Monday,

August 8, 2005

Part II

Department of 

Health and Human 

Services

Centers for Medicare & Medicaid Services 

42 CFR Part 405, et al. 

Medicare Program; Revisions to Payment 

Policies Under the Physician Fee 

Schedule for Calendar Year 2006; 

Proposed Rule

45764 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Part 405, 410, 411, 413, 414, 

and 426 

[CMS–1502–P] 

RIN 0938–AN84 

Medicare Program; Revisions to 

Payment Policies Under the Physician 

Fee Schedule for Calendar Year 2006

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS.

ACTION: Proposed rule.

SUMMARY: This proposed rule would 

refine the resource-based practice 

expense relative value units (PE RVUs) 

and propose changes to payment based 

on supplemental survey data for 

practice expense and revisions to our 

methodology for calculating practice 

expense RVUs, as well as make other 

proposed changes to Medicare Part B 

payment policy. We are also proposing 

policy changes related to revisions to 

malpractice RVUs, in addition to 

revising the list of telehealth services. In 

this proposed rule, we also discuss 

multiple procedure payment reduction 

for diagnostic imaging, and several 

coding issues. 

We are proposing these changes to 

ensure that our payment systems are 

updated to reflect changes in medical 

practice and the relative value of 

services. This proposed rule also 

discusses geographic locality changes; 

payment for covered outpatient drugs 

and biologicals; supplemental payments 

to federally qualified health centers 

(FQHCs); payment for renal dialysis 

services; the national coverage decision 

(NCD) process; coverage of screening for 

glaucoma; private contracts; and 

physician referrals for nuclear medicine 

services and supplies to health care 

entities with which they have financial 

relationships. 

In addition, we include discussions 

on payment for teaching 

anesthesiologists, the therapy cap, the 

chiropractic demonstration and the 

Sustainable Growth Rate (SGR).

DATES: Comment Date: Comments will 

be considered if we receive them at one 

of the addresses provided below, no 

later than 5 p.m. on September 30, 2005.

ADDRESSES: In commenting, please refer 

to file code CMS–1502–P. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

three ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on specific issues 

in this regulation to http://

www.cms.hhs.gov/regulations/

ecomments. (Attachments should be in 

Microsoft Word, WordPerfect, or Excel; 

however, we prefer Microsoft Word.) 

2. By mail. You may mail written 

comments (one original and two copies) 

to the following address ONLY: Centers 

for Medicare & Medicaid Services, 

Department of Health and Human 

Services, Attention: CMS–1502–P, P.O. 

Box 8017, Baltimore, MD 21244–8017. 

Please allow sufficient time for mailed 

comments to be received before the 

close of the comment period. 

3. By express or overnight mail. You 

may send written comments (one 

original and two copies) to the following 

address ONLY: Centers for Medicare & 

Medicaid Services, Department of 

Health and Human Services, Attention: 

CMS–1502–P, Mail Stop C4–26–05, 

7500 Security Boulevard, Baltimore, MD 

21244–1850. 

4. By hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments (one original 

and two copies) before the close of the 

comment period to one of the following 

addresses. If you intend to deliver your 

comments to the Baltimore address, 

please call telephone number (410) 786–

7197 in advance to schedule your 

arrival with one of our staff members. 

Room 445–G, Hubert H. Humphrey 

Building, 200 Independence Avenue, 

SW., Washington, DC 20201; or 7500 

Security Boulevard, Baltimore, MD 

21244–1850. 

(Because access to the interior of the 

HHH Building is not readily available to 

persons without Federal Government 

identification, commenters are 

encouraged to leave their comments in 

the CMS drop slots located in the main 

lobby of the building. A stamp-in clock 

is available for persons wishing to retain 

a proof of filing by stamping in and 

retaining an extra copy of the comments 

being filed.) 

Comments mailed to the addresses 

indicated as appropriate for hand or 

courier delivery may be delayed and 

received after the comment period. 

Submission of comments on 

paperwork requirements. You may 

submit comments on this document’s 

paperwork requirements by mailing 

your comments to the addresses 

provided at the end of the ‘‘Collection 

of Information Requirements’’ section in 

this document. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT:

Pam West (410) 786–2302 (for issues 

related to practice expense). 

Rick Ensor (410) 786–5617 (for issues 

related to the non-physician workpool 

and supplemental survey data). 

Stephanie Monroe (410) 786–6864 (for 

issues related to the geographic practice 

cost index). 

Craig Dobyski (410) 786–4584 (for 

issues related to list of telehealth 

services). 

Ken Marsalek (410) 786–4502 (for 

issues related to multiple procedure 

reduction for diagnostic imaging 

services and payment for teaching 

anesthesiologists). 

Henry Richter (410) 786–4562 (for 

issues related to payments for end stage 

renal disease facilities). 

Angela Mason (410) 786–7452 or 

Catherine Jansto (410) 786–7762 (for 

issues related to payment for covered 

outpatient drugs and biologicals). 

Fred Grabau (410) 786–0206 (for 

issues related to private contracts and 

opt out provision). 

David Worgo (410) 786–5919 (for 

issues related to Federally Qualified 

Health Centers). 

Vadim Lubarsky (410) 786–0840 (for 

issues related National Coverage 

Decision timeframes). 

Bill Larson (410) 786–7176 (for issues 

related to coverage of screening for 

glaucoma). 

Diane Milstead (410) 786–3355 or 

Gaysha Brooks (410) 786–9649 (for all 

other issues).

SUPPLEMENTARY INFORMATION:

Submitting Comments: We welcome 

comments from the public on all issues 

set forth in this rule to assist us in fully 

considering issues and developing 

policies. You can assist us by 

referencing the file code CMS–1502–P 

and the specific ‘‘issue identifier’’ that 

precedes the section on which you 

choose to comment. 

Inspection of Public Comments: All 

comments received before the close of 

the comment period are available for 

viewing by the public, including any 

personally identifiable or confidential 

business information that is included in 

a comment. CMS posts all electronic 

comments received before the close of 

the comment period on its public 

website as soon as possible after they 

have been received. Hard copy 

comments received timely will be 

available for public inspection as they 

are received, generally beginning 

approximately 3 weeks after publication 

of a document, at the headquarters of 

the Centers for Medicare & Medicaid 

Services, 7500 Security Boulevard, 

Baltimore, Maryland 21244, Monday 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45765

through Friday of each week from 8:30 

a.m. to 4 p.m. To schedule an 

appointment to view public comments, 

phone 1–800–743–3951. 

This Federal Register document is 

also available from the Federal Register

online database through GPO Access a 

service of the U.S. Government Printing 

Office. The Web site address is: http://

www.access.gpo.gov/nara/index.html. 

Information on the physician fee 

schedule can be found on the CMS 

homepage. You can access this data by 

using the following directions: 

1. Go to the CMS homepage (http://

www.cms.hhs.gov). 

2. Place your cursor over the word 

‘‘Professionals’’ in the blue areas near 

the top of the page. Select ‘‘physicians’’

from the drop-down menu. 

3. Under ‘‘Billing/Payment’’ select 

‘‘Physician Fee Schedule’’. 

To assist readers in referencing 

sections contained in this preamble, we 

are providing the following table of 

contents. Some of the issues discussed 

in this preamble affect the payment 

policies, but do not require changes to 

the regulations in the Code of Federal 

Regulations. Information on the 

regulation’s impact appears throughout 

the preamble and is not exclusively in 

section VI.

Table of Contents 

I. Background 

A. Introduction 

B. Development of the Relative Value 

System 

C. Components of the Fee Schedule 

Payment Amounts 

D. Most Recent Changes to the Fee 

Schedule 

II. Provisions of the Proposed Rule 

A. Resource-Based Practice Expense RVUs 

1. Current Methodology 

2. Practice Expense Proposals for Calendar 

Year 2006 

B. Geographic Practice Cost Indices 

C. Malpractice Relative Value Units (RVUs) 

D. Medicare Telehealth Services 

E. Contractor Pricing of Unlisted Therapy 

Modalities and Procedures 

F. Payment for Teaching Anesthesiologists 

G. End Stage Renal Disease (ESRD) Related 

Provisions 

1. Revised Pricing Methodology for 

Separately Billable Drugs and Biologicals 

Furnished by ESRD Facilities. 

2. Adjustment to Account for Changes in 

the Pricing of Separately Billable Drugs 

and Biologicals and the Estimated 

Increase in Expenditures for Drugs and 

Biologicals 

3. Proposed Revisions to Geographic 

Designations and Wage Indexes Applied 

to the End Stage Renal Disease 

Composite Payment Rate Wage Index 

4. Proposed Revisions to § 413.170 (Scope) 

and § 413.174 (Prospective rates for 

hospital-based and independent ESRD 

facilities) 

5. Proposed Revisions to the Composite 

Payment Rate Exceptions Process 

H. Payment for Covered Outpatient Drugs 

and Biologicals 

I. Private Contracts and Opt-out Provision 

J. Multiple Procedure Reduction for 

Diagnostic Imaging 

K. Therapy Cap 

L. Chiropractic Services Demonstration 

M. Supplemental Payments to Federally 

Qualified Health Centers (FQHCs) 

Subcontracting with Medicare 

Advantage Plans 

N. National Coverage Decisions 

Timeframes 

O. Coverage of Screening for Glaucoma 

P. Physician Referrals for Nuclear 

Medicine Services and Suppliers to 

Health Care Entities with Which They 

Have Financial Relationships 

Q. Sustainable Growth Rate 

III. Collection of Information Requirements 

IV. Response to Comments 

V. Regulatory Impact Analysis

Regulation Text 

Addendum A—Explanation and Use of 

Addendum B 

Addendum B—2006 Relative Value Units 

and Related Information Used in 

Determining Medicare Payments for 2006 

Addendum C—Codes for Which we Received 

Practice Expense Review Committee 

(PERC) Recommendations on Practice 

Expense Direct Cost Inputs. 

Addendum D—2006 Geographic Practice 

Cost Indices By Medicare Carrier and 

Locality 

Addendum E—Proposed 2006 Geographic 

Adjustment Factors (GAFs) 

Addendum F—ESRD Facilities Metropolitan 

Statistical Areas (MSA)/Core-Based 

Statistical Areas (CBSA) Crosswalk 

Addendum G—List of CPT/HCPCS Codes 

Used to Describe Nuclear Medicine 

Designated Health Services Under Section 

1877 of the Social Security Act

In addition, because of the many 

organizations and terms to which we refer by 

acronym in this proposed final rule, we are 

listing these acronyms and their 

corresponding terms in alphabetical order 

below:

AADA American Academy of Dermatology 

Association 

AAH American Association of Homecare 

ACC American College of Cardiology 

ACG American College of Gastroenterology 

ACR American College of Radiology 

AFROC Association of Freestanding 

Radiation Oncology Centers 

AGA American Gastroenterological 

Association 

AMA American Medical Association 

AMP Average manufacturer price 

ASA American Society of Anesthesiologists 

ASGE American Society of Gastrointestinal 

Endoscopy 

ASP Average sales price 

ASTRO American Society for Therapeutic 

Radiation Oncology 

ATA American Telemedicine Association 

AUA American Urological Association 

AWP Average wholesale price 

BBA Balanced Budget Act of 1997 

BBRA Balanced Budget Refinement Act of 

1999 

BES (Bureau of the Census’) Business 

Expenditure Survey 

BIPA Benefits Improvement and Protection 

Act of 2000 

BLS Bureau of Labor Statistics 

BMI Body mass index 

BNF Budget neutrality factor 

BSA Body surface area 

CAP College of American Pathologists 

CBSA Core-Based Statistical Area

CF Conversion factor 

CFR Code of Federal Regulations 

CMA California Medical Association 

CMS Centers for Medicare & Medicaid 

Services 

CNS Clinical nurse specialist 

CPEP Clinical Practice Expert Panel 

CPI Consumer Price Index 

CPO Care Plan Oversight 

CPT (Physicians’) Current Procedural 

Terminology (4th Edition, 2002, 

copyrighted by the American Medical 

Association) 

CRNA Certified Registered Nurse 

Anesthetist 

CT Computed tomography 

CTA Computed tomographic angiography 

CY Calendar year 

DHS Designated health services 

DME Durable medical equipment 

DMERC Durable Medical Equipment 

Regional Carrier 

DSMT Diabetes outpatient self-management 

training services 

E&M Evaluation and management 

EPO Erythopoeitin 

ESRD End stage renal disease 

FAX Facsimile 

FI Fiscal intermediary 

FQHC Federally qualified healthcare center 

FR Federal Register 

GAF Geographic adjustment factor 

GAO General Accounting Office 

GPCI Geographic practice cost index 

HCPAC Health Care Professional Advisory 

Committee 

HCPCS Healthcare Common Procedure 

Coding System 

HHA Home health agency 

HHS (Department of) Health and Human 

Services 

HOCM High Osmolar Contrast Media 

HPSA Health professional shortage area 

HRSA Health Resources Services 

Administration (HHS) 

IDTFs Independent diagnostic testing 

facilities 

IPF Inpatient psychiatric facility 

IPPS Inpatient prospective payment system 

IRF Inpatient rehabilitation facility 

ISO Insurance Services Office 

IVIG Intravenous immune globulin 

JCAAI Joint Council of Allergy, Asthma, 

and Immunology 

JUA Joint underwriting association 

LCD Local coverage determination 

LTCH Long-term care hospital 

LOCM Low Osmolar Contrast Media 

MA Medicare Advantage 

MCAC Medicare Coverage Advisory 

Committee 

MCG Medical College of Georgia 

MedPAC Medicare Payment Advisory 

Commission 

MEI Medicare Economic Index 

45766 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

MMA Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 

MNT Medical nutrition therapy 

MRA Magnetic resonance angiography 

MRI Magnetic resonance imaging 

MSA Metropolitan statistical area 

NCD National coverage determination 

NCQDIS National Coalition of Quality 

Diagnostic Imaging Services 

NDC National drug code 

NECMA New England County Metropolitan 

Area 

NECTA New England City and Town Area 

NP Nurse practitioner 

NPP Nonphysician practitioners 

OBRA Omnibus Budget Reconciliation Act 

OIG Office of Inspector General 

OMB Office of Management and Budget 

OPPS Outpatient prospective payment 

system 

PA Physician assistant 

PC Professional component 

PE Practice Expense 

PEAC Practice Expense Advisory 

Committee 

PERC Practice Expense Review Committee 

PET Positron emission tomography 

PFS Physician Fee Schedule 

PLI Professional liability insurance 

PPI Producer price index 

PPO Preferred provider organization 

PPS Prospective payment system 

PRA Paperwork Reduction Act 

PT Physical therapy 

RFA Regulatory Flexibility Act 

RIA Regulatory impact analysis 

RN Registered nurse 

RUC (AMA’s Specialty Society) Relative 

(Value) Update Committee 

RVU Relative value unit 

SGR Sustainable growth rate 

SMS (AMA’s) Socioeconomic Monitoring 

System 

SNF Skilled nursing facility 

SNM Society for Nuclear Medicine 

TA Technology assessment 

TC Technical component 

tPA Tissue-type plasminogen activator 

UAF Update adjustment factor 

WAC Wholesale acquisition cost 

WAMP Widely available market price

I. Background 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘BACKGROUND’’ at the beginning of 

your comments.] 

A. Introduction 

Since January 1, 1992, Medicare has 

paid for physicians’ services under 

section 1848 of the Social Security Act 

(the Act), ‘‘Payment for Physicians’

Services.’’ The Act requires that 

payments under the physician fee 

schedule (PFS) be based on national 

uniform relative value units (RVUs) 

based on the resources used in 

furnishing a service. Section 1848(c) of 

the Act requires that national RVUs be 

established for physician work, practice 

expense (PE), and malpractice expense. 

Prior to the establishment of the 

resource-based relative value system, 

Medicare payment for physicians’

services was based on reasonable 

charges. 

B. Development of the Relative Value 

System 

1. Work RVUs 

The concepts and methodology 

underlying the PFS were enacted as part 

of the Omnibus Budget Reconciliation 

Act (OBRA) of 1989, Pub. L. 101–239, 

and OBRA 1990, (Pub. L. 101–508). The 

final rule, published November 25, 1991 

(56 FR 59502), set forth the fee schedule 

for payment for physicians’ services 

beginning January 1, 1992. Initially, 

only the physician work RVUs were 

resource-based, and the PE and 

malpractice RVUs were based on 

average allowable charges. 

The physician work RVUs established 

for the implementation of the fee 

schedule in January 1992 were 

developed with extensive input from 

the physician community. A research 

team at the Harvard School of Public 

Health developed the original physician 

work RVUs for most codes in a 

cooperative agreement with the 

Department of Health and Human 

Services. In constructing the codespecific vignettes for the original 

physician work RVUs, Harvard worked 

with panels of experts, both inside and 

outside the government and obtained 

input from numerous physician 

specialty groups. 

Section 1848(b)(2)(A) of the Act 

specifies that the RVUs for radiology 

services are based on relative value 

scale we adopted under section 

1834(b)(1)(A) of the Act, (the American 

College of Radiology (ACR) relative 

value scale), which we integrated into 

the overall PFS. Section 1848(b)(2)(B) of 

the Act specifies that the RVUs for 

anesthesia services are based on RVUs 

from a uniform relative value guide. We 

established a separate conversion factor 

(CF) for anesthesia services, and we 

continue to utilize time units as a factor 

in determining payment for these 

services. As a result, there is a separate 

payment methodology for anesthesia 

services. 

We establish physician work RVUs for 

new and revised codes based on 

recommendations received from the 

American Medical Association’s (AMA) 

Specialty Society Relative Value Update 

Committee (RUC). 

2. Practice Expense Relative Value Units 

(PE RVUs) 

Section 121 of the Social Security Act 

Amendments of 1994 (Pub. L. 103–432), 

enacted on October 31, 1994, amended 

section 1848(c)(2)(C)(ii) of the Act and 

required us to develop resource-based 

PE RVUs for each physician’s service 

beginning in 1998. We were to consider 

general categories of expenses (such as 

office rent and wages of personnel, but 

excluding malpractice expenses) 

comprising practice expenses. 

Section 4505(a) of the Balanced 

Budget Act of 1997 (BBA) (Pub. L. 105–

33), amended section 1848(c)(2)(C)(ii) of 

the Act to delay implementation of the 

resource-based PE RVU system until 

January 1, 1999. In addition, section 

4505(b) of the BBA provided for a 4-year 

transition period from charge-based PE 

RVUs to resource-based RVUs. 

We established the resource-based PE 

RVUs for each physician’s service in a 

final rule, published November 2, 1998 

(63 FR 58814), effective for services 

furnished in 1999. Based on the 

requirement to transition to a resourcebased system for PE over a 4-year 

period, resource-based PE RVUs did not 

become fully effective until 2002. 

This resource-based system was based 

on two significant sources of actual PE 

data: The Clinical Practice Expert Panel 

(CPEP) data and the AMA’s 

Socioeconomic Monitoring System 

(SMS) data. The CPEP data were 

collected from panels of physicians, 

practice administrators, and 

nonphysicians (for example, registered 

nurses) nominated by physician 

specialty societies and other groups. 

The CPEP panels identified the direct 

inputs required for each physician’s 

service in both the office setting and 

out-of-office setting. The AMA’s SMS 

data provided aggregate specialtyspecific information on hours worked 

and practice expenses. 

Separate PE RVUs are established for 

procedures that can be performed in 

both a nonfacility setting, such as a 

physician’s office, and a facility setting, 

such as a hospital outpatient 

department. The difference between the 

facility and nonfacility RVUs reflects 

the fact that a facility receives separate 

payment from Medicare for its costs of 

providing the service, apart from 

payment under the PFS. The nonfacility 

RVUs reflect all of the direct and 

indirect practice expenses of providing 

a particular service.

Section 212 of the Balanced Budget 

Refinement Act of 1999 (BBRA) (Pub. L. 

106–113) directed the Secretary to 

establish a process under which we 

accept and use, to the maximum extent 

practicable and consistent with sound 

data practices, data collected or 

developed by entities and organizations 

to supplement the data we normally 

collect in determining the PE 

component. On May 3, 2000, we 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45767

published the interim final rule (65 FR 

25664) that set forth the criteria for the 

submission of these supplemental PE 

survey data. The criteria were modified 

in response to comments received, and 

published in the Federal Register (65 

FR 65376) as part of a November 1, 2000 

final rule. The PFS final rules published 

in 2001 and 2003, respectively, (66 FR 

55246 and 68 FR 63196) extended the 

period during which we would accept 

these supplemental data. 

3. Resource-Based Malpractice RVUs 

Section 4505(f) of the BBA amended 

section 1848(c) of the Act to require us 

to implement resource-based 

malpractice RVUs for services furnished 

on or after 2000. The resource-based 

malpractice RVUs were implemented in 

the PFS final rule published November 

2, 1999 (64 FR 59380). The malpractice 

RVUs were based on malpractice 

insurance premium data collected from 

commercial and physician-owned 

insurers from all the States, the District 

of Columbia, and Puerto Rico. 

4. Refinements to the RVUs 

Section 1848(c)(2)(B)(i) of the Act 

requires that we review all RVUs no less 

often than every five years. The first 5-

year review of the physician work RVUs 

went into effect in 1997, published on 

November 22, 1996 (61 FR 59489). The 

second 5-year review went into effect in 

2002, published on November 1, 2001 

(66 FR 55246). The next scheduled 5-

year review is scheduled to go into 

effect in 2007. 

In 1999, the AMA’s RUC established 

the Practice Expense Advisory 

Committee (PEAC) for the purpose of 

refining the direct PE inputs. Through 

March of 2004, the PEAC provided 

recommendations to CMS for over 7,600 

codes (all but a few hundred of the 

codes currently listed in the AMA’s 

Current Procedural Terminology (CPT) 

codes). 

In the November 15, 2004, PFS final 

rule (69 FR 66236), we implemented the 

first 5-year review of the malpractice 

RVUs (69 FR 66263). 

5. Adjustments to RVUs are Budget 

Neutral 

Section 1848(c)(2)(B)(ii)(II) of the Act 

provides that adjustments in RVUs for a 

year may not cause total PFS payments 

to differ by more than $20 million from 

what they would have been if the 

adjustments were not made. In 

accordance with section 

1848(c)(2)(B)(ii)(II) of the Act, if 

adjustments to RVUs cause 

expenditures to change by more than 

$20 million, we make adjustments to 

ensure that expenditures do not increase 

or decrease by more than $20 million. 

C. Components of the Fee Schedule 

Payment Amounts 

To calculate the payment for every 

physician service, the components of 

the fee schedule (physician work, PE, 

and malpractice RVUs) are adjusted by 

a geographic practice cost index (GPCI). 

The GPCIs reflect the relative costs of 

physician work, practice expenses, and 

malpractice insurance in an area 

compared to the national average costs 

for each component. 

Payments are converted to dollar 

amounts through the application of a 

CF, which is calculated by the Office of 

the Actuary and is updated annually for 

inflation. 

The general formula for calculating 

the Medicare fee schedule amount for a 

given service and fee schedule area can 

be expressed as: 

Payment = [(RVU work x GPCI work) 

+ (RVU PE x GPCI PE) + (RVU 

malpractice x GPCI malpractice)] x CF. 

D. Most Recent Changes to the Fee 

Schedule 

In the November 15, 2004 PFS final 

rule (69 FR 66236), we refined the 

resource-based PE RVUs and made other 

changes to Medicare Part B payment 

policy. These policy changes included—

• Supplemental survey data for PE; 

• Updated GPCIs for physician work 

and PE; 

• Updated malpractice RVUs; 

• Revised requirements for 

supervision of therapy assistants; 

• Revised payment rules for low 

osmolar contrast media; 

• Payment policies for physicians and 

practitioners managing dialysis patients; 

• Clarification of care plan oversight 

CPO) requirements; 

• Requirements for supervision of 

diagnostic psychological testing 

services; 

• Clarifications to the policies 

affecting therapy services provided 

incident to a physician’s service; 

• Requirements for assignment of 

Medicare claims; 

• Additions to the list of telehealth 

services; 

• Changes to payments for drug 

administration services; and 

• Several coding issues. 

The November 15, 2004, final rule 

also addressed the following provisions 

of the Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 (MMA) (Pub. L. 108–173):

• Coverage of an initial preventive 

physical examination. 

• Coverage of cardiovascular 

screening blood tests. 

• Coverage of diabetes screening tests. 

• Incentive payment improvements 

for physicians in physician shortage 

areas. 

• Changes to payment for covered 

outpatient drugs and biologicals and 

drug administration services. 

• Changes to payment for renal 

dialysis services. 

• Coverage of routine costs associated 

with certain clinical trials of category A 

devices as defined by the Food and Drug 

Administration. 

• Coverage of hospice consultation 

service. 

• Indexing the Part B deductible to 

inflation. 

• Extension of coverage of 

intravenous immune globulin (IVIG) for 

the treatment in the home of primary 

immune deficiency diseases. 

• Revisions to reassignment 

provisions. 

• Payment for diagnostic 

mammograms. 

• Coverage of religious nonmedical 

health care institution items and 

services to the beneficiary’s home. 

In addition, the November 15, 2004 

PFS final rule finalized the calendar 

year (CY) 2004 interim RVUs for new 

and revised codes in effect during CY 

2004 and issued interim RVUs for new 

and revised procedure codes for CY 

2005; updated the codes subject to the 

physician self-referral prohibition; 

discussed payment for set-up of portable 

x-ray equipment; discussed the third 5-

year refinement of work RVUs; and 

solicited comments on potentially 

misvalued work RVUs. 

In accordance with section 

1848(d)(1)(E) of the Act, we also 

announced that the PFS update for CY 

2005 would be 1.5 percent; the initial 

estimate for the sustainable growth rate 

for CY 2005 is 4.3; and the CF for CY 

2005 is $37.8975. 

II. Provisions of the Proposed Rule 

This proposed rule would affect the 

regulations set forth at Part 405, Federal 

Health Insurance for the Aged and 

Disabled; Part 410, Supplementary 

Medical Insurance (SMI) Benefits; Part 

411, Exclusions from Medicare and 

Limitations on Medicare Payment; Part 

413, Principles of Reasonable Cost 

Reimbursement, Payment for End-Stage 

Renal Disease Services, Prospectively 

Determined Payment Rates for Skilled 

Nursing Facilities; 414, Payment for Part 

B Medical and Other Health Services; 

Part 426, Review of National Coverage 

Determinations and Local Coverage 

Determinations. 

45768 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

A. Resource-Based Practice Expense 

(PE) RVUs 

Based on section 1848(c)(1)(B) of the 

Act practice expenses are the portion of 

the resources used in furnishing the 

service that reflects the general 

categories of physician and practitioner 

expenses (such as office rent and wages 

of personnel, but excluding malpractice 

expenses). 

Section 121 of the Social Security 

Amendments of 1994 (Pub. L. 103–432), 

enacted on October 31, 1994, required 

us to develop a methodology for a 

resource-based system for determining 

PE RVUs for each physician’s service. 

Up until this point, physicians’ practice 

expenses were based on historical 

allowed charges. This legislation stated 

that the revised PE methodology must 

consider the staff, equipment, and 

supplies used in the provision of 

various medical and surgical services in 

various settings beginning in 1998. The 

Secretary has interpreted this to mean 

that Medicare payments for each service 

would be based on the relative PE 

resources typically involved with 

performing the service. 

The initial implementation of 

resource-based PE RVUs was delayed 

until January 1, 1999, by section 4505(a) 

of the BBA 1997. In addition, section 

4505(b) of the BBA 1997 required the 

new payment methodology be phased-in 

over 4 years, effective for services 

furnished in CY 1999, and fully 

effective in CY 2002. The first step 

toward implementation called for by the 

statute was to adjust the PE values for 

certain services for CY 1998. Section 

4505(d) of BBA 1997 required that, in 

developing the resource-based PE RVUs, 

the Secretary must: 

• Use, to the maximum extent 

possible, generally accepted cost 

accounting principles that recognize all 

staff, equipment, supplies, and 

expenses, not solely those that can be 

linked to specific procedures. 

• Develop a refinement method to be 

used during the transition. 

• Consider, in the course of notice 

and comment rulemaking, impact 

projections that compare new proposed 

payment amounts to data on actual 

physician PEs. 

Beginning in CY 1999, Medicare 

began the four year transition to 

resource-based PE RVUs. In CY 2002, 

the resource-based PE RVUs were fully 

transitioned. 

1. Current Methodology 

The following sections discuss the 

current PE methodology. 

a. Data Sources 

There are two primary data sources 

used to calculate PEs. The American 

Medical Association’s (AMA) 

Socioeconomic Monitoring System 

(SMS) survey data are used to develop 

the PEs per hour for each specialty. The 

second source of data used to calculate 

PEs was originally developed by the 

Clinical Practice Expert Panels (CPEP). 

The CPEP data include the supplies, 

equipment and staff times specific to 

each procedure.

The AMA developed the SMS survey 

in 1981 and discontinued it in 1999. 

Beginning in 2002, we incorporated the 

1999 SMS survey data into our 

calculation of the PE RVUs, using a 5-

year average of SMS survey data. (See 

Revisions to Payment Policies and FiveYear Review of and Adjustments to the 

Relative Value Units Under the 

Physician Fee Schedule for Calendar 

Year 2002 final rule, published 

November 1, 2001 (66 FR 55246).) The 

SMS PE survey data are adjusted to a 

common year, 1995. The SMS data 

provide the following six categories of 

PE costs: 

• Clinical payroll expenses, which 

are payroll expenses (including fringe 

benefits) for nonphysician personnel. 

• Administrative payroll expenses, 

which are payroll expenses (including 

fringe benefits) for nonphysician 

personnel involved in administrative, 

secretarial or clerical activities. 

• Office expenses, which include 

expenses for rent, mortgage interest, 

depreciation on medical buildings, 

utilities and telephones. 

• Medical material and supply 

expenses, which include expenses for 

drugs, x-ray films, and disposable 

medical products. 

• Medical equipment expenses, 

which include expenses depreciation, 

leases, and rent of medical equipment 

used in the diagnosis or treatment of 

patients. 

• All other expenses, which include 

expenses for legal services, accounting, 

office management, professional 

association memberships, and any 

professional expenses not mentioned 

above. 

In accordance with section 212 of the 

BBRA, we established a process to 

supplement the SMS data for a specialty 

with data collected by entities and 

organizations other than the AMA (that 

is, the specialty itself). (See the Criteria 

for Submitting Supplemental Practice 

Expense Survey Data interim final rule 

with comment period, published on 

May 3, 2000 (65 FR 25664).) Originally, 

the deadline to submit supplementary 

survey data was through August 1, 2001. 

This deadline was extended in the 

November 1, 2001 final rule through 

August 1, 2003. (See the Revisions to 

Payment Policies and Five-Year Review 

of and Adjustments to the Relative 

Value Units Under the Physician Fee 

Schedule for Calendar Year 2002 final 

rule, published on November 1, 2001 

(66 FR 55246).) Then, to ensure 

maximum opportunity for specialties to 

submit supplementary survey data, we 

extended the deadline to submit surveys 

until March 1, 2005. (See the Revisions 

to Payment Policies Under the 

Physician Fee Schedule for Calendar 

Year 2002 final rule, published on 

November 7, 2003 (68 FR 63196).) 

The CPEPs consisted of panels of 

physicians, practice administrators, and 

nonphysicians (registered nurses (RNs), 

for example) who were nominated by 

physician specialty societies and other 

groups. There were 15 CPEPs consisting 

of 180 members from more than 61 

specialties and subspecialties. 

Approximately 50 percent of the 

panelists were physicians. 

The CPEPs identified specific inputs 

involved in each physician service 

provided in an office or facility setting. 

The inputs identified were the quantity 

and type of nonphysician labor, medical 

supplies, and medical equipment. 

In 1999, the AMA’s RUC established 

the Practice Expense Advisory 

Committee (PEAC). Since 1999, and 

until March 2004, the PEAC, a multispecialty committee, reviewed the 

original CPEP inputs and provided us 

with recommendations for refining 

these direct PE inputs for existing CPT 

codes. Through its last meeting in 

March 2004, the PEAC provided 

recommendations which we have 

reviewed and accepted for over 7,600 

codes. As a result of this scrutiny, the 

current CPEP inputs differ markedly 

from those originally recommended by 

the CPEPs. The PEAC has now been 

replaced by the Practice Expense 

Review Committee (PERC), which acts 

to assist the RUC in recommending PE 

inputs. 

b. Allocation of Practice Expenses to 

Services 

In order to establish PE RVUs for 

specific services, it is necessary to 

establish the direct and indirect PE 

associated with each service. Our 

current approach allocates aggregate 

specialty practice costs to specific 

procedures and, thus, is often referred to 

as a ‘‘top-down’’ approach. The 

specialty PEs are derived from the 

AMA’s SMS survey and supplementary 

survey data. The PEs for a given 

specialty are allocated to the services 

performed by that specialty on the basis 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45769

of the CPEP data and work RVUs 

assigned to each CPT code. The specific 

process is detailed as follows: 

Step 1—Calculation of the SMS Cost 

Pool for Each Specialty 

The six SMS cost categories can be 

described as either direct or indirect 

expenses. The three direct expense 

categories include clinical labor, 

medical supplies and medical 

equipment. Indirect expenses include 

administrative labor, office expense, and 

all other expenses. We combine these 

indirect expenses into a single category. 

The SMS cost pool for each specialty is 

calculated as follows: 

• The specialty PE per hour (PE/HR) 

for each of the three direct and one 

indirect cost categories from the SMS is 

calculated by dividing the aggregate PE 

per specialty by the specialty’s total 

hours spent in patient care activities 

(also determined by the SMS survey). 

The PE/HR is divided by 60 seconds to 

obtain the PE per minute (PE/MIN). 

• Each specialty’s PE pools (for each 

of the three direct and one indirect cost 

categories) are created by multiplying 

the PE/MIN for the specialty by the total 

time the specialty spent treating 

Medicare patients for all procedures 

(determined using Medicare utilization 

data). Physician time on a procedurespecific level is available through RUC 

surveys of new or revised codes and 

through surveys conducted as part of 

the 5 year review process. For codes that 

the RUC has not yet reviewed, the 

original data from the Harvard resourcebased RVU system survey is used. 

Physician time includes time spent on 

the case prior to, during, and after the 

procedure. The physician procedure 

time is multiplied by the frequency that 

each procedure is performed on 

Medicare patients by the specialty. 

• The total specialty-specific SMS PE 

for each cost category is the sum, for 

each direct and indirect cost category, of 

all of the procedure-specific total PEs.

Table 1 illustrates an example of the 

calculation of the total SMS cost pools 

for the three direct and one indirect cost 

categories discussed in step 1. For this 

specialty, PE/HR for clinical payroll 

expenses is $9.30 per hour. The hourly 

rate is divided by 60 minutes to obtain 

the clinical payroll per minute for the 

specialty. 

The total clinical payroll for 

providing hypothetical procedure 00001 

for this specialty of $3,633,465 is the 

result of taking the clinical payroll per 

minute of $0.16; multiplying this by the 

physician time for procedure 00001 (56 

minutes); and multiplying the result by 

the number of times this procedure was 

provided to Medicare patients by this 

specialty (418,602). The total amount 

spent on clinical payroll in this 

specialty is $667,457,018. This amount 

is calculated by summing the clinical 

payroll expenses of procedure 00001 

and all of the other services provided by 

this specialty.

TABLE 1.—CALCULATION OF SMS COST POOL

Standard methodology 

Clinical

payroll

(A) 

Medical

supplies

(B) 

Medical

equipment

(C) 

Indirect

expenses

(D) 

Total *

(E) 

(a) PE/HR ................................................................... $9.30 $4.80 $7.40 $46.50 $68.00 

(b) PE/Minute ............................................................. $0.16 $0.08 $0.12 $0.78 $1.13 

(c) Physician Time—00001 ........................................ 56 56 56 56 56 

(d) Number of Services .............................................. 418,602 418,602 418,602 418,602 418,602 

(e) Subtotal ................................................................ $3,633,465 $1,875,337 $2,891,144 $18,167,327 $26,567,274 

(f) All Other Services ................................................. $663,823,552 $342,618,608 $528,203,687 $3,319,117,762 $4,853,763,609 

(g) Total—SMS Pool .................................................. $667,457,018 $344,493,945 $531,094,831 $3,337,285,089 $4,880,330,883 

(b) = (a)/60 

(e) = (b)*(c)*(d) 

(g) = (e)+(f) 

* Components may not add to totals due to rounding. 

Step 2—Calculation of CPEP Cost Pool 

CPEP data provide expenditure 

amounts for the direct expense 

categories (clinical labor, supplies and 

equipment cost) at the procedure level. 

Multiplying the CPEP procedure-level 

PEs for each of these three categories by 

the number of times the specialty 

provided the procedure, produces a 

total category cost, per procedure, for 

that specialty. The sum of the total 

expenses from each procedure results in 

the total CPEP category cost for the 

specialty. 

For example, in Table 2, using CPEP 

data, the clinical labor cost of procedure 

00001 is $65.23. Under the methodology 

described above in this step, this is 

multiplied by the number of services for 

the specialty (418,602), to yield the total 

CPEP data clinical labor cost of the 

procedure: $27,305,408. In this 

example, the clinical labor cost for all 

other services performed by this 

specialty is $831,618,600. Therefore, the 

entire clinical labor CPEP expense pool 

for the specialty is $858,924,008. Step 2 

is repeated to calculate the CPEP supply 

and equipment costs.

TABLE 2.—CALCULATION OF CPEP COST POOL

Standard

methodology 

Clinical

labor

(A) 

Supplies

(B) 

Equipment

(C) 

(a) CPT 00001 ....................................................................................................................... $65.23 $52.49 $1,556.86 

(b) Allowed Services .............................................................................................................. 418,602 418,602 418,602 

(c) Subtotal ............................................................................................................................ $27,305,408 $21,972,838 $651,704,875 

(d) All Other Services ............................................................................................................ $831,618,600 $389,921,779 $5,277,570,148 

(e) Total CPEP Pool .............................................................................................................. $858,924,008 $411,894,617 $5,929,275,023 

(c) = (a)*(b) 

(e) = (c)+(d) 

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Step 3—Calculation and Application of 

Scaling Factors 

This step ensures that the total of the 

CPEP costs across all procedures 

performed by the specialty equates with 

the total direct costs for the specialty as 

reflected by the SMS data. To 

accomplish this, the CPEP data are 

scaled to SMS data by means of a 

scaling factor so that the total CPEP 

costs for each specialty equals the total 

SMS cost for the specialty. (The scaling 

factor is calculated by dividing the 

specialty’s SMS pool by the specialty’s 

CPEP pool.) 

The unscaled CPEP cost per 

procedure value, at the direct cost level, 

is then multiplied by the respective 

specialty scalar to yield the scaled CPEP 

procedure value. The sum of the scaled 

CPEP direct cost pool expenditures 

equals the total scaled direct expense for 

the specific procedure at the specialty 

level. 

In the Step 3 example shown in Table 

3, the SMS total clinical labor costs for 

the specialty is $667,457,018. This 

amount divided by the CPEP total 

clinical labor amount of $858,924,008 

yields a scaling factor of 0.78. The CPEP 

clinical labor cost for hypothetical 

procedure 00001 is $65.23. Multiplying 

the 0.78 scaling factor for clinical labor 

costs by $65.23 yields the scaled clinical 

labor cost amount of $50.69. Individual 

scaling factors must also be calculated 

for supply and equipment expenses. 

The sum of the scaled direct cost values, 

$50.69, $43.90 and $139.45, 

respectively, equals the total scaled 

direct expense of $234.04.

Step 4—Calculation of Indirect 

Expenses 

Indirect PEs cannot be directly 

attributed to a specific service because 

they are incurred by the practice as a 

whole. Indirect costs include rent, 

utilities, office equipment and supplies, 

and accounting and legal fees. There is 

not a single, universally accepted 

approach for allocating indirect practice 

costs to individual procedure codes. 

Rather allocation involves judgment in 

identifying the base or bases that are the 

best measures of a practice’s indirect 

costs. 

To allocate the indirect PEs to a 

specific service, we use the following 

methodology: 

• The scaled direct expenses and the 

converted work RVU (the work RVU for 

the service is multiplied by $34.5030, 

the 1995 CF) are added together, and 

then multiplied by the number of 

services provided by the specialty to 

Medicare patients; 

• The total indirect PEs per specialty 

are calculated by summing the indirect 

expenses for all other procedures 

provided by that specialty. 

In the Table 4, the physician work 

RVU for procedure 00001 is 2.36. 

Multiplying the work RVU by the 1995 

CF of $34.5030 equals $81.43. The 

physician work value is added to the 

scaled total direct expense from Step 3 

($234.04). The total of $314.47 is a 

proxy for the indirect PE for the 

specialty attributed to this procedure. 

The total indirect expenses are then 

multiplied by the number of services 

provided by the specialty (418,602), to 

calculate total indirect expenses for this 

procedure of $132,055,728. The process 

is repeated across all procedures 

performed by the specialty, and the 

indirect expenses for each service are 

summed to arrive at the total specialty 

indirect PE pool of $6,745,545,434.

TABLE 4.—CALCULATION OF INDIRECT EXPENSE

Standard methodology Physician 

work* 

Total direct expense Total 

(A) (B) (C) 

(a) CPT 00001 ....................................................................................................................... $81.43 $234.04 $315.47 

(b) Allowed Services .............................................................................................................. ........................ ........................ 418,602 

(c) Subtotal ............................................................................................................................ ........................ ........................ $132,055,728 

(d) All Other Services ............................................................................................................ ........................ ........................ $6,613,489,706 

(e) Total Indirect Expense ..................................................................................................... ........................ ........................ $6,745,545,434 

*Calculated by multiplying work RVU of 2.36 by 1995 conversion factor of $34.5030. 


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Step 5—Calculation and Application of 

Indirect Scaling Factors 

Similar to the direct costs, the indirect 

costs are scaled to ensure that the total 

across all procedures performed by the 

specialty equates with the total indirect 

costs for the specialty as reflected by the 

SMS data. To accomplish this, the 

indirect costs calculated in Step 4 

(Table 4) are scaled to SMS data. The 

calculation of the indirect scaling 

factors is as follows: 

• The specialty’s total SMS indirect 

expense pool is divided by the 

specialty’s total indirect expense pool 

calculated in Step 4 (Table 4), to yield 

the indirect expense scaling factor. 

• The unscaled indirect expense 

amount, at the procedure level, is 

multiplied by the specialty’s scaling 

factor to calculate the procedure’s 

scaled indirect expenses. 

• The sum of the scaled indirect 

expense amount and the procedure’s 

direct expenses yields the total PEs for 

the specialty for this procedure. 

In table 5, to calculate the indirect 

scaling factor for hypothetical procedure 

00001, divide the total SMS indirect 

pool, $3,337,285,089 (calculated in Step 

1—Table 1), by the total indirect 

expense for the specialty across all 

procedures of $6,745,545,434. This 

results in a scaling factor of 0.49. Next, 

the unscaled indirect cost of $315.47 is 

multiplied by the 0.49 scaling factor, 

resulting in scaled indirect cost of 

$156.07. To calculate the total PEs for 

the specialty for procedure 00001, the 

scaled direct and indirect expenses are 

added, totaling $390.12.

Step 6—Weighted Average of RVUs for 

Procedures Performed by More Than 

One Specialty 

For codes that are performed by more 

than one specialty, a weighted average 

PE is calculated based on Medicare 

frequency data of all specialties 

performing the procedure as shown in 

Table 6.

TABLE 6.—WEIGHT AVERAGING FOR ALL SPECIALTIES

Standard Methodology Practice expense value 

Percent of 

total allowed 

services 

(A) (B) 

(a) Specialty Total Practice Expense ...................................................................................................................... $390.12 83 

(b) Weighted Avg.—All Other Specialties ............................................................................................................... $929.87 17 

(c) Weighted Avg.—All Specialties .......................................................................................................................... $481.70 100 

Step 7—Budget Neutrality and Final 

RVU Calculation 

The total scaled direct and indirect 

inputs are then adjusted by a budget 

neutrality factor to calculate RVUs. 

Section 1848(c)(2)(B)(ii)(II) of the Act 

provides that adjustments in RVUs may 

not cause total PFS payments to differ 

by more than $20 million from what 

they would have been if the adjustments 

were not made. Budget neutrality for the 

upcoming year is determined relative to 

the sum of PE RVUs for the current year. 

Although the PE RVUs for any 

particular code may vary from year-toyear, the sum of PE RVUs across all 

codes is set equal to the current year. 

The budget neutrality factor (BNF) is 

equal to the sum of the current year’s PE 

RVUs, divided by the sum of the direct 

and indirect inputs across all codes for 

the upcoming year. The BNF is applied 

to (multiplied by) the scaled direct and 

indirect expenses for each code to set 

the PE RVU for the upcoming year. 

In Table 7, the sum of the scaled 

direct and indirect expenses for 

hypothetical code 00001 ($481.70) is 

multiplied by the BNF (0.02 in this 

example) to yield a PE RVU of 10.60.


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TABLE 7.—CALCULATE PE RVU 

Total scaled 

direct and indirect inputs 

Budget neutrality factor Final PE RVU 

(A) (B) (C) 

(a) Code 00001 ............................................................................................................................ $481.70 0.02 10.60 

c. Other Methodological Issues: 

Nonphysician Work Pool (NPWP) 

As an interim measure, until we could 

further analyze the effect of the topdown methodology on the Medicare 

payment for services with no physician 

work (including the technical 

components (TCs) of radiation oncology, 

radiology and other diagnostic tests), we 

created a separate PE pool for these 

services. However, any specialty society 

could request that its services be 

removed from the nonphysician work 

pool. We have removed some services 

from the nonphysician work pool if we 

find that the requesting specialty 

provides the service the majority of the 

time. 

NPWP Step 1—Calculation of the SMS 

Cost Pool for Each Specialty 

This step parallels the calculations 

described above for the standard ‘‘topdown’’ PE allocation methodology. For 

codes in the nonphysician work pool, 

the direct and indirect SMS costs are set 

equal to the weighted average of the PE/

HR for the specialties that provide the 

services in the pool. Clinical staff time 

is substituted for physician time in the 

calculation. The clinical staff time for 

the code is from CPEP data. Otherwise, 

the calculation is similar to the method 

described previously for codes with 

physician time.

The following example in Table 8 

illustrates this calculation for 

hypothetical code 00002. In this 

example, the average clinical payroll 

PE/HR for all specialties in the 

nonphysician work pool is $12.30 and 

the clinical staff time for code 00002 is 

116 minutes.

TABLE 8.—CALCULATE SMS COST POOLS FOR NONPHYSICIAN WORK POOL

Non-Physician work pool methodology (NPWP) Clinical payroll Medical supplies 

Medical equipment Indirect expenses Total* 

(A) (B) (C) (D) (E) 

(a) NPWP—PE/HR .............................................................. $12.30 $7.40 $3.20 $46.30 $69.00 

(b) NPWP—PE/Minute ......................................................... 0.21 0.12 0.05 0.77 1.15 

(c) Clinical Staff Time—00002 ............................................. 116 116 116 116 116 

(d) Number of Services ........................................................ 105,095 105,095 105,095 105,095 105,095 

(e) Total—NPWP ‘‘SMS’’ Pool ............................................. $2,499,159 $1,503,559 $650,188 $9,407,404 $14,019,673 

(b) = (a)/60 

(e) = (b)*(c)*(d) 

* Components may not add to totals due to rounding. 

NPWP Step 2—Calculation of Chargebased PE RVU Cost Pool 

The nonphysician work pool 

calculation uses the 1998 (charge-based) 

PE RVU value for the code, multiplied 

by the 1995 CF (25.74 × $34.503 = 

$888.11). The percentage of clinical 

labor, supplies and equipment are the 

percentage that each PE category 

represents for all physicians relative to 

the total PE for all physicians 

(calculated from the SMS data) as 

shown in Table 9.

TABLE 9.—CALCULATE CHARGE-BASED COST POOLS FOR NONPHYSICIAN WORK POOL

NPWP methodology Clinical Supplies Equipment 

(A) (B) (C) 

(a) CPT 00002—Charge Based Value ........................................................................................ $888.11 $888.11 $888.11 

(b) Percent Clinical, Supplies, Equipment ................................................................................... 0.18 0.11 0.05 

(c) CPT 00002 ............................................................................................................................. 158.08 95.03 41.74 

(d) Number of—NPWP ................................................................................................................ 105,095 105,095 105,095 

(e) Total NPWP ‘‘CPEP’’ Pool ..................................................................................................... $16,613,742 $4,386,775 $9,986,912 

(c) = (a)*(b) 

(e) = (c)*(d) 

NPWP Step 3—Calculation and 

Application of Scaling Factors 

After the total cost pools for each 

specialty and code performed by the 

specialty are calculated, the steps to 

ensure the total costs for all of the 

procedures performed by a specialty do 

not exceed the total costs for the 

specialty (scaling) are the same as those 

described previously for codes with 

physician work. 

In Table 10 below, the SMS total 

clinical labor costs is $2,499,159. This 

amount divided by the charge-based 

total clinical labor amount of 

$16,613,742 yields a scaling factor of 

0.15. The charge-based clinical labor 

cost for hypothetical procedure 00002 is 

$158.08 (from step 2—Table 2). 

Multiplying the 0.15 scaling factor for 

clinical labor costs by $158.08 yields the 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45773

scaled clinical labor cost amount of 

$23.78. Individual scaling factors must 

be calculated for both supply and 

equipment expenses. The sum of the 

scaled direct cost values, $23.78, $32.57 

and $2.72, respectively, equals the total 

scaled direct expense of $59.07.

NPWP Step 4—Calculation of Indirect 

Expenses 

Because codes in the nonphysician 

work pool do not have work RVUs, 

indirect expenses are set equal to direct 

expenses (for codes with physician 

work, indirect expenses equal the sum 

of the scaled direct expenses and the 

converted work RVU). This amount is 

then multiplied by the number of times 

the procedure is performed. 

In Table 11, the scaled total direct 

expense from Step 3 (Table 3) ($408.79) 

is also the proxy for the total indirect 

expense attributed to the procedure. The 

total indirect expense is multiplied by 

the number of services (105,095), to 

calculate total indirect cost for this 

procedure of $6,207,961.

TABLE 11.—CALCULATION OF INDIRECT EXPENSES

NPWP methodology Physician 

work* 

Total direct expense Total 

(A) (B) (C) 

(a) CPT 00002 ............................................................................................................................. $ $59.07 $59.07 

(b) Allowed Services—NPWP ..................................................................................................... ........................ ........................ 105,095 

(c) Total NPWP Indirect Expense ............................................................................................... ........................ ........................ $6,207,961 

NPWP Step 5—Calculation and 

Application of Indirect Scaling Factors 

Similar to the direct costs, the indirect 

costs are scaled to ensure that the total 

of the charge-based PE RVU costs across 

all procedures equates with the total 

indirect costs as reflected by the SMS 

data for the NPWP. To accomplish this, 

the charge-based data are scaled to SMS 

data so the total charge-based costs 

equal the total SMS costs. 

In Table 12, to calculate the indirect 

scaling factor for hypothetical procedure 

00002, divide the total SMS indirect 

expense, $9,407,404 (from Step 1—

Table 1), by the total charge-based 

indirect expense of $6,207,961. This 

results in a scaling factor of 1.51. Next, 

the unscaled indirect charge-based cost 

for procedure 00002 of $59.07 (from 

step 4—Table 4) is multiplied by the 

1.51 scaling factor, resulting in scaled 

indirect costs for this procedure of 

$89.19.


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NPWP Step 6—Budget Neutrality and 

Final RVU Calculation

Similar to the calculation for codes 

with physician work, the BNF is applied 

to (multiplied by) the scaled direct and 

indirect expenses for each code to set 

the PE RVU for the upcoming year. 

In Table 13, the sum of the scaled 

direct and indirect expenses for 

hypothetical code 00002 ($148.26) is 

multiplied by the BNF (0.022 in this 

example) to yield a PE RVU of 3.26.

TABLE 13.—BUDGET NEUTRALITY AND

FINAL RVU CALCULATION

Total 

scaled direct and 

indirect 

inputs 

Budget 

neutrality 

factor 

Final PE 

RVU 

Code 

00002 $148.26 0.022 3.26 

d. Facility/Non-facility Costs 

Procedures that can be performed in 

a physician’s office as well as in a 

hospital have two PE RVUs; facility and 

non-facility. The non-facility setting 

includes physicians’ offices, patients’

homes, freestanding imaging centers, 

and independent pathology labs. 

Facility settings include hospitals, 

ambulatory surgery centers, and skilled 

nursing facilities (SNFs). The 

methodology for calculating the PE RVU 

is the same for both facility and nonfacility RVUs, but is calculated 

independently to yield two separate PE 

RVUs. Because the PEs for services 

provided in a facility setting are 

generally included in the payment to 

the facility (rather than the payment to 

the physician under the fee schedule), 

the PE RVUs are generally lower for 

services provided in the facility setting. 

2. PE Proposals for CY 2006 

The following discussions outline the 

specific PE related proposals for CY 

2006. 

a. Supplemental PE Surveys 

The following discussions outline the 

criteria for supplemental survey 

submission as well as information we 

have received for approval. 

(1) Survey Criteria and Submission 

Dates 

In accordance with section 212 of the 

BBRA, we established criteria to 

evaluate survey data collected by 

organizations to supplement the SMS 

survey data normally used in the 

calculation of the PE component of the 

PFS. In the Payment Policies Under the 

Physician Fee Schedule for Calendar 

Year 2002 final rule, published 

November 7, 2003 (68 FR 63196), we 

provided that, beginning in 2004, 

supplemental survey data had to be 

submitted by March 1 to be considered 

for use in computing PE RVUs for the 

following year. This allows us to 

publish our decisions regarding survey 

data in the proposed rule and provides 

the opportunity for public comment on 

these results before implementation. 

To continue to ensure the maximum 

opportunity for specialties to submit 

supplemental PE data, we extended 

until 2005 the period that we would 

accept survey data that meet the criteria 

set forth in the November 2000 PFS 

final rule. The deadline for submission 

of supplemental data to be considered 

in CY 2006 was March 1, 2005. 

(2) Submission of Supplemental Survey 

Data 

The following discussion outlines the 

survey data submitted for CY 2004 and 

CY 2005. 

• Surveys Submitted in 2004 

As explained in the November 15, 

2004 Physician Fee Schedule final rule 

(69 FR 66242), we received surveys by 

March 1, 2004 from the American 

College of Cardiology (ACC), the 

American College of Radiology (ACR), 

and the American Society for 

Therapeutic Radiation Oncology 

(ASTRO). The data submitted by the 

ACC and the ACR met our criteria. 

However, as requested by the ACC and 

the ACR, we deferred using their data 

until issues related to the nonphysician 

work pool could be addressed. We are 

proposing to use the ACC and ACR 

survey data in the calculation of PE 

RVUs for 2006, but only as specified in 

the proposals relating to a revised 

methodology for establishing direct PE 

RVUs, and a transition period for the 

revised methodology, as described 

below. 

The survey data from ASTRO did not 

meet the precision criteria established 

for supplemental surveys, therefore, we 

did not use it in the calculation of PE 

RVUs for 2005. 

• Surveys Submitted in 2005 

This year we received surveys from 

the Association of Freestanding 

Radiation Oncology Centers (AFROC), 

the American Urological Association 

(AUA), the American Academy of 

Dermatology Association (AADA), the 

Joint Council of Allergy, Asthma, and 

Immunology (JCAAI), the National 

Coalition of Quality Diagnostic Imaging 

Services (NCQDIS) and a joint survey 

from the American Gastroenterological 

Association (AGA), the American 

Society of Gastrointestinal Endoscopy 

(ASGE) and the American College of 

Gastroenterology (ACG) 

We contract with the Lewin Group to 

evaluate whether the supplemental 


EP08AU05.092</GPH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45775

survey data that are submitted meet our 

criteria and to make recommendations 

to us regarding their suitability for use 

in calculating PE RVUs. (The Lewin 

Group report on the 2005 submissions is 

available on the CMS Web site at

http://www.cms.hhs.gov/physicians/pfs/

). The report indicated that, except for 

the survey from NCQDIS, all met our 

criteria and we are proposing to accept 

these. The survey data submitted by the 

NCQDIS on independent diagnostic 

testing facilities (IDTFs) did not meet 

the precision criterion of a 90 percent 

confidence interval with a range of plus 

or minus 15 percent of the mean (that 

is, 1.645 times the standard error of the 

mean, divided by the mean, is equal to 

or less than 15 percent of the mean). For 

the NCQDIS survey, the precision level 

was calculated at 16.3 percent of the 

mean PE/HR (weighted by the number 

of physicians in the practice). However, 

the Lewin Group has recommended that 

we accept the data from NCQDIS. The 

Lewin Group points out that PE data for 

IDTFs do not currently exist, and 

suggests that the need for data for the 

specialty should be weighed against the 

precision requirement. 

We are proposing not to accept the 

NCQDIS data to calculate the PE RVUs 

for services provided by IDTFs. As just 

noted, the NCQDIS data do not meet our 

precision requirements. We established 

the minimum precision standards 

because we believe it is necessary to 

ensure that the data used are valid and 

reliable, and the consistent application 

of the precision criteria is the best way 

to accomplish that objective. 

Section 303(a)(1) of the MMA added 

section 1848(c)(2)(I) of the Act to require 

us to use survey data submitted by a 

specialty group where at least 40 

percent of the specialty’s payments for 

Part B services are attributable to the 

administration of drugs in 2002 to 

adjust PE RVUs for drug administration 

services. The statute applies to surveys 

that include expenses for the 

administration of drugs and biologicals, 

and are received by March 1, 2005 for 

determining the CY 2006 PE RVUs. 

Section 303(a)(1) of the MMA also 

amended section 1848(c)(2)(B)(iv)(II) of 

the Act to provide an exemption from 

budget neutrality for any additional 

expenditures resulting from the use of 

these surveys. In the Changes to 

Medicare Payment for Drugs and 

Physician Fee Schedule Payments for 

Calendar Year 2004 interim final rule 

published January 7, 2004 (69 FR 1084), 

we stated that the specialty of urology 

meets the above criteria, along with 

gynecology and rheumatology (69 FR 

1094). Because we are accepting new 

survey data from the AUA, we are 

required to exempt, from the budget 

neutrality adjustment any impacts of 

accepting these data for purposes of 

calculating PE RVUs for drug 

administration services.

In addition, Lewin recommended 

blending the radiation oncology data 

from this year’s AFROC survey data 

with last year’s ASTRO survey data to 

calculate the PE/HR. According to the 

Lewin Group, the goal of the AFROC 

survey was to represent the population 

of freestanding radiation oncology 

centers only. In order to develop an 

overall average for the radiation 

oncology PE pool, the Lewin Group 

recommended we use the AFROC 

survey for freestanding radiation 

oncology centers, and the hospital-based 

subset of last year’s ASTRO survey. We 

agree that this blending of the AFROC 

and ASTRO data is a reasonable way to 

calculate an average PE/HR that fully 

reflects the practice of radiation 

oncology in all settings. Therefore, we 

are proposing to use the new PE/HR 

calculated in this manner for radiation 

oncology. 

We propose to use the following PE/

HR figures (deflated to 1995 values to be 

consistent with the SMS data):

TABLE 14.—PRACTICE EXPENSE PER HOUR FIGURES

Specialty Clinical staff Admin. staff Office expense 

Medical 

supplies 

Medical 

equipment Other Total 

Radiology ................................................. 14.8 18.6 16.5 6.5 13.1 26.8 96.3

Cardiology ................................................ 38.3 34.5 35.7 16.5 12.2 19.1 156.3

Radiation Oncology .................................. 35.6 18.9 28.5 4 20.1 21.2 128.3

Urology ..................................................... 18.4 27.9 35.3 16.7 7.5 15.9 121.7

Dermatology ............................................. 27.9 35.2 49.4 12.4 7.2 20 152.1

Allergy/Immunology .................................. 48.2 39.8 47 17.3 4.8 22.4 179.6

Gastroenterology ...................................... 15.4 23.2 26.8 4.8 3.3 11.5 85

The deadline to submit supplemental 

PE surveys was March 1, 2005. As 

discussed in detail below, we are 

proposing to revise our methodology to 

calculate direct PE RVUs from the 

current top-down cost allocation 

methodology to a bottom-up 

methodology. Although we would 

continue to use the SMS data and the 

incorporated supplemental survey data 

for indirect PEs, we are not proposing to 

extend the deadline for submitting 

supplemental survey data at this time. 

Instead, we are inviting comment on the 

most appropriate way to proceed to 

ensure the indirect PEs per hour are 

accurate and consistent across 

specialties. 

(3) Revisions to the PE Methodology 

Since 1997, when we first proposed a 

resource-based PE methodology, we 

have had several major goals for this 

payment system. One has been to 

encourage the maximum input from the 

medical community regarding our PE 

data and methodology. We have worked 

closely with the PEAC, PERC, RUC and 

the Health Care Professional Advisory 

Committee (HCPAC) which are all 

multi-specialty groups that allow the 

medical community to participate by 

making recommendations to us on the 

PE direct inputs. We also extended the 

deadline for the submission of 

supplementary PE surveys to ensure 

that specialties had the opportunity to 

submit new aggregate PE data. In 

addition, we have had scores of 

meetings with physician, practitioner 

and industry groups, and have made 

many modifications to our methodology 

in response to their comments and 

input. We look forward to continuing to 

work with the medical community as 

we strive to further improve our PE 

methodology. 

We also have had three specific goals 

for the resource-based PE methodology 

itself. The following goals have also 

been supported in numerous comments 

we have received from the medical 

community: 

• To ensure that the PE payments 

reflect, to the greatest extent possible, 

the actual relative resources required for 

each of the services on the PFS. This 

could only be accomplished by using 

45776 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

the best available data to calculate the 

PE RVUs. 

• To develop a payment system for 

PE that is understandable and at least 

somewhat intuitive, so that specialties 

could generally predict the impacts of 

changes in the PE data. 

• To stabilize the PE payments so that 

there are not large fluctuations in the 

payment for given procedures from 

year-to-year. 

We believe that we have consistently 

made a good faith effort to ensure 

fairness in our PE payment system by 

using the best data available at any one 

time. The change from the originally 

proposed ‘‘bottom-up’’ to the ‘‘topdown’’ methodology came about 

because of a concern that the resource 

input data developed in 1995 by the 

CPEP were less reliable than the 

aggregate specialty cost data derived 

from the SMS process. The adoption of 

the top-down approach necessitated the 

creation of the nonphysician work pool. 

The nonphysician work pool is a 

separate pool created to allocate PEs for 

codes that have only a technical (rather 

than professional) component, or codes 

that are not performed by physicians. In 

the Physician Fee Schedule (CY 2000); 

Payment Policies and Relative Value 

Unit Adjustment final rule, published 

November 2, 1999 (64 FR 59379), we 

indicated that ‘‘the purpose of this pool 

was only to protect the (TC) services 

from the substantial decreases * * * 

until further refinement could take 

place * * *’’ (64 FR 59406). 

However, the situation has now 

changed. The PEAC/PERC/RUC has 

completed the refinement of the original 

CPEP data and we believe that the 

refined PE inputs now, in general, 

accurately capture the relative direct 

costs of performing PFS services. On the 

other hand, although we have now 

accepted supplementary survey data 

from 13 specialties, we have not 

received updated aggregate cost data 

from most specialties. Thus, we believe 

that, in the aggregate, the refined CPEP 

data represent, more reliably, the 

relative direct costs PE inputs for 

physician services. 

The major specialties comprising the 

nonphysician work pool (radiology, 

radiation oncology and cardiology) have 

submitted supplemental survey data 

that we are proposing to accept. (See the 

discussion on supplementary surveys 

above.) Now that we have representative 

aggregate PE data for these specialties, 

the continued necessity and equity of 

treating these technical services outside 

the PE methodology applied to other 

services is questionable. 

We have also taken steps to make our 

complex top-down PE methodology 

more understandable. For example, we 

eliminated the somewhat arcane 

‘‘linking’’ of direct cost input data when 

more than one CPEP panel reviewed a 

service and did away with the confusing 

and unhelpful distinction between 

procedure-specific and indirect 

equipment. However, we acknowledge 

that most in the medical community 

would find our current methodology, as 

described above, neither clear nor 

intuitive. For example, because of the 

need to scale the CPEP/RUC inputs to 

the SMS PEs under our top-down 

methodology, the PE RVUs for a 

procedure do not necessarily change 

proportionately with changes in the 

direct inputs. This raises the question as 

to what would now be the most 

straightforward and intuitive 

methodology for calculating the direct 

PE RVUs. 

Due to the ongoing refinement by the 

RUC of the direct PE inputs, we had 

expected that the PE RVUs would 

necessarily fluctuate from year-to-year, 

frustrating temporarily our efforts to 

reach the goal of stabilizing the PE 

portion of the PFS. At the same time, it 

became apparent that certain aspects of 

our methodology exacerbated the yearly 

fluctuations. For example, the need to 

scale the CPEP costs to equal the SMS 

costs meant that any changes in the 

direct PE inputs for one service often 

leads to unexpected results for other 

services where the inputs had not been 

altered. In addition, the services priced 

by the nonphysician work pool 

methodology have proved to be 

especially vulnerable to any change in 

the pool’s composition. We understand 

the need for stable PE RVUs, so that 

physicians and other practitioners can 

anticipate from year-to-year what the 

relative payments will be for the 

services they perform. Now, that the 

CPEP/RUC refinement of existing 

services is virtually complete, this 

appears to be an opportunity for us to 

propose a way to provide stability to the 

PE RVUs.

Therefore, consistent with our goals of 

using the most appropriate data, 

simplifying our methodology, and 

increasing the stability of the payment 

system, we are proposing the following 

changes to our PE methodology: 

• Use a Bottom-Up Methodology To 

Calculate Direct PE Costs 

Instead of using the top-down 

approach to calculate the direct PE 

RVUs, where the aggregate CPEP/RUC 

costs for each specialty are scaled to 

match the aggregate SMS costs, we 

propose to adopt a bottom-up method of 

determining the relative direct costs for 

each service. Under this method, the 

direct costs would be determined by 

summing the costs of the resources—the 

clinical staff, equipment and supplies—

typically required to provide the 

service. The costs of the resources, in 

turn, would be calculated from the 

refined CPEP/RUC inputs in our PE 

database. 

• Eliminate the Nonphysician Work 

Pool 

Now that we have new survey data for 

the major specialties that comprise the 

nonphysician work pool, we would 

eliminate the pool and calculate the PE 

RVUs for the services currently in the 

pool by the same methodology used for 

all other services. This would allow the 

use of the refined CPEP/RUC data to 

price the direct costs of individual 

services, rather than utilizing the pre1998 charge-based PE RVUs. 

• Utilize the Current Indirect PE RVUs, 

Except for Those Services Affected by 

the Accepted Supplementary Survey 

Data 

As described previously, the SMS and 

supplementary survey data are the 

source for the specialty-specific 

aggregate indirect costs used in our PE 

calculations. We then allocate to 

particular codes on the basis of the 

direct costs allocated to a code and the 

work RVUs. Although we now believe 

the CPEP/RUC data are preferable to the 

SMS data for determining direct costs, 

we have no information that would 

indicate that the current indirect PE 

methodology is inaccurate. We also are 

not aware of any alternative approaches 

or data sources that we could use to 

calculate more appropriately the 

indirect PE, other than the new 

supplementary survey data, which we 

propose to incorporate into our PE 

calculations. Therefore, we propose to 

use the current indirect PEs in our 

calculation incorporating the new 

survey data into the codes performed by 

the specialities submitting the surveys. 

We would welcome any suggestions that 

would assist us in further refinement of 

this indirect PE methodology. For 

example, we are considering whether 

we should continue to accept 

supplementary survey data or whether it 

would be preferable and feasible to have 

an SMS-type survey of only indirect 

costs for all specialties, or whether a 

more formula-based methodology 

independent of the SMS data should be 

adopted, perhaps using the specialtyspecific indirect-to-total cost percentage 

as a basis of the calculation. For a prior 

discussion of many of the issues 

associated with allocating indirect costs, 

we would refer the reader to the 

Physician Fee Schedule (CY 2000); 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45777

Payment Policies and Relative Value 

Unit Adjustment proposed rule, 

published June 5, 1998 (63 FR 30823). 

• Transition the Resulting Revised PE 

RVUs over a Four-Year Period 

A complete analysis of the impacts of 

these changes is contained in the impact 

analysis in section V. of this proposed 

rule. We are concerned that, when 

combined with an expected negative 

update factor for CY 2006, the shifts in 

some of the PE RVUs resulting from our 

proposals could cause some measure of 

financial stress on medical practices. 

Therefore, we are proposing to 

transition the proposed PE changes over 

a 4-year period. This would also give 

ample opportunity for us, as well as the 

medical specialties and the RUC, to 

identify any anomalies in the PE data, 

to make any further appropriate 

revisions, and to collect additional data, 

as needed prior to the full 

implementation of the proposed PE 

changes. 

During the transition period, the PE 

RVUs will be calculated on the basis of 

a blend of RVUs calculated using our 

proposed methodology described above 

(weighted by 25 percent during CY 

2006, 50 percent during CY 2007, 75 

percent during CY 2008, and 100 

percent thereafter), and the current CY 

2005 PE RVUs for each existing code. 

We believe that implementing these 

proposed changes will meet our goals to 

produce a more accurate, more intuitive 

and more stable PE methodology. 

Now that the direct PE inputs have 

been refined, we believe that the 

proposed CPEP/RUC direct input data 

are superior to the specialty-specific 

SMS PE/HR data for the purposes of 

determining the typical direct PE 

resources required to perform each 

service on the PFS. First, we have 

received recommendations on the 

procedure-specific inputs from the 

multi-specialty PEAC that were based 

on presentations from the relevant 

specialties after being closely 

scrutinized by the PEAC using 

standards and packages agreed to by all 

involved specialties. Second, the refined 

CPEP/RUC data are more current than 

the SMS data for the majority of 

specialties. Third, for direct costs, it 

appears more accurate to assume that 

the costs of the clinical staff, supplies 

and equipment are the same for a given 

service, regardless of the specialty that 

is performing it. This assumption does 

not hold true under the top-down direct 

cost methodology, where the specialtyspecific scaling factors create widely 

differing costs for the same service. 

We also would argue that the 

proposed methodology is less confusing 

and more intuitive than the current 

approach. First, the nonphysician work 

pool would be eliminated and all 

services would be priced using one 

methodology, eliminating the 

complicated calculations needed to 

price nonphysician work pool services. 

Second, the method for calculation of 

direct costs can now be described in 

sentences rather than paragraphs. Third, 

any revisions made to the direct inputs 

would now have predictable results. 

Changes in the direct practice inputs for 

a service would proportionately change 

the PE RVUs for that service without 

significantly affecting the PE RVUs for 

unrelated services. 

The proposed methodology would 

also create a system that would be 

significantly more stable from year-toyear than the current approach. 

Specialties should no longer experience 

the wide fluctuations in payment for a 

given service due to an aberrant direct 

cost scaling factor. Direct PEs should 

only change for a service if it is further 

refined or when prices are updated, 

while indirect PEs should change only 

when there are changes in the mix of 

specialties performing the service or 

with the use of any future new survey 

data for indirect costs.

We recognize that there are still some 

outstanding issues that need further 

consideration, as well as input from the 

medical community. For example, 

although we believe that the elimination 

of the nonphysician work pool would 

be, on the whole, a positive step, some 

practitioner services, such as audiology 

and medical nutrition therapy, would be 

significantly impacted by the proposed 

change. In addition, there are still 

services, such as the ESRD visit codes, 

for which we have no direct input 

information. Also, as mentioned above, 

we do not have current SMS or 

supplementary survey data to calculate 

the indirect costs for most specialties. 

Further, we do not yet have accurate 

utilization for the new drug 

administration codes that were created 

in response to the MMA provision on 

drug administration. Therefore, we are 

not proposing to change the RVU for 

these services at this time, but to 

include them under our proposed 

methodology in next year’s rule when 

we have appropriate data. The proposed 

transition period would give us the 

opportunity to work with the affected 

specialties to collect the needed survey 

or other data or to determine whether 

further revisions to our PE methodology 

are needed. 

We, therefore, welcome all comments 

on these proposed changes, particularly 

those concerning additional 

modifications to the indirect PE 

methodology that might help us further 

our intended goals. 

(4) PE Recommendations on CPEP 

Inputs for CY 2006

Since 1999, the PEAC, an advisory 

committee of the AMA’s RUC, provided 

us with recommendations for refining 

the direct PE inputs (clinical staff, 

supplies, and equipment) for existing 

CPT codes. The PEAC held its last 

meeting in March 2004 and the AMA 

established a new committee, PERC, to 

assist the RUC in recommending PE 

inputs. 

The PERC completed refinement of 

approximately 200 remaining codes at 

its meetings held in September 2004 

and February 2005. (A list of these 

codes can be found in Addendum C of 

this proposed rule.) 

We have reviewed the PERCsubmitted recommendations and 

propose to adopt nearly all of them. We 

have worked with the AMA staff to 

correct any typographical errors and to 

make certain that the recommendations 

are in line with previously accepted 

standards. 

The complete PERC recommendations 

and the revised PE database can be 

found on our Web site. (See the 

‘‘Supplementary Information’’ section of 

this proposed rule for directions on 

accessing our Web site.) 

We disagreed with the PERC 

recommendation for clinical labor time 

for CPT code 36522, Extracorporeal 

Photophoresis. In last year’s Revisions 

to Payment Policies Under the 

Physician Fee Schedule for Calendar 

Year 2005 final rule, published 

November 15, 2004 (69 FR 66236) we 

assigned, on an interim basis, 223 

minutes of total clinical labor for the 

service period based on the typical 

treatment time of approximately 4 

hours. The PERC, however, 

recommended 122 minutes total clinical 

labor time for the service period, which 

allows for 90 minutes of nurse ‘‘intra 

service’’ time for the performance of the 

procedure (the society originally 

proposed 180 minutes). We believe that 

135 minutes is a more appropriate 

estimation of the clinical staff time 

actually needed for the intra time, as it 

more closely approximates the time 

assigned to the other procedures in this 

family of codes, including CPT codes 

36514, 36515, and 36516. Therefore, we 

are proposing a total clinical labor time 

of 167 minutes for the service period. 

The PERC/RUC also recommended 

that no inputs be assigned to several 

codes because the services were not 

performed in the office setting. 

However, our utilization data shows 

that four of these codes (CPT codes 

45778 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

15852, 76975, 78350, and 86585) are 

currently priced in the office and are 

performed with sufficient frequency in 

the office to warrant this. Therefore, we 

are proposing not to accept the PERC/

RUC recommendations for these 

services at this time, but are requesting 

comments from the relevant specialties 

as to whether the recommendations 

should be accepted. 

(5) Payment for Splint and Cast 

Supplies 

In the Physician Fee Schedule (CY 

2000); Payment Policies and Relative 

Value Unit Adjustment final rule, 

published November 2, 1999 (64 FR 

59379) and the Physician Fee Schedule 

(CY 2002); Payment Policies and 

Relative Value Units Five-Year Review 

and Adjustments final rule, published 

November 1, 2000 (66 FR 55245), we 

removed cast and splint supplies from 

the PE database for the CPT codes for 

fracture management and cast/strapping 

application procedures. Because casting 

supplies could be separately billed 

using Healthcare Common Procedure 

Coding System (HCPCS) codes that were 

established for payment of these 

supplies under section 1861(s)(5) of the 

Act, we did not want to make duplicate 

payment under the PFS for these items. 

However, in limiting payment of these 

supplies to the HCPCS codes Q4001 

through Q4051, we unintentionally 

prohibited remuneration for these 

supplies when they are not used for 

reduction of a fracture or dislocation, 

but rather, are provided (and covered) as 

incident to a physician’s service under 

section 1861(s)(2)(A) of the Act.

Because these casting supplies are 

covered either through sections 

1861(s)(5) of the Act or 1861(s)(2)(A) of 

the Act, we are proposing to eliminate 

the separate HCPCS codes for these 

casting supplies and to again include 

these supplies in the PE database. This 

will allow for payment for these 

supplies whether based on section 

1861(s)(5) of the Act or section 

1861(s)(2)(A) of the Act, while ensuring 

that no duplicate payments are made. In 

addition, by bundling the cost of the 

cast and splint supplies into the PE 

component of the applicable procedure 

codes under the PFS, physicians will no 

longer need to bill Q-codes in addition 

to the procedure codes to be paid for 

these materials. 

Because these supplies were removed 

from the PE database prior to the 

refinement of these services by the 

PEAC, we are proposing to add back the 

original CPEP supply data for casts and 

splints to each applicable CPT code. For 

this reason, it is imperative that the 

relevant medical societies review the 

‘‘Direct Practice Expense Inputs’’ on our 

Web site at http://www.cms.hhs.gov/

physicians/pfs (under the supporting 

documents for the 2006 proposed rule) 

and provide us with feedback regarding 

the appropriateness of the type and 

amount of casting and splinting 

supplies. We are also requesting specific 

information about the amount of casting 

supplies needed for the 10-day and 90-

day global procedures, because these 

supplies may not be required at each 

follow-up visit; therefore, the number of 

follow-up visits may not reflect the 

typical number of cast changes required 

for each service. 

The following cast and splint supplies 

have been reincorporated as direct 

inputs: fiberglass roll, 3 inch and 4 inch; 

cast padding, 4 inch; webril (now 

designated as cast padding, 3 inch); cast 

shoe; stockingnet/stockinette, 4 inch 

and 6 inch; dome paste bandage; cast 

sole; elastoplast roll; fiberglass splint; 

ace wrap, 6 inch; and kerlix (now 

designated as bandage, kerlix, sterile, 

4.5 inch) and malleable arch bars. The 

cast and splint supplies have been 

added to the following CPT codes: 

23500 through 23680, 24500 through 

24685, 25500 through 25695, 26600 

through 26785, 27500 through 27566, 

27750 through 27848, 28400 through 

28675, and 29000 through 29750. 

Because we are proposing to pay for 

splint and cast through the PE 

component of the PFS, we would no 

longer make separate payment for these 

items using the HCPCS Q-codes. 

(6) Miscellaneous PE Issues 

In this section, we discuss our 

specific proposals related to PE inputs.

• Supply Items for CPT Code 95015 

We are proposing to change the 

supply inputs for CPT code 95015, 

intracutaneous (intradermal) tests, 

sequential and incremental, with drugs, 

biologicals or venoms, immediate type 

reaction, specify number of tests, based 

on comments received from the JCAAI. 

The society reports that ‘‘venom’’ is the 

most typical test substance used when 

performing this service and that 

‘‘antigen’’, currently listed in the PE 

database, is never used. The JCAAI also 

suggests that the appropriate venom 

quantity should be 0.3 ml (instead of the 

0.1 ml now listed) because of the 

necessity to use all five venoms (honey 

bee, yellow jacket, yellow hornet, white 

face hornet and wasp) to perform this 

sensitivity testing; that is, 1 ml of each 

venom type for a total of 5 ml of venom. 

The diluted venoms are sequentially 

administered until sensitivity is shown, 

beginning with the lowest concentration 

of venom and subsequently 

administering increasing concentrations 

of each venom. The JCAAI states that 

the typical number of tests per session 

is approximately 17, consistent with the 

RUC-approved vignette, which 

represents 0.3 ml of venom per test 

when divided into the total of 5 ml of 

venom needed to perform the entire 

service. We accept the specialty’s 

argument and propose to change the test 

substance in CPT code 95015 to venom, 

at $10.70(from single antigen, at $5.18) 

and the quantity to 0.3 ml (from 0.1 ml). 

• Flow Cytometry Services 

In the November 15, 2004 final rule 

(69 FR 66236), we solicited comments 

on the interim RVUs and PE inputs for 

new and revised codes, including flow 

cytometry services. Based on comments 

received and additional discussions 

with representatives from the society 

representing independent laboratories, 

we are proposing to revise the PE inputs 

for the flow cytometry CPT codes 88184 

and 88185. 

The specialty society indicated that a 

cytotechnologist is the typical clinical 

staff type to perform the intra portion of 

this service for both codes. They also 

provided us with a list of six additional 

equipment items, along with 

documented prices, and with the 

minutes in use for each service. All six 

equipment items are necessary to 

perform the flow cytometry services 

described in CPT code 88184, while 

only two (the computer and printer) are 

needed for CPT code 88185. For 

supplies, the society believes the 

antibody cost currently reflected in the 

PE database is too low, and so they 

provided us with an average antibody 

cost of $8.50, derived from a survey of 

laboratories performing these services. 

Using the vignette for the myeloid/

lymphoid panel to represent the typical 

service, this average cost was based on 

the cost of the total number of 

antibodies that are required to report the 

typical number of reported markers. 

Based on this information, we are 

proposing to change the following direct 

inputs used for PE: 

+ Clinical Labor: Change the staff type 

in the service (intra)period in both CPT 

codes 88184 and 88185 to 

cytotechnologist, at $0.45 per minute 

(currently lab technician, at $0.33 per 

minute). 

+ Supplies: Change the antibody cost 

for both CPT codes 88184 and 88185 to 

$8.50 (from $3.544). 

+ Equipment: Add a computer, 

printer, slide strainer, biohazard hood, 

and FACS wash assistant to CPT code 

88184. Add a computer and printer to 

the equipment for CPT code 88185. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45779

• Low Osmolar Contrast Media (LOCM) 

and High Osmolar Contrast Media 

(HOCM) 

HOCM and LOCM are used to 

enhance images produced by various 

types of diagnostic radiological 

procedures. In the November 15, 2004 

final rule (69 FR 66356), we eliminated 

the criteria for the payment of LOCM 

that had been included at § 414.38. 

Effective January 1, 2005, providers can 

be paid for either LOCM or HOCM when 

used with procedures requiring contrast 

media. Payment for LOCM is made 

through the use of separate Q-codes, 

while payment for HOCM is currently 

included as part of the PE component 

under the PFS. Effective January 1, 

2006, we will no longer include 

payment for HOCM under the PFS. 

When HOCM is used, Q-codes that have 

been established specifically for HOCM 

will be used for payment. 

We have reviewed the PE database 

and are proposing to remove the 

following two supply items which we 

have identified as HOCM from the PE 

database: 

+ Conray inj. iothalamate 43 

percent(supply item #SH026, deleted 

from 64 procedures). 

+ Diatrizoate sodium 50 percent 

(supply item #SH0238, deleted from 74 

procedures). 

In reviewing the PE database we also 

identified 5 CPT codes (specifically CPT 

codes 42550, 70370, 93508, 93510 and 

93526) that include omnipaque as a 

supply item. Since omnipaque is 

actually a type of LOCM that is 

separately billable, we are proposing to 

remove this supply item from these five 

CPT codes. 

• Imaging Rooms 

We include standardized ‘‘rooms’’ for 

certain services in our PE equipment 

database, rather than listing each item 

separately. We received pricing 

information from the ACR for the 

following rooms that are included in the 

database. We have accepted most of the 

proposed items that meet the $500 

threshold for equipment and are 

proposing to include the items in each 

specific room, as follows: 

+ Basic Radiology Room: $127,750 (xray machine @ $125,550 and camera @ 

$2,200). The recommended viewbox 

was not included because most codes 

assigned this room have also been 

assigned an alternator (automated film 

viewer) or a 4-panel viewbox. 

+ Radiographic-Flouroscopic Room:

$367,664 (Radiographic machine @ 

$365,464 and camera @ $2,200). The 

recommended viewbox was not 

included because most codes assigned 

this room have also been assigned an 

alternator (automated film viewer) or a 

4-panel viewbox. 

+ Mammography Room: $168,214 

(mammography unit @ $124,900; 

reporting system @ $16,690; 

mammography phantom @ $674; 

densitometer @ $3,660; sensitometer @ 

$2,750; desktop PC for monitoring @ 

$1,840; and processor @ $17,700. 

Separately listed equipment items 

(densitometer, mammography reporting 

system, sensitometer, mammography 

phantom, desktop computer, and the 

film processor) that duplicated items 

included in the mammography room 

were removed from the codes assigned 

the room, eliminating the reporting 

system, sensitometer and phantom from 

the PE database. 

+ Computed tomography (CT) Room:

$1,284,000 (16-slice CT scanner with 

power injector and monitoring system)

+ Magnetic Resonance (MR) Room:

$1,605,000 (1.5T MR scanner with 

power injector and monitoring system) 

• Equipment Pricing for Select 

Services and Procedures from the 

November 15, 2004 final rule (69 FR 

66236). 

Equipment pricing for certain 

radiology services was received and 

supported with sufficient 

documentation from the ACR. We have 

accepted the following equipment 

prices as shown in table 15.

TABLE 15 

CAD processor (CPT 76082–83) $115,000 

Collimator, cardiofocal set (CPT 

78206–07, 78647, 78803, 

78807) ....................................... 8,543 

Densitometer/DPA (CPT 78351) .. 150,000 

Detector Probe (CPT 78455) ....... 19,995 

IVAC Injection Pump, single channel (CPT 78206–07, 78647, 

78803, 78807) ........................... 3,000 

Computer workstation/MRA includes: Includes 2 monitors, 

volume viewer, advanced x-ray 

analysis, data export, CD–RW, 

DICOM Print, 2 GB RAM (CPT 

71555, 72159, 72198, 73225, 

73727, 74185) ........................... 122,000 

We accepted the documentation 

supplied from the American College of 

Obstetricians and Gynecologists (ACOG) 

to price the following equipment for 

which we assigned an average price 

from the three sources, as follows:

Ultrasound color Doppler transducers 

and vaginal probe (CPT 59070, 59074, 

76818–19, 76825–28)—$157,897

For CPT 36522, extracorporeal 

photopheresis, we received and 

accepted equipment pricing information 

specific to this procedure, as follows:

Plasma pheresis machine with UV light 

source (CPT 36522)—$65,000

We received comments from the 

American Academy of Ophthalmology 

that included documentation from two 

sources for the pricing of the EMG botox 

machine used in CPT code 92265 and 

we are proposing to accept $16,188 as 

the average price for this equipment. 

• Supply Item for In Situ Hybridization 

Codes (CPT 88365, 88367, and 88368) 

We received comments from the 

College of American Pathologists (CAP) 

regarding the number of DNA probes 

assigned to the in situ hybridization 

codes, CPT codes 88365, 88367, and 

88368. Currently, CPT codes 88365 and 

88368 have 1.5 probes assigned, while 

CPT code 88367 has only .75 of a probe 

assigned. CAP requested that we also 

assign 1.5 probes to CPT code 88367, 

and the comment provided justification 

for this request. We accept the CAP 

rationale and propose to change the 

probe quantity for CPT code 88367 to 

1.5. 

• Supply Item for Percutaneous 

Vertebroplasty Procedures (CPT codes 

22520 and 22525) 

The Society for Interventional 

Radiology provided us with 

documentation for the price of the 

vertebroplasty kit used in CPT codes 

22520 and 22525. We propose to accept 

a new price of $696 for this supply, 

currently listed as $660.50, a 

placeholder price from last year’s final 

rule. 

• Clinical Labor for G-codes Related to 

Home Health and Hospice Physician 

Supervision, Certification and 

Recertification 

It has come to our attention that four 

G-codes related to home health and 

hospice physician supervision, 

certification and recertification, G0179, 

180, 181, and 182, are incorrectly 

valued for clinical labor. These codes 

are cross-walked from CPT codes 99375 

and 99378, which underwent PEAC 

refinement for the 2004 fee schedule. 

However, we did not apply the new 

refinements to these specific G-codes at 

that time, and are proposing to revise 

the PE database to reflect the new 

values. 

• Programmers for Implantable 

Neurostimulators and Intrathecal Drug 

Infusion Pumps 

We received comments from the 

neurological division of Medtronic 

Incorporated, the manufacturer of 

programmers for implantable 

neurostimulators and intrathecal drug 

infusion pumps, that the equipment 

45780 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

costs for these programmers are not a 

direct expense for the physicians 

performing the programming of these 

devices. The manufacturer furnishes 

these devices without cost because the 

programming device is considered a 

‘‘necessary, ancillary item to the 

neurostimulator and drug pump and can 

only be used to program these devices.’’

As such, we are proposing to remove the 

two programmers from the PE database: 

EQ208 for medication pump from 2 

codes (CPT 62367 and 62368) and 

EQ209 for the neurostimulator from 8 

codes (CPT 95970–97979). We are 

asking for comments from the specialty 

societies performing these services to let 

us know if this proposal reflects typical 

practice. 

• Pricing of New Supply and 

Equipment Items 

As part of last year’s rulemaking 

process, we reviewed and updated the 

prices for equipment items in our PE 

database and assigned a unique 

identifier to each equipment item with 

the first two elements corresponding to 

one of seven categories. It has come to 

our attention that we have assigned the 

same category identifier (ELXXX) for 

both ‘‘lanes/rooms’’ as well as 

‘‘laboratory equipment’’. To correct this, 

we are assigning laboratory equipment 

items the new category identifier 

‘‘EPXXX’’, but the specific numbers 

associated with each item will remain 

the same. Supply items were reviewed 

and updated in the rulemaking process 

for the 2004 PFS. During subsequent 

meetings of both the PEAC (now 

referred to as the PERC) and the RUC, 

supply and equipment items were 

added that were not included in the 

pricing updates. The following two 

tables (Table 16: Proposed Practice 

Expense Supply Items and Table 17: 

Proposed Practice Expense Equipment 

Items) list the additional supply and 

equipment items for 2006 and the 

proposed associated prices that we will 

use in the PE calculation.

TABLE 16.—PROPOSED PRACTICE EXPENSE SUPPLY ITEM ADDITIONS FOR 2006 

Supply

code Supply description Unit Unitprice 

*CPT code(s) associated with 

item Supply category 

SJ071 ........... ACD–A anticoagulant ......................................... item .... 6.58 36514, 36515, 36516 Pharmacy, NonRx. 

SL186 ........... Antibody, flow cytometry (each test) .................. item .... 8.5 88184, 88185 Lab. 

SL187 ........... Balance salt solution (BSS), sterile, 15cc .......... ml ....... 92265 Lab. 

SG093 .......... Bandage, Dome paste, 3in ................................. item .... 14.95 29580 Wound care, dressings. 

SJ072 ........... Brush, disposable applicator .............................. item .... 17360 Pharmacy, NonRx. 

SG094 .......... Cast, padding 3in x 4yd (Webril) ........................ item .... 1.22 18 codes Wound care, dressings. 

SG095 .......... Cast, sole ............................................................ item .... 14.74 29355, 29425, 29440 Wound care, dressings. 

SG096 .......... Casting tape, fiberglass 3in x 4 yds ................... item .... 9.2 29065, 29075, 29105, 29365, 

29405, 29425 

Wound care, dressings. 

SD216 .......... Catheter, balloon, esophageal or rectal (graded 

distention test).

item .... 217.00 91120, 91040 Accessory, Procedure. 

SK102 .......... Communication book/treatment notebook .......... item .... 92510 Office supply, grocery. 

SB049 .......... Condom, Diapulse, Asepticap ............................ item .... 0.69 G0329 Gown, drape. 

SK103 .......... Cork sheet, 1cm x 1cm ...................................... item .... 88355 Office supply, grocery. 

SD217 .......... Diaphragm fitting set .......................................... item .... 57170 Accessory, Procedure. 

SJ073 ........... DMV remover ..................................................... item .... 92311, 92312, 92313, 92314, 

92315, 92317, 92316, 92310 

Pharmacy, NonRx. 

SL188 ........... EM fixative, karnovsky’s ..................................... ml ....... 0.086 88355, 88356 Lab. 

SL189 ........... Ethanol, 100% .................................................... ml ....... 0.003 88365, 88367, 88368 Lab. 

SL190 ........... Ethanol, 70% ...................................................... ml ....... 0.003 88367, 88368, 88365 Lab. 

SL191 ........... Ethanol, 85% ...................................................... ml ....... 0.003 88368, 88367, 88365 Lab. 

SC088 .......... Fistula set, dialysis, 17g ..................................... item .... 36522 Hypodermic, IV. 

SK104 .......... Foil, aluminum, 10cm x 10cm ............................ item .... 88355 Office supply, grocery. 

SL192 ........... Formamide .......................................................... ml ....... 0.22 88368, 88365, 88367 Lab. 

SL193 ........... Glycolic acid, 20–50% ........................................ ml ....... 17360 Lab. 

SL194 ........... Hemo-De ............................................................ ml ....... 0.008 88368, 88367, 88365 Lab. 

SA089 .......... Kit, boston original system ................................. kit ....... 4.5 92311, 92315, 92310, 92313, 

92313, 92314, 92317, 92316 

Kit, Pack, Tray. 

SL195 ........... Kit, FISH paraffin pretreatment .......................... kit ....... 20.85 88367, 88368, 88365 Lab. 

SL196 ........... Kit, HER–2/neu DNA Probe ............................... kit ....... 105.00 88367, 88368 Lab. 

SA090 .......... Kit, moulage (implantech) ................................... kit ....... 75.00 19396 Kit, Pack, Tray. 

SL197 ........... Label for blood tube ........................................... item .... 0.004 36516, 36515, 36514 Lab. 

SL198 ........... Label, vial ........................................................... item .... 0.003 88355 Lab. 

SJ074 ........... Lens cleaner ....................................................... ounce 92342, 92313, 92340, 92341 Pharmacy, NonRx. 

SL199 ........... Lithium carbonate, saturated .............................. ml ....... 88355, 88356 Lab 

SH092 .......... LMX 4% anesthetic cream ................................. gm ...... 1.6 96567 Pharmacy, Rx. 

SJ075 ........... Methoxsalen, 10ml vial ....................................... item .... 49.5 36522 Pharmacy, NonRx. 

SF044 .......... Micro air burr ...................................................... item .... 28755, 28750, 28740, 28760 Cutters, closures, cautery 

SC089 .......... Needle, Vacutainer ............................................. item .... 0.32 36514, 36515, 36516 Hypodermic, IV. 

SJ076 ........... Nose pads .......................................................... item .... 92370 Pharmacy, NonRx. 

SG092 .......... Packing, gauze, plain, 1 in (5 yd uou) ............... item .... 57180 Wound care, dressings. 

SJ077 ........... Screws, spectacles ............................................. item .... 0.14 92370 Pharmacy, NonRx. 

SL200 ........... Sodium bicarbonate spray, 8 oz ........................ item .... 17360 Lab. 

Splint, fiberglass, 4in x 15in ............................... item .... 16.5 29125 Wound care, dressings. 

SL201 ........... Stain, eosin ......................................................... ml ....... 0.044 88356, 88355 Lab. 

SJ078 ........... Temple tips ......................................................... pair ..... 1.00 92370 Pharmacy, NonRx. 

SL202 ........... Tissue conditioner, coesoft ................................. item .... 42280 Lab. 

SA091 .......... Tray, scoop, fast track system ........................... item .... 750.00 31730 Kit, Pack, Tray. 

SC090 .......... Tube, gastrostomy .............................................. item .... 43760 Hypodermic, IV. 

SC091 .......... Vacutainer ........................................................... item .... 5.9 36514, 36515, 36516 Hypodermic, IV. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45781

TABLE 16.—PROPOSED PRACTICE EXPENSE SUPPLY ITEM ADDITIONS FOR 2006—Continued

Supply

code Supply description Unit Unitprice 

*CPT code(s) associated with 

item Supply category 

SL203 ........... Vial, 10 ml, plastic (¥70 degree storage) ......... item .... 1.016 88355 Lab. 

SL204 ........... Vial, kimble sample, non sterile glass, 20 ml ..... item .... 0.708 88356, 88355 Lab. 

*CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 

TABLE 17.—PROPOSED PRACTICE EXPENSE EQUIPMENT ITEM ADDITIONS FOR 2006 

Equip

code Equipment description Life Unitprice 

*CPT code(s) associated with 

item Equipment category 

EQ269 .......... Blood pressure monitor, ambulatory ................ 5 3000 93786, 93784, 93788 OTHER EQUIP. 

EP044 .......... Centrifuge, cytospin ......................................... 7 7330 88184 LABORATORY. 

EP045 .......... Chamber, hybridization .................................... 7 7107 88368, 88365, 88367 LABORATORY. 

EP046 .......... Freezer, ultradeep (¥70 degrees) .................. 10 16552 88355 LABORATORY. 

Light assembly, photophoresis ........................ 36522 OTHER EQUIP. 

EP047 .......... Loader, FACS .................................................. 7 22500 88184 LABORATORY. 

EP048 .......... Microfuge, benchtop ........................................ 7 2410 88368, 88367, 88365 LABORATORY. 

0EQ270 ........ Plasma pheresis machine w/ UV light ............. 6 65000 36522 OTHER EQUIP. 

EP049 .......... Oven, isotemp (lab) ......................................... 10 2383 88368, 88367, 88365 LABORATORY. 

EQ271 .......... Radiuscope ...................................................... 7 92315, 92317, 92316, 92310, 

92314, 92313, 92312, 92311 

OTHER EQUIP. 

EP050 .......... Scanner, AutoVysion ....................................... 5 135000 88367 LABORATORY. 

EQ272 .......... Sleep diagnostic system, attended .................. 5 46799 95805 OTHER EQUIP. 

EP051 .......... Slide warmer .................................................... 7 568 88368, 88365, 88367 LABORATORY. 

EP052 .......... Ultrasonic nebulizer ......................................... 10 1000 89220 LABORATORY. 

EP053 .......... Wash assistant, FACS ..................................... 7 38000 88184 LABORATORY. 

EP054 .......... Water bath, FISH procedures (lab) ................. 7 2111 88367, 88365 LABORATORY. 

*CPT codes and descriptions only are copyright 2004 American medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 

• Supply and Equipment Items 

Needing Specialty Input 

We have identified certain supply and 

equipment items for which we were 

unable to verify the pricing information 

(see Table 18: Supply Items Needing 

Specialty Input for Pricing and Table 19: 

Equipment Items Needing Specialty 

Input for Pricing). During last year’s 

rulemaking, we listed both supply and 

equipment items for which pricing 

documentation was needed from the 

medical specialty societies and, for 

many of these items, we received 

sufficient documentation in the form of 

catalog listings, vendor websites, and 

invoices. We have accepted the 

documented prices for many of these 

items and have already incorporated 

them into the PE database. The items 

listed on Tables 18 and 19 represent the 

outstanding items from last year and 

new items added from the RUC 

recommendations. Therefore, we are 

requesting that commenters, particularly 

specialty organizations, provide pricing 

information on items in these tables 

along with documentation to support 

the recommended price.

TABLE 18.—SUPPLY ITEMS NEEDING SPECIALTY INPUT FOR PRICING

Code 2005 Description Unit Unit

Price 

Primary specialties associated with item *CPT code(s) associated with 

item Status of item 

SK105 .......... Blood pressure recording form, average.Item .... 0.31 Cardiology ................... 93784, 93786, 93788 See Note A. 

SJ072 ........... Brush, disposable applicator.Item .... Dermatology ................ 17360 See Note A. 

SK102 .......... Communication book/

treatment notebook.

Item .... Audiology, ENT ........... 92510 See Note A. 

SK103 .......... Cork sheet, 1 cm x 1 

cm.

Item .... Pathology .................... 88355 See Note A. 

SJ073 ........... DMV remover .............. Item .... Optometry, 

Opthalmology.

92310–92317 See Note A. 

SD217 .......... Diaphragm fitting set ... Item .... Ob-gyn ........................ 57170 See Note A. 

SD053 .......... Electrode, EEG, tin cup 

(12 pack uou).

Item .... Neurology .................... 95812–13, 95816, 95819, 

95822, 95950, 95954, 95956

See Note A. 

SC088 .......... Fistula set, dialysis, 

17g.

Item .... Dermatology ................ 36522 See Note A 

SK104 .......... Foil, aluminum, 10 cm 

x 10 cm.

Item .... Pathology .................... 88355 See Note A. 

SL193 ........... Glycolic acid, 20–50% ml ....... Dermatology ................ 17360 See Note A. 

SA090 .......... Kit, moulage 

(implantech).

Item .... 75.00 Ob-Gyn ........................ 19396 See Note A. 

SJ074 ........... Lens cleaner ............... oz ....... Optometry, 

Opthalmology.

92313, 92341, 92342 See Note A. 

45782 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

TABLE 18.—SUPPLY ITEMS NEEDING SPECIALTY INPUT FOR PRICING—Continued

Code 2005 Description Unit Unit

Price 

Primary specialties associated with item *CPT code(s) associated with 

item Status of item 

SL199 ........... Lithium carbonate, 

saturated.

ml ....... Pathology .................... 88355, 88356 See Note A. 

SF044 ........... Micro air burr ............... Item .... Podiatry, Orthopedics .. 28740, 28750, 28755, 28760 See Note A. 

SJ076 ........... Nose pads ................... Item .... Optometry ................... 92370 See Note A. 

SG092 .......... Packing, gauze, plain, 

1 in (5yd uou).

Item .... Ob-Gyn ........................ 57180 See Note A. 

SH087 .......... Pentagastrin ................ ml ....... Gastroenterology ......... 91052 See Note A. 

SD140 .......... Pressure bag ............... Item .... 8.925 Cardiology ................... 93501, 93508, 93510, 93526 See Note A. 

SL119 ........... Sealant spray .............. oz ....... Radiation Oncology ..... 77333 See Note A. 

SL200 ........... Sodium bicarbonate 

spray, 8 oz.

Item .... Dermatology ................ 17360 See Note A. 

SL203 ........... Tissue conditioner, 

coesoft.

Item .... Maxillofacial Surgery 

ENT.

42280 See Note A. 

SA091 .......... Tray, scoop, fast track 

system.

Tray ... 750.00 ENT ............................. 31730 See Note A. 

SD213 .......... Tubing, sterile, nonvented (fluid administration).Item .... 1.99 Cardiology ................... 93501, 93508, 93510, 93526 See Note A. 

*CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 

Note A: Additional information required. Need detailed description (including kit contents), source, and current pricing information (including 

pricing per specified unit of measure in database). 

TABLE 19.—EQUIPMENT ITEMS NEEDING SPECIALTY INPUT FOR PRICING AND PROPOSED DELETIONS

Code 2005 Description Price Primary specialties associated with item 

* CPT code(s) associated 

with item Status of item 

EQ269 ......... Ambulatory blood pressure 

monitor.

3,000.00 Cardiology ........................... 93784, 93786, 93788 See Note A. 

EQ089 ......... cortical bipolar-biphasic 

stimulating equipment.

........................ Neurosurger, neurology ...... 95961, 95962 See Note A. 

EQ091 ......... Cryo-thermal unit ................. ........................ Anesthesia ........................... 64620 See Notes A and 

C. 

ER025 .......... densitometry unit, whole 

body, SPA.

22,500.00 Radiology ............................ 78350 See Notes A and 

C. 

EQ100 ......... dialysis access flow monitor 10,000.00 Nephrology .......................... 90940 See Note A. 

EQ101 ......... diathermy, microwave ......... ........................ anesthesia, GP, podiatry ..... 97020 See Notes A and 

C. 

EQ008 ......... ECG signal averaging system.8,250.00 Cardiology, IM ..................... 93278 See Note A. 

EQ112 ......... electromagnetic therapy machine.25,000.00 Physical therapy .................. G0329 See Note A. 

EQ122 ......... fetal monitor software .......... 35,000.00 ob-gyn, radiology ................. 76818, 76819 See Note A. 

ER029 .......... film alternator (motorized 

film viewbox).

27,500.00 Radiology ............................ 329 codes See Notes A and 

B. 

EQ124 ......... generator, constant current 950.00 Neurology, NP ..................... 95923 See Note A. 

EQ131 ......... hyperbaric chamber ............ 125,000.00 FP, IM, EM .......................... 99183 See Note A. 

ER036 .......... hyperthermia system, 

ultrasound, intracavitary.

250,000.00 radiation oncology ............... 77620 See Note A. 

...................... Light assembly, 

photopheresis.

........................ Dermatology ........................ 36522 See Note A. 

ER045 .......... orthovoltage radiotherapy 

system.

140,000.00 radiation oncology ............... 77401 See Note A. 

ER008 .......... OSHA ventilated hood ........ 5,000.00 radiation oncology ............... 77334 See Notes A and 

B. 

...................... plasma pheresis machine w/

UV light source.

37,900.00 radiology, dermatology ........ 36481, G0341 See Note A. 

EQ208 ......... Programmer, for implanted 

medication pump (spine).

1,975 anesthesiology, physical 

medicine.

62367 and 62368 See Note D. 

EQ209 ......... Programmer, 

neurostimulator (w-printer).

1,975 neurology, neuro surgery, 

anesthesiology.

95970, 95971, 95972, 95973, 

95974, 95975, 95978, 95979 

See Note D. 

EQ212 ......... pulse oxymetry recording 

software (prolonged monitoring).

3,660.00 Pulmonary disease, IM ....... 94762 See Note A. 

EP055 .......... Slide Stainer ........................ 9,291.00 Pathology ............................ 88184 See Note A. 

EQ271 ......... Radiuscope ......................... ........................ ophthalmology, optometry ... 92310—92317 See Note A. 

EQ220 ......... remote monitoring service 

(neurodiagnostics).

9,500.00 Neurology ............................ 95955 See Note A. 

EQ221 ......... review master ...................... 23,500.00 pulmonary disease, neurology.95805, 95807–11, 95816, 

95822, 95955–56 

See Note A. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45783

TABLE 19.—EQUIPMENT ITEMS NEEDING SPECIALTY INPUT FOR PRICING AND PROPOSED DELETIONS—Continued

Code 2005 Description Price Primary specialties associated with item 

* CPT code(s) associated 

with item Status of item 

EF022 .......... table, cystoscopy ................. ........................ Urology ................................ 52204–24, 52265–75, 

52310–17, 52327–32 

See Note A. 

EQ253 ......... ultrasound, echocardiography digital acquisition 

(Novo Microsonics, 

TomTec).

29,900.00 ob-gyn, cardiology, pediatrics.76825–28, 93303–12, 93314, 

93320, 93325, 93350 

See Note A. 

EQ261 ......... vacuum cart ......................... ........................ anesthesia ........................... 64620 See Notes A and 

C 

EP054 .......... Wash assistant, FACS ........ 38,000.00 pathology ............................. 88184 See Note A. 

*CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 

Notes:

A. Additional information required. Need detailed description (including system components as specified), source, and current pricing information. 

B. Proposed deletion as indirect expense. 

C. Item may no longer be available. 

D. Proposed deletion as supplied to physicians at no cost. 

B. Geographic Practice Cost Indices 

(GPCIs) 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘GPCIs’’ at the beginning of your 

comments.]

Section 1848(e)(1)(A) of the Act 

requires us to develop separate GPCIs to 

measure resource cost differences 

among localities compared to the 

national average for each of the three fee 

schedule components. While requiring 

that the practice expense and 

malpractice GPCIs reflect the full 

relative cost differences, section 

1848(e)(1)(A)(iii) of the Act requires that 

the physician work GPCIs reflect only 

one-quarter of the relative cost 

differences compared to the national 

average. 

Section 1848(1)(E) of the Act, as 

amended by section 412 of the MMA, 

established a floor of 1.0 for the work 

GPCI for any locality where the GPCI 

would otherwise fall below 1.0. This 1.0 

work GPCI floor was used for purposes 

of payment for services furnished on or 

after January 1, 2004 and before January 

1, 2007. This 1.0 floor will remain in 

effect in 2006. 

Section 602 of the MMA added 

section 1848(e)(1)(G) of the Act, which 

sets a floor of 1.67 for the work, practice 

expense, and malpractice GPCIs for 

services furnished in Alaska between 

January 1, 2004 and December 31, 2005 

for any locality where the GPCI would 

otherwise fall below 1.67. Effective 

January 1, 2006, this provision will end 

and the proposed 2006 GPCIs for Alaska 

will be 1.017 for physician work, 1.103 

for PE, and 1.029 for malpractice. 

Payment Localities 

In the August 15, 2004 PFS rule 

proposed rule, we discussed the issue of 

changes to the GPCI payment localities 

(69 FR 47504). In that proposed rule, we 

noted that we look for the support of a 

State medical society as the impetus for 

changes to existing payment localities. 

Because the GPCIs for each locality are 

calculated using the average of the 

county-specific data from all of the 

counties in the locality, removing highcost counties from a locality will result 

in lower GPCIs for the remaining 

counties. Therefore, because of this 

redistributive impact, we have 

refrained, in the past, from making 

changes to payment localities unless the 

State medical association provides 

evidence that any proposed change has 

statewide support. 

In the November 15, 2004 PFS final 

rule, we discussed a ‘‘placeholder’’

proposal submitted to us in comments 

received from the California Medical 

Association (CMA) (69 FR 66263). The 

proposal described in CMA’s comment 

would move any county with a countyspecific geographic adjustment factor 

(GAF) that is at least 5 percent greater 

than its locality GAF to its own 

individual county payment locality. 

(The GAF is the weighted average of the 

GPCIs for each locality. The GPCIs are 

weighted by the same weighting factors 

applied to physician work, practice 

expense, and malpractice in the 

Medicare Economic Index (MEI) used to 

update the CF.) However, in order to 

minimize reductions in the 2005 GAF of 

the Rest of California locality that would 

otherwise result from removal of the 

data for these high-cost counties, the 

CMA proposed maintaining Rest of 

California locality payments at the 2004 

level by redistributing payments from 

the existing (and newly created) 

payment localities. 

On October 21, 2004, the CMA Board 

of Trustees voted without objection to 

support the placeholder proposal with 

the amendment that the redistribution 

of payments designed to maintain 2004 

levels of payment for the Rest of 

California payment locality would occur 

for two years only, in 2005 and 2006. 

However, we determined that we do not 

have the authority under section 1848(e) 

of the Act to modify the GPCIs of some 

localities in a State solely in order to 

offset higher payments to other 

localities. 

After the publication of the November 

15, 2004 PFS final rule, the CMA 

submitted a proposal for a 

demonstration project that was the same 

as its proposal discussed in that final 

rule. There were several aspects of the 

proposal that made implementation 

problematic for us under our 

demonstration authority. For example, 

physicians whose payments would 

decrease under the demonstration could 

challenge the validity of a new locality 

configuration established without 

providing them the opportunity to 

comment through the regulatory process 

(as is our normal process for making 

locality changes). In particular, 

physicians who are not members of 

county medical societies or the CMA 

did not agree to participate in the 

proposed demonstration, and some of 

them may have challenged its 

implementation. 

Also, the Medicare PFS currently uses 

identical GPCIs to pay for services 

provided in an area by both physicians 

and nonphysician providers such as 

podiatrists, optometrists, physical 

therapists, and nurse practitioners 

(NPs). Changing the locality 

configuration for medical doctors and 

doctors of osteopathic medicine, but not 

for other professionals, would have 

some peculiar results that were not 

addressed in the CMA proposal. For 

example, in areas where the GPCIs 

would be reduced under the 

demonstration, some practitioners not 

45784 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

participating under the demonstration 

(such as physical therapists) could be 

paid more than physicians in the same 

locality. Conversely, where the GPCIs 

would be increased under the 

demonstration, there would likely be 

complaints from the nonphysician 

practitioners (NPP) not included in the 

demonstration. 

Nonetheless, we do recognize the 

potential impact of wide variations in 

the practice costs within a single 

payment locality. In last year’s PFS final 

rule, we noted that we received many 

comments from physicians and 

individuals in Santa Cruz County 

expressing the opinion that Santa Cruz 

County should be removed from the 

Rest of California payment locality and 

placed in its own payment locality. The 

county-specific GAF of Santa Cruz 

County is 10 percent higher than the 

Rest of California locality GAF. Santa 

Cruz County is adjacent to Santa Clara 

County and San Mateo County. Santa 

Clara and San Mateo Counties have two 

of the highest GAFs in the nation. The 

published 2006 GAF for the Rest of 

California payment locality is 24 

percent less than the GAFs of Santa 

Clara and San Mateo. 

Sonoma County is also part of the 

Rest of California payment locality. The 

county-specific GAF of Sonoma County 

is 8 percent higher than the Rest of 

California locality GAF. Sonoma County 

is bordered by Marin County and Napa 

County. Using published 2006 values, 

the payment locality that includes 

Marin and Napa counties has the fourth 

highest GAF in the nation, and is 13 

percent higher than the GAF of the Rest 

of California payment locality. 

We recognize that changing 

demographics over time may lead to 

payment disparities in particular 

circumstances. We rely upon State 

medical societies to identify and resolve 

these disparities because there are 

redistributive impacts within a State 

when new localities are created (or 

existing ones reconfigured). Yet we also 

recognize that CMS is ultimately 

responsible for establishing fee schedule 

areas. We have considered a number of 

alternative locality configurations 

including—

• The CMA approach which 

calculates county-specific GAFs, and 

compares them to their locality GAF 

and designating any county with a GAF 

at least 5 percent higher than its locality 

GAF as a new locality; 

• An approach that sorts counties by 

descending GAFs and compares the 

highest county to the second highest 

county. If the difference between these 

two counties is 5 percent or less, they 

are included in the same locality. The 

third highest county GAF is then 

compared to the highest county GAF 

and so on, until the next county GAP is 

not within 5 percent of the highest 

county GAF. At that point, the county 

GAF that is more than 5 percent lower 

than the highest county GAF becomes 

the comparison for the next lowest 

county GAF, to create a second locality. 

This process is repeated down 

throughout all of the counties; 

• An approach that compares the 

county with the highest GAF to the 

statewide average, removing counties 

that are 5 percent or more than the 

statewide average; and 

• An approach that uses Metropolitan 

Statistical Ares defined by the Office of 

Management and Budget.

However, because these 

reconfigurations would result in 

significant redistributions across most 

California counties, we are simply 

proposing that Santa Cruz and Sonoma 

Counties (the two counties with the 

most significant disparity between the 

assigned Rest of California GAF and the 

county-specific GAF) be removed from 

the Rest of California payment locality 

and that each would be its own payment 

locality. We invite comments regarding 

this proposal and possible alternative 

approaches to address this issue. We are 

particularly interested in whether the 

CMA supports this approach. 

If implemented, our proposal would 

change the 2006 GPCIs and GAFs for 

Santa Cruz County, Sonoma County and 

the Rest of California. The Santa Cruz 

GAF would be 1.119, a value 10 percent 

above the 2005 Rest of California GAF. 

The Sonoma County GAF would be 

1.098, a value 8 percent above the 2005 

Rest of California GAF. The Rest of 

California GAF would be 1.011, a value 

0.01 percent below the 2005 Rest of 

California GAF. We would note that the 

2006 Rest of California GAF published 

in the November 15, 2004 PFS final rule 

(69 FR 66695) was 1.017. This 

represents the second year of the 

transition to the new GPCIs and GAFs 

incorporating updated data (69 FR 

66260). The proposed 2006 Rest of 

California GAF of 1.011 fully reflects 

incorporating the updated data. 

The issue of payment locality 

designation in light of changing 

economic and population trends will be 

of importance to us for the foreseeable 

future. We are interested in other 

solutions to the problem, and will work 

with anyone who presents an idea or 

makes a suggestion that will help 

resolve the problems associated with the 

designation and revision of payment 

localities. 

C. Malpractice Relative Value Units 

(RVUs) 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Malpractice RVUs’’ at the beginning of 

your comments.]

As discussed in the Revisions to 

Payment Policies Under the Physician 

Fee Schedule for Calendar Year 2005 

final rule, published November 15, 2004 

(69 FR 66236), we revised the resourcebased malpractice expense RVUs using 

specialty-specific malpractice premium 

data because those data represent the 

actual malpractice expense to the 

physician and are widely available. 

Based upon discussions with the 

medical community, we concluded that 

the primary determinants of malpractice 

liability costs are physician specialty, 

level of surgical involvement, and the 

physician’s malpractice history. 

Malpractice premium data were 

collected for the 20 Medicare physician 

specialties with the largest share of 

malpractice RVUs. We collected data 

based on premiums for a $1 million/$3 

million mature claims-made policy (a 

policy covering claims made, rather 

than services provided during the policy 

term). We collected premium data from 

all 50 States, Washington, DC, and 

Puerto Rico. Data were collected from 

commercial and physician-owned 

insurers and from joint underwriting 

associations (JUAs). The premium data 

collected represented at least 50 percent 

of total physician malpractice premiums 

paid in each State. For a more detailed 

description of the methodology utilized 

in the development of resource based 

malpractice RVUs, refer to the 

November 15, 2004 final rule. 

1. Five Percent Specialty Threshold 

As discussed in the November 15, 

2004 final rule, we are concerned that 

the malpractice RVUs could be 

inappropriately inflated or deflated due 

to aberrant data based upon incorrectly 

reported specialty classifications. 

Therefore, we examined the impact of 

establishing a minimum percentage 

threshold for any procedure performed 

by any specialty before the risk factor of 

that specialty is included in the 

malpractice RVU calculation of a 

particular code. 

We conducted an analysis excluding 

data for any specialty that performs less 

than 5 percent of a particular service or 

procedure from the malpractice RVU 

calculation for that service or procedure. 

The purpose of applying the minimum 

threshold was to identify and remove 

from the data specialties listed 

infrequently as performing a certain 

procedure. The assumption was that the 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45785

infrequent instances of these specialties 

in our data represent aberrant 

occurrences and removing the 

associated risk factor from the 

malpractice RVU calculation would 

improve accuracy and stability of the 

RVUs. 

We excluded evaluation and 

management (E&M) services from the 

analysis. Medicare claims data show 

that E&M codes are performed by 

virtually all physician specialties. 

Therefore, in the case of E&M codes, it 

is likely that even the low relative 

percentages of performance by some 

specialties would accurately represent 

the provision of the service by those 

specialties. 

For all services other than E&M 

services, we believe removing data 

attributable to specialties that occur in 

our data less than 5 percent of the time 

would most appropriately balance the 

objective to identify aberrant data 

(claims with a specialty identified that 

is highly unlikely to have performed a 

particular procedure) while including 

specialties that perform a procedure a 

small percentage of the time. We believe 

a higher threshold would result in the 

removal of data for specialties actually 

performing the procedure, while a lower 

threshold would likely fail to remove 

some aberrant data, particularly for lowvolume codes (fewer than 100 

occurrences, where each claim represent 

1 or more percentage points). 

The overall impact of removing the 

risk factor for specialties that occur less 

than 5 percent of the time in our data 

for a procedure is minimal. There is no 

impact on the malpractice RVUs for 

over 5,280 codes, and there is an impact 

of less than 1 percent on the malpractice 

RVUs for over 1,300 additional codes. 

Only 16 codes decrease by at least 0.1 

RVUs, with the biggest decrease being a 

negative 0.28 impact on the malpractice 

RVU for CPT code 17108, Destruction of 

skin lesions, from a current RVU of 0.82 

to a proposed RVU of 0.54. 

Conversely, there are 219 codes for 

which RVUs increase by at least 0.1, the 

largest increase being a positive 0.81 

RVU increase for CPT code 61583, 

Craniofacial approach, skull, from a 

current RVU of 8.32 to a proposed RVU 

of 9.13. Among codes whose 

malpractice RVUs would increase under 

our proposal, 646 have increases of less 

than 1 percent. The impact analysis 

section of this proposed rule examines 

the effects of this proposed change by 

specialty. 

2. Specialty Crosswalk Issues 

Malpractice insurers generally use 

five-digit codes developed by the 

Insurance Services Office (ISO), an 

advisory body serving property and 

casualty insurers, to classify physician 

specialties into different risk classes for 

premium rating purposes. ISO codes 

classify physicians not only by 

specialty, but in many cases also by 

whether or not the specialty performs 

surgical procedures. A given specialty 

could thus have two ISO codes, one for 

use in rating a member of that specialty 

who performs surgical procedures and 

another for rating a member who does 

not perform surgery.

Medicare uses its own system of 

specialty classification for payment and 

data purposes. Therefore, to calculate 

the malpractice RVUs, it was necessary 

to map Medicare specialties to ISO 

codes and insurer risk classes. For some 

physician specialties, NPP, and other 

entities (for example, IDTFs) paid under 

the PFS, there was not a clear ISO 

assignment available. In these instances, 

we crosswalked these unassigned 

specialties to the most approximate 

existing ISO codes and risk classes 

based upon their relationship to those 

specialties for which we did have clear 

ISO crosswalks. The crosswalks we used 

to establish the 2005 malpractice RVUs 

were displayed in the November 15, 

2004 PFS final rule (69 FR 66268). In 

most instances, when an appropriate 

crosswalk could not be identified we 

utilized the average for all physicians 

category, which is a weighted average of 

all specialty premium data. 

Differences among specialties in 

malpractice premiums are a direct 

reflection of the malpractice risk 

associated with the services performed 

by a given specialty. The relative 

differences in national average 

premiums between various specialties 

can be expressed as a specialty risk 

factor. These risk factors are an index 

calculated by dividing the national 

average premium for each specialty by 

the national average premium for 

nephrology, which is the specialty with 

the lowest average premium among the 

20 specialties for which data were 

collected. 

We stated in the November 15, 2004 

PFS final rule that we would continue 

to work with the AMA RUC’s 

Professional Liability Insurance (PLI) 

Workgroup to address any potential 

inconsistencies that may still exist in 

our methodology. Based upon this 

commitment, the RUC PLI Workgroup 

has forwarded various 

recommendations for our consideration. 

The RUC developed its 

recommendations based upon 

comments submitted to them by 

physician specialty organizations. 

The RUC PLI Workgroup provided all 

specialty societies and the HCPAC with 

the opportunity to submit comments on 

the crosswalks listed in the November 

15, 2004 final rule. Based on the 

comments, the Workgroup believes the 

risk factors assigned to certain 

professions overestimate the insurance 

premiums for these professions. We 

crosswalked clinical psychology, 

licensed clinical social work, and 

psychology to the nonsurgical risk factor 

for psychiatry (risk factor of 1.11). We 

crosswalked occupational therapy to 

occupational medicine (risk factor of 

1.11). The PLI Workgroup recommends 

crosswalking these professions to 

allergy and immunology, with a risk 

factor of 1.00 (although the Workgroup 

suggests the actual risk factor for these 

professions may be below the risk factor 

for allergy and immunology and 

encourages the collection of malpractice 

premium data for these professions). 

The Workgroup also believes that 

opticians and optometrists should be 

assigned this risk factor of 1.0, as 

opposed to being crosswalked to 

ophthalmology (nonsurgical risk factor 

of 1.24, surgical risk factor of 2.31). The 

Workgroup further suggests that it 

would be more appropriate to assign the 

risk factor of 1.0 to the chiropractic and 

physical therapy specialties rather than 

their current crosswalk to physical 

medicine and rehabilitation 

(nonsurgical and surgical risk factors of 

1.26). The Workgroup felt that these 

specialties will not incur PLI premiums 

in excess of the current base premiums 

associated a risk factor of 1.0. 

We examined the risk factors assigned 

to these professions, and agree that the 

PLI associated with them should reflect 

the lowest physician specialty risk 

factor (absent actual premium data for 

these professions). Therefore, we 

propose assigning these specialties a 

risk factor of 1.00. We invite comment 

from representatives of the affected 

specialties and others regarding the 

appropriateness of this proposal, as well 

as other specialty crosswalks and 

suggestions for reliable sources of actual 

malpractice premium data for 

nonphysician groups. 

The RUC PLI Workgroup also felt that 

a number of professions that were 

assigned to the average for all 

physicians risk factor should be 

removed from the calculation of 

malpractice RVUs altogether. The PLI 

Workgroup believes that it would be 

more appropriate to exclude data from 

the following professions: Certified 

clinical nurse specialist (CNS), clinical 

laboratory, multispecialty clinic or 

group practice, NP, physician assistant 

(PA), and physiological laboratory 

(independent). In calculating the 

malpractice RVUs applicable for 2005, 

45786 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

34 Medicare specialties were excluded 

from the calculation because they could 

not be otherwise assigned or 

crosswalked. The RUC recommends the 

above specialties and professions be 

similarly excluded. We agree and 

propose to establish malpractice RVUs 

based upon the mix of specialties 

exclusive of the above specialties and 

professions. 

The PLI Workgroup also made the 

following recommendations that we are 

not accepting: Certified registered nurse 

anesthetists (CRNAs) should be 

crosswalked to anesthesiology which is 

2.84 rather than to the ‘‘all physicians’’

which is 3.04; colorectal surgeons 

should be crosswalked to general 

surgery (the current risk factor is based 

on actual data); and gynecologists and 

oncologists (currently 5.63) should be 

crosswalked to surgical oncology 

(currently 6.13). We believe the current 

crosswalks we are using for these 

specialties appropriately reflect the 

types of services they provide. However, 

we would welcome comments on these 

proposals as well.

3. Cardiac Catheterization and 

Angioplasty Exception 

In response to a comment received on 

our proposed methodology at the time, 

in the November 2, 1999 final rule (64 

FR 59384), we applied surgical risk 

factors to the following cardiology 

catheterization and angioplasty codes: 

92980 to 92998 and 93501 to 93536. 

This exception was established because 

these procedures are quite invasive and 

more akin to surgical than nonsurgical 

procedures. 

In the November 15, 2004 final rule 

(69 FR 66275), we discussed changes in 

those codes that would fall under the 

exception. Based on a recommendation 

by the RUC, we revised the list of codes 

to which this exception applies. The 

RUC’s PLI Workgroup requests that we 

correct a clerical error made by the RUC 

in identifying those codes that would 

fall under the exception. We agree with 

the RUC PLI Workgroup 

recommendation and propose that the 

following CPT codes be added to the 

existing list of codes under the 

exception: 92975; 92980 to 92998; and 

93617 to 93641. 

4. Dominant Specialty for Low-Volume 

Codes 

The final recommendation from the 

PLI Workgroup is to use the dominant 

specialty approach for services or 

procedures with fewer than 100 

occurrences. The Workgroup supplied a 

list of 1,844 services for our review and 

recommends that we utilize only the 

dominant specialty in calculating the 

final malpractice RVUs for these 

services. The PLI Workgroup worked in 

conjunction with various specialty 

organizations to identify the dominant 

specialty that performs each service. 

We recognize and appreciate the 

efforts of the Workgroup to review these 

codes. We have considered the data that 

was presented to us and the argument 

for using the dominant specialty to 

establish the malpractice RVUs for these 

1,844 codes. 

We have previously registered our 

concerns with the dominant specialty 

approach. We believe that basing 

payment on all specialties that perform 

a particular service ensures that the 

actual PLI costs of all specialties are 

included in the calculation of the 

malpractice RVUs. Therefore, we do not 

believe it would appropriate, even for 

these low-volume services, to include 

only the dominant specialty if other 

specialties regularly provide the service. 

However, as noted previously in our 

proposal to remove data for specialties 

that make up less than 5 percent of the 

total volume for that service, we also 

recognize the need to take steps to 

minimize the risk that aberrant data 

would inappropriately skew the 

malpractice RVU calculation. We 

believe that, for most services, the 

proposal to remove specialties making 

up less than 5 percent of the 

occurrences will ensure that aberrant 

data are removed. Yet for those services 

with especially low volumes, the 

malpractice RVUs may be especially 

susceptible to the influence of aberrant 

data in only a very few cases (but more 

than 5 percent, that is, 2 cases in a 

service with 20 occurrences). We will 

continue to evaluate ways to ensure 

these low-volume services are not 

skewed by a few occurrences of aberrant 

data, but we are concerned that 

including only the dominant specialty 

performing these services would 

exclude data from other specialties that 

are actually performing them. 

We are not proposing to adopt this 

methodology at this time. We would 

note that low volume procedures or 

services are not necessarily performed 

by only one specialty. As noted above, 

we would distinguish between 

excluding data presumed to be 

erroneous from data reflecting 

utilization by specialties that perform a 

service but are not the dominant 

specialty. However, we acknowledge 

that there may be instances where 

aberrant data exist that would not be 

identified and removed by our proposed 

5 percent threshold discussed 

previously. We will continue to work 

with the RUC PLI Workgroup examine 

this issue in the future. 

D. Medicare Telehealth Services 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘TELEHEALTH’’ at the beginning of 

your comments.] 

1. Requests for Adding Services to the 

List of Medicare Telehealth Services 

Section 1834(m) of the Act defines 

telehealth services as professional 

consultations, office and other 

outpatient visits, and office psychiatry 

services identified as of July 1, 2000 by 

CPT codes 99241 through 99275, 99201 

through 99215, 90804 through 90809, 

and 90862. In addition, the statute 

requires us to establish a process for 

adding services to or deleting services 

from the list of telehealth services on an 

annual basis. 

In the December 31, 2002 Federal 

Register (67 FR 79988), we established 

a process for adding or deleting services 

to the list of Medicare telehealth 

services. This process provides the 

public an ongoing opportunity to submit 

requests for adding services. We assign 

any request to make additions to the list 

of Medicare telehealth services to one of 

the following categories: 

• Category #1: Services that are 

similar to office and other outpatient 

visits, consultation, and office 

psychiatry services. In reviewing these 

requests, we look for similarities 

between the proposed and existing 

telehealth services for the roles of, and 

interactions among, the beneficiary, the 

physician (or other practitioner) at the 

distant site and, if necessary, the 

telepresenter. We also look for 

similarities in the telecommunications 

system used to deliver the proposed 

service, for example, the use of 

interactive audio and video equipment. 

• Category #2: Services that are not 

similar to the current list of telehealth 

services. Our review of these requests 

includes an assessment of whether the 

use of a telecommunications system to 

deliver the service produces similar 

diagnostic findings or therapeutic 

interventions as compared with the 

face-to-face ‘‘hands on’’ delivery of the 

same service. Requestors should submit 

evidence showing that the use of a 

telecommunications system does not 

affect the diagnosis or treatment plan as 

compared to a face-to-face delivery of 

the requested service. 

Since establishing the process, we 

have added the psychiatric diagnostic 

interview examination and ESRD 

services with 2 to 3 visits per month and 

4 or more visits per month to the list of 

Medicare telehealth services (although 

we require at least one visit a month by 

a physician, CNS, NP, or PA to examine 

the vascular access site).

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45787

Requests for adding services to the list 

of Medicare telehealth services must be 

submitted and received no later than 

December 31st of each CY to be 

considered for the next proposed rule. 

For example, requests submitted before 

the end of CY 2004 are considered for 

the CY 2006 proposed rule. For more 

information on submitting a request for 

an addition to the list of Medicare 

telehealth services, visit our Web site at 

http://www.cms.hhs.gov/physicians/

telehealth. 

2. Submitted Requests for Addition to 

the List of Telehealth Services 

We received the following public 

requests for additional approved 

services in CY 2004: (1) Diabetes 

outpatient self-management training 

services and medical nutritional 

therapy; and (2) modification of the 

definition of an interactive 

telecommunications system for 

purposes of furnishing a telehealth 

service. The following is a discussion of 

the requests submitted in CY 2004. 

a. Medical Nutrition Therapy and 

Diabetes Self-Management Training 

The American Telemedicine 

Association (ATA) and an individual 

practitioner submitted a request to add 

medical nutrition therapy (MNT) (as 

represented by HCPCS codes G0270, 

G0271 and 97802 through 97804) and 

diabetes outpatient self-management 

training services (DSMT) (as defined by 

HCPCS codes G0108 and G0109). The 

requestors believe that MNT and DSMT 

are similar to the services currently on 

the list of Medicare telehealth services 

and, therefore, should be added to the 

list of Medicare telehealth services. 

CMS Review 

Section 1861(s)(2) of the Act 

authorizes coverage and payment of 

MNT for certain beneficiaries who have 

diabetes or a renal disease. Individual 

MNT typically involves obtaining a 

nutrition history, counseling, the 

formulation of a treatment plan, 

implementation of a treatment plan 

through discussion with the patient, and 

follow-up with the patient. These 

components would be comparable to 

E&M office or other outpatient visits 

which are currently Medicare telehealth 

services. Additionally, the interactive 

dynamic of individual MNT is similar 

in nature to an E&M office visit because 

the nutrition professional is able to have 

a direct one-on-one discussion with the 

beneficiary and the beneficiary is able to 

ask immediate questions regarding his 

or role in following the treatment plan. 

Therefore, we propose to add individual 

MNT as represented by HCPCS codes 

G0270, 97802 and 97803 to the list of 

Medicare telehealth services. 

Practitioners Who May Furnish Medical 

Nutrition Therapy Services 

Section 1834(m) of the Act specifies 

that practitioners defined in section 

1842(b)(18)(C) of the Act may receive 

payment for furnishing telehealth 

services at the distant site. Effective 

January 1, 2002, section 1842(b)(18)(C) 

of the Act includes a registered dietitian 

or nutrition professional as a Medicare 

practitioner. As a condition of Medicare 

Part B payment, the statute allows only 

a registered dietitian or nutrition 

professional to furnish medical 

nutrition therapy services (subject to 

referral made by the treating physician) 

for the purpose of managing diabetes or 

renal disease. Medicare practitioners 

who are not a licensed or certified 

registered dietitian or other nutrition 

professional, as defined in § 410.134, 

may not furnish and receive payment 

for MNT services. 

We propose to revise § 410.78 and 

§ 414.65 to include individual MNT as 

a Medicare telehealth service. 

Additionally, since a certified registered 

dietitian or other nutrition professional 

are the only practitioners permitted by 

law to furnish MNT, we propose to 

revise § 410.78 to add a registered 

dietitian and nutrition professional as 

defined in § 410.134 to the list of 

practitioners that may furnish and 

receive payment for a telehealth service. 

Group Medical Nutritional Therapy 

(MNT) 

We believe that group counseling 

services have a different interactive 

dynamic between the physician or 

practitioner at the distant site and 

beneficiary at the originating site as 

compared to the current list of Medicare 

telehealth services. We do not currently 

have other group counseling services as 

telehealth services and do not believe 

that group MNT falls within the first 

category of requests. Category 1 requests 

must be similar to the current list of 

Medicare telehealth services in order to 

be added to the list. 

For instance, office and other 

outpatient visits, consultation and the 

current office psychiatry services 

involve an individual professional 

encounter between the physician or 

practitioner and beneficiary. Through 

direct discussion with the beneficiary, 

the physician or practitioner provides 

patient counseling regarding diagnostic 

test results, recommendations for 

further studies, prognosis, treatment 

options, and other follow-up 

instructions. In this interactive 

dynamic, the patient is able to ask 

immediate questions and the physician 

or practitioner is able to discern 

whether the beneficiary understands his 

or her responsibilities in following the 

treatment plan. However, group therapy 

services do not allow for the same 

degree of direct patient interaction as 

compared with individual therapy 

services.

As such, we were not able to conclude 

that the roles of and interaction among 

the physician or practitioner at the 

distant site and beneficiary at the 

originating site are similar to the 

existing Medicare telehealth services. 

Furthermore, the requestors did not 

submit comparative analyses illustrating 

that the use of a telecommunications 

system is an adequate substitute for the 

face-to-face delivery of group MNT 

services (which is a requirement for 

category 2). Therefore, we propose to 

not add group MNT (as described by 

HCPCS codes G0271 and 97804) to the 

list of Medicare telehealth services. 

However, we invite specific public 

comments on whether the use of an 

interactive telecommunications system 

is clinically adequate for furnishing 

group MNT. Additionally, if the 

requestors were to submit data showing 

that the use of a telecommunications 

system does not change the diagnosis or 

treatment plan as compared to face-toface delivery, we would consider 

approving group MNT as a category 2 

service. 

Diabetes Outpatient Self-Management 

Training Services (DSMT) 

The DSMT benefit, described at 

section 1861(qq) of the Act, is a 

comprehensive diabetes training 

program (one component of which is 

MNT). We consider DSMT as a category 

2 request because the major portion of 

DSMT is furnished in the group setting 

and, as explained above, we believe 

group therapy has a different interactive 

dynamic than the current list of 

Medicare telehealth services. 

Additionally, the statute requires the 

training content for DSMT to include 

teaching beneficiaries the skills 

necessary for the self-administration of 

injectable drugs. We question the merits 

of providing beneficiary training to 

administer insulin injections via 

telehealth. For example, teaching a 

patient how to inject insulin requires 

consideration and instruction regarding 

factors such as the type of needle to be 

used, the anatomic location of the 

injection, the injection technique, and 

possible complications of the injection, 

all of which we believe, absent evidence 

to the contrary, require the physical 

presence of the teaching practitioner. 

45788 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

These components are typically not 

part of the services currently on the list 

of telehealth services and the requestor 

did not provide any comparative 

analyses illustrating that the use of a 

telecommunications system is an 

adequate substitute for the in-person, 

collaborative, skill-based training 

required for DSMT services. Therefore, 

we propose to not add DSMT (as 

described by HCPCS codes G0108 and 

G0109) to the list of Medicare telehealth 

services. 

b. Definition of an Interactive 

Telecommunications System 

The Medical College of Georgia (MCG) 

requested that we modify our definition 

of an interactive telecommunications 

system for purposes of furnishing a 

telehealth consultation. The MCG uses 

an interactive audio and one-way, realtime video telecommunications system, 

over an internet-based protocol, to 

furnish consultations for acute ischemic 

stroke patients. The physician at the 

distant site (typically a neurologist) can 

see the patient; however, the patient and 

physician (or practitioner) in the 

emergency room who is with the patient 

cannot see the neurologist. Under this 

model, the neurologist at the distant site 

examines the stroke patient in real-time 

video and reviews CT scans and other 

critical laboratory data to assess the 

stroke patient’s suitability for tissuetype plasminogen activator (tPA) 

treatment. The requestor noted that the 

use of tPA treatment is restricted to 3 

hours after onset of stroke, and argued 

that rapid evaluation by a neurologist 

for stroke patients located in outlying 

rural hospitals is crucial. The requestor 

believes that the use of an interactive 

two-way video system does not provide 

added benefit to the consulting 

neurologist, would be unnecessarily 

cumbersome, and noted that the use of 

one-way video currently prohibits 

billing as a telehealth consultation. 

CMS Review 

As noted previously, consultations are 

included on the list of approved 

telehealth services. However, as a 

condition of payment, § 410.78 of the 

regulations requires the use of an 

interactive two-way audio and video 

telecommunications system to furnish a 

telehealth consultation. The use of oneway video does not meet the current 

interactive telecommunications system 

requirements for telehealth services and, 

therefore, the requestor cannot bill for a 

consultation service based on the model 

described above. 

We have concerns with modifying our 

definition of an interactive 

telecommunications system to permit 

one-way video in place of an interactive 

two-way video system. The use of an 

interactive audio and video 

telecommunications system permitting 

two-way real-time interaction between 

the physician or practitioner at the 

distant site and the beneficiary and 

telepresenter (if necessary) at the 

originating site is a substitute for the 

face-to-face examination requirements 

of a consultation under Medicare. 

We are concerned that the use of oneway video may not be clinically 

adequate for the evaluation of certain 

types of patients. Since telehealth 

services are intended as a substitute for 

services that traditionally require a faceto-face interaction between a physician 

(or practitioner) and a patient, we 

believe that the use of a two-way video 

communication is much less of a 

departure from this standard than a oneway video communication, because the 

face-to-face interaction between a 

physician and a patient allows two-way 

interactive communication, both 

verbally and physically. We are 

concerned that, without two-way video, 

communication of many subtle but 

important nuances of the interaction 

between the physician at the distant site 

and patient or clinical staff at the 

originating site would be lost, leading to 

reduced diagnostic accuracy and the 

possibility of unfavorable medical 

outcomes. 

However, we recognize that a timely 

neurological evaluation is critical for 

determining suitability for tPA 

treatment. Given the potential for 

adverse affects, such as the increased 

risk of bleeding, the decision to 

administer tPA (or not to administer) is 

crucial in determining the course of 

management for the stroke patient. 

Therefore, we are currently reviewing 

the definition of an interactive 

telecommunications system and request 

specific public comments regarding the 

added clinical value of two-way 

interactive video as compared to oneway video for the purpose of furnishing 

telehealth services. We are also 

interested in receiving comments as to 

whether an interactive audio and oneway video telecommunications system 

that permits the physician at the distant 

site to examine the patient in real-time 

is clinically adequate for a broad range 

of specialty consultations. 

c. Definition of a Telehealth Originating 

Site

Section 418 of the MMA required the 

Health Resources Services 

Administration (HRSA) within the 

Department of Health and Human 

Services (HHS), in consultation with 

CMS, to conduct an evaluation of 

demonstration projects under which 

SNFs, as defined in section 1819(a) of 

the Act, are treated as originating sites 

for Medicare telehealth services. The 

MMA also required HRSA to submit a 

report to the Congress that would 

include recommendations on 

‘‘mechanisms to ensure that permitting 

a SNF to serve as an originating site for 

the use of telehealth services or any 

other service delivered via a 

telecommunications system does not 

serve as a substitute for in-person visits 

furnished by a physician, or for inperson visits furnished by a PA, NP or 

CNS, as is otherwise required by the 

Secretary.’’ This report is currently 

under development. 

The MMA provides us with the 

authority to include a SNF as a 

Medicare telehealth originating site 

under section 1834(m) of the Act 

effective January 1, 2006, if the 

Secretary concludes in the report that it 

is advisable to do so and that 

mechanisms could be established to 

ensure that the use of a 

telecommunications system does not 

substitute for the required in-person 

physician or practitioner SNF visits. We 

will review and consider the 

recommendations of the report to 

determine whether to add SNFs to the 

list of approved originating sites. We are 

also soliciting public comments on this 

topic. 

E. Contractor Pricing of Unlisted 

Therapy Modalities and Procedures 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘CODING—CONTRACTOR PRICING’’

at the beginning of your comments.] 

We recognize that there may be 

services or procedures performed that 

have no specific CPT codes assigned. In 

these situations, it is appropriate to use 

one of the CPT codes designated for 

reporting unlisted procedures. These 

unlisted codes do not typically have 

RVUs assigned to them. 

For services coded using these 

unlisted codes, the provider includes a 

description of specific procedures that 

were furnished. The contractor uses this 

information to determine an appropriate 

valuation. 

Currently, there are two unlisted CPT 

codes with assigned RVUs, CPT 97039, 

Unlisted modality (specify and time if 

constant attendance), and 97139 

Unlisted therapeutic procedure. Given 

the variability of the services that could 

be provided using these nonspecific 

codes, use of assigned RVUs may not 

accurately reflect the resources actually 

associated with the provided services. 

This may result in an inappropriate 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45789

payment (overpayment or 

underpayment) for the service provided. 

Other unlisted services that are under 

the PFS are contractor priced. To make 

the pricing methodology consistent with 

our policy for other unlisted services, 

and to more appropriately match 

payments with the actual resources 

expended to deliver the services 

provided, we propose to have the 

contractors value CPT codes 97039 and 

97139. 

F. Payment for Teaching 

Anesthesiologists 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘TEACHING ANESTHESIOLOGISTS’’

at the beginning of your comments.] 

The following discussion summarizes 

the current policy for the payment for 

services provided by teaching 

anesthesiologists and solicits public 

comments on possible revisions to the 

current payment policy. 

1. Payment for Anesthesia Services 

Anesthesia services are paid under 

the PFS, but on a different basis than 

other physician services. Payments for 

anesthesia services are calculated using 

a ‘‘base unit’’ that is specific to the 

anesthesia code plus the anesthesia time 

units. As noted in our regulations at 

§ 414.46(a)(1), the base unit reflects all 

activities other than anesthesia time and 

includes the usual pre-operative and 

post-operative care. Anesthesia time 

units are computed (in 15 minute 

increments) from the actual elapsed 

time for the anesthesia procedure. 

Anesthesia services may be personally 

performed by the anesthesiologist, or 

the anesthesiologist may medically 

direct qualified individuals involved in 

up to four concurrent anesthesia cases. 

Qualified individuals can include 

anesthesiologist assistants (AAs), 

certified registered nurse anesthetists 

(CRNAs), interns, or residents, and, 

under certain circumstances, student 

nurse anesthetists. When the 

anesthesiologist medically directs an 

anesthesia case, the payment for the 

physician’s medical direction service is 

50 percent of the allowance otherwise 

recognized if the anesthesiologist 

personally performed the service. The 

physician would have to fulfill each of 

the medical direction criteria in 

§ 415.110(a) to bill under the medical 

direction policy. 

2. Teaching Physician Payment Policy 

Under the teaching physician 

payment policy for complex surgery, the 

full fee schedule payment can be made 

for the services of the teaching 

physician as long as the teaching 

physician is present with the resident 

for the critical or key portions of the 

service. In order to bill for two 

overlapping surgeries, the teaching 

surgeon must be present during the key 

or critical portions of both operations. 

Beginning in 1994, the teaching 

physician payment policy has been 

applied to anesthesiologists only when 

the teaching anesthesiologist is involved 

in one anesthesia case with a resident. 

If the teaching physician is involved 

with two concurrent cases, then the 

rules for ‘‘medical direction’’ of 

anesthesia apply. 

In August 2002, we released a 

Medicare Carriers Manual transmittal 

relating to the involvement of a nonmedically directed teaching CRNA with 

two student nurse anesthetists. The new 

policy allowed the teaching CRNA to be 

paid for his or her involvement with 

two concurrent cases with student nurse 

anesthetists, but not at the full fee level. 

If a teaching CRNA is involved with two 

concurrent cases with student nurse 

anesthetists, payment may be based on 

the base unit plus the time of each case 

that the teaching CRNA is present with 

the student nurse anesthetist. To bill the 

base unit, the teaching CRNA must be 

present with the student nurse 

anesthetist throughout the pre- and 

post-anesthesia care. 

In the Revisions to Payment Policies 

Under the Physician Fee Schedule for 

Calendar Year 2004 final rule, published 

November 7, 2003 (68 FR 63196–63395), 

we revised § 414.46 of our regulations to 

allow teaching anesthesiologists to bill 

in a similar manner to teaching CRNAs 

for the teaching anesthesiologist’s 

involvement in two concurrent cases 

involving residents. This policy took 

effect for services furnished on or after 

January 1, 2004. This was intended as 

an alternative to the ‘‘medical direction’’

payment policy applicable to concurrent 

cases involving teaching 

anesthesiologists and residents. 

Under this policy, teaching 

anesthesiologists can bill and be paid 

the full fee schedule for the base unit 

portion of the payment if they are 

present with the resident during the preand post-anesthesia care included in the 

base units. Teaching anesthesiologists 

can also bill and be paid the full fee 

schedule amount for anesthesia time 

based on the amount of time the 

physician is present with the resident 

during each of the two concurrent cases. 

Payment to a teaching anesthesiologist 

for two concurrent cases involving 

residents under this policy would be 

greater than under the medical direction 

payment policy. However, if the 

teaching anesthesiologist is not present 

with the resident during the pre- and 

post-anesthesia care for both concurrent 

cases, the physician could only bill the 

cases as ‘‘medically directed.’’

Despite the higher level of payment 

available under this policy, the 

American Society of Anesthesiologists 

(ASA) has informed us that it is not 

aware of any teaching anesthesia 

programs that have arranged their 

practices to meet the conditions 

necessary to bill under the revised 

policy. The ASA suggests that the 

teaching physician regulations for 

teaching anesthesiologists should be 

similar to those for teaching surgeons 

for overlapping complex surgery 

procedures. The ASA thinks that 

anesthesia is similar to complex surgery 

in terms of critical periods, overlap, and 

availability of teaching physicians. 

However, the critical portions of the 

teaching anesthesia service and the 

critical portions of the teaching surgeon 

service are not the same. The ASA 

believes that inadequate payment levels 

have contributed to the loss of teaching 

anesthesiologists and an inability to 

recruit new faculty.

We are requesting comments on a 

teaching physician policy for 

anesthesiologists that could build on the 

policy announced in the November 7, 

2003 PFS final rule, but provide the 

appropriate revisions that would allow 

it to be more flexible for teaching 

anesthesia programs. We would also be 

interested in receiving data and studies 

relevant to this issue as well as any 

offsetting savings that could be made to 

account for any potential costs that 

could be incurred if there was a policy 

change. 

G. End Stage Renal Disease (ESRD) 

Related Provisions 

On November 15, 2004, we published 

the Revisions to Payment Policies Under 

the Physician Fee Schedule for Calendar 

Year 2005 final rule in the Federal 

Register (69 FR 66319), revising 

payments to ESRD facilities in 

accordance with provisions of the 

MMA. This final rule implemented 

section 1881(b) of the Act, as amended 

by section 623 of the MMA, which 

directed the Secretary to make a number 

of revisions to the composite rate 

payment system, as well as payment for 

separately billable drugs furnished by 

ESRD facilities. Changes that were 

implemented January 1, 2005 included 

a revision to payments for drugs billed 

separately by ESRD facilities whereby 

the top ten ESRD drugs are paid based 

on acquisition costs (as determined by 

the Office of Inspector General (OIG)) 

and other separately billed drugs are 

paid average sales price (ASP) +6 

percent. 

45790 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

Also, in accordance with section 623 

of the MMA, an adjustment of 8.7 

percent was made to the composite 

payment rate to account for the 

difference between previous payments 

for separately billed drugs and 

biologicals and the revised pricing that 

took effect January 1, 2005. As required 

by section 623 of the MMA, we are 

proposing to update this add-on 

adjustment to reflect changes in ESRD 

drug utilization. In addition, we are 

proposing to revise the add-on 

adjustment to reflect the methodology 

we will be using for ESRD drugs. 

Section 623 of the MMA also required 

the establishment of basic case-mix 

adjustments to the composite payment 

rate for a limited number of patient 

characteristics. The November 15, 2004 

final rule implemented three categories 

of patient characteristic adjustments 

(age, low body mass index (BMI), and 

body surface area (BSA)) that were 

implemented April 1, 2005. We are 

proposing to maintain these categories 

and patient characteristics as 

established in the November 15, 2004 

final rule (69 FR 66238). 

Also, section 1881(b)(12) of the Act as 

amended by section 623 of the MMA 

provided authority to revise the 

geographic adjustment applied to the 

composite payment rate. Accordingly, 

we are proposing to revise the 

geographic classifications and wage 

indexes currently in effect for adjusting 

composite rate payments. As required 

by section 623 of the MMA, these 

proposed changes will be phased in 

over time. 

In addition, we are proposing 

revisions to the regulations applicable to 

the composite rate exceptions process to 

reflect section 623 of the MMA 

provisions that restrict exceptions to 

pediatric facilities. 

1. Revised Pricing Methodology for 

Separately Billable Drugs and 

Biologicals Furnished by ESRD 

Facilities 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘ESRD-Pricing Methodology’’ at the 

beginning of your comments.] 

In the Revisions to Payment Policies 

under the Physician Fee Schedule for 

Calendar Year 2005 final rule, published 

on November 15, 2004, we determined 

that for CY 2005, payment for the top 10 

separately billable ESRD drugs billed by 

freestanding facilities would be based 

on the acquisition cost of the drug, as 

determined by the OIG, updated by the 

Producer Price Index (PPI). The 

remaining separately billable ESRD 

drugs would be paid at the ASP +6 

percent for freestanding facilities. We 

also determined that hospital-based 

facilities would continue cost 

reimbursement for all drugs with the 

exception of erythopoeitin (EPO) which 

would be paid the acquisition cost, as 

determined by the OIG, updated by the 

PPI. 

As discussed in section II.H. of this 

proposed rule, for CY 2006, we are 

proposing that payment for a drug 

furnished in connection with renal 

dialysis services and separately billed 

by freestanding renal dialysis facilities 

will be based on section 1874A of the 

Act. We are also proposing to update the 

payment allowances quarterly based on 

the ASP reported to us by drug 

manufacturers. For CY 2006, we are 

proposing to continue cost 

reimbursement for hospital-based 

facilities; while, proposing to pay for 

EPO in hospital-based facilities at the 

ASP +6 percent. 

2. Adjustment to Account for Changes 

in the Pricing of Separately Billable 

Drugs and Biologicals, and the 

Estimated Increase in Expenditures for 

Drugs and Biologicals. 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘ESRD—Drugs and Biologicals’’ at the 

beginning of your comments.] 

Section 623(d) of the MMA, added 

section 1881(b)(12) of the Act which 

contains two provisions that describe 

how the drug add-on adjustment will be 

implemented in the ESRD payment 

system. First, that the add-on 

adjustment reflects the difference 

between payment methodology for 

separately billed drugs under the drug 

price in effect in CY 2004 and current 

drug pricing and, second, the aggregate 

payments for CY 2005 must equal 

aggregate payments absent this MMA 

provision. 

In the November 15, 2004 final rule 

(69 FR 66322), we described in detail 

the methodology that we used for 

developing the drug add-on adjustment 

to the composite rate to account for the 

difference between estimated drug 

payments under the average wholesale 

price (AWP) payment system and the 

acquisition costs as determined by the 

OIG. This adjustment was developed so 

that aggregate spending for composite 

rate plus separately billed drugs would 

remain budget neutral for CY 2005. 

Section 1881(b)(12) of the Act also 

contains two provisions related to 

adjustments to payments for drugs and 

biologicals for CY 2006. First, section 

1881(b)(12)(C)(ii) of the Act provides 

that we recalculate the add-on 

adjustment to reflect the drug pricing 

methodology applied by the Secretary 

under section 1881(b)(13)(A)(iii) of the 

Act. That is, we must compute the drug 

add-on adjustment based on the 

difference between estimated payments 

using the AWP payment methodology 

and the proposed new payment 

methodology using ASP +6 percent.

In addition, section 1881(b)(12)(F) of 

the Act requires that, beginning in 2006, 

we establish an annual update 

adjustment to reflect estimated growth 

in expenditures for separately billable 

drugs and biologicals furnished by 

ESRD facilities. This update would be 

applied only to the drug add-on portion 

of the composite rate. In order to meet 

both requirements, we are proposing to 

develop the CY 2006 drug add-on 

adjustment in two steps. 

First, we would recalculate the CY 

2005 add-on adjustment to reflect the 

difference in drug payments using 95 

percent AWP pricing and payments 

using ASP +6 pricing. This calculation 

would replace the current 8.7 percent 

adjustment and would be budget neutral 

to CY 2005 payments. The next step 

would be to develop a proposed annual 

update methodology that we would use 

in CY 2006 to reflect the estimated 

growth in drug expenditures each year. 

As mentioned above, this update would 

be applied only to the drug add-on 

portion of the composite payment rate. 

The following sections discuss the 

recomputation of the drug add-on 

adjustment followed by a discussion of 

the update of the adjustment for CY 

2006. 

a. Proposed Recalculation of the CY 

2005 Drug Add-on Adjustment 

For CY 2006, we are proposing to use 

the same method that we used to 

develop the drug add-on adjustment for 

CY 2005 to recalculate the adjustment to 

reflect the proposed revision to the 

ESRD drug payment methodology from 

acquisition costs to ASP +6 percent. 

That is, we propose to calculate the 

spread based on the difference in 

aggregate payments between estimated 

payment based on AWP pricing and 

estimated payment based on ASP +6 

pricing. As discussed in detail below, 

we propose to use pricing data from the 

second quarter of CY 2005. All of the 

data used to develop the proposed addon adjustment will be updated for the 

final rule, as more current data, 

including ASP data, will be available. 

(1) Historical Drug Expenditure Data 

To develop the drug add-on 

adjustment we used historical total 

aggregate payments for separately billed 

ESRD drugs for half of CY 2000 and all 

of CY 2001, CY 2002 and CY 2003. For 

EPO, these payments were broken down 

according to type of ESRD facility 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45791

(hospital-based versus independent). 

We also used the number of dialysis 

treatments performed by these two types 

of facilities over the same period. 

(2) ASP +6 Percent Prices 

We obtained the ASP +6 percent 

prices, for the second quarter of CY 

2005, as shown in the following table. 

For purposes of this proposed rule, we 

have used the latest ASP pricing 

available, which are second quarter 

prices. For the final rule, we will have 

prices for all 4 quarters of CY 2005 and 

plan to develop prices representing the 

average CY 2005 ASP payments for the 

drugs listed in Table 20 below.

TABLE 20. 

Drugs 

Second quarter ASP +6 

percent 

Epogen ................................... $9.25 

Calcitriol .................................. $0.86 

Doxercalciferol ........................ $2.78 

Iron_dextran ............................ $11.22 

Iron_sucrose ........................... $0.37 

Levocarnitine .......................... $11.12 

Paricalcitol .............................. $3.97 

Sodium_ferric_glut .................. $4.73 

Alteplase, Recombinant .......... $30.09 

Vancomycin ............................ $3.19 

(3) Estimated Medicare Payments Using 

95 Percent of AWP 

In order to estimate AWP payments 

we used the first quarter 2005 AWP 

prices and updated them to the second 

quarter by applying, for drugs other than 

EPO, an estimated AWP quarterly 

growth of approximately 0.74 percent 

(annual growth factor of 3 percent). This 

growth factor is based on historical 

trends of AWP pricing (for all drugs) for 

the year 1997–2003. We did not increase 

the payment rate for Epogen since 

payment was maintained at $10.00 per 

thousand units prior to MMA. (See 

Table 21.)

TABLE 21. 

Drugs 

AWP rates 

for the second quarter 

of 2005 

Epogen ................................... $10.00 * 

Calcitriol .................................. $1.40 

Doxercalciferol ........................ $3.11 

Iron_dextran ............................ $18.04 

TABLE 21.—Continued

Drugs 

AWP rates 

for the second quarter 

of 2005 

Iron_sucrose ........................... $0.66 

Levocarnitine .......................... $36.75 

Paricalcitol .............................. $5.37 

Sodium_ferric_glut .................. $8.23 

Alteplase, Recombinant .......... $38.82 

Vancomycin ............................ $5.55 

* Statutory rate. 

(4) Dialysis Treatments 

We updated the number of dialysis 

treatments by the actuarial projected 

growth in the number of ESRD 

beneficiaries. Since Medicare covers a 

maximum of three treatments per week, 

utilization growth is limited, and, 

therefore, any increase in the number of 

treatments should be due to beneficiary 

enrollment. In CY 2005, we estimate 

there will be a total of 34.5 million 

treatments performed. We note that this 

represents the most current actuarial 

projection and differs slightly from the 

projection published in the November, 

15, 2004 final rule. (69 FR 66323) 

(5) Drug Payments 

We updated the total aggregate 

Epogen drug payments for both 

hospital-based and independent 

facilities by using historical trend 

factors. For CY 2004 and CY 2005, the 

CY 2003 payment level was increased 

each year by trend factor of 9.0 percent. 

Using the 9 percent growth factor for 

Epogen, we updated the aggregate 

spending for separately billable drugs, 

other than EPO, for independent 

facilities. Aggregate payments in this 

category show extremely varied growth 

between 2000 and 2003, and, for this 

reason, we felt that trend analysis was 

not sufficient. Therefore, we believe it 

would be reasonable to correlate the 

growth of Epogen and separately 

billable drugs in an independent 

facility, since Epogen constitute the 

largest amount of drugs dispensed in an 

independent facility. Additionally, we 

deducted 50 cents for each 

administration of Epogen from the total 

Epogen spending for both hospitalbased and independent facilities, to 

account for spending on syringes that 

were included in the EPO payments 

prior to the implementation of the MMA 

drug payment provisions. In CY 2005, 

we estimate payments for these syringes 

will amount to $1.6 million for hospitalbased facilities and $26.8 million for 

independent facilities. For CY 2005, we 

estimate that total spending, after the 

deduction of payments for syringes, will 

reach $246 million for Epogen provided 

in hospital-based facilities, and $2.850 

million for drugs provided in 

independent facilities ($1.960 million 

for Epogen and $890 million for other 

drugs). We note that all other drugs 

provided in hospital-based ESRD 

facilities continue to be paid at cost. 

(6) Add-On Calculation and Budget 

Neutrality 

For each of the top 10 drugs (as 

explained below), we calculated the 

percent by which ASP +6 percent is 

projected to be less than payment 

amounts under the 95 percent of AWP 

pricing system for CY 2005. For Epogen, 

this amount is 7.5 percent. We applied 

this 7.5 percent figure to the total 

aggregate drug payments for Epogen in 

hospital-based facilities, resulting in a 

difference of $18 million. 

We then calculated a weighted 

average of the percentages by which 

ASP +6 percent would be below 95 

percent of AWP payment prices, for the 

top 10 ESRD drugs for independent 

facilities. We weighted these 

percentages by using the CY 2005 

estimated Medicare payment amounts 

for the top 10 drugs. This procedure 

resulted in a weighted average payment 

reduction of 12 percent. We note that in 

the previous calculation for the CY 2005 

add-on adjustment, we had used CY 

2002 values from the OIG. (See Table 22 

for the calculated drug weights, and 

Table 23 for the percentage by which 

ASP prices are lower than AWP prices.) 

The CY 2003 data projected forward to 

CY 2005 indicated a significant drop in 

payments for drugs other than Epogen 

that are provided in an independent 

facility. This trend, which we expect 

will continue when we obtain CY 2004 

historical data for the final rule, 

decreases the weights of the drugs, other 

than Epogen and increases the weight of 

Epogen. The overall effect is to lower 

the weighted average by several 

percentage points.

45792 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

TABLE 22. 

Drugs 

CY 2005 estimated drug 

payments as 

a percentage 

of total drug 

expenditures

(percent) 

CY 2002 OIG 

drug payments as a 

percentage of 

total drug expenditures

(percent) 

Epogen ......................................................................................................................................................................... 78.83 67.85 

Calcitriol ....................................................................................................................................................................... 0.13 1.22 

Doxercalciferol ............................................................................................................................................................. 1.74 1.28 

Iron_dextran ................................................................................................................................................................. 0.38 0.65 

Iron_sucrose ................................................................................................................................................................ 0.71 5.00 

Levocarnitine ................................................................................................................................................................ 0.89 1.68 

Paricalcitol .................................................................................................................................................................... 17.37 15.90 

Sodium_ferric_glut ....................................................................................................................................................... 0.53 6.03 

Alteplase, Recombinant ............................................................................................................................................... 0.18 0.19 

Vancomycin ................................................................................................................................................................. 0.24 0.20 

* Compared to the $10.00 statutory price. 

TABLE 23. 

Drugs 

Percent by 

which ASP+6 

percent rates 

are below 95 

percent of 

AWP prices 

(except EPO)

(percent) 

Epogen ................................... * 7.5 

Calcitriol .................................. 38.7 

Doxercalciferol ........................ 10.6 

Iron_dextran ............................ 37.8 

Iron_sucrose ........................... 45.1 

Levocarnitine .......................... 69.7 

Paricalcitol .............................. 26.0 

Sodium_ferric_glut .................. 42.6 

Alteplase, Recombinant .......... 22.5 

Vancomycin ............................ 42.6 

* Compared to the $10.00 statutory price. 

We estimate that these ten drugs 

represent nearly 92 percent of total CY 

2005 drug payments to independent 

facilities. To account for the drug spread 

related to the 8 percent of drug 

expenditures for which we do not have 

pricing data, we applied the weighted 

average to 100 percent of aggregate drug 

spending projections for independent 

facilities, producing a projected 

difference of $343 million. The 

weighted average is applied to 100 

percent of drug spending projections for 

independent facilities to account for the 

drug spread related to the 8 percent of 

drugs expenditures for which we do not 

have pricing data.

We combined the CY 2005 figures of 

$18 million for the hospital-based 

facilities and $343 million for the 

independent facilities, for a total of $362 

million. We distributed this over a total 

projected 34.5 million treatments 

resulting in a revised CY 2005 add-on to 

the per treatment composite rate of 8.1 

percent. By making this adjustment to 

the composite rate, we estimate that the 

aggregate payments to both independent 

and hospital-based ESRD facilities 

would be budget neutral with respect to 

drug payments for CY 2005, as required 

by the MMA. We note that this 8.1 

percent adjustment replaces the current 

8.7 percent adjustment for CY 2005 in 

our calculations. 

b. Calculation of the Proposed CY 2006 

Update to the Drug Add-On Adjustment 

This section describes the approach 

that we are proposing to use to update 

the drug add-on adjustment. 

(1) Drug Payments and Dialysis 

Treatments 

Similar to the process discussed in 

the previous section, we updated the 

total aggregate Epogen drug payments 

for each hospital-based and 

independent facility using historical 

trend factors. For CY 2006, the payment 

level was increased from CY 2005 by a 

trend factor of 9.0 percent. 

We also updated aggregate spending 

for separately billable drugs, other than 

EPO, for independent facilities using the 

9 percent growth factor for Epogen. As 

discussed earlier, payments in this 

category have shown extremely varied 

growth in recent history and historical 

data between CY 2002 and CY 2003 

showed a significant drop in aggregate 

spending. We felt it was reasonable to 

use trend analysis and correlate the 

growth of Epogen and other separately 

billable drugs. We expect that we will 

have further data for the final rule. This 

procedure resulted in projected 

expenditures of $268 million for Epogen 

provided in hospital-based facilities and 

$3.107 million for drugs provided in 

independent facilities ($2.137 million 

for Epogen and $970 million for other 

drugs). These numbers include an 

estimated reduction for the 50 cent 

payment for syringes of $1.6 million for 

hospital-based facilities and $27.5 

million for independent facilities. We 

also updated the projected number of 

dialysis treatments using CMS actuarial 

enrollment projections. This resulted in 

a projected 35.4 million treatments for 

CY 2006. 

(2) Adjustment to Composite Rate AddOn 

We then applied the 9 percent growth 

between projected CY 2005 and CY 

2006 aggregate drug expenditures to the 

CY 2005 expected drug spread figures of 

$18 million for Epogen provided in 

hospital-based facilities and $343 

million for drugs provided in 

independent facilities. This resulted in 

an incremental increase in the drug 

spread in CY 2006 of $2 million for 

Epogen provided in hospital-based 

facilities and $31 million for drugs 

provided in independent facilities. We 

distributed the combined $33 million 

over 35.4 million projected treatments, 

resulting in an additional 0.7 percent 

addition to the CY 2005 add-on of 8.1 

percent. 

(3) Proposed Drug Add-On Adjustment 

for CY 2006 

With the recalculated CY 2005 add-on 

to the per treatment composite rate 

being 8.1 percent and with the 

additional increment for expenditures 

in CY 2006 being 0.7 percent, we 

combine them to produce one drug addon adjustment for CY 2006 that would 

be 8.9 percent. 

(4) Add-On for Spread for Drugs 

Furnished in Hospital-Based Facilities 

In its June 2005 Report to Congress, 

MedPAC recommended that payment 

differences be eliminated for separately 

billed drugs furnished in independent 

and hospital-based facilities and that all 

these drugs be paid under the ASP +6 

percent system. While we agree with 

MedPAC that paying the same rates in 

both settings would be the preferable 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45793

policy, we have not proposed this 

policy because data on dosing units for 

drugs furnished by hospital-based 

facilities are not available. This data is 

needed to estimate the drug payments 

using ASP +6 percent pricing. That is a 

key component of the calculation of the 

drug add-on adjustment. In their report, 

MedPAC acknowledges these data 

issues and recommends that CMS take 

steps to collect data on acquisition costs 

and payment per unit for drugs 

provided in hospital-based ESRD 

facilities. We are currently examining 

approaches for obtaining these data. 

However, we seek comment about a 

potential method to estimate the drug 

add-on amount for drugs furnished in 

hospital-based facilities, and we seek 

comment about alternative estimation 

methodologies, data, or both. 

One estimation approach could be an 

approach where the pricing spread for 

drugs other than EPO furnished in 

hospital based facilities would be 

assumed to be the same as for those 

drugs in independent facilities. This 

aggregate approach would assume that 

the add-on amount for drugs other than 

EPO furnished in hospital-based 

facilities results in the same relative 

amount of drugs furnished as for those 

drugs in independent facilities. Using 

aggregate ratios, the drug add-on 

amounts calculated for drugs other than 

EPO furnished in independent facilities 

might be extrapolated for drugs other 

than EPO furnished in hospital-based 

facilities. 

Use of this approach could allow 

calculation of a reasonable estimate of 

aggregate drug add-on amount for drugs 

other than EPO furnished in hospitalbased facilities until the time that data 

becomes available to more accurately 

calculate the drug add-on adjustment. 

This approach would allow payment of 

all drugs furnished in hospital-based 

facilities under the ASP +6 percent 

payment methodology, achieve 

consistent payments for ESRD 

separately billed drugs regardless of 

setting, and provide a reasonable 

estimation of the drug add-on amount 

needed to adjust the composite rates for 

drugs other than EPO furnished in 

hospital-based facilities. We seek 

comment about this potential method to 

estimate spread for drugs furnished in 

hospital-based facilities, as well as 

alternative estimation methodologies, 

data, or both. 

3. Proposed Revisions to Geographic 

Designations and Wage Indexes Applied 

to the ESRD Composite Payment Rate 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘ESRD-Composite Payment Rate Wage 

Index’’ at the beginning of your 

comments.]

Because of the significance of labor 

costs in determining the total cost of 

care, the prospective payment systems 

(PPSs) which we administer 

traditionally have used a wage index to 

account for differences in area wage 

levels. The labor-related shares of costs 

used to develop the composite rates 

were 36.78 percent for hospital-based 

facilities and 40.65 percent for 

independent facilities. The current 

composite payment rates are calculated 

using a blend of two wage indexes, one 

based on hospital wage data for fiscal 

years ending in CY 1982, and the other 

developed from CY 1980 data from the 

Bureau of Labor Statistics (BLS). The 

wage indexes are calculated for each 

urban and rural area based on 1980 U.S. 

Census definitions of metropolitan 

statistical areas (MSAs) or their 

equivalents, and areas outside of MSAs 

in each State, respectively. (51 FR 

29411) 

Section 4201(a)(2) of OBRA 1990 

(Pub. L. 101–508) froze the composite 

payment rates, and the basis for their 

calculation, at the level in effect as of 

September 30, 1990 (except for 

subsequent statutory updates that did 

not affect the data used to calculate 

wage indexes). The OBRA 1990 

restriction on revising the ESRD 

composite payment rates has had 

another effect. ESRD facilities located in 

counties classified as rural based on the 

1980 Census, but which subsequently 

are classified as urban, are still 

considered rural for purposes of 

determining whether urban or rural 

composite payment rates apply. The 

rural rates are generally lower than 

those for urban ESRD facilities. 

In addition, restrictions also apply to 

the wage index values used to compute 

the ESRD composite payment rates. 

Payments to facilities in areas where 

labor costs fall below 90 percent of the 

national average, or exceed 130 percent 

of that average, are not adjusted beyond 

the 90 percent or 130 percent level. (See 

the Prospective Reimbursement for 

Dialysis Services and Approval of 

Special Purpose Renal Dialysis 

Facilities final rule (48 FR 21254) and 

the Composite Rates and Methodology 

for Determining the Rates final notice 

(51 FR 29404)). This effectively means 

that ESRD facilities located in areas 

with wage index values less than 0.9000 

are paid more than they would 

otherwise receive if we fully adjusted 

for area wage differences. Conversely, 

facilities in locales with wage index 

values greater than 1.3000 are paid less 

than they would receive if we fully 

adjusted the rates based on actual wage 

levels. 

Section 1881(b)(12)(D) of the Act, as 

amended by section 623(d) of the MMA, 

gave the Secretary the discretionary 

authority to revise the current wage 

index. That provision also requires that 

any revised measure be phased-in over 

a multiyear period. In the November 15, 

2004 final rule establishing new casemix adjusted composite payment rates 

(69 FR 66332), we stated that we were 

deferring replacing the current wage 

index pending further assessment. We 

have completed our review, and believe 

that modernizing the current ESRD 

wage index is a matter of some urgency. 

After further analysis we are proposing 

to use OMB’s revised geographic 

definitions announced in OMB Bulletin 

No. 03–04, issued June 6, 2003. These 

new definitions are known as CoreBased Statistical Areas (CBSAs). In 

conjunction with the CBSAs, we are 

also proposing to recalculate the ESRD 

wage indexes based on acute care 

hospital wage and employment data for 

FY 2002, as reported to us in connection 

with the development of the wage index 

used in the inpatient hospital 

prospective payment system (IPPS). In 

addition, we are also proposing to 

update the labor portion of the ESRD 

composite rate to which the wage index 

is applied. The basis for our proposed 

revisions to the current ESRD composite 

rate wage index to reflect these changes 

is set forth in the following sections. 

a. Current Urban and Rural Locales 

Based on MSAs 

We currently adjust the labor-related 

share of the composite payment rates to 

account for differences in area wage 

levels using a wage index which is a 

blend of two wage index values, one 

based on hospital wage data from FY 

1982, and the other developed from 

1980 hospital data from the BLS. The 

hospital and BLS proportions of the 

blended wage index are 40 percent and 

60 percent, respectively. The hospital 

and BLS wage index values used to 

compute the blended wage index were 

published in the Federal Register on 

August 15, 1986 (51 FR 29412). 

The use of a blended wage index 

results from our effort to transition 

ESRD facilities from composite payment 

rates using a wage index based on BLS 

data, to one developed from hospital 

wage and employment data obtained 

from Medicare cost reports (‘‘the 

hospital wage index’’). A major 

limitation of the BLS wage index was its 

inability to distinguish area differences 

in the use of part-time hospital workers. 

In order to mitigate the impact of 

changes in facility payment rates as a 

45794 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

result of our adoption of the new 

hospital wage index, we began a fiveyear phase-in of the new measure. 

During the phase-in period, we had 

intended to use a weighted wage index, 

under which the BLS portion would 

decrease 20 percent and the share 

represented by the hospital wage index 

would increase 20 percent each year. 

During the second year of the phase-in, 

for which the hospital and BLS portions 

of the wage index were 40 percent and 

60 percent, respectively, the wage index 

was frozen as a result of the OBRA 1990 

prohibition on composite payment rate 

revisions. 

The wage indexes are calculated for 

each urban and rural area. In general, an 

urban area is a MSA or New England 

County Metropolitan Area as defined by 

OMB based on 1980 U.S. Census 

definitions. A rural area consists of all 

counties within each State outside of an 

urban area. The counties which 

comprise the urban locales currently 

used to compute the wage index values 

incorporated in the urban composite 

payment rates were last published in the 

Federal Register on May 30, 1986 (51 

FR 19738–19739). Although OMB has 

revised the definitions of the MSAs 

since that time, the composite payment 

rate urban/rural designations have not 

been changed due to the prohibition on 

revising the ESRD payment 

methodology established under section 

4201(a)(2) of OBRA 1990. More current 

MSAs are used in connection with 

several other non-acute care Medicare 

PPSs that we administer, including 

those for SNFs, long-term care hospitals 

(LTCHs), inpatient psychiatric facilities 

(IPFs), home health agencies (HHAs), 

and inpatient rehabilitation facilities 

(IRFs). 

b. Revision of Geographic 

Classifications 

On June 6, 2003, OMB issued Bulletin 

03–04 that announced new geographic 

area designations based on the 2000 

Census. The bulletin established revised 

definitions for the nation’s MSAs, 

designated county based Metropolitan 

Divisions within the MSAs that have a 

single core with a population of at least 

2.5 million, created two new sets of 

statistical areas (Micropolitan Statistical 

Areas and Combined Statistical Areas), 

and defined New England City and 

Town Areas. The bulletin may be 

accessed on the Internet at: http://

www.whitehouse.gov/omb/bulletins/

bo3–04.html.

Section 623 of the MMA gave the 

Secretary the authority to revise the 

geographic areas used to develop the 

wage indexes currently reflected in the 

composite payment rates, removing the 

OBRA 1990 restriction. Although we 

published revised composite payment 

rates in the November 15, 2004 final 

rule implementing MMA mandated 

revisions to those rates, we did not 

propose revising the wage indexes, or 

the geographic areas on which they are 

based at that time. For reasons 

discussed below, we are proposing to 

use OMB’s list of geographic 

designations for purposes of adjusting 

the urban and rural composite payment 

rates. Facilities located in counties 

within MSAs or Metropolitan Divisions 

within CBSAs would be considered 

urban, while facilities located in 

micropolitan counties or other counties 

outside of the CBSAs would be 

classified as rural. We point out that 

these are the same urban and rural 

definitions used in connection with the 

Medicare IPPS, and are discussed in the 

August 11, 2004 final rule establishing 

the IPPS FY 2005 payment rates (69 FR 

49026). 

c. Core-Based Statistical Areas (CBSAs) 

OMB reviews its metropolitan area 

definitions preceding each decennial 

census. As explained in the August 11, 

2004 IPPS final rule (69 FR 49026), 

OMB chartered the Metropolitan 

Standards Review Committee to 

examine the metropolitan area 

standards and develop 

recommendations for possible changes 

to those standards. Three notices related 

to the review of the standards, providing 

an opportunity for public comment on 

the recommendations of the Committee, 

were published in the Federal Register

on December 21, 1998 (63 FR 70526), 

October 20, 1999 (64 FR 56628), and 

August 22, 2000 (65 FR 51060). 

In the December 27, 2000 Federal 

Register (65 FR 82228), OMB published 

a notice announcing its new standards. 

According to that notice, OMB defines 

a CBSA beginning in 2003 as ‘‘a 

geographic entity associated with at 

least one core of 10,000 or more 

population, plus adjacent territory that 

has a high degree of social and 

economic integration with the core as 

measured by commuting ties.’’ The 

standards designate and define two 

categories of CBSAs: MSAs and 

Micropolitan Statistical Areas (65 FR 

82235). 

According to OMB, MSAs are based 

on urbanized areas of 50,000 or more 

population, and Micropolitan Statistical 

Areas (referred to hereafter as 

Micropolitan Areas) are based on urban 

clusters with at least 10,000, but less 

than 50,000 population. Counties that 

do not fall within CBSAs are deemed 

‘‘Outside CBSAs’’. Previously OMB 

defined MSAs around areas with a 

minimum core population of 50,000, 

and smaller areas were ‘‘Outside 

MSAs’’. On June 6, 2003 OMB 

announced the new CBSAs, consisting 

of MSAs and the new Micropolitan 

Areas based on the results of the 2000 

Census. 

d. Adoption of MSAs as Urban Areas for 

Composite Payments 

In its June 6, 2003 announcement, 

OMB cautioned that its new 

metropolitan area definitions ‘‘should 

not be used to develop and implement 

Federal, State, and local nonstatistical 

programs and policies without full 

consideration of the effects of using 

these definitions for these purposes. 

These areas should not serve as a 

general purpose geographic framework 

for nonstatistical activities, and they 

may or may not be suitable for use in 

program funding formulas.’’

We point out that Medicare’s PPSs, 

including the ESRD composite payment 

rate, historically have used the 

metropolitan area definitions developed 

by OMB. While the hospital IPPS is the 

most significant of these, the OMB 

geographic designations are also used to 

define labor market areas for purposes 

of recognizing area differences in labor 

costs under the SNF, inpatient 

rehabilitation, IPFs, and home health 

PPSs. In discussing the adoption of the 

OMB geographic designation for the 

IPPS area labor adjustment, the FY 1985 

IPPS proposed rule published July 3, 

1984 (49 FR 27426) noted as follows:

[i]n administering a national payment 

system, we must have a national 

classification system built on clear, objective 

standards. Otherwise the program becomes 

increasingly difficult to administer because 

the distinction between rural and urban 

hospitals is blurred. We believe that the MSA 

system (developed by OMB) is the only one 

that currently meets the requirements for use 

as a classification system in a national 

payment program. The MSA classification 

system is a statistical standard developed for 

use by Federal agencies in the production, 

analysis, and publication of data on 

metropolitan areas. The standards have been 

developed with the aim of producing 

definitions that will be as consistent as 

possible for all MSAs nationwide.

The logic represented in the statement 

above still applies today. The process 

used by OMB to develop the geographic 

designations resulted in the creation of 

geographic locales that we believe also 

reflect the characteristics of unified 

labor market areas. The CBSAs contain 

a core population plus adjacent areas 

that reflect a high degree of social and 

economic integration. This integration is 

measured by commuting patterns, thus 

demonstrating that the areas likely draw 

workers from the same general locale. In 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45795

addition, the CBSAs reflect the most upto-date information, based on the 2000 

Census. OMB reviews its metropolitan 

area definitions preceding each 

decennial census to ensure 

consideration of the most recent 

population changes. Finally, in the 

context of the IPPS, we have reviewed 

alternative methods for determining 

geographic areas for purposes of the 

wage index. In each case, we have 

concluded that it was preferable to 

retain the independently developed 

OMB designations rather than replace 

them with alternatives. (See the August 

11, 2004 final IPPS rule at 69 FR 49027–

49028.) 

Aside from the long established 

precedent of using OMB geographic 

designations to adjust for differing area 

wage levels in the PPSs that we 

administer, we also point out that the 

Congress has recognized the propriety of 

the OMB definitions in distinguishing 

among geographic areas for making 

Medicare payments. For example, 

section 1886(d)(2)(D) of the Act defines 

an ‘‘urban area’’ as ‘‘an area within a 

MSA (as defined by the OMB) or within 

a similar area as the Secretary has 

recognized.’’ Similarly, in the sections 

of the Act governing the guidelines to be 

used by the Medicare Geographic 

Classification Review Board for hospital 

reclassification, the Congress directed 

the Secretary to create guidelines for 

‘‘determining whether the county in 

which the hospital is located should be 

treated as being a part of a particular 

[MSA]’’. (See sections 1886(d)(10)(A) 

and (D)(i)(II) of the Act.) The Congress 

has accepted the use of MSAs as a 

reasonable basis for dividing the nation 

into labor market areas for purposes of 

Medicare payments. Accordingly, we 

are proposing to revise the ESRD 

composite payment system labor market 

areas based on OMB’s geographic 

designations. Facilities located in 

counties within MSAs (including those 

in the MSA category of CBSA) would be 

classified as urban. We are proposing 

that facilities located in Micropolitan 

Areas (the other category of CBSA) or in 

other counties outside of CBSAs in each 

State, would be considered rural. 

e. Revised OMB Geographic Areas 

In the following sections we discuss 

the classification of facilities located in 

New England MSAs, within 

Metropolitan Divisions of MSAs, and 

our proposed treatment of the CBSA 

classification of Micropolitan Areas. 

(1) New England MSAs 

Under the current composite payment 

system, urban areas in New England 

reflect county-based locales known as 

New England County Metropolitan 

Areas (NECMAs), rather than MSAs. We 

use NECMAs in New England to 

provide consistency in labor market 

definitions compared to the MSAs used 

in the rest of the country, which are also 

based on counties. Under the new 

CBSAs, OMB has defined MSAs and 

Micropolitan Areas in New England on 

the basis of counties. OMB has also 

established a new classification, New 

England City and Town Areas 

(NECTAs), which are similar to the 

previous New England MSAs, but 

which are not used in the geographic 

area revisions proposed in this proposed 

rule. 

In the interest of consistency among 

all urban labor market areas, we are 

proposing to use the county-based 

definitions for all MSAs in the nation. 

As a result of the 2000 Census, we now 

have county-based MSAs in New 

England. We believe that adopting 

county-based definitions for all urban 

areas in the country provides 

consistency and stability, and 

minimizes administrative complexity in 

the Medicare program. We point out 

that our use of MSAs in New England 

comports with the implementation of 

the CBSA designations under the IPPS 

for New England urban locales. (See the 

August 11, 2004 Federal Register, 69 FR 

49208.) Accordingly, under the revised 

composite payment rates discussed in 

this proposed rule, we are proposing to 

use New England MSAs along with 

MSAs in the rest of the nation to define 

urban areas. As a result, urban locales 

in New England would no longer be 

based on NECMAs. 

(2) Metropolitan Divisions 

Under OMB’s new CBSA 

designations, a Metropolitan Division is 

a county or group of counties within a 

CBSA that contains a core population of 

at least 2.5 million, representing an 

employment center, plus adjacent 

counties associated with the main 

county or counties through commuting 

ties. A county qualifies as a main county 

if 65 percent or more of its employed 

residents work within the county, and 

the ratio of the number of jobs located 

in the county to the number of 

employed residents is at least 75 

percent. A county qualifies as a 

secondary county if at least 50 percent, 

but less than 65 percent, of its employed 

residents work within the county, and 

the ratio of the number of jobs located 

in the county to the number of 

employed residents is at least 75 

percent. After all the main and 

secondary counties are identified and 

grouped, each additional county that 

already has qualified for inclusion in 

the MSA falls within the Metropolitan 

Division associated with the main or 

secondary county or counties with 

which the county at issue has the 

highest employment interchange 

measure. Counties in a Metropolitan 

Division must be contiguous (See the 

December 27, 2000 Federal Register,

Standards for Defining Metropolitan and 

Micropolitan Statistical Areas, (65 FR 

82236)).

Under the CBSA definitions, there are 

11 MSAs containing Metropolitan 

Divisions: Boston; Chicago; Dallas; 

Detroit; Los Angeles; Miami; New York; 

Philadelphia; San Francisco; Seattle; 

and Washington, DC. We believe that 

these MSAs may be too large to 

accurately reflect the local labor costs 

prevailing within each of these areas. 

For example, the Chicago-NapervilleJoliet IL-IN-WI MSA consists of 14 

counties classified among 3 

Metropolitan Divisions: ChicagoNaperville-Joliet IL (8 counties); Lake 

County-Kenosha County IL-WI (2 

counties); and Gary IN (4 counties). 

Similarly, the New York-Newark-Edison 

NY-NJ-PA MSA consists of 23 counties 

classified among 4 Metropolitan 

Divisions: New York-Wayne-White 

Plains NY-NJ (11 counties); NewarkUnion NJ-PA (6 counties); Edison NJ (4 

counties); and Suffolk County-Nassau 

County NY (2 counties). Accordingly, 

for the 11 MSAs with Metropolitan 

Divisions, we are proposing to use the 

Metropolitan Division as the urban area 

for purposes of constructing the wage 

index and applying revised composite 

payment rates. 

We believe that the proposed use of 

Metropolitan Divisions would result in 

a more accurate adjustment accounting 

for local variation in labor costs within 

each of the 11 MSAs with those 

Divisions. We are proposing to 

recognize each county-based 

Metropolitan Division within the 11 

affected MSAs as a separate urban area 

for purposes of applying revised 

composite payment rates. Each 

Metropolitan Division would have its 

own wage index and its own urban 

composite payment rate. This proposed 

methodology is consistent with the new 

CBSA-based labor market definitions 

under the IPPS. (See the August 11, 

2004 Federal Register, 69 FR 49029.) 

(3) Micropolitan Statistical Areas 

In its June 6, 2003 bulletin, OMB also 

designated another classification of 

metropolitan area, Micropolitan 

Statistical Areas, which we will refer to 

as Micropolitan Areas. That bulletin 

listed 565 Micropolitan Areas. Of the 

3142 counties in the United States, 1090 

are in MSAs and 674 are in 

45796 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

Micropolitan Areas, with the remaining 

1378 outside of either classification. As 

discussed in greater detail in the August 

11, 2004 IPPS final rule (69 FR 49029–

49032), the way that Micropolitan Area 

counties are classified in connection 

with developing revised wage indexes 

has a substantial impact on the wage 

index adjustment. Specifically, whether 

or not Micropolitan Areas are included 

in computing the statewide rural wage 

indexes has a significant effect on the 

rural wage index in any State that 

contains these locales. Consistent with 

the IPPS final rule, we are proposing 

that each Micropolitan Area county 

continue to be considered part of each 

State’s rural labor market area. That is, 

we would continue to classify all 

Micropolitan counties as rural. 

To facilitate an understanding of our 

proposed policies relating to the 

revisions to the ESRD facility labor 

market areas discussed in this proposed 

rule, we have provided addendum F in 

the Addendum section to this proposed 

rule. Addendum F is a crosswalk table 

that contains a listing of each SSA State 

and county location code; state and 

county name; existing 1980 MSA based 

labor market area designation; and 

CBSA-based labor market area. 

Addendum F also contains the new 

wage indexes for each urban and rural 

area. 

f. Proposed Revisions to the Labor 

Component of the Composite Rate 

The current labor-related portions of 

the hospital-based and independent 

composite payment rates (in other 

words, the portion adjusted by each 

facility’s area wage index) are 36.78 

percent and 40.65 percent, respectively. 

These labor-related shares have not been 

revised since the inception of the ESRD 

composite payment system in 1983. 

When the composite rates were 

established in 1983, we developed the 

labor-related share of the rate based on 

1978 and 1979 cost data collected from 

110 ESRD facilities; 40 independent and 

70 hospital-based. For other PPSs 

administered by us, the labor-related 

shares are determined based on the 

labor components established in the 

relevant market baskets for each 

provider type. 

The basis for determining the current 

labor shares is based on outdated data 

from very few facilities relative to the 

current number of ESRD facilities (110 

versus approximately 4300 facilities). 

We are proposing to establish a single 

labor-related share applicable to all 

ESRD facilities based on the laborrelated categories included in the ESRD 

composite rate market basket. This 

change will bring the methodology for 

the ESRD composite rate labor-related 

share more in line with that for 

determining the labor-related shares for 

other Medicare PPSs. 

(1) ESRD Composite Rate Market Basket

In the following sections, we present 

a brief background on market baskets, 

provide a reference to the detailed 

methodology used to develop the ESRD 

composite rate market basket, and 

outline the methodology used to 

determine the proposed ESRD labor 

share. 

As required by section 422(b) of the 

Medicare, Medicaid, and SCHIP 

Benefits Improvement and Protection 

Act of 2000 (BIPA), Pub. L. 106–554, we 

developed an ESRD composite rate 

market basket. Each of the PPSs that we 

administer utilizes a market basket that 

reflects each type of provider’s 

production patterns used to furnish 

patient care. The market baskets capture 

the rate of price inflation for a fixed 

quantity of inputs (both goods and 

services used to provide medical 

services) relative to a base year. Each of 

the PPS market baskets distinguishes 

between labor-related and non-labor 

costs. Similar to other PPSs, we believe 

the ESRD composite rate market basket 

index is an appropriate measure for 

revising the labor-related portion of the 

composite payment rate. The detailed 

methodology used to develop the ESRD 

composite rate market basket, including 

data sources, cost categories, and price 

proxies, is set forth in the Secretary’s 

May 2003 report to the Congress, 

Toward a Bundled Outpatient Medicare 

ESRD Prospective Payment System.

That report is available on the Internet 

at http://qa.cms.hhs.gov/providers/esrd

and we recommend it to interested 

readers. We used CY 1997 as the base 

year for the development of the ESRD 

composite rate market basket cost 

categories. Source data included CY 

1997 Medicare cost reports (Form CMS–

265–94), supplemented with 1997 data 

from the U.S. Department of Commerce, 

Bureau of the Census’ Business 

Expenditure Survey (BES). Analysis of 

Medicare cost reports for CYs 1996, 

1997, 1998, and 1999 showed little 

difference in cost weights compared to 

CY 1997. Medicare cost reports from 

independent ESRD facilities were used 

to construct the market basket because 

data from independent ESRD facilities 

tend to reflect the actual cost structure 

faced by the ESRD facility itself, and are 

not influenced by the allocation of 

overhead over the entire institution as 

in hospital-based facilities. This 

approach is consistent with our 

standard methodology used in the 

development of other market baskets, 

particularly those used for updating the 

SNF and home health PPSs. We expect 

that the cost structure in both hospitalbased and independent ESRD facilities 

and units would be similar. Therefore, 

we are proposing to base the laborrelated share of the composite payment 

rates on data from freestanding facilities 

only. 

In Table 24, we have reproduced 

Table 2 from the May 2003 report to the 

Congress containing the ESRD 

composite rate market basket cost 

categories, weights, and price proxies in 

this proposed rule. This table lists all of 

the expenditure categories in the ESRD 

composite rate market basket.

TABLE 24.—ESRD COMPOSITE RATE MARKET BASKET COST CATEGORIES, WEIGHTS, AND PRICE PROXIES

Cost category Price/wage variable 

Base-year: 

CY 1997 

weights (percent) 

Total ............................................................................................. ..................................................................................................... 100.000 

Compensation .............................................................................. ..................................................................................................... 47.388 

Wages and Salaries .............................................................. ECI—Health Care Workers ......................................................... 38.808 

Employee Benefits ................................................................ ECI—Benefits Health Care Workers .......................................... 8.580 

Professional Fees ........................................................................ ECI—Compensation Prof. & Tech. (Priv.) .................................. 0.903 

Utilities .......................................................................................... ..................................................................................................... 1.524 

Electricity ............................................................................... WPI—Commercial Electric Power .............................................. 0.818 

Natural Gas ........................................................................... WPI—Commercial Natural Gas .................................................. 0.113 

Water and Sewerage ............................................................ CPI—Water & Sewage ............................................................... 0.593 

All Other ....................................................................................... ..................................................................................................... 36.156 

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TABLE 24.—ESRD COMPOSITE RATE MARKET BASKET COST CATEGORIES, WEIGHTS, AND PRICE PROXIES

Cost category Price/wage variable 

Base-year: 

CY 1997 

weights (percent) 

Pharmaceuticals .................................................................... WPI—Prescription Drugs ............................................................ 0.967 

Supplies ................................................................................ PPI—Surgical, Medical and Dental* ........................................... 17.748 

Labs ...................................................................................... PPI—Medical Labs ..................................................................... 0.433 

Telephone ............................................................................. CPI—Telephone Services ........................................................... 0.875 

Housekeeping and Operations ............................................. PPI—Building, cleaning, and maintenance ................................ 1.247 

Administrative and Other Costs ............................................ CPI—All items less food and energy .......................................... 14.886 

Capital Costs ................................................................................ ..................................................................................................... 14.029 

Capital Related—Building and Equipment ........................... CPI—Residential Rent ................................................................ 9.071 

Capital Related—Machinery ................................................. PPI—Electrical Machinery and Equipment ................................. 4.957 

The labor-related share of a market 

basket is determined by identifying the 

national average proportion of operating 

costs that are related to, influenced by, 

or vary with the local labor market. The 

labor-related share is typically the sum 

of wages and salaries, fringe benefits, 

professional fees, labor-intensive 

services, and a portion of the capital 

share from the appropriate market 

basket. 

We used the 1997-based ESRD 

composite rate market basket costs to 

determine the proposed labor-related 

share for ESRD facilities. The proposed 

labor-related share for ESRD facilities is 

53.711, as shown in Table 25. It is the 

sum of wages and salaries, employee 

benefits, professional fees, 

housekeeping and operations, and 46 

percent of the weight for capital-related 

building and equipment (the portion of 

capital that we have determined to be 

influenced by local labor markets). The 

following section describes each of the 

categories that make up the proposed 

labor-related share for the ESRD 

composite rate payment system and 

how they were derived.

TABLE 25.—PROPOSED ESRD COMPOSITE RATE LABOR-RELATED

SHARE

Cost category 

Proposed CY 

1997-based 

ESRD composite rate 

labor share 

(percent) 

Wages and salaries ................ 38.808 

Employee benefits .................. 8.580 

Professional fees .................... 0.903 

Housekeeping and operations 1.247 

SUBTOTAL ...................... 49.538 

Labor-related share of capital 

costs .................................... 4.173 

Total ................................. 53.711 

(2) Wage and Salaries 

The wages and salaries weight for the 

ESRD composite rate labor-related share 

includes salaries for both direct and 

indirect patient care. We computed a 

weight for wages and salaries for direct 

patient care from Worksheet B of the 

Medicare cost report. However, 

Worksheet B only includes direct 

patient care salaries. We had to derive 

an estimate for non-direct patient care 

salaries in order to calculate the market 

basket weight. We first computed the 

ratio of salaries to total cost in each cost 

center from the trial balance of the cost 

report (Worksheet A). We applied these 

ratios to the costs reported on 

Worksheet B for the corresponding cost 

centers to obtain the total wages and 

salaries for each composite rate cost 

center. These salaries were then 

summed and added to the direct patient 

care salary amount that is reported 

separately. When divided by total 

composite rate costs, the result is a cost 

weight for total salaries. This increased 

the expenditure weight from 34.154 

percent for direct patient care salaries to 

38.808 percent for total salaries. 

(3) Employee Benefits 

The benefits weight was derived from 

the BES since a benefit share for all 

employees is not available for the ESRD 

Medicare cost reports. The cost reports 

only reflect benefits for direct patient 

care. We applied the benefits proportion 

of wages and salaries for kidney dialysis 

centers from the BES to the salary 

amount calculated from the cost reports 

as described above. This resulted in a 

benefit weight that was 1.758 percentage 

points larger (8.850 versus 6.822) than 

the benefits for direct patient care 

calculated from the cost reports. To 

avoid double counting and to ensure all 

of the market basket weights still totaled 

100 percent, we removed this additional 

1.758 percentage points for benefits 

from pharmaceuticals, administrative 

and general, supplies, laboratory 

services, housekeeping and operations, 

and the capital components. This 

calculation reapportions the benefits 

expense for each of these categories 

using a method similar to the method 

used for distributing non-direct patient 

care salaries as described above. This 

method approximates the proportion of 

each cost center’s costs that are benefits 

using available salary expenditure data. 

(4) Professional Fees 

Professional fees include accounting, 

bookkeeping, and legal expenses. We 

derived the weight for professional fees 

from the BES since the Medicare cost 

reports do not include this level of 

detail. We first calculated the ratio of 

BES professional fees for kidney dialysis 

centers to total BES wages and salaries 

for kidney dialysis centers. We applied 

this ratio to the total wages and salaries 

share calculated from the cost reports to 

estimate the proportion of ESRD facility 

professional fees. The resulting weight 

was 0.903 percent. To avoid double 

counting, this proportion was deducted 

from the calculated weight for the 

administrative and other expenditure 

category, where the fees would have 

been reported on the Medicare cost 

reports. 

(5) Housekeeping and Operations 

The housekeeping and operations cost 

category includes expenses such as 

janitorial and building services costs. 

We developed a market basket weight 

for this category using data from both 

Worksheets A and B of the cost reports. 

Worksheet B combines the capitalrelated costs for buildings and fixtures 

with the operation and maintenance of 

plant (operations) and housekeeping 

cost centers, so we were unable to 

calculate a weight directly from 

Worksheet B. Accordingly, we 

computed the proportion of 

housekeeping and operations costs, to 

the combination of total capital-related 

costs for buildings and fixtures and 

housekeeping and operations costs 

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using Worksheet A because these 

categories are individually reported on 

this worksheet. We then subtracted this 

share from the proportion of Worksheet 

B total capital-related costs to yield a 

weight for housekeeping and operations. 

To avoid double counting, we 

subtracted utilities expenditures (which 

are included in the utilities weight 

shown in Table 24) from the 

housekeeping and operations weight, as 

well as the non-direct patient care 

salaries and benefits share associated 

with the operations and housekeeping 

cost centers from Worksheet A. The 

resulting market basket weight for 

housekeeping and operations was 1.247 

percent. 

(6) Labor-Related Share for CapitalRelated Expenses 

The labor-related share for capitalrelated expenses (46 percent of ESRD 

facilities’ adjusted capital-related 

building and equipment expenses) 

reflects the proportion of ESRD 

facilities’ capital-related building and 

equipment expenses that we believe 

varies with local area wages. 

Capital-related expenses are affected 

in some proportion by local area labor 

costs (such as construction worker 

wages) that are reflected in the price of 

the capital asset. However, many other 

inputs that determine capital costs are 

not related to local area wage costs, such 

as interest rates. Thus, it is appropriate 

that capital-related expenses would vary 

less with local wages than would the 

operating expenses for ESRD facilities. 

The 46 percent figure is based on 

regressions run for the Prospective 

Payment System for Inpatient Hospital 

Capital-Related Costs in 1991 (56 FR 

43375). 

We use a similar methodology to 

calculate capital-related expenses for 

the labor-related shares for 

rehabilitation facilities, psychiatric 

facilities, long-term care facilities, and 

SNFs. (See Rehabilitation Facility 

Prospective Payment System for FY 

2006, Part II (70 FR 30233) and 

Prospective Payment System and 

Consolidated Billing for Skilled Nursing 

Facilities-Update (66 FR 39585)).

Table 26 provides a comparison of the 

current and proposed labor/nonlabor 

portions of the ESRD base composite 

rate.

TABLE 26.—COMPARISON OF THE CURRENT AND PROPOSED LABOR/NONLABOR PORTIONS OF THE ESRD BASE

COMPOSITE RATE

Hospitalbased Independent 

Base Composite Rate .................................................................................................................................................. $132.41 $128.35 

Current Labor Share .................................................................................................................................................... 48.70 52.17 

Current NonLabor Share ............................................................................................................................................. 83.71 76.18 

Proposed Labor Share (53.711 percent) ..................................................................................................................... 71.12 68.94 

Proposed NonLabor Share .......................................................................................................................................... 61.29 59.41 

As indicated earlier in this 

discussion, the ESRD market basket was 

derived from CY 1997 data. As with 

other payment systems, we would 

propose updating the labor share of the 

composite payment when the 

components of the ESRD market basket 

are rebased to reflect more recent data. 

g. Implementation of Revised Composite 

Wage Indexes 

In the section below, we explain how 

each ESRD facility’s new composite 

payment rate would be determined to 

reflect the proposed 2 year transition, 

based on section 623(d)(1) of the MMA’s 

requirement that the application of any 

revised geographic index be phased in 

over a multi-year period. 

(1) Hospital Data Used 

In this proposed rule, for purposes of 

adjusting the labor-related portion of the 

ESRD composite rate beginning January 

1, 2006, we propose to use acute care 

hospital inpatient wage index data. This 

data was generated from cost reporting 

periods beginning FY 2002, and is the 

most recent complete data available. 

To determine the applicable ESRD 

wage index values, we are proposing to 

use the acute care hospital inpatient 

wage data without regard to any 

approved geographic reclassification 

under section 1886(d)(8) or (d)(10) of 

the Act, which only applies to hospitals 

that are paid under the IPPS. We note 

this policy is consistent with the area 

wage adjustments used in all other nonacute care facility PPSs (such as, SNFs, 

IPPSs, HHAs, and IRFs). 

The proposed wage index values that 

would be applicable to the ESRD 

composite rate for services furnished on 

or after January 1, 2006, are shown in 

Tables 27 and 28 in this proposed rule. 

(2) Labor Market Areas With No 

Hospital Wage Data 

In adopting OMB’s CBSA 

designations, we identified a small 

number of ESRD facilities in both urban 

and rural geographic areas where there 

were no hospitals, and, thus, no hospital 

wage index data on which to base the 

calculations of the FY 2006 ESRD wage 

index. The first situation is rural 

Massachusetts. Because there is no 

reasonable proxy for rural data within 

Massachusetts, we are proposing to use 

last year’s acute care hospital wage 

index value for rural Massachusetts. 

The second situation involves ESRD 

facilities in urban areas in Hinesville, 

GA (CBSA 25980) and Mansfield, OH 

(CBSA 31900). We propose to use a 

wage index based on the wage indexes 

in all of the other urban areas within the 

state to serve as a reasonable proxy for 

the urban areas without hospital wage 

index data. Specifically, we are 

proposing to use the average wage index 

for all urban areas within the State as 

the urban wage index value for purposes 

of the ESRD wage index for these areas. 

We solicit comments on these 

approaches to calculating the wage 

index values for areas without hospitals 

(and, thus, without hospital wage data) 

for FY 2006 and subsequent years. 

(3) Use of Floor/Ceiling Values 

As discussed in this preamble, the 

current wage index values applied to 

the labor share of the ESRD composite 

payment rate are restricted at the high 

and low ends with a floor of 0.9000 and 

a cap of 1.3000. The effects of these 

restrictions have been to overpay 

facilities in low wage areas and 

underpay facilities in high wage areas. 

The floor and cap were originally 

intended to remain in effect only until 

the transition from use of BLS wage date 

to hospital wage data ended. However, 

since the transition was never 

completed because of the statutory 

restrictions discussed above in this 

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preamble, the floor and cap have 

remained in effect since 1983. 

The basis for the 1.3000 wage index 

cap was to ensure that we did not pay 

any more than the allowable reasonable 

charge per treatment that was in effect 

before the composite payment rate 

system was implemented. Since the 

allowable reasonable charge screen no 

longer has any relevance to the current 

composite rate, and because of the effect 

it has had on restricting payment in 

high cost wage areas, we are proposing 

to eliminate the wage index cap. 

However, because of the potential 

adverse impact that removing the wage 

index floor could have on access to 

dialysis for ESRD beneficiaries, we are 

proposing to maintain a wage index 

floor at this time. We note that when we 

established the 0.9000 floor beginning 

in 1983, it was intended that the floor 

would be phased out by the end of the 

transition. Because the floor has been in 

place for so long, we are concerned that 

eliminating the floor entirely could 

decrease payments to facilities in some 

areas significantly. However, we believe 

that a floor of 0.9000 may be too high 

under the proposed revision to the labor 

market areas, since a substantial number 

of wage areas (172 out of 481 wage 

areas) have wage index values less than 

0.9000. The current wage areas used for 

adjusting composite rate payments have 

only 83 areas with wage index values 

below 0.9000.

Given that the distribution of wage 

index values has changed so 

significantly, we are proposing to 

reduce the floor to 0.8500 for CY 2006 

and to 0.8000 for CY 2007 as we 

transition to the new geographic areas 

and wage indexes. This would result in 

application of the wage index floor to 

17.7 percent of facilities that would 

otherwise have been subject to the 

current 0.9000 floor in CY 2006 and to 

10.0 percent of facilities in CY 2007. It 

would also protect 86 geographic areas 

at a floor of 0.8500 in CY 2006 and 36 

geographic areas at a floor of 0.8000 in 

CY 2007. 

Although we are proposing to 

maintain a wage index floor through CY 

2007, our goal is to eliminate the wage 

index floor in the future. Therefore, for 

CY 2008 we would re-evaluate the need 

for continuing the floor. We are 

soliciting comment on this issue, 

especially in light of the fact the any 

wage index changes must be budget 

neutral for aggregate payments to 

facilities. 

(4) Transition Period 

Section 623(d) of MMA added section 

1881(b)(12)(D) of the Act which requires 

that any revisions to the geographic 

adjustments applied to the composite 

payment rate must be phased-in over a 

multiyear period. In determining the 

best approach to phasing-in the 

proposed new wage index adjustments, 

we considered not only the immediate 

impact on payments from revising the 

wage index values, but also the impact 

on payments over time because of our 

inability to update the wage index. 

Facilities in areas where wages have 

increased at a higher rate than the 

national average may have been 

disadvantaged by the continued use of 

outdated wage data and geographic 

designations to adjust the composite 

payment rate. 

With both of these considerations in 

mind, we are proposing a two-year 

transition under which facilities would 

be paid the higher of the new wageadjusted composite rate, or a 50–50 

blend of the current wage adjusted 

composite rate and the new wageadjusted composite rate. This proposed 

transition would allow facilities that 

may have been disadvantaged under the 

current wage index adjustment to move 

immediately to the new wage 

adjustment. It also provides for a 

reasonable transition period for other 

facilities. Given the age of the current 

wage index adjustments, we believe it is 

appropriate to move as quickly as 

possible to the revised updated wage 

adjustments. Since we are proposing to 

maintain the wage index floor during 

the transition period, we believe the 

overall impact to facilities will be 

mitigated. Also, as discussed in the 

following section, the proposed budget 

neutrality adjustment will ensure that 

the level of aggregate payments to ESRD 

facilities is maintained. We note that 

our proposal to allow some facilities to 

move directly to the new wage-adjusted 

composite rate will have some impact 

on the level of the budget neutrality 

adjustment. However, we estimate that 

the overall effect on total payments to 

facilities would not be significant. For 

example, the impact on aggregate 

payments to rural facilities would be a 

decrease of about 0.2 percent and an 

increase of about 0.1 percent for urban 

facilities. This occurs because all of the 

facilities that are currently subject to the 

1.300 wage index cap are located in 

urban areas. 

We also considered alternative 

approaches for transitioning facilities to 

the proposed updated wage 

adjustments. Another approach would 

be to apply the proposed 50–50 

transition to all facilities, whether or not 

they do better using the updated wage 

index adjustment. This approach would 

treat all facilities equally for transition 

purposes, but would mean that those 

facilities that are currently underpaid 

because of the current outdated wage 

index adjustment would have to wait 

until the transition was completed to 

receive the higher payment to which 

they are entitled. 

An alternative to the proposed twoyear transition would be to adopt a 

three-year transition. This would allow 

facilities that would receive lower 

payments using the revised wage 

adjustment to have an additional year to 

adapt to the lower payment amount. 

This approach, if coupled with allowing 

facilities that do better to move 

immediately to the new wage index, 

would have a more significant impact 

on the budget neutrality adjustment 

required by MMA. (See budget 

neutrality discussion below.). 

We are specifically seeking comments 

on the proposed transition or any of the 

alternative approaches mentioned 

above. 

(5) ESRD Wage Index Budget Neutrality 

Section 623(d) of MMA amended 

section 1881(b)(12)(E)(i) of the Act 

which requires that any revisions to the 

ESRD composite rate payment system as 

a result of the MMA provision 

(including the geographic adjustment) 

be made in a budget neutral manner. 

This means that aggregate payments to 

ESRD facilities in CY 2006 should be 

the same as aggregate payments would 

have been if we had not made any 

changes to the geographic adjusters. In 

order to achieve budget neutrality, we 

are proposing to apply a budget 

neutrality adjustment factor directly to 

the revised ESRD wage index values, 

rather than applying the adjustment to 

the base composite payment rates. For 

payment purposes, we believe this is the 

simplest approach since it allows us to 

maintain a base composite rate for 

hospital-based facilities and one for 

independent facilities during the 

transition from the current wage 

adjustments to the revised wage 

adjustments.

In order to compute the proposed 

wage index budget neutrality 

adjustment factor, we used treatment 

counts from the CY 2004 billing data 

and facility-specific 2005 composite 

payment rates. We note that this file is 

currently only about 85 percent 

complete. For the final rule, we expect 

to use the most complete CY 2004 file 

available. Using the CY 2004 billing 

data, we first computed the estimated 

total dollar amount that ESRD facilities 

would have received in CY 2006 had 

there been no changes to the ESRD wage 

index. This amount becomes the 

estimated target amount of expenditures 

for all ESRD facilities. Then we 

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computed the estimated dollar amount 

that would be paid to the same ESRD 

facilities using the revised ESRD wage 

index. After comparing these two dollar 

amounts, we calculate an adjustment 

factor to the ESRD wage index as the 

factor that when multiplied by the 

revised ESRD wage index will result in 

the target amount of expenditures for all 

ESRD facilities. Since the revised wage 

index values are only applied to the 

labor-related portion of the composite 

payment rate, we computed the 

adjustment based on that proportion 

(that is, 53.711 percent). We applied the 

estimated budget neutrality adjustment 

factor to the revised wage index values 

and then simulated payments for CY 

2006 to ensure that estimated aggregate 

payments to ESRD facilities would 

remain budget neutral. This proposed 

adjustment factor would be 1.023024. 

Each ESRD wage index value has been 

adjusted by this factor to establish the 

budget neutral wage index values that 

we propose to use to adjust the labor 

portion of the composite payment rate 

beginning January 1, 2006. (See Tables 

27 and 28.) By using these adjusted 

ESRD wage index values, the estimated 

aggregate payments to ESRD facilities 

will meet the estimated target 

expenditure amount. 

This calculation becomes more 

complex because of our proposed 

transition policy. Under that policy an 

ESRD facility that would receive a 

higher composite rate payment using 

the new geographic adjustment would 

receive 100 percent of that rate in the 

first year of transition. However, if an 

ESRD facility’s composite rate using the 

new geographic adjustment is less than 

its current rate, then that facility will 

receive 50 percent of the composite rate 

payment it would have received using 

the current wage index and 50 percent 

of the composite rate using the revised 

wage index. To account for the 

differential payments, we compare the 

target amount of expenditures for all 

ESRD facilities in an iterative fashion 

until the time that the ESRD wage index 

adjustment factor would result in the 

target amount of expenditures for all 

ESRD facilities. This is shown in 

column 4 of Table 37 in section V. 

(Regulatory Impact Analysis) of this 

proposed rule. In aggregate the change 

to all ESRD facilities would be 0.0 

percent. The distributive effect of the 

revised ESRD wage index can be seen in 

the various impact table groupings in 

column 4 of Table 37 in section V. of 

this proposed rule. 

Another element of the proposed 

transition policy would be a proposed 

wage index floor of 0.8500. Using the 

method described above to compute the 

budget neutrality factor, makes it 

necessary to apply the budget neutrality 

factor to this floor which would result 

in a proposed adjusted floor of 0.8696. 

(6) Transition Examples 

In the following examples, we show 

the application of revised wage adjusted 

composite payment rates during the 

proposed two year transition period: 

• Example 1—Neighborhood Dialysis 

Center is an independent dialysis 

facility located in Baltimore County, 

Maryland. As the Crosswalk Table (see 

addendum F) reveals, Baltimore County 

was previously classified as part of the 

Baltimore MSA, and is still classified as 

an urban county under the new CBSA 

classification system. The current wageadjusted composite payment rate for 

Neighborhood Dialysis Center is 

$134.93. 

Because Neighborhood Dialysis 

Center is located within the BaltimoreTowson MD CBSA (code 12580), its new 

wage index, which has been adjusted for 

budget neutrality, is 1.0135. Applying 

the wage index of 1.0135 to the revised 

labor-related component of the base 

composite rate for independent facilities 

shown in Table 26, yields a labor 

adjusted payment rate of $129.28.

($68.94 × 1.0135) + $59.41 = $129.28

This labor adjusted payment rate of 

$129.28 is less than the wage-adjusted 

composite rate of $134.93 currently 

applicable to Neighborhood Dialysis 

Center. In accordance with our 

proposed two year transition, this 

facility would receive a wage-adjusted 

composite payment rate beginning 

January 1, 2006 equal to 50 percent of 

its current wage-adjusted rate plus 50 

percent of its new wage-adjusted rate. 

The CY 2006 blended wage-adjusted 

rate for this facility would be $132.11.

($0.50 × $134.93) + (0.50 × $129.28) = 

$132.11

The 8.9 percent drug add-on 

adjustment and relevant case-mix 

adjustments (related to the budget 

neutrality adjustment) would be applied 

to this blended rate. 

• Example 2—Serve U Well is a 

hospital-based dialysis facility located 

in Morrow County, Ohio. The Crosswalk 

table (see Addendum F) reveals that 

Morrow County was previously 

classified as rural, but is now classified 

urban as part of the Columbus, OH 

CBSA, code 18140. The new CBSA wage 

index applicable to Serve U Well, 

adjusted for budget neutrality, is 1.0077. 

Applying the wage index of 1.0077 to 

the revised labor related component of 

the base composite rate for hospitalbased facilities shown in Table 26 yields 

a wage-adjusted composite rate of 

$132.96.

($71.12 × 1.0077) + $61.29 = $132.96

Serve U Well’s current rural Ohio 

wage-adjusted composite payment rate 

is $128.66. Because the revised wageadjusted composite payment rate of 

$132.96 is greater than $128.66, Serve U 

Well would receive 100 percent of its 

new wage-adjusted composite payment 

rate of $132.96 beginning January 1, 

2006.

As in the previous example, the 8.9 

percent drug add-on adjustment and 

relevant case-mix adjustments (related 

to the budget neutrality adjustment) 

would be applied to this new wageadjusted composite rate. 

(7) Frequency of Update 

Section 623(d)(1) of the MMA 

provides that any revised wage index 

used in connection with the composite 

payment rates must be phased-in over a 

multiyear period. We are proposing a 

two-year transition period to the new 

wage indexes based on CBSAs. An issue 

remains as to how frequently the new 

wage index values should be updated to 

reflect changes in area wage levels. 

These changes would be detected 

through our receipt of hospital wage and 

employment data obtained from the 

Medicare hospital cost reports 

subsequent to FY 2005. In order to keep 

payments to ESRD facilities as up-todate as possible, we propose to update 

the wage index on an annual basis, as 

part of the overall ESRD payment 

update. 

(8) Wage Index Table 

The following two tables show the 

proposed ESRD wage index for urban 

areas (Table 27) and rural areas (Table 

28).

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BILLING CODE 4120–01–C


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TABLE 28.—PROPOSED ESRD WAGE

INDEX FOR RURAL AREAS BASED ON

CBSA LABOR MARKET AREAS

CBSA

code 

Nonurban

area 

Wage

index 

1 ........ Alabama ............................ 0.8696

2 ........ Alaska ............................... 1.2266

3 ........ Arizona .............................. 0.8979

4 ........ Arkansas ........................... 0.8696

5 ........ California ........................... 1.1107

6 ........ Colorado ............................ 0.9605

7 ........ Connecticut ....................... 1.2066

8 ........ Delaware ........................... 0.9827

10 ...... Florida ............................... 0.8796

11 ...... Georgia ............................. 0.8696

12 ...... Hawaii ............................... 1.0805

13 ...... Idaho ................................. 0.8696

14 ...... Illinois ................................ 0.8696

15 ...... Indiana .............................. 0.8829

16 ...... Iowa ................................... 0.8698

17 ...... Kansas .............................. 0.8696

18 ...... Kentucky ........................... 0.8696

19 ...... Louisiana ........................... 0.8696

20 ...... Maine ................................ 0.9056

21 ...... Maryland ........................... 0.9304

22 ...... Massachusetts .................. 1.0451

23 ...... Michigan ............................ 0.9074

24 ...... Minnesota .......................... 0.9394

25 ...... Mississippi ......................... 0.8696

26 ...... Missouri ............................. 0.8696

27 ...... Montana ............................ 0.9036

28 ...... Nebraska ........................... 0.8865

29 ...... Nevada .............................. 0.9283

30 ...... New Hampshire ................ 1.0923

32 ...... New Mexico ...................... 0.8843

33 ...... New York .......................... 0.8696

34 ...... North Carolina ................... 0.8764

35 ...... North Dakota ..................... 0.8696

36 ...... Ohio ................................... 0.8988

37 ...... Oklahoma .......................... 0.8696

38 ...... Oregon .............................. 1.0056

39 ...... Pennsylvania ..................... 0.8696

42 ...... South Carolina .................. 0.8840

43 ...... South Dakota .................... 0.8696

44 ...... Tennessee ........................ 0.8696

45 ...... Texas ................................ 0.8696

46 ...... Utah ................................... 0.8696

47 ...... Vermont ............................. 1.0067

48 ...... Virginia .............................. 0.8696

49 ...... Washington ....................... 1.0699

50 ...... West Virginia ..................... 0.8696

51 ...... Wisconsin .......................... 0.9698

52 ...... Wyoming ........................... 0.9426

(9) Crosswalk Table 

The crosswalk table for the MSA and 

CBSA can be found in Addendum F to 

this proposed rule. 

4. Proposed Revisions to § 413.170 

(Scope) and § 413.174 (Prospective 

Rates for Hospital-Based and 

Independent ESRD Facilities) 

Under section 623 of the MMA, we 

propose to revise § 413.170(b) to specify 

that this subpart provides procedures 

and criteria under which only a 

pediatric facility may receive an 

exception. 

Also under section 623 of the MMA, 

we propose to revise § 413.174 to reflect 

the changes in the additional payment 

for separately billable drugs. 

5. Proposed Revisions to the Composite 

Payment Rate Exceptions Process 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘ESRD-Exceptions Process’’ at the 

beginning of your comments.] 

The current regulations at § 413.180 

through § 413.192 contain the 

procedures for requesting exceptions to 

ESRD facility composite payment rates, 

and establish five criteria for approval of 

exception requests. The five criteria are 

as follows: 

• Atypical service intensity 

(§ 413.184). 

• Isolated essential facility 

(§ 413.186).

• Extraordinary circumstances 

(§ 413.188). 

• Self-dialysis training costs 

(§ 413.190). 

• Frequency of dialysis (§ 413.192). 

Under section 1881(b)(7) of the Act, 

when a facility’s costs were higher than 

the prospectively determined composite 

rate, we could, under certain conditions, 

grant the facility an exception to its 

composite payment rate and set a higher 

prospective rate. The facility had to 

show, on the basis of projected cost and 

utilization trends, that it would have an 

allowable cost per treatment higher than 

its prospective composite payment rate 

and that any excess costs were 

attributable to one or more of the 

specific exception criteria. 

As explained further below, ESRD 

facility exception rates in effect on 

December 31, 2000, or those that were 

subsequently approved based on an 

application under section 422(a)(2)(B) of 

BIPA, (collectively hereinafter termed 

‘‘existing exception rates’’), will remain 

in effect under section 422(a)(2)(C) of 

BIPA as long as the exception rate 

exceeds the facility’s updated composite 

payment rate. 

Section 623 of the MMA amended 

BIPA to provide that the prohibition on 

exceptions to the ESRD composite rate 

does not apply to pediatric facilities that 

do not have an exception rate in effect 

on October 1, 2002. As a result, only 

pediatric facilities can now qualify for 

exception rates. We do not intend for 

the proposed regulation changes 

detailed below to limit the exception 

criteria under which a pediatric facility 

may qualify. However, we believe that 

pediatric facilities would not qualify for 

an exception under most of the existing 

exception criteria because of the 

uniqueness of their pediatric patient 

population (at least 50 percent) and, in 

the past, ESRD facilities with high 

percentages of pediatric patients only 

qualified for exceptions under the 

‘‘atypical patient mix’’ criterion. 

Therefore, we are proposing to revise 

the regulations by eliminating the other 

exception criteria (Isolated essential 

facilities, Extraordinary circumstances, 

and Frequency of dialysis) specified in 

§ 413.182(b), (c), and (e). However, we 

are proposing to retain the exception 

criterion for self-dialysis training costs 

under § 413.182(d) because some 

pediatric facilities may qualify for an 

exception on that basis. 

a. Statutory Changes 

Section 422 of BIPA 2000, prohibited 

us from providing for any further 

composite rate exceptions on or after 

December 31, 2000; allowed one final 

opportunity for ESRD facilities that did 

not apply for an exception during 2000 

to apply for one by July 1, 2001; and 

provided for approved exceptions 

(either those in effect or those that were 

approved based on subsequent 

applications) to continue in effect as 

long as the rate exceeds the updated 

composite rate. 

By prohibiting future exceptions to 

the composite rate for ESRD facilities, 

we believe the Congress intended to 

make the ESRD composite rate payment 

system more compatible with other 

Medicare PPSs that do not allow 

exceptions to their payment rates. By 

providing for the continuation of 

existing exception rates as long as those 

rates exceed the updated case-mix 

adjusted composite rate, we believe the 

Congress intended, in effect, to provide 

for the transition of most ESRD facilities 

to payment under the composite rate 

payment system. 

In response to ESRD facility concerns 

about the current composite rate 

payment methodology, the Congress 

enacted section 623 of the MMA, which 

revised ESRD facility prospective 

composite payment rates. As a result, 

effective January 1, 2005, ESRD facility 

prospective composite payment rates 

were increased 1.6 percent and include 

a drug add-on of 8.7 percent. These 

increases were implemented in the PFS 

final rule published on November 15, 

2004 (69 FR 66319–66320). Section 623 

also amended section 422(a)(2) of BIPA 

to provide that the prohibition on 

exceptions to the ESRD composite rates 

does not apply as of October 1, 2002, to 

pediatric facilities that do not have an 

exception rate in effect on October 1, 

2002—in effect restoring the exception 

process for pediatric facilities. Pediatric 

facilities are defined as ‘‘renal facilities 

at least 50 percent of whose patients are 

individuals under 18 years of age.’’

Existing exception rates are protected 

under section 422(a)(2)(C) of BIPA 2000. 

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The ‘‘protection’’ clause for existing 

exception rates provides that exception 

rates in effect on December 1, 2000 (or 

approved based on an application by 

July 1, 2001) shall remain in effect as 

long as the facility’s exception rate is 

higher than the updated composite rate. 

Pediatric ESRD facility exception rates 

granted under the provisions of section 

623 of the MMA are not subject to the 

‘‘protection’’ clause for existing 

exception rates. 

b. Summary of Proposed Changes to Part 

413, Subpart H 

As a result of the statutory changes 

discussed above, we are proposing to 

revise both the content and the 

organization of the existing regulations 

at 42 CFR part 413, subpart H (Payment 

for ESRD Services and Organ 

Procurement Costs) by limiting certain 

qualifications and clarifying the 

regulations. Currently, all of the 

Medicare rules for requesting exceptions 

to composite rate payments for covered 

outpatient maintenance dialysis 

treatments can be found at § 413.180 

through § 413.192. We propose to revise 

the current regulations at part 413, 

subpart H by—

• Adding a definition of a ‘‘pediatric 

facility’’ (in accordance with section 

422(a)(2)of BIPA 2000, as amended by 

section 623(b) of the MMA) to mean a 

renal facility at least 50 percent of 

whose patients are individuals under 18 

years of age; 

• Removing existing exception 

criteria that are no longer applicable; 

and 

• Adjudicating future exception 

requests in accordance with the 

proposed revised exception criteria. 

(1) Proposed Revisions to § 413.180 

(Procedures for Requesting Exceptions 

to Payment Rates) 

In response to the changes made by 

section 422 of BIPA 2000 and section 

623 of MMA, we are proposing 

significant changes to the existing 

regulations at § 413.180 through 

§ 413.192 regarding ESRD exception 

criteria and application procedures. 

Under our current regulations, existing 

exception rates that were approved prior 

to December 31, 2000 (or those 

approved during the window that 

closed on July 1, 2001) would remain in 

effect as long as the conditions under 

which the exception was granted have 

not changed and as long as the facility 

files a request to retain the exception 

rate with its fiscal intermediary during 

the 30-day period before the opening of 

an exception cycle (and the request is 

approved by the fiscal intermediary.) 

Even though pediatric exceptions are 

not subject to the ‘‘protection’’ clause 

under section 422(a)(2)(C) of BIPA, we 

propose to continue all exception rates 

in effect on the same basis. Since 

section 422(a)(2)(B) of BIPA allows 

existing exception rates to continue in 

effect as long as the exception rate 

exceeds the facility’s updated composite 

payment rate, we expect that the 

facilities will compare their existing 

exception rates to their basic case-mix 

adjusted composite rates to determine 

which is the best payment rate for their 

facility. We expect that each ESRD 

facility would choose to be paid at the 

higher of its existing exception rate or 

its basic case-mix composite rate (which 

includes all the payment adjustments 

required under section 623 of the 

MMA). If the facility retains its 

exception rate, the rate is not subject to 

any of the adjustments specified in 

section 623 of the MMA. We believe the 

determination as to whether an ESRD 

facility’s exception rate per treatment 

will exceed its average case-mix 

adjusted composite rate per treatment is 

best left to the affected entity. An ESRD 

facility that has an existing exception 

rate may give up that rate if it 

determines that it should be paid 

instead under the case-mix adjusted 

composite rate methodology. 

In § 413.180, we propose to revise our 

regulations to provide that each ESRD 

facility must notify its fiscal 

intermediary (in writing) if it wishes to 

give up its exception rate. The facility 

would be paid based on its case-mix 

adjusted composite payment rate 

beginning thirty days after the 

intermediary’s receipt of written 

notification that the facility wishes to 

give up its exception rate. Once a 

facility notifies its fiscal intermediary 

that it wishes to give up its exception 

rate, that decision could not be 

subsequently rescinded or reversed. We 

also propose to revise paragraph (b) of 

this section to provide that ESRD 

facilities that retain their existing 

exception rates do not need to notify 

their intermediaries. Therefore, we 

propose to remove the last sentence 

from paragraph (b) that states, 

‘‘However, a facility may only request 

an exception or seek to retain its 

previously approved exception rate 

when authorized under the conditions 

specified in paragraphs (d) and (e) of 

this section.’’

In the past, an ESRD facility could 

request an exception to its prospective 

composite payment rate within 180 days 

of the effective date of its new 

composite rate(s) or the date on which 

we opened a specific exception 

window. Because only pediatric 

facilities can now file for exceptions, we 

expect to receive a minimal number of 

exception applications. In this section, 

we propose to revise paragraph (d) to 

remove the requirement that an 

application for an exception be filed 

within the 180-day window because we 

believe the small volume of applications 

will make it administratively feasible for 

us to accept applications on a rolling 

basis. Further, we are proposing to 

revise paragraph (d) to state that a 

pediatric ESRD facility may request an 

exception to its composite payment rate 

at any time after it is in operation for at 

least 12 consecutive months. 

We are proposing to permit pediatric 

ESRD facilities to file exception requests 

at any time. We also propose to change 

our regulations to continue pediatric 

facility exception rates granted under 

section 623 of the MMA (hereinafter 

referred to as ‘‘pediatric facility 

exception rates’’) in the same way as 

existing exception rates. Specifically, 

we are proposing that pediatric facility 

exception rates would remain in effect 

until the facility notifies its fiscal 

intermediary that it wishes to give up its 

rate because its case-mix adjusted 

composite rate is higher. Therefore, we 

propose to eliminate paragraph (e) of 

this section, entitled ‘‘Criteria for 

retaining a previously approved 

exception request’’ and replace it with 

paragraph (f) (Completion of 

requirements and criteria) of this 

section. We are proposing to eliminate 

paragraph (e) because ESRD facilities 

that have an approved exception rate 

(either an existing exception rate or a 

pediatric facility exception rate) and 

elect to retain it do not need to notify 

their intermediaries. Current paragraph 

(f), entitled, ‘‘Documentation for a 

payment rate exception request’’, would 

be redesignated as proposed paragraph 

(e). We are proposing to clarify existing 

regulations by indicating that the 

applicant must include in its 

documentation a copy of the most 

recent cost report filed in accordance 

with § 413.198. As a result of these 

proposed changes to this section, we 

propose to revise the remaining 

paragraphs as follows: 

• Current paragraph (g) would be 

redesignated as proposed paragraph (f). 

• Current paragraph (h) would be 

redesignated as proposed paragraph (g).

• Current paragraph (i) would be 

redesignated as proposed paragraph (h). 

• Current paragraph (j) provides the 

period of an exception approval. We 

would redesignate paragraph (j) as 

proposed paragraph (i). We propose to 

revise the redesignated paragraph to 

state that an approved exception 

payment rate applies for the period from 

the date the complete exception request 

45842 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

was filed with the facility’s fiscal 

intermediary until thirty days after the 

intermediary’s receipt of the facility’s 

letter notifying the intermediary of the 

facility’s request to give up its exception 

rate and become subject to the current 

composite payment rate methodology. 

Once a facility decides not to retain its 

current exception rate (and puts that 

decision in writing), that decision 

cannot be subsequently rescinded or 

reversed. 

• Current paragraph (k) would be 

removed. 

• Current paragraph (l) would be 

redesignated as proposed paragraph (j). 

• Current paragraph (m) would be 

redesignated as proposed paragraph (k). 

In the past, a pediatric facility denied an 

exception rate would have to wait until 

a subsequent exception window opened 

to file a new request. We are proposing 

to revise redesignated paragraph (m) to 

state that a pediatric ESRD facility that 

has been denied an exception rate may 

immediately file another exception 

request. Any subsequent exception 

request would be required to address 

and document the issues cited in our 

denial letter. 

(2) Proposed Revisions to § 413.182 

(Criteria for Approval of Exception 

Requests) 

We propose to revise this section to 

state that CMS may approve exceptions 

to a pediatric ESRD facility’s 

prospective payment rate if the pediatric 

facility did not have an approved 

exception rate as of October 1, 2002. 

The proposed revised section would 

also state that the pediatric facility 

would be required to demonstrate, by 

convincing objective evidence, that its 

total per treatment costs are reasonable 

and allowable under the relevant cost 

reimbursement principles of part 413 

and that its per treatment costs in excess 

of its payment rate would be directly 

attributable to any of the following 

criteria: 

• Pediatric patient mix, as specified 

in § 413.184. 

• Self-dialysis training costs in 

pediatric facilities, as specified in 

§ 413.186. 

In the future, pediatric facilities 

would file for an exception under the 

proposed revised exception criteria in 

revised § 413.184 (Payment exception: 

Pediatric patient mix) and redesignated 

§ 413.190 (Payment exception: Selfdialysis training costs in pediatric 

facilities). (We are proposing to revise 

§ 413.190 and redesignate it as 

§ 413.186, see discussion below.). 

(3) Proposed Revisions to § 413.184 

(Payment Exception: Atypical Service 

Intensity (Patient Mix)) 

Because only pediatric ESRD facilities 

(those with at least a 50 percent patient 

mix) may qualify for an exception rate, 

we are proposing to rename § 413.184 to 

read, ‘‘Payment exception: Pediatric 

patient mix’’. We also propose to revise 

paragraph (a) of this section to specify 

that to qualify for an exception to its 

prospective payment rate based on its 

pediatric patient mix, a facility would 

be required to demonstrate that—

• At least 50 percent of its patients 

are individuals under 18 years of age; 

• Its nursing personnel costs are 

allocated properly between each mode 

of care; 

• The additional nursing hours per 

treatment are not the result of an excess 

number of employees; 

• Its pediatric patients require a 

significantly higher staff-to-patient ratio 

than typical adult patients; and 

• These services, procedures, or 

supplies and its per treatment costs are 

clearly prudent and reasonable when 

compared to those of pediatric facilities 

with a similar patient mix. 

The ‘‘Atypical service intensity’’

criterion is the one under which 

exceptions for facilities that treated a 

high proportion of pediatric patients 

were granted in the past. In order to 

receive approval for an exception rate, 

pediatric facilities would still need to 

meet many of the same criteria 

previously required under § 413.184 for 

‘‘Atypical service intensity.’’

To better match the patient listing 

documentation requirements to the 

characteristics of pediatric ESRD 

facilities, we are proposing to eliminate 

five categories currently required in 

§ 413.184(b) (Documentation) and 

replace those items with a revised list. 

Under the proposed revised paragraph, 

a facility would be required to submit a 

listing of all outpatient dialysis patients 

(including all home patients) treated 

during its most recently completed and 

filed cost report (cost reporting 

requirements under § 413.198) 

showing—

• Age of patients, and the percentage 

of patients under the age of 18; 

• Individual patient diagnosis; 

• Home patients and ages; 

• In-facility patients, staff assisted, or 

self-dialysis; 

• Diabetic patients; and 

• Patients isolated because of 

contagious disease. 

(4) Proposed Removal of § 413.186 

(Payment Exception: Isolated Essential 

Facility) 

Since pediatric facilities are the only 

ESRD facilities that can now apply for 

exceptions, we are proposing to remove 

§ 413.186 to conform with the 

elimination of § 413.182(b), (c) and (e) 

as discussed above and redesignate 

§ 413.190 as the new § 413.186. We 

would also rename the section to read, 

‘‘Payment exception: Self-dialysis 

training costs in pediatric facilities’’. No 

further changes are proposed to 

§ 413.186. 

(5) Proposed Removal of § 413.188 

(Payment Exception: Extraordinary 

Circumstances) 

We are proposing to remove this 

§ 413.188 to conform with the 

elimination of elimination of 

§ 413.182(b), (c) and (e) as discussed 

above. 

(6) Proposed Redesignation of § 413.190 

(Payment Exception: Self-Dialysis 

Training Costs) 

We propose to continue to recognize 

exceptions for self-dialysis training 

costs under § 413.190 only for pediatric 

facilities, and to rename this section, 

‘‘Payment exception: Self-dialysis 

training costs in pediatric facilities.’’ We 

are proposing to change the name to 

conform with the current statute that 

prohibits exceptions for facilities other 

than pediatric ESRD facilities. We are 

also proposing to redesignate this 

section as § 413.186. (As discussed 

above, we are proposing to remove 

existing § 413.186.) The current 

regulatory language in § 413.190 

(proposed to be redesignated as 

§ 413.186) would remain unchanged. 

(7) Proposed Removal of § 413.192 

(Payment Exception: Frequency of 

Dialysis) 

We are proposing to remove this 

section to conform with the elimination 

of § 413.182(b), (c) and (e) as discussed 

above. 

H. Payment for Covered Outpatient 

Drugs and Biologicals 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Payment for Covered Outpatient Drugs 

and Biologicals’’ at the beginning of 

your comments.]

Medicare Part B covers a limited 

number of prescription drugs and 

biologicals. For the purposes of this 

proposed rule, the term ‘‘drugs’’ will 

hereafter refer to both drugs and 

biologicals. Medicare Part B covered 

drugs not paid on a cost or prospective 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45843

payment basis generally fall into three 

categories: 

• Drugs furnished incident to a 

physician’s service. 

• DME drugs. 

• Drugs specifically covered by 

statute (immunosuppressive drugs, for 

example). 

Beginning in CY 2005, the vast 

majority of Medicare Part B drugs not 

paid on a cost or prospective payment 

basis are paid under the ASP 

methodology. The ASP methodology is 

based on data submitted to us quarterly 

by manufacturers. In addition to the 

payment for the drug, Medicare 

currently pays a dispensing fee for 

inhalation drugs, a furnishing fee for 

blood clotting factors, and a supplying 

fee for certain Part B drugs. 

This section of the preamble discusses 

proposed changes and issues related to 

the determination of the payment 

amounts for covered Part B drugs and 

the separate payments allowable for 

dispensing inhalation drugs, furnishing 

blood clotting factor, and supplying 

certain other Part B drugs. This section 

of the preamble also discusses proposed 

changes in how manufacturers calculate 

and report ASP data to us. 

1. ASP Issues 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘ASP Issues’’ at the beginning of your 

comments.] 

