Addendum B.-Proposed OPPS Payment by HCPCS Code for CY

2012

HCPCS Code Short Descriptor CI SI APC Relative Weight Payment Rate National Unadjusted

Copayment Minimum Unadjusted Copayment

00100 Anesth salivary

gland N

00102 Anesth repair of cleft

lip N

00103 Anesth

blepharoplasty N

00104 Anesth

electroshock N

00120 Anesth ear

surgery N

00124 Anesth ear

exam N

00126 Anesth

tympanotomy N

00140 Anesth procedures on

eye N

00142 Anesth lens

surgery N

00144 Anesth corneal

transplant N

00145 Anesth vitreoretinal

surg N

00147 Anesth

iridectomy N

00148 Anesth eye

exam N

00160 Anesth nose/sinus

surgery N

00162 Anesth nose/sinus

surgery N

00164 Anesth biopsy of

nose N

00170 Anesth procedure on

mouth N

00172 Anesth cleft palate

repair N

00174 Anesth pharyngeal

surgery N

00176 Anesth pharyngealsurgery C

00190 Anesth face/skull bone

surg N

00192 Anesth facial bone

surgery C

00210 Anesth cranial surg

nos N

00211 Anesth cran surg

hemotoma C

00212 Anesth skull

drainage N

00214 Anesth skull

drainage C

00215 Anesth skull

repair/fract C

00216 Anesth head vessel

surgery N

00218 Anesth special head

surgery N

00220 Anesth intrcrn

nerve N

00222 Anesth head nerve

surgery N

00300 Anesth

head/neck/ptrunk N

00320 Anesth neck organ 1 &

over N

00322 Anesth biopsy of

thyroid N

00326 Anesth larynx/trach < 1

yr N

00350 Anesth neck vessel

surgery N

00352 Anesth neck vessel

surgery N

00400 Anesth skin

ext/per/atrunk N

00402 Anesth surgery of

breast N

00404 Anesth surgery of

breast N

00406 Anesth surgery of

breast N

00410 Anesth correct heartrhythm N

00450 Anesth surgery of

shoulder N

00452 Anesth surgery of

shoulder C

00454 Anesth collar bone

biopsy N

00470 Anesth removal of

rib N

00472 Anesth chest wall

repair N

00474 Anesth surgery of

rib(s) C

00500 Anesth esophageal

surgery N

00520 Anesth chest

procedure N

00522 Anesth chest lining

biopsy N

00524 Anesth chest

drainage C

00528 Anesth chest partition

view N

00529 Anesth chest partition

view N

00530 Anesth pacemaker

insertion N

00532 Anesth vascular

access N

00534 Anesth

cardioverter/defib N

00537 Anesth cardiac

electrophys N

00539 Anesth trach-bronch

reconst N

00540 Anesth chest

surgery C

00541 Anesth one lung

ventilation N

00542 Anesth release of

lung C

00546 Anesth lung chest wall

surg C

00548 Anesth trachea bronchisurg N

00550 Anesth sternal

debridement N

00560 Anesth heart surg w/o

pump C

00561 Anesth heart surg < 1

yr C

00562 Anesth hrt surg w/pmp age

1+ C

00563 Anesth heart surg

w/arrest N

00566 Anesth cabg w/o

pump N

00567 Anesth cabg

w/pump C

00580 Anesth heart/lung

transplnt C

00600 Anesth spine cord

surgery N

00604 Anesth sitting

procedure C

00620 Anesth spine cord

surgery N

00622 Anesth removal of

nerves C

00625 Anes spine tranthor w/o

vent N

00626 Anes spine transthor

w/vent N

00630 Anesth spine cord

surgery N

00632 Anesth removal of

nerves C

00634 Anesth for

chemonucleolysis N

00635 Anesth lumbar

puncture N

00640 Anesth spine

manipulation N

00670 Anesth spine cord

surgery C

00700 Anesth abdominal wall

surg N

00702 Anesth for liverbiopsy N

00730 Anesth abdominal wall

surg N

00740 Anesth upper gi

visualize N

00750 Anesth repair of

hernia N

00752 Anesth repair of

hernia N

00754 Anesth repair of

hernia N

00756 Anesth repair of

hernia N

00770 Anesth blood vessel

repair N

00790 Anesth surg upper

abdomen N

00792 Anesth hemorr/excise

liver C

00794 Anesth pancreas

removal C

00796 Anesth for liver

transplant C

00797 Anesth surgery for

obesity N

00800 Anesth abdominal wall

surg N

00802 Anesth fat layer

removal C

00810 Anesth low intestine

scope N

00820 Anesth abdominal wall

surg N

00830 Anesth repair of

hernia N

00832 Anesth repair of

hernia N

00834 Anesth hernia repair < 1

yr N

00836 Anesth hernia repair

preemie N

00840 Anesth surg lower

abdomen N

00842 Anesthamniocentesis N

00844 Anesth pelvis

surgery C

00846 Anesth

hysterectomy C

00848 Anesth pelvic organ

surg C

00851 Anesth tubal

ligation N

00860 Anesth surgery of

abdomen N

00862 Anesth kidney/ureter

surg N

00864 Anesth removal of

bladder C

00865 Anesth removal of

prostate C

00866 Anesth removal of

adrenal C

00868 Anesth kidney

transplant C

00870 Anesth bladder stone

surg N

00872 Anesth kidney stone

destruct N

00873 Anesth kidney stone

destruct N

00880 Anesth abdomen vessel

surg N

00882 Anesth major vein

ligation C

00902 Anesth anorectal

surgery N

00904 Anesth perineal

surgery C

00906 Anesth removal of

vulva N

00908 Anesth removal of

prostate C

00910 Anesth bladder

surgery N

00912 Anesth bladder tumor

surg N

00914 Anesth removal ofprostate N

00916 Anesth bleeding

control N

00918 Anesth stone

removal N

00920 Anesth genitalia

surgery N

00921 Anesth

vasectomy N

00922 Anesth sperm duct

surgery N

00924 Anesth testis

exploration N

00926 Anesth removal of

testis N

00928 Anesth removal of

testis N

00930 Anesth testis

suspension N

00932 Anesth amputation of

penis C

00934 Anesth penis nodes

removal C

00936 Anesth penis nodes

removal C

00938 Anesth insert penis

device N

00940 Anesth vaginal

procedures N

00942 Anesth surg on

vag/urethral N

00944 Anesth vaginal

hysterectomy C

00948 Anesth repair of

cervix N

00950 Anesth vaginal

endoscopy N

00952 Anesth

hysteroscope/graph N

01112 Anesth bone

aspirate/bx N

01120 Anesth pelvis

surgery N

01130 Anesth body castprocedure N

01140 Anesth amputation at

pelvis C

01150 Anesth pelvic tumor

surgery C

01160 Anesth pelvis

procedure N

01170 Anesth pelvis

surgery N

01173 Anesth fx repair

pelvis N

01180 Anesth pelvis nerve

removal N

01190 Anesth pelvis nerve

removal N

01200 Anesth hip joint

procedure N

01202 Anesth arthroscopy of

hip N

01210 Anesth hip joint

surgery N

01212 Anesth hip

disarticulation C

01214 Anesth hip

arthroplasty C

01215 Anesth revise hip

repair N

01220 Anesth procedure on

femur N

01230 Anesth surgery of

femur N

01232 Anesth amputation of

femur C

01234 Anesth radical femur

surg C

01250 Anesth upper leg

surgery N

01260 Anesth upper leg veins

surg N

01270 Anesth thigh arteries

surg N

01272 Anesth femoral artery

surg C

01274 Anesth femoralembolectomy C

01320 Anesth knee area

surgery N

01340 Anesth knee area

procedure N

01360 Anesth knee area

surgery N

01380 Anesth knee joint

procedure N

01382 Anesth dx knee

arthroscopy N

01390 Anesth knee area

procedure N

01392 Anesth knee area

surgery N

01400 Anesth knee joint

surgery N

01402 Anesth knee

arthroplasty C

01404 Anesth amputation at

knee C

01420 Anesth knee joint

casting N

01430 Anesth knee veins

surgery N

01432 Anesth knee vessel

surg N

01440 Anesth knee arteries

surg N

01442 Anesth knee artery

surg C

01444 Anesth knee artery

repair C

01462 Anesth lower leg

procedure N

01464 Anesth ankle/ft

arthroscopy N

01470 Anesth lower leg

surgery N

01472 Anesth achilles tendon

surg N

01474 Anesth lower leg

surgery N

01480 Anesth lower leg bonesurg N

01482 Anesth radical leg

surgery N

01484 Anesth lower leg

revision N

01486 Anesth ankle

replacement C

01490 Anesth lower leg

casting N

01500 Anesth leg arteries

surg N

01502 Anesth lwr leg

embolectomy C

01520 Anesth lower leg vein

surg N

01522 Anesth lower leg vein

surg N

01610 Anesth surgery of

shoulder N

01620 Anesth shoulder

procedure N

01622 Anes dx shoulder

arthroscopy N

01630 Anesth surgery of

shoulder N

01634 Anesth shoulder joint

amput C

01636 Anesth forequarter

amput C

01638 Anesth shoulder

replacement C

01650 Anesth shoulder artery

surg N

01652 Anesth shoulder vessel

surg C

01654 Anesth shoulder vessel

surg C

01656 Anesth arm-leg vessel

surg C

01670 Anesth shoulder vein

surg N

01680 Anesth shoulder

casting N

01682 Anesth airplanecast N

01710 Anesth elbow area

surgery N

01712 Anesth uppr arm tendon

surg N

01714 Anesth uppr arm tendon

surg N

01716 Anesth biceps tendon

repair N

01730 Anesth uppr arm

procedure N

01732 Anesth dx elbow

arthroscopy N

01740 Anesth upper arm

surgery N

01742 Anesth humerus

surgery N

01744 Anesth humerus

repair N

01756 Anesth radical humerus

surg C

01758 Anesth humeral lesion

surg N

01760 Anesth elbow

replacement N

01770 Anesth uppr arm artery

surg N

01772 Anesth uppr arm

embolectomy N

01780 Anesth upper arm vein

surg N

01782 Anesth uppr arm vein

repair N

01810 Anesth lower arm

surgery N

01820 Anesth lower arm

procedure N

01829 Anesth dx wrist

arthroscopy N

01830 Anesth lower arm

surgery N

01832 Anesth wrist

replacement N

01840 Anesth lwr arm arterysurg N

01842 Anesth lwr arm

embolectomy N

01844 Anesth vascular shunt

surg N

01850 Anesth lower arm vein

surg N

01852 Anesth lwr arm vein

repair N

01860 Anesth lower arm

casting N

01916 Anesth dx

arteriography N

01920 Anesth catheterize

heart N

01922 Anesth cat or mri

scan N

01924 Anes ther interven rad

art N

01925 Anes ther interven rad

car N

01926 Anes tx interv rad

hrt/cran N

01930 Anes ther interven rad

vei N

01931 Anes ther interven rad

tip N

01932 Anes tx interv rad th

vein N

01933 Anes tx interv rad cran

v N

01935 Anesth perc img dx sp

proc N

01936 Anesth perc img tx sp

proc N

01951 Anesth burn less 4

percent N

01952 Anesth burn 4-9

percent N

01953 Anesth burn each 9

percent N

01958 Anesth antepartum

manipul N

01960 Anesth vaginaldelivery N

01961 Anesth cs

delivery N

01962 Anesth emer

hysterectomy N

01963 Anesth cs

hysterectomy N

01965 Anesth inc/missed ab

proc N

01966 Anesth induced ab procedure N

01967 Anesth/analg vag

delivery N

01968 Anes/analg cs deliver

add-on N

01969 Anesth/analg cs hyst

add-on N

01990 Support for organ

donor C

01991 Anesth nerve

block/inj N

01992 Anesth n block/inj

prone N

01996 Hosp manage cont drug

admin N

01999 Unlisted anesth

procedure N

10021 Fna w/o

image T 0002 1.7462 $121.22

. $24.25

10022 Fna

w/image T 0004 4.5956 $319.03

. $63.81

10040 Acne

surgery T 0013 0.9786 $67.93

. $13.59

10060 Drainage of skin

abscess T 0006 1.4481 $100.53

. $20.11

10061 Drainage of skin

abscess T 0006 1.4481 $100.53

. $20.11

10080 Drainage of pilonidal

cyst T 0006 1.4481 $100.53

. $20.11

10081 Drainage of pilonidalcyst T 0007 13.4779 $935.64

. $187.13

10120 Remove foreign

body T 0016 2.8248 $196.10

. $39.22

10121 Remove foreign

body T 0021 17.1909 "$1,193.39"

. $238.68

10140 Drainage of

hematoma/fluid T 0007 13.4779 $935.64

. $187.13

10160 Puncture drainage of

lesion T 0006 1.4481 $100.53

. $20.11

10180 Complex drainage

wound T 0008 20.5401 "$1,425.89"

. $285.18

11000 Debride infected

skin T 0016 2.8248 $196.10

. $39.22

11001 Debride infected skin

add-on T 0013 0.9786 $67.93

. $13.59

11004 Debride genitalia &

perineum C

11005 Debride abdom

wall C

11006 Debride genit/per/abdom

wall C

11008 Remove mesh from abd

wall C

11010 Debride skin at fx

site T 0019 4.8763 $338.51

. $67.71

11011 Debride skin musc at fx

site T 0019 4.8763 $338.51

. $67.71

11012 Deb skin bone at fx

site T 0019 4.8763 $338.51

. $67.71

11042 Deb subq tissue 20 sq

cm/< T 0016 2.8248 $196.10

. $39.22

11043 Deb musc/fascia 20 sq

cm/< T 0016 2.8248 $196.10

. $39.22

11044 Deb bone 20 sq

cm/< T 0020 8.6164 $598.15

. $119.6311045 Deb subq tissue

add-on T 0016 2.8248 $196.10

. $39.22

11046 Deb musc/fascia

add-on T 0016 2.8248 $196.10

. $39.22

11047 Deb bone

add-on T 0020 8.6164 $598.15

. $119.63

11055 Trim skin

lesion T 0013 0.9786 $67.93

. $13.59

11056 Trim skin lesions 2 to

4 T 0013 0.9786 $67.93

. $13.59

11057 Trim skin lesions over

4 T 0013 0.9786 $67.93

. $13.59

11100 Biopsy skin

lesion T 0015 1.4936 $103.69

. $20.74

11101 Biopsy skin

add-on T 0013 0.9786 $67.93

. $13.59

11200 Removal of skin

tags T 0013 0.9786 $67.93

. $13.59

11201 Remove skin tags

add-on T 0013 0.9786 $67.93

. $13.59

11300 Shave skin

lesion T 0013 0.9786 $67.93

. $13.59

11301 Shave skin

lesion T 0013 0.9786 $67.93

. $13.59

11302 Shave skin

lesion T 0013 0.9786 $67.93

. $13.59

11303 Shave skin

lesion T 0015 1.4936 $103.69

. $20.74

11305 Shave skin

lesion T 0013 0.9786 $67.93

. $13.59

11306 Shave skin

lesion T 0013 0.9786 $67.93

. $13.59

11307 Shave skinlesion T 0013 0.9786 $67.93

. $13.59

11308 Shave skin

lesion T 0013 0.9786 $67.93

. $13.59

11310 Shave skin

lesion T 0013 0.9786 $67.93

. $13.59

11311 Shave skin

lesion T 0013 0.9786 $67.93

. $13.59

11312 Shave skin

lesion T 0013 0.9786 $67.93

. $13.59

11313 Shave skin

lesion T 0013 0.9786 $67.93

. $13.59

11400 Exc tr-ext b9+marg 0.5 <

cm T 0019 4.8763 $338.51

. $67.71

11401 Exc tr-ext b9+marg 0.6-1

cm T 0019 4.8763 $338.51

. $67.71

11402 Exc tr-ext b9+marg 1.1-2

cm T 0019 4.8763 $338.51

. $67.71

11403 Exc tr-ext b9+marg 2.1-3

cm T 0020 8.6164 $598.15

. $119.63

11404 Exc tr-ext b9+marg 3.1-4

cm T 0021 17.1909 "$1,193.39"

. $238.68

11406 Exc tr-ext b9+marg > 4.0

cm T 0021 17.1909 "$1,193.39"

. $238.68

11420 Exc h-f-nk-sp b9+marg 0.5

< T 0020 8.6164 $598.15

. $119.63

11421 Exc h-f-nk-sp b9+marg

0.6-1 T 0020 8.6164 $598.15

. $119.63

11422 Exc h-f-nk-sp b9+marg

1.1-2 T 0020 8.6164 $598.15

. $119.63

11423 Exc h-f-nk-sp b9+marg

2.1-3 T 0021 17.1909 "$1,193.39"

. $238.68

11424 Exc h-f-nk-sp b9+marg

3.1-4 T 0021 17.1909 "$1,193.39"

. $238.6811426 Exc h-f-nk-sp b9+marg > 4

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

11440 Exc face-mm b9+marg 0.5 <

cm T 0019 4.8763 $338.51

. $67.71

11441 Exc face-mm b9+marg 0.6-1

cm T 0019 4.8763 $338.51

. $67.71

11442 Exc face-mm b9+marg 1.1-2

cm T 0020 8.6164 $598.15

. $119.63

11443 Exc face-mm b9+marg 2.1-3

cm T 0020 8.6164 $598.15

. $119.63

11444 Exc face-mm b9+marg 3.1-4

cm T 0020 8.6164 $598.15

. $119.63

11446 Exc face-mm b9+marg > 4

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

11450 Removal sweat gland

lesion T 0022 23.4169 "$1,625.60" $350.05 $325.12

11451 Removal sweat gland

lesion T 0022 23.4169 "$1,625.60" $350.05 $325.12

11462 Removal sweat gland

lesion T 0022 23.4169 "$1,625.60" $350.05 $325.12

11463 Removal sweat gland

lesion T 0022 23.4169 "$1,625.60" $350.05 $325.12

11470 Removal sweat gland

lesion T 0022 23.4169 "$1,625.60" $350.05 $325.12

11471 Removal sweat gland

lesion T 0022 23.4169 "$1,625.60" $350.05 $325.12

11600 Exc tr-ext mlg+marg 0.5 <

cm T 0020 8.6164 $598.15

. $119.63

11601 Exc tr-ext mlg+marg 0.6-1

cm T 0019 4.8763 $338.51

. $67.71

11602 Exc tr-ext mlg+marg 1.1-2

cm T 0019 4.8763 $338.51

. $67.71

11603 Exc tr-ext mlg+marg 2.1-3cm T 0020 8.6164 $598.15

. $119.63

11604 Exc tr-ext mlg+marg 3.1-4

cm T 0020 8.6164 $598.15

. $119.63

11606 Exc tr-ext mlg+marg > 4

cm T 0021 17.1909 "$1,193.39"

. $238.68

11620 Exc h-f-nk-sp mlg+marg 0.5

< T 0020 8.6164 $598.15

. $119.63

11621 Exc h-f-nk-sp mlg+marg

0.6-1 T 0019 4.8763 $338.51

. $67.71

11622 Exc h-f-nk-sp mlg+marg

1.1-2 T 0020 8.6164 $598.15

. $119.63

11623 Exc h-f-nk-sp mlg+marg

2.1-3 T 0021 17.1909 "$1,193.39"

. $238.68

11624 Exc h-f-nk-sp mlg+marg

3.1-4 T 0021 17.1909 "$1,193.39"

. $238.68

11626 Exc h-f-nk-sp mlg+mar > 4

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

11640 Exc face-mm malig+marg 0.5

< T 0019 4.8763 $338.51

. $67.71

11641 Exc face-mm malig+marg

0.6-1 T 0019 4.8763 $338.51

. $67.71

11642 Exc face-mm malig+marg

1.1-2 T 0019 4.8763 $338.51

. $67.71

11643 Exc face-mm malig+marg

2.1-3 T 0020 8.6164 $598.15

. $119.63

11644 Exc face-mm malig+marg

3.1-4 T 0021 17.1909 "$1,193.39"

. $238.68

11646 Exc face-mm mlg+marg > 4

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

11719 Trim

nail(s) T 0012 0.4047 $28.09

. $5.62

11720 Debride nail

1-5 T 0013 0.9786 $67.93

. $13.5911721 Debride nail 6 or

more T 0013 0.9786 $67.93

. $13.59

11730 Removal of nail

plate T 0013 0.9786 $67.93

. $13.59

11732 Remove nail plate

add-on T 0013 0.9786 $67.93

. $13.59

11740 Drain blood from under

nail T 0012 0.4047 $28.09

. $5.62

11750 Removal of nail

bed T 0019 4.8763 $338.51

. $67.71

11752 Remove nail bed/finger

tip T 0022 23.4169 "$1,625.60" $350.05 $325.12

11755 Biopsy nail

unit T 0019 4.8763 $338.51

. $67.71

11760 Repair of nail

bed T 0133 1.2139 $84.27 $23.56 $16.86

11762 Reconstruction of nail

bed T 0136 17.2745 "$1,199.20"

. $239.84

11765 Excision of nail fold

toe T 0013 0.9786 $67.93

. $13.59

11770 Removal of pilonidal

lesion T 0022 23.4169 "$1,625.60" $350.05 $325.12

11771 Removal of pilonidal

lesion T 0022 23.4169 "$1,625.60" $350.05 $325.12

11772 Removal of pilonidal

lesion T 0022 23.4169 "$1,625.60" $350.05 $325.12

11900 Injection into skin

lesions T 0013 0.9786 $67.93

. $13.59

11901 Added skin lesions

injection T 0013 0.9786 $67.93

. $13.59

11920 Correct skin color

defects T 0134 3.2846 $228.02

. $45.61

11921 Correct skin colordefects T 0134 3.2846 $228.02

. $45.61

11922 Correct skin color

defects T 0134 3.2846 $228.02

. $45.61

11950 Therapy for contour defects CH

T 0134 3.2846 $228.02

. $45.61

11951 Therapy for contour defects CH

T 0134 3.2846 $228.02

. $45.61

11952 Therapy for contour defects CH

T 0134 3.2846 $228.02

. $45.61

11954 Therapy for contour

defects T 0133 1.2139 $84.27 $23.56 $16.86

11960 Insert tissue

expander(s) T 0137 21.8041 "$1,513.64"

. $302.73

11970 Replace tissue

expander T 0051 47.1841 "$3,275.52"

