A Laryngoscopy and 2.37 NA 1.46 0.20 NA 4.03 000
dilation.
31529............... .............. A Laryngoscopy and 2.68 NA 1.71 0.22 NA 4.61 000
dilation.
31530............... .............. A Operative 3.38 NA 1.95 0.29 NA 5.62 000
laryngoscopy.
31531............... .............. A Operative 3.58 NA 2.27 0.29 NA 6.14 000
laryngoscopy.
31535............... .............. A Operative 3.16 NA 1.99 0.26 NA 5.41 000
laryngoscopy.
31536............... .............. A Operative 3.55 NA 2.24 0.29 NA 6.08 000
laryngoscopy.
31540............... .............. A Operative 4.12 NA 2.54 0.34 NA 7.00 000
laryngoscopy.
31541............... .............. A Operative 4.52 NA 2.77 0.37 NA 7.66 000
laryngoscopy.
31560............... .............. A Operative 5.45 NA 3.15 0.44 NA 9.04 000
laryngoscopy.
31561............... .............. A Operative 5.99 NA 3.36 0.40 NA 9.75 000
laryngoscopy.
31570............... .............. A Laryngoscopy with 3.86 5.67 2.38 0.31 9.84 6.55 000
injection.
31571............... .............. A Laryngoscopy with 4.26 NA 2.59 0.35 NA 7.20 000
injection.
31575............... .............. A Diagnostic 1.10 1.90 0.89 0.09 3.09 2.08 000
laryngoscopy.
31576............... .............. A Laryngoscopy with 1.97 3.66 1.29 0.15 5.78 3.41 000
biopsy.
31577............... .............. A Remove foreign body, 2.47 3.76 1.53 0.20 6.43 4.20 000
larynx.
31578............... .............. A Removal of larynx 2.84 4.28 1.52 0.23 7.35 4.59 000
lesion.
31579............... .............. A Diagnostic 2.26 3.78 1.48 0.19 6.23 3.93 000
laryngoscopy.
31580............... .............. A Revision of larynx... 12.36 NA 15.92 1.00 NA 29.28 090
31582............... .............. A Revision of larynx... 21.59 NA 25.84 1.76 NA 49.19 090
31584............... .............. A Treat larynx fracture 19.61 NA 18.15 1.57 NA 39.33 090
31585............... .............. A Treat larynx fracture 4.63 NA 6.70 0.49 NA 11.82 090
31586............... .............. A Treat larynx fracture 8.02 NA 10.86 0.65 NA 19.53 090
31587............... .............. A Revision of larynx... 11.97 NA 9.26 0.99 NA 22.22 090
31588............... .............. A Revision of larynx... 13.09 NA 13.60 1.05 NA 27.74 090
31590............... .............. A Reinnervate larynx... 6.96 NA 15.54 0.85 NA 23.35 090
31595............... .............. A Larynx nerve surgery. 8.33 NA 10.58 0.79 NA 19.70 090
31600............... .............. A Incision of windpipe. 7.17 NA 3.18 0.80 NA 11.15 000
31601............... .............. A Incision of windpipe. 4.44 NA 2.39 0.47 NA 7.30 000
31603............... .............. A Incision of windpipe. 4.14 NA 1.71 0.45 NA 6.30 000
31605............... .............. A Incision of windpipe. 3.57 NA 1.18 0.39 NA 5.14 000
31610............... .............. A Incision of windpipe. 8.75 NA 8.27 0.80 NA 17.82 090
31611............... .............. A Surgery/speech 5.63 NA 6.11 0.47 NA 12.21 090
prosthesis.
31612............... .............. A Puncture/clear 0.91 1.10 0.35 0.08 2.09 1.34 000
windpipe.
31613............... .............. A Repair windpipe 4.58 NA 5.99 0.45 NA 11.02 090
opening.
31614............... .............. A Repair windpipe 7.11 NA 8.71 0.62 NA 16.44 090
opening.
31615............... .............. A Visualization of 2.09 2.59 1.20 0.16 4.84 3.45 000
windpipe.
31622............... .............. A Dx bronchoscope/wash. 2.78 5.71 1.06 0.19 8.68 4.03 000
31623............... .............. A Dx bronchoscope/brush 2.88 6.51 1.05 0.16 9.55 4.09 000
31624............... .............. A Dx bronchoscope/ 2.88 5.85 1.05 0.16 8.89 4.09 000
lavage.
31625............... .............. A Bronchoscopy w/ 3.36 5.91 1.21 0.20 9.47 4.77 000
biopsy(s).
31628............... .............. A Bronchoscopy/lung bx, 3.80 6.13 1.30 0.19 10.12 5.29 000
each.
31629............... .............. A Bronchoscopy/needle 4.09 13.50 1.40 0.17 17.76 5.66 000
bx, each.
31630............... .............. A Bronchoscopy dilate/ 3.81 NA 1.70 0.35 NA 5.86 000
fx repr.
31631............... .............. A Bronchoscopy, dilate 4.36 NA 1.74 0.37 NA 6.47 000
w/stent.
31632............... .............. A Bronchoscopy/lung bx, 1.03 0.83 0.31 0.19 2.05 1.53 ZZZ
add-l.
31633............... .............. A Bronchoscopy/needle 1.32 0.93 0.40 0.17 2.42 1.89 ZZZ
bx add-l.
31635............... .............. A Bronchoscopy w/fb 3.67 6.17 1.43 0.27 10.11 5.37 000
removal.
31640............... .............. A Bronchoscopy w/tumor 4.93 NA 2.07 0.44 NA 7.44 000
excise.
31641............... .............. A Bronchoscopy, treat 5.02 NA 1.88 0.37 NA 7.27 000
blockage.
31643............... .............. A Diag bronchoscope/ 3.49 NA 1.23 0.20 NA 4.92 000
catheter.
31645............... .............. A Bronchoscopy, clear 3.16 5.21 1.13 0.18 8.55 4.47 000
airways.
31646............... .............. A Bronchoscopy, reclear 2.72 4.93 1.00 0.16 7.81 3.88 000
airway.
31656............... .............. A Bronchoscopy, inj for 2.17 6.44 0.83 0.13 8.74 3.13 000
x-ray.
31700............... .............. A Insertion of airway 1.34 2.17 0.69 0.08 3.59 2.11 000
catheter.
31708............... .............. A Instill airway 1.41 2.12 0.46 0.07 3.60 1.94 000
contrast dye.
31710............... .............. A Insertion of airway 1.30 NA 0.41 0.09 NA 1.80 000
catheter.
31715............... .............. A Injection for 1.11 NA 0.34 0.07 NA 1.52 000
bronchus x-ray.
31717............... .............. A Bronchial brush 2.12 8.66 0.79 0.10 10.88 3.01 000
biopsy.
31720............... .............. A Clearance of airways. 1.06 0.33 0.33 0.08 1.47 1.47 000
31725............... .............. A Clearance of airways. 1.96 0.65 0.58 0.13 2.74 2.67 000
31730............... .............. A Intro, windpipe wire/ 2.85 2.20 0.99 0.22 5.27 4.06 000
tube.
31750............... .............. A Repair of windpipe... 13.00 NA 17.58 1.14 NA 31.72 090
[[Page 47609]]
31755............... .............. A Repair of windpipe... 15.91 NA 24.51 1.41 NA 41.83 090
31760............... .............. A Repair of windpipe... 22.32 NA 10.76 3.08 NA 36.16 090
31766............... .............. A Reconstruction of 30.38 NA 13.67 4.53 NA 48.58 090
windpipe.
31770............... .............. A Repair/graft of 22.48 NA 10.28 2.76 NA 35.52 090
bronchus.
31775............... .............. A Reconstruct bronchus. 23.50 NA 11.82 3.06 NA 38.38 090
31780............... .............. A Reconstruct windpipe. 17.69 NA 11.07 1.72 NA 30.48 090
31781............... .............. A Reconstruct windpipe. 23.49 NA 12.15 2.51 NA 38.15 090
31785............... .............. A Remove windpipe 17.20 NA 10.20 1.54 NA 28.94 090
lesion.
31786............... .............. A Remove windpipe 23.94 NA 13.12 3.33 NA 40.39 090
lesion.
31800............... .............. A Repair of windpipe 7.42 NA 9.29 0.76 NA 17.47 090
injury.
31805............... .............. A Repair of windpipe 13.11 NA 7.25 1.78 NA 22.14 090
injury.
31820............... .............. A Closure of windpipe 4.48 5.66 3.65 0.40 10.54 8.53 090
lesion.
31825............... .............. A Repair of windpipe 6.80 7.66 5.37 0.58 15.04 12.75 090
defect.
31830............... .............. A Revise windpipe scar. 4.49 5.76 3.98 0.43 10.68 8.90 090
32000............... .............. A Drainage of chest.... 1.54 3.10 0.48 0.09 4.73 2.11 000
32002............... .............. A Treatment of 2.19 3.24 1.06 0.13 5.56 3.38 000
collapsed lung.
32005............... .............. A Treat lung lining 2.19 6.50 0.70 0.22 8.91 3.11 000
chemically.
32020............... .............. A Insertion of chest 3.97 NA 1.35 0.42 NA 5.74 000
tube.
32035............... .............. A Exploration of chest. 8.66 NA 5.88 1.18 NA 15.72 090
32036............... .............. A Exploration of chest. 9.67 NA 6.46 1.32 NA 17.45 090
32095............... .............. A Biopsy through chest 8.35 NA 5.38 1.10 NA 14.83 090
wall.
32100............... .............. A Exploration/biopsy of 15.22 NA 7.84 2.03 NA 25.09 090
chest.
32110............... .............. A Explore/repair chest. 22.97 NA 10.74 3.01 NA 36.72 090
32120............... .............. A Re-exploration of 11.52 NA 7.10 1.54 NA 20.16 090
chest.
32124............... .............. A Explore chest free 12.70 NA 7.23 1.77 NA 21.70 090
adhesions.
32140............... .............. A Removal of lung 13.91 NA 7.70 1.88 NA 23.49 090
lesion(s).
32141............... .............. A Remove/treat lung 13.98 NA 7.57 1.86 NA 23.41 090
lesions.
32150............... .............. A Removal of lung 14.13 NA 7.63 1.88 NA 23.64 090
lesion(s).
32151............... .............. A Remove lung foreign 14.19 NA 8.03 1.61 NA 23.83 090
body.
32160............... .............. A Open chest heart 9.29 NA 5.28 1.20 NA 15.77 090
massage.
32200............... .............. A Drain, open, lung 15.27 NA 8.62 1.25 NA 25.14 090
lesion.
32201............... .............. A Drain, percut, lung 3.99 21.04 1.30 0.24 25.27 5.53 000
lesion.
32215............... .............. A Treat chest lining... 11.31 NA 6.92 1.50 NA 19.73 090
32220............... .............. A Release of lung...... 23.96 NA 12.96 3.20 NA 40.12 090
32225............... .............. A Partial release of 13.94 NA 7.68 1.86 NA 23.48 090
lung.
32310............... .............. A Removal of chest 13.42 NA 7.41 1.77 NA 22.60 090
lining.
32320............... .............. A Free/remove chest 23.96 NA 12.16 3.23 NA 39.35 090
lining.
32400............... .............. A Needle biopsy chest 1.76 2.14 0.55 0.10 4.00 2.41 000
lining.
32402............... .............. A Open biopsy chest 7.55 NA 5.14 1.00 NA 13.69 090
lining.
32405............... .............. A Biopsy, lung or 1.93 0.67 0.63 0.12 2.72 2.68 000
mediastinum.
32420............... .............. A Puncture/clear lung.. 2.18 NA 0.68 0.14 NA 3.00 000
32440............... .............. A Removal of lung...... 24.96 NA 12.89 3.33 NA 41.18 090
32442............... .............. A Sleeve pneumonectomy. 26.20 NA 14.75 3.14 NA 44.09 090
32445............... .............. A Removal of lung...... 25.05 NA 14.06 3.55 NA 42.66 090
32480............... .............. A Partial removal of 23.71 NA 12.05 3.16 NA 38.92 090
lung.
32482............... .............. A Bilobectomy.......... 24.96 NA 12.90 3.30 NA 41.16 090
32484............... .............. A Segmentectomy........ 20.66 NA 11.38 2.82 NA 34.86 090
32486............... .............. A Sleeve lobectomy..... 23.88 NA 13.24 3.36 NA 40.48 090
32488............... .............. A Completion 25.67 NA 13.78 3.55 NA 43.00 090
pneumonectomy.
32491............... .............. R Lung volume reduction 21.22 NA 12.62 3.11 NA 36.95 090
32500............... .............. A Partial removal of 21.97 NA 12.35 2.92 NA 37.24 090
lung.
32501............... .............. A Repair bronchus add- 4.68 NA 1.53 0.64 NA 6.85 ZZZ
on.
32520............... .............. A Remove lung & revise 21.65 NA 11.31 2.91 NA 35.87 090
chest.
32522............... .............. A Remove lung & revise 24.16 NA 12.11 3.29 NA 39.56 090
chest.
32525............... .............. A Remove lung & revise 26.46 NA 12.79 3.49 NA 42.74 090
chest.
32540............... .............. A Removal of lung 14.62 NA 9.63 1.96 NA 26.21 090
lesion.
32601............... .............. A Thoracoscopy, 5.45 NA 2.35 0.73 NA 8.53 000
diagnostic.
32602............... .............. A Thoracoscopy, 5.95 NA 2.51 0.80 NA 9.26 000
diagnostic.
32603............... .............. A Thoracoscopy, 7.80 NA 3.03 1.09 NA 11.92 000
diagnostic.
32604............... .............. A Thoracoscopy, 8.77 NA 3.44 1.12 NA 13.33 000
diagnostic.
32605............... .............. A Thoracoscopy, 6.92 NA 2.90 0.91 NA 10.73 000
diagnostic.
32606............... .............. A Thoracoscopy, 8.39 NA 3.33 0.85 NA 12.57 000
diagnostic.
32650............... .............. A Thoracoscopy, 10.73 NA 6.76 1.44 NA 18.93 090
surgical.
32651............... .............. A Thoracoscopy, 12.89 NA 7.23 1.75 NA 21.87 090
surgical.
32652............... .............. A Thoracoscopy, 18.63 NA 10.14 2.53 NA 31.30 090
surgical.
32653............... .............. A Thoracoscopy, 12.85 NA 6.97 1.76 NA 21.58 090
surgical.
32654............... .............. A Thoracoscopy, 12.42 NA 7.53 1.64 NA 21.59 090
surgical.
32655............... .............. A Thoracoscopy, 13.08 NA 7.24 1.75 NA 22.07 090
surgical.
32656............... .............. A Thoracoscopy, 12.89 NA 7.93 1.80 NA 22.62 090
surgical.
32657............... .............. A Thoracoscopy, 13.63 NA 7.68 1.86 NA 23.17 090
surgical.
32658............... .............. A Thoracoscopy, 11.61 NA 7.35 1.62 NA 20.58 090
surgical.
32659............... .............. A Thoracoscopy, 11.57 NA 7.45 1.55 NA 20.57 090
surgical.
32660............... .............. A Thoracoscopy, 17.40 NA 9.47 1.87 NA 28.74 090
surgical.
32661............... .............. A Thoracoscopy, 13.23 NA 7.79 1.77 NA 22.79 090
surgical.
32662............... .............. A Thoracoscopy, 16.42 NA 8.81 2.26 NA 27.49 090
surgical.
[[Page 47610]]
32663............... .............. A Thoracoscopy, 18.44 NA 10.75 2.56 NA 31.75 090
surgical.
32664............... .............. A Thoracoscopy, 14.18 NA 7.63 2.06 NA 23.87 090
surgical.
32665............... .............. A Thoracoscopy, 15.52 NA 8.13 2.03 NA 25.68 090
surgical.
32800............... .............. A Repair lung hernia... 13.67 NA 7.45 1.91 NA 23.03 090
32810............... .............. A Close chest after 13.03 NA 7.55 1.83 NA 22.41 090
drainage.
32815............... .............. A Close bronchial 23.12 NA 10.99 3.11 NA 37.22 090
fistula.
32820............... .............. A Reconstruct injured 21.45 NA 12.22 3.02 NA 36.69 090
chest.
32851............... .............. A Lung transplant, 38.57 NA 27.68 5.44 NA 71.69 090
single.
32852............... .............. A Lung transplant with 41.74 NA 33.18 5.79 NA 80.71 090
bypass.
32853............... .............. A Lung transplant, 47.74 NA 31.75 6.35 NA 85.84 090
double.
32854............... .............. A Lung transplant with 50.90 NA 34.78 7.07 NA 92.75 090
bypass.
32900............... .............. A Removal of rib(s).... 20.24 NA 9.90 2.79 NA 32.93 090
32905............... .............. A Revise & repair chest 20.72 NA 10.14 2.87 NA 33.73 090
wall.
32906............... .............. A Revise & repair chest 26.73 NA 12.08 3.74 NA 42.55 090
wall.
32940............... .............. A Revision of lung..... 19.40 NA 9.49 2.66 NA 31.55 090
32960............... .............. A Therapeutic 1.84 1.76 0.57 0.19 3.79 2.60 000
pneumothorax.
32997............... .............. A Total lung lavage.... 5.99 NA 1.90 0.42 NA 8.31 000
33010............... .............. A Drainage of heart sac 2.24 NA 0.78 0.15 NA 3.17 000
33011............... .............. A Repeat drainage of 2.24 NA 0.81 0.17 NA 3.22 000
heart sac.
33015............... .............. A Incision of heart sac 6.79 NA 4.95 0.64 NA 12.38 090
33020............... .............. A Incision of heart sac 12.59 NA 6.80 1.62 NA 21.01 090
33025............... .............. A Incision of heart sac 12.07 NA 6.36 1.60 NA 20.03 090
33030............... .............. A Partial removal of 18.68 NA 9.54 2.53 NA 30.75 090
heart sac.
33031............... .............. A Partial removal of 21.76 NA 10.05 2.89 NA 34.70 090
heart sac.
33050............... .............. A Removal of heart sac 14.34 NA 7.86 1.83 NA 24.03 090
lesion.
33120............... .............. A Removal of heart 24.52 NA 11.62 3.25 NA 39.39 090
lesion.
33130............... .............. A Removal of heart 21.36 NA 10.14 2.80 NA 34.30 090
lesion.
33140............... .............. A Heart revascularize 19.97 NA 10.89 2.66 NA 33.52 090
(tmr).
33141............... .............. A Heart tmr w/other 4.83 NA 1.57 0.62 NA 7.02 ZZZ
procedure.
33200............... .............. A Insertion of heart 12.46 NA 6.94 1.52 NA 20.92 090
pacemaker.
33201............... .............. A Insertion of heart 10.16 NA 6.69 1.18 NA 18.03 090
pacemaker.
33206............... .............. A Insertion of heart 6.66 NA 4.54 0.54 NA 11.74 090
pacemaker.
33207............... .............. A Insertion of heart 8.03 NA 4.73 0.63 NA 13.39 090
pacemaker.
33208............... .............. A Insertion of heart 8.12 NA 4.84 0.60 NA 13.56 090
pacemaker.
33210............... .............. A Insertion of heart 3.30 NA 1.25 0.20 NA 4.75 000
electrode.
33211............... .............. A Insertion of heart 3.39 NA 1.31 0.23 NA 4.93 000
electrode.
33212............... .............. A Insertion of pulse 5.51 NA 3.40 0.47 NA 9.38 090
generator.
33213............... .............. A Insertion of pulse 6.36 NA 3.76 0.50 NA 10.62 090
generator.
33214............... .............. A Upgrade of pacemaker 7.74 NA 4.97 0.58 NA 13.29 090
system.
33215............... .............. A Reposition pacing- 4.75 NA 3.18 0.39 NA 8.32 090
defib lead.
33216............... .............. A Insert lead pace- 5.77 NA 4.28 0.39 NA 10.44 090
defib, one.
33217............... .............. A Insert lead pace- 5.74 NA 4.31 0.43 NA 10.48 090
defib, dual.
33218............... .............. A Repair lead pace- 5.43 NA 4.34 0.43 NA 10.20 090
defib, one.
33220............... .............. A Repair lead pace- 5.51 NA 4.31 0.43 NA 10.25 090
defib, dual.
33222............... .............. A Revise pocket, 4.95 NA 4.34 0.42 NA 9.71 090
pacemaker.
33223............... .............. A Revise pocket, pacing- 6.45 NA 4.61 0.47 NA 11.53 090
defib.
33224............... .............. A Insert pacing lead & 9.04 NA 3.99 0.43 NA 13.46 000
connect.
33225............... .............. A L ventric pacing lead 8.33 NA 3.25 0.43 NA 12.01 ZZZ
add-on.
33226............... .............. A Reposition l ventric 8.68 NA 3.81 0.43 NA 12.92 000
lead.
33233............... .............. A Removal of pacemaker 3.29 NA 3.28 0.24 NA 6.81 090
system.
33234............... .............. A Removal of pacemaker 7.81 NA 4.92 0.60 NA 13.33 090
system.
33235............... .............. A Removal pacemaker 9.39 NA 6.82 0.76 NA 16.97 090
electrode.
33236............... .............. A Remove electrode/ 12.58 NA 7.45 1.72 NA 21.75 090
thoracotomy.
33237............... .............. A Remove electrode/ 13.69 NA 7.79 1.63 NA 23.11 090
thoracotomy.
33238............... .............. A Remove electrode/ 15.20 NA 8.22 1.94 NA 25.36 090
thoracotomy.
33240............... .............. A Insert pulse 7.59 NA 4.63 0.50 NA 12.72 090
generator.
33241............... .............. A Remove pulse 3.24 NA 2.97 0.22 NA 6.43 090
generator.
33243............... .............. A Remove eltrd/ 22.61 NA 11.45 2.80 NA 36.86 090
thoracotomy.
33244............... .............. A Remove eltrd, 13.74 NA 8.90 1.02 NA 23.66 090
transven.
33245............... .............. A Insert epic eltrd 14.28 NA 7.99 1.85 NA 24.12 090
pace-defib.
33246............... .............. A Insert epic eltrd/ 20.68 NA 10.35 2.46 NA 33.49 090
generator.
33249............... .............. A Eltrd/insert pace- 14.21 NA 8.44 0.86 NA 23.51 090
defib.
33250............... .............. A Ablate heart 21.82 NA 11.05 2.79 NA 35.66 090
dysrhythm focus.
33251............... .............. A Ablate heart 24.84 NA 11.68 2.87 NA 39.39 090
dysrhythm focus.
33253............... .............. A Reconstruct atria.... 31.01 NA 13.84 4.04 NA 48.89 090
33261............... .............. A Ablate heart 24.84 NA 11.79 2.82 NA 39.45 090
dysrhythm focus.
33282............... .............. A Implant pat-active ht 4.16 NA 4.07 0.25 NA 8.48 090
record.
33284............... .............. A Remove pat-active ht 2.50 NA 3.55 0.16 NA 6.21 090
record.
33300............... .............. A Repair of heart wound 17.89 NA 9.25 2.33 NA 29.47 090
33305............... .............. A Repair of heart wound 21.41 NA 10.64 2.79 NA 34.84 090
33310............... .............. A Exploratory heart 18.48 NA 9.60 2.58 NA 30.66 090
surgery.
33315............... .............. A Exploratory heart 22.34 NA 10.90 2.87 NA 36.11 090
surgery.
33320............... .............. A Repair major blood 16.76 NA 8.25 1.83 NA 26.84 090
vessel(s).
33321............... .............. A Repair major vessel.. 20.17 NA 9.81 2.69 NA 32.67 090
33322............... .............. A Repair major blood 20.59 NA 10.38 2.65 NA 33.62 090
vessel(s).
[[Page 47611]]
33330............... .............. A Insert major vessel 21.40 NA 10.28 2.65 NA 34.33 090
graft.
33332............... .............. A Insert major vessel 23.92 NA 10.53 3.11 NA 37.56 090
graft.
33335............... .............. A Insert major vessel 29.96 NA 13.35 3.86 NA 47.17 090
graft.
33400............... .............. A Repair of aortic 28.46 NA 15.65 3.69 NA 47.80 090
valve.
33401............... .............. A Valvuloplasty, open.. 23.87 NA 13.50 1.30 NA 38.67 090
33403............... .............. A Valvuloplasty, w/cp 24.85 NA 14.30 3.53 NA 42.68 090
bypass.
33404............... .............. A Prepare heart-aorta 28.50 NA 14.53 4.02 NA 47.05 090
conduit.
33405............... .............. A Replacement of aortic 34.95 NA 18.28 4.55 NA 57.78 090
valve.
33406............... .............. A Replacement of aortic 37.44 NA 19.11 4.93 NA 61.48 090
valve.
33410............... .............. A Replacement of aortic 32.41 NA 16.58 4.05 NA 53.04 090
valve.
33411............... .............. A Replacement of aortic 36.20 NA 18.74 4.86 NA 59.80 090
valve.
33412............... .............. A Replacement of aortic 41.94 NA 20.40 5.61 NA 67.95 090
valve.
33413............... .............. A Replacement of aortic 43.43 NA 20.80 5.94 NA 70.17 090
valve.
33414............... .............. A Repair of aortic 30.30 NA 14.15 4.00 NA 48.45 090
valve.
33415............... .............. A Revision, subvalvular 27.11 NA 12.05 3.56 NA 42.72 090
tissue.
33416............... .............. A Revise ventricle 30.30 NA 13.52 4.14 NA 47.96 090
muscle.
33417............... .............. A Repair of aortic 28.49 NA 13.63 3.96 NA 46.08 090
valve.
33420............... .............. A Revision of mitral 22.67 NA 9.61 1.89 NA 34.17 090
valve.
33422............... .............. A Revision of mitral 25.90 NA 13.64 3.39 NA 42.93 090
valve.
33425............... .............. A Repair of mitral 26.96 NA 13.05 3.59 NA 43.60 090
valve.
33426............... .............. A Repair of mitral 32.95 NA 17.13 4.25 NA 54.33 090
valve.
33427............... .............. A Repair of mitral 39.94 NA 19.35 5.27 NA 64.56 090
valve.
33430............... .............. A Replacement of mitral 33.45 NA 17.29 4.36 NA 55.10 090
valve.
33460............... .............. A Revision of tricuspid 23.56 NA 11.32 3.23 NA 38.11 090
valve.
33463............... .............. A Valvuloplasty, 25.58 NA 12.92 3.36 NA 41.86 090
tricuspid.
33464............... .............. A Valvuloplasty, 27.29 NA 13.53 3.52 NA 44.34 090
tricuspid.
33465............... .............. A Replace tricuspid 28.75 NA 12.98 3.88 NA 45.61 090
valve.
33468............... .............. A Revision of tricuspid 30.07 NA 13.68 4.35 NA 48.10 090
valve.
33470............... .............. A Revision of pulmonary 20.78 NA 10.71 2.01 NA 33.50 090
valve.
33471............... .............. A Valvotomy, pulmonary 22.22 NA 9.77 3.31 NA 35.30 090
valve.
33472............... .............. A Revision of pulmonary 22.22 NA 11.89 3.11 NA 37.22 090
valve.
33474............... .............. A Revision of pulmonary 23.01 NA 10.89 2.70 NA 36.60 090
valve.
33475............... .............. A Replacement, 32.95 NA 15.41 4.30 NA 52.66 090
pulmonary valve.
33476............... .............. A Revision of heart 25.73 NA 11.97 2.97 NA 40.67 090
chamber.
33478............... .............. A Revision of heart 26.70 NA 13.06 3.85 NA 43.61 090
chamber.
33496............... .............. A Repair, prosth valve 27.21 NA 12.76 3.60 NA 43.57 090
clot.
33500............... .............. A Repair heart vessel 25.51 NA 11.47 3.33 NA 40.31 090
fistula.
33501............... .............. A Repair heart vessel 17.75 NA 8.29 2.04 NA 28.08 090
fistula.
33502............... .............. A Coronary artery 21.01 NA 11.10 2.11 NA 34.22 090
correction.
33503............... .............. A Coronary artery graft 21.75 NA 9.78 1.84 NA 33.37 090
33504............... .............. A Coronary artery graft 24.62 NA 11.84 3.32 NA 39.78 090
33505............... .............. A Repair artery w/ 26.80 NA 12.93 2.67 NA 42.40 090
tunnel.
33506............... .............. A Repair artery, 35.45 NA 14.59 3.85 NA 53.89 090
translocation.
33508............... .............. A Endoscopic vein 0.31 NA 0.10 0.88 NA 1.29 ZZZ
harvest.
33510............... .............. A CABG, vein, single... 28.96 NA 16.33 3.75 NA 49.04 090
33511............... .............. A CABG, vein, two...... 29.96 NA 17.07 3.83 NA 50.86 090
33512............... .............. A CABG, vein, three.... 31.75 NA 17.60 4.13 NA 53.48 090
33513............... .............. A CABG, vein, four..... 31.95 NA 17.78 4.16 NA 53.89 090
33514............... .............. A CABG, vein, five..... 32.70 NA 18.05 4.00 NA 54.75 090
33516............... .............. A Cabg, vein, six or 34.95 NA 18.79 4.51 NA 58.25 090
more.
33517............... .............. A CABG, artery-vein, 2.57 NA 0.84 0.33 NA 3.74 ZZZ
single.
33518............... .............. A CABG, artery-vein, 4.84 NA 1.58 0.63 NA 7.05 ZZZ
two.
33519............... .............. A CABG, artery-vein, 7.11 NA 2.32 0.92 NA 10.35 ZZZ
three.
33521............... .............. A CABG, artery-vein, 9.39 NA 3.07 1.20 NA 13.66 ZZZ
four.
33522............... .............. A CABG, artery-vein, 11.65 NA 3.80 1.49 NA 16.94 ZZZ
five.
33523............... .............. A Cabg, art-vein, six 13.93 NA 4.52 1.81 NA 20.26 ZZZ
or more.
33530............... .............. A Coronary artery, 5.85 NA 1.90 0.77 NA 8.52 ZZZ
bypass/reop.
33533............... .............. A CABG, arterial, 29.96 NA 16.46 3.86 NA 50.28 090
single.
33534............... .............. A CABG, arterial, two.. 32.15 NA 17.70 4.13 NA 53.98 090
33535............... .............. A CABG, arterial, three 34.45 NA 18.13 4.43 NA 57.01 090
33536............... .............. A Cabg, arterial, four 37.44 NA 18.28 4.60 NA 60.32 090
or more.
33542............... .............. A Removal of heart 28.81 NA 13.01 3.79 NA 45.61 090
lesion.
33545............... .............. A Repair of heart 36.72 NA 15.64 4.81 NA 57.17 090
damage.
33572............... .............. A Open coronary 4.44 NA 1.45 0.58 NA 6.47 ZZZ
endarterectomy.
33600............... .............. A Closure of valve..... 29.47 NA 12.55 4.13 NA 46.15 090
33602............... .............. A Closure of valve..... 28.50 NA 12.46 3.25 NA 44.21 090
33606............... .............. A Anastomosis/artery- 30.69 NA 13.69 4.33 NA 48.71 090
aorta.
33608............... .............. A Repair anomaly w/ 31.04 NA 14.11 4.41 NA 49.56 090
conduit.
33610............... .............. A Repair by enlargement 30.56 NA 13.66 4.56 NA 48.78 090
33611............... .............. A Repair double 33.95 NA 14.15 4.11 NA 52.21 090
ventricle.
33612............... .............. A Repair double 34.95 NA 15.17 5.18 NA 55.30 090
ventricle.
33615............... .............. A Repair, modified 33.95 NA 13.27 2.90 NA 50.12 090
fontan.
33617............... .............. A Repair single 36.94 NA 16.02 4.88 NA 57.84 090
ventricle.
33619............... .............. A Repair single 44.93 NA 20.82 3.60 NA 69.35 090
ventricle.
33641............... .............. A Repair heart septum 21.36 NA 9.59 2.73 NA 33.68 090
defect.
[[Page 47612]]
33645............... .............. A Revision of heart 24.78 NA 11.78 3.26 NA 39.82 090
veins.
33647............... .............. A Repair heart septum 28.69 NA 13.79 3.12 NA 45.60 090
defects.
33660............... .............. A Repair of heart 29.96 NA 13.50 3.88 NA 47.34 090
defects.
33665............... .............. A Repair of heart 28.56 NA 13.85 4.21 NA 46.62 090
defects.
33670............... .............. A Repair of heart 34.95 NA 13.20 3.47 NA 51.62 090
chambers.
33681............... .............. A Repair heart septum 30.56 NA 14.69 4.03 NA 49.28 090
defect.
33684............... .............. A Repair heart septum 29.61 NA 13.63 4.08 NA 47.32 090
defect.
33688............... .............. A Repair heart septum 30.57 NA 10.52 4.39 NA 45.48 090
defect.
33690............... .............. A Reinforce pulmonary 19.52 NA 10.19 2.66 NA 32.37 090
artery.
33692............... .............. A Repair of heart 30.70 NA 13.94 4.58 NA 49.22 090
defects.
33694............... .............. A Repair of heart 33.95 NA 14.23 3.71 NA 51.89 090
defects.
33697............... .............. A Repair of heart 35.95 NA 14.87 4.32 NA 55.14 090
defects.
33702............... .............. A Repair of heart 26.50 NA 12.58 4.00 NA 43.08 090
defects.
33710............... .............. A Repair of heart 29.67 NA 14.00 3.01 NA 46.68 090
defects.
33720............... .............. A Repair of heart 26.52 NA 12.29 3.60 NA 42.41 090
defect.
33722............... .............. A Repair of heart 28.37 NA 13.88 4.33 NA 46.58 090
defect.
33730............... .............. A Repair heart-vein 34.20 NA 14.13 4.32 NA 52.65 090
defect(s).
33732............... .............. A Repair heart-vein 28.12 NA 13.41 2.88 NA 44.41 090
defect.
33735............... .............. A Revision of heart 21.36 NA 9.06 1.56 NA 31.98 090
chamber.
33736............... .............. A Revision of heart 23.48 NA 11.87 2.50 NA 37.85 090
chamber.
33737............... .............. A Revision of heart 21.73 NA 10.95 3.30 NA 35.98 090
chamber.
33750............... .............. A Major vessel shunt... 21.38 NA 10.24 2.56 NA 34.18 090
33755............... .............. A Major vessel shunt... 21.76 NA 8.82 3.24 NA 33.82 090
33762............... .............. A Major vessel shunt... 21.76 NA 10.17 3.18 NA 35.11 090
33764............... .............. A Major vessel shunt & 21.76 NA 10.25 2.15 NA 34.16 090
graft.
33766............... .............. A Major vessel shunt... 22.73 NA 11.68 3.39 NA 37.80 090
33767............... .............. A Major vessel shunt... 24.46 NA 11.75 2.74 NA 38.95 090
33770............... .............. A Repair great vessels 36.94 NA 14.69 5.42 NA 57.05 090
defect.
33771............... .............. A Repair great vessels 34.60 NA 12.42 5.63 NA 52.65 090
defect.
33774............... .............. A Repair great vessels 30.93 NA 14.75 4.70 NA 50.38 090
defect.
33775............... .............. A Repair great vessels 32.15 NA 15.02 5.23 NA 52.40 090
defect.
33776............... .............. A Repair great vessels 33.99 NA 15.80 5.52 NA 55.31 090
defect.
33777............... .............. A Repair great vessels 33.41 NA 14.87 5.44 NA 53.72 090
defect.
33778............... .............. A Repair great vessels 39.94 NA 16.89 5.83 NA 62.66 090
defect.
33779............... .............. A Repair great vessels 36.16 NA 15.39 1.74 NA 53.29 090
defect.
33780............... .............. A Repair great vessels 41.69 NA 19.06 5.15 NA 65.90 090
defect.
33781............... .............. A Repair great vessels 36.40 NA 13.48 5.92 NA 55.80 090
defect.
33786............... .............. A Repair arterial trunk 38.94 NA 16.70 2.03 NA 57.67 090
33788............... .............. A Revision of pulmonary 26.58 NA 11.95 4.02 NA 42.55 090
artery.
33800............... .............. A Aortic suspension.... 16.22 NA 8.16 2.28 NA 26.66 090
33802............... .............. A Repair vessel defect. 17.63 NA 9.24 1.66 NA 28.53 090
33803............... .............. A Repair vessel defect. 19.57 NA 9.78 3.17 NA 32.52 090
33813............... .............. A Repair septal defect. 20.62 NA 10.93 1.13 NA 32.68 090
33814............... .............. A Repair septal defect. 25.73 NA 12.66 3.56 NA 41.95 090
33820............... .............. A Revise major vessel.. 16.27 NA 8.39 2.19 NA 26.85 090
33822............... .............. A Revise major vessel.. 17.29 NA 8.98 1.92 NA 28.19 090
33824............... .............. A Revise major vessel.. 19.49 NA 10.01 2.91 NA 32.41 090
33840............... .............. A Remove aorta 20.60 NA 10.31 2.45 NA 33.36 090
constriction.
33845............... .............. A Remove aorta 22.09 NA 11.36 3.13 NA 36.58 090
constriction.
33851............... .............. A Remove aorta 21.24 NA 10.71 2.81 NA 34.76 090
constriction.
33852............... .............. A Repair septal defect. 23.67 NA 11.38 2.55 NA 37.60 090
33853............... .............. A Repair septal defect. 31.67 NA 14.84 4.13 NA 50.64 090
33860............... .............. A Ascending aortic 37.94 NA 16.46 5.05 NA 59.45 090
graft.
33861............... .............. A Ascending aortic 41.94 NA 17.72 5.45 NA 65.11 090
graft.
33863............... .............. A Ascending aortic 44.93 NA 18.70 5.46 NA 69.09 090
graft.
33870............... .............. A Transverse aortic 43.93 NA 18.39 5.96 NA 68.28 090
arch graft.
33875............... .............. A Thoracic aortic graft 33.01 NA 14.11 4.43 NA 51.55 090
33877............... .............. A Thoracoabdominal 42.54 NA 16.33 5.46 NA 64.33 090
graft.
33910............... .............. A Remove lung artery 24.55 NA 11.45 3.32 NA 39.32 090
emboli.
33915............... .............. A Remove lung artery 20.99 NA 9.64 1.73 NA 32.36 090
emboli.
33916............... .............. A Surgery of great 25.79 NA 11.37 3.47 NA 40.63 090
vessel.
33917............... .............. A Repair pulmonary 24.46 NA 12.21 3.25 NA 39.92 090
artery.
33918............... .............. A Repair pulmonary 26.41 NA 12.13 4.12 NA 42.66 090
atresia.
33919............... .............. A Repair pulmonary 39.94 NA 17.52 4.45 NA 61.91 090
atresia.
33920............... .............. A Repair pulmonary 31.90 NA 13.85 3.50 NA 49.25 090
atresia.
33922............... .............. A Transect pulmonary 23.48 NA 10.92 3.25 NA 37.65 090
artery.
33924............... .............. A Remove pulmonary 5.49 NA 1.83 0.70 NA 8.02 ZZZ
shunt.
33935............... .............. R Transplantation, 60.87 NA 28.77 9.19 NA 98.83 090
heart/lung.
33945............... .............. R Transplantation of 42.04 NA 21.38 5.91 NA 69.33 090
heart.
33960............... .............. A External circulation 19.33 NA 4.90 2.46 NA 26.69 000
assist.
33961............... .............. A External circulation 10.91 NA 3.61 1.08 NA 15.60 ZZZ
assist.
33967............... .............. A Insert ia percut 4.84 NA 1.83 0.35 NA 7.02 000
device.
33968............... .............. A Remove aortic assist 0.64 NA 0.23 0.06 NA 0.93 000
device.
33970............... .............. A Aortic circulation 6.74 NA 2.28 0.81 NA 9.83 000
assist.
33971............... .............. A Aortic circulation 9.68 NA 6.03 1.21 NA 16.92 090
assist.
[[Page 47613]]
33973............... .............. A Insert balloon device 9.75 NA 3.30 1.18 NA 14.23 000
33974............... .............. A Remove intra-aortic 14.39 NA 7.91 1.71 NA 24.01 090
balloon.
33975............... .............. A Implant ventricular 20.97 NA 6.27 2.95 NA 30.19 XXX
device.
33976............... .............. A Implant ventricular 22.97 NA 7.53 2.73 NA 33.23 XXX
device.
33977............... .............. A Remove ventricular 19.26 NA 11.08 2.68 NA 33.02 090
device.
33978............... .............. A Remove ventricular 21.70 NA 11.75 3.03 NA 36.48 090
device.
33979............... .............. A Insert intracorporeal 45.93 NA 14.89 4.80 NA 65.62 XXX
device.
33980............... .............. A Remove intracorporeal 56.17 NA 25.22 5.55 NA 86.94 090
device.
34001............... .............. A Removal of artery 12.89 NA 6.71 1.76 NA 21.36 090
clot.
34051............... .............. A Removal of artery 15.19 NA 7.77 2.20 NA 25.16 090
clot.
34101............... .............. A Removal of artery 9.99 NA 5.35 1.36 NA 16.70 090
clot.
34111............... .............. A Removal of arm artery 9.99 NA 5.35 1.36 NA 16.70 090
clot.
34151............... .............. A Removal of artery 24.96 NA 10.39 3.34 NA 38.69 090
clot.
34201............... .............. A Removal of artery 10.01 NA 5.41 1.38 NA 16.80 090
clot.
34203............... .............. A Removal of leg artery 16.48 NA 8.05 2.25 NA 26.78 090
clot.
34401............... .............. A Removal of vein clot. 24.96 NA 10.65 3.00 NA 38.61 090
34421............... .............. A Removal of vein clot. 11.98 NA 6.28 1.48 NA 19.74 090
34451............... .............. A Removal of vein clot. 26.96 NA 11.42 3.65 NA 42.03 090
34471............... .............. A Removal of vein clot. 10.16 NA 5.31 0.88 NA 16.35 090
34490............... .............. A Removal of vein clot. 9.85 NA 5.43 1.34 NA 16.62 090
34501............... .............. A Repair valve, femoral 15.98 NA 8.50 2.31 NA 26.79 090
vein.
34502............... .............. A Reconstruct vena cava 26.91 NA 12.28 3.41 NA 42.60 090
34510............... .............. A Transposition of vein 18.92 NA 9.43 2.39 NA 30.74 090
valve.
34520............... .............. A Cross-over vein graft 17.92 NA 8.48 1.63 NA 28.03 090
34530............... .............. A Leg vein fusion...... 16.62 NA 8.61 2.16 NA 27.39 090
34800............... .............. A Endovasc abdo repair 20.72 NA 9.15 2.35 NA 32.22 090
w/tube.
34802............... .............. A Endovasc abdo repr w/ 22.97 NA 9.77 2.34 NA 35.08 090
device.
34804............... .............. A Endovasc abdo repr w/ 22.97 NA 9.79 2.35 NA 35.11 090
device.
34805............... .............. A Endovasc abdo repair 21.85 NA 9.66 1.99 NA 33.50 090
w/pros.
34808............... .............. A Endovasc abdo occlud 4.12 NA 1.37 0.50 NA 5.99 ZZZ
device.
34812............... .............. A Xpose for endoprosth, 6.74 NA 2.23 1.09 NA 10.06 000
femorl.
34813............... .............. A Femoral endovas graft 4.79 NA 1.57 0.65 NA 7.01 ZZZ
add-on.
34820............... .............. A Xpose for endoprosth, 9.74 NA 3.23 1.35 NA 14.32 000
iliac.
34825............... .............. A Endovasc extend 11.98 NA 6.13 1.29 NA 19.40 090
prosth, init.
34826............... .............. A Endovasc exten 4.12 NA 1.37 0.45 NA 5.94 ZZZ
prosth, add-l.
34830............... .............. A Open aortic tube 32.54 NA 13.68 3.75 NA 49.97 090
prosth repr.
34831............... .............. A Open aortoiliac 35.29 NA 11.73 3.95 NA 50.97 090
prosth repr.
34832............... .............. A Open aortofemor 35.29 NA 14.60 4.05 NA 53.94 090
prosth repr.
34833............... .............. A Xpose for endoprosth, 11.98 NA 4.42 0.84 NA 17.24 000
iliac.
34834............... .............. A Xpose, endoprosth, 5.34 NA 2.19 0.59 NA 8.12 000
brachial.
34900............... .............. A Endovasc iliac repr w/ 16.36 NA 7.59 1.80 NA 25.75 090
graft.
35001............... .............. A Repair defect of 19.61 NA 9.54 2.64 NA 31.79 090
artery.
35002............... .............. A Repair artery 20.97 NA 9.68 2.38 NA 33.03 090
rupture, neck.
35005............... .............. A Repair defect of 18.09 NA 8.83 2.29 NA 29.21 090
artery.
35011............... .............. A Repair defect of 17.97 NA 7.97 2.42 NA 28.36 090
artery.
35013............... .............. A Repair artery 21.97 NA 9.66 2.98 NA 34.61 090
rupture, arm.
35021............... .............. A Repair defect of 19.62 NA 9.41 2.43 NA 31.46 090
artery.
35022............... .............. A Repair artery 23.15 NA 9.86 2.32 NA 35.33 090
rupture, chest.
35045............... .............. A Repair defect of arm 17.54 NA 7.53 2.38 NA 27.45 090
artery.
35081............... .............. A Repair defect of 27.97 NA 11.44 3.66 NA 43.07 090
artery.
35082............... .............. A Repair artery 38.44 NA 15.27 5.10 NA 58.81 090
rupture, aorta.
35091............... .............. A Repair defect of 35.35 NA 13.55 4.76 NA 53.66 090
artery.
35092............... .............. A Repair artery 44.93 NA 17.61 5.97 NA 68.51 090
rupture, aorta.
35102............... .............. A Repair defect of 30.71 NA 12.34 4.09 NA 47.14 090
artery.
35103............... .............. A Repair artery 40.44 NA 15.82 5.49 NA 61.75 090
rupture, groin.
35111............... .............. A Repair defect of 24.96 NA 10.45 3.35 NA 38.76 090
artery.
35112............... .............. A Repair artery 29.96 NA 11.95 3.89 NA 45.80 090
rupture,spleen.
35121............... .............. A Repair defect of 29.96 NA 12.35 4.05 NA 46.36 090
artery.
35122............... .............. A Repair artery 34.95 NA 13.78 4.48 NA 53.21 090
rupture, belly.
35131............... .............. A Repair defect of 24.96 NA 10.73 3.49 NA 39.18 090
artery.
35132............... .............. A Repair artery 29.96 NA 12.36 4.07 NA 46.39 090
rupture, groin.
35141............... .............. A Repair defect of 19.97 NA 8.90 2.72 NA 31.59 090
artery.
35142............... .............. A Repair artery 23.27 NA 10.35 3.11 NA 36.73 090
rupture, thigh.
35151............... .............. A Repair defect of 22.61 NA 9.98 3.04 NA 35.63 090
artery.
35152............... .............. A Repair artery 25.58 NA 11.36 3.35 NA 40.29 090
rupture, knee.
35161............... .............. A Repair defect of 18.73 NA 9.13 2.48 NA 30.34 090
artery.
35162............... .............. A Repair artery rupture 19.75 NA 9.56 2.75 NA 32.06 090
35180............... .............. A Repair blood vessel 13.60 NA 6.94 1.97 NA 22.51 090
lesion.
35182............... .............. A Repair blood vessel 29.96 NA 12.78 4.09 NA 46.83 090
lesion.
35184............... .............. A Repair blood vessel 17.97 NA 8.29 2.45 NA 28.71 090
lesion.
35188............... .............. A Repair blood vessel 14.26 NA 7.62 1.98 NA 23.86 090
lesion.
35189............... .............. A Repair blood vessel 27.96 NA 11.94 3.68 NA 43.58 090
lesion.
35190............... .............. A Repair blood vessel 12.73 NA 6.47 1.71 NA 20.91 090
lesion.
35201............... .............. A Repair blood vessel 16.12 NA 7.98 2.13 NA 26.23 090
lesion.
35206............... .............. A Repair blood vessel 13.23 NA 6.57 1.83 NA 21.63 090
lesion.
[[Page 47614]]
35207............... .............. A Repair blood vessel 10.13 NA 7.53 1.46 NA 19.12 090
lesion.
35211............... .............. A Repair blood vessel 22.09 NA 10.64 2.89 NA 35.62 090
lesion.
35216............... .............. A Repair blood vessel 18.72 NA 8.99 2.49 NA 30.20 090
lesion.
35221............... .............. A Repair blood vessel 24.35 NA 9.92 3.20 NA 37.47 090
lesion.
35226............... .............. A Repair blood vessel 14.48 NA 7.46 1.89 NA 23.83 090
lesion.
35231............... .............. A Repair blood vessel 19.97 NA 9.75 2.74 NA 32.46 090
lesion.
35236............... .............. A Repair blood vessel 17.08 NA 7.90 2.35 NA 27.33 090
lesion.
35241............... .............. A Repair blood vessel 23.09 NA 11.14 3.00 NA 37.23 090
lesion.
35246............... .............. A Repair blood vessel 26.41 NA 11.43 3.21 NA 41.05 090
lesion.
35251............... .............. A Repair blood vessel 30.15 NA 11.77 3.99 NA 45.91 090
lesion.
35256............... .............. A Repair blood vessel 18.33 NA 8.37 2.51 NA 29.21 090
lesion.
35261............... .............. A Repair blood vessel 17.77 NA 8.00 2.41 NA 28.18 090
lesion.
35266............... .............. A Repair blood vessel 14.89 NA 7.01 1.98 NA 23.88 090
lesion.
35271............... .............. A Repair blood vessel 22.09 NA 10.53 2.99 NA 35.61 090
lesion.
35276............... .............. A Repair blood vessel 24.21 NA 11.22 3.24 NA 38.67 090
lesion.
35281............... .............. A Repair blood vessel 27.96 NA 11.69 3.73 NA 43.38 090
lesion.
35286............... .............. A Repair blood vessel 16.14 NA 8.07 2.22 NA 26.43 090
lesion.
35301............... .............. A Rechanneling of 18.67 NA 8.44 2.52 NA 29.63 090
artery.
35311............... .............. A Rechanneling of 26.96 NA 11.73 3.47 NA 42.16 090
artery.
35321............... .............. A Rechanneling of 15.98 NA 7.37 2.18 NA 25.53 090
artery.
35331............... .............. A Rechanneling of 26.16 NA 11.22 3.56 NA 40.94 090
artery.
35341............... .............. A Rechanneling of 25.07 NA 10.85 3.44 NA 39.36 090
artery.
35351............... .............. A Rechanneling of 22.97 NA 9.58 3.16 NA 35.71 090
artery.
35355............... .............. A Rechanneling of 18.47 NA 8.08 2.51 NA 29.06 090
artery.
35361............... .............. A Rechanneling of 28.16 NA 11.69 3.84 NA 43.69 090
artery.
35363............... .............. A Rechanneling of 30.15 NA 12.56 4.16 NA 46.87 090
artery.
35371............... .............. A Rechanneling of 14.70 NA 6.94 2.01 NA 23.65 090
artery.
35372............... .............. A Rechanneling of 17.97 NA 8.04 2.47 NA 28.48 090
artery.
35381............... .............. A Rechanneling of 15.79 NA 7.81 2.14 NA 25.74 090
artery.
35390............... .............. A Reoperation, carotid 3.19 NA 1.06 0.43 NA 4.68 ZZZ
add-on.
35400............... .............. A Angioscopy........... 3.00 NA 1.11 0.42 NA 4.53 ZZZ
35450............... .............. A Repair arterial 10.05 NA 3.55 1.24 NA 14.84 000
blockage.
35452............... .............. A Repair arterial 6.90 NA 2.60 0.82 NA 10.32 000
blockage.
35454............... .............. A Repair arterial 6.03 NA 2.31 0.82 NA 9.16 000
blockage.
35456............... .............. A Repair arterial 7.34 NA 2.76 0.99 NA 11.09 000
blockage.
35458............... .............. A Repair arterial 9.48 NA 3.46 1.21 NA 14.15 000
blockage.
35459............... .............. A Repair arterial 8.62 NA 3.16 1.16 NA 12.94 000
blockage.
35460............... .............. A Repair venous 6.03 NA 2.26 0.82 NA 9.11 000
blockage.
35470............... .............. A Repair arterial 8.62 90.69 3.34 0.70 100.01 12.66 000
blockage.
35471............... .............. A Repair arterial 10.05 102.73 3.94 0.69 113.47 14.68 000
blockage.
35472............... .............. A Repair arterial 6.90 65.72 2.74 0.59 73.21 10.23 000
blockage.
35473............... .............. A Repair arterial 6.03 61.03 2.42 0.51 67.57 8.96 000
blockage.
35474............... .............. A Repair arterial 7.35 89.50 2.89 0.56 97.41 10.80 000
blockage.
35475............... .............. R Repair arterial 9.48 56.75 3.55 0.63 66.86 13.66 000
blockage.
35476............... .............. A Repair venous 6.03 45.31 2.35 0.39 51.73 8.77 000
blockage.
35480............... .............. A Atherectomy, open.... 11.06 NA 4.03 1.27 NA 16.36 000
35481............... .............. A Atherectomy, open.... 7.60 NA 2.87 0.99 NA 11.46 000
35482............... .............. A Atherectomy, open.... 6.64 NA 2.56 0.85 NA 10.05 000
35483............... .............. A Atherectomy, open.... 8.09 NA 3.02 1.05 NA 12.16 000
35484............... .............. A Atherectomy, open.... 10.42 NA 3.76 1.28 NA 15.46 000
35485............... .............. A Atherectomy, open.... 9.48 NA 3.53 1.30 NA 14.31 000
35490............... .............. A Atherectomy, 11.06 NA 4.69 0.63 NA 16.38 000
percutaneous.
35491............... .............. A Atherectomy, 7.60 NA 3.28 0.51 NA 11.39 000
percutaneous.
35492............... .............. A Atherectomy, 6.64 NA 3.19 0.42 NA 10.25 000
percutaneous.
35493............... .............. A Atherectomy, 8.09 NA 3.80 0.57 NA 12.46 000
percutaneous.
35494............... .............. A Atherectomy, 10.42 NA 4.45 0.79 NA 15.66 000
percutaneous.
35495............... .............. A Atherectomy, 9.48 NA 4.38 0.69 NA 14.55 000
percutaneous.
35500............... .............. A Harvest vein for 6.44 NA 2.02 0.88 NA 9.34 ZZZ
bypass.
35501............... .............. A Artery bypass graft.. 19.16 NA 8.46 2.67 NA 30.29 090
35506............... .............. A Artery bypass graft.. 19.64 NA 9.45 2.69 NA 31.78 090
35507............... .............. A Artery bypass graft.. 19.64 NA 9.41 2.66 NA 31.71 090
35508............... .............. A Artery bypass graft.. 18.62 NA 9.43 2.43 NA 30.48 090
35509............... .............. A Artery bypass graft.. 18.04 NA 8.75 2.47 NA 29.26 090
35510............... .............. A Artery bypass graft.. 22.97 NA 10.16 2.10 NA 35.23 090
35511............... .............. A Artery bypass graft.. 21.17 NA 9.34 2.38 NA 32.89 090
35512............... .............. A Artery bypass graft.. 22.47 NA 9.99 2.10 NA 34.56 090
35515............... .............. A Artery bypass graft.. 18.62 NA 9.27 2.50 NA 30.39 090
35516............... .............. A Artery bypass graft.. 16.30 NA 6.80 2.19 NA 25.29 090
35518............... .............. A Artery bypass graft.. 21.17 NA 8.96 2.84 NA 32.97 090
35521............... .............. A Artery bypass graft.. 22.17 NA 9.82 2.98 NA 34.97 090
35522............... .............. A Artery bypass graft.. 21.73 NA 9.74 2.10 NA 33.57 090
35525............... .............. A Artery bypass graft.. 20.60 NA 9.36 2.10 NA 32.06 090
35526............... .............. A Artery bypass graft.. 29.91 NA 12.49 2.43 NA 44.83 090
35531............... .............. A Artery bypass graft.. 36.15 NA 14.46 5.00 NA 55.61 090
35533............... .............. A Artery bypass graft.. 27.96 NA 11.71 3.59 NA 43.26 090
[[Page 47615]]
35536............... .............. A Artery bypass graft.. 31.65 NA 12.92 4.36 NA 48.93 090
35541............... .............. A Artery bypass graft.. 25.76 NA 11.19 3.49 NA 40.44 090
35546............... .............. A Artery bypass graft.. 25.50 NA 10.85 2.66 NA 39.01 090
35548............... .............. A Artery bypass graft.. 21.54 NA 9.41 2.84 NA 33.79 090
35549............... .............. A Artery bypass graft.. 23.31 NA 10.37 3.18 NA 36.86 090
35551............... .............. A Artery bypass graft.. 26.63 NA 11.48 3.71 NA 41.82 090
35556............... .............. A Artery bypass graft.. 21.73 NA 9.71 2.86 NA 34.30 090
35558............... .............. A Artery bypass graft.. 21.17 NA 9.53 2.83 NA 33.53 090
35560............... .............. A Artery bypass graft.. 31.95 NA 13.29 4.40 NA 49.64 090
35563............... .............. A Artery bypass graft.. 24.16 NA 10.50 3.39 NA 38.05 090
35565............... .............. A Artery bypass graft.. 23.17 NA 10.12 3.14 NA 36.43 090
35566............... .............. A Artery bypass graft.. 26.88 NA 11.37 3.63 NA 41.88 090
35571............... .............. A Artery bypass graft.. 24.02 NA 10.84 3.26 NA 38.12 090
35572............... .............. A Harvest 6.81 NA 2.23 0.76 NA 9.80 ZZZ
femoropopliteal vein.
35582............... .............. A Vein bypass graft.... 27.09 NA 11.55 3.32 NA 41.96 090
35583............... .............. A Vein bypass graft.... 22.34 NA 10.15 2.97 NA 35.46 090
35585............... .............. A Vein bypass graft.... 28.35 NA 12.23 3.81 NA 44.39 090
35587............... .............. A Vein bypass graft.... 24.71 NA 11.44 3.34 NA 39.49 090
35600............... .............. A Harvest artery for 4.94 NA 1.62 0.64 NA 7.20 ZZZ
cabg.
35601............... .............. A Artery bypass graft.. 17.47 NA 8.61 2.36 NA 28.44 090
35606............... .............. A Artery bypass graft.. 18.68 NA 9.00 2.52 NA 30.20 090
35612............... .............. A Artery bypass graft.. 15.74 NA 7.88 2.10 NA 25.72 090
35616............... .............. A Artery bypass graft.. 15.68 NA 8.10 2.18 NA 25.96 090
35621............... .............. A Artery bypass graft.. 19.97 NA 8.67 2.76 NA 31.40 090
35623............... .............. A Bypass graft, not 23.96 NA 10.48 3.30 NA 37.74 090
vein.
35626............... .............. A Artery bypass graft.. 27.71 NA 11.96 3.80 NA 43.47 090
35631............... .............. A Artery bypass graft.. 33.95 NA 13.81 4.64 NA 52.40 090
35636............... .............. A Artery bypass graft.. 29.46 NA 12.28 3.84 NA 45.58 090
35641............... .............. A Artery bypass graft.. 24.53 NA 11.05 3.28 NA 38.86 090
35642............... .............. A Artery bypass graft.. 17.95 NA 8.67 1.88 NA 28.50 090
35645............... .............. A Artery bypass graft.. 17.44 NA 8.27 2.21 NA 27.92 090
35646............... .............. A Artery bypass graft.. 30.95 NA 13.08 4.20 NA 48.23 090
35647............... .............. A Artery bypass graft.. 27.96 NA 11.76 3.78 NA 43.50 090
35650............... .............. A Artery bypass graft.. 18.97 NA 8.35 2.55 NA 29.87 090
35651............... .............. A Artery bypass graft.. 25.00 NA 10.73 3.08 NA 38.81 090
35654............... .............. A Artery bypass graft.. 24.96 NA 10.63 3.40 NA 38.99 090
35656............... .............. A Artery bypass graft.. 19.50 NA 8.60 2.61 NA 30.71 090
35661............... .............. A Artery bypass graft.. 18.97 NA 8.91 2.56 NA 30.44 090
35663............... .............. A Artery bypass graft.. 21.97 NA 9.96 2.99 NA 34.92 090
35665............... .............. A Artery bypass graft.. 20.97 NA 9.43 2.84 NA 33.24 090
35666............... .............. A Artery bypass graft.. 22.16 NA 10.64 3.00 NA 35.80 090
35671............... .............. A Artery bypass graft.. 19.30 NA 9.36 2.62 NA 31.28 090
35681............... .............. A Composite bypass 1.60 NA 0.53 0.20 NA 2.33 ZZZ
graft.
35682............... .............. A Composite bypass 7.19 NA 2.38 0.95 NA 10.52 ZZZ
graft.
35683............... .............. A Composite bypass 8.49 NA 2.81 1.10 NA 12.40 ZZZ
graft.
35685............... .............. A Bypass graft patency/ 4.04 NA 1.35 0.56 NA 5.95 ZZZ
patch.
35686............... .............. A Bypass graft/av fist 3.34 NA 1.12 0.47 NA 4.93 ZZZ
patency.
35691............... .............. A Arterial 18.02 NA 8.39 2.46 NA 28.87 090
transposition.
35693............... .............. A Arterial 15.34 NA 7.71 2.07 NA 25.12 090
transposition.
35694............... .............. A Arterial 19.13 NA 8.59 2.63 NA 30.35 090
transposition.
35695............... .............. A Arterial 19.13 NA 8.54 2.70 NA 30.37 090
transposition.
35697............... .............. A Reimplant artery each 3.00 NA 1.02 0.41 NA 4.43 ZZZ
35700............... .............. A Reoperation, bypass 3.08 NA 1.02 0.42 NA 4.52 ZZZ
graft.
35701............... .............. A Exploration, carotid 8.49 NA 5.15 1.16 NA 14.80 090
artery.
35721............... .............. A Exploration, femoral 7.17 NA 4.45 0.99 NA 12.61 090
artery.
35741............... .............. A Exploration popliteal 7.99 NA 4.68 1.08 NA 13.75 090
artery.
35761............... .............. A Exploration of artery/ 5.36 NA 4.04 0.73 NA 10.13 090
vein.
35800............... .............. A Explore neck vessels. 7.01 NA 4.65 0.93 NA 12.59 090
35820............... .............. A Explore chest vessels 12.86 NA 7.18 1.72 NA 21.76 090
35840............... .............. A Explore abdominal 9.76 NA 5.28 1.27 NA 16.31 090
vessels.
35860............... .............. A Explore limb vessels. 5.54 NA 4.03 0.75 NA 10.32 090
35870............... .............. A Repair vessel graft 22.14 NA 9.75 2.89 NA 34.78 090
defect.
35875............... .............. A Removal of clot in 10.11 NA 5.20 1.36 NA 16.67 090
graft.
35876............... .............. A Removal of clot in 16.97 NA 7.54 2.28 NA 26.79 090
graft.
35879............... .............. A Revise graft w/vein.. 15.98 NA 7.71 2.16 NA 25.85 090
35881............... .............. A Revise graft w/vein.. 17.97 NA 8.68 2.42 NA 29.07 090
35901............... .............. A Excision, graft, neck 8.18 NA 5.32 1.09 NA 14.59 090
35903............... .............. A Excision, graft, 9.38 NA 6.18 1.27 NA 16.83 090
extremity.
35905............... .............. A Excision, graft, 31.20 NA 13.18 4.40 NA 48.78 090
thorax.
35907............... .............. A Excision, graft, 34.95 NA 14.15 4.76 NA 53.86 090
abdomen.
36000............... .............. A Place needle in vein. 0.18 0.60 0.05 0.01 0.79 0.24 XXX
36002............... .............. A Pseudoaneurysm 1.96 2.87 0.97 0.18 5.01 3.11 000
injection trt.
36005............... .............. A Injection ext 0.95 7.89 0.31 0.06 8.90 1.32 000
venography.
36010............... .............. A Place catheter in 2.43 20.07 0.79 0.20 22.70 3.42 XXX
vein.
36011............... .............. A Place catheter in 3.14 28.80 1.06 0.24 32.18 4.44 XXX
vein.
[[Page 47616]]
36012............... .............. A Place catheter in 3.51 19.13 1.19 0.23 22.87 4.93 XXX
vein.
36013............... .............. A Place catheter in 2.52 22.22 0.69 0.25 24.99 3.46 XXX
artery.
36014............... .............. A Place catheter in 3.02 20.50 1.03 0.20 23.72 4.25 XXX
artery.
36015............... .............. A Place catheter in 3.51 24.30 1.19 0.22 28.03 4.92 XXX
artery.
36100............... .............. A Establish access to 3.02 12.32 1.11 0.28 15.62 4.41 XXX
artery.
36120............... .............. A Establish access to 2.01 10.85 0.64 0.15 13.01 2.80 XXX
artery.
36140............... .............. A Establish access to 2.01 13.05 0.64 0.16 15.22 2.81 XXX
artery.
36145............... .............. A Artery to vein shunt. 2.01 12.75 0.66 0.13 14.89 2.80 XXX
36160............... .............. A Establish access to 2.52 13.81 0.84 0.25 16.58 3.61 XXX
aorta.
36200............... .............. A Place catheter in 3.02 16.90 1.01 0.23 20.15 4.26 XXX
aorta.
36215............... .............. A Place catheter in 4.67 27.75 1.60 0.31 32.73 6.58 XXX
artery.
36216............... .............. A Place catheter in 5.27 29.86 1.79 0.36 35.49 7.42 XXX
artery.
36217............... .............. A Place catheter in 6.29 56.62 2.17 0.44 63.35 8.90 XXX
artery.
36218............... .............. A Place catheter in 1.01 5.18 0.34 0.07 6.26 1.42 ZZZ
artery.
36245............... .............. A Place catheter in 4.67 33.09 1.68 0.33 38.09 6.68 XXX
artery.
36246............... .............. A Place catheter in 5.27 30.97 1.81 0.38 36.62 7.46 XXX
artery.
36247............... .............. A Place catheter in 6.29 50.83 2.14 0.47 57.59 8.90 XXX
artery.
36248............... .............. A Place catheter in 1.01 4.12 0.34 0.07 5.20 1.42 ZZZ
artery.
36260............... .............. A Insertion of infusion 9.70 NA 4.91 1.26 NA 15.87 090
pump.
36261............... .............. A Revision of infusion 5.44 NA 3.68 0.62 NA 9.74 090
pump.
36262............... .............. A Removal of infusion 4.01 NA 2.75 0.52 NA 7.28 090
pump.
36400............... .............. A Bl draw < 3 yrs fem/ 0.38 0.28 0.09 0.03 0.69 0.50 XXX
jugular.
36405............... .............. A Bl draw < 3 yrs scalp 0.31 0.26 0.08 0.02 0.59 0.41 XXX
vein.
36406............... .............. A Bl draw < 3 yrs other 0.18 0.29 0.05 0.01 0.48 0.24 XXX
vein.
36410............... .............. A Non-routine bl draw > 0.18 0.30 0.05 0.01 0.49 0.24 XXX
3 yrs.
36420............... .............. A Vein access cutdown < 1.01 0.34 0.27 0.06 1.41 1.34 XXX
1 yr.
36425............... .............. A Vein access cutdown > 0.76 NA 0.22 0.06 NA 1.04 XXX
1 yr.
36430............... .............. A Blood transfusion 0.00 1.00 NA 0.06 1.06 NA XXX
service.
36440............... .............. A Bl push transfuse, 2 1.03 NA 0.29 0.07 NA 1.39 XXX
yr or <.
36450............... .............. A Bl exchange/ 2.23 NA 0.70 0.10 NA 3.03 XXX
transfuse, nb.
36455............... .............. A Bl exchange/transfuse 2.43 NA 1.01 0.14 NA 3.58 XXX
non-nb.
36460............... .............. A Transfusion service, 6.58 NA 2.24 0.88 NA 9.70 XXX
fetal.
36470............... .............. A Injection therapy of 1.09 2.69 0.73 0.13 3.91 1.95 010
vein.
36471............... .............. A Injection therapy of 1.57 3.08 0.96 0.19 4.84 2.72 010
veins.
36481............... .............. A Insertion of 6.98 6.04 2.58 0.48 13.50 10.04 000
catheter, vein.
36500............... .............. A Insertion of 3.51 NA 1.36 0.24 NA 5.11 000
catheter, vein.
36510............... .............. A Insertion of 1.09 3.95 0.61 0.08 5.12 1.78 000
catheter, vein.
36511............... .............. A Apheresis wbc........ 1.74 NA 0.73 0.08 NA 2.55 000
36512............... .............. A Apheresis rbc........ 1.74 NA 0.74 0.08 NA 2.56 000
36513............... .............. A Apheresis platelets.. 1.74 NA 0.73 0.08 NA 2.55 000
36514............... .............. A Apheresis plasma..... 1.74 17.69 0.71 0.08 19.51 2.53 000
36515............... .............. A Apheresis, adsorp/ 1.74 65.03 0.65 0.08 66.85 2.47 000
reinfuse.
36516............... .............. A Apheresis, selective. 1.22 84.13 0.48 0.08 85.43 1.78 000
36522............... .............. A Photopheresis........ 1.67 30.87 1.13 0.14 32.68 2.94 000
36550............... .............. A Declot vascular 0.00 0.40 NA 0.37 0.77 NA XXX
device.
36555............... .............. A Insert non-tunnel cv 2.68 5.80 0.80 0.12 8.60 3.60 000
cath.
36556............... .............. A Insert non-tunnel cv 2.50 5.75 0.74 0.19 8.44 3.43 000
cath.
36557............... .............. A Insert tunneled cv 5.09 21.23 2.64 0.58 26.90 8.31 010
cath.
36558............... .............. A Insert tunneled cv 4.79 21.12 2.54 0.58 26.49 7.91 010
cath.
36560............... .............. A Insert tunneled cv 6.24 29.79 3.03 0.58 36.61 9.85 010
cath.
36561............... .............. A Insert tunneled cv 5.99 29.70 2.94 0.58 36.27 9.51 010
cath.
