[Federal Register: November 1, 2002 (Volume 67, Number 212)]
[Rules and Regulations]
[Page 66817-66866]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr01no02-21]
[[pp. 66817-66866]] Medicare Program; Changes to the Hospital Outpatient Prospective
Payment System and Calendar Year 2003 Payment Rates; and Changes to
Payment Suspension for Unfiled Cost Reports
[[Continued from page 66816]]
[[Page 66817]]
0251 Level I ENT Procedures T................... 1.9089 $99.55 .......... $19.91
0252 Level II ENT T................... 5.8041 $302.69 $113.41 $60.54
Procedures.
0253 Level III ENT T................... 14.4473 $753.44 $282.29 $150.69
Procedures.
0254 Level IV ENT T................... 20.1158 $1,049.06 $321.35 $209.81
Procedures.
0256 Level V ENT Procedures T................... 34.0302 $1,774.71 .......... $354.94
0258 Tonsil and Adenoid T................... 19.8736 $1,036.43 $437.25 $207.29
Procedures.
0259 Level VI ENT T................... 367.6466 $19,173.14 $9,394.83 $3,834.63
Procedures.
0260 Level I Plain Film X................... 0.7655 $39.92 $21.95 $7.98
Except Teeth.
0261 Level II Plain Film X................... 1.2887 $67.21 .......... $13.44
Except Teeth
Including Bone
Density Measurement.
0262 Plain Film of Teeth... X................... 0.5717 $29.81 $9.82 $5.96
0263 Level I Miscellaneous X................... 1.8992 $99.05 $43.58 $19.81
Radiology Procedures.
0264 Level II Miscellaneous X................... 2.8197 $147.05 $79.41 $29.41
Radiology Procedures.
0265 Level I Diagnostic S................... 0.9787 $51.04 $28.07 $10.21
Ultrasound Except
Vascular.
0266 Level II Diagnostic S................... 1.5988 $83.38 $45.86 $16.68
Ultrasound Except
Vascular.
0267 Level III Diagnostic S................... 2.4418 $127.34 $65.52 $25.47
Ultrasound Except
Vascular.
0268 Ultrasound Guidance S................... 1.3856 $72.26 .......... $14.45
Procedures.
0269 Level III S................... 3.2170 $167.77 $87.24 $33.55
Echocardiogram Except
Transesophageal.
0270 Transesophageal S................... 5.3003 $276.42 $146.79 $55.28
Echocardiogram.
0271 Mammography........... S................... 0.6492 $33.86 $16.80 $6.77
0272 Level I Fluoroscopy... X................... 1.3372 $69.74 $38.36 $13.95
0274 Myelography........... S................... 3.8759 $202.13 $96.54 $40.43
0275 Arthrography.......... S................... 2.9747 $155.13 $69.09 $31.03
0276 Level I Digestive S................... 1.5891 $82.87 $41.72 $16.57
Radiology.
0277 Level II Digestive S................... 2.3546 $122.79 $60.47 $24.56
Radiology.
0278 Diagnostic Urography.. S................... 2.5290 $131.89 $66.07 $26.38
0279 Level II Angiography S................... 8.6432 $450.75 $174.57 $90.15
and Venography except
Extremity.
0280 Level III Angiography S................... 15.2128 $793.36 $353.85 $158.67
and Venography except
Extremity.
0281 Venography of S................... 5.2227 $272.37 $115.16 $54.47
Extremity.
0282 Miscellaneous S................... 1.6763 $87.42 $44.51 $17.48
Computerized Axial
Tomography.
0283 Computerized Axial S................... 4.5057 $234.98 $126.27 $47.00
Tomography with
Contrast Material.
0284 Magnetic Resonance S................... 7.2382 $377.48 $201.02 $75.50
Imaging and Magnetic
Resonance Angiography
with Contrast
Material.
0285 Myocardial Positron S................... 18.1294 $945.47 $409.56 $189.09
Emission Tomography
(PET).
0286 Myocardial Scans...... S................... 6.5309 $340.59 $187.32 $68.12
0287 Complex Venography.... S................... 6.9863 $364.34 $114.51 $72.87
0288 Bone Density:Axial S................... 1.2984 $67.71 .......... $13.54
Skeleton.
0289 Needle Localization X................... 1.8992 $99.05 $44.80 $19.81
for Breast Biopsy.
0290 Level I Diagnostic S................... 2.0251 $105.61 $53.17 $21.12
Nuclear Medicine
Excluding Myocardial
Scans.
0291 Level II Diagnostic S................... 3.9825 $207.69 $104.55 $41.54
Nuclear Medicine
Excluding Myocardial
Scans.
0292 Level III Diagnostic S................... 4.2925 $223.86 $112.69 $44.77
Nuclear Medicine
Excluding Myocardial
Scans.
0294 Level II Therapeutic S................... 4.0794 $212.74 $117.01 $42.55
Nuclear Medicine.
0296 Level I Therapeutic S................... 2.4127 $125.82 $69.20 $25.16
Radiologic Procedures.
0297 Level II Therapeutic S................... 7.6839 $400.72 $172.51 $80.14
Radiologic Procedures.
0299 Miscellaneous S................... 5.9785 $311.78 .......... $62.36
Radiation Treatment.
0300 Level I Radiation S................... 1.5794 $82.37 .......... $16.47
Therapy.
0301 Level II Radiation S................... 3.1588 $164.73 .......... $32.95
Therapy.
0302 Level III Radiation S................... 9.2343 $481.58 $182.43 $96.32
Therapy.
0303 Treatment Device X................... 2.8391 $148.06 $66.95 $29.61
Construction.
0304 Level I Therapeutic X................... 1.6182 $84.39 $41.52 $16.88
Radiation Treatment
Preparation.
0305 Level II Therapeutic X................... 3.6530 $190.51 $91.38 $38.10
Radiation Treatment
Preparation.
0310 Level III Therapeutic X................... 13.6625 $712.51 $325.27 $142.50
Radiation Treatment
Preparation.
0312 Radioelement S................... 52.8864 $2,758.08 .......... $551.62
Applications.
0313 Brachytherapy......... S................... 21.0363 $1,097.06 .......... $219.41
0314 Hyperthermic Therapies S................... 4.1763 $217.80 $101.77 $43.56
0320 Electroconvulsive S................... 4.2635 $222.35 $80.06 $44.47
Therapy.
0321 Biofeedback and Other S................... 1.2112 $63.17 $21.78 $12.63
Training.
0322 Brief Individual S................... 1.3275 $69.23 $12.40 $13.85
Psychotherapy.
0323 Extended Individual S................... 1.8410 $96.01 $21.26 $19.20
Psychotherapy.
0324 Family Psychotherapy.. S................... 2.4612 $128.35 .......... $25.67
0325 Group Psychotherapy... S................... 1.4244 $74.28 $18.27 $14.86
0330 Dental Procedures..... S................... 4.7770 $249.13 .......... $49.83
0332 Computerized Axial S................... 3.4398 $179.39 $91.27 $35.88
Tomography and
Computerized
Angiography without
Contrast Material.
0333 Computerized Axial S................... 5.3681 $279.95 $146.98 $55.99
Tomography and
Computerized Angio w/
o Contrast Material
followed by Contrast.
0335 Magnetic Resonance S................... 6.2983 $328.46 $151.46 $65.69
Imaging,
Miscellaneous.
[[Page 66818]]
0336 Magnetic Resonance S................... 6.5987 $344.13 $176.94 $68.83
Imaging and Magnetic
Resonance Angiography
without Contrast.
0337 MRI and Magnetic S................... 9.2440 $482.08 $240.77 $96.42
Resonance Angiography
without Contrast
Material followed by
Contrast Material.
0339 Observation........... S................... 7.2188 $376.47 .......... $75.29
0340 Minor Ancillary X................... 0.6492 $33.86 .......... $6.77
Procedures.
0341 Skin Tests and X................... 0.1453 $7.58 $3.08 $1.52
Miscellaneous Red
Blood Cell Tests.
0342 Level I Pathology..... X................... 0.2132 $11.12 $5.88 $2.22
0343 Level II Pathology.... X................... 0.4457 $23.24 $12.55 $4.65
0344 Level III Pathology... X................... 0.6201 $32.34 $17.46 $6.47
0345 Level I Transfusion X................... 0.1938 $10.11 $3.10 $2.02
Laboratory Procedures.
0346 Level II Transfusion X................... 0.5136 $26.78 $6.75 $5.36
Laboratory Procedures.
0347 Level III Transfusion X................... 1.1240 $58.62 $14.76 $11.72
Laboratory Procedures.
0348 Fertility Laboratory X................... 0.5523 $28.80 .......... $5.76
Procedures.
0352 Level I Injections.... X................... 0.2229 $11.62 .......... $2.32
0353 Level II Allergy X................... 0.3973 $20.72 .......... $4.14
Injections.
0355 Level III K................... 0.2132 $11.12 .......... $2.22
Immunizations.
0356 Level IV Immunizations K................... 0.7655 $39.92 .......... $7.98
0359 Level II Injections... X................... 1.1337 $59.12 .......... $11.82
0360 Level I Alimentary X................... 1.6279 $84.90 $42.45 $16.98
Tests.
