[Federal Register: August 24, 2001 (Volume 66, Number 165)] [Proposed Rules] [Page 44721-44770] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr24au01-39] [[pp. 44721-44770]] Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2002 Payment Rates [[Continued from page 44720]] [[Page 44721]] 0026 Level III Skin Repair..... T 13.51 $686.88 $277.92 $137.38 0027 Level IV Skin Repair...... T 19.31 $981.76 $383.10 $196.35 0028 Level I Incision/Excision T 14.95 $760.09 $303.74 $152.02 Breast. 0029 Level II Incision/Excision T 35.93 $1,826.75 $820.79 $365.35 Breast. 0030 Level I Breast T 25.95 $1,319.35 $646.48 $263.87 Reconstruction. 0032 Insertion of Central T 7.16 $364.03 $119.52 $72.81 Venous/Arterial Catheter. 0033 Partial Hospitalization... P 4.17 $212.01 ........... $42.40 0035 Placement of Arterial or T 0.13 $6.61 $2.18 $1.32 Central Venous Catheter. 0041 Arthroscopy............... T 26.18 $1,331.04 $592.08 $266.21 0042 Arthroscopically-Aided T 39.39 $2,002.67 $804.74 $400.53 Procedures. 0043 Closed Treatment Fracture T 4.13 $209.98 $42.00 $42.00 Finger/Toe/Trunk. 0044 Closed Treatment Fracture/ T 2.73 $138.80 $38.08 $27.76 Dislocation Except Finger/ Toe/Trunk. 0045 Bone/Joint Manipulation T 12.91 $656.37 $277.12 $131.27 Under Anesthesia. 0046 Open/Percutaneous T 25.36 $1,289.35 $535.76 $257.87 Treatment Fracture or Dislocation. 0047 Arthroplasty without T 28.54 $1,451.03 $537.03 $290.21 Prosthesis. 0048 Arthroplasty with T 32.37 $1,645.76 $725.94 $329.15 Prosthesis. 0049 Level I Musculoskeletal T 17.07 $867.87 $356.95 $173.57 Procedures Except Hand and Foot. 0050 Level II Musculoskeletal T 22.31 $1,134.29 $513.86 $226.86 Procedures Except Hand and Foot. 0051 Level III Musculoskeletal T 30.94 $1,573.05 $675.24 $314.61 Procedures Except Hand and Foot. 0052 Level IV Musculoskeletal T 38.88 $1,976.74 $930.91 $395.35 Procedures Except Hand and Foot. 0053 Level I Hand T 12.67 $644.17 $253.49 $128.83 Musculoskeletal Procedures. 0054 Level II Hand T 20.84 $1,059.55 $472.33 $211.91 Musculoskeletal Procedures. 0055 Level I Foot T 16.77 $852.62 $355.34 $170.52 Musculoskeletal Procedures. 0056 Level II Foot T 19.20 $976.17 $405.81 $195.23 Musculoskeletal Procedures. 0057 Bunion Procedures......... T 21.11 $1,073.27 $496.65 $214.65 0058 Level I Strapping and Cast S 1.36 $69.15 $19.27 $13.83 Application. 0059 Level II Strapping and S 2.34 $118.97 $29.59 $23.79 Cast Application. 0060 Manipulation Therapy...... S 0.25 $12.71 $2.54 $2.54 0068 CPAP Initiation........... S 3.33 $169.30 $93.12 $33.86 0069 Thoracoscopy.............. T 25.62 $1,302.57 $612.21 $260.51 0070 Thoracentesis/Lavage T 4.11 $208.96 $79.60 $41.79 Procedures. 0071 Level I Endoscopy Upper T 1.08 $54.91 $14.22 $10.98 Airway. 0072 Level II Endoscopy Upper T 1.29 $65.59 $36.08 $13.12 Airway. 0073 Level III Endoscopy Upper T 3.54 $179.98 $79.19 $36.00 Airway. 0074 Level IV Endoscopy Upper T 14.62 $743.31 $347.54 $148.66 Airway. 0075 Level V Endoscopy Upper T 19.08 $970.07 $467.29 $194.01 Airway. 0076 Endoscopy Lower Airway.... T 8.22 $417.92 $197.05 $83.58 0077 Level I Pulmonary S 0.42 $21.35 $11.74 $4.27 Treatment. 0078 Level II Pulmonary S 0.93 $47.28 $20.33 $9.46 Treatment. 0079 Ventilation Initiation and S 0.62 $31.52 $17.34 $6.30 Management. 0080 Diagnostic Cardiac T 32.20 $1,637.11 $838.92 $327.42 Catheterization. 0081 Non-Coronary Angioplasty T 22.04 $1,120.56 $549.07 $224.11 or Atherectomy. 0082 Coronary Atherectomy...... T 130.89 $6,654.71 $1,351.74 $1,330.94 0083 Coronary Angioplasty...... T 50.15 $2,549.73 $794.30 $509.95 0084 Level I Electrophysiologic S 4.94 $251.16 $82.88 $50.23 Evaluation. 0085 Level II S 27.39 $1,392.56 $654.48 $278.51 Electrophysiologic Evaluation. 0086 Ablate Heart Dysrhythm S 47.13 $2,396.18 $1,265.37 $479.24 Focus. 0087 Cardiac Electrophysiologic S 14.89 $757.04 $214.72 $151.41 Recording/Mapping. 0088 Thrombectomy.............. T 29.11 $1,480.01 $678.68 $296.00 0089 Insertion/Replacement of T 82.60 $4,199.55 $2,246.59 $839.91 Permanent Pacemaker and Electrodes. 0090 Insertion/Replacement of T 73.37 $3,730.28 $2,014.35 $746.06 Pacemaker Pulse Generator. 0091 Level I Vascular Ligation. T 22.17 $1,127.17 $348.23 $225.43 0092 Level II Vascular Ligation T 21.43 $1,089.54 $505.37 $217.91 0093 Vascular Repair/Fistula T 15.05 $765.17 $277.34 $153.03 Construction. 0094 Resuscitation and S 5.69 $289.29 $105.29 $57.86 Cardioversion. 0095 Cardiac Rehabilitation.... S 0.66 $33.56 $16.98 $6.71 0096 Non-Invasive Vascular S 1.87 $95.07 $52.29 $19.01 Studies. 0097 Cardiac Monitoring for 30 X 0.87 $44.23 $24.33 $8.85 days. 0098 Injection of Sclerosing T 1.34 $68.13 $20.88 $13.63 Solution. 0099 Electrocardiograms........ S 0.38 $19.32 $10.63 $3.86 0100 Stress Tests and X 1.63 $82.87 $45.58 $16.57 Continuous ECG. 0101 Tilt Table Evaluation..... S 4.03 $204.89 $112.69 $40.98 0103 Miscellaneous Vascular T 10.91 $554.69 $249.61 $110.94 Procedures. 0104 Transcatheter Placement of T 71.42 $3,631.14 $726.23 $726.23 Intracoronary Stents. 0105 Revision/Removal of T 16.56 $841.94 $372.32 $168.39 Pacemakers, AICD, or Vascular Device. 0106 Insertion/Replacement/ T 15.82 $804.32 $426.29 $160.86 Repair of Pacemaker and/ or Electrodes. 0107 Insertion of Cardioverter- T 155.27 $7,894.24 $4,224.27 $1,578.85 Defibrillator. 0108 Insertion/Replacement/ T 159.42 $8,105.23 $4,214.72 $1,621.05 Repair of Cardioverter- Defibrillator Leads. 0109 Removal of Implanted T 6.57 $334.03 $133.51 $66.81 Devices. 0110 Transfusion............... S 5.76 $292.85 $122.70 $58.57 0111 Blood Product Exchange.... S 16.69 $848.55 $300.74 $169.71 0112 Apheresis, Photopheresis, S 39.75 $2,020.97 $663.65 $404.19 and Plasmapheresis. 0113 Excision Lymphatic System. T 16.87 $857.70 $326.55 $171.54 0114 Thyroid/Lymphadenectomy T 30.50 $1,550.68 $493.78 $310.14 Procedures. 0115 Cannula/Access Device T 19.06 $969.05 $503.91 $193.81 Procedures. 0116 Chemotherapy S 0.98 $49.83 $9.97 $9.97 Administration by Other Technique Except Infusion. 0117 Chemotherapy S 3.48 $176.93 $52.69 $35.39 Administration by Infusion Only. 0118 Chemotherapy S 3.52 $178.96 $72.03 $35.79 Administration by Both Infusion and Other Technique. [[Page 44722]] 0119 Implantation of Devices... T 14.37 $730.60 $161.50 $146.12 0120 Infusion Therapy Except T 2.35 $119.48 $42.67 $23.90 Chemotherapy. 0121 Level I Tube changes and T 2.42 $123.04 $52.53 $24.61 Repositioning. 0122 Level II Tube changes and T 5.69 $289.29 $114.93 $57.86 Repositioning. 0123 Bone Marrow Harvesting and S 10.12 $514.52 $102.90 $102.90 Bone Marrow/Stem Cell Transplant. 0124 Revision of Implanted T 25.84 $1,313.76 $722.57 $262.75 Infusion Pump. 0125 Refilling of Infusion Pump T 3.20 $162.69 ........... $32.54 0130 Level I Laparoscopy....... T 27.92 $1,419.51 $659.53 $283.90 0131 Level II Laparoscopy...... T 39.80 $2,023.51 $1,052.23 $404.70 0132 Level III Laparoscopy..... T 60.31 $3,066.28 $1,239.22 $613.26 0140 Esophageal Dilation T 5.73 $291.32 $107.24 $58.26 without Endoscopy. 0141 Upper GI Procedures....... T 7.46 $379.28 $184.67 $75.86 0142 Small Intestine Endoscopy. T 7.61 $386.91 $162.42 $77.38 0143 Lower GI Endoscopy........ T 7.87 $400.13 $198.46 $80.03 0144 Diagnostic Anoscopy....... T 1.97 $100.16 $44.07 $20.03 0145 Therapeutic Anoscopy...... T 12.11 $615.70 $179.39 $123.14 0146 Level I Sigmoidoscopy..... T 2.95 $149.98 $65.15 $30.00 0147 Level II Sigmoidoscopy.... T 6.15 $312.68 $146.96 $62.54 0148 Level I Anal/Rectal T 2.58 $131.17 $43.59 $26.23 Procedure. 0149 Level III Anal/Rectal T 14.49 $736.70 $293.06 $147.34 Procedure. 0150 Level IV Anal/Rectal T 19.58 $995.49 $437.12 $199.10 Procedure. 0151 Endoscopic Retrograde T 16.22 $824.66 $245.46 $164.93 Cholangio-Pancreatography (ERCP). 0152 Percutaneous Biliary T 17.44 $886.68 $207.38 $177.34 Endoscopic Procedures. 0153 Peritoneal and Abdominal T 22.44 $1,140.89 $496.31 $228.18 Procedures. 0154 Hernia/Hydrocele T 24.09 $1,224.78 $556.98 $244.96 Procedures. 0155 Level II Anal/Rectal T 5.73 $291.32 $96.14 $58.26 Procedure. 0156 Level II Urinary and Anal T 2.62 $133.21 $39.96 $26.64 Procedures. 0157 Colorectal Cancer S 2.14 $108.80 ........... $27.20 Screening: Barium Enema. 0158 Colorectal Cancer S 7.00 $355.89 ........... $88.97 Screening: Colonoscopy. 0159 Colorectal Cancer S 2.51 $127.61 ........... $31.90 Screening: Flexible Sigmoidoscopy. 0160 Level I Cystourethroscopy T 5.98 $304.04 $110.11 $60.81 and other Genitourinary Procedures. 0161 Level II Cystourethroscopy T 16.45 $836.35 $249.36 $167.27 and other Genitourinary Procedures. 0162 Level III T 19.86 $1,009.72 $427.49 $201.94 Cystourethroscopy and other Genitourinary Procedures. 0163 Level IV Cystourethroscopy T 30.27 $1,538.99 $792.58 $307.80 and other Genitourinary Procedures. 0164 Level I Urinary and Anal T 0.98 $49.83 $14.95 $9.97 Procedures. 0165 Level III Urinary and Anal T 5.36 $272.51 $91.76 $54.50 Procedures. 0166 Level I Urethral T 13.02 $661.96 $218.73 $132.39 Procedures. 0167 Level II Urethral T 24.18 $1,229.36 $555.84 $245.87 Procedures. 0168 Level III Urethral T 31.68 $1,610.67 $536.11 $322.13 Procedures. 0169 Lithotripsy............... T 42.65 $2,168.41 $1,192.63 $433.68 0170 Dialysis for Other Than S 1.08 $54.91 $12.08 $10.98 ESRD Patients. 0180 Circumcision.............. T 16.29 $828.22 $304.87 $165.64 0181 Penile Procedures......... T 24.07 $1,223.77 $673.07 $244.75 0182 Insertion of Penile T 85.94 $4,369.36 $1,492.28 $873.87 Prosthesis. 0183 Testes/Epididymis T 20.37 $1,035.65 $448.94 $207.13 Procedures. 0184 Prostate Biopsy........... T 5.23 $265.90 $122.96 $53.18 0185 Removal or Repair of T 57.17 $2,906.64 $906.36 $581.33 Penile Prosthesis. 