. $655.11

11971 Remove tissue

expander(s) T 0022 23.4169 "$1,625.60" $350.05 $325.12

11975 Insert contraceptive

cap E

11976 Removal of contraceptive

cap T 0019 4.8763 $338.51

. $67.71

11977 Removal/reinsert contra

cap E

11980 Implant hormone

pellet(s) X 0340 0.6739 $46.78

. $9.36

11981 Insert drug implant

device X 0340 0.6739 $46.78

. $9.36

11982 Remove drug implant

device X 0340 0.6739 $46.78

. $9.36

11983 Remove/insert drug

implant X 0340 0.6739 $46.78

. $9.36

12001 Repair superficial

wound(s) T 0133 1.2139 $84.27 $23.56 $16.86

12002 Repair superficialwound(s) T 0133 1.2139 $84.27 $23.56 $16.86

12004 Repair superficial

wound(s) T 0133 1.2139 $84.27 $23.56 $16.86

12005 Repair superficial

wound(s) T 0133 1.2139 $84.27 $23.56 $16.86

12006 Repair superficial

wound(s) T 0133 1.2139 $84.27 $23.56 $16.86

12007 Repair superficial

wound(s) T 0133 1.2139 $84.27 $23.56 $16.86

12011 Repair superficial

wound(s) T 0133 1.2139 $84.27 $23.56 $16.86

12013 Repair superficial

wound(s) T 0133 1.2139 $84.27 $23.56 $16.86

12014 Repair superficial

wound(s) T 0133 1.2139 $84.27 $23.56 $16.86

12015 Repair superficial

wound(s) T 0133 1.2139 $84.27 $23.56 $16.86

12016 Repair superficial

wound(s) T 0133 1.2139 $84.27 $23.56 $16.86

12017 Repair superficial

wound(s) T 0133 1.2139 $84.27 $23.56 $16.86

12018 Repair superficial wound(s) CH

T 0134 3.2846 $228.02

. $45.61

12020 Closure of split

wound T 0135 5.1973 $360.80

. $72.16

12021 Closure of split

wound T 0134 3.2846 $228.02

. $45.61

12031 Intmd wnd repair s/tr/ext CH

T 0134 3.2846 $228.02

. $45.61

12032 Intmd wnd repair

s/tr/ext T 0134 3.2846 $228.02

. $45.61

12034 Intmd wnd repair s/tr/ext CH

T 0134 3.2846 $228.02

. $45.6112035 Intmd wnd repair s/tr/ext CH

T 0134 3.2846 $228.02

. $45.61

12036 Intmd wnd repair

s/tr/ext T 0134 3.2846 $228.02

. $45.61

12037 Intmd wnd repair

s/tr/ext T 0134 3.2846 $228.02

. $45.61

12041 Intmd wnd repair

n-hf/genit T 0133 1.2139 $84.27 $23.56 $16.86

12042 Intmd wnd repair n-hg/genit CH

T 0134 3.2846 $228.02

. $45.61

12044 Intmd wnd repair n-hg/genit CH

T 0134 3.2846 $228.02

. $45.61

12045 Intmd wnd repair

n-hg/genit T 0134 3.2846 $228.02

. $45.61

12046 Intmd wnd repair

n-hg/genit T 0134 3.2846 $228.02

. $45.61

12047 Intmd wnd repair

n-hg/genit T 0134 3.2846 $228.02

. $45.61

12051 Intmd wnd repair

face/mm T 0134 3.2846 $228.02

. $45.61

12052 Intmd wnd repair face/mm CH

T 0134 3.2846 $228.02

. $45.61

12053 Intmd wnd repair face/mm CH

T 0134 3.2846 $228.02

. $45.61

12054 Intmd wnd repair

face/mm T 0133 1.2139 $84.27 $23.56 $16.86

12055 Intmd wnd repair

face/mm T 0134 3.2846 $228.02

. $45.61

12056 Intmd wnd repair

face/mm T 0134 3.2846 $228.02

. $45.61

12057 Intmd wnd repair

face/mm T 0134 3.2846 $228.02

. $45.61

13100 Repair of wound orlesion T 0135 5.1973 $360.80

. $72.16

13101 Repair of wound or

lesion T 0135 5.1973 $360.80

. $72.16

13102 Repair wound/lesion add-on CH

T 0134 3.2846 $228.02

. $45.61

13120 Repair of wound or

lesion T 0134 3.2846 $228.02

. $45.61

13121 Repair of wound or

lesion T 0134 3.2846 $228.02

. $45.61

13122 Repair wound/lesion

add-on T 0133 1.2139 $84.27 $23.56 $16.86

13131 Repair of wound or

lesion T 0134 3.2846 $228.02

. $45.61

13132 Repair of wound or

lesion T 0135 5.1973 $360.80

. $72.16

13133 Repair wound/lesion

add-on T 0134 3.2846 $228.02

. $45.61

13150 Repair of wound or

lesion T 0135 5.1973 $360.80

. $72.16

13151 Repair of wound or

lesion T 0135 5.1973 $360.80

. $72.16

13152 Repair of wound or

lesion T 0135 5.1973 $360.80

. $72.16

13153 Repair wound/lesion

add-on T 0134 3.2846 $228.02

. $45.61

13160 Late closure of

wound T 0137 21.8041 "$1,513.64"

. $302.73

14000 Skin tissue

rearrangement T 0136 17.2745 "$1,199.20"

. $239.84

14001 Skin tissue

rearrangement T 0136 17.2745 "$1,199.20"

. $239.84

14020 Skin tissue

rearrangement T 0136 17.2745 "$1,199.20"

. $239.8414021 Skin tissue

rearrangement T 0136 17.2745 "$1,199.20"

. $239.84

14040 Skin tissue

rearrangement T 0136 17.2745 "$1,199.20"

. $239.84

14041 Skin tissue

rearrangement T 0136 17.2745 "$1,199.20"

. $239.84

14060 Skin tissue

rearrangement T 0136 17.2745 "$1,199.20"

. $239.84

14061 Skin tissue

rearrangement T 0136 17.2745 "$1,199.20"

. $239.84

14301 Skin tissue

rearrangement T 0137 21.8041 "$1,513.64"

. $302.73

14302 Skin tissue rearrange

add-on T 0137 21.8041 "$1,513.64"

. $302.73

14350 Skin tissue

rearrangement T 0137 21.8041 "$1,513.64"

. $302.73

15002 Wound prep

trk/arm/leg T 0135 5.1973 $360.80

. $72.16

15003 Wound prep addl 100

cm T 0135 5.1973 $360.80

. $72.16

15004 Wound prep f/n/hf/g CH

T 0134 3.2846 $228.02

. $45.61

15005 Wnd prep f/n/hf/g addl

cm T 0135 5.1973 $360.80

. $72.16

15040 Harvest cultured skin

graft T 0134 3.2846 $228.02

. $45.61

15050 Skin pinch graft CH

T 0134 3.2846 $228.02

. $45.61

15100 Skin splt grft

trnk/arm/leg T 0137 21.8041 "$1,513.64"

. $302.73

15101 Skin splt grft t/a/l

add-on T 0137 21.8041 "$1,513.64"

. $302.73

15110 Epidrm autogrfttrnk/arm/leg T 0135 5.1973 $360.80

. $72.16

15111 Epidrm autogrft t/a/l

add-on T 0135 5.1973 $360.80

. $72.16

15115 Epidrm a-grft

face/nck/hf/g T 0135 5.1973 $360.80

. $72.16

15116 Epidrm a-grft f/n/hf/g addl CH

T 0134 3.2846 $228.02

. $45.61

15120 Skn splt a-grft

fac/nck/hf/g T 0137 21.8041 "$1,513.64"

. $302.73

15121 Skn splt a-grft f/n/hf/g

add T 0137 21.8041 "$1,513.64"

. $302.73

15130 Derm autograft

trnk/arm/leg T 0136 17.2745 "$1,199.20"

. $239.84

15131 Derm autograft t/a/l

add-on T 0136 17.2745 "$1,199.20"

. $239.84

15135 Derm autograft

face/nck/hf/g T 0136 17.2745 "$1,199.20"

. $239.84

15136 Derm autograft f/n/hf/g

add T 0136 17.2745 "$1,199.20"

. $239.84

15150 Cult epiderm grft

t/arm/leg T 0135 5.1973 $360.80

. $72.16

15151 Cult epiderm grft t/a/l

addl T 0135 5.1973 $360.80

. $72.16

15152 Cult epiderm graft t/a/l

+% T 0135 5.1973 $360.80

. $72.16

15155 Cult epiderm graft

f/n/hf/g T 0135 5.1973 $360.80

. $72.16

15156 Cult epidrm grft f/n/hfg

add T 0135 5.1973 $360.80

. $72.16

15157 Cult epiderm grft f/n/hfg

+% T 0135 5.1973 $360.80

. $72.16

15170 Acell graft

trunk/arms/legs T 0135 5.1973 $360.80

. $72.1615171 Acell graft t/arm/leg

add-on T 0134 3.2846 $228.02

. $45.61

15175 Acellular graft

f/n/hf/g T 0135 5.1973 $360.80

. $72.16

15176 Acell graft f/n/hf/g

add-on T 0135 5.1973 $360.80

. $72.16

15200 Skin full graft

trunk T 0136 17.2745 "$1,199.20"

. $239.84

15201 Skin full graft trunk

add-on T 0136 17.2745 "$1,199.20"

. $239.84

15220 Skin full graft

sclp/arm/leg T 0136 17.2745 "$1,199.20"

. $239.84

15221 Skin full graft

add-on T 0135 5.1973 $360.80

. $72.16

15240 Skin full grft

face/genit/hf T 0136 17.2745 "$1,199.20"

. $239.84

15241 Skin full graft add-on CH

T 0134 3.2846 $228.02

. $45.61

15260 Skin full graft een &

lips T 0136 17.2745 "$1,199.20"

. $239.84

15261 Skin full graft

add-on T 0136 17.2745 "$1,199.20"

. $239.84

15300 Apply skinallogrft

t/arm/lg T 0135 5.1973 $360.80

. $72.16

15301 Apply sknallogrft t/a/l

addl T 0135 5.1973 $360.80

. $72.16

15320 Apply skin allogrft

f/n/hf/g T 0135 5.1973 $360.80

. $72.16

15321 Aply sknallogrft f/n/hfg

add T 0135 5.1973 $360.80

. $72.16

15330 Aply acell alogrft

t/arm/leg T 0135 5.1973 $360.80

. $72.16

15331 Aply acell grft t/a/ladd-on T 0135 5.1973 $360.80

. $72.16

15335 Apply acell graft

f/n/hf/g T 0135 5.1973 $360.80

. $72.16

15336 Aply acell grft f/n/hf/g

add T 0135 5.1973 $360.80

. $72.16

15340 Apply cult skin

substitute T 0134 3.2846 $228.02

. $45.61

15341 Apply cult skin sub

add-on T 0134 3.2846 $228.02

. $45.61

15360 Apply cult derm sub

t/a/l T 0134 3.2846 $228.02

. $45.61

15361 Aply cult derm sub t/a/l

add T 0134 3.2846 $228.02

. $45.61

15365 Apply cult derm sub

f/n/hf/g T 0134 3.2846 $228.02

. $45.61

15366 Apply cult derm f/hf/g

add T 0134 3.2846 $228.02

. $45.61

15400 Apply skin xenograft

t/a/l T 0135 5.1973 $360.80

. $72.16

15401 Apply skn xenogrft t/a/l

add T 0135 5.1973 $360.80

. $72.16

15420 Apply skin xgraft

f/n/hf/g T 0135 5.1973 $360.80

. $72.16

15421 Apply skn xgrft f/n/hf/g

add T 0135 5.1973 $360.80

. $72.16

15430 Apply acellular xenograft CH

T 0134 3.2846 $228.02

. $45.61

15431 Apply acellular xgraft

add T 0135 5.1973 $360.80

. $72.16

15570 Form skin pedicle

flap T 0137 21.8041 "$1,513.64"

. $302.73

15572 Form skin pedicle

flap T 0137 21.8041 "$1,513.64"

. $302.7315574 Form skin pedicle

flap T 0137 21.8041 "$1,513.64"

. $302.73

15576 Form skin pedicle

flap T 0137 21.8041 "$1,513.64"

. $302.73

15600 Skin

graft T 0137 21.8041 "$1,513.64"

. $302.73

15610 Skin

graft T 0137 21.8041 "$1,513.64"

. $302.73

15620 Skin

graft T 0137 21.8041 "$1,513.64"

. $302.73

15630 Skin

graft T 0137 21.8041 "$1,513.64"

. $302.73

15650 Transfer skin pedicle

flap T 0137 21.8041 "$1,513.64"

. $302.73

15731 Forehead flap w/vasc

pedicle T 0137 21.8041 "$1,513.64"

. $302.73

15732 Muscle-skin graft

head/neck T 0137 21.8041 "$1,513.64"

. $302.73

15734 Muscle-skin graft

trunk T 0137 21.8041 "$1,513.64"

. $302.73

15736 Muscle-skin graft

arm T 0137 21.8041 "$1,513.64"

. $302.73

15738 Muscle-skin graft

leg T 0137 21.8041 "$1,513.64"

. $302.73

15740 Island pedicle flap

graft T 0136 17.2745 "$1,199.20"

. $239.84

15750 Neurovascular pedicle

graft T 0137 21.8041 "$1,513.64"

. $302.73

15756 Free myo/skin flap

microvasc C

15757 Free skin flap

microvasc C

15758 Free fascial flap

microvasc C15760 Composite skin

graft T 0137 21.8041 "$1,513.64"

. $302.73

15770 Derma-fat-fascia

graft T 0137 21.8041 "$1,513.64"

. $302.73

15775 Hair transplant punch

grafts T 0133 1.2139 $84.27 $23.56 $16.86

15776 Hair transplant punch

grafts T 0133 1.2139 $84.27 $23.56 $16.86

15780 Abrasion treatment of

skin T 0022 23.4169 "$1,625.60" $350.05 $325.12

15781 Abrasion treatment of

skin T 0019 4.8763 $338.51

. $67.71

15782 Abrasion treatment of

skin T 0019 4.8763 $338.51

. $67.71

15783 Abrasion treatment of

skin T 0016 2.8248 $196.10

. $39.22

15786 Abrasion lesion

single T 0013 0.9786 $67.93

. $13.59

15787 Abrasion lesions

add-on T 0013 0.9786 $67.93

. $13.59

15788 Chemical peel face

epiderm T 0013 0.9786 $67.93

. $13.59

15789 Chemical peel face

dermal T 0015 1.4936 $103.69

. $20.74

15792 Chemical peel

nonfacial T 0015 1.4936 $103.69

. $20.74

15793 Chemical peel

nonfacial T 0013 0.9786 $67.93

. $13.59

15819 Plastic surgery

neck T 0134 3.2846 $228.02

. $45.61

15820 Revision of lower

eyelid T 0137 21.8041 "$1,513.64"

. $302.73

15821 Revision of lower

eyelid T 0137 21.8041 "$1,513.64"

. $302.7315822 Revision of upper

eyelid T 0137 21.8041 "$1,513.64"

. $302.73

15823 Revision of upper

eyelid T 0137 21.8041 "$1,513.64"

. $302.73

15824 Removal of forehead

wrinkles T 0137 21.8041 "$1,513.64"

. $302.73

15825 Removal of neck

wrinkles T 0137 21.8041 "$1,513.64"

. $302.73

15826 Removal of brow

wrinkles T 0137 21.8041 "$1,513.64"

. $302.73

15828 Removal of face

wrinkles T 0137 21.8041 "$1,513.64"

. $302.73

15829 Removal of skin

wrinkles T 0137 21.8041 "$1,513.64"

. $302.73

15830 Exc skin

abd T 0022 23.4169 "$1,625.60" $350.05 $325.12

15832 Excise excessive skin

tissue T 0022 23.4169 "$1,625.60" $350.05 $325.12

15833 Excise excessive skin

tissue T 0022 23.4169 "$1,625.60" $350.05 $325.12

15834 Excise excessive skin

tissue T 0022 23.4169 "$1,625.60" $350.05 $325.12

15835 Excise excessive skin

tissue T 0022 23.4169 "$1,625.60" $350.05 $325.12

15836 Excise excessive skin

tissue T 0021 17.1909 "$1,193.39"

. $238.68

15837 Excise excessive skin

tissue T 0021 17.1909 "$1,193.39"

. $238.68

15838 Excise excessive skin

tissue T 0021 17.1909 "$1,193.39"

. $238.68

15839 Excise excessive skin

tissue T 0021 17.1909 "$1,193.39"

. $238.6815840 Graft for face nerve

palsy T 0137 21.8041 "$1,513.64"

. $302.73

15841 Graft for face nerve

palsy T 0137 21.8041 "$1,513.64"

. $302.73

15842 Flap for face nerve

palsy T 0137 21.8041 "$1,513.64"

. $302.73

15845 Skin and muscle repair

face T 0137 21.8041 "$1,513.64"

. $302.73

15847 Exc skin abd

add-on T 0022 23.4169 "$1,625.60" $350.05 $325.12

15850 Removal of

sutures T 0016 2.8248 $196.10

. $39.22

15851 Removal of

sutures T 0016 2.8248 $196.10

. $39.22

15852 Dressing change not for

burn X 0340 0.6739 $46.78

. $9.36

15860 Test for blood flow in

graft X 0340 0.6739 $46.78

. $9.36

15876 Suction assisted

lipectomy T 0137 21.8041 "$1,513.64"

. $302.73

15877 Suction assisted

lipectomy T 0137 21.8041 "$1,513.64"

. $302.73

15878 Suction assisted

lipectomy T 0137 21.8041 "$1,513.64"

. $302.73

15879 Suction assisted

lipectomy T 0137 21.8041 "$1,513.64"

. $302.73

15920 Removal of tail bone

ulcer T 0019 4.8763 $338.51

. $67.71

15922 Removal of tail bone

ulcer T 0137 21.8041 "$1,513.64"

. $302.73

15931 Remove sacrum pressure

sore T 0022 23.4169 "$1,625.60" $350.05 $325.12

15933 Remove sacrum pressure

sore T 0022 23.4169 "$1,625.60" $350.05 $325.1215934 Remove sacrum pressure

sore T 0137 21.8041 "$1,513.64"

. $302.73

15935 Remove sacrum pressure

sore T 0137 21.8041 "$1,513.64"

. $302.73

15936 Remove sacrum pressure

sore T 0136 17.2745 "$1,199.20"

. $239.84

15937 Remove sacrum pressure

sore T 0137 21.8041 "$1,513.64"

. $302.73

15940 Remove hip pressure

sore T 0022 23.4169 "$1,625.60" $350.05 $325.12

15941 Remove hip pressure

sore T 0022 23.4169 "$1,625.60" $350.05 $325.12

15944 Remove hip pressure

sore T 0137 21.8041 "$1,513.64"

. $302.73

15945 Remove hip pressure

sore T 0137 21.8041 "$1,513.64"

. $302.73

15946 Remove hip pressure

sore T 0137 21.8041 "$1,513.64"

. $302.73

15950 Remove thigh pressure

sore T 0022 23.4169 "$1,625.60" $350.05 $325.12

15951 Remove thigh pressure

sore T 0022 23.4169 "$1,625.60" $350.05 $325.12

15952 Remove thigh pressure

sore T 0136 17.2745 "$1,199.20"

. $239.84

15953 Remove thigh pressure

sore T 0136 17.2745 "$1,199.20"

. $239.84

15956 Remove thigh pressure

sore T 0136 17.2745 "$1,199.20"

. $239.84

15958 Remove thigh pressure

sore T 0136 17.2745 "$1,199.20"

. $239.84

15999 Removal of pressure

sore T 0019 4.8763 $338.51

. $67.7116000 Initial treatment of

burn(s) T 0013 0.9786 $67.93

. $13.59

16020 Dress/debrid p-thick burn

s T 0015 1.4936 $103.69

. $20.74

16025 Dress/debrid p-thick burn

m T 0015 1.4936 $103.69

. $20.74

16030 Dress/debrid p-thick burn

l T 0015 1.4936 $103.69

. $20.74

16035 Incision of burn scab

initi T 0015 1.4936 $103.69

. $20.74

16036 Escharotomy addl

incision C

17000 Destruct premalg

lesion T 0013 0.9786 $67.93

. $13.59

17003 Destruct premalg les

2-14 T 0012 0.4047 $28.09

. $5.62

17004 Destroy premlg lesions

15+ T 0016 2.8248 $196.10

. $39.22

17106 Destruction of skin

lesions T 0016 2.8248 $196.10

. $39.22

17107 Destruction of skin

lesions T 0016 2.8248 $196.10

. $39.22

17108 Destruction of skin

lesions T 0016 2.8248 $196.10

. $39.22

17110 Destruct b9 lesion

1-14 T 0013 0.9786 $67.93

. $13.59

17111 Destruct lesion 15 or

more T 0015 1.4936 $103.69

. $20.74

17250 Chemical cautery

tissue T 0015 1.4936 $103.69

. $20.74

17260 Destruction of skin

lesions T 0015 1.4936 $103.69

. $20.74

17261 Destruction of skin

lesions T 0015 1.4936 $103.69

. $20.7417262 Destruction of skin

lesions T 0015 1.4936 $103.69

. $20.74

17263 Destruction of skin

lesions T 0015 1.4936 $103.69

. $20.74

17264 Destruction of skin

lesions T 0015 1.4936 $103.69

. $20.74

17266 Destruction of skin

lesions T 0016 2.8248 $196.10

. $39.22

17270 Destruction of skin

lesions T 0015 1.4936 $103.69

. $20.74

17271 Destruction of skin

lesions T 0015 1.4936 $103.69

. $20.74

17272 Destruction of skin

lesions T 0015 1.4936 $103.69

. $20.74

17273 Destruction of skin

lesions T 0016 2.8248 $196.10

. $39.22

17274 Destruction of skin

lesions T 0016 2.8248 $196.10

. $39.22

17276 Destruction of skin

lesions T 0016 2.8248 $196.10

. $39.22

17280 Destruction of skin

lesions T 0015 1.4936 $103.69

. $20.74

17281 Destruction of skin

lesions T 0016 2.8248 $196.10

. $39.22

17282 Destruction of skin

lesions T 0016 2.8248 $196.10

. $39.22

17283 Destruction of skin

lesions T 0016 2.8248 $196.10

. $39.22

17284 Destruction of skin

lesions T 0016 2.8248 $196.10

. $39.22

17286 Destruction of skin

lesions T 0016 2.8248 $196.10

. $39.22

17311 Mohs 1 stageh/n/hf/g T 0694 5.3689 $372.71 $91.69 $74.55

17312 Mohs addl

stage T 0694 5.3689 $372.71 $91.69 $74.55

17313 Mohs 1 stage

t/a/l T 0694 5.3689 $372.71 $91.69 $74.55

17314 Mohs addl stage

t/a/l T 0694 5.3689 $372.71 $91.69 $74.55

17315 Mohs surg addl

block T 0694 5.3689 $372.71 $91.69 $74.55

17340 Cryotherapy of

skin T 0013 0.9786 $67.93

. $13.59

17360 Skin peel

therapy T 0013 0.9786 $67.93

. $13.59

17380 Hair removal by

electrolysis T 0013 0.9786 $67.93

. $13.59

17999 Skin tissue

procedure T 0012 0.4047 $28.09

. $5.62

19000 Drainage of breast

lesion T 0004 4.5956 $319.03

. $63.81

19001 Drain breast lesion

add-on T 0002 1.7462 $121.22

. $24.25

19020 Incision of breast

lesion T 0008 20.5401 "$1,425.89"