Section 303(c) of the MMA amended 

Title XVIII of the Act by adding new 

section 1847A. This new section 

establishes the use of the ASP 

methodology for payment for most 

drugs and biologicals not paid on a cost 

or prospective payment basis furnished 

on or after January 1, 2005. The ASP 

reporting requirements are set forth in 

section 1927(b) of the Act. 

Manufacturers must submit ASP data to 

us quarterly. The manufacturers’

submissions are due to us not later than 

30 days after the last day of each 

calendar quarter. The methodology for 

developing Medicare drug payment 

allowances based on the manufacturers’

submitted ASP data is specified in the 

regulations in part 414, subpart K. Based 

on the data we receive, we update the 

Part B drug payment amounts quarterly. 

In this section of the preamble, we 

discuss issues and propose changes 

related to the methodology 

manufacturers use to apply the estimate 

of lagged price concessions in the ASP 

calculation. We also discuss the 

submission of ASP data, including 

WAC, and our intent to propose, in a 

separate notice, the collection of 

additional information from 

manufacturers, using a revised reporting 

format, to ensure more accurate 

calculation of the Medicare payment 

amounts. 

Also, included in this section is a 

discussion of the weighting 

methodology we follow to establish the 

Medicare payment amounts using the 

ASP data. 

a. Estimation Methodology for Lagged 

Price Concessions 

Section 1847A(c)(5)(A) of the Act 

states that the ASP is to be calculated by 

the manufacturer on a quarterly basis. 

As a part of that calculation, 

manufacturers are to take into account 

price concessions such as—

• Volume discounts. 

• Prompt pay discounts. 

• Cash discounts. 

• Free goods that are contingent on 

any purchase requirement. 

• Chargebacks. 

• Rebates (other than rebates under 

the Medicaid drug rebate programs). 

If the data on these price concessions 

are lagged, then the manufacturer is 

required to estimate costs attributable to 

these price concessions. Specifically, 

the manufacturer sums the price 

concessions for the most recent 12-

month period available associated with 

all sales subject to the ASP reporting 

requirements. The manufacturer then 

calculates a percentage using this 

summed amount as the numerator and 

the corresponding total sales data as the 

denominator. This results in a 12-month 

rolling average price concession 

percentage that is applied to the total in 

dollars for the sales subject to the ASP 

reporting requirement for the quarter 

being submitted to determine the price 

concession estimate for the quarter. The 

methodology is specified in 

§ 414.804(a)(3) and was published in the 

Manufacturer Submission of 

Manufacturer’s ASP Data for Medicare 

Part B Drugs and Biologicals final rule 

published on September 16, 2004 (69 FR 

55763). 

Our goal is to ensure that the ASP 

data submitted by manufacturers 

reflects an appropriate estimate of 

lagged price concessions. Since 

publication of the September 16, 2004 

final rule, we have identified a 

refinement of the ASP calculation and 

lagged price concession estimation 

methodology related to chargebacks that 

we believe will improve the accuracy of 

the estimate. As a result, we are 

proposing to clarify the ASP calculation 

in this proposed rule. 

b. Price Concessions: Wholesaler 

Chargebacks 

Wholesaler chargebacks are a type of 

price concession, generally paid on a 

lagged basis, that apply to sales to 

customers (for example, physicians) via 

a wholesaler (or distributor). Wholesaler 

chargeback arrangements may vary in 

scope and complexity. However, simply 

put, the wholesaler administers contract 

prices negotiated between the 

manufacturer and end purchasers (for 

example, physician or other health care 

providers), or otherwise implements 

pricing terms established by the 

manufacturer (for example, pricing that 

varies by type of purchaser or class of 

trade). The wholesaler charges the 

customer a certain price and charges 

back the manufacturer an agreed upon 

amount for the purposes of making up 

the difference between the wholesaler’s 

price (for example, WAC) and the 

customer’s price. 

Under the current estimation 

methodology for lagged price 

concessions, total lagged price 

concessions, including lagged 

wholesaler chargebacks, for the 12-

month period are divided by total sales 

for that same period to determine a ratio 

that is applied to the total sales for the 

reporting period. The ratio of lagged 

price concessions to sales is calculated 

over all sales, both indirect sales (sales 

to wholesalers and distributors and 

other similar entities that sells to others 

in the distribution chain) and direct 

sales (sales directly from manufacturer 

to providers, such as hospitals or 

HMOs). To the extent that the 

relationship between total dollars for 

indirect sales and total dollars for all 

sales is different for the reporting 

quarter and the 12-month period used, 

the current ratio methodology for 

estimating lagged price concessions may 

overstate or understate wholesaler 

chargebacks expected for the reporting 

period. A more accurate estimation of 

lagged price concessions would 

minimize the effect of quarter to quarter 

variations in the relationship between 

indirect sales and all sales. 

As a result, we propose to revise 

§ 414.804 to require manufacturers to 

calculate the ASP for direct sales 

independently from the ASP for all 

other sales subject to the ASP reporting 

requirement (indirect sales). Then, the 

manufacturer would calculate a 

weighted average of the direct sales ASP 

and the indirect sales ASP to submit to 

us. For example, for a National Drug 

Code (NDC), the manufacturer has 100 

direct sales and 200 indirect sales. 

Taking into account applicable price 

concessions for direct sales and those 

for indirect sales, including use of the 

ratio methodology for estimating lagged 

price concessions, the direct sales ASP 

is $25, and the indirect sales ASP is $27. 

45844 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

The weighted average of the ASPs 

would be as shown in this example.

100 25 200 27

100 200

33 ( ) × + × ( )

+ = $26.

We believe the weighted average of 

direct sales ASP and indirect sales ASP 

improves the overall accuracy of the 

ASP calculation, particularly for NDCs 

with significant fluctuations in the 

percentage of sales that are direct sales.

We are proposing conforming changes 

to § 414.804 for the methodology for 

calculating the lagged price concessions 

percentage. We are also proposing to 

revise the regulation text to clarify that 

the estimation ratio methodology relates 

to lagged price concessions. We also are 

proposing to define direct sales and 

indirect sales in § 414.802, and seek to 

develop definitions for these terms so 

that all sales subject to the ASP 

reporting requirement are included 

under these two definitions. 

We seek comments about the 

advisability of requiring manufacturers 

to calculate the ASP for direct sales, 

including price concessions, 

independently from the ASP for indirect 

sales and then calculating a weighted 

average of these ASPs to submit to CMS. 

We also seek comments about the 

potential affects of this approach on the 

ASP as well as our proposed definitions 

of direct sales and indirect sales (that is, 

that direct sales are from manufacturer 

to provider or supplier, and indirect 

sales are the remaining sales subject to 

the ASP reporting requirement). 

c. Determining the Payment Amount 

Based on ASP Data 

We have received inquiries related to 

the formula we use to calculate the 

payment amount for each billing code. 

We posted a Frequently Asked Question 

on this subject on our Web site

(http://www.questions.cms.hhs.gov) 

earlier this year. We are including this 

section in this preamble to ensure 

greater public access to this information. 

Our approach to calculating the 

payment amounts is as follows: 

• For each billing code, we calculate 

a weighted ASP using the ASP data 

submitted by manufacturers. 

• Manufacturers submit ASP data at 

the 11-digit NDC level. 

• Manufacturers submit the number 

of units of the 11-digit NDC sold and the 

ASP for those units. 

• We convert the manufacturers’ ASP 

for each NDC into the ASP per billing 

unit by dividing the manufacturer’s ASP 

for that NDC by the number of billing 

units in that NDC. For example, a 

manufacturer sells a box of 4 vials of a 

drug. Each vial contains 20 milligrams 

(mg). The billing code is per 10 mg. The 

conversion formula is: Manufacturer’s 

ASP/[(4 vials × 20 mg)/10 mg = 8 

billable units per NDC]. 

• Then, the ASP per billing unit and 

the number of units (11-digit NDCs) sold 

for each NDC assigned to the billing 

code are used to calculate a weighted 

ASP for the billing code. We sum the 

ASP per billing unit times the number 

of 11-digit NDCs sold for each NDC 

assigned to the billing code, and then 

divide by the total number of NDCs 

sold. The ASP per billing unit for each 

NDC is weighted equally regardless of 

package size.

d. Reporting WAC 

In response to manufacturer’s 

questions about reporting WAC, we 

posted a Frequently Asked Question on 

this subject on our Web site (http://

www.questions.cms.hhs.gov) last year. 

In the posting on the Web site, we state 

that manufacturers must report the 

WAC for a single source drug or 

biological if it is less than the ASP for 

a quarter and in cases where the ASP 

during the first quarter of sales is 

unavailable. Upon further review, we 

have determined that the WAC must be 

reported each quarter if required for 

payment to be made under section 

1847A of the Act, in addition to the 

ASP, if available. 

Section 1927(b)(3)(A)(iii) of the Act 

specifies the ASP data manufacturers 

must report. Section 

1927(b)(3)(A)(iii)(II) of the Act specifies 

that the manufacturer must report the 

WAC, if it is required in order for 

payment to be made under section 

1847A of the Act. Under section 1847A 

of the Act, the payment is based on 

WAC (as opposed to ASP) in the 

following cases: 

• For a single source drug or 

biological, when the WAC-based 

calculated payment is less than the 

ASP-based calculated payment for all 

NDCs assigned to such drug or 

biological product. (See section 

1847A(b)(4) of the Act.) 

• During an initial period in which 

data on the prices for sales for the drug 

or biological is not sufficiently available 

from the manufacturer to compute an 

ASP. (See section 1847A(c)(4) of the 

Act.) 

In these instances, we must make the 

determination of whether the payment 

amount is based on ASP or WAC. 

Therefore, WAC is required for payment 

in all of these instances. 

On April 6, 2004, we published the 

ASP reporting regulations in the 

Manufacturer Submission of 

Manufacturer’s ASP Data for Medicare 

Part B Drugs and Biologicals interim 

final rule with comment (66 FR 17935–

17941). In that interim final rule, we 

specified that manufacturers must 

report the ASP data to us using the 

template provided in Addendum A of 

that interim final rule. That template 

included the manufacturer’s name, 

NDC, manufacturer’s ASP, and number 

of units. The WAC was not included in 

the template. Therefore, in order to 

report the WAC, manufacturers have 

used several approaches. Some 

manufacturers have appended the WAC 

to the template; others have noted it in 

their written cover letters to their 

submissions. Still others have sent the 

WAC to us using electronic mail. 

Because a place for the WAC was not 

included in the template, it is possible 

that manufacturers may not have 

submitted the WAC even though it was 

required. On a few occasions, we have 

contacted the manufacturer to obtain the 

WAC when it was needed to determine 

the payment amount. Therefore, because 

of the requirement to submit the WAC 

and the confusion manufacturers have 

experienced in submitting the WAC 

data we will propose, in a separate 

information collection notice, to revise 

the reporting template to include a place 

to report WAC. See the discussion in 

section e. below for further details about 

potential changes to the reporting 

format. 

To clarify the instances when 

manufacturers are required to report the 

WAC, in this proposed rule we are 

clarifying that manufacturers are 

required to report quarterly both the 

ASP and the WAC for NDCs assigned to 

a single source drug or biological billing 

code. Manufacturers are also required to 

report the WAC for use in determining 

the payment during the initial period 

under section 1847A(c)(4) of the Act. 

That is, the WAC is reported for the 

reporting period prior to reporting the 

ASP based on a full quarter of sales. 

Because the WAC could change 

during a reporting period, we are 

proposing that in reporting the WAC, 

manufacturers would be required to 

report the WAC in effect on the last day 

of the reporting period. 

e. Revised Format for Submitting ASP 

Data 

As specified in the April 6, 2004 

interim final rule, manufacturers are 

required to report the ASP data to us in 

Microsoft Excel using the specified 

template. As discussed above, the 

current template does not provide 

adequate instructions for manufacturers 

to report both the ASP and the WAC. 

Therefore, in a separate information 

collection notice that will be published 

at or about the same time as this 


EP08AU05.042</MATH>
Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45845

proposed rule, we will propose to revise 

the ASP reporting format to 

accommodate submission of both the 

ASP and the WAC. We will also propose 

to collect the following additional 

information: 

• Drug name. 

• Package size (strength of product, 

volume per item, and number of items 

per NDC). 

• Expiration date for last lot 

manufactured. 

• Date the NDC was first marketed 

(for products first marketed on or after 

October 1, 2005). 

• Date of first sale for products first 

sold on or after October 1, 2005. 

We are mentioning the separate 

information collection notice in this 

proposed rule in order to broaden 

public awareness of the separate notice. 

The separate notice will be posted at 

http://www.cms.hhs.gov/regulations/

pra/. The current reporting format is an 

approved information collection. The 

OMB control number is 0938–0921. 

f. Limitations on ASP 

Section 1847A(d)(1) of the Act states 

that ‘‘the Inspector General of the 

Department of Health and Human 

Services shall conduct studies, which 

may include surveys to determine the 

widely available market prices of drugs 

and biologicals to which this section 

applies, as the Inspector General, in 

consultation with the Secretary 

determines to be appropriate.’’ Section 

1847A(d)(2) of the Act states that 

‘‘Based upon such studies and other 

data for drugs and biologicals, the 

Inspector General shall compare the 

ASP under this section for drugs and 

biologicals with—

• The widely available market price 

for such drugs and biologicals (if any); 

and 

• The average manufacturer price (as 

determined under section 1927(k)(1) for 

such drugs and biologicals.’’

Section 1847A(d)(3)(A) of the Act 

states that ‘‘The Secretary may disregard 

the ASP for a drug or biological that 

exceeds the widely available market 

price or the average manufacturer price 

for such drug or biological by the 

applicable threshold percentage (as 

defined in subparagraph (B)).’’ The 

applicable threshold is specified as 5 

percent for CY 2005. For CY 2006 and 

subsequent years, section 

1847A(d)(3)(B)of the Act establishes that 

the applicable threshold is ‘‘the 

percentage applied under this 

subparagraph subject to such 

adjustment as the Secretary may specify 

for the widely available market price or 

the average manufacturer price, or 

both.’’

For CY 2006, we propose to specify an 

applicable threshold percentage of 5 

percent for both the widely available 

market price (WAMP) and average 

manufacturer price (AMP). The OIG is 

conducting its first review. However, we 

did not receive the OIG’s final report in 

time for consideration before developing 

this proposed rule. Thus, we believe 

that continuing the CY 2005 threshold 

percentage applicable to both the 

WAMP and AMP is most appropriate. 

2. Payment for Drugs Furnished During 

CY 2006 in Connection With the 

Furnishing of Renal Dialysis Services if 

Separately Billed by Renal Dialysis 

Facilities 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Payment for ESRD Drugs’’ at the 

beginning of your comments.] 

Section 1881(b)(13)(A)(iii) of the Act 

indicates that payment for a drug 

furnished during CY 2006 and 

subsequent years in connection with the 

furnishing of renal dialysis services, if 

separately billed by renal dialysis 

facilities, will be based on the 

acquisition cost of the drug as 

determined by the OIG report to the 

Secretary as required by section 623(c) 

of the MMA or, the amount determined 

under section 1847A of the Act for the 

drug, as the Secretary may specify. In 

the report entitled, ‘‘Medicare 

Reimbursement for Existing End Stage 

Renal Disease Drugs,’’ the OIG obtained 

the drug acquisition costs for the top 10 

ESRD drugs for the 4 largest ESRD 

chains as well as a sampling of the 

remaining independent facilities. Based 

on the information obtained from this 

report, for CY 2005, payment for the top 

10 ESRD drugs billed by freestanding 

facilities and payment for EPO billed by 

hospital-based facilities was based on 

acquisition costs as determined by the 

OIG. Due to the lag in the data obtained 

by the OIG, we updated the acquisition 

costs for the top 10 ESRD drugs to 2005 

by the PPI. The separately billable ESRD 

drugs not contained in the OIG report 

were paid at the ASP +6 percent for 

freestanding facilities. The payment 

allowances for these remaining drugs 

were updated on a quarterly basis 

during 2005. 

Section 1881(b)(13)(A)(iii) of the Act 

gives the Secretary the authority to 

establish the payment amounts for 

separately billable ESRD drugs 

beginning in 2006 based on acquisition 

costs or the amount determined under 

section 1847A of the Act. For reasons 

discussed below, we do not believe that 

it is appropriate to continue to use 2002 

acquisition costs updated by the PPI for 

another year as the basis for payment. 

The acquisition costs are based on 2002 

data which, despite updates by the PPI, 

do not necessarily reflect current market 

conditions. As discussed below, the 

chances increase that Medicare 

payments will either overpay or 

underpay for drugs, thus, resulting in 

payments that are inconsistent with the 

goal of making accurate payments for 

drugs. We also considered whether 

actual acquisition cost data could be 

periodically updated. However, we do 

not believe that it would be feasible to 

base Medicare payments over the long 

term on continually acquiring data on 

actual acquisition costs from ESRD 

facilities. This approach would provide 

incentives for manufacturers and 

facilities to increase acquisition costs 

without constraint. It also would not 

necessarily provide data regarding 

current market rates. Therefore, we 

believe it is appropriate for the payment 

methodology for all ESRD drugs when 

separately billed by freestanding ESRD 

facilities during CY 2006 to be paid the 

amount determined under section 

1847A of the Act. This payment amount 

is the ASP +6 percent rate. 

In reaching the conclusion about 

establishing payment using the amount 

determined under section 1847A of the 

Act rather than actual acquisition costs, 

we analyzed the ASP +6 percent 

payment rates for all separately billable 

ESRD drugs, including the top 10, for 

both the first and second quarters of CY 

2005. (We note that the ASP payment 

rates are updated quarterly. The new 

rates are made available each quarter at 

the following Web site: http://

www.cms.hhs.gov/providers/drugs/

asp.asp.). Additionally, we analyzed the 

CY 2005 payment rates, based on OIG 

data, updated by the PPI to reflect 

inflation as well as the potential CY 

2006 payment rates, based on the OIG 

data, also updated by the PPI to reflect 

inflation for the top 10 separately 

billable ESRD drugs. As indicated in the 

‘‘Top 10 Separately Billable ESRD 

Drugs’’ chart, the payment rates for the 

top 10 separately billable ESRD drugs 

based on the acquisition costs (as 

determined by the OIG), updated by the 

PPI would increase by 7 percent for CY 

2006. In contrast, the percentage change 

in the ASP +6 percent payment rates for 

the top 10 separately billable ESRD 

drugs based on the first and second 

quarters of CY 2005 varied on a drugby-drug basis.

45846 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

TOP 10 SEPARATELY BILLABLE ESRD DRUGS

Drug name 2005 Payment 

rate 

Estimated 

2006 payment 

rate based on 

OIG data 

(2003 data inflated 16.2% 

to 2006 by the 

estimated PPI) 

Estimated 

2006 payment 

rate based on 

ASP+6 (2nd 

quarter 2005 

rates) 

Percent 

change in ASP 

+6 rates between 1st 

quarter and 

2nd quarter 

2005

(percent) 

Epoetin alpha ................................................................................................... $9.760 $10.440 $9.250 ¥1% 

Paricalcitol ........................................................................................................ $4.000 $4.270 $3.971 ¥1 

Sodium Ferric Gluconate ................................................................................. $4.950 $5.290 $4.726 ¥2 

Iron Sucrose .................................................................................................... $0.370 $0.390 $0.365 1 

Levocarnitine .................................................................................................... $13.630 $14.560 $11.122 ¥24 

Doxercalciferol ................................................................................................. $2.600 $2.780 $2.784 ¥0.5 

Calcitriol ........................................................................................................... $0.960 $1.030 $0.859 21 

Iron Dextran ..................................................................................................... $10.940 $11.700 $11.218 1 

Vancomycin ..................................................................................................... $2.980 $3.190 $3.188 32 

Alteplase, Recombinant ................................................................................... $31.740 $33.920 $30.089 0 

However, the percentage increases or 

decreases in the ASP +6 percent 

payment rates are relatively minimal. 

For example, the payment allowance for 

Alteplase, recombinant, J2997, 

decreased from first quarter 2005 to 

second quarter 2005 by less than 1 

percent. Based on an analysis of the 

2002 acquisition costs for the top 10 

separately billable ESRD drugs, when 

updated by the PPI for CY 2006, it is our 

contention that relying on 2002 

acquisition cost data updated for a 

number of years as would be necessary 

to establish a payment amount for 2006 

is not the most appropriate option for 

determining Medicare payment rates 

when other drug-specific pricing is 

available. Further, we contend that 

relying on the ASP +6 percent as the 

payment rate for all separately billable 

ESRD drugs when billed by freestanding 

ESRD facilities for CY 2006 is a more 

reliable indicator of the market 

transaction prices for these drugs. The 

ASP is reflective of manufacturer sales 

for specific drug products and is more 

indicative of market and sales trends for 

those specific products than the 2002 

OIG acquisition cost data. 

We also note MedPAC’s 

recommendation in its June 2005 report 

that the ASP be the basis of payment for 

all separately billable ESRD drugs 

provided by both freestanding and 

hospital-based facilities in CY 2006 

(MedPAC, ‘‘Report to the Congress: 

Issues in a Modernized Medicare 

Program,’’ June 2005). In making this 

recommendation, MedPAC states that 

the ASP data are more current (updated 

quarterly), and, thus, more likely to 

reflect actual transaction prices, 

compared with acquisition cost data 

which are not regularly collected by the 

OIG or CMS. Furthermore, the report 

indicated that utilizing the same 

payment policy for both freestanding 

and hospital-based facilities would 

ensure uniformity across the various 

settings irrespective of the site of care. 

In addition, MedPAC recommends in its 

report that we obtain, ‘‘* * * data to 

estimate hospitals’ costs and Medicare’s 

payment per unit for these drugs. No 

published source identifies the unit 

payment for these drugs because 

Medicare pays hospitals their 

reasonable costs.’’ MedPAC further 

states: ‘‘We attempted to calculate the 

unit payment from 2003 claims data, but 

the accuracy of the data fields we 

needed to make this calculation was 

unclear, particularly the number of 

units furnished and Medicare’s payment 

to the hospital.’’ MedPAC also 

recommends that CMS and/or OIG 

collect acquisition cost data periodically 

in the future to gauge the appropriate 

percentage of ASP for the payment 

amount. 

While we acknowledge MedPAC’s 

recommendations, we are proposing to 

make payment using the ASP +6 percent 

methodology for all separately billed 

ESRD drugs furnished in freestanding 

facilities and for EPO furnished in 

hospital-based facilities. Paying for EPO 

furnished in hospital-based facilities 

using the ASP +6 percent methodology 

is consistent with past practices where 

we have paid for EPO in hospital-based 

facilities consistent with freestanding 

facilities. That is, in 2005, we paid for 

EPO in hospital-based facilities based 

on acquisition costs consistent with 

freestanding facilities. While we are not 

proposing to pay for drugs other than 

EPO furnished in hospital-based 

facilities under the ASP +6 percent 

methodology at this time, we are 

interested in moving to this approach. 

We believe that it is more appropriate to 

pay for separately billed drugs furnished 

in hospital-based facilities under the 

ASP +6 percent methodology rather 

than on a reasonable cost basis, as we 

believe that there should be consistency 

across sites in payment for the same 

item or service. However, we have not 

made this proposal due to the lack of 

data regarding drug costs and 

expenditures associated with hospitalbased ESRD payments. We have 

discussed a potential approach to 

making estimates of these costs and 

units. We seek comments about the 

estimation method discussed in section 

II.G. of this proposed rule or other 

methods or data that could be used. 

Therefore, for CY 2006, we propose 

that payment for a drug furnished in 

connection with renal dialysis services 

and separately billed by freestanding 

renal dialysis facilities and EPO billed 

by hospital-based facilities be based on 

section 1847A of the Act. We propose to 

update the payment allowances 

quarterly based on the ASP reported to 

us by drug manufacturers. We seek 

comment on our proposed decision to 

revise the payment methodology for 

separately billable ESRD drugs. While 

we have not proposed to pay hospitalbased facilities under the ASP +6 

percent methodology for 2006, we seek 

comments about the potential method 

we have discussed to accomplish this 

policy. We also seek comment on how 

this proposed decision could affect 

beneficiaries or providers access to 

these drugs.

3. Clotting Factor Furnishing Fee 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Clotting Factor’’ at the beginning of 

your comments.] 

Section 303(e)(1) of the MMA added 

section 1842(o)(5) of the Act which 

requires the Secretary, beginning in CY 

2005 to pay a furnishing fee, in an 

amount the Secretary determines to be 

appropriate, to hemophilia treatment 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45847

1 GAO, ‘‘Medicare Payment for Covered 

Outpatient Drugs Exceed Providers’ Costs,’’

September 2001. OIG, ‘‘Excessive Medicare 

Reimbursement for Albuterol,’’ March 2002. OIG, 

‘‘Excessive Medicare Reimbursement for 

Ipratropium Bromide,’’ March 2002.

2For more details see the Interim Final Rule 

regarding Changes to Medicare Payment for Drugs 

and Physician Fee Schedule Payments for Calendar 

Year 2004 published in the Federal Register on 

January 7, 2004.

3 GAO, ‘‘Appropirate Dispensing Fee Needed for 

Suppliers of Inhalation Therapy Drugs,’’ GAO–05–

72, October 2004.

centers and homecare companies for the 

items and services associated with the 

furnishing of blood clotting factor. In 

the Revisions to Payment Policies Under 

the Physician Fee Schedule for Calendar 

Year 2005 final rule, published 

November 15, 2004 (69 FR 66236) we 

established a furnishing fee of $0.14 per 

unit of clotting factor for CY 2005. 

Section 1842(o)(5) of the Act specifies 

that the furnishing fee for clotting factor 

for years after CY 2005 will be equal to 

the fee for the previous year increased 

by the percentage increase in the 

consumer price index (CPI) for medical 

care for the 12-month period ending 

with June of the previous year. The CPI 

data for the 12-month period ending in 

June 2005 is not yet available. As a 

point of reference, we note that the 

percent change in the CPI for medical 

care for the 12-month period ending 

June 2004 was 5.1 percent. In the final 

rule, we will include the actual figure 

for the percent change in the CPI 

medical care for the 12-month period 

ending June 2005, and the updated 

furnishing fee for CY 2006 calculated 

based on that figure. 

4. Payment for Inhalation Drugs and 

Dispensing Fee 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Inhalation Drugs and Dispensing Fee’’

at the beginning of your comments.] 

Medicare Part B pays for inhalation 

drugs administered via a nebulizer, a 

covered item of DME. Medicare Part B 

pays for DME and associated supplies, 

including inhalations drugs that are 

necessary for the operation of the 

nebulizer. Metered-dose inhalers (MDIs) 

are another mode of delivery for 

inhalation drugs. MDIs are considered 

disposable medical equipment (for 

which there is no current Medicare Part 

B benefit category), and consequently 

are not currently covered under Part B. 

Beginning in CY 2006, coverage for 

MDIs will generally be available through 

the Medicare Part D benefit. This 

represents an important expansion in 

the options available to beneficiaries for 

inhalation drug coverage under 

Medicare. With Medicare coverage of 

both delivery methods available, we 

anticipate that physicians will choose 

the option that best suits a patient’s 

particular needs consistent with the 

applicable standards of medical 

practice. We expect that both modes of 

inhalation drug delivery will play an 

important role in the Medicare program 

in the years to come. 

Prior to CY 2004, most Medicare Part 

B covered drugs, including inhalation 

drugs, were paid at 95 percent of the 

AWP. Numerous studies by the OIG and 

General Accounting Office (GAO) 

indicated that 95 percent of AWP 

substantially exceeded suppliers’

acquisition costs for Medicare Part B 

drugs, particularly for the high volume 

nebulizer drugs, albuterol and 

ipratropium bromide.1 For example, 

supplier’s acquisition costs were 

estimated to be 34 percent of AWP for 

ipratropium bromide and 17 percent of 

AWP for albuterol based on averaging 

results from a GAO and an OIG study.2

The MMA changed the Medicare 

payment methodology for many Part B 

covered drugs. As an interim step, in CY 

2004, Medicare paid a reduced 

percentage of AWP, 80 percent of AWP 

in the case of albuterol and ipratropium 

bromide. Beginning with CY 2005, 

Medicare paid for nebulizer drugs at 106 

percent of the ASP. The move to the 

ASP system represented a substantial 

reduction in reimbursement for the high 

volume nebulizer drugs.

In addition to paying for the cost of 

the drug itself, Medicare has paid a 

dispensing fee for inhalation drugs. 

Prior to CY 2005, Medicare paid a 

monthly $5 dispensing fee for each 

covered nebulizer drug or combination 

of drugs used. In the Revisions to 

Payment Policies Under the Physician 

Fee Schedule for Calendar Year 2005 

proposed rule, published August 5, 

2004, we proposed to continue to pay a 

dispensing fee for these drugs. In that 

proposed rule, we sought comment on 

an appropriate dispensing fee level to 

cover the shipping, handling, 

compounding, and other pharmacy 

activities required to get these 

medications to beneficiaries. 

In response to last year’s proposed 

rule, we received a number of comments 

that varied substantially in terms of the 

dispensing fee amount that commenters 

thought was adequate. We received 

comments from a retail pharmacy that 

indicated that a dispensing fee of five to 

six times the prior $5 fee was necessary 

to cover costs. Another retail pharmacy 

indicated that a dispensing fee of $25 

would be an adequate amount and 

would be profitable. 

We also received several comments 

that asserted that a substantially higher 

fee was needed and that the dispensing 

fee should cover a variety of services. A 

number of commenters referenced an 

August 2004 report prepared for the 

American Association of Homecare 

(AAH) by a consultant that surveyed 

104 home care agencies, which 

indicated that in order to maintain the 

CY 2004 levels of service to Medicare 

beneficiaries and provide an operating 

margin of 7 percent, Medicare would 

have to pay a dispensing fee of $68.10 

per service encounter (service 

encounters they estimate occur on 

average every 42 days). The survey 

included costs for a wide range of 

activities including activities associated 

with getting the drug to the beneficiary, 

as well as other additional services. 

More specifically, the AAH data 

included the following cost categories: 

• Clinical intake. 

• Establishing and revising the plan 

of care. 

• Care coordination. 

• Patient education. 

• Caregiver training. 

• Compliance monitoring/refill calls. 

• In-home visits. 

• Delivery of services. 

• Billing/collections. 

• Other costs (not specified by AAH). 

As an example, the AAH data 

indicated that inhalation drug suppliers 

spent on average about 29 minutes per 

new patient on patient education and 

caregiver training and continued to 

spend on average about 17 minutes per 

month for each established patient on 

patient education and caregiver training. 

The data also indicated that suppliers 

spent on average about 23 minutes per 

patient each month on in-home visits, 

with there being substantial variation in 

the provision of this service. A number 

of commenters asserted that these and 

other services included in the AAH data 

were important to the provision of 

inhalation drugs, and should be paid for 

by Medicare.

Between publication of the August 5, 

2004 proposed rule and the November 

15, 2004 final rule, the GAO released a 

report based on a survey of 12 

inhalation therapy companies, 

representing 42 percent of the market, 

which indicated wide variation across 

companies in the patient monthly cost 

of dispensing inhalation drugs from a 

low of $7 to a high of $204.3 The GAO 

report indicated that the wide variation 

in supplier costs is due, in part, to 

variation in the services suppliers offer 

and that some of the costs incurred by 

suppliers may not be necessary to 

dispense inhalation drugs, for example, 

45848 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

marketing, overnight shipping, and 24-

hour hotlines.

In light of the substantial changes 

occurring in inhalation drug 

reimbursement in 2005, we viewed 2005 

as a transitional year. With the wide 

variation in the reported costs and 

services provided by inhalation drug 

suppliers suggested by the comments 

and the GAO study, we stated in last 

year’s final rule that we would establish 

an interim dispensing fee for inhalation 

drugs applicable for CY 2005 and 

reconsider the issue for CY 2006. The 

2005 dispensing fee for a 30-day supply 

of inhalation drugs was based on the 

industry recommended $68 fee from 

AAH study, excluding certain costs that 

Medicare generally does not reimburse 

regardless of the scope of the Medicare 

benefit (that is, sales and marketing, bad 

debt, and an explicit profit margin). The 

resulting fee established for a 30-day 

supply of inhalation drugs was $57 for 

CY 2005. This CY 2005 fee substantially 

exceeded some providers’ costs as 

reflected in a few comments on last 

year’s proposed rule and the GAO 

study. For example, as noted previously, 

we received comments from two retail 

pharmacy companies indicating that a 

fee of $25 or a fee of five to six times 

the prior $5 fee was adequate to cover 

costs. Because the AAH study did not 

include cost data for a 90-day supply, 

we applied the methodology used in the 

GAO report to convert the 30-day fee to 

a 90-day fee. The 2005 fee established 

for a 90-day supply was $80. In using 

the AAH data to establish an interim fee 

for dispensing for CY 2005, we 

indicated in last year’s final rule that we 

were concerned that some of the 

services included in the AAH study may 

be outside the scope of a dispensing fee 

and that we would consider this issue 

further in order to establish an 

appropriate dispensing fee for CY 2006. 

Authority for a dispensing fee for 

inhalation drugs is based on section 

1842(o)(2) of the Act. This section of the 

Act stipulates that if payment is made 

to a licensed pharmacy for a drug or 

biological under Medicare Part B, the 

Secretary may pay a dispensing fee (less 

the applicable deductible and 

coinsurance) to the pharmacy. The 

statute does not define ‘‘dispensing fee.’’

As noted above, the AAH data on which 

the 2005 dispensing fee is based 

includes a wide range of cost categories. 

The cost categories include basic 

pharmacy services such as delivery of 

drugs, as well as other services such as 

in-home visits. We are soliciting 

comments on what services 

appropriately fall within the scope of a 

dispensing fee, the cost of providing 

those services, and whether any of the 

services being provided by inhalation 

drug suppliers may be covered through 

another part of the Medicare program, 

such as the physician fee schedule or 

the DME benefit. We intend to establish 

a dispensing fee amount for 2006 that is 

adequate to cover the costs of those 

services that appropriately fall within 

the scope of a dispensing fee, and we 

think that it is likely that this fee 

amount will be lower than the 2005 

level. As discussed previously, we 

believe that 2005 was a transition year. 

Payment for inhalation drugs in 2005 

was reduced from a percentage of AWP 

to 106 percent of ASP and the 2005 

dispensing fee was set at a much higher 

level than previously paid based on the 

limited information available and taking 

into account the transition. Additional 

changes will occur in 2006 because the 

implementation of the Medicare 

prescription drug benefit will expand 

coverage options for inhalation drugs to 

include metered dose inhalers under 

Medicare Part D. As noted above, we 

expect that physicians will choose the 

treatment option that best suits a 

particular beneficiary’s needs and that 

both nebulizers and metered-dose 

inhalers will play an important role in 

the Medicare program. We do not know 

what the effect will be of this upcoming 

expansion of inhalation drug coverage 

options, but we believe it is important 

that this second transitional year be as 

smooth as possible. We are seeking 

comments on an appropriate dispensing 

fee level for 2006. We also seek data and 

information on the various services 

inhalation drug suppliers are currently 

providing to Medicare beneficiaries and 

the associated costs. Furthermore, we 

are also soliciting comments on how 

inhalation drug suppliers have utilized 

the newly available 90-day scripts in 

order to reduce unit shipping costs and 

any reasons as to why 90-day supplies 

may not have been utilized. We also 

seek information on how revised 

guidelines regarding the time frame for 

delivery of refills has affected the need 

for overnight delivery services. We are 

interested in comments that detail the 

extent to which suppliers have shifted 

their shipping to ground services. 

CMS takes quality of care seriously 

and we have been implementing a 

number of quality initiatives such as the 

chronic care improvement program. We 

expect that Medicare beneficiaries 

receive high quality care, and we seek 

data and information on any efforts by 

inhalation drug suppliers to measure 

patient outcomes. Furthermore, we seek 

comments and additional information 

about what are typical dispensing costs 

for an efficient, high-quality supplier. 

Finally, we seek comment on the 

potential impact on beneficiaries and 

providers of possible changes to the 

inhalation drug dispensing fee in 2006, 

as well as the impact of the new drug 

benefit on inhalation drug access. 

5. Supplying Fee 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘Supplying Fee’’ at the 

beginning of your comments.] 

Section 303(e)(2) of the MMA added 

section 1842(o)(6) of the Act that 

requires the Secretary to pay a 

supplying fee (less applicable 

deductible and coinsurance) to 

pharmacies for certain Medicare Part B 

drugs and biologicals, as determined 

appropriate by the Secretary. The types 

of Medicare Part B drugs and biologicals 

eligible for a supplying fee are 

immunosuppressive drugs described in 

section 1861(s)(2)(J) of the Act, oral 

anticancer chemotherapeutic drugs 

described in section 1861(s)(2)(Q) of the 

Act, and oral anti-emetic drugs used as 

part of an anticancer chemotherapeutic 

regimen described in section 

1861(s)(2)(T) of the Act.

Beginning with CY 2005, we 

established a supplying fee of $24 per 

prescription for these categories of 

drugs, with a higher fee of $50 for the 

initial oral immunosuppressive 

prescription supplied in the first month 

after a transplant. When multiple drugs 

are supplied to a beneficiary, a separate 

supplying fee is paid for each 

prescription, except when different 

strengths of the same drug are supplied 

on a single day. In the November 15, 

2004 final rule, we indicated that we 

were establishing a supplying fee that 

was higher than that of other payers due 

to the lack of on-line claims 

adjudication for Medicare Part B oral 

drugs. Other than the cost of billing 

Medicare Part B, we indicated that we 

did not believe there were any other 

significant cost differences between 

Medicare and other payers that justified 

a higher Medicare supplying fee for 

these drugs. We noted in last year’s final 

rule that many other payers with online 

adjudication have dispensing fees in the 

range of $5 to $10 per prescription. We 

also indicated that we had received 

comments that the average cost to a 

pharmacy to dispense a non-Medicaid 

third party or cash prescription for those 

drugs ranges anywhere from $7.50 to 

$8.00. 

When multiple drugs are supplied to 

a beneficiary on the same day or in the 

same month, current policy is to pay a 

full supplying fee for each additional 

drug. As mentioned previously, we 

established a supplying fee higher than 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45849

that of other payers to compensate for 

the added costs associated with our lack 

of online claims adjudication. However, 

in situations where multiple drugs are 

supplied to a beneficiary during the 

same month, many of which are likely 

to be supplied on the same day, we are 

concerned that we are overpaying for 

the costs associated with our lack of 

online claims adjudication. We believe 

that there are likely to be substantial 

economies of scale and that the burden 

associated with our lack of online 

claims adjudication would be relatively 

similar whether one prescription or 

multiple prescriptions were supplied 

during the same month. 

Consequently, in § 414.1001 (Basis of 

payment), we are proposing changes to 

the supplying fee for multiple 

prescriptions supplied during the same 

month. We would continue paying $24 

for the first prescription supplied during 

a month (or $50 for the first oral 

immunosuppressive prescription 

supplied in the first month after a 

transplant). We believe that this $24 

supplying fee for the first prescription 

would adequately compensate a 

supplier for the billing costs associated 

with the lack of on-line claims 

adjudication, and that the cost of 

supplying additional prescriptions in 

the same month should be comparable 

to that of other payers. Therefore, in that 

same section, we are proposing to pay 

a supplier an $8 supplying fee per 

prescription for any prescription, after 

the first one, that that supplier provided 

to a beneficiary during a month. If a 

beneficiary obtained prescriptions at 

two separate pharmacies during a onemonth period, each pharmacy would be 

paid a $24 fee for the first drug it 

supplied and an $8 fee per prescription 

for any subsequent prescriptions during 

the month. 

We are also proposing to expand the 

circumstances under which we pay 

supplying fees for multiple 

prescriptions filled on the same day. 

Currently, we pay a supplying fee for 

each prescription supplied on the same 

day as long as the prescriptions are for 

different drugs. We are now proposing 

to pay a supplying fee for each 

prescription, even if the prescriptions 

are for different strengths of the same 

drug. This change is intended to 

recognize the costs involved in filling 

separate prescriptions for different 

strengths of a drug. For example, if two 

prescriptions were supplied on a single 

day and they were for different strengths 

of the same drug, we are proposing to 

pay a supplying fee of $24 for the first 

prescription and a supplying fee of $8 

for the second prescription. 

Our goal is to ensure that each 

beneficiary who needs covered oral 

drugs has access to those medications 

while maintaining our fiduciary 

responsibility to pay appropriately for 

Medicare covered services. We seek 

comments about the appropriateness of 

our proposed supplying fee for multiple 

prescriptions supplied during a single 

month. We also seek data and 

information about the incremental costs 

of supplying additional prescriptions to 

a Medicare beneficiary during a single 

month, as well as data and information 

about how pharmacy costs and 

reimbursement for supplying oral drugs 

under Medicare compares to that of 

other payers. 

I. Private Contracts and Opt-Out 

Provision 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘PRIVATE CONTRACTS AND OP–

OUT’’ at the beginning of your 

comments.] 

Section 4507 of the BBA of 1997 

amended section 1802 of the Act to 

permit certain physicians and 

practitioners to opt-out of Medicare if 

certain conditions were met, and to 

provide through private contracts 

services that would otherwise be 

covered by Medicare. Under these 

private contracts, the mandatory claims 

submission and limiting charge rules of 

section 1848(g) of the Act would not 

apply. The amendments to section 1802 

of the Act, which were effective on 

January 1, 1998, made the provisions of 

the Medicare statute that would 

ordinarily preclude physicians and 

practitioners from contracting privately 

with Medicare beneficiaries to pay 

without regard to Medicare limits 

inapplicable if the conditions necessary 

for an effective ‘‘opt-out’’ are met. 

When a physician or practitioner fails 

to maintain the conditions necessary for 

opt-out and does not take good faith 

efforts to correct his or her failure to 

maintain opt-out, current regulations at 

§ 405.435(b) specify the consequences to 

that physician or practitioner for the 

remainder of that physician’s or 

practitioner’s 2-year opt-out period. 

However, § 405.435(b) describes a 

situation where the Medicare carrier 

notifies the physician or practitioner 

that he or she is violating the 

regulations and the statute. The current 

regulations do not address the 

consequences to physicians and 

practitioners in situations when a 

condition resulting in failure to 

maintain opt-out occurs during the 2-

year opt-out period, but a Medicare 

carrier does not discover or give notice 

of a physician’s or practitioner’s failure 

to maintain opt-out during the 2-year 

opt-out period. Therefore, we are 

proposing to amend § 405.435 in order 

to clarify that the consequences 

specified in § 405.435(b) for the failure 

on the part of a physician or practitioner 

to maintain opt-out will apply 

regardless of whether or when a carrier 

notifies a physician or practitioner of 

the failure to maintain opt-out. We are 

also proposing to add a new paragraph 

(d) to clarify that in situations where a 

violation of § 405.435(a) is not 

discovered by the carrier during the 2-

year opt-out period when the violation 

actually occurred, then the requirements 

of § 405.435(b)(1) through (b)(8) would 

be applicable from the date that the first 

violation of § 405.435(a) occurred until 

the end of the opt-out period during 

which the violation occurred (unless the 

physician or practitioner takes good 

faith efforts to restore opt-out 

conditions, for example, by refunding 

the amounts in excess of the charge 

limits to beneficiaries with whom he or 

she did not sign a private contract). 

These good faith efforts must be made 

within 45 days of any notice by the 

carrier that the physician or practitioner 

has failed to maintain opt-out (where 

the carrier discovers the failure after the 

two-year opt-out period has expired), or 

within 45 days after the physician or 

practitioner has discovered the failure to 

maintain opt-out, whichever is earlier. 

J. Multiple Procedure Reduction for 

Diagnostic Imaging 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘MULTIPLE PROCEDURE 

REDUCTION’’ at the beginning of your 

comments.]

Medicare has a longstanding policy of 

reducing payment for multiple surgical 

procedures performed on the same 

patient, by the same physician, on the 

same day. In those cases, full payment 

is made for the highest priced procedure 

and each subsequent procedure is paid 

at 50 percent. Effective January 1, 1995, 

the multiple procedure policy, with the 

same reductions, was extended to 

nuclear medicine diagnostic procedures 

(CPT codes 78306, 78320, 78802, 78803, 

78806 and 78807). In the Medicare 

Program Physician Fee Schedule for 

Calendar Year 1995 final rule, published 

on December 8, 1994 (59 FR 63410), we 

indicated that we would consider 

applying the policy to other diagnostic 

tests in the future. 

Under the PFS, diagnostic imaging 

procedures are priced in the following 

three ways: 

• The professional component (PC) 

represents the physician work, that is, 

the interpretation. 

45850 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

• The TC represents practice expense, 

that is, clinical staff, supplies, and 

equipment. 

• The global service represents both 

PC and TC. Generally, diagnostic 

imaging procedures even those 

performed on contiguous body parts are 

paid at 100 percent for each procedure. 

For example, the TC payment is 

approximately $978 for a magnetic 

resonance imaging (MRI) of the 

abdomen (without and with dye), and 

$529 for an MRI of the pelvis (with dye) 

(CPT codes 74183 and 72196, 

respectively), even when both 

procedures are performed in a single 

session. 

Under the resource-based PE 

methodology, specific PE inputs of 

clinical labor, supplies and equipment 

are used to calculate PE RVUs for each 

individual service. We do not believe 

these same inputs are needed to perform 

subsequent procedures. When multiple 

images are acquired in a single session, 

most of the clinical labor activities and 

most supplies are not performed or 

furnished twice. Specifically, we 

consider that the following clinical 

labor activities are not duplicated for 

subsequent procedures: 

• Greeting the patient. 

• Positioning and escorting the 

patient. 

• Providing education and obtaining 

consent. 

• Retrieving prior exams. 

• Setting up the IV. 

• Preparing and cleaning the room. 

In addition, we consider that 

supplies, with the exception of film, are 

not duplicated for subsequent 

procedures. Equipment time and 

indirect costs are allocated based on 

clinical labor time; therefore, these 

inputs should be reduced accordingly. 

Excluding the above practice expense 

inputs, along with the corresponding 

portion of equipment time and indirect 

costs, supports a 50 percent reduction in 

the payment for the TC of subsequent 

procedures. Applying this reduction to 

the two procedures indicated above 

would result in a full payment of $978 

for the highest priced procedure, and a 

reduced payment of $264.50 (50 percent 

× $529) for the second procedure. This 

same calculation is currently used for 

the multiple procedure payment 

reduction for surgery. We are not 

proposing to apply a multiple procedure 

reduction to PC services at this time 

because we believe physician work is 

not significantly affected for multiple 

procedures. 

The global service payment equals the 

combined PC and TC components. 

When the global service code is billed 

for these procedures, the TC would be 

reduced the same as above, but the PC 

would be paid in full at $117 and $90 

for codes 74183 and 72196, respectively. 

In our view, duplicate payment is 

currently being made for the TC of 

multiple diagnostic imaging services, 

particularly when contiguous body parts 

are viewed in a single session. The 

Medicare Payment Advisory 

Commission (MedPAC) supports this 

reduction in its March 2005 Report to 

the Congress on Medicare Payment 

Policy. 

We have identified 11 families of 

imaging procedures by imaging 

modality (ultrasound, CT and computed 

tomographic angiography (CTA), MRI 

and magnetic resonance angiography 

(MRA) and contiguous body area (for 

example, CT and CTA of Chest/Thorax/

Abdomen/Pelvis). MedPAC pointed out 

that Medicare’s payment rates are based 

on each service being provided 

independently and that the rates do not 

account for efficiencies that may be 

gained when multiple studies using the 

same imaging modality are performed in 

the same session. Those efficiencies are 

more likely when contiguous body areas 

are the focus of the imaging because the 

patient and equipment have already 

been prepared for the second and 

subsequent procedures, potentially 

yielding resource savings in areas such 

as clerical time, technical preparation, 

and supplies. Using billing data, we 

identified a number of contiguous body 

areas for which imaging is performed 

during the same session. Next, because 

our proposed discounting policies are 

based on the expectation that facilities 

will achieve savings by not having to 

expend more than once, many of the 

resources associated with performance 

of a second, and any subsequent 

procedures, we organized the families 

by imaging modality. 

We propose extending the multiple 

procedure payment reduction to TC 

only services and the TC portion of 

global services for the procedures in 

Table 29, below. At this time, we 

propose applying the reduction only to 

procedures involving contiguous body 

parts within a family of codes, not 

across families. For example, the 

reduction would not apply to an MRI of 

the brain (CPT 70552) in code family 5, 

when performed in the same session as 

an MRI of the neck and spine (CPT 

72142) in code family 6. When multiple 

procedures within the same family are 

performed in the same session, we 

propose making full payment for the TC 

of the highest priced procedure and 

payment at 50 percent of the TC for each 

additional procedure. The following is 

an example of the current and proposed 

payments:

74183 72196 Total current 

payment 

Total proposed 

payment Payment calculation 

PC ..................................................................... $117.00 $90.00 $207.00 $207.00 no reduction. 

TC ..................................................................... $978.00 $530.00 $1,507.00 $1,243 $978 + (.5 × $530) 

Global ................................................................ $1,095.00 $620.00 $1,714.00 $1,450 $207 + $978 + (.5 × $530) 

TABLE 29.—DIAGNOSTIC IMAGING

SERVICES

Family 1 Ultrasound (Chest/Abdomen/

Pelvis—Non-Obstetrical

76604 ............. Ultrasound exam, chest, bscan 

76645 ............. Ultrasound exam, breast(s) 

76700 ............. Ultrasound exam, abdom, 

complete 

76705 ............. Echo exam of abdomen 

76770 ............. Ultrasound exam abdo back 

wall, comp 

TABLE 29.—DIAGNOSTIC IMAGING

SERVICES—Continued

76775 ............. Ultrasound exam abdo back 

wall, lim 

76778 ............. Ultrasound exam kidney 

transplant 

76830 ............. Transvaginal Ultrasound, 

non-ob 

76831 ............. Echo exam, uterus 

76856 ............. Ultrasound exam, pelvic, 

complete 

76857 ............. Ultrasound exam, pelvic, limited 

TABLE 29.—DIAGNOSTIC IMAGING

SERVICES—Continued

Family 2 CT and CTA (Chest/Thorax/Abd/

Pelvis)

71250 ............. CT thorax w/o dye 

71260 ............. CT thorax w/ dye 

71270 ............. CT thorax w/o & w/ dye 

71275 ............. CTA, chest 

72191 ............. CTA, pelv w/o & w/ dye 

72192 ............. CT pelvis w/o dye 

72193 ............. CT pelvis w/ dye 

72194 ............. CT pelvis w/o & w/ dye 

74150 ............. CT abdomen w/o dye 

74160 ............. CT abdomen w/ dye 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45851

TABLE 29.—DIAGNOSTIC IMAGING

SERVICES—Continued

74170 ............. CT abdomen w/o & w/ dye 

74175 ............. CTA, abdom w/o & w/ dye 

75635 ............. CTA abdominal arteries 

0067T ............. CT colonography; dx 

Family 3 CT and CTA (Head/Brain/Orbit/

Maxillofacial/Neck)

70450 ............. CT head/brain w/o dye 

70460 ............. CT head/brain w/ dye 

70470 ............. CT head/brain w/o & w/ dye 

70480 ............. CT orbit/ear/fossa w/o dye 

70481 ............. CT orbit/ear/fossa w/ dye 

70482 ............. CT orbit/ear/fossa w/o & w/ 

dye 

70486 ............. CT maxillofacial w/o dye 

70487 ............. CT maxillofacial w/ dye 

70488 ............. CT maxillofacial w/o & w/ 

dye 

70490 ............. CT soft tissue neck w/o dye 

70491 ............. CT soft tissue neck w/ dye 

70492 ............. CT soft tissue neck w/o & w/ 

dye 

70496 ............. CTA, head 

70498 ............. CTA, neck 

Family 4 MRI and MRA (Chest/Abd/Pelvis)

71550 ............. MRI chest w/o dye 

71551 ............. MRI chest w/ dye 

71552 ............. MRI chest w/o & w/ dye 

71555 ............. MRI angio chest w/ or w/o 

dye 

72195 ............. MRI pelvis w/o dye 

72196 ............. MRI pelvis w/ dye 

72197 ............. MRI pelvis w/o &w/ dye 

72198 ............. MRI angio pelvis w/ or w/o 

dye 

74181 ............. MRI abdomen w/o dye 

74182 ............. MRI abdomen w/ dye 

74183 ............. MRI abdomen w/o and w/ 

dye 

74185 ............. MRI angio, abdom w/ or w/o 

dye 

Family 5 MRI and MRA (Head/Brain/Neck)

70540 ............. MRI orbit/face/neck w/o dye 

70542 ............. MRI orbit/face/neck w/ dye 

70543 ............. MRI orbit/face/neck w/o & w/

dye 

70544 ............. MRA head w/o dye 

70545 ............. MRA head w/dye 

70546 ............. MRA head w/o & w/dye 

70547 ............. MRA neck w/o dye 

70548 ............. MRA neck w/dye 

70549 ............. MRA neck w/o & w/dye 

70551 ............. MRI brain w/o dye 

70552 ............. MRI brain w/dye 

70553 ............. MRI brain w/o & w/dye 

Family 6 MRI and MRA (spine)

72141 ............. MRI neck spine w/o dye 

72142 ............. MRI neck spine w/dye 

72146 ............. MRI chest spine w/o dye 

72147 ............. MRI chest spine w/dye 

72148 ............. MRI lumbar spine w/o dye 

72149 ............. MRI lumbar spine w/dye 

72156 ............. MRI neck spine w/o & w/dye 

72157 ............. MRI chest spine w/o & w/

dye 

TABLE 29.—DIAGNOSTIC IMAGING

SERVICES—Continued

72158 ............. MRI lumbar spine w/o & w/

dye 

Family 7 CT (spine)

72125 ............. CT neck spine w/o dye 

72126 ............. CT neck spine w/dye 

72127 ............. CT neck spine w/o & w/dye 

72128 ............. CT chest spine w/o dye 

72129 ............. CT chest spine w/dye 

72130 ............. CT chest spine w/o & w/dye 

72131 ............. CT lumbar spine w/o dye 

72132 ............. CT lumbar spine w/dye 

72133 ............. CT lumbar spine w/o & w/

dye 

Family 8 MRI and MRA (lower extremities)

73718 ............. MRI lower extremity w/o dye 

73719 ............. MRI lower extremity w/dye 

73720 ............. MRI lower ext w/ & w/o dye 

73721 ............. MRI joint of lwr extre w/o 

dye 

73722 ............. MRI joint of lwr extr w/dye 

73723 ............. MRI joint of lwr extr w/o & w/

dye 

73725 ............. MRA lower ext w or w/o dye 

Family 9 CT and CTA (lower extremities)

73700 ............. CT lower extremity w/o dye 

73701 ............. CT lower extremity w/dye 

73702 ............. CT lower extremity w/o & w/

dye 

73706 ............. CTA lower ext w/o & w/dye 

Family 10 Mr and MRI (upper extremities 

and joints)

73218 ............. MRI upper extr w/o dye 

73219 ............. MRI upper extr w/dye 

73220 ............. MRI upper extremity w/o & 

w/dye 

73221 ............. MRI joint upper extr w/o dye 

73222 ............. MRI joint upper extr w/dye 

73223 ............. MRI joint upper extr w/o & 

w/dye 

Family 11 CT and CTA (upper extremities)

73200 ............. CT upper extremity w/o dye 

73201 ............. CT upper extremity w/dye 

73202 ............. CT upper extremity w/o & w/

dye 

73206 ............. CTA upper extr w/o & w/dye 

K. Therapy Cap 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘THERAPY CAP’’ at the beginning of 

your comments.] 

Section 1833(g)(1) of the Act applies 

an annual, per beneficiary combined 

cap on outpatient physical therapy (PT) 

and speech-language pathology services, 

and a similar separate cap on outpatient 

occupational therapy services under 

Medicare Part B. This cap was added by 

section 4541 of the BBA 1997, Pub. L. 

105–33. However, the application of the 

caps was suspended from CY 2000 

through CY 2002 under section 

1833(g)(4) of the Act by section 221 of 

the of BBRA 1999, Pub. L. 106–113, and 

extended by section 421 of BIPA 2000, 

Pub. L. 105–551. The caps were 

implemented from September 1, 2003 

through December 7, 2003. Section 624 

of the MMA reinstated the moratorium 

on the application of these caps from 

December 8, 2003 through December 31, 

2005. Thus, the caps will again become 

effective beginning January 1, 2006. 

Section 1883(g)(2) of the Act provides 

that, for 1999 through 2001, the caps 

were both $1500, and for years after 

2001, the caps are equal to the 

preceding year’s cap increased by the 

percentage increase in the MEI (except 

that if an increase for a year is not a 

multiple of $10, it is rounded to the 

nearest multiple of $10). We will 

publish the dollar amount for therapy 

caps in the final rule, when the MEI is 

available. Based on the April 4, 2005 

MEI estimate, the estimated value of 

therapy caps for 2006 would be $1,750. 

L. Chiropractic Services Demonstration 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘CHIROPRACTIC SERVICES’’ at the 

beginning of your comments.] 

Section 1861(r)(5) of the Act limits 

current Medicare coverage for 

chiropractic treatment by means of the 

manual manipulation of the spine for 

the purpose of correcting a subluxation, 

defined generally as a malfunction of 

the spine. Specifically, Medicare covers 

three CPT Codes provided by 

chiropractors: 98940 (manipulative 

treatment, 1–2 regions of the spine), 

98941 (manipulative treatment, 3–4 

regions of the spine), and 98942 

(manipulative treatment, 5 regions of 

the spine). Treatment must be provided 

for an active subluxation only, and not 

for prevention or maintenance. 

Additionally, treatment of the 

subluxation must be related to a 

neuromusculoskeletal condition where 

there is a reasonable expectation of 

recovery or functional improvement. 

Section 651 of the MMA provides for 

a 2-year demonstration to evaluate the 

feasibility and advisability of covering 

chiropractic services under Medicare. 

These services extend beyond the 

current coverage for manipulation to 

care for neuromusculoskeletal 

conditions typical among eligible 

beneficiaries, and will cover diagnostic 

and other services that a chiropractor is 

legally authorized to perform by the 

State or jurisdiction in which the 

treatment is provided. Physician 

approval will not be required for these 

services. The demonstration must be 

budget neutral and will be conducted in 

45852 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

four sites, two rural and two urban. One 

site of each area type must be a health 

professional shortage area (HPSA). 

On January 28, 2005, we published a 

notice in the Federal Register (70 FR 

4130) describing the covered services 

and site selection for this 

demonstration. As recognized in the 

notice, the statute requires the Secretary 

to ensure that aggregate payments made 

under the Medicare program do not 

exceed the amount that would have 

been paid under the Medicare program 

in the absence of this demonstration. 

Ensuring budget neutrality requires 

that the Secretary develop a strategy for 

recouping funds should the 

demonstration result in costs higher 

than would occur in the absence of the 

demonstration. In this case, we stated 

we would make adjustments in the 

national chiropractor fee schedule to 

recover the costs of the demonstration 

in excess of the amount estimated to 

yield budget neutrality. We indicated 

that we will assess budget neutrality by 

determining the change in costs based 

on a pre/post comparison of costs and 

the rate of change for specific diagnoses 

that are treated by chiropractors and 

physicians in the demonstration sites 

and control sites. We will not limit our 

analysis to reviewing only chiropractor 

claims, because the costs of the 

expanded chiropractor services may 

have an impact on other Medicare costs. 

We anticipate that any necessary 

reduction will be made in the 2010 and 

2011 fee schedules because it will take 

approximately 2 years to complete the 

claims analysis. If we determine that the 

adjustment for budget neutrality is 

greater than 2 percent of spending for 

the chiropractor fee schedule codes 

(comprised of the 3 currently covered 

CPT codes 98940, 98941 and 98942), we 

will implement the adjustment over a 2-

year period. However, if the adjustment 

is less than 2 percent of spending under 

the chiropractor fee schedule codes, we 

will implement the adjustment over a 1-

year period. We will include the 

detailed analysis of budget neutrality 

and the proposed offset in the 2009 

Federal Register publication of the PFS. 

PT services that are performed by 

chiropractors under the demonstration 

will be included under the PT cap 

described in section J above. We are 

including these services under the cap 

because chiropractors are subject to the 

same rules as medical doctors for 

therapy services under the 

demonstration. Therefore these services 

should be included under the therapy 

cap. See our Web site http://

www.cms.hhs.gov/researchers/demos/

eccs/ for additional information 

concerning the chiropractic services 

demonstration. 

M. Supplemental Payments to Federally 

Qualified Health Centers (FQHCs) 

Subcontracting With Medicare 

Advantage Plans 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘SUPPLEMENTAL PAYMENTS—

FQHCS’’ at the beginning of your 

comments.]

Title II of the MMA established the 

Medicare Advantage (MA) program. The 

MA program replaces the 

Medicare+Choice (M+C) program 

established under Part C of the Act. 

Although the MA program retains many 

key features of the M+C program, it 

includes several new features, such as 

the availability of a regional MA plan 

option. Regional MA plans must be 

preferred provider organization (PPO) 

plans. 

Section 237 of the MMA amended 

section 1833(a)(3) of the Act to provide 

supplemental payments to FQHCs that 

contract with MA organizations to, in 

general, cover the difference, if any, 

between the payment received by the 

health center for treating enrollees in 

MA plans offered by the MA 

organization and the payment that the 

FQHC is entitled to receive under the 

cost-based all-inclusive payment rate as 

set forth in part 405, subpart X. This 

new supplemental payment for covered 

Medicare FQHC services furnished to 

MA enrollees augments the direct 

payments made by MA Plans to FQHCs 

for covered Medicare FQHC services. 

Medicare’s obligation to provide 

supplemental payments to FQHCs 

applies to centers with direct or indirect 

subcontract arrangements following a 

written agreement with MA 

organizations. 

Centers eligible for supplemental 

payments under section 1833(a)(3) of 

the Act, as revised by Section 237 of the 

MMA, include any facility qualified to 

furnish FQHC services described in 

section 1832(a)(2)(D) of the Act. Only 

the following entities are qualified to 

furnish FQHC services: (1) entities 

receiving a grant under section 330 

(other than subsection (h)) of Public 

Health Services Act or receiving funding 

from this grant under a contract with its 

recipient and meets the requirements to 

receive this grant; (2) entities 

determined by the Secretary to meet the 

requirements for receiving this grant; (3) 

entities treated by the Secretary, for 

purposes of Part B, as a comprehensive 

Federally funded health center as of 

January 1, 1990; or (4) an outpatient 

health program or facility operated by a 

tribe or tribal organization receiving 

funds under title V of Indian Health 

Care Improvement Act. 

In order to implement this new 

payment provision, CMS must 

determine whether the Medicare costbased payments that the FQHC would 

be entitled to exceed the amount of 

payments received by the center from 

the MA organization and, if so, pay the 

difference to the FQHC at least 

quarterly. In determining the 

supplemental payment, the statute also 

excludes in the calculation of the 

supplemental payments any financial 

incentives provided to FQHCs under 

their MA arrangements, such as risk 

pool payments, bonuses, or withholds. 

Managed care organizations 

frequently use financial incentives in 

their contracts with providers to reduce 

unnecessary utilization of services. 

These incentives may be negative, such 

as withholding a portion of the 

capitation payments, if utilization goals 

are not satisfied. Incentives may also be 

positive, such as a bonus payment if 

utilization outcomes are achieved. In 

both cases, these incentives (whether 

positive or negative) are separate from 

the MA organization’s payment for 

services provided under its direct or 

indirect contract with the FQHC and are 

prohibited by statute from being 

included in our calculation of 

supplemental payments due to the 

Medicare FQHC. In other words, in 

determining the difference between 

payments from the MA organization to 

the FQHC and what the FQHC will 

receive on a cost basis, we are precluded 

from using the incentive payments in 

the calculation of the FQHC 

supplemental payment. Only capitated 

per month per beneficiary or fee-forservice payments from the MA plan for 

services furnished to MA enrollees are 

included in the calculations of the rate 

differential. 

Under original Medicare, each center 

is paid an all-inclusive per visit rate 

based on its reasonable costs as reported 

in the FQHC cost report. The payment 

is calculated, in general, by dividing the 

center’s total allowable cost by the total 

number of visits for FQHC services. At 

the beginning of the rate year, the 

Medicare Fiscal Intermediary (FI) 

calculates an interim rate based on 

estimated allowable costs and visits 

from the center if it is new to the FQHC 

program or actual costs and visits from 

the previous cost reporting period for 

existing FQHCs. The center’s interim 

rate is reconciled to actual reasonable 

costs at the end of the cost reporting 

period. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45853

Proposed Payment Methodology 

We are proposing a supplemental 

payment method based on a per visit 

calculation subject to an annual 

reconciliation. The supplemental 

payment for FQHC covered services 

rendered to MA enrollees is equal to the 

difference between 100 percent of the 

FQHC’s all-inclusive cost-based per visit 

rate and the average per visit rate 

received by the center from the MA plan 

in which the enrollee is enrolled, less 

any amount the FQHC may charge as 

described in section 1857(e)(3)(B) of the 

Act. Each center will be required to 

submit (for the first rate year) to the 

intermediary an estimate of the average 

MA payment per visit for covered FQHC 

services. Every eligible center will be 

required to submit a detailed estimate of 

its average per visit payment for 

enrollees in each MA plan offered by 

the MA organization and any other 

information as may be required to 

enable the intermediary to accurately 

establish an interim supplemental 

payment, which will be the difference 

between the estimated MA per visit 

payment rate and the center’s interim 

all-inclusive cost-based per visit rate. 

Expected payments from the MA plan 

will only be used until actual MA 

revenue and visits can be collected on 

the center’s FQHC cost report. The 

interim and final supplemental payment 

amount will vary by center depending 

on its current Medicare reimbursement 

rates and its contractual arrangements 

with MA plans.

Effective January 1, 2006, eligible 

FQHCs will report actual revenue 

received from the MA plan and visits on 

their cost reports. At the end of the cost 

reporting period the FI would use actual 

MA revenue and visit data along with 

the FQHCs’ final all-inclusive payment 

rate, to determine the center’s final 

actual supplemental per visit payment 

for enrollees in the relevant MA plan. 

This will serve as the interim rate for 

the subsequent rate year. Actual 

aggregated supplemental payments will 

then be reconciled with aggregated 

interim supplemental payments, and 

any underpayment or overpayment 

thereon will then be accounted for in 

determining final Medicare FQHC 

program liability at cost settlement. 

Necessary changes will be made to the 

FQHC cost report to effectuate the 

calculation of the supplemental rate. 

A supplemental payment will be 

made every time a face-to-face 

encounter occurs between a MA 

enrollee and any one of the following 

FQHC covered core practitioners: 

physicians, NPs, PAs, clinical nurse 

midwives, clinical psychologists, or 

clinical social workers. The 

supplemental payment is made directly 

to each qualified center through the 

Medicare FI. Each center is responsible 

for submitting Medicare claims with the 

proper codes for these visits. Necessary 

changes will be made to the instructions 

for the FQHC claim form to effectuate 

the billing and payment of 

supplemental payments. 

To conform our regulations to the 

statute, we are proposing to add 

§ 405.2469 to specify the per visit 

payment methodology for making 

supplemental payments to FQHCs 

under contract (directly or indirectly) 

with MA organizations. 

N. National Coverage Decisions 

Timeframes 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘NCD TIMEFRAMES’’ at the beginning 

of your comments.] 

We have established requirements 

concerning the administrative review of 

local coverage determinations (LCDs) 

and National Coverage Determinations 

(NCDs) at 42 CFR part 426, with subpart 

C specifically addressing the general 

provisions for the review of LCDs and 

NCDs. Under our existing regulations in 

part 426, subpart C, the Departmental 

Appeals Board may stay the 

adjudicatory proceedings in certain 

circumstances to allow CMS to consider 

significant new evidence that is 

submitted in the context of a challenge 

to an NCD. Our previous regulations at 

§ 426.340(e), permitted a brief stay of 

the adjudicatory proceedings (not more 

than 90 days), for CMS to complete its 

reconsideration of the NCD. Those time 

frames, although short, were consistent 

with the previous process for making 

NCDs that did not require publication of 

a proposed decision memorandum and 

an opportunity for public comment on 

the proposed decision memorandum. 

Section 731 of the MMA of 2003 

modifies certain timeframes in the NCD 

review process. Specifically, the MMA 

amended section 1862(l) of the Act to 

specify that for NCD requests not 

requiring an external technology 

assessment (TA) or Medicare Coverage 

Advisory Committee (MCAC) review, 

the decision on the request shall be 

made not later than 6 months after the 

date the request is received. For those 

NCD requests requiring either an 

external TA or MCAC review, where a 

clinical trial is not requested, the 

decision on the request must be made 

not later than 9 months after the date 

the request is received. 

Furthermore, section 731 of the MMA 

stipulates that not later than the end of 

the 6 or 9 month period described 

above, a draft of the proposed decision 

must be made available on the CMS 

website (or other appropriate means) for 

public comment. This comment period 

will last 30 days. Comments will be 

reviewed and a final decision will be 

issued not later than 60 days after the 

conclusion of the comment period. A 

summary of the public comments 

received and responses to the comments 

will continue to be included in the final 

NCD. 

In light of the procedural change 

made by section 731 of the MMA that 

requires a public comment period before 

we can issue a final determination for 

NCDs, we are proposing to amend 

§ 426.340 to reflect the new timeframes 

in the MMA. The regulation is amended 

to state that if the CMS informs the 

Board that a revision or reconsideration 

was or will be initiated, then the Board 

will stay the proceedings and set 

appropriate timeframes by which the 

revision or reconsideration will be 

completed, that reflects sufficient time 

for the publication of a proposed 

determination, a thirty day public 

comment period, and time for CMS to 

prepare a final determination that 

responds to public comments as 

specified in section 1862(l) of the Act. 

Subsequently, the reference to the 90 

day reconsideration period in 

§ 426.340(e)(3) will be eliminated for 

NCD appeals to reflect the new 

timeframes in the MMA. The LCD 

timeframes will not be affected by this 

change. 

O. Coverage of Screening for Glaucoma 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘COVERAGE OF SCREENING—

GLAUCOMA’’ at the beginning of your 

comments.] 

On January 1, 2002, we implemented 

regulations at § 410.23(a)(2), Conditions 

for and limitations on coverage of 

screening for glaucoma, requiring that 

the term ‘‘eligible beneficiary’’ be 

defined to include individuals in the 

following high risk categories: (i) 

Individual with diabetes mellitus; (ii) 

Individual with a family history of 

glaucoma; or (iii) African-Americans age 

50 and over. Based on our review of the 

current medical literature, we believe 

that there are other beneficiaries who 

are at risk for glaucoma and should be 

included in the definition of eligible 

beneficiary for purposes of the glaucoma 

screening benefit. 

The Eye Diseases Prevalence Research 

Group recently reviewed the literature 

on the prevalence of glaucoma in adults 

in the United States (Arch Ophthalmol 

2004; 122:532–538) and provided 

separate data for Hispanic persons. They 

45854 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

reported that Hispanic subjects had a 

marked higher prevalence in the oldest 

age group. After controlling for age and 

gender, rates of open angle glaucoma in 

Hispanic persons did not differ 

significantly from that among whites, 

except for those age 65 years and older. 

The prevalence of open angle glaucoma 

in Hispanic persons age 65 years and 

older was significantly higher than 

among whites. Overall, Hispanic 

subjects had a significantly lower 

prevalence of open angle glaucoma than 

African-Americans. One notable 

limitation of this review article is that 

the data on Hispanic persons came from 

a single study of mostly Mexican-born 

Hispanics from Arizona (Quigley HA et 

al. The prevalence of glaucoma in a 

population based study of Hispanic 

subjects: proyecto VER. Ann 

Ophthalmol 2001; 119:1819–1825). We 

believe the evidence is adequate to 

conclude that Hispanic persons age 65 

and older are at high risk and could 

benefit from glaucoma screening. 

Therefore in § 410.23(a)(2), we are 

proposing to revise the definition of an 

eligible beneficiary to include Hispanic 

Americans age 65 and over. If this 

proposal is adopted in the final rule, 

effective January 1, 2006, Hispanic 

Americans age 65 and older would 

qualify for Medicare coverage and 

payment for glaucoma screening 

services, if the applicable condition and 

limitations on coverage of screening for 

glaucoma specified in § 410.23(b) and 

(c) are met. 

In view of the possibility that it may 

be appropriate to include other 

individuals in the statutory definition of 

those at ‘‘high risk’’ for glaucoma, we 

are requesting comments on this issue. 

Specifically, we request that anyone 

providing us with specific 

recommendations on this issue provide 

documentation in support of them from 

the peer-reviewed medical literature.

P. Physician Referrals for Nuclear 

Medicine Services and Supplies to 

Health Care Entities With Which They 

Have Financial Relationships 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘NUCLEAR MEDICINE SERVICES’’ at 

the beginning of your comments.] 

1. Background 

Under section 1877 of the Act, a 

physician may not refer a Medicare 

patient for certain designated health 

services (DHS) to an entity with which 

the physician (or an immediate family 

member of the physician) has a financial 

relationship, unless an exception 

applies. Section 1877 of the Act also 

prohibits the DHS entity from 

submitting claims to Medicare or billing 

the beneficiary or any other entity for 

Medicare DHS that are furnished as a 

result of a prohibited referral. Sections 

1877(h)(6)(D) and (E) of the Act define 

DHS to include ‘‘[r]adiology services, 

including magnetic resonance imaging, 

computerized axial tomography and 

ultrasound services’’ and ‘‘[r]adiation 

therapy services and supplies.’’ This 

proposed rule would include diagnostic 

and therapeutic nuclear medicine 

procedures under the DHS categories for 

radiology and certain other imaging 

services and radiation therapy services 

and supplies, respectively. 

On January 9, 1998, we published a 

proposed rule (63 FR 1659) that, among 

other things, proposed regulatory 

definitions for the various DHS 

categories listed in the statute. In that 

proposed rule, we proposed to include 

nuclear medicine services in the 

definition of radiology services. In the 

January 4, 2001 physician self-referral 

Phase I final rule (66 FR 856), we 

defined ‘‘radiology and certain other 

imaging services’’ and ‘‘radiation 

therapy services and supplies’’ at 

§ 411.351. We did not include nuclear 

medicine services in either definition 

because, at that time, we believed that 

diagnostic nuclear medicine services 

were not commonly considered to be 

radiology services and that therapeutic 

nuclear medicine services were not 

commonly considered to be radiation 

therapy services. We received one 

comment urging us to include nuclear 

medicine services in the definition of 

radiology services. In the Phase II final 

rule, published on March 26, 2004 (69 

FR 16054), we indicated that we were 

concerned with the issues raised by the 

commenter and that we might revisit the 

issue of nuclear medicine in a proposed 

rule. 

2. Proposal To Include Nuclear 

Medicine 

Our knowledge of nuclear medicine, 

which is based in part on our awareness 

of the health care community’s view of 

nuclear medicine, has changed 

significantly since we published the 

Phase I final rule. As a result, we have 

reconsidered the question of whether 

nuclear medicine services should be 

considered a DHS. We are proposing to 

amend § 411.351 to include diagnostic 

nuclear medicine services in the 

definition of ‘‘radiology and certain 

other imaging services’’ and to include 

therapeutic nuclear medicine services in 

the definition of ‘‘radiation therapy 

services and supplies.’’ We believe this 

change is needed in light of the statute’s 

inclusion of radiology and radiation 

therapy as DHS. We also believe this 

change is appropriate, given the current 

manner in which these services are 

covered and paid under the Medicare 

program. As noted in the Phase I final 

rule (66 FR 860) and the Phase II final 

rule (69 FR 16071), we interpret the selfreferral prohibition in a manner that is 

consistent with existing Medicare 

coverage and payment rules. In 

addition, we believe nuclear medicine 

services (both diagnostic and 

therapeutic services and supplies) pose 

the same risk of abuse that the Congress 

intended to eliminate for other types of 

radiology, imaging, and radiation 

therapy services and supplies. In 

§ 411.351 (Definitions), we would revise 

the definition of ‘‘Radiation therapy 

services and supplies’’ to remove the 

language that excluded therapeutic 

nuclear medicine services and supplies 

from the definition. We would also 

revise the definition of ‘‘Radiology and 

certain other imaging services’’ to 

remove the language that excluded 

diagnostic nuclear medicine services 

from the definition. In addition, we 

would revise the list of radiology 

services on our website and in annual 

updates to include CPT and HCPCS 

codes that include the diagnostic uses of 

nuclear medicine, and the list of 

radiation therapy services and supplies 

to include the therapeutic use of nuclear 

medicine. For purposes of this proposed 

rule, we have attached Addendum G, 

which contains the codes for all 

diagnostic nuclear medicine procedures, 

all therapeutic nuclear medicine 

procedures, and the nuclear medicine 

radiopharmaceuticals. In the final rule, 

we intend to include the diagnostic 

nuclear medicine services in the list of 

codes for ‘‘Radiology and Certain Other 

Imaging Services’’ and the therapeutic 

nuclear medicine services in the list of 

‘‘Radiation Therapy Services and 

Supplies.’’ Each radiopharmaceutical 

would be included in each category in 

which it is used, that is, some may be 

included in both categories. We 

welcome comment on whether the list 

is accurate and complete. 

Section 1877(h)(6)(D) of the Act 

provides that ‘‘radiology services, 

including magnetic resonance imaging, 

computerized axial tomography scans, 

and ultrasound services’’ are DHS. We 

believe it is appropriate to include 

nuclear diagnostic services as radiology 

services within the meaning of this 

statute.

Dorland’s Illustrated Medical 

Dictionary, 29th Edition, 2000, at 1512, 

defines radiology as ‘‘that branch of the 

health sciences dealing with radioactive 

substances and radiant energy and with 

the diagnosis and treatment of disease 

by means of both ionizing (that is,

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45855

4The Encyclopaedia Britannica online explains 

that radiology is a branch of medicine using 

radiation for the diagnosis and treatment of disease. 

It states that ‘‘Radiology originally involved the use 

of X rays in the diagnosis of disease and the use 

of X rays, gamma rays, and other forms of ionizing 

radiation in the treatment of disease. In more recent 

years radiology has come also to embrace diagnosis 

by a method of organ scanning with the use of 

radioactive isotopes and also with non-ionizing 

radiation, such as ultrasound waves and nuclear 

magnetic resonance. Similarly, the scope of 

radiotherapy has extended to include, in the 

treatment of cancer, such agents as hormones and 

chemotherapeutic drugs.’’ (‘‘radiology.’’

Encyclopaedia Britannica, 2005, Encyclopaedia 

Britannica Online 3 June 2005 http://

search.ed.com/eb/article?tocid=9062423.)

x-rays) and non-ionizing (that is, 

ultrasound) radiations.’’ 4 Nuclear 

medicine uses very small amounts of 

radioactive materials 

(radiopharmaceuticals) to diagnose and 

treat disease. In nuclear imaging, the 

radiopharmaceuticals are detected by 

special types of cameras that work with 

computers to provide very precise 

pictures about the area of the body being 

imaged. In treatment or therapy, the 

radiopharmaceuticals go directly to the 

organ being treated. The amount of 

radiation in a typical nuclear imaging 

procedure is comparable to that 

received during a diagnostic x-ray. The 

Society for Nuclear Medicine (SNM) 

states that the science of nuclear 

medicine, particularly nuclear medicine 

imaging, provides physicians with 

information about both structure and 

function of certain internal body organs. 

SNM further states that ‘‘unlike a 

diagnostic X-ray where radiation is 

passed through the body, nuclear 

medicine tracers are taken internally; 

external detectors measure the radiation 

that they emit.’’ (http://www.snm.org) 

The ACR, in its March 26, 2004 letter to 

us, stated that nuclear medicine is 

considered a part of the specialty of 

radiology. It noted that the American 

Board of Radiology certifies diagnostic 

radiologists through an examination 

process that includes nuclear medicine 

in both the written and oral exams. The 

AMA also recognizes nuclear medicine 

as a subspecialty of radiology. The 

AMA’s ‘‘Current Procedural 

Terminology CPT 2005’’, (2004), 

identifies its ‘‘Radiology Guidelines 

(including Nuclear Medicine and 

Diagnostic Ultrasound)’’ as CPT codes 

in the 70000–79999 series. In its 

radiology section, at 273–302, the AMA 

includes both diagnostic imaging 

procedures (including diagnostic 

nuclear medicine), and therapeutic 

procedures. The radiology subsections 

are as follows: Diagnostic Radiology 

(Diagnostic Imaging) is comprised of 

CPT codes 70010–76499. Diagnostic 

Ultrasound is comprised of CPT codes 

76506–76999. Radiation Oncology is 

comprised of CPT codes 77261–77799. 

Nuclear Medicine (Diagnostic) is 

comprised of CPT codes 78000–78999, 

and Nuclear Medicine (Therapeutic) is 

comprised of CPT codes 79005–79999.

We also note that the Medicare statute 

places diagnostic nuclear medicine in 

the same category as diagnostic 

radiology for coverage and payment 

purposes. That is, we cover diagnostic 

nuclear medicine under our authority in 

section 1861(s)(3) of the Act, the same 

statutory section that authorizes 

coverage for diagnostic X-rays, CT 

scans, MRIs, and ultrasound services. In 

addition, section 1833(t) of the Act sets 

forth Medicare payment for ‘‘outpatient 

hospital radiology services (including 

diagnostic and therapeutic radiology, 

nuclear medicine and CAT scan 

procedures, magnetic resonance 

imaging, and ultrasound and other 

imaging services, but excluding 

screening mammography)’’ as described 

in section 1833(a)(2)(E)(i) of the Act. 

For these reasons, we believe that the 

Congress intended ‘‘radiology services’’

in section 1877(h)(6) of the Act to 

include diagnostic and therapeutic 

nuclear medicine. While we believe that 

diagnostic nuclear medicine is a subset 

of radiology, even if it is not, it is an 

imaging service covered by 1861(s)(3) of 

the Act, and of the type that the 

Congress intended to prohibit. 

Similarly, we believe it is proper to 

interpret the DHS category described in 

section 1877(h)(6)(E) of the Act, 

‘‘radiation therapy services and 

supplies’’ to include therapeutic nuclear 

medicine services. Radiation therapy is 

the treatment of disease (especially 

cancer) by exposure to radiation from a 

radioactive substance. Therapeutic 

nuclear medicine employs radioactive 

substances known as radionuclides. 

Medicare covers therapeutic nuclear 

medicine services and other forms of 

radiation therapy under section 

1861(s)(4) of the Act, which authorizes 

coverage and payment for ‘‘X-ray, 

radium, and radioactive isotope 

therapy.’’

Although our proposal to include as 

DHS diagnostic nuclear medicine 

services and therapeutic nuclear 

medicine services and supplies is based 

primarily on our view that nuclear 

medicine services are radiology and 

radiation therapy within the meaning of 

section 1877(h)(6) of the Act, we would 

resolve any doubt on the matter in favor 

of our proposal because of the risk of 

abuse and anti-competitive behavior 

inherent in physician self-referrals for 

nuclear medicine services. The risk of 

abuse and anti-competitiveness is 

exacerbated by the greater affordability 

of nuclear medicine equipment, by our 

expansive coverage of nuclear medicine 

services, and by the setting in which 

mostly diagnostic and some therapeutic 

nuclear medicine services now are 

primarily performed. 

At the time we were preparing the 

Phase I final rule, the vast majority of 

nuclear medicine procedures were 

already subject to the physician selfreferral prohibition because they were 

primarily performed in hospital 

facilities rather than in physicianowned freestanding facilities. Thus, 

they were performed as inpatient or 

outpatient hospital services and were 

therefore DHS subject to the self-referral 

prohibition in accordance with section 

1877(h)(6)(K) of the Act. Since 

publication of the Phase I final rule, 

however, many more nuclear medicine 

procedures have been performed in 

physician offices or in physician-owned 

freestanding facilities. This has occurred 

for several reasons. First, positron 

emission tomography (PET) scanners 

may be used outside of a hospital 

setting. Second, there have been 

significant technological advances; an 

entity does not have to own a particle 

accelerator to produce the radioactive 

tracer necessary for a PET scan because 

a small network of pharmacies now 

distribute radioactive tracer. Third, our 

coverage of PET scans has increased 

dramatically. We began covering PET 

scans in December 2000. This initial, 

limited, coverage was for only a few 

types of cancers. Since December 2001, 

we have significantly expanded our 

coverage to include an increased 

number of cancers and other conditions. 

In his March 17, 2005 testimony before 

the Congress concerning imaging 

services, the Executive Director of the 

MedPAC noted that diagnostic imaging 

services paid under Medicare’s PFS 

grew more rapidly than any other type 

of physician service between 1999 and 

2003. Whereas physician services grew 

22 percent in those years, imaging 

services grew twice as fast, by 45 

percent. This measure is the growth in 

the volume and intensity of services per 

beneficiary. However, not all imaging 

services grew at that rate, and some 

grew even faster. Nuclear medicine grew 

85 percent between those years (1999 

and 2003).

Under Medicare, almost all imaging 

services have two distinct parts: (1) The 

performance of the test; and (2) the 

interpretation of the results by a 

physician. If the study is performed in 

a physician office, the physician 

submits a TC claim and the interpreting 

physician submits a PC claim. Tests 

performed in a hospital result in a 

facility payment rather than a TC claim. 

45856 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

Thus, if more imaging services are 

performed in physician offices, TC 

claims will increase as a share of all fee 

schedule imagining claims. An increase 

in TC claims occurred between 1999 

and 2002, which indicates that imaging 

procedures shifted to physician offices. 

Because the TC of an imaging service 

generally is assigned a higher payment 

rate than the PC, growth of TC claims as 

a share of all imaging claims leads to 

additional payments under the PFS. 

These additional payments accounted 

for about 20 percent of the growth in the 

volume and intensity of imaging 

services between 1999 and 2002 

(MedPAC 2004). 

Recent studies and articles indicate 

that risk of abuse for radiology services 

(and diagnostic nuclear medicine) will 

continue if not specifically prohibited. 

The Journal of Radiology reported what 

happened after a managed care 

organization halted reimbursement to 

non-radiologists for some forms of 

imaging (other than CT scans, MRIs, 

sonography or nuclear medicine) but 

left the physicians free to refer their 

patients to radiologists if they believe 

the imaging they had been conducting 

on their patients was needed. The 

following specialties were not allowed 

to perform any imaging services: 

Gastroenterologists, general surgeons, 

nephrologists, neurosurgeons, 

oncologists, pediatric surgeons, and 

physiatrists. The study found that 

imaging declined 20 to 25 percent from 

what was expected given the previous 

trend of imaging growth, and an 

absolute decline of 6 percent. Prior to 

these prohibitions, non-radiologists 

were performing 39 percent of 

outpatient radiographs. The 20 to 25 

percent decline from the trend was 

roughly half of this 39 percent initial 

share. That is, the research showed that 

approximately half of the imaging 

performed by self-referrers ceased when 

these self-referrers lost their financial 

interest in the services. (The Effect of 

Imaging Guidelines on the Number and 

Quality of Outpatient Radiographic 

Examinations. AJR 2000; 175:9–15. 

Harold Moskowitz, Jonathan Sunshine, 

Donald Grossman, Leslie Adams, Lynn 

Gelinas. See also Recent Rapid Increase 

in Utilization of Radionuclide 

Myocardial Perfusion Imaging and 

Related Procedures; 1996–1998 Practice 

Patterns. Radiology 2002; 222:144–148. 

David C. Levin, MD, Laurence Parker, 

PhD, Charles M. Intenzo, MD, Jonathan 

H. Sunshine, PhD.) (Growth in 

utilization of Radionuclide Myocardial 

Perfusion Imaging (MPI) between 1996 

and 1998 was almost 10 times higher 

among cardiologists than radiologists). 

Although the Moskowitz study did not 

include nuclear imaging, we do not see 

a basis for assuming that physician 

behavior would be different for nuclear 

imaging than it is for other imaging 

services. To the contrary, we believe 

financial relationships related to 

diagnostic and therapeutic nuclear 

medicine, including joint ventures and 

leases, pose a risk of anti-competitive 

behavior and risk of abuse comparable 

to that associated with investment 

interests in CT, MRI, ultrasound, other 

radiology ventures, and radiation 

therapy facilities. 

Thus, we believe our proposal to 

include nuclear medicine as a DHS is 

consistent with the intent of the 

Congress to prevent over-utilization of 

health care services covered by 

Medicare and to prohibit physicians 

from selecting treatment modalities 

based on financial incentives. 

We have been told that consultants 

and others have been actively 

encouraging physicians to participate in 

joint ventures to purchase diagnostic 

nuclear medicine machines for 

investment because Phase I did not 

include nuclear medicine services. We 

have received many inquiries from 

physicians and attorneys asking 

whether physician ownership of, and 

referral to, nuclear medicine facilities 

complies with the physician self-referral 

provisions. We are mindful that our 

previous guidance, particularly that 

provided in the Phase I final rule, may 

have encouraged physician investment 

in nuclear medicine equipment and 

ventures, particularly PET scanners, 

which are very expensive and often 

require a substantial financial 

investment on the part of physicianowners. We are aware that including 

nuclear medicine services as DHS will 

require that physician-investors in 

nuclear medicine equipment (including 

PET scanners) divest their ownership or 

investment interests or be precluded 

from submitting claims to Medicare or 

billing the beneficiary or any entity for 

the nuclear medicine DHS referred by 

physician-owners and performed with 

the physician-owned equipment (unless 

the arrangement falls within an 

exception to section 1877 of the Act). 

We are soliciting comments as to 

whether, or how, to minimize the 

impact on physicians who are currently 

parties to arrangements that involve 

nuclear medicine services and supplies 

(that is, by specifying a delayed effective 

date or by grandfathering certain 

arrangements). 

Q. Sustainable Growth Rate 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘SGR’’ at the beginning of your 

comments.] 

1. Current Estimate 

Sections 1848(d) and (f) of the Act 

require the Secretary to set the 

physician fee schedule update under the 

SGR system. We are currently 

forecasting an update of ¥4.3 percent 

for 2006, and anticipate further negative 

updates in later years. As in the past, we 

will include a complete discussion of 

our methodology for calculating the 

SGR in the final rule. 

Underlying the projected rate 

reductions is substantial growth in 

Medicare spending. The vast majority of 

spending growth in 2004 is attributable 

to the following five areas: 

• An increase in spending for office 

visits, with a shift toward longer and 

more intense visits. 

• Greater utilization of minor 

procedures, including physical therapy 

and drug administration. 

• More patients receiving more 

frequent and more complex imaging 

services, such as MRIs and 

echocardiograms. 

• More laboratory and other 

physician-ordered tests. 

• Higher utilization of physicianadministered prescription drugs. 

We would like to understand these 

trends further, including which changes 

in utilization are likely to be associated 

with important health improvements 

and which ones may have more 

questionable health benefits. 

Consequently, we have had discussions 

on these topics with numerous 

physician and nonphysician groups, as 

well as other Medicare stakeholders 

such as the Congress and the Medicare 

Payment Advisory Commission 

(MedPAC).

The AMA has provided us with 

several illustrations of recent trends in 

medical practice that it believes 

contribute to the overall growth in 

spending on physicians’ services. For 

example, the AMA points out that some 

payers are encouraging physicians to 

determine the left ventricular valve 

function of their patients with 

congestive heart failure using an 

echocardiogram. Also, five years ago, 

statin therapy to lower cholesterol levels 

was only recommended for patients as 

old as 79. Now, patients as old as 86 

may receive statin therapy, resulting in 

additional laboratory tests. 

The AMA provided many other 

examples, and we are evaluating them 

to better understand their impact on 

physician spending. With regard to the 

specific examples mentioned above, we 

agree the utilization of these services 

has increased. However, in the case of 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45857

echocardiograms, the 19 percent rate of 

increase from 2003 to 2004 is similar to 

the increase observed for all imaging 

services. There was also a 17 percent 

rate of increase in laboratory tests (lipid 

panels) consistent with more patients 

receiving statin therapy (new 

prescriptions require more frequent 

visits and more lab tests). However, total 

spending for the service was only $42 

million. 

2. Ongoing Issues 

In addition to providing adequate 

payments, Medicare’s physician 

payment system should encourage 

physicians to provide quality care and 

prevent avoidable health care costs. We 

support MedPAC’s recommendation for 

the development of measures related to 

the quality and efficiency of care 

furnished by physicians. Physicians’

decisions are central to the health care 

their patients receive, and there are 

substantial variations across geographic 

areas and among similar specialties in 

the use of services, including those 

accounting for most of the spending 

growth. We want to work with 

physicians in this effort to better 

understand the consequences of these 

differences in the use of follow-up 

visits, imaging procedures, laboratory 

testing, minor therapeutic procedures, 

and physician-administered drugs for 

the health of beneficiaries, and to 

identify ways to provide better support 

for utilization decisions that clearly 

increase the quality of care while 

avoiding unnecessary costs for 

beneficiaries and the Medicare program. 

We are already engaged with the 

physician community in developing 

useful quality measures, and we expect 

to intensify these efforts given the rapid 

growth in spending. As an early step in 

using such measures to improve care, 

we are now exploring means of sharing 

information related to quality of care 

and use of resources with individual 

physicians. We anticipate that only data 

showing the quality of care and resource 

use in the aggregate would be released 

to the public. Some measures can be 

derived from claims data with little or 

no collection burden (for example, 

information on the frequency and 

complexity of minor therapy 

procedures, imaging procedures, lab 

test, and visits for their patients with 

chronic illnesses.) We believe that by 

providing feedback to physicians 

individually and by working with 

physician groups to understand and 

respond to the overall trends, we can 

provide more useful information and 

support physicians’ efforts to run more 

efficient practices. 

Finally, we continue to work closely 

with the medical community, Congress, 

MedPAC, and others toward a long-term 

approach ensuring adequate physician 

payments in the future while also 

ensuring Medicare’s payments are made 

only for care that is necessary and 

beneficial. We are particularly 

interested in comments that build on 

recent progress on payment reforms to 

promote higher quality and avoid 

unnecessary costs, and that are 

consistent with the President’s 

budgetary goal of paying for better value 

in Medicare without increasing overall 

Medicare costs. For example, we are 

interested in ways to promote higherquality ambulatory care that can achieve 

offsetting savings by avoiding 

complications or unnecessary services. 

In addition, it has been suggested that 

we have the authority to make certain 

administrative adjustments in the SGR 

methodology, such as removing Part B 

drug payments from the calculation of 

both projected and actual expenditures 

(retroactive to 1996) that are used to set 

the spending target. We encourage 

comments regarding possible changes to 

the SGR methodology, including the 

legal theories that support them. We are 

particularly interested in comments on 

steps to promote physician payment 

adequacy without increasing overall 

Medicare costs. 

III. Collection of Information 

Requirements 

Under the Paperwork Reduction Act 

of 1995, we are required to provide 60-

day notice in the Federal Register and 

solicit public comment before a 

collection of information requirement is 

submitted to the Office of Management 

and Budget (OMB) for review and 

approval. In order to fairly evaluate 

whether an information collection 

should be approved by OMB, section 

3506(c)(2)(A) of the Paperwork 

Reduction Act of 1995 requires that we 

solicit comment on the following issues: 

• The need for the information 

collection and its usefulness in carrying 

out the proper functions of our agency. 

• The accuracy of our estimate of the 

information collection burden. 

• The quality, utility, and clarity of 

the information to be collected.

• Recommendations to minimize the 

information collection burden on the 

affected public, including automated 

collection techniques. 

We are soliciting public comment on 

each of these issues for the following 

sections of this document that contain 

information collection requirements: 

Section 413.180 Procedures for 

Requesting Exceptions to Payment Rates 

Paragraph (b) specifies the criteria for 

a pediatric ESRD facility requesting an 

exception to payment rates. 

Paragraph (e) outlines the 

documentation that a pediatric ESRD 

facility must submit to CMS when 

requesting an exception to its payment 

rates. Paragraph (i) discusses the period 

of approval for payment exception 

requests. A prospective exception 

payment rate approved by CMS applies 

for the period from the date the 

complete exception request was filed 

with its intermediary until thirty days 

after the intermediary’s receipt of the 

facility’s letter notifying the 

intermediary of the facility’s request to 

give up its exception rate. 

The burden associated with the 

requirements in paragraph (e) is the 

time and effort required by the facility 

to prepare and submit the exception 

request to CMS. The burden associated 

with the requirement in paragraph (i) is 

the time and effort required by the 

facility to draft and mail the letter that 

notifies the intermediary of the facilities 

request to give up its exception rate. 

The collection requirement in this 

section has not changed. While this 

requirement is subject to the PRA, this 

requirement is currently approved in 

OMB No. 0938–0296. 

Section 413.184 Payment Exception: 

Pediatric Patient Mix 

Paragraph (b) specifies the 

documentation requirements that a 

pediatric ESRD facility must meet in 

order to qualify for an exception to its 

prospective payment rate based on its 

pediatric patient mix. In addition to the 

other qualifications specified in this 

section, this section states that a facility 

must submit a listing of all outpatient 

dialysis patients (including all home 

patients) treated during the most 

recently completed and filed cost report. 

The burden associated with this 

requirement is the time and effort for 

the facility to submit a listing of all 

outpatient dialysis patients (including 

all home patients) treated during the 

most recently completed and filed cost 

report. 

The collection requirement in this 

section has not changed. While this 

requirement is subject to the PRA, this 

requirement is currently approved in 

OMB No. 0938–0296. 

Section 413.186 Payment Exception: 

Self-Dialysis Training Costs in Pediatric 

Facilities 

In summary, this section outlines the 

requirements a pediatric ESRD facility 

45858 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

must meet to qualify for an exception to 

the prospective payment rate based on 

self-dialysis training costs. Paragraph (e) 

states that a facility must provide 

specific information to support its 

exception request. Paragraph (f) states 

that in addition to the other 

qualifications outlined in this section, 

pediatric ESRD facility must submit 

with its exception request a list of 

patients, by modality, trained during the 

most recent cost report period, in order 

to justify its accelerated training 

exception request. 

The burden associated with these 

requirements is the time and effort for 

the facility to prepare and submit the 

required information to support its 

exception request, and the time and 

effort for the pediatric ESRD facility to 

prepare and submit with its exception 

request a list of patients, by modality, 

trained during the most recent cost 

report period. 

The collection requirements in this 

section have not changed. While these 

requirements are subject to the PRA, 

they are currently approved in OMB No. 

0938–0296.

Section 414.804 Basis of Payment 

In summary, this section requires 

manufacturers to report ASP data to 

CMS. This section details the process a 

manufacturer must follow to calculate 

the ASP. The ASP reporting 

requirements are discussed in further 

detail in the interim final rule with 

comment, Medicare Program; 

Manufacturer Submission of 

Manufacturer’s Average Sales Price 

(ASP) Data for Medicare Part B Drugs 

and Biologicals, that published on April 

2, 2004 in the Federal Register

(69FR17935–17941). 

The burden associated with these 

requirements is the time and effort 

required by manufacturers of Medicare 

Part B Drugs and biologicals to prepare 

and submit to the required ASP data to 

CMS. 

While these requirements are subject 

to the PRA, the requirements are 

currently approved in OMB No. 0938–

0921, with a current expiration date of 

September 30, 2007. 

We intend to revise this information 

collection to include adequate 

instructions for manufacturers to report 

the ASP, the WAC, and other data 

elements. These revisions will be 

addressed in detail in a revised 

information collection request in 

accordance with the Paperwork 

Reduction Act of 1995. 

We have submitted a copy of this 

proposed rule to OMB for its review of 

the information collection requirements 

described above. These requirements are 

not effective until they have been 

approved by OMB. 

If you comment on these information 

collection and recordkeeping 

requirements, please mail copies 

directly to the following: 

Centers for Medicare & Medicaid 

Services, Office of Strategic Operations 

and Regulatory Affairs, Regulations 

Development Group, Attn: Jim 

Wickliffe, [CMS–1502–P], Room C4–26–

05, 7500 Security Boulevard, Baltimore, 

MD 21244–1850; and 

Office of Information and Regulatory 

Affairs, Office of Management and 

Budget, Room 10235, New Executive 

Office Building, Washington, DC 20503, 

Attn: Christopher Martin, CMS Desk 

Officer, CMS–1502–P, 

Christopher_Martin@omb.eop.gov. Fax 

(202) 395–6974. 

IV. Response to Comments 

Because of the large number of public 

comments we normally receive on 

Federal Register documents, we are not 

able to acknowledge or respond to them 

individually. We will consider all 

comments we receive by the date and 

time specified in the DATES section of 

this preamble, and, when we proceed 

with a subsequent document, we will 

respond to the comments in the 

preamble to that document. 

V. Regulatory Impact Analysis 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘IMPACT’’ at the beginning of your 

comments.] 

We have examined the impact of this 

rule as required by Executive Order 

12866 (September 1993, Regulatory 

Planning and Review), the Regulatory 

Flexibility Act (RFA) (September 16, 

1980 Pub. L. 96–354), section 1102(b) of 

the Social Security Act, the Unfunded 

Mandates Reform Act of 1995 (Pub. L. 

104–4), and Executive Order 13132. 

Executive Order 12866 (as amended 

by Executive Order 13258, which 

merely reassigns responsibilities of 

duties) directs agencies to assess all 

costs and benefits of available regulatory 

alternatives and, when regulation is 

necessary, to select regulatory 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety 

effects, distributive impacts, and 

equity). A regulatory impact analysis 

must be prepared for proposed rules 

with economically significant effects 

(that is, a proposed rule that would have 

an annual effect on the economy of $100 

million or more in any one year, or 

would adversely affect in a material way 

the economy, a sector of the economy, 

productivity, competition, jobs, the 

environment, public health or safety, or 

State, local, or tribal governments or 

communities). As indicated in more 

detail below, we estimate that the PFS 

provisions included in this proposed 

rule will redistribute more than $100 

million in one year. We are considering 

this proposed rule to be economically 

significant because its provisions are 

estimated to result in an increase, 

decrease or aggregate redistribution of 

Medicare spending that will exceed 

$100 million. Therefore, this proposed 

rule is a major rule and we have 

prepared a regulatory impact analysis. 

The RFA requires that we analyze 

regulatory options for small businesses 

and other entities. We prepare a 

regulatory flexibility analysis unless we 

certify that a rule would not have a 

significant economic impact on a 

substantial number of small entities. 

The analysis must include a justification 

concerning the reason action is being 

taken, the kinds and number of small 

entities the rule affects, and an 

explanation of any meaningful options 

that achieve the objectives with less 

significant adverse economic impact on 

the small entities. 

Section 1102(b) of the Act requires us 

to prepare a regulatory impact analysis 

for any proposed rule that may have a 

significant impact on the operations of 

a substantial number of small rural 

hospitals. This analysis must conform to 

the provisions of section 603 of the 

RFA. For purposes of section 1102(b) of 

the Act, we define a small rural hospital 

as a hospital that is located outside a 

Metropolitan Statistical Area and has 

fewer than 100 beds. We have 

determined that this proposed rule 

would have minimal impact on small 

hospitals located in rural areas. Of 213 

hospital-based ESRD facilities located in 

rural areas, only 40 are affiliated with 

hospitals with fewer than 100 beds. 

For purposes of the RFA, physicians, 

nonphysician practitioners, and 

suppliers are considered small 

businesses if they generate revenues of 

$6 million or less. Approximately 95 

percent of physicians are considered to 

be small entities. There are about 

875,000 physicians, other practitioners 

and medical suppliers that receive 

Medicare payment under the PFS. 

For purposes of the RFA, 

approximately 90 percent of suppliers of 

durable medical equipment (DME) and 

prosthetic devices are considered small 

businesses according to the Small 

Business Administration’s (SBA) size 

standards. We estimate that 106,000 

entities bill Medicare for durable 

medical equipment, prosthetics, 

orthotics, and supplies (DMEPOS) each 

year. Total annual estimated Medicare 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45859

revenues for DME suppliers exceed 

approximately $8.5 billion in 2004. Of 

this amount, approximately $1.4 billion 

were for nebulizer drugs in 2004. The 

vast majority, 95 percent, of retail 

pharmacy companies are small 

businesses as measured by the SBA size 

standard. Approximately, 16,000 

pharmacies billed Medicare for 

immunosuppressive, oral anti-cancer, or 

oral anti-emetic drugs in 2004. 

Pharmacies received Medicare revenues 

for those drugs of approximately $350 

million in 2004.

In addition, most ESRD facilities are 

considered small entities, either based 

on nonprofit status or by having 

revenues of $29 million or less in any 

year. We consider a substantial number 

of entities to be affected if the proposed 

rule is estimated to impact more than 5 

percent of the total number of small 

entities. Based on our analysis of the 

896 nonprofit ESRD facilities 

considered small entities in accordance 

with the above definitions, we estimate 

that the combined impact of the 

proposed changes to payment for renal 

dialysis services included in this 

proposed rule would have a 1.3 percent 

increase in overall payments relative to 

current overall payments. 

The analysis and discussion provided 

in this section, as well as elsewhere in 

this proposed rule, complies with the 

RFA requirements. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

rule that may result in expenditures in 

any year by State, local, or tribal 

governments, in the aggregate, or by the 

private sector, of $110 million. Medicare 

beneficiaries are considered to be part of 

the private sector for this purpose. 

We have examined this proposed rule 

in accordance with Executive Order 

13132 and have determined that this 

regulation would not have any 

significant impact on the rights, roles, or 

responsibilities of State, local, or tribal 

governments. A discussion concerning 

the impact of this rule on beneficiaries 

is found later in this section. 

We have prepared the following 

analysis, which, together with the 

information provided in the rest of this 

preamble, meets all assessment 

requirements. It explains the rationale 

for and purposes of the rule; details the 

costs and benefits of the rule; analyzes 

alternatives; and presents the measures 

we propose to use to minimize the 

burden on small entities. As indicated 

elsewhere in this proposed rule, we 

propose to change our methodology for 

calculating resource-based practice 

expense RVUs and make a variety of 

other changes to our regulations, 

payments, or payment policies to ensure 

that our payment systems reflect 

changes in medical practice and the 

relative value of services. We provide 

information for each of the policy 

changes in the relevant sections of this 

proposed rule. We are unaware of any 

relevant Federal rules that duplicate, 

overlap or conflict with this proposed 

rule. The relevant sections of this 

proposed rule contain a description of 

significant alternatives if applicable. 

A. Resource-Based PE RVUs 

Table 30 below shows the specialty 

level impact on payment of changes to 

the PE methodology being proposed for 

CY 2006. The columns in the table 

demonstrate the estimated impacts on 

payments (relative to estimated 2006 

payments, absent any adjustment for 

inflation or utilization) during each year 

of the transition. For example, the first 

column displays the impact of blending 

25 percent of the PE RVUs calculated 

using the methodology we are proposing 

with current PE RVUs. The percent of 

the RVUs based on the proposed 

method increase until the transition is 

complete in 2009. 

Our estimates of changes in physician 

Medicare revenues for PFS services 

compare payment rates for CY 2006 

with payment rates for CY 2005 using 

CY 2004 Medicare utilization for both 

years. In general, updating the 

utilization data has little or no impact 

on total payments to a specialty, but the 

practice expense values for a new code 

may change because we did not initially 

have Medicare utilization data to 

determine the specialty mix for the 

service. In these cases, we either 

assigned the code to a particular 

specialty’s practice expense pool based 

on the specialty most likely to provide 

the service, or we used the ‘‘all 

physician’’ practice expense pool to 

determine the code’s practice expense 

RVUs. While we try to minimize 

instability in the practice expense RVUs 

for new services by assigning the 

specialty that is most likely to perform 

the service until such time as we have 

actual utilization data, the addition of 

actual utilization data may still result in 

some change to the practice expense 

RVUs during the first few years a code 

is in existence. 

The estimated payment impacts 

reflect the averages for each specialty 

based on Medicare utilization. To the 

extent that there are year-to-year 

changes in the volume and mix of 

services provided by a specialty, the 

actual impact on total Medicare 

revenues may be different than those 

shown here. Also, the payment impact 

for an individual physician may be 

different from the specialty average 

impact, based on the mix of services the 

physician provides. Because physicians, 

practitioners and suppliers, furnish 

services to both Medicare and nonMedicare patients and they may receive 

substantial Medicare revenues for 

services that are not paid under the PFS, 

the average change in total revenues for 

any specialty, practitioner or supplier, 

would be less than the impacts 

displayed here. For instance, 

independent laboratories receive 

approximately 80 percent of their 

Medicare revenues from clinical 

laboratory services that are not paid 

under the PFS. The table shows only the 

payment impacts on PFS services. 

We modeled the impact of the 

proposed changes to the practice 

expense methodology and illustrated 

the effect in Table 30 below.

TABLE 30.—IMPACT OF PRACTICE EXPENSE CHANGES ON TOTAL MEDICARE ALLOWED CHARGES BY PHYSICIAN, 

PRACTITIONER AND SUPPLIER SUBCATEGORY

Specialty 2006 (25% 

Blend) 

2007 (50% 

Blend) 

2008 (75% 

Blend) 

2009 (100% 

Blend) 

Physicians: 

Allergy/Immunology .................................................................................. 0.6% 1.1% 1.7% 2.3%

Anesthesiology ......................................................................................... ¥0.7% ¥1.5% ¥2.2% ¥2.9%

Cardiac Surgery ........................................................................................ ¥1.0% ¥2.0% ¥2.9% ¥3.9%

Cardiology ................................................................................................. ¥0.5% ¥1.1% ¥1.6% ¥2.1%

Colon and Rectal Surgery ........................................................................ 0.7% 1.5% 2.2% 3.0%

Critical Care .............................................................................................. ¥0.3% ¥0.5% ¥0.8% ¥1.0%

Dermatology ............................................................................................. 4.1% 8.4% 12.8% 17.5%

45860 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

TABLE 30.—IMPACT OF PRACTICE EXPENSE CHANGES ON TOTAL MEDICARE ALLOWED CHARGES BY PHYSICIAN, 

PRACTITIONER AND SUPPLIER SUBCATEGORY—Continued

Specialty 2006 (25% 

Blend) 

2007 (50% 

Blend) 

2008 (75% 

Blend) 

2009 (100% 

Blend) 

Emergency Medicine ................................................................................ ¥0.4% ¥0.8% ¥1.3% ¥1.7%

Endocrinology ........................................................................................... ¥0.5% ¥1.0% ¥1.5% ¥1.9%

Family Practice ......................................................................................... 0.1% 0.1% 0.2% 0.2%

Gastroenterology ...................................................................................... 1.4% 2.8% 4.3% 5.7%

General Practice ....................................................................................... 0.2% 0.3% 0.5% 0.7%

General Surgery ....................................................................................... 0.2% 0.3% 0.5% 0.6%

Geriatrics .................................................................................................. ¥0.2% ¥0.5% ¥0.7% ¥1.0%

Hand Surgery ........................................................................................... ¥0.5% ¥1.0% ¥1.5% ¥1.9%

Hematology/Oncology .............................................................................. 0.4% 0.7% 1.1% 1.4%

Infectious Disease .................................................................................... ¥0.1% ¥0.2% ¥0.2% ¥0.3%

Internal Medicine ...................................................................................... ¥0.1% ¥0.3% ¥0.4% ¥0.6%

Interventional Radiology ........................................................................... 0.2% 0.5% 0.7% 0.9%

Nephrology ............................................................................................... ¥0.2% ¥0.4% ¥0.6% ¥0.8%

Neurology ................................................................................................. ¥0.6% ¥1.1% ¥1.7% ¥2.2%

Neurosurgery ............................................................................................ ¥0.7% ¥1.4% ¥2.0% ¥2.7%

Nuclear Medicine ...................................................................................... ¥0.3% ¥0.5% ¥0.8% ¥1.0%

Obstetrics/Gynecology .............................................................................. 0.0% 0.1% 0.1% 0.2%

Ophthalmology .......................................................................................... ¥1.1% ¥2.2% ¥3.3% ¥4.4%

Orthopedic Surgery .................................................................................. ¥0.4% ¥0.7% ¥1.1% ¥1.5%

Otolaryngology .......................................................................................... ¥0.6% ¥1.1% ¥1.7% ¥2.2%

Pathology .................................................................................................. 1.3% 2.6% 3.9% 5.3%

Pediatrics .................................................................................................. 0.1% 0.2% 0.3% 0.5%

Physical Medicine ..................................................................................... ¥0.5% ¥1.1% ¥1.6% ¥2.1%

Plastic Surgery ......................................................................................... 0.1% 0.1% 0.2% 0.3%

Psychiatry ................................................................................................. 0.0% 0.1% 0.1% 0.1%

Pulmonary Disease .................................................................................. ¥0.2% ¥0.4% ¥0.6% ¥0.7%

Radiation Oncology .................................................................................. 1.9% 3.9% 5.8% 7.9%

Radiology .................................................................................................. 0.4% 0.8% 1.2% 1.7%

Rheumatology ........................................................................................... ¥0.9% ¥1.8% ¥2.7% ¥3.6%

Thoracic Surgery ...................................................................................... ¥0.8% ¥1.5% ¥2.3% ¥3.0%

Urology ..................................................................................................... 1.8% 3.6% 5.5% 7.3%

Vascular Surgery ...................................................................................... 0.5% 0.9% 1.4% 1.9%

Practitioners: 

Audiologist ................................................................................................ ¥5.8% ¥11.3% ¥16.5% ¥21.3%

Chiropractor .............................................................................................. ¥1.3% ¥2.7% ¥4.0% ¥5.3%

Clinical Psychologist ................................................................................. ¥0.6% ¥1.1% ¥1.7% ¥2.2%

Clinical Social Worker ............................................................................... ¥0.6% ¥1.2% ¥1.8% ¥2.4%

Nurse Anesthetist ..................................................................................... ¥0.4% ¥0.8% ¥1.2% ¥1.6%

Nurse Practitioner ..................................................................................... 0.1% 0.1% 0.2% 0.2%

Optometry ................................................................................................. ¥0.8% ¥1.6% ¥2.4% ¥3.1%

Oral/Maxillofacial Surgery ......................................................................... 0.8% 1.6% 2.4% 3.2%

Physical/Occupational Therapy ................................................................ 1.5% 2.9% 4.4% 6.0%

Physician Assistants ................................................................................. 0.0% 0.1% 0.1% 0.2%

Podiatry ..................................................................................................... 1.3% 2.6% 3.9% 5.3%

Suppliers: 

Diagnostic Testing Facility ........................................................................ ¥2.4% ¥4.7% ¥7.0% ¥9.2%

Independent Laboratory ........................................................................... 6.4% 13.1% 20.3% 28.0%

Portable X-Ray Supplier ........................................................................... 0.4% 0.8% 1.1% 1.5%

The table shows the effect of the 

proposed refinements to the PE 

methodology. As described in section 

II.A.2. in the preamble of this proposed 

rule, we are proposing to use the 

updated practice expense per hour data 

from the accepted supplementary 

surveys only in the calculation of 

indirect PE, and to utilize a ‘‘bottomup’’ methodology to calculate direct PE. 

Even if no other changes were made 

to our PE calculation methodology, a 

significant redistribution of PE RVUs 

would still be produced by the 

acceptance of the supplementary PE 

surveys from seven specialties and the 

corresponding increases in the direct 

and indirect PE per hour for these 

specialties. As noted in the preamble 

discussion regarding our proposal to 

change the PE methodology, the 

nonphysician work pool was created to 

protect codes without physician work 

components until further refinement 

could occur. Removing these codes from 

the nonphysician work pool generally 

has a negative impact on these codes 

(although we note that we have 

consistently indicated this methodology 

was an interim approach until we had 

better data available). In addition, the 

limited number of codes remaining in 

the nonphysician work pool would also 

experience significant impacts. 

Eliminating the nonphysician work pool 

would generally negatively impact these 

codes remaining in the pool (for 

example, certain codes used by 

audiology and portable x-ray suppliers). 

We believe that much of this impact is 

due to the change in the scaling of the 

inputs when codes move from the 

nonphysician work pool to the 

individual specialty pool. 

We believe that, in addition to the 

increased accuracy and simplicity that 

result from using a ‘‘bottom-up’’

approach for direct costs, this proposed 

approach also helps mitigate some of 

the potentially inequitable 

redistribution of practice expense RVUs 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45861

resulting from the acceptance of new 

specialty-specific survey data. However, 

several of the impacts that are shown 

require further consideration. 

Audiology is clearly negatively 

impacted when its services are removed 

from the nonphysician work pool, 

though the impact is cut nearly in half 

when the ‘‘bottom-up’’ approach is used 

for the direct costs. This impact is in 

large part driven by the decrease in the 

PE RVUs for audiology CPT codes 

92557, 92567 and 92588, which we 

believe may now be more appropriately 

priced in our proposal than they were 

in the nonphysician work pool that uses 

historic charge-based RVUs to 

determine the direct practice expense 

for a service. However, we would 

welcome discussions with audiologists 

regarding this impact, so that we can 

ensure that the relative costs are 

reflected appropriately.

Despite submitting a supplementary 

survey that showed higher PE costs per 

hour, cardiology is shown to have an 

impact of ¥2.1 percent in the last 

column of Table 30. This is largely due 

to the decrease in direct PE for several 

high-volume services resulting from the 

adoption of the ‘‘bottom up’’ approach. 

For example, the RVUs for the complete 

electrocardiogram service, CPT code 

93000, decline by 43 percent. The RVUs 

for multiple 3-D heart imaging, CPT 

Code 78465, decline by 32 percent. 

However, it should be noted that, if the 

new survey data had not been used to 

calculate indirect PE, cardiology would 

have had a significantly larger (11 

percent) negative impact. 

Both physical/occupational therapy 

and independent laboratory show 

significant positive impacts in the last 

column of 6.0 and 28.0 percent, 

respectively. For therapy services, we 

had previously applied an adjustment 

that assigned all therapy services the 

therapy practice expense per hour, even 

when billed by specialties with higher 

costs. Under the top-down 

methodology, this adjustment was 

applied to both direct and indirect costs. 

However, under our proposed 

methodology, the practice expense per 

hour data would not be used to 

calculate direct expenses and this 

would eliminate the adjustment for 

direct practice expense costs. 

The total CPEP/RUC dollars for 

supplies and equipment for the services 

performed by independent laboratories 

are significantly higher than the 

aggregate dollars shown by the recent 

supplementary survey for these cost 

pools. Therefore, under the current topdown methodology, the CPEP/RUC 

dollars are scaled down to equal the 

survey dollars, and the practice expense 

RVUs are consequently reduced. Under 

our proposed methodology, the direct 

costs would no longer be scaled, 

resulting in higher practice expense 

RVUs for these services. (This also 

results in a positive 5.2 percent impact 

for pathologists, who also perform these 

services.) Although, as discussed above, 

we generally believe the refined CPEP/

RUC data to be more accurate for 

calculating direct costs than the SMS or 

supplementary survey data, we are 

concerned that there is such a 

discrepancy between the refined direct 

cost inputs and a recent survey. We will 

want to discuss this issue with both the 

specialty and the RUC to ensure that the 

refined CPEP/RUC data accurately 

reflect the typical resources needed for 

these services. However, as we 

indicated above, independent 

laboratories receive only approximately 

20 percent of their total Medicare 

revenues from PFS services, and there 

should not be significant impact on 

other specialties from this increase for 

independent laboratory services. 

As discussed in section II.C. of this 

proposed rule, we are proposing 

technical changes to the calculation of 

the malpractice RVUs. We are proposing 

to remove the malpractice data for 

specialties that occur less than 5 percent 

of the time in our data for a procedure 

code. In addition, the RUC practice 

liability workgroup has written to us 

recommending several changes to the 

crosswalks used to assign risk factors to 

specialties for which we did not have 

data otherwise. We are proposing to 

accept these recommendations, and, as 

also recommended, we are proposing to 

use the lowest risk factor of 1.00 for 

specialties such as clinical psychology, 

licensed clinical social work, 

chiropractors, and physical therapists. 

We are also proposing to add cardiology 

catheterization and angioplasty codes to 

the list of codes for which we apply 

surgical rather than nonsurgical risk 

adjustment factors. Table 31 below 

shows the impacts of these proposed 

changes. Because the malpractice RVUs 

account for less than 4 percent of total 

payments, the overall impacts on any 

particular specialty are negligible.

TABLE 31.—SPECIALTY IMPACT OF MALPRACTICE RVU CHANGES

Speciality 

Impact of removing aberrant malpractice data 

(percent) 

Impact of 

crosswalk 

changes (percent) 

Combined impacts * (percent) 

Physicians: 

Allergy/Immunology .............................................................................................................. 0.0 0.0 0.0 

Anesthesiology ..................................................................................................................... 0.0 0.0 ¥0.1 

Cardiac Surgery .................................................................................................................... 0.2 0.1 0.2 

Cardiology ............................................................................................................................. 0.0 0.1 0.1 

Colon and Rectal Surgery .................................................................................................... 0.0 0.0 0.0 

Critical Care .......................................................................................................................... 0.0 0.0 0.0 

Dermatology ......................................................................................................................... ¥0.1 0.0 ¥0.1 

Emergency Medicine ............................................................................................................ 0.0 0.0 0.0 

Endocrinology ....................................................................................................................... 0.0 0.0 0.0 

Family Practice ..................................................................................................................... 0.0 0.0 0.0 

Gastroenterology .................................................................................................................. 0.0 0.0 0.0 

General Practice ................................................................................................................... 0.0 0.0 0.0 

General Surgery ................................................................................................................... 0.0 0.0 0.1 

Geriatrics .............................................................................................................................. 0.0 0.0 0.0 

Hand Surgery ....................................................................................................................... 0.1 0.0 0.1 

Hematology/Oncology .......................................................................................................... 0.0 0.0 0.0 

Infectious Disease ................................................................................................................ 0.0 0.0 0.0 

Internal Medicine .................................................................................................................. 0.0 0.0 0.0 

Interventional Radiology ....................................................................................................... ¥0.1 0.0 ¥0.1 

45862 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

TABLE 31.—SPECIALTY IMPACT OF MALPRACTICE RVU CHANGES—Continued

Speciality 

Impact of removing aberrant malpractice data 

(percent) 

Impact of 

crosswalk 

changes (percent) 

Combined impacts * (percent) 

Nephrology ........................................................................................................................... 0.0 0.0 0.0 

Neurology ............................................................................................................................. 0.0 0.0 0.0 

Neurosurgery ........................................................................................................................ 0.2 0.1 0.2 

Nuclear Medicine .................................................................................................................. ¥0.1 0.0 ¥0.1 

Obstetrics/Gynecology .......................................................................................................... 0.0 0.0 0.0 

Ophthalmology ...................................................................................................................... 0.0 0.0 0.0 

Orthopedic Surgery .............................................................................................................. 0.1 0.0 0.1 

Otolaryngology ...................................................................................................................... 0.0 0.0 0.0 

Pathology .............................................................................................................................. 0.0 0.0 0.0 

Pediatrics .............................................................................................................................. 0.0 0.0 0.0 

Physical Medicine ................................................................................................................. 0.0 0.0 ¥0.1 

Plastic Surgery ..................................................................................................................... 0.0 0.0 0.0 

Psychiatry ............................................................................................................................. 0.0 ¥0.1 ¥0.1 

Pulmonary Disease .............................................................................................................. 0.0 0.0 0.0 

Radiation Oncology .............................................................................................................. 0.0 0.0 0.0 

Radiology .............................................................................................................................. 0.0 0.0 0.0 

Rheumatology ....................................................................................................................... 0.0 0.0 0.0 

Thoracic Surgery .................................................................................................................. 0.2 0.0 0.2 

Urology ................................................................................................................................. 0.0 0.0 0.0 

Vascular Surgery .................................................................................................................. 0.0 0.0 0.0 

Practitioners: 

Audiologist ............................................................................................................................ 0.0 0.0 0.0 

Chiropractor .......................................................................................................................... 0.0 ¥0.5 ¥0.6 

Clinical Psychologist ............................................................................................................. 0.0 0.0 ¥0.3 

Clinical Social Worker .......................................................................................................... 0.0 0.0 ¥0.4 

Nurse Anesthetist ................................................................................................................. 0.0 ¥0.2 0.0 

Nurse Practitioner ................................................................................................................. 0.0 0.0 0.0 

Optometry ............................................................................................................................. 0.0 ¥0.1 0.0 

Oral/Maxillofacial Surgery ..................................................................................................... 0.0 0.0 0.0 

Physical/Occupational Therapy ............................................................................................ 0.0 0.0 ¥0.5 

Physician Assistants ............................................................................................................. 0.0 0.0 0.0 

Podiatry ................................................................................................................................. 0.2 0.0 0.0 

Suppliers: 

Diagnostic Testing Facility .................................................................................................... 0.0 0.0 0.0 

Independent Laboratory ....................................................................................................... 0.0 0.0 0.0 

Portable X-Ray Supplier ....................................................................................................... 0.0 0.0 0.0 

*Sum of the columns may be different due to rounding. 

As discussed in section II.J. of this 

proposed rule, we are proposing to 

reduce payments for technical 

components of certain multiple imaging 

procedures performed in the same 

session within the same imaging 

families. In order to calculate the impact 

of this proposed change, we examined 

2004 PFS carrier claims processed 

through March 31, 2005. We extracted 

all claims that were billed on the same 

day, for the same beneficiary, at the 

same provider, for multiple diagnostic 

imaging procedures within the same 

family of codes. For each subset of 

claims, the procedures were arrayed 

based on the pricing of the technical 

component of these services. We 

simulated the effect of the multiple 

procedure payment reduction by 

accounting for 100 percent of the 

highest priced technical component, 

and 50 percent of all other technical 

components. Note that if the procedure 

was billed globally, the professional 

component was always calculated at 

100 percent of the professional 

component (modifier–26) value. 

The simulated total allowed charges 

for each family of codes includes all 

global, technical, and professional 

utilization for the family of codes (for 

example, the sum of claims where the 

multiple procedure payment reduction 

would have been in effect, in addition 

to claims that would not have been 

subject to the multiple procedure 

payment reduction). These simulated 

totals were then compared to the actual 

allowed charges for each family of codes 

within the same time period to calculate 

the impacts of the proposed change. 

Table 32 below shows the actual 2004 

allowed charges by family of imaging 

procedures and lists the percentage 

impact by family if this proposed policy 

had been in effect. Family 2 has the 

largest (¥18.9 percent) impact, while 

Family 11 has the smallest (¥1.3 

percent) impact.

TABLE 32.—IMPACT OF MULTIPLE PROCEDURE REDUCTION FOR DIAGNOSTIC IMAGING BY FAMILY OF IMAGING SERVICES

Family Description of family of imaging procedures 

2004 Medicare allowed 

charges

($ in millions) 

Percentage 

impact

(percent) 

01 ........... Ultrasound (Chest/Abdomen/Pelvis—Non-Obstetrical ............................................................................ $138 ¥6.8

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45863

TABLE 32.—IMPACT OF MULTIPLE PROCEDURE REDUCTION FOR DIAGNOSTIC IMAGING BY FAMILY OF IMAGING SERVICES—

Continued

Family Description of family of imaging procedures 

2004 Medicare allowed 

charges

($ in millions) 

Percentage 

impact

(percent) 

02 ........... CT and CTA (Chest/Thorax/Abd/Pelvis) ................................................................................................. 563 ¥18.9 

03 ........... CT and CTA (Head/Brain/Orbit/Maxillofacial/Neck) ................................................................................ 97 ¥2.6 

04 ........... MRI and MRA (Chest/Abd/Pelvis) .......................................................................................................... 105 ¥4.7 

05 ........... MRI and MRA (Head/Brain/Neck) ........................................................................................................... 532 ¥6.2 

06 ........... MRI and MRA (spine) ............................................................................................................................. 540 ¥4.3 

07 ........... CT (spine) ............................................................................................................................................... 24 ¥4.1 

08 ........... MRI and MRA (lower extremities) ........................................................................................................... 166 ¥3.2 

09 ........... CT and CTA (lower extremities) ............................................................................................................. 5 ¥2.0 

10 ........... MR and MRI (upper extremities and joints) ............................................................................................ 107 ¥2.7 

11 ........... CT and CTA (upper extremities) ............................................................................................................. 2 ¥1.3 

Total for all procedures subject to multiple imaging reductions ............................................................. 2,276 ¥8.3 

Using the same data, we also 

summarized the dollar value of the 

reductions by specialty. Specialtyspecific percentage impacts were 

calculated by comparing each 

specialty’s 2004 allowed charges for all 

Medicare allowed services to the 

reduced allowed charges that would 

have occurred had this proposal been in 

effect. As expected, the most significant 

impacts occur among radiologists, who 

would experience a ¥2.1 percent 

impact. Diagnostic testing facilities 

experience a ¥2.9 percent impact. Most 

other specialties experience a 0.2 

percent payment increase as a result of 

the budget neutrality adjustment. 

(Because this multiple procedure 

reduction adjustment would otherwise 

reduce overall payments by 0.2 percent, 

it is necessary to include a budget 

neutrality adjustment to the RVUs, 

resulting in positive impacts for most 

specialties.) Table 33 below shows the 

percentage impact by specialty in 

combination with other proposed 

changes. 

Table 33 below shows the estimated 

change in average payments by 

specialty, nonphysician practitioner, 

and supplier, resulting from proposed 

changes to the calculation of practice 

expense and malpractice RVUs, and the 

multiple imaging procedure discount. 

The first column displays Medicare 

allowed charges during 2004 for each 

specialty, practitioner, and supplier. 

The practice expense changes shown in 

the second column represent the first 

year impact of a 4-year transition 

resulting from all practice expense 

revisions including the adoption of the 

bottom-up approach and the elimination 

of the nonphysician work pool. The 

impact shown is identical to the first 

column of Table 30. The malpractice 

impacts shown in the third column are 

identical to those displayed above in 

Table 31. The fourth column in Table 33 

below demonstrates the impacts for 

each specialty of the proposed multiple 

imaging procedure discount. The fifth 

column shows the combined impact of 

all proposed changes by specialty. 

The largest impacts in this column are 

attributable to the proposed changes to 

the PE methodology. The final column 

includes the current estimate of the 

2006 PFS update factor of ¥4.3 percent. 

It also combines the impacts of the 

previous three columns. In addition, 

this column reflects the expiration of 

the transitional adjustment required by 

section 303 of the MMA for drug 

administration services. This 

adjustment was set at 32 percent for 

2004 and 3 percent for 2005. 

Section 1848(d) and (f) of the Act 

requires the Secretary to set the PFS 

update under the SGR system. We are 

currently forecasting a negative update 

of ¥4.3 percent for 2006 and negative 

updates for the next few years. As in the 

past, we will include a complete 

discussion of our methodology for 

calculating the SGR in the final rule.

TABLE 33.—IMPACT OF PRACTICE EXPENSE, MALPRACTICE RVUS, MULTIPLE IMAGING DISCOUNT, AND PHYSICIAN FEE

SCHEDULE UPDATE ON TOTAL MEDICARE ALLOWED CHARGES BY PHYSICIAN, PRACTITIONER, AND SUPPLIER SUBCATEGORY

Specialty 

Medicare

allowed 

charges for 

2004 ($ in millions) 

Impact of PE 

RVU changes 

(percent) 

Impact of

malpractice 

RVU changes

(percent) 

Impact of

multiple imaging discount

(percent) 

Impact of all 

proposed 

changes

(percent) 

Combined

impact: includes update 

and drug 

admin. trans.

(percent) 

Physicians: 

Allergy\Immunology .......................... $165 0.6 0.0 0.2 0.8 ¥3.5

Anesthesiology .................................. 1,486 ¥0.7 ¥0.1 0.2 ¥0.6 ¥4.9 

Cardiac Surgery ................................ 385 ¥1.0 0.2 0.2 ¥0.5 ¥4.8 

Cardiology ......................................... 7,219 ¥0.5 0.1 0.2 ¥0.2 ¥4.5 

Colon and Rectal Surgery ................ 118 0.7 0.0 0.2 1.0 ¥3.3 

Critical Care ...................................... 147 ¥0.3 0.0 0.2 ¥0.1 ¥4.4 

Dermatology ...................................... 2,033 4.1 ¥0.1 0.2 4.2 ¥0.1 

Emergency Medicine ........................ 1,841 ¥0.4 0.0 0.2 ¥0.2 ¥4.5 

Endocrinology ................................... 301 ¥0.5 0.0 0.2 ¥0.3 ¥4.6 

Family Practice ................................. 4,683 0.1 0.0 0.1 0.2 ¥4.1 

Gastroenterology .............................. 1,710 1.4 0.0 0.1 1.5 ¥2.8 

45864 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

TABLE 33.—IMPACT OF PRACTICE EXPENSE, MALPRACTICE RVUS, MULTIPLE IMAGING DISCOUNT, AND PHYSICIAN FEE

SCHEDULE UPDATE ON TOTAL MEDICARE ALLOWED CHARGES BY PHYSICIAN, PRACTITIONER, AND SUPPLIER SUBCATEGORY—Continued

Specialty 

Medicare

allowed 

charges for 

2004 ($ in millions) 

Impact of PE 

RVU changes 

(percent) 

Impact of

malpractice 

RVU changes

(percent) 

Impact of

multiple imaging discount

(percent) 

Impact of all 

proposed 

changes

(percent) 

Combined

impact: includes update 

and drug 

admin. trans.

(percent) 

General Practice ............................... 1,023 0.2 0.0 0.1 0.2 ¥4.1 

General Surgery ............................... 2,319 0.2 0.1 0.2 0.4 ¥3.9 

Geriatrics ........................................... 123 ¥0.2 0.0 0.2 ¥0.1 ¥4.4 

Hand Surgery .................................... 68 ¥0.5 0.1 0.2 ¥0.2 ¥4.5 

Hematology\Oncology ....................... 985 0.4 0.0 0.1 0.5 ¥5.2 

Infectious Disease ............................ 410 ¥0.1 0.0 0.2 0.1 ¥4.3 

Internal Medicine .............................. 9,257 ¥0.1 0.0 0.2 0.1 ¥4.2 

Interventional Radiology ................... 209 0.2 ¥0.1 ¥0.9 ¥0.8 ¥5.1 

Nephrology ........................................ 1,507 ¥0.2 0.0 0.2 0.0 ¥4.3 

Neurology .......................................... 1,284 ¥0.6 0.0 0.0 ¥0.6 ¥4.9 

Neurosurgery .................................... 538 ¥0.7 0.2 0.1 ¥0.3 ¥4.6 

Nuclear Medicine .............................. 87 ¥0.3 ¥0.1 ¥0.2 ¥0.5 ¥4.8 

Obstetrics\Gynecology ...................... 599 0.0 0.0 0.1 0.2 ¥4.2 

Ophthalmology .................................. 4,739 ¥1.1 0.0 0.2 ¥1.0 ¥5.3 

Orthopedic Surgery ........................... 3,145 ¥0.4 0.1 0.2 ¥0.1 ¥4.4 

Otolaryngology .................................. 871 ¥0.6 0.0 0.2 ¥0.4 ¥4.7 

Pathology .......................................... 915 1.3 0.0 0.2 1.5 ¥2.8 

Pediatrics .......................................... 66 0.1 0.0 0.2 0.3 ¥4.1 

Physical Medicine ............................. 750 ¥0.5 ¥0.1 0.2 ¥0.4 ¥4.7 

Plastic Surgery .................................. 279 0.1 0.0 0.2 0.3 ¥4.0 

Psychiatry ......................................... 1,127 0.0 ¥0.1 0.2 0.1 ¥4.2 

Pulmonary Disease ........................... 1,521 ¥0.2 0.0 0.2 0.0 ¥4.3 

Radiation Oncology .......................... 1,308 1.9 0.0 0.1 2.0 ¥2.3 

Radiology .......................................... 5,154 0.4 0.0 ¥2.1 ¥1.7 ¥6.0 

Rheumatology ................................... 400 ¥0.9 0.0 0.1 ¥0.8 ¥5.4 

Thoracic Surgery .............................. 464 ¥0.8 0.2 0.2 ¥0.4 ¥4.7 

Urology .............................................. 1,782 1.8 0.0 0.0 1.8 ¥2.6 

Vascular Surgery .............................. 560 0.5 0.0 0.2 0.7 ¥3.6 

Practitioners: 

Audiologist ........................................ 31 ¥5.8 0.0 0.2 ¥5.6 ¥9.9 

Chiropractor ...................................... 720 ¥1.3 ¥0.6 0.2 ¥1.8 ¥6.1 

Clinical Psychologist ......................... 527 ¥0.6 ¥0.3 0.2 ¥0.6 ¥4.9 

Clinical Social Worker ....................... 345 ¥0.6 ¥0.4 0.2 ¥0.8 ¥5.1 

Nurse Anesthetist ............................. 523 ¥0.4 0.0 0.2 ¥0.2 ¥4.5 

Nurse Practitioner ............................. 617 0.1 0.0 0.2 0.2 ¥4.1 

Optometry ......................................... 720 ¥0.8 0.0 0.2 ¥0.6 ¥4.9 

Oral\Maxillofacial Surgery ................. 37 0.8 0.0 0.2 1.0 ¥3.3 

Physical\Occupational Therapy ........ 1,283 1.5 ¥0.5 0.2 1.2 ¥3.1 

Physicians Assistant ......................... 472 0.0 0.0 0.2 0.3 ¥4.0 

Podiatry ............................................. 1,487 1.3 0.0 0.2 1.5 ¥2.8 

Suppliers: 

Diagnostic Testing Facility ................ 1,087 ¥2.4 0.0 ¥2.9 ¥5.3 ¥9.6 

Independent Laboratory .................... 631 6.4 0.0 0.2 6.6 2.3 

Portable X-Ray Supplier ................... 96 0.4 0.0 0.1 0.5 ¥3.8 

Table 34 below shows the impact on 

total payments for selected high-volume 

procedures of all of the changes 

previously discussed. We selected these 

procedures because they are the most 

commonly provided by a broad 

spectrum of physician specialties. There 

are separate columns that show the 

change in the facility rates and the 

nonfacility rates. For an explanation of 

facility and nonfacility practice expense 

refer to section II.A. in the preamble of 

this proposed rule. If we change any of 

the proposed provisions following the 

consideration of public comments, these 

figures may change.

TABLE 34.—IMPACT OF PROPOSED RULE ON PAYMENT FOR SELECTED PROCEDURES

HCPCS MOD Description 

Non-facility Facility 

Old New Percent

change Old New Percentchange 

11721 ......... ................ Debride nail, 6 or more .............................. $39.79 $38.77 ¥3 $31.08 $29.60 ¥5 

17000 ......... ................ Destroy benign/premlg lesion ..................... 60.64 62.54 3 44.34 44.39 0 

27130 ......... ................ Total hip arthroplasty .................................. N/A N/A N/A 1,396.14 1,321.88 ¥5 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45865

TABLE 34.—IMPACT OF PROPOSED RULE ON PAYMENT FOR SELECTED PROCEDURES—Continued

HCPCS MOD Description 

Non-facility Facility 

Old New Percent

change Old New Percentchange 

27244 ......... ................ Treat thigh fracture ..................................... N/A N/A N/A 1,134.65 1,073.62 ¥5 

27447 ......... ................ Total knee arthroplasty ............................... N/A N/A N/A 1,507.94 1,427.92 ¥5 

33533 ......... ................ CABG, arterial, single ................................. N/A N/A N/A 1,923.30 1,813.54 ¥6 

35301 ......... ................ Rechanneling of artery ............................... N/A N/A N/A 1,128.59 1,072.23 ¥5 

43239 ......... ................ Upper GI endoscopy, biopsy ...................... 333.50 336.27 1 162.20 159.18 ¥2 

66821 ......... ................ After cataract laser surgery ........................ 248.23 233.25 ¥6 230.42 216.83 ¥6 

66984 ......... ................ Cataract surg w/iol, 1 stage ....................... N/A N/A N/A 684.05 649.50 ¥5 

67210 ......... ................ Treatment of retinal lesion .......................... 599.54 568.15 ¥5 573.39 544.48 ¥5 

71010 ......... ................ Chest x-ray ................................................. 28.04 25.68 ¥8 N/A N/A N/A 

71010 ......... 26 Chest x-ray ................................................. 9.47 9.17 ¥3 9.47 9.17 ¥3 

76091 ......... ................ Mammogram, both breasts ........................ 97.40 101.39 4 N/A N/A N/A 

76091 ......... 26 Mammogram, both breasts ........................ 45.10 43.77 ¥3 45.10 43.77 ¥3 

76092 ......... ................ Mammogram, screening ............................. 85.65 83.77 ¥2 N/A N/A N/A 

76092 ......... 26 Mammogram, screening ............................. 36.38 35.33 ¥3 36.38 35.33 ¥3 

77427 ......... ................ Radiation tx management, x5 .................... 172.05 168.64 ¥2 172.05 166.10 ¥3 

78465 ......... 26 Heart image (3d), multiple .......................... 77.31 74.92 ¥3 77.31 74.92 ¥3 

88305 ......... 26 Tissue exam by pathologist ........................ 42.07 40.14 ¥5 42.07 40.14 ¥5 

90801 ......... ................ Psy dx interview ......................................... 153.11 147.29 ¥4 144.01 137.12 ¥5 

90862 ......... ................ Medication management ............................ 51.92 50.31 ¥3 48.89 46.77 ¥4 

90935 ......... ................ Hemodialysis, one evaluation ..................... N/A N/A N/A 73.14 69.37 ¥5 

92012 ......... ................ Eye exam established pat .......................... 65.18 61.63 ¥5 37.14 35.32 ¥5 

92014 ......... ................ Eye exam & treatment ................................ 96.26 91.31 ¥5 60.64 57.66 ¥5 

92980 ......... ................ Insert intracoronary stent ............................ N/A N/A N/A 809.11 786.38 ¥3 

93000 ......... ................ Electrocardiogram, complete ...................... 26.91 24.23 ¥10 N/A N/A N/A 

93010 ......... ................ Electrocardiogram report ............................ 9.10 8.81 ¥3 9.10 8.81 ¥3 

93015 ......... ................ Cardiovascular stress test .......................... 108.01 107.55 0 N/A N/A N/A 

93307 ......... 26 Echo exam of heart .................................... 49.27 47.67 ¥3 49.27 47.67 ¥3 

93510 ......... 26 Left heart catheterization ............................ 257.32 252.61 ¥2 257.32 252.61 ¥2 

98941 ......... ................ Chiropractic manipulation ........................... 36.76 34.78 ¥5 31.83 30.42 ¥4 

99203 ......... ................ Office/outpatient visit, new ......................... 97.02 93.33 ¥4 72.38 69.11 ¥5 

99213 ......... ................ Office/outpatient visit, est ........................... 52.68 50.65 ¥4 35.62 33.96 ¥5 

99214 ......... ................ Office/outpatient visit, est ........................... 82.62 79.62 ¥4 59.12 56.30 ¥5 

99222 ......... ................ Initial hospital care ...................................... N/A N/A N/A 112.93 107.79 ¥5 

99223 ......... ................ Initial hospital care ...................................... N/A N/A N/A 157.27 150.29 ¥4 

99231 ......... ................ Subsequent hospital care ........................... N/A N/A N/A 34.11 32.60 ¥4 

99232 ......... ................ Subsequent hospital care ........................... N/A N/A N/A 55.71 53.31 ¥4 

99233 ......... ................ Subsequent hospital care ........................... N/A N/A N/A 79.21 75.74 ¥4 

99236 ......... ................ Observ/hosp same date ............................. N/A N/A N/A 223.22 213.40 ¥4 

99239 ......... ................ Hospital discharge day ............................... N/A N/A N/A 96.64 92.53 ¥4 

99243 ......... ................ Office consultation ...................................... 122.79 118.66 ¥3 93.99 90.08 ¥4 

99244 ......... ................ Office consultation ...................................... 172.81 166.69 ¥4 138.70 133.04 ¥4 

99253 ......... ................ Initial inpatient consult ................................ N/A N/A N/A 98.91 94.99 ¥4 

99254 ......... ................ Initial inpatient consult ................................ N/A N/A N/A 142.12 136.30 ¥4 

99261 ......... ................ Follow-up inpatient consult ......................... N/A N/A N/A 22.36 21.43 ¥4 

99262 ......... ................ Follow-up inpatient consult ......................... N/A N/A N/A 45.48 43.50 ¥4 

99263 ......... ................ Follow-up inpatient consult ......................... N/A N/A N/A 67.46 64.57 ¥4 

99283 ......... ................ Emergency dept visit .................................. N/A N/A N/A 62.15 59.30 ¥5 

99284 ......... ................ Emergency dept visit .................................. N/A N/A N/A 97.02 92.54 ¥5 

99291 ......... ................ Critical care, first hour ................................ 256.57 243.87 ¥5 207.68 198.33 ¥4 

99292 ......... ................ Critical care, addï’l 30 min .................. 113.69 108.60 ¥4 103.84 99.17 ¥4 

99302 ......... ................ Nursing facility care .................................... 87.92 84.00 ¥4 87.92 84.00 ¥4 

99303 ......... ................ Nursing facility care .................................... 108.39 103.43 ¥5 108.39 103.43 ¥5 

99312 ......... ................ Nursing fac care, subseq ........................... 56.47 54.03 ¥4 56.47 54.03 ¥4 

99313 ......... ................ Nursing fac care, subseq ........................... 79.58 76.18 ¥4 79.58 76.18 ¥4 

99348 ......... ................ Home visit, est patient ................................ 72.01 68.65 ¥5 N/A N/A N/A 

99350 ......... ................ Home visit, est patient ................................ 164.48 156.46 ¥5 N/A N/A N/A 

G0008 ......... ................ Immunization admin ................................... 18.57 17.88 ¥4 N/A N/A N/A 

G0317 ......... ................ ESRD related svs 4+mo 20+yrs ................. 307.73 294.91 ¥4 307.73 294.91 ¥4 

G0344 ......... ................ Initial preventive exam ................................ 97.40 93.69 ¥4 72.76 69.47 ¥5 

G0366 ......... ................ EKG for initial prevent exam ...................... 26.91 24.23 ¥10 N/A N/A N/A 

G0367 ......... ................ EKG tracing for initial prev ......................... 17.81 15.42 ¥13 N/A N/A N/A 

G0368 ......... ................ EKG interpret & report preve ..................... 9.10 8.81 ¥3 9.10 8.81 ¥3 

In the November 15, 2004 PFS final 

rule, we showed the combined impact 

of PFS and drug payment changes on 

the total revenues for specialties that 

perform a significant volume of drug 

administration services. (69 FR 66406) 

Although we have not performed a 

similar combined impact analysis this 

year for all of the specialties considered 

45866 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

last year, we have undertaken a similar 

analysis of hematology/oncology. In last 

year’s final rule, we announced a oneyear demonstration to collect 

information about symptoms for cancer 

patients receiving chemotherapy (69 FR 

66308). Although this demonstration 

was implemented through the 

Secretary’s authority under sections 

402(a)(1)(B) and 402(a)(2) of the Social 

Security Act Amendments of 1967 (Pub. 

L. 90–248) and not through 

administrative rulemaking, we 

discussed the impacts of the additional 

payments from this demonstration in 

last year’s final rule impact analysis. 

Therefore, we are also including an 

analysis of the impact on payments to 

hematology/oncology as this 

demonstration project ends. As 

indicated in Table 35 below, PFS 

services account for approximately 28 

percent of Medicare revenues for 

hematology/oncology. Medicare 

payments for all PFS services provided 

by the specialties of hematology/

oncology are projected to decrease by 

5.2 percent for 2006. We estimate the 

impact of the one-year demonstration 

was 15 percent higher payments relative 

to PFS payments during 2005. We 

estimate that approximately 69 percent 

of total Medicare revenues for 

hematology/oncology are attributed to 

drugs, and, for purposes of this analysis, 

we are assuming no change in the 

payment levels for Part B drugs during 

2006. Assuming no changes in 

utilization for 2006, we project total 

Medicare revenues to oncologists would 

decline by 5.6 percent. However, if the 

volume of drugs and PFS services 

increased at historical rates, total 

Medicare revenues for hematology/

oncology would increase by 8.1 percent 

between 2005 and 2006.

TABLE 35—IMPACT OF DRUG AND PHYSICIAN FEE SCHEDULE PAYMENT CHANGES

Physician Fee Schedule Drugs All Revenues 

Specialty 

Percent of 

total medicare 

revenues from 

fee schedule 

(percent) 

Change medicare physician 

fee schedule 

revenues

(percent) 

Change oneyear

demonstration 

project

(percent) 

Percent of 

total medicare 

revenues from 

drugs 

Change medicare drug revenues

(percent) 

Combined percent change 

all medicare 

revenues* 

Combined percent change 

all medicare 

revenues with 

utilization 

increase** 

Hematology/Oncology .. 28 ¥5.2 ¥15 69 0 ¥5.6 8.1% 

*Note: Reflects changes in total Medicare revenues assuming no changes in utilization. Calculation reflects average changes in fee schedule 

payments and for drugs weighted by percent of Medicare revenues. 

** Note: We estimate that Medicare payments to oncologists would increase by 8% between 2005 and 2006 if growth in the volume of drugs 

and physician fee schedule services were to grow at historical rates, despite the effect of the end of the one-year demonstration project. 

B. Geographic Practice Cost Indices 

(GPCI)—Payment Localities 

As discussed in section II.B. of the 

preamble to this proposed rule, we are 

proposing two changes to the California 

GPCI payment localities. We are 

proposing to remove both Santa Cruz 

County and Sonoma County from the 

Rest of California payment locality, and 

make both of those counties separate 

payment localities. 

In the November 15, 2004 final rule, 

we published 2005 and 2006 GPCI and 

GAF values reflecting the 2 year phasein of the updated GPCI data. For the 

Rest of California payment locality that 

included Santa Cruz and Sonoma 

counties, the 2005 GAF is 1.012, and the 

2006 GAF published at that time was 

1.017. After removing Santa Cruz 

County from the Rest of California 

locality, its proposed 2006 GAF 

increases to 1.119. Removing Sonoma 

County from the Rest of California 

locality results in a proposed 2006 GAF 

of 1.098 for the new Sonoma County 

payment locality. The Rest of California 

proposed 2006 GAF is 1.011. Table 36 

below shows the impacts of the 

proposed changes in the GPCIs and 

GAFs. Although only Santa Cruz and 

Sonoma Counties and the Rest of 

California locality are specifically 

impacted by the proposed change, in 

Table 36, we are showing the GPCIs and 

GAFs for all California payment 

localities (the changes from the 2005 to 

2006 GAFs for these counties represent 

the second year of the transition to 

updated GPCIs).

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45867

TABLE 36.

—IMPACTS ON

CALIFORNIA

PAYMENT

LOCALITIES

Locality name County Work GPCI 

2005 GPCI 

GAF 

2006 Proposed GPCI Percent 

change 

from 

2005 

GAFs 

PE GPCI MP GPCI Work GPCI PE GPCI MP GPCI GAF 

Anaheim\Santa Ana ........................................ Orange ................................... 1.036 1.21 0.954 1.109 1.034 1.236 0.954 1.119 0.9 Los Angeles .................................................... Los Angeles ........................... 1.049 1.147 0.954 1.088 1.041 1.156 0.954 1.088 0.0 Marin\Napa\Solano ......................................... Marin, Napa, Solano .............. 1.025 1.294 0.651 1.128 1.035 1.34 0.651 1.154 2.3 Oakland\Berkley .............................................. Alameda, Contra Costa ......... 1.048 1.303 0.651 1.144 1.054 1.371 0.651 1.177 2.9 San Francisco ................................................. San Francisco ........................ 1.064 1.501 0.651 1.239 1.06 1.543 0.651 1.256 1.4 San Mateo ....................................................... San Mateo ............................. 1.061 1.484 0.639 1.23 1.073 1.536 0.639 1.259 2.4 Santa Clara ..................................................... Santa Clara ............................ 1.073 1.46 0.604 1.224 1.083 1.54 0.604 1.265 3.3 Santa Cruz ...................................................... Santa Cruz ............................. 1.007 1.043 0.733 1.012 1.014 1.218 0.717 1.119 10.6 Sonoma ........................................................... Sonoma .................................. 1.007 1.043 0.733 1.012 1.017 1.23 0.717 1.098 8.5 Ventura ............................................................ Ventura .................................. 1.028 1.152 0.744 1.072 1.028 1.179 0.744 1.083 1.0 Rest of California* ........................................... ........................................... 1.007 1.043 0.733 1.012 1.007 1.042 0.717 1.011 

¥0.1% 

*Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Fresno, Glenn, Humboldt, Imperial, Inyo, Kern, Kings, Lake, Lassen, Madera, Mariposa, Mendocino, Merced, Modoc, 

Mono, Monterey, Nevada, Placer, Plumas, Riverside, Sacramento, San Benito, San Bernardino, San Joaquin, San Diego, San Luis Obispo, Santa Barbara, Shasta, Sierra, Siskiyou, Stanislaus, Sutter, Tehama, Trinity, Tulare, Tuolumne, Yolo, Yuba 

45868 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

C. Medicare Telehealth Services 

In section II.D. of this proposed rule, 

we are proposing to add individual 

medical nutrition therapy, as 

represented by HCPCS codes G0270, 

97802, and 97803, to the list of 

telehealth services. We believe that this 

change will have little effect on 

Medicare expenditures. 

D. Contractor Pricing of CPT Codes 

97039 and 97139

As discussed earlier in the preamble 

of this proposed rule (section II.E.), we 

are proposing to have the contractors 

value CPT codes 97039 and 97139. This 

will make the pricing methodology for 

these services consistent with our policy 

for other unlisted services and we 

believe it will have no significant 

impact on Medicare expenditures. 

E. ESRD–MMA Related Provisions 

The ESRD related provisions in this 

proposed rule are discussed in section 

II.G. In order to understand the impact 

of the proposed changes affecting 

payments to different categories of 

ESRD facilities, it is necessary to 

compare estimated payments under the 

current payment system (current 

payments) to estimated payments under 

the proposed revisions to the composite 

rate payment system as set forth in this 

proposed rule (proposed payments). To 

estimate the impact among various 

classes of ESRD facilities, it is 

imperative that the estimates of current 

payments and proposed payments 

contain similar inputs. Therefore, we 

simulated payments only for those 

ESRD facilities for which we are able to 

calculate both current 2005 payments 

and proposed 2006 payments. 

Due to data limitations, we are unable 

to estimate current and proposed 

payments for 77 facilities that bill for 

ESRD dialysis treatments. ESRD 

providers were grouped into the 

categories based on characteristics 

provided in the Online Survey and 

Certification and Reporting (OSCAR) 

file and the most recent cost report data 

from the Healthcare Cost Report 

Information System (HCRIS). We also 

used the December 2004 update of CY 

2004 Standard Analytical File (SAF) 

claims as a basis for Medicare dialysis 

treatments and separately billable drugs 

and biologicals. While the December 

2004 update of the 2004 SAF file is not 

complete, we wanted to use the most 

recent data available, and plan to use an 

updated version of the 2004 SAF file for 

the final rule.

TABLE 37—IMPACT OF PROPOSED CHANGES IN PAYMENTS TO HOSPITAL BASED AND INDEPENDENT ESRD FACILITIES

(INCLUDES DRUG AND COMPOSITE RATE PAYMENTS) 

[Percent change in total payments to ESRD facilities (both program and beneficiaries)] 

Number of

facilities 

Number of Dialysis treatments

(in millions) 

Effect of 

changes in 

wage index1

Effect of 

changes in 

drug payments2

Overall effect 3

All ......................................................................................... 4,293 29.5 0.0 1.2 0.5 

Independent ......................................................................... 3,716 26.1 ¥0.1 1.2 0.4 

Hospital Based ..................................................................... 577 3.3 1.3 1.0 1.2 

Size: 

Small < than 5000 treatments per year ....................... 1,714 4.9 ¥0.5 1.1 0.1 

Medium 5000 to 9999 treatments per year .................. 1,724 12.4 0.1 1.3 0.6 

Large > than 10000 treatments per year ..................... 855 12.1 0.2 1.2 0.6 

Type of Ownership: 

Profit .............................................................................. 3,388 23.8 ¥0.2 1.2 0.4 

Nonprofit ....................................................................... 896 5.6 1.0 1.1 1.0 

Rural ............................................................................. 1,189 6.0 ¥0.6 1.1 0.1 

Urban ............................................................................ 3,104 23.5 0.2 1.2 0.6 

Region: 

New England ................................................................ 143 1.1 3.7 1.6 2.9 

Middle Atlantic .............................................................. 521 3.9 2.1 1.5 1.9 

East North Central ........................................................ 651 4.6 ¥1.9 0.9 ¥0.8 

West North Central ....................................................... 333 1.6 ¥0.9 1.0 ¥0.2 

South Atlantic ................................................................ 975 6.8 ¥0.3 1.2 0.4 

East South Central ....................................................... 342 2.2 ¥1.6 1.1 ¥0.4 

West South Central ...................................................... 585 4.1 ¥1.3 1.1 ¥0.3 

Mountain ....................................................................... 226 1.3 ¥0.6 1.1 0.0 

Pacific ........................................................................... 486 3.7 2.6 1.5 2.2 

Puerto Rico ................................................................... 31 0.3 ¥1.6 0.7 ¥0.7 

1This column shows the effect of wage changes to composite rate payments to ESRD providers. Composite rate payments computed using 

the current wage index are compared to composite rate payments using the proposed wage index changes. 2This column shows the effect of the changes in drug payments to ESRD providers. These include proposed changes In payment for separately billable drugs (2006 ASP+6) and the 8.9% drug add-on compared to current payment for separately billable drugs (2005 AAP) and the current 8.7 percent drug add-on. 3This column shows the percent change between proposed and current payments to ESRD facilities. The proposed payments include the 

wage adjusted composite rate, and the 8.9% drug add-on times treatments plus proposed payment for separately billable drugs. The current payment to ESRD facilities includes the current wage adjusted composite rate times treatments plus current drug payments for separately billable 

drugs. 

Table 37 above shows the impact of 

this year’s proposed changes to 

payments to hospital based and 

independent ESRD facilities. We have 

included both composite rate payments 

as well as payments for separately 

billable drugs and biologicals because 

both are affected by the proposed 

changes. The first column of Table 37 

identifies the type of ESRD provider, the 

second column indicates the number of 

ESRD facilities for each type, and the 

third column indicates the number of 

dialysis treatments. 

The fourth column shows the effect of 

proposed changes to the ESRD wage 

index as it affects the composite rate 

payments to ESRD facilities. The fourth 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45869

column compares aggregate wage 

adjusted composite rate payments using 

the proposed ESRD wage index 

compared to the current ESRD wage 

adjusted composite rate payments. The 

overall effect to all ESRD providers in 

aggregate is zero because the proposed 

ESRD wage index has been multiplied 

by a budget neutrality factor to comply 

with the statutory requirement that any 

wage index revisions be done in a 

manner that results in the same 

aggregate amount of expenditures as 

would have been made without any 

changes in the wage index. The percent 

changes shown in the fifth and sixth 

columns are the result of the increase to 

the drug add-on and the changes in drug 

prices which are explained in section G 

below.

The fifth column shows the effect of 

the proposed changes in drug payments 

to ESRD providers. Current payments 

for drugs represent 2005 Medicare 

reimbursement using AAP prices for the 

top ten drugs (as discussed earlier in 

this preamble). Current Medicare 

spending for the top ten drugs is 

estimated using 2005 AAP prices times 

actual drug utilization from 2004 

claims. (EPO units are estimated using 

payments because the units field on 

bills represents the number of EPO 

administrations rather than the number 

of EPO units). Spending under the 

proposed change is 2005 ASP +6 

percent for the top ten drugs times 

actual drug utilization from 2004 

claims. The proposed prices for these 

top ten drugs are discussed earlier in 

this preamble. In order to simulate what 

ASP +6 percent pricing will be in 2006 

we inflated the 2005 first quarter ASP 

+6 prices by a forecast of the PPI for 

prescription drugs (5.7 percent annual 

growth from 2005 to 2006). 

Proposed payment for drugs in 2006 

also includes the 8.9 percent drug addon to the composite rate. This amount 

is computed by multiplying the wage 

adjusted composite rate for each 

provider times dialysis treatments from 

2004 claims. Column 5 is computed by 

comparing spending under the proposed 

payment for drugs (ASP +6 percent 

inflated to 2006) including the 8.9 

percent drug add-on amount to 

spending under current payments for 

drugs with the current drug add-on of 

8.7 percent. In order to make column 5 

comparable with rest of Table 38, 

current composite rate payments to 

ESRD facilities were included in both 

current and proposed spending 

calculations. 

We did not simulate any case mix in 

this impact table because 2004 claims 

data do not include the new data fields 

(height and weight) that are needed to 

calculate case mix. These data fields 

were not required be reported by 

providers until January 1, 2005. 

However, we have not proposed any 

changes to case mix for calendar year 

2006. 

Column 6 shows the overall effect of 

all changes in drug and composite rate 

payments to ESRD providers. The 

overall effect is measured as the 

difference between proposed payment 

with all MMA changes as proposed in 

this rule and current payment. Proposed 

payment is computed by multiplying 

the composite rate for each provider 

(with both the proposed wage index and 

the 8.9 percent drug add-on) times 

dialysis treatments from 2004. In 

addition, the proposed payment 

includes payments for separately 

billable drugs under the ASP +6 drug 

pricing inflated to 2006 levels. Current 

payment is the current wage adjusted 

composite rate for each provider times 

dialysis treatments from 2004 claims 

plus current AAP priced drug payments 

for separately billable drugs with the 

current 8.7 percent drug add-on. 

The overall impact to ESRD providers 

in aggregate is 0.5 percent. Among the 

two separately shown effects, the effect 

of changes to the wage index has the 

most variation among provider type but 

is budget neutral in aggregate. The effect 

of change in drug payments contributes 

most to the overall effect, but varies 

little among provider types. 

We also note that the proposed 

revisions to the composite rate 

exceptions process will have no impact 

on payments to ESRD providers since 

we have only proposed changes in 

process and these changes do not affect 

which providers will be eligible for 

exceptions nor the amount of the 

exception. 

F. Payment for Covered Outpatient 

Drugs and Biologicals 

As discussed in section II.H. of this 

proposed rule, the proposal to pay a 

reduced supplying fee for each 

Medicare Part B oral drug prescription, 

after the first one, supplied to a 

beneficiary during a month is estimated 

to reduce total Federal expenditures by 

$8 million in 2006, and $30 million over 

the five-year period, CY 2006 to 2010. 

The preamble seeks comment on an 

appropriate inhalation drug dispensing 

fee amount for 2006. The effect on 

Federal expenditures of a potential 

change to the inhalation drug 

dispensing fee would depend on the 

dispensing fee amount established. 

G. Private Contracts and Opt-Out 

Provision 

The changes discussed in section II.I. 

of this proposed rule, with respect to 

private contracts and the opt-out 

provision, are currently estimated to 

have no significant impact on Medicare 

expenditures. However, we believe the 

changes will clarify that the 

consequences for the failure to maintain 

opt-out will apply regardless of whether 

the physician or practitioner was 

notified by the carrier. 

H. FQHC Supplemental Payment 

Provision 

Section 237 of the MMA amended 

section 1833(a)(3) of Act to provide 

supplemental payments to FQHCs that 

contract with Medicare Advantage (MA) 

organizations to cover the difference, if 

any, between the payment received by 

the health center for treating MA 

enrollees and the payment to which the 

FQHC would be entitled to receive 

under its cost-based all-inclusive 

payment rate. We estimate that this new 

MMA payment provision for FQHC 

services will not increase Medicare 

payments. In other words, this MMA 

provision would have no budgetary 

impact on the Medicare trust fund due 

to the fact that a supplemental payment 

would only be made when the MA 

payment to the health center is less than 

its original FQHC cost based rate. 

Consequently, no additional Medicare 

expenditures would be needed to pay 

the center up to what it would have 

received under original Medicare.

I. National Coverage Decisions 

Timeframes 

The proposed changes to § 426.340 

discussed in section II.N. of this 

proposed rule, are made in order to 

conform certain timeframes in the 

regulation to meet legislative changes 

made by the MMA of 2003. These 

changes to the regulation will meet 

Congressional intent in the development 

of NCDs, and will conform the 

regulation to the overall NCD process. 

There will be no budget implications as 

a result of these changes. 

J. Coverage of Screening for Glaucoma 

As discussed in section II.O. of the 

preamble to this proposed rule, we 

would expand the definition of an 

eligible beneficiary under the glaucoma 

screening benefit to include Hispanic 

Americans age 65 and over, effective 

January 1, 2006, subject to certain 

frequency and other limitations on 

coverage. At present, § 410.23(a)(2) 

(Conditions for and limitations on 

coverage of screening for glaucoma) 

defines the term ‘‘eligible beneficiary’’

45870 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

to include individuals in the following 

high risk categories: 

• Individual with diabetes mellitus. 

• Individual with a family history of 

glaucoma. 

• African-Americans age 50 and over. 

Based on the projected utilization of 

these screening services and related 

medically necessary follow-up tests and 

treatment that may be required for the 

additional beneficiaries screened, we 

estimate that this expanded benefit will 

result in an increase in Medicare 

payments to ophthalmologists or 

optometrists who will provide these 

screening tests and related follow-up 

tests and treatment. However, this is not 

expected to have a significant cost 

impact on the Medicare program. 

K. Physician Referral for Nuclear 

Medicine Services 

This proposal, which is discussed in 

section II.P. of this proposed rule, 

would primarily affect physicians and 

health care entities that furnish items 

and services to Medicare beneficiaries. 

We have attempted to minimize its 

effect by interpreting the law in a 

practical and realistic manner. We are 

unable to quantify the number of 

physicians who have either an 

ownership or an investment interest in 

entities that furnish nuclear medicine 

services and/or supplies. Even if we 

assume that a substantial number of 

physicians have ownership or 

investment interests in these types of 

entities, we believe that, in general, the 

economic impact on these physicians 

would not necessarily be substantial, for 

the reasons stated below. 

Physician owners/investors of entities 

that furnish nuclear medicine services 

and supplies in a manner that satisfies 

the requirements of the in-office 

ancillary services exception would not 

be affected by this proposed rule. In 

addition, physician ownership of or 

investment in entities that furnish 

nuclear medicine services and supplies 

to residents of rural areas would not be 

affected by this requirement. 

If a physician’s ownership or 

investment interest would lead to a 

prohibition on his or her referrals to that 

entity, the physician has two options. 

First, he or she can stop making referrals 

to that entity and make referrals to 

another entity. Second, the physician 

can divest himself or herself of the 

interest. While the impact on an 

individual physician may be significant, 

we do not believe that physicians, in 

general, will be significantly affected if 

they have to stop making referrals to an 

entity in which they have an ownership 

interest. We have come to this 

conclusion because we assume that the 

majority of physicians receive most of 

their income from the services they 

personally furnish, not from nuclear 

medicine services performed by entities 

that they own. In addition, we assume 

that, unless the physician established 

the entity to serve only his or her 

patients, the entity receives referrals 

from other physicians. Thus, the 

physician may still receive a return on 

the ownership or investment. We do not 

believe that the second option 

(divestiture of the ownership interest) 

would necessarily have a significant 

economic effect. However, we assume, 

that, at least from an economic 

standpoint, most physicians invest in 

entities because they are income 

producing. If an investment is 

successful, a physician may have little 

difficulty finding new investors willing 

to take over the physician’s investment. 

The physician, in turn, can then invest 

the monies received in some other 

investment. We believe the cost of 

divestiture will vary from situation to 

situation. 

We also do not believe that 

beneficiary access to medically 

necessary nuclear medicine services 

would be threatened simply because 

most physician ownership of entities 

that furnish nuclear medicine services 

would be prohibited. As indicated 

above, we see no reason why medically 

necessary nuclear medicine services 

could not be furnished by entities 

owned by those not in a position to refer 

such services. 

We expect that this proposed rule 

may result in savings to both the 

Medicare and Medicaid programs by 

minimizing anti-competitive business 

arrangements as well as financial 

incentives that encourage overutilization of costly nuclear medicine 

services. (See David Armstrong, ‘‘MRI 

and CT Centers Offer Doctors Way to 

Profit on Scans,’’ Wall Street Journal, 

May 2, 2005, et al.) We cannot gauge 

with any certainty the extent of these 

savings to either program at this time. 

L. Alternatives Considered 

This proposed rule contains a range of 

policies, including some proposals 

related to specific MMA provisions. The 

preamble provides descriptions of the 

statutory provisions that are addressed, 

identifies those policies when discretion 

has been exercised, presents rationale 

for our decisions and, where relevant, 

alternatives that were considered. 

M. Impact on Beneficiaries 

There are a number of changes made 

in this proposed rule that would have 

an effect on beneficiaries. In general, we 

believe these changes will improve 

beneficiary access to services that are 

currently covered or will expand the 

Medicare benefit package to include 

new services. As explained in more 

detail below, the regulatory provisions 

may affect beneficiary liability in some 

cases. Any changes in aggregate 

beneficiary liability from a particular 

provision will be a function of the 

coinsurance (20 percent if applicable for 

the particular provision after the 

beneficiary has met the deductible) and 

the effect of the aggregate cost (savings) 

of the provision on the calculation of 

the Medicare Part B premium rate 

(generally 25 percent of the provision’s 

cost or savings). 

To illustrate this point, as shown in 

Table 34, the 2005 national payment 

amount in the nonfacility setting for 

CPT code 99203 (Office/outpatient visit, 

new), is $97.02 which means that 

currently a beneficiary is responsible for 

20 percent of this amount, or $19.40. 

Under this proposed rule the 2006 

national payment amount in the 

nonfacility setting for CPT code 99203, 

as shown in Table 34, is $93.33 which 

means that, in 2006, the beneficiary 

coinsurance for this service would be 

$18.66. 

Very few of the changes we are 

proposing impact overall payments and 

therefore will affect Medicare 

beneficiaries’ coinsurance liability. 

Proposals discussed above that do affect 

overall spending would similarly 

impact beneficiaries’ coinsurance.

For example, we have tried to ensure 

that the proposal concerning physician 

self-referral for nuclear medicine 

services would not adversely impact the 

medical care of Medicare or Medicaid 

patients. While we recognize that these 

proposed revisions may have an impact 

on current arrangements under which 

patients are receiving medical care, 

there are other ways to structure these 

arrangements so that patients may 

continue to receive medically necessary 

nuclear medicine services. In almost all 

cases, we believe this proposal 

concerning physician referral for 

nuclear medicine services should not 

require substantial changes in delivery 

arrangements and would help minimize 

anti-competitive behavior that can affect 

where a beneficiary receives health care 

services and possibly the quality of the 

services furnished. We also believe it 

will minimize the number of medically 

unnecessary nuclear medicine 

procedures billed to the Medicare and 

Medicaid programs. 

N. Accounting Statement 

As required by OMB Circular A–4 

(available at http://www.whitehouse.

gov/omb/circulars/a004/a–4.pdf), in 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45871

Table 38 below, we have prepared an 

accounting statement showing the 

classification of the expenditures 

associated with the provisions of this 

proposed rule. This table includes the 

impact of the proposed changes in this 

rule on providers and suppliers and 

encompasses the anticipated negative 

update to the physician fee schedule 

based on the statutory SGR formula. 

Expenditures are classified as 

transfers to Medicare providers/or 

suppliers (that is, ESRD facilities and 

physicians, other practitioners and 

medical suppliers that receive payment 

under the physician fee schedule or 

Medicare Part B).

TABLE 38.—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM CY 2005 TO THE CY 

2006 

[in millions] 

Category Transfers 

Annualized Monetized Transfers ........................ Negative transfer-Estimated decrease in expenditures ($1,860). 

From Whom To Whom? ..................................... Federal Government To ESRD Medicare Providers; physicians, other practitioners and suppliers who receive payment under the Medicare Physician Fee Schedule; and Medicare 

Suppliers billing for Part B drugs. 

In accordance with the provisions of 

Executive Order 12866, this final rule 

was reviewed by the Office of 

Management and Budget.

List of Subjects 

42 CFR Part 405 

Administrative practice and 

procedure, Health facilities, Health 

professions, Kidney diseases, Medical 

devices, Medicare, Reporting and 

recordkeeping requirements, Rural 

areas, X-rays. 

42 CFR Part 410 

Health facilities, Health professions, 

Kidney diseases, Laboratories, 

Medicare, Reporting and recordkeeping 

requirements, Rural areas, X-rays. 

42 CFR Part 411 

Kidney diseases, Medicare, Physician 

Referral, Reporting and recordkeeping 

requirements. 

42 CFR Part 413 

Health facilities, Kidney diseases, 

Medicare, Reporting and recordkeeping 

requirements. 

42 CFR Part 414 

Administrative practice and 

procedure, Health facilities, Health 

professions, Kidney diseases, Medicare, 

Reporting and recordkeeping 

requirements. 

42 CFR Part 426 

Administrative practice and 

procedure, Medicare, Reporting and 

recordkeeping requirements.

For the reasons set forth in the 

preamble, the Centers for Medicare & 

Medicaid Services proposes to amend 

42 CFR chapter IV as set forth below:

PART 405—FEDERAL HEALTH 

INSURANCE FOR THE AGED AND 

DISABLED 

1. The authority citation for part 405 

continues to read as follows:

Authority: Secs. 1102, 1861, 1862(a), 1871, 

1874, 1881, and 1886(k) of the Social 

Security Act (42 U.S.C. 1302, 1395x, 

1395y(a), 1395hh, 1395kk, 1395rr, and 

1395ww(k)), and sec. 353 of the Public 

Health Service Act (42 U.S.C. 263a).

Subpart D—Private Contracts 

2. Section 405.435 is amended by—

A. Revising introductory text in 

paragraph (b). 

B. Adding paragraph (d). 

The revision and addition read as 

follows:

§ 405.435 Failure to maintain opt-out.

* * * * *

(b) If a physician or practitioner fails 

to maintain opt-out in accordance with 

paragraph (a) of this section, then, for 

the remainder of the opt-out period, 

except as provided by paragraph (d) of 

this section—

* * * * *

(d) If a physician or practitioner 

demonstrates that he or she has taken 

good faith efforts to maintain opt-out 

(including by refunding amounts in 

excess of the charge limits to 

beneficiaries with whom he or she did 

not sign a private contract) within 45 

days of a notice from the carrier of a 

violation of paragraph (a) of this section, 

then the requirements of paragraphs 

(b)(1) through (b)(8) of this section are 

not applicable. In situations where a 

violation of paragraph (a) of this section 

is not discovered by the carrier during 

the 2-year opt-out period when the 

violation actually occurred, then the 

requirements of paragraphs (b)(1) 

through (b)(8) of this section are 

applicable from the date that the first 

violation of paragraph (a) of this section 

occurred until the end of the opt-out 

period during which the violation 

occurred (unless the physician or 

practitioner takes good faith efforts, 

within 45 days of any notice from the 

carrier that the physician or practitioner 

failed to maintain opt-out, or the 

physician’s or practitioner’s discovery 

of the failure to maintain opt-out, 

whichever is earlier, to correct his or her 

violations of paragraph (a) of this 

section, for example, by refunding the 

amounts in excess of the charge limits 

to beneficiaries with whom he or she 

did not sign a private contract).

* * * * *

Subpart X—Rural Health Clinic and 

Federally Qualified Health Center 

Services

3. Add § 405.2469 to read as follows:

§ 405.2469 Federally Qualified Health 

Centers supplemental payments. 

Federally Qualified Health Centers 

under contract (directly or indirectly) 

with Medicare Advantage plans are 

eligible for supplemental payments for 

covered Federally Qualified Health 

Center services furnished to enrollees in 

Medicare Advantage plans offered by 

the Medicare Advantage organization to 

cover the difference, if any, between 

their payments from the Medicare 

Advantage plan and what they would 

receive under the cost-based Federally 

Qualified Health Center payment 

system. 

(a) Calculation of supplemental 

payment. (1) The supplemental payment 

for Federally Qualified Health Center 

covered services provided to Medicare 

patients enrolled in Medicare 

Advantage plans is based on—

(i) The difference between payments 

received by the center from the 

Medicare Advantage plan as determined 

on a per visit basis; 

45872 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

(ii) The Federally Qualified Health 

Center’s all-inclusive cost-based per 

visit rate as set forth in this subpart; 

(iii) Less any amount the FQHC may 

charge as described in section 

1857(e)(3)(B) of the Act. 

(2) Any financial incentives provided 

to Federally Qualified Health Centers 

under their Medicare Advantage 

contracts, such as risk pool payments, 

bonuses, or withholds, are prohibited 

from being included in the calculation 

of supplemental payments due to the 

Federally Qualified Health Center. 

(b) Per visit supplemental payment. A 

supplemental payment required under 

this section is made to the Federally 

Qualified Health Center when a covered 

face-to-face encounter occurs between a 

Medicare Advantage enrollee and a 

practitioner as set forth in § 405.4563.

PART 410—SUPPLEMENTARY 

MEDICAL INSURANCE (SMI) 

BENEFITS 

4. The authority citation for part 410 

continues to read as follows:

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh).

Subpart B—Medical and Other Health 

Services 

5. Section 410.23 is amended by 

revising paragraph (a)(2)(i) through (iv) 

to read as follows:

§ 410.23 Screening for glaucoma: 

Conditions for and limitations on coverage. 

(a) * * * 

(2) * * * 

(i) Individual with diabetes mellitus. 

(ii) Individual with a family history of 

glaucoma. 

(iii) African-Americans age 50 and 

over. 

(iv) Hispanic-Americans age 65 and 

over.

* * * * *

6. Section 410.78 is amended by—

A. Revising paragraph (b) 

introductory text. 

B. Adding paragraph (b)(2)(viii). 

The revision and addition read as 

follows:

§ 410.78 Telehealth services

* * * * *

(b) General rule. Medicare Part B pays 

for office and other outpatient visits, 

professional consultation, psychiatric 

diagnostic interview examination, 

individual psychotherapy, 

pharmacologic management, end stage 

renal disease related services included 

in the monthly capitation payment 

(except for one visit per month to 

examine the access site), and individual 

medical nutrition therapy furnished by 

an interactive telecommunications 

system if the following conditions are 

met: 

(2) * * * 

(viii) A registered dietician or 

nutrition professional as described in 

§ 410.134.

* * * * *

PART 411—EXCLUSIONS FROM 

MEDICARE AND LIMITATIONS ON 

MEDICARE PAYMENT 

7. The authority citation for part 411 

continues to read as follows:

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh).

Subpart J—Financial Relationships 

Between Physicians and Entities 

Furnishing Designated Health Services 

8. Section 411.351 is amended by—

A. Revising the definition ‘‘Radiation 

therapy services and supplies’’. 

B. Revising the definition ‘‘Radiology 

and certain other imaging services’’. 

The revisions read as follows:

§ 411.351 Definitions.

* * * * *

Radiation therapy services and 

supplies means those particular services 

and supplies so identified on the List of 

CPT/HCPCS Codes. All services and 

supplies identified on the List of CPT/

HCPCS Codes are radiation therapy 

services and supplies for purposes of 

this subpart. Any service or supply not 

specifically identified as radiation 

therapy services or supplies on the List 

of CPT/HCPCS Codes is not a radiation 

therapy service or supply for purposes 

of this subpart. The list of codes 

identifying radiation therapy services 

and supplies are those covered under 

section 1861(s)(4) of the Act and 

§ 410.35 of this chapter.

Radiation and certain other imaging 

services means those particular services 

so identified on the List of CPT/HCPCS 

Codes. All services so identified on the 

List of CPT/HCPCS Codes are radiology 

and certain other imaging services for 

purposes of this subpart. Any service 

not specifically identified as radiology 

and certain other imaging services on 

the List of CPT/HCPCS Codes, is not a 

radiology or certain other imaging 

service for purposes of this subpart. The 

list of codes identifying radiology and 

certain other imaging services includes 

the professional and technical 

components of any diagnostic test or 

procedure using x-rays, ultrasound, or 

other imaging services, computerized 

axial tomography, or magnetic 

resonance imaging, or diagnostic 

nuclear medicine, as covered under 

section 1861(s)(3) of the Act and 

§ 410.32 and § 410.34 of this chapter, 

but does not include—

(1) X-ray, fluoroscopy, or ultrasound 

procedures that require the insertion of 

a needle, catheter, tube, or probe 

through the skin or into a body orifice. 

(2) Radiology procedures that are 

integral to the performance of a nonradiological medical procedure and 

performed—

(i) During the nonradiological medical 

procedure; or 

(ii) Immediately following the nonradiological medical procedure where 

necessary to confirm placement of an 

item placed during the nonradiological 

medical procedure.

* * * * *

PART 413—PRINCIPLES OF 

REASONABLE COST 

REIMBURSEMENT; PAYMENT FOR 

END-STAGE RENAL DISEASE 

SERVICES; PROSPECTIVELY 

DETERMINED PAYMENT RATES FOR 

SKILLED NURSING FACILITIES 

9. The authority citation for part 413 

continues to read as follows:

Authority: Secs. 1102, 1812(d), 1814(b), 

1815, 1833(a), (i), and (n), 1871, 1881, 1883, 

and 1886 of the Social Security Act (42 

U.S.C. 1302, 1395D(D), 1395f(b), 1395g, 

13951(a), (i), and (n), 1395hh, 1395rr, 1395tt, 

and 1395ww).

Subpart H—Payment for End-Stage 

Renal Disease (ESRD) Services and 

Organ Procurement Costs 

10. Section 413.170 is amended by 

revising paragraph (b) to read as follows:

§ 413.170 Scope.

* * * * *

(b) Providing procedures and criteria 

under which a pediatric ESRD facility 

(an ESRD facility with at least a 50 

percent pediatric patient mix) may 

receive an exception to the prospective 

payment rates; and

* * * * *

11. Section 413.174 is amended by—

A. Revising paragraph (f). 

B. Removing paragraph (g). 

The revisions read as follows:

§ 413.174 Prospective rates for hospitalbased and independent ESRD facilities.

* * * * *

(f) Additional payment for separately 

billable drugs. CMS makes an additional 

payment for certain drugs furnished to 

ESRD patients by a Medicare-approved 

ESRD facility. CMS makes this payment 

directly to the ESRD facility. Payment 

for these drugs is made—

(1) Only on an assignment basis, 

directly to the facility which must 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45873

accept, as payment in full, the amount 

that CMS determines; 

(2) Subject to the Part B deductible 

and coinsurance; 

(3) To hospital-based facilities in 

accordance with the cost reimbursement 

rules set forth in this part, except for 

erythropoietin/epogen (commonly 

called EPO), which is paid the same 

amount as independent facilities; and 

(4) To independent facilities in 

accordance with the methodology set 

forth in § 405.517 of this chapter. 

12. Section 413.180 is amended by—

A. Revising paragraphs (b) and (d) 

B. Removing paragraphs (e) and (k). 

C. Redesignating paragraphs (f) 

through (j) as paragraphs (e) through (i). 

D. Redesignating paragraphs (l) and 

(m) as paragraphs (j) and (k). 

The amendment reads as follows:

§ 413.180 Procedures for requesting 

exceptions to payment rates.

* * * * *

(b) Criteria for requesting an 

exception. If a pediatric ESRD facility 

projects on the basis of prior year costs 

and utilization trends that it has an 

allowable cost per treatment higher than 

its prospective rate set under § 413.174, 

and if these excess costs are attributable 

to one or more of the factors in 

§ 413.182, the facility may request, in 

accordance with paragraph (e) of this 

section, that CMS approve an exception 

to that rate and set a higher prospective 

payment rate.

* * * * *

(d) Payment rate exception request.

Effective October 1, 2002, CMS may 

approve exceptions to a pediatric ESRD 

facility’s updated prospective payment 

rate, if the pediatric ESRD facility did 

not have an approved exception rate as 

of October 1, 2002. A pediatric ESRD 

facility may request an exception to its 

payment rate at any time after it is in 

operation for at least 12 consecutive 

months.

* * * * *

13. Section 413.182 is revised to read 

as follows:

§ 413.182 Criteria for approval of 

exception requests.

(a) CMS may approve exceptions to a 

pediatric ESRD facility’s prospective 

payment rate if the pediatric ESRD 

facility did not have an approved 

exception rate as of October 1, 2002. 

(b) The pediatric ESRD facility must 

demonstrate, by convincing objective 

evidence, that its total per treatment 

costs are reasonable and allowable 

under the relevant cost reimbursement 

principles of part 413 and that its per 

treatment costs in excess of its payment 

rate are directly attributable to any of 

the following criteria: 

(1) Pediatric patient mix, as specified 

in § 413.184. 

(2) Self-dialysis training costs in 

pediatric facilities, as specified in 

§ 413.186 

14. Section 413.184 is amended by 

revising paragraphs (a) and (b)(1) to read 

as follows:

§ 413.184 Payment exception: Pediatric 

patient mix. 

(a) Qualifications. To qualify for an 

exception to its prospective payment 

rate based on its pediatric patient mix 

a facility must demonstrate that—

(1) At least 50 percent of its patients 

are individuals under 18 years of age; 

(2) Its nursing personnel costs are 

allocated properly between each mode 

of care; 

(3) The additional nursing hours per 

treatment are not the result of an excess 

number of employees; 

(4) Its pediatric patients require a 

significantly higher staff-to-patient ratio 

than typical adult patients; and 

(5) These services, procedures, or 

supplies and its per treatment costs are 

clearly prudent and reasonable when 

compared to those of pediatric facilities 

with a similar patient mix. 

(b) Documentation. (1) A pediatric 

ESRD facility must submit a listing of all 

outpatient dialysis patients (including 

all home patients) treated during the 

most recently completed and filed cost 

report (in accordance with cost 

reporting requirements under § 413.198) 

showing—

(i) Age of patients and percentage of 

patients under the age of 18; 

(ii) Individual patient diagnosis; 

(iii) Home patients and ages; 

(iv) In-facility patients, staff-assisted, 

or self-dialysis; 

(v) Diabetic patients; and 

(vi) Patients isolated because of 

contagious disease.

* * * * *

§ 413.186 [Removed] 

15. Section 413.186 is removed.

§ 413.188 [Removed] 

16. Section 413.188 is removed. 

17. Redesignate § 413.190 as § 413.186 

and revise the newly designated 

§ 413.186 to read as follows:

§ 413.186 Payment exception: Self-dialysis 

training costs in pediatric facilities. 

(a) Qualification. To qualify for an 

exception to the prospective payment 

rate based on self-dialysis training costs, 

the pediatric ESRD facility must 

establish that it incurs per treatment 

costs for furnishing self-dialysis and 

home dialysis training that exceed the 

facility’s payment rate for the training 

sessions. 

(b) Justification. To justify its 

exception request, a facility must—

(1) Separately identify those elements 

contributing to its costs in excess of the 

composite training rate; and 

(2) Demonstrate that its per treatment 

costs are reasonable and allowable. 

(c) Criteria for determining proper 

cost reporting. CMS considers the 

pediatric ESRD facility’s total costs, cost 

finding and apportionment, including 

its allocation of costs, to determine if 

costs are properly reported by treatment 

modality. 

(d) Limitation of exception requests.

Exception requests for a higher training 

rate are limited to those cost 

components relating to training such as 

technical staff, medical supplies, and 

the special costs of education (manuals 

and education materials). These 

requests may include overhead and 

other indirect costs to the extent that 

these costs are directly attributable to 

the additional training costs. 

(e) Documentation. The pediatric 

ESRD facility must provide the 

following information to support its 

exception request: 

(1) A copy of the facility’s training 

program. 

(2) Computation of the facility’s cost 

per treatment for maintenance sessions 

and training sessions including an 

explanation of the cost difference 

between the two modalities. 

(3) Class size and patients’ training 

schedules. 

(4) Number of training sessions 

required, by treatment modality, to train 

patients. 

(5) Number of patients trained for the 

current year and the prior 2 years on a 

monthly basis. 

(6) Projection for the next 12 months 

of future training candidates. 

(7) The number and qualifications of 

staff at training sessions. 

(f) Accelerated training exception. (1) 

A pediatric ESRD facility may bill 

Medicare for a dialysis training session 

only when a patient receives a dialysis 

treatment (normally three times a week 

for hemodialysis). Continuous cycling 

peritoneal dialysis (CCPD) and 

continuous ambulatory peritoneal 

dialysis (CAPD) are daily treatment 

modalities; ESRD facilities are paid the 

equivalent of three hemodialysis 

treatments for each week that CCPD and 

CAPD treatments are provided. 

(2) If a pediatric ESRD facility elects 

to train all its patients using a particular 

treatment modality more often than 

during each dialysis treatment and, as a 

result, the number of billable training 

dialysis sessions is less than the number 

of actual training sessions, the facility 

45874 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

may request a composite rate exception, 

limited to the lesser of the—

(i) Facility’s projected training cost 

per treatment; or 

(ii) Cost per treatment the facility 

receives in training a patient if it had 

trained patients only during a dialysis 

treatment, that is, three times per week. 

(3) An ESRD facility may bill a 

maximum of 25 training sessions per 

patient for hemodialysis training and 15 

sessions for CCPD and CAPD training. 

(4) In computing the payment amount 

under an accelerated training exception, 

CMS uses a minimum number of 

training sessions per patient (15 for 

hemodialysis and 5 for CAPD and 

CCPD) when the facility actually 

provides fewer than the minimum 

number of training sessions.

(5) To justify an accelerated training 

exception request, an ESRD facility 

must document that a significant 

number of training sessions for a 

particular modality are provided during 

a shorter but more condensed period. 

(6) The facility must submit with the 

exception request a list of patients, by 

modality, trained during the most recent 

cost report period. The list must include 

each beneficiary’s—

(i) Name; 

(ii) Age; and 

(iii) Training status (completed, not 

completed, being retrained, or in the 

process of being trained). 

(7) The total treatments from the 

patient list must be the same as the total 

treatments reported on the cost report 

filed with the request.

§ 413.192 [Removed] 

18. Section 413.192 is removed.

PART 414—PAYMENT FOR PART B 

MEDICAL AND OTHER HEALTH 

SERVICES 

19. The authority citation for part 414 

continues to read as follows:

Authority: Secs. 1102, 1871, and 1881(b)(1) 

of the Social Security Act (42 U.S.C. 1302, 

1395hh, and 1395rr(b)(1)).

Subpart B—Physicians and Other 

Practitioners 

20. Section 414.65 is amended by 

revising paragraph (a)(1) to read as 

follows:.

§ 414.65 Payment for telehealth services 

(a) * * * 

(1) The Medicare payment amount for 

office or other outpatient visits, 

consultation, individual psychotherapy, 

psychiatric diagnostic interview 

examination, pharmacologic 

management, end stage renal disease 

related services included in the monthly 

capitation payment (except for one visit 

per month to examine the access site), 

and individual medical nutrition 

therapy furnished via an interactive 

telecommunications system is equal to 

the current fee schedule amount 

applicable for the service of the 

physician or practitioner.

* * * * *

21. Section 414.802 is amended by 

adding definitions of ‘‘direct sales’’ and 

‘‘indirect sales’’ to read as follows:

§ 414.802 Definitions

* * * * *

Direct Sales means sales directly from 

the manufacturer to the provider (for 

example, physician or other health care 

provider) or supplier.

* * * * *

Indirect Sales means from the 

manufacturer to a wholesaler, 

distributor, or similar entity that sells to 

others in the distribution chain. Indirect 

sales also include any sale subject to the 

average sales price reporting 

requirement that is not a direct sale.

* * * * *

22. Section 414.804(a) is amended by: 

A. Redesignating paragraphs (a)(3), 

(a)(4), (a)(5), and (a)(6), as paragraphs 

(a)(4), (a)(5), (a)(6), and (a)(7). 

B. Adding a new paragraph (a)(3). 

C. Revising newly redesignated 

paragraph (a)(4). 

The redesignations and revisions read 

as follows:

§ 414.804 Basis of payment. 

(a) * * * 

(3) In calculating the manufacturer’s 

average sales price, a manufacturer 

must—

(i) Calculate the average sales price for 

direct sales; 

(ii) Calculate the average sales price 

for indirect sales; and 

(iii) Calculate the weighted average of 

the results from paragraphs (a)(3)(i) and 

(a)(3)(ii). Example. [(ASP for direct sales 

× direct sales units) + (ASP for indirect 

sales × indirect sales units)]/(direct sales 

units + indirect units sales units). 

(4) To the extent that data on price 

concessions, as described in paragraph 

(a)(2) of this section, are available on a 

lagged basis, the manufacturer must 

estimate this amount in accordance with 

the methodology described in 

paragraphs (a)(4)(i) through (a)(4)(iv) of 

this section, for each of the amounts 

calculated under paragraphs (a)(3)(i) 

and (a)(3)(ii) of this section, before 

calculating the weighted average 

described in paragraph (a)(3)(iii) of this 

section. 

(i) For each National Drug Code, the 

manufacturer calculates a percentage 

equal to the sum of the price 

concessions for the most recent 12-

month period available associated with 

sales subject to the average sales price 

reporting requirement divided by the 

total in dollars for the sales subject to 

the average sales price reporting 

requirement for the same 12-month 

period. 

(ii) The manufacturer then multiplies 

the percentage described in paragraph 

(a)(4)(i) of this section by the total in 

dollars for the sales subject to the 

average sales price reporting 

requirement for the quarter being 

submitted. (The manufacturer must 

carry a sufficient number of decimal 

places in the calculation of the price 

concessions percentage in order to 

round accurately the net total sales 

amount for the quarter to the nearest 

whole dollar.) The result of this 

multiplication is then subtracted from 

the total in dollars for the sales subject 

to the average sales price reporting 

requirement for the quarter being 

submitted.

(iii) The manufacturer then uses the 

result of the calculation described in 

paragraph (a)(4)(ii) of this section as the 

numerator and the number of units sold 

in the quarter as the denominator to 

calculate the manufacturer’s average 

sales price for the National Drug Code 

in the quarter being submitted. 

(iv) Example. The total lagged price 

concessions (discounts, rebates, etc.) 

over the most recent 12-month period 

available associated with direct sales for 

National Drug Code 12345–6789–01 

subject to the ASP reporting 

requirement equal $200,000. The total 

in dollars for the direct sales subject to 

the average sales price reporting 

requirement for the same period equals 

$600,000. The lagged price concessions 

percentage for this period equals 

200,000/600,000 = .33333. The total in 

dollars for the direct sales subject to the 

average sales price reporting 

requirement for the quarter being 

reported equals $50,000 for 10,000 

direct sales units sold. Assuming no 

non-lagged price concessions apply, the 

manufacturer’s average sales price 

calculation for direct sales for this 

National Drug Code for this quarter is: 

$50,000—(0.33333 × $50,000) = $33,334 

(net total direct sales amount); $33,334/

10,000 = $3.33 (average sales price for 

direct sales). The average sales price for 

indirect sales is calculated 

independently.

* * * * *

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45875

Subpart L—Supplying and Dispensing 

Fees 

23. Section 414.1001 is amended by 

revising paragraph (a) as follows:

§ 414.1001 Basis of payment. 

(a) A supplying fee of $24 is paid to 

a supplier for the first prescription of 

drugs and biologicals described in 

sections 1861(s)(2)(J), 1861(s)(2)(Q), and 

1861(s)(2)(T) of the Act that that 

supplier provided to a beneficiary 

during a month. A supplying fee of $8 

is paid to a supplier for each 

prescription of drugs and biologicals 

described in sections 1861(s)(2)(J), 

1861(s)(2)(Q), and 1861(s)(2)(T) of the 

Act, after the first one, that that supplier 

provided to a beneficiary during a 

month.

* * * * *

PART 426—REVIEW OF NATIONAL 

COVERAGE DETERMINATIONS AND 

LOCAL COVERAGE 

DETERMINATIONS 

24. The authority citation for part 426 

continues to read as follows:

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh).

25. The heading for part 426 is revised 

to read as set forth above.

Subpart C—General Provisions for the 

Review of LCDs and NCDs 

26. Section 426.340 is amended by—

A. Revising paragraph (e)(2). 

B. Adding paragraph (e)(3). 

C. Revising paragraph (f)(2). 

D. Adding paragraph (f)(3). 

The revisions and additions read as 

follows:

§ 426.340 Procedures for review of new 

evidence.

* * * * *

(e) * * * 

(2) For LCDs, sets a reasonable 

timeframe, not more than 90 days, by 

which the contractor completes the 

reconsideration. 

(3) For NCDs, sets a reasonable 

timeframe, in compliance with the 

timeframes specified in section 1862(1) 

of the Act, by which CMS completes the 

reconsideration. 

(f) * * * 

(2) For LCDs, the 90-day 

reconsideration timeframe is not met. 

(3) For NCDs, the reconsideration 

timeframe as specified by the Board, in 

compliance with section 1862(1) of the 

Act, is not met.

* * * * *

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program).

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program).

Dated: July 12, 2005. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Approved: July 18, 2005. 

Michael O. Leavitt, 

Secretary.

45876 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

Note: These addenda will not appear in the 

Code of Federal Regulations.

Addendum A—Explanation and Use of 

Addenda B 

The addenda on the following pages 

provide various data pertaining to the 

Medicare fee schedule for physicians’

services furnished in 2006. Addendum 

B contains the RVUs for work, nonfacility practice expense, facility 

practice expense, and malpractice 

expense, and other information for all 

services included in the physician fee 

schedule. 

In previous years, we have listed 

many services in Addendum B that are 

not paid under the physician fee 

schedule. To avoid publishing as many 

pages of codes for these services, we are 

not including clinical laboratory codes 

and most alpha-numeric codes 

(Healthcare Common Procedure Coding 

System (HCPCS) codes not included in 

CPT) in Addendum B. 

Addendum B—2006 Relative Value 

Units and Related Information Used in 

Determining Medicare Payments For 

2006

This addendum contains the 

following information for each CPT 

code and alphanumeric HCPCS code, 

except for alphanumeric codes 

beginning with B (enteral and parenteral 

therapy), E (durable medical 

equipment), K (temporary codes for 

nonphysicians’ services or items), or L 

(orthotics), and codes for 

anesthesiology. 

1. CPT/HCPCS code. This is the CPT 

or alphanumeric HCPCS number for the 

service. Alphanumeric HCPCS codes are 

included at the end of this addendum. 

2. Modifier. A modifier is shown if 

there is a technical component (modifier 

TC) and a professional component (PC) 

(modifier –26) for the service. If there is 

a PC and a TC for the service, 

Addendum B contains three entries for 

the code: One for the global values (both 

professional and technical); one for 

modifier –26 (PC); and one for modifier 

TC. The global service is not designated 

by a modifier, and physicians must bill 

using the code without a modifier if the 

physician furnishes both the PC and the 

TC of the service. 

Modifier –53 is shown for a 

discontinued procedure. There will be 

RVUs for the code (CPT code 45378) 

with this modifier. 

3. Status indicator. This indicator 

shows whether the CPT/HCPCS code is 

in the physician fee schedule and 

whether it is separately payable if the 

service is covered. 

A = Active code. These codes are 

separately payable under the fee 

schedule if covered. There will be RVUs 

for codes with this status. The presence 

of an ‘‘A’’ indicator does not mean that 

Medicare has made a national coverage 

determination regarding the coverage of 

the service. Carriers remain responsible 

for coverage decisions in the absence of 

a national Medicare policy. 

B = Bundled code. Payment for 

covered services is always bundled into 

payment for other services not specified. 

If RVUs are shown, they are not used for 

Medicare payment. If these services are 

covered, payment for them is subsumed 

by the payment for the services to which 

they are incident. (An example is a 

telephone call from a hospital nurse 

regarding care of a patient.) 

C = Carrier-priced code. Carriers will 

establish RVUs and payment amounts 

for these services, generally on a caseby-case basis following review of 

documentation, such as an operative 

report. 

D = Deleted/discontinued code. These 

codes are deleted effective with the 

beginning of the calendar year. 

E = Excluded from physician fee 

schedule by regulation. These codes are 

for items or services that CMS chose to 

exclude from the physician fee schedule 

payment by regulation. No RVUs are 

shown, and no payment may be made 

under the physician fee schedule for 

these codes. Payment for them, if they 

are covered, continues under reasonable 

charge or other payment procedures. 

F = Deleted/discontinued codes. 

(Code not subject to a 90-day grace 

period.) These codes are deleted 

effective with the beginning of the year 

and are never subject to a grace period. 

This indicator is no longer effective 

with the 2006 physician fee schedule as 

of January 1, 2006. 

G = Code not valid for Medicare 

purposes. Medicare does not recognize 

codes assigned this status. Medicare 

uses another code for reporting of, and 

payment for, these services. (Code 

subject to a 90 day grace period.) This 

indicator is no longer effective with the 

2006 physician fee schedule as of 

January 1, 2006. 

H = Deleted modifier. For 2000 and 

later years, either the TC or PC 

component shown for the code has been 

deleted and the deleted component is 

shown in the data base with the H status 

indicator. 

I = Not valid for Medicare purposes. 

Medicare uses another code for the 

reporting of, and the payment for these 

services. (Code NOT subject to a 90-day 

grace period.) 

N = Noncovered service. These codes 

are noncovered services. Medicare 

payment may not be made for these 

codes. If RVUs are shown, they are not 

used for Medicare payment. 

P = Bundled or excluded code. There 

are no RVUs for these services. No 

separate payment is made for them 

under the physician fee schedule.

—If the item or service is covered as 

incident to a physician’s service and 

is furnished on the same day as a 

physician’s service, payment for it is 

bundled into the payment for the 

physician’s service to which it is 

incident (an example is an elastic 

bandage furnished by a physician 

incident to a physician’s service). 

—If the item or service is covered as 

other than incident to a physician’s 

service, it is excluded from the 

physician fee schedule (for example, 

colostomy supplies) and is paid under 

the other payment provisions of the 

Act.

R = Restricted coverage. Special 

coverage instructions apply. If the 

service is covered and no RVUs are 

shown, it is carrier-priced. 

T = Injections. There are RVUs for 

these services, but they are only paid if 

there are no other services payable 

under the physician fee schedule billed 

on the same date by the same provider. 

If any other services payable under the 

physician fee schedule are billed on the 

same date by the same provider, these 

services are bundled into the service(s) 

for which payment is made. 

X = Exclusion by law. These codes 

represent an item or service that is not 

within the definition of ‘‘physicians’

services’’ for physician fee schedule 

payment purposes. No RVUs are shown 

for these codes, and no payment may be 

made under the physician fee schedule. 

(Examples are ambulance services and 

clinical diagnostic laboratory services.) 

4. Description of code. This is an 

abbreviated version of the narrative 

description of the code. 

5. Physician work RVUs. These are the 

RVUs for the physician work for this 

service in 2005. Codes that are not used 

for Medicare payment are identified 

with a ‘‘+.’’

6. Non-facility practice expense 

RVUs. These are the fully implemented 

resource-based practice expense RVUs 

for non-facility settings. 

7. Facility practice expense RVUs.

These are the fully implemented 

resource-based practice expense RVUs 

for facility settings. 

8. Malpractice expense RVUs. These 

are the RVUs for the malpractice 

expense for the service for 2005. 

9. Facility total. This is the sum of the 

work, fully implemented facility 

practice expense, and malpractice 

expense RVUs. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 45877

10. Non-facility total. This is the sum 

of the work, fully implemented nonfacility practice expense, and 

malpractice expense RVUs. 

11. Global period. This indicator 

shows the number of days in the global 

period for the code (0, 10, or 90 days). 

An explanation of the alpha codes 

follows: 

MMM = The code describes a service 

furnished in uncomplicated maternity 

cases including antepartum care, 

delivery, and postpartum care. The 

usual global surgical concept does not 

apply. See the 1999 Physicians’ Current 

Procedural Terminology for specific 

definitions. 

XXX = The global concept does not 

apply. 

YYY = The global period is to be set 

by the carrier (for example, unlisted 

surgery codes). 

ZZZ = Code related to another service 

that is always included in the global 

period of the other service. (Note: 

Physician work and practice expense 

are associated with intra service time 

and in some instances the post service 

time.)