0187 Placement/Repositioning T 4.54 $230.82 $113.10 $46.16 Misc Catheters. 0188 Level II Female T 0.83 $42.20 $12.24 $8.44 Reproductive Proc. 0189 Level III Female T 1.38 $70.16 $17.54 $14.03 Reproductive Proc. 0190 Surgical Hysteroscopy..... T 18.27 $928.88 $443.89 $185.78 0191 Level I Female T 0.27 $13.73 $3.98 $2.75 Reproductive Proc. 0192 Level IV Female T 2.73 $138.80 $35.33 $27.76 Reproductive Proc. 0193 Level V Female T 12.17 $618.75 $171.13 $123.75 Reproductive Proc. 0194 Level VI Female T 17.18 $873.47 $395.94 $174.69 Reproductive Proc. 0195 Level VII Female T 22.22 $1,129.71 $483.80 $225.94 Reproductive Proc. 0196 Dilation and Curettage.... T 14.62 $743.31 $357.98 $148.66 0197 Infertility Procedures.... T 2.58 $131.17 $49.55 $26.23 0198 Pregnancy and Neonatal T 1.42 $72.20 $33.03 $14.44 Care Procedures. 0199 Vaginal Delivery.......... T 4.20 $213.54 $59.79 $42.71 0200 Therapeutic Abortion...... T 13.74 $698.57 $373.23 $139.71 0201 Spontaneous Abortion...... T 14.89 $757.04 $329.65 $151.41 0202 Level VIII Female T 39.56 $2,011.31 $864.86 $402.26 Reproductive Proc. 0203 Level V Nerve Injections.. T 7.62 $387.42 $166.59 $77.48 0204 Level VI Nerve Injections. T 2.44 $124.05 $47.14 $24.81 0206 Level III Nerve Injections T 3.88 $197.27 $82.85 $39.45 0207 Level IV Nerve Injections. T 4.13 $209.98 $94.49 $42.00 0208 Laminotomies and T 30.93 $1,572.54 $314.51 $314.51 Laminectomies. 0209 Extended EEG Studies and S 11.73 $596.38 $310.12 $119.28 Sleep Studies, Level II. 0212 Level II Nervous System T 4.17 $212.01 $88.78 $42.40 Injections. 0213 Extended EEG Studies and S 2.95 $149.98 $77.99 $30.00 Sleep Studies, Level I. 0214 Electroencephalogram...... S 2.27 $115.41 $57.71 $23.08 0215 Level I Nerve and Muscle S 0.66 $33.56 $17.45 $6.71 Tests. 0216 Level III Nerve and Muscle S 2.91 $147.95 $64.69 $29.59 Tests. 0218 Level II Nerve and Muscle S 1.09 $55.42 $23.83 $11.08 Tests. 0220 Level I Nerve Procedures.. T 14.76 $750.43 $326.21 $150.09 0221 Level II Nerve Procedures. T 22.68 $1,153.10 $463.62 $230.62 0222 Implantation of T 112.50 $5,719.73 $2,688.27 $1,143.95 Neurological Device. [[Page 44723]] 0223 Implantation of Pain T 8.87 $450.97 $154.27 $90.19 Management Device. 0224 Implantation of Reservoir/ T 29.95 $1,522.72 $453.41 $304.54 Pump/Shunt. 0225 Implantation of T 33.75 $1,715.92 $408.33 $343.18 Neurostimulator Electrodes. 0226 Implantation of Drug T 8.91 $453.00 $109.42 $90.60 Infusion Reservoir. 0227 Implantation of Drug T 94.89 $4,824.40 $964.88 $964.88 Infusion Device. 0228 Creation of Lumbar T 47.98 $2,439.40 $696.46 $487.88 Subarachnoid Shunt. 0229 Transcatherter Placement T 60.07 $3,054.08 $996.86 $610.82 of Intravascular Shunts. 0230 Level I Eye Tests & S 0.64 $32.54 $14.97 $6.51 Treatments. 0231 Level III Eye Tests & S 2.27 $115.41 $51.94 $23.08 Treatments. 0232 Level I Anterior Segment T 3.69 $187.61 $82.55 $37.52 Eye Procedures. 0233 Level II Anterior Segment T 11.78 $598.92 $287.48 $119.78 Eye Procedures. 0234 Level III Anterior Segment T 20.56 $1,045.31 $502.16 $209.06 Eye Procedures. 0235 Level I Posterior Segment T 5.39 $274.04 $78.91 $54.81 Eye Procedures. 0236 Level II Posterior Segment T 17.75 $902.45 $180.49 $180.49 Eye Procedures. 0237 Level III Posterior T 33.56 $1,706.26 $852.68 $341.25 Segment Eye Procedures. 0238 Level I Repair and Plastic T 2.84 $144.39 $58.96 $28.88 Eye Procedures. 0239 Level II Repair and T 6.25 $317.76 $123.42 $63.55 Plastic Eye Procedures. 0240 Level III Repair and T 14.86 $755.51 $315.31 $151.10 Plastic Eye Procedures. 0241 Level IV Repair and T 19.20 $976.17 $384.47 $195.23 Plastic Eye Procedures. 0242 Level V Repair and Plastic T 25.31 $1,286.81 $597.36 $257.36 Eye Procedures. 0243 Strabismus/Muscle T 19.22 $977.18 $431.39 $195.44 Procedures. 0244 Corneal Transplant........ T 41.43 $2,106.38 $851.42 $421.28 0245 Level I Cataract T 10.75 $546.55 $256.88 $109.31 Procedures without IOL Insert. 0246 Cataract Procedures with T 22.36 $1,136.83 $534.31 $227.37 IOL Insert. 0247 Laser Eye Procedures T 4.73 $240.48 $110.62 $48.10 Except Retinal. 0248 Laser Retinal Procedures.. T 4.15 $210.99 $94.05 $42.20 0249 Level II Cataract T 23.51 $1,195.30 $561.79 $239.06 Procedures without IOL Insert. 0250 Nasal Cauterization/ T 2.27 $115.41 $38.54 $23.08 Packing. 0251 Level I ENT Procedures.... T 2.71 $137.78 $27.99 $27.56 0252 Level II ENT Procedures... T 6.53 $332.00 $114.24 $66.40 0253 Level III ENT Procedures.. T 13.27 $674.67 $284.00 $134.93 0254 Level IV ENT Procedures... T 19.11 $971.59 $272.41 $194.32 0256 Level V ENT Procedures.... T 28.82 $1,465.27 $623.05 $293.05 0258 Tonsil and Adenoid T 18.86 $958.88 $462.81 $191.78 Procedures. 0259 Level VI ENT Procedures... T 306.15 $15,565.28 $6,537.42 $3,113.06 0260 Level I Plain Film Except X 0.76 $38.64 $21.25 $7.73 Teeth. 0261 Level II Plain Film Except X 1.31 $66.60 $36.63 $13.32 Teeth Including Bone Density Measurement. 0262 Plain Film of Teeth....... X 0.66 $33.56 $10.90 $6.71 0263 Level I Miscellaneous X 1.74 $88.47 $45.88 $17.69 Radiology Procedures. 0264 Level II Miscellaneous X 2.51 $127.61 $70.19 $25.52 Radiology Procedures. 0265 Level I Diagnostic S 1.02 $51.86 $28.52 $10.37 Ultrasound Except Vascular. 0266 Level II Diagnostic S 1.67 $84.91 $46.70 $16.98 Ultrasound Except Vascular. 0267 Vascular Ultrasound....... S 2.58 $131.17 $72.14 $26.23 0269 Level I Echocardiogram S 4.31 $219.13 $113.95 $43.83 Except Transesophageal. 0270 Transesophageal S 5.83 $296.41 $150.26 $59.28 Echocardiogram. 0271 Mammography............... S 0.64 $32.54 $17.90 $6.51 0272 Level I Fluoroscopy....... X 1.47 $74.74 $39.00 $14.95 0274 Myelography............... S 5.69 $289.29 $128.12 $57.86 0275 Arthrography.............. S 2.82 $143.37 $72.26 $28.67 0276 Level I Digestive S 1.63 $82.87 $45.58 $16.57 Radiology. 0277 Level II Digestive S 2.35 $119.48 $65.71 $23.90 Radiology. 0278 Diagnostic Urography...... S 2.56 $130.16 $71.59 $26.03 0279 Level I Angiography and S 8.37 $425.55 $174.57 $85.11 Venography except Extremity. 0280 Level II Angiography and S 14.40 $732.12 $373.38 $146.42 Venography except Extremity. 0281 Venography of Extremity... S 4.64 $235.91 $115.16 $47.18 0282 Miscellaneous Computerized S 1.63 $82.87 $45.58 $16.57 Axial Tomography. 0283 Computerized Axial S 4.89 $248.62 $136.74 $49.72 Tomography with Contrast Material. 0284 Magnetic Resonance Imaging S 7.80 $396.57 $218.11 $79.31 and Magnetic Resonance Angiography with Contrast Material. 0285 Positron Emission S 20.07 $1,020.40 $415.21 $204.08 Tomography (PET). 0286 Myocardial Scans.......... S 5.85 $297.43 $163.58 $59.49 0287 Complex Venography........ S 4.33 $220.15 $90.26 $44.03 0288 CT, Bone Density.......... S 1.27 $64.57 $35.51 $12.91 0289 Needle Localization for X 1.22 $62.03 $32.25 $12.41 Breast Biopsy. 0290 Standard Non-Imaging S 1.91 $97.11 $53.41 $19.42 Nuclear Medicine. 0291 Level I Diagnostic Nuclear S 3.78 $192.18 $90.20 $38.44 Medicine Excluding Myocardial Scans. 0292 Level II Diagnostic S 4.56 $231.84 $124.85 $46.37 Nuclear Medicine Excluding Myocardial Scans. 0294 Level I Therapeutic S 5.45 $277.09 $144.06 $55.42 Nuclear Medicine. 0295 Level II Therapeutic S 13.97 $710.26 $390.64 $142.05 Nuclear Medicine. 0296 Level I Therapeutic S 3.52 $178.96 $98.43 $35.79 Radiologic Procedures. 0297 Level II Therapeutic S 7.80 $396.57 $172.51 $79.31 Radiologic Procedures. 0300 Level I Radiation Therapy. S 2.25 $114.39 $47.72 $22.88 0301 Level II Radiation Therapy S 5.85 $297.43 $59.49 $59.49 0302 Level III Radiation S 11.96 $608.07 $216.55 $121.61 Therapy. 0303 Treatment Device X 3.98 $202.35 $69.28 $40.47 Construction. 0304 Level I Therapeutic X 1.80 $91.52 $41.52 $18.30 Radiation Treatment Preparation. 0305 Level II Therapeutic X 4.40 $223.70 $97.50 $44.74 Radiation Treatment Preparation. 0310 Level III Therapeutic X 17.14 $871.43 $339.05 $174.29 Radiation Treatment Preparation. [[Page 44724]] 0312 Radioelement Applications. S 7.77 $395.04 $109.65 $79.01 0313 Brachytherapy............. S 16.31 $829.23 $165.85 $165.85 0314 Hyperthermic Therapies.... S 5.16 $262.34 $133.80 $52.47 0320 Electroconvulsive Therapy. S 4.20 $213.54 $80.06 $42.71 0321 Biofeedback and Other S 1.02 $51.86 $23.86 $10.37 Training. 0322 Brief Individual S 1.25 $63.55 $13.35 $12.71 Psychotherapy. 0323 Extended Individual S 1.89 $96.09 $22.48 $19.22 Psychotherapy. 0324 Family Psychotherapy...... S 3.13 $159.14 $31.83 $31.83 0325 Group Psychotherapy....... S 1.49 $75.75 $19.70 $15.15 0330 Dental Procedures......... S 7.68 $390.47 $78.09 $78.09 0332 Computerized Axial S 3.51 $178.46 $98.15 $35.69 Tomography and Computerized Angiography without Contrast Material. 0333 Computerized Axial S 5.66 $287.77 $158.27 $57.55 Tomography and Computerized Angiography without Contrast Material followed by Contrast Material. 0335 Magnetic Resonance S 5.91 $300.48 $165.26 $60.10 Imaging, Miscellaneous. 0336 Magnetic Resonance Imaging S 6.85 $348.27 $191.55 $69.65 and Magnetic Resonance Angiography without Contrast Material. 0337 Magnetic Resonance Imaging S 9.26 $470.80 $258.94 $94.16 and Magnetic Resonance Angiography without Contrast Material followed by Contrast Material. 0339 Observation............... X 7.38 $375.21 ........... $75.04 0340 Minor Ancillary Procedures X 0.91 $46.27 $11.57 $9.25 0341 Immunology Tests.......... X 0.11 $5.59 $3.08 $1.12 0342 Level I Pathology......... X 0.22 $11.19 $6.15 $2.24 0343 Level II Pathology........ X 0.42 $21.35 $11.53 $4.27 0344 Level III Pathology....... X 0.60 $30.51 $16.78 $6.10 0345 Level I Transfusion X 0.29 $14.74 $5.37 $2.95 Laboratory Procedures. 