. $285.18

19030 Injection for breast

x-ray N

19100 Bx breast percut w/o

image T 0004 4.5956 $319.03

. $63.81

19101 Biopsy of breast

open T 0028 25.8383 "$1,793.69"

. $358.74

19102 Bx breast percut

w/image T 0005 8.1415 $565.18

. $113.04

19103 Bx breast percut

w/device T 0037 15.3594 "$1,066.25" $225.55 $213.2519105 Cryosurg ablate fa

each T 0029 33.8417 "$2,349.29" $581.52 $469.86

19110 Nipple

exploration T 0028 25.8383 "$1,793.69"

. $358.74

19112 Excise breast duct

fistula T 0028 25.8383 "$1,793.69"

. $358.74

19120 Removal of breast

lesion T 0028 25.8383 "$1,793.69"

. $358.74

19125 Excision breast

lesion T 0028 25.8383 "$1,793.69"

. $358.74

19126 Excision addl breast

lesion T 0028 25.8383 "$1,793.69"

. $358.74

19260 Removal of chest wall

lesion T 0021 17.1909 "$1,193.39"

. $238.68

19271 Revision of chest

wall C

19272 Extensive chest wall

surgery C

19290 Place needle wire

breast N

19291 Place needle wire

breast N

19295 Place breast clip

percut Q1 0340 0.6739 $46.78

. $9.36

19296 Place po breast cath for

rad T 0648 61.6690 "$4,281.06"

. $856.22

19297 Place breast cath for

rad T 0648 61.6690 "$4,281.06"

. $856.22

19298 Place breast rad

tube/caths T 0648 61.6690 "$4,281.06"

. $856.22

19300 Removal of breast

tissue T 0028 25.8383 "$1,793.69"

. $358.74

19301 Partical

mastectomy T 0028 25.8383 "$1,793.69"

. $358.74

19302 P-mastectomy w/ln

removal T 0030 45.0972 "$3,130.65" $747.07 $626.1319303 Mast simple

complete T 0029 33.8417 "$2,349.29" $581.52 $469.86

19304 Mast

subq T 0029 33.8417 "$2,349.29" $581.52 $469.86

19305 Mast

radical C

19306 Mast rad urban

type C

19307 Mast mod

rad T 0030 45.0972 "$3,130.65" $747.07 $626.13

19316 Suspension of

breast T 0029 33.8417 "$2,349.29" $581.52 $469.86

19318 Reduction of large

breast T 0030 45.0972 "$3,130.65" $747.07 $626.13

19324 Enlarge

breast T 0030 45.0972 "$3,130.65" $747.07 $626.13

19325 Enlarge breast with

implant T 0648 61.6690 "$4,281.06"

. $856.22

19328 Removal of breast

implant T 0029 33.8417 "$2,349.29" $581.52 $469.86

19330 Removal of implant

material T 0029 33.8417 "$2,349.29" $581.52 $469.86

19340 Immediate breast

prosthesis T 0030 45.0972 "$3,130.65" $747.07 $626.13

19342 Delayed breast

prosthesis T 0648 61.6690 "$4,281.06"

. $856.22

19350 Breast

reconstruction T 0028 25.8383 "$1,793.69"

. $358.74

19355 Correct inverted

nipple(s) T 0029 33.8417 "$2,349.29" $581.52 $469.86

19357 Breast

reconstruction T 0648 61.6690 "$4,281.06"

. $856.22

19361 Breast reconstr w/lat

flap C19364 Breast

reconstruction C

19366 Breast

reconstruction T 0029 33.8417 "$2,349.29" $581.52 $469.86

19367 Breast

reconstruction C

19368 Breast

reconstruction C

19369 Breast

reconstruction C

19370 Surgery of breast

capsule T 0029 33.8417 "$2,349.29" $581.52 $469.86

19371 Removal of breast

capsule T 0029 33.8417 "$2,349.29" $581.52 $469.86

19380 Revise breast

reconstruction T 0030 45.0972 "$3,130.65" $747.07 $626.13

19396 Design custom breast

implant T 0029 33.8417 "$2,349.29" $581.52 $469.86

19499 Breast surgery

procedure T 0028 25.8383 "$1,793.69"

. $358.74

20005 I&d abscess

subfascial T 0020 8.6164 $598.15

. $119.63

20100 Explore wound

neck T 0252 8.0353 $557.81

. $111.57

20101 Explore wound

chest T 0137 21.8041 "$1,513.64"

. $302.73

20102 Explore wound

abdomen T 0137 21.8041 "$1,513.64"

. $302.73

20103 Explore wound

extremity T 0007 13.4779 $935.64

. $187.13

20150 Excise epiphyseal

bar T 0051 47.1841 "$3,275.52"

. $655.11

20200 Muscle

biopsy T 0021 17.1909 "$1,193.39"

. $238.68

20205 Deep musclebiopsy T 0021 17.1909 "$1,193.39"

. $238.68

20206 Needle biopsy

muscle T 0005 8.1415 $565.18

. $113.04

20220 Bone biopsy

trocar/needle T 0020 8.6164 $598.15

. $119.63

20225 Bone biopsy

trocar/needle T 0021 17.1909 "$1,193.39"

. $238.68

20240 Bone biopsy

excisional T 0022 23.4169 "$1,625.60" $350.05 $325.12

20245 Bone biopsy

excisional T 0022 23.4169 "$1,625.60" $350.05 $325.12

20250 Open bone biopsy CH

T 0050 32.4101 "$2,249.91"

. $449.99

20251 Open bone biopsy CH

T 0050 32.4101 "$2,249.91"

. $449.99

20500 Injection of sinus

tract T 0252 8.0353 $557.81

. $111.57

20501 Inject sinus tract for

x-ray N

20520 Removal of foreign

body T 0019 4.8763 $338.51

. $67.71

20525 Removal of foreign

body T 0022 23.4169 "$1,625.60" $350.05 $325.12

20526 Ther injection carp

tunnel T 0204 2.7693 $192.24 $40.13 $38.45

20550 Inj tendon

sheath/ligament T 0204 2.7693 $192.24 $40.13 $38.45

20551 Inj tendon

origin/insertion T 0204 2.7693 $192.24 $40.13 $38.45

20552 Inj trigger point 1/2

muscl T 0204 2.7693 $192.24 $40.13 $38.45

20553 Inject trigger points =/>

3 T 0204 2.7693 $192.24 $40.13 $38.4520555 Place ndl musc/tis for

rt T 0050 32.4101 "$2,249.91"

. $449.99

20600 Drain/inject

joint/bursa T 0204 2.7693 $192.24 $40.13 $38.45

20605 Drain/inject

joint/bursa T 0204 2.7693 $192.24 $40.13 $38.45

20610 Drain/inject

joint/bursa T 0204 2.7693 $192.24 $40.13 $38.45

20612 Aspirate/inj ganglion

cyst T 0204 2.7693 $192.24 $40.13 $38.45

20615 Treatment of bone

cyst T 0004 4.5956 $319.03

. $63.81

20650 Insert and remove bone pin CH

T 0050 32.4101 "$2,249.91"

. $449.99

20660 Apply rem fixation

device T 0138 4.9874 $346.23

. $69.25

20661 Application of head

brace C

20662 Application of pelvis

brace T 0049 22.1674 "$1,538.86"

. $307.78

20663 Application of thigh brace CH

T 0050 32.4101 "$2,249.91"

. $449.99

20664 Application of

halo C

20665 Removal of fixation

device X 0340 0.6739 $46.78

. $9.36

20670 Removal of support

implant T 0021 17.1909 "$1,193.39"

. $238.68

20680 Removal of support

implant T 0022 23.4169 "$1,625.60" $350.05 $325.12

20690 Apply bone fixation

device T 0050 32.4101 "$2,249.91"

. $449.99

20692 Apply bone fixation

device T 0050 32.4101 "$2,249.91"

. $449.9920693 Adjust bone fixation device CH

T 0050 32.4101 "$2,249.91"

. $449.99

20694 Remove bone fixation

device T 0049 22.1674 "$1,538.86"

. $307.78

20696 Comp multiplane ext

fixation T 0050 32.4101 "$2,249.91"

. $449.99

20697 Comp ext fixate strut

change T 0139 18.6922 "$1,297.61"

. $259.53

20802 Replantation arm

complete C

20805 Replant forearm

complete C

20808 Replantation hand

complete C

20816 Replantation digit

complete C

20822 Replantation digit

complete T 0054 29.0181 "$2,014.44"

. $402.89

20824 Replantation thumb

complete C

20827 Replantation thumb

complete C

20838 Replantation foot

complete C

20900 Removal of bone for

graft T 0050 32.4101 "$2,249.91"

. $449.99

20902 Removal of bone for

graft T 0050 32.4101 "$2,249.91"

. $449.99

20910 Remove cartilage for

graft T 0137 21.8041 "$1,513.64"

. $302.73

20912 Remove cartilage for

graft T 0137 21.8041 "$1,513.64"

. $302.73

20920 Removal of fascia for

graft T 0136 17.2745 "$1,199.20"

. $239.84

20922 Removal of fascia for

graft T 0136 17.2745 "$1,199.20"

. $239.84

20924 Removal of tendon forgraft T 0050 32.4101 "$2,249.91"

. $449.99

20926 Removal of tissue for

graft T 0135 5.1973 $360.80

. $72.16

20930 Sp bone algrft morsel

add-on C

20931 Sp bone algrft struct

add-on C

20936 Sp bone agrft local

add-on C

20937 Sp bone agrft morsel

add-on C

20938 Sp bone agrft struct

add-on C

20950 Fluid pressure

muscle T 0006 1.4481 $100.53

. $20.11

20955 Fibula bone graft

microvasc C

20956 Iliac bone graft

microvasc C

20957 Mt bone graft

microvasc C

20962 Other bone graft

microvasc C

20969 Bone/skin graft

microvasc C

20970 Bone/skin graft iliac

crest C

20972 Bone/skin graft

metatarsal T 0056 57.2099 "$3,971.51"

. $794.31

20973 Bone/skin graft great

toe T 0056 57.2099 "$3,971.51"

. $794.31

20974 Electrical bone

stimulation A

20975 Electrical bone stimulation N

20979 Us bone stimulation X

0340 0.6739 $46.78

. $9.36

20982 Ablate bone tumor(s)

perq T 0051 47.1841 "$3,275.52"

. $655.11

20985 Cptr-asst dir ms px N20999 Musculoskeletal

surgery T 0049 22.1674 "$1,538.86"

. $307.78

21010 Incision of jaw

joint T 0254 25.1379 "$1,745.07"

. $349.02

21011 Exc face les sc < 2

cm T 0020 8.6164 $598.15

. $119.63

21012 Exc face les sbq 2+

cm T 0020 8.6164 $598.15

. $119.63

21013 Exc face tum deep < 2

cm T 0020 8.6164 $598.15

. $119.63

21014 Exc face tum deep 2+

cm T 0020 8.6164 $598.15

. $119.63

21015 Resect face tum < 2

cm T 0021 17.1909 "$1,193.39"

. $238.68

21016 Resect face tum +

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

21025 Excision of bone lower

jaw T 0256 45.1286 "$3,132.83"

. $626.57

21026 Excision of facial

bone(s) T 0256 45.1286 "$3,132.83"

. $626.57

21029 Contour of face bone

lesion T 0256 45.1286 "$3,132.83"

. $626.57

21030 Excise max/zygoma b9

tumor T 0254 25.1379 "$1,745.07"

. $349.02

21031 Remove exostosis

mandible T 0254 25.1379 "$1,745.07"

. $349.02

21032 Remove exostosis

maxilla T 0254 25.1379 "$1,745.07"

. $349.02

21034 Excise max/zygoma mlg

tumor T 0256 45.1286 "$3,132.83"

. $626.57

21040 Excise mandible

lesion T 0254 25.1379 "$1,745.07"

. $349.0221044 Removal of jaw bone

lesion T 0256 45.1286 "$3,132.83"

. $626.57

21045 Extensive jaw

surgery C

21046 Remove mandible cyst

complex T 0256 45.1286 "$3,132.83"

. $626.57

21047 Excise lwr jaw cyst

w/repair T 0256 45.1286 "$3,132.83"

. $626.57

21048 Remove maxilla cyst

complex T 0256 45.1286 "$3,132.83"

. $626.57

21049 Excis uppr jaw cyst

w/repair T 0256 45.1286 "$3,132.83"

. $626.57

21050 Removal of jaw

joint T 0256 45.1286 "$3,132.83"

. $626.57

21060 Remove jaw joint

cartilage T 0256 45.1286 "$3,132.83"

. $626.57

21070 Remove coronoid

process T 0256 45.1286 "$3,132.83"

. $626.57

21073 Mnpj of tmj

w/anesth T 0252 8.0353 $557.81

. $111.57

21076 Prepare face/oral

prosthesis T 0254 25.1379 "$1,745.07"

. $349.02

21077 Prepare face/oral

prosthesis T 0256 45.1286 "$3,132.83"

. $626.57

21079 Prepare face/oral

prosthesis T 0256 45.1286 "$3,132.83"

. $626.57

21080 Prepare face/oral

prosthesis T 0256 45.1286 "$3,132.83"

. $626.57

21081 Prepare face/oral

prosthesis T 0256 45.1286 "$3,132.83"

. $626.57

21082 Prepare face/oral

prosthesis T 0256 45.1286 "$3,132.83"

. $626.57

21083 Prepare face/oral

prosthesis T 0256 45.1286 "$3,132.83"

. $626.5721084 Prepare face/oral

prosthesis T 0256 45.1286 "$3,132.83"

. $626.57

21085 Prepare face/oral

prosthesis T 0253 16.9180 "$1,174.45" $277.61 $234.89

21086 Prepare face/oral

prosthesis T 0256 45.1286 "$3,132.83"

. $626.57

21087 Prepare face/oral

prosthesis T 0256 45.1286 "$3,132.83"

. $626.57

21088 Prepare face/oral

prosthesis T 0256 45.1286 "$3,132.83"

. $626.57

21089 Prepare face/oral

prosthesis T 0250 1.0875 $75.49 $24.28 $15.10

21100 Maxillofacial

fixation T 0256 45.1286 "$3,132.83"

. $626.57

21110 Interdental

fixation T 0252 8.0353 $557.81

. $111.57

21116 Injection jaw joint

x-ray N

21120 Reconstruction of

chin T 0254 25.1379 "$1,745.07"

. $349.02

21121 Reconstruction of

chin T 0254 25.1379 "$1,745.07"

. $349.02

21122 Reconstruction of

chin T 0254 25.1379 "$1,745.07"

. $349.02

21123 Reconstruction of

chin T 0254 25.1379 "$1,745.07"

. $349.02

21125 Augmentation lower jaw

bone T 0254 25.1379 "$1,745.07"

. $349.02

21127 Augmentation lower jaw

bone T 0256 45.1286 "$3,132.83"

. $626.57

21137 Reduction of

forehead T 0254 25.1379 "$1,745.07"

. $349.02

21138 Reduction of

forehead T 0256 45.1286 "$3,132.83"

. $626.5721139 Reduction of

forehead T 0256 45.1286 "$3,132.83"

. $626.57

21141 Reconstruct midface

lefort C

21142 Reconstruct midface

lefort C

21143 Reconstruct midface

lefort C

21145 Reconstruct midface

lefort C

21146 Reconstruct midface

lefort C

21147 Reconstruct midface

lefort C

21150 Reconstruct midface

lefort T 0256 45.1286 "$3,132.83"

. $626.57

21151 Reconstruct midface

lefort C

21154 Reconstruct midface

lefort C

21155 Reconstruct midface

lefort C

21159 Reconstruct midface

lefort C

21160 Reconstruct midface

lefort C

21172 Reconstruct

orbit/forehead T 0256 45.1286 "$3,132.83"

. $626.57

21175 Reconstruct

orbit/forehead T 0256 45.1286 "$3,132.83"

. $626.57

21179 Reconstruct entire

forehead C

21180 Reconstruct entire

forehead C

21181 Contour cranial bone

lesion T 0254 25.1379 "$1,745.07"

. $349.02

21182 Reconstruct cranial

bone C

21183 Reconstruct cranial

bone C21184 Reconstruct cranial

bone C

21188 Reconstruction of

midface C

21193 Reconst lwr jaw w/o

graft T 0256 45.1286 "$3,132.83"

. $626.57

21194 Reconst lwr jaw

w/graft C

21195 Reconst lwr jaw w/o

fixation T 0256 45.1286 "$3,132.83"

. $626.57

21196 Reconst lwr jaw

w/fixation C

21198 Reconstr lwr jaw

segment T 0256 45.1286 "$3,132.83"

. $626.57

21199 Reconstr lwr jaw

w/advance T 0256 45.1286 "$3,132.83"

. $626.57

21206 Reconstruct upper jaw

bone T 0256 45.1286 "$3,132.83"

. $626.57

21208 Augmentation of facial

bones T 0256 45.1286 "$3,132.83"

. $626.57

21209 Reduction of facial

bones T 0256 45.1286 "$3,132.83"

. $626.57

21210 Face bone

graft T 0256 45.1286 "$3,132.83"

. $626.57

21215 Lower jaw bone

graft T 0256 45.1286 "$3,132.83"

. $626.57

21230 Rib cartilage

graft T 0256 45.1286 "$3,132.83"

. $626.57

21235 Ear cartilage

graft T 0254 25.1379 "$1,745.07"

. $349.02

21240 Reconstruction of jaw

joint T 0256 45.1286 "$3,132.83"

. $626.57

21242 Reconstruction of jaw

joint T 0256 45.1286 "$3,132.83"

. $626.57

21243 Reconstruction of jawjoint T 0256 45.1286 "$3,132.83"

. $626.57

21244 Reconstruction of lower

jaw T 0256 45.1286 "$3,132.83"

. $626.57

21245 Reconstruction of

jaw T 0256 45.1286 "$3,132.83"

. $626.57

21246 Reconstruction of

jaw T 0256 45.1286 "$3,132.83"

. $626.57

21247 Reconstruct lower jaw

bone C

21248 Reconstruction of

jaw T 0256 45.1286 "$3,132.83"

. $626.57

21249 Reconstruction of

jaw T 0256 45.1286 "$3,132.83"

. $626.57

21255 Reconstruct lower jaw

bone C

21256 Reconstruction of

orbit T 0256 45.1286 "$3,132.83"

. $626.57

21260 Revise eye

sockets T 0256 45.1286 "$3,132.83"

. $626.57

21261 Revise eye

sockets T 0256 45.1286 "$3,132.83"

. $626.57

21263 Revise eye

sockets T 0256 45.1286 "$3,132.83"

. $626.57

21267 Revise eye

sockets T 0256 45.1286 "$3,132.83"

. $626.57

21268 Revise eye

sockets C

21270 Augmentation cheek

bone T 0256 45.1286 "$3,132.83"

. $626.57

21275 Revision orbitofacial

bones T 0256 45.1286 "$3,132.83"

. $626.57

21280 Revision of

eyelid T 0256 45.1286 "$3,132.83"

. $626.57

21282 Revision of

eyelid T 0253 16.9180 "$1,174.45" $277.61 $234.8921295 Revision of jaw

muscle/bone T 0252 8.0353 $557.81

. $111.57

21296 Revision of jaw

muscle/bone T 0254 25.1379 "$1,745.07"

. $349.02

21299 Cranio/maxillofacial

surgery T 0250 1.0875 $75.49 $24.28 $15.10

21310 Treatment of nose

fracture T 0250 1.0875 $75.49 $24.28 $15.10

21315 Treatment of nose

fracture T 0253 16.9180 "$1,174.45" $277.61 $234.89

21320 Treatment of nose

fracture T 0253 16.9180 "$1,174.45" $277.61 $234.89

21325 Treatment of nose

fracture T 0254 25.1379 "$1,745.07"

. $349.02

21330 Treatment of nose

fracture T 0254 25.1379 "$1,745.07"

. $349.02

21335 Treatment of nose

fracture T 0254 25.1379 "$1,745.07"

. $349.02

21336 Treat nasal septal

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

21337 Treat nasal septal

fracture T 0253 16.9180 "$1,174.45" $277.61 $234.89

21338 Treat nasoethmoid

fracture T 0254 25.1379 "$1,745.07"

. $349.02

21339 Treat nasoethmoid

fracture T 0254 25.1379 "$1,745.07"

. $349.02

21340 Treatment of nose

fracture T 0256 45.1286 "$3,132.83"

. $626.57

21343 Treatment of sinus

fracture C

21344 Treatment of sinus

fracture C

21345 Treat nose/jaw

fracture T 0254 25.1379 "$1,745.07"

. $349.0221346 Treat nose/jaw

fracture CH T 0254 25.1379 "$1,745.07"

. $349.02

21347 Treat nose/jaw

fracture C

21348 Treat nose/jaw

fracture C

21355 Treat cheek bone

fracture T 0256 45.1286 "$3,132.83"

. $626.57

21356 Treat cheek bone

fracture T 0254 25.1379 "$1,745.07"

. $349.02

21360 Treat cheek bone

fracture T 0254 25.1379 "$1,745.07"

. $349.02

21365 Treat cheek bone

fracture T 0256 45.1286 "$3,132.83"

. $626.57

21366 Treat cheek bone

fracture C

21385 Treat eye socket

fracture T 0256 45.1286 "$3,132.83"

. $626.57

21386 Treat eye socket

fracture T 0256 45.1286 "$3,132.83"

. $626.57

21387 Treat eye socket

fracture T 0256 45.1286 "$3,132.83"

. $626.57

21390 Treat eye socket

fracture T 0256 45.1286 "$3,132.83"

. $626.57

21395 Treat eye socket

fracture T 0256 45.1286 "$3,132.83"

. $626.57

21400 Treat eye socket

fracture T 0252 8.0353 $557.81

. $111.57

21401 Treat eye socket

fracture T 0253 16.9180 "$1,174.45" $277.61 $234.89

21406 Treat eye socket

fracture T 0256 45.1286 "$3,132.83"

. $626.57

21407 Treat eye socket

fracture T 0256 45.1286 "$3,132.83"

. $626.5721408 Treat eye socket

fracture T 0256 45.1286 "$3,132.83"

. $626.57

21421 Treat mouth roof

fracture T 0254 25.1379 "$1,745.07"

. $349.02

21422 Treat mouth roof

fracture C

21423 Treat mouth roof

fracture C

21431 Treat craniofacial

fracture C

21432 Treat craniofacial

fracture C

21433 Treat craniofacial

fracture C

21435 Treat craniofacial

fracture C

21436 Treat craniofacial

fracture C

21440 Treat dental ridge

fracture T 0254 25.1379 "$1,745.07"

. $349.02

21445 Treat dental ridge

fracture T 0254 25.1379 "$1,745.07"

. $349.02

21450 Treat lower jaw

fracture T 0251 3.3531 $232.77

. $46.56

21451 Treat lower jaw

fracture T 0252 8.0353 $557.81

. $111.57

21452 Treat lower jaw

fracture T 0253 16.9180 "$1,174.45" $277.61 $234.89

21453 Treat lower jaw

fracture T 0256 45.1286 "$3,132.83"

