[Federal Register: November 30, 2001 (Volume 66, Number 231)] [Rules and Regulations] [Page 60055-60104] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr30no01-34] [[pp. 60055-60104]] Medicare Program; Changes to the Hospital Outpatient Prospective Payment System for Calendar Year 2002 [[Continued from page 60054]] [[Page 60054]] D4920 E Unscheduled dressing ........... ........... ........... ........... ........... change. D4999 E Unspecified ........... ........... ........... ........... ........... periodontal proc. D5110 E Dentures complete ........... ........... ........... ........... ........... maxillary. D5120 E Dentures complete ........... ........... ........... ........... ........... mandible. D5130 E Dentures immediat ........... ........... ........... ........... ........... maxillary. D5140 E Dentures immediat ........... ........... ........... ........... ........... mandible. D5211 E Dentures maxill part ........... ........... ........... ........... ........... resin. D5212 E Dentures mand part ........... ........... ........... ........... ........... resin. D5213 E Dentures maxill part ........... ........... ........... ........... ........... metal. D5214 E Dentures mandibl ........... ........... ........... ........... ........... part metal. D5281 E Removable partial ........... ........... ........... ........... ........... denture. D5410 E Dentures adjust ........... ........... ........... ........... ........... cmplt maxil. D5411 E Dentures adjust ........... ........... ........... ........... ........... cmplt mand. D5421 E Dentures adjust part ........... ........... ........... ........... ........... maxill. D5422 E Dentures adjust part ........... ........... ........... ........... ........... mandbl. D5510 E Dentur repr broken ........... ........... ........... ........... ........... compl bas. D5520 E Replace denture ........... ........... ........... ........... ........... teeth complt. D5610 E Dentures repair ........... ........... ........... ........... ........... resin base. D5620 E Rep part denture ........... ........... ........... ........... ........... cast frame. D5630 E Rep partial denture ........... ........... ........... ........... ........... clasp. D5640 E Replace part denture ........... ........... ........... ........... ........... teeth. D5650 E Add tooth to partial ........... ........... ........... ........... ........... denture. D5660 E Add clasp to partial ........... ........... ........... ........... ........... denture. D5710 E Dentures rebase ........... ........... ........... ........... ........... cmplt maxil. D5711 E Dentures rebase ........... ........... ........... ........... ........... cmplt mand. D5720 E Dentures rebase part ........... ........... ........... ........... ........... maxill. D5721 E Dentures rebase part ........... ........... ........... ........... ........... mandbl. D5730 E Denture reln cmplt ........... ........... ........... ........... ........... maxil ch. D5731 E Denture reln cmplt ........... ........... ........... ........... ........... mand chr. D5740 E Denture reln part ........... ........... ........... ........... ........... maxil chr. D5741 E Denture reln part ........... ........... ........... ........... ........... mand chr. D5750 E Denture reln cmplt ........... ........... ........... ........... ........... max lab. D5751 E Denture reln cmplt ........... ........... ........... ........... ........... mand lab. D5760 E Denture reln part ........... ........... ........... ........... ........... maxil lab. D5761 E Denture reln part ........... ........... ........... ........... ........... mand lab. D5810 E Denture interm cmplt ........... ........... ........... ........... ........... maxill. D5811 E Denture interm cmplt ........... ........... ........... ........... ........... mandbl. D5820 E Denture interm part ........... ........... ........... ........... ........... maxill. D5821 E Denture interm part ........... ........... ........... ........... ........... mandbl. D5850 E Denture tiss conditn ........... ........... ........... ........... ........... maxill. D5851 E Denture tiss condtin ........... ........... ........... ........... ........... mandbl. D5860 E Overdenture complete ........... ........... ........... ........... ........... D5861 E Overdenture partial. ........... ........... ........... ........... ........... D5862 E Precision attachment ........... ........... ........... ........... ........... D5867 E Replacement of ........... ........... ........... ........... ........... precision att. D5875 E Prosthesis ........... ........... ........... ........... ........... modification. D5899 E Removable ........... ........... ........... ........... ........... prosthodontic proc. D5911 S Facial moulage 0330 10.97 $558.42 ........... $111.68 sectional. D5912 S Facial moulage 0330 10.97 $558.42 ........... $111.68 complete. D5913 E Nasal prosthesis.... ........... ........... ........... ........... ........... D5914 E Auricular prosthesis ........... ........... ........... ........... ........... D5915 E Orbital prosthesis.. ........... ........... ........... ........... ........... D5916 E Ocular prosthesis... ........... ........... ........... ........... ........... D5919 E Facial prosthesis... ........... ........... ........... ........... ........... D5922 E Nasal septal ........... ........... ........... ........... ........... prosthesis. D5923 E Ocular prosthesis ........... ........... ........... ........... ........... interim. D5924 E Cranial prosthesis.. ........... ........... ........... ........... ........... D5925 E Facial augmentation ........... ........... ........... ........... ........... implant. D5926 E Replacement nasal ........... ........... ........... ........... ........... prosthesis. D5927 E Auricular ........... ........... ........... ........... ........... replacement. D5928 E Orbital replacement. ........... ........... ........... ........... ........... D5929 E Facial replacement.. ........... ........... ........... ........... ........... D5931 E Surgical obturator.. ........... ........... ........... ........... ........... D5932 E Postsurgical ........... ........... ........... ........... ........... obturator. D5933 E Refitting of ........... ........... ........... ........... ........... obturator. D5934 E Mandibular flange ........... ........... ........... ........... ........... prosthesis. D5935 E Mandibular denture ........... ........... ........... ........... ........... prosth. D5936 E Temp obturator ........... ........... ........... ........... ........... prosthesis. D5937 E Trismus appliance... ........... ........... ........... ........... ........... D5951 E Feeding aid......... ........... ........... ........... ........... ........... D5952 E Pediatric speech aid ........... ........... ........... ........... ........... D5953 E Adult speech aid.... ........... ........... ........... ........... ........... D5954 E Superimposed ........... ........... ........... ........... ........... prosthesis. D5955 E Palatal lift ........... ........... ........... ........... ........... prosthesis. D5958 E Intraoral con def ........... ........... ........... ........... ........... inter plt. [[Page 60055]] D5959 E Intraoral con def ........... ........... ........... ........... ........... mod palat. D5960 E Modify speech aid ........... ........... ........... ........... ........... prosthesis. D5982 E Surgical stent...... ........... ........... ........... ........... ........... D5983 S Radiation applicator 0330 10.97 $558.42 ........... $111.68 D5984 S Radiation shield.... 0330 10.97 $558.42 ........... $111.68 D5985 S Radiation cone 0330 10.97 $558.42 ........... $111.68 locator. D5986 E Fluoride applicator. ........... ........... ........... ........... ........... D5987 S Commissure splint... 0330 10.97 $558.42 ........... $111.68 D5988 E Surgical splint..... ........... ........... ........... ........... ........... D5999 E Maxillofacial ........... ........... ........... ........... ........... prosthesis. D6010 E Odontics endosteal ........... ........... ........... ........... ........... implant. D6020 E Odontics abutment ........... ........... ........... ........... ........... placement. D6040 E Odontics eposteal ........... ........... ........... ........... ........... implant. D6050 E Odontics transosteal ........... ........... ........... ........... ........... implnt. D6055 E Implant connecting ........... ........... ........... ........... ........... bar. D6056 E Prefabricated ........... ........... ........... ........... ........... abutment. D6057 E Custom abutment..... ........... ........... ........... ........... ........... D6058 E Abutment supported ........... ........... ........... ........... ........... crown. D6059 E Abutment supported ........... ........... ........... ........... ........... mtl crown. D6060 E Abutment supported ........... ........... ........... ........... ........... mtl crown. D6061 E Abutment supported ........... ........... ........... ........... ........... mtl crown. D6062 E Abutment supported ........... ........... ........... ........... ........... mtl crown. D6063 E Abutment supported ........... ........... ........... ........... ........... mtl crown. D6064 E Abutment supported ........... ........... ........... ........... ........... mtl crown. D6065 E Implant supported ........... ........... ........... ........... ........... crown. D6066 E Implant supported ........... ........... ........... ........... ........... mtl crown. D6067 E Implant supported ........... ........... ........... ........... ........... mtl crown. D6068 E Abutment supported ........... ........... ........... ........... ........... retainer. D6069 E Abutment supported ........... ........... ........... ........... ........... retainer. D6070 E Abutment