0361 Level II Alimentary X................... 3.3914 $176.86 $83.23 $35.37
Tests.
0362 Level III X................... 2.8391 $148.06 .......... $29.61
Otorhinolaryngologic
Function Tests.
0363 Level I X................... 1.0852 $56.59 $20.94 $11.32
Otorhinolaryngologic
Function Tests.
0364 Level I Audiometry.... X................... 0.4457 $23.24 $9.06 $4.65
0365 Level II Audiometry... X................... 1.2112 $63.17 $18.95 $12.63
0367 Level I Pulmonary Test X................... 0.5814 $30.32 $15.16 $6.06
0368 Level II Pulmonary X................... 1.0562 $55.08 $27.55 $11.02
Tests.
0369 Level III Pulmonary X................... 2.5871 $134.92 $44.18 $26.98
Tests.
0370 Allergy Tests......... X................... 0.7752 $40.43 $11.58 $8.09
0371 Level I Allergy X................... 0.5039 $26.28 .......... $5.26
Injections.
0372 Therapeutic Phlebotomy X................... 0.5329 $27.79 $10.09 $5.56
0373 Neuropsychological X................... 2.2577 $117.74 .......... $23.55
Testing.
0374 Monitoring Psychiatric X................... 1.1434 $59.63 $9.97 $11.93
Drugs.
0600 Low Level Clinic V................... 0.8430 $43.96 .......... $8.79
Visits.
0601 Mid Level Clinic V................... 0.9690 $50.53 .......... $10.11
Visits.
0602 High Level Clinic V................... 1.4631 $76.30 .......... $15.26
Visits.
0610 Low Level Emergency V................... 1.4147 $73.78 $19.57 $14.76
Visits.
0611 Mid Level Emergency V................... 2.5290 $131.89 $36.47 $26.38
Visits.
0612 High Level Emergency V................... 4.3410 $226.39 $54.14 $45.28
Visits.
0620 Critical Care......... S................... 9.9610 $519.48 $150.55 $103.90
0648 Breast Reconstruction T................... 44.7955 $2,336.13 .......... $467.23
with Prosthesis.
0649 Prostate Brachytherapy T................... 115.0167 $5,998.24 .......... $1,199.65
Palladium Seeds.
0650 Intermediate/Complex S................... 12.0152 $626.60 .......... $125.32
Proton Beam Radiation
Therapy.
0651 Complex Interstitial S................... 54.7177 $2,853.58 .......... $570.72
Radiation Source
Application.
0652 Insertion of T................... 28.1292 $1,466.97 .......... $293.39
Intraperitoneal
Catheters.
0653 Vascular T................... 30.0284 $1,566.01 .......... $313.20
Reconstruction/
Fistula Repair with
Device.
0654 Insertion/Replacement T................... 91.8583 $4,790.50 .......... $958.10
of a permanent dual
chamber pacemaker.
0655 Insertion/Replacement/ T................... 122.8654 $6,407.55 .......... $1,281.51
Conversion of a
permanent dual
chamber pacemaker.
0656 Transcatheter T................... 96.7516 $5,045.69 .......... $1,009.14
Placement of
Intracoronary of Drug-
Eluting Stents.
0657 Placement of Tissue S................... 1.4438 $75.30 .......... $15.06
Clips.
0658 Percutaneous Breast T................... 5.2712 $274.90 .......... $54.98
Biopsies.
0659 Hyperbaric Oxygen..... S................... 3.2364 $168.78 .......... $33.76
0660 Level II X................... 1.5891 $82.87 $30.66 $16.57
Otorhinolaryngologic
Function Tests.
0661 Level IV Pathology.... X................... 3.5077 $182.93 $100.61 $36.59
0662 CT Angiography........ S................... 5.4553 $284.50 $156.47 $56.90
0664 Proton Beam Radiation S................... 10.0482 $524.02 .......... $104.80
Therapy.
0665 Bone S................... 0.8236 $42.95 .......... $8.59
Density:AppendicularS
keleton.
0666 Myocardial Add-on S................... 2.9650 $154.63 $85.05 $30.93
Scans.
0668 Level I Angiography S................... 10.3292 $538.68 $237.76 $107.74
and Venography except
Extremity.
0669 Digital Mammography... S................... 0.8915 $46.49 .......... $9.30
0670 Intravenous and S................... 30.2416 $1,577.13 $571.17 $315.43
Intracardiac
Ultrasound.
0671 Level II S................... 2.3643 $123.30 $64.12 $24.66
Echocardiogram Except
Transesophageal.
0672 Level IV Posterior T................... 37.9061 $1,976.84 $988.43 $395.37
Segment Procedures.
0673 Level IV Anterior T................... 25.9490 $1,353.27 $649.56 $270.65
Segment Eye
Procedures.
0674 Prostate Cryoablation. T................... 62.9152 $3,281.09 .......... $656.22
0675 Prostatic T................... 48.5648 $2,532.70 .......... $506.54
Thermotherapy.
0676 Level II Transcatheter T................... 4.1278 $215.27 $58.21 $43.05
Thrombolysis.
[[Page 66819]]
0677 Level I Transcatheter T................... 2.6453 $137.96 .......... $27.59
Thrombolysis.
0678 External T................... 2.2189 $115.72 .......... $23.14
Counterpulsation.
0679 Level II Resuscitation S................... 5.4069 $281.98 $95.30 $56.40
and Cardioversion.
0680 Insertion of Patient S................... 56.1324 $2,927.36 .......... $585.47
Activated Event
Recorders.
0681 Knee Arthroplasty..... T................... 147.8067 $7,708.27 $3,067.55 $1,541.65
0682 Level V Debridement & T................... 7.2770 $379.50 $174.57 $75.90
Destruction.
0683 Level II S................... 1.8992 $99.05 $35.65 $19.81
Photochemotherapy.
0684 Prostate Brachytherapy T................... 98.8349 $5,154.34 .......... $1,030.87
Iodine Seeds.
0685 Level III Needle T................... 5.9882 $312.29 $137.40 $62.46
Biopsy/Aspiration
Except Bone Marrow.
0686 Level III Skin Repair. T................... 14.2439 $742.83 $341.70 $148.57
0687 Revision/Removal of T................... 25.8424 $1,347.71 $619.95 $269.54
Neurostimulator
Electrodes.
0688 Revision/Removal of T................... 74.5719 $3,889.00 $1,905.61 $777.80
Neurostimulator Pulse
Generator Receiver.
0689 Electronic Analysis of S................... 0.5814 $30.32 .......... $6.06
Cardioverter-
defibrillators.
0690 Electronic Analysis of S................... 0.4263 $22.23 $10.63 $4.45
Pacemakers and other
Cardiac Devices.
0691 Electronic Analysis of S................... 2.9166 $152.10 $83.65 $30.42
Programmable Shunts/
Pumps.
0692 Electronic Analysis of S................... 6.2595 $326.44 $179.54 $65.29
Neurostimulator Pulse
Generators.
0693 Level II Breast T................... 37.5863 $1,960.16 $798.17 $392.03
Reconstruction.
0694 Mohs Surgery.......... T................... 3.4689 $180.91 $72.36 $36.18
0695 Level VII Debridement T................... 18.6817 $974.27 $266.59 $194.85
& Destruction.
0697 Level I Echocardiogram S................... 1.5697 $81.86 $42.57 $16.37
Except
Transesophageal.
0698 Level II Eye Tests & S................... 0.9205 $48.00 $18.72 $9.60
Treatments.
0699 Level IV Eye Tests & T................... 3.7596 $196.07 $88.23 $39.21
Treatments.
0701 SR 89 chloride, per K................... 8.9920 $468.94 .......... $93.79
mCi.
0702 SM 153 lexidronam, 50 K................... 14.6218 $762.54 .......... $152.51
mCi.
0706 New Technology - Level S................... .......... $25.00 .......... $5.00
I ($0 - $50).
0707 New Technology - Level S................... .......... $75.00 .......... $15.00
II ($50 - $100).
0708 New Technology - Level S................... .......... $150.00 .......... $30.00
III ($100 - $200).
0709 New Technology - Level S................... .......... $250.00 .......... $50.00
IV ($200 - $300).
0710 New Technology - Level S................... .......... $400.00 .......... $80.00
V ($300 - $500).
0711 New Technology - Level S................... .......... $625.00 .......... $125.00
VI ($500 - $750).
0712 New Technology - Level S................... .......... $875.00 .......... $175.00
VII ($750 - $1000).
0713 New Technology - Level S................... .......... $1,125.00 .......... $225.00
VIII ($1000 - $1250).
0714 New Technology - Level S................... .......... $1,375.00 .......... $275.00
IX ($1250 - $1500).
0715 New Technology - Level S................... .......... $1,625.00 .......... $325.00
X ($1500 - $1750).
0716 New Technology - Level S................... .......... $1,875.00 .......... $375.00
XI ($1750 - $2000).
0717 New Technology - Level S................... .......... $2,250.00 .......... $450.00
XII ($2000 - $2500).
0718 New Technology - Level S................... .......... $2,750.00 .......... $550.00
XIII ($2500 - $3000).
0719 New Technology-Level S................... .......... $3,250.00 .......... $650.00
XIV ($3000 - $3500).