. $626.57

21454 Treat lower jaw

fracture T 0254 25.1379 "$1,745.07"

. $349.02

21461 Treat lower jaw

fracture T 0256 45.1286 "$3,132.83"

. $626.57

21462 Treat lower jaw

fracture T 0256 45.1286 "$3,132.83"

. $626.5721465 Treat lower jaw

fracture T 0256 45.1286 "$3,132.83"

. $626.57

21470 Treat lower jaw

fracture T 0256 45.1286 "$3,132.83"

. $626.57

21480 Reset dislocated

jaw T 0250 1.0875 $75.49 $24.28 $15.10

21485 Reset dislocated

jaw T 0253 16.9180 "$1,174.45" $277.61 $234.89

21490 Repair dislocated

jaw T 0256 45.1286 "$3,132.83"

. $626.57

21495 Treat hyoid bone

fracture T 0253 16.9180 "$1,174.45" $277.61 $234.89

21497 Interdental

wiring T 0253 16.9180 "$1,174.45" $277.61 $234.89

21499 Head surgery

procedure T 0250 1.0875 $75.49 $24.28 $15.10

21501 Drain neck/chest

lesion T 0008 20.5401 "$1,425.89"

. $285.18

21502 Drain chest

lesion T 0049 22.1674 "$1,538.86"

. $307.78

21510 Drainage of bone

lesion C

21550 Biopsy of

neck/chest T 0021 17.1909 "$1,193.39"

. $238.68

21552 Exc neck les sc 3+

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

21554 Exc neck tum deep 5+

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

21555 Exc neck les sc < 3

cm T 0021 17.1909 "$1,193.39"

. $238.68

21556 Exc neck tum deep < 5

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

21557 Resect neck tum < 5

cm T 0021 17.1909 "$1,193.39"

. $238.6821558 Resect neck tum 5+

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

21600 Partial removal of

rib T 0050 32.4101 "$2,249.91"

. $449.99

21610 Partial removal of

rib T 0050 32.4101 "$2,249.91"

. $449.99

21615 Removal of

rib C

21616 Removal of rib and

nerves C

21620 Partial removal of

sternum C

21627 Sternal

debridement C

21630 Extensive sternum

surgery C

21632 Extensive sternum

surgery C

21685 Hyoid myotomy &

suspension T 0252 8.0353 $557.81

. $111.57

21700 Revision of neck

muscle T 0049 22.1674 "$1,538.86"

. $307.78

21705 Revision of neck

muscle/rib C

21720 Revision of neck

muscle T 0049 22.1674 "$1,538.86"

. $307.78

21725 Revision of neck

muscle T 0006 1.4481 $100.53

. $20.11

21740 Reconstruction of

sternum C

21742 Repair stern/nuss w/o

scope T 0051 47.1841 "$3,275.52"

. $655.11

21743 Repair sternum/nuss

w/scope T 0051 47.1841 "$3,275.52"

. $655.11

21750 Repair of sternum

separation C

21800 Treatment of rib

fracture T 0129 1.6063 $111.51

. $22.3121805 Treatment of rib

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

21810 Treatment of rib

fracture(s) C

21820 Treat sternum

fracture T 0129 1.6063 $111.51

. $22.31

21825 Treat sternum

fracture C

21899 Neck/chest surgery

procedure T 0250 1.0875 $75.49 $24.28 $15.10

21920 Biopsy soft tissue of

back T 0020 8.6164 $598.15

. $119.63

21925 Biopsy soft tissue of

back T 0022 23.4169 "$1,625.60" $350.05 $325.12

21930 Exc back les sc < 3

cm T 0021 17.1909 "$1,193.39"

. $238.68

21931 Exc back les sc 3+

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

21932 Exc back tum deep < 5

cm T 0021 17.1909 "$1,193.39"

. $238.68

21933 Exc back tum deep 5+

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

21935 Resect back tum < 5

cm T 0021 17.1909 "$1,193.39"

. $238.68

21936 Resect back tum 5+

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

22010 I&d p-spine

c/t/cerv-thor C

22015 I&d p-spine

l/s/ls C

22100 Remove part of neck

vertebra T 0208 51.1173 "$3,548.56"

. $709.72

22101 Remove part thorax

vertebra T 0208 51.1173 "$3,548.56"

. $709.7222102 Remove part lumbar

vertebra T 0208 51.1173 "$3,548.56"

. $709.72

22103 Remove extra spine

segment T 0208 51.1173 "$3,548.56"

. $709.72

22110 Remove part of neck

vertebra C

22112 Remove part thorax

vertebra C

22114 Remove part lumbar

vertebra C

22116 Remove extra spine

segment C

22206 Cut spine 3 col

thor C

22207 Cut spine 3 col

lumb C

22208 Cut spine 3 col addl

seg C

22210 Revision of neck

spine C

22212 Revision of thorax

spine C

22214 Revision of lumbar

spine C

22216 Revise extra spine

segment C

22220 Revision of neck

spine C

22222 Revision of thorax

spine T 0208 51.1173 "$3,548.56"

. $709.72

22224 Revision of lumbar

spine C

22226 Revise extra spine

segment C

22305 Treat spine process

fracture T 0129 1.6063 $111.51

. $22.31

22310 Treat spine

fracture T 0138 4.9874 $346.23

. $69.25

22315 Treat spine

fracture T 0139 18.6922 "$1,297.61"

. $259.5322318 Treat odontoid fx w/o

graft C

22319 Treat odontoid fx

w/graft C

22325 Treat spine

fracture C

22326 Treat neck spine

fracture C

22327 Treat thorax spine

fracture C

22328 Treat each add spine

fx C

22505 Manipulation of

spine T 0045 15.5166 "$1,077.16" $268.44 $215.44

22520 Percut vertebroplasty

thor T 0050 32.4101 "$2,249.91"

. $449.99

22521 Percut vertebroplasty

lumb T 0050 32.4101 "$2,249.91"

. $449.99

22522 Percut vertebroplasty

addl T 0050 32.4101 "$2,249.91"

. $449.99

22523 Percut kyphoplasty

thor T 0052 87.5671 "$6,078.91"

. "$1,215.79"

22524 Percut kyphoplasty

lumbar T 0052 87.5671 "$6,078.91"

. "$1,215.79"

22525 Percut kyphoplasty

add-on T 0052 87.5671 "$6,078.91"

. "$1,215.79"

22526 Idet single

level E

22527 Idet 1 or more

levels E

22532 Lat thorax spine

fusion C

22533 Lat lumbar spine

fusion C

22534 Lat thor/lumb addl

seg C

22548 Neck spine

fusion C

22551 Neck spine fuse&remove

addl C22552 Addl neck spine

fusion C

22554 Neck spine

fusion C

22556 Thorax spine

fusion C

22558 Lumbar spine

fusion C

22585 Additional spinal

fusion C

22590 Spine & skull spinal

fusion C

22595 Neck spinal

fusion C

22600 Neck spine

fusion C

22610 Thorax spine

fusion C

22612 Lumbar spine

fusion T 0208 51.1173 "$3,548.56"

. $709.72

22614 Spine fusion extra

segment T 0208 51.1173 "$3,548.56"

. $709.72

22630 Lumbar spine

fusion C

22632 Spine fusion extra

segment C

22800 Fusion of

spine C

22802 Fusion of

spine C

22804 Fusion of

spine C

22808 Fusion of

spine C

22810 Fusion of

spine C

22812 Fusion of

spine C

22818 Kyphectomy 1-2

segments C

22819 Kyphectomy 3 or

more C22830 Exploration of spinal

fusion C

22840 Insert spine fixation

device C

22841 Insert spine fixation

device C

22842 Insert spine fixation

device C

22843 Insert spine fixation

device C

22844 Insert spine fixation

device C

22845 Insert spine fixation

device C

22846 Insert spine fixation

device C

22847 Insert spine fixation

device C

22848 Insert pelv fixation

device C

22849 Reinsert spinal

fixation C

22850 Remove spine fixation

device C

22851 Apply spine prosth device CH

T 0050 32.4101 "$2,249.91"

. $449.99

22852 Remove spine fixation

device C

22855 Remove spine fixation

device C

22856 Cerv artific

diskectomy C

22857 Lumbar artif

diskectomy C

22861 Revise cerv artific

disc C

22862 Revise lumbar artif

disc C

22864 Remove cerv artif

disc C

22865 Remove lumb artif

disc C

22899 Spine surgery procedure CH

T 0050 32.4101 "$2,249.91"

. $449.9922900 Exc back tum deep < 5

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

22901 Exc back tum deep 5+

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

22902 Exc abd les sc < 3

cm T 0021 17.1909 "$1,193.39"

. $238.68

22903 Exc abd les sc > 3

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

22904 Resect abd tum < 5

cm T 0021 17.1909 "$1,193.39"

. $238.68

22905 Resect abd tum > 5

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

22999 Abdomen surgery

procedure T 0049 22.1674 "$1,538.86"

. $307.78

23000 Removal of calcium

deposits T 0021 17.1909 "$1,193.39"

. $238.68

23020 Release shoulder joint CH

T 0050 32.4101 "$2,249.91"

. $449.99

23030 Drain shoulder

lesion T 0008 20.5401 "$1,425.89"

. $285.18

23031 Drain shoulder

bursa T 0008 20.5401 "$1,425.89"

. $285.18

23035 Drain shoulder bone

lesion T 0049 22.1674 "$1,538.86"

. $307.78

23040 Exploratory shoulder

surgery T 0050 32.4101 "$2,249.91"

. $449.99

23044 Exploratory shoulder

surgery T 0050 32.4101 "$2,249.91"

. $449.99

23065 Biopsy shoulder

tissues T 0020 8.6164 $598.15

. $119.63

23066 Biopsy shoulder

tissues T 0022 23.4169 "$1,625.60" $350.05 $325.1223071 Exc shoulder les sc > 3

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

23073 Exc shoulder tum deep > 5

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

23075 Exc shoulder les sc < 3

cm T 0021 17.1909 "$1,193.39"

. $238.68

23076 Exc shoulder tum deep < 5

cm T 0021 17.1909 "$1,193.39"

. $238.68

23077 Resect shoulder tum < 5

cm T 0021 17.1909 "$1,193.39"

. $238.68

23078 Resect shoulder tum > 5

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

23100 Biopsy of shoulder

joint T 0049 22.1674 "$1,538.86"

. $307.78

23101 Shoulder joint

surgery T 0050 32.4101 "$2,249.91"

. $449.99

23105 Remove shoulder joint

lining T 0050 32.4101 "$2,249.91"

. $449.99

23106 Incision of collarbone

joint T 0050 32.4101 "$2,249.91"

. $449.99

23107 Explore treat shoulder

joint T 0050 32.4101 "$2,249.91"

. $449.99

23120 Partial removal collar

bone T 0050 32.4101 "$2,249.91"

. $449.99

23125 Removal of collar

bone T 0050 32.4101 "$2,249.91"

. $449.99

23130 Remove shoulder bone

part T 0051 47.1841 "$3,275.52"

. $655.11

23140 Removal of bone

lesion T 0049 22.1674 "$1,538.86"

. $307.78

23145 Removal of bone

lesion T 0050 32.4101 "$2,249.91"

. $449.99

23146 Removal of bone

lesion T 0050 32.4101 "$2,249.91"

. $449.9923150 Removal of humerus

lesion T 0050 32.4101 "$2,249.91"

. $449.99

23155 Removal of humerus

lesion T 0050 32.4101 "$2,249.91"

. $449.99

23156 Removal of humerus

lesion T 0050 32.4101 "$2,249.91"

. $449.99

23170 Remove collar bone

lesion T 0050 32.4101 "$2,249.91"

. $449.99

23172 Remove shoulder blade

lesion T 0050 32.4101 "$2,249.91"

. $449.99

23174 Remove humerus

lesion T 0050 32.4101 "$2,249.91"

. $449.99

23180 Remove collar bone

lesion T 0050 32.4101 "$2,249.91"

. $449.99

23182 Remove shoulder blade

lesion T 0050 32.4101 "$2,249.91"

. $449.99

23184 Remove humerus

lesion T 0050 32.4101 "$2,249.91"

. $449.99

23190 Partial removal of

scapula T 0050 32.4101 "$2,249.91"

. $449.99

23195 Removal of head of

humerus T 0050 32.4101 "$2,249.91"

. $449.99

23200 Resect clavicle

tumor C

23210 Resect scapula

tumor C

23220 Resect prox humerus

tumor C

23330 Remove shoulder foreign

body T 0020 8.6164 $598.15

. $119.63

23331 Remove shoulder foreign

body T 0022 23.4169 "$1,625.60" $350.05 $325.12

23332 Remove shoulder foreign

body C23350 Injection for shoulder

x-ray N

23395 Muscle transfer

shoulder/arm T 0051 47.1841 "$3,275.52"

. $655.11

23397 Muscle

transfers T 0052 87.5671 "$6,078.91"

. "$1,215.79"

23400 Fixation of shoulder

blade T 0050 32.4101 "$2,249.91"

. $449.99

23405 Incision of tendon &

muscle T 0050 32.4101 "$2,249.91"

. $449.99

23406 Incise tendon(s) &

muscle(s) T 0050 32.4101 "$2,249.91"

. $449.99

23410 Repair rotator cuff

acute T 0051 47.1841 "$3,275.52"

. $655.11

23412 Repair rotator cuff

chronic T 0051 47.1841 "$3,275.52"

. $655.11

23415 Release of shoulder

ligament T 0051 47.1841 "$3,275.52"

. $655.11

23420 Repair of

shoulder T 0051 47.1841 "$3,275.52"

. $655.11

23430 Repair biceps

tendon T 0051 47.1841 "$3,275.52"

. $655.11

23440 Remove/transplant tendon CH

T 0050 32.4101 "$2,249.91"

. $449.99

23450 Repair shoulder

capsule T 0052 87.5671 "$6,078.91"

. "$1,215.79"

23455 Repair shoulder

capsule T 0052 87.5671 "$6,078.91"

. "$1,215.79"

23460 Repair shoulder

capsule T 0052 87.5671 "$6,078.91"

. "$1,215.79"

23462 Repair shoulder

capsule T 0051 47.1841 "$3,275.52"

. $655.11

23465 Repair shoulder

capsule T 0052 87.5671 "$6,078.91"

. "$1,215.79"23466 Repair shoulder

capsule T 0051 47.1841 "$3,275.52"

. $655.11

23470 Reconstruct shoulder

joint T 0425 130.4476 "$9,055.67"

. "$1,811.14"

23472 Reconstruct shoulder

joint C

23480 Revision of collar

bone T 0051 47.1841 "$3,275.52"

. $655.11

23485 Revision of collar

bone T 0052 87.5671 "$6,078.91"

. "$1,215.79"

23490 Reinforce

clavicle T 0052 87.5671 "$6,078.91"

. "$1,215.79"

23491 Reinforce shoulder

bones T 0052 87.5671 "$6,078.91"

. "$1,215.79"

23500 Treat clavicle

fracture T 0129 1.6063 $111.51

. $22.31

23505 Treat clavicle

fracture T 0139 18.6922 "$1,297.61"

. $259.53

23515 Treat clavicle

fracture T 0064 67.0623 "$4,655.46"

. $931.10

23520 Treat clavicle

dislocation T 0138 4.9874 $346.23

. $69.25

23525 Treat clavicle

dislocation T 0138 4.9874 $346.23

. $69.25

23530 Treat clavicle

dislocation T 0063 49.4864 "$3,435.35"

. $687.07

23532 Treat clavicle

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

23540 Treat clavicle

dislocation T 0129 1.6063 $111.51

. $22.31

23545 Treat clavicle

dislocation T 0138 4.9874 $346.23

. $69.25

23550 Treat clavicle

dislocation T 0063 49.4864 "$3,435.35"

. $687.0723552 Treat clavicle

dislocation T 0063 49.4864 "$3,435.35"

. $687.07

23570 Treat shoulder blade

fx T 0129 1.6063 $111.51

. $22.31

23575 Treat shoulder blade

fx T 0138 4.9874 $346.23

. $69.25

23585 Treat scapula

fracture T 0064 67.0623 "$4,655.46"

. $931.10

23600 Treat humerus

fracture T 0129 1.6063 $111.51

. $22.31

23605 Treat humerus

fracture T 0139 18.6922 "$1,297.61"

. $259.53

23615 Treat humerus

fracture T 0064 67.0623 "$4,655.46"

. $931.10

23616 Treat humerus

fracture T 0064 67.0623 "$4,655.46"

. $931.10

23620 Treat humerus

fracture T 0129 1.6063 $111.51

. $22.31

23625 Treat humerus

fracture T 0139 18.6922 "$1,297.61"

. $259.53

23630 Treat humerus

fracture T 0064 67.0623 "$4,655.46"

. $931.10

23650 Treat shoulder

dislocation T 0129 1.6063 $111.51

. $22.31

23655 Treat shoulder

dislocation T 0045 15.5166 "$1,077.16" $268.44 $215.44

23660 Treat shoulder

dislocation T 0063 49.4864 "$3,435.35"

. $687.07

23665 Treat

dislocation/fracture T 0138 4.9874 $346.23

. $69.25

23670 Treat

dislocation/fracture T 0064 67.0623 "$4,655.46"

. $931.1023675 Treat

dislocation/fracture T 0129 1.6063 $111.51

. $22.31

23680 Treat

dislocation/fracture T 0063 49.4864 "$3,435.35"

. $687.07

23700 Fixation of

shoulder T 0045 15.5166 "$1,077.16" $268.44 $215.44

23800 Fusion of shoulder

joint T 0052 87.5671 "$6,078.91"

. "$1,215.79"

23802 Fusion of shoulder

joint T 0052 87.5671 "$6,078.91"

. "$1,215.79"

23900 Amputation of arm &

girdle C

23920 Amputation at shoulder

joint C

23921 Amputation follow-up

surgery T 0136 17.2745 "$1,199.20"

. $239.84

23929 Shoulder surgery

procedure T 0129 1.6063 $111.51

. $22.31

23930 Drainage of arm

lesion T 0008 20.5401 "$1,425.89"

. $285.18

23931 Drainage of arm

bursa T 0008 20.5401 "$1,425.89"

. $285.18

23935 Drain arm/elbow bone

lesion T 0049 22.1674 "$1,538.86"

. $307.78

24000 Exploratory elbow

surgery T 0050 32.4101 "$2,249.91"

. $449.99

24006 Release elbow

joint T 0050 32.4101 "$2,249.91"

. $449.99

24065 Biopsy arm/elbow soft

tissue T 0021 17.1909 "$1,193.39"

. $238.68

24066 Biopsy arm/elbow soft

tissue T 0021 17.1909 "$1,193.39"

. $238.68

24071 Exc arm/elbow les sc 3+

cm T 0022 23.4169 "$1,625.60" $350.05 $325.1224073 Ex arm/elbow tum deep > 5

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

24075 Exc arm/elbow les sc < 3

cm T 0021 17.1909 "$1,193.39"

. $238.68

24076 Ex arm/elbow tum deep < 5

cm T 0021 17.1909 "$1,193.39"

. $238.68

24077 Resect arm/elbow tum < 5

cm T 0021 17.1909 "$1,193.39"

. $238.68

24079 Resect arm/elbow tum > 5

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

24100 Biopsy elbow joint

lining T 0049 22.1674 "$1,538.86"

. $307.78

24101 Explore/treat elbow

joint T 0050 32.4101 "$2,249.91"

. $449.99

24102 Remove elbow joint

lining T 0050 32.4101 "$2,249.91"

. $449.99

24105 Removal of elbow

bursa T 0049 22.1674 "$1,538.86"

. $307.78

24110 Remove humerus

lesion T 0049 22.1674 "$1,538.86"

. $307.78

24115 Remove/graft bone

lesion T 0050 32.4101 "$2,249.91"

. $449.99

24116 Remove/graft bone

lesion T 0050 32.4101 "$2,249.91"

. $449.99

24120 Remove elbow

lesion T 0049 22.1674 "$1,538.86"

. $307.78

24125 Remove/graft bone

lesion T 0050 32.4101 "$2,249.91"

. $449.99

24126 Remove/graft bone

lesion T 0050 32.4101 "$2,249.91"

. $449.99

24130 Removal of head of

radius T 0050 32.4101 "$2,249.91"

. $449.99

24134 Removal of arm bone

lesion T 0050 32.4101 "$2,249.91"

. $449.9924136 Remove radius bone

lesion T 0050 32.4101 "$2,249.91"

. $449.99

24138 Remove elbow bone

lesion T 0050 32.4101 "$2,249.91"

. $449.99

24140 Partial removal of arm

bone T 0050 32.4101 "$2,249.91"

. $449.99

24145 Partial removal of

radius T 0050 32.4101 "$2,249.91"

. $449.99

24147 Partial removal of

elbow T 0050 32.4101 "$2,249.91"

. $449.99

24149 Radical resection of

elbow T 0050 32.4101 "$2,249.91"

. $449.99

24150 Resect distal humerus

tumor T 0051 47.1841 "$3,275.52"

. $655.11

24152 Resect radius

tumor T 0051 47.1841 "$3,275.52"

. $655.11

24155 Removal of elbow joint CH

T 0050 32.4101 "$2,249.91"

. $449.99

24160 Remove elbow joint

implant T 0050 32.4101 "$2,249.91"

. $449.99

24164 Remove radius head

implant T 0050 32.4101 "$2,249.91"

. $449.99

24200 Removal of arm foreign

body T 0019 4.8763 $338.51

. $67.71

24201 Removal of arm foreign

body T 0021 17.1909 "$1,193.39"

. $238.68

24220 Injection for elbow

x-ray N

24300 Manipulate elbow

w/anesth T 0045 15.5166 "$1,077.16" $268.44 $215.44

24301 Muscle/tendon

transfer T 0050 32.4101 "$2,249.91"

. $449.99

24305 Arm tendonlengthening T 0050 32.4101 "$2,249.91"

. $449.99

24310 Revision of arm

tendon T 0049 22.1674 "$1,538.86"

. $307.78

24320 Repair of arm tendon CH

T 0050 32.4101 "$2,249.91"

. $449.99

24330 Revision of arm

muscles T 0052 87.5671 "$6,078.91"

. "$1,215.79"

24331 Revision of arm

muscles T 0051 47.1841 "$3,275.52"

. $655.11

24332 Tenolysis triceps CH

T 0050 32.4101 "$2,249.91"

. $449.99

24340 Repair of biceps

tendon T 0051 47.1841 "$3,275.52"

. $655.11

24341 Repair arm

tendon/muscle T 0051 47.1841 "$3,275.52"

. $655.11

24342 Repair of ruptured

tendon T 0051 47.1841 "$3,275.52"

. $655.11

24343 Repr elbow lat ligmnt

w/tiss T 0050 32.4101 "$2,249.91"