45878

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

0003T ......... ............ C Cervicography ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0008T ......... ............ C Upper gi endoscopy w/suture ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0010T ......... ............ C Tb test, gamma interferon ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0016T ......... ............ C Thermotx choroid vasc lesion ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0017T ......... ............ C Photocoagulat macular drusen ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0018T ......... ............ C Transcranial magnetic stimul ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0019T ......... ............ I Extracorp shock wave tx, ms ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0020T ......... ............ C Extracorp shock wave tx, ft ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0021T ......... ............ C Fetal oximetry, trnsvag/cerv ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0023T ......... ............ C Phenotype drug test, hiv 1 .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0024T ......... ............ C Transcath cardiac reduction ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0026T ......... ............ C Measure remnant lipoproteins ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0027T ......... ............ C Endoscopic epidural lysis ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0028T ......... ............ C Dexa body composition study ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0029T ......... ............ C Magnetic tx for incontinence ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0030T ......... ............ C Antiprothrombin antibody ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0031T ......... ............ C Speculoscopy .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0032T ......... ............ C Speculoscopy w/direct sample .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0033T ......... ............ C Endovasc taa repr incl subcl ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0034T ......... ............ C Endovasc taa repr w/o subcl ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0035T ......... ............ C Insert endovasc prosth, taa ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0036T ......... ............ C Endovasc prosth, taa, add-on ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0037T ......... ............ C Artery transpose/endovas taa ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0038T ......... ............ C Rad endovasc taa rpr w/cover .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0039T ......... ............ C Rad s/i, endovasc taa repair ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0040T ......... ............ C Rad s/i, endovasc taa prosth ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0041T ......... ............ C Detect ur infect agnt w/cpas ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0042T ......... ............ C Ct perfusion w/contrast, cbf ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0043T ......... ............ C Co expired gas analysis .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0044T ......... ............ C Whole body photography ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0045T ......... ............ C Whole body photography ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0046T ......... ............ C Cath lavage, mammary duct(s .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0047T ......... ............ C Cath lavage, mammary duct(s) ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0048T ......... ............ C Implant ventricular device ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0049T ......... ............ C External circulation assist ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0050T ......... ............ C Removal circulation assist ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0051T ......... ............ C Implant total heart system ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0052T ......... ............ C Replace component heart syst ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0053T ......... ............ C Replace component heart syst ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0054T ......... ............ C Bone surgery using computer ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0055T ......... ............ C Bone surgery using computer ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0056T ......... ............ C Bone surgery using computer ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0058T ......... ............ C Cryopreservation, ovary tiss ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0059T ......... ............ C Cryopreservation, oocyte ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0060T ......... ............ C Electrical impedance scan .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0061T ......... ............ C Destruction of tumor, breast ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0062T ......... ............ C Rep intradisc annulus;1 lev ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0063T ......... ............ C Rep intradisc annulus;>1lev ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0064T ......... ............ C Spectroscop eval expired gas ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0065T ......... ............ C Ocular photoscreen bilat ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0066T ......... ............ N Ct colonography;screen .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0066T ......... 26 ....... N Ct colonography;screen .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0066T ......... TC ...... N Ct colonography;screen .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0067T ......... ............ C Ct colonography;dx ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0067T ......... 26 ....... C Ct colonography;dx ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0067T ......... TC ...... C Ct colonography;dx ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0068T ......... ............ C Interp/rept heart sound ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0069T ......... ............ C Analysis only heart sound ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0070T ......... ............ C Interp only heart sound ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0071T ......... ............ C U/s leiomyomata ablate <200 ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0072T ......... ............ C U/s leiomyomata ablate >200 ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0073T ......... ............ A Delivery, comp imrt ..................................... 0.00 16.71 NA 0.13 16.84 NA XXX 

0074T ......... ............ N Online physician e/m ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0075T ......... ............ C Perq stent/chest vert art .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0075T ......... 26 ....... C Perq stent/chest vert art .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0075T ......... TC ...... C Perq stent/chest vert art .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0076T ......... ............ C S&i stent/chest vert art ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0076T ......... 26 ....... C S&i stent/chest vert art ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0076T ......... TC ...... C S&i stent/chest vert art ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0077T ......... ............ C Cereb therm perfusion probe ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0078T ......... ............ C Endovasc aort repr w/device ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0079T ......... ............ C Endovasc visc extnsn repr .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0080T ......... ............ C Endovasc aort repr rad s&i ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0081T ......... ............ C Endovasc visc extnsn s&i ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

45879

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

0082T ......... ............ C Stereotactic rad delivery .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0083T ......... ............ C Stereotactic rad tx mngmt ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0084T ......... ............ C Temp prostate urethral stent ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0085T ......... ............ C Breath test heart reject ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0086T ......... ............ C L ventricle fill pressure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0087T ......... ............ C Sperm eval hyaluronan ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0088T ......... ............ C Rf tongue base vol reduxn .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0500F ......... ............ I Initial prenatal care visit .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0501F ......... ............ I Prenatal flow sheet ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0502F ......... ............ I Subsequent prenatal care ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0503F ......... ............ I Postpartum care visit ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

1000F ......... ............ I Tobacco use, smoking, assess ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

1001F ......... ............ I Tobacco use, non-smoking ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

10021 .......... ............ A Fna w/o image ............................................. 1.27 2.11 0.53 0.10 3.48 1.90 XXX 

10022 .......... ............ A Fna w/image ................................................ 1.27 2.51 0.44 0.08 3.86 1.79 XXX 

1002F ......... ............ I Assess anginal symptom/level .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

10040 .......... ............ A Acne surgery ............................................... 1.18 1.12 0.84 0.05 2.35 2.07 010 

10060 .......... ............ A Drainage of skin abscess ............................ 1.17 1.27 0.94 0.12 2.56 2.24 010 

10061 .......... ............ A Drainage of skin abscess ............................ 2.40 1.90 1.49 0.26 4.56 4.15 010 

10080 .......... ............ A Drainage of pilonidal cyst ............................ 1.17 2.98 1.07 0.11 4.27 2.36 010 

10081 .......... ............ A Drainage of pilonidal cyst ............................ 2.45 3.91 1.48 0.24 6.60 4.17 010 

10120 .......... ............ A Remove foreign body .................................. 1.22 2.14 0.94 0.12 3.49 2.28 010 

10121 .......... ............ A Remove foreign body .................................. 2.70 3.47 1.75 0.33 6.49 4.77 010 

10140 .......... ............ A Drainage of hematoma/fluid ........................ 1.53 1.83 1.29 0.19 3.56 3.01 010 

10160 .......... ............ A Puncture drainage of lesion ........................ 1.20 1.62 1.08 0.14 2.96 2.43 010 

10180 .......... ............ A Complex drainage, wound .......................... 2.25 2.95 1.93 0.35 5.55 4.53 010 

11000 .......... ............ A Debride infected skin ................................... 0.60 0.61 0.21 0.07 1.28 0.88 000 

11001 .......... ............ A Debride infected skin add-on ...................... 0.30 0.24 0.11 0.04 0.58 0.45 ZZZ 

11004 .......... ............ A Debride genitalia & perineum ...................... 10.33 NA 3.80 0.67 NA 14.80 000 

11005 .......... ............ A Debride abdom wall .................................... 13.78 NA 5.42 0.96 NA 20.16 000 

11006 .......... ............ A Debride genit/per/abdom wall ..................... 12.64 NA 4.73 1.28 NA 18.64 000 

11008 .......... ............ A Remove mesh from abd wall ...................... 5.01 NA 1.97 0.61 NA 7.59 ZZZ 

11010 .......... ............ A Debride skin, fx ........................................... 4.20 6.68 2.57 0.66 11.54 7.43 010 

11011 .......... ............ A Debride skin/muscle, fx ............................... 4.95 7.80 2.29 0.74 13.49 7.98 000 

11012 .......... ............ A Debride skin/muscle/bone, fx ...................... 6.88 11.37 3.73 1.16 19.41 11.78 000 

11040 .......... ............ A Debride skin, partial .................................... 0.50 0.55 0.21 0.06 1.11 0.77 000 

11041 .......... ............ A Debride skin, full .......................................... 0.82 0.68 0.32 0.10 1.60 1.24 000 

11042 .......... ............ A Debride skin/tissue ...................................... 1.12 0.98 0.43 0.13 2.23 1.68 000 

11043 .......... ............ A Debride tissue/muscle ................................. 2.38 3.33 2.54 0.32 6.03 5.25 010 

11044 .......... ............ A Debride tissue/muscle/bone ........................ 3.07 4.38 3.65 0.43 7.88 7.15 010 

11055 .......... ............ R Trim skin lesion ........................................... 0.43 0.60 0.17 0.05 1.08 0.65 000 

11056 .......... ............ R Trim skin lesions, 2 to 4 .............................. 0.61 0.68 0.23 0.07 1.36 0.91 000 

11057 .......... ............ R Trim skin lesions, over 4 ............................. 0.79 0.78 0.29 0.10 1.68 1.18 000 

11100 .......... ............ A Biopsy, skin lesion ....................................... 0.81 1.38 0.39 0.03 2.22 1.23 000 

11101 .......... ............ A Biopsy, skin add-on ..................................... 0.41 0.37 0.20 0.02 0.80 0.63 ZZZ 

11200 .......... ............ A Removal of skin tags ................................... 0.77 1.11 0.78 0.04 1.92 1.59 010 

11201 .......... ............ A Remove skin tags add-on ........................... 0.29 0.17 0.12 0.02 0.48 0.43 ZZZ 

11300 .......... ............ A Shave skin lesion ........................................ 0.51 1.05 0.21 0.03 1.59 0.75 000 

11301 .......... ............ A Shave skin lesion ........................................ 0.85 1.22 0.39 0.04 2.11 1.28 000 

11302 .......... ............ A Shave skin lesion ........................................ 1.05 1.43 0.46 0.05 2.53 1.57 000 

11303 .......... ............ A Shave skin lesion ........................................ 1.24 1.73 0.52 0.07 3.04 1.83 000 

11305 .......... ............ A Shave skin lesion ........................................ 0.67 0.91 0.27 0.07 1.65 1.01 000 

11306 .......... ............ A Shave skin lesion ........................................ 0.99 1.20 0.42 0.07 2.27 1.48 000 

11307 .......... ............ A Shave skin lesion ........................................ 1.14 1.41 0.49 0.07 2.63 1.70 000 

11308 .......... ............ A Shave skin lesion ........................................ 1.41 1.56 0.58 0.13 3.10 2.13 000 

11310 .......... ............ A Shave skin lesion ........................................ 0.73 1.19 0.32 0.04 1.96 1.09 000 

11311 .......... ............ A Shave skin lesion ........................................ 1.05 1.35 0.49 0.05 2.45 1.59 000 

11312 .......... ............ A Shave skin lesion ........................................ 1.20 1.57 0.55 0.06 2.83 1.81 000 

11313 .......... ............ A Shave skin lesion ........................................ 1.62 1.95 0.71 0.10 3.67 2.43 000 

11400 .......... ............ A Exc tr-ext b9+marg 0.5 < cm ...................... 0.85 1.98 0.88 0.06 2.89 1.79 010 

11401 .......... ............ A Exc tr-ext b9+marg 0.6-1 cm ...................... 1.23 2.08 1.01 0.10 3.42 2.35 010 

11402 .......... ............ A Exc tr-ext b9+marg 1.1-2 cm ...................... 1.51 2.26 1.07 0.13 3.91 2.72 010 

11403 .......... ............ A Exc tr-ext b9+marg 2.1-3 cm ...................... 1.79 2.43 1.32 0.17 4.39 3.28 010 

11404 .......... ............ A Exc tr-ext b9+marg 3.1-4 cm ...................... 2.06 2.74 1.40 0.21 5.01 3.67 010 

11406 .......... ............ A Exc tr-ext b9+marg > 4.0 cm ...................... 2.77 3.08 1.64 0.32 6.16 4.73 010 

11420 .......... ............ A Exc h-f-nk-sp b9+marg 0.5 < ...................... 0.98 1.79 0.93 0.09 2.86 2.00 010 

11421 .......... ............ A Exc h-f-nk-sp b9+marg 0.6-1 ...................... 1.42 2.11 1.10 0.13 3.66 2.66 010 

11422 .......... ............ A Exc h-f-nk-sp b9+marg 1.1-2 ...................... 1.63 2.30 1.33 0.16 4.09 3.12 010 

11423 .......... ............ A Exc h-f-nk-sp b9+marg 2.1-3 ...................... 2.01 2.61 1.45 0.20 4.83 3.66 010 

11424 .......... ............ A Exc h-f-nk-sp b9+marg 3.1-4 ...................... 2.43 2.87 1.60 0.25 5.55 4.28 010 

11426 .......... ............ A Exc h-f-nk-sp b9+marg > 4 cm ................... 3.78 3.50 2.09 0.44 7.72 6.30 010 

11440 .......... ............ A Exc face-mm b9+marg 0.5 < cm ................ 1.06 2.19 1.29 0.08 3.33 2.43 010 

11441 .......... ............ A Exc face-mm b9+marg 0.6-1 cm ................. 1.48 2.35 1.47 0.13 3.97 3.08 010 

11442 .......... ............ A Exc face-mm b9+marg 1.1-2 cm ................. 1.72 2.59 1.55 0.16 4.47 3.43 010 

45880

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

11443 .......... ............ A Exc face-mm b9+marg 2.1-3 cm ................. 2.29 2.96 1.78 0.22 5.48 4.30 010 

11444 .......... ............ A Exc face-mm b9+marg 3.1-4 cm ................. 3.15 3.52 2.14 0.30 6.97 5.59 010 

11446 .......... ............ A Exc face-mm b9+marg > 4 cm ................... 4.49 4.17 2.71 0.43 9.09 7.63 010 

11450 .......... ............ A Removal, sweat gland lesion ...................... 2.74 4.91 2.02 0.34 7.99 5.10 090 

11451 .......... ............ A Removal, sweat gland lesion ...................... 3.95 6.43 2.52 0.53 10.90 7.00 090 

11462 .......... ............ A Removal, sweat gland lesion ...................... 2.52 5.04 2.03 0.32 7.88 4.86 090 

11463 .......... ............ A Removal, sweat gland lesion ...................... 3.95 6.59 2.67 0.54 11.08 7.16 090 

11470 .......... ............ A Removal, sweat gland lesion ...................... 3.26 4.98 2.28 0.40 8.64 5.93 090 

11471 .......... ............ A Removal, sweat gland lesion ...................... 4.41 6.48 2.76 0.58 11.47 7.75 090 

11600 .......... ............ A Exc tr-ext mlg+marg 0.5 < cm .................... 1.31 2.68 0.96 0.10 4.09 2.38 010 

11601 .......... ............ A Exc tr-ext mlg+marg 0.6-1 cm ..................... 1.80 2.86 1.21 0.12 4.78 3.14 010 

11602 .......... ............ A Exc tr-ext mlg+marg 1.1-2 cm ..................... 1.95 3.00 1.25 0.12 5.07 3.32 010 

11603 .......... ............ A Exc tr-ext mlg+marg 2.1-3 cm ..................... 2.19 3.22 1.31 0.16 5.58 3.66 010 

11604 .......... ............ A Exc tr-ext mlg+marg 3.1-4 cm ..................... 2.40 3.52 1.37 0.20 6.13 3.98 010 

11606 .......... ............ A Exc tr-ext mlg+marg > 4 cm ....................... 3.43 4.22 1.70 0.36 8.01 5.49 010 

11620 .......... ............ A Exc h-f-nk-sp mlg+marg 0.5 < .................... 1.19 2.65 0.94 0.09 3.93 2.22 010 

11621 .......... ............ A Exc h-f-nk-sp mlg+marg 0.6-1 ..................... 1.76 2.86 1.22 0.12 4.74 3.11 010 

11622 .......... ............ A Exc h-f-nk-sp mlg+marg 1.1-2 ..................... 2.09 3.14 1.37 0.14 5.38 3.60 010 

11623 .......... ............ A Exc h-f-nk-sp mlg+marg 2.1-3 ..................... 2.62 3.49 1.55 0.20 6.30 4.36 010 

11624 .......... ............ A Exc h-f-nk-sp mlg+marg 3.1-4 ..................... 3.07 3.90 1.74 0.27 7.23 5.07 010 

11626 .......... ............ A Exc h-f-nk-sp mlg+mar > 4 cm ................... 4.30 4.79 2.34 0.45 9.54 7.09 010 

11640 .......... ............ A Exc face-mm malig+marg 0.5 < .................. 1.35 2.74 1.09 0.11 4.20 2.55 010 

11641 .......... ............ A Exc face-mm malig+marg 0.6-1 .................. 2.16 3.19 1.50 0.16 5.52 3.82 010 

11642 .......... ............ A Exc face-mm malig+marg 1.1-2 .................. 2.60 3.59 1.67 0.19 6.38 4.45 010 

11643 .......... ............ A Exc face-mm malig+marg 2.1-3 .................. 3.11 3.98 1.91 0.26 7.34 5.28 010 

11644 .......... ............ A Exc face-mm malig+marg 3.1-4 .................. 4.03 4.87 2.39 0.37 9.27 6.79 010 

11646 .......... ............ A Exc face-mm mlg+marg > 4 cm .................. 5.95 5.96 3.38 0.61 12.53 9.94 010 

11719 .......... ............ R Trim nail(s) .................................................. 0.17 0.27 0.07 0.02 0.46 0.26 000 

11720 .......... ............ A Debride nail, 1-5 .......................................... 0.32 0.36 0.12 0.04 0.72 0.48 000 

11721 .......... ............ A Debride nail, 6 or more ............................... 0.54 0.46 0.21 0.07 1.07 0.82 000 

11730 .......... ............ A Removal of nail plate .................................. 1.13 1.08 0.42 0.14 2.36 1.69 000 

11732 .......... ............ A Remove nail plate, add-on .......................... 0.57 0.46 0.22 0.07 1.10 0.86 ZZZ 

11740 .......... ............ A Drain blood from under nail ........................ 0.37 0.59 0.36 0.04 1.00 0.77 000 

11750 .......... ............ A Removal of nail bed .................................... 1.86 2.27 1.76 0.22 4.35 3.85 010 

11752 .......... ............ A Remove nail bed/finger tip .......................... 2.68 3.09 2.95 0.35 6.12 5.98 010 

11755 .......... ............ A Biopsy, nail unit ........................................... 1.31 1.70 0.78 0.14 3.15 2.23 000 

11760 .......... ............ A Repair of nail bed ........................................ 1.58 2.68 1.71 0.21 4.47 3.50 010 

11762 .......... ............ A Reconstruction of nail bed .......................... 2.90 3.00 2.27 0.36 6.26 5.53 010 

11765 .......... ............ A Excision of nail fold, toe .............................. 0.69 1.91 0.80 0.08 2.68 1.57 010 

11770 .......... ............ A Removal of pilonidal lesion ......................... 2.62 3.43 1.49 0.33 6.37 4.44 010 

11771 .......... ............ A Removal of pilonidal lesion ......................... 5.74 5.69 3.32 0.74 12.18 9.80 090 

11772 .......... ............ A Removal of pilonidal lesion ......................... 6.98 7.42 5.05 0.89 15.29 12.92 090 

11900 .......... ............ A Injection into skin lesions ............................ 0.52 0.72 0.22 0.02 1.26 0.76 000 

11901 .......... ............ A Added skin lesions injection ........................ 0.80 0.76 0.38 0.03 1.59 1.21 000 

11920 .......... ............ R Correct skin color defects ........................... 1.61 3.44 1.08 0.24 5.30 2.93 000 

11921 .......... ............ R Correct skin color defects ........................... 1.93 3.70 1.24 0.29 5.92 3.47 000 

11922 .......... ............ R Correct skin color defects ........................... 0.49 1.08 0.24 0.07 1.65 0.80 ZZZ 

11950 .......... ............ R Therapy for contour defects ........................ 0.84 1.13 0.41 0.06 2.03 1.31 000 

11951 .......... ............ R Therapy for contour defects ........................ 1.19 1.47 0.51 0.11 2.77 1.82 000 

11952 .......... ............ R Therapy for contour defects ........................ 1.69 1.81 0.67 0.16 3.66 2.52 000 

11954 .......... ............ R Therapy for contour defects ........................ 1.85 2.32 0.89 0.25 4.42 3.00 000 

11960 .......... ............ A Insert tissue expander(s) ............................. 9.09 NA 10.12 1.31 NA 20.51 090 

11970 .......... ............ A Replace tissue expander ............................. 7.06 NA 5.95 1.05 NA 14.07 090 

11971 .......... ............ A Remove tissue expander(s) ........................ 2.13 8.65 3.67 0.32 11.10 6.12 090 

11975 .......... ............ N Insert contraceptive cap .............................. 1.48 1.50 0.57 0.17 3.15 2.22 XXX 

11976 .......... ............ R Removal of contraceptive cap ..................... 1.78 1.75 0.66 0.21 3.74 2.66 000 

11977 .......... ............ N Removal/reinsert contra cap ....................... 3.31 2.31 1.25 0.37 5.99 4.93 XXX 

11980 .......... ............ A Implant hormone pellet(s) ........................... 1.48 1.12 0.58 0.13 2.73 2.19 000 

11981 .......... ............ A Insert drug implant device ........................... 1.48 1.82 0.67 0.12 3.43 2.28 XXX 

11982 .......... ............ A Remove drug implant device ...................... 1.78 2.03 0.82 0.17 3.98 2.78 XXX 

11983 .......... ............ A Remove/insert drug implant ........................ 3.31 2.51 1.51 0.23 6.05 5.04 XXX 

12001 .......... ............ A Repair superficial wound(s) ......................... 1.70 1.91 0.75 0.15 3.76 2.60 010 

12002 .......... ............ A Repair superficial wound(s) ......................... 1.86 1.97 0.87 0.17 4.00 2.90 010 

12004 .......... ............ A Repair superficial wound(s) ......................... 2.24 2.24 0.98 0.21 4.70 3.43 010 

12005 .......... ............ A Repair superficial wound(s) ......................... 2.87 2.73 1.16 0.27 5.87 4.30 010 

12006 .......... ............ A Repair superficial wound(s) ......................... 3.67 3.28 1.47 0.35 7.29 5.49 010 

12007 .......... ............ A Repair superficial wound(s) ......................... 4.12 3.69 1.76 0.45 8.26 6.33 010 

12011 .......... ............ A Repair superficial wound(s) ......................... 1.76 2.06 0.76 0.16 3.99 2.68 010 

12013 .......... ............ A Repair superficial wound(s) ......................... 1.99 2.20 0.90 0.18 4.37 3.07 010 

12014 .......... ............ A Repair superficial wound(s) ......................... 2.46 2.49 1.02 0.23 5.19 3.72 010 

12015 .......... ............ A Repair superficial wound(s) ......................... 3.20 3.03 1.21 0.29 6.52 4.70 010 

12016 .......... ............ A Repair superficial wound(s) ......................... 3.93 3.45 1.48 0.37 7.74 5.78 010 

12017 .......... ............ A Repair superficial wound(s) ......................... 4.71 NA 1.84 0.47 NA 7.02 010 

12018 .......... ............ A Repair superficial wound(s) ......................... 5.53 NA 2.19 0.64 NA 8.37 010 

45881

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

12020 .......... ............ A Closure of split wound ................................. 2.63 3.78 1.88 0.30 6.71 4.80 010 

12021 .......... ............ A Closure of split wound ................................. 1.84 1.82 1.40 0.24 3.90 3.48 010 

12031 .......... ............ A Layer closure of wound(s) ........................... 2.15 2.69 1.06 0.17 5.01 3.39 010 

12032 .......... ............ A Layer closure of wound(s) ........................... 2.47 4.16 1.76 0.16 6.80 4.39 010 

12034 .......... ............ A Layer closure of wound(s) ........................... 2.93 3.55 1.47 0.25 6.73 4.64 010 

12035 .......... ............ A Layer closure of wound(s) ........................... 3.43 5.25 2.09 0.39 9.07 5.91 010 

12036 .......... ............ A Layer closure of wound(s) ........................... 4.05 5.50 2.47 0.55 10.10 7.07 010 

12037 .......... ............ A Layer closure of wound(s) ........................... 4.67 6.07 2.88 0.66 11.40 8.21 010 

12041 .......... ............ A Layer closure of wound(s) ........................... 2.37 2.89 1.20 0.19 5.46 3.77 010 

12042 .......... ............ A Layer closure of wound(s) ........................... 2.75 3.58 1.49 0.17 6.50 4.41 010 

12044 .......... ............ A Layer closure of wound(s) ........................... 3.15 3.70 1.61 0.27 7.12 5.03 010 

12045 .......... ............ A Layer closure of wound(s) ........................... 3.64 5.20 2.22 0.41 9.25 6.27 010 

12046 .......... ............ A Layer closure of wound(s) ........................... 4.25 6.30 2.68 0.54 11.09 7.47 010 

12047 .......... ............ A Layer closure of wound(s) ........................... 4.65 6.42 2.99 0.58 11.64 8.22 010 

12051 .......... ............ A Layer closure of wound(s) ........................... 2.47 3.52 1.47 0.20 6.19 4.15 010 

12052 .......... ............ A Layer closure of wound(s) ........................... 2.78 3.56 1.46 0.17 6.50 4.40 010 

12053 .......... ............ A Layer closure of wound(s) ........................... 3.13 3.83 1.55 0.23 7.18 4.91 010 

12054 .......... ............ A Layer closure of wound(s) ........................... 3.46 4.13 1.64 0.30 7.89 5.40 010 

12055 .......... ............ A Layer closure of wound(s) ........................... 4.43 5.03 2.12 0.45 9.91 7.00 010 

12056 .......... ............ A Layer closure of wound(s) ........................... 5.24 6.86 2.95 0.59 12.69 8.78 010 

12057 .......... ............ A Layer closure of wound(s) ........................... 5.96 6.58 3.62 0.56 13.11 10.15 010 

13100 .......... ............ A Repair of wound or lesion ........................... 3.13 4.22 2.26 0.26 7.60 5.64 010 

13101 .......... ............ A Repair of wound or lesion ........................... 3.92 5.05 2.65 0.26 9.23 6.82 010 

13102 .......... ............ A Repair wound/lesion add-on ....................... 1.24 1.27 0.56 0.13 2.64 1.93 ZZZ 

13120 .......... ............ A Repair of wound or lesion ........................... 3.31 4.29 2.29 0.26 7.85 5.86 010 

13121 .......... ............ A Repair of wound or lesion ........................... 4.33 5.26 2.75 0.25 9.84 7.32 010 

13122 .......... ............ A Repair wound/lesion add-on ....................... 1.44 1.54 0.62 0.15 3.13 2.21 ZZZ 

13131 .......... ............ A Repair of wound or lesion ........................... 3.79 4.58 2.63 0.26 8.63 6.68 010 

13132 .......... ............ A Repair of wound or lesion ........................... 5.95 6.47 4.16 0.32 12.74 10.43 010 

13133 .......... ............ A Repair wound/lesion add-on ....................... 2.19 1.80 1.02 0.18 4.18 3.39 ZZZ 

13150 .......... ............ A Repair of wound or lesion ........................... 3.81 4.92 2.70 0.34 9.06 6.85 010 

13151 .......... ............ A Repair of wound or lesion ........................... 4.45 5.08 3.10 0.31 9.83 7.86 010 

13152 .......... ............ A Repair of wound or lesion ........................... 6.33 6.56 3.96 0.40 13.30 10.69 010 

13153 .......... ............ A Repair wound/lesion add-on ....................... 2.38 2.07 1.11 0.24 4.69 3.74 ZZZ 

13160 .......... ............ A Late closure of wound ................................. 10.48 NA 7.03 1.54 NA 19.05 090 

14000 .......... ............ A Skin tissue rearrangement .......................... 5.89 8.20 5.35 0.59 14.68 11.83 090 

14001 .......... ............ A Skin tissue rearrangement .......................... 8.48 10.09 6.90 0.82 19.39 16.20 090 

14020 .......... ............ A Skin tissue rearrangement .......................... 6.59 9.07 6.37 0.64 16.30 13.61 090 

14021 .......... ............ A Skin tissue rearrangement .......................... 10.06 10.93 8.08 0.81 21.80 18.95 090 

14040 .......... ............ A Skin tissue rearrangement .......................... 7.88 9.46 7.06 0.62 17.95 15.55 090 

14041 .......... ............ A Skin tissue rearrangement .......................... 11.49 11.70 8.59 0.73 23.92 20.81 090 

14060 .......... ............ A Skin tissue rearrangement .......................... 8.51 9.39 7.32 0.68 18.58 16.51 090 

14061 .......... ............ A Skin tissue rearrangement .......................... 12.29 12.73 9.39 0.76 25.78 22.44 090 

14300 .......... ............ A Skin tissue rearrangement .......................... 11.76 12.16 8.95 1.16 25.09 21.87 090 

14350 .......... ............ A Skin tissue rearrangement .......................... 9.62 NA 7.01 1.34 NA 17.97 090 

15000 .......... ............ A Skin graft ..................................................... 4.00 3.98 2.14 0.54 8.52 6.68 000 

15001 .......... ............ A Skin graft add-on ......................................... 1.00 1.32 0.40 0.14 2.46 1.54 ZZZ 

15050 .......... ............ A Skin pinch graft ........................................... 4.30 6.91 4.97 0.57 11.78 9.84 090 

15100 .......... ............ A Skin split graft .............................................. 9.06 12.29 7.58 1.28 22.63 17.91 090 

15101 .......... ............ A Skin split graft add-on ................................. 1.72 3.48 1.11 0.24 5.45 3.08 ZZZ 

15120 .......... ............ A Skin split graft .............................................. 9.84 11.33 7.57 1.16 22.32 18.57 090 

15121 .......... ............ A Skin split graft add-on ................................. 2.68 4.31 1.75 0.36 7.34 4.79 ZZZ 

15200 .......... ............ A Skin full graft ............................................... 8.04 9.81 6.07 0.98 18.82 15.09 090 

15201 .......... ............ A Skin full graft add-on ................................... 1.32 2.51 0.60 0.19 4.02 2.12 ZZZ 

15220 .......... ............ A Skin full graft ............................................... 7.88 9.79 6.51 0.84 18.51 15.23 090 

15221 .......... ............ A Skin full graft add-on ................................... 1.19 2.30 0.55 0.16 3.65 1.90 ZZZ 

15240 .......... ............ A Skin full graft ............................................... 9.05 10.88 7.76 0.92 20.85 17.72 090 

15241 .......... ............ A Skin full graft add-on ................................... 1.86 2.54 0.89 0.23 4.63 2.98 ZZZ 

15260 .......... ............ A Skin full graft ............................................... 10.06 11.18 8.47 0.69 21.93 19.22 090 

15261 .......... ............ A Skin full graft add-on ................................... 2.23 2.85 1.36 0.21 5.29 3.80 ZZZ 

15342 .......... ............ A Cultured skin graft, 25 cm ........................... 1.00 1.86 0.54 0.12 2.98 1.66 010 

15343 .......... ............ A Culture skn graft addl 25 cm ....................... 0.25 0.09 0.09 0.03 0.37 0.37 ZZZ 

15350 .......... ............ A Skin homograft ............................................ 4.00 6.20 3.75 0.51 10.71 8.26 090 

15351 .......... ............ A Skin homograft add-on ................................ 1.00 NA 0.36 0.14 NA 1.50 ZZZ 

15400 .......... ............ A Skin heterograft ........................................... 4.00 4.14 3.97 0.47 8.61 8.43 090 

15401 .......... ............ A Skin heterograft add-on ............................... 1.00 1.79 0.43 0.14 2.93 1.57 ZZZ 

15570 .......... ............ A Form skin pedicle flap ................................. 9.22 10.97 6.57 1.34 21.53 17.13 090 

15572 .......... ............ A Form skin pedicle flap ................................. 9.28 9.50 6.27 1.20 19.98 16.75 090 

15574 .......... ............ A Form skin pedicle flap ................................. 9.89 10.88 7.59 1.20 21.97 18.68 090 

15576 .......... ............ A Form skin pedicle flap ................................. 8.70 9.94 6.72 0.87 19.51 16.29 090 

15600 .......... ............ A Skin graft ..................................................... 1.91 7.11 2.95 0.27 9.29 5.13 090 

15610 .......... ............ A Skin graft ..................................................... 2.42 4.58 3.30 0.35 7.36 6.07 090 

15620 .......... ............ A Skin graft ..................................................... 2.95 7.48 3.77 0.35 10.77 7.07 090 

15630 .......... ............ A Skin graft ..................................................... 3.28 7.06 4.05 0.34 10.68 7.66 090 

45882

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

15650 .......... ............ A Transfer skin pedicle flap ............................ 3.97 7.20 4.12 0.42 11.59 8.50 090 

15732 .......... ............ A Muscle-skin graft, head/neck ...................... 17.85 17.55 11.84 1.99 37.38 31.67 090 

15734 .......... ............ A Muscle-skin graft, trunk ............................... 17.80 17.23 11.96 2.61 37.64 32.36 090 

15736 .......... ............ A Muscle-skin graft, arm ................................. 16.28 17.29 10.85 2.45 36.03 29.58 090 

15738 .......... ............ A Muscle-skin graft, leg .................................. 17.93 17.10 11.35 2.65 37.68 31.92 090 

15740 .......... ............ A Island pedicle flap graft ............................... 10.25 11.22 8.29 0.63 22.11 19.17 090 

15750 .......... ............ A Neurovascular pedicle graft ........................ 11.41 NA 8.81 1.42 NA 21.65 090 

15756 .......... ............ A Free myo/skin flap microvasc ..................... 35.25 NA 19.96 4.61 NA 59.82 090 

15757 .......... ............ A Free skin flap, microvasc ............................ 35.25 NA 20.93 3.89 NA 60.07 090 

15758 .......... ............ A Free fascial flap, microvasc ........................ 35.12 NA 20.93 4.23 NA 60.28 090 

15760 .......... ............ A Composite skin graft ................................... 8.75 10.37 7.07 0.85 19.97 16.66 090 

15770 .......... ............ A Derma-fat-fascia graft .................................. 7.53 NA 6.55 1.05 NA 15.13 090 

15775 .......... ............ R Hair transplant punch grafts ........................ 3.96 4.40 1.34 0.52 8.88 5.82 000 

15776 .......... ............ R Hair transplant punch grafts ........................ 5.54 5.71 2.82 0.72 11.97 9.08 000 

15780 .......... ............ A Abrasion treatment of skin .......................... 7.29 11.64 8.13 0.67 19.61 16.09 090 

15781 .......... ............ A Abrasion treatment of skin .......................... 4.85 7.37 5.36 0.34 12.56 10.55 090 

15782 .......... ............ A Abrasion treatment of skin .......................... 4.32 9.54 6.31 0.34 14.20 10.96 090 

15783 .......... ............ A Abrasion treatment of skin .......................... 4.29 7.10 4.35 0.28 11.67 8.92 090 

15786 .......... ............ A Abrasion, lesion, single ............................... 2.03 3.43 1.39 0.11 5.58 3.54 010 

15787 .......... ............ A Abrasion, lesions, add-on ............................ 0.33 1.02 0.16 0.04 1.40 0.53 ZZZ 

15788 .......... ............ R Chemical peel, face, epiderm ..................... 2.09 7.25 3.43 0.11 9.46 5.63 090 

15789 .......... ............ R Chemical peel, face, dermal ....................... 4.92 8.43 5.00 0.20 13.55 10.12 090 

15792 .......... ............ R Chemical peel, nonfacial ............................. 1.86 7.34 4.59 0.13 9.33 6.59 090 

15793 .......... ............ A Chemical peel, nonfacial ............................. 3.74 6.85 4.57 0.19 10.78 8.50 090 

15810 .......... ............ A Salabrasion .................................................. 4.74 0.00 3.74 0.51 5.25 8.99 090 

15811 .......... ............ A Salabrasion .................................................. 5.39 5.30 4.65 0.80 11.49 10.84 090 

15819 .......... ............ A Plastic surgery, neck ................................... 9.39 NA 7.02 0.97 NA 17.38 090 

15820 .......... ............ A Revision of lower eyelid .............................. 5.15 6.76 5.38 0.40 12.31 10.93 090 

15821 .......... ............ A Revision of lower eyelid .............................. 5.72 7.13 5.55 0.45 13.30 11.72 090 

15822 .......... ............ A Revision of upper eyelid .............................. 4.45 5.66 4.37 0.37 10.48 9.19 090 

15823 .......... ............ A Revision of upper eyelid .............................. 7.05 7.64 6.27 0.50 15.20 13.82 090 

15824 .......... ............ R Removal of forehead wrinkles ..................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15825 .......... ............ R Removal of neck wrinkles ........................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15826 .......... ............ R Removal of brow wrinkles ........................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15828 .......... ............ R Removal of face wrinkles ............................ 0.00 0.00 0.00 0.00 0.00 0.00 000 

15829 .......... ............ R Removal of skin wrinkles ............................ 0.00 0.00 0.00 0.00 0.00 0.00 000 

15831 .......... ............ A Excise excessive skin tissue ....................... 12.40 NA 7.99 1.75 NA 22.14 090 

15832 .......... ............ A Excise excessive skin tissue ....................... 11.59 NA 8.13 1.66 NA 21.39 090 

15833 .......... ............ A Excise excessive skin tissue ....................... 10.64 NA 7.89 1.49 NA 20.02 090 

15834 .......... ............ A Excise excessive skin tissue ....................... 10.85 NA 7.50 1.61 NA 19.96 090 

15835 .......... ............ A Excise excessive skin tissue ....................... 11.67 NA 7.42 1.60 NA 20.69 090 

15836 .......... ............ A Excise excessive skin tissue ....................... 9.35 NA 6.64 1.34 NA 17.33 090 

15837 .......... ............ A Excise excessive skin tissue ....................... 8.44 8.28 7.16 1.18 17.90 16.78 090 

15838 .......... ............ A Excise excessive skin tissue ....................... 7.13 NA 5.93 0.58 NA 13.64 090 

15839 .......... ............ A Excise excessive skin tissue ....................... 9.39 8.67 6.28 1.22 19.28 16.89 090 

15840 .......... ............ A Graft for face nerve palsy ........................... 13.27 NA 9.70 1.32 NA 24.28 090 

15841 .......... ............ A Graft for face nerve palsy ........................... 23.28 NA 14.69 2.54 NA 40.51 090 

15842 .......... ............ A Flap for face nerve palsy ............................ 37.98 NA 22.25 4.93 NA 65.16 090 

15845 .......... ............ A Skin and muscle repair, face ...................... 12.58 NA 9.08 0.81 NA 22.47 090 

15850 .......... ............ B Removal of sutures ..................................... 0.78 1.53 0.30 0.05 2.36 1.13 XXX 

15851 .......... ............ A Removal of sutures ..................................... 0.86 1.62 0.30 0.06 2.54 1.22 000 

15852 .......... ............ A Dressing change not for burn ..................... 0.86 1.77 0.32 0.09 2.72 1.27 000 

15860 .......... ............ A Test for blood flow in graft .......................... 1.95 NA 0.77 0.27 NA 2.99 000 

15876 .......... ............ R Suction assisted lipectomy .......................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15877 .......... ............ R Suction assisted lipectomy .......................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15878 .......... ............ R Suction assisted lipectomy .......................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15879 .......... ............ R Suction assisted lipectomy .......................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15920 .......... ............ A Removal of tail bone ulcer .......................... 7.96 NA 5.45 1.04 NA 14.44 090 

15922 .......... ............ A Removal of tail bone ulcer .......................... 9.91 NA 7.03 1.42 NA 18.36 090 

15931 .......... ............ A Remove sacrum pressure sore ................... 9.25 NA 5.58 1.25 NA 16.08 090 

15933 .......... ............ A Remove sacrum pressure sore ................... 10.85 NA 7.66 1.52 NA 20.03 090 

15934 .......... ............ A Remove sacrum pressure sore ................... 12.70 NA 7.84 1.78 NA 22.32 090 

15935 .......... ............ A Remove sacrum pressure sore ................... 14.58 NA 10.04 2.09 NA 26.71 090 

15936 .......... ............ A Remove sacrum pressure sore ................... 12.38 NA 7.99 1.76 NA 22.14 090 

15937 .......... ............ A Remove sacrum pressure sore ................... 14.22 NA 9.53 2.06 NA 25.81 090 

15940 .......... ............ A Remove hip pressure sore .......................... 9.35 NA 6.02 1.31 NA 16.68 090 

15941 .......... ............ A Remove hip pressure sore .......................... 11.43 NA 9.13 1.66 NA 22.23 090 

15944 .......... ............ A Remove hip pressure sore .......................... 11.46 NA 8.36 1.65 NA 21.47 090 

15945 .......... ............ A Remove hip pressure sore .......................... 12.70 NA 9.36 1.84 NA 23.90 090 

15946 .......... ............ A Remove hip pressure sore .......................... 21.58 NA 13.97 3.16 NA 38.71 090 

15950 .......... ............ A Remove thigh pressure sore ....................... 7.55 NA 5.30 1.04 NA 13.88 090 

15951 .......... ............ A Remove thigh pressure sore ....................... 10.72 NA 7.67 1.49 NA 19.88 090 

15952 .......... ............ A Remove thigh pressure sore ....................... 11.39 NA 7.57 1.60 NA 20.56 090 

15953 .......... ............ A Remove thigh pressure sore ....................... 12.64 NA 8.75 1.79 NA 23.18 090 

45883

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

15956 .......... ............ A Remove thigh pressure sore ....................... 15.53 NA 10.47 2.21 NA 28.21 090 

15958 .......... ............ A Remove thigh pressure sore ....................... 15.49 NA 10.73 2.25 NA 28.47 090 

15999 .......... ............ C Removal of pressure sore ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

16000 .......... ............ A Initial treatment of burn(s) ........................... 0.89 0.84 0.25 0.08 1.81 1.22 000 

16010 .......... ............ A Treatment of burn(s) ................................... 0.87 NA 0.61 0.09 NA 1.58 000 

16015 .......... ............ A Treatment of burn(s) ................................... 2.35 NA 1.13 0.32 NA 3.81 000 

16020 .......... ............ A Treatment of burn(s) ................................... 0.80 1.24 0.57 0.08 2.13 1.45 000 

16025 .......... ............ A Treatment of burn(s) ................................... 1.85 1.71 0.94 0.19 3.75 2.99 000 

16030 .......... ............ A Treatment of burn(s) ................................... 2.08 2.09 1.10 0.24 4.41 3.43 000 

16035 .......... ............ A Incision of burn scab, initi ........................... 3.75 NA 1.59 0.46 NA 5.80 090 

16036 .......... ............ A Escharotomy; add’l incision ......................... 1.50 NA 0.59 0.20 NA 2.29 ZZZ 

17000 .......... ............ A Destroy benign/premlg lesion ...................... 0.60 1.09 0.59 0.03 1.73 1.22 010 

17003 .......... ............ A Destroy lesions, 2-14 .................................. 0.15 0.12 0.08 0.01 0.28 0.24 ZZZ 

17004 .......... ............ A Destroy lesions, 15 or more ........................ 2.80 2.58 1.71 0.11 5.49 4.62 010 

17106 .......... ............ A Destruction of skin lesions .......................... 4.59 4.81 3.35 0.35 9.75 8.29 090 

17107 .......... ............ A Destruction of skin lesions .......................... 9.17 7.66 5.50 0.63 17.46 15.30 090 

17108 .......... ............ A Destruction of skin lesions .......................... 13.21 9.87 7.77 0.54 23.62 21.52 090 

17110 .......... ............ A Destruct lesion, 1-14 ................................... 0.65 1.65 0.75 0.05 2.35 1.45 010 

17111 .......... ............ A Destruct lesion, 15 or more ......................... 0.92 1.79 0.87 0.05 2.76 1.84 010 

17250 .......... ............ A Chemical cautery, tissue ............................. 0.50 1.23 0.34 0.06 1.79 0.90 000 

17260 .......... ............ A Destruction of skin lesions .......................... 0.91 1.33 0.69 0.04 2.28 1.64 010 

17261 .......... ............ A Destruction of skin lesions .......................... 1.17 1.83 0.91 0.05 3.05 2.13 010 

17262 .......... ............ A Destruction of skin lesions .......................... 1.58 2.13 1.11 0.06 3.78 2.76 010 

17263 .......... ............ A Destruction of skin lesions .......................... 1.79 2.32 1.18 0.07 4.19 3.04 010 

17264 .......... ............ A Destruction of skin lesions .......................... 1.94 2.51 1.19 0.08 4.53 3.22 010 

17266 .......... ............ A Destruction of skin lesions .......................... 2.34 2.79 1.26 0.09 5.23 3.69 010 

17270 .......... ............ A Destruction of skin lesions .......................... 1.32 1.89 0.94 0.05 3.27 2.31 010 

17271 .......... ............ A Destruction of skin lesions .......................... 1.49 2.01 1.07 0.06 3.56 2.63 010 

17272 .......... ............ A Destruction of skin lesions .......................... 1.77 2.25 1.21 0.07 4.10 3.06 010 

17273 .......... ............ A Destruction of skin lesions .......................... 2.05 2.48 1.31 0.08 4.62 3.44 010 

17274 .......... ............ A Destruction of skin lesions .......................... 2.60 2.87 1.53 0.10 5.56 4.23 010 

17276 .......... ............ A Destruction of skin lesions .......................... 3.21 3.26 1.72 0.16 6.63 5.08 010 

17280 .......... ............ A Destruction of skin lesions .......................... 1.17 1.80 0.87 0.05 3.03 2.09 010 

17281 .......... ............ A Destruction of skin lesions .......................... 1.72 2.15 1.18 0.07 3.94 2.98 010 

17282 .......... ............ A Destruction of skin lesions .......................... 2.04 2.43 1.35 0.08 4.55 3.47 010 

17283 .......... ............ A Destruction of skin lesions .......................... 2.65 2.86 1.58 0.11 5.61 4.34 010 

17284 .......... ............ A Destruction of skin lesions .......................... 3.22 3.26 1.82 0.13 6.60 5.17 010 

17286 .......... ............ A Destruction of skin lesions .......................... 4.44 4.01 2.44 0.23 8.68 7.11 010 

17304 .......... ............ A 1 stage mohs, up to 5 spec ........................ 7.61 9.35 3.85 0.30 17.26 11.76 000 

17305 .......... ............ A 2 stage mohs, up to 5 spec ........................ 2.86 4.64 1.46 0.11 7.61 4.42 000 

17306 .......... ............ A 3 stage mohs, up to 5 spec ........................ 2.86 4.79 1.47 0.11 7.76 4.44 000 

17307 .......... ............ A Mohs addl stage up to 5 spec .................... 2.86 4.39 1.49 0.11 7.36 4.45 000 

17310 .......... ............ A Mohs any stage > 5 spec each ................... 0.95 1.74 0.51 0.03 2.72 1.49 ZZZ 

17340 .......... ............ A Cryotherapy of skin ..................................... 0.76 0.38 0.36 0.05 1.19 1.17 010 

17360 .......... ............ A Skin peel therapy ........................................ 1.43 1.51 0.96 0.06 3.00 2.46 010 

17380 .......... ............ R Hair removal by electrolysis ........................ 0.00 0.00 0.00 0.00 0.00 0.00 000 

17999 .......... ............ C Skin tissue procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

19000 .......... ............ A Drainage of breast lesion ............................ 0.84 1.97 0.32 0.08 2.89 1.24 000 

19001 .......... ............ A Drain breast lesion add-on .......................... 0.42 0.25 0.15 0.04 0.71 0.61 ZZZ 

19020 .......... ............ A Incision of breast lesion .............................. 3.57 6.18 2.67 0.45 10.20 6.68 090 

19030 .......... ............ A Injection for breast x-ray ............................. 1.53 3.03 0.53 0.09 4.65 2.15 000 

19100 .......... ............ A Bx breast percut w/o image ........................ 1.27 2.06 0.43 0.16 3.50 1.86 000 

19101 .......... ............ A Biopsy of breast, open ................................ 3.19 4.65 1.98 0.39 8.23 5.56 010 

19102 .......... ............ A Bx breast percut w/image ........................... 2.00 3.99 0.68 0.14 6.13 2.83 000 

19103 .......... ............ A Bx breast percut w/device ........................... 3.70 11.81 1.26 0.30 15.81 5.25 000 

19110 .......... ............ A Nipple exploration ........................................ 4.30 5.75 2.87 0.57 10.62 7.74 090 

19112 .......... ............ A Excise breast duct fistula ............................ 3.67 5.89 2.69 0.48 10.04 6.84 090 

19120 .......... ............ A Removal of breast lesion ............................ 5.56 4.56 3.06 0.73 10.85 9.35 090 

19125 .......... ............ A Excision, breast lesion ................................ 6.06 4.77 3.28 0.80 11.63 10.14 090 

19126 .......... ............ A Excision, addl breast lesion ........................ 2.94 NA 0.98 0.38 NA 4.29 ZZZ 

19140 .......... ............ A Removal of breast tissue ............................ 5.14 7.05 3.39 0.69 12.88 9.22 090 

19160 .......... ............ A Partial mastectomy ...................................... 5.99 NA 3.41 0.79 NA 10.19 090 

19162 .......... ............ A P-mastectomy w/ln removal ........................ 13.54 NA 6.26 1.79 NA 21.59 090 

19180 .......... ............ A Removal of breast ....................................... 8.81 NA 5.00 1.18 NA 14.99 090 

19182 .......... ............ A Removal of breast ....................................... 7.74 NA 4.72 1.04 NA 13.50 090 

19200 .......... ............ A Removal of breast ....................................... 15.50 NA 7.87 1.92 NA 25.29 090 

19220 .......... ............ A Removal of breast ....................................... 15.73 NA 8.17 2.07 NA 25.98 090 

19240 .......... ............ A Removal of breast ....................................... 16.01 NA 8.15 2.12 NA 26.28 090 

19260 .......... ............ A Removal of chest wall lesion ...................... 15.45 NA 10.76 2.13 NA 28.34 090 

19271 .......... ............ A Revision of chest wall ................................. 18.91 NA 17.32 2.62 NA 38.84 090 

19272 .......... ............ A Extensive chest wall surgery ....................... 21.56 NA 18.30 2.99 NA 42.85 090 

19290 .......... ............ A Place needle wire, breast ............................ 1.27 3.01 0.44 0.07 4.36 1.78 000 

19291 .......... ............ A Place needle wire, breast ............................ 0.63 1.27 0.22 0.04 1.94 0.89 ZZZ 

19295 .......... ............ A Place breast clip, percut .............................. 0.00 2.74 NA 0.01 2.75 NA ZZZ 

45884

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

19296 .......... ............ A Place po breast cath for rad ....................... 3.64 117.96 1.50 0.36 121.96 5.49 000 

19297 .......... ............ A Place breast cath for rad ............................. 1.72 NA 0.62 0.17 NA 2.52 ZZZ 

19298 .......... ............ A Place breast rad tube/caths ........................ 6.01 39.56 2.35 0.43 46.00 8.79 000 

19316 .......... ............ A Suspension of breast .................................. 10.69 NA 7.30 1.64 NA 19.63 090 

19318 .......... ............ A Reduction of large breast ............................ 15.63 NA 10.79 2.92 NA 29.34 090 

19324 .......... ............ A Enlarge breast ............................................. 5.85 NA 4.79 0.84 NA 11.48 090 

19325 .......... ............ A Enlarge breast with implant ......................... 8.46 NA 6.33 1.33 NA 16.11 090 

19328 .......... ............ A Removal of breast implant .......................... 5.68 NA 4.88 0.91 NA 11.47 090 

19330 .......... ............ A Removal of implant material ....................... 7.60 NA 5.88 1.26 NA 14.74 090 

19340 .......... ............ A Immediate breast prosthesis ....................... 6.33 NA 3.03 1.06 NA 10.42 ZZZ 

19342 .......... ............ A Delayed breast prosthesis ........................... 11.20 NA 8.67 1.83 NA 21.70 090 

19350 .......... ............ A Breast reconstruction .................................. 8.93 13.03 6.95 1.41 23.37 17.28 090 

19355 .......... ............ A Correct inverted nipple(s) ............................ 7.58 9.85 4.63 0.92 18.34 13.12 090 

19357 .......... ............ A Breast reconstruction .................................. 18.17 NA 15.13 2.93 NA 36.23 090 

19361 .......... ............ A Breast reconstruction .................................. 19.27 NA 12.09 2.92 NA 34.28 090 

19364 .......... ............ A Breast reconstruction .................................. 41.02 NA 22.83 6.22 NA 70.07 090 

19366 .......... ............ A Breast reconstruction .................................. 21.29 NA 11.31 3.24 NA 35.84 090 

19367 .......... ............ A Breast reconstruction .................................. 25.74 NA 16.16 4.03 NA 45.93 090 

19368 .......... ............ A Breast reconstruction .................................. 32.43 NA 18.34 5.52 NA 56.30 090 

19369 .......... ............ A Breast reconstruction .................................. 29.84 NA 17.81 4.50 NA 52.15 090 

19370 .......... ............ A Surgery of breast capsule ........................... 8.06 NA 6.70 1.29 NA 16.05 090 

19371 .......... ............ A Removal of breast capsule ......................... 9.36 NA 7.60 1.62 NA 18.57 090 

19380 .......... ............ A Revise breast reconstruction ....................... 9.15 NA 7.48 1.44 NA 18.07 090 

19396 .......... ............ A Design custom breast implant ..................... 2.17 2.17 1.02 0.30 4.65 3.50 000 

19499 .......... ............ C Breast surgery procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

20000 .......... ............ A Incision of abscess ...................................... 2.12 2.70 1.73 0.25 5.07 4.10 010 

20005 .......... ............ A Incision of deep abscess ............................. 3.42 3.50 2.23 0.46 7.37 6.10 010 

2000F ......... ............ I Blood pressure, measured .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

20100 .......... ............ A Explore wound, neck ................................... 10.08 NA 4.35 1.21 NA 15.64 010 

20101 .......... ............ A Explore wound, chest .................................. 3.23 5.85 1.57 0.44 9.52 5.24 010 

20102 .......... ............ A Explore wound, abdomen ........................... 3.94 7.18 1.88 0.49 11.61 6.31 010 

20103 .......... ............ A Explore wound, extremity ............................ 5.30 8.22 3.29 0.75 14.27 9.34 010 

20150 .......... ............ A Excise epiphyseal bar ................................. 13.70 NA 7.00 2.03 NA 22.73 090 

20200 .......... ............ A Muscle biopsy .............................................. 1.46 2.95 0.74 0.23 4.64 2.44 000 

20205 .......... ............ A Deep muscle biopsy .................................... 2.35 3.79 1.17 0.33 6.47 3.86 000 

20206 .......... ............ A Needle biopsy, muscle ................................ 0.99 6.34 0.66 0.07 7.40 1.72 000 

20220 .......... ............ A Bone biopsy, trocar/needle ......................... 1.27 4.29 0.79 0.08 5.65 2.15 000 

20225 .......... ............ A Bone biopsy, trocar/needle ......................... 1.87 22.84 1.17 0.22 24.94 3.27 000 

20240 .......... ............ A Bone biopsy, excisional ............................... 3.24 NA 2.48 0.44 NA 6.16 010 

20245 .......... ............ A Bone biopsy, excisional ............................... 7.79 NA 6.39 1.31 NA 15.48 010 

20250 .......... ............ A Open bone biopsy ....................................... 5.03 NA 3.45 1.02 NA 9.50 010 

20251 .......... ............ A Open bone biopsy ....................................... 5.56 NA 4.09 1.15 NA 10.80 010 

20500 .......... ............ A Injection of sinus tract ................................. 1.23 2.10 1.46 0.12 3.46 2.81 010 

20501 .......... ............ A Inject sinus tract for x-ray ............................ 0.76 2.87 0.26 0.04 3.67 1.06 000 

20520 .......... ............ A Removal of foreign body ............................. 1.85 2.81 1.70 0.21 4.88 3.77 010 

20525 .......... ............ A Removal of foreign body ............................. 3.50 8.59 2.55 0.51 12.60 6.55 010 

20526 .......... ............ A Ther injection, carp tunnel ........................... 0.94 0.94 0.51 0.13 2.01 1.58 000 

20550 .......... ............ A Inj tendon sheath/ligament .......................... 0.75 0.69 0.23 0.09 1.54 1.07 000 

20551 .......... ............ A Inj tendon origin/insertion ............................ 0.75 0.67 0.32 0.08 1.50 1.15 000 

20552 .......... ............ A Inj trigger point, 1/2 muscl ........................... 0.66 0.70 0.20 0.05 1.41 0.91 000 

20553 .......... ............ A Inject trigger points, =/> 3 ........................... 0.75 0.79 0.21 0.04 1.58 1.00 000 

20600 .......... ............ A Drain/inject, joint/bursa ................................ 0.66 0.66 0.35 0.08 1.40 1.09 000 

20605 .......... ............ A Drain/inject, joint/bursa ................................ 0.68 0.75 0.35 0.08 1.52 1.11 000 

20610 .......... ............ A Drain/inject, joint/bursa ................................ 0.79 0.92 0.41 0.11 1.83 1.31 000 

20612 .......... ............ A Aspirate/inj ganglion cyst ............................ 0.70 0.70 0.35 0.10 1.50 1.15 000 

20615 .......... ............ A Treatment of bone cyst ............................... 2.28 3.38 1.82 0.20 5.87 4.31 010 

20650 .......... ............ A Insert and remove bone pin ........................ 2.23 2.35 1.54 0.31 4.90 4.09 010 

20660 .......... ............ A Apply, rem fixation device ........................... 2.52 2.95 1.58 0.59 6.05 4.68 000 

20661 .......... ............ A Application of head brace ........................... 4.89 NA 4.82 1.14 NA 10.85 090 

20662 .......... ............ A Application of pelvis brace .......................... 6.07 NA 5.39 0.56 NA 12.02 090 

20663 .......... ............ A Application of thigh brace ............................ 5.43 NA 4.71 0.94 NA 11.08 090 

20664 .......... ............ A Halo brace application ................................. 8.07 NA 6.89 1.74 NA 16.70 090 

20665 .......... ............ A Removal of fixation device .......................... 1.31 2.06 1.32 0.19 3.57 2.82 010 

20670 .......... ............ A Removal of support implant ........................ 1.74 10.66 2.02 0.28 12.68 4.04 010 

20680 .......... ............ A Removal of support implant ........................ 3.35 8.36 3.59 0.56 12.27 7.50 090 

20690 .......... ............ A Apply bone fixation device .......................... 3.52 NA 2.45 0.59 NA 6.56 090 

20692 .......... ............ A Apply bone fixation device .......................... 6.41 NA 3.67 1.05 NA 11.14 090 

20693 .......... ............ A Adjust bone fixation device ......................... 5.86 NA 5.26 0.98 NA 12.10 090 

20694 .......... ............ A Remove bone fixation device ...................... 4.16 6.78 3.93 0.71 11.65 8.80 090 

20802 .......... ............ A Replantation, arm, complete ....................... 41.17 NA 20.55 3.81 NA 65.53 090 

20805 .......... ............ A Replant forearm, complete .......................... 50.03 NA 32.77 4.84 NA 87.64 090 

20808 .......... ............ A Replantation hand, complete ...................... 61.68 NA 40.74 6.86 NA 109.28 090 

20816 .......... ............ A Replantation digit, complete ........................ 30.95 NA 35.39 4.52 NA 70.86 090 

20822 .......... ............ A Replantation digit, complete ........................ 25.60 NA 32.40 4.18 NA 62.18 090 

45885

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

20824 .......... ............ A Replantation thumb, complete .................... 30.95 NA 34.30 4.61 NA 69.86 090 

20827 .......... ............ A Replantation thumb, complete .................... 26.42 NA 34.08 3.66 NA 64.16 090 

20838 .......... ............ A Replantation foot, complete ........................ 41.43 NA 21.78 1.12 NA 64.34 090 

20900 .......... ............ A Removal of bone for graft ........................... 5.58 8.42 5.50 0.94 14.95 12.02 090 

20902 .......... ............ A Removal of bone for graft ........................... 7.56 NA 6.66 1.30 NA 15.52 090 

20910 .......... ............ A Remove cartilage for graft ........................... 5.34 NA 5.04 0.71 NA 11.09 090 

20912 .......... ............ A Remove cartilage for graft ........................... 6.35 NA 5.63 0.69 NA 12.67 090 

20920 .......... ............ A Removal of fascia for graft .......................... 5.31 NA 4.26 0.66 NA 10.23 090 

20922 .......... ............ A Removal of fascia for graft .......................... 6.61 7.41 4.87 0.70 14.72 12.18 090 

20924 .......... ............ A Removal of tendon for graft ........................ 6.48 NA 5.69 1.04 NA 13.22 090 

20926 .......... ............ A Removal of tissue for graft .......................... 5.53 NA 4.66 0.87 NA 11.06 090 

20930 .......... ............ B Spinal bone allograft ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

20931 .......... ............ A Spinal bone allograft ................................... 1.81 NA 0.90 0.43 NA 3.15 ZZZ 

20936 .......... ............ B Spinal bone autograft .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

20937 .......... ............ A Spinal bone autograft .................................. 2.80 NA 1.41 0.54 NA 4.74 ZZZ 

20938 .......... ............ A Spinal bone autograft .................................. 3.03 NA 1.52 0.64 NA 5.18 ZZZ 

20950 .......... ............ A Fluid pressure, muscle ................................ 1.26 6.35 0.97 0.20 7.81 2.43 000 

20955 .......... ............ A Fibula bone graft, microvasc ....................... 39.23 NA 23.52 4.89 NA 67.64 090 

20956 .......... ............ A Iliac bone graft, microvasc .......................... 39.29 NA 24.03 7.01 NA 70.33 090 

20957 .......... ............ A Mt bone graft, microvasc ............................. 40.67 NA 18.69 7.05 NA 66.42 090 

20962 .......... ............ A Other bone graft, microvasc ........................ 39.29 NA 25.76 6.55 NA 71.60 090 

20969 .......... ............ A Bone/skin graft, microvasc .......................... 43.94 NA 25.78 4.79 NA 74.51 090 

20970 .......... ............ A Bone/skin graft, iliac crest ........................... 43.09 NA 24.61 6.60 NA 74.30 090 

20972 .......... ............ A Bone/skin graft, metatarsal ......................... 43.02 NA 20.22 5.30 NA 68.54 090 

20973 .......... ............ A Bone/skin graft, great toe ............................ 45.78 NA 24.42 5.54 NA 75.74 090 

20974 .......... ............ A Electrical bone stimulation .......................... 0.62 0.71 0.53 0.11 1.44 1.26 000 

20975 .......... ............ A Electrical bone stimulation .......................... 2.61 NA 1.67 0.51 NA 4.78 000 

20979 .......... ............ A Us bone stimulation ..................................... 0.62 0.77 0.33 0.09 1.49 1.04 000 

20982 .......... ............ A Ablate, bone tumor(s) perq ......................... 7.28 105.12 12.41 0.69 113.09 20.38 000 

20999 .......... ............ C Musculoskeletal surgery .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

21010 .......... ............ A Incision of jaw joint ...................................... 10.14 NA 7.28 1.11 NA 18.53 090 

21015 .......... ............ A Resection of facial tumor ............................ 5.29 NA 4.86 0.70 NA 10.86 090 

21025 .......... ............ A Excision of bone, lower jaw ........................ 10.06 12.30 9.24 1.32 23.68 20.62 090 

21026 .......... ............ A Excision of facial bone(s) ............................ 4.85 7.94 6.20 0.60 13.39 11.65 090 

21029 .......... ............ A Contour of face bone lesion ........................ 7.72 9.32 6.85 0.94 17.98 15.50 090 

21030 .......... ............ A Excise max/zygoma b9 tumor ..................... 4.50 6.45 4.96 0.54 11.49 10.00 090 

21031 .......... ............ A Remove exostosis, mandible ...................... 3.25 5.29 3.62 0.48 9.01 7.35 090 

21032 .......... ............ A Remove exostosis, maxilla .......................... 3.25 5.45 3.51 0.47 9.16 7.23 090 

21034 .......... ............ A Excise max/zygoma mlg tumor ................... 16.18 15.67 12.29 1.71 33.56 30.19 090 

21040 .......... ............ A Excise mandible lesion ................................ 4.50 6.51 4.70 0.54 11.55 9.74 090 

21044 .......... ............ A Removal of jaw bone lesion ........................ 11.86 NA 9.18 1.12 NA 22.17 090 

21045 .......... ............ A Extensive jaw surgery ................................. 16.18 NA 12.08 1.52 NA 29.79 090 

21046 .......... ............ A Remove mandible cyst complex ................. 13.01 NA 11.91 1.85 NA 26.77 090 

21047 .......... ............ A Excise lwr jaw cyst w/repair ........................ 18.76 NA 13.17 2.12 NA 34.05 090 

21048 .......... ............ A Remove maxilla cyst complex ..................... 13.51 NA 12.13 1.76 NA 27.40 090 

21049 .......... ............ A Excis uppr jaw cyst w/repair ....................... 18.01 NA 12.78 1.59 NA 32.37 090 

21050 .......... ............ A Removal of jaw joint .................................... 10.77 NA 9.31 1.47 NA 21.56 090 

21060 .......... ............ A Remove jaw joint cartilage .......................... 10.23 NA 8.51 1.38 NA 20.12 090 

21070 .......... ............ A Remove coronoid process .......................... 8.21 NA 7.03 1.27 NA 16.50 090 

21076 .......... ............ A Prepare face/oral prosthesis ....................... 13.43 12.00 9.44 1.99 27.42 24.85 010 

21077 .......... ............ A Prepare face/oral prosthesis ....................... 33.77 29.60 24.40 4.55 67.91 62.72 090 

21079 .......... ............ A Prepare face/oral prosthesis ....................... 22.35 20.43 16.13 3.15 45.94 41.63 090 

21080 .......... ............ A Prepare face/oral prosthesis ....................... 25.11 23.16 18.23 3.74 52.01 47.08 090 

21081 .......... ............ A Prepare face/oral prosthesis ....................... 22.90 21.14 16.42 3.20 47.24 42.52 090 

21082 .......... ............ A Prepare face/oral prosthesis ....................... 20.88 18.48 14.83 3.11 42.47 38.82 090 

21083 .......... ............ A Prepare face/oral prosthesis ....................... 19.31 17.90 13.57 2.88 40.09 35.76 090 

21084 .......... ............ A Prepare face/oral prosthesis ....................... 22.52 21.12 16.44 2.18 45.82 41.15 090 

21085 .......... ............ A Prepare face/oral prosthesis ....................... 9.01 8.28 6.79 1.27 18.56 17.07 010 

21086 .......... ............ A Prepare face/oral prosthesis ....................... 24.93 22.34 18.15 3.71 50.98 46.79 090 

21087 .......... ............ A Prepare face/oral prosthesis ....................... 24.93 22.11 18.05 3.44 50.48 46.42 090 

21088 .......... ............ C Prepare face/oral prosthesis ....................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

21089 .......... ............ C Prepare face/oral prosthesis ....................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

21100 .......... ............ A Maxillofacial fixation .................................... 4.22 11.76 4.79 0.34 16.32 9.35 090 

21110 .......... ............ A Interdental fixation ....................................... 5.21 10.08 8.54 0.72 16.01 14.47 090 

21116 .......... ............ A Injection, jaw joint x-ray ............................... 0.81 4.08 0.34 0.06 4.95 1.21 000 

21120 .......... ............ A Reconstruction of chin ................................. 4.93 10.42 7.29 0.60 15.95 12.82 090 

21121 .......... ............ A Reconstruction of chin ................................. 7.65 9.92 7.81 0.90 18.47 16.36 090 

21122 .......... ............ A Reconstruction of chin ................................. 8.53 NA 8.55 1.07 NA 18.15 090 

21123 .......... ............ A Reconstruction of chin ................................. 11.16 NA 10.59 1.40 NA 23.15 090 

21125 .......... ............ A Augmentation, lower jaw bone .................... 10.62 55.80 8.18 0.79 67.21 19.59 090 

21127 .......... ............ A Augmentation, lower jaw bone .................... 11.12 48.12 9.27 1.52 60.76 21.91 090 

21137 .......... ............ A Reduction of forehead ................................. 9.83 NA 7.48 1.32 NA 18.63 090 

21138 .......... ............ A Reduction of forehead ................................. 12.19 NA 9.25 1.74 NA 23.18 090 

21139 .......... ............ A Reduction of forehead ................................. 14.62 NA 11.13 1.18 NA 26.93 090 

45886

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

21141 .......... ............ A Reconstruct midface, lefort ......................... 18.11 NA 13.41 2.35 NA 33.87 090 

21142 .......... ............ A Reconstruct midface, lefort ......................... 18.82 NA 12.75 2.38 NA 33.95 090 

21143 .......... ............ A Reconstruct midface, lefort ......................... 19.59 NA 14.37 1.66 NA 35.62 090 

21145 .......... ............ A Reconstruct midface, lefort ......................... 19.95 NA 13.66 2.84 NA 36.45 090 

21146 .......... ............ A Reconstruct midface, lefort ......................... 20.72 NA 15.04 3.09 NA 38.85 090 

21147 .......... ............ A Reconstruct midface, lefort ......................... 21.78 NA 14.88 1.84 NA 38.51 090 

21150 .......... ............ A Reconstruct midface, lefort ......................... 25.25 NA 16.60 2.55 NA 44.40 090 

21151 .......... ............ A Reconstruct midface, lefort ......................... 28.32 NA 21.89 2.30 NA 52.51 090 

21154 .......... ............ A Reconstruct midface, lefort ......................... 30.53 NA 22.45 2.48 NA 55.46 090 

21155 .......... ............ A Reconstruct midface, lefort ......................... 34.47 NA 23.33 6.64 NA 64.44 090 

21159 .......... ............ A Reconstruct midface, lefort ......................... 42.40 NA 27.95 8.18 NA 78.53 090 

21160 .......... ............ A Reconstruct midface, lefort ......................... 46.46 NA 27.92 4.13 NA 78.51 090 

21172 .......... ............ A Reconstruct orbit/forehead .......................... 27.82 NA 13.53 3.55 NA 44.90 090 

21175 .......... ............ A Reconstruct orbit/forehead .......................... 33.19 NA 17.38 4.83 NA 55.40 090 

21179 .......... ............ A Reconstruct entire forehead ........................ 22.26 NA 13.72 2.80 NA 38.78 090 

21180 .......... ............ A Reconstruct entire forehead ........................ 25.20 NA 14.96 3.48 NA 43.65 090 

21181 .......... ............ A Contour cranial bone lesion ........................ 9.91 NA 7.23 1.32 NA 18.46 090 

21182 .......... ............ A Reconstruct cranial bone ............................ 32.20 NA 18.55 2.80 NA 53.56 090 

21183 .......... ............ A Reconstruct cranial bone ............................ 35.33 NA 20.24 4.47 NA 60.04 090 

21184 .......... ............ A Reconstruct cranial bone ............................ 38.26 NA 21.33 5.70 NA 65.29 090 

21188 .......... ............ A Reconstruction of midface ........................... 22.47 NA 18.35 1.69 NA 42.52 090 

21193 .......... ............ A Reconst lwr jaw w/o graft ............................ 17.15 NA 12.42 2.23 NA 31.81 090 

21194 .......... ............ A Reconst lwr jaw w/graft ............................... 19.85 NA 13.45 2.02 NA 35.32 090 

21195 .......... ............ A Reconst lwr jaw w/o fixation ........................ 17.24 NA 14.61 1.64 NA 33.50 090 

21196 .......... ............ A Reconst lwr jaw w/fixation ........................... 18.92 NA 15.41 2.07 NA 36.40 090 

21198 .......... ............ A Reconstr lwr jaw segment ........................... 14.17 NA 12.46 1.44 NA 28.07 090 

21199 .......... ............ A Reconstr lwr jaw w/advance ....................... 16.01 NA 8.90 1.39 NA 26.30 090 

21206 .......... ............ A Reconstruct upper jaw bone ....................... 14.11 NA 12.46 1.33 NA 27.90 090 

21208 .......... ............ A Augmentation of facial bones ...................... 10.23 23.47 9.29 1.09 34.79 20.61 090 

21209 .......... ............ A Reduction of facial bones ............................ 6.72 10.88 7.90 0.90 18.50 15.52 090 

21210 .......... ............ A Face bone graft ........................................... 10.23 27.25 9.15 1.30 38.78 20.68 090 

21215 .......... ............ A Lower jaw bone graft ................................... 10.77 47.37 9.24 1.53 59.67 21.54 090 

21230 .......... ............ A Rib cartilage graft ........................................ 10.77 NA 7.79 1.29 NA 19.85 090 

21235 .......... ............ A Ear cartilage graft ........................................ 6.72 10.18 6.28 0.61 17.52 13.62 090 

21240 .......... ............ A Reconstruction of jaw joint .......................... 14.06 NA 11.95 2.24 NA 28.25 090 

21242 .......... ............ A Reconstruction of jaw joint .......................... 12.96 NA 11.42 1.78 NA 26.15 090 

21243 .......... ............ A Reconstruction of jaw joint .......................... 20.80 NA 17.27 3.25 NA 41.33 090 

21244 .......... ............ A Reconstruction of lower jaw ........................ 11.86 NA 11.91 1.25 NA 25.02 090 

21245 .......... ............ A Reconstruction of jaw .................................. 11.86 14.32 9.62 1.19 27.37 22.67 090 

21246 .......... ............ A Reconstruction of jaw .................................. 12.47 NA 8.83 1.35 NA 22.65 090 

21247 .......... ............ A Reconstruct lower jaw bone ........................ 22.65 NA 17.07 2.83 NA 42.54 090 

21248 .......... ............ A Reconstruction of jaw .................................. 11.48 12.29 9.24 1.55 25.32 22.28 090 

21249 .......... ............ A Reconstruction of jaw .................................. 17.52 16.75 12.47 2.48 36.76 32.47 090 

21255 .......... ............ A Reconstruct lower jaw bone ........................ 16.72 NA 15.70 2.38 NA 34.80 090 

21256 .......... ............ A Reconstruction of orbit ................................ 16.20 NA 11.48 1.50 NA 29.18 090 

21260 .......... ............ A Revise eye sockets ..................................... 16.53 NA 13.26 0.97 NA 30.76 090 

21261 .......... ............ A Revise eye sockets ..................................... 31.50 NA 23.50 3.42 NA 58.42 090 

21263 .......... ............ A Revise eye sockets ..................................... 28.44 NA 19.87 2.62 NA 50.93 090 

21267 .......... ............ A Revise eye sockets ..................................... 18.91 NA 18.95 1.70 NA 39.56 090 

21268 .......... ............ A Revise eye sockets ..................................... 24.49 NA 19.69 3.65 NA 47.83 090 

21270 .......... ............ A Augmentation, cheek bone ......................... 10.23 11.66 7.09 0.72 22.61 18.04 090 

21275 .......... ............ A Revision, orbitofacial bones ........................ 11.24 NA 7.91 1.29 NA 20.45 090 

21280 .......... ............ A Revision of eyelid ........................................ 6.03 NA 5.78 0.42 NA 12.23 090 

21282 .......... ............ A Revision of eyelid ........................................ 3.49 NA 4.35 0.26 NA 8.10 090 

21295 .......... ............ A Revision of jaw muscle/bone ...................... 1.53 NA 2.51 0.16 NA 4.20 090 

21296 .......... ............ A Revision of jaw muscle/bone ...................... 4.25 NA 4.95 0.34 NA 9.54 090 

21299 .......... ............ C Cranio/maxillofacial surgery ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

21300 .......... ............ A Treatment of skull fracture .......................... 0.72 2.00 0.26 0.13 2.85 1.11 000 

21310 .......... ............ A Treatment of nose fracture .......................... 0.58 2.16 0.15 0.05 2.79 0.78 000 

21315 .......... ............ A Treatment of nose fracture .......................... 1.51 4.19 1.81 0.14 5.84 3.46 010 

21320 .......... ............ A Treatment of nose fracture .......................... 1.85 3.89 1.58 0.18 5.92 3.61 010 

21325 .......... ............ A Treatment of nose fracture .......................... 3.77 NA 8.21 0.31 NA 12.29 090 

21330 .......... ............ A Treatment of nose fracture .......................... 5.38 NA 9.26 0.56 NA 15.20 090 

21335 .......... ............ A Treatment of nose fracture .......................... 8.62 NA 9.38 0.74 NA 18.74 090 

21336 .......... ............ A Treat nasal septal fracture .......................... 5.72 NA 9.31 0.55 NA 15.59 090 

21337 .......... ............ A Treat nasal septal fracture .......................... 2.71 5.96 3.49 0.28 8.95 6.48 090 

21338 .......... ............ A Treat nasoethmoid fracture ......................... 6.46 NA 13.21 0.82 NA 20.49 090 

21339 .......... ............ A Treat nasoethmoid fracture ......................... 8.10 NA 13.20 0.96 NA 22.26 090 

21340 .......... ............ A Treatment of nose fracture .......................... 10.77 NA 8.17 1.15 NA 20.09 090 

21343 .......... ............ A Treatment of sinus fracture ......................... 12.96 NA 14.86 1.47 NA 29.28 090 

21344 .......... ............ A Treatment of sinus fracture ......................... 19.73 NA 15.85 2.43 NA 38.01 090 

21345 .......... ............ A Treat nose/jaw fracture ............................... 8.17 9.82 7.04 0.92 18.91 16.13 090 

21346 .......... ............ A Treat nose/jaw fracture ............................... 10.61 NA 11.91 1.21 NA 23.73 090 

21347 .......... ............ A Treat nose/jaw fracture ............................... 12.70 NA 15.39 1.47 NA 29.55 090 

45887

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

21348 .......... ............ A Treat nose/jaw fracture ............................... 16.69 NA 10.81 2.48 NA 29.98 090 

21355 .......... ............ A Treat cheek bone fracture ........................... 3.77 6.07 3.42 0.34 10.18 7.52 010 

21356 .......... ............ A Treat cheek bone fracture ........................... 4.15 6.99 4.41 0.46 11.60 9.02 010 

21360 .......... ............ A Treat cheek bone fracture ........................... 6.46 NA 5.80 0.74 NA 13.00 090 

21365 .......... ............ A Treat cheek bone fracture ........................... 14.96 NA 10.51 1.69 NA 27.16 090 

21366 .......... ............ A Treat cheek bone fracture ........................... 17.78 NA 11.02 2.49 NA 31.29 090 

21385 .......... ............ A Treat eye socket fracture ............................ 9.17 NA 8.06 0.97 NA 18.20 090 

21386 .......... ............ A Treat eye socket fracture ............................ 9.17 NA 6.88 0.97 NA 17.01 090 

21387 .......... ............ A Treat eye socket fracture ............................ 9.71 NA 8.67 1.08 NA 19.46 090 

21390 .......... ............ A Treat eye socket fracture ............................ 10.13 NA 7.58 0.90 NA 18.61 090 

21395 .......... ............ A Treat eye socket fracture ............................ 12.69 NA 8.75 1.44 NA 22.88 090 

21400 .......... ............ A Treat eye socket fracture ............................ 1.40 2.60 1.82 0.15 4.15 3.37 090 

21401 .......... ............ A Treat eye socket fracture ............................ 3.27 7.77 3.44 0.38 11.41 7.09 090 

21406 .......... ............ A Treat eye socket fracture ............................ 7.01 NA 5.92 0.73 NA 13.67 090 

21407 .......... ............ A Treat eye socket fracture ............................ 8.62 NA 6.66 0.94 NA 16.22 090 

21408 .......... ............ A Treat eye socket fracture ............................ 12.38 NA 8.63 1.44 NA 22.45 090 

21421 .......... ............ A Treat mouth roof fracture ............................ 5.14 9.62 8.32 0.73 15.49 14.19 090 

21422 .......... ............ A Treat mouth roof fracture ............................ 8.33 NA 7.89 0.99 NA 17.20 090 

21423 .......... ............ A Treat mouth roof fracture ............................ 10.40 NA 9.02 1.27 NA 20.69 090 

21431 .......... ............ A Treat craniofacial fracture ........................... 7.05 NA 9.40 0.70 NA 17.15 090 

21432 .......... ............ A Treat craniofacial fracture ........................... 8.62 NA 7.96 0.81 NA 17.39 090 

21433 .......... ............ A Treat craniofacial fracture ........................... 25.36 NA 15.91 2.78 NA 44.05 090 

21435 .......... ............ A Treat craniofacial fracture ........................... 17.25 NA 12.37 1.98 NA 31.60 090 

21436 .......... ............ A Treat craniofacial fracture ........................... 28.06 NA 17.82 3.09 NA 48.96 090 

21440 .......... ............ A Treat dental ridge fracture ........................... 2.71 7.43 6.26 0.38 10.52 9.34 090 

21445 .......... ............ A Treat dental ridge fracture ........................... 5.38 10.05 8.32 0.78 16.21 14.48 090 

21450 .......... ............ A Treat lower jaw fracture .............................. 2.98 7.70 6.71 0.33 11.01 10.02 090 

21451 .......... ............ A Treat lower jaw fracture .............................. 4.87 9.77 8.44 0.63 15.27 13.94 090 

21452 .......... ............ A Treat lower jaw fracture .............................. 1.98 12.37 4.74 0.27 14.62 7.00 090 

21453 .......... ............ A Treat lower jaw fracture .............................. 5.54 11.18 10.71 0.74 17.46 16.99 090 

21454 .......... ............ A Treat lower jaw fracture .............................. 6.46 NA 6.17 0.82 NA 13.46 090 

21461 .......... ............ A Treat lower jaw fracture .............................. 8.10 26.43 12.53 0.98 35.51 21.60 090 

21462 .......... ............ A Treat lower jaw fracture .............................. 9.80 29.34 12.71 1.27 40.41 23.78 090 

21465 .......... ............ A Treat lower jaw fracture .............................. 11.91 NA 9.63 1.50 NA 23.05 090 

21470 .......... ............ A Treat lower jaw fracture .............................. 15.35 NA 11.78 1.96 NA 29.09 090 

21480 .......... ............ A Reset dislocated jaw ................................... 0.61 1.72 0.19 0.06 2.39 0.86 000 

21485 .......... ............ A Reset dislocated jaw ................................... 3.99 8.73 7.76 0.51 13.23 12.25 090 

21490 .......... ............ A Repair dislocated jaw .................................. 11.86 NA 9.55 1.96 NA 23.37 090 

21493 .......... ............ A Treat hyoid bone fracture ............................ 1.27 NA 0.53 0.12 NA 1.92 090 

21494 .......... ............ A Treat hyoid bone fracture ............................ 6.28 NA 3.42 0.57 NA 10.27 090 

21495 .......... ............ A Treat hyoid bone fracture ............................ 5.69 NA 8.55 0.46 NA 14.70 090 

21497 .......... ............ A Interdental wiring ......................................... 3.86 8.88 7.77 0.50 13.24 12.12 090 

21499 .......... ............ C Head surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

21501 .......... ............ A Drain neck/chest lesion ............................... 3.81 6.31 3.73 0.43 10.55 7.97 090 

21502 .......... ............ A Drain chest lesion ........................................ 7.12 NA 5.42 0.97 NA 13.52 090 

21510 .......... ............ A Drainage of bone lesion .............................. 5.74 NA 5.42 0.80 NA 11.96 090 

21550 .......... ............ A Biopsy of neck/chest ................................... 2.06 3.85 1.74 0.16 6.08 3.96 010 

21555 .......... ............ A Remove lesion, neck/chest ......................... 4.35 5.54 3.17 0.56 10.45 8.08 090 

21556 .......... ............ A Remove lesion, neck/chest ......................... 5.57 NA 4.05 0.65 NA 10.27 090 

21557 .......... ............ A Remove tumor, neck/chest ......................... 8.89 NA 5.23 1.08 NA 15.19 090 

21600 .......... ............ A Partial removal of rib ................................... 6.89 NA 5.68 0.99 NA 13.57 090 

21610 .......... ............ A Partial removal of rib ................................... 14.62 NA 8.68 3.07 NA 26.37 090 

21615 .......... ............ A Removal of rib ............................................. 9.88 NA 6.42 1.45 NA 17.75 090 

21616 .......... ............ A Removal of rib and nerves .......................... 12.04 NA 7.95 1.86 NA 21.85 090 

21620 .......... ............ A Partial removal of sternum .......................... 6.79 NA 5.72 0.98 NA 13.50 090 

21627 .......... ............ A Sternal debridement .................................... 6.81 NA 6.17 1.02 NA 14.00 090 

21630 .......... ............ A Extensive sternum surgery .......................... 17.38 NA 11.45 2.58 NA 31.42 090 

21632 .......... ............ A Extensive sternum surgery .......................... 18.15 NA 10.81 2.65 NA 31.60 090 

21685 .......... ............ A Hyoid myotomy & suspension ..................... 13.01 NA 9.82 1.06 NA 23.89 090 

21700 .......... ............ A Revision of neck muscle ............................. 6.19 NA 4.74 0.32 NA 11.26 090 

21705 .......... ............ A Revision of neck muscle/rib ........................ 9.61 NA 5.43 1.43 NA 16.47 090 

21720 .......... ............ A Revision of neck muscle ............................. 5.68 NA 2.87 0.91 NA 9.46 090 

21725 .......... ............ A Revision of neck muscle ............................. 6.99 NA 5.31 1.21 NA 13.51 090 

21740 .......... ............ A Reconstruction of sternum .......................... 16.51 NA 8.37 2.36 NA 27.24 090 

21742 .......... ............ C Repair stern/nuss w/o scope ....................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

21743 .......... ............ C Repair sternum/nuss w/scope ..................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

21750 .......... ............ A Repair of sternum separation ...................... 10.77 NA 5.94 1.63 NA 18.35 090 

21800 .......... ............ A Treatment of rib fracture ............................. 0.96 0.00 1.31 0.09 1.05 2.36 090 

21805 .......... ............ A Treatment of rib fracture ............................. 2.76 NA 3.20 0.38 NA 6.34 090 

21810 .......... ............ A Treatment of rib fracture(s) ......................... 6.86 NA 4.93 0.94 NA 12.74 090 

21820 .......... ............ A Treat sternum fracture ................................. 1.28 1.78 1.70 0.16 3.22 3.15 090 

21825 .......... ............ A Treat sternum fracture ................................. 7.41 NA 6.25 1.11 NA 14.78 090 

21899 .......... ............ C Neck/chest surgery procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

21920 .......... ............ A Biopsy soft tissue of back ........................... 2.06 3.54 1.48 0.14 5.74 3.68 010 

45888

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

21925 .......... ............ A Biopsy soft tissue of back ........................... 4.49 5.12 3.24 0.60 10.20 8.33 090 

21930 .......... ............ A Remove lesion, back or flank ...................... 5.00 5.82 3.39 0.66 11.48 9.05 090 

21935 .......... ............ A Remove tumor, back ................................... 17.97 NA 9.46 2.47 NA 29.90 090 

22100 .......... ............ A Remove part of neck vertebra .................... 9.74 NA 7.39 2.13 NA 19.26 090 

22101 .......... ............ A Remove part, thorax vertebra ..................... 9.82 NA 7.57 1.90 NA 19.28 090 

22102 .......... ............ A Remove part, lumbar vertebra .................... 9.82 NA 7.89 1.87 NA 19.58 090 

22103 .......... ............ A Remove extra spine segment ..................... 2.34 NA 1.17 0.44 NA 3.96 ZZZ 

22110 .......... ............ A Remove part of neck vertebra .................... 12.75 NA 8.96 2.76 NA 24.47 090 

22112 .......... ............ A Remove part, thorax vertebra ..................... 12.82 NA 9.03 2.52 NA 24.36 090 

22114 .......... ............ A Remove part, lumbar vertebra .................... 12.82 NA 9.02 2.63 NA 24.46 090 

22116 .......... ............ A Remove extra spine segment ..................... 2.32 NA 1.14 0.50 NA 3.96 ZZZ 

22210 .......... ............ A Revision of neck spine ................................ 23.83 NA 15.05 5.44 NA 44.31 090 

22212 .......... ............ A Revision of thorax spine .............................. 19.43 NA 12.99 3.90 NA 36.32 090 

22214 .......... ............ A Revision of lumbar spine ............................. 19.46 NA 13.43 3.91 NA 36.80 090 

22216 .......... ............ A Revise, extra spine segment ....................... 6.04 NA 3.04 1.29 NA 10.37 ZZZ 

22220 .......... ............ A Revision of neck spine ................................ 21.38 NA 13.33 5.06 NA 39.78 090 

22222 .......... ............ A Revision of thorax spine .............................. 21.53 NA 11.12 4.12 NA 36.78 090 

22224 .......... ............ A Revision of lumbar spine ............................. 21.53 NA 13.85 4.18 NA 39.56 090 

22226 .......... ............ A Revise, extra spine segment ....................... 6.04 NA 3.00 1.29 NA 10.34 ZZZ 

22305 .......... ............ A Treat spine process fracture ....................... 2.05 2.25 1.86 0.39 4.69 4.31 090 

22310 .......... ............ A Treat spine fracture ..................................... 2.62 2.72 2.28 0.50 5.84 5.40 090 

22315 .......... ............ A Treat spine fracture ..................................... 8.85 9.37 7.16 1.85 20.07 17.86 090 

22318 .......... ............ A Treat odontoid fx w/o graft .......................... 21.51 NA 13.09 5.28 NA 39.89 090 

22319 .......... ............ A Treat odontoid fx w/graft ............................. 24.01 NA 14.38 6.03 NA 44.41 090 

22325 .......... ............ A Treat spine fracture ..................................... 18.31 NA 11.94 3.87 NA 34.12 090 

22326 .......... ............ A Treat neck spine fracture ............................ 19.60 NA 12.41 4.42 NA 36.43 090 

22327 .......... ............ A Treat thorax spine fracture .......................... 19.21 NA 12.28 3.98 NA 35.47 090 

22328 .......... ............ A Treat each add spine fx .............................. 4.61 NA 2.21 0.94 NA 7.76 ZZZ 

22505 .......... ............ A Manipulation of spine .................................. 1.87 NA 0.92 0.36 NA 3.15 010 

22520 .......... ............ A Percut vertebroplasty thor ........................... 8.92 60.09 5.24 1.71 70.72 15.87 010 

22521 .......... ............ A Percut vertebroplasty lumb ......................... 8.35 54.29 5.08 1.60 64.24 15.03 010 

22522 .......... ............ A Percut vertebroplasty add’l .......................... 4.31 NA 1.70 0.82 NA 6.83 ZZZ 

22532 .......... ............ A Lat thorax spine fusion ................................ 24.01 NA 14.47 4.34 NA 42.82 090 

22533 .......... ............ A Lat lumbar spine fusion ............................... 23.14 NA 13.34 3.15 NA 39.63 090 

22534 .......... ............ A Lat thor/lumb, add’l seg ............................... 6.00 NA 2.95 1.25 NA 10.20 ZZZ 

22548 .......... ............ A Neck spine fusion ........................................ 25.83 NA 15.46 5.59 NA 46.88 090 

22554 .......... ............ A Neck spine fusion ........................................ 18.63 NA 12.07 4.45 NA 35.15 090 

22556 .......... ............ A Thorax spine fusion ..................................... 23.47 NA 14.33 4.34 NA 42.14 090 

22558 .......... ............ A Lumbar spine fusion .................................... 22.29 NA 12.94 3.15 NA 38.39 090 

22585 .......... ............ A Additional spinal fusion ............................... 5.53 NA 2.72 1.25 NA 9.50 ZZZ 

22590 .......... ............ A Spine & skull spinal fusion .......................... 20.52 NA 13.02 4.78 NA 38.32 090 

22595 .......... ............ A Neck spinal fusion ....................................... 19.40 NA 12.54 4.40 NA 36.34 090 

22600 .......... ............ A Neck spine fusion ........................................ 16.15 NA 10.93 3.72 NA 30.80 090 

22610 .......... ............ A Thorax spine fusion ..................................... 16.03 NA 11.12 3.52 NA 30.67 090 

22612 .......... ............ A Lumbar spine fusion .................................... 21.01 NA 13.81 4.46 NA 39.28 090 

22614 .......... ............ A Spine fusion, extra segment ....................... 6.44 NA 3.25 1.38 NA 11.08 ZZZ 

22630 .......... ............ A Lumbar spine fusion .................................... 20.85 NA 13.27 4.72 NA 38.84 090 

22632 .......... ............ A Spine fusion, extra segment ....................... 5.23 NA 2.59 1.16 NA 8.98 ZZZ 

22800 .......... ............ A Fusion of spine ............................................ 18.26 NA 12.40 3.75 NA 34.41 090 

22802 .......... ............ A Fusion of spine ............................................ 30.89 NA 19.00 6.15 NA 56.04 090 

22804 .......... ............ A Fusion of spine ............................................ 36.29 NA 22.00 6.98 NA 65.27 090 

22808 .......... ............ A Fusion of spine ............................................ 26.28 NA 15.86 4.92 NA 47.07 090 

22810 .......... ............ A Fusion of spine ............................................ 30.28 NA 17.84 5.13 NA 53.25 090 

22812 .......... ............ A Fusion of spine ............................................ 32.72 NA 19.47 5.28 NA 57.46 090 

22818 .......... ............ A Kyphectomy, 1-2 segments ......................... 31.84 NA 18.38 6.45 NA 56.67 090 

22819 .......... ............ A Kyphectomy, 3 or more ............................... 36.46 NA 19.51 7.65 NA 63.63 090 

22830 .......... ............ A Exploration of spinal fusion ......................... 10.85 NA 7.73 2.29 NA 20.87 090 

22840 .......... ............ A Insert spine fixation device .......................... 12.55 NA 6.31 2.78 NA 21.63 ZZZ 

22841 .......... ............ B Insert spine fixation device .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

22842 .......... ............ A Insert spine fixation device .......................... 12.59 NA 6.32 2.74 NA 21.64 ZZZ 

22843 .......... ............ A Insert spine fixation device .......................... 13.47 NA 6.41 2.85 NA 22.73 ZZZ 

22844 .......... ............ A Insert spine fixation device .......................... 16.45 NA 8.49 3.18 NA 28.12 ZZZ 

22845 .......... ............ A Insert spine fixation device .......................... 11.96 NA 5.91 2.85 NA 20.72 ZZZ 

22846 .......... ............ A Insert spine fixation device .......................... 12.42 NA 6.16 2.95 NA 21.53 ZZZ 

22847 .......... ............ A Insert spine fixation device .......................... 13.81 NA 6.82 2.99 NA 23.62 ZZZ 

22848 .......... ............ A Insert pelv fixation device ............................ 6.00 NA 3.09 1.15 NA 10.24 ZZZ 

22849 .......... ............ A Reinsert spinal fixation ................................ 18.52 NA 11.40 3.89 NA 33.80 090 

22850 .......... ............ A Remove spine fixation device ..................... 9.53 NA 6.80 2.04 NA 18.37 090 

22851 .......... ............ A Apply spine prosth device ........................... 6.71 NA 3.27 1.49 NA 11.47 ZZZ 

22852 .......... ............ A Remove spine fixation device ..................... 9.02 NA 6.60 1.89 NA 17.50 090 

22855 .......... ............ A Remove spine fixation device ..................... 15.14 NA 9.43 3.51 NA 28.08 090 

22899 .......... ............ C Spine surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

22900 .......... ............ A Remove abdominal wall lesion ................... 5.80 NA 3.22 0.76 NA 9.78 090 

22999 .......... ............ C Abdomen surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

45889

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

23000 .......... ............ A Removal of calcium deposits ...................... 4.36 8.16 4.28 0.68 13.20 9.32 090 

23020 .......... ............ A Release shoulder joint ................................. 8.94 NA 7.31 1.54 NA 17.79 090 

23030 .......... ............ A Drain shoulder lesion .................................. 3.43 7.02 2.81 0.57 11.01 6.81 010 

23031 .......... ............ A Drain shoulder bursa ................................... 2.75 7.33 2.62 0.46 10.54 5.83 010 

23035 .......... ............ A Drain shoulder bone lesion ......................... 8.62 NA 7.93 1.47 NA 18.02 090 

23040 .......... ............ A Exploratory shoulder surgery ...................... 9.21 NA 7.61 1.60 NA 18.42 090 

23044 .......... ............ A Exploratory shoulder surgery ...................... 7.12 NA 6.22 1.24 NA 14.58 090 

23065 .......... ............ A Biopsy shoulder tissues .............................. 2.27 2.71 1.60 0.20 5.18 4.08 010 

23066 .......... ............ A Biopsy shoulder tissues .............................. 4.16 7.54 3.89 0.63 12.33 8.68 090 

23075 .......... ............ A Removal of shoulder lesion ......................... 2.39 3.59 1.75 0.34 6.33 4.49 010 

23076 .......... ............ A Removal of shoulder lesion ......................... 7.64 NA 5.45 1.13 NA 14.21 090 

23077 .......... ............ A Remove tumor of shoulder .......................... 16.10 NA 9.99 2.33 NA 28.42 090 

23100 .......... ............ A Biopsy of shoulder joint ............................... 6.03 NA 5.48 1.04 NA 12.55 090 

23101 .......... ............ A Shoulder joint surgery ................................. 5.58 NA 5.15 0.96 NA 11.69 090 

23105 .......... ............ A Remove shoulder joint lining ....................... 8.24 NA 6.90 1.42 NA 16.56 090 

23106 .......... ............ A Incision of collarbone joint ........................... 5.96 NA 5.51 0.99 NA 12.46 090 

23107 .......... ............ A Explore treat shoulder joint ......................... 8.63 NA 7.15 1.49 NA 17.27 090 

23120 .......... ............ A Partial removal, collar bone ........................ 7.11 NA 6.24 1.23 NA 14.59 090 

23125 .......... ............ A Removal of collar bone ............................... 9.40 NA 7.32 1.62 NA 18.34 090 

23130 .......... ............ A Remove shoulder bone, part ....................... 7.56 NA 6.89 1.30 NA 15.75 090 

23140 .......... ............ A Removal of bone lesion .............................. 6.89 NA 5.09 1.08 NA 13.07 090 

23145 .......... ............ A Removal of bone lesion .............................. 9.10 NA 7.23 1.49 NA 17.82 090 

23146 .......... ............ A Removal of bone lesion .............................. 7.84 NA 6.88 1.35 NA 16.06 090 

23150 .......... ............ A Removal of humerus lesion ........................ 8.49 NA 6.70 1.32 NA 16.51 090 

23155 .......... ............ A Removal of humerus lesion ........................ 10.35 NA 8.07 1.80 NA 20.22 090 

23156 .......... ............ A Removal of humerus lesion ........................ 8.69 NA 7.14 1.50 NA 17.33 090 

23170 .......... ............ A Remove collar bone lesion .......................... 6.86 NA 5.82 1.12 NA 13.80 090 

23172 .......... ............ A Remove shoulder blade lesion .................... 6.90 NA 6.08 1.01 NA 13.99 090 

23174 .......... ............ A Remove humerus lesion ............................. 9.52 NA 8.10 1.65 NA 19.27 090 

23180 .......... ............ A Remove collar bone lesion .......................... 8.54 NA 8.60 1.47 NA 18.61 090 

23182 .......... ............ A Remove shoulder blade lesion .................... 8.16 NA 8.18 1.37 NA 17.71 090 

23184 .......... ............ A Remove humerus lesion ............................. 9.39 NA 8.92 1.63 NA 19.94 090 

23190 .......... ............ A Partial removal of scapula ........................... 7.24 NA 5.98 1.17 NA 14.40 090 

23195 .......... ............ A Removal of head of humerus ...................... 9.82 NA 7.48 1.70 NA 19.00 090 

23200 .......... ............ A Removal of collar bone ............................... 12.08 NA 8.44 1.93 NA 22.46 090 

23210 .......... ............ A Removal of shoulder blade ......................... 12.49 NA 8.72 2.02 NA 23.24 090 

23220 .......... ............ A Partial removal of humerus ......................... 14.57 NA 10.48 2.48 NA 27.53 090 

23221 .......... ............ A Partial removal of humerus ......................... 17.75 NA 11.47 3.05 NA 32.26 090 

23222 .......... ............ A Partial removal of humerus ......................... 23.93 NA 15.31 3.94 NA 43.17 090 

23330 .......... ............ A Remove shoulder foreign body ................... 1.85 3.54 1.81 0.24 5.64 3.90 010 

23331 .......... ............ A Remove shoulder foreign body ................... 7.38 NA 6.57 1.27 NA 15.23 090 

23332 .......... ............ A Remove shoulder foreign body ................... 11.62 NA 9.02 2.02 NA 22.66 090 

23350 .......... ............ A Injection for shoulder x-ray .......................... 1.00 3.39 0.35 0.06 4.45 1.41 000 

23395 .......... ............ A Muscle transfer,shoulder/arm ...................... 16.85 NA 12.46 2.93 NA 32.25 090 

23397 .......... ............ A Muscle transfers .......................................... 16.14 NA 11.05 2.73 NA 29.92 090 

23400 .......... ............ A Fixation of shoulder blade ........................... 13.55 NA 9.73 2.29 NA 25.57 090 

23405 .......... ............ A Incision of tendon & muscle ........................ 8.38 NA 6.69 1.45 NA 16.51 090 

23406 .......... ............ A Incise tendon(s) & muscle(s) ...................... 10.79 NA 8.07 1.87 NA 20.74 090 

23410 .......... ............ A Repair rotator cuff, acute ............................ 12.45 NA 9.10 2.16 NA 23.72 090 

23412 .......... ............ A Repair rotator cuff, chronic .......................... 13.32 NA 9.58 2.31 NA 25.20 090 

23415 .......... ............ A Release of shoulder ligament ..................... 9.98 NA 7.73 1.73 NA 19.44 090 

23420 .......... ............ A Repair of shoulder ....................................... 13.31 NA 10.51 2.31 NA 26.12 090 

23430 .......... ............ A Repair biceps tendon .................................. 9.99 NA 7.84 1.73 NA 19.56 090 

23440 .......... ............ A Remove/transplant tendon .......................... 10.48 NA 7.99 1.82 NA 20.29 090 

23450 .......... ............ A Repair shoulder capsule ............................. 13.41 NA 9.53 2.32 NA 25.26 090 

23455 .......... ............ A Repair shoulder capsule ............................. 14.38 NA 10.11 2.49 NA 26.98 090 

23460 .......... ............ A Repair shoulder capsule ............................. 15.38 NA 11.01 2.66 NA 29.05 090 

23462 .......... ............ A Repair shoulder capsule ............................. 15.31 NA 10.42 2.59 NA 28.32 090 

23465 .......... ............ A Repair shoulder capsule ............................. 15.86 NA 10.83 2.76 NA 29.46 090 

23466 .......... ............ A Repair shoulder capsule ............................. 14.23 NA 11.02 2.46 NA 27.71 090 

23470 .......... ............ A Reconstruct shoulder joint ........................... 17.15 NA 11.86 2.98 NA 32.00 090 

23472 .......... ............ A Reconstruct shoulder joint ........................... 21.11 NA 13.97 3.66 NA 38.74 090 

23480 .......... ............ A Revision of collar bone ................................ 11.18 NA 8.49 1.94 NA 21.61 090 

23485 .......... ............ A Revision of collar bone ................................ 13.44 NA 9.57 2.33 NA 25.34 090 

23490 .......... ............ A Reinforce clavicle ........................................ 11.86 NA 8.43 1.47 NA 21.76 090 

23491 .......... ............ A Reinforce shoulder bones ........................... 14.22 NA 10.37 2.46 NA 27.05 090 

23500 .......... ............ A Treat clavicle fracture .................................. 2.08 2.79 2.44 0.30 5.17 4.82 090 

23505 .......... ............ A Treat clavicle fracture .................................. 3.69 4.29 3.74 0.61 8.59 8.04 090 

23515 .......... ............ A Treat clavicle fracture .................................. 7.41 NA 6.34 1.28 NA 15.03 090 

23520 .......... ............ A Treat clavicle dislocation ............................. 2.16 2.77 2.67 0.34 5.28 5.17 090 

23525 .......... ............ A Treat clavicle dislocation ............................. 3.60 4.40 3.83 0.46 8.46 7.88 090 

23530 .......... ............ A Treat clavicle dislocation ............................. 7.31 NA 5.75 1.20 NA 14.27 090 

23532 .......... ............ A Treat clavicle dislocation ............................. 8.02 NA 6.76 1.38 NA 16.15 090 

23540 .......... ............ A Treat clavicle dislocation ............................. 2.23 2.79 2.28 0.29 5.31 4.81 090 

45890

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

23545 .......... ............ A Treat clavicle dislocation ............................. 3.26 4.10 3.29 0.35 7.71 6.90 090 

23550 .......... ............ A Treat clavicle dislocation ............................. 7.24 NA 6.18 1.25 NA 14.67 090 

23552 .......... ............ A Treat clavicle dislocation ............................. 8.46 NA 7.08 1.46 NA 17.00 090 

23570 .......... ............ A Treat shoulder blade fx ............................... 2.23 2.92 2.81 0.36 5.52 5.40 090 

23575 .......... ............ A Treat shoulder blade fx ............................... 4.06 4.75 4.19 0.59 9.40 8.84 090 

23585 .......... ............ A Treat scapula fracture ................................. 8.97 NA 7.39 1.54 NA 17.90 090 

23600 .......... ............ A Treat humerus fracture ................................ 2.94 4.40 3.44 0.48 7.81 6.86 090 

23605 .......... ............ A Treat humerus fracture ................................ 4.87 5.95 4.97 0.84 11.66 10.68 090 

23615 .......... ............ A Treat humerus fracture ................................ 9.36 NA 8.56 1.62 NA 19.54 090 

23616 .......... ............ A Treat humerus fracture ................................ 21.28 NA 13.70 3.69 NA 38.67 090 

23620 .......... ............ A Treat humerus fracture ................................ 2.40 3.51 2.89 0.40 6.31 5.69 090 

23625 .......... ............ A Treat humerus fracture ................................ 3.93 4.80 4.16 0.67 9.40 8.76 090 

23630 .......... ............ A Treat humerus fracture ................................ 7.35 NA 6.41 1.27 NA 15.04 090 

23650 .......... ............ A Treat shoulder dislocation ........................... 3.39 3.68 2.67 0.30 7.36 6.35 090 

23655 .......... ............ A Treat shoulder dislocation ........................... 4.57 NA 4.04 0.69 NA 9.30 090 

23660 .......... ............ A Treat shoulder dislocation ........................... 7.49 NA 6.18 1.29 NA 14.96 090 

23665 .......... ............ A Treat dislocation/fracture ............................. 4.47 5.18 4.59 0.71 10.36 9.77 090 

23670 .......... ............ A Treat dislocation/fracture ............................. 7.91 NA 6.61 1.36 NA 15.88 090 

23675 .......... ............ A Treat dislocation/fracture ............................. 6.05 6.63 5.66 1.01 13.70 12.73 090 

23680 .......... ............ A Treat dislocation/fracture ............................. 10.06 NA 7.86 1.75 NA 19.67 090 

23700 .......... ............ A Fixation of shoulder ..................................... 2.53 NA 2.11 0.44 NA 5.08 010 

23800 .......... ............ A Fusion of shoulder joint ............................... 14.17 NA 10.10 2.35 NA 26.62 090 

23802 .......... ............ A Fusion of shoulder joint ............................... 16.61 NA 9.87 2.70 NA 29.19 090 

23900 .......... ............ A Amputation of arm & girdle ......................... 19.73 NA 11.40 3.18 NA 34.31 090 

23920 .......... ............ A Amputation at shoulder joint ....................... 14.62 NA 9.65 2.46 NA 26.73 090 

23921 .......... ............ A Amputation follow-up surgery ...................... 5.49 NA 4.93 0.78 NA 11.20 090 

23929 .......... ............ C Shoulder surgery procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

23930 .......... ............ A Drainage of arm lesion ................................ 2.95 5.96 2.24 0.43 9.34 5.62 010 

23931 .......... ............ A Drainage of arm bursa ................................ 1.79 5.52 2.09 0.28 7.60 4.16 010 

23935 .......... ............ A Drain arm/elbow bone lesion ...................... 6.09 NA 5.72 1.05 NA 12.86 090 

24000 .......... ............ A Exploratory elbow surgery ........................... 5.82 NA 5.24 0.97 NA 12.03 090 

24006 .......... ............ A Release elbow joint ..................................... 9.32 NA 7.51 1.50 NA 18.33 090 

24065 .......... ............ A Biopsy arm/elbow soft tissue ...................... 2.08 3.47 1.72 0.17 5.73 3.97 010 

24066 .......... ............ A Biopsy arm/elbow soft tissue ...................... 5.21 8.65 4.03 0.80 14.66 10.04 090 

24075 .......... ............ A Remove arm/elbow lesion ........................... 3.92 7.23 3.34 0.56 11.71 7.81 090 

24076 .......... ............ A Remove arm/elbow lesion ........................... 6.30 NA 4.75 0.95 NA 12.01 090 

24077 .......... ............ A Remove tumor of arm/elbow ....................... 11.76 NA 7.55 1.72 NA 21.04 090 

24100 .......... ............ A Biopsy elbow joint lining .............................. 4.93 NA 4.39 0.85 NA 10.17 090 

24101 .......... ............ A Explore/treat elbow joint .............................. 6.13 NA 5.73 1.03 NA 12.90 090 

24102 .......... ............ A Remove elbow joint lining ........................... 8.04 NA 6.64 1.33 NA 16.01 090 

24105 .......... ............ A Removal of elbow bursa ............................. 3.61 NA 4.25 0.61 NA 8.47 090 

24110 .......... ............ A Remove humerus lesion ............................. 7.39 NA 6.46 1.28 NA 15.13 090 

24115 .......... ............ A Remove/graft bone lesion ........................... 9.64 NA 7.02 1.67 NA 18.33 090 

24116 .......... ............ A Remove/graft bone lesion ........................... 11.81 NA 8.78 2.05 NA 22.65 090 

24120 .......... ............ A Remove elbow lesion .................................. 6.65 NA 5.74 1.10 NA 13.49 090 

24125 .......... ............ A Remove/graft bone lesion ........................... 7.90 NA 6.05 1.06 NA 15.01 090 

24126 .......... ............ A Remove/graft bone lesion ........................... 8.32 NA 6.82 1.16 NA 16.30 090 

24130 .......... ............ A Removal of head of radius .......................... 6.25 NA 5.82 1.04 NA 13.11 090 

24134 .......... ............ A Removal of arm bone lesion ....................... 9.74 NA 8.50 1.64 NA 19.88 090 

24136 .......... ............ A Remove radius bone lesion ........................ 8.00 NA 7.04 1.38 NA 16.42 090 

24138 .......... ............ A Remove elbow bone lesion ......................... 8.06 NA 7.53 1.34 NA 16.92 090 

24140 .......... ............ A Partial removal of arm bone ........................ 9.19 NA 8.71 1.51 NA 19.41 090 

24145 .......... ............ A Partial removal of radius ............................. 7.59 NA 7.71 1.25 NA 16.54 090 

24147 .......... ............ A Partial removal of elbow .............................. 7.55 NA 8.23 1.30 NA 17.08 090 

24149 .......... ............ A Radical resection of elbow .......................... 14.21 NA 11.28 2.34 NA 27.82 090 

24150 .......... ............ A Extensive humerus surgery ......................... 13.28 NA 9.69 2.32 NA 25.28 090 

24151 .......... ............ A Extensive humerus surgery ......................... 15.59 NA 11.17 2.59 NA 29.36 090 

24152 .......... ............ A Extensive radius surgery ............................. 10.06 NA 7.49 1.48 NA 19.04 090 

24153 .......... ............ A Extensive radius surgery ............................. 11.54 NA 5.91 0.74 NA 18.20 090 

24155 .......... ............ A Removal of elbow joint ................................ 11.73 NA 8.15 1.92 NA 21.80 090 

24160 .......... ............ A Remove elbow joint implant ........................ 7.84 NA 6.68 1.30 NA 15.82 090 

24164 .......... ............ A Remove radius head implant ...................... 6.23 NA 5.58 1.03 NA 12.84 090 

24200 .......... ............ A Removal of arm foreign body ...................... 1.76 3.26 1.59 0.20 5.22 3.55 010 

24201 .......... ............ A Removal of arm foreign body ...................... 4.56 9.27 4.11 0.72 14.55 9.38 090 

24220 .......... ............ A Injection for elbow x-ray .............................. 1.31 3.46 0.46 0.08 4.85 1.85 000 

24300 .......... ............ A Manipulate elbow w/anesth ......................... 3.75 NA 5.52 0.65 NA 9.92 090 

24301 .......... ............ A Muscle/tendon transfer ................................ 10.20 NA 7.93 1.66 NA 19.79 090 

24305 .......... ............ A Arm tendon lengthening .............................. 7.45 NA 6.49 1.15 NA 15.10 090 

24310 .......... ............ A Revision of arm tendon ............................... 5.98 NA 5.40 0.96 NA 12.34 090 

24320 .......... ............ A Repair of arm tendon .................................. 10.56 NA 7.54 1.73 NA 19.83 090 

24330 .......... ............ A Revision of arm muscles ............................. 9.61 NA 7.63 1.60 NA 18.84 090 

24331 .......... ............ A Revision of arm muscles ............................. 10.65 NA 8.40 1.77 NA 20.82 090 

24332 .......... ............ A Tenolysis, triceps ......................................... 7.45 NA 6.56 1.23 NA 15.24 090 

24340 .......... ............ A Repair of biceps tendon .............................. 7.90 NA 6.76 1.36 NA 16.01 090 

45891

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

24341 .......... ............ A Repair arm tendon/muscle .......................... 7.91 NA 7.68 1.36 NA 16.94 090 

24342 .......... ............ A Repair of ruptured tendon ........................... 10.62 NA 8.25 1.85 NA 20.72 090 

24343 .......... ............ A Repr elbow lat ligmnt w/tiss ........................ 8.66 NA 7.89 1.43 NA 17.98 090 

24344 .......... ............ A Reconstruct elbow lat ligmnt ....................... 14.01 NA 11.16 2.36 NA 27.53 090 

24345 .......... ............ A Repr elbw med ligmnt w/tissu ..................... 8.66 NA 7.78 1.44 NA 17.87 090 

24346 .......... ............ A Reconstruct elbow med ligmnt .................... 14.01 NA 11.00 2.33 NA 27.34 090 

24350 .......... ............ A Repair of tennis elbow ................................ 5.25 NA 5.40 0.87 NA 11.52 090 

24351 .......... ............ A Repair of tennis elbow ................................ 5.91 NA 5.72 1.02 NA 12.65 090 

24352 .......... ............ A Repair of tennis elbow ................................ 6.43 NA 5.97 1.10 NA 13.50 090 

24354 .......... ............ A Repair of tennis elbow ................................ 6.48 NA 5.95 1.07 NA 13.50 090 

24356 .......... ............ A Revision of tennis elbow ............................. 6.68 NA 6.10 1.11 NA 13.90 090 

24360 .......... ............ A Reconstruct elbow joint ............................... 12.34 NA 9.17 2.05 NA 23.56 090 

24361 .......... ............ A Reconstruct elbow joint ............................... 14.09 NA 10.24 2.18 NA 26.51 090 

24362 .......... ............ A Reconstruct elbow joint ............................... 15.00 NA 9.75 2.60 NA 27.35 090 

24363 .......... ............ A Replace elbow joint ..................................... 18.50 NA 13.29 3.01 NA 34.80 090 

24365 .......... ............ A Reconstruct head of radius ......................... 8.40 NA 6.97 1.41 NA 16.78 090 

24366 .......... ............ A Reconstruct head of radius ......................... 9.14 NA 7.29 1.52 NA 17.95 090 

24400 .......... ............ A Revision of humerus ................................... 11.06 NA 8.58 1.92 NA 21.56 090 

24410 .......... ............ A Revision of humerus ................................... 14.83 NA 10.10 2.57 NA 27.49 090 

24420 .......... ............ A Revision of humerus ................................... 13.45 NA 10.21 2.17 NA 25.83 090 

24430 .......... ............ A Repair of humerus ....................................... 12.82 NA 9.43 2.21 NA 24.45 090 

24435 .......... ............ A Repair humerus with graft ........................... 13.18 NA 10.55 2.27 NA 25.99 090 

24470 .......... ............ A Revision of elbow joint ................................ 8.75 NA 7.46 1.48 NA 17.69 090 

24495 .......... ............ A Decompression of forearm .......................... 8.13 NA 8.34 1.18 NA 17.65 090 

24498 .......... ............ A Reinforce humerus ...................................... 11.92 NA 8.97 2.06 NA 22.95 090 

24500 .......... ............ A Treat humerus fracture ................................ 3.22 4.99 3.57 0.50 8.71 7.29 090 

24505 .......... ............ A Treat humerus fracture ................................ 5.17 6.69 5.24 0.89 12.75 11.30 090 

24515 .......... ............ A Treat humerus fracture ................................ 11.65 NA 9.09 2.02 NA 22.76 090 

24516 .......... ............ A Treat humerus fracture ................................ 11.65 NA 8.82 2.02 NA 22.49 090 

24530 .......... ............ A Treat humerus fracture ................................ 3.50 5.33 3.92 0.57 9.40 7.99 090 

24535 .......... ............ A Treat humerus fracture ................................ 6.87 7.89 6.43 1.18 15.94 14.48 090 

24538 .......... ............ A Treat humerus fracture ................................ 9.44 NA 8.42 1.64 NA 19.50 090 

24545 .......... ............ A Treat humerus fracture ................................ 10.46 NA 8.18 1.82 NA 20.46 090 

24546 .......... ............ A Treat humerus fracture ................................ 15.70 NA 10.96 2.73 NA 29.39 090 

24560 .......... ............ A Treat humerus fracture ................................ 2.81 4.64 3.09 0.44 7.88 6.33 090 

24565 .......... ............ A Treat humerus fracture ................................ 5.56 6.71 5.37 0.93 13.20 11.86 090 

24566 .......... ............ A Treat humerus fracture ................................ 7.80 NA 7.86 1.30 NA 16.96 090 

24575 .......... ............ A Treat humerus fracture ................................ 10.66 NA 8.14 1.86 NA 20.66 090 

24576 .......... ............ A Treat humerus fracture ................................ 2.87 4.90 3.60 0.46 8.23 6.93 090 

24577 .......... ............ A Treat humerus fracture ................................ 5.79 7.01 5.67 0.95 13.75 12.41 090 

24579 .......... ............ A Treat humerus fracture ................................ 11.60 NA 8.55 2.02 NA 22.17 090 

24582 .......... ............ A Treat humerus fracture ................................ 8.56 NA 8.78 1.48 NA 18.82 090 

24586 .......... ............ A Treat elbow fracture .................................... 15.22 NA 10.87 2.64 NA 28.73 090 

24587 .......... ............ A Treat elbow fracture .................................... 15.17 NA 10.68 2.52 NA 28.37 090 

24600 .......... ............ A Treat elbow dislocation ............................... 4.23 4.99 3.39 0.50 9.72 8.12 090 

24605 .......... ............ A Treat elbow dislocation ............................... 5.42 NA 5.20 0.89 NA 11.51 090 

24615 .......... ............ A Treat elbow dislocation ............................... 9.43 NA 7.57 1.60 NA 18.59 090 

24620 .......... ............ A Treat elbow fracture .................................... 6.98 NA 6.08 1.07 NA 14.13 090 

24635 .......... ............ A Treat elbow fracture .................................... 13.20 NA 13.92 2.28 NA 29.40 090 

24640 .......... ............ A Treat elbow dislocation ............................... 1.20 2.03 0.77 0.12 3.35 2.10 010 

24650 .......... ............ A Treat radius fracture .................................... 2.16 4.11 2.66 0.35 6.62 5.18 090 

24655 .......... ............ A Treat radius fracture .................................... 4.40 6.05 4.65 0.70 11.15 9.75 090 

24665 .......... ............ A Treat radius fracture .................................... 8.15 NA 7.26 1.41 NA 16.81 090 

24666 .......... ............ A Treat radius fracture .................................... 9.50 NA 7.80 1.62 NA 18.92 090 

24670 .......... ............ A Treat ulnar fracture ...................................... 2.55 4.27 2.98 0.41 7.23 5.93 090 

24675 .......... ............ A Treat ulnar fracture ...................................... 4.72 6.10 4.83 0.81 11.63 10.36 090 

24685 .......... ............ A Treat ulnar fracture ...................................... 8.81 NA 7.27 1.52 NA 17.60 090 

24800 .......... ............ A Fusion of elbow joint ................................... 11.20 NA 8.49 1.63 NA 21.33 090 

24802 .......... ............ A Fusion/graft of elbow joint ........................... 13.70 NA 10.04 2.37 NA 26.11 090 

24900 .......... ............ A Amputation of upper arm ............................ 9.61 NA 6.91 1.53 NA 18.05 090 

24920 .......... ............ A Amputation of upper arm ............................ 9.55 NA 6.77 1.61 NA 17.93 090 

24925 .......... ............ A Amputation follow-up surgery ...................... 7.07 NA 5.91 1.14 NA 14.12 090 

24930 .......... ............ A Amputation follow-up surgery ...................... 10.25 NA 7.05 1.67 NA 18.97 090 

24931 .......... ............ A Amputate upper arm & implant ................... 12.73 NA 5.68 1.89 NA 20.30 090 

24935 .......... ............ A Revision of amputation ................................ 15.57 NA 7.92 2.13 NA 25.62 090 

24940 .......... ............ C Revision of upper arm ................................. 0.00 0.00 0.00 0.00 0.00 0.00 090 

24999 .......... ............ C Upper arm/elbow surgery ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

25000 .......... ............ A Incision of tendon sheath ............................ 3.38 NA 6.49 0.55 NA 10.41 090 

25001 .......... ............ A Incise flexor carpi radialis ............................ 3.38 NA 4.10 0.55 NA 8.03 090 

25020 .......... ............ A Decompress forearm 1 space ..................... 5.92 NA 9.00 0.93 NA 15.85 090 

25023 .......... ............ A Decompress forearm 1 space ..................... 12.97 NA 14.21 2.03 NA 29.21 090 

25024 .......... ............ A Decompress forearm 2 spaces ................... 9.51 NA 7.28 1.36 NA 18.15 090 

25025 .......... ............ A Decompress forearm 2 spaces ................... 16.55 NA 9.75 1.82 NA 28.13 090 

25028 .......... ............ A Drainage of forearm lesion .......................... 5.25 NA 7.73 0.81 NA 13.79 090 

45892

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

25031 .......... ............ A Drainage of forearm bursa .......................... 4.14 NA 7.45 0.63 NA 12.22 090 

25035 .......... ............ A Treat forearm bone lesion ........................... 7.36 NA 12.69 1.24 NA 21.29 090 

25040 .......... ............ A Explore/treat wrist joint ................................ 7.18 NA 7.00 1.15 NA 15.34 090 

25065 .......... ............ A Biopsy forearm soft tissues ......................... 1.99 3.49 1.85 0.15 5.64 4.00 010 

25066 .......... ............ A Biopsy forearm soft tissues ......................... 4.13 NA 6.69 0.64 NA 11.46 090 

25075 .......... ............ A Removal forearm lesion subcu ................... 3.74 NA 5.66 0.55 NA 9.95 090 

25076 .......... ............ A Removal forearm lesion deep ..................... 4.92 NA 8.98 0.74 NA 14.64 090 

25077 .......... ............ A Remove tumor, forearm/wrist ...................... 9.77 NA 11.47 1.42 NA 22.66 090 

25085 .......... ............ A Incision of wrist capsule .............................. 5.50 NA 6.78 0.85 NA 13.13 090 

25100 .......... ............ A Biopsy of wrist joint ..................................... 3.90 NA 5.04 0.59 NA 9.53 090 

25101 .......... ............ A Explore/treat wrist joint ................................ 4.69 NA 5.64 0.75 NA 11.08 090 

25105 .......... ............ A Remove wrist joint lining ............................. 5.85 NA 6.97 0.92 NA 13.74 090 

25107 .......... ............ A Remove wrist joint cartilage ........................ 6.43 NA 7.98 0.99 NA 15.41 090 

25110 .......... ............ A Remove wrist tendon lesion ........................ 3.92 NA 6.65 0.62 NA 11.19 090 

25111 .......... ............ A Remove wrist tendon lesion ........................ 3.39 NA 4.51 0.53 NA 8.43 090 

25112 .......... ............ A Reremove wrist tendon lesion ..................... 4.53 NA 5.05 0.70 NA 10.28 090 

25115 .......... ............ A Remove wrist/forearm lesion ....................... 8.83 NA 13.21 1.31 NA 23.35 090 

25116 .......... ............ A Remove wrist/forearm lesion ....................... 7.11 NA 12.34 1.11 NA 20.56 090 

25118 .......... ............ A Excise wrist tendon sheath ......................... 4.37 NA 5.49 0.68 NA 10.54 090 

25119 .......... ............ A Partial removal of ulna ................................ 6.04 NA 7.25 0.96 NA 14.25 090 

25120 .......... ............ A Removal of forearm lesion .......................... 6.10 NA 11.29 1.00 NA 18.39 090 

25125 .......... ............ A Remove/graft forearm lesion ....................... 7.48 NA 12.05 1.06 NA 20.60 090 

25126 .......... ............ A Remove/graft forearm lesion ....................... 7.56 NA 12.20 1.27 NA 21.02 090 

25130 .......... ............ A Removal of wrist lesion ............................... 5.26 NA 6.15 0.80 NA 12.21 090 

25135 .......... ............ A Remove & graft wrist lesion ........................ 6.89 NA 7.22 1.02 NA 15.13 090 

25136 .......... ............ A Remove & graft wrist lesion ........................ 5.97 NA 6.35 1.03 NA 13.35 090 

25145 .......... ............ A Remove forearm bone lesion ...................... 6.37 NA 11.29 1.01 NA 18.67 090 

25150 .......... ............ A Partial removal of ulna ................................ 7.09 NA 7.83 1.14 NA 16.06 090 

25151 .......... ............ A Partial removal of radius ............................. 7.39 NA 11.93 1.18 NA 20.50 090 

25170 .......... ............ A Extensive forearm surgery .......................... 11.09 NA 14.28 1.77 NA 27.15 090 

25210 .......... ............ A Removal of wrist bone ................................ 5.95 NA 6.52 0.88 NA 13.35 090 

25215 .......... ............ A Removal of wrist bones ............................... 7.90 NA 8.37 1.19 NA 17.46 090 

25230 .......... ............ A Partial removal of radius ............................. 5.23 NA 5.89 0.79 NA 11.91 090 

25240 .......... ............ A Partial removal of ulna ................................ 5.17 NA 6.61 0.81 NA 12.59 090 

25246 .......... ............ A Injection for wrist x-ray ................................ 1.45 3.36 0.50 0.09 4.90 2.05 000 

25248 .......... ............ A Remove forearm foreign body .................... 5.14 NA 8.08 0.72 NA 13.94 090 

25250 .......... ............ A Removal of wrist prosthesis ........................ 6.60 NA 5.92 1.01 NA 13.53 090 

25251 .......... ............ A Removal of wrist prosthesis ........................ 9.58 NA 7.68 1.26 NA 18.52 090 

25259 .......... ............ A Manipulate wrist w/anesthes ....................... 3.75 NA 5.53 0.62 NA 9.90 090 

25260 .......... ............ A Repair forearm tendon/muscle .................... 7.81 NA 12.49 1.19 NA 21.49 090 

25263 .......... ............ A Repair forearm tendon/muscle .................... 7.83 NA 12.46 1.18 NA 21.47 090 

25265 .......... ............ A Repair forearm tendon/muscle .................... 9.89 NA 13.46 1.47 NA 24.82 090 

25270 .......... ............ A Repair forearm tendon/muscle .................... 6.00 NA 11.23 0.95 NA 18.18 090 

25272 .......... ............ A Repair forearm tendon/muscle .................... 7.04 NA 11.96 1.11 NA 20.11 090 

25274 .......... ............ A Repair forearm tendon/muscle .................... 8.76 NA 12.81 1.36 NA 22.92 090 

25275 .......... ............ A Repair forearm tendon sheath .................... 8.51 NA 7.34 1.31 NA 17.15 090 

25280 .......... ............ A Revise wrist/forearm tendon ....................... 7.22 NA 11.85 1.08 NA 20.15 090 

25290 .......... ............ A Incise wrist/forearm tendon ......................... 5.29 NA 13.90 0.82 NA 20.01 090 

25295 .......... ............ A Release wrist/forearm tendon ..................... 6.55 NA 11.39 1.00 NA 18.94 090 

25300 .......... ............ A Fusion of tendons at wrist ........................... 8.81 NA 8.15 1.26 NA 18.22 090 

25301 .......... ............ A Fusion of tendons at wrist ........................... 8.41 NA 7.76 1.29 NA 17.46 090 

25310 .......... ............ A Transplant forearm tendon .......................... 8.15 NA 12.25 1.21 NA 21.61 090 

25312 .......... ............ A Transplant forearm tendon .......................... 9.58 NA 13.12 1.41 NA 24.11 090 

25315 .......... ............ A Revise palsy hand tendon(s) ...................... 10.20 NA 13.54 1.58 NA 25.32 090 

25316 .......... ............ A Revise palsy hand tendon(s) ...................... 12.33 NA 15.27 1.74 NA 29.35 090 

25320 .......... ............ A Repair/revise wrist joint ............................... 10.77 NA 11.02 1.61 NA 23.40 090 

25332 .......... ............ A Revise wrist joint ......................................... 11.41 NA 8.89 1.83 NA 22.13 090 

25335 .......... ............ A Realignment of hand ................................... 12.89 NA 11.18 1.92 NA 25.99 090 

25337 .......... ............ A Reconstruct ulna/radioulnar ........................ 10.17 NA 10.64 1.61 NA 22.42 090 

25350 .......... ............ A Revision of radius ........................................ 8.79 NA 13.10 1.46 NA 23.35 090 

25355 .......... ............ A Revision of radius ........................................ 10.17 NA 13.71 1.73 NA 25.61 090 

25360 .......... ............ A Revision of ulna ........................................... 8.44 NA 12.99 1.41 NA 22.84 090 

25365 .......... ............ A Revise radius & ulna ................................... 12.40 NA 14.72 2.15 NA 29.28 090 

25370 .......... ............ A Revise radius or ulna .................................. 13.37 NA 15.25 2.28 NA 30.89 090 

25375 .......... ............ A Revise radius & ulna ................................... 13.05 NA 15.43 2.26 NA 30.73 090 

25390 .......... ............ A Shorten radius or ulna ................................. 10.40 NA 13.71 1.65 NA 25.76 090 

25391 .......... ............ A Lengthen radius or ulna .............................. 13.66 NA 15.64 2.21 NA 31.51 090 

25392 .......... ............ A Shorten radius & ulna ................................. 13.96 NA 15.22 2.10 NA 31.28 090 

25393 .......... ............ A Lengthen radius & ulna ............................... 15.88 NA 16.66 2.76 NA 35.30 090 

25394 .......... ............ A Repair carpal bone, shorten ........................ 10.40 NA 7.82 1.59 NA 19.81 090 

25400 .......... ............ A Repair radius or ulna ................................... 10.92 NA 14.27 1.82 NA 27.01 090 

25405 .......... ............ A Repair/graft radius or ulna .......................... 14.39 NA 16.29 2.32 NA 33.00 090 

25415 .......... ............ A Repair radius & ulna ................................... 13.36 NA 15.55 2.17 NA 31.07 090 

25420 .......... ............ A Repair/graft radius & ulna ........................... 16.34 NA 17.27 2.61 NA 36.23 090 

45893

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

25425 .......... ............ A Repair/graft radius or ulna .......................... 13.22 NA 20.06 2.08 NA 35.36 090 

25426 .......... ............ A Repair/graft radius & ulna ........................... 15.83 NA 15.84 2.54 NA 34.22 090 

25430 .......... ............ A Vasc graft into carpal bone ......................... 9.26 NA 7.15 1.27 NA 17.68 090 

25431 .......... ............ A Repair nonunion carpal bone ...................... 10.44 NA 8.14 1.90 NA 20.48 090 

25440 .......... ............ A Repair/graft wrist bone ................................ 10.44 NA 9.04 1.63 NA 21.11 090 

25441 .......... ............ A Reconstruct wrist joint ................................. 12.91 NA 9.69 2.07 NA 24.67 090 

25442 .......... ............ A Reconstruct wrist joint ................................. 10.85 NA 8.61 1.53 NA 21.00 090 

25443 .......... ............ A Reconstruct wrist joint ................................. 10.39 NA 8.50 1.37 NA 20.26 090 

25444 .......... ............ A Reconstruct wrist joint ................................. 11.15 NA 8.75 1.71 NA 21.61 090 

25445 .......... ............ A Reconstruct wrist joint ................................. 9.70 NA 7.74 1.55 NA 18.99 090 

25446 .......... ............ A Wrist replacement ....................................... 16.56 NA 11.56 2.47 NA 30.59 090 

25447 .......... ............ A Repair wrist joint(s) ..................................... 10.37 NA 8.38 1.61 NA 20.36 090 

25449 .......... ............ A Remove wrist joint implant .......................... 14.50 NA 10.34 2.21 NA 27.05 090 

25450 .......... ............ A Revision of wrist joint .................................. 7.88 NA 9.64 1.36 NA 18.87 090 

25455 .......... ............ A Revision of wrist joint .................................. 9.50 NA 10.38 0.96 NA 20.84 090 

25490 .......... ............ A Reinforce radius .......................................... 9.55 NA 12.92 1.43 NA 23.90 090 

25491 .......... ............ A Reinforce ulna ............................................. 9.97 NA 13.59 1.60 NA 25.16 090 

25492 .......... ............ A Reinforce radius and ulna ........................... 12.33 NA 14.41 2.14 NA 28.89 090 

25500 .......... ............ A Treat fracture of radius ................................ 2.45 3.74 2.64 0.35 6.55 5.44 090 

25505 .......... ............ A Treat fracture of radius ................................ 5.21 6.63 5.27 0.90 12.74 11.38 090 

25515 .......... ............ A Treat fracture of radius ................................ 9.19 NA 7.21 1.59 NA 17.99 090 

25520 .......... ............ A Treat fracture of radius ................................ 6.26 6.94 5.89 1.08 14.28 13.23 090 

25525 .......... ............ A Treat fracture of radius ................................ 12.24 NA 9.67 2.12 NA 24.04 090 

25526 .......... ............ A Treat fracture of radius ................................ 12.99 NA 13.19 2.19 NA 28.36 090 

25530 .......... ............ A Treat fracture of ulna ................................... 2.09 3.93 2.78 0.34 6.37 5.21 090 

25535 .......... ............ A Treat fracture of ulna ................................... 5.14 6.11 5.15 0.89 12.14 11.18 090 

25545 .......... ............ A Treat fracture of ulna ................................... 8.91 NA 7.41 1.53 NA 17.85 090 

25560 .......... ............ A Treat fracture radius & ulna ........................ 2.44 3.86 2.52 0.35 6.66 5.31 090 

25565 .......... ............ A Treat fracture radius & ulna ........................ 5.63 6.78 5.27 0.93 13.34 11.83 090 

25574 .......... ............ A Treat fracture radius & ulna ........................ 7.01 NA 6.97 1.21 NA 15.19 090 

25575 .......... ............ A Treat fracture radius/ulna ............................ 10.45 NA 9.21 1.81 NA 21.47 090 

25600 .......... ............ A Treat fracture radius/ulna ............................ 2.64 4.25 2.88 0.42 7.31 5.93 090 

25605 .......... ............ A Treat fracture radius/ulna ............................ 5.81 7.30 6.05 1.00 14.11 12.86 090 

25611 .......... ............ A Treat fracture radius/ulna ............................ 7.78 NA 8.63 1.34 NA 17.75 090 

25620 .......... ............ A Treat fracture radius/ulna ............................ 8.56 NA 7.02 1.42 NA 17.00 090 

25622 .......... ............ A Treat wrist bone fracture ............................. 2.62 4.43 3.00 0.41 7.45 6.03 090 

25624 .......... ............ A Treat wrist bone fracture ............................. 4.53 6.13 4.93 0.76 11.42 10.22 090 

25628 .......... ............ A Treat wrist bone fracture ............................. 8.44 NA 7.58 1.37 NA 17.38 090 

25630 .......... ............ A Treat wrist bone fracture ............................. 2.89 4.34 2.85 0.45 7.68 6.18 090 

25635 .......... ............ A Treat wrist bone fracture ............................. 4.39 6.05 3.80 0.74 11.18 8.92 090 

25645 .......... ............ A Treat wrist bone fracture ............................. 7.25 NA 6.41 1.20 NA 14.86 090 

25650 .......... ............ A Treat wrist bone fracture ............................. 3.06 4.20 3.07 0.45 7.71 6.57 090 

25651 .......... ............ A Pin ulnar styloid fracture ............................. 5.36 NA 5.32 0.86 NA 11.54 090 

25652 .......... ............ A Treat fracture ulnar styloid .......................... 7.61 NA 6.78 1.21 NA 15.60 090 

25660 .......... ............ A Treat wrist dislocation ................................. 4.76 NA 4.57 0.58 NA 9.91 090 

25670 .......... ............ A Treat wrist dislocation ................................. 7.93 NA 6.76 1.28 NA 15.96 090 

25671 .......... ............ A Pin radioulnar dislocation ............................ 6.00 NA 5.95 1.00 NA 12.96 090 

25675 .......... ............ A Treat wrist dislocation ................................. 4.67 5.76 4.51 0.62 11.05 9.80 090 

25676 .......... ............ A Treat wrist dislocation ................................. 8.05 NA 7.06 1.34 NA 16.45 090 

25680 .......... ............ A Treat wrist fracture ...................................... 5.99 NA 4.65 0.78 NA 11.42 090 

25685 .......... ............ A Treat wrist fracture ...................................... 9.79 NA 7.57 1.60 NA 18.96 090 

25690 .......... ............ A Treat wrist dislocation ................................. 5.50 NA 5.34 0.88 NA 11.72 090 

25695 .......... ............ A Treat wrist dislocation ................................. 8.35 NA 6.86 1.32 NA 16.53 090 

25800 .......... ............ A Fusion of wrist joint ..................................... 9.77 NA 8.74 1.57 NA 20.08 090 

25805 .......... ............ A Fusion/graft of wrist joint ............................. 11.28 NA 9.86 1.80 NA 22.94 090 

25810 .......... ............ A Fusion/graft of wrist joint ............................. 10.57 NA 9.54 1.67 NA 21.78 090 

25820 .......... ............ A Fusion of hand bones ................................. 7.45 NA 7.54 1.22 NA 16.21 090 

25825 .......... ............ A Fuse hand bones with graft ........................ 9.28 NA 8.88 1.41 NA 19.57 090 

25830 .......... ............ A Fusion, radioulnar jnt/ulna ........................... 10.06 NA 13.60 1.55 NA 25.21 090 

25900 .......... ............ A Amputation of forearm ................................. 9.02 NA 11.89 1.30 NA 22.21 090 

25905 .......... ............ A Amputation of forearm ................................. 9.13 NA 11.58 1.40 NA 22.11 090 

25907 .......... ............ A Amputation follow-up surgery ...................... 7.81 NA 11.06 1.10 NA 19.96 090 

25909 .......... ............ A Amputation follow-up surgery ...................... 8.97 NA 11.60 1.44 NA 22.01 090 

25915 .......... ............ A Amputation of forearm ................................. 17.08 NA 17.81 2.93 NA 37.83 090 

25920 .......... ............ A Amputate hand at wrist ............................... 8.69 NA 7.56 1.35 NA 17.59 090 

25922 .......... ............ A Amputate hand at wrist ............................... 7.42 NA 6.76 1.12 NA 15.31 090 

25924 .......... ............ A Amputation follow-up surgery ...................... 8.47 NA 7.77 1.32 NA 17.56 090 

25927 .......... ............ A Amputation of hand ..................................... 8.81 NA 11.04 1.27 NA 21.11 090 

25929 .......... ............ A Amputation follow-up surgery ...................... 7.60 NA 5.70 1.14 NA 14.43 090 

25931 .......... ............ A Amputation follow-up surgery ...................... 7.82 NA 10.79 1.15 NA 19.75 090 

25999 .......... ............ C Forearm or wrist surgery ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

26010 .......... ............ A Drainage of finger abscess ......................... 1.54 5.21 1.56 0.18 6.93 3.29 010 

26011 .......... ............ A Drainage of finger abscess ......................... 2.19 8.22 2.23 0.33 10.74 4.75 010 

26020 .......... ............ A Drain hand tendon sheath ........................... 4.67 NA 5.17 0.73 NA 10.56 090 

45894

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

26025 .......... ............ A Drainage of palm bursa ............................... 4.82 NA 4.94 0.76 NA 10.52 090 

26030 .......... ............ A Drainage of palm bursa(s) .......................... 5.93 NA 5.53 0.92 NA 12.38 090 

26034 .......... ............ A Treat hand bone lesion ............................... 6.23 NA 6.14 1.01 NA 13.38 090 

26035 .......... ............ A Decompress fingers/hand ........................... 9.52 NA 7.64 1.47 NA 18.62 090 

26037 .......... ............ A Decompress fingers/hand ........................... 7.25 NA 6.11 1.13 NA 14.50 090 

26040 .......... ............ A Release palm contracture ........................... 3.34 NA 3.91 0.53 NA 7.77 090 

26045 .......... ............ A Release palm contracture ........................... 5.56 NA 5.45 0.93 NA 11.94 090 

26055 .......... ............ A Incise finger tendon sheath ......................... 2.70 13.25 3.79 0.43 16.38 6.92 090 

26060 .......... ............ A Incision of finger tendon .............................. 2.82 NA 3.39 0.45 NA 6.65 090 

26070 .......... ............ A Explore/treat hand joint ............................... 3.69 NA 3.29 0.48 NA 7.45 090 

26075 .......... ............ A Explore/treat finger joint .............................. 3.79 NA 3.68 0.53 NA 7.99 090 

26080 .......... ............ A Explore/treat finger joint .............................. 4.24 NA 4.69 0.66 NA 9.59 090 

26100 .......... ............ A Biopsy hand joint lining ............................... 3.67 NA 3.99 0.54 NA 8.19 090 

26105 .......... ............ A Biopsy finger joint lining .............................. 3.71 NA 4.08 0.59 NA 8.38 090 

26110 .......... ............ A Biopsy finger joint lining .............................. 3.53 NA 3.91 0.53 NA 7.97 090 

26115 .......... ............ A Removal hand lesion subcut ....................... 3.86 12.36 4.61 0.59 16.81 9.06 090 

26116 .......... ............ A Removal hand lesion, deep ........................ 5.53 NA 5.81 0.84 NA 12.18 090 

26117 .......... ............ A Remove tumor, hand/finger ......................... 8.56 NA 6.86 1.26 NA 16.67 090 

26121 .......... ............ A Release palm contracture ........................... 7.55 NA 6.73 1.17 NA 15.44 090 

26123 .......... ............ A Release palm contracture ........................... 9.30 NA 8.57 1.43 NA 19.30 090 

26125 .......... ............ A Release palm contracture ........................... 4.61 NA 2.37 0.70 NA 7.68 ZZZ 

26130 .......... ............ A Remove wrist joint lining ............................. 5.42 NA 5.17 0.94 NA 11.53 090 

26135 .......... ............ A Revise finger joint, each .............................. 6.96 NA 6.25 1.07 NA 14.28 090 

26140 .......... ............ A Revise finger joint, each .............................. 6.17 NA 5.85 0.92 NA 12.94 090 

26145 .......... ............ A Tendon excision, palm/finger ...................... 6.32 NA 5.85 0.97 NA 13.15 090 

26160 .......... ............ A Remove tendon sheath lesion .................... 3.16 11.58 3.98 0.49 15.23 7.63 090 

26170 .......... ............ A Removal of palm tendon, each ................... 4.77 NA 4.78 0.69 NA 10.24 090 

26180 .......... ............ A Removal of finger tendon ............................ 5.18 NA 5.23 0.78 NA 11.19 090 

26185 .......... ............ A Remove finger bone .................................... 5.25 NA 5.85 0.81 NA 11.91 090 

26200 .......... ............ A Remove hand bone lesion .......................... 5.51 NA 5.19 0.88 NA 11.58 090 

26205 .......... ............ A Remove/graft bone lesion ........................... 7.71 NA 6.67 1.20 NA 15.57 090 

26210 .......... ............ A Removal of finger lesion ............................. 5.15 NA 5.24 0.79 NA 11.18 090 

26215 .......... ............ A Remove/graft finger lesion .......................... 7.10 NA 6.17 0.98 NA 14.25 090 

26230 .......... ............ A Partial removal of hand bone ...................... 6.33 NA 5.71 1.01 NA 13.05 090 

26235 .......... ............ A Partial removal, finger bone ........................ 6.19 NA 5.62 0.95 NA 12.76 090 

26236 .......... ............ A Partial removal, finger bone ........................ 5.32 NA 5.14 0.81 NA 11.27 090 

26250 .......... ............ A Extensive hand surgery ............................... 7.56 NA 6.23 1.07 NA 14.85 090 

26255 .......... ............ A Extensive hand surgery ............................... 12.43 NA 9.06 1.68 NA 23.18 090 

26260 .......... ............ A Extensive finger surgery .............................. 7.03 NA 5.99 1.01 NA 14.03 090 

26261 .......... ............ A Extensive finger surgery .............................. 9.10 NA 5.99 1.14 NA 16.23 090 

26262 .......... ............ A Partial removal of finger .............................. 5.67 NA 5.16 0.88 NA 11.71 090 

26320 .......... ............ A Removal of implant from hand .................... 3.98 NA 4.17 0.59 NA 8.74 090 

26340 .......... ............ A Manipulate finger w/anesth ......................... 2.51 NA 4.73 0.39 NA 7.62 090 

26350 .......... ............ A Repair finger/hand tendon ........................... 5.99 NA 13.59 0.93 NA 20.51 090 

26352 .......... ............ A Repair/graft hand tendon ............................ 7.69 NA 14.33 1.13 NA 23.15 090 

26356 .......... ............ A Repair finger/hand tendon ........................... 8.08 NA 17.23 1.21 NA 26.52 090 

26357 .......... ............ A Repair finger/hand tendon ........................... 8.59 NA 14.61 1.33 NA 24.52 090 

26358 .......... ............ A Repair/graft hand tendon ............................ 9.15 NA 15.56 1.38 NA 26.09 090 

26370 .......... ............ A Repair finger/hand tendon ........................... 7.11 NA 14.05 1.12 NA 22.28 090 

26372 .......... ............ A Repair/graft hand tendon ............................ 8.77 NA 15.41 1.40 NA 25.58 090 

26373 .......... ............ A Repair finger/hand tendon ........................... 8.17 NA 14.94 1.23 NA 24.33 090 

26390 .......... ............ A Revise hand/finger tendon .......................... 9.20 NA 12.48 1.40 NA 23.08 090 

26392 .......... ............ A Repair/graft hand tendon ............................ 10.26 NA 15.62 1.57 NA 27.45 090 

26410 .......... ............ A Repair hand tendon ..................................... 4.63 NA 11.08 0.73 NA 16.44 090 

26412 .......... ............ A Repair/graft hand tendon ............................ 6.31 NA 12.37 0.97 NA 19.65 090 

26415 .......... ............ A Excision, hand/finger tendon ....................... 8.35 NA 11.10 0.98 NA 20.43 090 

26416 .......... ............ A Graft hand or finger tendon ......................... 9.38 NA 13.70 0.79 NA 23.87 090 

26418 .......... ............ A Repair finger tendon .................................... 4.25 NA 11.46 0.67 NA 16.37 090 

26420 .......... ............ A Repair/graft finger tendon ........................... 6.77 NA 12.71 1.07 NA 20.55 090 

26426 .......... ............ A Repair finger/hand tendon ........................... 6.15 NA 12.28 0.95 NA 19.38 090 

26428 .......... ............ A Repair/graft finger tendon ........................... 7.21 NA 12.96 1.09 NA 21.26 090 

26432 .......... ............ A Repair finger tendon .................................... 4.02 NA 9.55 0.64 NA 14.21 090 

26433 .......... ............ A Repair finger tendon .................................... 4.56 NA 10.05 0.72 NA 15.32 090 

26434 .......... ............ A Repair/graft finger tendon ........................... 6.09 NA 10.81 0.93 NA 17.84 090 

26437 .......... ............ A Realignment of tendons .............................. 5.82 NA 10.83 0.89 NA 17.54 090 

26440 .......... ............ A Release palm/finger tendon ........................ 5.02 NA 12.48 0.75 NA 18.25 090 

26442 .......... ............ A Release palm & finger tendon .................... 8.17 NA 14.98 1.20 NA 24.35 090 

26445 .......... ............ A Release hand/finger tendon ........................ 4.31 NA 12.19 0.65 NA 17.15 090 

26449 .......... ............ A Release forearm/hand tendon ..................... 7.00 NA 14.77 1.06 NA 22.83 090 

26450 .......... ............ A Incision of palm tendon ............................... 3.67 NA 6.88 0.59 NA 11.14 090 

26455 .......... ............ A Incision of finger tendon .............................. 3.64 NA 6.84 0.58 NA 11.05 090 

26460 .......... ............ A Incise hand/finger tendon ............................ 3.46 NA 6.72 0.55 NA 10.72 090 

26471 .......... ............ A Fusion of finger tendons ............................. 5.73 NA 10.54 0.88 NA 17.15 090 

26474 .......... ............ A Fusion of finger tendons ............................. 5.32 NA 10.64 0.76 NA 16.72 090 

45895

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

26476 .......... ............ A Tendon lengthening ..................................... 5.18 NA 10.25 0.79 NA 16.22 090 

26477 .......... ............ A Tendon shortening ...................................... 5.15 NA 10.36 0.81 NA 16.32 090 

26478 .......... ............ A Lengthening of hand tendon ....................... 5.80 NA 11.05 0.90 NA 17.75 090 

26479 .......... ............ A Shortening of hand tendon .......................... 5.74 NA 10.82 0.92 NA 17.48 090 

26480 .......... ............ A Transplant hand tendon .............................. 6.69 NA 14.01 1.02 NA 21.73 090 

26483 .......... ............ A Transplant/graft hand tendon ...................... 8.30 NA 14.50 1.26 NA 24.06 090 

26485 .......... ............ A Transplant palm tendon .............................. 7.71 NA 14.35 1.15 NA 23.20 090 

26489 .......... ............ A Transplant/graft palm tendon ...................... 9.56 NA 11.43 1.26 NA 22.25 090 

26490 .......... ............ A Revise thumb tendon .................................. 8.42 NA 12.07 1.21 NA 21.70 090 

26492 .......... ............ A Tendon transfer with graft ........................... 9.63 NA 12.83 1.40 NA 23.86 090 

26494 .......... ............ A Hand tendon/muscle transfer ...................... 8.48 NA 12.21 1.28 NA 21.97 090 

26496 .......... ............ A Revise thumb tendon .................................. 9.60 NA 12.51 1.45 NA 23.56 090 

26497 .......... ............ A Finger tendon transfer ................................. 9.58 NA 12.79 1.41 NA 23.78 090 

26498 .......... ............ A Finger tendon transfer ................................. 14.01 NA 15.30 2.10 NA 31.41 090 

26499 .......... ............ A Revision of finger ........................................ 8.99 NA 12.25 1.35 NA 22.59 090 

26500 .......... ............ A Hand tendon reconstruction ........................ 5.96 NA 10.72 0.90 NA 17.58 090 

26502 .......... ............ A Hand tendon reconstruction ........................ 7.14 NA 11.30 1.13 NA 19.57 090 

26504 .......... ............ A Hand tendon reconstruction ........................ 7.47 NA 11.78 1.24 NA 20.50 090 

26508 .......... ............ A Release thumb contracture ......................... 6.01 NA 10.92 0.98 NA 17.92 090 

26510 .......... ............ A Thumb tendon transfer ................................ 5.43 NA 10.60 0.79 NA 16.82 090 

26516 .......... ............ A Fusion of knuckle joint ................................ 7.15 NA 11.48 1.10 NA 19.73 090 

26517 .......... ............ A Fusion of knuckle joints ............................... 8.84 NA 12.69 1.41 NA 22.94 090 

26518 .......... ............ A Fusion of knuckle joints ............................... 9.03 NA 12.59 1.35 NA 22.97 090 

26520 .......... ............ A Release knuckle contracture ....................... 5.30 NA 12.91 0.80 NA 19.01 090 

26525 .......... ............ A Release finger contracture .......................... 5.33 NA 12.98 0.81 NA 19.12 090 

26530 .......... ............ A Revise knuckle joint .................................... 6.69 NA 5.96 1.04 NA 13.70 090 

26531 .......... ............ A Revise knuckle with implant ........................ 7.92 NA 6.91 1.17 NA 16.00 090 

26535 .......... ............ A Revise finger joint ........................................ 5.24 NA 3.74 0.71 NA 9.69 090 

26536 .......... ............ A Revise/implant finger joint ........................... 6.37 NA 9.37 0.96 NA 16.70 090 

26540 .......... ............ A Repair hand joint ......................................... 6.43 NA 11.12 0.99 NA 18.55 090 

26541 .......... ............ A Repair hand joint with graft ......................... 8.63 NA 12.57 1.28 NA 22.48 090 

26542 .......... ............ A Repair hand joint with graft ......................... 6.78 NA 11.28 1.02 NA 19.08 090 

26545 .......... ............ A Reconstruct finger joint ............................... 6.92 NA 11.40 1.05 NA 19.37 090 

26546 .......... ............ A Repair nonunion hand ................................. 8.93 NA 14.18 1.44 NA 24.54 090 

26548 .......... ............ A Reconstruct finger joint ............................... 8.04 NA 12.05 1.20 NA 21.29 090 

26550 .......... ............ A Construct thumb replacement ..................... 21.25 NA 16.68 2.45 NA 40.38 090 

26551 .......... ............ A Great toe-hand transfer ............................... 46.60 NA 30.93 7.96 NA 85.49 090 

26553 .......... ............ A Single transfer, toe-hand ............................. 46.29 NA 24.09 2.41 NA 72.79 090 

26554 .......... ............ A Double transfer, toe-hand ........................... 54.98 NA 35.75 9.41 NA 100.14 090 

26555 .......... ............ A Positional change of finger .......................... 16.64 NA 17.43 2.48 NA 36.56 090 

26556 .......... ............ A Toe joint transfer ......................................... 47.28 NA 33.97 2.57 NA 83.82 090 

26560 .......... ............ A Repair of web finger .................................... 5.38 NA 9.22 0.85 NA 15.45 090 

26561 .......... ............ A Repair of web finger .................................... 10.92 NA 11.75 1.45 NA 24.12 090 

26562 .......... ............ A Repair of web finger .................................... 15.01 NA 16.25 2.23 NA 33.49 090 

26565 .......... ............ A Correct metacarpal flaw .............................. 6.74 NA 11.26 1.00 NA 19.01 090 

26567 .......... ............ A Correct finger deformity ............................... 6.82 NA 11.21 1.04 NA 19.08 090 

26568 .......... ............ A Lengthen metacarpal/finger ......................... 9.09 NA 14.50 1.49 NA 25.08 090 

26580 .......... ............ A Repair hand deformity ................................. 18.19 NA 13.16 2.28 NA 33.63 090 

26587 .......... ............ A Reconstruct extra finger .............................. 14.06 NA 8.99 1.53 NA 24.58 090 

26590 .......... ............ A Repair finger deformity ................................ 17.97 NA 13.46 2.77 NA 34.20 090 

26591 .......... ............ A Repair muscles of hand .............................. 3.26 NA 8.94 0.48 NA 12.68 090 

26593 .......... ............ A Release muscles of hand ............................ 5.31 NA 10.45 0.78 NA 16.54 090 

26596 .......... ............ A Excision constricting tissue ......................... 8.96 NA 8.42 1.43 NA 18.81 090 

26600 .......... ............ A Treat metacarpal fracture ............................ 1.96 3.79 2.57 0.30 6.05 4.83 090 

26605 .......... ............ A Treat metacarpal fracture ............................ 2.86 4.70 3.55 0.49 8.05 6.90 090 

26607 .......... ............ A Treat metacarpal fracture ............................ 5.36 NA 5.98 0.87 NA 12.21 090 

26608 .......... ............ A Treat metacarpal fracture ............................ 5.36 NA 6.00 0.88 NA 12.25 090 

26615 .......... ............ A Treat metacarpal fracture ............................ 5.33 NA 5.12 0.86 NA 11.31 090 

26641 .......... ............ A Treat thumb dislocation ............................... 3.94 4.72 3.42 0.39 9.05 7.75 090 

26645 .......... ............ A Treat thumb fracture .................................... 4.41 5.31 4.08 0.67 10.39 9.16 090 

26650 .......... ............ A Treat thumb fracture .................................... 5.72 NA 6.43 0.94 NA 13.09 090 

26665 .......... ............ A Treat thumb fracture .................................... 7.61 NA 6.39 0.90 NA 14.90 090 

26670 .......... ............ A Treat hand dislocation ................................. 3.69 4.41 2.85 0.39 8.49 6.92 090 

26675 .......... ............ A Treat hand dislocation ................................. 4.64 5.57 4.34 0.77 10.98 9.75 090 

26676 .......... ............ A Pin hand dislocation .................................... 5.52 NA 6.43 0.91 NA 12.86 090 

26685 .......... ............ A Treat hand dislocation ................................. 6.98 NA 5.94 1.09 NA 14.02 090 

26686 .......... ............ A Treat hand dislocation ................................. 7.95 NA 6.67 1.24 NA 15.86 090 

26700 .......... ............ A Treat knuckle dislocation ............................. 3.69 3.68 2.76 0.35 7.71 6.80 090 

26705 .......... ............ A Treat knuckle dislocation ............................. 4.19 5.43 4.18 0.66 10.28 9.03 090 

26706 .......... ............ A Pin knuckle dislocation ................................ 5.12 NA 4.95 0.81 NA 10.88 090 

26715 .......... ............ A Treat knuckle dislocation ............................. 5.74 NA 5.33 0.91 NA 11.98 090 

26720 .......... ............ A Treat finger fracture, each ........................... 1.66 2.70 1.98 0.24 4.60 3.89 090 

26725 .......... ............ A Treat finger fracture, each ........................... 3.34 4.60 3.40 0.53 8.47 7.26 090 

26727 .......... ............ A Treat finger fracture, each ........................... 5.23 NA 5.98 0.84 NA 12.05 090 

45896

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

26735 .......... ............ A Treat finger fracture, each ........................... 5.98 NA 5.37 0.95 NA 12.30 090 

26740 .......... ............ A Treat finger fracture, each ........................... 1.94 3.04 2.63 0.31 5.30 4.88 090 

26742 .......... ............ A Treat finger fracture, each ........................... 3.85 5.11 3.78 0.58 9.54 8.21 090 

26746 .......... ............ A Treat finger fracture, each ........................... 5.81 NA 5.37 0.91 NA 12.09 090 

26750 .......... ............ A Treat finger fracture, each ........................... 1.70 2.41 1.94 0.22 4.33 3.86 090 

26755 .......... ............ A Treat finger fracture, each ........................... 3.11 4.27 2.91 0.42 7.80 6.44 090 

26756 .......... ............ A Pin finger fracture, each .............................. 4.39 NA 5.49 0.71 NA 10.59 090 

26765 .......... ............ A Treat finger fracture, each ........................... 4.17 NA 4.24 0.66 NA 9.07 090 

26770 .......... ............ A Treat finger dislocation ................................ 3.03 3.34 2.32 0.27 6.64 5.62 090 

26775 .......... ............ A Treat finger dislocation ................................ 3.71 5.29 3.69 0.54 9.54 7.94 090 

26776 .......... ............ A Pin finger dislocation ................................... 4.80 NA 5.76 0.77 NA 11.33 090 

26785 .......... ............ A Treat finger dislocation ................................ 4.21 NA 4.37 0.68 NA 9.26 090 

26820 .......... ............ A Thumb fusion with graft ............................... 8.27 NA 12.42 1.30 NA 21.99 090 

26841 .......... ............ A Fusion of thumb .......................................... 7.13 NA 12.37 1.18 NA 20.69 090 

26842 .......... ............ A Thumb fusion with graft ............................... 8.25 NA 12.54 1.32 NA 22.11 090 

26843 .......... ............ A Fusion of hand joint ..................................... 7.62 NA 11.60 1.15 NA 20.37 090 

26844 .......... ............ A Fusion/graft of hand joint ............................ 8.74 NA 12.56 1.33 NA 22.63 090 

26850 .......... ............ A Fusion of knuckle ........................................ 6.97 NA 11.44 1.06 NA 19.48 090 

26852 .......... ............ A Fusion of knuckle with graft ........................ 8.47 NA 12.16 1.22 NA 21.85 090 

26860 .......... ............ A Fusion of finger joint .................................... 4.69 NA 10.46 0.73 NA 15.88 090 

26861 .......... ............ A Fusion of finger jnt, add-on ......................... 1.74 NA 0.90 0.27 NA 2.92 ZZZ 

26862 .......... ............ A Fusion/graft of finger joint ........................... 7.37 NA 11.62 1.10 NA 20.09 090 

26863 .......... ............ A Fuse/graft added joint ................................. 3.90 NA 2.05 0.56 NA 6.50 ZZZ 

26910 .......... ............ A Amputate metacarpal bone ......................... 7.61 NA 10.59 1.16 NA 19.36 090 

26951 .......... ............ A Amputation of finger/thumb ......................... 4.59 NA 9.50 0.71 NA 14.80 090 

26952 .......... ............ A Amputation of finger/thumb ......................... 6.31 NA 10.91 0.95 NA 18.17 090 

26989 .......... ............ C Hand/finger surgery ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

26990 .......... ............ A Drainage of pelvis lesion ............................. 7.48 NA 6.97 1.22 NA 15.67 090 

26991 .......... ............ A Drainage of pelvis bursa ............................. 6.68 10.53 5.30 1.11 18.32 13.09 090 

26992 .......... ............ A Drainage of bone lesion .............................. 13.03 NA 9.96 2.16 NA 25.15 090 

27000 .......... ............ A Incision of hip tendon .................................. 5.62 NA 5.11 0.98 NA 11.71 090 

27001 .......... ............ A Incision of hip tendon .................................. 6.94 NA 5.89 1.24 NA 14.08 090 

27003 .......... ............ A Incision of hip tendon .................................. 7.34 NA 6.33 1.12 NA 14.79 090 

27005 .......... ............ A Incision of hip tendon .................................. 9.67 NA 7.57 1.72 NA 18.95 090 

27006 .......... ............ A Incision of hip tendons ................................ 9.69 NA 7.73 1.69 NA 19.11 090 

27025 .......... ............ A Incision of hip/thigh fascia ........................... 11.16 NA 8.32 1.84 NA 21.33 090 

27030 .......... ............ A Drainage of hip joint .................................... 13.02 NA 9.33 2.26 NA 24.61 090 

27033 .......... ............ A Exploration of hip joint ................................. 13.40 NA 9.61 2.32 NA 25.33 090 

27035 .......... ............ A Denervation of hip joint ............................... 16.69 NA 10.89 2.15 NA 29.73 090 

27036 .......... ............ A Excision of hip joint/muscle ......................... 12.89 NA 9.70 2.26 NA 24.85 090 

27040 .......... ............ A Biopsy of soft tissues .................................. 2.88 5.38 2.05 0.27 8.53 5.20 010 

27041 .......... ............ A Biopsy of soft tissues .................................. 9.90 NA 6.60 1.35 NA 17.85 090 

27047 .......... ............ A Remove hip/pelvis lesion ............................ 7.45 7.18 4.71 1.03 15.67 13.19 090 

27048 .......... ............ A Remove hip/pelvis lesion ............................ 6.25 NA 4.72 0.92 NA 11.89 090 

27049 .......... ............ A Remove tumor, hip/pelvis ............................ 13.67 NA 8.24 2.06 NA 23.97 090 

27050 .......... ............ A Biopsy of sacroiliac joint .............................. 4.36 NA 4.30 0.60 NA 9.26 090 

27052 .......... ............ A Biopsy of hip joint ........................................ 6.23 NA 5.71 1.08 NA 13.02 090 

27054 .......... ............ A Removal of hip joint lining ........................... 8.55 NA 7.11 1.47 NA 17.13 090 

27060 .......... ............ A Removal of ischial bursa ............................. 5.43 NA 4.27 0.80 NA 10.50 090 

27062 .......... ............ A Remove femur lesion/bursa ........................ 5.37 NA 5.02 0.93 NA 11.32 090 

27065 .......... ............ A Removal of hip bone lesion ........................ 5.90 NA 5.29 1.01 NA 12.20 090 

27066 .......... ............ A Removal of hip bone lesion ........................ 10.33 NA 8.19 1.79 NA 20.31 090 

27067 .......... ............ A Remove/graft hip bone lesion ..................... 13.84 NA 10.34 1.84 NA 26.02 090 

27070 .......... ............ A Partial removal of hip bone ......................... 10.72 NA 8.80 1.74 NA 21.26 090 

27071 .......... ............ A Partial removal of hip bone ......................... 11.46 NA 9.74 1.92 NA 23.12 090 

27075 .......... ............ A Extensive hip surgery .................................. 35.02 NA 18.71 5.64 NA 59.37 090 

27076 .......... ............ A Extensive hip surgery .................................. 22.13 NA 14.10 3.70 NA 39.94 090 

27077 .......... ............ A Extensive hip surgery .................................. 40.02 NA 22.00 6.12 NA 68.14 090 

27078 .......... ............ A Extensive hip surgery .................................. 13.45 NA 9.64 2.22 NA 25.31 090 

27079 .......... ............ A Extensive hip surgery .................................. 13.76 NA 9.29 1.94 NA 24.99 090 

27080 .......... ............ A Removal of tail bone ................................... 6.39 NA 4.72 0.93 NA 12.05 090 

27086 .......... ............ A Remove hip foreign body ............................ 1.87 4.44 1.80 0.25 6.56 3.92 010 

27087 .......... ............ A Remove hip foreign body ............................ 8.55 NA 6.51 1.35 NA 16.41 090 

27090 .......... ............ A Removal of hip prosthesis ........................... 11.15 NA 8.50 1.94 NA 21.59 090 

27091 .......... ............ A Removal of hip prosthesis ........................... 22.15 NA 13.56 3.84 NA 39.56 090 

27093 .......... ............ A Injection for hip x-ray ................................... 1.30 4.24 0.49 0.13 5.67 1.92 000 

27095 .......... ............ A Injection for hip x-ray ................................... 1.50 5.37 0.52 0.14 7.01 2.17 000 

27096 .......... ............ A Inject sacroiliac joint .................................... 1.40 4.02 0.32 0.08 5.50 1.81 000 

27097 .......... ............ A Revision of hip tendon ................................ 8.81 NA 6.21 1.57 NA 16.58 090 

27098 .......... ............ A Transfer tendon to pelvis ............................ 8.84 NA 6.82 0.95 NA 16.61 090 

27100 .......... ............ A Transfer of abdominal muscle ..................... 11.08 NA 8.39 1.85 NA 21.33 090 

27105 .......... ............ A Transfer of spinal muscle ............................ 11.77 NA 8.87 1.72 NA 22.37 090 

27110 .......... ............ A Transfer of iliopsoas muscle ....................... 13.27 NA 8.88 2.18 NA 24.32 090 

27111 .......... ............ A Transfer of iliopsoas muscle ....................... 12.15 NA 8.85 1.94 NA 22.95 090 

45897

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

27120 .......... ............ A Reconstruction of hip socket ....................... 18.02 NA 11.51 3.08 NA 32.60 090 

27122 .......... ............ A Reconstruction of hip socket ....................... 14.99 NA 10.69 2.61 NA 28.29 090 

27125 .......... ............ A Partial hip replacement ............................... 14.70 NA 10.30 2.54 NA 27.54 090 

27130 .......... ............ A Total hip arthroplasty ................................... 20.13 NA 12.88 3.50 NA 36.51 090 

27132 .......... ............ A Total hip arthroplasty ................................... 23.32 NA 15.15 4.04 NA 42.51 090 

27134 .......... ............ A Revise hip joint replacement ....................... 28.54 NA 17.24 4.94 NA 50.72 090 

27137 .......... ............ A Revise hip joint replacement ....................... 21.18 NA 13.50 3.67 NA 38.35 090 

27138 .......... ............ A Revise hip joint replacement ....................... 22.18 NA 13.95 3.84 NA 39.97 090 

27140 .......... ............ A Transplant femur ridge ................................ 12.24 NA 9.11 2.11 NA 23.47 090 

27146 .......... ............ A Incision of hip bone ..................................... 17.43 NA 11.77 2.96 NA 32.17 090 

27147 .......... ............ A Revision of hip bone ................................... 20.59 NA 12.90 3.57 NA 37.06 090 

27151 .......... ............ A Incision of hip bones ................................... 22.52 NA 7.72 3.91 NA 34.16 090 

27156 .......... ............ A Revision of hip bones .................................. 24.64 NA 15.58 4.21 NA 44.43 090 

27158 .......... ............ A Revision of pelvis ........................................ 19.75 NA 10.86 3.16 NA 33.77 090 

27161 .......... ............ A Incision of neck of femur ............................. 16.71 NA 11.73 2.94 NA 31.38 090 

27165 .......... ............ A Incision/fixation of femur ............................. 17.92 NA 12.51 3.10 NA 33.53 090 

27170 .......... ............ A Repair/graft femur head/neck ...................... 16.08 NA 10.95 2.81 NA 29.85 090 

27175 .......... ............ A Treat slipped epiphysis ............................... 8.47 NA 6.48 1.46 NA 16.41 090 

27176 .......... ............ A Treat slipped epiphysis ............................... 12.05 NA 8.73 2.22 NA 23.01 090 

27177 .......... ............ A Treat slipped epiphysis ............................... 15.09 NA 10.56 2.61 NA 28.26 090 

27178 .......... ............ A Treat slipped epiphysis ............................... 11.99 NA 8.16 2.08 NA 22.24 090 

27179 .......... ............ A Revise head/neck of femur ......................... 12.99 NA 9.67 2.25 NA 24.91 090 

27181 .......... ............ A Treat slipped epiphysis ............................... 14.69 NA 9.92 1.57 NA 26.18 090 

27185 .......... ............ A Revision of femur epiphysis ........................ 9.19 NA 7.28 2.39 NA 18.86 090 

27187 .......... ............ A Reinforce hip bones .................................... 13.55 NA 9.99 2.37 NA 25.90 090 

27193 .......... ............ A Treat pelvic ring fracture ............................. 5.56 4.94 4.94 0.96 11.47 11.47 090 

27194 .......... ............ A Treat pelvic ring fracture ............................. 9.66 NA 7.43 1.65 NA 18.74 090 

27200 .......... ............ A Treat tail bone fracture ................................ 1.84 2.16 2.09 0.28 4.29 4.21 090 

27202 .......... ............ A Treat tail bone fracture ................................ 7.04 NA 15.72 1.06 NA 23.83 090 

27215 .......... ............ A Treat pelvic fracture(s) ................................ 10.05 NA 6.86 1.97 NA 18.88 090 

27216 .......... ............ A Treat pelvic ring fracture ............................. 15.20 NA 9.29 2.63 NA 27.12 090 

27217 .......... ............ A Treat pelvic ring fracture ............................. 14.12 NA 9.83 2.41 NA 26.36 090 

27218 .......... ............ A Treat pelvic ring fracture ............................. 20.16 NA 11.08 3.48 NA 34.72 090 

27220 .......... ............ A Treat hip socket fracture ............................. 6.18 5.56 5.47 1.07 12.81 12.72 090 

27222 .......... ............ A Treat hip socket fracture ............................. 12.71 NA 9.65 2.19 NA 24.54 090 

27226 .......... ............ A Treat hip wall fracture ................................. 14.92 NA 7.58 2.48 NA 24.97 090 

27227 .......... ............ A Treat hip fracture(s) ..................................... 23.46 NA 14.93 4.05 NA 42.44 090 

27228 .......... ............ A Treat hip fracture(s) ..................................... 27.17 NA 17.08 4.66 NA 48.92 090 

27230 .......... ............ A Treat thigh fracture ...................................... 5.50 5.35 4.95 0.95 11.80 11.41 090 

27232 .......... ............ A Treat thigh fracture ...................................... 10.68 NA 6.97 1.85 NA 19.50 090 

27235 .......... ............ A Treat thigh fracture ...................................... 12.16 NA 9.14 2.11 NA 23.42 090 

27236 .......... ............ A Treat thigh fracture ...................................... 15.61 NA 10.71 2.71 NA 29.03 090 

27238 .......... ............ A Treat thigh fracture ...................................... 5.52 NA 4.99 0.89 NA 11.40 090 

27240 .......... ............ A Treat thigh fracture ...................................... 12.50 NA 9.20 2.16 NA 23.87 090 

27244 .......... ............ A Treat thigh fracture ...................................... 15.95 NA 10.94 2.77 NA 29.67 090 

27245 .......... ............ A Treat thigh fracture ...................................... 20.32 NA 13.31 3.52 NA 37.15 090 

27246 .......... ............ A Treat thigh fracture ...................................... 4.71 4.33 4.30 0.81 9.85 9.82 090 

27248 .......... ............ A Treat thigh fracture ...................................... 10.45 NA 7.95 1.81 NA 20.21 090 

27250 .......... ............ A Treat hip dislocation .................................... 6.95 NA 4.46 0.62 NA 12.03 090 

27252 .......... ............ A Treat hip dislocation .................................... 10.39 NA 7.21 1.66 NA 19.26 090 

27253 .......... ............ A Treat hip dislocation .................................... 12.93 NA 9.47 2.24 NA 24.63 090 

27254 .......... ............ A Treat hip dislocation .................................... 18.27 NA 11.66 3.17 NA 33.10 090 

27256 .......... ............ A Treat hip dislocation .................................... 4.12 3.43 2.02 0.46 8.01 6.60 010 

27257 .......... ............ A Treat hip dislocation .................................... 5.22 NA 2.73 0.69 NA 8.64 010 

27258 .......... ............ A Treat hip dislocation .................................... 15.44 NA 10.55 2.64 NA 28.63 090 

27259 .......... ............ A Treat hip dislocation .................................... 21.56 NA 13.80 3.74 NA 39.11 090 

27265 .......... ............ A Treat hip dislocation .................................... 5.05 NA 4.64 0.63 NA 10.32 090 

27266 .......... ............ A Treat hip dislocation .................................... 7.49 NA 6.15 1.29 NA 14.94 090 

27275 .......... ............ A Manipulation of hip joint .............................. 2.27 NA 2.04 0.39 NA 4.71 010 

27280 .......... ............ A Fusion of sacroiliac joint .............................. 13.40 NA 9.96 2.53 NA 25.89 090 

27282 .......... ............ A Fusion of pubic bones ................................. 11.34 NA 8.03 1.86 NA 21.24 090 

27284 .......... ............ A Fusion of hip joint ........................................ 23.46 NA 14.32 3.92 NA 41.69 090 

27286 .......... ............ A Fusion of hip joint ........................................ 23.46 NA 15.30 3.12 NA 41.88 090 

27290 .......... ............ A Amputation of leg at hip .............................. 23.30 NA 13.67 3.43 NA 40.40 090 

27295 .......... ............ A Amputation of leg at hip .............................. 18.66 NA 10.98 2.95 NA 32.59 090 

27299 .......... ............ C Pelvis/hip joint surgery ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

27301 .......... ............ A Drain thigh/knee lesion ................................ 6.49 9.54 5.00 1.04 17.08 12.54 090 

27303 .......... ............ A Drainage of bone lesion .............................. 8.29 NA 6.75 1.43 NA 16.47 090 

27305 .......... ............ A Incise thigh tendon & fascia ........................ 5.92 NA 5.02 1.01 NA 11.95 090 

27306 .......... ............ A Incision of thigh tendon ............................... 4.62 NA 4.56 0.85 NA 10.03 090 

27307 .......... ............ A Incision of thigh tendons ............................. 5.80 NA 5.21 1.04 NA 12.05 090 

27310 .......... ............ A Exploration of knee joint .............................. 9.28 NA 7.35 1.61 NA 18.24 090 

27315 .......... ............ A Partial removal, thigh nerve ........................ 6.97 NA 4.85 1.09 NA 12.91 090 

27320 .......... ............ A Partial removal, thigh nerve ........................ 6.30 NA 5.10 1.06 NA 12.46 090 

45898

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

27323 .......... ............ A Biopsy, thigh soft tissues ............................ 2.28 3.74 1.85 0.24 6.26 4.37 010 

27324 .......... ............ A Biopsy, thigh soft tissues ............................ 4.90 NA 4.09 0.75 NA 9.74 090 

27327 .......... ............ A Removal of thigh lesion ............................... 4.47 5.95 3.65 0.64 11.06 8.76 090 

27328 .......... ............ A Removal of thigh lesion ............................... 5.57 NA 4.27 0.84 NA 10.68 090 

27329 .......... ............ A Remove tumor, thigh/knee .......................... 14.15 NA 8.81 2.14 NA 25.09 090 

27330 .......... ............ A Biopsy, knee joint lining .............................. 4.97 NA 4.42 0.86 NA 10.25 090 

27331 .......... ............ A Explore/treat knee joint ............................... 5.88 NA 5.34 1.02 NA 12.24 090 

27332 .......... ............ A Removal of knee cartilage .......................... 8.28 NA 6.89 1.43 NA 16.60 090 

27333 .......... ............ A Removal of knee cartilage .......................... 7.30 NA 6.46 1.26 NA 15.02 090 

27334 .......... ............ A Remove knee joint lining ............................. 8.71 NA 7.18 1.51 NA 17.39 090 

27335 .......... ............ A Remove knee joint lining ............................. 10.01 NA 7.96 1.74 NA 19.71 090 

27340 .......... ............ A Removal of kneecap bursa ......................... 4.18 NA 4.41 0.72 NA 9.31 090 

27345 .......... ............ A Removal of knee cyst .................................. 5.92 NA 5.44 1.00 NA 12.37 090 

27347 .......... ............ A Remove knee cyst ....................................... 5.78 NA 5.27 0.98 NA 12.03 090 

27350 .......... ............ A Removal of kneecap ................................... 8.18 NA 7.01 1.41 NA 16.60 090 

27355 .......... ............ A Remove femur lesion .................................. 7.66 NA 6.55 1.32 NA 15.53 090 

27356 .......... ............ A Remove femur lesion/graft .......................... 9.49 NA 7.61 1.65 NA 18.75 090 

27357 .......... ............ A Remove femur lesion/graft .......................... 10.53 NA 8.42 1.95 NA 20.90 090 

27358 .......... ............ A Remove femur lesion/fixation ...................... 4.74 NA 2.44 0.82 NA 8.00 ZZZ 

27360 .......... ............ A Partial removal, leg bone(s) ........................ 10.50 NA 9.16 1.83 NA 21.49 090 

27365 .......... ............ A Extensive leg surgery .................................. 16.28 NA 11.33 2.79 NA 30.40 090 

27370 .......... ............ A Injection for knee x-ray ................................ 0.96 3.56 0.33 0.08 4.60 1.38 000 

27372 .......... ............ A Removal of foreign body ............................. 5.07 9.52 4.54 0.84 15.43 10.45 090 

27380 .......... ............ A Repair of kneecap tendon ........................... 7.16 NA 6.99 1.24 NA 15.40 090 

27381 .......... ............ A Repair/graft kneecap tendon ....................... 10.34 NA 8.75 1.79 NA 20.88 090 

27385 .......... ............ A Repair of thigh muscle ................................ 7.77 NA 7.33 1.36 NA 16.45 090 

27386 .......... ............ A Repair/graft of thigh muscle ........................ 10.56 NA 9.15 1.85 NA 21.56 090 

27390 .......... ............ A Incision of thigh tendon ............................... 5.33 NA 4.95 0.92 NA 11.20 090 

27391 .......... ............ A Incision of thigh tendons ............................. 7.20 NA 6.35 1.23 NA 14.78 090 

27392 .......... ............ A Incision of thigh tendons ............................. 9.21 NA 7.35 1.57 NA 18.13 090 

27393 .......... ............ A Lengthening of thigh tendon ....................... 6.39 NA 5.64 1.10 NA 13.13 090 

27394 .......... ............ A Lengthening of thigh tendons ...................... 8.51 NA 6.98 1.47 NA 16.96 090 

27395 .......... ............ A Lengthening of thigh tendons ...................... 11.73 NA 9.02 2.04 NA 22.79 090 

27396 .......... ............ A Transplant of thigh tendon .......................... 7.87 NA 6.77 1.34 NA 15.97 090 

27397 .......... ............ A Transplants of thigh tendons ....................... 11.28 NA 8.76 1.82 NA 21.87 090 

27400 .......... ............ A Revise thigh muscles/tendons .................... 9.03 NA 7.04 1.31 NA 17.37 090 

27403 .......... ............ A Repair of knee cartilage .............................. 8.34 NA 6.95 1.44 NA 16.72 090 

27405 .......... ............ A Repair of knee ligament .............................. 8.66 NA 7.25 1.51 NA 17.42 090 

27407 .......... ............ A Repair of knee ligament .............................. 10.28 NA 8.05 1.78 NA 20.11 090 

27409 .......... ............ A Repair of knee ligaments ............................ 12.91 NA 9.63 2.24 NA 24.78 090 

27412 .......... ............ A Autochondrocyte implant knee .................... 23.28 NA 14.69 4.35 NA 42.32 090 

27415 .......... ............ A Osteochondral knee allograft ...................... 18.53 NA 12.45 4.35 NA 35.33 090 

27418 .......... ............ A Repair degenerated kneecap ...................... 10.85 NA 8.61 1.88 NA 21.34 090 

27420 .......... ............ A Revision of unstable kneecap ..................... 9.84 NA 7.85 1.71 NA 19.40 090 

27422 .......... ............ A Revision of unstable kneecap ..................... 9.79 NA 7.86 1.70 NA 19.35 090 

27424 .......... ............ A Revision/removal of kneecap ...................... 9.82 NA 7.83 1.70 NA 19.35 090 

27425 .......... ............ A Lat retinacular release open ....................... 5.22 NA 5.33 0.90 NA 11.45 090 

27427 .......... ............ A Reconstruction, knee ................................... 9.37 NA 7.56 1.63 NA 18.55 090 

27428 .......... ............ A Reconstruction, knee ................................... 14.01 NA 10.90 2.42 NA 27.33 090 

27429 .......... ............ A Reconstruction, knee ................................... 15.53 NA 12.03 2.70 NA 30.27 090 

27430 .......... ............ A Revision of thigh muscles ........................... 9.68 NA 7.75 1.69 NA 19.12 090 

27435 .......... ............ A Incision of knee joint ................................... 9.50 NA 8.21 1.69 NA 19.40 090 

27437 .......... ............ A Revise kneecap ........................................... 8.47 NA 7.01 1.49 NA 16.96 090 

27438 .......... ............ A Revise kneecap with implant ...................... 11.23 NA 8.28 1.95 NA 21.46 090 

27440 .......... ............ A Revision of knee joint .................................. 10.43 NA 5.82 1.81 NA 18.06 090 

27441 .......... ............ A Revision of knee joint .................................. 10.82 NA 6.50 1.88 NA 19.20 090 

27442 .......... ............ A Revision of knee joint .................................. 11.89 NA 8.64 2.09 NA 22.62 090 

27443 .......... ............ A Revision of knee joint .................................. 10.93 NA 8.44 1.90 NA 21.27 090 

27445 .......... ............ A Revision of knee joint .................................. 17.69 NA 11.96 3.08 NA 32.73 090 

27446 .......... ............ A Revision of knee joint .................................. 15.85 NA 10.91 2.80 NA 29.57 090 

27447 .......... ............ A Total knee arthroplasty ................................ 21.49 NA 14.16 3.79 NA 39.44 090 

27448 .......... ............ A Incision of thigh ........................................... 11.06 NA 8.33 1.94 NA 21.33 090 

27450 .......... ............ A Incision of thigh ........................................... 13.99 NA 10.24 2.42 NA 26.65 090 

27454 .......... ............ A Realignment of thigh bone .......................... 17.57 NA 12.12 3.12 NA 32.81 090 

27455 .......... ............ A Realignment of knee ................................... 12.83 NA 9.54 2.24 NA 24.61 090 

27457 .......... ............ A Realignment of knee ................................... 13.46 NA 9.60 2.34 NA 25.40 090 

27465 .......... ............ A Shortening of thigh bone ............................. 13.88 NA 9.89 2.47 NA 26.24 090 

27466 .......... ............ A Lengthening of thigh bone .......................... 16.34 NA 11.46 2.77 NA 30.58 090 

27468 .......... ............ A Shorten/lengthen thighs .............................. 18.98 NA 12.09 3.30 NA 34.37 090 

27470 .......... ............ A Repair of thigh ............................................. 16.08 NA 11.42 2.79 NA 30.29 090 

27472 .......... ............ A Repair/graft of thigh ..................................... 17.73 NA 12.28 3.07 NA 33.07 090 

27475 .......... ............ A Surgery to stop leg growth .......................... 8.65 NA 6.97 1.36 NA 16.98 090 

27477 .......... ............ A Surgery to stop leg growth .......................... 9.86 NA 7.49 1.73 NA 19.08 090 

27479 .......... ............ A Surgery to stop leg growth .......................... 12.81 NA 9.48 2.78 NA 25.07 090 

45899

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

27485 .......... ............ A Surgery to stop leg growth .......................... 8.85 NA 7.16 1.53 NA 17.53 090 

27486 .......... ............ A Revise/replace knee joint ............................ 19.28 NA 13.08 3.36 NA 35.71 090 

27487 .......... ............ A Revise/replace knee joint ............................ 25.28 NA 16.04 4.39 NA 45.71 090 

27488 .......... ............ A Removal of knee prosthesis ........................ 15.75 NA 11.34 2.74 NA 29.83 090 

27495 .......... ............ A Reinforce thigh ............................................ 15.56 NA 11.05 2.71 NA 29.32 090 

27496 .......... ............ A Decompression of thigh/knee ...................... 6.11 NA 5.42 0.99 NA 12.52 090 

27497 .......... ............ A Decompression of thigh/knee ...................... 7.17 NA 5.28 1.15 NA 13.61 090 

27498 .......... ............ A Decompression of thigh/knee ...................... 8.00 NA 5.79 1.24 NA 15.03 090 

27499 .......... ............ A Decompression of thigh/knee ...................... 9.01 NA 6.64 1.47 NA 17.11 090 

27500 .......... ............ A Treatment of thigh fracture .......................... 5.92 6.67 4.85 1.02 13.61 11.79 090 

27501 .......... ............ A Treatment of thigh fracture .......................... 5.92 6.35 5.23 1.03 13.30 12.18 090 

27502 .......... ............ A Treatment of thigh fracture .......................... 10.58 NA 7.88 1.78 NA 20.24 090 

27503 .......... ............ A Treatment of thigh fracture .......................... 10.58 NA 8.05 1.84 NA 20.47 090 

27506 .......... ............ A Treatment of thigh fracture .......................... 17.45 NA 12.39 3.03 NA 32.87 090 

27507 .......... ............ A Treatment of thigh fracture .......................... 14.00 NA 9.53 2.42 NA 25.95 090 

27508 .......... ............ A Treatment of thigh fracture .......................... 5.83 6.55 5.32 0.97 13.35 12.12 090 

27509 .......... ............ A Treatment of thigh fracture .......................... 7.72 NA 7.64 1.34 NA 16.69 090 

27510 .......... ............ A Treatment of thigh fracture .......................... 9.14 NA 7.12 1.53 NA 17.79 090 

27511 .......... ............ A Treatment of thigh fracture .......................... 13.65 NA 10.77 2.37 NA 26.79 090 

27513 .......... ............ A Treatment of thigh fracture .......................... 17.93 NA 13.38 3.12 NA 34.43 090 

27514 .......... ............ A Treatment of thigh fracture .......................... 17.30 NA 12.88 3.00 NA 33.19 090 

27516 .......... ............ A Treat thigh fx growth plate .......................... 5.37 6.45 5.36 0.81 12.63 11.54 090 

27517 .......... ............ A Treat thigh fx growth plate .......................... 8.79 NA 7.24 1.22 NA 17.25 090 

27519 .......... ............ A Treat thigh fx growth plate .......................... 15.03 NA 11.17 2.55 NA 28.75 090 

27520 .......... ............ A Treat kneecap fracture ................................ 2.87 4.69 3.34 0.47 8.03 6.67 090 

27524 .......... ............ A Treat kneecap fracture ................................ 10.01 NA 7.97 1.74 NA 19.72 090 

27530 .......... ............ A Treat knee fracture ...................................... 3.78 5.44 4.30 0.65 9.87 8.72 090 

27532 .......... ............ A Treat knee fracture ...................................... 7.30 7.13 6.27 1.26 15.69 14.83 090 

27535 .......... ............ A Treat knee fracture ...................................... 11.50 NA 9.71 2.00 NA 23.21 090 

27536 .......... ............ A Treat knee fracture ...................................... 15.66 NA 11.25 2.73 NA 29.64 090 

27538 .......... ............ A Treat knee fracture(s) .................................. 4.87 6.23 5.04 0.84 11.94 10.75 090 

27540 .......... ............ A Treat knee fracture ...................................... 13.11 NA 9.21 2.27 NA 24.59 090 

27550 .......... ............ A Treat knee dislocation ................................. 5.76 6.12 4.78 0.76 12.64 11.30 090 

27552 .......... ............ A Treat knee dislocation ................................. 7.91 NA 6.75 1.36 NA 16.01 090 

27556 .......... ............ A Treat knee dislocation ................................. 14.42 NA 11.21 2.50 NA 28.13 090 

27557 .......... ............ A Treat knee dislocation ................................. 16.77 NA 12.63 2.97 NA 32.38 090 

27558 .......... ............ A Treat knee dislocation ................................. 17.73 NA 12.57 3.08 NA 33.38 090 

27560 .......... ............ A Treat kneecap dislocation ........................... 3.82 4.97 3.08 0.40 9.19 7.29 090 

27562 .......... ............ A Treat kneecap dislocation ........................... 5.79 NA 4.62 0.94 NA 11.36 090 

27566 .......... ............ A Treat kneecap dislocation ........................... 12.23 NA 9.03 2.12 NA 23.38 090 

27570 .......... ............ A Fixation of knee joint ................................... 1.74 NA 1.72 0.30 NA 3.77 010 

27580 .......... ............ A Fusion of knee ............................................. 19.38 NA 14.25 3.37 NA 37.00 090 

27590 .......... ............ A Amputate leg at thigh .................................. 12.03 NA 6.53 1.74 NA 20.30 090 

27591 .......... ............ A Amputate leg at thigh .................................. 12.69 NA 8.40 2.02 NA 23.11 090 

27592 .......... ............ A Amputate leg at thigh .................................. 10.02 NA 6.02 1.45 NA 17.49 090 

27594 .......... ............ A Amputation follow-up surgery ...................... 6.92 NA 5.04 1.02 NA 12.99 090 

27596 .......... ............ A Amputation follow-up surgery ...................... 10.60 NA 6.65 1.57 NA 18.82 090 

27598 .......... ............ A Amputate lower leg at knee ........................ 10.53 NA 6.85 1.65 NA 19.03 090 

27599 .......... ............ C Leg surgery procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

27600 .......... ............ A Decompression of lower leg ........................ 5.65 NA 4.37 0.86 NA 10.88 090 

27601 .......... ............ A Decompression of lower leg ........................ 5.64 NA 4.68 0.80 NA 11.13 090 

27602 .......... ............ A Decompression of lower leg ........................ 7.35 NA 4.97 1.10 NA 13.43 090 

27603 .......... ............ A Drain lower leg lesion .................................. 4.94 7.21 4.07 0.74 12.89 9.75 090 

27604 .......... ............ A Drain lower leg bursa .................................. 4.47 5.96 3.87 0.69 11.12 9.03 090 

27605 .......... ............ A Incision of achilles tendon ........................... 2.88 7.29 2.26 0.41 10.58 5.55 010 

27606 .......... ............ A Incision of achilles tendon ........................... 4.14 NA 3.25 0.69 NA 8.07 010 

27607 .......... ............ A Treat lower leg bone lesion ......................... 7.98 NA 6.02 1.31 NA 15.30 090 

27610 .......... ............ A Explore/treat ankle joint ............................... 8.35 NA 6.79 1.40 NA 16.54 090 

27612 .......... ............ A Exploration of ankle joint ............................. 7.33 NA 5.95 1.13 NA 14.42 090 

27613 .......... ............ A Biopsy lower leg soft tissue ........................ 2.17 3.43 1.77 0.20 5.81 4.14 010 

27614 .......... ............ A Biopsy lower leg soft tissue ........................ 5.66 7.24 4.34 0.78 13.69 10.78 090 

27615 .......... ............ A Remove tumor, lower leg ............................ 12.57 NA 9.08 1.83 NA 23.48 090 

27618 .......... ............ A Remove lower leg lesion ............................. 5.09 6.11 3.92 0.72 11.92 9.73 090 

27619 .......... ............ A Remove lower leg lesion ............................. 8.41 9.38 5.82 1.25 19.03 15.48 090 

27620 .......... ............ A Explore/treat ankle joint ............................... 5.98 NA 5.31 0.97 NA 12.26 090 

27625 .......... ............ A Remove ankle joint lining ............................ 8.31 NA 6.30 1.28 NA 15.89 090 

27626 .......... ............ A Remove ankle joint lining ............................ 8.92 NA 6.73 1.48 NA 17.12 090 

27630 .......... ............ A Removal of tendon lesion ........................... 4.80 7.39 4.27 0.74 12.93 9.81 090 

27635 .......... ............ A Remove lower leg bone lesion .................... 7.79 NA 6.54 1.31 NA 15.63 090 

27637 .......... ............ A Remove/graft leg bone lesion ..................... 9.86 NA 8.03 1.66 NA 19.55 090 

27638 .......... ............ A Remove/graft leg bone lesion ..................... 10.57 NA 8.04 1.84 NA 20.45 090 

27640 .......... ............ A Partial removal of tibia ................................ 11.37 NA 9.90 1.88 NA 23.15 090 

27641 .......... ............ A Partial removal of fibula .............................. 9.25 NA 8.03 1.46 NA 18.74 090 

27645 .......... ............ A Extensive lower leg surgery ........................ 14.18 NA 11.57 2.41 NA 28.16 090 

45900

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

27646 .......... ............ A Extensive lower leg surgery ........................ 12.67 NA 10.60 2.05 NA 25.32 090 

27647 .......... ............ A Extensive ankle/heel surgery ...................... 12.24 NA 7.48 1.75 NA 21.47 090 

27648 .......... ............ A Injection for ankle x-ray ............................... 0.96 3.39 0.34 0.08 4.43 1.38 000 

27650 .......... ............ A Repair achilles tendon ................................. 9.70 NA 7.30 1.59 NA 18.59 090 

27652 .......... ............ A Repair/graft achilles tendon ........................ 10.33 NA 7.81 1.71 NA 19.85 090 

27654 .......... ............ A Repair of achilles tendon ............................ 10.02 NA 6.97 1.58 NA 18.57 090 

27656 .......... ............ A Repair leg fascia defect .............................. 4.57 8.20 3.70 0.69 13.46 8.96 090 

27658 .......... ............ A Repair of leg tendon, each .......................... 4.98 NA 4.45 0.79 NA 10.22 090 

27659 .......... ............ A Repair of leg tendon, each .......................... 6.81 NA 5.50 1.09 NA 13.40 090 

27664 .......... ............ A Repair of leg tendon, each .......................... 4.59 NA 4.42 0.76 NA 9.77 090 

27665 .......... ............ A Repair of leg tendon, each .......................... 5.40 NA 4.84 0.89 NA 11.14 090 

27675 .......... ............ A Repair lower leg tendons ............................ 7.18 NA 5.59 1.11 NA 13.89 090 

27676 .......... ............ A Repair lower leg tendons ............................ 8.43 NA 6.57 1.37 NA 16.36 090 

27680 .......... ............ A Release of lower leg tendon ....................... 5.74 NA 4.96 0.93 NA 11.63 090 

27681 .......... ............ A Release of lower leg tendons ..................... 6.82 NA 5.74 1.15 NA 13.72 090 

27685 .......... ............ A Revision of lower leg tendon ....................... 6.50 7.38 5.35 0.97 14.86 12.82 090 

27686 .......... ............ A Revise lower leg tendons ............................ 7.46 NA 6.30 1.24 NA 15.00 090 

27687 .......... ............ A Revision of calf tendon ................................ 6.24 NA 5.18 1.00 NA 12.43 090 

27690 .......... ............ A Revise lower leg tendon .............................. 8.72 NA 6.22 1.33 NA 16.27 090 

27691 .......... ............ A Revise lower leg tendon .............................. 9.97 NA 7.54 1.64 NA 19.15 090 

27692 .......... ............ A Revise additional leg tendon ....................... 1.87 NA 0.90 0.32 NA 3.10 ZZZ 

27695 .......... ............ A Repair of ankle ligament ............................. 6.51 NA 5.71 1.05 NA 13.27 090 

27696 .......... ............ A Repair of ankle ligaments ........................... 8.28 NA 6.28 1.28 NA 15.83 090 

27698 .......... ............ A Repair of ankle ligament ............................. 9.37 NA 6.77 1.47 NA 17.61 090 

27700 .......... ............ A Revision of ankle joint ................................. 9.30 NA 5.63 1.30 NA 16.23 090 

27702 .......... ............ A Reconstruct ankle joint ................................ 13.68 NA 10.12 2.37 NA 26.17 090 

27703 .......... ............ A Reconstruction, ankle joint .......................... 15.88 NA 10.91 2.76 NA 29.56 090 

27704 .......... ............ A Removal of ankle implant ............................ 7.63 NA 5.42 1.27 NA 14.31 090 

27705 .......... ............ A Incision of tibia ............................................ 10.38 NA 7.92 1.80 NA 20.10 090 

27707 .......... ............ A Incision of fibula .......................................... 4.37 NA 4.78 0.76 NA 9.91 090 

27709 .......... ............ A Incision of tibia & fibula ............................... 9.96 NA 7.87 1.73 NA 19.56 090 

27712 .......... ............ A Realignment of lower leg ............................ 14.26 NA 10.43 2.47 NA 27.15 090 

27715 .......... ............ A Revision of lower leg ................................... 14.40 NA 10.43 2.49 NA 27.32 090 

27720 .......... ............ A Repair of tibia .............................................. 11.79 NA 9.10 2.04 NA 22.93 090 

27722 .......... ............ A Repair/graft of tibia ...................................... 11.82 NA 8.84 2.05 NA 22.72 090 

27724 .......... ............ A Repair/graft of tibia ...................................... 18.21 NA 11.98 3.16 NA 33.34 090 

27725 .......... ............ A Repair of lower leg ...................................... 15.60 NA 11.56 2.71 NA 29.87 090 

27727 .......... ............ A Repair of lower leg ...................................... 14.02 NA 10.02 2.43 NA 26.47 090 

27730 .......... ............ A Repair of tibia epiphysis .............................. 7.41 NA 6.21 1.72 NA 15.35 090 

27732 .......... ............ A Repair of fibula epiphysis ............................ 5.32 NA 4.80 0.77 NA 10.90 090 

27734 .......... ............ A Repair lower leg epiphyses ......................... 8.49 NA 6.11 1.35 NA 15.95 090 

27740 .......... ............ A Repair of leg epiphyses .............................. 9.31 NA 7.72 1.62 NA 18.65 090 

27742 .......... ............ A Repair of leg epiphyses .............................. 10.30 NA 5.76 1.79 NA 17.85 090 

27745 .......... ............ A Reinforce tibia ............................................. 10.07 NA 7.91 1.75 NA 19.73 090 

27750 .......... ............ A Treatment of tibia fracture ........................... 3.20 4.90 3.74 0.55 8.65 7.49 090 

27752 .......... ............ A Treatment of tibia fracture ........................... 5.84 6.74 5.51 1.01 13.59 12.36 090 

27756 .......... ............ A Treatment of tibia fracture ........................... 6.78 NA 6.25 1.17 NA 14.20 090 

27758 .......... ............ A Treatment of tibia fracture ........................... 11.67 NA 8.89 2.03 NA 22.59 090 

27759 .......... ............ A Treatment of tibia fracture ........................... 13.77 NA 9.99 2.38 NA 26.13 090 

27760 .......... ............ A Treatment of ankle fracture ......................... 3.02 4.83 3.48 0.48 8.32 6.98 090 

27762 .......... ............ A Treatment of ankle fracture ......................... 5.25 6.43 5.12 0.85 12.53 11.22 090 

27766 .......... ............ A Treatment of ankle fracture ......................... 8.37 NA 6.99 1.44 NA 16.80 090 

27780 .......... ............ A Treatment of fibula fracture ......................... 2.66 4.05 3.12 0.41 7.12 6.18 090 

27781 .......... ............ A Treatment of fibula fracture ......................... 4.40 5.61 4.51 0.73 10.74 9.64 090 

27784 .......... ............ A Treatment of fibula fracture ......................... 7.11 NA 6.26 1.23 NA 14.60 090 

27786 .......... ............ A Treatment of ankle fracture ......................... 2.85 4.61 3.23 0.46 7.92 6.54 090 

27788 .......... ............ A Treatment of ankle fracture ......................... 4.45 5.76 4.52 0.74 10.95 9.71 090 

27792 .......... ............ A Treatment of ankle fracture ......................... 7.67 NA 6.74 1.32 NA 15.72 090 

27808 .......... ............ A Treatment of ankle fracture ......................... 2.84 4.94 3.59 0.46 8.24 6.89 090 

27810 .......... ............ A Treatment of ankle fracture ......................... 5.13 6.35 5.00 0.82 12.30 10.96 090 

27814 .......... ............ A Treatment of ankle fracture ......................... 10.68 NA 8.29 1.85 NA 20.82 090 

27816 .......... ............ A Treatment of ankle fracture ......................... 2.90 4.54 3.31 0.43 7.86 6.63 090 

27818 .......... ............ A Treatment of ankle fracture ......................... 5.50 6.47 5.02 0.82 12.79 11.34 090 

27822 .......... ............ A Treatment of ankle fracture ......................... 11.00 NA 13.08 1.91 NA 25.99 090 

27823 .......... ............ A Treatment of ankle fracture ......................... 13.01 NA 13.87 2.25 NA 29.12 090 

27824 .......... ............ A Treat lower leg fracture ............................... 2.90 4.22 3.47 0.45 7.56 6.81 090 

27825 .......... ............ A Treat lower leg fracture ............................... 6.19 6.69 5.23 1.02 13.91 12.44 090 

27826 .......... ............ A Treat lower leg fracture ............................... 8.55 NA 11.29 1.47 NA 21.31 090 

27827 .......... ............ A Treat lower leg fracture ............................... 14.07 NA 15.09 2.43 NA 31.58 090 

27828 .......... ............ A Treat lower leg fracture ............................... 16.24 NA 16.21 2.81 NA 35.26 090 

27829 .......... ............ A Treat lower leg joint ..................................... 5.49 NA 8.63 0.95 NA 15.08 090 

27830 .......... ............ A Treat lower leg dislocation .......................... 3.79 4.54 3.74 0.54 8.87 8.07 090 

27831 .......... ............ A Treat lower leg dislocation .......................... 4.56 NA 4.32 0.73 NA 9.61 090 

27832 .......... ............ A Treat lower leg dislocation .......................... 6.49 NA 5.97 1.03 NA 13.49 090 

45901

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

27840 .......... ............ A Treat ankle dislocation ................................ 4.58 NA 3.63 0.46 NA 8.67 090 

27842 .......... ............ A Treat ankle dislocation ................................ 6.21 NA 4.96 1.00 NA 12.17 090 

27846 .......... ............ A Treat ankle dislocation ................................ 9.80 NA 7.68 1.70 NA 19.18 090 

27848 .......... ............ A Treat ankle dislocation ................................ 11.20 NA 11.46 1.94 NA 24.61 090 

27860 .......... ............ A Fixation of ankle joint .................................. 2.34 NA 1.93 0.39 NA 4.67 010 

27870 .......... ............ A Fusion of ankle joint, open .......................... 13.92 NA 10.21 2.36 NA 26.49 090 

27871 .......... ............ A Fusion of tibiofibular joint ............................ 9.18 NA 7.35 1.59 NA 18.12 090 

27880 .......... ............ A Amputation of lower leg .............................. 11.85 NA 6.96 1.75 NA 20.56 090 

27881 .......... ............ A Amputation of lower leg .............................. 12.34 NA 8.58 1.98 NA 22.90 090 

27882 .......... ............ A Amputation of lower leg .............................. 8.95 NA 6.29 1.29 NA 16.53 090 

27884 .......... ............ A Amputation follow-up surgery ...................... 8.22 NA 5.60 1.22 NA 15.04 090 

27886 .......... ............ A Amputation follow-up surgery ...................... 9.33 NA 6.34 1.40 NA 17.06 090 

27888 .......... ............ A Amputation of foot at ankle ......................... 9.68 NA 7.28 1.51 NA 18.47 090 

27889 .......... ............ A Amputation of foot at ankle ......................... 9.99 NA 6.30 1.46 NA 17.75 090 

27892 .......... ............ A Decompression of leg ................................. 7.39 NA 5.44 1.10 NA 13.93 090 

27893 .......... ............ A Decompression of leg ................................. 7.35 NA 5.32 1.10 NA 13.78 090 

27894 .......... ............ A Decompression of leg ................................. 10.49 NA 7.57 1.65 NA 19.71 090 

27899 .......... ............ C Leg/ankle surgery procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

28001 .......... ............ A Drainage of bursa of foot ............................ 2.74 3.15 1.93 0.33 6.21 5.00 010 

28002 .......... ............ A Treatment of foot infection .......................... 4.62 5.17 3.71 0.61 10.39 8.94 010 

28003 .......... ............ A Treatment of foot infection .......................... 8.42 6.42 5.15 1.12 15.96 14.69 090 

28005 .......... ............ A Treat foot bone lesion ................................. 8.69 NA 5.96 1.16 NA 15.81 090 

28008 .......... ............ A Incision of foot fascia .................................. 4.45 4.77 3.20 0.57 9.79 8.22 090 

28010 .......... ............ A Incision of toe tendon .................................. 2.85 2.45 2.42 0.36 5.66 5.62 090 

28011 .......... ............ A Incision of toe tendons ................................ 4.14 0.00 3.28 0.59 4.73 8.01 090 

28020 .......... ............ A Exploration of foot joint ............................... 5.01 6.09 4.06 0.72 11.82 9.79 090 

28022 .......... ............ A Exploration of foot joint ............................... 4.67 5.39 3.80 0.62 10.68 9.09 090 

28024 .......... ............ A Exploration of toe joint ................................ 4.38 5.38 3.85 0.58 10.34 8.81 090 

28030 .......... ............ A Removal of foot nerve ................................. 6.15 NA 3.67 0.74 NA 10.56 090 

28035 .......... ............ A Decompression of tibia nerve ..................... 5.09 6.00 4.03 0.70 11.79 9.82 090 

28043 .......... ............ A Excision of foot lesion ................................. 3.54 3.94 3.14 0.46 7.94 7.13 090 

28045 .......... ............ A Excision of foot lesion ................................. 4.72 5.58 3.58 0.63 10.93 8.93 090 

28046 .......... ............ A Resection of tumor, foot .............................. 10.18 8.90 6.37 1.36 20.44 17.91 090 

28050 .......... ............ A Biopsy of foot joint lining ............................. 4.25 5.11 3.55 0.60 9.96 8.40 090 

28052 .......... ............ A Biopsy of foot joint lining ............................. 3.94 5.08 3.38 0.53 9.55 7.85 090 

28054 .......... ............ A Biopsy of toe joint lining .............................. 3.45 4.89 3.18 0.46 8.80 7.09 090 

28060 .......... ............ A Partial removal, foot fascia .......................... 5.23 5.69 3.86 0.70 11.62 9.79 090 

28062 .......... ............ A Removal of foot fascia ................................ 6.52 6.70 4.03 0.83 14.05 11.38 090 

28070 .......... ............ A Removal of foot joint lining .......................... 5.10 5.45 3.78 0.73 11.28 9.61 090 

28072 .......... ............ A Removal of foot joint lining .......................... 4.58 5.68 4.20 0.68 10.94 9.46 090 

28080 .......... ............ A Removal of foot lesion ................................ 3.58 5.41 3.72 0.47 9.45 7.77 090 

28086 .......... ............ A Excise foot tendon sheath ........................... 4.78 7.81 4.55 0.76 13.35 10.09 090 

28088 .......... ............ A Excise foot tendon sheath ........................... 3.86 5.80 3.79 0.61 10.26 8.26 090 

28090 .......... ............ A Removal of foot lesion ................................ 4.41 5.34 3.44 0.59 10.34 8.44 090 

28092 .......... ............ A Removal of toe lesions ................................ 3.64 5.34 3.47 0.49 9.47 7.59 090 

28100 .......... ............ A Removal of ankle/heel lesion ...................... 5.66 7.86 4.61 0.82 14.34 11.09 90 

28102 .......... ............ A Remove/graft foot lesion ............................. 7.74 NA 5.81 1.14 NA 14.68 090 

28103 .......... ............ A Remove/graft foot lesion ............................. 6.50 NA 4.57 0.91 NA 11.98 090 

28104 .......... ............ A Removal of foot lesion ................................ 5.12 5.69 3.88 0.70 11.51 9.70 090 

28106 .......... ............ A Remove/graft foot lesion ............................. 7.16 NA 4.44 0.97 NA 12.58 090 

28107 .......... ............ A Remove/graft foot lesion ............................. 5.56 6.67 4.17 0.74 12.97 10.47 090 

28108 .......... ............ A Removal of toe lesions ................................ 4.16 4.85 3.25 0.53 9.54 7.94 090 

28110 .......... ............ A Part removal of metatarsal .......................... 4.08 5.43 3.22 0.54 10.05 7.84 090 

28111 .......... ............ A Part removal of metatarsal .......................... 5.01 6.36 3.62 0.67 12.04 9.30 090 

28112 .......... ............ A Part removal of metatarsal .......................... 4.49 5.96 3.54 0.61 11.06 8.64 090 

28113 .......... ............ A Part removal of metatarsal .......................... 4.79 6.33 4.34 0.63 11.75 9.76 090 

28114 .......... ............ A Removal of metatarsal heads ..................... 9.80 11.63 8.27 1.42 22.85 19.49 090 

28116 .......... ............ A Revision of foot ........................................... 7.76 7.08 5.17 1.03 15.87 13.96 090 

28118 .......... ............ A Removal of heel bone ................................. 5.96 6.41 4.30 0.84 13.21 11.11 090 

28119 .......... ............ A Removal of heel spur .................................. 5.39 5.67 3.73 0.70 11.76 9.83 090 

28120 .......... ............ A Part removal of ankle/heel .......................... 5.40 7.28 4.34 0.77 13.45 10.51 090 

28122 .......... ............ A Partial removal of foot bone ........................ 7.29 7.04 5.23 0.98 15.31 13.50 090 

28124 .......... ............ A Partial removal of toe .................................. 4.81 5.27 3.67 0.60 10.68 9.08 090 

28126 .......... ............ A Partial removal of toe .................................. 3.52 4.46 2.98 0.45 8.43 6.95 090 

28130 .......... ............ A Removal of ankle bone ............................... 8.12 NA 6.57 1.26 NA 15.94 090 

28140 .......... ............ A Removal of metatarsal ................................ 6.91 7.29 4.70 0.92 15.12 12.53 090 

28150 .......... ............ A Removal of toe ............................................ 4.09 5.05 3.27 0.53 9.67 7.89 090 

28153 .......... ............ A Partial removal of toe .................................. 3.66 4.58 2.73 0.47 8.70 6.86 090 

28160 .......... ............ A Partial removal of toe .................................. 3.74 4.80 3.31 0.49 9.03 7.53 090 

28171 .......... ............ A Extensive foot surgery ................................. 9.61 NA 5.43 1.33 NA 16.37 090 

28173 .......... ............ A Extensive foot surgery ................................. 8.81 7.79 5.16 1.12 17.71 15.08 090 

28175 .......... ............ A Extensive foot surgery ................................. 6.05 5.93 3.73 0.73 12.71 10.51 090 

28190 .......... ............ A Removal of foot foreign body ...................... 1.96 3.47 1.44 0.22 5.65 3.62 010 

28192 .......... ............ A Removal of foot foreign body ...................... 4.64 5.62 3.60 0.61 10.87 8.85 090 

45902

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

28193 .......... ............ A Removal of foot foreign body ...................... 5.73 5.84 3.91 0.73 12.30 10.37 090 

28200 .......... ............ A Repair of foot tendon .................................. 4.60 5.32 3.53 0.61 10.53 8.74 090 

28202 .......... ............ A Repair/graft of foot tendon .......................... 6.84 7.31 4.47 0.91 15.06 12.23 090 

28208 .......... ............ A Repair of foot tendon .................................. 4.37 5.05 3.30 0.58 10.00 8.25 090 

28210 .......... ............ A Repair/graft of foot tendon .......................... 6.35 6.38 4.03 0.81 13.55 11.20 090 

28220 .......... ............ A Release of foot tendon ................................ 4.53 4.93 3.41 0.57 10.03 8.51 090 

28222 .......... ............ A Release of foot tendons .............................. 5.62 5.50 4.08 0.69 11.81 10.39 090 

28225 .......... ............ A Release of foot tendon ................................ 3.66 4.53 2.90 0.46 8.64 7.02 090 

28226 .......... ............ A Release of foot tendons .............................. 4.53 5.06 3.70 0.58 10.16 8.81 090 

28230 .......... ............ A Incision of foot tendon(s) ............................. 4.24 4.90 3.61 0.55 9.69 8.40 090 

28232 .......... ............ A Incision of toe tendon .................................. 3.39 4.71 3.26 0.44 8.54 7.08 090 

28234 .......... ............ A Incision of foot tendon ................................. 3.37 4.87 3.33 0.44 8.68 7.14 090 

28238 .......... ............ A Revision of foot tendon ............................... 7.74 7.39 4.89 1.06 16.19 13.69 090 

28240 .......... ............ A Release of big toe ....................................... 4.36 4.87 3.45 0.58 9.81 8.39 090 

28250 .......... ............ A Revision of foot fascia ................................. 5.92 5.82 4.10 0.82 12.57 10.84 090 

28260 .......... ............ A Release of midfoot joint .............................. 7.97 6.56 4.95 1.14 15.67 14.06 090 

28261 .......... ............ A Revision of foot tendon ............................... 11.73 8.87 7.22 1.57 22.17 20.53 090 

28262 .......... ............ A Revision of foot and ankle .......................... 15.84 13.37 10.63 2.59 31.81 29.06 090 

28264 .......... ............ A Release of midfoot joint .............................. 10.35 7.94 7.12 1.54 19.83 19.01 090 

28270 .......... ............ A Release of foot contracture ......................... 4.76 5.16 3.72 0.62 10.54 9.10 090 

28272 .......... ............ A Release of toe joint, each ........................... 3.80 4.44 2.87 0.46 8.70 7.12 090 

28280 .......... ............ A Fusion of toes .............................................. 5.19 6.34 4.39 0.73 12.26 10.31 090 

28285 .......... ............ A Repair of hammertoe .................................. 4.59 5.12 3.44 0.59 10.30 8.62 090 

28286 .......... ............ A Repair of hammertoe .................................. 4.56 5.06 3.27 0.57 10.19 8.40 090 

28288 .......... ............ A Partial removal of foot bone ........................ 4.74 6.20 4.83 0.65 11.59 10.22 090 

28289 .......... ............ A Repair hallux rigidus .................................... 7.04 8.06 5.68 1.02 16.12 13.74 090 

28290 .......... ............ A Correction of bunion .................................... 5.66 6.44 4.63 0.82 12.92 11.11 090 

28292 .......... ............ A Correction of bunion .................................... 7.04 7.80 5.60 0.91 15.75 13.55 090 

28293 .......... ............ A Correction of bunion .................................... 9.16 11.26 6.22 1.13 21.55 16.51 090 

28294 .......... ............ A Correction of bunion .................................... 8.57 7.68 4.72 1.09 17.34 14.38 090 

28296 .......... ............ A Correction of bunion .................................... 9.19 8.36 5.39 1.19 18.74 15.77 090 

28297 .......... ............ A Correction of bunion .................................... 9.19 9.04 6.14 1.32 19.55 16.65 090 

28298 .......... ............ A Correction of bunion .................................... 7.95 7.47 4.98 1.05 16.47 13.98 090 

28299 .......... ............ A Correction of bunion .................................... 10.58 8.99 6.05 1.37 20.94 18.00 090 

28300 .......... ............ A Incision of heel bone ................................... 9.55 NA 6.86 1.54 NA 17.95 090 

28302 .......... ............ A Incision of ankle bone ................................. 9.56 NA 6.72 1.42 NA 17.70 090 

28304 .......... ............ A Incision of midfoot bones ............................ 9.17 8.16 5.67 1.27 18.60 16.11 090 

28305 .......... ............ A Incise/graft midfoot bones ........................... 10.50 NA 6.72 1.27 NA 18.49 090 

28306 .......... ............ A Incision of metatarsal .................................. 5.86 6.96 4.14 0.84 13.66 10.84 090 

28307 .......... ............ A Incision of metatarsal .................................. 6.33 10.64 5.16 0.90 17.87 12.39 090 

28308 .......... ............ A Incision of metatarsal .................................. 5.29 6.01 3.71 0.70 12.00 9.71 090 

28309 .......... ............ A Incision of metatarsals ................................ 12.79 NA 7.83 2.04 NA 22.65 090 

28310 .......... ............ A Revision of big toe ...................................... 5.43 5.98 3.56 0.70 12.12 9.70 090 

28312 .......... ............ A Revision of toe ............................................ 4.55 5.67 3.60 0.63 10.85 8.78 090 

28313 .......... ............ A Repair deformity of toe ................................ 5.01 5.47 4.69 0.73 11.21 10.43 090 

28315 .......... ............ A Removal of sesamoid bone ........................ 4.86 5.15 3.35 0.63 10.63 8.84 090 

28320 .......... ............ A Repair of foot bones .................................... 9.19 NA 6.56 1.43 NA 17.18 090 

28322 .......... ............ A Repair of metatarsals .................................. 8.35 9.10 6.19 1.27 18.72 15.81 090 

28340 .......... ............ A Resect enlarged toe tissue ......................... 6.98 6.67 4.24 0.84 14.49 12.07 090 

28341 .......... ............ A Resect enlarged toe .................................... 8.42 7.22 4.82 1.01 16.64 14.25 090 

28344 .......... ............ A Repair extra toe(s) ...................................... 4.26 5.88 3.60 0.51 10.65 8.37 090 

28345 .......... ............ A Repair webbed toe(s) .................................. 5.92 6.38 4.61 0.80 13.10 11.33 090 

28360 .......... ............ A Reconstruct cleft foot .................................. 13.35 NA 10.20 2.28 NA 25.83 090 

28400 .......... ............ A Treatment of heel fracture ........................... 2.16 3.82 2.96 0.35 6.33 5.48 090 

28405 .......... ............ A Treatment of heel fracture ........................... 4.57 5.00 4.50 0.73 10.30 9.80 090 

28406 .......... ............ A Treatment of heel fracture ........................... 6.31 NA 6.54 1.11 NA 13.97 090 

28415 .......... ............ A Treat heel fracture ....................................... 15.98 NA 15.56 2.66 NA 34.20 090 

28420 .......... ............ A Treat/graft heel fracture ............................... 16.65 NA 15.18 2.80 NA 34.63 090 

28430 .......... ............ A Treatment of ankle fracture ......................... 2.09 3.58 2.48 0.31 5.98 4.88 090 

28435 .......... ............ A Treatment of ankle fracture ......................... 3.40 4.07 3.64 0.55 8.02 7.59 090 

28436 .......... ............ A Treatment of ankle fracture ......................... 4.71 NA 5.69 0.81 NA 11.21 090 

28445 .......... ............ A Treat ankle fracture ..................................... 15.63 NA 10.73 2.58 NA 28.94 090 

28450 .......... ............ A Treat midfoot fracture, each ........................ 1.90 3.31 2.40 0.28 5.50 4.58 090 

28455 .......... ............ A Treat midfoot fracture, each ........................ 3.10 3.64 3.37 0.44 7.18 6.91 090 

28456 .......... ............ A Treat midfoot fracture .................................. 2.69 NA 4.03 0.44 NA 7.15 090 

28465 .......... ............ A Treat midfoot fracture, each ........................ 7.01 NA 7.98 1.10 NA 16.10 090 

28470 .......... ............ A Treat metatarsal fracture ............................. 1.99 3.31 2.36 0.30 5.60 4.66 090 

28475 .......... ............ A Treat metatarsal fracture ............................. 2.98 3.53 3.12 0.44 6.94 6.54 090 

28476 .......... ............ A Treat metatarsal fracture ............................. 3.38 NA 4.82 0.54 NA 8.74 090 

28485 .......... ............ A Treat metatarsal fracture ............................. 5.71 NA 7.53 0.83 NA 14.07 090 

28490 .......... ............ A Treat big toe fracture ................................... 1.09 2.00 1.59 0.14 3.23 2.82 090 

28495 .......... ............ A Treat big toe fracture ................................... 1.58 2.21 2.01 0.20 3.99 3.79 090 

28496 .......... ............ A Treat big toe fracture ................................... 2.33 7.96 3.12 0.36 10.66 5.82 090 

28505 .......... ............ A Treat big toe fracture ................................... 3.81 9.34 5.68 0.56 13.71 10.05 090 

45903

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

28510 .......... ............ A Treatment of toe fracture ............................ 1.09 1.54 1.49 0.14 2.77 2.72 090 

28515 .......... ............ A Treatment of toe fracture ............................ 1.46 1.93 1.85 0.18 3.58 3.50 090 

28525 .......... ............ A Treat toe fracture ......................................... 3.33 8.76 5.19 0.49 12.58 9.01 090 

28530 .......... ............ A Treat sesamoid bone fracture ..................... 1.06 1.67 1.41 0.14 2.87 2.61 090 

28531 .......... ............ A Treat sesamoid bone fracture ..................... 2.35 7.40 3.45 0.34 10.09 6.14 090 

28540 .......... ............ A Treat foot dislocation ................................... 2.04 2.65 2.41 0.26 4.95 4.72 090 

28545 .......... ............ A Treat foot dislocation ................................... 2.45 2.60 2.48 0.37 5.42 5.30 090 

28546 .......... ............ A Treat foot dislocation ................................... 3.21 6.89 4.25 0.52 10.62 7.97 090 

28555 .......... ............ A Repair foot dislocation ................................. 6.30 11.09 7.52 1.04 18.43 14.86 090 

28570 .......... ............ A Treat foot dislocation ................................... 1.66 2.65 2.27 0.23 4.54 4.17 090 

28575 .......... ............ A Treat foot dislocation ................................... 3.32 3.92 3.70 0.56 7.79 7.58 090 

28576 .......... ............ A Treat foot dislocation ................................... 4.17 NA 4.11 0.69 NA 8.97 090 

28585 .......... ............ A Repair foot dislocation ................................. 8.00 8.69 7.47 1.25 17.94 16.71 090 

28600 .......... ............ A Treat foot dislocation ................................... 1.89 3.03 2.61 0.27 5.20 4.77 090 

28605 .......... ............ A Treat foot dislocation ................................... 2.72 3.35 3.16 0.40 6.46 6.28 090 

28606 .......... ............ A Treat foot dislocation ................................... 4.90 NA 4.64 0.82 NA 10.36 090 

28615 .......... ............ A Repair foot dislocation ................................. 7.78 NA 9.80 1.30 NA 18.87 090 

28630 .......... ............ A Treat toe dislocation .................................... 1.70 1.61 0.96 0.20 3.51 2.87 010 

28635 .......... ............ A Treat toe dislocation .................................... 1.91 2.21 1.51 0.26 4.38 3.68 010 

28636 .......... ............ A Treat toe dislocation .................................... 2.78 3.87 2.55 0.43 7.08 5.75 010 

28645 .......... ............ A Repair toe dislocation .................................. 4.22 5.95 4.24 0.57 10.74 9.03 090 

28660 .......... ............ A Treat toe dislocation .................................... 1.23 1.48 0.76 0.13 2.84 2.13 010 

28665 .......... ............ A Treat toe dislocation .................................... 1.92 0.00 1.42 0.26 2.18 3.60 010 

28666 .......... ............ A Treat toe dislocation .................................... 2.67 NA 2.48 0.43 NA 5.58 010 

28675 .......... ............ A Repair of toe dislocation ............................. 2.93 7.92 4.53 0.45 11.29 7.91 090 

28705 .......... ............ A Fusion of foot bones ................................... 18.81 NA 12.10 3.08 NA 33.99 090 

28715 .......... ............ A Fusion of foot bones ................................... 13.11 NA 9.48 2.16 NA 24.75 090 

28725 .......... ............ A Fusion of foot bones ................................... 11.61 NA 8.02 1.86 NA 21.49 090 

28730 .......... ............ A Fusion of foot bones ................................... 10.76 NA 8.29 1.70 NA 20.75 090 

28735 .......... ............ A Fusion of foot bones ................................... 10.85 NA 7.65 1.68 NA 20.18 090 

28737 .......... ............ A Revision of foot bones ................................ 9.65 NA 6.70 1.47 NA 17.82 090 

28740 .......... ............ A Fusion of foot bones ................................... 8.03 10.65 6.34 1.22 19.89 15.58 090 

28750 .......... ............ A Fusion of big toe joint .................................. 7.30 11.53 6.49 1.13 19.97 14.93 090 

28755 .......... ............ A Fusion of big toe joint .................................. 4.74 6.22 3.72 0.65 11.61 9.11 090 

28760 .......... ............ A Fusion of big toe joint .................................. 7.76 8.16 5.48 1.05 16.96 14.28 090 

28800 .......... ............ A Amputation of midfoot ................................. 8.22 NA 5.67 1.15 NA 15.04 090 

28805 .......... ............ A Amputation thru metatarsal ......................... 8.40 NA 5.52 1.18 NA 15.10 090 

28810 .......... ............ A Amputation toe & metatarsal ....................... 6.21 NA 4.39 0.86 NA 11.46 090 

28820 .......... ............ A Amputation of toe ........................................ 4.41 7.47 3.72 0.61 12.49 8.74 090 

28825 .......... ............ A Partial amputation of toe ............................. 3.59 6.95 3.42 0.50 11.03 7.50 090 

28899 .......... ............ C Foot/toes surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

29000 .......... ............ A Application of body cast .............................. 2.25 3.98 1.70 0.41 6.64 4.37 000 

29010 .......... ............ A Application of body cast .............................. 2.06 4.62 1.73 0.45 7.14 4.25 000 

29015 .......... ............ A Application of body cast .............................. 2.41 4.23 1.57 0.28 6.92 4.27 000 

29020 .......... ............ A Application of body cast .............................. 2.11 4.69 1.39 0.28 7.08 3.79 000 

29025 .......... ............ A Application of body cast .............................. 2.40 4.38 1.82 0.44 7.23 4.66 000 

29035 .......... ............ A Application of body cast .............................. 1.77 5.06 1.54 0.28 7.11 3.60 000 

29040 .......... ............ A Application of body cast .............................. 2.22 3.53 1.49 0.36 6.12 4.08 000 

29044 .......... ............ A Application of body cast .............................. 2.12 5.87 1.85 0.35 8.35 4.33 000 

29046 .......... ............ A Application of body cast .............................. 2.41 4.95 2.04 0.42 7.79 4.87 000 

29049 .......... ............ A Application of figure eight ............................ 0.89 2.01 0.51 0.13 3.03 1.54 000 

29055 .......... ............ A Application of shoulder cast ........................ 1.78 4.12 1.44 0.30 6.21 3.52 000 

29058 .......... ............ A Application of shoulder cast ........................ 1.31 2.28 0.70 0.17 3.76 2.19 000 

29065 .......... ............ A Application of long arm cast ........................ 0.87 2.25 0.73 0.15 3.28 1.75 000 

29075 .......... ............ A Application of forearm cast ......................... 0.77 2.08 0.66 0.13 2.98 1.57 000 

29085 .......... ............ A Apply hand/wrist cast .................................. 0.87 1.98 0.62 0.14 3.00 1.63 000 

29086 .......... ............ A Apply finger cast .......................................... 0.62 0.95 0.48 0.07 1.65 1.17 000 

29105 .......... ............ A Apply long arm splint ................................... 0.87 1.76 0.49 0.12 2.76 1.49 000 

29125 .......... ............ A Apply forearm splint .................................... 0.59 1.51 0.38 0.07 2.17 1.04 000 

29126 .......... ............ A Apply forearm splint .................................... 0.77 1.49 0.45 0.07 2.33 1.29 000 

29130 .......... ............ A Application of finger splint ........................... 0.50 0.46 0.17 0.06 1.02 0.73 000 

29131 .......... ............ A Application of finger splint ........................... 0.55 0.74 0.23 0.03 1.32 0.81 000 

29200 .......... ............ A Strapping of chest ....................................... 0.65 0.76 0.33 0.04 1.45 1.02 000 

29220 .......... ............ A Strapping of low back .................................. 0.64 0.74 0.39 0.04 1.42 1.07 000 

29240 .......... ............ A Strapping of shoulder .................................. 0.71 0.86 0.35 0.06 1.64 1.12 000 

29260 .......... ............ A Strapping of elbow or wrist ......................... 0.55 0.78 0.31 0.05 1.38 0.91 000 

29280 .......... ............ A Strapping of hand or finger ......................... 0.51 0.82 0.31 0.03 1.36 0.85 000 

29305 .......... ............ A Application of hip cast ................................. 2.03 4.78 1.72 0.35 7.17 4.10 000 

29325 .......... ............ A Application of hip casts ............................... 2.32 4.95 1.90 0.40 7.67 4.63 000 

29345 .......... ............ A Application of long leg cast ......................... 1.40 2.53 1.03 0.24 4.17 2.67 000 

29355 .......... ............ A Application of long leg cast ......................... 1.53 2.59 1.09 0.26 4.38 2.89 000 

29358 .......... ............ A Apply long leg cast brace ............................ 1.43 2.76 1.06 0.25 4.44 2.74 000 

29365 .......... ............ A Application of long leg cast ......................... 1.18 2.64 0.92 0.20 4.02 2.31 000 

29405 .......... ............ A Apply short leg cast ..................................... 0.86 2.14 0.69 0.14 3.14 1.70 000 

45904

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

29425 .......... ............ A Apply short leg cast ..................................... 1.01 2.20 0.73 0.15 3.36 1.89 000 

29435 .......... ............ A Apply short leg cast ..................................... 1.18 2.22 0.90 0.20 3.60 2.29 000 

29440 .......... ............ A Addition of walker to cast ............................ 0.57 1.06 0.27 0.08 1.71 0.92 000 

29445 .......... ............ A Apply rigid leg cast ...................................... 1.78 2.49 0.95 0.27 4.54 3.00 000 

29450 .......... ............ A Application of leg cast ................................. 2.08 1.97 1.07 0.27 4.32 3.43 000 

29505 .......... ............ A Application, long leg splint .......................... 0.69 1.50 0.44 0.08 2.27 1.21 000 

29515 .......... ............ A Application lower leg splint .......................... 0.73 1.16 0.45 0.09 1.98 1.27 000 

29520 .......... ............ A Strapping of hip ........................................... 0.54 0.88 0.46 0.03 1.45 1.03 000 

29530 .......... ............ A Strapping of knee ........................................ 0.57 0.83 0.32 0.05 1.45 0.94 000 

29540 .......... ............ A Strapping of ankle and/or ft ......................... 0.51 0.48 0.31 0.06 1.05 0.88 000 

29550 .......... ............ A Strapping of toes ......................................... 0.47 0.46 0.29 0.06 0.99 0.82 000 

29580 .......... ............ A Application of paste boot ............................. 0.57 0.76 0.35 0.07 1.40 0.99 000 

29590 .......... ............ A Application of foot splint .............................. 0.76 0.53 0.28 0.09 1.38 1.13 000 

29700 .......... ............ A Removal/revision of cast ............................. 0.57 0.89 0.27 0.08 1.54 0.92 000 

29705 .......... ............ A Removal/revision of cast ............................. 0.76 0.80 0.37 0.13 1.69 1.26 000 

29710 .......... ............ A Removal/revision of cast ............................. 1.34 1.49 0.68 0.20 3.03 2.22 000 

29715 .......... ............ A Removal/revision of cast ............................. 0.94 1.82 0.39 0.09 2.85 1.42 000 

29720 .......... ............ A Repair of body cast ..................................... 0.68 1.53 0.38 0.12 2.33 1.18 000 

29730 .......... ............ A Windowing of cast ....................................... 0.75 0.79 0.34 0.12 1.67 1.21 000 

29740 .......... ............ A Wedging of cast .......................................... 1.12 1.38 0.48 0.18 2.68 1.78 000 

29750 .......... ............ A Wedging of clubfoot cast ............................. 1.26 1.27 0.57 0.21 2.74 2.04 000 

29799 .......... ............ C Casting/strapping procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

29800 .......... ............ A Jaw arthroscopy/surgery ............................. 6.43 NA 6.72 0.99 NA 14.14 090 

29804 .......... ............ A Jaw arthroscopy/surgery ............................. 8.15 NA 7.64 1.38 NA 17.16 090 

29805 .......... ............ A Shoulder arthroscopy, dx ............................ 5.89 NA 5.48 1.02 NA 12.39 090 

29806 .......... ............ A Shoulder arthroscopy/surgery ..................... 14.38 NA 10.80 2.49 NA 27.67 090 

29807 .......... ............ A Shoulder arthroscopy/surgery ..................... 13.91 NA 10.64 2.41 NA 26.96 090 

29819 .......... ............ A Shoulder arthroscopy/surgery ..................... 7.63 NA 6.56 1.32 NA 15.51 090 

29820 .......... ............ A Shoulder arthroscopy/surgery ..................... 7.07 NA 6.01 1.22 NA 14.31 090 

29821 .......... ............ A Shoulder arthroscopy/surgery ..................... 7.73 NA 6.57 1.33 NA 15.63 090 

29822 .......... ............ A Shoulder arthroscopy/surgery ..................... 7.43 NA 6.46 1.28 NA 15.18 090 

29823 .......... ............ A Shoulder arthroscopy/surgery ..................... 8.18 NA 6.98 1.41 NA 16.57 090 

29824 .......... ............ A Shoulder arthroscopy/surgery ..................... 8.26 NA 7.29 1.42 NA 16.96 090 

29825 .......... ............ A Shoulder arthroscopy/surgery ..................... 7.63 NA 6.54 1.32 NA 15.48 090 

29826 .......... ............ A Shoulder arthroscopy/surgery ..................... 9.00 NA 7.28 1.55 NA 17.83 090 

29827 .......... ............ A Arthroscop rotator cuff repr ......................... 15.37 NA 11.16 2.66 NA 29.19 090 

29830 .......... ............ A Elbow arthroscopy ....................................... 5.76 NA 5.18 0.99 NA 11.93 090 

29834 .......... ............ A Elbow arthroscopy/surgery .......................... 6.28 NA 5.64 1.08 NA 13.00 090 

29835 .......... ............ A Elbow arthroscopy/surgery .......................... 6.48 NA 5.69 1.13 NA 13.30 090 

29836 .......... ............ A Elbow arthroscopy/surgery .......................... 7.56 NA 6.56 1.22 NA 15.33 090 

29837 .......... ............ A Elbow arthroscopy/surgery .......................... 6.87 NA 5.92 1.19 NA 13.99 090 

29838 .......... ............ A Elbow arthroscopy/surgery .......................... 7.72 NA 6.66 1.30 NA 15.67 090 

29840 .......... ............ A Wrist arthroscopy ........................................ 5.54 NA 5.15 0.84 NA 11.53 090 

29843 .......... ............ A Wrist arthroscopy/surgery ........................... 6.01 NA 5.44 0.92 NA 12.37 090 

29844 .......... ............ A Wrist arthroscopy/surgery ........................... 6.37 NA 5.63 1.04 NA 13.04 090 

29845 .......... ............ A Wrist arthroscopy/surgery ........................... 7.53 NA 6.29 0.99 NA 14.81 090 

29846 .......... ............ A Wrist arthroscopy/surgery ........................... 6.75 NA 5.86 1.07 NA 13.68 090 

29847 .......... ............ A Wrist arthroscopy/surgery ........................... 7.08 NA 5.99 1.08 NA 14.16 090 

29848 .......... ............ A Wrist endoscopy/surgery ............................. 5.44 NA 5.43 0.86 NA 11.73 090 

29850 .......... ............ A Knee arthroscopy/surgery ........................... 8.20 NA 5.02 1.25 NA 14.47 090 

29851 .......... ............ A Knee arthroscopy/surgery ........................... 13.11 NA 9.49 2.34 NA 24.93 090 

29855 .......... ............ A Tibial arthroscopy/surgery ........................... 10.62 NA 8.48 1.84 NA 20.95 090 

29856 .......... ............ A Tibial arthroscopy/surgery ........................... 14.15 NA 10.34 2.39 NA 26.87 090 

29860 .......... ............ A Hip arthroscopy, dx ..................................... 8.06 NA 6.73 1.36 NA 16.15 090 

29861 .......... ............ A Hip arthroscopy/surgery .............................. 9.16 NA 7.11 1.59 NA 17.86 090 

29862 .......... ............ A Hip arthroscopy/surgery .............................. 9.91 NA 8.29 1.62 NA 19.82 090 

29863 .......... ............ A Hip arthroscopy/surgery .............................. 9.91 NA 8.25 1.42 NA 19.58 090 

29866 .......... ............ A Autgrft implnt, knee w/scope ....................... 13.91 NA 10.98 2.39 NA 27.28 090 

29867 .......... ............ A Allgrft implnt, knee w/scope ........................ 17.03 NA 12.80 2.78 NA 32.61 090 

29868 .......... ............ A Meniscal trnspl, knee w/scpe ...................... 23.64 NA 16.26 4.35 NA 44.25 090 

29870 .......... ............ A Knee arthroscopy, dx .................................. 5.07 NA 4.72 0.85 NA 10.64 090 

29871 .......... ............ A Knee arthroscopy/drainage ......................... 6.55 NA 5.68 1.14 NA 13.38 090 

29873 .......... ............ A Knee arthroscopy/surgery ........................... 6.00 NA 6.35 1.04 NA 13.39 090 

29874 .......... ............ A Knee arthroscopy/surgery ........................... 7.05 NA 5.88 1.11 NA 14.04 090 

29875 .......... ............ A Knee arthroscopy/surgery ........................... 6.31 NA 5.65 1.09 NA 13.06 090 

29876 .......... ............ A Knee arthroscopy/surgery ........................... 7.93 NA 6.80 1.37 NA 16.09 090 

29877 .......... ............ A Knee arthroscopy/surgery ........................... 7.35 NA 6.52 1.28 NA 15.16 090 

29879 .......... ............ A Knee arthroscopy/surgery ........................... 8.05 NA 6.89 1.39 NA 16.32 090 

29880 .......... ............ A Knee arthroscopy/surgery ........................... 8.51 NA 7.12 1.47 NA 17.10 090 

29881 .......... ............ A Knee arthroscopy/surgery ........................... 7.77 NA 6.73 1.34 NA 15.84 090 

29882 .......... ............ A Knee arthroscopy/surgery ........................... 8.66 NA 7.01 1.50 NA 17.16 090 

29883 .......... ............ A Knee arthroscopy/surgery ........................... 11.05 NA 8.77 1.92 NA 21.74 090 

29884 .......... ............ A Knee arthroscopy/surgery ........................... 7.33 NA 6.48 1.27 NA 15.09 090 

29885 .......... ............ A Knee arthroscopy/surgery ........................... 9.10 NA 7.71 1.58 NA 18.39 090 

45905

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

29886 .......... ............ A Knee arthroscopy/surgery ........................... 7.55 NA 6.63 1.30 NA 15.47 090 

29887 .......... ............ A Knee arthroscopy/surgery ........................... 9.05 NA 7.67 1.57 NA 18.29 090 

29888 .......... ............ A Knee arthroscopy/surgery ........................... 13.91 NA 9.87 2.41 NA 26.19 090 

29889 .......... ............ A Knee arthroscopy/surgery ........................... 16.01 NA 12.04 2.78 NA 30.83 090 

29891 .......... ............ A Ankle arthroscopy/surgery ........................... 8.41 NA 7.29 1.39 NA 17.09 090 

29892 .......... ............ A Ankle arthroscopy/surgery ........................... 9.01 NA 7.52 1.41 NA 17.94 090 

29893 .......... ............ A Scope, plantar fasciotomy ........................... 5.22 6.64 4.09 0.63 12.49 9.94 090 

29894 .......... ............ A Ankle arthroscopy/surgery ........................... 7.21 NA 5.34 1.15 NA 13.71 090 

29895 .......... ............ A Ankle arthroscopy/surgery ........................... 6.99 NA 5.34 1.11 NA 13.44 090 

29897 .......... ............ A Ankle arthroscopy/surgery ........................... 7.18 NA 5.71 1.17 NA 14.06 090 

29898 .......... ............ A Ankle arthroscopy/surgery ........................... 8.33 NA 6.05 1.28 NA 15.66 090 

29899 .......... ............ A Ankle arthroscopy/surgery ........................... 13.92 NA 10.23 2.40 NA 26.54 090 

29900 .......... ............ A Mcp joint arthroscopy, dx ............................ 5.42 NA 5.67 0.94 NA 12.03 090 

29901 .......... ............ A Mcp joint arthroscopy, surg ......................... 6.13 NA 6.05 1.06 NA 13.25 090 

29902 .......... ............ A Mcp joint arthroscopy, surg ......................... 6.70 NA 6.33 1.12 NA 14.15 090 

29999 .......... ............ C Arthroscopy of joint ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

30000 .......... ............ A Drainage of nose lesion .............................. 1.43 3.99 1.37 0.12 5.54 2.92 010 

30020 .......... ............ A Drainage of nose lesion .............................. 1.43 3.41 1.45 0.12 4.97 3.00 010 

30100 .......... ............ A Intranasal biopsy ......................................... 0.94 2.03 0.80 0.07 3.04 1.82 000 

30110 .......... ............ A Removal of nose polyp(s) ........................... 1.63 3.28 1.54 0.14 5.05 3.31 010 

30115 .......... ............ A Removal of nose polyp(s) ........................... 4.35 NA 5.73 0.41 NA 10.49 090 

30117 .......... ............ A Removal of intranasal lesion ....................... 3.17 13.54 4.61 0.26 16.97 8.04 090 

30118 .......... ............ A Removal of intranasal lesion ....................... 9.70 NA 9.03 0.78 NA 19.50 090 

30120 .......... ............ A Revision of nose .......................................... 5.27 6.80 5.78 0.52 12.59 11.57 090 

30124 .......... ............ A Removal of nose lesion ............................... 3.11 NA 3.63 0.25 NA 6.98 090 

30125 .......... ............ A Removal of nose lesion ............................... 7.16 NA 8.11 0.63 NA 15.90 090 

30130 .......... ............ A Removal of turbinate bones ........................ 3.38 NA 5.52 0.31 NA 9.21 090 

30140 .......... ............ A Removal of turbinate bones ........................ 3.43 NA 6.22 0.35 NA 10.00 090 

30150 .......... ............ A Partial removal of nose ............................... 9.15 NA 10.64 0.93 NA 20.72 090 

30160 .......... ............ A Removal of nose ......................................... 9.59 NA 9.92 0.88 NA 20.39 090 

30200 .......... ............ A Injection treatment of nose .......................... 0.78 1.64 0.73 0.06 2.48 1.57 000 

30210 .......... ............ A Nasal sinus therapy ..................................... 1.08 2.12 1.29 0.09 3.30 2.46 010 

30220 .......... ............ A Insert nasal septal button ............................ 1.54 4.36 1.51 0.12 6.02 3.18 010 

30300 .......... ............ A Remove nasal foreign body ........................ 1.04 4.50 1.84 0.08 5.62 2.96 010 

30310 .......... ............ A Remove nasal foreign body ........................ 1.96 NA 3.04 0.16 NA 5.16 010 

30320 .......... ............ A Remove nasal foreign body ........................ 4.52 NA 6.84 0.39 NA 11.75 090 

30400 .......... ............ R Reconstruction of nose ............................... 9.84 NA 15.01 1.04 NA 25.89 090 

30410 .......... ............ R Reconstruction of nose ............................... 12.99 NA 17.64 1.42 NA 32.05 090 

30420 .......... ............ R Reconstruction of nose ............................... 15.89 NA 17.44 1.46 NA 34.80 090 

30430 .......... ............ R Revision of nose .......................................... 7.21 NA 15.31 0.77 NA 23.30 090 

30435 .......... ............ R Revision of nose .......................................... 11.71 NA 18.43 1.22 NA 31.36 090 

30450 .......... ............ R Revision of nose .......................................... 18.66 NA 21.03 1.96 NA 41.65 090 

30460 .......... ............ A Revision of nose .......................................... 9.97 NA 9.57 1.03 NA 20.57 090 

30462 .......... ............ A Revision of nose .......................................... 19.58 NA 19.21 2.53 NA 41.32 090 

30465 .......... ............ A Repair nasal stenosis .................................. 11.64 NA 11.57 1.06 NA 24.28 090 

30520 .......... ............ A Repair of nasal septum ............................... 5.70 NA 6.65 0.46 NA 12.81 090 

30540 .......... ............ A Repair nasal defect ..................................... 7.76 NA 9.00 0.67 NA 17.43 090 

30545 .......... ............ A Repair nasal defect ..................................... 11.38 NA 11.78 1.70 NA 24.86 090 

30560 .......... ............ A Release of nasal adhesions ........................ 1.26 4.73 2.09 0.10 6.09 3.45 010 

30580 .......... ............ A Repair upper jaw fistula .............................. 6.69 7.88 5.69 0.89 15.46 13.27 090 

30600 .......... ............ A Repair mouth/nose fistula ........................... 6.02 7.54 4.90 0.70 14.26 11.63 090 

30620 .......... ............ A Intranasal reconstruction ............................. 5.97 NA 8.69 0.57 NA 15.23 090 

30630 .......... ............ A Repair nasal septum defect ........................ 7.12 NA 7.85 0.61 NA 15.58 090 

30801 .......... ............ A Cauterization, inner nose ............................ 1.09 4.06 1.92 0.09 5.25 3.10 010 

30802 .......... ............ A Cauterization, inner nose ............................ 2.03 4.58 2.36 0.16 6.78 4.56 010 

30901 .......... ............ A Control of nosebleed ................................... 1.21 1.34 0.31 0.11 2.67 1.63 000 

30903 .......... ............ A Control of nosebleed ................................... 1.54 2.74 0.48 0.13 4.42 2.16 000 

30905 .......... ............ A Control of nosebleed ................................... 1.97 3.51 0.73 0.17 5.65 2.88 000 

30906 .......... ............ A Repeat control of nosebleed ....................... 2.45 3.89 1.15 0.20 6.55 3.81 000 

30915 .......... ............ A Ligation, nasal sinus artery ......................... 7.20 NA 6.62 0.58 NA 14.40 090 

30920 .......... ............ A Ligation, upper jaw artery ............................ 9.84 NA 8.89 0.80 NA 19.52 090 

30930 .......... ............ A Therapy, fracture of nose ............................ 1.26 NA 1.61 0.12 NA 2.99 010 

30999 .......... ............ C Nasal surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

31000 .......... ............ A Irrigation, maxillary sinus ............................. 1.15 2.85 1.38 0.09 4.09 2.63 010 

31002 .......... ............ A Irrigation, sphenoid sinus ............................ 1.91 NA 3.13 0.15 NA 5.19 010 

31020 .......... ............ A Exploration, maxillary sinus ......................... 2.95 8.41 5.16 0.29 11.65 8.40 090 

31030 .......... ............ A Exploration, maxillary sinus ......................... 5.92 11.21 6.59 0.60 17.73 13.11 090 

31032 .......... ............ A Explore sinus, remove polyps ..................... 6.57 NA 7.16 0.59 NA 14.32 090 

31040 .......... ............ A Exploration behind upper jaw ...................... 9.43 NA 9.43 0.87 NA 19.73 090 

31050 .......... ............ A Exploration, sphenoid sinus ........................ 5.28 NA 6.29 0.49 NA 12.06 090 

31051 .......... ............ A Sphenoid sinus surgery ............................... 7.11 NA 8.19 0.62 NA 15.92 090 

31070 .......... ............ A Exploration of frontal sinus .......................... 4.28 NA 5.90 0.38 NA 10.56 090 

31075 .......... ............ A Exploration of frontal sinus .......................... 9.17 NA 9.59 0.75 NA 19.51 090 

31080 .......... ............ A Removal of frontal sinus ............................. 11.42 NA 13.18 1.23 NA 25.83 090 

45906

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

31081 .......... ............ A Removal of frontal sinus ............................. 12.76 NA 13.68 2.46 NA 28.90 090 

31084 .......... ............ A Removal of frontal sinus ............................. 13.52 NA 13.27 1.19 NA 27.98 090 

31085 .......... ............ A Removal of frontal sinus ............................. 14.21 NA 13.72 1.72 NA 29.65 090 

31086 .......... ............ A Removal of frontal sinus ............................. 12.87 NA 13.07 1.07 NA 27.00 090 

31087 .......... ............ A Removal of frontal sinus ............................. 13.11 NA 12.29 1.44 NA 26.83 090 

31090 .......... ............ A Exploration of sinuses ................................. 9.54 NA 12.48 0.94 NA 22.96 090 

31200 .......... ............ A Removal of ethmoid sinus ........................... 4.97 NA 8.87 0.29 NA 14.13 090 

31201 .......... ............ A Removal of ethmoid sinus ........................... 8.38 NA 9.09 0.82 NA 18.28 090 

31205 .......... ............ A Removal of ethmoid sinus ........................... 10.24 NA 11.45 0.67 NA 22.36 090 

31225 .......... ............ A Removal of upper jaw ................................. 19.24 NA 17.49 1.59 NA 38.32 090 

31230 .......... ............ A Removal of upper jaw ................................. 21.95 NA 18.89 1.77 NA 42.62 090 

31231 .......... ............ A Nasal endoscopy, dx ................................... 1.10 3.34 0.86 0.09 4.54 2.05 000 

31233 .......... ............ A Nasal/sinus endoscopy, dx ......................... 2.18 4.23 1.44 0.20 6.62 3.82 000 

31235 .......... ............ A Nasal/sinus endoscopy, dx ......................... 2.65 4.82 1.67 0.26 7.72 4.57 000 

31237 .......... ............ A Nasal/sinus endoscopy, surg ...................... 2.99 5.08 1.82 0.28 8.35 5.09 000 

31238 .......... ............ A Nasal/sinus endoscopy, surg ...................... 3.27 5.11 2.02 0.27 8.65 5.56 000 

31239 .......... ............ A Nasal/sinus endoscopy, surg ...................... 8.71 NA 7.73 0.62 NA 17.05 010 

31240 .......... ............ A Nasal/sinus endoscopy, surg ...................... 2.62 NA 1.68 0.24 NA 4.53 000 

31254 .......... ............ A Revision of ethmoid sinus ........................... 4.65 NA 2.75 0.45 NA 7.85 000 

31255 .......... ............ A Removal of ethmoid sinus ........................... 6.96 NA 3.96 0.73 NA 11.65 000 

31256 .......... ............ A Exploration maxillary sinus .......................... 3.30 NA 2.04 0.33 NA 5.67 000 

31267 .......... ............ A Endoscopy, maxillary sinus ......................... 5.46 NA 3.17 0.55 NA 9.18 000 

31276 .......... ............ A Sinus endoscopy, surgical .......................... 8.86 NA 4.93 0.92 NA 14.71 000 

31287 .......... ............ A Nasal/sinus endoscopy, surg ...................... 3.92 NA 2.37 0.39 NA 6.68 000 

31288 .......... ............ A Nasal/sinus endoscopy, surg ...................... 4.58 NA 2.71 0.46 NA 7.75 000 

31290 .......... ............ A Nasal/sinus endoscopy, surg ...................... 17.24 NA 11.64 1.40 NA 30.29 010 

31291 .......... ............ A Nasal/sinus endoscopy, surg ...................... 18.20 NA 12.08 1.68 NA 31.95 010 

31292 .......... ............ A Nasal/sinus endoscopy, surg ...................... 14.77 NA 10.26 1.21 NA 26.24 010 

31293 .......... ............ A Nasal/sinus endoscopy, surg ...................... 16.22 NA 11.00 1.28 NA 28.50 010 

31294 .......... ............ A Nasal/sinus endoscopy, surg ...................... 19.07 NA 12.43 1.53 NA 33.03 010 

31299 .......... ............ C Sinus surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

31300 .......... ............ A Removal of larynx lesion ............................. 14.30 NA 14.71 1.17 NA 30.18 090 

31320 .......... ............ A Diagnostic incision, larynx ........................... 5.26 NA 10.05 0.46 NA 15.77 090 

31360 .......... ............ A Removal of larynx ....................................... 17.08 NA 16.42 1.38 NA 34.88 090 

31365 .......... ............ A Removal of larynx ....................................... 24.17 NA 19.92 1.97 NA 46.06 090 

31367 .......... ............ A Partial removal of larynx ............................. 21.87 NA 21.49 1.78 NA 45.14 090 

31368 .......... ............ A Partial removal of larynx ............................. 27.10 NA 25.03 2.20 NA 54.33 090 

31370 .......... ............ A Partial removal of larynx ............................. 21.39 NA 21.85 1.74 NA 44.98 090 

31375 .......... ............ A Partial removal of larynx ............................. 20.22 NA 20.05 1.63 NA 41.90 090 

31380 .......... ............ A Partial removal of larynx ............................. 20.22 NA 20.20 1.70 NA 42.12 090 

31382 .......... ............ A Partial removal of larynx ............................. 20.53 NA 21.26 1.67 NA 43.46 090 

31390 .......... ............ A Removal of larynx & pharynx ...................... 27.54 NA 23.90 2.23 NA 53.67 090 

31395 .......... ............ A Reconstruct larynx & pharynx ..................... 31.10 NA 27.81 2.48 NA 61.39 090 

31400 .......... ............ A Revision of larynx ........................................ 10.31 NA 13.38 0.83 NA 24.52 090 

31420 .......... ............ A Removal of epiglottis ................................... 10.22 NA 9.33 0.83 NA 20.38 090 

31500 .......... ............ A Insert emergency airway ............................. 2.33 NA 0.54 0.17 NA 3.04 000 

31502 .......... ............ A Change of windpipe airway ......................... 0.65 NA 0.28 0.05 NA 0.98 000 

31505 .......... ............ A Diagnostic laryngoscopy ............................. 0.61 1.43 0.60 0.05 2.09 1.26 000 

31510 .......... ............ A Laryngoscopy with biopsy ........................... 1.92 3.23 1.22 0.16 5.31 3.30 000 

31511 .......... ............ A Remove foreign body, larynx ...................... 2.16 3.06 1.03 0.19 5.41 3.38 000 

31512 .......... ............ A Removal of larynx lesion ............................. 2.07 3.15 1.32 0.18 5.40 3.58 000 

31513 .......... ............ A Injection into vocal cord .............................. 2.10 NA 1.42 0.17 NA 3.69 000 

31515 .......... ............ A Laryngoscopy for aspiration ........................ 1.80 3.44 1.04 0.14 5.38 2.98 000 

31520 .......... ............ A Diagnostic laryngoscopy ............................. 2.57 NA 1.52 0.20 NA 4.28 000 

31525 .......... ............ A Diagnostic laryngoscopy ............................. 2.64 3.59 1.61 0.21 6.43 4.46 000 

31526 .......... ............ A Diagnostic laryngoscopy ............................. 2.58 NA 1.67 0.21 NA 4.45 000 

31527 .......... ............ A Laryngoscopy for treatment ........................ 3.28 NA 1.82 0.26 NA 5.36 000 

31528 .......... ............ A Laryngoscopy and dilation .......................... 2.37 NA 1.43 0.19 NA 3.99 000 

31529 .......... ............ A Laryngoscopy and dilation .......................... 2.69 NA 1.66 0.22 NA 4.56 000 

31530 .......... ............ A Operative laryngoscopy ............................... 3.39 NA 1.89 0.29 NA 5.57 000 

31531 .......... ............ A Operative laryngoscopy ............................... 3.59 NA 2.20 0.29 NA 6.07 000 

31535 .......... ............ A Operative laryngoscopy ............................... 3.17 NA 1.93 0.26 NA 5.36 000 

31536 .......... ............ A Operative laryngoscopy ............................... 3.56 NA 2.18 0.29 NA 6.02 000 

31540 .......... ............ A Operative laryngoscopy ............................... 4.13 NA 2.45 0.33 NA 6.91 000 

31541 .......... ............ A Operative laryngoscopy ............................... 4.53 NA 2.69 0.37 NA 7.58 000 

31545 .......... ............ A Remove vc lesion w/scope ......................... 6.31 NA 3.38 0.37 NA 10.07 000 

31546 .......... ............ A Remove vc lesion scope/graft ..................... 9.75 NA 4.88 0.78 NA 15.41 000 

31560 .......... ............ A Operative laryngoscopy ............................... 5.46 NA 3.04 0.43 NA 8.93 000 

31561 .......... ............ A Operative laryngoscopy ............................... 6.00 NA 3.25 0.49 NA 9.74 000 

31570 .......... ............ A Laryngoscopy with injection ........................ 3.87 5.43 2.30 0.31 9.61 6.48 000 

31571 .......... ............ A Laryngoscopy with injection ........................ 4.27 NA 2.51 0.35 NA 7.13 000 

31575 .......... ............ A Diagnostic laryngoscopy ............................. 1.10 1.86 0.87 0.09 3.05 2.06 000 

31576 .......... ............ A Laryngoscopy with biopsy ........................... 1.97 3.62 1.26 0.14 5.73 3.37 000 

31577 .......... ............ A Remove foreign body, larynx ...................... 2.47 3.67 1.49 0.21 6.36 4.17 000 

45907

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

31578 .......... ............ A Removal of larynx lesion ............................. 2.85 4.19 1.48 0.23 7.27 4.55 000 

31579 .......... ............ A Diagnostic laryngoscopy ............................. 2.26 3.64 1.44 0.18 6.09 3.88 000 

31580 .......... ............ A Revision of larynx ........................................ 12.38 NA 15.50 1.00 NA 28.89 090 

31582 .......... ............ A Revision of larynx ........................................ 21.63 NA 25.01 1.75 NA 48.40 090 

31584 .......... ............ A Treat larynx fracture .................................... 19.65 NA 17.74 1.71 NA 39.10 090 

31585 .......... ............ A Treat larynx fracture .................................... 4.64 NA 6.55 0.38 NA 11.57 090 

31586 .......... ............ A Treat larynx fracture .................................... 8.04 NA 10.59 0.67 NA 19.29 090 

31587 .......... ............ A Revision of larynx ........................................ 11.99 NA 9.04 0.97 NA 22.00 090 

31588 .......... ............ A Revision of larynx ........................................ 13.12 NA 13.31 1.06 NA 27.48 090 

31590 .......... ............ A Reinnervate larynx ...................................... 6.97 NA 14.97 0.84 NA 22.79 090 

31595 .......... ............ A Larynx nerve surgery .................................. 8.35 NA 10.28 0.68 NA 19.31 090 

31599 .......... ............ C Larynx surgery procedure ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

31600 .......... ............ A Incision of windpipe ..................................... 7.18 NA 3.09 0.80 NA 11.08 000 

31601 .......... ............ A Incision of windpipe ..................................... 4.45 NA 2.32 0.40 NA 7.17 000 

31603 .......... ............ A Incision of windpipe ..................................... 4.15 NA 1.65 0.44 NA 6.24 000 

31605 .......... ............ A Incision of windpipe ..................................... 3.58 NA 1.15 0.40 NA 5.13 000 

31610 .......... ............ A Incision of windpipe ..................................... 8.77 NA 8.10 0.79 NA 17.66 090 

31611 .......... ............ A Surgery/speech prosthesis .......................... 5.64 NA 6.98 0.46 NA 13.08 090 

31612 .......... ............ A Puncture/clear windpipe .............................. 0.91 1.10 0.34 0.08 2.09 1.33 000 

31613 .......... ............ A Repair windpipe opening ............................. 4.59 NA 5.91 0.42 NA 10.92 090 

31614 .......... ............ A Repair windpipe opening ............................. 7.12 NA 8.67 0.58 NA 16.38 090 

31615 .......... ............ A Visualization of windpipe ............................. 2.09 2.55 1.17 0.16 4.80 3.43 000 

31620 .......... ............ A Endobronchial us add-on ............................ 1.40 5.59 0.54 0.11 7.10 2.05 ZZZ 

31622 .......... ............ A Dx bronchoscope/wash ............................... 2.79 5.46 1.04 0.18 8.42 4.00 000 

31623 .......... ............ A Dx bronchoscope/brush .............................. 2.89 6.17 1.03 0.13 9.19 4.05 000 

31624 .......... ............ A Dx bronchoscope/lavage ............................. 2.89 5.56 1.03 0.13 8.57 4.05 000 

31625 .......... ............ A Bronchoscopy w/biopsy(s) .......................... 3.37 5.61 1.18 0.18 9.16 4.73 000 

31628 .......... ............ A Bronchoscopy/lung bx, each ....................... 3.81 6.81 1.28 0.18 10.80 5.26 000 

31629 .......... ............ A Bronchoscopy/needle bx, each ................... 4.10 13.48 1.37 0.16 17.74 5.63 000 

31630 .......... ............ A Bronchoscopy dilate/fx repr ......................... 3.82 NA 1.66 0.32 NA 5.80 000 

31631 .......... ............ A Bronchoscopy, dilate w/stent ...................... 4.37 NA 1.72 0.34 NA 6.43 000 

31632 .......... ............ A Bronchoscopy/lung bx, add’l ....................... 1.03 0.80 0.30 0.18 2.01 1.52 ZZZ 

31633 .......... ............ A Bronchoscopy/needle bx add’l .................... 1.32 0.91 0.39 0.16 2.39 1.87 ZZZ 

31635 .......... ............ A Bronchoscopy w/fb removal ........................ 3.68 5.90 1.39 0.24 9.81 5.31 000 

31636 .......... ............ A Bronchoscopy, bronch stents ...................... 4.31 NA 1.72 0.31 NA 6.34 000 

31637 .......... ............ A Bronchoscopy, stent add-on ....................... 1.58 NA 0.55 0.13 NA 2.26 ZZZ 

31638 .......... ............ A Bronchoscopy, revise stent ......................... 4.89 NA 1.92 0.22 NA 7.03 000 

31640 .......... ............ A Bronchoscopy w/tumor excise .................... 4.94 NA 2.01 0.46 NA 7.41 000 

31641 .......... ............ A Bronchoscopy, treat blockage ..................... 5.03 NA 1.83 0.35 NA 7.21 000 

31643 .......... ............ A Diag bronchoscope/catheter ....................... 3.50 NA 1.20 0.20 NA 4.90 000 

31645 .......... ............ A Bronchoscopy, clear airways ...................... 3.17 4.95 1.10 0.16 8.28 4.43 000 

31646 .......... ............ A Bronchoscopy, reclear airway ..................... 2.73 4.68 0.98 0.14 7.54 3.85 000 

31656 .......... ............ A Bronchoscopy, inj for x-ray ......................... 2.17 6.94 0.83 0.15 9.27 3.16 000 

31700 .......... ............ A Insertion of airway catheter ......................... 1.34 2.16 0.67 0.08 3.58 2.10 000 

31708 .......... ............ A Instill airway contrast dye ............................ 1.41 NA 0.48 0.07 NA 1.97 000 

31710 .......... ............ A Insertion of airway catheter ......................... 1.30 NA 0.42 0.12 NA 1.84 000 

31715 .......... ............ A Injection for bronchus x-ray ......................... 1.11 NA 0.34 0.07 NA 1.53 000 

31717 .......... ............ A Bronchial brush biopsy ................................ 2.12 7.76 0.78 0.14 10.02 3.05 000 

31720 .......... ............ A Clearance of airways ................................... 1.06 NA 0.32 0.07 NA 1.46 000 

31725 .......... ............ A Clearance of airways ................................... 1.96 NA 0.57 0.14 NA 2.67 000 

31730 .......... ............ A Intro, windpipe wire/tube ............................. 2.86 7.21 0.97 0.21 10.27 4.03 000 

31750 .......... ............ A Repair of windpipe ...................................... 13.03 NA 17.23 1.05 NA 31.30 090 

31755 .......... ............ A Repair of windpipe ...................................... 15.94 NA 24.11 1.29 NA 41.34 090 

31760 .......... ............ A Repair of windpipe ...................................... 22.36 NA 10.59 2.94 NA 35.89 090 

31766 .......... ............ A Reconstruction of windpipe ......................... 30.44 NA 13.49 4.52 NA 48.45 090 

31770 .......... ............ A Repair/graft of bronchus .............................. 22.52 NA 10.00 2.83 NA 35.35 090 

31775 .......... ............ A Reconstruct bronchus ................................. 23.55 NA 11.47 3.01 NA 38.02 090 

31780 .......... ............ A Reconstruct windpipe .................................. 17.73 NA 10.66 1.65 NA 30.03 090 

31781 .......... ............ A Reconstruct windpipe .................................. 23.54 NA 11.70 2.24 NA 37.48 090 

31785 .......... ............ A Remove windpipe lesion ............................. 17.23 NA 9.85 1.59 NA 28.67 090 

31786 .......... ............ A Remove windpipe lesion ............................. 23.99 NA 12.72 3.29 NA 40.00 090 

31800 .......... ............ A Repair of windpipe injury ............................. 7.43 NA 8.95 0.79 NA 17.17 090 

31805 .......... ............ A Repair of windpipe injury ............................. 13.14 NA 7.04 1.82 NA 22.00 090 

31820 .......... ............ A Closure of windpipe lesion .......................... 4.49 5.62 3.57 0.38 10.49 8.44 090 

31825 .......... ............ A Repair of windpipe defect ........................... 6.81 7.56 5.24 0.53 14.90 12.58 090 

31830 .......... ............ A Revise windpipe scar .................................. 4.50 5.72 3.90 0.44 10.66 8.83 090 

31899 .......... ............ C Airways surgical procedure ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

32000 .......... ............ A Drainage of chest ........................................ 1.54 2.92 0.48 0.08 4.54 2.10 000 

32002 .......... ............ A Treatment of collapsed lung ........................ 2.19 3.14 1.08 0.12 5.45 3.39 000 

32005 .......... ............ A Treat lung lining chemically ......................... 2.19 6.09 0.68 0.23 8.51 3.11 000 

32019 .......... ............ A Insert pleural catheter ................................. 4.18 18.66 1.62 0.42 23.26 6.22 000 

32020 .......... ............ A Insertion of chest tube ................................. 3.98 NA 1.32 0.43 NA 5.73 000 

32035 .......... ............ A Exploration of chest ..................................... 8.68 NA 5.73 1.26 NA 15.67 090 

32036 .......... ............ A Exploration of chest ..................................... 9.69 NA 6.26 1.43 NA 17.38 090 

45908

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

32095 .......... ............ A Biopsy through chest wall ........................... 8.37 NA 5.25 1.22 NA 14.83 090 

32100 .......... ............ A Exploration/biopsy of chest ......................... 15.25 NA 7.65 2.23 NA 25.13 090 

32110 .......... ............ A Explore/repair chest .................................... 23.02 NA 10.50 3.21 NA 36.72 090 

32120 .......... ............ A Re-exploration of chest ............................... 11.54 NA 6.89 1.63 NA 20.06 090 

32124 .......... ............ A Explore chest free adhesions ...................... 12.73 NA 7.08 1.89 NA 21.69 090 

32140 .......... ............ A Removal of lung lesion(s) ........................... 13.94 NA 7.53 1.96 NA 23.43 090 

32141 .......... ............ A Remove/treat lung lesions ........................... 14.01 NA 7.39 2.00 NA 23.40 090 

32150 .......... ............ A Removal of lung lesion(s) ........................... 14.16 NA 7.47 2.00 NA 23.63 090 

32151 .......... ............ A Remove lung foreign body .......................... 14.22 NA 7.93 2.03 NA 24.18 090 

32160 .......... ............ A Open chest heart massage ......................... 9.31 NA 5.19 1.31 NA 15.81 090 

32200 .......... ............ A Drain, open, lung lesion .............................. 15.30 NA 8.72 2.13 NA 26.16 090 

32201 .......... ............ A Drain, percut, lung lesion ............................ 4.00 21.42 1.37 0.24 25.66 5.60 000 

32215 .......... ............ A Treat chest lining ......................................... 11.33 NA 6.72 1.68 NA 19.73 090 

32220 .......... ............ A Release of lung ........................................... 24.01 NA 12.63 3.56 NA 40.20 090 

32225 .......... ............ A Partial release of lung ................................. 13.97 NA 7.49 2.06 NA 23.52 090 

32310 .......... ............ A Removal of chest lining ............................... 13.45 NA 7.24 1.99 NA 22.67 090 

32320 .......... ............ A Free/remove chest lining ............................. 24.01 NA 11.91 3.51 NA 39.42 090 

32400 .......... ............ A Needle biopsy chest lining .......................... 1.76 2.16 0.56 0.10 4.03 2.42 000 

32402 .......... ............ A Open biopsy chest lining ............................. 7.57 NA 4.98 1.07 NA 13.62 090 

32405 .......... ............ A Biopsy, lung or mediastinum ....................... 1.93 0.69 0.66 0.11 2.74 2.71 000 

32420 .......... ............ A Puncture/clear lung ..................................... 2.18 NA 0.69 0.12 NA 2.99 000 