0720 New Technology - Level S................... .......... $4,250.00 .......... $850.00
XV ($3500 - $5000).
0721 New Technology - Level S................... .......... $5,500.00 .......... $1,100.00
XVI ($5000 - $6000).
0725 New Technology - Level S................... .......... $20,000.00 .......... $4,000.00
XX ($19500 - $20500).
0726 Dexrazoxane hcl K................... 2.2577 $117.74 .......... $23.55
injection, 250 mg.
0728 Filgrastim 300 mcg K................... 2.1027 $109.66 .......... $21.93
injection.
0730 Pamidronate disodium , K................... 3.2654 $170.29 .......... $34.06
30 mg.
0732 Mesna injection 200 mg K................... 0.5039 $26.28 .......... $5.26
0733 Non esrd epoetin alpha K................... 0.1744 $9.10 .......... $1.82
inj, 1000 u.
0734 Injection, darbepoetin K................... 0.0454 $2.37 .......... $.47
alfa (for non-ESRD
use), pre 1 mcg.
0800 Leuprolide acetate, K................... 3.7984 $198.09 .......... $39.62
3.75 mg.
0802 Etoposide oral 50 mg.. K................... 0.5523 $28.80 .......... $5.76
0807 Aldesleukin/single use K................... 7.2867 $380.01 .......... $76.00
vial.
0810 Goserelin acetate K................... 5.5619 $290.06 .......... $58.01
implant 3.6 mg.
0811 Carboplatin injection K................... 1.4922 $77.82 .......... $15.56
50 mg.
0812 Carmustine, 100 mg.... K................... 1.5310 $79.84 .......... $15.97
0813 Cisplatin 10 mg K................... 0.4263 $22.23 .......... $4.45
injection.
0820 Daunorubicin 10 mg.... K................... 1.9379 $101.06 .......... $20.21
0821 Daunorubicin citrate K................... 2.9069 $151.60 .......... $30.32
liposom 10 mg.
0822 Diethylstilbestrol K................... 2.0251 $105.61 .......... $21.12
injection 250 mg.
0823 Docetaxel, 20 mg...... K................... 3.8953 $203.14 .......... $40.63
0827 Floxuridine injection K................... 2.2189 $115.72 .......... $23.14
500 mg.
0828 Gemcitabine HCL 200 mg K................... 1.2984 $67.71 .......... $13.54
0830 Irinotecan injection K................... 1.7538 $91.46 .......... $18.29
20 mg.
0831 Ifosfomide injection 1 K................... 1.9186 $100.06 .......... $20.01
gm.
0832 Idarubicin hcl K................... 4.8642 $253.67 .......... $50.73
injection 5 mg.
0838 Interferon gamma 1-b K................... 3.0426 $158.67 .......... $31.73
inj, 3 million u.
0840 Melphalan hydrochl 50 K................... 4.5348 $236.49 .......... $47.30
mg.
0842 Fludarabine phosphate K................... 3.2848 $171.31 .......... $34.26
inj 50 mg.
0843 Pegaspargase, singl K................... 8.8079 $459.34 .......... $91.87
dose vial.
0844 Pentostatin injection, K................... 19.8833 $1,036.93 .......... $207.39
10 mg.
[[Page 66820]]
0849 Rituximab, 100 mg..... K................... 5.4941 $286.52 .......... $57.30
0852 Topotecan, 4 mg....... K................... 7.7130 $402.24 .......... $80.45
0855 Vinorelbine tartrate, K................... 1.0756 $56.09 .......... $11.22
10 mg.
0856 Porfimer sodium, 75 mg K................... 29.6117 $1,544.28 .......... $308.86
0857 Bleomycin sulfate K................... 3.1879 $166.25 .......... $33.25
injection 15 u.
0858 Cladribine, 1mg....... K................... 0.7946 $41.44 .......... $8.29
0861 Leuprolide acetate K................... 0.7752 $40.43 .......... $8.09
injection 1 mg.
0862 Mitomycin 5 mg inj.... K................... 1.1337 $59.12 .......... $11.82
0863 Paclitaxel injection, K................... 2.3158 $120.77 .......... $24.15
30 mg.
0864 Mitoxantrone hcl, 5 mg K................... 2.9263 $152.61 .......... $30.52
0888 Cyclosporine oral 100 K................... 0.0484 $2.52 .......... $.50
mg.
0890 Lymphocyte immune K................... 3.3429 $174.34 .......... $34.87
globulin 250 mg.
0891 Tacrolimus oral per 1 K................... 0.0291 $1.52 .......... $.30
mg.
0902 Botulinum toxin a, per K................... 0.0484 $2.52 .......... $.50
unit.
0903 Cytomegalovirus imm IV/ K................... 4.7383 $247.11 .......... $49.42
vial.
0905 Immune globulin 500 mg K................... 0.8333 $43.46 .......... $8.69
0906 RSV-ivig, 50 mg....... K................... 0.5911 $30.83 .......... $6.17
0909 Interferon beta-1a, 33 K................... 2.7906 $145.53 .......... $29.11
mcg.
0910 Interferon beta-1b / K................... 1.9864 $103.59 .......... $20.72
0.25 mg.
0916 Injection imiglucerase K................... 0.0484 $2.52 .......... $.50
/unit.
0917 Inj, Adenosine, 90 mg. K................... 3.1986 $166.81 .......... $33.36
0925 Factor viii per iu.... K................... 0.0097 $.51 .......... $.10
0926 Factor VIII (porcine) K................... 0.0291 $1.52 .......... $.30
per iu.
0927 Factor viii K................... 0.0194 $1.01 .......... $.20
recombinant per iu.
0928 Factor ix complex per K................... 0.0097 $.51 .......... $.10
iu.
0929 Anti-inhibitor per iu. K................... 0.0194 $1.01 .......... $.20
0930 Antithrombin iii K................... 0.0194 $1.01 .......... $.20
injection per iu.
0931 Factor IX non- K................... 0.0097 $.51 .......... $.10
recombinant, per iu.
0932 Factor IX recombinant, K................... 0.0194 $1.01 .......... $.20
per iu.
0949 Plasma, Pooled K................... 2.3837 $124.31 .......... $24.86
Multiple Donor,
Solvent/Detergent T.
0950 Blood (Whole) For K................... 1.6860 $87.93 .......... $17.59
Transfusion.
0952 Cryoprecipitate....... K................... 0.5620 $29.31 .......... $5.86
0954 RBC leukocytes reduced K................... 2.2868 $119.26 .......... $23.85
0955 Plasma, Fresh Frozen.. K................... 1.8217 $95.00 .......... $19.00
0956 Plasma Protein K................... 1.7829 $92.98 .......... $18.60
Fraction.
0957 Platelet Concentrate.. K................... 0.7946 $41.44 .......... $8.29
0958 Platelet Rich Plasma.. K................... 1.0271 $53.56 .......... $10.71
0959 Red Blood Cells....... K................... 1.6569 $86.41 .......... $17.28
0960 Washed Red Blood Cells K................... 3.0813 $160.69 .......... $32.14
0961 Infusion, Albumin K................... 0.9980 $52.05 .......... $10.41
(Human) 5%, 50 ml.
0963 Albumin (human), 5%, K................... 4.9708 $259.23 .......... $51.85
250 ml.
0964 Albumin (human), 25%, K................... 1.0756 $56.09 .......... $11.22
20 ml.
0965 Albumin (human), 25%, K................... 2.6840 $139.97 .......... $27.99
50ml.
0966 Plasmaprotein K................... 8.9145 $464.90 .......... $92.98
fract,5%,250ml.
0970 New Technology - Level T................... .......... $25.00 .......... $5.00
I ($0 - $50).
0971 New Technology - Level T................... .......... $75.00 .......... $15.00
II ($50 - $100).
0972 New Technology - Level T................... .......... $150.00 .......... $30.00
III ($100 - $200).
0973 New Technology - Level T................... .......... $250.00 .......... $50.00
IV ($200 - $300).
0974 New Technology - Level T................... .......... $400.00 .......... $80.00
V ($300 - $500).
0975 New Technology - Level T................... .......... $625.00 .......... $125.00
VI ($500 - $750).
0976 New Technology - Level T................... .......... $875.00 .......... $175.00
VII ($750 - $1000).
0977 New Technology - Level T................... .......... $1,125.00 .......... $225.00
VIII ($1000 - $1250).
0978 New Technology - Level T................... .......... $1,375.00 .......... $275.00
IX ($1250 - $1500).
0979 New Technology - Level T................... .......... $1,625.00 .......... $325.00
X ($1500 - $1750).
0980 New Technology - Level T................... .......... $1,875.00 .......... $375.00
XI ($1750 - $2000).
0981 New Technology - Level T................... .......... $2,250.00 .......... $450.00
XII ($2000 - $2500).
0982 New Technology - Level T................... .......... $2,750.00 .......... $550.00
XIII ($2500 - $3000).
0983 New Technology - Level T................... .......... $3,250.00 .......... $650.00
XIV ($3000 - $3500).
0984 New Technology - Level T................... .......... $4,250.00 .......... $850.00
XV ($3500 - $5000).