. $449.99

24344 Reconstruct elbow lat

ligmnt T 0052 87.5671 "$6,078.91"

. "$1,215.79"

24345 Repr elbw med ligmnt

w/tissu T 0050 32.4101 "$2,249.91"

. $449.99

24346 Reconstruct elbow med

ligmnt T 0052 87.5671 "$6,078.91"

. "$1,215.79"

24357 Repair elbow

perc T 0050 32.4101 "$2,249.91"

. $449.99

24358 Repair elbow w/deb

open T 0050 32.4101 "$2,249.91"

. $449.99

24359 Repair elbow deb/attch

open T 0050 32.4101 "$2,249.91"

. $449.99

24360 Reconstruct elbow

joint T 0047 41.2971 "$2,866.84"

. $573.3724361 Reconstruct elbow

joint T 0425 130.4476 "$9,055.67"

. "$1,811.14"

24362 Reconstruct elbow

joint T 0048 60.0335 "$4,167.53"

. $833.51

24363 Replace elbow

joint T 0425 130.4476 "$9,055.67"

. "$1,811.14"

24365 Reconstruct head of

radius T 0047 41.2971 "$2,866.84"

. $573.37

24366 Reconstruct head of

radius T 0425 130.4476 "$9,055.67"

. "$1,811.14"

24400 Revision of

humerus T 0052 87.5671 "$6,078.91"

. "$1,215.79"

24410 Revision of

humerus T 0051 47.1841 "$3,275.52"

. $655.11

24420 Revision of

humerus T 0051 47.1841 "$3,275.52"

. $655.11

24430 Repair of

humerus T 0052 87.5671 "$6,078.91"

. "$1,215.79"

24435 Repair humerus with

graft T 0052 87.5671 "$6,078.91"

. "$1,215.79"

24470 Revision of elbow

joint T 0051 47.1841 "$3,275.52"

. $655.11

24495 Decompression of

forearm T 0050 32.4101 "$2,249.91"

. $449.99

24498 Reinforce

humerus T 0052 87.5671 "$6,078.91"

. "$1,215.79"

24500 Treat humerus

fracture T 0129 1.6063 $111.51

. $22.31

24505 Treat humerus

fracture T 0129 1.6063 $111.51

. $22.31

24515 Treat humerus

fracture T 0064 67.0623 "$4,655.46"

. $931.10

24516 Treat humerusfracture T 0064 67.0623 "$4,655.46"

. $931.10

24530 Treat humerus

fracture T 0129 1.6063 $111.51

. $22.31

24535 Treat humerus

fracture T 0138 4.9874 $346.23

. $69.25

24538 Treat humerus

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

24545 Treat humerus

fracture T 0064 67.0623 "$4,655.46"

. $931.10

24546 Treat humerus

fracture T 0064 67.0623 "$4,655.46"

. $931.10

24560 Treat humerus

fracture T 0129 1.6063 $111.51

. $22.31

24565 Treat humerus

fracture T 0129 1.6063 $111.51

. $22.31

24566 Treat humerus

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

24575 Treat humerus

fracture T 0064 67.0623 "$4,655.46"

. $931.10

24576 Treat humerus

fracture T 0129 1.6063 $111.51

. $22.31

24577 Treat humerus

fracture T 0129 1.6063 $111.51

. $22.31

24579 Treat humerus

fracture T 0064 67.0623 "$4,655.46"

. $931.10

24582 Treat humerus

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

24586 Treat elbow

fracture T 0064 67.0623 "$4,655.46"

. $931.10

24587 Treat elbow

fracture T 0064 67.0623 "$4,655.46"

. $931.10

24600 Treat elbow

dislocation T 0129 1.6063 $111.51

. $22.3124605 Treat elbow

dislocation T 0045 15.5166 "$1,077.16" $268.44 $215.44

24615 Treat elbow

dislocation T 0064 67.0623 "$4,655.46"

. $931.10

24620 Treat elbow

fracture T 0139 18.6922 "$1,297.61"

. $259.53

24635 Treat elbow

fracture T 0064 67.0623 "$4,655.46"

. $931.10

24640 Treat elbow

dislocation T 0129 1.6063 $111.51

. $22.31

24650 Treat radius

fracture T 0129 1.6063 $111.51

. $22.31

24655 Treat radius

fracture T 0138 4.9874 $346.23

. $69.25

24665 Treat radius

fracture T 0063 49.4864 "$3,435.35"

. $687.07

24666 Treat radius

fracture T 0064 67.0623 "$4,655.46"

. $931.10

24670 Treat ulnar

fracture T 0129 1.6063 $111.51

. $22.31

24675 Treat ulnar

fracture T 0129 1.6063 $111.51

. $22.31

24685 Treat ulnar

fracture T 0063 49.4864 "$3,435.35"

. $687.07

24800 Fusion of elbow

joint T 0051 47.1841 "$3,275.52"

. $655.11

24802 Fusion/graft of elbow

joint T 0052 87.5671 "$6,078.91"

. "$1,215.79"

24900 Amputation of upper

arm C

24920 Amputation of upper

arm C

24925 Amputation follow-up

surgery T 0049 22.1674 "$1,538.86"

. $307.7824930 Amputation follow-up

surgery C

24931 Amputate upper arm &

implant C

24935 Revision of

amputation T 0052 87.5671 "$6,078.91"

. "$1,215.79"

24940 Revision of upper

arm C

24999 Upper arm/elbow

surgery T 0129 1.6063 $111.51

. $22.31

25000 Incision of tendon

sheath T 0049 22.1674 "$1,538.86"

. $307.78

25001 Incise flexor carpi

radialis T 0049 22.1674 "$1,538.86"

. $307.78

25020 Decompress forearm 1

space T 0050 32.4101 "$2,249.91"

. $449.99

25023 Decompress forearm 1

space T 0050 32.4101 "$2,249.91"

. $449.99

25024 Decompress forearm 2

spaces T 0050 32.4101 "$2,249.91"

. $449.99

25025 Decompress forearm 2

spaces T 0050 32.4101 "$2,249.91"

. $449.99

25028 Drainage of forearm

lesion T 0049 22.1674 "$1,538.86"

. $307.78

25031 Drainage of forearm

bursa T 0049 22.1674 "$1,538.86"

. $307.78

25035 Treat forearm bone

lesion T 0049 22.1674 "$1,538.86"

. $307.78

25040 Explore/treat wrist

joint T 0050 32.4101 "$2,249.91"

. $449.99

25065 Biopsy forearm soft

tissues T 0020 8.6164 $598.15

. $119.63

25066 Biopsy forearm soft

tissues T 0022 23.4169 "$1,625.60" $350.05 $325.1225071 Exc forearm les sc > 3

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

25073 Exc forearm tum deep 3+

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

25075 Exc forearm les sc < 3

cm T 0021 17.1909 "$1,193.39"

. $238.68

25076 Exc forearm tum deep < 3

cm T 0021 17.1909 "$1,193.39"

. $238.68

25077 Resect forearm/wrist

tum<3cm T 0021 17.1909 "$1,193.39"

. $238.68

25078 Resect forearm/wrist

tum3+cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

25085 Incision of wrist

capsule T 0049 22.1674 "$1,538.86"

. $307.78

25100 Biopsy of wrist

joint T 0049 22.1674 "$1,538.86"

. $307.78

25101 Explore/treat wrist

joint T 0050 32.4101 "$2,249.91"

. $449.99

25105 Remove wrist joint

lining T 0050 32.4101 "$2,249.91"

. $449.99

25107 Remove wrist joint

cartilage T 0050 32.4101 "$2,249.91"

. $449.99

25109 Excise tendon

forearm/wrist T 0049 22.1674 "$1,538.86"

. $307.78

25110 Remove wrist tendon

lesion T 0049 22.1674 "$1,538.86"

. $307.78

25111 Remove wrist tendon

lesion T 0049 22.1674 "$1,538.86"

. $307.78

25112 Reremove wrist tendon

lesion T 0049 22.1674 "$1,538.86"

. $307.78

25115 Remove wrist/forearm

lesion T 0049 22.1674 "$1,538.86"

. $307.78

25116 Remove wrist/forearm

lesion T 0049 22.1674 "$1,538.86"

. $307.7825118 Excise wrist tendon

sheath T 0050 32.4101 "$2,249.91"

. $449.99

25119 Partial removal of

ulna T 0050 32.4101 "$2,249.91"

. $449.99

25120 Removal of forearm

lesion T 0050 32.4101 "$2,249.91"

. $449.99

25125 Remove/graft forearm

lesion T 0050 32.4101 "$2,249.91"

. $449.99

25126 Remove/graft forearm

lesion T 0050 32.4101 "$2,249.91"

. $449.99

25130 Removal of wrist

lesion T 0050 32.4101 "$2,249.91"

. $449.99

25135 Remove & graft wrist

lesion T 0050 32.4101 "$2,249.91"

. $449.99

25136 Remove & graft wrist

lesion T 0050 32.4101 "$2,249.91"

. $449.99

25145 Remove forearm bone

lesion T 0050 32.4101 "$2,249.91"

. $449.99

25150 Partial removal of

ulna T 0050 32.4101 "$2,249.91"

. $449.99

25151 Partial removal of

radius T 0050 32.4101 "$2,249.91"

. $449.99

25170 Resect radius/ulnar tumor CH

T 0050 32.4101 "$2,249.91"

. $449.99

25210 Removal of wrist

bone T 0050 32.4101 "$2,249.91"

. $449.99

25215 Removal of wrist

bones T 0050 32.4101 "$2,249.91"

. $449.99

25230 Partial removal of

radius T 0050 32.4101 "$2,249.91"

. $449.99

25240 Partial removal of

ulna T 0050 32.4101 "$2,249.91"

. $449.9925246 Injection for wrist

x-ray N

25248 Remove forearm foreign

body T 0049 22.1674 "$1,538.86"

. $307.78

25250 Removal of wrist

prosthesis T 0050 32.4101 "$2,249.91"

. $449.99

25251 Removal of wrist

prosthesis T 0050 32.4101 "$2,249.91"

. $449.99

25259 Manipulate wrist

w/anesthes T 0139 18.6922 "$1,297.61"

. $259.53

25260 Repair forearm

tendon/muscle T 0050 32.4101 "$2,249.91"

. $449.99

25263 Repair forearm

tendon/muscle T 0050 32.4101 "$2,249.91"

. $449.99

25265 Repair forearm

tendon/muscle T 0050 32.4101 "$2,249.91"

. $449.99

25270 Repair forearm

tendon/muscle T 0050 32.4101 "$2,249.91"

. $449.99

25272 Repair forearm

tendon/muscle T 0050 32.4101 "$2,249.91"

. $449.99

25274 Repair forearm

tendon/muscle T 0050 32.4101 "$2,249.91"

. $449.99

25275 Repair forearm tendon

sheath T 0050 32.4101 "$2,249.91"

. $449.99

25280 Revise wrist/forearm

tendon T 0050 32.4101 "$2,249.91"

. $449.99

25290 Incise wrist/forearm

tendon T 0050 32.4101 "$2,249.91"

. $449.99

25295 Release wrist/forearm

tendon T 0049 22.1674 "$1,538.86"

. $307.78

25300 Fusion of tendons at

wrist T 0050 32.4101 "$2,249.91"

. $449.99

25301 Fusion of tendons at

wrist T 0050 32.4101 "$2,249.91"

. $449.9925310 Transplant forearm tendon CH

T 0050 32.4101 "$2,249.91"

. $449.99

25312 Transplant forearm

tendon T 0051 47.1841 "$3,275.52"

. $655.11

25315 Revise palsy hand tendon(s) CH

T 0050 32.4101 "$2,249.91"

. $449.99

25316 Revise palsy hand

tendon(s) T 0052 87.5671 "$6,078.91"

. "$1,215.79"

25320 Repair/revise wrist

joint T 0051 47.1841 "$3,275.52"

. $655.11

25332 Revise wrist

joint T 0047 41.2971 "$2,866.84"

. $573.37

25335 Realignment of

hand T 0051 47.1841 "$3,275.52"

. $655.11

25337 Reconstruct

ulna/radioulnar T 0051 47.1841 "$3,275.52"

. $655.11

25350 Revision of

radius T 0051 47.1841 "$3,275.52"

. $655.11

25355 Revision of

radius T 0051 47.1841 "$3,275.52"

. $655.11

25360 Revision of

ulna T 0051 47.1841 "$3,275.52"

. $655.11

25365 Revise radius &

ulna T 0052 87.5671 "$6,078.91"

. "$1,215.79"

25370 Revise radius or

ulna T 0051 47.1841 "$3,275.52"

. $655.11

25375 Revise radius &

ulna T 0051 47.1841 "$3,275.52"

. $655.11

25390 Shorten radius or

ulna T 0051 47.1841 "$3,275.52"

. $655.11

25391 Lengthen radius or

ulna T 0052 87.5671 "$6,078.91"

. "$1,215.79"

25392 Shorten radius &ulna T 0050 32.4101 "$2,249.91"

. $449.99

25393 Lengthen radius &

ulna T 0051 47.1841 "$3,275.52"

. $655.11

25394 Repair carpal bone

shorten T 0051 47.1841 "$3,275.52"

. $655.11

25400 Repair radius or

ulna T 0052 87.5671 "$6,078.91"

. "$1,215.79"

25405 Repair/graft radius or

ulna T 0052 87.5671 "$6,078.91"

. "$1,215.79"

25415 Repair radius &

ulna T 0052 87.5671 "$6,078.91"

. "$1,215.79"

25420 Repair/graft radius &

ulna T 0052 87.5671 "$6,078.91"

. "$1,215.79"

25425 Repair/graft radius or

ulna T 0052 87.5671 "$6,078.91"

. "$1,215.79"

25426 Repair/graft radius &

ulna T 0051 47.1841 "$3,275.52"

. $655.11

25430 Vasc graft into carpal

bone T 0051 47.1841 "$3,275.52"

. $655.11

25431 Repair nonunion carpal

bone T 0051 47.1841 "$3,275.52"

. $655.11

25440 Repair/graft wrist

bone T 0052 87.5671 "$6,078.91"

. "$1,215.79"

25441 Reconstruct wrist

joint T 0425 130.4476 "$9,055.67"

. "$1,811.14"

25442 Reconstruct wrist

joint T 0425 130.4476 "$9,055.67"

. "$1,811.14"

25443 Reconstruct wrist

joint T 0048 60.0335 "$4,167.53"

. $833.51

25444 Reconstruct wrist

joint T 0048 60.0335 "$4,167.53"

. $833.51

25445 Reconstruct wrist

joint T 0048 60.0335 "$4,167.53"

. $833.5125446 Wrist

replacement T 0425 130.4476 "$9,055.67"

. "$1,811.14"

25447 Repair wrist

joint(s) T 0047 41.2971 "$2,866.84"

. $573.37

25449 Remove wrist joint

implant T 0047 41.2971 "$2,866.84"

. $573.37

25450 Revision of wrist

joint T 0051 47.1841 "$3,275.52"

. $655.11

25455 Revision of wrist

joint T 0051 47.1841 "$3,275.52"

. $655.11

25490 Reinforce

radius T 0051 47.1841 "$3,275.52"

. $655.11

25491 Reinforce

ulna T 0051 47.1841 "$3,275.52"

. $655.11

25492 Reinforce radius and

ulna T 0051 47.1841 "$3,275.52"

. $655.11

25500 Treat fracture of

radius T 0129 1.6063 $111.51

. $22.31

25505 Treat fracture of

radius T 0138 4.9874 $346.23

. $69.25

25515 Treat fracture of

radius T 0063 49.4864 "$3,435.35"

. $687.07

25520 Treat fracture of

radius T 0138 4.9874 $346.23

. $69.25

25525 Treat fracture of

radius T 0063 49.4864 "$3,435.35"

. $687.07

25526 Treat fracture of

radius T 0063 49.4864 "$3,435.35"

. $687.07

25530 Treat fracture of

ulna T 0129 1.6063 $111.51

. $22.31

25535 Treat fracture of

ulna T 0129 1.6063 $111.51

. $22.31

25545 Treat fracture ofulna T 0063 49.4864 "$3,435.35"

. $687.07

25560 Treat fracture radius &

ulna T 0129 1.6063 $111.51

. $22.31

25565 Treat fracture radius &

ulna T 0138 4.9874 $346.23

. $69.25

25574 Treat fracture radius &

ulna T 0064 67.0623 "$4,655.46"

. $931.10

25575 Treat fracture

radius/ulna T 0064 67.0623 "$4,655.46"

. $931.10

25600 Treat fracture

radius/ulna T 0129 1.6063 $111.51

. $22.31

25605 Treat fracture

radius/ulna T 0138 4.9874 $346.23

. $69.25

25606 Treat fx distal

radial T 0062 26.2376 "$1,821.41" $371.33 $364.29

25607 Treat fx rad

extra-articul T 0064 67.0623 "$4,655.46"

. $931.10

25608 Treat fx rad

intra-articul T 0064 67.0623 "$4,655.46"

. $931.10

25609 Treat fx radial 3+

frag T 0064 67.0623 "$4,655.46"

. $931.10

25622 Treat wrist bone

fracture T 0129 1.6063 $111.51

. $22.31

25624 Treat wrist bone

fracture T 0138 4.9874 $346.23

. $69.25

25628 Treat wrist bone

fracture T 0063 49.4864 "$3,435.35"

. $687.07

25630 Treat wrist bone

fracture T 0129 1.6063 $111.51

. $22.31

25635 Treat wrist bone

fracture T 0129 1.6063 $111.51

. $22.31

25645 Treat wrist bone

fracture T 0063 49.4864 "$3,435.35"

. $687.0725650 Treat wrist bone

fracture T 0129 1.6063 $111.51

. $22.31

25651 Pin ulnar styloid

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

25652 Treat fracture ulnar

styloid T 0063 49.4864 "$3,435.35"

. $687.07

25660 Treat wrist

dislocation T 0129 1.6063 $111.51

. $22.31

25670 Treat wrist

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

25671 Pin radioulnar

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

25675 Treat wrist

dislocation T 0129 1.6063 $111.51

. $22.31

25676 Treat wrist

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

25680 Treat wrist

fracture T 0129 1.6063 $111.51

. $22.31

25685 Treat wrist

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

25690 Treat wrist

dislocation T 0139 18.6922 "$1,297.61"

. $259.53

25695 Treat wrist

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

25800 Fusion of wrist

joint T 0052 87.5671 "$6,078.91"

. "$1,215.79"

25805 Fusion/graft of wrist

joint T 0052 87.5671 "$6,078.91"

. "$1,215.79"

25810 Fusion/graft of wrist

joint T 0052 87.5671 "$6,078.91"

. "$1,215.79"

25820 Fusion of hand

bones T 0051 47.1841 "$3,275.52"

. $655.11

25825 Fuse hand bones withgraft T 0052 87.5671 "$6,078.91"

. "$1,215.79"

25830 Fusion radioulnar

jnt/ulna T 0052 87.5671 "$6,078.91"

. "$1,215.79"

25900 Amputation of

forearm C

25905 Amputation of

forearm C

25907 Amputation follow-up

surgery T 0049 22.1674 "$1,538.86"

. $307.78

25909 Amputation follow-up

surgery T 0049 22.1674 "$1,538.86"

. $307.78

25915 Amputation of

forearm C

25920 Amputate hand at

wrist C

25922 Amputate hand at

wrist T 0049 22.1674 "$1,538.86"

. $307.78

25924 Amputation follow-up

surgery C

25927 Amputation of

hand C

25929 Amputation follow-up

surgery T 0136 17.2745 "$1,199.20"

. $239.84

25931 Amputation follow-up

surgery T 0049 22.1674 "$1,538.86"

. $307.78

25999 Forearm or wrist

surgery T 0129 1.6063 $111.51

. $22.31

26010 Drainage of finger

abscess T 0006 1.4481 $100.53

. $20.11

26011 Drainage of finger

abscess T 0007 13.4779 $935.64

. $187.13

26020 Drain hand tendon

sheath T 0053 17.4096 "$1,208.57" $253.49 $241.72

26025 Drainage of palm

bursa T 0053 17.4096 "$1,208.57" $253.49 $241.72

26030 Drainage of palmbursa(s) T 0053 17.4096 "$1,208.57" $253.49 $241.72

26034 Treat hand bone

lesion T 0053 17.4096 "$1,208.57" $253.49 $241.72

26035 Decompress

fingers/hand T 0053 17.4096 "$1,208.57" $253.49 $241.72

26037 Decompress

fingers/hand T 0053 17.4096 "$1,208.57" $253.49 $241.72

26040 Release palm

contracture T 0053 17.4096 "$1,208.57" $253.49 $241.72

26045 Release palm

contracture T 0054 29.0181 "$2,014.44"

. $402.89

26055 Incise finger tendon

sheath T 0053 17.4096 "$1,208.57" $253.49 $241.72

26060 Incision of finger

tendon T 0053 17.4096 "$1,208.57" $253.49 $241.72

26070 Explore/treat hand

joint T 0053 17.4096 "$1,208.57" $253.49 $241.72

26075 Explore/treat finger

joint T 0053 17.4096 "$1,208.57" $253.49 $241.72

26080 Explore/treat finger

joint T 0053 17.4096 "$1,208.57" $253.49 $241.72

26100 Biopsy hand joint

lining T 0053 17.4096 "$1,208.57" $253.49 $241.72

26105 Biopsy finger joint

lining T 0053 17.4096 "$1,208.57" $253.49 $241.72

26110 Biopsy finger joint

lining T 0053 17.4096 "$1,208.57" $253.49 $241.72

26111 Exc hand les sc > 1.5

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

26113 Exc hand tum deep > 1.5

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

26115 Exc hand les sc < 1.5

cm T 0021 17.1909 "$1,193.39"

. $238.6826116 Exc hand tum deep < 1.5

cm T 0021 17.1909 "$1,193.39"

. $238.68

26117 Exc hand tum ra < 3

cm T 0021 17.1909 "$1,193.39"

. $238.68

26118 Exc hand tum ra > 3

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

26121 Release palm

contracture T 0054 29.0181 "$2,014.44"

. $402.89

26123 Release palm

contracture T 0054 29.0181 "$2,014.44"

. $402.89

26125 Release palm

contracture T 0053 17.4096 "$1,208.57" $253.49 $241.72

26130 Remove wrist joint

lining T 0053 17.4096 "$1,208.57" $253.49 $241.72

26135 Revise finger joint

each T 0054 29.0181 "$2,014.44"

. $402.89

26140 Revise finger joint

each T 0053 17.4096 "$1,208.57" $253.49 $241.72

26145 Tendon excision

palm/finger T 0053 17.4096 "$1,208.57" $253.49 $241.72

26160 Remove tendon sheath

lesion T 0053 17.4096 "$1,208.57" $253.49 $241.72

26170 Removal of palm tendon

each T 0053 17.4096 "$1,208.57" $253.49 $241.72

26180 Removal of finger

tendon T 0053 17.4096 "$1,208.57" $253.49 $241.72

26185 Remove finger

bone T 0053 17.4096 "$1,208.57" $253.49 $241.72

26200 Remove hand bone

lesion T 0053 17.4096 "$1,208.57" $253.49 $241.72

26205 Remove/graft bone

lesion T 0054 29.0181 "$2,014.44"