32440 .......... ............ A Removal of lung .......................................... 25.01 NA 12.36 3.68 NA 41.05 090 

32442 .......... ............ A Sleeve pneumonectomy .............................. 26.25 NA 14.11 3.84 NA 44.21 090 

32445 .......... ............ A Removal of lung .......................................... 25.10 NA 13.42 3.71 NA 42.23 090 

32480 .......... ............ A Partial removal of lung ................................ 23.76 NA 11.57 3.49 NA 38.82 090 

32482 .......... ............ A Bilobectomy ................................................. 25.01 NA 12.42 3.66 NA 41.09 090 

32484 .......... ............ A Segmentectomy ........................................... 20.70 NA 10.89 3.03 NA 34.62 090 

32486 .......... ............ A Sleeve lobectomy ........................................ 23.93 NA 12.60 3.51 NA 40.04 090 

32488 .......... ............ A Completion pneumonectomy ....................... 25.72 NA 13.17 3.80 NA 42.69 090 

32491 .......... ............ R Lung volume reduction ................................ 21.26 NA 11.97 2.98 NA 36.21 090 

32500 .......... ............ A Partial removal of lung ................................ 22.01 NA 11.78 3.25 NA 37.04 090 

32501 .......... ............ A Repair bronchus add-on .............................. 4.69 NA 1.51 0.65 NA 6.85 ZZZ 

32520 .......... ............ A Remove lung & revise chest ....................... 21.69 NA 10.81 3.20 NA 35.70 090 

32522 .......... ............ A Remove lung & revise chest ....................... 24.21 NA 11.65 3.32 NA 39.18 090 

32525 .......... ............ A Remove lung & revise chest ....................... 26.51 NA 12.30 3.87 NA 42.68 090 

32540 .......... ............ A Removal of lung lesion ................................ 14.65 NA 9.15 2.07 NA 25.87 090 

32601 .......... ............ A Thoracoscopy, diagnostic ............................ 5.46 NA 2.30 0.80 NA 8.57 000 

32602 .......... ............ A Thoracoscopy, diagnostic ............................ 5.96 NA 2.47 0.87 NA 9.30 000 

32603 .......... ............ A Thoracoscopy, diagnostic ............................ 7.82 NA 2.97 1.14 NA 11.92 000 

32604 .......... ............ A Thoracoscopy, diagnostic ............................ 8.79 NA 3.39 1.25 NA 13.43 000 

32605 .......... ............ A Thoracoscopy, diagnostic ............................ 6.93 NA 2.84 1.00 NA 10.78 000 

32606 .......... ............ A Thoracoscopy, diagnostic ............................ 8.41 NA 3.27 1.22 NA 12.89 000 

32650 .......... ............ A Thoracoscopy, surgical ............................... 10.75 NA 6.45 1.58 NA 18.78 090 

32651 .......... ............ A Thoracoscopy, surgical ............................... 12.92 NA 6.95 1.86 NA 21.73 090 

32652 .......... ............ A Thoracoscopy, surgical ............................... 18.67 NA 9.69 2.72 NA 31.08 090 

32653 .......... ............ A Thoracoscopy, surgical ............................... 12.88 NA 6.67 1.88 NA 21.42 090 

32654 .......... ............ A Thoracoscopy, surgical ............................... 12.44 NA 7.15 1.63 NA 21.22 090 

32655 .......... ............ A Thoracoscopy, surgical ............................... 13.11 NA 6.96 1.89 NA 21.96 090 

32656 .......... ............ A Thoracoscopy, surgical ............................... 12.92 NA 7.54 1.89 NA 22.34 090 

32657 .......... ............ A Thoracoscopy, surgical ............................... 13.66 NA 7.35 1.99 NA 22.99 090 

32658 .......... ............ A Thoracoscopy, surgical ............................... 11.63 NA 6.95 1.69 NA 20.27 090 

32659 .......... ............ A Thoracoscopy, surgical ............................... 11.59 NA 7.08 1.62 NA 20.29 090 

32660 .......... ............ A Thoracoscopy, surgical ............................... 17.43 NA 8.99 2.08 NA 28.50 090 

32661 .......... ............ A Thoracoscopy, surgical ............................... 13.26 NA 7.43 1.92 NA 22.61 090 

32662 .......... ............ A Thoracoscopy, surgical ............................... 16.45 NA 8.45 2.17 NA 27.07 090 

32663 .......... ............ A Thoracoscopy, surgical ............................... 18.48 NA 10.24 2.72 NA 31.44 090 

32664 .......... ............ A Thoracoscopy, surgical ............................... 14.21 NA 7.35 2.32 NA 23.88 090 

32665 .......... ............ A Thoracoscopy, surgical ............................... 15.55 NA 7.88 2.15 NA 25.58 090 

32800 .......... ............ A Repair lung hernia ....................................... 13.70 NA 7.28 1.98 NA 22.96 090 

32810 .......... ............ A Close chest after drainage .......................... 13.06 NA 7.37 1.93 NA 22.36 090 

32815 .......... ............ A Close bronchial fistula ................................. 23.17 NA 10.69 3.27 NA 37.12 090 

32820 .......... ............ A Reconstruct injured chest ............................ 21.49 NA 11.99 2.52 NA 36.00 090 

32851 .......... ............ A Lung transplant, single ................................ 38.65 NA 25.98 5.56 NA 70.19 090 

32852 .......... ............ A Lung transplant with bypass ....................... 41.82 NA 30.94 6.00 NA 78.76 090 

32853 .......... ............ A Lung transplant, double ............................... 47.84 NA 29.88 7.05 NA 84.77 090 

32854 .......... ............ A Lung transplant with bypass ....................... 51.00 NA 32.72 7.20 NA 90.92 090 

32855 .......... ............ C Prepare donor lung, single .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

32856 .......... ............ C Prepare donor lung, double ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

32900 .......... ............ A Removal of rib(s) ......................................... 20.28 NA 9.73 2.93 NA 32.94 090 

32905 .......... ............ A Revise & repair chest wall .......................... 20.76 NA 9.90 3.15 NA 33.81 090 

32906 .......... ............ A Revise & repair chest wall .......................... 26.78 NA 11.79 3.97 NA 42.54 090 

32940 .......... ............ A Revision of lung ........................................... 19.44 NA 9.22 2.88 NA 31.54 090 

32960 .......... ............ A Therapeutic pneumothorax ......................... 1.84 1.72 0.55 0.16 3.72 2.55 000 

32997 .......... ............ A Total lung lavage ......................................... 6.00 NA 1.86 0.55 NA 8.41 000 

45909

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

32999 .......... ............ C Chest surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

33010 .......... ............ A Drainage of heart sac .................................. 2.24 NA 0.80 0.14 NA 3.19 000 

33011 .......... ............ A Repeat drainage of heart sac ..................... 2.24 NA 0.84 0.15 NA 3.23 000 

33015 .......... ............ A Incision of heart sac .................................... 6.80 NA 4.87 0.65 NA 12.33 090 

33020 .......... ............ A Incision of heart sac .................................... 12.62 NA 6.63 1.79 NA 21.03 090 

33025 .......... ............ A Incision of heart sac .................................... 12.09 NA 6.19 1.80 NA 20.09 090 

33030 .......... ............ A Partial removal of heart sac ........................ 18.72 NA 9.25 2.83 NA 30.80 090 

33031 .......... ............ A Partial removal of heart sac ........................ 21.80 NA 9.77 3.13 NA 34.71 090 

33050 .......... ............ A Removal of heart sac lesion ....................... 14.37 NA 7.68 2.14 NA 24.18 090 

33120 .......... ............ A Removal of heart lesion .............................. 24.57 NA 11.29 3.69 NA 39.54 090 

33130 .......... ............ A Removal of heart lesion .............................. 21.40 NA 9.93 3.00 NA 34.34 090 

33140 .......... ............ A Heart revascularize (tmr) ............................. 20.01 NA 10.59 2.85 NA 33.45 090 

33141 .......... ............ A Heart tmr w/other procedure ....................... 4.84 NA 1.55 0.69 NA 7.08 ZZZ 

33200 .......... ............ A Insertion of heart pacemaker ...................... 12.48 NA 6.92 1.70 NA 21.11 090 

33201 .......... ............ A Insertion of heart pacemaker ...................... 10.18 NA 6.49 1.36 NA 18.03 090 

33206 .......... ............ A Insertion of heart pacemaker ...................... 6.67 NA 4.59 0.52 NA 11.79 090 

33207 .......... ............ A Insertion of heart pacemaker ...................... 8.05 NA 4.83 0.59 NA 13.46 090 

33208 .......... ............ A Insertion of heart pacemaker ...................... 8.14 NA 4.98 0.56 NA 13.67 090 

33210 .......... ............ A Insertion of heart electrode ......................... 3.31 NA 1.30 0.18 NA 4.78 000 

33211 .......... ............ A Insertion of heart electrode ......................... 3.40 NA 1.37 0.21 NA 4.97 000 

33212 .......... ............ A Insertion of pulse generator ........................ 5.52 NA 3.44 0.43 NA 9.39 090 

33213 .......... ............ A Insertion of pulse generator ........................ 6.37 NA 3.86 0.45 NA 10.68 090 

33214 .......... ............ A Upgrade of pacemaker system ................... 7.76 NA 5.09 0.58 NA 13.43 090 

33215 .......... ............ A Reposition pacing-defib lead ....................... 4.76 NA 3.38 0.37 NA 8.51 090 

33216 .......... ............ A Insert lead pace-defib, one ......................... 5.78 NA 4.39 0.36 NA 10.54 090 

33217 .......... ............ A Insert lead pace-defib, dual ......................... 5.75 NA 4.45 0.39 NA 10.59 090 

33218 .......... ............ A Repair lead pace-defib, one ........................ 5.44 NA 4.46 0.37 NA 10.27 090 

33220 .......... ............ A Repair lead pace-defib, dual ....................... 5.52 NA 4.46 0.37 NA 10.35 090 

33222 .......... ............ A Revise pocket, pacemaker .......................... 4.96 NA 4.42 0.42 NA 9.80 090 

33223 .......... ............ A Revise pocket, pacing-defib ........................ 6.46 NA 4.77 0.45 NA 11.68 090 

33224 .......... ............ A Insert pacing lead & connect ...................... 9.06 NA 4.21 0.54 NA 13.80 000 

33225 .......... ............ A L ventric pacing lead add-on ....................... 8.35 NA 3.40 0.45 NA 12.20 ZZZ 

33226 .......... ............ A Reposition l ventric lead .............................. 8.70 NA 3.97 0.59 NA 13.25 000 

33233 .......... ............ A Removal of pacemaker system ................... 3.30 NA 3.42 0.22 NA 6.94 090 

33234 .......... ............ A Removal of pacemaker system ................... 7.83 NA 5.06 0.56 NA 13.45 090 

33235 .......... ............ A Removal pacemaker electrode ................... 9.41 NA 7.06 0.73 NA 17.20 090 

33236 .......... ............ A Remove electrode/thoracotomy .................. 12.61 NA 7.35 1.68 NA 21.64 090 

33237 .......... ............ A Remove electrode/thoracotomy .................. 13.72 NA 7.78 1.59 NA 23.08 090 

33238 .......... ............ A Remove electrode/thoracotomy .................. 15.23 NA 8.15 2.02 NA 25.40 090 

33240 .......... ............ A Insert pulse generator ................................. 7.61 NA 4.72 0.41 NA 12.74 090 

33241 .......... ............ A Remove pulse generator ............................. 3.25 NA 3.09 0.18 NA 6.52 090 

33243 .......... ............ A Remove eltrd/thoracotomy .......................... 22.66 NA 11.36 2.09 NA 36.11 090 

33244 .......... ............ A Remove eltrd, transven ............................... 13.77 NA 9.12 0.99 NA 23.88 090 

33245 .......... ............ A Insert epic eltrd pace-defib .......................... 14.31 NA 8.05 2.01 NA 24.37 090 

33246 .......... ............ A Insert epic eltrd/generator ........................... 20.72 NA 10.36 2.63 NA 33.71 090 

33249 .......... ............ A Eltrd/insert pace-defib ................................. 14.24 NA 8.82 0.77 NA 23.83 090 

33250 .......... ............ A Ablate heart dysrhythm focus ..................... 21.86 NA 11.92 3.18 NA 36.96 090 

33251 .......... ............ A Ablate heart dysrhythm focus ..................... 24.89 NA 11.44 3.59 NA 39.92 090 

33253 .......... ............ A Reconstruct atria ......................................... 31.07 NA 13.48 4.52 NA 49.08 090 

33261 .......... ............ A Ablate heart dysrhythm focus ..................... 24.89 NA 11.47 3.45 NA 39.81 090 

33282 .......... ............ A Implant pat-active ht record ........................ 4.17 NA 4.20 0.23 NA 8.60 090 

33284 .......... ............ A Remove pat-active ht record ....................... 2.51 NA 3.56 0.14 NA 6.20 090 

33300 .......... ............ A Repair of heart wound ................................. 17.93 NA 9.18 2.65 NA 29.76 090 

33305 .......... ............ A Repair of heart wound ................................. 21.45 NA 10.32 3.12 NA 34.90 090 

33310 .......... ............ A Exploratory heart surgery ............................ 18.52 NA 9.32 2.58 NA 30.42 090 

33315 .......... ............ A Exploratory heart surgery ............................ 22.38 NA 10.57 3.27 NA 36.22 090 

33320 .......... ............ A Repair major blood vessel(s) ...................... 16.79 NA 8.23 2.07 NA 27.09 090 

33321 .......... ............ A Repair major vessel .................................... 20.21 NA 9.56 2.90 NA 32.67 090 

33322 .......... ............ A Repair major blood vessel(s) ...................... 20.63 NA 10.16 2.85 NA 33.64 090 

33330 .......... ............ A Insert major vessel graft .............................. 21.44 NA 10.06 2.81 NA 34.31 090 

33332 .......... ............ A Insert major vessel graft .............................. 23.97 NA 10.31 3.02 NA 37.30 090 

33335 .......... ............ A Insert major vessel graft .............................. 30.02 NA 12.98 4.27 NA 47.27 090 

33400 .......... ............ A Repair of aortic valve .................................. 28.52 NA 14.97 4.10 NA 47.59 090 

33401 .......... ............ A Valvuloplasty, open ..................................... 23.92 NA 13.45 3.56 NA 40.93 090 

33403 .......... ............ A Valvuloplasty, w/cp bypass ......................... 24.90 NA 13.75 3.54 NA 42.19 090 

33404 .......... ............ A Prepare heart-aorta conduit ........................ 28.56 NA 13.97 4.32 NA 46.84 090 

33405 .......... ............ A Replacement of aortic valve ........................ 35.02 NA 17.44 5.31 NA 57.77 090 

33406 .......... ............ A Replacement of aortic valve ........................ 37.51 NA 18.22 5.43 NA 61.16 090 

33410 .......... ............ A Replacement of aortic valve ........................ 32.47 NA 15.85 4.68 NA 53.00 090 

33411 .......... ............ A Replacement of aortic valve ........................ 36.27 NA 17.89 5.46 NA 59.63 090 

33412 .......... ............ A Replacement of aortic valve ........................ 42.02 NA 19.54 6.37 NA 67.93 090 

33413 .......... ............ A Replacement of aortic valve ........................ 43.52 NA 19.98 6.51 NA 70.00 090 

33414 .......... ............ A Repair of aortic valve .................................. 30.36 NA 13.80 4.56 NA 48.72 090 

33415 .......... ............ A Revision, subvalvular tissue ........................ 27.16 NA 11.72 4.13 NA 43.02 090 

45910

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

33416 .......... ............ A Revise ventricle muscle .............................. 30.36 NA 13.13 4.56 NA 48.05 090 

33417 .......... ............ A Repair of aortic valve .................................. 28.55 NA 13.26 4.09 NA 45.90 090 

33420 .......... ............ A Revision of mitral valve ............................... 22.72 NA 9.43 1.81 NA 33.95 090 

33422 .......... ............ A Revision of mitral valve ............................... 25.95 NA 12.99 3.93 NA 42.87 090 

33425 .......... ............ A Repair of mitral valve .................................. 27.01 NA 12.48 4.06 NA 43.56 090 

33426 .......... ............ A Repair of mitral valve .................................. 33.02 NA 16.35 5.01 NA 54.37 090 

33427 .......... ............ A Repair of mitral valve .................................. 40.02 NA 18.50 6.07 NA 64.59 090 

33430 .......... ............ A Replacement of mitral valve ........................ 33.52 NA 16.51 5.08 NA 55.10 090 

33460 .......... ............ A Revision of tricuspid valve .......................... 23.61 NA 10.97 3.44 NA 38.02 090 

33463 .......... ............ A Valvuloplasty, tricuspid ................................ 25.63 NA 12.58 3.86 NA 42.07 090 

33464 .......... ............ A Valvuloplasty, tricuspid ................................ 27.34 NA 13.16 4.14 NA 44.65 090 

33465 .......... ............ A Replace tricuspid valve ............................... 28.81 NA 12.64 4.38 NA 45.82 090 

33468 .......... ............ A Revision of tricuspid valve .......................... 30.13 NA 13.24 4.06 NA 47.43 090 

33470 .......... ............ A Revision of pulmonary valve ....................... 20.82 NA 10.71 1.03 NA 32.56 090 

33471 .......... ............ A Valvotomy, pulmonary valve ....................... 22.26 NA 9.77 3.38 NA 35.41 090 

33472 .......... ............ A Revision of pulmonary valve ....................... 22.26 NA 11.93 3.54 NA 37.73 090 

33474 .......... ............ A Revision of pulmonary valve ....................... 23.06 NA 10.74 3.21 NA 37.00 090 

33475 .......... ............ A Replacement, pulmonary valve ................... 33.02 NA 15.10 4.92 NA 53.04 090 

33476 .......... ............ A Revision of heart chamber .......................... 25.78 NA 12.17 2.41 NA 40.36 090 

33478 .......... ............ A Revision of heart chamber .......................... 26.75 NA 12.66 3.88 NA 43.29 090 

33496 .......... ............ A Repair, prosth valve clot ............................. 27.26 NA 12.45 4.12 NA 43.83 090 

33500 .......... ............ A Repair heart vessel fistula ........................... 25.56 NA 11.23 3.86 NA 40.65 090 

33501 .......... ............ A Repair heart vessel fistula ........................... 17.79 NA 8.19 1.90 NA 27.87 090 

33502 .......... ............ A Coronary artery correction .......................... 21.05 NA 10.82 2.99 NA 34.86 090 

33503 .......... ............ A Coronary artery graft ................................... 21.79 NA 9.79 1.77 NA 33.36 090 

33504 .......... ............ A Coronary artery graft ................................... 24.67 NA 11.64 3.35 NA 39.66 090 

33505 .......... ............ A Repair artery w/tunnel ................................. 26.85 NA 12.68 2.18 NA 41.72 090 

33506 .......... ............ A Repair artery, translocation ......................... 35.52 NA 14.19 4.65 NA 54.36 090 

33508 .......... ............ A Endoscopic vein harvest ............................. 0.31 NA 0.10 0.04 NA 0.45 ZZZ 

33510 .......... ............ A CABG, vein, single ...................................... 29.02 NA 15.53 4.40 NA 48.95 090 

33511 .......... ............ A CABG, vein, two .......................................... 30.02 NA 16.23 4.55 NA 50.80 090 

33512 .......... ............ A CABG, vein, three ....................................... 31.81 NA 16.76 4.66 NA 53.24 090 

33513 .......... ............ A CABG, vein, four ......................................... 32.01 NA 16.93 4.87 NA 53.81 090 

33514 .......... ............ A CABG, vein, five .......................................... 32.77 NA 17.19 4.76 NA 54.72 090 

33516 .......... ............ A Cabg, vein, six or more ............................... 35.02 NA 17.95 5.11 NA 58.08 090 

33517 .......... ............ A CABG, artery-vein, single ............................ 2.58 NA 0.82 0.39 NA 3.79 ZZZ 

33518 .......... ............ A CABG, artery-vein, two ............................... 4.85 NA 1.55 0.73 NA 7.13 ZZZ 

33519 .......... ............ A CABG, artery-vein, three ............................. 7.12 NA 2.28 1.04 NA 10.44 ZZZ 

33521 .......... ............ A CABG, artery-vein, four ............................... 9.41 NA 3.01 1.37 NA 13.79 ZZZ 

33522 .......... ............ A CABG, artery-vein, five ............................... 11.67 NA 3.74 1.77 NA 17.18 ZZZ 

33523 .......... ............ A Cabg, art-vein, six or more ......................... 13.96 NA 4.44 2.12 NA 20.52 ZZZ 

33530 .......... ............ A Coronary artery, bypass/reop ...................... 5.86 NA 1.87 0.88 NA 8.61 ZZZ 

33533 .......... ............ A CABG, arterial, single .................................. 30.02 NA 15.67 4.55 NA 50.24 090 

33534 .......... ............ A CABG, arterial, two ..................................... 32.21 NA 16.85 4.69 NA 53.75 090 

33535 .......... ............ A CABG, arterial, three ................................... 34.52 NA 17.30 5.01 NA 56.83 090 

33536 .......... ............ A Cabg, arterial, four or more ......................... 37.51 NA 17.58 5.42 NA 60.52 090 

33542 .......... ............ A Removal of heart lesion .............................. 28.87 NA 12.67 4.37 NA 45.91 090 

33545 .......... ............ A Repair of heart damage .............................. 36.79 NA 15.37 5.19 NA 57.35 090 

33572 .......... ............ A Open coronary endarterectomy .................. 4.45 NA 1.42 0.65 NA 6.52 ZZZ 

33600 .......... ............ A Closure of valve .......................................... 29.53 NA 12.38 4.41 NA 46.32 090 

33602 .......... ............ A Closure of valve .......................................... 28.56 NA 12.52 3.81 NA 44.88 090 

33606 .......... ............ A Anastomosis/artery-aorta ............................ 30.75 NA 13.32 4.40 NA 48.47 090 

33608 .......... ............ A Repair anomaly w/conduit ........................... 31.10 NA 13.68 4.73 NA 49.51 090 

33610 .......... ............ A Repair by enlargement ................................ 30.62 NA 13.44 4.55 NA 48.61 090 

33611 .......... ............ A Repair double ventricle ............................... 34.02 NA 13.78 4.36 NA 52.16 090 

33612 .......... ............ A Repair double ventricle ............................... 35.02 NA 14.82 5.28 NA 55.12 090 

33615 .......... ............ A Repair, modified fontan ............................... 34.02 NA 12.93 4.31 NA 51.26 090 

33617 .......... ............ A Repair single ventricle ................................. 37.01 NA 15.54 5.64 NA 58.19 090 

33619 .......... ............ A Repair single ventricle ................................. 45.02 NA 20.23 6.44 NA 71.69 090 

33641 .......... ............ A Repair heart septum defect ......................... 21.40 NA 9.33 3.22 NA 33.95 090 

33645 .......... ............ A Revision of heart veins ................................ 24.83 NA 11.50 3.78 NA 40.11 090 

33647 .......... ............ A Repair heart septum defects ....................... 28.75 NA 13.50 3.31 NA 45.56 090 

33660 .......... ............ A Repair of heart defects ................................ 30.02 NA 13.24 4.48 NA 47.74 090 

33665 .......... ............ A Repair of heart defects ................................ 28.62 NA 13.32 3.99 NA 45.93 090 

33670 .......... ............ A Repair of heart chambers ........................... 35.02 NA 13.52 4.64 NA 53.18 090 

33681 .......... ............ A Repair heart septum defect ......................... 30.62 NA 14.26 4.44 NA 49.32 090 

33684 .......... ............ A Repair heart septum defect ......................... 29.67 NA 13.27 3.38 NA 46.32 090 

33688 .......... ............ A Repair heart septum defect ......................... 30.63 NA 10.17 4.72 NA 45.52 090 

33690 .......... ............ A Reinforce pulmonary artery ......................... 19.56 NA 9.86 1.96 NA 31.38 090 

33692 .......... ............ A Repair of heart defects ................................ 30.76 NA 13.32 4.57 NA 48.66 090 

33694 .......... ............ A Repair of heart defects ................................ 34.02 NA 13.87 5.26 NA 53.15 090 

33697 .......... ............ A Repair of heart defects ................................ 36.02 NA 14.41 4.08 NA 54.51 090 

33702 .......... ............ A Repair of heart defects ................................ 26.55 NA 12.26 3.67 NA 42.48 090 

33710 .......... ............ A Repair of heart defects ................................ 29.73 NA 13.76 4.42 NA 47.91 090 

45911

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

33720 .......... ............ A Repair of heart defect ................................. 26.57 NA 11.98 3.83 NA 42.38 090 

33722 .......... ............ A Repair of heart defect ................................. 28.43 NA 13.09 1.30 NA 42.82 090 

33730 .......... ............ A Repair heart-vein defect(s) .......................... 34.27 NA 14.33 5.01 NA 53.61 090 

33732 .......... ............ A Repair heart-vein defect .............................. 28.18 NA 13.51 3.67 NA 45.36 090 

33735 .......... ............ A Revision of heart chamber .......................... 21.40 NA 9.04 1.91 NA 32.35 090 

33736 .......... ............ A Revision of heart chamber .......................... 23.53 NA 11.97 3.08 NA 38.57 090 

33737 .......... ............ A Revision of heart chamber .......................... 21.77 NA 11.26 3.24 NA 36.27 090 

33750 .......... ............ A Major vessel shunt ...................................... 21.42 NA 10.37 1.16 NA 32.95 090 

33755 .......... ............ A Major vessel shunt ...................................... 21.80 NA 8.58 3.25 NA 33.64 090 

33762 .......... ............ A Major vessel shunt ...................................... 21.80 NA 10.24 3.13 NA 35.18 090 

33764 .......... ............ A Major vessel shunt & graft .......................... 21.80 NA 10.24 3.00 NA 35.04 090 

33766 .......... ............ A Major vessel shunt ...................................... 22.78 NA 11.07 3.69 NA 37.53 090 

33767 .......... ............ A Major vessel shunt ...................................... 24.51 NA 11.37 3.81 NA 39.69 090 

33770 .......... ............ A Repair great vessels defect ........................ 37.01 NA 14.36 5.72 NA 57.09 090 

33771 .......... ............ A Repair great vessels defect ........................ 34.67 NA 12.11 5.66 NA 52.44 090 

33774 .......... ............ A Repair great vessels defect ........................ 30.99 NA 14.46 4.80 NA 50.25 090 

33775 .......... ............ A Repair great vessels defect ........................ 32.21 NA 14.39 4.98 NA 51.58 090 

33776 .......... ............ A Repair great vessels defect ........................ 34.06 NA 15.27 5.07 NA 54.40 090 

33777 .......... ............ A Repair great vessels defect ........................ 33.48 NA 14.86 5.47 NA 53.81 090 

33778 .......... ............ A Repair great vessels defect ........................ 40.02 NA 16.36 6.18 NA 62.56 090 

33779 .......... ............ A Repair great vessels defect ........................ 36.23 NA 15.87 2.91 NA 55.01 090 

33780 .......... ............ A Repair great vessels defect ........................ 41.77 NA 18.55 3.67 NA 64.00 090 

33781 .......... ............ A Repair great vessels defect ........................ 36.47 NA 13.19 5.95 NA 55.61 090 

33786 .......... ............ A Repair arterial trunk ..................................... 39.02 NA 15.99 5.69 NA 60.69 090 

33788 .......... ............ A Revision of pulmonary artery ...................... 26.63 NA 11.48 4.02 NA 42.13 090 

33800 .......... ............ A Aortic suspension ........................................ 16.25 NA 7.95 2.45 NA 26.65 090 

33802 .......... ............ A Repair vessel defect .................................... 17.67 NA 9.00 2.26 NA 28.93 090 

33803 .......... ............ A Repair vessel defect .................................... 19.61 NA 9.30 3.19 NA 32.10 090 

33813 .......... ............ A Repair septal defect .................................... 20.66 NA 10.52 3.12 NA 34.30 090 

33814 .......... ............ A Repair septal defect .................................... 25.78 NA 12.31 3.84 NA 41.93 090 

33820 .......... ............ A Revise major vessel .................................... 16.30 NA 8.10 2.34 NA 26.74 090 

33822 .......... ............ A Revise major vessel .................................... 17.32 NA 8.59 2.67 NA 28.59 090 

33824 .......... ............ A Revise major vessel .................................... 19.53 NA 9.68 2.88 NA 32.09 090 

33840 .......... ............ A Remove aorta constriction .......................... 20.64 NA 9.97 2.15 NA 32.76 090 

33845 .......... ............ A Remove aorta constriction .......................... 22.13 NA 10.97 3.21 NA 36.31 090 

33851 .......... ............ A Remove aorta constriction .......................... 21.28 NA 10.39 3.17 NA 34.84 090 

33852 .......... ............ A Repair septal defect .................................... 23.72 NA 11.20 2.15 NA 37.07 090 

33853 .......... ............ A Repair septal defect .................................... 31.73 NA 14.43 4.47 NA 50.63 090 

33860 .......... ............ A Ascending aortic graft ................................. 38.02 NA 16.03 5.74 NA 59.79 090 

33861 .......... ............ A Ascending aortic graft ................................. 42.02 NA 17.31 6.35 NA 65.68 090 

33863 .......... ............ A Ascending aortic graft ................................. 45.02 NA 18.24 6.57 NA 69.83 090 

33870 .......... ............ A Transverse aortic arch graft ........................ 44.02 NA 17.91 6.60 NA 68.53 090 

33875 .......... ............ A Thoracic aortic graft .................................... 33.08 NA 13.78 4.88 NA 51.73 090 

33877 .......... ............ A Thoracoabdominal graft .............................. 42.63 NA 16.01 5.92 NA 64.56 090 

33910 .......... ............ A Remove lung artery emboli ......................... 24.60 NA 11.12 3.69 NA 39.41 090 

33915 .......... ............ A Remove lung artery emboli ......................... 21.03 NA 9.71 1.44 NA 32.18 090 

33916 .......... ............ A Surgery of great vessel ............................... 25.84 NA 11.10 3.66 NA 40.60 090 

33917 .......... ............ A Repair pulmonary artery .............................. 24.51 NA 11.84 3.69 NA 40.04 090 

33918 .......... ............ A Repair pulmonary atresia ............................ 26.46 NA 11.61 4.14 NA 42.21 090 

33919 .......... ............ A Repair pulmonary atresia ............................ 40.02 NA 17.47 5.95 NA 63.44 090 

33920 .......... ............ A Repair pulmonary atresia ............................ 31.96 NA 13.44 4.37 NA 49.77 090 

33922 .......... ............ A Transect pulmonary artery .......................... 23.53 NA 10.87 3.09 NA 37.48 090 

33924 .......... ............ A Remove pulmonary shunt ........................... 5.50 NA 1.79 0.82 NA 8.11 ZZZ 

33933 .......... ............ C Prepare donor heart/lung ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

33935 .......... ............ R Transplantation, heart/lung .......................... 60.99 NA 27.47 9.03 NA 97.50 090 

33944 .......... ............ C Prepare donor heart .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

33945 .......... ............ R Transplantation of heart .............................. 42.12 NA 20.34 6.24 NA 68.70 090 

33960 .......... ............ A External circulation assist ............................ 19.37 NA 4.83 2.66 NA 26.86 000 

33961 .......... ............ A External circulation assist ............................ 10.93 NA 3.52 0.88 NA 15.33 ZZZ 

33967 .......... ............ A Insert ia percut device ................................. 4.85 NA 1.91 0.35 NA 7.11 000 

33968 .......... ............ A Remove aortic assist device ....................... 0.64 NA 0.23 0.07 NA 0.94 000 

33970 .......... ............ A Aortic circulation assist ................................ 6.75 NA 2.27 0.82 NA 9.84 000 

33971 .......... ............ A Aortic circulation assist ................................ 9.70 NA 6.06 1.25 NA 17.01 090 

33973 .......... ............ A Insert balloon device ................................... 9.77 NA 3.29 1.26 NA 14.32 000 

33974 .......... ............ A Remove intra-aortic balloon ........................ 14.42 NA 7.94 1.73 NA 24.09 090 

33975 .......... ............ A Implant ventricular device ........................... 21.01 NA 6.15 3.06 NA 30.22 XXX 

33976 .......... ............ A Implant ventricular device ........................... 23.02 NA 7.41 3.25 NA 33.68 XXX 

33977 .......... ............ A Remove ventricular device .......................... 19.30 NA 10.77 2.80 NA 32.87 090 

33978 .......... ............ A Remove ventricular device .......................... 21.74 NA 11.54 3.30 NA 36.58 090 

33979 .......... ............ A Insert intracorporeal device ......................... 46.02 NA 14.63 6.95 NA 67.60 XXX 

33980 .......... ............ A Remove intracorporeal device .................... 56.28 NA 24.71 8.56 NA 89.55 090 

33999 .......... ............ C Cardiac surgery procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

34001 .......... ............ A Removal of artery clot ................................. 12.92 NA 6.54 1.84 NA 21.29 090 

34051 .......... ............ A Removal of artery clot ................................. 15.22 NA 7.62 2.20 NA 25.04 090 

45912

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

34101 .......... ............ A Removal of artery clot ................................. 10.01 NA 5.21 1.41 NA 16.63 090 

34111 .......... ............ A Removal of arm artery clot .......................... 10.01 NA 5.24 1.40 NA 16.65 090 

34151 .......... ............ A Removal of artery clot ................................. 25.01 NA 10.17 3.55 NA 38.73 090 

34201 .......... ............ A Removal of artery clot ................................. 10.03 NA 5.25 1.45 NA 16.73 090 

34203 .......... ............ A Removal of leg artery clot ........................... 16.51 NA 7.83 2.35 NA 26.70 090 

34401 .......... ............ A Removal of vein clot .................................... 25.01 NA 10.75 3.09 NA 38.85 090 

34421 .......... ............ A Removal of vein clot .................................... 12.00 NA 6.19 1.55 NA 19.75 090 

34451 .......... ............ A Removal of vein clot .................................... 27.01 NA 11.17 3.83 NA 42.02 090 

34471 .......... ............ A Removal of vein clot .................................... 10.18 NA 5.27 1.18 NA 16.63 090 

34490 .......... ............ A Removal of vein clot .................................... 9.87 NA 5.32 1.41 NA 16.60 090 

34501 .......... ............ A Repair valve, femoral vein .......................... 16.01 NA 8.30 2.34 NA 26.66 090 

34502 .......... ............ A Reconstruct vena cava ................................ 26.96 NA 12.14 3.62 NA 42.72 090 

34510 .......... ............ A Transposition of vein valve ......................... 18.96 NA 9.10 2.32 NA 30.37 090 

34520 .......... ............ A Cross-over vein graft ................................... 17.96 NA 8.32 2.28 NA 28.56 090 

34530 .......... ............ A Leg vein fusion ............................................ 16.65 NA 8.38 1.73 NA 26.77 090 

34800 .......... ............ A Endovas aaa repr w/sm tube ...................... 20.76 NA 9.00 2.45 NA 32.21 090 

34802 .......... ............ A Endovas aaa repr w/2-p part ...................... 23.02 NA 9.69 2.32 NA 35.03 090 

34803 .......... ............ A Endovas aaa repr w/3-p part ...................... 24.05 NA 10.04 2.00 NA 36.08 090 

34804 .......... ............ A Endovas aaa repr w/1-p part ...................... 23.02 NA 9.71 2.29 NA 35.02 090 

34805 .......... ............ A Endovas aaa repr w/long tube .................... 21.89 NA 9.29 2.00 NA 33.18 090 

34808 .......... ............ A Endovas iliac a device add-on .................... 4.13 NA 1.36 0.59 NA 6.08 ZZZ 

34812 .......... ............ A Xpose for endoprosth, femorl ...................... 6.75 NA 2.18 1.18 NA 10.12 000 

34813 .......... ............ A Femoral endovas graft add-on .................... 4.80 NA 1.54 0.67 NA 7.01 ZZZ 

34820 .......... ............ A Xpose for endoprosth, iliac ......................... 9.76 NA 3.16 1.50 NA 14.42 000 

34825 .......... ............ A Endovasc extend prosth, init ....................... 12.00 NA 6.06 1.28 NA 19.35 090 

34826 .......... ............ A Endovasc exten prosth, add’l ...................... 4.13 NA 1.36 0.44 NA 5.93 ZZZ 

34830 .......... ............ A Open aortic tube prosth repr ....................... 32.61 NA 13.30 4.54 NA 50.45 090 

34831 .......... ............ A Open aortoiliac prosth repr ......................... 35.36 NA 11.49 4.88 NA 51.73 090 

34832 .......... ............ A Open aortofemor prosth repr ...................... 35.36 NA 14.18 4.84 NA 54.38 090 

34833 .......... ............ A Xpose for endoprosth, iliac ......................... 12.00 NA 4.44 1.69 NA 18.14 000 

34834 .......... ............ A Xpose, endoprosth, brachial ....................... 5.35 NA 2.20 0.76 NA 8.31 000 

34900 .......... ............ A Endovasc iliac repr w/graft .......................... 16.39 NA 7.46 1.99 NA 25.84 090 

35001 .......... ............ A Repair defect of artery ................................ 19.65 NA 9.25 2.80 NA 31.70 090 

35002 .......... ............ A Repair artery rupture, neck ......................... 21.01 NA 9.62 2.99 NA 33.62 090 

35005 .......... ............ A Repair defect of artery ................................ 18.13 NA 8.98 1.76 NA 28.87 090 

35011 .......... ............ A Repair defect of artery ................................ 18.01 NA 7.76 2.54 NA 28.31 090 

35013 .......... ............ A Repair artery rupture, arm ........................... 22.01 NA 9.41 3.09 NA 34.52 090 

35021 .......... ............ A Repair defect of artery ................................ 19.66 NA 9.21 2.86 NA 31.73 090 

35022 .......... ............ A Repair artery rupture, chest ........................ 23.20 NA 9.69 3.16 NA 36.05 090 

35045 .......... ............ A Repair defect of arm artery ......................... 17.58 NA 7.31 2.44 NA 27.33 090 

35081 .......... ............ A Repair defect of artery ................................ 28.03 NA 11.15 4.00 NA 43.18 090 

35082 .......... ............ A Repair artery rupture, aorta ......................... 38.52 NA 14.91 5.42 NA 58.85 090 

35091 .......... ............ A Repair defect of artery ................................ 35.42 NA 13.20 5.12 NA 53.74 090 

35092 .......... ............ A Repair artery rupture, aorta ......................... 45.02 NA 17.18 6.38 NA 68.58 090 

35102 .......... ............ A Repair defect of artery ................................ 30.77 NA 12.04 4.47 NA 47.28 090 

35103 .......... ............ A Repair artery rupture, groin ......................... 40.52 NA 15.45 5.74 NA 61.71 090 

35111 .......... ............ A Repair defect of artery ................................ 25.01 NA 10.22 3.46 NA 38.69 090 

35112 .......... ............ A Repair artery rupture,spleen ....................... 30.02 NA 11.74 4.07 NA 45.83 090 

35121 .......... ............ A Repair defect of artery ................................ 30.02 NA 12.04 4.29 NA 46.35 090 

35122 .......... ............ A Repair artery rupture, belly ......................... 35.02 NA 13.53 4.74 NA 53.29 090 

35131 .......... ............ A Repair defect of artery ................................ 25.01 NA 10.45 3.79 NA 39.25 090 

35132 .......... ............ A Repair artery rupture, groin ......................... 30.02 NA 12.07 4.29 NA 46.38 090 

35141 .......... ............ A Repair defect of artery ................................ 20.01 NA 8.64 2.89 NA 31.54 090 

35142 .......... ............ A Repair artery rupture, thigh ......................... 23.32 NA 10.07 3.35 NA 36.73 090 

35151 .......... ............ A Repair defect of artery ................................ 22.66 NA 9.70 3.23 NA 35.59 090 

35152 .......... ............ A Repair artery rupture, knee ......................... 25.63 NA 11.02 3.60 NA 40.25 090 

35180 .......... ............ A Repair blood vessel lesion .......................... 13.63 NA 6.76 1.00 NA 21.39 090 

35182 .......... ............ A Repair blood vessel lesion .......................... 30.02 NA 12.67 4.35 NA 47.04 090 

35184 .......... ............ A Repair blood vessel lesion .......................... 18.01 NA 8.08 2.52 NA 28.60 090 

35188 .......... ............ A Repair blood vessel lesion .......................... 14.29 NA 7.41 2.15 NA 23.85 090 

35189 .......... ............ A Repair blood vessel lesion .......................... 28.02 NA 11.63 4.00 NA 43.65 090 

35190 .......... ............ A Repair blood vessel lesion .......................... 12.76 NA 6.29 1.79 NA 20.83 090 

35201 .......... ............ A Repair blood vessel lesion .......................... 16.15 NA 7.72 2.33 NA 26.20 090 

35206 .......... ............ A Repair blood vessel lesion .......................... 13.26 NA 6.37 1.86 NA 21.48 090 

35207 .......... ............ A Repair blood vessel lesion .......................... 10.15 NA 7.14 1.48 NA 18.77 090 

35211 .......... ............ A Repair blood vessel lesion .......................... 22.13 NA 10.31 3.19 NA 35.63 090 

35216 .......... ............ A Repair blood vessel lesion .......................... 18.76 NA 8.81 2.64 NA 30.21 090 

35221 .......... ............ A Repair blood vessel lesion .......................... 24.40 NA 9.73 3.36 NA 37.49 090 

35226 .......... ............ A Repair blood vessel lesion .......................... 14.51 NA 7.48 2.01 NA 24.00 090 

35231 .......... ............ A Repair blood vessel lesion .......................... 20.01 NA 9.46 2.88 NA 32.35 090 

35236 .......... ............ A Repair blood vessel lesion .......................... 17.11 NA 7.66 2.42 NA 27.19 090 

35241 .......... ............ A Repair blood vessel lesion .......................... 23.14 NA 10.80 3.52 NA 37.46 090 

35246 .......... ............ A Repair blood vessel lesion .......................... 26.46 NA 11.26 3.85 NA 41.58 090 

35251 .......... ............ A Repair blood vessel lesion .......................... 30.21 NA 11.57 4.12 NA 45.90 090 

45913

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

35256 .......... ............ A Repair blood vessel lesion .......................... 18.37 NA 8.09 2.62 NA 29.08 090 

35261 .......... ............ A Repair blood vessel lesion .......................... 17.81 NA 7.90 2.60 NA 28.31 090 

35266 .......... ............ A Repair blood vessel lesion .......................... 14.92 NA 6.83 2.09 NA 23.84 090 

35271 .......... ............ A Repair blood vessel lesion .......................... 22.13 NA 10.20 3.15 NA 35.48 090 

35276 .......... ............ A Repair blood vessel lesion .......................... 24.26 NA 10.98 3.48 NA 38.72 090 

35281 .......... ............ A Repair blood vessel lesion .......................... 28.02 NA 11.44 3.96 NA 43.42 090 

35286 .......... ............ A Repair blood vessel lesion .......................... 16.17 NA 7.82 2.34 NA 26.34 090 

35301 .......... ............ A Rechanneling of artery ................................ 18.71 NA 8.19 2.67 NA 29.56 090 

35311 .......... ............ A Rechanneling of artery ................................ 27.01 NA 11.26 3.41 NA 41.69 090 

35321 .......... ............ A Rechanneling of artery ................................ 16.01 NA 7.16 2.24 NA 25.41 090 

35331 .......... ............ A Rechanneling of artery ................................ 26.21 NA 10.90 3.82 NA 40.93 090 

35341 .......... ............ A Rechanneling of artery ................................ 25.12 NA 10.55 3.77 NA 39.44 090 

35351 .......... ............ A Rechanneling of artery ................................ 23.02 NA 9.34 3.34 NA 35.69 090 

35355 .......... ............ A Rechanneling of artery ................................ 18.51 NA 7.87 2.66 NA 29.04 090 

35361 .......... ............ A Rechanneling of artery ................................ 28.22 NA 11.40 4.14 NA 43.75 090 

35363 .......... ............ A Rechanneling of artery ................................ 30.21 NA 12.24 4.32 NA 46.77 090 

35371 .......... ............ A Rechanneling of artery ................................ 14.73 NA 6.75 2.13 NA 23.61 090 

35372 .......... ............ A Rechanneling of artery ................................ 18.01 NA 7.81 2.62 NA 28.44 090 

35381 .......... ............ A Rechanneling of artery ................................ 15.82 NA 7.58 2.25 NA 25.65 090 

35390 .......... ............ A Reoperation, carotid add-on ........................ 3.20 NA 1.04 0.46 NA 4.69 ZZZ 

35400 .......... ............ A Angioscopy .................................................. 3.01 NA 1.08 0.43 NA 4.52 ZZZ 

35450 .......... ............ A Repair arterial blockage .............................. 10.07 NA 3.53 1.25 NA 14.85 000 

35452 .......... ............ A Repair arterial blockage .............................. 6.91 NA 2.54 0.94 NA 10.40 000 

35454 .......... ............ A Repair arterial blockage .............................. 6.04 NA 2.26 0.87 NA 9.17 000 

35456 .......... ............ A Repair arterial blockage .............................. 7.35 NA 2.70 1.04 NA 11.10 000 

35458 .......... ............ A Repair arterial blockage .............................. 9.50 NA 3.38 1.26 NA 14.14 000 

35459 .......... ............ A Repair arterial blockage .............................. 8.64 NA 3.10 1.21 NA 12.95 000 

35460 .......... ............ A Repair venous blockage .............................. 6.04 NA 2.22 0.83 NA 9.09 000 

35470 .......... ............ A Repair arterial blockage .............................. 8.64 87.06 3.50 0.69 96.39 12.82 000 

35471 .......... ............ A Repair arterial blockage .............................. 10.07 97.32 4.16 0.67 108.06 14.90 000 

35472 .......... ............ A Repair arterial blockage .............................. 6.91 63.69 2.86 0.58 71.19 10.36 000 

35473 .......... ............ A Repair arterial blockage .............................. 6.04 59.64 2.53 0.51 66.20 9.08 000 

35474 .......... ............ A Repair arterial blockage .............................. 7.36 85.82 3.03 0.57 93.76 10.96 000 

35475 .......... ............ R Repair arterial blockage .............................. 9.50 57.78 3.73 0.62 67.90 13.85 000 

35476 .......... ............ A Repair venous blockage .............................. 6.04 45.66 2.47 0.34 52.04 8.85 000 

35480 .......... ............ A Atherectomy, open ...................................... 11.08 NA 4.00 1.28 NA 16.36 000 

35481 .......... ............ A Atherectomy, open ...................................... 7.62 NA 2.83 1.13 NA 11.58 000 

35482 .......... ............ A Atherectomy, open ...................................... 6.65 NA 2.54 0.89 NA 10.08 000 

35483 .......... ............ A Atherectomy, open ...................................... 8.11 NA 2.98 1.15 NA 12.24 000 

35484 .......... ............ A Atherectomy, open ...................................... 10.44 NA 3.69 1.27 NA 15.40 000 

35485 .......... ............ A Atherectomy, open ...................................... 9.50 NA 3.49 1.35 NA 14.34 000 

35490 .......... ............ A Atherectomy, percutaneous ........................ 11.08 NA 4.92 0.71 NA 16.72 000 

35491 .......... ............ A Atherectomy, percutaneous ........................ 7.62 NA 3.37 0.74 NA 11.72 000 

35492 .......... ............ A Atherectomy, percutaneous ........................ 6.65 NA 3.29 0.43 NA 10.37 000 

35493 .......... ............ A Atherectomy, percutaneous ........................ 8.11 NA 3.99 0.56 NA 12.66 000 

35494 .......... ............ A Atherectomy, percutaneous ........................ 10.44 NA 4.70 0.59 NA 15.73 000 

35495 .......... ............ A Atherectomy, percutaneous ........................ 9.50 NA 4.63 0.69 NA 14.82 000 

35500 .......... ............ A Harvest vein for bypass .............................. 6.45 NA 1.97 0.93 NA 9.35 ZZZ 

35501 .......... ............ A Artery bypass graft ...................................... 19.20 NA 8.16 2.80 NA 30.16 090 

35506 .......... ............ A Artery bypass graft ...................................... 19.68 NA 9.16 2.86 NA 31.70 090 

35507 .......... ............ A Artery bypass graft ...................................... 19.68 NA 9.10 2.84 NA 31.62 090 

35508 .......... ............ A Artery bypass graft ...................................... 18.66 NA 9.26 2.77 NA 30.68 090 

35509 .......... ............ A Artery bypass graft ...................................... 18.08 NA 8.46 2.61 NA 29.14 090 

35510 .......... ............ A Artery bypass graft ...................................... 23.02 NA 10.15 2.11 NA 35.27 090 

35511 .......... ............ A Artery bypass graft ...................................... 21.21 NA 9.12 2.90 NA 33.23 090 

35512 .......... ............ A Artery bypass graft ...................................... 22.51 NA 9.96 2.11 NA 34.58 090 

35515 .......... ............ A Artery bypass graft ...................................... 18.66 NA 9.19 2.77 NA 30.61 090 

35516 .......... ............ A Artery bypass graft ...................................... 16.33 NA 6.58 2.33 NA 25.25 090 

35518 .......... ............ A Artery bypass graft ...................................... 21.21 NA 8.73 3.02 NA 32.97 090 

35521 .......... ............ A Artery bypass graft ...................................... 22.21 NA 9.54 3.12 NA 34.88 090 

35522 .......... ............ A Artery bypass graft ...................................... 21.77 NA 9.61 2.11 NA 33.50 090 

35525 .......... ............ A Artery bypass graft ...................................... 20.64 NA 9.13 2.11 NA 31.88 090 

35526 .......... ............ A Artery bypass graft ...................................... 29.97 NA 12.27 3.62 NA 45.86 090 

35531 .......... ............ A Artery bypass graft ...................................... 36.22 NA 14.08 5.16 NA 55.47 090 

35533 .......... ............ A Artery bypass graft ...................................... 28.02 NA 11.43 3.84 NA 43.28 090 

35536 .......... ............ A Artery bypass graft ...................................... 31.71 NA 12.60 4.61 NA 48.93 090 

35541 .......... ............ A Artery bypass graft ...................................... 25.81 NA 10.90 3.70 NA 40.41 090 

35546 .......... ............ A Artery bypass graft ...................................... 25.55 NA 10.58 3.69 NA 39.82 090 

35548 .......... ............ A Artery bypass graft ...................................... 21.58 NA 9.19 2.97 NA 33.74 090 

35549 .......... ............ A Artery bypass graft ...................................... 23.36 NA 10.07 3.29 NA 36.72 090 

35551 .......... ............ A Artery bypass graft ...................................... 26.68 NA 11.14 3.74 NA 41.57 090 

35556 .......... ............ A Artery bypass graft ...................................... 21.77 NA 9.44 3.09 NA 34.30 090 

35558 .......... ............ A Artery bypass graft ...................................... 21.21 NA 9.28 2.99 NA 33.48 090 

35560 .......... ............ A Artery bypass graft ...................................... 32.01 NA 12.93 4.74 NA 49.68 090 

45914

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

35563 .......... ............ A Artery bypass graft ...................................... 24.21 NA 10.24 3.51 NA 37.95 090 

35565 .......... ............ A Artery bypass graft ...................................... 23.22 NA 9.85 3.29 NA 36.36 090 

35566 .......... ............ A Artery bypass graft ...................................... 26.93 NA 11.05 3.82 NA 41.81 090 

35571 .......... ............ A Artery bypass graft ...................................... 24.07 NA 10.52 3.42 NA 38.01 090 

35572 .......... ............ A Harvest femoropopliteal vein ....................... 6.82 NA 2.20 0.99 NA 10.02 ZZZ 

35583 .......... ............ A Vein bypass graft ........................................ 22.38 NA 9.86 3.16 NA 35.41 090 

35585 .......... ............ A Vein bypass graft ........................................ 28.41 NA 11.88 4.01 NA 44.30 090 

35587 .......... ............ A Vein bypass graft ........................................ 24.76 NA 11.12 3.51 NA 39.39 090 

35600 .......... ............ A Harvest artery for cabg ............................... 4.95 NA 1.59 0.73 NA 7.27 ZZZ 

35601 .......... ............ A Artery bypass graft ...................................... 17.50 NA 8.32 2.49 NA 28.31 090 

35606 .......... ............ A Artery bypass graft ...................................... 18.72 NA 8.71 2.69 NA 30.12 090 

35612 .......... ............ A Artery bypass graft ...................................... 15.77 NA 7.64 2.08 NA 25.49 090 

35616 .......... ............ A Artery bypass graft ...................................... 15.71 NA 7.81 2.19 NA 25.71 090 

35621 .......... ............ A Artery bypass graft ...................................... 20.01 NA 8.42 2.91 NA 31.34 090 

35623 .......... ............ A Bypass graft, not vein ................................. 24.01 NA 10.18 3.45 NA 37.63 090 

35626 .......... ............ A Artery bypass graft ...................................... 27.77 NA 11.71 4.07 NA 43.54 090 

35631 .......... ............ A Artery bypass graft ...................................... 34.02 NA 13.43 4.95 NA 52.40 090 

35636 .......... ............ A Artery bypass graft ...................................... 29.52 NA 12.07 4.09 NA 45.68 090 

35641 .......... ............ A Artery bypass graft ...................................... 24.58 NA 10.71 3.53 NA 38.82 090 

35642 .......... ............ A Artery bypass graft ...................................... 17.99 NA 8.74 2.27 NA 28.99 090 

35645 .......... ............ A Artery bypass graft ...................................... 17.47 NA 8.09 2.49 NA 28.06 090 

35646 .......... ............ A Artery bypass graft ...................................... 31.01 NA 12.72 4.43 NA 48.16 090 

35647 .......... ............ A Artery bypass graft ...................................... 28.02 NA 11.42 3.98 NA 43.42 090 

35650 .......... ............ A Artery bypass graft ...................................... 19.01 NA 8.12 2.71 NA 29.84 090 

35651 .......... ............ A Artery bypass graft ...................................... 25.05 NA 10.43 3.35 NA 38.83 090 

35654 .......... ............ A Artery bypass graft ...................................... 25.01 NA 10.36 3.52 NA 38.89 090 

35656 .......... ............ A Artery bypass graft ...................................... 19.54 NA 8.36 2.79 NA 30.69 090 

35661 .......... ............ A Artery bypass graft ...................................... 19.01 NA 8.66 2.71 NA 30.38 090 

35663 .......... ............ A Artery bypass graft ...................................... 22.01 NA 9.68 3.10 NA 34.80 090 

35665 .......... ............ A Artery bypass graft ...................................... 21.01 NA 9.17 3.00 NA 33.18 090 

35666 .......... ............ A Artery bypass graft ...................................... 22.20 NA 10.32 3.15 NA 35.67 090 

35671 .......... ............ A Artery bypass graft ...................................... 19.34 NA 9.08 2.77 NA 31.19 090 

35681 .......... ............ A Composite bypass graft .............................. 1.60 NA 0.52 0.23 NA 2.35 ZZZ 

35682 .......... ............ A Composite bypass graft .............................. 7.20 NA 2.32 1.03 NA 10.56 ZZZ 

35683 .......... ............ A Composite bypass graft .............................. 8.51 NA 2.75 1.20 NA 12.46 ZZZ 

35685 .......... ............ A Bypass graft patency/patch ......................... 4.05 NA 1.34 0.58 NA 5.96 ZZZ 

35686 .......... ............ A Bypass graft/av fist patency ........................ 3.35 NA 1.12 0.47 NA 4.94 ZZZ 

35691 .......... ............ A Arterial transposition .................................... 18.06 NA 8.16 2.58 NA 28.79 090 

35693 .......... ............ A Arterial transposition .................................... 15.37 NA 7.60 2.21 NA 25.18 090 

35694 .......... ............ A Arterial transposition .................................... 19.17 NA 8.36 2.69 NA 30.22 090 

35695 .......... ............ A Arterial transposition .................................... 19.17 NA 8.30 2.73 NA 30.20 090 

35697 .......... ............ A Reimplant artery each ................................. 3.01 NA 1.00 0.41 NA 4.42 ZZZ 

35700 .......... ............ A Reoperation, bypass graft ........................... 3.09 NA 1.00 0.44 NA 4.52 ZZZ 

35701 .......... ............ A Exploration, carotid artery ........................... 8.51 NA 5.00 1.12 NA 14.63 090 

35721 .......... ............ A Exploration, femoral artery .......................... 7.18 NA 4.28 1.03 NA 12.49 090 

35741 .......... ............ A Exploration popliteal artery .......................... 8.01 NA 4.53 1.12 NA 13.65 090 

35761 .......... ............ A Exploration of artery/vein ............................ 5.37 NA 3.89 0.75 NA 10.01 090 

35800 .......... ............ A Explore neck vessels .................................. 7.02 NA 4.49 0.95 NA 12.47 090 

35820 .......... ............ A Explore chest vessels ................................. 12.89 NA 7.01 1.94 NA 21.84 090 

35840 .......... ............ A Explore abdominal vessels ......................... 9.78 NA 5.16 1.34 NA 16.28 090 

35860 .......... ............ A Explore limb vessels ................................... 5.55 NA 3.90 0.78 NA 10.23 090 

35870 .......... ............ A Repair vessel graft defect ........................... 22.18 NA 9.48 3.00 NA 34.67 090 

35875 .......... ............ A Removal of clot in graft ............................... 10.13 NA 5.10 1.41 NA 16.64 090 

35876 .......... ............ A Removal of clot in graft ............................... 17.00 NA 7.33 2.39 NA 26.72 090 

35879 .......... ............ A Revise graft w/vein ...................................... 16.01 NA 7.48 2.27 NA 25.76 090 

35881 .......... ............ A Revise graft w/vein ...................................... 18.01 NA 8.43 2.55 NA 28.99 090 

35901 .......... ............ A Excision, graft, neck .................................... 8.20 NA 5.13 1.15 NA 14.48 090 

35903 .......... ............ A Excision, graft, extremity ............................. 9.40 NA 5.97 1.30 NA 16.67 090 

35905 .......... ............ A Excision, graft, thorax .................................. 31.26 NA 12.78 4.43 NA 48.47 090 

35907 .......... ............ A Excision, graft, abdomen ............................. 35.02 NA 13.79 4.91 NA 53.71 090 

36000 .......... ............ A Place needle in vein .................................... 0.18 0.56 0.05 0.01 0.75 0.24 XXX 

36002 .......... ............ A Pseudoaneurysm injection trt ...................... 1.96 2.77 1.00 0.17 4.90 3.13 000 

36005 .......... ............ A Injection ext venography ............................. 0.95 8.00 0.33 0.05 9.00 1.33 000 

36010 .......... ............ A Place catheter in vein .................................. 2.43 18.12 0.80 0.20 20.76 3.44 XXX 

36011 .......... ............ A Place catheter in vein .................................. 3.15 27.36 1.09 0.27 30.78 4.51 XXX 

36012 .......... ............ A Place catheter in vein .................................. 3.52 20.90 1.26 0.23 24.64 5.00 XXX 

36013 .......... ............ A Place catheter in artery ............................... 2.53 20.81 0.69 0.25 23.58 3.46 XXX 

36014 .......... ............ A Place catheter in artery ............................... 3.03 20.65 1.09 0.19 23.86 4.31 XXX 

36015 .......... ............ A Place catheter in artery ............................... 3.52 23.90 1.26 0.21 27.63 4.98 XXX 

36100 .......... ............ A Establish access to artery ........................... 3.03 12.20 1.14 0.26 15.49 4.43 XXX 

36120 .......... ............ A Establish access to artery ........................... 2.01 10.97 0.67 0.14 13.13 2.83 XXX 

36140 .......... ............ A Establish access to artery ........................... 2.01 12.60 0.66 0.16 14.77 2.83 XXX 

36145 .......... ............ A Artery to vein shunt ..................................... 2.01 12.69 0.69 0.11 14.81 2.82 XXX 

36160 .......... ............ A Establish access to aorta ............................ 2.53 13.15 0.85 0.26 15.93 3.63 XXX 

45915

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

36200 .......... ............ A Place catheter in aorta ................................ 3.03 16.72 1.06 0.24 19.99 4.33 XXX 

36215 .......... ............ A Place catheter in artery ............................... 4.68 27.47 1.69 0.27 32.42 6.64 XXX 

36216 .......... ............ A Place catheter in artery ............................... 5.28 29.85 1.88 0.31 35.44 7.47 XXX 

36217 .......... ............ A Place catheter in artery ............................... 6.30 55.46 2.28 0.44 62.20 9.02 XXX 

36218 .......... ............ A Place catheter in artery ............................... 1.01 5.04 0.36 0.07 6.12 1.44 ZZZ 

36245 .......... ............ A Place catheter in artery ............................... 4.68 32.95 1.76 0.31 37.94 6.75 XXX 

36246 .......... ............ A Place catheter in artery ............................... 5.28 30.80 1.91 0.38 36.46 7.57 XXX 

36247 .......... ............ A Place catheter in artery ............................... 6.30 50.01 2.25 0.47 56.79 9.02 XXX 

36248 .......... ............ A Place catheter in artery ............................... 1.01 4.05 0.36 0.07 5.13 1.44 ZZZ 

36260 .......... ............ A Insertion of infusion pump ........................... 9.72 NA 4.82 1.29 NA 15.83 090 

36261 .......... ............ A Revision of infusion pump ........................... 5.45 NA 3.59 0.70 NA 9.75 090 

36262 .......... ............ A Removal of infusion pump .......................... 4.02 NA 2.71 0.54 NA 7.27 090 

36299 .......... ............ C Vessel injection procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

36400 .......... ............ A Bl draw < 3 yrs fem/jugular ......................... 0.38 0.29 0.09 0.03 0.70 0.50 XXX 

36405 .......... ............ A Bl draw < 3 yrs scalp vein ........................... 0.31 0.26 0.08 0.03 0.60 0.42 XXX 

36406 .......... ............ A Bl draw < 3 yrs other vein ........................... 0.18 0.28 0.05 0.01 0.47 0.24 XXX 

36410 .......... ............ A Non-routine bl draw > 3 yrs ........................ 0.18 0.30 0.05 0.01 0.49 0.24 XXX 

36416 .......... ............ B Capillary blood draw .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

36420 .......... ............ A Vein access cutdown < 1 yr ........................ 1.01 NA 0.27 0.07 NA 1.35 XXX 

36425 .......... ............ A Vein access cutdown > 1 yr ........................ 0.76 NA 0.22 0.06 NA 1.04 XXX 

36430 .......... ............ A Blood transfusion service ............................ 0.00 0.96 NA 0.06 1.02 NA XXX 

36440 .......... ............ A Bl push transfuse, 2 yr or < ........................ 1.03 NA 0.28 0.10 NA 1.42 XXX 

36450 .......... ............ A Bl exchange/transfuse, nb ........................... 2.23 NA 0.69 0.21 NA 3.14 XXX 

36455 .......... ............ A Bl exchange/transfuse non-nb .................... 2.43 NA 0.98 0.15 NA 3.57 XXX 

36460 .......... ............ A Transfusion service, fetal ............................ 6.59 NA 2.18 0.79 NA 9.57 XXX 

36468 .......... ............ R Injection(s), spider veins ............................. 0.00 0.00 0.00 0.00 0.00 0.00 000 

36469 .......... ............ R Injection(s), spider veins ............................. 0.00 0.00 0.00 0.00 0.00 0.00 000 

36470 .......... ............ A Injection therapy of vein .............................. 1.09 2.62 0.76 0.12 3.83 1.97 010 

36471 .......... ............ A Injection therapy of veins ............................ 1.57 2.99 0.95 0.19 4.75 2.71 010 

36475 .......... ............ A Endovenous rf, 1st vein .............................. 6.73 48.94 2.56 0.37 56.05 9.67 000 

36476 .......... ............ A Endovenous rf, vein add-on ........................ 3.39 7.59 1.16 0.18 11.15 4.72 ZZZ 

36478 .......... ............ A Endovenous laser, 1st vein ......................... 6.73 44.54 2.56 0.37 51.64 9.67 000 

36479 .......... ............ A Endovenous laser vein add-on ................... 3.39 7.69 1.16 0.18 11.26 4.72 ZZZ 

36481 .......... ............ A Insertion of catheter, vein ............................ 6.99 NA 2.68 0.55 NA 10.22 000 

36500 .......... ............ A Insertion of catheter, vein ............................ 3.52 NA 1.39 0.20 NA 5.11 000 

36510 .......... ............ A Insertion of catheter, vein ............................ 1.09 3.44 0.56 0.10 4.63 1.75 000 

36511 .......... ............ A Apheresis wbc ............................................. 1.74 NA 0.71 0.08 NA 2.53 000 

36512 .......... ............ A Apheresis rbc .............................................. 1.74 NA 0.72 0.08 NA 2.54 000 

36513 .......... ............ A Apheresis platelets ...................................... 1.74 NA 0.71 0.17 NA 2.62 000 

36514 .......... ............ A Apheresis plasma ........................................ 1.74 15.88 0.69 0.08 17.70 2.52 000 

36515 .......... ............ A Apheresis, adsorp/reinfuse .......................... 1.74 62.05 0.65 0.08 63.87 2.47 000 

36516 .......... ............ A Apheresis, selective .................................... 1.22 76.84 0.47 0.08 78.15 1.77 000 

36522 .......... ............ A Photopheresis .............................................. 1.67 32.02 1.04 0.13 33.83 2.85 000 

36540 .......... ............ B Collect blood venous device ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

36550 .......... ............ A Declot vascular device ................................ 0.00 0.38 NA 0.37 0.75 NA XXX 

36555 .......... ............ A Insert non-tunnel cv cath ............................. 2.69 5.43 0.79 0.11 8.22 3.58 000 

36556 .......... ............ A Insert non-tunnel cv cath ............................. 2.51 5.21 0.72 0.19 7.91 3.42 000 

36557 .......... ............ A Insert tunneled cv cath ................................ 5.10 20.41 2.67 0.57 26.08 8.34 010 

36558 .......... ............ A Insert tunneled cv cath ................................ 4.80 20.32 2.61 0.57 25.69 7.97 010 

36560 .......... ............ A Insert tunneled cv cath ................................ 6.25 28.86 3.04 0.57 35.68 9.87 010 

36561 .......... ............ A Insert tunneled cv cath ................................ 6.00 28.25 2.93 0.57 34.82 9.50 010 

36563 .......... ............ A Insert tunneled cv cath ................................ 6.20 24.94 2.90 0.84 31.99 9.95 010 

36565 .......... ............ A Insert tunneled cv cath ................................ 6.00 24.32 2.91 0.57 30.89 9.48 010 

36566 .......... ............ A Insert tunneled cv cath ................................ 6.50 24.65 3.04 0.57 31.72 10.12 010 

36568 .......... ............ A Insert picc cath ............................................ 1.92 7.06 0.60 0.11 9.10 2.64 000 

36569 .......... ............ A Insert picc cath ............................................ 1.82 7.26 0.62 0.19 9.27 2.63 000 

36570 .......... ............ A Insert picvad cath ........................................ 5.32 31.95 2.74 0.57 37.84 8.63 010 

36571 .......... ............ A Insert picvad cath ........................................ 5.30 31.47 2.71 0.57 37.34 8.58 010 

36575 .......... ............ A Repair tunneled cv cath .............................. 0.67 4.06 0.27 0.20 4.93 1.14 000 

36576 .......... ............ A Repair tunneled cv cath .............................. 3.20 6.61 1.84 0.19 10.00 5.23 010 

36578 .......... ............ A Replace tunneled cv cath ............................ 3.50 11.13 2.34 0.19 14.82 6.03 010 

36580 .......... ............ A Replace cvad cath ....................................... 1.31 6.63 0.43 0.19 8.13 1.93 000 

36581 .......... ............ A Replace tunneled cv cath ............................ 3.44 19.51 1.98 0.19 23.13 5.61 010 

36582 .......... ............ A Replace tunneled cv cath ............................ 5.20 26.90 2.91 0.19 32.29 8.30 010 

36583 .......... ............ A Replace tunneled cv cath ............................ 5.25 26.86 2.99 0.19 32.30 8.43 010 

36584 .......... ............ A Replace picc cath ........................................ 1.20 6.64 0.61 0.19 8.04 2.00 000 

36585 .......... ............ A Replace picvad cath .................................... 4.80 28.57 2.80 0.19 33.56 7.79 010 

36589 .......... ............ A Removal tunneled cv cath ........................... 2.27 2.16 1.41 0.24 4.68 3.92 010 

36590 .......... ............ A Removal tunneled cv cath ........................... 3.31 3.35 1.72 0.44 7.10 5.46 010 

36595 .......... ............ A Mech remov tunneled cv cath ..................... 3.60 16.43 1.51 0.21 20.23 5.32 000 

36596 .......... ............ A Mech remov tunneled cv cath ..................... 0.75 3.62 0.52 0.05 4.43 1.32 000 

36597 .......... ............ A Reposition venous catheter ......................... 1.21 2.44 0.46 0.07 3.72 1.74 000 

36600 .......... ............ A Withdrawal of arterial blood ........................ 0.32 0.48 0.09 0.02 0.82 0.43 XXX 

36620 .......... ............ A Insertion catheter, artery ............................. 1.15 NA 0.23 0.07 NA 1.45 000 

45916

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

36625 .......... ............ A Insertion catheter, artery ............................. 2.11 NA 0.52 0.26 NA 2.89 000 

36640 .......... ............ A Insertion catheter, artery ............................. 2.10 NA 1.02 0.21 NA 3.34 000 

36660 .......... ............ A Insertion catheter, artery ............................. 1.40 NA 0.43 0.14 NA 1.97 000 

36680 .......... ............ A Insert needle, bone cavity ........................... 1.20 NA 0.49 0.11 NA 1.81 000 

36800 .......... ............ A Insertion of cannula ..................................... 2.43 NA 1.76 0.25 NA 4.44 000 

36810 .......... ............ A Insertion of cannula ..................................... 3.97 NA 1.67 0.45 NA 6.09 000 

36815 .......... ............ A Insertion of cannula ..................................... 2.63 NA 1.14 0.35 NA 4.12 000 

36818 .......... ............ A Av fuse, uppr arm, cephalic ........................ 11.54 NA 6.06 1.89 NA 19.49 090 

36819 .......... ............ A Av fuse, uppr arm, basilic ........................... 14.01 NA 6.20 1.95 NA 22.16 090 

36820 .......... ............ A Av fusion/forearm vein ................................ 14.01 NA 6.21 1.94 NA 22.16 090 

36821 .......... ............ A Av fusion direct any site .............................. 8.94 NA 4.55 1.23 NA 14.71 090 

36822 .......... ............ A Insertion of cannula(s) ................................. 5.42 NA 4.32 0.79 NA 10.53 090 

36823 .......... ............ A Insertion of cannula(s) ................................. 21.01 NA 9.19 2.88 NA 33.09 090 

36825 .......... ............ A Artery-vein autograft .................................... 9.85 NA 4.92 1.35 NA 16.12 090 

36830 .......... ............ A Artery-vein nonautograft .............................. 12.00 NA 5.10 1.66 NA 18.77 090 

36831 .......... ............ A Open thrombect av fistula ........................... 8.01 NA 3.88 1.09 NA 12.98 090 

36832 .......... ............ A Av fistula revision, open .............................. 10.50 NA 4.62 1.44 NA 16.56 090 

36833 .......... ............ A Av fistula revision ........................................ 11.95 NA 5.08 1.65 NA 18.68 090 

36834 .......... ............ A Repair A-V aneurysm .................................. 9.94 NA 4.67 1.37 NA 15.98 090 

36835 .......... ............ A Artery to vein shunt ..................................... 7.15 NA 4.23 0.98 NA 12.37 090 

36838 .......... ............ A Dist revas ligation, hemo ............................. 20.64 NA 9.21 3.01 NA 32.86 090 

36860 .......... ............ A External cannula declotting ......................... 2.01 2.26 0.70 0.11 4.38 2.82 000 

36861 .......... ............ A Cannula declotting ....................................... 2.53 NA 1.54 0.27 NA 4.33 000 

36870 .......... ............ A Percut thrombect av fistula ......................... 5.16 52.60 3.30 0.29 58.05 8.75 090 

37140 .......... ............ A Revision of circulation ................................. 23.61 NA 10.93 2.01 NA 36.54 090 

37145 .......... ............ A Revision of circulation ................................. 24.62 NA 10.73 3.25 NA 38.60 090 

37160 .......... ............ A Revision of circulation ................................. 21.61 NA 9.10 2.81 NA 33.52 090 

37180 .......... ............ A Revision of circulation ................................. 24.62 NA 10.06 3.34 NA 38.02 090 

37181 .......... ............ A Splice spleen/kidney veins .......................... 26.69 NA 10.89 3.40 NA 40.98 090 

37182 .......... ............ A Insert hepatic shunt (tips) ............................ 17.00 NA 6.37 1.00 NA 24.37 000 

37183 .......... ............ A Remove hepatic shunt (tips) ....................... 8.01 NA 3.16 0.47 NA 11.63 000 

37195 .......... ............ C Thrombolytic therapy, stroke ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

37200 .......... ............ A Transcatheter biopsy ................................... 4.56 NA 1.58 0.27 NA 6.41 000 

37201 .......... ............ A Transcatheter therapy infuse ...................... 5.00 NA 2.67 0.33 NA 8.00 000 

37202 .......... ............ A Transcatheter therapy infuse ...................... 5.68 NA 3.25 0.43 NA 9.36 000 

37203 .......... ............ A Transcatheter retrieval ................................ 5.03 33.96 2.14 0.29 39.28 7.46 000 

37204 .......... ............ A Transcatheter occlusion .............................. 18.15 NA 6.22 1.48 NA 25.84 000 

37205 .......... ............ A Transcath iv stent, percut ............................ 8.29 NA 3.95 0.60 NA 12.84 000 

37206 .......... ............ A Transcath iv stent/perc addl ........................ 4.13 NA 1.50 0.31 NA 5.94 ZZZ 

37207 .......... ............ A Transcath iv stent, open .............................. 8.29 NA 3.10 1.17 NA 12.56 000 

37208 .......... ............ A Transcath iv stent/open addl ....................... 4.13 NA 1.36 0.59 NA 6.08 ZZZ 

37209 .......... ............ A Exchange arterial catheter .......................... 2.27 NA 0.78 0.15 NA 3.21 000 

37215 .......... ............ R Transcath stent, cca w/eps ......................... 18.75 NA 9.55 1.09 NA 29.39 090 

37216 .......... ............ R Transcath stent, cca w/o eps ...................... 18.02 NA 9.26 1.04 NA 28.31 090 

37250 .......... ............ A Iv us first vessel add-on .............................. 2.10 NA 0.76 0.21 NA 3.08 ZZZ 

37251 .......... ............ A Iv us each add vessel add-on ..................... 1.60 NA 0.55 0.19 NA 2.35 ZZZ 

37500 .......... ............ A Endoscopy ligate perf veins ........................ 11.00 NA 6.76 1.54 NA 19.30 090 

37501 .......... ............ C Vascular endoscopy procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

37565 .......... ............ A Ligation of neck vein ................................... 10.88 NA 5.51 1.33 NA 17.72 090 

37600 .......... ............ A Ligation of neck artery ................................. 11.25 NA 6.44 1.41 NA 19.11 090 

37605 .......... ............ A Ligation of neck artery ................................. 13.12 NA 6.74 1.98 NA 21.84 090 

37606 .......... ............ A Ligation of neck artery ................................. 6.28 NA 4.46 1.23 NA 11.97 090 

37607 .......... ............ A Ligation of a-v fistula ................................... 6.16 NA 3.48 0.85 NA 10.49 090 

37609 .......... ............ A Temporal artery procedure .......................... 3.01 4.38 1.93 0.36 7.75 5.29 010 

37615 .......... ............ A Ligation of neck artery ................................. 5.73 NA 4.00 0.68 NA 10.41 090 

37616 .......... ............ A Ligation of chest artery ................................ 16.50 NA 7.92 2.32 NA 26.74 090 

37617 .......... ............ A Ligation of abdomen artery ......................... 22.07 NA 9.00 2.97 NA 34.05 090 

37618 .......... ............ A Ligation of extremity artery .......................... 4.84 NA 3.50 0.67 NA 9.01 090 

37620 .......... ............ A Revision of major vein ................................. 10.56 NA 5.83 0.91 NA 17.30 090 

37650 .......... ............ A Revision of major vein ................................. 7.81 NA 4.55 1.01 NA 13.36 090 

37660 .......... ............ A Revision of major vein ................................. 21.01 NA 8.86 2.48 NA 32.35 090 

37700 .......... ............ A Revise leg vein ............................................ 3.73 NA 2.73 0.53 NA 6.99 090 

37720 .......... ............ A Removal of leg vein .................................... 5.66 NA 3.62 0.80 NA 10.08 090 

37730 .......... ............ A Removal of leg veins ................................... 7.33 NA 4.20 1.04 NA 12.57 090 

37735 .......... ............ A Removal of leg veins/lesion ........................ 10.53 NA 5.36 1.48 NA 17.37 090 

37760 .......... ............ A Ligation, leg veins, open ............................. 10.47 NA 5.22 1.44 NA 17.13 090 

37765 .......... ............ A Phleb veins - extrem - to 20 ....................... 7.35 NA 4.46 0.48 NA 12.30 090 

37766 .......... ............ A Phleb veins - extrem 20+ ............................ 9.31 NA 5.18 0.48 NA 14.97 090 

37780 .......... ............ A Revision of leg vein ..................................... 3.84 NA 2.79 0.53 NA 7.15 090 

37785 .......... ............ A Ligate/divide/excise vein ............................. 3.84 5.13 2.67 0.54 9.51 7.05 090 

37788 .......... ............ A Revascularization, penis ............................. 22.02 NA 10.13 2.25 NA 34.40 090 

37790 .......... ............ A Penile venous occlusion .............................. 8.35 NA 4.76 0.59 NA 13.70 090 

37799 .......... ............ C Vascular surgery procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

38100 .......... ............ A Removal of spleen, total ............................. 14.51 NA 6.10 1.91 NA 22.52 090 

45917

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

38101 .......... ............ A Removal of spleen, partial .......................... 15.32 NA 6.48 2.04 NA 23.84 090 

38102 .......... ............ A Removal of spleen, total ............................. 4.80 NA 1.61 0.63 NA 7.04 ZZZ 

38115 .......... ............ A Repair of ruptured spleen ........................... 15.83 NA 6.57 2.08 NA 24.48 090 

38120 .......... ............ A Laparoscopy, splenectomy .......................... 17.00 NA 7.30 2.24 NA 26.55 090 

38129 .......... ............ C Laparoscope proc, spleen ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

38200 .......... ............ A Injection for spleen x-ray ............................. 2.65 NA 0.93 0.14 NA 3.72 000 

38204 .......... ............ B Bl donor search management ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38205 .......... ............ R Harvest allogenic stem cells ....................... 1.50 NA 0.65 0.07 NA 2.22 000 

38206 .......... ............ R Harvest auto stem cells ............................... 1.50 NA 0.65 0.07 NA 2.22 000 

38207 .......... ............ I Cryopreserve stem cells .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38208 .......... ............ I Thaw preserved stem cells ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38209 .......... ............ I Wash harvest stem cells ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38210 .......... ............ I T-cell depletion of harvest ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38211 .......... ............ I Tumor cell deplete of harvst ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38212 .......... ............ I Rbc depletion of harvest ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38213 .......... ............ I Platelet deplete of harvest .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38214 .......... ............ I Volume deplete of harvest .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38215 .......... ............ I Harvest stem cell concentrte ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38220 .......... ............ A Bone marrow aspiration .............................. 1.08 3.52 0.51 0.05 4.66 1.64 XXX 

38221 .......... ............ A Bone marrow biopsy ................................... 1.37 3.73 0.63 0.07 5.17 2.07 XXX 

38230 .......... ............ R Bone marrow collection ............................... 4.54 NA 3.13 0.48 NA 8.15 010 

38240 .......... ............ R Bone marrow/stem transplant ..................... 2.24 NA 1.00 0.11 NA 3.35 XXX 

38241 .......... ............ R Bone marrow/stem transplant ..................... 2.24 NA 1.01 0.11 NA 3.36 XXX 

38242 .......... ............ A Lymphocyte infuse transplant ..................... 1.71 NA 0.76 0.08 NA 2.55 000 

38300 .......... ............ A Drainage, lymph node lesion ...................... 1.99 4.20 2.04 0.25 6.45 4.28 010 

38305 .......... ............ A Drainage, lymph node lesion ...................... 6.00 NA 4.41 0.88 NA 11.29 090 

38308 .......... ............ A Incision of lymph channels .......................... 6.45 NA 3.68 0.85 NA 10.99 090 

38380 .......... ............ A Thoracic duct procedure ............................. 7.46 NA 5.54 0.74 NA 13.75 090 

38381 .......... ............ A Thoracic duct procedure ............................. 12.89 NA 6.70 1.84 NA 21.43 090 

38382 .......... ............ A Thoracic duct procedure ............................. 10.08 NA 5.67 1.37 NA 17.12 090 

38500 .......... ............ A Biopsy/removal, lymph nodes ..................... 3.75 3.64 2.06 0.49 7.88 6.30 010 

38505 .......... ............ A Needle biopsy, lymph nodes ....................... 1.14 2.05 0.80 0.09 3.28 2.03 000 

38510 .......... ............ A Biopsy/removal, lymph nodes ..................... 6.43 5.44 3.41 0.72 12.59 10.56 010 

38520 .......... ............ A Biopsy/removal, lymph nodes ..................... 6.67 NA 3.96 0.84 NA 11.47 090 

38525 .......... ............ A Biopsy/removal, lymph nodes ..................... 6.07 NA 3.27 0.80 NA 10.15 090 

38530 .......... ............ A Biopsy/removal, lymph nodes ..................... 7.99 NA 4.30 1.12 NA 13.40 090 

38542 .......... ............ A Explore deep node(s), neck ........................ 5.91 NA 4.39 0.60 NA 10.90 090 

38550 .......... ............ A Removal, neck/armpit lesion ....................... 6.92 NA 3.86 0.88 NA 11.66 090 

38555 .......... ............ A Removal, neck/armpit lesion ....................... 14.15 NA 8.26 1.75 NA 24.16 090 

38562 .......... ............ A Removal, pelvic lymph nodes ..................... 10.49 NA 5.88 1.20 NA 17.57 090 

38564 .......... ............ A Removal, abdomen lymph nodes ............... 10.83 NA 5.25 1.32 NA 17.40 090 

38570 .......... ............ A Laparoscopy, lymph node biop ................... 9.26 NA 3.99 1.13 NA 14.38 010 

38571 .......... ............ A Laparoscopy, lymphadenectomy ................. 14.69 NA 6.36 1.15 NA 22.20 010 

38572 .......... ............ A Laparoscopy, lymphadenectomy ................. 16.60 NA 7.09 1.90 NA 25.60 010 

38589 .......... ............ C Laparoscope proc, lymphatic ...................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

38700 .......... ............ A Removal of lymph nodes, neck ................... 8.25 NA 6.11 0.72 NA 15.08 090 

38720 .......... ............ A Removal of lymph nodes, neck ................... 13.62 NA 9.11 1.20 NA 23.92 090 

38724 .......... ............ A Removal of lymph nodes, neck ................... 14.55 NA 9.57 1.28 NA 25.40 090 

38740 .......... ............ A Remove armpit lymph nodes ...................... 10.03 NA 4.90 1.32 NA 16.25 090 

38745 .......... ............ A Remove armpit lymph nodes ...................... 13.11 NA 6.02 1.73 NA 20.85 090 

38746 .......... ............ A Remove thoracic lymph nodes .................... 4.89 NA 1.57 0.72 NA 7.18 ZZZ 

38747 .......... ............ A Remove abdominal lymph nodes ................ 4.89 NA 1.63 0.64 NA 7.16 ZZZ 

38760 .......... ............ A Remove groin lymph nodes ........................ 12.96 NA 6.08 1.71 NA 20.75 090 

38765 .......... ............ A Remove groin lymph nodes ........................ 19.99 NA 8.92 2.47 NA 31.38 090 

38770 .......... ............ A Remove pelvis lymph nodes ....................... 13.24 NA 6.35 1.40 NA 20.99 090 

38780 .......... ............ A Remove abdomen lymph nodes ................. 16.60 NA 8.20 1.88 NA 26.69 090 

38790 .......... ............ A Inject for lymphatic x-ray ............................. 1.29 NA 0.78 0.13 NA 2.20 000 

38792 .......... ............ A Identify sentinel node .................................. 0.52 NA 0.46 0.06 NA 1.04 000 

38794 .......... ............ A Access thoracic lymph duct ........................ 4.45 NA 3.68 0.32 NA 8.45 090 

38999 .......... ............ C Blood/lymph system procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

39000 .......... ............ A Exploration of chest ..................................... 6.10 NA 4.54 0.89 NA 11.53 090 

39010 .......... ............ A Exploration of chest ..................................... 11.79 NA 7.16 1.75 NA 20.70 090 

39200 .......... ............ A Removal chest lesion .................................. 13.63 NA 7.22 2.02 NA 22.86 090 

39220 .......... ............ A Removal chest lesion .................................. 17.42 NA 8.95 2.45 NA 28.83 090 

39400 .......... ............ A Visualization of chest .................................. 5.61 NA 4.56 0.82 NA 10.99 010 

39499 .......... ............ C Chest procedure .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

39501 .......... ............ A Repair diaphragm laceration ....................... 13.20 NA 6.33 1.77 NA 21.29 090 

39502 .......... ............ A Repair paraesophageal hernia .................... 16.34 NA 7.04 2.16 NA 25.54 090 

39503 .......... ............ A Repair of diaphragm hernia ........................ 95.05 NA 32.58 10.95 NA 138.58 090 

39520 .......... ............ A Repair of diaphragm hernia ........................ 16.11 NA 7.79 2.23 NA 26.14 090 

39530 .......... ............ A Repair of diaphragm hernia ........................ 15.42 NA 6.96 2.10 NA 24.48 090 

39531 .......... ............ A Repair of diaphragm hernia ........................ 16.43 NA 7.20 2.21 NA 25.84 090 

39540 .......... ............ A Repair of diaphragm hernia ........................ 13.33 NA 6.11 1.79 NA 21.23 090 

39541 .......... ............ A Repair of diaphragm hernia ........................ 14.42 NA 6.45 1.92 NA 22.79 090 

45918

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

39545 .......... ............ A Revision of diaphragm ................................ 13.38 NA 7.43 1.83 NA 22.64 090 

39560 .......... ............ A Resect diaphragm, simple ........................... 12.00 NA 6.12 1.59 NA 19.72 090 

39561 .......... ............ A Resect diaphragm, complex ........................ 17.50 NA 9.27 2.44 NA 29.21 090 

39599 .......... ............ C Diaphragm surgery procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

4000F ......... ............ I Tobacco use txmnt counseling ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

4001F ......... ............ I Tobacco use txmnt, pharmacol ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

4002F ......... ............ I Statin therapy, rx ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

4006F ......... ............ I Beta-blocker therapy, rx .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

4009F ......... ............ I Ace inhibitor therapy, rx .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

4011F ......... ............ I Oral antiplatelet tx, rx .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

40490 .......... ............ A Biopsy of lip ................................................. 1.22 1.72 0.62 0.05 3.00 1.89 000 

40500 .......... ............ A Partial excision of lip ................................... 4.28 7.24 4.29 0.38 11.90 8.95 090 

40510 .......... ............ A Partial excision of lip ................................... 4.70 6.69 3.93 0.49 11.88 9.12 090 

40520 .......... ............ A Partial excision of lip ................................... 4.67 7.48 4.01 0.52 12.67 9.20 090 

40525 .......... ............ A Reconstruct lip with flap .............................. 7.56 NA 6.14 0.85 NA 14.55 090 

40527 .......... ............ A Reconstruct lip with flap .............................. 9.14 NA 7.15 0.97 NA 17.26 090 

40530 .......... ............ A Partial removal of lip ................................... 5.40 7.88 4.49 0.55 13.83 10.44 090 

40650 .......... ............ A Repair lip ..................................................... 3.64 6.63 3.19 0.38 10.65 7.21 090 

40652 .......... ............ A Repair lip ..................................................... 4.26 7.65 4.15 0.52 12.43 8.93 090 

40654 .......... ............ A Repair lip ..................................................... 5.31 8.62 4.82 0.60 14.53 10.73 090 

40700 .......... ............ A Repair cleft lip/nasal .................................... 12.80 NA 8.83 0.95 NA 22.57 090 

40701 .......... ............ A Repair cleft lip/nasal .................................... 15.86 NA 10.99 1.65 NA 28.51 090 

40702 .......... ............ A Repair cleft lip/nasal .................................... 13.05 NA 8.06 1.23 NA 22.34 090 

40720 .......... ............ A Repair cleft lip/nasal .................................... 13.56 NA 9.60 1.79 NA 24.95 090 

40761 .......... ............ A Repair cleft lip/nasal .................................... 14.73 NA 9.96 1.93 NA 26.62 090 

40799 .......... ............ C Lip surgery procedure ................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

40800 .......... ............ A Drainage of mouth lesion ............................ 1.17 3.06 1.77 0.13 4.36 3.07 010 

40801 .......... ............ A Drainage of mouth lesion ............................ 2.54 4.13 2.73 0.31 6.98 5.57 010 

40804 .......... ............ A Removal, foreign body, mouth .................... 1.24 3.40 1.80 0.11 4.75 3.15 010 

40805 .......... ............ A Removal, foreign body, mouth .................... 2.70 4.51 2.77 0.32 7.52 5.79 010 

40806 .......... ............ A Incision of lip fold ........................................ 0.31 1.86 0.50 0.04 2.21 0.85 000 

40808 .......... ............ A Biopsy of mouth lesion ................................ 0.96 2.75 1.48 0.10 3.81 2.54 010 

40810 .......... ............ A Excision of mouth lesion ............................. 1.31 2.97 1.65 0.13 4.41 3.09 010 

40812 .......... ............ A Excise/repair mouth lesion .......................... 2.31 3.83 2.37 0.28 6.42 4.96 010 

40814 .......... ............ A Excise/repair mouth lesion .......................... 3.42 5.05 3.85 0.41 8.88 7.67 090 

40816 .......... ............ A Excision of mouth lesion ............................. 3.67 5.28 3.95 0.40 9.35 8.02 090 

40818 .......... ............ A Excise oral mucosa for graft ....................... 2.41 5.21 3.88 0.21 7.84 6.50 090 

40819 .......... ............ A Excise lip or cheek fold ............................... 2.41 4.19 3.09 0.29 6.90 5.79 090 

40820 .......... ............ A Treatment of mouth lesion .......................... 1.28 4.09 2.45 0.11 5.48 3.84 010 

40830 .......... ............ A Repair mouth laceration .............................. 1.76 3.71 2.00 0.19 5.66 3.96 010 

40831 .......... ............ A Repair mouth laceration .............................. 2.46 4.69 2.96 0.30 7.45 5.73 010 

40840 .......... ............ R Reconstruction of mouth ............................. 8.74 9.82 6.80 1.08 19.64 16.62 090 

40842 .......... ............ R Reconstruction of mouth ............................. 8.74 10.09 6.62 1.08 19.91 16.44 090 

40843 .......... ............ R Reconstruction of mouth ............................. 12.10 12.11 7.61 1.39 25.60 21.11 090 

40844 .......... ............ R Reconstruction of mouth ............................. 16.02 15.74 11.32 1.99 33.76 29.33 090 

40845 .......... ............ R Reconstruction of mouth ............................. 18.59 17.02 12.90 2.00 37.61 33.48 090 

40899 .......... ............ C Mouth surgery procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

41000 .......... ............ A Drainage of mouth lesion ............................ 1.30 2.32 1.40 0.12 3.74 2.82 010 

41005 .......... ............ A Drainage of mouth lesion ............................ 1.26 3.42 1.71 0.12 4.80 3.09 010 

41006 .......... ............ A Drainage of mouth lesion ............................ 3.25 4.87 3.13 0.35 8.47 6.73 090 

41007 .......... ............ A Drainage of mouth lesion ............................ 3.11 5.08 2.98 0.31 8.50 6.40 090 

41008 .......... ............ A Drainage of mouth lesion ............................ 3.37 4.79 3.16 0.42 8.58 6.95 090 

41009 .......... ............ A Drainage of mouth lesion ............................ 3.59 5.09 3.53 0.47 9.15 7.59 090 

41010 .......... ............ A Incision of tongue fold ................................. 1.06 3.43 1.65 0.07 4.56 2.78 010 

41015 .......... ............ A Drainage of mouth lesion ............................ 3.96 5.52 4.14 0.46 9.93 8.56 090 

41016 .......... ............ A Drainage of mouth lesion ............................ 4.07 5.70 4.22 0.53 10.30 8.82 090 

41017 .......... ............ A Drainage of mouth lesion ............................ 4.07 5.72 4.29 0.53 10.32 8.89 090 

41018 .......... ............ A Drainage of mouth lesion ............................ 5.10 6.20 4.53 0.68 11.98 10.31 090 

41100 .......... ............ A Biopsy of tongue ......................................... 1.63 2.45 1.40 0.15 4.24 3.18 010 

41105 .......... ............ A Biopsy of tongue ......................................... 1.42 2.34 1.30 0.13 3.89 2.85 010 

41108 .......... ............ A Biopsy of floor of mouth .............................. 1.05 2.11 1.11 0.10 3.26 2.27 010 

41110 .......... ............ A Excision of tongue lesion ............................ 1.51 3.04 1.63 0.13 4.68 3.27 010 

41112 .......... ............ A Excision of tongue lesion ............................ 2.74 4.56 3.19 0.28 7.57 6.21 090 

41113 .......... ............ A Excision of tongue lesion ............................ 3.20 4.84 3.44 0.34 8.38 6.97 090 

41114 .......... ............ A Excision of tongue lesion ............................ 8.48 NA 7.11 0.83 NA 16.41 090 

41115 .......... ............ A Excision of tongue fold ................................ 1.74 3.40 1.83 0.18 5.33 3.75 010 

41116 .......... ............ A Excision of mouth lesion ............................. 2.44 4.49 2.78 0.23 7.16 5.45 090 

41120 .......... ............ A Partial removal of tongue ............................ 9.78 NA 15.03 0.79 NA 25.60 090 

41130 .......... ............ A Partial removal of tongue ............................ 11.15 NA 15.86 0.93 NA 27.94 090 

41135 .......... ............ A Tongue and neck surgery ........................... 23.11 NA 22.62 1.88 NA 47.60 090 

41140 .......... ............ A Removal of tongue ...................................... 25.51 NA 25.94 2.26 NA 53.71 090 

41145 .......... ............ A Tongue removal, neck surgery ................... 30.07 NA 29.85 2.54 NA 62.46 090 

41150 .......... ............ A Tongue, mouth, jaw surgery ....................... 23.06 NA 24.08 1.94 NA 49.08 090 

41153 .......... ............ A Tongue, mouth, neck surgery ..................... 23.78 NA 24.40 2.00 NA 50.17 090 

45919

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

41155 .......... ............ A Tongue, jaw, & neck surgery ...................... 27.74 NA 26.14 2.33 NA 56.21 090 

41250 .......... ............ A Repair tongue laceration ............................. 1.91 2.94 1.24 0.18 5.03 3.33 010 

41251 .......... ............ A Repair tongue laceration ............................. 2.27 3.33 1.61 0.22 5.83 4.10 010 

41252 .......... ............ A Repair tongue laceration ............................. 2.98 3.98 2.22 0.29 7.25 5.49 010 

41500 .......... ............ A Fixation of tongue ........................................ 3.71 NA 7.33 0.30 NA 11.34 090 

41510 .......... ............ A Tongue to lip surgery .................................. 3.42 NA 7.57 0.20 NA 11.18 090 

41520 .......... ............ A Reconstruction, tongue fold ........................ 2.74 4.77 3.55 0.27 7.78 6.56 090 

41599 .......... ............ C Tongue and mouth surgery ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

41800 .......... ............ A Drainage of gum lesion ............................... 1.17 2.92 1.40 0.12 4.21 2.69 010 

41805 .......... ............ A Removal foreign body, gum ........................ 1.24 3.00 2.30 0.13 4.37 3.68 010 

41806 .......... ............ A Removal foreign body,jawbone ................... 2.70 3.96 3.09 0.37 7.03 6.16 010 

41820 .......... ............ R Excision, gum, each quadrant ..................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

41821 .......... ............ R Excision of gum flap .................................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

41822 .......... ............ R Excision of gum lesion ................................ 2.31 3.99 1.90 0.31 6.62 4.53 010 

41823 .......... ............ R Excision of gum lesion ................................ 3.31 5.68 3.99 0.47 9.46 7.77 090 

41825 .......... ............ A Excision of gum lesion ................................ 1.31 3.12 2.11 0.15 4.59 3.57 010 

41826 .......... ............ A Excision of gum lesion ................................ 2.31 2.95 2.19 0.30 5.56 4.81 010 

41827 .......... ............ A Excision of gum lesion ................................ 3.42 5.67 3.61 0.35 9.44 7.38 090 

41828 .......... ............ R Excision of gum lesion ................................ 3.10 3.86 2.82 0.44 7.40 6.35 010 

41830 .......... ............ R Removal of gum tissue ............................... 3.35 5.14 3.57 0.44 8.93 7.35 010 

41850 .......... ............ R Treatment of gum lesion ............................. 0.00 0.00 0.00 0.00 0.00 0.00 000 

41870 .......... ............ R Gum graft .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

41872 .......... ............ R Repair gum .................................................. 2.60 5.14 3.43 0.30 8.03 6.33 090 

41874 .......... ............ R Repair tooth socket ..................................... 3.10 4.96 3.14 0.45 8.51 6.69 090 

41899 .......... ............ C Dental surgery procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

42000 .......... ............ A Drainage mouth roof lesion ......................... 1.23 2.52 1.25 0.12 3.87 2.60 010 

42100 .......... ............ A Biopsy roof of mouth ................................... 1.31 2.09 1.34 0.13 3.53 2.78 010 

42104 .......... ............ A Excision lesion, mouth roof ......................... 1.64 2.69 1.56 0.16 4.49 3.37 010 

42106 .......... ............ A Excision lesion, mouth roof ......................... 2.10 3.41 2.38 0.25 5.76 4.73 010 

42107 .......... ............ A Excision lesion, mouth roof ......................... 4.44 5.85 3.92 0.44 10.73 8.80 090 

42120 .......... ............ A Remove palate/lesion .................................. 6.17 NA 11.56 0.52 NA 18.25 090 

42140 .......... ............ A Excision of uvula ......................................... 1.62 3.76 2.07 0.13 5.52 3.82 090 

42145 .......... ............ A Repair palate, pharynx/uvula ...................... 8.06 NA 7.39 0.65 NA 16.10 090 

42160 .......... ............ A Treatment mouth roof lesion ....................... 1.80 4.16 2.20 0.17 6.13 4.17 010 

42180 .......... ............ A Repair palate ............................................... 2.51 3.11 2.06 0.21 5.82 4.78 010 

42182 .......... ............ A Repair palate ............................................... 3.83 3.90 2.95 0.40 8.13 7.18 010 

42200 .......... ............ A Reconstruct cleft palate ............................... 12.00 NA 9.92 1.27 NA 23.20 090 

42205 .......... ............ A Reconstruct cleft palate ............................... 13.30 NA 9.82 1.58 NA 24.70 090 

42210 .......... ............ A Reconstruct cleft palate ............................... 14.51 NA 11.21 2.16 NA 27.88 090 

42215 .......... ............ A Reconstruct cleft palate ............................... 8.83 NA 8.74 1.31 NA 18.88 090 

42220 .......... ............ A Reconstruct cleft palate ............................... 7.02 NA 6.92 0.73 NA 14.67 090 

42225 .......... ............ A Reconstruct cleft palate ............................... 9.55 NA 16.15 0.86 NA 26.56 090 

42226 .......... ............ A Lengthening of palate .................................. 10.01 NA 14.14 1.01 NA 25.16 090 

42227 .......... ............ A Lengthening of palate .................................. 9.53 NA 14.78 0.98 NA 25.29 090 

42235 .......... ............ A Repair palate ............................................... 7.88 NA 11.93 0.72 NA 20.52 090 

42260 .......... ............ A Repair nose to lip fistula ............................. 9.81 10.14 6.90 1.26 21.21 17.97 090 

42280 .......... ............ A Preparation, palate mold ............................. 1.54 1.98 1.11 0.19 3.71 2.85 010 

42281 .......... ............ A Insertion, palate prosthesis ......................... 1.93 2.69 1.84 0.17 4.79 3.94 010 

42299 .......... ............ C Palate/uvula surgery .................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

42300 .......... ............ A Drainage of salivary gland .......................... 1.93 2.83 1.80 0.16 4.92 3.89 010 

42305 .......... ............ A Drainage of salivary gland .......................... 6.07 NA 4.62 0.51 NA 11.21 090 

42310 .......... ............ A Drainage of salivary gland .......................... 1.56 2.33 1.52 0.13 4.02 3.21 010 

42320 .......... ............ A Drainage of salivary gland .......................... 2.35 3.31 2.06 0.21 5.88 4.62 010 

42325 .......... ............ A Create salivary cyst drain ............................ 2.76 4.68 2.36 0.27 7.71 5.38 090 

42326 .......... ............ A Create salivary cyst drain ............................ 3.78 6.24 3.09 0.29 10.31 7.16 090 

42330 .......... ............ A Removal of salivary stone ........................... 2.21 3.15 1.81 0.19 5.56 4.21 010 

42335 .......... ............ A Removal of salivary stone ........................... 3.32 4.98 3.10 0.29 8.59 6.71 090 

42340 .......... ............ A Removal of salivary stone ........................... 4.60 6.10 3.86 0.42 11.12 8.88 090 

42400 .......... ............ A Biopsy of salivary gland .............................. 0.78 1.68 0.72 0.06 2.52 1.56 000 

42405 .......... ............ A Biopsy of salivary gland .............................. 3.30 3.98 2.40 0.28 7.56 5.98 010 

42408 .......... ............ A Excision of salivary cyst .............................. 4.54 5.96 3.55 0.45 10.95 8.54 090 

42409 .......... ............ A Drainage of salivary cyst ............................. 2.82 4.58 2.72 0.27 7.67 5.80 090 

42410 .......... ............ A Excise parotid gland/lesion ......................... 9.35 NA 6.08 0.91 NA 16.34 090 

42415 .......... ............ A Excise parotid gland/lesion ......................... 16.89 NA 10.54 1.43 NA 28.87 090 

42420 .......... ............ A Excise parotid gland/lesion ......................... 19.60 NA 11.99 1.65 NA 33.24 090 

42425 .......... ............ A Excise parotid gland/lesion ......................... 13.03 NA 8.37 1.05 NA 22.45 090 

42426 .......... ............ A Excise parotid gland/lesion ......................... 21.27 NA 12.61 1.80 NA 35.68 090 

42440 .......... ............ A Excise submaxillary gland ........................... 6.97 NA 4.67 0.59 NA 12.23 090 

42450 .......... ............ A Excise sublingual gland ............................... 4.62 5.96 4.22 0.42 11.00 9.26 090 

42500 .......... ............ A Repair salivary duct ..................................... 4.30 5.74 4.11 0.41 10.45 8.82 090 

42505 .......... ............ A Repair salivary duct ..................................... 6.18 7.14 5.27 0.55 13.87 12.00 090 

42507 .......... ............ A Parotid duct diversion .................................. 6.11 NA 6.45 0.49 NA 13.05 090 

42508 .......... ............ A Parotid duct diversion .................................. 9.11 NA 8.25 1.04 NA 18.40 090 

42509 .......... ............ A Parotid duct diversion .................................. 11.54 NA 9.97 0.93 NA 22.44 090 

45920

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

42510 .......... ............ A Parotid duct diversion .................................. 8.16 NA 7.61 0.66 NA 16.43 090 

42550 .......... ............ A Injection for salivary x-ray ........................... 1.25 3.10 0.43 0.07 4.43 1.75 000 

42600 .......... ............ A Closure of salivary fistula ............................ 4.82 6.55 4.03 0.43 11.80 9.28 090 

42650 .......... ............ A Dilation of salivary duct ............................... 0.77 1.11 0.71 0.07 1.96 1.55 000 

42660 .......... ............ A Dilation of salivary duct ............................... 1.13 1.37 0.88 0.09 2.60 2.10 000 

42665 .......... ............ A Ligation of salivary duct .............................. 2.54 4.27 2.55 0.23 7.03 5.31 090 

42699 .......... ............ C Salivary surgery procedure ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

42700 .......... ............ A Drainage of tonsil abscess .......................... 1.62 2.65 1.68 0.13 4.40 3.43 010 

42720 .......... ............ A Drainage of throat abscess ......................... 5.42 4.79 3.69 0.44 10.65 9.55 010 

42725 .......... ............ A Drainage of throat abscess ......................... 10.72 NA 8.03 0.91 NA 19.66 090 

42800 .......... ............ A Biopsy of throat ........................................... 1.39 2.19 1.38 0.11 3.69 2.88 010 

42802 .......... ............ A Biopsy of throat ........................................... 1.54 4.59 1.99 0.12 6.26 3.65 010 

42804 .......... ............ A Biopsy of upper nose/throat ........................ 1.24 3.65 1.68 0.10 4.99 3.02 010 

42806 .......... ............ A Biopsy of upper nose/throat ........................ 1.58 3.97 1.87 0.13 5.68 3.58 010 

42808 .......... ............ A Excise pharynx lesion ................................. 2.30 3.08 1.88 0.19 5.58 4.38 010 

42809 .......... ............ A Remove pharynx foreign body .................... 1.81 2.30 1.30 0.16 4.27 3.27 010 

42810 .......... ............ A Excision of neck cyst ................................... 3.26 5.63 3.51 0.29 9.18 7.06 090 

42815 .......... ............ A Excision of neck cyst ................................... 7.07 NA 6.34 0.61 NA 14.02 090 

42820 .......... ............ A Remove tonsils and adenoids ..................... 3.91 NA 3.22 0.31 NA 7.44 090 

42821 .......... ............ A Remove tonsils and adenoids ..................... 4.29 NA 3.43 0.35 NA 8.07 090 

42825 .......... ............ A Removal of tonsils ....................................... 3.42 NA 3.12 0.25 NA 6.78 090 

42826 .......... ............ A Removal of tonsils ....................................... 3.38 NA 2.97 0.27 NA 6.62 090 

42830 .......... ............ A Removal of adenoids .................................. 2.58 NA 2.52 0.20 NA 5.30 090 

42831 .......... ............ A Removal of adenoids .................................. 2.72 NA 2.80 0.22 NA 5.73 090 

42835 .......... ............ A Removal of adenoids .................................. 2.30 NA 2.42 0.21 NA 4.93 090 

42836 .......... ............ A Removal of adenoids .................................. 3.19 NA 2.91 0.26 NA 6.35 090 

42842 .......... ............ A Extensive surgery of throat ......................... 8.77 NA 10.81 0.71 NA 20.29 090 

42844 .......... ............ A Extensive surgery of throat ......................... 14.32 NA 15.91 1.16 NA 31.39 090 

42845 .......... ............ A Extensive surgery of throat ......................... 24.30 NA 22.66 1.98 NA 48.94 090 

42860 .......... ............ A Excision of tonsil tags ................................. 2.22 NA 2.37 0.18 NA 4.78 090 

42870 .......... ............ A Excision of lingual tonsil .............................. 5.40 NA 8.48 0.44 NA 14.32 090 

42890 .......... ............ A Partial removal of pharynx .......................... 12.95 NA 13.90 1.05 NA 27.90 090 

42892 .......... ............ A Revision of pharyngeal walls ...................... 15.84 NA 16.83 1.28 NA 33.95 090 

42894 .......... ............ A Revision of pharyngeal walls ...................... 22.90 NA 21.54 1.86 NA 46.30 090 

42900 .......... ............ A Repair throat wound .................................... 5.25 NA 3.57 0.50 NA 9.32 010 

42950 .......... ............ A Reconstruction of throat .............................. 8.11 NA 11.60 0.72 NA 20.42 090 

42953 .......... ............ A Repair throat, esophagus ............................ 8.97 NA 16.55 0.88 NA 26.40 090 

42955 .......... ............ A Surgical opening of throat ........................... 7.39 NA 10.46 0.80 NA 18.66 090 

42960 .......... ............ A Control throat bleeding ................................ 2.33 NA 1.93 0.19 NA 4.46 010 

42961 .......... ............ A Control throat bleeding ................................ 5.59 NA 4.89 0.45 NA 10.93 090 

42962 .......... ............ A Control throat bleeding ................................ 7.14 NA 5.80 0.58 NA 13.52 090 

42970 .......... ............ A Control nose/throat bleeding ....................... 5.43 NA 4.09 0.39 NA 9.91 090 

42971 .......... ............ A Control nose/throat bleeding ....................... 6.21 NA 5.02 0.51 NA 11.74 090 

42972 .......... ............ A Control nose/throat bleeding ....................... 7.20 NA 5.58 0.62 NA 13.41 090 

42999 .......... ............ C Throat surgery procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43020 .......... ............ A Incision of esophagus ................................. 8.10 NA 5.31 0.87 NA 14.27 090 

43030 .......... ............ A Throat muscle surgery ................................ 7.70 NA 5.34 0.70 NA 13.74 090 

43045 .......... ............ A Incision of esophagus ................................. 20.13 NA 10.51 2.58 NA 33.22 090 

43100 .......... ............ A Excision of esophagus lesion ...................... 9.20 NA 6.06 0.93 NA 16.19 090 

43101 .......... ............ A Excision of esophagus lesion ...................... 16.25 NA 7.77 2.31 NA 26.33 090 

43107 .......... ............ A Removal of esophagus ............................... 40.02 NA 17.70 5.22 NA 62.94 090 

43108 .......... ............ A Removal of esophagus ............................... 34.21 NA 13.87 4.07 NA 52.14 090 

43112 .......... ............ A Removal of esophagus ............................... 43.52 NA 18.73 5.79 NA 68.04 090 

43113 .......... ............ A Removal of esophagus ............................... 35.29 NA 14.88 4.42 NA 54.59 090 

43116 .......... ............ A Partial removal of esophagus ..................... 31.23 NA 16.17 3.05 NA 50.45 090 

43117 .......... ............ A Partial removal of esophagus ..................... 40.02 NA 16.75 5.17 NA 61.94 090 

43118 .......... ............ A Partial removal of esophagus ..................... 33.22 NA 13.41 4.10 NA 50.73 090 

43121 .......... ............ A Partial removal of esophagus ..................... 29.21 NA 13.19 3.90 NA 46.30 090 

43122 .......... ............ A Partial removal of esophagus ..................... 40.02 NA 16.93 5.40 NA 62.35 090 

43123 .......... ............ A Partial removal of esophagus ..................... 33.22 NA 13.85 4.15 NA 51.22 090 

43124 .......... ............ A Removal of esophagus ............................... 27.33 NA 12.85 3.73 NA 43.92 090 

43130 .......... ............ A Removal of esophagus pouch .................... 11.75 NA 7.35 1.16 NA 20.27 090 

43135 .......... ............ A Removal of esophagus pouch .................... 16.11 NA 7.95 2.33 NA 26.39 090 

43200 .......... ............ A Esophagus endoscopy ................................ 1.59 4.08 1.08 0.13 5.80 2.80 000 

43201 .......... ............ A Esoph scope w/submucous inj .................... 2.09 4.71 1.14 0.15 6.95 3.39 000 

43202 .......... ............ A Esophagus endoscopy, biopsy ................... 1.89 5.75 0.98 0.15 7.79 3.03 000 

43204 .......... ............ A Esoph scope w/sclerosis inj ........................ 3.77 NA 1.66 0.30 NA 5.73 000 

43205 .......... ............ A Esophagus endoscopy/ligation .................... 3.79 NA 1.66 0.28 NA 5.73 000 

43215 .......... ............ A Esophagus endoscopy ................................ 2.61 NA 1.25 0.22 NA 4.08 000 

43216 .......... ............ A Esophagus endoscopy/lesion ...................... 2.40 0.00 1.13 0.20 2.60 3.73 000 

43217 .......... ............ A Esophagus endoscopy ................................ 2.91 7.19 1.27 0.26 10.35 4.43 000 

43219 .......... ............ A Esophagus endoscopy ................................ 2.81 NA 1.45 0.24 NA 4.50 000 

43220 .......... ............ A Esoph endoscopy, dilation .......................... 2.10 NA 1.04 0.17 NA 3.32 000 

43226 .......... ............ A Esoph endoscopy, dilation .......................... 2.34 NA 1.13 0.19 NA 3.66 000 

45921

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

43227 .......... ............ A Esoph endoscopy, repair ............................ 3.60 NA 1.57 0.28 NA 5.45 000 

43228 .......... ............ A Esoph endoscopy, ablation ......................... 3.77 NA 1.64 0.34 NA 5.75 000 

43231 .......... ............ A Esoph endoscopy w/us exam ..................... 3.20 NA 1.42 0.23 NA 4.85 000 

43232 .......... ............ A Esoph endoscopy w/us fn bx ...................... 4.48 NA 1.92 0.34 NA 6.74 000 

43234 .......... ............ A Upper GI endoscopy, exam ........................ 2.01 5.49 0.92 0.17 7.67 3.11 000 

43235 .......... ............ A Uppr gi endoscopy, diagnosis ..................... 2.39 5.55 1.11 0.19 8.13 3.70 000 

43236 .......... ............ A Uppr gi scope w/submuc inj ........................ 2.93 6.89 1.34 0.21 10.02 4.48 000 

43237 .......... ............ A Endoscopic us exam, esoph ....................... 3.99 NA 1.75 0.43 NA 6.17 000 

43238 .......... ............ A Uppr gi endoscopy w/us fn bx .................... 5.03 NA 2.14 0.43 NA 7.60 000 

43239 .......... ............ A Upper GI endoscopy, biopsy ....................... 2.88 6.18 1.30 0.22 9.28 4.39 000 

43240 .......... ............ A Esoph endoscope w/drain cyst ................... 6.86 NA 2.83 0.56 NA 10.25 000 

43241 .......... ............ A Upper GI endoscopy with tube ................... 2.60 NA 1.19 0.21 NA 4.00 000 

43242 .......... ............ A Uppr gi endoscopy w/us fn bx .................... 7.31 NA 2.93 0.53 NA 10.78 000 

43243 .......... ............ A Upper gi endoscopy & inject ....................... 4.57 NA 1.95 0.33 NA 6.85 000 

43244 .......... ............ A Upper GI endoscopy/ligation ....................... 5.05 NA 2.14 0.37 NA 7.56 000 

43245 .......... ............ A Uppr gi scope dilate strictr .......................... 3.19 NA 1.40 0.26 NA 4.85 000 

43246 .......... ............ A Place gastrostomy tube ............................... 4.33 NA 1.81 0.34 NA 6.48 000 

43247 .......... ............ A Operative upper GI endoscopy ................... 3.39 NA 1.49 0.27 NA 5.14 000 

43248 .......... ............ A Uppr gi endoscopy/guide wire ..................... 3.16 NA 1.45 0.23 NA 4.83 000 

43249 .......... ............ A Esoph endoscopy, dilation .......................... 2.91 NA 1.33 0.22 NA 4.46 000 

43250 .......... ............ A Upper GI endoscopy/tumor ......................... 3.21 NA 1.42 0.26 NA 4.89 000 

43251 .......... ............ A Operative upper GI endoscopy ................... 3.70 NA 1.61 0.29 NA 5.59 000 

43255 .......... ............ A Operative upper GI endoscopy ................... 4.82 NA 2.05 0.35 NA 7.22 000 

43256 .......... ............ A Uppr gi endoscopy w/stent .......................... 4.35 NA 1.85 0.32 NA 6.52 000 

43257 .......... ............ A Uppr gi scope w/thrml txmnt ....................... 5.51 NA 2.27 0.36 NA 8.14 000 

43258 .......... ............ A Operative upper GI endoscopy ................... 4.55 NA 1.93 0.33 NA 6.81 000 

43259 .......... ............ A Endoscopic ultrasound exam ...................... 5.20 NA 2.15 0.35 NA 7.70 000 

43260 .......... ............ A Endo cholangiopancreatograph .................. 5.96 NA 2.48 0.43 NA 8.87 000 

43261 .......... ............ A Endo cholangiopancreatograph .................. 6.27 NA 2.60 0.46 NA 9.33 000 

43262 .......... ............ A Endo cholangiopancreatograph .................. 7.39 NA 3.02 0.54 NA 10.96 000 

43263 .......... ............ A Endo cholangiopancreatograph .................. 7.29 NA 3.02 0.54 NA 10.85 000 

43264 .......... ............ A Endo cholangiopancreatograph .................. 8.91 NA 3.59 0.65 NA 13.15 000 

43265 .......... ............ A Endo cholangiopancreatograph .................. 10.02 NA 4.00 0.73 NA 14.75 000 

43267 .......... ............ A Endo cholangiopancreatograph .................. 7.39 NA 3.00 0.54 NA 10.94 000 

43268 .......... ............ A Endo cholangiopancreatograph .................. 7.39 NA 3.15 0.54 NA 11.08 000 

43269 .......... ............ A Endo cholangiopancreatograph .................. 8.22 NA 3.33 0.60 NA 12.15 000 

43271 .......... ............ A Endo cholangiopancreatograph .................. 7.39 NA 3.01 0.54 NA 10.94 000 

43272 .......... ............ A Endo cholangiopancreatograph .................. 7.39 NA 3.01 0.54 NA 10.94 000 

43280 .......... ............ A Laparoscopy, fundoplasty ........................... 17.25 NA 7.17 2.27 NA 26.69 090 

43289 .......... ............ C Laparoscope proc, esoph ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43300 .......... ............ A Repair of esophagus ................................... 9.15 NA 6.22 1.12 NA 16.49 090 

43305 .......... ............ A Repair esophagus and fistula ..................... 17.39 NA 10.37 1.54 NA 29.30 090 

43310 .......... ............ A Repair of esophagus ................................... 25.40 NA 10.89 3.60 NA 39.89 090 

43312 .......... ............ A Repair esophagus and fistula ..................... 28.44 NA 11.55 4.00 NA 43.99 090 

43313 .......... ............ A Esophagoplasty congenital ......................... 45.30 NA 18.40 5.45 NA 69.15 090 

43314 .......... ............ A Tracheo-esophagoplasty cong .................... 50.29 NA 18.88 6.63 NA 75.80 090 

43320 .......... ............ A Fuse esophagus & stomach ....................... 19.94 NA 9.05 2.73 NA 31.72 090 

43324 .......... ............ A Revise esophagus & stomach .................... 20.58 NA 8.62 2.75 NA 31.95 090 

43325 .......... ............ A Revise esophagus & stomach .................... 20.07 NA 8.66 2.59 NA 31.32 090 

43326 .......... ............ A Revise esophagus & stomach .................... 19.75 NA 9.17 2.84 NA 31.76 090 

43330 .......... ............ A Repair of esophagus ................................... 19.78 NA 8.46 2.62 NA 30.86 090 

43331 .......... ............ A Repair of esophagus ................................... 20.14 NA 9.83 2.93 NA 32.90 090 

43340 .......... ............ A Fuse esophagus & intestine ........................ 19.62 NA 8.81 2.45 NA 30.87 090 

43341 .......... ............ A Fuse esophagus & intestine ........................ 20.86 NA 10.35 2.91 NA 34.12 090 

43350 .......... ............ A Surgical opening, esophagus ...................... 15.79 NA 8.31 1.42 NA 25.52 090 

43351 .......... ............ A Surgical opening, esophagus ...................... 18.36 NA 9.70 2.46 NA 30.51 090 

43352 .......... ............ A Surgical opening, esophagus ...................... 15.27 NA 8.27 2.05 NA 25.59 090 

43360 .......... ............ A Gastrointestinal repair ................................. 35.72 NA 14.98 4.96 NA 55.66 090 

43361 .......... ............ A Gastrointestinal repair ................................. 40.52 NA 16.63 4.49 NA 61.64 090 

43400 .......... ............ A Ligate esophagus veins .............................. 21.21 NA 10.06 1.95 NA 33.22 090 

43401 .......... ............ A Esophagus surgery for veins ...................... 22.10 NA 9.26 3.04 NA 34.40 090 

43405 .......... ............ A Ligate/staple esophagus ............................. 20.02 NA 9.60 2.83 NA 32.45 090 

43410 .......... ............ A Repair esophagus wound ........................... 13.48 NA 7.54 1.71 NA 22.72 090 

43415 .......... ............ A Repair esophagus wound ........................... 25.01 NA 11.61 3.52 NA 40.14 090 

43420 .......... ............ A Repair esophagus opening ......................... 14.36 NA 7.24 1.43 NA 23.03 090 

43425 .......... ............ A Repair esophagus opening ......................... 21.04 NA 9.84 3.02 NA 33.90 090 

43450 .......... ............ A Dilate esophagus ......................................... 1.38 2.83 0.77 0.11 4.32 2.26 000 

43453 .......... ............ A Dilate esophagus ......................................... 1.51 6.53 0.82 0.11 8.15 2.44 000 

43456 .......... ............ A Dilate esophagus ......................................... 2.58 14.11 1.21 0.20 16.89 3.99 000 

43458 .......... ............ A Dilate esophagus ......................................... 3.07 7.20 1.40 0.24 10.51 4.70 000 

43460 .......... ............ A Pressure treatment esophagus ................... 3.80 NA 1.57 0.31 NA 5.68 000 

43496 .......... ............ C Free jejunum flap, microvasc ...................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

43499 .......... ............ C Esophagus surgery procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43500 .......... ............ A Surgical opening of stomach ....................... 11.05 NA 4.93 1.45 NA 17.43 090 

45922

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

43501 .......... ............ A Surgical repair of stomach .......................... 20.05 NA 8.20 2.64 NA 30.89 090 

43502 .......... ............ A Surgical repair of stomach .......................... 23.15 NA 9.34 3.09 NA 35.57 090 

43510 .......... ............ A Surgical opening of stomach ....................... 13.09 NA 6.97 1.48 NA 21.54 090 

43520 .......... ............ A Incision of pyloric muscle ............................ 10.00 NA 5.09 1.36 NA 16.45 090 

43600 .......... ............ A Biopsy of stomach ....................................... 1.91 NA 0.69 0.14 NA 2.74 000 

43605 .......... ............ A Biopsy of stomach ....................................... 11.98 NA 5.22 1.58 NA 18.79 090 

43610 .......... ............ A Excision of stomach lesion .......................... 14.61 NA 6.07 1.93 NA 22.61 090 

43611 .......... ............ A Excision of stomach lesion .......................... 17.85 NA 7.47 2.35 NA 27.67 090 

43620 .......... ............ A Removal of stomach ................................... 30.05 NA 11.60 3.95 NA 45.60 090 

43621 .......... ............ A Removal of stomach ................................... 30.74 NA 11.77 4.03 NA 46.54 090 

43622 .......... ............ A Removal of stomach ................................... 32.54 NA 12.36 4.29 NA 49.20 090 

43631 .......... ............ A Removal of stomach, partial ....................... 22.61 NA 9.03 2.98 NA 34.61 090 

43632 .......... ............ A Removal of stomach, partial ....................... 22.61 NA 9.03 2.98 NA 34.61 090 

43633 .......... ............ A Removal of stomach, partial ....................... 23.12 NA 9.19 3.05 NA 35.35 090 

43634 .......... ............ A Removal of stomach, partial ....................... 25.13 NA 9.90 3.32 NA 38.35 090 

43635 .......... ............ A Removal of stomach, partial ....................... 2.06 NA 0.68 0.27 NA 3.02 ZZZ 

43638 .......... ............ A Removal of stomach, partial ....................... 29.02 NA 11.70 3.80 NA 44.52 090 

43639 .......... ............ A Removal of stomach, partial ....................... 29.67 NA 11.47 3.90 NA 45.04 090 

43640 .......... ............ A Vagotomy & pylorus repair .......................... 17.02 NA 7.17 2.25 NA 26.44 090 

43641 .......... ............ A Vagotomy & pylorus repair .......................... 17.27 NA 7.28 2.24 NA 26.79 090 

43644 .......... ............ A Lap gastric bypass/roux-en-y ...................... 27.89 NA 11.14 3.15 NA 42.18 090 

43645 .......... ............ A Lap gastr bypass incl smll i ......................... 30.02 NA 12.02 3.53 NA 45.57 090 

43651 .......... ............ A Laparoscopy, vagus nerve .......................... 10.15 NA 4.71 1.33 NA 16.19 090 

43652 .......... ............ A Laparoscopy, vagus nerve .......................... 12.15 NA 5.63 1.55 NA 19.33 090 

43653 .......... ............ A Laparoscopy, gastrostomy .......................... 7.74 NA 4.16 1.01 NA 12.90 090 

43659 .......... ............ C Laparoscope proc, stom .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43750 .......... ............ A Place gastrostomy tube ............................... 4.49 NA 2.14 0.43 NA 7.06 010 

43752 .......... ............ A Nasal/orogastric w/stent .............................. 0.81 NA 0.27 0.02 NA 1.10 000 

43760 .......... ............ A Change gastrostomy tube ........................... 1.10 5.82 0.45 0.09 7.01 1.65 000 

43761 .......... ............ A Reposition gastrostomy tube ....................... 2.01 1.18 0.69 0.13 3.32 2.84 000 

43800 .......... ............ A Reconstruction of pylorus ............................ 13.70 NA 5.81 1.81 NA 21.32 090 

43810 .......... ............ A Fusion of stomach and bowel ..................... 14.66 NA 6.10 1.93 NA 22.69 090 

43820 .......... ............ A Fusion of stomach and bowel ..................... 15.38 NA 6.33 2.03 NA 23.74 090 

43825 .......... ............ A Fusion of stomach and bowel ..................... 19.23 NA 7.91 2.53 NA 29.67 090 

43830 .......... ............ A Place gastrostomy tube ............................... 9.54 NA 4.85 1.25 NA 15.64 090 

43831 .......... ............ A Place gastrostomy tube ............................... 7.85 NA 4.53 1.03 NA 13.41 090 

43832 .......... ............ A Place gastrostomy tube ............................... 15.61 NA 6.83 1.97 NA 24.41 090 

43840 .......... ............ A Repair of stomach lesion ............................ 15.57 NA 6.69 2.05 NA 24.31 090 

43842 .......... ............ A V-band gastroplasty .................................... 18.48 NA 7.69 2.44 NA 28.60 090 

43843 .......... ............ A Gastroplasty w/o v-band ............................. 18.66 NA 7.68 2.45 NA 28.79 090 

43845 .......... ............ C Gastroplasty duodenal switch ..................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

43846 .......... ............ A Gastric bypass for obesity ........................... 24.06 NA 9.88 3.18 NA 37.12 090 

43847 .......... ............ A Gastric bypass incl small i .......................... 26.93 NA 10.74 3.55 NA 41.23 090 

43848 .......... ............ A Revision gastroplasty .................................. 29.41 NA 11.64 3.87 NA 44.92 090 

43850 .......... ............ A Revise stomach-bowel fusion ..................... 24.73 NA 9.69 3.27 NA 37.69 090 

43855 .......... ............ A Revise stomach-bowel fusion ..................... 26.17 NA 10.20 3.46 NA 39.83 090 

43860 .......... ............ A Revise stomach-bowel fusion ..................... 25.01 NA 9.81 3.30 NA 38.12 090 

43865 .......... ............ A Revise stomach-bowel fusion ..................... 26.53 NA 10.32 3.50 NA 40.35 090 

43870 .......... ............ A Repair stomach opening ............................. 9.70 NA 4.51 1.27 NA 15.48 090 

43880 .......... ............ A Repair stomach-bowel fistula ...................... 24.66 NA 9.78 3.26 NA 37.70 090 

43999 .......... ............ C Stomach surgery procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

44005 .......... ............ A Freeing of bowel adhesion .......................... 16.24 NA 6.64 2.14 NA 25.02 090 

44010 .......... ............ A Incision of small bowel ................................ 12.53 NA 5.39 1.64 NA 19.56 090 

44015 .......... ............ A Insert needle cath bowel ............................. 2.63 NA 0.87 0.35 NA 3.84 ZZZ 

44020 .......... ............ A Explore small intestine ................................ 14.00 NA 5.87 1.85 NA 21.72 090 

44021 .......... ............ A Decompress small bowel ............................ 14.09 NA 5.92 1.86 NA 21.86 090 

44025 .......... ............ A Incision of large bowel ................................ 14.29 NA 5.96 1.89 NA 22.14 090 

44050 .......... ............ A Reduce bowel obstruction ........................... 14.04 NA 5.88 1.85 NA 21.77 090 

44055 .......... ............ A Correct malrotation of bowel ....................... 22.01 NA 8.59 2.90 NA 33.51 090 

44100 .......... ............ A Biopsy of bowel ........................................... 2.01 NA 0.75 0.17 NA 2.94 000 

44110 .......... ............ A Excise intestine lesion(s) ............................. 11.81 NA 5.18 1.55 NA 18.54 090 

44111 .......... ............ A Excision of bowel lesion(s) .......................... 14.30 NA 6.03 1.86 NA 22.19 090 

44120 .......... ............ A Removal of small intestine .......................... 17.00 NA 6.99 2.24 NA 26.23 090 

44121 .......... ............ A Removal of small intestine .......................... 4.45 NA 1.49 0.58 NA 6.51 ZZZ 

44125 .......... ............ A Removal of small intestine .......................... 17.55 NA 7.16 2.26 NA 26.97 090 

44126 .......... ............ A Enterectomy w/o taper, cong ...................... 35.52 NA 13.91 4.68 NA 54.11 090 

44127 .......... ............ A Enterectomy w/taper, cong ......................... 41.02 NA 15.47 5.75 NA 62.24 090 

44128 .......... ............ A Enterectomy cong, add-on .......................... 4.45 NA 1.49 0.61 NA 6.55 ZZZ 

44130 .......... ............ A Bowel to bowel fusion ................................. 14.50 NA 6.15 1.87 NA 22.52 090 

44132 .......... ............ R Enterectomy, cadaver donor ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

44133 .......... ............ R Enterectomy, live donor .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

44135 .......... ............ R Intestine transplnt, cadaver ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

44136 .......... ............ R Intestine transplant, live .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

44137 .......... ............ C Remove intestinal allograft .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

45923

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

44139 .......... ............ A Mobilization of colon .................................... 2.23 NA 0.74 0.28 NA 3.26 ZZZ 

44140 .......... ............ A Partial removal of colon .............................. 21.01 NA 8.53 2.70 NA 32.25 090 

44141 .......... ............ A Partial removal of colon .............................. 19.52 NA 9.91 2.52 NA 31.95 090 

44143 .......... ............ A Partial removal of colon .............................. 23.01 NA 10.52 3.04 NA 36.57 090 

44144 .......... ............ A Partial removal of colon .............................. 21.54 NA 9.50 2.85 NA 33.89 090 

44145 .......... ............ A Partial removal of colon .............................. 26.43 NA 10.68 3.28 NA 40.39 090 

44146 .......... ............ A Partial removal of colon .............................. 27.56 NA 12.67 3.40 NA 43.62 090 

44147 .......... ............ A Partial removal of colon .............................. 20.72 NA 8.60 2.55 NA 31.87 090 

44150 .......... ............ A Removal of colon ........................................ 23.96 NA 11.88 3.03 NA 38.87 090 

44151 .......... ............ A Removal of colon/ileostomy ........................ 26.89 NA 13.23 3.48 NA 43.60 090 

44152 .......... ............ A Removal of colon/ileostomy ........................ 27.85 NA 11.39 3.51 NA 42.75 090 

44153 .......... ............ A Removal of colon/ileostomy ........................ 30.60 NA 14.27 3.54 NA 48.41 090 

44155 .......... ............ A Removal of colon/ileostomy ........................ 27.88 NA 13.17 3.27 NA 44.31 090 

44156 .......... ............ A Removal of colon/ileostomy ........................ 30.80 NA 14.81 3.94 NA 49.56 090 

44160 .......... ............ A Removal of colon ........................................ 18.63 NA 7.65 2.36 NA 28.64 090 

44200 .......... ............ A Laparoscopy, enterolysis ............................. 14.45 NA 6.12 1.89 NA 22.46 090 

44201 .......... ............ A Laparoscopy, jejunostomy ........................... 9.79 NA 4.60 1.30 NA 15.69 090 

44202 .......... ............ A Lap resect s/intestine singl .......................... 22.05 NA 8.81 2.84 NA 33.71 090 

44203 .......... ............ A Lap resect s/intestine, addl ......................... 4.45 NA 1.46 0.57 NA 6.48 ZZZ 

44204 .......... ............ A Laparo partial colectomy ............................. 25.09 NA 9.81 3.10 NA 38.00 090 

44205 .......... ............ A Lap colectomy part w/ileum ........................ 22.24 NA 8.72 2.74 NA 33.71 090 

44206 .......... ............ A Lap part colectomy w/stoma ....................... 27.01 NA 11.08 3.45 NA 41.54 090 

44207 .......... ............ A L colectomy/coloproctostomy ...................... 30.02 NA 11.32 3.66 NA 45.00 090 

44208 .......... ............ A L colectomy/coloproctostomy ...................... 32.01 NA 12.97 3.87 NA 48.85 090 

44210 .......... ............ A Laparo total proctocolectomy ...................... 28.02 NA 11.74 3.41 NA 43.17 090 

44211 .......... ............ A Laparo total proctocolectomy ...................... 35.02 NA 14.52 4.16 NA 53.70 090 

44212 .......... ............ A Laparo total proctocolectomy ...................... 32.51 NA 13.56 3.77 NA 49.84 090 

44238 .......... ............ C Laparoscope proc, intestine ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

44239 .......... ............ C Laparoscope proc, rectum .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

44300 .......... ............ A Open bowel to skin ..................................... 12.11 NA 5.43 1.60 NA 19.15 090 

44310 .......... ............ A Ileostomy/jejunostomy ................................. 15.96 NA 6.62 1.98 NA 24.57 090 

44312 .......... ............ A Revision of ileostomy .................................. 8.03 NA 4.12 0.92 NA 13.06 090 

44314 .......... ............ A Revision of ileostomy .................................. 15.06 NA 6.65 1.74 NA 23.45 090 

44316 .......... ............ A Devise bowel pouch .................................... 21.10 NA 8.65 2.37 NA 32.12 090 

44320 .......... ............ A Colostomy .................................................... 17.65 NA 7.58 2.25 NA 27.48 090 

44322 .......... ............ A Colostomy with biopsies .............................. 11.98 NA 8.49 1.54 NA 22.01 090 

44340 .......... ............ A Revision of colostomy ................................. 7.73 NA 4.26 0.99 NA 12.98 090 

44345 .......... ............ A Revision of colostomy ................................. 15.44 NA 6.83 1.96 NA 24.23 090 

44346 .......... ............ A Revision of colostomy ................................. 16.99 NA 7.34 2.12 NA 26.45 090 

44360 .......... ............ A Small bowel endoscopy .............................. 2.60 NA 1.21 0.19 NA 4.00 000 

44361 .......... ............ A Small bowel endoscopy/biopsy ................... 2.88 NA 1.32 0.21 NA 4.40 000 

44363 .......... ............ A Small bowel endoscopy .............................. 3.50 NA 1.48 0.27 NA 5.25 000 

44364 .......... ............ A Small bowel endoscopy .............................. 3.74 NA 1.62 0.27 NA 5.63 000 

44365 .......... ............ A Small bowel endoscopy .............................. 3.32 NA 1.49 0.24 NA 5.05 000 

44366 .......... ............ A Small bowel endoscopy .............................. 4.41 NA 1.88 0.32 NA 6.61 000 

44369 .......... ............ A Small bowel endoscopy .............................. 4.52 NA 1.85 0.33 NA 6.70 000 

44370 .......... ............ A Small bowel endoscopy/stent ...................... 4.80 NA 2.16 0.37 NA 7.33 000 

44372 .......... ............ A Small bowel endoscopy .............................. 4.41 NA 1.85 0.35 NA 6.61 000 

44373 .......... ............ A Small bowel endoscopy .............................. 3.50 NA 1.53 0.27 NA 5.30 000 

44376 .......... ............ A Small bowel endoscopy .............................. 5.26 NA 2.17 0.42 NA 7.85 000 

44377 .......... ............ A Small bowel endoscopy/biopsy ................... 5.53 NA 2.32 0.40 NA 8.25 000 

44378 .......... ............ A Small bowel endoscopy .............................. 7.13 NA 2.92 0.52 NA 10.58 000 

44379 .......... ............ A S bowel endoscope w/stent ........................ 7.47 NA 3.13 0.62 NA 11.23 000 

44380 .......... ............ A Small bowel endoscopy .............................. 1.05 NA 0.63 0.08 NA 1.76 000 

44382 .......... ............ A Small bowel endoscopy .............................. 1.27 NA 0.71 0.12 NA 2.10 000 

44383 .......... ............ A Ileoscopy w/stent ......................................... 2.95 NA 1.42 0.21 NA 4.57 000 

44385 .......... ............ A Endoscopy of bowel pouch ......................... 1.82 3.53 0.83 0.15 5.51 2.80 000 

44386 .......... ............ A Endoscopy, bowel pouch/biop .................... 2.12 7.02 0.93 0.20 9.34 3.26 000 

44388 .......... ............ A Colonoscopy ................................................ 2.83 5.31 1.21 0.26 8.40 4.30 000 

44389 .......... ............ A Colonoscopy with biopsy ............................. 3.14 7.02 1.36 0.27 10.43 4.76 000 

44390 .......... ............ A Colonoscopy for foreign body ..................... 3.83 7.54 1.59 0.32 11.68 5.74 000 

44391 .......... ............ A Colonoscopy for bleeding ............................ 4.32 8.94 1.82 0.34 13.60 6.48 000 

44392 .......... ............ A Colonoscopy & polypectomy ....................... 3.82 6.91 1.57 0.34 11.06 5.73 000 

44393 .......... ............ A Colonoscopy, lesion removal ...................... 4.84 7.17 1.99 0.42 12.43 7.25 000 

44394 .......... ............ A Colonoscopy w/snare .................................. 4.43 8.31 1.82 0.38 13.12 6.63 000 

44397 .......... ............ A Colonoscopy w/stent ................................... 4.71 NA 1.88 0.39 NA 6.98 000 

44500 .......... ............ A Intro, gastrointestinal tube ........................... 0.49 NA 0.17 0.03 NA 0.69 000 

44602 .......... ............ A Suture, small intestine ................................. 16.04 NA 6.29 2.11 NA 24.44 090 

44603 .......... ............ A Suture, small intestine ................................. 18.67 NA 7.15 2.41 NA 28.23 090 

44604 .......... ............ A Suture, large intestine ................................. 16.04 NA 6.36 2.11 NA 24.51 090 

44605 .......... ............ A Repair of bowel lesion ................................. 19.54 NA 8.24 2.51 NA 30.29 090 

44615 .......... ............ A Intestinal stricturoplasty ............................... 15.94 NA 6.60 2.06 NA 24.60 090 

44620 .......... ............ A Repair bowel opening ................................. 12.20 NA 5.27 1.51 NA 18.99 090 

44625 .......... ............ A Repair bowel opening ................................. 15.06 NA 6.23 1.85 NA 23.14 090 

45924

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

44626 .......... ............ A Repair bowel opening ................................. 25.37 NA 9.65 3.26 NA 38.28 090 

44640 .......... ............ A Repair bowel-skin fistula ............................. 21.66 NA 8.45 2.77 NA 32.89 090 

44650 .......... ............ A Repair bowel fistula ..................................... 22.59 NA 8.78 2.92 NA 34.28 090 

44660 .......... ............ A Repair bowel-bladder fistula ........................ 21.37 NA 8.77 2.13 NA 32.27 090 

44661 .......... ............ A Repair bowel-bladder fistula ........................ 24.82 NA 9.74 2.80 NA 37.36 090 

44680 .......... ............ A Surgical revision, intestine .......................... 15.41 NA 6.37 1.99 NA 23.77 090 

44700 .......... ............ A Suspend bowel w/prosthesis ....................... 16.12 NA 6.68 1.83 NA 24.63 090 

44701 .......... ............ A Intraop colon lavage add-on ....................... 3.11 NA 1.03 0.37 NA 4.51 ZZZ 

44715 .......... ............ C Prepare donor intestine ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

44720 .......... ............ A Prep donor intestine/venous ....................... 5.01 NA 1.67 0.37 NA 7.05 XXX 

44721 .......... ............ A Prep donor intestine/artery .......................... 7.01 NA 2.33 0.97 NA 10.32 XXX 

44799 .......... ............ C Unlisted procedure intestine ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

44800 .......... ............ A Excision of bowel pouch ............................. 11.23 NA 5.38 1.47 NA 18.08 090 

44820 .......... ............ A Excision of mesentery lesion ...................... 12.09 NA 5.44 1.59 NA 19.12 090 

44850 .......... ............ A Repair of mesentery .................................... 10.74 NA 4.94 1.39 NA 17.07 090 

44899 .......... ............ C Bowel surgery procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

44900 .......... ............ A Drain app abscess, open ............................ 10.14 NA 4.67 1.33 NA 16.14 090 

44901 .......... ............ A Drain app abscess, percut .......................... 3.38 26.78 1.15 0.22 30.37 4.74 000 

44950 .......... ............ A Appendectomy ............................................. 10.01 NA 4.26 1.31 NA 15.58 090 

44955 .......... ............ A Appendectomy add-on ................................ 1.53 NA 0.53 0.20 NA 2.26 ZZZ 

44960 .......... ............ A Appendectomy ............................................. 12.34 NA 5.27 1.63 NA 19.24 090 

44970 .......... ............ A Laparoscopy, appendectomy ...................... 8.71 NA 4.06 1.14 NA 13.90 090 

44979 .......... ............ C Laparoscope proc, app ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

45000 .......... ............ A Drainage of pelvic abscess ......................... 4.52 NA 3.02 0.52 NA 8.06 090 

45005 .......... ............ A Drainage of rectal abscess ......................... 1.99 3.94 1.55 0.25 6.19 3.80 010 

45020 .......... ............ A Drainage of rectal abscess ......................... 4.72 NA 3.33 0.55 NA 8.60 090 

45100 .......... ............ A Biopsy of rectum ......................................... 3.68 NA 2.40 0.44 NA 6.52 090 

45108 .......... ............ A Removal of anorectal lesion ........................ 4.76 NA 2.78 0.59 NA 8.13 090 

45110 .......... ............ A Removal of rectum ...................................... 28.02 NA 12.24 3.35 NA 43.61 090 

45111 .......... ............ A Partial removal of rectum ............................ 16.49 NA 7.10 2.06 NA 25.65 090 

45112 .......... ............ A Removal of rectum ...................................... 30.55 NA 11.60 3.42 NA 45.57 090 

45113 .......... ............ A Partial proctectomy ...................................... 30.59 NA 12.48 3.48 NA 46.56 090 

45114 .......... ............ A Partial removal of rectum ............................ 27.33 NA 10.73 3.35 NA 41.42 090 

45116 .......... ............ A Partial removal of rectum ............................ 24.59 NA 9.88 2.87 NA 37.34 090 

45119 .......... ............ A Remove rectum w/reservoir ........................ 30.85 NA 12.33 3.35 NA 46.54 090 

45120 .......... ............ A Removal of rectum ...................................... 24.61 NA 10.07 2.89 NA 37.57 090 

45121 .......... ............ A Removal of rectum and colon ..................... 27.05 NA 10.96 3.24 NA 41.26 090 

45123 .......... ............ A Partial proctectomy ...................................... 16.71 NA 6.81 1.85 NA 25.37 090 

45126 .......... ............ A Pelvic exenteration ...................................... 45.18 NA 19.60 4.32 NA 69.10 090 

45130 .......... ............ A Excision of rectal prolapse .......................... 16.45 NA 6.73 1.79 NA 24.98 090 

45135 .......... ............ A Excision of rectal prolapse .......................... 19.29 NA 8.34 2.35 NA 29.98 090 

45136 .......... ............ A Excise ileoanal reservior ............................. 27.31 NA 12.34 2.81 NA 42.47 090 

45150 .......... ............ A Excision of rectal stricture ........................... 5.67 NA 3.01 0.61 NA 9.29 090 

45160 .......... ............ A Excision of rectal lesion .............................. 15.33 NA 6.62 1.67 NA 23.62 090 

45170 .......... ............ A Excision of rectal lesion .............................. 11.49 NA 5.21 1.35 NA 18.06 090 

45190 .......... ............ A Destruction, rectal tumor ............................. 9.75 NA 4.64 1.13 NA 15.52 090 

45300 .......... ............ A Proctosigmoidoscopy dx ............................. 0.38 1.56 0.29 0.04 1.98 0.71 000 

45303 .......... ............ A Proctosigmoidoscopy dilate ......................... 0.44 18.29 0.37 0.05 18.78 0.86 000 

45305 .......... ............ A Proctosigmoidoscopy w/bx .......................... 1.01 2.68 0.51 0.11 3.80 1.63 000 

45307 .......... ............ A Proctosigmoidoscopy fb .............................. 0.94 3.03 0.49 0.11 4.09 1.54 000 

45308 .......... ............ A Proctosigmoidoscopy removal .................... 0.83 2.10 0.45 0.09 3.02 1.37 000 

45309 .......... ............ A Proctosigmoidoscopy removal .................... 2.01 2.86 0.85 0.22 5.09 3.09 000 

45315 .......... ............ A Proctosigmoidoscopy removal .................... 1.40 2.95 0.65 0.15 4.50 2.20 000 

45317 .......... ............ A Proctosigmoidoscopy bleed ........................ 1.50 2.57 0.68 0.15 4.22 2.33 000 

45320 .......... ............ A Proctosigmoidoscopy ablate ....................... 1.58 3.10 0.74 0.16 4.84 2.48 000 

45321 .......... ............ A Proctosigmoidoscopy volvul ........................ 1.17 NA 0.58 0.13 NA 1.89 000 

45327 .......... ............ A Proctosigmoidoscopy w/stent ...................... 1.65 NA 0.69 0.16 NA 2.51 000 

45330 .......... ............ A Diagnostic sigmoidoscopy ........................... 0.96 2.33 0.55 0.08 3.37 1.59 000 

45331 .......... ............ A Sigmoidoscopy and biopsy ......................... 1.15 3.20 0.65 0.09 4.44 1.90 000 

45332 .......... ............ A Sigmoidoscopy w/fb removal ...................... 1.79 5.02 0.86 0.16 6.97 2.82 000 

45333 .......... ............ A Sigmoidoscopy & polypectomy ................... 1.79 5.08 0.87 0.15 7.02 2.81 000 

45334 .......... ............ A Sigmoidoscopy for bleeding ........................ 2.74 NA 1.24 0.20 NA 4.18 000 

45335 .......... ............ A Sigmoidoscopy w/submuc inj ...................... 1.46 3.34 0.75 0.11 4.91 2.33 000 

45337 .......... ............ A Sigmoidoscopy & decompress .................... 2.36 NA 1.07 0.21 NA 3.65 000 

45338 .......... ............ A Sigmoidoscopy w/tumr remove ................... 2.34 5.50 .09 0.19 8.04 3.62 000 

45339 .......... ............ A Sigmoidoscopy w/ablate tumr ..................... 3.15 3.72 1.39 0.26 7.12 4.79 000 

45340 .......... ............ A Sig w/balloon dilation .................................. 1.89 6.40 0.89 0.15 8.44 2.94 000 

45341 .......... ............ A Sigmoidoscopy w/ultrasound ....................... 2.61 NA 1.11 0.19 NA 3.90 000 

45342 .......... ............ A Sigmoidoscopy w/us guide bx ..................... 4.06 NA 1.61 0.30 NA 5.97 000 

45345 .......... ............ A Sigmoidoscopy w/stent ................................ 2.93 NA 1.21 0.23 NA 4.37 000 

45355 .......... ............ A Surgical colonoscopy .................................. 3.52 NA 1.41 0.36 NA 5.29 000 

45378 .......... ............ A Diagnostic colonoscopy ............................... 3.70 6.60 1.58 0.30 10.59 5.57 000 

45378 .......... 53 ....... A Diagnostic colonoscopy ............................... 0.96 2.33 0.55 0.08 3.37 1.59 000 

45379 .......... ............ A Colonoscopy w/fb removal .......................... 4.69 7.80 1.93 0.39 12.88 7.01 000 

45925

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

45380 .......... ............ A Colonoscopy and biopsy ............................. 4.44 7.80 1.86 0.35 12.59 6.65 000 

45381 .......... ............ A Colonoscopy, submucous inj ...................... 4.20 7.72 1.79 0.30 12.22 6.29 000 

45382 .......... ............ A Colonoscopy/control bleeding ..................... 5.69 10.76 2.36 0.41 16.86 8.47 000 

45383 .......... ............ A Lesion removal colonoscopy ....................... 5.87 8.55 2.37 0.48 14.91 8.72 000 

45384 .......... ............ A Lesion remove colonoscopy ........................ 4.70 7.38 1.96 0.38 12.46 7.04 000 

45385 .......... ............ A Lesion removal colonoscopy ....................... 5.31 8.44 2.18 0.42 14.17 7.91 000 

45386 .......... ............ A Colonoscopy dilate stricture ........................ 4.58 13.23 1.91 0.39 18.20 6.88 000 

45387 .......... ............ A Colonoscopy w/stent ................................... 5.91 NA 2.50 0.48 NA 8.89 000 

45391 .......... ............ A Colonoscopy w/endoscope us .................... 5.10 NA 2.15 0.42 NA 7.67 000 

45392 .......... ............ A Colonoscopy w/endoscopic fnb ................... 6.55 NA 2.69 0.42 NA 9.66 000 

45500 .......... ............ A Repair of rectum .......................................... 7.29 NA 3.57 0.75 NA 11.61 090 

45505 .......... ............ A Repair of rectum .......................................... 7.59 NA 3.91 0.86 NA 12.36 090 

45520 .......... ............ A Treatment of rectal prolapse ....................... 0.55 1.77 0.40 0.05 2.37 1.00 000 

45540 .......... ............ A Correct rectal prolapse ................................ 16.28 NA 6.73 1.84 NA 24.85 090 

45541 .......... ............ A Correct rectal prolapse ................................ 13.41 NA 5.92 1.55 NA 20.88 090 

45550 .......... ............ A Repair rectum/remove sigmoid ................... 23.02 NA 9.11 2.61 NA 34.74 090 

45560 .......... ............ A Repair of rectocele ...................................... 10.58 NA 5.13 1.13 NA 16.84 090 

45562 .......... ............ A Exploration/repair of rectum ........................ 15.39 NA 7.05 1.83 NA 24.27 090 

45563 .......... ............ A Exploration/repair of rectum ........................ 23.48 NA 10.44 3.10 NA 37.02 090 

45800 .......... ............ A Repair rect/bladder fistula ........................... 17.78 NA 7.84 1.85 NA 27.46 090 

45805 .......... ............ A Repair fistula w/colostomy .......................... 20.79 NA 9.62 2.02 NA 32.43 090 

45820 .......... ............ A Repair rectourethral fistula .......................... 18.49 NA 8.03 1.58 NA 28.09 090 

45825 .......... ............ A Repair fistula w/colostomy .......................... 21.26 NA 9.95 2.31 NA 33.53 090 

45900 .......... ............ A Reduction of rectal prolapse ....................... 2.62 NA 1.50 0.30 NA 4.41 010 

45905 .......... ............ A Dilation of anal sphincter ............................. 2.30 NA 1.47 0.27 NA 4.05 010 

45910 .......... ............ A Dilation of rectal narrowing ......................... 2.81 NA 1.76 0.30 NA 4.86 010 

45915 .......... ............ A Remove rectal obstruction .......................... 3.15 4.28 2.06 0.30 7.72 5.51 010 

45999 .......... ............ C Rectum surgery procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

46020 .......... ............ A Placement of seton ..................................... 2.91 2.40 1.89 0.31 5.62 5.10 010 

46030 .......... ............ A Removal of rectal marker ............................ 1.23 1.41 0.72 0.14 2.78 2.09 010 

46040 .......... ............ A Incision of rectal abscess ............................ 4.96 5.50 3.59 0.62 11.08 9.17 090 

46045 .......... ............ A Incision of rectal abscess ............................ 4.32 NA 2.92 0.54 NA 7.78 090 

46050 .......... ............ A Incision of anal abscess .............................. 1.19 2.55 0.84 0.14 3.88 2.17 010 

46060 .......... ............ A Incision of rectal abscess ............................ 5.69 NA 3.28 0.67 NA 9.64 090 

46070 .......... ............ A Incision of anal septum ............................... 2.72 NA 1.86 0.36 NA 4.93 090 

46080 .......... ............ A Incision of anal sphincter ............................ 2.49 2.40 1.13 0.30 5.20 3.92 010 

46083 .......... ............ A Incise external hemorrhoid .......................... 1.40 2.46 0.91 0.15 4.01 2.47 010 

46200 .......... ............ A Removal of anal fissure .............................. 3.42 4.08 2.92 0.39 7.89 6.73 090 

46210 .......... ............ A Removal of anal crypt ................................. 2.68 5.04 2.65 0.31 8.02 5.64 090 

46211 .......... ............ A Removal of anal crypts ............................... 4.25 5.43 3.67 0.48 10.16 8.40 090 

46220 .......... ............ A Removal of anal tag .................................... 1.56 2.33 0.96 0.17 4.06 2.70 010 

46221 .......... ............ A Ligation of hemorrhoid(s) ............................ 2.04 2.71 1.77 0.23 4.98 4.05 010 

46230 .......... ............ A Removal of anal tags .................................. 2.58 3.06 1.29 0.30 5.94 4.17 010 

46250 .......... ............ A Hemorrhoidectomy ...................................... 3.89 5.25 2.60 0.48 9.62 6.97 090 

46255 .......... ............ A Hemorrhoidectomy ...................................... 4.60 5.85 2.82 0.58 11.03 8.00 090 

46257 .......... ............ A Remove hemorrhoids & fissure ................... 5.40 NA 2.89 0.64 NA 8.93 090 

46258 .......... ............ A Remove hemorrhoids & fistula .................... 5.73 NA 3.31 0.68 NA 9.72 090 

46260 .......... ............ A Hemorrhoidectomy ...................................... 6.37 NA 3.20 0.76 NA 10.33 090 

46261 .......... ............ A Remove hemorrhoids & fissure ................... 7.08 NA 3.64 0.79 NA 11.51 090 

46262 .......... ............ A Remove hemorrhoids & fistula .................... 7.50 NA 3.77 0.83 NA 12.10 090 

46270 .......... ............ A Removal of anal fistula ................................ 3.72 4.97 2.85 0.46 9.15 7.02 090 

46275 .......... ............ A Removal of anal fistula ................................ 4.56 4.76 3.00 0.52 9.84 8.08 090 

46280 .......... ............ A Removal of anal fistula ................................ 5.98 NA 3.29 0.66 NA 9.94 090 

46285 .......... ............ A Removal of anal fistula ................................ 4.09 3.95 2.77 0.44 8.48 7.30 090 

46288 .......... ............ A Repair anal fistula ....................................... 7.13 NA 3.69 0.79 NA 11.62 090 

46320 .......... ............ A Removal of hemorrhoid clot ........................ 1.61 2.12 0.84 0.18 3.91 2.63 010 

46500 .......... ............ A Injection into hemorrhoid(s) ......................... 1.61 2.26 1.26 0.16 4.04 3.04 010 

46600 .......... ............ A Diagnostic anoscopy ................................... 0.50 1.52 0.34 0.05 2.07 0.89 000 

46604 .......... ............ A Anoscopy and dilation ................................. 1.31 9.37 0.64 0.12 10.81 2.08 000 

46606 .......... ............ A Anoscopy and biopsy .................................. 0.81 3.69 0.44 0.09 4.59 1.34 000 

46608 .......... ............ A Anoscopy, remove for body ........................ 1.51 4.23 0.65 0.16 5.91 2.32 000 

46610 .......... ............ A Anoscopy, remove lesion ............................ 1.32 3.92 0.62 0.15 5.40 2.10 000 

46611 .......... ............ A Anoscopy ..................................................... 1.81 3.20 0.78 0.19 5.20 2.78 000 

46612 .......... ............ A Anoscopy, remove lesions .......................... 2.34 5.32 1.01 0.28 7.95 3.64 000 

46614 .......... ............ A Anoscopy, control bleeding ......................... 2.01 2.48 0.87 0.20 4.69 3.08 000 

46615 .......... ............ A Anoscopy ..................................................... 2.69 2.43 1.07 0.33 5.45 4.09 000 

46700 .......... ............ A Repair of anal stricture ................................ 9.14 NA 4.24 0.94 NA 14.32 090 

46705 .......... ............ A Repair of anal stricture ................................ 6.90 NA 3.77 0.91 NA 11.58 090 

46706 .......... ............ A Repr of anal fistula w/glue .......................... 2.39 0.00 1.27 0.28 2.67 3.94 010 

46715 .......... ............ A Rep perf anoper fistu .................................. 7.20 NA 3.63 0.92 NA 11.75 090 

46716 .......... ............ A Rep perf anoper/vestib fistu ........................ 15.08 NA 7.93 1.58 NA 24.59 090 

46730 .......... ............ A Construction of absent anus ....................... 26.76 NA 11.97 2.46 NA 41.19 090 

46735 .......... ............ A Construction of absent anus ....................... 32.18 NA 13.46 3.20 NA 48.85 090 

46740 .......... ............ A Construction of absent anus ....................... 30.02 NA 13.17 2.41 NA 45.60 090 

45926

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

46742 .......... ............ A Repair of imperforated anus ....................... 35.82 NA 16.88 3.19 NA 55.89 090 

46744 .......... ............ A Repair of cloacal anomaly ........................... 52.66 NA 21.39 6.38 NA 80.42 090 

46746 .......... ............ A Repair of cloacal anomaly ........................... 58.25 NA 24.73 7.68 NA 90.65 090 

46748 .......... ............ A Repair of cloacal anomaly ........................... 64.24 NA 25.56 3.36 NA 93.15 090 

46750 .......... ............ A Repair of anal sphincter .............................. 10.25 NA 5.05 1.10 NA 16.40 090 

46751 .......... ............ A Repair of anal sphincter .............................. 8.78 NA 5.23 0.94 NA 14.94 090 

46753 .......... ............ A Reconstruction of anus ............................... 8.30 NA 3.85 0.94 NA 13.08 090 

46754 .......... ............ A Removal of suture from anus ...................... 2.20 3.53 1.72 0.19 5.93 4.11 010 

46760 .......... ............ A Repair of anal sphincter .............................. 14.44 NA 7.10 1.59 NA 23.13 090 

46761 .......... ............ A Repair of anal sphincter .............................. 13.85 NA 6.00 1.43 NA 21.28 090 

46762 .......... ............ A Implant artificial sphincter ............................ 12.72 NA 5.77 1.24 NA 19.72 090 

46900 .......... ............ A Destruction, anal lesion(s) ........................... 1.91 2.72 1.33 0.17 4.80 3.41 010 

46910 .......... ............ A Destruction, anal lesion(s) ........................... 1.86 3.04 1.07 0.19 5.09 3.13 010 

46916 .......... ............ A Cryosurgery, anal lesion(s) ......................... 1.86 3.30 1.52 0.11 5.27 3.49 010 

46917 .......... ............ A Laser surgery, anal lesions ......................... 1.86 9.15 1.15 0.21 11.23 3.22 010 

46922 .......... ............ A Excision of anal lesion(s) ............................ 1.86 3.33 1.08 0.22 5.42 3.16 010 

46924 .......... ............ A Destruction, anal lesion(s) ........................... 2.77 8.93 1.36 0.26 11.95 4.39 010 

46934 .......... ............ A Destruction of hemorrhoids ......................... 3.51 5.32 3.23 0.32 9.14 7.06 090 

46935 .......... ............ A Destruction of hemorrhoids ......................... 2.43 3.49 1.25 0.23 6.15 3.91 010 

46936 .......... ............ A Destruction of hemorrhoids ......................... 3.69 5.13 2.63 0.34 9.16 6.66 090 

46937 .......... ............ A Cryotherapy of rectal lesion ........................ 2.70 3.09 1.23 0.14 5.92 4.07 010 

46938 .......... ............ A Cryotherapy of rectal lesion ........................ 4.66 4.24 3.08 0.58 9.48 8.32 090 

46940 .......... ............ A Treatment of anal fissure ............................ 2.32 2.08 1.10 0.23 4.63 3.65 010 

46942 .......... ............ A Treatment of anal fissure ............................ 2.04 1.94 1.07 0.19 4.17 3.31 010 

46945 .......... ............ A Ligation of hemorrhoids ............................... 1.84 3.37 2.65 0.19 5.41 4.69 090 

46946 .......... ............ A Ligation of hemorrhoids ............................... 2.59 3.73 2.58 0.27 6.59 5.44 090 

46947 .......... ............ A Hemorrhoidopexy by stapling ...................... 5.21 NA 2.73 0.75 NA 8.69 090 

46999 .......... ............ C Anus surgery procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

47000 .......... ............ A Needle biopsy of liver .................................. 1.90 4.66 0.66 0.12 6.69 2.69 000 

47001 .......... ............ A Needle biopsy, liver add-on ........................ 1.90 NA 0.64 0.25 NA 2.79 ZZZ 

47010 .......... ............ A Open drainage, liver lesion ......................... 16.02 NA 8.67 1.80 NA 26.49 090 

47011 .......... ............ A Percut drain, liver lesion .............................. 3.70 NA 1.27 0.22 NA 5.18 000 

47015 .......... ............ A Inject/aspirate liver cyst ............................... 15.12 NA 7.48 1.83 NA 24.43 090 

47100 .......... ............ A Wedge biopsy of liver .................................. 11.67 NA 5.98 1.53 NA 19.18 090 

47120 .......... ............ A Partial removal of liver ................................ 35.52 NA 14.87 4.65 NA 55.05 090 

47122 .......... ............ A Extensive removal of liver ........................... 55.16 NA 20.98 7.19 NA 83.33 090 

47125 .......... ............ A Partial removal of liver ................................ 49.22 NA 19.10 6.45 NA 74.76 090 

47130 .......... ............ A Partial removal of liver ................................ 53.38 NA 20.51 6.94 NA 80.83 090 

47135 .......... ............ R Transplantation of liver ................................ 81.56 NA 31.02 9.93 NA 122.51 090 

47136 .......... ............ R Transplantation of liver ................................ 68.64 NA 26.67 8.41 NA 103.72 090 

47140 .......... ............ A Partial removal, donor liver ......................... 55.03 NA 22.05 5.17 NA 82.25 090 

47141 .......... ............ A Partial removal, donor liver ......................... 67.53 NA 26.60 5.17 NA 99.30 090 

47142 .......... ............ A Partial removal, donor liver ......................... 75.04 NA 29.09 5.17 NA 109.30 090 

47143 .......... ............ C Prep donor liver, whole ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

47144 .......... ............ C Prep donor liver, 3-segment ........................ 0.00 0.00 0.00 0.00 0.00 0.00 090 

47145 .......... ............ C Prep donor liver, lobe split .......................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

47146 .......... ............ A Prep donor liver/venous .............................. 6.01 NA 2.00 0.83 NA 8.84 XXX 

47147 .......... ............ A Prep donor liver/arterial ............................... 7.01 NA 2.33 0.97 NA 10.32 XXX 

47300 .......... ............ A Surgery for liver lesion ................................ 15.09 NA 7.14 1.98 NA 24.21 090 

47350 .......... ............ A Repair liver wound ...................................... 19.57 NA 8.75 2.58 NA 30.90 090 

47360 .......... ............ A Repair liver wound ...................................... 26.93 NA 11.43 3.37 NA 41.73 090 

47361 .......... ............ A Repair liver wound ...................................... 47.14 NA 18.17 5.85 NA 71.16 090 

47362 .......... ............ A Repair liver wound ...................................... 18.52 NA 8.58 2.50 NA 29.60 090 

47370 .......... ............ A Laparo ablate liver tumor rf ......................... 19.70 NA 8.04 2.55 NA 30.29 090 

47371 .......... ............ A Laparo ablate liver cryosurg ........................ 19.70 NA 8.03 2.60 NA 30.33 090 

47379 .......... ............ C Laparoscope procedure, liver ...................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

47380 .......... ............ A Open ablate liver tumor rf ........................... 23.02 NA 9.22 2.86 NA 35.10 090 

47381 .......... ............ A Open ablate liver tumor cryo ....................... 23.29 NA 9.55 2.84 NA 35.68 090 

47382 .......... ............ A Percut ablate liver rf .................................... 15.20 NA 6.19 0.96 NA 22.35 010 

47399 .......... ............ C Liver surgery procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

47400 .......... ............ A Incision of liver duct .................................... 32.50 NA 13.33 3.07 NA 48.90 090 

47420 .......... ............ A Incision of bile duct ..................................... 19.89 NA 8.62 2.62 NA 31.13 090 

47425 .......... ............ A Incision of bile duct ..................................... 19.84 NA 8.70 2.61 NA 31.15 090 

47460 .......... ............ A Incise bile duct sphincter ............................. 18.05 NA 8.55 2.20 NA 28.80 090 

47480 .......... ............ A Incision of gallbladder ................................. 10.82 NA 5.85 1.42 NA 18.09 090 

47490 .......... ............ A Incision of gallbladder ................................. 7.23 NA 5.80 0.43 NA 13.47 090 

47500 .......... ............ A Injection for liver x-rays ............................... 1.96 NA 0.68 0.12 NA 2.76 000 

47505 .......... ............ A Injection for liver x-rays ............................... 0.76 NA 0.26 0.04 NA 1.06 000 

47510 .......... ............ A Insert catheter, bile duct .............................. 7.84 NA 5.27 0.46 NA 13.56 090 

47511 .......... ............ A Insert bile duct drain .................................... 10.50 NA 5.35 0.62 NA 16.47 090 

47525 .......... ............ A Change bile duct catheter ........................... 5.55 15.88 2.95 0.33 21.77 8.83 010 

47530 .......... ............ A Revise/reinsert bile tube .............................. 5.85 34.20 3.89 0.37 40.42 10.11 090 

47550 .......... ............ A Bile duct endoscopy add-on ........................ 3.03 NA 1.00 0.40 NA 4.42 ZZZ 

47552 .......... ............ A Biliary endoscopy thru skin ......................... 6.04 NA 2.43 0.42 NA 8.89 000 

45927

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

47553 .......... ............ A Biliary endoscopy thru skin ......................... 6.35 NA 2.17 0.37 NA 8.89 000 

47554 .......... ............ A Biliary endoscopy thru skin ......................... 9.07 NA 3.38 0.96 NA 13.41 000 

47555 .......... ............ A Biliary endoscopy thru skin ......................... 7.57 NA 2.60 0.45 NA 10.62 000 

47556 .......... ............ A Biliary endoscopy thru skin ......................... 8.57 NA 2.94 0.50 NA 12.01 000 

47560 .......... ............ A Laparoscopy w/cholangio ............................ 4.89 NA 1.63 0.65 NA 7.17 000 

47561 .......... ............ A Laparo w/cholangio/biopsy .......................... 5.18 NA 1.88 0.66 NA 7.72 000 

47562 .......... ............ A Laparoscopic cholecystectomy ................... 11.09 NA 4.93 1.46 NA 17.48 090 

47563 .......... ............ A Laparo cholecystectomy/graph ................... 11.94 NA 5.24 1.58 NA 18.76 090 

47564 .......... ............ A Laparo cholecystectomy/explr ..................... 14.24 NA 5.87 1.88 NA 21.99 090 

47570 .......... ............ A Laparo cholecystoenterostomy ................... 12.59 NA 5.31 1.65 NA 19.55 090 

47579 .......... ............ C Laparoscope proc, biliary ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

47600 .......... ............ A Removal of gallbladder ............................... 13.59 NA 6.04 1.79 NA 21.42 090 

47605 .......... ............ A Removal of gallbladder ............................... 14.70 NA 6.41 1.94 NA 23.04 090 

47610 .......... ............ A Removal of gallbladder ............................... 18.83 NA 7.80 2.48 NA 29.11 090 

47612 .......... ............ A Removal of gallbladder ............................... 18.79 NA 7.76 2.47 NA 29.01 090 

47620 .......... ............ A Removal of gallbladder ............................... 20.65 NA 8.37 2.73 NA 31.76 090 

47630 .......... ............ A Remove bile duct stone .............................. 9.12 NA 5.10 0.65 NA 14.86 090 

47700 .......... ............ A Exploration of bile ducts .............................. 15.63 NA 7.31 2.06 NA 25.00 090 

47701 .......... ............ A Bile duct revision ......................................... 27.83 NA 11.28 3.67 NA 42.77 090 

47711 .......... ............ A Excision of bile duct tumor .......................... 23.05 NA 9.75 3.04 NA 35.84 090 

47712 .......... ............ A Excision of bile duct tumor .......................... 30.25 NA 12.16 3.92 NA 46.33 090 

47715 .......... ............ A Excision of bile duct cyst ............................. 18.81 NA 8.31 2.48 NA 29.60 090 

47716 .......... ............ A Fusion of bile duct cyst ............................... 16.45 NA 7.69 2.14 NA 26.29 090 

47720 .......... ............ A Fuse gallbladder & bowel ............................ 15.92 NA 7.37 2.10 NA 25.39 090 

47721 .......... ............ A Fuse upper gi structures ............................. 19.13 NA 8.43 2.52 NA 30.08 090 

47740 .......... ............ A Fuse gallbladder & bowel ............................ 18.49 NA 8.24 2.41 NA 29.14 090 

47741 .......... ............ A Fuse gallbladder & bowel ............................ 21.35 NA 9.13 2.82 NA 33.31 090 

47760 .......... ............ A Fuse bile ducts and bowel .......................... 25.86 NA 10.66 3.41 NA 39.93 090 

47765 .......... ............ A Fuse liver ducts & bowel ............................. 24.89 NA 10.59 3.29 NA 38.77 090 

47780 .......... ............ A Fuse bile ducts and bowel .......................... 26.51 NA 11.02 3.49 NA 41.02 090 

47785 .......... ............ A Fuse bile ducts and bowel .......................... 31.19 NA 12.65 4.09 NA 47.93 090 

47800 .......... ............ A Reconstruction of bile ducts ........................ 23.32 NA 9.89 3.07 NA 36.27 090 

47801 .......... ............ A Placement, bile duct support ....................... 15.18 NA 8.39 1.16 NA 24.73 090 

47802 .......... ............ A Fuse liver duct & intestine ........................... 21.56 NA 9.49 2.85 NA 33.90 090 

47900 .......... ............ A Suture bile duct injury ................................. 19.91 NA 8.73 2.64 NA 31.28 090 

47999 .......... ............ C Bile tract surgery procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

48000 .......... ............ A Drainage of abdomen .................................. 28.09 NA 11.45 3.47 NA 43.01 090 

48001 .......... ............ A Placement of drain, pancreas ..................... 35.47 NA 13.61 4.68 NA 53.77 090 

48005 .......... ............ A Resect/debride pancreas ............................ 42.19 NA 16.29 5.54 NA 64.02 090 

48020 .......... ............ A Removal of pancreatic stone ...................... 15.71 NA 7.25 2.12 NA 25.09 090 

48100 .......... ............ A Biopsy of pancreas, open ........................... 12.23 NA 5.54 1.62 NA 19.39 090 

48102 .......... ............ A Needle biopsy, pancreas ............................. 4.68 8.56 2.01 0.28 13.52 6.97 010 

48120 .......... ............ A Removal of pancreas lesion ........................ 15.86 NA 6.81 2.09 NA 24.76 090 

48140 .......... ............ A Partial removal of pancreas ........................ 22.96 NA 9.40 3.02 NA 35.37 090 

48145 .......... ............ A Partial removal of pancreas ........................ 24.03 NA 9.69 3.17 NA 36.88 090 

48146 .......... ............ A Pancreatectomy ........................................... 26.41 NA 11.78 3.49 NA 41.68 090 

48148 .......... ............ A Removal of pancreatic duct ........................ 17.34 NA 7.48 2.29 NA 27.12 090 

48150 .......... ............ A Partial removal of pancreas ........................ 48.03 NA 19.10 6.30 NA 73.43 090 

48152 .......... ............ A Pancreatectomy ........................................... 43.77 NA 17.84 5.78 NA 67.39 090 

48153 .......... ............ A Pancreatectomy ........................................... 47.92 NA 19.14 6.29 NA 73.35 090 

48154 .......... ............ A Pancreatectomy ........................................... 44.12 NA 17.89 5.82 NA 67.83 090 

48155 .......... ............ A Removal of pancreas .................................. 24.65 NA 11.47 3.26 NA 39.38 090 

48160 .......... ............ N Pancreas removal/transplant ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

48180 .......... ............ A Fuse pancreas and bowel ........................... 24.73 NA 10.02 3.27 NA 38.02 090 

48400 .......... ............ A Injection, intraop add-on .............................. 1.95 NA 0.67 0.15 NA 2.77 ZZZ 

48500 .......... ............ A Surgery of pancreatic cyst .......................... 15.29 NA 7.24 2.02 NA 24.55 090 

48510 .......... ............ A Drain pancreatic pseudocyst ....................... 14.32 NA 7.52 1.82 NA 23.66 090 

48511 .......... ............ A Drain pancreatic pseudocyst ....................... 4.00 21.86 1.37 0.24 26.10 5.61 000 

48520 .......... ............ A Fuse pancreas cyst and bowel ................... 15.60 NA 6.62 2.05 NA 24.27 090 

48540 .......... ............ A Fuse pancreas cyst and bowel ................... 19.73 NA 7.98 2.60 NA 30.31 090 

48545 .......... ............ A Pancreatorrhaphy ........................................ 18.19 NA 7.86 2.37 NA 28.42 090 

48547 .......... ............ A Duodenal exclusion ..................................... 25.84 NA 10.33 3.41 NA 39.58 090 

48551 .......... ............ C Prep donor pancreas ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

48552 .......... ............ A Prep donor pancreas/venous ...................... 4.31 NA 1.44 0.31 NA 6.06 XXX 

48554 .......... ............ R Transpl allograft pancreas ........................... 34.19 NA 18.44 4.18 NA 56.81 090 

48556 .......... ............ A Removal, allograft pancreas ....................... 15.72 NA 8.08 2.07 NA 25.87 090 

48999 .......... ............ C Pancreas surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

49000 .......... ............ A Exploration of abdomen .............................. 11.68 NA 5.34 1.52 NA 18.54 090 

49002 .......... ............ A Reopening of abdomen ............................... 10.49 NA 4.98 1.37 NA 16.85 090 

49010 .......... ............ A Exploration behind abdomen ...................... 12.28 NA 5.89 1.51 NA 19.68 090 

49020 .......... ............ A Drain abdominal abscess ............................ 22.86 NA 10.37 2.84 NA 36.07 090 

49021 .......... ............ A Drain abdominal abscess ............................ 3.38 21.59 1.15 0.20 25.17 4.73 000 

49040 .......... ............ A Drain, open, abdom abscess ...................... 13.53 NA 6.52 1.69 NA 21.74 090 

49041 .......... ............ A Drain, percut, abdom abscess .................... 4.00 20.71 1.37 0.24 24.95 5.60 000 

45928

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

49060 .......... ............ A Drain, open, retrop abscess ........................ 15.87 NA 7.69 1.74 NA 25.30 090 

49061 .......... ............ A Drain, percut, retroper absc ........................ 3.70 20.47 1.27 0.22 24.39 5.18 000 

49062 .......... ............ A Drain to peritoneal cavity ............................ 11.36 NA 5.43 1.39 NA 18.18 090 

49080 .......... ............ A Puncture, peritoneal cavity .......................... 1.35 3.87 0.48 0.08 5.30 1.91 000 

49081 .......... ............ A Removal of abdominal fluid ......................... 1.26 2.80 0.45 0.09 4.15 1.80 000 

49085 .......... ............ A Remove abdomen foreign body .................. 12.14 NA 5.45 1.62 NA 19.22 090 

49180 .......... ............ A Biopsy, abdominal mass ............................. 1.73 3.17 0.60 0.10 5.00 2.43 000 

49200 .......... ............ A Removal of abdominal lesion ...................... 10.25 NA 5.04 1.24 NA 16.53 090 

49201 .......... ............ A Remove abdom lesion, complex ................. 14.85 NA 6.97 1.87 NA 23.69 090 

49215 .......... ............ A Excise sacral spine tumor ........................... 33.52 NA 13.82 4.37 NA 51.70 090 

49220 .......... ............ A Multiple surgery, abdomen .......................... 14.89 NA 6.56 1.88 NA 23.33 090 

49250 .......... ............ A Excision of umbilicus ................................... 8.36 NA 4.23 1.08 NA 13.67 090 

49255 .......... ............ A Removal of omentum .................................. 11.14 NA 5.56 1.43 NA 18.13 090 

49320 .......... ............ A Diag laparo separate proc ........................... 5.10 NA 2.61 0.65 NA 8.36 010 

49321 .......... ............ A Laparoscopy, biopsy ................................... 5.40 NA 2.62 0.70 NA 8.72 010 

49322 .......... ............ A Laparoscopy, aspiration .............................. 5.70 NA 2.95 0.71 NA 9.36 010 

49323 .......... ............ A Laparo drain lymphocele ............................. 9.49 NA 4.56 1.20 NA 15.25 090 

49329 .......... ............ C Laparo proc, abdm/per/oment ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

49400 .......... ............ A Air injection into abdomen ........................... 1.88 3.03 0.64 0.15 5.06 2.67 000 

49419 .......... ............ A Insrt abdom cath for chemotx ..................... 6.65 NA 3.52 0.81 NA 10.99 090 

49420 .......... ............ A Insert abdom drain, temp ............................ 2.22 NA 1.16 0.21 NA 3.59 000 

49421 .......... ............ A Insert abdom drain, perm ............................ 5.54 NA 3.12 0.74 NA 9.40 090 

49422 .......... ............ A Remove perm cannula/catheter .................. 6.25 NA 2.86 0.83 NA 9.94 010 

49423 .......... ............ A Exchange drainage catheter ....................... 1.46 14.27 0.55 0.09 15.82 2.10 000 

49424 .......... ............ A Assess cyst, contrast inject ......................... 0.76 3.70 0.31 0.04 4.50 1.11 000 

49425 .......... ............ A Insert abdomen-venous drain ..................... 11.37 NA 5.48 1.54 NA 18.40 090 

49426 .......... ............ A Revise abdomen-venous shunt ................... 9.64 NA 4.71 1.28 NA 15.63 090 

49427 .......... ............ A Injection, abdominal shunt .......................... 0.89 NA 0.31 0.07 NA 1.27 000 

49428 .......... ............ A Ligation of shunt .......................................... 6.06 NA 3.73 0.80 NA 10.59 010 

49429 .......... ............ A Removal of shunt ........................................ 7.40 NA 3.35 1.02 NA 11.77 010 

49491 .......... ............ A Rpr hern preemie reduc .............................. 11.13 NA 5.10 1.40 NA 17.63 090 

49492 .......... ............ A Rpr ing hern premie, blocked ...................... 14.04 NA 6.08 1.80 NA 21.92 090 

49495 .......... ............ A Rpr ing hernia baby, reduc ......................... 5.89 NA 2.97 0.74 NA 9.60 090 

49496 .......... ............ A Rpr ing hernia baby, blocked ...................... 8.80 NA 4.26 1.07 NA 14.13 090 

49500 .......... ............ A Rpr ing hernia, init, reduce .......................... 5.48 NA 3.18 0.71 NA 9.37 090 

49501 .......... ............ A Rpr ing hernia, init blocked ......................... 8.89 NA 4.19 1.12 NA 14.20 090 

49505 .......... ............ A Prp i/hern init reduc >5 yr ........................... 7.61 NA 3.73 1.03 NA 12.37 090 

49507 .......... ............ A Prp i/hern init block >5 yr ............................ 9.58 NA 4.42 1.27 NA 15.27 090 

49520 .......... ............ A Rerepair ing hernia, reduce ........................ 9.64 NA 4.40 1.28 NA 15.32 090 

49521 .......... ............ A Rerepair ing hernia, blocked ....................... 11.97 NA 5.18 1.59 NA 18.75 090 

49525 .......... ............ A Repair ing hernia, sliding ............................ 8.58 NA 4.06 1.13 NA 13.77 090 

49540 .......... ............ A Repair lumbar hernia ................................... 10.39 NA 4.70 1.37 NA 16.47 090 

49550 .......... ............ A Rpr rem hernia, init, reduce ........................ 8.64 NA 4.09 1.14 NA 13.87 090 

49553 .......... ............ A Rpr fem hernia, init blocked ........................ 9.45 NA 4.38 1.24 NA 15.07 090 

49555 .......... ............ A Rerepair fem hernia, reduce ....................... 9.04 NA 4.23 1.20 NA 14.47 090 

49557 .......... ............ A Rerepair fem hernia, blocked ...................... 11.15 NA 4.93 1.47 NA 17.56 090 

49560 .......... ............ A Rpr ventral hern init, reduc ......................... 11.57 NA 5.09 1.52 NA 18.18 090 

49561 .......... ............ A Rpr ventral hern init, block .......................... 14.26 NA 5.98 1.88 NA 22.12 090 

49565 .......... ............ A Rerepair ventrl hern, reduce ....................... 11.57 NA 5.16 1.52 NA 18.25 090 

49566 .......... ............ A Rerepair ventrl hern, block .......................... 14.41 NA 6.05 1.90 NA 22.36 090 

49568 .......... ............ A Hernia repair w/mesh .................................. 4.89 NA 1.63 0.64 NA 7.16 ZZZ 

49570 .......... ............ A Rpr epigastric hern, reduce ......................... 5.69 NA 3.15 0.75 NA 9.59 090 

49572 .......... ............ A Rpr epigastric hern, blocked ....................... 6.73 NA 3.44 0.88 NA 11.06 090 

49580 .......... ............ A Rpr umbil hern, reduc < 5 yr ....................... 4.11 NA 2.58 0.54 NA 7.23 090 

49582 .......... ............ A Rpr umbil hern, block < 5 yr ....................... 6.65 NA 3.45 0.88 NA 10.99 090 

49585 .......... ............ A Rpr umbil hern, reduc > 5 yr ....................... 6.23 NA 3.28 0.82 NA 10.34 090 

49587 .......... ............ A Rpr umbil hern, block > 5 yr ....................... 7.57 NA 3.71 0.99 NA 12.27 090 

49590 .......... ............ A Repair spigelian hernia ............................... 8.55 NA 4.06 1.13 NA 13.73 090 

49600 .......... ............ A Repair umbilical lesion ................................ 10.96 NA 5.26 1.32 NA 17.54 090 

49605 .......... ............ A Repair umbilical lesion ................................ 76.04 NA 27.99 9.36 NA 113.39 090 

49606 .......... ............ A Repair umbilical lesion ................................ 18.61 NA 7.55 2.45 NA 28.60 090 

49610 .......... ............ A Repair umbilical lesion ................................ 10.50 NA 5.11 1.07 NA 16.68 090 

49611 .......... ............ A Repair umbilical lesion ................................ 8.93 NA 6.74 0.78 NA 16.45 090 

49650 .......... ............ A Laparo hernia repair initial .......................... 6.27 NA 3.18 0.93 NA 10.38 090 

49651 .......... ............ A Laparo hernia repair recur .......................... 8.25 NA 4.03 1.14 NA 13.41 090 

49659 .......... ............ C Laparo proc, hernia repair ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

49900 .......... ............ A Repair of abdominal wall ............................. 12.28 NA 6.21 1.62 NA 20.12 090 

49904 .......... ............ A Omental flap, extra-abdom .......................... 20.01 NA 14.59 2.69 NA 37.29 090 

49905 .......... ............ A Omental flap, intra-abdom ........................... 6.55 NA 2.26 0.75 NA 9.57 ZZZ 

49906 .......... ............ C Free omental flap, microvasc ...................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

49999 .......... ............ C Abdomen surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

50010 .......... ............ A Exploration of kidney ................................... 10.98 NA 5.82 0.93 NA 17.74 090 

50020 .......... ............ A Renal abscess, open drain ......................... 14.67 NA 8.25 1.34 NA 24.26 090 

50021 .......... ............ A Renal abscess, percut drain ....................... 3.38 22.82 1.16 0.20 26.39 4.74 000 

45929

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

50040 .......... ............ A Drainage of kidney ...................................... 14.95 NA 7.61 1.03 NA 23.59 090 

50045 .......... ............ A Exploration of kidney ................................... 15.47 NA 7.41 1.24 NA 24.12 090 

50060 .......... ............ A Removal of kidney stone ............................. 19.31 NA 9.10 1.36 NA 29.76 090 

50065 .......... ............ A Incision of kidney ......................................... 20.80 NA 6.01 1.59 NA 28.40 090 

50070 .......... ............ A Incision of kidney ......................................... 20.33 NA 9.43 1.44 NA 31.20 090 

50075 .......... ............ A Removal of kidney stone ............................. 25.35 NA 11.47 1.80 NA 38.62 090 

50080 .......... ............ A Removal of kidney stone ............................. 14.72 NA 7.28 1.04 NA 23.04 090 

50081 .......... ............ A Removal of kidney stone ............................. 21.81 NA 10.27 1.54 NA 33.62 090 

50100 .......... ............ A Revise kidney blood vessels ....................... 16.10 NA 7.67 2.06 NA 25.83 090 

50120 .......... ............ A Exploration of kidney ................................... 15.92 NA 7.79 1.21 NA 24.92 090 

50125 .......... ............ A Explore and drain kidney ............................ 16.53 NA 7.75 1.43 NA 25.71 090 

50130 .......... ............ A Removal of kidney stone ............................. 17.29 NA 8.29 1.22 NA 26.81 090 

50135 .......... ............ A Exploration of kidney ................................... 19.19 NA 8.99 1.33 NA 29.51 090 

50200 .......... ............ A Biopsy of kidney .......................................... 2.64 NA 1.32 0.16 NA 4.11 000 

50205 .......... ............ A Biopsy of kidney .......................................... 11.31 NA 5.32 1.30 NA 17.93 090 

50220 .......... ............ A Remove kidney, open ................................. 17.15 NA 8.12 1.35 NA 26.63 090 

50225 .......... ............ A Removal kidney open, complex .................. 20.24 NA 9.34 1.50 NA 31.08 090 

50230 .......... ............ A Removal kidney open, radical ..................... 22.08 NA 9.88 1.55 NA 33.51 090 

50234 .......... ............ A Removal of kidney & ureter ........................ 22.41 NA 10.18 1.59 NA 34.19 090 

50236 .......... ............ A Removal of kidney & ureter ........................ 24.87 NA 11.78 1.76 NA 38.41 090 

50240 .......... ............ A Partial removal of kidney ............................. 22.01 NA 10.38 1.55 NA 33.94 090 

50280 .......... ............ A Removal of kidney lesion ............................ 15.68 NA 7.62 1.19 NA 24.49 090 

50290 .......... ............ A Removal of kidney lesion ............................ 14.74 NA 6.95 1.41 NA 23.10 090 

50320 .......... ............ A Remove kidney, living donor ....................... 22.22 NA 11.43 2.35 NA 36.00 090 

50323 .......... ............ C Prep cadaver renal allograft ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

50325 .......... ............ C Prep donor renal graft ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

50327 .......... ............ A Prep renal graft/venous ............................... 4.01 NA 1.35 0.29 NA 5.65 XXX 

50328 .......... ............ A Prep renal graft/arterial ............................... 3.51 NA 1.18 0.26 NA 4.95 XXX 

50329 .......... ............ A Prep renal graft/ureteral .............................. 3.35 NA 1.13 0.25 NA 4.73 XXX 

50340 .......... ............ A Removal of kidney ....................................... 12.15 NA 6.71 1.65 NA 20.51 090 

50360 .......... ............ A Transplantation of kidney ............................ 31.54 NA 15.94 3.81 NA 51.29 090 

50365 .......... ............ A Transplantation of kidney ............................ 36.82 NA 18.27 4.42 NA 59.52 090 

50370 .......... ............ A Remove transplanted kidney ....................... 13.73 NA 7.40 1.67 NA 22.80 090 

50380 .......... ............ A Reimplantation of kidney ............................. 20.77 NA 12.41 2.50 NA 35.69 090 

50390 .......... ............ A Drainage of kidney lesion ............................ 1.96 NA 0.68 0.12 NA 2.76 000 

50391 .......... ............ A Instll rx agnt into rnal tub ............................ 1.96 1.68 0.74 0.14 3.79 2.85 000 

50392 .......... ............ A Insert kidney drain ....................................... 3.38 NA 1.61 0.20 NA 5.18 000 

50393 .......... ............ A Insert ureteral tube ...................................... 4.16 NA 1.88 0.25 NA 6.29 000 

50394 .......... ............ A Injection for kidney x-ray ............................. 0.76 2.72 0.70 0.05 3.53 1.51 000 

50395 .......... ............ A Create passage to kidney ........................... 3.38 NA 1.61 0.21 NA 5.19 000 

50396 .......... ............ A Measure kidney pressure ............................ 2.09 NA 1.15 0.13 NA 3.38 000 

50398 .......... ............ A Change kidney tube .................................... 1.46 16.40 0.55 0.09 17.95 2.10 000 

50400 .......... ............ A Revision of kidney/ureter ............................. 19.51 NA 9.04 1.38 NA 29.93 090 

50405 .......... ............ A Revision of kidney/ureter ............................. 23.94 NA 10.26 1.78 NA 35.98 090 

50500 .......... ............ A Repair of kidney wound .............................. 19.58 NA 8.86 2.01 NA 30.45 090 

50520 .......... ............ A Close kidney-skin fistula .............................. 17.23 NA 8.35 1.49 NA 27.07 090 

50525 .......... ............ A Repair renal-abdomen fistula ...................... 22.28 NA 9.57 1.83 NA 33.68 090 

50526 .......... ............ A Repair renal-abdomen fistula ...................... 24.03 NA 10.40 1.96 NA 36.38 090 

50540 .......... ............ A Revision of horseshoe kidney ..................... 19.94 NA 8.96 1.36 NA 30.26 090 

50541 .......... ............ A Laparo ablate renal cyst .............................. 16.01 NA 7.41 1.13 NA 24.55 090 

50542 .......... ............ A Laparo ablate renal mass ........................... 20.01 NA 9.49 1.39 NA 30.89 090 

50543 .......... ............ A Laparo partial nephrectomy ........................ 25.51 NA 11.90 1.80 NA 39.21 090 

50544 .......... ............ A Laparoscopy, pyeloplasty ............................ 22.41 NA 9.75 1.58 NA 33.74 090 

50545 .......... ............ A Laparo radical nephrectomy ........................ 24.01 NA 10.60 1.70 NA 36.31 090 

50546 .......... ............ A Laparoscopic nephrectomy ......................... 20.49 NA 9.49 1.57 NA 31.55 090 

50547 .......... ............ A Laparo removal donor kidney ..................... 25.51 NA 11.70 2.76 NA 39.97 090 

50548 .......... ............ A Laparo remove w/ureter .............................. 24.41 NA 10.57 1.72 NA 36.70 090 

50549 .......... ............ C Laparoscope proc, renal ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

50551 .......... ............ A Kidney endoscopy ....................................... 5.60 4.47 2.34 0.40 10.48 8.35 000 

50553 .......... ............ A Kidney endoscopy ....................................... 5.99 4.72 2.52 0.39 11.11 8.90 000 

50555 .......... ............ A Kidney endoscopy & biopsy ........................ 6.53 5.03 2.69 0.45 12.01 9.67 000 

50557 .......... ............ A Kidney endoscopy & treatment ................... 6.62 5.04 2.73 0.47 12.13 9.82 000 

50561 .......... ............ A Kidney endoscopy & treatment ................... 7.60 5.51 3.09 0.54 13.64 11.22 000 

50562 .......... ............ A Renal scope w/tumor resect ....................... 10.92 NA 4.95 0.73 NA 16.60 090 

50570 .......... ............ A Kidney endoscopy ....................................... 9.55 NA 3.81 0.68 NA 14.04 000 

50572 .......... ............ A Kidney endoscopy ....................................... 10.35 NA 4.07 0.85 NA 15.27 000 

50574 .......... ............ A Kidney endoscopy & biopsy ........................ 11.02 NA 4.37 0.77 NA 16.16 000 

50575 .......... ............ A Kidney endoscopy ....................................... 13.99 NA 5.49 0.99 NA 20.46 000 

50576 .......... ............ A Kidney endoscopy & treatment ................... 10.99 NA 4.34 0.78 NA 16.11 000 

50580 .......... ............ A Kidney endoscopy & treatment ................... 11.86 NA 4.69 0.83 NA 17.38 000 

50590 .......... ............ A Fragmenting of kidney stone ....................... 9.10 13.68 4.92 0.65 23.43 14.67 090 

50600 .......... ............ A Exploration of ureter .................................... 15.85 NA 7.56 1.13 NA 24.54 090 

50605 .......... ............ A Insert ureteral support ................................. 15.47 NA 7.37 1.45 NA 24.29 090 

50610 .......... ............ A Removal of ureter stone .............................. 15.93 NA 7.84 1.43 NA 25.20 090 

45930

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

50620 .......... ............ A Removal of ureter stone .............................. 15.17 NA 7.35 1.07 NA 23.59 090 

50630 .......... ............ A Removal of ureter stone .............................. 14.95 NA 7.26 1.09 NA 23.30 090 

50650 .......... ............ A Removal of ureter ........................................ 17.41 NA 8.32 1.23 NA 26.97 090 

50660 .......... ............ A Removal of ureter ........................................ 19.56 NA 9.17 1.38 NA 30.11 090 

50684 .......... ............ A Injection for ureter x-ray .............................. 0.76 4.95 0.55 0.05 5.76 1.37 000 

50686 .......... ............ A Measure ureter pressure ............................. 1.51 3.46 0.88 0.11 5.08 2.50 000 

50688 .......... ............ A Change of ureter tube ................................. 1.17 NA 1.12 0.07 NA 2.37 010 

50690 .......... ............ A Injection for ureter x-ray .............................. 1.16 1.88 0.78 0.07 3.12 2.02 000 

50700 .......... ............ A Revision of ureter ........................................ 15.22 NA 7.83 1.27 NA 24.32 090 

50715 .......... ............ A Release of ureter ......................................... 18.91 NA 8.92 2.13 NA 29.96 090 

50722 .......... ............ A Release of ureter ......................................... 16.36 NA 7.93 1.90 NA 26.19 090 

50725 .......... ............ A Release/revise ureter .................................. 18.50 NA 8.71 1.52 NA 28.73 090 

50727 .......... ............ A Revise ureter ............................................... 8.19 NA 4.89 0.61 NA 13.68 090 

50728 .......... ............ A Revise ureter ............................................... 12.02 NA 6.12 1.00 NA 19.15 090 

50740 .......... ............ A Fusion of ureter & kidney ............................ 18.43 NA 8.33 1.96 NA 28.72 090 

50750 .......... ............ A Fusion of ureter & kidney ............................ 19.52 NA 9.27 1.38 NA 30.17 090 

50760 .......... ............ A Fusion of ureters ......................................... 18.43 NA 8.59 1.55 NA 28.56 090 

50770 .......... ............ A Splicing of ureters ....................................... 19.52 NA 9.08 1.45 NA 30.05 090 

50780 .......... ............ A Reimplant ureter in bladder ......................... 18.37 NA 8.59 1.51 NA 28.47 090 

50782 .......... ............ A Reimplant ureter in bladder ......................... 19.55 NA 9.12 1.61 NA 30.28 090 

50783 .......... ............ A Reimplant ureter in bladder ......................... 20.56 NA 9.37 1.98 NA 31.91 090 

50785 .......... ............ A Reimplant ureter in bladder ......................... 20.53 NA 9.44 1.45 NA 31.42 090 

50800 .......... ............ A Implant ureter in bowel ................................ 14.53 NA 7.37 1.19 NA 23.09 090 

50810 .......... ............ A Fusion of ureter & bowel ............................. 20.06 NA 9.22 2.31 NA 31.59 090 

50815 .......... ............ A Urine shunt to intestine ............................... 19.94 NA 9.51 1.54 NA 30.99 090 

50820 .......... ............ A Construct bowel bladder ............................. 21.90 NA 9.64 1.89 NA 33.44 090 

50825 .......... ............ A Construct bowel bladder ............................. 28.20 NA 12.72 2.07 NA 42.98 090 

50830 .......... ............ A Revise urine flow ......................................... 31.29 NA 13.62 2.37 NA 47.28 090 

50840 .......... ............ A Replace ureter by bowel ............................. 20.01 NA 9.67 1.47 NA 31.15 090 

50845 .......... ............ A Appendico-vesicostomy ............................... 20.90 NA 10.32 1.57 NA 32.79 090 

50860 .......... ............ A Transplant ureter to skin ............................. 15.37 NA 7.50 1.29 NA 24.16 090 

50900 .......... ............ A Repair of ureter ........................................... 13.63 NA 6.74 1.14 NA 21.51 090 

50920 .......... ............ A Closure ureter/skin fistula ............................ 14.34 NA 7.23 1.01 NA 22.58 090 

50930 .......... ............ A Closure ureter/bowel fistula ......................... 18.73 NA 8.70 1.28 NA 28.71 090 

50940 .......... ............ A Release of ureter ......................................... 14.52 NA 7.19 1.26 NA 22.97 090 

50945 .......... ............ A Laparoscopy ureterolithotomy ..................... 17.00 NA 8.00 1.36 NA 26.37 090 

50947 .......... ............ A Laparo new ureter/bladder .......................... 24.51 NA 11.02 2.16 NA 37.69 090 

50948 .......... ............ A Laparo new ureter/bladder .......................... 22.51 NA 9.77 1.70 NA 33.99 090 

50949 .......... ............ C Laparoscope proc, ureter ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

50951 .......... ............ A Endoscopy of ureter .................................... 5.84 4.63 2.43 0.41 10.88 8.68 000 

50953 .......... ............ A Endoscopy of ureter .................................... 6.24 4.79 2.81 0.43 11.46 9.49 000 

50955 .......... ............ A Ureter endoscopy & biopsy ......................... 6.75 6.34 3.09 0.48 13.58 10.32 000 

50957 .......... ............ A Ureter endoscopy & treatment .................... 6.79 4.97 2.79 0.48 12.24 10.06 000 

50961 .......... ............ A Ureter endoscopy & treatment .................... 6.05 4.74 2.53 0.41 11.20 8.99 000 

50970 .......... ............ A Ureter endoscopy ........................................ 7.14 NA 2.91 0.52 NA 10.57 000 

50972 .......... ............ A Ureter endoscopy & catheter ...................... 6.89 NA 2.84 0.49 NA 10.23 000 

50974 .......... ............ A Ureter endoscopy & biopsy ......................... 9.18 NA 3.63 0.64 NA 13.45 000 

50976 .......... ............ A Ureter endoscopy & treatment .................... 9.05 NA 3.62 0.66 NA 13.33 000 

50980 .......... ............ A Ureter endoscopy & treatment .................... 6.85 NA 2.80 0.48 NA 10.13 000 

51000 .......... ............ A Drainage of bladder ..................................... 0.78 1.80 0.26 0.05 2.63 1.09 000 

51005 .......... ............ A Drainage of bladder ..................................... 1.02 4.33 0.36 0.10 5.45 1.48 000 

51010 .......... ............ A Drainage of bladder ..................................... 3.53 5.61 2.03 0.28 9.42 5.83 010 

51020 .......... ............ A Incise & treat bladder .................................. 6.71 NA 4.32 0.47 NA 11.50 090 

51030 .......... ............ A Incise & treat bladder .................................. 6.77 NA 4.37 0.58 NA 11.72 090 

51040 .......... ............ A Incise & drain bladder ................................. 4.40 NA 3.13 0.31 NA 7.84 090 

51045 .......... ............ A Incise bladder/drain ureter .......................... 6.77 NA 4.21 0.52 NA 11.50 090 

51050 .......... ............ A Removal of bladder stone ........................... 6.92 NA 4.21 0.49 NA 11.62 090 

51060 .......... ............ A Removal of ureter stone .............................. 8.86 NA 5.16 0.62 NA 14.64 090 

51065 .......... ............ A Remove ureter calculus .............................. 8.86 NA 5.01 0.63 NA 14.50 090 

51080 .......... ............ A Drainage of bladder abscess ...................... 5.96 NA 3.93 0.43 NA 10.32 090 

51500 .......... ............ A Removal of bladder cyst ............................. 10.14 NA 5.26 1.03 NA 16.43 090 

51520 .......... ............ A Removal of bladder lesion .......................... 9.30 NA 5.29 0.69 NA 15.28 090 

51525 .......... ............ A Removal of bladder lesion .......................... 13.98 NA 7.05 0.99 NA 22.01 090 

51530 .......... ............ A Removal of bladder lesion .......................... 12.38 NA 6.32 1.05 NA 19.76 090 

51535 .......... ............ A Repair of ureter lesion ................................. 12.58 NA 6.54 1.23 NA 20.35 090 

51550 .......... ............ A Partial removal of bladder ........................... 15.67 NA 7.46 1.31 NA 24.44 090 

51555 .......... ............ A Partial removal of bladder ........................... 21.24 NA 9.74 1.69 NA 32.68 090 

51565 .......... ............ A Revise bladder & ureter(s) .......................... 21.63 NA 10.17 1.63 NA 33.44 090 

51570 .......... ............ A Removal of bladder ..................................... 24.25 NA 11.12 1.71 NA 37.08 090 

51575 .......... ............ A Removal of bladder & nodes ...................... 30.46 NA 13.75 2.16 NA 46.37 090 

51580 .......... ............ A Remove bladder/revise tract ....................... 31.09 NA 14.21 2.24 NA 47.54 090 

51585 .......... ............ A Removal of bladder & nodes ...................... 35.25 NA 15.79 2.48 NA 53.52 090 

51590 .......... ............ A Remove bladder/revise tract ....................... 32.68 NA 14.45 2.27 NA 49.39 090 

51595 .......... ............ A Remove bladder/revise tract ....................... 37.15 NA 16.33 2.59 NA 56.08 090 

45931

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

51596 .......... ............ A Remove bladder/create pouch .................... 39.54 NA 17.59 2.77 NA 59.90 090 

51597 .......... ............ A Removal of pelvic structures ....................... 38.37 NA 16.73 2.81 NA 57.90 090 

51600 .......... ............ A Injection for bladder x-ray ........................... 0.88 5.08 0.32 0.06 6.02 1.26 000 

51605 .......... ............ A Preparation for bladder xray ....................... 0.64 NA 0.39 0.04 NA 1.07 000 

51610 .......... ............ A Injection for bladder x-ray ........................... 1.05 2.29 0.68 0.07 3.41 1.80 000 

51700 .......... ............ A Irrigation of bladder ..................................... 0.88 1.65 0.32 0.06 2.59 1.26 000 

51701 .......... ............ A Insert bladder catheter ................................ 0.50 1.55 0.20 0.04 2.09 0.74 000 

51702 .......... ............ A Insert temp bladder cath ............................. 0.50 2.06 0.25 0.04 2.60 0.79 000 

51703 .......... ............ A Insert bladder cath, complex ....................... 1.47 2.77 0.67 0.10 4.35 2.24 000 

51705 .......... ............ A Change of bladder tube .............................. 1.02 2.31 0.69 0.07 3.41 1.79 010 

51710 .......... ............ A Change of bladder tube .............................. 1.49 3.37 0.92 0.11 4.97 2.53 010 

51715 .......... ............ A Endoscopic injection/implant ....................... 3.74 NA 1.59 0.29 NA 5.61 000 

51720 .......... ............ A Treatment of bladder lesion ........................ 1.96 1.86 0.81 0.14 3.97 2.92 000 

51725 .......... ............ A Simple cystometrogram ............................... 1.51 5.51 NA 0.16 7.19 NA 000 

51725 .......... 26 ....... A Simple cystometrogram ............................... 1.51 0.57 0.57 0.12 2.20 2.20 000 

51725 .......... TC ...... A Simple cystometrogram ............................... 0.00 4.94 NA 0.04 4.98 NA 000 

51726 .......... ............ A Complex cystometrogram ........................... 1.71 7.56 NA 0.18 9.45 NA 000 

51726 .......... 26 ....... A Complex cystometrogram ........................... 1.71 0.65 0.65 0.13 2.49 2.49 000 

51726 .......... TC ...... A Complex cystometrogram ........................... 0.00 6.91 NA 0.05 6.96 NA 000 

51736 .......... ............ A Urine flow measurement ............................. 0.61 0.66 NA 0.06 1.33 NA 000 

51736 .......... 26 ....... A Urine flow measurement ............................. 0.61 0.23 0.23 0.05 0.89 0.89 000 

51736 .......... TC ...... A Urine flow measurement ............................. 0.00 0.43 NA 0.01 0.44 NA 000 

51741 .......... ............ A Electro-uroflowmetry, first ............................ 1.14 0.92 NA 0.11 2.17 NA 000 

51741 .......... 26 ....... A Electro-uroflowmetry, first ............................ 1.14 0.43 0.43 0.09 1.66 1.66 000 

51741 .......... TC ...... A Electro-uroflowmetry, first ............................ 0.00 0.49 NA 0.02 0.51 NA 000 

51772 .......... ............ A Urethra pressure profile .............................. 1.61 5.53 NA 0.20 7.34 NA 000 

51772 .......... 26 ....... A Urethra pressure profile .............................. 1.61 0.61 0.61 0.15 2.37 2.37 000 

51772 .......... TC ...... A Urethra pressure profile .............................. 0.00 4.91 NA 0.05 4.96 NA 000 

51784 .......... ............ A Anal/urinary muscle study ........................... 1.53 4.03 NA 0.16 5.73 NA 000 

51784 .......... 26 ....... A Anal/urinary muscle study ........................... 1.53 0.57 0.57 0.12 2.23 2.23 000 

51784 .......... TC ...... A Anal/urinary muscle study ........................... 0.00 3.46 NA 0.04 3.50 NA 000 

51785 .......... ............ A Anal/urinary muscle study ........................... 1.53 4.52 NA 0.15 6.21 NA 000 

51785 .......... 26 ....... A Anal/urinary muscle study ........................... 1.53 0.58 0.58 0.11 2.22 2.22 000 

51785 .......... TC ...... A Anal/urinary muscle study ........................... 0.00 3.95 NA 0.04 3.99 NA 000 

51792 .......... ............ A Urinary reflex study ..................................... 1.10 5.83 NA 0.20 7.13 NA 000 

51792 .......... 26 ....... A Urinary reflex study ..................................... 1.10 0.43 0.43 0.07 1.61 1.61 000 

51792 .......... TC ...... A Urinary reflex study ..................................... 0.00 5.39 NA 0.13 5.52 NA 000 

51795 .......... ............ A Urine voiding pressure study ...................... 1.53 7.32 NA 0.22 9.08 NA 000 

51795 .......... 26 ....... A Urine voiding pressure study ...................... 1.53 0.58 0.58 0.12 2.23 2.23 000 

51795 .......... TC ...... A Urine voiding pressure study ...................... 0.00 6.75 NA 0.10 6.85 NA 000 

51797 .......... ............ A Intraabdominal pressure test ....................... 1.60 5.74 NA 0.17 7.51 NA 000 

51797 .......... 26 ....... A Intraabdominal pressure test ....................... 1.60 0.61 0.61 0.12 2.33 2.33 000 

51797 .......... TC ...... A Intraabdominal pressure test ....................... 0.00 5.13 NA 0.05 5.18 NA 000 

51798 .......... ............ A Us urine capacity measure ......................... 0.00 0.39 NA 0.08 0.47 NA XXX 

51800 .......... ............ A Revision of bladder/urethra ......................... 17.42 NA 8.48 1.32 NA 27.22 090 

51820 .......... ............ A Revision of urinary tract .............................. 17.90 NA 8.52 1.74 NA 28.16 090 

51840 .......... ............ A Attach bladder/urethra ................................. 10.71 NA 5.82 1.06 NA 17.59 090 

51841 .......... ............ A Attach bladder/urethra ................................. 13.04 NA 6.70 1.24 NA 20.97 090 

51845 .......... ............ A Repair bladder neck .................................... 9.74 NA 5.32 0.79 NA 15.85 090 

51860 .......... ............ A Repair of bladder wound ............................. 12.02 NA 6.15 1.16 NA 19.33 090 

51865 .......... ............ A Repair of bladder wound ............................. 15.05 NA 7.37 1.23 NA 23.65 090 

51880 .......... ............ A Repair of bladder opening ........................... 7.67 NA 4.26 0.72 NA 12.64 090 

51900 .......... ............ A Repair bladder/vagina lesion ....................... 12.98 NA 6.71 1.21 NA 20.90 090 

51920 .......... ............ A Close bladder-uterus fistula ........................ 11.81 NA 6.19 1.18 NA 19.18 090 

51925 .......... ............ A Hysterectomy/bladder repair ....................... 15.59 NA 8.45 2.03 NA 26.08 090 

51940 .......... ............ A Correction of bladder defect ........................ 28.45 NA 12.82 2.14 NA 43.40 090 

51960 .......... ............ A Revision of bladder & bowel ....................... 23.03 NA 11.01 1.63 NA 35.67 090 

51980 .......... ............ A Construct bladder opening .......................... 11.36 NA 6.10 0.86 NA 18.33 090 

51990 .......... ............ A Laparo urethral suspension ......................... 12.50 NA 6.34 1.39 NA 20.23 090 

51992 .......... ............ A Laparo sling operation ................................. 14.02 NA 6.88 1.41 NA 22.30 090 

52000 .......... ............ A Cystoscopy .................................................. 2.01 3.39 0.90 0.14 5.55 3.06 000 

52001 .......... ............ A Cystoscopy, removal of clots ...................... 5.45 5.34 2.21 0.39 11.18 8.06 000 

52005 .......... ............ A Cystoscopy & ureter catheter ...................... 2.37 5.72 1.07 0.17 8.26 3.62 000 

52007 .......... ............ A Cystoscopy and biopsy ............................... 3.03 16.13 1.38 0.22 19.37 4.62 000 

52010 .......... ............ A Cystoscopy & duct catheter ........................ 3.03 10.59 1.37 0.21 13.83 4.61 000 

52204 .......... ............ A Cystoscopy .................................................. 2.37 14.04 1.08 0.17 16.59 3.63 000 

52214 .......... ............ A Cystoscopy and treatment .......................... 3.71 36.60 1.59 0.26 40.57 5.56 000 

52224 .......... ............ A Cystoscopy and treatment .......................... 3.15 34.94 1.38 0.22 38.31 4.74 000 

52234 .......... ............ A Cystoscopy and treatment .......................... 4.63 NA 1.98 0.33 NA 6.94 000 

52235 .......... ............ A Cystoscopy and treatment .......................... 5.45 NA 2.31 0.39 NA 8.15 000 

52240 .......... ............ A Cystoscopy and treatment .......................... 9.73 NA 3.93 0.69 NA 14.34 000 

52250 .......... ............ A Cystoscopy and radiotracer ........................ 4.50 NA 1.98 0.32 NA 6.80 000 

52260 .......... ............ A Cystoscopy and treatment .......................... 3.92 NA 1.70 0.28 NA 5.89 000 

52265 .......... ............ A Cystoscopy and treatment .......................... 2.95 12.97 1.33 0.22 16.13 4.49 000 

45932

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

52270 .......... ............ A Cystoscopy & revise urethra ....................... 3.37 10.79 1.49 0.24 14.40 5.10 000 

52275 .......... ............ A Cystoscopy & revise urethra ....................... 4.70 15.22 1.99 0.33 20.24 7.02 000 

52276 .......... ............ A Cystoscopy and treatment .......................... 5.00 NA 2.13 0.35 NA 7.48 000 

52277 .......... ............ A Cystoscopy and treatment .......................... 6.17 NA 2.59 0.44 NA 9.20 000 

52281 .......... ............ A Cystoscopy and treatment .......................... 2.81 7.08 1.30 0.20 10.08 4.31 000 

52282 .......... ............ A Cystoscopy, implant stent ........................... 6.40 NA 2.66 0.45 NA 9.51 000 

52283 .......... ............ A Cystoscopy and treatment .......................... 3.74 4.14 1.65 0.26 8.14 5.65 000 

52285 .......... ............ A Cystoscopy and treatment .......................... 3.61 4.23 1.60 0.26 8.09 5.47 000 

52290 .......... ............ A Cystoscopy and treatment .......................... 4.59 NA 1.97 0.32 NA 6.88 000 

52300 .......... ............ A Cystoscopy and treatment .......................... 5.31 NA 2.27 0.38 NA 7.97 000 

52301 .......... ............ A Cystoscopy and treatment .......................... 5.51 NA 2.03 0.46 NA 8.00 000 

52305 .......... ............ A Cystoscopy and treatment .......................... 5.31 NA 2.21 0.38 NA 7.90 000 

52310 .......... ............ A Cystoscopy and treatment .......................... 2.82 4.79 1.23 0.20 7.81 4.25 000 

52315 .......... ............ A Cystoscopy and treatment .......................... 5.21 8.76 2.18 0.37 14.34 7.76 000 

52317 .......... ............ A Remove bladder stone ................................ 6.72 28.18 2.71 0.48 35.38 9.91 000 

52318 .......... ............ A Remove bladder stone ................................ 9.20 NA 3.67 0.65 NA 13.52 000 

52320 .......... ............ A Cystoscopy and treatment .......................... 4.70 NA 1.94 0.33 NA 6.97 000 

52325 .......... ............ A Cystoscopy, stone removal ......................... 6.16 NA 2.52 0.44 NA 9.12 000 

52327 .......... ............ A Cystoscopy, inject material ......................... 5.19 30.65 2.14 0.37 36.21 7.70 000 

52330 .......... ............ A Cystoscopy and treatment .......................... 5.04 37.29 2.08 0.36 42.69 7.48 000 

52332 .......... ............ A Cystoscopy and treatment .......................... 2.84 5.70 1.26 0.21 8.75 4.31 000 

52334 .......... ............ A Create passage to kidney ........................... 4.83 NA 2.05 0.35 NA 7.23 000 

52341 .......... ............ A Cysto w/ureter stricture tx ........................... 6.00 NA 2.62 0.43 NA 9.05 000 

52342 .......... ............ A Cysto w/up stricture tx ................................. 6.50 NA 2.79 0.46 NA 9.75 000 

52343 .......... ............ A Cysto w/renal stricture tx ............................. 7.20 NA 3.06 0.51 NA 10.77 000 

52344 .......... ............ A Cysto/uretero, stricture tx ............................ 7.71 NA 3.34 0.55 NA 11.59 000 

52345 .......... ............ A Cysto/uretero w/up stricture ........................ 8.21 NA 3.53 0.58 NA 12.31 000 

52346 .......... ............ A Cystouretero w/renal strict .......................... 9.24 NA 3.92 0.65 NA 13.81 000 

52351 .......... ............ A Cystouretero & or pyeloscope ..................... 5.86 NA 2.56 0.41 NA 8.83 000 

52352 .......... ............ A Cystouretero w/stone remove ..................... 6.88 NA 2.99 0.49 NA 10.37 000 

52353 .......... ............ A Cystouretero w/lithotripsy ............................ 7.98 NA 3.40 0.57 NA 11.95 000 

52354 .......... ............ A Cystouretero w/biopsy ................................. 7.34 NA 3.16 0.52 NA 11.03 000 

52355 .......... ............ A Cystouretero w/excise tumor ....................... 8.83 NA 3.73 0.63 NA 13.19 000 

52400 .......... ............ A Cystouretero w/congen repr ........................ 9.69 NA 4.48 0.68 NA 14.85 090 

52402 .......... ............ A Cystourethro cut ejacul duct ....................... 5.28 NA 2.02 0.40 NA 7.70 000 

52450 .......... ............ A Incision of prostate ...................................... 7.65 NA 4.40 0.54 NA 12.58 090 

52500 .......... ............ A Revision of bladder neck ............................. 8.48 NA 4.70 0.60 NA 13.78 090 

52510 .......... ............ A Dilation prostatic urethra ............................. 6.72 NA 3.71 0.48 NA 10.91 090 

52601 .......... ............ A Prostatectomy (TURP) ................................ 12.37 NA 6.08 0.87 NA 19.33 090 

52606 .......... ............ A Control postop bleeding .............................. 8.14 NA 4.23 0.57 NA 12.93 090 

52612 .......... ............ A Prostatectomy, first stage ............................ 7.99 NA 4.40 0.56 NA 12.95 090 

52614 .......... ............ A Prostatectomy, second stage ...................... 6.84 NA 4.00 0.48 NA 11.33 090 

52620 .......... ............ A Remove residual prostate ........................... 6.61 NA 3.57 0.47 NA 10.65 090 

52630 .......... ............ A Remove prostate regrowth .......................... 7.26 NA 3.82 0.51 NA 11.59 090 

52640 .......... ............ A Relieve bladder contracture ........................ 6.62 NA 3.53 0.47 NA 10.63 090 

52647 .......... ............ A Laser surgery of prostate ............................ 10.36 70.90 5.42 0.73 81.99 16.51 090 

52648 .......... ............ A Laser surgery of prostate ............................ 11.21 NA 5.70 0.79 NA 17.70 090 

52700 .......... ............ A Drainage of prostate abscess ..................... 6.80 NA 3.78 0.48 NA 11.06 090 

53000 .......... ............ A Incision of urethra ........................................ 2.28 NA 1.67 0.16 NA 4.11 010 

53010 .......... ............ A Incision of urethra ........................................ 3.64 NA 3.21 0.24 NA 7.09 090 

53020 .......... ............ A Incision of urethra ........................................ 1.77 NA 0.80 0.13 NA 2.70 000 

53025 .......... ............ A Incision of urethra ........................................ 1.13 NA 0.63 0.08 NA 1.84 000 

53040 .......... ............ A Drainage of urethra abscess ....................... 6.40 NA 3.88 0.45 NA 10.73 090 

53060 .......... ............ A Drainage of urethra abscess ....................... 2.64 2.08 1.50 0.28 4.99 4.42 010 

53080 .......... ............ A Drainage of urinary leakage ........................ 6.29 NA 6.21 0.52 NA 13.02 090 

53085 .......... ............ A Drainage of urinary leakage ........................ 10.27 NA 7.86 0.92 NA 19.05 090 

53200 .......... ............ A Biopsy of urethra ......................................... 2.60 1.46 1.15 0.20 4.25 3.95 000 

53210 .......... ............ A Removal of urethra ...................................... 12.58 NA 6.55 0.89 NA 20.01 090 

53215 .......... ............ A Removal of urethra ...................................... 15.59 NA 7.67 1.10 NA 24.36 090 

53220 .......... ............ A Treatment of urethra lesion ......................... 7.00 NA 4.21 0.49 NA 11.70 090 

53230 .......... ............ A Removal of urethra lesion ........................... 9.59 NA 5.39 0.73 NA 15.71 090 

53235 .......... ............ A Removal of urethra lesion ........................... 10.14 NA 5.61 0.72 NA 16.47 090 

53240 .......... ............ A Surgery for urethra pouch ........................... 6.45 NA 3.96 0.52 NA 10.93 090 

53250 .......... ............ A Removal of urethra gland ............................ 5.89 NA 3.64 0.49 NA 10.02 090 

53260 .......... ............ A Treatment of urethra lesion ......................... 2.99 2.27 1.63 0.25 5.51 4.87 010 

53265 .......... ............ A Treatment of urethra lesion ......................... 3.13 2.83 1.67 0.24 6.19 5.04 010 

53270 .......... ............ A Removal of urethra gland ............................ 3.10 2.30 1.69 0.30 5.70 5.09 010 

53275 .......... ............ A Repair of urethra defect .............................. 4.53 NA 2.55 0.32 NA 7.39 010 

53400 .......... ............ A Revise urethra, stage 1 ............................... 12.78 NA 6.83 0.98 NA 20.58 090 

53405 .......... ............ A Revise urethra, stage 2 ............................... 14.49 NA 7.31 1.10 NA 22.90 090 

53410 .......... ............ A Reconstruction of urethra ............................ 16.45 NA 8.18 1.16 NA 25.80 090 

53415 .......... ............ A Reconstruction of urethra ............................ 19.42 NA 8.22 1.37 NA 29.01 090 

53420 .......... ............ A Reconstruct urethra, stage 1 ....................... 14.09 NA 6.54 0.96 NA 21.59 090 

53425 .......... ............ A Reconstruct urethra, stage 2 ....................... 15.99 NA 7.86 1.13 NA 24.99 090 

45933

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

53430 .......... ............ A Reconstruction of urethra ............................ 16.35 NA 7.95 1.15 NA 25.45 090 

53431 .......... ............ A Reconstruct urethra/bladder ........................ 19.90 NA 9.43 1.41 NA 30.74 090 

53440 .......... ............ A Male sling procedure ................................... 13.63 NA 6.96 0.96 NA 21.55 090 

53442 .......... ............ A Remove/revise male sling ........................... 11.57 NA 6.10 0.82 NA 18.50 090 

53444 .......... ............ A Insert tandem cuff ....................................... 13.41 NA 6.75 0.94 NA 21.10 090 

53445 .......... ............ A Insert uro/ves nck sphincter ........................ 14.07 NA 8.00 0.99 NA 23.06 090 

53446 .......... ............ A Remove uro sphincter ................................. 10.23 NA 5.98 0.72 NA 16.93 090 

53447 .......... ............ A Remove/replace ur sphincter ...................... 13.50 NA 7.35 0.95 NA 21.80 090 

53448 .......... ............ A Remov/replc ur sphinctr comp .................... 21.16 NA 10.38 1.50 NA 33.04 090 

53449 .......... ............ A Repair uro sphincter .................................... 9.71 NA 5.49 0.68 NA 15.88 090 

53450 .......... ............ A Revision of urethra ...................................... 6.14 NA 3.83 0.43 NA 10.40 090 

53460 .......... ............ A Revision of urethra ...................................... 7.12 NA 4.26 0.50 NA 11.88 090 

53500 .......... ............ A Urethrlys, transvag w/ scope ....................... 12.21 NA 6.83 0.90 NA 19.95 090 

53502 .......... ............ A Repair of urethra injury ............................... 7.64 NA 4.47 0.62 NA 12.73 090 

53505 .......... ............ A Repair of urethra injury ............................... 7.64 NA 4.46 0.54 NA 12.63 090 

53510 .......... ............ A Repair of urethra injury ............................... 10.11 NA 5.77 0.74 NA 16.62 090 

53515 .......... ............ A Repair of urethra injury ............................... 13.32 NA 6.71 1.05 NA 21.08 090 

53520 .......... ............ A Repair of urethra defect .............................. 8.69 NA 5.13 0.61 NA 14.43 090 

53600 .......... ............ A Dilate urethra stricture ................................. 1.21 1.21 0.50 0.09 2.51 1.81 000 

53601 .......... ............ A Dilate urethra stricture ................................. 0.98 1.34 0.44 0.07 2.39 1.49 000 

53605 .......... ............ A Dilate urethra stricture ................................. 1.28 NA 0.48 0.09 NA 1.85 000 

53620 .......... ............ A Dilate urethra stricture ................................. 1.62 2.05 0.71 0.11 3.78 2.44 000 

53621 .......... ............ A Dilate urethra stricture ................................. 1.35 2.13 0.58 0.10 3.58 2.04 000 

53660 .......... ............ A Dilation of urethra ........................................ 0.71 1.36 0.37 0.05 2.12 1.13 000 

53661 .......... ............ A Dilation of urethra ........................................ 0.72 1.35 0.35 0.05 2.12 1.12 000 

53665 .......... ............ A Dilation of urethra ........................................ 0.76 NA 0.28 0.06 NA 1.10 000 

53850 .......... ............ A Prostatic microwave thermotx ..................... 9.46 88.85 4.72 0.67 98.98 14.85 090 

53852 .......... ............ A Prostatic rf thermotx .................................... 9.89 84.87 5.22 0.70 95.46 15.81 090 

53853 .......... ............ A Prostatic water thermother .......................... 5.24 53.22 3.35 0.37 58.83 8.96 090 

53899 .......... ............ C Urology surgery procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

54000 .......... ............ A Slitting of prepuce ....................................... 1.54 2.98 1.12 0.11 4.63 2.77 010 

54001 .......... ............ A Slitting of prepuce ....................................... 2.19 3.29 1.32 0.15 5.63 3.66 010 

54015 .......... ............ A Drain penis lesion ........................................ 5.32 NA 2.90 0.38 NA 8.60 010 

54050 .......... ............ A Destruction, penis lesion(s) ......................... 1.24 1.81 1.15 0.08 3.13 2.48 010 

54055 .......... ............ A Destruction, penis lesion(s) ......................... 1.22 1.72 0.92 0.08 3.02 2.22 010 

54056 .......... ............ A Cryosurgery, penis lesion(s) ....................... 1.24 1.88 1.23 0.06 3.18 2.53 010 

54057 .......... ............ A Laser surg, penis lesion(s) .......................... 1.24 2.38 1.00 0.09 3.71 2.33 010 

54060 .......... ............ A Excision of penis lesion(s) .......................... 1.93 3.23 1.25 0.13 5.29 3.32 010 

54065 .......... ............ A Destruction, penis lesion(s) ......................... 2.42 2.90 1.43 0.13 5.45 3.99 010 

54100 .......... ............ A Biopsy of penis ............................................ 1.90 3.02 0.99 0.10 5.02 2.99 000 

54105 .......... ............ A Biopsy of penis ............................................ 3.50 4.45 2.18 0.25 8.20 5.93 010 

54110 .......... ............ A Treatment of penis lesion ............................ 10.13 NA 5.51 0.72 NA 16.36 090 

54111 .......... ............ A Treat penis lesion, graft .............................. 13.58 NA 6.75 0.96 NA 21.29 090 

54112 .......... ............ A Treat penis lesion, graft .............................. 15.87 NA 7.86 1.11 NA 24.84 090 

54115 .......... ............ A Treatment of penis lesion ............................ 6.15 4.90 3.98 0.43 11.48 10.56 090 

54120 .......... ............ A Partial removal of penis .............................. 9.98 NA 5.45 0.68 NA 16.11 090 

54125 .......... ............ A Removal of penis ........................................ 13.54 NA 6.79 0.95 NA 21.28 090 

54130 .......... ............ A Remove penis & nodes ............................... 20.15 NA 9.51 1.52 NA 31.18 090 

54135 .......... ............ A Remove penis & nodes ............................... 26.37 NA 11.79 1.87 NA 40.03 090 

54150 .......... ............ A Circumcision ................................................ 1.81 4.16 0.70 0.16 6.13 2.67 XXX 

54152 .......... ............ A Circumcision ................................................ 2.31 NA 1.36 0.19 NA 3.86 010 

54160 .......... ............ A Circumcision ................................................ 2.48 4.20 1.25 0.19 6.88 3.92 010 

54161 .......... ............ A Circumcision ................................................ 3.28 NA 1.83 0.23 NA 5.34 010 

54162 .......... ............ A Lysis penil circumic lesion ........................... 3.01 4.74 1.72 0.21 7.96 4.94 010 

54163 .......... ............ A Repair of circumcision ................................. 3.01 NA 2.30 0.21 NA 5.52 010 

54164 .......... ............ A Frenulotomy of penis ................................... 2.51 NA 2.10 0.18 NA 4.78 010 

54200 .......... ............ A Treatment of penis lesion ............................ 1.06 1.90 1.02 0.08 3.04 2.16 010 

54205 .......... ............ A Treatment of penis lesion ............................ 7.94 NA 5.26 0.56 NA 13.76 090 

54220 .......... ............ A Treatment of penis lesion ............................ 2.42 3.90 1.14 0.17 6.49 3.73 000 

54230 .......... ............ A Prepare penis study .................................... 1.34 1.21 0.75 0.09 2.65 2.18 000 

54231 .......... ............ A Dynamic cavernosometry ............................ 2.04 1.48 1.02 0.16 3.68 3.23 000 

54235 .......... ............ A Penile injection ............................................ 1.19 1.09 0.70 0.08 2.36 1.97 000 

54240 .......... ............ A Penis study .................................................. 1.31 1.12 NA 0.17 2.60 NA 000 

54240 .......... 26 ....... A Penis study .................................................. 1.31 0.47 0.47 0.11 1.90 1.90 000 

54240 .......... TC ...... A Penis study .................................................. 0.00 0.64 NA 0.06 0.70 NA 000 

54250 .......... ............ A Penis study .................................................. 2.22 0.98 NA 0.02 3.23 NA 000 

54250 .......... 26 ....... A Penis study .................................................. 2.22 0.82 0.82 0.16 3.20 3.20 000 

54250 .......... TC ...... A Penis study .................................................. 0.00 0.17 NA 0.02 0.19 NA 000 

54300 .......... ............ A Revision of penis ......................................... 10.41 NA 6.23 0.76 NA 17.40 090 

54304 .......... ............ A Revision of penis ......................................... 12.49 NA 7.09 0.88 NA 20.47 090 

54308 .......... ............ A Reconstruction of urethra ............................ 11.83 NA 6.69 0.84 NA 19.36 090 

54312 .......... ............ A Reconstruction of urethra ............................ 13.58 NA 7.82 1.24 NA 22.63 090 

54316 .......... ............ A Reconstruction of urethra ............................ 16.82 NA 8.81 1.21 NA 26.84 090 

54318 .......... ............ A Reconstruction of urethra ............................ 11.25 NA 6.34 1.39 NA 18.98 090 

45934

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

54322 .......... ............ A Reconstruction of urethra ............................ 13.02 NA 7.28 0.92 NA 21.22 090 

54324 .......... ............ A Reconstruction of urethra ............................ 16.32 NA 8.87 1.14 NA 26.34 090 

54326 .......... ............ A Reconstruction of urethra ............................ 15.73 NA 8.66 1.11 NA 25.51 090 

54328 .......... ............ A Revise penis/urethra ................................... 15.66 NA 8.24 0.98 NA 24.88 090 

54332 .......... ............ A Revise penis/urethra ................................... 17.08 NA 8.69 1.21 NA 26.98 090 

54336 .......... ............ A Revise penis/urethra ................................... 20.05 NA 11.00 2.20 NA 33.25 090 

54340 .......... ............ A Secondary urethral surgery ......................... 8.92 NA 5.40 0.63 NA 14.95 090 

54344 .......... ............ A Secondary urethral surgery ......................... 15.95 NA 8.70 1.54 NA 26.19 090 

54348 .......... ............ A Secondary urethral surgery ......................... 17.15 NA 9.18 1.23 NA 27.57 090 

54352 .......... ............ A Reconstruct urethra/penis ........................... 24.75 NA 12.36 2.24 NA 39.35 090 

54360 .......... ............ A Penis plastic surgery ................................... 11.93 NA 6.83 0.84 NA 19.60 090 

54380 .......... ............ A Repair penis ................................................ 13.19 NA 7.19 0.93 NA 21.31 090 

54385 .......... ............ A Repair penis ................................................ 15.40 NA 9.36 0.86 NA 25.62 090 

54390 .......... ............ A Repair penis and bladder ............................ 21.62 NA 10.88 1.54 NA 34.04 090 

54400 .......... ............ A Insert semi-rigid prosthesis ......................... 9.00 NA 5.00 0.64 NA 14.64 090 

54401 .......... ............ A Insert self-contd prosthesis ......................... 10.28 NA 6.69 0.73 NA 17.70 090 

54405 .......... ............ A Insert multi-comp penis pros ....................... 13.44 NA 6.85 0.95 NA 21.24 090 

54406 .......... ............ A Remove muti-comp penis pros ................... 12.10 NA 6.33 0.86 NA 19.30 090 

54408 .......... ............ A Repair multi-comp penis pros ..................... 12.76 NA 6.73 0.90 NA 20.39 090 

54410 .......... ............ A Remove/replace penis prosth ..................... 15.51 NA 7.78 1.10 NA 24.39 090 

54411 .......... ............ A Remov/replc penis pros, comp ................... 16.01 NA 8.24 1.13 NA 25.38 090 

54415 .......... ............ A Remove self-contd penis pros .................... 8.21 NA 4.88 0.58 NA 13.66 090 

54416 .......... ............ A Remv/repl penis contain pros ..................... 10.87 NA 6.30 0.77 NA 17.94 090 

54417 .......... ............ A Remv/replc penis pros, compl ..................... 14.20 NA 7.28 1.00 NA 22.48 090 

54420 .......... ............ A Revision of penis ......................................... 11.42 NA 6.21 0.81 NA 18.45 090 

54430 .......... ............ A Revision of penis ......................................... 10.15 NA 5.85 0.72 NA 16.72 090 

54435 .......... ............ A Revision of penis ......................................... 6.12 NA 4.09 0.43 NA 10.64 090 

54440 .......... ............ C Repair of penis ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 090 

54450 .......... ............ A Preputial stretching ...................................... 1.12 0.99 0.50 0.08 2.20 1.70 000 

54500 .......... ............ A Biopsy of testis ............................................ 1.31 NA 0.65 0.10 NA 2.06 000 

54505 .......... ............ A Biopsy of testis ............................................ 3.46 NA 2.15 0.27 NA 5.88 010 

54512 .......... ............ A Excise lesion testis ...................................... 8.59 NA 4.70 0.67 NA 13.96 090 

54520 .......... ............ A Removal of testis ......................................... 5.23 NA 3.16 0.50 NA 8.89 090 

54522 .......... ............ A Orchiectomy, partial .................................... 9.51 NA 5.36 0.89 NA 15.76 090 

54530 .......... ............ A Removal of testis ......................................... 8.59 NA 4.87 0.66 NA 14.11 090 

54535 .......... ............ A Extensive testis surgery .............................. 12.16 NA 6.19 0.95 NA 19.30 090 

54550 .......... ............ A Exploration for testis .................................... 7.79 NA 4.31 0.59 NA 12.68 090 

54560 .......... ............ A Exploration for testis .................................... 11.13 NA 5.74 0.90 NA 17.77 090 

54600 .......... ............ A Reduce testis torsion ................................... 7.01 NA 4.05 0.51 NA 11.57 090 

54620 .......... ............ A Suspension of testis .................................... 4.90 NA 2.78 0.37 NA 8.05 010 

54640 .......... ............ A Suspension of testis .................................... 6.90 NA 4.20 0.62 NA 11.72 090 

54650 .......... ............ A Orchiopexy (Fowler-Stephens) .................... 11.45 NA 6.03 1.16 NA 18.64 090 

54660 .......... ............ A Revision of testis ......................................... 5.11 NA 3.39 0.44 NA 8.94 090 

54670 .......... ............ A Repair testis injury ....................................... 6.41 NA 3.95 0.47 NA 10.83 090 

54680 .......... ............ A Relocation of testis(es) ................................ 12.66 NA 6.67 1.16 NA 20.48 090 

54690 .......... ............ A Laparoscopy, orchiectomy .......................... 10.96 NA 5.61 1.02 NA 17.59 090 

54692 .......... ............ A Laparoscopy, orchiopexy ............................ 12.89 NA 6.14 1.30 NA 20.33 090 

54699 .......... ............ C Laparoscope proc, testis ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

54700 .......... ............ A Drainage of scrotum .................................... 3.43 NA 2.13 0.28 NA 5.84 010 

54800 .......... ............ A Biopsy of epididymis ................................... 2.33 NA 1.03 0.23 NA 3.60 000 

54820 .......... ............ A Exploration of epididymis ............................ 5.14 NA 3.32 0.40 NA 8.86 090 

54830 .......... ............ A Remove epididymis lesion .......................... 5.38 NA 3.45 0.41 NA 9.25 090 

54840 .......... ............ A Remove epididymis lesion .......................... 5.20 NA 3.19 0.37 NA 8.76 090 

54860 .......... ............ A Removal of epididymis ................................ 6.32 NA 3.85 0.45 NA 10.62 090 

54861 .......... ............ A Removal of epididymis ................................ 8.91 NA 5.03 0.63 NA 14.57 090 

54900 .......... ............ A Fusion of spermatic ducts ........................... 13.21 NA 6.74 0.93 NA 20.87 090 

54901 .......... ............ A Fusion of spermatic ducts ........................... 17.95 NA 8.13 1.82 NA 27.89 090 

55000 .......... ............ A Drainage of hydrocele ................................. 1.43 2.08 0.74 0.11 3.63 2.28 000 

55040 .......... ............ A Removal of hydrocele ................................. 5.36 NA 3.26 0.43 NA 9.05 090 

55041 .......... ............ A Removal of hydroceles ................................ 7.75 NA 4.52 0.60 NA 12.86 090 

55060 .......... ............ A Repair of hydrocele ..................................... 5.52 NA 3.45 0.46 NA 9.43 090 

55100 .......... ............ A Drainage of scrotum abscess ..................... 2.13 3.74 1.72 0.17 6.04 4.02 010 