36563............... .............. A Insert tunneled cv 6.19 26.76 2.98 0.83 33.78 10.00 010
cath.
36565............... .............. A Insert tunneled cv 5.99 24.81 2.94 0.58 31.38 9.51 010
cath.
36566............... .............. A Insert tunneled cv 6.49 25.60 3.11 0.58 32.67 10.18 010
cath.
36568............... .............. A Insert tunneled cv 1.92 7.60 0.58 0.12 9.64 2.62 000
cath.
36569............... .............. A Insert tunneled cv 1.82 7.42 0.57 0.19 9.43 2.58 000
cath.
36570............... .............. A Insert tunneled cv 5.31 33.30 2.72 0.58 39.19 8.61 010
cath.
36571............... .............. A Insert tunneled cv 5.29 33.38 2.71 0.58 39.25 8.58 010
cath.
36575............... .............. A Repair tunneled cv 0.67 4.07 0.26 0.22 4.96 1.15 000
cath.
36576............... .............. A Repair tunneled cv 3.19 6.98 1.83 0.21 10.38 5.23 010
cath.
36578............... .............. A Replace tunneled cv 3.49 11.20 2.30 0.21 14.90 6.00 010
cath.
36580............... .............. A Replace tunneled cv 1.31 7.08 0.41 0.19 8.58 1.91 000
cath.
36581............... .............. A Replace tunneled cv 3.43 19.63 1.91 0.21 23.27 5.55 010
cath.
36582............... .............. A Replace tunneled cv 5.19 26.19 2.85 0.21 31.59 8.25 010
cath.
36583............... .............. A Replace tunneled cv 5.24 26.21 2.87 0.20 31.65 8.31 010
cath.
36584............... .............. A Replace tunneled cv 1.20 7.11 0.55 0.19 8.50 1.94 000
cath.
36585............... .............. A Replace tunneled cv 4.79 28.01 2.72 0.21 33.01 7.72 010
cath.
36589............... .............. A Removal tunneled cv 2.27 2.24 1.39 0.25 4.76 3.91 010
cath.
36590............... .............. A Removal tunneled cv 3.30 3.38 1.72 0.43 7.11 5.45 010
cath.
36595............... .............. A Mech remov tunneled 3.59 17.42 1.45 0.33 21.34 5.37 000
cv cath.
36596............... .............. A Mech remov tunneled 0.75 3.71 0.50 0.39 4.85 1.64 000
cv cath.
36597............... .............. A Reposition venous 1.21 2.41 0.44 0.08 3.70 1.73 000
catheter.
36600............... .............. A Withdrawal of 0.32 0.49 0.09 0.02 0.83 0.43 XXX
arterial blood.
36620............... .............. A Insertion catheter, 1.15 NA 0.23 0.07 NA 1.45 000
artery.
36625............... .............. A Insertion catheter, 2.11 NA 0.53 0.21 NA 2.85 000
artery.
[[Page 47617]]
36640............... .............. A Insertion catheter, 2.10 NA 1.05 0.22 NA 3.37 000
artery.
36660............... .............. A Insertion catheter, 1.40 NA 0.44 0.09 NA 1.93 000
artery.
36680............... .............. A Insert needle, bone 1.20 NA 0.49 0.13 NA 1.82 000
cavity.
36800............... .............. A Insertion of cannula. 2.43 NA 1.80 0.23 NA 4.46 000
36810............... .............. A Insertion of cannula. 3.96 NA 1.68 0.47 NA 6.11 000
36815............... .............. A Insertion of cannula. 2.62 NA 1.17 0.33 NA 4.12 000
36819............... .............. A Av fusion/uppr arm 13.98 NA 6.36 1.87 NA 22.21 090
vein.
36820............... .............. A Av fusion/forearm 13.98 NA 6.37 1.88 NA 22.23 090
vein.
36821............... .............. A Av fusion direct any 8.92 NA 4.67 1.18 NA 14.77 090
site.
36822............... .............. A Insertion of 5.41 NA 4.41 0.73 NA 10.55 090
cannula(s).
36823............... .............. A Insertion of 20.97 NA 9.38 2.64 NA 32.99 090
cannula(s).
36825............... .............. A Artery-vein autograft 9.83 NA 5.07 1.29 NA 16.19 090
36830............... .............. A Artery-vein 11.98 NA 5.25 1.60 NA 18.83 090
nonautograft.
36831............... .............. A Open thrombect av 7.99 NA 3.94 1.07 NA 13.00 090
fistula.
36832............... .............. A Av fistula revision, 10.48 NA 4.74 1.39 NA 16.61 090
open.
36833............... .............. A Av fistula revision.. 11.93 NA 5.21 1.60 NA 18.74 090
36834............... .............. A Repair A-V aneurysm.. 9.92 NA 4.79 1.34 NA 16.05 090
36835............... .............. A Artery to vein shunt. 7.14 NA 4.34 0.99 NA 12.47 090
36838............... .............. A Dist revas ligation, 20.60 NA 9.37 2.99 NA 32.96 090
hemo.
36860............... .............. A External cannula 2.01 1.77 0.67 0.13 3.91 2.81 000
declotting.
36861............... .............. A Cannula declotting... 2.52 NA 1.49 0.25 NA 4.26 000
36870............... .............. A Percut thrombect av 5.15 32.39 3.14 0.33 37.87 8.62 090
fistula.
37140............... .............. A Revision of 23.56 NA 10.46 1.71 NA 35.73 090
circulation.
37145............... .............. A Revision of 24.57 NA 10.87 2.99 NA 38.43 090
circulation.
37160............... .............. A Revision of 21.57 NA 9.25 2.79 NA 33.61 090
circulation.
37180............... .............. A Revision of 24.57 NA 10.29 3.12 NA 37.98 090
circulation.
37181............... .............. A Splice spleen/kidney 26.64 NA 10.99 3.37 NA 41.00 090
veins.
37182............... .............. A Insert hepatic shunt 16.97 NA 6.04 0.59 NA 23.60 000
(tips).
37183............... .............. A Remove hepatic shunt 7.99 NA 3.01 0.59 NA 11.59 000
(tips).
37195............... .............. A Thrombolytic therapy, 0.00 8.04 NA 0.46 8.50 NA XXX
stroke.
37200............... .............. A Transcatheter biopsy. 4.55 NA 1.49 0.27 NA 6.31 000
37201............... .............. A Transcatheter therapy 4.99 NA 2.54 0.35 NA 7.88 000
infuse.
37202............... .............. A Transcatheter therapy 5.67 NA 3.02 0.53 NA 9.22 000
infuse.
37203............... .............. A Transcatheter 5.02 33.39 2.03 0.33 38.74 7.38 000
retrieval.
37204............... .............. A Transcatheter 18.11 NA 5.89 1.37 NA 25.37 000
occlusion.
37205............... .............. A Transcatheter stent.. 8.27 NA 3.75 0.59 NA 12.61 000
37206............... .............. A Transcatheter stent 4.12 NA 1.43 0.31 NA 5.86 ZZZ
add-on.
37207............... .............. A Transcatheter stent.. 8.27 NA 3.15 1.10 NA 12.52 000
37208............... .............. A Transcatheter stent 4.12 NA 1.38 0.55 NA 6.05 ZZZ
add-on.
37209............... .............. A Exchange arterial 2.27 NA 0.74 0.16 NA 3.17 000
catheter.
37250............... .............. A Iv us first vessel 2.10 NA 0.75 0.20 NA 3.05 ZZZ
add-on.
37251............... .............. A Iv us each add vessel 1.60 NA 0.55 0.19 NA 2.34 ZZZ
add-on.
37500............... .............. A Endoscopy ligate perf 10.98 NA 6.88 0.48 NA 18.34 090
veins.
37565............... .............. A Ligation of neck vein 10.86 NA 5.61 1.31 NA 17.78 090
37600............... .............. A Ligation of neck 11.23 NA 6.62 1.30 NA 19.15 090
artery.
37605............... .............. A Ligation of neck 13.09 NA 6.90 1.93 NA 21.92 090
artery.
37606............... .............. A Ligation of neck 6.27 NA 4.56 0.94 NA 11.77 090
artery.
37607............... .............. A Ligation of a-v 6.15 NA 3.57 0.83 NA 10.55 090
fistula.
37609............... .............. A Temporal artery 3.00 4.51 1.96 0.36 7.87 5.32 010
procedure.
37615............... .............. A Ligation of neck 5.72 NA 4.10 0.69 NA 10.51 090
artery.
37616............... .............. A Ligation of chest 16.47 NA 8.10 2.19 NA 26.76 090
artery.
37617............... .............. A Ligation of abdomen 22.03 NA 9.17 2.85 NA 34.05 090
artery.
37618............... .............. A Ligation of extremity 4.83 NA 3.62 0.65 NA 9.10 090
artery.
37620............... .............. A Revision of major 10.54 NA 5.70 0.94 NA 17.18 090
vein.
37650............... .............. A Revision of major 7.79 NA 4.69 1.05 NA 13.53 090
vein.
37660............... .............. A Revision of major 20.97 NA 9.05 2.60 NA 32.62 090
vein.
37700............... .............. A Revise leg vein...... 3.72 NA 2.80 0.52 NA 7.04 090
37720............... .............. A Removal of leg vein.. 5.65 NA 3.71 0.79 NA 10.15 090
37730............... .............. A Removal of leg veins. 7.32 NA 4.26 0.97 NA 12.55 090
37735............... .............. A Removal of leg veins/ 10.51 NA 5.50 1.48 NA 17.49 090
lesion.
37760............... .............. A Ligation, leg veins, 10.45 NA 5.35 1.38 NA 17.18 090
open.
37765............... .............. A Phleb veins - extrem - 7.34 NA 4.61 0.48 NA 12.43 090
to 20.
37766............... .............. A Phleb veins - extrem 9.29 NA 5.31 0.48 NA 15.08 090
20+.
37780............... .............. A Revision of leg vein. 3.83 NA 2.86 0.54 NA 7.23 090
37785............... .............. A Ligate/divide/excise 3.83 5.22 2.73 0.53 9.58 7.09 090
vein.
37788............... .............. A Revascularization, 21.98 NA 9.18 1.56 NA 32.72 090
penis.
37790............... .............. A Penile venous 8.33 NA 4.47 0.62 NA 13.42 090
occlusion.
38100............... .............. A Removal of spleen, 14.48 NA 6.19 1.85 NA 22.52 090
total.
38101............... .............. A Removal of spleen, 15.29 NA 6.54 2.01 NA 23.84 090
partial.
38102............... .............. A Removal of spleen, 4.79 NA 1.63 0.61 NA 7.03 ZZZ
total.
38115............... .............. A Repair of ruptured 15.80 NA 6.65 1.97 NA 24.42 090
spleen.
38120............... .............. A Laparoscopy, 16.97 NA 7.38 2.18 NA 26.53 090
splenectomy.
38200............... .............. A Injection for spleen 2.64 NA 0.89 0.17 NA 3.70 000
x-ray.
38205............... .............. R Harvest allogenic 1.50 NA 0.68 0.06 NA 2.24 000
stem cells.
38206............... .............. R Harvest auto stem 1.50 NA 0.67 0.06 NA 2.23 000
cells.
[[Page 47618]]
38220............... .............. A Bone marrow 1.08 3.97 0.52 0.06 5.11 1.66 XXX
aspiration.
38221............... .............. A Bone marrow biopsy... 1.37 4.19 0.65 0.07 5.63 2.09 XXX
38230............... .............. R Bone marrow 4.53 NA 3.27 0.33 NA 8.13 010
collection.
38240............... .............. R Bone marrow/stem 2.24 NA 1.03 0.11 NA 3.38 XXX
transplant.
38241............... .............. R Bone marrow/stem 2.24 NA 1.04 0.11 NA 3.39 XXX
transplant.
38242............... .............. A Lymphocyte infuse 1.71 NA 0.78 0.07 NA 2.56 000
transplant.
38300............... .............. A Drainage, lymph node 1.99 4.36 2.06 0.22 6.57 4.27 010
lesion.
38305............... .............. A Drainage, lymph node 5.99 NA 4.47 0.60 NA 11.06 090
lesion.
38308............... .............. A Incision of lymph 6.44 NA 3.76 0.85 NA 11.05 090
channels.
38380............... .............. A Thoracic duct 7.45 NA 5.68 0.80 NA 13.93 090
procedure.
38381............... .............. A Thoracic duct 12.86 NA 6.90 1.81 NA 21.57 090
procedure.
38382............... .............. A Thoracic duct 10.06 NA 5.79 1.40 NA 17.25 090
procedure.
38500............... .............. A Biopsy/removal, lymph 3.74 3.71 2.08 0.48 7.93 6.30 010
nodes.
38505............... .............. A Needle biopsy, lymph 1.14 2.06 0.79 0.10 3.30 2.03 000
nodes.
38510............... .............. A Biopsy/removal, lymph 6.42 5.54 3.48 0.74 12.70 10.64 010
nodes.
38520............... .............. A Biopsy/removal, lymph 6.66 NA 4.06 0.84 NA 11.56 090
nodes.
38525............... .............. A Biopsy/removal, lymph 6.06 NA 3.33 0.79 NA 10.18 090
nodes.
38530............... .............. A Biopsy/removal, lymph 7.97 NA 4.43 1.06 NA 13.46 090
nodes.
38542............... .............. A Explore deep node(s), 5.90 NA 4.48 0.63 NA 11.01 090
neck.
38550............... .............. A Removal, neck/armpit 6.91 NA 3.96 0.87 NA 11.74 090
lesion.
38555............... .............. A Removal, neck/armpit 14.12 NA 8.57 1.67 NA 24.36 090
lesion.
38562............... .............. A Removal, pelvic lymph 10.47 NA 5.79 1.21 NA 17.47 090
nodes.
38564............... .............. A Removal, abdomen 10.81 NA 5.27 1.31 NA 17.39 090
lymph nodes.
38570............... .............. A Laparoscopy, lymph 9.24 NA 3.97 1.12 NA 14.33 010
node biop.
38571............... .............. A Laparoscopy, 14.66 NA 5.64 1.20 NA 21.50 010
lymphadenectomy.
38572............... .............. A Laparoscopy, 16.57 NA 7.07 1.89 NA 25.53 010
lymphadenectomy.
38700............... .............. A Removal of lymph 8.23 NA 6.22 0.76 NA 15.21 090
nodes, neck.
38720............... .............. A Removal of lymph 13.59 NA 9.35 1.24 NA 24.18 090
nodes, neck.
38724............... .............. A Removal of lymph 14.52 NA 9.82 1.32 NA 25.66 090
nodes, neck.
38740............... .............. A Remove armpit lymph 10.01 NA 4.98 1.30 NA 16.29 090
nodes.
38745............... .............. A Remove armpit lymph 13.08 NA 6.14 1.68 NA 20.90 090
nodes.
38746............... .............. A Remove thoracic lymph 4.88 NA 1.61 0.67 NA 7.16 ZZZ
nodes.
38747............... .............. A Remove abdominal 4.88 NA 1.66 0.62 NA 7.16 ZZZ
lymph nodes.
38760............... .............. A Remove groin lymph 12.93 NA 6.16 1.65 NA 20.74 090
nodes.
38765............... .............. A Remove groin lymph 19.95 NA 8.85 2.44 NA 31.24 090
nodes.
38770............... .............. A Remove pelvis lymph 13.21 NA 5.76 1.37 NA 20.34 090
nodes.
38780............... .............. A Remove abdomen lymph 16.57 NA 8.22 1.88 NA 26.67 090
nodes.
38790............... .............. A Inject for lymphatic 1.29 7.42 0.76 0.13 8.84 2.18 000
x-ray.
38792............... .............. A Identify sentinel 0.52 NA 0.44 0.06 NA 1.02 000
node.
38794............... .............. A Access thoracic lymph 4.44 NA 3.43 0.21 NA 8.08 090
duct.
39000............... .............. A Exploration of chest. 6.09 NA 4.68 0.83 NA 11.60 090
39010............... .............. A Exploration of chest. 11.77 NA 6.64 1.59 NA 20.00 090
39200............... .............. A Removal chest lesion. 13.60 NA 6.78 1.82 NA 22.20 090
39220............... .............. A Removal chest lesion. 17.39 NA 8.50 2.23 NA 28.12 090
39400............... .............. A Visualization of 5.60 NA 4.85 0.79 NA 11.24 010
chest.
39501............... .............. A Repair diaphragm 13.17 NA 6.48 1.68 NA 21.33 090
laceration.
39502............... .............. A Repair paraesophageal 16.31 NA 7.16 2.10 NA 25.57 090
hernia.
39503............... .............. A Repair of diaphragm 94.86 NA 33.37 11.59 NA 139.82 090
hernia.
39520............... .............. A Repair of diaphragm 16.08 NA 8.06 2.10 NA 26.24 090
hernia.
39530............... .............. A Repair of diaphragm 15.39 NA 7.15 1.97 NA 24.51 090
hernia.
39531............... .............. A Repair of diaphragm 16.40 NA 7.40 2.10 NA 25.90 090
hernia.
39540............... .............. A Repair of diaphragm 13.30 NA 6.25 1.67 NA 21.22 090
hernia.
39541............... .............. A Repair of diaphragm 14.39 NA 6.60 1.86 NA 22.85 090
hernia.
39545............... .............. A Revision of diaphragm 13.35 NA 7.57 1.81 NA 22.73 090
39560............... .............. A Resect diaphragm, 11.98 NA 6.31 1.55 NA 19.84 090
simple.
39561............... .............. A Resect diaphragm, 17.47 NA 9.35 2.27 NA 29.09 090
complex.
40490............... .............. A Biopsy of lip........ 1.22 1.63 0.61 0.11 2.96 1.94 000
40500............... .............. A Partial excision of 4.27 6.90 4.33 0.45 11.62 9.05 090
lip.
40510............... .............. A Partial excision of 4.69 6.61 4.01 0.51 11.81 9.21 090
lip.
40520............... .............. A Partial excision of 4.66 7.53 4.10 0.55 12.74 9.31 090
lip.
40525............... .............. A Reconstruct lip with 7.54 NA 6.29 0.88 NA 14.71 090
flap.
40527............... .............. A Reconstruct lip with 9.12 NA 7.33 1.01 NA 17.46 090
flap.
40530............... .............. A Partial removal of 5.39 7.81 4.57 0.60 13.80 10.56 090
lip.
40650............... .............. A Repair lip........... 3.63 6.79 3.32 0.39 10.81 7.34 090
40652............... .............. A Repair lip........... 4.25 7.74 4.27 0.53 12.52 9.05 090
40654............... .............. A Repair lip........... 5.30 8.59 4.93 0.67 14.56 10.90 090
40700............... .............. A Repair cleft lip/ 12.77 NA 9.06 1.08 NA 22.91 090
nasal.
40701............... .............. A Repair cleft lip/ 15.83 NA 11.30 2.36 NA 29.49 090
nasal.
40702............... .............. A Repair cleft lip/ 13.02 NA 8.27 0.92 NA 22.21 090
nasal.
40720............... .............. A Repair cleft lip/ 13.53 NA 9.86 1.74 NA 25.13 090
nasal.
40761............... .............. A Repair cleft lip/ 14.70 NA 10.24 1.70 NA 26.64 090
nasal.
40800............... .............. A Drainage of mouth 1.17 2.97 1.77 0.12 4.26 3.06 010
lesion.
40801............... .............. A Drainage of mouth 2.53 4.01 2.74 0.32 6.86 5.59 010
lesion.
40804............... .............. A Removal, foreign 1.24 3.41 1.87 0.12 4.77 3.23 010
body, mouth.
40805............... .............. A Removal, foreign 2.69 4.48 2.81 0.29 7.46 5.79 010
body, mouth.
[[Page 47619]]
40806............... .............. A Incision of lip fold. 0.31 1.83 0.50 0.03 2.17 0.84 000
40808............... .............. A Biopsy of mouth 0.96 2.65 1.48 0.10 3.71 2.54 010
lesion.
40810............... .............. A Excision of mouth 1.31 2.88 1.66 0.13 4.32 3.10 010
lesion.
40812............... .............. A Excise/repair mouth 2.31 3.71 2.40 0.28 6.30 4.99 010
lesion.
40814............... .............. A Excise/repair mouth 3.41 4.94 3.89 0.40 8.75 7.70 090
lesion.
40816............... .............. A Excision of mouth 3.66 5.17 3.99 0.39 9.22 8.04 090
lesion.
40818............... .............. A Excise oral mucosa 2.41 5.17 3.97 0.21 7.79 6.59 090
for graft.
40819............... .............. A Excise lip or cheek 2.41 4.08 3.09 0.27 6.76 5.77 090
fold.
40820............... .............. A Treatment of mouth 1.28 3.93 2.44 0.12 5.33 3.84 010
lesion.
40830............... .............. A Repair mouth 1.76 3.73 2.11 0.17 5.66 4.04 010
laceration.
40831............... .............. A Repair mouth 2.46 4.65 3.05 0.28 7.39 5.79 010
laceration.
40840............... .............. R Reconstruction of 8.72 9.77 6.96 0.98 19.47 16.66 090
mouth.
40842............... .............. R Reconstruction of 8.72 10.04 6.78 0.94 19.70 16.44 090
mouth.
40843............... .............. R Reconstruction of 12.08 11.93 7.80 1.39 25.40 21.27 090
mouth.
40844............... .............. R Reconstruction of 15.99 15.74 11.55 2.12 33.85 29.66 090
mouth.
40845............... .............. R Reconstruction of 18.55 17.03 13.19 2.02 37.60 33.76 090
mouth.
41000............... .............. A Drainage of mouth 1.30 2.32 1.41 0.12 3.74 2.83 010
lesion.
41005............... .............. A Drainage of mouth 1.26 3.33 1.73 0.15 4.74 3.14 010
lesion.
41006............... .............. A Drainage of mouth 3.24 4.79 3.16 0.34 8.37 6.74 090
lesion.
41007............... .............. A Drainage of mouth 3.10 5.11 3.02 0.34 8.55 6.46 090
lesion.
41008............... .............. A Drainage of mouth 3.36 4.67 3.20 0.44 8.47 7.00 090
lesion.
41009............... .............. A Drainage of mouth 3.58 4.96 3.56 0.45 8.99 7.59 090
lesion.
41010............... .............. A Incision of tongue 1.06 3.44 1.60 0.09 4.59 2.75 010
fold.
41015............... .............. A Drainage of mouth 3.95 5.39 4.14 0.49 9.83 8.58 090
lesion.
41016............... .............. A Drainage of mouth 4.06 5.60 4.22 0.51 10.17 8.79 090
lesion.
41017............... .............. A Drainage of mouth 4.06 5.62 4.30 0.53 10.21 8.89 090
lesion.
41018............... .............. A Drainage of mouth 5.09 6.13 4.58 0.65 11.87 10.32 090
lesion.
41100............... .............. A Biopsy of tongue..... 1.63 2.42 1.42 0.15 4.20 3.20 010
41105............... .............. A Biopsy of tongue..... 1.42 2.30 1.32 0.13 3.85 2.87 010
41108............... .............. A Biopsy of floor of 1.05 2.07 1.13 0.10 3.22 2.28 010
mouth.
41110............... .............. A Excision of tongue 1.51 2.99 1.64 0.13 4.63 3.28 010
lesion.
41112............... .............. A Excision of tongue 2.73 4.46 3.22 0.28 7.47 6.23 090
lesion.
41113............... .............. A Excision of tongue 3.19 4.73 3.46 0.35 8.27 7.00 090
lesion.
41114............... .............. A Excision of tongue 8.46 NA 7.18 0.84 NA 16.48 090
lesion.
41115............... .............. A Excision of tongue 1.74 3.28 1.85 0.19 5.21 3.78 010
fold.
41116............... .............. A Excision of mouth 2.44 4.35 2.80 0.23 7.02 5.47 090
lesion.
41120............... .............. A Partial removal of 9.76 NA 15.31 0.84 NA 25.91 090
tongue.
41130............... .............. A Partial removal of 11.13 NA 16.19 0.96 NA 28.28 090
tongue.
41135............... .............. A Tongue and neck 23.06 NA 23.23 2.01 NA 48.30 090
surgery.
41140............... .............. A Removal of tongue.... 25.46 NA 26.66 2.50 NA 54.62 090
41145............... .............. A Tongue removal, neck 30.01 NA 30.53 2.59 NA 63.13 090
surgery.
41150............... .............. A Tongue, mouth, jaw 23.01 NA 24.70 2.05 NA 49.76 090
surgery.
41153............... .............. A Tongue, mouth, neck 23.73 NA 25.01 2.10 NA 50.84 090
surgery.
41155............... .............. A Tongue, jaw, & neck 27.68 NA 26.79 2.44 NA 56.91 090
surgery.
41250............... .............. A Repair tongue 1.91 2.76 1.19 0.18 4.85 3.28 010
laceration.
41251............... .............. A Repair tongue 2.27 3.27 1.56 0.22 5.76 4.05 010
laceration.
41252............... .............. A Repair tongue 2.97 3.89 2.26 0.31 7.17 5.54 010
laceration.
41500............... .............. A Fixation of tongue... 3.70 NA 7.45 0.32 NA 11.47 090
41510............... .............. A Tongue to lip surgery 3.41 NA 7.99 0.38 NA 11.78 090
41520............... .............. A Reconstruction, 2.73 4.62 3.61 0.27 7.62 6.61 090
tongue fold.
41800............... .............. A Drainage of gum 1.17 2.59 1.29 0.12 3.88 2.58 010
lesion.
41805............... .............. A Removal foreign body, 1.24 2.67 2.22 0.15 4.06 3.61 010
gum.
41806............... .............. A Removal foreign 2.69 3.58 3.03 0.35 6.62 6.07 010
body,jawbone.
41822............... .............. R Excision of gum 2.31 3.88 1.86 0.34 6.53 4.51 010
lesion.
41823............... .............. R Excision of gum 3.30 5.56 4.00 0.44 9.30 7.74 090
lesion.
41825............... .............. A Excision of gum 1.31 3.06 2.24 0.15 4.52 3.70 010
lesion.
41826............... .............. A Excision of gum 2.31 2.43 2.10 0.30 5.04 4.71 010
lesion.
41827............... .............. A Excision of gum 3.41 5.51 3.66 0.37 9.29 7.44 090
lesion.
41828............... .............. R Excision of gum 3.09 3.80 2.96 0.44 7.33 6.49 010
lesion.
41830............... .............. R Removal of gum tissue 3.34 4.95 3.62 0.45 8.74 7.41 010
41872............... .............. R Repair gum........... 2.59 5.01 3.45 0.22 7.82 6.26 090
41874............... .............. R Repair tooth socket.. 3.09 4.83 3.17 0.45 8.37 6.71 090
42000............... .............. A Drainage mouth roof 1.23 2.57 1.26 0.11 3.91 2.60 010
lesion.
42100............... .............. A Biopsy roof of mouth. 1.31 2.08 1.36 0.13 3.52 2.80 010
42104............... .............. A Excision lesion, 1.64 2.53 1.55 0.16 4.33 3.35 010
mouth roof.
42106............... .............. A Excision lesion, 2.10 3.22 2.44 0.25 5.57 4.79 010
mouth roof.
42107............... .............. A Excision lesion, 4.43 5.70 3.94 0.46 10.59 8.83 090
mouth roof.
42120............... .............. A Remove palate/lesion. 6.16 NA 11.77 0.53 NA 18.46 090
42140............... .............. A Excision of uvula.... 1.62 3.72 2.09 0.13 5.47 3.84 090
42145............... .............. A Repair palate, 8.04 NA 7.49 0.66 NA 16.19 090
pharynx/uvula.
42160............... .............. A Treatment mouth roof 1.80 4.25 2.29 0.16 6.21 4.25 010
lesion.
42180............... .............. A Repair palate........ 2.50 3.07 2.10 0.21 5.78 4.81 010
42182............... .............. A Repair palate........ 3.82 3.87 3.02 0.40 8.09 7.24 010
42200............... .............. A Reconstruct cleft 11.98 NA 10.20 1.22 NA 23.40 090
palate.
42205............... .............. A Reconstruct cleft 13.27 NA 10.06 1.44 NA 24.77 090
palate.
[[Page 47620]]
42210............... .............. A Reconstruct cleft 14.48 NA 11.44 2.00 NA 27.92 090
palate.
42215............... .............. A Reconstruct cleft 8.81 NA 9.05 1.31 NA 19.17 090
palate.
42220............... .............. A Reconstruct cleft 7.01 NA 6.77 0.49 NA 14.27 090
palate.
42225............... .............. A Reconstruct cleft 9.53 NA 16.94 0.97 NA 27.44 090
palate.
42226............... .............. A Lengthening of palate 9.99 NA 14.63 0.89 NA 25.51 090
42227............... .............. A Lengthening of palate 9.51 NA 15.40 1.02 NA 25.93 090
42235............... .............. A Repair palate........ 7.86 NA 11.86 0.82 NA 20.54 090
42260............... .............. A Repair nose to lip 9.79 10.17 7.06 0.98 20.94 17.83 090
fistula.
42280............... .............. A Preparation, palate 1.54 1.95 1.14 0.21 3.70 2.89 010
mold.
42281............... .............. A Insertion, palate 1.93 2.62 1.87 0.16 4.71 3.96 010
prosthesis.
42300............... .............. A Drainage of salivary 1.93 2.82 1.81 0.17 4.92 3.91 010
gland.
42305............... .............. A Drainage of salivary 6.06 NA 4.72 0.53 NA 11.31 090
gland.
42310............... .............. A Drainage of salivary 1.56 2.26 1.54 0.15 3.97 3.25 010
gland.
42320............... .............. A Drainage of salivary 2.35 3.26 2.09 0.23 5.84 4.67 010
gland.
42325............... .............. A Create salivary cyst 2.75 4.61 2.31 0.22 7.58 5.28 090
drain.
42326............... .............. A Create salivary cyst 3.77 5.89 3.16 0.23 9.89 7.16 090
drain.
42330............... .............. A Removal of salivary 2.21 3.14 1.84 0.19 5.54 4.24 010
stone.
42335............... .............. A Removal of salivary 3.31 4.90 3.14 0.30 8.51 6.75 090
stone.
42340............... .............. A Removal of salivary 4.59 6.04 3.93 0.41 11.04 8.93 090
stone.
42400............... .............. A Biopsy of salivary 0.78 1.65 0.72 0.06 2.49 1.56 000
gland.
42405............... .............. A Biopsy of salivary 3.29 4.02 2.45 0.29 7.60 6.03 010
gland.
42408............... .............. A Excision of salivary 4.53 5.90 3.61 0.42 10.85 8.56 090
cyst.
42409............... .............. A Drainage of salivary 2.81 4.52 2.76 0.23 7.56 5.80 090
cyst.
42410............... .............. A Excise parotid gland/ 9.33 NA 6.21 0.93 NA 16.47 090
lesion.
42415............... .............. A Excise parotid gland/ 16.86 NA 10.84 1.49 NA 29.19 090
lesion.
42420............... .............. A Excise parotid gland/ 19.56 NA 12.35 1.72 NA 33.63 090
lesion.
42425............... .............. A Excise parotid gland/ 13.00 NA 8.60 1.14 NA 22.74 090
lesion.
42426............... .............. A Excise parotid gland/ 21.23 NA 12.99 1.86 NA 36.08 090
lesion.
42440............... .............. A Excise submaxillary 6.96 NA 4.79 0.61 NA 12.36 090
gland.
42450............... .............. A Excise sublingual 4.61 5.89 4.24 0.42 10.92 9.27 090
gland.
42500............... .............. A Repair salivary duct. 4.29 5.67 4.18 0.41 10.37 8.88 090
42505............... .............. A Repair salivary duct. 6.17 7.12 5.35 0.56 13.85 12.08 090
42507............... .............. A Parotid duct 6.10 NA 6.53 0.49 NA 13.12 090
diversion.
42508............... .............. A Parotid duct 9.09 NA 8.34 0.74 NA 18.17 090
diversion.
42509............... .............. A Parotid duct 11.52 NA 10.17 1.50 NA 23.19 090
diversion.
42510............... .............. A Parotid duct 8.14 NA 7.78 0.66 NA 16.58 090
diversion.
42550............... .............. A Injection for 1.25 3.25 0.41 0.08 4.58 1.74 000
salivary x-ray.
42600............... .............. A Closure of salivary 4.81 6.57 4.12 0.40 11.78 9.33 090
fistula.
42650............... .............. A Dilation of salivary 0.77 1.10 0.71 0.07 1.94 1.55 000
duct.
42660............... .............. A Dilation of salivary 1.13 1.35 0.85 0.09 2.57 2.07 000
duct.
42665............... .............. A Ligation of salivary 2.53 4.16 2.59 0.21 6.90 5.33 090
duct.
42700............... .............. A Drainage of tonsil 1.62 2.65 1.71 0.13 4.40 3.46 010
abscess.
42720............... .............. A Drainage of throat 5.41 4.82 3.78 0.48 10.71 9.67 010
abscess.
42725............... .............. A Drainage of throat 10.70 NA 8.21 0.96 NA 19.87 090
abscess.
42800............... .............. A Biopsy of throat..... 1.39 2.18 1.40 0.12 3.69 2.91 010
42802............... .............. A Biopsy of throat..... 1.54 4.77 2.06 0.13 6.44 3.73 010
42804............... .............. A Biopsy of upper nose/ 1.24 3.74 1.73 0.10 5.08 3.07 010
throat.
42806............... .............. A Biopsy of upper nose/ 1.58 4.08 1.93 0.13 5.79 3.64 010
throat.
42808............... .............. A Excise pharynx lesion 2.30 3.09 1.93 0.19 5.58 4.42 010
42809............... .............. A Remove pharynx 1.81 2.33 1.35 0.16 4.30 3.32 010
foreign body.
42810............... .............. A Excision of neck cyst 3.25 5.71 3.54 0.31 9.27 7.10 090
42815............... .............. A Excision of neck cyst 7.06 NA 6.40 0.63 NA 14.09 090
42820............... .............. A Remove tonsils and 3.90 NA 3.29 0.33 NA 7.52 090
adenoids.
42821............... .............. A Remove tonsils and 4.28 NA 3.50 0.35 NA 8.13 090
adenoids.
42825............... .............. A Removal of tonsils... 3.41 NA 3.17 0.28 NA 6.86 090
42826............... .............. A Removal of tonsils... 3.37 NA 3.03 0.28 NA 6.68 090
42830............... .............. A Removal of adenoids.. 2.57 NA 2.56 0.21 NA 5.34 090
42831............... .............. A Removal of adenoids.. 2.71 NA 2.84 0.22 NA 5.77 090
42835............... .............. A Removal of adenoids.. 2.30 NA 2.46 0.21 NA 4.97 090
42836............... .............. A Removal of adenoids.. 3.18 NA 2.95 0.26 NA 6.39 090
42842............... .............. A Extensive surgery of 8.75 NA 10.99 0.72 NA 20.46 090
throat.
42844............... .............. A Extensive surgery of 14.29 NA 16.23 1.24 NA 31.76 090
throat.
42845............... .............. A Extensive surgery of 24.25 NA 23.17 2.07 NA 49.49 090
throat.
42860............... .............. A Excision of tonsil 2.22 NA 2.40 0.19 NA 4.81 090
tags.
42870............... .............. A Excision of lingual 5.39 NA 8.57 0.45 NA 14.41 090
tonsil.
42890............... .............. A Partial removal of 12.92 NA 14.15 1.10 NA 28.17 090
pharynx.
42892............... .............. A Revision of 15.81 NA 17.17 1.33 NA 34.31 090
pharyngeal walls.
42894............... .............. A Revision of 22.85 NA 22.01 1.91 NA 46.77 090
pharyngeal walls.
42900............... .............. A Repair throat wound.. 5.24 NA 3.66 0.55 NA 9.45 010
42950............... .............. A Reconstruction of 8.09 NA 11.85 0.72 NA 20.66 090
throat.
42953............... .............. A Repair throat, 8.95 NA 17.22 0.88 NA 27.05 090
esophagus.
42955............... .............. A Surgical opening of 7.38 NA 10.69 0.70 NA 18.77 090
throat.
42960............... .............. A Control throat 2.33 NA 1.95 0.18 NA 4.46 010
bleeding.
42961............... .............. A Control throat 5.58 NA 4.96 0.46 NA 11.00 090
bleeding.
42962............... .............. A Control throat 7.13 NA 5.91 0.62 NA 13.66 090
bleeding.
[[Page 47621]]
42970............... .............. A Control nose/throat 5.42 NA 4.22 0.40 NA 10.04 090
bleeding.
42971............... .............. A Control nose/throat 6.20 NA 5.12 0.54 NA 11.86 090
bleeding.
42972............... .............. A Control nose/throat 7.19 NA 5.69 0.59 NA 13.47 090
bleeding.
43020............... .............. A Incision of esophagus 8.08 NA 5.41 0.92 NA 14.41 090
43030............... .............. A Throat muscle surgery 7.68 NA 5.48 0.70 NA 13.86 090
43045............... .............. A Incision of esophagus 20.09 NA 10.71 2.22 NA 33.02 090
43100............... .............. A Excision of esophagus 9.18 NA 6.23 0.98 NA 16.39 090
lesion.
43101............... .............. A Excision of esophagus 16.22 NA 7.89 2.09 NA 26.20 090
lesion.
43107............... .............. A Removal of esophagus. 39.94 NA 17.05 5.03 NA 62.02 090
43108............... .............. A Removal of esophagus. 34.14 NA 14.21 4.27 NA 52.62 090
43112............... .............. A Removal of esophagus. 43.43 NA 18.14 5.61 NA 67.18 090
43113............... .............. A Removal of esophagus. 35.22 NA 15.11 4.43 NA 54.76 090
43116............... .............. A Partial removal of 31.17 NA 16.69 3.02 NA 50.88 090
esophagus.
43117............... .............. A Partial removal of 39.94 NA 16.29 4.98 NA 61.21 090
esophagus.
43118............... .............. A Partial removal of 33.15 NA 13.79 4.27 NA 51.21 090
esophagus.
43121............... .............. A Partial removal of 29.15 NA 12.68 4.06 NA 45.89 090
esophagus.
43122............... .............. A Partial removal of 39.94 NA 16.40 5.11 NA 61.45 090
esophagus.
43123............... .............. A Partial removal of 33.15 NA 14.10 4.49 NA 51.74 090
esophagus.
43124............... .............. A Removal of esophagus. 27.28 NA 13.09 3.28 NA 43.65 090
43130............... .............. A Removal of esophagus 11.73 NA 7.57 1.22 NA 20.52 090
pouch.
43135............... .............. A Removal of esophagus 16.08 NA 8.11 2.16 NA 26.35 090
pouch.
43200............... .............. A Esophagus endoscopy.. 1.59 4.15 1.07 0.13 5.87 2.79 000
43201............... .............. A Esoph scope w/ 2.09 4.61 1.10 0.13 6.83 3.32 000
submucous inj.
43202............... .............. A Esophagus endoscopy, 1.89 5.59 0.94 0.16 7.64 2.99 000
biopsy.
43204............... .............. A Esoph scope w/ 3.76 NA 1.52 0.30 NA 5.58 000
sclerosis inj.
43205............... .............. A Esophagus endoscopy/ 3.78 NA 1.52 0.29 NA 5.59 000
ligation.
43215............... .............. A Esophagus endoscopy.. 2.60 NA 1.20 0.23 NA 4.03 000
43216............... .............. A Esophagus endoscopy/ 2.40 NA 1.19 0.20 NA 3.79 000
lesion.
43217............... .............. A Esophagus endoscopy.. 2.90 7.02 1.19 0.25 10.17 4.34 000
43219............... .............. A Esophagus endoscopy.. 2.80 NA 1.35 0.23 NA 4.38 000
43220............... .............. A Esoph endoscopy, 2.10 NA 0.97 0.17 NA 3.24 000
dilation.
43226............... .............. A Esoph endoscopy, 2.34 NA 1.03 0.19 NA 3.56 000
dilation.
43227............... .............. A Esoph endoscopy, 3.59 NA 1.45 0.28 NA 5.32 000
repair.
43228............... .............. A Esoph endoscopy, 3.76 NA 1.55 0.35 NA 5.66 000
ablation.
43231............... .............. A Esoph endoscopy w/us 3.19 NA 1.31 0.23 NA 4.73 000
exam.
43232............... .............. A Esoph endoscopy w/us 4.47 NA 1.81 0.31 NA 6.59 000
fn bx.
43234............... .............. A Upper GI endoscopy, 2.01 5.37 0.87 0.17 7.55 3.05 000
exam.
43235............... .............. A Uppr gi endoscopy, 2.39 5.22 1.02 0.19 7.80 3.60 000
diagnosis.
43236............... .............. A Uppr gi scope w/ 2.92 6.45 1.22 0.19 9.56 4.33 000
submuc inj.
43237............... .............. A Endoscopic us exam, 3.98 NA 1.59 0.43 NA 6.00 000
esoph.
43238............... .............. A Uppr gi endoscopy w/ 5.02 NA 1.96 0.43 NA 7.41 000
us fn bx.
43239............... .............. A Upper GI endoscopy, 2.87 5.77 1.19 0.23 8.87 4.29 000
biopsy.
43240............... .............. A Esoph endoscope w/ 6.85 NA 2.60 0.54 NA 9.99 000
drain cyst.
43241............... .............. A Upper GI endoscopy 2.59 NA 1.10 0.21 NA 3.90 000
with tube.
43242............... .............. A Uppr gi endoscopy w/ 7.30 NA 2.73 0.53 NA 10.56 000
us fn bx.
43243............... .............. A Upper gi endoscopy & 4.56 NA 1.79 0.34 NA 6.69 000
inject.
43244............... .............. A Upper GI endoscopy/ 5.04 NA 1.96 0.37 NA 7.37 000
ligation.
43245............... .............. A Uppr gi scope dilate 3.18 NA 1.30 0.28 NA 4.76 000
strictr.
43246............... .............. A Place gastrostomy 4.32 NA 1.69 0.34 NA 6.35 000
tube.
43247............... .............. A Operative upper GI 3.38 NA 1.37 0.27 NA 5.02 000
endoscopy.
43248............... .............. A Uppr gi endoscopy/ 3.15 NA 1.31 0.24 NA 4.70 000
guide wire.
43249............... .............. A Esoph endoscopy, 2.90 NA 1.21 0.22 NA 4.33 000
dilation.
43250............... .............. A Upper GI endoscopy/ 3.20 NA 1.31 0.26 NA 4.77 000
tumor.
43251............... .............. A Operative upper GI 3.69 NA 1.48 0.29 NA 5.46 000
endoscopy.
43255............... .............. A Operative upper GI 4.81 NA 1.88 0.36 NA 7.05 000
endoscopy.
43256............... .............. A Uppr gi endoscopy w 4.34 NA 1.71 0.37 NA 6.42 000
stent.
43258............... .............. A Operative upper GI 4.54 NA 1.78 0.35 NA 6.67 000
endoscopy.
43259............... .............. A Endoscopic ultrasound 5.19 NA 1.99 0.36 NA 7.54 000
exam.
43260............... .............. A Endo 5.95 NA 2.28 0.44 NA 8.67 000
cholangiopancreatogr
aph.
43261............... .............. A Endo 6.26 NA 2.39 0.46 NA 9.11 000
cholangiopancreatogr
aph.
43262............... .............. A Endo 7.38 NA 2.78 0.55 NA 10.71 000
cholangiopancreatogr
aph.
43263............... .............. A Endo 7.28 NA 2.76 0.55 NA 10.59 000
cholangiopancreatogr
aph.
43264............... .............. A Endo 8.89 NA 3.31 0.66 NA 12.86 000
cholangiopancreatogr
aph.
43265............... .............. A Endo 10.00 NA 3.69 0.74 NA 14.43 000
cholangiopancreatogr
aph.
43267............... .............. A Endo 7.38 NA 2.78 0.56 NA 10.72 000
cholangiopancreatogr
aph.
43268............... .............. A Endo 7.38 NA 2.88 0.55 NA 10.81 000
cholangiopancreatogr
aph.
43269............... .............. A Endo 8.20 NA 3.07 0.61 NA 11.88 000
cholangiopancreatogr
aph.
43271............... .............. A Endo 7.38 NA 2.77 0.54 NA 10.69 000
cholangiopancreatogr
aph.
43272............... .............. A Endo 7.38 NA 2.78 0.55 NA 10.71 000
cholangiopancreatogr
aph.
43280............... .............. A Laparoscopy, 17.22 NA 7.28 2.20 NA 26.70 090
fundoplasty.
43300............... .............. A Repair of esophagus.. 9.13 NA 6.45 1.01 NA 16.59 090
43305............... .............. A Repair esophagus and 17.36 NA 10.72 1.53 NA 29.61 090
fistula.
43310............... .............. A Repair of esophagus.. 25.35 NA 11.08 3.44 NA 39.87 090
43312............... .............. A Repair esophagus and 28.38 NA 11.93 3.43 NA 43.74 090
fistula.
43313............... .............. A Esophagoplasty 45.21 NA 18.82 6.55 NA 70.58 090
congenital.
[[Page 47622]]
43314............... .............. A Tracheo- 50.19 NA 19.15 6.67 NA 76.01 090
esophagoplasty cong.
43320............... .............. A Fuse esophagus & 19.90 NA 9.21 2.41 NA 31.52 090
stomach.
43324............... .............. A Revise esophagus & 20.54 NA 8.77 2.59 NA 31.90 090
stomach.
43325............... .............. A Revise esophagus & 20.03 NA 8.79 2.54 NA 31.36 090
stomach.
43326............... .............. A Revise esophagus & 19.71 NA 9.29 2.63 NA 31.63 090
stomach.
43330............... .............. A Repair of esophagus.. 19.74 NA 8.54 2.51 NA 30.79 090
43331............... .............. A Repair of esophagus.. 20.10 NA 9.79 2.65 NA 32.54 090
43340............... .............. A Fuse esophagus & 19.58 NA 8.97 2.49 NA 31.04 090
intestine.
43341............... .............. A Fuse esophagus & 20.82 NA 10.03 2.89 NA 33.74 090
intestine.
43350............... .............. A Surgical opening, 15.76 NA 8.46 1.78 NA 26.00 090
esophagus.
43351............... .............. A Surgical opening, 18.32 NA 9.79 2.46 NA 30.57 090
esophagus.
43352............... .............. A Surgical opening, 15.24 NA 8.39 1.85 NA 25.48 090
esophagus.
43360............... .............. A Gastrointestinal 35.65 NA 15.07 4.26 NA 54.98 090
repair.
43361............... .............. A Gastrointestinal 40.44 NA 16.88 4.52 NA 61.84 090
repair.
43400............... .............. A Ligate esophagus 21.17 NA 9.45 2.04 NA 32.66 090
veins.
43401............... .............. A Esophagus surgery for 22.06 NA 9.49 2.61 NA 34.16 090
veins.
43405............... .............. A Ligate/staple 19.98 NA 9.57 2.56 NA 32.11 090
esophagus.
43410............... .............. A Repair esophagus 13.45 NA 7.64 1.63 NA 22.72 090
wound.
43415............... .............. A Repair esophagus 24.96 NA 11.73 3.34 NA 40.03 090
wound.
43420............... .............. A Repair esophagus 14.33 NA 7.45 1.38 NA 23.16 090
opening.
43425............... .............. A Repair esophagus 21.00 NA 9.97 2.62 NA 33.59 090
opening.
43450............... .............. A Dilate esophagus..... 1.38 2.67 0.69 0.11 4.16 2.18 000
43453............... .............. A Dilate esophagus..... 1.51 6.11 0.73 0.11 7.73 2.35 000
43456............... .............. A Dilate esophagus..... 2.57 13.83 1.10 0.20 16.60 3.87 000
43458............... .............. A Dilate esophagus..... 3.06 6.69 1.28 0.25 10.00 4.59 000
43460............... .............. A Pressure treatment 3.79 NA 1.48 0.31 NA 5.58 000
esophagus.
43500............... .............. A Surgical opening of 11.03 NA 4.98 1.39 NA 17.40 090
stomach.
43501............... .............. A Surgical repair of 20.01 NA 8.31 2.57 NA 30.89 090
stomach.
43502............... .............. A Surgical repair of 23.10 NA 9.45 2.75 NA 35.30 090
stomach.
43510............... .............. A Surgical opening of 13.06 NA 6.61 1.54 NA 21.21 090
stomach.
43520............... .............. A Incision of pyloric 9.98 NA 5.27 1.30 NA 16.55 090
muscle.
43600............... .............. A Biopsy of stomach.... 1.91 NA 0.66 0.15 NA 2.72 000
43605............... .............. A Biopsy of stomach.... 11.96 NA 5.28 1.54 NA 18.78 090
43610............... .............. A Excision of stomach 14.58 NA 6.16 1.88 NA 22.62 090
lesion.
43611............... .............. A Excision of stomach 17.81 NA 7.56 2.30 NA 27.67 090
lesion.
43620............... .............. A Removal of stomach... 29.99 NA 11.80 3.85 NA 45.64 090
43621............... .............. A Removal of stomach... 30.68 NA 11.98 3.94 NA 46.60 090
43622............... .............. A Removal of stomach... 32.48 NA 12.58 4.17 NA 49.23 090
43631............... .............. A Removal of stomach, 22.56 NA 9.15 2.90 NA 34.61 090
partial.
43632............... .............. A Removal of stomach, 22.56 NA 9.15 2.90 NA 34.61 090
partial.
43633............... .............. A Removal of stomach, 23.07 NA 9.32 2.96 NA 35.35 090
partial.
43634............... .............. A Removal of stomach, 25.08 NA 10.08 3.13 NA 38.29 090
partial.
43635............... .............. A Removal of stomach, 2.06 NA 0.70 0.27 NA 3.03 ZZZ
partial.
43638............... .............. A Removal of stomach, 28.96 NA 11.87 3.72 NA 44.55 090
partial.
43639............... .............. A Removal of stomach, 29.61 NA 11.68 3.78 NA 45.07 090
partial.
43640............... .............. A Vagotomy & pylorus 16.99 NA 7.26 2.19 NA 26.44 090
repair.
43641............... .............. A Vagotomy & pylorus 17.24 NA 7.37 2.16 NA 26.77 090
repair.
43651............... .............. A Laparoscopy, vagus 10.13 NA 4.76 1.32 NA 16.21 090
nerve.
43652............... .............. A Laparoscopy, vagus 12.13 NA 5.75 1.51 NA 19.39 090
nerve.
43653............... .............. A Laparoscopy, 7.72 NA 4.19 0.98 NA 12.89 090
gastrostomy.
43750............... .............. A Place gastrostomy 4.48 NA 2.19 0.43 NA 7.10 010
tube.
43752............... .............. A Nasal/orogastric w/ 0.68 0.23 0.22 0.02 0.93 0.92 000
stent.
43760............... .............. A Change gastrostomy 1.10 2.10 0.45 0.09 3.29 1.64 000
tube.
43761............... .............. A Reposition 2.01 1.19 0.66 0.14 3.34 2.81 000
gastrostomy tube.
43800............... .............. A Reconstruction of 13.67 NA 5.91 1.76 NA 21.34 090
pylorus.
43810............... .............. A Fusion of stomach and 14.63 NA 6.19 1.91 NA 22.73 090
bowel.
43820............... .............. A Fusion of stomach and 15.35 NA 6.42 1.96 NA 23.73 090
bowel.
43825............... .............. A Fusion of stomach and 19.19 NA 8.01 2.45 NA 29.65 090
bowel.
43830............... .............. A Place gastrostomy 9.52 NA 4.85 1.18 NA 15.55 090
tube.
43831............... .............. A Place gastrostomy 7.83 NA 4.52 1.00 NA 13.35 090
tube.
43832............... .............. A Place gastrostomy 15.58 NA 6.86 1.94 NA 24.38 090
tube.
43840............... .............. A Repair of stomach 15.54 NA 6.77 2.00 NA 24.31 090
lesion.
43842............... .............. A Gastroplasty for 18.44 NA 7.95 2.40 NA 28.79 090
obesity.
43843............... .............. A Gastroplasty for 18.62 NA 7.91 2.45 NA 28.98 090
obesity.
43846............... .............. A Gastric bypass for 24.01 NA 10.17 3.09 NA 37.27 090
obesity.
43847............... .............. A Gastric bypass for 26.88 NA 11.07 3.49 NA 41.44 090
obesity.
43848............... .............. A Revision gastroplasty 29.35 NA 11.99 3.80 NA 45.14 090
43850............... .............. A Revise stomach-bowel 24.68 NA 9.81 3.17 NA 37.66 090
fusion.
43855............... .............. A Revise stomach-bowel 26.12 NA 10.32 3.43 NA 39.87 090
fusion.
43860............... .............. A Revise stomach-bowel 24.96 NA 9.97 3.19 NA 38.12 090
fusion.
43865............... .............. A Revise stomach-bowel 26.48 NA 10.50 3.46 NA 40.44 090
fusion.
43870............... .............. A Repair stomach 9.68 NA 4.53 1.21 NA 15.42 090
opening.
43880............... .............. A Repair stomach-bowel 24.61 NA 9.90 3.11 NA 37.62 090
fistula.
44005............... .............. A Freeing of bowel 16.21 NA 6.73 2.06 NA 25.00 090
adhesion.
44010............... .............. A Incision of small 12.50 NA 5.46 1.60 NA 19.56 090
bowel.
[[Page 47623]]
44015............... .............. A Insert needle cath 2.62 NA 0.88 0.33 NA 3.83 ZZZ
bowel.
44020............... .............. A Explore small 13.97 NA 5.94 1.77 NA 21.68 090
intestine.
44021............... .............. A Decompress small 14.06 NA 5.98 1.78 NA 21.82 090
bowel.
44025............... .............. A Incision of large 14.26 NA 6.03 1.81 NA 22.10 090
bowel.
44050............... .............. A Reduce bowel 14.01 NA 5.96 1.79 NA 21.76 090
obstruction.
44055............... .............. A Correct malrotation 21.97 NA 8.73 2.81 NA 33.51 090
of bowel.
44100............... .............. A Biopsy of bowel...... 2.01 NA 0.71 0.17 NA 2.89 000
44110............... .............. A Excise intestine 11.79 NA 5.24 1.48 NA 18.51 090
lesion(s).
44111............... .............. A Excision of bowel 14.27 NA 6.12 1.80 NA 22.19 090
lesion(s).
44120............... .............. A Removal of small 16.97 NA 7.08 2.13 NA 26.18 090
intestine.
44121............... .............. A Removal of small 4.44 NA 1.52 0.55 NA 6.51 ZZZ
intestine.
44125............... .............. A Removal of small 17.51 NA 7.26 2.19 NA 26.96 090
intestine.
44126............... .............. A Enterectomy w/o 35.45 NA 14.10 4.60 NA 54.15 090
taper, cong.
44127............... .............. A Enterectomy w/taper, 40.94 NA 15.69 5.41 NA 62.04 090
cong.
44128............... .............. A Enterectomy cong, add- 4.44 NA 1.53 0.59 NA 6.56 ZZZ
on.
44130............... .............. A Bowel to bowel fusion 14.47 NA 6.22 1.80 NA 22.49 090
44139............... .............. A Mobilization of colon 2.23 NA 0.76 0.28 NA 3.27 ZZZ
44140............... .............. A Partial removal of 20.97 NA 8.64 2.62 NA 32.23 090
colon.
44141............... .............. A Partial removal of 19.48 NA 10.04 2.42 NA 31.94 090
colon.
44143............... .............. A Partial removal of 22.96 NA 10.69 2.91 NA 36.56 090
colon.
44144............... .............. A Partial removal of 21.50 NA 9.62 2.71 NA 33.83 090
colon.
44145............... .............. A Partial removal of 26.38 NA 10.80 3.22 NA 40.40 090
colon.
44146............... .............. A Partial removal of 27.50 NA 12.85 3.35 NA 43.70 090
colon.
44147............... .............. A Partial removal of 20.68 NA 8.68 2.48 NA 31.84 090
colon.
44150............... .............. A Removal of colon..... 23.91 NA 12.03 2.98 NA 38.92 090
44151............... .............. A Removal of colon/ 26.84 NA 13.39 3.39 NA 43.62 090
ileostomy.
44152............... .............. A Removal of colon/ 27.79 NA 11.59 3.40 NA 42.78 090
ileostomy.
44153............... .............. A Removal of colon/ 30.54 NA 14.38 3.30 NA 48.22 090
ileostomy.
44155............... .............. A Removal of colon/ 27.82 NA 13.30 3.25 NA 44.37 090
ileostomy.
44156............... .............. A Removal of colon/ 30.74 NA 15.03 3.95 NA 49.72 090
ileostomy.
44160............... .............. A Removal of colon..... 18.59 NA 7.74 2.31 NA 28.64 090
44200............... .............. A Laparoscopy, 14.42 NA 6.19 1.75 NA 22.36 090
enterolysis.
44201............... .............. A Laparoscopy, 9.77 NA 4.66 1.25 NA 15.68 090
jejunostomy.
44202............... .............. A Lap resect s/ 22.01 NA 8.92 2.71 NA 33.64 090
intestine singl.
44203............... .............. A Lap resect s/ 4.44 NA 1.49 0.56 NA 6.49 ZZZ
intestine, addl.
44204............... .............. A Laparo partial 25.04 NA 9.94 3.05 NA 38.03 090
colectomy.
44205............... .............. A Lap colectomy part w/ 22.20 NA 8.83 2.69 NA 33.72 090
ileum.
44206............... .............. A Lap part colectomy w/ 26.96 NA 11.22 2.91 NA 41.09 090
stoma.
44207............... .............. A L colectomy/ 29.96 NA 11.46 3.22 NA 44.64 090
coloproctostomy.
44208............... .............. A L colectomy/ 31.95 NA 13.09 3.35 NA 48.39 090
coloproctostomy.
44210............... .............. A Laparo total 27.96 NA 11.83 2.98 NA 42.77 090
proctocolectomy.
44211............... .............. A Laparo total 34.95 NA 14.61 3.35 NA 52.91 090
proctocolectomy.
44212............... .............. A Laparo total 32.45 NA 13.59 3.25 NA 49.29 090
proctocolectomy.
44300............... .............. A Open bowel to skin... 12.09 NA 5.49 1.55 NA 19.13 090
44310............... .............. A Ileostomy/jejunostomy 15.93 NA 6.69 1.94 NA 24.56 090
44312............... .............. A Revision of ileostomy 8.01 NA 3.99 0.90 NA 12.90 090
44314............... .............. A Revision of ileostomy 15.03 NA 6.55 1.73 NA 23.31 090
44316............... .............. A Devise bowel pouch... 21.06 NA 8.54 2.41 NA 32.01 090
44320............... .............. A Colostomy............ 17.61 NA 7.65 2.21 NA 27.47 090
44322............... .............. A Colostomy with 11.96 NA 8.59 1.51 NA 22.06 090
biopsies.
44340............... .............. A Revision of colostomy 7.71 NA 4.27 0.97 NA 12.95 090
44345............... .............. A Revision of colostomy 15.41 NA 6.88 1.92 NA 24.21 090
44346............... .............. A Revision of colostomy 16.96 NA 7.38 2.07 NA 26.41 090
44360............... .............. A Small bowel endoscopy 2.59 NA 1.10 0.19 NA 3.88 000
44361............... .............. A Small bowel endoscopy/ 2.87 NA 1.20 0.21 NA 4.28 000
biopsy.
44363............... .............. A Small bowel endoscopy 3.49 NA 1.38 0.26 NA 5.13 000
44364............... .............. A Small bowel endoscopy 3.73 NA 1.49 0.28 NA 5.50 000
44365............... .............. A Small bowel endoscopy 3.31 NA 1.36 0.25 NA 4.92 000
44366............... .............. A Small bowel endoscopy 4.40 NA 1.73 0.32 NA 6.45 000
44369............... .............. A Small bowel endoscopy 4.51 NA 1.73 0.34 NA 6.58 000
44370............... .............. A Small bowel endoscopy/ 4.79 NA 1.97 0.36 NA 7.12 000
stent.
44372............... .............. A Small bowel endoscopy 4.40 NA 1.72 0.35 NA 6.47 000
44373............... .............. A Small bowel endoscopy 3.49 NA 1.42 0.26 NA 5.17 000
44376............... .............. A Small bowel endoscopy 5.25 NA 2.02 0.41 NA 7.68 000
44377............... .............. A Small bowel endoscopy/ 5.52 NA 2.13 0.40 NA 8.05 000
biopsy.
44378............... .............. A Small bowel endoscopy 7.12 NA 2.69 0.53 NA 10.34 000
44379............... .............. A S bowel endoscope w/ 7.46 NA 2.91 0.55 NA 10.92 000
stent.
44380............... .............. A Small bowel endoscopy 1.05 NA 0.55 0.08 NA 1.68 000
44382............... .............. A Small bowel endoscopy 1.27 NA 0.63 0.12 NA 2.02 000
44383............... .............. A Ileoscopy w/stent.... 2.94 NA 1.27 0.24 NA 4.45 000
44385............... .............. A Endoscopy of bowel 1.82 3.35 0.75 0.15 5.32 2.72 000
pouch.
44386............... .............. A Endoscopy, bowel 2.12 6.68 0.88 0.19 8.99 3.19 000
pouch/biop.
44388............... .............. A Colonoscopy.......... 2.82 5.14 1.15 0.26 8.22 4.23 000
44389............... .............. A Colonoscopy with 3.13 6.70 1.27 0.27 10.10 4.67 000
biopsy.
44390............... .............. A Colonoscopy for 3.82 7.19 1.49 0.30 11.31 5.61 000
foreign body.
[[Page 47624]]
44391............... .............. A Colonoscopy for 4.31 8.84 1.69 0.34 13.49 6.34 000
bleeding.
44392............... .............. A Colonoscopy & 3.81 6.66 1.49 0.34 10.81 5.64 000
polypectomy.
44393............... .............. A Colonoscopy, lesion 4.83 6.99 1.86 0.41 12.23 7.10 000
removal.
44394............... .............. A Colonoscopy w/snare.. 4.42 7.90 1.72 0.39 12.71 6.53 000
44397............... .............. A Colonoscopy w/stent.. 4.70 NA 1.78 0.42 NA 6.90 000
44500............... .............. A Intro, 0.49 NA 0.16 0.03 NA 0.68 000
gastrointestinal
tube.
44602............... .............. A Suture, small 16.01 NA 6.38 2.00 NA 24.39 090
intestine.
44603............... .............. A Suture, small 18.63 NA 7.26 2.37 NA 28.26 090
intestine.
44604............... .............. A Suture, large 16.01 NA 6.45 2.02 NA 24.48 090
intestine.
44605............... .............. A Repair of bowel 19.50 NA 8.38 2.46 NA 30.34 090
lesion.
44615............... .............. A Intestinal 15.91 NA 6.67 1.99 NA 24.57 090
stricturoplasty.
44620............... .............. A Repair bowel opening. 12.18 NA 5.32 1.47 NA 18.97 090
44625............... .............. A Repair bowel opening. 15.03 NA 6.30 1.82 NA 23.15 090
44626............... .............. A Repair bowel opening. 25.32 NA 9.80 3.19 NA 38.31 090
44640............... .............. A Repair bowel-skin 21.62 NA 8.57 2.71 NA 32.90 090
fistula.
44650............... .............. A Repair bowel fistula. 22.54 NA 8.87 2.79 NA 34.20 090
44660............... .............. A Repair bowel-bladder 21.33 NA 8.33 2.21 NA 31.87 090
fistula.
44661............... .............. A Repair bowel-bladder 24.77 NA 9.54 2.80 NA 37.11 090
fistula.
44680............... .............. A Surgical revision, 15.38 NA 6.44 1.95 NA 23.77 090
intestine.
44700............... .............. A Suspend bowel w/ 16.09 NA 6.65 1.79 NA 24.53 090
prosthesis.
44701............... .............. A Intraop colon lavage 3.10 NA 1.05 0.28 NA 4.43 ZZZ
add-on.
44800............... .............. A Excision of bowel 11.21 NA 5.39 1.40 NA 18.00 090
pouch.
44820............... .............. A Excision of mesentery 12.07 NA 5.48 1.53 NA 19.08 090
lesion.
44850............... .............. A Repair of mesentery.. 10.72 NA 5.00 1.35 NA 17.07 090
44900............... .............. A Drain app abscess, 10.12 NA 4.70 1.29 NA 16.11 090
open.
44901............... .............. A Drain app abscess, 3.37 28.20 1.11 0.22 31.79 4.70 000
percut.
44950............... .............. A Appendectomy......... 9.99 NA 4.31 1.27 NA 15.57 090
44955............... .............. A Appendectomy add-on.. 1.53 NA 0.54 0.19 NA 2.26 ZZZ
44960............... .............. A Appendectomy......... 12.32 NA 5.34 1.59 NA 19.25 090
44970............... .............. A Laparoscopy, 8.69 NA 4.21 1.12 NA 14.02 090
appendectomy.
45000............... .............. A Drainage of pelvic 4.51 NA 2.96 0.50 NA 7.97 090
abscess.
45005............... .............. A Drainage of rectal 1.99 4.08 1.59 0.24 6.31 3.82 010
abscess.
45020............... .............. A Drainage of rectal 4.71 NA 3.28 0.53 NA 8.52 090
abscess.
45100............... .............. A Biopsy of rectum..... 3.67 NA 2.37 0.41 NA 6.45 090
45108............... .............. A Removal of anorectal 4.75 NA 2.78 0.59 NA 8.12 090
lesion.
45110............... .............. A Removal of rectum.... 27.96 NA 12.39 3.35 NA 43.70 090
45111............... .............. A Partial removal of 16.46 NA 7.17 2.00 NA 25.63 090
rectum.
45112............... .............. A Removal of rectum.... 30.49 NA 11.75 3.51 NA 45.75 090
45113............... .............. A Partial proctectomy.. 30.53 NA 12.59 3.53 NA 46.65 090
45114............... .............. A Partial removal of 27.28 NA 10.85 3.32 NA 41.45 090
rectum.
45116............... .............. A Partial removal of 24.54 NA 10.01 2.90 NA 37.45 090
rectum.
45119............... .............. A Remove rectum w/ 30.79 NA 12.44 3.30 NA 46.53 090
reservoir.
45120............... .............. A Removal of rectum.... 24.56 NA 10.12 3.04 NA 37.72 090
45121............... .............. A Removal of rectum and 27.00 NA 11.10 3.37 NA 41.47 090
colon.
45123............... .............. A Partial proctectomy.. 16.68 NA 6.85 1.85 NA 25.38 090
45126............... .............. A Pelvic exenteration.. 45.09 NA 19.20 4.86 NA 69.15 090
45130............... .............. A Excision of rectal 16.42 NA 6.76 1.75 NA 24.93 090
prolapse.
45135............... .............. A Excision of rectal 19.25 NA 8.42 2.33 NA 30.00 090
prolapse.
45136............... .............. A Excise ileoanal 27.26 NA 12.45 2.93 NA 42.64 090
reservior.
45150............... .............. A Excision of rectal 5.66 NA 2.97 0.58 NA 9.21 090
stricture.
45160............... .............. A Excision of rectal 15.30 NA 6.64 1.64 NA 23.58 090
lesion.
45170............... .............. A Excision of rectal 11.47 NA 5.24 1.35 NA 18.06 090
lesion.
45190............... .............. A Destruction, rectal 9.73 NA 4.66 1.13 NA 15.52 090
tumor.
45300............... .............. A Proctosigmoidoscopy 0.38 1.55 0.29 0.04 1.97 0.71 000
dx.
45303............... .............. A Proctosigmoidoscopy 0.44 18.84 0.33 0.04 19.32 0.81 000
dilate.
45305............... .............. A Proctosigmoidoscopy w/ 1.01 2.65 0.50 0.11 3.77 1.62 000
bx.
45307............... .............. A Proctosigmoidoscopy 0.94 3.07 0.48 0.10 4.11 1.52 000
fb.
45308............... .............. A Proctosigmoidoscopy 0.83 2.00 0.44 0.09 2.92 1.36 000
removal.
45309............... .............. A Proctosigmoidoscopy 2.01 2.83 0.84 0.22 5.06 3.07 000
removal.
45315............... .............. A Proctosigmoidoscopy 1.40 2.89 0.64 0.16 4.45 2.20 000
removal.
45317............... .............. A Proctosigmoidoscopy 1.50 2.44 0.66 0.15 4.09 2.31 000
bleed.
45320............... .............. A Proctosigmoidoscopy 1.58 2.93 0.71 0.15 4.66 2.44 000
ablate.
45321............... .............. A Proctosigmoidoscopy 1.17 NA 0.56 0.13 NA 1.86 000
volvul.
45327............... .............. A Proctosigmoidoscopy w/ 1.65 NA 0.69 0.16 NA 2.50 000
stent.
45330............... .............. A Diagnostic 0.96 2.30 0.50 0.08 3.34 1.54 000
sigmoidoscopy.
45331............... .............. A Sigmoidoscopy and 1.15 3.11 0.59 0.09 4.35 1.83 000
biopsy.
45332............... .............. A Sigmoidoscopy w/fb 1.79 5.05 0.80 0.15 6.99 2.74 000
removal.
45333............... .............. A Sigmoidoscopy & 1.79 4.91 0.80 0.15 6.85 2.74 000
polypectomy.
45334............... .............. A Sigmoidoscopy for 2.73 NA 1.14 0.21 NA 4.08 000
bleeding.
45335............... .............. A Sigmoidoscopy w/ 1.46 3.22 0.69 0.04 4.72 2.19 000
submuc inj.
45337............... .............. A Sigmoidoscopy & 2.36 NA 1.00 0.22 NA 3.58 000
decompress.
45338............... .............. A Sigmoidoscopy w/tumr 2.34 5.24 1.00 0.20 7.78 3.54 000
remove.
45339............... .............. A Sigmoidoscopy w/ 3.14 3.47 1.28 0.26 6.87 4.68 000
ablate tumr.
