[Federal Register: September 8, 1998 (Volume 63, Number 173)]
[Proposed Rules]
[Page 47801-47850]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr08se98-39]

[[pp. 47801-47850]] Medicare Program; Prospective Payment System for Hospital
Outpatient Services

[[Continued from page 47800]]

[[Page 47800]]

470..     49999  UNLISTED PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
470..     50688  CHANGE OF URETEROSTOMY TUBE
470..     51705  CHANGE OF CYSTOSTOMY TUBE; SIMPLE
470..     51710  CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
521..  Level I Cystourethroscopy and   T                        5.06     $256.39         $112.10          $51.28
       other Genitourinary Procedures
521..     50398  CHANGE OF NEPHROSTOMY OR PYELOSTOMY TUBE
521..     52000  CYSTOURETHROSCOPY (SEPARATE PROCEDURE)
521..     52265  CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; LOCAL ANESTHESIA
522..  Level II Cystourethroscopy and  T                       10.46     $530.00         $262.39         $106.00
       other Genitourinary Procedures
522..     50551  RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION,
                  INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE;
522..     50553  RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION,
                  INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH URETERAL
                  CATHETERIZATION, WITH OR WITHOUT DILATION OF URETER
522..     50555  RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION,
                  INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH BIOPSY
522..     50557  RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION,
                  INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH FULGURATION AND/OR
                  INCISION, WITH OR WITHOUT BIOPSY
522..     50559  RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION,
                  INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH INSERTION OF
                  RADIOACTIVE SUBSTANCE WITH OR WITHOUT BIOPSY AND/OR FULGURATION
522..     50561  RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION,
                  INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH REMOVAL OF FOREIGN
                  BODY OR CALCULUS
522..     52005  CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR
                  URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE;
522..     52007  CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR
                  URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH BRUSH BIOPSY OF URETER AND/OR RENAL
                  PELVIS
522..     52010  CYSTOURETHROSCOPY, WITH EJACULATORY DUCT CATHETERIZATION, WITH OR WITHOUT IRRIGATION,
                  INSTILLATION, OR DUCT RADIOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE
522..     52204  CYSTOURETHROSCOPY, WITH BIOPSY
522..     52214  CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OF TRIGONE,
                  BLADDER NECK, PROSTATIC FOSSA, URETHRA, OR PERIURETHRAL GLANDS
522..     52224  CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OR TREATMENT OF
                  MINOR (LESS THAN 0.5 CM) LESION(S) WITH OR WITHOUT BIOPSY
522..     52260  CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; GENERAL OR CONDUCTION
                  (SPINAL) ANESTHESIA
522..     52270  CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; FEMALE
522..     52275  CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; MALE
522..     52276  CYSTOURETHROSCOPY WITH DIRECT VISION INTERNAL URETHROTOMY
522..     52281  CYSTOURETHROSCOPY, WITH CALIBRATION AND/OR DILATION OF URETHRAL STRICTURE OR STENOSIS, WITH OR
                  WITHOUT MEATOTOMY, WITH OR WITHOUT INJECTION PROCEDURE FOR CYSTOGRAPHY, MALE OR FEMALE
522..     52283  CYSTOURETHROSCOPY, WITH STEROID INJECTION INTO STRICTURE
522..     52285  CYSTOURETHROSCOPY FOR TREATMENT OF THE FEMALE URETHRAL SYNDROME WITH ANY OR ALL OF THE
                  FOLLOWING: URETHRAL MEATOTOMY, URETHRAL DILATION, INTERNAL URETHROTOMY, LYSIS OF
                  URETHROVAGINAL SEPTAL FIBROSIS, LATERAL INCISIONS OF THE BLADDER NECK, AND FULGURATION
522..     52290  CYSTOURETHROSCOPY; WITH URETERAL MEATOTOMY, UNILATERAL OR BILATERAL
522..     52300  CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ORTHOTOPIC URETEROCELE(S), UNILATERAL OR
                  BILATERAL
522..     52301  CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ECTOPIC URETEROCELE(S), UNILATERAL OR
                  BILATERAL
522..     52305  CYSTOURETHROSCOPY; WITH INCISION OR RESECTION OF ORIFICE OF BLADDER DIVERTICULUM, SINGLE OR
                  MULTIPLE
522..     52310  CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URETHRA OR
                  BLADDER (SEPARATE PROCEDURE); SIMPLE
522..     52315  CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URETHRA OR
                  BLADDER (SEPARATE PROCEDURE); COMPLICATED
522..     52327  CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH SUBURETERIC INJECTION OF IMPLANT
                  MATERIAL
522..     52510  TRANSURETHRAL BALLOON DILATION OF THE PROSTATIC URETHRA, ANY METHOD
522..     53605  DILATION OF URETHRAL STRICTURE OR VESICAL NECK BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE,
                  GENERAL OR CONDUCTION (SPINAL) ANESTHESIA
523..  Level III Cystourethroscopy     T                       16.87     $854.79         $447.03         $170.96
       and other Genitourinary
       Procedures
523..     50951  URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION,
                  OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE;
523..     50953  URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION,
                  OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH URETERAL CATHETERIZATION, WITH OR
                  WITHOUT DILATION OF URETER
523..     50955  URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION,
                  OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH BIOPSY
523..     50957  URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION,
                  OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH FULGURATION AND/OR INCISION, WITH
                  OR WITHOUT BIOPSY
523..     50959  URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION,
                  OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH INSERTION OF RADIOACTIVE
                  SUBSTANCE, WITH OR WITHOUT BIOPSY AND/OR FULGURATION (NOT INCLUDING PROVIS)
523..     50961  URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION,
                  OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH REMOVAL OF FOREIGN BODY OR
                  CALCULUS
523..     51020  CYSTOTOMY OR CYSTOSTOMY; WITH FULGURATION AND/OR INSERTION OF RADIOACTIVE MATERIAL
523..     51030  CYSTOTOMY OR CYSTOSTOMY; WITH CRYOSURGICAL DESTRUCTION OF INTRAVESICAL LESION

[[Page 47801]]

523..     51040  CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE
523..     51045  CYSTOTOMY, WITH INSERTION OF URETERAL CATHETER OR STENT (SEPARATE PROCEDURE)
523..     51050  CYSTOLITHOTOMY, CYSTOTOMY WITH REMOVAL OF CALCULUS, WITHOUT VESICAL NECK RESECTION
523..     51065  CYSTOTOMY, WITH STONE BASKET EXTRACTION AND/OR ULTRASONIC OR ELECTROHYDRAULIC FRAGMENTATION OF
                  URETERAL CALCULUS
523..     51520  CYSTOTOMY; FOR SIMPLE EXCISION OF VESICAL NECK (SEPARATE PROCEDURE)
523..     51880  CLOSURE OF CYSTOSTOMY (SEPARATE PROCEDURE)
523..     52234  CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION
                  OF; SMALL BLADDER TUMOR(S) (0.5 TO 2.0 CM)
523..     52235  CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION
                  OF; MEDIUM BLADDER TUMOR(S) (2.0 TO 5.0 CM)
523..     52240  CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION
                  OF; LARGE BLADDER TUMOR(S)
523..     52250  CYSTOURETHROSCOPY WITH INSERTION OF RADIOACTIVE SUBSTANCE, WITH OR WITHOUT BIOPSY OR
                  FULGURATION
523..     52277  CYSTOURETHROSCOPY, WITH RESECTION OF EXTERNAL SPHINCTER (SPHINCTEROTOMY)
523..     52282  CYSTOURETHROSCOPY, WITH INSERTION OF URETHRAL STENT
523..     52317  LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF
                  FRAGMENTS; SIMPLE OR SMALL (LESS THAN 2.5 CM)
523..     52318  LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF
                  FRAGMENTS; COMPLICATED OR LARGE (OVER 2.5 CM)
523..     52320  CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH REMOVAL OF URETERAL CALCULUS
523..     52325  CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH FRAGMENTATION OF URETERAL CALCULUS
                  (EG, ULTRASONIC OR ELECTRO-HYDRAULIC TECHNIQUE)
523..     52330  CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH MANIPULATION, WITHOUT REMOVAL OF
                  URETERAL CALCULUS
523..     52332  CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR DOUBLE-J TYPE)
523..     52334  CYSTOURETHROSCOPY WITH INSERTION OF URETERAL GUIDE WIRE THROUGH KIDNEY TO ESTABLISH A
                  PERCUTANEOUS NEPHROSTOMY, RETROGRADE
523..     52335  CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE URETER AND/OR
                  PYELOURETERAL JUNCTION BY ANY METHOD);
523..     52336  CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE URETER AND/OR
                  PYELOURETERAL JUNCTION BY ANY METHOD); WITH REMOVAL OR MANIPULATION OF CALCULUS (URETERAL
                  CATHETERIZATION IS INCLUDED)
523..     52338  CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE URETER AND/OR
                  PYELOURETERAL JUNCTION BY ANY METHOD); WITH BIOPSY AND/OR FULGURATION OF LESION
523..     52339  CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE URETER AND/OR
                  PYELOURETERAL JUNCTION BY ANY METHOD); WITH RESECTION OF TUMOR
523..     52340  CYSTOURETHROSCOPY WITH INCISION, FULGURATION, OR RESECTION OF CONGENITAL POSTERIOR URETHRAL
                  VALVES, OR CONGENITAL OBSTRUCTIVE HYPERTROPHIC MUCOSAL FOLDS
523..     52450  TRANSURETHRAL INCISION OF PROSTATE
523..     52500  TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)
523..     52606  TRANSURETHRAL FULGURATION FOR POSTOPERATIVE BLEEDING OCCURRING AFTER THE USUAL FOLLOW-UP TIME
523..     52640  TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK CONTRACTURE
523..     52700  TRANSURETHRAL DRAINAGE OF PROSTATIC ABSCESS
523..     55720  PROSTATOTOMY, EXTERNAL DRAINAGE OF PROSTATIC ABSCESS, ANY APPROACH; SIMPLE
523..     55725  PROSTATOTOMY, EXTERNAL DRAINAGE OF PROSTATIC ABSCESS, ANY APPROACH; COMPLICATED
523..     55859  TRANSPERINEAL PLACEMENT OF NEEDLES OR CATHETERS INTO PROSTATE FOR INTERSTITIAL RADIOELEMENT
                  APPLICATION, WITH OR WITHOUT CYSTOSCOPY
524..  Level IV Cystourethroscopy and  T                       28.89   $1,463.84         $833.38         $292.77
       other Genitourinary Procedures
524..     52337  CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE URETER AND/OR
                  PYELOURETERAL JUNCTION BY ANY METHOD); WITH LITHOTRIPSY (URETERAL CATHETERIZATION IS INCLUDED)
524..     52601  TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE
                  BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR
                  DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
524..     52612  TRANSURETHRAL RESECTION OF PROSTATE; FIRST STAGE OF TWO-STAGE RESECTION (PARTIAL RESECTION)
524..     52614  TRANSURETHRAL RESECTION OF PROSTATE; SECOND STAGE OF TWO-STAGE RESECTION (RESECTION COMPLETED)
524..     52620  TRANSURETHRAL RESECTION; OF RESIDUAL OBSTRUCTIVE TISSUE AFTER 90 DAYS POSTOPERATIVE
524..     52630  TRANSURETHRAL RESECTION; OF REGROWTH OF OBSTRUCTIVE TISSUE LONGER THAN ONE YEAR POSTOPERATIVE
524..     52647  NON-CONTACT LASER COAGULATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING,
                  COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND
                  INTERNAL URETHROTOMY ARE INCLUDED)
524..     52648  CONTACT LASER VAPORIZATION WITH OR WITHOUT TRANSURETHRAL RESECTION OF PROSTATE, INCLUDING
                  CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL
                  CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
524..     53850  TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY MICROWAVE THERMOTHERAPY
524..     53852  TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY RADIOFREQUENCY THERMOTHERAPY
527..  Lithotripsy                     T                       51.56   $2,612.52       $1,372.95          $522.5
527..     50590  LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE
529..  Simple Urinary Studies and      T                         2.5     $126.67          $63.05          $25.33
       Procedures
529..     50396  MANOMETRIC STUDIES THROUGH NEPHROSTOMY OR PYELOSTOMY TUBE, OR INDWELLING URETERAL CATHETER
529..     50686  MANOMETRIC STUDIES THROUGH URETEROSTOMY OR INDWELLING URETERAL CATHETER
529..     51725  SIMPLE CYSTOMETROGRAM (CMG) (EG, SPINAL MANOMETER)
529..     51726  COMPLEX CYSTOMETROGRAM (EG, CALIBRATED ELECTRONIC EQUIPMENT)
529..     51736  SIMPLE UROFLOWMETRY (UFR) (EG, STOP-WATCH FLOW RATE, MECHANICAL UROFLOWMETER)

[[Page 47802]]

529..     51741  COMPLEX UROFLOWMETRY (EG, CALIBRATED ELECTRONIC EQUIPMENT)
529..     51772  URETHRAL PRESSURE PROFILE STUDIES (UPP) (URETHRAL CLOSURE PRESSURE PROFILE), ANY TECHNIQUE
529..     51784  ELECTROMYOGRAPHY STUDIES (EMG) OF ANAL OR URETHRAL SPHINCTER, OTHER THAN NEEDLE, ANY TECHNIQUE
529..     51785  NEEDLE ELECTROMYOGRAPHY STUDIES (EMG) OF ANAL OR URETHRAL SPHINCTER, ANY TECHNIQUE
529..     51792  STIMULUS EVOKED RESPONSE (EG, MEASUREMENT OF BULBOCAVERNOSUS REFLEX LATENCY TIME)
529..     51795  VOIDING PRESSURE STUDIES (VP); BLADDER VOIDING PRESSURE, ANY TECHNIQUE
529..     51797  VOIDING PRESSURE STUDIES (VP); INTRA-ABDOMINAL VOIDING PRESSURE (AP) (RECTAL, GASTRIC,
                  INTRAPERITONEAL)
529..     54240  PENILE PLETHYSMOGRAPHY
529..     54250  NOCTURNAL PENILE TUMESCENCE AND/OR RIGIDITY TEST
530..  Genitourinary Procedures        T                        2.52     $127.69          $54.69          $25.54
530..     51000  ASPIRATION OF BLADDER BY NEEDLE
530..     51005  ASPIRATION OF BLADDER; BY TROCAR OR INTRACATHETER
530..     51010  ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER
530..     51700  BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION
530..     51720  BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING DETENTION TIME)
530..     53600  DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE; INITIAL
530..     53601  DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE; SUBSEQUENT
530..     53620  DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM AND FOLLOWER, MALE; INITIAL
530..     53621  DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM AND FOLLOWER, MALE; SUBSEQUENT
530..     53660  DILATION OF FEMALE URETHRA INCLUDING SUPPOSITORY AND/OR INSTILLATION; INITIAL
530..     53661  DILATION OF FEMALE URETHRA INCLUDING SUPPOSITORY AND/OR INSTILLATION; SUBSEQUENT
530..     53675  CATHETERIZATION, URETHRA; COMPLICATED (MAY INCLUDE DIFFICULT REMOVAL OF BALLOON CATHETER)
530..     53899  UNLISTED PROCEDURE, URINARY SYSTEM
530..     54200  INJECTION PROCEDURE FOR PEYRONIE DISEASE;
530..     54220  IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM
530..     54231  DYNAMIC CAVERNOSOMETRY, INCLUDING INTRACAVERNOSAL INJECTION OF VASOACTIVE DRUGS (EG,
                  PAPAVERINE, PHENTOLAMINE)
530..     54235  INJECTION OF CORPORA CAVERNOSA WITH PHARMACOLOGIC AGENT(S) (EG, PAPAVERINE, PHENTOLAMINE)
530..     54450  FORESKIN MANIPULATION INCLUDING LYSIS OF PREPUTIAL ADHESIONS AND STRETCHING
530..     55899  UNLISTED PROCEDURE, MALE GENITAL SYSTEM
531..  Level I Urethral Procedures     T                       18.94     $959.68         $527.26         $191.94
531..     51715  ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE SUBMUCOSAL TISSUES OF THE URETHRA AND/OR
                  BLADDER NECK
531..     53000  URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE PROCEDURE); PENDULOUS URETHRA
531..     53010  URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE PROCEDURE); PERINEAL URETHRA, EXTERNAL
531..     53020  MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); EXCEPT INFANT
531..     53025  MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); INFANT
531..     53040  DRAINAGE OF DEEP PERIURETHRAL ABSCESS
531..     53060  DRAINAGE OF SKENE'S GLAND ABSCESS OR CYST
531..     53080  DRAINAGE OF PERINEAL URINARY EXTRAVASATION; UNCOMPLICATED (SEPARATE PROCEDURE)
531..     53200  BIOPSY OF URETHRA
531..     53250  EXCISION OF BULBOURETHRAL GLAND (COWPER'S GLAND)
531..     53260  EXCISION OR FULGURATION; URETHRAL POLYP(S), DISTAL URETHRA
531..     53265  EXCISION OR FULGURATION; URETHRAL CARUNCLE
531..     53270  EXCISION OR FULGURATION; SKENE'S GLANDS
531..     53275  EXCISION OR FULGURATION; URETHRAL PROLAPSE
531..     53442  REMOVAL OF PERINEAL PROSTHESIS INTRODUCED FOR CONTINENCE
531..     53502  URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY, FEMALE
531..     53505  URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PENILE
531..     53510  URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PERINEAL
531..     53665  DILATION OF FEMALE URETHRA, GENERAL OR CONDUCTION (SPINAL) ANESTHESIA
531..     54000  SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); NEWBORN
531..     54001  SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); EXCEPT NEWBORN
532..  Level II Urethral Procedures    T                        25.5   $1,292.07         $602.18         $258.41
532..     53210  URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY; FEMALE
532..     53215  URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY; MALE
532..     53220  EXCISION OR FULGURATION OF CARCINOMA OF URETHRA
532..     53230  EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE); FEMALE
532..     53235  EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE); MALE
532..     53240  MARSUPIALIZATION OF URETHRAL DIVERTICULUM, MALE OR FEMALE
532..     53400  URETHROPLASTY; FIRST STAGE, FOR FISTULA, DIVERTICULUM, OR STRICTURE (EG, JOHANNSEN TYPE)
532..     53405  URETHROPLASTY; SECOND STAGE (FORMATION OF URETHRA), INCLUDING URINARY DIVERSION
532..     53410  URETHROPLASTY, ONE-STAGE RECONSTRUCTION OF MALE ANTERIOR URETHRA
532..     53420  URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR OF PROSTATIC OR MEMBRANOUS URETHRA; FIRST
                  STAGE
532..     53425  URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR OF PROSTATIC OR MEMBRANOUS URETHRA; SECOND
                  STAGE
532..     53430  URETHROPLASTY, RECONSTRUCTION OF FEMALE URETHRA
532..     53447  REMOVAL, REPAIR, OR REPLACEMENT OF INFLATABLE SPHINCTER INCLUDING PUMP AND/OR RESERVOIR AND/OR
                  CUFF
532..     53449  SURGICAL CORRECTION OF HYDRAULIC ABNORMALITY OF INFLATABLE SPHINCTER DEVICE
532..     53450  URETHROMEATOPLASTY, WITH MUCOSAL ADVANCEMENT
532..     53460  URETHROMEATOPLASTY, WITH PARTIAL EXCISION OF DISTAL URETHRAL SEGMENT (RICHARDSON TYPE
                  PROCEDURE)
532..     53515  URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PROSTATOMEMBRANOUS
532..     53520  CLOSURE OF URETHROSTOMY OR URETHROCUTANEOUS FISTULA, MALE (SEPARATE PROCEDURE)
536..  Circumcision                    T                       13.17     $667.32         $326.57         $133.46
536..     54150  CIRCUMCISION, USING CLAMP OR OTHER DEVICE; NEWBORN

[[Page 47803]]

536..     54152  CIRCUMCISION, USING CLAMP OR OTHER DEVICE; EXCEPT NEWBORN
536..     54160  CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE OR DORSAL SLIT; NEWBORN
536..     54161  CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE OR DORSAL SLIT; EXCEPT NEWBORN
537..  Penile Procedures               T                       28.72   $1,455.23         $864.34         $291.05
537..     37790  PENILE VENOUS OCCLUSIVE PROCEDURE
537..     54110  EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE);
537..     54111  EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT TO 5 CM IN LENGTH
537..     54112  EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT GREATER THAN 5 CM IN LENGTH
537..     54120  AMPUTATION OF PENIS; PARTIAL
537..     54205  INJECTION PROCEDURE FOR PEYRONIE DISEASE; WITH SURGICAL EXPOSURE OF PLAQUE
537..     54300  PLASTIC OPERATION OF PENIS FOR STRAIGHTENING OF CHORDEE (EG, HYPOSPADIAS), WITH OR WITHOUT
                  MOBILIZATION OF URETHRA
537..     54304  PLASTIC OPERATION ON PENIS FOR CORRECTION OF CHORDEE OR FOR FIRST STAGE HYPOSPADIAS REPAIR WITH
                  OR WITHOUT TRANSPLANTATION OF PREPUCE AND/OR SKIN FLAPS
537..     54308  URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY DIVERSION); LESS THAN 3 CM
537..     54312  URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY DIVERSION); GREATER THAN 3
                  CM
537..     54316  URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY DIVERSION) WITH FREE SKIN
                  GRAFT OBTAINED FROM SITE OTHER THAN GENITALIA
537..     54318  URETHROPLASTY FOR THIRD STAGE HYPOSPADIAS REPAIR TO RELEASE PENIS FROM SCROTUM (EG, THIRD STAGE
                  CECIL
537..     54322  ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH SIMPLE
                  MEATAL ADVANCEMENT (EG, MAGPI, V-FLAP)
537..     54324  ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH
                  URETHROPLASTY BY LOCAL SKIN FLAPS (EG, FLIP-FLAP, PREPUCIAL FLAP)
537..     54326  ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH
                  URETHROPLASTY BY LOCAL SKIN FLAPS AND MOBILIZATION OF URETHRA
537..     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
537..     54340  REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); BY CLOSURE,
                  INCISION, OR EXCISION,
537..     54344  REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); REQUIRING
                  MOBILIZATION OF SKIN FLAPS AND URETHROPLASTY WITH FLAP OR PATCH GRAFT
537..     54348  REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); REQUIRING EXTENSIVE
                  DISSECTION AND URETHROPLASTY WITH FLAP, PATCH OR TUBED GRAFT (INCLUDES URINARY DIVERSION)
537..     54352  REPAIR OF HYPOSPADIAS CRIPPLE REQUIRING EXTENSIVE DISSECTION AND EXCISION OF PREVIOUSLY
                  CONSTRUCTED STRUCTURES INCLUDING RE-RELEASE OF CHORDEE AND RECONSTRUCTION OF URETHRA AND PENIS
                  BY USE OF LOCAL SKIN AS GRAFTS AND ISLAND FLAPS AND SKIN BROUGHT IN AS F
537..     54360  PLASTIC OPERATION ON PENIS TO CORRECT ANGULATION
537..     54380  PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER;
537..     54385  PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER; WITH INCONTINENCE
537..     54402  REMOVAL OR REPLACEMENT OF NON-INFLATABLE (SEMI-RIGID) OR INFLATABLE (SELF-CONTAINED) PENILE
                  PROSTHESIS
537..     54407  REMOVAL, REPAIR, OR REPLACEMENT OF INFLATABLE (MULTI-COMPONENT) PENILE PROSTHESIS, INCLUDING
                  PUMP AND/OR RESERVOIR AND/OR CYLINDERS
537..     54409  SURGICAL CORRECTION OF HYDRAULIC ABNORMALITY OF INFLATABLE (MULTI-COMPONENT) PROSTHESIS
                  INCLUDING PUMP AND/OR RESERVOIR AND/OR CYLINDERS
537..     54420  CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT (PRIAPISM OPERATION), UNILATERAL OR BILATERAL
537..     54435  CORPORA CAVERNOSA-GLANS PENIS FISTULIZATION (EG, BIOPSY NEEDLE, WINTER PROCEDURE, RONGEUR, OR
                  PUNCH) FOR PRIAPISM
537..     54440  PLASTIC OPERATION OF PENIS FOR INJURY
538..  Insertion of Penile Prosthesis  T                       45.59   $2,310.02       $1,540.64         $462.00
538..     53440  OPERATION FOR CORRECTION OF MALE URINARY INCONTINENCE, WITH OR WITHOUT INTRODUCTION OF
                  PROSTHESIS
538..     53445  OPERATION FOR CORRECTION OF URINARY INCONTINENCE WITH PLACEMENT OF INFLATABLE URETHRAL OR
                  BLADDER NECK SPHINCTER, INCLUDING PLACEMENT OF PUMP AND/OR RESERVOIR
538..     54400  INSERTION OF PENILE PROSTHESIS; NON-INFLATABLE (SEMI-RIGID)
538..     54401  INSERTION OF PENILE PROSTHESIS; INFLATABLE (SELF-CONTAINED)
538..     54405  INSERTION OF INFLATABLE (MULTI-COMPONENT) PENILE PROSTHESIS, INCLUDING PLACEMENT OF PUMP,
                  CYLINDERS, AND/OR RESERVOIR
546..  Testes/Epididymis Procedures    T                       17.14     $868.47         $453.81         $173.69
546..     54505  BIOPSY OF TESTIS, INCISIONAL (SEPARATE PROCEDURE)
546..     54510  EXCISION OF LOCAL LESION OF TESTIS
546..     54520  ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR PROSTHESIS, SCROTAL OR
                  INGUINAL APPROACH
546..     54530  ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH
546..     54550  EXPLORATION FOR UNDESCENDED TESTIS (INGUINAL OR SCROTAL AREA)
546..     54600  REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATERAL TESTIS
546..     54620  FIXATION OF CONTRALATERAL TESTIS (SEPARATE PROCEDURE)
546..     54640  ORCHIOPEXY, INGUINAL APPROACH, WITH OR WITHOUT HERNIA REPAIR
546..     54660  INSERTION OF TESTICULAR PROSTHESIS (SEPARATE PROCEDURE)
546..     54670  SUTURE OR REPAIR OF TESTICULAR INJURY
546..     54680  TRANSPLANTATION OF TESTIS(ES) TO THIGH (BECAUSE OF SCROTAL DESTRUCTION)
546..     54700  INCISION AND DRAINAGE OF EPIDIDYMIS, TESTIS AND/OR SCROTAL SPACE (EG, ABSCESS OR HEMATOMA)
546..     54820  EXPLORATION OF EPIDIDYMIS, WITH OR WITHOUT BIOPSY
546..     54830  EXCISION OF LOCAL LESION OF EPIDIDYMIS
546..     54840  EXCISION OF SPERMATOCELE, WITH OR WITHOUT EPIDIDYMECTOMY
546..     54860  EPIDIDYMECTOMY; UNILATERAL
546..     54861  EPIDIDYMECTOMY; BILATERAL

[[Page 47804]]

546..     54900  EPIDIDYMOVASOSTOMY, ANASTOMOSIS OF EPIDIDYMIS TO VAS DEFERENS; UNILATERAL
546..     54901  EPIDIDYMOVASOSTOMY, ANASTOMOSIS OF EPIDIDYMIS TO VAS DEFERENS; BILATERAL
546..     55060  REPAIR OF TUNICA VAGINALIS HYDROCELE (BOTTLE TYPE)
546..     55110  SCROTAL EXPLORATION
546..     55120  REMOVAL OF FOREIGN BODY IN SCROTUM
546..     55150  RESECTION OF SCROTUM
546..     55175  SCROTOPLASTY; SIMPLE
546..     55180  SCROTOPLASTY; COMPLICATED
546..     55200  VASOTOMY, CANNULIZATION WITH OR WITHOUT INCISION OF VAS, UNILATERAL OR BILATERAL (SEPARATE
                  PROCEDURE)
546..     55250  VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN
                  EXAMINATION(S)
546..     55400  VASOVASOSTOMY, VASOVASORRHAPHY
546..     55450  LIGATION (PERCUTANEOUS) OF VAS DEFERENS, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)
546..     55500  EXCISION OF HYDROCELE OF SPERMATIC CORD, UNILATERAL (SEPARATE PROCEDURE)
546..     55520  EXCISION OF LESION OF SPERMATIC CORD (SEPARATE PROCEDURE)
546..     55530  EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; (SEPARATE PROCEDURE)
546..     55535  EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; ABDOMINAL APPROACH
546..     55540  EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; WITH HERNIA REPAIR
546..     55680  EXCISION OF MULLERIAN DUCT CYST
547..  Prostate Biopsy                 T                        4.39     $222.44          $125.2          $44.49
547..     55700  BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH
547..     55705  BIOPSY, PROSTATE; INCISIONAL, ANY APPROACH
550..  Surgical Hysteroscopy           T                       16.89     $855.81         $447.93         $171.16
550..     56351  HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR
                  WITHOUT D & C
550..     56352  HYSTEROSCOPY, SURGICAL; WITH LYSIS OF INTRAUTERINE ADHESIONS (ANY METHOD)
550..     56353  HYSTEROSCOPY, SURGICAL; WITH DIVISION OR RESECTION OF INTRAUTERINE SEPTUM (ANY METHOD)
550..     56354  HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA
550..     56355  HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY
550..     56356  HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (ANY METHOD)
551..  Level I Laparoscopy             T                       24.78   $1,255.59         $711.67         $251.12
551..     56300  LAPAROSCOPY (PERITONEOSCOPY), DIAGNOSTIC; (SEPARATE PROCEDURE)
551..     56301  LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION)
551..     56302  LAPAROSCOPY, SURGICAL; WITH OCCLUSION OF OVIDUCTS BY DEVICE (EG, BAND, CLIP, OR FALOPE RING)
551..     56303  LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VISCERA, OR
                  PERITONEAL SURFACE BY ANY METHOD
551..     56304  LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE
                  PROCEDURE)
551..     56305  LAPAROSCOPY, SURGICAL; WITH BIOPSY (SINGLE OR MULTIPLE)
551..     56306  LAPAROSCOPY, SURGICAL; WITH ASPIRATION (SINGLE OR MULTIPLE)
551..     56346  LAPAROSCOPY, SURGICAL; GASTROSTOMY, TEMPORARY (TUBE OR RUBBER OR PLASTIC) (SEPARATE PROCEDURE)
552..  Level II Laparoscopy            T                       37.71   $1,910.75       $1,053.16         $382.15
552..     56307  LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR
                  SALPINGECTOMY)
552..     56309  LAPAROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA (SINGLE OR MULTIPLE)
552..     56311  LAPAROSCOPY, SURGICAL; WITH RETROPERITONEAL LYMPH NODE SAMPLING (BIOPSY), SINGLE OR MULTIPLE
552..     56312  LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY
552..     56313  LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PERI-AORTIC LYMPH NODE
                  SAMPLING (BIOPSY), SINGLE OR MULTIPLE
552..     56316  LAPAROSCOPY, SURGICAL; REPAIR OF INITIAL INGUINAL HERNIA
552..     56317  LAPAROSCOPY, SURGICAL; REPAIR OF RECURRENT INGUINAL HERNIA
552..     56318  LAPAROSCOPY, SURGICAL; ORCHIECTOMY
552..     56320  LAPAROSCOPY, SURGICAL; WITH LIGATION OF SPERMATIC VEINS FOR VARICOCELE
552..     56343  LAPAROSCOPY, SURGICAL; WITH SALPINGOSTOMY (SALPINGONEOSTOMY)
552..     56344  LAPAROSCOPY, SURGICAL; WITH FIMBRIOPLASTY
552..     56362  LAPAROSCOPY WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY; WITHOUT BIOPSY
552..     56363  LAPAROSCOPY WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY; WITH BIOPSY
561..  Level I Female Reproductive     T                        1.52      $77.02          $24.63           $15.4
       Procedures
561..     56405  INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS
561..     56420  INCISION AND DRAINAGE OF BARTHOLIN'S GLAND ABSCESS
561..     56441  LYSIS OF LABIAL ADHESIONS
561..     57061  DESTRUCTION OF VAGINAL LESION(S); SIMPLE, ANY METHOD
561..     57100  BIOPSY OF VAGINAL MUCOSA; SIMPLE (SEPARATE PROCEDURE)
561..     57150  IRRIGATION OF VAGINA AND/OR APPLICATION OF MEDICAMENT FOR TREATMENT OF BACTERIAL, PARASITIC, OR
                  FUNGOID DISEASE
561..     57160  FITTING AND INSERTION OF PESSARY OR OTHER INTRAVAGINAL SUPPORT DEVICE
561..     57170  DIAPHRAGM OR CERVICAL CAP FITTING WITH INSTRUCTIONS
561..     57180  INTRODUCTION OF ANY HEMOSTATIC AGENT OR PACK FOR SPONTANEOUS OR TRAUMATIC NONOBSTETRICAL
                  VAGINAL HEMORRHAGE (SEPARATE PROCEDURE)
561..     57452  COLPOSCOPY (VAGINOSCOPY); (SEPARATE PROCEDURE)
561..     57454  COLPOSCOPY (VAGINOSCOPY); WITH BIOPSY(S) OF THE CERVIX AND/OR ENDOCERVICAL CURETTAGE
561..     57500  BIOPSY, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHOUT FULGURATION (SEPARATE
                  PROCEDURE)
561..     57505  ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A DILATION AND CURETTAGE)
561..     57510  CAUTERIZATION OF CERVIX; ELECTRO OR THERMAL
561..     57511  CAUTERIZATION OF CERVIX; CRYOCAUTERY, INITIAL OR REPEAT
561..     57513  CAUTERIZATION OF CERVIX; LASER ABLATION

[[Page 47805]]

561..     57800  DILATION OF CERVICAL CANAL, INSTRUMENTAL (SEPARATE PROCEDURE)
561..     58100  ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WITHOUT CERVICAL
                  DILATION, ANY METHOD (SEPARATE PROCEDURE)
561..     58301  REMOVAL OF INTRAUTERINE DEVICE (IUD)
561..     59200  INSERTION OF CERVICAL DILATOR (EG, LAMINARIA, PROSTAGLANDIN) (SEPARATE PROCEDURE)
562..  Level II Female Reproductive    T                       12.76     $646.54         $330.75         $129.31
       Procedures
562..     56350  HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE)
562..     56399  UNLISTED PROCEDURE, LAPAROSCOPY, HYSTEROSCOPY
562..     56440  MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST
562..     56700  PARTIAL HYMENECTOMY OR REVISION OF HYMENAL RING
562..     56720  HYMENOTOMY, SIMPLE INCISION
562..     56740  EXCISION OF BARTHOLIN'S GLAND OR CYST
562..     56800  PLASTIC REPAIR OF INTROITUS
562..     56810  PERINEOPLASTY, REPAIR OF PERINEUM, NONOBSTETRICAL (SEPARATE PROCEDURE)
562..     57000  COLPOTOMY; WITH EXPLORATION
562..     57010  COLPOTOMY; WITH DRAINAGE OF PELVIC ABSCESS
562..     57020  COLPOCENTESIS (SEPARATE PROCEDURE)
562..     57065  DESTRUCTION OF VAGINAL LESION(S); EXTENSIVE, ANY METHOD
562..     57105  BIOPSY OF VAGINAL MUCOSA; EXTENSIVE, REQUIRING SUTURE (INCLUDING CYSTS)
562..     57130  EXCISION OF VAGINAL SEPTUM
562..     57135  EXCISION OF VAGINAL CYST OR TUMOR
562..     57200  COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL)
562..     57210  COLPOPERINEORRHAPHY, SUTURE OF INJURY OF VAGINA AND/OR PERINEUM (NONOBSTETRICAL)
562..     57230  PLASTIC REPAIR OF URETHROCELE
562..     57400  DILATION OF VAGINA UNDER ANESTHESIA
562..     57410  PELVIC EXAMINATION UNDER ANESTHESIA
562..     57415  REMOVAL OF IMPACTED VAGINAL FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
562..     57460  COLPOSCOPY (VAGINOSCOPY); WITH LOOP ELECTRODE EXCISION PROCEDURE OF THE CERVIX
562..     57700  CERCLAGE OF UTERINE CERVIX, NONOBSTETRICAL
562..     57720  TRACHELORRHAPHY, PLASTIC REPAIR OF UTERINE CERVIX, VAGINAL APPROACH
562..     58345  TRANSCERVICAL INTRODUCTION OF FALLOPIAN TUBE CATHETER FOR DIAGNOSIS AND/OR RE-ESTABLISHING
                  PATENCY (ANY METHOD), WITH OR WITHOUT HYSTEROSALPINGOGRAPHY
562..     58350  CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS
562..     58970  FOLLICLE PUNCTURE FOR OOCYTE RETRIEVAL, ANY METHOD
562..     59300  EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING PHYSICIAN
562..     59320  CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL
562..     59871  REMOVAL OF CERCLAGE SUTURE UNDER ANESTHESIA (OTHER THAN LOCAL)
563..  Level III Female Reproductive   T                       16.90     $856.31         $464.88         $171.26
       Procedures
563..     56620  VULVECTOMY SIMPLE; PARTIAL
563..     56625  VULVECTOMY SIMPLE; COMPLETE
563..     57220  PLASTIC OPERATION ON URETHRAL SPHINCTER, VAGINAL APPROACH (EG, KELLY URETHRAL PLICATION)
563..     57240  ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH OR WITHOUT REPAIR OF URETHROCELE
563..     57250  POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY
563..     57260  COMBINED ANTEROPOSTERIOR COLPORRHAPHY;
563..     57265  COMBINED ANTEROPOSTERIOR COLPORRHAPHY; WITH ENTEROCELE REPAIR
563..     57268  REPAIR OF ENTEROCELE, VAGINAL APPROACH (SEPARATE PROCEDURE)
563..     57284  PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, STRESS URINARY INCONTINENCE, AND/OR
                  INCOMPLETE VAGINAL PROLAPSE)
563..     57288  SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
563..     57289  PEREYRA PROCEDURE, INCLUDING ANTERIOR COLPORRHAPHY
563..     57291  CONSTRUCTION OF ARTIFICIAL VAGINA; WITHOUT GRAFT
563..     57300  CLOSURE OF RECTOVAGINAL FISTULA; VAGINAL OR TRANSANAL APPROACH
563..     57520  CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH
                  OR WITHOUT REPAIR; COLD KNIFE OR LASER
563..     57522  CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH
                  OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION
563..     57530  TRACHELECTOMY (CERVICECTOMY), AMPUTATION OF CERVIX (SEPARATE PROCEDURE)
563..     57550  EXCISION OF CERVICAL STUMP, VAGINAL APPROACH;
563..     57555  EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; WITH ANTERIOR AND/OR POSTERIOR REPAIR
563..     57556  EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; WITH REPAIR OF ENTEROCELE
563..     58145  MYOMECTOMY, EXCISION OF FIBROID TUMOR OF UTERUS, SINGLE OR MULTIPLE (SEPARATE PROCEDURE);
                  VAGINAL APPROACH
563..     58800  DRAINAGE OF OVARIAN CYST(S), UNILATERAL OR BILATERAL, (SEPARATE PROCEDURE); VAGINAL APPROACH
563..     58820  DRAINAGE OF OVARIAN ABSCESS; VAGINAL APPROACH, OPEN
567..  D & C                           T                       13.61     $689.61         $364.09         $137.92
567..     57820  DILATION AND CURETTAGE OF CERVICAL STUMP
567..     58120  DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)
567..     59160  CURRETTAGE, POSTPARTUM
568..  Infertility Procedures          T                        2.49     $126.17          $49.49          $25.23
568..     55870  ELECTROEJACULATION
568..     58321  ARTIFICIAL INSEMINATION; INTRA-CERVICAL
568..     58322  ARTIFICIAL INSEMINATION; INTRA-UTERINE
568..     58323  SPERM WASHING FOR ARTIFICIAL INSEMINATION
568..     58974  EMBRYO TRANSFER, INTRAUTERINE