55110 .......... ............ A Explore scrotum .......................................... 5.70 NA 3.58 0.43 NA 9.71 090 

55120 .......... ............ A Removal of scrotum lesion .......................... 5.09 NA 3.35 0.39 NA 8.83 090 

55150 .......... ............ A Removal of scrotum .................................... 7.22 NA 4.36 0.56 NA 12.15 090 

55175 .......... ............ A Revision of scrotum ..................................... 5.24 NA 3.45 0.37 NA 9.06 090 

55180 .......... ............ A Revision of scrotum ..................................... 10.72 NA 6.05 0.90 NA 17.67 090 

55200 .......... ............ A Incision of sperm duct ................................. 4.24 12.12 2.67 0.33 16.69 7.23 090 

55250 .......... ............ A Removal of sperm duct(s) ........................... 3.30 11.22 2.51 0.25 14.77 6.05 090 

55300 .......... ............ A Prepare, sperm duct x-ray .......................... 3.51 NA 1.53 0.25 NA 5.28 000 

55400 .......... ............ A Repair of sperm duct ................................... 8.50 NA 4.68 0.64 NA 13.81 090 

55450 .......... ............ A Ligation of sperm duct ................................. 4.12 7.06 2.20 0.29 11.47 6.61 010 

55500 .......... ............ A Removal of hydrocele ................................. 5.59 NA 3.35 0.55 NA 9.49 090 

55520 .......... ............ A Removal of sperm cord lesion .................... 6.03 NA 3.31 0.75 NA 10.09 090 

45935

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

55530 .......... ............ A Revise spermatic cord veins ....................... 5.66 NA 3.41 0.45 NA 9.52 090 

55535 .......... ............ A Revise spermatic cord veins ....................... 6.56 NA 3.89 0.47 NA 10.92 090 

55540 .......... ............ A Revise hernia & sperm veins ...................... 7.68 NA 3.86 0.94 NA 12.47 090 

55550 .......... ............ A Laparo ligate spermatic vein ....................... 6.57 NA 3.59 0.57 NA 10.74 090 

55559 .......... ............ C Laparo proc, spermatic cord ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

55600 .......... ............ A Incise sperm duct pouch ............................. 6.38 NA 3.89 0.62 NA 10.89 090 

55605 .......... ............ A Incise sperm duct pouch ............................. 7.97 NA 4.86 0.64 NA 13.46 090 

55650 .......... ............ A Remove sperm duct pouch ......................... 11.80 NA 6.12 0.92 NA 18.84 090 

55680 .......... ............ A Remove sperm pouch lesion ...................... 5.19 NA 3.39 0.47 NA 9.05 090 

55700 .......... ............ A Biopsy of prostate ....................................... 1.57 4.22 0.76 0.11 5.90 2.45 000 

55705 .......... ............ A Biopsy of prostate ....................................... 4.57 NA 2.60 0.32 NA 7.49 010 

55720 .......... ............ A Drainage of prostate abscess ..................... 7.65 NA 4.35 0.95 NA 12.94 090 

55725 .......... ............ A Drainage of prostate abscess ..................... 8.69 NA 5.02 0.70 NA 14.40 090 

55801 .......... ............ A Removal of prostate .................................... 17.81 NA 8.72 1.34 NA 27.86 090 

55810 .......... ............ A Extensive prostate surgery .......................... 22.60 NA 10.31 1.60 NA 34.51 090 

55812 .......... ............ A Extensive prostate surgery .......................... 27.52 NA 12.47 2.04 NA 42.03 090 

55815 .......... ............ A Extensive prostate surgery .......................... 30.47 NA 13.65 2.16 NA 46.28 090 

55821 .......... ............ A Removal of prostate .................................... 14.26 NA 7.15 1.01 NA 22.42 090 

55831 .......... ............ A Removal of prostate .................................... 15.63 NA 7.67 1.10 NA 24.40 090 

55840 .......... ............ A Extensive prostate surgery .......................... 22.71 NA 10.68 1.61 NA 35.00 090 

55842 .......... ............ A Extensive prostate surgery .......................... 24.39 NA 11.28 1.72 NA 37.39 090 

55845 .......... ............ A Extensive prostate surgery .......................... 28.57 NA 12.67 2.02 NA 43.25 090 

55859 .......... ............ A Percut/needle insert, pros ........................... 12.53 NA 6.72 0.89 NA 20.13 090 

55860 .......... ............ A Surgical exposure, prostate ........................ 14.46 NA 7.23 1.02 NA 22.71 090 

55862 .......... ............ A Extensive prostate surgery .......................... 18.40 NA 8.62 1.49 NA 28.51 090 

55865 .......... ............ A Extensive prostate surgery .......................... 22.89 NA 10.64 1.63 NA 35.16 090 

55866 .......... ............ A Laparo radical prostatectomy ...................... 30.75 NA 13.70 2.16 NA 46.62 090 

55870 .......... ............ A Electroejaculation ........................................ 2.59 1.83 1.25 0.16 4.57 3.99 000 

55873 .......... ............ A Cryoablate prostate ..................................... 19.48 NA 10.16 1.38 NA 31.02 090 

55899 .......... ............ C Genital surgery procedure ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

55970 .......... ............ N Sex transformation, M to F ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

55980 .......... ............ N Sex transformation, F to M ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

56405 .......... ............ A I & D of vulva/perineum .............................. 1.44 1.31 1.14 0.17 2.92 2.75 010 

56420 .......... ............ A Drainage of gland abscess ......................... 1.39 2.14 0.98 0.16 3.69 2.53 010 

56440 .......... ............ A Surgery for vulva lesion .............................. 2.85 NA 1.70 0.34 NA 4.88 010 

56441 .......... ............ A Lysis of labial lesion(s) ................................ 1.97 1.82 1.48 0.20 4.00 3.65 010 

56501 .......... ............ A Destroy, vulva lesions, sim ......................... 1.53 1.76 1.24 0.18 3.48 2.95 010 

56515 .......... ............ A Destroy vulva lesion/s compl ...................... 2.77 2.55 1.79 0.33 5.64 4.89 010 

56605 .......... ............ A Biopsy of vulva/perineum ............................ 1.10 1.05 0.45 0.13 2.28 1.68 000 

56606 .......... ............ A Biopsy of vulva/perineum ............................ 0.55 0.47 0.22 0.07 1.09 0.84 ZZZ 

56620 .......... ............ A Partial removal of vulva ............................... 7.47 NA 4.72 0.90 NA 13.09 090 

56625 .......... ............ A Complete removal of vulva ......................... 8.41 NA 5.22 1.02 NA 14.64 090 

56630 .......... ............ A Extensive vulva surgery .............................. 12.36 NA 6.69 1.49 NA 20.55 090 

56631 .......... ............ A Extensive vulva surgery .............................. 16.21 NA 8.62 1.95 NA 26.78 090 

56632 .......... ............ A Extensive vulva surgery .............................. 20.30 NA 9.30 2.38 NA 31.98 090 

56633 .......... ............ A Extensive vulva surgery .............................. 16.48 NA 8.40 1.97 NA 26.86 090 

56634 .......... ............ A Extensive vulva surgery .............................. 17.89 NA 9.22 2.16 NA 29.26 090 

56637 .......... ............ A Extensive vulva surgery .............................. 21.98 NA 10.81 2.60 NA 35.39 090 

56640 .......... ............ A Extensive vulva surgery .............................. 22.18 NA 10.38 2.88 NA 35.44 090 

56700 .......... ............ A Partial removal of hymen ............................ 2.53 NA 1.84 0.30 NA 4.67 010 

56720 .......... ............ A Incision of hymen ........................................ 0.68 NA 0.51 0.08 NA 1.27 000 

56740 .......... ............ A Remove vagina gland lesion ....................... 4.57 NA 2.53 0.56 NA 7.66 010 

56800 .......... ............ A Repair of vagina .......................................... 3.89 NA 2.21 0.44 NA 6.54 010 

56805 .......... ............ A Repair clitoris ............................................... 18.87 NA 9.45 2.14 NA 30.46 090 

56810 .......... ............ A Repair of perineum ...................................... 4.13 NA 2.27 0.49 NA 6.89 010 

56820 .......... ............ A Exam of vulva w/scope ............................... 1.50 1.30 0.66 0.18 2.98 2.34 000 

56821 .......... ............ A Exam/biopsy of vulva w/scope .................... 2.05 1.72 0.89 0.25 4.03 3.20 000 

57000 .......... ............ A Exploration of vagina ................................... 2.98 NA 1.78 0.31 NA 5.06 010 

57010 .......... ............ A Drainage of pelvic abscess ......................... 6.03 NA 3.81 0.71 NA 10.55 090 

57020 .......... ............ A Drainage of pelvic fluid ................................ 1.50 0.92 0.58 0.18 2.60 2.26 000 

57022 .......... ............ A I & d vaginal hematoma, pp ........................ 2.57 NA 1.49 0.26 NA 4.32 010 

57023 .......... ............ A I & d vag hematoma, non-ob ...................... 4.75 NA 2.57 0.58 NA 7.90 010 

57061 .......... ............ A Destroy vag lesions, simple ........................ 1.25 1.63 1.13 0.15 3.03 2.53 010 

57065 .......... ............ A Destroy vag lesions, complex ..................... 2.62 2.26 1.66 0.31 5.19 4.58 010 

57100 .......... ............ A Biopsy of vagina .......................................... 1.20 1.06 0.48 0.14 2.40 1.82 000 

57105 .......... ............ A Biopsy of vagina .......................................... 1.69 1.76 1.42 0.20 3.65 3.31 010 

57106 .......... ............ A Remove vagina wall, partial ........................ 6.36 NA 4.16 0.73 NA 11.25 090 

57107 .......... ............ A Remove vagina tissue, part ........................ 23.02 NA 10.42 2.71 NA 36.14 090 

57109 .......... ............ A Vaginectomy partial w/nodes ...................... 27.01 NA 12.16 3.21 NA 42.39 090 

57110 .......... ............ A Remove vagina wall, complete ................... 14.30 NA 7.17 1.73 NA 23.20 090 

57111 .......... ............ A Remove vagina tissue, compl ..................... 27.01 NA 12.41 3.17 NA 42.60 090 

57112 .......... ............ A Vaginectomy w/nodes, compl ..................... 29.02 NA 12.99 3.07 NA 45.08 090 

57120 .......... ............ A Closure of vagina ........................................ 7.41 NA 4.55 0.89 NA 12.85 090 

57130 .......... ............ A Remove vagina lesion ................................. 2.43 2.13 1.55 0.29 4.86 4.27 010 

45936

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

57135 .......... ............ A Remove vagina lesion ................................. 2.68 2.23 1.66 0.31 5.21 4.64 010 

57150 .......... ............ A Treat vagina infection .................................. 0.55 1.01 0.21 0.07 1.64 0.83 000 

57155 .......... ............ A Insert uteri tandems/ovoids ......................... .27 NA 4.44 0.43 NA 11.15 090 

57160 .......... ............ A Insert pessary/other device ......................... 0.89 1.01 0.34 0.10 2.01 1.33 000 

57170 .......... ............ A Fitting of diaphragm/cap .............................. 0.91 1.33 0.32 0.11 2.35 1.34 000 

57180 .......... ............ A Treat vaginal bleeding ................................. 1.58 2.08 1.21 0.19 3.85 2.99 010 

57200 .......... ............ A Repair of vagina .......................................... 3.94 NA 2.90 0.46 NA 7.30 090 

57210 .......... ............ A Repair vagina/perineum .............................. 5.17 NA 3.41 0.62 NA 9.20 090 

57220 .......... ............ A Revision of urethra ...................................... 4.31 NA 3.10 0.51 NA 7.92 090 

57230 .......... ............ A Repair of urethral lesion .............................. 5.64 NA 3.54 0.54 NA 9.72 090 

57240 .......... ............ A Repair bladder & vagina ............................. 6.07 NA 3.93 0.62 NA 10.62 090 

57250 .......... ............ A Repair rectum & vagina .............................. 5.53 NA 3.55 0.65 NA 9.74 090 

57260 .......... ............ A Repair of vagina .......................................... 8.28 NA 4.79 0.97 NA 14.04 090 

57265 .......... ............ A Extensive repair of vagina ........................... 11.34 NA 5.98 1.32 NA 18.64 090 

57267 .......... ............ A Insert mesh/pelvic flr addon ........................ 4.89 NA 1.93 0.64 NA 7.46 ZZZ 

57268 .......... ............ A Repair of bowel bulge ................................. 6.76 NA 4.19 0.79 NA 11.74 090 

57270 .......... ............ A Repair of bowel pouch ................................ 12.11 NA 6.22 1.42 NA 19.75 090 

57280 .......... ............ A Suspension of vagina .................................. 15.05 NA 7.37 1.67 NA 24.09 090 

57282 .......... ............ A Colpopexy, extraperitoneal .......................... 6.87 NA 4.49 1.02 NA 12.38 090 

57283 .......... ............ A Colpopexy, intraperitoneal ........................... 10.86 NA 5.90 1.02 NA 17.78 090 

57284 .......... ............ A Repair paravaginal defect ........................... 12.71 NA 7.20 1.41 NA 21.32 090 

57287 .......... ............ A Revise/remove sling repair .......................... 10.71 NA 6.02 0.90 NA 17.63 090 

57288 .......... ............ A Repair bladder defect .................................. 13.03 NA 6.58 1.12 NA 20.73 090 

57289 .......... ............ A Repair bladder & vagina ............................. 11.58 NA 6.31 1.21 NA 19.10 090 

57291 .......... ............ A Construction of vagina ................................ 7.96 NA 4.96 0.93 NA 13.85 090 

57292 .......... ............ A Construct vagina with graft ......................... 13.10 NA 6.94 1.58 NA 21.61 090 

57300 .......... ............ A Repair rectum-vagina fistula ....................... 7.62 NA 4.27 0.87 NA 12.76 090 

57305 .......... ............ A Repair rectum-vagina fistula ....................... 13.78 NA 6.22 1.72 NA 21.72 090 

57307 .......... ............ A Fistula repair & colostomy ........................... 15.94 NA 6.93 2.01 NA 24.88 090 

57308 .......... ............ A Fistula repair, transperine ........................... 9.95 NA 5.08 1.14 NA 16.17 090 

57310 .......... ............ A Repair urethrovaginal lesion ....................... 6.78 NA 4.24 0.54 NA 11.56 090 

57311 .......... ............ A Repair urethrovaginal lesion ....................... 7.99 NA 4.58 0.65 NA 13.22 090 

57320 .......... ............ A Repair bladder-vagina lesion ...................... 8.02 NA 4.75 0.69 NA 13.46 090 

57330 .......... ............ A Repair bladder-vagina lesion ...................... 12.35 NA 6.33 1.06 NA 19.74 090 

57335 .......... ............ A Repair vagina .............................................. 18.74 NA 9.27 1.91 NA 29.92 090 

57400 .......... ............ A Dilation of vagina ......................................... 2.27 NA 1.12 0.26 NA 3.65 000 

57410 .......... ............ A Pelvic examination ...................................... 1.75 NA 0.92 0.18 NA 2.86 000 

57415 .......... ............ A Remove vaginal foreign body ..................... 2.17 NA 1.46 0.24 NA 3.88 010 

57420 .......... ............ A Exam of vagina w/scope ............................. 1.60 1.34 0.69 0.19 3.13 2.48 000 

57421 .......... ............ A Exam/biopsy of vag w/scope ...................... 2.20 1.81 0.94 0.27 4.28 3.42 000 

57425 .......... ............ A Laparoscopy, surg, colpopexy .................... 15.76 NA 6.86 1.75 NA 24.37 090 

57452 .......... ............ A Exam of cervix w/scope .............................. 1.50 1.27 0.80 0.18 2.95 2.49 000 

57454 .......... ............ A Bx/curett of cervix w/scope ......................... 2.33 1.61 1.13 0.28 4.23 3.75 000 

57455 .......... ............ A Biopsy of cervix w/scope ............................. 1.99 1.69 0.85 0.24 3.93 3.09 000 

57456 .......... ............ A Endocerv curettage w/scope ....................... 1.85 1.63 0.81 0.22 3.70 2.88 000 

57460 .......... ............ A Bx of cervix w/scope, leep .......................... 2.84 5.57 1.36 0.34 8.75 4.53 000 

57461 .......... ............ A Conz of cervix w/scope, leep ...................... 3.44 5.84 1.44 0.41 9.69 5.29 000 

57500 .......... ............ A Biopsy of cervix ........................................... 0.97 2.43 0.63 0.12 3.52 1.72 000 

57505 .......... ............ A Endocervical curettage ................................ 1.14 1.44 1.09 0.14 2.72 2.38 010 

57510 .......... ............ A Cauterization of cervix ................................. 1.90 1.53 1.03 0.23 3.66 3.17 010 

57511 .......... ............ A Cryocautery of cervix .................................. 1.90 1.79 1.36 0.23 3.92 3.49 010 

57513 .......... ............ A Laser surgery of cervix ................................ 1.90 1.70 1.39 0.23 3.83 3.52 010 

57520 .......... ............ A Conization of cervix ..................................... 4.04 3.85 2.83 0.49 8.38 7.36 090 

57522 .......... ............ A Conization of cervix ..................................... 3.36 3.09 2.42 0.41 6.85 6.19 090 

57530 .......... ............ A Removal of cervix ........................................ 4.79 NA 3.34 0.58 NA 8.71 090 

57531 .......... ............ A Removal of cervix, radical ........................... 28.02 NA 13.03 3.34 NA 44.39 090 

57540 .......... ............ A Removal of residual cervix .......................... 12.22 NA 6.16 1.49 NA 19.88 090 

57545 .......... ............ A Remove cervix/repair pelvis ........................ 13.04 NA 6.60 1.52 NA 21.15 090 

57550 .......... ............ A Removal of residual cervix .......................... 5.53 NA 3.79 0.67 NA 9.99 090 

57555 .......... ............ A Remove cervix/repair vagina ....................... 8.96 NA 5.03 1.09 NA 15.08 090 

57556 .......... ............ A Remove cervix, repair bowel ....................... 8.38 NA 4.85 0.92 NA 14.15 090 

57700 .......... ............ A Revision of cervix ........................................ 3.55 NA 3.14 0.41 NA 7.10 090 

57720 .......... ............ A Revision of cervix ........................................ 4.13 NA 3.09 0.49 NA 7.71 090 

57800 .......... ............ A Dilation of cervical canal ............................. 0.77 0.75 0.47 0.09 1.62 1.33 000 

57820 .......... ............ A D & c of residual cervix ............................... 1.67 1.46 1.13 0.20 3.33 3.00 010 

58100 .......... ............ A Biopsy of uterus lining ................................. 1.53 1.30 0.71 0.18 3.01 2.42 000 

58120 .......... ............ A Dilation and curettage ................................. 3.28 2.27 1.85 0.39 5.94 5.51 010 

58140 .......... ............ A Myomectomy abdom method ...................... 14.61 NA 6.99 1.81 NA 23.41 090 

58145 .......... ............ A Myomectomy vag method ........................... 8.05 NA 4.74 0.97 NA 13.75 090 

58146 .......... ............ A Myomectomy abdom complex .................... 19.01 NA 8.83 2.32 NA 30.16 090 

58150 .......... ............ A Total hysterectomy ...................................... 15.25 NA 7.36 1.84 NA 24.45 090 

58152 .......... ............ A Total hysterectomy ...................................... 20.61 NA 9.68 2.47 NA 32.76 090 

58180 .......... ............ A Partial hysterectomy .................................... 15.30 NA 7.32 1.64 NA 24.27 090 

58200 .......... ............ A Extensive hysterectomy .............................. 21.60 NA 9.79 2.54 NA 33.93 090 

45937

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

58210 .......... ............ A Extensive hysterectomy .............................. 28.87 NA 12.91 3.37 NA 45.14 090 

58240 .......... ............ A Removal of pelvis contents ......................... 38.41 NA 17.43 4.22 NA 60.06 090 

58260 .......... ............ A Vaginal hysterectomy .................................. 12.99 NA 6.61 1.57 NA 21.16 090 

58262 .......... ............ A Vag hyst including t/o .................................. 14.78 NA 7.28 1.79 NA 23.85 090 

58263 .......... ............ A Vag hyst w/t/o & vag repair ......................... 16.07 NA 7.77 1.94 NA 25.78 090 

58267 .......... ............ A Vag hyst w/urinary repair ............................ 17.04 NA 8.25 2.06 NA 27.35 090 

58270 .......... ............ A Vag hyst w/enterocele repair ...................... 14.27 NA 6.96 1.73 NA 22.96 090 

58275 .......... ............ A Hysterectomy/revise vagina ........................ 15.77 NA 7.66 1.91 NA 25.34 090 

58280 .......... ............ A Hysterectomy/revise vagina ........................ 17.01 NA 8.15 2.06 NA 27.23 090 

58285 .......... ............ A Extensive hysterectomy .............................. 22.27 NA 9.74 2.70 NA 34.72 090 

58290 .......... ............ A Vag hyst complex ........................................ 19.01 NA 8.96 2.29 NA 30.26 090 

58291 .......... ............ A Vag hyst incl t/o, complex ........................... 20.80 NA 9.69 2.52 NA 33.01 090 

58292 .......... ............ A Vag hyst t/o & repair, compl ....................... 22.09 NA 10.16 2.67 NA 34.93 090 

58293 .......... ............ A Vag hyst w/uro repair, compl ...................... 23.08 NA 10.44 2.78 NA 36.29 090 

58294 .......... ............ A Vag hyst w/enterocele, compl ..................... 20.29 NA 9.37 2.39 NA 32.05 090 

58300 .......... ............ N Insert intrauterine device ............................. 1.01 1.33 0.38 0.12 2.46 1.51 XXX 

58301 .......... ............ A Remove intrauterine device ........................ 1.27 1.28 0.47 0.15 2.70 1.89 000 

58321 .......... ............ A Artificial insemination ................................... 0.92 1.12 0.36 0.10 2.14 1.38 000 

58322 .......... ............ A Artificial insemination ................................... 1.10 1.18 0.41 0.13 2.41 1.64 000 

58323 .......... ............ A Sperm washing ............................................ 0.23 0.47 0.09 0.03 0.73 0.35 000 

58340 .......... ............ A Catheter for hysterography ......................... 0.88 3.02 0.68 0.09 3.99 1.65 000 

58345 .......... ............ A Reopen fallopian tube ................................. 4.66 NA 2.48 0.41 NA 7.55 010 

58346 .......... ............ A Insert heyman uteri capsule ........................ 6.75 NA 3.93 0.56 NA 11.24 090 

58350 .......... ............ A Reopen fallopian tube ................................. 1.01 1.50 0.92 0.12 2.64 2.05 010 

58353 .......... ............ A Endometr ablate, thermal ............................ 3.56 33.29 2.02 0.43 37.28 6.01 010 

58356 .......... ............ A Endometrial cryoablation ............................. 6.37 6.85 2.59 0.82 14.05 9.78 010 

58400 .......... ............ A Suspension of uterus .................................. 6.36 NA 3.91 0.75 NA 11.03 090 

58410 .......... ............ A Suspension of uterus .................................. 12.74 NA 6.33 1.45 NA 20.51 090 

58520 .......... ............ A Repair of ruptured uterus ............................ 11.92 NA 5.92 1.47 NA 19.31 090 

58540 .......... ............ A Revision of uterus ....................................... 14.65 NA 6.85 1.78 NA 23.28 090 

58545 .......... ............ A Laparoscopic myomectomy ......................... 14.61 NA 7.06 1.77 NA 23.44 090 

58546 .......... ............ A Laparo-myomectomy, complex ................... 19.01 NA 8.75 2.30 NA 30.06 090 

58550 .......... ............ A Laparo-asst vag hysterectomy .................... 14.20 NA 7.18 1.72 NA 23.10 090 

58552 .......... ............ A Laparo-vag hyst incl t/o ............................... 16.01 NA 7.88 1.72 NA 25.62 090 

58553 .......... ............ A Laparo-vag hyst, complex ........................... 19.01 NA 8.78 2.30 NA 30.09 090 

58554 .......... ............ A Laparo-vag hyst w/t/o, compl ...................... 22.01 NA 10.24 2.27 NA 34.52 090 

58555 .......... ............ A Hysteroscopy, dx, sep proc ......................... 3.34 2.16 1.52 0.40 5.90 5.26 000 

58558 .......... ............ A Hysteroscopy, biopsy .................................. 4.75 NA 2.13 0.57 NA 7.45 000 

58559 .......... ............ A Hysteroscopy, lysis ...................................... 6.17 NA 2.68 0.74 NA 9.60 000 

58560 .......... ............ A Hysteroscopy, resect septum ...................... 7.00 NA 3.02 0.84 NA 10.86 000 

58561 .......... ............ A Hysteroscopy, remove myoma .................... 10.01 NA 4.19 1.21 NA 15.41 000 

58562 .......... ............ A Hysteroscopy, remove fb ............................ 5.21 NA 2.30 0.63 NA 8.14 000 

58563 .......... ............ A Hysteroscopy, ablation ................................ 6.17 52.70 2.70 0.74 59.62 9.61 000 

58565 .......... ............ A Hysteroscopy, sterilization ........................... 7.03 46.78 3.88 1.19 55.01 12.11 090 

58578 .......... ............ C Laparo proc, uterus ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

58579 .......... ............ C Hysteroscope procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

58600 .......... ............ A Division of fallopian tube ............................. 5.60 NA 3.29 0.66 NA 9.55 090 

58605 .......... ............ A Division of fallopian tube ............................. 5.00 NA 3.06 0.59 NA 8.65 090 

58611 .......... ............ A Ligate oviduct(s) add-on .............................. 1.45 NA 0.56 0.18 NA 2.19 ZZZ 

58615 .......... ............ A Occlude fallopian tube(s) ............................ 3.90 NA 2.62 0.47 NA 6.98 010 

58660 .......... ............ A Laparoscopy, lysis ....................................... 11.29 NA 5.17 1.40 NA 17.87 090 

58661 .......... ............ A Laparoscopy, remove adnexa ..................... 11.05 NA 5.02 1.34 NA 17.41 010 

58662 .......... ............ A Laparoscopy, excise lesions ....................... 11.79 NA 5.68 1.43 NA 18.90 090 

58670 .......... ............ A Laparoscopy, tubal cautery ......................... 5.60 NA 3.23 0.67 NA 9.50 090 

58671 .......... ............ A Laparoscopy, tubal block ............................ 5.60 NA 3.23 0.68 NA 9.51 090 

58672 .......... ............ A Laparoscopy, fimbrioplasty .......................... 12.89 NA 6.06 1.60 NA 20.55 090 

58673 .......... ............ A Laparoscopy, salpingostomy ....................... 13.75 NA 6.45 1.69 NA 21.88 090 

58679 .......... ............ C Laparo proc, oviduct-ovary .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

58700 .......... ............ A Removal of fallopian tube ........................... 12.05 NA 5.91 1.51 NA 19.48 090 

58720 .......... ............ A Removal of ovary/tube(s) ............................ 11.36 NA 5.69 1.39 NA 18.44 090 

58740 .......... ............ A Revise fallopian tube(s) ............................... 14.01 NA 7.03 1.71 NA 22.74 090 

58750 .......... ............ A Repair oviduct ............................................. 14.85 NA 7.22 1.84 NA 23.91 090 

58752 .......... ............ A Revise ovarian tube(s) ................................ 14.85 NA 6.79 1.80 NA 23.44 090 

58760 .......... ............ A Remove tubal obstruction ........................... 13.14 NA 6.62 1.79 NA 21.54 090 

58770 .......... ............ A Create new tubal opening ........................... 13.98 NA 6.78 1.73 NA 22.49 090 

58800 .......... ............ A Drainage of ovarian cyst(s) ......................... 4.14 3.56 2.93 0.43 8.13 7.50 090 

58805 .......... ............ A Drainage of ovarian cyst(s) ......................... 5.88 NA 3.49 0.69 NA 10.06 090 

58820 .......... ............ A Drain ovary abscess, open ......................... 4.22 NA 3.35 0.52 NA 8.09 090 

58822 .......... ............ A Drain ovary abscess, percut ....................... 10.13 NA 5.19 1.16 NA 16.48 090 

58823 .......... ............ A Drain pelvic abscess, percut ....................... 3.38 21.63 1.16 0.24 25.24 4.77 000 

58825 .......... ............ A Transposition, ovary(s) ................................ 10.98 NA 5.69 1.32 NA 17.99 090 

58900 .......... ............ A Biopsy of ovary(s) ....................................... 5.99 NA 3.57 0.69 NA 10.25 090 

58920 .......... ............ A Partial removal of ovary(s) .......................... 11.36 NA 5.49 1.43 NA 18.28 090 

58925 .......... ............ A Removal of ovarian cyst(s) ......................... 11.36 NA 5.62 1.41 NA 18.39 090 

45938

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

58940 .......... ............ A Removal of ovary(s) .................................... 7.29 NA 4.08 0.91 NA 12.29 090 

58943 .......... ............ A Removal of ovary(s) .................................... 18.44 NA 8.48 2.22 NA 29.13 090 

58950 .......... ............ A Resect ovarian malignancy ......................... 16.93 NA 8.24 2.04 NA 27.22 090 

58951 .......... ............ A Resect ovarian malignancy ......................... 22.39 NA 10.22 2.63 NA 35.24 090 

58952 .......... ............ A Resect ovarian malignancy ......................... 25.02 NA 11.50 3.02 NA 39.54 090 

58953 .......... ............ A Tah, rad dissect for debulk ......................... 32.01 NA 14.24 3.83 NA 50.08 090 

58954 .......... ............ A Tah rad debulk/lymph remove .................... 35.02 NA 15.44 4.17 NA 54.63 090 

58956 .......... ............ A Bso, omentectomy w/tah ............................. 20.82 NA 10.08 4.00 NA 34.90 090 

58960 .......... ............ A Exploration of abdomen .............................. 14.66 NA 7.21 1.79 NA 23.66 090 

58970 .......... ............ A Retrieval of oocyte ...................................... 3.53 2.27 1.46 0.43 6.23 5.42 000 

58974 .......... ............ C Transfer of embryo ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

58976 .......... ............ A Transfer of embryo ...................................... 3.83 2.63 1.79 0.47 6.93 6.09 000 

58999 .......... ............ C Genital surgery procedure ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

59000 .......... ............ A Amniocentesis, diagnostic ........................... 1.30 2.01 0.66 0.31 3.63 2.27 000 

59001 .......... ............ A Amniocentesis, therapeutic ......................... 3.01 NA 1.39 0.71 NA 5.10 000 

59012 .......... ............ A Fetal cord puncture,prenatal ....................... 3.45 NA 1.51 0.82 NA 5.77 000 

59015 .......... ............ A Chorion biopsy ............................................ 2.20 1.54 1.02 0.52 4.26 3.75 000 

59020 .......... ............ A Fetal contract stress test ............................. 0.66 0.83 NA 0.26 1.76 NA 000 

59020 .......... 26 ....... A Fetal contract stress test ............................. 0.66 0.26 0.26 0.16 1.08 1.08 000 

59020 .......... TC ...... A Fetal contract stress test ............................. 0.00 0.58 NA 0.10 0.68 NA 000 

59025 .......... ............ A Fetal non-stress test .................................... 0.53 0.48 NA 0.15 1.16 NA 000 

59025 .......... 26 ....... A Fetal non-stress test .................................... 0.53 0.21 0.21 0.13 0.87 0.87 000 

59025 .......... TC ...... A Fetal non-stress test .................................... 0.00 0.27 NA 0.02 0.29 NA 000 

59030 .......... ............ A Fetal scalp blood sample ............................ 1.99 NA 0.75 0.47 NA 3.22 000 

59050 .......... ............ A Fetal monitor w/report ................................. 0.89 NA 0.34 0.21 NA 1.44 XXX 

59051 .......... ............ A Fetal monitor/interpret only ......................... 0.74 NA 0.28 0.17 NA 1.19 XXX 

59070 .......... ............ A Transabdom amnioinfus w/us ..................... 5.25 5.16 2.29 0.28 10.69 7.82 000 

59072 .......... ............ A Umbilical cord occlud w/us .......................... 9.01 NA 3.56 0.16 NA 12.73 000 

59074 .......... ............ A Fetal fluid drainage w/us ............................. 5.25 4.51 2.29 0.28 10.04 7.82 000 

59076 .......... ............ A Fetal shunt placement, w/us ....................... 9.01 NA 3.56 0.16 NA 12.73 000 

59100 .......... ............ A Remove uterus lesion ................................. 12.35 NA 6.36 2.94 NA 21.65 090 

59120 .......... ............ A Treat ectopic pregnancy .............................. 11.49 NA 6.14 2.72 NA 20.35 090 

59121 .......... ............ A Treat ectopic pregnancy .............................. 11.67 NA 6.21 2.78 NA 20.67 090 

59130 .......... ............ A Treat ectopic pregnancy .............................. 14.23 NA 4.59 3.38 NA 22.20 090 

59135 .......... ............ A Treat ectopic pregnancy .............................. 13.89 NA 7.09 3.30 NA 24.28 090 

59136 .......... ............ A Treat ectopic pregnancy .............................. 13.19 NA 6.48 3.13 NA 22.80 090 

59140 .......... ............ A Treat ectopic pregnancy .............................. 5.46 NA 2.49 1.29 NA 9.24 090 

59150 .......... ............ A Treat ectopic pregnancy .............................. 11.67 NA 5.90 2.78 NA 20.35 090 

59151 .......... ............ A Treat ectopic pregnancy .............................. 11.49 NA 5.95 2.73 NA 20.17 090 

59160 .......... ............ A D & c after delivery ..................................... 2.72 3.09 1.99 0.64 6.44 5.35 010 

59200 .......... ............ A Insert cervical dilator ................................... 0.79 1.15 0.30 0.19 2.13 1.28 000 

59300 .......... ............ A Episiotomy or vaginal repair ........................ 2.41 2.34 1.02 0.57 5.33 4.01 000 

59320 .......... ............ A Revision of cervix ........................................ 2.48 NA 1.22 0.59 NA 4.30 000 

59325 .......... ............ A Revision of cervix ........................................ 4.07 NA 1.86 0.88 NA 6.80 000 

59350 .......... ............ A Repair of uterus ........................................... 4.95 NA 1.84 1.17 NA 7.96 000 

59400 .......... ............ A Obstetrical care ........................................... 23.08 NA 15.13 5.48 NA 43.68 MMM 

59409 .......... ............ A Obstetrical care ........................................... 13.51 NA 5.17 3.21 NA 21.89 MMM 

59410 .......... ............ A Obstetrical care ........................................... 14.79 NA 6.16 3.51 NA 24.46 MMM 

59412 .......... ............ A Antepartum manipulation ............................ 1.71 NA 0.80 0.40 NA 2.91 MMM 

59414 .......... ............ A Deliver placenta ........................................... 1.61 NA 0.62 0.38 NA 2.62 MMM 

59425 .......... ............ A Antepartum care only .................................. 4.81 4.16 1.80 1.14 10.11 7.75 MMM 

59426 .......... ............ A Antepartum care only .................................. 8.29 7.48 3.14 1.97 17.74 13.40 MMM 

59430 .......... ............ A Care after delivery ....................................... 2.13 1.21 0.91 0.50 3.84 3.55 MMM 

59510 .......... ............ A Cesarean delivery ....................................... 26.23 NA 17.03 6.23 NA 49.50 MMM 

59514 .......... ............ A Cesarean delivery only ................................ 15.98 NA 6.06 3.79 NA 25.83 MMM 

59515 .......... ............ A Cesarean delivery ....................................... 17.37 NA 7.67 4.12 NA 29.16 MMM 

59525 .......... ............ A Remove uterus after cesarean .................... 8.55 NA 3.22 1.94 NA 13.71 ZZZ 

59610 .......... ............ A Vbac delivery ............................................... 24.63 NA 15.63 5.85 NA 46.11 MMM 

59612 .......... ............ A Vbac delivery only ....................................... 15.07 NA 5.90 3.58 NA 24.55 MMM 

59614 .......... ............ A Vbac care after delivery .............................. 16.35 NA 6.77 3.88 NA 27.00 MMM 

59618 .......... ............ A Attempted vbac delivery .............................. 27.80 NA 17.88 6.59 NA 52.26 MMM 

59620 .......... ............ A Attempted vbac delivery only ...................... 17.54 NA 6.59 4.16 NA 28.28 MMM 

59622 .......... ............ A Attempted vbac after care ........................... 18.94 NA 8.59 4.49 NA 32.02 MMM 

59812 .......... ............ A Treatment of miscarriage ............................ 4.01 NA 2.50 0.95 NA 7.46 090 

59820 .......... ............ A Care of miscarriage ..................................... 4.01 4.34 3.53 0.95 9.30 8.49 090 

59821 .......... ............ A Treatment of miscarriage ............................ 4.47 4.20 3.36 1.06 9.72 8.89 090 

59830 .......... ............ A Treat uterus infection .................................. 6.11 NA 3.91 1.44 NA 11.46 090 

59840 .......... ............ R Abortion ....................................................... 3.02 NA 2.09 0.71 NA 5.81 010 

59841 .......... ............ R Abortion ....................................................... 5.24 NA 2.93 1.24 NA 9.41 010 

59850 .......... ............ R Abortion ....................................................... 5.91 NA 3.22 1.28 NA 10.41 090 

59851 .......... ............ R Abortion ....................................................... 5.93 NA 3.70 1.28 NA 10.91 090 

59852 .......... ............ R Abortion ....................................................... 8.25 NA 4.94 1.80 NA 14.99 090 

59855 .......... ............ R Abortion ....................................................... 6.12 NA 3.48 1.45 NA 11.05 090 

59856 .......... ............ R Abortion ....................................................... 7.48 NA 4.00 1.78 NA 13.26 090 

45939

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

59857 .......... ............ R Abortion ....................................................... 9.30 NA 4.63 2.01 NA 15.94 090 

59866 .......... ............ R Abortion (mpr) ............................................. 4.00 NA 1.86 0.87 NA 6.73 000 

59870 .......... ............ A Evacuate mole of uterus ............................. 6.01 NA 4.43 1.42 NA 11.87 090 

59871 .......... ............ A Remove cerclage suture ............................. 2.13 NA 1.11 0.50 NA 3.75 000 

59897 .......... ............ C Fetal invas px w/us ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

59898 .......... ............ C Laparo proc, ob care/deliver ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

59899 .......... ............ C Maternity care procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

60000 .......... ............ A Drain thyroid/tongue cyst ............................ 1.76 1.94 1.73 0.15 3.85 3.64 010 

60001 .......... ............ A Aspirate/inject thyriod cyst .......................... 0.97 1.57 0.33 0.07 2.61 1.38 000 

60100 .......... ............ A Biopsy of thyroid .......................................... 1.56 1.38 0.55 0.10 3.05 2.21 000 

60200 .......... ............ A Remove thyroid lesion ................................. 9.56 NA 5.87 1.01 NA 16.44 090 

60210 .......... ............ A Partial thyroid excision ................................ 10.88 NA 5.53 1.23 NA 17.65 090 

60212 .......... ............ A Partial thyroid excision ................................ 16.04 NA 7.54 1.94 NA 25.52 090 

60220 .......... ............ A Partial removal of thyroid ............................ 11.90 NA 6.03 1.32 NA 19.25 090 

60225 .......... ............ A Partial removal of thyroid ............................ 14.20 NA 7.28 1.64 NA 23.12 090 

60240 .......... ............ A Removal of thyroid ...................................... 16.07 NA 7.41 1.85 NA 25.33 090 

60252 .......... ............ A Removal of thyroid ...................................... 20.58 NA 9.87 2.29 NA 32.75 090 

60254 .......... ............ A Extensive thyroid surgery ............................ 27.00 NA 13.74 2.60 NA 43.35 090 

60260 .......... ............ A Repeat thyroid surgery ................................ 17.47 NA 8.44 1.93 NA 27.84 090 

60270 .......... ............ A Removal of thyroid ...................................... 20.28 NA 10.12 2.32 NA 32.72 090 

60271 .......... ............ A Removal of thyroid ...................................... 16.83 NA 8.36 1.74 NA 26.93 090 

60280 .......... ............ A Remove thyroid duct lesion ......................... 5.87 NA 4.59 0.54 NA 11.00 090 

60281 .......... ............ A Remove thyroid duct lesion ......................... 8.54 NA 5.72 0.73 NA 14.98 090 

60500 .......... ............ A Explore parathyroid glands ......................... 16.24 NA 7.28 2.00 NA 25.52 090 

60502 .......... ............ A Re-explore parathyroids .............................. 20.36 NA 9.19 2.53 NA 32.08 090 

60505 .......... ............ A Explore parathyroid glands ......................... 21.50 NA 10.63 2.64 NA 34.77 090 

60512 .......... ............ A Autotransplant parathyroid .......................... 4.45 NA 1.58 0.53 NA 6.55 ZZZ 

60520 .......... ............ A Removal of thymus gland ........................... 16.81 NA 8.03 2.19 NA 27.04 090 

60521 .......... ............ A Removal of thymus gland ........................... 18.88 NA 9.28 2.81 NA 30.97 090 

60522 .......... ............ A Removal of thymus gland ........................... 23.11 NA 11.00 3.26 NA 37.37 090 

60540 .......... ............ A Explore adrenal gland ................................. 17.03 NA 7.94 1.74 NA 26.71 090 

60545 .......... ............ A Explore adrenal gland ................................. 19.89 NA 8.85 2.07 NA 30.81 090 

60600 .......... ............ A Remove carotid body lesion ........................ 17.94 NA 10.62 2.19 NA 30.75 090 

60605 .......... ............ A Remove carotid body lesion ........................ 20.25 NA 11.93 2.49 NA 34.67 090 

60650 .......... ............ A Laparoscopy adrenalectomy ....................... 20.01 NA 8.14 2.28 NA 30.43 090 

60659 .......... ............ C Laparo proc, endocrine ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

60699 .......... ............ C Endocrine surgery procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

61000 .......... ............ A Remove cranial cavity fluid ......................... 1.58 0.00 0.98 0.13 1.71 2.70 000 

61001 .......... ............ A Remove cranial cavity fluid ......................... 1.49 0.00 1.03 0.16 1.65 2.68 000 

61020 .......... ............ A Remove brain cavity fluid ............................ 1.51 0.00 1.33 0.34 1.85 3.18 000 

61026 .......... ............ A Injection into brain canal ............................. 1.69 0.00 1.38 0.33 2.02 3.40 000 

61050 .......... ............ A Remove brain canal fluid ............................ 1.51 NA 1.31 0.11 NA 2.94 000 

61055 .......... ............ A Injection into brain canal ............................. 2.10 NA 1.48 0.17 NA 3.75 000 

61070 .......... ............ A Brain canal shunt procedure ....................... 0.89 0.00 1.02 0.17 1.06 2.08 000 

61105 .......... ............ A Twist drill hole ............................................. 5.14 NA 3.87 1.32 NA 10.33 090 

61107 .......... ............ A Drill skull for implantation ............................ 5.00 NA 2.46 1.29 NA 8.75 000 

61108 .......... ............ A Drill skull for drainage ................................. 10.19 NA 7.02 2.63 NA 19.84 090 

61120 .......... ............ A Burr hole for puncture ................................. 8.77 NA 5.88 2.09 NA 16.74 090 

61140 .......... ............ A Pierce skull for biopsy ................................. 15.91 NA 9.69 4.11 NA 29.71 090 

61150 .......... ............ A Pierce skull for drainage ............................. 17.58 NA 10.16 4.31 NA 32.05 090 

61151 .......... ............ A Pierce skull for drainage ............................. 12.42 NA 7.65 3.00 NA 23.08 090 

61154 .......... ............ A Pierce skull & remove clot .......................... 15.00 NA 9.30 4.20 NA 28.50 090 

61156 .......... ............ A Pierce skull for drainage ............................. 16.33 NA 9.63 4.22 NA 30.18 090 

61210 .......... ............ A Pierce skull, implant device ......................... 5.84 NA 2.84 1.50 NA 10.18 000 

61215 .......... ............ A Insert brain-fluid device ............................... 4.89 NA 3.95 1.26 NA 10.10 090 

61250 .......... ............ A Pierce skull & explore ................................. 10.42 NA 6.72 2.76 NA 19.90 090 

61253 .......... ............ A Pierce skull & explore ................................. 12.36 NA 7.56 2.61 NA 22.54 090 

61304 .......... ............ A Open skull for exploration ........................... 21.97 NA 12.56 5.61 NA 40.14 090 

61305 .......... ............ A Open skull for exploration ........................... 26.62 NA 14.98 6.07 NA 47.67 090 

61312 .......... ............ A Open skull for drainage ............................... 24.58 NA 14.74 6.34 NA 45.66 090 

61313 .......... ............ A Open skull for drainage ............................... 24.94 NA 14.50 6.43 NA 45.87 090 

61314 .......... ............ A Open skull for drainage ............................... 24.24 NA 12.75 6.26 NA 43.25 090 

61315 .......... ............ A Open skull for drainage ............................... 27.70 NA 15.67 7.14 NA 50.51 090 

61316 .......... ............ A Implt cran bone flap to abdo ....................... 1.39 NA 0.59 0.35 NA 2.33 ZZZ 

61320 .......... ............ A Open skull for drainage ............................... 25.63 NA 14.43 6.60 NA 46.66 090 

61321 .......... ............ A Open skull for drainage ............................... 28.52 NA 15.77 7.12 NA 51.41 090 

61322 .......... ............ A Decompressive craniotomy ......................... 29.52 NA 15.34 7.61 NA 52.46 090 

61323 .......... ............ A Decompressive lobectomy .......................... 31.01 NA 15.73 8.01 NA 54.76 090 

61330 .......... ............ A Decompress eye socket .............................. 23.34 NA 13.39 2.31 NA 39.03 090 

61332 .......... ............ A Explore/biopsy eye socket .......................... 27.29 NA 15.22 4.82 NA 47.33 090 

61333 .......... ............ A Explore orbit/remove lesion ......................... 27.97 NA 15.20 3.91 NA 47.07 090 

61334 .......... ............ A Explore orbit/remove object ........................ 18.28 NA 10.39 1.74 NA 30.41 090 

61340 .......... ............ A Subtemporal decompression ....................... 18.67 NA 10.90 4.83 NA 34.40 090 

61343 .......... ............ A Incise skull (press relief) ............................. 29.79 NA 16.44 7.62 NA 53.84 090 

45940

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

61345 .......... ............ A Relieve cranial pressure .............................. 27.21 NA 15.07 7.02 NA 49.30 090 

61440 .......... ............ A Incise skull for surgery ................................ 26.64 NA 13.94 6.88 NA 47.46 090 

61450 .......... ............ A Incise skull for surgery ................................ 25.96 NA 13.98 5.77 NA 45.71 090 

61458 .......... ............ A Incise skull for brain wound ........................ 27.30 NA 15.18 7.01 NA 49.49 090 

61460 .......... ............ A Incise skull for surgery ................................ 28.41 NA 16.01 6.02 NA 50.43 090 

61470 .......... ............ A Incise skull for surgery ................................ 26.07 NA 13.55 5.88 NA 45.51 090 

61480 .......... ............ A Incise skull for surgery ................................ 26.50 NA 14.94 6.71 NA 48.16 090 

61490 .......... ............ A Incise skull for surgery ................................ 25.67 NA 14.02 6.90 NA 46.59 090 

61500 .......... ............ A Removal of skull lesion ............................... 17.93 NA 10.58 4.10 NA 32.60 090 

61501 .......... ............ A Remove infected skull bone ........................ 14.85 NA 9.06 3.21 NA 27.12 090 

61510 .......... ............ A Removal of brain lesion .............................. 28.47 NA 16.35 7.33 NA 52.15 090 

61512 .......... ............ A Remove brain lining lesion .......................... 35.11 NA 19.25 9.05 NA 63.41 090 

61514 .......... ............ A Removal of brain abscess ........................... 25.27 NA 14.13 6.52 NA 45.92 090 

61516 .......... ............ A Removal of brain lesion .............................. 24.62 NA 13.97 6.33 NA 44.91 090 

61517 .......... ............ A Implt brain chemotx add-on ........................ 1.38 NA 0.62 0.35 NA 2.36 ZZZ 

61518 .......... ............ A Removal of brain lesion .............................. 37.33 NA 20.64 9.62 NA 67.60 090 

61519 .......... ............ A Remove brain lining lesion .......................... 41.41 NA 22.14 10.60 NA 74.15 090 

61520 .......... ............ A Removal of brain lesion .............................. 54.87 NA 29.56 11.18 NA 95.61 090 

61521 .......... ............ A Removal of brain lesion .............................. 44.50 NA 23.66 11.36 NA 79.52 090 

61522 .......... ............ A Removal of brain abscess ........................... 29.47 NA 16.06 7.60 NA 53.13 090 

61524 .......... ............ A Removal of brain lesion .............................. 27.88 NA 15.32 7.14 NA 50.34 090 

61526 .......... ............ A Removal of brain lesion .............................. 52.19 NA 28.57 7.05 NA 87.82 090 

61530 .......... ............ A Removal of brain lesion .............................. 43.88 NA 24.30 6.13 NA 74.31 090 

61531 .......... ............ A Implant brain electrodes .............................. 14.64 NA 8.96 3.78 NA 27.37 090 

61533 .......... ............ A Implant brain electrodes .............................. 19.72 NA 11.30 5.10 NA 36.12 090 

61534 .......... ............ A Removal of brain lesion .............................. 20.98 NA 11.83 5.42 NA 38.24 090 

61535 .......... ............ A Remove brain electrodes ............................ 11.63 NA 7.29 3.01 NA 21.93 090 

61536 .......... ............ A Removal of brain lesion .............................. 35.54 NA 19.34 9.18 NA 64.06 090 

61537 .......... ............ A Removal of brain tissue .............................. 25.01 NA 14.46 6.92 NA 46.39 090 

61538 .......... ............ A Removal of brain tissue .............................. 26.82 NA 14.99 6.92 NA 48.73 090 

61539 .......... ............ A Removal of brain tissue .............................. 32.09 NA 17.37 8.30 NA 57.76 090 

61540 .......... ............ A Removal of brain tissue .............................. 30.02 NA 16.93 8.30 NA 55.25 090 

61541 .......... ............ A Incision of brain tissue ................................ 28.87 NA 15.84 6.58 NA 51.29 090 

61542 .......... ............ A Removal of brain tissue .............................. 31.03 NA 17.43 8.01 NA 56.47 090 

61543 .......... ............ A Removal of brain tissue .............................. 29.24 NA 16.02 7.54 NA 52.80 090 

61544 .......... ............ A Remove & treat brain lesion ....................... 25.51 NA 13.50 5.95 NA 44.96 090 

61545 .......... ............ A Excision of brain tumor ............................... 43.82 NA 23.67 10.60 NA 78.09 090 

61546 .......... ............ A Removal of pituitary gland .......................... 31.31 NA 17.12 7.65 NA 56.08 090 

61548 .......... ............ A Removal of pituitary gland .......................... 21.54 NA 12.46 3.42 NA 37.43 090 

61550 .......... ............ A Release of skull seams ............................... 14.66 NA 6.92 0.98 NA 22.56 090 

61552 .......... ............ A Release of skull seams ............................... 19.57 NA 9.46 1.06 NA 30.09 090 

61556 .......... ............ A Incise skull/sutures ...................................... 22.27 NA 11.14 4.64 NA 38.05 090 

61557 .......... ............ A Incise skull/sutures ...................................... 22.39 NA 13.35 5.78 NA 41.52 090 

61558 .......... ............ A Excision of skull/sutures .............................. 25.59 NA 13.91 1.36 NA 40.86 090 

61559 .......... ............ A Excision of skull/sutures .............................. 32.81 NA 18.91 8.48 NA 60.19 090 

61563 .......... ............ A Excision of skull tumor ................................ 26.84 NA 14.87 5.15 NA 46.87 090 

61564 .......... ............ A Excision of skull tumor ................................ 33.85 NA 17.88 8.75 NA 60.48 090 

61566 .......... ............ A Removal of brain tissue .............................. 31.01 NA 17.43 6.92 NA 55.36 090 

61567 .......... ............ A Incision of brain tissue ................................ 35.52 NA 20.22 6.52 NA 62.26 090 

61570 .......... ............ A Remove foreign body, brain ........................ 24.61 NA 13.62 5.86 NA 44.09 090 

61571 .......... ............ A Incise skull for brain wound ........................ 26.40 NA 14.81 6.77 NA 47.98 090 

61575 .......... ............ A Skull base/brainstem surgery ...................... 34.38 NA 19.10 5.32 NA 58.80 090 

61576 .......... ............ A Skull base/brainstem surgery ...................... 52.45 NA 33.91 5.56 NA 91.92 090 

61580 .......... ............ A Craniofacial approach, skull ........................ 30.36 NA 24.92 3.36 NA 58.65 090 

61581 .......... ............ A Craniofacial approach, skull ........................ 34.62 NA 22.74 3.91 NA 61.27 090 

61582 .......... ............ A Craniofacial approach, skull ........................ 31.67 NA 26.53 7.19 NA 65.39 090 

61583 .......... ............ A Craniofacial approach, skull ........................ 36.23 NA 24.49 9.18 NA 69.90 090 

61584 .......... ............ A Orbitocranial approach/skull ........................ 34.67 NA 23.90 8.16 NA 66.72 090 

61585 .......... ............ A Orbitocranial approach/skull ........................ 38.63 NA 25.74 7.01 NA 71.37 090 

61586 .......... ............ A Resect nasopharynx, skull .......................... 25.11 NA 21.90 4.36 NA 51.37 090 

61590 .......... ............ A Infratemporal approach/skull ....................... 41.80 NA 27.92 5.29 NA 75.01 090 

61591 .......... ............ A Infratemporal approach/skull ....................... 43.70 NA 28.74 5.64 NA 78.08 090 

61592 .......... ............ A Orbitocranial approach/skull ........................ 39.66 NA 25.87 10.04 NA 75.57 090 

61595 .......... ............ A Transtemporal approach/skull ..................... 29.59 NA 21.85 3.97 NA 55.41 090 

61596 .......... ............ A Transcochlear approach/skull ..................... 35.65 NA 23.83 3.39 NA 62.87 090 

61597 .......... ............ A Transcondylar approach/skull ..................... 37.98 NA 22.44 8.81 NA 69.23 090 

61598 .......... ............ A Transpetrosal approach/skull ...................... 33.43 NA 22.65 5.68 NA 61.75 090 

61600 .......... ............ A Resect/excise cranial lesion ........................ 25.86 NA 19.34 3.78 NA 48.98 090 

61601 .......... ............ A Resect/excise cranial lesion ........................ 27.91 NA 19.99 6.61 NA 54.51 090 

61605 .......... ............ A Resect/excise cranial lesion ........................ 29.35 NA 21.48 2.85 NA 53.68 090 

61606 .......... ............ A Resect/excise cranial lesion ........................ 38.85 NA 24.52 8.94 NA 72.31 090 

61607 .......... ............ A Resect/excise cranial lesion ........................ 36.29 NA 23.18 6.88 NA 66.35 090 

61608 .......... ............ A Resect/excise cranial lesion ........................ 42.12 NA 25.94 10.72 NA 78.79 090 

61609 .......... ............ A Transect artery, sinus .................................. 9.90 NA 4.72 2.55 NA 17.17 ZZZ 

45941

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

61610 .......... ............ A Transect artery, sinus .................................. 29.69 NA 12.81 7.66 NA 50.15 ZZZ 

61611 .......... ............ A Transect artery, sinus .................................. 7.42 NA 3.72 1.88 NA 13.03 ZZZ 

61612 .......... ............ A Transect artery, sinus .................................. 27.90 NA 12.98 4.30 NA 45.18 ZZZ 

61613 .......... ............ A Remove aneurysm, sinus ............................ 40.88 NA 25.62 8.42 NA 74.92 090 

61615 .......... ............ A Resect/excise lesion, skull .......................... 32.08 NA 22.18 4.72 NA 58.98 090 

61616 .......... ............ A Resect/excise lesion, skull .......................... 43.36 NA 27.92 8.24 NA 79.52 090 

61618 .......... ............ A Repair dura .................................................. 16.99 NA 10.21 3.71 NA 30.92 090 

61619 .......... ............ A Repair dura .................................................. 20.72 NA 11.95 3.94 NA 36.62 090 

61623 .......... ............ A Endovasc tempory vessel occl .................... 9.97 NA 4.07 1.05 NA 15.09 000 

61624 .......... ............ A Transcath occlusion, cns ............................. 20.16 NA 7.17 1.95 NA 29.28 000 

61626 .......... ............ A Transcath occlusion, non-cns ..................... 16.63 NA 5.79 1.24 NA 23.66 000 

61680 .......... ............ A Intracranial vessel surgery .......................... 30.72 NA 17.06 7.93 NA 55.71 090 

61682 .......... ............ A Intracranial vessel surgery .......................... 61.60 NA 31.45 15.85 NA 108.90 090 

61684 .......... ............ A Intracranial vessel surgery .......................... 39.83 NA 21.58 10.28 NA 71.69 090 

61686 .......... ............ A Intracranial vessel surgery .......................... 64.52 NA 33.92 16.66 NA 115.09 090 

61690 .......... ............ A Intracranial vessel surgery .......................... 29.33 NA 16.37 6.92 NA 52.62 090 

61692 .......... ............ A Intracranial vessel surgery .......................... 51.89 NA 26.84 13.39 NA 92.12 090 

61697 .......... ............ A Brain aneurysm repr, complx ...................... 50.54 NA 27.39 12.81 NA 90.74 090 

61698 .......... ............ A Brain aneurysm repr, complx ...................... 48.44 NA 26.12 12.50 NA 87.06 090 

61700 .......... ............ A Brain aneurysm repr, simple ....................... 50.54 NA 27.19 12.98 NA 90.72 090 

61702 .......... ............ A Inner skull vessel surgery ........................... 48.44 NA 25.43 10.76 NA 84.63 090 

61703 .......... ............ A Clamp neck artery ....................................... 17.47 NA 10.25 4.05 NA 31.78 090 

61705 .......... ............ A Revise circulation to head ........................... 36.22 NA 18.95 8.84 NA 64.01 090 

61708 .......... ............ A Revise circulation to head ........................... 35.32 NA 15.74 2.50 NA 53.56 090 

61710 .......... ............ A Revise circulation to head ........................... 29.69 NA 13.97 4.51 NA 48.16 090 

61711 .......... ............ A Fusion of skull arteries ................................ 36.35 NA 19.36 9.39 NA 65.10 090 

61720 .......... ............ A Incise skull/brain surgery ............................. 16.77 NA 9.79 2.78 NA 29.34 090 

61735 .......... ............ A Incise skull/brain surgery ............................. 20.44 NA 11.91 2.72 NA 35.07 090 

61750 .......... ............ A Incise skull/brain biopsy .............................. 18.21 NA 10.39 4.71 NA 33.31 090 

61751 .......... ............ A Brain biopsy w/ct/mr guide .......................... 17.63 NA 10.61 4.55 NA 32.79 090 

61760 .......... ............ A Implant brain electrodes .............................. 22.28 NA 8.51 5.40 NA 36.19 090 

61770 .......... ............ A Incise skull for treatment ............................. 21.45 NA 12.04 3.54 NA 37.03 090 

61790 .......... ............ A Treat trigeminal nerve ................................. 10.86 NA 5.79 2.81 NA 19.47 090 

61791 .......... ............ A Treat trigeminal tract ................................... 14.62 NA 8.74 3.39 NA 26.75 090 

61793 .......... ............ A Focus radiation beam .................................. 17.24 NA 9.91 4.45 NA 31.61 090 

61795 .......... ............ A Brain surgery using computer ..................... 4.04 NA 1.98 0.79 NA 6.80 ZZZ 

61850 .......... ............ A Implant neuroelectrodes .............................. 12.39 NA 7.61 3.21 NA 23.22 090 

61860 .......... ............ A Implant neuroelectrodes .............................. 20.88 NA 11.78 4.94 NA 37.61 090 

61863 .......... ............ A Implant neuroelectrode ................................ 19.01 NA 11.56 5.41 NA 35.98 090 

61864 .......... ............ A Implant neuroelectrde, add’l ........................ 4.50 NA 2.23 5.41 NA 12.14 ZZZ 

61867 .......... ............ A Implant neuroelectrode ................................ 31.35 NA 17.66 5.41 NA 54.42 090 

61868 .......... ............ A Implant neuroelectrde, add’l ........................ 7.93 NA 3.92 5.41 NA 17.25 ZZZ 

61870 .......... ............ A Implant neuroelectrodes .............................. 14.95 NA 9.43 3.86 NA 28.24 090 

61875 .......... ............ A Implant neuroelectrodes .............................. 15.07 NA 8.60 2.94 NA 26.61 090 

61880 .......... ............ A Revise/remove neuroelectrode ................... 6.29 NA 4.50 1.66 NA 12.45 090 

61885 .......... ............ A Insrt/redo neurostim 1 array ........................ 5.85 NA 5.25 1.59 NA 12.69 090 

61886 .......... ............ A Implant neurostim arrays ............................. 8.01 NA 6.26 1.96 NA 16.22 090 

61888 .......... ............ A Revise/remove neuroreceiver ..................... 5.07 NA 3.56 1.33 NA 9.96 010 

62000 .......... ............ A Treat skull fracture ...................................... 12.54 NA 6.22 1.06 NA 19.82 090 

62005 .......... ............ A Treat skull fracture ...................................... 16.18 NA 8.90 3.86 NA 28.94 090 

62010 .......... ............ A Treatment of head injury ............................. 19.82 NA 11.47 5.12 NA 36.41 090 

62100 .......... ............ A Repair brain fluid leakage ........................... 22.04 NA 12.49 4.83 NA 39.37 090 

62115 .......... ............ A Reduction of skull defect ............................. 21.67 NA 11.50 5.49 NA 38.67 090 

62116 .......... ............ A Reduction of skull defect ............................. 23.60 NA 13.10 6.09 NA 42.78 090 

62117 .......... ............ A Reduction of skull defect ............................. 26.61 NA 15.04 4.52 NA 46.17 090 

62120 .......... ............ A Repair skull cavity lesion ............................. 23.36 NA 18.07 2.99 NA 44.42 090 

62121 .......... ............ A Incise skull repair ........................................ 21.59 NA 15.08 4.16 NA 40.83 090 

62140 .......... ............ A Repair of skull defect .................................. 13.52 NA 8.16 3.46 NA 25.14 090 

62141 .......... ............ A Repair of skull defect .................................. 14.92 NA 8.86 3.75 NA 27.53 090 

62142 .......... ............ A Remove skull plate/flap ............................... 10.79 NA 6.86 2.72 NA 20.37 090 

62143 .......... ............ A Replace skull plate/flap ............................... 13.06 NA 7.89 3.36 NA 24.30 090 

62145 .......... ............ A Repair of skull & brain ................................. 18.83 NA 10.66 4.49 NA 33.98 090 

62146 .......... ............ A Repair of skull with graft ............................. 16.13 NA 9.43 3.61 NA 29.17 090 

62147 .......... ............ A Repair of skull with graft ............................. 19.35 NA 11.05 4.31 NA 34.71 090 

62148 .......... ............ A Retr bone flap to fix skull ............................ 2.00 NA 0.84 0.48 NA 3.32 ZZZ 

62160 .......... ............ A Neuroendoscopy add-on ............................. 3.01 NA 1.49 0.77 NA 5.27 ZZZ 

62161 .......... ............ A Dissect brain w/scope ................................. 20.01 NA 11.85 5.17 NA 37.03 090 

62162 .......... ............ A Remove colloid cyst w/scope ...................... 25.26 NA 14.54 5.89 NA 45.69 090 

62163 .......... ............ A Neuroendoscopy w/fb removal .................... 15.51 NA 9.73 4.00 NA 29.24 090 

62164 .......... ............ A Remove brain tumor w/scope ..................... 27.51 NA 14.65 5.36 NA 47.53 090 

62165 .......... ............ A Remove pituit tumor w/scope ...................... 22.01 NA 13.05 3.00 NA 38.07 090 

62180 .......... ............ A Establish brain cavity shunt ........................ 21.07 NA 12.03 4.97 NA 38.07 090 

62190 .......... ............ A Establish brain cavity shunt ........................ 11.07 NA 6.95 2.79 NA 20.81 090 

62192 .......... ............ A Establish brain cavity shunt ........................ 12.25 NA 7.48 3.01 NA 22.74 090 

45942

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

62194 .......... ............ A Replace/irrigate catheter ............................. 5.03 NA 2.47 0.92 NA 8.42 010 

62200 .......... ............ A Establish brain cavity shunt ........................ 18.33 NA 10.62 4.64 NA 33.59 090 

62201 .......... ............ A Brain cavity shunt w/scope ......................... 14.87 NA 9.26 3.67 NA 27.80 090 

62220 .......... ............ A Establish brain cavity shunt ........................ 13.01 NA 7.83 3.34 NA 24.18 090 

62223 .......... ............ A Establish brain cavity shunt ........................ 12.88 NA 8.10 3.13 NA 24.11 090 

62225 .......... ............ A Replace/irrigate catheter ............................. 5.41 NA 4.03 1.39 NA 10.83 090 

62230 .......... ............ A Replace/revise brain shunt .......................... 10.54 NA 6.36 2.70 NA 19.60 090 

62252 .......... ............ A Csf shunt reprogram ................................... 0.74 1.35 NA 0.21 2.30 NA XXX 

62252 .......... 26 ....... A Csf shunt reprogram ................................... 0.74 0.36 0.36 0.19 1.29 1.29 XXX 

62252 .......... TC ...... A Csf shunt reprogram ................................... 0.00 0.99 NA 0.02 1.01 NA XXX 

62256 .......... ............ A Remove brain cavity shunt .......................... 6.60 NA 4.62 1.71 NA 12.93 090 

62258 .......... ............ A Replace brain cavity shunt .......................... 14.55 NA 8.54 3.73 NA 26.82 090 

62263 .......... ............ A Epidural lysis mult sessions ........................ 6.14 12.01 3.10 0.41 18.56 9.65 010 

62264 .......... ............ A Epidural lysis on single day ........................ 4.43 7.34 1.38 0.27 12.04 6.08 010 

62268 .......... ............ A Drain spinal cord cyst .................................. 4.74 10.84 2.19 0.43 16.01 7.36 000 

62269 .......... ............ A Needle biopsy, spinal cord .......................... 5.02 13.60 2.02 0.37 18.99 7.41 000 

62270 .......... ............ A Spinal fluid tap, diagnostic .......................... 1.13 2.88 0.56 0.08 4.09 1.78 000 

62272 .......... ............ A Drain cerebro spinal fluid ............................ 1.35 3.51 0.71 0.18 5.05 2.24 000 

62273 .......... ............ A Inject epidural patch .................................... 2.15 2.60 0.69 0.13 4.88 2.98 000 

62280 .......... ............ A Treat spinal cord lesion ............................... 2.64 6.38 0.99 0.30 9.32 3.93 010 

62281 .......... ............ A Treat spinal cord lesion ............................... 2.67 5.32 0.87 0.19 8.18 3.72 010 

62282 .......... ............ A Treat spinal canal lesion ............................. 2.33 7.60 0.90 0.17 10.10 3.40 010 

62284 .......... ............ A Injection for myelogram ............................... 1.54 4.79 0.69 0.13 6.46 2.36 000 

62287 .......... ............ A Percutaneous diskectomy ........................... 8.09 NA 5.57 0.58 NA 14.23 090 

62290 .......... ............ A Inject for spine disk x-ray ............................ 3.01 6.76 1.38 0.23 9.99 4.61 000 

62291 .......... ............ A Inject for spine disk x-ray ............................ 2.92 5.66 1.23 0.26 8.83 4.41 000 

62292 .......... ............ A Injection into disk lesion .............................. 7.87 NA 4.34 0.82 NA 13.03 090 

62294 .......... ............ A Injection into spinal artery ........................... 11.83 NA 5.73 1.24 NA 18.80 090 

62310 .......... ............ A Inject spine c/t ............................................. 1.91 4.51 0.63 0.12 6.55 2.67 000 

62311 .......... ............ A Inject spine l/s (cd) ...................................... 1.54 4.58 0.58 0.09 6.21 2.21 000 

62318 .......... ............ A Inject spine w/cath, c/t ................................. 2.04 5.36 0.63 0.12 7.53 2.80 000 

62319 .......... ............ A Inject spine w/cath l/s (cd) .......................... 1.87 4.65 0.59 0.11 6.64 2.58 000 

62350 .......... ............ A Implant spinal canal cath ............................ 6.87 NA 3.85 1.02 NA 11.74 090 

62351 .......... ............ A Implant spinal canal cath ............................ 10.01 NA 6.96 2.24 NA 19.21 090 

62355 .......... ............ A Remove spinal canal catheter ..................... 5.45 NA 3.09 0.71 NA 9.25 090 

62360 .......... ............ A Insert spine infusion device ......................... 2.63 NA 2.63 0.34 NA 5.59 090 

62361 .......... ............ A Implant spine infusion pump ....................... 5.42 NA 3.82 0.80 NA 10.04 090 

62362 .......... ............ A Implant spine infusion pump ....................... 7.04 NA 4.27 1.18 NA 12.50 090 

62365 .......... ............ A Remove spine infusion device .................... 5.42 NA 3.50 0.86 NA 9.79 090 

62367 .......... ............ A Analyze spine infusion pump ...................... 0.48 0.22 0.12 0.00 0.70 0.60 XXX 

62368 .......... ............ A Analyze spine infusion pump ...................... 0.75 0.29 0.18 0.00 1.04 0.93 XXX 

63001 .......... ............ A Removal of spinal lamina ............................ 15.83 NA 9.30 3.76 NA 28.90 090 

63003 .......... ............ A Removal of spinal lamina ............................ 15.96 NA 9.63 3.72 NA 29.31 090 

63005 .......... ............ A Removal of spinal lamina ............................ 14.93 NA 9.73 3.34 NA 28.00 090 

63011 .......... ............ A Removal of spinal lamina ............................ 14.53 NA 8.08 3.37 NA 25.98 090 

63012 .......... ............ A Removal of spinal lamina ............................ 15.41 NA 9.87 3.48 NA 28.76 090 

63015 .......... ............ A Removal of spinal lamina ............................ 19.36 NA 11.62 4.75 NA 35.73 090 

63016 .......... ............ A Removal of spinal lamina ............................ 19.21 NA 11.52 4.58 NA 35.30 090 

63017 .......... ............ A Removal of spinal lamina ............................ 15.95 NA 10.15 3.63 NA 29.73 090 

63020 .......... ............ A Neck spine disk surgery .............................. 14.82 NA 9.47 3.71 NA 28.00 090 

63030 .......... ............ A Low back disk surgery ................................ 12.00 NA 8.23 3.00 NA 23.24 090 

63035 .......... ............ A Spinal disk surgery add-on ......................... 3.16 NA 1.55 0.79 NA 5.49 ZZZ 

63040 .......... ............ A Laminotomy, single cervical ........................ 18.82 NA 11.23 4.67 NA 34.72 090 

63042 .......... ............ A Laminotomy, single lumbar ......................... 17.47 NA 11.06 4.25 NA 32.78 090 

63043 .......... ............ C Laminotomy, add’l cervical .......................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

63044 .......... ............ C Laminotomy, add’l lumbar ........................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

63045 .......... ............ A Removal of spinal lamina ............................ 16.51 NA 10.13 3.98 NA 30.62 090 

63046 .......... ............ A Removal of spinal lamina ............................ 15.81 NA 9.94 3.55 NA 29.30 090 

63047 .......... ............ A Removal of spinal lamina ............................ 14.62 NA 9.65 3.23 NA 27.50 090 

63048 .......... ............ A Remove spinal lamina add-on .................... 3.27 NA 1.62 0.72 NA 5.60 ZZZ 

63050 .......... ............ A Cervical laminoplasty .................................. 20.79 NA 11.41 4.66 NA 36.86 090 

63051 .......... ............ A C-laminoplasty w/graft/plate ........................ 24.30 NA 12.97 4.66 NA 41.93 090 

63055 .......... ............ A Decompress spinal cord .............................. 22.00 NA 12.84 5.27 NA 40.11 090 

63056 .......... ............ A Decompress spinal cord .............................. 20.37 NA 12.25 4.75 NA 37.37 090 

63057 .......... ............ A Decompress spine cord add-on .................. 5.26 NA 2.56 1.22 NA 9.04 ZZZ 

63064 .......... ............ A Decompress spinal cord .............................. 24.62 NA 14.08 5.69 NA 44.39 090 

63066 .......... ............ A Decompress spine cord add-on .................. 3.27 NA 1.62 0.69 NA 5.57 ZZZ 

63075 .......... ............ A Neck spine disk surgery .............................. 19.42 NA 11.81 4.62 NA 35.85 090 

63076 .......... ............ A Neck spine disk surgery .............................. 4.05 NA 2.00 0.96 NA 7.00 ZZZ 

63077 .......... ............ A Spine disk surgery, thorax .......................... 21.45 NA 12.43 3.98 NA 37.87 090 

63078 .......... ............ A Spine disk surgery, thorax .......................... 3.29 NA 1.59 0.66 NA 5.54 ZZZ 

63081 .......... ............ A Removal of vertebral body .......................... 23.74 NA 13.98 5.54 NA 43.26 090 

63082 .......... ............ A Remove vertebral body add-on ................... 4.37 NA 2.16 1.02 NA 7.55 ZZZ 

63085 .......... ............ A Removal of vertebral body .......................... 26.93 NA 15.05 4.48 NA 46.47 090 

45943

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

63086 .......... ............ A Remove vertebral body add-on ................... 3.20 NA 1.55 0.59 NA 5.33 ZZZ 

63087 .......... ............ A Removal of vertebral body .......................... 35.59 NA 18.93 6.20 NA 60.72 090 

63088 .......... ............ A Remove vertebral body add-on ................... 4.33 NA 2.11 0.82 NA 7.26 ZZZ 

63090 .......... ............ A Removal of vertebral body .......................... 28.18 NA 15.60 4.21 NA 47.99 090 

63091 .......... ............ A Remove vertebral body add-on ................... 3.04 NA 1.42 0.48 NA 4.93 ZZZ 

63101 .......... ............ A Removal of vertebral body .......................... 32.01 NA 18.84 5.69 NA 56.54 090 

63102 .......... ............ A Removal of vertebral body .......................... 32.01 NA 18.78 5.69 NA 56.48 090 

63103 .......... ............ A Remove vertebral body add-on ................... 4.83 NA 2.41 0.69 NA 7.93 ZZZ 

63170 .......... ............ A Incise spinal cord tract(s) ............................ 19.84 NA 11.62 4.86 NA 36.32 090 

63172 .......... ............ A Drainage of spinal cyst ................................ 17.67 NA 10.42 4.48 NA 32.57 090 

63173 .......... ............ A Drainage of spinal cyst ................................ 22.00 NA 12.54 5.68 NA 40.22 090 

63180 .......... ............ A Revise spinal cord ligaments ...................... 18.28 NA 10.77 3.95 NA 33.00 090 

63182 .......... ............ A Revise spinal cord ligaments ...................... 20.51 NA 10.76 5.30 NA 36.57 090 

63185 .......... ............ A Incise spinal column/nerves ........................ 15.05 NA 7.93 2.79 NA 25.77 090 

63190 .......... ............ A Incise spinal column/nerves ........................ 17.45 NA 9.90 3.24 NA 30.59 090 

63191 .......... ............ A Incise spinal column/nerves ........................ 17.55 NA 10.21 6.34 NA 34.10 090 

63194 .......... ............ A Incise spinal column & cord ........................ 19.20 NA 11.48 3.26 NA 33.94 090 

63195 .......... ............ A Incise spinal column & cord ........................ 18.85 NA 10.81 4.87 NA 34.53 090 

63196 .......... ............ A Incise spinal column & cord ........................ 22.31 NA 13.11 5.76 NA 41.18 090 

63197 .......... ............ A Incise spinal column & cord ........................ 21.12 NA 11.95 5.36 NA 38.44 090 

63198 .......... ............ A Incise spinal column & cord ........................ 25.39 NA 8.28 6.43 NA 40.10 090 

63199 .......... ............ A Incise spinal column & cord ........................ 26.90 NA 14.73 1.40 NA 43.04 090 

63200 .......... ............ A Release of spinal cord ................................ 19.19 NA 11.10 4.96 NA 35.25 090 

63250 .......... ............ A Revise spinal cord vessels .......................... 40.78 NA 19.47 9.01 NA 69.26 090 

63251 .......... ............ A Revise spinal cord vessels .......................... 41.22 NA 22.08 10.41 NA 73.72 090 

63252 .......... ............ A Revise spinal cord vessels .......................... 41.21 NA 21.75 10.64 NA 73.60 090 

63265 .......... ............ A Excise intraspinal lesion .............................. 21.57 NA 12.49 5.43 NA 39.49 090 

63266 .......... ............ A Excise intraspinal lesion .............................. 22.31 NA 12.89 5.54 NA 40.74 090 

63267 .......... ............ A Excise intraspinal lesion .............................. 17.96 NA 10.83 4.37 NA 33.16 090 

63268 .......... ............ A Excise intraspinal lesion .............................. 18.53 NA 10.13 3.69 NA 32.35 090 

63270 .......... ............ A Excise intraspinal lesion .............................. 26.81 NA 15.13 6.82 NA 48.76 090 

63271 .......... ............ A Excise intraspinal lesion .............................. 26.93 NA 15.23 6.90 NA 49.06 090 

63272 .......... ............ A Excise intraspinal lesion .............................. 25.33 NA 14.36 6.18 NA 45.87 090 

63273 .......... ............ A Excise intraspinal lesion .............................. 24.30 NA 14.03 5.74 NA 44.06 090 

63275 .......... ............ A Biopsy/excise spinal tumor .......................... 23.69 NA 13.47 5.80 NA 42.95 090 

63276 .......... ............ A Biopsy/excise spinal tumor .......................... 23.46 NA 13.38 5.83 NA 42.66 090 

63277 .......... ............ A Biopsy/excise spinal tumor .......................... 20.84 NA 12.24 5.01 NA 38.09 090 

63278 .......... ............ A Biopsy/excise spinal tumor .......................... 20.57 NA 12.10 4.55 NA 37.22 090 

63280 .......... ............ A Biopsy/excise spinal tumor .......................... 28.37 NA 15.96 7.27 NA 51.59 090 

63281 .......... ............ A Biopsy/excise spinal tumor .......................... 28.07 NA 15.82 7.17 NA 51.06 090 

63282 .......... ............ A Biopsy/excise spinal tumor .......................... 26.40 NA 15.00 6.76 NA 48.17 090 

63283 .......... ............ A Biopsy/excise spinal tumor .......................... 25.01 NA 14.34 6.26 NA 45.61 090 

63285 .......... ............ A Biopsy/excise spinal tumor .......................... 36.02 NA 19.49 9.18 NA 64.69 090 

63286 .......... ............ A Biopsy/excise spinal tumor .......................... 35.65 NA 19.46 9.21 NA 64.32 090 

63287 .......... ............ A Biopsy/excise spinal tumor .......................... 36.71 NA 19.96 9.39 NA 66.06 090 

63290 .......... ............ A Biopsy/excise spinal tumor .......................... 37.39 NA 20.12 9.02 NA 66.54 090 

63295 .......... ............ A Repair of laminectomy defect ..................... 5.26 NA 2.07 1.03 NA 8.36 ZZZ 

63300 .......... ............ A Removal of vertebral body .......................... 24.44 NA 13.97 5.97 NA 44.37 090 

63301 .......... ............ A Removal of vertebral body .......................... 27.62 NA 15.16 5.39 NA 48.17 090 

63302 .......... ............ A Removal of vertebral body .......................... 27.83 NA 15.47 5.53 NA 48.82 090 

63303 .......... ............ A Removal of vertebral body .......................... 30.51 NA 16.47 4.68 NA 51.66 090 

63304 .......... ............ A Removal of vertebral body .......................... 30.34 NA 16.88 6.41 NA 53.63 090 

63305 .......... ............ A Removal of vertebral body .......................... 32.04 NA 17.60 5.71 NA 55.35 090 

63306 .......... ............ A Removal of vertebral body .......................... 32.23 NA 17.37 8.33 NA 57.93 090 

63307 .......... ............ A Removal of vertebral body .......................... 31.64 NA 16.65 4.46 NA 52.75 090 

63308 .......... ............ A Remove vertebral body add-on ................... 5.25 NA 2.53 1.29 NA 9.07 ZZZ 

63600 .......... ............ A Remove spinal cord lesion .......................... 14.03 NA 5.29 1.52 NA 20.83 090 

63610 .......... ............ A Stimulation of spinal cord ............................ 8.74 53.74 2.21 0.86 63.34 11.80 000 

63615 .......... ............ A Remove lesion of spinal cord ...................... 16.29 NA 9.07 2.84 NA 28.20 090 

63650 .......... ............ A Implant neuroelectrodes .............................. 6.74 NA 3.09 0.53 NA 10.36 090 

63655 .......... ............ A Implant neuroelectrodes .............................. 10.29 NA 6.75 2.43 NA 19.47 090 

63660 .......... ............ A Revise/remove neuroelectrode ................... 6.16 NA 3.53 0.78 NA 10.47 090 

63685 .......... ............ A Insrt/redo spine n generator ........................ 7.04 NA 4.05 1.05 NA 12.14 090 

63688 .......... ............ A Revise/remove neuroreceiver ..................... 5.39 NA 3.47 0.89 NA 9.76 090 

63700 .......... ............ A Repair of spinal herniation .......................... 16.54 NA 10.06 3.52 NA 30.12 090 

63702 .......... ............ A Repair of spinal herniation .......................... 18.49 NA 10.87 4.12 NA 33.48 090 

63704 .......... ............ A Repair of spinal herniation .......................... 21.19 NA 12.61 4.57 NA 38.37 090 

63706 .......... ............ A Repair of spinal herniation .......................... 24.12 NA 13.24 6.23 NA 43.58 090 

63707 .......... ............ A Repair spinal fluid leakage .......................... 11.26 NA 7.53 2.51 NA 21.30 090 

63709 .......... ............ A Repair spinal fluid leakage .......................... 14.33 NA 9.16 3.09 NA 26.58 090 

63710 .......... ............ A Graft repair of spine defect ......................... 14.08 NA 8.84 3.40 NA 26.32 090 

63740 .......... ............ A Install spinal shunt ....................................... 11.36 NA 7.22 2.93 NA 21.51 090 

63741 .......... ............ A Install spinal shunt ....................................... 8.26 NA 4.68 1.66 NA 14.60 090 

63744 .......... ............ A Revision of spinal shunt .............................. 8.11 NA 5.16 1.89 NA 15.16 090 

45944

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

63746 .......... ............ A Removal of spinal shunt .............................. 6.43 NA 3.70 1.53 NA 11.66 090 

64400 .......... ............ A N block inj, trigeminal .................................. 1.11 1.83 0.42 0.07 3.01 1.60 000 

64402 .......... ............ A N block inj, facial ......................................... 1.25 1.59 0.59 0.09 2.93 1.93 000 

64405 .......... ............ A N block inj, occipital .................................... 1.32 1.42 0.45 0.08 2.82 1.85 000 

64408 .......... ............ A N block inj, vagus ........................................ 1.41 1.57 0.83 0.10 3.08 2.34 000 

64410 .......... ............ A N block inj, phrenic ...................................... 1.43 2.36 0.45 0.09 3.89 1.97 000 

64412 .......... ............ A N block inj, spinal accessor ........................ 1.18 2.49 0.42 0.08 3.75 1.68 000 

64413 .......... ............ A N block inj, cervical plexus .......................... 1.40 1.77 0.49 0.08 3.25 1.97 000 

64415 .......... ............ A N block inj, brachial plexus ......................... 1.48 2.66 0.45 0.09 4.23 2.02 000 

64416 .......... ............ A N block cont infuse, b plex .......................... 3.50 NA 0.77 0.31 NA 4.58 010 

64417 .......... ............ A N block inj, axillary ...................................... 1.44 2.84 0.48 0.11 4.40 2.03 000 

64418 .......... ............ A N block inj, suprascapular ........................... 1.32 2.49 0.43 0.07 3.89 1.82 000 

64420 .......... ............ A N block inj, intercost, sng ............................ 1.18 3.62 0.41 0.08 4.89 1.67 000 

64421 .......... ............ A N block inj, intercost, mlt ............................. 1.68 5.65 0.51 0.11 7.44 2.30 000 

64425 .......... ............ A N block inj, ilio-ing/hypogi ........................... 1.75 1.62 0.53 0.13 3.51 2.41 000 

64430 .......... ............ A N block inj, pudendal ................................... 1.46 2.47 0.56 0.10 4.03 2.12 000 

64435 .......... ............ A N block inj, paracervical .............................. 1.45 2.42 0.68 0.16 4.03 2.29 000 

64445 .......... ............ A N block inj, sciatic, sng ............................... 1.48 2.52 0.49 0.10 4.11 2.07 000 

64446 .......... ............ A N blk inj, sciatic, cont inf ............................. 3.26 NA 0.97 0.20 NA 4.43 010 

64447 .......... ............ A N block inj fem, single ................................. 1.50 NA 0.42 0.09 NA 2.01 000 

64448 .......... ............ A N block inj fem, cont inf .............................. 3.01 NA 0.79 0.18 NA 3.98 010 

64449 .......... ............ A N block inj, lumbar plexus ........................... 3.01 NA 0.91 0.15 NA 4.07 010 

64450 .......... ............ A N block, other peripheral ............................. 1.27 1.25 0.47 0.13 2.65 1.87 000 

64470 .......... ............ A Inj paravertebral c/t ..................................... 1.85 6.70 0.69 0.11 8.66 2.66 000 

64472 .......... ............ A Inj paravertebral c/t add-on ......................... 1.29 2.16 0.33 0.08 3.53 1.71 ZZZ 

64475 .......... ............ A Inj paravertebral l/s ...................................... 1.41 6.37 0.62 0.10 7.89 2.13 000 

64476 .......... ............ A Inj paravertebral l/s add-on ......................... 0.98 1.95 0.24 0.07 3.00 1.29 ZZZ 

64479 .......... ............ A Inj foramen epidural c/t ............................... 2.20 6.90 0.87 0.12 9.22 3.19 000 

64480 .......... ............ A Inj foramen epidural add-on ........................ 1.54 2.62 0.46 0.10 4.26 2.10 ZZZ 

64483 .......... ............ A Inj foramen epidural l/s ................................ 1.90 7.23 0.81 0.11 9.25 2.82 000 

64484 .......... ............ A Inj foramen epidural add-on ........................ 1.33 3.01 0.36 0.08 4.42 1.77 ZZZ 

64505 .......... ............ A N block, spenopalatine gangl ...................... 1.36 1.21 0.64 0.10 2.68 2.10 000 

64508 .......... ............ A N block, carotid sinus s/p ............................ 1.12 3.15 0.76 0.07 4.35 1.95 000 

64510 .......... ............ A N block, stellate ganglion ............................ 1.22 3.19 0.50 0.07 4.49 1.79 000 

64517 .......... ............ A N block inj, hypogas plxs ............................ 2.20 2.65 0.87 0.11 4.96 3.19 000 

64520 .......... ............ A N block, lumbar/thoracic .............................. 1.35 4.76 0.54 0.08 6.19 1.97 000 

64530 .......... ............ A N block inj, celiac pelus .............................. 1.58 4.14 0.64 0.10 5.82 2.32 000 

64550 .......... ............ A Apply neurostimulator .................................. 0.18 0.27 0.05 0.01 0.46 0.24 000 

64553 .......... ............ A Implant neuroelectrodes .............................. 2.31 2.70 1.81 0.18 5.20 4.31 010 

64555 .......... ............ A Implant neuroelectrodes .............................. 2.27 2.98 1.26 0.19 5.44 3.73 010 

64560 .......... ............ A Implant neuroelectrodes .............................. 2.36 2.54 1.25 0.22 5.12 3.84 010 

64561 .......... ............ A Implant neuroelectrodes .............................. 6.74 29.47 3.21 0.51 36.73 10.46 010 

64565 .......... ............ A Implant neuroelectrodes .............................. 1.76 3.12 1.24 0.13 5.01 3.14 010 

64573 .......... ............ A Implant neuroelectrodes .............................. 7.50 NA 5.15 1.60 NA 14.25 090 

64575 .......... ............ A Implant neuroelectrodes .............................. 4.35 NA 2.84 0.61 NA 7.80 090 

64577 .......... ............ A Implant neuroelectrodes .............................. 4.62 NA 3.20 1.04 NA 8.86 090 

64580 .......... ............ A Implant neuroelectrodes .............................. 4.12 NA 3.44 0.36 NA 7.92 090 

64581 .......... ............ A Implant neuroelectrodes .............................. 13.51 NA 6.11 1.05 NA 20.67 090 

64585 .......... ............ A Revise/remove neuroelectrode ................... 2.06 10.39 2.13 0.20 12.65 4.39 010 

64590 .......... ............ A Insrt/redo perph n generator ....................... 2.40 6.92 2.33 0.19 9.51 4.92 010 

64595 .......... ............ A Revise/remove neuroreceiver ..................... 1.73 9.61 1.90 0.19 11.54 3.83 010 

64600 .......... ............ A Injection treatment of nerve ........................ 3.45 8.75 1.62 0.34 12.54 5.40 010 

64605 .......... ............ A Injection treatment of nerve ........................ 5.61 8.92 2.13 0.79 15.32 8.53 010 

64610 .......... ............ A Injection treatment of nerve ........................ 7.16 8.48 3.64 1.58 17.22 12.38 010 

64612 .......... ............ A Destroy nerve, face muscle ........................ 1.96 2.41 1.30 0.11 4.48 3.38 010 

64613 .......... ............ A Destroy nerve, spine muscle ....................... 1.96 2.86 1.20 0.11 4.93 3.28 010 

64614 .......... ............ A Destroy nerve, extrem musc ....................... 2.20 3.07 1.28 0.10 5.37 3.58 010 

64620 .......... ............ A Injection treatment of nerve ........................ 2.85 4.75 1.29 0.20 7.80 4.33 010 

64622 .......... ............ A Destr paravertebrl nerve l/s ......................... 3.01 7.17 1.33 0.18 10.35 4.52 010 

64623 .......... ............ A Destr paravertebral n add-on ...................... 0.99 2.74 0.22 0.06 3.79 1.27 ZZZ 

64626 .......... ............ A Destr paravertebrl nerve c/t ........................ 3.29 7.26 1.90 0.20 10.75 5.39 010 

64627 .......... ............ A Destr paravertebral n add-on ...................... 1.16 4.18 0.26 0.07 5.41 1.50 ZZZ 

64630 .......... ............ A Injection treatment of nerve ........................ 3.01 2.69 1.42 0.22 5.92 4.65 010 

64640 .......... ............ A Injection treatment of nerve ........................ 2.77 3.94 1.78 0.29 7.00 4.84 010 

64680 .......... ............ A Injection treatment of nerve ........................ 2.63 6.22 1.40 0.18 9.03 4.20 010 

64681 .......... ............ A Injection treatment of nerve ........................ 3.55 8.67 2.01 0.28 12.50 5.84 010 

64702 .......... ............ A Revise finger/toe nerve ............................... 4.23 NA 3.76 0.61 NA 8.60 090 

64704 .......... ............ A Revise hand/foot nerve ............................... 4.57 NA 3.29 0.61 NA 8.47 090 

64708 .......... ............ A Revise arm/leg nerve .................................. 6.12 NA 4.73 0.96 NA 11.81 090 

64712 .......... ............ A Revision of sciatic nerve ............................. 7.76 NA 4.79 0.95 NA 13.49 090 

64713 .......... ............ A Revision of arm nerve(s) ............................. 11.00 NA 5.70 1.82 NA 18.52 090 

64714 .......... ............ A Revise low back nerve(s) ............................ 10.33 NA 4.09 1.19 NA 15.61 090 

64716 .......... ............ A Revision of cranial nerve ............................. 6.31 NA 5.84 0.63 NA 12.78 090 

64718 .......... ............ A Revise ulnar nerve at elbow ....................... 5.99 NA 5.84 1.05 NA 12.88 090 

45945

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

64719 .......... ............ A Revise ulnar nerve at wrist ......................... 4.85 NA 4.39 0.77 NA 10.01 090 

64721 .......... ............ A Carpal tunnel surgery .................................. 4.29 0.00 5.17 0.73 5.02 10.19 090 

64722 .......... ............ A Relieve pressure on nerve(s) ...................... 4.70 NA 2.96 0.48 NA 8.14 090 

64726 .......... ............ A Release foot/toe nerve ................................ 4.18 NA 2.77 0.54 NA 7.49 090 

64727 .......... ............ A Internal nerve revision ................................. 3.11 NA 1.46 0.48 NA 5.04 ZZZ 

64732 .......... ............ A Incision of brow nerve ................................. 4.41 NA 3.45 0.98 NA 8.84 090 

64734 .......... ............ A Incision of cheek nerve ............................... 4.92 NA 3.99 0.89 NA 9.80 090 

64736 .......... ............ A Incision of chin nerve .................................. 4.60 NA 3.98 0.52 NA 9.10 090 

64738 .......... ............ A Incision of jaw nerve ................................... 5.73 NA 4.54 1.08 NA 11.36 090 

64740 .......... ............ A Incision of tongue nerve .............................. 5.59 NA 5.06 0.69 NA 11.34 090 

64742 .......... ............ A Incision of facial nerve ................................ 6.22 NA 4.61 0.73 NA 11.56 090 

64744 .......... ............ A Incise nerve, back of head .......................... 5.24 NA 3.71 1.16 NA 10.11 090 

64746 .......... ............ A Incise diaphragm nerve ............................... 5.93 NA 4.29 0.82 NA 11.04 090 

64752 .......... ............ A Incision of vagus nerve ............................... 7.06 NA 4.18 0.93 NA 12.17 090 

64755 .......... ............ A Incision of stomach nerves ......................... 13.53 NA 5.57 1.83 NA 20.93 090 

64760 .......... ............ A Incision of vagus nerve ............................... 6.96 NA 3.41 0.81 NA 11.19 090 

64761 .......... ............ A Incision of pelvis nerve ................................ 6.41 NA 3.50 0.53 NA 10.44 090 

64763 .......... ............ A Incise hip/thigh nerve .................................. 6.93 NA 5.06 0.94 NA 12.93 090 

64766 .......... ............ A Incise hip/thigh nerve .................................. 8.68 NA 5.25 1.06 NA 14.99 090 

64771 .......... ............ A Sever cranial nerve ..................................... 7.35 NA 5.45 1.23 NA 14.03 090 

64772 .......... ............ A Incision of spinal nerve ............................... 7.21 NA 4.83 1.40 NA 13.45 090 

64774 .......... ............ A Remove skin nerve lesion ........................... 5.17 NA 3.77 0.74 NA 9.68 090 

64776 .......... ............ A Remove digit nerve lesion ........................... 5.12 NA 3.61 0.76 NA 9.49 090 

64778 .......... ............ A Digit nerve surgery add-on .......................... 3.12 NA 1.46 0.46 NA 5.03 ZZZ 

64782 .......... ............ A Remove limb nerve lesion ........................... 6.23 NA 3.76 0.86 NA 10.85 090 

64783 .......... ............ A Limb nerve surgery add-on ......................... 3.72 NA 1.78 0.51 NA 6.01 ZZZ 

64784 .......... ............ A Remove nerve lesion .................................. 9.83 NA 6.43 1.38 NA 17.64 090 

64786 .......... ............ A Remove sciatic nerve lesion ....................... 15.47 NA 9.57 2.60 NA 27.64 090 

64787 .......... ............ A Implant nerve end ....................................... 4.30 NA 2.06 0.58 NA 6.94 ZZZ 

64788 .......... ............ A Remove skin nerve lesion ........................... 4.61 NA 3.43 0.73 NA 8.77 090 

64790 .......... ............ A Removal of nerve lesion ............................. 11.31 NA 7.05 2.10 NA 20.46 090 

64792 .......... ............ A Removal of nerve lesion ............................. 14.93 NA 8.63 2.48 NA 26.04 090 

64795 .......... ............ A Biopsy of nerve ........................................... 3.02 NA 1.53 0.52 NA 5.07 000 

64802 .......... ............ A Remove sympathetic nerves ....................... 9.16 NA 4.96 1.29 NA 15.41 090 

64804 .......... ............ A Remove sympathetic nerves ....................... 14.65 NA 6.92 2.14 NA 23.71 090 

64809 .......... ............ A Remove sympathetic nerves ....................... 13.68 NA 5.58 1.50 NA 20.76 090 

64818 .......... ............ A Remove sympathetic nerves ....................... 10.30 NA 5.10 1.33 NA 16.73 090 

64820 .......... ............ A Remove sympathetic nerves ....................... 10.37 NA 6.92 1.49 NA 18.78 090 

64821 .......... ............ A Remove sympathetic nerves ....................... 8.76 NA 7.13 1.24 NA 17.13 090 

64822 .......... ............ A Remove sympathetic nerves ....................... 8.76 NA 7.03 1.30 NA 17.09 090 

64823 .......... ............ A Remove sympathetic nerves ....................... 10.37 NA 7.91 1.57 NA 19.85 090 

64831 .......... ............ A Repair of digit nerve .................................... 9.45 NA 6.88 1.41 NA 17.74 090 

64832 .......... ............ A Repair nerve add-on ................................... 5.66 NA 2.85 0.85 NA 9.36 ZZZ 

64834 .......... ............ A Repair of hand or foot nerve ....................... 10.19 NA 6.90 1.54 NA 18.63 090 

64835 .......... ............ A Repair of hand or foot nerve ....................... 10.94 NA 7.48 1.73 NA 20.15 090 

64836 .......... ............ A Repair of hand or foot nerve ....................... 10.94 NA 7.45 1.67 NA 20.07 090 

64837 .......... ............ A Repair nerve add-on ................................... 6.26 NA 3.14 0.97 NA 10.37 ZZZ 

64840 .......... ............ A Repair of leg nerve ...................................... 13.03 NA 8.05 1.37 NA 22.44 090 

64856 .......... ............ A Repair/transpose nerve ............................... 13.81 NA 8.93 2.12 NA 24.86 090 

64857 .......... ............ A Repair arm/leg nerve ................................... 14.50 NA 9.37 2.21 NA 26.08 090 

64858 .......... ............ A Repair sciatic nerve ..................................... 16.50 NA 10.48 3.33 NA 30.31 090 

64859 .......... ............ A Nerve surgery .............................................. 4.26 NA 2.13 0.67 NA 7.06 ZZZ 

64861 .......... ............ A Repair of arm nerves .................................. 19.25 NA 11.42 4.08 NA 34.75 090 

64862 .......... ............ A Repair of low back nerves .......................... 19.45 NA 11.75 4.31 NA 35.50 090 

64864 .......... ............ A Repair of facial nerve .................................. 12.56 NA 8.49 1.26 NA 22.31 090 

64865 .......... ............ A Repair of facial nerve .................................. 15.25 NA 13.11 1.50 NA 29.86 090 

64866 .......... ............ A Fusion of facial/other nerve ......................... 15.75 NA 12.78 2.04 NA 30.57 090 

64868 .......... ............ A Fusion of facial/other nerve ......................... 14.05 NA 11.16 1.43 NA 26.64 090 

64870 .......... ............ A Fusion of facial/other nerve ......................... 16.00 NA 8.55 1.30 NA 25.85 090 

64872 .......... ............ A Subsequent repair of nerve ......................... 1.99 NA 1.05 0.29 NA 3.33 ZZZ 

64874 .......... ............ A Repair & revise nerve add-on ..................... 2.99 NA 1.48 0.42 NA 4.89 ZZZ 

64876 .......... ............ A Repair nerve/shorten bone .......................... 3.38 NA 1.70 0.47 NA 5.54 ZZZ 

64885 .......... ............ A Nerve graft, head or neck ........................... 17.54 NA 11.26 1.63 NA 30.42 090 

64886 .......... ............ A Nerve graft, head or neck ........................... 20.76 NA 13.11 2.08 NA 35.96 090 

64890 .......... ............ A Nerve graft, hand or foot ............................. 15.16 NA 9.71 2.29 NA 27.16 090 

64891 .......... ............ A Nerve graft, hand or foot ............................. 16.15 NA 7.41 1.63 NA 25.19 090 

64892 .......... ............ A Nerve graft, arm or leg ................................ 14.66 NA 8.65 2.47 NA 25.78 090 

64893 .......... ............ A Nerve graft, arm or leg ................................ 15.61 NA 9.60 2.61 NA 27.82 090 

64895 .......... ............ A Nerve graft, hand or foot ............................. 19.26 NA 9.45 2.57 NA 31.27 090 

64896 .......... ............ A Nerve graft, hand or foot ............................. 20.50 NA 10.93 3.16 NA 34.59 090 

64897 .......... ............ A Nerve graft, arm or leg ................................ 18.25 NA 10.41 2.54 NA 31.20 090 

64898 .......... ............ A Nerve graft, arm or leg ................................ 19.51 NA 11.53 2.77 NA 33.80 090 

64901 .......... ............ A Nerve graft add-on ...................................... 10.22 NA 5.09 1.37 NA 16.68 ZZZ 

64902 .......... ............ A Nerve graft add-on ...................................... 11.83 NA 5.76 1.55 NA 19.15 ZZZ 

45946

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

64905 .......... ............ A Nerve pedicle transfer ................................. 14.03 NA 8.29 2.00 NA 24.32 090 

64907 .......... ............ A Nerve pedicle transfer ................................. 18.84 NA 12.19 3.16 NA 34.19 090 

64999 .......... ............ C Nervous system surgery ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

65091 .......... ............ A Revise eye ................................................... 6.46 NA 8.01 0.32 NA 14.79 090 

65093 .......... ............ A Revise eye with implant .............................. 6.87 NA 8.36 0.34 NA 15.57 090 

65101 .......... ............ A Removal of eye ........................................... 7.03 NA 9.15 0.35 NA 16.53 090 

65103 .......... ............ A Remove eye/insert implant .......................... 7.58 NA 9.37 0.37 NA 17.31 090 

65105 .......... ............ A Remove eye/attach implant ......................... 8.50 NA 10.07 0.42 NA 18.99 090 

65110 .......... ............ A Removal of eye ........................................... 13.96 NA 13.20 0.81 NA 27.96 090 

65112 .......... ............ A Remove eye/revise socket .......................... 16.39 NA 15.51 1.30 NA 33.20 090 

65114 .......... ............ A Remove eye/revise socket .......................... 17.54 NA 15.76 1.02 NA 34.31 090 

65125 .......... ............ A Revise ocular implant .................................. 3.13 8.39 3.52 0.19 11.71 6.83 090 

65130 .......... ............ A Insert ocular implant .................................... 7.15 NA 8.82 0.35 NA 16.32 090 

65135 .......... ............ A Insert ocular implant .................................... 7.33 NA 8.96 0.36 NA 16.65 090 

65140 .......... ............ A Attach ocular implant ................................... 8.03 NA 9.51 0.40 NA 17.93 090 

65150 .......... ............ A Revise ocular implant .................................. 6.26 NA 7.66 0.31 NA 14.23 090 

65155 .......... ............ A Reinsert ocular implant ............................... 8.67 NA 10.07 0.50 NA 19.24 090 

65175 .......... ............ A Removal of ocular implant .......................... 6.28 NA 8.16 0.31 NA 14.75 090 

65205 .......... ............ A Remove foreign body from eye ................... 0.71 0.63 0.28 0.03 1.37 1.02 000 

65210 .......... ............ A Remove foreign body from eye ................... 0.84 0.80 0.37 0.04 1.68 1.25 000 

65220 .......... ............ A Remove foreign body from eye ................... 0.71 0.63 0.27 0.05 1.39 1.03 000 

65222 .......... ............ A Remove foreign body from eye ................... 0.93 0.87 0.37 0.04 1.85 1.34 000 

65235 .......... ............ A Remove foreign body from eye ................... 7.58 NA 6.60 0.37 NA 14.55 090 

65260 .......... ............ A Remove foreign body from eye ................... 10.96 NA 9.39 0.57 NA 20.92 090 

65265 .......... ............ A Remove foreign body from eye ................... 12.60 NA 10.34 0.62 NA 23.56 090 

65270 .......... ............ A Repair of eye wound ................................... 1.90 4.94 1.36 0.09 6.93 3.35 010 

65272 .......... ............ A Repair of eye wound ................................... 3.82 7.38 3.21 0.19 11.38 7.22 090 

65273 .......... ............ A Repair of eye wound ................................... 4.36 NA 3.49 0.22 NA 8.07 090 

65275 .......... ............ A Repair of eye wound ................................... 5.34 6.16 3.85 0.26 11.76 9.45 090 

65280 .......... ............ A Repair of eye wound ................................... 7.67 NA 6.08 0.38 NA 14.13 090 

65285 .......... ............ A Repair of eye wound ................................... 12.91 NA 8.99 0.64 NA 22.54 090 

65286 .......... ............ A Repair of eye wound ................................... 5.51 10.63 4.51 0.27 16.41 10.30 090 

65290 .......... ............ A Repair of eye socket wound ....................... 5.41 NA 4.61 0.31 NA 10.33 090 

65400 .......... ............ A Removal of eye lesion ................................. 6.06 8.08 5.99 0.30 14.45 12.35 090 

65410 .......... ............ A Biopsy of cornea ......................................... 1.47 2.03 0.95 0.07 3.57 2.49 000 

65420 .......... ............ A Removal of eye lesion ................................. 4.17 8.48 4.35 0.21 12.86 8.73 090 

65426 .......... ............ A Removal of eye lesion ................................. 5.25 9.74 4.82 0.25 15.24 10.32 090 

65430 .......... ............ A Corneal smear ............................................. 1.47 1.26 0.96 0.07 2.80 2.50 000 

65435 .......... ............ A Curette/treat cornea .................................... 0.92 0.98 0.70 0.04 1.94 1.66 000 

65436 .......... ............ A Curette/treat cornea .................................... 4.19 4.00 3.60 0.21 8.40 8.00 090 

65450 .......... ............ A Treatment of corneal lesion ........................ 3.28 3.98 3.86 0.16 7.42 7.30 090 

65600 .......... ............ A Revision of cornea ...................................... 3.40 4.85 3.28 0.17 8.42 6.85 090 

65710 .......... ............ A Corneal transplant ....................................... 12.35 NA 10.92 0.61 NA 23.89 090 

65730 .......... ............ A Corneal transplant ....................................... 14.26 NA 11.73 0.70 NA 26.69 090 

65750 .......... ............ A Corneal transplant ....................................... 15.01 NA 11.67 0.74 NA 27.42 090 

65755 .......... ............ A Corneal transplant ....................................... 14.90 NA 11.59 0.73 NA 27.22 090 

65760 .......... ............ N Revision of cornea ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

65765 .......... ............ N Revision of cornea ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

65767 .......... ............ N Corneal tissue transplant ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

65770 .......... ............ A Revise cornea with implant ......................... 17.57 NA 12.88 0.87 NA 31.31 090 

65771 .......... ............ N Radial keratotomy ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

65772 .......... ............ A Correction of astigmatism ........................... 4.29 5.36 4.05 0.21 9.86 8.55 090 

65775 .......... ............ A Correction of astigmatism ........................... 5.79 NA 5.80 0.28 NA 11.88 090 

65780 .......... ............ A Ocular reconst, transplant ........................... 10.25 NA 10.04 0.44 NA 20.73 090 

65781 .......... ............ A Ocular reconst, transplant ........................... 17.68 NA 13.35 0.44 NA 31.46 090 

65782 .......... ............ A Ocular reconst, transplant ........................... 15.01 NA 11.71 0.44 NA 27.16 090 

65800 .......... ............ A Drainage of eye ........................................... 1.91 1.73 1.16 0.09 3.73 3.16 000 

65805 .......... ............ A Drainage of eye ........................................... 1.91 2.09 1.17 0.09 4.10 3.17 000 

65810 .......... ............ A Drainage of eye ........................................... 4.87 NA 4.60 0.24 NA 9.71 090 

65815 .......... ............ A Drainage of eye ........................................... 5.05 9.56 4.71 0.25 14.86 10.01 090 

65820 .......... ............ A Relieve inner eye pressure ......................... 8.14 NA 8.75 0.40 NA 17.29 090 

65850 .......... ............ A Incision of eye ............................................. 10.52 NA 8.21 0.52 NA 19.25 090 

65855 .......... ............ A Laser surgery of eye ................................... 3.85 4.18 3.03 0.19 8.21 7.07 010 

65860 .......... ............ A Incise inner eye adhesions ......................... 3.55 3.92 2.45 0.18 7.64 6.17 090 

65865 .......... ............ A Incise inner eye adhesions ......................... 5.60 NA 5.47 0.28 NA 11.35 090 

65870 .......... ............ A Incise inner eye adhesions ......................... 6.27 NA 6.24 0.31 NA 12.82 090 

65875 .......... ............ A Incise inner eye adhesions ......................... 6.54 NA 6.61 0.32 NA 13.48 090 

65880 .......... ............ A Incise inner eye adhesions ......................... 7.09 NA 6.85 0.35 NA 14.29 090 

65900 .......... ............ A Remove eye lesion ...................................... 10.93 NA 9.95 0.54 NA 21.42 090 

65920 .......... ............ A Remove implant of eye ............................... 8.41 NA 7.96 0.41 NA 16.78 090 

65930 .......... ............ A Remove blood clot from eye ....................... 7.44 NA 6.64 0.37 NA 14.45 090 

66020 .......... ............ A Injection treatment of eye ............................ 1.59 2.99 1.41 0.08 4.66 3.08 010 

66030 .......... ............ A Injection treatment of eye ............................ 1.25 2.84 1.26 0.06 4.15 2.57 010 

66130 .......... ............ A Remove eye lesion ...................................... 7.70 9.24 5.49 0.38 17.31 13.56 090 

45947

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

66150 .......... ............ A Glaucoma surgery ....................................... 8.31 NA 9.16 0.46 NA 17.93 090 

66155 .......... ............ A Glaucoma surgery ....................................... 8.30 NA 9.11 0.41 NA 17.81 090 

66160 .......... ............ A Glaucoma surgery ....................................... 10.17 NA 9.93 0.50 NA 20.60 090 

66165 .......... ............ A Glaucoma surgery ....................................... 8.02 NA 9.01 0.40 NA 17.42 090 

66170 .......... ............ A Glaucoma surgery ....................................... 12.16 NA 11.92 0.60 NA 24.68 090 

66172 .......... ............ A Incision of eye ............................................. 15.05 NA 14.84 0.74 NA 30.63 090 

66180 .......... ............ A Implant eye shunt ........................................ 14.56 NA 10.51 0.71 NA 25.78 090 

66185 .......... ............ A Revise eye shunt ......................................... 8.15 NA 7.20 0.40 NA 15.75 090 

66220 .......... ............ A Repair eye lesion ........................................ 7.78 NA 6.93 0.40 NA 15.11 090 

66225 .......... ............ A Repair/graft eye lesion ................................ 11.05 NA 8.54 0.55 NA 20.14 090 

66250 .......... ............ A Follow-up surgery of eye ............................. 5.98 11.17 5.37 0.30 17.45 11.65 090 

66500 .......... ............ A Incision of iris .............................................. 3.71 NA 4.49 0.18 NA 8.38 090 

66505 .......... ............ A Incision of iris .............................................. 4.08 NA 4.84 0.20 NA 9.12 090 

66600 .......... ............ A Remove iris and lesion ................................ 8.69 NA 8.01 0.43 NA 17.12 090 

66605 .......... ............ A Removal of iris ............................................ 12.80 NA 9.77 0.77 NA 23.34 090 

66625 .......... ............ A Removal of iris ............................................ 5.13 NA 4.63 0.26 NA 10.02 090 

66630 .......... ............ A Removal of iris ............................................ 6.16 NA 5.59 0.31 NA 12.06 090 

66635 .......... ............ A Removal of iris ............................................ 6.25 NA 5.62 0.31 NA 12.18 090 

66680 .......... ............ A Repair iris & ciliary body ............................. 5.44 NA 5.15 0.27 NA 10.86 090 

66682 .......... ............ A Repair iris & ciliary body ............................. 6.21 NA 6.42 0.31 NA 12.95 090 

66700 .......... ............ A Destruction, ciliary body .............................. 4.78 5.20 3.87 0.24 10.21 8.88 090 

66710 .......... ............ A Ciliary transsleral therapy ............................ 4.78 5.03 3.77 0.23 10.04 8.78 090 

66711 .......... ............ A Ciliary endoscopic ablation ......................... 6.61 NA 6.35 0.30 NA 13.26 090 

66720 .......... ............ A Destruction, ciliary body .............................. 4.78 5.65 4.63 0.26 10.69 9.67 090 

66740 .......... ............ A Destruction, ciliary body .............................. 4.78 4.96 3.89 0.23 9.97 8.90 090 

6761 ............ ............ A Revision of iris ............................................. 4.07 5.44 4.23 0.20 9.70 8.49 090 

66762 .......... ............ A Revision of iris ............................................. 4.58 5.49 4.20 0.23 10.30 9.01 090 

66770 .......... ............ A Removal of inner eye lesion ....................... 5.18 5.91 4.70 0.26 11.35 10.14 090 

66820 .......... ............ A Incision, secondary cataract ........................ 3.89 NA 5.58 0.19 NA 9.66 090 

66821 .......... ............ A After cataract laser surgery ......................... 2.35 3.97 3.52 0.11 6.44 5.98 090 

66825 .......... ............ A Reposition intraocular lens .......................... 8.24 NA 8.76 0.40 NA 17.40 090 

66830 .......... ............ A Removal of lens lesion ................................ 8.21 NA 6.80 0.36 NA 15.36 090 

66840 .......... ............ A Removal of lens material ............................ 7.92 NA 6.71 0.39 NA 15.01 090 

66850 .......... ............ A Removal of lens material ............................ 9.12 NA 7.47 0.45 NA 17.04 090 

66852 .......... ............ A Removal of lens material ............................ 9.98 NA 7.92 0.49 NA 18.39 090 

66920 .......... ............ A Extraction of lens ......................................... 8.87 NA 7.13 0.44 NA 16.44 090 

66930 .......... ............ A Extraction of lens ......................................... 10.18 NA 7.96 0.49 NA 18.63 090 

66940 .......... ............ A Extraction of lens ......................................... 8.94 NA 7.43 0.43 NA 16.80 090 

66982 .......... ............ A Cataract surgery, complex .......................... 13.51 NA 9.65 0.63 NA 23.79 090 

66983 .......... ............ A Cataract surg w/iol, 1 stage ........................ 9.00 NA 6.09 0.14 NA 15.23 090 

66984 .......... ............ A Cataract surg w/iol, 1 stage ........................ 10.23 NA 7.27 0.39 NA 17.89 090 

66985 .......... ............ A Insert lens prosthesis .................................. 8.40 NA 7.30 0.36 NA 16.06 090 

66986 .......... ............ A Exchange lens prosthesis ........................... 12.28 NA 8.98 0.60 NA 21.86 090 

66990 .......... ............ A Ophthalmic endoscope add-on ................... 1.51 NA 0.67 0.07 NA 2.26 ZZZ 

66999 .......... ............ C Eye surgery procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

67005 .......... ............ A Partial removal of eye fluid ......................... 5.70 NA 4.77 0.28 NA 10.75 090 

67010 .......... ............ A Partial removal of eye fluid ......................... 6.87 NA 5.30 0.34 NA 12.52 090 

67015 .......... ............ A Release of eye fluid .................................... 6.92 NA 6.29 0.34 NA 13.55 090 

67025 .......... ............ A Replace eye fluid ......................................... 6.84 8.89 6.09 0.34 16.08 13.27 090 

67027 .......... ............ A Implant eye drug system ............................. 10.85 NA 7.82 0.54 NA 19.21 090 

67028 .......... ............ A Injection eye drug ........................................ 2.53 2.60 1.43 0.12 5.25 4.08 000 

67030 .......... ............ A Incise inner eye strands .............................. 4.84 NA 5.70 0.24 NA 10.78 090 

67031 .......... ............ A Laser surgery, eye strands ......................... 3.67 4.46 3.56 0.18 8.31 7.41 090 

67036 .......... ............ A Removal of inner eye fluid .......................... 11.89 NA 8.91 0.58 NA 21.38 090 

67038 .......... ............ A Strip retinal membrane ................................ 21.25 NA 15.11 1.04 NA 37.40 090 

67039 .......... ............ A Laser treatment of retina ............................. 14.53 NA 11.87 0.71 NA 27.11 090 

67040 .......... ............ A Laser treatment of retina ............................. 17.23 NA 13.34 0.85 NA 31.43 090 

67101 .......... ............ A Repair detached retina ................................ 7.54 8.91 6.39 0.37 16.81 14.30 090 

67105 .......... ............ A Repair detached retina ................................ 7.41 7.88 6.02 0.37 15.67 13.80 090 

67107 .......... ............ A Repair detached retina ................................ 14.85 NA 11.06 0.73 NA 26.64 090 

67108 .......... ............ A Repair detached retina ................................ 20.83 NA 14.10 1.02 NA 35.95 090 

67110 .......... ............ A Repair detached retina ................................ 8.82 9.91 7.23 0.44 19.16 16.49 090 

67112 .......... ............ A Rerepair detached retina ............................. 16.86 NA 11.54 0.83 NA 29.24 090 

67115 .......... ............ A Release encircling material ......................... 4.99 NA 4.97 0.25 NA 10.21 090 

67120 .......... ............ A Remove eye implant material ..................... 5.98 8.27 5.42 0.29 14.54 11.69 090 

67121 .......... ............ A Remove eye implant material ..................... 10.67 NA 8.34 0.53 NA 19.54 090 

67141 .......... ............ A Treatment of retina ...................................... 5.20 5.70 4.76 0.26 11.16 10.22 090 

67145 .......... ............ A Treatment of retina ...................................... 5.37 5.58 4.83 0.27 11.22 10.47 090 

67208 .......... ............ A Treatment of retinal lesion .......................... 6.70 5.98 5.40 0.33 13.01 12.43 090 

67210 .......... ............ A Treatment of retinal lesion .......................... 8.83 6.41 5.75 0.44 15.68 15.02 090 

67218 .......... ............ A Treatment of retinal lesion .......................... 18.54 NA 11.83 0.92 NA 31.29 090 

67220 .......... ............ A Treatment of choroid lesion ........................ 13.14 10.16 8.81 0.65 23.94 22.60 090 

67221 .......... ............ R Ocular photodynamic ther ........................... 4.01 4.15 1.79 0.20 8.35 6.00 000 

67225 .......... ............ A Eye photodynamic ther add-on ................... 0.47 0.25 0.21 0.02 0.74 0.70 ZZZ 

45948

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

67227 .......... ............ A Treatment of retinal lesion .......................... 6.58 6.42 5.40 0.33 13.33 12.32 090 

67228 .......... ............ A Treatment of retinal lesion .......................... 12.75 11.17 8.35 0.63 24.54 21.73 090 

67250 .......... ............ A Reinforce eye wall ....................................... 8.67 NA 8.85 0.47 NA 17.98 090 

67255 .......... ............ A Reinforce/graft eye wall ............................... 8.91 NA 9.54 0.44 NA 18.89 090 

67299 .......... ............ C Eye surgery procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

67311 .......... ............ A Revise eye muscle ...................................... 6.65 NA 5.88 0.37 NA 12.91 090 

67312 .......... ............ A Revise two eye muscles ............................. 8.55 NA 6.60 0.43 NA 15.58 090 

67314 .......... ............ A Revise eye muscle ...................................... 7.53 NA 6.41 0.39 NA 14.32 090 

67316 .......... ............ A Revise two eye muscles ............................. 9.67 NA 7.33 0.49 NA 17.49 090 

67318 .......... ............ A Revise eye muscle(s) .................................. 7.86 NA 6.78 0.41 NA 15.05 090 

67320 .......... ............ A Revise eye muscle(s) add-on ..................... 4.33 NA 1.90 0.22 NA 6.45 ZZZ 

67331 .......... ............ A Eye surgery follow-up add-on ..................... 4.06 NA 1.79 0.21 NA 6.05 ZZZ 

67332 .......... ............ A Rerevise eye muscles add-on ..................... 4.49 NA 1.97 0.23 NA 6.69 ZZZ 

67334 .......... ............ A Revise eye muscle w/suture ....................... 3.98 NA 1.75 0.20 NA 5.93 ZZZ 

67335 .......... ............ A Eye suture during surgery ........................... 2.49 NA 1.09 0.13 NA 3.72 ZZZ 

67340 .......... ............ A Revise eye muscle add-on .......................... 4.93 NA 2.15 0.25 NA 7.33 ZZZ 

67343 .......... ............ A Release eye tissue ...................................... 7.35 NA 6.37 0.37 NA 14.09 090 

67345 .......... ............ A Destroy nerve of eye muscle ...................... 2.97 2.52 1.97 0.17 5.65 5.10 010 

67350 .......... ............ A Biopsy eye muscle ...................................... 2.88 NA 1.84 0.15 NA 4.86 000 

67399 .......... ............ C Eye muscle surgery procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

67400 .......... ............ A Explore/biopsy eye socket .......................... 9.77 NA 10.83 0.56 NA 21.16 090 

67405 .......... ............ A Explore/drain eye socket ............................. 7.94 NA 9.42 0.44 NA 17.80 090 

67412 .......... ............ A Explore/treat eye socket .............................. 9.51 NA 10.47 0.48 NA 20.46 090 

67413 .......... ............ A Explore/treat eye socket .............................. 10.01 NA 10.36 0.50 NA 20.87 090 

67414 .......... ............ A Explr/decompress eye socket ..................... 11.13 NA 11.56 0.65 NA 23.34 090 

67415 .......... ............ A Aspiration, orbital contents .......................... 1.76 NA 0.74 0.09 NA 2.60 000 

67420 .......... ............ A Explore/treat eye socket .............................. 20.07 NA 16.76 1.15 NA 37.98 090 

67430 .......... ............ A Explore/treat eye socket .............................. 13.40 NA 14.29 0.86 NA 28.55 090 

67440 .......... ............ A Explore/drain eye socket ............................. 13.10 NA 13.73 0.70 NA 27.52 090 

67445 .......... ............ A Explr/decompress eye socket ..................... 14.43 NA 13.40 0.90 NA 28.73 090 

67450 .......... ............ A Explore/biopsy eye socket .......................... 13.52 NA 14.17 0.68 NA 28.36 090 

67500 .......... ............ A Inject/treat eye socket ................................. 0.79 0.65 0.28 0.05 1.49 1.12 000 

67505 .......... ............ A Inject/treat eye socket ................................. 0.82 0.67 0.30 0.05 1.54 1.17 000 

67515 .......... ............ A Inject/treat eye socket ................................. 0.61 0.57 0.37 0.03 1.21 1.01 000 

67550 .......... ............ A Insert eye socket implant ............................ 10.19 NA 10.89 0.72 NA 21.80 090 

67560 .......... ............ A Revise eye socket implant .......................... 10.60 NA 10.97 0.60 NA 22.17 090 

67570 .......... ............ A Decompress optic nerve ............................. 13.59 NA 13.08 0.68 NA 27.35 090 

67599 .......... ............ C Orbit surgery procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

67700 .......... ............ A Drainage of eyelid abscess ......................... 1.35 5.70 1.24 0.07 7.12 2.66 010 

67710 .......... ............ A Incision of eyelid .......................................... 1.02 5.07 1.18 0.05 6.14 2.25 010 

67715 .......... ............ A Incision of eyelid fold ................................... 1.22 5.09 1.26 0.06 6.37 2.54 010 

67800 .......... ............ A Remove eyelid lesion .................................. 1.38 1.58 1.02 0.07 3.03 2.47 010 

67801 .......... ............ A Remove eyelid lesions ................................ 1.88 1.91 1.23 0.09 3.89 3.21 010 

67805 .......... ............ A Remove eyelid lesions ................................ 2.22 2.46 1.61 0.11 4.79 3.95 010 

67808 .......... ............ A Remove eyelid lesion(s) .............................. 3.80 NA 3.69 0.19 NA 7.68 090 

67810 .......... ............ A Biopsy of eyelid ........................................... 1.48 3.44 0.67 0.06 4.98 2.22 000 

67820 .......... ............ A Revise eyelashes ........................................ 0.89 0.59 0.56 0.04 1.52 1.49 000 

67825 .......... ............ A Revise eyelashes ........................................ 1.38 1.67 1.38 0.07 3.13 2.84 010 

67830 .......... ............ A Revise eyelashes ........................................ 1.70 5.26 1.47 0.08 7.04 3.25 010 

67835 .......... ............ A Revise eyelashes ........................................ 5.56 NA 4.52 0.28 NA 10.36 090 

67840 .......... ............ A Remove eyelid lesion .................................. 2.04 5.22 1.62 0.10 7.37 3.76 010 

67850 .......... ............ A Treat eyelid lesion ....................................... 1.69 3.41 1.45 0.07 5.17 3.21 010 

67875 .......... ............ A Closure of eyelid by suture ......................... 1.35 3.13 0.92 0.07 4.56 2.35 000 

67880 .......... ............ A Revision of eyelid ........................................ 3.80 6.35 3.71 0.19 10.34 7.70 090 

67882 .......... ............ A Revision of eyelid ........................................ 5.07 7.35 4.70 0.25 12.67 10.02 090 

67900 .......... ............ A Repair brow defect ...................................... 6.14 8.72 5.11 0.38 15.24 11.63 090 

67901 .......... ............ A Repair eyelid defect .................................... 6.97 NA 5.26 0.51 NA 12.74 090 

67902 .......... ............ A Repair eyelid defect .................................... 7.03 NA 5.32 0.45 NA 12.80 090 

67903 .......... ............ A Repair eyelid defect .................................... 6.37 9.07 5.33 0.47 15.92 12.17 090 

67904 .......... ............ A Repair eyelid defect .................................... 6.26 9.25 5.11 0.41 15.92 11.78 090 

67906 .......... ............ A Repair eyelid defect .................................... 6.79 NA 4.92 0.46 NA 12.17 090 

67908 .......... ............ A Repair eyelid defect .................................... 5.13 6.41 5.19 0.28 11.82 10.60 090 

67909 .......... ............ A Revise eyelid defect .................................... 5.40 7.70 4.82 0.31 13.41 10.53 090 

67911 .......... ............ A Revise eyelid defect .................................... 5.27 NA 4.66 0.31 NA 10.24 090 

67912 .......... ............ A Correction eyelid w/implant ......................... 5.68 17.75 5.37 0.28 23.71 11.33 090 

67914 .......... ............ A Repair eyelid defect .................................... 3.68 6.06 2.99 0.19 9.92 6.85 090 

67915 .......... ............ A Repair eyelid defect .................................... 3.19 5.70 2.74 0.16 9.05 6.09 090 

67916 .......... ............ A Repair eyelid defect .................................... 5.31 7.74 4.65 0.28 13.33 10.24 090 

67917 .......... ............ A Repair eyelid defect .................................... 6.02 8.14 4.95 0.36 14.52 11.33 090 

67921 .......... ............ A Repair eyelid defect .................................... 3.40 5.91 2.83 0.17 9.48 6.40 090 

67922 .......... ............ A Repair eyelid defect .................................... 3.07 5.63 2.70 0.15 8.84 5.91 090 

67923 .......... ............ A Repair eyelid defect .................................... 5.88 7.82 4.86 0.30 14.00 11.04 090 

67924 .......... ............ A Repair eyelid defect .................................... 5.79 8.56 4.58 0.30 14.65 10.67 090 

67930 .......... ............ A Repair eyelid wound .................................... 3.61 5.47 2.12 0.19 9.26 5.91 010 

45949

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

67935 .......... ............ A Repair eyelid wound .................................... 6.22 8.21 4.28 0.39 14.82 10.89 090 

67938 .......... ............ A Remove eyelid foreign body ....................... 1.33 5.11 1.24 0.06 6.50 2.63 010 

67950 .......... ............ A Revision of eyelid ........................................ 5.82 8.28 5.07 0.36 14.46 11.25 090 

67961 .......... ............ A Revision of eyelid ........................................ 5.69 8.35 4.90 0.33 14.37 10.92 090 

67966 .......... ............ A Revision of eyelid ........................................ 6.57 8.78 5.41 0.37 15.72 12.35 090 

67971 .......... ............ A Reconstruction of eyelid .............................. 9.80 NA 7.11 0.53 NA 17.44 090 

67973 .......... ............ A Reconstruction of eyelid .............................. 12.88 NA 9.07 0.75 NA 22.69 090 

67974 .......... ............ A Reconstruction of eyelid .............................. 12.85 NA 9.00 0.75 NA 22.59 090 

67975 .......... ............ A Reconstruction of eyelid .............................. 9.14 NA 6.79 0.50 NA 16.43 090 

67999 .......... ............ C Revision of eyelid ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

68020 .......... ............ A Incise/drain eyelid lining .............................. 1.37 1.38 1.18 0.06 2.81 2.62 010 

68040 .......... ............ A Treatment of eyelid lesions ......................... 0.85 0.69 0.42 0.04 1.59 1.31 000 

68100 .......... ............ A Biopsy of eyelid lining ................................. 1.35 3.09 0.93 0.07 4.51 2.36 000 

68110 .......... ............ A Remove eyelid lining lesion ........................ 1.77 3.91 1.62 0.09 5.78 3.48 010 

68115 .......... ............ A Remove eyelid lining lesion ........................ 2.36 5.67 1.87 0.12 8.15 4.36 010 

68130 .......... ............ A Remove eyelid lining lesion ........................ 4.93 8.34 4.50 0.24 13.51 9.67 090 

68135 .......... ............ A Remove eyelid lining lesion ........................ 1.84 1.77 1.62 0.09 3.70 3.55 010 

68200 .......... ............ A Treat eyelid by injection .............................. 0.49 0.52 0.32 0.02 1.03 0.83 000 

68320 .......... ............ A Revise/graft eyelid lining ............................. 5.37 10.81 5.41 0.27 16.45 11.05 090 

68325 .......... ............ A Revise/graft eyelid lining ............................. 7.36 NA 6.39 0.44 NA 14.19 090 

68326 .......... ............ A Revise/graft eyelid lining ............................. 7.15 NA 6.27 0.35 NA 13.77 090 

68328 .......... ............ A Revise/graft eyelid lining ............................. 8.19 NA 7.08 0.54 NA 15.81 090 

68330 .......... ............ A Revise eyelid lining ..................................... 4.83 9.00 4.62 0.24 14.07 9.69 090 

68335 .......... ............ A Revise/graft eyelid lining ............................. 7.19 NA 6.24 0.36 NA 13.80 090 

68340 .......... ............ A Separate eyelid adhesions .......................... 4.17 8.47 4.02 0.21 12.85 8.39 090 

68360 .......... ............ A Revise eyelid lining ..................................... 4.37 7.70 4.10 0.22 12.29 8.68 090 

68362 .......... ............ A Revise eyelid lining ..................................... 7.34 NA 6.27 0.36 NA 13.97 090 

68371 .......... ............ A Harvest eye tissue, alograft ........................ 4.90 NA 4.61 0.44 NA 9.95 010 

68399 .......... ............ C Eyelid lining surgery .................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

68400 .......... ............ A Incise/drain tear gland ................................. 1.69 5.61 1.72 0.08 7.38 3.49 010 

68420 .......... ............ A Incise/drain tear sac .................................... 2.30 5.90 1.99 0.11 8.31 4.40 010 

68440 .......... ............ A Incise tear duct opening .............................. 0.94 1.93 1.24 0.05 2.92 2.23 010 

68500 .......... ............ A Removal of tear gland ................................. 11.02 NA 9.45 0.55 NA 21.02 090 

68505 .......... ............ A Partial removal, tear gland .......................... 10.94 NA 10.29 0.55 NA 21.78 090 

68510 .......... ............ A Biopsy of tear gland .................................... 4.61 6.97 2.13 0.23 11.81 6.97 000 

68520 .......... ............ A Removal of tear sac .................................... 7.52 NA 7.21 0.37 NA 15.09 090 

68525 .......... ............ A Biopsy of tear sac ....................................... 4.43 NA 1.97 0.22 NA 6.62 000 

68530 .......... ............ A Clearance of tear duct ................................. 3.66 7.71 2.55 0.18 11.55 6.39 010 

68540 .......... ............ A Remove tear gland lesion ........................... 10.60 NA 9.14 0.52 NA 20.26 090 

68550 .......... ............ A Remove tear gland lesion ........................... 13.27 NA 11.03 0.80 NA 25.09 090 

68700 .......... ............ A Repair tear ducts ......................................... 6.60 NA 5.84 0.32 NA 12.76 090 

68705 .......... ............ A Revise tear duct opening ............................ 2.06 3.97 1.75 0.10 6.13 3.92 010 

68720 .......... ............ A Create tear sac drain .................................. 8.97 NA 7.65 0.44 NA 17.05 090 

68745 .......... ............ A Create tear duct drain ................................. 8.64 NA 7.65 0.52 NA 16.80 090 

68750 .......... ............ A Create tear duct drain ................................. 8.67 NA 8.04 0.43 NA 17.14 090 

68760 .......... ............ A Close tear duct opening .............................. 1.73 3.37 1.60 0.09 5.19 3.42 010 

68761 .......... ............ A Close tear duct opening .............................. 1.36 2.19 1.31 0.06 3.62 2.73 010 

68770 .......... ............ A Close tear system fistula ............................. 7.02 NA 3.78 0.35 NA 11.15 090 

68801 .......... ............ A Dilate tear duct opening .............................. 0.94 1.90 1.46 0.05 2.89 2.45 010 

68810 .......... ............ A Probe nasolacrimal duct .............................. 1.90 3.55 2.62 0.10 5.56 4.62 010 

68811 .......... ............ A Probe nasolacrimal duct .............................. 2.35 NA 2.35 0.13 NA 4.84 010 

68815 .......... ............ A Probe nasolacrimal duct .............................. 3.21 7.87 2.75 0.17 11.25 6.12 010 

68840 .......... ............ A Explore/irrigate tear ducts ........................... 1.25 1.55 1.11 0.06 2.86 2.42 010 

68850 .......... ............ A Injection for tear sac x-ray .......................... 0.80 0.87 0.71 0.04 1.71 1.55 000 

68899 .......... ............ C Tear duct system surgery ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

69000 .......... ............ A Drain external ear lesion ............................. 1.45 2.83 1.32 0.12 4.41 2.90 010 

69005 .......... ............ A Drain external ear lesion ............................. 2.11 2.90 1.79 0.17 5.18 4.07 010 

69020 .......... ............ A Drain outer ear canal lesion ........................ 1.48 3.93 2.00 0.12 5.54 3.60 010 

69090 .......... ............ N Pierce earlobes ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

69100 .......... ............ A Biopsy of external ear ................................. 0.81 1.76 0.41 0.03 2.61 1.25 000 

69105 .......... ............ A Biopsy of external ear canal ....................... 0.85 2.35 0.76 0.07 3.27 1.68 000 

69110 .......... ............ A Remove external ear, partial ....................... 3.44 7.01 4.35 0.30 10.75 8.09 090 

69120 .......... ............ A Removal of external ear .............................. 4.05 NA 5.99 0.38 NA 10.42 090 

69140 .......... ............ A Remove ear canal lesion(s) ........................ 7.98 NA 13.09 0.65 NA 21.72 090 

69145 .......... ............ A Remove ear canal lesion(s) ........................ 2.63 5.85 3.28 0.21 8.68 6.11 090 

69150 .......... ............ A Extensive ear canal surgery ........................ 13.44 NA 13.05 1.22 NA 27.71 090 

69155 .......... ............ A Extensive ear/neck surgery ......................... 20.81 NA 19.00 1.92 NA 41.73 090 

69200 .......... ............ A Clear outer ear canal .................................. 0.77 2.30 0.54 0.06 3.13 1.37 000 

69205 .......... ............ A Clear outer ear canal .................................. 1.20 NA 1.34 0.10 NA 2.64 010 

69210 .......... ............ A Remove impacted ear wax ......................... 0.61 0.62 0.22 0.05 1.28 0.88 000 

69220 .......... ............ A Clean out mastoid cavity ............................. 0.83 2.34 0.72 0.07 3.24 1.62 000 

69222 .......... ............ A Clean out mastoid cavity ............................. 1.40 3.80 2.01 0.12 5.32 3.53 010 

69300 .......... ............ R Revise external ear ..................................... 6.36 0.00 4.43 0.72 7.08 11.51 YYY 

69310 .......... ............ A Rebuild outer ear canal ............................... 10.79 NA 15.97 0.85 NA 27.61 090 

45950

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

69320 .......... ............ A Rebuild outer ear canal ............................... 16.96 NA 21.39 1.37 NA 39.72 090 

69399 .......... ............ C Outer ear surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

69400 .......... ............ A Inflate middle ear canal ............................... 0.83 2.20 0.67 0.07 3.11 1.57 000 

69401 .......... ............ A Inflate middle ear canal ............................... 0.63 1.27 0.64 0.05 1.95 1.32 000 

69405 .......... ............ A Catheterize middle ear canal ...................... 2.64 3.49 2.26 0.21 6.33 5.10 010 

69410 .......... ............ A Inset middle ear (baffle) .............................. 0.33 2.06 0.48 0.03 2.42 0.84 000 

69420 .......... ............ A Incision of eardrum ...................................... 1.33 3.12 1.57 0.11 4.56 3.01 010 

69421 .......... ............ A Incision of eardrum ...................................... 1.73 NA 2.10 0.15 NA 3.98 010 

69424 .......... ............ A Remove ventilating tube .............................. 0.85 2.16 0.67 0.07 3.09 1.60 000 

69433 .......... ............ A Create eardrum opening ............................. 1.52 3.07 1.62 0.13 4.72 3.27 010 

69436 .......... ............ A Create eardrum opening ............................. 1.96 NA 2.22 0.19 NA 4.37 010 

69440 .......... ............ A Exploration of middle ear ............................ 7.58 NA 8.74 0.61 NA 16.93 090 

69450 .......... ............ A Eardrum revision ......................................... 5.57 NA 7.04 0.45 NA 13.06 090 

69501 .......... ............ A Mastoidectomy ............................................ 9.08 NA 8.89 0.73 NA 18.70 090 

69502 .......... ............ A Mastoidectomy ............................................ 12.38 NA 11.46 1.00 NA 24.85 090 

69505 .......... ............ A Remove mastoid structures ........................ 13.00 NA 16.86 1.05 NA 30.90 090 

69511 .......... ............ A Extensive mastoid surgery .......................... 13.53 NA 17.13 1.09 NA 31.75 090 

69530 .......... ............ A Extensive mastoid surgery .......................... 19.20 NA 21.15 1.54 NA 41.89 090 

69535 .......... ............ A Remove part of temporal bone ................... 36.16 NA 31.12 2.92 NA 70.20 090 

69540 .......... ............ A Remove ear lesion ...................................... 1.20 3.69 1.93 0.10 4.99 3.23 010 

69550 .......... ............ A Remove ear lesion ...................................... 10.99 NA 14.61 0.89 NA 26.49 090 

69552 .......... ............ A Remove ear lesion ...................................... 19.47 NA 20.18 1.59 NA 41.23 090 

69554 .......... ............ A Remove ear lesion ...................................... 33.18 NA 29.40 2.91 NA 65.48 090 

69601 .......... ............ A Mastoid surgery revision ............................. 13.25 NA 12.52 1.07 NA 26.84 090 

69602 .......... ............ A Mastoid surgery revision ............................. 13.59 NA 13.10 1.10 NA 27.79 090 

69603 .......... ............ A Mastoid surgery revision ............................. 14.03 NA 17.92 1.14 NA 33.08 090 

69604 .......... ............ A Mastoid surgery revision ............................. 14.03 NA 13.49 1.14 NA 28.66 090 

69605 .......... ............ A Mastoid surgery revision ............................. 18.50 NA 20.72 1.50 NA 40.71 090 

69610 .......... ............ A Repair of eardrum ....................................... 4.43 5.43 3.19 0.36 10.22 7.98 010 

69620 .......... ............ A Repair of eardrum ....................................... 5.89 10.93 6.17 0.48 17.30 12.54 090 

69631 .......... ............ A Repair eardrum structures .......................... 9.87 NA 11.14 0.80 NA 21.81 090 

69632 .......... ............ A Rebuild eardrum structures ......................... 12.76 NA 13.35 1.03 NA 27.14 090 

69633 .......... ............ A Rebuild eardrum structures ......................... 12.10 NA 12.97 0.98 NA 26.05 090 

69635 .......... ............ A Repair eardrum structures .......................... 13.34 NA 16.44 1.08 NA 30.86 090 

69636 .......... ............ A Rebuild eardrum structures ......................... 15.23 NA 18.98 1.23 NA 35.44 090 

69637 .......... ............ A Rebuild eardrum structures ......................... 15.12 NA 18.91 1.22 NA 35.25 090 

69641 .......... ............ A Revise middle ear & mastoid ...................... 12.72 NA 12.67 1.03 NA 26.41 090 

69642 .......... ............ A Revise middle ear & mastoid ...................... 16.84 NA 16.10 1.36 NA 34.30 090 

69643 .......... ............ A Revise middle ear & mastoid ...................... 15.33 NA 14.66 1.24 NA 31.23 090 

69644 .......... ............ A Revise middle ear & mastoid ...................... 16.97 NA 20.00 1.37 NA 38.35 090 

69645 .......... ............ A Revise middle ear & mastoid ...................... 16.39 NA 19.64 1.33 NA 37.36 090 

69646 .......... ............ A Revise middle ear & mastoid ...................... 18.00 NA 20.38 1.46 NA 39.83 090 

69650 .......... ............ A Release middle ear bone ............................ 9.67 NA 9.84 0.78 NA 20.29 090 

69660 .......... ............ A Revise middle ear bone .............................. 11.90 NA 11.04 0.96 NA 23.91 090 

69661 .......... ............ A Revise middle ear bone .............................. 15.75 NA 14.47 1.27 NA 31.49 090 

69662 .......... ............ A Revise middle ear bone .............................. 15.45 NA 13.54 1.25 NA 30.24 090 

69666 .......... ............ A Repair middle ear structures ....................... 9.76 NA 9.90 0.79 NA 20.45 090 

69667 .......... ............ A Repair middle ear structures ....................... 9.77 NA 9.90 0.79 NA 20.46 090 

69670 .......... ............ A Remove mastoid air cells ............................ 11.51 NA 11.57 0.93 NA 24.01 090 

69676 .......... ............ A Remove middle ear nerve ........................... 9.53 NA 10.65 0.81 NA 20.99 090 

69700 .......... ............ A Close mastoid fistula ................................... 8.24 NA 9.06 0.67 NA 17.97 090 

69710 .......... ............ N Implant/replace hearing aid ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

69711 .......... ............ A Remove/repair hearing aid .......................... 10.44 NA 10.65 0.83 NA 21.92 090 

69714 .......... ............ A Implant temple bone w/stimul ..................... 14.01 NA 12.46 1.13 NA 27.60 090 

69715 .......... ............ A Temple bne implnt w/stimulat ..................... 18.26 NA 14.75 1.48 NA 34.49 090 

69717 .......... ............ A Temple bone implant revision ..................... 14.99 NA 14.01 0.90 NA 29.90 090 

69718 .......... ............ A Revise temple bone implant ........................ 18.51 NA 14.97 3.21 NA 36.69 090 

69720 .......... ............ A Release facial nerve .................................... 14.39 NA 14.34 1.16 NA 29.89 090 

69725 .......... ............ A Release facial nerve .................................... 25.39 NA 19.77 2.44 NA 47.60 090 

69740 .......... ............ A Repair facial nerve ...................................... 15.97 NA 13.13 1.27 NA 30.37 090 

69745 .......... ............ A Repair facial nerve ...................................... 16.69 NA 14.67 1.14 NA 32.50 090 

69799 .......... ............ C Middle ear surgery procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

69801 .......... ............ A Incise inner ear ............................................ 8.57 NA 9.41 0.69 NA 18.67 090 

69802 .......... ............ A Incise inner ear ............................................ 13.11 NA 12.21 1.06 NA 26.37 090 

69805 .......... ............ A Explore inner ear ......................................... 13.83 NA 11.70 1.12 NA 26.64 090 

69806 .......... ............ A Explore inner ear ......................................... 12.35 NA 10.92 1.00 NA 24.27 090 

69820 .......... ............ A Establish inner ear window ......................... 10.34 NA 11.04 0.90 NA 22.28 090 

69840 .......... ............ A Revise inner ear window ............................. 10.26 NA 12.73 0.79 NA 23.78 090 

69905 .......... ............ A Remove inner ear ........................................ 11.10 NA 11.23 0.90 NA 23.23 090 

69910 .......... ............ A Remove inner ear & mastoid ...................... 13.64 NA 11.72 1.07 NA 26.42 090 

69915 .......... ............ A Incise inner ear nerve ................................. 21.24 NA 16.16 1.69 NA 39.09 090 

69930 .......... ............ A Implant cochlear device .............................. 16.81 NA 14.44 1.36 NA 32.61 090 

69949 .......... ............ C Inner ear surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

69950 .......... ............ A Incise inner ear nerve ................................. 25.65 NA 18.47 2.28 NA 46.40 090 

45951

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

69955 .......... ............ A Release facial nerve .................................... 27.05 NA 20.91 2.48 NA 50.45 090 

69960 .......... ............ A Release inner ear canal .............................. 27.05 NA 19.59 2.17 NA 48.81 090 

69970 .......... ............ A Remove inner ear lesion ............................. 30.05 NA 22.69 2.41 NA 55.15 090 

69979 .......... ............ C Temporal bone surgery ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

69990 .......... ............ R Microsurgery add-on ................................... 3.47 NA 1.74 0.89 NA 6.09 ZZZ 

70010 .......... ............ A Contrast x-ray of brain ................................ 1.19 4.33 NA 0.27 5.79 NA XXX 

70010 .......... 26 ....... A Contrast x-ray of brain ................................ 1.19 0.41 0.41 0.05 1.65 1.65 XXX 

70010 .......... TC ...... A Contrast x-ray of brain ................................ 0.00 3.92 NA 0.22 4.14 NA XXX 

70015 .......... ............ A Contrast x-ray of brain ................................ 1.19 2.34 NA 0.16 3.70 NA XXX 

70015 .......... 26 ....... A Contrast x-ray of brain ................................ 1.19 0.41 0.41 0.08 1.68 1.68 XXX 

70015 .......... TC ...... A Contrast x-ray of brain ................................ 0.00 1.94 NA 0.08 2.02 NA XXX 

70030 .......... ............ A X-ray eye for foreign body .......................... 0.17 0.53 NA 0.03 0.73 NA XXX 

70030 .......... 26 ....... A X-ray eye for foreign body .......................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

70030 .......... TC ...... A X-ray eye for foreign body .......................... 0.00 0.47 NA 0.02 0.49 NA XXX 

70100 .......... ............ A X-ray exam of jaw ....................................... 0.18 0.62 NA 0.03 0.83 NA XXX 

70100 .......... 26 ....... A X-ray exam of jaw ....................................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

70100 .......... TC ...... A X-ray exam of jaw ....................................... 0.00 0.56 NA 0.02 0.58 NA XXX 

70110 .......... ............ A X-ray exam of jaw ....................................... 0.25 0.74 NA 0.05 1.04 NA XXX 

70110 .......... 26 ....... A X-ray exam of jaw ....................................... 0.25 0.09 0.09 0.01 0.35 0.35 XXX 

70110 .......... TC ...... A X-ray exam of jaw ....................................... 0.00 0.66 NA 0.04 0.70 NA XXX 

70120 .......... ............ A X-ray exam of mastoids .............................. 0.18 0.72 NA 0.05 0.95 NA XXX 

70120 .......... 26 ....... A X-ray exam of mastoids .............................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

70120 .......... TC ...... A X-ray exam of mastoids .............................. 0.00 0.66 NA 0.04 0.70 NA XXX 

70130 .......... ............ A X-ray exam of mastoids .............................. 0.34 1.03 NA 0.07 1.44 NA XXX 

70130 .......... 26 ....... A X-ray exam of mastoids .............................. 0.34 0.12 0.12 0.02 0.48 0.48 XXX 

70130 .......... TC ...... A X-ray exam of mastoids .............................. 0.00 0.91 NA 0.05 0.96 NA XXX 

70134 .......... ............ A X-ray exam of middle ear ............................ 0.34 0.93 NA 0.07 1.34 NA XXX 

70134 .......... 26 ....... A X-ray exam of middle ear ............................ 0.34 0.12 0.12 0.02 0.48 0.48 XXX 

70134 .......... TC ...... A X-ray exam of middle ear ............................ 0.00 0.81 NA 0.05 0.86 NA XXX 

70140 .......... ............ A X-ray exam of facial bones ......................... 0.19 0.66 NA 0.05 0.90 NA XXX 

70140 .......... 26 ....... A X-ray exam of facial bones ......................... 0.19 0.06 0.06 0.01 0.26 0.26 XXX 

70140 .......... TC ...... A X-ray exam of facial bones ......................... 0.00 0.60 NA 0.04 0.64 NA XXX 

70150 .......... ............ A X-ray exam of facial bones ......................... 0.26 0.87 NA 0.06 1.19 NA XXX 

70150 .......... 26 ....... A X-ray exam of facial bones ......................... 0.26 0.09 0.09 0.01 0.36 0.36 XXX 

70150 .......... TC ...... A X-ray exam of facial bones ......................... 0.00 0.78 NA 0.05 0.83 NA XXX 

70160 .......... ............ A X-ray exam of nasal bones ......................... 0.17 0.61 NA 0.03 0.81 NA XXX 

70160 .......... 26 ....... A X-ray exam of nasal bones ......................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

70160 .......... TC ...... A X-ray exam of nasal bones ......................... 0.00 0.55 NA 0.02 0.57 NA XXX 

70170 .......... ............ A X-ray exam of tear duct .............................. 0.30 NA NA 0.07 NA NA XXX 

70170 .......... 26 ....... A X-ray exam of tear duct .............................. 0.30 0.11 0.11 0.01 0.42 0.42 XXX 

70170 .......... TC ...... A X-ray exam of tear duct .............................. 0.00 NA NA 0.06 NA NA XXX 

70190 .......... ............ A X-ray exam of eye sockets ......................... 0.21 0.71 NA 0.05 0.97 NA XXX 

70190 .......... 26 ....... A X-ray exam of eye sockets ......................... 0.21 0.07 0.07 0.01 0.29 0.29 XXX 

70190 .......... TC ...... A X-ray exam of eye sockets ......................... 0.00 0.64 NA 0.04 0.68 NA XXX 

70200 .......... ............ A X-ray exam of eye sockets ......................... 0.28 0.89 NA 0.06 1.23 NA XXX 

70200 .......... 26 ....... A X-ray exam of eye sockets ......................... 0.28 0.10 0.10 0.01 0.39 0.39 XXX 

70200 .......... TC ...... A X-ray exam of eye sockets ......................... 0.00 0.80 NA 0.05 0.85 NA XXX 

70210 .......... ............ A X-ray exam of sinuses ................................ 0.17 0.68 NA 0.05 0.90 NA XXX 

70210 .......... 26 ....... A X-ray exam of sinuses ................................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

70210 .......... TC ...... A X-ray exam of sinuses ................................ 0.00 0.62 NA 0.04 0.66 NA XXX 

70220 .......... ............ A X-ray exam of sinuses ................................ 0.25 0.85 NA 0.06 1.16 NA XXX 

70220 .......... 26 ....... A X-ray exam of sinuses ................................ 0.25 0.09 0.09 0.01 0.35 0.35 XXX 

70220 .......... TC ...... A X-ray exam of sinuses ................................ 0.00 0.77 NA 0.05 0.82 NA XXX 

70240 .......... ............ A X-ray exam, pituitary saddle ....................... 0.19 0.53 NA 0.03 0.75 NA XXX 

70240 .......... 26 ....... A X-ray exam, pituitary saddle ....................... 0.19 0.06 0.06 0.01 0.26 0.26 XXX 

70240 .......... TC ...... A X-ray exam, pituitary saddle ....................... 0.00 0.47 NA 0.02 0.49 NA XXX 

70250 .......... ............ A X-ray exam of skull ..................................... 0.24 0.71 NA 0.05 1.00 NA XXX 

70250 .......... 26 ....... A X-ray exam of skull ..................................... 0.24 0.08 0.08 0.01 0.33 0.33 XXX 

70250 .......... TC ...... A X-ray exam of skull ..................................... 0.00 0.63 NA 0.04 0.67 NA XXX 

70260 .......... ............ A X-ray exam of skull ..................................... 0.34 0.99 NA 0.08 1.41 NA XXX 

70260 .......... 26 ....... A X-ray exam of skull ..................................... 0.34 0.12 0.12 0.02 0.48 0.48 XXX 

70260 .......... TC ...... A X-ray exam of skull ..................................... 0.00 0.87 NA 0.06 0.93 NA XXX 

70300 .......... ............ A X-ray exam of teeth ..................................... 0.10 0.29 NA 0.03 0.42 NA XXX 

70300 .......... 26 ....... A X-ray exam of teeth ..................................... 0.10 0.05 0.05 0.01 0.16 0.16 XXX 

70300 .......... TC ...... A X-ray exam of teeth ..................................... 0.00 0.24 NA 0.02 0.26 NA XXX 

70310 .......... ............ A X-ray exam of teeth ..................................... 0.16 0.54 NA 0.03 0.73 NA XXX 

70310 .......... 26 ....... A X-ray exam of teeth ..................................... 0.16 0.08 0.08 0.01 0.25 0.25 XXX 

70310 .......... TC ...... A X-ray exam of teeth ..................................... 0.00 0.46 NA 0.02 0.48 NA XXX 

70320 .......... ............ A Full mouth x-ray of teeth ............................. 0.22 0.88 NA 0.06 1.16 NA XXX 

70320 .......... 26 ....... A Full mouth x-ray of teeth ............................. 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

70320 .......... TC ...... A Full mouth x-ray of teeth ............................. 0.00 0.80 NA 0.05 0.85 NA XXX 

70328 .......... ............ A X-ray exam of jaw joint ............................... 0.18 0.58 NA 0.03 0.79 NA XXX 

70328 .......... 26 ....... A X-ray exam of jaw joint ............................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

70328 .......... TC ...... A X-ray exam of jaw joint ............................... 0.00 0.52 NA 0.02 0.54 NA XXX 

45952

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

70330 .......... ............ A X-ray exam of jaw joints .............................. 0.24 0.98 NA 0.06 1.28 NA XXX 

70330 .......... 26 ....... A X-ray exam of jaw joints .............................. 0.24 0.08 0.08 0.01 0.33 0.33 XXX 

70330 .......... TC ...... A X-ray exam of jaw joints .............................. 0.00 0.89 NA 0.05 0.94 NA XXX 

70332 .......... ............ A X-ray exam of jaw joint ............................... 0.54 2.14 NA 0.14 2.83 NA XXX 

70332 .......... 26 ....... A X-ray exam of jaw joint ............................... 0.54 0.21 0.21 0.02 0.77 0.77 XXX 

70332 .......... TC ...... A X-ray exam of jaw joint ............................... 0.00 1.94 NA 0.12 2.06 NA XXX 

70336 .......... ............ A Magnetic image, jaw joint ............................ 1.48 11.68 NA 0.66 13.82 NA XXX 

70336 .......... 26 ....... A Magnetic image, jaw joint ............................ 1.48 0.51 0.51 0.07 2.07 2.07 XXX 

70336 .......... TC ...... A Magnetic image, jaw joint ............................ 0.00 11.16 NA 0.59 11.75 NA XXX 

70350 .......... ............ A X-ray head for orthodontia .......................... 0.17 0.42 NA 0.03 0.62 NA XXX 

70350 .......... 26 ....... A X-ray head for orthodontia .......................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX 

70350 .......... TC ...... A X-ray head for orthodontia .......................... 0.00 0.35 NA 0.02 0.37 NA XXX 

70355 .......... ............ A Panoramic x-ray of jaws .............................. 0.20 0.56 NA 0.05 0.81 NA XXX 

70355 .......... 26 ....... A Panoramic x-ray of jaws .............................. 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

70355 .......... TC ...... A Panoramic x-ray of jaws .............................. 0.00 0.48 NA 0.04 0.52 NA XXX 

70360 .......... ............ A X-ray exam of neck ..................................... 0.17 0.50 NA 0.03 0.70 NA XXX 

70360 .......... 26 ....... A X-ray exam of neck ..................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

70360 .......... TC ...... A X-ray exam of neck ..................................... 0.00 0.44 NA 0.02 0.46 NA XXX 

70370 .......... ............ A Throat x-ray & fluoroscopy .......................... 0.32 1.52 NA 0.08 1.92 NA XXX 

70370 .......... 26 ....... A Throat x-ray & fluoroscopy .......................... 0.32 0.11 0.11 0.01 0.44 0.44 XXX 

70370 .......... TC ...... A Throat x-ray & fluoroscopy .......................... 0.00 1.42 NA 0.07 1.49 NA XXX 

70371 .......... ............ A Speech evaluation, complex ....................... 0.84 2.22 NA 0.16 3.22 NA XXX 

70371 .......... 26 ....... A Speech evaluation, complex ....................... 0.84 0.29 0.29 0.04 1.17 1.17 XXX 

70371 .......... TC ...... A Speech evaluation, complex ....................... 0.00 1.93 NA 0.12 2.05 NA XXX 

70373 .......... ............ A Contrast x-ray of larynx ............................... 0.44 1.86 NA 0.13 2.43 NA XXX 

70373 .......... 26 ....... A Contrast x-ray of larynx ............................... 0.44 0.15 0.15 0.02 0.61 0.61 XXX 

70373 .......... TC ...... A Contrast x-ray of larynx ............................... 0.00 1.71 NA 0.11 1.82 NA XXX 

70380 .......... ............ A X-ray exam of salivary gland ...................... 0.17 0.77 NA 0.05 0.99 NA XXX 

70380 .......... 26 ....... A X-ray exam of salivary gland ...................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

70380 .......... TC ...... A X-ray exam of salivary gland ...................... 0.00 0.71 NA 0.04 0.75 NA XXX 

70390 .......... ............ A X-ray exam of salivary duct ........................ 0.38 2.07 NA 0.13 2.58 NA XXX 

70390 .......... 26 ....... A X-ray exam of salivary duct ........................ 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

70390 .......... TC ...... A X-ray exam of salivary duct ........................ 0.00 1.94 NA 0.11 2.05 NA XXX 

70450 .......... ............ A Ct head/brain w/o dye ................................. 0.85 4.94 NA 0.29 6.09 NA XXX 

70450 .......... 26 ....... A Ct head/brain w/o dye ................................. 0.85 0.29 0.29 0.04 1.18 1.18 XXX 

70450 .......... TC ...... A Ct head/brain w/o dye ................................. 0.00 4.65 NA 0.25 4.90 NA XXX 

70460 .......... ............ A Ct head/brain w/dye .................................... 1.13 6.12 NA 0.35 7.61 NA XXX 

70460 .......... 26 ....... A Ct head/brain w/dye .................................... 1.13 0.39 0.39 0.05 1.57 1.57 XXX 

70460 .......... TC ...... A Ct head/brain w/dye .................................... 0.00 5.74 NA 0.30 6.04 NA XXX 

70470 .......... ............ A Ct head/brain w/o & w/dye .......................... 1.27 7.58 NA 0.43 9.28 NA XXX 

70470 .......... 26 ....... A Ct head/brain w/o & w/dye .......................... 1.27 0.44 0.44 0.06 1.77 1.77 XXX 

70470 .......... TC ...... A Ct head/brain w/o & w/dye .......................... 0.00 7.14 NA 0.37 7.51 NA XXX 

70480 .......... ............ A Ct orbit/ear/fossa w/o dye ........................... 1.28 5.94 NA 0.31 7.53 NA XXX 

70480 .......... 26 ....... A Ct orbit/ear/fossa w/o dye ........................... 1.28 0.44 0.44 0.06 1.78 1.78 XXX 

70480 .......... TC ...... A Ct orbit/ear/fossa w/o dye ........................... 0.00 5.50 NA 0.25 5.75 NA XXX 

70481 .......... ............ A Ct orbit/ear/fossa w/dye .............................. 1.38 7.04 NA 0.36 8.78 NA XXX 

70481 .......... 26 ....... A Ct orbit/ear/fossa w/dye .............................. 1.38 0.47 0.47 0.06 1.92 1.92 XXX 

70481 .......... TC ...... A Ct orbit/ear/fossa w/dye .............................. 0.00 6.57 NA 0.30 6.87 NA XXX 

70482 .......... ............ A Ct orbit/ear/fossa w/o&w/dye ...................... 1.45 8.49 NA 0.43 10.38 NA XXX 

70482 .......... 26 ....... A Ct orbit/ear/fossa w/o&w/dye ...................... 1.45 0.50 0.50 0.06 2.02 2.02 XXX 

70482 .......... TC ...... A Ct orbit/ear/fossa w/o&w/dye ...................... 0.00 7.99 NA 0.37 8.36 NA XXX 

70486 .......... ............ A Ct maxillofacial w/o dye .............................. 1.14 5.48 NA 0.30 6.93 NA XXX 

70486 .......... 26 ....... A Ct maxillofacial w/o dye .............................. 1.14 0.39 0.39 0.05 1.58 1.58 XXX 

70486 .......... TC ...... A Ct maxillofacial w/o dye .............................. 0.00 5.09 NA 0.25 5.34 NA XXX 

70487 .......... ............ A Ct maxillofacial w/dye .................................. 1.30 6.63 NA 0.36 8.30 NA XXX 

70487 .......... 26 ....... A Ct maxillofacial w/dye .................................. 1.30 0.45 0.45 0.06 1.81 1.81 XXX 

70487 .......... TC ...... A Ct maxillofacial w/dye .................................. 0.00 6.18 NA 0.30 6.48 NA XXX 

70488 .......... ............ A Ct maxillofacial w/o & w/dye ....................... 1.42 8.20 NA 0.43 10.06 NA XXX 

70488 .......... 26 ....... A Ct maxillofacial w/o & w/dye ....................... 1.42 0.49 0.49 0.06 1.97 1.97 XXX 

70488 .......... TC ...... A Ct maxillofacial w/o & w/dye ....................... 0.00 7.72 NA 0.37 8.09 NA XXX 

70490 .......... ............ A Ct soft tissue neck w/o dye ......................... 1.28 5.44 NA 0.31 7.03 NA XXX 

70490 .......... 26 ....... A Ct soft tissue neck w/o dye ......................... 1.28 0.44 0.44 0.06 1.78 1.78 XXX 

70490 .......... TC ...... A Ct soft tissue neck w/o dye ......................... 0.00 4.99 NA 0.25 5.24 NA XXX 

70491 .......... ............ A Ct soft tissue neck w/dye ............................ 1.38 6.59 NA 0.36 8.33 NA XXX 

70491 .......... 26 ....... A Ct soft tissue neck w/dye ............................ 1.38 0.47 0.47 0.06 1.92 1.92 XXX 

70491 .......... TC ...... A Ct soft tissue neck w/dye ............................ 0.00 6.12 NA 0.30 6.42 NA XXX 

70492 .......... ............ A Ct sft tsue nck w/o & w/dye ........................ 1.45 8.14 NA 0.43 10.02 NA XXX 

70492 .......... 26 ....... A Ct sft tsue nck w/o & w/dye ........................ 1.45 0.50 0.50 0.06 2.01 2.01 XXX 

70492 .......... TC ...... A Ct sft tsue nck w/o & w/dye ........................ 0.00 7.64 NA 0.37 8.01 NA XXX 

70496 .......... ............ A Ct angiography, head .................................. 1.75 12.21 NA 0.66 14.63 NA XXX 

70496 .......... 26 ....... A Ct angiography, head .................................. 1.75 0.60 0.60 0.08 2.43 2.43 XXX 

70496 .......... TC ...... A Ct angiography, head .................................. 0.00 11.62 NA 0.58 12.20 NA XXX 

70498 .......... ............ A Ct angiography, neck .................................. 1.75 12.31 NA 0.66 14.73 NA XXX 

70498 .......... 26 ....... A Ct angiography, neck .................................. 1.75 0.60 0.60 0.08 2.43 2.43 XXX 

45953

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

70498 .......... TC ...... A Ct angiography, neck .................................. 0.00 11.71 NA 0.58 12.29 NA XXX 

70540 .......... ............ A Mri orbit/face/neck w/o dye ......................... 1.35 12.19 NA 0.45 13.99 NA XXX 

70540 .......... 26 ....... A Mri orbit/face/neck w/o dye ......................... 1.35 0.46 0.46 0.06 1.88 1.88 XXX 

70540 .......... TC ...... A Mri orbit/face/neck w/o dye ......................... 0.00 11.73 NA 0.39 12.12 NA XXX 

70542 .......... ............ A Mri orbit/face/neck w/dye ............................ 1.62 14.04 NA 0.54 16.20 NA XXX 

70542 .......... 26 ....... A Mri orbit/face/neck w/dye ............................ 1.62 0.56 0.56 0.07 2.25 2.25 XXX 

70542 .......... TC ...... A Mri orbit/face/neck w/dye ............................ 0.00 13.48 NA 0.47 13.95 NA XXX 

70543 .......... ............ A Mri orbt/fac/nck w/o & w/dye ....................... 2.15 23.46 NA 0.94 26.55 NA XXX 

70543 .......... 26 ....... A Mri orbt/fac/nck w/o & w/dye ....................... 2.15 0.74 0.74 0.10 3.00 3.00 XXX 

70543 .......... TC ...... A Mri orbt/fac/nck w/o & w/dye ....................... 0.00 22.71 NA 0.84 23.55 NA XXX 

70544 .......... ............ A Mr angiography head w/o dye .................... 1.20 12.25 NA 0.64 14.09 NA XXX 

70544 .......... 26 ....... A Mr angiography head w/o dye .................... 1.20 0.42 0.42 0.05 1.67 1.67 XXX 

70544 .......... TC ...... A Mr angiography head w/o dye .................... 0.00 11.83 NA 0.59 12.42 NA XXX 

70545 .......... ............ A Mr angiography head w/dye ........................ 1.20 12.22 NA 0.64 14.06 NA XXX 

70545 .......... 26 ....... A Mr angiography head w/dye ........................ 1.20 0.41 0.41 0.05 1.66 1.66 XXX 

70545 .......... TC ...... A Mr angiography head w/dye ........................ 0.00 11.81 NA 0.59 12.40 NA XXX 

70546 .......... ............ A Mr angiograph head w/o&w/dye ................. 1.80 22.67 NA 0.67 25.14 NA XXX 

70546 .......... 26 ....... A Mr angiograph head w/o&w/dye ................. 1.80 0.62 0.62 0.08 2.50 2.50 XXX 

70546 .......... TC ...... A Mr angiograph head w/o&w/dye ................. 0.00 22.05 NA 0.59 22.64 NA XXX 

70547 .......... ............ A Mr angiography neck w/o dye ..................... 1.20 12.23 NA 0.64 14.08 NA XXX 

70547 .......... 26 ....... A Mr angiography neck w/o dye ..................... 1.20 0.41 0.41 0.05 1.66 1.66 XXX 

70547 .......... TC ...... A Mr angiography neck w/o dye ..................... 0.00 11.82 NA 0.59 12.41 NA XXX 

70548 .......... ............ A Mr angiography neck w/dye ........................ 1.20 12.55 NA 0.64 14.39 NA XXX 

70548 .......... 26 ....... A Mr angiography neck w/dye ........................ 1.20 0.41 0.41 0.05 1.66 1.66 XXX 

70548 .......... TC ...... A Mr angiography neck w/dye ........................ 0.00 12.13 NA 0.59 12.72 NA XXX 

70549 .......... ............ A Mr angiograph neck w/o&w/dye .................. 1.80 22.83 NA 0.67 25.30 NA XXX 

70549 .......... 26 ....... A Mr angiograph neck w/o&w/dye .................. 1.80 0.62 0.62 0.08 2.50 2.50 XXX 

70549 .......... TC ...... A Mr angiograph neck w/o&w/dye .................. 0.00 22.21 NA 0.59 22.80 NA XXX 

70551 .......... ............ A Mri brain w/o dye ......................................... 1.48 12.02 NA 0.66 14.16 NA XXX 

70551 .......... 26 ....... A Mri brain w/o dye ......................................... 1.48 0.51 0.51 0.07 2.07 2.07 XXX 

70551 .......... TC ...... A Mri brain w/o dye ......................................... 0.00 11.51 NA 0.59 12.10 NA XXX 

70552 .......... ............ A Mri brain w/dye ............................................ 1.78 14.21 NA 0.78 16.77 NA XXX 

70552 .......... 26 ....... A Mri brain w/dye ............................................ 1.78 0.62 0.62 0.08 2.48 2.48 XXX 

70552 .......... TC ...... A Mri brain w/dye ............................................ 0.00 13.59 NA 0.70 14.29 NA XXX 

70553 .......... ............ A Mri brain w/o & w/dye ................................. 2.36 23.54 NA 1.41 27.31 NA XXX 

70553 .......... 26 ....... A Mri brain w/o & w/dye ................................. 2.36 0.82 0.82 0.10 3.28 3.28 XXX 

70553 .......... TC ...... A Mri brain w/o & w/dye ................................. 0.00 22.72 NA 1.31 24.03 NA XXX 

70557 .......... ............ C Mri brain w/o dye ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

70557 .......... 26 ....... A Mri brain w/o dye ......................................... 2.91 1.16 1.16 0.08 4.15 4.15 XXX 

70557 .......... TC ...... C Mri brain w/o dye ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

70558 .......... ............ C Mri brain w/dye ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

70558 .......... 26 ....... A Mri brain w/dye ............................................ 3.21 1.28 1.28 0.10 4.58 4.58 XXX 

70558 .......... TC ...... C Mri brain w/dye ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

70559 .......... ............ C Mri brain w/o & w/dye ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

70559 .......... 26 ....... A Mri brain w/o & w/dye ................................. 3.21 1.27 1.27 0.12 4.60 4.60 XXX 

70559 .......... TC ...... C Mri brain w/o & w/dye ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

71010 .......... ............ A Chest x-ray .................................................. 0.18 0.50 NA 0.03 0.71 NA XXX 

71010 .......... 26 ....... A Chest x-ray .................................................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

71010 .......... TC ...... A Chest x-ray .................................................. 0.00 0.44 NA 0.02 0.46 NA XXX 

71015 .......... ............ A Chest x-ray .................................................. 0.21 0.55 NA 0.03 0.79 NA XXX 

71015 .......... 26 ....... A Chest x-ray .................................................. 0.21 0.07 0.07 0.01 0.29 0.29 XXX 

71015 .......... TC ...... A Chest x-ray .................................................. 0.00 0.48 NA 0.02 0.50 NA XXX 

71020 .......... ............ A Chest x-ray .................................................. 0.22 0.68 NA 0.05 0.95 NA XXX 

71020 .......... 26 ....... A Chest x-ray .................................................. 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

71020 .......... TC ...... A Chest x-ray .................................................. 0.00 0.60 NA 0.04 0.64 NA XXX 

71021 .......... ............ A Chest x-ray .................................................. 0.27 0.81 NA 0.06 1.14 NA XXX 

71021 .......... 26 ....... A Chest x-ray .................................................. 0.27 0.10 0.10 0.01 0.38 0.38 XXX 

71021 .......... TC ...... A Chest x-ray .................................................. 0.00 0.72 NA 0.05 0.77 NA XXX 

71022 .......... ............ A Chest x-ray .................................................. 0.31 0.83 NA 0.06 1.20 NA XXX 

71022 .......... 26 ....... A Chest x-ray .................................................. 0.31 0.11 0.11 0.01 0.43 0.43 XXX 

71022 .......... TC ...... A Chest x-ray .................................................. 0.00 0.73 NA 0.05 0.78 NA XXX 

71023 .......... ............ A Chest x-ray and fluoroscopy ....................... 0.38 1.08 NA 0.06 1.52 NA XXX 

71023 .......... 26 ....... A Chest x-ray and fluoroscopy ....................... 0.38 0.14 0.14 0.01 0.53 0.53 XXX 

71023 .......... TC ...... A Chest x-ray and fluoroscopy ....................... 0.00 0.94 NA 0.05 0.99 NA XXX 

71030 .......... ............ A Chest x-ray .................................................. 0.31 0.92 NA 0.06 1.29 NA XXX 

71030 .......... 26 ....... A Chest x-ray .................................................. 0.31 0.11 0.11 0.01 0.43 0.43 XXX 

71030 .......... TC ...... A Chest x-ray .................................................. 0.00 0.82 NA 0.05 0.87 NA XXX 

71034 .......... ............ A Chest x-ray and fluoroscopy ....................... 0.46 1.72 NA 0.10 2.28 NA XXX 

71034 .......... 26 ....... A Chest x-ray and fluoroscopy ....................... 0.46 0.17 0.17 0.02 0.65 0.65 XXX 

71034 .......... TC ...... A Chest x-ray and fluoroscopy ....................... 0.00 1.55 NA 0.08 1.63 NA XXX 

71035 .......... ............ A Chest x-ray .................................................. 0.18 0.66 NA 0.03 0.87 NA XXX 

71035 .......... 26 ....... A Chest x-ray .................................................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

71035 .......... TC ...... A Chest x-ray .................................................. 0.00 0.59 NA 0.02 0.61 NA XXX 

71040 .......... ............ A Contrast x-ray of bronchi ............................. 0.58 1.86 NA 0.11 2.55 NA XXX 

45954

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

71040 .......... 26 ....... A Contrast x-ray of bronchi ............................. 0.58 0.20 0.20 0.03 0.81 0.81 XXX 

71040 .......... TC ...... A Contrast x-ray of bronchi ............................. 0.00 1.66 NA 0.08 1.74 NA XXX 

71060 .......... ............ A Contrast x-ray of bronchi ............................. 0.74 2.68 NA 0.16 3.58 NA XXX 

71060 .......... 26 ....... A Contrast x-ray of bronchi ............................. 0.74 0.25 0.25 0.03 1.02 1.02 XXX 

71060 .......... TC ...... A Contrast x-ray of bronchi ............................. 0.00 2.42 NA 0.13 2.55 NA XXX 

71090 .......... ............ A X-ray & pacemaker insertion ....................... 0.54 NA NA 0.13 NA NA XXX 

71090 .......... 26 ....... A X-ray & pacemaker insertion ....................... 0.54 0.22 0.22 0.02 0.78 0.78 XXX 

71090 .......... TC ...... A X-ray & pacemaker insertion ....................... 0.00 NA NA 0.11 NA NA XXX 

71100 .......... ............ A X-ray exam of ribs ....................................... 0.22 0.65 NA 0.05 0.92 NA XXX 

71100 .......... 26 ....... A X-ray exam of ribs ....................................... 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

71100 .......... TC ...... A X-ray exam of ribs ....................................... 0.00 0.58 NA 0.04 0.62 NA XXX 

71101 .......... ............ A X-ray exam of ribs/chest ............................. 0.27 0.78 NA 0.05 1.10 NA XXX 

71101 .......... 26 ....... A X-ray exam of ribs/chest ............................. 0.27 0.10 0.10 0.01 0.38 0.38 XXX 

71101 .......... TC ...... A X-ray exam of ribs/chest ............................. 0.00 0.68 NA 0.04 0.72 NA XXX 

71110 .......... ............ A X-ray exam of ribs ....................................... 0.27 0.87 NA 0.06 1.20 NA XXX 

71110 .......... 26 ....... A X-ray exam of ribs ....................................... 0.27 0.09 0.09 0.01 0.37 0.37 XXX 

71110 .......... TC ...... A X-ray exam of ribs ....................................... 0.00 0.77 NA 0.05 0.82 NA XXX 

71111 .......... ............ A X-ray exam of ribs/chest ............................. 0.32 1.03 NA 0.07 1.43 NA XXX 

71111 .......... 26 ....... A X-ray exam of ribs/chest ............................. 0.32 0.11 0.11 0.01 0.44 0.44 XXX 

71111 .......... TC ...... A X-ray exam of ribs/chest ............................. 0.00 0.93 NA 0.06 0.99 NA XXX 

71120 .......... ............ A X-ray exam of breastbone ........................... 0.20 0.72 NA 0.05 0.97 NA XXX 

71120 .......... 26 ....... A X-ray exam of breastbone ........................... 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

71120 .......... TC ...... A X-ray exam of breastbone ........................... 0.00 0.64 NA 0.04 0.68 NA XXX 

71130 .......... ............ A X-ray exam of breastbone ........................... 0.22 0.79 NA 0.05 1.06 NA XXX 

71130 .......... 26 ....... A X-ray exam of breastbone ........................... 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

71130 .......... TC ...... A X-ray exam of breastbone ........................... 0.00 0.72 NA 0.04 0.76 NA XXX 

71250 .......... ............ A Ct thorax w/o dye ........................................ 1.16 6.29 NA 0.36 7.81 NA XXX 

71250 .......... 26 ....... A Ct thorax w/o dye ........................................ 1.16 0.40 0.40 0.05 1.61 1.61 XXX 

71250 .......... TC ...... A Ct thorax w/o dye ........................................ 0.00 5.89 NA 0.31 6.20 NA XXX 

71260 .......... ............ A Ct thorax w/dye ........................................... 1.24 7.63 NA 0.42 9.30 NA XXX 

71260 .......... 26 ....... A Ct thorax w/dye ........................................... 1.24 0.43 0.43 0.05 1.72 1.72 XXX 

71260 .......... TC ...... A Ct thorax w/dye ........................................... 0.00 7.20 NA 0.37 7.57 NA XXX 

71270 .......... ............ A Ct thorax w/o & w/dye ................................. 1.38 9.45 NA 0.52 11.35 NA XXX 

71270 .......... 26 ....... A Ct thorax w/o & w/dye ................................. 1.38 0.47 0.47 0.06 1.92 1.92 XXX 

71270 .......... TC ...... A Ct thorax w/o & w/dye ................................. 0.00 8.98 NA 0.46 9.44 NA XXX 

71275 .......... ............ A Ct angiography, chest ................................. 1.92 12.83 NA 0.48 15.23 NA XXX 

71275 .......... 26 ....... A Ct angiography, chest ................................. 1.92 0.66 0.66 0.09 2.68 2.68 XXX 

71275 .......... TC ...... A Ct angiography, chest ................................. 0.00 12.17 NA 0.39 12.56 NA XXX 

71550 .......... ............ A Mri chest w/o dye ........................................ 1.46 12.57 NA 0.51 14.55 NA XXX 

71550 .......... 26 ....... A Mri chest w/o dye ........................................ 1.46 0.50 0.50 0.06 2.03 2.03 XXX 

71550 .......... TC ...... A Mri chest w/o dye ........................................ 0.00 12.07 NA 0.45 12.52 NA XXX 

71551 .......... ............ A Mri chest w/dye ........................................... 1.73 14.97 NA 0.60 17.30 NA XXX 

71551 .......... 26 ....... A Mri chest w/dye ........................................... 1.73 0.60 0.60 0.08 2.41 2.41 XXX 

71551 .......... TC ...... A Mri chest w/dye ........................................... 0.00 14.37 NA 0.52 14.89 NA XXX 

71552 .......... ............ A Mri chest w/o & w/dye ................................. 2.26 24.34 NA 0.78 27.38 NA XXX 

71552 .......... 26 ....... A Mri chest w/o & w/dye ................................. 2.26 0.78 0.78 0.10 3.14 3.14 XXX 

71552 .......... TC ...... A Mri chest w/o & w/dye ................................. 0.00 23.56 NA 0.68 24.24 NA XXX 

71555 .......... ............ R Mri angio chest w or w/o dye ...................... 1.81 12.49 NA 0.67 14.97 NA XXX 

71555 .......... 26 ....... R Mri angio chest w or w/o dye ...................... 1.81 0.63 0.63 0.08 2.52 2.52 XXX 

71555 .......... TC ...... R Mri angio chest w or w/o dye ...................... 0.00 11.86 NA 0.59 12.45 NA XXX 

72010 .......... ............ A X-ray exam of spine .................................... 0.45 1.29 NA 0.08 1.82 NA XXX 

72010 .......... 26 ....... A X-ray exam of spine .................................... 0.45 0.16 0.16 0.02 0.63 0.63 XXX 

72010 .......... TC ...... A X-ray exam of spine .................................... 0.00 1.13 NA 0.06 1.19 NA XXX 

72020 .......... ............ A X-ray exam of spine .................................... 0.15 0.48 NA 0.03 0.66 NA XXX 

72020 .......... 26 ....... A X-ray exam of spine .................................... 0.15 0.05 0.05 0.01 0.21 0.21 XXX 

72020 .......... TC ...... A X-ray exam of spine .................................... 0.00 0.43 NA 0.02 0.45 NA XXX 

72040 .......... ............ A X-ray exam of neck spine ........................... 0.22 0.71 NA 0.05 0.98 NA XXX 

72040 .......... 26 ....... A X-ray exam of neck spine ........................... 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

72040 .......... TC ...... A X-ray exam of neck spine ........................... 0.00 0.63 NA 0.04 0.67 NA XXX 

72050 .......... ............ A X-ray exam of neck spine ........................... 0.31 1.04 NA 0.07 1.42 NA XXX 

72050 .......... 26 ....... A X-ray exam of neck spine ........................... 0.31 0.11 0.11 0.01 0.43 0.43 XXX 

72050 .......... TC ...... A X-ray exam of neck spine ........................... 0.00 0.93 NA 0.06 0.99 NA XXX 

72052 .......... ............ A X-ray exam of neck spine ........................... 0.36 1.32 NA 0.08 1.76 NA XXX 

72052 .......... 26 ....... A X-ray exam of neck spine ........................... 0.36 0.13 0.13 0.02 0.51 0.51 XXX 

72052 .......... TC ...... A X-ray exam of neck spine ........................... 0.00 1.20 NA 0.06 1.26 NA XXX 

72069 .......... ............ A X-ray exam of trunk spine ........................... 0.22 0.64 NA 0.03 0.89 NA XXX 

72069 .......... 26 ....... A X-ray exam of trunk spine ........................... 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

72069 .......... TC ...... A X-ray exam of trunk spine ........................... 0.00 0.56 NA 0.02 0.58 NA XXX 

72070 .......... ............ A X-ray exam of thoracic spine ...................... 0.22 0.72 NA 0.05 0.99 NA XXX 

72070 .......... 26 ....... A X-ray exam of thoracic spine ...................... 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

72070 .......... TC ...... A X-ray exam of thoracic spine ...................... 0.00 0.65 NA 0.04 0.69 NA XXX 

72072 .......... ............ A X-ray exam of thoracic spine ...................... 0.22 0.82 NA 0.06 1.10 NA XXX 

72072 .......... 26 ....... A X-ray exam of thoracic spine ...................... 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

72072 .......... TC ...... A X-ray exam of thoracic spine ...................... 0.00 0.75 NA 0.05 0.80 NA XXX 

45955

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

72074 .......... ............ A X-ray exam of thoracic spine ...................... 0.22 1.00 NA 0.07 1.29 NA XXX 

72074 .......... 26 ....... A X-ray exam of thoracic spine ...................... 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

72074 .......... TC ...... A X-ray exam of thoracic spine ...................... 0.00 0.93 NA 0.06 0.99 NA XXX 

72080 .......... ............ A X-ray exam of trunk spine ........................... 0.22 0.74 NA 0.05 1.01 NA XXX 

72080 .......... 26 ....... A X-ray exam of trunk spine ........................... 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

72080 .......... TC ...... A X-ray exam of trunk spine ........................... 0.00 0.67 NA 0.04 0.71 NA XXX 

72090 .......... ............ A X-ray exam of trunk spine ........................... 0.28 0.85 NA 0.05 1.18 NA XXX 

72090 .......... 26 ....... A X-ray exam of trunk spine ........................... 0.28 0.10 0.10 0.01 0.39 0.39 XXX 

72090 .......... TC ...... A X-ray exam of trunk spine ........................... 0.00 0.76 NA 0.04 0.80 NA XXX 

72100 .......... ............ A X-ray exam of lower spine .......................... 0.22 0.77 NA 0.05 1.04 NA XXX 

72100 .......... 26 ....... A X-ray exam of lower spine .......................... 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

72100 .......... TC ...... A X-ray exam of lower spine .......................... 0.00 0.70 NA 0.04 0.74 NA XXX 

72110 .......... ............ A X-ray exam of lower spine .......................... 0.31 1.08 NA 0.07 1.46 NA XXX 

72110 .......... 26 ....... A X-ray exam of lower spine .......................... 0.31 0.11 0.11 0.01 0.43 0.43 XXX 

72110 .......... TC ...... A X-ray exam of lower spine .......................... 0.00 0.97 NA 0.06 1.03 NA XXX 

72114 .......... ............ A X-ray exam of lower spine .......................... 0.36 1.41 NA 0.08 1.85 NA XXX 

72114 .......... 26 ....... A X-ray exam of lower spine .......................... 0.36 0.13 0.13 0.02 0.51 0.51 XXX 

72114 .......... TC ...... A X-ray exam of lower spine .......................... 0.00 1.29 NA 0.06 1.35 NA XXX 

72120 .......... ............ A X-ray exam of lower spine .......................... 0.22 1.00 NA 0.07 1.29 NA XXX 

72120 .......... 26 ....... A X-ray exam of lower spine .......................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

72120 .......... TC ...... A X-ray exam of lower spine .......................... 0.00 0.93 NA 0.06 0.99 NA XXX 

72125 .......... ............ A Ct neck spine w/o dye ................................. 1.16 6.29 NA 0.36 7.81 NA XXX 

72125 .......... 26 ....... A Ct neck spine w/o dye ................................. 1.16 0.40 0.40 0.05 1.61 1.61 XXX 

72125 .......... TC ...... A Ct neck spine w/o dye ................................. 0.00 5.89 NA 0.31 6.20 NA XXX 

72126 .......... ............ A Ct neck spine w/dye .................................... 1.22 7.60 NA 0.42 9.25 NA XXX 

72126 .......... 26 ....... A Ct neck spine w/dye .................................... 1.22 0.42 0.42 0.05 1.69 1.69 XXX 

72126 .......... TC ...... A Ct neck spine w/dye .................................... 0.00 7.18 NA 0.37 7.55 NA XXX 

72127 .......... ............ A Ct neck spine w/o & w/dye ......................... 1.27 9.40 NA 0.52 11.19 NA XXX 

72127 .......... 26 ....... A Ct neck spine w/o & w/dye ......................... 1.27 0.44 0.44 0.06 1.77 1.77 XXX 

72127 .......... TC ...... A Ct neck spine w/o & w/dye ......................... 0.00 8.96 NA 0.46 9.42 NA XXX 

72128 .......... ............ A Ct chest spine w/o dye ................................ 1.16 6.29 NA 0.36 7.81 NA XXX 

72128 .......... 26 ....... A Ct chest spine w/o dye ................................ 1.16 0.40 0.40 0.05 1.61 1.61 XXX 

72128 .......... TC ...... A Ct chest spine w/o dye ................................ 0.00 5.89 NA 0.31 6.20 NA XXX 

72129 .......... ............ A Ct chest spine w/dye ................................... 1.22 7.58 NA 0.42 9.22 NA XXX 

72129 .......... 26 ....... A Ct chest spine w/dye ................................... 1.22 0.42 0.42 0.05 1.69 1.69 XXX 

72129 .......... TC ...... A Ct chest spine w/dye ................................... 0.00 7.15 NA 0.37 7.52 NA XXX 

72130 .......... ............ A Ct chest spine w/o & w/dye ........................ 1.27 9.44 NA 0.52 11.23 NA XXX 

72130 .......... 26 ....... A Ct chest spine w/o & w/dye ........................ 1.27 0.44 0.44 0.06 1.77 1.77 XXX 

72130 .......... TC ...... A Ct chest spine w/o & w/dye ........................ 0.00 9.00 NA 0.46 9.46 NA XXX 

72131 .......... ............ A Ct lumbar spine w/o dye ............................. 1.16 6.30 NA 0.36 7.82 NA XXX 

72131 .......... 26 ....... A Ct lumbar spine w/o dye ............................. 1.16 0.40 0.40 0.05 1.61 1.61 XXX 

72131 .......... TC ...... A Ct lumbar spine w/o dye ............................. 0.00 5.90 NA 0.31 6.21 NA XXX 

72132 .......... ............ A Ct lumbar spine w/dye ................................ 1.22 7.57 NA 0.42 9.22 NA XXX 

72132 .......... 26 ....... A Ct lumbar spine w/dye ................................ 1.22 0.42 0.42 0.05 1.69 1.69 XXX 

72132 .......... TC ...... A Ct lumbar spine w/dye ................................ 0.00 7.15 NA 0.37 7.52 NA XXX 

72133 .......... ............ A Ct lumbar spine w/o & w/dye ...................... 1.27 9.42 NA 0.52 11.22 NA XXX 

72133 .......... 26 ....... A Ct lumbar spine w/o & w/dye ...................... 1.27 0.44 0.44 0.06 1.77 1.77 XXX 

72133 .......... TC ...... A Ct lumbar spine w/o & w/dye ...................... 0.00 8.98 NA 0.46 9.44 NA XXX 

72141 .......... ............ A Mri neck spine w/o dye ............................... 1.60 11.72 NA 0.66 13.99 NA XXX 

72141 .......... 26 ....... A Mri neck spine w/o dye ............................... 1.60 0.56 0.56 0.07 2.23 2.23 XXX 

72141 .......... TC ...... A Mri neck spine w/o dye ............................... 0.00 11.17 NA 0.59 11.76 NA XXX 

72142 .......... ............ A Mri neck spine w/dye .................................. 1.92 14.23 NA 0.79 16.94 NA XXX 

72142 .......... 26 ....... A Mri neck spine w/dye .................................. 1.92 0.67 0.67 0.09 2.68 2.68 XXX 

72142 .......... TC ...... A Mri neck spine w/dye .................................. 0.00 13.56 NA 0.70 14.26 NA XXX 

72146 .......... ............ A Mri chest spine w/o dye .............................. 1.60 12.68 NA 0.71 14.99 NA XXX 

72146 .......... 26 ....... A Mri chest spine w/o dye .............................. 1.60 0.56 0.56 0.07 2.23 2.23 XXX 

72146 .......... TC ...... A Mri chest spine w/o dye .............................. 0.00 12.12 NA 0.64 12.76 NA XXX 

72147 .......... ............ A Mri chest spine w/dye ................................. 1.92 13.76 NA 0.79 16.48 NA XXX 

72147 .......... 26 ....... A Mri chest spine w/dye ................................. 1.92 0.66 0.66 0.09 2.68 2.68 XXX 

72147 .......... TC ...... A Mri chest spine w/dye ................................. 0.00 13.10 NA 0.70 13.80 NA XXX 

72148 .......... ............ A Mri lumbar spine w/o dye ............................ 1.48 12.61 NA 0.71 14.80 NA XXX 

72148 .......... 26 ....... A Mri lumbar spine w/o dye ............................ 1.48 0.51 0.51 0.07 2.07 2.07 XXX 

72148 .......... TC ...... A Mri lumbar spine w/o dye ............................ 0.00 12.10 NA 0.64 12.74 NA XXX 

72149 .......... ............ A Mri lumbar spine w/dye ............................... 1.78 14.26 NA 0.78 16.82 NA XXX 

72149 .......... 26 ....... A Mri lumbar spine w/dye ............................... 1.78 0.63 0.63 0.08 2.49 2.49 XXX 

72149 .......... TC ...... A Mri lumbar spine w/dye ............................... 0.00 13.63 NA 0.70 14.33 NA XXX 

72156 .......... ............ A Mri neck spine w/o & w/dye ........................ 2.58 23.52 NA 1.42 27.52 NA XXX 

72156 .......... 26 ....... A Mri neck spine w/o & w/dye ........................ 2.58 0.89 0.89 0.11 3.57 3.57 XXX 

72156 .......... TC ...... A Mri neck spine w/o & w/dye ........................ 0.00 22.63 NA 1.31 23.94 NA XXX 

72157 .......... ............ A Mri chest spine w/o & w/dye ....................... 2.58 23.15 NA 1.42 27.15 NA XXX 

72157 .......... 26 ....... A Mri chest spine w/o & w/dye ....................... 2.58 0.88 0.88 0.11 3.57 3.57 XXX 

72157 .......... TC ...... A Mri chest spine w/o & w/dye ....................... 0.00 22.27 NA 1.31 23.58 NA XXX 

72158 .......... ............ A Mri lumbar spine w/o & w/dye ..................... 2.36 23.45 NA 1.41 27.22 NA XXX 

72158 .......... 26 ....... A Mri lumbar spine w/o & w/dye ..................... 2.36 0.82 0.82 0.10 3.28 3.28 XXX 

45956

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

72158 .......... TC ...... A Mri lumbar spine w/o & w/dye ..................... 0.00 22.63 NA 1.31 23.94 NA XXX 

72159 .......... ............ N Mr angio spine w/o&w/dye .......................... 1.80 13.69 NA 0.74 16.23 NA XXX 

72159 .......... 26 ....... N Mr angio spine w/o&w/dye .......................... 1.80 0.69 0.69 0.10 2.59 2.59 XXX 

72159 .......... TC ...... N Mr angio spine w/o&w/dye .......................... 0.00 13.00 NA 0.64 13.64 NA XXX 

72170 .......... ............ A X-ray exam of pelvis ................................... 0.17 0.57 NA 0.03 0.77 NA XXX 

72170 .......... 26 ....... A X-ray exam of pelvis ................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

72170 .......... TC ...... A X-ray exam of pelvis ................................... 0.00 0.51 NA 0.02 0.53 NA XXX 

72190 .......... ............ A X-ray exam of pelvis ................................... 0.21 0.78 NA 0.05 1.04 NA XXX 

72190 .......... 26 ....... A X-ray exam of pelvis ................................... 0.21 0.07 0.07 0.01 0.29 0.29 XXX 

72190 .......... TC ...... A X-ray exam of pelvis ................................... 0.00 0.71 NA 0.04 0.75 NA XXX 

72191 .......... ............ A Ct angiograph pelv w/o&w/dye ................... 1.81 12.28 NA 0.47 14.56 NA XXX 

72191 .......... 26 ....... A Ct angiograph pelv w/o&w/dye ................... 1.81 0.62 0.62 0.08 2.52 2.52 XXX 

72191 .......... TC ...... A Ct angiograph pelv w/o&w/dye ................... 0.00 11.66 NA 0.39 12.05 NA XXX 

72192 .......... ............ A Ct pelvis w/o dye ......................................... 1.09 6.18 NA 0.36 7.63 NA XXX 

72192 .......... 26 ....... A Ct pelvis w/o dye ......................................... 1.09 0.38 0.38 0.05 1.52 1.52 XXX 

72192 .......... TC ...... A Ct pelvis w/o dye ......................................... 0.00 5.80 NA 0.31 6.11 NA XXX 

72193 .......... ............ A Ct pelvis w/dye ............................................ 1.16 7.32 NA 0.41 8.89 NA XXX 

72193 .......... 26 ....... A Ct pelvis w/dye ............................................ 1.16 0.40 0.40 0.05 1.61 1.61 XXX 

72193 .......... TC ...... A Ct pelvis w/dye ............................................ 0.00 6.92 NA 0.36 7.28 NA XXX 

72194 .......... ............ A Ct pelvis w/o & w/dye .................................. 1.22 9.11 NA 0.48 10.81 NA XXX 

72194 .......... 26 ....... A Ct pelvis w/o & w/dye .................................. 1.22 0.42 0.42 0.05 1.69 1.69 XXX 

72194 .......... TC ...... A Ct pelvis w/o & w/dye .................................. 0.00 8.69 NA 0.43 9.12 NA XXX 

72195 .......... ............ A Mri pelvis w/o dye ....................................... 1.46 12.01 NA 0.51 13.98 NA XXX 

72195 .......... 26 ....... A Mri pelvis w/o dye ....................................... 1.46 0.50 0.50 0.06 2.03 2.03 XXX 

72195 .......... TC ...... A Mri pelvis w/o dye ....................................... 0.00 11.50 NA 0.45 11.95 NA XXX 

72196 .......... ............ A Mri pelvis w/dye ........................................... 1.73 14.11 NA 0.60 16.44 NA XXX 

72196 .......... 26 ....... A Mri pelvis w/dye ........................................... 1.73 0.60 0.60 0.08 2.41 2.41 XXX 

72196 .......... TC ...... A Mri pelvis w/dye ........................................... 0.00 13.51 NA 0.52 14.03 NA XXX 

72197 .......... ............ A Mri pelvis w/o & w/dye ................................ 2.26 23.58 NA 1.02 26.87 NA XXX 

72197 .......... 26 ....... A Mri pelvis w/o & w/dye ................................ 2.26 0.78 0.78 0.10 3.14 3.14 XXX 

72197 .......... TC ...... A Mri pelvis w/o & w/dye ................................ 0.00 22.81 NA 0.92 23.73 NA XXX 

72198 .......... ............ A Mr angio pelvis w/o & w/dye ....................... 1.80 12.37 NA 0.67 14.85 NA XXX 

72198 .......... 26 ....... A Mr angio pelvis w/o & w/dye ....................... 1.80 0.62 0.62 0.08 2.50 2.50 XXX 

72198 .......... TC ...... A Mr angio pelvis w/o & w/dye ....................... 0.00 11.75 NA 0.59 12.34 NA XXX 

72200 .......... ............ A X-ray exam sacroiliac joints ........................ 0.17 0.61 NA 0.03 0.81 NA XXX 

72200 .......... 26 ....... A X-ray exam sacroiliac joints ........................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

72200 .......... TC ...... A X-ray exam sacroiliac joints ........................ 0.00 0.54 NA 0.02 0.56 NA XXX 

72202 .......... ............ A X-ray exam sacroiliac joints ........................ 0.19 0.72 NA 0.05 0.96 NA XXX 

72202 .......... 26 ....... A X-ray exam sacroiliac joints ........................ 0.19 0.06 0.06 0.01 0.26 0.26 XXX 

72202 .......... TC ...... A X-ray exam sacroiliac joints ........................ 0.00 0.66 NA 0.04 0.70 NA XXX 

72220 .......... ............ A X-ray exam of tailbone ................................ 0.17 0.63 NA 0.05 0.85 NA XXX 

72220 .......... 26 ....... A X-ray exam of tailbone ................................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

72220 .......... TC ...... A X-ray exam of tailbone ................................ 0.00 0.57 NA 0.04 0.61 NA XXX 

72240 .......... ............ A Contrast x-ray of neck spine ....................... 0.91 4.45 NA 0.29 5.66 NA XXX 

72240 .......... 26 ....... A Contrast x-ray of neck spine ....................... 0.91 0.30 0.30 0.04 1.25 1.25 XXX 

72240 .......... TC ...... A Contrast x-ray of neck spine ....................... 0.00 4.15 NA 0.25 4.40 NA XXX 

72255 .......... ............ A Contrast x-ray, thorax spine ........................ 0.91 4.03 NA 0.26 5.20 NA XXX 

72255 .......... 26 ....... A Contrast x-ray, thorax spine ........................ 0.91 0.28 0.28 0.04 1.23 1.23 XXX 

72255 .......... TC ...... A Contrast x-ray, thorax spine ........................ 0.00 3.74 NA 0.22 3.96 NA XXX 

72265 .......... ............ A Contrast x-ray, lower spine ......................... 0.83 3.91 NA 0.26 5.00 NA XXX 

72265 .......... 26 ....... A Contrast x-ray, lower spine ......................... 0.83 0.26 0.26 0.04 1.13 1.13 XXX 

72265 .......... TC ...... A Contrast x-ray, lower spine ......................... 0.00 3.65 NA 0.22 3.87 NA XXX 

72270 .......... ............ A Contrast x-ray, spine ................................... 1.33 5.96 NA 0.39 7.68 NA XXX 

72270 .......... 26 ....... A Contrast x-ray, spine ................................... 1.33 0.44 0.44 0.06 1.83 1.83 XXX 

72270 .......... TC ...... A Contrast x-ray, spine ................................... 0.00 5.52 NA 0.33 5.85 NA XXX 

72275 .......... ............ A Epidurography ............................................. 0.76 2.22 NA 0.26 3.25 NA XXX 

72275 .......... 26 ....... A Epidurography ............................................. 0.76 0.20 0.20 0.04 1.00 1.00 XXX 

72275 .......... TC ...... A Epidurography ............................................. 0.00 2.03 NA 0.22 2.25 NA XXX 

72285 .......... ............ A X-ray c/t spine disk ...................................... 1.16 7.10 NA 0.50 8.76 NA XXX 

72285 .......... 26 ....... A X-ray c/t spine disk ...................................... 1.16 0.37 0.37 0.07 1.60 1.60 XXX 

72285 .......... TC ...... A X-ray c/t spine disk ...................................... 0.00 6.73 NA 0.43 7.16 NA XXX 

72295 .......... ............ A X-ray of lower spine disk ............................. 0.83 6.61 NA 0.46 7.90 NA XXX 

72295 .......... 26 ....... A X-ray of lower spine disk ............................. 0.83 0.28 0.28 0.06 1.17 1.17 XXX 

72295 .......... TC ...... A X-ray of lower spine disk ............................. 0.00 6.34 NA 0.40 6.74 NA XXX 

73000 .......... ............ A X-ray exam of collar bone ........................... 0.16 0.57 NA 0.03 0.76 NA XXX 

73000 .......... 26 ....... A X-ray exam of collar bone ........................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73000 .......... TC ...... A X-ray exam of collar bone ........................... 0.00 0.52 NA 0.02 0.54 NA XXX 

73010 .......... ............ A X-ray exam of shoulder blade ..................... 0.17 0.59 NA 0.03 0.79 NA XXX 

73010 .......... 26 ....... A X-ray exam of shoulder blade ..................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73010 .......... TC ...... A X-ray exam of shoulder blade ..................... 0.00 0.52 NA 0.02 0.54 NA XXX 

73020 .......... ............ A X-ray exam of shoulder ............................... 0.15 0.51 NA 0.03 0.69 NA XXX 

73020 .......... 26 ....... A X-ray exam of shoulder ............................... 0.15 0.05 0.05 0.01 0.21 0.21 XXX 

73020 .......... TC ...... A X-ray exam of shoulder ............................... 0.00 0.45 NA 0.02 0.47 NA XXX 

73030 .......... ............ A X-ray exam of shoulder ............................... 0.18 0.62 NA 0.05 0.85 NA XXX 

45957

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

73030 .......... 26 ....... A X-ray exam of shoulder ............................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

73030 .......... TC ...... A X-ray exam of shoulder ............................... 0.00 0.56 NA 0.04 0.60 NA XXX 

73040 .......... ............ A Contrast x-ray of shoulder ........................... 0.54 2.30 NA 0.14 2.99 NA XXX 

73040 .......... 26 ....... A Contrast x-ray of shoulder ........................... 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

73040 .......... TC ...... A Contrast x-ray of shoulder ........................... 0.00 2.11 NA 0.12 2.23 NA XXX 

73050 .......... ............ A X-ray exam of shoulders ............................. 0.20 0.74 NA 0.05 0.99 NA XXX 

73050 .......... 26 ....... A X-ray exam of shoulders ............................. 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

73050 .......... TC ...... A X-ray exam of shoulders ............................. 0.00 0.67 NA 0.04 0.71 NA XXX 

73060 .......... ............ A X-ray exam of humerus ............................... 0.17 0.63 NA 0.05 0.85 NA XXX 

73060 .......... 26 ....... A X-ray exam of humerus ............................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73060 .......... TC ...... A X-ray exam of humerus ............................... 0.00 0.57 NA 0.04 0.61 NA XXX 

73070 .......... ............ A X-ray exam of elbow ................................... 0.15 0.57 NA 0.03 0.75 NA XXX 

73070 .......... 26 ....... A X-ray exam of elbow ................................... 0.15 0.05 0.05 0.01 0.21 0.21 XXX 

73070 .......... TC ...... A X-ray exam of elbow ................................... 0.00 0.52 NA 0.02 0.54 NA XXX 

73080 .......... ............ A X-ray exam of elbow ................................... 0.17 0.67 NA 0.05 0.89 NA XXX 

73080 .......... 26 ....... A X-ray exam of elbow ................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73080 .......... TC ...... A X-ray exam of elbow ................................... 0.00 0.61 NA 0.04 0.65 NA XXX 

73085 .......... ............ A Contrast x-ray of elbow ............................... 0.54 2.20 NA 0.14 2.88 NA XXX 

73085 .......... 26 ....... A Contrast x-ray of elbow ............................... 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

73085 .......... TC ...... A Contrast x-ray of elbow ............................... 0.00 2.01 NA 0.12 2.13 NA XXX 

73090 .......... ............ A X-ray exam of forearm ................................ 0.16 0.58 NA 0.03 0.77 NA XXX 

73090 .......... 26 ....... A X-ray exam of forearm ................................ 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73090 .......... TC ...... A X-ray exam of forearm ................................ 0.00 0.53 NA 0.02 0.55 NA XXX 

73092 .......... ............ A X-ray exam of arm, infant ........................... 0.16 0.56 NA 0.03 0.75 NA XXX 

73092 .......... 26 ....... A X-ray exam of arm, infant ........................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73092 .......... TC ...... A X-ray exam of arm, infant ........................... 0.00 0.51 NA 0.02 0.53 NA XXX 

73100 .......... ............ A X-ray exam of wrist ..................................... 0.16 0.55 NA 0.03 0.74 NA XXX 

73100 .......... 26 ....... A X-ray exam of wrist ..................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73100 .......... TC ...... A X-ray exam of wrist ..................................... 0.00 0.50 NA 0.02 0.52 NA XXX 

73110 .......... ............ A X-ray exam of wrist ..................................... 0.17 0.65 NA 0.03 0.85 NA XXX 

73110 .......... 26 ....... A X-ray exam of wrist ..................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73110 .......... TC ...... A X-ray exam of wrist ..................................... 0.00 0.59 NA 0.02 0.61 NA XXX 

73115 .......... ............ A Contrast x-ray of wrist ................................. 0.54 1.95 NA 0.12 2.61 NA XXX 

73115 .......... 26 ....... A Contrast x-ray of wrist ................................. 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

73115 .......... TC ...... A Contrast x-ray of wrist ................................. 0.00 1.76 NA 0.10 1.86 NA XXX 

73120 .......... ............ A X-ray exam of hand ..................................... 0.16 0.56 NA 0.03 0.75 NA XXX 

73120 .......... 26 ....... A X-ray exam of hand ..................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73120 .......... TC ...... A X-ray exam of hand ..................................... 0.00 0.51 NA 0.02 0.53 NA XXX 

73130 .......... ............ A X-ray exam of hand ..................................... 0.17 0.62 NA 0.03 0.82 NA XXX 

73130 .......... 26 ....... A X-ray exam of hand ..................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73130 .......... TC ...... A X-ray exam of hand ..................................... 0.00 0.56 NA 0.02 0.58 NA XXX 

73140 .......... ............ A X-ray exam of finger(s) ............................... 0.13 0.52 NA 0.03 0.68 NA XXX 

73140 .......... 26 ....... A X-ray exam of finger(s) ............................... 0.13 0.04 0.04 0.01 0.18 0.18 XXX 

73140 .......... TC ...... A X-ray exam of finger(s) ............................... 0.00 0.47 NA 0.02 0.49 NA XXX 

73200 .......... ............ A Ct upper extremity w/o dye ......................... 1.09 5.54 NA 0.30 6.93 NA XXX 

73200 .......... 26 ....... A Ct upper extremity w/o dye ......................... 1.09 0.38 0.38 0.05 1.52 1.52 XXX 

73200 .......... TC ...... A Ct upper extremity w/o dye ......................... 0.00 5.16 NA 0.25 5.41 NA XXX 

73201 .......... ............ A Ct upper extremity w/dye ............................ 1.16 6.72 NA 0.36 8.24 NA XXX 

73201 .......... 26 ....... A Ct upper extremity w/dye ............................ 1.16 0.40 0.40 0.05 1.61 1.61 XXX 

73201 .......... TC ...... A Ct upper extremity w/dye ............................ 0.00 6.32 NA 0.31 6.63 NA XXX 

73202 .......... ............ A Ct uppr extremity w/o&w/dye ...................... 1.22 8.51 NA 0.44 10.17 NA XXX 

73202 .......... 26 ....... A Ct uppr extremity w/o&w/dye ...................... 1.22 0.42 0.42 0.05 1.69 1.69 XXX 

73202 .......... TC ...... A Ct uppr extremity w/o&w/dye ...................... 0.00 8.09 NA 0.39 8.48 NA XXX 

73206 .......... ............ A Ct angio upr extrm w/o&w/dye .................... 1.81 11.18 NA 0.47 13.47 NA XXX 

73206 .......... 26 ....... A Ct angio upr extrm w/o&w/dye .................... 1.81 0.62 0.62 0.08 2.51 2.51 XXX 

73206 .......... TC ...... A Ct angio upr extrm w/o&w/dye .................... 0.00 10.56 NA 0.39 10.95 NA XXX 

73218 .......... ............ A Mri upper extremity w/o dye ........................ 1.35 11.98 NA 0.45 13.78 NA XXX 

73218 .......... 26 ....... A Mri upper extremity w/o dye ........................ 1.35 0.46 0.46 0.06 1.88 1.88 XXX 

73218 .......... TC ...... A Mri upper extremity w/o dye ........................ 0.00 11.52 NA 0.39 11.91 NA XXX 

73219 .......... ............ A Mri upper extremity w/dye ........................... 1.62 14.47 NA 0.54 16.63 NA XXX 

73219 .......... 26 ....... A Mri upper extremity w/dye ........................... 1.62 0.56 0.56 0.07 2.26 2.26 XXX 

73219 .......... TC ...... A Mri upper extremity w/dye ........................... 0.00 13.90 NA 0.47 14.37 NA XXX 

73220 .......... ............ A Mri uppr extremity w/o&w/dye ..................... 2.15 23.76 NA 0.94 26.86 NA XXX 

73220 .......... 26 ....... A Mri uppr extremity w/o&w/dye ..................... 2.15 0.75 0.75 0.10 3.00 3.00 XXX 

73220 .......... TC ...... A Mri uppr extremity w/o&w/dye ..................... 0.00 23.02 NA 0.84 23.86 NA XXX 

73221 .......... ............ A Mri joint upr extrem w/o dye ....................... 1.35 11.84 NA 0.45 13.64 NA XXX 

73221 .......... 26 ....... A Mri joint upr extrem w/o dye ....................... 1.35 0.46 0.46 0.06 1.88 1.88 XXX 

73221 .......... TC ...... A Mri joint upr extrem w/o dye ....................... 0.00 11.38 NA 0.39 11.77 NA XXX 

73222 .......... ............ A Mri joint upr extrem w/dye ........................... 1.62 13.74 NA 0.54 15.91 NA XXX 

73222 .......... 26 ....... A Mri joint upr extrem w/dye ........................... 1.62 0.56 0.56 0.07 2.25 2.25 XXX 

73222 .......... TC ...... A Mri joint upr extrem w/dye ........................... 0.00 13.18 NA 0.47 13.65 NA XXX 

73223 .......... ............ A Mri joint upr extr w/o&w/dye ........................ 2.15 23.20 NA 0.94 26.30 NA XXX 

73223 .......... 26 ....... A Mri joint upr extr w/o&w/dye ........................ 2.15 0.74 0.74 0.10 3.00 3.00 XXX 

73223 .......... TC ...... A Mri joint upr extr w/o&w/dye ........................ 0.00 22.46 NA 0.84 23.30 NA XXX 

45958

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

73225 .......... ............ N Mr angio upr extr w/o&w/dye ...................... 1.73 12.75 NA 0.69 15.17 NA XXX 

73225 .......... 26 ....... N Mr angio upr extr w/o&w/dye ...................... 1.73 0.66 0.66 0.10 2.50 2.50 XXX 

73225 .......... TC ...... N Mr angio upr extr w/o&w/dye ...................... 0.00 12.09 NA 0.59 12.68 NA XXX 

73500 .......... ............ A X-ray exam of hip ........................................ 0.17 0.52 NA 0.03 0.72 NA XXX 

73500 .......... 26 ....... A X-ray exam of hip ........................................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73500 .......... TC ...... A X-ray exam of hip ........................................ 0.00 0.46 NA 0.02 0.48 NA XXX 

73510 .......... ............ A X-ray exam of hip ........................................ 0.21 0.69 NA 0.05 0.95 NA XXX 

73510 .......... 26 ....... A X-ray exam of hip ........................................ 0.21 0.07 0.07 0.01 0.29 0.29 XXX 

73510 .......... TC ...... A X-ray exam of hip ........................................ 0.00 0.61 NA 0.04 0.65 NA XXX 

73520 .......... ............ A X-ray exam of hips ...................................... 0.26 0.78 NA 0.05 1.09 NA XXX 

73520 .......... 26 ....... A X-ray exam of hips ...................................... 0.26 0.09 0.09 0.01 0.36 0.36 XXX 

73520 .......... TC ...... A X-ray exam of hips ...................................... 0.00 0.69 NA 0.04 0.73 NA XXX 

73525 .......... ............ A Contrast x-ray of hip .................................... 0.54 2.24 NA 0.15 2.94 NA XXX 

73525 .......... 26 ....... A Contrast x-ray of hip .................................... 0.54 0.19 0.19 0.03 0.76 0.76 XXX 

73525 .......... TC ...... A Contrast x-ray of hip .................................... 0.00 2.06 NA 0.12 2.18 NA XXX 

73530 .......... ............ A X-ray exam of hip ........................................ 0.29 NA NA 0.03 NA NA XXX 

73530 .......... 26 ....... A X-ray exam of hip ........................................ 0.29 0.10 0.10 0.01 0.40 0.40 XXX 

73530 .......... TC ...... A X-ray exam of hip ........................................ 0.00 NA NA 0.02 NA NA XXX 

73540 .......... ............ A X-ray exam of pelvis & hips ........................ 0.20 0.67 NA 0.05 0.92 NA XXX 

73540 .......... 26 ....... A X-ray exam of pelvis & hips ........................ 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

73540 .......... TC ...... A X-ray exam of pelvis & hips ........................ 0.00 0.60 NA 0.04 0.64 NA XXX 

73542 .......... ............ A X-ray exam, sacroiliac joint ......................... 0.59 2.05 NA 0.15 2.79 NA XXX 

73542 .......... 26 ....... A X-ray exam, sacroiliac joint ......................... 0.59 0.16 0.16 0.03 0.78 0.78 XXX 

73542 .......... TC ...... A X-ray exam, sacroiliac joint ......................... 0.00 1.89 NA 0.12 2.01 NA XXX 

73550 .......... ............ A X-ray exam of thigh ..................................... 0.17 0.62 NA 0.05 0.84 NA XXX 

73550 .......... 26 ....... A X-ray exam of thigh ..................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73550 .......... TC ...... A X-ray exam of thigh ..................................... 0.00 0.56 NA 0.04 0.60 NA XXX 

73560 .......... ............ A X-ray exam of knee, 1 or 2 ......................... 0.17 0.59 NA 0.03 0.79 NA XXX 

73560 .......... 26 ....... A X-ray exam of knee, 1 or 2 ......................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73560 .......... TC ...... A X-ray exam of knee, 1 or 2 ......................... 0.00 0.52 NA 0.02 0.54 NA XXX 

73562 .......... ............ A X-ray exam of knee, 3 ................................. 0.18 0.66 NA 0.05 0.89 NA XXX 

73562 .......... 26 ....... A X-ray exam of knee, 3 ................................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

73562 .......... TC ...... A X-ray exam of knee, 3 ................................. 0.00 0.59 NA 0.04 0.63 NA XXX 

73564 .......... ............ A X-ray exam, knee, 4 or more ...................... 0.22 0.74 NA 0.05 1.01 NA XXX 

73564 .......... 26 ....... A X-ray exam, knee, 4 or more ...................... 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

73564 .......... TC ...... A X-ray exam, knee, 4 or more ...................... 0.00 0.67 NA 0.04 0.71 NA XXX 

73565 .......... ............ A X-ray exam of knees ................................... 0.17 0.57 NA 0.03 0.77 NA XXX 

73565 .......... 26 ....... A X-ray exam of knees ................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73565 .......... TC ...... A X-ray exam of knees ................................... 0.00 0.50 NA 0.02 0.52 NA XXX 

73580 .......... ............ A Contrast x-ray of knee joint ......................... 0.54 2.71 NA 0.17 3.42 NA XXX 

73580 .......... 26 ....... A Contrast x-ray of knee joint ......................... 0.54 0.18 0.18 0.03 0.75 0.75 XXX 

73580 .......... TC ...... A Contrast x-ray of knee joint ......................... 0.00 2.53 NA 0.14 2.67 NA XXX 

73590 .......... ............ A X-ray exam of lower leg .............................. 0.17 0.58 NA 0.03 0.78 NA XXX 

73590 .......... 26 ....... A X-ray exam of lower leg .............................. 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73590 .......... TC ...... A X-ray exam of lower leg .............................. 0.00 0.52 NA 0.02 0.54 NA XXX 

73592 .......... ............ A X-ray exam of leg, infant ............................. 0.16 0.56 NA 0.03 0.75 NA XXX 

73592 .......... 26 ....... A X-ray exam of leg, infant ............................. 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73592 .......... TC ...... A X-ray exam of leg, infant ............................. 0.00 0.51 NA 0.02 0.53 NA XXX 

73600 .......... ............ A X-ray exam of ankle .................................... 0.16 0.55 NA 0.03 0.74 NA XXX 

73600 .......... 26 ....... A X-ray exam of ankle .................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73600 .......... TC ...... A X-ray exam of ankle .................................... 0.00 0.50 NA 0.02 0.52 NA XXX 

73610 .......... ............ A X-ray exam of ankle .................................... 0.17 0.62 NA 0.03 0.82 NA XXX 

73610 .......... 26 ....... A X-ray exam of ankle .................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73610 .......... TC ...... A X-ray exam of ankle .................................... 0.00 0.56 NA 0.02 0.58 NA XXX 

73615 .......... ............ A Contrast x-ray of ankle ................................ 0.54 2.19 NA 0.15 2.89 NA XXX 

73615 .......... 26 ....... A Contrast x-ray of ankle ................................ 0.54 0.19 0.19 0.03 0.76 0.76 XXX 

73615 .......... TC ...... A Contrast x-ray of ankle ................................ 0.00 2.01 NA 0.12 2.13 NA XXX 

73620 .......... ............ A X-ray exam of foot ....................................... 0.16 0.53 NA 0.03 0.72 NA XXX 

73620 .......... 26 ....... A X-ray exam of foot ....................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73620 .......... TC ...... A X-ray exam of foot ....................................... 0.00 0.48 NA 0.02 0.50 NA XXX 

73630 .......... ............ A X-ray exam of foot ....................................... 0.17 0.61 NA 0.03 0.81 NA XXX 

73630 .......... 26 ....... A X-ray exam of foot ....................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73630 .......... TC ...... A X-ray exam of foot ....................................... 0.00 0.54 NA 0.02 0.56 NA XXX 

73650 .......... ............ A X-ray exam of heel ...................................... 0.16 0.53 NA 0.03 0.72 NA XXX 

73650 .......... 26 ....... A X-ray exam of heel ...................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73650 .......... TC ...... A X-ray exam of heel ...................................... 0.00 0.48 NA 0.02 0.50 NA XXX 

73660 .......... ............ A X-ray exam of toe(s) ................................... 0.13 0.51 NA 0.03 0.67 NA XXX 

73660 .......... 26 ....... A X-ray exam of toe(s) ................................... 0.13 0.04 0.04 0.01 0.18 0.18 XXX 

73660 .......... TC ...... A X-ray exam of toe(s) ................................... 0.00 0.47 NA 0.02 0.49 NA XXX 

73700 .......... ............ A Ct lower extremity w/o dye .......................... 1.09 5.54 NA 0.30 6.93 NA XXX 

73700 .......... 26 ....... A Ct lower extremity w/o dye .......................... 1.09 0.38 0.38 0.05 1.52 1.52 XXX 

73700 .......... TC ...... A Ct lower extremity w/o dye .......................... 0.00 5.16 NA 0.25 5.41 NA XXX 

73701 .......... ............ A Ct lower extremity w/dye ............................. 1.16 6.68 NA 0.36 8.20 NA XXX 

73701 .......... 26 ....... A Ct lower extremity w/dye ............................. 1.16 0.40 0.40 0.05 1.61 1.61 XXX 

45959

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

73701 .......... TC ...... A Ct lower extremity w/dye ............................. 0.00 6.28 NA 0.31 6.59 NA XXX 

73702 .......... ............ A Ct lwr extremity w/o&w/dye ......................... 1.22 8.40 NA 0.44 10.06 NA XXX 

73702 .......... 26 ....... A Ct lwr extremity w/o&w/dye ......................... 1.22 0.42 0.42 0.05 1.69 1.69 XXX 

73702 .......... TC ...... A Ct lwr extremity w/o&w/dye ......................... 0.00 7.98 NA 0.39 8.37 NA XXX 

73706 .......... ............ A Ct angio lwr extr w/o&w/dye ....................... 1.90 11.68 NA 0.47 14.06 NA XXX 

73706 .......... 26 ....... A Ct angio lwr extr w/o&w/dye ....................... 1.90 0.65 0.65 0.08 2.64 2.64 XXX 

73706 .......... TC ...... A Ct angio lwr extr w/o&w/dye ....................... 0.00 11.03 NA 0.39 11.42 NA XXX 

73718 .......... ............ A Mri lower extremity w/o dye ........................ 1.35 11.94 NA 0.45 13.74 NA XXX 

73718 .......... 26 ....... A Mri lower extremity w/o dye ........................ 1.35 0.46 0.46 0.06 1.88 1.88 XXX 

73718 .......... TC ...... A Mri lower extremity w/o dye ........................ 0.00 11.48 NA 0.39 11.87 NA XXX 

73719 .......... ............ A Mri lower extremity w/dye ........................... 1.62 13.98 NA 0.54 16.15 NA XXX 

73719 .......... 26 ....... A Mri lower extremity w/dye ........................... 1.62 0.56 0.56 0.07 2.25 2.25 XXX 

73719 .......... TC ...... A Mri lower extremity w/dye ........................... 0.00 13.43 NA 0.47 13.90 NA XXX 

73720 .......... ............ A Mri lwr extremity w/o&w/dye ....................... 2.15 23.69 NA 0.94 26.79 NA XXX 

73720 .......... 26 ....... A Mri lwr extremity w/o&w/dye ....................... 2.15 0.74 0.74 0.10 2.99 2.99 XXX 

73720 .......... TC ...... A Mri lwr extremity w/o&w/dye ....................... 0.00 22.96 NA 0.84 23.80 NA XXX 

73721 .......... ............ A Mri jnt of lwr extre w/o dye .......................... 1.35 11.94 NA 0.45 13.75 NA XXX 

73721 .......... 26 ....... A Mri jnt of lwr extre w/o dye .......................... 1.35 0.46 0.46 0.06 1.88 1.88 XXX 

73721 .......... TC ...... A Mri jnt of lwr extre w/o dye .......................... 0.00 11.48 NA 0.39 11.87 NA XXX 

73722 .......... ............ A Mri joint of lwr extr w/dye ............................ 1.62 13.75 NA 0.54 15.92 NA XXX 

73722 .......... 26 ....... A Mri joint of lwr extr w/dye ............................ 1.62 0.56 0.56 0.07 2.25 2.25 XXX 

73722 .......... TC ...... A Mri joint of lwr extr w/dye ............................ 0.00 13.19 NA 0.47 13.66 NA XXX 

73723 .......... ............ A Mri joint lwr extr w/o&w/dye ........................ 2.15 23.23 NA 0.94 26.32 NA XXX 

73723 .......... 26 ....... A Mri joint lwr extr w/o&w/dye ........................ 2.15 0.74 0.74 0.10 3.00 3.00 XXX 

73723 .......... TC ...... A Mri joint lwr extr w/o&w/dye ........................ 0.00 22.48 NA 0.84 23.32 NA XXX 

73725 .......... ............ R Mr ang lwr ext w or w/o dye ....................... 1.82 12.54 NA 0.67 15.03 NA XXX 

73725 .......... 26 ....... R Mr ang lwr ext w or w/o dye ....................... 1.82 0.63 0.63 0.08 2.53 2.53 XXX 

73725 .......... TC ...... R Mr ang lwr ext w or w/o dye ........................ 0.00 11.91 NA 0.59 12.50 NA XXX 

74000 .......... ............ A X-ray exam of abdomen .............................. 0.18 0.57 NA 0.03 0.78 NA XXX 

74000 .......... 26 ....... A X-ray exam of abdomen .............................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

74000 .......... TC ...... A X-ray exam of abdomen .............................. 0.00 0.50 NA 0.02 0.52 NA XXX 

74010 .......... ............ A X-ray exam of abdomen .............................. 0.23 0.71 NA 0.05 0.99 NA XXX 

74010 .......... 26 ....... A X-ray exam of abdomen .............................. 0.23 0.08 0.08 0.01 0.32 0.32 XXX 

74010 .......... TC ...... A X-ray exam of abdomen .............................. 0.00 0.63 NA 0.04 0.67 NA XXX 

74020 .......... ............ A X-ray exam of abdomen .............................. 0.27 0.75 NA 0.05 1.07 NA XXX 

74020 .......... 26 ....... A X-ray exam of abdomen .............................. 0.27 0.10 0.10 0.01 0.38 0.38 XXX 

74020 .......... TC ...... A X-ray exam of abdomen .............................. 0.00 0.65 NA 0.04 0.69 NA XXX 

74022 .......... ............ A X-ray exam series, abdomen ...................... 0.32 0.89 NA 0.06 1.27 NA XXX 

74022 .......... 26 ....... A X-ray exam series, abdomen ...................... 0.32 0.11 0.11 0.01 0.44 0.44 XXX 

74022 .......... TC ...... A X-ray exam series, abdomen ...................... 0.00 0.78 NA 0.05 0.83 NA XXX 

74150 .......... ............ A Ct abdomen w/o dye ................................... 1.19 6.02 NA 0.35 7.57 NA XXX 

74150 .......... 26 ....... A Ct abdomen w/o dye ................................... 1.19 0.41 0.41 0.05 1.65 1.65 XXX 

74150 .......... TC ...... A Ct abdomen w/o dye ................................... 0.00 5.61 NA 0.30 5.91 NA XXX 

74160 .......... ............ A Ct abdomen w/dye ...................................... 1.27 7.66 NA 0.42 9.36 NA XXX 

74160 .......... 26 ....... A Ct abdomen w/dye ...................................... 1.27 0.44 0.44 0.06 1.77 1.77 XXX 

74160 .......... TC ...... A Ct abdomen w/dye ...................................... 0.00 7.22 NA 0.36 7.58 NA XXX 

74170 .......... ............ A Ct abdomen w/o & w/dye ............................ 1.40 9.77 NA 0.49 11.66 NA XXX 

74170 .......... 26 ....... A Ct abdomen w/o & w/dye ............................ 1.40 0.48 0.48 0.06 1.95 1.95 XXX 

74170 .......... TC ...... A Ct abdomen w/o & w/dye ............................ 0.00 9.29 NA 0.43 9.72 NA XXX 

74175 .......... ............ A Ct angio abdom w/o & w/dye ...................... 1.90 12.48 NA 0.47 14.86 NA XXX 

74175 .......... 26 ....... A Ct angio abdom w/o & w/dye ...................... 1.90 0.65 0.65 0.08 2.64 2.64 XXX 

74175 .......... TC ...... A Ct angio abdom w/o & w/dye ...................... 0.00 11.83 NA 0.39 12.22 NA XXX 

74181 .......... ............ A Mri abdomen w/o dye .................................. 1.46 11.66 NA 0.51 13.63 NA XXX 

74181 .......... 26 ....... A Mri abdomen w/o dye .................................. 1.46 0.50 0.50 0.06 2.03 2.03 XXX 

74181 .......... TC ...... A Mri abdomen w/o dye .................................. 0.00 11.15 NA 0.45 11.60 NA XXX 

74182 .......... ............ A Mri abdomen w/dye ..................................... 1.73 14.55 NA 0.60 16.89 NA XXX 

74182 .......... 26 ....... A Mri abdomen w/dye ..................................... 1.73 0.60 0.60 0.08 2.41 2.41 XXX 

74182 .......... TC ...... A Mri abdomen w/dye ..................................... 0.00 13.96 NA 0.52 14.48 NA XXX 

74183 .......... ............ A Mri abdomen w/o & w/dye .......................... 2.26 23.60 NA 1.02 26.88 NA XXX 

74183 .......... 26 ....... A Mri abdomen w/o & w/dye .......................... 2.26 0.78 0.78 0.10 3.14 3.14 XXX 

74183 .......... TC ...... A Mri abdomen w/o & w/dye .......................... 0.00 22.82 NA 0.92 23.74 NA XXX 

74185 .......... ............ R Mri angio, abdom w orw/o dye .................... 1.80 12.41 NA 0.67 14.88 NA XXX 

74185 .......... 26 ....... R Mri angio, abdom w orw/o dye .................... 1.80 0.62 0.62 0.08 2.50 2.50 XXX 

74185 .......... TC ...... R Mri angio, abdom w orw/o dye .................... 0.00 11.79 NA 0.59 12.38 NA XXX 

74190 .......... ............ A X-ray exam of peritoneum ........................... 0.48 NA NA 0.09 NA NA XXX 

74190 .......... 26 ....... A X-ray exam of peritoneum ........................... 0.48 0.17 0.17 0.02 0.67 0.67 XXX 

74190 .......... TC ...... A X-ray exam of peritoneum ........................... 0.00 NA NA 0.07 NA NA XXX 

74210 .......... ............ A Contrst x-ray exam of throat ....................... 0.36 1.45 NA 0.08 1.89 NA XXX 

74210 .......... 26 ....... A Contrst x-ray exam of throat ....................... 0.36 0.13 0.13 0.02 0.51 0.51 XXX 

74210 .......... TC ...... A Contrst x-ray exam of throat ....................... 0.00 1.33 NA 0.06 1.39 NA XXX 

74220 .......... ............ A Contrast x-ray, esophagus .......................... 0.46 1.57 NA 0.08 2.11 NA XXX 

74220 .......... 26 ....... A Contrast x-ray, esophagus .......................... 0.46 0.16 0.16 0.02 0.64 0.64 XXX 

74220 .......... TC ...... A Contrast x-ray, esophagus .......................... 0.00 1.41 NA 0.06 1.47 NA XXX 

74230 .......... ............ A Cine/vid x-ray, throat/esoph ........................ 0.53 1.63 NA 0.09 2.25 NA XXX 

45960

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

74230 .......... 26 ....... A Cine/vid x-ray, throat/esoph ........................ 0.53 0.18 0.18 0.02 0.73 0.73 XXX 

74230 .......... TC ...... A Cine/vid x-ray, throat/esoph ........................ 0.00 1.45 NA 0.07 1.52 NA XXX 

74235 .......... ............ A Remove esophagus obstruction .................. 1.19 NA NA 0.19 NA NA XXX 

74235 .......... 26 ....... A Remove esophagus obstruction .................. 1.19 0.41 0.41 0.05 1.65 1.65 XXX 

74235 .......... TC ...... A Remove esophagus obstruction .................. 0.00 NA NA 0.14 NA NA XXX 

74240 .......... ............ A X-ray exam, upper gi tract .......................... 0.69 1.89 NA 0.11 2.69 NA XXX 

74240 .......... 26 ....... A X-ray exam, upper gi tract .......................... 0.69 0.24 0.24 0.03 0.96 0.96 XXX 

74240 .......... TC ...... A X-ray exam, upper gi tract .......................... 0.00 1.65 NA 0.08 1.73 NA XXX 

74241 .......... ............ A X-ray exam, upper gi tract .......................... 0.69 1.98 NA 0.11 2.78 NA XXX 

74241 .......... 26 ....... A X-ray exam, upper gi tract .......................... 0.69 0.24 0.24 0.03 0.96 0.96 XXX 

74241 .......... TC ...... A X-ray exam, upper gi tract .......................... 0.00 1.74 NA 0.08 1.82 NA XXX 

74245 .......... ............ A X-ray exam, upper gi tract .......................... 0.91 3.16 NA 0.17 4.24 NA XXX 

74245 .......... 26 ....... A X-ray exam, upper gi tract .......................... 0.91 0.32 0.32 0.04 1.27 1.27 XXX 

74245 .......... TC ...... A X-ray exam, upper gi tract .......................... 0.00 2.85 NA 0.13 2.98 NA XXX 

74246 .......... ............ A Contrst x-ray uppr gi tract ........................... 0.69 2.16 NA 0.13 2.98 NA XXX 

74246 .......... 26 ....... A Contrst x-ray uppr gi tract ........................... 0.69 0.24 0.24 0.03 0.96 0.96 XXX 

74246 .......... TC ...... A Contrst x-ray uppr gi tract ........................... 0.00 1.92 NA 0.10 2.02 NA XXX 

74247 .......... ............ A Contrst x-ray uppr gi tract ........................... 0.69 2.30 NA 0.14 3.13 NA XXX 

74247 .......... 26 ....... A Contrst x-ray uppr gi tract ........................... 0.69 0.24 0.24 0.03 0.96 0.96 XXX 

74247 .......... TC ...... A Contrst x-ray uppr gi tract ........................... 0.00 2.06 NA 0.11 2.17 NA XXX 

74249 .......... ............ A Contrst x-ray uppr gi tract ........................... 0.91 3.38 NA 0.18 4.47 NA XXX 

74249 .......... 26 ....... A Contrst x-ray uppr gi tract ........................... 0.91 0.32 0.32 0.04 1.27 1.27 XXX 

74249 .......... TC ...... A Contrst x-ray uppr gi tract ........................... 0.00 3.06 NA 0.14 3.20 NA XXX 

74250 .......... ............ A X-ray exam of small bowel .......................... 0.47 1.83 NA 0.09 2.39 NA XXX 

74250 .......... 26 ....... A X-ray exam of small bowel .......................... 0.47 0.16 0.16 0.02 0.65 0.65 XXX 

74250 .......... TC ...... A X-ray exam of small bowel .......................... 0.00 1.67 NA 0.07 1.74 NA XXX 

74251 .......... ............ A X-ray exam of small bowel .......................... 0.69 4.38 NA 0.10 5.17 NA XXX 

74251 .......... 26 ....... A X-ray exam of small bowel .......................... 0.69 0.24 0.24 0.03 0.96 0.96 XXX 

74251 .......... TC ...... A X-ray exam of small bowel .......................... 0.00 4.14 NA 0.07 4.21 NA XXX 

74260 .......... ............ A X-ray exam of small bowel .......................... 0.50 3.97 NA 0.10 4.57 NA XXX 

74260 .......... 26 ....... A X-ray exam of small bowel .......................... 0.50 0.17 0.17 0.02 0.69 0.69 XXX 

74260 .......... TC ...... A X-ray exam of small bowel .......................... 0.00 3.81 NA 0.08 3.89 NA XXX 

74270 .......... ............ A Contrast x-ray exam of colon ...................... 0.69 2.44 NA 0.14 3.27 NA XXX 

74270 .......... 26 ....... A Contrast x-ray exam of colon ...................... 0.69 0.24 0.24 0.03 0.96 0.96 XXX 

74270 .......... TC ...... A Contrast x-ray exam of colon ...................... 0.00 2.20 NA 0.11 2.31 NA XXX 

74280 .......... ............ A Contrast x-ray exam of colon ...................... 0.99 3.35 NA 0.17 4.51 NA XXX 

74280 .......... 26 ....... A Contrast x-ray exam of colon ...................... 0.99 0.34 0.34 0.04 1.37 1.37 XXX 

74280 .......... TC ...... A Contrast x-ray exam of colon ...................... 0.00 3.02 NA 0.13 3.15 NA XXX 

74283 .......... ............ A Contrast x-ray exam of colon ...................... 2.02 3.31 NA 0.23 5.57 NA XXX 

74283 .......... 26 ....... A Contrast x-ray exam of colon ...................... 2.02 0.69 0.69 0.09 2.81 2.81 XXX 

74283 .......... TC ...... A Contrast x-ray exam of colon ...................... 0.00 2.62 NA 0.14 2.76 NA XXX 

74290 .......... ............ A Contrast x-ray, gallbladder .......................... 0.32 1.08 NA 0.06 1.47 NA XXX 

74290 .......... 26 ....... A Contrast x-ray, gallbladder .......................... 0.32 0.11 0.11 0.01 0.44 0.44 XXX 

74290 .......... TC ...... A Contrast x-ray, gallbladder .......................... 0.00 0.98 NA 0.05 1.03 NA XXX 

74291 .......... ............ A Contrast x-rays, gallbladder ........................ 0.20 0.83 NA 0.03 1.06 NA XXX 

74291 .......... 26 ....... A Contrast x-rays, gallbladder ........................ 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