45340............... .............. A Sig w/balloon 1.89 6.18 0.83 0.04 8.11 2.76 000
dilation.
45341............... .............. A Sigmoidoscopy w/ 2.60 NA 1.07 0.20 NA 3.87 000
ultrasound.
[[Page 47625]]
45342............... .............. A Sigmoidoscopy w/us 4.05 NA 1.55 0.30 NA 5.90 000
guide bx.
45345............... .............. A Sigmoidoscopy w/stent 2.92 NA 1.16 0.24 NA 4.32 000
45355............... .............. A Surgical colonoscopy. 3.51 NA 1.38 0.35 NA 5.24 000
45378............... .............. A Diagnostic 3.69 6.20 1.47 0.24 10.13 5.40 000
colonoscopy.
45378............... 53............ A Diagnostic 0.96 2.30 0.50 0.08 3.34 1.54 000
colonoscopy.
45379............... .............. A Colonoscopy w/fb 4.68 7.75 1.81 0.38 12.81 6.87 000
removal.
45380............... .............. A Colonoscopy and 4.43 7.26 1.73 0.35 12.04 6.51 000
biopsy.
45381............... .............. A Colonoscopy, 4.19 7.17 1.65 0.31 11.67 6.15 000
submucous inj.
45382............... .............. A Colonoscopy/control 5.68 10.01 2.18 0.43 16.12 8.29 000
bleeding.
45383............... .............. A Lesion removal 5.86 7.99 2.22 0.48 14.33 8.56 000
colonoscopy.
45384............... .............. A Lesion remove 4.69 6.85 1.82 0.38 11.92 6.89 000
colonoscopy.
45385............... .............. A Lesion removal 5.30 7.86 2.03 0.42 13.58 7.75 000
colonoscopy.
45386............... .............. A Colonoscopy dilate 4.57 12.46 1.77 0.31 17.34 6.65 000
stricture.
45387............... .............. A Colonoscopy w/stent.. 5.90 NA 2.33 0.49 NA 8.72 000
45500............... .............. A Repair of rectum..... 7.28 NA 3.58 0.73 NA 11.59 090
45505............... .............. A Repair of rectum..... 7.57 NA 3.86 0.83 NA 12.26 090
45520............... .............. A Treatment of rectal 0.55 1.65 0.37 0.05 2.25 0.97 000
prolapse.
45540............... .............. A Correct rectal 16.25 NA 6.82 1.84 NA 24.91 090
prolapse.
45541............... .............. A Correct rectal 13.38 NA 5.96 1.53 NA 20.87 090
prolapse.
45550............... .............. A Repair rectum/remove 22.97 NA 9.23 2.61 NA 34.81 090
sigmoid.
45560............... .............. A Repair of rectocele.. 10.56 NA 5.09 1.14 NA 16.79 090
45562............... .............. A Exploration/repair of 15.36 NA 7.00 1.81 NA 24.17 090
rectum.
45563............... .............. A Exploration/repair of 23.43 NA 10.52 2.95 NA 36.90 090
rectum.
45800............... .............. A Repair rect/bladder 17.74 NA 7.45 1.89 NA 27.08 090
fistula.
45805............... .............. A Repair fistula w/ 20.75 NA 9.52 2.32 NA 32.59 090
colostomy.
45820............... .............. A Repair rectourethral 18.45 NA 7.64 1.66 NA 27.75 090
fistula.
45825............... .............. A Repair fistula w/ 21.22 NA 9.83 2.15 NA 33.20 090
colostomy.
45900............... .............. A Reduction of rectal 2.61 NA 1.51 0.29 NA 4.41 010
prolapse.
45905............... .............. A Dilation of anal 2.30 NA 1.43 0.27 NA 4.00 010
sphincter.
45910............... .............. A Dilation of rectal 2.80 NA 1.67 0.28 NA 4.75 010
narrowing.
45915............... .............. A Remove rectal 3.14 4.36 2.10 0.30 7.80 5.54 010
obstruction.
46020............... .............. A Placement of seton... 2.90 2.35 1.86 0.35 5.60 5.11 010
46030............... .............. A Removal of rectal 1.23 1.35 0.71 0.14 2.72 2.08 010
marker.
46040............... .............. A Incision of rectal 4.95 5.52 3.61 0.60 11.07 9.16 090
abscess.
46045............... .............. A Incision of rectal 4.31 NA 2.91 0.53 NA 7.75 090
abscess.
46050............... .............. A Incision of anal 1.19 2.56 0.85 0.14 3.89 2.18 010
abscess.
46060............... .............. A Incision of rectal 5.68 NA 3.28 0.67 NA 9.63 090
abscess.
46070............... .............. A Incision of anal 2.71 NA 1.86 0.20 NA 4.77 090
septum.
46080............... .............. A Incision of anal 2.49 2.38 1.13 0.30 5.17 3.92 010
sphincter.
46083............... .............. A Incise external 1.40 2.55 0.94 0.15 4.10 2.49 010
hemorrhoid.
46200............... .............. A Removal of anal 3.41 3.87 2.88 0.39 7.67 6.68 090
fissure.
46210............... .............. A Removal of anal crypt 2.67 5.16 2.64 0.31 8.14 5.62 090
46211............... .............. A Removal of anal 4.24 5.44 3.52 0.52 10.20 8.28 090
crypts.
46220............... .............. A Removal of anal tag.. 1.56 2.22 0.93 0.18 3.96 2.67 010
46221............... .............. A Ligation of 2.04 2.65 1.75 0.22 4.91 4.01 010
hemorrhoid(s).
46230............... .............. A Removal of anal tags. 2.57 3.00 1.27 0.29 5.86 4.13 010
46250............... .............. A Hemorrhoidectomy..... 3.88 5.34 2.62 0.46 9.68 6.96 090
46255............... .............. A Hemorrhoidectomy..... 4.59 5.87 2.84 0.57 11.03 8.00 090
46257............... .............. A Remove hemorrhoids & 5.39 NA 2.89 0.64 NA 8.92 090
fissure.
46258............... .............. A Remove hemorrhoids & 5.72 NA 3.29 0.68 NA 9.69 090
fistula.
46260............... .............. A Hemorrhoidectomy..... 6.36 NA 3.23 0.75 NA 10.34 090
46261............... .............. A Remove hemorrhoids & 7.07 NA 3.64 0.81 NA 11.52 090
fissure.
46262............... .............. A Remove hemorrhoids & 7.49 NA 3.77 0.85 NA 12.11 090
fistula.
46270............... .............. A Removal of anal 3.71 5.02 2.85 0.46 9.19 7.02 090
fistula.
46275............... .............. A Removal of anal 4.55 4.65 2.98 0.51 9.71 8.04 090
fistula.
46280............... .............. A Removal of anal 5.97 NA 3.29 0.66 NA 9.92 090
fistula.
46285............... .............. A Removal of anal 4.08 3.76 2.75 0.45 8.29 7.28 090
fistula.
46288............... .............. A Repair anal fistula.. 7.12 NA 3.71 0.79 NA 11.62 090
46320............... .............. A Removal of hemorrhoid 1.61 2.14 0.86 0.17 3.92 2.64 010
clot.
46500............... .............. A Injection into 1.61 2.12 1.16 0.16 3.89 2.93 010
hemorrhoid(s).
46600............... .............. A Diagnostic anoscopy.. 0.50 1.57 0.35 0.05 2.12 0.90 000
46604............... .............. A Anoscopy and dilation 1.31 9.16 0.62 0.13 10.60 2.06 000
46606............... .............. A Anoscopy and biopsy.. 0.81 3.81 0.43 0.09 4.71 1.33 000
46608............... .............. A Anoscopy, remove for 1.51 4.44 0.65 0.16 6.11 2.32 000
body.
46610............... .............. A Anoscopy, remove 1.32 4.05 0.61 0.15 5.52 2.08 000
lesion.
46611............... .............. A Anoscopy............. 1.81 3.36 0.78 0.19 5.36 2.78 000
46612............... .............. A Anoscopy, remove 2.34 5.21 0.98 0.28 7.83 3.60 000
lesions.
46614............... .............. A Anoscopy, control 2.01 2.33 0.84 0.20 4.54 3.05 000
bleeding.
46615............... .............. A Anoscopy............. 2.68 2.50 1.07 0.32 5.50 4.07 000
46700............... .............. A Repair of anal 9.12 NA 4.23 0.93 NA 14.28 090
stricture.
46705............... .............. A Repair of anal 6.89 NA 3.72 0.91 NA 11.52 090
stricture.
46706............... .............. A Repr of anal fistula 2.39 NA 1.25 0.51 NA 4.15 010
w/glue.
46715............... .............. A Repair of anovaginal 7.19 NA 3.61 0.92 NA 11.72 090
fistula.
46716............... .............. A Repair of anovaginal 15.05 NA 7.95 1.57 NA 24.57 090
fistula.
46730............... .............. A Construction of 26.71 NA 11.99 1.71 NA 40.41 090
absent anus.
[[Page 47626]]
46735............... .............. A Construction of 32.12 NA 13.51 3.18 NA 48.81 090
absent anus.
46740............... .............. A Construction of 29.96 NA 13.16 2.89 NA 46.01 090
absent anus.
46742............... .............. A Repair of 35.75 NA 17.47 4.73 NA 57.95 090
imperforated anus.
46744............... .............. A Repair of cloacal 52.55 NA 21.07 3.83 NA 77.45 090
anomaly.
46746............... .............. A Repair of cloacal 58.13 NA 25.05 3.03 NA 86.21 090
anomaly.
46748............... .............. A Repair of cloacal 64.11 NA 23.66 3.34 NA 91.11 090
anomaly.
46750............... .............. A Repair of anal 10.23 NA 5.08 1.13 NA 16.44 090
sphincter.
46751............... .............. A Repair of anal 8.76 NA 5.50 0.94 NA 15.20 090
sphincter.
46753............... .............. A Reconstruction of 8.28 NA 3.86 0.97 NA 13.11 090
anus.
46754............... .............. A Removal of suture 2.20 3.66 1.68 0.19 6.05 4.07 010
from anus.
46760............... .............. A Repair of anal 14.41 NA 7.09 1.57 NA 23.07 090
sphincter.
46761............... .............. A Repair of anal 13.82 NA 6.04 1.48 NA 21.34 090
sphincter.
46762............... .............. A Implant artificial 12.69 NA 5.53 1.24 NA 19.46 090
sphincter.
46900............... .............. A Destruction, anal 1.91 2.59 1.28 0.18 4.68 3.37 010
lesion(s).
46910............... .............. A Destruction, anal 1.86 2.92 1.06 0.19 4.97 3.11 010
lesion(s).
46916............... .............. A Cryosurgery, anal 1.86 3.17 1.40 0.16 5.19 3.42 010
lesion(s).
46917............... .............. A Laser surgery, anal 1.86 9.19 1.12 0.21 11.26 3.19 010
lesions.
46922............... .............. A Excision of anal 1.86 3.29 1.08 0.21 5.36 3.15 010
lesion(s).
46924............... .............. A Destruction, anal 2.76 8.72 1.36 0.27 11.75 4.39 010
lesion(s).
46934............... .............. A Destruction of 3.50 5.10 2.97 0.31 8.91 6.78 090
hemorrhoids.
46935............... .............. A Destruction of 2.43 3.49 1.21 0.22 6.14 3.86 010
hemorrhoids.
46936............... .............. A Destruction of 3.68 4.89 2.50 0.36 8.93 6.54 090
hemorrhoids.
46937............... .............. A Cryotherapy of rectal 2.69 2.77 1.23 0.28 5.74 4.20 010
lesion.
46938............... .............. A Cryotherapy of rectal 4.65 4.00 3.06 0.58 9.23 8.29 090
lesion.
46940............... .............. A Treatment of anal 2.32 1.99 1.09 0.22 4.53 3.63 010
fissure.
46942............... .............. A Treatment of anal 2.04 1.83 1.02 0.19 4.06 3.25 010
fissure.
46945............... .............. A Ligation of 1.84 3.36 2.49 0.19 5.39 4.52 090
hemorrhoids.
46946............... .............. A Ligation of 2.58 3.79 2.40 0.26 6.63 5.24 090
hemorrhoids.
47000............... .............. A Needle biopsy of 1.90 3.07 0.63 0.12 5.09 2.65 000
liver.
47001............... .............. A Needle biopsy, liver 1.90 NA 0.65 0.24 NA 2.79 ZZZ
add-on.
47010............... .............. A Open drainage, liver 15.99 NA 8.40 1.74 NA 26.13 090
lesion.
47011............... .............. A Percut drain, liver 3.69 NA 1.20 0.23 NA 5.12 000
lesion.
47015............... .............. A Inject/aspirate liver 15.09 NA 7.49 1.78 NA 24.36 090
cyst.
47100............... .............. A Wedge biopsy of liver 11.65 NA 6.04 1.48 NA 19.17 090
47120............... .............. A Partial removal of 35.45 NA 15.15 4.53 NA 55.13 090
liver.
47122............... .............. A Extensive removal of 55.05 NA 21.45 6.99 NA 83.49 090
liver.
47125............... .............. A Partial removal of 49.12 NA 19.51 6.23 NA 74.86 090
liver.
47130............... .............. A Partial removal of 53.27 NA 20.97 6.80 NA 81.04 090
liver.
47135............... .............. R Transplantation of 81.40 NA 31.49 9.89 NA 122.78 090
liver.
47136............... .............. R Transplantation of 68.50 NA 26.99 8.36 NA 103.85 090
liver.
47140............... .............. A Partial removal, 54.92 NA 22.25 4.87 NA 82.04 090
donor liver.
47141............... .............. A Partial removal, 67.40 NA 26.87 4.87 NA 99.14 090
donor liver.
47142............... .............. A Partial removal, 74.89 NA 29.43 4.87 NA 109.19 090
donor liver.
47300............... .............. A Surgery for liver 15.06 NA 7.23 1.91 NA 24.20 090
lesion.
47350............... .............. A Repair liver wound... 19.53 NA 8.86 2.48 NA 30.87 090
47360............... .............. A Repair liver wound... 26.88 NA 11.59 3.35 NA 41.82 090
47361............... .............. A Repair liver wound... 47.05 NA 18.51 5.77 NA 71.33 090
47362............... .............. A Repair liver wound... 18.48 NA 8.73 2.31 NA 29.52 090
47370............... .............. A Laparo ablate liver 19.66 NA 8.13 2.27 NA 30.06 090
tumor rf.
47371............... .............. A Laparo ablate liver 19.66 NA 8.14 2.11 NA 29.91 090
cryosurg.
47380............... .............. A Open ablate liver 22.97 NA 9.34 2.69 NA 35.00 090
tumor rf.
47381............... .............. A Open ablate liver 23.24 NA 9.58 2.39 NA 35.21 090
tumor cryo.
47382............... .............. A Percut ablate liver 15.17 NA 6.06 0.80 NA 22.03 010
rf.
47400............... .............. A Incision of liver 32.44 NA 13.43 3.46 NA 49.33 090
duct.
47420............... .............. A Incision of bile duct 19.85 NA 8.75 2.54 NA 31.14 090
47425............... .............. A Incision of bile duct 19.80 NA 8.81 2.46 NA 31.07 090
47460............... .............. A Incise bile duct 18.01 NA 8.38 2.00 NA 28.39 090
sphincter.
47480............... .............. A Incision of 10.80 NA 5.92 1.38 NA 18.10 090
gallbladder.
47490............... .............. A Incision of 7.22 NA 5.58 0.44 NA 13.24 090
gallbladder.
47500............... .............. A Injection for liver x- 1.96 NA 0.64 0.12 NA 2.72 000
rays.
47505............... .............. A Injection for liver x- 0.76 NA 0.25 0.05 NA 1.06 000
rays.
47510............... .............. A Insert catheter, bile 7.82 NA 5.00 0.50 NA 13.32 090
duct.
47511............... .............. A Insert bile duct 10.48 NA 5.07 0.64 NA 16.19 090
drain.
47525............... .............. A Change bile duct 5.54 12.22 2.80 0.33 18.09 8.67 010
catheter.
47530............... .............. A Revise/reinsert bile 5.84 25.23 3.70 0.38 31.45 9.92 090
tube.
47550............... .............. A Bile duct endoscopy 3.02 NA 1.02 0.39 NA 4.43 ZZZ
add-on.
47552............... .............. A Biliary endoscopy 6.03 NA 2.40 0.44 NA 8.87 000
thru skin.
47553............... .............. A Biliary endoscopy 6.34 NA 2.06 0.41 NA 8.81 000
thru skin.
47554............... .............. A Biliary endoscopy 9.05 NA 3.38 0.96 NA 13.39 000
thru skin.
47555............... .............. A Biliary endoscopy 7.55 NA 2.45 0.46 NA 10.46 000
thru skin.
47556............... .............. A Biliary endoscopy 8.55 NA 2.77 0.51 NA 11.83 000
thru skin.
47560............... .............. A Laparoscopy w/ 4.88 NA 1.66 0.59 NA 7.13 000
cholangio.
47561............... .............. A Laparo w/cholangio/ 5.17 NA 1.91 0.65 NA 7.73 000
biopsy.
47562............... .............. A Laparoscopic 11.07 NA 4.98 1.42 NA 17.47 090
cholecystectomy.
47563............... .............. A Laparo 11.92 NA 5.29 1.52 NA 18.73 090
cholecystectomy/
graph.
[[Page 47627]]
47564............... .............. A Laparo 14.21 NA 5.94 1.82 NA 21.97 090
cholecystectomy/
explr.
47570............... .............. A Laparo 12.56 NA 5.36 1.60 NA 19.52 090
cholecystoenterostom
y.
47600............... .............. A Removal of 13.56 NA 6.15 1.73 NA 21.44 090
gallbladder.
47605............... .............. A Removal of 14.67 NA 6.50 1.88 NA 23.05 090
gallbladder.
47610............... .............. A Removal of 18.79 NA 7.94 2.41 NA 29.14 090
gallbladder.
47612............... .............. A Removal of 18.75 NA 7.88 2.40 NA 29.03 090
gallbladder.
47620............... .............. A Removal of 20.61 NA 8.52 2.68 NA 31.81 090
gallbladder.
47630............... .............. A Remove bile duct 9.10 NA 4.86 0.69 NA 14.65 090
stone.
47700............... .............. A Exploration of bile 15.60 NA 7.43 1.89 NA 24.92 090
ducts.
47701............... .............. A Bile duct revision... 27.77 NA 11.49 3.55 NA 42.81 090
47711............... .............. A Excision of bile duct 23.00 NA 9.92 2.93 NA 35.85 090
tumor.
47712............... .............. A Excision of bile duct 30.19 NA 12.41 3.93 NA 46.53 090
tumor.
47715............... .............. A Excision of bile duct 18.77 NA 8.42 2.38 NA 29.57 090
cyst.
47716............... .............. A Fusion of bile duct 16.42 NA 7.83 2.08 NA 26.33 090
cyst.
47720............... .............. A Fuse gallbladder & 15.89 NA 7.48 2.03 NA 25.40 090
bowel.
47721............... .............. A Fuse upper gi 19.09 NA 8.57 2.46 NA 30.12 090
structures.
47740............... .............. A Fuse gallbladder & 18.45 NA 8.38 2.43 NA 29.26 090
bowel.
47741............... .............. A Fuse gallbladder & 21.31 NA 9.28 2.63 NA 33.22 090
bowel.
47760............... .............. A Fuse bile ducts and 25.81 NA 10.84 3.32 NA 39.97 090
bowel.
47765............... .............. A Fuse liver ducts & 24.84 NA 10.80 3.21 NA 38.85 090
bowel.
47780............... .............. A Fuse bile ducts and 26.46 NA 11.20 3.43 NA 41.09 090
bowel.
47785............... .............. A Fuse bile ducts and 31.13 NA 12.91 4.04 NA 48.08 090
bowel.
47800............... .............. A Reconstruction of 23.27 NA 10.06 2.94 NA 36.27 090
bile ducts.
47801............... .............. A Placement, bile duct 15.15 NA 8.15 1.24 NA 24.54 090
support.
47802............... .............. A Fuse liver duct & 21.52 NA 9.68 2.73 NA 33.93 090
intestine.
47900............... .............. A Suture bile duct 19.87 NA 8.87 2.57 NA 31.31 090
injury.
48000............... .............. A Drainage of abdomen.. 28.03 NA 11.49 3.40 NA 42.92 090
48001............... .............. A Placement of drain, 35.40 NA 13.87 4.47 NA 53.74 090
pancreas.
48005............... .............. A Resect/debride 42.11 NA 16.53 5.41 NA 64.05 090
pancreas.
48020............... .............. A Removal of pancreatic 15.68 NA 7.29 2.12 NA 25.09 090
stone.
48100............... .............. A Biopsy of pancreas, 12.21 NA 5.61 1.54 NA 19.36 090
open.
48102............... .............. A Needle biopsy, 4.67 7.95 1.94 0.29 12.91 6.90 010
pancreas.
48120............... .............. A Removal of pancreas 15.83 NA 6.86 1.98 NA 24.67 090
lesion.
48140............... .............. A Partial removal of 22.91 NA 9.53 2.91 NA 35.35 090
pancreas.
48145............... .............. A Partial removal of 23.98 NA 9.84 3.09 NA 36.91 090
pancreas.
48146............... .............. A Pancreatectomy....... 26.36 NA 11.98 3.40 NA 41.74 090
48148............... .............. A Removal of pancreatic 17.31 NA 7.62 2.20 NA 27.13 090
duct.
48150............... .............. A Partial removal of 47.93 NA 19.49 6.18 NA 73.60 090
pancreas.
48152............... .............. A Pancreatectomy....... 43.68 NA 18.20 5.68 NA 67.56 090
48153............... .............. A Pancreatectomy....... 47.82 NA 19.54 6.19 NA 73.55 090
48154............... .............. A Pancreatectomy....... 44.03 NA 18.23 5.74 NA 68.00 090
48155............... .............. A Removal of pancreas.. 24.60 NA 11.69 3.14 NA 39.43 090
48180............... .............. A Fuse pancreas and 24.68 NA 10.16 3.22 NA 38.06 090
bowel.
48400............... .............. A Injection, intraop 1.95 NA 0.64 0.16 NA 2.75 ZZZ
add-on.
48500............... .............. A Surgery of pancreatic 15.26 NA 7.34 2.04 NA 24.64 090
cyst.
48510............... .............. A Drain pancreatic 14.29 NA 7.43 1.80 NA 23.52 090
pseudocyst.
48511............... .............. A Drain pancreatic 3.99 21.20 1.30 0.25 25.44 5.54 000
pseudocyst.
48520............... .............. A Fuse pancreas cyst 15.57 NA 6.70 1.99 NA 24.26 090
and bowel.
48540............... .............. A Fuse pancreas cyst 19.69 NA 8.11 2.50 NA 30.30 090
and bowel.
48545............... .............. A Pancreatorrhaphy..... 18.15 NA 7.99 2.30 NA 28.44 090
48547............... .............. A Duodenal exclusion... 25.79 NA 10.48 3.28 NA 39.55 090
48554............... .............. R Transpl allograft 34.12 NA 18.29 4.19 NA 56.60 090
pancreas.
48556............... .............. A Removal, allograft 15.69 NA 8.07 1.96 NA 25.72 090
pancreas.
49000............... .............. A Exploration of 11.66 NA 5.38 1.44 NA 18.48 090
abdomen.
49002............... .............. A Reopening of abdomen. 10.47 NA 5.04 1.33 NA 16.84 090
49010............... .............. A Exploration behind 12.26 NA 5.91 1.49 NA 19.66 090
abdomen.
49020............... .............. A Drain abdominal 22.81 NA 10.19 2.71 NA 35.71 090
abscess.
49021............... .............. A Drain abdominal 3.37 21.58 1.11 0.21 25.16 4.69 000
abscess.
49040............... .............. A Drain, open, abdom 13.50 NA 6.44 1.65 NA 21.59 090
abscess.
49041............... .............. A Drain, percut, abdom 3.99 19.76 1.31 0.25 24.00 5.55 000
abscess.
49060............... .............. A Drain, open, retrop 15.84 NA 7.44 1.64 NA 24.92 090
abscess.
49061............... .............. A Drain, percut, 3.69 19.95 1.21 0.22 23.86 5.12 000
retroper absc.
49062............... .............. A Drain to peritoneal 11.34 NA 5.46 1.40 NA 18.20 090
cavity.
49080............... .............. A Puncture, peritoneal 1.35 4.15 0.45 0.09 5.59 1.89 000
cavity.
49081............... .............. A Removal of abdominal 1.26 2.66 0.43 0.09 4.01 1.78 000
fluid.
49085............... .............. A Remove abdomen 12.12 NA 5.51 1.43 NA 19.06 090
foreign body.
49180............... .............. A Biopsy, abdominal 1.73 3.14 0.56 0.11 4.98 2.40 000
mass.
49200............... .............. A Removal of abdominal 10.23 NA 5.05 1.14 NA 16.42 090
lesion.
49201............... .............. A Remove abdom lesion, 14.82 NA 7.06 1.77 NA 23.65 090
complex.
49215............... .............. A Excise sacral spine 33.45 NA 14.04 4.29 NA 51.78 090
tumor.
49220............... .............. A Multiple surgery, 14.86 NA 6.65 1.83 NA 23.34 090
abdomen.
49250............... .............. A Excision of umbilicus 8.34 NA 4.30 1.05 NA 13.69 090
49255............... .............. A Removal of omentum... 11.12 NA 5.63 1.39 NA 18.14 090
49320............... .............. A Diag laparo separate 5.09 NA 2.63 0.63 NA 8.35 010
proc.
49321............... .............. A Laparoscopy, biopsy.. 5.39 NA 2.64 0.68 NA 8.71 010
[[Page 47628]]
49322............... .............. A Laparoscopy, 5.69 NA 2.99 0.70 NA 9.38 010
aspiration.
49323............... .............. A Laparo drain 9.47 NA 4.49 1.12 NA 15.08 090
lymphocele.
49400............... .............. A Air injection into 1.88 3.16 0.62 0.16 5.20 2.66 000
abdomen.
49419............... .............. A Insrt abdom cath for 6.64 NA 3.55 0.70 NA 10.89 090
chemotx.
49420............... .............. A Insert abdom drain, 2.22 NA 1.09 0.21 NA 3.52 000
temp.
49421............... .............. A Insert abdom drain, 5.53 NA 3.17 0.70 NA 9.40 090
perm.
49422............... .............. A Remove perm cannula/ 6.24 NA 2.89 0.80 NA 9.93 010
catheter.
49423............... .............. A Exchange drainage 1.46 14.40 0.52 0.09 15.95 2.07 000
catheter.
49424............... .............. A Assess cyst, contrast 0.76 3.92 0.29 0.05 4.73 1.10 000
inject.
49425............... .............. A Insert abdomen-venous 11.35 NA 5.62 1.52 NA 18.49 090
drain.
49426............... .............. A Revise abdomen-venous 9.62 NA 4.78 1.23 NA 15.63 090
shunt.
49427............... .............. A Injection, abdominal 0.89 NA 0.30 0.06 NA 1.25 000
shunt.
49428............... .............. A Ligation of shunt.... 6.05 NA 3.92 0.84 NA 10.81 010
49429............... .............. A Removal of shunt..... 7.39 NA 3.42 0.99 NA 11.80 010
49491............... .............. A Rpr hern preemie 11.11 NA 5.04 1.47 NA 17.62 090
reduc.
49492............... .............. A Rpr ing hern premie, 14.01 NA 6.10 1.64 NA 21.75 090
blocked.
49495............... .............. A Rpr ing hernia baby, 5.88 NA 2.97 0.78 NA 9.63 090
reduc.
49496............... .............. A Rpr ing hernia baby, 8.78 NA 4.33 1.10 NA 14.21 090
blocked.
49500............... .............. A Rpr ing hernia, init, 5.47 NA 3.13 0.62 NA 9.22 090
reduce.
49501............... .............. A Rpr ing hernia, init 8.87 NA 4.21 1.13 NA 14.21 090
blocked.
49505............... .............. A Prp i/hern init 7.59 NA 3.75 0.99 NA 12.33 090
reduc>5 yr.
49507............... .............. A Prp i/hern init 9.56 NA 4.50 1.24 NA 15.30 090
block>5 yr.
49520............... .............. A Rerepair ing hernia, 9.62 NA 4.46 1.24 NA 15.32 090
reduce.
49521............... .............. A Rerepair ing hernia, 11.95 NA 5.25 1.56 NA 18.76 090
blocked.
49525............... .............. A Repair ing hernia, 8.56 NA 4.10 1.09 NA 13.75 090
sliding.
49540............... .............. A Repair lumbar hernia. 10.37 NA 4.77 1.34 NA 16.48 090
49550............... .............. A Rpr rem hernia, init, 8.62 NA 4.14 1.12 NA 13.88 090
reduce.
49553............... .............. A Rpr fem hernia, init 9.43 NA 4.43 1.22 NA 15.08 090
blocked.
49555............... .............. A Rerepair fem hernia, 9.02 NA 4.29 1.17 NA 14.48 090
reduce.
49557............... .............. A Rerepair fem hernia, 11.13 NA 5.00 1.44 NA 17.57 090
blocked.
49560............... .............. A Rpr ventral hern 11.55 NA 5.17 1.48 NA 18.20 090
init, reduc.
49561............... .............. A Rpr ventral hern 14.23 NA 6.07 1.83 NA 22.13 090
init, block.
49565............... .............. A Rerepair ventrl hern, 11.55 NA 5.24 1.48 NA 18.27 090
reduce.
49566............... .............. A Rerepair ventrl hern, 14.38 NA 6.14 1.85 NA 22.37 090
block.
49568............... .............. A Hernia repair w/mesh. 4.88 NA 1.67 0.63 NA 7.18 ZZZ
49570............... .............. A Rpr epigastric hern, 5.68 NA 3.18 0.73 NA 9.59 090
reduce.
49572............... .............. A Rpr epigastric hern, 6.72 NA 3.48 0.86 NA 11.06 090
blocked.
49580............... .............. A Rpr umbil hern, reduc 4.10 NA 2.62 0.52 NA 7.24 090
< 5 yr.
49582............... .............. A Rpr umbil hern, block 6.64 NA 3.51 0.86 NA 11.01 090
< 5 yr.
49585............... .............. A Rpr umbil hern, reduc 6.22 NA 3.32 0.79 NA 10.33 090
> 5 yr.
49587............... .............. A Rpr umbil hern, block 7.55 NA 3.75 0.97 NA 12.27 090
> 5 yr.
49590............... .............. A Repair spigilian 8.53 NA 4.11 1.09 NA 13.73 090
hernia.
49600............... .............. A Repair umbilical 10.94 NA 5.35 1.31 NA 17.60 090
lesion.
49605............... .............. A Repair umbilical 75.89 NA 28.48 9.95 NA 114.32 090
lesion.
49606............... .............. A Repair umbilical 18.57 NA 7.72 2.43 NA 28.72 090
lesion.
49610............... .............. A Repair umbilical 10.48 NA 5.24 0.57 NA 16.29 090
lesion.
49611............... .............. A Repair umbilical 8.91 NA 7.31 0.78 NA 17.00 090
lesion.
49650............... .............. A Laparo hernia repair 6.26 NA 3.20 0.90 NA 10.36 090
initial.
49651............... .............. A Laparo hernia repair 8.23 NA 4.06 1.10 NA 13.39 090
recur.
49900............... .............. A Repair of abdominal 12.26 NA 6.23 1.55 NA 20.04 090
wall.
49904............... .............. A Omental flap, extra- 19.97 NA 15.17 2.52 NA 37.66 090
abdom.
49905............... .............. A Omental flap, intra- 6.54 NA 2.29 0.79 NA 9.62 ZZZ
abdom.
50010............... .............. A Exploration of kidney 10.96 NA 5.21 0.93 NA 17.10 090
50020............... .............. A Renal abscess, open 14.64 NA 7.73 1.27 NA 23.64 090
drain.
50021............... .............. A Renal abscess, percut 3.37 21.89 1.10 0.20 25.46 4.67 000
drain.
50040............... .............. A Drainage of kidney... 14.92 NA 6.80 1.03 NA 22.75 090
50045............... .............. A Exploration of kidney 15.44 NA 6.59 1.24 NA 23.27 090
50060............... .............. A Removal of kidney 19.27 NA 7.81 1.46 NA 28.54 090
stone.
50065............... .............. A Incision of kidney... 20.76 NA 6.09 1.48 NA 28.33 090
50070............... .............. A Incision of kidney... 20.29 NA 8.20 1.48 NA 29.97 090
50075............... .............. A Removal of kidney 25.30 NA 9.88 1.93 NA 37.11 090
stone.
50080............... .............. A Removal of kidney 14.69 NA 6.27 1.04 NA 22.00 090
stone.
50081............... .............. A Removal of kidney 21.77 NA 8.74 1.57 NA 32.08 090
stone.
50100............... .............. A Revise kidney blood 16.07 NA 7.77 1.78 NA 25.62 090
vessels.
50120............... .............. A Exploration of kidney 15.89 NA 6.75 1.19 NA 23.83 090
50125............... .............. A Explore and drain 16.50 NA 6.96 1.34 NA 24.80 090
kidney.
50130............... .............. A Removal of kidney 17.26 NA 7.16 1.30 NA 25.72 090
stone.
50135............... .............. A Exploration of kidney 19.15 NA 7.76 1.43 NA 28.34 090
50200............... .............. A Biopsy of kidney..... 2.63 NA 1.29 0.16 NA 4.08 000
50205............... .............. A Biopsy of kidney..... 11.29 NA 5.01 1.28 NA 17.58 090
50220............... .............. A Remove kidney, open.. 17.12 NA 7.22 1.44 NA 25.78 090
50225............... .............. A Removal kidney open, 20.20 NA 8.13 1.58 NA 29.91 090
complex.
50230............... .............. A Removal kidney open, 22.04 NA 8.56 1.70 NA 32.30 090
radical.
50234............... .............. A Removal of kidney & 22.37 NA 8.81 1.67 NA 32.85 090
ureter.
50236............... .............. A Removal of kidney & 24.82 NA 10.23 1.88 NA 36.93 090
ureter.
[[Page 47629]]
50240............... .............. A Partial removal of 21.97 NA 8.99 1.66 NA 32.62 090
kidney.
50280............... .............. A Removal of kidney 15.65 NA 6.67 1.29 NA 23.61 090
lesion.
50290............... .............. A Removal of kidney 14.71 NA 6.45 1.22 NA 22.38 090
lesion.
50320............... .............. A Removal of donor 22.18 NA 10.66 2.33 NA 35.17 090
kidney.
50340............... .............. A Removal of kidney.... 12.13 NA 6.49 1.66 NA 20.28 090
50360............... .............. A Transplantation of 31.48 NA 15.48 3.73 NA 50.69 090
kidney.
50365............... .............. A Transplantation of 36.75 NA 18.26 4.25 NA 59.26 090
kidney.
50370............... .............. A Remove transplanted 13.70 NA 7.15 1.55 NA 22.40 090
kidney.
50380............... .............. A Reimplantation of 20.73 NA 12.06 2.53 NA 35.32 090
kidney.
50390............... .............. A Drainage of kidney 1.96 NA 0.64 0.12 NA 2.72 000
lesion.
50392............... .............. A Insert kidney drain.. 3.37 NA 1.52 0.21 NA 5.10 000
50393............... .............. A Insert ureteral tube. 4.15 NA 1.77 0.26 NA 6.18 000
50394............... .............. A Injection for kidney 0.76 3.04 0.66 0.05 3.85 1.47 000
x-ray.
50395............... .............. A Create passage to 3.37 NA 1.50 0.21 NA 5.08 000
kidney.
50396............... .............. A Measure kidney 2.09 NA 1.08 0.13 NA 3.30 000
pressure.
50398............... .............. A Change kidney tube... 1.46 16.30 0.52 0.09 17.85 2.07 000
50400............... .............. A Revision of kidney/ 19.47 NA 7.86 1.49 NA 28.82 090
ureter.
50405............... .............. A Revision of kidney/ 23.89 NA 9.01 1.79 NA 34.69 090
ureter.
50500............... .............. A Repair of kidney 19.54 NA 8.39 1.96 NA 29.89 090
wound.
50520............... .............. A Close kidney-skin 17.20 NA 7.41 1.55 NA 26.16 090
fistula.
50525............... .............. A Repair renal-abdomen 22.24 NA 8.99 2.30 NA 33.53 090
fistula.
50526............... .............. A Repair renal-abdomen 23.98 NA 9.84 4.17 NA 37.99 090
fistula.
50540............... .............. A Revision of horseshoe 19.90 NA 8.32 1.76 NA 29.98 090
kidney.
50541............... .............. A Laparo ablate renal 15.98 NA 6.47 1.22 NA 23.67 090
cyst.
50542............... .............. A Laparo ablate renal 19.97 NA 8.11 1.66 NA 29.74 090
mass.
50543............... .............. A Laparo partial 25.46 NA 10.17 1.66 NA 37.29 090
nephrectomy.
50544............... .............. A Laparoscopy, 22.37 NA 8.51 1.69 NA 32.57 090
pyeloplasty.
50545............... .............. A Laparo radical 23.96 NA 9.17 1.82 NA 34.95 090
nephrectomy.
50546............... .............. A Laparoscopic 20.45 NA 8.35 1.60 NA 30.40 090
nephrectomy.
50547............... .............. A Laparo removal donor 25.46 NA 11.10 2.80 NA 39.36 090
kidney.
50548............... .............. A Laparo remove w/ 24.36 NA 9.15 1.84 NA 35.35 090
ureter.
50551............... .............. A Kidney endoscopy..... 5.59 4.14 1.96 0.40 10.13 7.95 000
50553............... .............. A Kidney endoscopy..... 5.98 4.35 2.16 0.39 10.72 8.53 000
50555............... .............. A Kidney endoscopy & 6.52 4.82 2.33 0.49 11.83 9.34 000
biopsy.
50557............... .............. A Kidney endoscopy & 6.61 4.57 2.29 0.48 11.66 9.38 000
treatment.
50559............... .............. A Renal endoscopy/ 6.77 5.30 2.78 0.41 12.48 9.96 000
radiotracer.
50561............... .............. A Kidney endoscopy & 7.58 5.08 2.64 0.55 13.21 10.77 000
treatment.
50562............... .............. A Renal scope w/tumor 10.90 NA 4.27 0.48 NA 15.65 090
resect.
50570............... .............. A Kidney endoscopy..... 9.53 NA 3.20 0.66 NA 13.39 000
50572............... .............. A Kidney endoscopy..... 10.33 NA 3.49 0.87 NA 14.69 000
50574............... .............. A Kidney endoscopy & 11.00 NA 3.74 0.74 NA 15.48 000
biopsy.
50575............... .............. A Kidney endoscopy..... 13.96 NA 4.62 1.00 NA 19.58 000
50576............... .............. A Kidney endoscopy & 10.97 NA 3.65 0.76 NA 15.38 000
treatment.
50578............... .............. A Renal endoscopy/ 11.33 NA 3.79 0.81 NA 15.93 000
radiotracer.
50580............... .............. A Kidney endoscopy & 11.84 NA 3.95 0.84 NA 16.63 000
treatment.
50590............... .............. A Fragmenting of kidney 9.08 12.49 4.11 0.66 22.23 13.85 090
stone.
50600............... .............. A Exploration of ureter 15.82 NA 6.66 1.34 NA 23.82 090
50605............... .............. A Insert ureteral 15.44 NA 6.73 1.44 NA 23.61 090
support.
50610............... .............. A Removal of ureter 15.90 NA 6.96 1.28 NA 24.14 090
stone.
50620............... .............. A Removal of ureter 15.14 NA 6.32 1.12 NA 22.58 090
stone.
50630............... .............. A Removal of ureter 14.92 NA 6.27 1.14 NA 22.33 090
stone.
50650............... .............. A Removal of ureter.... 17.38 NA 7.21 1.26 NA 25.85 090
50660............... .............. A Removal of ureter.... 19.52 NA 7.94 1.55 NA 29.01 090
50684............... .............. A Injection for ureter 0.76 5.00 0.47 0.05 5.81 1.28 000
x-ray.
50686............... .............. A Measure ureter 1.51 3.43 0.82 0.11 5.05 2.44 000
pressure.
50688............... .............. A Change of ureter tube 1.17 NA 1.06 0.07 NA 2.30 010
50690............... .............. A Injection for ureter 1.16 1.80 0.72 0.08 3.04 1.96 000
x-ray.
50700............... .............. A Revision of ureter... 15.19 NA 7.10 1.25 NA 23.54 090
50715............... .............. A Release of ureter.... 18.87 NA 8.73 2.06 NA 29.66 090
50722............... .............. A Release of ureter.... 16.33 NA 7.80 1.88 NA 26.01 090
50725............... .............. A Release/revise ureter 18.46 NA 8.04 1.58 NA 28.08 090
50727............... .............. A Revise ureter........ 8.17 NA 4.27 0.65 NA 13.09 090
50728............... .............. A Revise ureter........ 12.00 NA 5.55 1.05 NA 18.60 090
50740............... .............. A Fusion of ureter & 18.39 NA 7.73 1.88 NA 28.00 090
kidney.
50750............... .............. A Fusion of ureter & 19.48 NA 7.97 1.54 NA 28.99 090
kidney.
50760............... .............. A Fusion of ureters.... 18.39 NA 7.67 1.53 NA 27.59 090
50770............... .............. A Splicing of ureters.. 19.48 NA 7.96 1.61 NA 29.05 090
50780............... .............. A Reimplant ureter in 18.33 NA 7.58 1.59 NA 27.50 090
bladder.
50782............... .............. A Reimplant ureter in 19.51 NA 8.80 1.61 NA 29.92 090
bladder.
50783............... .............. A Reimplant ureter in 20.52 NA 8.20 1.64 NA 30.36 090
bladder.
50785............... .............. A Reimplant ureter in 20.49 NA 8.28 1.63 NA 30.40 090
bladder.
50800............... .............. A Implant ureter in 14.50 NA 6.46 1.23 NA 22.19 090
bowel.
50810............... .............. A Fusion of ureter & 20.02 NA 9.08 2.16 NA 31.26 090
bowel.
50815............... .............. A Urine shunt to 19.90 NA 8.43 1.62 NA 29.95 090
intestine.
50820............... .............. A Construct bowel 21.86 NA 8.62 1.83 NA 32.31 090
bladder.
[[Page 47630]]
50825............... .............. A Construct bowel 28.14 NA 11.10 2.14 NA 41.38 090
bladder.
50830............... .............. A Revise urine flow.... 31.23 NA 12.15 2.58 NA 45.96 090
50840............... .............. A Replace ureter by 19.97 NA 8.42 1.56 NA 29.95 090
bowel.
50845............... .............. A Appendico-vesicostomy 20.86 NA 8.89 1.53 NA 31.28 090
50860............... .............. A Transplant ureter to 15.34 NA 6.61 1.21 NA 23.16 090
skin.
50900............... .............. A Repair of ureter..... 13.60 NA 6.13 1.26 NA 20.99 090
50920............... .............. A Closure ureter/skin 14.31 NA 6.56 1.13 NA 22.00 090
fistula.
50930............... .............. A Closure ureter/bowel 18.69 NA 7.96 1.28 NA 27.93 090
fistula.
50940............... .............. A Release of ureter.... 14.49 NA 6.39 1.40 NA 22.28 090
50945............... .............. A Laparoscopy 16.97 NA 7.02 1.18 NA 25.17 090
ureterolithotomy.
50947............... .............. A Laparo new ureter/ 24.46 NA 9.66 1.97 NA 36.09 090
bladder.
50948............... .............. A Laparo new ureter/ 22.47 NA 8.67 1.60 NA 32.74 090
bladder.
50951............... .............. A Endoscopy of ureter.. 5.83 4.28 2.05 0.42 10.53 8.30 000
50953............... .............. A Endoscopy of ureter.. 6.23 4.40 2.36 0.44 11.07 9.03 000
50955............... .............. A Ureter endoscopy & 6.74 6.66 2.68 0.46 13.86 9.88 000
biopsy.
50957............... .............. A Ureter endoscopy & 6.78 4.56 2.37 0.48 11.82 9.63 000
treatment.
50959............... .............. A Ureter endoscopy & 4.39 NA 1.88 0.25 NA 6.52 000
tracer.
50961............... .............. A Ureter endoscopy & 6.04 4.36 2.18 0.42 10.82 8.64 000
treatment.
50970............... .............. A Ureter endoscopy..... 7.13 NA 2.45 0.50 NA 10.08 000
50972............... .............. A Ureter endoscopy & 6.88 NA 2.46 0.50 NA 9.84 000
catheter.
50974............... .............. A Ureter endoscopy & 9.16 NA 3.10 0.63 NA 12.89 000
biopsy.
50976............... .............. A Ureter endoscopy & 9.03 NA 3.06 0.64 NA 12.73 000
treatment.
50978............... .............. A Ureter endoscopy & 5.09 NA 1.83 0.36 NA 7.28 000
tracer.
50980............... .............. A Ureter endoscopy & 6.84 NA 2.36 0.51 NA 9.71 000
treatment.
51000............... .............. A Drainage of bladder.. 0.78 1.97 0.24 0.06 2.81 1.08 000
51005............... .............. A Drainage of bladder.. 1.02 4.75 0.34 0.09 5.86 1.45 000
51010............... .............. A Drainage of bladder.. 3.52 5.59 1.87 0.28 9.39 5.67 010
51020............... .............. A Incise & treat 6.70 NA 3.91 0.53 NA 11.14 090
bladder.
51030............... .............. A Incise & treat 6.76 NA 4.04 0.56 NA 11.36 090
bladder.
51040............... .............. A Incise & drain 4.39 NA 2.82 0.33 NA 7.54 090
bladder.
51045............... .............. A Incise bladder/drain 6.76 NA 4.00 0.58 NA 11.34 090
ureter.
51050............... .............. A Removal of bladder 6.91 NA 3.69 0.50 NA 11.10 090
stone.
51060............... .............. A Removal of ureter 8.84 NA 4.56 0.68 NA 14.08 090
stone.
51065............... .............. A Remove ureter 8.84 NA 4.40 0.67 NA 13.91 090
calculus.
51080............... .............. A Drainage of bladder 5.95 NA 3.61 0.47 NA 10.03 090
abscess.
51500............... .............. A Removal of bladder 10.12 NA 5.03 1.10 NA 16.25 090
cyst.
51520............... .............. A Removal of bladder 9.28 NA 4.72 0.72 NA 14.72 090
lesion.
51525............... .............. A Removal of bladder 13.95 NA 6.17 1.05 NA 21.17 090
lesion.
51530............... .............. A Removal of bladder 12.36 NA 5.80 1.12 NA 19.28 090
lesion.
51535............... .............. A Repair of ureter 12.55 NA 6.16 1.20 NA 19.91 090
lesion.
51550............... .............. A Partial removal of 15.64 NA 6.78 1.37 NA 23.79 090
bladder.
51555............... .............. A Partial removal of 21.20 NA 8.71 1.80 NA 31.71 090
bladder.
51565............... .............. A Revise bladder & 21.59 NA 9.01 1.69 NA 32.29 090
ureter(s).
51570............... .............. A Removal of bladder... 24.20 NA 9.81 1.89 NA 35.90 090
51575............... .............. A Removal of bladder & 30.40 NA 12.10 2.27 NA 44.77 090
nodes.
51580............... .............. A Remove bladder/revise 31.03 NA 12.58 2.29 NA 45.90 090
tract.
51585............... .............. A Removal of bladder & 35.18 NA 13.77 2.80 NA 51.75 090
nodes.
51590............... .............. A Remove bladder/revise 32.61 NA 12.69 2.43 NA 47.73 090
tract.
51595............... .............. A Remove bladder/revise 37.08 NA 14.19 2.74 NA 54.01 090
tract.
51596............... .............. A Remove bladder/create 39.46 NA 15.30 2.88 NA 57.64 090
pouch.
51597............... .............. A Removal of pelvic 38.29 NA 14.91 2.97 NA 56.17 090
structures.
51600............... .............. A Injection for bladder 0.88 5.08 0.29 0.06 6.02 1.23 000
x-ray.
51605............... .............. A Preparation for 0.64 6.03 0.35 0.04 6.71 1.03 000
bladder xray.
51610............... .............. A Injection for bladder 1.05 2.33 0.60 0.07 3.45 1.72 000
x-ray.
51700............... .............. A Irrigation of bladder 0.88 1.60 0.28 0.06 2.54 1.22 000
51701............... .............. A Insert bladder 0.50 1.57 0.19 0.04 2.11 0.73 000
catheter.
51702............... .............. A Insert temp bladder 0.50 2.08 0.24 0.04 2.62 0.78 000
cath.
51703............... .............. A Insert bladder cath, 1.47 2.72 0.56 0.08 4.27 2.11 000
complex.
51705............... .............. A Change of bladder 1.02 2.27 0.62 0.07 3.36 1.71 010
tube.
51710............... .............. A Change of bladder 1.49 3.32 0.77 0.11 4.92 2.37 010
tube.
51715............... .............. A Endoscopic injection/ 3.73 3.88 1.35 0.29 7.90 5.37 000
implant.
51720............... .............. A Treatment of bladder 1.96 1.74 0.69 0.14 3.84 2.79 000
lesion.
51725............... .............. A Simple cystometrogram 1.51 5.58 NA 0.16 7.25 NA 000
51725............... 26............ A Simple cystometrogram 1.51 0.49 0.49 0.12 2.12 2.12 000
51725............... TC............ A Simple cystometrogram 0.00 5.09 NA 0.04 5.13 NA 000
51726............... .............. A Complex 1.71 7.48 NA 0.18 9.37 NA 000
cystometrogram.
51726............... 26............ A Complex 1.71 0.56 0.56 0.13 2.40 2.40 000
cystometrogram.
51726............... TC............ A Complex 0.00 6.92 NA 0.05 6.97 NA 000
cystometrogram.
51736............... .............. A Urine flow 0.61 0.58 NA 0.06 1.25 NA 000
measurement.
51736............... 26............ A Urine flow 0.61 0.20 0.20 0.05 0.86 0.86 000
measurement.
51736............... TC............ A Urine flow 0.00 0.38 NA 0.01 0.39 NA 000
measurement.
51741............... .............. A Electro-uroflowmetry, 1.14 0.80 NA 0.11 2.05 NA 000
first.
51741............... 26............ A Electro-uroflowmetry, 1.14 0.37 0.37 0.09 1.60 1.60 000
first.
51741............... TC............ A Electro-uroflowmetry, 0.00 0.43 NA 0.02 0.45 NA 000
first.
51772............... .............. A Urethra pressure 1.61 5.58 NA 0.19 7.38 NA 000
profile.
[[Page 47631]]
51772............... 26............ A Urethra pressure 1.61 0.55 0.55 0.14 2.30 2.30 000
profile.
51772............... TC............ A Urethra pressure 0.00 5.03 NA 0.05 5.08 NA 000
profile.
51784............... .............. A Anal/urinary muscle 1.53 3.99 NA 0.16 5.68 NA 000
study.
51784............... 26............ A Anal/urinary muscle 1.53 0.50 0.50 0.12 2.15 2.15 000
study.
51784............... TC............ A Anal/urinary muscle 0.00 3.48 NA 0.04 3.52 NA 000
study.
51785............... .............. A Anal/urinary muscle 1.53 4.44 NA 0.15 6.12 NA 000
study.
51785............... 26............ A Anal/urinary muscle 1.53 0.50 0.50 0.11 2.14 2.14 000
study.
51785............... TC............ A Anal/urinary muscle 0.00 3.94 NA 0.04 3.98 NA 000
study.
51792............... .............. A Urinary reflex study. 1.10 5.99 NA 0.20 7.29 NA 000
51792............... 26............ A Urinary reflex study. 1.10 0.41 0.41 0.07 1.58 1.58 000
51792............... TC............ A Urinary reflex study. 0.00 5.57 NA 0.13 5.70 NA 000
51795............... .............. A Urine voiding 1.53 7.28 NA 0.22 9.03 NA 000
pressure study.
51795............... 26............ A Urine voiding 1.53 0.50 0.50 0.12 2.15 2.15 000
pressure study.
51795............... TC............ A Urine voiding 0.00 6.78 NA 0.10 6.88 NA 000
pressure study.
51797............... .............. A Intraabdominal 1.60 5.76 NA 0.17 7.53 NA 000
pressure test.
51797............... 26............ A Intraabdominal 1.60 0.52 0.52 0.12 2.24 2.24 000
pressure test.
51797............... TC............ A Intraabdominal 0.00 5.23 NA 0.05 5.28 NA 000
pressure test.
51798............... .............. A Us urine capacity 0.00 0.34 NA 0.08 0.42 NA XXX
measure.
51800............... .............. A Revision of bladder/ 17.39 NA 7.60 1.38 NA 26.37 090
urethra.
51820............... .............. A Revision of urinary 17.86 NA 8.38 1.90 NA 28.14 090
tract.
51840............... .............. A Attach bladder/ 10.69 NA 5.56 1.10 NA 17.35 090
urethra.
51841............... .............. A Attach bladder/ 13.01 NA 6.37 1.30 NA 20.68 090
urethra.
51845............... .............. A Repair bladder neck.. 9.72 NA 4.80 0.81 NA 15.33 090
51860............... .............. A Repair of bladder 12.00 NA 5.83 1.20 NA 19.03 090
wound.
51865............... .............. A Repair of bladder 15.02 NA 6.74 1.33 NA 23.09 090
wound.
51880............... .............. A Repair of bladder 7.65 NA 4.02 0.70 NA 12.37 090
opening.
51900............... .............. A Repair bladder/vagina 12.95 NA 6.13 1.15 NA 20.23 090
lesion.
51920............... .............. A Close bladder-uterus 11.79 NA 5.68 0.90 NA 18.37 090
fistula.
51925............... .............. A Hysterectomy/bladder 15.56 NA 8.75 1.38 NA 25.69 090
repair.
51940............... .............. A Correction of bladder 28.39 NA 12.23 2.39 NA 43.01 090
defect.
51960............... .............. A Revision of bladder & 22.98 NA 9.74 1.73 NA 34.45 090
bowel.
51980............... .............. A Construct bladder 11.34 NA 5.42 0.88 NA 17.64 090
opening.
51990............... .............. A Laparo urethral 12.48 NA 6.13 1.41 NA 20.02 090
suspension.
51992............... .............. A Laparo sling 13.99 NA 6.19 1.36 NA 21.54 090
operation.
52000............... .............. A Cystoscopy........... 2.01 3.29 0.76 0.15 5.45 2.92 000
52001............... .............. A Cystoscopy, removal 5.44 5.06 1.86 0.17 10.67 7.47 000
of clots.
52005............... .............. A Cystoscopy & ureter 2.37 5.54 0.89 0.17 8.08 3.43 000
catheter.
52007............... .............. A Cystoscopy and biopsy 3.02 16.43 1.15 0.22 19.67 4.39 000
52010............... .............. A Cystoscopy & duct 3.02 10.81 1.15 0.22 14.05 4.39 000
catheter.
52204............... .............. A Cystoscopy........... 2.37 14.45 0.90 0.17 16.99 3.44 000
52214............... .............. A Cystoscopy and 3.70 37.93 1.33 0.27 41.90 5.30 000
treatment.
52224............... .............. A Cystoscopy and 3.14 36.30 1.15 0.22 39.66 4.51 000
treatment.
52234............... .............. A Cystoscopy and 4.62 NA 1.65 0.33 NA 6.60 000
treatment.
52235............... .............. A Cystoscopy and 5.44 NA 1.93 0.39 NA 7.76 000
treatment.
52240............... .............. A Cystoscopy and 9.71 NA 3.29 0.69 NA 13.69 000
treatment.
52250............... .............. A Cystoscopy and 4.49 NA 1.65 0.33 NA 6.47 000
radiotracer.
52260............... .............. A Cystoscopy and 3.91 NA 1.42 0.29 NA 5.62 000
treatment.
52265............... .............. A Cystoscopy and 2.94 13.28 1.11 0.22 16.44 4.27 000
treatment.
52270............... .............. A Cystoscopy & revise 3.36 10.99 1.24 0.24 14.59 4.84 000
urethra.
52275............... .............. A Cystoscopy & revise 4.69 15.48 1.66 0.34 20.51 6.69 000
urethra.
52276............... .............. A Cystoscopy and 4.99 NA 1.78 0.36 NA 7.13 000
treatment.
52277............... .............. A Cystoscopy and 6.16 NA 2.22 0.45 NA 8.83 000
treatment.
52281............... .............. A Cystoscopy and 2.80 7.07 1.08 0.20 10.07 4.08 000
treatment.
52282............... .............. A Cystoscopy, implant 6.39 NA 2.23 0.46 NA 9.08 000
stent.
52283............... .............. A Cystoscopy and 3.73 3.94 1.38 0.27 7.94 5.38 000
treatment.
52285............... .............. A Cystoscopy and 3.60 4.00 1.33 0.27 7.87 5.20 000
treatment.
52290............... .............. A Cystoscopy and 4.58 NA 1.65 0.33 NA 6.56 000
treatment.
52300............... .............. A Cystoscopy and 5.30 NA 1.90 0.38 NA 7.58 000
treatment.
52301............... .............. A Cystoscopy and 5.50 NA 1.99 0.48 NA 7.97 000
treatment.
52305............... .............. A Cystoscopy and 5.30 NA 1.85 0.39 NA 7.54 000
treatment.
52310............... .............. A Cystoscopy and 2.81 4.68 1.03 0.20 7.69 4.04 000
treatment.
52315............... .............. A Cystoscopy and 5.20 8.68 1.83 0.37 14.25 7.40 000
treatment.
52317............... .............. A Remove bladder stone. 6.71 28.82 2.27 0.48 36.01 9.46 000
52318............... .............. A Remove bladder stone. 9.18 NA 3.09 0.66 NA 12.93 000
52320............... .............. A Cystoscopy and 4.69 NA 1.63 0.34 NA 6.66 000
treatment.
52325............... .............. A Cystoscopy, stone 6.15 NA 2.10 0.44 NA 8.69 000
removal.
52327............... .............. A Cystoscopy, inject 5.18 31.67 1.81 0.39 37.24 7.38 000
material.
52330............... .............. A Cystoscopy and 5.03 38.66 1.74 0.36 44.05 7.13 000
treatment.
52332............... .............. A Cystoscopy and 2.83 5.73 1.05 0.21 8.77 4.09 000
treatment.
52334............... .............. A Create passage to 4.82 NA 1.73 0.34 NA 6.89 000
kidney.
52341............... .............. A Cysto w/ureter 5.99 NA 2.21 0.43 NA 8.63 000
stricture tx.
52342............... .............. A Cysto w/up stricture 6.49 NA 2.34 0.47 NA 9.30 000
tx.
52343............... .............. A Cysto w/renal 7.19 NA 2.57 0.51 NA 10.27 000
stricture tx.
52344............... .............. A Cysto/uretero, stone 7.69 NA 2.79 0.56 NA 11.04 000
remove.
52345............... .............. A Cysto/uretero w/up 8.19 NA 2.95 0.58 NA 11.72 000
stricture.
[[Page 47632]]
52346............... .............. A Cystouretero w/renal 9.22 NA 3.27 0.67 NA 13.16 000
strict.
52347............... .............. A Cystoscopy, resect 5.27 NA 1.70 0.38 NA 7.35 000
ducts.
52351............... .............. A Cystouretero & or 5.85 NA 2.14 0.42 NA 8.41 000
pyeloscope.
52352............... .............. A Cystouretero w/stone 6.87 NA 2.50 0.49 NA 9.86 000
remove.
52353............... .............. A Cystouretero w/ 7.96 NA 2.85 0.57 NA 11.38 000
lithotripsy.
52354............... .............. A Cystouretero w/biopsy 7.33 NA 2.66 0.53 NA 10.52 000
52355............... .............. A Cystouretero w/excise 8.81 NA 3.13 0.63 NA 12.57 000
tumor.
52400............... .............. A Cystouretero w/congen 9.67 NA 3.75 0.69 NA 14.11 090
repr.
52450............... .............. A Incision of prostate. 7.63 NA 3.68 0.55 NA 11.86 090
52500............... .............. A Revision of bladder 8.46 NA 3.92 0.60 NA 12.98 090
neck.
52510............... .............. A Dilation prostatic 6.71 NA 3.12 0.49 NA 10.32 090
urethra.
52601............... .............. A Prostatectomy (TURP). 12.35 NA 5.11 0.88 NA 18.34 090
52606............... .............. A Control postop 8.12 NA 3.55 0.58 NA 12.25 090
bleeding.
52612............... .............. A Prostatectomy, first 7.97 NA 3.74 0.57 NA 12.28 090
stage.
52614............... .............. A Prostatectomy, second 6.83 NA 3.35 0.49 NA 10.67 090
stage.
52620............... .............. A Remove residual 6.60 NA 2.98 0.47 NA 10.05 090
prostate.
52630............... .............. A Remove prostate 7.25 NA 3.19 0.52 NA 10.96 090
regrowth.
52640............... .............. A Relieve bladder 6.61 NA 2.96 0.47 NA 10.04 090
contracture.
52647............... .............. A Laser surgery of 10.34 73.74 4.53 0.74 84.82 15.61 090
prostate.
52648............... .............. A Laser surgery of 11.19 NA 4.79 0.80 NA 16.78 090
prostate.
52700............... .............. A Drainage of prostate 6.79 NA 3.18 0.49 NA 10.46 090
abscess.
53000............... .............. A Incision of urethra.. 2.28 NA 1.55 0.16 NA 3.99 010
53010............... .............. A Incision of urethra.. 3.63 NA 2.97 0.26 NA 6.86 090
53020............... .............. A Incision of urethra.. 1.77 2.99 0.67 0.13 4.89 2.57 000
53025............... .............. A Incision of urethra.. 1.13 3.71 0.51 0.09 4.93 1.73 000
53040............... .............. A Drainage of urethra 6.39 NA 3.43 0.47 NA 10.29 090
abscess.
53060............... .............. A Drainage of urethra 2.63 2.09 1.37 0.27 4.99 4.27 010
abscess.
53080............... .............. A Drainage of urinary 6.28 NA 6.06 0.55 NA 12.89 090
leakage.
53085............... .............. A Drainage of urinary 10.25 NA 7.45 0.92 NA 18.62 090
leakage.
53200............... .............. A Biopsy of urethra.... 2.59 1.32 0.98 0.20 4.11 3.77 000
53210............... .............. A Removal of urethra... 12.55 NA 5.91 1.00 NA 19.46 090
53215............... .............. A Removal of urethra... 15.56 NA 6.69 1.13 NA 23.38 090
53220............... .............. A Treatment of urethra 6.99 NA 3.79 0.54 NA 11.32 090
lesion.
53230............... .............. A Removal of urethra 9.57 NA 4.76 0.72 NA 15.05 090
lesion.
53235............... .............. A Removal of urethra 10.12 NA 4.96 0.79 NA 15.87 090
lesion.
53240............... .............. A Surgery for urethra 6.44 NA 3.59 0.54 NA 10.57 090
pouch.
53250............... .............. A Removal of urethra 5.88 NA 3.35 0.50 NA 9.73 090
gland.
53260............... .............. A Treatment of urethra 2.98 2.25 1.42 0.26 5.49 4.66 010
lesion.
53265............... .............. A Treatment of urethra 3.12 2.71 1.42 0.24 6.07 4.78 010
lesion.
53270............... .............. A Removal of urethra 3.09 2.20 1.54 0.32 5.61 4.95 010
gland.
53275............... .............. A Repair of urethra 4.52 NA 2.24 0.33 NA 7.09 010
defect.
53400............... .............. A Revise urethra, stage 12.75 NA 6.02 1.04 NA 19.81 090
1.
53405............... .............. A Revise urethra, stage 14.46 NA 6.37 1.22 NA 22.05 090
2.
53410............... .............. A Reconstruction of 16.42 NA 7.12 1.21 NA 24.75 090
urethra.
53415............... .............. A Reconstruction of 19.38 NA 7.40 1.46 NA 28.24 090
urethra.
53420............... .............. A Reconstruct urethra, 14.06 NA 6.43 0.98 NA 21.47 090
stage 1.
53425............... .............. A Reconstruct urethra, 15.96 NA 6.96 1.16 NA 24.08 090
stage 2.
53430............... .............. A Reconstruction of 16.32 NA 7.05 1.27 NA 24.64 090
urethra.
53431............... .............. A Reconstruct urethra/ 19.86 NA 8.09 1.44 NA 29.39 090
bladder.
53440............... .............. A Male sling procedure. 13.60 NA 5.97 0.89 NA 20.46 090
53442............... .............. A Remove/revise male 11.55 NA 5.45 0.61 NA 17.61 090
sling.
53444............... .............. A Insert tandem cuff... 13.38 NA 5.87 0.99 NA 20.24 090
53445............... .............. A Insert uro/ves nck 14.04 NA 7.14 1.03 NA 22.21 090
sphincter.
53446............... .............. A Remove uro sphincter. 10.21 NA 5.21 0.74 NA 16.16 090
53447............... .............. A Remove/replace ur 13.47 NA 6.41 0.98 NA 20.86 090
sphincter.
53448............... .............. A Remov/replc ur 21.12 NA 9.03 1.51 NA 31.66 090
sphinctr comp.
53449............... .............. A Repair uro sphincter. 9.69 NA 4.77 0.65 NA 15.11 090
53450............... .............. A Revision of urethra.. 6.13 NA 3.35 0.44 NA 9.92 090
53460............... .............. A Revision of urethra.. 7.11 NA 3.75 0.53 NA 11.39 090
53500............... .............. A Urethrlys, transvag w/ 12.19 NA 6.19 0.91 NA 19.29 090
scope.
53502............... .............. A Repair of urethra 7.62 NA 4.06 0.63 NA 12.31 090
injury.
53505............... .............. A Repair of urethra 7.62 NA 3.92 0.55 NA 12.09 090
injury.
53510............... .............. A Repair of urethra 10.09 NA 5.23 0.74 NA 16.06 090
injury.
53515............... .............. A Repair of urethra 13.29 NA 5.98 0.95 NA 20.22 090
injury.
53520............... .............. A Repair of urethra 8.67 NA 4.53 0.64 NA 13.84 090
defect.
53600............... .............. A Dilate urethra 1.21 1.14 0.42 0.09 2.44 1.72 000
stricture.
53601............... .............. A Dilate urethra 0.98 1.26 0.37 0.07 2.31 1.42 000
stricture.
53605............... .............. A Dilate urethra 1.28 NA 0.41 0.09 NA 1.78 000
stricture.
53620............... .............. A Dilate urethra 1.62 1.99 0.59 0.12 3.73 2.33 000
stricture.
53621............... .............. A Dilate urethra 1.35 2.06 0.49 0.10 3.51 1.94 000
stricture.
53660............... .............. A Dilation of urethra.. 0.71 1.31 0.31 0.05 2.07 1.07 000
53661............... .............. A Dilation of urethra.. 0.72 1.30 0.29 0.05 2.07 1.06 000
53665............... .............. A Dilation of urethra.. 0.76 NA 0.25 0.06 NA 1.07 000
53850............... .............. A Prostatic microwave 9.44 94.10 3.94 0.67 104.21 14.05 090
thermotx.
53852............... .............. A Prostatic rf thermotx 9.87 88.49 4.37 0.70 99.06 14.94 090
[[Page 47633]]
53853............... .............. A Prostatic water 5.23 55.09 2.85 0.29 60.61 8.37 090
thermother.
54000............... .............. A Slitting of prepuce.. 1.54 2.91 0.93 0.11 4.56 2.58 010
54001............... .............. A Slitting of prepuce.. 2.19 3.18 1.11 0.16 5.53 3.46 010
54015............... .............. A Drain penis lesion... 5.31 NA 2.55 0.40 NA 8.26 010
54050............... .............. A Destruction, penis 1.24 1.67 1.04 0.10 3.01 2.38 010
lesion(s).
54055............... .............. A Destruction, penis 1.22 1.57 0.80 0.09 2.88 2.11 010
lesion(s).
54056............... .............. A Cryosurgery, penis 1.24 1.70 1.14 0.10 3.04 2.48 010
lesion(s).
54057............... .............. A Laser surg, penis 1.24 2.22 0.83 0.09 3.55 2.16 010
lesion(s).
54060............... .............. A Excision of penis 1.93 3.09 1.06 0.15 5.17 3.14 010
lesion(s).
54065............... .............. A Destruction, penis 2.42 2.63 1.23 0.19 5.24 3.84 010
lesion(s).
54100............... .............. A Biopsy of penis...... 1.90 2.82 0.82 0.15 4.87 2.87 000
54105............... .............. A Biopsy of penis...... 3.49 4.28 1.93 0.25 8.02 5.67 010
54110............... .............. A Treatment of penis 10.11 NA 4.75 0.74 NA 15.60 090
lesion.
54111............... .............. A Treat penis lesion, 13.55 NA 5.75 0.96 NA 20.26 090
graft.
54112............... .............. A Treat penis lesion, 15.84 NA 6.78 1.13 NA 23.75 090
graft.
54115............... .............. A Treatment of penis 6.14 4.37 3.45 0.44 10.95 10.03 090
lesion.
54120............... .............. A Partial removal of 9.96 NA 4.67 0.72 NA 15.35 090
penis.
54125............... .............. A Removal of penis..... 13.51 NA 5.82 0.99 NA 20.32 090
54130............... .............. A Remove penis & nodes. 20.11 NA 8.16 1.43 NA 29.70 090
54135............... .............. A Remove penis & nodes. 26.32 NA 10.15 1.87 NA 38.34 090
54150............... .............. A Circumcision......... 1.81 4.53 0.97 0.19 6.53 2.97 010
54152............... .............. A Circumcision......... 2.31 NA 1.20 0.19 NA 3.70 010
54160............... .............. A Circumcision......... 2.48 4.13 1.09 0.19 6.80 3.76 010
54161............... .............. A Circumcision......... 3.27 NA 1.56 0.24 NA 5.07 010
54162............... .............. A Lysis penil circumic 3.00 4.63 1.44 0.22 7.85 4.66 010
lesion.