supported ........... ........... ........... ........... ........... retainer. D6071 E Abutment supported ........... ........... ........... ........... ........... retainer. D6072 E Abutment supported ........... ........... ........... ........... ........... retainer. D6073 E Abutment supported ........... ........... ........... ........... ........... retainer. D6074 E Abutment supported ........... ........... ........... ........... ........... retainer. D6075 E Implant supported ........... ........... ........... ........... ........... retainer. D6076 E Implant supported ........... ........... ........... ........... ........... retainer. D6077 E Implant supported ........... ........... ........... ........... ........... retainer. D6078 E Implnt/abut suprtd ........... ........... ........... ........... ........... fixd dent. D6079 E Implnt/abut suprtd ........... ........... ........... ........... ........... fixd dent. D6080 E Implant maintenance. ........... ........... ........... ........... ........... D6090 E Repair implant...... ........... ........... ........... ........... ........... D6095 E Odontics repr ........... ........... ........... ........... ........... abutment. D6100 E Removal of implant.. ........... ........... ........... ........... ........... D6199 E Implant procedure... ........... ........... ........... ........... ........... D6210 E Prosthodont high ........... ........... ........... ........... ........... noble metal. D6211 E Bridge base metal ........... ........... ........... ........... ........... cast. D6212 E Bridge noble metal ........... ........... ........... ........... ........... cast. D6240 E Bridge porcelain ........... ........... ........... ........... ........... high noble. D6241 E Bridge porcelain ........... ........... ........... ........... ........... base metal. D6242 E Bridge porcelain ........... ........... ........... ........... ........... nobel metal. D6245 E Bridge porcelain/ ........... ........... ........... ........... ........... ceramic. D6250 E Bridge resin w/high ........... ........... ........... ........... ........... noble. D6251 E Bridge resin base ........... ........... ........... ........... ........... metal. D6252 E Bridge resin w/noble ........... ........... ........... ........... ........... metal. D6519 E Inlay/onlay porce/ ........... ........... ........... ........... ........... ceramic. D6520 E Dental retainer two ........... ........... ........... ........... ........... surfaces. D6530 E Retainer metallic 3+ ........... ........... ........... ........... ........... surface. D6543 E Dental retainr onlay ........... ........... ........... ........... ........... 3 surf. D6544 E Dental retainr onlay ........... ........... ........... ........... ........... 4/more. D6545 E Dental retainr cast ........... ........... ........... ........... ........... metl. D6548 E Porcelain/ceramic ........... ........... ........... ........... ........... retainer. D6720 E Retain crown resin w ........... ........... ........... ........... ........... hi nble. D6721 E Crown resin w/base ........... ........... ........... ........... ........... metal. D6722 E Crown resin w/noble ........... ........... ........... ........... ........... metal. D6740 E Crown porcelain/ ........... ........... ........... ........... ........... ceramic. D6750 E Crown porcelain high ........... ........... ........... ........... ........... noble. D6751 E Crown porcelain base ........... ........... ........... ........... ........... metal. D6752 E Crown porcelain ........... ........... ........... ........... ........... noble metal. D6780 E Crown 3/4 high noble ........... ........... ........... ........... ........... metal. D6781 E Crown 3/4 cast based ........... ........... ........... ........... ........... metal. D6782 E Crown 3/4 cast noble ........... ........... ........... ........... ........... metal. D6783 E Crown 3/4 porcelain/ ........... ........... ........... ........... ........... ceramic. D6790 E Crown full high ........... ........... ........... ........... ........... noble metal. D6791 E Crown full base ........... ........... ........... ........... ........... metal cast. D6792 E Crown full noble ........... ........... ........... ........... ........... metal cast. [[Page 60056]] D6920 S Dental connector bar 0330 10.97 $558.42 ........... $111.68 D6930 E Dental recement ........... ........... ........... ........... ........... bridge. D6940 E Stress breaker...... ........... ........... ........... ........... ........... D6950 E Precision attachment ........... ........... ........... ........... ........... D6970 E Post & core plus ........... ........... ........... ........... ........... retainer. D6971 E Cast post bridge ........... ........... ........... ........... ........... retainer. D6972 E Prefab post & core ........... ........... ........... ........... ........... plus reta. D6973 E Core build up for ........... ........... ........... ........... ........... retainer. D6975 E Coping metal........ ........... ........... ........... ........... ........... D6976 E Each addtnl cast ........... ........... ........... ........... ........... post. D6977 E Each addtl prefab ........... ........... ........... ........... ........... post. D6980 E Bridge repair....... ........... ........... ........... ........... ........... D6999 E Fixed prosthodontic ........... ........... ........... ........... ........... proc. D7110 S Oral surgery single 0330 10.97 $558.42 ........... $111.68 tooth. D7120 S Each add tooth 0330 10.97 $558.42 ........... $111.68 extraction. D7130 S Tooth root removal.. 0330 10.97 $558.42 ........... $111.68 D7210 S Rem imp tooth w 0330 10.97 $558.42 ........... $111.68 mucoper flp. D7220 S Impact tooth remov 0330 10.97 $558.42 ........... $111.68 soft tiss. D7230 S Impact tooth remov 0330 10.97 $558.42 ........... $111.68 part bony. D7240 S Impact tooth remov 0330 10.97 $558.42 ........... $111.68 comp bony. D7241 S Impact tooth rem 0330 10.97 $558.42 ........... $111.68 bony w/comp. D7250 S Tooth root removal.. 0330 10.97 $558.42 ........... $111.68 D7260 S Oral antral fistula 0330 10.97 $558.42 ........... $111.68 closure. D7270 E Tooth reimplantation ........... ........... ........... ........... ........... D7272 E Tooth ........... ........... ........... ........... ........... transplantation. D7280 E Exposure impact ........... ........... ........... ........... ........... tooth orthod. D7281 E Exposure tooth aid ........... ........... ........... ........... ........... eruption. D7285 E Biopsy of oral ........... ........... ........... ........... ........... tissue hard. D7286 E Biopsy of oral ........... ........... ........... ........... ........... tissue soft. D7290 E Repositioning of ........... ........... ........... ........... ........... teeth. D7291 S Transseptal 0330 10.97 $558.42 ........... $111.68 fiberotomy. D7310 E Alveoplasty w/ ........... ........... ........... ........... ........... extraction. D7320 E Alveoplasty w/o ........... ........... ........... ........... ........... extraction. D7340 E Vestibuloplasty ........... ........... ........... ........... ........... ridge extens. D7350 E Vestibuloplasty ........... ........... ........... ........... ........... exten graft. D7410 E Rad exc lesion up to ........... ........... ........... ........... ........... 1.25 cm. D7420 E Lesion > 1.25 cm.... ........... ........... ........... ........... ........... D7430 E Exc benign tumor to ........... ........... ........... ........... ........... 1.25 cm. D7431 E Benign tumor exc > ........... ........... ........... ........... ........... 1.25 cm. D7440 E Malig tumor exc to ........... ........... ........... ........... ........... 1.25 cm. D7441 E Malig tumor > 1.25 ........... ........... ........... ........... ........... cm. D7450 E Rem odontogen cyst ........... ........... ........... ........... ........... to 1.25cm. D7451 E Rem odontogen cyst > ........... ........... ........... ........... ........... 1.25 cm. D7460 E Rem nonodonto cyst ........... ........... ........... ........... ........... to 1.25cm. D7461 E Rem nonodonto cyst > ........... ........... ........... ........... ........... 1.25 cm. D7465 E Lesion destruction.. ........... ........... ........... ........... ........... D7471 E Rem exostosis any ........... ........... ........... ........... ........... site. D7480 E Partial ostectomy... ........... ........... ........... ........... ........... D7490 E Mandible resection.. ........... ........... ........... ........... ........... D7510 E I&d absc intraoral ........... ........... ........... ........... ........... soft tiss. D7520 E I&d abscess ........... ........... ........... ........... ........... extraoral. D7530 E Removal fb skin/ ........... ........... ........... ........... ........... areolar tiss. D7540 E Removal of fb ........... ........... ........... ........... ........... reaction. D7550 E Removal of sloughed ........... ........... ........... ........... ........... off bone. D7560 E Maxillary sinusotomy ........... ........... ........... ........... ........... D7610 E Maxilla open reduct ........... ........... ........... ........... ........... simple. D7620 E Clsd reduct simpl ........... ........... ........... ........... ........... maxilla fx. D7630 E Open red simpl ........... ........... ........... ........... ........... mandible fx. D7640 E Clsd red simpl ........... ........... ........... ........... ........... mandible fx. D7650 E Open red simp malar/ ........... ........... ........... ........... ........... zygom fx. D7660 E Clsd red simp malar/ ........... ........... ........... ........... ........... zygom fx. D7670 E Closd rductn splint ........... ........... ........... ........... ........... alveolus. D7680 E Reduct simple facial ........... ........... ........... ........... ........... bone