[[Page 47806]]

568..     58976  GAMETE, ZYGOTE, OR EMBRYO INTRAFALLOPIAN TRANSFER, ANY METHOD
578..  Pregnancy and Neonatal Care     T                        1.26      $63.84           $33.9          $12.77
       Procedures
578..     59000  AMNIOCENTESIS, ANY METHOD
578..     59012  CORDOCENTESIS (INTRAUTERINE), ANY METHOD
578..     59015  CHORIONIC VILLUS SAMPLING, ANY METHOD
578..     59020  FETAL CONTRACTION STRESS TEST
578..     59025  FETAL NON-STRESS TEST
578..     59030  FETAL SCALP BLOOD SAMPLING
578..     59050  FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN (IE, NON-ATTENDING PHYSICIAN) WITH
                  WRITTEN REPORT; SUPERVISION AND INTERPRETATION
578..     59899  UNLISTED PROCEDURE, MATERNITY CARE AND DELIVERY
580..  Vaginal Delivery                T                        4.59     $232.57         $146.34          $46.51
580..     59409  VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS);
580..     59412  EXTERNAL CEPHALIC VERSION, WITH OR WITHOUT TOCOLYSIS (LIST IN ADDITION TO CODE(S) FOR DELIVERY)
580..     59414  DELIVERY OF PLACENTA (SEPARATE PROCEDURE)
580..     59612  VAGINAL DELIVERY ONLY, AFTER PREVIOUS CESAREAN DELIVERY (WITH OR WITHOUT EPISIOTOMY AND/OR
                  FORCEPS);
586..  Therapeutic Abortion            T                        12.5     $633.37         $431.89         $126.67
586..     59840  INDUCED ABORTION, BY DILATION AND CURETTAGE
586..     59841  INDUCED ABORTION, BY DILATION AND EVACUATION
587..  Spontaneous Abortion            T                       13.25     $671.37         $347.02         $134.27
587..     59812  TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY
587..     59820  TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER
587..     59821  TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER
587..     59870  UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE
600..  Spinal Tap                      T                        2.63     $133.26          $61.47          $26.65
600..     62270  SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC
600..     62272  SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF SPINAL FLUID (BY NEEDLE OR CATHETER)
601..  Level I Nervous System          T                        3.11     $157.58          $74.13          $31.52
       Injections
601..     64400  INJECTION, ANESTHETIC AGENT; TRIGEMINAL NERVE, ANY DIVISION OR BRANCH
601..     64402  INJECTION, ANESTHETIC AGENT; FACIAL NERVE
601..     64405  INJECTION, ANESTHETIC AGENT; GREATER OCCIPITAL NERVE
601..     64408  INJECTION, ANESTHETIC AGENT; VAGUS NERVE
601..     64410  INJECTION, ANESTHETIC AGENT; PHRENIC NERVE
601..     64412  INJECTION, ANESTHETIC AGENT; SPINAL ACCESSORY NERVE
601..     64413  INJECTION, ANESTHETIC AGENT; CERVICAL PLEXUS
601..     64415  INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS
601..     64417  INJECTION, ANESTHETIC AGENT; AXILLARY NERVE
601..     64418  INJECTION, ANESTHETIC AGENT; SUPRASCAPULAR NERVE
601..     64420  INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE
601..     64421  INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVES, MULTIPLE, REGIONAL BLOCK
601..     64425  INJECTION, ANESTHETIC AGENT; ILIOINGUINAL, ILIOHYPOGASTRIC NERVES
601..     64430  INJECTION, ANESTHETIC AGENT; PUDENDAL NERVE
601..     64435  INJECTION, ANESTHETIC AGENT; PARACERVICAL (UTERINE) NERVE
601..     64440  INJECTION, ANESTHETIC AGENT; PARAVERTEBRAL NERVE (THORACIC, LUMBAR, SACRAL, COCCYGEAL), SINGLE
                  VERTEBRAL LEVEL
601..     64441  INJECTION, ANESTHETIC AGENT; PARAVERTEBRAL NERVES, MULTIPLE LEVELS (EG, REGIONAL BLOCK)
601..     64442  INJECTION, ANESTHETIC AGENT; PARAVERTEBRAL FACET JOINT NERVE, LUMBAR, SINGLE LEVEL
601..     64443  INJECTION, ANESTHETIC AGENT; PARAVERTEBRAL FACET JOINT NERVE, LUMBAR, EACH ADDITIONAL LEVEL
601..     64445  INJECTION, ANESTHETIC AGENT; SCIATIC NERVE
601..     64450  INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
601..     64505  INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION
601..     64508  INJECTION, ANESTHETIC AGENT; CAROTID SINUS (SEPARATE PROCEDURE)
601..     64510  INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC)
601..     64520  INJECTION, ANESTHETIC AGENT; LUMBAR OR THORACIC (PARAVERTEBRAL SYMPATHETIC)
601..     64530  INJECTION, ANESTHETIC AGENT; CELIAC PLEXUS, WITH OR WITHOUT RADIOLOGIC MONITORING
601..     64600  DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SUPRAORBITAL, INFRAORBITAL, MENTAL, OR
                  INFERIOR ALVEOLAR BRANCH
601..     64605  DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SECOND AND THIRD DIVISION BRANCHES AT
                  FORAMEN OVALE
601..     64610  DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SECOND AND THIRD DIVISION BRANCHES AT
                  FORAMEN OVALE UNDER RADIOLOGIC MONITORING
601..     64612  DESTRUCTION BY NEUROLYTIC AGENT (CHEMODENERVATION OF MUSCLE ENDPLATE); MUSCLES ENERVATED BY
                  FACIAL NERVE (EG, FOR BLEPHAROSPASM, HEMIFACIAL SPASM)
601..     64613  DESTRUCTION BY NEUROLYTIC AGENT (CHEMODENERVATION OF MUSCLE ENDPLATE); CERVICAL SPINAL MUSCLES
                  (EG, FOR SPASMODIC TORTICOLLIS)
601..     64620  DESTRUCTION BY NEUROLYTIC AGENT; INTERCOSTAL NERVE
601..     64622  DESTRUCTION BY NEUROLYTIC AGENT; PARAVERTEBRAL FACET JOINT NERVE, LUMBAR, SINGLE LEVEL
601..     64623  DESTRUCTION BY NEUROLYTIC AGENT; PARAVERTEBRAL FACET JOINT NERVE, LUMBAR, EACH ADDITIONAL LEVEL
601..     64630  DESTRUCTION BY NEUROLYTIC AGENT; PUDENDAL NERVE
601..     64640  DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
601..     64680  DESTRUCTION BY NEUROLYTIC AGENT, CELIAC PLEXUS, WITH OR WITHOUT RADIOLOGIC MONITORING
601..     64999  UNLISTED PROCEDURE, NERVOUS SYSTEM
602..  Level II Nervous System         T                        3.33     $168.73          $87.69          $33.75
       Injections

[[Page 47807]]

602..     61000  SUBDURAL TAP THROUGH FONTANELLE, OR SUTURE, INFANT, UNILATERAL OR BILATERAL; INITIAL
602..     61001  SUBDURAL TAP THROUGH FONTANELLE, OR SUTURE, INFANT, UNILATERAL OR BILATERAL; SUBSEQUENT TAPS
602..     61020  VENTRICULAR PUNCTURE THROUGH PREVIOUS BURR HOLE, FONTANELLE, SUTURE, OR IMPLANTED VENTRICULAR
                  CATHETER/RESERVOIR; WITHOUT INJECTION
602..     61026  VENTRICULAR PUNCTURE THROUGH PREVIOUS BURR HOLE, FONTANELLE, SUTURE, OR IMPLANTED VENTRICULAR
                  CATHETER/RESERVOIR; WITH INJECTION OF DRUG OR OTHER SUBSTANCE FOR DIAGNOSIS OR TREATMENT
602..     61050  CISTERNAL OR LATERAL CERVICAL (C1-C2) PUNCTURE; WITHOUT INJECTION (SEPARATE PROCEDURE)
602..     61055  CISTERNAL OR LATERAL CERVICAL (C1-C2) PUNCTURE; WITH INJECTION OF DRUG OR OTHER SUBSTANCE FOR
                  DIAGNOSIS OR TREATMENT (EG, C1-C2)
602..     61070  PUNCTURE OF SHUNT TUBING OR RESERVOIR FOR ASPIRATION OR INJECTION PROCEDURE
602..     62194  REPLACEMENT OR IRRIGATION, SUBARACHNOID/SUBDURAL CATHETER
602..     62225  REPLACEMENT OR IRRIGATION, VENTRICULAR CATHETER
602..     62268  PERCUTANEOUS ASPIRATION, SPINAL CORD CYST OR SYRINX
602..     62273  INJECTION, LUMBAR EPIDURAL, OF BLOOD OR CLOT PATCH
602..     62274  INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING
                  NARCOTICS); SUBARACHNOID OR SUBDURAL, SINGLE
602..     62275  INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING
                  NARCOTICS); EPIDURAL, CERVICAL OR THORACIC, SINGLE
602..     62276  INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING
                  NARCOTICS); SUBARACHNOID OR SUBDURAL, DIFFERENTIAL
602..     62277  INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING
                  NARCOTICS); SUBARACHNOID OR SUBDURAL, CONTINUOUS
602..     62278  INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING
                  NARCOTICS); EPIDURAL, LUMBAR OR CAUDAL, SINGLE
602..     62279  INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING
                  NARCOTICS); EPIDURAL, LUMBAR OR CAUDAL, CONTINUOUS
602..     62280  INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS); SUBARACHNOID
602..     62281  INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS); EPIDURAL,
                  CERVICAL OR THORACIC
602..     62282  INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS); EPIDURAL,
                  LUMBAR OR CAUDAL
602..     62288  INJECTION OF SUBSTANCE OTHER THAN ANESTHETIC, ANTISPASMODIC, CONTRAST, OR NEUROLYTIC SOLUTIONS;
                  SUBARACHNOID (SEPARATE PROCEDURE)
602..     62289  INJECTION OF SUBSTANCE OTHER THAN ANESTHETIC, ANTISPASMODIC, CONTRAST, OR NEUROLYTIC SOLUTIONS;
                  LUMBAR OR CAUDAL EPIDURAL (SEPARATE PROCEDURE)
602..     62292  INJECTION PROCEDURE FOR CHEMONUCLEOLYSIS, INCLUDING DISKOGRAPHY, INTERVERTEBRAL DISK, SINGLE OR
                  MULTIPLE LEVELS, LUMBAR
602..     62294  INJECTION PROCEDURE, ARTERIAL, FOR OCCLUSION OF ARTERIOVENOUS MALFORMATION, SPINAL
602..     62298  INJECTION OF SUBSTANCE OTHER THAN ANESTHETIC, CONTRAST, OR NEUROLYTIC SOLUTIONS, EPIDURAL,
                  CERVICAL OR THORACIC (SEPARATE PROCEDURE)
616..  Implantation of                 T                       14.43     $731.16         $366.57         $146.23
       Neurostimulator Electrodes
616..     63650  PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; EPIDURAL
616..     64553  PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; CRANIAL NERVE
616..     64555  PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE
616..     64560  PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; AUTONOMIC NERVE
616..     64565  PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; NEUROMUSCULAR
616..     64573  INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; CRANIAL NERVE
616..     64575  INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE
616..     64577  INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; AUTONOMIC NERVE
616..     64580  INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; NEUROMUSCULAR
617..  Revision/Removal Neurological   T                       11.56     $585.74         $287.59         $117.15
       Device
617..     62230  REPLACEMENT OR REVISION OF CSF SHUNT, OBSTRUCTED VALVE, OR DISTAL CATHETER IN SHUNT SYSTEM
617..     62350  IMPLANTATION, REVISION OR REPOSITIONING OF INTRATHECAL OR EPIDURAL CATHETER, FOR IMPLANTABLE
                  RESERVOIR OR IMPLANTABLE INFUSION PUMP; WITHOUT LAMINECTOMY
617..     62355  REMOVAL OF PREVIOUSLY IMPLANTED INTRATHECAL OR EPIDURAL CATHETER
617..     62365  REMOVAL OF SUBCUTANEOUS RESERVOIR OR PUMP, PREVIOUSLY IMPLANTED FOR INTRATHECAL OR EPIDURAL
                  INFUSION
617..     63660  REVISION OR REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODES
617..     63688  REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER
617..     63744  REPLACEMENT, IRRIGATION OR REVISION OF LUMBOSUBARACHNOID SHUNT
617..     63746  REMOVAL OF ENTIRE LUMBOSUBARACHNOID SHUNT SYSTEM WITHOUT REPLACEMENT
617..     64585  REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODES
617..     64595  REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER
618..  Implantation of Neurological    T                       25.56   $1,295.11         $780.49         $259.02
       Device
618..     61215  INSERTION OF SUBCUTANEOUS RESERVOIR, PUMP OR CONTINUOUS INFUSION SYSTEM FOR CONNECTION TO
                  VENTRICULAR CATHETER
618..     61885  INCISION AND SUBCUTANEOUS PLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER,
                  DIRECT OR INDUCTIVE COUPLING
618..     62360  IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; SUBCUTANEOUS
                  RESERVOIR
618..     62361  IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; NON-
                  PROGRAMMABLE PUMP
618..     62362  IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; PROGRAMMABLE
                  PUMP, INCLUDING PREPARATION OF PUMP, WITH OR WITHOUT PROGRAMMING
618..     63685  INCISION AND SUBCUTANEOUS PLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER,
                  DIRECT OR INDUCTIVE COUPLING
618..     64590  INCISION AND SUBCUTANEOUS PLACEMENT OF PERIPHERAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER,
                  DIRECT OR INDUCTIVE COUPLING

[[Page 47808]]

631..  Level I Nerve Procedures        T                       12.98     $657.69          $333.8         $131.54
631..     27315  NEURECTOMY, HAMSTRING MUSCLE
631..     27320  NEURECTOMY, POPLITEAL (GASTROCNEMIUS)
631..     28030  NEURECTOMY OF INTRINSIC MUSCULATURE OF FOOT
631..     28035  TARSAL TUNNEL RELEASE (POSTERIOR TIBIAL NERVE DECOMPRESSION)
631..     61790  CREATION OF LESION BY STEREOTACTIC METHOD, PERCUTANEOUS, BY NEUROLYTIC AGENT (EG, ALCOHOL,
                  THERMAL, ELECTRICAL, RADIOFREQUENCY); GASSERIAN GANGLION
631..     62287  ASPIRATION PROCEDURE, PERCUTANEOUS, OF NUCLEUS PULPOSUS OF INTERVERTEBRAL DISK, ANY METHOD,
                  SINGLE OR MULTIPLE LEVELS, LUMBAR
631..     63600  CREATION OF LESION OF SPINAL CORD BY STEREOTACTIC METHOD, PERCUTANEOUS, ANY MODALITY (INCLUDING
                  STIMULATION AND/OR RECORDING)
631..     63610  STEREOTACTIC STIMULATION OF SPINAL CORD, PERCUTANEOUS, SEPARATE PROCEDURE NOT FOLLOWED BY OTHER
                  SURGERY
631..     63615  STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION OF LESION, SPINAL CORD
631..     64702  NEUROPLASTY; DIGITAL, ONE OR BOTH, SAME DIGIT
631..     64704  NEUROPLASTY; NERVE OF HAND OR FOOT
631..     64708  NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; OTHER THAN SPECIFIED
631..     64712  NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; SCIATIC NERVE
631..     64713  NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; BRACHIAL PLEXUS
631..     64714  NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; LUMBAR PLEXUS
631..     64716  NEUROPLASTY AND/OR TRANSPOSITION; CRANIAL NERVE (SPECIFY)
631..     64718  NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW
631..     64719  NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRIST
631..     64721  NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
631..     64722  DECOMPRESSION; UNSPECIFIED NERVE(S) (SPECIFY)
631..     64726  DECOMPRESSION; PLANTAR DIGITAL NERVE
631..     64727  INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE
                  FOR NEUROPLASTY) (NEUROPLASTY INCLUDES EXTERNAL NEUROLYSIS)
631..     64732  TRANSECTION OR AVULSION OF; SUPRAORBITAL NERVE
631..     64734  TRANSECTION OR AVULSION OF; INFRAORBITAL NERVE
631..     64736  TRANSECTION OR AVULSION OF; MENTAL NERVE
631..     64738  TRANSECTION OR AVULSION OF; INFERIOR ALVEOLAR NERVE BY OSTEOTOMY
631..     64740  TRANSECTION OR AVULSION OF; LINGUAL NERVE
631..     64742  TRANSECTION OR AVULSION OF; FACIAL NERVE, DIFFERENTIAL OR COMPLETE
631..     64744  TRANSECTION OR AVULSION OF; GREATER OCCIPITAL NERVE
631..     64746  TRANSECTION OR AVULSION OF; PHRENIC NERVE
631..     64761  TRANSECTION OR AVULSION OF; PUDENDAL NERVE
631..     64771  TRANSECTION OR AVULSION OF OTHER CRANIAL NERVE, EXTRADURAL
631..     64772  TRANSECTION OR AVULSION OF OTHER SPINAL NERVE, EXTRADURAL
631..     64774  EXCISION OF NEUROMA; CUTANEOUS NERVE, SURGICALLY IDENTIFIABLE
631..     64776  EXCISION OF NEUROMA; DIGITAL NERVE, ONE OR BOTH, SAME DIGIT
631..     64778  EXCISION OF NEUROMA; DIGITAL NERVE, EACH ADDITIONAL DIGIT (LIST SEPARATELY BY THIS NUMBER)
631..     64782  EXCISION OF NEUROMA; HAND OR FOOT, EXCEPT DIGITAL NERVE
631..     64783  EXCISION OF NEUROMA; HAND OR FOOT, EACH ADDITIONAL NERVE, EXCEPT SAME DIGIT (LIST SEPARATELY BY
                  THIS NUMBER)
631..     64784  EXCISION OF NEUROMA; MAJOR PERIPHERAL NERVE, EXCEPT SCIATIC
631..     64787  IMPLANTATION OF NERVE END INTO BONE OR MUSCLE (LIST SEPARATELY IN ADDITION TO NEUROMA EXCISION)
631..     64788  EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; CUTANEOUS NERVE
631..     64790  EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; MAJOR PERIPHERAL NERVE
631..     64795  BIOPSY OF NERVE
631..     64830  MICRODISSECTION AND/OR MICROREPAIR OF NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR NERVE
                  REPAIR)
632..  Level II Nerve Procedures       T                       18.13     $918.64         $461.04         $183.73
632..     64786  EXCISION OF NEUROMA; SCIATIC NERVE
632..     64792  EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; EXTENSIVE (INCLUDING MALIGNANT TYPE)
632..     64831  SUTURE OF DIGITAL NERVE, HAND OR FOOT; ONE NERVE
632..     64832  SUTURE OF DIGITAL NERVE, HAND OR FOOT; EACH ADDITIONAL DIGITAL NERVE
632..     64834  SUTURE OF ONE NERVE, HAND OR FOOT; COMMON SENSORY NERVE
632..     64835  SUTURE OF ONE NERVE, HAND OR FOOT; MEDIAN MOTOR THENAR
632..     64836  SUTURE OF ONE NERVE, HAND OR FOOT; ULNAR MOTOR
632..     64837  SUTURE OF EACH ADDITIONAL NERVE, HAND OR FOOT
632..     64840  SUTURE OF POSTERIOR TIBIAL NERVE
632..     64856  SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPT SCIATIC; INCLUDING TRANSPOSITION
632..     64857  SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPT SCIATIC; WITHOUT TRANSPOSITION
632..     64858  SUTURE OF SCIATIC NERVE
632..     64859  SUTURE OF EACH ADDITIONAL MAJOR PERIPHERAL NERVE
632..     64861  SUTURE OF; BRACHIAL PLEXUS
632..     64862  SUTURE OF; LUMBAR PLEXUS
632..     64864  SUTURE OF FACIAL NERVE; EXTRACRANIAL
632..     64865  SUTURE OF FACIAL NERVE; INFRATEMPORAL, WITH OR WITHOUT GRAFTING
632..     64870  ANASTOMOSIS; FACIAL-PHRENIC
632..     64872  SUTURE OF NERVE; REQUIRING SECONDARY OR DELAYED SUTURE (LIST SEPARATELY IN ADDITION TO CODE FOR
                  PRIMARY NEURORRHAPHY)
632..     64874  SUTURE OF NERVE; REQUIRING EXTENSIVE MOBILIZATION, OR TRANSPOSITION OF NERVE (LIST SEPARATELY
                  IN ADDITION TO CODE FOR NERVE SUTURE)
632..     64876  SUTURE OF NERVE; REQUIRING SHORTENING OF BONE OF EXTREMITY (LIST SEPARATELY IN ADDITION TO CODE
                  FOR NERVE SUTURE)
632..     64885  NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; UP TO 4 CM IN LENGTH

[[Page 47809]]

632..     64886  NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; MORE THAN 4 CM LENGTH
632..     64890  NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, HAND OR FOOT; UP TO 4 CM LENGTH
632..     64891  NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, HAND OR FOOT; MORE THAN 4 CM LENGTH
632..     64892  NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARM OR LEG; UP TO 4 CM LENGTH
632..     64893  NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARM OR LEG; MORE THAN 4 CM LENGTH
632..     64895  NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), HAND OR FOOT; UP TO 4 CM
                  LENGTH
632..     64896  NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), HAND OR FOOT; MORE THAN 4 CM
                  LENGTH
632..     64897  NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), ARM OR LEG; UP TO 4 CM LENGTH
632..     64898  NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), ARM OR LEG; MORE THAN 4 CM
                  LENGTH
632..     64901  NERVE GRAFT, EACH ADDITIONAL NERVE; SINGLE STRAND
632..     64902  NERVE GRAFT, EACH ADDITIONAL NERVE; MULTIPLE STRANDS (CABLE)
632..     64905  NERVE PEDICLE TRANSFER; FIRST STAGE
632..     64907  NERVE PEDICLE TRANSFER; SECOND STAGE
648..  Laser Retinal Procedures        T                        3.94     $199.64          $95.15          $39.93
648..     67105  REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS; PHOTOCOAGULATION, WITH OR WITHOUT DRAINAGE
                  OF SUBRETINAL FLUID
648..     67145  PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK, LATTICE DEGENERATION) WITHOUT DRAINAGE,
                  ONE OR MORE SESSIONS; PHOTOCOAGULATION (LASER OR XENON ARC)
648..     67210  DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULOPATHY, CHOROIDOPATHY, SMALL TUMORS), ONE
                  OR MORE SESSIONS; PHOTOCOAGULATION (LASER OR XENON ARC)
648..     67228  DESTRUCTION OF EXTENSIVE OR PROGRESSIVE RETINOPATHY (EG, DIABETIC RETINOPATHY), ONE OR MORE
                  SESSIONS; PHOTOCOAGULATION (LASER OR XENON ARC)
649..  Laser Eye Procedures except     T                        4.44     $224.97         $111.64          $44.99
       Retinal
649..     65855  TRABECULOPLASTY BY LASER SURGERY, ONE OR MORE SESSIONS (DEFINED TREATMENT SERIES)
649..     65860  SEVERING ADHESIONS OF ANTERIOR SEGMENT, LASER TECHNIQUE (SEPARATE PROCEDURE)
649..     66761  IRIDOTOMY/IRIDECTOMY BY LASER SURGERY (EG, FOR GLAUCOMA) (ONE OR MORE SESSIONS)
649..     66762  IRIDOPLASTY BY PHOTOCOAGULATION (ONE OR MORE SESSIONS) (EG, FOR IMPROVEMENT OF VISION, FOR
                  WIDENING OF ANTERIOR CHAMBER ANGLE)
649..     66770  DESTRUCTION OF CYST OR LESION IRIS OR CILIARY BODY (NONEXCISIONAL PROCEDURE)
649..     66821  DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR
                  HYALOID); LASER SURGERY (EG, YAG LASER) (ONE OR MORE STAGES)
649..     66999  UNLISTED PROCEDURE, ANTERIOR SEGMENT OF EYE
649..     67031  SEVERING OF VITREOUS STRANDS, VITREOUS FACE ADHESIONS, SHEETS, MEMBRANES OR OPACITIES, LASER
                  SURGERY (ONE OR MORE STAGES)
649..     67299  UNLISTED PROCEDURE, POSTERIOR SEGMENT
651..  Level I Anterior Segment Eye    T                        7.24     $366.85          $174.7          $73.37
       Procedures
651..     65272  REPAIR OF LACERATION; CONJUNCTIVA, BY MOBILIZATION AND REARRANGEMENT, WITHOUT HOSPITALIZATION
651..     65275  REPAIR OF LACERATION; CORNEA, NONPERFORATING, WITH OR WITHOUT REMOVAL FOREIGN BODY
651..     65286  REPAIR OF LACERATION; APPLICATION OF TISSUE GLUE, WOUNDS OF CORNEA AND/OR SCLERA
651..     65420  EXCISION OR TRANSPOSITION OF PTERYGIUM; WITHOUT GRAFT
651..     65436  REMOVAL OF CORNEAL EPITHELIUM; WITH APPLICATION OF CHELATING AGENT (EG, EDTA)
651..     65450  DESTRUCTION OF LESION OF CORNEA BY CRYOTHERAPY, PHOTOCOAGULATION OR THERMOCAUTERIZATION
651..     65772  CORNEAL RELAXING INCISION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM
651..     65810  PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH REMOVAL OF VITREOUS AND/OR
                  DISCISSION OF ANTERIOR HYALOID MEMBRANE, WITH OR WITHOUT AIR INJECTION
651..     65815  PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH REMOVAL OF BLOOD, WITH OR
                  WITHOUT IRRIGATION AND/OR AIR INJECTION
651..     65820  GONIOTOMY
651..     66130  EXCISION OF LESION, SCLERA
651..     66500  IRIDOTOMY BY STAB INCISION (SEPARATE PROCEDURE); EXCEPT TRANSFIXION
651..     66505  IRIDOTOMY BY STAB INCISION (SEPARATE PROCEDURE); WITH TRANSFIXION AS FOR IRIS BOMBE
651..     66600  IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; FOR REMOVAL OF LESION
651..     66625  IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; PERIPHERAL FOR GLAUCOMA (SEPARATE PROCEDURE)
651..     66630  IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; SECTOR FOR GLAUCOMA (SEPARATE PROCEDURE)
651..     66700  CILIARY BODY DESTRUCTION; DIATHERMY
651..     66710  CILIARY BODY DESTRUCTION; CYCLOPHOTOCOAGULATION
651..     66720  CILIARY BODY DESTRUCTION; CRYOTHERAPY
651..     66820  DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR
                  HYALOID); STAB INCISION TECHNIQUE (ZIEGLER OR WHEELER KNIFE)
651..     66825  REPOSITIONING OF INTRAOCULAR LENS PROSTHESIS, REQUIRING AN INCISION (SEPARATE PROCEDURE)
652..  Level II Anterior Segment Eye   T                       16.48     $835.03         $433.69         $167.01
       Procedures
652..     65235  REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM ANTERIOR CHAMBER OR LENS
652..     65280  REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, NOT INVOLVING UVEAL TISSUE
652..     65285  REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, WITH REPOSITION OR RESECTION OF UVEAL
                  TISSUE
652..     65400  EXCISION OF LESION, CORNEA (KERATECTOMY, LAMELLAR, PARTIAL), EXCEPT PTERYGIUM
652..     65426  EXCISION OR TRANSPOSITION OF PTERYGIUM; WITH GRAFT
652..     65770  KERATOPROSTHESIS
652..     65775  CORNEAL WEDGE RESECTION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM
652..     65850  TRABECULOTOMY AB EXTERNO
652..     65865  SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION
                  OF AIR OR LIQUID) (SEPARATE PROCEDURE); GONIOSYNECHIAE
652..     65870  SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION
                  OF AIR OR LIQUID) (SEPARATE PROCEDURE); ANTERIOR SYNECHIAE, EXCEPT GONIOSYNECHIAE

[[Page 47810]]

652..     65875  SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION
                  OF AIR OR LIQUID) (SEPARATE PROCEDURE); POSTERIOR SYNECHIAE
652..     65880  SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION
                  OF AIR OR LIQUID) (SEPARATE PROCEDURE); CORNEOVITREAL ADHESIONS
652..     65900  REMOVAL OF EPITHELIAL DOWNGROWTH, ANTERIOR CHAMBER EYE
652..     65920  REMOVAL OF IMPLANTED MATERIAL, ANTERIOR SEGMENT EYE
652..     65930  REMOVAL OF BLOOD CLOT, ANTERIOR SEGMENT EYE
652..     66150  FISTULIZATION OF SCLERA FOR GLAUCOMA; TREPHINATION WITH IRIDECTOMY
652..     66155  FISTULIZATION OF SCLERA FOR GLAUCOMA; THERMOCAUTERIZATION WITH IRIDECTOMY
652..     66160  FISTULIZATION OF SCLERA FOR GLAUCOMA; SCLERECTOMY WITH PUNCH OR SCISSORS, WITH IRIDECTOMY
652..     66165  FISTULIZATION OF SCLERA FOR GLAUCOMA; IRIDENCLEISIS OR IRIDOTASIS
652..     66170  FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY AB EXTERNO IN ABSENCE OF PREVIOUS SURGERY
652..     66172  FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY AB EXTERNO WITH SCARRING FROM PREVIOUS
                  OCULAR SURGERY OR TRAUMA (INCLUDES INJECTION OF ANTIFIBROTIC AGENTS)
652..     66180  AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR (EG, MOLTENO, SCHOCKET, DENVER-KRUPIN)
652..     66185  REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR
652..     66225  REPAIR OF SCLERAL STAPHYLOMA; WITH GRAFT
652..     66250  REVISION OR REPAIR OF OPERATIVE WOUND OF ANTERIOR SEGMENT, ANY TYPE, EARLY OR LATE, MAJOR OR
                  MINOR PROCEDURE
652..     66605  IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; WITH CYCLECTOMY
652..     66635  IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; OPTICAL (SEPARATE PROCEDURE)
652..     66680  REPAIR OF IRIS, CILIARY BODY (AS FOR IRIDODIALYSIS)
652..     66682  SUTURE OF IRIS, CILIARY BODY (SEPARATE PROCEDURE) WITH RETRIEVAL OF SUTURE THROUGH SMALL
                  INCISION (EG, MCCANNEL SUTURE)
652..     66740  CILIARY BODY DESTRUCTION; CYCLODIALYSIS
652..     66830  REMOVAL OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR
                  HYALOID) WITH CORNEO-SCLERAL SECTION, WITH OR WITHOUT IRIDECTOMY (IRIDOCAPSULOTOMY,
                  IRIDOCAPSULECTOMY)
652..     68130  EXCISION OF LESION, CONJUNCTIVA; WITH ADJACENT SCLERA
652..     68330  REPAIR OF SYMBLEPHARON; CONJUNCTIVOPLASTY, WITHOUT GRAFT
652..     68360  CONJUNCTIVAL FLAP; BRIDGE OR PARTIAL (SEPARATE PROCEDURE)
652..     68362  CONJUNCTIVAL FLAP; TOTAL (SUCH AS GUNDERSON THIN FLAP OR PURSE STRING FLAP)
667..  Cataract Procedures             T                       15.33     $776.40         $521.72         $155.28
667..     66840  REMOVAL OF LENS MATERIAL; ASPIRATION TECHNIQUE, ONE OR MORE STAGES
667..     66850  REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR ULTRASONIC) (EG,
                  PHACOEMULSIFICATION), WITH ASPIRATION
667..     66852  REMOVAL OF LENS MATERIAL; PARS PLANA APPROACH, WITH OR WITHOUT VITRECTOMY
667..     66920  REMOVAL OF LENS MATERIAL; INTRACAPSULAR
667..     66930  REMOVAL OF LENS MATERIAL; INTRACAPSULAR, FOR DISLOCATED LENS
667..     66940  REMOVAL OF LENS MATERIAL; EXTRACAPSULAR (OTHER THAN 66840, 66850, 66852)
668..  Cataract Procedures with IOL    T                       19.28     $976.91         $530.87         $195.38
       Insert
668..     66983  INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ONE STAGE
                  PROCEDURE)
668..     66984  EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ONE STAGE
                  PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR
                  PHACOEMULSIFICATION)
668..     66985  INSERTION OF INTRAOCULAR LENS PROSTHESIS (SECONDARY IMPLANT), NOT ASSOCIATED WITH CONCURRENT
                  CATARACT REMOVAL
668..     66986  EXCHANGE OF INTRAOCULAR LENS
670..  Corneal Transplant              T                       29.23   $1,481.07          $847.5         $296.21
670..     65710  KERATOPLASTY (CORNEAL TRANSPLANT); LAMELLAR
670..     65730  KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (EXCEPT IN APHAKIA)
670..     65750  KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN APHAKIA)
670..     65755  KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN PSEUDOPHAKIA)
676..  Posterior Segment Eye           T                         6.3     $319.22         $140.35          $63.84
       Procedures
676..     65260  REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM POSTERIOR SEGMENT, MAGNETIC EXTRACTION, ANTERIOR OR
                  POSTERIOR ROUTE
676..     65265  REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM POSTERIOR SEGMENT, NONMAGNETIC EXTRACTION
676..     66220  REPAIR OF SCLERAL STAPHYLOMA; WITHOUT GRAFT
676..     67005  REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); PARTIAL REMOVAL
676..     67010  REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); SUBTOTAL
                  REMOVAL WITH MECHANICAL VITRECTOMY
676..     67015  ASPIRATION OR RELEASE OF VITREOUS, SUBRETINAL OR CHOROIDAL FLUID, PARS PLANA APPROACH
                  (POSTERIOR SCLEROTOMY)
676..     67030  DISCISSION OF VITREOUS STRANDS (WITHOUT REMOVAL), PARS PLANA APPROACH
676..     67101  REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS; CRYOTHERAPY OR DIATHERMY, WITH OR WITHOUT
                  DRAINAGE OF SUBRETINAL FLUID
676..     67110  REPAIR OF RETINAL DETACHMENT; BY INJECTION OF AIR OR OTHER GAS (EG, PNEUMATIC RETINOPEXY)
676..     67115  RELEASE OF ENCIRCLING MATERIAL (POSTERIOR SEGMENT)
676..     67120  REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT; EXTRAOCULAR
676..     67121  REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT; INTRAOCULAR
676..     67141  PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK, LATTICE DEGENERATION) WITHOUT DRAINAGE,
                  ONE OR MORE SESSIONS; CRYOTHERAPY, DIATHERMY
676..     67208  DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULOPATHY, CHOROIDOPATHY, SMALL TUMORS), ONE
                  OR MORE SESSIONS; CRYOTHERAPY, DIATHERMY
676..     67218  DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULOPATHY, CHOROIDOPATHY, SMALL TUMORS), ONE
                  OR MORE SESSIONS; RADIATION BY IMPLANTATION OF SOURCE (INCLUDES REMOVAL OF SOURCE)

[[Page 47811]]