54163............... .............. A Repair of 3.00 NA 2.00 0.22 NA 5.22 010
circumcision.
54164............... .............. A Frenulotomy of penis. 2.50 NA 1.83 0.18 NA 4.51 010
54200............... .............. A Treatment of penis 1.06 1.79 0.98 0.08 2.93 2.12 010
lesion.
54205............... .............. A Treatment of penis 7.92 NA 4.73 0.56 NA 13.21 090
lesion.
54220............... .............. A Treatment of penis 2.42 3.83 0.95 0.18 6.43 3.55 000
lesion.
54230............... .............. A Prepare penis study.. 1.34 1.08 0.63 0.10 2.52 2.07 000
54231............... .............. A Dynamic 2.04 1.38 0.87 0.15 3.57 3.06 000
cavernosometry.
54235............... .............. A Penile injection..... 1.19 0.96 0.58 0.09 2.24 1.86 000
54240............... .............. A Penis study.......... 1.31 1.01 NA 0.17 2.49 NA 000
54240............... 26............ A Penis study.......... 1.31 0.43 0.43 0.11 1.85 1.85 000
54240............... TC............ A Penis study.......... 0.00 0.59 NA 0.06 0.65 NA 000
54250............... .............. A Penis study.......... 2.22 0.92 NA 0.19 3.33 NA 000
54250............... 26............ A Penis study.......... 2.22 0.71 0.71 0.17 3.10 3.10 000
54250............... TC............ A Penis study.......... 0.00 0.21 NA 0.02 0.23 NA 000
54300............... .............. A Revision of penis.... 10.39 NA 5.65 0.74 NA 16.78 090
54304............... .............. A Revision of penis.... 12.47 NA 6.43 0.92 NA 19.82 090
54308............... .............. A Reconstruction of 11.81 NA 6.05 0.84 NA 18.70 090
urethra.
54312............... .............. A Reconstruction of 13.55 NA 7.07 0.96 NA 21.58 090
urethra.
54316............... .............. A Reconstruction of 16.79 NA 8.05 1.21 NA 26.05 090
urethra.
54318............... .............. A Reconstruction of 11.23 NA 5.88 0.80 NA 17.91 090
urethra.
54322............... .............. A Reconstruction of 12.99 NA 6.53 0.99 NA 20.51 090
urethra.
54324............... .............. A Reconstruction of 16.29 NA 8.10 1.48 NA 25.87 090
urethra.
54326............... .............. A Reconstruction of 15.70 NA 7.89 1.12 NA 24.71 090
urethra.
54328............... .............. A Revise penis/urethra. 15.63 NA 7.33 1.11 NA 24.07 090
54332............... .............. A Revise penis/urethra. 17.05 NA 7.82 1.21 NA 26.08 090
54336............... .............. A Revise penis/urethra. 20.01 NA 10.59 1.42 NA 32.02 090
54340............... .............. A Secondary urethral 8.90 NA 5.16 0.59 NA 14.65 090
surgery.
54344............... .............. A Secondary urethral 15.92 NA 7.86 1.13 NA 24.91 090
surgery.
54348............... .............. A Secondary urethral 17.12 NA 8.48 1.18 NA 26.78 090
surgery.
54352............... .............. A Reconstruct urethra/ 24.70 NA 11.36 1.81 NA 37.87 090
penis.
54360............... .............. A Penis plastic surgery 11.91 NA 6.08 0.86 NA 18.85 090
54380............... .............. A Repair penis......... 13.16 NA 6.78 1.00 NA 20.94 090
54385............... .............. A Repair penis......... 15.37 NA 8.57 1.20 NA 25.14 090
54390............... .............. A Repair penis and 21.58 NA 9.47 1.28 NA 32.33 090
bladder.
54400............... .............. A Insert semi-rigid 8.98 NA 4.40 0.65 NA 14.03 090
prosthesis.
54401............... .............. A Insert self-contd 10.26 NA 5.75 0.73 NA 16.74 090
prosthesis.
54405............... .............. A Insert multi-comp 13.41 NA 5.98 0.99 NA 20.38 090
penis pros.
54406............... .............. A Remove muti-comp 12.08 NA 5.41 0.88 NA 18.37 090
penis pros.
54408............... .............. A Repair multi-comp 12.73 NA 5.72 0.92 NA 19.37 090
penis pros.
54410............... .............. A Remove/replace penis 15.48 NA 6.61 1.13 NA 23.22 090
prosth.
54411............... .............. A Remov/replc penis 15.98 NA 7.02 1.17 NA 24.17 090
pros, comp.
54415............... .............. A Remove self-contd 8.19 NA 4.18 0.59 NA 12.96 090
penis pros.
54416............... .............. A Remv/repl penis 10.85 NA 5.36 0.79 NA 17.00 090
contain pros.
54417............... .............. A Remv/replc penis 14.17 NA 6.15 1.01 NA 21.33 090
pros, compl.
54420............... .............. A Revision of penis.... 11.40 NA 5.63 0.91 NA 17.94 090
54430............... .............. A Revision of penis.... 10.13 NA 5.16 0.73 NA 16.02 090
54435............... .............. A Revision of penis.... 6.11 NA 3.66 0.47 NA 10.24 090
54450............... .............. A Preputial stretching. 1.12 0.95 0.44 0.08 2.15 1.64 000
54500............... .............. A Biopsy of testis..... 1.31 0.60 0.56 0.11 2.02 1.98 000
54505............... .............. A Biopsy of testis..... 3.45 NA 1.91 0.28 NA 5.64 010
[[Page 47634]]
54512............... .............. A Excise lesion testis. 8.57 NA 4.12 0.65 NA 13.34 090
54520............... .............. A Removal of testis.... 5.22 NA 2.81 0.50 NA 8.53 090
54522............... .............. A Orchiectomy, partial. 9.49 NA 4.85 0.91 NA 15.25 090
54530............... .............. A Removal of testis.... 8.57 NA 4.26 0.68 NA 13.51 090
54535............... .............. A Extensive testis 12.14 NA 5.59 1.09 NA 18.82 090
surgery.
54550............... .............. A Exploration for 7.77 NA 3.84 0.63 NA 12.24 090
testis.
54560............... .............. A Exploration for 11.11 NA 5.20 0.96 NA 17.27 090
testis.
54600............... .............. A Reduce testis torsion 7.00 NA 3.57 0.53 NA 11.10 090
54620............... .............. A Suspension of testis. 4.89 NA 2.43 0.42 NA 7.74 010
54640............... .............. A Suspension of testis. 6.89 NA 3.76 0.63 NA 11.28 090
54650............... .............. A Orchiopexy (Fowler- 11.43 NA 5.45 1.41 NA 18.29 090
Stephens).
54660............... .............. A Revision of testis... 5.10 NA 3.01 0.40 NA 8.51 090
54670............... .............. A Repair testis injury. 6.40 NA 3.56 0.50 NA 10.46 090
54680............... .............. A Relocation of 12.63 NA 6.22 1.23 NA 20.08 090
testis(es).
54690............... .............. A Laparoscopy, 10.94 NA 4.99 1.23 NA 17.16 090
orchiectomy.
54692............... .............. A Laparoscopy, 12.86 NA 5.40 1.05 NA 19.31 090
orchiopexy.
54700............... .............. A Drainage of scrotum.. 3.42 NA 1.93 0.28 NA 5.63 010
54800............... .............. A Biopsy of epididymis. 2.33 0.94 0.89 0.22 3.49 3.44 000
54820............... .............. A Exploration of 5.13 NA 2.96 0.39 NA 8.48 090
epididymis.
54830............... .............. A Remove epididymis 5.37 NA 3.04 0.42 NA 8.83 090
lesion.
54840............... .............. A Remove epididymis 5.19 NA 2.80 0.37 NA 8.36 090
lesion.
54860............... .............. A Removal of epididymis 6.31 NA 3.33 0.46 NA 10.10 090
54861............... .............. A Removal of epididymis 8.89 NA 4.33 0.64 NA 13.86 090
54900............... .............. A Fusion of spermatic 13.18 NA 5.80 1.62 NA 20.60 090
ducts.
54901............... .............. A Fusion of spermatic 17.91 NA 7.55 1.28 NA 26.74 090
ducts.
55000............... .............. A Drainage of hydrocele 1.43 2.06 0.65 0.12 3.61 2.20 000
55040............... .............. A Removal of hydrocele. 5.35 NA 2.92 0.44 NA 8.71 090
55041............... .............. A Removal of hydroceles 7.73 NA 3.98 0.60 NA 12.31 090
55060............... .............. A Repair of hydrocele.. 5.51 NA 3.09 0.46 NA 9.06 090
55100............... .............. A Drainage of scrotum 2.13 3.67 1.56 0.17 5.97 3.86 010
abscess.
55110............... .............. A Explore scrotum...... 5.69 NA 3.12 0.45 NA 9.26 090
55120............... .............. A Removal of scrotum 5.08 NA 2.94 0.39 NA 8.41 090
lesion.
55150............... .............. A Removal of scrotum... 7.21 NA 3.83 0.58 NA 11.62 090
55175............... .............. A Revision of scrotum.. 5.23 NA 3.00 0.40 NA 8.63 090
55180............... .............. A Revision of scrotum.. 10.70 NA 5.34 0.85 NA 16.89 090
55200............... .............. A Incision of sperm 4.23 12.26 2.37 0.30 16.79 6.90 090
duct.
55250............... .............. A Removal of sperm 3.29 11.44 2.21 0.26 14.99 5.76 090
duct(s).
55300............... .............. A Prepare, sperm duct x- 3.50 NA 1.31 0.26 NA 5.07 000
ray.
55400............... .............. A Repair of sperm duct. 8.48 NA 4.05 0.74 NA 13.27 090
55450............... .............. A Ligation of sperm 4.11 6.96 1.86 0.29 11.36 6.26 010
duct.
55500............... .............. A Removal of hydrocele. 5.58 NA 3.11 0.55 NA 9.24 090
55520............... .............. A Removal of sperm cord 6.02 NA 3.28 0.73 NA 10.03 090
lesion.
55530............... .............. A Revise spermatic cord 5.65 NA 3.03 0.46 NA 9.14 090
veins.
55535............... .............. A Revise spermatic cord 6.55 NA 3.41 0.53 NA 10.49 090
veins.
55540............... .............. A Revise hernia & sperm 7.66 NA 3.83 0.94 NA 12.43 090
veins.
55550............... .............. A Laparo ligate 6.56 NA 3.29 0.66 NA 10.51 090
spermatic vein.
55600............... .............. A Incise sperm duct 6.37 NA 3.35 0.59 NA 10.31 090
pouch.
55605............... .............. A Incise sperm duct 7.95 NA 4.32 0.97 NA 13.24 090
pouch.
55650............... .............. A Remove sperm duct 11.78 NA 5.29 0.95 NA 18.02 090
pouch.
55680............... .............. A Remove sperm pouch 5.18 NA 2.98 0.47 NA 8.63 090
lesion.
55700............... .............. A Biopsy of prostate... 1.57 4.18 0.64 0.11 5.86 2.32 000
55705............... .............. A Biopsy of prostate... 4.56 NA 2.29 0.33 NA 7.18 010
55720............... .............. A Drainage of prostate 7.63 NA 3.88 0.55 NA 12.06 090
abscess.
55725............... .............. A Drainage of prostate 8.67 NA 4.55 0.74 NA 13.96 090
abscess.
55801............... .............. A Removal of prostate.. 17.77 NA 7.65 1.37 NA 26.79 090
55810............... .............. A Extensive prostate 22.55 NA 8.99 1.66 NA 33.20 090
surgery.
55812............... .............. A Extensive prostate 27.47 NA 11.03 2.22 NA 40.72 090
surgery.
55815............... .............. A Extensive prostate 30.41 NA 11.94 2.39 NA 44.74 090
surgery.
55821............... .............. A Removal of prostate.. 14.23 NA 6.24 1.05 NA 21.52 090
55831............... .............. A Removal of prostate.. 15.60 NA 6.69 1.16 NA 23.45 090
55840............... .............. A Extensive prostate 22.66 NA 9.33 1.68 NA 33.67 090
surgery.
55842............... .............. A Extensive prostate 24.34 NA 9.89 1.82 NA 36.05 090
surgery.
55845............... .............. A Extensive prostate 28.51 NA 10.99 2.13 NA 41.63 090
surgery.
55859............... .............. A Percut/needle insert, 12.50 NA 5.87 0.88 NA 19.25 090
pros.
55860............... .............. A Surgical exposure, 14.43 NA 6.45 0.99 NA 21.87 090
prostate.
55862............... .............. A Extensive prostate 18.36 NA 7.88 1.31 NA 27.55 090
surgery.
55865............... .............. A Extensive prostate 22.84 NA 9.29 1.73 NA 33.86 090
surgery.
55866............... .............. A Laparo radical 30.69 NA 11.68 1.68 NA 44.05 090
prostatectomy.
55870............... .............. A Electroejaculation... 2.58 1.53 1.08 0.17 4.28 3.83 000
55873............... .............. A Cryoablate prostate.. 19.44 NA 8.92 1.39 NA 29.75 090
56405............... .............. A I & D of vulva/ 1.44 1.33 1.14 0.17 2.94 2.75 010
perineum.
56420............... .............. A Drainage of gland 1.39 2.28 1.05 0.15 3.82 2.59 010
abscess.
56440............... .............. A Surgery for vulva 2.84 NA 1.71 0.34 NA 4.89 010
lesion.
56441............... .............. A Lysis of labial 1.97 1.81 1.42 0.19 3.97 3.58 010
lesion(s).
56501............... .............. A Destroy, vulva 1.53 1.78 1.25 0.18 3.49 2.96 010
lesions, sim.
[[Page 47635]]
56515............... .............. A Destroy vulva lesion/ 2.76 2.55 1.81 0.32 5.63 4.89 010
s compl.
56605............... .............. A Biopsy of vulva/ 1.10 1.08 0.46 0.13 2.31 1.69 000
perineum.
56606............... .............. A Biopsy of vulva/ 0.55 0.49 0.22 0.07 1.11 0.84 ZZZ
perineum.
56620............... .............. A Partial removal of 7.46 NA 4.83 0.89 NA 13.18 090
vulva.
56625............... .............. A Complete removal of 8.39 NA 5.39 1.00 NA 14.78 090
vulva.
56630............... .............. A Extensive vulva 12.34 NA 6.96 1.45 NA 20.75 090
surgery.
56631............... .............. A Extensive vulva 16.18 NA 8.98 1.92 NA 27.08 090
surgery.
56632............... .............. A Extensive vulva 20.26 NA 9.64 2.35 NA 32.25 090
surgery.
56633............... .............. A Extensive vulva 16.45 NA 8.71 1.93 NA 27.09 090
surgery.
56634............... .............. A Extensive vulva 17.85 NA 9.60 2.09 NA 29.54 090
surgery.
56637............... .............. A Extensive vulva 21.94 NA 11.24 2.56 NA 35.74 090
surgery.
56640............... .............. A Extensive vulva 22.14 NA 10.78 2.61 NA 35.53 090
surgery.
56700............... .............. A Partial removal of 2.52 NA 1.83 0.29 NA 4.64 010
hymen.
56720............... .............. A Incision of hymen.... 0.68 NA 0.51 0.08 NA 1.27 000
56740............... .............. A Remove vagina gland 4.56 NA 2.56 0.55 NA 7.67 010
lesion.
56800............... .............. A Repair of vagina..... 3.88 NA 2.18 0.44 NA 6.50 010
56805............... .............. A Repair clitoris...... 18.83 NA 9.38 2.08 NA 30.29 090
56810............... .............. A Repair of perineum... 4.12 NA 2.29 0.48 NA 6.89 010
56820............... .............. A Exam of vulva w/scope 1.50 1.32 0.65 0.11 2.93 2.26 000
56821............... .............. A Exam/biopsy of vulva 2.05 1.76 0.91 0.15 3.96 3.11 000
w/scope.
57000............... .............. A Exploration of vagina 2.97 NA 1.72 0.30 NA 4.99 010
57010............... .............. A Drainage of pelvic 6.02 NA 3.83 0.69 NA 10.54 090
abscess.
57020............... .............. A Drainage of pelvic 1.50 0.95 0.59 0.18 2.63 2.27 000
fluid.
57022............... .............. A I & d vaginal 2.56 NA 1.50 0.27 NA 4.33 010
hematoma, pp.
57023............... .............. A I & d vag hematoma, 4.74 NA 2.57 0.55 NA 7.86 010
non-ob.
57061............... .............. A Destroy vag lesions, 1.25 1.66 1.12 0.15 3.06 2.52 010
simple.
57065............... .............. A Destroy vag lesions, 2.61 2.30 1.68 0.31 5.22 4.60 010
complex.
57100............... .............. A Biopsy of vagina..... 1.20 1.09 0.48 0.14 2.43 1.82 000
57105............... .............. A Biopsy of vagina..... 1.69 1.79 1.43 0.20 3.68 3.32 010
57106............... .............. A Remove vagina wall, 6.35 NA 4.19 0.73 NA 11.27 090
partial.
57107............... .............. A Remove vagina tissue, 22.97 NA 10.45 2.67 NA 36.09 090
part.
57109............... .............. A Vaginectomy partial w/ 26.96 NA 11.28 3.10 NA 41.34 090
nodes.
57110............... .............. A Remove vagina wall, 14.27 NA 7.28 1.67 NA 23.22 090
complete.
57111............... .............. A Remove vagina tissue, 26.96 NA 12.58 2.95 NA 42.49 090
compl.
57112............... .............. A Vaginectomy w/nodes, 28.96 NA 12.12 2.61 NA 43.69 090
compl.
57120............... .............. A Closure of vagina.... 7.40 NA 4.62 0.87 NA 12.89 090
57130............... .............. A Remove vagina lesion. 2.43 2.16 1.54 0.27 4.86 4.24 010
57135............... .............. A Remove vagina lesion. 2.67 2.27 1.65 0.31 5.25 4.63 010
57150............... .............. A Treat vagina 0.55 1.10 0.21 0.07 1.72 0.83 000
infection.
57155............... .............. A Insert uteri tandems/ 6.26 NA 4.61 0.45 NA 11.32 090
ovoids.
57160............... .............. A Insert pessary/other 0.89 1.01 0.34 0.10 2.00 1.33 000
device.
57170............... .............. A Fitting of diaphragm/ 0.91 1.49 0.33 0.11 2.51 1.35 000
cap.
57180............... .............. A Treat vaginal 1.58 2.17 1.27 0.18 3.93 3.03 010
bleeding.
57200............... .............. A Repair of vagina..... 3.93 NA 2.89 0.45 NA 7.27 090
57210............... .............. A Repair vagina/ 5.16 NA 3.43 0.61 NA 9.20 090
perineum.
57220............... .............. A Revision of urethra.. 4.30 NA 3.10 0.50 NA 7.90 090
57230............... .............. A Repair of urethral 5.63 NA 3.40 0.57 NA 9.60 090
lesion.
57240............... .............. A Repair bladder & 6.06 NA 3.81 0.62 NA 10.49 090
vagina.
57250............... .............. A Repair rectum & 5.52 NA 3.57 0.64 NA 9.73 090
vagina.
57260............... .............. A Repair of vagina..... 8.26 NA 4.83 0.96 NA 14.05 090
57265............... .............. A Extensive repair of 11.32 NA 6.03 1.32 NA 18.67 090
vagina.
57268............... .............. A Repair of bowel bulge 6.75 NA 4.19 0.78 NA 11.72 090
57270............... .............. A Repair of bowel pouch 12.09 NA 6.24 1.39 NA 19.72 090
57280............... .............. A Suspension of vagina. 15.02 NA 7.35 1.65 NA 24.02 090
57282............... .............. A Repair of vaginal 8.85 NA 5.29 1.02 NA 15.16 090
prolapse.
57284............... .............. A Repair paravaginal 12.68 NA 7.13 1.44 NA 21.25 090
defect.
57287............... .............. A Revise/remove sling 10.69 NA 5.46 0.91 NA 17.06 090
repair.
57288............... .............. A Repair bladder defect 13.00 NA 5.90 1.14 NA 20.04 090
57289............... .............. A Repair bladder & 11.56 NA 6.03 1.17 NA 18.76 090
vagina.
57291............... .............. A Construction of 7.94 NA 4.92 0.94 NA 13.80 090
vagina.
57292............... .............. A Construct vagina with 13.07 NA 6.93 1.57 NA 21.57 090
graft.
57300............... .............. A Repair rectum-vagina 7.60 NA 4.29 0.88 NA 12.77 090
fistula.
57305............... .............. A Repair rectum-vagina 13.75 NA 6.26 1.67 NA 21.68 090
fistula.
57307............... .............. A Fistula repair & 15.91 NA 7.02 1.96 NA 24.89 090
colostomy.
57308............... .............. A Fistula repair, 9.93 NA 5.13 1.12 NA 16.18 090
transperine.
57310............... .............. A Repair urethrovaginal 6.77 NA 3.86 0.57 NA 11.20 090
lesion.
57311............... .............. A Repair urethrovaginal 7.97 NA 4.14 0.68 NA 12.79 090
lesion.
57320............... .............. A Repair bladder-vagina 8.00 NA 4.39 0.65 NA 13.04 090
lesion.
57330............... .............. A Repair bladder-vagina 12.33 NA 5.73 1.07 NA 19.13 090
lesion.
57335............... .............. A Repair vagina........ 18.70 NA 9.03 1.84 NA 29.57 090
57400............... .............. A Dilation of vagina... 2.27 NA 1.11 0.26 NA 3.64 000
57410............... .............. A Pelvic examination... 1.75 2.02 0.89 0.17 3.94 2.81 000
57415............... .............. A Remove vaginal 2.17 NA 1.43 0.23 NA 3.83 010
foreign body.
57420............... .............. A Exam of vagina w/ 1.60 1.36 0.67 0.11 3.07 2.38 000
scope.
57421............... .............. A Exam/biopsy of vag w/ 2.20 1.85 0.96 0.15 4.20 3.31 000
scope.
[[Page 47636]]
57425............... .............. A Laparoscopy, surg, 15.73 NA 6.63 1.74 NA 24.10 090
colpopexy.
57452............... .............. A Exam of cervix w/ 1.50 1.29 0.77 0.11 2.90 2.38 000
scope.
57454............... .............. A Bx/curett of cervix w/ 2.33 1.64 1.15 0.15 4.12 3.63 000
scope.
57455............... .............. A Biopsy of cervix w/ 1.99 1.72 0.87 0.15 3.86 3.01 000
scope.
57456............... .............. A Endocerv curettage w/ 1.85 1.65 0.82 0.15 3.65 2.82 000
scope.
57460............... .............. A Bx of cervix w/scope, 2.83 5.85 1.37 0.33 9.01 4.53 000
leep.
57461............... .............. A Conz of cervix w/ 3.43 6.11 1.47 0.33 9.87 5.23 000
scope, leep.
57500............... .............. A Biopsy of cervix..... 0.97 2.55 0.63 0.11 3.63 1.71 000
57505............... .............. A Endocervical 1.14 1.47 1.10 0.13 2.74 2.37 010
curettage.
57510............... .............. A Cauterization of 1.90 1.57 1.04 0.22 3.69 3.16 010
cervix.
57511............... .............. A Cryocautery of cervix 1.90 1.83 1.38 0.22 3.95 3.50 010
57513............... .............. A Laser surgery of 1.90 1.73 1.41 0.23 3.86 3.54 010
cervix.
57520............... .............. A Conization of cervix. 4.03 3.93 2.88 0.48 8.44 7.39 090
57522............... .............. A Conization of cervix. 3.35 3.15 2.46 0.40 6.90 6.21 090
57530............... .............. A Removal of cervix.... 4.78 NA 3.42 0.56 NA 8.76 090
57531............... .............. A Removal of cervix, 27.96 NA 13.18 3.29 NA 44.43 090
radical.
57540............... .............. A Removal of residual 12.20 NA 6.24 1.39 NA 19.83 090
cervix.
57545............... .............. A Remove cervix/repair 13.01 NA 6.67 1.57 NA 21.25 090
pelvis.
57550............... .............. A Removal of residual 5.52 NA 3.85 0.67 NA 10.04 090
cervix.
57555............... .............. A Remove cervix/repair 8.94 NA 5.11 1.08 NA 15.13 090
vagina.
57556............... .............. A Remove cervix, repair 8.36 NA 4.87 0.95 NA 14.18 090
bowel.
57700............... .............. A Revision of cervix... 3.54 NA 3.08 0.40 NA 7.02 090
57720............... .............. A Revision of cervix... 4.12 NA 3.14 0.49 NA 7.75 090
57800............... .............. A Dilation of cervical 0.77 0.76 0.47 0.09 1.62 1.33 000
canal.
57820............... .............. A D & c of residual 1.67 1.48 1.14 0.20 3.35 3.01 010
cervix.
58100............... .............. A Biopsy of uterus 1.53 1.32 0.72 0.18 3.03 2.43 000
lining.
58120............... .............. A Dilation and 3.27 2.30 1.87 0.39 5.96 5.53 010
curettage.
58140............... .............. A Myomectomy abdom 14.58 NA 7.10 1.77 NA 23.45 090
method.
58145............... .............. A Myomectomy vag method 8.03 NA 4.82 0.96 NA 13.81 090
58146............... .............. A Myomectomy abdom 18.97 NA 8.90 1.77 NA 29.64 090
complex.
58150............... .............. A Total hysterectomy... 15.22 NA 7.48 1.81 NA 24.51 090
58152............... .............. A Total hysterectomy... 20.57 NA 9.83 2.39 NA 32.79 090
58180............... .............. A Partial hysterectomy. 15.27 NA 7.44 1.83 NA 24.54 090
58200............... .............. A Extensive 21.56 NA 10.00 2.52 NA 34.08 090
hysterectomy.
58210............... .............. A Extensive 28.81 NA 13.20 3.31 NA 45.32 090
hysterectomy.
58240............... .............. A Removal of pelvis 38.33 NA 17.63 4.33 NA 60.29 090
contents.
58260............... .............. A Vaginal hysterectomy. 12.96 NA 6.68 1.54 NA 21.18 090
58262............... .............. A Vag hyst including t/ 14.75 NA 7.36 1.75 NA 23.86 090
o.
58263............... .............. A Vag hyst w/t/o & vag 16.04 NA 7.86 1.90 NA 25.80 090
repair.
58267............... .............. A Vag hyst w/urinary 17.01 NA 8.36 2.01 NA 27.38 090
repair.
58270............... .............. A Vag hyst w/enterocele 14.24 NA 7.05 1.69 NA 22.98 090
repair.
58275............... .............. A Hysterectomy/revise 15.74 NA 7.75 1.86 NA 25.35 090
vagina.
58280............... .............. A Hysterectomy/revise 16.98 NA 8.23 1.99 NA 27.20 090
vagina.
58285............... .............. A Extensive 22.23 NA 9.97 2.65 NA 34.85 090
hysterectomy.
58290............... .............. A Vag hyst complex..... 18.97 NA 9.10 1.48 NA 29.55 090
58291............... .............. A Vag hyst incl t/o, 20.76 NA 9.86 1.75 NA 32.37 090
complex.
58292............... .............. A Vag hyst t/o & 22.05 NA 10.34 1.90 NA 34.29 090
repair, compl.
58293............... .............. A Vag hyst w/uro 23.03 NA 10.66 2.01 NA 35.70 090
repair, compl.
58294............... .............. A Vag hyst w/ 20.25 NA 9.54 1.69 NA 31.48 090
enterocele, compl.
58301............... .............. A Remove intrauterine 1.27 1.32 0.48 0.14 2.73 1.89 000
device.
58321............... .............. A Artificial 0.92 1.15 0.37 0.11 2.18 1.40 000
insemination.
58322............... .............. A Artificial 1.10 1.21 0.42 0.13 2.44 1.65 000
insemination.
58323............... .............. A Sperm washing........ 0.23 0.53 0.09 0.03 0.79 0.35 000
58340............... .............. A Catheter for 0.88 3.16 0.65 0.09 4.13 1.62 000
hysterography.
58345............... .............. A Reopen fallopian tube 4.65 NA 2.43 0.33 NA 7.41 010
58346............... .............. A Insert heyman uteri 6.74 NA 3.93 0.79 NA 11.46 090
capsule.
58350............... .............. A Reopen fallopian tube 1.01 1.49 0.93 0.12 2.62 2.06 010
58353............... .............. A Endometr ablate, 3.55 35.73 2.04 0.42 39.70 6.01 010
thermal.
58400............... .............. A Suspension of uterus. 6.35 NA 3.96 0.75 NA 11.06 090
58410............... .............. A Suspension of uterus. 12.71 NA 6.46 1.37 NA 20.54 090
58520............... .............. A Repair of ruptured 11.90 NA 6.04 1.32 NA 19.26 090
uterus.
58540............... .............. A Revision of uterus... 14.62 NA 6.95 1.76 NA 23.33 090
58545............... .............. A Laparoscopic 14.58 NA 7.21 1.71 NA 23.50 090
myomectomy.
58546............... .............. A Laparo-myomectomy, 18.97 NA 9.05 1.71 NA 29.73 090
complex.
58550............... .............. A Laparo-asst vag 14.17 NA 7.28 1.70 NA 23.15 090
hysterectomy.
58552............... .............. A Laparo-vag hyst incl 15.98 NA 8.00 1.70 NA 25.68 090
t/o.
58553............... .............. A Laparo-vag hyst, 18.97 NA 8.93 1.54 NA 29.44 090
complex.
58554............... .............. A Laparo-vag hyst w/t/ 21.97 NA 10.41 1.54 NA 33.92 090
o, compl.
58555............... .............. A Hysteroscopy, dx, sep 3.33 2.19 1.55 0.40 5.92 5.28 000
proc.
58558............... .............. A Hysteroscopy, biopsy. 4.74 NA 2.17 0.57 NA 7.48 000
58559............... .............. A Hysteroscopy, lysis.. 6.16 NA 2.72 0.73 NA 9.61 000
58560............... .............. A Hysteroscopy, resect 6.99 NA 3.07 0.84 NA 10.90 000
septum.
58561............... .............. A Hysteroscopy, remove 9.99 NA 4.27 1.18 NA 15.44 000
myoma.
58562............... .............. A Hysteroscopy, remove 5.20 NA 2.34 0.62 NA 8.16 000
fb.
[[Page 47637]]
58563............... .............. A Hysteroscopy, 6.16 56.02 2.74 0.74 62.92 9.64 000
ablation.
58600............... .............. A Division of fallopian 5.59 NA 3.35 0.67 NA 9.61 090
tube.
58605............... .............. A Division of fallopian 4.99 NA 3.14 0.59 NA 8.72 090
tube.
58611............... .............. A Ligate oviduct(s) add- 1.45 NA 0.57 0.17 NA 2.19 ZZZ
on.
58615............... .............. A Occlude fallopian 3.89 NA 2.71 0.48 NA 7.08 010
tube(s).
58660............... .............. A Laparoscopy, lysis... 11.27 NA 5.25 1.38 NA 17.90 090
58661............... .............. A Laparoscopy, remove 11.03 NA 5.11 1.31 NA 17.45 010
adnexa.
58662............... .............. A Laparoscopy, excise 11.77 NA 5.78 1.42 NA 18.97 090
lesions.
58670............... .............. A Laparoscopy, tubal 5.59 NA 3.27 0.66 NA 9.52 090
cautery.
58671............... .............. A Laparoscopy, tubal 5.59 NA 3.28 0.67 NA 9.54 090
block.
58672............... .............. A Laparoscopy, 12.86 NA 6.21 1.49 NA 20.56 090
fimbrioplasty.
58673............... .............. A Laparoscopy, 13.72 NA 6.59 1.68 NA 21.99 090
salpingostomy.
58700............... .............. A Removal of fallopian 12.03 NA 5.99 1.47 NA 19.49 090
tube.
58720............... .............. A Removal of ovary/ 11.34 NA 5.79 1.36 NA 18.49 090
tube(s).
58740............... .............. A Revise fallopian 13.98 NA 7.13 1.68 NA 22.79 090
tube(s).
58750............... .............. A Repair oviduct....... 14.82 NA 7.37 1.72 NA 23.91 090
58752............... .............. A Revise ovarian 14.82 NA 6.96 1.82 NA 23.60 090
tube(s).
58760............... .............. A Remove tubal 13.11 NA 6.71 1.53 NA 21.35 090
obstruction.
58770............... .............. A Create new tubal 13.95 NA 6.91 1.52 NA 22.38 090
opening.
58800............... .............. A Drainage of ovarian 4.13 3.64 2.90 0.47 8.24 7.50 090
cyst(s).
58805............... .............. A Drainage of ovarian 5.87 NA 3.53 0.66 NA 10.06 090
cyst(s).
58820............... .............. A Drain ovary abscess, 4.21 NA 3.32 0.41 NA 7.94 090
open.
58822............... .............. A Drain ovary abscess, 10.11 NA 5.22 1.23 NA 16.56 090
percut.
58823............... .............. A Drain pelvic abscess, 3.37 21.77 1.12 0.25 25.39 4.74 000
percut.
58825............... .............. A Transposition, 10.96 NA 5.80 1.33 NA 18.09 090
ovary(s).
58900............... .............. A Biopsy of ovary(s)... 5.98 NA 3.59 0.70 NA 10.27 090
58920............... .............. A Partial removal of 11.34 NA 5.60 1.37 NA 18.31 090
ovary(s).
58925............... .............. A Removal of ovarian 11.34 NA 5.69 1.39 NA 18.42 090
cyst(s).
58940............... .............. A Removal of ovary(s).. 7.28 NA 4.12 0.88 NA 12.28 090
58943............... .............. A Removal of ovary(s).. 18.40 NA 8.73 2.19 NA 29.32 090
58950............... .............. A Resect ovarian 16.90 NA 8.48 2.01 NA 27.39 090
malignancy.
58951............... .............. A Resect ovarian 22.35 NA 10.52 2.62 NA 35.49 090
malignancy.
58952............... .............. A Resect ovarian 24.97 NA 11.83 2.96 NA 39.76 090
malignancy.
58953............... .............. A Tah, rad dissect for 31.95 NA 14.54 3.77 NA 50.26 090
debulk.
58954............... .............. A Tah rad debulk/lymph 34.95 NA 15.68 4.14 NA 54.77 090
remove.
58960............... .............. A Exploration of 14.63 NA 7.44 1.74 NA 23.81 090
abdomen.
58970............... .............. A Retrieval of oocyte.. 3.52 2.31 1.49 0.29 6.12 5.30 000
58976............... .............. A Transfer of embryo... 3.82 2.65 1.82 0.47 6.94 6.11 000
59000............... .............. A Amniocentesis, 1.30 2.08 0.67 0.31 3.69 2.28 000
diagnostic.
59001............... .............. A Amniocentesis, 3.00 NA 1.40 0.71 NA 5.11 000
therapeutic.
59012............... .............. A Fetal cord 3.44 NA 1.53 0.82 NA 5.79 000
puncture,prenatal.
59015............... .............. A Chorion biopsy....... 2.20 1.56 1.04 0.52 4.28 3.76 000
59020............... .............. A Fetal contract stress 0.66 0.78 NA 0.26 1.70 NA 000
test.
59020............... 26............ A Fetal contract stress 0.66 0.26 0.26 0.16 1.08 1.08 000
test.
59020............... TC............ A Fetal contract stress 0.00 0.52 NA 0.10 0.62 NA 000
test.
59025............... .............. A Fetal non-stress test 0.53 0.44 NA 0.15 1.12 NA 000
59025............... 26............ A Fetal non-stress test 0.53 0.21 0.21 0.13 0.87 0.87 000
59025............... TC............ A Fetal non-stress test 0.00 0.23 NA 0.02 0.25 NA 000
59030............... .............. A Fetal scalp blood 1.99 NA 0.77 0.47 NA 3.23 000
sample.
59050............... .............. A Fetal monitor w/ 0.89 NA 0.35 0.21 NA 1.45 XXX
report.
59051............... .............. A Fetal monitor/ 0.74 NA 0.29 0.18 NA 1.21 XXX
interpret only.
59070............... .............. A Transabdom amnioinfus 5.24 5.06 2.29 0.28 10.58 7.81 000
w/ us.
59072............... .............. A Umbilical cord occlud 8.99 NA 3.11 0.16 NA 12.26 000
w/ us.
59074............... .............. A Fetal fluid drainage 5.24 4.47 2.29 0.28 9.99 7.81 000
w/ us.
59076............... .............. A Fetal shunt 8.99 NA 3.11 0.16 NA 12.26 000
placement, w/ us.
59100............... .............. A Remove uterus lesion. 12.33 NA 6.46 2.93 NA 21.72 090
59120............... .............. A Treat ectopic 11.47 NA 6.24 2.73 NA 20.44 090
pregnancy.
59121............... .............. A Treat ectopic 11.65 NA 6.32 2.77 NA 20.74 090
pregnancy.
59130............... .............. A Treat ectopic 14.20 NA 4.86 1.96 NA 21.02 090
pregnancy.
59135............... .............. A Treat ectopic 13.86 NA 7.22 3.00 NA 24.08 090
pregnancy.
59136............... .............. A Treat ectopic 13.16 NA 6.61 2.85 NA 22.62 090
pregnancy.
59140............... .............. A Treat ectopic 5.45 2.20 2.20 1.30 8.95 8.95 090
pregnancy.
59150............... .............. A Treat ectopic 11.65 NA 6.02 2.77 NA 20.44 090
pregnancy.
59151............... .............. A Treat ectopic 11.47 NA 6.06 2.73 NA 20.26 090
pregnancy.
59160............... .............. A D & c after delivery. 2.71 3.29 2.13 0.64 6.64 5.48 010
59200............... .............. A Insert cervical 0.79 1.19 0.30 0.19 2.17 1.28 000
dilator.
59300............... .............. A Episiotomy or vaginal 2.41 2.20 0.95 0.57 5.18 3.93 000
repair.
59320............... .............. A Revision of cervix... 2.48 NA 1.24 0.59 NA 4.31 000
59325............... .............. A Revision of cervix... 4.06 NA 1.89 0.88 NA 6.83 000
59350............... .............. A Repair of uterus..... 4.94 NA 1.86 1.18 NA 7.98 000
59400............... .............. A Obstetrical care..... 23.03 NA 15.35 5.48 NA 43.86 MMM
59409............... .............. A Obstetrical care..... 13.48 NA 5.29 3.21 NA 21.98 MMM
59410............... .............. A Obstetrical care..... 14.76 NA 6.29 3.51 NA 24.56 MMM
59412............... .............. A Antepartum 1.71 NA 0.81 0.41 NA 2.93 MMM
manipulation.
59414............... .............. A Deliver placenta..... 1.61 NA 0.64 0.38 NA 2.63 MMM
[[Page 47638]]
59425............... .............. A Antepartum care only. 4.80 4.22 1.85 1.14 10.16 7.79 MMM
59426............... .............. A Antepartum care only. 8.27 7.58 3.21 1.97 17.82 13.45 MMM
59430............... .............. A Care after delivery.. 2.13 1.23 0.93 0.51 3.87 3.57 MMM
59510............... .............. A Cesarean delivery.... 26.18 NA 17.26 6.23 NA 49.67 MMM
59514............... .............. A Cesarean delivery 15.95 NA 6.19 3.79 NA 25.93 MMM
only.
59515............... .............. A Cesarean delivery.... 17.34 NA 7.81 4.13 NA 29.28 MMM
59525............... .............. A Remove uterus after 8.53 NA 3.29 2.03 NA 13.85 ZZZ
cesarean.
59610............... .............. A Vbac delivery........ 24.58 NA 15.89 5.85 NA 46.32 MMM
59612............... .............. A Vbac delivery only... 15.04 NA 6.03 3.58 NA 24.65 MMM
59614............... .............. A Vbac care after 16.32 NA 6.91 3.88 NA 27.11 MMM
delivery.
59618............... .............. A Attempted vbac 27.74 NA 18.29 6.60 NA 52.63 MMM
delivery.
59620............... .............. A Attempted vbac 17.50 NA 6.74 4.17 NA 28.41 MMM
delivery only.
59622............... .............. A Attempted vbac after 18.90 NA 8.61 4.50 NA 32.01 MMM
care.
59812............... .............. A Treatment of 4.00 NA 2.54 0.95 NA 7.49 090
miscarriage.
59820............... .............. A Care of miscarriage.. 4.00 4.43 3.56 0.95 9.38 8.51 090
59821............... .............. A Treatment of 4.46 4.26 3.40 1.06 9.78 8.92 090
miscarriage.
59830............... .............. A Treat uterus 6.10 NA 3.99 1.45 NA 11.54 090
infection.
59840............... .............. R Abortion............. 3.01 NA 2.12 0.72 NA 5.85 010
59841............... .............. R Abortion............. 5.23 2.56 2.56 1.25 9.04 9.04 010
59850............... .............. R Abortion............. 5.90 NA 3.25 1.28 NA 10.43 090
59851............... .............. R Abortion............. 5.92 NA 3.73 1.41 NA 11.06 090
59852............... .............. R Abortion............. 8.23 NA 5.05 1.79 NA 15.07 090
59855............... .............. R Abortion............. 6.11 NA 3.55 1.45 NA 11.11 090
59856............... .............. R Abortion............. 7.47 NA 4.05 1.62 NA 13.14 090
59857............... .............. R Abortion............. 9.28 NA 4.59 2.00 NA 15.87 090
59866............... .............. R Abortion (mpr)....... 3.99 NA 1.82 0.87 NA 6.68 000
59870............... .............. A Evacuate mole of 6.00 NA 4.42 1.43 NA 11.85 090
uterus.
59871............... .............. A Remove cerclage 2.13 1.74 1.13 0.51 4.38 3.77 000
suture.
60000............... .............. A Drain thyroid/tongue 1.76 1.94 1.73 0.14 3.84 3.63 010
cyst.
60001............... .............. A Aspirate/inject 0.97 1.43 0.33 0.08 2.48 1.38 000
thyriod cyst.
60100............... .............. A Biopsy of thyroid.... 1.56 1.40 0.53 0.10 3.06 2.19 000
60200............... .............. A Remove thyroid lesion 9.54 NA 6.08 1.01 NA 16.63 090
60210............... .............. A Partial thyroid 10.86 NA 5.72 1.24 NA 17.82 090
excision.
60212............... .............. A Partial thyroid 16.01 NA 7.75 1.59 NA 25.35 090
excision.
60220............... .............. A Partial removal of 11.88 NA 6.24 1.34 NA 19.46 090
thyroid.
60225............... .............. A Partial removal of 14.17 NA 7.48 1.65 NA 23.30 090
thyroid.
60240............... .............. A Removal of thyroid... 16.04 NA 7.68 1.84 NA 25.56 090
60252............... .............. A Removal of thyroid... 20.54 NA 10.20 2.28 NA 33.02 090
60254............... .............. A Extensive thyroid 26.95 NA 14.28 2.75 NA 43.98 090
surgery.
60260............... .............. A Repeat thyroid 17.44 NA 8.77 1.94 NA 28.15 090
surgery.
60270............... .............. A Removal of thyroid... 20.24 NA 10.56 2.27 NA 33.07 090
60271............... .............. A Removal of thyroid... 16.80 NA 8.70 1.83 NA 27.33 090
60280............... .............. A Remove thyroid duct 5.86 NA 4.78 0.53 NA 11.17 090
lesion.
60281............... .............. A Remove thyroid duct 8.52 NA 5.94 0.80 NA 15.26 090
lesion.
60500............... .............. A Explore parathyroid 16.21 NA 7.47 1.98 NA 25.66 090
glands.
60502............... .............. A Re-explore 20.32 NA 9.41 2.50 NA 32.23 090
parathyroids.
60505............... .............. A Explore parathyroid 21.46 NA 11.03 2.65 NA 35.14 090
glands.
60512............... .............. A Autotransplant 4.44 NA 1.62 0.54 NA 6.60 ZZZ
parathyroid.
60520............... .............. A Removal of thymus 16.78 NA 8.31 2.16 NA 27.25 090
gland.
60521............... .............. A Removal of thymus 18.84 NA 9.57 1.92 NA 30.33 090
gland.
60522............... .............. A Removal of thymus 23.06 NA 11.28 3.13 NA 37.47 090
gland.
60540............... .............. A Explore adrenal gland 17.00 NA 7.58 1.75 NA 26.33 090
60545............... .............. A Explore adrenal gland 19.85 NA 8.54 2.05 NA 30.44 090
60600............... .............. A Remove carotid body 17.90 NA 10.76 2.15 NA 30.81 090
lesion.
60605............... .............. A Remove carotid body 20.21 NA 12.59 2.45 NA 35.25 090
lesion.
60650............... .............. A Laparoscopy 19.97 NA 7.95 2.32 NA 30.24 090
adrenalectomy.
61000............... .............. A Remove cranial cavity 1.58 NA 0.96 0.17 NA 2.71 000
fluid.
61001............... .............. A Remove cranial cavity 1.49 NA 1.07 0.18 NA 2.74 000
fluid.
61020............... .............. A Remove brain cavity 1.51 NA 1.35 0.30 NA 3.16 000
fluid.
61026............... .............. A Injection into brain 1.69 NA 1.40 0.25 NA 3.34 000
canal.
61050............... .............. A Remove brain canal 1.51 NA 1.27 0.12 NA 2.90 000
fluid.
61055............... .............. A Injection into brain 2.10 NA 1.43 0.16 NA 3.69 000
canal.
61070............... .............. A Brain canal shunt 0.89 NA 1.03 0.14 NA 2.06 000
procedure.
61105............... .............. A Twist drill hole..... 5.13 NA 3.93 1.26 NA 10.32 090
61107............... .............. A Drill skull for 4.99 NA 2.52 1.24 NA 8.75 000
implantation.
61108............... .............. A Drill skull for 10.17 NA 7.13 2.53 NA 19.83 090
drainage.
61120............... .............. A Burr hole for 8.75 NA 5.99 2.04 NA 16.78 090
puncture.
61140............... .............. A Pierce skull for 15.88 NA 9.87 3.63 NA 29.38 090
biopsy.
61150............... .............. A Pierce skull for 17.54 NA 10.36 3.95 NA 31.85 090
drainage.
61151............... .............. A Pierce skull for 12.40 NA 7.81 2.97 NA 23.18 090
drainage.
61154............... .............. A Pierce skull & remove 14.97 NA 9.47 3.76 NA 28.20 090
clot.
61156............... .............. A Pierce skull for 16.30 NA 9.82 4.03 NA 30.15 090
drainage.
61210............... .............. A Pierce skull, implant 5.83 NA 2.91 1.45 NA 10.19 000
device.
61215............... .............. A Insert brain-fluid 4.88 NA 4.00 1.21 NA 10.09 090
device.
61250............... .............. A Pierce skull & 10.40 NA 6.84 2.15 NA 19.39 090
explore.
[[Page 47639]]
61253............... .............. A Pierce skull & 12.34 NA 7.72 2.01 NA 22.07 090
explore.
61304............... .............. A Open skull for 21.93 NA 12.83 4.96 NA 39.72 090
exploration.
61305............... .............. A Open skull for 26.57 NA 15.30 6.08 NA 47.95 090
exploration.
61312............... .............. A Open skull for 24.53 NA 15.03 5.60 NA 45.16 090
drainage.
61313............... .............. A Open skull for 24.89 NA 14.79 5.79 NA 45.47 090
drainage.
61314............... .............. A Open skull for 24.19 NA 13.03 5.53 NA 42.75 090
drainage.
61315............... .............. A Open skull for 27.64 NA 16.00 6.33 NA 49.97 090
drainage.
61316............... .............. A Implt cran bone flap 1.39 NA 0.60 0.52 NA 2.51 ZZZ
to abdo.
61320............... .............. A Open skull for 25.58 NA 14.74 5.81 NA 46.13 090
drainage.
61321............... .............. A Open skull for 28.46 NA 16.11 6.55 NA 51.12 090
drainage.
61322............... .............. A Decompressive 29.46 NA 15.68 6.02 NA 51.16 090
craniotomy.
61323............... .............. A Decompressive 30.95 NA 16.13 6.02 NA 53.10 090
lobectomy.
61330............... .............. A Decompress eye socket 23.29 NA 13.70 3.67 NA 40.66 090
61332............... .............. A Explore/biopsy eye 27.24 NA 15.57 4.76 NA 47.57 090
socket.
61333............... .............. A Explore orbit/remove 27.91 NA 15.55 3.55 NA 47.01 090
lesion.
61334............... .............. A Explore orbit/remove 18.24 NA 10.62 3.15 NA 32.01 090
object.
61340............... .............. A Subtemporal 18.63 NA 11.12 4.26 NA 34.01 090
decompression.
61343............... .............. A Incise skull (press 29.73 NA 16.81 6.70 NA 53.24 090
relief).
61345............... .............. A Relieve cranial 27.16 NA 15.40 5.70 NA 48.26 090
pressure.
61440............... .............. A Incise skull for 26.59 NA 14.21 6.88 NA 47.68 090
surgery.
61450............... .............. A Incise skull for 25.91 NA 14.28 5.43 NA 45.62 090
surgery.
61458............... .............. A Incise skull for 27.25 NA 15.50 6.24 NA 48.99 090
brain wound.
61460............... .............. A Incise skull for 28.35 NA 16.40 5.35 NA 50.10 090
surgery.
61470............... .............. A Incise skull for 26.02 NA 13.85 6.74 NA 46.61 090
surgery.
61480............... .............. A Incise skull for 26.45 NA 15.27 6.10 NA 47.82 090
surgery.
61490............... .............. A Incise skull for 25.62 NA 14.32 6.26 NA 46.20 090
surgery.
61500............... .............. A Removal of skull 17.89 NA 10.80 3.71 NA 32.40 090
lesion.
61501............... .............. A Remove infected skull 14.82 NA 9.21 3.00 NA 27.03 090
bone.
61510............... .............. A Removal of brain 28.41 NA 16.68 6.49 NA 51.58 090
lesion.
61512............... .............. A Remove brain lining 35.04 NA 19.66 8.06 NA 62.76 090
lesion.
61514............... .............. A Removal of brain 25.22 NA 14.42 6.01 NA 45.65 090
abscess.
61516............... .............. A Removal of brain 24.57 NA 14.27 5.43 NA 44.27 090
lesion.
61517............... .............. A Implt brain chemotx 1.38 NA 0.64 0.10 NA 2.12 ZZZ
add-on.
61518............... .............. A Removal of brain 37.26 NA 21.09 8.46 NA 66.81 090
lesion.
61519............... .............. A Remove brain lining 41.33 NA 22.64 9.61 NA 73.58 090
lesion.
61520............... .............. A Removal of brain 54.76 NA 30.31 10.02 NA 95.09 090
lesion.
61521............... .............. A Removal of brain 44.41 NA 24.21 9.76 NA 78.38 090
lesion.
61522............... .............. A Removal of brain 29.41 NA 16.42 6.78 NA 52.61 090
abscess.
61524............... .............. A Removal of brain 27.82 NA 15.67 6.02 NA 49.51 090
lesion.
61526............... .............. A Removal of brain 52.09 NA 29.46 7.10 NA 88.65 090
lesion.
61530............... .............. A Removal of brain 43.79 NA 25.06 5.67 NA 74.52 090
lesion.
61531............... .............. A Implant brain 14.61 NA 9.13 3.60 NA 27.34 090
electrodes.
61533............... .............. A Implant brain 19.68 NA 11.54 4.43 NA 35.65 090
electrodes.
61534............... .............. A Removal of brain 20.94 NA 12.10 5.32 NA 38.36 090
lesion.
61535............... .............. A Remove brain 11.61 NA 7.43 2.81 NA 21.85 090
electrodes.
61536............... .............. A Removal of brain 35.47 NA 19.78 7.56 NA 62.81 090
lesion.
61537............... .............. A Removal of brain 24.96 NA 14.72 6.05 NA 45.73 090
tissue.
61538............... .............. A Removal of brain 26.77 NA 15.31 6.05 NA 48.13 090
tissue.
61539............... .............. A Removal of brain 32.03 NA 17.77 7.41 NA 57.21 090
tissue.
61540............... .............. A Removal of brain 29.96 NA 17.23 7.41 NA 54.60 090
tissue.
61541............... .............. A Incision of brain 28.81 NA 16.20 6.10 NA 51.11 090
tissue.
61542............... .............. A Removal of brain 30.97 NA 17.82 7.83 NA 56.62 090
tissue.
61543............... .............. A Removal of brain 29.18 NA 16.39 6.58 NA 52.15 090
tissue.
61544............... .............. A Remove & treat brain 25.46 NA 13.84 5.73 NA 45.03 090
lesion.
61545............... .............. A Excision of brain 43.73 NA 24.21 10.03 NA 77.97 090
tumor.
61546............... .............. A Removal of pituitary 31.25 NA 17.49 7.15 NA 55.89 090
gland.
61548............... .............. A Removal of pituitary 21.50 NA 12.79 3.31 NA 37.60 090
gland.
61550............... .............. A Release of skull 14.63 NA 6.98 1.37 NA 22.98 090
seams.
61552............... .............. A Release of skull 19.53 NA 9.14 5.06 NA 33.73 090
seams.
61556............... .............. A Incise skull/sutures. 22.23 NA 11.37 5.12 NA 38.72 090
61557............... .............. A Incise skull/sutures. 22.35 NA 13.62 5.79 NA 41.76 090
61558............... .............. A Excision of skull/ 25.54 NA 14.18 3.15 NA 42.87 090
sutures.
61559............... .............. A Excision of skull/ 32.74 NA 19.30 2.01 NA 54.05 090
sutures.
61563............... .............. A Excision of skull 26.79 NA 15.25 5.75 NA 47.79 090
tumor.
61564............... .............. A Excision of skull 33.78 NA 18.27 8.28 NA 60.33 090
tumor.
61566............... .............. A Removal of brain 30.95 NA 17.75 6.05 NA 54.75 090
tissue.
61567............... .............. A Incision of brain 35.45 NA 20.66 6.49 NA 62.60 090
tissue.
61570............... .............. A Remove foreign body, 24.56 NA 13.90 5.07 NA 43.53 090
brain.
61571............... .............. A Incise skull for 26.35 NA 15.13 5.77 NA 47.25 090
brain wound.
61575............... .............. A Skull base/brainstem 34.31 NA 19.64 5.42 NA 59.37 090
surgery.
61576............... .............. A Skull base/brainstem 52.35 NA 34.69 5.80 NA 92.84 090
surgery.
61580............... .............. A Craniofacial 30.30 NA 25.50 3.37 NA 59.17 090
approach, skull.
61581............... .............. A Craniofacial 34.55 NA 23.42 3.30 NA 61.27 090
approach, skull.
61582............... .............. A Craniofacial 31.61 NA 27.28 6.96 NA 65.85 090
approach, skull.
61583............... .............. A Craniofacial 36.16 NA 25.08 8.12 NA 69.36 090
approach, skull.
[[Page 47640]]
61584............... .............. A Orbitocranial 34.60 NA 24.48 7.51 NA 66.59 090
approach/skull.
61585............... .............. A Orbitocranial 38.55 NA 26.44 7.50 NA 72.49 090
approach/skull.
61586............... .............. A Resect nasopharynx, 25.06 NA 22.52 4.95 NA 52.53 090
skull.
61590............... .............. A Infratemporal 41.72 NA 28.54 5.11 NA 75.37 090
approach/skull.
61591............... .............. A Infratemporal 43.61 NA 29.45 5.64 NA 78.70 090
approach/skull.
61592............... .............. A Orbitocranial 39.58 NA 26.46 8.93 NA 74.97 090
approach/skull.
61595............... .............. A Transtemporal 29.53 NA 22.27 3.81 NA 55.61 090
approach/skull.
61596............... .............. A Transcochlear 35.58 NA 24.37 4.83 NA 64.78 090
approach/skull.
61597............... .............. A Transcondylar 37.90 NA 22.96 8.56 NA 69.42 090
approach/skull.
61598............... .............. A Transpetrosal 33.36 NA 23.18 5.50 NA 62.04 090
approach/skull.
61600............... .............. A Resect/excise cranial 25.81 NA 19.72 3.60 NA 49.13 090
lesion.
61601............... .............. A Resect/excise cranial 27.85 NA 20.46 6.16 NA 54.47 090
lesion.
61605............... .............. A Resect/excise cranial 29.29 NA 21.89 2.90 NA 54.08 090
lesion.
61606............... .............. A Resect/excise cranial 38.77 NA 25.10 8.22 NA 72.09 090
lesion.
61607............... .............. A Resect/excise cranial 36.22 NA 23.74 6.58 NA 66.54 090
lesion.
61608............... .............. A Resect/excise cranial 42.04 NA 26.54 9.67 NA 78.25 090
lesion.
61609............... .............. A Transect artery, 9.88 NA 4.85 1.57 NA 16.30 ZZZ
sinus.
61610............... .............. A Transect artery, 29.63 NA 13.11 4.25 NA 46.99 ZZZ
sinus.
61611............... .............. A Transect artery, 7.41 NA 3.81 1.87 NA 13.09 ZZZ
sinus.
61612............... .............. A Transect artery, 27.84 NA 13.29 2.08 NA 43.21 ZZZ
sinus.
61613............... .............. A Remove aneurysm, 40.80 NA 26.22 8.76 NA 75.78 090
sinus.
61615............... .............. A Resect/excise lesion, 32.02 NA 22.66 5.07 NA 59.75 090
skull.
61616............... .............. A Resect/excise lesion, 43.27 NA 28.59 8.13 NA 79.99 090
skull.
61618............... .............. A Repair dura.......... 16.96 NA 10.46 3.42 NA 30.84 090
61619............... .............. A Repair dura.......... 20.68 NA 12.25 3.41 NA 36.34 090
61623............... .............. A Endovasc tempory 9.95 NA 4.07 0.60 NA 14.62 000
vessel occl.
61624............... .............. A Transcath occlusion, 20.12 NA 6.88 1.84 NA 28.84 000
cns.
61626............... .............. A Transcath occlusion, 16.60 NA 5.50 1.17 NA 23.27 000
non-cns.
61680............... .............. A Intracranial vessel 30.66 NA 17.44 7.03 NA 55.13 090
surgery.
61682............... .............. A Intracranial vessel 61.48 NA 32.20 14.22 NA 107.90 090
surgery.
61684............... .............. A Intracranial vessel 39.75 NA 21.99 9.24 NA 70.98 090
surgery.
61686............... .............. A Intracranial vessel 64.39 NA 34.70 14.04 NA 113.13 090
surgery.
61690............... .............. A Intracranial vessel 29.27 NA 16.72 7.58 NA 53.57 090
surgery.
61692............... .............. A Intracranial vessel 51.79 NA 27.47 11.64 NA 90.90 090
surgery.
61697............... .............. A Brain aneurysm repr, 50.44 NA 27.98 12.05 NA 90.47 090
complx.
61698............... .............. A Brain aneurysm repr, 48.34 NA 26.67 11.01 NA 86.02 090
complx.
61700............... .............. A Brain aneurysm repr, 50.44 NA 27.78 11.94 NA 90.16 090
simple.
61702............... .............. A Inner skull vessel 48.34 NA 26.02 11.56 NA 85.92 090
surgery.
61703............... .............. A Clamp neck artery.... 17.44 NA 10.48 3.72 NA 31.64 090
61705............... .............. A Revise circulation to 36.15 NA 19.24 8.11 NA 63.50 090
head.
61708............... .............. A Revise circulation to 35.25 NA 15.14 2.67 NA 53.06 090
head.
61710............... .............. A Revise circulation to 29.63 NA 13.63 3.78 NA 47.04 090
head.
61711............... .............. A Fusion of skull 36.28 NA 19.80 8.36 NA 64.44 090
arteries.
61720............... .............. A Incise skull/brain 16.74 NA 9.98 3.55 NA 30.27 090
surgery.
61735............... .............. A Incise skull/brain 20.40 NA 12.16 3.83 NA 36.39 090
surgery.
61750............... .............. A Incise skull/brain 18.17 NA 10.61 4.48 NA 33.26 090
biopsy.
61751............... .............. A Brain biopsy w/ct/mr 17.59 NA 10.82 4.34 NA 32.75 090
guide.
61760............... .............. A Implant brain 22.24 NA 8.73 5.49 NA 36.46 090
electrodes.
61770............... .............. A Incise skull for 21.41 NA 12.26 4.44 NA 38.11 090
treatment.
61790............... .............. A Treat trigeminal 10.84 NA 5.92 2.66 NA 19.42 090
nerve.
61791............... .............. A Treat trigeminal 14.59 NA 8.92 3.51 NA 27.02 090
tract.
61793............... .............. A Focus radiation beam. 17.21 NA 10.13 4.22 NA 31.56 090
61795............... .............. A Brain surgery using 4.03 NA 2.03 0.80 NA 6.86 ZZZ
computer.
61850............... .............. A Implant 12.37 NA 7.68 1.98 NA 22.03 090
neuroelectrodes.
61860............... .............. A Implant 20.84 NA 12.07 4.87 NA 37.78 090
neuroelectrodes.
61863............... .............. A Implant 18.97 NA 11.76 4.66 NA 35.39 090
neuroelectrode.
61864............... .............. A Implant 4.49 NA 2.27 4.66 NA 11.42 ZZZ
neuroelectrde, add-l.
61867............... .............. A Implant 31.29 NA 18.00 4.66 NA 53.95 090
neuroelectrode.
61868............... .............. A Implant 7.91 NA 4.01 4.66 NA 16.58 ZZZ
neuroelectrde, add-l.
61870............... .............. A Implant 14.92 NA 9.73 2.05 NA 26.70 090
neuroelectrodes.
61875............... .............. A Implant 15.04 NA 8.57 2.39 NA 26.00 090
neuroelectrodes.
61880............... .............. A Revise/remove 6.28 NA 4.59 1.50 NA 12.37 090
neuroelectrode.
61885............... .............. A Implant neurostim one 5.84 NA 5.31 1.35 NA 12.50 090
array.
61886............... .............. A Implant neurostim 7.99 NA 6.36 1.78 NA 16.13 090
arrays.
61888............... .............. A Revise/remove 5.06 NA 3.67 1.22 NA 9.95 010
neuroreceiver.
62000............... .............. A Treat skull fracture. 12.51 NA 5.50 1.28 NA 19.29 090
62005............... .............. A Treat skull fracture. 16.15 NA 8.79 3.26 NA 28.20 090
62010............... .............. A Treatment of head 19.78 NA 11.70 4.64 NA 36.12 090
injury.
62100............... .............. A Repair brain fluid 22.00 NA 12.80 4.71 NA 39.51 090
leakage.
62115............... .............. A Reduction of skull 21.63 NA 11.64 5.46 NA 38.73 090
defect.
62116............... .............. A Reduction of skull 23.55 NA 13.36 1.92 NA 38.83 090
defect.
62117............... .............. A Reduction of skull 26.56 NA 15.37 6.88 NA 48.81 090
defect.
62120............... .............. A Repair skull cavity 23.31 NA 18.61 2.64 NA 44.56 090
lesion.
62121............... .............. A Incise skull repair.. 21.55 NA 15.41 3.49 NA 40.45 090
62140............... .............. A Repair of skull 13.49 NA 8.33 3.02 NA 24.84 090
defect.
[[Page 47641]]
62141............... .............. A Repair of skull 14.89 NA 9.06 3.26 NA 27.21 090
defect.
62142............... .............. A Remove skull plate/ 10.77 NA 7.00 2.41 NA 20.18 090
flap.
62143............... .............. A Replace skull plate/ 13.03 NA 8.05 3.02 NA 24.10 090
flap.
62145............... .............. A Repair of skull & 18.79 NA 10.90 3.77 NA 33.46 090
brain.
62146............... .............. A Repair of skull with 16.10 NA 9.64 3.20 NA 28.94 090
graft.
62147............... .............. A Repair of skull with 19.31 NA 11.32 4.35 NA 34.98 090
graft.
62148............... .............. A Retr bone flap to fix 2.00 NA 0.86 0.52 NA 3.38 ZZZ
skull.
62160............... .............. A Neuroendoscopy add-on 3.00 NA 1.53 0.63 NA 5.16 ZZZ
62161............... .............. A Dissect brain w/scope 19.97 NA 12.08 4.46 NA 36.51 090
62162............... .............. A Remove colloid cyst w/ 25.21 NA 15.07 6.96 NA 47.24 090
scope.
62163............... .............. A Neuroendoscopy w/fb 15.48 NA 9.91 4.46 NA 29.85 090
removal.
62164............... .............. A Remove brain tumor w/ 27.46 NA 14.95 6.96 NA 49.37 090
scope.
62165............... .............. A Remove pituit tumor w/ 21.97 NA 13.34 4.38 NA 39.69 090
scope.
62180............... .............. A Establish brain 21.03 NA 12.29 4.55 NA 37.87 090
cavity shunt.
62190............... .............. A Establish brain 11.05 NA 7.09 2.67 NA 20.81 090
cavity shunt.
62192............... .............. A Establish brain 12.23 NA 7.63 2.79 NA 22.65 090
cavity shunt.
62194............... .............. A Replace/irrigate 5.02 NA 2.44 0.62 NA 8.08 010
catheter.
62200............... .............. A Establish brain 18.29 NA 10.85 4.45 NA 33.59 090
cavity shunt.
62201............... .............. A Brain cavity shunt w/ 14.84 NA 9.45 2.88 NA 27.17 090
scope.
62220............... .............. A Establish brain 12.98 NA 8.00 2.85 NA 23.83 090
cavity shunt.
62223............... .............. A Establish brain 12.85 NA 8.25 2.83 NA 23.93 090
cavity shunt.
62225............... .............. A Replace/irrigate 5.40 NA 4.10 1.32 NA 10.82 090
catheter.
62230............... .............. A Replace/revise brain 10.52 NA 6.49 2.40 NA 19.41 090
shunt.
62252............... .............. A Csf shunt reprogram.. 0.74 1.47 NA 0.20 2.41 NA XXX
62252............... 26............ A Csf shunt reprogram.. 0.74 0.37 0.37 0.18 1.29 1.29 XXX
62252............... TC............ A Csf shunt reprogram.. 0.00 1.10 NA 0.02 1.12 NA XXX
62256............... .............. A Remove brain cavity 6.59 NA 4.71 1.57 NA 12.87 090
shunt.
62258............... .............. A Replace brain cavity 14.52 NA 8.71 3.27 NA 26.50 090
shunt.
62263............... .............. A Epidural lysis mult 6.13 12.79 3.22 0.40 19.32 9.75 010
sessions.
62264............... .............. A Epidural lysis on 4.42 7.75 1.42 0.40 12.57 6.24 010
single day.
62268............... .............. A Drain spinal cord 4.73 11.63 2.14 0.31 16.67 7.18 000
cyst.
62269............... .............. A Needle biopsy, spinal 5.01 15.11 1.97 0.39 20.51 7.37 000
cord.
62270............... .............. A Spinal fluid tap, 1.13 2.98 0.56 0.08 4.19 1.77 000
diagnostic.
62272............... .............. A Drain cerebro spinal 1.35 3.60 0.71 0.17 5.12 2.23 000
fluid.
62273............... .............. A Treat epidural spine 2.15 2.73 0.72 0.14 5.02 3.01 000
lesion.
62280............... .............. A Treat spinal cord 2.63 6.99 1.01 0.23 9.85 3.87 010
lesion.
62281............... .............. A Treat spinal cord 2.66 5.70 0.90 0.18 8.54 3.74 010
lesion.
62282............... .............. A Treat spinal canal 2.33 8.43 0.92 0.17 10.93 3.42 010
lesion.
62284............... .............. A Injection for 1.54 5.02 0.68 0.13 6.69 2.35 000
myelogram.
62287............... .............. A Percutaneous 8.07 NA 5.55 0.69 NA 14.31 090
diskectomy.
62290............... .............. A Inject for spine disk 3.00 7.19 1.38 0.26 10.45 4.64 000
x-ray.
62291............... .............. A Inject for spine disk 2.91 5.99 1.23 0.28 9.18 4.42 000
x-ray.
62292............... .............. A Injection into disk 7.85 NA 4.49 0.84 NA 13.18 090
lesion.
62294............... .............. A Injection into spinal 11.81 NA 5.59 1.38 NA 18.78 090
artery.
62310............... .............. A Inject spine c/t..... 1.91 4.85 0.65 0.12 6.88 2.68 000
62311............... .............. A Inject spine l/s (cd) 1.54 4.94 0.60 0.10 6.58 2.24 000
62318............... .............. A Inject spine w/cath, 2.04 5.76 0.65 0.13 7.93 2.82 000
c/t.
62319............... .............. A Inject spine w/cath l/ 1.87 5.03 0.61 0.12 7.02 2.60 000
s (cd).
62350............... .............. A Implant spinal canal 6.86 NA 3.97 0.86 NA 11.69 090
cath.
62351............... .............. A Implant spinal canal 9.99 NA 7.12 1.88 NA 18.99 090
cath.
62355............... .............. A Remove spinal canal 5.44 NA 3.18 0.69 NA 9.31 090
catheter.
62360............... .............. A Insert spine infusion 2.62 NA 2.71 0.33 NA 5.66 090
device.
62361............... .............. A Implant spine 5.41 NA 3.94 0.69 NA 10.04 090
infusion pump.
62362............... .............. A Implant spine 7.03 NA 4.37 1.08 NA 12.48 090
infusion pump.
62365............... .............. A Remove spine infusion 5.41 NA 3.59 0.77 NA 9.77 090
device.
62367............... 26............ A Analyze spine 0.48 0.13 0.13 0.03 0.64 0.64 XXX
infusion pump.
62368............... 26............ A Analyze spine 0.75 0.19 0.19 0.06 1.00 1.00 XXX
infusion pump.
63001............... .............. A Removal of spinal 15.80 NA 9.50 3.30 NA 28.60 090
lamina.
63003............... .............. A Removal of spinal 15.93 NA 9.85 3.41 NA 29.19 090
lamina.