fx. D7710 E Maxilla open reduct ........... ........... ........... ........... ........... compound. D7720 E Clsd reduct compd ........... ........... ........... ........... ........... maxilla fx. D7730 E Open reduct compd ........... ........... ........... ........... ........... mandble fx. D7740 E Clsd reduct compd ........... ........... ........... ........... ........... mandble fx. D7750 E Open red comp malar/ ........... ........... ........... ........... ........... zygma fx. D7760 E Clsd red comp malar/ ........... ........... ........... ........... ........... zygma fx. D7770 E Open reduc compd ........... ........... ........... ........... ........... alveolus fx. D7780 E Reduct compnd facial ........... ........... ........... ........... ........... bone fx. D7810 E Tmj open reduct- ........... ........... ........... ........... ........... dislocation. D7820 E Closed tmp ........... ........... ........... ........... ........... manipulation. D7830 E Tmj manipulation ........... ........... ........... ........... ........... under anest. D7840 E Removal of tmj ........... ........... ........... ........... ........... condyle. [[Page 60057]] D7850 E Tmj meniscectomy.... ........... ........... ........... ........... ........... D7852 E Tmj repair of joint ........... ........... ........... ........... ........... disc. D7854 E Tmj excisn of joint ........... ........... ........... ........... ........... membrane. D7856 E Tmj cutting of a ........... ........... ........... ........... ........... muscle. D7858 E Tmj reconstruction.. ........... ........... ........... ........... ........... D7860 E Tmj cutting into ........... ........... ........... ........... ........... joint. D7865 E Tmj reshaping ........... ........... ........... ........... ........... components. D7870 E Tmj aspiration joint ........... ........... ........... ........... ........... fluid. D7871 E Lysis + lavage w ........... ........... ........... ........... ........... catheters. D7872 E Tmj diagnostic ........... ........... ........... ........... ........... arthroscopy. D7873 E Tmj arthroscopy ........... ........... ........... ........... ........... lysis adhesn. D7874 E Tmj arthroscopy disc ........... ........... ........... ........... ........... reposit. D7875 E Tmj arthroscopy ........... ........... ........... ........... ........... synovectomy. D7876 E Tmj arthroscopy ........... ........... ........... ........... ........... discectomy. D7877 E Tmj arthroscopy ........... ........... ........... ........... ........... debridement. D7880 E Occlusal orthotic ........... ........... ........... ........... ........... appliance. D7899 E Tmj unspecified ........... ........... ........... ........... ........... therapy. D7910 E Dent sutur recent ........... ........... ........... ........... ........... wnd to 5cm. D7911 E Dental suture wound ........... ........... ........... ........... ........... to 5 cm. D7912 E Suture complicate ........... ........... ........... ........... ........... wnd > 5 cm. D7920 E Dental skin graft... ........... ........... ........... ........... ........... D7940 S Reshaping bone 0330 10.97 $558.42 ........... $111.68 orthognathic. D7941 E Bone cutting ramus ........... ........... ........... ........... ........... closed. D7943 E Cutting ramus open w/ ........... ........... ........... ........... ........... graft. D7944 E Bone cutting ........... ........... ........... ........... ........... segmented. D7945 E Bone cutting body ........... ........... ........... ........... ........... mandible. D7946 E Reconstruction ........... ........... ........... ........... ........... maxilla total. D7947 E Reconstruct maxilla ........... ........... ........... ........... ........... segment. D7948 E Reconstruct midface ........... ........... ........... ........... ........... no graft. D7949 E Reconstruct midface ........... ........... ........... ........... ........... w/graft. D7950 E Mandible graft...... ........... ........... ........... ........... ........... D7955 E Repair maxillofacial ........... ........... ........... ........... ........... defects. D7960 E Frenulectomy/ ........... ........... ........... ........... ........... frenulotomy. D7970 E Excision ........... ........... ........... ........... ........... hyperplastic tissue. D7971 E Excision pericoronal ........... ........... ........... ........... ........... gingiva. D7980 E Sialolithotomy...... ........... ........... ........... ........... ........... D7981 E Excision of salivary ........... ........... ........... ........... ........... gland. D7982 E Sialodochoplasty.... ........... ........... ........... ........... ........... D7983 E Closure of salivary ........... ........... ........... ........... ........... fistula. D7990 E Emergency ........... ........... ........... ........... ........... tracheotomy. D7991 E Dental ........... ........... ........... ........... ........... coronoidectomy. D7995 E Synthetic graft ........... ........... ........... ........... ........... facial bones. D7996 E Implant mandible for ........... ........... ........... ........... ........... augment. D7997 E Appliance removal... ........... ........... ........... ........... ........... D7999 E Oral surgery ........... ........... ........... ........... ........... procedure. D8010 E Limited dental tx ........... ........... ........... ........... ........... primary. D8020 E Limited dental tx ........... ........... ........... ........... ........... transition. D8030 E Limited dental tx ........... ........... ........... ........... ........... adolescent. D8040 E Limited dental tx ........... ........... ........... ........... ........... adult. D8050 E Intercep dental tx ........... ........... ........... ........... ........... primary. D8060 E Intercep dental tx ........... ........... ........... ........... ........... transitn. D8070 E Compre dental tx ........... ........... ........... ........... ........... transition. D8080 E Compre dental tx ........... ........... ........... ........... ........... adolescent. D8090 E Compre dental tx ........... ........... ........... ........... ........... adult. D8210 E Orthodontic rem ........... ........... ........... ........... ........... appliance tx. D8220 E Fixed appliance ........... ........... ........... ........... ........... therapy habt. D8660 E Preorthodontic tx ........... ........... ........... ........... ........... visit. D8670 E Periodic orthodontc ........... ........... ........... ........... ........... tx visit. D8680 E Orthodontic ........... ........... ........... ........... ........... retention. D8690 E Orthodontic ........... ........... ........... ........... ........... treatment. D8691 E Repair ortho ........... ........... ........... ........... ........... appliance. D8692 E Replacement retainer ........... ........... ........... ........... ........... D8999 E Orthodontic ........... ........... ........... ........... ........... procedure. D9110 N Tx dental pain minor ........... ........... ........... ........... ........... proc. D9210 E Dent anesthesia w/o ........... ........... ........... ........... ........... surgery. D9211 E Regional block ........... ........... ........... ........... ........... anesthesia. D9212 E Trigeminal block ........... ........... ........... ........... ........... anesthesia. D9215 E Local anesthesia.... ........... ........... ........... ........... ........... D9220 E General anesthesia.. ........... ........... ........... ........... ........... D9221 E General anesthesia ........... ........... ........... ........... ........... ea ad 15m. D9230 N Analgesia........... ........... ........... ........... ........... ........... D9241 E Intravenous sedation ........... ........... ........... ........... ........... D9242 E IV sedation ea ad 30 ........... ........... ........... ........... ........... m. D9248 N Sedation (non-iv)... ........... ........... ........... ........... ........... D9310 E Dental consultation. ........... ........... ........... ........... ........... [[Page 60058]] D9410 E Dental house call... ........... ........... ........... ........... ........... D9420 E Hospital call....... ........... ........... ........... ........... ........... D9430 E Office visit during ........... ........... ........... ........... ........... hours. D9440 E Office visit after ........... ........... ........... ........... ........... hours. D9610 E Dent therapeutic ........... ........... ........... ........... ........... drug inject. D9630 S Other drugs/ 0330 10.97 $558.42 ........... $111.68 medicaments. D9910 E Dent appl ........... ........... ........... ........... ........... desensitizing med. D9911 E Appl desensitizing ........... ........... ........... ........... ........... resin. D9920 E Behavior management. ........... ........... ........... ........... ........... D9930 S Treatment of 0330 10.97 $558.42 ........... $111.68 complications. D9940 S Dental occlusal 0330 10.97 $558.42 ........... $111.68 guard. D9941 E Fabrication athletic ........... ........... ........... ........... ........... guard. D9950 S Occlusion analysis.. 