676..     67227  DESTRUCTION OF EXTENSIVE OR PROGRESSIVE RETINOPATHY (EG, DIABETIC RETINOPATHY), ONE OR MORE
                  SESSIONS; CRYOTHERAPY, DIATHERMY
676..     92018  OPHTHALMOLOGICAL EXAMINATION AND EVALUATION, UNDER GENERAL ANESTHESIA, WITH OR WITHOUT
                  MANIPULATION OF GLOBE FOR PASSIVE RANGE OF MOTION OR OTHER MANIPULATION TO FACILITATE
                  DIAGNOSTIC EXAMINATION; COMPLETE
676..     92019  OPHTHALMOLOGICAL EXAMINATION AND EVALUATION, UNDER GENERAL ANESTHESIA, WITH OR WITHOUT
                  MANIPULATION OF GLOBE FOR PASSIVE RANGE OF MOTION OR OTHER MANIPULATION TO FACILITATE
                  DIAGNOSTIC EXAMINATION; LIMITED
677..  Strabismus/Muscle Procedures    T                       16.26     $823.89         $436.63         $164.78
677..     65290  REPAIR OF WOUND, EXTRAOCULAR MUSCLE, TENDON AND/OR TENON'S CAPSULE
677..     67311  STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON); ONE
                  HORIZONTAL MUSCLE
677..     67312  STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON); TWO
                  HORIZONTAL MUSCLES
677..     67314  STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON); ONE
                  VERTICAL MUSCLE (EXCLUDING SUPERIOR OBLIQUE)
677..     67316  STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON); TWO
                  OR MORE VERTICAL MUSCLES (EXCLUDING SUPERIOR OBLIQUE)
677..     67318  STRABISMUS SURGERY, ANY PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON), SUPERIOR OBLIQUE MUSCLE
677..     67320  TRANSPOSITION PROCEDURE (EG, FOR PARETIC EXTRAOCULAR MUSCLE), ANY EXTRAOCULAR MUSCLE (SPECIFY)
677..     67331  STRABISMUS SURGERY ON PATIENT WITH PREVIOUS EYE SURGERY OR INJURY THAT DID NOT INVOLVE THE
                  EXTRAOCULAR MUSCLES
677..     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)
677..     67334  STRABISMUS SURGERY BY POSTERIOR FIXATION SUTURE TECHNIQUE, WITH OR WITHOUT MUSCLE RECESSION
677..     67335  PLACEMENT OF ADJUSTABLE SUTURE(S) DURING STRABISMUS SURGERY, INCLUDING POSTOPERATIVE
                  ADJUSTMENT(S) OF SUTURE(S) (REPORT IN ADDITION TO CODE FOR SPECIFIC STRABISMUS SURGERY)
677..     67340  STRABISMUS SURGERY INVOLVING EXPLORATION AND/OR REPAIR OF DETACHED EXTRAOCULAR MUSCLE(S)
677..     67343  RELEASE OF EXTENSIVE SCAR TISSUE WITHOUT DETACHING EXTRAOCULAR MUSCLE (SEPARATE PROCEDURE)
681..  Level I Eye Procedures          T                        1.67      $84.62          $30.51          $16.92
681..     65125  MODIFICATION OF OCULAR IMPLANT WITH PLACEMENT OR REPLACEMENT OF PEGS (EG, DRILLING RECEPTACLE
                  FOR PROSTHESIS APPENDAGE) (SEPARATE PROCEDURE)
681..     65205  REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL SUPERFICIAL
681..     65210  REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL EMBEDDED (INCLUDES CONCRETIONS),
                  SUBCONJUNCTIVAL, OR SCLERAL NONPERFORATING
681..     65220  REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITHOUT SLIT LAMP
681..     65222  REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITH SLIT LAMP
681..     65430  SCRAPING OF CORNEA, DIAGNOSTIC, FOR SMEAR AND/OR CULTURE
681..     65435  REMOVAL OF CORNEAL EPITHELIUM; WITH OR WITHOUT CHEMOCAUTERIZATION (ABRASION, CURETTAGE)
681..     65600  MULTIPLE PUNCTURES OF ANTERIOR CORNEA (EG, FOR CORNEAL EROSION, TATTOO)
681..     67345  CHEMODENERVATION OF EXTRAOCULAR MUSCLE
681..     67500  RETROBULBAR INJECTION; MEDICATION (SEPARATE PROCEDURE, DOES NOT INCLUDE SUPPLY OF MEDICATION)
681..     67505  RETROBULBAR INJECTION; ALCOHOL
681..     67515  INJECTION OF THERAPEUTIC AGENT INTO TENON'S CAPSULE
681..     67599  UNLISTED PROCEDURE, ORBIT
681..     68200  SUBCONJUNCTIVAL INJECTION
681..     68761  CLOSURE OF THE LACRIMAL PUNCTUM; BY PLUG, EACH
681..     68899  UNLISTED PROCEDURE, LACRIMAL SYSTEM
682..  Level II Eye Procedures         T                        3.54     $179.37          $81.36          $35.87
682..     67028  INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE PROCEDURE)
682..     67700  BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID
682..     67710  SEVERING OF TARSORRHAPHY
682..     67800  EXCISION OF CHALAZION; SINGLE
682..     67801  EXCISION OF CHALAZION; MULTIPLE, SAME LID
682..     67805  EXCISION OF CHALAZION; MULTIPLE, DIFFERENT LIDS
682..     67810  BIOPSY OF EYELID
682..     67820  CORRECTION OF TRICHIASIS; EPILATION, BY FORCEPS ONLY
682..     67825  CORRECTION OF TRICHIASIS; EPILATION BY OTHER THAN FORCEPS (EG, BY ELECTROSURGERY, CRYOTHERAPY,
                  LASER SURGERY
682..     67840  EXCISION OF LESION OF EYELID (EXCEPT CHALAZION) WITHOUT CLOSURE OR WITH SIMPLE DIRECT CLOSURE
682..     67850  DESTRUCTION OF LESION OF LID MARGIN (UP TO 1 CM)
682..     67875  TEMPORARY CLOSURE OF EYELIDS BY SUTURE (EG, FROST SUTURE)
682..     67915  REPAIR OF ECTROPION; THERMOCAUTERIZATION
682..     67922  REPAIR OF ENTROPION; THERMOCAUTERIZATION
682..     67930  SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN, TARSUS, AND/OR PALPEBRAL CONJUNCTIVA
                  DIRECT CLOSURE; PARTIAL THICKNESS
682..     67938  REMOVAL OF EMBEDDED FOREIGN BODY, EYELID
682..     67999  UNLISTED PROCEDURE, EYELIDS
682..     68020  INCISION OF CONJUNCTIVA, DRAINAGE OF CYST
682..     68040  EXPRESSION OF CONJUNCTIVAL FOLLICLES (EG, FOR TRACHOMA)
682..     68400  INCISION, DRAINAGE OF LACRIMAL GLAND
682..     68420  INCISION, DRAINAGE OF LACRIMAL SAC (DACRYOCYSTOTOMY OR DACRYOCYSTOSTOMY)
682..     68440  SNIP INCISION OF LACRIMAL PUNCTUM
682..     68530  REMOVAL OF FOREIGN BODY OR DACRYOLITH, LACRIMAL PASSAGES
682..     68705  CORRECTION OF EVERTED PUNCTUM, CAUTERY
682..     68760  CLOSURE OF THE LACRIMAL PUNCTUM; BY THERMOCAUTERIZATION, LIGATION, OR LASER SURGERY
682..     68801  DILATION OF LACRIMAL PUNCTUM, WITH OR WITHOUT IRRIGATION

[[Page 47812]]

682..     68840  PROBING OF LACRIMAL CANALICULI, WITH OR WITHOUT IRRIGATION
683..  Level III Eye Procedures        T                       10.19     $516.32         $257.87         $103.26
683..     65175  REMOVAL OF OCULAR IMPLANT
683..     65410  BIOPSY OF CORNEA
683..     65800  PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH DIAGNOSTIC ASPIRATION OF
                  AQUEOUS
683..     65805  PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH THERAPEUTIC RELEASE OF
                  AQUEOUS
683..     66020  INJECTION, ANTERIOR CHAMBER (SEPARATE PROCEDURE); AIR OR LIQUID
683..     66030  INJECTION, ANTERIOR CHAMBER (SEPARATE PROCEDURE); MEDICATION
683..     67025  INJECTION OF VITREOUS SUBSTITUTE, PARS PLANA OR LIMBAL APPROACH, (FLUID-GAS EXCHANGE), WITH OR
                  WITHOUT ASPIRATION (SEPARATE PROCEDURE)
683..     67715  CANTHOTOMY (SEPARATE PROCEDURE)
683..     67830  CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN
683..     67880  CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY
683..     67935  SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN, TARSUS, AND/OR PALPEBRAL CONJUNCTIVA
                  DIRECT CLOSURE; FULL THICKNESS
683..     68510  BIOPSY OF LACRIMAL GLAND
683..     68525  BIOPSY OF LACRIMAL SAC
683..     68810  PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION;
684..  Level IV Eye Procedures         T                       13.48     $683.02         $348.94          $136.6
684..     65091  EVISCERATION OF OCULAR CONTENTS; WITHOUT IMPLANT
684..     65093  EVISCERATION OF OCULAR CONTENTS; WITH IMPLANT
684..     65101  ENUCLEATION OF EYE; WITHOUT IMPLANT
684..     65103  ENUCLEATION OF EYE; WITH IMPLANT, MUSCLES NOT ATTACHED TO IMPLANT
684..     65105  ENUCLEATION OF EYE; WITH IMPLANT, MUSCLES ATTACHED TO IMPLANT
684..     65130  INSERTION OF OCULAR IMPLANT SECONDARY; AFTER EVISCERATION, IN SCLERAL SHELL
684..     65135  INSERTION OF OCULAR IMPLANT SECONDARY; AFTER ENUCLEATION, MUSCLES NOT ATTACHED TO IMPLANT
684..     65140  INSERTION OF OCULAR IMPLANT SECONDARY; AFTER ENUCLEATION, MUSCLES ATTACHED TO IMPLANT
684..     65150  REINSERTION OF OCULAR IMPLANT; WITH OR WITHOUT CONJUNCTIVAL GRAFT
684..     65155  REINSERTION OF OCULAR IMPLANT; WITH USE OF FOREIGN MATERIAL FOR REINFORCEMENT AND/OR ATTACHMENT
                  OF MUSCLES TO IMPLANT
684..     67250  SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITHOUT GRAFT
684..     67255  SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITH GRAFT
684..     67400  ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); FOR EXPLORATION, WITH OR
                  WITHOUT BIOPSY
684..     67405  ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH DRAINAGE ONLY
684..     67412  ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH REMOVAL OF LESION
684..     67413  ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH REMOVAL OF FOREIGN
                  BODY
684..     67550  ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE); INSERTION
684..     67560  ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE); REMOVAL OR REVISION
684..     67808  EXCISION OF CHALAZION; UNDER GENERAL ANESTHESIA AND/OR REQUIRING HOSPITALIZATION, SINGLE OR
                  MULTIPLE
684..     67835  CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN, WITH FREE MUCOUS MEMBRANE GRAFT
684..     67882  CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY; WITH
                  TRANSPOSITION OF TARSAL PLATE
684..     67900  REPAIR OF BROW PTOSIS (SUPRACILIARY, MID-FOREHEAD OR CORONAL APPROACH)
684..     67901  REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITH SUTURE OR OTHER MATERIAL
684..     67902  REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITH FASCIAL SLING (INCLUDES OBTAINING
                  FASCIA)
684..     67903  REPAIR OF BLEPHAROPTOSIS; (TARSO)LEVATOR RESECTION OR ADVANCEMENT, INTERNAL APPROACH
684..     67904  REPAIR OF BLEPHAROPTOSIS; (TARSO)LEVATOR RESECTION OR ADVANCEMENT, EXTERNAL APPROACH
684..     67906  REPAIR OF BLEPHAROPTOSIS; SUPERIOR RECTUS TECHNIQUE WITH FASCIAL SLING (INCLUDES OBTAINING
                  FASCIA)
684..     67908  REPAIR OF BLEPHAROPTOSIS; CONJUNCTIVO-TARSO-MULLER'S MUSCLE-LEVATOR RESECTION (EG, FASANELLA-
                  SERVAT TYPE)
684..     67909  REDUCTION OF OVERCORRECTION OF PTOSIS
684..     67911  CORRECTION OF LID RETRACTION
684..     67914  REPAIR OF ECTROPION; SUTURE
684..     67916  REPAIR OF ECTROPION; BLEPHAROPLASTY, EXCISION TARSAL WEDGE
684..     67917  REPAIR OF ECTROPION; BLEPHAROPLASTY, EXTENSIVE (EG, KUHNT-SZYMANOWSKI OR TARSAL STRIP
                  OPERATIONS)
684..     67921  REPAIR OF ENTROPION; SUTURE
684..     67923  REPAIR OF ENTROPION; BLEPHAROPLASTY, EXCISION TARSAL WEDGE
684..     67924  REPAIR OF ENTROPION; BLEPHAROPLASTY, EXTENSIVE (EG, WHEELER OPERATION)
684..     67950  CANTHOPLASTY (RECONSTRUCTION OF CANTHUS)
684..     67961  EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS, CONJUNCTIVA, CANTHUS, OR FULL
                  THICKNESS, MAY INCLUDE PREPARATION FOR SKIN GRAFT OR PEDICLE FLAP WITH ADJACENT TISSUE
                  TRANSFER OR REARRANGEMENT; UP TO ONE-FOURTH OF LID MARGIN
684..     67966  EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS, CONJUNCTIVA, CANTHUS, OR FULL
                  THICKNESS, MAY INCLUDE PREPARATION FOR SKIN GRAFT OR PEDICLE FLAP WITH ADJACENT TISSUE
                  TRANSFER OR REARRANGEMENT; OVER ONE-FOURTH OF LID MARGIN
684..     67971  RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING
                  EYELID; UP TO TWO-THIRDS OF EYELID, ONE STAGE OR FIRST STAGE
684..     67973  RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING
                  EYELID; TOTAL EYELID, LOWER, ONE STAGE OR FIRST STAGE
684..     67974  RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING
                  EYELID; TOTAL EYELID, UPPER, ONE STAGE OR FIRST STAGE
684..     67975  RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING
                  EYELID; SECOND STAGE
684..     68320  CONJUNCTIVOPLASTY; WITH CONJUNCTIVAL GRAFT OR EXTENSIVE REARRANGEMENT

[[Page 47813]]

684..     68325  CONJUNCTIVOPLASTY; WITH BUCCAL MUCOUS MEMBRANE GRAFT (INCLUDES OBTAINING GRAFT)
684..     68326  CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; WITH CONJUNCTIVAL GRAFT OR EXTENSIVE
                  REARRANGEMENT
684..     68328  CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; WITH BUCCAL MUCOUS MEMBRANE GRAFT (INCLUDES
                  OBTAINING GRAFT)
684..     68335  REPAIR OF SYMBLEPHARON; WITH FREE GRAFT CONJUNCTIVA OR BUCCAL MUCOUS MEMBRANE (INCLUDES
                  OBTAINING GRAFT)
684..     68340  REPAIR OF SYMBLEPHARON; DIVISION OF SYMBLEPHARON, WITH OR WITHOUT INSERTION OF CONFORMER OR
                  CONTACT LENS
684..     68500  EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR TUMOR; TOTAL
684..     68505  EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR TUMOR; PARTIAL
684..     68520  EXCISION OF LACRIMAL SAC (DACRYOCYSTECTOMY)
684..     68540  EXCISION OF LACRIMAL GLAND TUMOR; FRONTAL APPROACH
684..     68550  EXCISION OF LACRIMAL GLAND TUMOR; INVOLVING OSTEOTOMY
684..     68700  PLASTIC REPAIR OF CANALICULI
684..     68720  DACRYOCYSTORHINOSTOMY (FISTULIZATION OF LACRIMAL SAC TO NASAL CAVITY)
684..     68745  CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA TO NASAL CAVITY); WITHOUT TUBE
684..     68750  CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA TO NASAL CAVITY); WITH INSERTION OF TUBE OR
                  STENT
684..     68770  CLOSURE OF LACRIMAL FISTULA (SEPARATE PROCEDURE)
684..     68811  PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; REQUIRING GENERAL ANESTHESIA
684..     68815  PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; WITH INSERTION OF TUBE OR STENT
690..  Vitrectomy                      T                       30.54   $1,547.45         $852.02         $309.49
690..     67027  IMPLANTATION OR REPLACEMENT OF INTRAVITREAL DRUG DELIVERY SYSTEM (EG, GANCICLOVIR IMPLANT),
                  INCLUDES CONCOMITANT REMOVAL OF VITREOUS
690..     67036  VITRECTOMY, MECHANICAL, PARS PLANA APPROACH;
690..     67038  VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH EPIRETINAL MEMBRANE STRIPPING
690..     67039  VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH FOCAL ENDOLASER PHOTOCOAGULATION
690..     67040  VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH ENDOLASER PANRETINAL PHOTOCOAGULATION
690..     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
690..     67108  REPAIR OF RETINAL DETACHMENT; WITH VITRECTOMY, ANY METHOD, WITH OR WITHOUT AIR OR GAS
                  TAMPONADE, FOCAL ENDOLASER PHOTOCOAGULATION, CRYOTHERAPY, DRAINAGE OF SUBRETINAL FLUID,
                  SCLERAL BUCKLING, AND/OR REMOVAL OF LENS BY SAME TECHNIQUE
690..     67112  REPAIR OF RETINAL DETACHMENT; BY SCLERAL BUCKLING OR VITRECTOMY, ON PATIENT HAVING PREVIOUS
                  IPSILATERAL RETINAL DETACHMENT REPAIR(S) USING SCLERAL BUCKLING OR VITRECTOMY TECHNIQUES
700..  Plain Film                      X                        0.78      $39.52          $22.37           $7.90
700..     70030  RADIOLOGIC EXAMINATION, EYE, FOR DETECTION OF FOREIGN BODY
700..     70100  RADIOLOGIC EXAMINATION, MANDIBLE; PARTIAL, LESS THAN FOUR VIEWS
700..     70110  RADIOLOGIC EXAMINATION, MANDIBLE; COMPLETE, MINIMUM OF FOUR VIEWS
700..     70120  RADIOLOGIC EXAMINATION, MASTOIDS; LESS THAN THREE VIEWS PER SIDE
700..     70130  RADIOLOGIC EXAMINATION, MASTOIDS; COMPLETE, MINIMUM OF THREE VIEWS PER SIDE
700..     70134  RADIOLOGIC EXAMINATION, INTERNAL AUDITORY MEATI, COMPLETE
700..     70140  RADIOLOGIC EXAMINATION, FACIAL BONES; LESS THAN THREE VIEWS
700..     70150  RADIOLOGIC EXAMINATION, FACIAL BONES; COMPLETE, MINIMUM OF THREE VIEWS
700..     70160  RADIOLOGIC EXAMINATION, NASAL BONES, COMPLETE, MINIMUM OF THREE VIEWS
700..     70190  RADIOLOGIC EXAMINATION; OPTIC FORAMINA
700..     70200  RADIOLOGIC EXAMINATION; ORBITS, COMPLETE, MINIMUM OF FOUR VIEWS
700..     70210  RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, LESS THAN THREE VIEWS
700..     70220  RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, COMPLETE, MINIMUM OF THREE VIEWS
700..     70240  RADIOLOGIC EXAMINATION, SELLA TURCICA
700..     70250  RADIOLOGIC EXAMINATION, SKULL; LESS THAN FOUR VIEWS, WITH OR WITHOUT STEREO
700..     70260  RADIOLOGIC EXAMINATION, SKULL; COMPLETE, MINIMUM OF FOUR VIEWS, WITH OR WITHOUT STEREO
700..     70300  RADIOLOGIC EXAMINATION, TEETH; SINGLE VIEW
700..     70310  RADIOLOGIC EXAMINATION, TEETH; PARTIAL EXAMINATION, LESS THAN FULL MOUTH
700..     70320  RADIOLOGIC EXAMINATION, TEETH; COMPLETE, FULL MOUTH
700..     70328  RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND CLOSED MOUTH; UNILATERAL
700..     70330  RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND CLOSED MOUTH; BILATERAL
700..     70350  CEPHALOGRAM, ORTHODONTIC
700..     70355  ORTHOPANTOGRAM
700..     70360  RADIOLOGIC EXAMINATION; NECK, SOFT TISSUE
700..     70380  RADIOLOGIC EXAMINATION, SALIVARY GLAND FOR CALCULUS
700..     71010  RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL
700..     71015  RADIOLOGIC EXAMINATION, CHEST; STEREO, FRONTAL
700..     71020  RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL;
700..     71021  RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH APICAL LORDOTIC PROCEDURE
700..     71022  RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH OBLIQUE PROJECTIONS
700..     71030  RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOUR VIEWS;
700..     71035  RADIOLOGIC EXAMINATION, CHEST, SPECIAL VIEWS (EG, LATERAL DECUBITUS, BUCKY STUDIES)
700..     71100  RADIOLOGIC EXAMINATION, RIBS, UNILATERAL; TWO VIEWS
700..     71101  RADIOLOGIC EXAMINATION, RIBS, UNILATERAL; INCLUDING POSTEROANTERIOR CHEST, MINIMUM OF THREE
                  VIEWS
700..     71110  RADIOLOGIC EXAMINATION, RIBS, BILATERAL; THREE VIEWS
700..     71111  RADIOLOGIC EXAMINATION, RIBS, BILATERAL; INCLUDING POSTEROANTERIOR CHEST, MINIMUM OF FOUR VIEWS
700..     71120  RADIOLOGIC EXAMINATION; STERNUM, MINIMUM OF TWO VIEWS
700..     71130  RADIOLOGIC EXAMINATION; STERNOCLAVICULAR JOINT OR JOINTS, MINIMUM OF THREE VIEWS
700..     72010  RADIOLOGIC EXAMINATION, SPINE, ENTIRE, SURVEY STUDY, ANTEROPOSTERIOR AND LATERAL
700..     72020  RADIOLOGIC EXAMINATION, SPINE, SINGLE VIEW, SPECIFY LEVEL
700..     72040  RADIOLOGIC EXAMINATION, SPINE, CERVICAL; ANTEROPOSTERIOR AND LATERAL

[[Page 47814]]

700..     72050  RADIOLOGIC EXAMINATION, SPINE, CERVICAL; MINIMUM OF FOUR VIEWS
700..     72052  RADIOLOGIC EXAMINATION, SPINE, CERVICAL; COMPLETE, INCLUDING OBLIQUE AND FLEXION AND/OR
                  EXTENSION STUDIES
700..     72069  RADIOLOGIC EXAMINATION, SPINE, THORACOLUMBAR, STANDING (SCOLIOSIS)
700..     72070  RADIOLOGIC EXAMINATION, SPINE; THORACIC, ANTEROPOSTERIOR AND LATERAL
700..     72072  RADIOLOGIC EXAMINATION, SPINE; THORACIC, ANTEROPOSTERIOR AND LATERAL, INCLUDING SWIMMER'S VIEW
                  OF THE CERVICOTHORACIC JUNCTION
700..     72074  RADIOLOGIC EXAMINATION, SPINE; THORACIC, COMPLETE, INCLUDING OBLIQUES, MINIMUM OF FOUR VIEWS
700..     72080  RADIOLOGIC EXAMINATION, SPINE; THORACOLUMBAR, ANTEROPOSTERIOR AND LATERAL
700..     72090  RADIOLOGIC EXAMINATION, SPINE; SCOLIOSIS STUDY, INCLUDING SUPINE AND ERECT STUDIES
700..     72100  RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; ANTEROPOSTERIOR AND LATERAL
700..     72110  RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; COMPLETE, WITH OBLIQUE VIEWS
700..     72114  RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; COMPLETE, INCLUDING BENDING VIEWS
700..     72120  RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL, BENDING VIEWS ONLY, MINIMUM OF FOUR VIEWS
700..     72170  RADIOLOGIC EXAMINATION, PELVIS; ANTEROPOSTERIOR ONLY
700..     72190  RADIOLOGIC EXAMINATION, PELVIS; COMPLETE, MINIMUM OF THREE VIEWS
700..     72200  RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; LESS THAN THREE VIEWS
700..     72202  RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; THREE OR MORE VIEWS
700..     72220  RADIOLOGIC EXAMINATION, SACRUM AND COCCYX, MINIMUM OF TWO VIEWS
700..     73000  RADIOLOGIC EXAMINATION; CLAVICLE, COMPLETE
700..     73010  RADIOLOGIC EXAMINATION; SCAPULA, COMPLETE
700..     73020  RADIOLOGIC EXAMINATION, SHOULDER; ONE VIEW
700..     73030  RADIOLOGIC EXAMINATION, SHOULDER; COMPLETE, MINIMUM OF TWO VIEWS
700..     73050  RADIOLOGIC EXAMINATION; ACROMIOCLAVICULAR JOINTS, BILATERAL, WITH OR WITHOUT WEIGHTED
                  DISTRACTION
700..     73060  RADIOLOGIC EXAMINATION; HUMERUS, MINIMUM OF TWO VIEWS
700..     73070  RADIOLOGIC EXAMINATION, ELBOW; ANTEROPOSTERIOR AND LATERAL VIEWS
700..     73080  RADIOLOGIC EXAMINATION, ELBOW; COMPLETE, MINIMUM OF THREE VIEWS
700..     73090  RADIOLOGIC EXAMINATION; FOREARM, ANTEROPOSTERIOR AND LATERAL VIEWS
700..     73092  RADIOLOGIC EXAMINATION; UPPER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS
700..     73100  RADIOLOGIC EXAMINATION, WRIST; ANTEROPOSTERIOR AND LATERAL VIEWS
700..     73110  RADIOLOGIC EXAMINATION, WRIST; COMPLETE, MINIMUM OF THREE VIEWS
700..     73120  RADIOLOGIC EXAMINATION, HAND; TWO VIEWS
700..     73130  RADIOLOGIC EXAMINATION, HAND; MINIMUM OF THREE VIEWS
700..     73140  RADIOLOGIC EXAMINATION, FINGER(S), MINIMUM OF TWO VIEWS
700..     73500  RADIOLOGIC EXAMINATION, HIP, UNILATERAL; ONE VIEW
700..     73510  RADIOLOGIC EXAMINATION, HIP, UNILATERAL; COMPLETE, MINIMUM OF TWO VIEWS
700..     73520  RADIOLOGIC EXAMINATION, HIPS, BILATERAL, MINIMUM OF TWO VIEWS OF EACH HIP, INCLUDING
                  ANTEROPOSTERIOR VIEW OF PELVIS
700..     73530  RADIOLOGIC EXAMINATION, HIP, DURING OPERATIVE PROCEDURE
700..     73540  RADIOLOGIC EXAMINATION, PELVIS AND HIPS, INFANT OR CHILD, MINIMUM OF TWO VIEWS
700..     73550  RADIOLOGIC EXAMINATION, FEMUR, ANTEROPOSTERIOR AND LATERAL VIEWS
700..     73560  RADIOLOGIC EXAMINATION, KNEE; ANTEROPOSTERIOR AND LATERAL VIEWS
700..     73562  RADIOLOGIC EXAMINATION, KNEE; ANTEROPOSTERIOR AND LATERAL, WITH OBLIQUE(S), MINIMUM OF THREE
                  VIEWS
700..     73564  RADIOLOGIC EXAMINATION, KNEE; COMPLETE, INCLUDING OBLIQUE(S), AND TUNNEL, AND/OR PATELLAR AND/
                  OR STANDING VIEWS
700..     73565  RADIOLOGIC EXAMINATION, KNEE; BOTH KNEES, STANDING, ANTEROPOSTERIOR
700..     73590  RADIOLOGIC EXAMINATION; TIBIA AND FIBULA, ANTEROPOSTERIOR AND LATERAL VIEWS
700..     73592  RADIOLOGIC EXAMINATION; LOWER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS
700..     73600  RADIOLOGIC EXAMINATION, ANKLE; ANTEROPOSTERIOR AND LATERAL VIEWS
700..     73610  RADIOLOGIC EXAMINATION, ANKLE; COMPLETE, MINIMUM OF THREE VIEWS
700..     73620  RADIOLOGIC EXAMINATION, FOOT; ANTEROPOSTERIOR AND LATERAL VIEWS
700..     73630  RADIOLOGIC EXAMINATION, FOOT; COMPLETE, MINIMUM OF THREE VIEWS
700..     73650  RADIOLOGIC EXAMINATION; CALCANEUS, MINIMUM OF TWO VIEWS
700..     73660  RADIOLOGIC EXAMINATION; TOE(S), MINIMUM OF TWO VIEWS
700..     74000  RADIOLOGIC EXAMINATION, ABDOMEN; SINGLE ANTEROPOSTERIOR VIEW
700..     74010  RADIOLOGIC EXAMINATION, ABDOMEN; ANTEROPOSTERIOR AND ADDITIONAL OBLIQUE AND CONE VIEWS
700..     74020  RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE, INCLUDING DECUBITUS AND/OR ERECT VIEWS
700..     74022  RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE ACUTE ABDOMEN SERIES, INCLUDING SUPINE, ERECT, AND/
                  OR DECUBITUS VIEWS, UPRIGHT PA CHEST
700..     74710  PELVIMETRY, WITH OR WITHOUT PLACENTAL LOCALIZATION
700..     76010  RADIOLOGIC EXAMINATION FROM NOSE TO RECTUM FOR FOREIGN BODY, SINGLE FILM, CHILD
700..     76020  BONE AGE STUDIES
700..     76040  BONE LENGTH STUDIES (ORTHOROENTGENOGRAM, SCANOGRAM)
700..     76061  RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; LIMITED (EG, FOR METASTASES)
700..     76062  RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; COMPLETE (AXIAL AND APPENDICULAR SKELETON)
700..     76065  RADIOLOGIC EXAMINATION, OSSEOUS SURVEY, INFANT
700..     76066  JOINT SURVEY, SINGLE VIEW, ONE OR MORE JOINTS (SPECIFY)
700..     76076  DUAL ENERGY X-RAY ABSORPTIOMETRY (DEXA), BONE DENSITY STUDY, ONE OR MORE SITES; APPENDICULAR
                  SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL)
700..     76078  RADIOGRAPHIC ABSORPTIOMETRY (PHOTODENSITOMETRY), ONE OR MORE SITES
700..     76098  RADIOLOGICAL EXAMINATION, SURGICAL SPECIMEN
700..     76100  RADIOLOGIC EXAMINATION, SINGLE PLANE BODY SECTION (EG, TOMOGRAPHY), OTHER THAN WITH UROGRAPHY
700..     76120  CINERADIOGRAPHY, EXCEPT WHERE SPECIFICALLY INCLUDED
700..     76125  CINERADIOGRAPHY TO COMPLEMENT ROUTINE EXAMINATION
700..     76150  XERORADIOGRAPHY
700..     76499  UNLISTED DIAGNOSTIC RADIOLOGIC PROCEDURE
700..     77417  THERAPEUTIC RADIOLOGY PORT FILM(S)
700..     78350  BONE DENSITY (BONE MINERAL CONTENT) STUDY, ONE OR MORE SITES; SINGLE PHOTON ABSORPTIOMETRY

[[Page 47815]]

706..  Miscellaneous Radiological      X                        1.96      $99.31          $57.63          $19.86
       Procedures
706..     70170  DACRYOCYSTOGRAPHY, NASOLACRIMAL DUCT, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     70373  LARYNGOGRAPHY, CONTRAST, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     70390  SIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     71040  BRONCHOGRAPHY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     71060  BRONCHOGRAPHY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     74190  PERITONEOGRAM (EG, AFTER INJECTION OF AIR OR CONTRAST), RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
706..     74305  CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; POSTOPERATIVE, RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
706..     74320  CHOLANGIOGRAPHY, PERCUTANEOUS, TRANSHEPATIC, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     74328  ENDOSCOPIC CATHETERIZATION OF THE BILIARY DUCTAL SYSTEM, RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
706..     74329  ENDOSCOPIC CATHETERIZATION OF THE PANCREATIC DUCTAL SYSTEM, RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
706..     74330  COMBINED ENDOSCOPIC CATHETERIZATION OF THE BILIARY AND PANCREATIC DUCTAL SYSTEMS, RADIOLOGICAL
                  SUPERVISION AND INTERPRETATION
706..     74350  PERCUTANEOUS PLACEMENT OF GASTROSTOMY TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     74355  PERCUTANEOUS PLACEMENT OF ENTEROCLYSIS TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     74470  RADIOLOGIC EXAMINATION, RENAL CYST STUDY, TRANSLUMBAR, CONTRAST VISUALIZATION, RADIOLOGICAL
                  SUPERVISION AND INTERPRETATION
706..     74740  HYSTEROSALPINGOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     74742  TRANSCERVICAL CATHETERIZATION OF FALLOPIAN TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     75801  LYMPHANGIOGRAPHY, EXTREMITY ONLY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     75803  LYMPHANGIOGRAPHY, EXTREMITY ONLY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     75805  LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     75807  LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     75809  SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED INDWELLING NONVASCULAR SHUNT (EG, LEVEEN
                  SHUNT, VENTRICULOPERITONEAL SHUNT), RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     75898  ANGIOGRAM THROUGH EXISTING CATHETER FOR FOLLOW-UP STUDY FOR TRANSCATHETER THERAPY, EMBOLIZATION
                  OR INFUSION
706..     76075  DUAL ENERGY X-RAY ABSORPTIOMETRY (DEXA), BONE DENSITY STUDY, ONE OR MORE SITES; AXIAL SKELETON
                  (EG, HIPS, PELVIS, SPINE)
706..     76080  RADIOLOGIC EXAMINATION, ABSCESS, FISTULA OR SINUS TRACT STUDY, RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
706..     76086  MAMMARY DUCTOGRAM OR GALACTOGRAM, SINGLE DUCT, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     76088  MAMMARY DUCTOGRAM OR GALACTOGRAM, MULTIPLE DUCTS, RADIOLOGICAL SUPERVISION AND INTERPRETATION
706..     76095  STEREOTACTIC LOCALIZATION FOR BREAST BIOPSY, EACH LESION, RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
706..     76096  PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE, BREAST, RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
706..     76101  RADIOLOGIC EXAMINATION, COMPLEX MOTION (IE, HYPERCYCLOIDAL) BODY SECTION (EG, MASTOID
                  POLYTOMOGRAPHY), OTHER THAN WITH UROGRAPHY; UNILATERAL
706..     76102  RADIOLOGIC EXAMINATION, COMPLEX MOTION (IE, HYPERCYCLOIDAL) BODY SECTION (EG, MASTOID
                  POLYTOMOGRAPHY), OTHER THAN WITH UROGRAPHY; BILATERAL
710..  Computerized Axial Tomography   S                        5.06     $256.39         $176.28          $51.28
710..     70450  COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL
710..     70460  COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BRAIN; WITH CONTRAST MATERIAL(S)
710..     70470  COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
                  MATERIAL(S) AND FURTHER SECTIONS
710..     70480  COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR INNER EAR;
                  WITHOUT CONTRAST MATERIAL
710..     70481  COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR INNER EAR;
                  WITH CONTRAST MATERIAL(S)
710..     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
710..     70486  COMPUTERIZED AXIAL TOMOGRAPHY, MAXILLOFACIAL AREA; WITHOUT CONTRAST MATERIAL
710..     70487  COMPUTERIZED AXIAL TOMOGRAPHY, MAXILLOFACIAL AREA; WITH CONTRAST MATERIAL(S)
710..     70488  COMPUTERIZED AXIAL TOMOGRAPHY, MAXILLOFACIAL AREA; WITHOUT CONTRAST MATERIAL, FOLLOWED BY
                  CONTRAST MATERIAL(S) AND FURTHER SECTIONS
710..     70490  COMPUTERIZED AXIAL TOMOGRAPHY, SOFT TISSUE NECK; WITHOUT CONTRAST MATERIAL
710..     70491  COMPUTERIZED AXIAL TOMOGRAPHY, SOFT TISSUE NECK; WITH CONTRAST MATERIAL(S)
710..     70492  COMPUTERIZED AXIAL TOMOGRAPHY, SOFT TISSUE NECK; WITHOUT CONTRAST MATERIAL FOLLOWED BY CONTRAST
                  MATERIAL(S) AND FURTHER SECTIONS
710..     71250  COMPUTERIZED AXIAL TOMOGRAPHY, THORAX; WITHOUT CONTRAST MATERIAL
710..     71260  COMPUTERIZED AXIAL TOMOGRAPHY, THORAX; WITH CONTRAST MATERIAL(S)
710..     71270  COMPUTERIZED AXIAL TOMOGRAPHY, THORAX; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
                  MATERIAL(S) AND FURTHER SECTIONS
710..     72125  COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL
710..     72126  COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITH CONTRAST MATERIAL
710..     72127  COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
                  MATERIAL(S) AND FURTHER SECTIONS
710..     72128  COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL
710..     72129  COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE; WITH CONTRAST MATERIAL
710..     72130  COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
                  MATERIAL(S) AND FURTHER SECTIONS
710..     72131  COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL
710..     72132  COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITH CONTRAST MATERIAL
710..     72133  COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
                  MATERIAL(S) AND FURTHER SECTIONS
710..     72192  COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL
710..     72193  COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITH CONTRAST MATERIAL(S)

[[Page 47816]]

710..     72194  COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
                  MATERIAL(S) AND FURTHER SECTIONS
710..     73200  COMPUTERIZED AXIAL TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL
710..     73201  COMPUTERIZED AXIAL TOMOGRAPHY, UPPER EXTREMITY; WITH CONTRAST MATERIAL(S)
710..     73202  COMPUTERIZED AXIAL TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
                  MATERIAL(S) AND FURTHER SECTIONS
710..     73700  COMPUTERIZED AXIAL TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL
710..     73701  COMPUTERIZED AXIAL TOMOGRAPHY, LOWER EXTREMITY; WITH CONTRAST MATERIAL(S)
710..     73702  COMPUTERIZED AXIAL TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
                  MATERIAL(S) AND FURTHER SECTIONS
710..     74150  COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL
710..     74160  COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITH CONTRAST MATERIAL(S)
710..     74170  COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
                  MATERIAL(S) AND FURTHER SECTIONS
710..     76355  COMPUTERIZED TOMOGRAPHY GUIDANCE FOR STEREOTACTIC LOCALIZATION
710..     76360  COMPUTERIZED TOMOGRAPHY GUIDANCE FOR NEEDLE BIOPSY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
710..     76365  COMPUTERIZED TOMOGRAPHY GUIDANCE FOR CYST ASPIRATION, RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
710..     76370  COMPUTERIZED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS
710..     76375  CORONAL, SAGITTAL, MULTIPLANAR, OBLIQUE, 3-DIMENSIONAL AND/OR HOLOGRAPHIC RECONSTRUCTION OF
                  COMPUTERIZED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, OR OTHER TOMOGRAPHIC MODALITY
710..     76380  COMPUTERIZED TOMOGRAPHY, LIMITED OR LOCALIZED FOLLOW-UP STUDY
716..  Fluoroscopy                     X                        1.59      $80.56          $47.91          $16.11
716..     70370  RADIOLOGIC EXAMINATION; PHARYNX OR LARYNX, INCLUDING FLUOROSCOPY AND/OR MAGNIFICATION TECHNIQUE
716..     70371  COMPLEX DYNAMIC PHARYNGEAL AND SPEECH EVALUATION BY CINE OR VIDEO RECORDING
716..     71023  RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH FLUOROSCOPY
716..     71034  RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOUR VIEWS; WITH FLUOROSCOPY
716..     71036  NEEDLE BIOPSY OF INTRATHORACIC LESION, INCLUDING FOLLOW-UP FILMS, FLUOROSCOPIC LOCALIZATION
                  ONLY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
716..     71038  FLUOROSCOPIC LOCALIZATION FOR TRANSBRONCHIAL BIOPSY OR BRUSHING
716..     71090  INSERTION PACEMAKER, FLUOROSCOPY AND RADIOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
716..     74340  INTRODUCTION OF LONG GASTROINTESTINAL TUBE (EG, MILLER-ABBOTT), INCLUDING MULTIPLE
                  FLUOROSCOPIES AND FILMS, RADIOLOGICAL SUPERVISION AND INTERPRETATION
716..     75989  RADIOLOGICAL GUIDANCE FOR PERCUTANEOUS DRAINAGE OF ABSCESS, OR SPECIMEN COLLECTION (IE,
                  FLUOROSCOPY, ULTRASOUND, OR COMPUTED TOMOGRAPHY), WITH PLACEMENT OF INDWELLING CATHETER,
                  RADIOLOGICAL SUPERVISION AND INTERPRETATION
716..     76000  FLUOROSCOPY (SEPARATE PROCEDURE), UP TO ONE HOUR PHYSICIAN TIME, OTHER THAN 71023 OR 71034 (EG,
                  CARDIAC FLUOROSCOPY)
716..     76001  FLUOROSCOPY, PHYSICIAN TIME MORE THAN ONE HOUR, ASSISTING A NON-RADIOLOGIC PHYSICIAN (EG,
                  NEPHROSTOLITHOTOMY, ERCP, BRONCHOSCOPY, TRANSBRONCHIAL BIOPSY)
716..     76003  FLUOROSCOPIC LOCALIZATION FOR NEEDLE BIOPSY OR FINE NEEDLE ASPIRATION
720..  Magnetic Resonance Angiography  S                        6.34     $321.24          206.11          $64.25
720..     70541  MAGNETIC RESONANCE ANGIOGRAPHY, HEAD AND/OR NECK, WITH OR WITHOUT CONTRAST MATERIAL(S)
726..  Magnetic Resonance Imaging      S                        7.96     $403.33         $258.09          $80.67
726..     70336  MAGNETIC RESONANCE (EG, PROTON) IMAGING, TEMPOROMANDIBULAR JOINT
726..     70540  MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND NECK
726..     70551  MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST
                  MATERIAL
726..     70552  MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITH CONTRAST
                  MATERIAL(S)
726..     70553  MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST
                  MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES
726..     71550  MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND MEDIASTINAL
                  LYMPHADENOPATHY)
726..     72141  MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, CERVICAL; WITHOUT CONTRAST
                  MATERIAL
726..     72142  MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, CERVICAL; WITH CONTRAST
                  MATERIAL(S)
726..     72146  MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, THORACIC; WITHOUT CONTRAST
                  MATERIAL
726..     72147  MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, THORACIC; WITH CONTRAST
                  MATERIAL(S)
726..     72148  MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR; WITHOUT CONTRAST
                  MATERIAL
726..     72149  MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR; WITH CONTRAST
                  MATERIAL(S)
726..     72156  MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT CONTRAST MATERIAL,
                  FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; CERVICAL
726..     72157  MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT CONTRAST MATERIAL,
                  FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; THORACIC
726..     72158  MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT CONTRAST MATERIAL,
                  FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; LUMBAR
726..     72196  MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS
726..     73220  MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT
726..     73221  MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY
726..     73720  MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY, OTHER THAN JOINT
726..     73721  MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY
726..     74181  MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN
726..     75552  CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY; WITHOUT CONTRAST MATERIAL
726..     75553  CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY; WITH CONTRAST MATERIAL
726..     75554  CARDIAC MAGNETIC RESONANCE IMAGING FOR FUNCTION, WITH OR WITHOUT MORPHOLOGY; COMPLETE STUDY
726..     75555  CARDIAC MAGNETIC RESONANCE IMAGING FOR FUNCTION, WITH OR WITHOUT MORPHOLOGY; LIMITED STUDY
726..     76093  MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); UNILATERAL
726..     76094  MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); BILATERAL