0985 New Technology - Level T................... .......... $5,500.00 .......... $1,100.00
XVI ($5000 - $6000).
0989 New Technology - Level T................... .......... $20,000.00 .......... $4,000.00
XX ($19500-$20500).
1009 Cryoprecip reduced K................... 0.7170 $37.39 .......... $7.48
plasma.
1010 Blood, L/R, CMV-neg... K................... 2.3352 $121.78 .......... $24.36
1011 Platelets, HLA-m, L/R, K................... 9.5831 $499.77 .......... $99.95
unit.
1013 Platelet concentrate, K................... 0.9496 $49.52 .......... $9.90
L/R, unit.
1016 Blood, L/R, froz/ K................... 5.7848 $301.68 .......... $60.34
deglycerol/washed.
1017 Platelets, aph/pher, L/ K................... 7.5386 $393.15 .......... $78.63
R, CMV-neg, unit.
1018 Blood, L/R, irradiated K................... 2.5387 $132.40 .......... $26.48
[[Page 66821]]
1019 Platelets, aph/pher, L/ K................... 7.7905 $406.28 .......... $81.26
R, irradiated, unit.
1020 Pit, pher,L/ K................... 9.4959 $495.22 .......... $99.04
R,CMV,irrad.
1021 RBC, frz/deg/wsh, L/R, K................... 6.4436 $336.04 .......... $67.21
irrad.
1022 RBC, L/R, CMV neg, K................... 3.8565 $201.12 .......... $40.22
irrad.
1045 Iobenguane sulfate I- K................... 1.5697 $81.86 .......... $16.37
31per 0.5 mCi.
1059 Cultured chondrocytes K................... 114.2706 $5,959.33 .......... $1,191.87
implnt.
1084 Denileukin diftitox, K................... 12.1315 $632.67 .......... $126.53
300 MCG.
1086 Temozolomide,oral 5 mg K................... 0.0581 $3.03 .......... $.61
1091 IN 111 Oxyquinoline, K................... 4.7092 $245.59 .......... $49.12
per .5 mCi.
1092 IN 111 Pentetate, per K................... 4.4379 $231.44 .......... $46.29
0.5 mCi.
1095 Technetium TC 99M K................... 5.6006 $292.08 .......... $58.42
Depreotide.
1096 TC 99M Exametazime, K................... 4.4379 $231.44 .......... $46.29
per dose.
1122 TC 99M arcitumomab, K................... 11.4726 $598.31 .......... $119.66
per vial.
1167 Epirubicin hcl, 2 mg.. K................... 0.3294 $17.18 .......... $3.44
1178 Busulfan IV, 6 mg..... K................... 0.4845 $25.27 .......... $5.05
1203 Verteporfin for K................... 16.5209 $861.58 .......... $172.32
injection.
1207 Octreotide acetate K................... 1.4244 $74.28 .......... $14.86
depot 1mg.
1305 Apligraf.............. K................... 13.0520 $680.67 .......... $136.13
1348 I-131 sol, per 1-6 mCi K................... 0.9399 $49.02 .......... $9.80
1409 Factor viia K................... 20.7844 $1,083.93 .......... $216.79
recombinant, per 1.2
mg.
1604 IN 111 capromab K................... 16.4434 $857.54 .......... $171.51
pendetide, per dose.
1605 Abciximab injection, K................... 5.8526 $305.22 .......... $61.04
10 mg.
1609 Rho(D) immune globulin K................... 0.2229 $11.62 .......... $2.32
h, sd, 100 iu.
1611 Hylan G-F 20 K................... 2.3643 $123.30 .......... $24.66
injection, 16 mg.
1612 Daclizumab, K................... 4.3991 $229.42 .......... $45.88
parenteral, 25 mg.
1613 Trastuzumab, 10 mg.... K................... 0.6298 $32.84 .......... $6.57
1614 Valrubicin, 200 mg.... K................... 3.5658 $185.96 .......... $37.19
1615 Basiliximab, 20 mg.... K................... 13.3621 $696.85 .......... $139.37
1618 Vonwillebrandfactrcmpl K................... 0.0194 $1.01 .......... $.20
x, per iu.
1620 Technetium tc99m K................... 3.8759 $202.13 .......... $40.43
bicisate.
1625 Indium 111-in K................... 8.2169 $428.52 .......... $85.70
pentetreotide.
1628 Chromic phosphate p32. K................... 1.5891 $82.87 .......... $16.57
1716 Brachytx seed, Gold K................... 0.4360 $22.74 .......... $4.55
198.
1718 Brachytx seed, Iodine K................... 0.6008 $31.33 .......... $6.27
125.
1719 Brachytxseed, Non-HDR K................... 0.5232 $27.29 .......... $5.46
Ir-192.
1720 Brachytx seed, K................... 0.8430 $43.96 .......... $8.79
Palladium 103.
1765 Adhesion barrier...... H................... .......... .......... .......... ..........
1775 FDG, per dose (4-40 K................... 7.5289 $392.64 .......... $78.53
mCi/ml).
1783 Ocular implant, H................... .......... .......... .......... ..........
aqueous drain device.
1888 Endovascular non- H................... .......... .......... .......... ..........
cardiac ablation
catheter.
1900 Lead coronary venous.. H................... .......... .......... .......... ..........
2614 Probe, percutaneous H................... .......... .......... .......... ..........
lumbar disc.
2616 Brachytx seed, Yttrium- K................... 8.8370 $460.86 .......... $92.17
90.
2618 Probe, cryoablation... H................... .......... .......... .......... ..........
2632 Brachytx sol, I-125, H................... .......... .......... .......... ..........
per mCi.
7000 Amifostine, 500 mg.... K................... 4.5057 $234.98 .......... $47.00
7001 Amphotericin B lipid K................... 2.3449 $122.29 .......... $24.46
complex, 50 mg.
7011 Oprelvekin injection, K................... 2.7325 $142.50 .......... $28.50
5 mg.
7024 Corticorelin ovine K................... 2.2965 $119.76 .......... $23.95
triflutat.
7025 Digoxin immune FAB K................... 4.9805 $259.74 .......... $51.95
(ovine).
7030 Hemin, per 1 mg....... K................... 0.0097 $.51 .......... $.10
7031 Octreotide acetate K................... 1.2694 $66.20 .......... $13.24
injection.
7034 Somatropin injection.. K................... 0.7170 $37.39 .......... $7.48
7035 Teniposide, 50 mg..... K................... 1.9573 $102.08 .......... $20.42
7038 Muromonab-CD3, 5 mg... K................... 6.9572 $362.82 .......... $72.56
7041 Tirofiban K................... 4.9417 $257.71 .......... $51.54
hydrochloride 12.5 mg.
7042 Capecitabine, oral, K................... 0.0291 $1.52 .......... $.30
150 mg.
7043 Infliximab injection K................... 0.7364 $38.40 .......... $7.68
10 mg.
7045 Trimetrexate K................... 1.3081 $68.22 .......... $13.64
glucoronate.
7046 Doxorubicin hcl K................... 4.3894 $228.91 .......... $45.78
liposome inj 10 mg.
7049 Filgrastim 480 mcg K................... 3.2267 $168.28 .......... $33.66
injection.
7051 Leuprolide acetate G................... .......... $5,399.80 .......... $807.13
implant, 65 mg.
9000 Na chromate Cr51, per K................... 1.8798 $98.03 .......... $19.61
0.25mCi.
9002 Tenecteplase, 50mg/ K................... 27.5963 $1,439.17 .......... $287.83
vial.
9003 Palivizumab, per 50mg. K................... 8.5657 $446.71 .......... $89.34
9005 Reteplase injection... K................... 12.6547 $659.96 .......... $131.99
9009 Baclofen refill kit - K................... 0.7267 $37.90 .......... $7.58
per 2000 mcg.
9010 Baclofen refill kit - K................... 0.9205 $48.00 .......... $9.60
per 4000 mcg.
[[Page 66822]]
9012 Arsenic Trioxide...... G................... .......... $31.35 .......... $4.69
9015 Mycophenolate mofetil K................... 0.0291 $1.52 .......... $.30
oral 250 mg.
9016 Echocardiography G................... .......... $118.75 .......... $17.75
contrast.
9018 Botulinum toxin B, per G................... .......... $8.79 .......... $1.31
100 u.
9019 Caspofungin acetate, 5 G................... .......... $34.20 .......... $5.11
mg.
9020 Sirolimus tablet, 1 mg K................... 0.0581 $3.03 .......... $.61
9021 Immune globulin 10 mg. K................... 0.0097 $.51 .......... $.10
9022 IM inj interferon beta K................... 0.9302 $48.51 .......... $9.70
1-a.
9023 Rho d immune globulin K................... 0.0484 $2.52 .......... $.50
50 mcg.
9024 Amphotericin b lipid K................... 0.4167 $21.73 .......... $4.35
complex.
9104 Anti-thymocycte K................... 2.6356 $137.45 .......... $27.49
globulin rabbit.
9105 Hep B imm glob, per 1 K................... 1.5116 $78.83 .......... $15.77
ml.
9108 Thyrotropin alfa, per K................... 7.5870 $395.67 .......... $79.13
1.1 mg.