0330 10.97 $558.42 ........... $111.68 D9951 S Limited occlusal 0330 10.97 $558.42 ........... $111.68 adjustment. D9952 S Complete occlusal 0330 10.97 $558.42 ........... $111.68 adjustment. D9970 E Enamel microabrasion ........... ........... ........... ........... ........... D9971 E Odontoplasty 1-2 ........... ........... ........... ........... ........... teeth. D9972 E Extrnl bleaching per ........... ........... ........... ........... ........... arch. D9973 E Extrnl bleaching per ........... ........... ........... ........... ........... tooth. D9974 E Intrnl bleaching per ........... ........... ........... ........... ........... tooth. D9999 E Adjunctive procedure ........... ........... ........... ........... ........... E0100 A Cane adjust/fixed ........... ........... ........... ........... ........... with tip. E0105 A Cane adjust/fixed ........... ........... ........... ........... ........... quad/3 pro. E0110 A Crutch forearm pair. ........... ........... ........... ........... ........... E0111 A Crutch forearm each. ........... ........... ........... ........... ........... E0112 A Crutch underarm pair ........... ........... ........... ........... ........... wood. E0113 A Crutch underarm each ........... ........... ........... ........... ........... wood. E0114 A Crutch underarm pair ........... ........... ........... ........... ........... no wood. E0116 A Crutch underarm each ........... ........... ........... ........... ........... no wood. E0130 A Walker rigid adjust/ ........... ........... ........... ........... ........... fixed ht. E0135 A Walker folding ........... ........... ........... ........... ........... adjust/fixed. E0141 A Rigid walker wheeled ........... ........... ........... ........... ........... wo seat. E0142 A Walker rigid wheeled ........... ........... ........... ........... ........... with se. E0143 A Walker folding ........... ........... ........... ........... ........... wheeled w/o s. E0144 A Enclosed walker w ........... ........... ........... ........... ........... rear seat. E0145 A Walker whled seat/ ........... ........... ........... ........... ........... crutch att. E0146 A Folding walker ........... ........... ........... ........... ........... wheels w seat. E0147 A Walker variable ........... ........... ........... ........... ........... wheel resist. E0148 A Heavyduty walker no ........... ........... ........... ........... ........... wheels. E0149 A Heavy duty wheeled ........... ........... ........... ........... ........... walker. E0153 A Forearm crutch ........... ........... ........... ........... ........... platform atta. E0154 A Walker platform ........... ........... ........... ........... ........... attachment. E0155 A Walker wheel ........... ........... ........... ........... ........... attachment,pair. E0156 A Walker seat ........... ........... ........... ........... ........... attachment. E0157 A Walker crutch ........... ........... ........... ........... ........... attachment. E0158 A Walker leg extenders ........... ........... ........... ........... ........... set of4. E0159 A Brake for wheeled ........... ........... ........... ........... ........... walker. E0160 A Sitz type bath or ........... ........... ........... ........... ........... equipment. E0161 A Sitz bath/equipment ........... ........... ........... ........... ........... w/faucet. E0162 A Sitz bath chair..... ........... ........... ........... ........... ........... E0163 A Commode chair ........... ........... ........... ........... ........... stationry fxd. E0164 A Commode chair mobile ........... ........... ........... ........... ........... fixed a. E0165 A Commode chair ........... ........... ........... ........... ........... stationry det. E0166 A Commode chair mobile ........... ........... ........... ........... ........... detach. E0167 A Commode chair pail ........... ........... ........... ........... ........... or pan. E0168 A Heavyduty/wide ........... ........... ........... ........... ........... commode chair. *E0169 A Seatlift incorp ........... ........... ........... ........... ........... commodechair. E0175 A Commode chair foot ........... ........... ........... ........... ........... rest. E0176 A Air pressre pad/ ........... ........... ........... ........... ........... cushion nonp. E0177 A Water press pad/ ........... ........... ........... ........... ........... cushion nonp. E0178 A Gel pressre pad/ ........... ........... ........... ........... ........... cushion nonp. E0179 A Dry pressre pad/ ........... ........... ........... ........... ........... cushion nonp. E0180 A Press pad ........... ........... ........... ........... ........... alternating w pump. E0181 A Press pad ........... ........... ........... ........... ........... alternating w/ pum. E0182 A Pressure pad ........... ........... ........... ........... ........... alternating pum. E0184 A Dry pressure ........... ........... ........... ........... ........... mattress. E0185 A Gel pressure ........... ........... ........... ........... ........... mattress pad. E0186 A Air pressure ........... ........... ........... ........... ........... mattress. E0187 A Water pressure ........... ........... ........... ........... ........... mattress. E0188 E Synthetic sheepskin ........... ........... ........... ........... ........... pad. E0189 E Lambswool sheepskin ........... ........... ........... ........... ........... pad. E0191 A Protector heel or ........... ........... ........... ........... ........... elbow. E0192 A Pad wheelchr low ........... ........... ........... ........... ........... press/posit. E0193 A Powered air ........... ........... ........... ........... ........... flotation bed. E0194 A Air fluidized bed... ........... ........... ........... ........... ........... [[Page 60059]] E0196 A Gel pressure ........... ........... ........... ........... ........... mattress. E0197 A Air pressure pad for ........... ........... ........... ........... ........... mattres. E0198 A Water pressure pad ........... ........... ........... ........... ........... for mattr. E0199 A Dry pressure pad for ........... ........... ........... ........... ........... mattres. E0200 A Heat lamp without ........... ........... ........... ........... ........... stand. E0202 A Phototherapy light w/ ........... ........... ........... ........... ........... photom. E0205 A Heat lamp with stand ........... ........... ........... ........... ........... E0210 A Electric heat pad ........... ........... ........... ........... ........... standard. E0215 A Electric heat pad ........... ........... ........... ........... ........... moist. E0217 A Water circ heat pad ........... ........... ........... ........... ........... w pump. E0218 E Water circ cold pad ........... ........... ........... ........... ........... w pump. E0220 A Hot water bottle.... ........... ........... ........... ........... ........... *E0221 A Infrared heating pad ........... ........... ........... ........... ........... system. E0225 A Hydrocollator unit.. ........... ........... ........... ........... ........... E0230 A Ice cap or collar... ........... ........... ........... ........... ........... *E0231 A Wound warming device ........... ........... ........... ........... ........... *E0232 A Warming card for NWT ........... ........... ........... ........... ........... E0235 A Paraffin bath unit ........... ........... ........... ........... ........... portable. E0236 A Pump for water ........... ........... ........... ........... ........... circulating p. E0238 A Heat pad non- ........... ........... ........... ........... ........... electric moist. E0239 A Hydrocollator unit ........... ........... ........... ........... ........... portable. E0241 E Bath tub wall rail.. ........... ........... ........... ........... ........... E0242 E Bath tub rail floor. ........... ........... ........... ........... ........... E0243 E Toilet rail......... ........... ........... ........... ........... ........... E0244 E Toilet seat raised.. ........... ........... ........... ........... ........... E0245 E Tub stool or bench.. ........... ........... ........... ........... ........... E0246 E Transfer tub rail ........... ........... ........... ........... ........... attachment. E0249 A Pad water ........... ........... ........... ........... ........... circulating heat u. E0250 A Hosp bed fixed ht w/ ........... ........... ........... ........... ........... mattres. E0251 A Hosp bed fixd ht w/o ........... ........... ........... ........... ........... mattres. E0255 A Hospital bed var ht ........... ........... ........... ........... ........... w/ mattr. E0256 A Hospital bed var ht ........... ........... ........... ........... ........... w/o matt. E0260 A Hosp bed semi-electr ........... ........... ........... ........... ........... w/ matt. E0261 A Hosp bed semi-electr ........... ........... ........... ........... ........... w/o mat. E0265 A Hosp bed total ........... ........... ........... ........... ........... electr w/ mat. E0266 A Hosp bed total elec ........... ........... ........... ........... ........... w/o matt. E0270 E Hospital bed ........... ........... ........... ........... ........... institutional t. E0271 A Mattress innerspring ........... ........... ........... ........... ........... E0272 A Mattress foam rubber ........... ........... ........... ........... ........... E0273 E Bed board........... ........... ........... ........... ........... ........... E0274 E Over-bed table...... ........... ........... ........... ........... ........... E0275 A Bed pan standard.... ........... ........... ........... ........... ........... E0276 A Bed pan fracture.... ........... ........... ........... ........... ........... E0277 A Powered pres-redu ........... ........... ........... ........... ........... air mattrs. E0280 A Bed cradle.......... ........... ........... ........... ........... ........... E0290 A Hosp bed fx ht w/o ........... ........... ........... ........... ........... rails w/m. E0291 A Hosp bed fx ht w/o ........... ........... ........... ........... ........... rail w/o. E0292 A Hosp bed var ht w/o ........... ........... ........... ........... ........... rail w/o. E0293 A Hosp bed var ht w/o ........... ........... ........... ........... ........... rail w/. E0294 A Hosp bed semi-elect ........... ........... ........... ........... ........... w/ mattr. E0295 A Hosp bed semi-elect ........... ........... ........... ........... ........... w/o matt. E0296 A Hosp