0346 Level II Transfusion X 0.83 $42.20 $12.03 $8.44 Laboratory Procedures. 0347 Level III Transfusion X 1.73 $87.96 $20.13 $17.59 Laboratory Procedures. 0348 Fertility Laboratory X 0.85 $43.22 $8.64 $8.64 Procedures. 0349 Miscellaneous Laboratory X 0.34 $17.29 $3.46 $3.46 Procedures. 0352 Level II Injections....... X 0.45 $22.88 $4.58 $4.58 0353 Level II Allergy X 0.27 $13.73 $2.75 $2.75 Injections. 0354 Administration of K 0.11 $5.59 ........... ........... Influenza/Pneumonia Vaccine. 0355 Level I Immunizations..... K 0.20 $10.17 ........... $2.03 0356 Level II Immunizations.... K 1.20 $61.01 ........... $12.20 0359 Level II Injections....... X 1.91 $97.11 $19.42 $19.42 0360 Level I Alimentary Tests.. X 1.40 $71.18 $34.75 $14.24 0361 Level II Alimentary Tests. X 3.52 $178.96 $88.09 $35.79 0362 Fitting of Vision Aids.... X 0.83 $42.20 $9.63 $8.44 0363 Otorhinolaryngologic X 2.06 $104.73 $38.75 $20.95 Function Tests. 0364 Level I Audiometry........ X 0.55 $27.96 $10.91 $5.59 0365 Level II Audiometry....... X 1.42 $72.20 $21.66 $14.44 0367 Level I Pulmonary Test.... X 0.76 $38.64 $19.32 $7.73 0368 Level II Pulmonary Tests.. X 1.53 $77.79 $39.67 $15.56 0369 Level III Pulmonary Tests. X 3.99 $202.86 $58.50 $40.57 0370 Allergy Tests............. X 0.87 $44.23 $11.81 $8.85 0371 Level I Allergy Injections X 0.76 $38.64 $7.73 $7.73 0372 Therapeutic Phlebotomy.... X 0.57 $28.98 $10.09 $5.80 0373 Neuropsychological Testing X 1.11 $56.43 $15.80 $11.29 0374 Monitoring Psychiatric X 0.96 $48.81 $10.74 $9.76 Drugs. 0600 Low Level Clinic Visits... V 0.93 $47.28 $9.46 $9.46 0601 Mid Level Clinic Visits... V 1.02 $51.86 $10.37 $10.37 0602 High Level Clinic Visits.. V 1.49 $75.75 $15.15 $15.15 0610 Low Level Emergency Visits V 1.34 $68.13 $20.65 $13.63 0611 Mid Level Emergency Visits V 2.33 $118.46 $36.47 $23.69 0612 High Level Emergency V 3.75 $190.66 $54.14 $38.13 Visits. 0620 Critical Care............. S 9.13 $464.19 $152.78 $92.84 0689 Electronic Analysis of S 0.49 $24.91 $13.70 $4.98 Cardioverter- defibrillators. 0690 Electronic Analysis of S 0.40 $20.34 $11.19 $4.07 Pacemakers and other Cardiac Devices. 0691 Electronic Analysis of S 3.36 $170.83 $93.96 $34.17 Programmable Shunts/Pumps. 0692 Electronic Analysis of S 1.73 $87.96 $48.38 $17.59 Neurostimulator Pulse Generators. 0693 Level II Breast T 33.16 $1,685.92 $826.10 $337.18 Reconstruction. 0694 Level III Excision/Biopsy. T 4.28 $217.60 $65.28 $43.52 0695 Level VII Debridement & T 17.06 $867.36 $398.99 $173.47 Destruction. 0697 Level II Echocardiogram S 2.00 $101.68 $52.88 $20.34 Except Transesophageal. 0698 Level II Eye Tests & S 1.09 $55.42 $24.94 $11.08 Treatments. 0699 Level IV Eye Tests & T 6.91 $351.32 $158.09 $70.26 Treatment. 0701 SR 89 chloride, per mCi... G ........... $963.42 ........... $137.92 0702 SM 153 lexidronam, 50 mCi. G ........... $1,020.00 ........... $146.02 0704 IN 111 Satumomab pendetide G ........... $831.25 ........... $119.00 per dose. 0705 TC 99M tetrofosmin, per G ........... $129.96 ........... $18.60 dose. 0725 Leucovorin calcium inj, 50 G ........... $4.98 ........... $.45 mg. 0726 Dexrazoxane hcl injection, G ........... $194.53 ........... $27.85 250 mg. 0727 Etidronate disodium inj G ........... $63.65 ........... $9.11 300 mg. 0728 Filgrastim 300 mcg G ........... $179.08 ........... $25.64 injection. 0730 Pamidronate disodium , 30 G ........... $253.68 ........... $32.58 mg. 0731 Sargramostim injection 50 G ........... $29.06 ........... $4.16 mcg. 0732 Mesna injection 200 mg.... G ........... $40.44 ........... $5.79 [[Page 44725]] 0733 Non esrd epoetin alpha G ........... $11.85 ........... $1.52 inj, 1000 u. 0750 Dolasetron mesylate, 10 mg G ........... $16.45 ........... $2.11 0754 Metoclopramide hcl G ........... $1.55 ........... $.20 injection up to 10 mg. 0755 Thiethylperazine maleate G ........... $5.43 ........... $.70 inj up to 10 mg. 0762 Dronabinol 2.5mg oral..... G ........... $3.28 ........... $.42 0763 Dolasetron mesylate oral, G ........... $69.64 ........... $8.94 100 mg. 0764 Granisetron hcl injection G ........... $18.54 ........... $2.38 10 mcg. 0765 Granisetron hcl 1 mg oral. G ........... $44.70 ........... $5.74 0768 Ondansetron hcl injection G ........... $3.92 ........... $.50 1 mg. 0769 Ondansetron hcl 8mg oral.. G ........... $25.15 ........... $3.23 0800 Leuprolide acetate, 3.75 G ........... $81.60 ........... $7.39 mg. 0801 Cyclophosphamide oral 25 G ........... $2.23 ........... $.32 mg. 0802 Etoposide oral 50 mg...... G ........... $50.89 ........... $7.29 0803 Melphalan oral 2 mg....... G ........... $2.18 ........... $.31 0807 Aldesleukin/single use G ........... $641.25 ........... $91.80 vial. 0809 Bcg live intravesical vac. G ........... $166.44 ........... $21.37 0810 Goserelin acetate implant G ........... $446.49 ........... $63.92 3.6 mg. 0811 Carboplatin injection 50 G ........... $111.11 ........... $15.91 mg. 0812 Carmus bischl nitro inj G ........... $114.41 ........... $16.38 100 mg. 0813 Cisplatin 10 mg injection. G ........... $47.12 ........... $6.75 0814 Asparaginase injection G ........... $59.70 ........... $8.55 10,000 u. 0815 Cyclophosphamide 100 mg G ........... $5.98 ........... $.77 inj. 0816 Cyclophosphamide G ........... $6.13 ........... $.79 lyophilized 100 mg. 0817 Cytarabine hcl 100 mg inj. G ........... $4.75 ........... $.43 0818 Dactinomycin 0.5 mg....... G ........... $13.23 ........... $1.89 0819 Dacarbazine 100 mg inj.... G ........... $11.28 ........... $1.02 0820 Daunorubicin 10 mg........ G ........... $76.62 ........... $6.94 0821 Daunorubicin citrate G ........... $64.60 ........... $9.25 liposom 10 mg. 0822 Diethylstilbestrol G ........... $3.99 ........... $.57 injection 250 mg. 0823 Docetaxel, 20 mg.......... G ........... $297.83 ........... $42.64 0824 Etoposide 10 mg inj....... G ........... $3.86 ........... $.35 0826 Methotrexate Oral 2.5 mg.. G ........... $2.73 ........... $.25 0827 Floxuridine injection 500 G ........... $129.56 ........... $11.73 mg. 0828 Gemcitabine HCL 200 mg.... G ........... $102.13 ........... $14.62 0830 Irinotecan injection 20 mg G ........... $125.47 ........... $17.96 0831 Ifosfomide injection 1 gm. G ........... $156.65 ........... $22.43 0832 Idarubicin hcl injection 5 G ........... $412.21 ........... $59.01 mg. 0833 Interferon alfacon-1, 1 G ........... $4.10 ........... $.59 mcg. 0834 Interferon alfa-2a inj G ........... $34.87 ........... $4.99 recombinant 3 million u. 0836 Interferon alfa-2b inj G ........... $12.98 ........... $1.67 recombinant, 1 million. 0838 Interferon gamma 1-b inj, G ........... $285.64 ........... $40.89 3 million u. 0839 Mechlorethamine hcl inj 10 G ........... $11.88 ........... $1.70 mg. 0840 Melphalan hydrochl 50 mg.. G ........... $381.65 ........... $54.64 0841 Methotrexate sodium inj 5 G ........... $.41 ........... $.04 mg. 0842 Fludarabine phosphate inj G ........... $258.88 ........... $37.06 50 mg. 0843 Pegaspargase, singl dose G ........... $1,255.57 ........... $179.74 vial. 0844 Pentostatin injection, 10 G ........... $1,654.14 ........... $236.80 mg. 0847 Doxorubicin hcl 10 mg vl G ........... $9.00 ........... $1.29 chemo. 0849 Rituximab, 100 mg......... G ........... $454.55 ........... $65.07 0850 Streptozocin injection, 1 G ........... $117.64 ........... $16.84 gm. 0851 Thiotepa injection, 15 mg. G ........... $116.97 ........... $16.75 0852 Topotecan, 4 mg........... G ........... $632.56 ........... $90.56 0853 Vinblastine sulfate inj, 1 G ........... $4.11 ........... $.37 mg. 0854 Vincristine sulfate 1 mg G ........... $30.16 ........... $2.73 inj. 0855 Vinorelbine tartrate, 10 G ........... $79.28 ........... $11.35 mg. 0856 Porfimer sodium, 75 mg.... G ........... $2,603.67 ........... $372.74 0857 Bleomycin sulfate G ........... $289.37 ........... $41.43 injection 15 u. 0858 Cladribine, 1mg........... G ........... $56.08 ........... $8.03 0859 Fluorouracil injection 500 G ........... $1.48 ........... $.13 mg. 0860 Plicamycin (mithramycin) G ........... $93.80 ........... $13.43 inj 2.5 mg. 0861 Leuprolide acetate G ........... $26.15 ........... $2.37 injection 1 mg. 0862 Mitomycin 5 mg inj........ G ........... $121.65 ........... $11.01 0863 Paclitaxel injection, 30 G ........... $164.08 ........... $21.07 mg. 0864 Mitoxantrone hcl, 5 mg.... G ........... $244.20 ........... $34.96 0865 Interferon alfa-n3 inj, G ........... $7.86 ........... $1.12 human leukocyte derived, 250,000 iu. 0884 Rho d immune globulin inj, G ........... $34.11 ........... $4.38 1 dose pkg. 0886 Azathioprine oral 50mg.... G ........... $1.24 ........... $.16 0887 Azathioprine parenteral G ........... $.75 ........... $.10 100 mg. 0888 Cyclosporine oral 100 mg.. G ........... $5.23 ........... $.47 0889 Cyclosporin parenteral G ........... $25.08 ........... $2.27 250mg. 0890 Lymphocyte immune globulin G ........... $249.47 ........... $32.04 250 mg. 0891 Tacrolimus oral per 1 mg.. G ........... $2.91 ........... $.42 0900 Alglucerase injection, per G ........... $37.53 ........... $5.37 10 u. 0901 Alpha 1 proteinase G ........... $2.09 ........... $.30 inhibitor, 10 mg. 0902 Botulinum toxin a, per G ........... $4.39 ........... $.56 unit. 0903 Cytomegalovirus imm IV, 50 G ........... $656.27 ........... $84.28 mg. 0905 Immune globulin 500 mg.... G ........... $25.92 ........... $3.33 0906 RSV-ivig, 50 mg........... G ........... $406.34 ........... $58.17 [[Page 44726]] 0907 Ganciclovir Sodium 500 mg K 0.46 $23.39 ........... $4.51 injection. 