63005............... .............. A Removal of spinal 14.90 NA 9.96 2.77 NA 27.63 090
lamina.
63011............... .............. A Removal of spinal 14.50 NA 8.27 3.17 NA 25.94 090
lamina.
63012............... .............. A Removal of spinal 15.38 NA 10.11 3.04 NA 28.53 090
lamina.
63015............... .............. A Removal of spinal 19.32 NA 11.86 4.14 NA 35.32 090
lamina.
63016............... .............. A Removal of spinal 19.17 NA 11.77 4.03 NA 34.97 090
lamina.
63017............... .............. A Removal of spinal 15.92 NA 10.38 3.20 NA 29.50 090
lamina.
63020............... .............. A Neck spine disk 14.79 NA 9.66 3.29 NA 27.74 090
surgery.
63030............... .............. A Low back disk surgery 11.98 NA 8.41 2.43 NA 22.82 090
63035............... .............. A Spinal disk surgery 3.15 NA 1.59 0.67 NA 5.41 ZZZ
add-on.
63040............... .............. A Laminotomy, single 18.78 NA 11.49 4.07 NA 34.34 090
cervical.
63042............... .............. A Laminotomy, single 17.44 NA 11.32 3.58 NA 32.34 090
lumbar.
63045............... .............. A Removal of spinal 16.48 NA 10.34 3.47 NA 30.29 090
lamina.
63046............... .............. A Removal of spinal 15.78 NA 10.17 3.17 NA 29.12 090
lamina.
63047............... .............. A Removal of spinal 14.59 NA 9.88 2.77 NA 27.24 090
lamina.
63048............... .............. A Remove spinal lamina 3.26 NA 1.66 0.63 NA 5.55 ZZZ
add-on.
63055............... .............. A Decompress spinal 21.96 NA 13.12 4.73 NA 39.81 090
cord.
[[Page 47642]]
63056............... .............. A Decompress spinal 20.33 NA 12.54 4.07 NA 36.94 090
cord.
63057............... .............. A Decompress spine cord 5.25 NA 2.63 1.11 NA 8.99 ZZZ
add-on.
63064............... .............. A Decompress spinal 24.57 NA 14.41 5.05 NA 44.03 090
cord.
63066............... .............. A Decompress spine cord 3.26 NA 1.66 0.66 NA 5.58 ZZZ
add-on.
63075............... .............. A Neck spine disk 19.38 NA 12.07 3.95 NA 35.40 090
surgery.
63076............... .............. A Neck spine disk 4.04 NA 2.05 0.82 NA 6.91 ZZZ
surgery.
63077............... .............. A Spine disk surgery, 21.41 NA 12.77 3.41 NA 37.59 090
thorax.
63078............... .............. A Spine disk surgery, 3.28 NA 1.63 0.53 NA 5.44 ZZZ
thorax.
63081............... .............. A Removal of vertebral 23.69 NA 14.30 4.86 NA 42.85 090
body.
63082............... .............. A Remove vertebral body 4.36 NA 2.22 0.91 NA 7.49 ZZZ
add-on.
63085............... .............. A Removal of vertebral 26.88 NA 15.45 4.23 NA 46.56 090
body.
63086............... .............. A Remove vertebral body 3.19 NA 1.59 0.57 NA 5.35 ZZZ
add-on.
63087............... .............. A Removal of vertebral 35.52 NA 19.43 5.70 NA 60.65 090
body.
63088............... .............. A Remove vertebral body 4.32 NA 2.17 0.72 NA 7.21 ZZZ
add-on.
63090............... .............. A Removal of vertebral 28.12 NA 16.01 4.09 NA 48.22 090
body.
63091............... .............. A Remove vertebral body 3.03 NA 1.45 0.47 NA 4.95 ZZZ
add-on.
63101............... .............. A Removal of vertebral 31.95 NA 19.28 5.05 NA 56.28 090
body.
63102............... .............. A Removal of vertebral 31.95 NA 19.28 5.05 NA 56.28 090
body.
63103............... .............. A Remove vertebral body 3.89 NA 2.03 0.66 NA 6.58 ZZZ
add-on.
63170............... .............. A Incise spinal cord 19.80 NA 12.08 4.48 NA 36.36 090
tract(s).
63172............... .............. A Drainage of spinal 17.63 NA 10.90 4.06 NA 32.59 090
cyst.
63173............... .............. A Drainage of spinal 21.96 NA 13.06 4.95 NA 39.97 090
cyst.
63180............... .............. A Revise spinal cord 18.24 NA 11.24 2.46 NA 31.94 090
ligaments.
63182............... .............. A Revise spinal cord 20.47 NA 11.18 3.47 NA 35.12 090
ligaments.
63185............... .............. A Incise spinal column/ 15.02 NA 8.29 2.22 NA 25.53 090
nerves.
63190............... .............. A Incise spinal column/ 17.42 NA 10.34 3.35 NA 31.11 090
nerves.
63191............... .............. A Incise spinal column/ 17.51 NA 10.71 4.53 NA 32.75 090
nerves.
63194............... .............. A Incise spinal column 19.16 NA 11.93 3.82 NA 34.91 090
& cord.
63195............... .............. A Incise spinal column 18.81 NA 11.26 4.37 NA 34.44 090
& cord.
63196............... .............. A Incise spinal column 22.27 NA 13.60 5.62 NA 41.49 090
& cord.
63197............... .............. A Incise spinal column 21.08 NA 12.41 4.20 NA 37.69 090
& cord.
63198............... .............. A Incise spinal column 25.34 NA 8.58 6.40 NA 40.32 090
& cord.
63199............... .............. A Incise spinal column 26.85 NA 15.23 6.78 NA 48.86 090
& cord.
63200............... .............. A Release of spinal 19.15 NA 11.50 4.31 NA 34.96 090
cord.
63250............... .............. A Revise spinal cord 40.70 NA 19.92 8.81 NA 69.43 090
vessels.
63251............... .............. A Revise spinal cord 41.14 NA 22.57 9.46 NA 73.17 090
vessels.
63252............... .............. A Revise spinal cord 41.13 NA 22.22 9.52 NA 72.87 090
vessels.
63265............... .............. A Excise intraspinal 21.53 NA 12.76 4.85 NA 39.14 090
lesion.
63266............... .............. A Excise intraspinal 22.27 NA 13.18 4.89 NA 40.34 090
lesion.
63267............... .............. A Excise intraspinal 17.92 NA 11.07 3.79 NA 32.78 090
lesion.
63268............... .............. A Excise intraspinal 18.49 NA 10.38 3.01 NA 31.88 090
lesion.
63270............... .............. A Excise intraspinal 26.76 NA 15.46 5.94 NA 48.16 090
lesion.
63271............... .............. A Excise intraspinal 26.88 NA 15.56 6.38 NA 48.82 090
lesion.
63272............... .............. A Excise intraspinal 25.28 NA 14.68 5.41 NA 45.37 090
lesion.
63273............... .............. A Excise intraspinal 24.25 NA 14.33 6.05 NA 44.63 090
lesion.
63275............... .............. A Biopsy/excise spinal 23.64 NA 13.77 5.20 NA 42.61 090
tumor.
63276............... .............. A Biopsy/excise spinal 23.41 NA 13.67 5.16 NA 42.24 090
tumor.
63277............... .............. A Biopsy/excise spinal 20.80 NA 12.51 4.32 NA 37.63 090
tumor.
63278............... .............. A Biopsy/excise spinal 20.53 NA 12.38 4.07 NA 36.98 090
tumor.
63280............... .............. A Biopsy/excise spinal 28.31 NA 16.30 6.47 NA 51.08 090
tumor.
63281............... .............. A Biopsy/excise spinal 28.01 NA 16.16 6.41 NA 50.58 090
tumor.
63282............... .............. A Biopsy/excise spinal 26.35 NA 15.32 6.03 NA 47.70 090
tumor.
63283............... .............. A Biopsy/excise spinal 24.96 NA 14.65 5.64 NA 45.25 090
tumor.
63285............... .............. A Biopsy/excise spinal 35.95 NA 19.92 9.19 NA 65.06 090
tumor.
63286............... .............. A Biopsy/excise spinal 35.58 NA 19.88 8.10 NA 63.56 090
tumor.
63287............... .............. A Biopsy/excise spinal 36.64 NA 20.41 8.00 NA 65.05 090
tumor.
63290............... .............. A Biopsy/excise spinal 37.32 NA 20.57 9.00 NA 66.89 090
tumor.
63300............... .............. A Removal of vertebral 24.39 NA 14.29 4.92 NA 43.60 090
body.
63301............... .............. A Removal of vertebral 27.56 NA 15.54 5.21 NA 48.31 090
body.
63302............... .............. A Removal of vertebral 27.77 NA 15.83 5.11 NA 48.71 090
body.
63303............... .............. A Removal of vertebral 30.45 NA 16.89 4.99 NA 52.33 090
body.
63304............... .............. A Removal of vertebral 30.28 NA 17.26 6.03 NA 53.57 090
body.
63305............... .............. A Removal of vertebral 31.98 NA 18.03 5.92 NA 55.93 090
body.
63306............... .............. A Removal of vertebral 32.17 NA 17.78 6.13 NA 56.08 090
body.
63307............... .............. A Removal of vertebral 31.58 NA 16.79 4.80 NA 53.17 090
body.
63308............... .............. A Remove vertebral body 5.24 NA 2.60 1.15 NA 8.99 ZZZ
add-on.
63600............... .............. A Remove spinal cord 14.00 NA 5.41 1.29 NA 20.70 090
lesion.
63610............... .............. A Stimulation of spinal 8.72 59.95 2.25 0.55 69.22 11.52 000
cord.
63615............... .............. A Remove lesion of 16.26 NA 9.30 1.89 NA 27.45 090
spinal cord.
63650............... .............. A Implant 6.73 NA 3.19 0.54 NA 10.46 090
neuroelectrodes.
63655............... .............. A Implant 10.27 NA 6.90 2.07 NA 19.24 090
neuroelectrodes.
63660............... .............. A Revise/remove 6.15 NA 3.63 0.80 NA 10.58 090
neuroelectrode.
63685............... .............. A Implant neuroreceiver 7.03 NA 4.16 0.99 NA 12.18 090
63688............... .............. A Revise/remove 5.38 NA 3.57 0.85 NA 9.80 090
neuroreceiver.
63700............... .............. A Repair of spinal 16.51 NA 10.29 3.14 NA 29.94 090
herniation.
[[Page 47643]]
63702............... .............. A Repair of spinal 18.45 NA 11.05 3.43 NA 32.93 090
herniation.
63704............... .............. A Repair of spinal 21.15 NA 12.90 4.54 NA 38.59 090
herniation.
63706............... .............. A Repair of spinal 24.07 NA 13.58 5.45 NA 43.10 090
herniation.
63707............... .............. A Repair spinal fluid 11.24 NA 7.70 2.18 NA 21.12 090
leakage.
63709............... .............. A Repair spinal fluid 14.30 NA 9.39 2.77 NA 26.46 090
leakage.
63710............... .............. A Graft repair of spine 14.05 NA 9.04 3.02 NA 26.11 090
defect.
63740............... .............. A Install spinal shunt. 11.34 NA 7.35 2.44 NA 21.13 090
63741............... .............. A Install spinal shunt. 8.24 NA 4.76 1.69 NA 14.69 090
63744............... .............. A Revision of spinal 8.09 NA 5.26 1.54 NA 14.89 090
shunt.
63746............... .............. A Removal of spinal 6.42 NA 3.79 1.60 NA 11.81 090
shunt.
64400............... .............. A N block inj, 1.11 1.89 0.43 0.09 3.09 1.63 000
trigeminal.
64402............... .............. A N block inj, facial.. 1.25 1.62 0.60 0.08 2.95 1.93 000
64405............... .............. A N block inj, 1.32 1.46 0.46 0.09 2.87 1.87 000
occipital.
64408............... .............. A N block inj, vagus... 1.41 1.58 0.85 0.09 3.08 2.35 000
64410............... .............. A N block inj, phrenic. 1.43 2.52 0.47 0.09 4.04 1.99 000
64412............... .............. A N block inj, spinal 1.18 2.66 0.43 0.08 3.92 1.69 000
accessor.
64413............... .............. A N block inj, cervical 1.40 1.85 0.50 0.10 3.35 2.00 000
plexus.
64415............... .............. A N block inj, brachial 1.48 2.81 0.46 0.10 4.39 2.04 000
plexus.
64416............... .............. A N block cont infuse, 3.49 NA 0.79 0.10 NA 4.38 010
b plex.
64417............... .............. A N block inj, axillary 1.44 3.04 0.49 0.12 4.60 2.05 000
64418............... .............. A N block inj, 1.32 2.63 0.44 0.08 4.03 1.84 000
suprascapular.
64420............... .............. A N block inj, 1.18 3.98 0.42 0.08 5.24 1.68 000
intercost, sng.
64421............... .............. A N block inj, 1.68 6.19 0.52 0.12 7.99 2.32 000
intercost, mlt.
64425............... .............. A N block inj ilio-ing/ 1.75 1.65 0.54 0.14 3.54 2.43 000
hypogi.
64430............... .............. A N block inj, pudendal 1.46 2.51 0.55 0.11 4.08 2.12 000
64435............... .............. A N block inj, 1.45 2.52 0.69 0.17 4.14 2.31 000
paracervical.
64445............... .............. A N block inj, sciatic, 1.48 2.68 0.50 0.10 4.26 2.08 000
sng.
64446............... .............. A N blk inj, sciatic, 3.25 NA 1.01 0.10 NA 4.36 010
cont inf.
64447............... .............. A N block inj fem, 1.50 NA 0.43 0.10 NA 2.03 000
single.
64448............... .............. A N block inj fem, cont 3.00 NA 0.81 0.10 NA 3.91 010
inf.
64449............... .............. A N block inj, lumbar 3.00 NA 0.96 0.10 NA 4.06 010
plexus.
64450............... .............. A N block, other 1.27 1.24 0.48 0.10 2.61 1.85 000
peripheral.
64470............... .............. A Inj paravertebral c/t 1.85 7.29 0.72 0.14 9.28 2.71 000
64472............... .............. A Inj paravertebral c/t 1.29 2.35 0.34 0.09 3.73 1.72 ZZZ
add-on.
64475............... .............. A Inj paravertebral l/s 1.41 6.93 0.63 0.11 8.45 2.15 000
64476............... .............. A Inj paravertebral l/s 0.98 2.14 0.24 0.08 3.20 1.30 ZZZ
add-on.
64479............... .............. A Inj foramen epidural 2.20 7.56 0.89 0.16 9.92 3.25 000
c/t.
64480............... .............. A Inj foramen epidural 1.54 2.87 0.47 0.12 4.53 2.13 ZZZ
add-on.
64483............... .............. A Inj foramen epidural 1.90 7.95 0.83 0.12 9.97 2.85 000
l/s.
64484............... .............. A Inj foramen epidural 1.33 3.31 0.37 0.09 4.73 1.79 ZZZ
add-on.
64505............... .............. A N block, 1.36 1.25 0.66 0.09 2.70 2.11 000
spenopalatine gangl.
64508............... .............. A N block, carotid 1.12 3.39 0.74 0.09 4.60 1.95 000
sinus s/p.
64510............... .............. A N block, stellate 1.22 3.51 0.51 0.08 4.81 1.81 000
ganglion.
64517............... .............. A N block inj, hypogas 2.20 2.73 0.87 0.11 5.04 3.18 000
plxs.
64520............... .............. A N block, lumbar/ 1.35 5.21 0.55 0.09 6.65 1.99 000
thoracic.
64530............... .............. A N block inj, celiac 1.58 4.49 0.66 0.10 6.17 2.34 000
pelus.
64550............... .............. A Apply neurostimulator 0.18 0.28 0.05 0.01 0.47 0.24 000
64553............... .............. A Implant 2.31 2.83 1.85 0.23 5.37 4.39 010
neuroelectrodes.
64555............... .............. A Implant 2.27 3.11 1.20 0.23 5.61 3.70 010
neuroelectrodes.
64560............... .............. A Implant 2.36 2.66 1.30 0.24 5.26 3.90 010
neuroelectrodes.
64561............... .............. A Implant 6.73 30.03 2.82 0.51 37.27 10.06 010
neuroelectrodes.
64565............... .............. A Implant 1.76 3.30 1.26 0.10 5.16 3.12 010
neuroelectrodes.
64573............... .............. A Implant 7.49 NA 5.25 1.48 NA 14.22 090
neuroelectrodes.
64575............... .............. A Implant 4.34 NA 2.69 0.45 NA 7.48 090
neuroelectrodes.
64577............... .............. A Implant 4.61 NA 3.30 0.61 NA 8.52 090
neuroelectrodes.
64580............... .............. A Implant 4.11 NA 3.57 0.23 NA 7.91 090
neuroelectrodes.
64581............... .............. A Implant 13.48 NA 5.36 1.05 NA 19.89 090
neuroelectrodes.
64585............... .............. A Revise/remove 2.06 11.26 2.14 0.22 13.54 4.42 010
neuroelectrode.
64590............... .............. A Implant neuroreceiver 2.40 7.15 2.28 0.23 9.78 4.91 010
64595............... .............. A Revise/remove 1.73 10.42 1.93 0.22 12.37 3.88 010
neuroreceiver.
64600............... .............. A Injection treatment 3.44 9.36 1.66 0.33 13.13 5.43 010
of nerve.
64605............... .............. A Injection treatment 5.60 9.58 2.19 0.92 16.10 8.71 010
of nerve.
64610............... .............. A Injection treatment 7.15 8.92 3.71 1.35 17.42 12.21 010
of nerve.
64612............... .............. A Destroy nerve, face 1.96 2.48 1.32 0.12 4.56 3.40 010
muscle.
64613............... .............. A Destroy nerve, spine 1.96 2.90 1.22 0.12 4.98 3.30 010
muscle.
64614............... .............. A Destroy nerve, extrem 2.20 3.21 1.31 0.12 5.53 3.63 010
musc.
64620............... .............. A Injection treatment 2.84 5.13 1.34 0.20 8.17 4.38 010
of nerve.
64622............... .............. A Destr paravertebrl 3.00 7.82 1.38 0.21 11.03 4.59 010
nerve l/s.
64623............... .............. A Destr paravertebral n 0.99 2.98 0.22 0.07 4.04 1.28 ZZZ
add-on.
64626............... .............. A Destr paravertebrl 3.28 7.84 1.98 0.22 11.34 5.48 010
nerve c/t.
64627............... .............. A Destr paravertebral n 1.16 4.58 0.27 0.08 5.82 1.51 ZZZ
add-on.
64630............... .............. A Injection treatment 3.00 2.73 1.42 0.23 5.96 4.65 010
of nerve.
64640............... .............. A Injection treatment 2.76 4.19 1.85 0.19 7.14 4.80 010
of nerve.
64680............... .............. A Injection treatment 2.62 6.75 1.44 0.18 9.55 4.24 010
of nerve.
64681............... .............. A Injection treatment 3.54 9.36 2.06 0.19 13.09 5.79 010
of nerve.
[[Page 47644]]
64702............... .............. A Revise finger/toe 4.22 NA 3.86 0.60 NA 8.68 090
nerve.
64704............... .............. A Revise hand/foot 4.56 NA 3.31 0.47 NA 8.34 090
nerve.
64708............... .............. A Revise arm/leg nerve. 6.11 NA 4.87 0.92 NA 11.90 090
64712............... .............. A Revision of sciatic 7.74 NA 4.98 0.98 NA 13.70 090
nerve.
64713............... .............. A Revision of arm 10.98 NA 5.88 1.68 NA 18.54 090
nerve(s).
64714............... .............. A Revise low back 10.31 NA 4.23 1.04 NA 15.58 090
nerve(s).
64716............... .............. A Revision of cranial 6.30 NA 5.96 0.64 NA 12.90 090
nerve.
64718............... .............. A Revise ulnar nerve at 5.98 NA 5.98 1.03 NA 12.99 090
elbow.
64719............... .............. A Revise ulnar nerve at 4.84 NA 4.53 0.78 NA 10.15 090
wrist.
64721............... .............. A Carpal tunnel surgery 4.28 NA 5.35 0.72 NA 10.35 090
64722............... .............. A Relieve pressure on 4.69 NA 3.06 0.45 NA 8.20 090
nerve(s).
64726............... .............. A Release foot/toe 4.17 NA 2.80 0.40 NA 7.37 090
nerve.
64727............... .............. A Internal nerve 3.10 NA 1.50 0.49 NA 5.09 ZZZ
revision.
64732............... .............. A Incision of brow 4.40 NA 3.52 0.81 NA 8.73 090
nerve.
64734............... .............. A Incision of cheek 4.91 NA 4.05 0.95 NA 9.91 090
nerve.
64736............... .............. A Incision of chin 4.59 NA 4.03 0.64 NA 9.26 090
nerve.
64738............... .............. A Incision of jaw nerve 5.72 NA 4.61 1.24 NA 11.57 090
64740............... .............. A Incision of tongue 5.58 NA 5.11 0.57 NA 11.26 090
nerve.
64742............... .............. A Incision of facial 6.21 NA 4.70 0.57 NA 11.48 090
nerve.
64744............... .............. A Incise nerve, back of 5.23 NA 3.78 1.03 NA 10.04 090
head.
64746............... .............. A Incise diaphragm 5.92 NA 4.51 0.82 NA 11.25 090
nerve.
64752............... .............. A Incision of vagus 7.05 NA 4.30 0.89 NA 12.24 090
nerve.
64755............... .............. A Incision of stomach 13.50 NA 5.65 1.63 NA 20.78 090
nerves.
64760............... .............. A Incision of vagus 6.95 NA 3.48 0.79 NA 11.22 090
nerve.
64761............... .............. A Incision of pelvis 6.40 NA 3.54 0.45 NA 10.39 090
nerve.
64763............... .............. A Incise hip/thigh 6.92 NA 5.23 0.98 NA 13.13 090
nerve.
64766............... .............. A Incise hip/thigh 8.66 NA 5.26 1.11 NA 15.03 090
nerve.
64771............... .............. A Sever cranial nerve.. 7.34 NA 5.56 1.04 NA 13.94 090
64772............... .............. A Incision of spinal 7.20 NA 4.93 1.25 NA 13.38 090
nerve.
64774............... .............. A Remove skin nerve 5.16 NA 3.83 0.63 NA 9.62 090
lesion.
64776............... .............. A Remove digit nerve 5.11 NA 3.70 0.66 NA 9.47 090
lesion.
64778............... .............. A Digit nerve surgery 3.11 NA 1.50 0.46 NA 5.07 ZZZ
add-on.
64782............... .............. A Remove limb nerve 6.22 NA 3.77 0.71 NA 10.70 090
lesion.
64783............... .............. A Limb nerve surgery 3.71 NA 1.83 0.52 NA 6.06 ZZZ
add-on.
64784............... .............. A Remove nerve lesion.. 9.81 NA 6.60 1.39 NA 17.80 090
64786............... .............. A Remove sciatic nerve 15.44 NA 9.84 2.52 NA 27.80 090
lesion.
64787............... .............. A Implant nerve end.... 4.29 NA 2.11 0.56 NA 6.96 ZZZ
64788............... .............. A Remove skin nerve 4.60 NA 3.48 0.64 NA 8.72 090
lesion.
64790............... .............. A Removal of nerve 11.29 NA 7.20 1.76 NA 20.25 090
lesion.
64792............... .............. A Removal of nerve 14.90 NA 8.82 2.29 NA 26.01 090
lesion.
64795............... .............. A Biopsy of nerve...... 3.01 NA 1.58 0.50 NA 5.09 000
64802............... .............. A Remove sympathetic 9.14 NA 5.15 1.17 NA 15.46 090
nerves.
64804............... .............. A Remove sympathetic 14.62 NA 7.17 1.99 NA 23.78 090
nerves.
64809............... .............. A Remove sympathetic 13.65 NA 5.77 1.79 NA 21.21 090
nerves.
64818............... .............. A Remove sympathetic 10.28 NA 5.29 1.32 NA 16.89 090
nerves.
64820............... .............. A Remove sympathetic 10.35 NA 7.14 1.54 NA 19.03 090
nerves.
64821............... .............. A Remove sympathetic 8.74 NA 7.33 1.38 NA 17.45 090
nerves.
64822............... .............. A Remove sympathetic 8.74 NA 7.22 1.33 NA 17.29 090
nerves.
64823............... .............. A Remove sympathetic 10.35 NA 8.13 1.58 NA 20.06 090
nerves.
64831............... .............. A Repair of digit nerve 9.43 NA 7.08 1.40 NA 17.91 090
64832............... .............. A Repair nerve add-on.. 5.65 NA 2.93 0.83 NA 9.41 ZZZ
64834............... .............. A Repair of hand or 10.17 NA 7.09 1.57 NA 18.83 090
foot nerve.
64835............... .............. A Repair of hand or 10.92 NA 7.70 1.61 NA 20.23 090
foot nerve.
64836............... .............. A Repair of hand or 10.92 NA 7.67 1.63 NA 20.22 090
foot nerve.
64837............... .............. A Repair nerve add-on.. 6.25 NA 3.22 0.95 NA 10.42 ZZZ
64840............... .............. A Repair of leg nerve.. 13.00 NA 8.25 1.44 NA 22.69 090
64856............... .............. A Repair/transpose 13.78 NA 9.18 2.06 NA 25.02 090
nerve.
64857............... .............. A Repair arm/leg nerve. 14.47 NA 9.63 2.22 NA 26.32 090
64858............... .............. A Repair sciatic nerve. 16.47 NA 10.77 2.98 NA 30.22 090
64859............... .............. A Nerve surgery........ 4.25 NA 2.19 0.59 NA 7.03 ZZZ
64861............... .............. A Repair of arm nerves. 19.21 NA 11.78 4.24 NA 35.23 090
64862............... .............. A Repair of low back 19.41 NA 11.93 2.98 NA 34.32 090
nerves.
64864............... .............. A Repair of facial 12.53 NA 8.75 1.35 NA 22.63 090
nerve.
64865............... .............. A Repair of facial 15.22 NA 13.44 1.82 NA 30.48 090
nerve.
64866............... .............. A Fusion of facial/ 15.72 NA 13.10 1.63 NA 30.45 090
other nerve.
64868............... .............. A Fusion of facial/ 14.02 NA 11.39 1.64 NA 27.05 090
other nerve.
64870............... .............. A Fusion of facial/ 15.97 NA 8.72 0.80 NA 25.49 090
other nerve.
64872............... .............. A Subsequent repair of 1.99 NA 1.08 0.28 NA 3.35 ZZZ
nerve.
64874............... .............. A Repair & revise nerve 2.98 NA 1.53 0.41 NA 4.92 ZZZ
add-on.
64876............... .............. A Repair nerve/shorten 3.37 NA 1.27 0.47 NA 5.11 ZZZ
bone.
64885............... .............. A Nerve graft, head or 17.50 NA 11.59 1.69 NA 30.78 090
neck.
64886............... .............. A Nerve graft, head or 20.72 NA 13.52 2.06 NA 36.30 090
neck.
64890............... .............. A Nerve graft, hand or 15.13 NA 9.99 2.24 NA 27.36 090
foot.
64891............... .............. A Nerve graft, hand or 16.12 NA 7.60 1.38 NA 25.10 090
foot.
64892............... .............. A Nerve graft, arm or 14.63 NA 8.87 1.97 NA 25.47 090
leg.
[[Page 47645]]
64893............... .............. A Nerve graft, arm or 15.58 NA 9.87 2.28 NA 27.73 090
leg.
64895............... .............. A Nerve graft, hand or 19.22 NA 9.65 2.43 NA 31.30 090
foot.
64896............... .............. A Nerve graft, hand or 20.46 NA 11.00 1.97 NA 33.43 090
foot.
64897............... .............. A Nerve graft, arm or 18.21 NA 10.69 2.61 NA 31.51 090
leg.
64898............... .............. A Nerve graft, arm or 19.47 NA 11.79 2.14 NA 33.40 090
leg.
64901............... .............. A Nerve graft add-on... 10.20 NA 5.25 1.22 NA 16.67 ZZZ
64902............... .............. A Nerve graft add-on... 11.81 NA 5.95 1.43 NA 19.19 ZZZ
64905............... .............. A Nerve pedicle 14.00 NA 8.50 1.53 NA 24.03 090
transfer.
64907............... .............. A Nerve pedicle 18.80 NA 12.50 2.16 NA 33.46 090
transfer.
65091............... .............. A Revise eye........... 6.45 NA 8.37 0.34 NA 15.16 090
65093............... .............. A Revise eye with 6.86 NA 8.73 0.36 NA 15.95 090
implant.
65101............... .............. A Removal of eye....... 7.02 NA 9.55 0.37 NA 16.94 090
65103............... .............. A Remove eye/insert 7.56 NA 9.75 0.39 NA 17.70 090
implant.
65105............... .............. A Remove eye/attach 8.48 NA 10.48 0.44 NA 19.40 090
implant.
65110............... .............. A Removal of eye....... 13.93 NA 13.66 0.86 NA 28.45 090
65112............... .............. A Remove eye/revise 16.36 NA 16.08 0.98 NA 33.42 090
socket.
65114............... .............. A Remove eye/revise 17.50 NA 16.31 1.07 NA 34.88 090
socket.
65125............... .............. A Revise ocular implant 3.12 8.84 3.59 0.18 12.14 6.89 090
65130............... .............. A Insert ocular implant 7.14 NA 9.18 0.38 NA 16.70 090
65135............... .............. A Insert ocular implant 7.32 NA 9.32 0.38 NA 17.02 090
65140............... .............. A Attach ocular implant 8.01 NA 9.88 0.43 NA 18.32 090
65150............... .............. A Revise ocular implant 6.25 NA 7.99 0.35 NA 14.59 090
65155............... .............. A Reinsert ocular 8.65 NA 10.48 0.50 NA 19.63 090
implant.
65175............... .............. A Removal of ocular 6.27 NA 8.49 0.34 NA 15.10 090
implant.
65205............... .............. A Remove foreign body 0.71 0.64 0.30 0.04 1.39 1.05 000
from eye.
65210............... .............. A Remove foreign body 0.84 0.81 0.38 0.04 1.69 1.26 000
from eye.
65220............... .............. A Remove foreign body 0.71 0.65 0.29 0.05 1.41 1.05 000
from eye.
65222............... .............. A Remove foreign body 0.93 0.89 0.38 0.05 1.87 1.36 000
from eye.
65235............... .............. A Remove foreign body 7.56 NA 6.74 0.38 NA 14.68 090
from eye.
65260............... .............. A Remove foreign body 10.94 NA 9.65 0.56 NA 21.15 090
from eye.
65265............... .............. A Remove foreign body 12.57 NA 10.63 0.66 NA 23.86 090
from eye.
65270............... .............. A Repair of eye wound.. 1.90 5.24 1.39 0.10 7.24 3.39 010
65272............... .............. A Repair of eye wound.. 3.81 7.73 3.29 0.20 11.74 7.30 090
65273............... .............. A Repair of eye wound.. 4.35 NA 3.57 0.25 NA 8.17 090
65275............... .............. A Repair of eye wound.. 5.33 6.33 3.95 0.30 11.96 9.58 090
65280............... .............. A Repair of eye wound.. 7.65 NA 6.23 0.39 NA 14.27 090
65285............... .............. A Repair of eye wound.. 12.88 NA 9.20 0.65 NA 22.73 090
65286............... .............. A Repair of eye wound.. 5.50 11.17 4.62 0.28 16.95 10.40 090
65290............... .............. A Repair of eye socket 5.40 NA 4.73 0.36 NA 10.49 090
wound.
65400............... .............. A Removal of eye lesion 6.05 8.33 6.12 0.30 14.68 12.47 090
65410............... .............. A Biopsy of cornea..... 1.47 2.11 0.97 0.07 3.65 2.51 000
65420............... .............. A Removal of eye lesion 4.16 8.86 4.44 0.21 13.23 8.81 090
65426............... .............. A Removal of eye lesion 5.24 10.19 4.92 0.26 15.69 10.42 090
65430............... .............. A Corneal smear........ 1.47 1.29 0.98 0.07 2.83 2.52 000
65435............... .............. A Curette/treat cornea. 0.92 1.00 0.71 0.05 1.97 1.68 000
65436............... .............. A Curette/treat cornea. 4.18 4.10 3.67 0.21 8.49 8.06 090
65450............... .............. A Treatment of corneal 3.27 4.03 3.86 0.17 7.47 7.30 090
lesion.
65600............... .............. A Revision of cornea... 3.39 5.49 3.03 0.17 9.05 6.59 090
65710............... .............. A Corneal transplant... 12.33 NA 11.43 0.62 NA 24.38 090
65730............... .............. A Corneal transplant... 14.23 NA 11.83 0.71 NA 26.77 090
65750............... .............. A Corneal transplant... 14.98 NA 12.29 0.75 NA 28.02 090
65755............... .............. A Corneal transplant... 14.87 NA 12.22 0.74 NA 27.83 090
65770............... .............. A Revise cornea with 17.53 NA 13.20 0.87 NA 31.60 090
implant.
65772............... .............. A Correction of 4.28 5.53 4.13 0.21 10.02 8.62 090
astigmatism.
65775............... .............. A Correction of 5.78 NA 6.25 0.29 NA 12.32 090
astigmatism.
65780............... .............. A Ocular reconst, 10.23 NA 10.30 0.45 NA 20.98 090
transplant.
65781............... .............. A Ocular reconst, 17.64 NA 13.67 0.45 NA 31.76 090
transplant.
65782............... .............. A Ocular reconst, 14.98 NA 11.99 0.45 NA 27.42 090
transplant.
65800............... .............. A Drainage of eye...... 1.91 1.79 1.18 0.10 3.80 3.19 000
65805............... .............. A Drainage of eye...... 1.91 2.17 1.18 0.10 4.18 3.19 000
65810............... .............. A Drainage of eye...... 4.86 NA 4.70 0.25 NA 9.81 090
65815............... .............. A Drainage of eye...... 5.04 10.02 4.81 0.26 15.32 10.11 090
65820............... .............. A Relieve inner eye 8.12 NA 9.06 0.42 NA 17.60 090
pressure.
65850............... .............. A Incision of eye...... 10.50 NA 8.44 0.52 NA 19.46 090
65855............... .............. A Laser surgery of eye. 3.84 4.32 3.10 0.19 8.35 7.13 010
65860............... .............. A Incise inner eye 3.54 4.05 2.50 0.18 7.77 6.22 090
adhesions.
65865............... .............. A Incise inner eye 5.59 NA 5.63 0.28 NA 11.50 090
adhesions.
65870............... .............. A Incise inner eye 6.26 NA 6.41 0.31 NA 12.98 090
adhesions.
65875............... .............. A Incise inner eye 6.53 NA 6.80 0.33 NA 13.66 090
adhesions.
65880............... .............. A Incise inner eye 7.08 NA 7.04 0.35 NA 14.47 090
adhesions.
65900............... .............. A Remove eye lesion.... 10.91 NA 10.42 0.56 NA 21.89 090
65920............... .............. A Remove implant of eye 8.39 NA 8.17 0.42 NA 16.98 090
65930............... .............. A Remove blood clot 7.43 NA 6.84 0.37 NA 14.64 090
from eye.
66020............... .............. A Injection treatment 1.59 3.13 1.43 0.08 4.80 3.10 010
of eye.
66030............... .............. A Injection treatment 1.25 2.97 1.28 0.06 4.28 2.59 010
of eye.
[[Page 47646]]
66130............... .............. A Remove eye lesion.... 7.68 9.64 5.60 0.39 17.71 13.67 090
66150............... .............. A Glaucoma surgery..... 8.29 NA 9.41 0.44 NA 18.14 090
66155............... .............. A Glaucoma surgery..... 8.28 NA 9.37 0.43 NA 18.08 090
66160............... .............. A Glaucoma surgery..... 10.15 NA 10.20 0.52 NA 20.87 090
66165............... .............. A Glaucoma surgery..... 8.00 NA 9.24 0.42 NA 17.66 090
66170............... .............. A Glaucoma surgery..... 12.14 NA 12.23 0.61 NA 24.98 090
66172............... .............. A Incision of eye...... 15.02 NA 15.21 0.75 NA 30.98 090
66180............... .............. A Implant eye shunt.... 14.53 NA 10.76 0.73 NA 26.02 090
66185............... .............. A Revise eye shunt..... 8.13 NA 7.38 0.41 NA 15.92 090
66220............... .............. A Repair eye lesion.... 7.76 NA 7.11 0.41 NA 15.28 090
66225............... .............. A Repair/graft eye 11.03 NA 8.73 0.55 NA 20.31 090
lesion.
66250............... .............. A Follow-up surgery of 5.97 11.71 5.48 0.30 17.98 11.75 090
eye.
66500............... .............. A Incision of iris..... 3.70 NA 4.65 0.19 NA 8.54 090
66505............... .............. A Incision of iris..... 4.07 NA 4.99 0.20 NA 9.26 090
66600............... .............. A Remove iris and 8.67 NA 8.23 0.44 NA 17.34 090
lesion.
66605............... .............. A Removal of iris...... 12.77 NA 10.02 0.79 NA 23.58 090
66625............... .............. A Removal of iris...... 5.12 NA 4.73 0.27 NA 10.12 090
66630............... .............. A Removal of iris...... 6.15 NA 5.70 0.31 NA 12.16 090
66635............... .............. A Removal of iris...... 6.24 NA 5.74 0.32 NA 12.30 090
66680............... .............. A Repair iris & ciliary 5.43 NA 5.27 0.27 NA 10.97 090
body.
66682............... .............. A Repair iris & ciliary 6.20 NA 6.61 0.31 NA 13.12 090
body.
66700............... .............. A Destruction, ciliary 4.77 5.25 3.93 0.25 10.27 8.95 090
body.
66710............... .............. A Destruction, ciliary 4.77 5.17 3.84 0.24 10.18 8.85 090
body.
66720............... .............. A Destruction, ciliary 4.77 5.82 4.71 0.26 10.85 9.74 090
body.
66740............... .............. A Destruction, ciliary 4.77 5.09 3.97 0.24 10.10 8.98 090
body.
66761............... .............. A Revision of iris..... 4.06 5.59 4.31 0.21 9.86 8.58 090
66762............... .............. A Revision of iris..... 4.57 5.66 4.28 0.23 10.46 9.08 090
66770............... .............. A Removal of inner eye 5.17 6.09 4.80 0.26 11.52 10.23 090
lesion.
66820............... .............. A Incision, secondary 3.88 NA 5.83 0.19 NA 9.90 090
cataract.
66821............... .............. A After cataract laser 2.35 3.81 3.63 0.11 6.27 6.09 090
surgery.
66825............... .............. A Reposition 8.22 NA 9.07 0.40 NA 17.69 090
intraocular lens.
66830............... .............. A Removal of lens 8.19 NA 6.95 0.40 NA 15.54 090
lesion.
66840............... .............. A Removal of lens 7.90 NA 6.86 0.39 NA 15.15 090
material.
66850............... .............. A Removal of lens 9.10 NA 7.64 0.45 NA 17.19 090
material.
66852............... .............. A Removal of lens 9.96 NA 8.10 0.50 NA 18.56 090
material.
66920............... .............. A Extraction of lens... 8.85 NA 7.30 0.44 NA 16.59 090
66930............... .............. A Extraction of lens... 10.16 NA 8.14 0.51 NA 18.81 090
66940............... .............. A Extraction of lens... 8.92 NA 7.67 0.44 NA 17.03 090
66982............... .............. A Cataract surgery, 13.48 NA 9.86 0.63 NA 23.97 090
complex.
66983............... .............. A Cataract surg w/iol, 8.98 NA 6.11 0.21 NA 15.30 090
1 stage.
66984............... .............. A Cataract surg w/iol, 10.21 NA 7.41 0.42 NA 18.04 090
1 stage.
66985............... .............. A Insert lens 8.38 NA 7.45 0.39 NA 16.22 090
prosthesis.
66986............... .............. A Exchange lens 12.26 NA 9.17 0.60 NA 22.03 090
prosthesis.
66990............... .............. A Ophthalmic endoscope 1.51 NA 0.69 0.07 NA 2.27 ZZZ
add-on.
67005............... .............. A Partial removal of 5.69 NA 4.37 0.29 NA 10.35 090
eye fluid.
67010............... .............. A Partial removal of 6.86 NA 4.91 0.34 NA 12.11 090
eye fluid.
67015............... .............. A Release of eye fluid. 6.91 NA 6.46 0.35 NA 13.72 090
67025............... .............. A Replace eye fluid.... 6.83 9.24 6.22 0.34 16.41 13.39 090
67027............... .............. A Implant eye drug 10.83 NA 8.00 0.55 NA 19.38 090
system.
67028............... .............. A Injection eye drug... 2.52 2.70 1.45 0.13 5.35 4.10 000
67030............... .............. A Incise inner eye 4.83 NA 5.85 0.25 NA 10.93 090
strands.
67031............... .............. A Laser surgery, eye 3.66 4.61 3.64 0.18 8.45 7.48 090
strands.
67036............... .............. A Removal of inner eye 11.87 NA 9.12 0.60 NA 21.59 090
fluid.
67038............... .............. A Strip retinal 21.21 NA 15.49 1.07 NA 37.77 090
membrane.
67039............... .............. A Laser treatment of 14.50 NA 12.18 0.73 NA 27.41 090
retina.
67040............... .............. A Laser treatment of 17.20 NA 13.68 0.87 NA 31.75 090
retina.
67101............... .............. A Repair detached 7.52 9.13 6.53 0.38 17.03 14.43 090
retina.
67105............... .............. A Repair detached 7.40 8.09 6.15 0.37 15.86 13.92 090
retina.
67107............... .............. A Repair detached 14.82 NA 11.30 0.74 NA 26.86 090
retina.
67108............... .............. A Repair detached 20.79 NA 14.41 1.05 NA 36.25 090
retina.
67110............... .............. A Repair detached 8.80 10.24 7.39 0.44 19.48 16.63 090
retina.
67112............... .............. A Rerepair detached 16.83 NA 11.81 0.85 NA 29.49 090
retina.
67115............... .............. A Release encircling 4.98 NA 5.08 0.25 NA 10.31 090
material.
67120............... .............. A Remove eye implant 5.97 8.59 5.52 0.30 14.86 11.79 090
material.
67121............... .............. A Remove eye implant 10.65 NA 8.53 0.53 NA 19.71 090
material.
67141............... .............. A Treatment of retina.. 5.19 5.85 4.86 0.26 11.30 10.31 090
67145............... .............. A Treatment of retina.. 5.36 5.72 4.93 0.27 11.35 10.56 090
67208............... .............. A Treatment of retinal 6.69 6.12 5.51 0.34 13.15 12.54 090
lesion.
67210............... .............. A Treatment of retinal 8.81 6.58 5.87 0.44 15.83 15.12 090
lesion.
67218............... .............. A Treatment of retinal 18.50 NA 12.15 0.93 NA 31.58 090
lesion.
67220............... .............. A Treatment of choroid 13.11 10.43 9.01 0.66 24.20 22.78 090
lesion.
67221............... .............. R Ocular photodynamic 4.00 4.34 1.80 0.20 8.54 6.00 000
ther.
67225............... .............. A Eye photodynamic ther 0.47 0.25 0.21 0.02 0.74 0.70 ZZZ
add-on.
67227............... .............. A Treatment of retinal 6.57 6.58 5.52 0.33 13.48 12.42 090
lesion.
67228............... .............. A Treatment of retinal 12.72 11.49 8.54 0.64 24.85 21.90 090
lesion.
[[Page 47647]]
67250............... .............. A Reinforce eye wall... 8.65 NA 9.18 0.43 NA 18.26 090
67255............... .............. A Reinforce/graft eye 8.89 NA 9.91 0.45 NA 19.25 090
wall.
67311............... .............. A Revise eye muscle.... 6.64 NA 6.02 0.37 NA 13.03 090
67312............... .............. A Revise two eye 8.53 NA 6.75 0.44 NA 15.72 090
muscles.
67314............... .............. A Revise eye muscle.... 7.51 NA 6.55 0.40 NA 14.46 090
67316............... .............. A Revise two eye 9.65 NA 7.50 0.51 NA 17.66 090
muscles.
67318............... .............. A Revise eye muscle(s). 7.84 NA 6.93 0.41 NA 15.18 090
67320............... .............. A Revise eye muscle(s) 4.32 NA 1.95 0.23 NA 6.50 ZZZ
add-on.
67331............... .............. A Eye surgery follow-up 4.05 NA 1.82 0.21 NA 6.08 ZZZ
add-on.
67332............... .............. A Rerevise eye muscles 4.48 NA 2.02 0.24 NA 6.74 ZZZ
add-on.
67334............... .............. A Revise eye muscle w/ 3.97 NA 1.79 0.20 NA 5.96 ZZZ
suture.
67335............... .............. A Eye suture during 2.49 NA 1.12 0.13 NA 3.74 ZZZ
surgery.
67340............... .............. A Revise eye muscle add- 4.92 NA 2.20 0.26 NA 7.38 ZZZ
on.
67343............... .............. A Release eye tissue... 7.34 NA 6.50 0.42 NA 14.26 090
67345............... .............. A Destroy nerve of eye 2.96 2.58 2.01 0.18 5.72 5.15 010
muscle.
67350............... .............. A Biopsy eye muscle.... 2.87 NA 1.86 0.15 NA 4.88 000
67400............... .............. A Explore/biopsy eye 9.75 NA 11.27 0.58 NA 21.60 090
socket.
67405............... .............. A Explore/drain eye 7.92 NA 9.78 0.49 NA 18.19 090
socket.
67412............... .............. A Explore/treat eye 9.49 NA 10.95 0.53 NA 20.97 090
socket.
67413............... .............. A Explore/treat eye 9.99 NA 10.78 0.56 NA 21.33 090
socket.
67414............... .............. A Explr/decompress eye 11.11 NA 12.06 0.66 NA 23.83 090
socket.
67415............... .............. A Aspiration, orbital 1.76 NA 0.76 0.09 NA 2.61 000
contents.
67420............... .............. A Explore/treat eye 20.03 NA 17.39 1.21 NA 38.63 090
socket.
67430............... .............. A Explore/treat eye 13.37 NA 15.08 0.84 NA 29.29 090
socket.
67440............... .............. A Explore/drain eye 13.07 NA 14.27 0.76 NA 28.10 090
socket.
67445............... .............. A Explr/decompress eye 14.40 NA 13.93 0.92 NA 29.25 090
socket.
67450............... .............. A Explore/biopsy eye 13.49 NA 14.71 0.75 NA 28.95 090
socket.
67500............... .............. A Inject/treat eye 0.79 0.67 0.29 0.05 1.51 1.13 000
socket.
67505............... .............. A Inject/treat eye 0.82 0.69 0.31 0.05 1.56 1.18 000
socket.
67515............... .............. A Inject/treat eye 0.61 0.59 0.38 0.03 1.23 1.02 000
socket.
67550............... .............. A Insert eye socket 10.17 NA 11.29 0.66 NA 22.12 090
implant.
67560............... .............. A Revise eye socket 10.58 NA 11.37 0.70 NA 22.65 090
implant.
67570............... .............. A Decompress optic 13.56 NA 13.60 0.82 NA 27.98 090
nerve.
67700............... .............. A Drainage of eyelid 1.35 6.05 1.27 0.07 7.47 2.69 010
abscess.
67710............... .............. A Incision of eyelid... 1.02 5.40 1.20 0.05 6.47 2.27 010
67715............... .............. A Incision of eyelid 1.22 5.39 1.29 0.06 6.67 2.57 010
fold.
67800............... .............. A Remove eyelid lesion. 1.38 1.62 1.03 0.07 3.07 2.48 010
67801............... .............. A Remove eyelid lesions 1.88 1.96 1.26 0.10 3.94 3.24 010
67805............... .............. A Remove eyelid lesions 2.22 2.52 1.64 0.12 4.86 3.98 010
67808............... .............. A Remove eyelid 3.79 NA 3.77 0.21 NA 7.77 090
lesion(s).
67810............... .............. A Biopsy of eyelid..... 1.48 3.34 0.67 0.11 4.93 2.26 000
67820............... .............. A Revise eyelashes..... 0.89 0.60 0.56 0.04 1.53 1.49 000
67825............... .............. A Revise eyelashes..... 1.38 1.73 1.41 0.07 3.18 2.86 010
67830............... .............. A Revise eyelashes..... 1.70 5.55 1.50 0.09 7.34 3.29 010
67835............... .............. A Revise eyelashes..... 5.55 NA 4.61 0.29 NA 10.45 090
67840............... .............. A Remove eyelid lesion. 2.04 5.49 1.65 0.11 7.64 3.80 010
67850............... .............. A Treat eyelid lesion.. 1.69 3.37 1.46 0.11 5.17 3.26 010
67875............... .............. A Closure of eyelid by 1.35 3.31 0.94 0.08 4.74 2.37 000
suture.
67880............... .............. A Revision of eyelid... 3.79 6.63 3.79 0.20 10.62 7.78 090
67882............... .............. A Revision of eyelid... 5.06 7.65 4.80 0.27 12.98 10.13 090
67900............... .............. A Repair brow defect... 6.13 9.05 5.23 0.39 15.57 11.75 090
67901............... .............. A Repair eyelid defect. 6.96 NA 5.38 0.53 NA 12.87 090
67902............... .............. A Repair eyelid defect. 7.02 NA 5.44 0.46 NA 12.92 090
67903............... .............. A Repair eyelid defect. 6.36 9.58 5.47 0.44 16.38 12.27 090
67904............... .............. A Repair eyelid defect. 6.25 9.69 5.22 0.41 16.35 11.88 090
67906............... .............. A Repair eyelid defect. 6.78 5.39 5.02 0.44 12.61 12.24 090
67908............... .............. A Repair eyelid defect. 5.12 7.04 5.24 0.30 12.46 10.66 090
67909............... .............. A Revise eyelid defect. 5.39 8.03 4.93 0.32 13.74 10.64 090
67911............... .............. A Revise eyelid defect. 5.26 NA 4.77 0.31 NA 10.34 090
67912............... .............. A Correction eyelid w/ 5.67 18.69 5.46 0.28 24.64 11.41 090
implant.
67914............... .............. A Repair eyelid defect. 3.67 6.35 3.04 0.21 10.23 6.92 090
67915............... .............. A Repair eyelid defect. 3.18 6.00 2.80 0.17 9.35 6.15 090
67916............... .............. A Repair eyelid defect. 5.30 8.06 4.76 0.30 13.66 10.36 090
67917............... .............. A Repair eyelid defect. 6.01 8.47 5.07 0.37 14.85 11.45 090
67921............... .............. A Repair eyelid defect. 3.39 6.21 2.89 0.18 9.78 6.46 090
67922............... .............. A Repair eyelid defect. 3.06 5.93 2.75 0.16 9.15 5.97 090
67923............... .............. A Repair eyelid defect. 5.87 8.14 4.97 0.32 14.33 11.16 090
67924............... .............. A Repair eyelid defect. 5.78 8.94 4.68 0.32 15.04 10.78 090
67930............... .............. A Repair eyelid wound.. 3.60 5.74 2.17 0.20 9.54 5.97 010
67935............... .............. A Repair eyelid wound.. 6.21 8.53 4.40 0.39 15.13 11.00 090
67938............... .............. A Remove eyelid foreign 1.33 5.40 1.27 0.07 6.80 2.67 010
body.
67950............... .............. A Revision of eyelid... 5.81 8.63 5.19 0.36 14.80 11.36 090
67961............... .............. A Revision of eyelid... 5.68 8.68 5.01 0.33 14.69 11.02 090
67966............... .............. A Revision of eyelid... 6.56 9.13 5.53 0.39 16.08 12.48 090
67971............... .............. A Reconstruction of 9.78 NA 7.27 0.54 NA 17.59 090
eyelid.
[[Page 47648]]
67973............... .............. A Reconstruction of 12.85 NA 9.29 0.73 NA 22.87 090
eyelid.
67974............... .............. A Reconstruction of 12.82 NA 9.21 0.70 NA 22.73 090
eyelid.
67975............... .............. A Reconstruction of 9.12 NA 6.94 0.49 NA 16.55 090
eyelid.
68020............... .............. A Incise/drain eyelid 1.37 1.41 1.21 0.07 2.85 2.65 010
lining.
68040............... .............. A Treatment of eyelid 0.85 0.71 0.43 0.04 1.60 1.32 000
lesions.
68100............... .............. A Biopsy of eyelid 1.35 3.25 0.95 0.07 4.67 2.37 000
lining.
68110............... .............. A Remove eyelid lining 1.77 4.10 1.64 0.09 5.96 3.50 010
lesion.
68115............... .............. A Remove eyelid lining 2.36 5.97 1.91 0.12 8.45 4.39 010
lesion.
68130............... .............. A Remove eyelid lining 4.92 8.72 4.59 0.25 13.89 9.76 090
lesion.
68135............... .............. A Remove eyelid lining 1.84 1.81 1.65 0.09 3.74 3.58 010
lesion.
68200............... .............. A Treat eyelid by 0.49 0.54 0.33 0.02 1.05 0.84 000
injection.
68320............... .............. A Revise/graft eyelid 5.36 11.29 5.52 0.29 16.94 11.17 090
lining.
68325............... .............. A Revise/graft eyelid 7.35 NA 6.53 0.41 NA 14.29 090
lining.
68326............... .............. A Revise/graft eyelid 7.14 NA 6.40 0.38 NA 13.92 090
lining.
68328............... .............. A Revise/graft eyelid 8.17 NA 7.26 0.55 NA 15.98 090
lining.
68330............... .............. A Revise eyelid lining. 4.82 9.41 4.71 0.25 14.48 9.78 090
68335............... .............. A Revise/graft eyelid 7.18 NA 6.37 0.36 NA 13.91 090
lining.
68340............... .............. A Separate eyelid 4.16 8.89 4.10 0.21 13.26 8.47 090
adhesions.
68360............... .............. A Revise eyelid lining. 4.36 8.05 4.18 0.22 12.63 8.76 090
68362............... .............. A Revise eyelid lining. 7.33 NA 6.40 0.37 NA 14.10 090
68371............... .............. A Harvest eye tissue, 4.89 NA 4.73 0.45 NA 10.07 010
alograft.
68400............... .............. A Incise/drain tear 1.69 5.92 1.83 0.09 7.70 3.61 010
gland.
68420............... .............. A Incise/drain tear sac 2.30 6.22 2.11 0.12 8.64 4.53 010
68440............... .............. A Incise tear duct 0.94 2.09 1.27 0.05 3.08 2.26 010
opening.
68500............... .............. A Removal of tear gland 11.00 NA 9.73 0.63 NA 21.36 090
68505............... .............. A Partial removal, tear 10.92 NA 10.59 0.61 NA 22.12 090
gland.
68510............... .............. A Biopsy of tear gland. 4.60 7.35 2.09 0.24 12.19 6.93 000
68520............... .............. A Removal of tear sac.. 7.50 NA 7.41 0.39 NA 15.30 090
68525............... .............. A Biopsy of tear sac... 4.42 NA 2.01 0.24 NA 6.67 000
68530............... .............. A Clearance of tear 3.65 8.19 2.64 0.20 12.04 6.49 010
duct.
68540............... .............. A Remove tear gland 10.58 NA 9.38 0.53 NA 20.49 090
lesion.
68550............... .............. A Remove tear gland 13.24 NA 11.33 0.66 NA 25.23 090
lesion.
68700............... .............. A Repair tear ducts.... 6.59 NA 5.97 0.35 NA 12.91 090
68705............... .............. A Revise tear duct 2.06 4.19 1.78 0.10 6.35 3.94 010
opening.
68720............... .............. A Create tear sac drain 8.95 NA 7.86 0.50 NA 17.31 090
68745............... .............. A Create tear duct 8.62 NA 7.86 0.43 NA 16.91 090
drain.
68750............... .............. A Create tear duct 8.65 NA 8.27 0.46 NA 17.38 090
drain.
68760............... .............. A Close tear duct 1.73 3.55 1.63 0.09 5.37 3.45 010
opening.
68761............... .............. A Close tear duct 1.36 2.27 1.32 0.07 3.70 2.75 010
opening.
68770............... .............. A Close tear system 7.01 3.17 3.17 0.36 10.54 10.54 090
fistula.
68801............... .............. A Dilate tear duct 0.94 1.95 1.48 0.05 2.94 2.47 010
opening.
68810............... .............. A Probe nasolacrimal 1.90 3.66 2.67 0.11 5.67 4.68 010
duct.
68811............... .............. A Probe nasolacrimal 2.35 NA 2.40 0.14 NA 4.89 010
duct.
68815............... .............. A Probe nasolacrimal 3.20 8.27 2.81 0.18 11.65 6.19 010
duct.
68840............... .............. A Explore/irrigate tear 1.25 1.61 1.12 0.06 2.92 2.43 010
ducts.
68850............... .............. A Injection for tear 0.80 0.88 0.67 0.04 1.72 1.51 000
sac x-ray.
69000............... .............. A Drain external ear 1.45 2.89 1.38 0.12 4.46 2.95 010
lesion.
69005............... .............. A Drain external ear 2.11 2.93 1.83 0.18 5.22 4.12 010
lesion.
69020............... .............. A Drain outer ear canal 1.48 3.97 2.07 0.12 5.57 3.67 010
lesion.
69100............... .............. A Biopsy of external 0.81 1.71 0.39 0.07 2.59 1.27 000
ear.
69105............... .............. A Biopsy of external 0.85 2.32 0.77 0.07 3.24 1.69 000
ear canal.
69110............... .............. A Remove external ear, 3.43 6.73 4.46 0.34 10.50 8.23 090
partial.
69120............... .............. A Removal of external 4.04 NA 6.16 0.39 NA 10.59 090
ear.
69140............... .............. A Remove ear canal 7.96 NA 13.21 0.67 NA 21.84 090
lesion(s).
69145............... .............. A Remove ear canal 2.62 5.73 3.28 0.22 8.57 6.12 090
lesion(s).
69150............... .............. A Extensive ear canal 13.41 NA 13.32 1.27 NA 28.00 090
surgery.
69155............... .............. A Extensive ear/neck 20.77 NA 19.43 1.84 NA 42.04 090
surgery.
69200............... .............. A Clear outer ear canal 0.77 2.38 0.56 0.06 3.21 1.39 000
69205............... .............. A Clear outer ear canal 1.20 NA 1.35 0.10 NA 2.65 010
69210............... .............. A Remove impacted ear 0.61 0.63 0.23 0.05 1.29 0.89 000
wax.
69220............... .............. A Clean out mastoid 0.83 2.35 0.74 0.07 3.25 1.64 000
cavity.
69222............... .............. A Clean out mastoid 1.40 3.82 2.05 0.12 5.34 3.57 010
cavity.
69300............... .............. R Revise external ear.. 6.35 NA 4.21 0.75 NA 11.31 YYY
69310............... .............. A Rebuild outer ear 10.77 NA 16.18 0.89 NA 27.84 090
canal.
69320............... .............. A Rebuild outer ear 16.93 NA 21.71 1.45 NA 40.09 090
canal.
69400............... .............. A Inflate middle ear 0.83 2.16 0.67 0.07 3.06 1.57 000
canal.
69401............... .............. A Inflate middle ear 0.63 1.24 0.65 0.05 1.92 1.33 000
canal.
69405............... .............. A Catheterize middle 2.63 3.46 2.29 0.21 6.30 5.13 010
ear canal.
69410............... .............. A Inset middle ear 0.33 2.12 0.48 0.03 2.48 0.84 000
(baffle).
69420............... .............. A Incision of eardrum.. 1.33 3.12 1.58 0.11 4.56 3.02 010
69421............... .............. A Incision of eardrum.. 1.73 NA 2.15 0.16 NA 4.04 010
69424............... .............. A Remove ventilating 0.85 2.17 0.68 0.07 3.09 1.60 000
tube.
69433............... .............. A Create eardrum 1.52 3.09 1.64 0.13 4.74 3.29 010
opening.
69436............... .............. A Create eardrum 1.96 NA 2.27 0.19 NA 4.42 010
opening.
69440............... .............. A Exploration of middle 7.56 NA 8.71 0.62 NA 16.89 090
ear.
[[Page 47649]]
69450............... .............. A Eardrum revision..... 5.56 NA 6.99 0.45 NA 13.00 090
69501............... .............. A Mastoidectomy........ 9.06 NA 8.96 0.76 NA 18.78 090
69502............... .............. A Mastoidectomy........ 12.36 NA 11.54 1.03 NA 24.93 090
69505............... .............. A Remove mastoid 12.97 NA 17.11 1.08 NA 31.16 090
structures.
69511............... .............. A Extensive mastoid 13.50 NA 17.39 1.09 NA 31.98 090
surgery.
69530............... .............. A Extensive mastoid 19.16 NA 21.52 1.44 NA 42.12 090
surgery.
69535............... .............. A Remove part of 36.09 NA 31.85 2.98 NA 70.92 090
temporal bone.
69540............... .............. A Remove ear lesion.... 1.20 3.71 1.95 0.10 5.01 3.25 010
69550............... .............. A Remove ear lesion.... 10.97 NA 14.79 0.90 NA 26.66 090
69552............... .............. A Remove ear lesion.... 19.43 NA 20.60 1.55 NA 41.58 090
69554............... .............. A Remove ear lesion.... 33.11 NA 30.18 2.94 NA 66.23 090
69601............... .............. A Mastoid surgery 13.22 NA 12.60 1.07 NA 26.89 090
revision.
69602............... .............. A Mastoid surgery 13.56 NA 13.16 1.05 NA 27.77 090
revision.
69603............... .............. A Mastoid surgery 14.00 NA 18.26 1.14 NA 33.40 090
revision.
69604............... .............. A Mastoid surgery 14.00 NA 13.63 0.92 NA 28.55 090
revision.
69605............... .............. A Mastoid surgery 18.46 NA 20.85 1.51 NA 40.82 090
revision.
69610............... .............. A Repair of eardrum.... 4.42 5.50 3.26 0.36 10.28 8.04 010
69620............... .............. A Repair of eardrum.... 5.88 11.03 6.25 0.48 17.39 12.61 090
69631............... .............. A Repair eardrum 9.85 NA 11.13 0.81 NA 21.79 090
structures.
69632............... .............. A Rebuild eardrum 12.73 NA 13.39 1.04 NA 27.16 090
structures.
69633............... .............. A Rebuild eardrum 12.08 NA 12.97 0.99 NA 26.04 090
structures.
69635............... .............. A Repair eardrum 13.31 NA 16.66 1.08 NA 31.05 090
structures.
69636............... .............. A Rebuild eardrum 15.20 NA 19.18 1.23 NA 35.61 090
structures.
69637............... .............. A Rebuild eardrum 15.09 NA 19.11 1.25 NA 35.45 090
structures.
69641............... .............. A Revise middle ear & 12.69 NA 12.70 1.04 NA 26.43 090
mastoid.
69642............... .............. A Revise middle ear & 16.81 NA 16.19 1.37 NA 34.37 090
mastoid.
69643............... .............. A Revise middle ear & 15.30 NA 14.73 1.26 NA 31.29 090
mastoid.
69644............... .............. A Revise middle ear & 16.94 NA 20.30 1.38 NA 38.62 090
mastoid.
69645............... .............. A Revise middle ear & 16.36 NA 19.92 1.35 NA 37.63 090
mastoid.
69646............... .............. A Revise middle ear & 17.96 NA 20.65 1.48 NA 40.09 090
mastoid.
69650............... .............. A Release middle ear 9.65 NA 9.85 0.78 NA 20.28 090
bone.
69660............... .............. A Revise middle ear 11.88 NA 11.13 0.95 NA 23.96 090
bone.
69661............... .............. A Revise middle ear 15.72 NA 14.62 1.29 NA 31.63 090
bone.
69662............... .............. A Revise middle ear 15.42 NA 13.68 1.26 NA 30.36 090
bone.
69666............... .............. A Repair middle ear 9.74 NA 9.91 0.79 NA 20.44 090
structures.
69667............... .............. A Repair middle ear 9.75 NA 9.92 0.79 NA 20.46 090
structures.
69670............... .............. A Remove mastoid air 11.49 NA 11.65 0.96 NA 24.10 090
cells.
69676............... .............. A Remove middle ear 9.51 NA 10.67 0.84 NA 21.02 090
nerve.
69700............... .............. A Close mastoid fistula 8.22 NA 9.20 0.66 NA 18.08 090
69711............... .............. A Remove/repair hearing 10.42 NA 10.74 0.85 NA 22.01 090
aid.
69714............... .............. A Implant temple bone w/ 13.98 NA 12.61 1.21 NA 27.80 090
stimul.
69715............... .............. A Temple bne implnt w/ 18.22 NA 14.96 1.49 NA 34.67 090
stimulat.
69717............... .............. A Temple bone implant 14.96 NA 14.46 1.35 NA 30.77 090
revision.
69718............... .............. A Revise temple bone 18.47 NA 15.26 1.62 NA 35.35 090
implant.
69720............... .............. A Release facial nerve. 14.36 NA 14.43 1.24 NA 30.03 090
69725............... .............. A Release facial nerve. 25.34 NA 20.02 2.29 NA 47.65 090
69740............... .............. A Repair facial nerve.. 15.94 NA 13.37 1.58 NA 30.89 090
69745............... .............. A Repair facial nerve.. 16.66 NA 14.91 1.36 NA 32.93 090
69801............... .............. A Incise inner ear..... 8.55 NA 9.41 0.70 NA 18.66 090
69802............... .............. A Incise inner ear..... 13.08 NA 12.25 1.07 NA 26.40 090
69805............... .............. A Explore inner ear.... 13.80 NA 11.82 1.16 NA 26.78 090
69806............... .............. A Explore inner ear.... 12.33 NA 10.99 1.04 NA 24.36 090
69820............... .............. A Establish inner ear 10.32 NA 11.19 0.82 NA 22.33 090
window.
69840............... .............. A Revise inner ear 10.24 NA 13.15 0.74 NA 24.13 090
window.
69905............... .............. A Remove inner ear..... 11.08 NA 11.29 0.90 NA 23.27 090
69910............... .............. A Remove inner ear & 13.61 NA 11.88 1.10 NA 26.59 090
mastoid.
69915............... .............. A Incise inner ear 21.20 NA 16.39 1.70 NA 39.29 090
nerve.
69930............... .............. A Implant cochlear 16.78 NA 14.68 1.38 NA 32.84 090
device.
69950............... .............. A Incise inner ear 25.60 NA 18.82 3.07 NA 47.49 090
nerve.
69955............... .............. A Release facial nerve. 27.00 NA 21.29 2.77 NA 51.06 090
69960............... .............. A Release inner ear 27.00 NA 19.98 2.69 NA 49.67 090
canal.
69970............... .............. A Remove inner ear 29.99 NA 23.17 2.73 NA 55.89 090
lesion.
69990............... .............. R Microsurgery add-on.. 3.46 NA 1.78 0.81 NA 6.05 ZZZ
70010............... .............. A Contrast x-ray of 1.19 4.72 NA 0.28 6.19 NA XXX
brain.
70010............... 26............ A Contrast x-ray of 1.19 0.39 0.39 0.06 1.64 1.64 XXX
brain.
70010............... TC............ A Contrast x-ray of 0.00 4.32 NA 0.22 4.54 NA XXX
brain.
70015............... .............. A Contrast x-ray of 1.19 1.74 NA 0.14 3.07 NA XXX
brain.
70015............... 26............ A Contrast x-ray of 1.19 0.39 0.39 0.06 1.64 1.64 XXX
brain.
70015............... TC............ A Contrast x-ray of 0.00 1.35 NA 0.08 1.43 NA XXX
brain.
70030............... .............. A X-ray eye for foreign 0.17 0.47 NA 0.03 0.67 NA XXX
body.
70030............... 26............ A X-ray eye for foreign 0.17 0.06 0.06 0.01 0.24 0.24 XXX
body.
70030............... TC............ A X-ray eye for foreign 0.00 0.42 NA 0.02 0.44 NA XXX
body.
70100............... .............. A X-ray exam of jaw.... 0.18 0.58 NA 0.03 0.79 NA XXX
70100............... 26............ A X-ray exam of jaw.... 0.18 0.06 0.06 0.01 0.25 0.25 XXX
70100............... TC............ A X-ray exam of jaw.... 0.00 0.52 NA 0.02 0.54 NA XXX
[[Page 47650]]
70110............... .............. A X-ray exam of jaw.... 0.25 0.70 NA 0.05 1.00 NA XXX
70110............... 26............ A X-ray exam of jaw.... 0.25 0.08 0.08 0.01 0.34 0.34 XXX
70110............... TC............ A X-ray exam of jaw.... 0.00 0.62 NA 0.04 0.66 NA XXX
70120............... .............. A X-ray exam of 0.18 0.68 NA 0.05 0.91 NA XXX
mastoids.
70120............... 26............ A X-ray exam of 0.18 0.06 0.06 0.01 0.25 0.25 XXX
mastoids.
70120............... TC............ A X-ray exam of 0.00 0.62 NA 0.04 0.66 NA XXX
mastoids.
70130............... .............. A X-ray exam of 0.34 0.89 NA 0.07 1.30 NA XXX
mastoids.
70130............... 26............ A X-ray exam of 0.34 0.11 0.11 0.02 0.47 0.47 XXX
mastoids.
70130............... TC............ A X-ray exam of 0.00 0.78 NA 0.05 0.83 NA XXX
mastoids.
70134............... .............. A X-ray exam of middle 0.34 0.85 NA 0.07 1.26 NA XXX
ear.
70134............... 26............ A X-ray exam of middle 0.34 0.11 0.11 0.02 0.47 0.47 XXX
ear.
70134............... TC............ A X-ray exam of middle 0.00 0.73 NA 0.05 0.78 NA XXX
ear.
70140............... .............. A X-ray exam of facial 0.19 0.68 NA 0.05 0.92 NA XXX
bones.
70140............... 26............ A X-ray exam of facial 0.19 0.06 0.06 0.01 0.26 0.26 XXX
bones.