bed total elect ........... ........... ........... ........... ........... w/ matt. E0297 A Hosp bed total elect ........... ........... ........... ........... ........... w/o mat. E0298 D Heavyduty/xtra wide ........... ........... ........... ........... ........... hosp bed. E0305 A Rails bed side half ........... ........... ........... ........... ........... length. E0310 A Rails bed side full ........... ........... ........... ........... ........... length. E0315 E Bed accessory brd/ ........... ........... ........... ........... ........... tbl/supprt. *E0316 A Bed safety enclosure ........... ........... ........... ........... ........... E0325 A Urinal male jug-type ........... ........... ........... ........... ........... E0326 A Urinal female jug- ........... ........... ........... ........... ........... type. E0350 E Control unit bowel ........... ........... ........... ........... ........... system. E0352 E Disposable pack w/ ........... ........... ........... ........... ........... bowel syst. E0370 E Air elevator for ........... ........... ........... ........... ........... heel. E0371 A Nonpower mattress ........... ........... ........... ........... ........... overlay. E0372 A Powered air mattress ........... ........... ........... ........... ........... overlay. E0373 A Nonpowered pressure ........... ........... ........... ........... ........... mattress. E0424 A Stationary ........... ........... ........... ........... ........... compressed gas 02. E0425 E Gas system ........... ........... ........... ........... ........... stationary compre. E0430 E Oxygen system gas ........... ........... ........... ........... ........... portable. E0431 A Portable gaseous 02. ........... ........... ........... ........... ........... E0434 A Portable liquid 02.. ........... ........... ........... ........... ........... E0435 E Oxygen system liquid ........... ........... ........... ........... ........... portabl. E0439 A Stationary liquid 02 ........... ........... ........... ........... ........... E0440 E Oxygen system liquid ........... ........... ........... ........... ........... station. E0441 A Oxygen contents, ........... ........... ........... ........... ........... gaseous. [[Page 60060]] E0442 A Oxygen contents, ........... ........... ........... ........... ........... liquid. E0443 A Portable 02 ........... ........... ........... ........... ........... contents, gas. E0444 A Portable 02 ........... ........... ........... ........... ........... contents, liquid. E0450 A Volume vent ........... ........... ........... ........... ........... stationary/porta. E0455 A Oxygen tent excl ........... ........... ........... ........... ........... croup/ped t. E0457 A Chest shell......... ........... ........... ........... ........... ........... E0459 A Chest wrap.......... ........... ........... ........... ........... ........... E0460 A Neg press vent ........... ........... ........... ........... ........... portabl/statn. E0462 A Rocking bed w/ or w/ ........... ........... ........... ........... ........... o side r. E0480 A Percussor elect/ ........... ........... ........... ........... ........... pneum home m. *E0481 A Intrpulmnry percuss ........... ........... ........... ........... ........... vent sys. *E0482 A Cough stimulating ........... ........... ........... ........... ........... device. E0500 A Ippb all types...... ........... ........... ........... ........... ........... E0550 A Humidif extens ........... ........... ........... ........... ........... supple w ippb. E0555 A Humidifier for use w/ ........... ........... ........... ........... ........... regula. E0560 A Humidifier ........... ........... ........... ........... ........... supplemental w/ i. E0565 A Compressor air power ........... ........... ........... ........... ........... source. E0570 A Nebulizer with ........... ........... ........... ........... ........... compression. E0571 A Aerosol compressor ........... ........... ........... ........... ........... for svneb. E0572 A Aerosol compressor ........... ........... ........... ........... ........... adjust pr. E0574 A Ultrasonic generator ........... ........... ........... ........... ........... w svneb. E0575 A Nebulizer ultrasonic ........... ........... ........... ........... ........... E0580 A Nebulizer for use w/ ........... ........... ........... ........... ........... regulat. E0585 A Nebulizer w/ ........... ........... ........... ........... ........... compressor & he. E0590 A Dispensing fee dme ........... ........... ........... ........... ........... neb drug. E0600 A Suction pump portab ........... ........... ........... ........... ........... hom modl. E0601 A Cont airway pressure ........... ........... ........... ........... ........... device. E0602 E Breast pump......... ........... ........... ........... ........... ........... *E0603 A Electric breast pump ........... ........... ........... ........... ........... *E0604 A Hosp grade elec ........... ........... ........... ........... ........... breast pump. E0605 A Vaporizer room type. ........... ........... ........... ........... ........... E0606 A Drainage board ........... ........... ........... ........... ........... postural. E0607 A Blood glucose ........... ........... ........... ........... ........... monitor home. E0608 A Apnea monitor....... ........... ........... ........... ........... ........... E0609 D Blood gluc mon w/ ........... ........... ........... ........... ........... special fea. E0610 A Pacemaker monitr ........... ........... ........... ........... ........... audible/vis. E0615 A Pacemaker monitr ........... ........... ........... ........... ........... digital/vis. E0616 N Cardiac event ........... ........... ........... ........... ........... recorder. E0617 A Automatic ext ........... ........... ........... ........... ........... defibrillator. *E0620 A Cap bld skin ........... ........... ........... ........... ........... piercing laser. E0621 A Patient lift sling ........... ........... ........... ........... ........... or seat. E0625 E Patient lift ........... ........... ........... ........... ........... bathroom or toi. E0627 A Seat lift incorp ........... ........... ........... ........... ........... lift-chair. E0628 A Seat lift for pt ........... ........... ........... ........... ........... furn-electr. E0629 A Seat lift for pt ........... ........... ........... ........... ........... furn-non-el. E0630 A Patient lift ........... ........... ........... ........... ........... hydraulic. E0635 A Patient lift ........... ........... ........... ........... ........... electric. E0650 A Pneuma compresor non- ........... ........... ........... ........... ........... segment. E0651 A Pneum compressor ........... ........... ........... ........... ........... segmental. E0652 A Pneum compres w/cal ........... ........... ........... ........... ........... pressure. E0655 A Pneumatic appliance ........... ........... ........... ........... ........... half arm. E0660 A Pneumatic appliance ........... ........... ........... ........... ........... full leg. E0665 A Pneumatic appliance ........... ........... ........... ........... ........... full arm. E0666 A Pneumatic appliance ........... ........... ........... ........... ........... half leg. E0667 A Seg pneumatic appl ........... ........... ........... ........... ........... full leg. E0668 A Seg pneumatic appl ........... ........... ........... ........... ........... full arm. E0669 A Seg pneumatic appli ........... ........... ........... ........... ........... half leg. E0671 A Pressure pneum appl ........... ........... ........... ........... ........... full leg. E0672 A Pressure pneum appl ........... ........... ........... ........... ........... full arm. E0673 A Pressure pneum appl ........... ........... ........... ........... ........... half leg. E0690 A Ultraviolet cabinet. ........... ........... ........... ........... ........... E0700 E Safety equipment.... ........... ........... ........... ........... ........... E0710 E Restraints any type. ........... ........... ........... ........... ........... E0720 A Tens two lead....... ........... ........... ........... ........... ........... E0730 A Tens four lead...... ........... ........... ........... ........... ........... E0731 A Conductive garment ........... ........... ........... ........... ........... for tens/. E0740 E Incontinence ........... ........... ........... ........... ........... treatment systm. E0744 A Neuromuscular stim ........... ........... ........... ........... ........... for scoli. E0745 A Neuromuscular stim ........... ........... ........... ........... ........... for shock. E0746 E Electromyograph ........... ........... ........... ........... ........... biofeedback. E0747 A Elec osteogen stim ........... ........... ........... ........... ........... not spine. E0748 A Elec osteogen stim ........... ........... ........... ........... ........... spinal. E0749 N Elec osteogen stim ........... ........... ........... ........... ........... implanted. *E0752 E Neurostimulator ........... ........... ........... ........... ........... electrode. E0753 D Neurostimulator ........... ........... ........... ........... ........... electrodes. [[Page 60061]] *E0754 A Pulsegenerator pt ........... ........... ........... ........... ........... programmer. E0755 E Electronic salivary ........... ........... ........... ........... ........... reflex s. E0756 E Implantable pulse ........... ........... ........... ........... ........... generator. E0757 E Implantable RF ........... ........... ........... ........... ........... receiver. E0758 A External RF ........... ........... ........... ........... ........... transmitter. *E0759 A Replace rdfrquncy ........... ........... ........... ........... ........... transmittr. E0760 E