. $402.89

26210 Removal of fingerlesion T 0053 17.4096 "$1,208.57" $253.49 $241.72

26215 Remove/graft finger

lesion T 0053 17.4096 "$1,208.57" $253.49 $241.72

26230 Partial removal of hand

bone T 0053 17.4096 "$1,208.57" $253.49 $241.72

26235 Partial removal finger

bone T 0053 17.4096 "$1,208.57" $253.49 $241.72

26236 Partial removal finger

bone T 0053 17.4096 "$1,208.57" $253.49 $241.72

26250 Extensive hand

surgery T 0053 17.4096 "$1,208.57" $253.49 $241.72

26260 Resect prox finger

tumor T 0053 17.4096 "$1,208.57" $253.49 $241.72

26262 Resect distal finger

tumor T 0053 17.4096 "$1,208.57" $253.49 $241.72

26320 Removal of implant from

hand T 0021 17.1909 "$1,193.39"

. $238.68

26340 Manipulate finger

w/anesth T 0138 4.9874 $346.23

. $69.25

26350 Repair finger/hand

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26352 Repair/graft hand

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26356 Repair finger/hand

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26357 Repair finger/hand

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26358 Repair/graft hand

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26370 Repair finger/hand

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26372 Repair/graft hand

tendon T 0054 29.0181 "$2,014.44"

. $402.8926373 Repair finger/hand

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26390 Revise hand/finger

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26392 Repair/graft hand

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26410 Repair hand

tendon T 0053 17.4096 "$1,208.57" $253.49 $241.72

26412 Repair/graft hand

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26415 Excision hand/finger

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26416 Graft hand or finger

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26418 Repair finger

tendon T 0053 17.4096 "$1,208.57" $253.49 $241.72

26420 Repair/graft finger

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26426 Repair finger/hand

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26428 Repair/graft finger

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26432 Repair finger

tendon T 0053 17.4096 "$1,208.57" $253.49 $241.72

26433 Repair finger

tendon T 0053 17.4096 "$1,208.57" $253.49 $241.72

26434 Repair/graft finger

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26437 Realignment of

tendons T 0053 17.4096 "$1,208.57" $253.49 $241.72

26440 Release palm/finger

tendon T 0053 17.4096 "$1,208.57" $253.49 $241.72

26442 Release palm & fingertendon T 0054 29.0181 "$2,014.44"

. $402.89

26445 Release hand/finger

tendon T 0053 17.4096 "$1,208.57" $253.49 $241.72

26449 Release forearm/hand

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26450 Incision of palm

tendon T 0053 17.4096 "$1,208.57" $253.49 $241.72

26455 Incision of finger

tendon T 0053 17.4096 "$1,208.57" $253.49 $241.72

26460 Incise hand/finger

tendon T 0053 17.4096 "$1,208.57" $253.49 $241.72

26471 Fusion of finger

tendons T 0053 17.4096 "$1,208.57" $253.49 $241.72

26474 Fusion of finger

tendons T 0053 17.4096 "$1,208.57" $253.49 $241.72

26476 Tendon

lengthening T 0053 17.4096 "$1,208.57" $253.49 $241.72

26477 Tendon

shortening T 0053 17.4096 "$1,208.57" $253.49 $241.72

26478 Lengthening of hand

tendon T 0053 17.4096 "$1,208.57" $253.49 $241.72

26479 Shortening of hand

tendon T 0053 17.4096 "$1,208.57" $253.49 $241.72

26480 Transplant hand

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26483 Transplant/graft hand

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26485 Transplant palm

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26489 Transplant/graft palm

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26490 Revise thumb

tendon T 0054 29.0181 "$2,014.44"

. $402.8926492 Tendon transfer with

graft T 0054 29.0181 "$2,014.44"

. $402.89

26494 Hand tendon/muscle

transfer T 0054 29.0181 "$2,014.44"

. $402.89

26496 Revise thumb

tendon T 0054 29.0181 "$2,014.44"

. $402.89

26497 Finger tendon

transfer T 0054 29.0181 "$2,014.44"

. $402.89

26498 Finger tendon

transfer T 0054 29.0181 "$2,014.44"

. $402.89

26499 Revision of

finger T 0054 29.0181 "$2,014.44"

. $402.89

26500 Hand tendon

reconstruction T 0053 17.4096 "$1,208.57" $253.49 $241.72

26502 Hand tendon

reconstruction T 0054 29.0181 "$2,014.44"

. $402.89

26508 Release thumb

contracture T 0053 17.4096 "$1,208.57" $253.49 $241.72

26510 Thumb tendon

transfer T 0054 29.0181 "$2,014.44"

. $402.89

26516 Fusion of knuckle

joint T 0054 29.0181 "$2,014.44"

. $402.89

26517 Fusion of knuckle

joints T 0054 29.0181 "$2,014.44"

. $402.89

26518 Fusion of knuckle

joints T 0054 29.0181 "$2,014.44"

. $402.89

26520 Release knuckle

contracture T 0053 17.4096 "$1,208.57" $253.49 $241.72

26525 Release finger

contracture T 0053 17.4096 "$1,208.57" $253.49 $241.72

26530 Revise knuckle

joint T 0047 41.2971 "$2,866.84"

. $573.37

26531 Revise knuckle withimplant T 0048 60.0335 "$4,167.53"

. $833.51

26535 Revise finger

joint T 0047 41.2971 "$2,866.84"

. $573.37

26536 Revise/implant finger

joint T 0048 60.0335 "$4,167.53"

. $833.51

26540 Repair hand

joint T 0053 17.4096 "$1,208.57" $253.49 $241.72

26541 Repair hand joint with

graft T 0054 29.0181 "$2,014.44"

. $402.89

26542 Repair hand joint with

graft T 0053 17.4096 "$1,208.57" $253.49 $241.72

26545 Reconstruct finger

joint T 0054 29.0181 "$2,014.44"

. $402.89

26546 Repair nonunion

hand T 0054 29.0181 "$2,014.44"

. $402.89

26548 Reconstruct finger

joint T 0054 29.0181 "$2,014.44"

. $402.89

26550 Construct thumb

replacement T 0054 29.0181 "$2,014.44"

. $402.89

26551 Great toe-hand

transfer C

26553 Single transfer

toe-hand C

26554 Double transfer

toe-hand C

26555 Positional change of

finger T 0054 29.0181 "$2,014.44"

. $402.89

26556 Toe joint

transfer C

26560 Repair of web

finger T 0053 17.4096 "$1,208.57" $253.49 $241.72

26561 Repair of web

finger T 0054 29.0181 "$2,014.44"

. $402.89

26562 Repair of web

finger T 0054 29.0181 "$2,014.44"

. $402.8926565 Correct metacarpal

flaw T 0054 29.0181 "$2,014.44"

. $402.89

26567 Correct finger

deformity T 0054 29.0181 "$2,014.44"

. $402.89

26568 Lengthen

metacarpal/finger T 0054 29.0181 "$2,014.44"

. $402.89

26580 Repair hand

deformity T 0053 17.4096 "$1,208.57" $253.49 $241.72

26587 Reconstruct extra

finger T 0053 17.4096 "$1,208.57" $253.49 $241.72

26590 Repair finger

deformity T 0053 17.4096 "$1,208.57" $253.49 $241.72

26591 Repair muscles of

hand T 0054 29.0181 "$2,014.44"

. $402.89

26593 Release muscles of

hand T 0053 17.4096 "$1,208.57" $253.49 $241.72

26596 Excision constricting

tissue T 0053 17.4096 "$1,208.57" $253.49 $241.72

26600 Treat metacarpal

fracture T 0129 1.6063 $111.51

. $22.31

26605 Treat metacarpal

fracture T 0129 1.6063 $111.51

. $22.31

26607 Treat metacarpal

fracture T 0139 18.6922 "$1,297.61"

. $259.53

26608 Treat metacarpal

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

26615 Treat metacarpal

fracture T 0063 49.4864 "$3,435.35"

. $687.07

26641 Treat thumb

dislocation T 0129 1.6063 $111.51

. $22.31

26645 Treat thumb

fracture T 0138 4.9874 $346.23

. $69.25

26650 Treat thumbfracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

26665 Treat thumb

fracture T 0063 49.4864 "$3,435.35"

. $687.07

26670 Treat hand

dislocation T 0129 1.6063 $111.51

. $22.31

26675 Treat hand

dislocation T 0129 1.6063 $111.51

. $22.31

26676 Pin hand

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

26685 Treat hand

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

26686 Treat hand

dislocation T 0064 67.0623 "$4,655.46"

. $931.10

26700 Treat knuckle

dislocation T 0129 1.6063 $111.51

. $22.31

26705 Treat knuckle

dislocation T 0129 1.6063 $111.51

. $22.31

26706 Pin knuckle

dislocation T 0139 18.6922 "$1,297.61"

. $259.53

26715 Treat knuckle

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

26720 Treat finger fracture

each T 0129 1.6063 $111.51

. $22.31

26725 Treat finger fracture

each T 0129 1.6063 $111.51

. $22.31

26727 Treat finger fracture

each T 0062 26.2376 "$1,821.41" $371.33 $364.29

26735 Treat finger fracture

each T 0062 26.2376 "$1,821.41" $371.33 $364.29

26740 Treat finger fracture

each T 0129 1.6063 $111.51

. $22.31

26742 Treat finger fracture

each T 0129 1.6063 $111.51

. $22.3126746 Treat finger fracture

each T 0062 26.2376 "$1,821.41" $371.33 $364.29

26750 Treat finger fracture

each T 0129 1.6063 $111.51

. $22.31

26755 Treat finger fracture

each T 0129 1.6063 $111.51

. $22.31

26756 Pin finger fracture

each T 0062 26.2376 "$1,821.41" $371.33 $364.29

26765 Treat finger fracture

each T 0062 26.2376 "$1,821.41" $371.33 $364.29

26770 Treat finger

dislocation T 0129 1.6063 $111.51

. $22.31

26775 Treat finger

dislocation T 0045 15.5166 "$1,077.16" $268.44 $215.44

26776 Pin finger

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

26785 Treat finger

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

26820 Thumb fusion with

graft T 0054 29.0181 "$2,014.44"

. $402.89

26841 Fusion of

thumb T 0054 29.0181 "$2,014.44"

. $402.89

26842 Thumb fusion with

graft T 0054 29.0181 "$2,014.44"

. $402.89

26843 Fusion of hand

joint T 0054 29.0181 "$2,014.44"

. $402.89

26844 Fusion/graft of hand

joint T 0054 29.0181 "$2,014.44"

. $402.89

26850 Fusion of

knuckle T 0054 29.0181 "$2,014.44"

. $402.89

26852 Fusion of knuckle with

graft T 0054 29.0181 "$2,014.44"

. $402.89

26860 Fusion of fingerjoint T 0054 29.0181 "$2,014.44"

. $402.89

26861 Fusion of finger jnt

add-on T 0054 29.0181 "$2,014.44"

. $402.89

26862 Fusion/graft of finger

joint T 0054 29.0181 "$2,014.44"

. $402.89

26863 Fuse/graft added

joint T 0054 29.0181 "$2,014.44"

. $402.89

26910 Amputate metacarpal

bone T 0054 29.0181 "$2,014.44"

. $402.89

26951 Amputation of

finger/thumb T 0053 17.4096 "$1,208.57" $253.49 $241.72

26952 Amputation of

finger/thumb T 0053 17.4096 "$1,208.57" $253.49 $241.72

26989 Hand/finger

surgery T 0129 1.6063 $111.51

. $22.31

26990 Drainage of pelvis

lesion T 0049 22.1674 "$1,538.86"

. $307.78

26991 Drainage of pelvis

bursa T 0049 22.1674 "$1,538.86"

. $307.78

26992 Drainage of bone

lesion C

27000 Incision of hip

tendon T 0049 22.1674 "$1,538.86"

. $307.78

27001 Incision of hip

tendon T 0050 32.4101 "$2,249.91"

. $449.99

27003 Incision of hip

tendon T 0050 32.4101 "$2,249.91"

. $449.99

27005 Incision of hip

tendon C

27006 Incision of hip

tendons T 0050 32.4101 "$2,249.91"

. $449.99

27025 Incision of hip/thigh

fascia C

27027 Buttock fasciotomy CH

T 0050 32.4101 "$2,249.91"

. $449.9927030 Drainage of hip

joint C

27033 Exploration of hip

joint T 0051 47.1841 "$3,275.52"

. $655.11

27035 Denervation of hip joint CH

T 0050 32.4101 "$2,249.91"

. $449.99

27036 Excision of hip

joint/muscle C

27040 Biopsy of soft

tissues T 0020 8.6164 $598.15

. $119.63

27041 Biopsy of soft

tissues T 0020 8.6164 $598.15

. $119.63

27043 Exc hip pelvis les sc > 3

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

27045 Exc hip/pelv tum deep > 5

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

27047 Exc hip/pelvis les sc < 3

cm T 0021 17.1909 "$1,193.39"

. $238.68

27048 Exc hip/pelv tum deep < 5

cm T 0021 17.1909 "$1,193.39"

. $238.68

27049 Resect hip/pelv tum < 5

cm T 0021 17.1909 "$1,193.39"

. $238.68

27050 Biopsy of sacroiliac

joint T 0049 22.1674 "$1,538.86"

. $307.78

27052 Biopsy of hip

joint T 0049 22.1674 "$1,538.86"

. $307.78

27054 Removal of hip joint

lining C

27057 Buttock fasciotomy

w/dbrdmt T 0049 22.1674 "$1,538.86"

. $307.78

27059 Resect hip/pelv tum > 5

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

27060 Removal of ischial

bursa T 0049 22.1674 "$1,538.86"

. $307.7827062 Remove femur

lesion/bursa T 0049 22.1674 "$1,538.86"

. $307.78

27065 Remove hip bone les

super T 0049 22.1674 "$1,538.86"

. $307.78

27066 Remove hip bone les

deep T 0050 32.4101 "$2,249.91"

. $449.99

27067 Remove/graft hip bone

lesion T 0050 32.4101 "$2,249.91"

. $449.99

27070 Part remove hip bone

super C

27071 Part removal hip bone

deep C

27075 Resect hip

tumor C

27076 Resect hip tum incl

acetabul C

27077 Resect hip tum w/innom

bone C

27078 Rsect hip tum incl

femur C

27080 Removal of tail

bone T 0050 32.4101 "$2,249.91"

. $449.99

27086 Remove hip foreign

body T 0020 8.6164 $598.15

. $119.63

27087 Remove hip foreign

body T 0049 22.1674 "$1,538.86"

. $307.78

27090 Removal of hip

prosthesis C

27091 Removal of hip

prosthesis C

27093 Injection for hip

x-ray N

27095 Injection for hip

x-ray N

27096 Inject sacroiliac

joint B

27097 Revision of hip

tendon T 0050 32.4101 "$2,249.91"

. $449.9927098 Transfer tendon to

pelvis T 0050 32.4101 "$2,249.91"

. $449.99

27100 Transfer of abdominal

muscle T 0051 47.1841 "$3,275.52"

. $655.11

27105 Transfer of spinal

muscle T 0051 47.1841 "$3,275.52"

. $655.11

27110 Transfer of iliopsoas

muscle T 0051 47.1841 "$3,275.52"

. $655.11

27111 Transfer of iliopsoas

muscle T 0051 47.1841 "$3,275.52"

. $655.11

27120 Reconstruction of hip

socket C

27122 Reconstruction of hip

socket C

27125 Partial hip

replacement C

27130 Total hip

arthroplasty C

27132 Total hip

arthroplasty C

27134 Revise hip joint

replacement C

27137 Revise hip joint

replacement C

27138 Revise hip joint

replacement C

27140 Transplant femur

ridge C

27146 Incision of hip

bone C

27147 Revision of hip

bone C

27151 Incision of hip

bones C

27156 Revision of hip

bones C

27158 Revision of

pelvis C

27161 Incision of neck of

femur C

27165 Incision/fixation offemur C

27170 Repair/graft femur

head/neck C

27175 Treat slipped

epiphysis C

27176 Treat slipped

epiphysis C

27177 Treat slipped

epiphysis C

27178 Treat slipped

epiphysis C

27179 Revise head/neck of

femur T 0052 87.5671 "$6,078.91"

. "$1,215.79"

27181 Treat slipped

epiphysis C

27185 Revision of femur

epiphysis C

27187 Reinforce hip

bones C

27193 Treat pelvic ring

fracture T 0129 1.6063 $111.51

. $22.31

27194 Treat pelvic ring

fracture T 0045 15.5166 "$1,077.16" $268.44 $215.44

27200 Treat tail bone

fracture T 0129 1.6063 $111.51

. $22.31

27202 Treat tail bone

fracture T 0063 49.4864 "$3,435.35"

. $687.07

27215 Treat pelvic

fracture(s) E

27216 Treat pelvic ring

fracture E

27217 Treat pelvic ring

fracture E

27218 Treat pelvic ring

fracture E

27220 Treat hip socket

fracture T 0129 1.6063 $111.51

. $22.31

27222 Treat hip socket

fracture C

27226 Treat hip wallfracture C

27227 Treat hip

fracture(s) C

27228 Treat hip

fracture(s) C

27230 Treat thigh

fracture T 0129 1.6063 $111.51

. $22.31

27232 Treat thigh

fracture C

27235 Treat thigh

fracture T 0050 32.4101 "$2,249.91"

. $449.99

27236 Treat thigh

fracture C

27238 Treat thigh

fracture T 0138 4.9874 $346.23

. $69.25

27240 Treat thigh

fracture C

27244 Treat thigh

fracture C

27245 Treat thigh

fracture C

27246 Treat thigh

fracture T 0138 4.9874 $346.23

. $69.25

27248 Treat thigh

fracture C

27250 Treat hip

dislocation T 0129 1.6063 $111.51

. $22.31

27252 Treat hip

dislocation T 0045 15.5166 "$1,077.16" $268.44 $215.44

27253 Treat hip

dislocation C

27254 Treat hip

dislocation C

27256 Treat hip

dislocation T 0129 1.6063 $111.51

. $22.31

27257 Treat hip

dislocation T 0045 15.5166 "$1,077.16" $268.44 $215.44

27258 Treat hip

dislocation C27259 Treat hip

dislocation C

27265 Treat hip

dislocation T 0129 1.6063 $111.51

. $22.31

27266 Treat hip

dislocation T 0045 15.5166 "$1,077.16" $268.44 $215.44

27267 Cltx thigh

fx T 0129 1.6063 $111.51

. $22.31

27268 Cltx thigh fx

w/mnpj C

27269 Optx thigh

fx C

27275 Manipulation of hip

joint T 0045 15.5166 "$1,077.16" $268.44 $215.44

27280 Fusion of sacroiliac

joint C

27282 Fusion of pubic

bones C

27284 Fusion of hip

joint C

27286 Fusion of hip

joint C

27290 Amputation of leg at

hip C

27295 Amputation of leg at

hip C

27299 Pelvis/hip joint

surgery T 0129 1.6063 $111.51

. $22.31

27301 Drain thigh/knee

lesion T 0008 20.5401 "$1,425.89"

. $285.18

27303 Drainage of bone

lesion C

27305 Incise thigh tendon &

fascia T 0049 22.1674 "$1,538.86"

. $307.78

27306 Incision of thigh

tendon T 0049 22.1674 "$1,538.86"

. $307.78

27307 Incision of thigh tendons CH

T 0050 32.4101 "$2,249.91"

. $449.9927310 Exploration of knee

joint T 0050 32.4101 "$2,249.91"

. $449.99

27323 Biopsy thigh soft

tissues T 0020 8.6164 $598.15

. $119.63

27324 Biopsy thigh soft

tissues T 0022 23.4169 "$1,625.60" $350.05 $325.12

27325 Neurectomy

hamstring T 0220 19.0626 "$1,323.33"

. $264.67

27326 Neurectomy

popliteal T 0220 19.0626 "$1,323.33"

. $264.67

27327 Exc thigh/knee les sc < 3

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

27328 Exc thigh/knee tum deep

<5cm T 0021 17.1909 "$1,193.39"

. $238.68

27329 Resect thigh/knee tum < 5

cm T 0021 17.1909 "$1,193.39"

. $238.68

27330 Biopsy knee joint

lining T 0050 32.4101 "$2,249.91"

. $449.99

27331 Explore/treat knee

joint T 0050 32.4101 "$2,249.91"

. $449.99

27332 Removal of knee

cartilage T 0050 32.4101 "$2,249.91"

. $449.99

27333 Removal of knee

cartilage T 0050 32.4101 "$2,249.91"

. $449.99

27334 Remove knee joint

lining T 0050 32.4101 "$2,249.91"

. $449.99

27335 Remove knee joint

lining T 0050 32.4101 "$2,249.91"

. $449.99

27337 Exc thigh/knee les sc 3+

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

27339 Exc thigh/knee tum deep

5+cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

27340 Removal of kneecapbursa T 0049 22.1674 "$1,538.86"

. $307.78

27345 Removal of knee

cyst T 0049 22.1674 "$1,538.86"

. $307.78

27347 Remove knee

cyst T 0049 22.1674 "$1,538.86"

. $307.78

27350 Removal of

kneecap T 0050 32.4101 "$2,249.91"

. $449.99

27355 Remove femur

lesion T 0050 32.4101 "$2,249.91"

. $449.99

27356 Remove femur

lesion/graft T 0050 32.4101 "$2,249.91"

. $449.99

27357 Remove femur

lesion/graft T 0050 32.4101 "$2,249.91"

. $449.99

27358 Remove femur

lesion/fixation T 0050 32.4101 "$2,249.91"

. $449.99

27360 Partial removal leg

bone(s) T 0050 32.4101 "$2,249.91"

. $449.99

27364 Resect thigh/knee tum 5+

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

27365 Resect femur/knee

tumor C

27370 Injection for knee

x-ray N

27372 Removal of foreign

body T 0022 23.4169 "$1,625.60" $350.05 $325.12

27380 Repair of kneecap tendon CH

T 0050 32.4101 "$2,249.91"

. $449.99

27381 Repair/graft kneecap tendon CH

T 0050 32.4101 "$2,249.91"

. $449.99

27385 Repair of thigh muscle CH

T 0050 32.4101 "$2,249.91"

. $449.99

27386 Repair/graft of thigh muscle CH

T 0050 32.4101 "$2,249.91"

. $449.99

27390 Incision of thightendon T 0049 22.1674 "$1,538.86"

. $307.78

27391 Incision of thigh

tendons T 0049 22.1674 "$1,538.86"

. $307.78

27392 Incision of thigh tendons CH

T 0050 32.4101 "$2,249.91"

. $449.99

27393 Lengthening of thigh

tendon T 0050 32.4101 "$2,249.91"

