DEPARTMENT OF PUBLIC WELFARE Medical Assistance Program Fee Schedule Revisions [36 Pa.B. 7698]
[Saturday, December 16, 2006]The Department of Public Welfare (Department) announces that it will revise the fees, or a component of the fee, on the Medical Assistance (MA) Program Fee Schedule for select medical, surgical, diagnostic, laboratory, radiological procedure codes and the physician component of select emergency room procedure codes, effective January 2, 2007. In addition, the Department will remove from the MA Program Fee Schedule procedure codes for the treatment of infertility.
Fee Schedule Revisions
The Pennsylvania Medicaid State Plan (State Plan) specifies that maximum fees for services covered under the MA Program are to be determined on the basis of the following: fees may not exceed the Medicare upper limit when applicable; fees must be consistent with efficiency, economy and quality of care and fees must be sufficient to assure the availability of services to recipients.
The Department has determined that MA payment rates for 1573 medical, surgical, diagnostic, laboratory, radiological and the physician component of emergency room physician procedure codes/modifier combinations are above the Medicare-approved amount for the same procedure codes. The Department is adjusting the MA Program Fee Schedule payment rates for these 1573 procedure code/modifier combinations to equal the Medicare-approved amount. Revision of these fees is necessary to comply with the State Plan and to avoid a Federal disallowance.
In reviewing the MA payment rates for these procedure codes, the Department discovered it had transposed the professional and technical component fees for the following procedure code. The Department is correcting this error. In addition, the total fee is being increased to equal the Medicare rate. The new fees are as follows:
Procedure Code Procedure Description Fees 77295 THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; THREE-DIMENSIONAL $1020.00 (Total Component Fee)
$229.75 (26-Professional Comp)
$790.25 (TC--Technical Comp)The Department is also correcting the assistant surgeon rate (80 modifier) as well as decreasing the total component rate to equal the Medicare rate for the following procedure code, as it has determined that the previous assistant surgeon rate was incorrect. As set forth in 55 Pa.Code § 1150.54(a)(3) (relating to surgical services), the maximum payment to the assistant surgeon will be an amount equal to 20% of the MA maximum allowable payment made to the surgeon.
Procedure Code Procedure Description Fees 21199 OSTEOTOMY, MANDIBLE, SEGMENTAL; WITH GENIOGLOSSUS ADVANCEMENT $ 960.50 (Primary Surgeon File)
$192.10 (80--Assistant Surgeon Fee)The Department has also determined that for the following ten procedure codes, the sum of the professional and technical component rates did not equal the total component rate. The Department has adjusted the rates by decreasing the professional component fee and, in one instance, decreasing the technical component fee. The Department also reduced the total component fee to equal the Medicare rate for these ten procedure codes.
Procedure Code Procedure Description Fees 70320 RADIOLOGIC EXAMINATION, TEETH; COMPLETE, FULL MOUTH $ 35.37 (Total Component Fee)
$ 11.38 (26--Professional Comp)
No Change (TC--Technical Comp)74182 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITH CONTRAST MATERIAL(S) $ 399.69 (Total Component Fee)
$ 87.49 (26--Professional Comp)
No Change (TC--Technical Comp)76086 MAMMARY DUCTOGRAM OR GALACTOGRAM, SINGLE DUCT, RADIOLOGICAL SUPERVISION AND INTERPRETATION $ 98.34 (Total Component Fee)
$ 18.36 (26--Professional Comp)
No Change (TC--Technical Comp)76088 MAMMARY DUCTOGRAM OR GALACTOGRAM, MULTIPLE DUCTS, RADIOLOGICAL SUPERVISION AND INTERPRETATION $ 133.85 (Total Component Fee)
$ 22.79 (26--Professional Comp)
No Change (TC--Technical Comp)76093 MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); UNILATERAL $ 626.11 (Total Component Fee)
$ 82.03 (26--Professional Comp)
No Change (TC--Technical Comp)76094 MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); BILATERAL $ 819.98 (Total Component Fee)
$ 82.03 (26--Professional Comp)
No Change (TC--Technical Comp)92544 OPTOKINETIC NYSTAGMUS TEST, BIDIRECTIONAL, FOVEAL OR PERIPHERAL STIMULATION, WITH RECORDING $ 21.57 (Total Component Fee)
$ 14.26 (26--Professional Comp)
No Change (TC--Technical Comp)92545 OSCILLATING TRACKING TEST, WITH RECORDING $ 20.09 (Total Component Fee)
$ 12.78 (26--Professional Comp)
No Change (TC--Technical Comp)92546 SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING $ 24.00 (Total Component Fee)
$ 15.74 (26--Professional Comp)
No Change (TC--Technical Comp)94450 BREATHING RESPONSE TO HYPOXIA (HYPOXIA RESPONSE CURVE) $ 45.43 (Total Component Fee)
$ 19.87 (26--Professional Comp)
$ 25.56 (TC--Technical Comp)In addition, the Department is end-dating the following procedure codes covering services related to infertility treatment. Section 443.6(f) of the Public Welfare Code (62 P. S. § 443.6(f)), prohibits the Department from paying a provider for any medical services, procedures or drugs related to infertility therapy.
Procedure Code Procedure Description 58752 TUBOUTERINE IMPLANTATION 58770 SALPINGOSTOMY (SALPINGONEOSTOMY) As set forth as follows, the Department will revise the total fee (billed with no modifier) and either the professional component fee (billed with modifier 26), the technical component fee (billed with modifier TC), or the assistant surgeon fee (billed with modifier 80), as applicable, for the following procedure codes:
Procedure Codes with Fees Exceeding 100% Medicare Code Description Assistant Surgeon Fee Revision (Billing with Modifier 80) Professional Component Fee Revision (Billing with Modifier 26) Technical Component Fee Revision (Billing with Modifier TC) Total Fee Revision (Billing with No Modifier) G0108 DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, INDIVIDUAL, PER 30 MINUTES N/A N/A N/A $28.68 G0109 DIABETES SELF-MANAGEMENT TRAINING SERVICES, GROUP SESSION (2 OR MORE), PER 30 MINUTES N/A N/A N/A $16.71 G0202 SCREENING MAMMOGRAPHY, PRODUCING DIRECT DIGITAL IMAGE, BILATERAL, ALL VIEWS N/A $35.31 No Change $98.74 Q0035 CARDIOKYMOGRAPHY N/A $8.80 No Change $20.66 11001 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; EACH ADDITIONAL 10% OF THE BODY SURFACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $16.35 11101 BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE (INCLUDING SIMPLE CLOSURE), UNLESS OTHERWISE LISTED (SEPARATE PROCEDURE); EACH SEPARATE/ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $22.64 11201 REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; EACH ADDITIONAL TEN LESIONS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $15.70 11450 EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH SIMPLE OR INTERMEDIATE REPAIR N/A N/A N/A $183.24 11451 EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, AXILLARY; WITH COMPLEX REPAIR N/A N/A N/A $252.67 11462 EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH SIMPLE OR INTERMEDIATE REPAIR N/A N/A N/A $173.95 11463 EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, INGUINAL; WITH COMPLEX REPAIR N/A N/A N/A $257.76 11470 EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL, OR UMBILICAL; WITH SIMPLE OR INTERMEDIATE REPAIR N/A N/A N/A $212.98 11471 EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS, PERIANAL, PERINEAL, OR UMBILICAL; WITH COMPLEX REPAIR N/A N/A N/A $279.15 11970 REPLACEMENT OF TISSUE EXPANDER WITH PERMANENT PROSTHESIS N/A N/A N/A $509.48 15101 SPLIT GRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $22.50 N/A N/A $112.51 15121 SPLIT GRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET AND/OR MULTIPLE DIGITS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY IN ADDITION $35.08 N/A N/A $175.42 15201 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, TRUNK; EACH ADDITIONAL 20 SQ CM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $77.02 15221 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, SCALP, ARMS AND/OR LEGS; EACH ADDITIONAL 20 SQ CM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $13.83 N/A N/A $69.13 15241 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; EACH ADDITIONAL 20 SQ CM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $108.62 15261 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELIDS AND/OR LIPS; EACH ADDITIONAL 20 SQ CM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $138.78 15400 XENOGRAFT, SKIN (DERMAL), FOR TEMPORARY WOUND CLOSURE; TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN N/A N/A N/A $302.99 15572 FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; SCALP, ARMS OR LEGS $121.75 N/A N/A $608.75 15576 FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; EYELIDS, NOSE, EARS, LIPS OR INTRAORAL $118.28 N/A N/A $591.39 15600 DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT TRUNK N/A N/A N/A $185.57 15610 DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT SCALP, ARMS, OR LEGS N/A N/A N/A $219.65 15786 ABRASION; SINGLE LESION (EG, KERATOSIS, SCAR) N/A N/A N/A $125.41 15787 ABRASION; EACH ADDITIONAL FOUR LESIONS OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $19.20 15820 BLEPHAROPLASTY, LOWER EYELID; N/A N/A N/A $397.76 15821 BLEPHAROPLASTY, LOWER EYELID; WITH EXTENSIVE HERNIATED FAT PAD N/A N/A N/A $426.01 15822 BLEPHAROPLASTY, UPPER EYELID; N/A N/A N/A $333.39 15831 EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); ABDOMEN (ABDOMINOPLASTY) $160.45 N/A N/A $802.25 15936 EXCISION, SACRAL PRESSURE ULCER, IN PREPARATION FOR MUSCLE OR MYOCUTANEOUS FLAP OR SKIN GRAFT CLOSURE; $160.77 N/A N/A $803.85 15937 EXCISION, SACRAL PRESSURE ULCER, IN PREPARATION FOR MUSCLE OR MYOCUTANEOUS FLAP OR SKIN GRAFT CLOSURE; WITH OSTECTOMY $187.48 N/A N/A $937.40 16035 ESCHAROTOMY; INITIAL INCISION N/A N/A N/A $209.80 17003 DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), ALL BENIGN OR PREMALIGNANT LESIONS (EG, ACTINIC KERATOSES) OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; SECOND THROUGH 14 LESIONS, (LIST SEPARATELY IN ADDITION TO CODE FOR FIRST LESION) N/A N/A N/A $8.38 17266 DESTRUCTION, MALIGNANT LESION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), TRUNK, ARMS OR LEGS; LESION DIAMETER OVER 4.0 CM N/A N/A N/A $133.13 17310 CHEMOSURGERY (MOHS MICROGRAPHIC TECHNIQUE), INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS BY THE SURGEON, AND COMPLETE HISTOPATHOLOGIC PREPARATION INCLUDING THE FIRST ROUTINE STAIN(EG,HEMATOXYLIN AND EROSIN,TOLUIDINE BLUE); EACH ADDITIONAL SPECIMEN, AFTER THE FIRST FIVE SPECIMENS, FIXED OR FRESH TISSUE, ANY STAGE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $52.64 19001 PUNCTURE ASPIRATION OF CYST OF BREAST; EACH ADDITIONAL CYST (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $21.92 19102 BIOPSY OF BREAST; PERCUTANEOUS, NEEDLE CORE, USING IMAGING GUIDANCE N/A N/A N/A $102.63 19126 EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL MARKER, OPEN; EACH ADDITIONAL LESION SEPARATELY IDENTIFIED BY A PREOPERATIVE RADIOLOGICAL MARKER (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $31.37 N/A N/A $156.83 19324 MAMMAPLASTY, AUGMENTATION; WITHOUT PROSTHETIC IMPLANT N/A N/A N/A $414.48 19325 MAMMAPLASTY, AUGMENTATION; WITH PROSTHETIC IMPLANT $116.81 N/A N/A $584.04 19340 IMMEDIATE INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN RECONSTRUCTION $75.71 N/A N/A $378.54 19380 REVISION OF RECONSTRUCTED BREAST $130.78 N/A N/A $653.89 20100 EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); NECK $114.20 N/A N/A $571.01 20150 EXCISION OF EPIPHYSEAL BAR, WITH OR WITHOUT AUTOGENOUS SOFT TISSUE GRAFT OBTAINED THROUGH SAME FASCIAL INCISION $164.21 N/A N/A $821.06 20660 APPLICATION OF CRANIAL TONGS, CALIPER OR STEREOTACTIC FRAME, INCLUDING REMOVAL (SEPARATE PROCEDURE) N/A N/A N/A $168.18 20910 CARTILAGE GRAFT; COSTOCHONDRAL N/A N/A N/A $401.44 20912 CARTILAGE GRAFT; NASAL SEPTUM N/A N/A N/A $459.95 20920 FASCIA LATA GRAFT; BY STRIPPER $73.12 N/A N/A $365.61 20924 TENDON GRAFT, FROM A DISTANCE (EG, PALMARIS, TOE EXTENSOR, PLANTARIS) $95.73 N/A N/A $478.65 20926 TISSUE GRAFTS, OTHER (EG, PARATENON, FAT, DERMIS) N/A N/A N/A $398.48 20974 ELECTRICAL STIMULATION TO AID BONE HEALING; NONINVASIVE (NONOPERATIVE) N/A N/A N/A $45.32 21120 GENIOPLASTY; AUGMENTATION (AUTOGRAFT, ALLOGRAFT, PROSTHETIC MATERIAL) $92.30 N/A N/A $461.50 21123 GENIOPLASTY; SLIDING, AUGMENTATION WITH INTERPOSITIONAL BONE GRAFTS (INCLUDES OBTAINING AUTOGRAFTS) $167.03 N/A N/A $835.15 21137 REDUCTION FOREHEAD; CONTOURING ONLY $135.40 N/A N/A $677.02 21138 REDUCTION FOREHEAD; CONTOURING AND APPLICATION OF PROSTHETIC MATERIAL OR BONE GRAFT (INCLUDES OBTAINING AUTOGRAFT) $168.23 N/A N/A $841.16 21209 OSTEOPLASTY, FACIAL BONES; REDUCTION $111.67 N/A N/A $558.33 21242 ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH ALLOGRAFT $187.77 N/A N/A $938.86 21270 MALAR AUGMENTATION, PROSTHETIC MATERIAL N/A N/A N/A $657.44 21275 SECONDARY REVISION OF ORBITOCRANIOFACIAL RECONSTRUCTION $148.85 N/A N/A $744.23 21280 MEDIAL CANTHOPEXY (SEPARATE PROCEDURE) $88.80 N/A N/A $444.02 21282 LATERAL CANTHOPEXY N/A N/A N/A $293.31 21295 REDUCTION OF MASSETER MUSCLE AND BONE (EG, FOR TREATMENT OF BENIGN MASSETERIC HYPERTROPHY); EXTRAORAL APPROACH $29.94 N/A N/A $149.70 21296 REDUCTION OF MASSETER MUSCLE AND BONE (EG, FOR TREATMENT OF BENIGN MASSETERIC HYPERTROPHY); INTRAORAL APPROACH $67.85 N/A N/A $339.25 21386 OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; PERIORBITAL APPROACH $123.75 N/A N/A $618.75 21387 OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; COMBINED APPROACH N/A N/A $707.18 21390 OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; PERIORBITAL APPROACH, WITH ALLOPLASTIC OR OTHER IMPLANT $135.59 N/A N/A $677.95 21400 CLOSED TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITHOUT MANIPULATION N/A N/A N/A $121.90 21401 CLOSED TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITH MANIPULATION N/A N/A N/A $254.80 21406 OPEN TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITHOUT IMPLANT N/A N/A N/A $496.10 21407 OPEN TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITH IMPLANT $117.96 N/A N/A $589.81 21454 OPEN TREATMENT OF MANDIBULAR FRACTURE WITH EXTERNAL FIXATION N/A N/A N/A $484.16 21480 CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION; INITIAL OR SUBSEQUENT N/A N/A N/A $31.45 21557 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF NECK OR THORAX $110.54 N/A N/A $552.71 21740 RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM OR CARINATUM; OPEN $197.71 N/A N/A $988.57 22103 PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA OR FACET) FOR INTRINSIC BONY LESION, SINGLE VERTEBRAL SEGMENT; EACH ADDITIONAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $28.70 N/A N/A $143.48 22116 PARTIAL EXCISION OF VERTEBRAL BODY, FOR INTRINSIC BONY LESION, WITHOUT DECOMPRESSION OF SPINAL CORD OR NERVE ROOT(S), SINGLE VERTEBRAL SEGMENT; EACH ADDITIONAL VERTEBRAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $28.64 N/A N/A $143.19 22226 OSTEOTOMY OF