70140............... TC............ A X-ray exam of facial 0.00 0.62 NA 0.04 0.66 NA XXX
bones.
70150............... .............. A X-ray exam of facial 0.26 0.87 NA 0.06 1.19 NA XXX
bones.
70150............... 26............ A X-ray exam of facial 0.26 0.08 0.08 0.01 0.35 0.35 XXX
bones.
70150............... TC............ A X-ray exam of facial 0.00 0.78 NA 0.05 0.83 NA XXX
bones.
70160............... .............. A X-ray exam of nasal 0.17 0.58 NA 0.03 0.78 NA XXX
bones.
70160............... 26............ A X-ray exam of nasal 0.17 0.06 0.06 0.01 0.24 0.24 XXX
bones.
70160............... TC............ A X-ray exam of nasal 0.00 0.52 NA 0.02 0.54 NA XXX
bones.
70170............... .............. A X-ray exam of tear 0.30 1.04 NA 0.07 1.41 NA XXX
duct.
70170............... 26............ A X-ray exam of tear 0.30 0.10 0.10 0.01 0.41 0.41 XXX
duct.
70170............... TC............ A X-ray exam of tear 0.00 0.95 NA 0.06 1.01 NA XXX
duct.
70190............... .............. A X-ray exam of eye 0.21 0.69 NA 0.05 0.95 NA XXX
sockets.
70190............... 26............ A X-ray exam of eye 0.21 0.07 0.07 0.01 0.29 0.29 XXX
sockets.
70190............... TC............ A X-ray exam of eye 0.00 0.62 NA 0.04 0.66 NA XXX
sockets.
70200............... .............. A X-ray exam of eye 0.28 0.87 NA 0.06 1.21 NA XXX
sockets.
70200............... 26............ A X-ray exam of eye 0.28 0.09 0.09 0.01 0.38 0.38 XXX
sockets.
70200............... TC............ A X-ray exam of eye 0.00 0.78 NA 0.05 0.83 NA XXX
sockets.
70210............... .............. A X-ray exam of sinuses 0.17 0.67 NA 0.05 0.89 NA XXX
70210............... 26............ A X-ray exam of sinuses 0.17 0.06 0.06 0.01 0.24 0.24 XXX
70210............... TC............ A X-ray exam of sinuses 0.00 0.62 NA 0.04 0.66 NA XXX
70220............... .............. A X-ray exam of sinuses 0.25 0.86 NA 0.06 1.17 NA XXX
70220............... 26............ A X-ray exam of sinuses 0.25 0.08 0.08 0.01 0.34 0.34 XXX
70220............... TC............ A X-ray exam of sinuses 0.00 0.78 NA 0.05 0.83 NA XXX
70240............... .............. A X-ray exam, pituitary 0.19 0.48 NA 0.03 0.70 NA XXX
saddle.
70240............... 26............ A X-ray exam, pituitary 0.19 0.06 0.06 0.01 0.26 0.26 XXX
saddle.
70240............... TC............ A X-ray exam, pituitary 0.00 0.42 NA 0.02 0.44 NA XXX
saddle.
70250............... .............. A X-ray exam of skull.. 0.24 0.70 NA 0.05 0.99 NA XXX
70250............... 26............ A X-ray exam of skull.. 0.24 0.08 0.08 0.01 0.33 0.33 XXX
70250............... TC............ A X-ray exam of skull.. 0.00 0.62 NA 0.04 0.66 NA XXX
70260............... .............. A X-ray exam of skull.. 0.34 1.00 NA 0.08 1.42 NA XXX
70260............... 26............ A X-ray exam of skull.. 0.34 0.11 0.11 0.02 0.47 0.47 XXX
70260............... TC............ A X-ray exam of skull.. 0.00 0.89 NA 0.06 0.95 NA XXX
70300............... .............. A X-ray exam of teeth.. 0.10 0.31 NA 0.03 0.44 NA XXX
70300............... 26............ A X-ray exam of teeth.. 0.10 0.05 0.05 0.01 0.16 0.16 XXX
70300............... TC............ A X-ray exam of teeth.. 0.00 0.26 NA 0.02 0.28 NA XXX
70310............... .............. A X-ray exam of teeth.. 0.16 0.49 NA 0.03 0.68 NA XXX
70310............... 26............ A X-ray exam of teeth.. 0.16 0.08 0.08 0.01 0.25 0.25 XXX
70310............... TC............ A X-ray exam of teeth.. 0.00 0.42 NA 0.02 0.44 NA XXX
70320............... .............. A Full mouth x-ray of 0.22 0.86 NA 0.06 1.14 NA XXX
teeth.
70320............... 26............ A Full mouth x-ray of 0.22 0.08 0.08 0.01 0.31 0.31 XXX
teeth.
70320............... TC............ A Full mouth x-ray of 0.00 0.78 NA 0.05 0.83 NA XXX
teeth.
70328............... .............. A X-ray exam of jaw 0.18 0.55 NA 0.03 0.76 NA XXX
joint.
70328............... 26............ A X-ray exam of jaw 0.18 0.06 0.06 0.01 0.25 0.25 XXX
joint.
70328............... TC............ A X-ray exam of jaw 0.00 0.49 NA 0.02 0.51 NA XXX
joint.
70330............... .............. A X-ray exam of jaw 0.24 0.92 NA 0.06 1.22 NA XXX
joints.
70330............... 26............ A X-ray exam of jaw 0.24 0.08 0.08 0.01 0.33 0.33 XXX
joints.
70330............... TC............ A X-ray exam of jaw 0.00 0.84 NA 0.05 0.89 NA XXX
joints.
70332............... .............. A X-ray exam of jaw 0.54 2.29 NA 0.15 2.98 NA XXX
joint.
70332............... 26............ A X-ray exam of jaw 0.54 0.20 0.20 0.03 0.77 0.77 XXX
joint.
70332............... TC............ A X-ray exam of jaw 0.00 2.09 NA 0.12 2.21 NA XXX
joint.
70336............... .............. A Magnetic image, jaw 1.48 11.67 NA 0.66 13.81 NA XXX
joint.
70336............... 26............ A Magnetic image, jaw 1.48 0.49 0.49 0.07 2.04 2.04 XXX
joint.
70336............... TC............ A Magnetic image, jaw 0.00 11.19 NA 0.59 11.78 NA XXX
joint.
70350............... .............. A X-ray head for 0.17 0.45 NA 0.03 0.65 NA XXX
orthodontia.
70350............... 26............ A X-ray head for 0.17 0.07 0.07 0.01 0.25 0.25 XXX
orthodontia.
70350............... TC............ A X-ray head for 0.00 0.38 NA 0.02 0.40 NA XXX
orthodontia.
70355............... .............. A Panoramic x-ray of 0.20 0.64 NA 0.05 0.89 NA XXX
jaws.
70355............... 26............ A Panoramic x-ray of 0.20 0.07 0.07 0.01 0.28 0.28 XXX
jaws.
70355............... TC............ A Panoramic x-ray of 0.00 0.57 NA 0.04 0.61 NA XXX
jaws.
70360............... .............. A X-ray exam of neck... 0.17 0.47 NA 0.03 0.67 NA XXX
70360............... 26............ A X-ray exam of neck... 0.17 0.06 0.06 0.01 0.24 0.24 XXX
70360............... TC............ A X-ray exam of neck... 0.00 0.42 NA 0.02 0.44 NA XXX
[[Page 47651]]
70370............... .............. A Throat x-ray & 0.32 1.41 NA 0.08 1.81 NA XXX
fluoroscopy.
70370............... 26............ A Throat x-ray & 0.32 0.10 0.10 0.01 0.43 0.43 XXX
fluoroscopy.
70370............... TC............ A Throat x-ray & 0.00 1.30 NA 0.07 1.37 NA XXX
fluoroscopy.
70371............... .............. A Speech evaluation, 0.84 2.37 NA 0.16 3.37 NA XXX
complex.
70371............... 26............ A Speech evaluation, 0.84 0.27 0.27 0.04 1.15 1.15 XXX
complex.
70371............... TC............ A Speech evaluation, 0.00 2.09 NA 0.12 2.21 NA XXX
complex.
70373............... .............. A Contrast x-ray of 0.44 1.92 NA 0.13 2.49 NA XXX
larynx.
70373............... 26............ A Contrast x-ray of 0.44 0.14 0.14 0.02 0.60 0.60 XXX
larynx.
70373............... TC............ A Contrast x-ray of 0.00 1.78 NA 0.11 1.89 NA XXX
larynx.
70380............... .............. A X-ray exam of 0.17 0.72 NA 0.05 0.94 NA XXX
salivary gland.
70380............... 26............ A X-ray exam of 0.17 0.06 0.06 0.01 0.24 0.24 XXX
salivary gland.
70380............... TC............ A X-ray exam of 0.00 0.67 NA 0.04 0.71 NA XXX
salivary gland.
70390............... .............. A X-ray exam of 0.38 1.90 NA 0.13 2.41 NA XXX
salivary duct.
70390............... 26............ A X-ray exam of 0.38 0.12 0.12 0.02 0.52 0.52 XXX
salivary duct.
70390............... TC............ A X-ray exam of 0.00 1.78 NA 0.11 1.89 NA XXX
salivary duct.
70450............... .............. A Ct head/brain w/o dye 0.85 4.99 NA 0.29 6.13 NA XXX
70450............... 26............ A Ct head/brain w/o dye 0.85 0.28 0.28 0.04 1.17 1.17 XXX
70450............... TC............ A Ct head/brain w/o dye 0.00 4.71 NA 0.25 4.96 NA XXX
70460............... .............. A Ct head/brain w/dye.. 1.13 6.02 NA 0.35 7.50 NA XXX
70460............... 26............ A Ct head/brain w/dye.. 1.13 0.37 0.37 0.05 1.55 1.55 XXX
70460............... TC............ A Ct head/brain w/dye.. 0.00 5.65 NA 0.30 5.95 NA XXX
70470............... .............. A Ct head/brain w/o & w/ 1.27 7.47 NA 0.43 9.17 NA XXX
dye.
70470............... 26............ A Ct head/brain w/o & w/ 1.27 0.42 0.42 0.06 1.75 1.75 XXX
dye.
70470............... TC............ A Ct head/brain w/o & w/ 0.00 7.06 NA 0.37 7.43 NA XXX
dye.
70480............... .............. A Ct orbit/ear/fossa w/ 1.28 5.13 NA 0.31 6.72 NA XXX
o dye.
70480............... 26............ A Ct orbit/ear/fossa w/ 1.28 0.42 0.42 0.06 1.76 1.76 XXX
o dye.
70480............... TC............ A Ct orbit/ear/fossa w/ 0.00 4.71 NA 0.25 4.96 NA XXX
o dye.
70481............... .............. A Ct orbit/ear/fossa w/ 1.38 6.10 NA 0.36 7.84 NA XXX
dye.
70481............... 26............ A Ct orbit/ear/fossa w/ 1.38 0.45 0.45 0.06 1.89 1.89 XXX
dye.
70481............... TC............ A Ct orbit/ear/fossa w/ 0.00 5.65 NA 0.30 5.95 NA XXX
dye.
70482............... .............. A Ct orbit/ear/fossa w/ 1.45 7.53 NA 0.44 9.42 NA XXX
o&w dye.
70482............... 26............ A Ct orbit/ear/fossa w/ 1.45 0.47 0.47 0.07 1.99 1.99 XXX
o&w dye.
70482............... TC............ A Ct orbit/ear/fossa w/ 0.00 7.06 NA 0.37 7.43 NA XXX
o&w dye.
70486............... .............. A Ct maxillofacial w/o 1.14 5.08 NA 0.30 6.52 NA XXX
dye.
70486............... 26............ A Ct maxillofacial w/o 1.14 0.37 0.37 0.05 1.56 1.56 XXX
dye.
70486............... TC............ A Ct maxillofacial w/o 0.00 4.71 NA 0.25 4.96 NA XXX
dye.
70487............... .............. A Ct maxillofacial w/ 1.30 6.07 NA 0.36 7.73 NA XXX
dye.
70487............... 26............ A Ct maxillofacial w/ 1.30 0.43 0.43 0.06 1.79 1.79 XXX
dye.
70487............... TC............ A Ct maxillofacial w/ 0.00 5.65 NA 0.30 5.95 NA XXX
dye.
70488............... .............. A Ct maxillofacial w/o 1.42 7.52 NA 0.43 9.37 NA XXX
& w dye.
70488............... 26............ A Ct maxillofacial w/o 1.42 0.46 0.46 0.06 1.94 1.94 XXX
& w dye.
70488............... TC............ A Ct maxillofacial w/o 0.00 7.06 NA 0.37 7.43 NA XXX
& w dye.
70490............... .............. A Ct soft tissue neck w/ 1.28 5.13 NA 0.31 6.72 NA XXX
o dye.
70490............... 26............ A Ct soft tissue neck w/ 1.28 0.42 0.42 0.06 1.76 1.76 XXX
o dye.
70490............... TC............ A Ct soft tissue neck w/ 0.00 4.71 NA 0.25 4.96 NA XXX
o dye.
70491............... .............. A Ct soft tissue neck w/ 1.38 6.10 NA 0.36 7.84 NA XXX
dye.
70491............... 26............ A Ct soft tissue neck w/ 1.38 0.45 0.45 0.06 1.89 1.89 XXX
dye.
70491............... TC............ A Ct soft tissue neck w/ 0.00 5.65 NA 0.30 5.95 NA XXX
dye.
70492............... .............. A Ct sft tsue nck w/o & 1.45 7.53 NA 0.44 9.42 NA XXX
w/dye.
70492............... 26............ A Ct sft tsue nck w/o & 1.45 0.47 0.47 0.07 1.99 1.99 XXX
w/dye.
70492............... TC............ A Ct sft tsue nck w/o & 0.00 7.06 NA 0.37 7.43 NA XXX
w/dye.
70496............... .............. A Ct angiography, head. 1.75 11.16 NA 0.66 13.57 NA XXX
70496............... 26............ A Ct angiography, head. 1.75 0.57 0.57 0.08 2.40 2.40 XXX
70496............... TC............ A Ct angiography, head. 0.00 10.59 NA 0.58 11.17 NA XXX
70498............... .............. A Ct angiography, neck. 1.75 11.16 NA 0.66 13.57 NA XXX
70498............... 26............ A Ct angiography, neck. 1.75 0.57 0.57 0.08 2.40 2.40 XXX
70498............... TC............ A Ct angiography, neck. 0.00 10.59 NA 0.58 11.17 NA XXX
70540............... .............. A Mri orbit/face/neck w/ 1.35 11.63 NA 0.45 13.43 NA XXX
o dye.
70540............... 26............ A Mri orbit/face/neck w/ 1.35 0.44 0.44 0.06 1.85 1.85 XXX
o dye.
70540............... TC............ A Mri orbit/face/neck w/ 0.00 11.19 NA 0.39 11.58 NA XXX
o dye.
70542............... .............. A Mri orbit/face/neck w/ 1.62 13.95 NA 0.54 16.11 NA XXX
dye.
70542............... 26............ A Mri orbit/face/neck w/ 1.62 0.53 0.53 0.07 2.22 2.22 XXX
dye.
70542............... TC............ A Mri orbit/face/neck w/ 0.00 13.42 NA 0.47 13.89 NA XXX
dye.
70543............... .............. A Mri orbt/fac/nck w/o 2.15 25.55 NA 0.94 28.64 NA XXX
& w dye.
70543............... 26............ A Mri orbt/fac/nck w/o 2.15 0.71 0.71 0.10 2.96 2.96 XXX
& w dye.
70543............... TC............ A Mri orbt/fac/nck w/o 0.00 24.84 NA 0.84 25.68 NA XXX
& w dye.
70544............... .............. A Mr angiography head w/ 1.20 11.58 NA 0.64 13.42 NA XXX
o dye.
70544............... 26............ A Mr angiography head w/ 1.20 0.39 0.39 0.05 1.64 1.64 XXX
o dye.
70544............... TC............ A Mr angiography head w/ 0.00 11.19 NA 0.59 11.78 NA XXX
o dye.
70545............... .............. A Mr angiography head w/ 1.20 11.58 NA 0.65 13.43 NA XXX
dye.
70545............... 26............ A Mr angiography head w/ 1.20 0.39 0.39 0.06 1.65 1.65 XXX
dye.
70545............... TC............ A Mr angiography head w/ 0.00 11.19 NA 0.59 11.78 NA XXX
dye.
70546............... .............. A Mr angiograph head w/ 1.80 22.96 NA 0.67 25.43 NA XXX
o&w dye.
70546............... 26............ A Mr angiograph head w/ 1.80 0.59 0.59 0.08 2.47 2.47 XXX
o&w dye.
70546............... TC............ A Mr angiograph head w/ 0.00 22.37 NA 0.59 22.96 NA XXX
o&w dye.
[[Page 47652]]
70547............... .............. A Mr angiography neck w/ 1.20 11.58 NA 0.64 13.42 NA XXX
o dye.
70547............... 26............ A Mr angiography neck w/ 1.20 0.39 0.39 0.05 1.64 1.64 XXX
o dye.
70547............... TC............ A Mr angiography neck w/ 0.00 11.19 NA 0.59 11.78 NA XXX
o dye.
70548............... .............. A Mr angiography neck w/ 1.20 11.58 NA 0.64 13.42 NA XXX
dye.
70548............... 26............ A Mr angiography neck w/ 1.20 0.39 0.39 0.05 1.64 1.64 XXX
dye.
70548............... TC............ A Mr angiography neck w/ 0.00 11.19 NA 0.59 11.78 NA XXX
dye.
70549............... .............. A Mr angiograph neck w/ 1.80 22.97 NA 0.67 25.44 NA XXX
o&w dye.
70549............... 26............ A Mr angiograph neck w/ 1.80 0.59 0.59 0.08 2.47 2.47 XXX
o&w dye.
70549............... TC............ A Mr angiograph neck w/ 0.00 22.37 NA 0.59 22.96 NA XXX
o&w dye.
70551............... .............. A Mri brain w/o dye.... 1.48 11.67 NA 0.66 13.81 NA XXX
70551............... 26............ A Mri brain w/o dye.... 1.48 0.49 0.49 0.07 2.04 2.04 XXX
70551............... TC............ A Mri brain w/o dye.... 0.00 11.19 NA 0.59 11.78 NA XXX
70552............... .............. A Mri brain w/ dye..... 1.78 14.01 NA 0.79 16.58 NA XXX
70552............... 26............ A Mri brain w/ dye..... 1.78 0.59 0.59 0.09 2.46 2.46 XXX
70552............... TC............ A Mri brain w/ dye..... 0.00 13.42 NA 0.70 14.12 NA XXX
70553............... .............. A Mri brain w/o & w/ 2.36 25.62 NA 1.42 29.40 NA XXX
dye.
70553............... 26............ A Mri brain w/o & w/ 2.36 0.77 0.77 0.11 3.24 3.24 XXX
dye.
70553............... TC............ A Mri brain w/o & w/ 0.00 24.84 NA 1.31 26.15 NA XXX
dye.
70557............... 26............ A Mri brain w/o dye.... 2.90 1.12 1.12 0.08 4.10 4.10 XXX
70558............... 26............ A Mri brain w/ dye..... 3.20 1.23 1.23 0.10 4.53 4.53 XXX
70559............... 26............ A Mri brain w/o & w/ 3.20 1.23 1.23 0.12 4.55 4.55 XXX
dye.
71010............... .............. A Chest x-ray.......... 0.18 0.53 NA 0.03 0.74 NA XXX
71010............... 26............ A Chest x-ray.......... 0.18 0.06 0.06 0.01 0.25 0.25 XXX
71010............... TC............ A Chest x-ray.......... 0.00 0.47 NA 0.02 0.49 NA XXX
71015............... .............. A Chest x-ray.......... 0.21 0.59 NA 0.03 0.83 NA XXX
71015............... 26............ A Chest x-ray.......... 0.21 0.07 0.07 0.01 0.29 0.29 XXX
71015............... TC............ A Chest x-ray.......... 0.00 0.52 NA 0.02 0.54 NA XXX
71020............... .............. A Chest x-ray.......... 0.22 0.69 NA 0.05 0.96 NA XXX
71020............... 26............ A Chest x-ray.......... 0.22 0.07 0.07 0.01 0.30 0.30 XXX
71020............... TC............ A Chest x-ray.......... 0.00 0.62 NA 0.04 0.66 NA XXX
71021............... .............. A Chest x-ray.......... 0.27 0.82 NA 0.06 1.15 NA XXX
71021............... 26............ A Chest x-ray.......... 0.27 0.09 0.09 0.01 0.37 0.37 XXX
71021............... TC............ A Chest x-ray.......... 0.00 0.73 NA 0.05 0.78 NA XXX
71022............... .............. A Chest x-ray.......... 0.31 0.83 NA 0.06 1.20 NA XXX
71022............... 26............ A Chest x-ray.......... 0.31 0.10 0.10 0.01 0.42 0.42 XXX
71022............... TC............ A Chest x-ray.......... 0.00 0.73 NA 0.05 0.78 NA XXX
71023............... .............. A Chest x-ray and 0.38 0.91 NA 0.07 1.36 NA XXX
fluoroscopy.
71023............... 26............ A Chest x-ray and 0.38 0.13 0.13 0.02 0.53 0.53 XXX
fluoroscopy.
71023............... TC............ A Chest x-ray and 0.00 0.78 NA 0.05 0.83 NA XXX
fluoroscopy.
71030............... .............. A Chest x-ray.......... 0.31 0.88 NA 0.06 1.25 NA XXX
71030............... 26............ A Chest x-ray.......... 0.31 0.10 0.10 0.01 0.42 0.42 XXX
71030............... TC............ A Chest x-ray.......... 0.00 0.78 NA 0.05 0.83 NA XXX
71034............... .............. A Chest x-ray and 0.46 1.60 NA 0.10 2.16 NA XXX
fluoroscopy.
71034............... 26............ A Chest x-ray and 0.46 0.16 0.16 0.02 0.64 0.64 XXX
fluoroscopy.
71034............... TC............ A Chest x-ray and 0.00 1.44 NA 0.08 1.52 NA XXX
fluoroscopy.
71035............... .............. A Chest x-ray.......... 0.18 0.58 NA 0.03 0.79 NA XXX
71035............... 26............ A Chest x-ray.......... 0.18 0.06 0.06 0.01 0.25 0.25 XXX
71035............... TC............ A Chest x-ray.......... 0.00 0.52 NA 0.02 0.54 NA XXX
71040............... .............. A Contrast x-ray of 0.58 1.65 NA 0.11 2.34 NA XXX
bronchi.
71040............... 26............ A Contrast x-ray of 0.58 0.19 0.19 0.03 0.80 0.80 XXX
bronchi.
71040............... TC............ A Contrast x-ray of 0.00 1.46 NA 0.08 1.54 NA XXX
bronchi.
71060............... .............. A Contrast x-ray of 0.74 2.44 NA 0.17 3.35 NA XXX
bronchi.
71060............... 26............ A Contrast x-ray of 0.74 0.24 0.24 0.04 1.02 1.02 XXX
bronchi.
71060............... TC............ A Contrast x-ray of 0.00 2.20 NA 0.13 2.33 NA XXX
bronchi.
71090............... .............. A X-ray & pacemaker 0.54 1.89 NA 0.13 2.56 NA XXX
insertion.
71090............... 26............ A X-ray & pacemaker 0.54 0.21 0.21 0.02 0.77 0.77 XXX
insertion.
71090............... TC............ A X-ray & pacemaker 0.00 1.68 NA 0.11 1.79 NA XXX
insertion.
71100............... .............. A X-ray exam of ribs... 0.22 0.64 NA 0.05 0.91 NA XXX
71100............... 26............ A X-ray exam of ribs... 0.22 0.07 0.07 0.01 0.30 0.30 XXX
71100............... TC............ A X-ray exam of ribs... 0.00 0.57 NA 0.04 0.61 NA XXX
71101............... .............. A X-ray exam of ribs/ 0.27 0.75 NA 0.05 1.07 NA XXX
chest.
71101............... 26............ A X-ray exam of ribs/ 0.27 0.09 0.09 0.01 0.37 0.37 XXX
chest.
71101............... TC............ A X-ray exam of ribs/ 0.00 0.67 NA 0.04 0.71 NA XXX
chest.
71110............... .............. A X-ray exam of ribs... 0.27 0.87 NA 0.06 1.20 NA XXX
71110............... 26............ A X-ray exam of ribs... 0.27 0.09 0.09 0.01 0.37 0.37 XXX
71110............... TC............ A X-ray exam of ribs... 0.00 0.78 NA 0.05 0.83 NA XXX
71111............... .............. A X-ray exam of ribs/ 0.32 0.99 NA 0.07 1.38 NA XXX
chest.
71111............... 26............ A X-ray exam of ribs/ 0.32 0.10 0.10 0.01 0.43 0.43 XXX
chest.
71111............... TC............ A X-ray exam of ribs/ 0.00 0.89 NA 0.06 0.95 NA XXX
chest.
71120............... .............. A X-ray exam of 0.20 0.71 NA 0.05 0.96 NA XXX
breastbone.
71120............... 26............ A X-ray exam of 0.20 0.07 0.07 0.01 0.28 0.28 XXX
breastbone.
71120............... TC............ A X-ray exam of 0.00 0.65 NA 0.04 0.69 NA XXX
breastbone.
71130............... .............. A X-ray exam of 0.22 0.78 NA 0.05 1.05 NA XXX
breastbone.
71130............... 26............ A X-ray exam of 0.22 0.07 0.07 0.01 0.30 0.30 XXX
breastbone.
71130............... TC............ A X-ray exam of 0.00 0.70 NA 0.04 0.74 NA XXX
breastbone.
[[Page 47653]]
71250............... .............. A Ct thorax w/o dye.... 1.16 6.28 NA 0.36 7.80 NA XXX
71250............... 26............ A Ct thorax w/o dye.... 1.16 0.38 0.38 0.05 1.59 1.59 XXX
71250............... TC............ A Ct thorax w/o dye.... 0.00 5.90 NA 0.31 6.21 NA XXX
71260............... .............. A Ct thorax w/dye...... 1.24 7.46 NA 0.43 9.13 NA XXX
71260............... 26............ A Ct thorax w/dye...... 1.24 0.40 0.40 0.06 1.70 1.70 XXX
71260............... TC............ A Ct thorax w/dye...... 0.00 7.06 NA 0.37 7.43 NA XXX
71270............... .............. A Ct thorax w/o & w/ 1.38 9.28 NA 0.52 11.18 NA XXX
dye.
71270............... 26............ A Ct thorax w/o & w/ 1.38 0.45 0.45 0.06 1.89 1.89 XXX
dye.
71270............... TC............ A Ct thorax w/o & w/ 0.00 8.83 NA 0.46 9.29 NA XXX
dye.
71275............... .............. A Ct angiography, chest 1.92 12.99 NA 0.48 15.39 NA XXX
71275............... 26............ A Ct angiography, chest 1.92 0.63 0.63 0.09 2.64 2.64 XXX
71275............... TC............ A Ct angiography, chest 0.00 12.36 NA 0.39 12.75 NA XXX
71550............... .............. A Mri chest w/o dye.... 1.46 11.66 NA 0.52 13.64 NA XXX
71550............... 26............ A Mri chest w/o dye.... 1.46 0.48 0.48 0.07 2.01 2.01 XXX
71550............... TC............ A Mri chest w/o dye.... 0.00 11.19 NA 0.45 11.64 NA XXX
71551............... .............. A Mri chest w/dye...... 1.73 13.98 NA 0.60 16.31 NA XXX
71551............... 26............ A Mri chest w/dye...... 1.73 0.56 0.56 0.08 2.37 2.37 XXX
71551............... TC............ A Mri chest w/dye...... 0.00 13.42 NA 0.52 13.94 NA XXX
71552............... .............. A Mri chest w/o & w/dye 2.26 25.58 NA 0.78 28.62 NA XXX
71552............... 26............ A Mri chest w/o & w/dye 2.26 0.74 0.74 0.10 3.10 3.10 XXX
71552............... TC............ A Mri chest w/o & w/dye 0.00 24.84 NA 0.68 25.52 NA XXX
71555............... .............. R Mri angio chest w or 1.81 11.78 NA 0.67 14.26 NA XXX
w/o dye.
71555............... 26............ R Mri angio chest w or 1.81 0.60 0.60 0.08 2.49 2.49 XXX
w/o dye.
71555............... TC............ R Mri angio chest w or 0.00 11.19 NA 0.59 11.78 NA XXX
w/o dye.
72010............... .............. A X-ray exam of spine.. 0.45 1.17 NA 0.08 1.70 NA XXX
72010............... 26............ A X-ray exam of spine.. 0.45 0.15 0.15 0.02 0.62 0.62 XXX
72010............... TC............ A X-ray exam of spine.. 0.00 1.02 NA 0.06 1.08 NA XXX
72020............... .............. A X-ray exam of spine.. 0.15 0.46 NA 0.03 0.64 NA XXX
72020............... 26............ A X-ray exam of spine.. 0.15 0.05 0.05 0.01 0.21 0.21 XXX
72020............... TC............ A X-ray exam of spine.. 0.00 0.42 NA 0.02 0.44 NA XXX
72040............... .............. A X-ray exam of neck 0.22 0.67 NA 0.05 0.94 NA XXX
spine.
72040............... 26............ A X-ray exam of neck 0.22 0.07 0.07 0.01 0.30 0.30 XXX
spine.
72040............... TC............ A X-ray exam of neck 0.00 0.60 NA 0.04 0.64 NA XXX
spine.
72050............... .............. A X-ray exam of neck 0.31 0.99 NA 0.07 1.37 NA XXX
spine.
72050............... 26............ A X-ray exam of neck 0.31 0.10 0.10 0.01 0.42 0.42 XXX
spine.
72050............... TC............ A X-ray exam of neck 0.00 0.89 NA 0.06 0.95 NA XXX
spine.
72052............... .............. A X-ray exam of neck 0.36 1.25 NA 0.08 1.69 NA XXX
spine.
72052............... 26............ A X-ray exam of neck 0.36 0.12 0.12 0.02 0.50 0.50 XXX
spine.
72052............... TC............ A X-ray exam of neck 0.00 1.13 NA 0.06 1.19 NA XXX
spine.
72069............... .............. A X-ray exam of trunk 0.22 0.57 NA 0.03 0.82 NA XXX
spine.
72069............... 26............ A X-ray exam of trunk 0.22 0.08 0.08 0.01 0.31 0.31 XXX
spine.
72069............... TC............ A X-ray exam of trunk 0.00 0.49 NA 0.02 0.51 NA XXX
spine.
72070............... .............. A X-ray exam of 0.22 0.72 NA 0.05 0.99 NA XXX
thoracic spine.
72070............... 26............ A X-ray exam of 0.22 0.07 0.07 0.01 0.30 0.30 XXX
thoracic spine.
72070............... TC............ A X-ray exam of 0.00 0.65 NA 0.04 0.69 NA XXX
thoracic spine.
72072............... .............. A X-ray exam of 0.22 0.81 NA 0.06 1.09 NA XXX
thoracic spine.
72072............... 26............ A X-ray exam of 0.22 0.07 0.07 0.01 0.30 0.30 XXX
thoracic spine.
72072............... TC............ A X-ray exam of 0.00 0.73 NA 0.05 0.78 NA XXX
thoracic spine.
72074............... .............. A X-ray exam of 0.22 0.98 NA 0.07 1.27 NA XXX
thoracic spine.
72074............... 26............ A X-ray exam of 0.22 0.07 0.07 0.01 0.30 0.30 XXX
thoracic spine.
72074............... TC............ A X-ray exam of 0.00 0.91 NA 0.06 0.97 NA XXX
thoracic spine.
72080............... .............. A X-ray exam of trunk 0.22 0.74 NA 0.05 1.01 NA XXX
spine.
72080............... 26............ A X-ray exam of trunk 0.22 0.07 0.07 0.01 0.30 0.30 XXX
spine.
72080............... TC............ A X-ray exam of trunk 0.00 0.67 NA 0.04 0.71 NA XXX
spine.
72090............... .............. A X-ray exam of trunk 0.28 0.76 NA 0.05 1.09 NA XXX
spine.
72090............... 26............ A X-ray exam of trunk 0.28 0.09 0.09 0.01 0.38 0.38 XXX
spine.
72090............... TC............ A X-ray exam of trunk 0.00 0.67 NA 0.04 0.71 NA XXX
spine.
72100............... .............. A X-ray exam of lower 0.22 0.74 NA 0.05 1.01 NA XXX
spine.
72100............... 26............ A X-ray exam of lower 0.22 0.07 0.07 0.01 0.30 0.30 XXX
spine.
72100............... TC............ A X-ray exam of lower 0.00 0.67 NA 0.04 0.71 NA XXX
spine.
72110............... .............. A X-ray exam of lower 0.31 1.01 NA 0.07 1.39 NA XXX
spine.
72110............... 26............ A X-ray exam of lower 0.31 0.10 0.10 0.01 0.42 0.42 XXX
spine.
72110............... TC............ A X-ray exam of lower 0.00 0.91 NA 0.06 0.97 NA XXX
spine.
72114............... .............. A X-ray exam of lower 0.36 1.31 NA 0.08 1.75 NA XXX
spine.
72114............... 26............ A X-ray exam of lower 0.36 0.12 0.12 0.02 0.50 0.50 XXX
spine.
72114............... TC............ A X-ray exam of lower 0.00 1.19 NA 0.06 1.25 NA XXX
spine.
72120............... .............. A X-ray exam of lower 0.22 0.96 NA 0.07 1.25 NA XXX
spine.
72120............... 26............ A X-ray exam of lower 0.22 0.07 0.07 0.01 0.30 0.30 XXX
spine.
72120............... TC............ A X-ray exam of lower 0.00 0.89 NA 0.06 0.95 NA XXX
spine.
72125............... .............. A Ct neck spine w/o dye 1.16 6.28 NA 0.36 7.80 NA XXX
72125............... 26............ A Ct neck spine w/o dye 1.16 0.38 0.38 0.05 1.59 1.59 XXX
72125............... TC............ A Ct neck spine w/o dye 0.00 5.90 NA 0.31 6.21 NA XXX
72126............... .............. A Ct neck spine w/dye.. 1.22 7.45 NA 0.43 9.10 NA XXX
72126............... 26............ A Ct neck spine w/dye.. 1.22 0.40 0.40 0.06 1.68 1.68 XXX
72126............... TC............ A Ct neck spine w/dye.. 0.00 7.06 NA 0.37 7.43 NA XXX
[[Page 47654]]
72127............... .............. A Ct neck spine w/o & w/ 1.27 9.25 NA 0.52 11.04 NA XXX
dye.
72127............... 26............ A Ct neck spine w/o & w/ 1.27 0.42 0.42 0.06 1.75 1.75 XXX
dye.
72127............... TC............ A Ct neck spine w/o & w/ 0.00 8.83 NA 0.46 9.29 NA XXX
dye.
72128............... .............. A Ct chest spine w/o 1.16 6.28 NA 0.36 7.80 NA XXX
dye.
72128............... 26............ A Ct chest spine w/o 1.16 0.38 0.38 0.05 1.59 1.59 XXX
dye.
72128............... TC............ A Ct chest spine w/o 0.00 5.90 NA 0.31 6.21 NA XXX
dye.
72129............... .............. A Ct chest spine w/dye. 1.22 7.45 NA 0.43 9.10 NA XXX
72129............... 26............ A Ct chest spine w/dye. 1.22 0.40 0.40 0.06 1.68 1.68 XXX
72129............... TC............ A Ct chest spine w/dye. 0.00 7.06 NA 0.37 7.43 NA XXX
72130............... .............. A Ct chest spine w/o & 1.27 9.25 NA 0.52 11.04 NA XXX
w/dye.
72130............... 26............ A Ct chest spine w/o & 1.27 0.42 0.42 0.06 1.75 1.75 XXX
w/dye.
72130............... TC............ A Ct chest spine w/o & 0.00 8.83 NA 0.46 9.29 NA XXX
w/dye.
72131............... .............. A Ct lumbar spine w/o 1.16 6.28 NA 0.36 7.80 NA XXX
dye.
72131............... 26............ A Ct lumbar spine w/o 1.16 0.38 0.38 0.05 1.59 1.59 XXX
dye.
72131............... TC............ A Ct lumbar spine w/o 0.00 5.90 NA 0.31 6.21 NA XXX
dye.
72132............... .............. A Ct lumbar spine w/dye 1.22 7.45 NA 0.43 9.10 NA XXX
72132............... 26............ A Ct lumbar spine w/dye 1.22 0.40 0.40 0.06 1.68 1.68 XXX
72132............... TC............ A Ct lumbar spine w/dye 0.00 7.06 NA 0.37 7.43 NA XXX
72133............... .............. A Ct lumbar spine w/o & 1.27 9.25 NA 0.52 11.04 NA XXX
w/dye.
72133............... 26............ A Ct lumbar spine w/o & 1.27 0.42 0.42 0.06 1.75 1.75 XXX
w/dye.
72133............... TC............ A Ct lumbar spine w/o & 0.00 8.83 NA 0.46 9.29 NA XXX
w/dye.
72141............... .............. A Mri neck spine w/o 1.60 11.71 NA 0.66 13.97 NA XXX
dye.
72141............... 26............ A Mri neck spine w/o 1.60 0.53 0.53 0.07 2.20 2.20 XXX
dye.
72141............... TC............ A Mri neck spine w/o 0.00 11.19 NA 0.59 11.78 NA XXX
dye.
72142............... .............. A Mri neck spine w/dye. 1.92 14.06 NA 0.79 16.77 NA XXX
72142............... 26............ A Mri neck spine w/dye. 1.92 0.64 0.64 0.09 2.65 2.65 XXX
72142............... TC............ A Mri neck spine w/dye. 0.00 13.42 NA 0.70 14.12 NA XXX
72146............... .............. A Mri chest spine w/o 1.60 12.95 NA 0.71 15.26 NA XXX
dye.
72146............... 26............ A Mri chest spine w/o 1.60 0.52 0.52 0.07 2.19 2.19 XXX
dye.
72146............... TC............ A Mri chest spine w/o 0.00 12.42 NA 0.64 13.06 NA XXX
dye.
72147............... .............. A Mri chest spine w/dye 1.92 14.05 NA 0.79 16.76 NA XXX
72147............... 26............ A Mri chest spine w/dye 1.92 0.63 0.63 0.09 2.64 2.64 XXX
72147............... TC............ A Mri chest spine w/dye 0.00 13.42 NA 0.70 14.12 NA XXX
72148............... .............. A Mri lumbar spine w/o 1.48 12.91 NA 0.71 15.10 NA XXX
dye.
72148............... 26............ A Mri lumbar spine w/o 1.48 0.49 0.49 0.07 2.04 2.04 XXX
dye.
72148............... TC............ A Mri lumbar spine w/o 0.00 12.42 NA 0.64 13.06 NA XXX
dye.
72149............... .............. A Mri lumbar spine w/ 1.78 14.01 NA 0.79 16.58 NA XXX
dye.
72149............... 26............ A Mri lumbar spine w/ 1.78 0.59 0.59 0.09 2.46 2.46 XXX
dye.
72149............... TC............ A Mri lumbar spine w/ 0.00 13.42 NA 0.70 14.12 NA XXX
dye.
72156............... .............. A Mri neck spine w/o & 2.57 25.69 NA 1.43 29.69 NA XXX
w/dye.
72156............... 26............ A Mri neck spine w/o & 2.57 0.85 0.85 0.12 3.54 3.54 XXX
w/dye.
72156............... TC............ A Mri neck spine w/o & 0.00 24.84 NA 1.31 26.15 NA XXX
w/dye.
72157............... .............. A Mri chest spine w/o & 2.57 25.68 NA 1.43 29.68 NA XXX
w/dye.
72157............... 26............ A Mri chest spine w/o & 2.57 0.84 0.84 0.12 3.53 3.53 XXX
w/dye.
72157............... TC............ A Mri chest spine w/o & 0.00 24.84 NA 1.31 26.15 NA XXX
w/dye.
72158............... .............. A Mri lumbar spine w/o 2.36 25.62 NA 1.42 29.40 NA XXX
& w/dye.
72158............... 26............ A Mri lumbar spine w/o 2.36 0.77 0.77 0.11 3.24 3.24 XXX
& w/dye.
72158............... TC............ A Mri lumbar spine w/o 0.00 24.84 NA 1.31 26.15 NA XXX
& w/dye.
72170............... .............. A X-ray exam of pelvis. 0.17 0.58 NA 0.03 0.78 NA XXX
72170............... 26............ A X-ray exam of pelvis. 0.17 0.06 0.06 0.01 0.24 0.24 XXX
72170............... TC............ A X-ray exam of pelvis. 0.00 0.52 NA 0.02 0.54 NA XXX
72190............... .............. A X-ray exam of pelvis. 0.21 0.74 NA 0.05 1.00 NA XXX
72190............... 26............ A X-ray exam of pelvis. 0.21 0.07 0.07 0.01 0.29 0.29 XXX
72190............... TC............ A X-ray exam of pelvis. 0.00 0.67 NA 0.04 0.71 NA XXX
72191............... .............. A Ct angiograph pelv w/ 1.81 12.60 NA 0.47 14.88 NA XXX
o&w/dye.
72191............... 26............ A Ct angiograph pelv w/ 1.81 0.60 0.60 0.08 2.49 2.49 XXX
o&w/dye.
72191............... TC............ A Ct angiograph pelv w/ 0.00 12.01 NA 0.39 12.40 NA XXX
o&w/dye.
72192............... .............. A Ct pelvis w/o dye.... 1.09 6.25 NA 0.36 7.70 NA XXX
72192............... 26............ A Ct pelvis w/o dye.... 1.09 0.36 0.36 0.05 1.50 1.50 XXX
72192............... TC............ A Ct pelvis w/o dye.... 0.00 5.90 NA 0.31 6.21 NA XXX
72193............... .............. A Ct pelvis w/dye...... 1.16 7.21 NA 0.41 8.78 NA XXX
72193............... 26............ A Ct pelvis w/dye...... 1.16 0.38 0.38 0.05 1.59 1.59 XXX
72193............... TC............ A Ct pelvis w/dye...... 0.00 6.83 NA 0.36 7.19 NA XXX
72194............... .............. A Ct pelvis w/o & w/dye 1.22 8.87 NA 0.48 10.57 NA XXX
72194............... 26............ A Ct pelvis w/o & w/dye 1.22 0.40 0.40 0.05 1.67 1.67 XXX
72194............... TC............ A Ct pelvis w/o & w/dye 0.00 8.47 NA 0.43 8.90 NA XXX
72195............... .............. A Mri pelvis w/o dye... 1.46 11.66 NA 0.52 13.64 NA XXX
72195............... 26............ A Mri pelvis w/o dye... 1.46 0.48 0.48 0.07 2.01 2.01 XXX
72195............... TC............ A Mri pelvis w/o dye... 0.00 11.19 NA 0.45 11.64 NA XXX
72196............... .............. A Mri pelvis w/dye..... 1.73 13.98 NA 0.60 16.31 NA XXX
72196............... 26............ A Mri pelvis w/dye..... 1.73 0.56 0.56 0.08 2.37 2.37 XXX
72196............... TC............ A Mri pelvis w/dye..... 0.00 13.42 NA 0.52 13.94 NA XXX
72197............... .............. A Mri pelvis w/o & w/ 2.26 25.58 NA 1.02 28.86 NA XXX
dye.
72197............... 26............ A Mri pelvis w/o & w/ 2.26 0.74 0.74 0.10 3.10 3.10 XXX
dye.
72197............... TC............ A Mri pelvis w/o & w/ 0.00 24.84 NA 0.92 25.76 NA XXX
dye.
[[Page 47655]]
72198............... .............. A Mr angio pelvis w/o & 1.80 11.77 NA 0.69 14.26 NA XXX
w/dye.
72198............... 26............ A Mr angio pelvis w/o & 1.80 0.59 0.59 0.10 2.49 2.49 XXX
w/dye.
72198............... TC............ A Mr angio pelvis w/o & 0.00 11.19 NA 0.59 11.78 NA XXX
w/dye.
72200............... .............. A X-ray exam sacroiliac 0.17 0.58 NA 0.03 0.78 NA XXX
joints.
72200............... 26............ A X-ray exam sacroiliac 0.17 0.06 0.06 0.01 0.24 0.24 XXX
joints.
72200............... TC............ A X-ray exam sacroiliac 0.00 0.52 NA 0.02 0.54 NA XXX
joints.
72202............... .............. A X-ray exam sacroiliac 0.19 0.68 NA 0.05 0.92 NA XXX
joints.
72202............... 26............ A X-ray exam sacroiliac 0.19 0.06 0.06 0.01 0.26 0.26 XXX
joints.
72202............... TC............ A X-ray exam sacroiliac 0.00 0.62 NA 0.04 0.66 NA XXX
joints.
72220............... .............. A X-ray exam of 0.17 0.63 NA 0.05 0.85 NA XXX
tailbone.
72220............... 26............ A X-ray exam of 0.17 0.06 0.06 0.01 0.24 0.24 XXX
tailbone.
72220............... TC............ A X-ray exam of 0.00 0.57 NA 0.04 0.61 NA XXX
tailbone.
72240............... .............. A Contrast x-ray of 0.91 5.03 NA 0.29 6.23 NA XXX
neck spine.
72240............... 26............ A Contrast x-ray of 0.91 0.29 0.29 0.04 1.24 1.24 XXX
neck spine.
72240............... TC............ A Contrast x-ray of 0.00 4.74 NA 0.25 4.99 NA XXX
neck spine.
72255............... .............. A Contrast x-ray, 0.91 4.59 NA 0.26 5.76 NA XXX
thorax spine.
72255............... 26............ A Contrast x-ray, 0.91 0.27 0.27 0.04 1.22 1.22 XXX
thorax spine.
72255............... TC............ A Contrast x-ray, 0.00 4.32 NA 0.22 4.54 NA XXX
thorax spine.
72265............... .............. A Contrast x-ray, lower 0.83 4.32 NA 0.26 5.41 NA XXX
spine.
72265............... 26............ A Contrast x-ray, lower 0.83 0.25 0.25 0.04 1.12 1.12 XXX
spine.
72265............... TC............ A Contrast x-ray, lower 0.00 4.06 NA 0.22 4.28 NA XXX
spine.
72270............... .............. A Contrast x-ray, spine 1.33 6.51 NA 0.40 8.24 NA XXX
72270............... 26............ A Contrast x-ray, spine 1.33 0.42 0.42 0.07 1.82 1.82 XXX
72270............... TC............ A Contrast x-ray, spine 0.00 6.09 NA 0.33 6.42 NA XXX
72275............... .............. A Epidurography........ 0.76 2.29 NA 0.27 3.32 NA XXX
72275............... 26............ A Epidurography........ 0.76 0.20 0.20 0.05 1.01 1.01 XXX
72275............... TC............ A Epidurography........ 0.00 2.09 NA 0.22 2.31 NA XXX
72285............... .............. A X-ray c/t spine disk. 1.16 8.72 NA 0.50 10.38 NA XXX
72285............... 26............ A X-ray c/t spine disk. 1.16 0.35 0.35 0.07 1.58 1.58 XXX
72285............... TC............ A X-ray c/t spine disk. 0.00 8.37 NA 0.43 8.80 NA XXX
72295............... .............. A X-ray of lower spine 0.83 8.11 NA 0.46 9.40 NA XXX
disk.
72295............... 26............ A X-ray of lower spine 0.83 0.27 0.27 0.06 1.16 1.16 XXX
disk.
72295............... TC............ A X-ray of lower spine 0.00 7.85 NA 0.40 8.25 NA XXX
disk.
73000............... .............. A X-ray exam of collar 0.16 0.57 NA 0.03 0.76 NA XXX
bone.
73000............... 26............ A X-ray exam of collar 0.16 0.05 0.05 0.01 0.22 0.22 XXX
bone.
73000............... TC............ A X-ray exam of collar 0.00 0.52 NA 0.02 0.54 NA XXX
bone.
73010............... .............. A X-ray exam of 0.17 0.58 NA 0.03 0.78 NA XXX
shoulder blade.
73010............... 26............ A X-ray exam of 0.17 0.06 0.06 0.01 0.24 0.24 XXX
shoulder blade.
73010............... TC............ A X-ray exam of 0.00 0.52 NA 0.02 0.54 NA XXX
shoulder blade.
73020............... .............. A X-ray exam of 0.15 0.52 NA 0.03 0.70 NA XXX
shoulder.
73020............... 26............ A X-ray exam of 0.15 0.05 0.05 0.01 0.21 0.21 XXX
shoulder.
73020............... TC............ A X-ray exam of 0.00 0.47 NA 0.02 0.49 NA XXX
shoulder.
73030............... .............. A X-ray exam of 0.18 0.63 NA 0.05 0.86 NA XXX
shoulder.
73030............... 26............ A X-ray exam of 0.18 0.06 0.06 0.01 0.25 0.25 XXX
shoulder.
73030............... TC............ A X-ray exam of 0.00 0.57 NA 0.04 0.61 NA XXX
shoulder.
73040............... .............. A Contrast x-ray of 0.54 2.27 NA 0.14 2.95 NA XXX
shoulder.
73040............... 26............ A Contrast x-ray of 0.54 0.18 0.18 0.02 0.74 0.74 XXX
shoulder.
73040............... TC............ A Contrast x-ray of 0.00 2.09 NA 0.12 2.21 NA XXX
shoulder.
73050............... .............. A X-ray exam of 0.20 0.73 NA 0.05 0.98 NA XXX
shoulders.
73050............... 26............ A X-ray exam of 0.20 0.07 0.07 0.01 0.28 0.28 XXX
shoulders.
73050............... TC............ A X-ray exam of 0.00 0.67 NA 0.04 0.71 NA XXX
shoulders.
73060............... .............. A X-ray exam of humerus 0.17 0.63 NA 0.05 0.85 NA XXX
73060............... 26............ A X-ray exam of humerus 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73060............... TC............ A X-ray exam of humerus 0.00 0.57 NA 0.04 0.61 NA XXX
73070............... .............. A X-ray exam of elbow.. 0.15 0.57 NA 0.03 0.75 NA XXX
73070............... 26............ A X-ray exam of elbow.. 0.15 0.05 0.05 0.01 0.21 0.21 XXX
73070............... TC............ A X-ray exam of elbow.. 0.00 0.52 NA 0.02 0.54 NA XXX
73080............... .............. A X-ray exam of elbow.. 0.17 0.63 NA 0.05 0.85 NA XXX
73080............... 26............ A X-ray exam of elbow.. 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73080............... TC............ A X-ray exam of elbow.. 0.00 0.57 NA 0.04 0.61 NA XXX
73085............... .............. A Contrast x-ray of 0.54 2.28 NA 0.15 2.97 NA XXX
elbow.
73085............... 26............ A Contrast x-ray of 0.54 0.18 0.18 0.03 0.75 0.75 XXX
elbow.
73085............... TC............ A Contrast x-ray of 0.00 2.09 NA 0.12 2.21 NA XXX
elbow.
73090............... .............. A X-ray exam of forearm 0.16 0.57 NA 0.03 0.76 NA XXX
73090............... 26............ A X-ray exam of forearm 0.16 0.05 0.05 0.01 0.22 0.22 XXX
73090............... TC............ A X-ray exam of forearm 0.00 0.52 NA 0.02 0.54 NA XXX
73092............... .............. A X-ray exam of arm, 0.16 0.54 NA 0.03 0.73 NA XXX
infant.
73092............... 26............ A X-ray exam of arm, 0.16 0.05 0.05 0.01 0.22 0.22 XXX
infant.
73092............... TC............ A X-ray exam of arm, 0.00 0.49 NA 0.02 0.51 NA XXX
infant.
73100............... .............. A X-ray exam of wrist.. 0.16 0.55 NA 0.03 0.74 NA XXX
73100............... 26............ A X-ray exam of wrist.. 0.16 0.05 0.05 0.01 0.22 0.22 XXX
73100............... TC............ A X-ray exam of wrist.. 0.00 0.49 NA 0.02 0.51 NA XXX
73110............... .............. A X-ray exam of wrist.. 0.17 0.59 NA 0.03 0.79 NA XXX
73110............... 26............ A X-ray exam of wrist.. 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73110............... TC............ A X-ray exam of wrist.. 0.00 0.53 NA 0.02 0.55 NA XXX
[[Page 47656]]
73115............... .............. A Contrast x-ray of 0.54 1.76 NA 0.13 2.43 NA XXX
wrist.
73115............... 26............ A Contrast x-ray of 0.54 0.18 0.18 0.03 0.75 0.75 XXX
wrist.
73115............... TC............ A Contrast x-ray of 0.00 1.57 NA 0.10 1.67 NA XXX
wrist.
73120............... .............. A X-ray exam of hand... 0.16 0.55 NA 0.03 0.74 NA XXX
73120............... 26............ A X-ray exam of hand... 0.16 0.05 0.05 0.01 0.22 0.22 XXX
73120............... TC............ A X-ray exam of hand... 0.00 0.49 NA 0.02 0.51 NA XXX
73130............... .............. A X-ray exam of hand... 0.17 0.59 NA 0.03 0.79 NA XXX
73130............... 26............ A X-ray exam of hand... 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73130............... TC............ A X-ray exam of hand... 0.00 0.53 NA 0.02 0.55 NA XXX
73140............... .............. A X-ray exam of 0.13 0.46 NA 0.03 0.62 NA XXX
finger(s).
73140............... 26............ A X-ray exam of 0.13 0.04 0.04 0.01 0.18 0.18 XXX
finger(s).
73140............... TC............ A X-ray exam of 0.00 0.42 NA 0.02 0.44 NA XXX
finger(s).
73200............... .............. A Ct upper extremity w/ 1.09 5.31 NA 0.30 6.70 NA XXX
o dye.
73200............... 26............ A Ct upper extremity w/ 1.09 0.36 0.36 0.05 1.50 1.50 XXX
o dye.
73200............... TC............ A Ct upper extremity w/ 0.00 4.95 NA 0.25 5.20 NA XXX
o dye.
73201............... .............. A Ct upper extremity w/ 1.16 6.28 NA 0.36 7.80 NA XXX
dye.
73201............... 26............ A Ct upper extremity w/ 1.16 0.38 0.38 0.05 1.59 1.59 XXX
dye.
73201............... TC............ A Ct upper extremity w/ 0.00 5.90 NA 0.31 6.21 NA XXX
dye.
73202............... .............. A Ct uppr extremity w/ 1.22 7.81 NA 0.44 9.47 NA XXX
o&w/dye.
73202............... 26............ A Ct uppr extremity w/ 1.22 0.40 0.40 0.05 1.67 1.67 XXX
o&w/dye.
73202............... TC............ A Ct uppr extremity w/ 0.00 7.41 NA 0.39 7.80 NA XXX
o&w/dye.
73206............... .............. A Ct angio upr extrm w/ 1.81 11.54 NA 0.47 13.82 NA XXX
o&w/dye.
73206............... 26............ A Ct angio upr extrm w/ 1.81 0.59 0.59 0.08 2.48 2.48 XXX
o&w/dye.
73206............... TC............ A Ct angio upr extrm w/ 0.00 10.94 NA 0.39 11.33 NA XXX
o&w/dye.
73218............... .............. A Mri upper extremity w/ 1.35 11.63 NA 0.45 13.43 NA XXX
o dye.
73218............... 26............ A Mri upper extremity w/ 1.35 0.44 0.44 0.06 1.85 1.85 XXX
o dye.
73218............... TC............ A Mri upper extremity w/ 0.00 11.19 NA 0.39 11.58 NA XXX
o dye.
73219............... .............. A Mri upper extremity w/ 1.62 13.95 NA 0.54 16.11 NA XXX
dye.
73219............... 26............ A Mri upper extremity w/ 1.62 0.53 0.53 0.07 2.22 2.22 XXX
dye.
73219............... TC............ A Mri upper extremity w/ 0.00 13.42 NA 0.47 13.89 NA XXX
dye.
73220............... .............. A Mri uppr extremity w/ 2.15 25.55 NA 0.94 28.64 NA XXX
o&w/dye.
73220............... 26............ A Mri uppr extremity w/ 2.15 0.71 0.71 0.10 2.96 2.96 XXX
o&w/dye.
73220............... TC............ A Mri uppr extremity w/ 0.00 24.84 NA 0.84 25.68 NA XXX
o&w/dye.
73221............... .............. A Mri joint upr extrem 1.35 11.63 NA 0.45 13.43 NA XXX
w/o dye.
73221............... 26............ A Mri joint upr extrem 1.35 0.44 0.44 0.06 1.85 1.85 XXX
w/o dye.
73221............... TC............ A Mri joint upr extrem 0.00 11.19 NA 0.39 11.58 NA XXX
w/o dye.
73222............... .............. A Mri joint upr extrem 1.62 13.95 NA 0.54 16.11 NA XXX
w/dye.
73222............... 26............ A Mri joint upr extrem 1.62 0.53 0.53 0.07 2.22 2.22 XXX
w/dye.
73222............... TC............ A Mri joint upr extrem 0.00 13.42 NA 0.47 13.89 NA XXX
w/dye.
73223............... .............. A Mri joint upr extr w/ 2.15 25.55 NA 0.94 28.64 NA XXX
o&w/dye.
73223............... 26............ A Mri joint upr extr w/ 2.15 0.71 0.71 0.10 2.96 2.96 XXX
o&w/dye.
73223............... TC............ A Mri joint upr extr w/ 0.00 24.84 NA 0.84 25.68 NA XXX
o&w/dye.
73500............... .............. A X-ray exam of hip.... 0.17 0.53 NA 0.03 0.73 NA XXX
73500............... 26............ A X-ray exam of hip.... 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73500............... TC............ A X-ray exam of hip.... 0.00 0.47 NA 0.02 0.49 NA XXX
73510............... .............. A X-ray exam of hip.... 0.21 0.64 NA 0.05 0.90 NA XXX
73510............... 26............ A X-ray exam of hip.... 0.21 0.07 0.07 0.01 0.29 0.29 XXX
73510............... TC............ A X-ray exam of hip.... 0.00 0.57 NA 0.04 0.61 NA XXX
73520............... .............. A X-ray exam of hips... 0.26 0.75 NA 0.05 1.06 NA XXX
73520............... 26............ A X-ray exam of hips... 0.26 0.09 0.09 0.01 0.36 0.36 XXX
73520............... TC............ A X-ray exam of hips... 0.00 0.67 NA 0.04 0.71 NA XXX
73525............... .............. A Contrast x-ray of hip 0.54 2.27 NA 0.15 2.96 NA XXX
73525............... 26............ A Contrast x-ray of hip 0.54 0.18 0.18 0.03 0.75 0.75 XXX
73525............... TC............ A Contrast x-ray of hip 0.00 2.09 NA 0.12 2.21 NA XXX
73530............... .............. A X-ray exam of hip.... 0.29 0.62 NA 0.03 0.94 NA XXX
73530............... 26............ A X-ray exam of hip.... 0.29 0.10 0.10 0.01 0.40 0.40 XXX
73530............... TC............ A X-ray exam of hip.... 0.00 0.52 NA 0.02 0.54 NA XXX
73540............... .............. A X-ray exam of pelvis 0.20 0.64 NA 0.05 0.89 NA XXX
& hips.
73540............... 26............ A X-ray exam of pelvis 0.20 0.07 0.07 0.01 0.28 0.28 XXX
& hips.
73540............... TC............ A X-ray exam of pelvis 0.00 0.57 NA 0.04 0.61 NA XXX
& hips.
73542............... .............. A X-ray exam, 0.59 2.25 NA 0.15 2.99 NA XXX
sacroiliac joint.
73542............... 26............ A X-ray exam, 0.59 0.16 0.16 0.03 0.78 0.78 XXX
sacroiliac joint.
73542............... TC............ A X-ray exam, 0.00 2.09 NA 0.12 2.21 NA XXX
sacroiliac joint.
73550............... .............. A X-ray exam of thigh.. 0.17 0.63 NA 0.05 0.85 NA XXX
73550............... 26............ A X-ray exam of thigh.. 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73550............... TC............ A X-ray exam of thigh.. 0.00 0.57 NA 0.04 0.61 NA XXX
73560............... .............. A X-ray exam of knee, 1 0.17 0.58 NA 0.03 0.78 NA XXX
or 2.
73560............... 26............ A X-ray exam of knee, 1 0.17 0.06 0.06 0.01 0.24 0.24 XXX
or 2.
73560............... TC............ A X-ray exam of knee, 1 0.00 0.52 NA 0.02 0.54 NA XXX
or 2.
73562............... .............. A X-ray exam of knee, 3 0.18 0.63 NA 0.05 0.86 NA XXX
73562............... 26............ A X-ray exam of knee, 3 0.18 0.06 0.06 0.01 0.25 0.25 XXX
73562............... TC............ A X-ray exam of knee, 3 0.00 0.57 NA 0.04 0.61 NA XXX
73564............... .............. A X-ray exam, knee, 4 0.22 0.69 NA 0.05 0.96 NA XXX
or more.
73564............... 26............ A X-ray exam, knee, 4 0.22 0.07 0.07 0.01 0.30 0.30 XXX
or more.
73564............... TC............ A X-ray exam, knee, 4 0.00 0.62 NA 0.04 0.66 NA XXX
or more.
[[Page 47657]]
73565............... .............. A X-ray exam of knees.. 0.17 0.55 NA 0.03 0.75 NA XXX
73565............... 26............ A X-ray exam of knees.. 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73565............... TC............ A X-ray exam of knees.. 0.00 0.49 NA 0.02 0.51 NA XXX
73580............... .............. A Contrast x-ray of 0.54 2.79 NA 0.17 3.50 NA XXX
knee joint.
73580............... 26............ A Contrast x-ray of 0.54 0.17 0.17 0.03 0.74 0.74 XXX
knee joint.
73580............... TC............ A Contrast x-ray of 0.00 2.62 NA 0.14 2.76 NA XXX
knee joint.
73590............... .............. A X-ray exam of lower 0.17 0.58 NA 0.03 0.78 NA XXX
leg.
73590............... 26............ A X-ray exam of lower 0.17 0.06 0.06 0.01 0.24 0.24 XXX
leg.
73590............... TC............ A X-ray exam of lower 0.00 0.52 NA 0.02 0.54 NA XXX
leg.
73592............... .............. A X-ray exam of leg, 0.16 0.55 NA 0.03 0.74 NA XXX
infant.
73592............... 26............ A X-ray exam of leg, 0.16 0.05 0.05 0.01 0.22 0.22 XXX
infant.
73592............... TC............ A X-ray exam of leg, 0.00 0.49 NA 0.02 0.51 NA XXX
infant.
73600............... .............. A X-ray exam of ankle.. 0.16 0.55 NA 0.03 0.74 NA XXX
73600............... 26............ A X-ray exam of ankle.. 0.16 0.05 0.05 0.01 0.22 0.22 XXX
73600............... TC............ A X-ray exam of ankle.. 0.00 0.49 NA 0.02 0.51 NA XXX
73610............... .............. A X-ray exam of ankle.. 0.17 0.59 NA 0.03 0.79 NA XXX
73610............... 26............ A X-ray exam of ankle.. 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73610............... TC............ A X-ray exam of ankle.. 0.00 0.53 NA 0.02 0.55 NA XXX
73615............... .............. A Contrast x-ray of 0.54 2.28 NA 0.15 2.97 NA XXX
ankle.
73615............... 26............ A Contrast x-ray of 0.54 0.18 0.18 0.03 0.75 0.75 XXX
ankle.
73615............... TC............ A Contrast x-ray of 0.00 2.09 NA 0.12 2.21 NA XXX
ankle.
73620............... .............. A X-ray exam of foot... 0.16 0.55 NA 0.03 0.74 NA XXX
73620............... 26............ A X-ray exam of foot... 0.16 0.05 0.05 0.01 0.22 0.22 XXX
73620............... TC............ A X-ray exam of foot... 0.00 0.49 NA 0.02 0.51 NA XXX
73630............... .............. A X-ray exam of foot... 0.17 0.59 NA 0.03 0.79 NA XXX
73630............... 26............ A X-ray exam of foot... 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73630............... TC............ A X-ray exam of foot... 0.00 0.53 NA 0.02 0.55 NA XXX
73650............... .............. A X-ray exam of heel... 0.16 0.53 NA 0.03 0.72 NA XXX
73650............... 26............ A X-ray exam of heel... 0.16 0.05 0.05 0.01 0.22 0.22 XXX
73650............... TC............ A X-ray exam of heel... 0.00 0.47 NA 0.02 0.49 NA XXX
73660............... .............. A X-ray exam of toe(s). 0.13 0.46 NA 0.03 0.62 NA XXX
73660............... 26............ A X-ray exam of toe(s). 0.13 0.04 0.04 0.01 0.18 0.18 XXX
73660............... TC............ A X-ray exam of toe(s). 0.00 0.42 NA 0.02 0.44 NA XXX
73700............... .............. A Ct lower extremity w/ 1.09 5.31 NA 0.30 6.70 NA XXX
o dye.
73700............... 26............ A Ct lower extremity w/ 1.09 0.36 0.36 0.05 1.50 1.50 XXX
o dye.
73700............... TC............ A Ct lower extremity w/ 0.00 4.95 NA 0.25 5.20 NA XXX
o dye.
73701............... .............. A Ct lower extremity w/ 1.16 6.28 NA 0.36 7.80 NA XXX
dye.
73701............... 26............ A Ct lower extremity w/ 1.16 0.38 0.38 0.05 1.59 1.59 XXX
dye.
73701............... TC............ A Ct lower extremity w/ 0.00 5.90 NA 0.31 6.21 NA XXX
dye.
73702............... .............. A Ct lwr extremity w/ 1.22 7.81 NA 0.45 9.48 NA XXX
o&w/dye.
73702............... 26............ A Ct lwr extremity w/ 1.22 0.40 0.40 0.06 1.68 1.68 XXX
o&w/dye.
73702............... TC............ A Ct lwr extremity w/ 0.00 7.41 NA 0.39 7.80 NA XXX
o&w/dye.
73706............... .............. A Ct angio lwr extr w/ 1.90 11.57 NA 0.48 13.95 NA XXX
o&w/dye.
73706............... 26............ A Ct angio lwr extr w/ 1.90 0.62 0.62 0.09 2.61 2.61 XXX
o&w/dye.
73706............... TC............ A Ct angio lwr extr w/ 0.00 10.94 NA 0.39 11.33 NA XXX
o&w/dye.
73718............... .............. A Mri lower extremity w/ 1.35 11.63 NA 0.45 13.43 NA XXX
o dye.
73718............... 26............ A Mri lower extremity w/ 1.35 0.44 0.44 0.06 1.85 1.85 XXX
o dye.
73718............... TC............ A Mri lower extremity w/ 0.00 11.19 NA 0.39 11.58 NA XXX
o dye.
73719............... .............. A Mri lower extremity w/ 1.62 13.95 NA 0.54 16.11 NA XXX
dye.
73719............... 26............ A Mri lower extremity w/ 1.62 0.53 0.53 0.07 2.22 2.22 XXX
dye.
73719............... TC............ A Mri lower extremity w/ 0.00 13.42 NA 0.47 13.89 NA XXX
dye.
73720............... .............. A Mri lwr extremity w/ 2.15 25.55 NA 0.94 28.64 NA XXX
o&w/dye.
73720............... 26............ A Mri lwr extremity w/ 2.15 0.70 0.70 0.10 2.95 2.95 XXX
o&w/dye.
73720............... TC............ A Mri lwr extremity w/ 0.00 24.84 NA 0.84 25.68 NA XXX
o&w/dye.
73721............... .............. A Mri jnt of lwr extre 1.35 11.63 NA 0.45 13.43 NA XXX
w/o dye.
73721............... 26............ A Mri jnt of lwr extre 1.35 0.44 0.44 0.06 1.85 1.85 XXX
w/o dye.
73721............... TC............ A Mri jnt of lwr extre 0.00 11.19 NA 0.39 11.58 NA XXX
w/o dye.
73722............... .............. A Mri joint of lwr extr 1.62 13.95 NA 0.55 16.12 NA XXX
w/dye.
73722............... 26............ A Mri joint of lwr extr 1.62 0.53 0.53 0.08 2.23 2.23 XXX
w/dye.
73722............... TC............ A Mri joint of lwr extr 0.00 13.42 NA 0.47 13.89 NA XXX
w/dye.
73723............... .............. A Mri joint lwr extr w/ 2.15 25.55 NA 0.94 28.64 NA XXX
o&w/dye.
73723............... 26............ A Mri joint lwr extr w/ 2.15 0.71 0.71 0.10 2.96 2.96 XXX
o&w/dye.
73723............... TC............ A Mri joint lwr extr w/ 0.00 24.84 NA 0.84 25.68 NA XXX
o&w/dye.
73725............... .............. R Mr ang lwr ext w or w/ 1.82 11.78 NA 0.67 14.27 NA XXX
o dye.
73725............... 26............ R Mr ang lwr ext w or w/ 1.82 0.60 0.60 0.08 2.50 2.50 XXX
o dye.
73725............... TC............ R Mr ang lwr ext w or w/ 0.00 11.19 NA 0.59 11.78 NA XXX
o dye.
74000............... .............. A X-ray exam of abdomen 0.18 0.58 NA 0.03 0.79 NA XXX
74000............... 26............ A X-ray exam of abdomen 0.18 0.06 0.06 0.01 0.25 0.25 XXX
74000............... TC............ A X-ray exam of abdomen 0.00 0.52 NA 0.02 0.54 NA XXX
74010............... .............. A X-ray exam of abdomen 0.23 0.64 NA 0.05 0.92 NA XXX
74010............... 26............ A X-ray exam of abdomen 0.23 0.07 0.07 0.01 0.31 0.31 XXX
74010............... TC............ A X-ray exam of abdomen 0.00 0.57 NA 0.04 0.61 NA XXX
74020............... .............. A X-ray exam of abdomen 0.27 0.71 NA 0.05 1.03 NA XXX
74020............... 26............ A X-ray exam of abdomen 0.27 0.09 0.09 0.01 0.37 0.37 XXX
74020............... TC............ A X-ray exam of abdomen 0.00 0.62 NA 0.04 0.66 NA XXX
[[Page 47658]]
74022............... .............. A X-ray exam series, 0.32 0.84 NA 0.06 1.22 NA XXX
abdomen.