74291 .......... TC ...... A Contrast x-rays, gallbladder ........................ 0.00 0.76 NA 0.02 0.78 NA XXX 

74300 .......... ............ C X-ray bile ducts/pancreas ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

74300 .......... 26 ....... A X-ray bile ducts/pancreas ............................ 0.36 0.13 0.13 0.02 0.51 0.51 XXX 

74300 .......... TC ...... C X-ray bile ducts/pancreas ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

74301 .......... ............ C X-rays at surgery add-on ............................ 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

74301 .......... 26 ....... A X-rays at surgery add-on ............................ 0.21 0.07 0.07 0.01 0.29 0.29 ZZZ 

74301 .......... TC ...... C X-rays at surgery add-on ............................ 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

74305 .......... ............ A X-ray bile ducts/pancreas ............................ 0.42 NA NA 0.07 NA NA XXX 

74305 .......... 26 ....... A X-ray bile ducts/pancreas ............................ 0.42 0.15 0.15 0.02 0.59 0.59 XXX 

74305 .......... TC ...... A X-ray bile ducts/pancreas ............................ 0.00 NA NA 0.05 NA NA XXX 

74320 .......... ............ A Contrast x-ray of bile ducts ......................... 0.54 3.15 NA 0.19 3.88 NA XXX 

74320 .......... 26 ....... A Contrast x-ray of bile ducts ......................... 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

74320 .......... TC ...... A Contrast x-ray of bile ducts ......................... 0.00 2.96 NA 0.17 3.13 NA XXX 

74327 .......... ............ A X-ray bile stone removal ............................. 0.70 2.28 NA 0.14 3.12 NA XXX 

74327 .......... 26 ....... A X-ray bile stone removal ............................. 0.70 0.24 0.24 0.03 0.97 0.97 XXX 

74327 .......... TC ...... A X-ray bile stone removal ............................. 0.00 2.03 NA 0.11 2.14 NA XXX 

74328 .......... ............ A X-ray bile duct endoscopy ........................... 0.70 NA NA 0.20 NA NA XXX 

74328 .......... 26 ....... A X-ray bile duct endoscopy ........................... 0.70 0.24 0.24 0.03 0.97 0.97 XXX 

74328 .......... TC ...... A X-ray bile duct endoscopy ........................... 0.00 NA NA 0.17 NA NA XXX 

74329 .......... ............ A X-ray for pancreas endoscopy .................... 0.70 NA NA 0.20 NA NA XXX 

74329 .......... 26 ....... A X-ray for pancreas endoscopy .................... 0.70 0.24 0.24 0.03 0.97 0.97 XXX 

74329 .......... TC ...... A X-ray for pancreas endoscopy .................... 0.00 NA NA 0.17 NA NA XXX 

74330 .......... ............ A X-ray bile/panc endoscopy .......................... 0.90 NA NA 0.21 NA NA XXX 

74330 .......... 26 ....... A X-ray bile/panc endoscopy .......................... 0.90 0.31 0.31 0.04 1.25 1.25 XXX 

74330 .......... TC ...... A X-ray bile/panc endoscopy .......................... 0.00 NA NA 0.17 NA NA XXX 

74340 .......... ............ A X-ray guide for GI tube ............................... 0.54 NA NA 0.16 NA NA XXX 

74340 .......... 26 ....... A X-ray guide for GI tube ............................... 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

74340 .......... TC ...... A X-ray guide for GI tube ............................... 0.00 NA NA 0.14 NA NA XXX 

45961

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

74350 .......... ............ A X-ray guide, stomach tube .......................... 0.76 3.17 NA 0.20 4.13 NA XXX 

74350 .......... 26 ....... A X-ray guide, stomach tube .......................... 0.76 0.26 0.26 0.03 1.05 1.05 XXX 

74350 .......... TC ...... A X-ray guide, stomach tube .......................... 0.00 2.90 NA 0.17 3.07 NA XXX 

74355 .......... ............ A X-ray guide, intestinal tube ......................... 0.76 NA NA 0.17 NA NA XXX 

74355 .......... 26 ....... A X-ray guide, intestinal tube ......................... 0.76 0.26 0.26 0.03 1.05 1.05 XXX 

74355 .......... TC ...... A X-ray guide, intestinal tube ......................... 0.00 NA NA 0.14 NA NA XXX 

74360 .......... ............ A X-ray guide, GI dilation ............................... 0.54 NA NA 0.19 NA NA XXX 

74360 .......... 26 ....... A X-ray guide, GI dilation ............................... 0.54 0.20 0.20 0.02 0.76 0.76 XXX 

74360 .......... TC ...... A X-ray guide, GI dilation ............................... 0.00 NA NA 0.17 NA NA XXX 

74363 .......... ............ A X-ray, bile duct dilation ................................ 0.88 NA NA 0.37 NA NA XXX 

74363 .......... 26 ....... A X-ray, bile duct dilation ................................ 0.88 0.31 0.31 0.04 1.23 1.23 XXX 

74363 .......... TC ...... A X-ray, bile duct dilation ................................ 0.00 NA NA 0.33 NA NA XXX 

74400 .......... ............ A Contrst x-ray, urinary tract .......................... 0.49 2.16 NA 0.13 2.79 NA XXX 

74400 .......... 26 ....... A Contrst x-ray, urinary tract .......................... 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

74400 .......... TC ...... A Contrst x-ray, urinary tract .......................... 0.00 2.00 NA 0.11 2.11 NA XXX 

74410 .......... ............ A Contrst x-ray, urinary tract .......................... 0.49 2.39 NA 0.13 3.01 NA XXX 

74410 .......... 26 ....... A Contrst x-ray, urinary tract .......................... 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

74410 .......... TC ...... A Contrst x-ray, urinary tract .......................... 0.00 2.22 NA 0.11 2.33 NA XXX 

74415 .......... ............ A Contrst x-ray, urinary tract .......................... 0.49 2.73 NA 0.14 3.36 NA XXX 

74415 .......... 26 ....... A Contrst x-ray, urinary tract .......................... 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

74415 .......... TC ...... A Contrst x-ray, urinary tract .......................... 0.00 2.56 NA 0.12 2.68 NA XXX 

74420 .......... ............ A Contrst x-ray, urinary tract .......................... 0.36 NA NA 0.16 NA NA XXX 

74420 .......... 26 ....... A Contrst x-ray, urinary tract .......................... 0.36 0.13 0.13 0.02 0.51 0.51 XXX 

74420 .......... TC ...... A Contrst x-ray, urinary tract .......................... 0.00 NA NA 0.14 NA NA XXX 

74425 .......... ............ A Contrst x-ray, urinary tract .......................... 0.36 NA NA 0.09 NA NA XXX 

74425 .......... 26 ....... A Contrst x-ray, urinary tract .......................... 0.36 0.13 0.13 0.02 0.51 0.51 XXX 

74425 .......... TC ...... A Contrst x-ray, urinary tract .......................... 0.00 NA NA 0.07 NA NA XXX 

74430 .......... ............ A Contrast x-ray, bladder ................................ 0.32 1.46 NA 0.08 1.86 NA XXX 

74430 .......... 26 ....... A Contrast x-ray, bladder ................................ 0.32 0.11 0.11 0.02 0.45 0.45 XXX 

74430 .......... TC ...... A Contrast x-ray, bladder ................................ 0.00 1.35 NA 0.06 1.41 NA XXX 

74440 .......... ............ A X-ray, male genital tract .............................. 0.38 1.37 NA 0.08 1.83 NA XXX 

74440 .......... 26 ....... A X-ray, male genital tract .............................. 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

74440 .......... TC ...... A X-ray, male genital tract .............................. 0.00 1.24 NA 0.06 1.30 NA XXX 

74445 .......... ............ A X-ray exam of penis .................................... 1.14 NA NA 0.13 NA NA XXX 

74445 .......... 26 ....... A X-ray exam of penis .................................... 1.14 0.41 0.41 0.07 1.62 1.62 XXX 

74445 .......... TC ...... A X-ray exam of penis .................................... 0.00 NA NA 0.06 NA NA XXX 

74450 .......... ............ A X-ray, urethra/bladder ................................. 0.33 NA NA 0.10 NA NA XXX 

74450 .......... 26 ....... A X-ray, urethra/bladder ................................. 0.33 0.12 0.12 0.02 0.47 0.47 XXX 

74450 .......... TC ...... A X-ray, urethra/bladder ................................. 0.00 NA NA 0.08 NA NA XXX 

74455 .......... ............ A X-ray, urethra/bladder ................................. 0.33 1.87 NA 0.12 2.32 NA XXX 

74455 .......... 26 ....... A X-ray, urethra/bladder ................................. 0.33 0.12 0.12 0.02 0.47 0.47 XXX 

74455 .......... TC ...... A X-ray, urethra/bladder ................................. 0.00 1.76 NA 0.10 1.86 NA XXX 

74470 .......... ............ A X-ray exam of kidney lesion ........................ 0.54 NA NA 0.09 NA NA XXX 

74470 .......... 26 ....... A X-ray exam of kidney lesion ........................ 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

74470 .......... TC ...... A X-ray exam of kidney lesion ........................ 0.00 NA NA 0.07 NA NA XXX 

74475 .......... ............ A X-ray control, cath insert ............................. 0.54 3.97 NA 0.24 4.75 NA XXX 

74475 .......... 26 ....... A X-ray control, cath insert ............................. 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

74475 .......... TC ...... A X-ray control, cath insert ............................. 0.00 3.78 NA 0.22 4.00 NA XXX 

74480 .......... ............ A X-ray control, cath insert ............................. 0.54 3.72 NA 0.24 4.51 NA XXX 

74480 .......... 26 ....... A X-ray control, cath insert ............................. 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

74480 .......... TC ...... A X-ray control, cath insert ............................. 0.00 3.53 NA 0.22 3.75 NA XXX 

74485 .......... ............ A X-ray guide, GU dilation .............................. 0.54 3.17 NA 0.20 3.91 NA XXX 

74485 .......... 26 ....... A X-ray guide, GU dilation .............................. 0.54 0.19 0.19 0.03 0.76 0.76 XXX 

74485 .......... TC ...... A X-ray guide, GU dilation .............................. 0.00 2.98 NA 0.17 3.15 NA XXX 

74710 .......... ............ A X-ray measurement of pelvis ...................... 0.34 1.05 NA 0.08 1.47 NA XXX 

74710 .......... 26 ....... A X-ray measurement of pelvis ...................... 0.34 0.12 0.12 0.02 0.48 0.48 XXX 

74710 .......... TC ...... A X-ray measurement of pelvis ...................... 0.00 0.93 NA 0.06 0.99 NA XXX 

74740 .......... ............ A X-ray, female genital tract ........................... 0.38 1.55 NA 0.09 2.02 NA XXX 

74740 .......... 26 ....... A X-ray, female genital tract ........................... 0.38 0.14 0.14 0.02 0.54 0.54 XXX 

74740 .......... TC ...... A X-ray, female genital tract ........................... 0.00 1.42 NA 0.07 1.49 NA XXX 

74742 .......... ............ A X-ray, fallopian tube .................................... 0.61 NA NA 0.20 NA NA XXX 

74742 .......... 26 ....... A X-ray, fallopian tube .................................... 0.61 0.21 0.21 0.03 0.85 0.85 XXX 

74742 .......... TC ...... A X-ray, fallopian tube .................................... 0.00 NA NA 0.17 NA NA XXX 

74775 .......... ............ A X-ray exam of perineum .............................. 0.62 NA NA 0.11 NA NA XXX 

74775 .......... 26 ....... A X-ray exam of perineum .............................. 0.62 0.22 0.22 0.03 0.87 0.87 XXX 

74775 .......... TC ...... A X-ray exam of perineum .............................. 0.00 NA NA 0.08 NA NA XXX 

75552 .......... ............ A Heart mri for morph w/o dye ....................... 1.60 13.56 NA 0.66 15.82 NA XXX 

75552 .......... 26 ....... A Heart mri for morph w/o dye ....................... 1.60 0.56 0.56 0.07 2.23 2.23 XXX 

75552 .......... TC ...... A Heart mri for morph w/o dye ....................... 0.00 13.00 NA 0.59 13.59 NA XXX 

75553 .......... ............ A Heart mri for morph w/dye .......................... 2.00 13.77 NA 0.66 16.43 NA XXX 

75553 .......... 26 ....... A Heart mri for morph w/dye .......................... 2.00 0.68 0.68 0.07 2.76 2.76 XXX 

75553 .......... TC ...... A Heart mri for morph w/dye .......................... 0.00 13.08 NA 0.59 13.67 NA XXX 

75554 .......... ............ A Cardiac MRI/function ................................... 1.83 17.01 NA 0.66 19.50 NA XXX 

75554 .......... 26 ....... A Cardiac MRI/function ................................... 1.83 0.68 0.68 0.07 2.58 2.58 XXX 

45962

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

75554 .......... TC ...... A Cardiac MRI/function ................................... 0.00 16.33 NA 0.59 16.92 NA XXX 

75555 .......... ............ A Cardiac MRI/limited study ........................... 1.74 15.87 NA 0.66 18.27 NA XXX 

75555 .......... 26 ....... A Cardiac MRI/limited study ........................... 1.74 0.67 0.67 0.07 2.49 2.49 XXX 

75555 .......... TC ...... A Cardiac MRI/limited study ........................... 0.00 15.20 NA 0.59 15.79 NA XXX 

75556 .......... ............ N Cardiac MRI/flow mapping .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75600 .......... ............ A Contrast x-ray exam of aorta ...................... 0.49 11.90 NA 0.67 13.06 NA XXX 

75600 .......... 26 ....... A Contrast x-ray exam of aorta ...................... 0.49 0.20 0.20 0.02 0.71 0.71 XXX 

75600 .......... TC ...... A Contrast x-ray exam of aorta ...................... 0.00 11.70 NA 0.65 12.35 NA XXX 

75605 .......... ............ A Contrast x-ray exam of aorta ...................... 1.14 10.80 NA 0.70 12.65 NA XXX 

75605 .......... 26 ....... A Contrast x-ray exam of aorta ...................... 1.14 0.42 0.42 0.05 1.61 1.61 XXX 

75605 .......... TC ...... A Contrast x-ray exam of aorta ...................... 0.00 10.38 NA 0.65 11.03 NA XXX 

75625 .......... ............ A Contrast x-ray exam of aorta ...................... 1.14 10.87 NA 0.71 12.73 NA XXX 

75625 .......... 26 ....... A Contrast x-ray exam of aorta ...................... 1.14 0.40 0.40 0.06 1.60 1.60 XXX 

75625 .......... TC ...... A Contrast x-ray exam of aorta ...................... 0.00 10.47 NA 0.65 11.12 NA XXX 

75630 .......... ............ A X-ray aorta, leg arteries .............................. 1.79 11.50 NA 0.80 14.09 NA XXX 

75630 .......... 26 ....... A X-ray aorta, leg arteries .............................. 1.79 0.64 0.64 0.11 2.54 2.54 XXX 

75630 .......... TC ...... A X-ray aorta, leg arteries .............................. 0.00 10.86 NA 0.69 11.55 NA XXX 

75635 .......... ............ A Ct angio abdominal arteries ........................ 2.40 15.78 NA 0.50 18.68 NA XXX 

75635 .......... 26 ....... A Ct angio abdominal arteries ........................ 2.40 0.83 0.83 0.11 3.35 3.35 XXX 

75635 .......... TC ...... A Ct angio abdominal arteries ........................ 0.00 14.94 NA 0.39 15.33 NA XXX 

75650 .......... ............ A Artery x-rays, head & neck ......................... 1.49 10.92 NA 0.72 13.13 NA XXX 

75650 .......... 26 ....... A Artery x-rays, head & neck ......................... 1.49 0.52 0.52 0.07 2.08 2.08 XXX 

75650 .......... TC ...... A Artery x-rays, head & neck ......................... 0.00 10.40 NA 0.65 11.05 NA XXX 

75658 .......... ............ A Artery x-rays, arm ........................................ 1.31 10.93 NA 0.72 12.96 NA XXX 

75658 .......... 26 ....... A Artery x-rays, arm ........................................ 1.31 0.49 0.49 0.07 1.87 1.87 XXX 

75658 .......... TC ...... A Artery x-rays, arm ........................................ 0.00 10.44 NA 0.65 11.09 NA XXX 

75660 .......... ............ A Artery x-rays, head & neck ......................... 1.31 10.89 NA 0.71 12.91 NA XXX 

75660 .......... 26 ....... A Artery x-rays, head & neck ......................... 1.31 0.46 0.46 0.06 1.84 1.84 XXX 

75660 .......... TC ...... A Artery x-rays, head & neck ......................... 0.00 10.42 NA 0.65 11.07 NA XXX 

75662 .......... ............ A Artery x-rays, head & neck ......................... 1.66 11.28 NA 0.71 13.65 NA XXX 

75662 .......... 26 ....... A Artery x-rays, head & neck ......................... 1.66 0.62 0.62 0.06 2.34 2.34 XXX 

75662 .......... TC ...... A Artery x-rays, head & neck ......................... 0.00 10.66 NA 0.65 11.31 NA XXX 

75665 .......... ............ A Artery x-rays, head & neck ......................... 1.31 10.88 NA 0.74 12.93 NA XXX 

75665 .......... 26 ....... A Artery x-rays, head & neck ......................... 1.31 0.46 0.46 0.09 1.86 1.86 XXX 

75665 .......... TC ...... A Artery x-rays, head & neck ......................... 0.00 10.42 NA 0.65 11.07 NA XXX 

75671 .......... ............ A Artery x-rays, head & neck ......................... 1.66 11.32 NA 0.72 13.70 NA XXX 

75671 .......... 26 ....... A Artery x-rays, head & neck ......................... 1.66 0.58 0.58 0.07 2.31 2.31 XXX 

75671 .......... TC ...... A Artery x-rays, head & neck ......................... 0.00 10.74 NA 0.65 11.39 NA XXX 

75676 .......... ............ A Artery x-rays, neck ...................................... 1.31 11.00 NA 0.72 13.03 NA XXX 

75676 .......... 26 ....... A Artery x-rays, neck ...................................... 1.31 0.46 0.46 0.07 1.84 1.84 XXX 

75676 .......... TC ...... A Artery x-rays, neck ...................................... 0.00 10.54 NA 0.65 11.19 NA XXX 

75680 .......... ............ A Artery x-rays, neck ...................................... 1.66 11.21 NA 0.72 13.60 NA XXX 

75680 .......... 26 ....... A Artery x-rays, neck ...................................... 1.66 0.58 0.58 0.07 2.31 2.31 XXX 

75680 .......... TC ...... A Artery x-rays, neck ...................................... 0.00 10.63 NA 0.65 11.28 NA XXX 

75685 .......... ............ A Artery x-rays, spine ..................................... 1.31 10.92 NA 0.71 12.94 NA XXX 

75685 .......... 26 ....... A Artery x-rays, spine ..................................... 1.31 0.45 0.45 0.06 1.83 1.83 XXX 

75685 .......... TC ...... A Artery x-rays, spine ..................................... 0.00 10.47 NA 0.65 11.12 NA XXX 

75705 .......... ............ A Artery x-rays, spine ..................................... 2.18 11.26 NA 0.78 14.22 NA XXX 

75705 .......... 26 ....... A Artery x-rays, spine ..................................... 2.18 0.77 0.77 0.13 3.08 3.08 XXX 

75705 .......... TC ...... A Artery x-rays, spine ..................................... 0.00 10.49 NA 0.65 11.14 NA XXX 

75710 .......... ............ A Artery x-rays, arm/leg .................................. 1.14 10.90 NA 0.72 12.76 NA XXX 

75710 .......... 26 ....... A Artery x-rays, arm/leg .................................. 1.14 0.41 0.41 0.07 1.62 1.62 XXX 

75710 .......... TC ...... A Artery x-rays, arm/leg .................................. 0.00 10.49 NA 0.65 11.14 NA XXX 

75716 .......... ............ A Artery x-rays, arms/legs .............................. 1.31 11.30 NA 0.72 13.33 NA XXX 

75716 .......... 26 ....... A Artery x-rays, arms/legs .............................. 1.31 0.46 0.46 0.07 1.84 1.84 XXX 

75716 .......... TC ...... A Artery x-rays, arms/legs .............................. 0.00 10.84 NA 0.65 11.49 NA XXX 

75722 .......... ............ A Artery x-rays, kidney ................................... 1.14 10.99 NA 0.70 12.84 NA XXX 

75722 .......... 26 ....... A Artery x-rays, kidney ................................... 1.14 0.42 0.42 0.05 1.61 1.61 XXX 

75722 .......... TC ...... A Artery x-rays, kidney ................................... 0.00 10.57 NA 0.65 11.22 NA XXX 

75724 .......... ............ A Artery x-rays, kidneys .................................. 1.49 11.60 NA 0.70 13.79 NA XXX 

75724 .......... 26 ....... A Artery x-rays, kidneys .................................. 1.49 0.59 0.59 0.05 2.13 2.13 XXX 

75724 .......... TC ...... A Artery x-rays, kidneys .................................. 0.00 11.01 NA 0.65 11.66 NA XXX 

75726 .......... ............ A Artery x-rays, abdomen ............................... 1.14 10.86 NA 0.70 12.70 NA XXX 

75726 .......... 26 ....... A Artery x-rays, abdomen ............................... 1.14 0.39 0.39 0.05 1.58 1.58 XXX 

75726 .......... TC ...... A Artery x-rays, abdomen ............................... 0.00 10.47 NA 0.65 11.12 NA XXX 

75731 .......... ............ A Artery x-rays, adrenal gland ........................ 1.14 10.63 NA 0.71 12.49 NA XXX 

75731 .......... 26 ....... A Artery x-rays, adrenal gland ........................ 1.14 0.39 0.39 0.06 1.60 1.60 XXX 

75731 .......... TC ...... A Artery x-rays, adrenal gland ........................ 0.00 10.24 NA 0.65 10.89 NA XXX 

75733 .......... ............ A Artery x-rays, adrenals ................................ 1.31 11.21 NA 0.71 13.24 NA XXX 

75733 .......... 26 ....... A Artery x-rays, adrenals ................................ 1.31 0.46 0.46 0.06 1.84 1.84 XXX 

75733 .......... TC ...... A Artery x-rays, adrenals ................................ 0.00 10.75 NA 0.65 11.40 NA XXX 

75736 .......... ............ A Artery x-rays, pelvis ..................................... 1.14 10.89 NA 0.71 12.74 NA XXX 

75736 .......... 26 ....... A Artery x-rays, pelvis ..................................... 1.14 0.40 0.40 0.06 1.60 1.60 XXX 

75736 .......... TC ...... A Artery x-rays, pelvis ..................................... 0.00 10.49 NA 0.65 11.14 NA XXX 

45963

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

75741 .......... ............ A Artery x-rays, lung ....................................... 1.31 10.77 NA 0.71 12.79 NA XXX 

75741 .......... 26 ....... A Artery x-rays, lung ....................................... 1.31 0.46 0.46 0.06 1.83 1.83 XXX 

75741 .......... TC ...... A Artery x-rays, lung ....................................... 0.00 10.32 NA 0.65 10.97 NA XXX 

75743 .......... ............ A Artery x-rays, lungs ..................................... 1.66 10.97 NA 0.72 13.36 NA XXX 

75743 .......... 26 ....... A Artery x-rays, lungs ..................................... 1.66 0.57 0.57 0.07 2.31 2.31 XXX 

75743 .......... TC ...... A Artery x-rays, lungs ..................................... 0.00 10.40 NA 0.65 11.05 NA XXX 

75746 .......... ............ A Artery x-rays, lung ....................................... 1.14 10.87 NA 0.70 12.72 NA XXX 

75746 .......... 26 ....... A Artery x-rays, lung ....................................... 1.14 0.40 0.40 0.05 1.59 1.59 XXX 

75746 .......... TC ...... A Artery x-rays, lung ....................................... 0.00 10.47 NA 0.65 11.12 NA XXX 

75756 .......... ............ A Artery x-rays, chest ..................................... 1.14 11.30 NA 0.69 13.13 NA XXX 

75756 .......... 26 ....... A Artery x-rays, chest ..................................... 1.14 0.47 0.47 0.04 1.65 1.65 XXX 

75756 .......... TC ...... A Artery x-rays, chest ..................................... 0.00 10.82 NA 0.65 11.47 NA XXX 

75774 .......... ............ A Artery x-ray, each vessel ............................ 0.36 10.44 NA 0.67 11.47 NA ZZZ 

75774 .......... 26 ....... A Artery x-ray, each vessel ............................ 0.36 0.13 0.13 0.02 0.51 0.51 ZZZ 

75774 .......... TC ...... A Artery x-ray, each vessel ............................ 0.00 10.31 NA 0.65 10.96 NA ZZZ 

75790 .......... ............ A Visualize A-V shunt ..................................... 1.84 2.36 NA 0.17 4.38 NA XXX 

75790 .......... 26 ....... A Visualize A-V shunt ..................................... 1.84 0.63 0.63 0.09 2.56 2.56 XXX 

75790 .......... TC ...... A Visualize A-V shunt ..................................... 0.00 1.73 NA 0.08 1.81 NA XXX 

75801 .......... ............ A Lymph vessel x-ray, arm/leg ....................... 0.81 NA NA 0.37 NA NA XXX 

75801 .......... 26 ....... A Lymph vessel x-ray, arm/leg ....................... 0.81 0.28 0.28 0.08 1.17 1.17 XXX 

75801 .......... TC ...... A Lymph vessel x-ray, arm/leg ....................... 0.00 NA NA 0.29 NA NA XXX 

75803 .......... ............ A Lymph vessel x-ray,arms/legs ..................... 1.17 NA NA 0.34 NA NA XXX 

75803 .......... 26 ....... A Lymph vessel x-ray,arms/legs ..................... 1.17 0.40 0.40 0.05 1.62 1.62 XXX 

75803 .......... TC ...... A Lymph vessel x-ray,arms/legs ..................... 0.00 NA NA 0.29 NA NA XXX 

75805 .......... ............ A Lymph vessel x-ray, trunk ........................... 0.81 NA NA 0.38 NA NA XXX 

75805 .......... 26 ....... A Lymph vessel x-ray, trunk ........................... 0.81 0.28 0.28 0.05 1.14 1.14 XXX 

75805 .......... TC ...... A Lymph vessel x-ray, trunk ........................... 0.00 NA NA 0.33 NA NA XXX 

75807 .......... ............ A Lymph vessel x-ray, trunk ........................... 1.17 NA NA 0.38 NA NA XXX 

75807 .......... 26 ....... A Lymph vessel x-ray, trunk ........................... 1.17 0.40 0.40 0.05 1.63 1.63 XXX 

75807 .......... TC ...... A Lymph vessel x-ray, trunk ........................... 0.00 NA NA 0.33 NA NA XXX 

75809 .......... ............ A Nonvascular shunt, x-ray ............................ 0.47 1.26 NA 0.07 1.80 NA XXX 

75809 .......... 26 ....... A Nonvascular shunt, x-ray ............................ 0.47 0.16 0.16 0.02 0.65 0.65 XXX 

75809 .......... TC ...... A Nonvascular shunt, x-ray ............................ 0.00 1.10 NA 0.05 1.15 NA XXX 

75810 .......... ............ A Vein x-ray, spleen/liver ................................ 1.14 NA NA 0.70 NA NA XXX 

75810 .......... 26 ....... A Vein x-ray, spleen/liver ................................ 1.14 0.39 0.39 0.05 1.58 1.58 XXX 

75810 .......... TC ...... A Vein x-ray, spleen/liver ................................ 0.00 NA NA 0.65 NA NA XXX 

75820 .......... ............ A Vein x-ray, arm/leg ...................................... 0.70 1.67 NA 0.09 2.46 NA XXX 

75820 .......... 26 ....... A Vein x-ray, arm/leg ...................................... 0.70 0.24 0.24 0.03 0.97 0.97 XXX 

75820 .......... TC ...... A Vein x-ray, arm/leg ...................................... 0.00 1.43 NA 0.06 1.49 NA XXX 

75822 .......... ............ A Vein x-ray, arms/legs .................................. 1.06 2.25 NA 0.13 3.44 NA XXX 

75822 .......... 26 ....... A Vein x-ray, arms/legs .................................. 1.06 0.37 0.37 0.05 1.48 1.48 XXX 

75822 .......... TC ...... A Vein x-ray, arms/legs .................................. 0.00 1.88 NA 0.08 1.96 NA XXX 

75825 .......... ............ A Vein x-ray, trunk .......................................... 1.14 10.64 NA 0.72 12.50 NA XXX 

75825 .......... 26 ....... A Vein x-ray, trunk .......................................... 1.14 0.39 0.39 0.07 1.60 1.60 XXX 

75825 .......... TC ...... A Vein x-ray, trunk .......................................... 0.00 10.25 NA 0.65 10.90 NA XXX 

75827 .......... ............ A Vein x-ray, chest ......................................... 1.14 10.67 NA 0.70 12.51 NA XXX 

75827 .......... 26 ....... A Vein x-ray, chest ......................................... 1.14 0.39 0.39 0.05 1.58 1.58 XXX 

75827 .......... TC ...... A Vein x-ray, chest ......................................... 0.00 10.28 NA 0.65 10.93 NA XXX 

75831 .......... ............ A Vein x-ray, kidney ........................................ 1.14 10.64 NA 0.71 12.49 NA XXX 

75831 .......... 26 ....... A Vein x-ray, kidney ........................................ 1.14 0.39 0.39 0.06 1.59 1.59 XXX 

75831 .......... TC ...... A Vein x-ray, kidney ........................................ 0.00 10.25 NA 0.65 10.90 NA XXX 

75833 .......... ............ A Vein x-ray, kidneys ...................................... 1.49 10.96 NA 0.74 13.19 NA XXX 

75833 .......... 26 ....... A Vein x-ray, kidneys ...................................... 1.49 0.52 0.52 0.09 2.10 2.10 XXX 

75833 .......... TC ...... A Vein x-ray, kidneys ...................................... 0.00 10.43 NA 0.65 11.08 NA XXX 

75840 .......... ............ A Vein x-ray, adrenal gland ............................ 1.14 10.79 NA 0.72 12.66 NA XXX 

75840 .......... 26 ....... A Vein x-ray, adrenal gland ............................ 1.14 0.39 0.39 0.07 1.61 1.61 XXX 

75840 .......... TC ...... A Vein x-ray, adrenal gland ............................ 0.00 10.40 NA 0.65 11.05 NA XXX 

75842 .......... ............ A Vein x-ray, adrenal glands .......................... 1.49 10.98 NA 0.72 13.19 NA XXX 

75842 .......... 26 ....... A Vein x-ray, adrenal glands .......................... 1.49 0.51 0.51 0.07 2.07 2.07 XXX 

75842 .......... TC ...... A Vein x-ray, adrenal glands .......................... 0.00 10.47 NA 0.65 11.12 NA XXX 

75860 .......... ............ A Vein x-ray, neck .......................................... 1.14 10.70 NA 0.69 12.53 NA XXX 

75860 .......... 26 ....... A Vein x-ray, neck .......................................... 1.14 0.41 0.41 0.04 1.59 1.59 XXX 

75860 .......... TC ...... A Vein x-ray, neck .......................................... 0.00 10.29 NA 0.65 10.94 NA XXX 

75870 .......... ............ A Vein x-ray, skull ........................................... 1.14 10.60 NA 0.70 12.45 NA XXX 

75870 .......... 26 ....... A Vein x-ray, skull ........................................... 1.14 0.41 0.41 0.05 1.60 1.60 XXX 

75870 .......... TC ...... A Vein x-ray, skull ........................................... 0.00 10.20 NA 0.65 10.85 NA XXX 

75872 .......... ............ A Vein x-ray, skull ........................................... 1.14 10.61 NA 0.79 12.54 NA XXX 

75872 .......... 26 ....... A Vein x-ray, skull ........................................... 1.14 0.39 0.39 0.14 1.67 1.67 XXX 

75872 .......... TC ...... A Vein x-ray, skull ........................................... 0.00 10.22 NA 0.65 10.87 NA XXX 

75880 .......... ............ A Vein x-ray, eye socket ................................. 0.70 1.65 NA 0.09 2.44 NA XXX 

75880 .......... 26 ....... A Vein x-ray, eye socket ................................. 0.70 0.24 0.24 0.03 0.97 0.97 XXX 

75880 .......... TC ...... A Vein x-ray, eye socket ................................. 0.00 1.41 NA 0.06 1.47 NA XXX 

75885 .......... ............ A Vein x-ray, liver ........................................... 1.44 11.06 NA 0.71 13.21 NA XXX 

75885 .......... 26 ....... A Vein x-ray, liver ........................................... 1.44 0.50 0.50 0.06 2.00 2.00 XXX 

45964

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

75885 .......... TC ...... A Vein x-ray, liver ........................................... 0.00 10.56 NA 0.65 11.21 NA XXX 

75887 .......... ............ A Vein x-ray, liver ........................................... 1.44 11.75 NA 0.71 13.90 NA XXX 

75887 .......... 26 ....... A Vein x-ray, liver ........................................... 1.44 0.50 0.50 0.06 2.00 2.00 XXX 

75887 .......... TC ...... A Vein x-ray, liver ........................................... 0.00 11.25 NA 0.65 11.90 NA XXX 

75889 .......... ............ A Vein x-ray, liver ........................................... 1.14 10.77 NA 0.70 12.61 NA XXX 

75889 .......... 26 ....... A Vein x-ray, liver ........................................... 1.14 0.39 0.39 0.05 1.58 1.58 XXX 

75889 .......... TC ...... A Vein x-ray, liver ........................................... 0.00 10.38 NA 0.65 11.03 NA XXX 

75891 .......... ............ A Vein x-ray, liver ........................................... 1.14 10.56 NA 0.70 12.40 NA XXX 

75891 .......... 26 ....... A Vein x-ray, liver ........................................... 1.14 0.39 0.39 0.05 1.58 1.58 XXX 

75891 .......... TC ...... A Vein x-ray, liver ........................................... 0.00 10.17 NA 0.65 10.82 NA XXX 

75893 .......... ............ A Venous sampling by catheter ...................... 0.54 11.08 NA 0.67 12.30 NA XXX 

75893 .......... 26 ....... A Venous sampling by catheter ...................... 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

75893 .......... TC ...... A Venous sampling by catheter ...................... 0.00 10.89 NA 0.65 11.54 NA XXX 

75894 .......... ............ A X-rays, transcath therapy ............................ 1.31 NA NA 1.35 NA NA XXX 

75894 .......... 26 ....... A X-rays, transcath therapy ............................ 1.31 0.45 0.45 0.08 1.85 1.85 XXX 

75894 .......... TC ...... A X-rays, transcath therapy ............................ 0.00 NA NA 1.27 NA NA XXX 

75896 .......... ............ A X-rays, transcath therapy ............................ 1.31 NA NA 1.15 NA NA XXX 

75896 .......... 26 ....... A X-rays, transcath therapy ............................ 1.31 0.47 0.47 0.05 1.84 1.84 XXX 

75896 .......... TC ...... A X-rays, transcath therapy ............................ 0.00 NA NA 1.10 NA NA XXX 

75898 .......... ............ A Follow-up angiography ................................ 1.65 NA NA 0.13 NA NA XXX 

75898 .......... 26 ....... A Follow-up angiography ................................ 1.65 0.58 0.58 0.07 2.30 2.30 XXX 

75898 .......... TC ...... A Follow-up angiography ................................ 0.00 NA NA 0.06 NA NA XXX 

75900 .......... ............ A Arterial catheter exchange .......................... 0.49 NA NA 1.14 NA NA XXX 

75900 .......... 26 ....... A Arterial catheter exchange .......................... 0.49 0.17 0.17 0.03 0.69 0.69 XXX 

75900 .......... TC ...... A Arterial catheter exchange .......................... 0.00 NA NA 1.11 NA NA XXX 

75901 .......... ............ A Remove cva device obstruct ....................... 0.49 2.30 NA 0.85 3.64 NA XXX 

75901 .......... 26 ....... A Remove cva device obstruct ....................... 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

75901 .......... TC ...... A Remove cva device obstruct ....................... 0.00 2.13 NA 0.83 2.96 NA XXX 

75902 .......... ............ A Remove cva lumen obstruct ....................... 0.39 1.56 NA 0.85 2.80 NA XXX 

75902 .......... 26 ....... A Remove cva lumen obstruct ....................... 0.39 0.14 0.14 0.02 0.55 0.55 XXX 

75902 .......... TC ...... A Remove cva lumen obstruct ....................... 0.00 1.43 NA 0.83 2.26 NA XXX 

75940 .......... ............ A X-ray placement, vein filter ......................... 0.54 NA NA 0.69 NA NA XXX 

75940 .......... 26 ....... A X-ray placement, vein filter ......................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX 

75940 .......... TC ...... A X-ray placement, vein filter ......................... 0.00 NA NA 0.65 NA NA XXX 

75945 .......... ............ A Intravascular us ........................................... 0.40 NA NA 0.28 NA NA XXX 

75945 .......... 26 ....... A Intravascular us ........................................... 0.40 0.14 0.14 0.04 0.58 0.58 XXX 

75945 .......... TC ...... A Intravascular us ........................................... 0.00 NA NA 0.24 NA NA XXX 

75946 .......... ............ A Intravascular us add-on ............................... 0.40 NA NA 0.18 NA NA ZZZ 

75946 .......... 26 ....... A Intravascular us add-on ............................... 0.40 0.14 0.14 0.05 0.59 0.59 ZZZ 

75946 .......... TC ...... A Intravascular us add-on ............................... 0.00 NA NA 0.13 NA NA ZZZ 

75952 .......... ............ C Endovasc repair abdom aorta ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75952 .......... 26 ....... A Endovasc repair abdom aorta ..................... 4.50 1.51 1.51 0.43 6.44 6.44 XXX 

75952 .......... TC ...... C Endovasc repair abdom aorta ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75953 .......... ............ C Abdom aneurysm endovas rpr .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75953 .......... 26 ....... A Abdom aneurysm endovas rpr .................... 1.36 0.46 0.46 0.13 1.95 1.95 XXX 

75953 .......... TC ...... C Abdom aneurysm endovas rpr .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75954 .......... ............ C Iliac aneurysm endovas rpr ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75954 .......... 26 ....... A Iliac aneurysm endovas rpr ......................... 2.25 0.81 0.81 0.15 3.22 3.22 XXX 

75954 .......... TC ...... C Iliac aneurysm endovas rpr ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75960 .......... ............ A Transcath iv stent rs&i ................................ 0.82 NA NA 0.82 NA NA XXX 

75960 .......... 26 ....... A Transcath iv stent rs&i ................................ 0.82 0.30 0.30 0.05 1.17 1.17 XXX 

75960 .......... TC ...... A Transcath iv stent rs&i ................................ 0.00 NA NA 0.77 NA NA XXX 

75961 .......... ............ A Retrieval, broken catheter ........................... 4.25 10.29 NA 0.73 15.27 NA XXX 

75961 .......... 26 ....... A Retrieval, broken catheter ........................... 4.25 1.47 1.47 0.18 5.90 5.90 XXX 

75961 .......... TC ...... A Retrieval, broken catheter ........................... 0.00 8.82 NA 0.55 9.37 NA XXX 

75962 .......... ............ A Repair arterial blockage .............................. 0.54 13.03 NA 0.86 14.43 NA XXX 

75962 .......... 26 ....... A Repair arterial blockage .............................. 0.54 0.19 0.19 0.03 0.76 0.76 XXX 

75962 .......... TC ...... A Repair arterial blockage .............................. 0.00 12.84 NA 0.83 13.67 NA XXX 

75964 .......... ............ A Repair artery blockage, each ...................... 0.36 7.07 NA 0.46 7.89 NA ZZZ 

75964 .......... 26 ....... A Repair artery blockage, each ...................... 0.36 0.13 0.13 0.03 0.52 0.52 ZZZ 

75964 .......... TC ...... A Repair artery blockage, each ...................... 0.00 6.94 NA 0.43 7.37 NA ZZZ 

75966 .......... ............ A Repair arterial blockage .............................. 1.31 13.24 NA 0.89 15.44 NA XXX 

75966 .......... 26 ....... A Repair arterial blockage .............................. 1.31 0.48 0.48 0.06 1.86 1.86 XXX 

75966 .......... TC ...... A Repair arterial blockage .............................. 0.00 12.75 NA 0.83 13.58 NA XXX 

75968 .......... ............ A Repair artery blockage, each ...................... 0.36 7.01 NA 0.45 7.82 NA ZZZ 

75968 .......... 26 ....... A Repair artery blockage, each ...................... 0.36 0.14 0.14 0.02 0.52 0.52 ZZZ 

75968 .......... TC ...... A Repair artery blockage, each ...................... 0.00 6.87 NA 0.43 7.30 NA ZZZ 

75970 .......... ............ A Vascular biopsy ........................................... 0.83 NA NA 0.64 NA NA XXX 

75970 .......... 26 ....... A Vascular biopsy ........................................... 0.83 0.30 0.30 0.04 1.17 1.17 XXX 

75970 .......... TC ...... A Vascular biopsy ........................................... 0.00 NA NA 0.60 NA NA XXX 

75978 .......... ............ A Repair venous blockage .............................. 0.54 13.02 NA 0.85 14.41 NA XXX 

75978 .......... 26 ....... A Repair venous blockage .............................. 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

75978 .......... TC ...... A Repair venous blockage .............................. 0.00 12.83 NA 0.83 13.66 NA XXX 

75980 .......... ............ A Contrast xray exam bile duct ...................... 1.44 NA NA 0.35 NA NA XXX 

45965

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

75980 .......... 26 ....... A Contrast xray exam bile duct ...................... 1.44 0.50 0.50 0.06 2.00 2.00 XXX 

75980 .......... TC ...... A Contrast xray exam bile duct ...................... 0.00 NA NA 0.29 NA NA XXX 

75982 .......... ............ A Contrast xray exam bile duct ...................... 1.44 NA NA 0.39 NA NA XXX 

75982 .......... 26 ....... A Contrast xray exam bile duct ...................... 1.44 0.50 0.50 0.06 2.00 2.00 XXX 

75982 .......... TC ...... A Contrast xray exam bile duct ...................... 0.00 NA NA 0.33 NA NA XXX 

75984 .......... ............ A Xray control catheter change ...................... 0.72 2.31 NA 0.14 3.18 NA XXX 

75984 .......... 26 ....... A Xray control catheter change ...................... 0.72 0.25 0.25 0.03 1.00 1.00 XXX 

75984 .......... TC ...... A Xray control catheter change ...................... 0.00 2.07 NA 0.11 2.18 NA XXX 

75989 .......... ............ A Abscess drainage under x-ray .................... 1.19 3.31 NA 0.22 4.72 NA XXX 

75989 .......... 26 ....... A Abscess drainage under x-ray .................... 1.19 0.41 0.41 0.05 1.65 1.65 XXX 

75989 .......... TC ...... A Abscess drainage under x-ray .................... 0.00 2.90 NA 0.17 3.07 NA XXX 

75992 .......... ............ A Atherectomy, x-ray exam ............................ 0.54 NA NA 0.86 NA NA XXX 

75992 .......... 26 ....... A Atherectomy, x-ray exam ............................ 0.54 0.20 0.20 0.03 0.77 0.77 XXX 

75992 .......... TC ...... A Atherectomy, x-ray exam ............................ 0.00 NA NA 0.83 NA NA XXX 

75993 .......... ............ A Atherectomy, x-ray exam ............................ 0.36 NA NA 0.45 NA NA ZZZ 

75993 .......... 26 ....... A Atherectomy, x-ray exam ............................ 0.36 0.14 0.14 0.02 0.52 0.52 ZZZ 

75993 .......... TC ...... A Atherectomy, x-ray exam ............................ 0.00 NA NA 0.43 NA NA ZZZ 

75994 .......... ............ A Atherectomy, x-ray exam ............................ 1.31 NA NA 0.90 NA NA XXX 

75994 .......... 26 ....... A Atherectomy, x-ray exam ............................ 1.31 0.48 0.48 0.07 1.86 1.86 XXX 

75994 .......... TC ...... A Atherectomy, x-ray exam ............................ 0.00 NA NA 0.83 NA NA XXX 

75995 .......... ............ A Atherectomy, x-ray exam ............................ 1.31 NA NA 0.88 NA NA XXX 

75995 .......... 26 ....... A Atherectomy, x-ray exam ............................ 1.31 0.50 0.50 0.05 1.86 1.86 XXX 

75995 .......... TC ...... A Atherectomy, x-ray exam ............................ 0.00 NA NA 0.83 NA NA XXX 

75996 .......... ............ A Atherectomy, x-ray exam ............................ 0.36 NA NA 0.45 NA NA ZZZ 

75996 .......... 26 ....... A Atherectomy, x-ray exam ............................ 0.36 0.12 0.12 0.02 0.50 0.50 ZZZ 

75996 .......... TC ...... A Atherectomy, x-ray exam ............................ 0.00 NA NA 0.43 NA NA ZZZ 

75998 .......... ............ A Fluoroguide for vein device ......................... 0.38 1.88 NA 0.11 2.37 NA ZZZ 

75998 .......... 26 ....... A Fluoroguide for vein device ......................... 0.38 0.14 0.14 0.01 0.53 0.53 ZZZ 

75998 .......... TC ...... A Fluoroguide for vein device ......................... 0.00 1.75 NA 0.10 1.85 NA ZZZ 

76000 .......... ............ A Fluoroscope examination ............................ 0.17 1.78 NA 0.08 2.03 NA XXX 

76000 .......... 26 ....... A Fluoroscope examination ............................ 0.17 0.05 0.05 0.01 0.23 0.23 XXX 

76000 .......... TC ...... A Fluoroscope examination ............................ 0.00 1.72 NA 0.07 1.79 NA XXX 

76001 .......... ............ A Fluoroscope exam, extensive ..................... 0.67 NA NA 0.19 NA NA XXX 

76001 .......... 26 ....... A Fluoroscope exam, extensive ..................... 0.67 0.23 0.23 0.05 0.95 0.95 XXX 

76001 .......... TC ...... A Fluoroscope exam, extensive ..................... 0.00 NA NA 0.14 NA NA XXX 

76003 .......... ............ A Needle localization by x-ray ........................ 0.54 1.47 NA 0.09 2.10 NA XXX 

76003 .......... 26 ....... A Needle localization by x-ray ........................ 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

76003 .......... TC ...... A Needle localization by x-ray ........................ 0.00 1.30 NA 0.07 1.37 NA XXX 

76005 .......... ............ A Fluoroguide for spine inject ......................... 0.60 1.34 NA 0.10 2.04 NA XXX 

76005 .......... 26 ....... A Fluoroguide for spine inject ......................... 0.60 0.15 0.15 0.03 0.78 0.78 XXX 

76005 .......... TC ...... A Fluoroguide for spine inject ......................... 0.00 1.19 NA 0.07 1.26 NA XXX 

76006 .......... ............ A X-ray stress view ......................................... 0.41 0.32 0.17 0.06 0.79 0.64 XXX 

76010 .......... ............ A X-ray, nose to rectum .................................. 0.18 0.58 NA 0.03 0.79 NA XXX 

76010 .......... 26 ....... A X-ray, nose to rectum .................................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

76010 .......... TC ...... A X-ray, nose to rectum .................................. 0.00 0.52 NA 0.02 0.54 NA XXX 

76012 .......... ............ C Percut vertebroplasty fluor .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76012 .......... 26 ....... A Percut vertebroplasty fluor .......................... 1.31 0.49 0.49 0.10 1.90 1.90 XXX 

76012 .......... TC ...... C Percut vertebroplasty fluor .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76013 .......... ............ C Percut vertebroplasty, ct ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76013 .......... 26 ....... A Percut vertebroplasty, ct ............................. 1.38 0.50 0.50 0.07 1.96 1.96 XXX 

76013 .......... TC ...... C Percut vertebroplasty, ct ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76020 .......... ............ A X-rays for bone age .................................... 0.19 0.55 NA 0.03 0.77 NA XXX 

76020 .......... 26 ....... A X-rays for bone age .................................... 0.19 0.06 0.06 0.01 0.26 0.26 XXX 

76020 .......... TC ...... A X-rays for bone age .................................... 0.00 0.49 NA 0.02 0.51 NA XXX 

76040 .......... ............ A X-rays, bone evaluation .............................. 0.27 0.82 NA 0.06 1.15 NA XXX 

76040 .......... 26 ....... A X-rays, bone evaluation .............................. 0.27 0.09 0.09 0.01 0.37 0.37 XXX 

76040 .......... TC ...... A X-rays, bone evaluation .............................. 0.00 0.73 NA 0.05 0.78 NA XXX 

76061 .......... ............ A X-rays, bone survey .................................... 0.45 1.31 NA 0.08 1.84 NA XXX 

76061 .......... 26 ....... A X-rays, bone survey .................................... 0.45 0.16 0.16 0.02 0.63 0.63 XXX 

76061 .......... TC ...... A X-rays, bone survey .................................... 0.00 1.15 NA 0.06 1.21 NA XXX 

76062 .......... ............ A X-rays, bone survey .................................... 0.54 1.93 NA 0.10 2.57 NA XXX 

76062 .......... 26 ....... A X-rays, bone survey .................................... 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

76062 .......... TC ...... A X-rays, bone survey .................................... 0.00 1.74 NA 0.08 1.82 NA XXX 

76065 .......... ............ A X-rays, bone evaluation .............................. 0.70 1.27 NA 0.08 2.05 NA XXX 

76065 .......... 26 ....... A X-rays, bone evaluation .............................. 0.70 0.24 0.24 0.03 0.97 0.97 XXX 

76065 .......... TC ...... A X-rays, bone evaluation .............................. 0.00 1.03 NA 0.05 1.08 NA XXX 

76066 .......... ............ A Joint survey, single view ............................. 0.31 1.06 NA 0.08 1.45 NA XXX 

76066 .......... 26 ....... A Joint survey, single view ............................. 0.31 0.11 0.11 0.02 0.44 0.44 XXX 

76066 .......... TC ...... A Joint survey, single view ............................. 0.00 0.96 NA 0.06 1.02 NA XXX 

76070 .......... ............ A Ct bone density, axial .................................. 0.25 3.37 NA 0.17 3.79 NA XXX 

76070 .......... 26 ....... A Ct bone density, axial .................................. 0.25 0.09 0.09 0.01 0.35 0.35 XXX 

76070 .......... TC ...... A Ct bone density, axial .................................. 0.00 3.29 NA 0.16 3.45 NA XXX 

76071 .......... ............ A Ct bone density, peripheral ......................... 0.22 2.43 NA 0.06 2.71 NA XXX 

76071 .......... 26 ....... A Ct bone density, peripheral ......................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

45966

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

76071 .......... TC ...... A Ct bone density, peripheral ......................... 0.00 2.36 NA 0.05 2.41 NA XXX 

76075 .......... ............ A Dxa bone density, axial ............................... 0.30 2.58 NA 0.18 3.06 NA XXX 

76075 .......... 26 ....... A Dxa bone density, axial ............................... 0.30 0.11 0.11 0.01 0.42 0.42 XXX 

76075 .......... TC ...... A Dxa bone density, axial ............................... 0.00 2.47 NA 0.17 2.64 NA XXX 

76076 .......... ............ A Dxa bone density/peripheral ....................... 0.22 0.75 NA 0.06 1.03 NA XXX 

76076 .......... 26 ....... A Dxa bone density/peripheral ....................... 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

76076 .......... TC ...... A Dxa bone density/peripheral ....................... 0.00 0.67 NA 0.05 0.72 NA XXX 

76077 .......... ............ A Dxa bone density/v-fracture ........................ 0.17 0.71 NA 0.06 0.94 NA XXX 

76077 .......... 26 ....... A Dxa bone density/v-fracture ........................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

76077 .......... TC ...... A Dxa bone density/v-fracture ........................ 0.00 0.65 NA 0.05 0.70 NA XXX 

76078 .......... ............ A Radiographic absorptiometry ...................... 0.20 0.70 NA 0.06 0.96 NA XXX 

76078 .......... 26 ....... A Radiographic absorptiometry ...................... 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

76078 .......... TC ...... A Radiographic absorptiometry ...................... 0.00 0.63 NA 0.05 0.68 NA XXX 

76080 .......... ............ A X-ray exam of fistula ................................... 0.54 1.23 NA 0.08 1.86 NA XXX 

76080 .......... 26 ....... A X-ray exam of fistula ................................... 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

76080 .......... TC ...... A X-ray exam of fistula ................................... 0.00 1.05 NA 0.06 1.11 NA XXX 

76082 .......... ............ A Computer mammogram add-on .................. 0.06 0.39 NA 0.02 0.47 NA ZZZ 

76082 .......... 26 ....... A Computer mammogram add-on .................. 0.06 0.02 0.02 0.01 0.09 0.09 ZZZ 

76082 .......... TC ...... A Computer mammogram add-on .................. 0.00 0.37 NA 0.01 0.38 NA ZZZ 

76083 .......... ............ A Computer mammogram add-on .................. 0.06 0.39 NA 0.02 0.47 NA ZZZ 

76083 .......... 26 ....... A Computer mammogram add-on .................. 0.06 0.02 0.02 0.01 0.09 0.09 ZZZ 

76083 .......... TC ...... A Computer mammogram add-on .................. 0.00 0.37 NA 0.01 0.38 NA ZZZ 

76086 .......... ............ A X-ray of mammary duct ............................... 0.36 2.40 NA 0.16 2.92 NA XXX 

76086 .......... 26 ....... A X-ray of mammary duct ............................... 0.36 0.13 0.13 0.02 0.51 0.51 XXX 

76086 .......... TC ...... A X-ray of mammary duct ............................... 0.00 2.28 NA 0.14 2.42 NA XXX 

76088 .......... ............ A X-ray of mammary ducts ............................. 0.45 3.32 NA 0.21 3.99 NA XXX 

76088 .......... 26 ....... A X-ray of mammary ducts ............................. 0.45 0.16 0.16 0.02 0.63 0.63 XXX 

76088 .......... TC ...... A X-ray of mammary ducts ............................. 0.00 3.17 NA 0.19 3.36 NA XXX 

76090 .......... ............ A Mammogram, one breast ............................ 0.70 1.44 NA 0.09 2.23 NA XXX 

76090 .......... 26 ....... A Mammogram, one breast ............................ 0.70 0.24 0.24 0.03 0.97 0.97 XXX 

76090 .......... TC ...... A Mammogram, one breast ............................ 0.00 1.20 NA 0.06 1.26 NA XXX 

76091 .......... ............ A Mammogram, both breasts ......................... 0.87 1.82 NA 0.11 2.80 NA XXX 

76091 .......... 26 ....... A Mammogram, both breasts ......................... 0.87 0.30 0.30 0.04 1.21 1.21 XXX 

76091 .......... TC ...... A Mammogram, both breasts ......................... 0.00 1.52 NA 0.07 1.59 NA XXX 

76092 .......... ............ A Mammogram, screening .............................. 0.70 1.51 NA 0.10 2.31 NA XXX 

76092 .......... 26 ....... A Mammogram, screening .............................. 0.70 0.24 0.24 0.03 0.97 0.97 XXX 

76092 .......... TC ...... A Mammogram, screening .............................. 0.00 1.27 NA 0.07 1.34 NA XXX 

76093 .......... ............ A Magnetic image, breast ............................... 1.63 18.79 NA 0.99 21.41 NA XXX 

76093 .......... 26 ....... A Magnetic image, breast ............................... 1.63 0.56 0.56 0.07 2.26 2.26 XXX 

76093 .......... TC ...... A Magnetic image, breast ............................... 0.00 18.23 NA 0.92 19.15 NA XXX 

76094 .......... ............ A Magnetic image, both breasts ..................... 1.63 23.36 NA 1.31 26.31 NA XXX 

76094 .......... 26 ....... A Magnetic image, both breasts ..................... 1.63 0.56 0.56 0.07 2.26 2.26 XXX 

76094 .......... TC ...... A Magnetic image, both breasts ..................... 0.00 22.81 NA 1.24 24.05 NA XXX 

76095 .......... ............ A Stereotactic breast biopsy ........................... 1.59 6.38 NA 0.46 8.43 NA XXX 

76095 .......... 26 ....... A Stereotactic breast biopsy ........................... 1.59 0.54 0.54 0.09 2.22 2.22 XXX 

76095 .......... TC ...... A Stereotactic breast biopsy ........................... 0.00 5.84 NA 0.37 6.21 NA XXX 

76096 .......... ............ A X-ray of needle wire, breast ........................ 0.56 1.37 NA 0.09 2.02 NA XXX 

76096 .......... 26 ....... A X-ray of needle wire, breast ........................ 0.56 0.19 0.19 0.02 0.77 0.77 XXX 

76096 .......... TC ...... A X-ray of needle wire, breast ........................ 0.00 1.17 NA 0.07 1.24 NA XXX 

76098 .......... ............ A X-ray exam, breast specimen ..................... 0.16 0.46 NA 0.03 0.65 NA XXX 

76098 .......... 26 ....... A X-ray exam, breast specimen ..................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

76098 .......... TC ...... A X-ray exam, breast specimen ..................... 0.00 0.40 NA 0.02 0.42 NA XXX 

76100 .......... ............ A X-ray exam of body section ........................ 0.58 2.02 NA 0.10 2.70 NA XXX 

76100 .......... 26 ....... A X-ray exam of body section ........................ 0.58 0.20 0.20 0.03 0.81 0.81 XXX 

76100 .......... TC ...... A X-ray exam of body section ........................ 0.00 1.82 NA 0.07 1.89 NA XXX 

76101 .......... ............ A Complex body section x-ray ........................ 0.58 2.53 NA 0.11 3.22 NA XXX 

76101 .......... 26 ....... A Complex body section x-ray ........................ 0.58 0.20 0.20 0.03 0.81 0.81 XXX 

76101 .......... TC ...... A Complex body section x-ray ........................ 0.00 2.32 NA 0.08 2.40 NA XXX 

76102 .......... ............ A Complex body section x-rays ...................... 0.58 3.39 NA 0.14 4.11 NA XXX 

76102 .......... 26 ....... A Complex body section x-rays ...................... 0.58 0.20 0.20 0.03 0.81 0.81 XXX 

76102 .......... TC ...... A Complex body section x-rays ...................... 0.00 3.19 NA 0.11 3.30 NA XXX 

76120 .......... ............ A Cine/video x-rays ......................................... 0.38 1.78 NA 0.08 2.24 NA XXX 

76120 .......... 26 ....... A Cine/video x-rays ......................................... 0.38 0.14 0.14 0.02 0.54 0.54 XXX 

76120 .......... TC ...... A Cine/video x-rays ......................................... 0.00 1.65 NA 0.06 1.71 NA XXX 

76125 .......... ............ A Cine/video x-rays add-on ............................ 0.27 NA NA 0.06 NA NA ZZZ 

76125 .......... 26 ....... A Cine/video x-rays add-on ............................ 0.27 0.10 0.10 0.01 0.38 0.38 ZZZ 

76125 .......... TC ...... A Cine/video x-rays add-on ............................ 0.00 NA NA 0.05 NA NA ZZZ 

76140 .......... ............ I X-ray consultation ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76150 .......... ............ A X-ray exam, dry process ............................. 0.00 0.45 NA 0.02 0.47 NA XXX 

76350 .......... ............ C Special x-ray contrast study ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76355 .......... ............ A Ct scan for localization ................................ 1.21 12.79 NA 0.47 14.47 NA XXX 

76355 .......... 26 ....... A Ct scan for localization ................................ 1.21 0.42 0.42 0.05 1.68 1.68 XXX 

76355 .......... TC ...... A Ct scan for localization ................................ 0.00 12.37 NA 0.42 12.79 NA XXX 

76360 .......... ............ A Ct scan for needle biopsy ........................... 1.16 7.23 NA 0.47 8.86 NA XXX 

45967

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

76360 .......... 26 ....... A Ct scan for needle biopsy ........................... 1.16 0.40 0.40 0.05 1.61 1.61 XXX 

76360 .......... TC ...... A Ct scan for needle biopsy ........................... 0.00 6.83 NA 0.42 7.25 NA XXX 

76362 .......... ............ A Ct guide for tissue ablation ......................... 4.00 NA NA 1.65 NA NA XXX 

76362 .......... 26 ....... A Ct guide for tissue ablation ......................... 4.00 1.37 1.37 0.18 5.55 5.55 XXX 

76362 .......... TC ...... A Ct guide for tissue ablation ......................... 0.00 NA NA 1.46 NA NA XXX 

76370 .......... ............ A Ct scan for therapy guide ............................ 0.85 3.57 NA 0.20 4.63 NA XXX 

76370 .......... 26 ....... A Ct scan for therapy guide ............................ 0.85 0.29 0.29 0.04 1.18 1.18 XXX 

76370 .......... TC ...... A Ct scan for therapy guide ............................ 0.00 3.28 NA 0.16 3.44 NA XXX 

76375 .......... ............ A 3d/holograph reconstr add-on ..................... 0.16 2.92 NA 0.19 3.27 NA XXX 

76375 .......... 26 ....... A 3d/holograph reconstr add-on ..................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

76375 .......... TC ...... A 3d/holograph reconstr add-on ..................... 0.00 2.87 NA 0.18 3.05 NA XXX 

76380 .......... ............ A CAT scan follow-up study ........................... 0.98 4.06 NA 0.22 5.27 NA XXX 

76380 .......... 26 ....... A CAT scan follow-up study ........................... 0.98 0.34 0.34 0.04 1.36 1.36 XXX 

76380 .......... TC ...... A CAT scan follow-up study ........................... 0.00 3.73 NA 0.18 3.91 NA XXX 

76390 .......... ............ N Mr spectroscopy .......................................... 1.40 10.86 NA 0.66 12.92 NA XXX 

76390 .......... 26 ....... N Mr spectroscopy .......................................... 1.40 0.49 0.49 0.07 1.96 1.96 XXX 

76390 .......... TC ...... N Mr spectroscopy .......................................... 0.00 10.37 NA 0.59 10.96 NA XXX 

76393 .......... ............ A Mr guidance for needle place ..................... 1.50 11.11 NA 0.64 13.25 NA XXX 

76393 .......... 26 ....... A Mr guidance for needle place ..................... 1.50 0.52 0.52 0.09 2.11 2.11 XXX 

76393 .......... TC ...... A Mr guidance for needle place ..................... 0.00 10.59 NA 0.55 11.14 NA XXX 

76394 .......... ............ A Mri for tissue ablation .................................. 4.25 NA NA 1.81 NA NA XXX 

76394 .......... 26 ....... A Mri for tissue ablation .................................. 4.25 1.45 1.45 0.24 5.94 5.94 XXX 

76394 .......... TC ...... A Mri for tissue ablation .................................. 0.00 NA NA 1.57 NA NA XXX 

76400 .......... ............ A Magnetic image, bone marrow .................... 1.60 12.18 NA 0.66 14.45 NA XXX 

76400 .......... 26 ....... A Magnetic image, bone marrow .................... 1.60 0.55 0.55 0.07 2.22 2.22 XXX 

76400 .......... TC ...... A Magnetic image, bone marrow .................... 0.00 11.63 NA 0.59 12.22 NA XXX 

76496 .......... ............ C Fluoroscopic procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76496 .......... 26 ....... C Fluoroscopic procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76496 .......... TC ...... C Fluoroscopic procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76497 .......... ............ C Ct procedure ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76497 .......... 26 ....... C Ct procedure ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76497 .......... TC ...... C Ct procedure ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76498 .......... ............ C Mri procedure .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76498 .......... 26 ....... C Mri procedure .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76498 .......... TC ...... C Mri procedure .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76499 .......... ............ C Radiographic procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76499 .......... 26 ....... C Radiographic procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76499 .......... TC ...... C Radiographic procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76506 .......... ............ A Echo exam of head ..................................... 0.63 1.95 NA 0.14 2.72 NA XXX 

76506 .......... 26 ....... A Echo exam of head ..................................... 0.63 0.24 0.24 0.06 0.93 0.93 XXX 

76506 .......... TC ...... A Echo exam of head ..................................... 0.00 1.71 NA 0.08 1.79 NA XXX 

76510 .......... ............ A Ophth us, b & quant a ................................. 1.55 2.73 NA 0.10 4.38 NA XXX 

76510 .......... 26 ....... A Ophth us, b & quant a ................................. 1.55 0.67 0.67 0.03 2.25 2.25 XXX 

76510 .......... TC ...... A Ophth us, b & quant a ................................. 0.00 2.06 NA 0.07 2.13 NA XXX 

76511 .......... ............ A Ophth us, quant a only ................................ 0.94 2.24 NA 0.10 3.28 NA XXX 

76511 .......... 26 ....... A Ophth us, quant a only ................................ 0.94 0.40 0.40 0.03 1.37 1.37 XXX 

76511 .......... TC ...... A Ophth us, quant a only ................................ 0.00 1.85 NA 0.07 1.92 NA XXX 

76512 .......... ............ A Ophth us, b w/non-quant a ......................... 0.94 2.05 NA 0.12 3.11 NA XXX 

76512 .......... 26 ....... A Ophth us, b w/non-quant a ......................... 0.94 0.41 0.41 0.02 1.37 1.37 XXX 

76512 .......... TC ...... A Ophth us, b w/non-quant a ......................... 0.00 1.64 NA 0.10 1.74 NA XXX 

76513 .......... ............ A Echo exam of eye, water bath .................... 0.66 1.73 NA 0.12 2.51 NA XXX 

76513 .......... 26 ....... A Echo exam of eye, water bath .................... 0.66 0.28 0.28 0.02 0.96 0.96 XXX 

76513 .......... TC ...... A Echo exam of eye, water bath .................... 0.00 1.45 NA 0.10 1.55 NA XXX 

76514 .......... ............ A Echo exam of eye, thickness ...................... 0.17 0.13 NA 0.02 0.32 NA XXX 

76514 .......... 26 ....... A Echo exam of eye, thickness ...................... 0.17 0.08 0.08 0.01 0.26 0.26 XXX 

76514 .......... TC ...... A Echo exam of eye, thickness ...................... 0.00 0.05 NA 0.01 0.06 NA XXX 

76516 .......... ............ A Echo exam of eye ....................................... 0.54 1.39 NA 0.08 2.01 NA XXX 

76516 .......... 26 ....... A Echo exam of eye ....................................... 0.54 0.24 0.24 0.01 0.79 0.79 XXX 

76516 .......... TC ...... A Echo exam of eye ....................................... 0.00 1.16 NA 0.07 1.23 NA XXX 

76519 .......... ............ A Echo exam of eye ....................................... 0.54 1.48 NA 0.08 2.10 NA XXX 

76519 .......... 26 ....... A Echo exam of eye ....................................... 0.54 0.24 0.24 0.01 0.79 0.79 XXX 

76519 .......... TC ...... A Echo exam of eye ....................................... 0.00 1.25 NA 0.07 1.32 NA XXX 

76529 .......... ............ A Echo exam of eye ....................................... 0.57 1.33 NA 0.10 2.00 NA XXX 

76529 .......... 26 ....... A Echo exam of eye ....................................... 0.57 0.24 0.24 0.02 0.83 0.83 XXX 

76529 .......... TC ...... A Echo exam of eye ....................................... 0.00 1.09 NA 0.08 1.17 NA XXX 

76536 .......... ............ A Us exam of head and neck ......................... 0.56 1.90 NA 0.10 2.56 NA XXX 

76536 .......... 26 ....... A Us exam of head and neck ......................... 0.56 0.19 0.19 0.02 0.77 0.77 XXX 

76536 .......... TC ...... A Us exam of head and neck ......................... 0.00 1.71 NA 0.08 1.79 NA XXX 

76604 .......... ............ A Us exam, chest, b-scan .............................. 0.55 1.66 NA 0.09 2.30 NA XXX 

76604 .......... 26 ....... A Us exam, chest, b-scan .............................. 0.55 0.19 0.19 0.02 0.76 0.76 XXX 

76604 .......... TC ...... A Us exam, chest, b-scan .............................. 0.00 1.47 NA 0.07 1.54 NA XXX 

76645 .......... ............ A Us exam, breast(s) ...................................... 0.54 1.47 NA 0.08 2.09 NA XXX 

76645 .......... 26 ....... A Us exam, breast(s) ...................................... 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

76645 .......... TC ...... A Us exam, breast(s) ...................................... 0.00 1.29 NA 0.06 1.35 NA XXX 

45968

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

76700 .......... ............ A Us exam, abdom, complete ........................ 0.81 2.52 NA 0.15 3.48 NA XXX 

76700 .......... 26 ....... A Us exam, abdom, complete ........................ 0.81 0.28 0.28 0.04 1.13 1.13 XXX 

76700 .......... TC ...... A Us exam, abdom, complete ........................ 0.00 2.24 NA 0.11 2.35 NA XXX 

76705 .......... ............ A Echo exam of abdomen .............................. 0.59 1.91 NA 0.11 2.61 NA XXX 

76705 .......... 26 ....... A Echo exam of abdomen .............................. 0.59 0.20 0.20 0.03 0.82 0.82 XXX 

76705 .......... TC ...... A Echo exam of abdomen .............................. 0.00 1.71 NA 0.08 1.79 NA XXX 

76770 .......... ............ A Us exam abdo back wall, comp .................. 0.74 2.52 NA 0.14 3.40 NA XXX 

76770 .......... 26 ....... A Us exam abdo back wall, comp .................. 0.74 0.25 0.25 0.03 1.02 1.02 XXX 

76770 .......... TC ...... A Us exam abdo back wall, comp .................. 0.00 2.27 NA 0.11 2.38 NA XXX 

76775 .......... ............ A Us exam abdo back wall, lim ...................... 0.58 1.89 NA 0.11 2.58 NA XXX 

76775 .......... 26 ....... A Us exam abdo back wall, lim ...................... 0.58 0.20 0.20 0.03 0.81 0.81 XXX 

76775 .......... TC ...... A Us exam abdo back wall, lim ...................... 0.00 1.69 NA 0.08 1.77 NA XXX 

76778 .......... ............ A Us exam kidney transplant .......................... 0.74 2.52 NA 0.14 3.40 NA XXX 

76778 .......... 26 ....... A Us exam kidney transplant .......................... 0.74 0.25 0.25 0.03 1.02 1.02 XXX 

76778 .......... TC ...... A Us exam kidney transplant .......................... 0.00 2.27 NA 0.11 2.38 NA XXX 

76800 .......... ............ A Us exam, spinal canal ................................. 1.13 1.98 NA 0.13 3.24 NA XXX 

76800 .......... 26 ....... A Us exam, spinal canal ................................. 1.13 0.34 0.34 0.05 1.52 1.52 XXX 

76800 .......... TC ...... A Us exam, spinal canal ................................. 0.00 1.64 NA 0.08 1.72 NA XXX 

76801 .......... ............ A Ob us < 14 wks, single fetus ...................... 0.99 2.44 NA 0.16 3.59 NA XXX 

76801 .......... 26 ....... A Ob us < 14 wks, single fetus ...................... 0.99 0.35 0.35 0.04 1.38 1.38 XXX 

76801 .......... TC ...... A Ob us < 14 wks, single fetus ...................... 0.00 2.09 NA 0.12 2.21 NA XXX 

76802 .......... ............ A Ob us < 14 wks, add’l fetus ........................ 0.83 1.26 NA 0.16 2.25 NA ZZZ 

76802 .......... 26 ....... A Ob us < 14 wks, add’l fetus ........................ 0.83 0.30 0.30 0.04 1.17 1.17 ZZZ 

76802 .......... TC ...... A Ob us < 14 wks, add’l fetus ........................ 0.00 0.96 NA 0.12 1.08 NA ZZZ 

76805 .......... ............ A Ob us >/= 14 wks, sngl fetus ...................... 0.99 2.57 NA 0.16 3.72 NA XXX 

76805 .......... 26 ....... A Ob us >/= 14 wks, sngl fetus ...................... 0.99 0.35 0.35 0.04 1.38 1.38 XXX 

76805 .......... TC ...... A Ob us >/= 14 wks, sngl fetus ...................... 0.00 2.22 NA 0.12 2.34 NA XXX 

76810 .......... ............ A Ob us >/= 14 wks, addl fetus ...................... 0.98 1.46 NA 0.26 2.70 NA ZZZ 

76810 .......... 26 ....... A Ob us >/= 14 wks, addl fetus ...................... 0.98 0.35 0.35 0.04 1.37 1.37 ZZZ 

76810 .......... TC ...... A Ob us >/= 14 wks, addl fetus ...................... 0.00 1.11 NA 0.22 1.33 NA ZZZ 

76811 .......... ............ A Ob us, detailed, sngl fetus .......................... 1.90 3.92 NA 0.52 6.34 NA XXX 

76811 .......... 26 ....... A Ob us, detailed, sngl fetus .......................... 1.90 0.71 0.71 0.09 2.71 2.71 XXX 

76811 .......... TC ...... A Ob us, detailed, sngl fetus .......................... 0.00 3.21 NA 0.43 3.64 NA XXX 

76812 .......... ............ A Ob us, detailed, addl fetus .......................... 1.78 2.26 NA 0.49 4.54 NA ZZZ 

76812 .......... 26 ....... A Ob us, detailed, addl fetus .......................... 1.78 0.66 0.66 0.08 2.53 2.53 ZZZ 

76812 .......... TC ...... A Ob us, detailed, addl fetus .......................... 0.00 1.60 NA 0.41 2.01 NA ZZZ 

76815 .......... ............ A Ob us, limited, fetus(s) ................................ 0.65 1.67 NA 0.11 2.43 NA XXX 

76815 .......... 26 ....... A Ob us, limited, fetus(s) ................................ 0.65 0.23 0.23 0.03 0.91 0.91 XXX 

76815 .......... TC ...... A Ob us, limited, fetus(s) ................................ 0.00 1.44 NA 0.08 1.52 NA XXX 

76816 .......... ............ A Ob us, follow-up, per fetus .......................... 0.85 1.64 NA 0.10 2.59 NA XXX 

76816 .......... 26 ....... A Ob us, follow-up, per fetus .......................... 0.85 0.32 0.32 0.04 1.21 1.21 XXX 

76816 .......... TC ...... A Ob us, follow-up, per fetus .......................... 0.00 1.32 NA 0.06 1.38 NA XXX 

76817 .......... ............ A Transvaginal us, obstetric ........................... 0.75 1.83 NA 0.09 2.67 NA XXX 

76817 .......... 26 ....... A Transvaginal us, obstetric ........................... 0.75 0.27 0.27 0.03 1.05 1.05 XXX 

76817 .......... TC ...... A Transvaginal us, obstetric ........................... 0.00 1.56 NA 0.06 1.62 NA XXX 

76818 .......... ............ A Fetal biophys profile w/nst .......................... 1.05 2.03 NA 0.15 3.24 NA XXX 

76818 .......... 26 ....... A Fetal biophys profile w/nst .......................... 1.05 0.39 0.39 0.05 1.49 1.49 XXX 

76818 .......... TC ...... A Fetal biophys profile w/nst .......................... 0.00 1.64 NA 0.10 1.74 NA XXX 

76819 .......... ............ A Fetal biophys profil w/o nst ......................... 0.77 1.82 NA 0.13 2.73 NA XXX 

76819 .......... 26 ....... A Fetal biophys profil w/o nst ......................... 0.77 0.28 0.28 0.03 1.08 1.08 XXX 

76819 .......... TC ...... A Fetal biophys profil w/o nst ......................... 0.00 1.54 NA 0.10 1.64 NA XXX 

76820 .......... ............ A Umbilical artery echo ................................... 0.50 1.50 NA 0.15 2.15 NA XXX 

76820 .......... 26 ....... A Umbilical artery echo ................................... 0.50 0.19 0.19 0.03 0.72 0.72 XXX 

76820 .......... TC ...... A Umbilical artery echo ................................... 0.00 1.32 NA 0.12 1.44 NA XXX 

76821 .......... ............ A Middle cerebral artery echo ........................ 0.70 1.88 NA 0.15 2.73 NA XXX 

76821 .......... 26 ....... A Middle cerebral artery echo ........................ 0.70 0.26 0.26 0.03 0.99 0.99 XXX 

76821 .......... TC ...... A Middle cerebral artery echo ........................ 0.00 1.61 NA 0.12 1.73 NA XXX 

76825 .......... ............ A Echo exam of fetal heart ............................. 1.67 3.06 NA 0.18 4.91 NA XXX 

76825 .......... 26 ....... A Echo exam of fetal heart ............................. 1.67 0.60 0.60 0.07 2.34 2.34 XXX 

76825 .......... TC ...... A Echo exam of fetal heart ............................. 0.00 2.46 NA 0.11 2.57 NA XXX 

76826 .......... ............ A Echo exam of fetal heart ............................. 0.83 1.47 NA 0.08 2.38 NA XXX 

76826 .......... 26 ....... A Echo exam of fetal heart ............................. 0.83 0.29 0.29 0.03 1.15 1.15 XXX 

76826 .......... TC ...... A Echo exam of fetal heart ............................. 0.00 1.17 NA 0.05 1.22 NA XXX 

76827 .......... ............ A Echo exam of fetal heart ............................. 0.58 1.73 NA 0.14 2.45 NA XXX 

76827 .......... 26 ....... A Echo exam of fetal heart ............................. 0.58 0.21 0.21 0.02 0.81 0.81 XXX 

76827 .......... TC ...... A Echo exam of fetal heart ............................. 0.00 1.52 NA 0.12 1.64 NA XXX 

76828 .......... ............ A Echo exam of fetal heart ............................. 0.56 1.16 NA 0.11 1.84 NA XXX 

76828 .......... 26 ....... A Echo exam of fetal heart ............................. 0.56 0.22 0.22 0.03 0.81 0.81 XXX 

76828 .......... TC ...... A Echo exam of fetal heart ............................. 0.00 0.95 NA 0.08 1.03 NA XXX 

76830 .......... ............ A Transvaginal us, non-ob .............................. 0.69 2.01 NA 0.13 2.83 NA XXX 

76830 .......... 26 ....... A Transvaginal us, non-ob .............................. 0.69 0.24 0.24 0.03 0.96 0.96 XXX 

76830 .......... TC ...... A Transvaginal us, non-ob .............................. 0.00 1.77 NA 0.10 1.87 NA XXX 

76831 .......... ............ A Echo exam, uterus ...................................... 0.72 1.98 NA 0.13 2.84 NA XXX 

76831 .......... 26 ....... A Echo exam, uterus ...................................... 0.72 0.26 0.26 0.03 1.01 1.01 XXX 

45969

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

76831 .......... TC ...... A Echo exam, uterus ...................................... 0.00 1.73 NA 0.10 1.83 NA XXX 

76856 .......... ............ A Us exam, pelvic, complete .......................... 0.69 2.10 NA 0.13 2.92 NA XXX 

76856 .......... 26 ....... A Us exam, pelvic, complete .......................... 0.69 0.24 0.24 0.03 0.96 0.96 XXX 

76856 .......... TC ...... A Us exam, pelvic, complete .......................... 0.00 1.86 NA 0.10 1.96 NA XXX 

76857 .......... ............ A Us exam, pelvic, limited .............................. 0.38 2.08 NA 0.08 2.54 NA XXX 

76857 .......... 26 ....... A Us exam, pelvic, limited .............................. 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

76857 .......... TC ...... A Us exam, pelvic, limited .............................. 0.00 1.95 NA 0.06 2.01 NA XXX 

76870 .......... ............ A Us exam, scrotum ....................................... 0.64 2.12 NA 0.13 2.89 NA XXX 

76870 .......... 26 ....... A Us exam, scrotum ....................................... 0.64 0.22 0.22 0.03 0.89 0.89 XXX 

76870 .......... TC ...... A Us exam, scrotum ....................................... 0.00 1.90 NA 0.10 2.00 NA XXX 

76872 .......... ............ A Us, transrectal ............................................. 0.69 2.59 NA 0.14 3.42 NA XXX 

76872 .......... 26 ....... A Us, transrectal ............................................. 0.69 0.25 0.25 0.04 0.98 0.98 XXX 

76872 .......... TC ...... A Us, transrectal ............................................. 0.00 2.35 NA 0.10 2.45 NA XXX 

76873 .......... ............ A Echograp trans r, pros study ....................... 1.55 3.05 NA 0.25 4.85 NA XXX 

76873 .......... 26 ....... A Echograp trans r, pros study ....................... 1.55 0.55 0.55 0.09 2.19 2.19 XXX 

76873 .......... TC ...... A Echograp trans r, pros study ....................... 0.00 2.50 NA 0.16 2.66 NA XXX 

76880 .......... ............ A Us exam, extremity ..................................... 0.59 2.06 NA 0.11 2.77 NA XXX 

76880 .......... 26 ....... A Us exam, extremity ..................................... 0.59 0.20 0.20 0.03 0.82 0.82 XXX 

76880 .......... TC ...... A Us exam, extremity ..................................... 0.00 1.86 NA 0.08 1.94 NA XXX 

76885 .......... ............ A Us exam infant hips, dynamic ..................... 0.74 2.21 NA 0.13 3.09 NA XXX 

76885 .......... 26 ....... A Us exam infant hips, dynamic ..................... 0.74 0.25 0.25 0.03 1.02 1.02 XXX 

76885 .......... TC ...... A Us exam infant hips, dynamic ..................... 0.00 1.96 NA 0.10 2.06 NA XXX 

76886 .......... ............ A Us exam infant hips, static .......................... 0.62 1.82 NA 0.11 2.55 NA XXX 

76886 .......... 26 ....... A Us exam infant hips, static .......................... 0.62 0.21 0.21 0.03 0.86 0.86 XXX 

76886 .......... TC ...... A Us exam infant hips, static .......................... 0.00 1.61 NA 0.08 1.69 NA XXX 

76930 .......... ............ A Echo guide, cardiocentesis ......................... 0.67 1.69 NA 0.12 2.48 NA XXX 

76930 .......... 26 ....... A Echo guide, cardiocentesis ......................... 0.67 0.26 0.26 0.02 0.95 0.95 XXX 

76930 .......... TC ...... A Echo guide, cardiocentesis ......................... 0.00 1.43 NA 0.10 1.53 NA XXX 

76932 .......... ............ A Echo guide for heart biopsy ........................ 0.67 NA NA 0.12 NA NA XXX 

76932 .......... 26 ....... A Echo guide for heart biopsy ........................ 0.67 0.26 0.26 0.02 0.95 0.95 XXX 

76932 .......... TC ...... A Echo guide for heart biopsy ........................ 0.00 NA NA 0.10 NA NA XXX 

76936 .......... ............ A Echo guide for artery repair ........................ 1.99 6.80 NA 0.47 9.26 NA XXX 

76936 .......... 26 ....... A Echo guide for artery repair ........................ 1.99 0.68 0.68 0.13 2.81 2.81 XXX 

76936 .......... TC ...... A Echo guide for artery repair ........................ 0.00 6.11 NA 0.34 6.45 NA XXX 

76937 .......... ............ A Us guide, vascular access .......................... 0.30 0.58 NA 0.13 1.01 NA ZZZ 

76937 .......... 26 ....... A Us guide, vascular access .......................... 0.30 0.11 0.11 0.03 0.44 0.44 ZZZ 

76937 .......... TC ...... A Us guide, vascular access .......................... 0.00 0.47 NA 0.10 0.57 NA ZZZ 

76940 .......... ............ A Us guide, tissue ablation ............................. 2.00 NA NA 0.60 NA NA XXX 

76940 .......... 26 ....... A Us guide, tissue ablation ............................. 2.00 0.67 0.67 0.31 2.98 2.98 XXX 

76940 .......... TC ...... A Us guide, tissue ablation ............................. 0.00 NA NA 0.29 NA NA XXX 

76941 .......... ............ A Echo guide for transfusion .......................... 1.34 NA NA 0.15 NA NA XXX 

76941 .......... 26 ....... A Echo guide for transfusion .......................... 1.34 0.48 0.48 0.07 1.90 1.90 XXX 

76941 .......... TC ...... A Echo guide for transfusion .......................... 0.00 NA NA 0.08 NA NA XXX 

76942 .......... ............ A Echo guide for biopsy ................................. 0.67 3.73 NA 0.13 4.53 NA XXX 

76942 .......... 26 ....... A Echo guide for biopsy ................................. 0.67 0.24 0.24 0.03 0.94 0.94 XXX 

76942 .......... TC ...... A Echo guide for biopsy ................................. 0.00 3.49 NA 0.10 3.59 NA XXX 

76945 .......... ............ A Echo guide, villus sampling ......................... 0.67 NA NA 0.11 NA NA XXX 

76945 .......... 26 ....... A Echo guide, villus sampling ......................... 0.67 0.23 0.23 0.03 0.93 0.93 XXX 

76945 .......... TC ...... A Echo guide, villus sampling ......................... 0.00 NA NA 0.08 NA NA XXX 

76946 .......... ............ A Echo guide for amniocentesis ..................... 0.38 1.36 NA 0.12 1.86 NA XXX 

76946 .......... 26 ....... A Echo guide for amniocentesis ..................... 0.38 0.14 0.14 0.02 0.54 0.54 XXX 

76946 .......... TC ...... A Echo guide for amniocentesis ..................... 0.00 1.21 NA 0.10 1.31 NA XXX 

76948 .......... ............ A Echo guide, ova aspiration .......................... 0.38 1.39 NA 0.12 1.89 NA XXX 

76948 .......... 26 ....... A Echo guide, ova aspiration .......................... 0.38 0.14 0.14 0.02 0.54 0.54 XXX 

76948 .......... TC ...... A Echo guide, ova aspiration .......................... 0.00 1.25 NA 0.10 1.35 NA XXX 

76950 .......... ............ A Echo guidance radiotherapy ....................... 0.58 1.55 NA 0.10 2.23 NA XXX 

76950 .......... 26 ....... A Echo guidance radiotherapy ....................... 0.58 0.20 0.20 0.03 0.81 0.81 XXX 

76950 .......... TC ...... A Echo guidance radiotherapy ....................... 0.00 1.35 NA 0.07 1.42 NA XXX 

76965 .......... ............ A Echo guidance radiotherapy ....................... 1.34 4.86 NA 0.37 6.57 NA XXX 

76965 .......... 26 ....... A Echo guidance radiotherapy ....................... 1.34 0.49 0.49 0.08 1.91 1.91 XXX 

76965 .......... TC ...... A Echo guidance radiotherapy ....................... 0.00 4.38 NA 0.29 4.67 NA XXX 

76970 .......... ............ A Ultrasound exam follow-up .......................... 0.40 1.43 NA 0.08 1.91 NA XXX 

76970 .......... 26 ....... A Ultrasound exam follow-up .......................... 0.40 0.14 0.14 0.02 0.56 0.56 XXX 

76970 .......... TC ...... A Ultrasound exam follow-up .......................... 0.00 1.29 NA 0.06 1.35 NA XXX 

76975 .......... ............ A GI endoscopic ultrasound ........................... 0.81 3.41 NA 0.14 4.37 NA XXX 

76975 .......... 26 ....... A GI endoscopic ultrasound ........................... 0.81 0.30 0.30 0.04 1.15 1.15 XXX 

76975 .......... TC ...... A GI endoscopic ultrasound ........................... 0.00 3.12 NA 0.10 3.22 NA XXX 

76977 .......... ............ A Us bone density measure ........................... 0.05 0.65 NA 0.06 0.76 NA XXX 

76977 .......... 26 ....... A Us bone density measure ........................... 0.05 0.02 0.02 0.01 0.08 0.08 XXX 

76977 .......... TC ...... A Us bone density measure ........................... 0.00 0.63 NA 0.05 0.68 NA XXX 

76986 .......... ............ A Ultrasound guide intraoper .......................... 1.20 NA NA 0.27 NA NA XXX 

76986 .......... 26 ....... A Ultrasound guide intraoper .......................... 1.20 0.41 0.41 0.13 1.75 1.75 XXX 

76986 .......... TC ...... A Ultrasound guide intraoper .......................... 0.00 NA NA 0.14 NA NA XXX 

76999 .......... ............ C Echo examination procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

45970

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

76999 .......... 26 ....... C Echo examination procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76999 .......... TC ...... C Echo examination procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77261 .......... ............ A Radiation therapy planning ......................... 1.39 0.53 0.52 0.07 1.99 1.98 XXX 

77262 .......... ............ A Radiation therapy planning ......................... 2.11 0.77 0.76 0.11 2.99 2.99 XXX 

77263 .......... ............ A Radiation therapy planning ......................... 3.15 1.12 1.12 0.16 4.43 4.43 XXX 

77280 .......... ............ A Set radiation therapy field ........................... 0.70 3.85 NA 0.22 4.77 NA XXX 

77280 .......... 26 ....... A Set radiation therapy field ........................... 0.70 0.23 0.23 0.04 0.97 0.97 XXX 

77280 .......... TC ...... A Set radiation therapy field ........................... 0.00 3.62 NA 0.18 3.80 NA XXX 

77285 .......... ............ A Set radiation therapy field ........................... 1.05 6.38 NA 0.35 7.78 NA XXX 

77285 .......... 26 ....... A Set radiation therapy field ........................... 1.05 0.35 0.35 0.05 1.45 1.45 XXX 

77285 .......... TC ...... A Set radiation therapy field ........................... 0.00 6.03 NA 0.30 6.33 NA XXX 

77290 .......... ............ A Set radiation therapy field ........................... 1.56 8.57 NA 0.43 10.56 NA XXX 

77290 .......... 26 ....... A Set radiation therapy field ........................... 1.56 0.52 0.52 0.08 2.16 2.16 XXX 

77290 .......... TC ...... A Set radiation therapy field ........................... 0.00 8.05 NA 0.35 8.40 NA XXX 

77295 .......... ............ A Set radiation therapy field ........................... 4.57 24.31 NA 1.72 30.60 NA XXX 

77295 .......... 26 ....... A Set radiation therapy field ........................... 4.57 1.51 1.51 0.23 6.30 6.30 XXX 

77295 .......... TC ...... A Set radiation therapy field ........................... 0.00 22.80 NA 1.48 24.28 NA XXX 

77299 .......... ............ C Radiation therapy planning ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77299 .......... 26 ....... C Radiation therapy planning ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77299 .......... TC ...... C Radiation therapy planning ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77300 .......... ............ A Radiation therapy dose plan ....................... 0.62 1.49 NA 0.10 2.21 NA XXX 

77300 .......... 26 ....... A Radiation therapy dose plan ....................... 0.62 0.21 0.21 0.03 0.86 0.86 XXX 

77300 .......... TC ...... A Radiation therapy dose plan ....................... 0.00 1.28 NA 0.07 1.35 NA XXX 

77301 .......... ............ A Radiotherapy dose plan, imrt ...................... 8.01 38.62 NA 1.89 48.51 NA XXX 

77301 .......... 26 ....... A Radiotherapy dose plan, imrt ...................... 8.01 2.66 2.66 0.40 11.06 11.06 XXX 

77301 .......... TC ...... A Radiotherapy dose plan, imrt ...................... 0.00 35.96 NA 1.48 37.44 NA XXX 

77305 .......... ............ A Teletx isodose plan simple .......................... 0.70 1.83 NA 0.15 2.68 NA XXX 

77305 .......... 26 ....... A Teletx isodose plan simple .......................... 0.70 0.24 0.24 0.04 0.98 0.98 XXX 

77305 .......... TC ...... A Teletx isodose plan simple .......................... 0.00 1.59 NA 0.11 1.70 NA XXX 

77310 .......... ............ A Teletx isodose plan intermed ...................... 1.05 2.36 NA 0.18 3.59 NA XXX 

77310 .......... 26 ....... A Teletx isodose plan intermed ...................... 1.05 0.35 0.35 0.05 1.45 1.45 XXX 

77310 .......... TC ...... A Teletx isodose plan intermed ...................... 0.00 2.01 NA 0.13 2.14 NA XXX 

77315 .......... ............ A Teletx isodose plan complex ....................... 1.56 2.97 NA 0.22 4.75 NA XXX 

77315 .......... 26 ....... A Teletx isodose plan complex ....................... 1.56 0.52 0.52 0.08 2.16 2.16 XXX 

77315 .......... TC ...... A Teletx isodose plan complex ....................... 0.00 2.45 NA 0.14 2.59 NA XXX 

7321 ............ ............ A Special teletx port plan ................................ 0.95 3.68 NA 0.26 4.89 NA XXX 

77321 .......... 26 ....... A Special teletx port plan ................................ 0.95 0.31 0.31 0.05 1.31 1.31 XXX 

77321 .......... TC ...... A Special teletx port plan ................................ 0.00 3.37 NA 0.21 3.58 NA XXX 

77326 .......... ............ A Brachytx isodose calc simp ......................... 0.93 2.90 NA 0.18 4.01 NA XXX 

77326 .......... 26 ....... A Brachytx isodose calc simp ......................... 0.93 0.31 0.31 0.05 1.29 1.29 XXX 

77326 .......... TC ...... A Brachytx isodose calc simp ......................... 0.00 2.59 NA 0.13 2.72 NA XXX 

77327 .......... ............ A Brachytx isodose calc interm ...................... 1.39 4.19 NA 0.25 5.83 NA XXX 

77327 .......... 26 ....... A Brachytx isodose calc interm ...................... 1.39 0.46 0.46 0.07 1.92 1.92 XXX 

77327 .......... TC ...... A Brachytx isodose calc interm ...................... 0.00 3.73 NA 0.18 3.91 NA XXX 

77328 .......... ............ A Brachytx isodose plan compl ...................... 2.09 5.81 NA 0.36 8.27 NA XXX 

77328 .......... 26 ....... A Brachytx isodose plan compl ...................... 2.09 0.69 0.69 0.11 2.90 2.90 XXX 

77328 .......... TC ...... A Brachytx isodose plan compl ...................... 0.00 5.12 NA 0.25 5.37 NA XXX 

77331 .......... ............ A Special radiation dosimetry ......................... 0.87 0.81 NA 0.06 1.74 NA XXX 

77331 .......... 26 ....... A Special radiation dosimetry ......................... 0.87 0.29 0.29 0.04 1.20 1.20 XXX 

77331 .......... TC ...... A Special radiation dosimetry ......................... 0.00 0.52 NA 0.02 0.54 NA XXX 

77332 .......... ............ A Radiation treatment aid(s) ........................... 0.54 1.59 NA 0.10 2.23 NA XXX 

77332 .......... 26 ....... A Radiation treatment aid(s) ........................... 0.54 0.18 0.18 0.03 0.75 0.75 XXX 

77332 .......... TC ...... A Radiation treatment aid(s) ........................... 0.00 1.41 NA 0.07 1.48 NA XXX 

77333 .......... ............ A Radiation treatment aid(s) ........................... 0.84 1.79 NA 0.15 2.78 NA XXX 

77333 .......... 26 ....... A Radiation treatment aid(s) ........................... 0.84 0.28 0.28 0.04 1.16 1.16 XXX 

77333 .......... TC ...... A Radiation treatment aid(s) ........................... 0.00 1.51 NA 0.11 1.62 NA XXX 

77334 .......... ............ A Radiation treatment aid(s) ........................... 1.24 3.55 NA 0.23 5.02 NA XXX 

77334 .......... 26 ....... A Radiation treatment aid(s) ........................... 1.24 0.41 0.41 0.06 1.71 1.71 XXX 

77334 .......... TC ...... A Radiation treatment aid(s) ........................... 0.00 3.14 NA 0.17 3.31 NA XXX 

77336 .......... ............ A Radiation physics consult ............................ 0.00 2.57 NA 0.16 2.73 NA XXX 

77370 .......... ............ A Radiation physics consult ............................ 0.00 3.45 NA 0.18 3.63 NA XXX 

77399 .......... ............ C External radiation dosimetry ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77399 .......... 26 ....... C External radiation dosimetry ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77399 .......... TC ...... C External radiation dosimetry ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77401 .......... ............ A Radiation treatment delivery ....................... 0.00 1.53 NA 0.11 1.64 NA XXX 

77402 .......... ............ A Radiation treatment delivery ....................... 0.00 2.26 NA 0.11 2.37 NA XXX 

77403 .......... ............ A Radiation treatment delivery ....................... 0.00 2.14 NA 0.11 2.25 NA XXX 

77404 .......... ............ A Radiation treatment delivery ....................... 0.00 2.26 NA 0.11 2.37 NA XXX 

77406 .......... ............ A Radiation treatment delivery ....................... 0.00 2.24 NA 0.11 2.35 NA XXX 

77407 .......... ............ A Radiation treatment delivery ....................... 0.00 2.84 NA 0.12 2.96 NA XXX 

77408 .......... ............ A Radiation treatment delivery ....................... 0.00 2.69 NA 0.12 2.81 NA XXX 

77409 .......... ............ A Radiation treatment delivery ....................... 0.00 2.81 NA 0.12 2.93 NA XXX 

77411 .......... ............ A Radiation treatment delivery ....................... 0.00 2.79 NA 0.12 2.91 NA XXX 

77412 .......... ............ A Radiation treatment delivery ....................... 0.00 3.24 NA 0.13 3.37 NA XXX 

45971

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

77413 .......... ............ A Radiation treatment delivery ....................... 0.00 3.22 NA 0.13 3.35 NA XXX 

77414 .......... ............ A Radiation treatment delivery ....................... 0.00 3.39 NA 0.13 3.52 NA XXX 

77416 .......... ............ A Radiation treatment delivery ....................... 0.00 3.36 NA 0.13 3.49 NA XXX 

77417 .......... ............ A Radiology port film(s) .................................. 0.00 0.56 NA 0.04 0.60 NA XXX 

77418 .......... ............ A Radiation tx delivery, imrt ............................ 0.00 16.71 NA 0.13 16.84 NA XXX 

77427 .......... ............ A Radiation tx management, x5 ..................... 3.32 1.16 1.09 0.17 4.65 4.58 XXX 

77431 .......... ............ A Radiation therapy management .................. 1.81 0.79 0.68 0.09 2.70 2.58 XXX 

77432 .......... ............ A Stereotactic radiation trmt ........................... 7.94 2.92 2.92 0.41 11.27 11.27 XXX 

77470 .......... ............ A Special radiation treatment ......................... 2.09 9.53 NA 0.70 12.32 NA XXX 

77470 .......... 26 ....... A Special radiation treatment ......................... 2.09 0.69 0.69 0.11 2.90 2.90 XXX 

77470 .......... TC ...... A Special radiation treatment ......................... 0.00 8.84 NA 0.59 9.43 NA XXX 

77499 .......... ............ C Radiation therapy management .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77499 .......... 26 ....... C Radiation therapy management .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77499 .......... TC ...... C Radiation therapy management .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77520 .......... ............ C Proton trmt, simple w/o comp ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77522 .......... ............ C Proton trmt, simple w/comp ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77523 .......... ............ C Proton trmt, intermediate ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77525 .......... ............ C Proton treatment, complex .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77600 .......... ............ R Hyperthermia treatment ............................... 1.56 5.57 NA 0.24 7.38 NA XXX 

77600 .......... 26 ....... R Hyperthermia treatment ............................... 1.56 0.52 0.52 0.08 2.16 2.16 XXX 

77600 .......... TC ...... R Hyperthermia treatment ............................... 0.00 5.06 NA 0.16 5.22 NA XXX 

77605 .......... ............ R Hyperthermia treatment ............................... 2.09 8.40 NA 0.38 10.87 NA XXX 

77605 .......... 26 ....... R Hyperthermia treatment ............................... 2.09 0.68 0.68 0.16 2.94 2.94 XXX 

77605 .......... TC ...... R Hyperthermia treatment ............................... 0.00 7.71 NA 0.22 7.93 NA XXX 

77610 .......... ............ R Hyperthermia treatment ............................... 1.56 7.34 NA 0.24 9.14 NA XXX 

77610 .......... 26 ....... R Hyperthermia treatment ............................... 1.56 0.53 0.53 0.08 2.17 2.17 XXX 

77610 .......... TC ...... R Hyperthermia treatment ............................... 0.00 6.81 NA 0.16 6.97 NA XXX 

77615 .......... ............ R Hyperthermia treatment ............................... 2.09 11.06 NA 0.33 13.49 NA XXX 

77615 .......... 26 ....... R Hyperthermia treatment ............................... 2.09 0.69 0.69 0.11 2.89 2.89 XXX 

77615 .......... TC ...... R Hyperthermia treatment ............................... 0.00 10.37 NA 0.22 10.59 NA XXX 

77620 .......... ............ R Hyperthermia treatment ............................... 1.56 4.94 NA 0.36 6.87 NA XXX 

77620 .......... 26 ....... R Hyperthermia treatment ............................... 1.56 0.54 0.54 0.20 2.30 2.30 XXX 

77620 .......... TC ...... R Hyperthermia treatment ............................... 0.00 4.40 NA 0.16 4.56 NA XXX 

77750 .......... ............ A Infuse radioactive materials ........................ 4.91 3.28 NA 0.32 8.51 NA 090 

77750 .......... 26 ....... A Infuse radioactive materials ........................ 4.91 1.63 1.63 0.25 6.79 6.79 090 

77750 .......... TC ...... A Infuse radioactive materials ........................ 0.00 1.65 NA 0.07 1.72 NA 090 

77761 .......... ............ A Apply intrcav radiat simple .......................... 3.81 4.43 NA 0.33 8.57 NA 090 

77761 .......... 26 ....... A Apply intrcav radiat simple .......................... 3.81 1.10 1.10 0.19 5.10 5.10 090 

77761 .......... TC ...... A Apply intrcav radiat simple .......................... 0.00 3.32 NA 0.14 3.46 NA 090 

77762 .......... ............ A Apply intrcav radiat interm .......................... 5.72 6.33 NA 0.48 12.53 NA 090 

77762 .......... 26 ....... A Apply intrcav radiat interm .......................... 5.72 1.86 1.86 0.29 7.88 7.88 090 

77762 .......... TC ...... A Apply intrcav radiat interm .......................... 0.00 4.47 NA 0.19 4.66 NA 090 

77763 .......... ............ A Apply intrcav radiat compl ........................... 8.58 8.26 NA 0.66 17.50 NA 090 

77763 .......... 26 ....... A Apply intrcav radiat compl ........................... 8.58 2.80 2.80 0.43 11.81 11.81 090 

77763 .......... TC ...... A Apply intrcav radiat compl ........................... 0.00 5.46 NA 0.23 5.69 NA 090 

77776 .......... ............ A Apply interstit radiat simpl ........................... 4.66 4.34 NA 0.57 9.57 NA 090 

77776 .......... 26 ....... A Apply interstit radiat simpl ........................... 4.66 0.94 0.94 0.44 6.04 6.04 090 

77776 .......... TC ...... A Apply interstit radiat simpl ........................... 0.00 3.40 NA 0.13 3.53 NA 090 

77777 .......... ............ A Apply interstit radiat inter ............................ 7.48 6.94 NA 0.61 15.04 NA 090 

77777 .......... 26 ....... A Apply interstit radiat inter ............................ 7.48 2.48 2.48 0.39 10.36 10.36 090 

77777 .......... TC ...... A Apply interstit radiat inter ............................ 0.00 4.45 NA 0.22 4.67 NA 090 

77778 .......... ............ A Apply interstit radiat compl .......................... 11.19 9.63 NA 0.84 21.67 NA 090 

77778 .......... 26 ....... A Apply interstit radiat compl .......................... 11.19 3.71 3.71 0.57 15.47 15.47 090 

77778 .......... TC ...... A Apply interstit radiat compl .......................... 0.00 5.92 NA 0.27 6.19 NA 090 

77781 .......... ............ A High intensity brachytherapy ....................... 1.66 16.99 NA 1.14 19.79 NA 090 

77781 .......... 26 ....... A High intensity brachytherapy ....................... 1.66 0.54 0.54 0.08 2.29 2.29 090 

77781 .......... TC ...... A High intensity brachytherapy ....................... 0.00 16.45 NA 1.06 17.51 NA 090 

77782 .......... ............ A High intensity brachytherapy ....................... 2.49 19.56 NA 1.19 23.24 NA 090 

77782 .......... 26 ....... A High intensity brachytherapy ....................... 2.49 0.82 0.82 0.13 3.45 3.45 090 

77782 .......... TC ...... A High intensity brachytherapy ....................... 0.00 18.73 NA 1.06 19.79 NA 090 

77783 .......... ............ A High intensity brachytherapy ....................... 3.73 23.47 NA 1.25 28.45 NA 090 

77783 .......... 26 ....... A High intensity brachytherapy ....................... 3.73 1.23 1.23 0.19 5.14 5.14 090 

77783 .......... TC ...... A High intensity brachytherapy ....................... 0.00 22.24 NA 1.06 23.30 NA 090 

77784 .......... ............ A High intensity brachytherapy ....................... 5.61 29.75 NA 1.35 36.71 NA 090 

77784 .......... 26 ....... A High intensity brachytherapy ....................... 5.61 1.85 1.85 0.29 7.75 7.75 090 

77784 .......... TC ...... A High intensity brachytherapy ....................... 0.00 27.90 NA 1.06 28.96 NA 090 

77789 .......... ............ A Apply surface radiation ................................ 1.12 1.18 NA 0.08 2.38 NA 000 

77789 .......... 26 ....... A Apply surface radiation ................................ 1.12 0.38 0.38 0.06 1.56 1.56 000 

77789 .......... TC ...... A Apply surface radiation ................................ 0.00 0.80 NA 0.02 0.82 NA 000 

77790 .......... ............ A Radiation handling ....................................... 1.05 1.02 NA 0.07 2.14 NA XXX 

77790 .......... 26 ....... A Radiation handling ....................................... 1.05 0.35 0.35 0.05 1.45 1.45 XXX 

77790 .......... TC ...... A Radiation handling ....................................... 0.00 0.67 NA 0.02 0.69 NA XXX 

77799 .......... ............ C Radium/radioisotope therapy ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77799 .......... 26 ....... C Radium/radioisotope therapy ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

45972

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

77799 .......... TC ...... C Radium/radioisotope therapy ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78000 .......... ............ A Thyroid, single uptake ................................. 0.19 1.18 NA 0.07 1.44 NA XXX 

78000 .......... 26 ....... A Thyroid, single uptake ................................. 0.19 0.06 0.06 0.01 0.26 0.26 XXX 

78000 .......... TC ...... A Thyroid, single uptake ................................. 0.00 1.12 NA 0.06 1.18 NA XXX 

78001 .......... ............ A Thyroid, multiple uptakes ............................ 0.26 1.60 NA 0.08 1.94 NA XXX 

78001 .......... 26 ....... A Thyroid, multiple uptakes ............................ 0.26 0.09 0.09 0.01 0.36 0.36 XXX 

001 .............. TC ...... A Thyroid, multiple uptakes ............................ 0.00 1.51 NA 0.07 1.58 NA XXX 

78003 .......... ............ A Thyroid suppress/stimul .............................. 0.33 1.31 NA 0.07 1.71 NA XXX 

78003 .......... 26 ....... A Thyroid suppress/stimul .............................. 0.33 0.12 0.12 0.01 0.46 0.46 XXX 

78003 .......... TC ...... A Thyroid suppress/stimul .............................. 0.00 1.19 NA 0.06 1.25 NA XXX 

78006 .......... ............ A Thyroid imaging with uptake ....................... 0.49 3.24 NA 0.15 3.88 NA XXX 

78006 .......... 26 ....... A Thyroid imaging with uptake ....................... 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

78006 .......... TC ...... A Thyroid imaging with uptake ....................... 0.00 3.07 NA 0.13 3.20 NA XXX 

78007 .......... ............ A Thyroid image, mult uptakes ....................... 0.50 2.88 NA 0.16 3.54 NA XXX 

78007 .......... 26 ....... A Thyroid image, mult uptakes ....................... 0.50 0.18 0.18 0.02 0.70 0.70 XXX 

78007 .......... TC ...... A Thyroid image, mult uptakes ....................... 0.00 2.70 NA 0.14 2.84 NA XXX 

78010 .......... ............ A Thyroid imaging ........................................... 0.39 2.41 NA 0.13 2.93 NA XXX 

78010 .......... 26 ....... A Thyroid imaging ........................................... 0.39 0.14 0.14 0.02 0.55 0.55 XXX 

78010 .......... TC ...... A Thyroid imaging ........................................... 0.00 2.27 NA 0.11 2.38 NA XXX 

78011 .......... ............ A Thyroid imaging with flow ............................ 0.45 2.97 NA 0.15 3.57 NA XXX 

78011 .......... 26 ....... A Thyroid imaging with flow ............................ 0.45 0.16 0.16 0.02 0.63 0.63 XXX 

78011 .......... TC ...... A Thyroid imaging with flow ............................ 0.00 2.81 NA 0.13 2.94 NA XXX 

78015 .......... ............ A Thyroid met imaging .................................... 0.67 3.19 NA 0.17 4.04 NA XXX 

78015 .......... 26 ....... A Thyroid met imaging .................................... 0.67 0.24 0.24 0.03 0.94 0.94 XXX 

78015 .......... TC ...... A Thyroid met imaging .................................... 0.00 2.95 NA 0.14 3.09 NA XXX 

78016 .......... ............ A Thyroid met imaging/studies ....................... 0.82 4.61 NA 0.21 5.64 NA XXX 

78016 .......... 26 ....... A Thyroid met imaging/studies ....................... 0.82 0.30 0.30 0.03 1.15 1.15 XXX 

78016 .......... TC ...... A Thyroid met imaging/studies ....................... 0.00 4.32 NA 0.18 4.50 NA XXX 

78018 .......... ............ A Thyroid met imaging, body .......................... 0.86 5.95 NA 0.33 7.14 NA XXX 

78018 .......... 26 ....... A Thyroid met imaging, body .......................... 0.86 0.31 0.31 0.04 1.21 1.21 XXX 

78018 .......... TC ...... A Thyroid met imaging, body .......................... 0.00 5.64 NA 0.29 5.93 NA XXX 

78020 .......... ............ A Thyroid met uptake ..................................... 0.60 1.61 NA 0.16 2.37 NA ZZZ 

78020 .......... 26 ....... A Thyroid met uptake ..................................... 0.60 0.22 0.22 0.02 0.84 0.84 ZZZ 

78020 .......... TC ...... A Thyroid met uptake ..................................... 0.00 1.39 NA 0.14 1.53 NA ZZZ 

78070 .......... ............ A Parathyroid nuclear imaging ....................... 0.82 4.32 NA 0.15 5.30 NA XXX 

78070 .......... 26 ....... A Parathyroid nuclear imaging ....................... 0.82 0.29 0.29 0.04 1.15 1.15 XXX 

78070 .......... TC ...... A Parathyroid nuclear imaging ....................... 0.00 4.03 NA 0.11 4.14 NA XXX 

78075 .......... ............ A Adrenal nuclear imaging ............................. 0.74 6.80 NA 0.32 7.87 NA XXX 

78075 .......... 26 ....... A Adrenal nuclear imaging ............................. 0.74 0.27 0.27 0.03 1.04 1.04 XXX 

78075 .......... TC ...... A Adrenal nuclear imaging ............................. 0.00 6.53 NA 0.29 6.82 NA XXX 

78099 .......... ............ C Endocrine nuclear procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78099 .......... 26 ....... C Endocrine nuclear procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78099 .......... TC ...... C Endocrine nuclear procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78102 .......... ............ A Bone marrow imaging, ltd ........................... 0.55 2.64 NA 0.14 3.33 NA XXX 

78102 .......... 26 ....... A Bone marrow imaging, ltd ........................... 0.55 0.20 0.20 0.02 0.77 0.77 XXX 

78102 .......... TC ...... A Bone marrow imaging, ltd ........................... 0.00 2.43 NA 0.12 2.55 NA XXX 

78103 .......... ............ A Bone marrow imaging, mult ........................ 0.75 3.81 NA 0.20 4.76 NA XXX 

78103 .......... 26 ....... A Bone marrow imaging, mult ........................ 0.75 0.27 0.27 0.03 1.05 1.05 XXX 

78103 .......... TC ...... A Bone marrow imaging, mult ........................ 0.00 3.54 NA 0.17 3.71 NA XXX 

78104 .......... ............ A Bone marrow imaging, body ....................... 0.80 4.58 NA 0.25 5.63 NA XXX 

78104 .......... 26 ....... A Bone marrow imaging, body ....................... 0.80 0.28 0.28 0.03 1.11 1.11 XXX 

78104 .......... TC ...... A Bone marrow imaging, body ....................... 0.00 4.29 NA 0.22 4.51 NA XXX 

78110 .......... ............ A Plasma volume, single ................................ 0.19 1.22 NA 0.07 1.48 NA XXX 

78110 .......... 26 ....... A Plasma volume, single ................................ 0.19 0.07 0.07 0.01 0.27 0.27 XXX 

78110 .......... TC ...... A Plasma volume, single ................................ 0.00 1.15 NA 0.06 1.21 NA XXX 

78111 .......... ............ A Plasma volume, multiple ............................. 0.22 2.38 NA 0.15 2.75 NA XXX 

78111 .......... 26 ....... A Plasma volume, multiple ............................. 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

78111 .......... TC ...... A Plasma volume, multiple ............................. 0.00 2.30 NA 0.14 2.44 NA XXX 

78120 .......... ............ A Red cell mass, single .................................. 0.23 1.74 NA 0.12 2.09 NA XXX 

78120 .......... 26 ....... A Red cell mass, single .................................. 0.23 0.08 0.08 0.01 0.32 0.32 XXX 

78120 .......... TC ...... A Red cell mass, single .................................. 0.00 1.65 NA 0.11 1.76 NA XXX 

78121 .......... ............ A Red cell mass, multiple ............................... 0.32 2.69 NA 0.15 3.16 NA XXX 

78121 .......... 26 ....... A Red cell mass, multiple ............................... 0.32 0.12 0.12 0.01 0.45 0.45 XXX 

78121 .......... TC ...... A Red cell mass, multiple ............................... 0.00 2.58 NA 0.14 2.72 NA XXX 

78122 .......... ............ A Blood volume ............................................... 0.45 4.15 NA 0.26 4.86 NA XXX 

78122 .......... 26 ....... A Blood volume ............................................... 0.45 0.17 0.17 0.02 0.64 0.64 XXX 

78122 .......... TC ...... A Blood volume ............................................... 0.00 3.98 NA 0.24 4.22 NA XXX 

78130 .......... ............ A Red cell survival study ................................ 0.61 2.95 NA 0.17 3.73 NA XXX 

78130 .......... 26 ....... A Red cell survival study ................................ 0.61 0.22 0.22 0.03 0.86 0.86 XXX 

78130 .......... TC ...... A Red cell survival study ................................ 0.00 2.73 NA 0.14 2.87 NA XXX 

78135 .......... ............ A Red cell survival kinetics ............................. 0.64 5.59 NA 0.28 6.51 NA XXX 

78135 .......... 26 ....... A Red cell survival kinetics ............................. 0.64 0.23 0.23 0.03 0.90 0.90 XXX 

78135 .......... TC ...... A Red cell survival kinetics ............................. 0.00 5.36 NA 0.25 5.61 NA XXX 

78140 .......... ............ A Red cell sequestration ................................. 0.61 3.79 NA 0.24 4.64 NA XXX 

45973

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

78140 .......... 26 ....... A Red cell sequestration ................................. 0.61 0.21 0.21 0.03 0.85 0.85 XXX 

78140 .......... TC ...... A Red cell sequestration ................................. 0.00 3.58 NA 0.21 3.79 NA XXX 

78160 .......... ............ A Plasma iron turnover ................................... 0.33 3.04 NA 0.23 3.60 NA XXX 

78160 .......... 26 ....... A Plasma iron turnover ................................... 0.33 0.12 0.12 0.04 0.49 0.49 XXX 

78160 .......... TC ...... A Plasma iron turnover ................................... 0.00 2.92 NA 0.19 3.11 NA XXX 

78162 .......... ............ A Radioiron absorption exam ......................... 0.45 2.73 NA 0.19 3.37 NA XXX 

78162 .......... 26 ....... A Radioiron absorption exam ......................... 0.45 0.19 0.19 0.02 0.66 0.66 XXX 

78162 .......... TC ...... A Radioiron absorption exam ......................... 0.00 2.54 NA 0.17 2.71 NA XXX 

78170 .......... ............ A Red cell iron utilization ................................ 0.41 4.36 NA 0.30 5.07 NA XXX 

78170 .......... 26 ....... A Red cell iron utilization ................................ 0.41 0.15 0.15 0.02 0.58 0.58 XXX 

78170 .......... TC ...... A Red cell iron utilization ................................ 0.00 4.22 NA 0.28 4.50 NA XXX 

78172 .......... ............ C Total body iron estimation ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78172 .......... 26 ....... A Total body iron estimation ........................... 0.53 0.18 0.18 0.02 0.73 0.73 XXX 

78172 .......... TC ...... C Total body iron estimation ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78185 .......... ............ A Spleen imaging ............................................ 0.40 2.96 NA 0.15 3.51 NA XXX 

78185 .......... 26 ....... A Spleen imaging ............................................ 0.40 0.15 0.15 0.02 0.57 0.57 XXX 

78185 .......... TC ...... A Spleen imaging ............................................ 0.00 2.81 NA 0.13 2.94 NA XXX 

78190 .......... ............ A Platelet survival, kinetics ............................. 1.09 6.43 NA 0.38 7.90 NA XXX 

78190 .......... 26 ....... A Platelet survival, kinetics ............................. 1.09 0.41 0.41 0.08 1.58 1.58 XXX 

78190 .......... TC ...... A Platelet survival, kinetics ............................. 0.00 6.02 NA 0.30 6.32 NA XXX 

78191 .......... ............ A Platelet survival ........................................... 0.61 6.53 NA 0.40 7.54 NA XXX 

78191 .......... 26 ....... A Platelet survival ........................................... 0.61 0.21 0.21 0.03 0.85 0.85 XXX 

78191 .......... TC ...... A Platelet survival ........................................... 0.00 6.32 NA 0.37 6.69 NA XXX 

78195 .......... ............ A Lymph system imaging ............................... 1.20 5.19 NA 0.28 6.68 NA XXX 

78195 .......... 26 ....... A Lymph system imaging ............................... 1.20 0.43 0.43 0.06 1.69 1.69 XXX 

78195 .......... TC ...... A Lymph system imaging ............................... 0.00 4.76 NA 0.22 4.98 NA XXX 

78199 .......... ............ C Blood/lymph nuclear exam .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78199 .......... 26 ....... C Blood/lymph nuclear exam .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78199 .......... TC ...... C Blood/lymph nuclear exam .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78201 .......... ............ A Liver imaging ............................................... 0.44 2.96 NA 0.15 3.55 NA XXX 

78201 .......... 26 ....... A Liver imaging ............................................... 0.44 0.16 0.16 0.02 0.62 0.62 XXX 

78201 .......... TC ...... A Liver imaging ............................................... 0.00 2.80 NA 0.13 2.93 NA XXX 

78202 .......... ............ A Liver imaging with flow ................................ 0.51 3.44 NA 0.16 4.11 NA XXX 

78202 .......... 26 ....... A Liver imaging with flow ................................ 0.51 0.18 0.18 0.02 0.71 0.71 XXX 

78202 .......... TC ...... A Liver imaging with flow ................................ 0.00 3.26 NA 0.14 3.40 NA XXX 

78205 .......... ............ A Liver imaging (3D) ....................................... 0.71 5.87 NA 0.34 6.92 NA XXX 

78205 .......... 26 ....... A Liver imaging (3D) ....................................... 0.71 0.25 0.25 0.03 0.99 0.99 XXX 

78205 .......... TC ...... A Liver imaging (3D) ....................................... 0.00 5.61 NA 0.31 5.92 NA XXX 

78206 .......... ............ A Liver image (3d) with flow ........................... 0.96 8.15 NA 0.15 9.26 NA XXX 

78206 .......... 26 ....... A Liver image (3d) with flow ........................... 0.96 0.34 0.34 0.04 1.35 1.35 XXX 

78206 .......... TC ...... A Liver image (3d) with flow ........................... 0.00 7.80 NA 0.11 7.91 NA XXX 

78215 .......... ............ A Liver and spleen imaging ............................ 0.49 3.48 NA 0.16 4.13 NA XXX 

78215 .......... 26 ....... A Liver and spleen imaging ............................ 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

78215 .......... TC ...... A Liver and spleen imaging ............................ 0.00 3.31 NA 0.14 3.45 NA XXX 

78216 .......... ............ A Liver & spleen image/flow ........................... 0.57 3.49 NA 0.20 4.26 NA XXX 

78216 .......... 26 ....... A Liver & spleen image/flow ........................... 0.57 0.20 0.20 0.02 0.79 0.79 XXX 

78216 .......... TC ...... A Liver & spleen image/flow ........................... 0.00 3.29 NA 0.18 3.47 NA XXX 

78220 .......... ............ A Liver function study ..................................... 0.49 3.67 NA 0.21 4.37 NA XXX 

78220 .......... 26 ....... A Liver function study ..................................... 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

78220 .......... TC ...... A Liver function study ..................................... 0.00 3.50 NA 0.19 3.69 NA XXX 

78223 .......... ............ A Hepatobiliary imaging .................................. 0.84 4.79 NA 0.23 5.86 NA XXX 

78223 .......... 26 ....... A Hepatobiliary imaging .................................. 0.84 0.29 0.29 0.04 1.17 1.17 XXX 

78223 .......... TC ...... A Hepatobiliary imaging .................................. 0.00 4.49 NA 0.19 4.68 NA XXX 

78230 .......... ............ A Salivary gland imaging ................................ 0.45 2.74 NA 0.15 3.34 NA XXX 

78230 .......... 26 ....... A Salivary gland imaging ................................ 0.45 0.15 0.15 0.02 0.62 0.62 XXX 

78230 .......... TC ...... A Salivary gland imaging ................................ 0.00 2.58 NA 0.13 2.71 NA XXX 

78231 .......... ............ A Serial salivary imaging ................................ 0.52 3.14 NA 0.19 3.85 NA XXX 

78231 .......... 26 ....... A Serial salivary imaging ................................ 0.52 0.19 0.19 0.02 0.73 0.73 XXX 

78231 .......... TC ...... A Serial salivary imaging ................................ 0.00 2.96 NA 0.17 3.13 NA XXX 

78232 .......... ............ A Salivary gland function exam ...................... 0.47 3.47 NA 0.20 4.14 NA XXX 

78232 .......... 26 ....... A Salivary gland function exam ...................... 0.47 0.17 0.17 0.02 0.66 0.66 XXX 

78232 .......... TC ...... A Salivary gland function exam ...................... 0.00 3.30 NA 0.18 3.48 NA XXX 

78258 .......... ............ A Esophageal motility study ........................... 0.74 3.70 NA 0.17 4.61 NA XXX 

78258 .......... 26 ....... A Esophageal motility study ........................... 0.74 0.26 0.26 0.03 1.03 1.03 XXX 

78258 .......... TC ...... A Esophageal motility study ........................... 0.00 3.44 NA 0.14 3.58 NA XXX 

78261 .......... ............ A Gastric mucosa imaging .............................. 0.69 4.56 NA 0.25 5.51 NA XXX 

78261 .......... 26 ....... A Gastric mucosa imaging .............................. 0.69 0.25 0.25 0.03 0.97 0.97 XXX 

78261 .......... TC ...... A Gastric mucosa imaging .............................. 0.00 4.31 NA 0.22 4.53 NA XXX 

78262 .......... ............ A Gastroesophageal reflux exam ................... 0.68 4.57 NA 0.25 5.50 NA XXX 

78262 .......... 26 ....... A Gastroesophageal reflux exam ................... 0.68 0.24 0.24 0.03 0.95 0.95 XXX 

78262 .......... TC ...... A Gastroesophageal reflux exam ................... 0.00 4.33 NA 0.22 4.55 NA XXX 

78264 .......... ............ A Gastric emptying study ................................ 0.78 4.86 NA 0.25 5.89 NA XXX 

78264 .......... 26 ....... A Gastric emptying study ................................ 0.78 0.27 0.27 0.03 1.08 1.08 XXX 

78264 .......... TC ...... A Gastric emptying study ................................ 0.00 4.59 NA 0.22 4.81 NA XXX 

45974

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

78270 .......... ............ A Vit B-12 absorption exam ............................ 0.20 1.55 NA 0.11 1.86 NA XXX 

78270 .......... 26 ....... A Vit B-12 absorption exam ............................ 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

78270 .......... TC ...... A Vit B-12 absorption exam ............................ 0.00 1.48 NA 0.10 1.58 NA XXX 

78271 .......... ............ A Vit b-12 absrp exam, int fac ........................ 0.20 1.64 NA 0.11 1.95 NA XXX 

78271 .......... 26 ....... A Vit b-12 absrp exam, int fac ........................ 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

78271 .......... TC ...... A Vit b-12 absrp exam, int fac ........................ 0.00 1.56 NA 0.10 1.66 NA XXX 

78272 .......... ............ A Vit B-12 absorp, combined .......................... 0.27 2.15 NA 0.14 2.56 NA XXX 

78272 .......... 26 ....... A Vit B-12 absorp, combined .......................... 0.27 0.10 0.10 0.01 0.38 0.38 XXX 

78272 .......... TC ...... A Vit B-12 absorp, combined .......................... 0.00 2.06 NA 0.13 2.19 NA XXX 

78278 .......... ............ A Acute GI blood loss imaging ....................... 0.99 6.10 NA 0.29 7.38 NA XXX 

78278 .......... 26 ....... A Acute GI blood loss imaging ....................... 0.99 0.35 0.35 0.04 1.38 1.38 XXX 

78278 .......... TC ...... A Acute GI blood loss imaging ....................... 0.00 5.75 NA 0.25 6.00 NA XXX 

78282 .......... ............ C GI protein loss exam ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78282 .......... 26 ....... A GI protein loss exam ................................... 0.38 0.14 0.14 0.02 0.54 0.54 XXX 

78282 .......... TC ...... C GI protein loss exam ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78290 .......... ............ A Meckel’s divert exam ................................... 0.68 4.32 NA 0.19 5.19 NA XXX 

78290 .......... 26 ....... A Meckel’s divert exam ................................... 0.68 0.24 0.24 0.03 0.95 0.95 XXX 

78290 .......... TC ...... A Meckel’s divert exam ................................... 0.00 4.08 NA 0.16 4.24 NA XXX 

78291 .......... ............ A Leveen/shunt patency exam ....................... 0.88 4.00 NA 0.20 5.08 NA XXX 

78291 .......... 26 ....... A Leveen/shunt patency exam ....................... 0.88 0.31 0.31 0.04 1.23 1.23 XXX 

78291 .......... TC ...... A Leveen/shunt patency exam ....................... 0.00 3.68 NA 0.16 3.84 NA XXX 

78299 .......... ............ C GI nuclear procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78299 .......... 26 ....... C GI nuclear procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78299 .......... TC ...... C GI nuclear procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78300 .......... ............ A Bone imaging, limited area ......................... 0.62 2.97 NA 0.17 3.76 NA XXX 

78300 .......... 26 ....... A Bone imaging, limited area ......................... 0.62 0.22 0.22 0.03 0.87 0.87 XXX 

78300 .......... TC ...... A Bone imaging, limited area ......................... 0.00 2.75 NA 0.14 2.89 NA XXX 

78305 .......... ............ A Bone imaging, multiple areas ...................... 0.83 4.16 NA 0.23 5.22 NA XXX 

78305 .......... 26 ....... A Bone imaging, multiple areas ...................... 0.83 0.29 0.29 0.04 1.16 1.16 XXX 

78305 .......... TC ...... A Bone imaging, multiple areas ...................... 0.00 3.87 NA 0.19 4.06 NA XXX 

78306 .......... ............ A Bone imaging, whole body .......................... 0.86 4.77 NA 0.26 5.89 NA XXX 

78306 .......... 26 ....... A Bone imaging, whole body .......................... 0.86 0.30 0.30 0.04 1.20 1.20 XXX 

78306 .......... TC ...... A Bone imaging, whole body .......................... 0.00 4.47 NA 0.22 4.69 NA XXX 

78315 .......... ............ A Bone imaging, 3 phase ............................... 1.02 5.69 NA 0.29 7.00 NA XXX 

78315 .......... 26 ....... A Bone imaging, 3 phase ............................... 1.02 0.36 0.36 0.04 1.42 1.42 XXX 

78315 .......... TC ...... A Bone imaging, 3 phase ............................... 0.00 5.33 NA 0.25 5.58 NA XXX 

78320 .......... ............ A Bone imaging (3D) ...................................... 1.04 5.89 NA 0.35 7.28 NA XXX 

78320 .......... 26 ....... A Bone imaging (3D) ...................................... 1.04 0.38 0.38 0.04 1.46 1.46 XXX 

78320 .......... TC ...... A Bone imaging (3D) ...................................... 0.00 5.51 NA 0.31 5.82 NA XXX 

78350 .......... ............ A Bone mineral, single photon ....................... 0.22 1.00 NA 0.06 1.28 NA XXX 

78350 .......... 26 ....... A Bone mineral, single photon ....................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

78350 .......... TC ...... A Bone mineral, single photon ....................... 0.00 0.93 NA 0.05 0.98 NA XXX 

78351 .......... ............ N Bone mineral, dual photon .......................... 0.30 1.86 0.12 0.01 2.17 0.43 XXX 

78399 .......... ............ C Musculoskeletal nuclear exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78399 .......... 26 ....... C Musculoskeletal nuclear exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78399 .......... TC ...... C Musculoskeletal nuclear exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78414 .......... ............ C Non-imaging heart function ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78414 .......... 26 ....... A Non-imaging heart function ......................... 0.45 0.17 0.17 0.02 0.64 0.64 XXX 

78414 .......... TC ...... C Non-imaging heart function ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78428 .......... ............ A Cardiac shunt imaging ................................ 0.78 3.31 NA 0.16 4.25 NA XXX 

78428 .......... 26 ....... A Cardiac shunt imaging ................................ 0.78 0.30 0.30 0.03 1.11 1.11 XXX 

78428 .......... TC ...... A Cardiac shunt imaging ................................ 0.00 3.00 NA 0.13 3.13 NA XXX 

78445 .......... ............ A Vascular flow imaging ................................. 0.49 2.74 NA 0.13 3.36 NA XXX 

78445 .......... 26 ....... A Vascular flow imaging ................................. 0.49 0.18 0.18 0.02 0.69 0.69 XXX 

78445 .......... TC ...... A Vascular flow imaging ................................. 0.00 2.57 NA 0.11 2.68 NA XXX 

78455 .......... ............ A Venous thrombosis study ............................ 0.73 4.31 NA 0.24 5.28 NA XXX 

78455 .......... 26 ....... A Venous thrombosis study ............................ 0.73 0.26 0.26 0.03 1.02 1.02 XXX 

78455 .......... TC ...... A Venous thrombosis study ............................ 0.00 4.05 NA 0.21 4.26 NA XXX 

78456 .......... ............ A Acute venous thrombus image ................... 1.00 5.25 NA 0.33 6.58 NA XXX 

78456 .......... 26 ....... A Acute venous thrombus image ................... 1.00 0.36 0.36 0.04 1.40 1.40 XXX 

78456 .......... TC ...... A Acute venous thrombus image ................... 0.00 4.89 NA 0.29 5.18 NA XXX 

78457 .......... ............ A Venous thrombosis imaging ........................ 0.77 3.11 NA 0.17 4.06 NA XXX 

78457 .......... 26 ....... A Venous thrombosis imaging ........................ 0.77 0.27 0.27 0.03 1.07 1.07 XXX 

78457 .......... TC ...... A Venous thrombosis imaging ........................ 0.00 2.85 NA 0.14 2.99 NA XXX 

78458 .......... ............ A Ven thrombosis images, bilat ...................... 0.90 4.31 NA 0.25 5.46 NA XXX 

78458 .......... 26 ....... A Ven thrombosis images, bilat ...................... 0.90 0.33 0.33 0.04 1.27 1.27 XXX 

78458 .......... TC ...... A Ven thrombosis images, bilat ...................... 0.00 3.98 NA 0.21 4.19 NA XXX 

78459 .......... ............ C Heart muscle imaging (PET) ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78459 .......... 26 ....... A Heart muscle imaging (PET) ....................... 1.50 0.59 0.59 0.05 2.15 2.15 XXX 

78459 .......... TC ...... C Heart muscle imaging (PET) ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78460 .......... ............ A Heart muscle blood, single .......................... 0.86 3.23 NA 0.17 4.27 NA XXX 

78460 .......... 26 ....... A Heart muscle blood, single .......................... 0.86 0.30 0.30 0.04 1.20 1.20 XXX 

78460 .......... TC ...... A Heart muscle blood, single .......................... 0.00 2.93 NA 0.13 3.06 NA XXX 

78461 .......... ............ A Heart muscle blood, multiple ....................... 1.23 5.17 NA 0.30 6.70 NA XXX 

45975

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

78461 .......... 26 ....... A Heart muscle blood, multiple ....................... 1.23 0.45 0.45 0.05 1.73 1.73 XXX 

78461 .......... TC ...... A Heart muscle blood, multiple ....................... 0.00 4.72 NA 0.25 4.97 NA XXX 

78464 .......... ............ A Heart image (3d), single .............................. 1.09 7.18 NA 0.41 8.68 NA XXX 

78464 .......... 26 ....... A Heart image (3d), single .............................. 1.09 0.40 0.40 0.04 1.53 1.53 XXX 

78464 .......... TC ...... A Heart image (3d), single .............................. 0.00 6.78 NA 0.37 7.15 NA XXX 

78465 .......... ............ A Heart image (3d), multiple ........................... 1.46 12.23 NA 0.67 14.37 NA XXX 

78465 .......... 26 ....... A Heart image (3d), multiple ........................... 1.46 0.54 0.54 0.05 2.06 2.06 XXX 

78465 .......... TC ...... A Heart image (3d), multiple ........................... 0.00 11.69 NA 0.62 12.31 NA XXX 

78466 .......... ............ A Heart infarct image ...................................... 0.69 3.35 NA 0.17 4.22 NA XXX 

78466 .......... 26 ....... A Heart infarct image ...................................... 0.69 0.25 0.25 0.03 0.97 0.97 XXX 

78466 .......... TC ...... A Heart infarct image ...................................... 0.00 3.10 NA 0.14 3.24 NA XXX 

78468 .......... ............ A Heart infarct image (ef) ............................... 0.80 4.53 NA 0.22 5.55 NA XXX 

78468 .......... 26 ....... A Heart infarct image (ef) ............................... 0.80 0.29 0.29 0.03 1.12 1.12 XXX 

78468 .......... TC ...... A Heart infarct image (ef) ............................... 0.00 4.25 NA 0.19 4.44 NA XXX 

78469 .......... ............ A Heart infarct image (3D) .............................. 0.92 5.38 NA 0.31 6.61 NA XXX 

78469 .......... 26 ....... A Heart infarct image (3D) .............................. 0.92 0.32 0.32 0.03 1.27 1.27 XXX 

78469 .......... TC ...... A Heart infarct image (3D) .............................. 0.00 5.06 NA 0.28 5.34 NA XXX 

78472 .......... ............ A Gated heart, planar, single .......................... 0.98 5.73 NA 0.34 7.06 NA XXX 

78472 .......... 26 ....... A Gated heart, planar, single .......................... 0.98 0.36 0.36 0.04 1.38 1.38 XXX 

78472 .......... TC ...... A Gated heart, planar, single .......................... 0.00 5.38 NA 0.30 5.68 NA XXX 

78473 .......... ............ A Gated heart, multiple ................................... 1.47 7.69 NA 0.48 9.64 NA XXX 

78473 .......... 26 ....... A Gated heart, multiple ................................... 1.47 0.53 0.53 0.06 2.07 2.07 XXX 

78473 .......... TC ...... A Gated heart, multiple ................................... 0.00 7.15 NA 0.42 7.57 NA XXX 

78478 .......... ............ A Heart wall motion add-on ............................ 0.62 1.58 NA 0.12 2.32 NA XXX 

78478 .......... 26 ....... A Heart wall motion add-on ............................ 0.62 0.24 0.24 0.02 0.88 0.88 XXX 

78478 .......... TC ...... A Heart wall motion add-on ............................ 0.00 1.34 NA 0.10 1.44 NA XXX 

78480 .......... ............ A Heart function add-on .................................. 0.62 1.57 NA 0.12 2.31 NA XXX 

78480 .......... 26 ....... A Heart function add-on .................................. 0.62 0.23 0.23 0.02 0.87 0.87 XXX 

78480 .......... TC ...... A Heart function add-on .................................. 0.00 1.34 NA 0.10 1.44 NA XXX 

78481 .......... ............ A Heart first pass, single ................................ 0.98 4.47 NA 0.31 5.76 NA XXX 

78481 .......... 26 ....... A Heart first pass, single ................................ 0.98 0.38 0.38 0.03 1.39 1.39 XXX 

78481 .......... TC ...... A Heart first pass, single ................................ 0.00 4.10 NA 0.28 4.38 NA XXX 

78483 .......... ............ A Heart first pass, multiple ............................. 1.47 6.69 NA 0.46 8.62 NA XXX 

78483 .......... 26 ....... A Heart first pass, multiple ............................. 1.47 0.56 0.56 0.05 2.08 2.08 XXX 

78483 .......... TC ...... A Heart first pass, multiple ............................. 0.00 6.13 NA 0.41 6.54 NA XXX 

78491 .......... ............ C Heart image (pet), single ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78491 .......... 26 ....... A Heart image (pet), single ............................. 1.50 0.00 0.00 0.06 1.56 1.56 XXX 

78491 .......... TC ...... C Heart image (pet), single ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78492 .......... ............ C Heart image (pet), multiple .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78492 .......... 26 ....... A Heart image (pet), multiple .......................... 1.87 0.00 0.00 0.07 1.94 1.94 XXX 

78492 .......... TC ...... C Heart image (pet), multiple .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78494 .......... ............ A Heart image, spect ...................................... 1.19 7.24 NA 0.35 8.78 NA XXX 

78494 .......... 26 ....... A Heart image, spect ...................................... 1.19 0.44 0.44 0.05 1.68 1.68 XXX 

78494 .......... TC ...... A Heart image, spect ...................................... 0.00 6.80 NA 0.30 7.10 NA XXX 

78496 .......... ............ A Heart first pass add-on ................................ 0.50 5.71 NA 0.32 6.53 NA ZZZ 

78496 .......... 26 ....... A Heart first pass add-on ................................ 0.50 0.19 0.19 0.02 0.71 0.71 ZZZ 

78496 .......... TC ...... A Heart first pass add-on ................................ 0.00 5.52 NA 0.30 5.82 NA ZZZ 

78499 .......... ............ C Cardiovascular nuclear exam ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78499 .......... 26 ....... C Cardiovascular nuclear exam ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78499 .......... TC ...... C Cardiovascular nuclear exam ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78580 .......... ............ A Lung perfusion imaging ............................... 0.74 4.07 NA 0.21 5.02 NA XXX 

78580 .......... 26 ....... A Lung perfusion imaging ............................... 0.74 0.26 0.26 0.03 1.03 1.03 XXX 

78580 .......... TC ...... A Lung perfusion imaging ............................... 0.00 3.81 NA 0.18 3.99 NA XXX 

78584 .......... ............ A Lung V/Q image single breath .................... 0.99 3.50 NA 0.21 4.70 NA XXX 

78584 .......... 26 ....... A Lung V/Q image single breath .................... 0.99 0.35 0.35 0.04 1.38 1.38 XXX 

78584 .......... TC ...... A Lung V/Q image single breath .................... 0.00 3.15 NA 0.17 3.32 NA XXX 

78585 .......... ............ A Lung V/Q imaging ....................................... 1.09 6.36 NA 0.35 7.80 NA XXX 

78585 .......... 26 ....... A Lung V/Q imaging ....................................... 1.09 0.38 0.38 0.05 1.52 1.52 XXX 

78585 .......... TC ...... A Lung V/Q imaging ....................................... 0.00 5.98 NA 0.30 6.28 NA XXX 

78586 .......... ............ A Aerosol lung image, single .......................... 0.40 3.04 NA 0.16 3.60 NA XXX 

78586 .......... 26 ....... A Aerosol lung image, single .......................... 0.40 0.14 0.14 0.02 0.56 0.56 XXX 

78586 .......... TC ...... A Aerosol lung image, single .......................... 0.00 2.90 NA 0.14 3.04 NA XXX 

78587 .......... ............ A Aerosol lung image, multiple ....................... 0.49 3.41 NA 0.16 4.06 NA XXX 

78587 .......... 26 ....... A Aerosol lung image, multiple ....................... 0.49 0.18 0.18 0.02 0.69 0.69 XXX 

78587 .......... TC ...... A Aerosol lung image, multiple ....................... 0.00 3.23 NA 0.14 3.37 NA XXX 

78588 .......... ............ A Perfusion lung image .................................. 1.09 4.60 NA 0.23 5.93 NA XXX 

78588 .......... 26 ....... A Perfusion lung image .................................. 1.09 0.38 0.38 0.05 1.52 1.52 XXX 

78588 .......... TC ...... A Perfusion lung image .................................. 0.00 4.23 NA 0.18 4.41 NA XXX 

78591 .......... ............ A Vent image, 1 breath, 1 proj ....................... 0.40 3.12 NA 0.16 3.68 NA XXX 

78591 .......... 26 ....... A Vent image, 1 breath, 1 proj ....................... 0.40 0.14 0.14 0.02 0.56 0.56 XXX 

78591 .......... TC ...... A Vent image, 1 breath, 1 proj ....................... 0.00 2.98 NA 0.14 3.12 NA XXX 

78593 .......... ............ A Vent image, 1 proj, gas ............................... 0.49 3.76 NA 0.20 4.45 NA XXX 

78593 .......... 26 ....... A Vent image, 1 proj, gas ............................... 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

78593 .......... TC ...... A Vent image, 1 proj, gas ............................... 0.00 3.59 NA 0.18 3.77 NA XXX 

45976

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

78594 .......... ............ A Vent image, mult proj, gas .......................... 0.53 5.09 NA 0.27 5.89 NA XXX 

78594 .......... 26 ....... A Vent image, mult proj, gas .......................... 0.53 0.19 0.19 0.02 0.74 0.74 XXX 

78594 .......... TC ...... A Vent image, mult proj, gas .......................... 0.00 4.90 NA 0.25 5.15 NA XXX 

78596 .......... ............ A Lung differential function ............................. 1.27 7.35 NA 0.42 9.05 NA XXX 

78596 .......... 26 ....... A Lung differential function ............................. 1.27 0.44 0.44 0.05 1.76 1.76 XXX 

78596 .......... TC ...... A Lung differential function ............................. 0.00 6.92 NA 0.37 7.29 NA XXX 

78599 .......... ............ C Respiratory nuclear exam ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78599 .......... 26 ....... C Respiratory nuclear exam ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78599 .......... TC ...... C Respiratory nuclear exam ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78600 .......... ............ A Brain imaging, ltd static ............................... 0.44 3.50 NA 0.16 4.11 NA XXX 

78600 .......... 26 ....... A Brain imaging, ltd static ............................... 0.44 0.16 0.16 0.02 0.62 0.62 XXX 

78600 .......... TC ...... A Brain imaging, ltd static ............................... 0.00 3.35 NA 0.14 3.49 NA XXX 

78601 .......... ............ A Brain imaging, ltd w/flow ............................. 0.51 3.91 NA 0.20 4.62 NA XXX 

78601 .......... 26 ....... A Brain imaging, ltd w/flow ............................. 0.51 0.18 0.18 0.02 0.71 0.71 XXX 

78601 .......... TC ...... A Brain imaging, ltd w/flow ............................. 0.00 3.73 NA 0.18 3.91 NA XXX 

78605 .......... ............ A Brain imaging, complete .............................. 0.53 3.77 NA 0.20 4.50 NA XXX 

78605 .......... 26 ....... A Brain imaging, complete .............................. 0.53 0.19 0.19 0.02 0.74 0.74 XXX 

78605 .......... TC ...... A Brain imaging, complete .............................. 0.00 3.58 NA 0.18 3.76 NA XXX 

78606 .......... ............ A Brain imaging, compl w/flow ....................... 0.64 4.79 NA 0.24 5.67 NA XXX 

78606 .......... 26 ....... A Brain imaging, compl w/flow ....................... 0.64 0.22 0.22 0.03 0.89 0.89 XXX 

78606 .......... TC ...... A Brain imaging, compl w/flow ....................... 0.00 4.57 NA 0.21 4.78 NA XXX 

78607 .......... ............ A Brain imaging (3D) ...................................... 1.23 8.26 NA 0.40 9.90 NA XXX 

78607 .......... 26 ....... A Brain imaging (3D) ...................................... 1.23 0.45 0.45 0.05 1.73 1.73 XXX 

78607 .......... TC ...... A Brain imaging (3D) ...................................... 0.00 7.82 NA 0.35 8.17 NA XXX 

78608 .......... ............ C Brain imaging (PET) .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78608 .......... 26 ....... A Brain imaging (PET) .................................... 1.50 0.00 0.00 0.06 1.56 1.56 XXX 

78608 .......... TC ...... C Brain imaging (PET) .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78609 .......... ............ C Brain imaging (PET) .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78609 .......... 26 ....... A Brain imaging (PET) .................................... 1.50 0.00 0.00 0.06 1.56 1.56 XXX 

78609 .......... TC ...... C Brain imaging (PET) .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78610 .......... ............ A Brain flow imaging only ............................... 0.30 2.15 NA 0.11 2.56 NA XXX 

78610 .......... 26 ....... A Brain flow imaging only ............................... 0.30 0.11 0.11 0.01 0.42 0.42 XXX 

78610 .......... TC ...... A Brain flow imaging only ............................... 0.00 2.03 NA 0.10 2.13 NA XXX 

78615 .......... ............ A Cerebral vascular flow image ...................... 0.42 4.07 NA 0.23 4.72 NA XXX 

78615 .......... 26 ....... A Cerebral vascular flow image ...................... 0.42 0.16 0.16 0.02 0.60 0.60 XXX 

78615 .......... TC ...... A Cerebral vascular flow image ...................... 0.00 3.91 NA 0.21 4.12 NA XXX 

78630 .......... ............ A Cerebrospinal fluid scan .............................. 0.68 5.67 NA 0.30 6.65 NA XXX 

78630 .......... 26 ....... A Cerebrospinal fluid scan .............................. 0.68 0.24 0.24 0.03 0.95 0.95 XXX 

78630 .......... TC ...... A Cerebrospinal fluid scan .............................. 0.00 5.43 NA 0.27 5.70 NA XXX 

78635 .......... ............ A CSF ventriculography .................................. 0.61 3.91 NA 0.16 4.68 NA XXX 

78635 .......... 26 ....... A CSF ventriculography .................................. 0.61 0.24 0.24 0.02 0.87 0.87 XXX 

78635 .......... TC ...... A CSF ventriculography .................................. 0.00 3.66 NA 0.14 3.80 NA XXX 

78645 .......... ............ A CSF shunt evaluation .................................. 0.57 4.91 NA 0.20 5.68 NA XXX 

78645 .......... 26 ....... A CSF shunt evaluation .................................. 0.57 0.20 0.20 0.02 0.79 0.79 XXX 

78645 .......... TC ...... A CSF shunt evaluation .................................. 0.00 4.71 NA 0.18 4.89 NA XXX 

78647 .......... ............ A Cerebrospinal fluid scan .............................. 0.90 8.47 NA 0.35 9.73 NA XXX 

78647 .......... 26 ....... A Cerebrospinal fluid scan .............................. 0.90 0.32 0.32 0.04 1.26 1.26 XXX 

78647 .......... TC ...... A Cerebrospinal fluid scan .............................. 0.00 8.15 NA 0.31 8.46 NA XXX 

78650 .......... ............ A CSF leakage imaging .................................. 0.61 5.35 NA 0.27 6.23 NA XXX 

78650 .......... 26 ....... A CSF leakage imaging .................................. 0.61 0.22 0.22 0.03 0.86 0.86 XXX 

78650 .......... TC ...... A CSF leakage imaging .................................. 0.00 5.13 NA 0.24 5.37 NA XXX 

78660 .......... ............ A Nuclear exam of tear flow ........................... 0.53 2.68 NA 0.14 3.35 NA XXX 

78660 .......... 26 ....... A Nuclear exam of tear flow ........................... 0.53 0.19 0.19 0.02 0.74 0.74 XXX 

78660 .......... TC ...... A Nuclear exam of tear flow ........................... 0.00 2.49 NA 0.12 2.61 NA XXX 

78699 .......... ............ C Nervous system nuclear exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78699 .......... 26 ....... C Nervous system nuclear exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78699 .......... TC ...... C Nervous system nuclear exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78700 .......... ............ A Kidney imaging, static ................................. 0.45 3.42 NA 0.18 4.05 NA XXX 

78700 .......... 26 ....... A Kidney imaging, static ................................. 0.45 0.16 0.16 0.02 0.63 0.63 XXX 

78700 .......... TC ...... A Kidney imaging, static ................................. 0.00 3.26 NA 0.16 3.42 NA XXX 

78701 .......... ............ A Kidney imaging with flow ............................. 0.49 3.93 NA 0.20 4.62 NA XXX 

78701 .......... 26 ....... A Kidney imaging with flow ............................. 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

78701 .......... TC ...... A Kidney imaging with flow ............................. 0.00 3.76 NA 0.18 3.94 NA XXX 

78704 .......... ............ A Imaging renogram ....................................... 0.74 4.35 NA 0.24 5.34 NA XXX 

78704 .......... 26 ....... A Imaging renogram ....................................... 0.74 0.26 0.26 0.03 1.03 1.03 XXX 

78704 .......... TC ...... A Imaging renogram ....................................... 0.00 4.09 NA 0.21 4.30 NA XXX 

78707 .......... ............ A Kidney flow/function image ......................... 0.96 4.89 NA 0.27 6.12 NA XXX 

78707 .......... 26 ....... A Kidney flow/function image ......................... 0.96 0.34 0.34 0.04 1.34 1.34 XXX 

78707 .......... TC ...... A Kidney flow/function image ......................... 0.00 4.56 NA 0.23 4.79 NA XXX 

78708 .......... ............ A Kidney flow/function image ......................... 1.21 4.63 NA 0.28 6.12 NA XXX 

78708 .......... 26 ....... A Kidney flow/function image ......................... 1.21 0.43 0.43 0.05 1.69 1.69 XXX 

78708 .......... TC ...... A Kidney flow/function image ......................... 0.00 4.20 NA 0.23 4.43 NA XXX 

78709 .......... ............ A Kidney flow/function image ......................... 1.41 5.73 NA 0.29 7.43 NA XXX 

78709 .......... 26 ....... A Kidney flow/function image ......................... 1.41 0.49 0.49 0.06 1.97 1.97 XXX 

45977

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

78709 .......... TC ...... A Kidney flow/function image ......................... 0.00 5.24 NA 0.23 5.47 NA XXX 

78710 .......... ............ A Kidney imaging (3D) .................................... 0.66 5.79 NA 0.34 6.79 NA XXX 

78710 .......... 26 ....... A Kidney imaging (3D) .................................... 0.66 0.23 0.23 0.03 0.92 0.92 XXX 

78710 .......... TC ...... A Kidney imaging (3D) .................................... 0.00 5.55 NA 0.31 5.86 NA XXX 

78715 .......... ............ A Renal vascular flow exam ........................... 0.30 2.36 NA 0.11 2.78 NA XXX 

78715 .......... 26 ....... A Renal vascular flow exam ........................... 0.30 0.11 0.11 0.01 0.42 0.42 XXX 

78715 .......... TC ...... A Renal vascular flow exam ........................... 0.00 2.25 NA 0.10 2.35 NA XXX 

78725 .......... ............ A Kidney function study .................................. 0.38 1.93 NA 0.13 2.44 NA XXX 

78725 .......... 26 ....... A Kidney function study .................................. 0.38 0.14 0.14 0.02 0.54 0.54 XXX 

78725 .......... TC ...... A Kidney function study .................................. 0.00 1.79 NA 0.11 1.90 NA XXX 

78730 .......... ............ A Urinary bladder retention ............................. 0.36 2.27 NA 0.10 2.73 NA XXX 

78730 .......... 26 ....... A Urinary bladder retention ............................. 0.36 0.13 0.13 0.02 0.51 0.51 XXX 

78730 .......... TC ...... A Urinary bladder retention ............................. 0.00 2.13 NA 0.08 2.21 NA XXX 

78740 .......... ............ A Ureteral reflux study .................................... 0.57 2.79 NA 0.15 3.51 NA XXX 

78740 .......... 26 ....... A Ureteral reflux study .................................... 0.57 0.20 0.20 0.03 0.80 0.80 XXX 

78740 .......... TC ...... A Ureteral reflux study .................................... 0.00 2.59 NA 0.12 2.71 NA XXX 

78760 .......... ............ A Testicular imaging ....................................... 0.66 3.08 NA 0.17 3.91 NA XXX 

78760 .......... 26 ....... A Testicular imaging ....................................... 0.66 0.23 0.23 0.03 0.92 0.92 XXX 

78760 .......... TC ...... A Testicular imaging ....................................... 0.00 2.85 NA 0.14 2.99 NA XXX 

78761 .......... ............ A Testicular imaging/flow ................................ 0.71 3.69 NA 0.20 4.60 NA XXX 

78761 .......... 26 ....... A Testicular imaging/flow ................................ 0.71 0.25 0.25 0.03 0.99 0.99 XXX 

78761 .......... TC ...... A Testicular imaging/flow ................................ 0.00 3.44 NA 0.17 3.61 NA XXX 

78799 .......... ............ C Genitourinary nuclear exam ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78799 .......... 26 ....... C Genitourinary nuclear exam ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78799 .......... TC ...... C Genitourinary nuclear exam ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78800 .......... ............ A Tumor imaging, limited area ....................... 0.66 3.68 NA 0.22 4.56 NA XXX 

78800 .......... 26 ....... A Tumor imaging, limited area ....................... 0.66 0.23 0.23 0.04 0.93 0.93 XXX 

78800 .......... TC ...... A Tumor imaging, limited area ....................... 0.00 3.45 NA 0.18 3.63 NA XXX 

78801 .......... ............ A Tumor imaging, mult areas ......................... 0.79 4.81 NA 0.27 5.87 NA XXX 

78801 .......... 26 ....... A Tumor imaging, mult areas ......................... 0.79 0.28 0.28 0.05 1.12 1.12 XXX 

78801 .......... TC ...... A Tumor imaging, mult areas ......................... 0.00 4.53 NA 0.22 4.75 NA XXX 

78802 .......... ............ A Tumor imaging, whole body ........................ 0.86 6.11 NA 0.34 7.31 NA XXX 

78802 .......... 26 ....... A Tumor imaging, whole body ........................ 0.86 0.30 0.30 0.04 1.20 1.20 XXX 

78802 .......... TC ...... A Tumor imaging, whole body ........................ 0.00 5.81 NA 0.30 6.11 NA XXX 

78803 .......... ............ A Tumor imaging (3D) .................................... 1.09 8.16 NA 0.40 9.65 NA XXX 

78803 .......... 26 ....... A Tumor imaging (3D) .................................... 1.09 0.40 0.40 0.05 1.54 1.54 XXX 

78803 .......... TC ...... A Tumor imaging (3D) .................................... 0.00 7.77 NA 0.35 8.12 NA XXX 

78804 .......... ............ A Tumor imaging, whole body ........................ 1.07 11.45 NA 0.34 12.87 NA XXX 

78804 .......... 26 ....... A Tumor imaging, whole body ........................ 1.07 0.39 0.39 0.04 1.50 1.50 XXX 

78804 .......... TC ...... A Tumor imaging, whole body ........................ 0.00 11.06 NA 0.30 11.36 NA XXX 

78805 .......... ............ A Abscess imaging, ltd area ........................... 0.73 3.72 NA 0.21 4.66 NA XXX 

78805 .......... 26 ....... A Abscess imaging, ltd area ........................... 0.73 0.26 0.26 0.03 1.02 1.02 XXX 

78805 .......... TC ...... A Abscess imaging, ltd area ........................... 0.00 3.46 NA 0.18 3.64 NA XXX 

78806 .......... ............ A Abscess imaging, whole body ..................... 0.86 6.80 NA 0.39 8.05 NA XXX 

78806 .......... 26 ....... A Abscess imaging, whole body ..................... 0.86 0.30 0.30 0.04 1.20 1.20 XXX 

78806 .......... TC ...... A Abscess imaging, whole body ..................... 0.00 6.49 NA 0.35 6.84 NA XXX 

78807 .......... ............ A Nuclear localization/abscess ....................... 1.09 7.96 NA 0.39 9.44 NA XXX 

78807 .......... 26 ....... A Nuclear localization/abscess ....................... 1.09 0.41 0.41 0.04 1.54 1.54 XXX 

78807 .......... TC ...... A Nuclear localization/abscess ....................... 0.00 7.56 NA 0.35 7.91 NA XXX 

78811 .......... ............ C Tumor imaging (pet), limited ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78811 .......... 26 ....... A Tumor imaging (pet), limited ....................... 1.54 0.00 0.00 0.11 1.65 1.65 XXX 

78811 .......... TC ...... C Tumor imaging (pet), limited ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78812 .......... ............ C Tumor image (pet)/skul-thigh ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78812 .......... 26 ....... A Tumor image (pet)/skul-thigh ...................... 1.93 0.00 0.00 0.11 2.04 2.04 XXX 

78812 .......... TC ...... C Tumor image (pet)/skul-thigh ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78813 .......... ............ C Tumor image (pet) full body ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78813 .......... 26 ....... A Tumor image (pet) full body ........................ 2.00 0.00 0.00 0.11 2.11 2.11 XXX 

78813 .......... TC ...... C Tumor image (pet) full body ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78814 .......... ............ C Tumor image pet/ct, limited ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78814 .......... 26 ....... A Tumor image pet/ct, limited ......................... 2.20 0.00 0.00 0.11 2.31 2.31 XXX 

78814 .......... TC ...... C Tumor image pet/ct, limited ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78815 .......... ............ C Tumorimage pet/ct skul-thigh ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78815 .......... 26 ....... A Tumorimage pet/ct skul-thigh ...................... 2.44 0.00 0.00 0.11 2.55 2.55 XXX 

78815 .......... TC ...... C Tumorimage pet/ct skul-thigh ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78816 .......... ............ C Tumor image pet/ct full body ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78816 .......... 26 ....... A Tumor image pet/ct full body ...................... 2.50 0.00 0.00 0.11 2.61 2.61 XXX 

78816 .......... TC ...... C Tumor image pet/ct full body ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78890 .......... ............ B Nuclear medicine data proc ........................ 0.05 1.08 NA 0.07 1.20 NA XXX 

78890 .......... 26 ....... B Nuclear medicine data proc ........................ 0.05 0.02 0.02 0.01 0.08 0.08 XXX 

78890 .......... TC ...... B Nuclear medicine data proc ........................ 0.00 1.06 NA 0.06 1.12 NA XXX 

78891 .......... ............ B Nuclear med data proc ................................ 0.10 2.15 NA 0.14 2.39 NA XXX 

78891 .......... 26 ....... B Nuclear med data proc ................................ 0.10 0.04 0.04 0.01 0.15 0.15 XXX 

78891 .......... TC ...... B Nuclear med data proc ................................ 0.00 2.11 NA 0.13 2.24 NA XXX 

78999 .......... ............ C Nuclear diagnostic exam ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

45978

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

78999 .......... 26 ....... C Nuclear diagnostic exam ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78999 .......... TC ...... C Nuclear diagnostic exam ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79005 .......... ............ A Nuclear rx, oral admin ................................. 1.80 2.82 NA 0.22 4.85 NA XXX 

79005 .......... 26 ....... A Nuclear rx, oral admin ................................. 1.80 0.62 0.62 0.08 2.51 2.51 XXX 

79005 .......... TC ...... A Nuclear rx, oral admin ................................. 0.00 2.20 NA 0.14 2.34 NA XXX 

79101 .......... ............ A Nuclear rx, iv admin .................................... 1.96 2.98 NA 0.22 5.16 NA XXX 

79101 .......... 26 ....... A Nuclear rx, iv admin .................................... 1.96 0.70 0.70 0.08 2.75 2.75 XXX 

79101 .......... TC ...... A Nuclear rx, iv admin .................................... 0.00 2.28 NA 0.14 2.42 NA XXX 

79200 .......... ............ A Nuclear rx, intracav admin .......................... 1.99 3.18 NA 0.23 5.41 NA XXX 

79200 .......... 26 ....... A Nuclear rx, intracav admin .......................... 1.99 0.71 0.71 0.09 2.79 2.79 XXX 

79200 .......... TC ...... A Nuclear rx, intracav admin .......................... 0.00 2.47 NA 0.14 2.61 NA XXX 

79300 .......... ............ C Nuclr rx, interstit colloid ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79300 .......... 26 ....... A Nuclr rx, interstit colloid ............................... 1.60 0.59 0.59 0.13 2.32 2.32 XXX 

79300 .......... TC ...... C Nuclr rx, interstit colloid ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79403 .......... ............ A Hematopoietic nuclear tx ............................. 2.25 5.17 NA 0.24 7.66 NA XXX 

79403 .......... 26 ....... A Hematopoietic nuclear tx ............................. 2.25 0.92 0.92 0.10 3.28 3.28 XXX 

79403 .......... TC ...... A Hematopoietic nuclear tx ............................. 0.00 4.25 NA 0.14 4.39 NA XXX 

79440 .......... ............ A Nuclear rx, intra-articular ............................. 1.99 2.95 NA 0.22 5.16 NA XXX 

79440 .......... 26 ....... A Nuclear rx, intra-articular ............................. 1.99 0.75 0.75 0.08 2.82 2.82 XXX 

79440 .......... TC ...... A Nuclear rx, intra-articular ............................. 0.00 2.20 NA 0.14 2.34 NA XXX 

79445 .......... ............ A Nuclear rx, intra-arterial ............................... 2.40 NA NA 0.28 NA NA XXX 

79445 .......... 26 ....... A Nuclear rx, intra-arterial ............................... 2.40 0.86 0.86 0.12 3.39 3.39 XXX 

79445 .......... TC ...... A Nuclear rx, intra-arterial ............................... 0.00 NA NA 0.16 NA NA XXX 

79999 .......... ............ C Nuclear medicine therapy ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79999 .......... 26 ....... C Nuclear medicine therapy ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79999 .......... TC ...... C Nuclear medicine therapy ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

80500 .......... ............ A Lab pathology consultation ......................... 0.37 0.20 0.16 0.01 0.58 0.54 XXX 

80502 .......... ............ A Lab pathology consultation ......................... 1.33 0.53 0.53 0.04 1.90 1.90 XXX 

83020 .......... 26 ....... A Hemoglobin electrophoresis ........................ 0.37 0.15 0.15 0.01 0.53 0.53 XXX 

83912 .......... 26 ....... A Genetic examination .................................... 0.37 0.12 0.12 0.01 0.50 0.50 XXX 

84165 .......... 26 ....... A Protein e-phoresis, serum ........................... 0.37 0.14 0.14 0.01 0.52 0.52 XXX 

84166 .......... 26 ....... A Protein e-phoresis/urine/csf ......................... 0.37 0.14 0.14 0.01 0.52 0.52 XXX 

84181 .......... 26 ....... A Western blot test ......................................... 0.37 0.14 0.14 0.01 0.52 0.52 XXX 

84182 .......... 26 ....... A Protein, western blot test ............................ 0.37 0.16 0.16 0.02 0.55 0.55 XXX 

85060 .......... ............ A Blood smear interpretation .......................... 0.45 0.18 0.18 0.02 0.65 0.65 XXX 

85097 .......... ............ A Bone marrow interpretation ......................... 0.94 1.82 0.40 0.04 2.80 1.38 XXX 

85390 .......... 26 ....... A Fibrinolysins screen ..................................... 0.37 0.13 0.13 0.01 0.51 0.51 XXX 

85396 .......... ............ A Clotting assay, whole blood ........................ 0.37 NA 0.16 0.04 NA 0.57 XXX 

85576 .......... 26 ....... A Blood platelet aggregation .......................... 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

86077 .......... ............ A Physician blood bank service ...................... 0.94 0.38 0.38 0.03 1.35 1.35 XXX 

86078 .......... ............ A Physician blood bank service ...................... 0.94 0.45 0.39 0.03 1.42 1.36 XXX 

86079 .......... ............ A Physician blood bank service ...................... 0.94 0.44 0.40 0.03 1.41 1.37 XXX 

86255 .......... 26 ....... A Fluorescent antibody, screen ...................... 0.37 0.15 0.15 0.01 0.53 0.53 XXX 

86256 .......... 26 ....... A Fluorescent antibody, titer ........................... 0.37 0.15 0.15 0.01 0.53 0.53 XXX 

86320 .......... 26 ....... A Serum immunoelectrophoresis .................... 0.37 0.15 0.15 0.01 0.53 0.53 XXX 

86325 .......... 26 ....... A Other immunoelectrophoresis ..................... 0.37 0.13 0.13 0.01 0.51 0.51 XXX 

86327 .......... 26 ....... A Immunoelectrophoresis assay ..................... 0.42 0.18 0.18 0.02 0.62 0.62 XXX 

86334 .......... 26 ....... A Immunofix e-phoresis, serum ...................... 0.37 0.15 0.15 0.01 0.53 0.53 XXX 

86335 .......... 26 ....... A Immunfix e-phorsis/urine/csf ....................... 0.37 0.14 0.14 0.01 0.52 0.52 XXX 

86485 .......... ............ C Skin test, candida ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

86490 .......... ............ A Coccidioidomycosis skin test ...................... 0.00 0.28 NA 0.02 0.30 NA XXX 

86510 .......... ............ A Histoplasmosis skin test .............................. 0.00 0.30 NA 0.02 0.32 NA XXX 

86580 .......... ............ A TB intradermal test ...................................... 0.00 0.22 NA 0.02 0.24 NA XXX 

86585 .......... ............ A TB tine test .................................................. 0.00 0.21 NA 0.01 0.22 NA XXX 

86586 .......... ............ C Skin test, unlisted ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

87164 .......... 26 ....... A Dark field examination ................................. 0.37 0.12 0.12 0.01 0.50 0.50 XXX 

87207 .......... 26 ....... A Smear, special stain .................................... 0.37 0.17 0.16 0.01 0.55 0.54 XXX 

88104 .......... ............ A Cytopathology, fluids ................................... 0.56 0.87 NA 0.04 1.47 NA XXX 

88104 .......... 26 ....... A Cytopathology, fluids ................................... 0.56 0.23 0.23 0.02 0.81 0.81 XXX 

88104 .......... TC ...... A Cytopathology, fluids ................................... 0.00 0.64 NA 0.02 0.66 NA XXX 

88106 .......... ............ A Cytopathology, fluids ................................... 0.56 1.35 NA 0.04 1.95 NA XXX 

88106 .......... 26 ....... A Cytopathology, fluids ................................... 0.56 0.23 0.23 0.02 0.81 0.81 XXX 

88106 .......... TC ...... A Cytopathology, fluids ................................... 0.00 1.11 NA 0.02 1.13 NA XXX 

88107 .......... ............ A Cytopathology, fluids ................................... 0.76 1.54 NA 0.05 2.35 NA XXX 

88107 .......... 26 ....... A Cytopathology, fluids ................................... 0.76 0.32 0.32 0.03 1.11 1.11 XXX 

88107 .......... TC ...... A Cytopathology, fluids ................................... 0.00 1.21 NA 0.02 1.23 NA XXX 

88108 .......... ............ A Cytopath, concentrate tech ......................... 0.56 1.22 NA 0.04 1.82 NA XXX 

88108 .......... 26 ....... A Cytopath, concentrate tech ......................... 0.56 0.23 0.23 0.02 0.81 0.81 XXX 

88108 .......... TC ...... A Cytopath, concentrate tech ......................... 0.00 0.99 NA 0.02 1.01 NA XXX 

88112 .......... ............ A Cytopath, cell enhance tech ........................ 1.18 1.91 NA 0.04 3.14 NA XXX 

88112 .......... 26 ....... A Cytopath, cell enhance tech ........................ 1.18 0.50 0.50 0.02 1.70 1.70 XXX 

88112 .......... TC ...... A Cytopath, cell enhance tech ........................ 0.00 1.42 NA 0.02 1.44 NA XXX 

88125 .......... ............ A Forensic cytopathology ............................... 0.26 0.25 NA 0.02 0.53 NA XXX 

88125 .......... 26 ....... A Forensic cytopathology ............................... 0.26 0.11 0.11 0.01 0.38 0.38 XXX 

45979

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

88125 .......... TC ...... A Forensic cytopathology ............................... 0.00 0.14 NA 0.01 0.15 NA XXX 

88141 .......... ............ A Cytopath, c/v, interpret ................................ 0.42 0.23 0.15 0.02 0.67 0.59 XXX 

88160 .......... ............ A Cytopath smear, other source ..................... 0.50 0.83 NA 0.04 1.38 NA XXX 

88160 .......... 26 ....... A Cytopath smear, other source ..................... 0.50 0.21 0.21 0.02 0.73 0.73 XXX 

88160 .......... TC ...... A Cytopath smear, other source ..................... 0.00 0.63 NA 0.02 0.65 NA XXX 

88161 .......... ............ A Cytopath smear, other source ..................... 0.50 0.93 NA 0.04 1.47 NA XXX 

88161 .......... 26 ....... A Cytopath smear, other source ..................... 0.50 0.21 0.21 0.02 0.73 0.73 XXX 

88161 .......... TC ...... A Cytopath smear, other source ..................... 0.00 0.73 NA 0.02 0.75 NA XXX 

88162 .......... ............ A Cytopath smear, other source ..................... 0.76 1.03 NA 0.05 1.84 NA XXX 

88162 .......... 26 ....... A Cytopath smear, other source ..................... 0.76 0.32 0.32 0.03 1.11 1.11 XXX 

88162 .......... TC ...... A Cytopath smear, other source ..................... 0.00 0.71 NA 0.02 0.73 NA XXX 

88172 .......... ............ A Cytopathology eval of fna ........................... 0.60 0.73 NA 0.04 1.37 NA XXX 

88172 .......... 26 ....... A Cytopathology eval of fna ........................... 0.60 0.25 0.25 0.02 0.87 0.87 XXX 

88172 .......... TC ...... A Cytopathology eval of fna ........................... 0.00 0.47 NA 0.02 0.49 NA XXX 

88173 .......... ............ A Cytopath eval, fna, report ............................ 1.39 2.11 NA 0.07 3.57 NA XXX 

88173 .......... 26 ....... A Cytopath eval, fna, report ............................ 1.39 0.58 0.58 0.05 2.02 2.02 XXX 

88173 .......... TC ...... A Cytopath eval, fna, report ............................ 0.00 1.53 NA 0.02 1.55 NA XXX 

88182 .......... ............ A Cell marker study ........................................ 0.77 2.00 NA 0.07 2.84 NA XXX 

88182 .......... 26 ....... A Cell marker study ........................................ 0.77 0.32 0.32 0.03 1.12 1.12 XXX 

88182 .......... TC ...... A Cell marker study ........................................ 0.00 1.67 NA 0.04 1.71 NA XXX 

88184 .......... ............ A Flowcytometry/ tc, 1 marker ........................ 0.00 1.62 NA 0.02 1.64 NA XXX 

88185 .......... ............ A Flowcytometry/tc, add-on ............................ 0.00 0.86 NA 0.02 0.88 NA ZZZ 

88187 .......... ............ A Flowcytometry/read, 2-8 .............................. 1.36 0.42 0.42 0.01 1.79 1.79 XXX 

88188 .......... ............ A Flowcytometry/read, 9-15 ............................ 1.69 0.53 0.53 0.01 2.23 2.23 XXX 

88189 .......... ............ A Flowcytometry/read, 16 & > ........................ 2.23 0.69 0.69 0.01 2.94 2.94 XXX 

88199 .......... ............ C Cytopathology procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88199 .......... 26 ....... C Cytopathology procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88199 .......... TC ...... C Cytopathology procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88291 .......... ............ A Cyto/molecular report .................................. 0.52 0.21 0.18 0.02 0.75 0.72 XXX 

88299 .......... ............ C Cytogenetic study ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88300 .......... ............ A Surgical path, gross .................................... 0.08 0.45 NA 0.02 0.55 NA XXX 

88300 .......... 26 ....... A Surgical path, gross .................................... 0.08 0.03 0.03 0.01 0.12 0.12 XXX 

88300 .......... TC ...... A Surgical path, gross .................................... 0.00 0.42 NA 0.01 0.43 NA XXX 

88302 .......... ............ A Tissue exam by pathologist ........................ 0.13 1.03 NA 0.03 1.19 NA XXX 

88302 .......... 26 ....... A Tissue exam by pathologist ........................ 0.13 0.06 0.06 0.01 0.20 0.20 XXX 

88302 .......... TC ...... A Tissue exam by pathologist ........................ 0.00 0.98 NA 0.02 1.00 NA XXX 

88304 .......... ............ A Tissue exam by pathologist ........................ 0.22 1.43 NA 0.03 1.68 NA XXX 

88304 .......... 26 ....... A Tissue exam by pathologist ........................ 0.22 0.09 0.09 0.01 0.32 0.32 XXX 

88304 .......... TC ...... A Tissue exam by pathologist ........................ 0.00 1.34 NA 0.02 1.36 NA XXX 

88305 .......... ............ A Tissue exam by pathologist ........................ 0.75 2.09 NA 0.07 2.91 NA XXX 

88305 .......... 26 ....... A Tissue exam by pathologist ........................ 0.75 0.33 0.33 0.03 1.11 1.11 XXX 

88305 .......... TC ...... A Tissue exam by pathologist ........................ 0.00 1.76 NA 0.04 1.80 NA XXX 

88307 .......... ............ A Tissue exam by pathologist ........................ 1.59 3.27 NA 0.12 4.98 NA XXX 

88307 .......... 26 ....... A Tissue exam by pathologist ........................ 1.59 0.66 0.66 0.06 2.32 2.32 XXX 

88307 .......... TC ...... A Tissue exam by pathologist ........................ 0.00 2.60 NA 0.06 2.66 NA XXX 

88309 .......... ............ A Tissue exam by pathologist ........................ 2.28 4.52 NA 0.14 6.95 NA XXX 

88309 .......... 26 ....... A Tissue exam by pathologist ........................ 2.28 0.95 0.95 0.08 3.31 3.31 XXX 

88309 .......... TC ...... A Tissue exam by pathologist ........................ 0.00 3.57 NA 0.06 3.63 NA XXX 

88311 .......... ............ A Decalcify tissue ........................................... 0.24 0.23 NA 0.02 0.49 NA XXX 

88311 .......... 26 ....... A Decalcify tissue ........................................... 0.24 0.10 0.10 0.01 0.35 0.35 XXX 

88311 .......... TC ...... A Decalcify tissue ........................................... 0.00 0.13 NA 0.01 0.14 NA XXX 

88312 .......... ............ A Special stains .............................................. 0.54 1.66 NA 0.03 2.23 NA XXX 

88312 .......... 26 ....... A Special stains .............................................. 0.54 0.23 0.23 0.02 0.79 0.79 XXX 

88312 .......... TC ...... A Special stains .............................................. 0.00 1.44 NA 0.01 1.45 NA XXX 

88313 .......... ............ A Special stains .............................................. 0.24 1.35 NA 0.02 1.61 NA XXX 

88313 .......... 26 ....... A Special stains .............................................. 0.24 0.10 0.10 0.01 0.35 0.35 XXX 

88313 .......... TC ...... A Special stains .............................................. 0.00 1.25 NA 0.01 1.26 NA XXX 

88314 .......... ............ A Histochemical stain ..................................... 0.45 2.06 NA 0.04 2.55 NA XXX 

88314 .......... 26 ....... A Histochemical stain ..................................... 0.45 0.19 0.19 0.02 0.66 0.66 XXX 

88314 .......... TC ...... A Histochemical stain ..................................... 0.00 1.88 NA 0.02 1.90 NA XXX 

88318 .......... ............ A Chemical histochemistry ............................. 0.42 1.77 NA 0.03 2.22 NA XXX 

88318 .......... 26 ....... A Chemical histochemistry ............................. 0.42 0.18 0.18 0.02 0.62 0.62 XXX 

88318 .......... TC ...... A Chemical histochemistry ............................. 0.00 1.60 NA 0.01 1.61 NA XXX 

88319 .......... ............ A Enzyme histochemistry ............................... 0.53 3.39 NA 0.04 3.96 NA XXX 

88319 .......... 26 ....... A Enzyme histochemistry ............................... 0.53 0.22 0.22 0.02 0.77 0.77 XXX 

88319 .......... TC ...... A Enzyme histochemistry ............................... 0.00 3.17 NA 0.02 3.19 NA XXX 

88321 .......... ............ A Microslide consultation ................................ 1.30 0.80 0.55 0.05 2.15 1.90 XXX 

88323 .......... ............ A Microslide consultation ................................ 1.35 1.84 NA 0.07 3.26 NA XXX 

88323 .......... 26 ....... A Microslide consultation ................................ 1.35 0.56 0.56 0.05 1.96 1.96 XXX 

88323 .......... TC ...... A Microslide consultation ................................ 0.00 1.28 NA 0.02 1.30 NA XXX 

88325 .......... ............ A Comprehensive review of data ................... 2.22 2.87 0.93 0.07 5.16 3.22 XXX 

88329 .......... ............ A Path consult introp ...................................... 0.67 0.64 0.28 0.02 1.34 0.97 XXX 

88331 .......... ............ A Path consult intraop, 1 bloc ........................ 1.19 1.12 NA 0.08 2.40 NA XXX 

88331 .......... 26 ....... A Path consult intraop, 1 bloc ........................ 1.19 0.50 0.50 0.04 1.73 1.73 XXX 

45980

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

88331 .......... TC ...... A Path consult intraop, 1 bloc ........................ 0.00 0.63 NA 0.04 0.67 NA XXX 

88332 .......... ............ A Path consult intraop, add’l ........................... 0.59 0.46 NA 0.04 1.09 NA XXX 

88332 .......... 26 ....... A Path consult intraop, add’l ........................... 0.59 0.24 0.24 0.02 0.85 0.85 XXX 

88332 .......... TC ...... A Path consult intraop, add’l ........................... 0.00 0.21 NA 0.02 0.23 NA XXX 

88342 .......... ............ A Immunohistochemistry ................................. 0.85 1.52 NA 0.05 2.42 NA XXX 

88342 .......... 26 ....... A Immunohistochemistry ................................. 0.85 0.35 0.35 0.03 1.23 1.23 XXX 

88342 .......... TC ...... A Immunohistochemistry ................................. 0.00 1.16 NA 0.02 1.18 NA XXX 

88346 .......... ............ A Immunofluorescent study ............................ 0.86 1.65 NA 0.05 2.56 NA XXX 

88346 .......... 26 ....... A Immunofluorescent study ............................ 0.86 0.36 0.36 0.03 1.25 1.25 XXX 

88346 .......... TC ...... A Immunofluorescent study ............................ 0.00 1.29 NA 0.02 1.31 NA XXX 

88347 .......... ............ A Immunofluorescent study ............................ 0.86 1.31 NA 0.05 2.22 NA XXX 

88347 .......... 26 ....... A Immunofluorescent study ............................ 0.86 0.34 0.34 0.03 1.23 1.23 XXX 

88347 .......... TC ...... A Immunofluorescent study ............................ 0.00 0.97 NA 0.02 0.99 NA XXX 

88348 .......... ............ A Electron microscopy .................................... 1.51 10.48 NA 0.13 12.12 NA XXX 

88348 .......... 26 ....... A Electron microscopy .................................... 1.51 0.62 0.62 0.06 2.20 2.20 XXX 

88348 .......... TC ...... A Electron microscopy .................................... 0.00 9.85 NA 0.07 9.92 NA XXX 

88349 .......... ............ A Scanning electron microscopy .................... 0.76 4.10 NA 0.09 4.95 NA XXX 

88349 .......... 26 ....... A Scanning electron microscopy .................... 0.76 0.32 0.32 0.03 1.11 1.11 XXX 

88349 .......... TC ...... A Scanning electron microscopy .................... 0.00 3.78 NA 0.06 3.84 NA XXX 

88355 .......... ............ A Analysis, skeletal muscle ............................ 1.85 8.06 NA 0.13 10.04 NA XXX 

88355 .......... 26 ....... A Analysis, skeletal muscle ............................ 1.85 0.77 0.77 0.07 2.70 2.70 XXX 

88355 .......... TC ...... A Analysis, skeletal muscle ............................ 0.00 7.29 NA 0.06 7.35 NA XXX 

88356 .......... ............ A Analysis, nerve ............................................ 3.03 4.70 NA 0.19 7.91 NA XXX 

88356 .......... 26 ....... A Analysis, nerve ............................................ 3.03 1.23 1.23 0.12 4.37 4.37 XXX 

88356 .......... TC ...... A Analysis, nerve ............................................ 0.00 3.47 NA 0.07 3.54 NA XXX 

88358 .......... ............ A Analysis, tumor ............................................ 0.95 0.92 NA 0.17 2.04 NA XXX 

88358 .......... 26 ....... A Analysis, tumor ............................................ 0.95 0.39 0.39 0.10 1.44 1.44 XXX 

88358 .......... TC ...... A Analysis, tumor ............................................ 0.00 0.53 NA 0.07 0.60 NA XXX 

88360 .......... ............ A Tumor immunohistochem/manual ............... 1.10 1.81 NA 0.08 2.99 NA XXX 

88360 .......... 26 ....... A Tumor immunohistochem/manual ............... 1.10 0.46 0.46 0.06 1.62 1.62 XXX 

88360 .......... TC ...... A Tumor immunohistochem/manual ............... 0.00 1.35 NA 0.02 1.37 NA XXX 

88361 .......... ............ A Tumor immunohistochem/comput ............... 1.18 3.07 NA 0.17 4.42 NA XXX 

88361 .......... 26 ....... A Tumor immunohistochem/comput ............... 1.18 0.48 0.48 0.10 1.76 1.76 XXX 

88361 .......... TC ...... A Tumor immunohistochem/comput ............... 0.00 2.59 NA 0.07 2.66 NA XXX 

88362 .......... ............ A Nerve teasing preparations ......................... 2.17 4.63 NA 0.15 6.95 NA XXX 

88362 .......... 26 ....... A Nerve teasing preparations ......................... 2.17 0.89 0.89 0.09 3.16 3.16 XXX 

88362 .......... TC ...... A Nerve teasing preparations ......................... 0.00 3.73 NA 0.06 3.79 NA XXX 

88365 .......... ............ A Insitu hybridization (fish) ............................. 1.20 2.32 NA 0.05 3.58 NA XXX 

88365 .......... 26 ....... A Insitu hybridization (fish) ............................. 1.20 0.50 0.50 0.03 1.73 1.73 XXX 

88365 .......... TC ...... A Insitu hybridization (fish) ............................. 0.00 1.83 NA 0.02 1.85 NA XXX 

88367 .......... ............ A Insitu hybridization, auto ............................. 1.30 4.76 NA 0.12 6.18 NA XXX 

88367 .......... 26 ....... A Insitu hybridization, auto ............................. 1.30 0.53 0.53 0.06 1.89 1.89 XXX 

88367 .......... TC ...... A Insitu hybridization, auto ............................. 0.00 4.23 NA 0.06 4.29 NA XXX 

88368 .......... ............ A Insitu hybridization, manual ......................... 1.40 3.95 NA 0.12 5.47 NA XXX 

88368 .......... 26 ....... A Insitu hybridization, manual ......................... 1.40 0.58 0.58 0.06 2.05 2.05 XXX 

88368 .......... TC ...... A Insitu hybridization, manual ......................... 0.00 3.37 NA 0.06 3.43 NA XXX 

88371 .......... 26 ....... A Protein, western blot tissue ......................... 0.37 0.13 0.13 0.01 0.51 0.51 XXX 

88372 .......... 26 ....... A Protein analysis w/probe ............................. 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

88380 .......... ............ C Microdissection ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88380 .......... 26 ....... C Microdissection ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88380 .......... TC ...... C Microdissection ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88399 .......... ............ C Surgical pathology procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88399 .......... 26 ....... C Surgical pathology procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88399 .......... TC ...... C Surgical pathology procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

89060 .......... 26 ....... A Exam,synovial fluid crystals ........................ 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

89100 .......... ............ A Sample intestinal contents .......................... 0.60 3.64 0.32 0.03 4.27 0.95 XXX 

89105 .......... ............ A Sample intestinal contents .......................... 0.50 3.28 0.28 0.02 3.80 0.80 XXX 

89130 .......... ............ A Sample stomach contents ........................... 0.45 3.07 0.19 0.02 3.54 0.66 XXX 

89132 .......... ............ A Sample stomach contents ........................... 0.19 2.84 0.16 0.01 3.04 0.36 XXX 

89135 .......... ............ A Sample stomach contents ........................... 0.79 3.96 0.32 0.04 4.79 1.15 XXX 

89136 .......... ............ A Sample stomach contents ........................... 0.21 2.93 0.15 0.01 3.15 0.37 XXX 

89140 .......... ............ A Sample stomach contents ........................... 0.94 3.28 0.36 0.04 4.26 1.35 XXX 

89141 .......... ............ A Sample stomach contents ........................... 0.85 3.72 0.40 0.03 4.60 1.29 XXX 

89220 .......... ............ A Sputum specimen collection ....................... 0.00 0.39 NA 0.02 0.41 NA XXX 

89230 .......... ............ A Collect sweat for test ................................... 0.00 0.11 NA 0.02 0.13 NA XXX 

89240 .......... ............ C Pathology lab procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90281 .......... ............ I Human ig, im ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90283 .......... ............ I Human ig, iv ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90287 .......... ............ I Botulinum antitoxin ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90288 .......... ............ I Botulism ig, iv .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90291 .......... ............ I Cmv ig, iv .................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90296 .......... ............ E Diphtheria antitoxin ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90371 .......... ............ E Hep b ig, im ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90375 .......... ............ E Rabies ig, im/sc ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

45981

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

90376 .......... ............ E Rabies ig, heat treated ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90379 .......... ............ I Rsv ig, iv ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90384 .......... ............ I Rh ig, full-dose, im ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90385 .......... ............ E Rh ig, minidose, im ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90386 .......... ............ I Rh ig, iv ....................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90389 .......... ............ I Tetanus ig, im .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90393 .......... ............ E Vaccina ig, im .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90396 .......... ............ E Varicella-zoster ig, im .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90399 .......... ............ I Immune globulin .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90465 .......... ............ A Immune admin 1 inj, < 8 yrs ....................... 0.17 0.31 0.27 0.01 0.49 0.45 XXX 

90466 .......... ............ A Immune admin addl inj, < 8 y ..................... 0.15 0.13 0.12 0.01 0.29 0.28 ZZZ 

90467 .......... ............ R Immune admin o or n, < 8 yrs .................... 0.17 0.31 0.00 0.01 0.49 0.18 XXX 

90468 .......... ............ R Immune admin o/n, addl < 8 y .................... 0.15 0.13 0.00 0.01 0.29 0.16 ZZZ 

90471 .......... ............ A Immunization admin .................................... 0.17 0.31 NA 0.01 0.49 NA XXX 

90472 .......... ............ A Immunization admin, each add ................... 0.15 0.13 NA 0.01 0.29 NA ZZZ 

90473 .......... ............ R Immune admin oral/nasal ............................ 0.17 0.31 0.00 0.01 0.49 0.18 XXX 

90474 .......... ............ R Immune admin oral/nasal addl .................... 0.15 0.13 0.00 0.01 0.29 0.16 ZZZ 

90476 .......... ............ E Adenovirus vaccine, type 4 ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90477 .......... ............ E Adenovirus vaccine, type 7 ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90581 .......... ............ E Anthrax vaccine, sc ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90585 .......... ............ E Bcg vaccine, percut ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90586 .......... ............ E Bcg vaccine, intravesical ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90632 .......... ............ E Hep a vaccine, adult im .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90633 .......... ............ E Hep a vacc, ped/adol, 2 dose ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90634 .......... ............ E Hep a vacc, ped/adol, 3 dose ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90636 .......... ............ E Hep a/hep b vacc, adult im ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90645 .......... ............ E Hib vaccine, hboc, im .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90646 .......... ............ E Hib vaccine, prp-d, im ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90647 .......... ............ E Hib vaccine, prp-omp, im ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90648 .......... ............ E Hib vaccine, prp-t, im .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90665 .......... ............ E Lyme disease vaccine, im ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90669 .......... ............ N Pneumococcal vacc, ped <5 ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90675 .......... ............ E Rabies vaccine, im ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90676 .......... ............ E Rabies vaccine, id ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90680 .......... ............ E Rotovirus vaccine, oral ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90690 .......... ............ E Typhoid vaccine, oral .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90691 .......... ............ E Typhoid vaccine, im .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90692 .......... ............ E Typhoid vaccine, h-p, sc/id ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90693 .......... ............ E Typhoid vaccine, akd, sc ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90698 .......... ............ E Dtap-hib-ip vaccine, im ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90700 .......... ............ E Dtap vaccine, < 7 yrs, im ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90701 .......... ............ E Dtp vaccine, im ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90702 .......... ............ E Dt vaccine < 7, im ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90703 .......... ............ E Tetanus vaccine, im .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90704 .......... ............ E Mumps vaccine, sc ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90705 .......... ............ E Measles vaccine, sc .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90706 .......... ............ E Rubella vaccine, sc ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90707 .......... ............ E Mmr vaccine, sc .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90708 .......... ............ E Measles-rubella vaccine, sc ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90710 .......... ............ E Mmrv vaccine, sc ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90712 .......... ............ E Oral poliovirus vaccine ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90713 .......... ............ E Poliovirus, ipv, sc ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90715 .......... ............ E Tdap vaccine >7 im ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90716 .......... ............ E Chicken pox vaccine, sc ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90717 .......... ............ E Yellow fever vaccine, sc .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90718 .......... ............ E Td vaccine > 7, im ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90719 .......... ............ E Diphtheria vaccine, im ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90720 .......... ............ E Dtp/hib vaccine, im ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90721 .......... ............ E Dtap/hib vaccine, im .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90723 .......... ............ I Dtap-hep b-ipv vaccine, im ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90725 .......... ............ E Cholera vaccine, injectable ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90727 .......... ............ E Plague vaccine, im ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XX 

90733 .......... ............ E Meningococcal vaccine, sc ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90734 .......... ............ E Meningococcal vaccine, im ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90735 .......... ............ E Encephalitis vaccine, sc .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90748 .......... ............ I Hep b/hib vaccine, im .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90749 .......... ............ E Vaccine toxoid ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90780 .......... ............ I IV infusion therapy, 1 hour .......................... 0.17 0.00 0.00 0.07 0.24 0.24 XXX 

90781 .......... ............ I IV infusion, additional hour .......................... 0.17 0.00 0.00 0.04 0.21 0.21 ZZZ 

90782 .......... ............ I Injection, sc/im ............................................. 0.17 0.00 0.00 0.01 0.18 0.18 XXX 

90783 .......... ............ A Injection, ia .................................................. 0.17 0.31 NA 0.02 0.50 NA XXX 

90784 .......... ............ I Injection, iv .................................................. 0.17 0.00 0.00 0.04 0.21 0.21 XXX 

90788 .......... ............ A Injection of antibiotic .................................... 0.17 0.26 NA 0.01 0.44 NA XXX 

90799 .......... ............ C Ther/prophylactic/dx inject ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

45982

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

90801 .......... ............ A Psy dx interview .......................................... 2.81 1.19 0.91 0.06 4.05 3.77 XXX 

90802 .......... ............ A Intac psy dx interview .................................. 3.02 1.23 0.96 0.07 4.32 4.05 XXX 

90804 .......... ............ A Psytx, office, 20-30 min ............................... 1.21 0.49 0.37 0.03 1.74 1.61 XXX 

90805 .......... ............ A Psytx, off, 20-30 min w/e&m ....................... 1.37 0.51 0.41 0.03 1.91 1.81 XXX 

90806 .......... ............ A Psytx, off, 45-50 min ................................... 1.86 0.68 0.58 0.04 2.59 2.49 XXX 

90807 .......... ............ A Psytx, off, 45-50 min w/e&m ....................... 2.02 0.70 0.61 0.05 2.78 2.69 XXX 

90808 .......... ............ A Psytx, office, 75-80 min ............................... 2.80 1.00 0.87 0.06 3.85 3.73 XXX 

90809 .......... ............ A Psytx, off, 75-80, w/e&m ............................. 2.96 0.99 0.90 0.07 4.02 3.92 XXX 

90810 .......... ............ A Intac psytx, off, 20-30 min ........................... 1.32 0.51 0.41 0.04 1.87 1.77 XXX 

90811 .......... ............ A Intac psytx, 20-30, w/e&m ........................... 1.48 0.58 0.45 0.04 2.10 1.97 XXX 

90812 .......... ............ A Intac psytx, off, 45-50 min ........................... 1.97 0.77 0.62 0.04 2.79 2.64 XXX 

90813 .......... ............ A Intac psytx, 45-50 min w/e&m ..................... 2.13 0.77 0.65 0.05 2.96 2.84 XXX 

90814 .......... ............ A Intac psytx, off, 75-80 min ........................... 2.91 1.07 0.94 0.06 4.04 3.91 XXX 

90815 .......... ............ A Intac psytx, 75-80 w/e&m ............................ 3.07 1.05 0.92 0.07 4.19 4.06 XXX 

90816 .......... ............ A Psytx, hosp, 20-30 min ............................... 1.25 NA 0.45 0.03 NA 1.73 XXX 

90817 .......... ............ A Psytx, hosp, 20-30 min w/e&m ................... 1.41 NA 0.45 0.03 NA 1.90 XXX 

90818 .......... ............ A Psytx, hosp, 45-50 min ............................... 1.89 NA 0.67 0.04 NA 2.60 XXX 

90819 .......... ............ A Psytx, hosp, 45-50 min w/e&m ................... 2.05 NA 0.64 0.05 NA 2.75 XXX 

90821 .......... ............ A Psytx, hosp, 75-80 min ............................... 2.84 NA 0.97 0.06 NA 3.87 XXX 

90822 .......... ............ A Psytx, hosp, 75-80 min w/e&m ................... 3.00 NA 0.93 0.08 NA 4.01 XXX 

90823 .......... ............ A Intac psytx, hosp, 20-30 min ....................... 1.36 NA 0.47 0.03 NA 1.86 XXX 

90824 .......... ............ A Intac psytx, hsp 20-30 w/e&m ..................... 1.52 NA 0.48 0.04 NA 2.05 XXX 

90826 .......... ............ A Intac psytx, hosp, 45-50 min ....................... 2.01 NA 0.70 0.05 NA 2.76 XXX 

90827 .......... ............ A Intac psytx, hsp 45-50 w/e&m ..................... 2.16 NA 0.67 0.05 NA 2.89 XXX 

90828 .......... ............ A Intac psytx, hosp, 75-80 min ....................... 2.95 NA 1.02 0.06 NA 4.03 XXX 

90829 .......... ............ A Intac psytx, hsp 75-80 w/e&m ..................... 3.11 NA 0.96 0.07 NA 4.14 XXX 

90845 .......... ............ A Psychoanalysis ............................................ 1.79 0.57 0.54 0.04 2.40 2.37 XXX 

90846 .......... ............ R Family psytx w/o patient .............................. 1.83 0.64 0.63 0.04 2.51 2.50 XXX 

90847 .......... ............ R Family psytx w/patient ................................. 2.21 0.81 0.74 0.05 3.08 3.01 XXX 

90849 .......... ............ R Multiple family group psytx .......................... 0.59 0.27 0.24 0.02 0.88 0.85 XXX 

90853 .......... ............ A Group psychotherapy .................................. 0.59 0.25 0.23 0.01 0.85 0.83 XXX 

90857 .......... ............ A Intac group psytx ......................................... 0.63 0.29 0.25 0.01 0.93 0.89 XXX 

90862 .......... ............ A Medication management ............................. 0.95 0.42 0.32 0.02 1.39 1.29 XXX 

90865 .......... ............ A Narcosynthesis ............................................ 2.85 1.35 0.89 0.12 4.31 3.86 XXX 

90870 .......... ............ A Electroconvulsive therapy ........................... 1.88 1.82 0.58 0.04 3.74 2.50 000 

90871 .......... ............ N Electroconvulsive therapy ........................... 2.73 NA 0.99 0.07 NA 3.78 000 

90875 .......... ............ N Psychophysiological therapy ....................... 1.20 0.85 0.46 0.04 2.09 1.70 XXX 

90876 .......... ............ N Psychophysiological therapy ....................... 1.90 1.11 0.72 0.05 3.06 2.68 XXX 

90880 .......... ............ A Hypnotherapy .............................................. 2.19 0.98 0.67 0.05 3.22 2.92 XXX 

90882 .......... ............ N Environmental manipulation ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90885 .......... ............ B Psy evaluation of records ............................ 0.97 0.37 0.37 0.02 1.36 1.36 XXX 

90887 .......... ............ B Consultation with family .............................. 1.48 0.82 0.56 0.04 2.34 2.08 XXX 

90889 .......... ............ B Preparation of report ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90899 .......... ............ C Psychiatric service/therapy .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90901 .......... ............ A Biofeedback train, any meth ....................... 0.41 0.64 0.14 0.02 1.07 0.57 000 

90911 .......... ............ A Biofeedback peri/uro/rectal .......................... 0.89 1.58 0.33 0.06 2.53 1.28 000 

90918 .......... ............ I ESRD related services, month .................... 11.18 5.96 5.96 0.36 17.50 17.50 XXX 

90919 .......... ............ I ESRD related services, month .................... 8.55 3.90 3.90 0.29 12.74 12.74 XXX 

90920 .......... ............ I ESRD related services, month .................... 7.27 3.65 3.65 0.23 11.16 11.16 XXX 

90921 .......... ............ I ESRD related services, month .................... 4.47 2.37 2.37 0.14 6.98 6.98 XXX 

90922 .......... ............ I ESRD related services, day ........................ 0.37 0.21 0.21 0.01 0.59 0.59 XXX 

90923 .......... ............ I Esrd related services, day ........................... 0.28 0.13 0.13 0.01 0.42 0.42 XXX 

90924 .......... ............ I Esrd related services, day ........................... 0.24 0.12 0.12 0.01 0.37 0.37 XXX 

90925 .......... ............ I Esrd related services, day ........................... 0.15 0.08 0.08 0.01 0.24 0.24 XXX 

90935 .......... ............ A Hemodialysis, one evaluation ..................... 1.22 NA 0.65 0.04 NA 1.91 000 

90937 .......... ............ A Hemodialysis, repeated eval ....................... 2.11 NA 0.95 0.07 NA 3.13 000 

90945 .......... ............ A Dialysis, one evaluation .............................. 1.28 NA 0.67 0.04 NA 1.99 000 

90947 .......... ............ A Dialysis, repeated eval ................................ 2.16 NA 0.97 0.07 NA 3.20 000 

90997 .......... ............ A Hemoperfusion ............................................ 1.84 NA 0.65 0.06 NA 2.55 000 

90999 .......... ............ C Dialysis procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91000 .......... ............ A Esophageal intubation ................................. 0.73 0.84 NA 0.04 1.62 NA 000 

91000 .......... 26 ....... A Esophageal intubation ................................. 0.73 0.25 0.25 0.03 1.01 1.01 000 

91000 .......... TC ...... A Esophageal intubation ................................. 0.00 0.59 NA 0.01 0.60 NA 000 

91010 .......... ............ A Esophagus motility study ............................ 1.25 4.76 NA 0.12 6.14 NA 000 

91010 .......... 26 ....... A Esophagus motility study ............................ 1.25 0.47 0.47 0.06 1.78 1.78 000 

91010 .......... TC ...... A Esophagus motility study ............................ 0.00 4.30 NA 0.06 4.36 NA 000 

91011 .......... ............ A Esophagus motility study ............................ 1.50 5.79 NA 0.13 7.42 NA 000 

91011 .......... 26 ....... A Esophagus motility study ............................ 1.50 0.57 0.57 0.07 2.15 2.15 000 

91011 .......... TC ...... A Esophagus motility study ............................ 0.00 5.22 NA 0.06 5.28 NA 000 

91012 .......... ............ A Esophagus motility study ............................ 1.46 5.76 NA 0.13 7.35 NA 000 

91012 .......... 26 ....... A Esophagus motility study ............................ 1.46 0.55 0.55 0.06 2.07 2.07 000 

91012 .......... TC ...... A Esophagus motility study ............................ 0.00 5.21 NA 0.07 5.28 NA 000 

91020 .......... ............ A Gastric motility ............................................. 1.44 4.49 NA 0.13 6.07 NA 000 

91020 .......... 26 ....... A Gastric motility ............................................. 1.44 0.51 0.51 0.07 2.02 2.02 000 

45983

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

91020 .......... TC ...... A Gastric motility ............................................. 0.00 3.99 NA 0.06 4.05 NA 000 

91030 .......... ............ A Acid perfusion of esophagus ....................... 0.91 2.67 NA 0.06 3.64 NA 000 

91030 .......... 26 ....... A Acid perfusion of esophagus ....................... 0.91 0.35 0.35 0.04 1.30 1.30 000 

91030 .......... TC ...... A Acid perfusion of esophagus ....................... 0.00 2.32 NA 0.02 2.34 NA 000 

91034 .......... ............ A Gastroesophageal reflux test ...................... 0.97 5.70 NA 0.12 6.79 NA XXX 

91034 .......... 26 ....... A Gastroesophageal reflux test ...................... 0.97 0.36 0.36 0.06 1.40 1.40 XXX 

91034 .......... TC ...... A Gastroesophageal reflux test ...................... 0.00 5.33 NA 0.06 5.39 NA XXX 

91035 .......... ............ A G-esoph reflx tst w/electrod ........................ 1.59 11.65 NA 0.12 13.36 NA XXX 

91035 .......... 26 ....... A G-esoph reflx tst w/electrod ........................ 1.59 0.60 0.60 0.06 2.25 2.25 XXX 

91035 .......... TC ...... A G-esoph reflx tst w/electrod ........................ 0.00 11.05 NA 0.06 11.11 NA XXX 

91037 .......... ............ A Esoph imped function test ........................... 0.97 3.22 NA 0.12 4.32 NA XXX 

91037 .......... 26 ....... A Esoph imped function test ........................... 0.97 0.36 0.36 0.06 1.40 1.40 XXX 

91037 .......... TC ...... A Esoph imped function test ........................... 0.00 2.86 NA 0.06 2.92 NA XXX 

91038 .......... ............ A Esoph imped funct test > 1h ....................... 1.10 2.47 NA 0.12 3.69 NA XXX 

91038 .......... 26 ....... A Esoph imped funct test > 1h ....................... 1.10 0.42 0.42 0.06 1.58 1.58 XXX 

91038 .......... TC ...... A Esoph imped funct test > 1h ....................... 0.00 2.05 NA 0.06 2.11 NA XXX 

91040 .......... ............ A Esoph balloon distension tst ....................... 0.97 11.26 NA 0.12 12.35 NA XXX 

91040 .......... 26 ....... A Esoph balloon distension tst ....................... 0.97 0.36 0.36 0.06 1.40 1.40 XXX 

91040 .......... TC ...... A Esoph balloon distension tst ....................... 0.00 10.89 NA 0.06 10.95 NA XXX 

91052 .......... ............ A Gastric analysis test .................................... 0.79 2.64 NA 0.05 3.48 NA 000 

91052 .......... 26 ....... A Gastric analysis test .................................... 0.79 0.30 0.30 0.03 1.12 1.12 000 

91052 .......... TC ...... A Gastric analysis test .................................... 0.00 2.34 NA 0.02 2.36 NA 000 

91055 .......... ............ A Gastric intubation for smear ........................ 0.94 2.91 NA 0.07 3.92 NA 000 

91055 .......... 26 ....... A Gastric intubation for smear ........................ 0.94 0.27 0.27 0.05 1.26 1.26 000 

91055 .......... TC ...... A Gastric intubation for smear ........................ 0.00 2.64 NA 0.02 2.66 NA 000 

91060 .......... ............ A Gastric saline load test ................................ 0.45 1.89 NA 0.05 2.39 NA 000 

91060 .......... 26 ....... A Gastric saline load test ................................ 0.45 0.14 0.14 0.03 0.62 0.62 000 

91060 .......... TC ...... A Gastric saline load test ................................ 0.00 1.75 NA 0.02 1.77 NA 000 

91065 .......... ............ A Breath hydrogen test ................................... 0.20 1.62 NA 0.03 1.85 NA 000 

91065 .......... 26 ....... A Breath hydrogen test ................................... 0.20 0.07 0.07 0.01 0.28 0.28 000 

91065 .......... TC ...... A Breath hydrogen test ................................... 0.00 1.55 NA 0.02 1.57 NA 000 

91100 .......... ............ A Pass intestine bleeding tube ....................... 1.08 2.70 0.28 0.07 3.85 1.43 000 

91105 .......... ............ A Gastric intubation treatment ........................ 0.37 1.99 0.09 0.03 2.39 0.49 000 

91110 .......... ............ A Gi tract capsule endoscopy ......................... 3.65 24.17 NA 0.16 27.98 NA XXX 

91110 .......... 26 ....... A Gi tract capsule endoscopy ......................... 3.65 1.38 1.38 0.09 5.12 5.12 XXX 

91110 .......... TC ...... A Gi tract capsule endoscopy ......................... 0.00 22.79 NA 0.07 22.86 NA XXX 

91120 .......... ............ A Rectal sensation test ................................... 0.97 11.11 NA 0.11 12.19 NA XXX 

91120 .......... 26 ....... A Rectal sensation test ................................... 0.97 0.36 0.36 0.07 1.41 1.41 XXX 

91120 .......... TC ...... A Rectal sensation test ................................... 0.00 10.74 NA 0.04 10.78 NA XXX 

91122 .......... ............ A Anal pressure record ................................... 1.77 5.15 NA 0.21 7.13 NA 000 

91122 .......... 26 ....... A Anal pressure record ................................... 1.77 0.62 0.62 0.13 2.52 2.52 000 

91122 .......... TC ...... A Anal pressure record ................................... 0.00 4.53 NA 0.08 4.61 NA 000 

91123 .......... ............ B Irrigate fecal impaction ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91132 .......... ............ C Electrogastrography .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91132 .......... 26 ....... A Electrogastrography .................................... 0.52 0.20 0.20 0.02 0.74 0.74 XXX 

91132 .......... TC ...... C Electrogastrography .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91133 .......... ............ C Electrogastrography w/test .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91133 .......... 26 ....... A Electrogastrography w/test .......................... 0.66 0.25 0.25 0.03 0.94 0.94 XXX 

91133 .......... TC ...... C Electrogastrography w/test .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91299 .......... ............ C Gastroenterology procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91299 .......... 26 ....... C Gastroenterology procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91299 .......... TC ...... C Gastroenterology procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92002 .......... ............ A Eye exam, new patient ................................ 0.88 0.97 0.33 0.02 1.87 1.23 XXX 

92004 .......... ............ A Eye exam, new patient ................................ 1.67 1.68 0.66 0.04 3.40 2.38 XXX 

92012 .......... ............ A Eye exam established pat ........................... 0.67 1.01 0.28 0.02 1.70 0.97 XXX 

92014 .......... ............ A Eye exam & treatment ................................ 1.10 1.39 0.46 0.03 2.52 1.59 XXX 

92015 .......... ............ N Refraction .................................................... 0.38 1.21 0.15 0.01 1.61 0.54 XXX 

92018 .......... ............ A New eye exam & treatment ........................ 2.51 NA 1.05 0.07 NA 3.62 XXX 

92019 .......... ............ A Eye exam & treatment ................................ 1.31 NA 0.55 0.03 NA 1.89 XXX 

92020 .......... ............ A Special eye evaluation ................................ 0.37 0.33 0.16 0.01 0.71 0.54 XXX 

92060 .......... ............ A Special eye evaluation ................................ 0.69 0.72 NA 0.03 1.45 NA XXX 

92060 .......... 26 ....... A Special eye evaluation ................................ 0.69 0.28 0.28 0.02 0.99 0.99 XXX 

92060 .......... TC ...... A Special eye evaluation ................................ 0.00 0.44 NA 0.01 0.45 NA XXX 

92065 .......... ............ A Orthoptic/pleoptic training ............................ 0.37 0.57 NA 0.02 0.96 NA XXX 

92065 .......... 26 ....... A Orthoptic/pleoptic training ............................ 0.37 0.15 0.15 0.01 0.53 0.53 XXX 

92065 .......... TC ...... A Orthoptic/pleoptic training ............................ 0.00 0.43 NA 0.01 0.44 NA XXX 

92070 .......... ............ A Fitting of contact lens .................................. 0.70 1.04 0.31 0.02 1.76 1.03 XXX 

92081 .......... ............ A Visual field examination(s) .......................... 0.36 0.93 NA 0.02 1.31 NA XXX 

92081 .......... 26 ....... A Visual field examination(s) .......................... 0.36 0.15 0.15 0.01 0.52 0.52 XXX 

92081 .......... TC ...... A Visual field examination(s) .......................... 0.00 0.78 NA 0.01 0.79 NA XXX 

92082 .......... ............ A Visual field examination(s) .......................... 0.44 1.22 NA 0.02 1.68 NA XXX 

92082 .......... 26 ....... A Visual field examination(s) .......................... 0.44 0.19 0.19 0.01 0.64 0.64 XXX 

92082 .......... TC ...... A Visual field examination(s) .......................... 0.00 1.03 NA 0.01 1.04 NA XXX 

92083 .......... ............ A Visual field examination(s) .......................... 0.50 1.41 NA 0.02 1.93 NA XXX 

45984

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

92083 .......... 26 ....... A Visual field examination(s) .......................... 0.50 0.22 0.22 0.01 0.73 0.73 XXX 

92083 .......... TC ...... A Visual field examination(s) .......................... 0.00 1.19 NA 0.01 1.20 NA XXX 

92100 .......... ............ A Serial tonometry exam(s) ............................ 0.92 1.34 0.35 0.02 2.28 1.30 XXX 

92120 .......... ............ A Tonography & eye evaluation ..................... 0.81 1.06 0.31 0.02 1.89 1.14 XXX 

92130 .......... ............ A Water provocation tonography .................... 0.81 1.26 0.36 0.02 2.09 1.19 XXX 

92135 .......... ............ A Opthalmic dx imaging .................................. 0.35 0.77 NA 0.02 1.14 NA XXX 

92135 .......... 26 ....... A Opthalmic dx imaging .................................. 0.35 0.15 0.15 0.01 0.51 0.51 XXX 

92135 .......... TC ...... A Opthalmic dx imaging .................................. 0.00 0.63 NA 0.01 0.64 NA XXX 

92136 .......... ............ A Ophthalmic biometry ................................... 0.54 1.58 NA 0.08 2.20 NA XXX 

92136 .......... 26 ....... A Ophthalmic biometry ................................... 0.54 0.24 0.24 0.01 0.79 0.79 XXX 

92136 .......... TC ...... A Ophthalmic biometry ................................... 0.00 1.35 NA 0.07 1.42 NA XXX 

92140 .......... ............ A Glaucoma provocative tests ........................ 0.50 0.98 0.21 0.01 1.49 0.72 XXX 

92225 .......... ............ A Special eye exam, initial ............................. 0.38 0.22 0.16 0.01 0.61 0.55 XXX 

92226 .......... ............ A Special eye exam, subsequent ................... 0.33 0.21 0.14 0.01 0.55 0.48 XXX 

92230 .......... ............ A Eye exam with photos ................................. 0.60 1.39 0.20 0.02 2.01 0.82 XXX 

92235 .......... ............ A Eye exam with photos ................................. 0.81 2.50 NA 0.08 3.39 NA XXX 

92235 .......... 26 ....... A Eye exam with photos ................................. 0.81 0.36 0.36 0.02 1.19 1.19 XXX 

92235 .......... TC ...... A Eye exam with photos ................................. 0.00 2.14 NA 0.06 2.20 NA XXX 

92240 .......... ............ A Icg angiography ........................................... 1.10 5.75 NA 0.09 6.94 NA XXX 

92240 .......... 26 ....... A Icg angiography ........................................... 1.10 0.49 0.49 0.03 1.62 1.62 XXX 

92240 .......... TC ...... A Icg angiography ........................................... 0.00 5.27 NA 0.06 5.33 NA XXX 

92250 .......... ............ A Eye exam with photos ................................. 0.44 1.47 NA 0.02 1.93 NA XXX 

92250 .......... 26 ....... A Eye exam with photos ................................. 0.44 0.19 0.19 0.01 0.64 0.64 XXX 

92250 .......... TC ...... A Eye exam with photos ................................. 0.00 1.29 NA 0.01 1.30 NA XXX 

92260 .......... ............ A Ophthalmoscopy/dynamometry ................... 0.20 0.25 0.09 0.01 0.46 0.30 XXX 

92265 .......... ............ A Eye muscle evaluation ................................ 0.81 1.39 NA 0.06 2.26 NA XXX 

92265 .......... 26 ....... A Eye muscle evaluation ................................ 0.81 0.28 0.28 0.04 1.13 1.13 XXX 

92265 .......... TC ...... A Eye muscle evaluation ................................ 0.00 1.11 NA 0.02 1.13 NA XXX 

92270 .......... ............ A Electro-oculography ..................................... 0.81 1.49 NA 0.05 2.35 NA XXX 

92270 .......... 26 ....... A Electro-oculography ..................................... 0.81 0.32 0.32 0.03 1.16 1.16 XXX 

92270 .......... TC ...... A Electro-oculography ..................................... 0.00 1.17 NA 0.02 1.19 NA XXX 

92275 .......... ............ A Electroretinography ..................................... 1.01 1.92 NA 0.05 2.98 NA XXX 

92275 .......... 26 ....... A Electroretinography ..................................... 1.01 0.42 0.42 0.03 1.46 1.46 XXX 

92275 .......... TC ...... A Electroretinography ..................................... 0.00 1.50 NA 0.02 1.52 NA XXX 

92283 .......... ............ A Color vision examination ............................. 0.17 0.84 NA 0.02 1.03 NA XXX 

92283 .......... 26 ....... A Color vision examination ............................. 0.17 0.07 0.07 0.01 0.25 0.25 XXX 

92283 .......... TC ...... A Color vision examination ............................. 0.00 0.77 NA 0.01 0.78 NA XXX 

92284 .......... ............ A Dark adaptation eye exam .......................... 0.24 1.74 NA 0.02 2.00 NA XXX 

92284 .......... 26 ....... A Dark adaptation eye exam .......................... 0.24 0.08 0.08 0.01 0.33 0.33 XXX 

92284 .......... TC ...... A Dark adaptation eye exam .......................... 0.00 1.66 NA 0.01 1.67 NA XXX 

92285 .......... ............ A Eye photography ......................................... 0.20 0.94 NA 0.02 1.16 NA XXX 

92285 .......... 26 ....... A Eye photography ......................................... 0.20 0.09 0.09 0.01 0.30 0.30 XXX 

92285 .......... TC ...... A Eye photography ......................................... 0.00 0.86 NA 0.01 0.87 NA XXX 

92286 .......... ............ A Internal eye photography ............................ 0.66 2.88 NA 0.04 3.58 NA XXX 

92286 .......... 26 ....... A Internal eye photography ............................ 0.66 0.29 0.29 0.02 0.97 0.97 XXX 

92286 .......... TC ...... A Internal eye photography ............................ 0.00 2.59 NA 0.02 2.61 NA XXX 

92287 .......... ............ A Internal eye photography ............................ 0.81 2.28 0.30 0.02 3.12 1.13 XXX 

92310 .......... ............ N Contact lens fitting ....................................... 1.17 1.13 0.45 0.04 2.34 1.66 XXX 

92311 .......... ............ A Contact lens fitting ....................................... 1.08 1.14 0.35 0.03 2.25 1.47 XXX 

92312 .......... ............ A Contact lens fitting ....................................... 1.26 1.17 0.49 0.03 2.47 1.78 XXX 

92313 .......... ............ A Contact lens fitting ....................................... 0.92 1.13 0.28 0.02 2.07 1.22 XXX 

92314 .......... ............ N Prescription of contact lens ......................... 0.69 0.98 0.27 0.01 1.68 0.97 XXX 

92315 .......... ............ A Prescription of contact lens ......................... 0.45 0.95 0.16 0.01 1.41 0.62 XXX 

92316 .......... ............ A Prescription of contact lens ......................... 0.68 1.05 0.28 0.02 1.75 0.98 XXX 

92317 .......... ............ A Prescription of contact lens ......................... 0.45 1.05 0.15 0.01 1.52 0.61 XXX 

92325 .......... ............ A Modification of contact lens ......................... 0.00 0.49 NA 0.01 0.50 NA XXX 

92326 .......... ............ A Replacement of contact lens ....................... 0.00 1.41 NA 0.06 1.47 NA XXX 

92330 .......... ............ A Fitting of artificial eye .................................. 1.08 0.99 0.32 0.03 2.10 1.43 XXX 

92335 .......... ............ A Fitting of artificial eye .................................. 0.45 0.88 0.16 0.01 1.34 0.62 XXX 

92340 .......... ............ N Fitting of spectacles .................................... 0.37 0.66 NA 0.01 1.04 NA XXX 

92341 .......... ............ N Fitting of spectacles .................................... 0.47 0.70 NA 0.01 1.18 NA XXX 

92342 .......... ............ N Fitting of spectacles .................................... 0.53 0.72 NA 0.01 1.27 NA XXX 

92352 .......... ............ B Special spectacles fitting ............................. 0.37 0.67 NA 0.01 1.05 NA XXX 

92353 .......... ............ B Special spectacles fitting ............................. 0.50 0.72 NA 0.02 1.24 NA XXX 

92354 .......... ............ B Special spectacles fitting ............................. 0.00 7.13 NA 0.10 7.23 NA XXX 

92355 .......... ............ B Special spectacles fitting ............................. 0.00 3.53 NA 0.01 3.54 NA XXX 

92358 .......... ............ B Eye prosthesis service ................................ 0.00 0.81 NA 0.05 0.86 NA XXX 

92370 .......... ............ N Repair & adjust spectacles ......................... 0.32 0.53 NA 0.02 0.87 NA XXX 

92371 .......... ............ B Repair & adjust spectacles ......................... 0.00 0.53 NA 0.02 0.55 NA XXX 

92390 .......... ............ N Supply of spectacles ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92391 .......... ............ N Supply of contact lenses ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92392 .......... ............ I Supply of low vision aids ............................. 0.00 0.00 0.00 0.02 0.02 0.02 XXX 

92393 .......... ............ I Supply of artificial eye ................................. 0.00 0.00 0.00 0.57 0.57 0.57 XXX 

92395 .......... ............ I Supply of spectacles ................................... 0.00 0.00 0.00 0.10 0.10 0.10 XXX 

45985

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

92396 .......... ............ I Supply of contact lenses ............................. 0.00 0.00 0.00 0.07 0.07 0.07 XXX 

92499 .......... ............ C Eye service or procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92499 .......... 26 ....... C Eye service or procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92499 .......... TC ...... C Eye service or procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92502 .......... ............ A Ear and throat examination ......................... 1.51 NA 1.08 0.05 NA 2.65 000 

92504 .......... ............ A Ear microscopy examination ....................... 0.18 0.50 0.09 0.01 0.69 0.28 XXX 

92506 .......... ............ A Speech/hearing evaluation .......................... 0.86 2.68 0.38 0.03 3.57 1.27 XXX 

92507 .......... ............ A Speech/hearing therapy .............................. 0.52 1.10 0.22 0.02 1.65 0.76 XXX 

92508 .......... ............ A Speech/hearing therapy .............................. 0.26 0.51 0.12 0.01 0.78 0.39 XXX 

92510 .......... ............ I Rehab for ear implant ................................. 1.50 0.00 0.00 0.07 1.57 1.57 XXX 

92511 .......... ............ A Nasopharyngoscopy .................................... 0.84 3.23 0.76 0.03 4.10 1.64 000 

92512 .......... ............ A Nasal function studies ................................. 0.55 1.13 0.18 0.02 1.70 0.75 XXX 

92516 .......... ............ A Facial nerve function test ............................ 0.43 1.18 0.21 0.01 1.62 0.65 XXX 

92520 .......... ............ A Laryngeal function studies .......................... 0.76 0.51 0.38 0.03 1.31 1.17 XXX 

92526 .......... ............ A Oral function therapy ................................... 0.55 1.75 0.20 0.02 2.32 0.77 XXX 

92531 .......... ............ B Spontaneous nystagmus study ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92532 .......... ............ B Positional nystagmus test ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92533 .......... ............ B Caloric vestibular test .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92534 .......... ............ B Optokinetic nystagmus test ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92541 .......... ............ A Spontaneous nystagmus test ...................... 0.40 1.02 NA 0.04 1.47 NA XXX 

92541 .......... 26 ....... A Spontaneous nystagmus test ...................... 0.40 0.18 0.18 0.02 0.60 0.60 XXX 

92541 .......... TC ...... A Spontaneous nystagmus test ...................... 0.00 0.84 NA 0.02 0.86 NA XXX 

92542 .......... ............ A Positional nystagmus test ........................... 0.33 1.13 NA 0.03 1.50 NA XXX 

92542 .......... 26 ....... A Positional nystagmus test ........................... 0.33 0.15 0.15 0.01 0.49 0.49 XXX 

92542 .......... TC ...... A Positional nystagmus test ........................... 0.00 0.98 NA 0.02 1.00 NA XXX 

92543 .......... ............ A Caloric vestibular test .................................. 0.10 0.57 NA 0.02 0.69 NA XXX 

92543 .......... 26 ....... A Caloric vestibular test .................................. 0.10 0.05 0.05 0.01 0.16 0.16 XXX 

92543 .......... TC ...... A Caloric vestibular test .................................. 0.00 0.52 NA 0.01 0.53 NA XXX 

92544 .......... ............ A Optokinetic nystagmus test ......................... 0.26 0.90 NA 0.03 1.19 NA XXX 

92544 .......... 26 ....... A Optokinetic nystagmus test ......................... 0.26 0.12 0.12 0.01 0.39 0.39 XXX 

92544 .......... TC ...... A Optokinetic nystagmus test ......................... 0.00 0.78 NA 0.02 0.80 NA XXX 

92545 .......... ............ A Oscillating tracking test ............................... 0.23 0.81 NA 0.03 1.07 NA XXX 

92545 .......... 26 ....... A Oscillating tracking test ............................... 0.23 0.11 0.11 0.01 0.35 0.35 XXX 

92545 .......... TC ...... A Oscillating tracking test ............................... 0.00 0.71 NA 0.02 0.73 NA XXX 

92546 .......... ............ A Sinusoidal rotational test ............................. 0.29 1.93 NA 0.03 2.25 NA XXX 

92546 .......... 26 ....... A Sinusoidal rotational test ............................. 0.29 0.13 0.13 0.01 0.43 0.43 XXX 

92546 .......... TC ...... A Sinusoidal rotational test ............................. 0.00 1.81 NA 0.02 1.83 NA XXX 

92547 .......... ............ A Supplemental electrical test ........................ 0.00 0.08 NA 0.06 0.14 NA ZZZ 

92548 .......... ............ A Posturography ............................................. 0.50 2.14 NA 0.15 2.79 NA XXX 

92548 .......... 26 ....... A Posturography ............................................. 0.50 0.25 0.25 0.02 0.77 0.77 XXX 

92548 .......... TC ...... A Posturography ............................................. 0.00 1.89 NA 0.13 2.02 NA XXX 

92551 .......... ............ N Pure tone hearing test, air .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92552 .......... ............ A Pure tone audiometry, air ............................ 0.00 0.44 NA 0.04 0.48 NA XXX 

92553 .......... ............ A Audiometry, air & bone ............................... 0.00 0.63 NA 0.06 0.69 NA XXX 

92555 .......... ............ A Speech threshold audiometry ..................... 0.00 0.35 NA 0.04 0.39 NA XXX 

92556 .......... ............ A Speech audiometry, complete ..................... 0.00 0.54 NA 0.06 0.60 NA XXX 

92557 .......... ............ A Comprehensive hearing test ....................... 0.00 1.12 NA 0.12 1.24 NA XXX 

92559 .......... ............ N Group audiometric testing ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92560 .......... ............ N Bekesy audiometry, screen ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92561 .......... ............ A Bekesy audiometry, diagnosis .................... 0.00 0.68 NA 0.06 0.74 NA XXX 

92562 .......... ............ A Loudness balance test ................................ 0.00 0.42 NA 0.04 0.46 NA XXX 

92563 .......... ............ A Tone decay hearing test ............................. 0.00 0.37 NA 0.04 0.41 NA XXX 

92564 .......... ............ A Sisi hearing test ........................................... 0.00 0.45 NA 0.05 0.50 NA XXX 

92565 .......... ............ A Stenger test, pure tone ............................... 0.00 0.36 NA 0.04 0.40 NA XXX 

92567 .......... ............ A Tympanometry ............................................. 0.00 0.48 NA 0.06 0.54 NA XXX 

92568 .......... ............ A Acoustic reflex testing ................................. 0.00 0.32 NA 0.04 0.36 NA XXX 

92569 .......... ............ A Acoustic reflex decay test ........................... 0.00 0.34 NA 0.04 0.38 NA XXX 

92571 .......... ............ A Filtered speech hearing test ........................ 0.00 0.36 NA 0.04 0.40 NA XXX 

92572 .......... ............ A Staggered spondaic word test .................... 0.00 0.17 NA 0.01 0.18 NA XXX 

92573 .......... ............ A Lombard test ............................................... 0.00 0.33 NA 0.04 0.37 NA XXX 

92575 .......... ............ A Sensorineural acuity test ............................. 0.00 0.41 NA 0.02 0.43 NA XXX 

92576 .......... ............ A Synthetic sentence test ............................... 0.00 0.42 NA 0.05 0.47 NA XXX 

92577 .......... ............ A Stenger test, speech ................................... 0.00 0.60 NA 0.07 0.67 NA XXX 

92579 .......... ............ A Visual audiometry (vra) ............................... 0.00 0.68 NA 0.06 0.74 NA XXX 

92582 .......... ............ A Conditioning play audiometry ...................... 0.00 0.72 NA 0.06 0.78 NA XXX 

92583 .......... ............ A Select picture audiometry ............................ 0.00 0.79 NA 0.08 0.87 NA XXX 

92584 .......... ............ A Electrocochleography .................................. 0.00 2.15 NA 0.21 2.36 NA XXX 

92585 .......... ............ A Auditor evoke potent, compre ..................... 0.50 1.97 NA 0.17 2.64 NA XXX 

92585 .......... 26 ....... A Auditor evoke potent, compre ..................... 0.50 0.21 0.21 0.03 0.74 0.74 XXX 

92585 .......... TC ...... A Auditor evoke potent, compre ..................... 0.00 1.77 NA 0.14 1.91 NA XXX 

92586 .......... ............ A Auditor evoke potent, limit ........................... 0.00 1.67 NA 0.14 1.81 NA XXX 

92587 .......... ............ A Evoked auditory test .................................... 0.13 1.15 NA 0.12 1.40 NA XXX 

92587 .......... 26 ....... A Evoked auditory test .................................... 0.13 0.06 0.06 0.01 0.20 0.20 XXX 

92587 .......... TC ...... A Evoked auditory test .................................... 0.00 1.09 NA 0.11 1.20 NA XXX 

45986

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

92588 .......... ............ A Evoked auditory test .................................... 0.36 1.43 NA 0.14 1.93 NA XXX 

92588 .......... 26 ....... A Evoked auditory test .................................... 0.36 0.15 0.15 0.01 0.52 0.52 XXX 

92588 .......... TC ...... A Evoked auditory test .................................... 0.00 1.28 NA 0.13 1.41 NA XXX 

92590 .......... ............ N Hearing aid exam, one ear ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92591 .......... ............ N Hearing aid exam, both ears ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92592 .......... ............ N Hearing aid check, one ear ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92593 .......... ............ N Hearing aid check, both ears ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92594 .......... ............ N Electro hearng aid test, one ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92595 .......... ............ N Electro hearng aid tst, both ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92596 .......... ............ A Ear protector evaluation .............................. 0.00 0.58 NA 0.06 0.64 NA XXX 

92597 .......... ............ A Oral speech device eval .............................. 0.86 1.68 0.43 0.03 2.57 1.32 XXX 

92601 .......... ............ A Cochlear implt f/up exam < 7 ...................... 0.00 3.54 NA 0.07 3.61 NA XXX 

92602 .......... ............ A Reprogram cochlear implt < 7 ..................... 0.00 2.41 NA 0.07 2.48 NA XXX 

92603 .......... ............ A Cochlear implt f/up exam 7 > ...................... 0.00 2.19 NA 0.07 2.26 NA XXX 

92604 .......... ............ A Reprogram cochlear implt 7 > ..................... 0.00 1.39 NA 0.07 1.46 NA XXX 

92605 .......... ............ B Eval for nonspeech device rx ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92606 .......... ............ B Non-speech device service ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92607 .......... ............ A Ex for speech device rx, 1hr ....................... 0.00 3.11 NA 0.05 3.16 NA XXX 

92608 .......... ............ A Ex for speech device rx addl ...................... 0.00 0.56 NA 0.05 0.61 NA XXX 

92609 .......... ............ A Use of speech device service ..................... 0.00 1.61 NA 0.04 1.65 NA XXX 

92610 .......... ............ A Evaluate swallowing function ...................... 0.00 2.97 NA 0.08 3.05 NA XXX 

92611 .......... ............ A Motion fluoroscopy/swallow ......................... 0.00 3.09 NA 0.08 3.17 NA XXX 

92612 .......... ............ A Endoscopy swallow tst (fees) ...................... 1.27 2.74 0.63 0.04 4.06 1.95 XXX 

92613 .......... ............ A Endoscopy swallow tst (fees) ...................... 0.71 0.38 0.38 0.05 1.14 1.14 XXX 

92614 .......... ............ A Laryngoscopic sensory test ......................... 1.27 2.47 0.63 0.04 3.78 1.95 XXX 

92615 .......... ............ A Eval laryngoscopy sense tst ....................... 0.63 0.34 0.34 0.05 1.02 1.02 XXX 

92616 .......... ............ A Fees w/laryngeal sense test ....................... 1.88 3.31 0.95 0.06 5.26 2.90 XXX 

92617 .......... ............ A Interprt fees/laryngeal test ........................... 0.79 0.42 0.42 0.05 1.26 1.26 XXX 

92620 .......... ............ A Auditory function, 60 min ............................ 0.00 1.18 NA 0.06 1.24 NA XXX 

92621 .......... ............ A Auditory function, + 15 min ......................... 0.00 0.26 NA 0.06 0.32 NA ZZZ 

92625 .......... ............ A Tinnitus assessment .................................... 0.00 1.16 NA 0.06 1.22 NA XXX 

92700 .......... ............ C Ent procedure/service ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92950 .......... ............ A Heart/lung resuscitation cpr ........................ 3.80 3.97 0.95 0.28 8.04 5.03 000 

92953 .......... ............ A Temporary external pacing ......................... 0.23 NA 0.07 0.02 NA 0.32 000 

92960 .......... ............ A Cardioversion electric, ext ........................... 2.25 6.22 1.26 0.07 8.55 3.58 000 

92961 .......... ............ A Cardioversion, electric, int ........................... 4.60 NA 2.19 0.29 NA 7.08 000 

92970 .......... ............ A Cardioassist, internal ................................... 3.52 NA 1.06 0.16 NA 4.74 000 

92971 .......... ............ A Cardioassist, external .................................. 1.77 NA 0.91 0.06 NA 2.74 000 

92973 .......... ............ A Percut coronary thrombectomy ................... 3.29 NA 1.35 0.23 NA 4.86 ZZZ 

92974 .......... ............ A Cath place, cardio brachytx ........................ 3.01 NA 1.24 0.21 NA 4.45 ZZZ 

92975 .......... ............ A Dissolve clot, heart vessel .......................... 7.25 NA 2.94 0.50 NA 10.69 000 

92977 .......... ............ A Dissolve clot, heart vessel .......................... 0.00 6.62 NA 0.46 7.08 NA XXX 

92978 .......... ............ A Intravasc us, heart add-on .......................... 1.80 NA NA 0.30 NA NA ZZZ 

92978 .......... 26 ....... A Intravasc us, heart add-on .......................... 1.80 0.74 0.74 0.06 2.61 2.61 ZZZ 

92978 .......... TC ...... A Intravasc us, heart add-on .......................... 0.00 NA NA 0.24 NA NA ZZZ 

92979 .......... ............ A Intravasc us, heart add-on .......................... 1.44 NA NA 0.19 NA NA ZZZ 

92979 .......... 26 ....... A Intravasc us, heart add-on .......................... 1.44 0.59 0.59 0.06 2.09 2.09 ZZZ 

92979 .......... TC ...... A Intravasc us, heart add-on .......................... 0.00 NA NA 0.13 NA NA ZZZ 

92980 .......... ............ A Insert intracoronary stent ............................ 14.85 NA 6.36 1.03 NA 22.24 000 

92981 .......... ............ A Insert intracoronary stent ............................ 4.17 NA 1.71 0.29 NA 6.17 ZZZ 

92982 .......... ............ A Coronary artery dilation ............................... 10.98 NA 4.77 0.76 NA 16.52 000 

92984 .......... ............ A Coronary artery dilation ............................... 2.98 NA 1.21 0.21 NA 4.40 ZZZ 

92986 .......... ............ A Revision of aortic valve ............................... 21.81 NA 12.62 1.51 NA 35.94 090 

92987 .......... ............ A Revision of mitral valve ............................... 22.72 NA 13.01 1.59 NA 37.32 090 

92990 .......... ............ A Revision of pulmonary valve ....................... 17.34 NA 10.33 1.20 NA 28.87 090 

92992 .......... ............ C Revision of heart chamber .......................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

92993 .......... ............ C Revision of heart chamber .......................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

92995 .......... ............ A Coronary atherectomy ................................. 12.09 NA 5.22 0.84 NA 18.16 000 

92996 .......... ............ A Coronary atherectomy add-on .................... 3.27 NA 1.33 0.10 NA 4.70 ZZZ 

92997 .......... ............ A Pul art balloon repr, percut ......................... 12.00 NA 5.04 0.40 NA 17.44 000 

92998 .......... ............ A Pul art balloon repr, percut ......................... 6.00 NA 2.24 0.28 NA 8.53 ZZZ 

93000 .......... ............ A Electrocardiogram, complete ....................... 0.17 0.47 NA 0.03 0.67 NA XXX 

93005 .......... ............ A Electrocardiogram, tracing .......................... 0.00 0.41 NA 0.02 0.43 NA XXX 

93010 .......... ............ A Electrocardiogram report ............................. 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

93012 .......... ............ A Transmission of ecg .................................... 0.00 4.81 NA 0.18 4.99 NA XXX 

93014 .......... ............ A Report on transmitted ecg ........................... 0.52 0.19 0.19 0.02 0.73 0.73 XXX 

93015 .......... ............ A Cardiovascular stress test ........................... 0.75 2.11 NA 0.14 3.00 NA XXX 

93016 .......... ............ A Cardiovascular stress test ........................... 0.45 0.18 0.18 0.02 0.65 0.65 XXX 

93017 .......... ............ A Cardiovascular stress test ........................... 0.00 1.82 NA 0.11 1.93 NA XXX 

93018 .......... ............ A Cardiovascular stress test ........................... 0.30 0.12 0.12 0.01 0.43 0.43 XXX 

93024 .......... ............ A Cardiac drug stress test .............................. 1.17 1.93 NA 0.12 3.22 NA XXX 

93024 .......... 26 ....... A Cardiac drug stress test .............................. 1.17 0.47 0.47 0.04 1.68 1.68 XXX 

93024 .......... TC ...... A Cardiac drug stress test .............................. 0.00 1.46 NA 0.08 1.54 NA XXX 

93025 .......... ............ A Microvolt t-wave assess .............................. 0.75 7.06 NA 0.14 7.95 NA XXX 

45987

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

93025 .......... 26 ....... A Microvolt t-wave assess .............................. 0.75 0.30 0.30 0.03 1.08 1.08 XXX 

93025 .......... TC ...... A Microvolt t-wave assess .............................. 0.00 6.76 NA 0.11 6.87 NA XXX 

93040 .......... ............ A Rhythm ECG with report ............................. 0.16 0.21 NA 0.02 0.39 NA XXX 

93041 .......... ............ A Rhythm ECG, tracing .................................. 0.00 0.16 NA 0.01 0.17 NA XXX 

93042 .......... ............ A Rhythm ECG, report .................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

93224 .......... ............ A ECG monitor/report, 24 hrs ......................... 0.52 3.30 NA 0.24 4.07 NA XXX 

93225 .......... ............ A ECG monitor/record, 24 hrs ........................ 0.00 1.20 NA 0.08 1.28 NA XXX 