0908 Tetanus immune globulin G ........... $102.60 ........... $14.69 inj up to 250 u. 0909 Interferon beta-1a, 33 mcg G ........... $225.23 ........... $32.24 0910 Interferon beta-1b , .25 G ........... $54.15 ........... $7.75 mg. 0911 Streptokinase per 250,000 K 1.80 $91.52 ........... $17.68 iu. 0913 Ganciclovir long act G ........... $4,750.00 ........... $680.00 implant 4.5 mg. 0916 Imiglucerase, unit........ G ........... $3.75 ........... $.54 0917 Pharmacologic stressors... K 0.37 $18.81 ........... $3.62 0925 Factor viii per iu........ G ........... $.87 ........... $.11 0926 Factor VIII (porcine) per G ........... $2.09 ........... $.30 iu. 0927 Factor viii recombinant G ........... $1.19 ........... $.15 per iu. 0928 Factor ix complex per iu.. G ........... $.68 ........... $.09 0929 Anti-inhibitor per iu..... G ........... $1.43 ........... $.18 0930 Antithrombin iii injection G ........... $1.05 ........... $.15 per iu. 0931 Factor IX non-recombinant, G ........... $.76 ........... $.10 per iu. 0932 Factor IX recombinant, per G ........... $1.12 ........... $.16 iu. 0949 Plasma, Pooled Multiple K 3.00 $152.53 ........... $30.51 Donor, Solvent/Detergent Treated, Frozen. 0950 Blood (Whole) For K 2.13 $108.29 ........... $21.66 Transfusion. 0952 Cryoprecipitate........... K 0.72 $36.61 ........... $7.32 0954 RBC leukocytes reduced.... K 2.89 $146.93 ........... $29.39 0955 Plasma, Fresh Frozen...... K 2.31 $117.45 ........... $23.49 0956 Plasma Protein Fraction... K 1.29 $65.59 ........... $13.12 0957 Platelet Concentrate...... K 1.00 $50.84 ........... $10.17 0958 Platelet Rich Plasma...... K 1.19 $60.50 ........... $12.10 0959 Red Blood Cells........... K 2.09 $106.26 ........... $21.25 0960 Washed Red Blood Cells.... K 3.89 $197.78 ........... $39.56 0961 Infusion, Albumin (Human) K 2.24 $113.89 ........... $22.78 5%, 50 ml. 0962 Infusion, Albumin (Human) K 1.12 $56.94 ........... $11.39 25%, 10 ml. 0970 New Technology - Level I T 0.47 $23.90 ........... $4.78 ($0 - $50). 0971 New Technology - Level II S 1.42 $72.20 ........... $14.44 ($50 - $100). 0972 New Technology - Level III T 2.84 $144.39 ........... $28.88 ($100 - $200). 0973 New Technology - Level IV T 4.73 $240.48 ........... $48.10 ($200 - $300). 0974 New Technology - Level V S 7.57 $384.87 ........... $76.97 ($300 - $500). 0975 New Technology - Level VI T 11.83 $601.46 ........... $120.29 ($500 - $750). 0976 New Technology - Level VII S 16.56 $841.94 ........... $168.39 ($750 - $1000). 0977 New Technology - Level T 21.30 $1,082.93 ........... $216.59 VIII ($1000 - $1250). 0978 New Technology - Level IX T 26.03 $1,323.42 ........... $264.68 ($1250 - $1500). 0979 New Technology - Level X T 30.76 $1,563.90 ........... $312.78 ($1500 - $1750). 0980 New Technology - Level XI T 35.49 $1,804.38 ........... $360.88 ($1750 - $2000). 0981 New Technology - Level XII S 42.59 $2,165.36 ........... $433.07 ($2000 - $2500). 0982 New Technology - Level T 52.06 $2,646.83 ........... $529.37 XIII ($2500 - $3000). 0983 New Technology-Level XIV T 61.52 $3,127.80 ........... ........... ($3000- $3500). 0984 New Technology - Level XV T 80.45 $4,090.24 ........... $818.05 ($3500 - $5000). 0985 New Technology - Level XVI T 104.11 $5,293.16 ........... $1,058.63 ($5000 - $6000). 1002 Cochlear Implant System... H ........... ........... ........... ........... 1009 Cryoprecip reduced plasma. K 0.88 $44.74 ........... $8.95 1010 Blood, L/R, CMV-neg....... K 2.94 $149.48 ........... $29.90 1011 Platelets, HLA-m, L/R, K 12.12 $616.21 ........... $123.24 unit. 1012 Platelet concentrate, L/R, K 1.96 $99.65 ........... $19.93 irradiated, unit. 1013 Platelet concentrate, L/R, K 1.20 $61.01 ........... $12.20 unit. 1014 Platelets, aph/pher, L/R, K 9.13 $464.19 ........... $92.84 unit. 1016 Blood, L/R, froz/ K 7.31 $371.66 ........... $74.33 deglycerol/washed. 1017 Platelets, aph/pher, L/R, K 9.53 $484.52 ........... $96.90 CMV-neg, unit. 1018 Blood, L/R, irradiated.... K 3.20 $162.69 ........... $32.54 1019 Platelets, aph/pher, L/R, K 9.85 $500.79 ........... $100.16 irradiated, unit. 1024 Quinupristin/dalfopristin. G ........... $102.05 ........... $14.61 1045 Iobenguane sulfate i-131.. G ........... $495.65 ........... $44.87 1059 Cultured chondrocytes G ........... $14,250.00 ........... $2,040.00 implnt. 1079 CO 57/58 0.5 mCi.......... G ........... $253.84 ........... $36.34 1084 Denileukin diftitox, 300 G ........... $999.88 ........... $143.14 MCG. 1086 Temozolomide,oral 5 mg.... G ........... $5.93 ........... $.85 1087 I-123 per uci, dx use..... G ........... $.65 ........... $.09 1089 Cyanocobalamin cobalt co57 G ........... $97.85 ........... $14.01 1090 IN 111 Chloride, per mCi.. G ........... $152.00 ........... $21.76 1091 IN 111 Oxyquinoline, per 5 G ........... $482.84 ........... $69.12 mCi. 1092 IN 111 Pentetate, per 1.5 G ........... $769.50 ........... $110.16 mCi. 1094 TC 99M Albumin aggr, per G ........... $33.09 ........... $4.74 vial. 1095 TC 99M Depreotide, per G ........... $760.00 ........... $108.80 vial. 1096 TC 99M Exametazime, per G ........... $423.04 ........... $60.56 dose. 1097 TC 99M Mebrofenin, per G ........... $51.43 ........... $7.36 vial. 1098 TC 99M Pentetate, per vial G ........... $22.64 ........... $2.76 1099 TC 99M Pyrophosphate, per G ........... $42.75 ........... $6.12 vial. 1122 TC 99M arcitumomab, per G ........... $1,235.00 ........... $176.80 vial. 1166 Cytarabine liposomal, 10 G ........... $371.45 ........... $53.18 mg. 1167 Epirubicin hcl, 2 mg...... G ........... $24.94 ........... $3.57 1178 Busulfan IV, 6 mg......... G ........... $26.49 ........... $3.79 1188 I-131 per uci, dx use..... G ........... $.78 ........... $.10 1200 TC 99M Sodium G ........... $107.40 ........... $15.37 Glucoheptonate, per vial. [[Page 44727]] 1201 TC 99M succimer, per vial. G ........... $135.66 ........... $19.42 1202 TC 99M Sulfur Colloid, per G ........... $36.10 ........... $3.27 dose. 1203 Verteporfin for injection. G ........... $1,458.25 ........... $208.76 1205 Technetium tc99m disofenin G ........... $85.50 ........... $7.74 1207 Octreotide acetate depot G ........... $140.37 ........... $20.10 1mg. 1305 Apligraf.................. G ........... $1,157.81 ........... $165.75 1348 I-131 per mci sol, rx use. G ........... $146.57 ........... $20.98 1400 Diphenhydramine hcl 50mg.. G ........... $.12 ........... $.01 1401 Prochlorperazine maleate G ........... $.57 ........... $.05 5mg. 1402 Promethazine hcl 12.5mg G ........... $.03 ........... $.00 oral. 1403 Chlorpromazine hcl 10mg G ........... $.07 ........... $.01 oral. 1404 Trimethobenzamide hcl G ........... $.36 ........... $.03 250mg. 1405 Thiethylperazine G ........... $.56 ........... $.08 maleate10mg. 1406 Perphenazine 4mg oral..... G ........... $.62 ........... $.06 1407 Hydroxyzine pamoate 25mg.. G ........... $.20 ........... $.02 1409 Factor viia recombinant, G ........... $1,596.00 ........... $228.48 per 1.2 mg. 1600 TC 99M sestamibi, per G ........... $115.90 ........... $16.59 syringe. 1601 TC 99M medronate, per dose G ........... $36.46 ........... $3.30 1602 TC 99M apcitide, per vial. G ........... $45.13 ........... $6.46 1603 TL 201, mCi............... G ........... $29.45 ........... $3.78 1604 IN 111 capromab pendetide, G ........... $1,128.13 ........... $161.50 per dose. 1605 Abciximab injection, 10 mg G ........... $513.02 ........... $73.44 1606 Anistreplase, 30 u........ G ........... $2,559.11 ........... $366.36 1607 Eptifibatide injection, 5 G ........... $13.58 ........... $1.94 mg. 1608 Etanercept injection, 25 G ........... $140.98 ........... $20.18 mg. 1609 Rho(D) immune globulin h, G ........... $20.64 ........... $2.65 sd, 100 iu. 1611 Hylan G-F 20 injection, 16 G ........... $213.86 ........... $30.62 mg. 1612 Daclizumab, parenteral, 25 G ........... $397.29 ........... $56.88 mg. 1613 Trastuzumab, 10 mg........ G ........... $52.83 ........... $7.56 1614 Valrubicin, 200 mg........ G ........... $423.23 ........... $60.59 1615 Basiliximab, 20 mg........ G ........... $1,348.76 ........... $193.09 1616 Histrelin Acetate, 0.5 mg. G ........... $14.16 ........... $2.03 1617 Lepirdin, 50 mg........... G ........... $131.96 ........... $18.89 1618 Von Willebrand factor, per G ........... $.95 ........... $.14 iu. 1619 Ga 67, per mCi............ G ........... $24.38 ........... $3.13 1620 TC 99M Bicisate, per vial. G ........... $384.75 ........... $55.08 1621 Xe 133, per mCi........... G ........... $29.93 ........... $3.84 1622 TC 99M Mertiatide, per G ........... $176.53 ........... $25.27 vial. 1623 TC 99M Gluceptate......... G ........... $22.61 ........... $3.24 1624 P32 sodium, per mCi....... G ........... $81.10 ........... $11.61 1625 IN 111 Pentetreotide, per G ........... $935.75 ........... $133.96 mCi. 1626 TC 99M Oxidronate, per G ........... $36.74 ........... $5.26 vial. 1627 TC-99 labeled red blood G ........... $40.90 ........... $5.85 cell, per test. 1628 P32 phosphate chromic, per G ........... $150.86 ........... $21.60 mCi. 1713 Anchor/screw bn/bn,tis/bn. H ........... ........... ........... ........... 1714 Cath, trans atherectomy, H ........... ........... ........... ........... dir. 1715 Brachytherapy needle...... H ........... ........... ........... ........... 1716 Brachytx seed, Gold 198... H ........... ........... ........... ........... 1717 Brachytx seed, HDR Ir-192. H ........... ........... ........... ........... 1718 Brachytx seed, Iodine 125. H ........... ........... ........... ........... 1719 Brachytxseed, Non-HDR Ir- H ........... ........... ........... ........... 