Osteogen ultrasound ........... ........... ........... ........... ........... stimltor. E0765 E Nerve stimulator for ........... ........... ........... ........... ........... tx n&v. E0776 A Iv pole............. ........... ........... ........... ........... ........... E0779 A Amb infusion pump ........... ........... ........... ........... ........... mechanical. E0780 A Mech amb infusion ........... ........... ........... ........... ........... pump 8hrs. E0781 A External ambulatory ........... ........... ........... ........... ........... infus pu. E0782 E Non-programble ........... ........... ........... ........... ........... infusion pump. E0783 E Programmable ........... ........... ........... ........... ........... infusion pump. E0784 A Ext amb infusn pump ........... ........... ........... ........... ........... insulin. E0785 E Replacement impl ........... ........... ........... ........... ........... pump cathet. E0786 E Implantable pump ........... ........... ........... ........... ........... replacement. E0791 A Parenteral infusion ........... ........... ........... ........... ........... pump sta. E0830 N Ambulatory traction ........... ........... ........... ........... ........... device. E0840 A Tract frame attach ........... ........... ........... ........... ........... headboard. E0850 A Traction stand free ........... ........... ........... ........... ........... standing. E0855 A Cervical traction ........... ........... ........... ........... ........... equipment. E0860 A Tract equip cervical ........... ........... ........... ........... ........... tract. E0870 A Tract frame attach ........... ........... ........... ........... ........... footboard. E0880 A Trac stand free ........... ........... ........... ........... ........... stand extrem. E0890 A Traction frame ........... ........... ........... ........... ........... attach pelvic. E0900 A Trac stand free ........... ........... ........... ........... ........... stand pelvic. E0910 A Trapeze bar attached ........... ........... ........... ........... ........... to bed. E0920 A Fracture frame ........... ........... ........... ........... ........... attached to b. E0930 A Fracture frame free ........... ........... ........... ........... ........... standing. E0935 A Exercise device ........... ........... ........... ........... ........... passive moti. E0940 A Trapeze bar free ........... ........... ........... ........... ........... standing. E0941 A Gravity assisted ........... ........... ........... ........... ........... traction de. E0942 A Cervical head ........... ........... ........... ........... ........... harness/halter. E0943 A Cervical pillow..... ........... ........... ........... ........... ........... E0944 A Pelvic belt/harness/ ........... ........... ........... ........... ........... boot. E0945 A Belt/harness ........... ........... ........... ........... ........... extremity. E0946 A Fracture frame dual ........... ........... ........... ........... ........... w cross. E0947 A Fracture frame ........... ........... ........... ........... ........... attachmnts pe. E0948 A Fracture frame ........... ........... ........... ........... ........... attachmnts ce. E0950 E Tray................ ........... ........... ........... ........... ........... E0951 E Loop heel........... ........... ........... ........... ........... ........... E0952 E Loop tie............ ........... ........... ........... ........... ........... E0953 E Pneumatic tire...... ........... ........... ........... ........... ........... E0954 E Wheelchair semi- ........... ........... ........... ........... ........... pneumatic ca. E0958 A Whlchr att- conv 1 ........... ........... ........... ........... ........... arm drive. E0959 E Amputee adapter..... ........... ........... ........... ........... ........... E0961 E Wheelchair brake ........... ........... ........... ........... ........... extension. E0962 A Wheelchair 1 inch ........... ........... ........... ........... ........... cushion. E0963 A Wheelchair 2 inch ........... ........... ........... ........... ........... cushion. E0964 A Wheelchair 3 inch ........... ........... ........... ........... ........... cushion. E0965 A Wheelchair 4 inch ........... ........... ........... ........... ........... cushion. E0966 E Wheelchair head rest ........... ........... ........... ........... ........... extensi. E0967 E Wheelchair hand rims ........... ........... ........... ........... ........... E0968 A Wheelchair commode ........... ........... ........... ........... ........... seat. E0969 E Wheelchair narrowing ........... ........... ........... ........... ........... device. E0970 E Wheelchair no. 2 ........... ........... ........... ........... ........... footplates. E0971 E Wheelchair anti- ........... ........... ........... ........... ........... tipping devi. E0972 A Transfer board or ........... ........... ........... ........... ........... device. E0973 E Wheelchair adjustabl ........... ........... ........... ........... ........... height. E0974 E Wheelchair grade-aid ........... ........... ........... ........... ........... E0975 E Wheelchair ........... ........... ........... ........... ........... reinforced seat u. E0976 E Wheelchair ........... ........... ........... ........... ........... reinforced back u. E0977 E Wheelchair wedge ........... ........... ........... ........... ........... cushion. E0978 E Wheelchair belt w/ ........... ........... ........... ........... ........... airplane b. E0979 E Wheelchair belt with ........... ........... ........... ........... ........... velcro. E0980 E Wheelchair safety ........... ........... ........... ........... ........... vest. E0990 E Whellchair elevating ........... ........... ........... ........... ........... leg res. E0991 E Wheelchair upholstry ........... ........... ........... ........... ........... seat. E0992 E Wheelchair solid ........... ........... ........... ........... ........... seat insert. E0993 E Wheelchair back ........... ........... ........... ........... ........... upholstery. E0994 E Wheelchair arm rest. ........... ........... ........... ........... ........... E0995 E Wheelchair calf rest ........... ........... ........... ........... ........... E0996 E Wheelchair tire ........... ........... ........... ........... ........... solid. E0997 E Wheelchair caster w/ ........... ........... ........... ........... ........... a fork. [[Page 60062]] E0998 E Wheelchair caster w/ ........... ........... ........... ........... ........... o a fork. E0999 E Wheelchr pneumatic ........... ........... ........... ........... ........... tire w/wh. E1000 E Wheelchair tire ........... ........... ........... ........... ........... pneumatic ca. E1001 E Wheelchair wheel.... ........... ........... ........... ........... ........... E1031 A Rollabout chair with ........... ........... ........... ........... ........... casters. E1035 E Patient transfer ........... ........... ........... ........... ........... system. E1050 A Whelchr fxd full ........... ........... ........... ........... ........... length arms. E1060 A Wheelchair ........... ........... ........... ........... ........... detachable arms. E1065 E Wheelchair power ........... ........... ........... ........... ........... attachment. E1066 E Wheelchair battery ........... ........... ........... ........... ........... charger. E1069 E Wheelchair deep ........... ........... ........... ........... ........... cycle batter. E1070 A Wheelchair ........... ........... ........... ........... ........... detachable foot r. E1083 A Hemi-wheelchair ........... ........... ........... ........... ........... fixed arms. E1084 A Hemi-wheelchair ........... ........... ........... ........... ........... detachable a. E1085 A Hemi-wheelchair ........... ........... ........... ........... ........... fixed arms. E1086 A Hemi-wheelchair ........... ........... ........... ........... ........... detachable a. E1087 A Wheelchair lightwt ........... ........... ........... ........... ........... fixed arm. E1088 A Wheelchair ........... ........... ........... ........... ........... lightweight det a. E1089 A Wheelchair lightwt ........... ........... ........... ........... ........... fixed arm. E1090 A Wheelchair ........... ........... ........... ........... ........... lightweight det a. E1091 A Wheelchair youth.... ........... ........... ........... ........... ........... E1092 A Wheelchair wide w/ ........... ........... ........... ........... ........... leg rests. E1093 A Wheelchair wide w/ ........... ........... ........... ........... ........... foot rest. E1100 A Whchr s-recl fxd arm ........... ........... ........... ........... ........... leg res. E1110 A Wheelchair semi-recl ........... ........... ........... ........... ........... detach. E1130 A Whlchr stand fxd arm ........... ........... ........... ........... ........... ft rest. E1140 A Wheelchair standard ........... ........... ........... ........... ........... detach a. E1150 A Wheelchair standard ........... ........... ........... ........... ........... w/ leg r. E1160 A Wheelchair fixed ........... ........... ........... ........... ........... arms. E1170 A Whlchr ampu fxd arm ........... ........... ........... ........... ........... leg rest. E1171 A Wheelchair amputee w/ ........... ........... ........... ........... ........... o leg r. E1172 A Wheelchair amputee ........... ........... ........... ........... ........... detach ar. E1180 A Wheelchair amputee w/ ........... ........... ........... ........... ........... foot r. E1190 A Wheelchair amputee w/ ........... ........... ........... ........... ........... leg re. E1195 A Wheelchair amputee ........... ........... ........... ........... ........... heavy dut. E1200 A Wheelchair amputee ........... ........... ........... ........... ........... fixed