[[Page 47817]]

726..     76390  MAGNETIC RESONANCE SPECTROSCOPY
726..     76400  MAGNETIC RESONANCE (EG, PROTON) IMAGING, BONE MARROW BLOOD SUPPLY
728..  Myelography                     S                        4.07     $206.22         $113.23          $41.24
728..     70010  MYELOGRAPHY, POSTERIOR FOSSA, RADIOLOGICAL SUPERVISION AND INTERPRETATION
728..     70015  CISTERNOGRAPHY, POSITIVE CONTRAST, RADIOLOGICAL SUPERVISION AND INTERPRETATION
728..     72240  MYELOGRAPHY, CERVICAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
728..     72255  MYELOGRAPHY, THORACIC, RADIOLOGICAL SUPERVISION AND INTERPRETATION
728..     72265  MYELOGRAPHY, LUMBOSACRAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
728..     72270  MYELOGRAPHY, ENTIRE SPINAL CANAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
728..     72285  DISKOGRAPHY, CERVICAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
728..     72295  DISKOGRAPHY, LUMBAR, RADIOLOGICAL SUPERVISION AND INTERPRETATION
730..  Arthography                     S                        2.48     $125.66          $72.09          $25.13
730..     70332  TEMPOROMANDIBULAR JOINT ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
730..     73040  RADIOLOGIC EXAMINATION, SHOULDER, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
730..     73085  RADIOLOGIC EXAMINATION, ELBOW, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
730..     73115  RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
730..     73525  RADIOLOGIC EXAMINATION, HIP, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
730..     73580  RADIOLOGIC EXAMINATION, KNEE, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
730..     73615  RADIOLOGIC EXAMINATION, ANKLE, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
736..  Digestive Radiology             S                        1.85      $93.74          $54.24          $18.75
736..     74210  RADIOLOGIC EXAMINATION; PHARYNX AND/OR CERVICAL ESOPHAGUS
736..     74220  RADIOLOGIC EXAMINATION; ESOPHAGUS
736..     74230  SWALLOWING FUNCTION, PHARYNX AND/OR ESOPHAGUS, WITH CINERADIOGRAPHY AND/OR VIDEO
736..     74240  RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUT DELAYED FILMS, WITHOUT
                  KUB
736..     74241  RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUT DELAYED FILMS, WITH KUB
736..     74245  RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH SMALL BOWEL, INCLUDES MULTIPLE
                  SERIAL FILMS
736..     74246  RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH SPECIFIC HIGH
                  DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH OR WITHOUT DELAYED FILMS,
                  WITHOUT KUB
736..     74247  RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH SPECIFIC HIGH
                  DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH OR WITHOUT DELAYED FILMS,
                  WITH KUB
736..     74249  RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH SPECIFIC HIGH
                  DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH SMALL BOWEL FOLLOW-THROUGH
736..     74250  RADIOLOGIC EXAMINATION, SMALL BOWEL, INCLUDES MULTIPLE SERIAL FILMS;
736..     74251  RADIOLOGIC EXAMINATION, SMALL BOWEL, INCLUDES MULTIPLE SERIAL FILMS; VIA ENTEROCLYSIS TUBE
736..     74260  DUODENOGRAPHY, HYPOTONIC
736..     74270  RADIOLOGIC EXAMINATION, COLON; BARIUM ENEMA, WITH OR WITHOUT KUB
736..     74280  RADIOLOGIC EXAMINATION, COLON; AIR CONTRAST WITH SPECIFIC HIGH DENSITY BARIUM, WITH OR WITHOUT
                  GLUCAGON
736..     74283  THERAPEUTIC ENEMA, CONTRAST OR AIR, FOR REDUCTION OF INTUSSUSCEPTION OR OTHER INTRALUMINAL
                  OBSTRUCTION (EG, MECONIUM ILEUS)
736..     74290  CHOLECYSTOGRAPHY, ORAL CONTRAST;
736..     74291  CHOLECYSTOGRAPHY, ORAL CONTRAST; ADDITIONAL OR REPEAT EXAMINATION OR MULTIPLE DAY EXAMINATION
736..     G0106  Colorectal Ca screening
736..     G0120  Colorectal Ca screening
737..  Diagnostic Urography            S                        2.81     $142.38          $86.56          $28.48
737..     74400  UROGRAPHY (PYELOGRAPHY), INTRAVENOUS, WITH OR WITHOUT KUB, WITH OR WITHOUT TOMOGRAPHY;
737..     74405  UROGRAPHY (PYELOGRAPHY), INTRAVENOUS, WITH OR WITHOUT KUB, WITH OR WITHOUT TOMOGRAPHY; WITH
                  SPECIAL HYPERTENSIVE CONTRAST CONCENTRATION AND/OR CLEARANCE STUDIES
737..     74410  UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE;
737..     74415  UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE; WITH NEPHROTOMOGRAPHY
737..     74420  UROGRAPHY, RETROGRADE, WITH OR WITHOUT KUB
737..     74425  UROGRAPHY, ANTEGRADE, (PYELOSTOGRAM, NEPHROSTOGRAM, LOOPOGRAM), RADIOLOGICAL SUPERVISION AND
737..     74430  CYSTOGRAPHY, MINIMUM OF THREE VIEWS, RADIOLOGICAL SUPERVISION AND INTERPRETATION
737..     74440  VASOGRAPHY, VESICULOGRAPHY, OR EPIDIDYMOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
737..     74445  CORPORA CAVERNOSOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
737..     74450  URETHROCYSTOGRAPHY, RETROGRADE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
737..     74455  URETHROCYSTOGRAPHY, VOIDING, RADIOLOGICAL SUPERVISION AND INTERPRETATION
737..     74775  PERINEOGRAM (EG, VAGINOGRAM, FOR SEX DETERMINATION OR EXTENT OF ANOMALIES)
738..  Therapeutic Radiologic          S                        4.48     $227.00         $133.23           $45.4
       Procedures
738..     74235  REMOVAL OF FOREIGN BODY(S), ESOPHAGEAL, WITH USE OF BALLOON CATHETER, RADIOLOGICAL SUPERVISION
                  AND INTERPRETATION
738..     74327  POSTOPERATIVE BILIARY DUCT STONE REMOVAL, PERCUTANEOUS VIA T-TUBE TRACT, BASKET, OR SNARE (EG,
                  BURHENNE TECHNIQUE), RADIOLOGICAL SUPERVISION AND INTERPRETATION
738..     74360  INTRALUMINAL DILATION OF STRICTURES AND/OR OBSTRUCTIONS (EG, ESOPHAGUS), RADIOLOGICAL
                  SUPERVISION AND INTERPRETATION
738..     74363  PERCUTANEOUS TRANSHEPATIC DILATATION OF BILIARY DUCT STRICTURE WITH OR WITHOUT PLACEMENT OF
                  STENT, RADIOLOGICAL SUPERVISION AND INTERPRETATION
738..     74475  INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR INJECTION,
                  PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION
738..     74480  INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETER THROUGH RENAL PELVIS FOR DRAINAGE AND/OR
                  INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION
738..     74485  DILATION OF NEPHROSTOMY, URETERS, OR URETHRA, RADIOLOGICAL SUPERVISION AND INTERPRETATION
738..     75980  PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE WITH CONTRAST MONITORING, RADIOLOGICAL SUPERVISION
                  AND INTERPRETATION

[[Page 47818]]

738..     75982  PERCUTANEOUS PLACEMENT OF DRAINAGE CATHETER FOR COMBINED INTERNAL AND EXTERNAL BILIARY DRAINAGE
                  OR OF A DRAINAGE STENT FOR INTERNAL BILIARY DRAINAGE IN PATIENTS WITH AN INOPERABLE MECHANICAL
                  BILIARY OBSTRUCTION, RADIOLOGICAL SUPERVISION AND INTERPRETATION
738..     75984  CHANGE OF PERCUTANEOUS TUBE OR DRAINAGE CATHETER WITH CONTRAST MONITORING (EG, GASTROINTESTINAL
                  SYSTEM, GENITOURINARY SYSTEM, ABSCESS), RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..  Diagnostic Angiography and      S                        5.83     $295.40         $168.71          $59.08
       Venography
739..     75600  AORTOGRAPHY, THORACIC, WITHOUT SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75605  AORTOGRAPHY, THORACIC, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75625  AORTOGRAPHY, ABDOMINAL, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75630  AORTOGRAPHY, ABDOMINAL PLUS BILATERAL ILIOFEMORAL LOWER EXTREMITY, CATHETER, BY SERIALOGRAPHY,
                  RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75650  ANGIOGRAPHY, CERVICOCEREBRAL, CATHETER, INCLUDING VESSEL ORIGIN, RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
739..     75658  ANGIOGRAPHY, BRACHIAL, RETROGRADE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75660  ANGIOGRAPHY, EXTERNAL CAROTID, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
739..     75662  ANGIOGRAPHY, EXTERNAL CAROTID, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
739..     75665  ANGIOGRAPHY, CAROTID, CEREBRAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75671  ANGIOGRAPHY, CAROTID, CEREBRAL, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75676  ANGIOGRAPHY, CAROTID, CERVICAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75680  ANGIOGRAPHY, CAROTID, CERVICAL, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75685  ANGIOGRAPHY, VERTEBRAL, CERVICAL, AND/OR INTRACRANIAL, RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
739..     75705  ANGIOGRAPHY, SPINAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75710  ANGIOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75716  ANGIOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75722  ANGIOGRAPHY, RENAL, UNILATERAL, SELECTIVE (INCLUDING FLUSH AORTOGRAM), RADIOLOGICAL SUPERVISION
                  AND INTERPRETATION
739..     75724  ANGIOGRAPHY, RENAL, BILATERAL, SELECTIVE (INCLUDING FLUSH AORTOGRAM), RADIOLOGICAL SUPERVISION
                  AND INTERPRETATION
739..     75726  ANGIOGRAPHY, VISCERAL, SELECTIVE OR SUPRASELECTIVE, (WITH OR WITHOUT FLUSH AORTOGRAM),
                  RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75731  ANGIOGRAPHY, ADRENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75733  ANGIOGRAPHY, ADRENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75736  ANGIOGRAPHY, PELVIC, SELECTIVE OR SUPRASELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75741  ANGIOGRAPHY, PULMONARY, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75743  ANGIOGRAPHY, PULMONARY, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75746  ANGIOGRAPHY, PULMONARY, BY NONSELECTIVE CATHETER OR VENOUS INJECTION, RADIOLOGICAL SUPERVISION
                  AND INTERPRETATION
739..     75756  ANGIOGRAPHY, INTERNAL MAMMARY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75774  ANGIOGRAPHY, SELECTIVE, EACH ADDITIONAL VESSEL STUDIED AFTER BASIC EXAMINATION, RADIOLOGICAL
                  SUPERVISION AND INTERPRETATION
739..     75790  ANGIOGRAPHY, ARTERIOVENOUS SHUNT (EG, DIALYSIS PATIENT), RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
739..     75810  SPLENOPORTOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75820  VENOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75822  VENOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75825  VENOGRAPHY, CAVAL, INFERIOR, WITH SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75827  VENOGRAPHY, CAVAL, SUPERIOR, WITH SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75831  VENOGRAPHY, RENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75833  VENOGRAPHY, RENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75840  VENOGRAPHY, ADRENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75842  VENOGRAPHY, ADRENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75860  VENOGRAPHY, SINUS OR JUGULAR, CATHETER, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75870  VENOGRAPHY, SUPERIOR SAGITTAL SINUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75872  VENOGRAPHY, EPIDURAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75880  VENOGRAPHY, ORBITAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
739..     75885  PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
739..     75887  PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITHOUT HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION
                  AND INTERPRETATION
739..     75889  HEPATIC VENOGRAPHY, WEDGED OR FREE, WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
739..     75891  HEPATIC VENOGRAPHY, WEDGED OR FREE, WITHOUT HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION
                  AND INTERPRETATION
746..  Mammography                     S                        0.69      $34.96          $19.44           $6.99
746..     76090  MAMMOGRAPHY; UNILATERAL
746..     76091  MAMMOGRAPHY; BILATERAL
747..  Diagnostic Ultrasound Except    S                        1.65      $83.60          $54.69          $16.72
       Vascular
747..     76506  ECHOENCEPHALOGRAPHY, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION (GRAY SCALE) (FOR
                  DETERMINATION OF VENTRICULAR SIZE, DELINEATION OF CEREBRAL CONTENTS AND DETECTION OF FLUID
                  MASSES OR OTHER INTRACRANIAL ABNORMALITIES), INCLUDING A-MODE ENCEPHALOGRAPH
747..     76511  OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DIAGNOSTIC; A-SCAN ONLY, WITH AMPLITUDE QUANTIFICATION
747..     76512  OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DIAGNOSTIC; CONTACT B-SCAN (WITH OR WITHOUT SIMULTANEOUS A-
                  SCAN)
747..     76513  OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DIAGNOSTIC; IMMERSION (WATER BATH) B-SCAN
747..     76516  OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN;
747..     76519  OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN; WITH INTRAOCULAR LENS POWER CALCULATION
747..     76529  OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION

[[Page 47819]]

747..     76536  ECHOGRAPHY, SOFT TISSUES OF HEAD AND NECK (EG, THYROID, PARATHYROID, PAROTID), B-SCAN AND/OR
                  REAL TIME WITH IMAGE DOCUMENTATION
747..     76604  ECHOGRAPHY, CHEST, B-SCAN (INCLUDES MEDIASTINUM) AND/OR REAL TIME WITH IMAGE DOCUMENTATION
747..     76645  ECHOGRAPHY, BREAST(S) (UNILATERAL OR BILATERAL), B-SCAN AND/ OR REAL TIME WITH IMAGE
                  DOCUMENTATION
747..     76700  ECHOGRAPHY, ABDOMINAL, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE
747..     76705  ECHOGRAPHY, ABDOMINAL, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED (EG, SINGLE
                  ORGAN, QUADRANT, FOLLOW-UP)
747..     76770  ECHOGRAPHY, RETROPERITONEAL (EG, RENAL, AORTA, NODES), B-SCAN AND/OR REAL TIME WITH IMAGE
                  DOCUMENTATION; COMPLETE
747..     76775  ECHOGRAPHY, RETROPERITONEAL (EG, RENAL, AORTA, NODES), B-SCAN AND/OR REAL TIME WITH IMAGE
                  DOCUMENTATION; LIMITED
747..     76778  ECHOGRAPHY OF TRANSPLANTED KIDNEY, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION, WITH OR
                  WITHOUT DUPLEX DOPPLER STUDIES
747..     76800  ECHOGRAPHY, SPINAL CANAL AND CONTENTS
747..     76805  ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE
                  (COMPLETE FETAL AND MATERNAL EVALUATION)
747..     76810  ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE
                  (COMPLETE FETAL AND MATERNAL EVALUATION), MULTIPLE GESTATION, AFTER THE FIRST TRIMESTER
747..     76815  ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED (FETAL
                  SIZE, HEART BEAT, PLACENTAL LOCATION, FETAL POSITION, OR EMERGENCY IN THE DELIVERY ROOM)
747..     76816  ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; FOLLOW-UP OR
                  REPEAT
747..     76818  FETAL BIOPHYSICAL PROFILE
747..     76830  ECHOGRAPHY, TRANSVAGINAL
747..     76831  HYSTEROSONOGRAPHY, WITH OR WITHOUT COLOR FLOW DOPPLER
747..     76856  ECHOGRAPHY, PELVIC (NONOBSTETRIC), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE
747..     76857  ECHOGRAPHY, PELVIC (NONOBSTETRIC), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED OR
                  FOLLOW-UP (EG, FOR FOLLICLES)
747..     76870  ECHOGRAPHY, SCROTUM AND CONTENTS
747..     76872  ECHOGRAPHY, TRANSRECTAL
747..     76880  ECHOGRAPHY, EXTREMITY, NON-VASCULAR, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION
747..     76885  ECHOGRAPHY OF INFANT HIPS, REAL TIME WITH IMAGING DOCUMENTATION; DYNAMIC (EG, REQUIRING
                  MANIPULATION)
747..     76886  ECHOGRAPHY OF INFANT HIPS, REAL TIME WITH IMAGING DOCUMENTATION; LIMITED, STATIC (EG, NOT
                  REQUIRING MANIPULATION
747..     76970  ULTRASOUND STUDY FOLLOW-UP (SPECIFY)
747..     76975  GASTROINTESTINAL ENDOSCOPIC ULTRASOUND, RADIOLOGICAL SUPERVISION AND INTERPRETATION
747..     76986  ECHOGRAPHY, INTRAOPERATIVE
747..     76999  UNLISTED ULTRASOUND PROCEDURE
747..     G0050  POST-VOIDAL RESIDUAL URINE/BLADDER CAPACITY
749..  Guidance under Ultrasound       X                        2.44     $123.63          $76.16          $24.73
749..     76930  ULTRASONIC GUIDANCE FOR PERICARDIOCENTESIS, RADIOLOGICAL SUPERVISION AND INTERPRETATION
749..     76932  ULTRASONIC GUIDANCE FOR ENDOMYOCARDIAL BIOPSY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
749..     76934  ULTRASONIC GUIDANCE FOR THORACENTESIS OR ABDOMINAL PARACENTESIS, RADIOLOGICAL SUPERVISION AND
                  INTERPRETATION
749..     76936  ULTRASOUND GUIDED COMPRESSION REPAIR OF ARTERIAL PSEUDO-ANEURYSM OR ARTERIOVENOUS FISTULAE
                  (INCLUDES DIAGNOSTIC ULTRASOUND EVALUATION, COMPRESSION OF LESION AND IMAGING)
749..     76938  ULTRASONIC GUIDANCE FOR CYST (ANY LOCATION) OR RENAL PELVIS ASPIRATION, RADIOLOGICAL
                  SUPERVISION AND INTERPRETATION
749..     76941  ULTRASONIC GUIDANCE FOR INTRAUTERINE FETAL TRANSFUSION OR CORDOCENTESIS, RADIOLOGICAL
                  SUPERVISION AND INTERPRETATION
749..     76942  ULTRASONIC GUIDANCE FOR NEEDLE BIOPSY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
749..     76945  ULTRASONIC GUIDANCE FOR CHORIONIC VILLUS SAMPLING, RADIOLOGICAL SUPERVISION AND INTERPRETATION
749..     76946  ULTRASONIC GUIDANCE FOR AMNIOCENTESIS, RADIOLOGICAL SUPERVISION AND INTERPRETATION
749..     76948  ULTRASONIC GUIDANCE FOR ASPIRATION OF OVA, RADIOLOGICAL SUPERVISION AND INTERPRETATION
749..     76950  ECHOGRAPHY FOR PLACEMENT OF RADIATION THERAPY FIELDS, B-SCAN
749..     76960  ULTRASONIC GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS, EXCEPT FOR B-SCAN ECHOGRAPHY
749..     76965  ULTRASONIC GUIDANCE FOR INTERSTITIAL RADIOELEMENT APPLICATION
750..  Therapeutic Radiation           X                        0.91      $46.11          $25.54           $9.22
       Treatment Planning
750..     77261  THERAPEUTIC RADIOLOGY TREATMENT PLANNING; SIMPLE
750..     77262  THERAPEUTIC RADIOLOGY TREATMENT PLANNING; INTERMEDIATE
750..     77263  THERAPEUTIC RADIOLOGY TREATMENT PLANNING; COMPLEX
750..     77336  CONTINUING MEDICAL RADIATION PHYSICS CONSULTATION IN SUPPORT OF THERAPEUTIC RADIOLOGIST
                  INCLUDING CONTINUING QUALITY ASSURANCE REPORTED PER WEEK OF THERAPY
750..     77370  SPECIAL MEDICAL RADIATION PHYSICS CONSULTATION
750..     77399  UNLISTED PROCEDURE, MEDICAL RADIATION PHYSICS, DOSIMETRY AND TREATMENT DEVICES
750..     77431  RADIATION THERAPY MANAGEMENT WITH COMPLETE COURSE OF THERAPY CONSISTING OF ONE OR TWO FRACTIONS
                  ONLY
750..     77432  STEREOTACTIC RADIATION TREATMENT MANAGEMENT OF CEREBRAL LESION(S) (COMPLETE COURSE OF TREATMENT
                  CONSISTING OF ONE SESSION)
751..  Level I Therapeutic Radiation   X                        1.15      $58.27          $33.22          $11.65
       Treatment Preparation
751..     77299  UNLISTED PROCEDURE, THERAPEUTIC RADIOLOGY CLINICAL TREATMENT PLANNING
751..     77300  BASIC RADIATION DOSIMETRY CALCULATION, CENTRAL AXIS DEPTH DOSE, TDF, NSD, GAP CALCULATION, OFF
                  AXIS FACTOR, TISSUE INHOMOGENEITY FACTORS, AS REQUIRED DURING COURSE OF TREATMENT, ONLY WHEN
                  PRESCRIBED BY THE TREATING PHYSICIAN
751..     77305  TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTER CALCULATED); SIMPLE (ONE OR TWO PARALLEL
                  OPPOSED UNMODIFIED PORTS DIRECTED TO A SINGLE AREA OF INTEREST)

[[Page 47820]]

751..     77310  TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTER CALCULATED); INTERMEDIATE (THREE OR MORE
                  TREATMENT PORTS DIRECTED TO A SINGLE AREA OF INTEREST)
751..     77315  TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTER CALCULATED); COMPLEX (MANTLE OR INVERTED Y,
                  TANGENTIAL PORTS, THE USE OF WEDGES, COMPENSATORS, COMPLEX BLOCKING, ROTATIONAL BEAM, OR
                  SPECIAL BEAM CONSIDERATIONS)
751..     77321  SPECIAL TELETHERAPY PORT PLAN, PARTICLES, HEMIBODY, TOTAL BODY
751..     77326  BRACHYTHERAPY ISODOSE CALCULATION; SIMPLE (CALCULATION MADE FROM SINGLE PLANE, ONE TO FOUR
                  SOURCES/ RIBBON APPLICATION, REMOTE AFTERLOADING BRACHYTHERAPY, 1 TO 8 SOURCES)
751..     77327  BRACHYTHERAPY ISODOSE CALCULATION; INTERMEDIATE (MULTIPLANE DOSAGE CALCULATIONS, APPLICATION
                  INVOLVING 5 TO 10 SOURCES/RIBBONS, REMOTE AFTERLOADING BRACHYTHERAPY, 9 TO 12 SOURCES)
751..     77328  BRACHYTHERAPY ISODOSE CALCULATION; COMPLEX (MULTIPLANE ISODOSE PLAN, VOLUME IMPLANT
                  CALCULATIONS, OVER 10 SOURCES/RIBBONS USED, SPECIAL SPATIAL RECONSTRUCTION, REMOTE
                  AFTERLOADING BRACHYTHERAPY, OVER 12 SOURCES)
751..     77331  SPECIAL DOSIMETRY (EG, TLD, MICRODOSIMETRY) (SPECIFY), ONLY WHEN PRESCRIBED BY THE TREATING
                  PHYSICIAN
751..     77332  TREATMENT DEVICES, DESIGN AND CONSTRUCTION; SIMPLE (SIMPLE BLOCK, SIMPLE BOLUS)
751..     77333  TREATMENT DEVICES, DESIGN AND CONSTRUCTION; INTERMEDIATE (MULTIPLE BLOCKS, STENTS, BITE BLOCKS,
                  SPECIAL BOLUS)
751..     77334  TREATMENT DEVICES, DESIGN AND CONSTRUCTION; COMPLEX (IRREGULAR BLOCKS, SPECIAL SHIELDS,
                  COMPENSATORS, WEDGES, MOLDS OR CASTS)
752..  Level II Therapeutic Radiation  X                        3.54     $179.37          $88.82          $35.87
       Treatment
752..     77280  THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; SIMPLE
752..     77285  THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; INTERMEDIATE
752..     77290  THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; COMPLEX
752..     77295  THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; THREE-DIMENSIONAL
757..  Radiation Therapy               S                        2.30     $116.54          $52.43          $23.31
757..     61793  STEREOTACTIC RADIOSURGERY (PARTICLE BEAM, GAMMA RAY OR LINEAR ACCELERATOR), ONE OR MORE
                  SESSIONS
757..     77401  RADIATION TREATMENT DELIVERY, SUPERFICIAL AND/OR ORTHO VOLTAGE
757..     77402  RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL OPPOSED PORTS,
                  SIMPLE BLOCKS OR NO BLOCKS; UP TO 5 MEV
757..     77403  RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL OPPOSED PORTS,
                  SIMPLE BLOCKS OR NO BLOCKS; 6-10 MEV
757..     77404  RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL OPPOSED PORTS,
                  SIMPLE BLOCKS OR NO BLOCKS; 11-19 MEV
757..     77406  RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL OPPOSED PORTS,
                  SIMPLE BLOCKS OR NO BLOCKS; 20 MEV OR GREATER
757..     77407  RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS ON A SINGLE
                  TREATMENT AREA, USE OF MULTIPLE BLOCKS; UP TO 5 MEV
757..     77408  RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS ON A SINGLE
                  TREATMENT AREA, USE OF MULTIPLE BLOCKS; 6-10 MEV
757..     77409  RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS ON A SINGLE
                  TREATMENT AREA, USE OF MULTIPLE BLOCKS; 11-19 MEV
757..     77411  RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS ON A SINGLE
                  TREATMENT AREA, USE OF MULTIPLE BLOCKS; 20 MEV OR GREATER
757..     77412  RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM BLOCKING,
                  TANGENTIAL PORTS, WEDGES, ROTATIONAL BEAM, COMPENSATORS, SPECIAL PARTICLE BEAM (EG, ELECTRON
                  OR NEUTRONS); UP TO 5 MEV
757..     77413  RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM BLOCKING,
                  TANGENTIAL PORTS, WEDGES, ROTATIONAL BEAM, COMPENSATORS, SPECIAL PARTICLE BEAM (EG, ELECTRON
                  OR NEUTRONS); 6-10 MEV
757..     77414  RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM BLOCKING,
                  TANGENTIAL PORTS, WEDGES, ROTATIONAL BEAM, COMPENSATORS, SPECIAL PARTICLE BEAM (EG, ELECTRON
                  OR NEUTRONS); 11-19 MEV
757..     77416  RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM BLOCKING,
                  TANGENTIAL PORTS, WEDGES, ROTATIONAL BEAM, COMPENSATORS, SPECIAL PARTICLE BEAM (EG, ELECTRON
                  OR NEUTRONS); 20 MEV OR GREATER
757..     77470  SPECIAL TREATMENT PROCEDURE (EG, TOTAL BODY IRRADIATION, HEMIBODY IRRADIATION, PER ORAL,
                  VAGINAL CONE IRRADIATION
758..  Hyperthermic Therapies          S                        3.41     $172.78          $76.84          $34.56
758..     77600  HYPERTHERMIA, EXTERNALLY GENERATED; SUPERFICIAL (IE, HEATING TO A DEPTH OF 4 CM OR LESS)
758..     77605  HYPERTHERMIA, EXTERNALLY GENERATED; DEEP (IE, HEATING TO DEPTHS GREATER THAN 4 CM)
758..     77610  HYPERTHERMIA GENERATED BY INTERSTITIAL PROBE(S); 5 OR FEWER INTERSTITIAL APPLICATORS
758..     77615  HYPERTHERMIA GENERATED BY INTERSTITIAL PROBE(S); MORE THAN 5 INTERSTITIAL APPLICATORS
758..     77620  HYPERTHERMIA GENERATED BY INTRACAVITARY PROBE(S)
759..  Brachytherapy and Complex       S                        7.98     $404.34         $160.01          $80.87
       Radioelement Applications
759..     77750  INFUSION OR INSTILLATION OF RADIOELEMENT SOLUTION
759..     77761  INTRACAVITARY RADIOELEMENT APPLICATION; SIMPLE
759..     77762  INTRACAVITARY RADIOELEMENT APPLICATION; INTERMEDIATE
759..     77763  INTRACAVITARY RADIOELEMENT APPLICATION; COMPLEX
759..     77776  INTERSTITIAL RADIOELEMENT APPLICATION; SIMPLE
759..     77777  INTERSTITIAL RADIOELEMENT APPLICATION; INTERMEDIATE
759..     77778  INTERSTITIAL RADIOELEMENT APPLICATION; COMPLEX
759..     77781  REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; 1-4 SOURCE POSITIONS OR CATHETERS
759..     77782  REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; 5-8 SOURCE POSITIONS OR CATHETERS
759..     77783  REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; 9-12 SOURCE POSITIONS OR CATHETERS
759..     77784  REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; OVER 12 SOURCE POSITIONS OR CATHETERS
759..     77789  SURFACE APPLICATION OF RADIOELEMENT
759..     77799  UNLISTED PROCEDURE, CLINICAL BRACHYTHERAPY
760..  PET Scans                       S                       17.26     $874.55         $419.46         $174.91
760..     78459  MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), METABOLIC EVALUATION

[[Page 47821]]

760..     78608  BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); METABOLIC EVALUATION
760..     78609  BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); PERFUSION EVALUATION
760..     78810  TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), METABOLIC EVALUATION
760..     G0030  PET imaging prev PET single
760..     G0031  PET imaging prev PET multple
760..     G0032  PET follow SPECT 78464 singl
760..     G0033  PET follow SPECT 78464 mult
760..     G0034  PET follow SPECT 76865 singl
760..     G0035  PET follow SPECT 78465 mult
760..     G0036  PET follow cornry angio sing
760..     G0037  PET follow cornry angio mult
760..     G0038  PET follow myocard perf sing
760..     G0039  PET follow myocard perf mult
760..     G0040  PET follow stress echo singl
760..     G0041  PET follow stress echo mult
760..     G0042  PET follow ventriculogm sing
760..     G0043  PET follow ventriculogm mult
760..     G0044  PET following rest ECG singl
760..     G0045  PET following rest ECG mult
760..     G0046  PET follow stress ECG singl
760..     G0047  PET follow stress ECG mult
761..  Standard Non-Imaging Nuclear    S                        2.04     $103.37          $61.47          $20.67
       Medicine
761..     78000  THYROID UPTAKE; SINGLE DETERMINATION
761..     78099  UNLISTED ENDOCRINE PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
761..     78110  PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE (SEPARATE PROCEDURE); SINGLE
                  SAMPLING
761..     78111  PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE (SEPARATE PROCEDURE); MULTIPLE
                  SAMPLINGS
761..     78120  RED CELL VOLUME DETERMINATION (SEPARATE PROCEDURE); SINGLE SAMPLING
761..     78199  UNLISTED HEMATOPOIETIC, RETICULOENDOTHELIAL AND LYMPHATIC PROCEDURE, DIAGNOSTIC NUCLEAR
                  MEDICINE
761..     78270  VITAMIN B-12 ABSORPTION STUDY (EG, SCHILLING TEST); WITHOUT INTRINSIC FACTOR
761..     78271  VITAMIN B-12 ABSORPTION STUDY (EG, SCHILLING TEST); WITH INTRINSIC FACTOR
761..     78272  VITAMIN B-12 ABSORPTION STUDIES COMBINED, WITH AND WITHOUT INTRINSIC FACTOR
761..     78282  GASTROINTESTINAL PROTEIN LOSS
761..     78299  UNLISTED GASTROINTESTINAL PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
761..     78725  KIDNEY FUNCTION STUDY WITHOUT PHARMACOLOGIC INTERVENTION
761..     78999  UNLISTED MISCELLANEOUS PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
762..  Complex Non-Imaging Nuclear     S                        1.78      $90.19          $51.53          $18.04
       Medicine
762..     78001  THYROID UPTAKE; MULTIPLE DETERMINATIONS
762..     78003  THYROID UPTAKE; STIMULATION, SUPPRESSION OR DISCHARGE (NOT INCLUDING INITIAL UPTAKE STUDIES)
762..     78121  RED CELL VOLUME DETERMINATION (SEPARATE PROCEDURE); MULTIPLE SAMPLINGS
762..     78122  WHOLE BLOOD VOLUME DETERMINATION, INCLUDING SEPARATE MEASUREMENT OF PLASMA VOLUME AND RED CELL
                  VOLUME (RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE)
762..     78130  RED CELL SURVIVAL STUDY;
762..     78135  RED CELL SURVIVAL STUDY; DIFFERENTIAL ORGAN/TISSUE KINETICS, (EG, SPLENIC AND/OR HEPATIC
                  SEQUESTRATION)
762..     78140  LABELED RED CELL SEQUESTRATION, DIFFERENTIAL ORGAN/TISSUE, (EG, SPLENIC AND/OR HEPATIC)
762..     78160  PLASMA RADIOIRON DISAPPEARANCE (TURNOVER) RATE
762..     78162  RADIOIRON ORAL ABSORPTION
762..     78170  RADIOIRON RED CELL UTILIZATION
762..     78172  CHELATABLE IRON FOR ESTIMATION OF TOTAL BODY IRON
762..     78190  KINETICS, STUDY OF PLATELET SURVIVAL, WITH OR WITHOUT DIFFERENTIAL ORGAN/TISSUE LOCALIZATION
762..     78191  PLATELET SURVIVAL STUDY
762..     78414  DETERMINATION OF CENTRAL C-V HEMODYNAMICS (NON-IMAGING) (EG, EJECTION FRACTION WITH PROBE
                  TECHNIQUE) WITH OR WITHOUT PHARMACOLOGIC INTERVENTION OR EXERCISE, SINGLE OR MULTIPLE
                  DETERMINATIONS
762..     78455  VENOUS THROMBOSIS STUDY (EG, RADIOACTIVE FIBRINOGEN)
762..     78499  UNLISTED CARDIOVASCULAR PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
771..  Standard Planar Nuclear         S                        3.78     $191.53         $116.84          $38.31
       Medicine
771..     78006  THYROID IMAGING, WITH UPTAKE; SINGLE DETERMINATION
771..     78010  THYROID IMAGING; ONLY
771..     78011  THYROID IMAGING; WITH VASCULAR FLOW
771..     78015  THYROID CARCINOMA METASTASES IMAGING; LIMITED AREA (EG, NECK AND CHEST ONLY)
771..     78102  BONE MARROW IMAGING; LIMITED AREA
771..     78103  BONE MARROW IMAGING; MULTIPLE AREAS
771..     78104  BONE MARROW IMAGING; WHOLE BODY
771..     78185  SPLEEN IMAGING ONLY, WITH OR WITHOUT VASCULAR FLOW
771..     78201  LIVER IMAGING; STATIC ONLY
771..     78202  LIVER IMAGING; WITH VASCULAR FLOW
771..     78215  LIVER AND SPLEEN IMAGING; STATIC ONLY
771..     78216  LIVER AND SPLEEN IMAGING; WITH VASCULAR FLOW
771..     78230  SALIVARY GLAND IMAGING;
771..     78231  SALIVARY GLAND IMAGING; WITH SERIAL IMAGES
771..     78261  GASTRIC MUCOSA IMAGING
771..     78290  BOWEL IMAGING (EG, ECTOPIC GASTRIC MUCOSA, MECKEL'S LOCALIZATION, VOLVULUS)
771..     78300  BONE AND/OR JOINT IMAGING; LIMITED AREA
771..     78305  BONE AND/OR JOINT IMAGING; MULTIPLE AREAS
771..     78306  BONE AND/OR JOINT IMAGING; WHOLE BODY

[[Page 47822]]