. $449.99

27394 Lengthening of thigh

tendons T 0050 32.4101 "$2,249.91"

. $449.99

27395 Lengthening of thigh

tendons T 0051 47.1841 "$3,275.52"

. $655.11

27396 Transplant of thigh

tendon T 0050 32.4101 "$2,249.91"

. $449.99

27397 Transplants of thigh

tendons T 0051 47.1841 "$3,275.52"

. $655.11

27400 Revise thigh

muscles/tendons T 0051 47.1841 "$3,275.52"

. $655.11

27403 Repair of knee

cartilage T 0050 32.4101 "$2,249.91"

. $449.99

27405 Repair of knee

ligament T 0051 47.1841 "$3,275.52"

. $655.11

27407 Repair of knee

ligament T 0052 87.5671 "$6,078.91"

. "$1,215.79"

27409 Repair of knee

ligaments T 0052 87.5671 "$6,078.91"

. "$1,215.79"

27412 Autochondrocyte implant

knee T 0052 87.5671 "$6,078.91"

. "$1,215.79"

27415 Osteochondral knee

allograft T 0052 87.5671 "$6,078.91"

. "$1,215.79"

27416 Osteochondral knee

autograft T 0051 47.1841 "$3,275.52"

. $655.11

27418 Repair degenerated

kneecap T 0051 47.1841 "$3,275.52"

. $655.1127420 Revision of unstable

kneecap T 0051 47.1841 "$3,275.52"

. $655.11

27422 Revision of unstable

kneecap T 0051 47.1841 "$3,275.52"

. $655.11

27424 Revision/removal of

kneecap T 0051 47.1841 "$3,275.52"

. $655.11

27425 Lat retinacular release

open T 0050 32.4101 "$2,249.91"

. $449.99

27427 Reconstruction

knee T 0052 87.5671 "$6,078.91"

. "$1,215.79"

27428 Reconstruction

knee T 0052 87.5671 "$6,078.91"

. "$1,215.79"

27429 Reconstruction

knee T 0052 87.5671 "$6,078.91"

. "$1,215.79"

27430 Revision of thigh

muscles T 0051 47.1841 "$3,275.52"

. $655.11

27435 Incision of knee joint CH

T 0050 32.4101 "$2,249.91"

. $449.99

27437 Revise

kneecap T 0047 41.2971 "$2,866.84"

. $573.37

27438 Revise kneecap with

implant T 0048 60.0335 "$4,167.53"

. $833.51

27440 Revision of knee

joint T 0047 41.2971 "$2,866.84"

. $573.37

27441 Revision of knee

joint T 0047 41.2971 "$2,866.84"

. $573.37

27442 Revision of knee

joint T 0047 41.2971 "$2,866.84"

. $573.37

27443 Revision of knee

joint T 0047 41.2971 "$2,866.84"

. $573.37

27445 Revision of knee

joint C

27446 Revision of knee

joint T 0425 130.4476 "$9,055.67"

. "$1,811.14"27447 Total knee

arthroplasty C

27448 Incision of

thigh C

27450 Incision of

thigh C

27454 Realignment of thigh

bone C

27455 Realignment of

knee C

27457 Realignment of

knee C

27465 Shortening of thigh

bone C

27466 Lengthening of thigh

bone C

27468 Shorten/lengthen

thighs C

27470 Repair of

thigh C

27472 Repair/graft of

thigh C

27475 Surgery to stop leg

growth T 0050 32.4101 "$2,249.91"

. $449.99

27477 Surgery to stop leg

growth C

27479 Surgery to stop leg

growth T 0050 32.4101 "$2,249.91"

. $449.99

27485 Surgery to stop leg

growth C

27486 Revise/replace knee

joint C

27487 Revise/replace knee

joint C

27488 Removal of knee

prosthesis C

27495 Reinforce

thigh C

27496 Decompression of

thigh/knee T 0050 32.4101 "$2,249.91"

. $449.99

27497 Decompression ofthigh/knee T 0049 22.1674 "$1,538.86"

. $307.78

27498 Decompression of

thigh/knee T 0050 32.4101 "$2,249.91"

. $449.99

27499 Decompression of

thigh/knee T 0050 32.4101 "$2,249.91"

. $449.99

27500 Treatment of thigh

fracture T 0138 4.9874 $346.23

. $69.25

27501 Treatment of thigh

fracture T 0129 1.6063 $111.51

. $22.31

27502 Treatment of thigh

fracture T 0139 18.6922 "$1,297.61"

. $259.53

27503 Treatment of thigh

fracture T 0129 1.6063 $111.51

. $22.31

27506 Treatment of thigh

fracture C

27507 Treatment of thigh

fracture C

27508 Treatment of thigh

fracture T 0129 1.6063 $111.51

. $22.31

27509 Treatment of thigh

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

27510 Treatment of thigh

fracture T 0138 4.9874 $346.23

. $69.25

27511 Treatment of thigh

fracture C

27513 Treatment of thigh

fracture C

27514 Treatment of thigh

fracture C

27516 Treat thigh fx growth

plate T 0129 1.6063 $111.51

. $22.31

27517 Treat thigh fx growth

plate T 0129 1.6063 $111.51

. $22.31

27519 Treat thigh fx growth

plate C

27520 Treat kneecapfracture T 0129 1.6063 $111.51

. $22.31

27524 Treat kneecap

fracture T 0063 49.4864 "$3,435.35"

. $687.07

27530 Treat knee

fracture T 0129 1.6063 $111.51

. $22.31

27532 Treat knee

fracture T 0139 18.6922 "$1,297.61"

. $259.53

27535 Treat knee

fracture C

27536 Treat knee

fracture C

27538 Treat knee

fracture(s) T 0129 1.6063 $111.51

. $22.31

27540 Treat knee

fracture C

27550 Treat knee

dislocation T 0129 1.6063 $111.51

. $22.31

27552 Treat knee

dislocation T 0045 15.5166 "$1,077.16" $268.44 $215.44

27556 Treat knee

dislocation C

27557 Treat knee

dislocation C

27558 Treat knee

dislocation C

27560 Treat kneecap

dislocation T 0129 1.6063 $111.51

. $22.31

27562 Treat kneecap

dislocation T 0045 15.5166 "$1,077.16" $268.44 $215.44

27566 Treat kneecap

dislocation T 0063 49.4864 "$3,435.35"

. $687.07

27570 Fixation of knee

joint T 0045 15.5166 "$1,077.16" $268.44 $215.44

27580 Fusion of

knee C

27590 Amputate leg at

thigh C27591 Amputate leg at

thigh C

27592 Amputate leg at

thigh C

27594 Amputation follow-up

surgery T 0049 22.1674 "$1,538.86"

. $307.78

27596 Amputation follow-up

surgery C

27598 Amputate lower leg at

knee C

27599 Leg surgery

procedure T 0129 1.6063 $111.51

. $22.31

27600 Decompression of lower

leg T 0049 22.1674 "$1,538.86"

. $307.78

27601 Decompression of lower

leg T 0049 22.1674 "$1,538.86"

. $307.78

27602 Decompression of lower leg CH

T 0050 32.4101 "$2,249.91"

. $449.99

27603 Drain lower leg

lesion T 0008 20.5401 "$1,425.89"

. $285.18

27604 Drain lower leg bursa CH

T 0050 32.4101 "$2,249.91"

. $449.99

27605 Incision of achilles

tendon T 0055 22.1739 "$1,539.31" $351.47 $307.87

27606 Incision of achilles

tendon T 0049 22.1674 "$1,538.86"

. $307.78

27607 Treat lower leg bone

lesion T 0049 22.1674 "$1,538.86"

. $307.78

27610 Explore/treat ankle

joint T 0050 32.4101 "$2,249.91"

. $449.99

27612 Exploration of ankle

joint T 0050 32.4101 "$2,249.91"

. $449.99

27613 Biopsy lower leg soft

tissue T 0020 8.6164 $598.15

. $119.63

27614 Biopsy lower leg softtissue T 0022 23.4169 "$1,625.60" $350.05 $325.12

27615 Resect leg/ankle tum < 5

cm T 0021 17.1909 "$1,193.39"

. $238.68

27616 Resect leg/ankle tum 5+

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

27618 Exc leg/ankle tum < 3

cm T 0021 17.1909 "$1,193.39"

. $238.68

27619 Exc leg/ankle tum deep <5

cm T 0021 17.1909 "$1,193.39"

. $238.68

27620 Explore/treat ankle

joint T 0050 32.4101 "$2,249.91"

. $449.99

27625 Remove ankle joint

lining T 0050 32.4101 "$2,249.91"

. $449.99

27626 Remove ankle joint

lining T 0050 32.4101 "$2,249.91"

. $449.99

27630 Removal of tendon

lesion T 0049 22.1674 "$1,538.86"

. $307.78

27632 Exc leg/ankle les sc 3+

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

27634 Exc leg/ankle tum deep 5+

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

27635 Remove lower leg bone

lesion T 0050 32.4101 "$2,249.91"

. $449.99

27637 Remove/graft leg bone

lesion T 0050 32.4101 "$2,249.91"

. $449.99

27638 Remove/graft leg bone

lesion T 0050 32.4101 "$2,249.91"

. $449.99

27640 Partial removal of tibia CH

T 0050 32.4101 "$2,249.91"

. $449.99

27641 Partial removal of

fibula T 0050 32.4101 "$2,249.91"

. $449.99

27645 Resect tibia

tumor C27646 Resect fibula

tumor C

27647 Resect talus/calcaneus tum CH

T 0050 32.4101 "$2,249.91"

. $449.99

27648 Injection for ankle

x-ray N

27650 Repair achilles

tendon T 0051 47.1841 "$3,275.52"

. $655.11

27652 Repair/graft achilles

tendon T 0052 87.5671 "$6,078.91"

. "$1,215.79"

27654 Repair of achilles

tendon T 0051 47.1841 "$3,275.52"

. $655.11

27656 Repair leg fascia

defect T 0049 22.1674 "$1,538.86"

. $307.78

27658 Repair of leg tendon

each T 0049 22.1674 "$1,538.86"

. $307.78

27659 Repair of leg tendon

each T 0049 22.1674 "$1,538.86"

. $307.78

27664 Repair of leg tendon

each T 0050 32.4101 "$2,249.91"

. $449.99

27665 Repair of leg tendon

each T 0050 32.4101 "$2,249.91"

. $449.99

27675 Repair lower leg

tendons T 0049 22.1674 "$1,538.86"

. $307.78

27676 Repair lower leg

tendons T 0050 32.4101 "$2,249.91"

. $449.99

27680 Release of lower leg

tendon T 0050 32.4101 "$2,249.91"

. $449.99

27681 Release of lower leg

tendons T 0050 32.4101 "$2,249.91"

. $449.99

27685 Revision of lower leg

tendon T 0050 32.4101 "$2,249.91"

. $449.99

27686 Revise lower leg

tendons T 0050 32.4101 "$2,249.91"

. $449.9927687 Revision of calf

tendon T 0050 32.4101 "$2,249.91"

. $449.99

27690 Revise lower leg

tendon T 0051 47.1841 "$3,275.52"

. $655.11

27691 Revise lower leg

tendon T 0051 47.1841 "$3,275.52"

. $655.11

27692 Revise additional leg

tendon T 0051 47.1841 "$3,275.52"

. $655.11

27695 Repair of ankle

ligament T 0050 32.4101 "$2,249.91"

. $449.99

27696 Repair of ankle

ligaments T 0050 32.4101 "$2,249.91"

. $449.99

27698 Repair of ankle

ligament T 0050 32.4101 "$2,249.91"

. $449.99

27700 Revision of ankle

joint T 0047 41.2971 "$2,866.84"

. $573.37

27702 Reconstruct ankle

joint C

27703 Reconstruction ankle

joint C

27704 Removal of ankle

implant T 0049 22.1674 "$1,538.86"

. $307.78

27705 Incision of

tibia T 0051 47.1841 "$3,275.52"

. $655.11

27707 Incision of fibula CH

T 0050 32.4101 "$2,249.91"

. $449.99

27709 Incision of tibia &

fibula T 0050 32.4101 "$2,249.91"

. $449.99

27712 Realignment of lower

leg C

27715 Revision of lower

leg C

27720 Repair of

tibia T 0063 49.4864 "$3,435.35"

. $687.07

27722 Repair/graft of

tibia T 0064 67.0623 "$4,655.46"

. $931.1027724 Repair/graft of

tibia C

27725 Repair of lower

leg C

27726 Repair fibula

nonunion T 0063 49.4864 "$3,435.35"

. $687.07

27727 Repair of lower

leg C

27730 Repair of tibia

epiphysis T 0050 32.4101 "$2,249.91"

. $449.99

27732 Repair of fibula

epiphysis T 0050 32.4101 "$2,249.91"

. $449.99

27734 Repair lower leg

epiphyses T 0050 32.4101 "$2,249.91"

. $449.99

27740 Repair of leg

epiphyses T 0050 32.4101 "$2,249.91"

. $449.99

27742 Repair of leg

epiphyses T 0051 47.1841 "$3,275.52"

. $655.11

27745 Reinforce

tibia T 0052 87.5671 "$6,078.91"

. "$1,215.79"

27750 Treatment of tibia

fracture T 0129 1.6063 $111.51

. $22.31

27752 Treatment of tibia

fracture T 0139 18.6922 "$1,297.61"

. $259.53

27756 Treatment of tibia

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

27758 Treatment of tibia

fracture T 0063 49.4864 "$3,435.35"

. $687.07

27759 Treatment of tibia

fracture T 0064 67.0623 "$4,655.46"

. $931.10

27760 Cltx medial ankle

fx T 0129 1.6063 $111.51

. $22.31

27762 Cltx med ankle fx

w/mnpj T 0139 18.6922 "$1,297.61"

. $259.5327766 Optx medial ankle

fx T 0063 49.4864 "$3,435.35"

. $687.07

27767 Cltx post ankle

fx T 0129 1.6063 $111.51

. $22.31

27768 Cltx post ankle fx

w/mnpj T 0129 1.6063 $111.51

. $22.31

27769 Optx post ankle

fx T 0063 49.4864 "$3,435.35"

. $687.07

27780 Treatment of fibula

fracture T 0129 1.6063 $111.51

. $22.31

27781 Treatment of fibula

fracture T 0139 18.6922 "$1,297.61"

. $259.53

27784 Treatment of fibula

fracture T 0063 49.4864 "$3,435.35"

. $687.07

27786 Treatment of ankle

fracture T 0129 1.6063 $111.51

. $22.31

27788 Treatment of ankle

fracture T 0129 1.6063 $111.51

. $22.31

27792 Treatment of ankle

fracture T 0063 49.4864 "$3,435.35"

. $687.07

27808 Treatment of ankle

fracture T 0129 1.6063 $111.51

. $22.31

27810 Treatment of ankle

fracture T 0129 1.6063 $111.51

. $22.31

27814 Treatment of ankle

fracture T 0063 49.4864 "$3,435.35"

. $687.07

27816 Treatment of ankle

fracture T 0129 1.6063 $111.51

. $22.31

27818 Treatment of ankle

fracture T 0138 4.9874 $346.23

. $69.25

27822 Treatment of ankle

fracture T 0063 49.4864 "$3,435.35"

. $687.07

27823 Treatment of anklefracture T 0064 67.0623 "$4,655.46"

. $931.10

27824 Treat lower leg

fracture T 0129 1.6063 $111.51

. $22.31

27825 Treat lower leg

fracture T 0139 18.6922 "$1,297.61"

. $259.53

27826 Treat lower leg

fracture T 0063 49.4864 "$3,435.35"

. $687.07

27827 Treat lower leg

fracture T 0064 67.0623 "$4,655.46"

. $931.10

27828 Treat lower leg

fracture T 0064 67.0623 "$4,655.46"

. $931.10

27829 Treat lower leg

joint T 0063 49.4864 "$3,435.35"

. $687.07

27830 Treat lower leg

dislocation T 0129 1.6063 $111.51

. $22.31

27831 Treat lower leg

dislocation T 0139 18.6922 "$1,297.61"

. $259.53

27832 Treat lower leg

dislocation T 0063 49.4864 "$3,435.35"

. $687.07

27840 Treat ankle

dislocation T 0129 1.6063 $111.51

. $22.31

27842 Treat ankle

dislocation T 0045 15.5166 "$1,077.16" $268.44 $215.44

27846 Treat ankle

dislocation T 0063 49.4864 "$3,435.35"

. $687.07

27848 Treat ankle

dislocation T 0063 49.4864 "$3,435.35"

. $687.07

27860 Fixation of ankle

joint T 0045 15.5166 "$1,077.16" $268.44 $215.44

27870 Fusion of ankle joint

open T 0052 87.5671 "$6,078.91"

. "$1,215.79"

27871 Fusion of tibiofibular

joint T 0052 87.5671 "$6,078.91"

. "$1,215.79"27880 Amputation of lower

leg C

27881 Amputation of lower

leg C

27882 Amputation of lower

leg C

27884 Amputation follow-up

surgery T 0049 22.1674 "$1,538.86"

. $307.78

27886 Amputation follow-up

surgery C

27888 Amputation of foot at

ankle C

27889 Amputation of foot at

ankle T 0050 32.4101 "$2,249.91"

. $449.99

27892 Decompression of

leg T 0050 32.4101 "$2,249.91"

. $449.99

27893 Decompression of

leg T 0050 32.4101 "$2,249.91"

. $449.99

27894 Decompression of

leg T 0050 32.4101 "$2,249.91"

. $449.99

27899 Leg/ankle surgery

procedure T 0129 1.6063 $111.51

. $22.31

28001 Drainage of bursa of

foot T 0007 13.4779 $935.64

. $187.13

28002 Treatment of foot

infection T 0049 22.1674 "$1,538.86"

. $307.78

28003 Treatment of foot

infection T 0049 22.1674 "$1,538.86"

. $307.78

28005 Treat foot bone

lesion T 0055 22.1739 "$1,539.31" $351.47 $307.87

28008 Incision of foot

fascia T 0055 22.1739 "$1,539.31" $351.47 $307.87

28010 Incision of toe

tendon T 0055 22.1739 "$1,539.31" $351.47 $307.87

28011 Incision of toe

tendons T 0055 22.1739 "$1,539.31" $351.47 $307.8728020 Exploration of foot

joint T 0055 22.1739 "$1,539.31" $351.47 $307.87

28022 Exploration of foot

joint T 0055 22.1739 "$1,539.31" $351.47 $307.87

28024 Exploration of toe

joint T 0055 22.1739 "$1,539.31" $351.47 $307.87

28035 Decompression of tibia

nerve T 0220 19.0626 "$1,323.33"

. $264.67

28039 Exc foot/toe tum sc > 1.5

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

28041 Exc foot/toe tum deep

1.5cm+ T 0022 23.4169 "$1,625.60" $350.05 $325.12

28043 Exc foot/toe tum sc < 1.5

cm T 0021 17.1909 "$1,193.39"

. $238.68

28045 Exc foot/toe tum deep

<1.5cm T 0021 17.1909 "$1,193.39"

. $238.68

28046 Resect foot/toe tumor < 3

cm T 0021 17.1909 "$1,193.39"

. $238.68

28047 Resect foot/toe tumor > 3

cm T 0022 23.4169 "$1,625.60" $350.05 $325.12

28050 Biopsy of foot joint

lining T 0055 22.1739 "$1,539.31" $351.47 $307.87

28052 Biopsy of foot joint

lining T 0055 22.1739 "$1,539.31" $351.47 $307.87

28054 Biopsy of toe joint

lining T 0055 22.1739 "$1,539.31" $351.47 $307.87

28055 Neurectomy

foot T 0220 19.0626 "$1,323.33"

. $264.67

28060 Partial removal foot

fascia T 0055 22.1739 "$1,539.31" $351.47 $307.87

28062 Removal of foot

fascia T 0055 22.1739 "$1,539.31" $351.47 $307.8728070 Removal of foot joint

lining T 0055 22.1739 "$1,539.31" $351.47 $307.87

28072 Removal of foot joint

lining T 0055 22.1739 "$1,539.31" $351.47 $307.87

28080 Removal of foot

lesion T 0055 22.1739 "$1,539.31" $351.47 $307.87

28086 Excise foot tendon

sheath T 0055 22.1739 "$1,539.31" $351.47 $307.87

28088 Excise foot tendon

sheath T 0055 22.1739 "$1,539.31" $351.47 $307.87

28090 Removal of foot

lesion T 0055 22.1739 "$1,539.31" $351.47 $307.87

28092 Removal of toe

lesions T 0055 22.1739 "$1,539.31" $351.47 $307.87

28100 Removal of ankle/heel

lesion T 0055 22.1739 "$1,539.31" $351.47 $307.87

28102 Remove/graft foot

lesion T 0056 57.2099 "$3,971.51"

. $794.31

28103 Remove/graft foot

lesion T 0056 57.2099 "$3,971.51"

. $794.31

28104 Removal of foot

lesion T 0055 22.1739 "$1,539.31" $351.47 $307.87

28106 Remove/graft foot

lesion T 0056 57.2099 "$3,971.51"

. $794.31

28107 Remove/graft foot

lesion T 0056 57.2099 "$3,971.51"

. $794.31

28108 Removal of toe

lesions T 0055 22.1739 "$1,539.31" $351.47 $307.87

28110 Part removal of

metatarsal T 0055 22.1739 "$1,539.31" $351.47 $307.87

28111 Part removal of

metatarsal T 0055 22.1739 "$1,539.31" $351.47 $307.87

28112 Part removal of

metatarsal T 0055 22.1739 "$1,539.31" $351.47 $307.8728113 Part removal of

metatarsal T 0055 22.1739 "$1,539.31" $351.47 $307.87

28114 Removal of metatarsal

heads T 0055 22.1739 "$1,539.31" $351.47 $307.87

28116 Revision of

foot T 0055 22.1739 "$1,539.31" $351.47 $307.87

28118 Removal of heel

bone T 0055 22.1739 "$1,539.31" $351.47 $307.87

28119 Removal of heel

spur T 0055 22.1739 "$1,539.31" $351.47 $307.87

28120 Part removal of

ankle/heel T 0055 22.1739 "$1,539.31" $351.47 $307.87

28122 Partial removal of foot

bone T 0055 22.1739 "$1,539.31" $351.47 $307.87

28124 Partial removal of

toe T 0055 22.1739 "$1,539.31" $351.47 $307.87

28126 Partial removal of

toe T 0055 22.1739 "$1,539.31" $351.47 $307.87

28130 Removal of ankle

bone T 0055 22.1739 "$1,539.31" $351.47 $307.87

28140 Removal of

metatarsal T 0055 22.1739 "$1,539.31" $351.47 $307.87

28150 Removal of

toe T 0055 22.1739 "$1,539.31" $351.47 $307.87

28153 Partial removal of

toe T 0055 22.1739 "$1,539.31" $351.47 $307.87

28160 Partial removal of

toe T 0055 22.1739 "$1,539.31" $351.47 $307.87

28171 Resect tarsal

tumor T 0055 22.1739 "$1,539.31" $351.47 $307.87

28173 Resect metatarsal

tumor T 0055 22.1739 "$1,539.31" $351.47 $307.8728175 Resect phalanx of toe

tumor T 0055 22.1739 "$1,539.31" $351.47 $307.87

28190 Removal of foot foreign

body T 0020 8.6164 $598.15

. $119.63

28192 Removal of foot foreign

body T 0021 17.1909 "$1,193.39"