93226 .......... ............ A ECG monitor/report, 24 hrs ......................... 0.00 1.90 NA 0.14 2.04 NA XXX 

93227 .......... ............ A ECG monitor/review, 24 hrs ........................ 0.52 0.20 0.20 0.02 0.74 0.74 XXX 

93230 .......... ............ A ECG monitor/report, 24 hrs ......................... 0.52 3.42 NA 0.26 4.20 NA XXX 

93231 .......... ............ A Ecg monitor/record, 24 hrs .......................... 0.00 1.38 NA 0.11 1.49 NA XXX 

93232 .......... ............ A ECG monitor/report, 24 hrs ......................... 0.00 1.85 NA 0.13 1.98 NA XXX 

93233 .......... ............ A ECG monitor/review, 24 hrs ........................ 0.52 0.20 0.20 0.02 0.74 0.74 XXX 

93235 .......... ............ A ECG monitor/report, 24 hrs ......................... 0.45 2.79 NA 0.16 3.40 NA XXX 

93236 .......... ............ A ECG monitor/report, 24 hrs ......................... 0.00 2.63 NA 0.14 2.77 NA XXX 

93237 .......... ............ A ECG monitor/review, 24 hrs ........................ 0.45 0.17 0.17 0.02 0.64 0.64 XXX 

93268 .......... ............ A ECG record/review ...................................... 0.52 5.84 NA 0.28 6.65 NA XXX 

93270 .......... ............ A ECG recording ............................................. 0.00 1.04 NA 0.08 1.12 NA XXX 

93271 .......... ............ A Ecg/monitoring and analysis ....................... 0.00 4.60 NA 0.18 4.78 NA XXX 

93272 .......... ............ A Ecg/review, interpret only ............................ 0.52 0.19 0.19 0.02 0.73 0.73 XXX 

93278 .......... ............ A ECG/signal-averaged .................................. 0.25 1.10 NA 0.12 1.47 NA XXX 

93278 .......... 26 ....... A ECG/signal-averaged .................................. 0.25 0.10 0.10 0.01 0.36 0.36 XXX 

93278 .......... TC ...... A ECG/signal-averaged .................................. 0.00 1.00 NA 0.11 1.11 NA XXX 

93303 .......... ............ A Echo transthoracic ....................................... 1.30 4.74 NA 0.27 6.32 NA XXX 

93303 .......... 26 ....... A Echo transthoracic ....................................... 1.30 0.50 0.50 0.04 1.84 1.84 XXX 

93303 .......... TC ...... A Echo transthoracic ....................................... 0.00 4.25 NA 0.23 4.48 NA XXX 

93304 .......... ............ A Echo transthoracic ....................................... 0.75 2.71 NA 0.15 3.61 NA XXX 

93304 .......... 26 ....... A Echo transthoracic ....................................... 0.75 0.29 0.29 0.02 1.06 1.06 XXX 

93304 .......... TC ...... A Echo transthoracic ....................................... 0.00 2.42 NA 0.13 2.55 NA XXX 

93307 .......... ............ A Echo exam of heart ..................................... 0.92 4.30 NA 0.26 5.48 NA XXX 

93307 .......... 26 ....... A Echo exam of heart ..................................... 0.92 0.36 0.36 0.03 1.32 1.32 XXX 

93307 .......... TC ...... A Echo exam of heart ..................................... 0.00 3.94 NA 0.23 4.17 NA XXX 

93308 .......... ............ A Echo exam of heart ..................................... 0.53 2.39 NA 0.15 3.08 NA XXX 

93308 .......... 26 ....... A Echo exam of heart ..................................... 0.53 0.21 0.21 0.02 0.76 0.76 XXX 

93308 .......... TC ...... A Echo exam of heart ..................................... 0.00 2.19 NA 0.13 2.32 NA XXX 

93312 .......... ............ A Echo transesophageal ................................. 2.20 5.88 NA 0.37 8.45 NA XXX 

93312 .......... 26 ....... A Echo transesophageal ................................. 2.20 0.82 0.82 0.08 3.10 3.10 XXX 

93312 .......... TC ...... A Echo transesophageal ................................. 0.00 5.06 NA 0.29 5.35 NA XXX 

93313 .......... ............ A Echo transesophageal ................................. 0.95 0.00 0.21 0.06 1.01 1.22 XXX 

93314 .......... ............ A Echo transesophageal ................................. 1.25 5.32 NA 0.33 6.91 NA XXX 

93314 .......... 26 ....... A Echo transesophageal ................................. 1.25 0.49 0.49 0.04 1.78 1.78 XXX 

93314 .......... TC ...... A Echo transesophageal ................................. 0.00 4.84 NA 0.29 5.13 NA XXX 

93315 .......... ............ C Echo transesophageal ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93315 .......... 26 ....... A Echo transesophageal ................................. 2.79 1.04 1.04 0.09 3.92 3.92 XXX 

93315 .......... TC ...... C Echo transesophageal ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93316 .......... ............ A Echo transesophageal ................................. 0.95 NA 0.24 0.05 NA 1.24 XXX 

93317 .......... ............ C Echo transesophageal ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93317 .......... 26 ....... A Echo transesophageal ................................. 1.83 0.69 0.69 0.08 2.60 2.60 XXX 

93317 .......... TC ...... C Echo transesophageal ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93318 .......... ............ C Echo transesophageal intraop .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93318 .......... 26 ....... A Echo transesophageal intraop .................... 2.20 0.47 0.47 0.14 2.82 2.82 XXX 

93318 .......... TC ...... C Echo transesophageal intraop .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93320 .......... ............ A Doppler echo exam, heart ........................... 0.38 1.92 NA 0.13 2.43 NA ZZZ 

93320 .......... 26 ....... A Doppler echo exam, heart ........................... 0.38 0.16 0.16 0.01 0.55 0.55 ZZZ 

93320 .......... TC ...... A Doppler echo exam, heart ........................... 0.00 1.76 NA 0.12 1.88 NA ZZZ 

93321 .......... ............ A Doppler echo exam, heart ........................... 0.15 1.07 NA 0.09 1.31 NA ZZZ 

93321 .......... 26 ....... A Doppler echo exam, heart ........................... 0.15 0.06 0.06 0.01 0.22 0.22 ZZZ 

93321 .......... TC ...... A Doppler echo exam, heart ........................... 0.00 1.01 NA 0.08 1.09 NA ZZZ 

93325 .......... ............ A Doppler color flow add-on ........................... 0.07 2.41 NA 0.22 2.70 NA ZZZ 

93325 .......... 26 ....... A Doppler color flow add-on ........................... 0.07 0.03 0.03 0.01 0.11 0.11 ZZZ 

93325 .......... TC ...... A Doppler color flow add-on ........................... 0.00 2.38 NA 0.21 2.59 NA ZZZ 

93350 .......... ............ A Echo transthoracic ....................................... 1.48 3.36 NA 0.18 5.02 NA XXX 

93350 .......... 26 ....... A Echo transthoracic ....................................... 1.48 0.59 0.59 0.05 2.12 2.12 XXX 

93350 .......... TC ...... A Echo transthoracic ....................................... 0.00 2.77 NA 0.13 2.90 NA XXX 

93501 .......... ............ A Right heart catheterization .......................... 3.03 21.04 NA 1.26 25.33 NA 000 

93501 .......... 26 ....... A Right heart catheterization .......................... 3.03 1.19 1.19 0.21 4.43 4.43 000 

93501 .......... TC ...... A Right heart catheterization .......................... 0.00 19.84 NA 1.05 20.89 NA 000 

93503 .......... ............ A Insert/place heart catheter .......................... 2.92 NA 0.67 0.20 NA 3.79 000 

93505 .......... ............ A Biopsy of heart lining ................................... 4.38 10.54 NA 0.46 15.38 NA 000 

93505 .......... 26 ....... A Biopsy of heart lining ................................... 4.38 1.75 1.75 0.30 6.42 6.42 000 

93505 .......... TC ...... A Biopsy of heart lining ................................... 0.00 8.79 NA 0.16 8.95 NA 000 

93508 .......... ............ A Cath placement, angiography ..................... 4.10 15.76 NA 0.93 20.78 NA 000 

93508 .......... 26 ....... A Cath placement, angiography ..................... 4.10 2.23 2.23 0.28 6.61 6.61 000 

93508 .......... TC ...... A Cath placement, angiography ..................... 0.00 13.52 NA 0.65 14.17 NA 000 

45988

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

93510 .......... ............ A Left heart catheterization ............................. 4.33 35.48 NA 2.61 42.42 NA 000 

93510 .......... 26 ....... A Left heart catheterization ............................. 4.33 2.34 2.34 0.30 6.97 6.97 000 

93510 .......... TC ...... A Left heart catheterization ............................. 0.00 33.14 NA 2.31 35.45 NA 000 

93511 .......... ............ A Left heart catheterization ............................. 5.03 NA NA 2.59 NA NA 000 

93511 .......... 26 ....... A Left heart catheterization ............................. 5.03 2.62 2.62 0.35 8.00 8.00 000 

93511 .......... TC ...... A Left heart catheterization ............................. 0.00 NA NA 2.24 NA NA 000 

93514 .......... ............ A Left heart catheterization ............................. 7.05 NA NA 2.74 NA NA 000 

93514 .......... 26 ....... A Left heart catheterization ............................. 7.05 3.31 3.31 0.49 10.85 10.85 000 

93514 .......... TC ...... A Left heart catheterization ............................. 0.00 NA NA 2.24 NA NA 000 

93524 .......... ............ A Left heart catheterization ............................. 6.95 NA NA 3.43 NA NA 000 

93524 .......... 26 ....... A Left heart catheterization ............................. 6.95 3.38 3.38 0.48 10.81 10.81 000 

93524 .......... TC ...... A Left heart catheterization ............................. 0.00 NA NA 2.95 NA NA 000 

93526 .......... ............ A Rt & Lt heart catheters ................................ 5.99 49.26 NA 3.46 58.71 NA 000 

93526 .......... 26 ....... A Rt & Lt heart catheters ................................ 5.99 3.00 3.00 0.42 9.42 9.42 000 

93526 .......... TC ...... A Rt & Lt heart catheters ................................ 0.00 46.25 NA 3.04 49.29 NA 000 

93527 .......... ............ A Rt & Lt heart catheters ................................ 7.28 NA NA 3.46 NA NA 000 

93527 .......... 26 ....... A Rt & Lt heart catheters ................................ 7.28 3.52 3.52 0.51 11.32 11.32 000 

93527 .......... TC ...... A Rt & Lt heart catheters ................................ 0.00 NA NA 2.95 NA NA 000 

93528 .......... ............ A Rt & Lt heart catheters ................................ 9.01 NA NA 3.57 NA NA 000 

93528 .......... 26 ....... A Rt & Lt heart catheters ................................ 9.01 4.30 4.30 0.62 13.93 13.93 000 

93528 .......... TC ...... A Rt & Lt heart catheters ................................ 0.00 NA NA 2.95 NA NA 000 

93529 .......... ............ A Rt, lt heart catheterization ........................... 4.80 NA NA 3.28 NA NA 000 

93529 .......... 26 ....... A Rt, lt heart catheterization ........................... 4.80 2.42 2.42 0.33 7.55 7.55 000 

93529 .......... TC ...... A Rt, lt heart catheterization ........................... 0.00 NA NA 2.95 NA NA 000 

93530 .......... ............ A Rt heart cath, congenital ............................. 4.23 NA NA 1.34 NA NA 000 

93530 .......... 26 ....... A Rt heart cath, congenital ............................. 4.23 2.02 2.02 0.29 6.54 6.54 000 

93530 .......... TC ...... A Rt heart cath, congenital ............................. 0.00 NA NA 1.05 NA NA 000 

93531 .......... ............ A R & l heart cath, congenital ........................ 8.36 NA NA 3.62 NA NA 000 

93531 .......... 26 ....... A R & l heart cath, congenital ........................ 8.36 3.74 3.74 0.58 12.68 12.68 000 

93531 .......... TC ...... A R & l heart cath, congenital ........................ 0.00 NA NA 3.04 NA NA 000 

93532 .......... ............ A R & l heart cath, congenital ........................ 10.01 NA NA 3.64 NA NA 000 

93532 .......... 26 ....... A R & l heart cath, congenital ........................ 10.01 4.44 4.44 0.69 15.14 15.14 000 

93532 .......... TC ...... A R & l heart cath, congenital ........................ 0.00 NA NA 2.95 NA NA 000 

93533 .......... ............ A R & l heart cath, congenital ........................ 6.70 NA NA 3.42 NA NA 000 

93533 .......... 26 ....... A R & l heart cath, congenital ........................ 6.70 2.87 2.87 0.47 10.04 10.04 000 

93533 .......... TC ...... A R & l heart cath, congenital ........................ 0.00 NA NA 2.95 NA NA 000 

93539 .......... ............ A Injection, cardiac cath ................................. 0.40 NA 0.17 0.01 NA 0.58 000 

93540 .......... ............ A Injection, cardiac cath ................................. 0.43 NA 0.18 0.01 NA 0.62 000 

93541 .......... ............ A Injection for lung angiogram ........................ 0.29 NA 0.12 0.01 NA 0.42 000 

93542 .......... ............ A Injection for heart x-rays ............................. 0.29 NA 0.12 0.01 NA 0.42 000 

93543 .......... ............ A Injection for heart x-rays ............................. 0.29 NA 0.12 0.01 NA 0.42 000 

93544 .......... ............ A Injection for aortography ............................. 0.25 NA 0.10 0.01 NA 0.36 000 

93545 .......... ............ A Inject for coronary x-rays ............................ 0.40 NA 0.17 0.01 NA 0.58 000 

93555 .......... ............ A Imaging, cardiac cath .................................. 0.81 5.12 NA 0.37 6.30 NA XXX 

93555 .......... 26 ....... A Imaging, cardiac cath .................................. 0.81 0.33 0.33 0.03 1.17 1.17 XXX 

93555 .......... TC ...... A Imaging, cardiac cath .................................. 0.00 4.79 NA 0.34 5.13 NA XXX 

93556 .......... ............ A Imaging, cardiac cath .................................. 0.83 7.95 NA 0.54 9.32 NA XXX 

93556 .......... 26 ....... A Imaging, cardiac cath .................................. 0.83 0.34 0.34 0.03 1.20 1.20 XXX 

93556 .......... TC ...... A Imaging, cardiac cath .................................. 0.00 7.61 NA 0.51 8.12 NA XXX 

93561 .......... ............ A Cardiac output measurement ...................... 0.50 NA NA 0.08 NA NA 000 

93561 .......... 26 ....... A Cardiac output measurement ...................... 0.50 0.16 0.16 0.02 0.68 0.68 000 

93561 .......... TC ...... A Cardiac output measurement ...................... 0.00 NA NA 0.06 NA NA 000 

93562 .......... ............ A Cardiac output measurement ...................... 0.16 NA NA 0.05 NA NA 000 

93562 .......... 26 ....... A Cardiac output measurement ...................... 0.16 0.05 0.05 0.01 0.22 0.22 000 

93562 .......... TC ...... A Cardiac output measurement ...................... 0.00 NA NA 0.04 NA NA 000 

93571 .......... ............ A Heart flow reserve measure ........................ 1.80 NA NA 0.30 NA NA ZZZ 

93571 .......... 26 ....... A Heart flow reserve measure ........................ 1.80 0.70 0.70 0.06 2.57 2.57 ZZZ 

93571 .......... TC ...... A Heart flow reserve measure ........................ 0.00 NA NA 0.24 NA NA ZZZ 

93572 .......... ............ A Heart flow reserve measure ........................ 1.44 NA NA 0.17 NA NA ZZZ 

93572 .......... 26 ....... A Heart flow reserve measure ........................ 1.44 0.50 0.50 0.04 1.98 1.98 ZZZ 

93572 .......... TC ...... A Heart flow reserve measure ........................ 0.00 NA NA 0.13 NA NA ZZZ 

93580 .......... ............ A Transcath closure of asd ............................. 18.01 NA 7.75 1.25 NA 27.00 000 

93581 .......... ............ A Transcath closure of vsd ............................. 24.44 NA 9.69 1.71 NA 35.84 000 

93600 .......... ............ A Bundle of His recording ............................... 2.12 NA NA 0.29 NA NA 000 

93600 .......... 26 ....... A Bundle of His recording ............................... 2.12 0.87 0.87 0.16 3.15 3.15 000 

93600 .......... TC ...... A Bundle of His recording ............................... 0.00 NA NA 0.13 NA NA 000 

93602 .......... ............ A Intra-atrial recording .................................... 2.12 NA NA 0.24 NA NA 000 

93602 .......... 26 ....... A Intra-atrial recording .................................... 2.12 0.86 0.86 0.17 3.15 3.15 000 

93602 .......... TC ...... A Intra-atrial recording .................................... 0.00 NA NA 0.07 NA NA 000 

93603 .......... ............ A Right ventricular recording .......................... 2.12 NA NA 0.29 NA NA 000 

93603 .......... 26 ....... A Right ventricular recording .......................... 2.12 0.84 0.84 0.18 3.15 3.15 000 

93603 .......... TC ...... A Right ventricular recording .......................... 0.00 NA NA 0.11 NA NA 000 

93609 .......... ............ A Map tachycardia, add-on ............................. 5.00 NA NA 0.52 NA NA ZZZ 

93609 .......... 26 ....... A Map tachycardia, add-on ............................. 5.00 2.03 2.03 0.35 7.38 7.38 ZZZ 

45989

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

93609 .......... TC ...... A Map tachycardia, add-on ............................. 0.00 NA NA 0.17 NA NA ZZZ 

93610 .......... ............ A Intra-atrial pacing ......................................... 3.03 NA NA 0.34 NA NA 000 

93610 .......... 26 ....... A Intra-atrial pacing ......................................... 3.03 1.21 1.21 0.24 4.47 4.47 000 

93610 .......... TC ...... A Intra-atrial pacing ......................................... 0.00 NA NA 0.10 NA NA 000 

93612 .......... ............ A Intraventricular pacing ................................. 3.03 NA NA 0.36 NA NA 000 

93612 .......... 26 ....... A Intraventricular pacing ................................. 3.03 1.20 1.20 0.25 4.48 4.48 000 

93612 .......... TC ...... A Intraventricular pacing ................................. 0.00 NA NA 0.11 NA NA 000 

93613 .......... ............ A Electrophys map 3d, add-on ....................... 7.00 NA 2.90 0.49 NA 10.39 ZZZ 

93615 .......... ............ A Esophageal recording ................................. 0.99 NA NA 0.05 NA NA 000 

93615 .......... 26 ....... A Esophageal recording ................................. 0.99 0.27 0.27 0.03 1.30 1.30 000 

93615 .......... TC ...... A Esophageal recording ................................. 0.00 NA NA 0.02 NA NA 000 

93616 .......... ............ A Esophageal recording ................................. 1.49 NA NA 0.11 NA NA 000 

93616 .......... 26 ....... A Esophageal recording ................................. 1.49 0.44 0.44 0.09 2.02 2.02 000 

93616 .......... TC ...... A Esophageal recording ................................. 0.00 NA NA 0.02 NA NA 000 

93618 .......... ............ A Heart rhythm pacing .................................... 4.26 NA NA 0.54 NA NA 000 

93618 .......... 26 ....... A Heart rhythm pacing .................................... 4.26 1.75 1.75 0.30 6.30 6.30 000 

93618 .......... TC ...... A Heart rhythm pacing .................................... 0.00 NA NA 0.24 NA NA 000 

93619 .......... ............ A Electrophysiology evaluation ....................... 7.32 NA NA 0.98 NA NA 000 

93619 .......... 26 ....... A Electrophysiology evaluation ....................... 7.32 3.37 3.37 0.51 11.21 11.21 000 

93619 .......... TC ...... A Electrophysiology evaluation ....................... 0.00 NA NA 0.47 NA NA 000 

93620 .......... ............ C Electrophysiology evaluation ....................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

93620 .......... 26 ....... A Electrophysiology evaluation ....................... 11.59 5.11 5.11 0.80 17.50 17.50 000 

93620 .......... TC ...... C Electrophysiology evaluation ....................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

93621 .......... ............ C Electrophysiology evaluation ....................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93621 .......... 26 ....... A Electrophysiology evaluation ....................... 2.10 0.86 0.86 0.15 3.11 3.11 ZZZ 

93621 .......... TC ...... C Electrophysiology evaluation ....................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93622 .......... ............ C Electrophysiology evaluation ....................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93622 .......... 26 ....... A Electrophysiology evaluation ....................... 3.11 1.26 1.26 0.22 4.59 4.59 ZZZ 

93622 .......... TC ...... C Electrophysiology evaluation ....................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93623 .......... ............ C Stimulation, pacing heart ............................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93623 .......... 26 ....... A Stimulation, pacing heart ............................. 2.86 1.16 1.16 0.20 4.21 4.21 ZZZ 

93623 .......... TC ...... C Stimulation, pacing heart ............................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93624 .......... ............ A Electrophysiologic study .............................. 4.81 NA NA 0.46 NA NA 000 

93624 .......... 26 ....... A Electrophysiologic study .............................. 4.81 2.33 2.33 0.33 7.47 7.47 000 

93624 .......... TC ...... A Electrophysiologic study .............................. 0.00 NA NA 0.13 NA NA 000 

93631 .......... ............ A Heart pacing, mapping ................................ 7.61 NA NA 1.60 NA NA 000 

93631 .......... 26 ....... A Heart pacing, mapping ................................ 7.61 2.83 2.83 0.97 11.41 11.41 000 

93631 .......... TC ...... A Heart pacing, mapping ................................ 0.00 NA NA 0.62 NA NA 000 

93640 .......... ............ A Evaluation heart device ............................... 3.52 NA NA 0.66 NA NA 000 

93640 .......... 26 ....... A Evaluation heart device ............................... 3.52 1.42 1.42 0.24 5.18 5.18 000 

93640 .......... TC ...... A Evaluation heart device ............................... 0.00 NA NA 0.42 NA NA 000 

93641 .......... ............ A Electrophysiology evaluation ....................... 5.93 NA NA 0.83 NA NA 000 

93641 .......... 26 ....... A Electrophysiology evaluation ....................... 5.93 2.41 2.41 0.41 8.75 8.75 000 

93641 .......... TC ...... A Electrophysiology evaluation ....................... 0.00 NA NA 0.42 NA NA 000 

93642 .......... ............ A Electrophysiology evaluation ....................... 4.89 8.17 NA 0.57 13.63 NA 000 

93642 .......... 26 ....... A Electrophysiology evaluation ....................... 4.89 2.35 2.35 0.15 7.39 7.39 000 

93642 .......... TC ...... A Electrophysiology evaluation ....................... 0.00 5.81 NA 0.42 6.23 NA 000 

93650 .......... ............ A Ablate heart dysrhythm focus ..................... 10.51 NA 4.68 0.73 NA 15.92 000 

93651 .......... ............ A Ablate heart dysrhythm focus ..................... 16.26 NA 6.61 1.13 NA 24.00 000 

93652 .......... ............ A Ablate heart dysrhythm focus ..................... 17.69 NA 7.17 1.23 NA 26.08 000 

93660 .......... ............ A Tilt table evaluation ..................................... 1.89 2.58 NA 0.08 4.55 NA 000 

93660 .......... 26 ....... A Tilt table evaluation ..................................... 1.89 0.77 0.77 0.06 2.73 2.73 000 

93660 .......... TC ...... A Tilt table evaluation ..................................... 0.00 1.81 NA 0.02 1.83 NA 000 

93662 .......... ............ C Intracardiac ecg (ice) ................................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93662 .......... 26 ....... A Intracardiac ecg (ice) ................................... 2.81 1.16 1.16 0.09 4.06 4.06 ZZZ 

93662 .......... TC ...... C Intracardiac ecg (ice) ................................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93668 .......... ............ N Peripheral vascular rehab ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93701 .......... ............ A Bioimpedance, thoracic ............................... 0.17 0.94 NA 0.02 1.13 NA XXX 

93701 .......... 26 ....... A Bioimpedance, thoracic ............................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX 

93701 .......... TC ...... A Bioimpedance, thoracic ............................... 0.00 0.87 NA 0.01 0.88 NA XXX 

93720 .......... ............ A Total body plethysmography ....................... 0.17 0.92 NA 0.07 1.16 NA XXX 

93721 .......... ............ A Plethysmography tracing ............................. 0.00 0.87 NA 0.06 0.93 NA XXX 

93722 .......... ............ A Plethysmography report .............................. 0.17 0.05 0.05 0.01 0.23 0.23 XXX 

93724 .......... ............ A Analyze pacemaker system ........................ 4.89 5.22 NA 0.39 10.50 NA 000 

93724 .......... 26 ....... A Analyze pacemaker system ........................ 4.89 2.00 2.00 0.15 7.04 7.04 000 

93724 .......... TC ...... A Analyze pacemaker system ........................ 0.00 3.22 NA 0.24 3.46 NA 000 

93727 .......... ............ A Analyze ilr system ....................................... 0.52 0.37 0.20 0.02 0.91 0.74 XXX 

93731 .......... ............ A Analyze pacemaker system ........................ 0.45 0.74 NA 0.05 1.24 NA XXX 

93731 .......... 26 ....... A Analyze pacemaker system ........................ 0.45 0.18 0.18 0.01 0.64 0.64 XXX 

93731 .......... TC ...... A Analyze pacemaker system ........................ 0.00 0.56 NA 0.04 0.60 NA XXX 

93732 .......... ............ A Analyze pacemaker system ........................ 0.92 0.98 NA 0.07 1.97 NA XXX 

93732 .......... 26 ....... A Analyze pacemaker system ........................ 0.92 0.37 0.37 0.03 1.32 1.32 XXX 

93732 .......... TC ...... A Analyze pacemaker system ........................ 0.00 0.62 NA 0.04 0.66 NA XXX 

93733 .......... ............ A Telephone analy, pacemaker ...................... 0.17 0.69 NA 0.07 0.93 NA XXX 

45990

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

93733 .......... 26 ....... A Telephone analy, pacemaker ...................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX 

93733 .......... TC ...... A Telephone analy, pacemaker ...................... 0.00 0.62 NA 0.06 0.68 NA XXX 

93734 .......... ............ A Analyze pacemaker system ........................ 0.38 0.59 NA 0.03 1.00 NA XXX 

93734 .......... 26 ....... A Analyze pacemaker system ........................ 0.38 0.16 0.16 0.01 0.55 0.55 XXX 

93734 .......... TC ...... A Analyze pacemaker system ........................ 0.00 0.43 NA 0.02 0.45 NA XXX 

93735 .......... ............ A Analyze pacemaker system ........................ 0.74 0.82 NA 0.06 1.62 NA XXX 

93735 .......... 26 ....... A Analyze pacemaker system ........................ 0.74 0.29 0.29 0.02 1.05 1.05 XXX 

93735 .......... TC ...... A Analyze pacemaker system ........................ 0.00 0.53 NA 0.04 0.57 NA XXX 

93736 .......... ............ A Telephonic analy, pacemaker ..................... 0.15 0.60 NA 0.07 0.82 NA XXX 

93736 .......... 26 ....... A Telephonic analy, pacemaker ..................... 0.15 0.06 0.06 0.01 0.22 0.22 XXX 

93736 .......... TC ...... A Telephonic analy, pacemaker ..................... 0.00 0.54 NA 0.06 0.60 NA XXX 

93740 .......... ............ B Temperature gradient studies ..................... 0.16 0.16 NA 0.02 0.34 NA XXX 

93740 .......... 26 ....... B Temperature gradient studies ..................... 0.16 0.04 0.04 0.01 0.21 0.21 XXX 

93740 .......... TC ...... B Temperature gradient studies ..................... 0.00 0.12 NA 0.01 0.13 NA XXX 

93741 .......... ............ A Analyze ht pace device sngl ....................... 0.80 1.04 NA 0.07 1.91 NA XXX 

93741 .......... 26 ....... A Analyze ht pace device sngl ....................... 0.80 0.32 0.32 0.03 1.15 1.15 XXX 

93741 .......... TC ...... A Analyze ht pace device sngl ....................... 0.00 0.72 NA 0.04 0.76 NA XXX 

93742 .......... ............ A Analyze ht pace device sngl ....................... 0.91 1.11 NA 0.07 2.09 NA XXX 

93742 .......... 26 ....... A Analyze ht pace device sngl ....................... 0.91 0.38 0.38 0.03 1.32 1.32 XXX 

93742 .......... TC ...... A Analyze ht pace device sngl ....................... 0.00 0.73 NA 0.04 0.77 NA XXX 

93743 .......... ............ A Analyze ht pace device dual ....................... 1.03 1.20 NA 0.07 2.30 NA XXX 

93743 .......... 26 ....... A Analyze ht pace device dual ....................... 1.03 0.42 0.42 0.03 1.48 1.48 XXX 

93743 .......... TC ...... A Analyze ht pace device dual ....................... 0.00 0.78 NA 0.04 0.82 NA XXX 

93744 .......... ............ A Analyze ht pace device dual ....................... 1.18 1.23 NA 0.08 2.50 NA XXX 

93744 .......... 26 ....... A Analyze ht pace device dual ....................... 1.18 0.48 0.48 0.04 1.70 1.70 XXX 

93744 .......... TC ...... A Analyze ht pace device dual ....................... 0.00 0.75 NA 0.04 0.79 NA XXX 

93745 .......... ............ C Set-up cardiovert-defibrill ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93745 .......... 26 ....... C Set-up cardiovert-defibrill ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93745 .......... TC ...... C Set-up cardiovert-defibrill ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93760 .......... ............ N Cephalic thermogram .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93762 .......... ............ N Peripheral thermogram ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93770 .......... ............ B Measure venous pressure ........................... 0.16 0.07 NA 0.02 0.25 NA XXX 

93770 .......... 26 ....... B Measure venous pressure ........................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

93770 .......... TC ...... B Measure venous pressure ........................... 0.00 0.02 NA 0.01 0.03 NA XXX 

93784 .......... ............ A Ambulatory BP monitoring .......................... 0.38 1.66 NA 0.03 2.07 NA XXX 

93786 .......... ............ A Ambulatory BP recording ............................ 0.00 0.99 NA 0.01 1.00 NA XXX 

93788 .......... ............ A Ambulatory BP analysis .............................. 0.00 0.55 NA 0.01 0.56 NA XXX 

93790 .......... ............ A Review/report BP recording ........................ 0.38 0.13 0.13 0.01 0.52 0.52 XXX 

93797 .......... ............ A Cardiac rehab .............................................. 0.18 0.34 0.07 0.01 0.53 0.26 000 

93798 .......... ............ A Cardiac rehab/monitor ................................. 0.28 0.50 0.11 0.01 0.79 0.40 000 

93799 .......... ............ C Cardiovascular procedure ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93799 .......... 26 ....... C Cardiovascular procedure ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93799 .......... TC ...... C Cardiovascular procedure ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93875 .......... ............ A Extracranial study ........................................ 0.22 2.40 NA 0.12 2.75 NA XXX 

93875 .......... 26 ....... A Extracranial study ........................................ 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

93875 .......... TC ...... A Extracranial study ........................................ 0.00 2.32 NA 0.11 2.43 NA XXX 

93880 .......... ............ A Extracranial study ........................................ 0.60 5.78 NA 0.39 6.78 NA XXX 

93880 .......... 26 ....... A Extracranial study ........................................ 0.60 0.21 0.21 0.04 0.85 0.85 XXX 

93880 .......... TC ...... A Extracranial study ........................................ 0.00 5.58 NA 0.35 5.93 NA XXX 

93882 .......... ............ A Extracranial study ........................................ 0.40 3.57 NA 0.26 4.23 NA XXX 

93882 .......... 26 ....... A Extracranial study ........................................ 0.40 0.14 0.14 0.04 0.58 0.58 XXX 

93882 .......... TC ...... A Extracranial study ........................................ 0.00 3.43 NA 0.22 3.65 NA XXX 

93886 .......... ............ A Intracranial study ......................................... 0.94 6.78 NA 0.45 8.17 NA XXX 

93886 .......... 26 ....... A Intracranial study ......................................... 0.94 0.36 0.36 0.06 1.37 1.37 XXX 

93886 .......... TC ...... A Intracranial study ......................................... 0.00 6.42 NA 0.39 6.81 NA XXX 

93888 .......... ............ A Intracranial study ......................................... 0.62 4.33 NA 0.32 5.27 NA XXX 

93888 .......... 26 ....... A Intracranial study ......................................... 0.62 0.23 0.23 0.05 0.90 0.90 XXX 

93888 .......... TC ...... A Intracranial study ......................................... 0.00 4.11 NA 0.27 4.38 NA XXX 

93890 .......... ............ A Tcd, vasoreactivity study ............................. 1.00 5.09 NA 0.45 6.54 NA XXX 

93890 .......... 26 ....... A Tcd, vasoreactivity study ............................. 1.00 0.39 0.39 0.06 1.45 1.45 XXX 

93890 .......... TC ...... A Tcd, vasoreactivity study ............................. 0.00 4.70 NA 0.39 5.09 NA XXX 

93892 .......... ............ A Tcd, emboli detect w/o inj ........................... 1.15 5.40 NA 0.45 7.00 NA XXX 

93892 .......... 26 ....... A Tcd, emboli detect w/o inj ........................... 1.15 0.45 0.45 0.06 1.66 1.66 XXX 

93892 .......... TC ...... A Tcd, emboli detect w/o inj ........................... 0.00 4.95 NA 0.39 5.34 NA XXX 

93893 .......... ............ A Tcd, emboli detect w/inj .............................. 1.15 5.23 NA 0.45 6.83 NA XXX 

93893 .......... 26 ....... A Tcd, emboli detect w/inj .............................. 1.15 0.45 0.45 0.06 1.66 1.66 XXX 

93893 .......... TC ...... A Tcd, emboli detect w/inj .............................. 0.00 4.78 NA 0.39 5.17 NA XXX 

93922 .......... ............ A Extremity study ............................................ 0.25 2.74 NA 0.15 3.14 NA XXX 

93922 .......... 26 ....... A Extremity study ............................................ 0.25 0.08 0.08 0.02 0.35 0.35 XXX 

93922 .......... TC ...... A Extremity study ............................................ 0.00 2.65 NA 0.13 2.78 NA XXX 

93923 .......... ............ A Extremity study ............................................ 0.45 4.15 NA 0.26 4.86 NA XXX 

93923 .......... 26 ....... A Extremity study ............................................ 0.45 0.15 0.15 0.04 0.64 0.64 XXX 

93923 .......... TC ...... A Extremity study ............................................ 0.00 4.00 NA 0.22 4.22 NA XXX 

93924 .......... ............ A Extremity study ............................................ 0.50 5.02 NA 0.30 5.82 NA XXX 

45991

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

93924 .......... 26 ....... A Extremity study ............................................ 0.50 0.17 0.17 0.05 0.72 0.72 XXX 

93924 .......... TC ...... A Extremity study ............................................ 0.00 4.85 NA 0.25 5.10 NA XXX 

93925 .......... ............ A Lower extremity study ................................. 0.58 7.09 NA 0.39 8.06 NA XXX 

93925 .......... 26 ....... A Lower extremity study ................................. 0.58 0.20 0.20 0.04 0.82 0.82 XXX 

93925 .......... TC ...... A Lower extremity study ................................. 0.00 6.89 NA 0.35 7.24 NA XXX 

93926 .......... ............ A Lower extremity study ................................. 0.39 4.21 NA 0.27 4.87 NA XXX 

93926 .......... 26 ....... A Lower extremity study ................................. 0.39 0.13 0.13 0.04 0.56 0.56 XXX 

93926 .......... TC ...... A Lower extremity study ................................. 0.00 4.08 NA 0.23 4.31 NA XXX 

93930 .......... ............ A Upper extremity study ................................. 0.46 5.52 NA 0.41 6.39 NA XXX 

93930 .......... 26 ....... A Upper extremity study ................................. 0.46 0.16 0.16 0.04 0.66 0.66 XXX 

93930 .......... TC ...... A Upper extremity study ................................. 0.00 5.35 NA 0.37 5.72 NA XXX 

93931 .......... ............ A Upper extremity study ................................. 0.31 3.65 NA 0.27 4.24 NA XXX 

93931 .......... 26 ....... A Upper extremity study ................................. 0.31 0.10 0.10 0.03 0.44 0.44 XXX 

93931 .......... TC ...... A Upper extremity study ................................. 0.00 3.55 NA 0.24 3.79 NA XXX 

93965 .......... ............ A Extremity study ............................................ 0.35 2.85 NA 0.14 3.34 NA XXX 

93965 .......... 26 ....... A Extremity study ............................................ 0.35 0.12 0.12 0.02 0.49 0.49 XXX 

93965 .......... TC ...... A Extremity study ............................................ 0.00 2.73 NA 0.12 2.85 NA XXX 

93970 .......... ............ A Extremity study ............................................ 0.68 5.46 NA 0.46 6.60 NA XXX 

93970 .......... 26 ....... A Extremity study ............................................ 0.68 0.23 0.23 0.06 0.97 0.97 XXX 

93970 .......... TC ...... A Extremity study ............................................ 0.00 5.22 NA 0.40 5.62 NA XXX 

93971 .......... ............ A Extremity study ............................................ 0.45 3.69 NA 0.30 4.44 NA XXX 

93971 .......... 26 ....... A Extremity study ............................................ 0.45 0.16 0.16 0.03 0.64 0.64 XXX 

93971 .......... TC ...... A Extremity study ............................................ 0.00 3.53 NA 0.27 3.80 NA XXX 

93975 .......... ............ A Vascular study ............................................. 1.80 8.00 NA 0.56 10.36 NA XXX 

93975 .......... 26 ....... A Vascular study ............................................. 1.80 0.62 0.62 0.13 2.55 2.55 XXX 

93975 .......... TC ...... A Vascular study ............................................. 0.00 7.38 NA 0.43 7.81 NA XXX 

93976 .......... ............ A Vascular study ............................................. 1.21 4.46 NA 0.35 6.02 NA XXX 

93976 .......... 26 ....... A Vascular study ............................................. 1.21 0.42 0.42 0.05 1.68 1.68 XXX 

93976 .......... TC ...... A Vascular study ............................................. 0.00 4.04 NA 0.30 4.34 NA XXX 

93978 .......... ............ A Vascular study ............................................. 0.65 4.79 NA 0.43 5.88 NA XXX 

93978 .......... 26 ....... A Vascular study ............................................. 0.65 0.22 0.22 0.06 0.93 0.93 XXX 

93978 .......... TC ...... A Vascular study ............................................. 0.00 4.57 NA 0.37 4.94 NA XXX 

93979 .......... ............ A Vascular study ............................................. 0.44 3.39 NA 0.27 4.10 NA XXX 

93979 .......... 26 ....... A Vascular study ............................................. 0.44 0.15 0.15 0.03 0.62 0.62 XXX 

93979 .......... TC ...... A Vascular study ............................................. 0.00 3.24 NA 0.24 3.48 NA XXX 

93980 .......... ............ A Penile vascular study .................................. 1.25 3.13 NA 0.42 4.80 NA XXX 

93980 .......... 26 ....... A Penile vascular study .................................. 1.25 0.44 0.44 0.08 1.78 1.78 XXX 

93980 .......... TC ...... A Penile vascular study .................................. 0.00 2.69 NA 0.34 3.03 NA XXX 

93981 .......... ............ A Penile vascular study .................................. 0.44 2.85 NA 0.33 3.62 NA XXX 

93981 .......... 26 ....... A Penile vascular study .................................. 0.44 0.15 0.15 0.02 0.61 0.61 XXX 

93981 .......... TC ...... A Penile vascular study .................................. 0.00 2.71 NA 0.31 3.02 NA XXX 

93990 .......... ............ A Doppler flow testing ..................................... 0.25 4.13 NA 0.26 4.64 NA XXX 

93990 .......... 26 ....... A Doppler flow testing ..................................... 0.25 0.09 0.09 0.03 0.37 0.37 XXX 

93990 .......... TC ...... A Doppler flow testing ..................................... 0.00 4.03 NA 0.23 4.26 NA XXX 

94010 .......... ............ A Breathing capacity test ................................ 0.17 0.67 NA 0.03 0.87 NA XXX 

94010 .......... 26 ....... A Breathing capacity test ................................ 0.17 0.05 0.05 0.01 0.23 0.23 XXX 

94010 .......... TC ...... A Breathing capacity test ................................ 0.00 0.62 NA 0.02 0.64 NA XXX 

94014 .......... ............ A Patient recorded spirometry ........................ 0.52 0.77 NA 0.03 1.32 NA XXX 

94015 .......... ............ A Patient recorded spirometry ........................ 0.00 0.60 NA 0.01 0.61 NA XXX 

94016 .......... ............ A Review patient spirometry ........................... 0.52 0.17 0.17 0.02 0.71 0.71 XXX 

94060 .......... ............ A Evaluation of wheezing ............................... 0.31 1.08 NA 0.07 1.46 NA XXX 

94060 .......... 26 ....... A Evaluation of wheezing ............................... 0.31 0.09 0.09 0.01 0.41 0.41 XXX 

94060 .......... TC ...... A Evaluation of wheezing ............................... 0.00 0.99 NA 0.06 1.05 NA XXX 

94070 .......... ............ A Evaluation of wheezing ............................... 0.60 0.83 NA 0.13 1.57 NA XXX 

94070 .......... 26 ....... A Evaluation of wheezing ............................... 0.60 0.18 0.18 0.03 0.81 0.81 XXX 

94070 .......... TC ...... A Evaluation of wheezing ............................... 0.00 0.66 NA 0.10 0.76 NA XXX 

94150 .......... ............ B Vital capacity test ........................................ 0.07 0.47 NA 0.02 0.56 NA XXX 

94150 .......... 26 ....... B Vital capacity test ........................................ 0.07 0.03 0.03 0.01 0.11 0.11 XXX 

94150 .......... TC ...... B Vital capacity test ........................................ 0.00 0.44 NA 0.01 0.45 NA XXX 

94200 .......... ............ A Lung function test (MBC/MVV) ................... 0.11 0.44 NA 0.03 0.58 NA XXX 

94200 .......... 26 ....... A Lung function test (MBC/MVV) ................... 0.11 0.03 0.03 0.01 0.15 0.15 XXX 

94200 .......... TC ...... A Lung function test (MBC/MVV) ................... 0.00 0.41 NA 0.02 0.43 NA XXX 

94240 .......... ............ A Residual lung capacity ................................ 0.26 0.66 NA 0.06 0.98 NA XXX 

94240 .......... 26 ....... A Residual lung capacity ................................ 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94240 .......... TC ...... A Residual lung capacity ................................ 0.00 0.58 NA 0.05 0.63 NA XXX 

94250 .......... ............ A Expired gas collection ................................. 0.11 0.61 NA 0.02 0.74 NA XXX 

94250 .......... 26 ....... A Expired gas collection ................................. 0.11 0.03 0.03 0.01 0.15 0.15 XXX 

94250 .......... TC ...... A Expired gas collection ................................. 0.00 0.58 NA 0.01 0.59 NA XXX 

94260 .......... ............ A Thoracic gas volume ................................... 0.13 0.58 NA 0.05 0.76 NA XXX 

94260 .......... 26 ....... A Thoracic gas volume ................................... 0.13 0.04 0.04 0.01 0.18 0.18 XXX 

94260 .......... TC ...... A Thoracic gas volume ................................... 0.00 0.54 NA 0.04 0.58 NA XXX 

94350 .......... ............ A Lung nitrogen washout curve ...................... 0.26 0.72 NA 0.05 1.03 NA XXX 

94350 .......... 26 ....... A Lung nitrogen washout curve ...................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94350 .......... TC ...... A Lung nitrogen washout curve ...................... 0.00 0.64 NA 0.04 0.68 NA XXX 

45992

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

94360 .......... ............ A Measure airflow resistance ......................... 0.26 0.71 NA 0.07 1.04 NA XXX 

94360 .......... 26 ....... A Measure airflow resistance ......................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94360 .......... TC ...... A Measure airflow resistance ......................... 0.00 0.63 NA 0.06 0.69 NA XXX 

94370 .......... ............ A Breath airway closing volume ..................... 0.26 0.69 NA 0.03 0.98 NA XXX 

94370 .......... 26 ....... A Breath airway closing volume ..................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94370 .......... TC ...... A Breath airway closing volume ..................... 0.00 0.61 NA 0.02 0.63 NA XXX 

94375 .......... ............ A Respiratory flow volume loop ...................... 0.31 0.60 NA 0.03 0.94 NA XXX 

94375 .......... 26 ....... A Respiratory flow volume loop ...................... 0.31 0.09 0.09 0.01 0.41 0.41 XXX 

94375 .......... TC ...... A Respiratory flow volume loop ...................... 0.00 0.51 NA 0.02 0.53 NA XXX 

94400 .......... ............ A CO2 breathing response curve ................... 0.40 0.86 NA 0.09 1.35 NA XXX 

94400 .......... 26 ....... A CO2 breathing response curve ................... 0.40 0.12 0.12 0.03 0.55 0.55 XXX 

94400 .......... TC ...... A CO2 breathing response curve ................... 0.00 0.74 NA 0.06 0.80 NA XXX 

94450 .......... ............ A Hypoxia response curve .............................. 0.40 0.86 NA 0.04 1.30 NA XXX 

94450 .......... 26 ....... A Hypoxia response curve .............................. 0.40 0.12 0.12 0.02 0.54 0.54 XXX 

94450 .......... TC ...... A Hypoxia response curve .............................. 0.00 0.74 NA 0.02 0.76 NA XXX 

94452 .......... ............ A Hast w/report ............................................... 0.31 1.00 NA 0.04 1.35 NA XXX 

94452 .......... 26 ....... A Hast w/report ............................................... 0.31 0.09 0.09 0.02 0.42 0.42 XXX 

94452 .......... TC ...... A Hast w/report ............................................... 0.00 0.92 NA 0.02 0.94 NA XXX 

94453 .......... ............ A Hast w/oxygen titrate ................................... 0.40 1.47 NA 0.04 1.91 NA XXX 

94453 .......... 26 ....... A Hast w/oxygen titrate ................................... 0.40 0.12 0.12 0.02 0.54 0.54 XXX 

94453 .......... TC ...... A Hast w/oxygen titrate ................................... 0.00 1.36 NA 0.02 1.38 NA XXX 

94620 .......... ............ A Pulmonary stress test/simple ...................... 0.64 2.17 NA 0.13 2.94 NA XXX 

94620 .......... 26 ....... A Pulmonary stress test/simple ...................... 0.64 0.20 0.20 0.03 0.87 0.87 XXX 

94620 .......... TC ...... A Pulmonary stress test/simple ...................... 0.00 1.98 NA 0.10 2.08 NA XXX 

94621 .......... ............ A Pulm stress test/complex ............................ 1.42 2.21 NA 0.16 3.79 NA XXX 

94621 .......... 26 ....... A Pulm stress test/complex ............................ 1.42 0.43 0.43 0.06 1.91 1.91 XXX 

94621 .......... TC ...... A Pulm stress test/complex ............................ 0.00 1.78 NA 0.10 1.88 NA XXX 

94640 .......... ............ A Airway inhalation treatment ......................... 0.00 0.30 NA 0.02 0.32 NA XXX 

94642 .......... ............ C Aerosol inhalation treatment ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94656 .......... ............ A Initial ventilator mgmt .................................. 1.22 1.16 0.31 0.06 2.44 1.59 XXX 

94657 .......... ............ A Continued ventilator mgmt .......................... 0.83 0.98 0.24 0.04 1.85 1.11 XXX 

94660 .......... ............ A Pos airway pressure, CPAP ........................ 0.76 0.62 0.23 0.04 1.42 1.03 XXX 

94662 .......... ............ A Neg press ventilation, cnp ........................... 0.76 NA 0.23 0.03 NA 1.02 XXX 

94664 .......... ............ A Evaluate pt use of inhaler ........................... 0.00 0.31 NA 0.04 0.35 NA XXX 

94667 .......... ............ A Chest wall manipulation .............................. 0.00 0.51 NA 0.05 0.56 NA XXX 

94668 .......... ............ A Chest wall manipulation .............................. 0.00 0.44 NA 0.02 0.46 NA XXX 

94680 .......... ............ A Exhaled air analysis, o2 .............................. 0.26 1.70 NA 0.07 2.03 NA XXX 

94680 .......... 26 ....... A Exhaled air analysis, o2 .............................. 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94680 .......... TC ...... A Exhaled air analysis, o2 .............................. 0.00 1.62 NA 0.06 1.68 NA XXX 

94681 .......... ............ A Exhaled air analysis, o2/co2 ....................... 0.20 2.27 NA 0.13 2.60 NA XXX 

94681 .......... 26 ....... A Exhaled air analysis, o2/co2 ....................... 0.20 0.06 0.06 0.01 0.27 0.27 XXX 

94681 .......... TC ...... A Exhaled air analysis, o2/co2 ....................... 0.00 2.21 NA 0.12 2.33 NA XXX 

94690 .......... ............ A Exhaled air analysis .................................... 0.07 1.76 NA 0.05 1.88 NA XXX 

94690 .......... 26 ....... A Exhaled air analysis .................................... 0.07 0.02 0.02 0.01 0.10 0.10 XXX 

94690 .......... TC ...... A Exhaled air analysis .................................... 0.00 1.74 NA 0.04 1.78 NA XXX 

94720 .......... ............ A Monoxide diffusing capacity ........................ 0.26 0.98 NA 0.07 1.31 NA XXX 

94720 .......... 26 ....... A Monoxide diffusing capacity ........................ 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94720 .......... TC ...... A Monoxide diffusing capacity ........................ 0.00 0.90 NA 0.06 0.96 NA XXX 

94725 .......... ............ A Membrane diffusion capacity ...................... 0.26 2.55 NA 0.13 2.94 NA XXX 

94725 .......... 26 ....... A Membrane diffusion capacity ...................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94725 .......... TC ...... A Membrane diffusion capacity ...................... 0.00 2.47 NA 0.12 2.59 NA XXX 

94750 .......... ............ A Pulmonary compliance study ...................... 0.23 1.37 NA 0.05 1.65 NA XXX 

94750 .......... 26 ....... A Pulmonary compliance study ...................... 0.23 0.07 0.07 0.01 0.31 0.31 XXX 

94750 .......... TC ...... A Pulmonary compliance study ...................... 0.00 1.30 NA 0.04 1.34 NA XXX 

94760 .......... ............ T Measure blood oxygen level ....................... 0.00 0.04 NA 0.02 0.06 NA XXX 

94761 .......... ............ T Measure blood oxygen level ....................... 0.00 0.07 NA 0.06 0.13 NA XXX 

94762 .......... ............ A Measure blood oxygen level ....................... 0.00 0.52 NA 0.10 0.62 NA XXX 

94770 .......... ............ A Exhaled carbon dioxide test ........................ 0.15 0.76 NA 0.08 0.99 NA XXX 

94770 .......... 26 ....... A Exhaled carbon dioxide test ........................ 0.15 0.04 0.04 0.01 0.20 0.20 XXX 

94770 .......... TC ...... A Exhaled carbon dioxide test ........................ 0.00 0.72 NA 0.07 0.79 NA XXX 

94772 .......... ............ C Breath recording, infant ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94772 .......... 26 ....... C Breath recording, infant ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94772 .......... TC ...... C Breath recording, infant ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94799 .......... ............ C Pulmonary service/procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94799 .......... 26 ....... C Pulmonary service/procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94799 .......... TC ...... C Pulmonary service/procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95004 .......... ............ A Percut allergy skin tests .............................. 0.00 0.11 NA 0.01 0.12 NA XXX 

95010 .......... ............ A Percut allergy titrate test ............................. 0.15 0.33 0.07 0.01 0.49 0.23 XXX 

95015 .......... ............ A Id allergy titrate-drug/bug ............................ 0.15 0.16 0.06 0.01 0.32 0.22 XXX 

95024 .......... ............ A Id allergy test, drug/bug .............................. 0.00 0.16 NA 0.01 0.17 NA XXX 

95027 .......... ............ A Id allergy titrate-airborne ............................. 0.00 0.16 NA 0.01 0.17 NA XXX 

95028 .......... ............ A Id allergy test-delayed type ......................... 0.00 0.23 NA 0.01 0.24 NA XXX 

95044 .......... ............ A Allergy patch tests ....................................... 0.00 0.19 NA 0.01 0.20 NA XXX 

95052 .......... ............ A Photo patch test .......................................... 0.00 0.23 NA 0.01 0.24 NA XXX 

45993

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

95056 .......... ............ A Photosensitivity tests ................................... 0.00 0.34 NA 0.01 0.35 NA XXX 

95060 .......... ............ A Eye allergy tests .......................................... 0.00 0.42 NA 0.02 0.44 NA XXX 

95065 .......... ............ A Nose allergy test ......................................... 0.00 0.31 NA 0.01 0.32 NA XXX 

95070 .......... ............ A Bronchial allergy tests ................................. 0.00 1.91 NA 0.02 1.93 NA XXX 

95071 .......... ............ A Bronchial allergy tests ................................. 0.00 2.50 NA 0.02 2.52 NA XXX 

95075 .......... ............ A Ingestion challenge test .............................. 0.95 0.83 0.40 0.03 1.81 1.38 XXX 

95078 .......... ............ A Provocative testing ...................................... 0.00 0.27 NA 0.02 0.29 NA XXX 

95115 .......... ............ A Immunotherapy, one injection ..................... 0.00 0.35 NA 0.02 0.37 NA 000 

95117 .......... ............ A Immunotherapy injections ........................... 0.00 0.45 NA 0.02 0.47 NA 000 

95120 .......... ............ I Immunotherapy, one injection ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95125 .......... ............ I Immunotherapy, many antigens .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95130 .......... ............ I Immunotherapy, insect venom .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95131 .......... ............ I Immunotherapy, insect venoms .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95132 .......... ............ I Immunotherapy, insect venoms .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95133 .......... ............ I Immunotherapy, insect venoms .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95134 .......... ............ I Immunotherapy, insect venoms .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95144 .......... ............ A Antigen therapy services ............................. 0.06 0.21 0.02 0.01 0.28 0.09 000 

95145 .......... ............ A Antigen therapy services ............................. 0.06 0.33 0.02 0.01 0.40 0.09 000 

95146 .......... ............ A Antigen therapy services ............................. 0.06 0.48 0.03 0.01 0.55 0.10 000 

95147 .......... ............ A Antigen therapy services ............................. 0.06 0.46 0.02 0.01 0.53 0.09 000 

95148 .......... ............ A Antigen therapy services ............................. 0.06 0.65 0.03 0.01 0.72 0.10 000 

95149 .......... ............ A Antigen therapy services ............................. 0.06 0.89 0.03 0.01 0.96 0.10 000 

95165 .......... ............ A Antigen therapy services ............................. 0.06 0.20 0.02 0.01 0.27 0.09 000 

95170 .......... ............ A Antigen therapy services ............................. 0.06 0.15 0.03 0.01 0.22 0.10 000 

95180 .......... ............ A Rapid desensitization .................................. 2.01 2.07 0.97 0.04 4.13 3.03 000 

95199 .......... ............ C Allergy immunology services ....................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

95250 .......... ............ A Glucose monitoring, cont ............................ 0.00 3.91 NA 0.01 3.92 NA XXX 

95805 .......... ............ A Multiple sleep latency test ........................... 1.88 15.27 NA 0.43 17.58 NA XXX 

95805 .......... 26 ....... A Multiple sleep latency test ........................... 1.88 0.64 0.64 0.09 2.62 2.62 XXX 

95805 .......... TC ...... A Multiple sleep latency test ........................... 0.00 14.62 NA 0.34 14.96 NA XXX 

95806 .......... ............ A Sleep study, unattended ............................. 1.66 3.31 NA 0.39 5.36 NA XXX 

95806 .......... 26 ....... A Sleep study, unattended ............................. 1.66 0.53 0.53 0.08 2.27 2.27 XXX 

95806 .......... TC ...... A Sleep study, unattended ............................. 0.00 2.78 NA 0.31 3.09 NA XXX 

95807 .......... ............ A Sleep study, attended ................................. 1.66 11.70 NA 0.50 13.86 NA XXX 

95807 .......... 26 ....... A Sleep study, attended ................................. 1.66 0.52 0.52 0.08 2.26 2.26 XXX 

95807 .......... TC ...... A Sleep study, attended ................................. 0.00 11.18 NA 0.42 11.60 NA XXX 

95808 .......... ............ A Polysomnography, 1-3 ................................ 2.66 12.98 NA 0.55 16.18 NA XXX 

95808 .......... 26 ....... A Polysomnography, 1-3 ................................ 2.66 0.90 0.90 0.13 3.68 3.68 XXX 

95808 .......... TC ...... A Polysomnography, 1-3 ................................ 0.00 12.08 NA 0.42 12.50 NA XXX 

95810 .......... ............ A Polysomnography, 4 or more ...................... 3.53 17.14 NA 0.59 21.26 NA XXX 

95810 .......... 26 ....... A Polysomnography, 4 or more ...................... 3.53 1.15 1.15 0.17 4.85 4.85 XXX 

95810 .......... TC ...... A Polysomnography, 4 or more ...................... 0.00 15.99 NA 0.42 16.41 NA XXX 

95811 .......... ............ A Polysomnography w/cpap ........................... 3.80 18.83 NA 0.61 23.24 NA XXX 

95811 .......... 26 ....... A Polysomnography w/cpap ........................... 3.80 1.24 1.24 0.18 5.22 5.22 XXX 

95811 .......... TC ...... A Polysomnography w/cpap ........................... 0.00 17.59 NA 0.43 18.02 NA XXX 

95812 .......... ............ A Eeg, 41-60 minutes ..................................... 1.08 3.85 NA 0.17 5.10 NA XXX 

95812 .......... 26 ....... A Eeg, 41-60 minutes ..................................... 1.08 0.44 0.44 0.06 1.58 1.58 XXX 

95812 .......... TC ...... A Eeg, 41-60 minutes ..................................... 0.00 3.40 NA 0.11 3.51 NA XXX 

95813 .......... ............ A Eeg, over 1 hour ......................................... 1.73 4.77 NA 0.20 6.71 NA XXX 

95813 .......... 26 ....... A Eeg, over 1 hour ......................................... 1.73 0.68 0.68 0.09 2.50 2.50 XXX 

95813 .......... TC ...... A Eeg, over 1 hour ......................................... 0.00 4.09 NA 0.11 4.20 NA XXX 

95816 .......... ............ A Eeg, awake and drowsy .............................. 1.08 3.52 NA 0.16 4.77 NA XXX 

95816 .......... 26 ....... A Eeg, awake and drowsy .............................. 1.08 0.45 0.45 0.06 1.59 1.59 XXX 

95816 .......... TC ...... A Eeg, awake and drowsy .............................. 0.00 3.08 NA 0.10 3.18 NA XXX 

95819 .......... ............ A Eeg, awake and asleep ............................... 1.08 3.00 NA 0.16 4.24 NA XXX 

95819 .......... 26 ....... A Eeg, awake and asleep ............................... 1.08 0.45 0.45 0.06 1.59 1.59 XXX 

95819 .......... TC ...... A Eeg, awake and asleep ............................... 0.00 2.55 NA 0.10 2.65 NA XXX 

95822 .......... ............ A Eeg, coma or sleep only ............................. 1.08 4.29 NA 0.19 5.56 NA XXX 

95822 .......... 26 ....... A Eeg, coma or sleep only ............................. 1.08 0.45 0.45 0.06 1.59 1.59 XXX 

95822 .......... TC ...... A Eeg, coma or sleep only ............................. 0.00 3.84 NA 0.13 3.97 NA XXX 

95824 .......... ............ C Eeg, cerebral death only ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95824 .......... 26 ....... A Eeg, cerebral death only ............................. 0.74 0.30 0.30 0.04 1.08 1.08 XXX 

95824 .......... TC ...... C Eeg, cerebral death only ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95827 .......... ............ A Eeg, all night recording ............................... 1.08 5.15 NA 0.19 6.42 NA XXX 

95827 .......... 26 ....... A Eeg, all night recording ............................... 1.08 0.40 0.40 0.05 1.53 1.53 XXX 

95827 .......... TC ...... A Eeg, all night recording ............................... 0.00 4.75 NA 0.14 4.89 NA XXX 

95829 .......... ............ A Surgery electrocorticogram ......................... 6.21 28.77 NA 0.50 35.49 NA XXX 

95829 .......... 26 ....... A Surgery electrocorticogram ......................... 6.21 2.25 2.25 0.48 8.94 8.94 XXX 

95829 .......... TC ...... A Surgery electrocorticogram ......................... 0.00 26.53 NA 0.02 26.55 NA XXX 

95830 .......... ............ A Insert electrodes for EEG ............................ 1.70 3.14 0.71 0.11 4.95 2.52 XXX 

95831 .......... ............ A Limb muscle testing, manual ...................... 0.28 0.44 NA 0.01 0.73 NA XXX 

95832 .......... ............ A Hand muscle testing, manual ...................... 0.29 0.33 NA 0.02 0.64 NA XXX 

95833 .......... ............ A Body muscle testing, manual ...................... 0.47 0.56 NA 0.02 1.05 NA XXX 

95834 .......... ............ A Body muscle testing, manual ...................... 0.60 0.62 NA 0.03 1.25 NA XXX 

45994

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

95851 .......... ............ A Range of motion measurements ................. 0.16 0.35 NA 0.01 0.52 NA XXX 

95852 .......... ............ A Range of motion measurements ................. 0.11 0.25 NA 0.01 0.37 NA XXX 

95857 .......... ............ A Tensilon test ................................................ 0.53 0.59 0.22 0.02 1.14 0.77 XXX 

95858 .......... ............ A Tensilon test & myogram ............................ 1.56 NA NA 0.12 NA NA XXX 

95858 .......... 26 ....... A Tensilon test & myogram ............................ 1.56 0.65 0.65 0.08 2.30 2.30 XXX 

95858 .......... TC ...... A Tensilon test & myogram ............................ 0.00 NA NA 0.04 NA NA XXX 

95860 .......... ............ A Muscle test, one limb .................................. 0.96 1.35 NA 0.07 2.38 NA XXX 

95860 .......... 26 ....... A Muscle test, one limb .................................. 0.96 0.41 0.41 0.05 1.42 1.42 XXX 

95860 .......... TC ...... A Muscle test, one limb .................................. 0.00 0.94 NA 0.02 0.96 NA XXX 

95861 .......... ............ A Muscle test, 2 limbs .................................... 1.54 1.47 NA 0.13 3.15 NA XXX 

95861 .......... 26 ....... A Muscle test, 2 limbs .................................... 1.54 0.66 0.66 0.07 2.27 2.27 XXX 

95861 .......... TC ...... A Muscle test, 2 limbs .................................... 0.00 0.81 NA 0.06 0.87 NA XXX 

95863 .......... ............ A Muscle test, 3 limbs .................................... 1.87 1.78 NA 0.15 3.80 NA XXX 

95863 .......... 26 ....... A Muscle test, 3 limbs .................................... 1.87 0.78 0.78 0.09 2.74 2.74 XXX 

95863 .......... TC ...... A Muscle test, 3 limbs .................................... 0.00 0.99 NA 0.06 1.05 NA XXX 

95864 .......... ............ A Muscle test, 4 limbs .................................... 1.99 2.53 NA 0.21 4.73 NA XXX 

95864 .......... 26 ....... A Muscle test, 4 limbs .................................... 1.99 0.85 0.85 0.09 2.93 2.93 XXX 

95864 .......... TC ...... A Muscle test, 4 limbs .................................... 0.00 1.68 NA 0.12 1.80 NA XXX 

95867 .......... ............ A Muscle test cran nerv unilat ........................ 0.79 0.96 NA 0.07 1.82 NA XXX 

95867 .......... 26 ....... A Muscle test cran nerv unilat ........................ 0.79 0.34 0.34 0.03 1.16 1.16 XXX 

95867 .......... TC ...... A Muscle test cran nerv unilat ........................ 0.00 0.62 NA 0.04 0.66 NA XXX 

95868 .......... ............ A Muscle test cran nerve bilat ........................ 1.18 1.26 NA 0.10 2.54 NA XXX 

95868 .......... 26 ....... A Muscle test cran nerve bilat ........................ 1.18 0.49 0.49 0.05 1.73 1.73 XXX 

95868 .......... TC ...... A Muscle test cran nerve bilat ........................ 0.00 0.77 NA 0.05 0.82 NA XXX 

95869 .......... ............ A Muscle test, thor paraspinal ........................ 0.37 0.52 NA 0.04 0.93 NA XXX 

95869 .......... 26 ....... A Muscle test, thor paraspinal ........................ 0.37 0.16 0.16 0.02 0.55 0.55 XXX 

95869 .......... TC ...... A Muscle test, thor paraspinal ........................ 0.00 0.37 NA 0.02 0.39 NA XXX 

95870 .......... ............ A Muscle test, nonparaspinal ......................... 0.37 0.51 NA 0.04 0.92 NA XXX 

95870 .......... 26 ....... A Muscle test, nonparaspinal ......................... 0.37 0.16 0.16 0.02 0.55 0.55 XXX 

95870 .......... TC ...... A Muscle test, nonparaspinal ......................... 0.00 0.35 NA 0.02 0.37 NA XXX 

95872 .......... ............ A Muscle test, one fiber .................................. 1.50 1.28 NA 0.13 2.91 NA XXX 

95872 .......... 26 ....... A Muscle test, one fiber .................................. 1.50 0.61 0.61 0.08 2.20 2.20 XXX 

95872 .......... TC ...... A Muscle test, one fiber .................................. 0.00 0.66 NA 0.05 0.71 NA XXX 

95875 .......... ............ A Limb exercise test ....................................... 1.10 1.40 NA 0.11 2.61 NA XXX 

95875 .......... 26 ....... A Limb exercise test ....................................... 1.10 0.46 0.46 0.05 1.61 1.61 XXX 

95875 .......... TC ...... A Limb exercise test ....................................... 0.00 0.94 NA 0.06 1.00 NA XXX 

95900 .......... ............ A Motor nerve conduction test ........................ 0.42 1.18 NA 0.04 1.64 NA XXX 

95900 .......... 26 ....... A Motor nerve conduction test ........................ 0.42 0.18 0.18 0.02 0.62 0.62 XXX 

95900 .......... TC ...... A Motor nerve conduction test ........................ 0.00 1.00 NA 0.02 1.02 NA XXX 

95903 .......... ............ A Motor nerve conduction test ........................ 0.60 1.14 NA 0.05 1.79 NA XXX 

95903 .......... 26 ....... A Motor nerve conduction test ........................ 0.60 0.25 0.25 0.03 0.88 0.88 XXX 

95903 .......... TC ...... A Motor nerve conduction test ........................ 0.00 0.89 NA 0.02 0.91 NA XXX 

95904 .......... ............ A Sense nerve conduction test ....................... 0.34 1.03 NA 0.04 1.41 NA XXX 

95904 .......... 26 ....... A Sense nerve conduction test ....................... 0.34 0.15 0.15 0.02 0.51 0.51 XXX 

95904 .......... TC ...... A Sense nerve conduction test ....................... 0.00 0.88 NA 0.02 0.90 NA XXX 

95920 .......... ............ A Intraop nerve test add-on ............................ 2.11 2.06 NA 0.23 4.40 NA ZZZ 

95920 .......... 26 ....... A Intraop nerve test add-on ............................ 2.11 0.90 0.90 0.16 3.18 3.18 ZZZ 

95920 .......... TC ...... A Intraop nerve test add-on ............................ 0.00 1.15 NA 0.07 1.22 NA ZZZ 

95921 .......... ............ A Autonomic nerv function test ....................... 0.90 0.79 NA 0.06 1.75 NA XXX 

95921 .......... 26 ....... A Autonomic nerv function test ....................... 0.90 0.32 0.32 0.04 1.26 1.26 XXX 

95921 .......... TC ...... A Autonomic nerv function test ....................... 0.00 0.47 NA 0.02 0.49 NA XXX 

95922 .......... ............ A Autonomic nerv function test ....................... 0.96 0.89 NA 0.07 1.92 NA XXX 

95922 .......... 26 ....... A Autonomic nerv function test ....................... 0.96 0.40 0.40 0.05 1.41 1.41 XXX 

95922 .......... TC ...... A Autonomic nerv function test ....................... 0.00 0.50 NA 0.02 0.52 NA XXX 

95923 .......... ............ A Autonomic nerv function test ....................... 0.90 1.87 NA 0.07 2.84 NA XXX 

95923 .......... 26 ....... A Autonomic nerv function test ....................... 0.90 0.37 0.37 0.05 1.32 1.32 XXX 

95923 .......... TC ...... A Autonomic nerv function test ....................... 0.00 1.50 NA 0.02 1.52 NA XXX 

95925 .......... ............ A *Somatosensory testing .............................. 0.54 1.57 NA 0.10 2.21 NA XXX 

95925 .......... 26 ....... A Somatosensory testing ................................ 0.54 0.22 0.22 0.04 0.80 0.80 XXX 

95925 .......... TC ...... A Somatosensory testing ................................ 0.00 1.35 NA 0.06 1.41 NA XXX 

95926 .......... ............ A *Somatosensory testing .............................. 0.54 1.52 NA 0.09 2.15 NA XXX 

95926 .......... 26 ....... A Somatosensory testing ................................ 0.54 0.23 0.23 0.03 0.80 0.80 XXX 

95926 .......... TC ...... A Somatosensory testing ................................ 0.00 1.30 NA 0.06 1.36 NA XXX 

95927 .......... ............ A Somatosensory testing ................................ 0.54 1.63 NA 0.10 2.27 NA XXX 

95927 .......... 26 ....... A Somatosensory testing ................................ 0.54 0.24 0.24 0.04 0.82 0.82 XXX 

95927 .......... TC ...... A Somatosensory testing ................................ 0.00 1.39 NA 0.06 1.45 NA XXX 

95928 .......... ............ A C motor evoked, uppr limbs ........................ 1.50 3.03 NA 0.09 4.63 NA XXX 

95928 .......... 26 ....... A C motor evoked, uppr limbs ........................ 1.50 0.63 0.63 0.06 2.19 2.19 XXX 

95928 .......... TC ...... A C motor evoked, uppr limbs ........................ 0.00 2.40 NA 0.03 2.43 NA XXX 

95929 .......... ............ A Cmotor evoked, lwr limbs ............................ 1.50 3.23 NA 0.09 4.82 NA XXX 

95929 .......... 26 ....... A C motor evoked, lwr limbs .......................... 1.50 0.63 0.63 0.06 2.19 2.19 XXX 

95929 .......... TC ...... A C motor evoked, lwr limbs .......................... 0.00 2.60 NA 0.03 2.63 NA XXX 

95930 .......... ............ A Visual evoked potential test ........................ 0.35 2.20 NA 0.03 2.59 NA XXX 

95930 .......... 26 ....... A Visual evoked potential test ........................ 0.35 0.15 0.15 0.02 0.52 0.52 XXX 

45995

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

95930 .......... TC ...... A Visual evoked potential test ........................ 0.00 2.06 NA 0.01 2.07 NA XXX 

95933 .......... ............ A Blink reflex test ............................................ 0.59 1.02 NA 0.10 1.71 NA XXX 

95933 .......... 26 ....... A Blink reflex test ............................................ 0.59 0.23 0.23 0.04 0.86 0.86 XXX 

95933 .......... TC ...... A Blink reflex test ............................................ 0.00 0.78 NA 0.06 0.84 NA XXX 

95934 .......... ............ A H-reflex test ................................................. 0.51 0.55 NA 0.04 1.10 NA XXX 

95934 .......... 26 ....... A H-reflex test ................................................. 0.51 0.22 0.22 0.02 0.75 0.75 XXX 

95934 .......... TC ...... A H-reflex test ................................................. 0.00 0.34 NA 0.02 0.36 NA XXX 

95936 .......... ............ A H-reflex test ................................................. 0.55 0.48 NA 0.05 1.08 NA XXX 

95936 .......... 26 ....... A H-reflex test ................................................. 0.55 0.23 0.23 0.03 0.81 0.81 XXX 

95936 .......... TC ...... A H-reflex test ................................................. 0.00 0.25 NA 0.02 0.27 NA XXX 

95937 .......... ............ A Neuromuscular junction test ........................ 0.65 0.65 NA 0.10 1.41 NA XXX 

95937 .......... 26 ....... A Neuromuscular junction test ........................ 0.65 0.26 0.26 0.08 0.99 0.99 XXX 

95937 .......... TC ...... A Neuromuscular junction test ........................ 0.00 0.39 NA 0.02 0.41 NA XXX 

95950 .......... ............ A Ambulatory eeg monitoring ......................... 1.51 3.77 NA 0.51 5.79 NA XXX 

95950 .......... 26 ....... A Ambulatory eeg monitoring ......................... 1.51 0.62 0.62 0.08 2.22 2.22 XXX 

95950 .......... TC ...... A Ambulatory eeg monitoring ......................... 0.00 3.15 NA 0.43 3.58 NA XXX 

95951 .......... TC ...... C EEG monitoring/videorecord ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95951 .......... 26 ....... A EEG monitoring/videorecord ....................... 6.00 2.48 2.48 0.32 8.81 8.81 XXX 

95951 .......... TC ...... C EEG monitoring/videorecord ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95953 .......... ............ A EEG monitoring/computer ........................... 3.09 7.05 NA 0.60 10.73 NA XXX 

95953 .......... 26 ....... A EEG monitoring/computer ........................... 3.09 1.25 1.25 0.17 4.51 4.51 XXX 

95953 .......... TC ...... A EEG monitoring/computer ........................... 0.00 5.79 NA 0.43 6.22 NA XXX 

95954 .......... ............ A EEG monitoring/giving drugs ...................... 2.45 4.19 NA 0.19 6.83 NA XXX 

95954 .......... 26 ....... A EEG monitoring/giving drugs ...................... 2.45 1.01 1.01 0.13 3.60 3.60 XXX 

95954 .......... TC ...... A EEG monitoring/giving drugs ...................... 0.00 3.17 NA 0.06 3.23 NA XXX 

95955 .......... ............ A EEG during surgery ..................................... 1.01 2.70 NA 0.22 3.93 NA XXX 

95955 .......... 26 ....... A EEG during surgery ..................................... 1.01 0.35 0.35 0.05 1.41 1.41 XXX 

95955 .......... TC ...... A EEG during surgery ..................................... 0.00 2.34 NA 0.17 2.51 NA XXX 

95956 .......... TC ...... A Eeg monitoring, cable/radio ........................ 3.09 14.65 NA 0.59 18.33 NA XXX 

95956 .......... 26 ....... A Eeg monitoring, cable/radio ........................ 3.09 1.27 1.27 0.16 4.51 4.51 XXX 

95956 .......... TC ...... A Eeg monitoring, cable/radio ........................ 0.00 13.38 NA 0.43 13.81 NA XXX 

95957 .......... ............ A EEG digital analysis .................................... 1.98 3.19 NA 0.23 5.41 NA XXX 

95957 .......... 26 ....... A EEG digital analysis .................................... 1.98 0.83 0.83 0.11 2.92 2.92 XXX 

95957 .......... TC ...... A EEG digital analysis .................................... 0.00 2.36 NA 0.12 2.48 NA XXX 

95958 .......... ............ A EEG monitoring/function test ...................... 4.25 3.95 NA 0.34 8.54 NA XXX 

95958 .......... 26 ....... A EEG monitoring/function test ...................... 4.25 1.71 1.71 0.21 6.17 6.17 XXX 

95958 .......... TC ...... A EEG monitoring/function test ...................... 0.00 2.24 NA 0.13 2.37 NA XXX 

95961 .......... ............ A Electrode stimulation, brain ......................... 2.98 2.76 NA 0.55 6.28 NA XXX 

95961 .......... 26 ....... A Electrode stimulation, brain ......................... 2.98 1.29 1.29 0.48 4.74 4.74 XXX 

95961 .......... TC ...... A Electrode stimulation, brain ......................... 0.00 1.47 NA 0.07 1.54 NA XXX 

95962 .......... ............ A Electrode stim, brain add-on ....................... 3.22 2.58 NA 0.39 6.18 NA ZZZ 

95962 .......... 26 ....... A Electrode stim, brain add-on ....................... 3.22 1.36 1.36 0.32 4.89 4.89 ZZZ 

95962 .......... TC ...... A Electrode stim, brain add-on ....................... 0.00 1.22 NA 0.07 1.29 NA ZZZ 

95965 .......... ............ C Meg, spontaneous ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95965 .......... 26 ....... A Meg, spontaneous ....................................... 8.01 3.36 3.36 0.46 11.83 11.83 XXX 

95965 .......... TC ...... C Meg, spontaneous ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95966 .......... ............ C Meg, evoked, single .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95966 .......... 26 ....... A Meg, evoked, single .................................... 4.00 1.67 1.67 0.19 5.85 5.85 XXX 

95966 .......... TC ...... C Meg, evoked, single .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95967 .......... ............ C Meg, evoked, each add’l ............................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

95967 .......... 26 ....... A Meg, evoked, each add’l ............................. 3.50 1.23 1.23 0.16 4.89 4.89 ZZZ 

95967 .......... TC ...... C Meg, evoked, each add’l ............................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

95970 .......... ............ A Analyze neurostim, no prog ........................ 0.45 0.84 0.14 0.03 1.32 0.62 XXX 

95971 .......... ............ A Analyze neurostim, simple .......................... 0.78 0.67 0.22 0.07 1.53 1.07 XXX 

95972 .......... ............ A Analyze neurostim, complex ....................... 1.50 1.21 0.48 0.14 2.85 2.13 XXX 

95973 .......... ............ A Analyze neurostim, complex ....................... 0.92 0.62 0.33 0.07 1.61 1.32 ZZZ 

95974 .......... ............ A Cranial neurostim, complex ......................... 3.01 1.68 1.27 0.16 4.85 4.43 XXX 

95975 .......... ............ A Cranial neurostim, complex ......................... 1.70 0.88 0.71 0.12 2.70 2.53 ZZZ 

95978 .......... ............ A Analyze neurostim brain/1h ......................... 3.51 1.96 1.32 0.18 5.65 5.00 XXX 

95979 .......... ............ A Analyz neurostim brain add-on ................... 1.64 0.86 0.67 0.08 2.58 2.39 ZZZ 

95990 .......... ............ A Spin/brain pump refil & main ....................... 0.00 1.53 NA 0.06 1.59 NA XXX 

95991 .......... ............ A Spin/brain pump refil & main ....................... 0.77 1.38 NA 0.06 2.21 NA XXX 

95999 .......... ............ C Neurological procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

96000 .......... ............ A Motion analysis, video/3d ............................ 1.80 NA 0.52 0.11 NA 2.43 XXX 

96001 .......... ............ A Motion test w/ft press meas ........................ 2.15 NA 0.64 0.10 NA 2.90 XXX 

96002 .......... ............ A Dynamic surface emg ................................. 0.41 NA 0.15 0.02 NA 0.58 XXX 

96003 .......... ............ A Dynamic fine wire emg ................................ 0.37 NA 0.13 0.02 NA 0.52 XXX 

96004 .......... ............ A Phys review of motion tests ........................ 2.14 0.96 0.89 0.11 3.21 3.15 XXX 

96100 .......... ............ A Psychological testing ................................... 0.00 1.74 NA 0.18 1.92 NA XXX 

96105 .......... ............ A Assessment of aphasia ............................... 0.00 1.64 NA 0.18 1.82 NA XXX 

96110 .......... ............ A Developmental test, lim ............................... 0.00 0.17 NA 0.18 0.35 NA XXX 

96111 .......... ............ A Developmental test, extend ......................... 2.61 1.01 0.99 0.18 3.79 3.78 XXX 

96115 .......... ............ A Neurobehavior status exam ........................ 0.00 1.82 NA 0.18 2.00 NA XXX 

96117 .......... ............ A Neuropsych test battery .............................. 0.00 1.78 NA 0.18 1.96 NA XXX 

45996

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

96150 .......... ............ A Assess hlth/behave, init .............................. 0.50 0.17 0.17 0.01 0.68 0.68 XXX 

96151 .......... ............ A Assess hlth/behave, subseq ....................... 0.48 0.17 0.16 0.01 0.66 0.65 XXX 

96152 .......... ............ A Intervene hlth/behave, indiv ........................ 0.46 0.16 0.15 0.01 0.63 0.62 XXX 

96153 .......... ............ A Intervene hlth/behave, group ...................... 0.10 0.04 0.03 0.01 0.15 0.14 XXX 

96154 .......... ............ A Interv hlth/behav, fam w/pt .......................... 0.45 0.16 0.15 0.01 0.62 0.61 XXX 

96155 .......... ............ N Interv hlth/behav fam no pt ......................... 0.44 0.17 0.16 0.02 0.63 0.62 XXX 

96400 .......... ............ I Chemotherapy, sc/im .................................. 0.17 0.00 0.00 0.01 0.18 0.18 XXX 

96405 .......... ............ A Intralesional chemo admin .......................... 0.52 2.58 0.24 0.03 3.13 0.79 000 

96406 .......... ............ A Intralesional chemo admin .......................... 0.80 3.20 0.29 0.03 4.03 1.12 000 

96408 .......... ............ I Chemotherapy, push technique .................. 0.17 0.00 0.00 0.06 0.23 0.23 XXX 

96410 .......... ............ I Chemotherapy,infusion method .................. 0.17 0.00 0.00 0.08 0.25 0.25 XXX 

96412 .......... ............ I Chemo, infuse method add-on .................... 0.17 0.00 0.00 0.07 0.24 0.24 ZZZ 

96414 .......... ............ I Chemo, infuse method add-on .................... 0.17 0.00 0.00 0.08 0.25 0.25 XXX 

96420 .......... ............ A Chemotherapy, push technique .................. 0.17 2.67 NA 0.08 2.92 NA XXX 

96422 .......... ............ A Chemotherapy,infusion method .................. 0.17 4.87 NA 0.08 5.12 NA XXX 

96423 .......... ............ A Chemo, infuse method add-on .................... 0.17 1.89 NA 0.02 2.08 NA ZZZ 

96425 .......... ............ A Chemotherapy,infusion method .................. 0.17 4.50 NA 0.08 4.75 NA XXX 

96440 .......... ............ A Chemotherapy, intracavitary ....................... 2.37 7.56 1.20 0.17 10.10 3.74 000 

96445 .......... ............ A Chemotherapy, intracavitary ....................... 2.20 7.64 1.15 0.14 9.99 3.50 000 

96450 .......... ............ A Chemotherapy, into CNS ............................ 1.89 6.62 1.07 0.08 8.59 3.04 000 

96520 .......... ............ A Port pump refill & main ............................... 0.21 3.79 NA 0.06 4.06 NA XXX 

96530 .......... ............ A Syst pump refill & main ............................... 0.21 2.66 NA 0.06 2.93 NA XXX 

96542 .......... ............ A Chemotherapy injection ............................... 1.42 4.09 0.64 0.06 5.57 2.12 XXX 

96545 .......... ............ B Provide chemotherapy agent ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

96549 .......... ............ C Chemotherapy, unspecified ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

96567 .......... ............ A Photodynamic tx, skin ................................. 0.00 1.45 NA 0.04 1.49 NA XXX 

96570 .......... ............ A Photodynamic tx, 30 min ............................. 1.10 0.00 0.37 0.11 1.21 1.58 ZZZ 

96571 .......... ............ A Photodynamic tx, addl 15 min ..................... 0.55 0.00 0.20 0.03 0.58 0.78 ZZZ 

96900 .......... ............ A Ultraviolet light therapy ................................ 0.00 0.45 NA 0.02 0.47 NA XXX 

96902 .......... ............ B Trichogram .................................................. 0.41 0.18 0.16 0.01 0.60 0.58 XXX 

96910 .......... ............ A Photochemotherapy with UV-B ................... 0.00 1.13 NA 0.04 1.17 NA XXX 

96912 .......... ............ A Photochemotherapy with UV-A ................... 0.00 1.45 NA 0.05 1.50 NA XXX 

96913 .......... ............ A Photochemotherapy, UV-A or B .................. 0.00 1.97 NA 0.10 2.07 NA XXX 

96920 .......... ............ A Laser tx, skin < 250 sq cm .......................... 1.15 2.91 0.61 0.02 4.08 1.78 000 

96921 .......... ............ A Laser tx, skin 250-500 sq cm ...................... 1.17 3.00 0.63 0.03 4.21 1.83 000 

96922 .......... ............ A Laser tx, skin > 500 sq cm .......................... 2.10 3.96 0.60 0.04 6.10 2.75 000 

96999 .......... ............ C Dermatological procedure ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97001 .......... ............ A Pt evaluation ................................................ 1.20 0.75 NA 0.05 2.00 NA XXX 

97002 .......... ............ A Pt re-evaluation ........................................... 0.60 0.44 NA 0.02 1.06 NA XXX 

97003 .......... ............ A Ot evaluation ............................................... 1.20 0.86 NA 0.06 2.12 NA XXX 

97004 .......... ............ A Ot re-evaluation ........................................... 0.60 0.64 NA 0.02 1.26 NA XXX 

97005 .......... ............ I Athletic train eval ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97006 .......... ............ I Athletic train reeval ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97010 .......... ............ B Hot or cold packs therapy ........................... 0.06 0.06 NA 0.01 0.13 NA XXX 

97012 .......... ............ A Mechanical traction therapy ........................ 0.25 0.14 NA 0.01 0.40 NA XXX 

97014 .......... ............ I Electric stimulation therapy ......................... 0.18 0.19 NA 0.01 0.38 NA XXX 

97016 .......... ............ A Vasopneumatic device therapy ................... 0.18 0.19 NA 0.01 0.38 NA XXX 

97018 .......... ............ A Paraffin bath therapy ................................... 0.06 0.11 NA 0.01 0.18 NA XXX 

97020 .......... ............ A Microwave therapy ...................................... 0.06 0.06 NA 0.01 0.13 NA XXX 

97022 .......... ............ A Whirlpool therapy ........................................ 0.17 0.23 NA 0.01 0.41 NA XXX 

97024 .......... ............ A Diathermy treatment .................................... 0.06 0.07 NA 0.01 0.14 NA XXX 

97026 .......... ............ A Infrared therapy ........................................... 0.06 0.06 NA 0.01 0.13 NA XXX 

97028 .......... ............ A Ultraviolet therapy ....................................... 0.08 0.07 NA 0.01 0.16 NA XXX 

97032 .......... ............ A Electrical stimulation .................................... 0.25 0.17 NA 0.01 0.43 NA XXX 

97033 .......... ............ A Electric current therapy ............................... 0.26 0.30 NA 0.01 0.57 NA XXX 

97034 .......... ............ A Contrast bath therapy .................................. 0.21 0.16 NA 0.01 0.38 NA XXX 

97035 .......... ............ A Ultrasound therapy ...................................... 0.21 0.10 NA 0.01 0.32 NA XXX 

97036 .......... ............ A Hydrotherapy ............................................... 0.28 0.34 NA 0.01 0.63 NA XXX 

97039 .......... ............ C Physical therapy treatment .......................... 0.20 0.10 NA 0.01 0.31 NA XXX 

97110 .......... ............ A Therapeutic exercises ................................. 0.45 0.28 NA 0.02 0.75 NA XXX 

97112 .......... ............ A Neuromuscular reeducation ........................ 0.45 0.32 NA 0.01 0.78 NA XXX 

97113 .......... ............ A Aquatic therapy/exercises ........................... 0.44 0.42 NA 0.01 0.87 NA XXX 

97116 .......... ............ A Gait training therapy .................................... 0.40 0.25 NA 0.01 0.66 NA XXX 

97124 .......... ............ A Massage therapy ......................................... 0.35 0.24 NA 0.01 0.60 NA XXX 

97139 .......... ............ C Physical medicine procedure ...................... 0.21 0.21 NA 0.01 0.43 NA XXX 

97140 .......... ............ A Manual therapy ............................................ 0.43 0.26 NA 0.01 0.70 NA XXX 

97150 .......... ............ A Group therapeutic procedures .................... 0.27 0.19 NA 0.01 0.47 NA XXX 

97504 .......... ............ A Orthotic training ........................................... 0.45 0.35 NA 0.03 0.83 NA XXX 

97520 .......... ............ A Prosthetic training ........................................ 0.45 0.28 NA 0.01 0.74 NA XXX 

97530 .......... ............ A Therapeutic activities ................................... 0.44 0.33 NA 0.01 0.78 NA XXX 

97532 .......... ............ A Cognitive skills development ....................... 0.44 0.21 NA 0.01 0.66 NA XXX 

97533 .......... ............ A Sensory integration ..................................... 0.44 0.25 NA 0.01 0.70 NA XXX 

97535 .......... ............ A Self care mngment training ......................... 0.45 0.34 NA 0.01 0.80 NA XXX 

97537 .......... ............ A Community/work reintegration ..................... 0.45 0.27 NA 0.01 0.73 NA XXX 

45997

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

97542 .......... ............ A Wheelchair mngment training ..................... 0.45 0.29 NA 0.01 0.75 NA XXX 

97545 .......... ............ R Work hardening ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97546 .......... ............ R Work hardening add-on ............................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

97597 .......... ............ A Active wound care/20 cm or < .................... 0.58 0.74 NA 0.05 1.37 NA XXX 

97598 .......... ............ A Active wound care > 20 cm ........................ 0.80 0.88 NA 0.05 1.73 NA XXX 

97602 .......... ............ B Wound(s) care non-selective ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97605 .......... ............ B Neg press wound tx, < 50 cm ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97606 .......... ............ B Neg press wound tx, > 50 cm ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97703 .......... ............ A Prosthetic checkout ..................................... 0.25 0.47 NA 0.02 0.74 NA XXX 

97750 .......... ............ A Physical performance test ........................... 0.45 0.33 NA 0.02 0.80 NA XXX 

97755 .......... ............ A Assistive technology assess ....................... 0.62 0.29 NA 0.02 0.93 NA XXX 

97799 .......... ............ C Physical medicine procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97802 .......... ............ A Medical nutrition, indiv, in ............................ 0.00 0.43 NA 0.01 0.44 NA XXX 

97803 .......... ............ A Med nutrition, indiv, subseq ........................ 0.00 0.42 NA 0.01 0.43 NA XXX 

97804 .......... ............ A Medical nutrition, group ............................... 0.00 0.16 NA 0.01 0.17 NA XXX 

97810 .......... ............ N Acupunct w/o stimul 15 min ........................ 0.60 0.09 0.06 0.03 0.72 0.69 XXX 

97811 .......... ............ N Acupunct w/o stimul addl 15m .................... 0.50 0.06 0.05 0.03 0.59 0.58 ZZZ 

97813 .......... ............ N Acupunct w/stimul 15 min ........................... 0.65 0.09 0.06 0.03 0.77 0.74 XXX 

97814 .......... ............ N Acupunct w/stimul addl 15m ....................... 0.55 0.07 0.05 0.03 0.65 0.63 ZZZ 

98925 .......... ............ A Osteopathic manipulation ............................ 0.45 0.31 0.14 0.02 0.78 0.61 000 

98926 .......... ............ A Osteopathic manipulation ............................ 0.65 0.40 0.24 0.03 1.08 0.92 000 

98927 .......... ............ A Osteopathic manipulation ............................ 0.87 0.49 0.28 0.03 1.40 1.18 000 

98928 .......... ............ A Osteopathic manipulation ............................ 1.03 0.58 0.33 0.04 1.65 1.41 000 

98929 .......... ............ A Osteopathic manipulation ............................ 1.19 0.66 0.36 0.05 1.90 1.60 000 

98940 .......... ............ A Chiropractic manipulation ............................ 0.45 0.22 0.12 0.01 0.68 0.58 000 

98941 .......... ............ A Chiropractic manipulation ............................ 0.65 0.29 0.17 0.01 0.95 0.83 000 

98942 .......... ............ A Chiropractic manipulation ............................ 0.87 0.35 0.23 0.02 1.24 1.12 000 

98943 .......... ............ N Chiropractic manipulation ............................ 0.40 0.24 0.16 0.01 0.65 0.57 XXX 

99000 .......... ............ B Specimen handling ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99001 .......... ............ B Specimen handling ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99002 .......... ............ B Device handling ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99024 .......... ............ B Postop follow-up visit .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99026 .......... ............ N In-hospital on call service ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99027 .......... ............ N Out-of-hosp on call service ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99050 .......... ............ B Medical services after hrs ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99052 .......... ............ B Medical services at night ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99054 .......... ............ B Medical servcs, unusual hrs ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99056 .......... ............ B Non-office medical services ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99058 .......... ............ B Office emergency care ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99070 .......... ............ B Special supplies .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99071 .......... ............ B Patient education materials ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99075 .......... ............ N Medical testimony ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99078 .......... ............ B Group health education ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99080 .......... ............ B Special reports or forms .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99082 .......... ............ C Unusual physician travel ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99090 .......... ............ B Computer data analysis .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99091 .......... ............ B Collect/review data from pt ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99100 .......... ............ B Special anesthesia service .......................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99116 .......... ............ B Anesthesia with hypothermia ...................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99135 .......... ............ B Special anesthesia procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99140 .......... ............ B Emergency anesthesia ................................ 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99141 .......... ............ B Sedation, iv/im or inhalant ........................... 0.80 1.84 0.38 0.05 2.69 1.23 XXX 

99142 .......... ............ B Sedation, oral/rectal/nasal ........................... 0.60 0.94 0.30 0.04 1.59 0.94 XXX 

99170 .......... ............ A Anogenitalexam, child ................................. 1.75 1.71 0.55 0.08 3.55 2.38 000 

99172 .......... ............ N Ocular function screen ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99173 .......... ............ N Visual acuity screen .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99175 .......... ............ A Induction of vomiting ................................... 0.00 1.16 NA 0.10 1.26 NA XXX 

99183 .......... ............ A Hyperbaric oxygen therapy ......................... 2.34 3.09 0.70 0.16 5.60 3.21 XXX 

99185 .......... ............ A Regional hypothermia ................................. 0.00 0.82 NA 0.04 0.86 NA XXX 

99186 .......... ............ A Total body hypothermia ............................... 0.00 1.62 NA 0.45 2.07 NA XXX 

99195 .......... ............ A Phlebotomy .................................................. 0.00 0.88 NA 0.02 0.90 NA XXX 

99199 .......... ............ C Special service/proc/report .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99201 .......... ............ A Office/outpatient visit, new .......................... 0.45 0.51 0.15 0.03 0.99 0.63 XXX 

99202 .......... ............ A Office/outpatient visit, new .......................... 0.88 0.81 0.31 0.05 1.74 1.24 XXX 

99203 .......... ............ A Office/outpatient visit, new .......................... 1.34 1.14 0.47 0.09 2.57 1.91 XXX 

99204 .......... ............ A Office/outpatient visit, new .......................... 2.00 1.51 0.70 0.12 3.63 2.82 XXX 

99205 .......... ............ A Office/outpatient visit, new .......................... 2.68 1.78 0.93 0.15 4.61 3.76 XXX 

99211 .......... ............ A Office/outpatient visit, est ............................ 0.17 0.38 0.06 0.01 0.56 0.24 XXX 

99212 .......... ............ A Office/outpatient visit, est ............................ 0.45 0.55 0.16 0.03 1.03 0.64 XXX 

99213 .......... ............ A Office/outpatient visit, est ............................ 0.67 0.70 0.24 0.03 1.40 0.94 XXX 

99214 .......... ............ A Office/outpatient visit, est ............................ 1.10 1.04 0.40 0.05 2.20 1.55 XXX 

99215 .......... ............ A Office/outpatient visit, est ............................ 1.77 1.33 0.64 0.08 3.18 2.49 XXX 

99217 .......... ............ A Observation care discharge ........................ 1.28 NA 0.54 0.06 NA 1.88 XXX 

99218 .......... ............ A Observation care ......................................... 1.28 NA 0.43 0.06 NA 1.78 XXX 

45998

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

99219 .......... ............ A Observation care ......................................... 2.14 NA 0.71 0.10 NA 2.95 XXX 

99220 .......... ............ A Observation care ......................................... 3.00 NA 1.02 0.14 NA 4.16 XXX 

99221 .......... ............ A Initial hospital care ...................................... 1.28 NA 0.44 0.07 NA 1.80 XXX 

99222 .......... ............ A Initial hospital care ...................................... 2.14 NA 0.73 0.10 NA 2.97 XXX 

99223 .......... ............ A Initial hospital care ...................................... 3.00 NA 1.02 0.13 NA 4.15 XXX 

99231 .......... ............ A Subsequent hospital care ............................ 0.64 NA 0.23 0.03 NA 0.90 XXX 

99232 .......... ............ A Subsequent hospital care ............................ 1.06 NA 0.37 0.04 NA 1.47 XXX 

99233 .......... ............ A Subsequent hospital care ............................ 1.51 NA 0.52 0.06 NA 2.09 XXX 

99234 .......... ............ A Observ/hosp same date .............................. 2.57 NA 0.88 0.13 NA 3.58 XXX 

99235 .......... ............ A Observ/hosp same date .............................. 3.42 NA 1.14 0.16 NA 4.71 XXX 

99236 .......... ............ A Observ/hosp same date .............................. 4.27 NA 1.43 0.19 NA 5.89 XXX 

99238 .......... ............ A Hospital discharge day ................................ 1.28 NA 0.54 0.05 NA 1.87 XXX 

99239 .......... ............ A Hospital discharge day ................................ 1.75 NA 0.73 0.07 NA 2.55 XXX 

99241 .......... ............ A Office consultation ....................................... 0.64 0.65 NA 0.05 1.34 NA XXX 

99242 .......... ............ A Office consultation ....................................... 1.29 1.07 NA 0.10 2.46 NA XXX 

99243 .......... ............ A Office consultation ....................................... 1.72 1.42 NA 0.13 3.27 NA XXX 

99244 .......... ............ A Office consultation ....................................... 2.59 1.85 NA 0.16 4.60 NA XXX 

99245 .......... ............ A Office consultation ....................................... 3.43 2.29 NA 0.21 5.93 NA XXX 

99251 .......... ............ A Initial inpatient consult ................................. 0.66 NA 0.24 0.05 NA 0.95 XXX 

99252 .......... ............ A Initial inpatient consult ................................. 1.32 NA 0.50 0.09 NA 1.92 XXX 

99253 .......... ............ A Initial inpatient consult ................................. 1.82 NA 0.69 0.11 NA 2.62 XXX 

99254 .......... ............ A Initial inpatient consult ................................. 2.65 NA 0.98 0.13 NA 3.76 XXX 

99255 .......... ............ A Initial inpatient consult ................................. 3.65 NA 1.35 0.18 NA 5.17 XXX 

99261 .......... ............ A Follow-up inpatient consult .......................... 0.42 NA 0.15 0.02 NA 0.59 XXX 

99262 .......... ............ A Follow-up inpatient consult .......................... 0.85 NA 0.31 0.04 NA 1.20 XXX 

99263 .......... ............ A Follow-up inpatient consult .......................... 1.27 NA 0.45 0.06 NA 1.78 XXX 

99271 .......... ............ A Confirmatory consultation ............................ 0.45 0.55 0.16 0.03 1.03 0.64 XXX 

99272 .......... ............ A Confirmatory consultation ............................ 0.84 0.84 0.31 0.06 1.74 1.21 XXX 

99273 .......... ............ A Confirmatory consultation ............................ 1.19 1.11 0.45 0.10 2.40 1.74 XXX 

99274 .......... ............ A Confirmatory consultation ............................ 1.73 1.37 0.64 0.12 3.22 2.49 XXX 

99275 .......... ............ A Confirmatory consultation ............................ 2.31 1.65 0.83 0.15 4.12 3.30 XXX 

99281 .......... ............ A Emergency dept visit ................................... 0.33 NA 0.09 0.02 NA 0.44 XXX 

99282 .......... ............ A Emergency dept visit ................................... 0.55 NA 0.14 0.04 NA 0.73 XXX 

99283 .......... ............ A Emergency dept visit ................................... 1.24 NA 0.30 0.09 NA 1.64 XXX 

99284 .......... ............ A Emergency dept visit ................................... 1.95 NA 0.46 0.14 NA 2.55 XXX 

99285 .......... ............ A Emergency dept visit ................................... 3.07 NA 0.70 0.23 NA 4.00 XXX 

99288 .......... ............ B Direct advanced life support ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99289 .......... ............ A Ped crit care transport ................................. 4.80 NA 1.42 0.24 NA 6.45 XXX 

99290 .......... ............ A Ped crit care transport addl ......................... 2.40 NA 0.81 0.12 NA 3.34 ZZZ 

99291 .......... ............ A Critical care, first hour ................................. 4.00 2.52 1.26 0.21 6.73 5.47 XXX 

99292 .......... ............ A Critical care, addl 30 min ............................ 2.00 0.89 0.63 0.11 3.01 2.75 ZZZ 

99293 .......... ............ A Ped critical care, initial ................................ 16.01 NA 4.66 1.12 NA 21.80 XXX 

99294 .......... ............ A Ped critical care, subseq ............................. 8.01 NA 2.35 0.45 NA 10.81 XXX 

99295 .......... ............ A Neonate crit care, initial .............................. 18.50 NA 5.27 1.16 NA 24.93 XXX 

99296 .......... ............ A Neonate critical care subseq ....................... 8.01 NA 2.47 0.32 NA 10.80 XXX 

99298 .......... ............ A Ic for lbw infant < 1500 gm ......................... 2.76 NA 0.92 0.17 NA 3.85 XXX 

99299 .......... ............ A Ic, lbw infant 1500-2500 gm ........................ 2.51 NA 0.84 0.16 NA 3.51 XXX 

99301 .......... ............ A Nursing facility care ..................................... 1.20 0.50 0.50 0.05 1.75 1.75 XXX 

99302 .......... ............ A Nursing facility care ..................................... 1.61 0.63 0.63 0.07 2.32 2.32 XXX 

99303 .......... ............ A Nursing facility care ..................................... 2.01 0.75 0.75 0.08 2.84 2.84 XXX 

99311 .......... ............ A Nursing fac care, subseq ............................ 0.60 0.27 0.27 0.03 0.90 0.90 XXX 

99312 .......... ............ A Nursing fac care, subseq ............................ 1.00 0.45 0.45 0.04 1.49 1.49 XXX 

99313 .......... ............ A Nursing fac care, subseq ............................ 1.42 0.62 0.62 0.06 2.10 2.10 XXX 

99315 .......... ............ A Nursing fac discharge day .......................... 1.13 0.45 0.45 0.05 1.63 1.63 XXX 

99316 .......... ............ A Nursing fac discharge day .......................... 1.50 0.58 0.58 0.06 2.14 2.14 XXX 

99321 .......... ............ A Rest home visit, new patient ....................... 0.71 0.34 0.32 0.03 1.08 1.06 XXX 

99322 .......... ............ A Rest home visit, new patient ....................... 1.01 0.45 0.44 0.05 1.52 1.50 XXX 

99323 .......... ............ A Rest home visit, new patient ....................... 1.28 0.54 0.52 0.05 1.87 1.85 XXX 

99331 .......... ............ A Rest home visit, est pat .............................. 0.60 0.31 0.29 0.03 0.94 0.92 XXX 

99332 .......... ............ A Rest home visit, est pat .............................. 0.80 0.37 0.35 0.03 1.20 1.18 XXX 

99333 .......... ............ A Rest home visit, est pat .............................. 1.00 0.45 0.43 0.04 1.49 1.47 XXX 

99341 .......... ............ A Home visit, new patient ............................... 1.01 0.48 0.45 0.05 1.54 1.52 XXX 

99342 .......... ............ A Home visit, new patient ............................... 1.52 0.67 0.65 0.07 2.27 2.24 XXX 

99343 .......... ............ A Home visit, new patient ............................... 2.27 0.92 0.90 0.10 3.30 3.27 XXX 

99344 .......... ............ A Home visit, new patient ............................... 3.04 1.15 1.13 0.13 4.32 4.29 XXX 

99345 .......... ............ A Home visit, new patient ............................... 3.79 1.40 1.37 0.16 5.34 5.32 XXX 

99347 .......... ............ A Home visit, est patient ................................. 0.76 0.40 0.37 0.04 1.20 1.17 XXX 

99348 .......... ............ A Home visit, est patient ................................. 1.26 0.57 0.54 0.06 1.89 1.87 XXX 

99349 .......... ............ A Home visit, est patient ................................. 2.02 0.81 0.79 0.09 2.93 2.90 XXX 

99350 .......... ............ A Home visit, est patient ................................. 3.04 1.15 1.12 0.13 4.32 4.29 XXX 

99354 .......... ............ A Prolonged service, office ............................. 1.77 0.77 0.65 0.08 2.63 2.50 ZZZ 

99355 .......... ............ A Prolonged service, office ............................. 1.77 0.75 0.61 0.07 2.59 2.45 ZZZ 

99356 .......... ............ A Prolonged service, inpatient ........................ 1.71 NA 0.61 0.07 NA 2.39 ZZZ 

99357 .......... ............ A Prolonged service, inpatient ........................ 1.71 NA 0.62 0.08 NA 2.42 ZZZ 

45999

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

99358 .......... ............ B Prolonged serv, w/o contact ........................ 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99359 .......... ............ B Prolonged serv, w/o contact ........................ 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99361 .......... ............ B Physician/team conference ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99362 .......... ............ B Physician/team conference ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99371 .......... ............ B Physician phone consultation ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99372 .......... ............ B Physician phone consultation ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99373 .......... ............ B Physician phone consultation ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99374 .......... ............ B Home health care supervision .................... 1.10 0.70 0.42 0.05 1.85 1.57 XXX 

99375 .......... ............ I Home health care supervision .................... 1.73 0.00 0.00 0.07 1.80 1.80 XXX 

99377 .......... ............ B Hospice care supervision ............................ 1.10 0.70 0.42 0.05 1.85 1.57 XXX 

99378 .......... ............ I Hospice care supervision ............................ 1.73 0.00 0.00 0.07 1.80 1.80 XXX 

99379 .......... ............ B Nursing fac care supervision ....................... 1.10 0.70 0.42 0.04 1.84 1.56 XXX 

99380 .......... ............ B Nursing fac care supervision ....................... 1.73 0.99 0.66 0.06 2.79 2.45 XXX 

99381 .......... ............ N Prev visit, new, infant .................................. 1.19 1.42 0.45 0.05 2.67 1.69 XXX 

99382 .......... ............ N Prev visit, new, age 1-4 .............................. 1.36 1.47 0.52 0.05 2.88 1.93 XXX 

99383 .......... ............ N Prev visit, new, age 5-11 ............................ 1.36 1.42 0.52 0.05 2.83 1.93 XXX 

99384 .......... ............ N Prev visit, new, age 12-17 .......................... 1.53 1.49 0.59 0.06 3.08 2.18 XXX 

99385 .......... ............ N Prev visit, new, age 18-39 .......................... 1.53 1.49 0.59 0.06 3.08 2.18 XXX 

99386 .......... ............ N Prev visit, new, age 40-64 .......................... 1.88 1.66 0.72 0.07 3.62 2.67 XXX 

99387 .......... ............ N Prev visit, new, 65 & over ........................... 2.06 1.80 0.78 0.07 3.94 2.92 XXX 

99391 .......... ............ N Prev visit, est, infant .................................... 1.02 1.02 0.39 0.04 2.08 1.45 XXX 

99392 .......... ............ N Prev visit, est, age 1-4 ................................ 1.19 1.09 0.45 0.05 2.33 1.69 XXX 

99393 .......... ............ N Prev visit, est, age 5-11 .............................. 1.19 1.07 0.45 0.05 2.31 1.69 XXX 

99394 .......... ............ N Prev visit, est, age 12-17 ............................ 1.36 1.13 0.52 0.05 2.55 1.93 XXX 

99395 .......... ............ N Prev visit, est, age 18-39 ............................ 1.36 1.16 0.52 0.05 2.57 1.93 XXX 

99396 .......... ............ N Prev visit, est, age 40-64 ............................ 1.53 1.24 0.59 0.06 2.83 2.18 XXX 

99397 .......... ............ N Prev visit, est, 65 & over ............................. 1.71 1.37 0.65 0.06 3.14 2.43 XXX 

99401 .......... ............ N Preventive counseling, indiv ........................ 0.48 0.58 0.19 0.01 1.07 0.68 XXX 

99402 .......... ............ N Preventive counseling, indiv ........................ 0.98 0.81 0.37 0.02 1.81 1.37 XXX 

99403 .......... ............ N Preventive counseling, indiv ........................ 1.46 1.02 0.56 0.04 2.52 2.06 XXX 

99404 .......... ............ N Preventive counseling, indiv ........................ 1.95 1.24 0.74 0.05 3.24 2.75 XXX 

99411 .......... ............ N Preventive counseling, group ...................... 0.15 0.20 0.06 0.01 0.36 0.22 XXX 

99412 .......... ............ N Preventive counseling, group ...................... 0.25 0.26 0.10 0.01 0.52 0.36 XXX 

99420 .......... ............ N Health risk assessment test ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99429 .......... ............ N Unlisted preventive service ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99431 .......... ............ A Initial care, normal newborn ........................ 1.17 0.00 0.37 0.05 1.22 1.59 XXX 

99432 .......... ............ A Newborn care, not in hosp .......................... 1.26 1.01 NA 0.07 2.34 NA XXX 

99433 .......... ............ A Normal newborn care/hospital .................... 0.62 NA 0.19 0.02 NA 0.83 XXX 

99435 .......... ............ A Newborn discharge day hosp ..................... 1.50 NA 0.59 0.06 NA 2.15 XXX 

99436 .......... ............ A Attendance, birth ......................................... 1.50 NA 0.46 0.06 NA 2.02 XXX 

99440 .......... ............ A Newborn resuscitation ................................. 2.94 NA 0.91 0.12 NA 3.96 XXX 

99450 .......... ............ N Life/disability evaluation .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99455 .......... ............ R Disability examination .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99456 .......... ............ R Disability examination .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99499 .......... ............ C Unlisted e&m service .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99500 .......... ............ I Home visit, prenatal .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99501 .......... ............ I Home visit, postnatal ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99502 .......... ............ I Home visit, nb care ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99503 .......... ............ I Home visit, resp therapy ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99504 .......... ............ I Home visit mech ventilator .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99505 .......... ............ I Home visit, stoma care ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99506 .......... ............ I Home visit, im injection ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99507 .......... ............ I Home visit, cath maintain ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99509 .......... ............ I Home visit day life activity ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99510 .......... ............ I Home visit, sing/m/fam couns ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99511 .......... ............ I Home visit, fecal/enema mgmt .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99512 .......... ............ I Home visit for hemodialysis ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99600 .......... ............ I Home visit nos ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99601 .......... ............ I Home infusion/visit, 2 hrs ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99602 .......... ............ I Home infusion, each addtl hr ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

A4890 ......... ............ R Repair/maint cont hemo equip .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0150 ......... ............ R Comprehensve oral evaluation ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0240 ......... ............ R Intraoral occlusal film .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0250 ......... ............ R Extraoral first film ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0260 ......... ............ R Extraoral ea additional film .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0270 ......... ............ R Dental bitewing single film .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0272 ......... ............ R Dental bitewings two films ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0274 ......... ............ R Dental bitewings four films .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0277 ......... ............ R Vert bitewings-sev to eight .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0416 ......... ............ R Viral culture ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0421 ......... ............ R Gen tst suscept oral disease ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0431 ......... ............ R Diag tst detect mucos abnorm .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0460 ......... ............ R Pulp vitality test ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0472 ......... ............ R Gross exam, prep & report ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

46000

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

D0473 ......... ............ R Micro exam, prep & report .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0474 ......... ............ R Micro w exam of surg margins .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0475 ......... ............ R Decalcification procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0476 ......... ............ R Spec stains for microorganis ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0477 ......... ............ R Spec stains not for microorg ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0478 ......... ............ R Immunohistochemical stains ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0479 ......... ............ R Tissue in-situ hybridization .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0480 ......... ............ R Cytopath smear prep & report .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0481 ......... ............ R Electron microscopy diagnost ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0482 ......... ............ R Direct immunofluorescence ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0483 ......... ............ R Indirect immunofluorescence ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0484 ......... ............ R Consult slides prep elsewher ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0485 ......... ............ R Consult inc prep of slides ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0502 ......... ............ R Other oral pathology procedu ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0999 ......... ............ R Unspecified diagnostic proce ...................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D1510 ......... ............ R Space maintainer fxd unilat ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D1515 ......... ............ R Fixed bilat space maintainer ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D1520 ......... ............ R Remove unilat space maintain .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D1525 ......... ............ R Remove bilat space maintain ...................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D1550 ......... ............ R Recement space maintainer ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D2999 ......... ............ R Dental unspec restorative pr ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D3460 ......... ............ R Endodontic endosseous implan .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D3999 ......... ............ R Endodontic procedure ................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4260 ......... ............ R Osseous surgery per quadrant ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4263 ......... ............ R Bone replce graft first site ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4264 ......... ............ R Bone replce graft each add ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4268 ......... ............ R Surgical revision procedure ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D4270 ......... ............ R Pedicle soft tissue graft pr .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4271 ......... ............ R Free soft tissue graft proc ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4273 ......... ............ R Subepithelial tissue graft ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4355 ......... ............ R Full mouth debridement .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4381 ......... ............ R Localized delivery antimicro ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D5911 ......... ............ R Facial moulage sectional ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D5912 ......... ............ R Facial moulage complete ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D5951 ......... ............ R Feeding aid .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D5983 ......... ............ R Radiation applicator ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D5984 ......... ............ R Radiation shield ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D5985 ......... ............ R Radiation cone locator ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D5987 ......... ............ R Commissure splint ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D6920 ......... ............ R Dental connector bar ................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7111 ......... ............ R Extraction coronal remnants ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D7140 ......... ............ R Extraction erupted tooth/exr ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D7210 ......... ............ R Rem imp tooth w mucoper flp ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7220 ......... ............ R Impact tooth remov soft tiss ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7230 ......... ............ R Impact tooth remov part bony ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7240 ......... ............ R Impact tooth remov comp bony .................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7241 ......... ............ R Impact tooth rem bony w/comp ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7250 ......... ............ R Tooth root removal ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7260 ......... ............ R Oral antral fistula closure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7261 ......... ............ R Primary closure sinus perf .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D7283 ......... ............ R Place device impacted tooth ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D7288 ......... ............ R Brush biopsy ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D7291 ......... ............ R Transseptal fiberotomy ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7321 ......... ............ R Alveoloplasty not w/extracts ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D7511 ......... ............ R Incision/drain abscess intra ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D7521 ......... ............ R Incision/drain abscess extra ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D7940 ......... ............ R Reshaping bone orthognathic ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9110 ......... ............ R Tx dental pain minor proc ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9230 ......... ............ R Analgesia ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9248 ......... ............ R Sedation (non-iv) ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D9630 ......... ............ R Other drugs/medicaments ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9930 ......... ............ R Treatment of complications ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9940 ......... ............ R Dental occlusal guard .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9950 ......... ............ R Occlusion analysis ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9951 ......... ............ R Limited occlusal adjustment ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9952 ......... ............ R Complete occlusal adjustment .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

G0008 ......... ............ X Admin influenza virus vac ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0009 ......... ............ X Admin pneumococcal vaccine ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0010 ......... ............ X Admin hepatitis b vaccine ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0030 ......... ............ I PET imaging prev PET single ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0030 ......... 26 ....... I PET imaging prev PET single ..................... 1.50 0.61 0.61 0.06 2.17 2.17 XXX 

G0030 ......... TC ...... I PET imaging prev PET single ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0031 ......... ............ I PET imaging prev PET multple ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0031 ......... 26 ....... I PET imaging prev PET multple ................... 1.87 0.76 0.76 0.07 2.70 2.70 XXX 

46001

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

G0031 ......... TC ...... I PET imaging prev PET multple ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0032 ......... ............ I PET follow SPECT 78464 singl .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0032 ......... 26 ....... I PET follow SPECT 78464 singl .................. 1.50 0.57 0.57 0.06 2.13 2.13 XXX 

G0032 ......... TC ...... I PET follow SPECT 78464 singl .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0033 ......... ............ I PET follow SPECT 78464 mult ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0033 ......... 26 ....... I PET follow SPECT 78464 mult ................... 1.87 0.78 0.78 0.07 2.72 2.72 XXX 

G0033 ......... TC ...... I PET follow SPECT 78464 mult ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0034 ......... ............ I PET follow SPECT 76865 singl .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0034 ......... 26 ....... I PET follow SPECT 76865 singl .................. 1.50 0.60 0.60 0.05 2.15 2.15 XXX 

G0034 ......... TC ...... I PET follow SPECT 76865 singl .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0035 ......... ............ I PET follow SPECT 78465 mult ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0035 ......... 26 ....... I PET follow SPECT 78465 mult ................... 1.87 0.76 0.76 0.06 2.70 2.70 XXX 

G0035 ......... TC ...... I PET follow SPECT 78465 mult ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0036 ......... ............ I PET follow cornry angio sing ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0036 ......... 26 ....... I PET follow cornry angio sing ...................... 1.50 0.59 0.59 0.05 2.14 2.14 XXX 

G0036 ......... TC ...... I PET follow cornry angio sing ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0037 ......... ............ I PET follow cornry angio mult ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0037 ......... 26 ....... I PET follow cornry angio mult ...................... 1.87 0.74 0.74 0.06 2.67 2.67 XXX 

G0037 ......... TC ...... I PET follow cornry angio mult ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0038 ......... ............ I PET follow myocard perf sing ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0038 ......... 26 ....... I PET follow myocard perf sing ..................... 1.50 0.51 0.51 0.07 2.09 2.09 XXX 

G0038 ......... TC ...... I PET follow myocard perf sing ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0039 ......... ............ I PET follow myocard perf mult ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0039 ......... 26 ....... I PET follow myocard perf mult ..................... 1.87 0.74 0.74 0.07 2.69 2.69 XXX 

G0039 ......... TC ...... I PET follow myocard perf mult ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0040 ......... ............ I PET follow stress echo singl ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0040 ......... 26 ....... I PET follow stress echo singl ....................... 1.50 0.61 0.61 0.06 2.18 2.18 XXX 

G0040 ......... TC ...... I PET follow stress echo singl ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0041 ......... ............ I PET follow stress echo mult ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0041 ......... 26 ....... I PET follow stress echo mult ....................... 1.87 0.76 0.76 0.06 2.70 2.70 XXX 

G0041 ......... TC ...... I PET follow stress echo mult ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0042 ......... ............ I PET follow ventriculogm sing ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0042 ......... 26 ....... I PET follow ventriculogm sing ...................... 1.50 0.63 0.63 0.05 2.18 2.18 XXX 

G0042 ......... TC ...... I PET follow ventriculogm sing ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0043 ......... ............ I PET follow ventriculogm mult ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0043 ......... 26 ....... I PET follow ventriculogm mult ...................... 1.87 0.79 0.79 0.07 2.73 2.73 XXX 

G0043 ......... TC ...... I PET follow ventriculogm mult ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0044 ......... ............ I PET following rest ECG singl ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0044 ......... 26 ....... I PET following rest ECG singl ...................... 1.50 0.62 0.62 0.05 2.17 2.17 XXX 

G0044 ......... TC ...... I PET following rest ECG singl ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0045 ......... ............ I PET following rest ECG mult ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0045 ......... 26 ....... I PET following rest ECG mult ...................... 1.87 0.75 0.75 0.06 2.69 2.69 XXX 

G0045 ......... TC ...... I PET following rest ECG mult ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0046 ......... ............ I PET follow stress ECG singl ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0046 ......... 26 ....... I PET follow stress ECG singl ....................... 1.50 0.62 0.62 0.05 2.17 2.17 XXX 

G0046 ......... TC ...... I PET follow stress ECG singl ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0047 ......... ............ I PET follow stress ECG mult ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0047 ......... 26 ....... I PET follow stress ECG mult ....................... 1.87 0.76 0.76 0.06 2.70 2.70 XXX 

G0047 ......... TC ...... I PET follow stress ECG mult ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0101 ......... ............ A CA screen;pelvic/breast exam .................... 0.45 0.51 0.17 0.02 0.98 0.64 XXX 

G0102 ......... ............ A Prostate ca screening; dre .......................... 0.17 0.38 0.06 0.01 0.56 0.24 XXX 

G0104 ......... ............ A CA screen;flexi sigmoidscope ..................... 0.96 2.33 0.55 0.08 3.37 1.59 000 

G0105 ......... ............ A Colorectal scrn; hi risk ind ........................... 3.70 6.60 1.58 0.30 10.59 5.57 000 

G0105 ......... 53 ....... A Colorectal scrn; hi risk ind ........................... 0.96 2.33 0.55 0.08 3.37 1.59 000 

G0106 ......... ............ A Colon CA screen;barium enema ................. 0.99 3.35 NA 0.17 4.51 NA XXX 

G0106 ......... 26 ....... A Colon CA screen;barium enema ................. 0.99 0.34 0.34 0.04 1.37 1.37 XXX 

G0106 ......... TC ...... A Colon CA screen;barium enema ................. 0.00 3.02 NA 0.13 3.15 NA XXX 

G0108 ......... ............ A Diab manage trn per indiv ........................... 0.00 0.83 NA 0.01 0.84 NA XXX 

G0109 ......... ............ A Diab manage trn ind/group ......................... 0.00 0.48 NA 0.01 0.49 NA XXX 

G0110 ......... ............ R Nett pulm-rehab educ; ind ........................... 0.90 0.68 NA 0.04 1.62 NA XXX 

G0111 ......... ............ R Nett pulm-rehab educ; group ...................... 0.27 0.30 NA 0.01 0.58 NA XXX 

G0112 ......... ............ R Nett;nutrition guid, initial .............................. 1.72 1.26 0.65 0.04 3.02 2.41 XXX 

G0113 ......... ............ R Nett;nutrition guid,subseqnt ......................... 1.29 0.81 0.40 0.05 2.15 1.74 XXX 

G0114 ......... ............ R Nett; psychosocial consult ........................... 1.20 0.46 NA 0.05 1.71 NA XXX 

G0115 ......... ............ R Nett; psychological testing .......................... 1.20 0.78 NA 0.03 2.01 NA XXX 

G0116 ......... ............ R Nett; psychosocial counsel .......................... 1.11 0.94 0.32 0.05 2.10 1.49 XXX 

G0117 ......... ............ T Glaucoma scrn hgh risk direc ..................... 0.45 0.73 0.19 0.01 1.19 0.65 XXX 

G0118 ......... ............ T Glaucoma scrn hgh risk direc ..................... 0.17 0.55 0.06 0.01 0.73 0.24 XXX 

G0120 ......... ............ A Colon ca scrn; barium enema ..................... 0.99 3.35 NA 0.17 4.51 NA XXX 

G0120 ......... 26 ....... A Colon ca scrn; barium enema ..................... 0.99 0.34 0.34 0.04 1.37 1.37 XXX 

G0120 ......... TC ...... A Colon ca scrn; barium enema ..................... 0.00 3.02 NA 0.13 3.15 NA XXX 

G0121 ......... ............ A Colon ca scrn not hi rsk ind ........................ 3.70 6.60 1.58 0.30 10.59 5.57 000 

G0121 ......... 53 ....... A Colon ca scrn not hi rsk ind ........................ 0.96 2.33 0.55 0.08 3.37 1.59 000 

G0122 ......... ............ N Colon ca scrn; barium enema ..................... 0.99 3.51 NA 0.18 4.68 NA XXX 

46002

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

G0122 ......... 26 ....... N Colon ca scrn; barium enema ..................... 0.99 0.38 0.38 0.05 1.42 1.42 XXX 

G0122 ......... TC ...... N Colon ca scrn; barium enema ..................... 0.00 3.13 NA 0.13 3.26 NA XXX 

G0124 ......... ............ A Screen c/v thin layer by MD ........................ 0.42 0.23 0.15 0.02 0.67 0.59 XXX 

G0125 ......... ............ I PET image pulmonary nodule ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0125 ......... 26 ....... I PET image pulmonary nodule ..................... 1.50 0.54 0.54 0.06 2.11 2.11 XXX 

G0125 ......... TC ...... I PET image pulmonary nodule ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0127 ......... ............ R Trim nail(s) .................................................. 0.17 0.27 0.07 0.01 0.45 0.25 000 

G0128 ......... ............ R CORF skilled nursing service ...................... 0.08 0.03 0.03 0.01 0.12 0.12 XXX 

G0130 ......... ............ A Single energy x-ray study ........................... 0.22 0.88 NA 0.06 1.16 NA XXX 

G0130 ......... 26 ....... A Single energy x-ray study ........................... 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

G0130 ......... TC ...... A Single energy x-ray study ........................... 0.00 0.80 NA 0.05 0.85 NA XXX 

G0141 ......... ............ A Scr c/v cyto,autosys and md ....................... 0.42 0.23 0.15 0.02 0.67 0.59 XXX 

G0166 ......... ............ A Extrnl counterpulse, per tx .......................... 0.07 3.93 0.03 0.01 4.01 0.11 XXX 

G0168 ......... ............ A Wound closure by adhesive ........................ 0.45 1.80 0.21 0.03 2.28 0.69 000 

G0179 ......... ............ A MD recertification HHA PT .......................... 0.45 0.94 0.87 0.02 1.41 1.35 XXX 

G0180 ......... ............ A MD certification HHA patient ....................... 0.67 1.15 1.08 0.03 1.85 1.78 XXX 

G0181 ......... ............ A Home health care supervision .................... 1.73 1.38 1.31 0.07 3.18 3.12 XXX 

G0182 ......... ............ A Hospice care supervision ............................ 1.73 1.54 1.47 0.07 3.34 3.27 XXX 

G0186 ......... ............ C Dstry eye lesn,fdr vssl tech ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

G0202 ......... ............ A Screeningmammographydigital ................... 0.70 2.78 NA 0.10 3.58 NA XXX 

G0202 ......... 26 ....... A Screeningmammographydigital ................... 0.70 0.23 0.23 0.03 0.96 0.96 XXX 

G0202 ......... TC ...... A Screeningmammographydigital ................... 0.00 2.55 NA 0.07 2.62 NA XXX 

G0204 ......... ............ A Diagnosticmammographydigital .................. 0.87 2.79 NA 0.11 3.77 NA XXX 

G0204 ......... 26 ....... A Diagnosticmammographydigital .................. 0.87 0.28 0.28 0.04 1.19 1.19 XXX 

G0204 ......... TC ...... A Diagnosticmammographydigital .................. 0.00 2.51 NA 0.07 2.58 NA XXX 

G0206 ......... ............ A Diagnosticmammographydigital .................. 0.70 2.25 NA 0.09 3.05 NA XXX 

G0206 ......... 26 ....... A Diagnosticmammographydigital .................. 0.70 0.23 0.23 0.03 0.96 0.96 XXX 

G0206 ......... TC ...... A Diagnosticmammographydigital .................. 0.00 2.02 NA 0.06 2.08 NA XXX 

G0210 ......... ............ I PET img wholebody dxlung ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0210 ......... 26 ....... I PET img wholebody dxlung ........................ 1.50 0.54 0.54 0.06 2.10 2.10 XXX 

G0210 ......... TC ...... I PET img wholebody dxlung ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0211 ......... ............ I PET img wholbody init lung ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0211 ......... 26 ....... I PET img wholbody init lung ........................ 1.50 0.53 0.53 0.06 2.10 2.10 XXX 

G0211 ......... TC ...... I PET img wholbody init lung ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0212 ......... ............ I PET img wholebod restag lung ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0212 ......... 26 ....... I PET img wholebod restag lung ................... 1.50 0.54 0.54 0.06 2.10 2.10 XXX 

G0212 ......... TC ...... I PET img wholebod restag lung ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0213 ......... ............ I PET img wholbody dx ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0213 ......... 26 ....... I PET img wholbody dx ................................. 1.50 0.53 0.53 0.06 2.10 2.10 XXX 

G0213 ......... TC ...... I PET img wholbody dx ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0214 ......... ............ I PET img wholebod init ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0214 ......... 26 ....... I PET img wholebod init ................................ 1.50 0.53 0.53 0.06 2.10 2.10 XXX 

G0214 ......... TC ...... I PET img wholebod init ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0215 ......... ............ I PETimg wholebod restag ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0215 ......... 26 ....... I PETimg wholebod restag ............................ 1.50 0.54 0.54 0.06 2.10 2.10 XXX 

G0215 ......... TC ...... I PETimg wholebod restag ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0216 ......... ............ I PET img wholebod dx melanoma ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0216 ......... 26 ....... I PET img wholebod dx melanoma ............... 1.50 0.54 0.54 0.06 2.10 2.10 XXX 

G0216 ......... TC ...... I PET img wholebod dx melanoma ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0217 ......... ............ I PET img wholebod init melan ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0217 ......... 26 ....... I PET img wholebod init melan ..................... 1.50 0.54 0.54 0.06 2.10 2.10 XXX 

G0217 ......... TC ...... I PET img wholebod init melan ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0218 ......... ............ I PET img wholebod restag mela .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0218 ......... 26 ....... I PET img wholebod restag mela .................. 1.50 0.54 0.54 0.06 2.11 2.11 XXX 

G0218 ......... TC ...... I PET img wholebod restag mela .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0219 ......... ............ N PET img wholbod melano nonco ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0219 ......... 26 ....... N PET img wholbod melano nonco ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0219 ......... TC ...... N PET img wholbod melano nonco ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0220 ......... ............ I PET img wholebod dx lymphoma ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0220 ......... 26 ....... I PET img wholebod dx lymphoma ............... 1.50 0.54 0.54 0.06 2.10 2.10 XXX 

G0220 ......... TC ...... I PET img wholebod dx lymphoma ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0221 ......... ............ I PET imag wholbod init lympho ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0221 ......... 26 ....... I PET imag wholbod init lympho ................... 1.50 0.54 0.54 0.06 2.10 2.10 XXX 

G0221 ......... TC ...... I PET imag wholbod init lympho ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0222 ......... ............ I PET imag wholbod resta lymph .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0222 ......... 26 ....... I PET imag wholbod resta lymph .................. 1.50 0.54 0.54 0.06 2.11 2.11 XXX 

G0222 ......... TC ...... I PET imag wholbod resta lymph .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0223 ......... ............ I PET imag wholbod reg dx head ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0223 ......... 26 ....... I PET imag wholbod reg dx head ................. 1.50 0.54 0.54 0.06 2.10 2.10 XXX 

G0223 ......... TC ...... I PET imag wholbod reg dx head ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0224 ......... ............ I PET imag wholbod reg ini hea .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0224 ......... 26 ....... I PET imag wholbod reg ini hea .................... 1.50 0.54 0.54 0.06 2.10 2.10 XXX 

G0224 ......... TC ...... I PET imag wholbod reg ini hea .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0225 ......... ............ I PET whol restag headneckonly .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

46003

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

G0225 ......... 26 ....... I PET whol restag headneckonly .................. 1.50 0.54 0.54 0.06 2.11 2.11 XXX 

G0225 ......... TC ...... I PET whol restag headneckonly .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0226 ......... ............ I PET img wholbody dx esophagl ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0226 ......... 26 ....... I PET img wholbody dx esophagl ................. 1.50 0.55 0.55 0.06 2.12 2.12 XXX 

G0226 ......... TC ...... I PET img wholbody dx esophagl ................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0227 ......... ............ I PET img wholbod ini esophage .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0227 ......... 26 ....... I PET img wholbod ini esophage .................. 1.50 0.55 0.55 0.06 2.11 2.11 XXX 

G0227 ......... TC ...... I PET img wholbod ini esophage .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0228 ......... ............ I PET img wholbod restg esopha .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0228 ......... 26 ....... I PET img wholbod restg esopha .................. 1.50 0.54 0.54 0.06 2.10 2.10 XXX 

G0228 ......... TC ...... I PET img wholbod restg esopha .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0229 ......... ............ I PET img metaboloc brain pres ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0229 ......... 26 ....... I PET img metaboloc brain pres ................... 1.50 0.54 0.54 0.06 2.10 2.10 XXX 

G0229 ......... TC ...... I PET img metaboloc brain pres ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0230 ......... ............ I PET myocard viability post .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0230 ......... 26 ....... I PET myocard viability post .......................... 1.50 0.55 0.55 0.06 2.12 2.12 XXX 

G0230 ......... TC ...... I PET myocard viability post .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0231 ......... ............ I PET WhBD colorec; gamma cam ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0231 ......... 26 ....... I PET WhBD colorec; gamma cam ............... 1.50 0.54 0.54 0.06 2.10 2.10 XXX 

G0231 ......... TC ...... I PET WhBD colorec; gamma cam ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0232 ......... ............ I PET whbd lymphoma; gamma cam ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0232 ......... 26 ....... I PET whbd lymphoma; gamma cam ............ 1.50 0.55 0.55 0.06 2.11 2.11 XXX 

G0232 ......... TC ...... I PET whbd lymphoma; gamma cam ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0233 ......... ............ I PET whbd melanoma; gamma cam ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0233 ......... 26 ....... I PET whbd melanoma; gamma cam ............ 1.50 0.55 0.55 0.06 2.11 2.11 XXX 

G0233 ......... TC ...... I PET whbd melanoma; gamma cam ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0234 ......... ............ I PET WhBD pulm nod; gamma cam ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0234 ......... 26 ....... I PET WhBD pulm nod; gamma cam ............ 1.50 0.54 0.54 0.06 2.11 2.11 XXX 

G0234 ......... TC ...... I PET WhBD pulm nod; gamma cam ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0235 ......... ............ N PET not otherwise specified ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0235 ......... 26 ....... N PET not otherwise specified ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0235 ......... TC ...... N PET not otherwise specified ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0237 ......... ............ A Therapeutic procd strg endur ...................... 0.00 0.40 NA 0.02 0.42 NA XXX 

G0238 ......... ............ A Oth resp proc, indiv ..................................... 0.00 0.49 NA 0.00 0.49 NA XXX 

G0239 ......... ............ A Oth resp proc, group ................................... 0.00 0.33 NA 0.00 0.33 NA XXX 

G0244 ......... ............ E Observ care by facility topt ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0245 ......... ............ R Initial foot exam pt lops ............................... 0.88 0.81 0.31 0.04 1.73 1.23 XXX 

G0246 ......... ............ R Followup eval of foot pt lop ......................... 0.45 0.55 0.16 0.02 1.02 0.63 XXX 

G0247 ......... ............ R Routine footcare pt w lops .......................... 0.50 0.55 0.21 0.02 1.07 0.73 ZZZ 

G0248 ......... ............ R Demonstrate use home inr mon ................. 0.00 6.05 NA 0.01 6.06 NA XXX 

G0249 ......... ............ R Provide test material,equipm ....................... 0.00 3.64 NA 0.01 3.65 NA XXX 

G0250 ......... ............ R MD review interpret of test .......................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

G0251 ......... ............ E Linear acc based stero radio ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0252 ......... ............ N PET imaging initial dx ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0252 ......... 26 ....... N PET imaging initial dx ................................. 1.50 0.59 0.59 0.04 2.13 2.13 XXX 

G0252 ......... TC ...... N PET imaging initial dx ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0253 ......... ............ I PET image brst dection recur ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0253 ......... 26 ....... I PET image brst dection recur ..................... 1.87 0.66 0.66 0.08 2.62 2.62 XXX 

G0253 ......... TC ...... I PET image brst dection recur ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0254 ......... ............ I PET image brst eval to tx ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0254 ......... 26 ....... I PET image brst eval to tx ........................... 1.87 0.68 0.68 0.08 2.64 2.64 XXX 

G0254 ......... TC ...... I PET image brst eval to tx ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0255 ......... ............ N Current percep threshold tst ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0255 ......... 26 ....... N Current percep threshold tst ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0255 ......... TC ...... N Current percep threshold tst ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0257 ......... ............ E Unsched dialysis ESRD pt hos ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0258 ......... ............ E IV infusion during obs stay .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0259 ......... ............ E Inject for sacroiliac joint ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0260 ......... ............ E Inj for sacroiliac jt anesth ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0263 ......... ............ E Adm with CHF, CP, asthma ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0264 ......... ............ E Assmt otr CHF, CP, asthma ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0268 ......... ............ A Removal of impacted wax md ..................... 0.61 0.62 0.23 0.02 1.25 0.86 000 

G0269 ......... ............ B Occlusive device in vein art ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0270 ......... ............ A MNT subs tx for change dx ......................... 0.00 0.42 NA 0.01 0.43 NA XXX 

G0271 ......... ............ A Group MNT 2 or more 30 mins ................... 0.00 0.16 NA 0.01 0.17 NA XXX 

G0275 ......... ............ A Renal angio, cardiac cath ........................... 0.25 NA 0.11 0.01 NA 0.37 ZZZ 

G0278 ......... ............ A Iliac art angio,cardiac cath .......................... 0.25 NA 0.11 0.01 NA 0.37 ZZZ 

G0279 ......... ............ C Excorp shock tx, elbow epi ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0280 ......... ............ C Excorp shock tx other than ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0281 ......... ............ A Elec stim unattend for press ....................... 0.18 0.12 NA 0.01 0.31 NA XXX 

G0282 ......... ............ N Elect stim wound care not pd ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0283 ......... ............ A Elec stim other than wound ........................ 0.18 0.12 NA 0.01 0.31 NA XXX 

G0288 ......... ............ A Recon, CTA for surg plan ........................... 0.00 10.63 NA 0.18 10.81 NA XXX 

G0289 ......... ............ A Arthro, loose body + chondro ...................... 1.48 NA 0.78 0.26 NA 2.52 ZZZ 

46004

——————————

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3+Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

G0290 ......... ............ E Drug-eluting stents, single ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0291 ......... ............ E Drug-eluting stents,each add ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0293 ......... ............ E Non-cov surg proc,clin trial ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0294 ......... ............ E Non-cov proc, clinical trial ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0295 ......... ............ N Electromagnetic therapy onc ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0308 ......... ............ A ESRD related svc 4+mo < 2yrs .................. 12.77 8.56 8.56 0.42 21.74 21.74 XXX 

G0309 ......... ............ A ESRD related svc 2-3mo <2yrs .................. 10.63 7.11 7.11 0.36 18.11 18.11 XXX 

G0310 ......... ............ A ESRD related svc 1 vst <2yrs ..................... 8.51 5.69 5.69 0.28 14.48 14.48 XXX 

G0311 ......... ............ A ESRD related svs 4+mo 2-11yr .................. 9.75 4.73 4.73 0.34 14.82 14.82 XXX 

G0312 ......... ............ A ESRD relate svs 2-3 mo 2-11y ................... 8.13 3.93 3.93 0.29 12.34 12.34 XXX 

G0313 ......... ............ A ESRD related svs 1 mon 2-11y .................. 6.50 3.15 3.15 0.22 9.87 9.87 XXX 

G0314 ......... ............ A ESRD related svs 4+ mo 12-19 .................. 8.30 4.43 4.43 0.27 13.00 13.00 XXX 

G0315 ......... ............ A ESRD related svs 2-3mo/12-19 .................. 6.91 3.68 3.68 0.23 10.82 10.82 XXX 

G0316 ......... ............ A ESRD related svs 1vis/12-19y .................... 5.53 2.95 2.95 0.17 8.65 8.65 XXX 

G0317 ......... ............ A ESRD related svs 4+mo 20+yrs ................. 5.10 2.87 2.87 0.17 8.14 8.14 XXX 

G0318 ......... ............ A ESRD related svs 2-3 mo 20+y .................. 4.25 2.38 2.38 0.14 6.77 6.77 XXX 

G0319 ......... ............ A ESRD related svs 1visit 20+y ..................... 3.40 1.90 1.90 0.11 5.41 5.41 XXX 

G0320 ......... ............ A ESD related svs home undr 2 ..................... 10.63 7.11 7.11 0.36 18.11 18.11 XXX 

G0321 ......... ............ A ESRDrelatedsvs home mo 2-11y ................ 8.13 3.93 3.93 0.29 12.34 12.34 XXX 

G0322 ......... ............ A ESRD related svs hom mo12-19 ................ 6.91 3.68 3.68 0.23 10.82 10.82 XXX 

G0323 ......... ............ A ESRD related svs home mo 20+ ................ 4.25 2.38 2.38 0.14 6.77 6.77 XXX 

G0324 ......... ............ A ESRD related serv/dy,2y ............................. 0.35 0.24 0.24 0.01 0.60 0.60 XXX 

G0325 ......... ............ A ESRD relate serv/dy 2-11yr ........................ 0.23 0.12 0.12 0.01 0.36 0.36 XXX 

G0326 ......... ............ A ESRD relate serv/dy 12-19y ....................... 0.27 0.13 0.13 0.01 0.41 0.41 XXX 

G0327 ......... ............ A ESRD relate serv/dy 20+yrs ........................ 0.14 0.08 0.08 0.01 0.23 0.23 XXX 

G0329 ......... ............ A Electromagntic tx for ulcers ......................... 0.06 0.14 NA 0.01 0.21 NA XXX 

G0336 ......... ............ I PET imaging brain alzheimers .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0336 ......... 26 ....... I PET imaging brain alzheimers .................... 1.50 0.52 0.52 0.05 2.07 2.07 XXX 

G0336 ......... TC ...... I PET imaging brain alzheimers .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0337 ......... ............ X Hospice evaluation preelecti ....................... 1.34 0.51 0.51 0.09 1.94 1.94 XXX 

G0341 ......... ............ A Percutaneous islet celltrans ........................ 6.99 NA 2.68 0.48 NA 10.15 000 

G0342 ......... ............ A Laparoscopy islet cell trans ......................... 11.94 NA 5.24 1.46 NA 18.64 090 

G0343 ......... ............ A Laparotomy islet cell transp ........................ 19.89 NA 8.62 2.06 NA 30.57 090 

G0344 ......... ............ A Initial preventive exam ................................ 1.34 1.14 0.47 0.10 2.58 1.92 XXX 

G0345 ......... ............ A IV infuse hydration, initial ............................ 0.17 1.43 NA 0.07 1.67 NA XXX 

G0346 ......... ............ A Each additional infuse hour ......................... 0.09 0.40 NA 0.04 0.53 NA ZZZ 

G0347 ......... ............ A IV infusion therapy/diagnost ........................ 0.21 1.76 NA 0.07 2.04 NA XXX 

G0348 ......... ............ A Each additional hr up to 8hr ........................ 0.18 0.46 NA 0.04 0.68 NA ZZZ 

G0349 ......... ............ A Additional sequential infuse ........................ 0.19 0.90 NA 0.04 1.13 NA ZZZ 

G0350 ......... ............ A Concurrent infusion ..................................... 0.17 0.44 NA 0.04 0.65 NA ZZZ 

G0351 ......... ............ A Therapeutic/diagnostic injec ........................ 0.17 0.31 NA 0.01 0.49 NA XXX 

G0353 ......... ............ A IV push,single orinitial dru ........................... 0.18 1.30 NA 0.04 1.52 NA XXX 

G0354 ......... ............ A Each addition sequential IV ........................ 0.10 0.57 NA 0.04 0.71 NA ZZZ 

G0355 ......... ............ A Chemo adminisrate subcut/IM .................... 0.21 1.15 NA 0.01 1.37 NA XXX 

G0356 ......... ............ A Hormonal anti-neoplastic ............................. 0.19 0.75 NA 0.01 0.95 NA XXX 

G0357 ......... ............ A IV push single/initial subst ........................... 0.24 2.94 NA 0.06 3.24 NA XXX 

G0358 ......... ............ A IV push each additional drug ...................... 0.20 1.62 NA 0.06 1.88 NA ZZZ 

G0359 ......... ............ A Chemotherapy IV one hr initi ...................... 0.28 4.22 NA 0.08 4.58 NA XXX 

G0360 ......... ............ A Each additional hr 1-8 hrs ........................... 0.19 0.78 NA 0.07 1.04 NA ZZZ 

G0361 ......... ............ A Prolong chemo infuse>8hrs pu ................... 0.21 4.63 NA 0.08 4.92 NA XXX 

G0362 ......... ............ A Each add sequential infusion ...................... 0.21 1.95 NA 0.07 2.23 NA ZZZ 

G0363 ......... ............ T Irrigate implanted venous de ....................... 0.04 0.70 NA 0.01 0.75 NA XXX 

G0364 ......... ............ A Bone marrow aspirate &biopsy ................... 0.16 0.14 0.06 0.04 0.34 0.26 ZZZ 

G0365 ......... ............ A Vessel mapping hemo access .................... 0.25 4.13 NA 0.25 4.63 NA XXX 

G0365 ......... 26 ....... A Vessel mapping hemo access .................... 0.25 0.09 0.09 0.02 0.36 0.36 XXX 

G0365 ......... TC ...... A Vessel mapping hemo access .................... 0.00 4.03 NA 0.23 4.26 NA XXX 

G0366 ......... ............ A EKG for initial prevent exam ....................... 0.17 0.47 0.00 0.03 0.67 0.20 XXX 

G0367 ......... ............ A EKG tracing for initial prev .......................... 0.00 0.41 NA 0.02 0.43 NA XXX 

G0368 ......... ............ A EKG interpret & report preve ...................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

G0375 ......... ............ A Smoke/Tobacco counseling3-10 ................. 0.24 0.00 0.00 0.01 0.25 0.25 XXX 

G0376 ......... ............ A Smoke/Tobacco counseling >10 ................. 0.48 0.00 0.00 0.01 0.49 0.49 XXX 

G9013 ......... ............ N ESRD demo bundle level I .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9014 ......... ............ N ESRD demo bundle-level II ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9016 ......... ............ N Demo-smoking cessation coun ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

M0064 ......... ............ A Visit for drug monitoring .............................. 0.37 0.38 0.12 0.01 0.76 0.50 XXX 

P3001 ......... ............ A Screening pap smear by phys .................... 0.42 0.23 0.15 0.02 0.67 0.59 XXX 

Q0035 ......... ............ A Cardiokymography ...................................... 0.17 0.41 NA 0.03 0.61 NA XXX 

Q0035 ......... 26 ....... A Cardiokymography ...................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

Q0035 ......... TC ...... A Cardiokymography ...................................... 0.00 0.35 NA 0.02 0.37 NA XXX 

Q0091 ......... ............ A Obtaining screen pap smear ....................... 0.37 0.68 NA 0.02 1.07 NA XXX 

Q0092 ......... ............ A Set up port xray equipment ......................... 0.00 0.33 NA 0.01 0.34 NA XXX 

Q3001 ......... ............ C Brachytherapy Radioelements .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

R0070 ......... ............ C Transport portable x-ray .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

R0075 ......... ............ C Transport port x-ray multipl ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

46005

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1

HCPCS2 Mod Status Description 

Physician

work

RVUs 3

Nonfacility

PE

RVUs 

Facility

PE

RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

R0076 ......... ............ B Transport portable EKG .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

V5299 ......... ............ R Hearing service ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

1 CPT codes and descriptions only are copyright 2005 American Medical Associaiton. All rights reserved. Applicable FARS/DFARS apply. 2 Copyright 2005 American Dental Association. All rights reserved. 

3 +Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

46006 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PRACTICE EXPENSE

REVIEW COMMITTEE (PERC) RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS

CPT

Code Short descriptors 

00104 .. Anesth, electroshock 

00124 .. Anesth, ear exam 

11100 .. Biopsy, skin lesion 

11101 .. Biopsy, skin add-on 

11950 .. Therapy for contour defects 

11951 .. Therapy for contour defects 

11952 .. Therapy for contour defects 

11954 .. Therapy for contour defects 

11975 .. Insert contraceptive cap 

11976 .. Removal of contraceptive cap 

11977 .. Removal/reinsert contra cap 

12031 .. Layer closure of wound(s) 

12034 .. Layer closure of wound(s) 

12041 .. Layer closure of wound(s) 

12042 .. Layer closure of wound(s) 

12044 .. Layer closure of wound(s) 

12051 .. Layer closure of wound(s) 

12052 .. Layer closure of wound(s) 

12053 .. Layer closure of wound(s) 

12054 .. Layer closure of wound(s) 

12055 .. Layer closure of wound(s) 

12056 .. Layer closure of wound(s) 

12057 .. Layer closure of wound(s) 

13152 .. Repair of wound or lesion 

15775 .. Hair transplant punch grafts 

15776 .. Hair transplant punch grafts 

15851 .. Removal of sutures 

15852 .. Dressing change not for burn 

17250 .. Chemical cautery, tissue 

17304 .. 1 stage mohs, up to 5 spec 

17305 .. 2 stage mohs, up to 5 spec 

17306 .. 3 stage mohs, up to 5 spec 

17307 .. Mohs addl stage up to 5 spec 

17310 .. Mohs any stage > 5 spec each 

17360 .. Skin peel therapy 

19000 .. Drainage of breast lesion 

19396 .. Design custom breast implant 

20500 .. Injection of sinus tract 

21300 .. Treatment of skull fracture 

21310 .. Treatment of nose fracture 

21480 .. Reset dislocated jaw 

31700 .. Insertion of airway catheter 

31730 .. Intro, windpipe wire/tube 

32960 .. Therapeutic pneumothorax 

33960 .. External circulation assist 

33961 .. External circulation assist 

36522 .. Photopheresis 

36860 .. External cannula declotting 

38230 .. Bone marrow collection 

38794 .. Access thoracic lymph duct 

40490 .. Biopsy of lip 

41250 .. Repair tongue laceration 

41251 .. Repair tongue laceration 

41252 .. Repair tongue laceration 

41800 .. Drainage of gum lesion 

41805 .. Removal foreign body, gum 

41806 .. Removal foreign body,jawbone 

41822 .. Excision of gum lesion 

41825 .. Excision of gum lesion 

41826 .. Excision of gum lesion 

41828 .. Excision of gum lesion 

41830 .. Removal of gum tissue 

42100 .. Biopsy roof of mouth 

42104 .. Excision lesion, mouth roof 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PRACTICE EXPENSE

REVIEW COMMITTEE (PERC) RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

Code Short descriptors 

42106 .. Excision lesion, mouth roof 

42107 .. Excision lesion, mouth roof 

42160 .. Treatment mouth roof lesion 

42280 .. Preparation, palate mold 

43750 .. Place gastrostomy tube 

43760 .. Change gastrostomy tube 

47000 .. Needle biopsy of liver 

48102 .. Needle biopsy, pancreas 

49080 .. Puncture, peritoneal cavity 

49081 .. Removal of abdominal fluid 

49428 .. Ligation of shunt 

51000 .. Drainage of bladder 

51005 .. Drainage of bladder 

54450 .. Preputial stretching 

56420 .. Drainage of gland abscess 

57150 .. Treat vagina infection 

57170 .. Fitting of diaphragm/cap 

57180 .. Treat vaginal bleeding 

58300 .. Insert intrauterine device 

58323 .. Sperm washing 

59160 .. D & c after delivery 

59300 .. Episiotomy or vaginal repair 

60000 .. Drain thyroid/tongue cyst 

60001 .. Aspirate/inject thyriod cyst 

61888 .. Revise/remove neuroreceiver 

62194 .. Replace/irrigate catheter 

67221 .. Ocular photodynamic ther 

67225 .. Eye photodynamic ther add-on 

68400 .. Incise/drain tear gland 

68420 .. Incise/drain tear sac 

68510 .. Biopsy of tear gland 

68530 .. Clearance of tear duct 

69100 .. Biopsy of external ear 

69300 .. Revise external ear 

76120 .. Cine/video x-rays 

76940 .. Us guide, tissue ablation 

76942 .. Echo guide for biopsy 

76975 .. GI endoscopic ultrasound 

78160 .. Plasma iron turnover 

78162 .. Radioiron absorption exam 

78170 .. Red cell iron utilization 

78172 .. Total body iron estimation 

78282 .. GI protein loss exam 

78350 .. Bone mineral, single photon 

78351 .. Bone mineral, dual photon 

78455 .. Venous thrombosis study 

79200 .. Nuclear rx, intracav admin 

79300 .. Nuclr rx, interstit colloid 

79440 .. Nuclear rx, intra-articular 

86585 .. TB tine test 

88355 .. Analysis, skeletal muscle 

88356 .. Analysis, nerve 

89100 .. Sample intestinal contents 

89105 .. Sample intestinal contents 

89130 .. Sample stomach contents 

89132 .. Sample stomach contents 

89135 .. Sample stomach contents 

89136 .. Sample stomach contents 

89140 .. Sample stomach contents 

89141 .. Sample stomach contents 

90465 .. Immune admin 1 inj, < 8 yrs 

90466 .. Immune admin addl inj, < 8 y 

90467 .. Immune admin o or n, < 8 yrs 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PRACTICE EXPENSE

REVIEW COMMITTEE (PERC) RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

Code Short descriptors 

90468 .. Immune admin o/n, addl < 8 y 

90880 .. Hypnotherapy 

90997 .. Hemoperfusion 

92015 .. Refraction 

92230 .. Eye exam with photos 

92260 .. Ophthalmoscopy/dynamometry 

92265 .. Eye muscle evaluation 

92284 .. Dark adaptation eye exam 

92287 .. Internal eye photography 

92310 .. Contact lens fitting 

92311 .. Contact lens fitting 

92312 .. Contact lens fitting 

92313 .. Contact lens fitting 

92314 .. Prescription of contact lens 

92315 .. Prescription of contact lens 

92316 .. Prescription of contact lens 

92317 .. Prescription of contact lens 

92340 .. Fitting of spectacles 

92341 .. Fitting of spectacles 

92342 .. Fitting of spectacles 

92370 .. Repair & adjust spectacles 

92510 .. Rehab for ear implant 

92551 .. Pure tone hearing test, air 

93012 .. Transmission of ecg 

93271 .. Ecg/monitoring and analysis 

93561 .. Cardiac output measurement 

93562 .. Cardiac output measurement 

94014 .. Patient recorded spirometry 

94015 .. Patient recorded spirometry 

94016 .. Review patient spirometry 

94200 .. Lung function test (MBC/MVV) 

94250 .. Expired gas collection 

94350 .. Lung nitrogen washout curve 

94370 .. Breath airway closing volume 

94400 .. CO2 breathing response curve 

94620 .. Pulmonary stress test/simple 

94660 .. Pos airway pressure, CPAP 

94667 .. Chest wall manipulation 

94668 .. Chest wall manipulation 

94680 .. Exhaled air analysis, o2 

94681 .. Exhaled air analysis, o2/co2 

94690 .. Exhaled air analysis 

94725 .. Membrane diffusion capacity 

94750 .. Pulmonary compliance study 

95060 .. Eye allergy tests 

95065 .. Nose allergy test 

95071 .. Bronchial allergy tests 

95075 .. Ingestion challenge test 

95078 .. Provocative testing 

95805 .. Multiple sleep latency test 

95812 .. Eeg, 41-60 minutes 

95813 .. Eeg, over 1 hour 

95816 .. Eeg, awake and drowsy 

95819 .. Eeg, awake and asleep 

95822 .. Eeg, coma or sleep only 

95950 .. Ambulatory eeg monitoring 

95954 .. EEG monitoring/giving drugs 

95956 .. Eeg monitoring, cable/radio 

96900 .. Ultraviolet light therapy 

96105 .. Assessment of aphasia 

99185 .. Regional hypothermia 

99186 .. Total body hypothermia 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46007

ADDENDUM D—2006 GEOGRAPHIC PRACTICE COST INDICIES (GPCI) BY MEDICARE CARRIER AND LOCALITY

Carrier Locality Locality name Work

GPCI 

PE

GPCI 

MP

GPCI 

00510 ....... 00 ............. Alabama .............................................................................................................................. 1.000 0.846 0.752 

00831 ....... 01 ............. Alaska .................................................................................................................................. 1.017 1.103 1.029 

00832 ....... 00 ............. Arizona ................................................................................................................................ 1.000 0.992 1.069 

00520 ....... 13 ............. Arkansas .............................................................................................................................. 1.000 0.831 0.438 

31140 ....... 03 ............. Marin/Napa/Solano, CA ....................................................................................................... 1.035 1.340 0.651 

31140 ....... 05 ............. San Francisco, CA .............................................................................................................. 1.060 1.543 0.651 

31140 ....... 06 ............. San Mateo, CA .................................................................................................................... 1.073 1.536 0.639 

31140 ....... 07 ............. Oakland/Berkley, CA ........................................................................................................... 1.054 1.371 0.651 

31140 ....... 09 ............. Santa Clara, CA .................................................................................................................. 1.083 1.540 0.604 

31140 ....... TBD** ....... Santa Cruz, CA ................................................................................................................... 1.014 1.218 0.717 

31140 ....... 99 ............. Rest of California* ............................................................................................................... 1.010 1.042 0.717 

31146 ....... 17 ............. Ventura, CA ......................................................................................................................... 1.028 1.179 0.744 

31146 ....... 18 ............. Los Angeles, CA ................................................................................................................. 1.041 1.156 0.954 

31146 ....... 26 ............. Anaheim/Santa Ana, CA ..................................................................................................... 1.034 1.236 0.954 

31140 ....... TBD** ....... Sonoma, CA ........................................................................................................................ 1.017 1.230 0.717 

31146 ....... 99 ............. Rest of California* ............................................................................................................... 1.010 1.042 0.717 

00824 ....... 01 ............. Colorado .............................................................................................................................. 1.000 1.014 0.803 

00591 ....... 00 ............. Connecticut .......................................................................................................................... 1.038 1.170 0.900 

00903 ....... 01 ............. DC + MD/VA Suburbs ......................................................................................................... 1.048 1.250 0.926 

00902 ....... 01 ............. Delaware ............................................................................................................................. 1.012 1.018 0.892 

00590 ....... 03 ............. Fort Lauderdale, FL ............................................................................................................. 1.000 0.988 1.703 

00590 ....... 04 ............. Miami, FL ............................................................................................................................. 1.000 1.046 2.269 

00590 ....... 99 ............. Rest of Florida ..................................................................................................................... 1.000 0.934 1.272 

00511 ....... 01 ............. Atlanta, GA .......................................................................................................................... 1.010 1.089 0.966 

00511 ....... 99 ............. Rest of Georgia ................................................................................................................... 1.000 0.872 0.966 

00833 ....... 01 ............. Hawaii/Guam ....................................................................................................................... 1.005 1.111 0.800 

05130 ....... 00 ............. Idaho .................................................................................................................................... 1.000 0.868 0.459 

00952 ....... 12 ............. East St. Louis, IL ................................................................................................................. 1.000 0.939 1.750 

00952 ....... 15 ............. Suburban Chicago, IL ......................................................................................................... 1.018 1.115 1.652 

00952 ....... 16 ............. Chicago, IL .......................................................................................................................... 1.025 1.126 1.867 

00952 ....... 99 ............. Rest of Illinois ...................................................................................................................... 1.000 0.872 1.193 

00630 ....... 00 ............. Indiana ................................................................................................................................. 1.000 0.906 0.436 

00826 ....... 00 ............. Iowa ..................................................................................................................................... 1.000 0.868 0.589 

00650 ....... 00 ............. Kansas* ............................................................................................................................... 1.000 0.878 0.721 

00740 ....... 04 ............. Kansas* ............................................................................................................................... 1.000 0.878 0.721 

00660 ....... 00 ............. Kentucky .............................................................................................................................. 1.000 0.854 0.873 

00528 ....... 01 ............. New Orleans, LA ................................................................................................................. 1.000 0.946 1.197 

00528 ....... 99 ............. Rest of Louisiana ................................................................................................................ 1.000 0.847 1.058 

31142 ....... 03 ............. Southern Maine ................................................................................................................... 1.000 1.013 0.637 

31142 ....... 99 ............. Rest of Maine ...................................................................................................................... 1.000 0.886 0.637 

00901 ....... 01 ............. Baltimore/Surr. Cntys, MD .................................................................................................. 1.012 1.078 0.947 

00901 ....... 99 ............. Rest of Maryland ................................................................................................................. 1.000 0.980 0.760 

31143 ....... 01 ............. Metropolitan Boston ............................................................................................................ 1.030 1.329 0.823 

31143 ....... 99 ............. Rest of Massachusetts ........................................................................................................ 1.007 1.103 0.823 

00953 ....... 01 ............. Detroit, MI ............................................................................................................................ 1.037 1.054 2.744 

00953 ....... 99 ............. Rest of Michigan ................................................................................................................. 1.000 0.921 1.518 

00954 ....... 00 ............. Minnesota ............................................................................................................................ 1.000 1.005 0.410 

00512 ....... 00 ............. Mississippi ........................................................................................................................... 1.000 0.839 0.722 

00740 ....... 02 ............. Metropolitan Kansas City, MO ............................................................................................ 1.000 0.975 0.946 

00523 ....... 01 ............. Metropolitan St. Louis, MO ................................................................................................. 1.000 0.955 0.941 

00523 ....... 99 ............. Rest of Missouri* ................................................................................................................. 1.000 0.802 0.892 

00740 ....... 99 ............. Rest of Missouri* ................................................................................................................. 1.000 0.802 0.892 

00751 ....... 01 ............. Montana ............................................................................................................................... 1.000 0.844 0.904 

00655 ....... 00 ............. Nebraska ............................................................................................................................. 1.000 0.875 0.454 

00834 ....... 00 ............. Nevada ................................................................................................................................ 1.003 1.043 1.068 

31144 ....... 40 ............. New Hampshire ................................................................................................................... 1.000 1.027 0.942 

00805 ....... 01 ............. Northern NJ ......................................................................................................................... 1.058 1.220 0.973 

00805 ....... 99 ............. Rest of New Jersey ............................................................................................................. 1.043 1.119 0.973 

00521 ....... 05 ............. New Mexico ......................................................................................................................... 1.000 0.887 0.895 

00801 ....... 99 ............. Rest of New York ................................................................................................................ 1.000 0.917 0.677 

00803 ....... 01 ............. Manhattan, NY .................................................................................................................... 1.065 1.298 1.504 

00803 ....... 02 ............. NYC Suburbs/Long I., NY ................................................................................................... 1.052 1.280 1.785 

00803 ....... 03 ............. Poughkpsie/N NYC Suburbs, NY ........................................................................................ 1.014 1.074 1.167 

14330 ....... 04 ............. Queens, NY ......................................................................................................................... 1.032 1.228 1.710 

05535 ....... 00 ............. North Carolina ..................................................................................................................... 1.000 0.920 0.640 

00820 ....... 01 ............. North Dakota ....................................................................................................................... 1.000 0.860 0.602 

00883 ....... 00 ............. Ohio ..................................................................................................................................... 1.000 0.933 0.976 

00522 ....... 00 ............. Oklahoma ............................................................................................................................ 1.000 0.854 0.382 

00835 ....... 01 ............. Portland, OR ........................................................................................................................ 1.002 1.057 0.441 

00835 ....... 99 ............. Rest of Oregon .................................................................................................................... 1.000 0.925 0.441 

00865 ....... 01 ............. Metropolitan Philadelphia, PA ............................................................................................. 1.016 1.104 1.386 

46008 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM D—2006 GEOGRAPHIC PRACTICE COST INDICIES (GPCI) BY MEDICARE CARRIER AND LOCALITY—Continued

Carrier Locality Locality name Work

GPCI 

PE

GPCI 

MP

GPCI 

00865 ....... 99 ............. Rest of Pennsylvania .......................................................................................................... 1.000 0.902 0.806 

00973 ....... 20 ............. Puerto Rico .......................................................................................................................... 1.000 0.698 0.261 

00870 ....... 01 ............. Rhode Island ....................................................................................................................... 1.045 0.989 0.909 

00880 ....... 01 ............. South Carolina ..................................................................................................................... 1.000 0.893 0.394 

00820 ....... 02 ............. South Dakota ....................................................................................................................... 1.000 0.876 0.365 

05440 ....... 35 ............. Tennessee ........................................................................................................................... 1.000 0.879 0.631 

00900 ....... 09 ............. Brazoria, TX ........................................................................................................................ 1.020 0.961 1.298 

00900 ....... 11 ............. Dallas, TX ............................................................................................................................ 1.009 1.062 1.061 

00900 ....... 15 ............. Galveston, TX ...................................................................................................................... 1.000 0.952 1.298 

00900 ....... 18 ............. Houston, TX ........................................................................................................................ 1.016 1.014 1.297 

00900 ....... 20 ............. Beaumont, TX ..................................................................................................................... 1.000 0.860 1.298 

00900 ....... 28 ............. Fort Worth, TX ..................................................................................................................... 1.000 0.989 1.061 

00900 ....... 31 ............. Austin, TX ............................................................................................................................ 1.000 1.046 0.986 

00900 ....... 99 ............. Rest of Texas ...................................................................................................................... 1.000 0.865 1.138 

00910 ....... 09 ............. Utah ..................................................................................................................................... 1.000 0.937 0.662 

31145 ....... 50 ............. Vermont ............................................................................................................................... 1.000 0.968 0.514 

00973 ....... 50 ............. Virgin Islands ....................................................................................................................... 1.000 1.014 1.003 

00904 ....... 00 ............. Virginia ................................................................................................................................. 1.000 0.940 0.579 

00836 ....... 02 ............. Seattle (King Cnty), WA ...................................................................................................... 1.014 1.131 0.819 

00836 ....... 99 ............. Rest of Washington ............................................................................................................. 1.000 0.978 0.819 

00884 ....... 16 ............. West Virginia ....................................................................................................................... 1.000 0.819 1.547 

00951 ....... 00 ............. Wisconsin ............................................................................................................................ 1.000 0.918 0.790 

00825 ....... 21 ............. Wyoming .............................................................................................................................. 1.000 0.853 0.935 

For 2005 and 2006, if the work GPCI falls below a 1.0 work index, then the work GPCI equals 1.0. 

For 2005, if the Work, PE and MP GPCI for Alaska falls below 1.67, then the Work, PE and MP GPCIs equal 1.67. 

* states are served by more than one carrier 

** locality numbers not assigned to proposed localities 

ADDENDUM E.—PROPOSED 2006 GEOGRAPHIC ADJUSTMENT FACTORS (GAFS) 

Carrier Locality Locality name 2006 

GAF 

31140 ....... 06 ............. San Mateo, CA .................................................................................................................................................... 1.259 

31140 ....... 05 ............. San Francisco, CA ............................................................................................................................................... 1.256 

31140 ....... 09 ............. Santa Clara, CA ................................................................................................................................................... 1.256 

00803 ....... 01 ............. Manhattan, NY ..................................................................................................................................................... 1.184 

00803 ....... 02 ............. NYC Suburbs/Long I., NY ................................................................................................................................... 1.180 

31140 ....... 07 ............. Oakland/Berkley, CA ........................................................................................................................................... 1.177 

31140 ....... 03 ............. Marin/Napa/Solano, CA ....................................................................................................................................... 1.154 

31143 ....... 01 ............. Metropolitan Boston ............................................................................................................................................. 1.153 

14330 ....... 04 ............. Queens, NY ......................................................................................................................................................... 1.144 

00903 ....... 01 ............. DC + MD/VA Suburbs ......................................................................................................................................... 1.132 

00805 ....... 01 ............. Northern NJ ......................................................................................................................................................... 1.126 

31146 ....... 26 ............. Anaheim/Santa Ana, CA ...................................................................................................................................... 1.119 

31140 ....... TBD* * ...... Santa Cruz, CA .................................................................................................................................................... 1.119 

00953 ....... 01 ............. Detroit, MI ............................................................................................................................................................ 1.111 

00952 ....... 16 ............. Chicago, IL ........................................................................................................................................................... 1.102 

31140 ....... TBD* * ...... Sonoma, CA ........................................................................................................................................................ 1.098 

00591 ....... 00 ............. Connecticut .......................................................................................................................................................... 1.091 

31146 ....... 18 ............. Los Angeles, CA .................................................................................................................................................. 1.088 

00952 ....... 15 ............. Suburban Chicago, IL .......................................................................................................................................... 1.085 

31146 ....... 17 ............. Ventura, CA ......................................................................................................................................................... 1.083 

00805 ....... 99 ............. Rest of New Jersey ............................................................................................................................................. 1.074 

00865 ....... 01 ............. Metropolitan Philadelphia, PA ............................................................................................................................. 1.069 

00590 ....... 04 ............. Miami, FL ............................................................................................................................................................. 1.069 

00836 ....... 02 ............. Seattle (King Cnty), WA ...................................................................................................................................... 1.058 

00831 ....... 01 ............. Alaska .................................................................................................................................................................. 1.055 

00803 ....... 03 ............. Poughkpsie/N NYC Suburbs, NY ........................................................................................................................ 1.046 

00833 ....... 01 ............. Hawaii/Guam ....................................................................................................................................................... 1.044 

00511 ....... 01 ............. Atlanta, GA .......................................................................................................................................................... 1.043 

31143 ....... 99 ............. Rest of Massachusetts ........................................................................................................................................ 1.042 

00901 ....... 01 ............. Baltimore/Surr. Cntys, MD ................................................................................................................................... 1.039 

00900 ....... 11 ............. Dallas, TX ............................................................................................................................................................ 1.034 

00900 ....... 18 ............. Houston, TX ......................................................................................................................................................... 1.026 

00834 ....... 00 ............. Nevada ................................................................................................................................................................. 1.023 

00590 ....... 03 ............. Fort Lauderdale, FL ............................................................................................................................................. 1.022 

00900 ....... 31 ............. Austin, TX ............................................................................................................................................................ 1.020 

31146 ....... 99 ............. Rest of California * ............................................................................................................................................... 1.014 

31140 ....... 99 ............. Rest of California * ............................................................................................................................................... 1.014 

31144 ....... 40 ............. New Hampshire ................................................................................................................................................... 1.010 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46009

ADDENDUM E.—PROPOSED 2006 GEOGRAPHIC ADJUSTMENT FACTORS (GAFS)—Continued

Carrier Locality Locality name 2006 

GAF 

00902 ....... 01 ............. Delaware .............................................................................................................................................................. 1.010 

00973 ....... 50 ............. Virgin Islands ....................................................................................................................................................... 1.007 

00900 ....... 09 ............. Brazoria, TX ......................................................................................................................................................... 1.005 

00835 ....... 01 ............. Portland, OR ........................................................................................................................................................ 1.005 

00952 ....... 12 ............. East St. Louis, IL ................................................................................................................................................. 1.003 

00832 ....... 00 ............. Arizona ................................................................................................................................................................. 0.999 

00824 ....... 01 ............. Colorado .............................................................................................................................................................. 0.999 

00900 ....... 28 ............. Fort Worth, TX ..................................................................................................................................................... 0.998 

31142 ....... 03 ............. Southern Maine ................................................................................................................................................... 0.992 

00900 ....... 15 ............. Galveston, TX ...................................................................................................................................................... 0.991 

00740 ....... 02 ............. Metropolitan Kansas City, MO ............................................................................................................................. 0.987 

00953 ....... 99 ............. Rest of Michigan .................................................................................................................................................. 0.986 

00836 ....... 99 ............. Rest of Washington ............................................................................................................................................. 0.984 

00528 ....... 01 ............. New Orleans, LA ................................................................................................................................................. 0.984 

00901 ....... 99 ............. Rest of Maryland ................................................................................................................................................. 0.982 

00590 ....... 99 ............. Rest of Florida ..................................................................................................................................................... 0.982 

00954 ....... 00 ............. Minnesota ............................................................................................................................................................ 0.980 

00523 ....... 01 ............. Metropolitan St. Louis, MO .................................................................................................................................. 0.978 

00883 ....... 00 ............. Ohio ..................................................................................................................................................................... 0.970 

31145 ....... 50 ............. Vermont ............................................................................................................................................................... 0.968 

00910 ....... 09 ............. Utah ..................................................................................................................................................................... 0.960 

00904 ....... 00 ............. Virginia ................................................................................................................................................................. 0.958 

00951 ....... 00 ............. Wisconsin ............................................................................................................................................................. 0.956 

00952 ....... 99 ............. Rest of Illinois ...................................................................................................................................................... 0.952 

00801 ....... 99 ............. Rest of New York ................................................................................................................................................ 0.952 

05535 ....... 00 ............. North Carolina ...................................................................................................................................................... 0.951 

00900 ....... 20 ............. Beaumont, TX ...................................................................................................................................................... 0.951 

00865 ....... 99 ............. Rest of Pennsylvania ........................................................................................................................................... 0.950 

00900 ....... 99 ............. Rest of Texas ...................................................................................................................................................... 0.947 

00521 ....... 05 ............. New Mexico ......................................................................................................................................................... 0.947 

00835 ....... 99 ............. Rest of Oregon .................................................................................................................................................... 0.946 

00511 ....... 99 ............. Rest of Georgia ................................................................................................................................................... 0.943 

00884 ....... 16 ............. West Virginia ........................................................................................................................................................ 0.942 

00630 ....... 00 ............. Indiana ................................................................................................................................................................. 0.937 

31142 ....... 99 ............. Rest of Maine ...................................................................................................................................................... 0.936 

00740 ....... 04 ............. Kansas * ............................................................................................................................................................... 0.936 

00650 ....... 00 ............. Kansas * ............................................................................................................................................................... 0.936 

00528 ....... 99 ............. Rest of Louisiana ................................................................................................................................................. 0.936 

00825 ....... 21 ............. Wyoming .............................................................................................................................................................. 0.934 

05440 ....... 35 ............. Tennessee ........................................................................................................................................................... 0.933 

00660 ....... 00 ............. Kentucky .............................................................................................................................................................. 0.932 

00880 ....... 01 ............. South Carolina ..................................................................................................................................................... 0.930 

00870 ....... 01 ............. Rhode Island ........................................................................................................................................................ 0.930 

00751 ....... 01 ............. Montana ............................................................................................................................................................... 0.928 

00826 ....... 00 ............. Iowa ..................................................................................................................................................................... 0.927 

00655 ....... 00 ............. Nebraska .............................................................................................................................................................. 0.925 

00820 ....... 01 ............. North Dakota ........................................................................................................................................................ 0.924 

00510 ....... 00 ............. Alabama ............................................................................................................................................................... 0.923 

05130 ....... 00 ............. Idaho .................................................................................................................................................................... 0.922 

00820 ....... 02 ............. South Dakota ....................................................................................................................................................... 0.922 

00512 ....... 00 ............. Mississippi ............................................................................................................................................................ 0.919 

00522 ....... 00 ............. Oklahoma ............................................................................................................................................................. 0.913 

00740 ....... 99 ............. Rest of Missouri * ................................................................................................................................................. 0.910 

00523 ....... 99 ............. Rest of Missouri * ................................................................................................................................................. 0.910 

00520 ....... 13 ............. Arkansas .............................................................................................................................................................. 0.905 

00973 ....... 20 ............. Puerto Rico .......................................................................................................................................................... 0.840 

For 2005 and 2006, if the work GPCI falls below a 1.0 work index, the work GPCI equals 1.0. 

* states are served by more than one carrier 

** locality numbers not assigned to proposed localities 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

01000 ......................... Autauga County, Alabama .................................................................................................. 5240 33860 

01010 ......................... Baldwin County, Alabama ................................................................................................... 5160 01 

01020 ......................... Barbour County, Alabama ................................................................................................... 01 01 

01030 ......................... Bibb County, Alabama ........................................................................................................ 01 13820 

46010 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

01040 ......................... Blount County, Alabama ..................................................................................................... 1000 13820 

01050 ......................... Bullock County, Alabama .................................................................................................... 01 01 

01060 ......................... Butler County, Alabama ...................................................................................................... 01 01 

01070 ......................... Calhoun County, Alabama .................................................................................................. 0450 11500 

01080 ......................... Chambers County, Alabama ............................................................................................... 01 01 

01090 ......................... Cherokee County, Alabama ................................................................................................ 01 01 

01100 ......................... Chilton County, Alabama .................................................................................................... 01 13820 

01110 ......................... Choctaw County, Alabama .................................................................................................. 01 01 

01120 ......................... Clarke County, Alabama ..................................................................................................... 01 01 

01130 ......................... Clay County, Alabama ........................................................................................................ 01 01 

01140 ......................... Cleburne County, Alabama ................................................................................................. 01 01 

01150 ......................... Coffee County, Alabama ..................................................................................................... 01 01 

01160 ......................... Colbert County, Alabama .................................................................................................... 2650 22520 

01170 ......................... Conecuh County, Alabama ................................................................................................. 01 01 

01180 ......................... Coosa County, Alabama ..................................................................................................... 01 01 

01190 ......................... Covington County, Alabama ............................................................................................... 01 01 

01200 ......................... Crenshaw County, Alabama ............................................................................................... 01 01 

01210 ......................... Cullman County, Alabama .................................................................................................. 01 01 

01220 ......................... Dale County, Alabama ........................................................................................................ 2180 01 

01230 ......................... Dallas County, Alabama ...................................................................................................... 01 01 

01240 ......................... De Kalb County, Alabama ................................................................................................... 01 01 

01250 ......................... Elmore County, Alabama .................................................................................................... 5240 33860 

01260 ......................... Escambia County, Alabama ................................................................................................ 01 01 

01270 ......................... Etowah County, Alabama .................................................................................................... 2880 23460 

01280 ......................... Fayette County, Alabama .................................................................................................... 01 01 

01290 ......................... Franklin County, Alabama ................................................................................................... 01 01 

01300 ......................... Geneva County, Alabama ................................................................................................... 01 20020 

01310 ......................... Greene County, Alabama .................................................................................................... 01 46220 

01320 ......................... Hale County, Alabama ........................................................................................................ 01 46220 

01330 ......................... Henry County, Alabama ...................................................................................................... 01 20020 

01340 ......................... Houston County, Alabama .................................................................................................. 2180 20020 

01350 ......................... Jackson County, Alabama .................................................................................................. 01 01 

01360 ......................... Jefferson County, Alabama ................................................................................................. 1000 13820 

01370 ......................... Lamar County, Alabama ..................................................................................................... 01 01 

01380 ......................... Lauderdale County, Alabama .............................................................................................. 2650 22520 

01390 ......................... Lawrence County, Alabama ................................................................................................ 01 19460 

01400 ......................... Lee County, Alabama .......................................................................................................... 01 12220 

01410 ......................... Limestone County, Alabama ............................................................................................... 01 26620 

01420 ......................... Lowndes County, Alabama ................................................................................................. 01 33860 

01430 ......................... Macon County, Alabama ..................................................................................................... 01 01 

01440 ......................... Madison County, Alabama .................................................................................................. 3440 26620 

01450 ......................... Marengo County, Alabama ................................................................................................. 01 01 

01460 ......................... Marion County, Alabama ..................................................................................................... 01 01 

01470 ......................... Marshall County, Alabama .................................................................................................. 01 01 

01480 ......................... Mobile County, Alabama ..................................................................................................... 5160 33660 

01490 ......................... Monroe County, Alabama ................................................................................................... 01 01 

01500 ......................... Montgomery County, Alabama ............................................................................................ 5240 33860 

01510 ......................... Morgan County, Alabama ................................................................................................... 01 19460 

01520 ......................... Perry County, Alabama ....................................................................................................... 01 01 

01530 ......................... Pickens County, Alabama ................................................................................................... 01 01 

01540 ......................... Pike County, Alabama ......................................................................................................... 01 01 

01550 ......................... Randolph County, Alabama ................................................................................................ 01 01 

01560 ......................... Russell County, Alabama .................................................................................................... 1800 17980 

01570 ......................... St Clair County, Alabama .................................................................................................... 1000 13820 

01580 ......................... Shelby County, Alabama ..................................................................................................... 1000 13820 

01590 ......................... Sumter County, Alabama .................................................................................................... 01 01 

01600 ......................... Talladega County, Alabama ................................................................................................ 01 01 

01610 ......................... Tallapoosa County, Alabama .............................................................................................. 01 01 

01620 ......................... Tuscaloosa County, Alabama ............................................................................................. 8600 46220 

01630 ......................... Walker County, Alabama .................................................................................................... 1000 13820 

01640 ......................... Washington County, Alabama ............................................................................................. 01 01 

01650 ......................... Wilcox County, Alabama ..................................................................................................... 01 01 

01660 ......................... Winston County, Alabama ................................................................................................... 01 01 

02013 ......................... Aleutians County East, Alaska ............................................................................................ 02 02 

02016 ......................... Aleutians County West, Alaska ........................................................................................... 02 02 

02020 ......................... Anchorage County, Alaska .................................................................................................. 0380 11260 

02030 ......................... Angoon County, Alaska ....................................................................................................... 02 02 

02040 ......................... Barrow-North Slope County, Alaska ................................................................................... 02 02 

02050 ......................... Bethel County, Alaska ......................................................................................................... 02 02 

02060 ......................... Bristol Bay Borough County, Alaska ................................................................................... 02 02 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46011

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

02068 ......................... Denali County, Alaska ......................................................................................................... 02 02 

02070 ......................... Bristol Bay County, Alaska .................................................................................................. 02 02 

02080 ......................... Cordova-Mc Carthy County, Alaska .................................................................................... 02 02 

02090 ......................... Fairbanks County, Alaska ................................................................................................... 02 21820 

02100 ......................... Haines County, Alaska ........................................................................................................ 02 02 

02110 ......................... Juneau County, Alaska ....................................................................................................... 02 02 

02120 ......................... Kenai-Cook Inlet County, Alaska ........................................................................................ 02 02 

02122 ......................... Kenai Peninsula Borough, Alaska ....................................................................................... 02 02 

02130 ......................... Ketchikan County, Alaska ................................................................................................... 02 02 

02140 ......................... Kobuk County, Alaska ......................................................................................................... 02 02 

02150 ......................... Kodiak County, Alaska ........................................................................................................ 02 02 

02160 ......................... Kuskokwin County, Alaska .................................................................................................. 02 02 

02164 ......................... Lake and Peninsula Borough, Alaska ................................................................................. 02 02 

02170 ......................... Matanuska County, Alaska ................................................................................................. 02 11260 

02180 ......................... Nome County, Alaska ......................................................................................................... 02 02 

02185 ......................... North Slope Borough, Alaska .............................................................................................. 02 02 

02188 ......................... Northwest Arctic Borough, Alaska ...................................................................................... 02 02 

02190 ......................... Outer Ketchikan County, Alaska ......................................................................................... 02 02 

02200 ......................... Prince Of Wales County, Alaska ......................................................................................... 02 02 

02201 ......................... Prince of Wales-Outer Ketchikan Census Area, Alaska ..................................................... 02 02 

02210 ......................... Seward County, Alaska ....................................................................................................... 02 02 

02220 ......................... Sitka County, Alaska ........................................................................................................... 02 02 

02230 ......................... Skagway-Yakutat County, Alaska ....................................................................................... 02 02 

02231 ......................... Skagway-Yakutat-Angoon Census Area, Alaska ................................................................ 02 02 

02232 ......................... Skagway-Hoonah-Angoon Census Area, Alaska ............................................................... 02 02 

02240 ......................... Southeast Fairbanks County, Alaska .................................................................................. 02 02 

02250 ......................... Upper Yukon County, Alaska .............................................................................................. 02 02 

02260 ......................... Valdz-Chitna-Whitier County, Alaska .................................................................................. 02 02 

02261 ......................... Valdex-Cordove Census Area, Alaska ................................................................................ 02 02 

02270 ......................... Wade Hampton County, Alaska .......................................................................................... 02 02 

02280 ......................... Wrangell-Petersburg County, Alaska .................................................................................. 02 02 

02282 ......................... Yakutat Borough, Alaska ..................................................................................................... 02 02 

02290 ......................... Yukon-Koyukuk County, Alaska .......................................................................................... 02 02 

03000 ......................... Apache County, Arizona ..................................................................................................... 03 03 

03010 ......................... Cochise County, Arizona ..................................................................................................... 03 03 

03020 ......................... Coconino County, Arizona .................................................................................................. 03 22380 

03030 ......................... Gila County, Arizona ........................................................................................................... 03 03 

03040 ......................... Graham County, Arizona ..................................................................................................... 03 03 

03050 ......................... Greenlee County, Arizona ................................................................................................... 03 03 

03055 ......................... La Paz County, Arizona ...................................................................................................... 03 03 

03060 ......................... Maricopa County, Arizona ................................................................................................... 6200 38060 

03070 ......................... Mohave County, Arizona ..................................................................................................... 03 03 

03080 ......................... Navajo County, Arizona ...................................................................................................... 03 03 

03090 ......................... Pima County, Arizona ......................................................................................................... 8520 46060 

03100 ......................... Pinal County, Arizona .......................................................................................................... 03 38060 

03110 ......................... Santa Cruz County, Arizona ............................................................................................... 03 03 

03120 ......................... Yavapai County, Arizona ..................................................................................................... 03 39140 

03130 ......................... Yuma County, Arizona ........................................................................................................ 03 49740 

04000 ......................... Arkansas County, Arkansas ................................................................................................ 04 04 

04010 ......................... Ashley County, Arkansas .................................................................................................... 04 04 

04020 ......................... Baxter County, Arkansas .................................................................................................... 04 04 

04030 ......................... Benton County, Arkansas ................................................................................................... 04 22220 

04040 ......................... Boone County, Arkansas .................................................................................................... 04 04 

04050 ......................... Bradley County, Arkansas ................................................................................................... 04 04 

04060 ......................... Calhoun County, Arkansas ................................................................................................. 04 04 

04070 ......................... Carroll County, Arkansas .................................................................................................... 04 04 

04080 ......................... Chicot County, Arkansas ..................................................................................................... 04 04 

04090 ......................... Clark County, Arkansas ...................................................................................................... 04 04 

04100 ......................... Clay County, Arkansas ........................................................................................................ 04 04 

04110 ......................... Cleburne County, Arkansas ................................................................................................ 04 04 

04120 ......................... Cleveland County, Arkansas ............................................................................................... 04 38220 

04130 ......................... Columbia County, Arkansas ................................................................................................ 04 04 

04140 ......................... Conway County, Arkansas .................................................................................................. 04 04 

04150 ......................... Craighead County, Arkansas .............................................................................................. 04 27860 

04160 ......................... Crawford County, Arkansas ................................................................................................ 2720 22900 

04170 ......................... Crittenden County, Arkansas .............................................................................................. 4920 32820 

04180 ......................... Cross County, Arkansas ..................................................................................................... 04 04 

04190 ......................... Dallas County, Arkansas ..................................................................................................... 04 04 

04200 ......................... Desha County, Arkansas .................................................................................................... 04 04 

04210 ......................... Drew County, Arkansas ...................................................................................................... 04 04 

46012 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

04220 ......................... Faulkner County, Arkansas ................................................................................................. 4400 30780 

04230 ......................... Franklin County, Arkansas .................................................................................................. 04 22900 

04240 ......................... Fulton County, Arkansas ..................................................................................................... 04 04 

04250 ......................... Garland County, Arkansas .................................................................................................. 04 26300 

04260 ......................... Grant County, Arkansas ...................................................................................................... 04 30780 

04270 ......................... Greene County, Arkansas ................................................................................................... 04 04 

04280 ......................... Hempstead County, Arkansas ............................................................................................ 04 04 

04290 ......................... Hot Spring County, Arkansas .............................................................................................. 04 04 

04300 ......................... Howard County, Arkansas .................................................................................................. 04 04 

04310 ......................... Independence County, Arkansas ........................................................................................ 04 04 

04320 ......................... Izard County, Arkansas ....................................................................................................... 04 04 

04330 ......................... Jackson County, Arkansas .................................................................................................. 04 04 

04340 ......................... Jefferson County, Arkansas ................................................................................................ 6240 38220 

04350 ......................... Johnson County, Arkansas ................................................................................................. 04 04 

04360 ......................... Lafayette County, Arkansas ................................................................................................ 04 04 

04370 ......................... Lawrence County, Arkansas ............................................................................................... 04 04 

04380 ......................... Lee County, Arkansas ......................................................................................................... 04 04 

04390 ......................... Lincoln County, Arkansas ................................................................................................... 04 38220 

04400 ......................... Little River County, Arkansas .............................................................................................. 04 04 

04410 ......................... Logan County, Arkansas ..................................................................................................... 04 04 

04420 ......................... Lonoke County, Arkansas ................................................................................................... 4400 30780 

04430 ......................... Madison County, Arkansas ................................................................................................. 04 22220 

04440 ......................... Marion County, Arkansas .................................................................................................... 04 04 

04450 ......................... Miller County, Arkansas ...................................................................................................... 8360 45500 

04460 ......................... Mississippi County, Arkansas ............................................................................................. 04 04 

04470 ......................... Monroe County, Arkansas ................................................................................................... 04 04 

04480 ......................... Montgomery County, Arkansas ........................................................................................... 04 04 

04490 ......................... Nevada County, Arkansas .................................................................................................. 04 04 

04500 ......................... Newton County, Arkansas ................................................................................................... 04 04 

04510 ......................... Ouachita County, Arkansas ................................................................................................ 04 04 

04520 ......................... Perry County, Arkansas ...................................................................................................... 04 30780 

04530 ......................... Phillips County, Arkansas ................................................................................................... 04 04 

04540 ......................... Pike County, Arkansas ........................................................................................................ 04 04 

04550 ......................... Poinsett County, Arkansas .................................................................................................. 04 27860 

04560 ......................... Polk County, Arkansas ........................................................................................................ 04 04 

04570 ......................... Pope County, Arkansas ...................................................................................................... 04 04 

04580 ......................... Prairie County, Arkansas .................................................................................................... 04 04 

04590 ......................... Pulaski County, Arkansas ................................................................................................... 4400 30780 

04600 ......................... Randolph County, Arkansas ............................................................................................... 04 04 

04610 ......................... St Francis County, Arkansas .............................................................................................. 04 04 

04620 ......................... Saline County, Arkansas ..................................................................................................... 4400 30780 

04630 ......................... Scott County, Arkansas ....................................................................................................... 04 04 

04640 ......................... Searcy County, Arkansas .................................................................................................... 04 04 

04650 ......................... Sebastian County, Arkansas ............................................................................................... 2720 22900 

04660 ......................... Sevier County, Arkansas ..................................................................................................... 04 04 

04670 ......................... Sharp County, Arkansas ..................................................................................................... 04 04 

04680 ......................... Stone County, Arkansas ..................................................................................................... 04 04 

04690 ......................... Union County, Arkansas ..................................................................................................... 04 04 

04700 ......................... Van Buren County, Arkansas .............................................................................................. 04 04 

04710 ......................... Washington County, Arkansas ............................................................................................ 2580 22220 

04720 ......................... White County, Arkansas ...................................................................................................... 04 04 

04730 ......................... Woodruff County, Arkansas ................................................................................................ 04 04 

04740 ......................... Yell County, Arkansas ......................................................................................................... 04 04 

05000 ......................... Alameda County, California ................................................................................................ 5775 36084 

05010 ......................... Alpine County, California ..................................................................................................... 05 05 

05020 ......................... Amador County, California .................................................................................................. 05 05 

05030 ......................... Butte County, California ...................................................................................................... 1620 17020 

05040 ......................... Calaveras County, California .............................................................................................. 05 05 

05050 ......................... Colusa County, California ................................................................................................... 05 05 

05060 ......................... Contra Costa County, California ......................................................................................... 5775 36084 

05070 ......................... Del Norte County, California ............................................................................................... 05 05 

05080 ......................... Eldorado County, California ................................................................................................ 6920 40900 

05090 ......................... Fresno County, California ................................................................................................... 2840 23420 

05100 ......................... Glenn County, California ..................................................................................................... 05 05 

05110 ......................... Humboldt County, California ............................................................................................... 05 05 

05120 ......................... Imperial County, California .................................................................................................. 05 20940 

05130 ......................... Inyo County, California ........................................................................................................ 05 05 

05140 ......................... Kern County, California ....................................................................................................... 0680 12540 

05150 ......................... Kings County, California ...................................................................................................... 05 25260 

05160 ......................... Lake County, California ....................................................................................................... 05 05 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46013

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

05170 ......................... Lassen County, California ................................................................................................... 05 05 

05200 ......................... Los Angeles County, California ........................................................................................... 4480 31084 

05210 ......................... Los Angeles County, California ........................................................................................... 4480 31084 

05300 ......................... Madera County, California .................................................................................................. 05 31460 

05310 ......................... Marin County, California ...................................................................................................... 7360 41884 

05320 ......................... Mariposa County, California ................................................................................................ 05 05 

05330 ......................... Mendocino County, California ............................................................................................. 05 05 

05340 ......................... Merced County, California ................................................................................................... 4940 32900 

05350 ......................... Modoc County, California .................................................................................................... 05 05 

05360 ......................... Mono County, California ...................................................................................................... 05 05 

05370 ......................... Monterey County, California ................................................................................................ 7120 41500 

05380 ......................... Napa County, California ...................................................................................................... 8720 34900 

05390 ......................... Nevada County, California .................................................................................................. 05 05 

05400 ......................... Orange County, California ................................................................................................... 0360 42044 

05410 ......................... Placer County, California .................................................................................................... 6920 40900 

05420 ......................... Plumas County, California ................................................................................................... 05 05 

05430 ......................... Riverside County, California ................................................................................................ 6780 40140 

05440 ......................... Sacramento County, California ........................................................................................... 6920 40900 

05450 ......................... San Benito County, California ............................................................................................. 05 41940 

05460 ......................... San Bernardino County, California ..................................................................................... 6780 40140 

05470 ......................... San Diego County, California .............................................................................................. 7320 41740 

05480 ......................... San Francisco County, California ....................................................................................... 7360 41884 

05490 ......................... San Joaquin County, California .......................................................................................... 8120 44700 

05500 ......................... San Luis Obispo County, California .................................................................................... 05 42020 

05510 ......................... San Mateo County, California ............................................................................................. 7360 41884 

05520 ......................... Santa Barbara County, California ....................................................................................... 7480 42060 

05530 ......................... Santa Clara County, California ........................................................................................... 7400 41940 

05540 ......................... Santa Cruz County, California ............................................................................................ 7485 42100 

05550 ......................... Shasta County, California ................................................................................................... 6690 39820 

05560 ......................... Sierra County, California ..................................................................................................... 05 05 

05570 ......................... Siskiyou County, California ................................................................................................. 05 05 

05580 ......................... Solano County, California ................................................................................................... 8720 46700 

05590 ......................... Sonoma County, California ................................................................................................. 7500 42220 

05600 ......................... Stanislaus County, California .............................................................................................. 5170 33700 

05610 ......................... Sutter County, California ..................................................................................................... 9340 49700 

05620 ......................... Tehama County, California ................................................................................................. 05 05 

05630 ......................... Trinity County, California ..................................................................................................... 05 05 

05640 ......................... Tulare County, California .................................................................................................... 8780 47300 

05650 ......................... Tuolumne County, California ............................................................................................... 05 05 

05660 ......................... Ventura County, California .................................................................................................. 6000 37100 

05670 ......................... Yolo County, California ....................................................................................................... 6920 40900 

05680 ......................... Yuba County, California ...................................................................................................... 9340 49700 

06000 ......................... Adams County, Colorado .................................................................................................... 2080 19740 

06010 ......................... Alamosa County, Colorado ................................................................................................. 06 06 

06020 ......................... Arapahoe County, Colorado ................................................................................................ 2080 19740 

06030 ......................... Archuleta County, Colorado ................................................................................................ 06 06 

06040 ......................... Baca County, Colorado ....................................................................................................... 06 06 

06050 ......................... Bent County, Colorado ........................................................................................................ 06 06 

06060 ......................... Boulder County, Colorado ................................................................................................... 1125 14500 

06070 ......................... Chaffee County, Colorado ................................................................................................... 06 06 

06080 ......................... Cheyenne County, Colorado ............................................................................................... 06 06 

06090 ......................... Clear Creek County, Colorado ............................................................................................ 06 19740 

06100 ......................... Conejos County, Colorado .................................................................................................. 06 06 

06110 ......................... Costilla County, Colorado ................................................................................................... 06 06 

06120 ......................... Crowley County, Colorado .................................................................................................. 06 06 

06130 ......................... Custer County, Colorado ..................................................................................................... 06 06 

06140 ......................... Delta County, Colorado ....................................................................................................... 06 06 

06150 ......................... Denver County, Colorado .................................................................................................... 2080 19740 

06160 ......................... Dolores County, Colorado ................................................................................................... 06 06 

06170 ......................... Douglas County, Colorado .................................................................................................. 2080 19740 

06180 ......................... Eagle County, Colorado ...................................................................................................... 06 06 

06190 ......................... Elbert County, Colorado ...................................................................................................... 06 19740 

06200 ......................... El Paso County, Colorado ................................................................................................... 1720 17820 

06210 ......................... Fremont County, Colorado .................................................................................................. 06 06 

06220 ......................... Garfield County, Colorado ................................................................................................... 06 06 

06230 ......................... Gilpin County, Colorado ...................................................................................................... 06 19740 

06240 ......................... Grand County, Colorado ..................................................................................................... 06 06 

06250 ......................... Gunnison County, Colorado ................................................................................................ 06 06 

06260 ......................... Hinsdale County, Colorado ................................................................................................. 06 06 

06270 ......................... Huerfano County, Colorado ................................................................................................ 06 06 

46014 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

06280 ......................... Jackson County, Colorado .................................................................................................. 06 06 

06290 ......................... Jefferson County, Colorado ................................................................................................ 2080 19740 

06300 ......................... Kiowa County, Colorado ..................................................................................................... 06 06 

06310 ......................... Kit Carson County, Colorado .............................................................................................. 06 06 

06320 ......................... Lake County, Colorado ....................................................................................................... 06 06 

06330 ......................... La Plata County, Colorado .................................................................................................. 06 06 

06340 ......................... Larimer County, Colorado ................................................................................................... 2670 22660 

06350 ......................... Las Animas County, Colorado ............................................................................................ 06 06 

06360 ......................... Lincoln County, Colorado .................................................................................................... 06 06 

06370 ......................... Logan County, Colorado ..................................................................................................... 06 06 

06380 ......................... Mesa County, Colorado ...................................................................................................... 06 24300 

06390 ......................... Mineral County, Colorado ................................................................................................... 06 06 

06400 ......................... Moffat County, Colorado ..................................................................................................... 06 06 

06410 ......................... Montezuma County, Colorado ............................................................................................ 06 06 

06420 ......................... Montrose County, Colorado ................................................................................................ 06 06 

06430 ......................... Morgan County, Colorado ................................................................................................... 06 06 

06440 ......................... Otero County, Colorado ...................................................................................................... 06 06 

06450 ......................... Ouray County, Colorado ..................................................................................................... 06 06 

06460 ......................... Park County, Colorado ........................................................................................................ 06 19740 

06470 ......................... Phillips County, Colorado .................................................................................................... 06 06 

06480 ......................... Pitkin County, Colorado ...................................................................................................... 06 06 

06490 ......................... Prowers County, Colorado .................................................................................................. 06 06 

06500 ......................... Pueblo County, Colorado .................................................................................................... 6560 39380 

06510 ......................... Rio Blanco County, Colorado .............................................................................................. 06 06 

06520 ......................... Rio Grande County, Colorado ............................................................................................. 06 06 

06530 ......................... Routt County, Colorado ....................................................................................................... 06 06 

06540 ......................... Saguache County, Colorado ............................................................................................... 06 06 

06550 ......................... San Juan County, Colorado ................................................................................................ 06 06 

06560 ......................... San Miguel County, Colorado ............................................................................................. 06 06 

06570 ......................... Sedgwick County, Colorado ................................................................................................ 06 06 

06580 ......................... Summit County, Colorado ................................................................................................... 06 06 

06590 ......................... Teller County, Colorado ...................................................................................................... 06 17820 

06600 ......................... Washington County, Colorado ............................................................................................ 06 06 

06610 ......................... Weld County, Colorado ....................................................................................................... 3060 24540 

06620 ......................... Yuma County, Colorado ...................................................................................................... 06 06 

06630 ......................... Broomfield County, Colorado .............................................................................................. 06 19740 

07000 ......................... Fairfield County, Connecticut .............................................................................................. 1163 14860 

07010 ......................... Hartford County, Connecticut .............................................................................................. 3283 25540 

07020 ......................... Litchfield County, Connecticut ............................................................................................. 3283 25540 

07030 ......................... Middlesex County, Connecticut ........................................................................................... 3283 25540 

07040 ......................... New Haven County, Connecticut ........................................................................................ 5483 35300 

07050 ......................... New London County, Connecticut ...................................................................................... 5523 35980 

07060 ......................... Tolland County, Connecticut ............................................................................................... 3283 25540 

07070 ......................... Windham County, Connecticut ............................................................................................ 07 07 

08000 ......................... Kent County, Delaware ....................................................................................................... 07 20100 

08010 ......................... New Castle County, Delaware ............................................................................................ 9160 48864 

08020 ......................... Sussex County, Delaware ................................................................................................... 08 08 

09000 ......................... Washington DC County, Dist Of Col ................................................................................... 8840 47894 

10000 ......................... Alachua County, Florida ...................................................................................................... 2900 23540 

10010 ......................... Baker County, Florida ......................................................................................................... 10 27260 

10020 ......................... Bay County, Florida ............................................................................................................. 6015 37460 

10030 ......................... Bradford County, Florida ..................................................................................................... 10 10 

10040 ......................... Brevard County, Florida ...................................................................................................... 4900 37340 

10050 ......................... Broward County, Florida ..................................................................................................... 2680 22744 

10060 ......................... Calhoun County, Florida ..................................................................................................... 10 10 

10070 ......................... Charlotte County, Florida .................................................................................................... 10 39460 

10080 ......................... Citrus County, Florida ......................................................................................................... 10 10 

10090 ......................... Clay County, Florida ............................................................................................................ 3600 27260 

10100 ......................... Collier County, Florida ......................................................................................................... 5345 34940 

10110 ......................... Columbia County, Florida .................................................................................................... 10 10 

10120 ......................... Dade County, Florida .......................................................................................................... 5000 33124 

10130 ......................... De Soto County, Florida ...................................................................................................... 10 10 

10140 ......................... Dixie County, Florida ........................................................................................................... 10 10 

10150 ......................... Duval County, Florida .......................................................................................................... 3600 27260 

10160 ......................... Escambia County, Florida ................................................................................................... 6080 37860 

10170 ......................... Flagler County, Florida ........................................................................................................ 10 10 

10180 ......................... Franklin County, Florida ...................................................................................................... 10 10 

10190 ......................... Gadsden County, Florida .................................................................................................... 8240 45220 

10200 ......................... Gilchrist County, Florida ...................................................................................................... 10 23540 

10210 ......................... Glades County, Florida ....................................................................................................... 10 10 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46015

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

10220 ......................... Gulf County, Florida ............................................................................................................ 10 10 

10230 ......................... Hamilton County, Florida ..................................................................................................... 10 10 

10240 ......................... Hardee County, Florida ....................................................................................................... 10 10 

10250 ......................... Hendry County, Florida ....................................................................................................... 10 10 

10260 ......................... Hernando County, Florida ................................................................................................... 8280 45300 

10270 ......................... Highlands County, Florida ................................................................................................... 10 10 

10280 ......................... Hillsborough County, Florida ............................................................................................... 8280 45300 

10290 ......................... Holmes County, Florida ....................................................................................................... 10 10 

10300 ......................... Indian River County, Florida ............................................................................................... 10 46940 

10310 ......................... Jackson County, Florida ...................................................................................................... 10 10 

10320 ......................... Jefferson County, Florida .................................................................................................... 10 45220 

10330 ......................... Lafayette County, Florida .................................................................................................... 10 10 

10340 ......................... Lake County, Florida ........................................................................................................... 10 36740 

10350 ......................... Lee County, Florida ............................................................................................................. 2700 15980 

10360 ......................... Leon County, Florida ........................................................................................................... 8240 45220 

10370 ......................... Levy County, Florida ........................................................................................................... 10 10 

10380 ......................... Liberty County, Florida ........................................................................................................ 10 10 

10390 ......................... Madison County, Florida ..................................................................................................... 10 10 

10400 ......................... Manatee County, Florida ..................................................................................................... 1140 42260 

10410 ......................... Marion County, Florida ........................................................................................................ 5790 36100 

10420 ......................... Martin County, Florida ......................................................................................................... 2710 38940 

10430 ......................... Monroe County, Florida ....................................................................................................... 10 10 

10440 ......................... Nassau County, Florida ....................................................................................................... 3600 27260 

10450 ......................... Okaloosa County, Florida .................................................................................................... 2750 23020 

10460 ......................... Okeechobee County, Florida .............................................................................................. 10 10 

10470 ......................... Orange County, Florida ....................................................................................................... 5960 36740 

10480 ......................... Osceola County, Florida ...................................................................................................... 5960 36740 

10490 ......................... Palm Beach County, Florida ............................................................................................... 8960 48424 

10500 ......................... Pasco County, Florida ......................................................................................................... 8280 45300 

10510 ......................... Pinellas County, Florida ...................................................................................................... 8280 45300 

10520 ......................... Polk County, Florida ............................................................................................................ 3980 29460 

10530 ......................... Putnam County, Florida ...................................................................................................... 10 10 

10540 ......................... St. Johns County, Florida .................................................................................................... 3600 27260 

10550 ......................... St Lucie County, Florida ...................................................................................................... 2710 38940 

10560 ......................... Santa Rosa County, Florida ................................................................................................ 6080 37860 

10570 ......................... Sarasota County, Florida .................................................................................................... 7510 42260 

10580 ......................... Seminole County, Florida .................................................................................................... 5960 36740 

10590 ......................... Sumter County, Florida ....................................................................................................... 10 10 

10600 ......................... Suwannee County, Florida .................................................................................................. 10 10 

10610 ......................... Taylor County, Florida ......................................................................................................... 10 10 

10620 ......................... Union County, Florida ......................................................................................................... 10 10 

10630 ......................... Volusia County, Florida ....................................................................................................... 2020 19660 

10640 ......................... Wakulla County, Florida ...................................................................................................... 10 45220 

10650 ......................... Walton County, Florida ........................................................................................................ 10 10 

10660 ......................... Washington County, Florida ................................................................................................ 10 10 

11000 ......................... Appling County, Georgia ..................................................................................................... 11 11 

11010 ......................... Atkinson County, Georgia ................................................................................................... 11 11 

11011 ......................... Bacon County, Georgia ....................................................................................................... 11 11 

11020 ......................... Baker County, Georgia ........................................................................................................ 11 10500 

11030 ......................... Baldwin County, Georgia .................................................................................................... 11 11 

11040 ......................... Banks County, Georgia ....................................................................................................... 11 11 

11050 ......................... Barrow County, Georgia ...................................................................................................... 0520 12060 

11060 ......................... Bartow County, Georgia ...................................................................................................... 11 12060 

11070 ......................... Ben Hill County, Georgia .................................................................................................... 11 11 

11080 ......................... Berrien County, Georgia ..................................................................................................... 11 11 

11090 ......................... Bibb County, Georgia .......................................................................................................... 4680 31420 

11100 ......................... Bleckley County, Georgia .................................................................................................... 11 11 

11110 ......................... Brantley County, Georgia .................................................................................................... 11 15260 

11120 ......................... Brooks County, Georgia ...................................................................................................... 11 46660 

11130 ......................... Bryan County, Georgia ........................................................................................................ 11 42340 

11140 ......................... Bulloch County, Georgia ..................................................................................................... 11 11 

11150 ......................... Burke County, Georgia ........................................................................................................ 11 12260 

11160 ......................... Butts County, Georgia ......................................................................................................... 0520 12060 

11161 ......................... Calhoun County, Georgia .................................................................................................... 11 11 

11170 ......................... Camden County, Georgia ................................................................................................... 11 11 

11180 ......................... Candler County, Georgia .................................................................................................... 11 11 

11190 ......................... Carroll County, Georgia ...................................................................................................... 11 12060 

11200 ......................... Catoosa County, Georgia .................................................................................................... 1560 16860 

11210 ......................... Charlton County, Georgia ................................................................................................... 11 11 

11220 ......................... Chatham County, Georgia .................................................................................................. 7520 42340 

46016 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

11230 ......................... Chattahoochee County, Georgia ......................................................................................... 1800 17980 

11240 ......................... Chattooga County, Georgia ................................................................................................ 11 11 

11250 ......................... Cherokee County, Georgia ................................................................................................. 0520 12060 

11260 ......................... Clarke County, Georgia ....................................................................................................... 0500 12020 

11270 ......................... Clay County, Georgia .......................................................................................................... 11 11 

11280 ......................... Clayton County, Georgia ..................................................................................................... 0520 12060 

11281 ......................... Clinch County, Georgia ....................................................................................................... 11 11 

11290 ......................... Cobb County, Georgia ........................................................................................................ 0520 12060 

11291 ......................... Coffee County, Georgia ...................................................................................................... 11 11 

11300 ......................... Colquitt County, Georgia ..................................................................................................... 11 11 

11310 ......................... Columbia County, Georgia .................................................................................................. 0600 12260 

11311 ......................... Cook County, Georgia ......................................................................................................... 11 11 

11320 ......................... Coweta County, Georgia ..................................................................................................... 0520 12060 

11330 ......................... Crawford County, Georgia .................................................................................................. 11 31420 

11340 ......................... Crisp County, Georgia ......................................................................................................... 11 11 

11341 ......................... Dade County, Georgia ........................................................................................................ 1560 16860 

11350 ......................... Dawson County, Georgia .................................................................................................... 11 12060 

11360 ......................... Decatur County, Georgia .................................................................................................... 11 11 

11370 ......................... De Kalb County, Georgia .................................................................................................... 0520 12060 

11380 ......................... Dodge County, Georgia ...................................................................................................... 11 11 

11381 ......................... Dooly County, Georgia ........................................................................................................ 11 11 

11390 ......................... Dougherty County, Georgia ................................................................................................ 0120 10500 

11400 ......................... Douglas County, Georgia .................................................................................................... 0520 12060 

11410 ......................... Early County, Georgia ......................................................................................................... 11 11 

11420 ......................... Echols County, Georgia ...................................................................................................... 11 46660 

11421 ......................... Effingham County, Georgia ................................................................................................. 7520 42340 

11430 ......................... Elbert County, Georgia ........................................................................................................ 11 11 

11440 ......................... Emanuel County, Georgia ................................................................................................... 11 11 

11441 ......................... Evans County, Georgia ....................................................................................................... 11 11 

11450 ......................... Fannin County, Georgia ...................................................................................................... 11 11 

11451 ......................... Fayette County, Georgia ..................................................................................................... 0520 12060 

11460 ......................... Floyd County, Georgia ........................................................................................................ 11 40660 

11461 ......................... Forsyth County, Georgia ..................................................................................................... 0520 12060 

11462 ......................... Franklin County, Georgia .................................................................................................... 11 11 

11470 ......................... Fulton County, Georgia ....................................................................................................... 0520 12060 

11471 ......................... Gilmer County, Georgia ...................................................................................................... 11 11 

11480 ......................... Glascock County, Georgia .................................................................................................. 11 11 

11490 ......................... Glynn County, Georgia ........................................................................................................ 11 15260 

11500 ......................... Gordon County, Georgia ..................................................................................................... 11 11 

11510 ......................... Grady County, Georgia ....................................................................................................... 11 11 

11520 ......................... Greene County, Georgia ..................................................................................................... 11 11 

11530 ......................... Gwinnett County, Georgia ................................................................................................... 0520 12060 

11540 ......................... Habersham County, Georgia .............................................................................................. 11 11 

11550 ......................... Hall County, Georgia ........................................................................................................... 11 23580 

11560 ......................... Hancock County, Georgia ................................................................................................... 11 11 

11570 ......................... Haralson County, Georgia ................................................................................................... 11 12060 

11580 ......................... Harris County, Georgia ....................................................................................................... 11 17980 

11581 ......................... Hart County, Georgia .......................................................................................................... 11 11 

11590 ......................... Heard County, Georgia ....................................................................................................... 11 12060 

11591 ......................... Henry County, Georgia ....................................................................................................... 0520 12060 

11600 ......................... Houston County, Georgia .................................................................................................... 4680 47580 

11601 ......................... Irwin County, Georgia ......................................................................................................... 11 11 

11610 ......................... Jackson County, Georgia .................................................................................................... 0500 11 

11611 ......................... Jasper County, Georgia ...................................................................................................... 11 12060 

11612 ......................... Jeff Davis County, Georgia ................................................................................................. 11 11 

11620 ......................... Jefferson County, Georgia .................................................................................................. 11 11 

11630 ......................... Jenkins County, Georgia ..................................................................................................... 11 11 

11640 ......................... Johnson County, Georgia ................................................................................................... 11 11 

11650 ......................... Jones County, Georgia ....................................................................................................... 4680 31420 

11651 ......................... Lamar County, Georgia ....................................................................................................... 11 12060 

11652 ......................... Lanier County, Georgia ....................................................................................................... 11 46660 

11660 ......................... Laurens County, Georgia .................................................................................................... 11 11 

11670 ......................... Lee County, Georgia ........................................................................................................... 0120 10500 

11680 ......................... Liberty County, Georgia ...................................................................................................... 11 25980 

11690 ......................... Lincoln County, Georgia ...................................................................................................... 11 11 

11691 ......................... Long County, Georgia ......................................................................................................... 11 25980 

11700 ......................... Lowndes County, Georgia ................................................................................................... 11 46660 

11701 ......................... Lumpkin County, Georgia ................................................................................................... 11 11 

11702 ......................... Mc Duffie County, Georgia .................................................................................................. 0600 12260 

11703 ......................... Mc Intosh County, Georgia ................................................................................................. 11 15260 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46017

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

11710 ......................... Macon County, Georgia ...................................................................................................... 11 11 

11720 ......................... Madison County, Georgia ................................................................................................... 0500 12020 

11730 ......................... Marion County, Georgia ...................................................................................................... 11 17980 

11740 ......................... Meriwether County, Georgia ............................................................................................... 11 12060 

11741 ......................... Miller County, Georgia ........................................................................................................ 11 11 

11750 ......................... Mitchell County, Georgia ..................................................................................................... 11 11 

11760 ......................... Monroe County, Georgia ..................................................................................................... 11 31420 

11770 ......................... Montgomery County, Georgia ............................................................................................. 11 11 

11771 ......................... Morgan County, Georgia ..................................................................................................... 11 11 

11772 ......................... Murray County, Georgia ...................................................................................................... 11 19140 

11780 ......................... Muscogee County, Georgia ................................................................................................ 1800 17980 

11790 ......................... Newton County, Georgia ..................................................................................................... 0520 12060 

11800 ......................... Oconee County, Georgia .................................................................................................... 0500 12020 

11801 ......................... Oglethorpe County, Georgia ............................................................................................... 11 12020 

11810 ......................... Paulding County, Georgia ................................................................................................... 0520 12060 

11811 ......................... Peach County, Georgia ....................................................................................................... 4680 11 

11812 ......................... Pickens County, Georgia .................................................................................................... 11 12060 

11820 ......................... Pierce County, Georgia ....................................................................................................... 11 11 

11821 ......................... Pike County, Georgia .......................................................................................................... 11 12060 

11830 ......................... Polk County, Georgia .......................................................................................................... 11 11 

11831 ......................... Pulaski County, Georgia ..................................................................................................... 11 11 

11832 ......................... Putnam County, Georgia ..................................................................................................... 11 11 

11833 ......................... Quitman County, Georgia ................................................................................................... 11 11 

11834 ......................... Rabun County, Georgia ...................................................................................................... 11 11 

11835 ......................... Randolph County, Georgia .................................................................................................. 11 11 

11840 ......................... Richmond County, Georgia ................................................................................................. 0600 12260 

11841 ......................... Rockdale County, Georgia .................................................................................................. 0520 12060 

11842 ......................... Schley County, Georgia ...................................................................................................... 11 11 

11850 ......................... Screven County, Georgia .................................................................................................... 11 11 

11851 ......................... Seminole County, Georgia .................................................................................................. 11 11 

11860 ......................... Spalding County, Georgia ................................................................................................... 0520 12060 

11861 ......................... Stephens County, Georgia .................................................................................................. 11 11 

11862 ......................... Stewart County, Georgia ..................................................................................................... 11 11 

11870 ......................... Sumter County, Georgia ..................................................................................................... 11 11 

11880 ......................... Talbot County, Georgia ....................................................................................................... 11 11 

11881 ......................... Taliaferro County, Georgia .................................................................................................. 11 11 

11882 ......................... Tattnall County, Georgia ..................................................................................................... 11 11 

11883 ......................... Taylor County, Georgia ....................................................................................................... 11 11 

11884 ......................... Telfair County, Georgia ....................................................................................................... 11 11 

11885 ......................... Terrell County, Georgia ....................................................................................................... 11 10500 

11890 ......................... Thomas County, Georgia .................................................................................................... 11 11 

11900 ......................... Tift County, Georgia ............................................................................................................ 11 11 

11901 ......................... Toombs County, Georgia .................................................................................................... 11 11 

11902 ......................... Towns County, Georgia ...................................................................................................... 11 11 

11903 ......................... Treutlen County, Georgia .................................................................................................... 11 11 

11910 ......................... Troup County, Georgia ........................................................................................................ 11 11 

11911 ......................... Turner County, Georgia ...................................................................................................... 11 11 

11912 ......................... Twiggs County, Georgia ...................................................................................................... 11 31420 

11913 ......................... Union County, Georgia ........................................................................................................ 11 11 

11920 ......................... Upson County, Georgia ....................................................................................................... 11 11 

11921 ......................... Walker County, Georgia ...................................................................................................... 1560 16860 

11930 ......................... Walton County, Georgia ...................................................................................................... 0520 12060 

11940 ......................... Ware County, Georgia ........................................................................................................ 11 11 

11941 ......................... Warren County, Georgia ..................................................................................................... 11 11 

11950 ......................... Washington County, Georgia .............................................................................................. 11 11 

11960 ......................... Wayne County, Georgia ...................................................................................................... 11 11 

11961 ......................... Webster County, Georgia .................................................................................................... 11 11 

11962 ......................... Wheeler County, Georgia .................................................................................................... 11 11 

11963 ......................... White County, Georgia ........................................................................................................ 11 11 

11970 ......................... Whitfield County, Georgia ................................................................................................... 11 19140 

11971 ......................... Wilcox County, Georgia ...................................................................................................... 11 11 

11972 ......................... Wilkes County, Georgia ...................................................................................................... 11 11 

11973 ......................... Wilkinson County, Georgia .................................................................................................. 11 11 

11980 ......................... Worth County, Georgia ....................................................................................................... 11 10500 

12005 ......................... Kalawao County, Hawaii ..................................................................................................... 12 12 

12010 ......................... Hawaii County, Hawaii ........................................................................................................ 12 12 

12020 ......................... Honolulu County, Hawaii ..................................................................................................... 3320 26180 

12040 ......................... Kauai County, Hawaii .......................................................................................................... 12 12 

12050 ......................... Maui County, Hawaii ........................................................................................................... 12 12 

13000 ......................... Ada County, Idaho .............................................................................................................. 1080 14260 

46018 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

13010 ......................... Adams County, Idaho .......................................................................................................... 13 13 

13020 ......................... Bannock County, Idaho ....................................................................................................... 13 38540 

13030 ......................... Bear Lake County, Idaho .................................................................................................... 13 13 

13040 ......................... Benewah County, Idaho ...................................................................................................... 13 13 

13050 ......................... Bingham County, Idaho ....................................................................................................... 13 13 

13060 ......................... Blaine County, Idaho ........................................................................................................... 13 13 

13070 ......................... Boise County, Idaho ............................................................................................................ 13 14260 

13080 ......................... Bonner County, Idaho ......................................................................................................... 13 13 

13090 ......................... Bonneville County, Idaho .................................................................................................... 13 26820 

13100 ......................... Boundary County, Idaho ..................................................................................................... 13 13 

13110 ......................... Butte County, Idaho ............................................................................................................ 13 13 

13120 ......................... Camas County, Idaho ......................................................................................................... 13 13 

13130 ......................... Canyon County, Idaho ........................................................................................................ 13 14260 

13140 ......................... Caribou County, Idaho ........................................................................................................ 13 13 

13150 ......................... Cassia County, Idaho .......................................................................................................... 13 13 

13160 ......................... Clark County, Idaho ............................................................................................................ 13 13 

13170 ......................... Clearwater County, Idaho ................................................................................................... 13 13 

13180 ......................... Custer County, Idaho .......................................................................................................... 13 13 

13190 ......................... Elmore County, Idaho ......................................................................................................... 13 13 

13200 ......................... Franklin County, Idaho ........................................................................................................ 13 30860 

13210 ......................... Fremont County, Idaho ....................................................................................................... 13 13 

13220 ......................... Gem County, Idaho ............................................................................................................. 13 14260 

13230 ......................... Gooding County, Idaho ....................................................................................................... 13 13 

13240 ......................... Idaho County, Idaho ............................................................................................................ 13 13 

13250 ......................... Jefferson County, Idaho ...................................................................................................... 13 26820 

13260 ......................... Jerome County, Idaho ......................................................................................................... 13 13 

13270 ......................... Kootenai County, Idaho ....................................................................................................... 13 17660 

13280 ......................... Latah County, Idaho ............................................................................................................ 13 13 

13290 ......................... Lemhi County, Idaho ........................................................................................................... 13 13 

13300 ......................... Lewis County, Idaho ............................................................................................................ 13 13 

13310 ......................... Lincoln County, Idaho ......................................................................................................... 13 13 

13320 ......................... Madison County, Idaho ....................................................................................................... 13 13 

13330 ......................... Minidoka County, Idaho ...................................................................................................... 13 13 

13340 ......................... Nez Perce County, Idaho .................................................................................................... 13 30300 

13350 ......................... Oneida County, Idaho ......................................................................................................... 13 13 

13360 ......................... Owyhee County, Idaho ........................................................................................................ 13 14260 

13370 ......................... Payette County, Idaho ......................................................................................................... 13 13 

13380 ......................... Power County, Idaho ........................................................................................................... 13 38540 

13390 ......................... Shoshone County, Idaho ..................................................................................................... 13 13 

13400 ......................... Teton County, Idaho ............................................................................................................ 13 13 

13410 ......................... Twin Falls County, Idaho .................................................................................................... 13 13 

13420 ......................... Valley County, Idaho ........................................................................................................... 13 13 

13430 ......................... Washington County, Idaho .................................................................................................. 13 13 

14000 ......................... Adams County, Illinois ......................................................................................................... 14 14 

14010 ......................... Alexander County, Illinois .................................................................................................... 14 14 

14020 ......................... Bond County, Illinois ........................................................................................................... 14 41180 

14030 ......................... Boone County, Illinois ......................................................................................................... 6880 40420 

14040 ......................... Brown County, Illinois .......................................................................................................... 14 14 

14050 ......................... Bureau County, Illinois ........................................................................................................ 14 14 

14060 ......................... Calhoun County, Illinois ...................................................................................................... 14 41180 

14070 ......................... Carroll County, Illinois ......................................................................................................... 14 14 

14080 ......................... Cass County, Illinois ............................................................................................................ 14 14 

14090 ......................... Champaign County, Illinois ................................................................................................. 1400 16580 

14100 ......................... Christian County, Illinois ...................................................................................................... 14 14 

14110 ......................... Clark County, Illinois ........................................................................................................... 14 14 

14120 ......................... Clay County, Illinois ............................................................................................................. 14 14 

14130 ......................... Clinton County, Illinois ......................................................................................................... 7040 41180 

14140 ......................... Coles County, Illinois ........................................................................................................... 14 14 

14141 ......................... Cook County, Illinois ........................................................................................................... 1600 16974 

14150 ......................... Crawford County, Illinois ..................................................................................................... 14 14 

14160 ......................... Cumberland County, Illinois ................................................................................................ 14 14 

14170 ......................... De Kalb County, Illinois ....................................................................................................... 14 16974 

14180 ......................... De Witt County, Illinois ........................................................................................................ 14 14 

14190 ......................... Douglas County, Illinois ....................................................................................................... 14 14 

14250 ......................... Du Page County, Illinois ...................................................................................................... 1600 16974 

14310 ......................... Edgar County, Illinois .......................................................................................................... 14 14 

14320 ......................... Edwards County, Illinois ...................................................................................................... 14 14 

14330 ......................... Effingham County, Illinois .................................................................................................... 14 14 

14340 ......................... Fayette County, Illinois ........................................................................................................ 14 14 

14350 ......................... Ford County, Illinois ............................................................................................................ 14 16580 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46019

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

14360 ......................... Franklin County, Illinois ....................................................................................................... 14 14 

14370 ......................... Fulton County, Illinois .......................................................................................................... 14 14 

14380 ......................... Gallatin County, Illinois ........................................................................................................ 14 14 

14390 ......................... Greene County, Illinois ........................................................................................................ 14 14 

14400 ......................... Grundy County, Illinois ........................................................................................................ 3690 16974 

14410 ......................... Hamilton County, Illinois ...................................................................................................... 14 14 

14420 ......................... Hancock County, Illinois ...................................................................................................... 14 14 

14421 ......................... Hardin County, Illinois ......................................................................................................... 14 14 

14440 ......................... Henderson County, Illinois .................................................................................................. 14 14 

14450 ......................... Henry County, Illinois .......................................................................................................... 1960 19340 

14460 ......................... Iroquois County, Illinois ....................................................................................................... 14 14 

14470 ......................... Jackson County, Illinois ....................................................................................................... 14 14 

14480 ......................... Jasper County, Illinois ......................................................................................................... 14 14 

14490 ......................... Jefferson County, Illinois ..................................................................................................... 14 14 

14500 ......................... Jersey County, Illinois ......................................................................................................... 7040 41180 

14510 ......................... Jo Daviess County, Illinois .................................................................................................. 14 14 

14520 ......................... Johnson County, Illinois ...................................................................................................... 14 14 

14530 ......................... Kane County, Illinois ........................................................................................................... 0620 16974 

14540 ......................... Kankakee County, Illinois .................................................................................................... 3740 28100 

14550 ......................... Kendall County, Illinois ........................................................................................................ 0620 16974 

14560 ......................... Knox County, Illinois ............................................................................................................ 14 14 

14570 ......................... Lake County, Illinois ............................................................................................................ 3965 29404 

14580 ......................... La Salle County, Illinois ....................................................................................................... 14 14 

14590 ......................... Lawrence County, Illinois .................................................................................................... 14 14 

14600 ......................... Lee County, Illinois .............................................................................................................. 14 14 

14610 ......................... Livingston County, Illinois .................................................................................................... 14 14 

14620 ......................... Logan County, Illinois .......................................................................................................... 14 14 

14630 ......................... Mc Donough County, Illinois ............................................................................................... 14 14 

14640 ......................... Mc Henry County, Illinois .................................................................................................... 1600 16974 

14650 ......................... Mclean County, Illinois ........................................................................................................ 1040 14060 

14660 ......................... Macon County, Illinois ......................................................................................................... 2040 19500 

14670 ......................... Macoupin County, Illinois .................................................................................................... 14 41180 

14680 ......................... Madison County, Illinois ...................................................................................................... 7040 41180 

14690 ......................... Marion County, Illinois ......................................................................................................... 14 14 

14700 ......................... Marshall County, Illinois ...................................................................................................... 14 37900 

14710 ......................... Mason County, Illinois ......................................................................................................... 14 14 

14720 ......................... Massac County, Illinois ....................................................................................................... 14 14 

14730 ......................... Menard County, Illinois ........................................................................................................ 7880 44100 

14740 ......................... Mercer County, Illinois ......................................................................................................... 14 19340 

14750 ......................... Monroe County, Illinois ........................................................................................................ 7040 41180 

14760 ......................... Montgomery County, Illinois ................................................................................................ 14 14 

14770 ......................... Morgan County, Illinois ........................................................................................................ 14 14 

14780 ......................... Moultrie County, Illinois ....................................................................................................... 14 14 

14790 ......................... Ogle County, Illinois ............................................................................................................ 14 14 

14800 ......................... Peoria County, Illinois ......................................................................................................... 6120 37900 

14810 ......................... Perry County, Illinois ........................................................................................................... 14 14 

14820 ......................... Piatt County, Illinois ............................................................................................................. 14 16580 

14830 ......................... Pike County, Illinois ............................................................................................................. 14 14 

14831 ......................... Pope County, Illinois ........................................................................................................... 14 14 

14850 ......................... Pulaski County, Illinois ........................................................................................................ 14 14 

14860 ......................... Putnam County, Illinois ....................................................................................................... 14 14 

14870 ......................... Randolph County, Illinois .................................................................................................... 14 14 

14880 ......................... Richland County, Illinois ...................................................................................................... 14 14 

14890 ......................... Rock Island County, Illinois ................................................................................................. 1960 19340 

14900 ......................... St Clair County, Illinois ........................................................................................................ 7040 41180 

14910 ......................... Saline County, Illinois .......................................................................................................... 14 14 

14920 ......................... Sangamon County, Illinois .................................................................................................. 7880 44100 

14921 ......................... Schuyler County, Illinois ...................................................................................................... 14 14 

14940 ......................... Scott County, Illinois ............................................................................................................ 14 14 

14950 ......................... Shelby County, Illinois ......................................................................................................... 14 14 

14960 ......................... Stark County, Illinois ........................................................................................................... 14 37900 

14970 ......................... Stephenson County, Illinois ................................................................................................. 14 14 

14980 ......................... Tazewell County, Illinois ...................................................................................................... 6120 37900 

14981 ......................... Union County, Illinois .......................................................................................................... 14 14 

14982 ......................... Vermilion County, Illinois ..................................................................................................... 14 19180 

14983 ......................... Wabash County, Illinois ....................................................................................................... 14 14 

14984 ......................... Warren County, Illinois ........................................................................................................ 14 14 

14985 ......................... Washington County, Illinois ................................................................................................. 14 14 

14986 ......................... Wayne County, Illinois ......................................................................................................... 14 14 

14987 ......................... White County, Illinois ........................................................................................................... 14 14 

46020 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

14988 ......................... Whiteside County, Illinois .................................................................................................... 14 14 

14989 ......................... Will County, Illinois .............................................................................................................. 3690 16974 

14990 ......................... Williamson County, Illinois .................................................................................................. 14 14 

14991 ......................... Winnebago County, Illinois .................................................................................................. 6880 40420 

14992 ......................... Woodford County, Illinois .................................................................................................... 6120 37900 

15000 ......................... Adams County, Indiana ....................................................................................................... 15 15 

15010 ......................... Allen County, Indiana .......................................................................................................... 2760 23060 

15020 ......................... Bartholomew County, Indiana ............................................................................................. 15 18020 

15030 ......................... Benton County, Indiana ....................................................................................................... 15 29140 

15040 ......................... Blackford County, Indiana ................................................................................................... 15 15 

15050 ......................... Boone County, Indiana ........................................................................................................ 3480 26900 

15060 ......................... Brown County, Indiana ........................................................................................................ 15 26900 

15070 ......................... Carroll County, Indiana ....................................................................................................... 15 29140 

15080 ......................... Cass County, Indiana .......................................................................................................... 15 15 

15090 ......................... Clark County, Indiana .......................................................................................................... 4520 31140 

15100 ......................... Clay County, Indiana ........................................................................................................... 8320 45460 

15110 ......................... Clinton County, Indiana ....................................................................................................... 15 15 

15120 ......................... Crawford County, Indiana ................................................................................................... 15 15 

15130 ......................... Daviess County, Indiana ..................................................................................................... 15 15 

15140 ......................... Dearborn County, Indiana ................................................................................................... 1640 17140 

15150 ......................... Decatur County, Indiana ..................................................................................................... 15 15 

15160 ......................... De Kalb County, Indiana ..................................................................................................... 2760 15 

15170 ......................... Delaware County, Indiana ................................................................................................... 5280 34620 

15180 ......................... Dubois County, Indiana ....................................................................................................... 15 15 

15190 ......................... Elkhart County, Indiana ....................................................................................................... 2330 21140 

15200 ......................... Fayette County, Indiana ...................................................................................................... 15 15 

15210 ......................... Floyd County, Indiana ......................................................................................................... 4520 31140 

15220 ......................... Fountain County, Indiana .................................................................................................... 15 15 

15230 ......................... Franklin County, Indiana ..................................................................................................... 15 17140 

15240 ......................... Fulton County, Indiana ........................................................................................................ 15 15 

15250 ......................... Gibson County, Indiana ....................................................................................................... 15 21780 

15260 ......................... Grant County, Indiana ......................................................................................................... 15 15 

15270 ......................... Greene County, Indiana ...................................................................................................... 15 14020 

15280 ......................... Hamilton County, Indiana .................................................................................................... 3480 26900 

15290 ......................... Hancock County, Indiana .................................................................................................... 3480 26900 

15300 ......................... Harrison County, Indiana .................................................................................................... 4520 31140 

15310 ......................... Hendricks County, Indiana .................................................................................................. 3480 26900 

15320 ......................... Henry County, Indiana ........................................................................................................ 15 15 

15330 ......................... Howard County, Indiana ...................................................................................................... 3850 29020 

15340 ......................... Huntington County, Indiana ................................................................................................. 15 15 

15350 ......................... Jackson County, Indiana ..................................................................................................... 15 15 

15360 ......................... Jasper County, Indiana ....................................................................................................... 15 23844 

15370 ......................... Jay County, Indiana ............................................................................................................ 15 15 

15380 ......................... Jefferson County, Indiana ................................................................................................... 15 15 

15390 ......................... Jennings County, Indiana .................................................................................................... 15 15 

15400 ......................... Johnson County, Indiana .................................................................................................... 3480 26900 

15410 ......................... Knox County, Indiana .......................................................................................................... 15 15 

15420 ......................... Kosciusko County, Indiana .................................................................................................. 15 15 

15430 ......................... Lagrange County, Indiana ................................................................................................... 15 15 

15440 ......................... Lake County, Indiana .......................................................................................................... 2960 23844 

15450 ......................... La Porte County, Indiana .................................................................................................... 15 33140 

15460 ......................... Lawrence County, Indiana .................................................................................................. 15 15 

15470 ......................... Madison County, Indiana .................................................................................................... 0400 11300 

15480 ......................... Marion County, Indiana ....................................................................................................... 3480 26900 

15490 ......................... Marshall County, Indiana .................................................................................................... 15 15 

15500 ......................... Martin County, Indiana ........................................................................................................ 15 15 

15510 ......................... Miami County, Indiana ........................................................................................................ 15 15 

15520 ......................... Monroe County, Indiana ...................................................................................................... 1020 14020 

15530 ......................... Montgomery County, Indiana .............................................................................................. 15 15 

15540 ......................... Morgan County, Indiana ...................................................................................................... 3480 26900 

15550 ......................... Newton County, Indiana ...................................................................................................... 15 23844 

15560 ......................... Noble County, Indiana ......................................................................................................... 15 15 

15570 ......................... Ohio County, Indiana .......................................................................................................... 15 17140 

15580 ......................... Orange County, Indiana ...................................................................................................... 15 15 

15590 ......................... Owen County, Indiana ......................................................................................................... 15 14020 

15600 ......................... Parke County, Indiana ......................................................................................................... 15 15 

15610 ......................... Perry County, Indiana ......................................................................................................... 15 15 

15620 ......................... Pike County, Indiana ........................................................................................................... 15 15 

15630 ......................... Porter County, Indiana ........................................................................................................ 2960 23844 

15640 ......................... Posey County, Indiana ........................................................................................................ 2440 21780 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46021

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

15650 ......................... Pulaski County, Indiana ...................................................................................................... 15 15 

15660 ......................... Putnam County, Indiana ...................................................................................................... 15 26900 

15670 ......................... Randolph County, Indiana ................................................................................................... 15 15 

15680 ......................... Ripley County, Indiana ........................................................................................................ 15 15 

15690 ......................... Rush County, Indiana .......................................................................................................... 15 15 

15700 ......................... St Joseph County, Indiana .................................................................................................. 7800 43780 

15710 ......................... Scott County, Indiana .......................................................................................................... 15 15 

15720 ......................... Shelby County, Indiana ....................................................................................................... 3480 26900 

15730 ......................... Spencer County, Indiana ..................................................................................................... 15 15 

15740 ......................... Starke County, Indiana ........................................................................................................ 15 15 

15750 ......................... Steuben County, Indiana ..................................................................................................... 15 15 

15760 ......................... Sullivan County, Indiana ..................................................................................................... 15 45460 

15770 ......................... Switzerland County, Indiana ............................................................................................... 15 15 

15780 ......................... Tippecanoe County, Indiana ............................................................................................... 3920 29140 

15790 ......................... Tipton County, Indiana ........................................................................................................ 3850 29020 

15800 ......................... Union County, Indiana ......................................................................................................... 15 15 

15810 ......................... Vanderburgh County, Indiana ............................................................................................. 2440 21780 

15820 ......................... Vermillion County, Indiana .................................................................................................. 15 45460 

15830 ......................... Vigo County, Indiana ........................................................................................................... 8320 45460 

15840 ......................... Wabash County, Indiana ..................................................................................................... 15 15 

15850 ......................... Warren County, Indiana ...................................................................................................... 15 15 

15860 ......................... Warrick County, Indiana ...................................................................................................... 2440 21780 

15870 ......................... Washington County, Indiana ............................................................................................... 15 31140 

15880 ......................... Wayne County, Indiana ....................................................................................................... 15 15 

15890 ......................... Wells County, Indiana ......................................................................................................... 15 23060 

15900 ......................... White County, Indiana ......................................................................................................... 15 15 

15910 ......................... Whitley County, Indiana ...................................................................................................... 2760 23060 

16000 ......................... Adair County, Iowa .............................................................................................................. 16 16 