SPINE, INCLUDING DISKECTOMY, ANTERIOR APPROACH, SINGLE VERTEBRAL SEGMENT; EACH ADDITIONAL VERTEBRAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $74.78 N/A N/A $373.89 22328 OPEN TREATMENT AND/OR REDUCTION OF VERTEBRAL FRACTURE(S) AND/ OR DISLOCATION(S), POSTERIOR APPROACH, ONE FRACTURED VERTEBRAE OR DISLOCATED SEGMENT; EACH ADDITIONAL FRACTURED VERTEBRAE OR DISLOCATED SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $56.13 N/A N/A $280.64 22585 ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISKECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $68.62 N/A N/A $343.09 22614 ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; EACH ADDITIONAL VERTEBRAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $80.14 N/A N/A $400.69 22632 ARTHRODESIS, POSTERIOR INTERBODY TECHNIQUE, INCLUDING LAMINECTOMY AND/OR DISKECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE; EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $64.91 N/A N/A $324.53 22840 POSTERIOR NONSEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD TECHNIQUE, PEDICLE FIXATION ACROSS ONE INTERSPACE, ATLANTOAXIAL TRANSARTICULAR SCREW FIXATION, SUBLAMINAR WIRING AT C1, FACET SCREW FIXATION) $156.39 N/A N/A $781.93 22842 POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIPLE HOOKS AND SUBLAMINAR WIRES); THREE TO SIX VERTEBRAL SEGMENTS $156.51 N/A N/A $782.56 22845 ANTERIOR INSTRUMENTATION; 2 TO 3 VERTEBRAL SEGMENTS $149.55 N/A N/A $747.73 22848 PELVIC FIXATION (ATTACHMENT OF CAUDAL END OF INSTRUMENTATION TO PELVIC BONY STRUCTURES) OTHER THAN SACRUM $74.24 N/A N/A $371.18 23105 ARTHROTOMY; GLENOHUMERAL JOINT, WITH SYNOVECTOMY, WITH OR WITHOUT BIOPSY N/A N/A N/A $598.96 23106 ARTHROTOMY; STERNOCLAVICULAR JOINT, WITH SYNOVECTOMY, WITH OR WITHOUT BIOPSY N/A N/A N/A $451.26 23210 RADICAL RESECTION FOR TUMOR; SCAPULA $168.52 N/A N/A $842.62 23921 DISARTICULATION OF SHOULDER; SECONDARY CLOSURE OR SCAR REVISION N/A N/A N/A $405.50 24100 ARTHROTOMY, ELBOW; WITH SYNOVIAL BIOPSY ONLY N/A N/A N/A $367.27 24152 RADICAL RESECTION FOR TUMOR, RADIAL HEAD OR NECK $138.12 N/A N/A $690.62 24365 ARTHROPLASTY, RADIAL HEAD $121.49 N/A N/A $607.46 24366 ARTHROPLASTY, RADIAL HEAD; WITH IMPLANT $130.10 N/A N/A $650.48 24931 AMPUTATION, ARM THROUGH HUMERUS; WITH IMPLANT $147.05 N/A N/A $735.24 24935 STUMP ELONGATION, UPPER EXTREMITY N/A N/A N/A $928.82 25335 CENTRALIZATION OF WRIST ON ULNA (EG, RADIAL CLUB HAND) N/A N/A N/A $943.22 25574 OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL OR EXTERNAL FIXATION; OF RADIUS OR ULNA $109.81 N/A N/A $549.05 26125 FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL INTERPHALANGEAL JOINT, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT OR SKIN GRAFTING (INCLUDES OBTAINING GRAFT); EACH ADDITIONAL DIGIT (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE) $55.89 N/A N/A $279.46 26531 ARTHROPLASTY, METACARPOPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, EACH JOINT $115.84 N/A N/A $579.20 26536 ARTHROPLASTY, INTERPHALANGEAL JOINT; WITH PROSTHETIC IMPLANT, EACH JOINT $120.25 N/A N/A $601.25 26591 REPAIR, INTRINSIC MUSCLES OF HAND, EACH MUSCLE N/A N/A N/A $467.70 26861 ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; EACH ADDITIONAL INTERPHALANGEAL JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $105.98 26863 ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT), EACH ADDITIONAL JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $237.00 27036 CAPSULECTOMY OR CAPSULOTOMY, HIP, WITH OR WITHOUT EXCISION OF HETEROTOPIC BONE, WITH RELEASE OF HIP FLEXOR MUSCLES (IE, GLUTEUS MEDIUS, GLUTEUS MINIMUS, TENSOR FASCIA LATAE, RECTUS FEMORIS, SARTORIUS, ILIOPSOAS) N/A N/A N/A $899.26 27052 ARTHROTOMY, WITH BIOPSY; HIP JOINT N/A N/A N/A $470.39 27054 ARTHROTOMY WITH SYNOVECTOMY, HIP JOINT N/A N/A N/A $619.76 27071 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION) (EG, OSTEOMYELITIS OR BONE ABSCESS); DEEP (SUBFASCIAL OR INTRAMUSCULAR) $167.83 N/A N/A $839.16 27096 INJECTION PROCEDURE FOR SACROILIAC JOINT, ARTHROGRAPHY AND/ OR ANESTHETIC/STEROID N/A N/A N/A $66.78 27178 OPEN TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; CLOSED MANIPULATION WITH SINGLE OR MULTIPLE PINNING $161.14 N/A N/A $805.68 27334 ARTHROTOMY, WITH SYNOVECTOMY, KNEE; ANTERIOR OR POSTERIOR N/A N/A N/A $629.44 27335 ARTHROTOMY, WITH SYNOVECTOMY, KNEE; ANTERIOR AND POSTERIOR INCLUDING POPLITEAL AREA N/A N/A N/A $713.42 27358 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF FEMUR; WITH INTERNAL FIXATION (LIST IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $58.16 N/A N/A $290.79 27396 TRANSPLANT, HAMSTRING TENDON TO PATELLA; SINGLE TENDON $115.68 N/A N/A $578.39 27425 LATERAL RETINACULAR RELEASE OPEN $82.86 N/A N/A $414.31 27427 LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; EXTRA-ARTICULAR $134.29 N/A N/A $671.45 27438 ARTHROPLASTY, PATELLA; WITH PROSTHESIS $155.40 N/A N/A $777.01 27692 TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); EACH ADDITIONAL TENDON (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $22.49 N/A N/A $112.43 27700 ARTHROPLASTY, ANKLE; $117.25 N/A N/A $586.24 27742 ARREST, EPIPHYSEAL (EPIPHYSIODESIS), ANY METHOD, COMBINED, PROXIMAL AND DISTAL TIBIA AND FIBULA; AND DISTAL FEMUR $127.00 N/A N/A $635.01 27871 ARTHRODESIS, TIBIOFIBULAR JOINT, PROXIMAL OR DISTAL $131.10 N/A N/A $655.50 28160 HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE, PROXIMAL END OF PHALANX, EACH N/A N/A N/A $270.50 28456 PERCUTANEOUS SKELETAL FIXATION OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS), WITH MANIPULATION, EACH N/A N/A N/A $257.21 28530 CLOSED TREATMENT OF SESAMOID FRACTURE N/A N/A N/A $93.67 28725 ARTHRODESIS; SUBTALAR $155.68 N/A N/A $778.40 29131 APPLICATION OF FINGER SPLINT; DYNAMIC N/A N/A N/A $29.96 29325 APPLICATION OF HIP SPICA CAST; ONE AND ONE-HALF SPICA OR BOTH LEGS N/A N/A N/A $167.14 29820 ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PARTIAL $103.63 N/A N/A $518.13 29834 ARTHROSCOPY, ELBOW, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY $94.12 N/A N/A $470.58 29835 ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, PARTIAL $96.28 N/A N/A $481.40 29837 ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, LIMITED $101.31 N/A N/A $506.55 29843 ARTHROSCOPY, WRIST, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE $89.66 N/A N/A $448.28 29850 ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF THE KNEE, WITH OR WITHOUT MANIPULATION; WITHOUT INTERNAL OR EXTERNAL FIXATION (INCLUDES ARTHROSCOPY) $104.16 N/A N/A $520.81 29871 ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE N/A N/A N/A $484.01 29874 ARTHROSCOPY, KNEE, SURGICAL; FOR REMOVAL OF LOOSE BODY OR FOREIGN BODY (EG, OSTEOCHONDRITIS DISSECANS FRAGMENTATION, CHONDRAL FRAGMENTATION) $101.78 N/A N/A $508.88 [Continued on next Web Page]
[Continued from previous Web Page] Procedure Codes with Fees Exceeding 100% Medicare Code Description Assistant Surgeon Fee Revision (Billing with Modifier 80) Professional Component Fee Revision (Billing with Modifier 26) Technical Component Fee Revision (Billing with Modifier TC) Total Fee Revision (Billing with No Modifier) 29875 ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG, PLICA OR SHELF RESECTION) (SEPARATE PROCEDURE) $94.54 N/A N/A $472.71 29894 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY $99.13 N/A N/A $495.66 29895 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; SYNOVECTOMY, PARTIAL $97.22 N/A N/A $486.10 29897 ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, LIMITED $101.83 N/A N/A $509.15 30150 RHINECTOMY; PARTIAL N/A N/A N/A $751.80 30160 RHINECTOMY; TOTAL $147.92 N/A N/A $739.60 30540 REPAIR CHOANAL ATRESIA; INTRANASAL N/A N/A N/A $631.70 31239 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DACRYOCYSTORHINOSTOMY $124.48 N/A N/A $622.42 31240 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION $33.14 N/A N/A $165.72 31255 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, TOTAL (ANTERIOR AND POSTERIOR) $85.30 N/A N/A $426.52 31287 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; $48.84 N/A N/A $244.18 31288 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS $56.73 N/A N/A $283.64 31292 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH MEDIAL OR INFERIOR ORBITAL WALL DECOMPRESSION $191.86 N/A N/A $959.28 31512 LARYNGOSCOPY, INDIRECT; WITH REMOVAL OF LESION N/A N/A N/A $130.44 31513 LARYNGOSCOPY, INDIRECT; WITH VOCAL CORD INJECTION N/A N/A N/A $134.69 31528 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATION, INITIAL N/A N/A N/A $145.53 31535 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY N/A N/A N/A $196.06 31540 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS N/A N/A N/A $253.39 31560 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY N/A N/A N/A $327.70 31561 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY; WITH OPERATING MICROSCOPE OR TELESCOPE N/A N/A N/A $357.51 31576 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH BIOPSY N/A N/A N/A $123.03 31578 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL OF LESION N/A N/A N/A $166.61 31603 TRACHEOSTOMY, EMERGENCY PROCEDURE; TRANSTRACHEAL N/A N/A N/A $228.79 31605 TRACHEOSTOMY, EMERGENCY PROCEDURE; CRICOTHYROID MEMBRANE N/A N/A N/A $188.19 31630 BRONCHOSCOPY, RIGID OR FLEXIBLE, WITH OR WITHOUT FLUOROSCOPIC GUIDANCE; WITH TRACHEAL/BRONCHIAL DILATION OR CLOSED REDUCTION OF FRACTURE N/A N/A N/A $212.96 31643 BRONCHOSCOPY, (RIGID OR FLEXIBLE); WITH PLACEMENT OF CATHETER(S) FOR INTRACAVITARY RADIOELEMENT APPLICATION N/A N/A N/A $180.42 31710 CATHETERIZATION FOR BRONCHOGRAPHY, WITH OR WITHOUT INSTILLATION OF CONTRAST MATERIAL N/A N/A N/A $66.95 31820 SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITHOUT PLASTIC REPAIR N/A N/A N/A $306.50 32020 TUBE THORACOSTOMY WITH OR WITHOUT WATER SEAL (EG, FOR ABSCESS, HEMOTHORAX, EMPYEMA) (SEPARATE PROCEDURE) N/A N/A N/A $209.74 32160 THORACOTOMY, MAJOR; WITH CARDIAC MASSAGE $114.51 N/A N/A $572.57 32402 BIOPSY, PLEURA; OPEN $98.77 N/A N/A $493.83 32405 BIOPSY, LUNG OR MEDIASTINUM, PERCUTANEOUS NEEDLE N/A N/A N/A $98.04 32420 PNEUMOCENTESIS, PUNCTURE OF LUNG FOR ASPIRATION N/A N/A N/A $109.53 32501 RESECTION AND REPAIR OF PORTION OF BRONCHUS (BRONCHOPLASTY) WHEN PERFORMED AT TIME OF LOBECTOMY OR SEGMENTECTOMY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $49.97 N/A N/A $249.86 32602 THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); LUNGS AND PLEURAL SPACE, WITH BIOPSY $67.71 N/A N/A $338.55 32651 THORACOSCOPY, SURGICAL; WITH PARTIAL PULMONARY DECORTICATION $158.63 N/A N/A $793.14 32653 THORACOSCOPY, SURGICAL; WITH REMOVAL OF INTRAPLEURAL FOREIGN BODY OR FIBRIN DEPOSIT $156.67 N/A N/A $783.35 32654 THORACOSCOPY, SURGICAL; WITH CONTROL OF TRAUMATIC HEMORRHAGE $155.71 N/A N/A $778.56 32655 THORACOSCOPY, SURGICAL; WITH EXCISION-PLICATION OF BULLAE, INCLUDING ANY PLEURAL PROCEDURE $160.32 N/A N/A $801.60 32656 THORACOSCOPY, SURGICAL; WITH PARIETAL PLEURECTOMY $163.67 N/A N/A $818.33 32657 THORACOSCOPY, SURGICAL; WITH WEDGE RESECTION OF LUNG, SINGLE OR MULTIPLE $168.11 N/A N/A $840.54 32658 THORACOSCOPY, SURGICAL; WITH REMOVAL OF CLOT OR FOREIGN BODY FROM PERICARDIAL SAC $148.71 N/A N/A $743.54 32659 THORACOSCOPY, SURGICAL; WITH CREATION OF PERICARDIAL WINDOW OR PARTIAL RESECTION OF PERICARDIAL SAC FOR DRAINAGE $148.66 N/A N/A $743.31 32662 THORACOSCOPY, SURGICAL; WITH EXCISION OF MEDIASTINAL CYST, TUMOR OR MASS $198.22 N/A N/A $991.08 32665 THORACOSCOPY, SURGICAL; WITH ESOPHAGOMYOTOMY (HELLER TYPE) $186.49 N/A N/A $932.44 33010 PERICARDIOCENTESIS; INITIAL N/A N/A N/A $115.83 33011 PERICARDIOCENTESIS; SUBSEQUENT N/A N/A N/A $117.16 33206 INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL $84.22 N/A N/A $421.08 33207 INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); VENTRICULAR N/A N/A N/A $481.98 33208 INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL AND VENTRICULAR N/A N/A N/A $488.23 33210 INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS SINGLE CHAMBER CARDIAC ELECTRODE OR PACEMAKER CATHETER (SEPARATE PROCEDURE) N/A N/A N/A $173.29 33211 INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS DUAL CHAMBER PACING ELECTRODES (SEPARATE PROCEDURE) $35.93 N/A N/A $179.67 33213 INSERTION OR REPLACEMENT OF PACEMAKER PULSE GENERATOR ONLY; DUAL CHAMBER $76.46 N/A N/A $382.28 33216 INSERTION OF A TRANSVENOUS ELECTRODE; SINGLE CHAMBER (ONE ELECTRODE) PERMANENT PACEMAKER OR SINGLE CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR N/A N/A N/A $373.58 33218 REPAIR OF SINGLE TRANSVENOUS ELECTRODE FOR A SINGLE CHAMBER, PERMANENT PACEMAKER OR SINGLE CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR N/A N/A N/A $364.42 33222 REVISION OR RELOCATION OF SKIN POCKET FOR PACEMAKER N/A N/A N/A $347.41 33223 REVISION OF SKIN POCKET FOR SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR $83.09 N/A N/A $415.43 33233 REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR $48.70 N/A N/A $243.52 33249 INSERTION OR REPOSITIONING OF ELECTRODE LEAD(S) FOR SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR AND INSERTION OF PULSE GENERATOR N/A N/A N/A $848.50 33282 IMPLANTATION OF PATIENT-ACTIVATED CARDIAC EVENT RECORDER $60.49 N/A N/A $302.44 33284 REMOVAL OF AN IMPLANTABLE, PATIENT-ACTIVATED CARDIAC EVENT RECORDER $44.01 N/A N/A $220.03 33517 CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); SINGLE VEIN GRAFT (LIST SEPARATELY IN ADDITION TO CODE FOR ARTERIAL GRAFT) $27.60 N/A N/A $138.02 33518 CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); TWO VENOUS GRAFTS (LIST SEPARATELY IN ADDITION TO CODE FOR ARTERIAL GRAFT) $51.95 N/A N/A $259.73 33519 CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); THREE VENOUS GRAFTS (LIST SEPARATELY IN ADDITION TO CODE FOR ARTERIAL GRAFT) $76.17 N/A N/A $380.87 33521 CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); FOUR VENOUS GRAFTS (LIST SEPARATELY IN ADDITION TO CODE FOR ARTERIAL GRAFT) $100.60 N/A N/A $502.99 33522 CORONARY ARTERY BYPASS, USING VENOUS GRAFT(S) AND ARTERIAL GRAFT(S); FIVE VENOUS GRAFTS (LIST SEPARATELY IN ADDITION TO CODE FOR ARTERIAL GRAFT) $125.23 N/A N/A $626.15 33530 REOPERATION, CORONARY ARTERY BYPASS PROCEDURE OR VALVE PROCEDURE, MORE THAN ONE MONTH AFTER ORIGINAL OPERATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $62.84 N/A N/A $314.21 33572 CORONARY ENDARTERECTOMY, OPEN, ANY METHOD, OF LEFT ANTERIOR DESCENDING, CIRCUMFLEX, OR RIGHT CORONARY ARTERY PERFORMED IN CONJUNCTION WITH CORONARY ARTERY BYPASS GRAFT PROCEDURE, EACH VESSEL (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE) $47.54 N/A N/A $237.69 33924 LIGATION AND TAKEDOWN OF A SYSTEMIC-TO-PULMONARY ARTERY SHUNT, PERFORMED IN CONJUNCTION WITH A CONGENITAL HEART PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $59.27 N/A N/A $296.34 33961 PROLONGED EXTRACORPOREAL CIRCULATION FOR CARDIOPULMONARY INSUFFICIENCY; EACH ADDITIONAL 24 HOURS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $112.82 N/A N/A $564.09 33968 REMOVAL OF INTRA-AORTIC BALLOON ASSIST DEVICE, PERCUTANEOUS N/A N/A N/A $34.25 33970 INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE THROUGH THE FEMORAL