74022............... 26............ A X-ray exam series, 0.32 0.10 0.10 0.01 0.43 0.43 XXX
abdomen.
74022............... TC............ A X-ray exam series, 0.00 0.73 NA 0.05 0.78 NA XXX
abdomen.
74150............... .............. A Ct abdomen w/o dye... 1.19 6.03 NA 0.35 7.57 NA XXX
74150............... 26............ A Ct abdomen w/o dye... 1.19 0.39 0.39 0.05 1.63 1.63 XXX
74150............... TC............ A Ct abdomen w/o dye... 0.00 5.65 NA 0.30 5.95 NA XXX
74160............... .............. A Ct abdomen w/dye..... 1.27 7.25 NA 0.42 8.94 NA XXX
74160............... 26............ A Ct abdomen w/dye..... 1.27 0.41 0.41 0.06 1.74 1.74 XXX
74160............... TC............ A Ct abdomen w/dye..... 0.00 6.83 NA 0.36 7.19 NA XXX
74170............... .............. A Ct abdomen w/o &w / 1.40 8.93 NA 0.49 10.82 NA XXX
dye.
74170............... 26............ A Ct abdomen w/o &w / 1.40 0.46 0.46 0.06 1.92 1.92 XXX
dye.
74170............... TC............ A Ct abdomen w/o &w / 0.00 8.47 NA 0.43 8.90 NA XXX
dye.
74175............... .............. A Ct angio abdom w/o & 1.90 12.63 NA 0.48 15.01 NA XXX
w/dye.
74175............... 26............ A Ct angio abdom w/o & 1.90 0.62 0.62 0.09 2.61 2.61 XXX
w/dye.
74175............... TC............ A Ct angio abdom w/o & 0.00 12.01 NA 0.39 12.40 NA XXX
w/dye.
74181............... .............. A Mri abdomen w/o dye.. 1.46 11.66 NA 0.52 13.64 NA XXX
74181............... 26............ A Mri abdomen w/o dye.. 1.46 0.48 0.48 0.07 2.01 2.01 XXX
74181............... TC............ A Mri abdomen w/o dye.. 0.00 11.19 NA 0.45 11.64 NA XXX
74182............... .............. A Mri abdomen w/dye.... 1.73 13.98 NA 0.60 16.31 NA XXX
74182............... 26............ A Mri abdomen w/dye.... 1.73 0.56 0.56 0.08 2.37 2.37 XXX
74182............... TC............ A Mri abdomen w/dye.... 0.00 13.42 NA 0.52 13.94 NA XXX
74183............... .............. A Mri abdomen w/o & w/ 2.26 25.58 NA 1.02 28.86 NA XXX
dye.
74183............... 26............ A Mri abdomen w/o & w/ 2.26 0.74 0.74 0.10 3.10 3.10 XXX
dye.
74183............... TC............ A Mri abdomen w/o & w/ 0.00 24.84 NA 0.92 25.76 NA XXX
dye.
74185............... .............. R Mri angio, abdom w 1.80 11.78 NA 0.67 14.25 NA XXX
orw/o dye.
74185............... 26............ R Mri angio, abdom w 1.80 0.59 0.59 0.08 2.47 2.47 XXX
orw/o dye.
74185............... TC............ R Mri angio, abdom w 0.00 11.19 NA 0.59 11.78 NA XXX
orw/o dye.
74190............... .............. A X-ray exam of 0.48 1.46 NA 0.09 2.03 NA XXX
peritoneum.
74190............... 26............ A X-ray exam of 0.48 0.16 0.16 0.02 0.66 0.66 XXX
peritoneum.
74190............... TC............ A X-ray exam of 0.00 1.30 NA 0.07 1.37 NA XXX
peritoneum.
74210............... .............. A Contrst x-ray exam of 0.36 1.30 NA 0.08 1.74 NA XXX
throat.
74210............... 26............ A Contrst x-ray exam of 0.36 0.12 0.12 0.02 0.50 0.50 XXX
throat.
74210............... TC............ A Contrst x-ray exam of 0.00 1.19 NA 0.06 1.25 NA XXX
throat.
74220............... .............. A Contrast x-ray, 0.46 1.34 NA 0.08 1.88 NA XXX
esophagus.
74220............... 26............ A Contrast x-ray, 0.46 0.15 0.15 0.02 0.63 0.63 XXX
esophagus.
74220............... TC............ A Contrast x-ray, 0.00 1.19 NA 0.06 1.25 NA XXX
esophagus.
74230............... .............. A Cine/vid x-ray, 0.53 1.48 NA 0.09 2.10 NA XXX
throat/esoph.
74230............... 26............ A Cine/vid x-ray, 0.53 0.17 0.17 0.02 0.72 0.72 XXX
throat/esoph.
74230............... TC............ A Cine/vid x-ray, 0.00 1.30 NA 0.07 1.37 NA XXX
throat/esoph.
74235............... .............. A Remove esophagus 1.19 3.01 NA 0.19 4.39 NA XXX
obstruction.
74235............... 26............ A Remove esophagus 1.19 0.39 0.39 0.05 1.63 1.63 XXX
obstruction.
74235............... TC............ A Remove esophagus 0.00 2.62 NA 0.14 2.76 NA XXX
obstruction.
74240............... .............. A X-ray exam, upper gi 0.69 1.68 NA 0.11 2.48 NA XXX
tract.
74240............... 26............ A X-ray exam, upper gi 0.69 0.22 0.22 0.03 0.94 0.94 XXX
tract.
74240............... TC............ A X-ray exam, upper gi 0.00 1.46 NA 0.08 1.54 NA XXX
tract.
74241............... .............. A X-ray exam, upper gi 0.69 1.71 NA 0.11 2.51 NA XXX
tract.
74241............... 26............ A X-ray exam, upper gi 0.69 0.22 0.22 0.03 0.94 0.94 XXX
tract.
74241............... TC............ A X-ray exam, upper gi 0.00 1.49 NA 0.08 1.57 NA XXX
tract.
74245............... .............. A X-ray exam, upper gi 0.91 2.67 NA 0.17 3.75 NA XXX
tract.
74245............... 26............ A X-ray exam, upper gi 0.91 0.30 0.30 0.04 1.25 1.25 XXX
tract.
74245............... TC............ A X-ray exam, upper gi 0.00 2.37 NA 0.13 2.50 NA XXX
tract.
74246............... .............. A Contrst x-ray uppr gi 0.69 1.87 NA 0.13 2.69 NA XXX
tract.
74246............... 26............ A Contrst x-ray uppr gi 0.69 0.23 0.23 0.03 0.95 0.95 XXX
tract.
74246............... TC............ A Contrst x-ray uppr gi 0.00 1.64 NA 0.10 1.74 NA XXX
tract.
74247............... .............. A Contrst x-ray uppr gi 0.69 1.90 NA 0.14 2.73 NA XXX
tract.
74247............... 26............ A Contrst x-ray uppr gi 0.69 0.23 0.23 0.03 0.95 0.95 XXX
tract.
74247............... TC............ A Contrst x-ray uppr gi 0.00 1.68 NA 0.11 1.79 NA XXX
tract.
74249............... .............. A Contrst x-ray uppr gi 0.91 2.86 NA 0.18 3.95 NA XXX
tract.
74249............... 26............ A Contrst x-ray uppr gi 0.91 0.30 0.30 0.04 1.25 1.25 XXX
tract.
74249............... TC............ A Contrst x-ray uppr gi 0.00 2.57 NA 0.14 2.71 NA XXX
tract.
74250............... .............. A X-ray exam of small 0.47 1.46 NA 0.09 2.02 NA XXX
bowel.
74250............... 26............ A X-ray exam of small 0.47 0.15 0.15 0.02 0.64 0.64 XXX
bowel.
74250............... TC............ A X-ray exam of small 0.00 1.30 NA 0.07 1.37 NA XXX
bowel.
74251............... .............. A X-ray exam of small 0.69 1.53 NA 0.10 2.32 NA XXX
bowel.
74251............... 26............ A X-ray exam of small 0.69 0.22 0.22 0.03 0.94 0.94 XXX
bowel.
74251............... TC............ A X-ray exam of small 0.00 1.30 NA 0.07 1.37 NA XXX
bowel.
74260............... .............. A X-ray exam of small 0.50 1.65 NA 0.10 2.25 NA XXX
bowel.
74260............... 26............ A X-ray exam of small 0.50 0.16 0.16 0.02 0.68 0.68 XXX
bowel.
74260............... TC............ A X-ray exam of small 0.00 1.49 NA 0.08 1.57 NA XXX
bowel.
74270............... .............. A Contrast x-ray exam 0.69 1.92 NA 0.14 2.75 NA XXX
of colon.
74270............... 26............ A Contrast x-ray exam 0.69 0.22 0.22 0.03 0.94 0.94 XXX
of colon.
74270............... TC............ A Contrast x-ray exam 0.00 1.70 NA 0.11 1.81 NA XXX
of colon.
74280............... .............. A Contrast x-ray exam 0.99 2.55 NA 0.17 3.71 NA XXX
of colon.
74280............... 26............ A Contrast x-ray exam 0.99 0.32 0.32 0.04 1.35 1.35 XXX
of colon.
74280............... TC............ A Contrast x-ray exam 0.00 2.23 NA 0.13 2.36 NA XXX
of colon.
[[Page 47659]]
74283............... .............. A Contrast x-ray exam 2.02 3.22 NA 0.23 5.47 NA XXX
of colon.
74283............... 26............ A Contrast x-ray exam 2.02 0.66 0.66 0.09 2.77 2.77 XXX
of colon.
74283............... TC............ A Contrast x-ray exam 0.00 2.56 NA 0.14 2.70 NA XXX
of colon.
74290............... .............. A Contrast x-ray, 0.32 0.84 NA 0.06 1.22 NA XXX
gallbladder.
74290............... 26............ A Contrast x-ray, 0.32 0.10 0.10 0.01 0.43 0.43 XXX
gallbladder.
74290............... TC............ A Contrast x-ray, 0.00 0.73 NA 0.05 0.78 NA XXX
gallbladder.
74291............... .............. A Contrast x-rays, 0.20 0.48 NA 0.03 0.71 NA XXX
gallbladder.
74291............... 26............ A Contrast x-rays, 0.20 0.07 0.07 0.01 0.28 0.28 XXX
gallbladder.
74291............... TC............ A Contrast x-rays, 0.00 0.42 NA 0.02 0.44 NA XXX
gallbladder.
74300............... 26............ A X-ray bile ducts/ 0.36 0.12 0.12 0.02 0.50 0.50 XXX
pancreas.
74301............... 26............ A X-rays at surgery add- 0.21 0.07 0.07 0.01 0.29 0.29 ZZZ
on.
74305............... .............. A X-ray bile ducts/ 0.42 0.92 NA 0.07 1.41 NA XXX
pancreas.
74305............... 26............ A X-ray bile ducts/ 0.42 0.14 0.14 0.02 0.58 0.58 XXX
pancreas.
74305............... TC............ A X-ray bile ducts/ 0.00 0.78 NA 0.05 0.83 NA XXX
pancreas.
74320............... .............. A Contrast x-ray of 0.54 3.32 NA 0.19 4.05 NA XXX
bile ducts.
74320............... 26............ A Contrast x-ray of 0.54 0.18 0.18 0.02 0.74 0.74 XXX
bile ducts.
74320............... TC............ A Contrast x-ray of 0.00 3.15 NA 0.17 3.32 NA XXX
bile ducts.
74327............... .............. A X-ray bile stone 0.70 1.98 NA 0.14 2.82 NA XXX
removal.
74327............... 26............ A X-ray bile stone 0.70 0.23 0.23 0.03 0.96 0.96 XXX
removal.
74327............... TC............ A X-ray bile stone 0.00 1.76 NA 0.11 1.87 NA XXX
removal.
74328............... .............. A X-ray bile duct 0.70 3.38 NA 0.20 4.28 NA XXX
endoscopy.
74328............... 26............ A X-ray bile duct 0.70 0.23 0.23 0.03 0.96 0.96 XXX
endoscopy.
74328............... TC............ A X-ray bile duct 0.00 3.15 NA 0.17 3.32 NA XXX
endoscopy.
74329............... .............. A X-ray for pancreas 0.70 3.38 NA 0.20 4.28 NA XXX
endoscopy.
74329............... 26............ A X-ray for pancreas 0.70 0.23 0.23 0.03 0.96 0.96 XXX
endoscopy.
74329............... TC............ A X-ray for pancreas 0.00 3.15 NA 0.17 3.32 NA XXX
endoscopy.
74330............... .............. A X-ray bile/panc 0.90 3.44 NA 0.21 4.55 NA XXX
endoscopy.
74330............... 26............ A X-ray bile/panc 0.90 0.29 0.29 0.04 1.23 1.23 XXX
endoscopy.
74330............... TC............ A X-ray bile/panc 0.00 3.15 NA 0.17 3.32 NA XXX
endoscopy.
74340............... .............. A X-ray guide for GI 0.54 2.79 NA 0.16 3.49 NA XXX
tube.
74340............... 26............ A X-ray guide for GI 0.54 0.18 0.18 0.02 0.74 0.74 XXX
tube.
74340............... TC............ A X-ray guide for GI 0.00 2.62 NA 0.14 2.76 NA XXX
tube.
74350............... .............. A X-ray guide, stomach 0.76 3.39 NA 0.20 4.35 NA XXX
tube.
74350............... 26............ A X-ray guide, stomach 0.76 0.25 0.25 0.03 1.04 1.04 XXX
tube.
74350............... TC............ A X-ray guide, stomach 0.00 3.15 NA 0.17 3.32 NA XXX
tube.
74355............... .............. A X-ray guide, 0.76 2.86 NA 0.17 3.79 NA XXX
intestinal tube.
74355............... 26............ A X-ray guide, 0.76 0.25 0.25 0.03 1.04 1.04 XXX
intestinal tube.
74355............... TC............ A X-ray guide, 0.00 2.62 NA 0.14 2.76 NA XXX
intestinal tube.
74360............... .............. A X-ray guide, GI 0.54 3.33 NA 0.19 4.06 NA XXX
dilation.
74360............... 26............ A X-ray guide, GI 0.54 0.19 0.19 0.02 0.75 0.75 XXX
dilation.
74360............... TC............ A X-ray guide, GI 0.00 3.15 NA 0.17 3.32 NA XXX
dilation.
74363............... .............. A X-ray, bile duct 0.88 6.38 NA 0.37 7.63 NA XXX
dilation.
74363............... 26............ A X-ray, bile duct 0.88 0.29 0.29 0.04 1.21 1.21 XXX
dilation.
74363............... TC............ A X-ray, bile duct 0.00 6.09 NA 0.33 6.42 NA XXX
dilation.
74400............... .............. A Contrst x-ray, 0.49 1.84 NA 0.13 2.46 NA XXX
urinary tract.
74400............... 26............ A Contrst x-ray, 0.49 0.16 0.16 0.02 0.67 0.67 XXX
urinary tract.
74400............... TC............ A Contrst x-ray, 0.00 1.68 NA 0.11 1.79 NA XXX
urinary tract.
74410............... .............. A Contrst x-ray, 0.49 2.11 NA 0.13 2.73 NA XXX
urinary tract.
74410............... 26............ A Contrst x-ray, 0.49 0.16 0.16 0.02 0.67 0.67 XXX
urinary tract.
74410............... TC............ A Contrst x-ray, 0.00 1.95 NA 0.11 2.06 NA XXX
urinary tract.
74415............... .............. A Contrst x-ray, 0.49 2.27 NA 0.14 2.90 NA XXX
urinary tract.
74415............... 26............ A Contrst x-ray, 0.49 0.16 0.16 0.02 0.67 0.67 XXX
urinary tract.
74415............... TC............ A Contrst x-ray, 0.00 2.11 NA 0.12 2.23 NA XXX
urinary tract.
74420............... .............. A Contrst x-ray, 0.36 2.73 NA 0.16 3.25 NA XXX
urinary tract.
74420............... 26............ A Contrst x-ray, 0.36 0.12 0.12 0.02 0.50 0.50 XXX
urinary tract.
74420............... TC............ A Contrst x-ray, 0.00 2.62 NA 0.14 2.76 NA XXX
urinary tract.
74425............... .............. A Contrst x-ray, 0.36 1.42 NA 0.09 1.87 NA XXX
urinary tract.
74425............... 26............ A Contrst x-ray, 0.36 0.12 0.12 0.02 0.50 0.50 XXX
urinary tract.
74425............... TC............ A Contrst x-ray, 0.00 1.30 NA 0.07 1.37 NA XXX
urinary tract.
74430............... .............. A Contrast x-ray, 0.32 1.16 NA 0.08 1.56 NA XXX
bladder.
74430............... 26............ A Contrast x-ray, 0.32 0.10 0.10 0.02 0.44 0.44 XXX
bladder.
74430............... TC............ A Contrast x-ray, 0.00 1.05 NA 0.06 1.11 NA XXX
bladder.
74440............... .............. A X-ray, male genital 0.38 1.25 NA 0.08 1.71 NA XXX
tract.
74440............... 26............ A X-ray, male genital 0.38 0.12 0.12 0.02 0.52 0.52 XXX
tract.
74440............... TC............ A X-ray, male genital 0.00 1.13 NA 0.06 1.19 NA XXX
tract.
74445............... .............. A X-ray exam of penis.. 1.14 1.50 NA 0.12 2.76 NA XXX
74445............... 26............ A X-ray exam of penis.. 1.14 0.37 0.37 0.06 1.57 1.57 XXX
74445............... TC............ A X-ray exam of penis.. 0.00 1.13 NA 0.06 1.19 NA XXX
74450............... .............. A X-ray, urethra/ 0.33 1.56 NA 0.10 1.99 NA XXX
bladder.
74450............... 26............ A X-ray, urethra/ 0.33 0.11 0.11 0.02 0.46 0.46 XXX
bladder.
74450............... TC............ A X-ray, urethra/ 0.00 1.46 NA 0.08 1.54 NA XXX
bladder.
74455............... .............. A X-ray, urethra/ 0.33 1.68 NA 0.12 2.13 NA XXX
bladder.
74455............... 26............ A X-ray, urethra/ 0.33 0.11 0.11 0.02 0.46 0.46 XXX
bladder.
74455............... TC............ A X-ray, urethra/ 0.00 1.57 NA 0.10 1.67 NA XXX
bladder.
74470............... .............. A X-ray exam of kidney 0.54 1.42 NA 0.10 2.06 NA XXX
lesion.
[[Page 47660]]
74470............... 26............ A X-ray exam of kidney 0.54 0.18 0.18 0.03 0.75 0.75 XXX
lesion.
74470............... TC............ A X-ray exam of kidney 0.00 1.25 NA 0.07 1.32 NA XXX
lesion.
74475............... .............. A X-ray control, cath 0.54 4.24 NA 0.24 5.02 NA XXX
insert.
74475............... 26............ A X-ray control, cath 0.54 0.18 0.18 0.02 0.74 0.74 XXX
insert.
74475............... TC............ A X-ray control, cath 0.00 4.06 NA 0.22 4.28 NA XXX
insert.
74480............... .............. A X-ray control, cath 0.54 4.24 NA 0.24 5.02 NA XXX
insert.
74480............... 26............ A X-ray control, cath 0.54 0.18 0.18 0.02 0.74 0.74 XXX
insert.
74480............... TC............ A X-ray control, cath 0.00 4.06 NA 0.22 4.28 NA XXX
insert.
74485............... .............. A X-ray guide, GU 0.54 3.32 NA 0.20 4.06 NA XXX
dilation.
74485............... 26............ A X-ray guide, GU 0.54 0.17 0.17 0.03 0.74 0.74 XXX
dilation.
74485............... TC............ A X-ray guide, GU 0.00 3.15 NA 0.17 3.32 NA XXX
dilation.
74710............... .............. A X-ray measurement of 0.34 1.16 NA 0.08 1.58 NA XXX
pelvis.
74710............... 26............ A X-ray measurement of 0.34 0.11 0.11 0.02 0.47 0.47 XXX
pelvis.
74710............... TC............ A X-ray measurement of 0.00 1.05 NA 0.06 1.11 NA XXX
pelvis.
74740............... .............. A X-ray, female genital 0.38 1.43 NA 0.09 1.90 NA XXX
tract.
74740............... 26............ A X-ray, female genital 0.38 0.13 0.13 0.02 0.53 0.53 XXX
tract.
74740............... TC............ A X-ray, female genital 0.00 1.30 NA 0.07 1.37 NA XXX
tract.
74742............... .............. A X-ray, fallopian tube 0.61 3.35 NA 0.20 4.16 NA XXX
74742............... 26............ A X-ray, fallopian tube 0.61 0.20 0.20 0.03 0.84 0.84 XXX
74742............... TC............ A X-ray, fallopian tube 0.00 3.15 NA 0.17 3.32 NA XXX
74775............... .............. A X-ray exam of 0.62 1.66 NA 0.11 2.39 NA XXX
perineum.
74775............... 26............ A X-ray exam of 0.62 0.21 0.21 0.03 0.86 0.86 XXX
perineum.
74775............... TC............ A X-ray exam of 0.00 1.46 NA 0.08 1.54 NA XXX
perineum.
75552............... .............. A Heart mri for morph w/ 1.60 11.71 NA 0.66 13.97 NA XXX
o dye.
75552............... 26............ A Heart mri for morph w/ 1.60 0.53 0.53 0.07 2.20 2.20 XXX
o dye.
75552............... TC............ A Heart mri for morph w/ 0.00 11.19 NA 0.59 11.78 NA XXX
o dye.
75553............... .............. A Heart mri for morph w/ 2.00 11.84 NA 0.68 14.52 NA XXX
dye.
75553............... 26............ A Heart mri for morph w/ 2.00 0.65 0.65 0.09 2.74 2.74 XXX
dye.
75553............... TC............ A Heart mri for morph w/ 0.00 11.19 NA 0.59 11.78 NA XXX
dye.
75554............... .............. A Cardiac MRI/function. 1.83 11.83 NA 0.66 14.32 NA XXX
75554............... 26............ A Cardiac MRI/function. 1.83 0.64 0.64 0.07 2.54 2.54 XXX
75554............... TC............ A Cardiac MRI/function. 0.00 11.19 NA 0.59 11.78 NA XXX
75555............... .............. A Cardiac MRI/limited 1.74 11.82 NA 0.66 14.22 NA XXX
study.
75555............... 26............ A Cardiac MRI/limited 1.74 0.64 0.64 0.07 2.45 2.45 XXX
study.
75555............... TC............ A Cardiac MRI/limited 0.00 11.19 NA 0.59 11.78 NA XXX
study.
75600............... .............. A Contrast x-ray exam 0.49 12.76 NA 0.67 13.92 NA XXX
of aorta.
75600............... 26............ A Contrast x-ray exam 0.49 0.19 0.19 0.02 0.70 0.70 XXX
of aorta.
75600............... TC............ A Contrast x-ray exam 0.00 12.58 NA 0.65 13.23 NA XXX
of aorta.
75605............... .............. A Contrast x-ray exam 1.14 12.97 NA 0.70 14.81 NA XXX
of aorta.
75605............... 26............ A Contrast x-ray exam 1.14 0.40 0.40 0.05 1.59 1.59 XXX
of aorta.
75605............... TC............ A Contrast x-ray exam 0.00 12.58 NA 0.65 13.23 NA XXX
of aorta.
75625............... .............. A Contrast x-ray exam 1.14 12.95 NA 0.71 14.80 NA XXX
of aorta.
75625............... 26............ A Contrast x-ray exam 1.14 0.38 0.38 0.06 1.58 1.58 XXX
of aorta.
75625............... TC............ A Contrast x-ray exam 0.00 12.58 NA 0.65 13.23 NA XXX
of aorta.
75630............... .............. A X-ray aorta, leg 1.79 13.72 NA 0.79 16.30 NA XXX
arteries.
75630............... 26............ A X-ray aorta, leg 1.79 0.61 0.61 0.10 2.50 2.50 XXX
arteries.
75630............... TC............ A X-ray aorta, leg 0.00 13.11 NA 0.69 13.80 NA XXX
arteries.
75635............... .............. A Ct angio abdominal 2.40 16.68 NA 0.50 19.58 NA XXX
arteries.
75635............... 26............ A Ct angio abdominal 2.40 0.79 0.79 0.11 3.30 3.30 XXX
arteries.
75635............... TC............ A Ct angio abdominal 0.00 15.89 NA 0.39 16.28 NA XXX
arteries.
75650............... .............. A Artery x-rays, head & 1.49 13.07 NA 0.72 15.28 NA XXX
neck.
75650............... 26............ A Artery x-rays, head & 1.49 0.49 0.49 0.07 2.05 2.05 XXX
neck.
75650............... TC............ A Artery x-rays, head & 0.00 12.58 NA 0.65 13.23 NA XXX
neck.
75658............... .............. A Artery x-rays, arm... 1.31 13.05 NA 0.72 15.08 NA XXX
75658............... 26............ A Artery x-rays, arm... 1.31 0.47 0.47 0.07 1.85 1.85 XXX
75658............... TC............ A Artery x-rays, arm... 0.00 12.58 NA 0.65 13.23 NA XXX
75660............... .............. A Artery x-rays, head & 1.31 13.02 NA 0.72 15.05 NA XXX
neck.
75660............... 26............ A Artery x-rays, head & 1.31 0.44 0.44 0.07 1.82 1.82 XXX
neck.
75660............... TC............ A Artery x-rays, head & 0.00 12.58 NA 0.65 13.23 NA XXX
neck.
75662............... .............. A Artery x-rays, head & 1.66 13.17 NA 0.73 15.56 NA XXX
neck.
75662............... 26............ A Artery x-rays, head & 1.66 0.59 0.59 0.08 2.33 2.33 XXX
neck.
75662............... TC............ A Artery x-rays, head & 0.00 12.58 NA 0.65 13.23 NA XXX
neck.
75665............... .............. A Artery x-rays, head & 1.31 13.01 NA 0.74 15.06 NA XXX
neck.
75665............... 26............ A Artery x-rays, head & 1.31 0.44 0.44 0.09 1.84 1.84 XXX
neck.
75665............... TC............ A Artery x-rays, head & 0.00 12.58 NA 0.65 13.23 NA XXX
neck.
75671............... .............. A Artery x-rays, head & 1.66 13.12 NA 0.73 15.51 NA XXX
neck.
75671............... 26............ A Artery x-rays, head & 1.66 0.55 0.55 0.08 2.29 2.29 XXX
neck.
75671............... TC............ A Artery x-rays, head & 0.00 12.58 NA 0.65 13.23 NA XXX
neck.
75676............... .............. A Artery x-rays, neck.. 1.31 13.01 NA 0.73 15.05 NA XXX
75676............... 26............ A Artery x-rays, neck.. 1.31 0.44 0.44 0.08 1.83 1.83 XXX
75676............... TC............ A Artery x-rays, neck.. 0.00 12.58 NA 0.65 13.23 NA XXX
75680............... .............. A Artery x-rays, neck.. 1.66 13.12 NA 0.73 15.51 NA XXX
75680............... 26............ A Artery x-rays, neck.. 1.66 0.55 0.55 0.08 2.29 2.29 XXX
75680............... TC............ A Artery x-rays, neck.. 0.00 12.58 NA 0.65 13.23 NA XXX
75685............... .............. A Artery x-rays, spine. 1.31 13.01 NA 0.72 15.04 NA XXX
[[Page 47661]]
75685............... 26............ A Artery x-rays, spine. 1.31 0.43 0.43 0.07 1.81 1.81 XXX
75685............... TC............ A Artery x-rays, spine. 0.00 12.58 NA 0.65 13.23 NA XXX
75705............... .............. A Artery x-rays, spine. 2.18 13.31 NA 0.78 16.27 NA XXX
75705............... 26............ A Artery x-rays, spine. 2.18 0.73 0.73 0.13 3.04 3.04 XXX
75705............... TC............ A Artery x-rays, spine. 0.00 12.58 NA 0.65 13.23 NA XXX
75710............... .............. A Artery x-rays, arm/ 1.14 12.96 NA 0.71 14.81 NA XXX
leg.
75710............... 26............ A Artery x-rays, arm/ 1.14 0.39 0.39 0.06 1.59 1.59 XXX
leg.
75710............... TC............ A Artery x-rays, arm/ 0.00 12.58 NA 0.65 13.23 NA XXX
leg.
75716............... .............. A Artery x-rays, arms/ 1.31 13.01 NA 0.72 15.04 NA XXX
legs.
75716............... 26............ A Artery x-rays, arms/ 1.31 0.43 0.43 0.07 1.81 1.81 XXX
legs.
75716............... TC............ A Artery x-rays, arms/ 0.00 12.58 NA 0.65 13.23 NA XXX
legs.
75722............... .............. A Artery x-rays, kidney 1.14 12.97 NA 0.71 14.82 NA XXX
75722............... 26............ A Artery x-rays, kidney 1.14 0.40 0.40 0.06 1.60 1.60 XXX
75722............... TC............ A Artery x-rays, kidney 0.00 12.58 NA 0.65 13.23 NA XXX
75724............... .............. A Artery x-rays, 1.49 13.13 NA 0.71 15.33 NA XXX
kidneys.
75724............... 26............ A Artery x-rays, 1.49 0.56 0.56 0.06 2.11 2.11 XXX
kidneys.
75724............... TC............ A Artery x-rays, 0.00 12.58 NA 0.65 13.23 NA XXX
kidneys.
75726............... .............. A Artery x-rays, 1.14 12.95 NA 0.70 14.79 NA XXX
abdomen.
75726............... 26............ A Artery x-rays, 1.14 0.37 0.37 0.05 1.56 1.56 XXX
abdomen.
75726............... TC............ A Artery x-rays, 0.00 12.58 NA 0.65 13.23 NA XXX
abdomen.
75731............... .............. A Artery x-rays, 1.14 12.95 NA 0.70 14.79 NA XXX
adrenal gland.
75731............... 26............ A Artery x-rays, 1.14 0.37 0.37 0.05 1.56 1.56 XXX
adrenal gland.
75731............... TC............ A Artery x-rays, 0.00 12.58 NA 0.65 13.23 NA XXX
adrenal gland.
75733............... .............. A Artery x-rays, 1.31 13.01 NA 0.70 15.02 NA XXX
adrenals.
75733............... 26............ A Artery x-rays, 1.31 0.43 0.43 0.05 1.79 1.79 XXX
adrenals.
75733............... TC............ A Artery x-rays, 0.00 12.58 NA 0.65 13.23 NA XXX
adrenals.
75736............... .............. A Artery x-rays, pelvis 1.14 12.95 NA 0.71 14.80 NA XXX
75736............... 26............ A Artery x-rays, pelvis 1.14 0.37 0.37 0.06 1.57 1.57 XXX
75736............... TC............ A Artery x-rays, pelvis 0.00 12.58 NA 0.65 13.23 NA XXX
75741............... .............. A Artery x-rays, lung.. 1.31 13.01 NA 0.71 15.03 NA XXX
75741............... 26............ A Artery x-rays, lung.. 1.31 0.43 0.43 0.06 1.80 1.80 XXX
75741............... TC............ A Artery x-rays, lung.. 0.00 12.58 NA 0.65 13.23 NA XXX
75743............... .............. A Artery x-rays, lungs. 1.66 13.12 NA 0.73 15.51 NA XXX
75743............... 26............ A Artery x-rays, lungs. 1.66 0.54 0.54 0.08 2.28 2.28 XXX
75743............... TC............ A Artery x-rays, lungs. 0.00 12.58 NA 0.65 13.23 NA XXX
75746............... .............. A Artery x-rays, lung.. 1.14 12.95 NA 0.70 14.79 NA XXX
75746............... 26............ A Artery x-rays, lung.. 1.14 0.38 0.38 0.05 1.57 1.57 XXX
75746............... TC............ A Artery x-rays, lung.. 0.00 12.58 NA 0.65 13.23 NA XXX
75756............... .............. A Artery x-rays, chest. 1.14 13.02 NA 0.69 14.85 NA XXX
75756............... 26............ A Artery x-rays, chest. 1.14 0.45 0.45 0.04 1.63 1.63 XXX
75756............... TC............ A Artery x-rays, chest. 0.00 12.58 NA 0.65 13.23 NA XXX
75774............... .............. A Artery x-ray, each 0.36 12.70 NA 0.67 13.73 NA ZZZ
vessel.
75774............... 26............ A Artery x-ray, each 0.36 0.12 0.12 0.02 0.50 0.50 ZZZ
vessel.
75774............... TC............ A Artery x-ray, each 0.00 12.58 NA 0.65 13.23 NA ZZZ
vessel.
75790............... .............. A Visualize A-V shunt.. 1.84 1.95 NA 0.18 3.97 NA XXX
75790............... 26............ A Visualize A-V shunt.. 1.84 0.60 0.60 0.10 2.54 2.54 XXX
75790............... TC............ A Visualize A-V shunt.. 0.00 1.35 NA 0.08 1.43 NA XXX
75801............... .............. A Lymph vessel x-ray, 0.81 5.67 NA 0.37 6.85 NA XXX
arm/leg.
75801............... 26............ A Lymph vessel x-ray, 0.81 0.27 0.27 0.08 1.16 1.16 XXX
arm/leg.
75801............... TC............ A Lymph vessel x-ray, 0.00 5.40 NA 0.29 5.69 NA XXX
arm/leg.
75803............... .............. A Lymph vessel x- 1.17 5.79 NA 0.34 7.30 NA XXX
ray,arms/legs.
75803............... 26............ A Lymph vessel x- 1.17 0.38 0.38 0.05 1.60 1.60 XXX
ray,arms/legs.
75803............... TC............ A Lymph vessel x- 0.00 5.40 NA 0.29 5.69 NA XXX
ray,arms/legs.
75805............... .............. A Lymph vessel x-ray, 0.81 6.36 NA 0.38 7.55 NA XXX
trunk.
75805............... 26............ A Lymph vessel x-ray, 0.81 0.27 0.27 0.05 1.13 1.13 XXX
trunk.
75805............... TC............ A Lymph vessel x-ray, 0.00 6.09 NA 0.33 6.42 NA XXX
trunk.
75807............... .............. A Lymph vessel x-ray, 1.17 6.47 NA 0.39 8.03 NA XXX
trunk.
75807............... 26............ A Lymph vessel x-ray, 1.17 0.38 0.38 0.06 1.61 1.61 XXX
trunk.
75807............... TC............ A Lymph vessel x-ray, 0.00 6.09 NA 0.33 6.42 NA XXX
trunk.
75809............... .............. A Nonvascular shunt, x- 0.47 0.94 NA 0.07 1.48 NA XXX
ray.
75809............... 26............ A Nonvascular shunt, x- 0.47 0.15 0.15 0.02 0.64 0.64 XXX
ray.
75809............... TC............ A Nonvascular shunt, x- 0.00 0.78 NA 0.05 0.83 NA XXX
ray.
75810............... .............. A Vein x-ray, spleen/ 1.14 12.95 NA 0.70 14.79 NA XXX
liver.
75810............... 26............ A Vein x-ray, spleen/ 1.14 0.37 0.37 0.05 1.56 1.56 XXX
liver.
75810............... TC............ A Vein x-ray, spleen/ 0.00 12.58 NA 0.65 13.23 NA XXX
liver.
75820............... .............. A Vein x-ray, arm/leg.. 0.70 1.17 NA 0.10 1.97 NA XXX
75820............... 26............ A Vein x-ray, arm/leg.. 0.70 0.23 0.23 0.04 0.97 0.97 XXX
75820............... TC............ A Vein x-ray, arm/leg.. 0.00 0.95 NA 0.06 1.01 NA XXX
75822............... .............. A Vein x-ray, arms/legs 1.06 1.82 NA 0.13 3.01 NA XXX
75822............... 26............ A Vein x-ray, arms/legs 1.06 0.35 0.35 0.05 1.46 1.46 XXX
75822............... TC............ A Vein x-ray, arms/legs 0.00 1.48 NA 0.08 1.56 NA XXX
75825............... .............. A Vein x-ray, trunk.... 1.14 12.95 NA 0.72 14.81 NA XXX
75825............... 26............ A Vein x-ray, trunk.... 1.14 0.37 0.37 0.07 1.58 1.58 XXX
75825............... TC............ A Vein x-ray, trunk.... 0.00 12.58 NA 0.65 13.23 NA XXX
75827............... .............. A Vein x-ray, chest.... 1.14 12.95 NA 0.71 14.80 NA XXX
[[Page 47662]]
75827............... 26............ A Vein x-ray, chest.... 1.14 0.37 0.37 0.06 1.57 1.57 XXX
75827............... TC............ A Vein x-ray, chest.... 0.00 12.58 NA 0.65 13.23 NA XXX
75831............... .............. A Vein x-ray, kidney... 1.14 12.94 NA 0.70 14.78 NA XXX
75831............... 26............ A Vein x-ray, kidney... 1.14 0.37 0.37 0.06 1.57 1.57 XXX
75831............... TC............ A Vein x-ray, kidney... 0.00 12.58 NA 0.65 13.23 NA XXX
75833............... .............. A Vein x-ray, kidneys.. 1.49 13.06 NA 0.73 15.28 NA XXX
75833............... 26............ A Vein x-ray, kidneys.. 1.49 0.49 0.49 0.08 2.06 2.06 XXX
75833............... TC............ A Vein x-ray, kidneys.. 0.00 12.58 NA 0.65 13.23 NA XXX
75840............... .............. A Vein x-ray, adrenal 1.14 12.95 NA 0.70 14.79 NA XXX
gland.
75840............... 26............ A Vein x-ray, adrenal 1.14 0.38 0.38 0.05 1.57 1.57 XXX
gland.
75840............... TC............ A Vein x-ray, adrenal 0.00 12.58 NA 0.65 13.23 NA XXX
gland.
75842............... .............. A Vein x-ray, adrenal 1.49 13.06 NA 0.73 15.28 NA XXX
glands.
75842............... 26............ A Vein x-ray, adrenal 1.49 0.48 0.48 0.08 2.05 2.05 XXX
glands.
75842............... TC............ A Vein x-ray, adrenal 0.00 12.58 NA 0.65 13.23 NA XXX
glands.
75860............... .............. A Vein x-ray, neck..... 1.14 12.97 NA 0.70 14.81 NA XXX
75860............... 26............ A Vein x-ray, neck..... 1.14 0.39 0.39 0.05 1.58 1.58 XXX
75860............... TC............ A Vein x-ray, neck..... 0.00 12.58 NA 0.65 13.23 NA XXX
75870............... .............. A Vein x-ray, skull.... 1.14 12.96 NA 0.71 14.81 NA XXX
75870............... 26............ A Vein x-ray, skull.... 1.14 0.39 0.39 0.06 1.59 1.59 XXX
75870............... TC............ A Vein x-ray, skull.... 0.00 12.58 NA 0.65 13.23 NA XXX
75872............... .............. A Vein x-ray, skull.... 1.14 12.95 NA 0.76 14.85 NA XXX
75872............... 26............ A Vein x-ray, skull.... 1.14 0.37 0.37 0.11 1.62 1.62 XXX
75872............... TC............ A Vein x-ray, skull.... 0.00 12.58 NA 0.65 13.23 NA XXX
75880............... .............. A Vein x-ray, eye 0.70 1.18 NA 0.10 1.98 NA XXX
socket.
75880............... 26............ A Vein x-ray, eye 0.70 0.23 0.23 0.04 0.97 0.97 XXX
socket.
75880............... TC............ A Vein x-ray, eye 0.00 0.95 NA 0.06 1.01 NA XXX
socket.
75885............... .............. A Vein x-ray, liver.... 1.44 13.04 NA 0.72 15.20 NA XXX
75885............... 26............ A Vein x-ray, liver.... 1.44 0.47 0.47 0.07 1.98 1.98 XXX
75885............... TC............ A Vein x-ray, liver.... 0.00 12.58 NA 0.65 13.23 NA XXX
75887............... .............. A Vein x-ray, liver.... 1.44 13.04 NA 0.72 15.20 NA XXX
75887............... 26............ A Vein x-ray, liver.... 1.44 0.47 0.47 0.07 1.98 1.98 XXX
75887............... TC............ A Vein x-ray, liver.... 0.00 12.58 NA 0.65 13.23 NA XXX
75889............... .............. A Vein x-ray, liver.... 1.14 12.95 NA 0.70 14.79 NA XXX
75889............... 26............ A Vein x-ray, liver.... 1.14 0.37 0.37 0.05 1.56 1.56 XXX
75889............... TC............ A Vein x-ray, liver.... 0.00 12.58 NA 0.65 13.23 NA XXX
75891............... .............. A Vein x-ray, liver.... 1.14 12.95 NA 0.70 14.79 NA XXX
75891............... 26............ A Vein x-ray, liver.... 1.14 0.37 0.37 0.05 1.56 1.56 XXX
75891............... TC............ A Vein x-ray, liver.... 0.00 12.58 NA 0.65 13.23 NA XXX
75893............... .............. A Venous sampling by 0.54 12.75 NA 0.68 13.97 NA XXX
catheter.
75893............... 26............ A Venous sampling by 0.54 0.18 0.18 0.03 0.75 0.75 XXX
catheter.
75893............... TC............ A Venous sampling by 0.00 12.58 NA 0.65 13.23 NA XXX
catheter.
75894............... .............. A X-rays, transcath 1.31 24.52 NA 1.35 27.18 NA XXX
therapy.
75894............... 26............ A X-rays, transcath 1.31 0.43 0.43 0.08 1.82 1.82 XXX
therapy.
75894............... TC............ A X-rays, transcath 0.00 24.09 NA 1.27 25.36 NA XXX
therapy.
75896............... .............. A X-rays, transcath 1.31 21.40 NA 1.16 23.87 NA XXX
therapy.
75896............... 26............ A X-rays, transcath 1.31 0.45 0.45 0.06 1.82 1.82 XXX
therapy.
75896............... TC............ A X-rays, transcath 0.00 20.95 NA 1.10 22.05 NA XXX
therapy.
75898............... .............. A Follow-up angiography 1.65 1.60 NA 0.14 3.39 NA XXX
75898............... 26............ A Follow-up angiography 1.65 0.55 0.55 0.08 2.28 2.28 XXX
75898............... TC............ A Follow-up angiography 0.00 1.05 NA 0.06 1.11 NA XXX
75900............... .............. A Arterial catheter 0.49 21.09 NA 1.14 22.72 NA XXX
exchange.
75900............... 26............ A Arterial catheter 0.49 0.16 0.16 0.03 0.68 0.68 XXX
exchange.
75900............... TC............ A Arterial catheter 0.00 20.93 NA 1.11 22.04 NA XXX
exchange.
75901............... .............. A Remove cva device 0.49 1.46 NA 1.04 2.99 NA XXX
obstruct.
75901............... 26............ A Remove cva device 0.49 0.16 0.16 0.21 0.86 0.86 XXX
obstruct.
75901............... TC............ A Remove cva device 0.00 1.30 NA 0.83 2.13 NA XXX
obstruct.
75902............... .............. A Remove cva lumen 0.39 1.43 NA 0.86 2.68 NA XXX
obstruct.
75902............... 26............ A Remove cva lumen 0.39 0.13 0.13 0.03 0.55 0.55 XXX
obstruct.
75902............... TC............ A Remove cva lumen 0.00 1.30 NA 0.83 2.13 NA XXX
obstruct.
75940............... .............. A X-ray placement, vein 0.54 12.75 NA 0.68 13.97 NA XXX
filter.
75940............... 26............ A X-ray placement, vein 0.54 0.18 0.18 0.03 0.75 0.75 XXX
filter.
75940............... TC............ A X-ray placement, vein 0.00 12.58 NA 0.65 13.23 NA XXX
filter.
75945............... .............. A Intravascular us..... 0.40 4.70 NA 0.27 5.37 NA XXX
75945............... 26............ A Intravascular us..... 0.40 0.14 0.14 0.03 0.57 0.57 XXX
75945............... TC............ A Intravascular us..... 0.00 4.56 NA 0.24 4.80 NA XXX
75946............... .............. A Intravascular us add- 0.40 2.42 NA 0.18 3.00 NA ZZZ
on.
75946............... 26............ A Intravascular us add- 0.40 0.14 0.14 0.05 0.59 0.59 ZZZ
on.
75946............... TC............ A Intravascular us add- 0.00 2.29 NA 0.13 2.42 NA ZZZ
on.
75952............... 26............ A Endovasc repair abdom 4.49 1.49 1.49 0.43 6.41 6.41 XXX
aorta.
75953............... 26............ A Abdom aneurysm 1.36 0.45 0.45 0.13 1.94 1.94 XXX
endovas rpr.
75954............... 26............ A Iliac aneurysm 2.25 0.77 0.77 0.05 3.07 3.07 XXX
endovas rpr.
75960............... .............. A Transcatheter intro, 0.82 15.16 NA 0.82 16.80 NA XXX
stent.
75960............... 26............ A Transcatheter intro, 0.82 0.28 0.28 0.05 1.15 1.15 XXX
stent.
75960............... TC............ A Transcatheter intro, 0.00 14.87 NA 0.77 15.64 NA XXX
stent.
75961............... .............. A Retrieval, broken 4.24 11.87 NA 0.76 16.87 NA XXX
catheter.
[[Page 47663]]
75961............... 26............ A Retrieval, broken 4.24 1.39 1.39 0.21 5.84 5.84 XXX
catheter.
75961............... TC............ A Retrieval, broken 0.00 10.48 NA 0.55 11.03 NA XXX
catheter.
75962............... .............. A Repair arterial 0.54 15.90 NA 0.86 17.30 NA XXX
blockage.
75962............... 26............ A Repair arterial 0.54 0.18 0.18 0.03 0.75 0.75 XXX
blockage.
75962............... TC............ A Repair arterial 0.00 15.71 NA 0.83 16.54 NA XXX
blockage.
75964............... .............. A Repair artery 0.36 8.50 NA 0.45 9.31 NA ZZZ
blockage, each.
75964............... 26............ A Repair artery 0.36 0.12 0.12 0.02 0.50 0.50 ZZZ
blockage, each.
75964............... TC............ A Repair artery 0.00 8.38 NA 0.43 8.81 NA ZZZ
blockage, each.
75966............... .............. A Repair arterial 1.31 16.18 NA 0.89 18.38 NA XXX
blockage.
75966............... 26............ A Repair arterial 1.31 0.46 0.46 0.06 1.83 1.83 XXX
blockage.
75966............... TC............ A Repair arterial 0.00 15.71 NA 0.83 16.54 NA XXX
blockage.
75968............... .............. A Repair artery 0.36 8.51 NA 0.45 9.32 NA ZZZ
blockage, each.
75968............... 26............ A Repair artery 0.36 0.13 0.13 0.02 0.51 0.51 ZZZ
blockage, each.
75968............... TC............ A Repair artery 0.00 8.38 NA 0.43 8.81 NA ZZZ
blockage, each.
75970............... .............. A Vascular biopsy...... 0.83 11.80 NA 0.64 13.27 NA XXX
75970............... 26............ A Vascular biopsy...... 0.83 0.28 0.28 0.04 1.15 1.15 XXX
75970............... TC............ A Vascular biopsy...... 0.00 11.52 NA 0.60 12.12 NA XXX
75978............... .............. A Repair venous 0.54 15.89 NA 0.86 17.29 NA XXX
blockage.
75978............... 26............ A Repair venous 0.54 0.18 0.18 0.03 0.75 0.75 XXX
blockage.
75978............... TC............ A Repair venous 0.00 15.71 NA 0.83 16.54 NA XXX
blockage.
75980............... .............. A Contrast xray exam 1.44 5.87 NA 0.36 7.67 NA XXX
bile duct.
75980............... 26............ A Contrast xray exam 1.44 0.47 0.47 0.07 1.98 1.98 XXX
bile duct.
75980............... TC............ A Contrast xray exam 0.00 5.40 NA 0.29 5.69 NA XXX
bile duct.
75982............... .............. A Contrast xray exam 1.44 6.56 NA 0.40 8.40 NA XXX
bile duct.
75982............... 26............ A Contrast xray exam 1.44 0.47 0.47 0.07 1.98 1.98 XXX
bile duct.
75982............... TC............ A Contrast xray exam 0.00 6.09 NA 0.33 6.42 NA XXX
bile duct.
75984............... .............. A Xray control catheter 0.72 2.18 NA 0.14 3.04 NA XXX
change.
75984............... 26............ A Xray control catheter 0.72 0.23 0.23 0.03 0.98 0.98 XXX
change.
75984............... TC............ A Xray control catheter 0.00 1.95 NA 0.11 2.06 NA XXX
change.
75989............... .............. A Abscess drainage 1.19 3.53 NA 0.22 4.94 NA XXX
under x-ray.
75989............... 26............ A Abscess drainage 1.19 0.39 0.39 0.05 1.63 1.63 XXX
under x-ray.
75989............... TC............ A Abscess drainage 0.00 3.15 NA 0.17 3.32 NA XXX
under x-ray.
75992............... .............. A Atherectomy, x-ray 0.54 15.90 NA 0.86 17.30 NA XXX
exam.
75992............... 26............ A Atherectomy, x-ray 0.54 0.19 0.19 0.03 0.76 0.76 XXX
exam.
75992............... TC............ A Atherectomy, x-ray 0.00 15.71 NA 0.83 16.54 NA XXX
exam.
75993............... .............. A Atherectomy, x-ray 0.36 8.51 NA 0.45 9.32 NA ZZZ
exam.
75993............... 26............ A Atherectomy, x-ray 0.36 0.13 0.13 0.02 0.51 0.51 ZZZ
exam.
75993............... TC............ A Atherectomy, x-ray 0.00 8.38 NA 0.43 8.81 NA ZZZ
exam.
75994............... .............. A Atherectomy, x-ray 1.31 16.18 NA 0.87 18.36 NA XXX
exam.
75994............... 26............ A Atherectomy, x-ray 1.31 0.46 0.46 0.04 1.81 1.81 XXX
exam.
75994............... TC............ A Atherectomy, x-ray 0.00 15.71 NA 0.83 16.54 NA XXX
exam.
75995............... .............. A Atherectomy, x-ray 1.31 16.18 NA 0.91 18.40 NA XXX
exam.
75995............... 26............ A Atherectomy, x-ray 1.31 0.47 0.47 0.08 1.86 1.86 XXX
exam.
75995............... TC............ A Atherectomy, x-ray 0.00 15.71 NA 0.83 16.54 NA XXX
exam.
75996............... .............. A Atherectomy, x-ray 0.36 8.50 NA 0.44 9.30 NA ZZZ
exam.
75996............... 26............ A Atherectomy, x-ray 0.36 0.12 0.12 0.01 0.49 0.49 ZZZ
exam.
75996............... TC............ A Atherectomy, x-ray 0.00 8.38 NA 0.43 8.81 NA ZZZ
exam.
75998............... .............. A Fluoroguide for vein 0.38 1.43 NA 0.11 1.92 NA ZZZ
device.
75998............... 26............ A Fluoroguide for vein 0.38 0.13 0.13 0.01 0.52 0.52 ZZZ
device.
75998............... TC............ A Fluoroguide for vein 0.00 1.30 NA 0.10 1.40 NA ZZZ
device.
76000............... .............. A Fluoroscope 0.17 1.36 NA 0.08 1.61 NA XXX
examination.
76000............... 26............ A Fluoroscope 0.17 0.05 0.05 0.01 0.23 0.23 XXX
examination.
76000............... TC............ A Fluoroscope 0.00 1.30 NA 0.07 1.37 NA XXX
examination.
76001............... .............. A Fluoroscope exam, 0.67 2.84 NA 0.18 3.69 NA XXX
extensive.
76001............... 26............ A Fluoroscope exam, 0.67 0.22 0.22 0.04 0.93 0.93 XXX
extensive.
76001............... TC............ A Fluoroscope exam, 0.00 2.62 NA 0.14 2.76 NA XXX
extensive.
76003............... .............. A Needle localization 0.54 1.47 NA 0.10 2.11 NA XXX
by x-ray.
76003............... 26............ A Needle localization 0.54 0.17 0.17 0.03 0.74 0.74 XXX
by x-ray.
76003............... TC............ A Needle localization 0.00 1.30 NA 0.07 1.37 NA XXX
by x-ray.
76005............... .............. A Fluoroguide for spine 0.60 1.46 NA 0.11 2.17 NA XXX
inject.
76005............... 26............ A Fluoroguide for spine 0.60 0.15 0.15 0.04 0.79 0.79 XXX
inject.
76005............... TC............ A Fluoroguide for spine 0.00 1.30 NA 0.07 1.37 NA XXX
inject.
76006............... .............. A X-ray stress view.... 0.41 0.18 0.18 0.06 0.65 0.65 XXX
76010............... .............. A X-ray, nose to rectum 0.18 0.58 NA 0.03 0.79 NA XXX
76010............... 26............ A X-ray, nose to rectum 0.18 0.06 0.06 0.01 0.25 0.25 XXX
76010............... TC............ A X-ray, nose to rectum 0.00 0.52 NA 0.02 0.54 NA XXX
76012............... 26............ A Percut vertebroplasty 1.31 0.47 0.47 0.09 1.87 1.87 XXX
fluor.
76013............... 26............ A Percut 1.38 0.47 0.47 0.08 1.93 1.93 XXX
vertebroplasty, ct.
76020............... .............. A X-rays for bone age.. 0.19 0.58 NA 0.03 0.80 NA XXX
76020............... 26............ A X-rays for bone age.. 0.19 0.06 0.06 0.01 0.26 0.26 XXX
76020............... TC............ A X-rays for bone age.. 0.00 0.52 NA 0.02 0.54 NA XXX
76040............... .............. A X-rays, bone 0.27 0.87 NA 0.06 1.20 NA XXX
evaluation.
76040............... 26............ A X-rays, bone 0.27 0.09 0.09 0.01 0.37 0.37 XXX
evaluation.
76040............... TC............ A X-rays, bone 0.00 0.78 NA 0.05 0.83 NA XXX
evaluation.
76061............... .............. A X-rays, bone survey.. 0.45 1.14 NA 0.08 1.67 NA XXX
[[Page 47664]]
76061............... 26............ A X-rays, bone survey.. 0.45 0.15 0.15 0.02 0.62 0.62 XXX
76061............... TC............ A X-rays, bone survey.. 0.00 0.99 NA 0.06 1.05 NA XXX
76062............... .............. A X-rays, bone survey.. 0.54 1.61 NA 0.10 2.25 NA XXX
76062............... 26............ A X-rays, bone survey.. 0.54 0.18 0.18 0.02 0.74 0.74 XXX
76062............... TC............ A X-rays, bone survey.. 0.00 1.44 NA 0.08 1.52 NA XXX
76065............... .............. A X-rays, bone 0.70 0.97 NA 0.08 1.75 NA XXX
evaluation.
76065............... 26............ A X-rays, bone 0.70 0.23 0.23 0.03 0.96 0.96 XXX
evaluation.
76065............... TC............ A X-rays, bone 0.00 0.73 NA 0.05 0.78 NA XXX
evaluation.
76066............... .............. A Joint survey, single 0.31 1.21 NA 0.08 1.60 NA XXX
view.
76066............... 26............ A Joint survey, single 0.31 0.10 0.10 0.02 0.43 0.43 XXX
view.
76066............... TC............ A Joint survey, single 0.00 1.11 NA 0.06 1.17 NA XXX
view.
76070............... .............. A Ct bone density, 0.25 3.03 NA 0.17 3.45 NA XXX
axial.
76070............... 26............ A Ct bone density, 0.25 0.08 0.08 0.01 0.34 0.34 XXX
axial.
76070............... TC............ A Ct bone density, 0.00 2.94 NA 0.16 3.10 NA XXX
axial.
76071............... .............. A Ct bone density, 0.22 3.02 NA 0.06 3.30 NA XXX
peripheral.
76071............... 26............ A Ct bone density, 0.22 0.07 0.07 0.01 0.30 0.30 XXX
peripheral.
76071............... TC............ A Ct bone density, 0.00 2.94 NA 0.05 2.99 NA XXX
peripheral.
76075............... .............. A Dexa, axial skeleton 0.30 3.19 NA 0.18 3.67 NA XXX
study.
76075............... 26............ A Dexa, axial skeleton 0.30 0.10 0.10 0.01 0.41 0.41 XXX
study.
76075............... TC............ A Dexa, axial skeleton 0.00 3.09 NA 0.17 3.26 NA XXX
study.
76076............... .............. A Dexa, peripheral 0.22 0.83 NA 0.06 1.11 NA XXX
study.
76076............... 26............ A Dexa, peripheral 0.22 0.07 0.07 0.01 0.30 0.30 XXX
study.
76076............... TC............ A Dexa, peripheral 0.00 0.75 NA 0.05 0.80 NA XXX
study.
76078............... .............. A Radiographic 0.20 0.82 NA 0.06 1.08 NA XXX
absorptiometry.
76078............... 26............ A Radiographic 0.20 0.07 0.07 0.01 0.28 0.28 XXX
absorptiometry.
76078............... TC............ A Radiographic 0.00 0.75 NA 0.05 0.80 NA XXX
absorptiometry.
76080............... .............. A X-ray exam of fistula 0.54 1.23 NA 0.08 1.85 NA XXX
76080............... 26............ A X-ray exam of fistula 0.54 0.18 0.18 0.02 0.74 0.74 XXX
76080............... TC............ A X-ray exam of fistula 0.00 1.05 NA 0.06 1.11 NA XXX
76082............... .............. A Computer mammogram 0.06 0.43 NA 0.01 0.50 NA ZZZ
add-on.
76082............... 26............ A Computer mammogram 0.06 0.02 0.02 0.00 0.08 0.08 ZZZ
add-on.
76082............... TC............ A Computer mammogram 0.00 0.42 NA 0.01 0.43 NA ZZZ
add-on.
76083............... .............. A Computer mammogram 0.06 0.43 NA 0.01 0.50 NA ZZZ
add-on.
76083............... 26............ A Computer mammogram 0.06 0.02 0.02 0.00 0.08 0.08 ZZZ
add-on.
76083............... TC............ A Computer mammogram 0.00 0.42 NA 0.01 0.43 NA ZZZ
add-on.
76086............... .............. A X-ray of mammary duct 0.36 2.73 NA 0.16 3.25 NA XXX
76086............... 26............ A X-ray of mammary duct 0.36 0.12 0.12 0.02 0.50 0.50 XXX
76086............... TC............ A X-ray of mammary duct 0.00 2.62 NA 0.14 2.76 NA XXX
76088............... .............. A X-ray of mammary 0.45 3.80 NA 0.21 4.46 NA XXX
ducts.
76088............... 26............ A X-ray of mammary 0.45 0.15 0.15 0.02 0.62 0.62 XXX
ducts.
76088............... TC............ A X-ray of mammary 0.00 3.66 NA 0.19 3.85 NA XXX
ducts.
76090............... .............. A Mammogram, one breast 0.70 1.28 NA 0.09 2.07 NA XXX
76090............... 26............ A Mammogram, one breast 0.70 0.23 0.23 0.03 0.96 0.96 XXX
76090............... TC............ A Mammogram, one breast 0.00 1.05 NA 0.06 1.11 NA XXX
76091............... .............. A Mammogram, both 0.87 1.59 NA 0.11 2.57 NA XXX
breasts.
76091............... 26............ A Mammogram, both 0.87 0.28 0.28 0.04 1.19 1.19 XXX
breasts.
76091............... TC............ A Mammogram, both 0.00 1.30 NA 0.07 1.37 NA XXX
breasts.
76092............... .............. A Mammogram, screening. 0.70 1.45 NA 0.10 2.25 NA XXX
76092............... 26............ A Mammogram, screening. 0.70 0.23 0.23 0.03 0.96 0.96 XXX
76092............... TC............ A Mammogram, screening. 0.00 1.23 NA 0.07 1.30 NA XXX
76093............... .............. A Magnetic image, 1.63 18.13 NA 0.99 20.75 NA XXX
breast.
76093............... 26............ A Magnetic image, 1.63 0.53 0.53 0.07 2.23 2.23 XXX
breast.
76093............... TC............ A Magnetic image, 0.00 17.59 NA 0.92 18.51 NA XXX
breast.
76094............... .............. A Magnetic image, both 1.63 24.40 NA 1.31 27.34 NA XXX
breasts.
76094............... 26............ A Magnetic image, both 1.63 0.53 0.53 0.07 2.23 2.23 XXX
breasts.
76094............... TC............ A Magnetic image, both 0.00 23.87 NA 1.24 25.11 NA XXX
breasts.
76095............... .............. A Stereotactic breast 1.59 7.67 NA 0.47 9.73 NA XXX
biopsy.
76095............... 26............ A Stereotactic breast 1.59 0.52 0.52 0.10 2.21 2.21 XXX
biopsy.
76095............... TC............ A Stereotactic breast 0.00 7.15 NA 0.37 7.52 NA XXX
biopsy.
76096............... .............. A X-ray of needle wire, 0.56 1.49 NA 0.10 2.15 NA XXX
breast.
76096............... 26............ A X-ray of needle wire, 0.56 0.18 0.18 0.03 0.77 0.77 XXX
breast.
76096............... TC............ A X-ray of needle wire, 0.00 1.30 NA 0.07 1.37 NA XXX
breast.
76098............... .............. A X-ray exam, breast 0.16 0.47 NA 0.03 0.66 NA XXX
specimen.
76098............... 26............ A X-ray exam, breast 0.16 0.05 0.05 0.01 0.22 0.22 XXX
specimen.
76098............... TC............ A X-ray exam, breast 0.00 0.42 NA 0.02 0.44 NA XXX
specimen.
76100............... .............. A X-ray exam of body 0.58 1.43 NA 0.10 2.11 NA XXX
section.
76100............... 26............ A X-ray exam of body 0.58 0.19 0.19 0.03 0.80 0.80 XXX
section.
76100............... TC............ A X-ray exam of body 0.00 1.25 NA 0.07 1.32 NA XXX
section.
76101............... .............. A Complex body section 0.58 1.61 NA 0.11 2.30 NA XXX
x-ray.
76101............... 26............ A Complex body section 0.58 0.19 0.19 0.03 0.80 0.80 XXX
x-ray.
76101............... TC............ A Complex body section 0.00 1.42 NA 0.08 1.50 NA XXX
x-ray.
76102............... .............. A Complex body section 0.58 1.92 NA 0.14 2.64 NA XXX
x-rays.
76102............... 26............ A Complex body section 0.58 0.19 0.19 0.03 0.80 0.80 XXX
x-rays.
76102............... TC............ A Complex body section 0.00 1.73 NA 0.11 1.84 NA XXX
x-rays.
76120............... .............. A Cine/video x-rays.... 0.38 1.18 NA 0.08 1.64 NA XXX
[[Page 47665]]
76120............... 26............ A Cine/video x-rays.... 0.38 0.13 0.13 0.02 0.53 0.53 XXX
76120............... TC............ A Cine/video x-rays.... 0.00 1.05 NA 0.06 1.11 NA XXX
76125............... .............. A Cine/video x-rays add- 0.27 0.87 NA 0.06 1.20 NA ZZZ
on.
76125............... 26............ A Cine/video x-rays add- 0.27 0.09 0.09 0.01 0.37 0.37 ZZZ
on.
76125............... TC............ A Cine/video x-rays add- 0.00 0.78 NA 0.05 0.83 NA ZZZ
on.
76150............... .............. A X-ray exam, dry 0.00 0.42 NA 0.02 0.44 NA XXX
process.
76355............... .............. A Ct scan for 1.21 8.64 NA 0.48 10.33 NA XXX
localization.
76355............... 26............ A Ct scan for 1.21 0.40 0.40 0.06 1.67 1.67 XXX
localization.
76355............... TC............ A Ct scan for 0.00 8.24 NA 0.42 8.66 NA XXX
localization.
76360............... .............. A Ct scan for needle 1.16 8.62 NA 0.47 10.25 NA XXX
biopsy.
76360............... 26............ A Ct scan for needle 1.16 0.38 0.38 0.05 1.59 1.59 XXX
biopsy.
76360............... TC............ A Ct scan for needle 0.00 8.24 NA 0.42 8.66 NA XXX
biopsy.
76362............... .............. A Ct guide for tissue 3.99 9.54 NA 1.64 15.17 NA XXX
ablation.
76362............... 26............ A Ct guide for tissue 3.99 1.30 1.30 0.18 5.47 5.47 XXX
ablation.
76362............... TC............ A Ct guide for tissue 0.00 8.24 NA 1.46 9.70 NA XXX
ablation.
76370............... .............. A Ct scan for therapy 0.85 3.22 NA 0.20 4.27 NA XXX
guide.
76370............... 26............ A Ct scan for therapy 0.85 0.28 0.28 0.04 1.17 1.17 XXX
guide.
76370............... TC............ A Ct scan for therapy 0.00 2.94 NA 0.16 3.10 NA XXX
guide.
76375............... .............. A 3d/holograph reconstr 0.16 3.58 NA 0.19 3.93 NA XXX
add-on.
76375............... 26............ A 3d/holograph reconstr 0.16 0.05 0.05 0.01 0.22 0.22 XXX
add-on.
76375............... TC............ A 3d/holograph reconstr 0.00 3.53 NA 0.18 3.71 NA XXX
add-on.
76380............... .............. A CAT scan follow-up 0.98 3.81 NA 0.22 5.01 NA XXX
study.
76380............... 26............ A CAT scan follow-up 0.98 0.32 0.32 0.04 1.34 1.34 XXX
study.
76380............... TC............ A CAT scan follow-up 0.00 3.49 NA 0.18 3.67 NA XXX
study.
76393............... .............. A Mr guidance for 1.50 11.68 NA 0.65 13.83 NA XXX
needle place.
76393............... 26............ A Mr guidance for 1.50 0.50 0.50 0.10 2.10 2.10 XXX
needle place.
76393............... TC............ A Mr guidance for 0.00 11.19 NA 0.55 11.74 NA XXX
needle place.
76394............... .............. A Mri for tissue 4.24 12.57 NA 1.80 18.61 NA XXX
ablation.
76394............... 26............ A Mri for tissue 4.24 1.38 1.38 0.24 5.86 5.86 XXX
ablation.
76394............... TC............ A Mri for tissue 0.00 11.19 NA 1.56 12.75 NA XXX
ablation.
76400............... .............. A Magnetic image, bone 1.60 11.71 NA 0.66 13.97 NA XXX
marrow.
76400............... 26............ A Magnetic image, bone 1.60 0.52 0.52 0.07 2.19 2.19 XXX
marrow.
76400............... TC............ A Magnetic image, bone 0.00 11.19 NA 0.59 11.78 NA XXX
marrow.
76506............... .............. A Echo exam of head.... 0.63 1.66 NA 0.12 2.41 NA XXX
76506............... 26............ A Echo exam of head.... 0.63 0.24 0.24 0.04 0.91 0.91 XXX
76506............... TC............ A Echo exam of head.... 0.00 1.42 NA 0.08 1.50 NA XXX
76511............... .............. A Echo exam of eye..... 0.94 1.85 NA 0.10 2.89 NA XXX
76511............... 26............ A Echo exam of eye..... 0.94 0.40 0.40 0.03 1.37 1.37 XXX
76511............... TC............ A Echo exam of eye..... 0.00 1.45 NA 0.07 1.52 NA XXX
76512............... .............. A Echo exam of eye..... 0.66 1.73 NA 0.12 2.51 NA XXX
76512............... 26............ A Echo exam of eye..... 0.66 0.29 0.29 0.02 0.97 0.97 XXX
76512............... TC............ A Echo exam of eye..... 0.00 1.44 NA 0.10 1.54 NA XXX
76513............... .............. A Echo exam of eye, 0.66 1.82 NA 0.12 2.60 NA XXX
water bath.
76513............... 26............ A Echo exam of eye, 0.66 0.29 0.29 0.02 0.97 0.97 XXX
water bath.
76513............... TC............ A Echo exam of eye, 0.00 1.52 NA 0.10 1.62 NA XXX
water bath.
76514............... .............. A Echo exam of eye, 0.17 0.13 NA 0.02 0.32 NA XXX
thickness.
76514............... 26............ A Echo exam of eye, 0.17 0.08 0.08 0.01 0.26 0.26 XXX
thickness.
76514............... TC............ A Echo exam of eye, 0.00 0.05 NA 0.01 0.06 NA XXX
thickness.
76516............... .............. A Echo exam of eye..... 0.54 1.46 NA 0.08 2.08 NA XXX
76516............... 26............ A Echo exam of eye..... 0.54 0.24 0.24 0.01 0.79 0.79 XXX
76516............... TC............ A Echo exam of eye..... 0.00 1.22 NA 0.07 1.29 NA XXX
76519............... .............. A Echo exam of eye..... 0.54 1.56 NA 0.08 2.18 NA XXX
76519............... 26............ A Echo exam of eye..... 0.54 0.24 0.24 0.01 0.79 0.79 XXX
76519............... TC............ A Echo exam of eye..... 0.00 1.32 NA 0.07 1.39 NA XXX
76529............... .............. A Echo exam of eye..... 0.57 1.38 NA 0.10 2.05 NA XXX
76529............... 26............ A Echo exam of eye..... 0.57 0.24 0.24 0.02 0.83 0.83 XXX
76529............... TC............ A Echo exam of eye..... 0.00 1.14 NA 0.08 1.22 NA XXX
76536............... .............. A Us exam of head and 0.56 1.60 NA 0.11 2.27 NA XXX
neck.
76536............... 26............ A Us exam of head and 0.56 0.18 0.18 0.03 0.77 0.77 XXX
neck.
76536............... TC............ A Us exam of head and 0.00 1.42 NA 0.08 1.50 NA XXX
neck.