192. 1720 Brachytx seed, Palladium H ........... ........... ........... ........... 103. 1721 AICD, dual chamber........ H ........... ........... ........... ........... 1722 AICD, single chamber...... H ........... ........... ........... ........... 1723 Cath, ablation, non- H ........... ........... ........... ........... cardiac. 1724 Cath, trans H ........... ........... ........... ........... atherec,rotation. 1725 Cath, translumin non-laser H ........... ........... ........... ........... 1726 Cath, bal dil, non- H ........... ........... ........... ........... vascular. 1727 Cath, bal tis dis, non-vas H ........... ........... ........... ........... 1728 Cath, brachytx seed adm... H ........... ........... ........... ........... 1729 Cath, drainage............ H ........... ........... ........... ........... 1730 Cath, EP, 19 or fewer H ........... ........... ........... ........... elect. 1731 Cath, EP, 20 or more elec. H ........... ........... ........... ........... 1732 Cath, EP, diag/abl, 3D/ H ........... ........... ........... ........... vect. 1733 Cath, EP, othr than cool- H ........... ........... ........... ........... tip. 1750 Cath, hemodialysis,long- H ........... ........... ........... ........... term. 1751 Cath, inf, per/cent/ H ........... ........... ........... ........... midline. 1752 Cath, hemodialysis,short- H ........... ........... ........... ........... term. 1753 Cath, intravas ultrasound. H ........... ........... ........... ........... 1754 Catheter, intradiscal..... H ........... ........... ........... ........... 1755 Catheter, intraspinal..... H ........... ........... ........... ........... 1756 Cath, pacing, transesoph.. H ........... ........... ........... ........... 1757 Cath, thrombectomy/ H ........... ........... ........... ........... embolect. 1758 Cath, ureteral............ H ........... ........... ........... ........... 1759 Cath, intra H ........... ........... ........... ........... echocardiography. 1760 Closure dev, vasc, imp/ H ........... ........... ........... ........... insert. 1762 Conn tiss, human (inc H ........... ........... ........... ........... fascia). 1763 Conn tiss, non-human...... H ........... ........... ........... ........... [[Page 44728]] 1764 Event recorder, cardiac... H ........... ........... ........... ........... 1765 Adhesion barrier.......... H ........... ........... ........... ........... 1766 Intro/sheath,strble,non- H ........... ........... ........... ........... peel. 1767 Generator, neurostim, imp. H ........... ........... ........... ........... 1768 Graft, vascular........... H ........... ........... ........... ........... 1769 Guide wire................ H ........... ........... ........... ........... 1770 Imaging coil, MR, H ........... ........... ........... ........... insertable. 1771 Rep dev, urinary, w/sling. H ........... ........... ........... ........... 1772 Infusion pump, H ........... ........... ........... ........... programmable. 1773 Retrieval dev, insert..... H ........... ........... ........... ........... 1776 Joint device (implantable) H ........... ........... ........... ........... 1777 Lead, AICD, endo single H ........... ........... ........... ........... coil. 1778 Lead, neurostimulator..... H ........... ........... ........... ........... 1779 Lead, pmkr, transvenous H ........... ........... ........... ........... VDD. 1780 Lens, intraocular......... H ........... ........... ........... ........... 1781 Mesh (implantable)........ H ........... ........... ........... ........... 1782 Morcellator............... H ........... ........... ........... ........... 1784 Ocular dev, intraop, det H ........... ........... ........... ........... ret. 1785 Pmkr, dual, rate-resp..... H ........... ........... ........... ........... 1786 Pmkr, single, rate-resp... H ........... ........... ........... ........... 1787 Patient progr, neurostim.. H ........... ........... ........... ........... 1788 Port, indwelling, imp..... H ........... ........... ........... ........... 1789 Prosthesis, breast, imp... H ........... ........... ........... ........... 1813 Prosthesis, penile, H ........... ........... ........... ........... inflatab. 1815 Pros, urinary sph, imp.... H ........... ........... ........... ........... 1816 Receiver/transmitter, H ........... ........... ........... ........... neuro. 1817 Septal defect imp sys..... H ........... ........... ........... ........... 1874 Stent, coated/cov w/del H ........... ........... ........... ........... sys. 1875 Stent, coated/cov w/o del H ........... ........... ........... ........... sy. 1876 Stent, non-coa/no-cov w/ H ........... ........... ........... ........... del. 1877 Stent, non-coat/cov w/o H ........... ........... ........... ........... del. 1878 Matrl for vocal cord...... H ........... ........... ........... ........... 1879 Tissue marker, imp........ H ........... ........... ........... ........... 1880 Vena cava filter.......... H ........... ........... ........... ........... 1881 Dialysis access system.... H ........... ........... ........... ........... 1882 AICD, other than sing/dual H ........... ........... ........... ........... 1883 Adapt/ext, pacing/neuro H ........... ........... ........... ........... lead. 1885 Cath, translumin angio H ........... ........... ........... ........... laser. 1887 Catheter, guiding......... H ........... ........... ........... ........... 1891 Infusion pump,non- H ........... ........... ........... ........... prog,perm. 1892 Intro/sheath,fixed,peel- H ........... ........... ........... ........... away. 1893 Intro/sheath,fixed,non- H ........... ........... ........... ........... peel. 1894 Intro/sheath, non-laser... H ........... ........... ........... ........... 1895 Lead, AICD, endo dual coil H ........... ........... ........... ........... 1896 Lead, AICD, non sing/dual. H ........... ........... ........... ........... 1897 Lead, neurostim test kit.. H ........... ........... ........... ........... 1898 Lead, pmkr, other than H ........... ........... ........... ........... trans. 1899 Lead, pmkr/AICD H ........... ........... ........... ........... combination. 2615 Sealant, pulmonary, liquid H ........... ........... ........... ........... 2616 Brachytx seed, Yttrium-90. H ........... ........... ........... ........... 2617 Stent, non-cor, tem w/o H ........... ........... ........... ........... del. 2618 Probe, cryoablation....... H ........... ........... ........... ........... 2619 Pmkr, dual, non rate-resp. H ........... ........... ........... ........... 2620 Pmkr, single, non rate- H ........... ........... ........... ........... resp. 2621 Pmkr, other than sing/dual H ........... ........... ........... ........... 2622 Prosthesis, penile, non- H ........... ........... ........... ........... inf. 2625 Stent, non-cor, tem w/del H ........... ........... ........... ........... sys. 2626 Infusion pump, non- H ........... ........... ........... ........... prog,temp. 2627 Cath, suprapubic/ H ........... ........... ........... ........... cystoscopic. 2628 Catheter, occlusion....... H ........... ........... ........... ........... 2629 Intro/sheath, laser....... H ........... ........... ........... ........... 2630 Cath, EP, cool-tip........ H ........... ........... ........... ........... 2631 Rep dev, urinary, w/o H ........... ........... ........... ........... sling. 7000 Amifostine, 500 mg........ G ........... $392.06 ........... $56.13 7001 Amphotericin B lipid G ........... $109.25 ........... $15.64 complex, 50 mg. 7003 Epoprostenol injection 0.5 G ........... $17.37 ........... $2.49 mg. 7005 Gonadorelin hydroch, 100 G ........... $38.47 ........... $5.51 mcg. 7007 Milrinone lactate, per 5 K 0.48 $24.40 ........... $4.88 ml, inj. 7010 Morphine sulfate G ........... $7.41 ........... $.95 (preservative free) 10 mg. 7011 Oprelvekin injection, 5 mg G ........... $236.31 ........... $33.83 7014 Fentanyl citrate inj up 2 G ........... $1.40 ........... $.18 ml. 7015 Busulfan, oral, 2 mg...... G ........... $1.81 ........... $.23 7019 Aprotinin, 10,000 kiu..... G ........... $2.06 ........... $.30 7022 Elliot's B solution, per G ........... $14.25 ........... $2.04 ml. 7023 Treatment for bladder G ........... $24.70 ........... $3.54 calculi, per 500 ml. 7024 Corticorelin ovine G ........... $368.03 ........... $52.69 triflutate, per 0.1 mg. 7025 Digoxin immune FAB G ........... $551.66 ........... $78.97 (Ovine), 40 mg vial. 7026 Ethanolamine oleate, 100 G ........... $39.73 ........... $5.69 mg. [[Page 44729]] 7027 Fomepizole, 1.5 mg........ G ........... $1.09 ........... $.16 7028 Fosphenytoin, 50 mg....... G ........... $9.55 ........... $1.37 7029 Glatiramer acetate, 20 mg. G ........... $30.07 ........... $4.30 7030 Hemin, 1 mg............... G ........... $.99 ........... $.14 7031 Octreotide acetate G ........... $125.65 ........... $17.99 injection 1mg. 7032 Sermorelin acetate, 0.5 mg G ........... $15.78 ........... $2.26 7033 Somatrem, 5 mg............ G ........... $209.48 ........... $29.99 7034 Somatropin, 1 mg (any G ........... $39.90 ........... $5.12 derivation). 