9109 Tirofliban hcl, per K................... 2.1996 $114.71 .......... $22.94
6.25 mg.
9110 Alemtuzumab, per ml... G................... .......... $511.22 .......... $76.41
9111 Inj, bivalirudin, per G................... .......... $397.81 .......... $56.46
250 mg vial.
9112 Perflutren lipid G................... .......... $4.94 .......... $.74
micro, per 2ml.
9113 Inj, pantoprazole G................... .......... $22.80 .......... $3.41
sodium, vial.
9114 Nesiritide, per 1.5 mg G................... .......... $433.20 .......... $64.75
vial.
9115 Inj, zoledronic acid, G................... .......... $406.78 .......... $60.80
per 2 mg.
9116 Inj, Ertapenem sodium, G................... .......... $45.31 .......... $6.77
per 1 gm vial.
9119 Inj, Pegfilgrastim, G................... .......... $2,802.50 .......... $418.90
per 6 mg single dose
vial.
9120 Inj, Fulvestrant, per G................... .......... $87.58 .......... $13.09
50 mg.
9121 Inj, Argatroban, per 5 G................... .......... $14.25 .......... $2.13
mg.
9200 Orcel, per 36 cm2..... G................... .......... $1,135.25 .......... $169.69
9201 Dermagraft, per 37.5 G................... .......... $577.60 .......... $86.34
sq cm.
9217 Leuprolide acetate K................... 6.5696 $342.61 .......... $68.52
suspnsion, 7.5 mg.
9500 Platelets, irradiated. K................... 1.4341 $74.79 .......... $14.96
9501 Platelets, pheresis... K................... 7.8390 $408.81 .......... $81.76
9502 Platelet pheresis K................... 8.5076 $443.68 .......... $88.74
irradiated.
9503 Fresh frozen plasma, K................... 1.3372 $69.74 .......... $13.95
ea unit.
9504 RBC deglycerolized.... K................... 3.5174 $183.44 .......... $36.69
9505 RBC irradiated........ K................... 2.0833 $108.65 .......... $21.73
9506 Granulocytes, pheresis K................... 23.9432 $1,248.66 .......... $249.73
----------------------------------------------------------------------------------------------------------------
--------------------
CPT codes and descriptions only are copyright American Medical
Association. All Rights Reserved. Applicable FARS/DFARS Apply.
Copyright American Dental Association. All rights reserved.
*Code is new in 2002.
[[Page 66822]]
-----------------------------------------------------------------------
Addendum B.--Payment Status by HCPCS Code and Related Information
[Calendar Year 2003]
--------------------------------------------------------------------------------------------------------------------------------------------------------
National Minimum
CPT/ HCPCS Status indicator Condition Description APC Relative Payment unadjusted unadjusted
weight rate copayment copayment
--------------------------------------------------------------------------------------------------------------------------------------------------------
0001T C................ ................... Endovas repr abdo ao ........... ........... ........... ........... ...........
aneurys.
0002T C................ ................... Endovas repr abdo ao ........... ........... ........... ........... ...........
aneurys.
0003T S................ ................... Cervicography.............. 0706 ........... $25.00 ........... $5.00
0005T C................ ................... Perc cath stent/brain cv ........... ........... ........... ........... ...........
art.
0006T C................ ................... Perc cath stent/brain cv ........... ........... ........... ........... ...........
art.
0007T C................ ................... Perc cath stent/brain cv ........... ........... ........... ........... ...........
art.
0008T E................ ................... Upper gi endoscopy w/suture ........... ........... ........... ........... ...........
0009T T................ ................... Endometrial cryoablation... 0980 ........... $1,875.00 ........... $375.00
00100 N................ ................... Anesth, salivary gland..... ........... ........... ........... ........... ...........
00102 N................ ................... Anesth, repair of cleft lip ........... ........... ........... ........... ...........
00103 N................ ................... Anesth, blepharoplasty..... ........... ........... ........... ........... ...........
00104 N................ ................... Anesth, electroshock....... ........... ........... ........... ........... ...........
0010T A................ ................... Tb test, gamma interferon.. ........... ........... ........... ........... ...........
00120 N................ ................... Anesth, ear surgery........ ........... ........... ........... ........... ...........
00124 N................ ................... Anesth, ear exam........... ........... ........... ........... ........... ...........
00126 N................ ................... Anesth, tympanotomy........ ........... ........... ........... ........... ...........
0012T T................ ................... Osteochondral knee 0041 26.1234 $1,362.36 ........... $272.47
autograft.
0013T T................ ................... Osteochondral knee 0041 26.1234 $1,362.36 ........... $272.47
allograft.
00140 N................ ................... Anesth, procedures on eye.. ........... ........... ........... ........... ...........
00142 N................ ................... Anesth, lens surgery....... ........... ........... ........... ........... ...........
[[Page 66823]]
00144 N................ ................... Anesth, corneal transplant. ........... ........... ........... ........... ...........
00145 N................ ................... Anesth, vitreoretinal surg. ........... ........... ........... ........... ...........
00147 N................ ................... Anesth, iridectomy......... ........... ........... ........... ........... ...........
00148 N................ ................... Anesth, eye exam........... ........... ........... ........... ........... ...........
0014T T................ ................... Meniscal transplant, knee.. 0041 26.1234 $1,362.36 ........... $272.47
00160 N................ ................... Anesth, nose/sinus surgery. ........... ........... ........... ........... ...........
00162 N................ ................... Anesth, nose/sinus surgery. ........... ........... ........... ........... ...........
00164 N................ ................... Anesth, biopsy of nose..... ........... ........... ........... ........... ...........
0016T E................ ................... Thermotx choroid vasc ........... ........... ........... ........... ...........
lesion.
00170 N................ ................... Anesth, procedure on mouth. ........... ........... ........... ........... ...........
00172 N................ ................... Anesth, cleft palate repair ........... ........... ........... ........... ...........
00174 C................ ................... Anesth, pharyngeal surgery. ........... ........... ........... ........... ...........
00176 C................ ................... Anesth, pharyngeal surgery. ........... ........... ........... ........... ...........
0017T E................ ................... Photocoagulat macular ........... ........... ........... ........... ...........
drusen.
0018T S................ ................... Transcranial magnetic 0215 0.5814 $30.32 $15.76 $6.06
stimul.
00190 N................ ................... Anesth, face/skull bone ........... ........... ........... ........... ...........
surg.
00192 C................ ................... Anesth, facial bone surgery ........... ........... ........... ........... ...........
0019T A................ ................... Extracorp shock wave tx, ms ........... ........... ........... ........... ...........
0020T A................ ................... Extracorp shock wave tx, ft ........... ........... ........... ........... ...........
00210 N................ ................... Anesth, open head surgery.. ........... ........... ........... ........... ...........
00212 N................ ................... Anesth, skull drainage..... ........... ........... ........... ........... ...........
00214 C................ ................... Anesth, skull drainage..... ........... ........... ........... ........... ...........
00215 C................ ................... Anesth, skull repair/fract. ........... ........... ........... ........... ...........
00216 N................ ................... Anesth, head vessel surgery ........... ........... ........... ........... ...........
00218 N................ ................... Anesth, special head ........... ........... ........... ........... ...........
surgery.
0021T C................ ................... Fetal oximetry, trnsvag/ ........... ........... ........... ........... ...........
cerv.
00220 N................ ................... Anesth, intrcrn nerve...... ........... ........... ........... ........... ...........
00222 N................ ................... Anesth, head nerve surgery. ........... ........... ........... ........... ...........
0023T A................ ................... Phenotype drug test, hiv 1. ........... ........... ........... ........... ...........
0024T C................ ................... Transcath cardiac reduction ........... ........... ........... ........... ...........
0025T S................ ................... Ultrasonic pachymetry...... 0230 0.7364 $38.40 $14.97 $7.68
0026T A................ ................... Measure remnant ........... ........... ........... ........... ...........
lipoproteins.
0027T T................ NI................. Endoscopic epidural lysis.. 0976 ........... $875.00 ........... $175.00
0028T N................ NI................. Dexa body composition study ........... ........... ........... ........... ...........
0029T N................ NI................. Magnetic tx for ........... ........... ........... ........... ...........
incontinence.
00300 N................ ................... Anesth, head/neck/ptrunk... ........... ........... ........... ........... ...........
0030T A................ NI................. Antiprothrombin antibody... ........... ........... ........... ........... ...........
0031T N................ NI................. Speculoscopy............... ........... ........... ........... ........... ...........
00320 N................ ................... Anesth, neck organ surgery. ........... ........... ........... ........... ...........
00322 N................ ................... Anesth, biopsy of thyroid.. ........... ........... ........... ........... ...........
00326 N................ NI................. Anesth, larynx/trach, < 1 ........... ........... ........... ........... ...........
yr.
0032T N................ NI................. Speculoscopy w/direct ........... ........... ........... ........... ...........
sample.
0033T C................ NI................. Endovasc taa repr incl ........... ........... ........... ........... ...........
subcl.
0034T C................ NI................. Endovasc taa repr w/o subcl ........... ........... ........... ........... ...........
00350 N................ ................... Anesth, neck vessel surgery ........... ........... ........... ........... ...........