arm. E1210 A Whlchr moto ful arm ........... ........... ........... ........... ........... leg rest. E1211 A Wheelchair motorized ........... ........... ........... ........... ........... w/ det. E1212 A Wheelchair motorized ........... ........... ........... ........... ........... w full. E1213 A Wheelchair motorized ........... ........... ........... ........... ........... w/ det. E1220 A Whlchr special size/ ........... ........... ........... ........... ........... constrc. E1221 A Wheelchair spec size ........... ........... ........... ........... ........... w foot. E1222 A Wheelchair spec size ........... ........... ........... ........... ........... w/ leg. E1223 A Wheelchair spec size ........... ........... ........... ........... ........... w foot. E1224 A Wheelchair spec size ........... ........... ........... ........... ........... w/ leg. E1225 A Wheelchair spec sz ........... ........... ........... ........... ........... semi-recl. E1226 E Wheelchair spec sz ........... ........... ........... ........... ........... full-recl. E1227 E Wheelchair spec sz ........... ........... ........... ........... ........... spec ht a. E1228 A Wheelchair spec sz ........... ........... ........... ........... ........... spec ht b. E1230 A Power operated ........... ........... ........... ........... ........... vehicle. E1240 A Whchr litwt det arm ........... ........... ........... ........... ........... leg rest. E1250 A Wheelchair lightwt ........... ........... ........... ........... ........... fixed arm. E1260 A Wheelchair lightwt ........... ........... ........... ........... ........... foot rest. E1270 A Wheelchair ........... ........... ........... ........... ........... lightweight leg r. E1280 A Whchr h-duty det arm ........... ........... ........... ........... ........... leg res. E1285 A Wheelchair heavy ........... ........... ........... ........... ........... duty fixed. E1290 A Wheelchair hvy duty ........... ........... ........... ........... ........... detach a. E1295 A Wheelchair heavy ........... ........... ........... ........... ........... duty fixed. E1296 A Wheelchair special ........... ........... ........... ........... ........... seat heig. E1297 A Wheelchair special ........... ........... ........... ........... ........... seat dept. E1298 A Wheelchair spec seat ........... ........... ........... ........... ........... depth/w. E1300 E Whirlpool portable.. ........... ........... ........... ........... ........... E1310 A Whirlpool non- ........... ........... ........... ........... ........... portable. E1340 A Repair for DME, per ........... ........... ........... ........... ........... 15 min. E1353 A Oxygen supplies ........... ........... ........... ........... ........... regulator. E1355 A Oxygen supplies ........... ........... ........... ........... ........... stand/rack. E1372 A Oxy suppl heater for ........... ........... ........... ........... ........... nebuliz. E1390 A Oxygen concentrator. ........... ........... ........... ........... ........... E1399 A Durable medical ........... ........... ........... ........... ........... equipment mi. E1405 A O2/water vapor ........... ........... ........... ........... ........... enrich w/heat. E1406 A O2/water vapor ........... ........... ........... ........... ........... enrich w/o he. *E1500 A Centrifuge.......... ........... ........... ........... ........... ........... E1510 A Kidney dialysate ........... ........... ........... ........... ........... delivry sys. E1520 A Heparin infusion ........... ........... ........... ........... ........... pump for di. E1530 A Air bubble detector ........... ........... ........... ........... ........... for dial. [[Page 60063]] E1540 A Pressure alarm for ........... ........... ........... ........... ........... dialysis. E1550 A Bath conductivity ........... ........... ........... ........... ........... meter. E1560 A Blood leak detector ........... ........... ........... ........... ........... for dial. E1570 A Adjustable chair for ........... ........... ........... ........... ........... esrd pt. E1575 A Transducer protector/ ........... ........... ........... ........... ........... fluid b. E1580 A Unipuncture control ........... ........... ........... ........... ........... system. E1590 A Hemodialysis machine ........... ........... ........... ........... ........... E1592 A Auto interm ........... ........... ........... ........... ........... peritoneal dialy. E1594 A Cycler dialysis ........... ........... ........... ........... ........... machine. E1600 A Deliv/install equip ........... ........... ........... ........... ........... for dial. E1610 A Reverse osmosis ........... ........... ........... ........... ........... water purifi. E1615 A Deionizer water ........... ........... ........... ........... ........... purification. E1620 A Blood pump for ........... ........... ........... ........... ........... dialysis. E1625 A Water softening ........... ........... ........... ........... ........... system. E1630 A Reciprocating ........... ........... ........... ........... ........... peritoneal dia. E1632 A Wearable artificial ........... ........... ........... ........... ........... kidney. E1635 A Compact travel ........... ........... ........... ........... ........... hemodialyzer. E1636 A Sorbent cartridges ........... ........... ........... ........... ........... for dialy. *E1637 A Hemostats for ........... ........... ........... ........... ........... dialysis, each. *E1638 A Peri dialysis ........... ........... ........... ........... ........... heating pad. *E1639 A Dialysis scale...... ........... ........... ........... ........... ........... E1640 D Replacement ........... ........... ........... ........... ........... components for d. E1699 A Dialysis equipment ........... ........... ........... ........... ........... unspecifi. E1700 A Jaw motion rehab ........... ........... ........... ........... ........... system. E1701 A Repl cushions for ........... ........... ........... ........... ........... jaw motion. E1702 A Repl measr scales ........... ........... ........... ........... ........... jaw motion. E1800 A Adjust elbow ext/ ........... ........... ........... ........... ........... flex device. *E1801 A SPS elbow device.... ........... ........... ........... ........... ........... E1805 A Adjust wrist ext/ ........... ........... ........... ........... ........... flex device. *E1806 A SPS wrist device.... ........... ........... ........... ........... ........... E1810 A Adjust knee ext/flex ........... ........... ........... ........... ........... device. *E1811 A SPS knee device..... ........... ........... ........... ........... ........... E1815 A Adjust ankle ext/ ........... ........... ........... ........... ........... flex device. *E1816 A SPS ankle device.... ........... ........... ........... ........... ........... *E1818 A SPS forearm device.. ........... ........... ........... ........... ........... E1820 A Soft interface ........... ........... ........... ........... ........... material. *E1821 A Replacement ........... ........... ........... ........... ........... interface SPSD. E1825 A Adjust finger ext/ ........... ........... ........... ........... ........... flex devc. E1830 A Adjust toe ext/flex ........... ........... ........... ........... ........... device. *E1840 A Adj shoulder ext/ ........... ........... ........... ........... ........... flex device. E1900 D Speech communication ........... ........... ........... ........... ........... device. *E1902 A AAC non-electronic ........... ........... ........... ........... ........... board. *E2000 A Gastric suction pump ........... ........... ........... ........... ........... hme mdl. *E2100 A Bld glucose monitor ........... ........... ........... ........... ........... w voice. *E2101 A Bld glucose monitor ........... ........... ........... ........... ........... w lance. G0001 A Drawing blood for ........... ........... ........... ........... ........... specimen. G0002 N Temporary urinary ........... ........... ........... ........... ........... catheter. G0004 E ECG transm phys ........... ........... ........... ........... ........... review & int. G0005 X ECG 24 hour 0097 0.84 $42.76 $23.51 $8.55 recording. G0006 X ECG transmission & 0097 0.84 $42.76 $23.51 $8.55 analysis. G0007 N ECG phy review & ........... ........... ........... ........... ........... interpret. G0008 K Admin influenza 0354 0.10 $5.09 ........... ........... virus vac. G0009 K Admin pneumococcal 0354 0.10 $5.09 ........... ........... vaccine. G0010 N Admin hepatitis b ........... ........... ........... ........... ........... vaccine. G0015 X Post symptom ECG 0097 0.84 $42.76 $23.51 $8.55 tracing. G0016 D Post symptom ECG md ........... ........... ........... ........... ........... review. G0025 N Collagen skin test ........... ........... ........... ........... ........... kit. G0026 A Fecal leukocyte ........... ........... ........... ........... ........... examination. G0027 A Semen analysis...... ........... ........... ........... ........... ........... G0030 S PET imaging prev PET 0285 18.72 $952.92 $415.21 $190.58 single. G0031 S PET imaging prev PET 0285 18.72 $952.92 $415.21 $190.58 multple. G0032 S PET follow SPECT 0285 18.72 $952.92 $415.21 $190.58 78464 singl. G0033 S PET follow SPECT 0285 18.72 $952.92 $415.21 $190.58 78464 mult. G0034 S PET follow SPECT 0285 18.72 $952.92 $415.21 $190.58 76865 singl. G0035 S PET follow SPECT 0285 18.72 $952.92 $415.21 $190.58 78465 mult. G0036 S PET follow cornry 0285 18.72 $952.92 $415.21 $190.58 angio sing. G0037 S PET follow cornry 0285 18.72 $952.92 $415.21 $190.58 angio mult. G0038 S PET follow myocard 0285 18.72 $952.92 $415.21 $190.58 perf sing. G0039 S PET follow myocard 0285 18.72 $952.92 $415.21 $190.58 perf mult. G0040 S PET follow stress 0285 