7035 Teniposide, 50 mg......... G ........... $216.32 ........... $30.97 7037 Urofollitropin, 75 I.U.... G ........... $73.29 ........... $9.41 7038 Muromonab-CD3, 5 mg....... G ........... $777.31 ........... $111.28 7039 Pegademase bovine inj 25 G ........... $139.33 ........... $19.95 I.U. 7040 Pentastarch 10% inj, 100 G ........... $15.11 ........... $2.16 ml. 7041 Tirofiban hydrochloride G ........... $435.27 ........... $62.31 12.5 mg. 7042 Capecitabine, oral, 150 mg G ........... $2.43 ........... $.35 7043 Infliximab injection 10 mg G ........... $63.23 ........... $9.05 7045 Trimetrexate glucoronate G ........... $86.09 ........... $12.32 25 mg. 7046 Doxorubicin hcl liposome G ........... $358.95 ........... $51.39 inj 10 mg. 7047 Droperidol/fentanyl inj... G ........... $6.67 ........... $.95 7048 Alteplase recombinant..... K 0.39 $19.83 ........... $3.97 7049 Filgrastim 480 mcg G ........... $285.38 ........... $40.85 injection. 7050 Prednisone oral........... G ........... $.07 ........... $.01 7315 Sodium hyaluronate, 20 mg. G ........... $136.80 ........... $19.58 9000 Na chromate Cr51, per G ........... $.32 ........... $.05 0.25mCi. 9001 Linezolid inj, 200mg...... G ........... $34.14 ........... $4.89 9002 Tenecteplase, 50mg/vial... G ........... $2,612.50 ........... $374.00 9003 Palivizumab, per 50mg..... G ........... $664.49 ........... $95.13 9004 Gemtuzumab ozogamicin G ........... $1,929.69 ........... $276.25 inj,5mg. 9005 Reteplase injection....... G ........... $1,306.25 ........... $187.00 9006 Tacrolimus inj, per 5mg (1 G ........... $113.15 ........... $16.20 amp). 9007 Baclofen Intrathecal kit- G ........... $79.80 ........... $11.42 1amp. 9008 Baclofen Refill Kit-- G ........... $233.70 ........... $33.46 500mcg. 9009 Baclofen Refill Kit-- G ........... $491.15 ........... $70.31 2000mcg. 9010 Baclofen Refill Kit-- G ........... $861.65 ........... $123.35 4000mcg. 9011 Caffeine Citrate, inj, 1ml G ........... $12.22 ........... $1.75 9012 Arsenic Trioxide, 1mg/kg.. G ........... $237.50 ........... $34.00 9013 Co 57 Cobaltous Cl, 1 ml.. G ........... $10.02 ........... $1.43 9015 Mycophenolate mofetil oral G ........... $2.40 ........... $.34 9016 Echocardiography contrast. G ........... $39.58 ........... $5.67 9018 Botulinum tox B, per 100 u G ........... $8.79 ........... $1.26 9019 Caspofungin acetate, 50 mg G ........... $34.20 ........... $4.90 9020 Sirolimus tablet, 1 mg.... G ........... $6.51 ........... $.89 9100 Iodinated I-131 Albumin... G ........... $9.84 ........... $1.41 9102 51 Na chromate, 50mCi..... G ........... $.65 ........... $.09 9103 Na Iothalamate I-125, G ........... $11.66 ........... $1.67 10uCi. 9104 Anti-thymocyte G ........... $251.75 ........... $36.04 globulin,25mg. 9105 Hep B imm glob, per 1 ml.. G ........... $135.43 ........... $12.26 9106 Sirolimus, oral........... G ........... $6.51 ........... $.93 9108 Thyrotropin alfa, 1.1 mg.. G ........... $531.05 ........... $76.02 9109 Tirofliban hcl, 6.25 mg... G ........... $217.64 ........... $31.16 9217 Leuprolide acetate G ........... $564.92 ........... $51.14 suspnsion. 9500 Platelets, irradiated..... K 1.81 $92.02 ........... $18.40 9501 Platelets, pheresis....... K 9.91 $503.84 ........... $100.77 9502 Platelet pheresis K 10.75 $546.55 ........... $109.31 irradiated. 9503 Fresh frozen plasma, ea K 1.69 $85.92 ........... $17.18 unit. 9504 RBC deglycerolized........ K 4.45 $226.25 ........... $45.25 9505 RBC irradiated............ K 2.64 $134.22 ........... $26.84 ---------------------------------------------------------------------------------------------------------------- Addendum D.--Payment Status Indicators for the Hospital Outpatient Prospective Payment System ---------------------------------------------------------------------------------------------------------------- Indicator Service Status ---------------------------------------------------------------------------------------------------------------- A...................... Pulmonary Rehabilitation Not Paid Under Outpatient PPS Clinical Trial. A...................... Durable Medical Equipment, DMEPOS Fee Schedule Prosthetics and Orthotics. A...................... Physical, Occupational and Physician Fee Schedule Speech Therapy. A...................... Ambulance...................... Ambulance Fee Schedule A...................... EPO for ESRD Patients.......... National Rate A...................... Clinical Diagnostic Laboratory Laboratory Fee Schedule Services. A...................... Physician Services for ESRD Physician Fee Schedule Patients. A...................... Screening Mammography.......... Lower of Charges or National Rate C...................... Inpatient Procedures........... Admit Patient E...................... Non-Covered Items and Services. Not Paid Under Outpatient PPS F...................... Acquisition of Corneal Tissue.. Paid at Reasonable Cost G...................... Drug/Biological Pass-Through... Additional Payment H...................... Device Pass-Through............ Additional Payment K...................... Non Pass-Through Drug/ Paid Under Outpatient PPS Biological. N...................... Incidental Services, packaged Packaged into APC Rate. P...................... Partial Hospitalization........ Paid Per Diem APC [[Page 44730]] S...................... Significant Procedure, Not Paid Under Outpatient PPS Discounted When Multiple. T...................... Significant Procedure, Multiple Paid Under Outpatient PPS Procedure Reduction Applies. V...................... Visit to Clinic or Emergency Paid Under Outpatient PPS Department. X...................... Ancillary Service.............. Paid Under Outpatient PPS ---------------------------------------------------------------------------------------------------------------- -------------------- CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All rights reserved. [[Page 44730]] Addendum B.--Payment Status by HCPCS Code and Related Information Calender Year 2002 ---------------------------------------------------------------------------------------------------------------- National Minimum CPT/ HOPD Status Description APC Relative Payment Unadjusted Unadjusted HCPCS Indicator Weight Rate Copayment Copayment ---------------------------------------------------------------------------------------------------------------- 00100 N Anesth, salivary ........... ........... ........... ........... ........... gland. 00103 N Anesth, ........... ........... ........... ........... ........... blepharoplasty. 00104 N Anesth, electroshock ........... ........... ........... ........... ........... 00120 N Anesth, ear surgery. ........... ........... ........... ........... ........... 00124 N Anesth, ear exam.... ........... ........... ........... ........... ........... 00126 N Anesth, tympanotomy. ........... ........... ........... ........... ........... 00140 N Anesth, procedures ........... ........... ........... ........... ........... on eye. 00142 N Anesth, lens surgery ........... ........... ........... ........... ........... 00144 N Anesth, corneal ........... ........... ........... ........... ........... transplant. 00145 N Anesth, ........... ........... ........... ........... ........... vitreoretinal surg. 00147 N Anesth, iridectomy.. ........... ........... ........... ........... ........... 00148 N Anesth, eye exam.... ........... ........... ........... ........... ........... 00160 N Anesth, nose/sinus ........... ........... ........... ........... ........... surgery. 00162 N Anesth, nose/sinus ........... ........... ........... ........... ........... surgery. 00164 N Anesth, biopsy of ........... ........... ........... ........... ........... nose. 00170 N Anesth, procedure on ........... ........... ........... ........... ........... mouth. 00172 N Anesth, cleft palate ........... ........... ........... ........... ........... repair. 00174 N Anesth, pharyngeal ........... ........... ........... ........... ........... surgery. 00176 N Anesth, pharyngeal ........... ........... ........... ........... ........... surgery. 00190 N Anesth, face/skull ........... ........... ........... ........... ........... bone surg. 00192 N Anesth, facial bone ........... ........... ........... ........... ........... surgery. 00210 N Anesth, open head ........... ........... ........... ........... ........... surgery. 00212 N Anesth, skull ........... ........... ........... ........... ........... drainage. 00214 N Anesth, skull ........... ........... ........... ........... ........... drainage. 00215 N Anesth, skull repair/ ........... ........... ........... ........... ........... fract. 00216 N Anesth, head vessel ........... ........... ........... ........... ........... surgery. 00218 N Anesth, special head ........... ........... ........... ........... ........... surgery. 00220 N Anesth, spinal fluid ........... ........... ........... ........... ........... shunt. 00222 N Anesth, head nerve ........... ........... ........... ........... ........... surgery. 00300 N Anesth, head/neck/ ........... ........... ........... ........... ........... ptrunk. 00320 N Anesth, neck organ ........... ........... ........... ........... ........... surgery. 00322 N Anesth, biopsy of ........... ........... ........... ........... ........... thyroid. 00350 N Anesth, neck vessel ........... ........... ........... ........... ........... surgery. 00352 N Anesth, neck vessel ........... ........... ........... ........... ........... surgery. 00400 N Anesth, skin, ext/ ........... ........... ........... ........... ........... per/atrunk. 00402 N Anesth, surgery of ........... ........... ........... ........... ........... breast. 00404 N Anesth, surgery of ........... ........... ........... ........... ........... breast. 