ARTERY, OPEN APPROACH N/A N/A N/A $358.76 33973 INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE THROUGH THE ASCENDING AORTA $104.30 N/A N/A $521.48 34051 EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; INNOMINATE, SUBCLAVIAN ARTERY, BY THORACIC INCISION $181.90 N/A N/A $909.49 34201 EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; FEMOROPOPLITEAL, AORTOILIAC ARTERY, BY LEG INCISION $121.85 N/A N/A $609.26 35180 REPAIR, CONGENITAL ARTERIOVENOUS FISTULA; HEAD AND NECK $156.77 N/A N/A $783.87 35188 REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA; HEAD AND NECK $173.52 N/A N/A $867.60 35190 REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA; EXTREMITIES $151.79 N/A N/A $758.96 35207 REPAIR BLOOD VESSEL, DIRECT; HAND, FINGER $136.21 N/A N/A $681.04 35390 REOPERATION, CAROTID, THROMBOENDARTERECTOMY, MORE THAN ONE MONTH AFTER ORIGINAL OPERATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $34.24 N/A N/A $171.18 35450 TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; RENAL OR OTHER VISCERAL ARTERY $108.22 N/A N/A $541.09 35454 TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; ILIAC $66.88 N/A N/A $334.40 35456 TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; FEMORAL-POPLITEAL N/A N/A N/A $404.62 35458 TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; BRACHIOCEPHALIC TRUNK OR BRANCHES, EACH VESSEL $103.34 N/A N/A $516.71 35459 TRANSLUMINAL BALLOON ANGIOPLASTY, OPEN; TIBIOPERONEAL TRUNK AND BRANCHES $94.47 N/A N/A $472.34 35480 TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; RENAL OR OTHER VISCERAL ARTERY $119.34 N/A N/A $596.69 35481 TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; AORTIC $84.20 N/A N/A $420.99 35482 TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; ILIAC $73.34 N/A N/A $366.68 35483 TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; FEMORAL-POPLITEAL $89.06 N/A N/A $445.29 35484 TRANSLUMINAL PERIPHERAL ATHERECTOMY, OPEN; BRACHIOCEPHALIC TRUNK OR BRANCHES, EACH VESSEL $112.58 N/A N/A $562.90 35492 TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; ILIAC $74.83 N/A N/A $374.16 35493 TRANSLUMINAL PERIPHERAL ATHERECTOMY, PERCUTANEOUS; FEMORAL-POPLITEAL $90.79 N/A N/A $453.94 35681 BYPASS GRAFT; COMPOSITE, PROSTHETIC AND VEIN (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $17.16 N/A N/A $85.78 35682 BYPASS GRAFT; AUTOGENOUS COMPOSITE, TWO SEGMENTS OF VEINS FROM TWO LOCATIONS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $77.13 N/A N/A $385.64 35683 BYPASS GRAFT; AUTOGENOUS COMPOSITE, THREE OR MORE SEGMENTS OF VEIN FROM TWO OR MORE LOCATIONS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $91.03 N/A N/A $455.14 35700 REOPERATION, FEMORAL-POPLITEAL OR FEMORAL (POPLITEAL)-ANTERIOR TIBIAL, POSTERIOR TIBIAL, PERONEAL ARTERY OR OTHER DISTAL VESSELS, MORE THAN 1 MONTH AFTER ORIGINAL OPERATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $33.01 N/A N/A $165.03 35860 EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; EXTREMITY $74.38 N/A N/A $371.88 35875 THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT (OTHER THAN HEMODIALYSIS GRAFT OR FISTULA) $120.79 N/A N/A $603.97 36000 INTRODUCTION OF NEEDLE OR INTRACATHETER, VEIN N/A N/A N/A $8.84 36450 EXCHANGE TRANSFUSION, BLOOD; NEWBORN N/A N/A N/A $115.20 36455 EXCHANGE TRANSFUSION, BLOOD; OTHER THAN NEWBORN N/A N/A N/A $131.20 36550 DECLOTTING BY THROMBOLYTIC AGENT OF IMPLANTED VASCULAR ACCESS DEVICE OR CATHETER N/A N/A N/A $24.63 36590 REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION N/A N/A N/A $197.30 36620 ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION (SEPARATE PROCEDURE); PERCUTANEOUS N/A N/A N/A $53.58 36800 INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); ARTERIOVENOUS, EXTERNAL REVISION, OR CLOSURE N/A N/A N/A $161.60 36810 INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); ARTERIOVENOUS, EXTERNAL (SCRIBNER TYPE) N/A N/A N/A $221.25 36815 INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE (SEPARATE PROCEDURE); ARTERIOVENOUS, EXTERNAL REVISION, OR CLOSURE N/A N/A N/A $149.98 36821 ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE (EG, CIMINO TYPE) (SEPARATE PROCEDURE) N/A N/A N/A $534.91 36825 CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); AUTOGENOUS GRAFT N/A N/A N/A $586.74 36830 CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT (EG, BIOLOGICAL COLLAGEN, THERMOPLASTIC GRAFT) N/A N/A N/A $684.18 36832 REVISION, OPEN, ARTERIOVENOUS FISTULA; WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE) $120.57 N/A N/A $602.84 36834 PLASTIC REPAIR OF ARTERIOVENOUS ANEURYSM (SEPARATE PROCEDURE) $116.37 N/A N/A $581.87 36835 INSERTION OF THOMAS SHUNT (SEPARATE PROCEDURE) $89.71 N/A N/A $448.54 36860 EXTERNAL CANNULA DECLOTTING (SEPARATE PROCEDURE); WITHOUT BALLOON CATHETER N/A N/A N/A $102.78 36861 EXTERNAL CANNULA DECLOTTING (SEPARATE PROCEDURE); WITH BALLOON CATHETER N/A N/A N/A $154.68 37207 TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), (NONCORONARY VESSEL), OPEN; INITIAL VESSEL N/A N/A N/A $457.51 37208 TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), (NON-CORONARY VESSEL), OPEN; EACH ADDITIONAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $221.33 37618 LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); EXTREMITY $65.45 N/A N/A $327.25 37700 LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTIONS $50.58 N/A N/A $252.88 38102 SPLENECTOMY; TOTAL, EN BLOC FOR EXTENSIVE DISEASE, IN CONJUNCTION WITH OTHER PROCEDURE (LIST IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $51.37 N/A N/A $256.83 38230 BONE MARROW HARVESTING FOR TRANSPLANTATION N/A N/A N/A $296.75 38240 BONE MARROW OR BLOOD-DERIVED PERIPHERAL STEM CELL TRANSPLANTATION; ALLOGENIC N/A N/A N/A $123.46 38241 BONE MARROW OR BLOOD-DERIVED PERIPHERAL STEM CELL TRANSPLANTATION; AUTOLOGOUS $24.76 N/A N/A $123.80 38382 SUTURE AND/OR LIGATION OF THORACIC DUCT; ABDOMINAL APPROACH $124.07 N/A N/A $620.34 38505 BIOPSY OR EXCISION OF LYMPH NODE(S); BY NEEDLE, SUPERFICIAL (EG, CERVICAL, INGUINAL, AXILLARY) N/A N/A N/A $72.62 38700 SUPRAHYOID LYMPHADENECTOMY $109.51 N/A N/A $547.54 38747 ABDOMINAL LYMPHADENECTOMY, REGIONAL, INCLUDING CELIAC, GASTRIC, PORTAL, PERIPANCREATIC, WITH OR WITHOUT PARA-AORTIC AND VENA CAVAL NODES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $52.32 N/A N/A $261.58 38770 PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL ILIAC, HYPOGASTRIC, AND OBTURATOR NODES (SEPARATE PROCEDURE) $148.06 N/A N/A $740.29 39000 MEDIASTINOTOMY WITH EXPLORATION, DRAINAGE, REMOVAL OF FOREIGN BODY, OR BIOPSY; CERVICAL APPROACH $83.46 N/A N/A $417.28 39540 REPAIR, DIAPHRAGMATIC HERNIA (OTHER THAN NEONATAL), TRAUMATIC; ACUTE $154.40 N/A N/A $772.02 39541 REPAIR, DIAPHRAGMATIC HERNIA (OTHER THAN NEONATAL), TRAUMATIC; CHRONIC $165.92 N/A N/A $829.60 39545 IMBRICATION OF DIAPHRAGM FOR EVENTRATION, TRANSTHORACIC OR TRANSABDOMINAL, PARALYTIC OR NONPARALYTIC $164.05 N/A N/A $820.26 40525 EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH LOCAL FLAP (EG, ESTLANDER OR FAN) N/A N/A N/A $527.75 40527 EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH CROSS LIP FLAP (ABBE-ESTLANDER) N/A N/A N/A $627.19 40650 REPAIR LIP, FULL THICKNESS; VERMILION ONLY N/A N/A N/A $261.98 40818 EXCISION OF MUCOSA OF VESTIBULE OF MOUTH AS DONOR GRAFT N/A N/A N/A $233.80 41112 EXCISION OF LESION OF TONGUE WITH CLOSURE; ANTERIOR TWO-THIRDS N/A N/A N/A $222.43 41113 EXCISION OF LESION OF TONGUE WITH CLOSURE; POSTERIOR ONE-THIRD N/A N/A N/A $250.24 42106 EXCISION, LESION OF PALATE, UVULA; WITH SIMPLE PRIMARY CLOSURE N/A N/A N/A $170.97 42107 EXCISION, LESION OF PALATE, UVULA; WITH LOCAL FLAP CLOSURE N/A N/A N/A $316.69 42120 RESECTION OF PALATE OR EXTENSIVE RESECTION OF LESION $130.54 N/A N/A $652.70 42145 PALATOPHARYNGOPLASTY (EG, UVULOPALATOPHARYNGOPLASTY, UVULOPHARYNGOPLASTY) N/A N/A N/A $581.27 42220 PALATOPLASTY FOR CLEFT PALATE; SECONDARY LENGTHENING PROCEDURE $104.08 N/A N/A $520.41 42280 MAXILLARY IMPRESSION FOR PALATAL PROSTHESIS N/A N/A N/A $103.14 42408 EXCISION OF SUBLINGUAL SALIVARY CYST (RANULA) N/A N/A N/A $309.17 42450 EXCISION OF SUBLINGUAL GLAND N/A N/A N/A $333.16 42507 PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE) N/A N/A N/A $470.04 42508 PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH EXCISION OF ONE SUBMANDIBULAR GLAND $132.41 N/A N/A $662.03 42509 PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH EXCISION OF BOTH SUBMANDIBULAR GLANDS N/A N/A N/A $814.34 42510 PAROTID DUCT DIVERSION, BILATERAL (WILKE TYPE PROCEDURE); WITH LIGATION OF BOTH SUBMANDIBULAR (WHARTONOS) DUCTS $119.12 N/A N/A $595.62 43020 ESOPHAGOTOMY, CERVICAL APPROACH, WITH REMOVAL OF FOREIGN BODY $103.68 N/A N/A $518.40 43100 EXCISION OF LESION, ESOPHAGUS, WITH PRIMARY REPAIR; CERVICAL APPROACH $117.92 N/A N/A $589.61 43204 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INJECTION SCLEROSIS OF ESOPHAGEAL VARICES N/A N/A $203.62 43215 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF FOREIGN BODY $29.25 N/A N/A $146.27 43216 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY $26.66 N/A N/A $133.30 43220 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BALLOON DILATION (LESS THAN 30 MM DIAMETER) N/A N/A N/A $117.94 43226 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INSERTION OF GUIDE WIRE FOLLOWED BY DILATION OVER GUIDE WIRE N/A N/A N/A $129.69 43227 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR CAUTERY, LASER, HEATER PROBE, STAPLER, PLASMA COAGULATOR) N/A N/A N/A $194.17 43231 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION N/A N/A N/A $172.70 43241 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH TRANSENDOSCOPIC INTRALUMINAL TUBE OR CATHETER PLACEMENT N/A N/A N/A $142.17 43243 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH INJECTION SCLEROSIS OF ESOPHAGEAL AND/OR GASTRIC VARICES N/A N/A N/A $244.42 43245 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH DILATION OF GASTRIC OUTLET FOR OBSTRUCTION (EG, BALLOON, GUIDE WIRE, BOUGIE) N/A N/A N/A $172.89 43246 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH DIRECTED PLACEMENT OF PERCUTANEOUS GASTROSTOMY TUBE $46.37 N/A N/A $231.87 43247 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH REMOVAL OF FOREIGN BODY N/A N/A N/A $183.17 43249 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER) $31.60 N/A N/A $157.98 43250 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY $34.80 N/A N/A $173.99 43251 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS, STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE N/A N/A N/A $199.29 43260 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE) N/A N/A N/A $316.90 43261 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH BIOPSY, SINGLE OR MULTIPLE $66.67 N/A N/A $333.33 43262 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH SPHINCTEROTOMY/PAPILLOTOMY N/A N/A N/A $391.55 43267 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE INSERTION OF NASOBILIARY OR NASOPANCREATIC DRAINAGE TUBE N/A N/A N/A $391.55 [Continued on next Web Page]
[Continued from previous Web Page] Procedure Codes with Fees Exceeding 100% Medicare Code Description Assistant Surgeon Fee Revision (Billing with Modifier 80) Professional Component Fee Revision (Billing with Modifier 26) Technical Component Fee Revision (Billing with Modifier TC) Total Fee Revision (Billing with No Modifier) 43268 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE INSERTION OF TUBE OR STENT INTO BILE OR PANCREATIC DUCT N/A N/A N/A $394.97 43269 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE REMOVAL OF FOREIGN BODY AND/OR CHANGE OF TUBE OR STENT N/A N/A N/A $434.37 43271 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE BALLOON DILATION OF AMPULLA, BILIARY AND/OR PANCREATIC DUCT(S) N/A N/A N/A $391.55 43272 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE N/A N/A N/A $391.55 43300 ESOPHAGOPLASTY, (PLASTIC REPAIR OR RECONSTRUCTION), CERVICAL APPROACH; WITHOUT REPAIR OF TRACHEOESOPHAGEAL FISTULA $119.73 N/A N/A $598.65 43635 VAGOTOMY WHEN PERFORMED WITH PARTIAL DISTAL GASTRECTOMY (LIST SEPARATELY IN ADDITION TO CODE(S) FOR PRIMARY PROCEDURE) $22.05 N/A N/A $110.24 43761 REPOSITIONING OF THE GASTRIC FEEDING TUBE, ANY METHOD, THROUGH THE DUODENUM FOR ENTERIC NUTRITION N/A N/A N/A $102.71 44015 TUBE OR NEEDLE CATHETER JEJUNOSTOMY FOR ENTERAL ALIMENTATION, INTRAOPERATIVE, ANY METHOD (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE) N/A N/A N/A $140.06 44121 ENTERECTOMY, RESECTION OF SMALL INTESTINE; EACH ADDITIONAL RESECTION AND ANASTOMOSIS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $47.59 N/A N/A $237.94 44139 MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN CONJUNCTION WITH PARTIAL COLECTOMY (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE) $23.81 N/A N/A $119.04 44360 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE) N/A N/A N/A $141.56 44361 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH BIOPSY, SINGLE OR MULTIPLE N/A N/A N/A $156.20 44363 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH REMOVAL OF FOREIGN BODY N/A N/A N/A $187.68 44364 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE N/A N/A N/A $200.54 44365 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY $35.85 N/A N/A $179.26 44373 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH CONVERSION OF PERCUTANEOUS GASTROSTOMY TUBE TO PERCUTANEOUS JEJUNOSTOMY TUBE N/A N/A N/A $189.05 44376 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLUDING ILEUM; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE) $56.24 N/A N/A $281.18 44377 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLUDING ILEUM; WITH BIOPSY, SINGLE OR MULTIPLE $58.91 N/A N/A $294.57 44378 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLUDING ILEUM; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR CAUTERY, LASER, HEATER PROBE, STAPLER, PLASMA COAGULATOR) $75.60 N/A N/A $378.01 44380 ILEOSCOPY, THROUGH STOMA; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE) N/A N/A N/A $61.04 44382 ILEOSCOPY, THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE N/A N/A N/A $73.33 44385 ENDOSCOPIC EVALUATION OF SMALL INTESTINAL (ABDOMINAL OR PELVIC) POUCH; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE) N/A N/A N/A $99.19 44392 COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY N/A N/A N/A $205.71 44393 COLONOSCOPY THROUGH STOMA; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE N/A N/A N/A $259.80 44955 APPENDECTOMY; WHEN DONE FOR INDICATED PURPOSE AT TIME OF OTHER MAJOR PROCEDURE (NOT AS SEPARATE PROCEDURE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $82.55 45123 PROCTECTOMY, PARTIAL, WITHOUT ANASTOMOSIS, PERINEAL APPROACH $184.70 N/A N/A $923.48 45150 DIVISION OF STRICTURE OF RECTUM N/A N/A N/A $334.66 45307 PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF FOREIGN BODY N/A N/A N/A $55.39 45308 PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP OR OTHER LESION BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY N/A N/A N/A $49.24 45320 PROCTOSIGMOIDOSCOPY, RIGID; WITH ABLATION OF TUMOR(S), POLYP(S) OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE (EG, LASER) N/A