18.72 $952.92 $415.21 $190.58 echo singl. G0041 S PET follow stress 0285 18.72 $952.92 $415.21 $190.58 echo mult. G0042 S PET follow 0285 18.72 $952.92 $415.21 $190.58 ventriculogm sing. G0043 S PET follow 0285 18.72 $952.92 $415.21 $190.58 ventriculogm mult. G0044 S PET following rest 0285 18.72 $952.92 $415.21 $190.58 ECG singl. G0045 S PET following rest 0285 18.72 $952.92 $415.21 $190.58 ECG mult. [[Page 60064]] G0046 S PET follow stress 0285 18.72 $952.92 $415.21 $190.58 ECG singl. G0047 S PET follow stress 0285 18.72 $952.92 $415.21 $190.58 ECG mult. G0050 S Residual urine by 0265 0.95 $48.36 $26.59 $9.67 ultrasound. G0101 V CA screen;pelvic/ 0600 0.86 $43.78 ........... $8.76 breast exam. G0102 N Prostate ca ........... ........... ........... ........... ........... screening; dre. G0103 A Psa, total screening ........... ........... ........... ........... ........... G0104 S CA screen;flexi 0159 2.33 $118.61 $29.65 $23.72 sigmoidscope. G0105 T Colorectal scrn; hi 0158 6.55 $333.42 $83.36 $66.68 risk ind. G0106 S Colon CA 0157 1.98 $100.79 $22.19 $20.16 screen;barium enema. G0107 A CA screen; fecal ........... ........... ........... ........... ........... blood test. G0108 A Diab manage trn per ........... ........... ........... ........... ........... indiv. G0109 A Diab manage trn ind/ ........... ........... ........... ........... ........... group. G0110 A Nett pulm-rehab ........... ........... ........... ........... ........... educ; ind. G0111 A Nett pulm-rehab ........... ........... ........... ........... ........... educ; group. G0112 A Nett;nutrition guid, ........... ........... ........... ........... ........... initial. G0113 A Nett;nutrition ........... ........... ........... ........... ........... guid,subseqnt. G0114 A Nett; psychosocial ........... ........... ........... ........... ........... consult. G0115 A Nett; psychological ........... ........... ........... ........... ........... testing. G0116 A Nett; psychosocial ........... ........... ........... ........... ........... counsel. *G0117 S Glaucoma scrn hgh 0230 0.61 $31.05 $14.28 $6.21 risk direc. *G0118 S Glaucoma scrn hgh 0230 0.61 $31.05 $14.28 $6.21 risk direc. G0120 S Colon ca scrn; 0157 1.98 $100.79 $22.19 $20.16 barium enema. G0121 T Colon ca scrn not hi 0158 6.55 $333.42 $83.36 $66.68 rsk ind. G0122 E Colon ca scrn; ........... ........... ........... ........... ........... barium enema. G0123 A Screen cerv/vag thin ........... ........... ........... ........... ........... layer. G0124 A Screen c/v thin ........... ........... ........... ........... ........... layer by MD. G0125 T PET image pulmonary 0976 ........... $875.00 ........... $175.00 nodule. G0126 D Lung image (PET) ........... ........... ........... ........... ........... staging. G0127 T Trim nail(s)........ 0009 0.63 $32.07 $8.34 $6.41 G0128 E CORF skilled nursing ........... ........... ........... ........... ........... service. G0129 P Partial hosp prog 0033 4.17 $212.27 $48.17 $42.45 service. G0130 X Single energy x-ray 0261 1.21 $61.59 $33.87 $12.32 study. G0131 S CT scan, bone 0288 1.17 $59.56 $32.75 $11.91 density study. G0132 S CT scan, bone 0288 1.17 $59.56 $32.75 $11.91 density study. G0141 E Scr c/v cyto,autosys ........... ........... ........... ........... ........... and md. G0143 A Scr c/v ........... ........... ........... ........... ........... cyto,thinlayer,resc r. G0144 A Scr c/v ........... ........... ........... ........... ........... cyto,thinlayer,resc r. G0145 A Scr c/v ........... ........... ........... ........... ........... cyto,thinlayer,resc r. G0147 A Scr c/v cyto, ........... ........... ........... ........... ........... automated sys. G0148 A Scr c/v cyto, ........... ........... ........... ........... ........... autosys, rescr. G0151 E HHCP-serv of pt,ea ........... ........... ........... ........... ........... 15 min. G0152 E HHCP-serv of ot,ea ........... ........... ........... ........... ........... 15 min. G0153 E HHCP-svs of s/l ........... ........... ........... ........... ........... path,ea 15mn. G0154 E HHCP-svs of rn,ea 15 ........... ........... ........... ........... ........... min. G0155 E HHCP-svs of csw,ea ........... ........... ........... ........... ........... 15 min. G0156 E HHCP-svs of aide,ea ........... ........... ........... ........... ........... 15 min. G0163 D Pet for rec of ........... ........... ........... ........... ........... colorectal ca. G0164 D Pet for lymphoma ........... ........... ........... ........... ........... staging. G0165 D Pet,rec of melanoma/ ........... ........... ........... ........... ........... met ca. G0166 T Extrnl counterpulse, 0972 ........... $150.00 ........... $30.00 per tx. G0167 E Hyperbaric oz tx;no ........... ........... ........... ........... ........... md reqrd. G0168 T Wound closure by 0970 ........... $25.00 ........... $5.00 adhesive. G0173 S Stereo 0721 ........... $5,500.00 ........... $1,100.00 radoisurgery,comple te. G0174 D Intensitymodulatedra ........... ........... ........... ........... ........... diation. G0175 V OPPS Service,sched 0602 1.38 $70.25 ........... $14.05 team conf. G0176 P OPPS/PHP;activity 0033 4.17 $212.27 $48.17 $42.45 therapy. G0177 P OPPS/PHP; train & 0033 4.17 $212.27 $48.17 $42.45 educ serv. G0178 D Intensitymodulatedra ........... ........... ........... ........... ........... diation. G0179 E MD recertification ........... ........... ........... ........... ........... HHA PT. G0180 E MD certification HHA ........... ........... ........... ........... ........... patient. G0181 E Home health care ........... ........... ........... ........... ........... supervision. G0182 E Hospice care ........... ........... ........... ........... ........... supervision. G0184 D Ocular photdynamicTx 0235 5.57 $283.54 $78.91 $56.71 2nd eye. G0185 T Transpuppillary 0235 5.57 $283.54 $78.91 $56.71 thermotx. G0186 T Dstry eye lesn,fdr 0235 5.57 $283.54 $78.91 $56.71 vssl tech. G0187 T Dstry mclr 0235 5.57 $283.54 $78.91 $56.71 drusen,photocoag. G0188 D Xray lwr extrmty- 0261 1.21 $61.59 $33.87 $12.32 full lngth. G0190 D Immunization ........... ........... ........... ........... ........... administration. G0191 D Immunization ........... ........... ........... ........... ........... admin,each add. G0192 N Immunization oral/ ........... ........... ........... ........... ........... intranasal. G0193 A Endoscopicstudyswall ........... ........... ........... ........... ........... owfunctn. G0194 A Sensorytestingendosc ........... ........... ........... ........... ........... opicstud. G0195 A Clinicalevalswallowi ........... ........... ........... ........... ........... ngfunct. G0196 A Evalofswallowingwith ........... ........... ........... ........... ........... radioopa. G0197 A Evalofptforprescipsp ........... ........... ........... ........... ........... eechdevi. [[Page 60065]] G0198 A Patientadapation&tra ........... ........... ........... ........... ........... inforspe. G0199 A Reevaluationofpatien ........... ........... ........... ........... ........... tusespec. G0200 A Evalofpatientprescip ........... ........... ........... ........... ........... ofvoicep. G0201 A Modifortraininginuse ........... ........... ........... ........... ........... voicepro. G0202 A Screeningmammography ........... ........... ........... ........... ........... digital. G0203 D Screenmammographyfil ........... ........... ........... ........... ........... mdigital. G0204 S Diagnosticmammograph 0707 ........... $75.00 ........... $15.00 ydigital. G0205 D Diagnosticmammograph ........... ........... ........... ........... ........... yfilmpro. G0206 S Diagnosticmammograph 0707 ........... $75.00 ........... $15.00 ydigital. G0207 D Diagnostic ........... ........... ........... ........... ........... mammography film. G0210 S PET img wholebody 0712 ........... $875.00 ........... $175.00 dxlung ca. G0211 S PET img wholebody 0712 ........... $875.00 ........... $175.00 init lung. G0212 S PET img wholebod 0712 ........... $875.00 ........... $175.00 restag lung. G0213 S PET img wholebody dx 0712 ........... $875.00 ........... $175.00 colorec. G0214 S PET img wholebod 0712 ........... $875.00 ........... $175.00 init colore. G0215 S PETimg wholebod 0712 ........... $875.00 ........... $175.00 restag colre. G0216 S PET img wholebod dx 0712 ........... $875.00 ........... $175.00 melanoma. G0217 S PET img wholebod 0712 ........... $875.00 ........... $175.00 init melano. G0218 S PET img wholebod 0712 ........... $875.00 ........... $175.00 restag mela. G0219 S PET img wholbod 0712 ........... $875.00 ........... $175.00 melano nonco. G0220 S PET img wholebod dx 0712 ........... $875.00 ........... $175.00 lymphoma. G0221 S PET imag wholbod 0712 ........... $875.00 ........... $175.00 init lympho. G0222 S PET imag wholbod 0712 ........... $875.00 ........... $175.00 resta lymph. G0223 S PET imag wholbod reg 0712 ........... $875.00 ........... $175.00 dx head. G0224 S PET imag wholbod reg 0712 ........... $875.00 ........... $175.00 ini hea. G0225 S PET whol restag 0712 ........... $875.00 ........... $175.00 headneck onl. G0226 S PET img wholbody dx 0712 ........... $875.00 ........... $175.00 esophagl. G0227 S PET img wholbod ini 0712 ........... $875.00 ........... $175.00 esophage. G0228 S PET img wholbod 0712 ........... $875.00 ........... $175.00 restg esopha. G0229 S PET img metabolic 0712 ........... $875.00 ........... $175.00 brain pres. G0230 S PET myocard 0712 ........... $875.00 ........... $175.00 viability post s. *G0231 S PET WhBD colorec; 0712 ........... $875.00 ........... $175.00 gamma cam. *G0232 S PET WhBD lymphoma; 0712 ........... $875.00 ........... $175.00 gamma cam. *G0233 S PET WhBD melanoma; 0712 ........... $875.00 ........... $175.00 gamma cam. *G0234 S PET WhBD pulm nod; 0712 ........... $875.00 ........... $175.00 gamma cam. *G0236 S digital film convert 0706 ........... $25.00 ........... $5.00 diag