00406 N Anesth, surgery of ........... ........... ........... ........... ........... breast. 00410 N Anesth, correct ........... ........... ........... ........... ........... heart rhythm. 00450 N Anesth, surgery of ........... ........... ........... ........... ........... shoulder. 00452 N Anesth, surgery of ........... ........... ........... ........... ........... shoulder. 00454 N Anesth, collar bone ........... ........... ........... ........... ........... biopsy. 00470 N Anesth, removal of ........... ........... ........... ........... ........... rib. 00472 N Anesth, chest wall ........... ........... ........... ........... ........... repair. 00474 N Anesth, surgery of ........... ........... ........... ........... ........... rib(s). 00500 N Anesth, esophageal ........... ........... ........... ........... ........... surgery. 00520 N Anesth, chest ........... ........... ........... ........... ........... procedure. 00522 N Anesth, chest lining ........... ........... ........... ........... ........... biopsy. 00524 N Anesth, chest ........... ........... ........... ........... ........... drainage. 00528 N Anesth, chest ........... ........... ........... ........... ........... partition view. 00530 N Anesth, pacemaker ........... ........... ........... ........... ........... insertion. 00532 N Anesth, vascular ........... ........... ........... ........... ........... access. 00534 N Anesth, cardioverter/ ........... ........... ........... ........... ........... defib. 00537 N Anesth, cardiac ........... ........... ........... ........... ........... electrophys. 00540 N Anesth, chest ........... ........... ........... ........... ........... surgery. 00542 N Anesth, release of ........... ........... ........... ........... ........... lung. 00544 N Anesth, chest lining ........... ........... ........... ........... ........... removal. 00546 N Anesth, lung,chest ........... ........... ........... ........... ........... wall surg. 00548 N Anesth, ........... ........... ........... ........... ........... trachea,bronchi surg. 00550 N Anesth, sternal ........... ........... ........... ........... ........... debridement. 00560 N Anesth, open heart ........... ........... ........... ........... ........... surgery. 00562 N Anesth, open heart ........... ........... ........... ........... ........... surgery. 00563 N Anesth, heart proc w/ ........... ........... ........... ........... ........... pump. 00566 N Anesth, cabg w/o ........... ........... ........... ........... ........... pump. 00580 N Anesth heart/lung ........... ........... ........... ........... ........... transplant. [[Page 44731]] 00600 N Anesth, spine, cord ........... ........... ........... ........... ........... surgery. 00604 N Anesth, sitting ........... ........... ........... ........... ........... procedure. 00620 N Anesth, spine, cord ........... ........... ........... ........... ........... surgery. 00622 N Anesth, removal of ........... ........... ........... ........... ........... nerves. 00630 N Anesth, spine, cord ........... ........... ........... ........... ........... surgery. 00632 N Anesth, removal of ........... ........... ........... ........... ........... nerves. 00634 N Anesth for ........... ........... ........... ........... ........... chemonucleolysis. 00635 N Anesth, lumbar ........... ........... ........... ........... ........... puncture. 00670 N Anesth, spine, cord ........... ........... ........... ........... ........... surgery. 00700 N Anesth, abdominal ........... ........... ........... ........... ........... wall surg. 00702 N Anesth, for liver ........... ........... ........... ........... ........... biopsy. 00730 N Anesth, abdominal ........... ........... ........... ........... ........... wall surg. 00740 N Anesth, upper gi ........... ........... ........... ........... ........... visualize. 00750 N Anesth, repair of ........... ........... ........... ........... ........... hernia. 00752 N Anesth, repair of ........... ........... ........... ........... ........... hernia. 00754 N Anesth, repair of ........... ........... ........... ........... ........... hernia. 00756 N Anesth, repair of ........... ........... ........... ........... ........... hernia. 00770 N Anesth, blood vessel ........... ........... ........... ........... ........... repair. 00790 N Anesth, surg upper ........... ........... ........... ........... ........... abdomen. 00792 N Anesth, hemorr/ ........... ........... ........... ........... ........... excise liver. 00794 N Anesth, pancreas ........... ........... ........... ........... ........... removal. 00796 N Anesth, for liver ........... ........... ........... ........... ........... transplant. 00800 N Anesth, abdominal ........... ........... ........... ........... ........... wall surg. 00802 N Anesth, fat layer ........... ........... ........... ........... ........... removal. 00810 N Anesth, low ........... ........... ........... ........... ........... intestine scope. 00820 N Anesth, abdominal ........... ........... ........... ........... ........... wall surg. 00830 N Anesth, repair of ........... ........... ........... ........... ........... hernia. 00832 N Anesth, repair of ........... ........... ........... ........... ........... hernia. 00840 N Anesth, surg lower ........... ........... ........... ........... ........... abdomen. 00842 N Anesth, ........... ........... ........... ........... ........... amniocentesis. 00844 N Anesth, pelvis ........... ........... ........... ........... ........... surgery. 00846 N Anesth, hysterectomy ........... ........... ........... ........... ........... 00848 N Anesth, pelvic organ ........... ........... ........... ........... ........... surg. 00850 N Anesth, cesarean ........... ........... ........... ........... ........... section. 00855 N Anesth, hysterectomy ........... ........... ........... ........... ........... 00857 N Analgesia, labor & c- ........... ........... ........... ........... ........... section. 00860 N Anesth, surgery of ........... ........... ........... ........... ........... abdomen. 00862 N Anesth, kidney/ ........... ........... ........... ........... ........... ureter surg. 00864 N Anesth, removal of ........... ........... ........... ........... ........... bladder. 00865 N Anesth, removal of ........... ........... ........... ........... ........... prostate. 00866 N Anesth, removal of ........... ........... ........... ........... ........... adrenal. 00868 N Anesth, kidney ........... ........... ........... ........... ........... transplant. 00870 N Anesth, bladder ........... ........... ........... ........... ........... stone surg. 00872 N Anesth kidney stone ........... ........... ........... ........... ........... destruct. 00873 N Anesth kidney stone ........... ........... ........... ........... ........... destruct. 00880 N Anesth, abdomen ........... ........... ........... ........... ........... vessel surg. 00882 N Anesth, major vein ........... ........... ........... ........... ........... ligation. 00884 N Anesth, major vein ........... ........... ........... ........... ........... revision. 00902 N Anesth, anorectal ........... ........... ........... ........... ........... surgery. 00904 N Anesth, perineal ........... ........... ........... ........... ........... surgery. 00906 N Anesth, removal of ........... ........... ........... ........... ........... vulva. 00908 N Anesth, removal of ........... ........... ........... ........... ........... prostate. 00910 N Anesth, bladder ........... ........... ........... ........... ........... surgery. 00912 N Anesth, bladder ........... ........... ........... ........... ........... tumor surg. 00914 N Anesth, removal of ........... ........... ........... ........... ........... prostate. 00916 N Anesth, bleeding ........... ........... ........... ........... ........... control. 00918 N Anesth, stone ........... ........... ........... ........... ........... removal. 00920 N Anesth, genitalia ........... ........... ........... ........... ........... surgery. 00922 N Anesth, sperm duct ........... ........... ........... ........... ........... surgery. 00924 N Anesth, testis ........... ........... ........... ........... ........... exploration. 00926 N Anesth, removal of ........... ........... ........... ........... ........... testis. 00928 N Anesth, removal of ........... ........... ........... ........... ........... testis. 00930 N Anesth, testis ........... ........... ........... ........... ........... suspension. 00932 N Anesth, amputation ........... ........... ........... ........... ........... of penis. 00934 N Anesth, penis, nodes ........... ........... ........... ........... ........... removal. 00936 N Anesth, penis, nodes ........... ........... ........... ........... ........... removal. 00938 N Anesth, insert penis ........... ........... ........... ........... ........... device. 00940 N Anesth, vaginal ........... ........... ........... ........... ........... procedures. 00942 N Anesth, surg on vag/ ........... ........... ........... ........... ........... urethal. 00944 N Anesth, vaginal ........... ........... ........... ........... ........... hysterectomy. 00946 N Anesth, vaginal ........... ........... ........... ........... ........... delivery. 00948 N Anesth, repair of ........... ........... ........... ........... ........... cervix. 