16010 ......................... Adams County, Iowa ........................................................................................................... 16 16 

16020 ......................... Allamakee County, Iowa ..................................................................................................... 16 16 

16030 ......................... Appanoose County, Iowa .................................................................................................... 16 16 

16040 ......................... Audubon County, Iowa ........................................................................................................ 16 16 

16050 ......................... Benton County, Iowa ........................................................................................................... 16 16300 

16060 ......................... Black Hawk County, Iowa ................................................................................................... 8920 47940 

16070 ......................... Boone County, Iowa ............................................................................................................ 16 16 

16080 ......................... Bremer County, Iowa .......................................................................................................... 8920 47940 

16090 ......................... Buchanan County, Iowa ...................................................................................................... 16 16 

16100 ......................... Buena Vista County, Iowa ................................................................................................... 16 16 

16110 ......................... Butler County, Iowa ............................................................................................................. 16 16 

16120 ......................... Calhoun County, Iowa ......................................................................................................... 16 16 

16130 ......................... Carroll County, Iowa ............................................................................................................ 16 16 

16140 ......................... Cass County, Iowa .............................................................................................................. 16 16 

16150 ......................... Cedar County, Iowa ............................................................................................................ 16 16 

16160 ......................... Cerro Gordo County, Iowa .................................................................................................. 16 16 

16170 ......................... Cherokee County, Iowa ....................................................................................................... 16 16 

16180 ......................... Chickasaw County, Iowa ..................................................................................................... 16 16 

16190 ......................... Clarke County, Iowa ............................................................................................................ 16 16 

16200 ......................... Clay County, Iowa ............................................................................................................... 16 16 

16210 ......................... Clayton County, Iowa .......................................................................................................... 16 16 

16220 ......................... Clinton County, Iowa ........................................................................................................... 16 16 

16230 ......................... Crawford County, Iowa ........................................................................................................ 16 16 

16240 ......................... Dallas County, Iowa ............................................................................................................ 2120 19780 

16250 ......................... Davis County, Iowa ............................................................................................................. 16 16 

16260 ......................... Decatur County, Iowa .......................................................................................................... 16 16 

16270 ......................... Delaware County, Iowa ....................................................................................................... 16 16 

16280 ......................... Des Moines County, Iowa ................................................................................................... 16 16 

16290 ......................... Dickinson County, Iowa ....................................................................................................... 16 16 

16300 ......................... Dubuque County, Iowa ........................................................................................................ 2200 20220 

16310 ......................... Emmet County, Iowa ........................................................................................................... 16 16 

16320 ......................... Fayette County, Iowa .......................................................................................................... 16 16 

16330 ......................... Floyd County, Iowa ............................................................................................................. 16 16 

16340 ......................... Franklin County, Iowa ......................................................................................................... 16 16 

16350 ......................... Fremont County, Iowa ......................................................................................................... 16 16 

16360 ......................... Greene County, Iowa .......................................................................................................... 16 16 

16370 ......................... Grundy County, Iowa .......................................................................................................... 16 47940 

16380 ......................... Guthrie County, Iowa .......................................................................................................... 16 19780 

16390 ......................... Hamilton County, Iowa ........................................................................................................ 16 16 

16400 ......................... Hancock County, Iowa ........................................................................................................ 16 16 

16410 ......................... Hardin County, Iowa ............................................................................................................ 16 16 

16420 ......................... Harrison County, Iowa ......................................................................................................... 16 36540 

46022 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

16430 ......................... Henry County, Iowa ............................................................................................................. 16 16 

16440 ......................... Howard County, Iowa .......................................................................................................... 16 16 

16450 ......................... Humboldt County, Iowa ....................................................................................................... 16 16 

16460 ......................... Ida County, Iowa ................................................................................................................. 16 16 

16470 ......................... Iowa County, Iowa ............................................................................................................... 16 16 

16480 ......................... Jackson County, Iowa ......................................................................................................... 16 16 

16490 ......................... Jasper County, Iowa ........................................................................................................... 16 16 

16500 ......................... Jefferson County, Iowa ....................................................................................................... 16 16 

16510 ......................... Johnson County, Iowa ......................................................................................................... 3500 26980 

16520 ......................... Jones County, Iowa ............................................................................................................. 16 16300 

16530 ......................... Keokuk County, Iowa .......................................................................................................... 16 16 

16540 ......................... Kossuth County, Iowa ......................................................................................................... 16 16 

16550 ......................... Lee County, Iowa ................................................................................................................ 16 16 

16560 ......................... Linn County, Iowa ............................................................................................................... 1360 16300 

16570 ......................... Louisa County, Iowa ............................................................................................................ 16 16 

16580 ......................... Lucas County, Iowa ............................................................................................................. 16 16 

16590 ......................... Lyon County, Iowa .............................................................................................................. 16 16 

16600 ......................... Madison County, Iowa ......................................................................................................... 16 19780 

16610 ......................... Mahaska County, Iowa ........................................................................................................ 16 16 

16620 ......................... Marion County, Iowa ........................................................................................................... 16 16 

16630 ......................... Marshall County, Iowa ......................................................................................................... 16 16 

16640 ......................... Mills County, Iowa ............................................................................................................... 16 36540 

16650 ......................... Mitchell County, Iowa .......................................................................................................... 16 16 

16660 ......................... Monona County, Iowa ......................................................................................................... 16 16 

16670 ......................... Monroe County, Iowa .......................................................................................................... 16 16 

16680 ......................... Montgomery County, Iowa .................................................................................................. 16 16 

16690 ......................... Muscatine County, Iowa ...................................................................................................... 16 16 

16700 ......................... O Brien County, Iowa .......................................................................................................... 16 16 

16710 ......................... Osceola County, Iowa ......................................................................................................... 16 16 

16720 ......................... Page County, Iowa .............................................................................................................. 16 16 

16730 ......................... Palo Alto County, Iowa ........................................................................................................ 16 16 

16740 ......................... Plymouth County, Iowa ....................................................................................................... 16 16 

16750 ......................... Pocahontas County, Iowa ................................................................................................... 16 16 

16760 ......................... Polk County, Iowa ............................................................................................................... 2120 19780 

16770 ......................... Pottawattamie County, Iowa ............................................................................................... 5920 36540 

16780 ......................... Poweshiek County, Iowa ..................................................................................................... 16 16 

16790 ......................... Ringgold County, Iowa ........................................................................................................ 16 16 

16800 ......................... Sac County, Iowa ................................................................................................................ 16 16 

16810 ......................... Scott County, Iowa .............................................................................................................. 1960 19340 

16820 ......................... Shelby County, Iowa ........................................................................................................... 16 16 

16830 ......................... Sioux County, Iowa ............................................................................................................. 16 16 

16840 ......................... Story County, Iowa .............................................................................................................. 16 11180 

16850 ......................... Tama County, Iowa ............................................................................................................. 16 16 

16860 ......................... Taylor County, Iowa ............................................................................................................ 16 16 

16870 ......................... Union County, Iowa ............................................................................................................. 16 16 

16880 ......................... Van Buren County, Iowa ..................................................................................................... 16 16 

16890 ......................... Wapello County, Iowa ......................................................................................................... 16 16 

16900 ......................... Warren County, Iowa .......................................................................................................... 2120 19780 

16910 ......................... Washington County, Iowa ................................................................................................... 16 26980 

16920 ......................... Wayne County, Iowa ........................................................................................................... 16 16 

16930 ......................... Webster County, Iowa ......................................................................................................... 16 16 

16940 ......................... Winnebago County, Iowa .................................................................................................... 16 16 

16950 ......................... Winneshiek County, Iowa .................................................................................................... 16 16 

16960 ......................... Woodbury County, Iowa ...................................................................................................... 7720 43580 

16970 ......................... Worth County, Iowa ............................................................................................................. 16 16 

16980 ......................... Wright County, Iowa ............................................................................................................ 16 16 

17000 ......................... Allen County, Kansas .......................................................................................................... 17 17 

17010 ......................... Anderson County, Kansas .................................................................................................. 17 17 

17020 ......................... Atchison County, Kansas .................................................................................................... 17 17 

17030 ......................... Barber County, Kansas ....................................................................................................... 17 17 

17040 ......................... Barton County, Kansas ....................................................................................................... 17 17 

17050 ......................... Bourbon County, Kansas .................................................................................................... 17 17 

17060 ......................... Brown County, Kansas ........................................................................................................ 17 17 

17070 ......................... Butler County, Kansas ........................................................................................................ 9040 48620 

17080 ......................... Chase County, Kansas ....................................................................................................... 17 17 

17090 ......................... Chautauqua County, Kansas .............................................................................................. 17 17 

17100 ......................... Cherokee County, Kansas .................................................................................................. 17 17 

17110 ......................... Cheyenne County, Kansas ................................................................................................. 17 17 

17120 ......................... Clark County, Kansas ......................................................................................................... 17 17 

17130 ......................... Clay County, Kansas ........................................................................................................... 17 17 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46023

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

17140 ......................... Cloud County, Kansas ........................................................................................................ 17 17 

17150 ......................... Coffey County, Kansas ....................................................................................................... 17 17 

17160 ......................... Comanche County, Kansas ................................................................................................ 17 17 

17170 ......................... Cowley County, Kansas ...................................................................................................... 17 17 

17180 ......................... Crawford County, Kansas ................................................................................................... 17 17 

17190 ......................... Decatur County, Kansas ..................................................................................................... 17 17 

17200 ......................... Dickinson County, Kansas .................................................................................................. 17 17 

17210 ......................... Doniphan County, Kansas .................................................................................................. 17 41140 

17220 ......................... Douglas County, Kansas ..................................................................................................... 4150 29940 

17230 ......................... Edwards County, Kansas .................................................................................................... 17 17 

17240 ......................... Elk County, Kansas ............................................................................................................. 17 17 

17250 ......................... Ellis County, Kansas ........................................................................................................... 17 17 

17260 ......................... Ellsworth County, Kansas ................................................................................................... 17 17 

17270 ......................... Finney County, Kansas ....................................................................................................... 17 17 

17280 ......................... Ford County, Kansas .......................................................................................................... 17 17 

17290 ......................... Franklin County, Kansas ..................................................................................................... 17 28140 

17300 ......................... Geary County, Kansas ........................................................................................................ 17 17 

17310 ......................... Gove County, Kansas ......................................................................................................... 17 17 

17320 ......................... Graham County, Kansas ..................................................................................................... 17 17 

17330 ......................... Grant County, Kansas ......................................................................................................... 17 17 

17340 ......................... Gray County, Kansas .......................................................................................................... 17 17 

17350 ......................... Greeley County, Kansas ..................................................................................................... 17 17 

17360 ......................... Greenwood County, Kansas ............................................................................................... 17 17 

17370 ......................... Hamilton County, Kansas .................................................................................................... 17 17 

17380 ......................... Harper County, Kansas ....................................................................................................... 17 17 

17390 ......................... Harvey County, Kansas ...................................................................................................... 17 48620 

17391 ......................... Haskell County, Kansas ...................................................................................................... 17 17 

17410 ......................... Hodgeman County, Kansas ................................................................................................ 17 17 

17420 ......................... Jackson County, Kansas ..................................................................................................... 17 45820 

17430 ......................... Jefferson County, Kansas ................................................................................................... 17 45820 

17440 ......................... Jewell County, Kansas ........................................................................................................ 17 17 

17450 ......................... Johnson County, Kansas .................................................................................................... 3760 28140 

17451 ......................... Kearny County, Kansas ...................................................................................................... 17 17 

17470 ......................... Kingman County, Kansas .................................................................................................... 17 17 

17480 ......................... Kiowa County, Kansas ........................................................................................................ 17 17 

17490 ......................... Labette County, Kansas ...................................................................................................... 17 17 

17500 ......................... Lane County, Kansas .......................................................................................................... 17 17 

17510 ......................... Leavenworth County, Kansas ............................................................................................. 3760 28140 

17520 ......................... Lincoln County, Kansas ...................................................................................................... 17 17 

17530 ......................... Linn County, Kansas ........................................................................................................... 17 28140 

17540 ......................... Logan County, Kansas ........................................................................................................ 17 17 

17550 ......................... Lyon County, Kansas .......................................................................................................... 17 17 

17560 ......................... Mc Pherson County, Kansas .............................................................................................. 17 17 

17570 ......................... Marion County, Kansas ....................................................................................................... 17 17 

17580 ......................... Marshall County, Kansas .................................................................................................... 17 17 

17590 ......................... Meade County, Kansas ....................................................................................................... 17 17 

17600 ......................... Miami County, Kansas ........................................................................................................ 3760 28140 

17610 ......................... Mitchell County, Kansas ...................................................................................................... 17 17 

17620 ......................... Montgomery County, Kansas .............................................................................................. 17 17 

17630 ......................... Morris County, Kansas ........................................................................................................ 17 17 

17640 ......................... Morton County, Kansas ....................................................................................................... 17 17 

17650 ......................... Nemaha County, Kansas .................................................................................................... 17 17 

17660 ......................... Neosho County, Kansas ..................................................................................................... 17 17 

17670 ......................... Ness County, Kansas .......................................................................................................... 17 17 

17680 ......................... Norton County, Kansas ....................................................................................................... 17 17 

17690 ......................... Osage County, Kansas ....................................................................................................... 17 45820 

17700 ......................... Osborne County, Kansas .................................................................................................... 17 17 

17710 ......................... Ottawa County, Kansas ...................................................................................................... 17 17 

17720 ......................... Pawnee County, Kansas ..................................................................................................... 17 17 

17730 ......................... Phillips County, Kansas ...................................................................................................... 17 17 

17740 ......................... Pottawatomie County, Kansas ............................................................................................ 17 17 

17750 ......................... Pratt County, Kansas .......................................................................................................... 17 17 

17760 ......................... Rawlins County, Kansas ..................................................................................................... 17 17 

17770 ......................... Reno County, Kansas ......................................................................................................... 17 17 

17780 ......................... Republic County, Kansas .................................................................................................... 17 17 

17790 ......................... Rice County, Kansas ........................................................................................................... 17 17 

17800 ......................... Riley County, Kansas .......................................................................................................... 17 17 

17810 ......................... Rooks County, Kansas ........................................................................................................ 17 17 

17820 ......................... Rush County, Kansas ......................................................................................................... 17 17 

17830 ......................... Russell County, Kansas ...................................................................................................... 17 17 

46024 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

17840 ......................... Saline County, Kansas ........................................................................................................ 17 17 

17841 ......................... Scott County, Kansas .......................................................................................................... 17 17 

17860 ......................... Sedgwick County, Kansas .................................................................................................. 9040 48620 

17870 ......................... Seward County, Kansas ...................................................................................................... 17 17 

17880 ......................... Shawnee County, Kansas ................................................................................................... 8440 45820 

17890 ......................... Sheridan County, Kansas ................................................................................................... 17 17 

17900 ......................... Sherman County, Kansas ................................................................................................... 17 17 

17910 ......................... Smith County, Kansas ......................................................................................................... 17 17 

17920 ......................... Stafford County, Kansas ..................................................................................................... 17 17 

17921 ......................... Stanton County, Kansas ..................................................................................................... 17 17 

17940 ......................... Stevens County, Kansas ..................................................................................................... 17 17 

17950 ......................... Sumner County, Kansas ..................................................................................................... 17 48620 

17960 ......................... Thomas County, Kansas ..................................................................................................... 17 17 

17970 ......................... Trego County, Kansas ........................................................................................................ 17 17 

17980 ......................... Wabaunsee County, Kansas ............................................................................................... 17 17 

17981 ......................... Wallace County, Kansas ..................................................................................................... 17 17 

17982 ......................... Washington County, Kansas ............................................................................................... 17 17 

17983 ......................... Wichita County, Kansas ...................................................................................................... 17 17 

17984 ......................... Wilson County, Kansas ....................................................................................................... 17 17 

17985 ......................... Woodson County, Kansas ................................................................................................... 17 17 

17986 ......................... Wyandotte County, Kansas ................................................................................................. 3760 28140 

18000 ......................... Adair County, Kentucky ....................................................................................................... 18 18 

18010 ......................... Allen County, Kentucky ....................................................................................................... 18 18 

18020 ......................... Anderson County, Kentucky ................................................................................................ 18 18 

18030 ......................... Ballard County, Kentucky .................................................................................................... 18 18 

18040 ......................... Barren County, Kentucky .................................................................................................... 18 18 

18050 ......................... Bath County, Kentucky ........................................................................................................ 18 18 

18060 ......................... Bell County, Kentucky ......................................................................................................... 18 18 

18070 ......................... Boone County, Kentucky ..................................................................................................... 1640 17140 

18080 ......................... Bourbon County, Kentucky ................................................................................................. 4280 30460 

18090 ......................... Boyd County, Kentucky ....................................................................................................... 3400 26580 

18100 ......................... Boyle County, Kentucky ...................................................................................................... 18 18 

18110 ......................... Bracken County, Kentucky .................................................................................................. 18 17140 

18120 ......................... Breathitt County, Kentucky .................................................................................................. 18 18 

18130 ......................... Breckinridge County, Kentucky ........................................................................................... 18 18 

18140 ......................... Bullitt County, Kentucky ...................................................................................................... 4520 31140 

18150 ......................... Butler County, Kentucky ...................................................................................................... 18 18 

18160 ......................... Caldwell County, Kentucky ................................................................................................. 18 18 

18170 ......................... Calloway County, Kentucky ................................................................................................ 18 18 

18180 ......................... Campbell County, Kentucky ................................................................................................ 1640 17140 

18190 ......................... Carlisle County, Kentucky ................................................................................................... 18 18 

18191 ......................... Carroll County, Kentucky .................................................................................................... 18 18 

18210 ......................... Carter County, Kentucky ..................................................................................................... 3400 18 

18220 ......................... Casey County, Kentucky ..................................................................................................... 18 18 

18230 ......................... Christian County, Kentucky ................................................................................................. 1660 17300 

18240 ......................... Clark County, Kentucky ....................................................................................................... 4280 30460 

18250 ......................... Clay County, Kentucky ........................................................................................................ 18 18 

18260 ......................... Clinton County, Kentucky .................................................................................................... 18 18 

18270 ......................... Crittenden County, Kentucky .............................................................................................. 18 18 

18271 ......................... Cumberland County, Kentucky ........................................................................................... 18 18 

18290 ......................... Daviess County, Kentucky .................................................................................................. 5990 36980 

18291 ......................... Edmonson County, Kentucky .............................................................................................. 18 14540 

18310 ......................... Elliott County, Kentucky ...................................................................................................... 18 18 

18320 ......................... Estill County, Kentucky ....................................................................................................... 18 18 

18330 ......................... Fayette County, Kentucky ................................................................................................... 4280 30460 

18340 ......................... Fleming County, Kentucky .................................................................................................. 18 18 

18350 ......................... Floyd County, Kentucky ...................................................................................................... 18 18 

18360 ......................... Franklin County, Kentucky .................................................................................................. 18 18 

18361 ......................... Fulton County, Kentucky ..................................................................................................... 18 18 

18362 ......................... Gallatin County, Kentucky ................................................................................................... 18 17140 

18390 ......................... Garrard County, Kentucky ................................................................................................... 18 18 

18400 ......................... Grant County, Kentucky ...................................................................................................... 18 17140 

18410 ......................... Graves County, Kentucky ................................................................................................... 18 18 

18420 ......................... Grayson County, Kentucky ................................................................................................. 18 18 

18421 ......................... Green County, Kentucky ..................................................................................................... 18 18 

18440 ......................... Greenup County, Kentucky ................................................................................................. 3400 26580 

18450 ......................... Hancock County, Kentucky ................................................................................................. 18 36980 

18460 ......................... Hardin County, Kentucky .................................................................................................... 18 21060 

18470 ......................... Harlan County, Kentucky .................................................................................................... 18 18 

18480 ......................... Harrison County, Kentucky ................................................................................................. 18 18 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46025

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

18490 ......................... Hart County, Kentucky ........................................................................................................ 18 18 

18500 ......................... Henderson County, Kentucky ............................................................................................. 2440 21780 

18510 ......................... Henry County, Kentucky ..................................................................................................... 18 31140 

18511 ......................... Hickman County, Kentucky ................................................................................................. 18 18 

18530 ......................... Hopkins County, Kentucky .................................................................................................. 18 18 

18540 ......................... Jackson County, Kentucky .................................................................................................. 18 18 

18550 ......................... Jefferson County, Kentucky ................................................................................................ 4520 31140 

18560 ......................... Jessamine County, Kentucky .............................................................................................. 4280 30460 

18570 ......................... Johnson County, Kentucky ................................................................................................. 18 18 

18580 ......................... Kenton County, Kentucky .................................................................................................... 1640 17140 

18590 ......................... Knott County, Kentucky ....................................................................................................... 18 18 

18600 ......................... Knox County, Kentucky ....................................................................................................... 18 18 

18610 ......................... Larue County, Kentucky ...................................................................................................... 18 21060 

18620 ......................... Laurel County, Kentucky ..................................................................................................... 18 18 

18630 ......................... Lawrence County, Kentucky ............................................................................................... 18 18 

18640 ......................... Lee County, Kentucky ......................................................................................................... 18 18 

18650 ......................... Leslie County, Kentucky ...................................................................................................... 18 18 

18660 ......................... Letcher County, Kentucky ................................................................................................... 18 18 

18670 ......................... Lewis County, Kentucky ...................................................................................................... 18 18 

18680 ......................... Lincoln County, Kentucky .................................................................................................... 18 18 

18690 ......................... Livingston County, Kentucky ............................................................................................... 18 18 

18700 ......................... Logan County, Kentucky ..................................................................................................... 18 18 

18710 ......................... Lyon County, Kentucky ....................................................................................................... 18 18 

18720 ......................... Mc Cracken County, Kentucky ............................................................................................ 18 18 

18730 ......................... Mc Creary County, Kentucky .............................................................................................. 18 18 

18740 ......................... Mc Lean County, Kentucky ................................................................................................. 18 18 

18750 ......................... Madison County, Kentucky ................................................................................................. 18 18 

18760 ......................... Magoffin County, Kentucky ................................................................................................. 18 18 

18770 ......................... Marion County, Kentucky .................................................................................................... 18 18 

18780 ......................... Marshall County, Kentucky ................................................................................................. 18 18 

18790 ......................... Martin County, Kentucky ..................................................................................................... 18 18 

18800 ......................... Mason County, Kentucky .................................................................................................... 18 18 

18801 ......................... Meade County, Kentucky .................................................................................................... 18 31140 

18802 ......................... Menifee County, Kentucky .................................................................................................. 18 18 

18830 ......................... Mercer County, Kentucky .................................................................................................... 18 18 

18831 ......................... Metcalfe County, Kentucky ................................................................................................. 18 18 

18850 ......................... Monroe County, Kentucky ................................................................................................... 18 18 

18860 ......................... Montgomery County, Kentucky ........................................................................................... 18 18 

18861 ......................... Morgan County, Kentucky ................................................................................................... 18 18 

18880 ......................... Muhlenberg County, Kentucky ............................................................................................ 18 18 

18890 ......................... Nelson County, Kentucky .................................................................................................... 18 31140 

18900 ......................... Nicholas County, Kentucky ................................................................................................. 18 18 

18910 ......................... Ohio County, Kentucky ....................................................................................................... 18 18 

18920 ......................... Oldham County, Kentucky .................................................................................................. 4520 31140 

18930 ......................... Owen County, Kentucky ...................................................................................................... 18 18 

18931 ......................... Owsley County, Kentucky ................................................................................................... 18 18 

18932 ......................... Pendleton County, Kentucky ............................................................................................... 18 17140 

18960 ......................... Perry County, Kentucky ...................................................................................................... 18 18 

18970 ......................... Pike County, Kentucky ........................................................................................................ 18 18 

18971 ......................... Powell County, Kentucky .................................................................................................... 18 18 

18972 ......................... Pulaski County, Kentucky ................................................................................................... 18 18 

18973 ......................... Robertson County, Kentucky .............................................................................................. 18 18 

18974 ......................... Rockcastle County, Kentucky ............................................................................................. 18 18 

18975 ......................... Rowan County, Kentucky .................................................................................................... 18 18 

18976 ......................... Russell County, Kentucky ................................................................................................... 18 18 

18977 ......................... Scott County, Kentucky ....................................................................................................... 4280 30460 

18978 ......................... Shelby County, Kentucky .................................................................................................... 4520 31140 

18979 ......................... Simpson County, Kentucky ................................................................................................. 18 18 

18980 ......................... Spencer County, Kentucky .................................................................................................. 18 31140 

18981 ......................... Taylor County, Kentucky ..................................................................................................... 18 18 

18982 ......................... Todd County, Kentucky ....................................................................................................... 18 18 

18983 ......................... Trigg County, Kentucky ....................................................................................................... 18 17300 

18984 ......................... Trimble County, Kentucky ................................................................................................... 18 31140 

18985 ......................... Union County, Kentucky ...................................................................................................... 18 18 

18986 ......................... Warren County, Kentucky ................................................................................................... 18 14540 

18987 ......................... Washington County, Kentucky ............................................................................................ 18 18 

18988 ......................... Wayne County, Kentucky .................................................................................................... 18 18 

18989 ......................... Webster County, Kentucky .................................................................................................. 18 21780 

18990 ......................... Whitley County, Kentucky ................................................................................................... 18 18 

18991 ......................... Wolfe County, Kentucky ...................................................................................................... 18 18 

46026 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

18992 ......................... Woodford County, Kentucky ............................................................................................... 4280 30460 

19000 ......................... Acadia County, Louisiana ................................................................................................... 19 19 

19010 ......................... Allen County, Louisiana ...................................................................................................... 19 19 

19020 ......................... Ascension County, Louisiana .............................................................................................. 0760 12940 

19030 ......................... Assumption County, Louisiana ............................................................................................ 19 19 

19040 ......................... Avoyelles County, Louisiana ............................................................................................... 19 19 

19050 ......................... Beauregard County, Louisiana ............................................................................................ 19 19 

19060 ......................... Bienville County, Louisiana ................................................................................................. 19 19 

19070 ......................... Bossier County, Louisiana .................................................................................................. 7680 43340 

19080 ......................... Caddo County, Louisiana .................................................................................................... 7680 43340 

19090 ......................... Calcasieu County, Louisiana ............................................................................................... 3960 29340 

19100 ......................... Caldwell County, Louisiana ................................................................................................. 19 19 

19110 ......................... Cameron County, Louisiana ................................................................................................ 19 29340 

19120 ......................... Catahoula County, Louisiana .............................................................................................. 19 19 

19130 ......................... Claiborne County, Louisiana ............................................................................................... 19 19 

19140 ......................... Concordia County, Louisiana .............................................................................................. 19 19 

19150 ......................... De Soto County, Louisiana ................................................................................................. 19 43340 

19160 ......................... East Baton Rouge County, Louisiana ................................................................................. 0760 12940 

19170 ......................... East Carroll County, Louisiana ........................................................................................... 19 19 

19180 ......................... East Feliciana County, Louisiana ........................................................................................ 19 12940 

19190 ......................... Evangeline County, Louisiana ............................................................................................. 19 19 

19200 ......................... Franklin County, Louisiana .................................................................................................. 19 19 

19210 ......................... Grant County, Louisiana ..................................................................................................... 19 10780 

19220 ......................... Iberia County, Louisiana ..................................................................................................... 19 19 

19230 ......................... Iberville County, Louisiana .................................................................................................. 19 12940 

19240 ......................... Jackson County, Louisiana ................................................................................................. 19 19 

19250 ......................... Jefferson County, Louisiana ................................................................................................ 5560 35380 

19260 ......................... Jefferson Davis County, Louisiana ..................................................................................... 19 19 

19270 ......................... Lafayette County, Louisiana ................................................................................................ 3880 29180 

19280 ......................... Lafourche County, Louisiana .............................................................................................. 3350 26380 

19290 ......................... La Salle County, Louisiana ................................................................................................. 19 19 

19300 ......................... Lincoln County, Louisiana ................................................................................................... 19 19 

19310 ......................... Livingston County, Louisiana .............................................................................................. 0760 12940 

19320 ......................... Madison County, Louisiana ................................................................................................. 19 19 

19330 ......................... Morehouse County, Louisiana ............................................................................................ 19 19 

19340 ......................... Natchitoches County, Louisiana .......................................................................................... 19 19 

19350 ......................... Orleans County, Louisiana .................................................................................................. 5560 35380 

19360 ......................... Ouachita County, Louisiana ................................................................................................ 5200 33740 

19370 ......................... Plaquemines County, Louisiana .......................................................................................... 19 35380 

19380 ......................... Pointe Coupee County, Louisiana ...................................................................................... 19 12940 

19390 ......................... Rapides County, Louisiana ................................................................................................. 0220 10780 

19400 ......................... Red River County, Louisiana .............................................................................................. 19 19 

19410 ......................... Richland County, Louisiana ................................................................................................ 19 19 

19420 ......................... Sabine County, Louisiana ................................................................................................... 19 19 

19430 ......................... St Bernard County, Louisiana ............................................................................................. 5560 35380 

19440 ......................... St Charles County, Louisiana ............................................................................................. 5560 35380 

19450 ......................... St Helena County, Louisiana .............................................................................................. 19 12940 

19460 ......................... St James County, Louisiana ............................................................................................... 19 19 

19470 ......................... St John Baptist County, Louisiana ...................................................................................... 5560 35380 

19480 ......................... St Landry County, Louisiana ............................................................................................... .19 19 

19490 ......................... St Martin County, Louisiana ................................................................................................ 3880 29180 

19500 ......................... St Mary County, Louisiana .................................................................................................. 19 19 

19510 ......................... St Tammany County, Louisiana .......................................................................................... 5560 35380 

19520 ......................... Tangipahoa County, Louisiana ........................................................................................... 19 19 

19530 ......................... Tensas County, Louisiana ................................................................................................... 19 19 

19540 ......................... Terrebonne County, Louisiana ............................................................................................ 3350 26380 

19550 ......................... Union County, Louisiana ..................................................................................................... 19 33740 

19560 ......................... Vermilion County, Louisiana ............................................................................................... 19 19 

19570 ......................... Vernon County, Louisiana ................................................................................................... 19 19 

19580 ......................... Washington County, Louisiana ........................................................................................... 19 19 

19590 ......................... Webster County, Louisiana ................................................................................................. 19 19 

19600 ......................... West Baton Rouge County, Louisiana ................................................................................ 0760 12940 

19610 ......................... West Carroll County, Louisiana .......................................................................................... 19 19 

19620 ......................... West Feliciana County, Louisiana ....................................................................................... 19 12940 

19630 ......................... Winn County, Louisiana ...................................................................................................... 19 19 

20000 ......................... Androscoggin County, Maine .............................................................................................. 4243 30340 

20010 ......................... Aroostook County, Maine .................................................................................................... 20 20 

20020 ......................... Cumberland County, Maine ................................................................................................ 6403 38860 

20030 ......................... Franklin County, Maine ....................................................................................................... 20 20 

20040 ......................... Hancock County, Maine ...................................................................................................... 20 20 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46027

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

20050 ......................... Kennebec County, Maine .................................................................................................... 20 20 

20060 ......................... Knox County, Maine ............................................................................................................ 20 20 

20070 ......................... Lincoln County, Maine ......................................................................................................... 20 20 

20080 ......................... Oxford County, Maine ......................................................................................................... 20 20 

20090 ......................... Penobscot County, Maine ................................................................................................... 0733 12620 

20100 ......................... Piscataquis County, Maine .................................................................................................. 20 20 

20110 ......................... Sagadahoc County, Maine .................................................................................................. 6403 38860 

20120 ......................... Somerset County, Maine ..................................................................................................... 20 20 

20130 ......................... Waldo County, Maine .......................................................................................................... 20 20 

20140 ......................... Washington County, Maine ................................................................................................. 20 20 

20150 ......................... York County, Maine ............................................................................................................. 6403 38860 

21000 ......................... Allegany County, Maryland ................................................................................................. 1900 19060 

21010 ......................... Anne Arundel County, Maryland ......................................................................................... 0720 12580 

21020 ......................... Baltimore County, Maryland ................................................................................................ 0720 12580 

21030 ......................... Baltimore City County, Maryland ........................................................................................ 0720 12580 

21040 ......................... Calvert County, Maryland .................................................................................................... 8840 47894 

21050 ......................... Caroline County, Maryland .................................................................................................. 21 21 

21060 ......................... Carroll County, Maryland .................................................................................................... 0720 12580 

21070 ......................... Cecil County, Maryland ....................................................................................................... 9160 48864 

21080 ......................... Charles County, Maryland ................................................................................................... 8840 47894 

21090 ......................... Dorchester County, Maryland ............................................................................................. 21 21 

21100 ......................... Frederick County, Maryland ................................................................................................ 8840 13644 

21110 ......................... Garrett County, Maryland .................................................................................................... 21 21 

21120 ......................... Harford County, Maryland ................................................................................................... 0720 12580 

21130 ......................... Howard County, Maryland ................................................................................................... 0720 12580 

21140 ......................... Kent County, Maryland ........................................................................................................ 21 21 

21150 ......................... Montgomery County, Maryland ........................................................................................... 8840 13644 

21160 ......................... Prince Georges County, Maryland ...................................................................................... 8840 47894 

21170 ......................... Queen Annes County, Maryland ......................................................................................... 0720 12580 

21180 ......................... St Marys County, Maryland ................................................................................................. 21 21 

21190 ......................... Somerset County, Maryland ................................................................................................ 21 41540 

21200 ......................... Talbot County, Maryland ..................................................................................................... 21 21 

21210 ......................... Washington County, Maryland ............................................................................................ 3180 25180 

21220 ......................... Wicomico County, Maryland ............................................................................................... 21 41540 

21230 ......................... Worcester County, Maryland ............................................................................................... 21 21 

22000 ......................... Barnstable County, Massachusetts ..................................................................................... 0743 12700 

22010 ......................... Berkshire County, Massachusetts ....................................................................................... 6323 38340 

22020 ......................... Bristol County, Massachusetts ............................................................................................ 5403 39300 

22030 ......................... Dukes County, Massachusetts ............................................................................................ 22 22 

22040 ......................... Essex County, Massachusetts ............................................................................................ 1123 21604 

22060 ......................... Franklin County, Massachusetts ......................................................................................... 22 44140 

22070 ......................... Hampden County, Massachusetts ...................................................................................... 8003 44140 

22080 ......................... Hampshire County, Massachusetts .................................................................................... 8003 44140 

22090 ......................... Middlesex County, Massachusetts ...................................................................................... 1123 15764 

22120 ......................... Nantucket County, Massachusetts ...................................................................................... 22 22 

22130 ......................... Norfolk County, Massachusetts .......................................................................................... 1123 14484 

22150 ......................... Plymouth County, Massachusetts ....................................................................................... 1123 14484 

22160 ......................... Suffolk County, Massachusetts ........................................................................................... 1123 14484 

22170 ......................... Worcester County, Massachusetts ..................................................................................... 9243 49340 

23000 ......................... Alcona County, Michigan .................................................................................................... 23 23 

23010 ......................... Alger County, Michigan ....................................................................................................... 23 23 

23020 ......................... Allegan County, Michigan ................................................................................................... 23 23 

23030 ......................... Alpena County, Michigan .................................................................................................... 23 23 

23040 ......................... Antrim County, Michigan ..................................................................................................... 23 23 

23050 ......................... Arenac County, Michigan .................................................................................................... 23 23 

23060 ......................... Baraga County, Michigan .................................................................................................... 23 23 

23070 ......................... Barry County, Michigan ....................................................................................................... 23 24340 

23080 ......................... Bay County, Michigan ......................................................................................................... 6960 13020 

23090 ......................... Benzie County, Michigan .................................................................................................... 23 23 

23100 ......................... Berrien County, Michigan .................................................................................................... 0870 35660 

23110 ......................... Branch County, Michigan .................................................................................................... 23 23 

23120 ......................... Calhoun County, Michigan .................................................................................................. 0780 12980 

23130 ......................... Cass County, Michigan ....................................................................................................... 23 43780 

23140 ......................... Charlevoix County, Michigan .............................................................................................. 23 23 

23150 ......................... Cheboygan County, Michigan ............................................................................................. 23 23 

23160 ......................... Chippewa County, Michigan ............................................................................................... 23 23 

23170 ......................... Clare County, Michigan ....................................................................................................... 23 23 

23180 ......................... Clinton County, Michigan .................................................................................................... 4040 29620 

23190 ......................... Crawford County, Michigan ................................................................................................. 23 23 

23200 ......................... Delta County, Michigan ....................................................................................................... 23 23 

46028 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

23210 ......................... Dickinson County, Michigan ................................................................................................ 23 23 

23220 ......................... Eaton County, Michigan ...................................................................................................... 4040 29620 

23230 ......................... Emmet County, Michigan .................................................................................................... 23 23 

23240 ......................... Genesee County, Michigan ................................................................................................. 2640 22420 

23250 ......................... Gladwin County, Michigan .................................................................................................. 23 23 

23260 ......................... Gogebic County, Michigan .................................................................................................. 23 23 

23270 ......................... Grand Traverse County, Michigan ...................................................................................... 23 23 

23280 ......................... Gratiot County, Michigan ..................................................................................................... 23 23 

23290 ......................... Hillsdale County, Michigan .................................................................................................. 23 23 

23300 ......................... Houghton County, Michigan ................................................................................................ 23 23 

23310 ......................... Huron County, Michigan ...................................................................................................... 23 23 

23320 ......................... Ingham County, Michigan ................................................................................................... 4040 29620 

23330 ......................... Ionia County, Michigan ........................................................................................................ 23 24340 

23340 ......................... Iosco County, Michigan ....................................................................................................... 23 23 

23350 ......................... Iron County, Michigan ......................................................................................................... 23 23 

23360 ......................... Isabella County, Michigan ................................................................................................... 23 23 

23370 ......................... Jackson County, Michigan .................................................................................................. 3520 27100 

23380 ......................... Kalamazoo County, Michigan ............................................................................................. 3720 28020 

23390 ......................... Kalkaska County, Michigan ................................................................................................. 23 23 

23400 ......................... Kent County, Michigan ........................................................................................................ 3000 24340 

23410 ......................... Keweenaw County, Michigan .............................................................................................. 23 23 

23420 ......................... Lake County, Michigan ........................................................................................................ 23 23 

23430 ......................... Lapeer County, Michigan .................................................................................................... 2160 47644 

23440 ......................... Leelanau County, Michigan ................................................................................................. 23 23 

23450 ......................... Lenawee County, Michigan ................................................................................................. 23 23 

23460 ......................... Livingston County, Michigan ............................................................................................... 2160 47644 

23470 ......................... Luce County, Michigan ........................................................................................................ 23 23 

23480 ......................... Mackinac County, Michigan ................................................................................................ 23 23 

23490 ......................... Macomb County, Michigan .................................................................................................. 2160 47644 

23500 ......................... Manistee County, Michigan ................................................................................................. 23 23 

23510 ......................... Marquette County, Michigan ............................................................................................... 23 23 

23520 ......................... Mason County, Michigan ..................................................................................................... 23 23 

23530 ......................... Mecosta County, Michigan .................................................................................................. 23 23 

23540 ......................... Menominee County, Michigan ............................................................................................. 23 23 

23550 ......................... Midland County, Michigan ................................................................................................... 6960 23 

23560 ......................... Missaukee County, Michigan .............................................................................................. 23 23 

23570 ......................... Monroe County, Michigan ................................................................................................... 2160 33780 

23580 ......................... Montcalm County, Michigan ................................................................................................ 23 23 

23590 ......................... Montmorency County, Michigan .......................................................................................... 23 23 

23600 ......................... Muskegon County, Michigan ............................................................................................... 5320 34740 

23610 ......................... Newaygo County, Michigan ................................................................................................ 23 24340 

23620 ......................... Oakland County, Michigan .................................................................................................. 2160 47644 

23630 ......................... Oceana County, Michigan ................................................................................................... 23 23 

23640 ......................... Ogemaw County, Michigan ................................................................................................. 23 23 

23650 ......................... Ontonagon County, Michigan .............................................................................................. 23 23 

23660 ......................... Osceola County, Michigan .................................................................................................. 23 23 

23670 ......................... Oscoda County, Michigan ................................................................................................... 23 23 

23680 ......................... Otsego County, Michigan .................................................................................................... 23 23 

23690 ......................... Ottawa County, Michigan .................................................................................................... 3000 26100 

23700 ......................... Presque Isle County, Michigan ........................................................................................... 23 23 

23710 ......................... Roscommon County, Michigan ........................................................................................... 23 23 

23720 ......................... Saginaw County, Michigan .................................................................................................. 6960 40980 

23730 ......................... St Clair County, Michigan ................................................................................................... 2160 47644 

23740 ......................... St Joseph County, Michigan ............................................................................................... 23 23 

23750 ......................... Sanilac County, Michigan .................................................................................................... 23 23 

23760 ......................... Schoolcraft County, Michigan ............................................................................................. 23 23 

23770 ......................... Shiawassee County, Michigan ............................................................................................ 23 23 

23780 ......................... Tuscola County, Michigan ................................................................................................... 23 23 

23790 ......................... Van Buren County, Michigan .............................................................................................. 23 28020 

23800 ......................... Washtenaw County, Michigan ............................................................................................. 0440 11460 

23810 ......................... Wayne County, Michigan .................................................................................................... 2160 19804 

23830 ......................... Wexford County, Michigan .................................................................................................. 23 23 

24000 ......................... Aitkin County, Minnesota .................................................................................................... 24 24 

24010 ......................... Anoka County, Minnesota ................................................................................................... 5120 33460 

24020 ......................... Becker County, Minnesota .................................................................................................. 24 24 

24030 ......................... Beltrami County, Minnesota ................................................................................................ 24 24 

24040 ......................... Benton County, Minnesota .................................................................................................. 6980 41060 

24050 ......................... Big Stone County, Minnesota ............................................................................................. 24 24 

24060 ......................... Blue Earth County, Minnesota ............................................................................................ 24 24 

24070 ......................... Brown County, Minnesota ................................................................................................... 24 24 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46029

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

24080 ......................... Carlton County, Minnesota .................................................................................................. 24 20260 

24090 ......................... Carver County, Minnesota .................................................................................................. 5120 33460 

24100 ......................... Cass County, Minnesota ..................................................................................................... 24 24 

24110 ......................... Chippewa County, Minnesota ............................................................................................. 24 24 

24120 ......................... Chisago County, Minnesota ................................................................................................ 5120 33460 

24130 ......................... Clay County, Minnesota ...................................................................................................... 2520 22020 

24140 ......................... Clearwater County, Minnesota ............................................................................................ 24 24 

24150 ......................... Cook County, Minnesota ..................................................................................................... 24 24 

24160 ......................... Cottonwood County, Minnesota .......................................................................................... 24 24 

24170 ......................... Crow Wing County, Minnesota ........................................................................................... 24 24 

24180 ......................... Dakota County, Minnesota .................................................................................................. 5120 33460 

24190 ......................... Dodge County, Minnesota ................................................................................................... 24 40340 

24200 ......................... Douglas County, Minnesota ................................................................................................ 24 24 

24210 ......................... Faribault County, Minnesota ............................................................................................... 24 24 

24220 ......................... Fillmore County, Minnesota ................................................................................................ 24 24 

24230 ......................... Freeborn County, Minnesota ............................................................................................... 24 24 

24240 ......................... Goodhue County, Minnesota .............................................................................................. 24 24 

24250 ......................... Grant County, Minnesota .................................................................................................... 24 24 

24260 ......................... Hennepin County, Minnesota .............................................................................................. 5120 33460 

24270 ......................... Houston County, Minnesota ................................................................................................ 24 29100 

24280 ......................... Hubbard County, Minnesota ............................................................................................... 24 24 

24290 ......................... Isanti County, Minnesota ..................................................................................................... 5120 33460 

24300 ......................... Itasca County, Minnesota .................................................................................................... 24 24 

24310 ......................... Jackson County, Minnesota ................................................................................................ 24 24 

24320 ......................... Kanabec County, Minnesota ............................................................................................... 24 24 

24330 ......................... Kandiyohi County, Minnesota ............................................................................................. 24 24 

24340 ......................... Kittson County, Minnesota .................................................................................................. 24 24 

24350 ......................... Koochiching County, Minnesota .......................................................................................... 24 24 

24360 ......................... Lac Qui Parle County, Minnesota ....................................................................................... 24 24 

24370 ......................... Lake County, Minnesota ..................................................................................................... 24 24 

24380 ......................... Lake Of Woods County, Minnesota .................................................................................... 24 24 

24390 ......................... Le Sueur County, Minnesota .............................................................................................. 24 24 

24400 ......................... Lincoln County, Minnesota .................................................................................................. 24 24 

24410 ......................... Lyon County, Minnesota ..................................................................................................... 24 24 

24420 ......................... Mc Leod County, Minnesota ............................................................................................... 24 24 

24430 ......................... Mahnomen County, Minnesota ........................................................................................... 24 24 

24440 ......................... Marshall County, Minnesota ................................................................................................ 24 24 

24450 ......................... Martin County, Minnesota ................................................................................................... 24 24 

24460 ......................... Meeker County, Minnesota ................................................................................................. 24 24 

24470 ......................... Mille Lacs County, Minnesota ............................................................................................. 24 24 

24480 ......................... Morrison County, Minnesota ............................................................................................... 24 24 

24490 ......................... Mower County, Minnesota .................................................................................................. 24 24 

24500 ......................... Murray County, Minnesota .................................................................................................. 24 24 

24510 ......................... Nicollet County, Minnesota ................................................................................................. 24 24 

24520 ......................... Nobles County, Minnesota .................................................................................................. 24 24 

24530 ......................... Norman County, Minnesota ................................................................................................ 24 24 

24540 ......................... Olmsted County, Minnesota ................................................................................................ 6820 40340 

24550 ......................... Otter Tail County, Minnesota .............................................................................................. 24 24 

24560 ......................... Pennington County, Minnesota ........................................................................................... 24 24 

24570 ......................... Pine County, Minnesota ...................................................................................................... 24 24 

24580 ......................... Pipestone County, Minnesota ............................................................................................. 24 24 

24590 ......................... Polk County, Minnesota ...................................................................................................... 24 24220 

24600 ......................... Pope County, Minnesota ..................................................................................................... 24 24 

24610 ......................... Ramsey County, Minnesota ................................................................................................ 5120 33460 

24620 ......................... Red Lake County, Minnesota .............................................................................................. 24 24 

24630 ......................... Redwood County, Minnesota .............................................................................................. 24 24 

24640 ......................... Renville County, Minnesota ................................................................................................ 24 24 

24650 ......................... Rice County, Minnesota ...................................................................................................... 24 24 

24660 ......................... Rock County, Minnesota ..................................................................................................... 24 24 

24670 ......................... Roseau County, Minnesota ................................................................................................. 24 24 

24680 ......................... St Louis County, Minnesota ................................................................................................ 2240 20260 

24690 ......................... Scott County, Minnesota ..................................................................................................... 5120 33460 

24700 ......................... Sherburne County, Minnesota ............................................................................................ 6980 33460 

24710 ......................... Sibley County, Minnesota ................................................................................................... 24 24 

24720 ......................... Stearns County, Minnesota ................................................................................................. 6980 41060 

24730 ......................... Steele County, Minnesota ................................................................................................... 24 24 

24740 ......................... Stevens County, Minnesota ................................................................................................ 24 24 

24750 ......................... Swift County, Minnesota ..................................................................................................... 24 24 

24760 ......................... Todd County, Minnesota ..................................................................................................... 24 24 

24770 ......................... Traverse County, Minnesota ............................................................................................... 24 24 

46030 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

24780 ......................... Wabasha County, Minnesota .............................................................................................. 24 40340 

24790 ......................... Wadena County, Minnesota ................................................................................................ 24 24 

24800 ......................... Waseca County, Minnesota ................................................................................................ 24 24 

24810 ......................... Washington County, Minnesota .......................................................................................... 5120 33460 

24820 ......................... Watonwan County, Minnesota ............................................................................................ 24 24 

24830 ......................... Wilkin County, Minnesota .................................................................................................... 24 24 

24840 ......................... Winona County, Minnesota ................................................................................................. 24 24 

24850 ......................... Wright County, Minnesota ................................................................................................... 5120 33460 

24860 ......................... Yellow Medicine County, Minnesota ................................................................................... 24 24 

25000 ......................... Adams County, Mississippi ................................................................................................. 25 25 

25010 ......................... Alcorn County, Mississippi .................................................................................................. 25 25 

25020 ......................... Amite County, Mississippi ................................................................................................... 25 25 

25030 ......................... Attala County, Mississippi ................................................................................................... 25 25 

25040 ......................... Benton County, Mississippi ................................................................................................. 25 25 

25050 ......................... Bolivar County, Mississippi ................................................................................................. 25 25 

25060 ......................... Calhoun County, Mississippi ............................................................................................... 25 25 

25070 ......................... Carroll County, Mississippi .................................................................................................. 25 25 

25080 ......................... Chickasaw County, Mississippi ........................................................................................... 25 25 

25090 ......................... Choctaw County, Mississippi .............................................................................................. 25 25 

25100 ......................... Claiborne County, Mississippi ............................................................................................. 25 25 

25110 ......................... Clarke County, Mississippi .................................................................................................. 25 25 

25120 ......................... Clay County, Mississippi ..................................................................................................... 25 25 

25130 ......................... Coahoma County, Mississippi ............................................................................................. 25 25 

25140 ......................... Copiah County, Mississippi ................................................................................................. 25 27140 

25150 ......................... Covington County, Mississippi ............................................................................................ 25 25 

25160 ......................... Desoto County, Mississippi ................................................................................................. 4920 32820 

25170 ......................... Forrest County, Mississippi ................................................................................................. 25 25620 

25180 ......................... Franklin County, Mississippi ................................................................................................ 25 25 

25190 ......................... George County, Mississippi ................................................................................................ 25 37700 

25200 ......................... Greene County, Mississippi ................................................................................................ 25 25 

25210 ......................... Grenada County, Mississippi .............................................................................................. 25 25 

25220 ......................... Hancock County, Mississippi .............................................................................................. 0920 25060 

25230 ......................... Harrison County, Mississippi ............................................................................................... 0920 25060 

25240 ......................... Hinds County, Mississippi ................................................................................................... 3560 27140 

25250 ......................... Holmes County, Mississippi ................................................................................................ 25 25 

25260 ......................... Humphreys County, Mississippi .......................................................................................... 25 25 

25270 ......................... Issaquena County, Mississippi ............................................................................................ 25 25 

25280 ......................... Itawamba County, Mississippi ............................................................................................. 25 25 

25290 ......................... Jackson County, Mississippi ............................................................................................... 6025 37700 

25300 ......................... Jasper County, Mississippi .................................................................................................. 25 25 

25310 ......................... Jefferson County, Mississippi .............................................................................................. 25 25 

25320 ......................... Jefferson Davis County, Mississippi ................................................................................... 25 25 

25330 ......................... Jones County, Mississippi ................................................................................................... 25 25 

25340 ......................... Kemper County, Mississippi ................................................................................................ 25 25 

25350 ......................... Lafayette County, Mississippi .............................................................................................. 25 25 

25360 ......................... Lamar County, Mississippi .................................................................................................. 25 25620 

25370 ......................... Lauderdale County, Mississippi .......................................................................................... 25 25 

25380 ......................... Lawrence County, Mississippi ............................................................................................. 25 25 

25390 ......................... Leake County, Mississippi ................................................................................................... 25 25 

25400 ......................... Lee County, Mississippi ...................................................................................................... 25 25 

25410 ......................... Leflore County, Mississippi ................................................................................................. 25 25 

25420 ......................... Lincoln County, Mississippi ................................................................................................. 25 25 

25430 ......................... Lowndes County, Mississippi .............................................................................................. 25 25 

25440 ......................... Madison County, Mississippi ............................................................................................... 3560 27140 

25450 ......................... Marion County, Mississippi ................................................................................................. 25 25 

25460 ......................... Marshall County, Mississippi ............................................................................................... 25 32820 

25470 ......................... Monroe County, Mississippi ................................................................................................ 25 25 

25480 ......................... Montgomery County, Mississippi ........................................................................................ 25 25 

25490 ......................... Neshoba County, Mississippi .............................................................................................. 25 25 

25500 ......................... Newton County, Mississippi ................................................................................................ 25 25 

25510 ......................... Noxubee County, Mississippi .............................................................................................. 25 25 

25520 ......................... Oktibbeha County, Mississippi ............................................................................................ 25 25 

25530 ......................... Panola County, Mississippi ................................................................................................. 25 25 

25540 ......................... Pearl River County, Mississippi .......................................................................................... 25 25 

25550 ......................... Perry County, Mississippi .................................................................................................... 25 25620 

25560 ......................... Pike County, Mississippi ..................................................................................................... 25 25 

25570 ......................... Pontotoc County, Mississippi .............................................................................................. 25 25 

25580 ......................... Prentiss County, Mississippi ............................................................................................... 25 25 

25590 ......................... Quitman County, Mississippi ............................................................................................... 25 25 

25600 ......................... Rankin County, Mississippi ................................................................................................. 3560 27140 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46031

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

25610 ......................... Scott County, Mississippi .................................................................................................... 25 25 

25620 ......................... Sharkey County, Mississippi ............................................................................................... 25 25 

25630 ......................... Simpson County, Mississippi .............................................................................................. 25 27140 

25640 ......................... Smith County, Mississippi ................................................................................................... 25 25 

25650 ......................... Stone County, Mississippi ................................................................................................... 25 25060 

25660 ......................... Sunflower County, Mississippi ............................................................................................ 25 25 

25670 ......................... Tallahatchie County, Mississippi ......................................................................................... 25 25 

25680 ......................... Tate County, Mississippi ..................................................................................................... 25 32820 

25690 ......................... Tippah County, Mississippi ................................................................................................. 25 25 

25700 ......................... Tishomingo County, Mississippi .......................................................................................... 25 25 

25710 ......................... Tunica County, Mississippi .................................................................................................. 25 32820 

25720 ......................... Union County, Mississippi ................................................................................................... 25 25 

25730 ......................... Walthall County, Mississippi ................................................................................................ 25 25 

25740 ......................... Warren County, Mississippi ................................................................................................. 25 25 

25750 ......................... Washington County, Mississippi ......................................................................................... 25 25 

25760 ......................... Wayne County, Mississippi ................................................................................................. 25 25 

25770 ......................... Webster County, Mississippi ............................................................................................... 25 25 

25780 ......................... Wilkinson County, Mississippi ............................................................................................. 25 25 

25790 ......................... Winston County, Mississippi ............................................................................................... 25 25 

25800 ......................... Yalobusha County, Mississippi ........................................................................................... 25 25 

25810 ......................... Yazoo County, Mississippi .................................................................................................. 25 25 

26000 ......................... Adair County, Missouri ........................................................................................................ 26 26 

26010 ......................... Andrew County, Missouri .................................................................................................... 26 41140 

26020 ......................... Atchison County, Missouri ................................................................................................... 26 26 

26030 ......................... Audrain County, Missouri .................................................................................................... 26 26 

26040 ......................... Barry County, Missouri ........................................................................................................ 26 26 

26050 ......................... Barton County, Missouri ...................................................................................................... 26 26 

26060 ......................... Bates County, Missouri ....................................................................................................... 26 28140 

26070 ......................... Benton County, Missouri ..................................................................................................... 26 26 

26080 ......................... Bollinger County, Missouri .................................................................................................. 26 26 

26090 ......................... Boone County, Missouri ...................................................................................................... 1740 17860 

26100 ......................... Buchanan County, Missouri ................................................................................................ 7000 41140 

26110 ......................... Butler County, Missouri ....................................................................................................... 26 26 

26120 ......................... Caldwell County, Missouri ................................................................................................... 26 28140 

26130 ......................... Callaway County, Missouri .................................................................................................. 26 27620 

26140 ......................... Camden County, Missouri ................................................................................................... 26 26 

26150 ......................... Cape Girardeau County, Missouri ....................................................................................... 26 26 

26160 ......................... Carroll County, Missouri ...................................................................................................... 26 26 

26170 ......................... Carter County, Missouri ...................................................................................................... 26 26 

26180 ......................... Cass County, Missouri ........................................................................................................ 3760 28140 

26190 ......................... Cedar County, Missouri ....................................................................................................... 26 26 

26200 ......................... Chariton County, Missouri ................................................................................................... 26 26 

26210 ......................... Christian County, Missouri .................................................................................................. 7920 44180 

26220 ......................... Clark County, Missouri ........................................................................................................ 26 26 

26230 ......................... Clay County, Missouri ......................................................................................................... 3760 28140 

26240 ......................... Clinton County, Missouri ..................................................................................................... 26 28140 

26250 ......................... Cole County, Missouri ......................................................................................................... 26 27620 

26260 ......................... Cooper County, Missouri ..................................................................................................... 26 26 

26270 ......................... Crawford County, Missouri .................................................................................................. 26 41180 

26280 ......................... Dade County, Missouri ........................................................................................................ 26 26 

26290 ......................... Dallas County, Missouri ...................................................................................................... 26 44180 

26300 ......................... Daviess County, Missouri .................................................................................................... 26 26 

26310 ......................... De Kalb County, Missouri ................................................................................................... 26 41140 

26320 ......................... Dent County, Missouri ......................................................................................................... 26 26 

26330 ......................... Douglas County, Missouri ................................................................................................... 26 26 

26340 ......................... Dunklin County, Missouri .................................................................................................... 26 26 

26350 ......................... Franklin County, Missouri .................................................................................................... 7040 41180 

26360 ......................... Gasconade County, Missouri .............................................................................................. 26 26 

26370 ......................... Gentry County, Missouri ...................................................................................................... 26 26 

26380 ......................... Greene County, Missouri .................................................................................................... 7920 44180 

26390 ......................... Grundy County, Missouri ..................................................................................................... 26 26 

26400 ......................... Harrison County, Missouri ................................................................................................... 26 26 

26410 ......................... Henry County, Missouri ....................................................................................................... 26 26 

26411 ......................... Hickory County, Missouri .................................................................................................... 26 26 

26412 ......................... Holt County, Missouri .......................................................................................................... 26 26 

26440 ......................... Howard County, Missouri .................................................................................................... 26 17860 

26450 ......................... Howell County, Missouri ...................................................................................................... 26 26 

26460 ......................... Iron County, Missouri .......................................................................................................... 26 26 

26470 ......................... Jackson County, Missouri ................................................................................................... 3760 28140 

26480 ......................... Jasper County, Missouri ...................................................................................................... 3710 27900 

46032 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

26490 ......................... Jefferson County, Missouri .................................................................................................. 7040 41180 

26500 ......................... Johnson County, Missouri ................................................................................................... 26 26 

26510 ......................... Knox County, Missouri ........................................................................................................ 26 26 

26520 ......................... Laclede County, Missouri .................................................................................................... 26 26 

26530 ......................... Lafayette County, Missouri .................................................................................................. 3760 28140 

26540 ......................... Lawrence County, Missouri ................................................................................................. 26 26 

26541 ......................... Lewis County, Missouri ....................................................................................................... 26 26 

26560 ......................... Lincoln County, Missouri ..................................................................................................... 26 41180 

26570 ......................... Linn County, Missouri .......................................................................................................... 26 26 

26580 ......................... Livingston County, Missouri ................................................................................................ 26 26 

26590 ......................... Mc Donald County, Missouri ............................................................................................... 26 22220 

26600 ......................... Macon County, Missouri ...................................................................................................... 26 26 

26601 ......................... Madison County, Missouri ................................................................................................... 26 26 

26620 ......................... Maries County, Missouri ...................................................................................................... 26 26 

26630 ......................... Marion County, Missouri ..................................................................................................... 26 26 

26631 ......................... Mercer County, Missouri ..................................................................................................... 26 26 

26650 ......................... Miller County, Missouri ........................................................................................................ 26 26 

26660 ......................... Mississippi County, Missouri ............................................................................................... 26 26 

26670 ......................... Moniteau County, Missouri .................................................................................................. 26 27620 

26680 ......................... Monroe County, Missouri .................................................................................................... 26 26 

26690 ......................... Montgomery County, Missouri ............................................................................................ 26 26 

26700 ......................... Morgan County, Missouri .................................................................................................... 26 26 

26710 ......................... New Madrid County, Missouri ............................................................................................. 26 26 

26720 ......................... Newton County, Missouri .................................................................................................... 3710 27900 

26730 ......................... Nodaway County, Missouri ................................................................................................. 26 26 

26740 ......................... Oregon County, Missouri .................................................................................................... 26 26 

26750 ......................... Osage County, Missouri ...................................................................................................... 26 27620 

26751 ......................... Ozark County, Missouri ....................................................................................................... 26 26 

26770 ......................... Pemiscot County, Missouri .................................................................................................. 26 26 

26780 ......................... Perry County, Missouri ........................................................................................................ 26 26 

26790 ......................... Pettis County, Missouri ....................................................................................................... 26 26 

26800 ......................... Phelps County, Missouri ..................................................................................................... 26 26 

26810 ......................... Pike County, Missouri ......................................................................................................... 26 26 

26820 ......................... Platte County, Missouri ....................................................................................................... 3760 28140 

26821 ......................... Polk County, Missouri ......................................................................................................... 26 44180 

26840 ......................... Pulaski County, Missouri ..................................................................................................... 26 26 

26850 ......................... Putnam County, Missouri .................................................................................................... 26 26 

26860 ......................... Ralls County, Missouri ........................................................................................................ 26 26 

26870 ......................... Randolph County, Missouri ................................................................................................. 26 26 

26880 ......................... Ray County, Missouri .......................................................................................................... 3760 28140 

26881 ......................... Reynolds County, Missouri ................................................................................................. 26 26 

26900 ......................... Ripley County, Missouri ...................................................................................................... 26 26 

26910 ......................... St Charles County, Missouri ............................................................................................... 7040 41180 

26911 ......................... St Clair County, Missouri .................................................................................................... 26 26 

26930 ......................... St Francois County, Missouri .............................................................................................. 26 26 

26940 ......................... St Louis County, Missouri ................................................................................................... 7040 41180 

26950 ......................... St Louis City County, Missouri ............................................................................................ 7040 41180 

26960 ......................... Ste Genevieve County, Missouri ......................................................................................... 26 26 

26970 ......................... Saline County, Missouri ...................................................................................................... 26 26 

26980 ......................... Schuyler County, Missouri .................................................................................................. 26 26 

26981 ......................... Scotland County, Missouri .................................................................................................. 26 26 

26982 ......................... Scott County, Missouri ........................................................................................................ 26 26 

26983 ......................... Shannon County, Missouri .................................................................................................. 26 26 

26984 ......................... Shelby County, Missouri ..................................................................................................... 26 26 

26985 ......................... Stoddard County, Missouri .................................................................................................. 26 26 

26986 ......................... Stone County, Missouri ....................................................................................................... 26 26 

26987 ......................... Sullivan County, Missouri .................................................................................................... 26 26 

26988 ......................... Taney County, Missouri ...................................................................................................... 26 26 

26989 ......................... Texas County, Missouri ....................................................................................................... 26 26 

26990 ......................... Vernon County, Missouri ..................................................................................................... 26 26 

26991 ......................... Warren County, Missouri ..................................................................................................... 26 41180 

26992 ......................... Washington County, Missouri ............................................................................................. 26 41180 

26993 ......................... Wayne County, Missouri ..................................................................................................... 26 26 

26994 ......................... Webster County, Missouri ................................................................................................... 26 44180 

26995 ......................... Worth County, Missouri ....................................................................................................... 26 26 

26996 ......................... Wright County, Missouri ...................................................................................................... 26 26 

27000 ......................... Beaverhead County, Montana ............................................................................................ 27 27 

27010 ......................... Big Horn County, Montana .................................................................................................. 27 27 

27020 ......................... Blaine County, Montana ...................................................................................................... 27 27 

27030 ......................... Broadwater County, Montana ............................................................................................. 27 27 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46033

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

27040 ......................... Carbon County, Montana .................................................................................................... 27 13740 

27050 ......................... Carter County, Montana ...................................................................................................... 27 27 

27060 ......................... Cascade County, Montana .................................................................................................. 3040 24500 

27070 ......................... Chouteau County, Montana ................................................................................................ 27 27 

27080 ......................... Custer County, Montana ..................................................................................................... 27 27 

27090 ......................... Daniels County, Montana .................................................................................................... 27 27 

27100 ......................... Dawson County, Montana ................................................................................................... 27 27 

27110 ......................... Deer Lodge County, Montana ............................................................................................. 27 27 

27113 ......................... Yellowstone National Park, Montana .................................................................................. 0880 27 

27120 ......................... Fallon County, Montana ...................................................................................................... 27 27 

27130 ......................... Fergus County, Montana ..................................................................................................... 27 27 

27140 ......................... Flathead County, Montana .................................................................................................. 27 27 

27150 ......................... Gallatin County, Montana .................................................................................................... 27 27 

27160 ......................... Garfield County, Montana ................................................................................................... 27 27 

27170 ......................... Glacier County, Montana .................................................................................................... 27 27 

27180 ......................... Golden Valley County, Montana ......................................................................................... 27 27 

27190 ......................... Granite County, Montana .................................................................................................... 27 27 

27200 ......................... Hill County, Montana ........................................................................................................... 27 27 

27210 ......................... Jefferson County, Montana ................................................................................................. 27 27 

27220 ......................... Judith Basin County, Montana ............................................................................................ 27 27 

27230 ......................... Lake County, Montana ........................................................................................................ 27 27 

27240 ......................... Lewis And Clark County, Montana ..................................................................................... 27 27 

27250 ......................... Liberty County, Montana ..................................................................................................... 27 27 

27260 ......................... Lincoln County, Montana .................................................................................................... 27 27 

27270 ......................... Mc Cone County, Montana ................................................................................................. 27 27 

27280 ......................... Madison County, Montana .................................................................................................. 27 27 

27290 ......................... Meagher County, Montana .................................................................................................. 27 27 

27300 ......................... Mineral County, Montana .................................................................................................... 27 27 

27310 ......................... Missoula County, Montana .................................................................................................. 27 33540 

27320 ......................... Musselshell County, Montana ............................................................................................. 27 27 

27330 ......................... Park County, Montana ........................................................................................................ 27 27 

27340 ......................... Petroleum County, Montana ............................................................................................... 27 27 

27350 ......................... Phillips County, Montana .................................................................................................... 27 27 

27360 ......................... Pondera County, Montana .................................................................................................. 27 27 

27370 ......................... Powder River County, Montana .......................................................................................... 27 27 

27380 ......................... Powell County, Montana ..................................................................................................... 27 27 

27390 ......................... Prairie County, Montana ..................................................................................................... 27 27 

27400 ......................... Ravalli County, Montana ..................................................................................................... 27 27 

27410 ......................... Richland County, Montana .................................................................................................. 27 27 

27420 ......................... Roosevelt County, Montana ................................................................................................ 27 27 

27430 ......................... Rosebud County, Montana ................................................................................................. 27 27 

27440 ......................... Sanders County, Montana .................................................................................................. 27 27 

27450 ......................... Sheridan County, Montana ................................................................................................. 27 27 

27460 ......................... Silver Bow County, Montana ............................................................................................... 27 27 

27470 ......................... Stillwater County, Montana ................................................................................................. 27 27 

27480 ......................... Sweet Grass County, Montana ........................................................................................... 27 27 

27490 ......................... Teton County, Montana ....................................................................................................... 27 27 

27500 ......................... Toole County, Montana ....................................................................................................... 27 27 

27510 ......................... Treasure County, Montana ................................................................................................. 27 27 

27520 ......................... Valley County, Montana ...................................................................................................... 27 27 

27530 ......................... Wheatland County, Montana ............................................................................................... 27 27 

27540 ......................... Wibaux County, Montana .................................................................................................... 27 27 

27550 ......................... Yellowstone County, Montana ............................................................................................ 0880 13740 

28000 ......................... Adams County, Nebraska ................................................................................................... 28 28 

28010 ......................... Antelope County, Nebraska ................................................................................................ 28 28 

28020 ......................... Arthur County, Nebraska ..................................................................................................... 28 28 

28030 ......................... Banner County, Nebraska ................................................................................................... 28 28 

28040 ......................... Blaine County, Nebraska .................................................................................................... 28 28 

28050 ......................... Boone County, Nebraska .................................................................................................... 28 28 

28060 ......................... Box Butte County, Nebraska ............................................................................................... 28 28 

28070 ......................... Boyd County, Nebraska ...................................................................................................... 28 28 

28080 ......................... Brown County, Nebraska .................................................................................................... 28 28 

28090 ......................... Buffalo County, Nebraska ................................................................................................... 28 28 

28100 ......................... Burt County, Nebraska ........................................................................................................ 28 28 

28110 ......................... Butler County, Nebraska ..................................................................................................... 28 28 

28120 ......................... Cass County, Nebraska ...................................................................................................... 28 36540 

28130 ......................... Cedar County, Nebraska ..................................................................................................... 28 28 

28140 ......................... Chase County, Nebraska .................................................................................................... 28 28 

28150 ......................... Cherry County, Nebraska .................................................................................................... 28 28 

28160 ......................... Cheyenne County, Nebraska .............................................................................................. 28 28 

46034 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

28170 ......................... Clay County, Nebraska ....................................................................................................... 28 28 

28180 ......................... Colfax County, Nebraska .................................................................................................... 28 28 

28190 ......................... Cuming County, Nebraska .................................................................................................. 28 28 

28200 ......................... Custer County, Nebraska .................................................................................................... 28 28 

28210 ......................... Dakota County, Nebraska ................................................................................................... 7720 43580 

28220 ......................... Dawes County, Nebraska ................................................................................................... 28 28 

28230 ......................... Dawson County, Nebraska ................................................................................................. 28 28 

28240 ......................... Deuel County, Nebraska ..................................................................................................... 28 28 

28250 ......................... Dixon County, Nebraska ..................................................................................................... 28 43580 

28260 ......................... Dodge County, Nebraska .................................................................................................... 28 28 

28270 ......................... Douglas County, Nebraska ................................................................................................. 5920 36540 

28280 ......................... Dundy County, Nebraska .................................................................................................... 28 28 

28290 ......................... Fillmore County, Nebraska .................................................................................................. 28 28 

28300 ......................... Franklin County, Nebraska .................................................................................................. 28 28 

28310 ......................... Frontier County, Nebraska .................................................................................................. 28 28 

28320 ......................... Furnas County, Nebraska ................................................................................................... 28 28 

28330 ......................... Gage County, Nebraska ...................................................................................................... 28 28 

28340 ......................... Garden County, Nebraska .................................................................................................. 28 28 

28350 ......................... Garfield County, Nebraska .................................................................................................. 28 28 

28360 ......................... Gosper County, Nebraska ................................................................................................... 28 28 

28370 ......................... Grant County, Nebraska ..................................................................................................... 28 28 

28380 ......................... Greeley County, Nebraska .................................................................................................. 28 28 

28390 ......................... Hall County, Nebraska ........................................................................................................ 28 28 

28400 ......................... Hamilton County, Nebraska ................................................................................................ 28 28 

28410 ......................... Harlan County, Nebraska .................................................................................................... 28 28 

28420 ......................... Hayes County, Nebraska .................................................................................................... 28 28 

28430 ......................... Hitchcock County, Nebraska ............................................................................................... 28 28 

28440 ......................... Holt County, Nebraska ........................................................................................................ 28 28 

28450 ......................... Hooker County, Nebraska ................................................................................................... 28 28 

28460 ......................... Howard County, Nebraska .................................................................................................. 28 28 

28470 ......................... Jefferson County, Nebraska ................................................................................................ 28 28 

28480 ......................... Johnson County, Nebraska ................................................................................................. 28 28 

28490 ......................... Kearney County, Nebraska ................................................................................................. 28 28 

28500 ......................... Keith County, Nebraska ...................................................................................................... 28 28 

28510 ......................... Keya Paha County, Nebraska ............................................................................................. 28 28 

28520 ......................... Kimball County, Nebraska ................................................................................................... 28 28 

28530 ......................... Knox County, Nebraska ...................................................................................................... 28 28 

28540 ......................... Lancaster County, Nebraska ............................................................................................... 4360 30700 

28550 ......................... Lincoln County, Nebraska ................................................................................................... 28 28 

28560 ......................... Logan County, Nebraska .................................................................................................... 28 28 

28570 ......................... Loup County, Nebraska ...................................................................................................... 28 28 

28580 ......................... Mc Pherson County, Nebraska ........................................................................................... 28 28 

28590 ......................... Madison County, Nebraska ................................................................................................. 28 28 

28600 ......................... Merrick County, Nebraska ................................................................................................... 28 28 

28610 ......................... Morrill County, Nebraska ..................................................................................................... 28 28 

28620 ......................... Nance County, Nebraska .................................................................................................... 28 28 

28630 ......................... Nemaha County, Nebraska ................................................................................................. 28 28 

28640 ......................... Nuckolls County, Nebraska ................................................................................................. 28 28 

28650 ......................... Otoe County, Nebraska ....................................................................................................... 28 28 

28660 ......................... Pawnee County, Nebraska ................................................................................................. 28 28 

28670 ......................... Perkins County, Nebraska .................................................................................................. 28 28 

28680 ......................... Phelps County, Nebraska ................................................................................................... 28 28 

28690 ......................... Pierce County, Nebraska .................................................................................................... 28 28 

28700 ......................... Platte County, Nebraska ..................................................................................................... 28 28 

28710 ......................... Polk County, Nebraska ....................................................................................................... 28 28 

28720 ......................... Redwillow County, Nebraska .............................................................................................. 28 28 

28730 ......................... Richardson County, Nebraska ............................................................................................ 28 28 

28740 ......................... Rock County, Nebraska ...................................................................................................... 28 28 

28750 ......................... Saline County, Nebraska .................................................................................................... 28 28 

28760 ......................... Sarpy County, Nebraska ..................................................................................................... 5920 36540 

28770 ......................... Saunders County, Nebraska ............................................................................................... 28 36540 

28780 ......................... Scotts Bluff County, Nebraska ............................................................................................ 28 28 

28790 ......................... Seward County, Nebraska .................................................................................................. 28 30700 

28800 ......................... Sheridan County, Nebraska ................................................................................................ 28 28 

28810 ......................... Sherman County, Nebraska ................................................................................................ 28 28 

28820 ......................... Sioux County, Nebraska ..................................................................................................... 28 28 

28830 ......................... Stanton County, Nebraska .................................................................................................. 28 28 

28840 ......................... Thayer County, Nebraska ................................................................................................... 28 28 

28850 ......................... Thomas County, Nebraska ................................................................................................. 28 28 

28860 ......................... Thurston County, Nebraska ................................................................................................ 28 28 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46035

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

28870 ......................... Valley County, Nebraska ..................................................................................................... 28 28 

28880 ......................... Washington County, Nebraska ........................................................................................... 5920 36540 

28890 ......................... Wayne County, Nebraska ................................................................................................... 28 28 

28900 ......................... Webster County, Nebraska ................................................................................................. 28 28 

28910 ......................... Wheeler County, Nebraska ................................................................................................. 28 28 

28920 ......................... York County, Nebraska ....................................................................................................... 28 28 

29000 ......................... Churchill County, Nevada ................................................................................................... 29 29 

29010 ......................... Clark County, Nevada ......................................................................................................... 4120 29820 

29020 ......................... Douglas County, Nevada .................................................................................................... 29 29 

29030 ......................... Elko County, Nevada .......................................................................................................... 29 29 

29040 ......................... Esmeralda County, Nevada ................................................................................................ 29 29 

29050 ......................... Eureka County, Nevada ...................................................................................................... 29 29 

29060 ......................... Humboldt County, Nevada .................................................................................................. 29 29 

29070 ......................... Lander County, Nevada ...................................................................................................... 29 29 

29080 ......................... Lincoln County, Nevada ...................................................................................................... 29 29 

29090 ......................... Lyon County, Nevada .......................................................................................................... 29 29 

29100 ......................... Mineral County, Nevada ...................................................................................................... 29 29 

29110 ......................... Nye County, Nevada ........................................................................................................... 29 29 

29120 ......................... Carson City County, Nevada .............................................................................................. 29 16180 

29130 ......................... Pershing County, Nevada ................................................................................................... 29 29 

29140 ......................... Storey County, Nevada ....................................................................................................... 29 39900 

29150 ......................... Washoe County, Nevada .................................................................................................... 6720 39900 

29160 ......................... White Pine County, Nevada ................................................................................................ 29 29 

30000 ......................... Belknap County, New Hampshire ....................................................................................... 30 30 

30010 ......................... Carroll County, New Hampshire ......................................................................................... 30 30 

30020 ......................... Cheshire County, New Hampshire ...................................................................................... 30 30 

30030 ......................... Coos County, New Hampshire ............................................................................................ 30 30 

30040 ......................... Grafton County, New Hampshire ........................................................................................ 30 30 

30050 ......................... Hillsboro County, New Hampshire ...................................................................................... 4763 31700 

30060 ......................... Merrimack County, New Hampshire ................................................................................... 4763 31700 

30070 ......................... Rockingham County, New Hampshire ................................................................................ 6453 40484 

30080 ......................... Strafford County, New Hampshire ...................................................................................... 6453 40484 

30090 ......................... Sullivan County, New Hampshire ....................................................................................... 30 30 

31000 ......................... Atlantic County, New Jersey ............................................................................................... 0560 12100 

31100 ......................... Bergen County, New Jersey ............................................................................................... 0875 35644 

31150 ......................... Burlington County, New Jersey ........................................................................................... 6160 15804 

31160 ......................... Camden County, New Jersey ............................................................................................. 6160 15804 

31180 ......................... Cape May County, New Jersey .......................................................................................... 0560 36140 

31190 ......................... Cumberland County, New Jersey ....................................................................................... 8760 47220 

31200 ......................... Essex County, New Jersey ................................................................................................. 5640 35084 

31220 ......................... Gloucester County, New Jersey ......................................................................................... 6160 15804 

31230 ......................... Hudson County, New Jersey .............................................................................................. 3640 35644 

31250 ......................... Hunterdon County, New Jersey .......................................................................................... 5015 35084 

31260 ......................... Mercer County, New Jersey ................................................................................................ 8480 45940 

31270 ......................... Middlesex County, New Jersey ........................................................................................... 5015 20764 

31290 ......................... Monmouth County, New Jersey .......................................................................................... 5190 20764 

31300 ......................... Morris County, New Jersey ................................................................................................. 5640 35084 

31310 ......................... Ocean County, New Jersey ................................................................................................ 5190 20764 

31320 ......................... Passaic County, New Jersey .............................................................................................. 0875 35644 

31340 ......................... Salem County, New Jersey ................................................................................................. 9160 48864 

31350 ......................... Somerset County, New Jersey ........................................................................................... 5015 20764 

31360 ......................... Sussex County, New Jersey ............................................................................................... 5640 35084 

31370 ......................... Union County, New Jersey ................................................................................................. 5640 35084 

31390 ......................... Warren County, New Jersey ............................................................................................... 0240 10900 

32000 ......................... Bernalillo County, New Mexico ........................................................................................... 0200 10740 

32010 ......................... Catron County, New Mexico ............................................................................................... 32 32 

32020 ......................... Chaves County, New Mexico .............................................................................................. 32 32 

32025 ......................... Cibola County, New Mexico ................................................................................................ 32 32 

32030 ......................... Colfax County, New Mexico ................................................................................................ 32 32 

32040 ......................... Curry County, New Mexico ................................................................................................. 32 32 

32050 ......................... De Baca County, New Mexico ............................................................................................ 32 32 

32060 ......................... Dona Ana County, New Mexico .......................................................................................... 4100 29740 

32070 ......................... Eddy County, New Mexico .................................................................................................. 32 32 

32080 ......................... Grant County, New Mexico ................................................................................................. 32 32 

32090 ......................... Guadalupe County, New Mexico ........................................................................................ 32 32 

32100 ......................... Harding County, New Mexico ............................................................................................. 32 32 

32110 ......................... Hidalgo County, New Mexico .............................................................................................. 32 32 

32120 ......................... Lea County, New Mexico .................................................................................................... 32 32 

32130 ......................... Lincoln County, New Mexico ............................................................................................... 32 32 

32131 ......................... Los Alamos County, New Mexico ....................................................................................... 7490 32 

46036 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

32140 ......................... Luna County, New Mexico .................................................................................................. 32 32 

32150 ......................... Mc Kinley County, New Mexico .......................................................................................... 32 32 

32160 ......................... Mora County, New Mexico .................................................................................................. 32 32 

32170 ......................... Otero County, New Mexico ................................................................................................. 32 32 

32180 ......................... Quay County, New Mexico ................................................................................................. 32 32 

32190 ......................... Rio Arriba County, New Mexico .......................................................................................... 32 32 

32200 ......................... Roosevelt County, New Mexico .......................................................................................... 32 32 

32210 ......................... Sandoval County, New Mexico ........................................................................................... 32 10740 

32220 ......................... San Juan County, New Mexico ........................................................................................... 32 22140 

32230 ......................... San Miguel County, New Mexico ........................................................................................ 32 32 

32240 ......................... Santa Fe County, New Mexico ........................................................................................... 7490 42140 

32250 ......................... Sierra County, New Mexico ................................................................................................ 32 32 

32260 ......................... Socorro County, New Mexico ............................................................................................. 32 32 

32270 ......................... Taos County, New Mexico .................................................................................................. 32 32 

32280 ......................... Torrance County, New Mexico ............................................................................................ 32 10740 

32290 ......................... Union County, New Mexico ................................................................................................. 32 32 

32300 ......................... Valencia County, New Mexico ............................................................................................ 32 10740 

33000 ......................... Albany County, New York ................................................................................................... 0160 10580 

33010 ......................... Allegany County, New York ................................................................................................ 33 33 

33020 ......................... Bronx County, New York ..................................................................................................... 5600 35644 

33030 ......................... Broome County, New York ................................................................................................. 0960 13780 

33040 ......................... Cattaraugus County, New York .......................................................................................... 33 33 

33050 ......................... Cayuga County, New York .................................................................................................. 33 33 

33060 ......................... Chautauqua County, New York .......................................................................................... 33 33 

33070 ......................... Chemung County, New York .............................................................................................. 2335 21300 

33080 ......................... Chenango County, New York ............................................................................................. 33 33 

33090 ......................... Clinton County, New York ................................................................................................... 33 33 

33200 ......................... Columbia County, New York ............................................................................................... 33 33 

33210 ......................... Cortland County, New York ................................................................................................ 33 33 

33220 ......................... Delaware County, New York ............................................................................................... 33 33 

33230 ......................... Dutchess County, New York ............................................................................................... 6460 39100 

33240 ......................... Erie County, New York ........................................................................................................ 1280 15380 

33260 ......................... Essex County, New York .................................................................................................... 33 33 

33270 ......................... Franklin County, New York ................................................................................................. 33 33 

33280 ......................... Fulton County, New York .................................................................................................... 33 33 

33290 ......................... Genesee County, New York ............................................................................................... 33 33 

33300 ......................... Greene County, New York .................................................................................................. 0160 33 

33310 ......................... Hamilton County, New York ................................................................................................ 33 33 

33320 ......................... Herkimer County, New York ............................................................................................... 8680 46540 

33330 ......................... Jefferson County, New York ............................................................................................... 33 33 

33331 ......................... Kings County, New York ..................................................................................................... 5600 35644 

33340 ......................... Lewis County, New York ..................................................................................................... 33 33 

33350 ......................... Livingston County, New York .............................................................................................. 6840 40380 

33360 ......................... Madison County, New York ................................................................................................ 8160 45060 

33370 ......................... Monroe County, New York .................................................................................................. 6840 40380 

33380 ......................... Montgomery County, New York .......................................................................................... 0160 33 

33400 ......................... Nassau County, New York .................................................................................................. 5380 35004 

33420 ......................... New York County, New York .............................................................................................. 5600 35644 

33500 ......................... Niagara County, New York ................................................................................................. 5700 15380 

33510 ......................... Oneida County, New York .................................................................................................. 8680 46540 

33520 ......................... Onondaga County, New York ............................................................................................. 8160 45060 

33530 ......................... Ontario County, New York .................................................................................................. 6840 40380 

33540 ......................... Orange County, New York .................................................................................................. 5950 39100 

33550 ......................... Orleans County, New York ................................................................................................. 6840 40380 

33560 ......................... Oswego County, New York ................................................................................................. 8160 45060 

33570 ......................... Otsego County, New York .................................................................................................. 33 33 

33580 ......................... Putnam County, New York .................................................................................................. 5600 35644 

33590 ......................... Queens County, New York ................................................................................................. 5600 35644 

33600 ......................... Rensselaer County, New York ............................................................................................ 0160 10580 

33610 ......................... Richmond County, New York .............................................................................................. 5600 35644 

33620 ......................... Rockland County, New York ............................................................................................... 5600 35644 

33630 ......................... St Lawrence County, New York .......................................................................................... 33 33 

33640 ......................... Saratoga County, New York ............................................................................................... 0160 10580 

33650 ......................... Schenectady County, New York ......................................................................................... 0160 10580 

33660 ......................... Schoharie County, New York .............................................................................................. 33 10580 

33670 ......................... Schuyler County, New York ................................................................................................ 33 33 

33680 ......................... Seneca County, New York .................................................................................................. 33 33 

33690 ......................... Steuben County, New York ................................................................................................. 33 33 

33700 ......................... Suffolk County, New York ................................................................................................... 5380 35004 

33710 ......................... Sullivan County, New York ................................................................................................. 33 33 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46037

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

33720 ......................... Tioga County, New York ..................................................................................................... 0960 13780 

33730 ......................... Tompkins County, New York .............................................................................................. 33 27060 

33740 ......................... Ulster County, New York ..................................................................................................... 33 28740 

33750 ......................... Warren County, New York .................................................................................................. 2975 24020 

33760 ......................... Washington County, New York ........................................................................................... 2975 24020 

33770 ......................... Wayne County, New York ................................................................................................... 6840 40380 

33800 ......................... Westchester County, New York .......................................................................................... 5600 35644 

33900 ......................... Wyoming County, New York ............................................................................................... 33 33 

33910 ......................... Yates County, New York ..................................................................................................... 33 33 

34000 ......................... Alamance County, N Carolina ............................................................................................. 1300 15500 

34010 ......................... Alexander County, N Carolina ............................................................................................ 3290 25860 

34020 ......................... Alleghany County, N Carolina ............................................................................................. 34 34 

34030 ......................... Anson County, N Carolina .................................................................................................. 34 16740 

34040 ......................... Ashe County, N Carolina .................................................................................................... 34 34 

34050 ......................... Avery County, N Carolina ................................................................................................... 34 34 

34060 ......................... Beaufort County, N Carolina ............................................................................................... 34 34 

34070 ......................... Bertie County, N Carolina ................................................................................................... 34 34 

34080 ......................... Bladen County, N Carolina ................................................................................................. 34 34 

34090 ......................... Brunswick County, N Carolina ............................................................................................ 34 48900 

34100 ......................... Buncombe County, N Carolina ........................................................................................... 0480 11700 

34110 ......................... Burke County, N Carolina ................................................................................................... 3290 25860 

34120 ......................... Cabarrus County, N Carolina .............................................................................................. 1520 16740 

34130 ......................... Caldwell County, N Carolina ............................................................................................... 34 25860 

34140 ......................... Camden County, N Carolina ............................................................................................... 34 34 

34150 ......................... Carteret County, N Carolina ................................................................................................ 34 34 

34160 ......................... Caswell County, N Carolina ................................................................................................ 34 34 

34170 ......................... Catawba County, N Carolina .............................................................................................. 3290 25860 

34180 ......................... Chatham County, N Carolina .............................................................................................. 34 20500 

34190 ......................... Cherokee County, N Carolina ............................................................................................. 34 34 

34200 ......................... Chowan County, N Carolina ............................................................................................... 34 34 

34210 ......................... Clay County, N Carolina ..................................................................................................... 34 34 

34220 ......................... Cleveland County, N Carolina ............................................................................................. 34 34 

34230 ......................... Columbus County, N Carolina ............................................................................................ 34 34 

34240 ......................... Craven County, N Carolina ................................................................................................. 34 34 

34250 ......................... Cumberland County, N Carolina ......................................................................................... 2560 22180 

34251 ......................... Currituck County, N Carolina .............................................................................................. 34 47260 

34270 ......................... Dare County, N Carolina ..................................................................................................... 34 34 

34280 ......................... Davidson County, N Carolina .............................................................................................. 3120 34 

34290 ......................... Davie County, N Carolina ................................................................................................... 3120 49180 

34300 ......................... Duplin County, N Carolina .................................................................................................. 34 34 

34310 ......................... Durham County, N Carolina ................................................................................................ 6640 20500 

34320 ......................... Edgecombe County, N Carolina ......................................................................................... 34 40580 

34330 ......................... Forsyth County, N Carolina ................................................................................................. 3120 49180 

34340 ......................... Franklin County, N Carolina ................................................................................................ 6640 39580 

34350 ......................... Gaston County, N Carolina ................................................................................................. 1520 16740 

34360 ......................... Gates County, N Carolina ................................................................................................... 34 34 

34370 ......................... Graham County, N Carolina ................................................................................................ 34 34 

34380 ......................... Granville County, N Carolina .............................................................................................. 34 34 

34390 ......................... Greene County, N Carolina ................................................................................................. 34 24780 

34400 ......................... Guilford County, N Carolina ................................................................................................ 3120 24660 

34410 ......................... Halifax County, N Carolina .................................................................................................. 34 34 

34420 ......................... Harnett County, N Carolina ................................................................................................. 34 34 

34430 ......................... Haywood County, N Carolina .............................................................................................. 34 11700 

34440 ......................... Henderson County, N Carolina ........................................................................................... 34 11700 

34450 ......................... Hertford County, N Carolina ................................................................................................ 34 34 

34460 ......................... Hoke County, N Carolina .................................................................................................... 34 22180 

34470 ......................... Hyde County, N Carolina .................................................................................................... 34 34 

34480 ......................... Iredell County, N Carolina ................................................................................................... 34 34 

34490 ......................... Jackson County, N Carolina ............................................................................................... 34 34 

34500 ......................... Johnston County, N Carolina .............................................................................................. 34 39580 

34510 ......................... Jones County, N Carolina ................................................................................................... 34 34 

34520 ......................... Lee County, N Carolina ....................................................................................................... 34 34 

34530 ......................... Lenoir County, N Carolina ................................................................................................... 34 34 

34540 ......................... Lincoln County, N Carolina ................................................................................................. 1520 34 

34550 ......................... Mc Dowell County, N Carolina ............................................................................................ 34 34 

34560 ......................... Macon County, N Carolina .................................................................................................. 34 34 

34570 ......................... Madison County, N Carolina ............................................................................................... 34 11700 

34580 ......................... Martin County, N Carolina ................................................................................................... 34 34 

34590 ......................... Mecklenburg County, N Carolina ........................................................................................ 1520 16740 

34600 ......................... Mitchell County, N Carolina ................................................................................................ 34 34 

46038 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

34610 ......................... Montgomery County, N Carolina ......................................................................................... 34 34 

34620 ......................... Moore County, N Carolina .................................................................................................. 34 34 

34630 ......................... Nash County, N Carolina .................................................................................................... 34 40580 

34640 ......................... New Hanover County, N Carolina ....................................................................................... 9200 48900 

34650 ......................... Northampton County, N Carolina ........................................................................................ 34 34 

34660 ......................... Onslow County, N Carolina ................................................................................................. 3605 27340 

34670 ......................... Orange County, N Carolina ................................................................................................. 6640 20500 

34680 ......................... Pamlico County, N Carolina ................................................................................................ 34 34 

34690 ......................... Pasquotank County, N Carolina .......................................................................................... 34 34 

34700 ......................... Pender County, N Carolina ................................................................................................. 34 48900 

34710 ......................... Perquimans County, N Carolina ......................................................................................... 34 34 

34720 ......................... Person County, N Carolina ................................................................................................. 34 20500 

34730 ......................... Pitt County, N Carolina ....................................................................................................... 34 24780 

34740 ......................... Polk County, N Carolina ...................................................................................................... 34 34 

34750 ......................... Randolph County, N Carolina ............................................................................................. 3120 24660 

34760 ......................... Richmond County, N Carolina ............................................................................................ 34 34 

34770 ......................... Robeson County, N Carolina .............................................................................................. 34 34 

34780 ......................... Rockingham County, N Carolina ......................................................................................... 34 24660 

34790 ......................... Rowan County, N Carolina ................................................................................................. 1520 34 

34800 ......................... Rutherford County, N Carolina ............................................................................................ 34 34 

34810 ......................... Sampson County, N Carolina ............................................................................................. 34 34 

34820 ......................... Scotland County, N Carolina ............................................................................................... 34 34 

34830 ......................... Stanly County, N Carolina ................................................................................................... 34 16740 

34840 ......................... Stokes County, N Carolina .................................................................................................. 3120 49180 

34850 ......................... Surry County, N Carolina .................................................................................................... 34 34 

34860 ......................... Swain County, N Carolina ................................................................................................... 34 34 

34870 ......................... Transylvania County, N Carolina ........................................................................................ 34 34 

34880 ......................... Tyrrell County, N Carolina ................................................................................................... 34 34 

34890 ......................... Union County, N Carolina ................................................................................................... 1520 16740 

34900 ......................... Vance County, N Carolina .................................................................................................. 34 34 

34910 ......................... Wake County, N Carolina ................................................................................................... 6640 39580 

34920 ......................... Warren County, N Carolina ................................................................................................. 34 34 

34930 ......................... Washington County, N Carolina .......................................................................................... 34 34 

34940 ......................... Watauga County, N Carolina .............................................................................................. 34 34 

34950 ......................... Wayne County, N Carolina ................................................................................................. 34 24140 

34960 ......................... Wilkes County, N Carolina .................................................................................................. 34 34 

34970 ......................... Wilson County, N Carolina .................................................................................................. 34 34 

34980 ......................... Yadkin County, N Carolina .................................................................................................. 3120 49180 

34981 ......................... Yancey County, N Carolina ................................................................................................. 34 34 

35000 ......................... Adams County, N Dakota ................................................................................................... 35 35 

35010 ......................... Barnes County, N Dakota ................................................................................................... 35 35 

35020 ......................... Benson County, N Dakota .................................................................................................. 35 35 

35030 ......................... Billings County, N Dakota ................................................................................................... 35 35 

35040 ......................... Bottineau County, N Dakota ............................................................................................... 35 35 

35050 ......................... Bowman County, N Dakota ................................................................................................. 35 35 

35060 ......................... Burke County, N Dakota ..................................................................................................... 35 35 

35070 ......................... Burleigh County, N Dakota ................................................................................................. 1010 13900 

35080 ......................... Cass County, N Dakota ...................................................................................................... 2520 22020 

35090 ......................... Cavalier County, N Dakota ................................................................................................. 35 35 

35100 ......................... Dickey County, N Dakota .................................................................................................... 35 35 

35110 ......................... Divide County, N Dakota ..................................................................................................... 35 35 

35120 ......................... Dunn County, N Dakota ...................................................................................................... 35 35 

35130 ......................... Eddy County, N Dakota ...................................................................................................... 35 35 

35140 ......................... Emmons County, N Dakota ................................................................................................ 35 35 

35150 ......................... Foster County, N Dakota .................................................................................................... 35 35 

35160 ......................... Golden Valley County, N Dakota ........................................................................................ 35 35 

35170 ......................... Grand Forks County, N Dakota .......................................................................................... 2985 24220 

35180 ......................... Grant County, N Dakota ...................................................................................................... 35 35 

35190 ......................... Griggs County, N Dakota .................................................................................................... 35 35 

35200 ......................... Hettinger County, N Dakota ................................................................................................ 35 35 

35210 ......................... Kidder County, N Dakota .................................................................................................... 35 35 

35220 ......................... La Moure County, N Dakota ............................................................................................... 35 35 

35230 ......................... Logan County, N Dakota ..................................................................................................... 35 35 

35240 ......................... Mc Henry County, N Dakota ............................................................................................... 35 35 

35250 ......................... Mc Intosh County, N Dakota ............................................................................................... 35 35 

35260 ......................... Mc Kenzie County, N Dakota .............................................................................................. 35 35 

35270 ......................... Mc Lean County, N Dakota ................................................................................................. 35 35 

35280 ......................... Mercer County, N Dakota ................................................................................................... 35 35 

35290 ......................... Morton County, N Dakota ................................................................................................... 1010 13900 

35300 ......................... Mountrail County, N Dakota ................................................................................................ 35 35 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46039

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

35310 ......................... Nelson County, N Dakota ................................................................................................... 35 35 

35320 ......................... Oliver County, N Dakota ..................................................................................................... 35 35 

35330 ......................... Pembina County, N Dakota ................................................................................................ 35 35 

35340 ......................... Pierce County, N Dakota .................................................................................................... 35 35 

35350 ......................... Ramsey County, N Dakota ................................................................................................. 35 35 

35360 ......................... Ransom County, N Dakota ................................................................................................. 35 35 

35370 ......................... Renville County, N Dakota .................................................................................................. 35 35 

35380 ......................... Richland County, N Dakota ................................................................................................. 35 35 

35390 ......................... Rolette County, N Dakota ................................................................................................... 35 35 

35400 ......................... Sargent County, N Dakota .................................................................................................. 35 35 

35410 ......................... Sheridan County, N Dakota ................................................................................................ 35 35 

35420 ......................... Sioux County, N Dakota ...................................................................................................... 35 35 

35430 ......................... Slope County, N Dakota ..................................................................................................... 35 35 

35440 ......................... Stark County, N Dakota ...................................................................................................... 35 35 

35450 ......................... Steele County, N Dakota .................................................................................................... 35 35 

35460 ......................... Stutsman County, N Dakota ............................................................................................... 35 35 

35470 ......................... Towner County, N Dakota ................................................................................................... 35 35 

35480 ......................... Traill County, N Dakota ....................................................................................................... 35 35 

35490 ......................... Walsh County, N Dakota ..................................................................................................... 35 35 

35500 ......................... Ward County, N Dakota ...................................................................................................... 35 35 

35510 ......................... Wells County, N Dakota ...................................................................................................... 35 35 

35520 ......................... Williams County, N Dakota ................................................................................................. 35 35 

36000 ......................... Adams County, Ohio ........................................................................................................... 36 36 

36010 ......................... Allen County, Ohio .............................................................................................................. 4320 30620 

36020 ......................... Ashland County, Ohio ......................................................................................................... 36 36 

36030 ......................... Ashtabula County, Ohio ...................................................................................................... 36 36 

36040 ......................... Athens County, Ohio ........................................................................................................... 36 36 

36050 ......................... Auglaize County, Ohio ........................................................................................................ 4320 36 

36060 ......................... Belmont County, Ohio ......................................................................................................... 9000 48540 

36070 ......................... Brown County, Ohio ............................................................................................................ 36 17140 

36080 ......................... Butler County, Ohio ............................................................................................................. 3200 17140 

36090 ......................... Carroll County, Ohio ............................................................................................................ 1320 15940 

36100 ......................... Champaign County, Ohio .................................................................................................... 36 36 

36110 ......................... Clark County, Ohio .............................................................................................................. 2000 44220 

36120 ......................... Clermont County, Ohio ........................................................................................................ 1640 17140 

36130 ......................... Clinton County, Ohio ........................................................................................................... 36 36 

36140 ......................... Columbiana County, Ohio ................................................................................................... 36 36 

36150 ......................... Coshocton County, Ohio ..................................................................................................... 36 36 

36160 ......................... Crawford County, Ohio ........................................................................................................ 36 36 

36170 ......................... Cuyahoga County, Ohio ...................................................................................................... 1680 17460 

36190 ......................... Darke County, Ohio ............................................................................................................. 36 36 

36200 ......................... Defiance County, Ohio ........................................................................................................ 36 36 

36210 ......................... Delaware County, Ohio ....................................................................................................... 1840 18140 

36220 ......................... Erie County, Ohio ................................................................................................................ 36 41780 

36230 ......................... Fairfield County, Ohio ......................................................................................................... 1840 18140 

36240 ......................... Fayette County, Ohio .......................................................................................................... 36 36 

36250 ......................... Franklin County, Ohio ......................................................................................................... 1840 18140 

36260 ......................... Fulton County, Ohio ............................................................................................................ 8400 45780 

36270 ......................... Gallia County, Ohio ............................................................................................................. 36 36 

36280 ......................... Geauga County, Ohio ......................................................................................................... 1680 17460 

36290 ......................... Greene County, Ohio .......................................................................................................... 2000 19380 

36300 ......................... Guernsey County, Ohio ....................................................................................................... 36 36 

36310 ......................... Hamilton County, Ohio ........................................................................................................ 1640 17140 

36330 ......................... Hancock County, Ohio ........................................................................................................ 36 36 

36340 ......................... Hardin County, Ohio ............................................................................................................ 36 36 

36350 ......................... Harrison County, Ohio ......................................................................................................... 36 36 

36360 ......................... Henry County, Ohio ............................................................................................................. 36 36 

36370 ......................... Highland County, Ohio ........................................................................................................ 36 36 

36380 ......................... Hocking County, Ohio ......................................................................................................... 36 36 

36390 ......................... Holmes County, Ohio .......................................................................................................... 36 36 

36400 ......................... Huron County, Ohio ............................................................................................................ 36 36 

36410 ......................... Jackson County, Ohio ......................................................................................................... 36 36 

36420 ......................... Jefferson County, Ohio ....................................................................................................... 8080 48260 

36430 ......................... Knox County, Ohio .............................................................................................................. 36 36 

36440 ......................... Lake County, Ohio .............................................................................................................. 1680 17460 

36450 ......................... Lawrence County, Ohio ....................................................................................................... 3400 26580 

36460 ......................... Licking County, Ohio ........................................................................................................... 1840 18140 

36470 ......................... Logan County, Ohio ............................................................................................................ 36 36 

36480 ......................... Lorain County, Ohio ............................................................................................................ 4440 17460 

36490 ......................... Lucas County, Ohio ............................................................................................................. 8400 45780 

46040 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

36500 ......................... Madison County, Ohio ......................................................................................................... 1840 18140 

36510 ......................... Mahoning County, Ohio ...................................................................................................... 9320 49660 

36520 ......................... Marion County, Ohio ........................................................................................................... 36 36 

36530 ......................... Medina County, Ohio .......................................................................................................... 1680 17460 

36540 ......................... Meigs County, Ohio ............................................................................................................. 36 36 

36550 ......................... Mercer County, Ohio ........................................................................................................... 36 36 

36560 ......................... Miami County, Ohio ............................................................................................................. 2000 19380 

36570 ......................... Monroe County, Ohio .......................................................................................................... 36 36 

36580 ......................... Montgomery County, Ohio .................................................................................................. 2000 19380 

36590 ......................... Morgan County, Ohio .......................................................................................................... 36 36 

36600 ......................... Morrow County, Ohio .......................................................................................................... 36 18140 

36610 ......................... Muskingum County, Ohio .................................................................................................... 36 36 

36620 ......................... Noble County, Ohio ............................................................................................................. 36 36 

36630 ......................... Ottawa County, Ohio ........................................................................................................... 36 45780 

36640 ......................... Paulding County, Ohio ........................................................................................................ 36 36 

36650 ......................... Perry County, Ohio .............................................................................................................. 36 36 

36660 ......................... Pickaway County, Ohio ....................................................................................................... 1840 18140 

36670 ......................... Pike County, Ohio ............................................................................................................... 36 36 

36680 ......................... Portage County, Ohio .......................................................................................................... 0080 10420 

36690 ......................... Preble County, Ohio ............................................................................................................ 36 19380 

36700 ......................... Putnam County, Ohio .......................................................................................................... 36 36 

36710 ......................... Richland County, Ohio ........................................................................................................ 4800 31900 

36720 ......................... Ross County, Ohio .............................................................................................................. 36 36 

36730 ......................... Sandusky County, Ohio ...................................................................................................... 36 36 

36740 ......................... Scioto County, Ohio ............................................................................................................ 36 36 

36750 ......................... Seneca County, Ohio .......................................................................................................... 36 36 

36760 ......................... Shelby County, Ohio ........................................................................................................... 36 36 

36770 ......................... Stark County, Ohio .............................................................................................................. 1320 15940 

36780 ......................... Summit County, Ohio .......................................................................................................... 0080 10420 

36790 ......................... Trumbull County, Ohio ........................................................................................................ 9320 49660 

36800 ......................... Tuscarawas County, Ohio ................................................................................................... 36 36 

36810 ......................... Union County, Ohio ............................................................................................................. 1840 18140 

36820 ......................... Van Wert County, Ohio ....................................................................................................... 36 36 

36830 ......................... Vinton County, Ohio ............................................................................................................ 36 36 

36840 ......................... Warren County, Ohio .......................................................................................................... 1640 17140 

36850 ......................... Washington County, Ohio ................................................................................................... 6020 37620 

36860 ......................... Wayne County, Ohio ........................................................................................................... 36 36 

36870 ......................... Williams County, Ohio ......................................................................................................... 36 36 

36880 ......................... Wood County, Ohio ............................................................................................................. 8400 45780 

36890 ......................... Wyandot County, Ohio ........................................................................................................ 36 36 

37000 ......................... Adair County, Oklahoma ..................................................................................................... 37 37 

37010 ......................... Alfalfa County, Oklahoma ................................................................................................... 37 37 

37020 ......................... Atoka County, Oklahoma .................................................................................................... 37 37 

37030 ......................... Beaver County, Oklahoma .................................................................................................. 37 37 

37040 ......................... Beckham County, Oklahoma .............................................................................................. 37 37 

37050 ......................... Blaine County, Oklahoma ................................................................................................... 37 37 

37060 ......................... Bryan County, Oklahoma .................................................................................................... 37 37 

37070 ......................... Caddo County, Oklahoma ................................................................................................... 37 37 

37080 ......................... Canadian County, Oklahoma .............................................................................................. 5880 36420 

37090 ......................... Carter County, Oklahoma ................................................................................................... 37 37 

37100 ......................... Cherokee County, Oklahoma .............................................................................................. 37 37 

37110 ......................... Choctaw County, Oklahoma ............................................................................................... 37 37 

37120 ......................... Cimarron County, Oklahoma ............................................................................................... 37 37 

37130 ......................... Cleveland County, Oklahoma ............................................................................................. 5880 36420 

37140 ......................... Coal County, Oklahoma ...................................................................................................... 37 37 

37150 ......................... Comanche County, Oklahoma ............................................................................................ 4200 30020 

37160 ......................... Cotton County, Oklahoma ................................................................................................... 37 37 

37170 ......................... Craig County, Oklahoma ..................................................................................................... 37 37 

37180 ......................... Creek County, Oklahoma .................................................................................................... 8560 46140 

37190 ......................... Custer County, Oklahoma ................................................................................................... 37 37 

37200 ......................... Delaware County, Oklahoma .............................................................................................. 37 37 

37210 ......................... Dewey County, Oklahoma .................................................................................................. 37 37 

37220 ......................... Ellis County, Oklahoma ....................................................................................................... 37 37 

37230 ......................... Garfield County, Oklahoma ................................................................................................. 2340 37 

37240 ......................... Garvin County, Oklahoma ................................................................................................... 37 37 

37250 ......................... Grady County, Oklahoma .................................................................................................... 37 36420 

37260 ......................... Grant County, Oklahoma .................................................................................................... 37 37 

37270 ......................... Greer County, Oklahoma .................................................................................................... 37 37 

37280 ......................... Harmon County, Oklahoma ................................................................................................. 37 37 

37290 ......................... Harper County, Oklahoma .................................................................................................. 37 37 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46041

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

37300 ......................... Haskell County, Oklahoma .................................................................................................. 37 37 

37310 ......................... Hughes County, Oklahoma ................................................................................................. 37 37 

37320 ......................... Jackson County, Oklahoma ................................................................................................ 37 37 

37330 ......................... Jefferson County, Oklahoma ............................................................................................... 37 37 

37340 ......................... Johnston County, Oklahoma ............................................................................................... 37 37 

37350 ......................... Kay County, Oklahoma ....................................................................................................... 37 37 

37360 ......................... Kingfisher County, Oklahoma ............................................................................................. 37 37 

37370 ......................... Kiowa County, Oklahoma .................................................................................................... 37 37 

37380 ......................... Latimer County, Oklahoma ................................................................................................. 37 37 

37390 ......................... Le Flore County, Oklahoma ................................................................................................ 37 22900 

37400 ......................... Lincoln County, Oklahoma .................................................................................................. 37 36420 

37410 ......................... Logan County, Oklahoma ................................................................................................... 5880 36420 

37420 ......................... Love County, Oklahoma ...................................................................................................... 37 37 

37430 ......................... Mc Clain County, Oklahoma ............................................................................................... 5880 36420 

37440 ......................... Mc Curtain County, Oklahoma ............................................................................................ 37 37 

37450 ......................... Mc Intosh County, Oklahoma .............................................................................................. 37 37 

37460 ......................... Major County, Oklahoma .................................................................................................... 37 37 

37470 ......................... Marshall County, Oklahoma ................................................................................................ 37 37 

37480 ......................... Mayes County, Oklahoma ................................................................................................... 37 37 

37490 ......................... Murray County, Oklahoma .................................................................................................. 37 37 

37500 ......................... Muskogee County, Oklahoma ............................................................................................. 37 37 

37510 ......................... Noble County, Oklahoma .................................................................................................... 37 37 

37520 ......................... Nowata County, Oklahoma ................................................................................................. 37 37 

37530 ......................... Okfuskee County, Oklahoma .............................................................................................. 37 37 

37540 ......................... Oklahoma County, Oklahoma ............................................................................................. 5880 36420 

37550 ......................... Okmulgee County, Oklahoma ............................................................................................. 37 46140 

37560 ......................... Osage County, Oklahoma ................................................................................................... 8560 46140 

37570 ......................... Ottawa County, Oklahoma .................................................................................................. 37 37 

37580 ......................... Pawnee County, Oklahoma ................................................................................................ 37 46140 

37590 ......................... Payne County, Oklahoma ................................................................................................... 37 37 

37600 ......................... Pittsburg County, Oklahoma ............................................................................................... 37 37 

37610 ......................... Pontotoc County, Oklahoma ............................................................................................... 37 37 

37620 ......................... Pottawatomie County, Oklahoma ........................................................................................ 5880 37 

37630 ......................... Pushmataha County, Oklahoma ......................................................................................... 37 37 

37640 ......................... Roger Mills County, Oklahoma ........................................................................................... 37 37 

37650 ......................... Rogers County, Oklahoma .................................................................................................. 8560 46140 

37660 ......................... Seminole County, Oklahoma .............................................................................................. 37 37 

37670 ......................... Sequoyah County, Oklahoma ............................................................................................. 2720 22900 

37680 ......................... Stephens County, Oklahoma .............................................................................................. 37 37 

37690 ......................... Texas County, Oklahoma .................................................................................................... 37 37 

37700 ......................... Tillman County, Oklahoma .................................................................................................. 37 37 

37710 ......................... Tulsa County, Oklahoma ..................................................................................................... 8560 46140 

37720 ......................... Wagoner County, Oklahoma ............................................................................................... 8560 46140 

37730 ......................... Washington County, Oklahoma .......................................................................................... 37 37 

37740 ......................... Washita County, Oklahoma ................................................................................................ 37 37 

37750 ......................... Woods County, Oklahoma .................................................................................................. 37 37 

37760 ......................... Woodward County, Oklahoma ............................................................................................ 37 37 

38000 ......................... Baker County, Oregon ........................................................................................................ 38 38 

38010 ......................... Benton County, Oregon ...................................................................................................... 38 18700 

38020 ......................... Clackamas County, Oregon ................................................................................................ 6440 38900 

38030 ......................... Clatsop County, Oregon ...................................................................................................... 38 38 

38040 ......................... Columbia County, Oregon ................................................................................................... 38 38900 

38050 ......................... Coos County, Oregon ......................................................................................................... 38 38 

38060 ......................... Crook County, Oregon ........................................................................................................ 38 38 

38070 ......................... Curry County, Oregon ......................................................................................................... 38 38 

38080 ......................... Deschutes County, Oregon ................................................................................................. 38 13460 

38090 ......................... Douglas County, Oregon ..................................................................................................... 38 38 

38100 ......................... Gilliam County, Oregon ....................................................................................................... 38 38 

38110 ......................... Grant County, Oregon ......................................................................................................... 38 38 

38120 ......................... Harney County, Oregon ...................................................................................................... 38 38 

38130 ......................... Hood River County, Oregon ................................................................................................ 38 38 

38140 ......................... Jackson County, Oregon ..................................................................................................... 4890 32780 

38150 ......................... Jefferson County, Oregon ................................................................................................... 38 38 

38160 ......................... Josephine County, Oregon ................................................................................................. 38 38 

38170 ......................... Klamath County, Oregon ..................................................................................................... 38 38 

38180 ......................... Lake County, Oregon .......................................................................................................... 38 38 

38190 ......................... Lane County, Oregon .......................................................................................................... 2400 21660 

38200 ......................... Lincoln County, Oregon ...................................................................................................... 38 38 

38210 ......................... Linn County, Oregon ........................................................................................................... 38 38 

38220 ......................... Malheur County, Oregon ..................................................................................................... 38 38 

46042 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

38230 ......................... Marion County, Oregon ....................................................................................................... 7080 41420 

38240 ......................... Morrow County, Oregon ...................................................................................................... 38 38 

38250 ......................... Multnomah County, Oregon ................................................................................................ 6440 38900 

38260 ......................... Polk County, Oregon ........................................................................................................... 7080 41420 

38270 ......................... Sherman County, Oregon ................................................................................................... 38 38 

38280 ......................... Tillamook County, Oregon .................................................................................................. 38 38 

38290 ......................... Umatilla County, Oregon ..................................................................................................... 38 38 

38300 ......................... Union County, Oregon ........................................................................................................ 38 38 

38310 ......................... Wallowa County, Oregon .................................................................................................... 38 38 

38320 ......................... Wasco County, Oregon ....................................................................................................... 38 38 

38330 ......................... Washington County, Oregon ............................................................................................... 6440 38900 

38340 ......................... Wheeler County, Oregon .................................................................................................... 38 38 

38350 ......................... Yamhill County, Oregon ...................................................................................................... 6440 38900 

39000 ......................... Adams County, Pennsylvania ............................................................................................. 9280 39 

39010 ......................... Allegheny County, Pennsylvania ......................................................................................... 6280 38300 

39070 ......................... Armstrong County, Pennsylvania ........................................................................................ 39 38300 

39080 ......................... Beaver County, Pennsylvania ............................................................................................. 0845 38300 

39100 ......................... Bedford County, Pennsylvania ............................................................................................ 39 39 

39110 ......................... Berks County, Pennsylvania ............................................................................................... 6680 39740 

39120 ......................... Blair County, Pennsylvania ................................................................................................. 0280 11020 

39130 ......................... Bradford County, Pennsylvania ........................................................................................... 39 39 

39140 ......................... Bucks County, Pennsylvania ............................................................................................... 6160 37964 

39150 ......................... Butler County, Pennsylvania ............................................................................................... 39 38300 

39160 ......................... Cambria County, Pennsylvania ........................................................................................... 3680 27780 

39180 ......................... Cameron County, Pennsylvania .......................................................................................... 39 39 

39190 ......................... Carbon County, Pennsylvania ............................................................................................. 0240 10900 

39200 ......................... Centre County, Pennsylvania .............................................................................................. 8050 44300 

39210 ......................... Chester County, Pennsylvania ............................................................................................ 6160 37964 

39220 ......................... Clarion County, Pennsylvania ............................................................................................. 39 39 

39230 ......................... Clearfield County, Pennsylvania ......................................................................................... 39 39 

39240 ......................... Clinton County, Pennsylvania ............................................................................................. 39 39 

39250 ......................... Columbia County, Pennsylvania ......................................................................................... 7560 39 

39260 ......................... Crawford County, Pennsylvania .......................................................................................... 39 39 

39270 ......................... Cumberland County, Pennsylvania ..................................................................................... 3240 25420 

39280 ......................... Dauphin County, Pennsylvania ........................................................................................... 3240 25420 

39290 ......................... Delaware County, Pennsylvania ......................................................................................... 6160 37964 

39310 ......................... Elk County, Pennsylvania ................................................................................................... 39 39 

39320 ......................... Erie County, Pennsylvania .................................................................................................. 2360 21500 

39330 ......................... Fayette County, Pennsylvania ............................................................................................ 6280 38300 

39340 ......................... Forest County, Pennsylvania .............................................................................................. 39 39 

39350 ......................... Franklin County, Pennsylvania ............................................................................................ 39 39 

39360 ......................... Fulton County, Pennsylvania .............................................................................................. 39 39 

39370 ......................... Greene County, Pennsylvania ............................................................................................ 39 39 

39380 ......................... Huntingdon County, Pennsylvania ...................................................................................... 39 39 

39390 ......................... Indiana County, Pennsylvania ............................................................................................. 39 39 

39400 ......................... Jefferson County, Pennsylvania .......................................................................................... 39 39 

39410 ......................... Juniata County, Pennsylvania ............................................................................................. 39 39 

39420 ......................... Lackawanna County, Pennsylvania .................................................................................... 7560 42540 

39440 ......................... Lancaster County, Pennsylvania ......................................................................................... 4000 29540 

39450 ......................... Lawrence County, Pennsylvania ......................................................................................... 39 39 

39460 ......................... Lebanon County, Pennsylvania .......................................................................................... 3240 30140 

39470 ......................... Lehigh County, Pennsylvania .............................................................................................. 0240 10900 

39480 ......................... Luzerne County, Pennsylvania ........................................................................................... 7560 42540 

39510 ......................... Lycoming County, Pennsylvania ......................................................................................... 9140 48700 

39520 ......................... Mc Kean County, Pennsylvania .......................................................................................... 39 39 

39530 ......................... Mercer County, Pennsylvania ............................................................................................. 7610 49660 

39540 ......................... Mifflin County, Pennsylvania ............................................................................................... 39 39 

39550 ......................... Monroe County, Pennsylvania ............................................................................................ 7560 39 

39560 ......................... Montgomery County, Pennsylvania .................................................................................... 6160 37964 

39580 ......................... Montour County, Pennsylvania ........................................................................................... 39 39 

39590 ......................... Northampton County, Pennsylvania .................................................................................... 0240 10900 

39600 ......................... Northumberland County, Pennsylvania ............................................................................... 39 39 

39610 ......................... Perry County, Pennsylvania ................................................................................................ 3240 25420 

39620 ......................... Philadelphia County, Pennsylvania ..................................................................................... 6160 37964 

39630 ......................... Pike County, Pennsylvania ................................................................................................. 5660 35084 

39640 ......................... Potter County, Pennsylvania ............................................................................................... 39 39 

39650 ......................... Schuylkill County, Pennsylvania ......................................................................................... 39 39 

39670 ......................... Snyder County, Pennsylvania ............................................................................................. 39 39 

39680 ......................... Somerset County, Pennsylvania ......................................................................................... 3680 39 

39690 ......................... Sullivan County, Pennsylvania ............................................................................................ 39 39 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46043

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

39700 ......................... Susquehanna County, Pennsylvania .................................................................................. 39 39 

39710 ......................... Tioga County, Pennsylvania ............................................................................................... 39 39 

39720 ......................... Union County, Pennsylvania ............................................................................................... 39 39 

39730 ......................... Venango County, Pennsylvania .......................................................................................... 39 39 

39740 ......................... Warren County, Pennsylvania ............................................................................................. 39 39 

39750 ......................... Washington County, Pennsylvania ..................................................................................... 6280 38300 

39760 ......................... Wayne County, Pennsylvania ............................................................................................. 39 39 

39770 ......................... Westmoreland County, Pennsylvania ................................................................................. 6280 38300 

39790 ......................... Wyoming County, Pennsylvania ......................................................................................... 7560 42540 

39800 ......................... York County, Pennsylvania ................................................................................................. 9280 49620 

40010 ......................... Adjuntas County, Puerto Rico ............................................................................................. 40 40 

40020 ......................... Aguada County, Puerto Rico .............................................................................................. 0060 10380 

40030 ......................... Aguadilla County, Puerto Rico ............................................................................................ 0060 10380 

40040 ......................... Aguas Buenas County, Puerto Rico ................................................................................... 7440 41980 

40050 ......................... Aibonito County, Puerto Rico .............................................................................................. 40 41980 

40060 ......................... Anasco County, Puerto Rico ............................................................................................... 4840 10380 

40070 ......................... Arecibo County, Puerto Rico ............................................................................................... 0470 41980 

40080 ......................... Arroyo County, Puerto Rico ................................................................................................ 40 25020 

40090 ......................... Barceloneta County, Puerto Rico ........................................................................................ 7440 41980 

40100 ......................... Barranquitas County, Puerto Rico ...................................................................................... 40 41980 

40110 ......................... Bayamon County, Puerto Rico ............................................................................................ 7440 41980 

40120 ......................... Cabo Rojo County, Puerto Rico .......................................................................................... 4840 41900 

40130 ......................... Caguas County, Puerto Rico .............................................................................................. 1310 41980 

40140 ......................... Camuy County, Puerto Rico ............................................................................................... 0470 41980 

40145 ......................... Canovanas County, Puerto Rico ......................................................................................... 7440 41980 

40150 ......................... Carolina County, Puerto Rico ............................................................................................. 7440 41980 

40160 ......................... Catano County, Puerto Rico ............................................................................................... 7440 41980 

40170 ......................... Cayey County, Puerto Rico ................................................................................................. 1310 41980 

40180 ......................... Ceiba County, Puerto Rico ................................................................................................. 40 21940 

40190 ......................... Ciales County, Puerto Rico ................................................................................................. 40 41980 

40200 ......................... Cidra County, Puerto Rico .................................................................................................. 1310 41980 

40210 ......................... Coamo County, Puerto Rico ............................................................................................... 40 40 

40220 ......................... Comerio County, Puerto Rico ............................................................................................. 40 41980 

40230 ......................... Corozal County, Puerto Rico .............................................................................................. 40 41980 

40240 ......................... Culebra County, Puerto Rico .............................................................................................. 40 40 

40250 ......................... Dorado County, Puerto Rico ............................................................................................... 40 41980 

40260 ......................... Fajardo County, Puerto Rico ............................................................................................... 40 21940 

40265 ......................... Florida County, Puerto Rico ................................................................................................ 40 41980 

40270 ......................... Guanica County, Puerto Rico ............................................................................................. 40 49500 

40280 ......................... Guayama County, Puerto Rico ........................................................................................... 40 25020 

40290 ......................... Guayanilla County, Puerto Rico .......................................................................................... 6360 49500 

40300 ......................... Guaynabo County, Puerto Rico .......................................................................................... 40 41980 

40310 ......................... Gurabo County, Puerto Rico ............................................................................................... 1310 41980 

40320 ......................... Hatillo County, Puerto Rico ................................................................................................. 0470 41980 

40330 ......................... Hormigueros County, Puerto Rico ...................................................................................... 4840 32420 

40340 ......................... Humacao County, Puerto Rico ........................................................................................... 40 41980 

40350 ......................... Isabela County, Puerto Rico ............................................................................................... 40 10380 

40360 ......................... Jayuya County, Puerto Rico ............................................................................................... 40 40 

40370 ......................... Juana Diaz County, Puerto Rico ......................................................................................... 6360 38660 

40380 ......................... Juncos County, Puerto Rico ............................................................................................... 40 41980 

40390 ......................... Lajas County, Puerto Rico .................................................................................................. 40 41900 

40400 ......................... Lares County, Puerto Rico .................................................................................................. 40 10380 

40410 ......................... Las Marias County, Puerto Rico ......................................................................................... 40 40 

40420 ......................... Las Piedras County, Puerto Rico ........................................................................................ 40 41980 

40430 ......................... Loiza County, Puerto Rico .................................................................................................. 7440 41980 

40440 ......................... Luquillo County, Puerto Rico .............................................................................................. 40 21940 

40450 ......................... Manati County, Puerto Rico ................................................................................................ 40 41980 

40460 ......................... Maricao County, Puerto Rico .............................................................................................. 40 40 

40470 ......................... Maunabo County, Puerto Rico ............................................................................................ 40 41980 

40480 ......................... Mayaguez County, Puerto Rico .......................................................................................... 4840 32420 

40490 ......................... Moca County, Puerto Rico .................................................................................................. 0060 10380 

40500 ......................... Morovis County, Puerto Rico .............................................................................................. 40 41980 

40510 ......................... Naguabo County, Puerto Rico ............................................................................................ 40 41980 

40520 ......................... Naranjito County, Puerto Rico ............................................................................................ 40 41980 

40530 ......................... Orocovis County, Puerto Rico ............................................................................................. 40 41980 

40540 ......................... Patillas County, Puerto Rico ............................................................................................... 40 25020 

40550 ......................... Penuelas County, Puerto Rico ............................................................................................ 6360 49500 

40560 ......................... Ponce County, Puerto Rico ................................................................................................. 6360 38660 

40570 ......................... Quebradillas County, Puerto Rico ....................................................................................... 40 41980 

40580 ......................... Rincon County, Puerto Rico ................................................................................................ 40 10380 

46044 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

40590 ......................... Rio Grande County, Puerto Rico ........................................................................................ 40 41980 

40610 ......................... Sabana Grande County, Puerto Rico ................................................................................. 4840 41900 

40620 ......................... Salinas County, Puerto Rico ............................................................................................... 40 40 

40630 ......................... San German County, Puerto Rico ...................................................................................... 4840 41900 

40640 ......................... San Juan County, Puerto Rico ........................................................................................... 40 41980 

40650 ......................... San Lorenzo County, Puerto Rico ...................................................................................... 1310 41980 

40660 ......................... San Sebastian County, Puerto Rico ................................................................................... 40 10380 

40670 ......................... Santa Isabel County, Puerto Rico ....................................................................................... 40 40 

40680 ......................... Toa Alta County, Puerto Rico ............................................................................................. 40 41980 

40690 ......................... Toa Baja County, Puerto Rico ............................................................................................ 40 41980 

40700 ......................... Trujillo Alto County, Puerto Rico ......................................................................................... 40 41980 

40710 ......................... Utuado County, Puerto Rico ............................................................................................... 40 40 

40720 ......................... Vega Alta County, Puerto Rico ........................................................................................... 40 41980 

40730 ......................... Vega Baja County, Puerto Rico .......................................................................................... 40 41980 

40740 ......................... Vieques County, Puerto Rico .............................................................................................. 40 40 

40750 ......................... Villalba County, Puerto Rico ............................................................................................... 6360 38660 

40760 ......................... Yabucoa County, Puerto Rico ............................................................................................. 40 41980 

40770 ......................... Yauco County, Puerto Rico ................................................................................................. 6360 49500 

41000 ......................... Bristol County, Rhode Island .............................................................................................. 6483 39300 

41010 ......................... Kent County, Rhode Island ................................................................................................. 6483 39300 

41020 ......................... Newport County, Rhode Island ........................................................................................... 6483 39300 

41030 ......................... Providence County, Rhode Island ...................................................................................... 6483 39300 

41050 ......................... Washington County, Rhode Island ..................................................................................... 6483 39300 

42000 ......................... Abbeville County, S Carolina .............................................................................................. 42 42 

42010 ......................... Aiken County, S Carolina .................................................................................................... 0600 12260 

42020 ......................... Allendale County, S Carolina .............................................................................................. 42 42 

42030 ......................... Anderson County, S Carolina ............................................................................................. 3160 11340 

42040 ......................... Bamberg County, S Carolina .............................................................................................. 42 42 

42050 ......................... Barnwell County, S Carolina ............................................................................................... 42 42 

42060 ......................... Beaufort County, S Carolina ............................................................................................... 42 42 

42070 ......................... Berkeley County, S Carolina ............................................................................................... 1440 16700 

42080 ......................... Calhoun County, S Carolina ............................................................................................... 42 17900 

42090 ......................... Charleston County, S Carolina ........................................................................................... 1440 16700 

42100 ......................... Cherokee County, S Carolina ............................................................................................. 42 42 

42110 ......................... Chester County, S Carolina ................................................................................................ 42 42 

42120 ......................... Chesterfield County, S Carolina .......................................................................................... 42 42 

42130 ......................... Clarendon County, S Carolina ............................................................................................ 42 42 

42140 ......................... Colleton County, S Carolina ................................................................................................ 42 42 

42150 ......................... Darlington County, S Carolina ............................................................................................ 42 22500 

42160 ......................... Dillon County, S Carolina .................................................................................................... 42 42 

42170 ......................... Dorchester County, S Carolina ........................................................................................... 1440 16700 

42180 ......................... Edgefield County, S Carolina .............................................................................................. 42 12260 

42190 ......................... Fairfield County, S Carolina ................................................................................................ 42 17900 

42200 ......................... Florence County, S Carolina ............................................................................................... 2655 22500 

42210 ......................... Georgetown County, S Carolina ......................................................................................... 42 42 

42220 ......................... Greenville County, S Carolina ............................................................................................. 3160 24860 

42230 ......................... Greenwood County, S Carolina .......................................................................................... 42 42 

42240 ......................... Hampton County, S Carolina .............................................................................................. 42 42 

42250 ......................... Horry County, S Carolina .................................................................................................... 42 34820 

42260 ......................... Jasper County, S Carolina .................................................................................................. 42 42 

42270 ......................... Kershaw County, S Carolina ............................................................................................... 42 17900 

42280 ......................... Lancaster County, S Carolina ............................................................................................. 42 42 

42290 ......................... Laurens County, S Carolina ................................................................................................ 42 24860 

42300 ......................... Lee County, S Carolina ....................................................................................................... 42 42 

42310 ......................... Lexington County, S Carolina ............................................................................................. 1760 17900 

42320 ......................... Mc Cormick County, S Carolina .......................................................................................... 42 42 

42330 ......................... Marion County, S Carolina .................................................................................................. 42 42 

42340 ......................... Marlboro County, S Carolina ............................................................................................... 42 42 

42350 ......................... Newberry County, S Carolina ............................................................................................. 42 42 

42360 ......................... Oconee County, S Carolina ................................................................................................ 42 42 

42370 ......................... Orangeburg County, S Carolina .......................................................................................... 42 42 

42380 ......................... Pickens County, S Carolina ................................................................................................ 3160 24860 

42390 ......................... Richland County, S Carolina ............................................................................................... 1760 17900 

42400 ......................... Saluda County, S Carolina .................................................................................................. 42 17900 

42410 ......................... Spartanburg County, S Carolina ......................................................................................... 3160 43900 

42420 ......................... Sumter County, S Carolina ................................................................................................. 42 44940 

42430 ......................... Union County, S Carolina ................................................................................................... 42 42 

42440 ......................... Williamsburg County, S Carolina ........................................................................................ 42 42 

42450 ......................... York County, S Carolina ..................................................................................................... 1520 16740 

43010 ......................... Aurora County, S Dakota .................................................................................................... 43 43 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46045

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

43020 ......................... Beadle County, S Dakota .................................................................................................... 43 43 

43030 ......................... Bennett County, S Dakota .................................................................................................. 43 43 

43040 ......................... Bon Homme County, S Dakota ........................................................................................... 43 43 

43050 ......................... Brookings County, S Dakota ............................................................................................... 43 43 

43060 ......................... Brown County, S Dakota ..................................................................................................... 43 43 

43070 ......................... Brule County, S Dakota ...................................................................................................... 43 43 

43080 ......................... Buffalo County, S Dakota .................................................................................................... 43 43 

43090 ......................... Butte County, S Dakota ...................................................................................................... 43 43 

43100 ......................... Campbell County, S Dakota ................................................................................................ 43 43 

43110 ......................... Charles Mix County, S Dakota ............................................................................................ 43 43 

43120 ......................... Clark County, S Dakota ...................................................................................................... 43 43 

43130 ......................... Clay County, S Dakota ........................................................................................................ 43 43 

43140 ......................... Codington County, S Dakota .............................................................................................. 43 43 

43150 ......................... Corson County, S Dakota ................................................................................................... 43 43 

43160 ......................... Custer County, S Dakota .................................................................................................... 43 43 

43170 ......................... Davison County, S Dakota .................................................................................................. 43 43 

43180 ......................... Day County, S Dakota ........................................................................................................ 43 43 

43190 ......................... Deuel County, S Dakota ..................................................................................................... 43 43 

43200 ......................... Dewey County, S Dakota .................................................................................................... 43 43 

43210 ......................... Douglas County, S Dakota .................................................................................................. 43 43 

43220 ......................... Edmunds County, S Dakota ................................................................................................ 43 43 

43230 ......................... Fall River County, S Dakota ............................................................................................... 43 43 

43240 ......................... Faulk County, S Dakota ...................................................................................................... 43 43 

43250 ......................... Grant County, S Dakota ...................................................................................................... 43 43 

43260 ......................... Gregory County, S Dakota .................................................................................................. 43 43 

43270 ......................... Haakon County, S Dakota .................................................................................................. 43 43 

43280 ......................... Hamlin County, S Dakota .................................................................................................... 43 43 

43290 ......................... Hand County, S Dakota ...................................................................................................... 43 43 

43300 ......................... Hanson County, S Dakota .................................................................................................. 43 43 

43310 ......................... Harding County, S Dakota .................................................................................................. 43 43 

43320 ......................... Hughes County, S Dakota .................................................................................................. 43 43 

43330 ......................... Hutchinson County, S Dakota ............................................................................................. 43 43 

43340 ......................... Hyde County, S Dakota ...................................................................................................... 43 43 

43350 ......................... Jackson County, S Dakota .................................................................................................. 43 43 

43360 ......................... Jerauld County, S Dakota ................................................................................................... 43 43 

43370 ......................... Jones County, S Dakota ..................................................................................................... 43 43 

43380 ......................... Kingsbury County, S Dakota ............................................................................................... 43 43 

43390 ......................... Lake County, S Dakota ....................................................................................................... 43 43 

43400 ......................... Lawrence County, S Dakota ............................................................................................... 43 43 

43410 ......................... Lincoln County, S Dakota ................................................................................................... 43 43620 

43420 ......................... Lyman County, S Dakota .................................................................................................... 43 43 

43430 ......................... Mc Cook County, S Dakota ................................................................................................ 43 43620 

43440 ......................... Mc Pherson County, S Dakota ........................................................................................... 43 43 

43450 ......................... Marshall County, S Dakota ................................................................................................. 43 43 

43460 ......................... Meade County, S Dakota .................................................................................................... 43 39660 

43470 ......................... Mellette County, S Dakota .................................................................................................. 43 43 

43480 ......................... Miner County, S Dakota ...................................................................................................... 43 43 

43490 ......................... Minnehaha County, S Dakota ............................................................................................. 7760 43620 

43500 ......................... Moody County, S Dakota .................................................................................................... 43 43 

43510 ......................... Pennington County, S Dakota ............................................................................................. 6660 39660 

43520 ......................... Perkins County, S Dakota ................................................................................................... 43 43 

43530 ......................... Potter County, S Dakota ..................................................................................................... 43 43 

43540 ......................... Roberts County, S Dakota .................................................................................................. 43 43 

43550 ......................... Sanborn County, S Dakota ................................................................................................. 43 43 

43560 ......................... Shannon County, S Dakota ................................................................................................ 43 43 

43570 ......................... Spink County, S Dakota ...................................................................................................... 43 43 

43580 ......................... Stanley County, S Dakota ................................................................................................... 43 43 

43590 ......................... Sully County, S Dakota ....................................................................................................... 43 43 

43600 ......................... Todd County, S Dakota ....................................................................................................... 43 43 

43610 ......................... Tripp County, S Dakota ....................................................................................................... 43 43 

43620 ......................... Turner County, S Dakota .................................................................................................... 43 43620 

43630 ......................... Union County, S Dakota ..................................................................................................... 43 43580 

43640 ......................... Walworth County, S Dakota ................................................................................................ 43 43 

43650 ......................... Washabaugh County, S Dakota .......................................................................................... 43 43 

43670 ......................... Yankton County, S Dakota .................................................................................................. 43 43 

43680 ......................... Ziebach County, S Dakota .................................................................................................. 43 43 

44000 ......................... Anderson County, Tennessee ............................................................................................. 3840 28940 

44010 ......................... Bedford County, Tennessee ............................................................................................... 44 44 

44020 ......................... Benton County, Tennessee ................................................................................................. 44 44 

44030 ......................... Bledsoe County, Tennessee ............................................................................................... 44 44 

46046 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

44040 ......................... Blount County, Tennessee .................................................................................................. 3840 28940 

44050 ......................... Bradley County, Tennessee ................................................................................................ 44 17420 

44060 ......................... Campbell County, Tennessee ............................................................................................. 44 44 

44070 ......................... Cannon County, Tennessee ............................................................................................... 44 34980 

44080 ......................... Carroll County, Tennessee ................................................................................................. 44 44 

44090 ......................... Carter County, Tennessee .................................................................................................. 3660 27740 

44100 ......................... Cheatham County, Tennessee ........................................................................................... 5360 34980 

44110 ......................... Chester County, Tennessee ............................................................................................... 44 27180 

44120 ......................... Claiborne County, Tennessee ............................................................................................. 44 44 

44130 ......................... Clay County, Tennessee ..................................................................................................... 44 44 

44140 ......................... Cocke County, Tennessee .................................................................................................. 44 44 

44150 ......................... Coffee County, Tennessee ................................................................................................. 44 44 

44160 ......................... Crockett County, Tennessee ............................................................................................... 44 44 

44170 ......................... Cumberland County, Tennessee ........................................................................................ 44 44 

44180 ......................... Davidson County, Tennessee ............................................................................................. 5360 34980 

44190 ......................... Decatur County, Tennessee ............................................................................................... 44 44 

44200 ......................... De Kalb County, Tennessee ............................................................................................... 44 44 

44210 ......................... Dickson County, Tennessee ............................................................................................... 5360 34980 

44220 ......................... Dyer County, Tennessee .................................................................................................... 44 44 

44230 ......................... Fayette County, Tennessee ................................................................................................ 44 32820 

44240 ......................... Fentress County, Tennessee .............................................................................................. 44 44 

44250 ......................... Franklin County, Tennessee ............................................................................................... 44 44 

44260 ......................... Gibson County, Tennessee ................................................................................................. 44 44 

44270 ......................... Giles County, Tennessee .................................................................................................... 44 44 

44280 ......................... Grainger County, Tennessee .............................................................................................. 3840 34100 

44290 ......................... Greene County, Tennessee ................................................................................................ 44 44 

44300 ......................... Grundy County, Tennessee ................................................................................................ 44 44 

44310 ......................... Hamblen County, Tennessee .............................................................................................. 44 34100 

44320 ......................... Hamilton County, Tennessee .............................................................................................. 1560 16860 

44330 ......................... Hancock County, Tennessee .............................................................................................. 44 44 

44340 ......................... Hardeman County, Tennessee ........................................................................................... 44 44 

44350 ......................... Hardin County, Tennessee ................................................................................................. 44 44 

44360 ......................... Hawkins County, Tennessee .............................................................................................. 3660 28700 

44370 ......................... Haywood County, Tennessee ............................................................................................. 44 44 

44380 ......................... Henderson County, Tennessee .......................................................................................... 44 44 

44390 ......................... Henry County, Tennessee .................................................................................................. 44 44 

44400 ......................... Hickman County, Tennessee .............................................................................................. 44 34980 

44410 ......................... Houston County, Tennessee ............................................................................................... 44 44 

44420 ......................... Humphreys County, Tennessee .......................................................................................... 44 44 

44430 ......................... Jackson County, Tennessee ............................................................................................... 44 44 

44440 ......................... Jefferson County, Tennessee ............................................................................................. 3840 34100 

44450 ......................... Johnson County, Tennessee .............................................................................................. 44 44 

44460 ......................... Knox County, Tennessee .................................................................................................... 3840 28940 

44470 ......................... Lake County, Tennessee .................................................................................................... 44 44 

44480 ......................... Lauderdale County, Tennessee .......................................................................................... 44 44 

44490 ......................... Lawrence County, Tennessee ............................................................................................ 44 44 

44500 ......................... Lewis County, Tennessee ................................................................................................... 44 44 

44510 ......................... Lincoln County, Tennessee ................................................................................................. 44 44 

44520 ......................... Loudon County, Tennessee ................................................................................................ 44 28940 

44530 ......................... Mc Minn County, Tennessee .............................................................................................. 44 44 

44540 ......................... Mc Nairy County, Tennessee .............................................................................................. 44 44 

44550 ......................... Macon County, Tennessee ................................................................................................. 44 34980 

44560 ......................... Madison County, Tennessee .............................................................................................. 3580 27180 

44570 ......................... Marion County, Tennessee ................................................................................................. 1560 16860 

44580 ......................... Marshall County, Tennessee .............................................................................................. 44 44 

44590 ......................... Maury County, Tennessee .................................................................................................. 44 44 

44600 ......................... Meigs County, Tennessee .................................................................................................. 44 44 

44610 ......................... Monroe County, Tennessee ................................................................................................ 44 44 

44620 ......................... Montgomery County, Tennessee ........................................................................................ 1660 17300 

44630 ......................... Moore County, Tennessee .................................................................................................. 44 44 

44640 ......................... Morgan County, Tennessee ................................................................................................ 44 44 

44650 ......................... Obion County, Tennessee .................................................................................................. 44 44 

44660 ......................... Overton County, Tennessee ............................................................................................... 44 44 

44670 ......................... Perry County, Tennessee ................................................................................................... 44 44 

44680 ......................... Pickett County, Tennessee ................................................................................................. 44 44 

44690 ......................... Polk County, Tennessee ..................................................................................................... 44 17420 

44700 ......................... Putnam County, Tennessee ................................................................................................ 44 44 

44710 ......................... Rhea County, Tennessee ................................................................................................... 44 44 

44720 ......................... Roane County, Tennessee ................................................................................................. 44 44 

44730 ......................... Robertson County, Tennessee ........................................................................................... 5360 34980 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46047

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

44740 ......................... Rutherford County, Tennessee ........................................................................................... 5360 34980 

44750 ......................... Scott County, Tennessee .................................................................................................... 44 44 

44760 ......................... Sequatchie County, Tennessee .......................................................................................... 1560 16860 

44770 ......................... Sevier County, Tennessee .................................................................................................. 3840 44 

44780 ......................... Shelby County, Tennessee ................................................................................................. 4920 32820 

44790 ......................... Smith County, Tennessee ................................................................................................... 44 34980 

44800 ......................... Stewart County, Tennessee ................................................................................................ 44 17300 

44810 ......................... Sullivan County, Tennessee ............................................................................................... 3660 28700 

44820 ......................... Sumner County, Tennessee ............................................................................................... 5360 34980 

44830 ......................... Tipton County, Tennessee .................................................................................................. 4920 32820 

44840 ......................... Trousdale County, Tennessee ............................................................................................ 44 34980 

44850 ......................... Unicoi County, Tennessee .................................................................................................. 3660 27740 

44860 ......................... Union County, Tennessee ................................................................................................... 3840 28940 

44870 ......................... Van Buren County, Tennessee ........................................................................................... 44 44 

44880 ......................... Warren County, Tennessee ................................................................................................ 44 44 

44890 ......................... Washington County, Tennessee ......................................................................................... 3660 27740 

44900 ......................... Wayne County, Tennessee ................................................................................................. 44 44 

44910 ......................... Weakley County, Tennessee .............................................................................................. 44 44 

44920 ......................... White County, Tennessee ................................................................................................... 44 44 

44930 ......................... Williamson County, Tennessee ........................................................................................... 5360 34980 

44940 ......................... Wilson County, Tennessee ................................................................................................. 5360 34980 

45000 ......................... Anderson County, Texas ..................................................................................................... 45 45 

45010 ......................... Andrews County, Texas ...................................................................................................... 45 45 

45020 ......................... Angelina County, Texas ...................................................................................................... 45 45 

45030 ......................... Aransas County, Texas ....................................................................................................... 45 18580 

45040 ......................... Archer County, Texas ......................................................................................................... 9080 48660 

45050 ......................... Armstrong County, Texas ................................................................................................... 45 11100 

45060 ......................... Atascosa County, Texas ..................................................................................................... 45 41700 

45070 ......................... Austin County, Texas .......................................................................................................... 45 26420 

45080 ......................... Bailey County, Texas .......................................................................................................... 45 45 

45090 ......................... Bandera County, Texas ...................................................................................................... 45 41700 

45100 ......................... Bastrop County, Texas ........................................................................................................ 0640 12420 

45110 ......................... Baylor County, Texas .......................................................................................................... 45 45 

45113 ......................... Bee County, Texas .............................................................................................................. 45 45 

45120 ......................... Bell County, Texas .............................................................................................................. 3810 28660 

45130 ......................... Bexar County, Texas ........................................................................................................... 7240 41700 

45140 ......................... Blanco County, Texas ......................................................................................................... 45 45 

45150 ......................... Borden County, Texas ........................................................................................................ 45 45 

45160 ......................... Bosque County, Texas ........................................................................................................ 45 45 

45170 ......................... Bowie County, Texas .......................................................................................................... 8360 45500 

45180 ......................... Brazoria County, Texas ....................................................................................................... 1145 26420 

45190 ......................... Brazos County, Texas ......................................................................................................... 1260 17780 

45200 ......................... Brewster County, Texas ...................................................................................................... 45 45 

45201 ......................... Briscoe County, Texas ........................................................................................................ 45 45 

45210 ......................... Brooks County, Texas ......................................................................................................... 45 45 

45220 ......................... Brown County, Texas .......................................................................................................... 45 45 

45221 ......................... Burleson County, Texas ...................................................................................................... 45 17780 

45222 ......................... Burnet County, Texas ......................................................................................................... 45 45 

45223 ......................... Caldwell County, Texas ...................................................................................................... 45 12420 

45224 ......................... Calhoun County, Texas ....................................................................................................... 45 47020 

45230 ......................... Callahan County, Texas ...................................................................................................... 45 10180 

45240 ......................... Cameron County, Texas ..................................................................................................... 1240 15180 

45250 ......................... Camp County, Texas .......................................................................................................... 45 45 

45251 ......................... Carson County, Texas ........................................................................................................ 45 11100 

45260 ......................... Cass County, Texas ............................................................................................................ 45 45 

45270 ......................... Castro County, Texas ......................................................................................................... 45 45 

45280 ......................... Chambers County, Texas ................................................................................................... 45 26420 

45281 ......................... Cherokee County, Texas .................................................................................................... 45 45 

45290 ......................... Childress County, Texas ..................................................................................................... 45 45 

45291 ......................... Clay County, Texas ............................................................................................................. 45 48660 

45292 ......................... Cochran County, Texas ...................................................................................................... 45 45 

45300 ......................... Coke County, Texas ............................................................................................................ 45 45 

45301 ......................... Coleman County, Texas ...................................................................................................... 45 45 

45310 ......................... Collin County, Texas ........................................................................................................... 1920 19124 

45311 ......................... Collingsworth County, Texas .............................................................................................. 45 45 

45312 ......................... Colorado County, Texas ..................................................................................................... 45 45 

45320 ......................... Comal County, Texas .......................................................................................................... 7240 41700 

45321 ......................... Comanche County, Texas ................................................................................................... 45 45 

45330 ......................... Concho County, Texas ........................................................................................................ 45 45 

45340 ......................... Cooke County, Texas .......................................................................................................... 45 45 

46048 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

45341 ......................... Coryell County, Texas ......................................................................................................... 3810 28660 

45350 ......................... Cottle County, Texas ........................................................................................................... 45 45 

45360 ......................... Crane County, Texas .......................................................................................................... 45 45 

45361 ......................... Crockett County, Texas ....................................................................................................... 45 45 

45362 ......................... Crosby County, Texas ......................................................................................................... 45 31180 

45370 ......................... Culberson County, Texas .................................................................................................... 45 45 

45380 ......................... Dallam County, Texas ......................................................................................................... 45 45 

45390 ......................... Dallas County, Texas .......................................................................................................... 1920 19124 

45391 ......................... Dawson County, Texas ....................................................................................................... 45 45 

45392 ......................... Deaf Smith County, Texas .................................................................................................. 45 45 

45400 ......................... Delta County, Texas ............................................................................................................ 45 19124 

45410 ......................... Denton County, Texas ........................................................................................................ 1920 19124 

45420 ......................... De Witt County, Texas ........................................................................................................ 45 45 

45421 ......................... Dickens County, Texas ....................................................................................................... 45 45 

45430 ......................... Dimmit County, Texas ......................................................................................................... 45 45 

45431 ......................... Donley County, Texas ......................................................................................................... 45 45 

45440 ......................... Duval County, Texas ........................................................................................................... 45 45 

45450 ......................... Eastland County, Texas ...................................................................................................... 45 45 

45451 ......................... Ector County, Texas ............................................................................................................ 5800 36220 

45460 ......................... Edwards County, Texas ...................................................................................................... 45 45 

45470 ......................... Ellis County, Texas ............................................................................................................. 1920 19124 

45480 ......................... El Paso County, Texas ....................................................................................................... 2320 21340 

45490 ......................... Erath County, Texas ........................................................................................................... 45 45 

45500 ......................... Falls County, Texas ............................................................................................................ 45 45 

45510 ......................... Fannin County, Texas ......................................................................................................... 45 45 

45511 ......................... Fayette County, Texas ........................................................................................................ 45 45 

45520 ......................... Fisher County, Texas .......................................................................................................... 45 45 

45521 ......................... Floyd County, Texas ........................................................................................................... 45 45 

45522 ......................... Foard County, Texas ........................................................................................................... 45 45 

45530 ......................... Fort Bend County, Texas .................................................................................................... 3360 26420 

45531 ......................... Franklin County, Texas ....................................................................................................... 45 45 

45540 ......................... Freestone County, Texas .................................................................................................... 45 45 

45541 ......................... Frio County, Texas .............................................................................................................. 45 45 

45542 ......................... Gaines County, Texas ......................................................................................................... 45 45 

45550 ......................... Galveston County, Texas .................................................................................................... 2920 26420 

45551 ......................... Garza County, Texas .......................................................................................................... 45 45 

45552 ......................... Gillespie County, Texas ...................................................................................................... 45 45 

45560 ......................... Glasscock County, Texas ................................................................................................... 45 45 

45561 ......................... Goliad County, Texas .......................................................................................................... 45 47020 

45562 ......................... Gonzales County, Texas ..................................................................................................... 45 45 

45563 ......................... Gray County, Texas ............................................................................................................ 45 45 

45564 ......................... Grayson County, Texas ...................................................................................................... 7640 43300 

45570 ......................... Gregg County, Texas .......................................................................................................... 4420 30980 

45580 ......................... Grimes County, Texas ........................................................................................................ 45 45 

45581 ......................... Guadaloupe County, Texas ................................................................................................ 7240 41700 

45582 ......................... Hale County, Texas ............................................................................................................. 45 45 

45583 ......................... Hall County, Texas .............................................................................................................. 45 45 

45590 ......................... Hamilton County, Texas ...................................................................................................... 45 45 

45591 ......................... Hansford County, Texas ..................................................................................................... 45 45 

45592 ......................... Hardeman County, Texas ................................................................................................... 45 45 

45600 ......................... Hardin County, Texas ......................................................................................................... 0840 13140 

45610 ......................... Harris County, Texas .......................................................................................................... 3360 26420 

45620 ......................... Harrison County, Texas ...................................................................................................... 4420 45 

45621 ......................... Hartley County, Texas ......................................................................................................... 45 45 

45630 ......................... Haskell County, Texas ........................................................................................................ 45 45 

45631 ......................... Hays County, Texas ............................................................................................................ 0640 12420 

45632 ......................... Hemphill County, Texas ...................................................................................................... 45 45 

45640 ......................... Henderson County, Texas .................................................................................................. 45 45 

45650 ......................... Hidalgo County, Texas ........................................................................................................ 4880 32580 

45651 ......................... Hill County, Texas ............................................................................................................... 45 45 

45652 ......................... Hockley County, Texas ....................................................................................................... 45 45 

45653 ......................... Hood County, Texas ........................................................................................................... 45 45 

45654 ......................... Hopkins County, Texas ....................................................................................................... 45 45 

45660 ......................... Houston County, Texas ....................................................................................................... 45 45 

45661 ......................... Howard County, Texas ........................................................................................................ 45 45 

45662 ......................... Hudspeth County, Texas ..................................................................................................... 45 45 

45670 ......................... Hunt County, Texas ............................................................................................................ 45 19124 

45671 ......................... Hutchinson County, Texas .................................................................................................. 45 45 

45672 ......................... Irion County, Texas ............................................................................................................. 45 41660 

45680 ......................... Jack County, Texas ............................................................................................................. 45 45 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46049

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

45681 ......................... Jackson County, Texas ....................................................................................................... 45 45 

45690 ......................... Jasper County, Texas ......................................................................................................... 45 45 

45691 ......................... Jeff Davis County, Texas .................................................................................................... 45 45 

45700 ......................... Jefferson County, Texas ..................................................................................................... 0840 13140 

45710 ......................... Jim Hogg County, Texas ..................................................................................................... 45 45 

45711 ......................... Jim Wells County, Texas .................................................................................................... 45 45 

45720 ......................... Johnson County, Texas ...................................................................................................... 2800 23104 

45721 ......................... Jones County, Texas .......................................................................................................... 45 10180 

45722 ......................... Karnes County, Texas ......................................................................................................... 45 45 

45730 ......................... Kaufman County, Texas ...................................................................................................... 1920 19124 

45731 ......................... Kendall County, Texas ........................................................................................................ 45 41700 

45732 ......................... Kenedy County, Texas ........................................................................................................ 45 45 

45733 ......................... Kent County, Texas ............................................................................................................. 45 45 

45734 ......................... Kerr County, Texas ............................................................................................................. 45 45 

45740 ......................... Kimble County, Texas ......................................................................................................... 45 45 

45741 ......................... King County, Texas ............................................................................................................. 45 45 

45742 ......................... Kinney County, Texas ......................................................................................................... 45 45 

45743 ......................... Kleberg County, Texas ........................................................................................................ 45 45 

45744 ......................... Knox County, Texas ............................................................................................................ 45 45 

45750 ......................... Lamar County, Texas .......................................................................................................... 45 45 

45751 ......................... Lamb County, Texas ........................................................................................................... 45 45 

45752 ......................... Lampasas County, Texas ................................................................................................... 45 28660 

45753 ......................... La Salle County, Texas ....................................................................................................... 45 45 

45754 ......................... Lavaca County, Texas ........................................................................................................ 45 45 

45755 ......................... Lee County, Texas .............................................................................................................. 45 45 

45756 ......................... Leon County, Texas ............................................................................................................ 45 45 

45757 ......................... Liberty County, Texas ......................................................................................................... 3360 26420 

45758 ......................... Limestone County, Texas ................................................................................................... 45 45 

45759 ......................... Lipscomb County, Texas ..................................................................................................... 45 45 

45760 ......................... Live Oak County, Texas ...................................................................................................... 45 45 

45761 ......................... Llano County, Texas ........................................................................................................... 45 45 

45762 ......................... Loving County, Texas ......................................................................................................... 45 45 

45770 ......................... Lubbock County, Texas ...................................................................................................... 4600 31180 

45771 ......................... Lynn County, Texas ............................................................................................................ 45 45 

45772 ......................... Mc Culloch County, Texas .................................................................................................. 45 45 

45780 ......................... Mc Lennan County, Texas .................................................................................................. 8800 47380 

45781 ......................... Mc Mullen County, Texas ................................................................................................... 45 45 

45782 ......................... Madison County, Texas ...................................................................................................... 45 45 

45783 ......................... Marion County, Texas ......................................................................................................... 45 45 

45784 ......................... Martin County, Texas .......................................................................................................... 45 45 

45785 ......................... Mason County, Texas ......................................................................................................... 45 45 

45790 ......................... Matagorda County, Texas ................................................................................................... 45 45 

45791 ......................... Maverick County, Texas ...................................................................................................... 45 45 

45792 ......................... Medina County, Texas ........................................................................................................ 45 41700 

45793 ......................... Menard County, Texas ........................................................................................................ 45 45 

45794 ......................... Midland County, Texas ....................................................................................................... 5040 33260 

45795 ......................... Milam County, Texas .......................................................................................................... 45 45 

45796 ......................... Mills County, Texas ............................................................................................................. 45 45 

45797 ......................... Mitchell County, Texas ........................................................................................................ 45 45 

45800 ......................... Montague County, Texas .................................................................................................... 45 45 

45801 ......................... Montgomery County, Texas ................................................................................................ 3360 26420 

45802 ......................... Moore County, Texas .......................................................................................................... 45 45 

45803 ......................... Morris County, Texas .......................................................................................................... 45 45 

45804 ......................... Motley County, Texas ......................................................................................................... 45 45 

45810 ......................... Nacogdoches County, Texas .............................................................................................. 45 45 

45820 ......................... Navarro County, Texas ....................................................................................................... 45 45 

45821 ......................... Newton County, Texas ........................................................................................................ 45 45 

45822 ......................... Nolan County, Texas ........................................................................................................... 45 45 

45830 ......................... Nueces County, Texas ........................................................................................................ 1880 18580 

45831 ......................... Ochiltree County, Texas ...................................................................................................... 45 45 

45832 ......................... Oldham County, Texas ....................................................................................................... 45 45 

45840 ......................... Orange County, Texas ........................................................................................................ 0840 13140 

45841 ......................... Palo Pinto County, Texas ................................................................................................... 45 45 

45842 ......................... Panola County, Texas ......................................................................................................... 45 45 

45843 ......................... Parker County, Texas ......................................................................................................... 2800 23104 

45844 ......................... Parmer County, Texas ........................................................................................................ 45 45 

45845 ......................... Pecos County, Texas .......................................................................................................... 45 45 

45850 ......................... Polk County, Texas ............................................................................................................. 45 45 

45860 ......................... Potter County, Texas .......................................................................................................... 0320 11100 

45861 ......................... Presidio County, Texas ....................................................................................................... 45 45 

46050 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

45870 ......................... Rains County, Texas ........................................................................................................... 45 45 

45871 ......................... Randall County, Texas ........................................................................................................ 0320 11100 

45872 ......................... Reagan County, Texas ....................................................................................................... 45 45 

45873 ......................... Real County, Texas ............................................................................................................. 45 45 

45874 ......................... Red River County, Texas .................................................................................................... 45 45 

45875 ......................... Reeves County, Texas ........................................................................................................ 45 45 

45876 ......................... Refugio County, Texas ........................................................................................................ 45 45 

45877 ......................... Roberts County, Texas ....................................................................................................... 45 45 

45878 ......................... Robertson County, Texas ................................................................................................... 45 17780 

45879 ......................... Rockwall County, Texas ...................................................................................................... 1920 19124 

45880 ......................... Runnels County, Texas ....................................................................................................... 45 45 

45881 ......................... Rusk County, Texas ............................................................................................................ 45 30980 

45882 ......................... Sabine County, Texas ......................................................................................................... 45 45 

45883 ......................... San Augustine County, Texas ............................................................................................ 45 45 

45884 ......................... San Jacinto County, Texas ................................................................................................. 45 26420 

45885 ......................... San Patricio County, Texas ................................................................................................ 1880 18580 

45886 ......................... San Saba County, Texas .................................................................................................... 45 45 

45887 ......................... Schleicher County, Texas ................................................................................................... 45 45 

45888 ......................... Scurry County, Texas .......................................................................................................... 45 45 

45889 ......................... Shackelford County, Texas ................................................................................................. 45 45 

45890 ......................... Shelby County, Texas ......................................................................................................... 45 45 

45891 ......................... Sherman County, Texas ..................................................................................................... 45 45 

45892 ......................... Smith County, Texas ........................................................................................................... 8640 46340 

45893 ......................... Somervell County, Texas .................................................................................................... 45 45 

45900 ......................... Starr County, Texas ............................................................................................................ 45 45 

45901 ......................... Stephens County, Texas ..................................................................................................... 45 45 

45902 ......................... Sterling County, Texas ........................................................................................................ 45 45 

45903 ......................... Stonewall County, Texas .................................................................................................... 45 45 

45904 ......................... Sutton County, Texas .......................................................................................................... 45 45 

45905 ......................... Swisher County, Texas ....................................................................................................... 45 45 

45910 ......................... Tarrant County, Texas ........................................................................................................ 2800 23104 

45911 ......................... Taylor County, Texas .......................................................................................................... 0040 10180 

45912 ......................... Terrell County, Texas .......................................................................................................... 45 45 

45913 ......................... Terry County, Texas ............................................................................................................ 45 45 

45920 ......................... Throckmorton County, Texas .............................................................................................. 45 45 

45921 ......................... Titus County, Texas ............................................................................................................ 45 45 

45930 ......................... Tom Green County, Texas .................................................................................................. 7200 41660 

45940 ......................... Travis County, Texas .......................................................................................................... 0640 12420 

45941 ......................... Trinity County, Texas .......................................................................................................... 45 45 

45942 ......................... Tyler County, Texas ............................................................................................................ 45 45 

45943 ......................... Upshur County, Texas ........................................................................................................ 45 30980 

45944 ......................... Upton County, Texas .......................................................................................................... 45 45 

45945 ......................... Uvalde County, Texas ......................................................................................................... 45 45 

45946 ......................... Val Verde County, Texas .................................................................................................... 45 45 

45947 ......................... Van Zandt County, Texas ................................................................................................... 45 45 

45948 ......................... Victoria County, Texas ........................................................................................................ 8750 47020 

45949 ......................... Walker County, Texas ......................................................................................................... 45 45 

45950 ......................... Waller County, Texas .......................................................................................................... 3360 26420 

45951 ......................... Ward County, Texas ........................................................................................................... 45 45 

45952 ......................... Washington County, Texas ................................................................................................. 45 45 

45953 ......................... Webb County, Texas ........................................................................................................... 4080 29700 

45954 ......................... Wharton County, Texas ...................................................................................................... 45 45 

45955 ......................... Wheeler County, Texas ....................................................................................................... 45 45 

45960 ......................... Wichita County, Texas ........................................................................................................ 9080 48660 

45961 ......................... Wilbarger County, Texas ..................................................................................................... 45 45 

45962 ......................... Willacy County, Texas ......................................................................................................... 45 45 

45970 ......................... Williamson County, Texas ................................................................................................... 0640 12420 

45971 ......................... Wilson County, Texas ......................................................................................................... 45 41700 

45972 ......................... Winkler County, Texas ........................................................................................................ 45 45 

45973 ......................... Wise County, Texas ............................................................................................................ 45 23104 

45974 ......................... Wood County, Texas ........................................................................................................... 45 45 

45980 ......................... Yoakum County, Texas ....................................................................................................... 45 45 

45981 ......................... Young County, Texas .......................................................................................................... 45 45 

45982 ......................... Zapata County, Texas ......................................................................................................... 45 45 

45983 ......................... Zavala County, Texas ......................................................................................................... 45 45 

46000 ......................... Beaver County, Utah ........................................................................................................... 46 46 

46010 ......................... Box Elder County, Utah ...................................................................................................... 46 46 

46020 ......................... Cache County, Utah ............................................................................................................ 46 30860 

46030 ......................... Carbon County, Utah .......................................................................................................... 46 46 

46040 ......................... Daggett County, Utah .......................................................................................................... 46 46 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46051

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

46050 ......................... Davis County, Utah ............................................................................................................. 7160 36260 

46060 ......................... Duchesne County, Utah ...................................................................................................... 46 46 

46070 ......................... Emery County, Utah ............................................................................................................ 46 46 

46080 ......................... Garfield County, Utah .......................................................................................................... 46 46 

46090 ......................... Grand County, Utah ............................................................................................................ 46 46 

46100 ......................... Iron County, Utah ................................................................................................................ 46 46 

46110 ......................... Juab County, Utah .............................................................................................................. 46 39340 

46120 ......................... Kane County, Utah .............................................................................................................. 45 46 

46130 ......................... Millard County, Utah ............................................................................................................ 46 46 

46140 ......................... Morgan County, Utah .......................................................................................................... 46 36260 

46150 ......................... Piute County, Utah .............................................................................................................. 46 46 

46160 ......................... Rich County, Utah ............................................................................................................... 46 46 

46170 ......................... Salt Lake County, Utah ....................................................................................................... 7160 41620 

46180 ......................... San Juan County, Utah ....................................................................................................... 46 46 

46190 ......................... Sanpete County, Utah ......................................................................................................... 46 46 

46200 ......................... Sevier County, Utah ............................................................................................................ 46 46 

46210 ......................... Summit County, Utah .......................................................................................................... 46 41620 

46220 ......................... Tooele County, Utah ........................................................................................................... 46 41620 

46230 ......................... Uintah County, Utah ............................................................................................................ 46 46 

46240 ......................... Utah County, Utah ............................................................................................................... 6520 39340 

46250 ......................... Wasatch County, Utah ........................................................................................................ 46 46 

46260 ......................... Washington County, Utah ................................................................................................... 46 41100 

46270 ......................... Wayne County, Utah ........................................................................................................... 46 46 

46280 ......................... Weber County, Utah ............................................................................................................ 7160 36260 

47000 ......................... Addison County, Vermont ................................................................................................... 47 47 

47010 ......................... Bennington County, Vermont .............................................................................................. 47 47 

47020 ......................... Caledonia County, Vermont ................................................................................................ 47 47 

47030 ......................... Chittenden County, Vermont ............................................................................................... 1303 15540 

47040 ......................... Essex County, Vermont ...................................................................................................... 47 47 

47050 ......................... Franklin County, Vermont ................................................................................................... 47 15540 

47060 ......................... Grand Isle County, Vermont ............................................................................................... 1303 15540 

47070 ......................... Lamoille County, Vermont ................................................................................................... 47 47 

47080 ......................... Orange County, Vermont .................................................................................................... 47 47 

47090 ......................... Orleans County, Vermont .................................................................................................... 47 47 

47100 ......................... Rutland County, Vermont .................................................................................................... 47 47 

47110 ......................... Washington County, Vermont ............................................................................................. 47 47 

47120 ......................... Windham County, Vermont ................................................................................................. 47 47 

47130 ......................... Windsor County, Vermont ................................................................................................... 47 47 

49000 ......................... Accomack County, Virginia ................................................................................................. 49 49 

49010 ......................... Albemarle County, Virginia .................................................................................................. 1540 16820 

49011 ......................... Alexandria City County, Virginia ......................................................................................... 8840 47894 

49020 ......................... Alleghany County, Virginia .................................................................................................. 49 49 

49030 ......................... Amelia County, Virginia ....................................................................................................... 49 40060 

49040 ......................... Amherst County, Virginia .................................................................................................... 4640 31340 

49050 ......................... Appomattox County, Virginia ............................................................................................... 49 31340 

49060 ......................... Arlington County, Virginia .................................................................................................... 8840 47894 

49070 ......................... Augusta County, Virginia ..................................................................................................... 49 49 

49080 ......................... Bath County, Virginia .......................................................................................................... 49 49 

49088 ......................... Bedford City County, Virginia .............................................................................................. 49 31340 

49090 ......................... Bedford County, Virginia ..................................................................................................... 49 31340 

49100 ......................... Bland County, Virginia ......................................................................................................... 49 49 

49110 ......................... Botetourt County, Virginia ................................................................................................... 6800 40220 

49111 ......................... Bristol City County, Virginia ................................................................................................ 3660 28700 

49120 ......................... Brunswick County, Virginia ................................................................................................. 49 49 

49130 ......................... Buchanan County, Virginia .................................................................................................. 49 49 

49140 ......................... Buckingham County, Virginia .............................................................................................. 49 49 

49141 ......................... Buena Vista City County, Virginia ....................................................................................... 49 49 

49150 ......................... Campbell County, Virginia ................................................................................................... 4640 31340 

49160 ......................... Caroline County, Virginia .................................................................................................... 49 40060 

49170 ......................... Carroll County, Virginia ....................................................................................................... 49 49 

49180 ......................... Charles City County, Virginia .............................................................................................. 6760 40060 

49190 ......................... Charlotte County, Virginia ................................................................................................... 49 49 

49191 ......................... Charlottesville City County, Virginia .................................................................................... 1540 16820 

49194 ......................... Chesapeake County, Virginia .............................................................................................. 5720 47260 

49200 ......................... Chesterfield County, Virginia ............................................................................................... 6760 40060 

49210 ......................... Clarke County, Virginia ....................................................................................................... 49 47894 

49211 ......................... Clifton Forge City County, Virginia ...................................................................................... 49 49 

49212 ......................... Colonial Heights County, Virginia ....................................................................................... 6760 40060 

49213 ......................... Covington City County, Virginia .......................................................................................... 49 49 

49220 ......................... Craig County, Virginia ......................................................................................................... 49 40220 

46052 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

49230 ......................... Culpeper County, Virginia ................................................................................................... 49 49 

49240 ......................... Cumberland County, Virginia .............................................................................................. 49 40060 

49241 ......................... Danville City County, Virginia .............................................................................................. 1950 19260 

49250 ......................... Dickenson County, Virginia ................................................................................................. 49 49 

49260 ......................... Dinniddie County, Virginia ................................................................................................... 6760 40060 

49270 ......................... Emporia County, Virginia .................................................................................................... 49 49 

49280 ......................... Essex County, Virginia ........................................................................................................ 49 49 

49288 ......................... Fairfax City County, Virginia ............................................................................................... 8840 47894 

49290 ......................... Fairfax County, Virginia ....................................................................................................... 8840 47894 

49291 ......................... Falls Church City County, Virginia ...................................................................................... 8840 47894 

49300 ......................... Fauquier County, Virginia .................................................................................................... 49 47894 

49310 ......................... Floyd County, Virginia ......................................................................................................... 49 49 

49320 ......................... Fluvanna County, Virginia ................................................................................................... 1540 16820 

49328 ......................... Franklin City County, Virginia .............................................................................................. 49 49 

49330 ......................... Franklin County, Virginia ..................................................................................................... 49 40220 

49340 ......................... Frederick County, Virginia ................................................................................................... 49 49020 

49342 ......................... Fredericksburg City County, Virginia .................................................................................. 49 47894 

49343 ......................... Galax City County, Virginia ................................................................................................. 49 49 

49350 ......................... Giles County, Virginia .......................................................................................................... 49 13980 

49360 ......................... Gloucester County, Virginia ................................................................................................ 5720 47260 

49370 ......................... Goochland County, Virginia ................................................................................................ 6760 40060 

49380 ......................... Grayson County, Virginia .................................................................................................... 49 49 

49390 ......................... Greene County, Virginia ...................................................................................................... 1540 16820 

49400 ......................... Greensville County, Virginia ................................................................................................ 49 49 

49410 ......................... Halifax County, Virginia ....................................................................................................... 49 49 

49411 ......................... Hampton City County, Virginia ............................................................................................ 5720 47260 

49420 ......................... Hanover County, Virginia .................................................................................................... 6760 40060 

49421 ......................... Harrisonburg City County, Virginia ...................................................................................... 49 25500 

49430 ......................... Henrico County, Virginia ..................................................................................................... 6760 40060 

49440 ......................... Henry County, Virginia ........................................................................................................ 49 49 

49450 ......................... Highland County, Virginia .................................................................................................... 49 49 

49451 ......................... Hopewell City County, Virginia ............................................................................................ 6760 40060 

49460 ......................... Isle Of Wight County, Virginia ............................................................................................. 49 47260 

49470 ......................... James City Co County, Virginia .......................................................................................... 5720 47260 

49480 ......................... King And Queen County, Virginia ....................................................................................... 49 40060 

49490 ......................... King George County, Virginia ............................................................................................. 49 49 

49500 ......................... King William County, Virginia .............................................................................................. 49 40060 

49510 ......................... Lancaster County, Virginia .................................................................................................. 49 49 

49520 ......................... Lee County, Virginia ............................................................................................................ 49 49 

49522 ......................... Lexington County, Virginia .................................................................................................. 49 49 

49530 ......................... Loudoun County, Virginia .................................................................................................... 8840 47894 

49540 ......................... Louisa County, Virginia ....................................................................................................... 49 40060 

49550 ......................... Lunenburg County, Virginia ................................................................................................. 49 49 

49551 ......................... Lynchburg City County, Virginia .......................................................................................... 4640 31340 

49560 ......................... Madison County, Virginia .................................................................................................... 49 49 

49561 ......................... Martinsville City County, Virginia ........................................................................................ 49 49 

49563 ......................... Manassas City County, Virginia .......................................................................................... 8840 47894 

49565 ......................... Manassas Park City County, Virginia ................................................................................. 8840 47894 

49570 ......................... Mathews County, Virginia ................................................................................................... 49 47260 

49580 ......................... Mecklenburg County, Virginia ............................................................................................. 49 49 

49590 ......................... Middlesex County, Virginia .................................................................................................. 49 49 

49600 ......................... Montgomery County, Virginia .............................................................................................. 49 13980 

49610 ......................... Nansemond County, Virginia .............................................................................................. 49 49 

49620 ......................... Nelson County, Virginia ....................................................................................................... 49 16820 

49621 ......................... New Kent County, Virginia .................................................................................................. 6760 40060 

49622 ......................... Newport News City County, Virginia ................................................................................... 5720 47260 

49641 ......................... Norfolk City County, Virginia ............................................................................................... 5720 47260 

49650 ......................... Northampton County, Virginia ............................................................................................. 49 49 

49660 ......................... Northumberland County, Virginia ........................................................................................ 49 49 

49661 ......................... Norton City County, Virginia ................................................................................................ 49 49 

49670 ......................... Nottoway County, Virginia ................................................................................................... 49 49 

49680 ......................... Orange County, Virginia ...................................................................................................... 49 49 

49690 ......................... Page County, Virginia ......................................................................................................... 49 49 

49700 ......................... Patrick County, Virginia ....................................................................................................... 49 49 

49701 ......................... Petersburg City County, Virginia ......................................................................................... 6760 40060 

49710 ......................... Pittsylvania County, Virginia ................................................................................................ 1950 19260 

49711 ......................... Portsmouth City County, Virginia ........................................................................................ 5720 47260 

49712 ......................... Poquoson City County, Virginia .......................................................................................... 5720 47260 

49720 ......................... Powhatan County, Virginia .................................................................................................. 6760 40060 

49730 ......................... Prince Edward County, Virginia .......................................................................................... 49 49 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46053

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

49740 ......................... Prince George County, Virginia .......................................................................................... 6760 40060 

49750 ......................... Prince William County, Virginia ........................................................................................... 8840 47894 

49770 ......................... Pulaski County, Virginia ...................................................................................................... 49 13980 

49771 ......................... Radford City County, Virginia .............................................................................................. 49 13980 

49780 ......................... Rappahannock County, Virginia .......................................................................................... 49 49 

49790 ......................... Richmond County, Virginia .................................................................................................. 49 49 

49791 ......................... Richmond City County, Virginia .......................................................................................... 6760 40060 

49800 ......................... Roanoke County, Virginia ................................................................................................... 6800 40220 

49801 ......................... Roanoke City County, Virginia ............................................................................................ 6800 40220 

49810 ......................... Rockbridge County, Virginia ................................................................................................ 49 49 

49820 ......................... Rockingham County, Virginia .............................................................................................. 49 25500 

49830 ......................... Russell County, Virginia ...................................................................................................... 49 49 

49838 ......................... Salem County, Virginia ........................................................................................................ 6800 40220 

49840 ......................... Scott County, Virginia .......................................................................................................... 3660 28700 

49850 ......................... Shenandoah County, Virginia ............................................................................................. 49 49 

49860 ......................... Smyth County, Virginia ........................................................................................................ 49 49 

49867 ......................... South Boston City County, Virginia ..................................................................................... 49 49 

49870 ......................... Southampton County, Virginia ............................................................................................ 49 49 

49880 ......................... Spotsylvania County, Virginia ............................................................................................. 49 47894 

49890 ......................... Stafford County, Virginia ..................................................................................................... 8840 47894 

49891 ......................... Staunton City County, Virginia ............................................................................................ 49 49 

49892 ......................... Suffolk City County, Virginia ............................................................................................... 5720 47260 

49900 ......................... Surry County, Virginia ......................................................................................................... 49 47260 

49910 ......................... Sussex County, Virginia ...................................................................................................... 49 40060 

49920 ......................... Tazewell County, Virginia .................................................................................................... 49 49 

49921 ......................... Virginia Beach City County, Virginia ................................................................................... 5720 47260 

49930 ......................... Warren County, Virginia ...................................................................................................... 49 47894 

49950 ......................... Washington County, Virginia ............................................................................................... 3660 28700 

49951 ......................... Waynesboro City County, Virginia ...................................................................................... 49 49 

49960 ......................... Westmoreland County, Virginia ........................................................................................... 49 49 

49961 ......................... Williamsburg City County, Virginia ...................................................................................... 5720 47260 

49962 ......................... Winchester City County, Virginia ........................................................................................ 49 49020 

49970 ......................... Wise County, Virginia .......................................................................................................... 49 49 

49980 ......................... Wythe County, Virginia ........................................................................................................ 49 49 

49981 ......................... York County, Virginia .......................................................................................................... 5720 47260 

50000 ......................... Adams County, Washington ................................................................................................ 50 50 

50010 ......................... Asotin County, Washington ................................................................................................. 50 30300 

50020 ......................... Benton County, Washington ............................................................................................... 6740 28420 

50030 ......................... Chelan County, Washington ............................................................................................... 50 48300 

50040 ......................... Clallam County, Washington ............................................................................................... 50 50 

50050 ......................... Clark County, Washington .................................................................................................. 8725 38900 

50060 ......................... Columbia County, Washington ............................................................................................ 50 50 

50070 ......................... Cowlitz County, Washington ............................................................................................... 50 31020 

50080 ......................... Douglas County, Washington .............................................................................................. 50 48300 

50090 ......................... Ferry County, Washington .................................................................................................. 50 50 

50100 ......................... Franklin County, Washington .............................................................................................. 6740 28420 

50110 ......................... Garfield County, Washington .............................................................................................. 50 50 

50120 ......................... Grant County, Washington .................................................................................................. 50 50 

50130 ......................... Grays Harbor County, Washington ..................................................................................... 50 50 

50140 ......................... Island County, Washington ................................................................................................. 50 50 

50150 ......................... Jefferson County, Washington ............................................................................................ 50 50 

50160 ......................... King County, Washington .................................................................................................... 7600 42644 

50170 ......................... Kitsap County, Washington ................................................................................................. 1150 14740 

50180 ......................... Kittitas County, Washington ................................................................................................ 50 50 

50190 ......................... Klickitat County, Washington .............................................................................................. 50 50 

50200 ......................... Lewis County, Washington .................................................................................................. 50 50 

50210 ......................... Lincoln County, Washington ............................................................................................... 50 50 

50220 ......................... Mason County, Washington ................................................................................................ 50 50 

50230 ......................... Okanogan County, Washington .......................................................................................... 50 50 

50240 ......................... Pacific County, Washington ................................................................................................ 50 50 

50250 ......................... Pend Oreille County, Washington ....................................................................................... 50 50 

50260 ......................... Pierce County, Washington ................................................................................................. 8200 45104 

50270 ......................... San Juan County, Washington ........................................................................................... 50 50 

50280 ......................... Skagit County, Washington ................................................................................................. 50 34580 

50290 ......................... Skamania County, Washington ........................................................................................... 50 38900 

50300 ......................... Snohomish County, Washington ......................................................................................... 7600 42644 

50310 ......................... Spokane County, Washington ............................................................................................. 7840 44060 

50320 ......................... Stevens County, Washington .............................................................................................. 50 50 

50330 ......................... Thurston County, Washington ............................................................................................. 5910 36500 

50340 ......................... Wahkiakum County, Washington ........................................................................................ 50 50 

46054 Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

50350 ......................... Walla Walla County, Washington ........................................................................................ 50 50 

50360 ......................... Whatcom County, Washington ............................................................................................ 0860 13380 

50370 ......................... Whitman County, Washington ............................................................................................. 50 50 

50380 ......................... Yakima County, Washington ............................................................................................... 9260 49420 

51000 ......................... Barbour County, W Virginia ................................................................................................ 51 51 

51010 ......................... Berkeley County, W Virginia ............................................................................................... 51 25180 

51020 ......................... Boone County, W Virginia ................................................................................................... 51 16620 

51030 ......................... Braxton County, W Virginia ................................................................................................. 51 51 

51040 ......................... Brooke County, W Virginia .................................................................................................. 8080 48260 

51050 ......................... Cabell County, W Virginia ................................................................................................... 3400 26580 

51060 ......................... Calhoun County, W Virginia ................................................................................................ 51 51 

51070 ......................... Clay County, W Virginia ...................................................................................................... 51 16620 

51080 ......................... Doddridge County, W Virginia ............................................................................................. 51 51 

51090 ......................... Fayette County, W Virginia ................................................................................................. 51 51 

51100 ......................... Gilmer County, W Virginia ................................................................................................... 51 51 

51110 ......................... Grant County, W Virginia .................................................................................................... 51 51 

51120 ......................... Greenbrier County, W Virginia ............................................................................................ 51 51 

51130 ......................... Hampshire County, W Virginia ............................................................................................ 51 49020 

51140 ......................... Hancock County, W Virginia ............................................................................................... 8080 48260 

51150 ......................... Hardy County, W Virginia .................................................................................................... 51 51 

51160 ......................... Harrison County, W Virginia ................................................................................................ 51 51 

51170 ......................... Jackson County, W Virginia ................................................................................................ 51 51 

51180 ......................... Jefferson County, W Virginia .............................................................................................. 51 47894 

51190 ......................... Kanawha County, W Virginia .............................................................................................. 1480 16620 

51200 ......................... Lewis County, W Virginia .................................................................................................... 51 51 

51210 ......................... Lincoln County, W Virginia .................................................................................................. 51 16620 

51220 ......................... Logan County, W Virginia ................................................................................................... 51 51 

51230 ......................... Mc Dowell County, W Virginia ............................................................................................ 51 51 

51240 ......................... Marion County, W Virginia .................................................................................................. 51 51 

51250 ......................... Marshall County, W Virginia ................................................................................................ 9000 48540 

51260 ......................... Mason County, W Virginia .................................................................................................. 51 51 

51270 ......................... Mercer County, W Virginia .................................................................................................. 51 51 

51280 ......................... Mineral County, W Virginia ................................................................................................. 1900 19060 

51290 ......................... Mingo County, W Virginia ................................................................................................... 51 51 

51300 ......................... Monongalia County, W Virginia ........................................................................................... 51 34060 

51310 ......................... Monroe County, W Virginia ................................................................................................. 51 51 

51320 ......................... Morgan County, W Virginia ................................................................................................. 51 25180 

51330 ......................... Nicholas County, W Virginia ............................................................................................... 51 51 

51340 ......................... Ohio County, W Virginia ...................................................................................................... 9000 48540 

51350 ......................... Pendleton County, W Virginia ............................................................................................. 51 51 

51360 ......................... Pleasants County, W Virginia ............................................................................................. 51 37620 

51370 ......................... Pocahontas County, W Virginia .......................................................................................... 51 51 

51380 ......................... Preston County, W Virginia ................................................................................................. 51 34060 

51390 ......................... Putnam County, W Virginia ................................................................................................. 1480 16620 

51400 ......................... Raleigh County, W Virginia ................................................................................................. 51 51 

51410 ......................... Randolph County, W Virginia .............................................................................................. 51 51 

51420 ......................... Ritchie County, W Virginia .................................................................................................. 51 51 

51430 ......................... Roane County, W Virginia ................................................................................................... 51 51 

51440 ......................... Summers County, W Virginia .............................................................................................. 51 51 

51450 ......................... Taylor County, W Virginia ................................................................................................... 51 51 

51460 ......................... Tucker County, W Virginia .................................................................................................. 51 51 

51470 ......................... Tyler County, W Virginia ..................................................................................................... 51 51 

51480 ......................... Upshur County, W Virginia .................................................................................................. 51 51 

51490 ......................... Wayne County, W Virginia .................................................................................................. 3400 26580 

51500 ......................... Webster County, W Virginia ................................................................................................ 51 51 

51510 ......................... Wetzel County, W Virginia .................................................................................................. 51 51 

51520 ......................... Wirt County, W Virginia ....................................................................................................... 51 37620 

51530 ......................... Wood County, W Virginia .................................................................................................... 6020 37620 

51540 ......................... Wyoming County, W Virginia .............................................................................................. 51 51 

52000 ......................... Adams County, Wisconsin .................................................................................................. 52 52 

52010 ......................... Ashland County, Wisconsin ................................................................................................ 52 52 

52020 ......................... Barron County, Wisconsin ................................................................................................... 52 52 

52030 ......................... Bayfield County, Wisconsin ................................................................................................. 52 52 

52040 ......................... Brown County, Wisconsin ................................................................................................... 3080 24580 

52050 ......................... Buffalo County, Wisconsin .................................................................................................. 52 52 

52060 ......................... Burnett County, Wisconsin .................................................................................................. 52 52 

52070 ......................... Calumet County, Wisconsin ................................................................................................ 0460 11540 

52080 ......................... Chippewa County, Wisconsin ............................................................................................. 2290 20740 

52090 ......................... Clark County, Wisconsin ..................................................................................................... 52 52 

52100 ......................... Columbia County, Wisconsin .............................................................................................. 52 31540 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 46055

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

52110 ......................... Crawford County, Wisconsin ............................................................................................... 52 52 

52120 ......................... Dane County, Wisconsin ..................................................................................................... 4720 31540 

52130 ......................... Dodge County, Wisconsin ................................................................................................... 52 52 

52140 ......................... Door County, Wisconsin ...................................................................................................... 52 52 

52150 ......................... Douglas County, Wisconsin ................................................................................................ 2240 20260 

52160 ......................... Dunn County, Wisconsin ..................................................................................................... 52 52 

52170 ......................... Eau Claire County, Wisconsin ............................................................................................ 2290 20740 

52180 ......................... Florence County, Wisconsin ............................................................................................... 52 52 

52190 ......................... Fond Du Lac County, Wisconsin ........................................................................................ 52 22540 

52200 ......................... Forest County, Wisconsin ................................................................................................... 52 52 

52210 ......................... Grant County, Wisconsin .................................................................................................... 52 52 

52220 ......................... Green County, Wisconsin ................................................................................................... 52 52 

52230 ......................... Green Lake County, Wisconsin .......................................................................................... 52 52 

52240 ......................... Iowa County, Wisconsin ...................................................................................................... 52 31540 

52250 ......................... Iron County, Wisconsin ....................................................................................................... 52 52 

52260 ......................... Jackson County, Wisconsin ................................................................................................ 52 52 

52270 ......................... Jefferson County, Wisconsin ............................................................................................... 52 52 

52280 ......................... Juneau County, Wisconsin .................................................................................................. 52 52 

52290 ......................... Kenosha County, Wisconsin ............................................................................................... 3800 29404 

52300 ......................... Kewaunee County, Wisconsin ............................................................................................ 52 24580 

52310 ......................... La Crosse County, Wisconsin ............................................................................................. 3870 29100 

52320 ......................... Lafayette County, Wisconsin ............................................................................................... 3880 52 

52330 ......................... Langlade County, Wisconsin ............................................................................................... 52 52 

52340 ......................... Lincoln County, Wisconsin .................................................................................................. 52 52 

52350 ......................... Manitowoc County, Wisconsin ............................................................................................ 52 52 

52360 ......................... Marathon County, Wisconsin .............................................................................................. 8940 48140 

52370 ......................... Marinette County, Wisconsin .............................................................................................. 52 52 

52380 ......................... Marquette County, Wisconsin ............................................................................................. 52 52 

52381 ......................... Menominee County, Wisconsin ........................................................................................... 52 52 

52390 ......................... Milwaukee County, Wisconsin ............................................................................................ 5080 33340 

52400 ......................... Monroe County, Wisconsin ................................................................................................. 52 52 

52410 ......................... Oconto County, Wisconsin .................................................................................................. 52 24580 

52420 ......................... Oneida County, Wisconsin .................................................................................................. 52 52 

52430 ......................... Outagamie County, Wisconsin ............................................................................................ 0460 11540 

52440 ......................... Ozaukee County, Wisconsin ............................................................................................... 5080 33340 

52450 ......................... Pepin County, Wisconsin .................................................................................................... 52 52 

52460 ......................... Pierce County, Wisconsin ................................................................................................... 52 33460 

52470 ......................... Polk County, Wisconsin ...................................................................................................... 52 52 

52480 ......................... Portage County, Wisconsin ................................................................................................. 52 52 

52490 ......................... Price County, Wisconsin ..................................................................................................... 52 52 

52500 ......................... Racine County, Wisconsin .................................................................................................. 6600 39540 

52510 ......................... Richland County, Wisconsin ............................................................................................... 52 52 

52520 ......................... Rock County, Wisconsin ..................................................................................................... 3620 27500 

52530 ......................... Rusk County, Wisconsin ..................................................................................................... 52 52 

52540 ......................... St Croix County, Wisconsin ................................................................................................ 5120 33460 

52550 ......................... Sauk County, Wisconsin ..................................................................................................... 52 52 

52560 ......................... Sawyer County, Wisconsin ................................................................................................. 52 52 

52570 ......................... Shawano County, Wisconsin .............................................................................................. 52 52 

52580 ......................... Sheboygan County, Wisconsin ........................................................................................... 7620 43100 

52590 ......................... Taylor County, Wisconsin ................................................................................................... 52 52 

52600 ......................... Trempealeau County, Wisconsin ........................................................................................ 52 52 

52610 ......................... Vernon County, Wisconsin .................................................................................................. 52 52 

52620 ......................... Vilas County, Wisconsin ...................................................................................................... 52 52 

52630 ......................... Walworth County, Wisconsin .............................................................................................. 52 52 

52640 ......................... Washburn County, Wisconsin ............................................................................................. 52 52 

52650 ......................... Washington County, Wisconsin .......................................................................................... 5080 33340 

52660 ......................... Waukesha County, Wisconsin ............................................................................................ 5080 33340 

52670 ......................... Waupaca County, Wisconsin .............................................................................................. 52 52 

52680 ......................... Waushara County, Wisconsin ............................................................................................. 52 52 

52690 ......................... Winnebago County, Wisconsin ........................................................................................... 0460 36780 

52700 ......................... Wood County, Wisconsin .................................................................................................... 52 52 

53000 ......................... Albany County, Wyoming .................................................................................................... 53 53 

53010 ......................... Big Horn County, Wyoming ................................................................................................. 53 53 

53020 ......................... Campbell County, Wyoming ................................................................................................ 53 53 

53030 ......................... Carbon County, Wyoming ................................................................................................... 53 53 

53040 ......................... Converse County, Wyoming ............................................................................................... 53 53 

53050 ......................... Crook County, Wyoming ..................................................................................................... 53 53 

53060 ......................... Fremont County, Wyoming ................................................................................................. 53 53 

53070 ......................... Goshen County, Wyoming .................................................................................................. 53 53 

53080 ......................... Hot Springs County, Wyoming ............................................................................................ 53 53 

46056

ADDENDUM F.—ESRD FACILITIES—METROPOLITAN STATISTICAL AREAS (MSA)/CORE-BASED STATISTICAL AREAS (CBSA) 

CROSSWALK—Continued

SSA state/county 

code County and state name ESRD MSA No. CBSA No. 

53090 ......................... Johnson County, Wyoming ................................................................................................. 53 53 

53100 ......................... Laramie County, Wyoming .................................................................................................. 1580 16940 

53110 ......................... Lincoln County, Wyoming ................................................................................................... 53 53 

53120 ......................... Natrona County, Wyoming .................................................................................................. 1350 16220 

53130 ......................... Niobrara County, Wyoming ................................................................................................. 53 53 

53140 ......................... Park County, Wyoming ....................................................................................................... 53 53 

53150 ......................... Platte County, Wyoming ...................................................................................................... 53 53 

53160 ......................... Sheridan County, Wyoming ................................................................................................ 53 53 

53170 ......................... Sublette County, Wyoming .................................................................................................. 53 53 

53180 ......................... Sweetwater County, Wyoming ............................................................................................ 53 53 

53190 ......................... Teton County, Wyoming ...................................................................................................... 53 53 

53200 ......................... Uinta County, Wyoming ...................................................................................................... 53 53 

53210 ......................... Washakie County, Wyoming ............................................................................................... 53 53 

53220 ......................... Weston County, Wyoming ................................................................................................... 53 53 

——————————

CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES

UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT

[Effective January 1, 2006] 

CPT/HCPCS

Codes MOD Description Statuscode 

78000 ............................ .................. Thyroid, single uptake .................................................................................................................... A 

78000 ............................ TC ............ Thyroid, single uptake .................................................................................................................... A 

78000 ............................ 26 ............. Thyroid, single uptake .................................................................................................................... A 

78001 ............................ .................. Thyroid, multiple uptakes ............................................................................................................... A 

78001 ............................ TC ............ Thyroid, multiple uptakes ............................................................................................................... A 

78001 ............................ 26 ............. Thyroid, multiple uptakes ............................................................................................................... A 

78003 ............................ .................. Thyroid suppress/stimul ................................................................................................................. A 

78003 ............................ TC ............ Thyroid suppress/stimul ................................................................................................................. A 

78003 ............................ 26 ............. Thyroid suppress/stimul ................................................................................................................. A 

78006 ............................ .................. Thyroid imaging with uptake .......................................................................................................... A 

78006 ............................ TC ............ Thyroid imaging with uptake .......................................................................................................... A 

78006 ............................ 26 ............. Thyroid imaging with uptake .......................................................................................................... A 

78007 ............................ .................. Thyroid image, mult uptakes .......................................................................................................... A 

78007 ............................ TC ............ Thyroid image, mult uptakes .......................................................................................................... A 

78007 ............................ 26 ............. Thyroid image, mult uptakes .......................................................................................................... A 

78010 ............................ .................. Thyroid imaging .............................................................................................................................. A 

78010 ............................ TC ............ Thyroid imaging .............................................................................................................................. A 

78010 ............................ 26 ............. Thyroid imaging .............................................................................................................................. A 

78011 ............................ .................. Thyroid imaging with flow .............................................................................................................. A 

78011 ............................ TC ............ Thyroid imaging with flow .............................................................................................................. A 

78011 ............................ 26 ............. Thyroid imaging with flow .............................................................................................................. A 

78015 ............................ .................. Thyroid met imaging ...................................................................................................................... A 

78015 ............................ TC ............ Thyroid met imaging ...................................................................................................................... A 

78015 ............................ 26 ............. Thyroid met imaging ...................................................................................................................... A 

78016 ............................ .................. Thyroid met imaging/studies .......................................................................................................... A 

78016 ............................ TC ............ Thyroid met imaging/studies .......................................................................................................... A 

78016 ............................ 26 ............. Thyroid met imaging/studies .......................................................................................................... A 

78018 ............................ .................. Thyroid met imaging, body ............................................................................................................ A 

78018 ............................ TC ............ Thyroid met imaging, body ............................................................................................................ A 

78018 ............................ 26 ............. Thyroid met imaging, body ............................................................................................................ A 

78020 ............................ .................. Thyroid met uptake ........................................................................................................................ A 

78020 ............................ TC ............ Thyroid met uptake ........................................................................................................................ A 

78020 ............................ 26 ............. Thyroid met uptake ........................................................................................................................ A 

78070 ............................ .................. Parathyroid nuclear imaging .......................................................................................................... A 

78070 ............................ TC ............ Parathyroid nuclear imaging .......................................................................................................... A 

78070 ............................ 26 ............. Parathyroid nuclear imaging .......................................................................................................... A 

78075 ............................ .................. Adrenal nuclear imaging ................................................................................................................ A 

78075 ............................ TC ............ Adrenal nuclear imaging ................................................................................................................ A 

78075 ............................ 26 ............. Adrenal nuclear imaging ................................................................................................................ A 

78099 ............................ .................. Endocrine nuclear procedure ......................................................................................................... C 

78099 ............................ TC ............ Endocrine nuclear procedure ......................................................................................................... C 

78099 ............................ 26 ............. Endocrine nuclear procedure ......................................................................................................... C 

46057

——————————

CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES

UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued

[Effective January 1, 2006] 

CPT/HCPCS

Codes MOD Description Statuscode 

78102 ............................ .................. Bone marrow imaging, ltd .............................................................................................................. A 

78102 ............................ TC ............ Bone marrow imaging, ltd .............................................................................................................. A 

78102 ............................ 26 ............. Bone marrow imaging, ltd .............................................................................................................. A 

78103 ............................ .................. Bone marrow imaging, mult ........................................................................................................... A 

78103 ............................ TC ............ Bone marrow imaging, mult ........................................................................................................... A 

78103 ............................ 26 ............. Bone marrow imaging, mult ........................................................................................................... A 

78104 ............................ .................. Bone marrow imaging, body .......................................................................................................... A 

78104 ............................ TC ............ Bone marrow imaging, body .......................................................................................................... A 

78104 ............................ 26 ............. Bone marrow imaging, body .......................................................................................................... A 

78110 ............................ .................. Plasma volume, single ................................................................................................................... A 

78110 ............................ TC ............ Plasma volume, single ................................................................................................................... A 

78110 ............................ 26 ............. Plasma volume, single ................................................................................................................... A 

78111 ............................ .................. Plasma volume, multiple ................................................................................................................ A 

78111 ............................ TC ............ Plasma volume, multiple ................................................................................................................ A 

78111 ............................ 26 ............. Plasma volume, multiple ................................................................................................................ A 

78120 ............................ .................. Red cell mass, single ..................................................................................................................... A 

78120 ............................ TC ............ Red cell mass, single ..................................................................................................................... A 

78120 ............................ 26 ............. Red cell mass, single ..................................................................................................................... A 

78121 ............................ .................. Red cell mass, multiple .................................................................................................................. A 

78121 ............................ TC ............ Red cell mass, multiple .................................................................................................................. A 

78121 ............................ 26 ............. Red cell mass, multiple .................................................................................................................. A 

78122 ............................ .................. Blood volume ................................................................................................................................. A 

78122 ............................ TC ............ Blood volume ................................................................................................................................. A 

78122 ............................ 26 ............. Blood volume ................................................................................................................................. A 

78130 ............................ .................. Red cell survival study ................................................................................................................... A 

78130 ............................ TC ............ Red cell survival study ................................................................................................................... A 

78130 ............................ 26 ............. Red cell survival study ................................................................................................................... A 

78135 ............................ .................. Red cell survival kinetics ................................................................................................................ A 

78135 ............................ TC ............ Red cell survival kinetics ................................................................................................................ A 

78135 ............................ 26 ............. Red cell survival kinetics ................................................................................................................ A 

78140 ............................ .................. Red cell sequestration ................................................................................................................... A 

78140 ............................ TC ............ Red cell sequestration ................................................................................................................... A 

78140 ............................ 26 ............. Red cell sequestration ................................................................................................................... A 

78160 ............................ .................. Plasma iron turnover ...................................................................................................................... A 

78160 ............................ TC ............ Plasma iron turnover ...................................................................................................................... A 

78160 ............................ 26 ............. Plasma iron turnover ...................................................................................................................... A 

78162 ............................ .................. Radioiron absorption exam ............................................................................................................ A 

78162 ............................ TC ............ Radioiron absorption exam ............................................................................................................ A 

78162 ............................ 26 ............. Radioiron absorption exam ............................................................................................................ A 

78170 ............................ .................. Red cell iron utilization ................................................................................................................... A 

78170 ............................ TC ............ Red cell iron utilization ................................................................................................................... A 

78170 ............................ 26 ............. Red cell iron utilization ................................................................................................................... A 

78172 ............................ .................. Total body iron estimation .............................................................................................................. C 

78172 ............................ TC ............ Total body iron estimation .............................................................................................................. C 

78172 ............................ 26 ............. Total body iron estimation .............................................................................................................. A 

78185 ............................ .................. Spleen imaging .............................................................................................................................. A 

78185 ............................ TC ............ Spleen imaging .............................................................................................................................. A 

78185 ............................ 26 ............. Spleen imaging .............................................................................................................................. A 

78190 ............................ .................. Platelet survival, kinetics ................................................................................................................ A 

78190 ............................ TC ............ Platelet survival, kinetics ................................................................................................................ A 

78190 ............................ 26 ............. Platelet survival, kinetics ................................................................................................................ A 

78191 ............................ .................. Platelet survival .............................................................................................................................. A 

78191 ............................ TC ............ Platelet survival .............................................................................................................................. A 

78191 ............................ 26 ............. Platelet survival .............................................................................................................................. A 

78195 ............................ .................. Lymph system imaging .................................................................................................................. A 

78195 ............................ TC ............ Lymph system imaging .................................................................................................................. A 

78195 ............................ 26 ............. Lymph system imaging .................................................................................................................. A 

78199 ............................ .................. Blood/lymph nuclear exam ............................................................................................................. C 

78199 ............................ TC ............ Blood/lymph nuclear exam ............................................................................................................. C 

78199 ............................ 26 ............. Blood/lymph nuclear exam ............................................................................................................. C 

78201 ............................ .................. Liver imaging .................................................................................................................................. A 

78201 ............................ TC ............ Liver imaging .................................................................................................................................. A 

78201 ............................ 26 ............. Liver imaging .................................................................................................................................. A 

78202 ............................ .................. Liver imaging with flow ................................................................................................................... A 

46058

——————————

CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES

UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued

[Effective January 1, 2006] 

CPT/HCPCS

Codes MOD Description Statuscode 

78202 ............................ TC ............ Liver imaging with flow ................................................................................................................... A 

78202 ............................ 26 ............. Liver imaging with flow ................................................................................................................... A 

78205 ............................ .................. Liver imaging (3D) .......................................................................................................................... A 

78205 ............................ TC ............ Liver imaging (3D) .......................................................................................................................... A 

78205 ............................ 26 ............. Liver imaging (3D) .......................................................................................................................... A 

78206 ............................ .................. Liver image (3d) with flow .............................................................................................................. A 

78206 ............................ TC ............ Liver image (3d) with flow .............................................................................................................. A 

78206 ............................ 26 ............. Liver image (3d) with flow .............................................................................................................. A 

78215 ............................ .................. Liver and spleen imaging ............................................................................................................... A 

78215 ............................ TC ............ Liver and spleen imaging ............................................................................................................... A 

78215 ............................ 26 ............. Liver and spleen imaging ............................................................................................................... A 

78216 ............................ .................. Liver & spleen image/flow .............................................................................................................. A 

78216 ............................ TC ............ Liver & spleen image/flow .............................................................................................................. A 

78216 ............................ 26 ............. Liver & spleen image/flow .............................................................................................................. A 

78220 ............................ .................. Liver function study ........................................................................................................................ A 

78220 ............................ TC ............ Liver function study ........................................................................................................................ A 

78220 ............................ 26 ............. Liver function study ........................................................................................................................ A 

78223 ............................ .................. Hepatobiliary imaging ..................................................................................................................... A 

78223 ............................ TC ............ Hepatobiliary imaging ..................................................................................................................... A 

78223 ............................ 26 ............. Hepatobiliary imaging ..................................................................................................................... A 

78230 ............................ .................. Salivary gland imaging ................................................................................................................... A 

78230 ............................ TC ............ Salivary gland imaging ................................................................................................................... A 

78230 ............................ 26 ............. Salivary gland imaging ................................................................................................................... A 

78231 ............................ .................. Serial salivary imaging ................................................................................................................... A 

78231 ............................ TC ............ Serial salivary imaging ................................................................................................................... A 

78231 ............................ 26 ............. Serial salivary imaging ................................................................................................................... A 

78232 ............................ .................. Salivary gland function exam ......................................................................................................... A 

78232 ............................ TC ............ Salivary gland function exam ......................................................................................................... A 

78232 ............................ 26 ............. Salivary gland function exam ......................................................................................................... A 

78258 ............................ .................. Esophageal motility study .............................................................................................................. A 

78258 ............................ TC ............ Esophageal motility study .............................................................................................................. A 

78258 ............................ 26 ............. Esophageal motility study .............................................................................................................. A 

78261 ............................ .................. Gastric mucosa imaging ................................................................................................................ A 

78261 ............................ TC ............ Gastric mucosa imaging ................................................................................................................ A 

78261 ............................ 26 ............. Gastric mucosa imaging ................................................................................................................ A 

78262 ............................ .................. Gastroesophageal reflux exam ...................................................................................................... A 

78262 ............................ TC ............ Gastroesophageal reflux exam ...................................................................................................... A 

78262 ............................ 26 ............. Gastroesophageal reflux exam ...................................................................................................... A 

78264 ............................ .................. Gastric emptying study .................................................................................................................. A 

78264 ............................ TC ............ Gastric emptying study .................................................................................................................. A 

78264 ............................ 26 ............. Gastric emptying study .................................................................................................................. A 

78270 ............................ .................. Vit B-12 absorption exam .............................................................................................................. A 

78270 ............................ TC ............ Vit B-12 absorption exam .............................................................................................................. A 

78270 ............................ 26 ............. Vit B-12 absorption exam .............................................................................................................. A 

78271 ............................ .................. Vit b-12 absrp exam, int fac ........................................................................................................... A 

78271 ............................ TC ............ Vit b-12 absrp exam, int fac ........................................................................................................... A 

78271 ............................ 26 ............. Vit b-12 absrp exam, int fac ........................................................................................................... A 

78272 ............................ .................. Vit B-12 absorp, combined ............................................................................................................ A 

78272 ............................ TC ............ Vit B-12 absorp, combined ............................................................................................................ A 

78272 ............................ 26 ............. Vit B-12 absorp, combined ............................................................................................................ A 

78278 ............................ .................. Acute GI blood loss imaging .......................................................................................................... A 

78278 ............................ TC ............ Acute GI blood loss imaging .......................................................................................................... A 

78278 ............................ 26 ............. Acute GI blood loss imaging .......................................................................................................... A 

78282 ............................ .................. GI protein loss exam ...................................................................................................................... C 

78282 ............................ TC ............ GI protein loss exam ...................................................................................................................... C 

78282 ............................ 26 ............. GI protein loss exam ...................................................................................................................... A 

78290 ............................ .................. Meckel’s divert exam ..................................................................................................................... A 

78290 ............................ TC ............ Meckel’s divert exam ..................................................................................................................... A 

78290 ............................ 26 ............. Meckel’s divert exam ..................................................................................................................... A 

78291 ............................ .................. Leveen/shunt patency exam .......................................................................................................... A 

78291 ............................ TC ............ Leveen/shunt patency exam .......................................................................................................... A 

78291 ............................ 26 ............. Leveen/shunt patency exam .......................................................................................................... A 

78299 ............................ .................. GI nuclear procedure ..................................................................................................................... C 

78299 ............................ TC ............ GI nuclear procedure ..................................................................................................................... C 

46059

——————————

CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES

UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued

[Effective January 1, 2006] 

CPT/HCPCS

Codes MOD Description Statuscode 

78299 ............................ 26 ............. GI nuclear procedure ..................................................................................................................... C 

78300 ............................ .................. Bone imaging, limited area ............................................................................................................ A 

78300 ............................ TC ............ Bone imaging, limited area ............................................................................................................ A 

78300 ............................ 26 ............. Bone imaging, limited area ............................................................................................................ A 

78305 ............................ .................. Bone imaging, multiple areas ........................................................................................................ A 

78305 ............................ TC ............ Bone imaging, multiple areas ........................................................................................................ A 

78305 ............................ 26 ............. Bone imaging, multiple areas ........................................................................................................ A 

78306 ............................ .................. Bone imaging, whole body ............................................................................................................. A 

78306 ............................ TC ............ Bone imaging, whole body ............................................................................................................. A 

78306 ............................ 26 ............. Bone imaging, whole body ............................................................................................................. A 

78315 ............................ .................. Bone imaging, 3 phase .................................................................................................................. A 

78315 ............................ TC ............ Bone imaging, 3 phase .................................................................................................................. A 

78315 ............................ 26 ............. Bone imaging, 3 phase .................................................................................................................. A 

78320 ............................ .................. Bone imaging (3D) ......................................................................................................................... A 

78320 ............................ TC ............ Bone imaging (3D) ......................................................................................................................... A 

78320 ............................ 26 ............. Bone imaging (3D) ......................................................................................................................... A 

78350 ............................ .................. Bone mineral, single photon .......................................................................................................... A 

78350 ............................ TC ............ Bone mineral, single photon .......................................................................................................... A 

78350 ............................ 26 ............. Bone mineral, single photon .......................................................................................................... A 

78351 ............................ .................. Bone mineral, dual photon ............................................................................................................. N 

78399 ............................ .................. Musculoskeletal nuclear exam ....................................................................................................... C 

78399 ............................ TC ............ Musculoskeletal nuclear exam ....................................................................................................... C 

78399 ............................ 26 ............. Musculoskeletal nuclear exam ....................................................................................................... C 

78414 ............................ .................. Non-imaging heart function ............................................................................................................ C 

78414 ............................ TC ............ Non-imaging heart function ............................................................................................................ C 

78414 ............................ 26 ............. Non-imaging heart function ............................................................................................................ A 

78428 ............................ .................. Cardiac shunt imaging ................................................................................................................... A 

78428 ............................ TC ............ Cardiac shunt imaging ................................................................................................................... A 

78428 ............................ 26 ............. Cardiac shunt imaging ................................................................................................................... A 

78445 ............................ .................. Vascular flow imaging .................................................................................................................... A 

78445 ............................ TC ............ Vascular flow imaging .................................................................................................................... A 

78445 ............................ 26 ............. Vascular flow imaging .................................................................................................................... A 

78455 ............................ .................. Venous thrombosis study ............................................................................................................... A 

78455 ............................ TC ............ Venous thrombosis study ............................................................................................................... A 

78455 ............................ 26 ............. Venous thrombosis study ............................................................................................................... A 

78456 ............................ .................. Acute venous thrombus image ...................................................................................................... A 

78456 ............................ TC ............ Acute venous thrombus image ...................................................................................................... A 

78456 ............................ 26 ............. Acute venous thrombus image ...................................................................................................... A 

78457 ............................ .................. Venous thrombosis imaging ........................................................................................................... A 

78457 ............................ TC ............ Venous thrombosis imaging ........................................................................................................... A 

78457 ............................ 26 ............. Venous thrombosis imaging ........................................................................................................... A 

78458 ............................ .................. Ven thrombosis images, bilat ......................................................................................................... A 

78458 ............................ TC ............ Ven thrombosis images, bilat ......................................................................................................... A 

78458 ............................ 26 ............. Ven thrombosis images, bilat ......................................................................................................... A 

78459 ............................ .................. Heart muscle imaging (PET) .......................................................................................................... C 

78459 ............................ TC ............ Heart muscle imaging (PET) .......................................................................................................... C 

78459 ............................ 26 ............. Heart muscle imaging (PET) .......................................................................................................... A 

78460 ............................ .................. Heart muscle blood, single ............................................................................................................ A 

78460 ............................ TC ............ Heart muscle blood, single ............................................................................................................ A 

78460 ............................ 26 ............. Heart muscle blood, single ............................................................................................................ A 

78461 ............................ .................. Heart muscle blood, multiple ......................................................................................................... A 

78461 ............................ TC ............ Heart muscle blood, multiple ......................................................................................................... A 

78461 ............................ 26 ............. Heart muscle blood, multiple ......................................................................................................... A 

78464 ............................ .................. Heart image (3d), single ................................................................................................................ A 

78464 ............................ TC ............ Heart image (3d), single ................................................................................................................ A 

78464 ............................ 26 ............. Heart image (3d), single ................................................................................................................ A 

78465 ............................ .................. Heart image (3d), multiple ............................................................................................................. A 

78465 ............................ TC ............ Heart image (3d), multiple ............................................................................................................. A 

78465 ............................ 26 ............. Heart image (3d), multiple ............................................................................................................. A 

78466 ............................ .................. Heart infarct image ......................................................................................................................... A 

78466 ............................ TC ............ Heart infarct image ......................................................................................................................... A 

78466 ............................ 26 ............. Heart infarct image ......................................................................................................................... A 

78468 ............................ .................. Heart infarct image (ef) .................................................................................................................. A 

78468 ............................ TC ............ Heart infarct image (ef) .................................................................................................................. A 

46060

——————————

CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES

UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued

[Effective January 1, 2006] 

CPT/HCPCS

Codes MOD Description Statuscode 

78468 ............................ 26 ............. Heart infarct image (ef) .................................................................................................................. A 

78469 ............................ .................. Heart infarct image (3D) ................................................................................................................ A 

78469 ............................ TC ............ Heart infarct image (3D) ................................................................................................................ A 

78469 ............................ 26 ............. Heart infarct image (3D) ................................................................................................................ A 

78472 ............................ .................. Gated heart, planar, single ............................................................................................................ A 

78472 ............................ TC ............ Gated heart, planar, single ............................................................................................................ A 

78472 ............................ 26 ............. Gated heart, planar, single ............................................................................................................ A 

78473 ............................ .................. Gated heart, multiple ...................................................................................................................... A 

78473 ............................ TC ............ Gated heart, multiple ...................................................................................................................... A 

78473 ............................ 26 ............. Gated heart, multiple ...................................................................................................................... A 

78478 ............................ .................. Heart wall motion add-on ............................................................................................................... A 

78478 ............................ TC ............ Heart wall motion add-on ............................................................................................................... A 

78478 ............................ 26 ............. Heart wall motion add-on ............................................................................................................... A 

78480 ............................ .................. Heart function add-on .................................................................................................................... A 

78480 ............................ TC ............ Heart function add-on .................................................................................................................... A 

78480 ............................ 26 ............. Heart function add-on .................................................................................................................... A 

78481 ............................ .................. Heart first pass, single ................................................................................................................... A 

78481 ............................ TC ............ Heart first pass, single ................................................................................................................... A 

78481 ............................ 26 ............. Heart first pass, single ................................................................................................................... A 

78483 ............................ .................. Heart first pass, multiple ................................................................................................................ A 

78483 ............................ TC ............ Heart first pass, multiple ................................................................................................................ A 

78483 ............................ 26 ............. Heart first pass, multiple ................................................................................................................ A 

78491 ............................ .................. Heart image (pet), single ............................................................................................................... C 

78491 ............................ TC ............ Heart image (pet), single ............................................................................................................... C 

78491 ............................ 26 ............. Heart image (pet), single ............................................................................................................... A 

78492 ............................ .................. Heart image (pet), multiple ............................................................................................................ C 

78492 ............................ TC ............ Heart image (pet), multiple ............................................................................................................ C 

78492 ............................ 26 ............. Heart image (pet), multiple ............................................................................................................ A 

78494 ............................ .................. Heart image, spect ......................................................................................................................... A 

78494 ............................ TC ............ Heart image, spect ......................................................................................................................... A 

78494 ............................ 26 ............. Heart image, spect ......................................................................................................................... A 

78496 ............................ .................. Heart first pass add-on .................................................................................................................. A 

78496 ............................ TC ............ Heart first pass add-on .................................................................................................................. A 

78496 ............................ 26 ............. Heart first pass add-on .................................................................................................................. A 

78499 ............................ .................. Cardiovascular nuclear exam ........................................................................................................ C 

78499 ............................ TC ............ Cardiovascular nuclear exam ........................................................................................................ C 

78499 ............................ 26 ............. Cardiovascular nuclear exam ........................................................................................................ C 

78580 ............................ .................. Lung perfusion imaging .................................................................................................................. A 

78580 ............................ TC ............ Lung perfusion imaging .................................................................................................................. A 

78580 ............................ 26 ............. Lung perfusion imaging .................................................................................................................. A 

78584 ............................ .................. Lung V/Q image single breath ....................................................................................................... A 

78584 ............................ TC ............ Lung V/Q image single breath ....................................................................................................... A 

78584 ............................ 26 ............. Lung V/Q image single breath ....................................................................................................... A 

78585 ............................ .................. Lung V/Q imaging .......................................................................................................................... A 

78585 ............................ TC ............ Lung V/Q imaging .......................................................................................................................... A 

78585 ............................ 26 ............. Lung V/Q imaging .......................................................................................................................... A 

78586 ............................ .................. Aerosol lung image, single ............................................................................................................. A 

78586 ............................ TC ............ Aerosol lung image, single ............................................................................................................. A 

78586 ............................ 26 ............. Aerosol lung image, single ............................................................................................................. A 

78587 ............................ .................. Aerosol lung image, multiple .......................................................................................................... A 

78587 ............................ TC ............ Aerosol lung image, multiple .......................................................................................................... A 

78587 ............................ 26 ............. Aerosol lung image, multiple .......................................................................................................... A 

78588 ............................ .................. Perfusion lung image ..................................................................................................................... A 

78588 ............................ TC ............ Perfusion lung image ..................................................................................................................... A 

78588 ............................ 26 ............. Perfusion lung image ..................................................................................................................... A 

78591 ............................ .................. Vent image, 1 breath, 1 proj .......................................................................................................... A 

78591 ............................ TC ............ Vent image, 1 breath, 1 proj .......................................................................................................... A 

78591 ............................ 26 ............. Vent image, 1 breath, 1 proj .......................................................................................................... A 

78593 ............................ .................. Vent image, 1 proj, gas .................................................................................................................. A 

78593 ............................ TC ............ Vent image, 1 proj, gas .................................................................................................................. A 

78593 ............................ 26 ............. Vent image, 1 proj, gas .................................................................................................................. A 

78594 ............................ .................. Vent image, mult proj, gas ............................................................................................................. A 

78594 ............................ TC ............ Vent image, mult proj, gas ............................................................................................................. A 

78594 ............................ 26 ............. Vent image, mult proj, gas ............................................................................................................. A 

46061

——————————

CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES

UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued

[Effective January 1, 2006] 

CPT/HCPCS

Codes MOD Description Statuscode 

78596 ............................ .................. Lung differential function ................................................................................................................ A 

78596 ............................ TC ............ Lung differential function ................................................................................................................ A 

78596 ............................ 26 ............. Lung differential function ................................................................................................................ A 

78599 ............................ .................. Respiratory nuclear exam .............................................................................................................. C 

78599 ............................ TC ............ Respiratory nuclear exam .............................................................................................................. C 

78599 ............................ 26 ............. Respiratory nuclear exam .............................................................................................................. C 

78600 ............................ .................. Brain imaging, ltd static .................................................................................................................. A 

78600 ............................ TC ............ Brain imaging, ltd static .................................................................................................................. A 

78600 ............................ 26 ............. Brain imaging, ltd static .................................................................................................................. A 

78601 ............................ .................. Brain imaging, ltd w/flow ................................................................................................................ A 

78601 ............................ TC ............ Brain imaging, ltd w/flow ................................................................................................................ A 

78601 ............................ 26 ............. Brain imaging, ltd w/flow ................................................................................................................ A 

78605 ............................ .................. Brain imaging, complete ................................................................................................................ A 

78605 ............................ TC ............ Brain imaging, complete ................................................................................................................ A 

78605 ............................ 26 ............. Brain imaging, complete ................................................................................................................ A 

78606 ............................ .................. Brain imaging, compl w/flow .......................................................................................................... A 

78606 ............................ TC ............ Brain imaging, compl w/flow .......................................................................................................... A 

78606 ............................ 26 ............. Brain imaging, compl w/flow .......................................................................................................... A 

78607 ............................ .................. Brain imaging (3D) ......................................................................................................................... A 

78607 ............................ TC ............ Brain imaging (3D) ......................................................................................................................... A 

78607 ............................ 26 ............. Brain imaging (3D) ......................................................................................................................... A 

78608 ............................ .................. Brain imaging (PET) ....................................................................................................................... C 

78608 ............................ TC ............ Brain imaging (PET) ....................................................................................................................... C 

78608 ............................ 26 ............. Brain imaging (PET) ....................................................................................................................... A 

78609 ............................ .................. Brain imaging (PET) ....................................................................................................................... C 

78609 ............................ TC ............ Brain imaging (PET) ....................................................................................................................... C 

78609 ............................ 26 ............. Brain imaging (PET) ....................................................................................................................... A 

78610 ............................ .................. Brain flow imaging only .................................................................................................................. A 

78610 ............................ TC ............ Brain flow imaging only .................................................................................................................. A 

78610 ............................ 26 ............. Brain flow imaging only .................................................................................................................. A 

78615 ............................ .................. Cerebral vascular flow image ........................................................................................................ A 

78615 ............................ TC ............ Cerebral vascular flow image ........................................................................................................ A 

78615 ............................ 26 ............. Cerebral vascular flow image ........................................................................................................ A 

78630 ............................ .................. Cerebrospinal fluid scan ................................................................................................................ A 

78630 ............................ TC ............ Cerebrospinal fluid scan ................................................................................................................ A 

78630 ............................ 26 ............. Cerebrospinal fluid scan ................................................................................................................ A 

78635 ............................ .................. CSF ventriculography ..................................................................................................................... A 

78635 ............................ TC ............ CSF ventriculography ..................................................................................................................... A 

78635 ............................ 26 ............. CSF ventriculography ..................................................................................................................... A 

78645 ............................ .................. CSF shunt evaluation ..................................................................................................................... A 

78645 ............................ TC ............ CSF shunt evaluation ..................................................................................................................... A 

78645 ............................ 26 ............. CSF shunt evaluation ..................................................................................................................... A 

78647 ............................ .................. Cerebrospinal fluid scan ................................................................................................................ A 

78647 ............................ TC ............ Cerebrospinal fluid scan ................................................................................................................ A 

78647 ............................ 26 ............. Cerebrospinal fluid scan ................................................................................................................ A 

78650 ............................ .................. CSF leakage imaging ..................................................................................................................... A 

78650 ............................ TC ............ CSF leakage imaging ..................................................................................................................... A 

78650 ............................ 26 ............. CSF leakage imaging ..................................................................................................................... A 

78660 ............................ .................. Nuclear exam of tear flow .............................................................................................................. A 

78660 ............................ TC ............ Nuclear exam of tear flow .............................................................................................................. A 

78660 ............................ 26 ............. Nuclear exam of tear flow .............................................................................................................. A 

78699 ............................ .................. Nervous system nuclear exam ...................................................................................................... C 

78699 ............................ TC ............ Nervous system nuclear exam ...................................................................................................... C 

78699 ............................ 26 ............. Nervous system nuclear exam ...................................................................................................... C 

78700 ............................ .................. Kidney imaging, static .................................................................................................................... A 

78700 ............................ TC ............ Kidney imaging, static .................................................................................................................... A 

78700 ............................ 26 ............. Kidney imaging, static .................................................................................................................... A 

78701 ............................ .................. Kidney imaging with flow ............................................................................................................... A 

78701 ............................ TC ............ Kidney imaging with flow ............................................................................................................... A 

78701 ............................ 26 ............. Kidney imaging with flow ............................................................................................................... A 

78704 ............................ .................. Imaging renogram .......................................................................................................................... A 

78704 ............................ TC ............ Imaging renogram .......................................................................................................................... A 

78704 ............................ 26 ............. Imaging renogram .......................................................................................................................... A 

78707 ............................ .................. Kidney flow/function image ............................................................................................................ A 

46062

——————————

CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES

UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued

[Effective January 1, 2006] 

CPT/HCPCS

Codes MOD Description Statuscode 

78707 ............................ TC ............ Kidney flow/function image ............................................................................................................ A 

78707 ............................ 26 ............. Kidney flow/function image ............................................................................................................ A 

78708 ............................ .................. Kidney flow/function image ............................................................................................................ A 

78708 ............................ TC ............ Kidney flow/function image ............................................................................................................ A 

78708 ............................ 26 ............. Kidney flow/function image ............................................................................................................ A 

78709 ............................ .................. Kidney flow/function image ............................................................................................................ A 

78709 ............................ TC ............ Kidney flow/function image ............................................................................................................ A 

78709 ............................ 26 ............. Kidney flow/function image ............................................................................................................ A 

78710 ............................ .................. Kidney imaging (3D) ...................................................................................................................... A 

78710 ............................ TC ............ Kidney imaging (3D) ...................................................................................................................... A 

78710 ............................ 26 ............. Kidney imaging (3D) ...................................................................................................................... A 

78715 ............................ .................. Renal vascular flow exam .............................................................................................................. A 

78715 ............................ TC ............ Renal vascular flow exam .............................................................................................................. A 

78715 ............................ 26 ............. Renal vascular flow exam .............................................................................................................. A 

78725 ............................ .................. Kidney function study ..................................................................................................................... A 

78725 ............................ TC ............ Kidney function study ..................................................................................................................... A 

78725 ............................ 26 ............. Kidney function study ..................................................................................................................... A 

78730 ............................ .................. Urinary bladder retention ............................................................................................................... A 

78730 ............................ TC ............ Urinary bladder retention ............................................................................................................... A 

78730 ............................ 26 ............. Urinary bladder retention ............................................................................................................... A 

78740 ............................ .................. Ureteral reflux study ....................................................................................................................... A 

78740 ............................ TC ............ Ureteral reflux study ....................................................................................................................... A 

78740 ............................ 26 ............. Ureteral reflux study ....................................................................................................................... A 

78760 ............................ .................. Testicular imaging .......................................................................................................................... A 

78760 ............................ TC ............ Testicular imaging .......................................................................................................................... A 

78760 ............................ 26 ............. Testicular imaging .......................................................................................................................... A 

78761 ............................ .................. Testicular imaging/flow ................................................................................................................... A 

78761 ............................ TC ............ Testicular imaging/flow ................................................................................................................... A 

78761 ............................ 26 ............. Testicular imaging/flow ................................................................................................................... A 

78799 ............................ .................. Genitourinary nuclear exam ........................................................................................................... C 

78799 ............................ TC ............ Genitourinary nuclear exam ........................................................................................................... C 

78799 ............................ 26 ............. Genitourinary nuclear exam ........................................................................................................... C 

78800 ............................ .................. Tumor imaging, limited area .......................................................................................................... A 

78800 ............................ TC ............ Tumor imaging, limited area .......................................................................................................... A 

78800 ............................ 26 ............. Tumor imaging, limited area .......................................................................................................... A 

78801 ............................ .................. Tumor imaging, mult areas ............................................................................................................ A 

78801 ............................ TC ............ Tumor imaging, mult areas ............................................................................................................ A 

78801 ............................ 26 ............. Tumor imaging, mult areas ............................................................................................................ A 

78802 ............................ .................. Tumor imaging, whole body ........................................................................................................... A 

78802 ............................ TC ............ Tumor imaging, whole body ........................................................................................................... A 

78802 ............................ 26 ............. Tumor imaging, whole body ........................................................................................................... A 

78803 ............................ .................. Tumor imaging (3D) ....................................................................................................................... A 

78803 ............................ TC ............ Tumor imaging (3D) ....................................................................................................................... A 

78803 ............................ 26 ............. Tumor imaging (3D) ....................................................................................................................... A 

78804 ............................ .................. Tumor imaging, whole body ........................................................................................................... A 

78804 ............................ TC ............ Tumor imaging, whole body ........................................................................................................... A 

78804 ............................ 26 ............. Tumor imaging, whole body ........................................................................................................... A 

78805 ............................ .................. Abscess imaging, ltd area .............................................................................................................. A 

78805 ............................ TC ............ Abscess imaging, ltd area .............................................................................................................. A 

78805 ............................ 26 ............. Abscess imaging, ltd area .............................................................................................................. A 

78806 ............................ .................. Abscess imaging, whole body ....................................................................................................... A 

78806 ............................ TC ............ Abscess imaging, whole body ....................................................................................................... A 

78806 ............................ 26 ............. Abscess imaging, whole body ....................................................................................................... A 

78807 ............................ .................. Nuclear localization/abscess .......................................................................................................... A 

78807 ............................ TC ............ Nuclear localization/abscess .......................................................................................................... A 

78807 ............................ 26 ............. Nuclear localization/abscess .......................................................................................................... A 

78811 ............................ .................. Tumor imaging (pet), limited .......................................................................................................... C 

78811 ............................ TC ............ Tumor imaging (pet), limited .......................................................................................................... C 

78811 ............................ 26 ............. Tumor imaging (pet), limited .......................................................................................................... A 

78812 ............................ .................. Tumor image (pet)/skul-thigh ......................................................................................................... C 

78812 ............................ TC ............ Tumor image (pet)/skul-thigh ......................................................................................................... C 

78812 ............................ 26 ............. Tumor image (pet)/skul-thigh ......................................................................................................... A 

78813 ............................ .................. Tumor image (pet) full body ........................................................................................................... C 

78813 ............................ TC ............ Tumor image (pet) full body ........................................................................................................... C 

46063

——————————

CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES

UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued

[Effective January 1, 2006] 

CPT/HCPCS

Codes MOD Description Statuscode 

78813 ............................ 26 ............. Tumor image (pet) full body ........................................................................................................... A 

78814 ............................ .................. Tumor image pet/ct, limited ........................................................................................................... C 

78814 ............................ TC ............ Tumor image pet/ct, limited ........................................................................................................... C 

78814 ............................ 26 ............. Tumor image pet/ct, limited ........................................................................................................... A 

78815 ............................ .................. Tumorimage pet/ct skul-thigh ......................................................................................................... C 

78815 ............................ TC ............ Tumorimage pet/ct skul-thigh ......................................................................................................... C 

78815 ............................ 26 ............. Tumorimage pet/ct skul-thigh ......................................................................................................... A 

78816 ............................ .................. Tumor image pet/ct full body ......................................................................................................... C 

78816 ............................ TC ............ Tumor image pet/ct full body ......................................................................................................... C 

78816 ............................ 26 ............. Tumor image pet/ct full body ......................................................................................................... A 

78890 ............................ .................. Nuclear medicine data proc ........................................................................................................... B 

78890 ............................ TC ............ Nuclear medicine data proc ........................................................................................................... B 

78890 ............................ 26 ............. Nuclear medicine data proc ........................................................................................................... B 

78891 ............................ .................. Nuclear med data proc .................................................................................................................. B 

78891 ............................ TC ............ Nuclear med data proc .................................................................................................................. B 

78891 ............................ 26 ............. Nuclear med data proc .................................................................................................................. B 

78999 ............................ .................. Nuclear diagnostic exam ................................................................................................................ C 

78999 ............................ TC ............ Nuclear diagnostic exam ................................................................................................................ C 

78999 ............................ 26 ............. Nuclear diagnostic exam ................................................................................................................ C 

79005 ............................ .................. Nuclear rx, oral admin .................................................................................................................... A 

79005 ............................ TC ............ Nuclear rx, oral admin .................................................................................................................... A 

79005 ............................ 26 ............. Nuclear rx, oral admin .................................................................................................................... A 

79101 ............................ .................. Nuclear rx, iv admin ....................................................................................................................... A 

79101 ............................ TC ............ Nuclear rx, iv admin ....................................................................................................................... A 

79101 ............................ 26 ............. Nuclear rx, iv admin ....................................................................................................................... A 

79200 ............................ .................. Nuclear rx, intracav admin ............................................................................................................. A 

79200 ............................ TC ............ Nuclear rx, intracav admin ............................................................................................................. A 

79200 ............................ 26 ............. Nuclear rx, intracav admin ............................................................................................................. A 

79300 ............................ .................. Nuclr rx, interstit colloid .................................................................................................................. C 

79300 ............................ TC ............ Nuclr rx, interstit colloid .................................................................................................................. C 

79300 ............................ 26 ............. Nuclr rx, interstit colloid .................................................................................................................. A 

79403 ............................ .................. Hematopoietic nuclear tx ............................................................................................................... A 

79403 ............................ TC ............ Hematopoietic nuclear tx ............................................................................................................... A 

79403 ............................ 26 ............. Hematopoietic nuclear tx ............................................................................................................... A 

79440 ............................ .................. Nuclear rx, intra-articular ................................................................................................................ A 

79440 ............................ TC ............ Nuclear rx, intra-articular ................................................................................................................ A 

79440 ............................ 26 ............. Nuclear rx, intra-articular ................................................................................................................ A 

79445 ............................ .................. Nuclear rx, intra-arterial ................................................................................................................. A 

79445 ............................ TC ............ Nuclear rx, intra-arterial ................................................................................................................. A 

79445 ............................ 26 ............. Nuclear rx, intra-arterial ................................................................................................................. A 

79999 ............................ .................. Nuclear medicine therapy .............................................................................................................. C 

79999 ............................ TC ............ Nuclear medicine therapy .............................................................................................................. C 

79999 ............................ 26 ............. Nuclear medicine therapy .............................................................................................................. C 

A4641 ........................... .................. Diagnostic imaging agent.

A4642 ........................... .................. Satumomab pendetide per dose.

A9500 ........................... .................. Technetium TC 99m sestamibi.

A9502 ........................... .................. Technetium TC99M tetrofosmin.

A9503 ........................... .................. Technetium TC 99m medronate.

A9504 ........................... .................. Technetium tc 99m apcitide.

A9505 ........................... .................. Thallous chloride TL 201/mci.

A9507 ........................... .................. Indium/111 capromab pendetid.

A9508 ........................... .................. Iobenguane sulfate I-131.

A9510 ........................... .................. Technetium TC99m Disofenin.

A9511 ........................... .................. Technetium TC 99m depreotide.

A9512 ........................... .................. Technetiumtc99mpertechnetate.

A9513 ........................... .................. Technetium tc-99m mebrofenin.

A9514 ........................... .................. Technetiumtc99mpyrophosphate.

A9515 ........................... .................. Technetium tc-99m pentetate.

A9516 ........................... .................. I-123 sodium iodide capsule.

A9517 ........................... .................. Th I131 so iodide cap millic.

A9519 ........................... .................. Technetiumtc-99mmacroag albu.

A9520 ........................... .................. Technetiumtc-99m sulfur clld.

A9521 ........................... .................. Technetiumtc-99m exametazine.

A9522 ........................... .................. Indium111ibritumomabtiuxetan.

46064

ADDENDUM G.—LIST OF CPT/HCPCS CODES USED TO DESCRIBE NUCLEAR MEDICINE DESIGNATED HEALTH SERVICES

UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT—Continued

[Effective January 1, 2006] 

CPT/HCPCS

Codes MOD Description Statuscode 

A9523 ........................... .................. Yttrium90ibritumomabtiuxetan.

A9524 ........................... .................. Iodinated I-131 serumalbumin.

A9526 ........................... .................. Ammonia N-13, per dose.

A9527 ........................... .................. I-131 tositumomab therapeut.

A9528 ........................... .................. Dx I131 so iodide cap millic.

A9529 ........................... .................. Dx I131 so iodide sol millic.

A9530 ........................... .................. Th I131 so iodide sol millic.

A9531 ........................... .................. Dx I131 so iodide microcurie.

A9532 ........................... .................. I-125 serum albumin micro.

A9533 ........................... .................. I-131 tositumomab diagnostic.

A9534 ........................... .................. I-131 tositumomab therapeut.

A9600 ........................... .................. Strontium-89 chloride.

A9603 ........................... .................. I-131sodiumiodidecap per mci.

A9605 ........................... .................. Samarium sm153 lexidronamm.

A9699 ........................... .................. Noc therapeutic radiopharm.

C1079 ........................... .................. CO 57/58 per 0.5 uCi.

C1080 ........................... .................. I-131 tositumomab, dx.

C1081 ........................... .................. I-131 tositumomab, tx.

C1082 ........................... .................. In-111 ibritumomab tiuxetan.

C1083 ........................... .................. Yttrium 90 ibritumomab tiuxe.

C1091 ........................... .................. IN111 oxyquinoline,per0.5mCi.

C1092 ........................... .................. IN 111 pentetate per 0.5 mCi.

C1093 ........................... .................. TC99M fanolesomab.

C1122 ........................... .................. Tc 99M ARCITUMOMAB PER VIAL.

C1200 ........................... .................. TC 99M Sodium Glucoheptonat.

C1201 ........................... .................. TC 99M SUCCIMER, PER Vial.

C1775 ........................... .................. FDG, per dose (4-40 mCi/ml).

C9102 ........................... .................. 51 Na Chromate, 50mCi.

C9103 ........................... .................. Na Iothalamate I-125, 10 uCi.

C9400 ........................... .................. Thallous chloride, brand.

C9401 ........................... .................. Strontium-89 chloride,brand.

C9402 ........................... .................. Th I131 so iodide cap, brand.

C9403 ........................... .................. Dx I131 so iodide cap, brand.

C9404 ........................... .................. Dx I131 so iodide sol, brand.

C9405 ........................... .................. Th I131 so iodide sol, brand.

Q3000 ........................... .................. Rubidium RB-82.

Q3002 ........................... .................. Gallium ga 67.

Q3003 ........................... .................. Technetium tc99m bicisate.

Q3004 ........................... .................. Xenon xe 133.

Q3005 ........................... .................. Technetium tc99m mertiatide.

Q3006 ........................... .................. Technetium tc99m glucepatate.

Q3007 ........................... .................. Sodium phosphate p32.

Q3008 ........................... .................. Indium 111-in pentetreotide.

Q3009 ........................... .................. Technetium tc99m oxidronate.

Q3010 ........................... .................. Technetium tc99mlabeledrbcs.

Q3011 ........................... .................. Chromic phosphate p32.

CPT codes and descriptions only are copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 

Federal Register / Vol. 70, No. 151 / Monday, August 8, 2005 / Proposed Rules 

[FR Doc. 05–15370 Filed 8–1–05; 4:16 pm] 

BILLING CODE 4120–01–P