N/A N/A $89.04 45321 PROCTOSIGMOIDOSCOPY, RIGID; WITH DECOMPRESSION OF VOLVULUS N/A N/A N/A $67.45 45337 SIGMOIDOSCOPY, FLEXIBLE; WITH DECOMPRESSION OF VOLVULUS, ANY METHOD N/A N/A N/A $130.04 45339 SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S) OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE N/A N/A N/A $170.69 45341 SIGMOIDOSCOPY, FLEXIBLE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION N/A N/A N/A $140.91 46030 REMOVAL OF ANAL SETON, OTHER MARKER N/A N/A N/A $75.16 46715 REPAIR OF LOW IMPERFORATE ANUS; WITH ANOPERINEAL FISTULA (CUT-BACK PROCEDURE) N/A N/A N/A $422.96 46751 SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE OR PROLAPSE; CHILD $109.26 N/A N/A $546.31 47505 INJECTION PROCEDURE FOR CHOLANGIOGRAPHY THROUGH AN EXISTING CATHETER (EG, PERCUTANEOUS TRANSHEPATIC OR T-TUBE) N/A N/A N/A $38.57 47550 BILIARY ENDOSCOPY, INTRAOPERATIVE (CHOLEDOCHOSCOPY) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $161.54 48102 BIOPSY OF PANCREAS, PERCUTANEOUS NEEDLE N/A N/A N/A $252.19 48400 INJECTION PROCEDURE FOR INTRAOPERATIVE PANCREATOGRAPHY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $100.36 49180 BIOPSY, ABDOMINAL OR RETROPERITONEAL MASS, PERCUTANEOUS NEEDLE N/A N/A N/A $88.10 49420 INSERTION OF INTRAPERITONEAL CANNULA OR CATHETER FOR DRAINAGE OR DIALYSIS; TEMPORARY N/A N/A N/A $127.81 49422 REMOVAL OF PERMANENT INTRAPERITONEAL CANNULA OR CATHETER N/A N/A N/A $360.97 49568 IMPLANTATION OF MESH OR OTHER PROSTHESIS FOR INCISIONAL OR VENTRAL HERNIA REPAIR (LIST SEPARATELY IN ADDITION TO CODE FOR THE INCISIONAL OR VENTRAL HERNIA REPAIR) $52.32 N/A N/A $261.58 49572 REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); INCARCERATED OR STRANGULATED $80.03 N/A N/A $400.17 49580 REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; REDUCIBLE $52.15 N/A N/A $260.75 49582 REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; INCARCERATED OR STRANGULATED $79.43 N/A N/A $397.14 49905 OMENTAL FLAP, INTRA-ABDOMINAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $69.88 N/A N/A $349.38 50390 ASPIRATION AND/OR INJECTION OF RENAL CYST OR PELVIS BY NEEDLE, PERCUTANEOUS N/A N/A N/A $99.82 50392 INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS N/A N/A N/A $185.78 50393 INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETER THROUGH RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS N/A N/A N/A $226.10 50394 INJECTION PROCEDURE FOR PYELOGRAPHY (AS NEPHROSTOGRAM, PYELOSTOGRAM, ANTEGRADE PYELOURETEROGRAMS) THROUGH NEPHROSTOMY OR PYELOSTOMY TUBE, OR INDWELLING URETERAL CATHETER N/A N/A N/A $52.89 50395 INTRODUCTION OF GUIDE INTO RENAL PELVIS AND/OR URETER WITH DILATION TO ESTABLISH NEPHROSTOMY TRACT, PERCUTANEOUS N/A N/A N/A $185.40 50575 RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH ENDOPYELOTOMY (INCLUDES CYSTOSCOPY, URETEROSCOPY, DILATION OF URETER AND URETERAL PELVIC JUNCTION,AND INSERTION OF ENDOPHYELOTOMY STENT) $143.58 N/A N/A $717.90 50980 URETERAL ENDOSCOPY THROUGH URETEROTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH REMOVAL OF FOREIGN BODY OR CALCULUS N/A N/A N/A $355.24 51020 CYSTOTOMY OR CYSTOSTOMY; WITH FULGURATION AND/OR INSERTION OF RADIOACTIVE MATERIAL $80.04 N/A N/A $400.22 51030 CYSTOTOMY OR CYSTOSTOMY; WITH CRYOSURGICAL DESTRUCTION OF INTRAVESICAL LESION $81.99 N/A N/A $409.95 51050 CYSTOLITHOTOMY, CYSTOTOMY WITH REMOVAL OF CALCULUS, WITHOUT VESICAL NECK RESECTION $80.32 N/A N/A $401.61 51798 MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND, NONIMAGING N/A N/A N/A $14.07 51845 ABDOMINO-VAGINAL VESICAL NECK SUSPENSION, WITH OR WITHOUT ENDOSCOPIC CONTROL (EG, STAMEY, RAZ, MODIFIED PEREYRA) N/A N/A N/A $554.87 51980 CUTANEOUS VESICOSTOMY $128.06 N/A N/A $640.28 52235 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF; MEDIUM BLADDER TUMOR(S) (2.0 TO 5.0 CM) N/A N/A N/A $284.39 52276 CYSTOURETHROSCOPY WITH DIRECT VISION INTERNAL URETHROTOMY N/A N/A N/A $260.99 52301 CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ECTOPIC URETEROCELE(S), UNILATERAL OR BILATERAL N/A N/A N/A $290.51 52320 CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH REMOVAL OF URETERAL CALCULUS N/A N/A N/A $243.54 52325 CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH FRAGMENTATION OF URETERAL CALCULUS (EG, ULTRASONIC OR ELECTRO-HYDRAULIC TECHNIQUE) N/A N/A N/A $318.98 52612 TRANSURETHRAL RESECTION OF PROSTATE; FIRST STAGE OF TWO-STAGE RESECTION (PARTIAL RESECTION) N/A N/A N/A $446.99 52614 TRANSURETHRAL RESECTION OF PROSTATE; SECOND STAGE OF TWO-STAGE RESECTION (RESECTION COMPLETED) N/A N/A N/A $388.02 52630 TRANSURETHRAL RESECTION; OF REGROWTH OF OBSTRUCTIVE TISSUE LONGER THAN 1 YEAR POSTOPERATIVE N/A N/A N/A $399.72 54065 DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY) N/A N/A N/A $137.73 54111 EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT TO 5 CM IN LENGTH $148.08 N/A N/A $740.42 54112 EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT GREATER THAN 5 CM IN LENGTH $173.40 N/A N/A $866.99 54115 REMOVAL FOREIGN BODY FROM DEEP PENILE TISSUE (EG, PLASTIC IMPLANT) N/A N/A N/A $364.10 54328 ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH EXTENSIVE DISSECTION TO CORRECT CHORDEE AND URETHROPLASTY WITH LOCAL SKIN FLAPS, SKIN GRAFT PATCH AND/OR ISLAND FLAP $174.09 N/A N/A $870.44 54332 ONE STAGE PROXIMAL PENILE OR PENOSCROTAL HYPOSPADIAS REPAIR REQUIRING EXTENSIVE DISSECTION TO CORRECT CHORDEE AND URETHROPLASTY BY USE OF SKIN GRAFT TUBE AND/OR ISLAND FLAP $189.54 N/A N/A $947.69 54344 REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); REQUIRING MOBILIZATION OF SKIN FLAPS AND URETHROPLASTY WITH FLAP OR PATCH GRAFT $183.13 N/A N/A $915.63 54348 REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); REQUIRING EXTENSIVE DISSECTION AND URETHROPLASTY WITH FLAP, PATCH OR TUBED GRAFT (INCLUDES URINARY DIVERSION) $194.43 N/A N/A $972.15 54430 CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT (PRIAPISM OPERATION), UNILATERAL OR BILATERAL $116.11 N/A N/A $580.57 55680 EXCISION OF MULLERIAN DUCT CYST $62.44 N/A N/A $312.19 56606 BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); EACH SEPARATE ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $30.50 56720 HYMENOTOMY, SIMPLE INCISION N/A N/A N/A $45.65 57065 DESTRUCTION OF VAGINAL LESION(S); EXTENSIVE (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY) N/A N/A N/A $165.47 57282 COLPOPEXY, VAGINAL; EXTRA-PERITONEAL APPROACH (SACROSPINOUS, ILIOCOCCYGEUS) $89.06 N/A N/A $445.30 57284 PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, STRESS URINARY INCONTINENCE, AND/OR INCOMPLETE VAGINAL PROLAPSE) $153.67 N/A N/A $768.36 57291 CONSTRUCTION OF ARTIFICIAL VAGINA; WITHOUT GRAFT N/A N/A N/A $497.84 57308 CLOSURE OF RECTOVAGINAL FISTULA; TRANSPERINEAL APPROACH, WITH PERINEAL BODY RECONSTRUCTION, WITH OR WITHOUT LEVATOR PLICATION N/A N/A N/A $585.48 57310 CLOSURE OF URETHROVAGINAL FISTULA $80.87 N/A N/A $404.33 57311 CLOSURE OF URETHROVAGINAL FISTULA; WITH BULBOCAVERNOSUS TRANSPLANT $92.55 N/A N/A $462.73 57320 CLOSURE OF VESICOVAGINAL FISTULA; VAGINAL APPROACH $94.73 N/A N/A $473.64 57522 CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION N/A N/A N/A $223.57 57556 EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; WITH REPAIR OF ENTEROCELE $102.21 N/A N/A $511.06 57820 DILATION AND CURETTAGE OF CERVICAL STUMP N/A N/A N/A $108.37 58960 LAPAROTOMY, FOR STAGING OR RESTAGING OF OVARIAN, TUBAL OR PRIMARY PERITONEAL MALIGNANCY (SECOND LOOK), WITH OR WITHOUT OMENTECTOMY, PERITONEAL WASHING, BIOPSY OF ABDOMINAL AND PELVIC PERITONEUM, DIAPHRAGMATIC ASSESSMENT WITH PELVIC AND LIMITED PARA-AORTIC LYPHADENECTOMY $172.21 N/A N/A $861.05 59856 INDUCED ABORTION, BY ONE OR MORE VAGINAL SUPPOSITORIES (EG, PROSTAGLANDIN) WITH OR WITHOUT CERVICAL DILATION (EG, LAMINARIA), INCLUDING HOSPITAL ADMISSION AND VISITS, DELIVERY OF FETUS AND SECUNDINES; WITH DILATION AND CURETTAGE AND/OR EVACUATION N/A N/A N/A $476.59 59857 INDUCED ABORTION, BY ONE OR MORE VAGINAL SUPPOSITORIES (EG, PROSTAGLANDIN) WITH OR WITHOUT CERVICAL DILATION (EG, LAMINARIA), INCLUDING HOSPITAL ADMISSION AND VISITS, DELIVERY OF FETUS AND SECUNDINES; WITH HYSTEROTOMY (FAILED MEDICAL EVACUATION) N/A N/A N/A $574.43 60210 PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY $128.45 N/A N/A $642.27 60212 PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERAL SUBTOTAL LOBECTOMY, INCLUDING ISTHMUSECTOMY $185.77 N/A N/A $928.87 60271 THYROIDECTOMY, INCLUDING SUBSTERNAL THYROID; CERVICAL APPROACH $196.76 N/A N/A $983.81 60512 PARATHYROID AUTOTRANSPLANTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $47.97 N/A N/A $239.83 61000 SUBDURAL TAP THROUGH FONTANELLE, OR SUTURE, INFANT, UNILATERAL OR BILATERAL; INITIAL N/A N/A N/A $96.32 61001 SUBDURAL TAP THROUGH FONTANELLE, OR SUTURE, INFANT, UNILATERAL OR BILATERAL; SUBSEQUENT TAPS N/A N/A N/A $97.59 61020 VENTRICULAR PUNCTURE THROUGH PREVIOUS BURR HOLE, FONTANELLE, SUTURE OR IMPLANTED VENTRICULAR CATHETER/RESERVOIR; WITHOUT INJECTION N/A N/A N/A $113.42 61026 VENTRICULAR PUNCTURE THROUGH PREVIOUS BURR HOLE, FONTANELLE, SUTURE, OR IMPLANTED VENTRICULAR CATHETER/RESERVOIR; WITH INJECTION OF MEDICATION OR OTHER SUBSTANCE FOR DIAGNOSIS OR TREATMENT N/A N/A N/A $121.64 61050 CISTERNAL OR LATERAL CERVICAL (C1-C2) PUNCTURE; WITHOUT INJECTION (SEPARATE PROCEDURE) N/A N/A N/A $104.00 61105 TWIST DRILL HOLE FOR SUBDURAL OR VENTRICULAR PUNCTURE N/A N/A N/A $369.42 61107 TWIST DRILL HOLE FOR SUBDURAL OR VENTRICULAR PUNCTURE; FOR IMPLANTING VENTRICULAR CATHETER OR PRESSURE RECORDING DEVICE N/A N/A N/A $315.34 61210 BURR HOLE(S); FOR IMPLANTING VENTRICULAR CATHETER, RESERVOIR, EEG ELECTRODE(S) OR PRESSURE RECORDING DEVICE (SEPARATE PROCEDURE) N/A N/A N/A $366.58 61215 INSERTION OF SUBCUTANEOUS RESERVOIR, PUMP OR CONTINUOUS INFUSION SYSTEM FOR CONNECTION TO VENTRICULAR CATHETER N/A N/A N/A $360.50 61531 SUBDURAL IMPLANTATION OF STRIP ELECTRODES THROUGH ONE OR MORE BURR OR TREPHINE HOLE(S) FOR LONG TERM SEIZURE MONITORING $196.38 N/A N/A $981.92 61550 CRANIECTOMY FOR CRANIOSYNOSTOSIS; SINGLE CRANIAL SUTURE $164.39 N/A N/A $821.95 61626 TRANSCATHETER OCCLUSION OR EMBOLIZATION (EG, FOR TUMOR DESTRUCTION, TO ACHIEVE HEMOSTASIS, TO OCCLUDE A VASCULAR MALFORMATION), PERCUTANEOUS, ANY METHOD; NONCENTRAL NERVOUS SYSTEM, HEAD OR NECK (EXTRACRANIAL, BRACHIOCEPHALIC BRANCH) N/A N/A N/A $856.01 61880 REVISION OR REMOVAL OF INTRACRANIAL NEUROSTIMULATOR ELECTRODES N/A N/A N/A $445.26 61885 INSERTION OR REPLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING; WITH CONNECTION TO A SINGLE ELECTRODE ARRAY N/A N/A N/A $451.75 61888 REVISION OR REMOVAL OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER N/A N/A N/A $358.18 62140 CRANIOPLASTY FOR SKULL DEFECT; UP TO 5 CM DIAMETER $180.40 N/A N/A $902.02 62141 CRANIOPLASTY FOR SKULL DEFECT; LARGER THAN 5 CM DIAMETER $197.78 N/A N/A $988.88 62142 REMOVAL OF BONE FLAP OR PROSTHETIC PLATE OF SKULL $146.17 N/A N/A $730.87 62143 REPLACEMENT OF BONE FLAP OR PROSTHETIC PLATE OF SKULL $174.39 N/A N/A $871.96 62192 CREATION OF SHUNT; SUBARACHNOID/SUBDURAL-PERITONEAL, -PLEURAL, OTHER TERMINUS $163.32 N/A N/A $816.59 62194 REPLACEMENT OR IRRIGATION, SUBARACHNOID/SUBDURAL CATHETER N/A N/A N/A $301.76 62201 VENTRICULOCISTERNOSTOMY, THIRD VENTRICLE; STEREOTACTIC, NEUROENDOSCOPIC METHOD $199.64 N/A N/A $998.22 62287 ASPIRATION OR DECOMPRESSION PROCEDURE, PERCUTANEOUS, OF NUCLEUS PULPOSUS OF INTERVERTEBRAL DISK, ANY METHOD, SINGLE OR MULTIPLE LEVELS, LUMBAR (EG, MANUAL OR AUTOMATED PERCUTANEOUS DISKECTOMY, PERCUTANEOUS LASER DISKECTOMY) $102.79 N/A N/A $513.95 62350 IMPLANTATION, REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL OR EPIDURAL CATHETER, FOR LONG-TERM MEDICATION ADMINISTRATION VIA AN EXTERNAL PUMP OR IMPLANTABLE RESERVOIR/INFUSION PUMP; WITHOUT LAMINECTOMY $85.23 N/A N/A $426.16 62355 REMOVAL OF PREVIOUSLY IMPLANTED INTRATHECAL OR EPIDURAL CATHETER $67.24 N/A N/A $336.21 62365 REMOVAL OF SUBCUTANEOUS RESERVOIR OR PUMP, PREVIOUSLY IMPLANTED FOR INTRATHECAL OR EPIDURAL INFUSION $70.80 N/A N/A $354.01 63030 LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISK; ONE INTERSPACE, LUMBAR (INCLUDING OPEN OR ENDOSCOPICALLY-ASSISTED APPROACH) $166.83 N/A N/A $834.16 63035 LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISK; EACH ADDITIONAL INTERSPACE, CERVICAL OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $39.57 N/A N/A $197.86 63047 LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT(S), (EG, SPINAL OR LATERAL RECESS STENOSIS)), SINGLE VERTEBRAL SEGMENT; LUMBAR $198.14 N/A N/A $990.69 63048 LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT(S), (EG, SPINAL OR LATERAL RECESS STENOSIS)), SINGLE VERTEBRAL SEGMENT; EACH ADDITIONAL SEGMENT, CERVICAL, THORACIC OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $40.46 N/A N/A $202.28 63057 TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE ROOT(S) (EG, HERNIATED INTERVERTEBRAL DISK), SINGLE SEGMENT; EACH ADDITIONAL SEGMENT, THORACIC OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $65.29 N/A N/A $326.47 63066 COSTOVERTEBRAL APPROACH WITH DECOMPRESSION OF SPINAL CORD OR NERVE ROOT(S), (EG, HERNIATED INTERVERTEBRAL DISK), THORACIC; EACH ADDITIONAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $40.27 N/A N/A $201.37 63076 DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/ OR NERVE ROOT(S), INCLUDING OSTEOPHYTECTOMY; CERVICAL, EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $50.57 N/A N/A $252.85 63078 DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/ OR NERVE ROOT(S), INCLUDING OSTEOPHYTECTOMY; THORACIC, EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $40.10 N/A N/A $200.52 63082 VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, ANTERIOR APPROACH WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S); CERVICAL, EACH ADDITIONAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $54.52 N/A N/A $272.62 63086 VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, TRANSTHORACIC APPROACH WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S); THORACIC, EACH ADDITIONAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $38.65 N/A N/A $193.27 [Continued on next Web Page]