00950 N Anesth, vaginal ........... ........... ........... ........... ........... endoscopy. 00952 N Anesth, hysteroscope/ ........... ........... ........... ........... ........... graph. 00955 N Analgesia, vaginal ........... ........... ........... ........... ........... delivery. [[Page 44732]] 01112 N Anesth, bone ........... ........... ........... ........... ........... aspirate/bx. 01120 N Anesth, pelvis ........... ........... ........... ........... ........... surgery. 01130 N Anesth, body cast ........... ........... ........... ........... ........... procedure. 01140 N Anesth, amputation ........... ........... ........... ........... ........... at pelvis. 01150 N Anesth, pelvic tumor ........... ........... ........... ........... ........... surgery. 01160 N Anesth, pelvis ........... ........... ........... ........... ........... procedure. 01170 N Anesth, pelvis ........... ........... ........... ........... ........... surgery. 01180 N Anesth, pelvis nerve ........... ........... ........... ........... ........... removal. 01190 N Anesth, pelvis nerve ........... ........... ........... ........... ........... removal. 01200 N Anesth, hip joint ........... ........... ........... ........... ........... procedure. 01202 N Anesth, arthroscopy ........... ........... ........... ........... ........... of hip. 01210 N Anesth, hip joint ........... ........... ........... ........... ........... surgery. 01212 N Anesth, hip ........... ........... ........... ........... ........... disarticulation. 01214 N Anesth, replacement ........... ........... ........... ........... ........... of hip. 01215 N Anesth, revise hip ........... ........... ........... ........... ........... repair. 01220 N Anesth, procedure on ........... ........... ........... ........... ........... femur. 01230 N Anesth, surgery of ........... ........... ........... ........... ........... femur. 01232 N Anesth, amputation ........... ........... ........... ........... ........... of femur. 01234 N Anesth, radical ........... ........... ........... ........... ........... femur surg. 01250 N Anesth, upper leg ........... ........... ........... ........... ........... surgery. 01260 N Anesth, upper leg ........... ........... ........... ........... ........... veins surg. 01270 N Anesth, thigh ........... ........... ........... ........... ........... arteries surg. 01272 N Anesth, femoral ........... ........... ........... ........... ........... artery surg. 01274 N Anesth, femoral ........... ........... ........... ........... ........... embolectomy. 01320 N Anesth, knee area ........... ........... ........... ........... ........... surgery. 01340 N Anesth, knee area ........... ........... ........... ........... ........... procedure. 01360 N Anesth, knee area ........... ........... ........... ........... ........... surgery. 01380 N Anesth, knee joint ........... ........... ........... ........... ........... procedure. 01382 N Anesth, knee ........... ........... ........... ........... ........... arthroscopy. 01390 N Anesth, knee area ........... ........... ........... ........... ........... procedure. 01392 N Anesth, knee area ........... ........... ........... ........... ........... surgery. 01400 N Anesth, knee joint ........... ........... ........... ........... ........... surgery. 01402 N Anesth, replacement ........... ........... ........... ........... ........... of knee. 01404 N Anesth, amputation ........... ........... ........... ........... ........... at knee. 01420 N Anesth, knee joint ........... ........... ........... ........... ........... casting. 01430 N Anesth, knee veins ........... ........... ........... ........... ........... surgery. 01432 N Anesth, knee vessel ........... ........... ........... ........... ........... surg. 01440 N Anesth, knee ........... ........... ........... ........... ........... arteries surg. 01442 N Anesth, knee artery ........... ........... ........... ........... ........... surg. 01444 N Anesth, knee artery ........... ........... ........... ........... ........... repair. 01462 N Anesth, lower leg ........... ........... ........... ........... ........... procedure. 01464 N Anesth, ankle ........... ........... ........... ........... ........... arthroscopy. 01470 N Anesth, lower leg ........... ........... ........... ........... ........... surgery. 01472 N Anesth, achilles ........... ........... ........... ........... ........... tendon surg. 01474 N Anesth, lower leg ........... ........... ........... ........... ........... surgery. 01480 N Anesth, lower leg ........... ........... ........... ........... ........... bone surg. 01482 N Anesth, radical leg ........... ........... ........... ........... ........... surgery. 01484 N Anesth, lower leg ........... ........... ........... ........... ........... revision. 01486 N Anesth, ankle ........... ........... ........... ........... ........... replacement. 01490 N Anesth, lower leg ........... ........... ........... ........... ........... casting. 01500 N Anesth, leg arteries ........... ........... ........... ........... ........... surg. 01502 N Anesth, lwr leg ........... ........... ........... ........... ........... embolectomy. 01520 N Anesth, lower leg ........... ........... ........... ........... ........... vein surg. 01522 N Anesth, lower leg ........... ........... ........... ........... ........... vein surg. 01610 N Anesth, surgery of ........... ........... ........... ........... ........... shoulder. 01620 N Anesth, shoulder ........... ........... ........... ........... ........... procedure. 01622 N Anesth, shoulder ........... ........... ........... ........... ........... arthroscopy. 01630 N Anesth, surgery of ........... ........... ........... ........... ........... shoulder. 01632 N Anesth, surgery of ........... ........... ........... ........... ........... shoulder. 01634 N Anesth, shoulder ........... ........... ........... ........... ........... joint amput. 01636 N Anesth, forequarter ........... ........... ........... ........... ........... amput. 01638 N Anesth, shoulder ........... ........... ........... ........... ........... replacement. 01650 N Anesth, shoulder ........... ........... ........... ........... ........... artery surg. 01652 N Anesth, shoulder ........... ........... ........... ........... ........... vessel surg. 01654 N Anesth, shoulder ........... ........... ........... ........... ........... vessel surg. 01656 N Anesth, arm-leg ........... ........... ........... ........... ........... vessel surg. 01670 N Anesth, shoulder ........... ........... ........... ........... ........... vein surg. 01680 N Anesth, shoulder ........... ........... ........... ........... ........... casting. 01682 N Anesth, airplane ........... ........... ........... ........... ........... cast. 01710 N Anesth, elbow area ........... ........... ........... ........... ........... surgery. 01712 N Anesth, uppr arm ........... ........... ........... ........... ........... tendon surg. 01714 N Anesth, uppr arm ........... ........... ........... ........... ........... tendon surg. 01716 N Anesth, biceps ........... ........... ........... ........... ........... tendon repair. 01730 N Anesth, uppr arm ........... ........... ........... ........... ........... procedure. 01732 N Anesth, elbow ........... ........... ........... ........... ........... arthroscopy. [[Page 44733]] 01740 N Anesth, upper arm ........... ........... ........... ........... ........... surgery. 01742 N Anesth, humerus ........... ........... ........... ........... ........... surgery. 01744 N Anesth, humerus ........... ........... ........... ........... ........... repair. 01756 N Anesth, radical ........... ........... ........... ........... ........... humerus surg. 01758 N Anesth, humeral ........... ........... ........... ........... ........... lesion surg. 01760 N Anesth, elbow ........... ........... ........... ........... ........... replacement. 01770 N Anesth, uppr arm ........... ........... ........... ........... ........... artery surg. 01772 N Anesth, uppr arm ........... ........... ........... ........... ........... embolectomy. 01780 N Anesth, upper arm ........... ........... ........... ........... ........... vein surg. 01782 N Anesth, uppr arm ........... ........... ........... ........... ........... vein repair. 01810 N Anesth, lower arm ........... ........... ........... ........... ........... surgery. 01820 N Anesth, lower arm ........... ........... ........... ........... ........... procedure. 01830 N Anesth, lower arm ........... ........... ........... ........... ........... surgery. 01832 N Anesth, wrist ........... ........... ........... ........... ........... replacement. 01840 N Anesth, lwr arm ........... ........... ........... ........... ........... artery surg. 01842 N Anesth, lwr arm ........... ........... ........... ........... ........... embolectomy. 01844 N Anesth, vascular ........... ........... ........... ........... ........... shunt surg. 01850 N Anesth, lower arm ........... ........... ........... ........... ........... vein surg. 01852 N Anesth, lwr arm vein ........... ........... ........... ........... ........... repair. 01860 N Anesth, lower arm ........... ........... ........... ........... ........... casting. 01904 N Anesth, skull x-ray ........... ........... ........... ........... ........... inject. 01906 N Anesth, lumbar ........... ........... ........... ........... ........... my