771..     78399  UNLISTED MUSCULOSKELETAL PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
771..     78428  CARDIAC SHUNT DETECTION
771..     78445  NON-CARDIAC VASCULAR FLOW IMAGING (IE, ANGIOGRAPHY, VENOGRAPHY)
771..     78457  VENOUS THROMBOSIS IMAGING (EG, VENOGRAM); UNILATERAL
771..     78458  VENOUS THROMBOSIS IMAGING (EG, VENOGRAM); BILATERAL
771..     78460  MYOCARDIAL PERFUSION IMAGING; (PLANAR) SINGLE STUDY, AT REST OR STRESS (EXERCISE AND/OR
                  PHARMACOLOGIC), WITH OR WITHOUT QUANTIFICATION
771..     78466  MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; QUALITATIVE OR QUANTITATIVE
771..     78478  MYOCARDIAL PERFUSION STUDY WITH WALL MOTION, QUALITATIVE OR QUANTITATIVE STUDY (LIST SEPARATELY
                  IN ADDITION TO CODE FOR PRIMARY PROCEDURE) (USE ONLY FOR CODES 78460, 78461, 78464, 78465)
771..     78480  MYOCARDIAL PERFUSION STUDY WITH EJECTION FRACTION (LIST SEPARATELY IN ADDITION TO CODE FOR
                  PRIMARY PROCEDURE) (USE ONLY FOR CODES 78460, 78461, 78464, 78465)
771..     78481  CARDIAC BLOOD POOL IMAGING, (PLANAR), FIRST PASS TECHNIQUE; SINGLE STUDY, AT REST OR WITH
                  STRESS (EXERCISE AND/OR PHARMACOLOGIC), WALL MOTION STUDY PLUS EJECTION FRACTION, WITH OR
                  WITHOUT QUANTIFICATION
771..     78580  PULMONARY PERFUSION IMAGING, PARTICULATE
771..     78586  PULMONARY VENTILATION IMAGING, AEROSOL; SINGLE PROJECTION
771..     78587  PULMONARY VENTILATION IMAGING, AEROSOL; MULTIPLE PROJECTIONS (EG, ANTERIOR, POSTERIOR, LATERAL
                  VIEWS)
771..     78591  PULMONARY VENTILATION IMAGING, GASEOUS, SINGLE BREATH, SINGLE PROJECTION
771..     78593  PULMONARY VENTILATION IMAGING, GASEOUS, WITH REBREATHING AND WASHOUT WITH OR WITHOUT SINGLE
                  BREATH; SINGLE PROJECTION
771..     78599  UNLISTED RESPIRATORY PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
771..     78600  BRAIN IMAGING, LIMITED PROCEDURE; STATIC
771..     78601  BRAIN IMAGING, LIMITED PROCEDURE; WITH VASCULAR FLOW
771..     78605  BRAIN IMAGING, COMPLETE STUDY; STATIC
771..     78610  BRAIN IMAGING, VASCULAR FLOW ONLY
771..     78660  RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY
771..     78699  UNLISTED NERVOUS SYSTEM PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
771..     78700  KIDNEY IMAGING; STATIC ONLY
771..     78701  KIDNEY IMAGING; WITH VASCULAR FLOW
771..     78704  KIDNEY IMAGING; WITH FUNCTION STUDY (IE, IMAGING RENOGRAM)
771..     78707  KIDNEY IMAGING WITH VASCULAR FLOW AND FUNCTION; SINGLE STUDY WITHOUT PHARMACOLOGICAL
                  INTERVENTION
771..     78715  KIDNEY VASCULAR FLOW ONLY
771..     78730  URINARY BLADDER RESIDUAL STUDY
771..     78760  TESTICULAR IMAGING;
771..     78761  TESTICULAR IMAGING; WITH VASCULAR FLOW
771..     78799  UNLISTED GENITOURINARY PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE
772..  Complex Planar Nuclear          S                        4.22     $213.83         $127.92          $42.77
       Medicine
772..     78007  THYROID IMAGING, WITH UPTAKE; MULTIPLE DETERMINATIONS
772..     78016  THYROID CARCINOMA METASTASES IMAGING; WITH ADDITIONAL STUDIES (EG, URINARY RECOVERY)
772..     78017  THYROID CARCINOMA METASTASES IMAGING; MULTIPLE AREAS
772..     78018  THYROID CARCINOMA METASTASES IMAGING; WHOLE BODY
772..     78070  PARATHYROID IMAGING
772..     78075  ADRENAL IMAGING, CORTEX AND/OR MEDULLA
772..     78195  LYMPHATICS AND LYMPH GLANDS IMAGING
772..     78220  LIVER FUNCTION STUDY WITH HEPATOBILIARY AGENTS, WITH SERIAL IMAGES
772..     78223  HEPATOBILIARY DUCTAL SYSTEM IMAGING, INCLUDING GALLBLADDER, WITH OR WITHOUT PHARMACOLOGIC
                  INTERVENTION, WITH OR WITHOUT QUANTITATIVE MEASUREMENT OF GALLBLADDER FUNCTION
772..     78232  SALIVARY GLAND FUNCTION STUDY
772..     78258  ESOPHAGEAL MOTILITY
772..     78262  GASTROESOPHAGEAL REFLUX STUDY
772..     78264  GASTRIC EMPTYING STUDY
772..     78278  ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
772..     78291  PERITONEAL-VENOUS SHUNT PATENCY TEST (EG, FOR LEVEEN, DENVER SHUNT)
772..     78315  BONE AND/OR JOINT IMAGING; THREE PHASE STUDY
772..     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
772..     78468  MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; WITH EJECTION FRACTION BY FIRST PASS TECHNIQUE
772..     78472  CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM; SINGLE STUDY AT REST OR STRESS (EXERCISE AND/OR
                  PHARMACOLOGIC), WALL MOTION STUDY PLUS EJECTION FRACTION, WITH OR WITHOUT ADDITIONAL
                  QUANTITATIVE PROCESSING
772..     78473  MULTIPLE STUDIES, WALL MOTION STUDY PLUS EJECTION FRACTION, AT REST AND STRESS (EXERCISE AND/OR
                  PHARMACOLOGIC), WITH OR WITHOUT ADDITIONAL QUANTIFICATION
772..     78483  CARDIAC BLOOD POOL IMAGING, (PLANAR), FIRST PASS TECHNIQUE; MULTIPLE STUDIES, AT REST AND WITH
                  STRESS (EXERCISE AND/OR PHARMACOLOGIC), WALL MOTION STUDY PLUS EJECTION FRACTION, WITH OR
                  WITHOUT QUANTIFICATION
772..     78584  PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION; SINGLE BREATH
772..     78585  PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION; REBREATHING AND WASHOUT, WITH OR
                  WITHOUT SINGLE BREATH
772..     78594  PULMONARY VENTILATION IMAGING, GASEOUS, WITH REBREATHING AND WASHOUT WITH OR WITHOUT SINGLE
                  BREATH; MULTIPLE PROJECTIONS (EG, ANTERIOR, POSTERIOR, LATERAL VIEWS)
772..     78596  PULMONARY QUANTITATIVE DIFFERENTIAL FUNCTION (VENTILATION/PERFUSION) STUDY
772..     78606  BRAIN IMAGING, COMPLETE STUDY; WITH VASCULAR FLOW
772..     78615  CEREBRAL BLOOD FLOW
772..     78630  CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); CISTERNOGRAPHY
772..     78635  CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); VENTRICULOGRAPHY
772..     78645  CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); SHUNT EVALUATION
772..     78650  CSF LEAKAGE DETECTION AND LOCALIZATION

[[Page 47823]]

772..     78708  KIDNEY IMAGING WITH VASCULAR FLOW AND FUNCTION; SINGLE STUDY, WITH PHARMACOLOGICAL INTERVENTION
                  (EG, ANGIOTENSIN CONVERTING ENZYME INHIBITOR AND/OR DIURETIC)
772..     78709  KIDNEY IMAGING WITH VASCULAR FLOW AND FUNCTION; MULTIPLE STUDIES, WITH AND WITHOUT
                  PHARMACOLOGICAL INTERVENTION (EG, ANGIOTENSIN CONVERTING ENZYME INHIBITOR AND/OR DIURETIC)
772..     78740  URETERAL REFLUX STUDY (RADIOPHARMACEUTICAL VOIDING CYSTOGRAM)
772..     78800  RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; LIMITED AREA
772..     78801  RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; MULTIPLE AREAS
772..     78802  RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; WHOLE BODY
772..     78805  RADIOPHARMACEUTICAL LOCALIZATION OF ABSCESS; LIMITED AREA
772..     78806  RADIOPHARMACEUTICAL LOCALIZATION OF ABSCESS; WHOLE BODY
781..  Standard SPECT Nuclear          S                        5.26     $266.52         $145.77          $53.30
       Medicine
781..     78205  LIVER IMAGING (SPECT)
781..     78320  BONE AND/OR JOINT IMAGING; TOMOGRAPHIC (SPECT)
781..     78464  MYOCARDIAL PERFUSION IMAGING; TOMOGRAPHIC (SPECT), SINGLE STUDY AT REST OR STRESS (EXERCISE AND/
                  OR PHARMACOLOGIC), WITH OR WITHOUT QUANTIFICATION
781..     78469  MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; TOMOGRAPHIC SPECT WITH OR WITHOUT QUANTIFICATION
781..     78607  BRAIN IMAGING, COMPLETE STUDY; TOMOGRAPHIC (SPECT)
781..     78647  CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); TOMOGRAPHIC (SPECT)
781..     78710  KIDNEY IMAGING, TOMOGRAPHIC (SPECT)
782..  Complex SPECT Nuclear Medicine  S                        9.28     $470.21         $275.04          $94.04
782..     78465  MYOCARDIAL PERFUSION IMAGING; TOMOGRAPHIC (SPECT), MULTIPLE STUDIES, AT REST AND/OR STRESS
                  (EXERCISE AND/OR PHARMACOLOGIC) AND REDISTRIBUTION AND/OR REST INJECTION, WITH OR WITHOUT
                  QUANTIFICATION
782..     78803  RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; TOMOGRAPHIC (SPECT)
782..     78807  RADIOPHARMACEUTICAL LOCALIZATION OF ABSCESS; TOMOGRAPHIC (SPECT)
791..  Standard Therapeutic Nuclear    S                       15.83     $802.10         $562.06         $160.42
       Medicine
791..     79001  RADIOPHARMACEUTICAL THERAPY, HYPERTHYROIDISM; SUBSEQUENT, EACH THERAPY
791..     79100  RADIOPHARMACEUTICAL THERAPY, POLYCYTHEMIA VERA, CHRONIC LEUKEMIA, EACH TREATMENT
791..     79300  INTERSTITIAL RADIOACTIVE COLLOID THERAPY
791..     79400  RADIOPHARMACEUTICAL THERAPY, NONTHYROID, NONHEMATOLOGIC
791..     79420  INTRAVASCULAR RADIOPHARMACEUTICAL THERAPY, PARTICULATE
791..     79440  INTRA-ARTICULAR RADIOPHARMACEUTICAL THERAPY
791..     79999  UNLISTED RADIOPHARMACEUTICAL THERAPEUTIC PROCEDURE
792..  Complex Therapeutic Nuclear     S                        4.80     $243.21         $144.19          $48.64
       Medicine
792..     79000  RADIOPHARMACEUTICAL THERAPY, HYPERTHYROIDISM; INITIAL, INCLUDING EVALUATION OF PATIENT
792..     79020  RADIOPHARMACEUTICAL THERAPY, THYROID SUPPRESSION (EUTHYROID CARDIAC DISEASE), INCLUDING
                  EVALUATION OF PATIENT
792..     79030  RADIOPHARMACEUTICAL ABLATION OF GLAND FOR THYROID CARCINOMA
792..     79035  RADIOPHARMACEUTICAL THERAPY FOR METASTASES OF THYROID CARCINOMA
792..     79200  INTRACAVITARY RADIOACTIVE COLLOID THERAPY
861..  Immunology Tests                X                        0.13       $6.59           $3.62           $1.32
861..     86485  SKIN TEST; CANDIDA
861..     86490  SKIN TEST; COCCIDIOIDOMYCOSIS
861..     86510  SKIN TEST; HISTOPLASMOSIS
861..     86580  SKIN TEST; TUBERCULOSIS, INTRADERMAL
861..     86585  SKIN TEST; TUBERCULOSIS, TINE TEST
861..     86586  SKIN TEST; UNLISTED ANTIGEN, EACH
881..  Level I Pathology               X                        0.20      $10.13           $6.78           $2.03
881..     88125  CYTOPATHOLOGY, FORENSIC (EG, SPERM)
881..     88199  UNLISTED CYTOPATHOLOGY PROCEDURE
881..     88300  LEVEL I - SURGICAL PATHOLOGY, GROSS EXAMINATION ONLY
881..     88311  DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY
                  EXAMINATION)
881..     88313  SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION); GROUP
                  II, ALL OTHER, (EG, IRON, TRICHROME), EXCEPT IMMUNOCYTOCHEMISTRY AND IMMUNOPEROXIDASE STAINS,
                  EACH
881..     88399  UNLISTED SURGICAL PATHOLOGY PROCEDURE
881..     89350  SPUTUM, OBTAINING SPECIMEN, AEROSOL INDUCED TECHNIQUE (SEPARATE PROCEDURE)
881..     89360  SWEAT COLLECTION BY IONTOPHORESIS
881..     89399  UNLISTED MISCELLANEOUS PATHOLOGY TEST
881..     G0025  Collagen skin test kit
882..  Level II Pathology              X                        0.39      $19.76          $11.75           $3.95
882..     80500  CLINICAL PATHOLOGY CONSULTATION; LIMITED, WITHOUT REVIEW OF PATIENT'S HISTORY AND MEDICAL
                  RECORDS
882..     80502  CLINICAL PATHOLOGY CONSULTATION; COMPREHENSIVE, FOR A COMPLEX DIAGNOSTIC PROBLEM, WITH REVIEW
                  OF PATIENT'S HISTORY AND MEDICAL RECORDS
882..     85060  BLOOD SMEAR, PERIPHERAL, INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT
882..     85097  BONE MARROW; SMEAR INTERPRETATION ONLY, WITH OR WITHOUT DIFFERENTIAL CELL COUNT
882..     86077  BLOOD BANK PHYSICIAN SERVICES; DIFFICULT CROSS MATCH AND/OR EVALUATION OF IRREGULAR
                  ANTIBODY(S), INTERPRETATION AND WRITTEN REPORT
882..     86078  BLOOD BANK PHYSICIAN SERVICES; INVESTIGATION OF TRANSFUSION REACTION INCLUDING SUSPICION OF
                  TRANSMISSIBLE DISEASE, INTERPRETATION AND WRITTEN REPORT
882..     86079  BLOOD BANK PHYSICIAN SERVICES; AUTHORIZATION FOR DEVIATION FROM STANDARD BLOOD BANKING
                  PROCEDURES (EG, USE OF OUTDATED BLOOD, TRANSFUSION OF RH INCOMPATIBLE UNITS), WITH WRITTEN
                  REPORT
882..     88104  CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SMEARS WITH
                  INTERPRETATION

[[Page 47824]]

882..     88106  CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; FILTER METHOD ONLY
                  WITH INTERPRETATION
882..     88107  CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SMEARS AND FILTER
                  PREPARATION WITH INTERPRETATION
882..     88108  CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND INTERPRETATION (EG, SACCOMANNO TECHNIQUE)
882..     88160  CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; SCREENING AND INTERPRETATION
882..     88161  CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; PREPARATION, SCREENING AND INTERPRETATION
882..     88162  CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; EXTENDED STUDY INVOLVING OVER 5 SLIDES AND/OR MULTIPLE
                  STAINS
882..     88172  EVALUATION OF FINE NEEDLE ASPIRATE WITH OR WITHOUT PREPARATION OF SMEARS; IMMEDIATE
                  CYTOHISTOLOGIC STUDY TO DETERMINE ADEQUACY OF SPECIMEN(S)
882..     88173  EVALUATION OF FINE NEEDLE ASPIRATE WITH OR WITHOUT PREPARATION OF SMEARS; INTERPRETATION AND
                  REPORT
882..     88180  FLOW CYTOMETRY; EACH CELL SURFACE MARKER
882..     88182  FLOW CYTOMETRY; CELL CYCLE OR DNA ANALYSIS
882..     88302  LEVEL II - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
882..     88304  LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
882..     88305  LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
882..     88312  SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION); GROUP
                  I FOR MICROORGANISMS (EG, GRIDLEY, ACID FAST, METHENAMINE SILVER), EACH
882..     88314  SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION);
                  HISTOCHEMICAL STAINING WITH FROZEN SECTION(S)
882..     88318  DETERMINATIVE HISTOCHEMISTRY TO IDENTIFY CHEMICAL COMPONENTS (EG, COPPER, ZINC)
882..     88319  DETERMINATIVE HISTOCHEMISTRY OR CYTOCHEMISTRY TO IDENTIFY ENZYME CONSTITUENTS, EACH
882..     88321  CONSULTATION AND REPORT ON REFERRED SLIDES PREPARED ELSEWHERE
882..     88323  CONSULTATION AND REPORT ON REFERRED MATERIAL REQUIRING PREPARATION OF SLIDES
882..     88325  CONSULTATION, COMPREHENSIVE, WITH REVIEW OF RECORDS AND SPECIMENS, WITH REPORT ON REFERRED
                  MATERIAL
882..     88329  PATHOLOGY CONSULTATION DURING SURGERY;
882..     88331  PATHOLOGY CONSULTATION DURING SURGERY; WITH FROZEN SECTION(S), SINGLE SPECIMEN
882..     88332  PATHOLOGY CONSULTATION DURING SURGERY; EACH ADDITIONAL TISSUE BLOCK WITH FROZEN SECTION(S)
882..     88342  IMMUNOCYTOCHEMISTRY (INCLUDING TISSUE IMMUNOPEROXIDASE), EACH ANTIBODY
882..     88346  IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; DIRECT METHOD
882..     88347  IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; INDIRECT METHOD
883..  Level III Pathology             X                        0.65      $32.94          $20.34           $6.59
883..     88307  LEVEL V - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
883..     88309  LEVEL VI - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION
883..     88348  ELECTRON MICROSCOPY; DIAGNOSTIC
883..     88349  ELECTRON MICROSCOPY; SCANNING
883..     88355  MORPHOMETRIC ANALYSIS; SKELETAL MUSCLE
883..     88356  MORPHOMETRIC ANALYSIS; NERVE
883..     88358  MORPHOMETRIC ANALYSIS; TUMOR
883..     88362  NERVE TEASING PREPARATIONS
883..     88365  TISSUE IN SITU HYBRIDIZATION, INTERPRETATION AND REPORT
900..  Critical Care                   V                        7.44     $376.98         $144.87          $75.40
900..     99291  CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE UNSTABLE CRITICALLY ILL OR UNSTABLE CRITICALLY
                  INJURED PATIENT, REQUIRING THE CONSTANT ATTENDANCE OF THE PHYSICIAN; FIRST HOUR
901..  Level I Immunization            X                        0.07       $3.55           $2.49           $0.71
901..     90700  IMMUNIZATION, ACTIVE; DIPHTHERIA, TETANUS TOXOIDS, AND ACELLULAR PERTUSSIS VACCINE (DTAP)
901..     90701  IMMUNIZATION, ACTIVE; DIPHTHERIA AND TETANUS TOXOIDS AND PERTUSSIS VACCINE (DTP)
901..     90702  IMMUNIZATION, ACTIVE; DIPHTHERIA AND TETANUS TOXOIDS (DT)
901..     90703  IMMUNIZATION, ACTIVE; TETANUS TOXOID
901..     90704  IMMUNIZATION, ACTIVE; MUMPS VIRUS VACCINE, LIVE
901..     90705  IMMUNIZATION, ACTIVE; MEASLES VIRUS VACCINE, LIVE, ATTENUATED
901..     90706  IMMUNIZATION, ACTIVE; RUBELLA VIRUS VACCINE, LIVE
901..     90708  IMMUNIZATION, ACTIVE; MEASLES AND RUBELLA VIRUS VACCINE, LIVE
901..     90709  IMMUNIZATION, ACTIVE; RUBELLA AND MUMPS VIRUS VACCINE, LIVE
901..     90710  IMMUNIZATION, ACTIVE; MEASLES, MUMPS, RUBELLA, AND VARICELLA VACCINE
901..     90711  IMMUNIZATION, ACTIVE; DIPHTHERIA, TETANUS TOXOIDS, AND PERTUSSIS (DTP) AND INJECTABLE
                  POLIOMYELITIS VACCINE
901..     90714  IMMUNIZATION, ACTIVE; TYPHOID VACCINE
901..     90718  IMMUNIZATION, ACTIVE; TETANUS AND DIPHTHERIA TOXOIDS ABSORBED, FOR ADULT USE (TD)
901..     90719  IMMUNIZATION, ACTIVE; DIPHTHERIA TOXOID
901..     90724  IMMUNIZATION, ACTIVE; INFLUENZA VIRUS VACCINE
901..     90725  IMMUNIZATION, ACTIVE; CHOLERA VACCINE
901..     90730  IMMUNIZATION, ACTIVE; HEPATITIS A VACCINE
901..     90732  IMMUNIZATION, ACTIVE; PNEUMOCOCCAL VACCINE, POLYVALENT
901..     90748  IMMUNIZATION, ACTIVE, HEPATITIS B AND HEMOPHILUS INFLUENZA B (HIB) VACCINE
901..     90749  UNLISTED IMMUNIZATION PROCEDURE
901..     95149  PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY
                  (SPECIFY NUMBER OF DOSES); FIVE SINGLE STINGING INSECT VENOMS
901..     95170  PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY;
                  WHOLE BODY EXTRACT OF BITING INSECT OR OTHER ARTHROPOD (SPECIFY NUMBER OF DOSES)
901..     G0008  INFLUENZA VACCINE
901..     G0009  PNEUMOCOCCAL VACCINE
901..     Q0034  INFLUENZA VACCINE
902..  Level II Immunization           X                        1.78      $90.19          $41.47          $18.04

[[Page 47825]]

902..     90707  IMMUNIZATION, ACTIVE; MEASLES, MUMPS AND RUBELLA VIRUS VACCINE, LIVE
902..     90712  IMMUNIZATION, ACTIVE; POLIOVIRUS VACCINE, LIVE, ORAL (ANY TYPE(S))
902..     90713  IMMUNIZATION, ACTIVE; POLIOMYELITIS VACCINE
902..     90716  IMMUNIZATION, ACTIVE; VARICELLA (CHICKEN POX) VACCINE
902..     90717  IMMUNIZATION, ACTIVE; YELLOW FEVER VACCINE
902..     90720  IMMUNIZATION, ACTIVE; DIPHTHERIA, TETANUS TOXOIDS, AND PERTUSSIS (DTP) AND HEMOPHILUS INFLUENZA
                  B (HIB) VACCINE
902..     90733  IMMUNIZATION, ACTIVE; MENINGOCOCCAL POLYSACCHARIDE VACCINE (ANY GROUP(S))
902..     90737  IMMUNIZATION, ACTIVE; HEMOPHILUS INFLUENZA B
902..     90741  IMMUNIZATION, PASSIVE; IMMUNE SERUM GLOBULIN, HUMAN (ISG)
902..     90744  IMMUNIZATION, ACTIVE, HEPATITIS B VACCINE; NEWBORN TO 11 YEARS
902..     90745  IMMUNIZATION, ACTIVE, HEPATITIS B VACCINE; 11-19 YEARS
902..     90746  IMMUNIZATION, ACTIVE, HEPATITIS B VACCINE; 20 YEARS AND ABOVE
902..     90747  IMMUNIZATION, ACTIVE, HEPATITIS B VACCINE; DIALYSIS OR IMMUNOSUPPRESSED PATIENT, ANY AGE
902..     G0010  HEPATITIS B VACCINE
903..  Level III Immunization          X                        1.16      $58.78          $25.65          $11.76
903..     90721  IMMUNIZATION, ACTIVE; DIPHTHERIA, TETANUS TOXOIDS, AND ACELLULAR PERTUSSIS VACCINE (DTAP) AND
                  HEMOPHILUS INFLUENZA B (HIB) VACCINE
903..     90726  IMMUNIZATION, ACTIVE; RABIES VACCINE
903..     90727  IMMUNIZATION, ACTIVE; PLAGUE VACCINE
903..     90728  IMMUNIZATION, ACTIVE; BCG VACCINE
903..     90735  IMMUNIZATION, ACTIVE; ENCEPHALITIS VIRUS VACCINE
903..     90742  IMMUNIZATION, PASSIVE; SPECIFIC HYPERIMMUNE SERUM GLOBULIN (EG, HEPATITIS B, MEASLES,
                  PERTUSSIS, RABIES, RHO(D), TETANUS, VACCINIA, VARICELLA-ZOSTER)
906..  Infusion Therapy except         X                        1.46      $73.98          $42.49          $14.80
       Chemotherapy
906..     36680  PLACEMENT OF NEEDLE FOR INTRAOSSEOUS INFUSION
906..     90780  IV INFUSION FOR THERAPY/DIAGNOSIS, ADMINISTERED BY PHYSICIAN OR UNDER DIRECT SUPERVISION OF
                  PHYSICIAN; UP TO ONE HOUR
906..     90781  IV INFUSION FOR THERAPY/DIAGNOSIS, ADMINISTERED BY PHYSICIAN OR UNDER DIRECT SUPERVISION OF
                  PHYSICIAN; EACH ADDITIONAL HOUR, UP TO EIGHT (8) HOURS
906..     Q0081  INFUSION THERAPY
907..  Intramuscular Injections        X                        0.85      $43.07          $11.98           $8.61
907..     90782  THERAPEUTIC OR DIAGNOSTIC INJECTION (SPECIFY MATERIAL INJECTED); SUBCUTANEOUS OR INTRAMUSCULAR
907..     90783  THERAPEUTIC OR DIAGNOSTIC INJECTION (SPECIFY MATERIAL INJECTED); INTRA-ARTERIAL
907..     90784  THERAPEUTIC OR DIAGNOSTIC INJECTION (SPECIFY MATERIAL INJECTED); INTRAVENOUS
907..     90788  INTRAMUSCULAR INJECTION OF ANTIBIOTIC (SPECIFY)
907..     90799  UNLISTED THERAPEUTIC OR DIAGNOSTIC INJECTION
919..  Electroconvulsive Therapy       S                        3.17     $160.62          $80.00          $32.12
919..     90870  ELECTROCONVULSIVE THERAPY (INCLUDES NECESSARY MONITORING); SINGLE SEIZURE
919..     90871  ELECTROCONVULSIVE THERAPY (INCLUDES NECESSARY MONITORING); MULTIPLE SEIZURES, PER DAY
920..  Biofeedback and other Training  S                        1.17      $59.28          $29.61          $11.86
920..     90901  BIOFEEDBACK TRAINING BY ANY MODALITY
920..     90911  BIOFEEDBACK TRAINING, PERINEAL MUSCLES, ANORECTAL OR URETHRAL SPHINCTER, INCLUDING EMG AND/OR
                  MANOMETRY
921..  Diabetes Education              S
921..     99078  PHYSICIAN EDUCATIONAL SERVICES RENDERED TO PATIENTS IN A GROUP SETTING (EG, PRENATAL, OBESITY,
                  OR DIABETIC INSTRUCTIONS)
926..  Dialysis for other than ESRD    S                        4.28     $216.87          $69.83          $43.37
       patients
926..     90935  HEMODIALYSIS PROCEDURE WITH SINGLE PHYSICIAN EVALUATION
926..     90937  HEMODIALYSIS PROCEDURE REQUIRING REPEATED EVALUATION(S) WITH OR WITHOUT SUBSTANTIAL REVISION OF
                  DIALYSIS PRESCRIPTION
926..     90945  DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL, HEMOFILTRATION), WITH SINGLE
                  PHYSICIAN EVALUATION
926..     90947  DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL, HEMOFILTRATION) REQUIRING REPEATED
                  EVALUATIONS, WITH OR WITHOUT SUBSTANTIAL REVISION OF DIALYSIS PRESCRIPTION
926..     90997  HEMOPERFUSION (EG, WITH ACTIVATED CHARCOAL OR RESIN)
926..     90999  UNLISTED DIALYSIS PROCEDURE, INPATIENT OR OUTPATIENT
928..  Alimentary Tests                X                        3.11     $157.58          $83.85          $31.52
928..     89100  DUODENAL INTUBATION AND ASPIRATION; SINGLE SPECIMEN (EG, SIMPLE BILE STUDY OR AFFERENT LOOP
                  CULTURE) PLUS APPROPRIATE TEST PROCEDURE
928..     89105  DUODENAL INTUBATION AND ASPIRATION; COLLECTION OF MULTIPLE FRACTIONAL SPECIMENS WITH PANCREATIC
                  OR GALLBLADDER STIMULATION, SINGLE OR DOUBLE LUMEN TUBE
928..     89130  GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC, EACH SPECIMEN, FOR CHEMICAL ANALYSES OR
                  CYTOPATHOLOGY;
928..     89132  GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC, EACH SPECIMEN, AFTER STIMULATION
928..     89135  GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC SECRETORY STUDY); ONE
                  HOUR
928..     89136  GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC SECRETORY STUDY); TWO
                  HOURS
928..     89140  GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC SECRETORY STUDY); TWO
                  HOURS INCLUDING GASTRIC STIMULATION (EG, HISTALOG, PENTAGASTRIN)
928..     89141  GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC SECRETORY STUDY); THREE
                  HOURS, INCLUDING GASTRIC STIMULATION
928..     91000  ESOPHAGEAL INTUBATION AND COLLECTION OF WASHINGS FOR CYTOLOGY, INCLUDING PREPARATION OF
                  SPECIMENS (SEPARATE PROCEDURE)
928..     91010  ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/OR GASTROESOPHAGEAL JUNCTION) STUDY;

[[Page 47826]]

928..     91011  ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/OR GASTROESOPHAGEAL JUNCTION) STUDY;
                  WITH MECHOLYL OR SIMILAR STIMULANT
928..     91012  ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/OR GASTROESOPHAGEAL JUNCTION) STUDY;
                  WITH ACID PERFUSION STUDIES
928..     91020  GASTRIC MOTILITY (MANOMETRIC) STUDIES
928..     91030  ESOPHAGUS, ACID PERFUSION (BERNSTEIN) TEST FOR ESOPHAGITIS
928..     91032  ESOPHAGUS, ACID REFLUX TEST, WITH INTRALUMINAL PH ELECTRODE FOR DETECTION OF GASTROESOPHAGEAL
                  REFLUX;
928..     91033  ESOPHAGUS, ACID REFLUX TEST, WITH INTRALUMINAL PH ELECTRODE FOR DETECTION OF GASTROESOPHAGEAL
                  REFLUX; PROLONGED RECORDING
928..     91052  GASTRIC ANALYSIS TEST WITH INJECTION OF STIMULANT OF GASTRIC SECRETION (EG, HISTAMINE, INSULIN,
                  PENTAGASTRIN, CALCIUM AND SECRETIN)
928..     91055  GASTRIC INTUBATION, WASHINGS, AND PREPARING SLIDES FOR CYTOLOGY (SEPARATE PROCEDURE)
928..     91060  GASTRIC SALINE LOAD TEST
928..     91065  BREATH HYDROGEN TEST (EG, FOR DETECTION OF LACTASE DEFICIENCY)
928..     91100  INTESTINAL BLEEDING TUBE, PASSAGE, POSITIONING AND MONITORING
928..     91105  GASTRIC INTUBATION, AND ASPIRATION OR LAVAGE FOR TREATMENT (EG, FOR INGESTED POISONS)
928..     91299  UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE
928..     95075  INGESTION CHALLENGE TEST (SEQUENTIAL AND INCREMENTAL INGESTION OF TEST ITEMS, EG, FOOD, DRUG OR
                  OTHER SUBSTANCE SUCH AS METABISULFITE)
930..  Minor Eye Examinations          X                        1.02      $51.68          $22.83          $10.34
930..     92060  SENSORIMOTOR EXAMINATION WITH MULTIPLE MEASUREMENTS OF OCULAR DEVIATION (EG, RESTRICTIVE OR
                  PARETIC MUSCLE WITH DIPLOPIA) WITH INTERPRETATION AND REPORT (SEPARATE PROCEDURE)
930..     92065  ORTHOPTIC AND/OR PLEOPTIC TRAINING, WITH CONTINUING MEDICAL DIRECTION AND EVALUATION
930..     92081  VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND REPORT; LIMITED
                  EXAMINATION (EG, TANGENT SCREEN, AUTOPLOT, ARC PERIMETER, OR SINGLE STIMULUS LEVEL AUTOMATED
                  TEST, SUCH AS OCTOPUS 3 OR 7 EQUIVALENT)
930..     92082  VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND REPORT; INTERMEDIATE
                  EXAMINATION (EG, AT LEAST 2 ISOPTERS ON GOLDMANN PERIMETER, OR SEMIQUANTITATIVE, AUTOMATED
                  SUPRATHRESHOLD SCREENING PROGRAM, HUMPHREY SUPRATHRESHOLD AUTOMATIC
930..     92083  VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND REPORT; EXTENDED
                  EXAMINATION (EG, GOLDMANN VISUAL FIELDS WITH AT LEAST 3 ISOPTERS PLOTTED AND STATIC
                  DETERMINATION WITHIN THE CENTRAL 30!, OR QUANTITATIVE, AUTOMATED THRESHOLD PERI
930..     92140  PROVOCATIVE TESTS FOR GLAUCOMA, WITH INTERPRETATION AND REPORT, WITHOUT TONOGRAPHY
930..     92283  COLOR VISION EXAMINATION, EXTENDED, EG, ANOMALOSCOPE OR EQUIVALENT
930..     92284  DARK ADAPTATION EXAMINATION WITH INTERPRETATION AND REPORT
930..     92285  EXTERNAL OCULAR PHOTOGRAPHY WITH INTERPRETATION AND REPORT FOR DOCUMENTATION OF MEDICAL
                  PROGRESS (EG, CLOSE-UP PHOTOGRAPHY, SLIT LAMP PHOTOGRAPHY, GONIOPHOTOGRAPHY, STEREO-
                  PHOTOGRAPHY)
931..  Level I Eye Tests               X                        0.74       $37.5          $21.47           $7.50
931..     92120  TONOGRAPHY WITH INTERPRETATION AND REPORT, RECORDING INDENTATION TONOMETER METHOD OR PERILIMBAL
                  SUCTION METHOD
931..     92130  TONOGRAPHY WITH WATER PROVOCATION
931..     92230  FLUORESCEIN ANGIOSCOPY WITH INTERPRETATION AND REPORT
931..     92240  INDOCYANINE-GREEN ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) WITH INTERPRETATION AND REPORT
931..     92250  FUNDUS PHOTOGRAPHY WITH INTERPRETATION AND REPORT
931..     92499  UNLISTED OPHTHALMOLOGICAL SERVICE OR PROCEDURE
932..  Level II Eye Tests              X                        2.52     $127.69          $65.09          $25.54
932..     92235  FLUORESCEIN ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) WITH INTERPRETATION AND REPORT
932..     92265  NEEDLE OCULOELECTROMYOGRAPHY, ONE OR MORE EXTRAOCULAR MUSCLES, ONE OR BOTH EYES, WITH
                  INTERPRETATION AND REPORT
932..     92270  ELECTRO-OCULOGRAPHY WITH INTERPRETATION AND REPORT
932..     92286  SPECIAL ANTERIOR SEGMENT PHOTOGRAPHY WITH INTERPRETATION AND REPORT; WITH SPECULAR ENDOTHELIAL
                  MICROSCOPY AND CELL COUNT
932..     92287  SPECIAL ANTERIOR SEGMENT PHOTOGRAPHY WITH INTERPRETATION AND REPORT; WITH FLUORESCEIN
                  ANGIOGRAPHY
936..  Fitting of Vision Aids          X                        0.52      $26.35           $9.49           $5.27
936..     92311  PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT LENS, WITH
                  MEDICAL SUPERVISION OF ADAPTATION; CORNEAL LENS FOR APHAKIA, ONE EYE
936..     92312  PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT LENS, WITH
                  MEDICAL SUPERVISION OF ADAPTATION; CORNEAL LENS FOR APHAKIA, BOTH EYES
936..     92313  PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT LENS, WITH
                  MEDICAL SUPERVISION OF ADAPTATION; CORNEOSCLERAL LENS
936..     92315  PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH MEDICAL SUPERVISION
                  OF ADAPTATION AND DIRECTION OF FITTING BY INDEPENDENT TECHNICIAN; CORNEAL LENS FOR APHAKIA,
                  ONE EYE
936..     92316  PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH MEDICAL SUPERVISION
                  OF ADAPTATION AND DIRECTION OF FITTING BY INDEPENDENT TECHNICIAN; CORNEAL LENS FOR APHAKIA,
                  BOTH EYES
936..     92317  PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH MEDICAL SUPERVISION
                  OF ADAPTATION AND DIRECTION OF FITTING BY INDEPENDENT TECHNICIAN; CORNEOSCLERAL LENS
936..     92325  MODIFICATION OF CONTACT LENS (SEPARATE PROCEDURE), WITH MEDICAL SUPERVISION OF ADAPTATION
936..     92326  REPLACEMENT OF CONTACT LENS
936..     92330  PRESCRIPTION, FITTING, AND SUPPLY OF OCULAR PROSTHESIS (ARTIFICIAL EYE), WITH MEDICAL
                  SUPERVISION OF ADAPTATION
936..     92352  FITTING OF SPECTACLE PROSTHESIS FOR APHAKIA; MONOFOCAL
936..     92353  FITTING OF SPECTACLE PROSTHESIS FOR APHAKIA; MULTIFOCAL
936..     92354  FITTING OF SPECTACLE MOUNTED LOW VISION AID; SINGLE ELEMENT SYSTEM
936..     92355  FITTING OF SPECTACLE MOUNTED LOW VISION AID; TELESCOPIC OR OTHER COMPOUND LENS SYSTEM

[[Page 47827]]

936..     92358  PROSTHESIS SERVICE FOR APHAKIA, TEMPORARY (DISPOSABLE OR LOAN, INCLUDING MATERIALS)
936..     92371  REPAIR AND REFITTING SPECTACLES; SPECTACLE PROSTHESIS FOR APHAKIA
940..  Otorhinolaryngologic Function   X                        3.04     $154.04          $51.98          $30.81
       Tests
940..     92512  NASAL FUNCTION STUDIES (EG, RHINOMANOMETRY)
940..     92516  FACIAL NERVE FUNCTION STUDIES (EG, ELECTRONEURONOGRAPHY)
940..     92520  LARYNGEAL FUNCTION STUDIES
940..     92541  SPONTANEOUS NYSTAGMUS TEST, INCLUDING GAZE AND FIXATION NYSTAGMUS, WITH RECORDING
940..     92542  POSITIONAL NYSTAGMUS TEST, MINIMUM OF 4 POSITIONS, WITH RECORDING
940..     92543  CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, BITHERMAL STIMULATION CONSTITUTES FOUR
                  TESTS), WITH
940..     92544  OPTOKINETIC NYSTAGMUS TEST, BIDIRECTIONAL, FOVEAL OR PERIPHERAL STIMULATION, WITH RECORDING
940..     92545  OSCILLATING TRACKING TEST, WITH RECORDING
940..     92546  SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING
940..     92547  USE OF VERTICAL ELECTRODES IN ANY OR ALL OF ABOVE TESTS COUNTS AS ONE ADDITIONAL TEST
940..     92548  COMPUTERIZED DYNAMIC POSTUROGRAPHY
940..     92584  ELECTROCOCHLEOGRAPHY
940..     92587  EVOKED OTOACOUSTIC EMISSIONS; LIMITED (SINGLE STIMULUS LEVEL, EITHER TRANSIENT OR DISTORTION
                  PRODUCTS)
940..     92588  EVOKED OTOACOUSTIC EMISSIONS; COMPREHENSIVE OR DIAGNOSTIC EVALUATION (COMPARISON OF TRANSIENT
                  AND/OR DISTORTION PRODUCT OTOACOUSTIC EMISSIONS AT MULTIPLE LEVELS AND FREQUENCIES)
941..  Level I Audiometry              X                        0.74      $37.50          $13.56           $7.50
941..     92552  PURE TONE AUDIOMETRY (THRESHOLD); AIR ONLY
941..     92553  PURE TONE AUDIOMETRY (THRESHOLD); AIR AND BONE
941..     92555  SPEECH AUDIOMETRY THRESHOLD;
941..     92556  SPEECH AUDIOMETRY THRESHOLD; WITH SPEECH RECOGNITION
941..     92567  TYMPANOMETRY (IMPEDANCE TESTING)
941..     92599  UNLISTED OTORHINOLARYNGOLOGICAL SERVICE OR PROCEDURE
942..  Level II Audiometry             X                        1.48      $74.99          $22.15          $15.00
942..     92557  COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION AND SPEECH RECOGNITION (92553 AND 92556 COMBINED)
942..     92561  BEKESY AUDIOMETRY; DIAGNOSTIC
942..     92562  LOUDNESS BALANCE TEST, ALTERNATE BINAURAL OR MONAURAL
942..     92563  TONE DECAY TEST
942..     92564  SHORT INCREMENT SENSITIVITY INDEX (SISI)
942..     92565  STENGER TEST, PURE TONE
942..     92568  ACOUSTIC REFLEX TESTING
942..     92569  ACOUSTIC REFLEX DECAY TEST
942..     92571  FILTERED SPEECH TEST
942..     92572  STAGGERED SPONDAIC WORD TEST
942..     92573  LOMBARD TEST
942..     92575  SENSORINEURAL ACUITY LEVEL TEST
942..     92576  SYNTHETIC SENTENCE IDENTIFICATION TEST
942..     92577  STENGER TEST, SPEECH
942..     92579  VISUAL REINFORCEMENT AUDIOMETRY (VRA)
942..     92582  CONDITIONING PLAY AUDIOMETRY
942..     92583  SELECT PICTURE AUDIOMETRY
942..     92589  CENTRAL AUDITORY FUNCTION TEST(S) (SPECIFY)
942..     92596  EAR PROTECTOR ATTENUATION MEASUREMENTS
947..  Resuscitation and               S                        4.07     $206.22         $109.61          $41.24
       Cardioversion
947..     31500  INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE
947..     92950  CARDIOPULMONARY RESUSCITATION (EG, IN CARDIAC ARREST)
947..     92953  TEMPORARY TRANSCUTANEOUS PACING
947..     92960  CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF ARRHYTHMIA, EXTERNAL
947..     99440  NEWBORN RESUSCITATION: PROVISION OF POSITIVE PRESSURE VENTILATION AND/OR CHEST COMPRESSIONS IN
                  THE PRESENCE OF ACUTE INADEQUATE VENTILATION AND/OR CARDIAC OUTPUT
948..  Cardiac Rehabilitation          X                        0.81      $41.04          $16.95           $8.21
948..     93797  PHYSICIAN SERVICES FOR OUTPATIENT CARDIAC REHABILITATION; WITHOUT CONTINUOUS ECG MONITORING
                  (PER SESSION)
948..     93798  PHYSICIAN SERVICES FOR OUTPATIENT CARDIAC REHABILITATION; WITH CONTINUOUS ECG MONITORING (PER
                  SESSION)
949..  Cardiovascular Stress Test      X                        1.46      $73.98          $62.83          $14.80
949..     93017  CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINOUS
                  ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL STRESS; TRACING ONLY, WITHOUT
                  INTERPRETATION AND REPORT
949..     93024  ERGONOVINE PROVOCATION TEST
950..  Electrocardiogram (ECG)         X                        0.35      $17.73          $15.82           $3.55
950..     93005  ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; TRACING ONLY, WITHOUT INTERPRETATION AND
                  REPORT
950..     93041  RHYTHM ECG, ONE TO THREE LEADS; TRACING ONLY WITHOUT INTERPRETATION AND REPORT
950..     Q0035  CARDIOKYMOGRAPHY
956..  Continuous ECG and Blood        X                        1.11      $56.24          $55.82          $11.25
       Pressure Monitoring
956..     93012  TELEPHONIC TRANSMISSION OF POST-SYMPTOM ELECTROCARDIOGRAM RHYTHM STRIP(S), PER 30 DAY PERIOD OF
                  TIME; TRACING ONLY
956..     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