[Continued from previous Web Page] Procedure Codes with Fees Exceeding 100% Medicare Code Description Assistant Surgeon Fee Revision (Billing with Modifier 80) Professional Component Fee Revision (Billing with Modifier 26) Technical Component Fee Revision (Billing with Modifier TC) Total Fee Revision (Billing with No Modifier) 63088 VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, COMBINED THORACOLUMBAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA OR NERVE ROOT(S), LOWER THORACIC OR LUMBAR; EACH ADDITIONAL SEGMENT (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE) $52.66 N/A N/A $263.28 63091 VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, TRANSPERITONEAL OR RETROPERITONEAL APPROACH WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA OR NERVE ROOT(S), LOWER THORACIC, LUMBAR OR SACRAL; EACH ADDITIONAL SEGMENT (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE) $35.88 N/A N/A $179.40 63308 VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR EXCISION OF INTRASPINAL LESION, SINGLE SEGMENT; EACH ADDITIONAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODES FOR SINGLE SEGMENT) $65.44 N/A N/A $327.21 63655 LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL $139.93 N/A N/A $699.64 63707 REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK, NOT REQUIRING LAMINECTOMY $153.31 N/A N/A $766.53 63709 REPAIR OF DURAL/CEREBROSPINAL FLUID LEAK OR PSEUDOMENINGOCELE, WITH LAMINECTOMY $191.67 N/A N/A $958.33 63710 DURAL GRAFT, SPINAL $189.20 N/A N/A $946.02 63740 CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL, -PLEURAL, OR OTHER; INCLUDING LAMINECTOMY $154.17 N/A N/A $770.85 63741 CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL, -PLEURAL, OR OTHER; PERCUTANEOUS, NOT REQUIRING LAMINECTOMY $105.14 N/A N/A $525.69 63744 REPLACEMENT, IRRIGATION OR REVISION OF LUMBOSUBARACHNOID SHUNT $108.89 N/A N/A $544.47 63746 REMOVAL OF ENTIRE LUMBOSUBARACHNOID SHUNT SYSTEM WITHOUT REPLACEMENT N/A N/A N/A $419.25 64472 INJECTION, ANESTHETIC AGENT AND/OR STEROID, PARAVERTEBRAL FACET JOINT OR FACET JOINT NERVE; CERVICAL OR THORACIC, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $62.95 64476 INJECTION, ANESTHETIC AGENT AND/OR STEROID, PARAVERTEBRAL FACET JOINT OR FACET JOINT NERVE; LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $47.48 64480 INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL; CERVICAL OR THORACIC, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $77.48 64555 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE (EXCLUDES SACRAL NERVE) N/A N/A N/A $132.51 64575 INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE (EXCLUDES SACRAL NERVE) N/A N/A N/A $274.72 64714 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; LUMBAR PLEXUS $114.20 N/A N/A $570.98 64722 DECOMPRESSION; UNSPECIFIED NERVE(S) (SPECIFY) $59.33 N/A N/A $296.66 64726 DECOMPRESSION; PLANTAR DIGITAL NERVE N/A N/A N/A $270.24 64727 INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR NEUROPLASTY) (NEUROPLASTY INCLUDES EXTERNAL NEUROLYSIS) N/A N/A N/A $183.42 64740 TRANSECTION OR AVULSION OF; LINGUAL NERVE $81.58 N/A N/A $407.91 64742 TRANSECTION OR AVULSION OF; FACIAL NERVE, DIFFERENTIAL OR COMPLETE $83.73 N/A N/A $418.65 64752 TRANSECTION OR AVULSION OF; VAGUS NERVE (VAGOTOMY), TRANSTHORACIC $88.45 N/A N/A $442.23 64760 TRANSECTION OR AVULSION OF; VAGUS NERVE (VAGOTOMY), ABDOMINAL $81.28 N/A N/A $406.40 64761 TRANSECTION OR AVULSION OF; PUDENDAL NERVE N/A N/A N/A $379.40 64771 TRANSECTION OR AVULSION OF OTHER CRANIAL NERVE, EXTRADURAL $101.23 N/A N/A $506.14 64772 TRANSECTION OR AVULSION OF OTHER SPINAL NERVE, EXTRADURAL $96.83 N/A N/A $484.15 64778 EXCISION OF NEUROMA; DIGITAL NERVE, EACH ADDITIONAL DIGIT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A $183.19 64787 IMPLANTATION OF NERVE END INTO BONE OR MUSCLE (LIST SEPARATELY IN ADDITION TO NEUROMA EXCISION) $50.62 N/A N/A $253.11 64795 BIOPSY OF NERVE N/A N/A N/A $183.28 64832 SUTURE OF DIGITAL NERVE, HAND OR FOOT; EACH ADDITIONAL DIGITAL NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $340.58 64859 SUTURE OF EACH ADDITIONAL MAJOR PERIPHERAL NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) $51.35 N/A N/A $256.73 64868 ANASTOMOSIS; FACIAL-HYPOGLOSSAL $193.35 N/A N/A $966.75 64870 ANASTOMOSIS; FACIAL-PHRENIC $188.81 N/A N/A $944.04 64872 SUTURE OF NERVE; REQUIRING SECONDARY OR DELAYED SUTURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY NEURORRHAPHY) $24.24 N/A N/A $121.19 64874 SUTURE OF NERVE; REQUIRING EXTENSIVE MOBILIZATION, OR TRANSPOSITION OF NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR NERVE SUTURE) $35.61 N/A N/A $178.06 64876 SUTURE OF NERVE; REQUIRING SHORTENING OF BONE OF EXTREMITY (LIST SEPARATELY IN ADDITION TO CODE FOR NERVE SUTURE) $40.38 N/A N/A $201.89 65125 MODIFICATION OF OCULAR IMPLANT WITH PLACEMENT OR REPLACEMENT OF PEGS (EG, DRILLING RECEPTACLE FOR PROSTHESIS APPENDAGE) (SEPARATE PROCEDURE) N/A N/A N/A $247.45 65150 REINSERTION OF OCULAR IMPLANT; WITH OR WITHOUT CONJUNCTIVAL GRAFT N/A N/A N/A $519.45 65280 REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, NOT INVOLVING UVEAL TISSUE N/A N/A N/A $515.17 65710 KERATOPLASTY (CORNEAL TRANSPLANT); LAMELLAR N/A N/A N/A $869.79 65730 KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (EXCEPT IN APHAKIA) N/A N/A N/A $972.57 65755 KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN PSEUDOPHAKIA) N/A N/A N/A $993.30 65772 CORNEAL RELAXING INCISION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM N/A N/A N/A $310.14 65775 CORNEAL WEDGE RESECTION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM N/A N/A N/A $431.68 65855 TRABECULOPLASTY BY LASER SURGERY, ONE OR MORE SESSIONS (DEFINED TREATMENT SERIES) N/A N/A N/A $257.64 65860 SEVERING ADHESIONS OF ANTERIOR SEGMENT, LASER TECHNIQUE (SEPARATE PROCEDURE) $45.09 N/A N/A $225.46 65900 REMOVAL OF EPITHELIAL DOWNGROWTH, ANTERIOR CHAMBER OF EYE N/A N/A N/A $781.36 66155 FISTULIZATION OF SCLERA FOR GLAUCOMA; THERMOCAUTERIZATION WITH IRIDECTOMY N/A N/A N/A $646.96 66220 REPAIR OF SCLERAL STAPHYLOMA; WITHOUT GRAFT N/A N/A N/A $549.69 66225 REPAIR OF SCLERAL STAPHYLOMA; WITH GRAFT N/A N/A N/A $734.26 66625 IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; PERIPHERAL FOR GLAUCOMA (SEPARATE PROCEDURE) N/A N/A N/A $364.01 66682 SUTURE OF IRIS, CILIARY BODY (SEPARATE PROCEDURE) WITH RETRIEVAL OF SUTURE THROUGH SMALL INCISION (EG, MCCANNEL SUTURE) N/A N/A N/A $471.07 66700 CILIARY BODY DESTRUCTION; DIATHERMY N/A N/A N/A $322.79 66740 CILIARY BODY DESTRUCTION; CYCLODIALYSIS N/A N/A N/A $323.85 66821 DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR HYALOID); LASER SURGERY (EG, YAG LASER) (ONE OR MORE STAGES) N/A N/A N/A $216.51 66830 REMOVAL OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR HYALOID) WITH CORNEO-SCLERAL SECTION, WITH OR WITHOUT IRIDECTOMY (IRIDOCAPSULOTOMY, IRIDOCAPSULECTOMY) N/A N/A N/A $559.64 66850 REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR ULTRASONIC) (EG, PHACOEMULSIFICATION), WITH ASPIRATION N/A N/A N/A $620.46 66920 REMOVAL OF LENS MATERIAL; INTRACAPSULAR N/A N/A N/A $599.06 66940 REMOVAL OF LENS MATERIAL; EXTRACAPSULAR (OTHER THAN 66840, 66850, 66852) N/A N/A N/A $611.66 66983 INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ONE STAGE PROCEDURE) N/A N/A N/A $554.14 66984 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ONE STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION) N/A N/A N/A $653.17 66985 INSERTION OF INTRAOCULAR LENS PROSTHESIS (SECONDARY IMPLANT), NOT ASSOCIATED WITH CONCURRENT CATARACT REMOVAL N/A N/A N/A $583.93 67005 REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); PARTIAL REMOVAL N/A N/A N/A $390.66 67010 REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); SUBTOTAL REMOVAL WITH MECHANICAL VITRECTOMY N/A N/A N/A $455.98 67028 INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE PROCEDURE) N/A N/A N/A $149.08 67031 SEVERING OF VITREOUS STRANDS, VITREOUS FACE ADHESIONS, SHEETS, MEMBRANES OR OPACITIES, LASER SURGERY (ONE OR MORE STAGES) N/A N/A N/A $268.97 67036 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH $156.07 N/A N/A $780.34 67107 REPAIR OF RETINAL DETACHMENT; SCLERAL BUCKLING (SUCH AS LAMELLAR SCLERAL DISSECTION, IMBRICATION OR ENCIRCLING PROCEDURE), WITH OR WITHOUT IMPLANT, WITH OR WITHOUT CRYOTHERAPY, PHOTOCOAGULATION, AND DRAINAGE OF SUBRETINAL FLUID $194.25 N/A N/A $971.24 67115 RELEASE OF ENCIRCLING MATERIAL (POSTERIOR SEGMENT) N/A N/A N/A $370.36 67227 DESTRUCTION OF EXTENSIVE OR PROGRESSIVE RETINOPATHY (EG, DIABETIC RETINOPATHY), ONE OR MORE SESSIONS; CRYOTHERAPY, DIATHERMY N/A N/A N/A $448.44 67250 SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITHOUT GRAFT N/A N/A N/A $656.66 67255 SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITH GRAFT N/A N/A N/A $689.45 67311 STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; ONE HORIZONTAL MUSCLE N/A N/A N/A $469.41 67320 TRANSPOSITION PROCEDURE (EG, FOR PARETIC EXTRAOCULAR MUSCLE), ANY EXTRAOCULAR MUSCLE (SPECIFY) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $237.44 67331 STRABISMUS SURGERY ON PATIENT WITH PREVIOUS EYE SURGERY OR INJURY THAT DID NOT INVOLVE THE EXTRAOCULAR MUSCLES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $222.80 67332 STRABISMUS SURGERY ON PATIENT WITH SCARRING OF EXTRAOCULAR MUSCLES (EG, PRIOR OCULAR INJURY, STRABISMUS OR RETINAL DETACHMENT SURGERY) OR RESTRICTIVE MYOPATHY (EG, DYSTHYROID OPHTHALMOPATHY) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $246.20 67334 STRABISMUS SURGERY BY POSTERIOR FIXATION SUTURE TECHNIQUE, WITH OR WITHOUT MUSCLE RECESSION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $218.09 67335 PLACEMENT OF ADJUSTABLE SUTURE(S) DURING STRABISMUS SURGERY, INCLUDING POSTOPERATIVE ADJUSTMENT(S) OF SUTURE(S) (LIST SEPARATELY IN ADDITION TO CODE FOR SPECIFIC STRABISMUS SURGERY) N/A N/A N/A $136.62 67340 STRABISMUS SURGERY INVOLVING EXPLORATION AND/OR REPAIR OF DETACHED EXTRAOCULAR MUSCLE(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $269.64 67415 FINE NEEDLE ASPIRATION OF ORBITAL CONTENTS N/A N/A N/A $95.43 67500 RETROBULBAR INJECTION; MEDICATION (SEPARATE PROCEDURE, DOES NOT INCLUDE SUPPLY OF MEDICATION) N/A N/A N/A $41.38 67505 RETROBULBAR INJECTION; ALCOHOL N/A N/A N/A $43.20 67515 INJECTION OF MEDICATION OR OTHER SUBSTANCE INTO TENONOS CAPSULE N/A N/A N/A $37.02 67825 CORRECTION OF TRICHIASIS; EPILATION BY OTHER THAN FORCEPS (EG, BY ELECTROSURGERY, CRYOTHERAPY, LASER SURGERY) N/A N/A N/A $102.64 67830 CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN N/A N/A N/A $118.14 67835 CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN, WITH FREE MUCOUS MEMBRANE GRAFT N/A N/A N/A $377.15 67901 REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITH SUTURE OR OTHER MATERIAL (EG, BANKED FASCIA) N/A N/A N/A $481.83 67903 REPAIR OF BLEPHAROPTOSIS; (TARSO) LEVATOR RESECTION OR ADVANCEMENT, INTERNAL APPROACH N/A N/A N/A $444.42 67904 REPAIR OF BLEPHAROPTOSIS; (TARSO) LEVATOR RESECTION OR ADVANCEMENT, EXTERNAL APPROACH N/A N/A N/A $428.85 67908 REPAIR OF BLEPHAROPTOSIS; CONJUNCTIVO-TARSO-MULLEROS MUSCLE-LEVATOR RESECTION (EG, FASANELLA-SERVAT TYPE) N/A N/A N/A $385.81 67921 REPAIR OF ENTROPION; SUTURE N/A N/A N/A $232.80 67924 REPAIR OF ENTROPION; EXTENSIVE (EG, TARSAL STRIP OR CAPSULOPALPEBRAL FASCIA REPAIRS OPERATION) N/A N/A N/A $388.53 68325 CONJUNCTIVOPLASTY; WITH BUCCAL MUCOUS MEMBRANE GRAFT (INCLUDES OBTAINING GRAFT) N/A N/A N/A $516.23 68326 CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; WITH CONJUNCTIVAL GRAFT OR EXTENSIVE REARRANGEMENT N/A N/A N/A $501.08 68330 REPAIR OF SYMBLEPHARON; CONJUNCTIVOPLASTY, WITHOUT GRAFT N/A N/A N/A $351.69 68335 REPAIR OF SYMBLEPHARON; WITH FREE GRAFT CONJUNCTIVA OR BUCCAL MUCOUS MEMBRANE (INCLUDES OBTAINING GRAFT) N/A N/A N/A $501.88 68340 REPAIR OF SYMBLEPHARON; DIVISION OF SYMBLEPHARON, WITH OR WITHOUT INSERTION OF CONFORMER OR CONTACT LENS N/A N/A N/A $304.56 68700 PLASTIC REPAIR OF CANALICULI N/A N/A N/A $464.62 68720 DACRYOCYSTORHINOSTOMY (FISTULIZATION OF LACRIMAL SAC TO NASAL CAVITY) $124.40 N/A N/A $621.99 69005 DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; COMPLICATED N/A N/A N/A $148.05 69105 BIOPSY EXTERNAL AUDITORY CANAL N/A N/A N/A $60.67 69120 EXCISION EXTERNAL EAR; COMPLETE AMPUTATION N/A N/A N/A $376.65 69300 OTOPLASTY, PROTRUDING EAR, WITH OR WITHOUT SIZE REDUCTION N/A N/A N/A $407.24 69450 TYMPANOLYSIS, TRANSCANAL N/A N/A N/A $465.45 69501 TRANSMASTOID ANTROTOMY (SIMPLE MASTOIDECTOMY) N/A N/A N/A $674.33 69550 EXCISION AURAL GLOMUS TUMOR; TRANSCANAL N/A N/A N/A $952.26 69801 LABYRINTHOTOMY, WITH OR WITHOUT CRYOSURGERY INCLUDING OTHER NONEXCISIONAL DESTRUCTIVE PROCEDURES OR PERFUSION OF VESTIBULOACTIVE DRUGS (SINGLE OR MULTIPLE PERFUSIONS); TRANSCANAL N/A N/A N/A $669.50 69806 ENDOLYMPHATIC SAC OPERATION; WITH SHUNT N/A N/A N/A $876.23 69990 MICROSURGICAL TECHNIQUES, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $219.84 70015 CISTERNOGRAPHY, POSITIVE CONTRAST, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $60.87 $48.59 $109.46 70030 RADIOLOGIC EXAMINATION, EYE, FOR DETECTION OF FOREIGN BODY N/A $8.80 $14.97 $23.77 70100 RADIOLOGIC EXAMINATION, MANDIBLE; PARTIAL, LESS THAN FOUR VIEWS N/A $9.18 No Change $25.68 70120 RADIOLOGIC EXAMINATION, MASTOIDS; LESS THAN THREE VIEWS PER SIDE N/A $9.18 No Change $25.68 70130 RADIOLOGIC EXAMINATION, MASTOIDS; COMPLETE, MINIMUM OF THREE VIEWS PER SIDE N/A $17.26 No Change $44.76 70134 RADIOLOGIC EXAMINATION, INTERNAL AUDITORY MEATI, COMPLETE N/A $17.26 No Change $39.76 70140 RADIOLOGIC EXAMINATION, FACIAL BONES; LESS THAN THREE VIEWS N/A $9.56 No Change $29.56 70150 RADIOLOGIC EXAMINATION, FACIAL BONES; COMPLETE, MINIMUM OF THREE VIEWS N/A $12.89 No Change $35.39 70170 DACRYOCYSTOGRAPHY, NASOLACRIMAL DUCT, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $15.09 No Change $41.59 70190 RADIOLOGIC EXAMINATION; OPTIC FORAMINA N/A $10.66 No Change $31.66 70200 RADIOLOGIC EXAMINATION; ORBITS, COMPLETE, MINIMUM OF FOUR VIEWS N/A $13.99 No Change $34.99 70210 RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, LESS THAN THREE VIEWS N/A $8.80 No Change $25.30 70220 RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, COMPLETE, MINIMUM OF THREE VIEWS N/A $12.51 No Change $35.01 70250 RADIOLOGIC EXAMINATION, SKULL; LESS THAN FOUR VIEWS N/A $12.14 No Change $33.14 70260 RADIOLOGIC EXAMINATION, SKULL; COMPLETE, MINIMUM OF FOUR VIEWS N/A $17.26 No Change $44.76 70328 RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND CLOSED MOUTH; UNILATERAL N/A $9.18 No Change $25.68 70380 RADIOLOGIC EXAMINATION, SALIVARY GLAND FOR CALCULUS N/A $8.80 No Change $29.80 70470 COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $64.32 No Change $164.32 70480 COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE OR INNER EAR; WITHOUT CONTRAST MATERIAL N/A $64.70 No Change $178.70 70481 COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE OR INNER EAR; WITH CONTRAST MATERIAL(S) N/A $69.51 No Change $198.51 70482 COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE OR INNER EAR; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $73.19 No Change $225.19 70496 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEAD, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POSTPROCESSING N/A $88.25 No Change $288.45 70498 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, NECK, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POSTPROCESSING N/A $88.25 No Change $288.45 70540 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE AND NECK; WITHOUT CONTRAST MATERIAL(S) N/A $68.04 No Change $337.04 70542 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE AND NECK; WITHOUT CONTRAST MATERIAL(S) N/A $81.65 No Change $389.40 70543 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE AND NECK; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $108.80 No Change $662.69 70545 MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITH CONTRAST MATERIAL(S) N/A $60.34 No Change $327.75 70546 MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $90.83 No Change $596.30 70547 MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S) N/A $60.34 No Change $327.75 70548 MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITH CONTRAST MATERIAL(S) N/A $60.34 No Change $327.75 70549 MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $90.83 No Change $596.30 71021 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH APICAL LORDOTIC PROCEDURE N/A $13.61 No Change $28.61 71035 RADIOLOGIC EXAMINATION, CHEST, SPECIAL VIEWS (EG, LATERAL DECUBITUS, BUCKY STUDIES) N/A $9.18 $18.39 $27.56 71551 MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND MEDIASTINAL LYMPHADENOPATHY); WITH CONTRAST MATERIAL(S) N/A $87.49 No Change $399.59 71552 MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND MEDIASTINAL LYMPHADENOPATHY); WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $114.00 No Change $667.72 72010 RADIOLOGIC EXAMINATION, SPINE, ENTIRE, SURVEY STUDY, ANTEROPOSTERIOR AND LATERAL N/A $22.79 $36.70 $59.49 72020 RADIOLOGIC EXAMINATION, SPINE, SINGLE VIEW, SPECIFY LEVEL N/A $7.70 $14.97 $22.67 72050 RADIOLOGIC EXAMINATION, SPINE, CERVICAL; MINIMUM OF FOUR VIEWS N/A $15.47 No Change $41.97 72052 RADIOLOGIC EXAMINATION, SPINE, CERVICAL; COMPLETE, INCLUDING OBLIQUE AND FLEXION AND/OR EXTENSION STUDIES N/A $18.36 No Change $50.86 72069 RADIOLOGIC EXAMINATION, SPINE, THORACOLUMBAR, STANDING (SCOLIOSIS) N/A $11.38 $17.36 $28.74 72070 RADIOLOGIC EXAMINATION, SPINE; THORACIC, TWO VIEWS N/A $11.04 No Change $32.04 72072 RADIOLOGIC EXAMINATION, SPINE; THORACIC, THREE VIEWS N/A $11.04 No Change $32.54 72074 RADIOLOGIC EXAMINATION, SPINE; THORACIC, MINIMUM OF FOUR VIEWS N/A $11.04 No Change $32.54 72090 RADIOLOGIC EXAMINATION, SPINE; SCOLIOSIS STUDY, INCLUDING SUPINE AND ERECT STUDIES N/A $13.99 No Change $34.99 72100 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; TWO OR THREE VIEWS N/A $11.04 No Change $33.54 72120 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL, BENDING VIEWS ONLY, MINIMUM OF FOUR VIEWS N/A $11.04 No Change $32.04 72126 COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITH CONTRAST MATERIAL N/A $61.44 No Change $155.44 72127 COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $64.32 No Change $200.32 72128 COMPUTED TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL N/A $58.48 No Change $145.98 72130 COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $64.32 No Change $200.32 72132 COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITH CONTRAST MATERIAL N/A $61.44 No Change $155.44 72133 COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $64.32 No Change $200.32 72190 RADIOLOGIC EXAMINATION, PELVIS; COMPLETE, MINIMUM OF THREE VIEWS N/A $10.66 No Change $31.66 72191 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, PELVIS, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POSTPROCESSING N/A $91.55 No Change $301.35 72194 COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $61.44 No Change $163.94 72195 MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S) N/A $73.57 No Change $334.69 72196 MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITH CONTRAST MATERIAL(S) N/A $87.49 No Change $290.89 72197 MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $114.00 No Change $673.01 72200 RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; LESS THAN THREE VIEWS N/A $8.80 No Change $25.30 72202 RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; THREE OR MORE VIEWS N/A $9.56 No Change $26.06 72220 RADIOLOGIC EXAMINATION, SACRUM AND COCCYX, MINIMUM OF TWO VIEWS N/A $8.80 No Change $25.30 73020 RADIOLOGIC EXAMINATION, SHOULDER; ONE VIEW N/A $7.70 No Change $24.20 73030 RADIOLOGIC EXAMINATION, SHOULDER; COMPLETE, MINIMUM OF TWO VIEWS N/A $9.18 No Change $25.68 73050 RADIOLOGIC EXAMINATION; ACROMIOCLAVICULAR JOINTS, BILATERAL, WITH OR WITHOUT WEIGHTED DISTRACTION N/A $10.28 No Change $29.28 73202 COMPUTERIZED AXIAL TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $61.44 No Change $153.94 [Continued on next Web Page]
[Continued from previous Web Page] Procedure Codes with Fees Exceeding 100% Medicare Code Description Assistant Surgeon Fee Revision (Billing with Modifier 80) Professional Component Fee Revision (Billing with Modifier 26) Technical Component Fee Revision (Billing with Modifier TC) Total Fee Revision (Billing with No Modifier) 73206 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, UPPER EXTREMITY, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POSTPROCESSING N/A $91.21 No Change $279.78 73218 MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT; WITHOUT CONTRAST MATERIAL(S) N/A $68.04 No Change $324.90 73219 MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT; WITH CONTRAST MATERIAL(S) N/A $81.99 No Change $389.74 73221 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL(S) N/A $68.04 No Change $337.04 73222 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITH CONTRAST MATERIAL(S) N/A $81.65 No Change $389.40 73223 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $108.80 No Change $662.69 73510 RADIOLOGIC EXAMINATION, HIP, UNILATERAL; COMPLETE, MINIMUM OF TWO VIEWS N/A $10.66 No Change $27.16 73525 RADIOLOGIC EXAMINATION, HIP, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.53 No Change $75.03 73530 RADIOLOGIC EXAMINATION, HIP, DURING OPERATIVE PROCEDURE N/A $14.71 $18.39 $33.10 73542 RADIOLOGICAL EXAMINATION, SACROILIAC JOINT ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $28.75 No Change $84.69 73550 RADIOLOGIC EXAMINATION, FEMUR, TWO VIEWS N/A $8.80 No Change $25.30 73560 RADIOLOGIC EXAMINATION, KNEE; ONE OR TWO VIEWS N/A $8.80 No Change $25.30 73562 RADIOLOGIC EXAMINATION, KNEE; THREE VIEWS N/A $9.18 No Change $25.68 73565 RADIOLOGIC EXAMINATION, KNEE; BOTH KNEES, STANDING, ANTEROPOSTERIOR N/A $8.80 $17.36 $26.16 73590 RADIOLOGIC EXAMINATION; TIBIA AND FIBULA, TWO VIEWS N/A $8.80 No Change $25.30 73592 RADIOLOGIC EXAMINATION; LOWER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS N/A $8.08 No Change $24.58 73702 COMPUTERIZED AXIAL TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $61.44 No Change $153.94 73706 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, LOWER EXTREMITY, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POST-PROCESSING N/A $95.64 No Change $284.21 73718 MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITHOUT CONTRAST MATERIAL(S) N/A $68.04 No Change $324.90 73719 MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITH CONTRAST MATERIAL(S) N/A $81.65 No Change $389.40 73721 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL N/A $68.04 No Change $337.04 73722 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITH CONTRAST MATERIAL(S) N/A $81.65 No Change $389.40 73723 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES N/A $108.80 No Change $662.69 74022 RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE ACUTE ABDOMEN SERIES, INCLUDING SUPINE, ERECT, AND/OR DECUBITUS VIEWS, SINGLE VIEW CHEST N/A $15.85 No Change $39.85 74170 COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS N/A $70.61 No Change $182.11 74175 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMEN, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POSTPROCESSING N/A $95.64 No Change $305.44 74249 RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH SMALL INTESTINE FOLLOW THROUGH N/A $45.96 No Change $121.96 74291 CHOLECYSTOGRAPHY, ORAL CONTRAST; ADDITIONAL OR REPEAT EXAMINATION OR MULTIPLE DAY EXAMINATION N/A $10.28 $14.97 $25.25 74301 CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; ADDITIONAL SET INTRAOPERATIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $10.66 No Change $36.16 74350 PERCUTANEOUS PLACEMENT OF GASTROSTOMY TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $38.26 $113.21 $151.48 74355 PERCUTANEOUS PLACEMENT OF ENTEROCLYSIS TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $38.26 $94.18 $132.44 74360 INTRALUMINAL DILATION OF STRICTURES AND/OR OBSTRUCTIONS (EG, ESOPHAGUS), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.57 No Change $109.94 74363 PERCUTANEOUS TRANSHEPATIC DILATION OF BILIARY DUCT STRICTURE WITH OR WITHOUT PLACEMENT OF STENT, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $44.48 No Change $179.48 74475 INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.23 No Change $107.23 74480 INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETER THROUGH RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.23 No Change $63.23 74485 DILATION OF NEPHROSTOMY, URETERS, OR URETHRA, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.19 $113.21 $140.40 74742 TRANSCERVICAL CATHETERIZATION OF FALLOPIAN TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $30.87 No Change $77.87 75630 AORTOGRAPHY, ABDOMINAL PLUS BILATERAL ILIOFEMORAL LOWER EXTREMITY, CATHETER, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $92.05 No Change $278.05 75635 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMINAL AORTA AND BILATERAL ILIOFEMORAL LOWER EXTREMITY RUNOFF, RADIOLOGICAL SUPERVISION AND INTERPRETATION, WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS, INCLUDING IMAGE POST PROCESSING N/A $121.32 No Change $349.68 75790 ANGIOGRAPHY, ARTERIOVENOUS SHUNT (EG, DIALYSIS PATIENT), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $92.99 $48.59 $141.58 75809 SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED INDWELLING NONVASCULAR SHUNT (EG, LEVEEN SHUNT, VENTRICULOPERITONEAL SHUNT, INDWELLING INFUSION PUMP), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $23.55 $28.19 $51.74 75885 PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $72.47 No Change $198.97 75889 HEPATIC VENOGRAPHY, WEDGED OR FREE, WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $57.38 No Change $188.88 75891 HEPATIC VENOGRAPHY, WEDGED OR FREE, WITHOUT HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $57.38 No Change $178.88 75893 VENOUS SAMPLING THROUGH CATHETER, WITH OR WITHOUT ANGIOGRAPHY (EG, FOR PARATHYROID HORMONE, RENIN), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.23 No Change $128.23 75894 TRANSCATHETER THERAPY, EMBOLIZATION, ANY METHOD, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $66.79 No Change $167.79 75896 TRANSCATHETER THERAPY, INFUSION, ANY METHOD (EG, THROMBOLYSIS OTHER THAN CORONARY), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $66.56 No Change $167.56 75898 ANGIOGRAPHY THROUGH EXISTING CATHETER FOR FOLLOW-UP STUDY FOR TRANSCATHETER THERAPY, EMBOLIZATION OR INFUSION N/A No Change $37.73 $107.73 75940 PERCUTANEOUS PLACEMENT OF IVC FILTER, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.84 No Change $263.84 75962 TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.53 No Change $325.13 75964 TRANSLUMINAL BALLOON ANGIOPLASTY, EACH ADDITIONAL PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $18.66 No Change $207.66 75966 TRANSLUMINAL BALLOON ANGIOPLASTY, RENAL OR OTHER VISCERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $67.20 No Change $364.80 75968 TRANSLUMINAL BALLOON ANGIOPLASTY, EACH ADDITIONAL VISCERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $18.70 No Change $207.70 75978 TRANSLUMINAL BALLOON ANGIOPLASTY, VENOUS (EG, SUBCLAVIAN STENOSIS), RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.23 No Change $296.23 75992 TRANSLUMINAL ATHERECTOMY, PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $27.88 No Change $557.18 75993 TRANSLUMINAL ATHERECTOMY, EACH ADDITIONAL PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $18.70 No Change $301.20 75994 TRANSLUMINAL ATHERECTOMY, EACH ADDITIONAL PERIPHERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $67.51 No Change $591.20 75995 TRANSLUMINAL ATHERECTOMY, VISCERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $67.24 No Change $590.93 75996 TRANSLUMINAL ATHERECTOMY, EACH ADDITIONAL VISCERAL ARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $18.36 No Change $300.86 76020 BONE AGE STUDIES N/A $9.56 $18.39 $27.94 76040 BONE LENGTH STUDIES (ORTHOROENTGENOGRAM, SCANOGRAM) N/A $13.61 No Change $41.11 76061 RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; LIMITED (EG, FOR METASTASES) N/A $22.79 $36.02 $58.81 76062 RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; COMPLETE (AXIAL AND APPENDICULAR SKELETON) N/A $27.23 No Change $72.23 76066 JOINT SURVEY, SINGLE VIEW, TWO OR MORE JOINTS (SPECIFY) N/A $15.78 No Change $49.38 76098 RADIOLOGICAL EXAMINATION, SURGICAL SPECIMEN N/A $8.08 $14.97 $23.05 76120 CINERADIOGRAPHY/VIDEORADIOGRAPHY, EXCEPT WHERE SPECIFICALLY INCLUDED N/A $19.46 No Change $54.46 76150 XERORADIOGRAPHY N/A N/A N/A $14.97 76370 COMPUTED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS N/A $43.01 $106.07 $149.08 76380 COMPUTED TOMOGRAPHY, LIMITED OR LOCALIZED FOLLOW-UP STUDY N/A $49.30 No Change $128.50 76393 MAGNETIC RESONANCE GUIDANCE FOR NEEDLE PLACEMENT (EG, FOR BIOPSY, NEEDLE ASPIRATION, INJECTION, OR PLACEMENT OF LOCALIZATION DEVICE) RADIOLOGICAL SUPERVISION AND INTERPRETATION N/A $76.69 No Change $350.69 76516 OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN; N/A $28.97 $43.84 $72.82 76519 OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN; WITH INTRAOCULAR LENS POWER CALCULATION N/A $28.97 $46.92 $75.89 76529 OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION N/A $30.42 $41.07 $71.49 76536 ULTRASOUND, SOFT TISSUES OF HEAD AND NECK (EG, THYROID, PARATHYROID, PAROTID), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION N/A $27.99 $50.98 $78.97 76604 ULTRASOUND, CHEST, B-SCAN (INCLUDES MEDIASTINUM) AND/OR REAL TIME WITH IMAGE DOCUMENTATION N/A $27.61 $46.92 $74.53 76645 ULTRASOUND, BREAST(S) (UNILATERAL OR BILATERAL), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION N/A $27.23 $37.73 $64.95 76775 ULTRASOUND, RETROPERITONEAL (EG, RENAL, AORTA, NODES), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED N/A $29.39 No Change $78.39 76800 ULTRASOUND, SPINAL CANAL AND CONTENTS N/A $55.97 $50.98 $106.96 76810 ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FETAL AND MATERNAL EVALUATION, AFTER FIRST TRIMESTER (> OR = 14 WEEKS 0 DAYS), TRANSABDOMINAL APPROACH; EACH ADDITIONAL GESTATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A No Change $42.61 $74.11 76816 ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FOLLOW-UP (EG, RE-EVALUATION OF FETAL SIZE BY MEASURING STANDARD GROWTH PARAMETERS AND AMNIOTIC FLUID VOLUME, RE-EVALUATION OF ORGAN SYSTEM(S) SUSPECTED OR CONFIRMED TO BE ABNORMAL ON A PREVIOUS SCAN),TRANSABDOMINAL APPROACH, PER FETUS N/A No Change $39.78 $72.28 76818 FETAL BIOPHYSICAL PROFILE; WITH NONSTRESS TESTING N/A $54.65 $58.09 $112.74 76826 ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE DOCUMENTATION (2D), WITH OR WITHOUT M-MODE RECORDING; FOLLOW-UP OR REPEAT STUDY N/A No Change $25.80 $44.80 76827 DOPPLER ECHOCARDIOGRAPHY, FETAL, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY; COMPLETE N/A $29.77 No Change $79.67 76828 DOPPLER ECHOCARDIOGRAPHY, FETAL, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY; FOLLOW-UP OR REPEAT STUDY N/A $29.66 No Change $58.06 76872 ULTRASOUND, TRANSRECTAL N/A $34.89 No Change $89.04 76880 ULTRASOUND, EXTREMITY, NONVASCULAR, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION N/A $29.77 No Change $77.27 