00352 N................ ................... Anesth, neck vessel surgery ........... ........... ........... ........... ...........
0035T C................ NI................. Insert endovasc prosth, taa ........... ........... ........... ........... ...........
0036T C................ NI................. Endovasc prosth, taa, add- ........... ........... ........... ........... ...........
on.
0037T C................ NI................. Artery transpose/endovas ........... ........... ........... ........... ...........
taa.
0038T C................ NI................. Rad endovasc taa rpr w/ ........... ........... ........... ........... ...........
cover.
0039T C................ NI................. Rad s/i, endovasc taa ........... ........... ........... ........... ...........
repair.
00400 N................ ................... Anesth, skin, ext/per/ ........... ........... ........... ........... ...........
atrunk.
00402 N................ ................... Anesth, surgery of breast.. ........... ........... ........... ........... ...........
00404 C................ ................... Anesth, surgery of breast.. ........... ........... ........... ........... ...........
00406 C................ ................... Anesth, surgery of breast.. ........... ........... ........... ........... ...........
0040T C................ NI................. Rad s/i, endovasc taa ........... ........... ........... ........... ...........
prosth.
00410 N................ ................... Anesth, correct heart ........... ........... ........... ........... ...........
rhythm.
0041T A................ NI................. Detect ur infect agnt w/ ........... ........... ........... ........... ...........
cpas.
0042T N................ NI................. Ct perfusion w/contrast, ........... ........... ........... ........... ...........
cbf.
0043T A................ NI................. Co expired gas analysis.... ........... ........... ........... ........... ...........
0044T N................ NI................. Whole body photography..... ........... ........... ........... ........... ...........
00450 N................ ................... Anesth, surgery of shoulder ........... ........... ........... ........... ...........
00452 C................ ................... Anesth, surgery of shoulder ........... ........... ........... ........... ...........
00454 N................ ................... Anesth, collar bone biopsy. ........... ........... ........... ........... ...........
00470 N................ ................... Anesth, removal of rib..... ........... ........... ........... ........... ...........
[[Page 66824]]
00472 N................ ................... Anesth, chest wall repair.. ........... ........... ........... ........... ...........
00474 C................ ................... Anesth, surgery of rib(s).. ........... ........... ........... ........... ...........
00500 N................ ................... Anesth, esophageal surgery. ........... ........... ........... ........... ...........
00520 N................ ................... Anesth, chest procedure.... ........... ........... ........... ........... ...........
00522 N................ ................... Anesth, chest lining biopsy ........... ........... ........... ........... ...........
00524 C................ ................... 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 ........... ........... ........... ........... ...........
00539 N................ NI................. Anesth, trach-bronch ........... ........... ........... ........... ...........
reconst.
00540 C................ ................... Anesth, chest surgery...... ........... ........... ........... ........... ...........
00541 N................ NI................. Anesth, one lung ........... ........... ........... ........... ...........
ventilation.
00542 C................ ................... Anesth, release of lung.... ........... ........... ........... ........... ...........
00544 C................ ................... Anesth, chest lining ........... ........... ........... ........... ...........
removal.
00546 C................ ................... Anesth, lung,chest wall ........... ........... ........... ........... ...........
surg.
00548 N................ ................... Anesth, trachea,bronchi ........... ........... ........... ........... ...........
surg.
00550 N................ ................... Anesth, sternal debridement ........... ........... ........... ........... ...........
00560 C................ ................... Anesth, open heart surgery. ........... ........... ........... ........... ...........
00562 C................ ................... Anesth, open heart surgery. ........... ........... ........... ........... ...........
00563 N................ ................... Anesth, heart proc w/pump.. ........... ........... ........... ........... ...........
00566 N................ ................... Anesth, cabg w/o pump...... ........... ........... ........... ........... ...........
00580 C................ ................... Anesth, heart/lung ........... ........... ........... ........... ...........
transplnt.
00600 N................ ................... Anesth, spine, cord surgery ........... ........... ........... ........... ...........
00604 C................ ................... Anesth, sitting procedure.. ........... ........... ........... ........... ...........
00620 N................ ................... Anesth, spine, cord surgery ........... ........... ........... ........... ...........
00622 C................ ................... Anesth, removal of nerves.. ........... ........... ........... ........... ...........
00630 N................ ................... Anesth, spine, cord surgery ........... ........... ........... ........... ...........
00632 C................ ................... Anesth, removal of nerves.. ........... ........... ........... ........... ...........
00634 C................ ................... Anesth for chemonucleolysis ........... ........... ........... ........... ...........
00635 N................ ................... Anesth, lumbar puncture.... ........... ........... ........... ........... ...........
00640 N................ NI................. Anesth, spine manipulation. ........... ........... ........... ........... ...........
00670 C................ ................... 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 C................ ................... Anesth, hemorr/excise liver ........... ........... ........... ........... ...........
00794 C................ ................... Anesth, pancreas removal... ........... ........... ........... ........... ...........
00796 C................ ................... Anesth, for liver ........... ........... ........... ........... ...........
transplant.
00797 N................ ................... Anesth, surgery for obesity ........... ........... ........... ........... ...........
00800 N................ ................... Anesth, abdominal wall surg ........... ........... ........... ........... ...........
00802 C................ ................... 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... ........... ........... ........... ........... ...........
00834 N................ NI................. Anesth, hernia repair< 1 yr ........... ........... ........... ........... ...........
00836 N................ NI................. Anesth hernia repair ........... ........... ........... ........... ...........
preemie.
00840 N................ ................... Anesth, surg lower abdomen. ........... ........... ........... ........... ...........
00842 N................ ................... Anesth, amniocentesis...... ........... ........... ........... ........... ...........
00844 C................ ................... Anesth, pelvis surgery..... ........... ........... ........... ........... ...........
00846 C................ ................... Anesth, hysterectomy....... ........... ........... ........... ........... ...........
00848 C................ ................... Anesth, pelvic organ surg.. ........... ........... ........... ........... ...........
00851 N................ ................... Anesth, tubal ligation..... ........... ........... ........... ........... ...........
00860 N................ ................... Anesth, surgery of abdomen. ........... ........... ........... ........... ...........
00862 N................ ................... Anesth, kidney/ureter surg. ........... ........... ........... ........... ...........
00864 C................ ................... Anesth, removal of bladder. ........... ........... ........... ........... ...........
[[Page 66825]]
00865 C................ ................... Anesth, removal of prostate ........... ........... ........... ........... ...........
00866 C................ ................... Anesth, removal of adrenal. ........... ........... ........... ........... ...........
00868 C................ ................... Anesth, kidney transplant.. ........... ........... ........... ........... ...........
00869 N................ DG................. Anesth, vasectomy.......... ........... ........... ........... ........... ...........
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 C................ ................... Anesth, major vein ligation ........... ........... ........... ........... ...........
00902 N................ ................... Anesth, anorectal surgery.. ........... ........... ........... ........... ...........
00904 C................ ................... Anesth, perineal surgery... ........... ........... ........... ........... ...........
00906 N................ ................... Anesth, removal of vulva... ........... ........... ........... ........... ...........
00908 C................ ................... 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.. ........... ........... ........... ........... ...........
00921 N................ NI................. Anesth, vasectomy.......... ........... ........... ........... ........... ...........
00922 N................ ................... Anesth, sperm duct surgery. ........... ........... ........... ........... ...........
00924 N................ ................... Anesth, testis exploration. ........... ........... ........... ........... ...........
00926 N................ ................... Anesth, removal of testis.. ........... ........... ........... ........... ...........
00928 C................ ................... Anesth, removal of testis.. ........... ........... ........... ........... ...........
00930 N................ ................... Anesth, testis suspension.. ........... ........... ........... ........... ...........
00932 C................ ................... Anesth, amputation of penis ........... ........... ........... ........... ...........
00934 C................ ................... Anesth, penis, nodes ........... ........... ........... ........... ...........
removal.
00936 C................ ................... Anesth, penis, nodes ........... ........... ........... ........... ...........
removal.
00938 N................ ................... Anesth, insert penis device ........... ........... ........... ........... ...........
00940 N................ ................... Anesth, vaginal procedures. ........... ........... ........... ........... ...........
00942 N................ ................... Anesth, surg on vag/ ........... ........... ........... ........... ...........
urethral.
00944 C................ ................... Anesth, vaginal ........... ........... ........... ........... ...........
hysterectomy.
00948 N................ ................... Anesth, repair of cervix... ........... ........... ........... ........... ...........
00950 N................ ................... Anesth, vaginal endoscopy.. ........... ........... ........... ........... ...........
00952 N................ ................... Anesth, hysteroscope/graph. ........... ........... ........... ........... ...........
01112 N................ ................... Anesth, bone aspirate/bx... ........... ........... ........... ........... ...........
01120 N................ ................... Anesth, pelvis surgery..... ........... ........... ........... ........... ...........
01130 N................ ................... Anesth, body cast procedure ........... ........... ........... ........... ...........
01140 C................ ................... Anesth, amputation at ........... ........... ........... ........... ...........
pelvis.
01150 C................ ................... Anesth, pelvic tumor ........... ........... ........... ........... ...........
surgery.
01160 N................ ................... Anesth, pelvis procedure... ........... ........... ........... ........... ...........