76604............... .............. A Us exam, chest, b- 0.55 1.48 NA 0.10 2.13 NA XXX
scan.
76604............... 26............ A Us exam, chest, b- 0.55 0.18 0.18 0.03 0.76 0.76 XXX
scan.
76604............... TC............ A Us exam, chest, b- 0.00 1.30 NA 0.07 1.37 NA XXX
scan.
76645............... .............. A Us exam, breast(s)... 0.54 1.23 NA 0.08 1.85 NA XXX
76645............... 26............ A Us exam, breast(s)... 0.54 0.18 0.18 0.02 0.74 0.74 XXX
76645............... TC............ A Us exam, breast(s)... 0.00 1.05 NA 0.06 1.11 NA XXX
76700............... .............. A Us exam, abdom, 0.81 2.23 NA 0.15 3.19 NA XXX
complete.
76700............... 26............ A Us exam, abdom, 0.81 0.26 0.26 0.04 1.11 1.11 XXX
complete.
76700............... TC............ A Us exam, abdom, 0.00 1.97 NA 0.11 2.08 NA XXX
complete.
76705............... .............. A Echo exam of abdomen. 0.59 1.61 NA 0.11 2.31 NA XXX
76705............... 26............ A Echo exam of abdomen. 0.59 0.19 0.19 0.03 0.81 0.81 XXX
76705............... TC............ A Echo exam of abdomen. 0.00 1.42 NA 0.08 1.50 NA XXX
76770............... .............. A Us exam abdo back 0.74 2.21 NA 0.14 3.09 NA XXX
wall, comp.
76770............... 26............ A Us exam abdo back 0.74 0.24 0.24 0.03 1.01 1.01 XXX
wall, comp.
76770............... TC............ A Us exam abdo back 0.00 1.97 NA 0.11 2.08 NA XXX
wall, comp.
[[Page 47666]]
76775............... .............. A Us exam abdo back 0.58 1.61 NA 0.11 2.30 NA XXX
wall, lim.
76775............... 26............ A Us exam abdo back 0.58 0.19 0.19 0.03 0.80 0.80 XXX
wall, lim.
76775............... TC............ A Us exam abdo back 0.00 1.42 NA 0.08 1.50 NA XXX
wall, lim.
76778............... .............. A Us exam kidney 0.74 2.21 NA 0.14 3.09 NA XXX
transplant.
76778............... 26............ A Us exam kidney 0.74 0.24 0.24 0.03 1.01 1.01 XXX
transplant.
76778............... TC............ A Us exam kidney 0.00 1.97 NA 0.11 2.08 NA XXX
transplant.
76800............... .............. A Us exam, spinal canal 1.13 1.76 NA 0.14 3.03 NA XXX
76800............... 26............ A Us exam, spinal canal 1.13 0.34 0.34 0.06 1.53 1.53 XXX
76800............... TC............ A Us exam, spinal canal 0.00 1.42 NA 0.08 1.50 NA XXX
76801............... .............. A Ob us < 14 wks, 0.99 2.43 NA 0.17 3.59 NA XXX
single fetus.
76801............... 26............ A Ob us < 14 wks, 0.99 0.34 0.34 0.05 1.38 1.38 XXX
single fetus.
76801............... TC............ A Ob us < 14 wks, 0.00 2.09 NA 0.12 2.21 NA XXX
single fetus.
76802............... .............. A Ob us < 14 wks, add-l 0.83 1.34 NA 0.17 2.34 NA ZZZ
fetus.
76802............... 26............ A Ob us < 14 wks, add-l 0.83 0.29 0.29 0.05 1.17 1.17 ZZZ
fetus.
76802............... TC............ A Ob us < 14 wks, add-l 0.00 1.05 NA 0.12 1.17 NA ZZZ
fetus.
76805............... .............. A Ob us >/= 14 wks, 0.99 2.43 NA 0.17 3.59 NA XXX
sngl fetus.
76805............... 26............ A Ob us >/= 14 wks, 0.99 0.34 0.34 0.05 1.38 1.38 XXX
sngl fetus.
76805............... TC............ A Ob us >/= 14 wks, 0.00 2.09 NA 0.12 2.21 NA XXX
sngl fetus.
76810............... .............. A Ob us >/= 14 wks, 0.98 1.39 NA 0.31 2.68 NA ZZZ
addl fetus.
76810............... 26............ A Ob us >/= 14 wks, 0.98 0.34 0.34 0.09 1.41 1.41 ZZZ
addl fetus.
76810............... TC............ A Ob us >/= 14 wks, 0.00 1.05 NA 0.22 1.27 NA ZZZ
addl fetus.
76811............... .............. A Ob us, detailed, sngl 1.90 4.23 NA 0.48 6.61 NA XXX
fetus.
76811............... 26............ A Ob us, detailed, sngl 1.90 0.71 0.71 0.05 2.66 2.66 XXX
fetus.
76811............... TC............ A Ob us, detailed, sngl 0.00 3.52 NA 0.43 3.95 NA XXX
fetus.
76812............... .............. A Ob us, detailed, addl 1.78 1.71 NA 0.50 3.99 NA ZZZ
fetus.
76812............... 26............ A Ob us, detailed, addl 1.78 0.66 0.66 0.09 2.53 2.53 ZZZ
fetus.
76812............... TC............ A Ob us, detailed, addl 0.00 1.05 NA 0.41 1.46 NA ZZZ
fetus.
76815............... .............. A Ob us, limited, 0.65 1.65 NA 0.11 2.41 NA XXX
fetus(s).
76815............... 26............ A Ob us, limited, 0.65 0.23 0.23 0.03 0.91 0.91 XXX
fetus(s).
76815............... TC............ A Ob us, limited, 0.00 1.42 NA 0.08 1.50 NA XXX
fetus(s).
76816............... .............. A Ob us, follow-up, per 0.85 1.42 NA 0.09 2.36 NA XXX
fetus.
76816............... 26............ A Ob us, follow-up, per 0.85 0.31 0.31 0.03 1.19 1.19 XXX
fetus.
76816............... TC............ A Ob us, follow-up, per 0.00 1.11 NA 0.06 1.17 NA XXX
fetus.
76817............... .............. A Transvaginal us, 0.75 1.78 NA 0.09 2.62 NA XXX
obstetric.
76817............... 26............ A Transvaginal us, 0.75 0.26 0.26 0.03 1.04 1.04 XXX
obstetric.
76817............... TC............ A Transvaginal us, 0.00 1.52 NA 0.06 1.58 NA XXX
obstetric.
76818............... .............. A Fetal biophys profile 1.05 2.00 NA 0.15 3.20 NA XXX
w/nst.
76818............... 26............ A Fetal biophys profile 1.05 0.39 0.39 0.05 1.49 1.49 XXX
w/nst.
76818............... TC............ A Fetal biophys profile 0.00 1.61 NA 0.10 1.71 NA XXX
w/nst.
76819............... .............. A Fetal biophys profil 0.77 1.89 NA 0.14 2.80 NA XXX
w/o nst.
76819............... 26............ A Fetal biophys profil 0.77 0.28 0.28 0.04 1.09 1.09 XXX
w/o nst.
76819............... TC............ A Fetal biophys profil 0.00 1.61 NA 0.10 1.71 NA XXX
w/o nst.
76825............... .............. A Echo exam of fetal 1.67 2.57 NA 0.18 4.42 NA XXX
heart.
76825............... 26............ A Echo exam of fetal 1.67 0.60 0.60 0.07 2.34 2.34 XXX
heart.
76825............... TC............ A Echo exam of fetal 0.00 1.97 NA 0.11 2.08 NA XXX
heart.
76826............... .............. A Echo exam of fetal 0.83 0.99 NA 0.09 1.91 NA XXX
heart.
76826............... 26............ A Echo exam of fetal 0.83 0.29 0.29 0.04 1.16 1.16 XXX
heart.
76826............... TC............ A Echo exam of fetal 0.00 0.70 NA 0.05 0.75 NA XXX
heart.
76827............... .............. A Echo exam of fetal 0.58 1.93 NA 0.15 2.66 NA XXX
heart.
76827............... 26............ A Echo exam of fetal 0.58 0.21 0.21 0.03 0.82 0.82 XXX
heart.
76827............... TC............ A Echo exam of fetal 0.00 1.72 NA 0.12 1.84 NA XXX
heart.
76828............... .............. A Echo exam of fetal 0.56 1.32 NA 0.11 1.99 NA XXX
heart.
76828............... 26............ A Echo exam of fetal 0.56 0.21 0.21 0.03 0.80 0.80 XXX
heart.
76828............... TC............ A Echo exam of fetal 0.00 1.11 NA 0.08 1.19 NA XXX
heart.
76830............... .............. A Transvaginal us, non- 0.69 1.74 NA 0.13 2.56 NA XXX
ob.
76830............... 26............ A Transvaginal us, non- 0.69 0.23 0.23 0.03 0.95 0.95 XXX
ob.
76830............... TC............ A Transvaginal us, non- 0.00 1.52 NA 0.10 1.62 NA XXX
ob.
76831............... .............. A Echo exam, uterus.... 0.72 1.77 NA 0.13 2.62 NA XXX
76831............... 26............ A Echo exam, uterus.... 0.72 0.25 0.25 0.03 1.00 1.00 XXX
76831............... TC............ A Echo exam, uterus.... 0.00 1.52 NA 0.10 1.62 NA XXX
76856............... .............. A Us exam, pelvic, 0.69 1.74 NA 0.13 2.56 NA XXX
complete.
76856............... 26............ A Us exam, pelvic, 0.69 0.23 0.23 0.03 0.95 0.95 XXX
complete.
76856............... TC............ A Us exam, pelvic, 0.00 1.52 NA 0.10 1.62 NA XXX
complete.
76857............... .............. A Us exam, pelvic, 0.38 1.83 NA 0.08 2.29 NA XXX
limited.
76857............... 26............ A Us exam, pelvic, 0.38 0.12 0.12 0.02 0.52 0.52 XXX
limited.
76857............... TC............ A Us exam, pelvic, 0.00 1.70 NA 0.06 1.76 NA XXX
limited.
76870............... .............. A Us exam, scrotum..... 0.64 1.72 NA 0.13 2.49 NA XXX
76870............... 26............ A Us exam, scrotum..... 0.64 0.21 0.21 0.03 0.88 0.88 XXX
76870............... TC............ A Us exam, scrotum..... 0.00 1.52 NA 0.10 1.62 NA XXX
76872............... .............. A Us, transrectal...... 0.69 2.25 NA 0.14 3.08 NA XXX
76872............... 26............ A Us, transrectal...... 0.69 0.22 0.22 0.04 0.95 0.95 XXX
76872............... TC............ A Us, transrectal...... 0.00 2.02 NA 0.10 2.12 NA XXX
76873............... .............. A Echograp trans r, 1.55 2.59 NA 0.25 4.39 NA XXX
pros study.
76873............... 26............ A Echograp trans r, 1.55 0.50 0.50 0.09 2.14 2.14 XXX
pros study.
76873............... TC............ A Echograp trans r, 0.00 2.09 NA 0.16 2.25 NA XXX
pros study.
[[Page 47667]]
76880............... .............. A Us exam, extremity... 0.59 1.61 NA 0.11 2.31 NA XXX
76880............... 26............ A Us exam, extremity... 0.59 0.19 0.19 0.03 0.81 0.81 XXX
76880............... TC............ A Us exam, extremity... 0.00 1.42 NA 0.08 1.50 NA XXX
76885............... .............. A Us exam infant hips, 0.74 1.76 NA 0.13 2.63 NA XXX
dynamic.
76885............... 26............ A Us exam infant hips, 0.74 0.24 0.24 0.03 1.01 1.01 XXX
dynamic.
76885............... TC............ A Us exam infant hips, 0.00 1.52 NA 0.10 1.62 NA XXX
dynamic.
76886............... .............. A Us exam infant hips, 0.62 1.62 NA 0.11 2.35 NA XXX
static.
76886............... 26............ A Us exam infant hips, 0.62 0.20 0.20 0.03 0.85 0.85 XXX
static.
76886............... TC............ A Us exam infant hips, 0.00 1.42 NA 0.08 1.50 NA XXX
static.
76930............... .............. A Echo guide, 0.67 1.77 NA 0.12 2.56 NA XXX
cardiocentesis.
76930............... 26............ A Echo guide, 0.67 0.25 0.25 0.02 0.94 0.94 XXX
cardiocentesis.
76930............... TC............ A Echo guide, 0.00 1.52 NA 0.10 1.62 NA XXX
cardiocentesis.
76932............... .............. A Echo guide for heart 0.67 1.77 NA 0.12 2.56 NA XXX
biopsy.
76932............... 26............ A Echo guide for heart 0.67 0.25 0.25 0.02 0.94 0.94 XXX
biopsy.
76932............... TC............ A Echo guide for heart 0.00 1.52 NA 0.10 1.62 NA XXX
biopsy.
76936............... .............. A Echo guide for artery 1.99 6.94 NA 0.47 9.40 NA XXX
repair.
76936............... 26............ A Echo guide for artery 1.99 0.66 0.66 0.13 2.78 2.78 XXX
repair.
76936............... TC............ A Echo guide for artery 0.00 6.28 NA 0.34 6.62 NA XXX
repair.
76937............... .............. A Us guide, vascular 0.30 0.47 NA 0.13 0.90 NA ZZZ
access.
76937............... 26............ A Us guide, vascular 0.30 0.10 0.10 0.03 0.43 0.43 ZZZ
access.
76937............... TC............ A Us guide, vascular 0.00 0.38 NA 0.10 0.48 NA ZZZ
access.
76940............... .............. A Us guide, tissue 2.00 2.17 NA 0.48 4.65 NA XXX
ablation.
76940............... 26............ A Us guide, tissue 2.00 0.65 0.65 0.19 2.84 2.84 XXX
ablation.
76940............... TC............ A Us guide, tissue 0.00 1.52 NA 0.29 1.81 NA XXX
ablation.
76941............... .............. A Echo guide for 1.34 2.00 NA 0.14 3.48 NA XXX
transfusion.
76941............... 26............ A Echo guide for 1.34 0.47 0.47 0.06 1.87 1.87 XXX
transfusion.
76941............... TC............ A Echo guide for 0.00 1.52 NA 0.08 1.60 NA XXX
transfusion.
76942............... .............. A Echo guide for biopsy 0.67 3.03 NA 0.13 3.83 NA XXX
76942............... 26............ A Echo guide for biopsy 0.67 0.22 0.22 0.03 0.92 0.92 XXX
76942............... TC............ A Echo guide for biopsy 0.00 2.81 NA 0.10 2.91 NA XXX
76945............... .............. A Echo guide, villus 0.67 1.75 NA 0.11 2.53 NA XXX
sampling.
76945............... 26............ A Echo guide, villus 0.67 0.22 0.22 0.03 0.92 0.92 XXX
sampling.
76945............... TC............ A Echo guide, villus 0.00 1.52 NA 0.08 1.60 NA XXX
sampling.
76946............... .............. A Echo guide for 0.38 1.66 NA 0.12 2.16 NA XXX
amniocentesis.
76946............... 26............ A Echo guide for 0.38 0.14 0.14 0.02 0.54 0.54 XXX
amniocentesis.
76946............... TC............ A Echo guide for 0.00 1.52 NA 0.10 1.62 NA XXX
amniocentesis.
76948............... .............. A Echo guide, ova 0.38 1.64 NA 0.12 2.14 NA XXX
aspiration.
76948............... 26............ A Echo guide, ova 0.38 0.13 0.13 0.02 0.53 0.53 XXX
aspiration.
76948............... TC............ A Echo guide, ova 0.00 1.52 NA 0.10 1.62 NA XXX
aspiration.
76950............... .............. A Echo guidance 0.58 1.49 NA 0.10 2.17 NA XXX
radiotherapy.
76950............... 26............ A Echo guidance 0.58 0.19 0.19 0.03 0.80 0.80 XXX
radiotherapy.
76950............... TC............ A Echo guidance 0.00 1.30 NA 0.07 1.37 NA XXX
radiotherapy.
76965............... .............. A Echo guidance 1.34 5.99 NA 0.38 7.71 NA XXX
radiotherapy.
76965............... 26............ A Echo guidance 1.34 0.43 0.43 0.09 1.86 1.86 XXX
radiotherapy.
76965............... TC............ A Echo guidance 0.00 5.56 NA 0.29 5.85 NA XXX
radiotherapy.
76970............... .............. A Ultrasound exam 0.40 1.18 NA 0.08 1.66 NA XXX
follow-up.
76970............... 26............ A Ultrasound exam 0.40 0.13 0.13 0.02 0.55 0.55 XXX
follow-up.
76970............... TC............ A Ultrasound exam 0.00 1.05 NA 0.06 1.11 NA XXX
follow-up.
76975............... .............. A GI endoscopic 0.81 1.79 NA 0.14 2.74 NA XXX
ultrasound.
76975............... 26............ A GI endoscopic 0.81 0.28 0.28 0.04 1.13 1.13 XXX
ultrasound.
76975............... TC............ A GI endoscopic 0.00 1.52 NA 0.10 1.62 NA XXX
ultrasound.
76977............... .............. A Us bone density 0.05 0.84 NA 0.05 0.94 NA XXX
measure.
76977............... 26............ A Us bone density 0.05 0.02 0.02 0.00 0.07 0.07 XXX
measure.
76977............... TC............ A Us bone density 0.00 0.82 NA 0.05 0.87 NA XXX
measure.
76986............... .............. A Ultrasound guide 1.20 3.01 NA 0.24 4.45 NA XXX
intraoper.
76986............... 26............ A Ultrasound guide 1.20 0.40 0.40 0.10 1.70 1.70 XXX
intraoper.
76986............... TC............ A Ultrasound guide 0.00 2.62 NA 0.14 2.76 NA XXX
intraoper.
77261............... .............. A Radiation therapy 1.39 0.51 0.51 0.07 1.97 1.97 XXX
planning.
77262............... .............. A Radiation therapy 2.11 0.76 0.76 0.11 2.98 2.98 XXX
planning.
77263............... .............. A Radiation therapy 3.14 1.11 1.11 0.16 4.41 4.41 XXX
planning.
77280............... .............. A Set radiation therapy 0.70 3.69 NA 0.22 4.61 NA XXX
field.
77280............... 26............ A Set radiation therapy 0.70 0.22 0.22 0.04 0.96 0.96 XXX
field.
77280............... TC............ A Set radiation therapy 0.00 3.46 NA 0.18 3.64 NA XXX
field.
77285............... .............. A Set radiation therapy 1.05 5.89 NA 0.35 7.29 NA XXX
field.
77285............... 26............ A Set radiation therapy 1.05 0.34 0.34 0.05 1.44 1.44 XXX
field.
77285............... TC............ A Set radiation therapy 0.00 5.56 NA 0.30 5.86 NA XXX
field.
77290............... .............. A Set radiation therapy 1.56 6.99 NA 0.43 8.98 NA XXX
field.
77290............... 26............ A Set radiation therapy 1.56 0.50 0.50 0.08 2.14 2.14 XXX
field.
77290............... TC............ A Set radiation therapy 0.00 6.50 NA 0.35 6.85 NA XXX
field.
77295............... .............. A Set radiation therapy 4.56 29.34 NA 1.72 35.62 NA XXX
field.
77295............... 26............ A Set radiation therapy 4.56 1.46 1.46 0.24 6.26 6.26 XXX
field.
77295............... TC............ A Set radiation therapy 0.00 27.88 NA 1.48 29.36 NA XXX
field.
77300............... .............. A Radiation therapy 0.62 1.54 NA 0.10 2.26 NA XXX
dose plan.
77300............... 26............ A Radiation therapy 0.62 0.20 0.20 0.03 0.85 0.85 XXX
dose plan.
77300............... TC............ A Radiation therapy 0.00 1.34 NA 0.07 1.41 NA XXX
dose plan.
[[Page 47668]]
77301............... .............. A Radiotherapy dose 7.99 30.44 NA 1.88 40.31 NA XXX
plan, imrt.
77301............... 26............ A Radiotherapy dose 7.99 2.55 2.55 0.40 10.94 10.94 XXX
plan, imrt.
77301............... TC............ A Radiotherapy dose 0.00 27.88 NA 1.48 29.36 NA XXX
plan, imrt.
77305............... .............. A Teletx isodose plan 0.70 2.08 NA 0.15 2.93 NA XXX
simple.
77305............... 26............ A Teletx isodose plan 0.70 0.23 0.23 0.04 0.97 0.97 XXX
simple.
77305............... TC............ A Teletx isodose plan 0.00 1.85 NA 0.11 1.96 NA XXX
simple.
77310............... .............. A Teletx isodose plan 1.05 2.66 NA 0.18 3.89 NA XXX
intermed.
77310............... 26............ A Teletx isodose plan 1.05 0.34 0.34 0.05 1.44 1.44 XXX
intermed.
77310............... TC............ A Teletx isodose plan 0.00 2.33 NA 0.13 2.46 NA XXX
intermed.
77315............... .............. A Teletx isodose plan 1.56 3.15 NA 0.22 4.93 NA XXX
complex.
77315............... 26............ A Teletx isodose plan 1.56 0.50 0.50 0.08 2.14 2.14 XXX
complex.
77315............... TC............ A Teletx isodose plan 0.00 2.65 NA 0.14 2.79 NA XXX
complex.
77321............... .............. A Special teletx port 0.95 4.34 NA 0.26 5.55 NA XXX
plan.
77321............... 26............ A Special teletx port 0.95 0.30 0.30 0.05 1.30 1.30 XXX
plan.
77321............... TC............ A Special teletx port 0.00 4.03 NA 0.21 4.24 NA XXX
plan.
77326............... .............. A Brachytx isodose calc 0.93 2.65 NA 0.18 3.76 NA XXX
simp.
77326............... 26............ A Brachytx isodose calc 0.93 0.30 0.30 0.05 1.28 1.28 XXX
simp.
77326............... TC............ A Brachytx isodose calc 0.00 2.35 NA 0.13 2.48 NA XXX
simp.
77327............... .............. A Brachytx isodose calc 1.39 3.91 NA 0.25 5.55 NA XXX
interm.
77327............... 26............ A Brachytx isodose calc 1.39 0.44 0.44 0.07 1.90 1.90 XXX
interm.
77327............... TC............ A Brachytx isodose calc 0.00 3.46 NA 0.18 3.64 NA XXX
interm.
77328............... .............. A Brachytx isodose plan 2.09 5.62 NA 0.36 8.07 NA XXX
compl.
77328............... 26............ A Brachytx isodose plan 2.09 0.67 0.67 0.11 2.87 2.87 XXX
compl.
77328............... TC............ A Brachytx isodose plan 0.00 4.95 NA 0.25 5.20 NA XXX
compl.
77331............... .............. A Special radiation 0.87 0.78 NA 0.06 1.71 NA XXX
dosimetry.
77331............... 26............ A Special radiation 0.87 0.28 0.28 0.04 1.19 1.19 XXX
dosimetry.
77331............... TC............ A Special radiation 0.00 0.50 NA 0.02 0.52 NA XXX
dosimetry.
77332............... .............. A Radiation treatment 0.54 1.51 NA 0.10 2.15 NA XXX
aid(s).
77332............... 26............ A Radiation treatment 0.54 0.17 0.17 0.03 0.74 0.74 XXX
aid(s).
77332............... TC............ A Radiation treatment 0.00 1.34 NA 0.07 1.41 NA XXX
aid(s).
77333............... .............. A Radiation treatment 0.84 2.16 NA 0.15 3.15 NA XXX
aid(s).
77333............... 26............ A Radiation treatment 0.84 0.27 0.27 0.04 1.15 1.15 XXX
aid(s).
77333............... TC............ A Radiation treatment 0.00 1.89 NA 0.11 2.00 NA XXX
aid(s).
77334............... .............. A Radiation treatment 1.24 3.64 NA 0.23 5.11 NA XXX
aid(s).
77334............... 26............ A Radiation treatment 1.24 0.40 0.40 0.06 1.70 1.70 XXX
aid(s).
77334............... TC............ A Radiation treatment 0.00 3.24 NA 0.17 3.41 NA XXX
aid(s).
77336............... .............. A Radiation physics 0.00 2.97 NA 0.16 3.13 NA XXX
consult.
77370............... .............. A Radiation physics 0.00 3.48 NA 0.18 3.66 NA XXX
consult.
77401............... .............. A Radiation treatment 0.00 1.77 NA 0.11 1.88 NA XXX
delivery.
77402............... .............. A Radiation treatment 0.00 1.77 NA 0.11 1.88 NA XXX
delivery.
77403............... .............. A Radiation treatment 0.00 1.77 NA 0.11 1.88 NA XXX
delivery.
77404............... .............. A Radiation treatment 0.00 1.77 NA 0.11 1.88 NA XXX
delivery.
77406............... .............. A Radiation treatment 0.00 1.77 NA 0.11 1.88 NA XXX
delivery.
77407............... .............. A Radiation treatment 0.00 2.08 NA 0.12 2.20 NA XXX
delivery.
77408............... .............. A Radiation treatment 0.00 2.08 NA 0.12 2.20 NA XXX
delivery.
77409............... .............. A Radiation treatment 0.00 2.08 NA 0.12 2.20 NA XXX
delivery.
77411............... .............. A Radiation treatment 0.00 2.08 NA 0.12 2.20 NA XXX
delivery.
77412............... .............. A Radiation treatment 0.00 2.33 NA 0.13 2.46 NA XXX
delivery.
77413............... .............. A Radiation treatment 0.00 2.33 NA 0.13 2.46 NA XXX
delivery.
77414............... .............. A Radiation treatment 0.00 2.33 NA 0.13 2.46 NA XXX
delivery.
77416............... .............. A Radiation treatment 0.00 2.33 NA 0.13 2.46 NA XXX
delivery.
77417............... .............. A Radiology port 0.00 0.59 NA 0.04 0.63 NA XXX
film(s).
77418............... .............. A Radiation tx 0.00 17.95 NA 0.13 18.08 NA XXX
delivery, imrt.
77427............... .............. A Radiation tx 3.31 1.06 1.06 0.17 4.54 4.54 090
management, x5.
77431............... .............. A Radiation therapy 1.81 0.68 0.68 0.09 2.58 2.58 XXX
management.
77432............... .............. A Stereotactic 7.92 2.91 2.91 0.42 11.25 11.25 XXX
radiation trmt.
77470............... .............. A Special radiation 2.09 11.79 NA 0.70 14.58 NA XXX
treatment.
77470............... 26............ A Special radiation 2.09 0.67 0.67 0.11 2.87 2.87 XXX
treatment.
77470............... TC............ A Special radiation 0.00 11.13 NA 0.59 11.72 NA XXX
treatment.
77600............... .............. R Hyperthermia 1.56 3.54 NA 0.24 5.34 NA XXX
treatment.
77600............... 26............ R Hyperthermia 1.56 0.50 0.50 0.08 2.14 2.14 XXX
treatment.
77600............... TC............ R Hyperthermia 0.00 3.04 NA 0.16 3.20 NA XXX
treatment.
77605............... .............. R Hyperthermia 2.09 4.72 NA 0.33 7.14 NA XXX
treatment.
77605............... 26............ R Hyperthermia 2.09 0.66 0.66 0.11 2.86 2.86 XXX
treatment.
77605............... TC............ R Hyperthermia 0.00 4.05 NA 0.22 4.27 NA XXX
treatment.
77610............... .............. R Hyperthermia 1.56 3.55 NA 0.24 5.35 NA XXX
treatment.
77610............... 26............ R Hyperthermia 1.56 0.51 0.51 0.07 2.14 2.14 XXX
treatment.
77610............... TC............ R Hyperthermia 0.00 3.04 NA 0.16 3.20 NA XXX
treatment.
77615............... .............. R Hyperthermia 2.09 4.72 NA 0.33 7.14 NA XXX
treatment.
77615............... 26............ R Hyperthermia 2.09 0.66 0.66 0.11 2.86 2.86 XXX
treatment.
77615............... TC............ R Hyperthermia 0.00 4.05 NA 0.22 4.27 NA XXX
treatment.
77620............... .............. R Hyperthermia 1.56 3.56 NA 0.23 5.35 NA XXX
treatment.
77620............... 26............ R Hyperthermia 1.56 0.52 0.52 0.19 2.27 2.27 XXX
treatment.
77620............... TC............ R Hyperthermia 0.00 3.04 NA 0.16 3.20 NA XXX
treatment.
77750............... .............. A Infuse radioactive 4.90 2.91 NA 0.32 8.13 NA 090
materials.
[[Page 47669]]
77750............... 26............ A Infuse radioactive 4.90 1.58 1.58 0.25 6.73 6.73 090
materials.
77750............... TC............ A Infuse radioactive 0.00 1.33 NA 0.07 1.40 NA 090
materials.
77761............... .............. A Apply intrcav radiat 3.80 3.59 NA 0.33 7.72 NA 090
simple.
77761............... 26............ A Apply intrcav radiat 3.80 1.09 1.09 0.19 5.08 5.08 090
simple.
77761............... TC............ A Apply intrcav radiat 0.00 2.50 NA 0.14 2.64 NA 090
simple.
77762............... .............. A Apply intrcav radiat 5.71 5.43 NA 0.48 11.62 NA 090
interm.
77762............... 26............ A Apply intrcav radiat 5.71 1.83 1.83 0.29 7.83 7.83 090
interm.
77762............... TC............ A Apply intrcav radiat 0.00 3.60 NA 0.19 3.79 NA 090
interm.
77763............... .............. A Apply intrcav radiat 8.56 7.21 NA 0.67 16.44 NA 090
compl.
77763............... 26............ A Apply intrcav radiat 8.56 2.73 2.73 0.44 11.73 11.73 090
compl.
77763............... TC............ A Apply intrcav radiat 0.00 4.48 NA 0.23 4.71 NA 090
compl.
77776............... .............. A Apply interstit 4.65 3.12 NA 0.48 8.25 NA 090
radiat simpl.
77776............... 26............ A Apply interstit 4.65 0.95 0.95 0.35 5.95 5.95 090
radiat simpl.
77776............... TC............ A Apply interstit 0.00 2.17 NA 0.13 2.30 NA 090
radiat simpl.
77777............... .............. A Apply interstit 7.47 6.59 NA 0.62 14.68 NA 090
radiat inter.
77777............... 26............ A Apply interstit 7.47 2.37 2.37 0.40 10.24 10.24 090
radiat inter.
77777............... TC............ A Apply interstit 0.00 4.23 NA 0.22 4.45 NA 090
radiat inter.
77778............... .............. A Apply interstit 11.17 8.69 NA 0.85 20.71 NA 090
radiat compl.
77778............... 26............ A Apply interstit 11.17 3.56 3.56 0.58 15.31 15.31 090
radiat compl.
77778............... TC............ A Apply interstit 0.00 5.12 NA 0.27 5.39 NA 090
radiat compl.
77781............... .............. A High intensity 1.66 20.80 NA 1.14 23.60 NA 090
brachytherapy.
77781............... 26............ A High intensity 1.66 0.53 0.53 0.08 2.27 2.27 090
brachytherapy.
77781............... TC............ A High intensity 0.00 20.27 NA 1.06 21.33 NA 090
brachytherapy.
77782............... .............. A High intensity 2.49 21.07 NA 1.19 24.75 NA 090
brachytherapy.
77782............... 26............ A High intensity 2.49 0.80 0.80 0.13 3.42 3.42 090
brachytherapy.
77782............... TC............ A High intensity 0.00 20.27 NA 1.06 21.33 NA 090
brachytherapy.
77783............... .............. A High intensity 3.72 21.46 NA 1.25 26.43 NA 090
brachytherapy.
77783............... 26............ A High intensity 3.72 1.19 1.19 0.19 5.10 5.10 090
brachytherapy.
77783............... TC............ A High intensity 0.00 20.27 NA 1.06 21.33 NA 090
brachytherapy.
77784............... .............. A High intensity 5.60 22.06 NA 1.35 29.01 NA 090
brachytherapy.
77784............... 26............ A High intensity 5.60 1.79 1.79 0.29 7.68 7.68 090
brachytherapy.
77784............... TC............ A High intensity 0.00 20.27 NA 1.06 21.33 NA 090
brachytherapy.
77789............... .............. A Apply surface 1.12 0.82 NA 0.08 2.02 NA 000
radiation.
77789............... 26............ A Apply surface 1.12 0.37 0.37 0.06 1.55 1.55 000
radiation.
77789............... TC............ A Apply surface 0.00 0.45 NA 0.02 0.47 NA 000
radiation.
77790............... .............. A Radiation handling... 1.05 0.84 NA 0.07 1.96 NA XXX
77790............... 26............ A Radiation handling... 1.05 0.34 0.34 0.05 1.44 1.44 XXX
77790............... TC............ A Radiation handling... 0.00 0.50 NA 0.02 0.52 NA XXX
78000............... .............. A Thyroid, single 0.19 1.03 NA 0.07 1.29 NA XXX
uptake.
78000............... 26............ A Thyroid, single 0.19 0.06 0.06 0.01 0.26 0.26 XXX
uptake.
78000............... TC............ A Thyroid, single 0.00 0.97 NA 0.06 1.03 NA XXX
uptake.
78001............... .............. A Thyroid, multiple 0.26 1.39 NA 0.08 1.73 NA XXX
uptakes.
78001............... 26............ A Thyroid, multiple 0.26 0.09 0.09 0.01 0.36 0.36 XXX
uptakes.
78001............... TC............ A Thyroid, multiple 0.00 1.30 NA 0.07 1.37 NA XXX
uptakes.
78003............... .............. A Thyroid suppress/ 0.33 1.07 NA 0.07 1.47 NA XXX
stimul.
78003............... 26............ A Thyroid suppress/ 0.33 0.11 0.11 0.01 0.45 0.45 XXX
stimul.
78003............... TC............ A Thyroid suppress/ 0.00 0.97 NA 0.06 1.03 NA XXX
stimul.
78006............... .............. A Thyroid imaging with 0.49 2.54 NA 0.15 3.18 NA XXX
uptake.
78006............... 26............ A Thyroid imaging with 0.49 0.16 0.16 0.02 0.67 0.67 XXX
uptake.
78006............... TC............ A Thyroid imaging with 0.00 2.37 NA 0.13 2.50 NA XXX
uptake.
78007............... .............. A Thyroid image, mult 0.50 2.73 NA 0.16 3.39 NA XXX
uptakes.
78007............... 26............ A Thyroid image, mult 0.50 0.17 0.17 0.02 0.69 0.69 XXX
uptakes.
78007............... TC............ A Thyroid image, mult 0.00 2.57 NA 0.14 2.71 NA XXX
uptakes.
78010............... .............. A Thyroid imaging...... 0.39 1.94 NA 0.13 2.46 NA XXX
78010............... 26............ A Thyroid imaging...... 0.39 0.13 0.13 0.02 0.54 0.54 XXX
78010............... TC............ A Thyroid imaging...... 0.00 1.81 NA 0.11 1.92 NA XXX
78011............... .............. A Thyroid imaging with 0.45 2.55 NA 0.15 3.15 NA XXX
flow.
78011............... 26............ A Thyroid imaging with 0.45 0.15 0.15 0.02 0.62 0.62 XXX
flow.
78011............... TC............ A Thyroid imaging with 0.00 2.40 NA 0.13 2.53 NA XXX
flow.
78015............... .............. A Thyroid met imaging.. 0.67 2.79 NA 0.17 3.63 NA XXX
78015............... 26............ A Thyroid met imaging.. 0.67 0.23 0.23 0.03 0.93 0.93 XXX
78015............... TC............ A Thyroid met imaging.. 0.00 2.57 NA 0.14 2.71 NA XXX
78016............... .............. A Thyroid met imaging/ 0.82 3.76 NA 0.21 4.79 NA XXX
studies.
78016............... 26............ A Thyroid met imaging/ 0.82 0.28 0.28 0.03 1.13 1.13 XXX
studies.
78016............... TC............ A Thyroid met imaging/ 0.00 3.47 NA 0.18 3.65 NA XXX
studies.
78018............... .............. A Thyroid met imaging, 0.86 5.71 NA 0.33 6.90 NA XXX
body.
78018............... 26............ A Thyroid met imaging, 0.86 0.29 0.29 0.04 1.19 1.19 XXX
body.
78018............... TC............ A Thyroid met imaging, 0.00 5.41 NA 0.29 5.70 NA XXX
body.
78020............... .............. A Thyroid met uptake... 0.60 1.51 NA 0.17 2.28 NA ZZZ
78020............... 26............ A Thyroid met uptake... 0.60 0.21 0.21 0.03 0.84 0.84 ZZZ
78020............... TC............ A Thyroid met uptake... 0.00 1.30 NA 0.14 1.44 NA ZZZ
78070............... .............. A Parathyroid nuclear 0.82 4.54 NA 0.15 5.51 NA XXX
imaging.
78070............... 26............ A Parathyroid nuclear 0.82 0.28 0.28 0.04 1.14 1.14 XXX
imaging.
78070............... TC............ A Parathyroid nuclear 0.00 4.27 NA 0.11 4.38 NA XXX
imaging.
78075............... .............. A Adrenal nuclear 0.74 5.68 NA 0.32 6.74 NA XXX
imaging.
[[Page 47670]]
78075............... 26............ A Adrenal nuclear 0.74 0.26 0.26 0.03 1.03 1.03 XXX
imaging.
78075............... TC............ A Adrenal nuclear 0.00 5.41 NA 0.29 5.70 NA XXX
imaging.
78102............... .............. A Bone marrow imaging, 0.55 2.23 NA 0.14 2.92 NA XXX
ltd.
78102............... 26............ A Bone marrow imaging, 0.55 0.19 0.19 0.02 0.76 0.76 XXX
ltd.
78102............... TC............ A Bone marrow imaging, 0.00 2.04 NA 0.12 2.16 NA XXX
ltd.
78103............... .............. A Bone marrow imaging, 0.75 3.42 NA 0.20 4.37 NA XXX
mult.
78103............... 26............ A Bone marrow imaging, 0.75 0.26 0.26 0.03 1.04 1.04 XXX
mult.
78103............... TC............ A Bone marrow imaging, 0.00 3.17 NA 0.17 3.34 NA XXX
mult.
78104............... .............. A Bone marrow imaging, 0.80 4.33 NA 0.26 5.39 NA XXX
body.
78104............... 26............ A Bone marrow imaging, 0.80 0.27 0.27 0.04 1.11 1.11 XXX
body.
78104............... TC............ A Bone marrow imaging, 0.00 4.06 NA 0.22 4.28 NA XXX
body.
78110............... .............. A Plasma volume, single 0.19 1.02 NA 0.07 1.28 NA XXX
78110............... 26............ A Plasma volume, single 0.19 0.07 0.07 0.01 0.27 0.27 XXX
78110............... TC............ A Plasma volume, single 0.00 0.95 NA 0.06 1.01 NA XXX
78111............... .............. A Plasma volume, 0.22 2.65 NA 0.15 3.02 NA XXX
multiple.
78111............... 26............ A Plasma volume, 0.22 0.08 0.08 0.01 0.31 0.31 XXX
multiple.
78111............... TC............ A Plasma volume, 0.00 2.57 NA 0.14 2.71 NA XXX
multiple.
78120............... .............. A Red cell mass, single 0.23 1.81 NA 0.12 2.16 NA XXX
78120............... 26............ A Red cell mass, single 0.23 0.08 0.08 0.01 0.32 0.32 XXX
78120............... TC............ A Red cell mass, single 0.00 1.73 NA 0.11 1.84 NA XXX
78121............... .............. A Red cell mass, 0.32 3.02 NA 0.15 3.49 NA XXX
multiple.
78121............... 26............ A Red cell mass, 0.32 0.11 0.11 0.01 0.44 0.44 XXX
multiple.
78121............... TC............ A Red cell mass, 0.00 2.91 NA 0.14 3.05 NA XXX
multiple.
78122............... .............. A Blood volume......... 0.45 4.75 NA 0.26 5.46 NA XXX
78122............... 26............ A Blood volume......... 0.45 0.16 0.16 0.02 0.63 0.63 XXX
78122............... TC............ A Blood volume......... 0.00 4.59 NA 0.24 4.83 NA XXX
78130............... .............. A Red cell survival 0.61 3.06 NA 0.17 3.84 NA XXX
study.
78130............... 26............ A Red cell survival 0.61 0.21 0.21 0.03 0.85 0.85 XXX
study.
78130............... TC............ A Red cell survival 0.00 2.85 NA 0.14 2.99 NA XXX
study.
78135............... .............. A Red cell survival 0.64 5.08 NA 0.28 6.00 NA XXX
kinetics.
78135............... 26............ A Red cell survival 0.64 0.22 0.22 0.03 0.89 0.89 XXX
kinetics.
78135............... TC............ A Red cell survival 0.00 4.86 NA 0.25 5.11 NA XXX
kinetics.
78140............... .............. A Red cell 0.61 4.13 NA 0.24 4.98 NA XXX
sequestration.
78140............... 26............ A Red cell 0.61 0.20 0.20 0.03 0.84 0.84 XXX
sequestration.
78140............... TC............ A Red cell 0.00 3.93 NA 0.21 4.14 NA XXX
sequestration.
78160............... .............. A Plasma iron turnover. 0.33 3.78 NA 0.20 4.31 NA XXX
78160............... 26............ A Plasma iron turnover. 0.33 0.12 0.12 0.01 0.46 0.46 XXX
78160............... TC............ A Plasma iron turnover. 0.00 3.66 NA 0.19 3.85 NA XXX
78162............... .............. A Radioiron absorption 0.45 3.38 NA 0.18 4.01 NA XXX
exam.
78162............... 26............ A Radioiron absorption 0.45 0.19 0.19 0.01 0.65 0.65 XXX
exam.
78162............... TC............ A Radioiron absorption 0.00 3.19 NA 0.17 3.36 NA XXX
exam.
78170............... .............. A Red cell iron 0.41 5.44 NA 0.30 6.15 NA XXX
utilization.
78170............... 26............ A Red cell iron 0.41 0.14 0.14 0.02 0.57 0.57 XXX
utilization.
78170............... TC............ A Red cell iron 0.00 5.30 NA 0.28 5.58 NA XXX
utilization.
78172............... 26............ A Total body iron 0.53 0.17 0.17 0.02 0.72 0.72 XXX
estimation.
78185............... .............. A Spleen imaging....... 0.40 2.49 NA 0.15 3.04 NA XXX
78185............... 26............ A Spleen imaging....... 0.40 0.14 0.14 0.02 0.56 0.56 XXX
78185............... TC............ A Spleen imaging....... 0.00 2.35 NA 0.13 2.48 NA XXX
78190............... .............. A Platelet survival, 1.09 6.10 NA 0.34 7.53 NA XXX
kinetics.
78190............... 26............ A Platelet survival, 1.09 0.39 0.39 0.04 1.52 1.52 XXX
kinetics.
78190............... TC............ A Platelet survival, 0.00 5.70 NA 0.30 6.00 NA XXX
kinetics.
78191............... .............. A Platelet survival.... 0.61 7.53 NA 0.40 8.54 NA XXX
78191............... 26............ A Platelet survival.... 0.61 0.20 0.20 0.03 0.84 0.84 XXX
78191............... TC............ A Platelet survival.... 0.00 7.33 NA 0.37 7.70 NA XXX
78195............... .............. A Lymph system imaging. 1.20 4.47 NA 0.28 5.95 NA XXX
78195............... 26............ A Lymph system imaging. 1.20 0.41 0.41 0.06 1.67 1.67 XXX
78195............... TC............ A Lymph system imaging. 0.00 4.06 NA 0.22 4.28 NA XXX
78201............... .............. A Liver imaging........ 0.44 2.50 NA 0.15 3.09 NA XXX
78201............... 26............ A Liver imaging........ 0.44 0.15 0.15 0.02 0.61 0.61 XXX
78201............... TC............ A Liver imaging........ 0.00 2.35 NA 0.13 2.48 NA XXX
78202............... .............. A Liver imaging with 0.51 3.05 NA 0.16 3.72 NA XXX
flow.
78202............... 26............ A Liver imaging with 0.51 0.17 0.17 0.02 0.70 0.70 XXX
flow.
78202............... TC............ A Liver imaging with 0.00 2.88 NA 0.14 3.02 NA XXX
flow.
78205............... .............. A Liver imaging (3D)... 0.71 6.14 NA 0.34 7.19 NA XXX
78205............... 26............ A Liver imaging (3D)... 0.71 0.24 0.24 0.03 0.98 0.98 XXX
78205............... TC............ A Liver imaging (3D)... 0.00 5.90 NA 0.31 6.21 NA XXX
78206............... .............. A Liver image (3d) with 0.96 6.23 NA 0.15 7.34 NA XXX
flow.
78206............... 26............ A Liver image (3d) with 0.96 0.33 0.33 0.04 1.33 1.33 XXX
flow.
78206............... TC............ A Liver image (3d) with 0.00 5.90 NA 0.11 6.01 NA XXX
flow.
78215............... .............. A Liver and spleen 0.49 3.10 NA 0.16 3.75 NA XXX
imaging.
78215............... 26............ A Liver and spleen 0.49 0.16 0.16 0.02 0.67 0.67 XXX
imaging.
78215............... TC............ A Liver and spleen 0.00 2.93 NA 0.14 3.07 NA XXX
imaging.
78216............... .............. A Liver & spleen image/ 0.57 3.67 NA 0.20 4.44 NA XXX
flow.
78216............... 26............ A Liver & spleen image/ 0.57 0.19 0.19 0.02 0.78 0.78 XXX
flow.
78216............... TC............ A Liver & spleen image/ 0.00 3.47 NA 0.18 3.65 NA XXX
flow.
[[Page 47671]]
78220............... .............. A Liver function study. 0.49 3.88 NA 0.21 4.58 NA XXX
78220............... 26............ A Liver function study. 0.49 0.16 0.16 0.02 0.67 0.67 XXX
78220............... TC............ A Liver function study. 0.00 3.72 NA 0.19 3.91 NA XXX
78223............... .............. A Hepatobiliary imaging 0.84 3.94 NA 0.23 5.01 NA XXX
78223............... 26............ A Hepatobiliary imaging 0.84 0.28 0.28 0.04 1.16 1.16 XXX
78223............... TC............ A Hepatobiliary imaging 0.00 3.66 NA 0.19 3.85 NA XXX
78230............... .............. A Salivary gland 0.45 2.32 NA 0.15 2.92 NA XXX
imaging.
78230............... 26............ A Salivary gland 0.45 0.15 0.15 0.02 0.62 0.62 XXX
imaging.
78230............... TC............ A Salivary gland 0.00 2.17 NA 0.13 2.30 NA XXX
imaging.
78231............... .............. A Serial salivary 0.52 3.35 NA 0.19 4.06 NA XXX
imaging.
78231............... 26............ A Serial salivary 0.52 0.18 0.18 0.02 0.72 0.72 XXX
imaging.
78231............... TC............ A Serial salivary 0.00 3.17 NA 0.17 3.34 NA XXX
imaging.
78232............... .............. A Salivary gland 0.47 3.70 NA 0.20 4.37 NA XXX
function exam.
78232............... 26............ A Salivary gland 0.47 0.16 0.16 0.02 0.65 0.65 XXX
function exam.
78232............... TC............ A Salivary gland 0.00 3.53 NA 0.18 3.71 NA XXX
function exam.
78258............... .............. A Esophageal motility 0.74 3.12 NA 0.17 4.03 NA XXX
study.
78258............... 26............ A Esophageal motility 0.74 0.25 0.25 0.03 1.02 1.02 XXX
study.
78258............... TC............ A Esophageal motility 0.00 2.88 NA 0.14 3.02 NA XXX
study.
78261............... .............. A Gastric mucosa 0.69 4.33 NA 0.25 5.27 NA XXX
imaging.
78261............... 26............ A Gastric mucosa 0.69 0.24 0.24 0.03 0.96 0.96 XXX
imaging.
78261............... TC............ A Gastric mucosa 0.00 4.09 NA 0.22 4.31 NA XXX
imaging.
78262............... .............. A Gastroesophageal 0.68 4.48 NA 0.25 5.41 NA XXX
reflux exam.
78262............... 26............ A Gastroesophageal 0.68 0.23 0.23 0.03 0.94 0.94 XXX
reflux exam.
78262............... TC............ A Gastroesophageal 0.00 4.25 NA 0.22 4.47 NA XXX
reflux exam.
78264............... .............. A Gastric emptying 0.78 4.38 NA 0.25 5.41 NA XXX
study.
78264............... 26............ A Gastric emptying 0.78 0.26 0.26 0.03 1.07 1.07 XXX
study.
78264............... TC............ A Gastric emptying 0.00 4.12 NA 0.22 4.34 NA XXX
study.
78270............... .............. A Vit B-12 absorption 0.20 1.61 NA 0.11 1.92 NA XXX
exam.
78270............... 26............ A Vit B-12 absorption 0.20 0.07 0.07 0.01 0.28 0.28 XXX
exam.
78270............... TC............ A Vit B-12 absorption 0.00 1.54 NA 0.10 1.64 NA XXX
exam.
78271............... .............. A Vit b-12 absrp exam, 0.20 1.71 NA 0.11 2.02 NA XXX
int fac.
78271............... 26............ A Vit b-12 absrp exam, 0.20 0.07 0.07 0.01 0.28 0.28 XXX
int fac.
78271............... TC............ A Vit b-12 absrp exam, 0.00 1.64 NA 0.10 1.74 NA XXX
int fac.
78272............... .............. A Vit B-12 absorp, 0.27 2.41 NA 0.14 2.82 NA XXX
combined.
78272............... 26............ A Vit B-12 absorp, 0.27 0.09 0.09 0.01 0.37 0.37 XXX
combined.
78272............... TC............ A Vit B-12 absorp, 0.00 2.32 NA 0.13 2.45 NA XXX
combined.
78278............... .............. A Acute GI blood loss 0.99 5.19 NA 0.29 6.47 NA XXX
imaging.
78278............... 26............ A Acute GI blood loss 0.99 0.33 0.33 0.04 1.36 1.36 XXX
imaging.
78278............... TC............ A Acute GI blood loss 0.00 4.86 NA 0.25 5.11 NA XXX
imaging.
78282............... 26............ A GI protein loss exam. 0.38 0.13 0.13 0.02 0.53 0.53 XXX
78290............... .............. A Meckel-s divert exam. 0.68 3.27 NA 0.19 4.14 NA XXX
78290............... 26............ A Meckel-s divert exam. 0.68 0.23 0.23 0.03 0.94 0.94 XXX
78290............... TC............ A Meckel-s divert exam. 0.00 3.04 NA 0.16 3.20 NA XXX
78291............... .............. A Leveen/shunt patency 0.88 3.36 NA 0.20 4.44 NA XXX
exam.
78291............... 26............ A Leveen/shunt patency 0.88 0.30 0.30 0.04 1.22 1.22 XXX
exam.
78291............... TC............ A Leveen/shunt patency 0.00 3.06 NA 0.16 3.22 NA XXX
exam.
78300............... .............. A Bone imaging, limited 0.62 2.69 NA 0.17 3.48 NA XXX
area.
78300............... 26............ A Bone imaging, limited 0.62 0.21 0.21 0.03 0.86 0.86 XXX
area.
78300............... TC............ A Bone imaging, limited 0.00 2.48 NA 0.14 2.62 NA XXX
area.
78305............... .............. A Bone imaging, 0.83 3.93 NA 0.23 4.99 NA XXX
multiple areas.
78305............... 26............ A Bone imaging, 0.83 0.28 0.28 0.04 1.15 1.15 XXX
multiple areas.
78305............... TC............ A Bone imaging, 0.00 3.66 NA 0.19 3.85 NA XXX
multiple areas.
78306............... .............. A Bone imaging, whole 0.86 4.55 NA 0.26 5.67 NA XXX
body.
78306............... 26............ A Bone imaging, whole 0.86 0.29 0.29 0.04 1.19 1.19 XXX
body.
78306............... TC............ A Bone imaging, whole 0.00 4.27 NA 0.22 4.49 NA XXX
body.
78315............... .............. A Bone imaging, 3 phase 1.02 5.11 NA 0.29 6.42 NA XXX
78315............... 26............ A Bone imaging, 3 phase 1.02 0.34 0.34 0.04 1.40 1.40 XXX
78315............... TC............ A Bone imaging, 3 phase 0.00 4.77 NA 0.25 5.02 NA XXX
78320............... .............. A Bone imaging (3D).... 1.04 6.26 NA 0.36 7.66 NA XXX
78320............... 26............ A Bone imaging (3D).... 1.04 0.36 0.36 0.05 1.45 1.45 XXX
78320............... TC............ A Bone imaging (3D).... 0.00 5.90 NA 0.31 6.21 NA XXX
78350............... .............. A Bone mineral, single 0.22 0.83 NA 0.06 1.11 NA XXX
photon.
78350............... 26............ A Bone mineral, single 0.22 0.07 0.07 0.01 0.30 0.30 XXX
photon.
78350............... TC............ A Bone mineral, single 0.00 0.75 NA 0.05 0.80 NA XXX
photon.
78414............... 26............ A Non-imaging heart 0.45 0.16 0.16 0.02 0.63 0.63 XXX
function.
78428............... .............. A Cardiac shunt imaging 0.78 2.54 NA 0.16 3.48 NA XXX
78428............... 26............ A Cardiac shunt imaging 0.78 0.29 0.29 0.03 1.10 1.10 XXX
78428............... TC............ A Cardiac shunt imaging 0.00 2.25 NA 0.13 2.38 NA XXX
78445............... .............. A Vascular flow imaging 0.49 2.02 NA 0.13 2.64 NA XXX
78445............... 26............ A Vascular flow imaging 0.49 0.17 0.17 0.02 0.68 0.68 XXX
78445............... TC............ A Vascular flow imaging 0.00 1.85 NA 0.11 1.96 NA XXX
78455............... .............. A Venous thrombosis 0.73 4.22 NA 0.24 5.19 NA XXX
study.
78455............... 26............ A Venous thrombosis 0.73 0.25 0.25 0.03 1.01 1.01 XXX
study.
78455............... TC............ A Venous thrombosis 0.00 3.98 NA 0.21 4.19 NA XXX
study.
78456............... .............. A Acute venous thrombus 1.00 4.32 NA 0.33 5.65 NA XXX
image.
[[Page 47672]]
78456............... 26............ A Acute venous thrombus 1.00 0.34 0.34 0.04 1.38 1.38 XXX
image.
78456............... TC............ A Acute venous thrombus 0.00 3.98 NA 0.29 4.27 NA XXX
image.
78457............... .............. A Venous thrombosis 0.77 2.91 NA 0.18 3.86 NA XXX
imaging.
78457............... 26............ A Venous thrombosis 0.77 0.26 0.26 0.04 1.07 1.07 XXX
imaging.
78457............... TC............ A Venous thrombosis 0.00 2.65 NA 0.14 2.79 NA XXX
imaging.
78458............... .............. A Ven thrombosis 0.90 4.34 NA 0.25 5.49 NA XXX
images, bilat.
78458............... 26............ A Ven thrombosis 0.90 0.32 0.32 0.04 1.26 1.26 XXX
images, bilat.
78458............... TC............ A Ven thrombosis 0.00 4.02 NA 0.21 4.23 NA XXX
images, bilat.
78459............... 26............ R Heart muscle imaging 1.50 0.57 0.57 0.06 2.13 2.13 XXX
(PET).
78460............... .............. A Heart muscle blood, 0.86 2.65 NA 0.17 3.68 NA XXX
single.
78460............... 26............ A Heart muscle blood, 0.86 0.29 0.29 0.04 1.19 1.19 XXX
single.
78460............... TC............ A Heart muscle blood, 0.00 2.35 NA 0.13 2.48 NA XXX
single.
78461............... .............. A Heart muscle blood, 1.23 5.14 NA 0.30 6.67 NA XXX
multiple.
78461............... 26............ A Heart muscle blood, 1.23 0.43 0.43 0.05 1.71 1.71 XXX
multiple.
78461............... TC............ A Heart muscle blood, 0.00 4.71 NA 0.25 4.96 NA XXX
multiple.
78464............... .............. A Heart image (3d), 1.09 7.44 NA 0.41 8.94 NA XXX
single.
78464............... 26............ A Heart image (3d), 1.09 0.38 0.38 0.04 1.51 1.51 XXX
single.
78464............... TC............ A Heart image (3d), 0.00 7.06 NA 0.37 7.43 NA XXX
single.
78465............... .............. A Heart image (3d), 1.46 12.30 NA 0.68 14.44 NA XXX
multiple.
78465............... 26............ A Heart image (3d), 1.46 0.52 0.52 0.06 2.04 2.04 XXX
multiple.
78465............... TC............ A Heart image (3d), 0.00 11.77 NA 0.62 12.39 NA XXX
multiple.
78466............... .............. A Heart infarct image.. 0.69 2.86 NA 0.17 3.72 NA XXX
78466............... 26............ A Heart infarct image.. 0.69 0.24 0.24 0.03 0.96 0.96 XXX
78466............... TC............ A Heart infarct image.. 0.00 2.62 NA 0.14 2.76 NA XXX
78468............... .............. A Heart infarct image 0.80 3.93 NA 0.22 4.95 NA XXX
(ef).
78468............... 26............ A Heart infarct image 0.80 0.27 0.27 0.03 1.10 1.10 XXX
(ef).
78468............... TC............ A Heart infarct image 0.00 3.66 NA 0.19 3.85 NA XXX
(ef).
78469............... .............. A Heart infarct image 0.92 5.53 NA 0.31 6.76 NA XXX
(3D).
78469............... 26............ A Heart infarct image 0.92 0.31 0.31 0.03 1.26 1.26 XXX
(3D).
78469............... TC............ A Heart infarct image 0.00 5.21 NA 0.28 5.49 NA XXX
(3D).
78472............... .............. A Gated heart, planar, 0.98 5.84 NA 0.34 7.16 NA XXX
single.
78472............... 26............ A Gated heart, planar, 0.98 0.34 0.34 0.04 1.36 1.36 XXX
single.
78472............... TC............ A Gated heart, planar, 0.00 5.50 NA 0.30 5.80 NA XXX
single.
78473............... .............. A Gated heart, multiple 1.47 8.75 NA 0.48 10.70 NA XXX
78473............... 26............ A Gated heart, multiple 1.47 0.51 0.51 0.06 2.04 2.04 XXX
78473............... TC............ A Gated heart, multiple 0.00 8.24 NA 0.42 8.66 NA XXX
78478............... .............. A Heart wall motion add- 0.62 1.78 NA 0.12 2.52 NA XXX
on.
78478............... 26............ A Heart wall motion add- 0.62 0.22 0.22 0.02 0.86 0.86 XXX
on.
78478............... TC............ A Heart wall motion add- 0.00 1.55 NA 0.10 1.65 NA XXX
on.
78480............... .............. A Heart function add-on 0.62 1.78 NA 0.12 2.52 NA XXX
78480............... 26............ A Heart function add-on 0.62 0.22 0.22 0.02 0.86 0.86 XXX
78480............... TC............ A Heart function add-on 0.00 1.55 NA 0.10 1.65 NA XXX
78481............... .............. A Heart first pass, 0.98 5.57 NA 0.32 6.87 NA XXX
single.
78481............... 26............ A Heart first pass, 0.98 0.36 0.36 0.04 1.38 1.38 XXX
single.
78481............... TC............ A Heart first pass, 0.00 5.21 NA 0.28 5.49 NA XXX
single.
78483............... .............. A Heart first pass, 1.47 8.39 NA 0.46 10.32 NA XXX
multiple.
78483............... 26............ A Heart first pass, 1.47 0.54 0.54 0.05 2.06 2.06 XXX
multiple.
78483............... TC............ A Heart first pass, 0.00 7.86 NA 0.41 8.27 NA XXX
multiple.
78494............... .............. A Heart image, spect... 1.19 7.47 NA 0.35 9.01 NA XXX
78494............... 26............ A Heart image, spect... 1.19 0.42 0.42 0.05 1.66 1.66 XXX
78494............... TC............ A Heart image, spect... 0.00 7.06 NA 0.30 7.36 NA XXX
78496............... .............. A Heart first pass add- 0.50 7.24 NA 0.32 8.06 NA ZZZ
on.
78496............... 26............ A Heart first pass add- 0.50 0.18 0.18 0.02 0.70 0.70 ZZZ
on.
78496............... TC............ A Heart first pass add- 0.00 7.06 NA 0.30 7.36 NA ZZZ
on.
78580............... .............. A Lung perfusion 0.74 3.67 NA 0.21 4.62 NA XXX
imaging.
78580............... 26............ A Lung perfusion 0.74 0.25 0.25 0.03 1.02 1.02 XXX
imaging.
78580............... TC............ A Lung perfusion 0.00 3.43 NA 0.18 3.61 NA XXX
imaging.
78584............... .............. A Lung V/Q image single 0.99 3.52 NA 0.21 4.72 NA XXX
breath.
78584............... 26............ A Lung V/Q image single 0.99 0.32 0.32 0.04 1.35 1.35 XXX
breath.
78584............... TC............ A Lung V/Q image single 0.00 3.19 NA 0.17 3.36 NA XXX
breath.
78585............... .............. A Lung V/Q imaging..... 1.09 5.99 NA 0.35 7.43 NA XXX
78585............... 26............ A Lung V/Q imaging..... 1.09 0.36 0.36 0.05 1.50 1.50 XXX
78585............... TC............ A Lung V/Q imaging..... 0.00 5.63 NA 0.30 5.93 NA XXX
78586............... .............. A Aerosol lung image, 0.40 2.72 NA 0.16 3.28 NA XXX
single.
78586............... 26............ A Aerosol lung image, 0.40 0.13 0.13 0.02 0.55 0.55 XXX
single.
78586............... TC............ A Aerosol lung image, 0.00 2.59 NA 0.14 2.73 NA XXX
single.
78587............... .............. A Aerosol lung image, 0.49 2.96 NA 0.16 3.61 NA XXX
multiple.
78587............... 26............ A Aerosol lung image, 0.49 0.16 0.16 0.02 0.67 0.67 XXX
multiple.
78587............... TC............ A Aerosol lung image, 0.00 2.80 NA 0.14 2.94 NA XXX
multiple.
78588............... .............. A Perfusion lung image. 1.09 3.56 NA 0.23 4.88 NA XXX
78588............... 26............ A Perfusion lung image. 1.09 0.36 0.36 0.05 1.50 1.50 XXX
78588............... TC............ A Perfusion lung image. 0.00 3.19 NA 0.18 3.37 NA XXX
78591............... .............. A Vent image, 1 breath, 0.40 2.98 NA 0.16 3.54 NA XXX
1 proj.
78591............... 26............ A Vent image, 1 breath, 0.40 0.13 0.13 0.02 0.55 0.55 XXX
1 proj.
78591............... TC............ A Vent image, 1 breath, 0.00 2.85 NA 0.14 2.99 NA XXX
1 proj.
[[Page 47673]]
78593............... .............. A Vent image, 1 proj, 0.49 3.61 NA 0.20 4.30 NA XXX
gas.
78593............... 26............ A Vent image, 1 proj, 0.49 0.16 0.16 0.02 0.67 0.67 XXX
gas.
78593............... TC............ A Vent image, 1 proj, 0.00 3.45 NA 0.18 3.63 NA XXX
gas.
78594............... .............. A Vent image, mult 0.53 5.15 NA 0.27 5.95 NA XXX
proj, gas.
78594............... 26............ A Vent image, mult 0.53 0.18 0.18 0.02 0.73 0.73 XXX
proj, gas.
78594............... TC............ A Vent image, mult 0.00 4.97 NA 0.25 5.22 NA XXX
proj, gas.
78596............... .............. A Lung differential 1.27 7.48 NA 0.43 9.18 NA XXX
function.
78596............... 26............ A Lung differential 1.27 0.42 0.42 0.06 1.75 1.75 XXX
function.
78596............... TC............ A Lung differential 0.00 7.06 NA 0.37 7.43 NA XXX
function.
78600............... .............. A Brain imaging, ltd 0.44 3.03 NA 0.16 3.63 NA XXX
static.
78600............... 26............ A Brain imaging, ltd 0.44 0.15 0.15 0.02 0.61 0.61 XXX
static.
78600............... TC............ A Brain imaging, ltd 0.00 2.88 NA 0.14 3.02 NA XXX
static.
78601............... .............. A Brain imaging, ltd w/ 0.51 3.57 NA 0.20 4.28 NA XXX
flow.
78601............... 26............ A Brain imaging, ltd w/ 0.51 0.17 0.17 0.02 0.70 0.70 XXX
flow.
78601............... TC............ A Brain imaging, ltd w/ 0.00 3.40 NA 0.18 3.58 NA XXX
flow.
78605............... .............. A Brain imaging, 0.53 3.58 NA 0.20 4.31 NA XXX
complete.
78605............... 26............ A Brain imaging, 0.53 0.18 0.18 0.02 0.73 0.73 XXX
complete.
78605............... TC............ A Brain imaging, 0.00 3.40 NA 0.18 3.58 NA XXX
complete.
78606............... .............. A Brain imaging, compl 0.64 4.07 NA 0.24 4.95 NA XXX
w/flow.
78606............... 26............ A Brain imaging, compl 0.64 0.21 0.21 0.03 0.88 0.88 XXX
w/flow.
78606............... TC............ A Brain imaging, compl 0.00 3.86 NA 0.21 4.07 NA XXX
w/flow.
78607............... .............. A Brain imaging (3D)... 1.23 6.97 NA 0.40 8.60 NA XXX
78607............... 26............ A Brain imaging (3D)... 1.23 0.43 0.43 0.05 1.71 1.71 XXX
78607............... TC............ A Brain imaging (3D)... 0.00 6.54 NA 0.35 6.89 NA XXX
78610............... .............. A Brain flow imaging 0.30 1.68 NA 0.11 2.09 NA XXX
only.
78610............... 26............ A Brain flow imaging 0.30 0.11 0.11 0.01 0.42 0.42 XXX
only.
78610............... TC............ A Brain flow imaging 0.00 1.57 NA 0.10 1.67 NA XXX
only.
78615............... .............. A Cerebral vascular 0.42 3.99 NA 0.23 4.64 NA XXX
flow image.
78615............... 26............ A Cerebral vascular 0.42 0.15 0.15 0.02 0.59 0.59 XXX
flow image.
78615............... TC............ A Cerebral vascular 0.00 3.84 NA 0.21 4.05 NA XXX
flow image.
78630............... .............. A Cerebrospinal fluid 0.68 5.26 NA 0.30 6.24 NA XXX
scan.
78630............... 26............ A Cerebrospinal fluid 0.68 0.23 0.23 0.03 0.94 0.94 XXX
scan.
78630............... TC............ A Cerebrospinal fluid 0.00 5.03 NA 0.27 5.30 NA XXX
scan.
78635............... .............. A CSF ventriculography. 0.61 2.77 NA 0.16 3.54 NA XXX
78635............... 26............ A CSF ventriculography. 0.61 0.23 0.23 0.02 0.86 0.86 XXX
78635............... TC............ A CSF ventriculography. 0.00 2.54 NA 0.14 2.68 NA XXX
78645............... .............. A CSF shunt evaluation. 0.57 3.62 NA 0.20 4.39 NA XXX
78645............... 26............ A CSF shunt evaluation. 0.57 0.19 0.19 0.02 0.78 0.78 XXX
78645............... TC............ A CSF shunt evaluation. 0.00 3.43 NA 0.18 3.61 NA XXX
78647............... .............. A Cerebrospinal fluid 0.90 6.21 NA 0.35 7.46 NA XXX
scan.
78647............... 26............ A Cerebrospinal fluid 0.90 0.31 0.31 0.04 1.25 1.25 XXX
scan.
78647............... TC............ A Cerebrospinal fluid 0.00 5.90 NA 0.31 6.21 NA XXX
scan.
78650............... .............. A CSF leakage imaging.. 0.61 4.84 NA 0.27 5.72 NA XXX
78650............... 26............ A CSF leakage imaging.. 0.61 0.21 0.21 0.03 0.85 0.85 XXX
78650............... TC............ A CSF leakage imaging.. 0.00 4.63 NA 0.24 4.87 NA XXX
78660............... .............. A Nuclear exam of tear 0.53 2.29 NA 0.14 2.96 NA XXX
flow.
78660............... 26............ A Nuclear exam of tear 0.53 0.18 0.18 0.02 0.73 0.73 XXX
flow.
78660............... TC............ A Nuclear exam of tear 0.00 2.11 NA 0.12 2.23 NA XXX
flow.
78700............... .............. A Kidney imaging, 0.45 3.19 NA 0.18 3.82 NA XXX
static.
78700............... 26............ A Kidney imaging, 0.45 0.15 0.15 0.02 0.62 0.62 XXX
static.
78700............... TC............ A Kidney imaging, 0.00 3.04 NA 0.16 3.20 NA XXX
static.
78701............... .............. A Kidney imaging with 0.49 3.71 NA 0.20 4.40 NA XXX
flow.
78701............... 26............ A Kidney imaging with 0.49 0.16 0.16 0.02 0.67 0.67 XXX
flow.
78701............... TC............ A Kidney imaging with 0.00 3.55 NA 0.18 3.73 NA XXX
flow.
78704............... .............. A Imaging renogram..... 0.74 4.19 NA 0.24 5.17 NA XXX
78704............... 26............ A Imaging renogram..... 0.74 0.25 0.25 0.03 1.02 1.02 XXX
78704............... TC............ A Imaging renogram..... 0.00 3.95 NA 0.21 4.16 NA XXX
78707............... .............. A Kidney flow/function 0.96 4.78 NA 0.27 6.01 NA XXX
image.
78707............... 26............ A Kidney flow/function 0.96 0.32 0.32 0.04 1.32 1.32 XXX
image.
78707............... TC............ A Kidney flow/function 0.00 4.46 NA 0.23 4.69 NA XXX
image.
78708............... .............. A Kidney flow/function 1.21 4.87 NA 0.28 6.36 NA XXX