76945 ULTRASONIC GUIDANCE FOR CHORIONIC VILLUS SAMPLING, IMAGING SUPERVISION AND INTERPRETATION N/A $33.83 No Change $81.07 76946 ULTRASONIC GUIDANCE FOR AMNIOCENTESIS, IMAGING SUPERVISION AND INTERPRETATION N/A $19.80 No Change $66.30 76970 ULTRASOUND STUDY FOLLOW-UP (SPECIFY) N/A $20.21 $37.73 $57.94 76977 ULTRASOUND BONE DENSITY MEASUREMENT AND INTERPRETATION, PERIPHERAL SITE(S), ANY METHOD N/A $2.88 No Change $31.57 77261 THERAPEUTIC RADIOLOGY TREATMENT PLANNING; SIMPLE N/A N/A N/A $72.25 77262 THERAPEUTIC RADIOLOGY TREATMENT PLANNING; INTERMEDIATE N/A N/A N/A $108.96 77263 THERAPEUTIC RADIOLOGY TREATMENT PLANNING; COMPLEX N/A N/A N/A $161.83 77326 BRACHYTHERAPY ISODOSE PLAN; SIMPLE (CALCULATION MADE FROM SINGLE PLANE, ONE TO FOUR SOURCES/RIBBON APPLICATION, REMOTE AFTERLOADING BRACHYTHERAPY, ONE TO EIGHT SOURCES) N/A $47.03 No Change $119.53 77331 SPECIAL DOSIMETRY (EG, TLD, MICRODOSIMETRY) (SPECIFY), ONLY WHEN PRESCRIBED BY THE TREATING PHYSICIAN N/A $43.76 $17.70 $61.47 77610 HYPERTHERMIA GENERATED BY INTERSTITIAL PROBE(S); FIVE OR FEWER INTERSTITIAL APPLICATORS N/A $79.00 $109.49 $188.49 77615 HYPERTHERMIA GENERATED BY INTERSTITIAL PROBE(S); MORE THAN FIVE INTERSTITIAL APPLICATORS N/A $105.13 $145.85 $250.97 77620 HYPERTHERMIA GENERATED BY INTRACAVITARY PROBE(S) N/A $83.00 $109.49 $192.49 77750 INFUSION OR INSTILLATION OF RADIOELEMENT SOLUTION (INCLUDES THREE MONTHS FOLLOW-UP CARE) N/A No Change $47.60 $96.60 77761 INTRACAVITARY RADIATION SOURCE APPLICATION; SIMPLE N/A No Change $90.08 $211.08 77762 INTRACAVITARY RADIATION SOURCE APPLICATION; INTERMEDIATE N/A No Change $129.55 $250.55 77763 INTRACAVITARY RADIATION SOURCE APPLICATION; COMPLEX N/A No Change $160.85 $281.85 77776 INTERSTITIAL RADIATION SOURCE APPLICATION; SIMPLE N/A No Change $78.83 $223.83 77777 INTERSTITIAL RADIATION SOURCE APPLICATION; INTERMEDIATE N/A No Change $151.66 $296.66 77778 INTERSTITIAL RADIATION SOURCE APPLICATION; COMPLEX N/A No Change $183.95 $328.95 77781 REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; 1-4 SOURCE POSITIONS OR CATHETERS N/A $83.47 No Change $203.47 77782 REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; 5-8 SOURCE POSITIONS OR CATHETERS N/A $125.68 No Change $305.68 77784 REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; OVER 12 SOURCE POSITIONS OR CATHETERS N/A $282.61 No Change $672.61 77790 SUPERVISION, HANDLING, LOADING OF RADIATION SOURCE N/A No Change $17.70 $54.20 78000 THYROID UPTAKE; SINGLE DETERMINATION N/A $9.56 No Change $29.56 78006 THYROID IMAGING, WITH UPTAKE; SINGLE DETERMINATION N/A $24.65 No Change $62.15 78011 THYROID IMAGING; WITH VASCULAR FLOW N/A $22.79 No Change $67.79 78103 BONE MARROW IMAGING; MULTIPLE AREAS N/A $38.23 No Change $109.73 78110 PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE (SEPARATE PROCEDURE); SINGLE SAMPLING N/A $9.90 No Change $29.90 78111 PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE (SEPARATE PROCEDURE); MULTIPLE SAMPLINGS N/A $11.38 No Change $35.38 78120 RED CELL VOLUME DETERMINATION (SEPARATE PROCEDURE); SINGLE SAMPLING N/A $11.76 No Change $30.76 78121 RED CELL VOLUME DETERMINATION (SEPARATE PROCEDURE); MULTIPLE SAMPLINGS N/A $16.19 No Change $43.69 78122 WHOLE BLOOD VOLUME DETERMINATION, INCLUDING SEPARATE MEASUREMENT OF PLASMA VOLUME AND RED CELL VOLUME (RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE) N/A $23.13 No Change $91.13 78130 RED CELL SURVIVAL STUDY N/A $31.21 No Change $77.71 78135 RED CELL SURVIVAL STUDY; DIFFERENTIAL ORGAN/TISSUE KINETICS, (EG, SPLENIC AND/OR HEPATIC SEQUESTRATION) N/A $32.69 No Change $197.69 78185 SPLEEN IMAGING ONLY, WITH OR WITHOUT VASCULAR FLOW N/A $20.56 No Change $59.56 78201 LIVER IMAGING; STATIC ONLY N/A $22.41 No Change $68.91 78202 LIVER IMAGING; WITH VASCULAR FLOW N/A $25.75 No Change $75.75 78205 LIVER IMAGING (SPECT) N/A $36.03 No Change $171.03 78206 LIVER IMAGING (SPECT); WITH VASCULAR FLOW N/A $48.88 No Change $187.76 78215 LIVER AND SPLEEN IMAGING; STATIC ONLY N/A $24.65 No Change $71.15 78216 LIVER AND SPLEEN IMAGING; WITH VASCULAR FLOW N/A $28.71 No Change $90.21 78220 LIVER FUNCTION STUDY WITH HEPATOBILIARY AGENTS, WITH SERIAL IMAGES N/A $24.65 No Change $68.65 78223 HEPATOBILIARY DUCTAL SYSTEM IMAGING, INCLUDING GALLBLADDER, WITH OR WITHOUT PHARMACOLOGIC INTERVENTION, WITH OR WITHOUT QUANTITATIVE MEASUREMENT OF GALLBLADDER FUNCTION N/A $42.63 No Change $115.63 78230 SALIVARY GLAND IMAGING N/A $22.79 No Change $61.79 78232 SALIVARY GLAND FUNCTION STUDY N/A $23.89 No Change $62.89 78258 ESOPHAGEAL MOTILITY N/A $37.51 No Change $101.51 78264 GASTRIC EMPTYING STUDY N/A $39.36 No Change $138.36 78270 VITAMIN B-12 ABSORPTION STUDY (EG, SCHILLING TEST); WITHOUT INTRINSIC FACTOR N/A $10.28 No Change $30.28 78271 VITAMIN B-12 ABSORPTION STUDY (EG, SCHILLING TEST); WITH INTRINSIC FACTOR N/A $10.28 No Change $29.28 78282 GASTROINTESTINAL PROTEIN LOSS N/A $19.46 No Change $58.46 78291 PERITONEAL-VENOUS SHUNT PATENCY TEST (EG, FOR LEVEEN, DENVER SHUNT) N/A $44.83 $109.83 $154.66 78315 BONE AND/OR JOINT IMAGING; THREE PHASE STUDY N/A $51.50 No Change $170.50 78414 DETERMINATION OF CENTRAL C-V HEMODYNAMICS (NONIMAGING) (EG, EJECTION FRACTION WITH PROBE TECHNIQUE) WITH OR WITHOUT PHARMACOLOGIC INTERVENTION OR EXERCISE, SINGLE OR MULTIPLE DETERMINATIONS N/A $23.13 No Change $84.13 78428 CARDIAC SHUNT DETECTION N/A $40.39 No Change $115.39 78456 ACUTE VENOUS THROMBOSIS IMAGING, PEPTIDE N/A $50.74 No Change $157.40 78457 VENOUS THROMBOSIS IMAGING, VENOGRAM; UNILATERAL N/A $38.99 No Change $103.99 78460 MYOCARDIAL PERFUSION IMAGING; (PLANAR) SINGLE STUDY, AT REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC), WITH OR WITHOUT QUANTIFICATION N/A $43.73 $84.99 $128.71 78461 MYOCARDIAL PERFUSION IMAGING; MULTIPLE STUDIES, (PLANAR) AT REST AND/OR STRESS (EXERCISE AND/OR PHARMACOLOGIC), AND REDISTRIBUTION AND/OR REST INJECTION, WITH OR WITHOUT QUANTIFICATION N/A $62.84 $169.32 $232.16 78464 MYOCARDIAL PERFUSION IMAGING; TOMOGRAPHIC (SPECT), SINGLE STUDY (INCLUDING ATTENUATION CORRECTION WHEN PERFORMED), AT REST OR STRESS (EXERCISE AND/ OR PHARMACOLOGIC), WITH OR WITHOUT QUANTIFICATION N/A $55.52 No Change $268.52 78466 MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; QUALITATIVE OR QUANTITATIVE N/A $35.27 No Change $91.27 78473 CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM; MULTIPLE STUDIES, WALL MOTION STUDY PLUS EJECTION FRACTION, AT REST AND STRESS (EXERCISE AND/OR PHARMACOLOGIC), WITH OR WITHOUT ADDITIONAL QUANTIFICATION N/A $74.98 No Change $301.98 78494 CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM, SPECT, AT REST, WALL MOTION STUDY PLUS EJECTION FRACTION, WITH OR WITHOUT QUANTITATIVE PROCESSING N/A $60.98 No Change $231.73 78496 CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM, SINGLE STUDY, AT REST, WITH RIGHT VENTRICULAR EJECTION FRACTION BY FIRST PASS TECHNIQUE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $25.71 No Change $74.14 78586 PULMONARY VENTILATION IMAGING, AEROSOL; SINGLE PROJECTION N/A $20.21 No Change $62.71 78587 PULMONARY VENTILATION IMAGING, AEROSOL; MULTIPLE PROJECTIONS (EG, ANTERIOR, POSTERIOR, LATERAL VIEWS) N/A $24.99 No Change $73.99 78588 PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION IMAGING, AEROSOL, ONE OR MULTIPLE PROJECTIONS N/A $55.14 $115.23 $170.37 78591 PULMONARY VENTILATION IMAGING, GASEOUS, SINGLE BREATH, SINGLE PROJECTION N/A $20.21 No Change $84.21 78593 PULMONARY VENTILATION IMAGING, GASEOUS, WITH REBREATHING AND WASHOUT WITH OR WITHOUT SINGLE BREATH; SINGLE PROJECTION N/A $24.65 No Change $68.65 78594 PULMONARY VENTILATION IMAGING, GASEOUS, WITH REBREATHING AND WASHOUT WITH OR WITHOUT SINGLE BREATH; MULTIPLE PROJECTIONS (EG, ANTERIOR, POSTERIOR, LATERAL VIEWS) N/A $26.85 No Change $84.35 78600 BRAIN IMAGING, LIMITED PROCEDURE; STATIC N/A $22.41 No Change $79.91 78601 BRAIN IMAGING, LIMITED PROCEDURE; WITH VASCULAR FLOW N/A $25.75 No Change $95.75 78605 BRAIN IMAGING, COMPLETE STUDY; STATIC N/A $26.85 No Change $80.85 78606 BRAIN IMAGING, COMPLETE STUDY; WITH VASCULAR FLOW N/A $32.35 No Change $91.35 78610 BRAIN IMAGING, VASCULAR FLOW ONLY N/A $15.43 No Change $49.43 78615 CEREBRAL VASCULAR FLOW N/A $21.66 No Change $55.66 78630 CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); CISTERNOGRAPHY N/A $34.55 No Change $116.05 78645 CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); SHUNT EVALUATION N/A $28.71 No Change $138.71 78650 CEREBROSPINAL FLUID LEAKAGE DETECTION AND LOCALIZATION N/A $31.21 No Change $85.21 78700 KIDNEY IMAGING; STATIC ONLY N/A $22.79 No Change $64.29 78701 KIDNEY IMAGING; WITH VASCULAR FLOW N/A $24.65 No Change $79.65 78704 KIDNEY IMAGING; WITH FUNCTION STUDY (IE, IMAGING RENOGRAM) N/A $37.51 No Change $102.51 78710 KIDNEY IMAGING, TOMOGRAPHIC (SPECT) N/A $33.45 No Change $233.42 78715 KIDNEY VASCULAR FLOW ONLY N/A $15.43 No Change $44.43 78725 KIDNEY FUNCTION STUDY, NONIMAGING RADIOISOTOPIC STUDY N/A $19.46 $64.55 $84.00 78730 URINARY BLADDER RESIDUAL STUDY N/A $18.36 $52.35 $70.71 78740 URETERAL REFLUX STUDY (RADIOPHARMACEUTICAL VOIDING CYSTOGRAM) N/A $29.01 No Change $79.01 78761 TESTICULAR IMAGING; WITH VASCULAR FLOW N/A $36.03 No Change $131.03 [Continued on next Web Page]
[Continued from previous Web Page] Procedure Codes with Fees Exceeding 100% Medicare Code Description Assistant Surgeon Fee Revision (Billing with Modifier 80) Professional Component Fee Revision (Billing with Modifier 26) Technical Component Fee Revision (Billing with Modifier TC) Total Fee Revision (Billing with No Modifier) 78800 RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION OF RADIOPHARMACEUTICAL AGENT(S); LIMITED AREA N/A $33.75 No Change $88.75 78802 RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION OF RADIOPHARMACEUTICAL AGENT(S); WHOLE BODY, SINGLE DAY IMAGING N/A $43.73 No Change $113.73 78806 RADIOPHARMACEUTICAL LOCALIZATION OF INFLAMMATORY PROCESS; WHOLE BODY N/A $43.73 No Change $113.73 79200 RADIOPHARMACEUTICAL THERAPY, BY INTRACAVITARY ADMINISTRATION N/A No Change $94.18 $159.18 79300 RADIOPHARMACEUTICAL THERAPY, BY INTERSTITIAL RADIOACTIVE COLLOID ADMINISTRATION N/A $83.75 No Change $191.25 88302 LEVEL II--SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION APPENDIX, INCIDENTAL FALLOPIAN TUBE, STERILIZATION FINGERS/TOES, AMPUTATION, TRAUMATIC FORESKIN, NEWBORN HERNIA SAC, ANY LOCATION HYDROCELE SAC NERVE SKIN, PLASTIC REPAIR SYMPATHETIC GANGLION TESTIS, CASTRATION VAGINAL MUCOSA, INCIDENTAL VAS DEFERENS, STERILIZATION N/A $7.28 No Change $12.28 88304 LEVEL III--SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION N/A $11.72 No Change $18.22 88311 DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION) N/A N/A N/A $17.57 88314 SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION); HISTOCHEMICAL STAINING WITH FROZEN SECTION(S) N/A $24.16 No Change $32.75 88332 PATHOLOGY CONSULTATION DURING SURGERY; EACH ADDITIONAL TISSUE BLOCK WITH FROZEN SECTION(S) N/A No Change $7.79 $36.79 88349 ELECTRON MICROSCOPY; SCANNING N/A $41.00 No Change $65.60 88358 MORPHOMETRIC ANALYSIS; TUMOR (EG, DNA PLOIDY) N/A $52.73 $17.18 $69.91 88368 MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZATION, (QUANTITATIVE OR SEMIQUANTITATIVE) EACH PROBE; MANUAL N/A No Change $63.36 $123.94 89230 SWEAT COLLECTION BY IONTOPHORESIS N/A N/A N/A $4.37 91060 GASTRIC SALINE LOAD TEST N/A $22.76 No Change $29.58 92270 ELECTRO-OCULOGRAPHY WITH INTERPRETATION AND REPORT N/A No Change $41.63 $79.63 92283 COLOR VISION EXAMINATION, EXTENDED, EG, ANOMALOSCOPE OR EQUIVALENT N/A $9.14 No Change $12.68 92284 DARK ADAPTATION EXAMINATION WITH INTERPRETATION AND REPORT N/A $12.14 No Change $54.14 92285 EXTERNAL OCULAR PHOTOGRAPHY WITH INTERPRETATION AND REPORT FOR DOCUMENTATION OF MEDICAL PROGRESS (EG, CLOSE-UP PHOTOGRAPHY, SLIT LAMP PHOTOGRAPHY, GONIOPHOTOGRAPHY, STEREO-PHOTOGRAPHY) N/A $10.96 No Change $14.21 92542 POSITIONAL NYSTAGMUS TEST, MINIMUM OF FOUR POSITIONS, WITH RECORDING N/A $18.28 No Change $27.66 92543 CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, BITHERMAL STIMULATION CONSTITUTES FOUR TESTS), WITH RECORDING N/A $5.80 No Change $20.73 92547 USE OF VERTICAL ELECTRODES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $4.57 92562 LOUDNESS BALANCE TEST, ALTERNATE BINAURAL OR MONAURA N/A N/A N/A $15.24 92563 TONE DECAY TEST N/A N/A N/A $14.21 92564 SHORT INCREMENT SENSITIVITY INDEX (SISI) N/A N/A N/A $17.59 92565 STENGER TEST, PURE TONE N/A N/A N/A $14.90 92569 ACOUSTIC REFLEX TESTING; DECAY N/A N/A N/A $15.24 92572 STAGGERED SPONDAIC WORD TEST N/A N/A N/A $3.38 92575 SENSORINEURAL ACUITY LEVEL TEST N/A N/A N/A $10.87 92577 STENGER TEST, SPEECH N/A N/A N/A $26.75 92587 EVOKED OTOACOUSTIC EMISSIONS; LIMITED (SINGLE STIMULUS LEVEL, EITHER TRANSIENT OR DISTORTION PRODUCTS) N/A $7.28 No Change $48.64 92588 EVOKED OTOACOUSTIC EMISSIONS; COMPREHENSIVE OR DIAGNOSTIC EVALUATION (COMPARISON OF TRANSIENT AND/OR DISTORTION PRODUCT OTOACOUSTIC EMISSIONS AT MULTIPLE LEVELS AND FREQUENCIES) N/A $19.42 No Change $66.25 92603 DIAGNOSTIC ANALYSIS OF COCHLEAR IMPLANT, AGE 7 YEARS OR OLDER; WITH PROGRAMMING N/A N/A N/A $75.63 92612 FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING BY CINE OR VIDEO RECORDING; N/A N/A N/A $71.91 92613 FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING BY CINE OR VIDEO RECORDING; PHYSICIAN INTERPRETATION AND REPORT ONLY N/A N/A N/A $41.77 92615 FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION, LARYNGEAL SENSORY TESTING BY CINE OR VIDEO RECORDING; PHYSICIAN INTERPRETATION AND REPORT ONLY N/A N/A N/A $37.37 92617 FLEXIBLE FIBEROPTIC ENDOSCOPIC EVALUATION OF SWALLOWING AND LARYNGEAL SENSORY TESTING BY CINE OR VIDEO RECORDING; PHYSICIAN INTERPRETATION AND REPORT ONLY N/A N/A N/A $46.51 92975 THROMBOLYSIS, CORONARY; BY INTRACORONARY INFUSION, INCLUDING SELECTIVE CORONARY ANGIOGRAPHY N/A N/A N/A $386.05 92978 INTRAVASCULAR ULTRASOUND (CORONARY VESSEL OR GRAFT) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION INCLUDING IMAGING SUPERVISION, INTERPRETATION AND REPORT; INITIAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A $94.32 No Change $244.45 92980 TRANSCATHETER PLACEMENT OF AN INTRACORONARY STENT(S), PERCUTANEOUS, WITH OR WITHOUT OTHER THERAPEUTIC INTERVENTION, ANY METHOD; SINGLE VESSEL N/A N/A N/A $800.60 92981 TRANSCATHETER PLACEMENT OF AN INTRACORONARY STENT(S), PERCUTANEOUS, WITH OR WITHOUT OTHER THERAPEUTIC INTERVENTION, ANY METHOD; EACH ADDITIONAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $222.23 92982 PERCUTANEOUS TRANSLUMINAL CORONARY BALLOON ANGIOPLASTY; SINGLE VESSEL N/A N/A N/A $593.76 92984 PERCUTANEOUS TRANSLUMINAL CORONARY BALLOON ANGIOPLASTY; EACH ADDITIONAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $158.62 92995 PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, BY MECHANICAL OR OTHER METHOD, WITH OR WITHOUT BALLOON ANGIOPLASTY; SINGLE VESSEL N/A N/A N/A $652.97 92996 PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, BY MECHANICAL OR OTHER METHOD, WITH OR WITHOUT BALLOON ANGIOPLASTY; EACH ADDITIONAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $170.01 92997 PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY BALLOON ANGIOPLASTY; SINGLE VESSEL N/A N/A N/A $631.34 92998 PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY BALLOON ANGIOPLASTY; EACH ADDITIONAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) N/A N/A N/A $311.10 93014 TELEPHONIC TRANSMISSION OF POST-SYMPTOM ELECTROCARDIOGRAM RHYTHM STRIP(S), 24 HOUR ATTENDED MONITORING, PER 30 DAY PERIOD OF TIME; PHYSICIAN REVIEW WITH INTERPRETATION AND REPORT ONLY N/A N/A N/A $26.81 93015 CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL STRESS; WITH PHYSICIAN SUPERVISION, WITH INTERPRETATION AND REPORT N/A N/A N/A $99.70 93016 CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL STRESS; PHYSICIAN SUPERVISION ONLY, WITHOUT INTERPRETATION AND REPORT N/A N/A N/A $23.48 93018 CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL STRESS; INTERPRETATION AND REPORT ONLY N/A N/A N/A $15.43 93040 RHYTHM ECG, ONE TO THREE LEADS; WITH INTERPRETATION AND REPORT N/A N/A N/A $13.51 93041 RHYTHM ECG, ONE TO THREE LEADS; TRACING ONLY WITHOUT INTERPRETATION AND REPORT N/A N/A N/A $5.43 93224 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS ORIGINAL ECG WAVEFORM RECORDING AND STORAGE, WITH VISUAL SUPERIMPOSITION SCANNING; INCLUDES RECORDING, SCANNING ANALYSIS WITH REPORT, PHYSICIAN REVIEW AND INTERPRETATION N/A N/A N/A $150.78 93227 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS ORIGINAL ECG WAVEFORM RECORDING AND STORAGE, WITH VISUAL SUPERIMPOSITION SCANNING; PHYSICIAN REVIEW AND INTERPRETATION N/A N/A N/A $26.81 93233 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS ORIGINAL ECG WAVEFORM RECORDING AND STORAGE WITHOUT SUPERIMPOSITION SCANNING UTILIZING A DEVICE CAPABLE OF PRODUCING A FULL MINIATURIZED PRINTOUT; PHYSICIAN REVIEW AND INTERPRETATION N/A N/A N/A $26.81 93237 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS COMPUTERIZED MONITORING AND NONCONTINUOUS RECORDING, AND REAL-TIME DATA ANALYSIS UTILIZING A DEVICE CAPABLE OF PRODUCING INTERMITTENT FULL-SIZED WAVEFORM TRACINGS, POSSIBLY PATIENT ACTIVATED N/A N/A N/A $23.13 93272 PATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRESYMPTOM MEMORY LOOP, 24-HOUR ATTENDED MONITORING, PER 30 DAY PERIOD OF TIME; PHYSICIAN REVIEW AND INTERPRETATION ONLY N/A N/A N/A $26.81 93278 SIGNAL-AVERAGED ELECTROCARDIOGRAPHY (SAECG), WITH OR WITHOUT ECG N/A $13.20 No Change $49.69 93312 ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING); INCLUDING PROBE PLACEMENT, IMAGE ACQUISITION, INTERPRETATION AND REPORT N/A $112.82 No Change $245.75 93313 ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING); PLACEMENT OF TRANSESOPHAGEAL PROBE ONLY N/A N/A N/A $45.01 93316 TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; PLACEMENT OF TRANSESOPHAGEAL PROBE ONLY N/A N/A N/A $45.73 93321 DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING); FOLLOW-UP OR LIMITED STUDY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING) N/A $8.04 $40.39 $48.43 93503 INSERTION AND PLACEMENT OF FLOW DIRECTED CATHETER (EG, SWAN-GANZ) FOR MONITORING PURPOSES N/A N/A N/A $139.64 93539 INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR SELECTIVE OPACIFICATION OF ARTERIAL CONDUITS (EG, INTERNAL MAMMARY), WHETHER NATIVE OR USED FOR BYPASS N/A N/A N/A $20.93 93540 INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR SELECTIVE OPACIFICATION OF AORTOCORONARY VENOUS BYPASS GRAFTS, ONE OR MORE CORONARY ARTERIES N/A N/A N/A $22.41 93541 INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR PULMONARY ANGIOGRAPHY N/A N/A N/A $15.06 93542 INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR SELECTIVE RIGHT VENTRICULAR OR RIGHT ATRIAL ANGIOGRAPHY N/A N/A N/A $15.06 93543 INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR SELECTIVE LEFT VENTRICULAR OR LEFT ATRIAL ANGIOGRAPHY N/A N/A N/A $15.06 93544 INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR AORTOGRAPHY N/A N/A N/A $13.20 93545 INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION; FOR SELECTIVE CORONARY ANGIOGRAPHY (INJECTION OF RADIOPAQUE MATERIAL MAY BE BY HAND) N/A N/A N/A $20.93 93556 IMAGING SUPERVISION, INTERPRETATION AND REPORT FOR INJECTION PROCEDURE(S) DURING CARDIAC CATHETERIZATION; PULMONARY ANGIOGRAPHY, AORTOGRAPHY, AND/OR SELECTIVE CORONARY ANGIOGRAPHY INCLUDING VENOUS BYPASS GRAFTS AND ARTERIAL CONDUITS (WHETHER NATIVE OR USED IN BYPASS) N/A $43.31 No Change $391.42 93562 INDICATOR DILUTION STUDIES SUCH AS DYE OR THERMAL DILUTION, INCLUDING ARTERIAL AND/OR VENOUS CATHETERIZATION; SUBSEQUENT MEASUREMENT OF CARDIAC OUTPUT N/A N/A N/A $20.24 93603 RIGHT VENTRICULAR RECORDING N/A N/A N/A $174.32 93619 COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION WITH RIGHT ATRIAL PACING AND RECORDING, RIGHT VENTRICULAR PACING AND RECORDING, HIS BUNDLE RECORDING, INCLUDING INSERTION AND REPOSITIONING OF MULTIPLE ELECTRODE CATHETERS, WITHOUT INDUCTION OR ATTEMPTED IN N/A N/A N/A $679.91 93641 ELECTROPHYSIOLOGIC EVALUATION OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR LEADS INCLUDING DEFIBRILLATION THRESHOLD EVALUATION (INDUCTION OF ARRHYTHMIA, EVALUATION OF SENSING AND PACING FOR ARRHYTHMIA TERMINATION) AT TIME OF INITIAL IMPLANTATION WITH TESTING OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR PULSE GENERATOR N/A N/A N/A $574.79 93642 ELECTROPHYSIOLOGIC EVALUATION OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR (INCLUDES DEFIBRILLATION THRESHOLD EVALUATION, INDUCTION OF ARRHYTHMIA, EVALUATION OF SENSING AND PACING FOR ARRHYTHMIA TERMINATION, AND PROGRAMMING OR REPROGRAMMING OF SENSING OR THERAPEUTIC PARAMETERS N/A N/A N/A $524.02 93650 INTRACARDIAC CATHETER ABLATION OF ATRIOVENTRICULAR NODE FUNCTION, ATRIOVENTRICULAR CONDUCTION FOR CREATION OF COMPLETE HEART BLOCK, WITH OR WITHOUT TEMPORARY PACEMAKER PLACEMENT N/A N/A N/A $571.62 93651 INTRACARDIAC CATHETER ABLATION OF ARRHYTHMOGENIC FOCUS; FOR TREATMENT OF SUPRAVENTRICULAR TACHYCARDIA BY ABLATION OF FAST OR SLOW ATRIOVENTRICULAR PATHWAYS, ACCESSORY ATRIOVENTRICULAR CONNECTIONS OR OTHER ATRIAL FOCI, SINGLY OR IN COMBINATION N/A N/A N/A $866.32 93652 INTRACARDIAC CATHETER ABLATION OF ARRHYTHMOGENIC FOCUS; FOR TREATMENT OF SUPRAVENTRICULAR TACHYCARDIA BY ABLATION OF FAST OR SLOW ATRIOVENTRICULAR PATHWAYS, ACCESSORY ATRIOVENTRICULAR CONNECTIONS OR OTHER ATRIAL FOCI, SINGLY OR IN COMBINATION FOR TREATMENT OF VENTRICULAR TACHYCARDIA N/A N/A N/A $942.33 93722 PLETHYSMOGRAPHY, TOTAL BODY; INTERPRETATION AND REPORT ONLY N/A N/A N/A $8.46 93733 ELECTRONIC ANALYSIS OF DUAL CHAMBER INTERNAL PACEMAKER SYSTEM (MAY INCLUDE RATE, PULSE AMPLITUDE AND DURATION, CONFIGURATION OF WAVE FORM, AND/OR TESTING OF SENSORY FUNCTION OF PACEMAKER), TELEPHONIC ANALYSIS N/A $9.14 No Change $27.74 93735 ELECTRONIC ANALYSIS OF SINGLE CHAMBER PACEMAKER SYSTEM (INCLUDES EVALUATION OF PROGRAMMABLE PARAMETERS AT REST AND DURING ACTIVITY WHERE APPLICABLE, USING ELECTROCARDIOGRAPHIC RECORDING AND INTERPRETATION OF RECORDINGS AT REST AND DURING EXERCISE, ANALYSIS OF EVENT MARKERS AND DEVICE RESPONSE); WITH REPROGRAMMING N/A No Change $16.26 $28.66 93736 ELECTRONIC ANALYSIS OF SINGLE CHAMBER INTERNAL PACEMAKER SYSTEM (MAY INCLUDE RATE, PULSE AMPLITUDE AND DURATION, CONFIGURATION OF WAVE FORM, AND/OR TESTING OF SENSORY FUNCTION OF PACEMAKER), TELEPHONIC ANALYSIS N/A $8.04 No Change $26.64 93875 NONINVASIVE PHYSIOLOGIC STUDIES OF EXTRACRANIAL ARTERIES, COMPLETE BILATERAL STUDY (EG, PERIORBITAL FLOW DIRECTION WITH ARTERIAL COMPRESSION, OCULAR PNEUMOPLETHYSMOGRAPHY, DOPPLER ULTRASOUND SPECTRAL ANALYSIS) N/A $11.38 No Change $47.38 93880 DUPLEX SCAN OF EXTRACRANIAL ARTERIES; COMPLETE BILATERAL STUDY N/A $30.80 No Change $150.14 93886 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; COMPLETE STUDY N/A $50.10 No Change $169.44 93888 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; LIMITED STUDY N/A $32.89 No Change $85.69 93922 NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, SINGLE LEVEL, BILATERAL (EG, ANKLE/BRACHIAL INDICES, DOPPLER WAVEFORM ANALYSIS, VOLUME PLETHYSMOGRAPHY, TRANSCUTANEOUS OXYGEN TENSION MEASUREMENT) N/A $12.82 No Change $49.93 93924 NONINVASIVE PHYSIOLOGIC STUDIES OF LOWER EXTREMITY ARTERIES, AT REST AND FOLLOWING TREADMILL STRESS TESTING, COMPLETE BILATERAL STUDY N/A $26.29 No Change $102.88 93925 DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE BILATERAL STUDY N/A $30.04 No Change $149.38 93926 DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY N/A $20.45 No Change $99.05 93930 DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE BILATERAL STUDY N/A $24.12 No Change $143.46 93931 DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY N/A $16.08 No Change $94.68 93965 NONINVASIVE PHYSIOLOGIC STUDIES OF EXTREMITY VEINS, COMPLETE BILATERAL STUDY (EG, DOPPLER WAVEFORM ANALYSIS WITH RESPONSES TO COMPRESSION AND OTHER MANEUVERS, PHLEBORHEOGRAPHY, IMPEDANCE PLETHYSMOGRAPHY) N/A $17.98 No Change $53.98 93978 DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE OR BYPASS GRAFTS; COMPLETE STUDY N/A $33.99 No Change $142.06 93979 DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE OR BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY N/A $22.72 No Change $101.32 93980 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; COMPLETE STUDY N/A $63.83 $94.14 $157.97 93981 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; FOLLOW-UP OR LIMITED STUDY N/A $22.07 No Change $79.07 93990 DUPLEX SCAN OF HEMODIALYSIS ACCESS (INCLUDING ARTERIAL INFLOW, BODY OF ACCESS AND VENOUS OUTFLOW) N/A $13.47 No Change $93.98 94260 THORACIC GAS VOLUME N/A $6.60 No Change $21.00 94375 RESPIRATORY FLOW VOLUME LOOP N/A No Change $18.04 $32.04 94400 BREATHING RESPONSE TO CO2 (CO2 RESPONSE CURVE) N/A $20.18 No Change $32.60 94621 PULMONARY STRESS TESTING; COMPLEX (INCLUDING MEASUREMENTS OF CO2 PRODUCTION, O2 UPTAKE AND ELECTROCARDIOGRAPHIC RECORDINGS) N/A No Change $63.56 $108.31 94657 VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTILATORS FOR ASSISTED OR CONTROLLED BREATHING; SUBSEQUENT DAYS N/A N/A N/A $41.22 94660 CONTINUOUS POSITIVE AIRWAY PRESSURE VENTILATION (CPAP), INITIATION AND MANAGEMENT N/A N/A N/A $37.89 94662 CONTINUOUS NEGATIVE PRESSURE VENTILATION (CNP), INITIATION AND MANAGEMENT N/A N/A N/A $37.58 94664 DEMONSTRATION AND/OR EVALUATION OF PATIENT UTILIZATION OF AN AEROSOL GENERATOR, NEBULIZER, METERED DOSE INHALER OR IPPB DEVICE N/A N/A N/A $11.82 94681 OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; INCLUDING CO2 OUTPUT, PERCENTAGE OXYGEN EXTRACTED N/A $9.94 No Change $32.44 94760 NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; SINGLE DETERMINATION N/A N/A N/A $1.98 94761 NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; MULTIPLE DETERMINATIONS (EG, DURING EXERCISE) N/A N/A N/A $4.23 95027 INTRACUTANEOUS (INTRADERMAL) TESTS, SEQUENTIAL AND INCREMENTAL, WITH ALLERGENIC EXTRACTS FOR AIRBORNE ALLERGENS, IMMEDIATE TYPE REACTION, SPECIFY NUMBER OF TESTS N/A N/A N/A $5.43 95165 PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY; SINGLE OR MULTIPLE ANTIGENS (SPECIFY NUMBER OF DOSES) N/A N/A N/A $3.26 95831 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE) WITH REPORT; EXTREMITY (EXCLUDING HAND) OR TRUNK N/A N/A N/A $15.36 95832 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE) WITH REPORT; HAND, WITH OR WITHOUT COMPARISON WITH NORMAL SIDE N/A N/A N/A $15.70 95851 RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE); EACH EXTREMITY (EXCLUDING HAND) OR EACH TRUNK SECTION (SPINE) N/A N/A N/A $9.10 95852 RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE); HAND, WITH OR WITHOUT COMPARISON WITH NORMAL SIDE N/A N/A N/A $6.18 95868 NEEDLE ELECTROMYOGRAPHY, CRANIAL NERVE SUPPLIED MUSCLES, BILATERAL N/A No Change $25.46 $56.46 95869 NEEDLE ELECTROMYOGRAPHY; THORACIC PARASPINAL MUSCLES (EXCLUDING T1 OR T12) N/A No Change $7.79 $21.79 95926 SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIPHERAL NERVES OR SKIN SITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM; IN LOWER LIMBS N/A $29.24 No Change $61.70 95927 SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIPHERAL NERVES OR SKIN SITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM; IN THE TRUNK OR HEAD N/A $30.23 No Change $62.69 95937 NEUROMUSCULAR JUNCTION TESTING (REPETITIVE STIMULATION, PAIRED STIMULI), EACH NERVE, ANY ONE METHOD N/A No Change $12.23 $19.73 95955 ELECTROENCEPHALOGRAM (EEG) DURING NONINTRACRANIAL SURGERY (EG, CAROTID SURGERY) N/A $52.11 $72.53 $124.64 95958 WADA ACTIVATION TEST FOR HEMISPHERIC FUNCTION, INCLUDING ELECTROENCEPHALOGRAPHIC (EEG) MONITORING N/A No Change $63.79 $108.99 97012 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; TRACTION, MECHANICAL N/A N/A N/A $14.22 97016 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; VASOPNEUMATIC DEVICES N/A N/A N/A $13.28 97018 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; PARAFFIN BATH N/A N/A N/A $6.00 97022 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; WHIRLPOOL N/A N/A N/A $13.93 97024 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; DIATHERMY (EG, MICROWAVE) N/A N/A N/A $4.97 97026 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; INFRARED N/A N/A N/A $4.63 97028 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRAVIOLET N/A N/A N/A $5.73 97034 APPLICATION OF A MODALITY TO ONE OR MORE AREAS; CONTRAST BATHS, EACH 15 MINUTES N/A N/A N/A $13.39 99281 EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: A PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINATION AND STRAIGHTFORWARD MEDICAL DECISION MAKING. COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE PROVIDED CONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENT'S AND/OR FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEMS ARE SELF LIMITED OR MINOR N/A N/A N/A $16.19 99282 EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: A PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINATION AND STRAIGHTFORWARD MEDICAL DECISION MAKING. COUNSELING AND/OR COORDINATION OF CARE WITH OTHER PROVIDERS OR AGENCIES ARE PROVIDED CONSISTENT WITH THE NATURE OF THE PROBLEM(S) AND THE PATIENT'S AND/OR FAMILY'S NEEDS. USUALLY, THE PRESENTING PROBLEMS ARE OF LOW TO MODERATE SEVERITY N/A N/A N/A $26.85 Fiscal Impact
It is anticipated that these revisions will result in savings of $1.228 million ($0.667 million in State funds) in the Medical Assistance-Capitation Program in Fiscal Year 2006-2007 and annualized savings of $3.685 million ($2.010 million in State funds) in Fiscal Year 2007-2008.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department at the following address: Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary's Office, Attention: Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received will be reviewed and considered for any subsequent revision to the MA Program Fee Schedule.
Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Service, (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-493. No fiscal impact; recommends adoption. Implementation of this regulation should save the Commonwealth $667,000 for Fiscal Year 2006-07 and $2,010,000 for Fiscal Year 2007-08.
[Pa.B. Doc. No. 06-2478. Filed for public inspection December 15, 2006, 9:00 a.m.]