01170 N................ ................... Anesth, pelvis surgery..... ........... ........... ........... ........... ...........
01180 N................ ................... Anesth, pelvis nerve ........... ........... ........... ........... ...........
removal.
01190 C................ ................... Anesth, pelvis nerve ........... ........... ........... ........... ...........
removal.
01200 N................ ................... Anesth, hip joint procedure ........... ........... ........... ........... ...........
01202 N................ ................... Anesth, arthroscopy of hip. ........... ........... ........... ........... ...........
01210 N................ ................... Anesth, hip joint surgery.. ........... ........... ........... ........... ...........
01212 C................ ................... Anesth, hip disarticulation ........... ........... ........... ........... ...........
01214 C................ ................... Anesth, hip arthroplasty... ........... ........... ........... ........... ...........
01215 N................ ................... Anesth, revise hip repair.. ........... ........... ........... ........... ...........
01220 N................ ................... Anesth, procedure on femur. ........... ........... ........... ........... ...........
01230 N................ ................... Anesth, surgery of femur... ........... ........... ........... ........... ...........
01232 C................ ................... Anesth, amputation of femur ........... ........... ........... ........... ...........
01234 C................ ................... Anesth, radical femur surg. ........... ........... ........... ........... ...........
01250 N................ ................... Anesth, upper leg surgery.. ........... ........... ........... ........... ...........
01260 N................ ................... Anesth, upper leg veins ........... ........... ........... ........... ...........
surg.
01270 N................ ................... Anesth, thigh arteries surg ........... ........... ........... ........... ...........
01272 C................ ................... Anesth, femoral artery surg ........... ........... ........... ........... ...........
01274 C................ ................... 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 ........... ........... ........... ........... ...........
[[Page 66826]]
01392 N................ ................... Anesth, knee area surgery.. ........... ........... ........... ........... ...........
01400 N................ ................... Anesth, knee joint surgery. ........... ........... ........... ........... ...........
01402 C................ ................... Anesth, knee arthroplasty.. ........... ........... ........... ........... ...........
01404 C................ ................... 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 C................ ................... Anesth, knee artery surg... ........... ........... ........... ........... ...........
01444 C................ ................... 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 C................ ................... Anesth, ankle replacement.. ........... ........... ........... ........... ...........
01490 N................ ................... Anesth, lower leg casting.. ........... ........... ........... ........... ...........
01500 N................ ................... Anesth, leg arteries surg.. ........... ........... ........... ........... ...........
01502 C................ ................... 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 C................ ................... Anesth, surgery of shoulder ........... ........... ........... ........... ...........
01634 C................ ................... Anesth, shoulder joint ........... ........... ........... ........... ...........
amput.
01636 C................ ................... Anesth, forequarter amput.. ........... ........... ........... ........... ...........
01638 C................ ................... Anesth, shoulder ........... ........... ........... ........... ...........
replacement.
01650 N................ ................... Anesth, shoulder artery ........... ........... ........... ........... ...........
surg.
01652 C................ ................... Anesth, shoulder vessel ........... ........... ........... ........... ...........
surg.
01654 C................ ................... Anesth, shoulder vessel ........... ........... ........... ........... ...........
surg.
01656 C................ ................... 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.. ........... ........... ........... ........... ...........
01740 N................ ................... Anesth, upper arm surgery.. ........... ........... ........... ........... ...........
01742 N................ ................... Anesth, humerus surgery.... ........... ........... ........... ........... ...........
01744 N................ ................... Anesth, humerus repair..... ........... ........... ........... ........... ...........
01756 C................ ................... 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 ........... ........... ........... ........... ...........
01829 N................ NI................. Anesth, dx wrist ........... ........... ........... ........... ...........
arthroscopy.
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 ........... ........... ........... ........... ...........
[[Page 66827]]
01860 N................ ................... Anesth, lower arm casting.. ........... ........... ........... ........... ...........
01905 N................ ................... Anes, spine inject, x-ray/ ........... ........... ........... ........... ...........
re.
01916 N................ ................... Anesth, dx arteriography... ........... ........... ........... ........... ...........
01920 N................ ................... Anesth, catheterize heart.. ........... ........... ........... ........... ...........
01922 N................ ................... Anesth, cat or MRI scan.... ........... ........... ........... ........... ...........
01924 N................ ................... Anes, ther interven rad, ........... ........... ........... ........... ...........
art.
01925 N................ ................... Anes, ther interven rad, ........... ........... ........... ........... ...........
car.
01926 N................ ................... Anes, tx interv rad hrt/ ........... ........... ........... ........... ...........
cran.
01930 N................ ................... Anes, ther interven rad, ........... ........... ........... ........... ...........
vei.
01931 N................ ................... Anes, ther interven rad, ........... ........... ........... ........... ...........
tip.
01932 N................ ................... Anes, tx interv rad, th ........... ........... ........... ........... ...........
vein.
01933 N................ ................... Anes, tx interv rad, cran v ........... ........... ........... ........... ...........
01951 N................ ................... Anesth, burn, less 4 ........... ........... ........... ........... ...........
percent.
01952 N................ ................... Anesth, burn, 4-9 percent.. ........... ........... ........... ........... ...........
01953 N................ ................... Anesth, burn, each 9 ........... ........... ........... ........... ...........
percent.
01960 N................ ................... Anesth, vaginal delivery... ........... ........... ........... ........... ...........
01961 N................ ................... Anesth, cs delivery........ ........... ........... ........... ........... ...........
01962 N................ ................... Anesth, emer hysterectomy.. ........... ........... ........... ........... ...........
01963 N................ ................... Anesth, cs hysterectomy.... ........... ........... ........... ........... ...........
01964 N................ ................... Anesth, abortion procedures ........... ........... ........... ........... ...........
01967 N................ ................... Anesth/analg, vag delivery. ........... ........... ........... ........... ...........
01968 N................ ................... Anes/analg cs deliver add- ........... ........... ........... ........... ...........
on.
01969 N................ ................... Anesth/analg cs hyst add-on ........... ........... ........... ........... ...........
01990 C................ ................... Support for organ donor.... ........... ........... ........... ........... ...........
01991 N................ NI................. Anesth, nerve block/inj.... ........... ........... ........... ........... ...........
01992 N................ NI................. Anesth, n block/inj, prone. ........... ........... ........... ........... ...........
01995 N................ ................... Regional anesthesia limb... ........... ........... ........... ........... ...........
01996 N................ ................... Manage daily drug therapy.. ........... ........... ........... ........... ...........
01999 N................ ................... Unlisted anesth procedure.. ........... ........... ........... ........... ...........
10021 T................ ................... Fna w/o image.............. 0002 0.5911 $30.83 ........... $6.17
10022 T................ ................... Fna w/image................ 0002 0.5911 $30.83 ........... $6.17
10040 T................ ................... Acne surgery............... 0010 0.6589 $34.36 $10.08 $6.87
10060 T................ ................... Drainage of skin abscess... 0006 1.7926 $93.49 $24.12 $18.70
10061 T................ ................... Drainage of skin abscess... 0006 1.7926 $93.49 $24.12 $18.70
10080 T................ ................... Drainage of pilonidal cyst. 0006 1.7926 $93.49 $24.12 $18.70
10081 T................ ................... Drainage of pilonidal cyst. 0007 10.0191 $522.51 $108.89 $104.50
10120 T................ ................... Remove foreign body........ 0006 1.7926 $93.49 $24.12 $18.70
10121 T................ ................... Remove foreign body........ 0021 13.9338 $726.66 $219.48 $145.33
10140 T................ ................... Drainage of hematoma/fluid. 0007 10.0191 $522.51 $108.89 $104.50
10160 T................ ................... Puncture drainage of lesion 0018 0.9399 $49.02 $16.04 $9.80
10180 T................ ................... Complex drainage, wound.... 0007 10.0191 $522.51 $108.89 $104.50
11000 T................ ................... Debride infected skin...... 0015 1.5407 $80.35 $20.35 $16.07
11001 T................ ................... Debride infected skin add- 0013 1.0756 $56.09 $14.20 $11.22
on.
11010 T................ ................... Debride skin, fx........... 0022 17.3930 $907.06 $354.45 $181.41
11011 T................ ................... Debride skin/muscle, fx.... 0022 17.3930 $907.06 $354.45 $181.41
11012 T................ ................... Debride skin/muscle/bone, 0022 17.3930 $907.06 $354.45 $181.41
fx.