[[Page 47828]]

956..     93225  ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS ORIGINAL ECG WAVEFORM RECORDING AND
                  STORAGE, WITH VISUAL SUPERIMPOSITION SCANNING; RECORDING (INCLUDES HOOK-UP, RECORDING, AND
                  DISCONNECTION)
956..     93226  ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS ORIGINAL ECG WAVEFORM RECORDING AND
                  STORAGE, WITH VISUAL SUPERIMPOSITION SCANNING; SCANNING ANALYSIS WITH REPORT
956..     93230  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; INCLUDES RECORDING, MICROPROCESSOR-BASED ANALYSIS
956..     93231  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; RECORDING (INCLUDES HOOK-UP, RECORDING, AND DISCO
956..     93232  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; MICROPROCESSOR-BASED ANALYSIS WITH REPORT
956..     93235  ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS COMPUTERIZED MONITORING AND NON-
                  CONTINUOUS RECORDING, AND REAL-TIME DATA ANALYSIS UTILIZING A DEVICE CAPABLE OF PRODUCING
                  INTERMITTENT FULL-SIZED WAVEFORM TRACINGS, POSSIBLY PATIENT ACTIVATED; INC
956..     93236  ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS COMPUTERIZED MONITORING AND NON-
                  CONTINUOUS RECORDING, AND REAL-TIME DATA ANALYSIS UTILIZING A DEVICE CAPABLE OF PRODUCING
                  INTERMITTENT FULL-SIZED WAVEFORM TRACINGS, POSSIBLY PATIENT ACTIVATED; MON
956..     93268  PATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRESYMPTOM MEMORY LOOP, PER 30 DAY
                  PERIOD OF TIME; INCLUDES TRANSMISSION, PHYSICIAN REVIEW AND INTERPRETATION
956..     93270  PATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRESYMPTOM MEMORY LOOP, PER 30 DAY
                  PERIOD OF TIME; RECORDING (INCLUDES HOOK-UP, RECORDING, AND DISCONNECTION)
956..     93271  PATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRESYMPTOM MEMORY LOOP, PER 30 DAY
                  PERIOD OF TIME; MONITORING, RECEIPT OF TRANSMISSIONS, AND ANALYSIS
956..     93278  SIGNAL-AVERAGED ELECTROCARDIOGRAPHY (SAECG), WITH OR WITHOUT ECG
956..     G0004  ECG TRANSM PHYS REVIEW & INt
956..     G0005  ECG 24 HOUR RECORDING
956..     G0006  ECG TRANSMISSION & ANALYSIS
956..     G0015  POST SYMPTOM ECG TRACING
957..  Echocardiography                S                        2.83     $143.39         $117.07          $28.68
957..     76825  ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE DOCUMENTATION (2D), WITH
                  OR WITHOUT M-MODE RECORDING;
957..     76826  ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE DOCUMENTATION (2D), WITH
                  OR WITHOUT M-MODE RECORDING; FOLLOW-UP OR REPEAT STUDY
957..     76827  DOPPLER ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, PULSED WAVE AND/OR CONTINUOUS WAVE WITH
                  SPECTRAL DISPLAY; COMPLETE
957..     76828  DOPPLER ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, PULSED WAVE AND/OR CONTINUOUS WAVE WITH
                  SPECTRAL DISPLAY; FOLLOW-UP OR REPEAT STUDY
957..     93303  TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; COMPLETE
957..     93304  TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; FOLLOW-UP OR LIMITED STUDY
957..     93307  ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D) WITH OR WITHOUT M-MODE
                  RECORDING; COMPLETE
957..     93308  ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D) WITH OR WITHOUT M-MODE
                  RECORDING; FOLLOW-UP OR LIMITED STUDY
957..     93312  ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-
                  MODE RECORDING); INCLUDING PROBE PLACEMENT, IMAGE ACQUISITION, INTERPRETATION AND REPORT
957..     93313  ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-
                  MODE RECORDING); PLACEMENT OF TRANSESOPHAGEAL PROBE ONLY
957..     93315  TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; INCLUDING PROBE PLACEMENT,
                  IMAGE ACQUISITION, INTERPRETATION AND REPORT
957..     93316  TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; PLACEMENT OF TRANSESOPHAGEAL
                  PROBE ONLY
957..     93320  DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY (LIST
                  SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING 93303, 93304, 93307, 93308,
                  93312, 93314, 93315, 93317, 93350); COMPLETE
957..     93321  DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY (LIST
                  SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING 93303, 93304, 93307, 93308,
                  93312, 93314, 93315, 93317, 93350); FOLLOW-UP OR LIMITED STUDY
957..     93325  DOPPLER COLOR FLOW VELOCITY MAPPING (LIST SEPARATELY IN ADDITION TO CODE FOR ECHOCARDIOGRAPHY
                  76825, 76826, 76827, 76828, 93303, 93304, 93307, 93308, 93312, 93314, 93315, 93317, 93320,
                  93321, 93350)
957..     93350  ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), WITH OR WITHOUT M-
                  MODE RECORDING, DURING REST AND CARDIOVASCULAR STRESS TEST USING TREADMILL, BICYCLE EXERCISE
                  AND/OR PHARMACOLOGICALLY INDUCED STRESS, WITH INTERPRETATION AND REPOR
958..  Diagnostic Cardiac              T                       26.11   $1,322.98         $659.47         $264.60
       Catheterization
958..     93501  RIGHT HEART CATHETERIZATION
958..     93503  INSERTION AND PLACEMENT OF FLOW DIRECTED CATHETER (EG, SWAN-GANZ) FOR MONITORING PURPOSES
958..     93505  ENDOMYOCARDIAL BIOPSY
958..     93510  LEFT HEART CATHETERIZATION, RETROGRADE, FROM THE BRACHIAL ARTERY, AXILLARY ARTERY OR FEMORAL
                  ARTERY; PERCUTANEOUS
958..     93511  LEFT HEART CATHETERIZATION, RETROGRADE, FROM THE BRACHIAL ARTERY, AXILLARY ARTERY OR FEMORAL
                  ARTERY; BY CUTDOWN
958..     93514  LEFT HEART CATHETERIZATION BY LEFT VENTRICULAR PUNCTURE
958..     93524  COMBINED TRANSSEPTAL AND RETROGRADE LEFT HEART CATHETERIZATION
958..     93526  COMBINED RIGHT HEART CATHETERIZATION AND RETROGRADE LEFT HEART CATHETERIZATION

[[Page 47829]]

958..     93527  COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION THROUGH INTACT
                  SEPTUM (WITH OR WITHOUT RETROGRADE LEFT HEART CATHETERIZATION)
958..     93528  COMBINED RIGHT HEART CATHETERIZATION WITH LEFT VENTRICULAR PUNCTURE (WITH OR WITHOUT RETROGRADE
                  LEFT HEART CATHETERIZATION)
958..     93529  COMBINED RIGHT HEART CATHETERIZATION AND LEFT HEART CATHETERIZATION THROUGH EXISTING SEPTAL
                  OPENING (WITH OR WITHOUT RETROGRADE LEFT HEART CATHETERIZATION)
958..     93530  RIGHT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES
958..     93531  COMBINED RIGHT HEART CATHETERIZATION AND RETROGRADE LEFT HEART CATHETERIZATION, FOR CONGENITAL
                  CARDIAC ANOMALIES
958..     93532  COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION THROUGH INTACT
                  SEPTUM WITH OR WITHOUT RETROGRADE LEFT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES
958..     93533  COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION THROUGH
                  EXISTING SEPTAL OPENING, WITH OR WITHOUT RETROGRADE LEFT HEART CATHETERIZATION, FOR CONGENITAL
                  CARDIAC ANOMALIES
958..     93536  PERCUTANEOUS INSERTION OF INTRA-AORTIC BALLOON CATHETER
960..  Cardiac Electrophysiologic      S                        4.24     $214.84         $144.41          $42.97
       Tests/Procedures
960..     93600  BUNDLE OF HIS RECORDING
960..     93602  INTRA-ATRIAL RECORDING
960..     93603  RIGHT VENTRICULAR RECORDING
960..     93607  LEFT VENTRICULAR RECORDING
960..     93609  INTRAVENTRICULAR AND/OR INTRA-ATRIAL MAPPING OF TACHYCARDIA SITE(S) WITH CATHETER MANIPULATION
                  TO RECORD FROM MULTIPLE SITES TO IDENTIFY ORIGIN OF TACHYCARDIA
960..     93610  INTRA-ATRIAL PACING
960..     93612  INTRAVENTRICULAR PACING
960..     93615  ESOPHAGEAL RECORDING OF ATRIAL ELECTROGRAM WITH OR WITHOUT VENTRICULAR ELECTROGRAM(S);
960..     93616  ESOPHAGEAL RECORDING OF ATRIAL ELECTROGRAM WITH OR WITHOUT VENTRICULAR ELECTROGRAM(S); WITH
                  PACING
960..     93618  INDUCTION OF ARRHYTHMIA BY ELECTRICAL PACING
960..     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 INDUCTI
960..     93620  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; WITH INDUCTION OR ATTEMPTED INDUCTION
960..     93621  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; WITH LEFT ATRIAL RECORDINGS FROM CORON
960..     93622  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; WITH LEFT VENTRICULAR RECORDINGS, WITH
960..     93623  PROGRAMMED STIMULATION AND PACING AFTER INTRAVENOUS DRUG INFUSION (USE THIS CODE WITH 93620,
                  93621, 93622)
960..     93624  ELECTROPHYSIOLOGIC FOLLOW-UP STUDY WITH PACING AND RECORDING TO TEST EFFECTIVENESS OF THERAPY,
                  INCLUDING INDUCTION OR ATTEMPTED INDUCTION OF ARRHYTHMIA
960..     93631  INTRA-OPERATIVE EPICARDIAL AND ENDOCARDIAL PACING AND MAPPING TO LOCALIZE THE SITE OF
                  TACHYCARDIA OR ZONE OF SLOW CONDUCTION FOR SURGICAL CORRECTION
960..     93640  ELECTROPHYSIOLOGIC EVALUATION OF CARDIOVERTER-DEFIBRILLATOR LEADS (INCLUDES DEFIBRILLATION
                  THRESHOLD TESTING AND SENSING FUNCTION) AT TIME OF INITIAL IMPLANTATION OR REPLACEMENT;
960..     93641  ELECTROPHYSIOLOGIC EVALUATION OF CARDIOVERTER-DEFIBRILLATOR LEADS (INCLUDES DEFIBRILLATION
                  THRESHOLD TESTING AND SENSING FUNCTION) AT TIME OF INITIAL IMPLANTATION OR REPLACEMENT; WITH
                  TESTING OF CARDIOVERTER-DEFIBRILLATOR PULSE GENERATOR
960..     93642  ELECTROPHYSIOLOGIC EVALUATION OF 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 PAR
960..     93650  INTRACARDIAC CATHETER ABLATION OF ATRIOVENTRICULAR NODE FUNCTION, ATRIOVENTRICULAR CONDUCTION
                  FOR CREATION OF COMPLETE HEART BLOCK, WITH OR WITHOUT TEMPORARY PACEMAKER PLACEMENT
960..     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
960..     93652  INTRACARDIAC CATHETER ABLATION OF ARRHYTHMOGENIC FOCUS; FOR TREATMENT OF VENTRICULAR
                  TACHYCARDIA
960..     93660  EVALUATION OF CARDIOVASCULAR FUNCTION WITH TILT TABLE EVALUATION, WITH CONTINUOUS ECG
                  MONITORING AND INTERMITTENT BLOOD PRESSURE MONITORING, WITH OR WITHOUT PHARMACOLOGICAL
                  INTERVENTION
960..     93724  ELECTRONIC ANALYSIS OF ANTITACHYCARDIA PACEMAKER SYSTEM (INCLUDES ELECTROCARDIOGRAPHIC
                  RECORDING, PROGRAMMING OF DEVICE, INDUCTION AND TERMINATION OF TACHYCARDIA VIA IMPLANTED
                  PACEMAKER, AND INTERPRETATION OF RECORDINGS)
966..  Electronic Analysis of          X                        0.39      $19.76          $12.43           $3.95
       Pacemakers/other devices
966..     62367  ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL DRUG INFUSION
                  (INCLUDES EVALUATION OF RESERVOIR STATUS, ALARM STATUS, DRUG PRESCRIPTION STATUS); WITHOUT
                  REPROGRAMMING
966..     62368  ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL DRUG INFUSION
                  (INCLUDES EVALUATION OF RESERVOIR STATUS, ALARM STATUS, DRUG PRESCRIPTION STATUS); WITH
                  REPROGRAMMING
966..     63690  ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (MAY INCLUDE RATE,
                  PULSE AMPLITUDE AND DURATION, CONFIGURATION OF WAVE FORM, BATTERY STATUS, ELECTRODE
                  SELECTABILITY, OUTPUT MODULATION, CYCLING, IMPEDANCE AND PATIENT COMPLIANCE MEAS
966..     63691  ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (MAY INCLUDE RATE,
                  PULSE AMPLITUDE AND DURATION, CONFIGURATION OF WAVE FORM, BATTERY STATUS, ELECTRODE
                  SELECTABILITY, OUTPUT MODULATION, CYCLING, IMPEDANCE AND PATIENT COMPLIANCE MEAS

[[Page 47830]]

966..     93731  ELECTRONIC ANALYSIS OF DUAL-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
966..     93732  ELECTRONIC ANALYSIS OF DUAL-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
966..     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
966..     93734  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, ANALYSI
966..     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, ANALYSI
966..     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
966..     93737  ELECTRONIC ANALYSIS OF CARDIOVERTER/DEFIBRILLATOR ONLY (INTERROGATION, EVALUATION OF PULSE
                  GENERATOR STATUS); WITHOUT REPROGRAMMING
966..     93738  ELECTRONIC ANALYSIS OF CARDIOVERTER/DEFIBRILLATOR ONLY (INTERROGATION, EVALUATION OF PULSE
                  GENERATOR STATUS); WITH REPROGRAMMING
967..  Non-Invasive Vascular Studies   X                        1.70      $86.14          $57.40          $17.23
967..     93720  PLETHYSMOGRAPHY, TOTAL BODY; WITH INTERPRETATION AND REPORT
967..     93721  PLETHYSMOGRAPHY, TOTAL BODY; TRACING ONLY, WITHOUT INTERPRETATION AND REPORT
967..     93740  TEMPERATURE GRADIENT STUDIES
967..     93799  UNLISTED CARDIOVASCULAR SERVICE OR PROCEDURE
967..     93922  NON-INVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, SINGLE LEVEL, BILATERAL
                  (EG, ANKLE/BRACHIAL INDICES, DOPPLER WAVEFORM ANALYSIS, VOLUME PLETHYSMOGRAPHY, TRANSCUTANEOUS
                  OXYGEN TENSION MEASUREMENT)
967..     93923  NON-INVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, MULTIPLE LEVELS OR WITH
                  PROVOCATIVE FUNCTIONAL MANEUVERS, COMPLETE BILATERAL STUDY (EG, SEGMENTAL BLOOD PRESSURE
                  MEASUREMENTS, SEGMENTAL DOPPLER WAVEFORM ANALYSIS, SEGMENTAL VOLUME PLE
967..     93924  NON-INVASIVE PHYSIOLOGIC STUDIES OF LOWER EXTREMITY ARTERIES, AT REST AND FOLLOWING TREADMILL
                  STRESS TESTING, COMPLETE BILATERAL STUDY
967..     93965  NON-INVASIVE PHYSIOLOGIC STUDIES OF EXTREMITY VEINS, COMPLETE BILATERAL STUDY (EG, DOPPLER
                  WAVEFORM ANALYSIS WITH RESPONSES TO COMPRESSION AND OTHER MANEUVERS, PHLEBORHEOGRAPHY,
                  IMPEDANCE PLETHYSMOGRAPHY)
968..  Vascular Ultrasound             X                        2.37     $120.09          $79.55          $24.02
968..     93875  NON-INVASIVE PHYSIOLOGIC STUDIES OF EXTRACRANIAL ARTERIES, COMPLETE BILATERAL STUDY (EG,
                  PERIORBITAL FLOW DIRECTION WITH ARTERIAL COMPRESSION, OCULAR PNEUMOPLETHYSMOGRAPHY, DOPPLER
                  ULTRASOUND SPECTRAL ANALYSIS)
968..     93880  DUPLEX SCAN OF EXTRACRANIAL ARTERIES; COMPLETE BILATERAL STUDY
968..     93882  DUPLEX SCAN OF EXTRACRANIAL ARTERIES; UNILATERAL OR LIMITED STUDY
968..     93886  TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; COMPLETE STUDY
968..     93888  TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; LIMITED STUDY
968..     93925  DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE BILATERAL STUDY
968..     93926  DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY
968..     93930  DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE BILATERAL STUDY
968..     93931  DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY
968..     93970  DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; COMPLETE
                  BILATERAL STUDY
968..     93971  DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS;
                  UNILATERAL OR LIMITED STUDY
968..     93975  DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR
                  RETROPERITONEAL ORGANS; COMPLETE STUDY
968..     93976  DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR
                  RETROPERITONEAL ORGANS; LIMITED STUDY
968..     93978  DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS; COMPLETE STUDY
968..     93979  DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS; UNILATERAL OR
                  LIMITED STUDY
968..     93980  DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; COMPLETE STUDY
968..     93981  DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; FOLLOW-UP OR LIMITED STUDY
968..     93990  DUPLEX SCAN OF HEMODIALYSIS ACCESS (INCLUDING ARTERIAL INFLOW, BODY OF ACCESS AND VENOUS
                  OUTFLOW)
969..  Hyperbaric Oxygen               S                        2.65     $134.27         $141.70          $26.85
969..     99183  PHYSICIAN ATTENDANCE AND SUPERVISION OF HYPERBARIC OXYGEN THERAPY, PER SESSION
971..  Level I Pulmonary Tests         X                        0.78      $39.52          $21.47           $7.90
971..     94010  SPIROMETRY, INCLUDING GRAPHIC RECORD, TOTAL AND TIMED VITAL CAPACITY, EXPIRATORY FLOW RATE
                  MEASUREMENT(S), WITH OR WITHOUT MAXIMAL VOLUNTARY VENTILATION
971..     94060  BRONCHOSPASM EVALUATION: SPIROMETRY AS IN 94010, BEFORE AND AFTER BRONCHODILATOR (AEROSOL OR
                  PARENTERAL) OR EXERCISE
971..     94200  MAXIMUM BREATHING CAPACITY, MAXIMAL VOLUNTARY VENTILATION
971..     94250  EXPIRED GAS COLLECTION, QUANTITATIVE, SINGLE PROCEDURE (SEPARATE PROCEDURE)
971..     94260  THORACIC GAS VOLUME
971..     94360  DETERMINATION OF RESISTANCE TO AIRFLOW, OSCILLATORY OR PLETHYSMOGRAPHIC METHODS
971..     94375  RESPIRATORY FLOW VOLUME LOOP
971..     94400  BREATHING RESPONSE TO CO2 (CO2 RESPONSE CURVE)
971..     94450  BREATHING RESPONSE TO HYPOXIA (HYPOXIA RESPONSE CURVE)

[[Page 47831]]

971..     94762  NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; BY CONTINUOUS OVERNIGHT MONITORING
                  (SEPARATE PROCEDURE)
971..     94770  CARBON DIOXIDE, EXPIRED GAS DETERMINATION BY INFRARED ANALYZER
971..     94799  UNLISTED PULMONARY SERVICE OR PROCEDURE
972..  Level II Pulmonary Tests        X                        1.02      $51.68          $29.38          $10.34
972..     94240  FUNCTIONAL RESIDUAL CAPACITY OR RESIDUAL VOLUME: HELIUM METHOD, NITROGEN OPEN CIRCUIT METHOD,
                  OR OTHER METHOD
972..     94350  DETERMINATION OF MALDISTRIBUTION OF INSPIRED GAS: MULTIPLE BREATH NITROGEN WASHOUT CURVE
                  INCLUDING ALVEOLAR NITROGEN OR HELIUM EQUILIBRATION TIME
972..     94370  DETERMINATION OF AIRWAY CLOSING VOLUME, SINGLE BREATH TESTS
972..     94680  OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST AND EXERCISE, DIRECT, SIMPLE
972..     94681  OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; INCLUDING CO2 OUTPUT, PERCENTAGE OXYGEN EXTRACTED
972..     94690  OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST, INDIRECT (SEPARATE PROCEDURE)
972..     94720  CARBON MONOXIDE DIFFUSING CAPACITY, ANY METHOD
972..     94725  MEMBRANE DIFFUSION CAPACITY
973..  Level III Pulmonary Tests       S                        1.89      $95.77          $55.82          $19.15
973..     94070  PROLONGED POSTEXPOSURE EVALUATION OF BRONCHOSPASM WITH MULTIPLE SPIROMETRIC DETERMINATIONS
                  AFTER ANTIGEN, COLD AIR, METHACHOLINE OR OTHER CHEMICAL AGENT, WITH SPIROMETRY AS IN 94010
973..     94620  PULMONARY STRESS TESTING, SIMPLE OR COMPLEX
973..     94750  PULMONARY COMPLIANCE STUDY, ANY METHOD
973..     94772  CIRCADIAN RESPIRATORY PATTERN RECORDING (PEDIATRIC PNEUMOGRAM), 12 TO 24 HOUR CONTINUOUS
                  RECORDING, INFANT
973..     95070  INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING NECESSARY PULMONARY FUNCTION TESTS); WITH
                  HISTAMINE, METHACHOLINE, OR SIMILAR COMPOUNDS
973..     95071  INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING NECESSARY PULMONARY FUNCTION TESTS); WITH
                  ANTIGENS OR GASES, SPECIFY
976..  Pulmonary Therapy               S                        0.44      $22.29          $14.92           $4.46
976..     94640  NONPRESSURIZED INHALATION TREATMENT FOR ACUTE AIRWAY OBSTRUCTION
976..     94642  AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS CARINII PNEUMONIA TREATMENT OR PROPHYLAXIS
976..     94650  INTERMITTENT POSITIVE PRESSURE BREATHING (IPPB) TREATMENT, AIR OR OXYGEN, WITH OR WITHOUT
                  NEBULIZED MEDICATION; INITIAL DEMONSTRATION AND/OR EVALUATION
976..     94651  INTERMITTENT POSITIVE PRESSURE BREATHING (IPPB) TREATMENT, AIR OR OXYGEN, WITH OR WITHOUT
                  NEBULIZED MEDICATION; SUBSEQUENT
976..     94657  VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTILATORS FOR
                  ASSISTED OR CONTROLLED BREATHING; SUBSEQUENT DAYS
976..     94660  CONTINUOUS POSITIVE AIRWAY PRESSURE VENTILATION (CPAP), INITIATION AND MANAGEMENT
976..     94662  CONTINUOUS NEGATIVE PRESSURE VENTILATION (CNP), INITIATION AND MANAGEMENT
976..     94664  AEROSOL OR VAPOR INHALATIONS FOR SPUTUM MOBILIZATION, BRONCHODILATION, OR SPUTUM INDUCTION FOR
                  DIAGNOSTIC PURPOSES; INITIAL DEMONSTRATION AND/OR EVALUATION
976..     94665  AEROSOL OR VAPOR INHALATIONS FOR SPUTUM MOBILIZATION, BRONCHODILATION, OR SPUTUM INDUCTION FOR
                  DIAGNOSTIC PURPOSES; SUBSEQUENT
977..  Allergy Tests                   X                        0.63      $31.92          $12.66           $6.38
977..     95004  PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) WITH ALLERGENIC EXTRACTS, IMMEDIATE TYPE
                  REACTION, SPECIFY NUMBER OF TESTS
977..     95010  PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) SEQUENTIAL AND INCREMENTAL, WITH DRUGS,
                  BIOLOGICALS OR VENOMS, IMMEDIATE TYPE REACTION, SPECIFY NUMBER OF TESTS
977..     95015  INTRACUTANEOUS (INTRADERMAL) TESTS, SEQUENTIAL AND INCREMENTAL, WITH DRUGS, BIOLOGICALS, OR
                  VENOMS, IMMEDIATE TYPE REACTION, SPECIFY NUMBER OF TESTS
977..     95024  INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, IMMEDIATE TYPE REACTION, SPECIFY
                  NUMBER OF TESTS
977..     95027  SKIN END POINT TITRATION
977..     95028  INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, DELAYED TYPE REACTION, INCLUDING
                  READING, SPECIFY NUMBER OF TESTS
977..     95044  PATCH OR APPLICATION TEST(S) (SPECIFY NUMBER OF TESTS)
977..     95052  PHOTO PATCH TEST(S) (SPECIFY NUMBER OF TESTS)
977..     95056  PHOTO TESTS
977..     95060  OPHTHALMIC MUCOUS MEMBRANE TESTS
977..     95065  DIRECT NASAL MUCOUS MEMBRANE TEST
977..     95078  PROVOCATIVE TESTING (EG, RINKEL TEST)
977..     95180  RAPID DESENSITIZATION PROCEDURE, EACH HOUR (EG, INSULIN, PENICILLIN, HORSE SERUM)
977..     95199  UNLISTED ALLERGY/CLINICAL IMMUNOLOGIC SERVICE OR PROCEDURE
978..  Allergy Injections              X                        0.31      $15.71           $3.39           $3.14
978..     95115  PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC
                  EXTRACTS; SINGLE INJECTION
978..     95117  PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC
                  EXTRACTS; TWO OR MORE INJECTIONS
978..     95144  PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY,
                  SINGLE OR MULTIPLE ANTIGENS, SINGLE DOSE VIALS (SPECIFY NUMBER OF VIALS)
978..     95145  PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY
                  (SPECIFY NUMBER OF DOSES); SINGLE STINGING INSECT VENOM
978..     95146  PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY
                  (SPECIFY NUMBER OF DOSES); TWO SINGLE STINGING INSECT VENOMS
978..     95147  PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY
                  (SPECIFY NUMBER OF DOSES); THREE SINGLE STINGING INSECT VENOMS

[[Page 47832]]

978..     95148  PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY
                  (SPECIFY NUMBER OF DOSES); FOUR SINGLE STINGING INSECT VENOMS
978..     95165  PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY;
                  SINGLE OR MULTIPLE ANTIGENS (SPECIFY NUMBER OF DOSES)
979..  Extended EEG Studies and Sleep  S                       10.17     $515.31         $288.83         $103.06
       Studies
979..     95805  MULTIPLE SLEEP LATENCY OR MAINTENANCE OF WAKEFULNESS TESTING, RECORDING, ANALYSIS AND
                  INTERPRETATION OF PHYSIOLOGICAL MEASUREMENTS OF SLEEP DURING MULTIPLE TRIALS TO ASSESS
                  SLEEPINESS
979..     95806  SLEEP STUDY, SIMULTANEOUS RECORDING OF VENTILATION, RESPIRATORY EFFORT, ECG OR HEART RATE, AND
                  OXYGEN SATURATION, UNATTENDED BY A TECHNOLOGIST
979..     95807  SLEEP STUDY, SIMULTANEOUS RECORDING OF VENTILATION, RESPIRATORY EFFORT, ECG OR HEART RATE, AND
                  OXYGEN SATURATION, ATTENDED BY A TECHNOLOGIST
979..     95808  POLYSOMNOGRAPHY; SLEEP STAGING WITH 1-3 ADDITIONAL PARAMETERS OF SLEEP, ATTENDED BY A
                  TECHNOLOGIST
979..     95810  POLYSOMNOGRAPHY; OF SLEEP, ATTENDED BY A TECHNOLOGIST SLEEP STAGING WITH 4 OR MORE ADDITIONAL
                  PARAMETERS OF SLEEP, ATTENDED BY A TECHNOLOGIST
979..     95811  POLYSOMNOGRAPHY; OF SLEEP, ATTENDED BY A TECHNOLOGIST SLEEP STAGING WITH 4 OR MORE ADDITIONAL
                  PARAMETERS OF SLEEP, WITH INITIATION OF CONTINUOUS POSITIVE AIRWAY PRESSURE THERAPY OR BILEVEL
                  VENTILATION, ATTENDED BY A TECHNOLOGIST
979..     95812  ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; UP TO ONE HOUR
979..     95813  ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; GREATER THAN ONE HOUR
979..     95827  ELECTROENCEPHALOGRAM (EEG); ALL NIGHT SLEEP ONLY
979..     95951  MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY CABLE OR RADIO, 16 OR MORE CHANNEL
                  TELEMETRY, COMBINED ELECTROENCEPHALOGRAPHIC (EEG) AND VIDEO RECORDING AND INTERPRETATION (EG,
                  FOR PRESURGICAL LOCALIZATION), EACH 24 HOURS
979..     95953  MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY COMPUTERIZED PORTABLE 16 OR MORE
                  CHANNEL EEG, ELECTROENCEPHALOGRAPHIC (EEG) RECORDING AND INTERPRETATION, EACH 24 HOURS
979..     95954  PHARMACOLOGICAL OR PHYSICAL ACTIVATION REQUIRING PHYSICIAN ATTENDANCE DURING EEG RECORDING OF
                  ACTIVATION PHASE (EG, THIOPENTAL ACTIVATION TEST)
979..     95956  MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY CABLE OR RADIO, 16 OR MORE CHANNEL
                  TELEMETRY, ELECTROENCEPHALOGRAPHIC (EEG) RECORDING AND INTERPRETATION, EACH 24 HOURS
979..     95958  WADA ACTIVATION TEST FOR HEMISPHERIC FUNCTION, INCLUDING ELECTROENCEPHALOGRAPHIC (EEG)
                  MONITORING
980..  Electroencephalogram            S                        2.15     $108.94          $57.86          $21.79
980..     92275  ELECTRORETINOGRAPHY WITH INTERPRETATION AND REPORT
980..     95857  TENSILON TEST FOR MYASTHENIA GRAVIS;
980..     95867  NEEDLE ELECTROMYOGRAPHY, CRANIAL NERVE SUPPLIED MUSCLES, UNILATERAL
980..     95869  NEEDLE ELECTROMYOGRAPHY; THORACIC PARASPINAL MUSCLES
980..     95870  NEEDLE ELECTROMYOGRAPHY; OTHER THAN PARASPINAL (EG, ABDOMEN, THORAX)
980..     95900  NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE, ANY/ALL SITE(S) ALONG THE
                  NERVE; MOTOR, WITHOUT F-WAVE STUDY
980..     95921  TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; CARDIOVAGAL INNERVATION (PARASYMPATHETIC
                  FUNCTION), INCLUDING TWO OR MORE OF THE FOLLOWING: HEART RATE RESPONSE TO DEEP BREATHING WITH
                  RECORDED R-R INTERVAL, VALSALVA RATIO, AND 30:15 RATIO
980..     95922  TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; VASOMOTOR ADRENERGIC INNERVATION (SYMPATHETIC
                  ADRENERGIC FUNCTION), INCLUDING BEAT-TO-BEAT BLOOD PRESSURE AND R-R INTERVAL CHANGES DURING
                  VALSALVA MANEUVER AND AT LEAST FIVE MINUTES OF PASSIVE TILT
980..     95923  TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; SUDOMOTOR, INCLUDING ONE OR MORE OF THE
                  FOLLOWING: QUANTITATIVE SUDOMOTOR AXON REFLEX TEST (QSART), SILASTIC SWEAT IMPRINT,
                  THERMOREGULATORY SWEAT TEST, AND CHANGES IN SYMPATHETIC SKIN POTENTIAL
980..     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
980..     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
980..     95930  VISUAL EVOKED POTENTIAL (VEP) TESTING CENTRAL NERVOUS SYSTEM, CHECKERBOARD OR FLASH
980..     95933  ORBICULARIS OCULI (BLINK) REFLEX, BY ELECTRODIAGNOSTIC TESTING
980..     95934  H-REFLEX, AMPLITUDE AND LATENCY STUDY; RECORD GASTROCNEMIUS/SOLEUS MUSCLE
980..     95936  H-REFLEX, AMPLITUDE AND LATENCY STUDY; RECORD MUSCLE OTHER THAN GASTROCNEMIUS/SOLEUS MUSCLE
980..     95937  NEUROMUSCULAR JUNCTION TESTING (REPETITIVE STIMULATION, PAIRED STIMULI), EACH NERVE, ANY ONE
                  METHOD
980..     95950  MONITORING FOR IDENTIFICATION AND LATERALIZATION OF CEREBRAL SEIZURE FOCUS,
                  ELECTROENCEPHALOGRAPHIC (EG, 8 CHANNEL EEG) RECORDING AND INTERPRETATION, EACH 24 HOURS
981..  Level I Nerve and Muscle Tests  X                        1.46      $73.98          $41.81          $14.80
981..     92585  AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF THE CENTRAL NERVOUS
                  SYSTEM
981..     95858  TENSILON TEST FOR MYASTHENIA GRAVIS; WITH ELECTROMYOGRAPHIC RECORDING
981..     95860  NEEDLE ELECTROMYOGRAPHY, ONE EXTREMITY WITH OR WITHOUT RELATED PARASPINAL AREAS
981..     95861  NEEDLE ELECTROMYOGRAPHY, TWO EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS
981..     95863  NEEDLE ELECTROMYOGRAPHY, THREE EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS
981..     95864  NEEDLE ELECTROMYOGRAPHY, FOUR EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS
981..     95868  NEEDLE ELECTROMYOGRAPHY, CRANIAL NERVE SUPPLIED MUSCLES, BILATERAL
981..     95872  NEEDLE ELECTROMYOGRAPHY USING SINGLE FIBER ELECTRODE, WITH QUANTITATIVE MEASUREMENT OF JITTER,
                  BLOCKING AND/OR FIBER DENSITY, ANY/ALL SITES OF EACH MUSCLE STUDIED
981..     95875  ISCHEMIC LIMB EXERCISE WITH NEEDLE ELECTROMYOGRAPHY, WITH LACTIC ACID DETERMINATION
981..     95903  NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE, ANY/ALL SITE(S) ALONG THE
                  NERVE; MOTOR, WITH F-WAVE STUDY
981..     95904  NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE, ANY/ALL SITE(S) ALONG THE
                  NERVE; SENSORY
981..     95920  INTRAOPERATIVE NEUROPHYSIOLOGY TESTING, PER HOUR

[[Page 47833]]

981..     95925  SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIPHERAL NERVES OR
                  SKIN SITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM; IN UPPER LIMBS
982..  Level II Nerve and Muscle       X                        1.39      $70.43          $38.87          $14.09
       Tests
982..     92585  Auditory evoked potential
982..     95858  Tensilon test & myogram
982..     95860  Muscle test, one limb
982..     95861  Muscle test, two limbs
982..     95863  Muscle test, 3 limbs
982..     95864  Muscle test, 4 limbs
982..     95868  Muscle test, head or neck
982..     95872  Muscle test, one fiber
982..     95875  Limb exercise test
982..     95925  Somatosensory testing
987..  Subcutaneous or Intramuscular   S                         .65      $32.94          $13.33           $6.59
       Chemotherapy
987..     96400  CHEMOTHERAPY ADMINISTRATION, SUBCUTANEOUS OR INTRAMUSCULAR, WITH OR WITHOUT LOCAL ANESTHESIA
987..     96405  CHEMOTHERAPY ADMINISTRATION, INTRALESIONAL; UP TO AND INCLUDING 7 LESIONS
987..     96406  CHEMOTHERAPY ADMINISTRATION, INTRALESIONAL; MORE THAN 7 LESIONS
987..     96549  UNLISTED CHEMOTHERAPY PROCEDURE
987..     Q0083  Chemo other than infusion
988..  Chemotherapy except by          S                        4.15     $210.28          $97.52          $42.06
       Extended Infusion
988..     96408  CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS; PUSH TECHNIQUE
988..     96410  CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS; INFUSION TECHNIQUE, UP TO ONE HOUR
988..     96412  CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS; INFUSION TECHNIQUE, ONE TO 8 HOURS, EACH ADDITIONAL
                  HOUR
988..     96420  CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; PUSH TECHNIQUE
988..     96422  CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUSION TECHNIQUE, UP TO ONE HOUR
988..     96423  CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUSION TECHNIQUE, ONE TO 8 HOURS, EACH
                  ADDITIONAL HOUR
989..  Chemotherapy by Extended        S                        1.72      $87.15          $40.68          $17.43
       Infusion
989..     96414  CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS; INFUSION TECHNIQUE, INITIATION OF PROLONGED INFUSION
                  (MORE THAN 8 HOURS), REQUIRING THE USE OF A PORTABLE OR IMPLANTABLE PUMP
989..     96425  CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUSION TECHNIQUE, INITIATION OF PROLONGED
                  INFUSION (MORE THAN 8 HOURS), REQUIRING THE USE OF A PORTABLE OR IMPLANTABLE PUMP
989..     96440  CHEMOTHERAPY ADMINISTRATION INTO PLEURAL CAVITY, REQUIRING AND INCLUDING THORACENTESIS
989..     96445  CHEMOTHERAPY ADMINISTRATION INTO PERITONEAL CAVITY, REQUIRING AND INCLUDING PERITONEOCENTESIS
989..     96450  CHEMOTHERAPY ADMINISTRATION, INTO CNS (EG, INTRATHECAL), REQUIRING AND INCLUDING LUMBAR
                  PUNCTURE
989..     96542  CHEMOTHERAPY INJECTION, SUBARACHNOID OR INTRAVENTRICULAR VIA SUBCUTANEOUS RESERVOIR, SINGLE OR
                  MULTIPLE AGENTS
989..     Q0084  Chemo, infusion only
989..     Q0085  Chemo, infusion and other technique
990..  Photochemotherapy               S                         .43      $21.79           $8.14           $4.36
990..     96900  ACTINOTHERAPY (ULTRAVIOLET LIGHT)
990..     96910  PHOTOCHEMOTHERAPY; TAR AND ULTRAVIOLET B (GOECKERMAN TREATMENT) OR PETROLATUM AND ULTRAVIOLET B
990..     96912  PHOTOCHEMOTHERAPY; PSORALENS AND ULTRAVIOLET A (PUVA)
990..     96913  PHOTOCHEMOTHERAPY (GOECKERMAN AND/OR PUVA) FOR SEVERE PHOTORESPONSIVE DERMATOSES REQUIRING AT
                  LEAST FOUR TO EIGHT HOURS OF CARE UNDER DIRECT SUPERVISION OF THE PHYSICIAN (INCLUDES
                  APPLICATION OF MEDICATION AND DRESSINGS)
990..     96999  UNLISTED SPECIAL DERMATOLOGICAL SERVICE OR PROCEDURE
997..  Manipulation Therapy            S                         .69      $34.96           $7.23           $6.99
997..     97250  MYOFASCIAL RELEASE/SOFT TISSUE MOBILIZATION, ONE OR MORE REGIONS
997..     97260  MANIPULATION (CERVICAL, THORACIC, LUMBOSACRAL, SACROILIAC, HAND, WRIST) (SEPARATE PROCEDURE),
                  PERFORMED BY PHYSICIAN; ONE AREA
997..     97261  MANIPULATION (CERVICAL, THORACIC, LUMBOSACRAL, SACROILIAC, HAND, WRIST) (SEPARATE PROCEDURE),
                  PERFORMED BY PHYSICIAN; EACH ADDITIONAL AREA
997..     98925  OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); ONE TO TWO BODY REGIONS INVOLVED
997..     98926  OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); THREE TO FOUR BODY REGIONS INVOLVED
997..     98927  OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); FIVE TO SIX BODY REGIONS INVOLVED
997..     98928  OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); SEVEN TO EIGHT BODY REGIONS INVOLVED
997..     98929  OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); NINE TO TEN BODY REGIONS INVOLVED
997..     98940  CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, ONE TO TWO REGIONS
997..     98941  CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, THREE TO FOUR REGIONS
997..     98942  CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, FIVE REGIONS
999..  Therapeutic Phlebotomy          X                         .43      $21.79          $10.85           $4.36
999..     99195  PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE)
----------------------------------------------------------------------------------------------------------------







[[Page 47834]]

                                      Addendum D.--Summary of Medical APCs
----------------------------------------------------------------------------------------------------------------
                                                                        CPT \1\
                                 APC                                     HCPCS             Description
--------------------------------------------------------------------------\2\-----------------------------------
911  Low Level Clinic Visits
                                                                          99201  Office/outpatient visit, new
                                                                          99202  Office/outpatient visit, new
                                                                          99211  Office/outpatient visit, est
                                                                          99212  Office/outpatient visit, est
                                                                          99241  Office consultation
                                                                          99242  Office consultation
                                                                          99271  Confirmatory consultation
                                                                          99272  Confirmatory consultation
                                                                          G0101  Cancer Screening Exam, Women
913  Mid Level Clinic Visits
                                                                          92002  Eye exam, new patient
                                                                          92012  Eye exam established pt
                                                                          99203  Office/outpatient visit, new
                                                                          99213  Office/outpatient visit, est
                                                                          99243  Office consultation
                                                                          99273  Confirmatory consultation
915  High Level Clinic Visits
                                                                          92004  Eye exam, new patient
                                                                          92014  Eye exam & treatment
                                                                          92506  Speech & hearing evaluation
                                                                          99204  Office/outpatient visit, new
                                                                          99205  Office/outpatient visit, new
                                                                          99214  Office/outpatient visit, est
                                                                          99215  Office/outpatient visit, est
                                                                          99244  Office consultation
                                                                          99245  Office consultation
                                                                          99274  Confirmatory consultation
                                                                          99275  Confirmatory consultation
951  Low Level Emergency Visits
                                                                          99281  Emergency dept visit
                                                                          99282  Emergency dept visit
953  Mid Level Emergency Visits
                                                                          99283  Emergency dept visit
955  High Level Emergency Visits
                                                                          99284  Emergency dept visit
                                                                          99285  Emergency dept visit
----------------------------------------------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved.
  Applicable FARS/DFARS Apply.
\2\ Copyright 1994 American Dental Association. All rights reserved.
Note: Medical visit APCs are created by combining level of visit from Addendum D with reason for visit from
  Addendum E. Thus a midlevel clinic visit (99203) for an eye disorder groups to APC 91368.