11040 T................ ................... Debride skin, partial...... 0015 1.5407 $80.35 $20.35 $16.07
11041 T................ ................... Debride skin, full......... 0015 1.5407 $80.35 $20.35 $16.07
11042 T................ ................... Debride skin/tissue........ 0016 2.6162 $136.44 $57.31 $27.29
11043 T................ ................... Debride tissue/muscle...... 0016 2.6162 $136.44 $57.31 $27.29
11044 T................ ................... Debride tissue/muscle/bone. 0682 7.2770 $379.50 $174.57 $75.90
11055 T................ ................... Trim skin lesion........... 0012 0.7849 $40.93 $11.18 $8.19
11056 T................ ................... Trim skin lesions, 2 to 4.. 0012 0.7849 $40.93 $11.18 $8.19
11057 T................ ................... Trim skin lesions, over 4.. 0012 0.7849 $40.93 $11.18 $8.19
11100 T................ ................... Biopsy of skin lesion...... 0018 0.9399 $49.02 $16.04 $9.80
11101 T................ ................... Biopsy, skin add-on........ 0018 0.9399 $49.02 $16.04 $9.80
11200 T................ ................... Removal of skin tags....... 0013 1.0756 $56.09 $14.20 $11.22
11201 T................ ................... Remove skin tags add-on.... 0015 1.5407 $80.35 $20.35 $16.07
11300 T................ ................... Shave skin lesion.......... 0012 0.7849 $40.93 $11.18 $8.19
11301 T................ ................... Shave skin lesion.......... 0012 0.7849 $40.93 $11.18 $8.19
11302 T................ ................... Shave skin lesion.......... 0013 1.0756 $56.09 $14.20 $11.22
11303 T................ ................... Shave skin lesion.......... 0015 1.5407 $80.35 $20.35 $16.07
11305 T................ ................... Shave skin lesion.......... 0013 1.0756 $56.09 $14.20 $11.22
11306 T................ ................... Shave skin lesion.......... 0013 1.0756 $56.09 $14.20 $11.22
11307 T................ ................... Shave skin lesion.......... 0013 1.0756 $56.09 $14.20 $11.22
[[Page 66828]]
11308 T................ ................... Shave skin lesion.......... 0013 1.0756 $56.09 $14.20 $11.22
11310 T................ ................... Shave skin lesion.......... 0013 1.0756 $56.09 $14.20 $11.22
11311 T................ ................... Shave skin lesion.......... 0013 1.0756 $56.09 $14.20 $11.22
11312 T................ ................... Shave skin lesion.......... 0013 1.0756 $56.09 $14.20 $11.22
11313 T................ ................... Shave skin lesion.......... 0016 2.6162 $136.44 $57.31 $27.29
11400 T................ ................... Removal of skin lesion..... 0019 3.7693 $196.57 $71.87 $39.31
11401 T................ ................... Removal of skin lesion..... 0019 3.7693 $196.57 $71.87 $39.31
11402 T................ ................... Removal of skin lesion..... 0019 3.7693 $196.57 $71.87 $39.31
11403 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11404 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11406 T................ ................... Removal of skin lesion..... 0021 13.9338 $726.66 $219.48 $145.33
11420 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11421 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11422 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11423 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11424 T................ ................... Removal of skin lesion..... 0021 13.9338 $726.66 $219.48 $145.33
11426 T................ ................... Removal of skin lesion..... 0022 17.3930 $907.06 $354.45 $181.41
11440 T................ ................... Removal of skin lesion..... 0019 3.7693 $196.57 $71.87 $39.31
11441 T................ ................... Removal of skin lesion..... 0019 3.7693 $196.57 $71.87 $39.31
11442 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11443 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11444 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11446 T................ ................... Removal of skin lesion..... 0022 17.3930 $907.06 $354.45 $181.41
11450 T................ ................... Removal, sweat gland lesion 0022 17.3930 $907.06 $354.45 $181.41
11451 T................ ................... Removal, sweat gland lesion 0022 17.3930 $907.06 $354.45 $181.41
11462 T................ ................... Removal, sweat gland lesion 0022 17.3930 $907.06 $354.45 $181.41
11463 T................ ................... Removal, sweat gland lesion 0022 17.3930 $907.06 $354.45 $181.41
11470 T................ ................... Removal, sweat gland lesion 0022 17.3930 $907.06 $354.45 $181.41
11471 T................ ................... Removal, sweat gland lesion 0022 17.3930 $907.06 $354.45 $181.41
11600 T................ ................... Removal of skin lesion..... 0019 3.7693 $196.57 $71.87 $39.31
11601 T................ ................... Removal of skin lesion..... 0019 3.7693 $196.57 $71.87 $39.31
11602 T................ ................... Removal of skin lesion..... 0019 3.7693 $196.57 $71.87 $39.31
11603 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11604 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11606 T................ ................... Removal of skin lesion..... 0021 13.9338 $726.66 $219.48 $145.33
11620 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11621 T................ ................... Removal of skin lesion..... 0019 3.7693 $196.57 $71.87 $39.31
11622 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11623 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11624 T................ ................... Removal of skin lesion..... 0021 13.9338 $726.66 $219.48 $145.33
11626 T................ ................... Removal of skin lesion..... 0022 17.3930 $907.06 $354.45 $181.41
11640 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11641 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11642 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11643 T................ ................... Removal of skin lesion..... 0020 7.1898 $374.96 $113.25 $74.99
11644 T................ ................... Removal of skin lesion..... 0021 13.9338 $726.66 $219.48 $145.33
11646 T................ ................... Removal of skin lesion..... 0022 17.3930 $907.06 $354.45 $181.41
11719 T................ ................... Trim nail(s)............... 0009 0.6298 $32.84 $8.34 $6.57
11720 T................ ................... Debride nail, 1-5.......... 0009 0.6298 $32.84 $8.34 $6.57
11721 T................ ................... Debride nail, 6 or more.... 0009 0.6298 $32.84 $8.34 $6.57
11730 T................ ................... Removal of nail plate...... 0013 1.0756 $56.09 $14.20 $11.22
11732 T................ ................... Remove nail plate, add-on.. 0012 0.7849 $40.93 $11.18 $8.19
11740 T................ ................... Drain blood from under nail 0009 0.6298 $32.84 $8.34 $6.57
11750 T................ ................... Removal of nail bed........ 0019 3.7693 $196.57 $71.87 $39.31
11752 T................ ................... Remove nail bed/finger tip. 0022 17.3930 $907.06 $354.45 $181.41
11755 T................ ................... Biopsy, nail unit.......... 0019 3.7693 $196.57 $71.87 $39.31
11760 T................ ................... Repair of nail bed......... 0024 1.8507 $96.52 $34.75 $19.30
11762 T................ ................... Reconstruction of nail bed. 0024 1.8507 $96.52 $34.75 $19.30
11765 T................ ................... Excision of nail fold, toe. 0015 1.5407 $80.35 $20.35 $16.07
11770 T................ ................... Removal of pilonidal lesion 0022 17.3930 $907.06 $354.45 $181.41
11771 T................ ................... Removal of pilonidal lesion 0022 17.3930 $907.06 $354.45 $181.41
11772 T................ ................... Removal of pilonidal lesion 0022 17.3930 $907.06 $354.45 $181.41
11900 T................ ................... Injection into skin lesions 0012 0.7849 $40.93 $11.18 $8.19
11901 T................ ................... Added skin lesions 0012 0.7849 $40.93 $11.18 $8.19
injection.
11920 T................ ................... Correct skin color defects. 0024 1.8507 $96.52 $34.75 $19.30
[[Page 66829]]
11921 T................ ................... Correct skin color defects. 0024 1.8507 $96.52 $34.75 $19.30
11922 T................ ................... Correct skin color defects. 0024 1.8507 $96.52 $34.75 $19.30
11950 T................ ................... Therapy for contour defects 0024 1.8507 $96.52 $34.75 $19.30
11951 T................ ................... Therapy for contour defects 0024 1.8507 $96.52 $34.75 $19.30
11952 T................ ................... Therapy for contour defects 0024 1.8507 $96.52 $34.75 $19.30
11954 T................ ................... Therapy for contour defects 0024 1.8507 $96.52 $34.75 $19.30
11960 T................ ................... Insert tissue expander(s).. 0027 15.2225 $793.87 $329.72 $158.77
11970 T................ ................... Replace tissue expander.... 0027 15.2225 $793.87 $329.72 $158.77
11971 T................ ................... Remove tissue expander(s).. 0022 17.3930 $907.06 $354.45 $181.41
11975 E................ ................... Insert contraceptive cap... ........... ........... ........... ........... ...........
11976 T................ ................... Removal of contraceptive 0019 3.7693 $196.57 $71.87 $39.31
cap.
11977 E................ ................... Removal/reinsert contra cap ........... ........... ........... ........... ...........
11980 X................ ................... Implant hormone pellet(s).. 0340 0.6492 $33.86 ........... $6.77
11981 X................ ................... Insert drug implant device. 0340 0.6492 $33.86 ........... $6.77
11982 X................ ................... Remove drug implant device. 0340 0.6492 $33.86 ........... $6.77
11983 X................ ................... Remove/insert drug implant. 0340 0.6492 $33.86 ........... $6.77
12001 T................ ................... Repair superficial wound(s) 0024 1.8507 $96.52 $34.75 $19.30
12002 T................ ................... Repair superficial wound(s) 0024 1.8507 $96.52 $34.75 $19.30
12004 T................ ................... Repair superficial wound(s) 0024 1.8507 $96.52 $34.75 $19.30
12005 T................ ................... Repair superficial wound(s) 0024 1.8507 $96.52 $34.75 $19.30
12006 T................ ................... Repair superficial wound(s) 0024 1.8507 $96.52 $34.75 $19.30
12007 T................ ................... Repair superficial wound(s) 0024 1.8507 $96.52 $34.75 $19.30
12011 T................ ................... Repair 