             Addendum E.--Major Diagnostic Categories (MDCs)
------------------------------------------------------------------------
 MDC                              Description
------------------------------------------------------------------------
11...  Well care and administrative
18...  Skin and breast diseases
24...  Musculoskeletal diseases
31...  Ear, nose, mouth and throat diseases
33...  Respiratory system diseases
36...  Cardiovascular system diseases
41...  Digestive system diseases
53...  Kidney, urinary tract and male genital diseases
56...  Female genital system diseases
57...  Pregnancy and Neonatal Care
63...  Nervous System Diseases
68...  Eye Diseases
72...  Trauma and poisoning
78...  Major signs, symptoms and findings
82...  Endocrine, nutritional and metabolic diseases
86...  Immunologic and hematologic diseases
88...  Malignancy
91...  Psychiatric Disorders
97...  Infectious disease
99...  Unknown cause of mortality
------------------------------------------------------------------------





  <hbond><hbond><hbond><hbond><hbond><hbond><hbond><hbond><hbond><hbond>
<hbond><hbond>

  Addendum F.--ICD-9 Codes With Major Diagnostic Categories (MDCs) for
       Payment of Medical Visits Under the Hospital Outpatient PPS
------------------------------------------------------------------------
  ICD-9                     ICD-9 Description                      MDC
------------------------------------------------------------------------
0010....  CHOLERA D/T VIB CHOLERAE............................        41
0011....  CHOLERA D/T VIB EL TOR..............................        41
0019....  CHOLERA NOS.........................................        41

[[Page 47835]]

0020....  TYPHOID FEVER.......................................        97
0021....  PARATYPHOID FEVER A.................................        97
0022....  PARATYPHOID FEVER B.................................        97
0023....  PARATYPHOID FEVER C.................................        97
0029....  PARATYPHOID FEVER NOS...............................        97
0030....  SALMONELLA ENTERITIS................................        41
0031....  SALMONELLA SEPTICEMIA...............................        97
00320...  LOCAL SALMONELLA INF NOS............................        97
00321...  SALMONELLA MENINGITIS...............................        97
00322...  SALMONELLA PNEUMONIA................................        33
00323...  SALMONELLA ARTHRITIS................................        24
00324...  SALMONELLA OSTEOMYELITIS............................        24
00329...  LOCAL SALMONELLA INF NEC............................        97
0038....  SALMONELLA INFECTION NEC............................        97
0039....  SALMONELLA INFECTION NOS............................        97
0040....  SHIGELLA DYSENTERIAE................................        41
0041....  SHIGELLA FLEXNERI...................................        41
0042....  SHIGELLA BOYDII.....................................        41
0043....  SHIGELLA SONNEI.....................................        41
0048....  SHIGELLA INFECTION NEC..............................        41
0049....  SHIGELLOSIS NOS.....................................        41
0050....  STAPH FOOD POISONING................................        41
0051....  BOTULISM............................................        97
0052....  FOOD POIS D/T C. PERFRIN............................        41
0053....  FOOD POIS: CLOSTRID NEC.............................        41
0054....  FOOD POIS: V. PARAHAEM..............................        41
00581...  FOOD POISN D/T V. VULNIF............................        41
00589...  BACT FOOD POISONING NEC.............................        41
0059....  FOOD POISONING NOS..................................        41
0060....  AC AMEBIASIS W/O ABSCESS............................        41
0061....  CHR AMEBIASIS W/O ABSCES............................        41
0062....  AMEBIC NONDYSENT COLITIS............................        41
0063....  AMEBIC LIVER ABSCESS................................        41
0064....  AMEBIC LUNG ABSCESS.................................        33
0065....  AMEBIC BRAIN ABSCESS................................        97
0066....  AMEBIC SKIN ULCERATION..............................        18
0068....  AMEBIC INFECTION NEC................................        97
0069....  AMEBIASIS NOS.......................................        97
0070....  BALANTIDIASIS.......................................        41
0071....  GIARDIASIS..........................................        41
0072....  COCCIDIOSIS.........................................        41
0073....  INTEST TRICHOMONIASIS...............................        41
0078....  PROTOZOAL INTEST DIS NEC............................        41
0079....  PROTOZOAL INTEST DIS NOS............................        41
00800...  INTEST INFEC E COLI NOS.............................        41
00801...  INT INF E COLI ENTRPATH.............................        41
00802...  INT INF E COLI ENTRTOXGN............................        41
00803...  INT INF E COLI ENTRNVSV.............................        41
00804...  INT INF E COLI ENTRHMRG.............................        41
00809...  INT INF E COLI SPCF NEC.............................        41
0081....  ARIZONA ENTERITIS...................................        41
0082....  AEROBACTER ENTERITIS................................        41
0083....  PROTEUS ENTERITIS...................................        41
00841...  STAPHYLOCOCC ENTERITIS..............................        41
00842...  PSEUDOMONAS ENTERITIS...............................        41
00843...  INT INFEC CAMPYLOBACTER.............................        41
00844...  INT INF YRSNIA ENTRCLTCA............................        41
00845...  INT INF CLSTRDIUM DFCILE............................        41
00846...  INTES INFEC OTH ANEROBES............................        41
00847...  INT INF OTH GRM NEG BCTR............................        41
00849...  BACTERIAL ENTERITIS NEC.............................        41
0085....  BACTERIAL ENTERITIS NOS.............................        41
00861...  INTES INFEC ROTAVIRUS...............................        41
00862...  INTES INFEC ADENOVIRUS..............................        41
00863...  INT INF NORWALK VIRUS...............................        41
00864...  INT INF OTH SML RND VRUS............................        41
00865...  INTES INFEC CALCIVIRUS..............................        41
00866...  INTES INFEC ASTROVIRUS..............................        41
00867...  INT INF ENTEROVIRUS NEC.............................        41
00869...  OTHER VIRAL INTES INFEC.............................        41
0088....  VIRAL ENTERITIS NOS.................................        41
0090....  INFECTIOUS ENTERITIS NOS............................        41
0091....  ENTERITIS OF INFECT ORIG............................        41
0092....  INFECTIOUS DIARRHEA NOS.............................        41
0093....  DIARRHEA OF INFECT ORIG.............................        41
01000...  PRIM TB COMPLEX-UNSPEC..............................        33

[[Page 47836]]

01001...  PRIM TB COMPLEX-NO EXAM.............................        33
01002...  PRIM TB COMPLEX-EXM UNKN............................        33
01003...  PRIM TB COMPLEX-MICRO DX............................        33
01004...  PRIM TB COMPLEX-CULT DX.............................        33
01005...  PRIM TB COMPLEX-HISTO DX............................        33
01006...  PRIM TB COMPLEX-OTH TEST............................        33
01010...  PRIM TB PLEURISY-UNSPEC.............................        33
01011...  PRIM TB PLEURISY-NO EXAM............................        33
01012...  PRIM TB PLEUR-EXAM UNKN.............................        33
01013...  PRIM TB PLEURIS-MICRO DX............................        33
01014...  PRIM TB PLEURISY-CULT DX............................        33
01015...  PRIM TB PLEURIS-HISTO DX............................        33
01016...  PRIM TB PLEURIS-OTH TEST............................        33
01080...  PRIM PROG TB NEC-UNSPEC.............................        33
01081...  PRIM PROG TB NEC-NO EXAM............................        33
01082...  PRIM PR TB NEC-EXAM UNKN............................        33
01083...  PRIM PRG TB NEC-MICRO DX............................        33
01084...  PRIM PROG TB NEC-CULT DX............................        33
01085...  PRIM PRG TB NEC-HISTO DX............................        33
01086...  PRIM PRG TB NEC-OTH TEST............................        33
01090...  PRIMARY TB NOS-UNSPEC...............................        33
01091...  PRIMARY TB NOS-NO EXAM..............................        33
01092...  PRIMARY TB NOS-EXAM UNKN............................        33
01093...  PRIMARY TB NOS-MICRO DX.............................        33
01094...  PRIMARY TB NOS-CULT DX..............................        33
01095...  PRIMARY TB NOS-HISTO DX.............................        33
01096...  PRIMARY TB NOS-OTH TEST.............................        33
01100...  TB LUNG INFILTR-UNSPEC..............................        33
01101...  TB LUNG INFILTR-NO EXAM.............................        33
01102...  TB LUNG INFILTR-EXM UNKN............................        33
01103...  TB LUNG INFILTR-MICRO DX............................        33
01104...  TB LUNG INFILTR-CULT DX.............................        33
01105...  TB LUNG INFILTR-HISTO DX............................        33
01106...  TB LUNG INFILTR-OTH TEST............................        33
01110...  TB LUNG NODULAR-UNSPEC..............................        33
01111...  TB LUNG NODULAR-NO EXAM.............................        33
01112...  TB LUNG NODUL-EXAM UNKN.............................        33
01113...  TB LUNG NODULAR-MICRO DX............................        33
01114...  TB LUNG NODULAR-CULT DX.............................        33
01115...  TB LUNG NODULAR-HISTO DX............................        33
01116...  TB LUNG NODULAR-OTH TEST............................        33
01120...  TB LUNG W CAVITY-UNSPEC.............................        33
01121...  TB LUNG W CAVITY-NO EXAM............................        33
01122...  TB LUNG CAVITY-EXAM UNKN............................        33
01123...  TB LUNG W CAVIT-MICRO DX............................        33
01124...  TB LUNG W CAVITY-CULT DX............................        33
01125...  TB LUNG W CAVIT-HISTO DX............................        33
01126...  TB LUNG W CAVIT-OTH TEST............................        33
01130...  TB OF BRONCHUS-UNSPEC...............................        33
01131...  TB OF BRONCHUS-NO EXAM..............................        33
01132...  TB OF BRONCHUS-EXAM UNKN............................        33
01133...  TB OF BRONCHUS-MICRO DX.............................        33
01134...  TB OF BRONCHUS-CULT DX..............................        33
01135...  TB OF BRONCHUS-HISTO DX.............................        33
01136...  TB OF BRONCHUS-OTH TEST.............................        33
01140...  TB LUNG FIBROSIS-UNSPEC.............................        33
01141...  TB LUNG FIBROSIS-NO EXAM............................        33
01142...  TB LUNG FIBROS-EXAM UNKN............................        33
01143...  TB LUNG FIBROS-MICRO DX.............................        33
01144...  TB LUNG FIBROSIS-CULT DX............................        33
01145...  TB LUNG FIBROS-HISTO DX.............................        33
01146...  TB LUNG FIBROS-OTH TEST.............................        33
01150...  TB BRONCHIECTASIS-UNSPEC............................        33
01151...  TB BRONCHIECT-NO EXAM...............................        33
01152...  TB BRONCHIECT-EXAM UNKN.............................        33
01153...  TB BRONCHIECT-MICRO DX..............................        33
01154...  TB BRONCHIECT-CULT DX...............................        33
01155...  TB BRONCHIECT-HISTO DX..............................        33
01156...  TB BRONCHIECT-OTH TEST..............................        33
01160...  TB PNEUMONIA-UNSPEC.................................        33
01161...  TB PNEUMONIA-NO EXAM................................        33
01162...  TB PNEUMONIA-EXAM UNKN..............................        33
01163...  TB PNEUMONIA-MICRO DX...............................        33
01164...  TB PNEUMONIA-CULT DX................................        33
01165...  TB PNEUMONIA-HISTO DX...............................        33
01166...  TB PNEUMONIA-OTH TEST...............................        33

[[Page 47837]]

01170...  TB PNEUMOTHORAX-UNSPEC..............................        33
01171...  TB PNEUMOTHORAX-NO EXAM.............................        33
01172...  TB PNEUMOTHORX-EXAM UNKN............................        33
01173...  TB PNEUMOTHORAX-MICRO DX............................        33
01174...  TB PNEUMOTHORAX-CULT DX.............................        33
01175...  TB PNEUMOTHORAX-HISTO DX............................        33
01176...  TB PNEUMOTHORAX-OTH TEST............................        33
01180...  PULMONARY TB NEC-UNSPEC.............................        33
01181...  PULMONARY TB NEC-NO EXAM............................        33
01182...  PULMON TB NEC-EXAM UNKN.............................        33
01183...  PULMON TB NEC-MICRO DX..............................        33
01184...  PULMON TB NEC-CULT DX...............................        33
01185...  PULMON TB NEC-HISTO DX..............................        33
01186...  PULMON TB NEC-OTH TEST..............................        33
01190...  PULMONARY TB NOS-UNSPEC.............................        33
01191...  PULMONARY TB NOS-NO EXAM............................        33
01192...  PULMON TB NOS-EXAM UNKN.............................        33
01193...  PULMON TB NOS-MICRO DX..............................        33
01194...  PULMON TB NOS-CULT DX...............................        33
01195...  PULMON TB NOS-HISTO DX..............................        33
01196...  PULMON TB NOS-OTH TEST..............................        33
01200...  TB PLEURISY-UNSPEC..................................        33
01201...  TB PLEURISY-NO EXAM.................................        33
01202...  TB PLEURISY-EXAM UNKN...............................        33
01203...  TB PLEURISY-MICRO DX................................        33
01204...  TB PLEURISY-CULT DX.................................        33
01205...  TB PLEURISY-HISTOLOG DX.............................        33
01206...  TB PLEURISY-OTH TEST................................        33
01210...  TB THORACIC NODES-UNSPEC............................        33
01211...  TB THORAX NODE-NO EXAM..............................        33
01212...  TB THORAX NODE-EXAM UNKN............................        33
01213...  TB THORAX NODE-MICRO DX.............................        33
01214...  TB THORAX NODE-CULT DX..............................        33
01215...  TB THORAX NODE-HISTO DX.............................        33
01216...  TB THORAX NODE-OTH TEST.............................        33
01220...  ISOL TRACHEAL TB-UNSPEC.............................        31
01221...  ISOL TRACHEAL TB-NO EXAM............................        31
01222...  ISOL TRACH TB-EXAM UNKN.............................        31
01223...  ISOLAT TRACH TB-MICRO DX............................        31
01224...  ISOL TRACHEAL TB-CULT DX............................        31
01225...  ISOLAT TRACH TB-HISTO DX............................        31
01226...  ISOLAT TRACH TB-OTH TEST............................        31
01230...  TB LARYNGITIS-UNSPEC................................        31
01231...  TB LARYNGITIS-NO EXAM...............................        31
01232...  TB LARYNGITIS-EXAM UNKN.............................        31
01233...  TB LARYNGITIS-MICRO DX..............................        31
01234...  TB LARYNGITIS-CULT DX...............................        31
01235...  TB LARYNGITIS-HISTO DX..............................        31
01236...  TB LARYNGITIS-OTH TEST..............................        31
01280...  RESP TB NEC-UNSPEC..................................        33
01281...  RESP TB NEC-NO EXAM.................................        33
01282...  RESP TB NEC-EXAM UNKN...............................        33
01283...  RESP TB NEC-MICRO DX................................        33
01284...  RESP TB NEC-CULT DX.................................        33
01285...  RESP TB NEC-HISTO DX................................        33
01286...  RESP TB NEC-OTH TEST................................        33
01300...  TB MENINGITIS-UNSPEC................................        63
01301...  TB MENINGITIS-NO EXAM...............................        63
01302...  TB MENINGITIS-EXAM UNKN.............................        63
01303...  TB MENINGITIS-MICRO DX..............................        63
01304...  TB MENINGITIS-CULT DX...............................        63
01305...  TB MENINGITIS-HISTO DX..............................        63
01306...  TB MENINGITIS-OTH TEST..............................        63
01310...  TUBRCLMA MENINGES-UNSPEC............................        63
01311...  TUBRCLMA MENING-NO EXAM.............................        63
01312...  TUBRCLMA MENIN-EXAM UNKN............................        63
01313...  TUBRCLMA MENING-MICRO DX............................        63
01314...  TUBRCLMA MENING-CULT DX.............................        63
01315...  TUBRCLMA MENING-HISTO DX............................        63
01316...  TUBRCLMA MENING-OTH TEST............................        63
01320...  TUBERCULOMA BRAIN-UNSPEC............................        63
01321...  TUBRCLOMA BRAIN-NO EXAM.............................        63
01322...  TUBRCLMA BRAIN-EXAM UNKN............................        63
01323...  TUBRCLOMA BRAIN-MICRO DX............................        63
01324...  TUBRCLOMA BRAIN-CULT DX.............................        63
01325...  TUBRCLOMA BRAIN-HISTO DX............................        63

[[Page 47838]]

01326...  TUBRCLOMA BRAIN-OTH TEST............................        63
01330...  TB BRAIN ABSCESS-UNSPEC.............................        63
01331...  TB BRAIN ABSCESS-NO EXAM............................        63
01332...  TB BRAIN ABSC-EXAM UNKN.............................        63
01333...  TB BRAIN ABSC-MICRO DX..............................        63
01334...  TB BRAIN ABSCESS-CULT DX............................        63
01335...  TB BRAIN ABSC-HISTO DX..............................        63
01336...  TB BRAIN ABSC-OTH TEST..............................        63
01340...  TUBRCLMA SP CORD-UNSPEC.............................        63
01341...  TUBRCLMA SP CORD-NO EXAM............................        63
01342...  TUBRCLMA SP CD-EXAM UNKN............................        63
01343...  TUBRCLMA SP CRD-MICRO DX............................        63
01344...  TUBRCLMA SP CORD-CULT DX............................        63
01345...  TUBRCLMA SP CRD-HISTO DX............................        63
01346...  TUBRCLMA SP CRD-OTH TEST............................        63
01350...  TB SP CRD ABSCESS-UNSPEC............................        63
01351...  TB SP CRD ABSC-NO EXAM..............................        63
01352...  TB SP CRD ABSC-EXAM UNKN............................        63
01353...  TB SP CRD ABSC-MICRO DX.............................        63
01354...  TB SP CRD ABSC-CULT DX..............................        63
01355...  TB SP CRD ABSC-HISTO DX.............................        63
01356...  TB SP CRD ABSC-OTH TEST.............................        63
01360...  TB ENCEPHALITIS-UNSPEC..............................        63
01361...  TB ENCEPHALITIS-NO EXAM.............................        63
01362...  TB ENCEPHALIT-EXAM UNKN.............................        63
01363...  TB ENCEPHALITIS-MICRO DX............................        63
01364...  TB ENCEPHALITIS-CULT DX.............................        63
01365...  TB ENCEPHALITIS-HISTO DX............................        63
01366...  TB ENCEPHALITIS-OTH TEST............................        63
01380...  CNS TB NEC-UNSPEC...................................        63
01381...  CNS TB NEC-NO EXAM..................................        63
01382...  CNS TB NEC-EXAM UNKN................................        63
01383...  CNS TB NEC-MICRO DX.................................        63
01384...  CNS TB NEC-CULT DX..................................        63
01385...  CNS TB NEC-HISTO DX.................................        63
01386...  CNS TB NEC-OTH TEST.................................        63
01390...  CNS TB NOS-UNSPEC...................................        63
01391...  CNS TB NOS-NO EXAM..................................        63
01392...  CNS TB NOS-EXAM UNKN................................        63
01393...  CNS TB NOS-MICRO DX.................................        63
01394...  CNS TB NOS-CULT DX..................................        63
01395...  CNS TB NOS-HISTO DX.................................        63
01396...  CNS TB NOS-OTH TEST.................................        63
01400...  TB PERITONITIS-UNSPEC...............................        41
01401...  TB PERITONITIS-NO EXAM..............................        41
01402...  TB PERITONITIS-EXAM UNKN............................        41
01403...  TB PERITONITIS-MICRO DX.............................        41
01404...  TB PERITONITIS-CULT DX..............................        41
01405...  TB PERITONITIS-HISTO DX.............................        41
01406...  TB PERITONITIS-OTH TEST.............................        41
01480...  INTESTINAL TB NEC-UNSPEC............................        41
01481...  INTESTIN TB NEC-NO EXAM.............................        41
01482...  INTEST TB NEC-EXAM UNKN.............................        41
01483...  INTESTIN TB NEC-MICRO DX............................        41
01484...  INTESTIN TB NEC-CULT DX.............................        41
01485...  INTESTIN TB NEC-HISTO DX............................        41
01486...  INTESTIN TB NEC-OTH TEST............................        41
01500...  TB OF VERTEBRA-UNSPEC...............................        24
01501...  TB OF VERTEBRA-NO EXAM..............................        24
01502...  TB OF VERTEBRA-EXAM UNKN............................        24
01503...  TB OF VERTEBRA-MICRO DX.............................        24
01504...  TB OF VERTEBRA-CULT DX..............................        24
01505...  TB OF VERTEBRA-HISTO DX.............................        24
01506...  TB OF VERTEBRA-OTH TEST.............................        24
01510...  TB OF HIP-UNSPEC....................................        24
01511...  TB OF HIP-NO EXAM...................................        24
01512...  TB OF HIP-EXAM UNKN.................................        24
01513...  TB OF HIP-MICRO DX..................................        24
01514...  TB OF HIP-CULT DX...................................        24
01515...  TB OF HIP-HISTO DX..................................        24
01516...  TB OF HIP-OTH TEST..................................        24
01520...  TB OF KNEE-UNSPEC...................................        24
01521...  TB OF KNEE-NO EXAM..................................        24
01522...  TB OF KNEE-EXAM UNKN................................        24
01523...  TB OF KNEE-MICRO DX.................................        24
01524...  TB OF KNEE-CULT DX..................................        24

[[Page 47839]]

01525...  TB OF KNEE-HISTO DX.................................        24
01526...  TB OF KNEE-OTH TEST.................................        24
01550...  TB OF LIMB BONES-UNSPEC.............................        24
01551...  TB LIMB BONES-NO EXAM...............................        24
01552...  TB LIMB BONES-EXAM UNKN.............................        24
01553...  TB LIMB BONES-MICRO DX..............................        24
01554...  TB LIMB BONES-CULT DX...............................        24
01555...  TB LIMB BONES-HISTO DX..............................        24
01556...  TB LIMB BONES-OTH TEST..............................        24
01560...  TB OF MASTOID-UNSPEC................................        31
01561...  TB OF MASTOID-NO EXAM...............................        31
01562...  TB OF MASTOID-EXAM UNKN.............................        31
01563...  TB OF MASTOID-MICRO DX..............................        31
01564...  TB OF MASTOID-CULT DX...............................        31
01565...  TB OF MASTOID-HISTO DX..............................        31
01566...  TB OF MASTOID-OTH TEST..............................        31
01570...  TB OF BONE NEC-UNSPEC...............................        24
01571...  TB OF BONE NEC-NO EXAM..............................        24
01572...  TB OF BONE NEC-EXAM UNKN............................        24
01573...  TB OF BONE NEC-MICRO DX.............................        24
01574...  TB OF BONE NEC-CULT DX..............................        24
01575...  TB OF BONE NEC-HISTO DX.............................        24
01576...  TB OF BONE NEC-OTH TEST.............................        24
01580...  TB OF JOINT NEC-UNSPEC..............................        24
01581...  TB OF JOINT NEC-NO EXAM.............................        24
01582...  TB JOINT NEC-EXAM UNKN..............................        24
01583...  TB OF JOINT NEC-MICRO DX............................        24
01584...  TB OF JOINT NEC-CULT DX.............................        24
01585...  TB OF JOINT NEC-HISTO DX............................        24
01586...  TB OF JOINT NEC-OTH TEST............................        24
01590...  TB BONE/JOINT NOS-UNSPEC............................        24
01591...  TB BONE/JT NOS-NO EXAM..............................        24
01592...  TB BONE/JT NOS-EXAM UNKN............................        24
01593...  TB BONE/JT NOS-MICRO DX.............................        24
01594...  TB BONE/JT NOS-CULT DX..............................        24
01595...  TB BONE/JT NOS-HISTO DX.............................        24
01596...  TB BONE/JT NOS-OTH TEST.............................        24
01600...  TB OF KIDNEY-UNSPEC.................................        53
01601...  TB OF KIDNEY-NO EXAM................................        53
01602...  TB OF KIDNEY-EXAM UNKN..............................        53
01603...  TB OF KIDNEY-MICRO DX...............................        53
01604...  TB OF KIDNEY-CULT DX................................        53
01605...  TB OF KIDNEY-HISTO DX...............................        53
01606...  TB OF KIDNEY-OTH TEST...............................        53
01610...  TB OF BLADDER-UNSPEC................................        53
01611...  TB OF BLADDER-NO EXAM...............................        53
01612...  TB OF BLADDER-EXAM UNKN.............................        53
01613...  TB OF BLADDER-MICRO DX..............................        53
01614...  TB OF BLADDER-CULT DX...............................        53
01615...  TB OF BLADDER-HISTO DX..............................        53
01616...  TB OF BLADDER-OTH TEST..............................        53
01620...  TB OF URETER-UNSPEC.................................        53
01621...  TB OF URETER-NO EXAM................................        53
01622...  TB OF URETER-EXAM UNKN..............................        53
01623...  TB OF URETER-MICRO DX...............................        53
01624...  TB OF URETER-CULT DX................................        53
01625...  TB OF URETER-HISTO DX...............................        53
01626...  TB OF URETER-OTH TEST...............................        53
01630...  TB URINARY NEC-UNSPEC...............................        53
01631...  TB URINARY NEC-NO EXAM..............................        53
01632...  TB URINARY NEC-EXAM UNKN............................        53
01633...  TB URINARY NEC-MICRO DX.............................        53
01634...  TB URINARY NEC-CULT DX..............................        53
01635...  TB URINARY NEC-HISTO DX.............................        53
01636...  TB URINARY NEC-OTH TEST.............................        53
01640...  TB EPIDIDYMIS-UNSPEC................................        53
01641...  TB EPIDIDYMIS-NO EXAM...............................        53
01642...  TB EPIDIDYMIS-EXAM UNKN.............................        53
01643...  TB EPIDIDYMIS-MICRO DX..............................        53
01644...  TB EPIDIDYMIS-CULT DX...............................        53
01645...  TB EPIDIDYMIS-HISTO DX..............................        53
01646...  TB EPIDIDYMIS-OTH TEST..............................        53
01650...  TB MALE GENIT NEC-UNSPEC............................        53
01651...  TB MALE GEN NEC-NO EXAM.............................        53
01652...  TB MALE GEN NEC-EX UNKN.............................        53
01653...  TB MALE GEN NEC-MICRO DX............................        53

[[Page 47840]]

01654...  TB MALE GEN NEC-CULT DX.............................        53
01655...  TB MALE GEN NEC-HISTO DX............................        53
01656...  TB MALE GEN NEC-OTH TEST............................        53
01660...  TB OVARY & TUBE-UNSPEC..............................        56
01661...  TB OVARY & TUBE-NO EXAM.............................        56
01662...  TB OVARY/TUBE-EXAM UNKN.............................        56
01663...  TB OVARY & TUBE-MICRO DX............................        56
01664...  TB OVARY & TUBE-CULT DX.............................        56
01665...  TB OVARY & TUBE-HISTO DX............................        56
01666...  TB OVARY & TUBE-OTH TEST............................        56
01670...  TB FEMALE GEN NEC-UNSPEC............................        56
01671...  TB FEM GEN NEC-NO EXAM..............................        56
01672...  TB FEM GEN NEC-EXAM UNKN............................        56
01673...  TB FEM GEN NEC-MICRO DX.............................        56
01674...  TB FEM GEN NEC-CULT DX..............................        56
01675...  TB FEM GEN NEC-HISTO DX.............................        56
01676...  TB FEM GEN NEC-OTH TEST.............................        56
01690...  GU TB NOS-UNSPEC....................................        53
01691...  GU TB NOS-NO EXAM...................................        53
01692...  GU TB NOS-EXAM UNKN.................................        53
01693...  GU TB NOS-MICRO DX..................................        53
01694...  GU TB NOS-CULT DX...................................        53
01695...  GU TB NOS-HISTO DX..................................        53
01696...  GU TB NOS-OTH TEST..................................        53
01700...  TB SKIN/SUBCUTAN-UNSPEC.............................        18
01701...  TB SKIN/SUBCUT-NO EXAM..............................        18
01702...  TB SKIN/SUBCUT-EXAM UNKN............................        18
01703...  TB SKIN/SUBCUT-MICRO DX.............................        18
01704...  TB SKIN/SUBCUT-CULT DX..............................        18
01705...  TB SKIN/SUBCUT-HISTO DX.............................        18
01706...  TB SKIN/SUBCUT-OTH TEST.............................        18
01710...  ERYTHEMA NODOS TB-UNSPEC............................        18
01711...  ERYTHEM NODOS TB-NO EXAM............................        18
01712...  ERYTHEM NOD TB-EXAM UNKN............................        18
01713...  ERYTHEM NOD TB-MICRO DX.............................        18
01714...  ERYTHEM NODOS TB-CULT DX............................        18
01715...  ERYTHEM NOD TB-HISTO DX.............................        18
01716...  ERYTHEM NOD TB-OTH TEST.............................        18
01720...  TB PERIPH LYMPH-UNSPEC..............................        86
01721...  TB PERIPH LYMPH-NO EXAM.............................        86
01722...  TB PERIPH LYMPH-EXAM UNK............................        86
01723...  TB PERIPH LYMPH-MICRO DX............................        86
01724...  TB PERIPH LYMPH-CULT DX.............................        86
01725...  TB PERIPH LYMPH-HISTO DX............................        86
01726...  TB PERIPH LYMPH-OTH TEST............................        86
01730...  TB OF EYE-UNSPEC....................................        68
01731...  TB OF EYE-NO EXAM...................................        68
01732...  TB OF EYE-EXAM UNKN.................................        68
01733...  TB OF EYE-MICRO DX..................................        68
01734...  TB OF EYE-CULT DX...................................        68
01735...  TB OF EYE-HISTO DX..................................        68
01736...  TB OF EYE-OTH TEST..................................        68
01740...  TB OF EAR-UNSPEC....................................        31
01741...  TB OF EAR-NO EXAM...................................        31
01742...  TB OF EAR-EXAM UNKN.................................        31
01743...  TB OF EAR-MICRO DX..................................        31
01744...  TB OF EAR-CULT DX...................................        31
01745...  TB OF EAR-HISTO DX..................................        31
01746...  TB OF EAR-OTH TEST..................................        31
01750...  TB OF THYROID-UNSPEC................................        82
01751...  TB OF THYROID-NO EXAM...............................        82
01752...  TB OF THYROID-EXAM UNKN.............................        82
01753...  TB OF THYROID-MICRO DX..............................        82
01754...  TB OF THYROID-CULT DX...............................        82
01755...  TB OF THYROID-HISTO DX..............................        82
01756...  TB OF THYROID-OTH TEST..............................        82
01760...  TB OF ADRENAL-UNSPEC................................        82
01761...  TB OF ADRENAL-NO EXAM...............................        82
01762...  TB OF ADRENAL-EXAM UNKN.............................        82
01763...  TB OF ADRENAL-MICRO DX..............................        82
01764...  TB OF ADRENAL-CULT DX...............................        82
01765...  TB OF ADRENAL-HISTO DX..............................        82
01766...  TB OF ADRENAL-OTH TEST..............................        82
01770...  TB OF SPLEEN-UNSPEC.................................        86
01771...  TB OF SPLEEN-NO EXAM................................        86
01772...  TB OF SPLEEN-EXAM UNKN..............................        86

[[Page 47841]]

01773...  TB OF SPLEEN-MICRO DX...............................        86
01774...  TB OF SPLEEN-CULT DX................................        86
01775...  TB OF SPLEEN-HISTO DX...............................        86
01776...  TB OF SPLEEN-OTH TEST...............................        86
01780...  TB ESOPHAGUS-UNSPEC.................................        41
01781...  TB ESOPHAGUS-NO EXAM................................        41
01782...  TB ESOPHAGUS-EXAM UNKN..............................        41
01783...  TB ESOPHAGUS-MICRO DX...............................        41
01784...  TB ESOPHAGUS-CULT DX................................        41
01785...  TB ESOPHAGUS-HISTO DX...............................        41
01786...  TB ESOPHAGUS-OTH TEST...............................        41
01790...  TB OF ORGAN NEC-UNSPEC..............................        97
01791...  TB OF ORGAN NEC-NO EXAM.............................        97
01792...  TB ORGAN NEC-EXAM UNKN..............................        97
01793...  TB OF ORGAN NEC-MICRO DX............................        97
01794...  TB OF ORGAN NEC-CULT DX.............................        97
01795...  TB OF ORGAN NEC-HISTO DX............................        97
01796...  TB OF ORGAN NEC-OTH TEST............................        97
01800...  ACUTE MILIARY TB-UNSPEC.............................        97
01801...  ACUTE MILIARY TB-NO EXAM............................        97
01802...  AC MILIARY TB-EXAM UNKN.............................        97
01803...  AC MILIARY TB-MICRO DX..............................        97
01804...  ACUTE MILIARY TB-CULT DX............................        97
01805...  AC MILIARY TB-HISTO DX..............................        97
01806...  AC MILIARY TB-OTH TEST..............................        97
01880...  MILIARY TB NEC-UNSPEC...............................        97
01881...  MILIARY TB NEC-NO EXAM..............................        97
01882...  MILIARY TB NEC-EXAM UNKN............................        97
01883...  MILIARY TB NEC-MICRO DX.............................        97
01884...  MILIARY TB NEC-CULT DX..............................        97
01885...  MILIARY TB NEC-HISTO DX.............................        97
01886...  MILIARY TB NEC-OTH TEST.............................        97
01890...  MILIARY TB NOS-UNSPEC...............................        97
01891...  MILIARY TB NOS-NO EXAM..............................        97
01892...  MILIARY TB NOS-EXAM UNKN............................        97
01893...  MILIARY TB NOS-MICRO DX.............................        97
01894...  MILIARY TB NOS-CULT DX..............................        97
01895...  MILIARY TB NOS-HISTO DX.............................        97
01896...  MILIARY TB NOS-OTH TEST.............................        97
0200....  BUBONIC PLAGUE......................................        97
0201....  CELLULOCUTANEOUS PLAGUE.............................        97
0202....  SEPTICEMIC PLAGUE...................................        97
0203....  PRIMARY PNEUMONIC PLAGUE............................        33
0204....  SECONDARY PNEUMON PLAGUE............................        33
0205....  PNEUMONIC PLAGUE NOS................................        33
0208....  OTHER TYPES OF PLAGUE...............................        97
0209....  PLAGUE NOS..........................................        97
0210....  ULCEROGLANDUL TULAREMIA.............................        97
0211....  ENTERIC TULAREMIA...................................        41
0212....  PULMONARY TULAREMIA.................................        33
0213....  OCULOGLANDULAR TULAREMIA............................        97
0218....  TULAREMIA NEC.......................................        97
0219....  TULAREMIA NOS.......................................        97
0220....  CUTANEOUS ANTHRAX...................................        18
0221....  PULMONARY ANTHRAX...................................        33
0222....  GASTROINTESTINAL ANTHRAX............................        41
0223....  ANTHRAX SEPTICEMIA..................................        97
0228....  OTHER ANTHRAX MANIFEST..............................        97
0229....  ANTHRAX NOS.........................................        97
0230....  BRUCELLA MELITENSIS.................................        97
0231....  BRUCELLA ABORTUS....................................        97
0232....  BRUCELLA SUIS.......................................        97
0233....  BRUCELLA CANIS......................................        97
0238....  BRUCELLOSIS NEC.....................................        97
0239....  BRUCELLOSIS NOS.....................................        97
024.....  GLANDERS............................................        97
025.....  MELIOIDOSIS.........................................        97
0260....  SPIRILLARY FEVER....................................        97
0261....  STREPTOBACILLARY FEVER..............................        97
0269....  RAT-BITE FEVER NOS..................................        97
0270....  LISTERIOSIS.........................................        97
0271....  ERYSIPELOTHRIX INFECTION............................        97
0272....  PASTEURELLOSIS......................................        97
0278....  ZOONOTIC BACT DIS NEC...............................        97
0279....  ZOONOTIC BACT DIS NOS...............................        97
0300....  LEPROMATOUS LEPROSY.................................        97

[[Page 47842]]

0301....  TUBERCULOID LEPROSY.................................        97
0302....  INDETERMINATE LEPROSY...............................        97
0303....  BORDERLINE LEPROSY..................................        97
0308....  LEPROSY NEC.........................................        97
0309....  LEPROSY NOS.........................................        97
0310....  PULMONARY MYCOBACTERIA..............................        33
0311....  CUTANEOUS MYCOBACTERIA..............................        18
0318....  MYCOBACTERIAL DIS NEC...............................        97
0319....  MYCOBACTERIAL DIS NOS...............................        97
0320....  FAUCIAL DIPHTHERIA..................................        31
0321....  NASOPHARYNX DIPHTHERIA..............................        31
0322....  ANT NASAL DIPHTHERIA................................        31
0323....  LARYNGEAL DIPHTHERIA................................        31
03281...  CONJUNCTIVAL DIPHTHERIA.............................        68
03282...  DIPHTHERITIC MYOCARDITIS............................        36
03283...  DIPHTHERITIC PERITONITIS............................        41
03284...  DIPHTHERITIC CYSTITIS...............................        53
03285...  CUTANEOUS DIPHTHERIA................................        18
03289...  DIPHTHERIA NEC......................................        97
0329....  DIPHTHERIA NOS......................................        97
0330....  BORDETELLA PERTUSSIS................................        33
0331....  BORDETELLA PARAPERTUSSIS............................        33
0338....  WHOOPING COUGH NEC..................................        33
0339....  WHOOPING COUGH NOS..................................        33
0340....  STREP SORE THROAT...................................        31
0341....  SCARLET FEVER.......................................        97
035.....  ERYSIPELAS..........................................        18
0360....  MENINGOCOCCAL MENINGITIS............................        63
0361....  MENINGOCOCC ENCEPHALITIS............................        63
0362....  MENINGOCOCCEMIA.....................................        97
0363....  MENINGOCOCC ADRENAL SYND............................        97
03640...  MENINGOCOCC CARDITIS NOS............................        36
03641...  MENINGOCOCC PERICARDITIS............................        36
03642...  MENINGOCOCC ENDOCARDITIS............................        36
03643...  MENINGOCOCC MYOCARDITIS.............................        36
03681...  MENINGOCOCC OPTIC NEURIT............................        68
03682...  MENINGOCOCC ARTHROPATHY.............................        24
03689...  MENINGOCOCCAL INFECT NEC............................        97
0369....  MENINGOCOCCAL INFECT NOS............................        97
037.....  TETANUS.............................................        97
0380....  STREPTOCOCCAL SEPTICEMIA............................        97
0382....  PNEUMOCOCCAL SEPTICEMIA.............................        97
0383....  ANAEROBIC SEPTICEMIA................................        97
03840...  GRAM-NEG SEPTICEMIA NOS.............................        97
03841...  H. INFLUENAE SEPTICEMIA.............................        97
03842...  E COLI SEPTICEMIA...................................        97
03843...  PSEUDOMONAS SEPTICEMIA..............................        97
03844...  SERRATIA SEPTICEMIA.................................        97
03849...  GRAM-NEG SEPTICEMIA NEC.............................        97
0388....  SEPTICEMIA NEC......................................        97
0389....  SEPTICEMIA NOS......................................        97
0390....  CUTANEOUS ACTINOMYCOSIS.............................        18
0391....  PULMONARY ACTINOMYCOSIS.............................        33
0392....  ABDOMINAL ACTINOMYCOSIS.............................        41
0393....  CERVICOFAC ACTINOMYCOSIS............................        18
0394....  MADURA FOOT.........................................        18
0398....  ACTINOMYCOSIS NEC...................................        97
0399....  ACTINOMYCOSIS NOS...................................        97
0400....  GAS GANGRENE........................................        97
0401....  RHINOSCLEROMA.......................................        97
0402....  WHIPPLE'S DISEASE...................................        41
0403....  NECROBACILLOSIS.....................................        97
04081...  TROPICAL PYOMYOSITIS................................        24
04089...  BACTERIAL DISEASES NEC..............................        97
04100...  STREPTOCOCCUS UNSPECF...............................        97
04101...  STREPTOCOCCUS GROUP A...............................        97
04102...  STREPTOCOCCUS GROUP B...............................        97
04103...  STREPTOCOCCUS GROUP C...............................        97
04104...  STREPTOCOCCUS GROUP D...............................        97
04105...  STREPTOCOCCUS GROUP G...............................        97
04109...  OTHER STREPTOCOCCUS.................................        97
04110...  STAPHYLOCOCCUS UNSPCFIED............................        97
04111...  STAPHYLOCOCCUS AUREUS...............................        97
04119...  OTHER STAPHYLOCOCCUS................................        97
0412....  PNEUMOCOCCUS INFECT NOS.............................        97
0413....  KLEBSIELLA INFECT NOS...............................        97

[[Page 47843]]

0414....  E. COLI INFECT NOS..................................        97
0415....  H. INFLUENZAE INFECT NOS............................        97
0416....  PROTEUS INFECTION NOS...............................        97
0417....  PSEUDOMONAS INFECT NOS..............................        97
04181...  MYCOPLASMA..........................................        97
04182...  BACILLUS FRAGILIS...................................        97
04183...  CLOSTRIDIUM PERFRINGENS.............................        97
04184...  OTHER ANAEROBES.....................................        97
04185...  OTH GRAM NEGATV BACTERIA............................        97
04186...  HELICOBACTER PYLORI.................................        41
04189...  OTH SPECF BACTERIA..................................        97
0419....  BACTERIAL INFECTION NOS.............................        97
042.....  HUMAN IMMUNO VIRUS DIS..............................        86
04500...  AC BULBAR POLIO-TYPE NOS............................        63
04501...  AC BULBAR POLIO-TYPE 1..............................        63
04502...  AC BULBAR POLIO-TYPE 2..............................        63
04503...  AC BULBAR POLIO-TYPE 3..............................        63
04510...  PARAL POLIO NEC-TYPE NOS............................        63
04511...  PARAL POLIO NEC-TYPE 1..............................        63
04512...  PARAL POLIO NEC-TYPE 2..............................        63
04513...  PARAL POLIO NEC-TYPE 3..............................        63
04520...  NONPARALY POLIO-TYPE NOS............................        63
04521...  NONPARALYT POLIO-TYPE 1.............................        63
04522...  NONPARALYT POLIO-TYPE 2.............................        63
04523...  NONPARALYT POLIO-TYPE 3.............................        63
04590...  AC POLIO NOS-TYPE NOS...............................        63
04591...  AC POLIO NOS-TYPE 1.................................        63
04592...  AC POLIO NOS-TYPE 2.................................        63
04593...  AC POLIO NOS-TYPE 3.................................        63
0460....  KURU................................................        63
0461....  JAKOB-CREUTZFELDT DIS...............................        63
0462....  SUBAC SCLEROS PANENCEPH.............................        63
0463....  PROG MULTIFOC LEUKOENCEP............................        63
0468....  CNS SLOW VIRUS INFEC NEC............................        63
0469....  CNS SLOW VIRUS INFEC NOS............................        63
0470....  COXSACKIE VIRUS MENING..............................        63
0471....  ECHO VIRUS MENINGITIS...............................        63
0478....  VIRAL MENINGITIS NEC................................        63
0479....  VIRAL MENINGITIS NOS................................        63
048.....  OTH ENTEROVIRAL CNS DIS.............................        97
0490....  LYMPHOCYTIC CHORIOMENING............................        63
0491....  ADENOVIRAL MENINGITIS...............................        63
0498....  VIRAL ENCEPHALITIS NEC..............................        63
0499....  VIRAL ENCEPHALITIS NOS..............................        63
0500....  VARIOLA MAJOR.......................................        97
0501....  ALASTRIM............................................        97
0502....  MODIFIED SMALLPOX...................................        97
0509....  SMALLPOX NOS........................................        97
0510....  COWPOX..............................................        97
0511....  PSEUDOCOWPOX........................................        18
0512....  CONTAGIOUS PUSTULAR DERM............................        18
0519....  PARAVACCINIA NOS....................................        97
0520....  POSTVARICELLA ENCEPHALIT............................        63
0521....  VARICELLA PNEUMONITIS...............................        33
0527....  VARICELLA COMPLICAT NEC.............................        97
0528....  VARICELLA COMPLICAT NOS.............................        97
0529....  VARICELLA UNCOMPLICATED.............................        97
0530....  HERPES ZOSTER MENINGITIS............................        63
05310...  H ZOSTER NERV SYST NOS..............................        63
05311...  GENICULATE HERPES ZOSTER............................        63
05312...  POSTHERPES TRIGEM NEURAL............................        63
05313...  POSTHERPES POLYNEUROPATH............................        63
05319...  H ZOSTER NERV SYST NEC..............................        63
05320...  HERPES ZOSTER OF EYELID.............................        68
05321...  H ZOSTER KERATOCONJUNCT.............................        68
05322...  H ZOSTER IRIDOCYCLITIS..............................        68
05329...  HERPES ZOSTER OF EYE NEC............................        68
05371...  H ZOSTER OTITIS EXTERNA.............................        31
05379...  H ZOSTER COMPLICATED NEC............................        97
0538....  H ZOSTER COMPLICATED NOS............................        97
0539....  HERPES ZOSTER NOS...................................        18
0540....  ECZEMA HERPETICUM...................................        18
05410...  GENITAL HERPES NOS..................................        97
05411...  HERPETIC VULVOVAGINITIS.............................        97
05412...  HERPETIC ULCER OF VULVA.............................        97
05413...  HERPETIC INFECT OF PENIS............................        97

[[Page 47844]]

05419...  GENITAL HERPES NEC..................................        97
0542....  HERPETIC GINGIVOSTOMAT..............................        31
0543....  HERPETIC ENCEPHALITIS...............................        63
05440...  HERPES SIMPLEX EYE NOS..............................        68
05441...  HERPES SIMPLEX OF EYELID............................        68
05442...  DENDRITIC KERATITIS.................................        68
05443...  H SIMPLEX KERATITIS.................................        68
05444...  H SIMPLEX IRIDOCYCLITIS.............................        68
05449...  HERPES SIMPLEX EYE NEC..............................        68
0545....  HERPETIC SEPTICEMIA.................................        97
0546....  HERPETIC WHITLOW....................................        18
05471...  VISCERAL HERPES SIMPLEX.............................        41
05472...  H SIMPLEX MENINGITIS................................        63
05473...  H SIMPLEX OTITIS EXTERNA............................        31
05479...  H SIMPLEX COMPLICAT NEC.............................        97
0548....  H SIMPLEX COMPLICAT NOS.............................        97
0549....  HERPES SIMPLEX NOS..................................        18
0550....  POSTMEASLES ENCEPHALITIS............................        63
0551....  POSTMEASLES PNEUMONIA...............................        33
0552....  POSTMEASLES OTITIS MEDIA............................        31
05571...  MEASLES KERATITIS...................................        68
05579...  MEASLES COMPLICATION NEC............................        97
0558....  MEASLES COMPLICATION NOS............................        97
0559....  MEASLES UNCOMPLICATED...............................        97
05600...  RUBELLA NERVE COMPL NOS.............................        63
05601...  RUBELLA ENCEPHALITIS................................        63
05609...  RUBELLA NERVE COMPL NEC.............................        63
05671...  ARTHRITIS DUE TO RUBELLA............................        24
05679...  RUBELLA COMPLICATION NEC............................        97
0568....  RUBELLA COMPLICATION NOS............................        97
0569....  RUBELLA UNCOMPLICATED...............................        97
0570....  ERYTHEMA INFECTIOSUM................................        97
0578....  VIRAL EXANTHEMATA NEC...............................        97
0579....  VIRAL EXANTHEMATA NOS...............................        97
0600....  SYLVATIC YELLOW FEVER...............................        97
0601....  URBAN YELLOW FEVER..................................        97
0609....  YELLOW FEVER NOS....................................        97
061.....  DENGUE..............................................        97
0620....  JAPANESE ENCEPHALITIS...............................        63
0621....  WEST EQUINE ENCEPHALITIS............................        63
0622....  EAST EQUINE ENCEPHALITIS............................        63
0623....  ST LOUIS ENCEPHALITIS...............................        63
0624....  AUSTRALIAN ENCEPHALITIS.............................        63
0625....  CALIFORNIA ENCEPHALITIS.............................        97
0628....  MOSQUIT-BORNE ENCEPH NEC............................        97
0629....  MOSQUIT-BORNE ENCEPH NOS............................        97
0630....  RUSSIA SPR-SUMMER ENCEPH............................        97
0631....  LOUPING ILL.........................................        97
0632....  CENT EUROPE ENCEPHALITIS............................        63
0638....  TICK-BORNE ENCEPH NEC...............................        97
0639....  TICK-BORNE ENCEPH NOS...............................        97
064.....  VIR ENCEPH ARTHROPOD NEC............................        63
0650....  CRIMEAN HEMORRHAGIC FEV.............................        97
0651....  OMSK HEMORRHAGIC FEVER..............................        97
0652....  KYASANUR FOREST DISEASE.............................        97
0653....  TICK-BORNE HEM FEVER NEC............................        97
0654....  MOSQUITO-BORNE HEM FEVER............................        97
0658....  ARTHROPOD HEM FEVER NEC.............................        97
0659....  ARTHROPOD HEM FEVER NOS.............................        97
0660....  PHLEBOTOMUS FEVER...................................        97
0661....  TICK-BORNE FEVER....................................        97
0662....  VENEZUELAN EQUINE FEVER.............................        63
0663....  MOSQUITO-BORNE FEVER NEC............................        97
0668....  ARTHROPOD VIRUS NEC.................................        97
0669....  ARTHROPOD VIRUS NOS.................................        97
0700....  HEPATITIS A WITH COMA...............................        78
0701....  HEPATITIS A W/O COMA................................        41
07020...  HPT B ACTE COMA WO DLTA.............................        78
07021...  HPT B ACTE COMA W DLTA..............................        78
07022...  HPT B CHRN COMA WO DLTA.............................        78
07023...  HPT B CHRN COMA W DLTA..............................        78
07030...  HPT B ACTE WO CM WO DLTA............................        41
07031...  HPT B ACTE WO CM W DLTA.............................        41
07032...  HPT B CHRN WO CM WO DLTA............................        41
07033...  HPT B CHRN WO CM W DLTA.............................        41
07041...  HPT C ACUTE W HEPAT COMA............................        78

[[Page 47845]]

07042...  HPT DLT WO B W HPT COMA.............................        78
07043...  HPT E W HEPAT COMA..................................        78
07044...  CHRNC HPT C W HEPAT COMA............................        78
07049...  OTH VRL HEPAT W HPT COMA............................        78
07051...  HPT C ACUTE WO HPAT COMA............................        41
07052...  HPT DLT WO B WO HPT COMA............................        41
07053...  HPT E WO HEPAT COMA.................................        41
07054...  CHRNC HPT C WO HPAT COMA............................        41
07059...  OTH VRL HPAT WO HPT COMA............................        41
0706....  VIRAL HEPAT NOS W COMA..............................        78
0709....  VIRAL HEPAT NOS W/O COMA............................        41
071.....  RABIES..............................................        63
0720....  MUMPS ORCHITIS......................................        53
0721....  MUMPS MENINGITIS....................................        63
0722....  MUMPS ENCEPHALITIS..................................        63
0723....  MUMPS PANCREATITIS..................................        41
07271...  MUMPS HEPATITIS.....................................        41
07272...  MUMPS POLYNEUROPATHY................................        63
07279...  MUMPS COMPLICATION NEC..............................        97
0728....  MUMPS COMPLICATION NOS..............................        97
0729....  MUMPS UNCOMPLICATED.................................        97
0730....  ORNITHOSIS PNEUMONIA................................        33
0737....  ORNITHOSIS COMPLICAT NEC............................        97
0738....  ORNITHOSIS COMPLICAT NOS............................        97
0739....  ORNITHOSIS NOS......................................        97
0740....  HERPANGINA..........................................        31
0741....  EPIDEMIC PLEURODYNIA................................        33
07420...  COXSACKIE CARDITIS NOS..............................        36
07421...  COXSACKIE PERICARDITIS..............................        36
07422...  COXSACKIE ENDOCARDITIS..............................        36
07423...  COXSACKIE MYOCARDITIS...............................        36
0743....  HAND, FOOT & MOUTH DIS..............................        97
0748....  COXSACKIE VIRUS NEC.................................        97
075.....  INFECTIOUS MONONUCLEOSIS............................        97
0760....  TRACHOMA, INITIAL STAGE.............................        68
0761....  TRACHOMA, ACTIVE STAGE..............................        68
0769....  TRACHOMA NOS........................................        68
0770....  INCLUSION CONJUNCTIVITIS............................        68
0771....  EPIDEM KERATOCONJUNCTIV.............................        68
0772....  PHARYNGOCONJUNCT FEVER..............................        68
0773....  ADENOVIRAL CONJUNCT NEC.............................        68
0774....  EPIDEM HEM CONJUNCTIVIT.............................        68
0778....  VIRAL CONJUNCTIVITIS NEC............................        68
07798...  UNSP DS CONJUC CHLAMYDIA............................        97
07799...  UNSP DS CONJUC VIRUSES..............................        97
0780....  MOLLUSCUM CONTAGIOSUM...............................        18
07810...  VIRAL WARTS NOS.....................................        97
07811...  CONDYLOMA ACUMINATUM................................        97
07819...  OTH SPECFD VIRAL WARTS..............................        97
0782....  SWEATING FEVER......................................        97
0783....  CAT-SCRATCH DISEASE.................................        97
0784....  FOOT & MOUTH DISEASE................................        97
0785....  CYTOMEGALOVIRAL DISEASE.............................        97
0786....  HEM NEPHROSONEPHRITIS...............................        53
0787....  ARENAVIRAL HEM FEVER................................        97
07881...  EPIDEMIC VERTIGO....................................        31
07882...  EPIDEMIC VOMITING SYND..............................        41
07888...  OTH SPEC DIS CHLAMYDIAE.............................        97
07889...  OTH SPEC DIS VIRUSES................................        97
0790....  ADENOVIRUS INFECT NOS...............................        97
0791....  ECHO VIRUS INFECT NOS...............................        97
0792....  COXSACKIE VIRUS INF NOS.............................        97
0793....  RHINOVIRUS INFECT NOS...............................        97
0794....  HUMAN PAPILLOMA VIRUS...............................        97
07950...  RETROVIRUS, UNSPECIFIED.............................        86
07951...  HTLV-1 INFECTION OTH DIS............................        86
07952...  HTLV-II INFECTN OTH DIS.............................        86
07953...  HIV-2 INFECTION OTH DIS.............................        86
07959...  OTH SPECFIED RETROVIRUS.............................        86
07981...  HANTAVIRUS INFECTION................................        97
07988...  OTH SPCF CHLAMYDIAL INFC............................        97
07989...  OTH SPECF VIRAL INFECTN.............................        97
07998...  CHLAMYDIAL INFECTION NOS............................        97
07999...  VIRAL INFECTION NOS.................................        97
080.....  LOUSE-BORNE TYPHUS..................................        97
0810....  MURINE TYPHUS.......................................        97

[[Page 47846]]

0811....  BRILL'S DISEASE.....................................        97
0812....  SCRUB TYPHUS........................................        97
0819....  TYPHUS NOS..........................................        97
0820....  SPOTTED FEVERS......................................        97
0821....  BOUTONNEUSE FEVER...................................        97
0822....  NORTH ASIAN TICK FEVER..............................        97
0823....  QUEENSLAND TICK TYPHUS..............................        97
0828....  TICK-BORNE RICKETTS NEC.............................        97
0829....  TICK-BORNE RICKETTS NOS.............................        97
0830....  Q FEVER.............................................        97
0831....  TRENCH FEVER........................................        97
0832....  RICKETTSIALPOX......................................        97
0838....  RICKETTSIOSES NEC...................................        97
0839....  RICKETTSIOSIS NOS...................................        97
0840....  FALCIPARUM MALARIA..................................        97
0841....  VIVAX MALARIA.......................................        97
0842....  QUARTAN MALARIA.....................................        97
0843....  OVALE MALARIA.......................................        97
0844....  MALARIA NEC.........................................        97
0845....  MIXED MALARIA.......................................        97
0846....  MALARIA NOS.........................................        97
0847....  INDUCED MALARIA.....................................        97
0848....  BLACKWATER FEVER....................................        97
0849....  MALARIA COMPLICATED NEC.............................        97
0850....  VISCERAL LEISHMANIASIS..............................        97
0851....  CUTAN LEISHMANIAS URBAN.............................        18
0852....  CUTAN LEISHMANIAS ASIAN.............................        18
0853....  CUTAN LEISHMANIAS ETHIOP............................        18
0854....  CUTAN LEISHMANIAS AMER..............................        18
0855....  MUCOCUTAN LEISHMANIASIS.............................        18
0859....  LEISHMANIASIS NOS...................................        97
0860....  CHAGAS DISEASE OF HEART.............................        36
0861....  CHAGAS DIS OF OTH ORGAN.............................        97
0862....  CHAGAS DISEASE NOS..................................        97
0863....  GAMBIAN TRYPANOSOMIASIS.............................        97
0864....  RHODESIAN TRYPANOSOMIAS.............................        97
0865....  AFRICAN TRYPANOSOMA NOS.............................        97
0869....  TRYPANOSOMIASIS NOS.................................        97
0870....  LOUSE-BORNE RELAPS FEVER............................        97
0871....  TICK-BORNE RELAPS FEVER.............................        97
0879....  RELAPSING FEVER NOS.................................        97
0880....  BARTONELLOSIS.......................................        97
08881...  LYME DISEASE........................................        97
08882...  BABESIOSIS..........................................        97
08889...  OTH ARTHROPOD-BORNE DIS.............................        97
0889....  ARTHROPOD-BORNE DIS NOS.............................        97
0900....  EARLY CONG SYPH SYMPTOM.............................        97
0901....  EARLY CONGEN SYPH LATENT............................        97
0902....  EARLY CONGEN SYPH NOS...............................        97
0903....  SYPHILITIC KERATITIS................................        68
09040...  JUVENILE NEUROSYPH NOS..............................        63
09041...  CONGEN SYPH ENCEPHALITIS............................        63
09042...  CONGEN SYPH MENINGITIS..............................        63
09049...  JUVENILE NEUROSYPH NEC..............................        63
0905....  LATE CONGEN SYPH SYMPTOM............................        97
0906....  LATE CONGEN SYPH LATENT.............................        97
0907....  LATE CONGEN SYPH NOS................................        97
0909....  CONGENITAL SYPHILIS NOS.............................        97
0910....  PRIMARY GENITAL SYPHILIS............................        97
0911....  PRIMARY ANAL SYPHILIS...............................        41
0912....  PRIMARY SYPHILIS NEC................................        97
0913....  SECONDARY SYPH SKIN.................................        18
0914....  SYPHILITIC ADENOPATHY...............................        97
09150...  SYPHILITIC UVEITIS NOS..............................        68
09151...  SYPHILIT CHORIORETINITIS............................        68
09152...  SYPHILITIC IRIDOCYCLITIS............................        68
09161...  SYPHILITIC PERIOSTITIS..............................        24
09162...  SYPHILITIC HEPATITIS................................        41
09169...  SECOND SYPH VISCERA NEC.............................        41
0917....  SECOND SYPHILIS RELAPSE.............................        97
09181...  ACUTE SYPHIL MENINGITIS.............................        63
09182...  SYPHILITIC ALOPECIA.................................        18
09189...  SECONDARY SYPHILIS NEC..............................        97
0919....  SECONDARY SYPHILIS NOS..............................        97
0920....  EARLY SYPH LATENT RELAPS............................        97
0929....  EARLY SYPHIL LATENT NOS.............................        97

[[Page 47847]]

0930....  AORTIC ANEURYSM, SYPHIL.............................        36
0931....  SYPHILITIC AORTITIS.................................        36
09320...  SYPHIL ENDOCARDITIS NOS.............................        36
09321...  SYPHILITIC MITRAL VALVE.............................        36
09322...  SYPHILITIC AORTIC VALVE.............................        36
09323...  SYPHIL TRICUSPID VALVE..............................        36
09324...  SYPHIL PULMONARY VALVE..............................        36
09381...  SYPHILITIC PERICARDITIS.............................        36
09382...  SYPHILITIC MYOCARDITIS..............................        36
09389...  CARDIOVASCULAR SYPH NEC.............................        36
0939....  CARDIOVASCULAR SYPH NOS.............................        36
0940....  TABES DORSALIS......................................        63
0941....  GENERAL PARESIS.....................................        63
0942....  SYPHILITIC MENINGITIS...............................        63
0943....  ASYMPTOMAT NEUROSYPHILIS............................        63
09481...  SYPHILITIC ENCEPHALITIS.............................        63
09482...  SYPHILITIC PARKINSONISM.............................        63
09483...  SYPH DISSEM RETINITIS...............................        68
09484...  SYPHILITIC OPTIC ATROPHY............................        68
09485...  SYPH RETROBULB NEURITIS.............................        63
09486...  SYPHIL ACOUSTIC NEURITIS............................        31
09487...  SYPH RUPT CEREB ANEURYSM............................        63
09489...  NEUROSYPHILIS NEC...................................        63
0949....  NEUROSYPHILIS NOS...................................        63
0950....  SYPHILITIC EPISCLERITIS.............................        68
0951....  SYPHILIS OF LUNG....................................        33
0952....  SYPHILITIC PERITONITIS..............................        41
0953....  SYPHILIS OF LIVER...................................        41
0954....  SYPHILIS OF KIDNEY..................................        53
0955....  SYPHILIS OF BONE....................................        24
0956....  SYPHILIS OF MUSCLE..................................        24
0957....  SYPHILIS OF TENDON/BURSA............................        24
0958....  LATE SYMPT SYPHILIS NEC.............................        97
0959....  LATE SYMPT SYPHILIS NOS.............................        97
096.....  LATE SYPHILIS LATENT................................        97
0970....  LATE SYPHILIS NOS...................................        97
0971....  LATENT SYPHILIS NOS.................................        97
0979....  SYPHILIS NOS........................................        97
0980....  ACUTE GC INFECT LOWER GU............................        97
09810...  GC (ACUTE) UPPER GU NOS.............................        97
09811...  GC CYSTITIS (ACUTE).................................        53
09812...  GC PROSTATITIS (ACUTE)..............................        53
09813...  GC ORCHITIS (ACUTE).................................        97
09814...  GC SEM VESICULIT (ACUTE)............................        97
09815...  GC CERVICITIS (ACUTE)...............................        97
09816...  GC ENDOMETRITIS (ACUTE).............................        97
09817...  ACUTE GC SALPINGITIS................................        97
09819...  GC (ACUTE) UPPER GU NEC.............................        97
0982....  CHR GC INFECT LOWER GU..............................        97
09830...  CHR GC UPPER GU NOS.................................        53
09831...  GC CYSTITIS, CHRONIC................................        53
09832...  GC PROSTATITIS, CHRONIC.............................        53
09833...  GC ORCHITIS, CHRONIC................................        97
09834...  GC SEM VESICULITIS, CHR.............................        97
09835...  GC CERVICITIS, CHRONIC..............................        97
09836...  GC ENDOMETRITIS, CHRONIC............................        97
09837...  GC SALPINGITIS (CHRONIC)............................        97
09839...  CHR GC UPPER GU NEC.................................        97
09840...  GONOCOCCAL CONJUNCTIVIT.............................        68
09841...  GONOCOCCAL IRIDOCYCLITIS............................        68
09842...  GONOCOCCAL ENDOPHTHALMIA............................        68
09843...  GONOCOCCAL KERATITIS................................        68
09849...  GONOCOCCAL EYE NEC..................................        68
09850...  GONOCOCCAL ARTHRITIS................................        24
09851...  GONOCOCCAL SYNOVITIS................................        24
09852...  GONOCOCCAL BURSITIS.................................        24
09853...  GONOCOCCAL SPONDYLITIS..............................        24
09859...  GC INFECT JOINT NEC.................................        24
0986....  GONOCOCCAL INFEC PHARYNX............................        31
0987....  GC INFECT ANUS & RECTUM.............................        97
09881...  GONOCOCCAL KERATOSIS................................        68
09882...  GONOCOCCAL MENINGITIS...............................        63
09883...  GONOCOCCAL PERICARDITIS.............................        36
09884...  GONOCOCCAL ENDOCARDITIS.............................        36
09885...  GONOCOCCAL HEART DIS NEC............................        36
09886...  GONOCOCCAL PERITONITIS..............................        41

[[Page 47848]]

09889...  GONOCOCCAL INF SITE NEC.............................        97
0990....  CHANCROID...........................................        97
0991....  LYMPHOGRANULOMA VENEREUM............................        97
0992....  GRANULOMA INGUINALE.................................        97
0993....  REITER'S DISEASE....................................        24
09940...  UNSPCF NONGNCCL URETHRTS............................        97
09941...  CHLMYD TRACHOMATIS URETH............................        97
09949...  NONGC URTH OTH SPF ORGSM............................        97
09950...  OTH VD CHLM TRCH UNSP ST............................        97
09951...  OTH VD CHLM TRCH PHARYNX............................        97
09952...  OTH VD CHLM TRCH ANS RCT............................        97
09953...  OTH VD CHLM TRCH LOWR GU............................        97
09954...  OTH VD CHLM TRCH OTH GU.............................        97
09955...  OT VD CHLM TRCH UNSPF GU............................        97
09956...  OT VD CHLM TRCH PRTONEUM............................        97
09959...  OTH VD CHLM TRCH SPCF ST............................        97
0998....  VENEREAL DISEASE NEC................................        97
0999....  VENEREAL DISEASE NOS................................        97
1000....  LEPTOSPIROS ICTEROHEM...............................        97
10081...  LEPTOSPIRAL MENINGITIS..............................        63
10089...  LEPTOSPIRAL INFECT NEC..............................        63
1009....  LEPTOSPIROSIS NOS...................................        97
101.....  VINCENT'S ANGINA....................................        31
1020....  INITIAL LESIONS YAWS................................        18
1021....  MULTIPLE PAPILLOMATA................................        18
1022....  EARLY SKIN YAWS NEC.................................        18
1023....  HYPERKERATOSIS OF YAWS..............................        18
1024....  GUMMATA AND ULCERS, YAWS............................        18
1025....  GANGOSA.............................................        31
1026....  YAWS OF BONE & JOINT................................        24
1027....  YAWS MANIFESTATIONS NEC.............................        97
1028....  LATENT YAWS.........................................        97
1029....  YAWS NOS............................................        97
1030....  PINTA PRIMARY LESIONS...............................        18
1031....  PINTA INTERMED LESIONS..............................        18
1032....  PINTA LATE LESIONS..................................        97
1033....  PINTA MIXED LESIONS.................................        18
1039....  PINTA NOS...........................................        97
1040....  NONVENEREAL ENDEMIC SYPH............................        97
1048....  SPIROCHETAL INFECT NEC..............................        97
1049....  SPIROCHETAL INFECT NOS..............................        97
1100....  DERMATOPHYT SCALP/BEARD.............................        18
1101....  DERMATOPHYTOSIS OF NAIL.............................        18
1102....  DERMATOPHYTOSIS OF HAND.............................        18
1103....  DERMATOPHYTOSIS OF GROIN............................        18
1104....  DERMATOPHYTOSIS OF FOOT.............................        18
1105....  DERMATOPHYTOSIS OF BODY.............................        18
1106....  DEEP DERMATOPHYTOSIS................................        18
1108....  DERMATOPHYTOSIS SITE NEC............................        18
1109....  DERMATOPHYTOSIS SITE NOS............................        18
1110....  PITYRIASIS VERSICOLOR...............................        18
1111....  TINEA NIGRA.........................................        18
1112....  TINEA BLANCA........................................        18
1113....  BLACK PIEDRA........................................        18
1118....  DERMATOMYCOSES NEC..................................        18
1119....  DERMATOMYCOSIS NOS..................................        18
1120....  THRUSH..............................................        31
1121....  CANDIDAL VULVOVAGINITIS.............................        97
1122....  CANDIDIAS UROGENITAL NEC............................        97
1123....  CUTANEOUS CANDIDIASIS...............................        18
1124....  CANDIDIASIS OF LUNG.................................        33
1125....  DISSEMINATED CANDIDIASIS............................        97
11281...  CANDIDAL ENDOCARDITIS...............................        36
11282...  CANDIDAL OTITIS EXTERNA.............................        31
11283...  CANDIDAL MENINGITIS.................................        63
11284...  CANDIDAL ESOPHAGITIS................................        97
11285...  CANDIDAL ENTERITIS..................................        97
11289...  CANDIDIASIS SITE NEC................................        97
1129....  CANDIDIASIS SITE NOS................................        18
1140....  PRIMARY COCCIDIOIDOMYCOS............................        33
1141....  PRIM CUTAN COCCIDIOID...............................        18
1142....  COCCIDIOIDAL MENINGITIS.............................        63
1143....  PROGRESS COCCIDIOID NEC.............................        97
1144....  CH PL COCCIDIOIDOMYCOSIS............................        97
1145....  PL COCIDIOIDOMYCOSIS NOS............................        97
1149....  COCCIDIOIDOMYCOSIS NOS..............................        97

[[Page 47849]]

11500...  HISTOPLASMA CAPSULAT NOS............................        97
11501...  HISTOPLASM CAPSUL MENING............................        63
11502...  HISTOPLASM CAPSUL RETINA............................        68
11503...  HISTOPLASM CAPS PERICARD............................        36
11504...  HISTOPLASM CAPS ENDOCARD............................        36
11505...  HISTOPLASM CAPS PNEUMON.............................        33
11509...  HISTOPLASMA CAPSULAT NEC............................        97
11510...  HISTOPLASMA DUBOISII NOS............................        97
11511...  HISTOPLASM DUBOIS MENING............................        63
11512...  HISTOPLASM DUBOIS RETINA............................        68
11513...  HISTOPLASM DUB PERICARD.............................        36
11514...  HISTOPLASM DUB ENDOCARD.............................        36
11515...  HISTOPLASM DUB PNEUMONIA............................        33
11519...  HISTOPLASMA DUBOISII NEC............................        97
11590...  HISTOPLASMOSIS NOS..................................        97
11591...  HISTOPLASMOSIS MENINGIT.............................        63
11592...  HISTOPLASMOSIS RETINITIS............................        68
11593...  HISTOPLASMOSIS PERICARD.............................        36
11594...  HISTOPLASMOSIS ENDOCARD.............................        36
11595...  HISTOPLASMOSIS PNEUMONIA............................        33
11599...  HISTOPLASMOSIS NEC..................................        97
1160....  BLASTOMYCOSIS.......................................        97
1161....  PARACOCCIDIOIDOMYCOSIS..............................        97
1162....  LOBOMYCOSIS.........................................        97
1170....  RHINOSPORIDIOSIS....................................        97
1171....  SPOROTRICHOSIS......................................        97
1172....  CHROMOBLASTOMYCOSIS.................................        97
1173....  ASPERGILLOSIS.......................................        97
1174....  MYCOTIC MYCETOMAS...................................        97
1175....  CRYPTOCOCCOSIS......................................        97
1176....  ALLESCHERIOSIS......................................        97
1177....  ZYGOMYCOSIS.........................................        97
1178....  DEMATIACIOUS FUNGI INF..............................        97
1179....  MYCOSES NEC & NOS...................................        18
118.....  OPPORTUNISTIC MYCOSES...............................        97
1200....  SCHISTOSOMA HAEMATOBIUM.............................        53
1201....  SCHISTOSOMA MANSONI.................................        41
1202....  SCHISTOSOMA JAPONICUM...............................        97
1203....  CUTANEOUS SCHISTOSOMA...............................        18
1208....  SCHISTOSOMIASIS NEC.................................        97
1209....  SCHISTOSOMIASIS NOS.................................        97
1210....  OPISTHORCHIASIS.....................................        41
1211....  CLONORCHIASIS.......................................        41
1212....  PARAGONIMIASIS......................................        33
1213....  FASCIOLIASIS........................................        41
1214....  FASCIOLOPSIASIS.....................................        41
1215....  METAGONIMIASIS......................................        97
1216....  HETEROPHYIASIS......................................        97
1218....  TREMATODE INFECTION NEC.............................        97
1219....  TREMATODE INFECTION NOS.............................        97
1220....  ECHINOCOCC GRANUL LIVER.............................        41
1221....  ECHINOCOCC GRANUL LUNG..............................        33
1222....  ECHINOCOCC GRAN THYROID.............................        82
1223....  ECHINOCOCC GRANUL NEC...............................        97
1224....  ECHINOCOCC GRANUL NOS...............................        97
1225....  ECHINOCOC MULTILOC LIVER............................        41
1226....  ECHINOCOCC MULTILOC NEC.............................        97
1227....  ECHINOCOCC MULTILOC NOS.............................        97
1228....  ECHINOCOCCOSIS NOS LIVER............................        41
1229....  ECHINOCOCCOSIS NEC/NOS..............................        97
1230....  TAENIA SOLIUM INTESTINE.............................        41
1231....  CYSTICERCOSIS.......................................        41
1232....  TAENIA SAGINATA INFECT..............................        41
1233....  TAENIASIS NOS.......................................        41
1234....  DIPHYLLOBOTHRIAS INTEST.............................        41
1235....  SPARGANOSIS.........................................        41
1236....  HYMENOLEPIASIS......................................        41
1238....  CESTODE INFECTION NEC...............................        41
1239....  CESTODE INFECTION NOS...............................        41
124.....  TRICHINOSIS.........................................        97
1250....  BANCROFTIAN FILARIASIS..............................        97
1251....  MALAYAN FILARIASIS..................................        97
1252....  LOIASIS.............................................        97
1253....  ONCHOCERCIASIS......................................        97
1254....  DIPETALONEMIASIS....................................        97
1255....  MANSONELLA OZZARDI INFEC............................        97

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