. $238.68

28193 Removal of foot foreign

body T 0020 8.6164 $598.15

. $119.63

28200 Repair of foot

tendon T 0055 22.1739 "$1,539.31" $351.47 $307.87

28202 Repair/graft of foot

tendon T 0055 22.1739 "$1,539.31" $351.47 $307.87

28208 Repair of foot

tendon T 0055 22.1739 "$1,539.31" $351.47 $307.87

28210 Repair/graft of foot

tendon T 0056 57.2099 "$3,971.51"

. $794.31

28220 Release of foot

tendon T 0055 22.1739 "$1,539.31" $351.47 $307.87

28222 Release of foot

tendons T 0055 22.1739 "$1,539.31" $351.47 $307.87

28225 Release of foot

tendon T 0055 22.1739 "$1,539.31" $351.47 $307.87

28226 Release of foot

tendons T 0055 22.1739 "$1,539.31" $351.47 $307.87

28230 Incision of foot

tendon(s) T 0055 22.1739 "$1,539.31" $351.47 $307.87

28232 Incision of toe

tendon T 0055 22.1739 "$1,539.31" $351.47 $307.87

28234 Incision of foot

tendon T 0055 22.1739 "$1,539.31" $351.47 $307.87

28238 Revision of foot

tendon T 0056 57.2099 "$3,971.51"

. $794.31

28240 Release of big

toe T 0055 22.1739 "$1,539.31" $351.47 $307.8728250 Revision of foot

fascia T 0055 22.1739 "$1,539.31" $351.47 $307.87

28260 Release of midfoot

joint T 0055 22.1739 "$1,539.31" $351.47 $307.87

28261 Revision of foot

tendon T 0055 22.1739 "$1,539.31" $351.47 $307.87

28262 Revision of foot and

ankle T 0055 22.1739 "$1,539.31" $351.47 $307.87

28264 Release of midfoot

joint T 0056 57.2099 "$3,971.51"

. $794.31

28270 Release of foot

contracture T 0055 22.1739 "$1,539.31" $351.47 $307.87

28272 Release of toe joint

each T 0055 22.1739 "$1,539.31" $351.47 $307.87

28280 Fusion of

toes T 0055 22.1739 "$1,539.31" $351.47 $307.87

28285 Repair of

hammertoe T 0055 22.1739 "$1,539.31" $351.47 $307.87

28286 Repair of

hammertoe T 0055 22.1739 "$1,539.31" $351.47 $307.87

28288 Partial removal of foot

bone T 0055 22.1739 "$1,539.31" $351.47 $307.87

28289 Repair hallux

rigidus T 0055 22.1739 "$1,539.31" $351.47 $307.87

28290 Correction of

bunion T 0057 32.5456 "$2,259.32" $469.58 $451.87

28292 Correction of

bunion T 0057 32.5456 "$2,259.32" $469.58 $451.87

28293 Correction of

bunion T 0057 32.5456 "$2,259.32" $469.58 $451.87

28294 Correction of

bunion T 0057 32.5456 "$2,259.32" $469.58 $451.8728296 Correction of

bunion T 0057 32.5456 "$2,259.32" $469.58 $451.87

28297 Correction of

bunion T 0057 32.5456 "$2,259.32" $469.58 $451.87

28298 Correction of

bunion T 0057 32.5456 "$2,259.32" $469.58 $451.87

28299 Correction of

bunion T 0057 32.5456 "$2,259.32" $469.58 $451.87

28300 Incision of heel

bone T 0056 57.2099 "$3,971.51"

. $794.31

28302 Incision of ankle

bone T 0055 22.1739 "$1,539.31" $351.47 $307.87

28304 Incision of midfoot

bones T 0056 57.2099 "$3,971.51"

. $794.31

28305 Incise/graft midfoot

bones T 0056 57.2099 "$3,971.51"

. $794.31

28306 Incision of

metatarsal T 0055 22.1739 "$1,539.31" $351.47 $307.87

28307 Incision of

metatarsal T 0055 22.1739 "$1,539.31" $351.47 $307.87

28308 Incision of

metatarsal T 0055 22.1739 "$1,539.31" $351.47 $307.87

28309 Incision of

metatarsals T 0056 57.2099 "$3,971.51"

. $794.31

28310 Revision of big

toe T 0055 22.1739 "$1,539.31" $351.47 $307.87

28312 Revision of

toe T 0055 22.1739 "$1,539.31" $351.47 $307.87

28313 Repair deformity of

toe T 0055 22.1739 "$1,539.31" $351.47 $307.87

28315 Removal of sesamoid

bone T 0055 22.1739 "$1,539.31" $351.47 $307.87

28320 Repair of foot

bones T 0056 57.2099 "$3,971.51"

. $794.3128322 Repair of

metatarsals T 0056 57.2099 "$3,971.51"

. $794.31

28340 Resect enlarged toe

tissue T 0055 22.1739 "$1,539.31" $351.47 $307.87

28341 Resect enlarged

toe T 0055 22.1739 "$1,539.31" $351.47 $307.87

28344 Repair extra

toe(s) T 0055 22.1739 "$1,539.31" $351.47 $307.87

28345 Repair webbed

toe(s) T 0055 22.1739 "$1,539.31" $351.47 $307.87

28360 Reconstruct cleft

foot T 0056 57.2099 "$3,971.51"

. $794.31

28400 Treatment of heel

fracture T 0129 1.6063 $111.51

. $22.31

28405 Treatment of heel

fracture T 0139 18.6922 "$1,297.61"

. $259.53

28406 Treatment of heel

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

28415 Treat heel

fracture T 0064 67.0623 "$4,655.46"

. $931.10

28420 Treat/graft heel

fracture T 0063 49.4864 "$3,435.35"

. $687.07

28430 Treatment of ankle

fracture T 0129 1.6063 $111.51

. $22.31

28435 Treatment of ankle

fracture T 0129 1.6063 $111.51

. $22.31

28436 Treatment of ankle

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

28445 Treat ankle

fracture T 0063 49.4864 "$3,435.35"

. $687.07

28446 Osteochondral talus

autogrft T 0056 57.2099 "$3,971.51"

. $794.3128450 Treat midfoot fracture

each T 0129 1.6063 $111.51

. $22.31

28455 Treat midfoot fracture

each T 0129 1.6063 $111.51

. $22.31

28456 Treat midfoot

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

28465 Treat midfoot fracture

each T 0063 49.4864 "$3,435.35"

. $687.07

28470 Treat metatarsal

fracture T 0129 1.6063 $111.51

. $22.31

28475 Treat metatarsal

fracture T 0129 1.6063 $111.51

. $22.31

28476 Treat metatarsal

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

28485 Treat metatarsal

fracture T 0063 49.4864 "$3,435.35"

. $687.07

28490 Treat big toe

fracture T 0129 1.6063 $111.51

. $22.31

28495 Treat big toe

fracture T 0129 1.6063 $111.51

. $22.31

28496 Treat big toe

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

28505 Treat big toe

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

28510 Treatment of toe

fracture T 0129 1.6063 $111.51

. $22.31

28515 Treatment of toe

fracture T 0129 1.6063 $111.51

. $22.31

28525 Treat toe

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.29

28530 Treat sesamoid bone

fracture T 0129 1.6063 $111.51

. $22.31

28531 Treat sesamoid bone

fracture T 0062 26.2376 "$1,821.41" $371.33 $364.2928540 Treat foot

dislocation T 0129 1.6063 $111.51

. $22.31

28545 Treat foot

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

28546 Treat foot

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

28555 Repair foot

dislocation T 0063 49.4864 "$3,435.35"

. $687.07

28570 Treat foot

dislocation T 0129 1.6063 $111.51

. $22.31

28575 Treat foot

dislocation T 0139 18.6922 "$1,297.61"

. $259.53

28576 Treat foot

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

28585 Repair foot

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

28600 Treat foot

dislocation T 0129 1.6063 $111.51

. $22.31

28605 Treat foot

dislocation T 0129 1.6063 $111.51

. $22.31

28606 Treat foot

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

28615 Repair foot

dislocation T 0063 49.4864 "$3,435.35"

. $687.07

28630 Treat toe

dislocation T 0129 1.6063 $111.51

. $22.31

28635 Treat toe

dislocation T 0045 15.5166 "$1,077.16" $268.44 $215.44

28636 Treat toe

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

28645 Repair toe

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.2928660 Treat toe

dislocation T 0129 1.6063 $111.51

. $22.31

28665 Treat toe

dislocation T 0045 15.5166 "$1,077.16" $268.44 $215.44

28666 Treat toe

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

28675 Repair of toe

dislocation T 0062 26.2376 "$1,821.41" $371.33 $364.29

28705 Fusion of foot

bones T 0056 57.2099 "$3,971.51"

. $794.31

28715 Fusion of foot

bones T 0052 87.5671 "$6,078.91"

. "$1,215.79"

28725 Fusion of foot

bones T 0056 57.2099 "$3,971.51"

. $794.31

28730 Fusion of foot

bones T 0056 57.2099 "$3,971.51"

. $794.31

28735 Fusion of foot

bones T 0056 57.2099 "$3,971.51"

. $794.31

28737 Revision of foot

bones T 0056 57.2099 "$3,971.51"

. $794.31

28740 Fusion of foot

bones T 0056 57.2099 "$3,971.51"

. $794.31

28750 Fusion of big toe

joint T 0056 57.2099 "$3,971.51"

. $794.31

28755 Fusion of big toe

joint T 0055 22.1739 "$1,539.31" $351.47 $307.87

28760 Fusion of big toe

joint T 0056 57.2099 "$3,971.51"

. $794.31

28800 Amputation of

midfoot C

28805 Amputation thru

metatarsal T 0055 22.1739 "$1,539.31" $351.47 $307.87

28810 Amputation toe &

metatarsal T 0055 22.1739 "$1,539.31" $351.47 $307.8728820 Amputation of

toe T 0055 22.1739 "$1,539.31" $351.47 $307.87

28825 Partial amputation of

toe T 0055 22.1739 "$1,539.31" $351.47 $307.87

28890 High energy eswt plantar

f T 0050 32.4101 "$2,249.91"

. $449.99

28899 Foot/toes surgery

procedure T 0129 1.6063 $111.51

. $22.31

29000 Application of body

cast S 0058 1.1378 $78.99

. $15.80

29010 Application of body

cast S 0426 2.7059 $187.84

. $37.57

29015 Application of body

cast S 0426 2.7059 $187.84

. $37.57

29020 Application of body

cast S 0058 1.1378 $78.99

. $15.80

29025 Application of body

cast S 0058 1.1378 $78.99

. $15.80

29035 Application of body

cast S 0426 2.7059 $187.84

. $37.57

29040 Application of body

cast S 0058 1.1378 $78.99

. $15.80

29044 Application of body

cast S 0426 2.7059 $187.84

. $37.57

29046 Application of body

cast S 0426 2.7059 $187.84

. $37.57

29049 Application of figure

eight S 0058 1.1378 $78.99

. $15.80

29055 Application of shoulder

cast S 0426 2.7059 $187.84

. $37.57

29058 Application of shoulder

cast S 0058 1.1378 $78.99

. $15.80

29065 Application of long armcast S 0426 2.7059 $187.84

. $37.57

29075 Application of forearm

cast S 0426 2.7059 $187.84

. $37.57

29085 Apply hand/wrist

cast S 0058 1.1378 $78.99

. $15.80

29086 Apply finger

cast S 0058 1.1378 $78.99

. $15.80

29105 Apply long arm

splint S 0058 1.1378 $78.99

. $15.80

29125 Apply forearm

splint S 0058 1.1378 $78.99

. $15.80

29126 Apply forearm

splint S 0058 1.1378 $78.99

. $15.80

29130 Application of finger

splint S 0058 1.1378 $78.99

. $15.80

29131 Application of finger

splint S 0058 1.1378 $78.99

. $15.80

29200 Strapping of

chest S 0058 1.1378 $78.99

. $15.80

29240 Strapping of

shoulder S 0058 1.1378 $78.99

. $15.80

29260 Strapping of elbow or

wrist S 0058 1.1378 $78.99

. $15.80

29280 Strapping of hand or

finger S 0058 1.1378 $78.99

. $15.80

29305 Application of hip

cast S 0426 2.7059 $187.84

. $37.57

29325 Application of hip

casts S 0426 2.7059 $187.84

. $37.57

29345 Application of long leg

cast S 0426 2.7059 $187.84

. $37.57

29355 Application of long leg

cast S 0426 2.7059 $187.84

. $37.5729358 Apply long leg cast

brace S 0426 2.7059 $187.84

. $37.57

29365 Application of long leg

cast S 0426 2.7059 $187.84

. $37.57

29405 Apply short leg

cast S 0426 2.7059 $187.84

. $37.57

29425 Apply short leg

cast S 0426 2.7059 $187.84

. $37.57

29435 Apply short leg

cast S 0426 2.7059 $187.84

. $37.57

29440 Addition of walker to

cast S 0058 1.1378 $78.99

. $15.80

29445 Apply rigid leg

cast S 0426 2.7059 $187.84

. $37.57

29450 Application of leg

cast S 0058 1.1378 $78.99

. $15.80

29505 Application long leg

splint S 0058 1.1378 $78.99

. $15.80

29515 Application lower leg

splint S 0058 1.1378 $78.99

. $15.80

29520 Strapping of

hip S 0058 1.1378 $78.99

. $15.80

29530 Strapping of

knee S 0058 1.1378 $78.99

. $15.80

29540 Strapping of ankle and/or

ft S 0058 1.1378 $78.99

. $15.80

29550 Strapping of

toes S 0058 1.1378 $78.99

. $15.80

29580 Application of paste

boot S 0058 1.1378 $78.99

. $15.80

29581 Apply multlay comprs lwr

leg S 0058 1.1378 $78.99

. $15.80

29590 Application of footsplint S 0058 1.1378 $78.99

. $15.80

29700 Removal/revision of

cast S 0058 1.1378 $78.99

. $15.80

29705 Removal/revision of

cast S 0058 1.1378 $78.99

. $15.80

29710 Removal/revision of

cast S 0426 2.7059 $187.84

. $37.57

29715 Removal/revision of

cast S 0058 1.1378 $78.99

. $15.80

29720 Repair of body

cast S 0058 1.1378 $78.99

. $15.80

29730 Windowing of

cast S 0058 1.1378 $78.99

. $15.80

29740 Wedging of

cast S 0058 1.1378 $78.99

. $15.80

29750 Wedging of clubfoot

cast S 0058 1.1378 $78.99

. $15.80

29799 Casting/strapping

procedure S 0058 1.1378 $78.99

. $15.80

29800 Jaw

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29804 Jaw

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29805 Shoulder arthroscopy

dx T 0041 29.4235 "$2,042.58"

. $408.52

29806 Shoulder

arthroscopy/surgery T 0042 48.4545 "$3,363.71" $804.74 $672.75

29807 Shoulder

arthroscopy/surgery T 0042 48.4545 "$3,363.71" $804.74 $672.75

29819 Shoulder

arthroscopy/surgery T 0042 48.4545 "$3,363.71" $804.74 $672.75

29820 Shoulder

arthroscopy/surgery T 0042 48.4545 "$3,363.71" $804.74 $672.7529821 Shoulder

arthroscopy/surgery T 0042 48.4545 "$3,363.71" $804.74 $672.75

29822 Shoulder

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29823 Shoulder

arthroscopy/surgery T 0042 48.4545 "$3,363.71" $804.74 $672.75

29824 Shoulder

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29825 Shoulder

arthroscopy/surgery T 0042 48.4545 "$3,363.71" $804.74 $672.75

29826 Shoulder

arthroscopy/surgery T 0042 48.4545 "$3,363.71" $804.74 $672.75

29827 Arthroscop rotator cuff

repr T 0042 48.4545 "$3,363.71" $804.74 $672.75

29828 Arthroscopy biceps

tenodesis T 0042 48.4545 "$3,363.71" $804.74 $672.75

29830 Elbow

arthroscopy T 0041 29.4235 "$2,042.58"

. $408.52

29834 Elbow

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29835 Elbow

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29836 Elbow

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29837 Elbow

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29838 Elbow

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29840 Wrist

arthroscopy T 0041 29.4235 "$2,042.58"

. $408.52

29843 Wrist

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29844 Wristarthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29845 Wrist

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29846 Wrist

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29847 Wrist

arthroscopy/surgery T 0042 48.4545 "$3,363.71" $804.74 $672.75

29848 Wrist

endoscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29850 Knee

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29851 Knee

arthroscopy/surgery T 0042 48.4545 "$3,363.71" $804.74 $672.75

29855 Tibial

arthroscopy/surgery T 0042 48.4545 "$3,363.71" $804.74 $672.75

29856 Tibial

arthroscopy/surgery T 0042 48.4545 "$3,363.71" $804.74 $672.75

29860 Hip arthroscopy

dx T 0042 48.4545 "$3,363.71" $804.74 $672.75

29861 Hip arthro w/fb

removal T 0042 48.4545 "$3,363.71" $804.74 $672.75

29862 Hip arthr0

w/debridement T 0042 48.4545 "$3,363.71" $804.74 $672.75

29863 Hip arthr0

w/synovectomy T 0042 48.4545 "$3,363.71" $804.74 $672.75

29866 Autgrft implnt knee

w/scope T 0042 48.4545 "$3,363.71" $804.74 $672.75

29867 Allgrft implnt knee

w/scope T 0042 48.4545 "$3,363.71" $804.74 $672.75

29868 Meniscal trnspl knee

w/scpe T 0042 48.4545 "$3,363.71" $804.74 $672.75

29870 Knee arthroscopy

dx T 0041 29.4235 "$2,042.58"

. $408.5229871 Knee

arthroscopy/drainage T 0041 29.4235 "$2,042.58"

. $408.52

29873 Knee

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29874 Knee

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29875 Knee

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29876 Knee

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29877 Knee

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29879 Knee

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29880 Knee

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29881 Knee

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29882 Knee

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29883 Knee

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29884 Knee

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29885 Knee

arthroscopy/surgery T 0042 48.4545 "$3,363.71" $804.74 $672.75

29886 Knee

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29887 Knee

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29888 Knee

arthroscopy/surgery T 0052 87.5671 "$6,078.91"

. "$1,215.79"

29889 Kneearthroscopy/surgery T 0052 87.5671 "$6,078.91"

. "$1,215.79"

29891 Ankle

arthroscopy/surgery T 0042 48.4545 "$3,363.71" $804.74 $672.75

29892 Ankle

arthroscopy/surgery T 0052 87.5671 "$6,078.91"

. "$1,215.79"

29893 Scope plantar

fasciotomy T 0055 22.1739 "$1,539.31" $351.47 $307.87

29894 Ankle

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29895 Ankle

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29897 Ankle

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29898 Ankle

arthroscopy/surgery T 0041 29.4235 "$2,042.58"

. $408.52

29899 Ankle

arthroscopy/surgery T 0042 48.4545 "$3,363.71" $804.74 $672.75

29900 Mcp joint arthroscopy

dx T 0041 29.4235 "$2,042.58"

. $408.52

29901 Mcp joint arthroscopy

surg T 0041 29.4235 "$2,042.58"

. $408.52

29902 Mcp joint arthroscopy

surg T 0041 29.4235 "$2,042.58"

. $408.52

29904 Subtalar arthro w/fb

rmvl T 0041 29.4235 "$2,042.58"

. $408.52

29905 Subtalar arthro

w/exc T 0041 29.4235 "$2,042.58"

. $408.52

29906 Subtalar arthro

w/deb T 0041 29.4235 "$2,042.58"

. $408.52

29907 Subtalar arthro

w/fusion T 0042 48.4545 "$3,363.71" $804.74 $672.75

29914 Hip arthro

w/femoroplasty T 0042 48.4545 "$3,363.71" $804.74 $672.7529915 Hip arthro

acetabuloplasty T 0042 48.4545 "$3,363.71" $804.74 $672.75

29916 Hip arthro w/labral

repair T 0042 48.4545 "$3,363.71" $804.74 $672.75

29999 Arthroscopy of

joint T 0041 29.4235 "$2,042.58"

. $408.52

30000 Drainage of nose

lesion T 0251 3.3531 $232.77

. $46.56

30020 Drainage of nose

lesion T 0251 3.3531 $232.77

. $46.56

30100 Intranasal

biopsy T 0252 8.0353 $557.81

. $111.57

30110 Removal of nose

polyp(s) T 0253 16.9180 "$1,174.45" $277.61 $234.89

30115 Removal of nose

polyp(s) T 0253 16.9180 "$1,174.45" $277.61 $234.89

30117 Removal of intranasal

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

30118 Removal of intranasal

lesion T 0254 25.1379 "$1,745.07"

. $349.02

30120 Revision of

nose T 0254 25.1379 "$1,745.07"

. $349.02

30124 Removal of nose

lesion T 0252 8.0353 $557.81

. $111.57

30125 Removal of nose

lesion T 0256 45.1286 "$3,132.83"

. $626.57

30130 Excise inferior

turbinate T 0253 16.9180 "$1,174.45" $277.61 $234.89

30140 Resect inferior

turbinate T 0254 25.1379 "$1,745.07"

. $349.02

30150 Partial removal of

nose T 0256 45.1286 "$3,132.83"

. $626.57

30160 Removal ofnose T 0256 45.1286 "$3,132.83"

. $626.57

30200 Injection treatment of

nose T 0252 8.0353 $557.81

. $111.57

30210 Nasal sinus

therapy T 0252 8.0353 $557.81

. $111.57

30220 Insert nasal septal

button T 0252 8.0353 $557.81

. $111.57

30300 Remove nasal foreign

body X 0340 0.6739 $46.78

. $9.36

30310 Remove nasal foreign

body T 0253 16.9180 "$1,174.45" $277.61 $234.89

30320 Remove nasal foreign

body T 0253 16.9180 "$1,174.45" $277.61 $234.89

30400 Reconstruction of

nose T 0256 45.1286 "$3,132.83"

. $626.57

30410 Reconstruction of

nose T 0256 45.1286 "$3,132.83"

. $626.57

30420 Reconstruction of

nose T 0256 45.1286 "$3,132.83"

. $626.57

30430 Revision of

nose T 0254 25.1379 "$1,745.07"

. $349.02

30435 Revision of

nose T 0256 45.1286 "$3,132.83"

. $626.57

30450 Revision of

nose T 0256 45.1286 "$3,132.83"

. $626.57

30460 Revision of

nose T 0256 45.1286 "$3,132.83"

. $626.57

30462 Revision of

nose T 0256 45.1286 "$3,132.83"

. $626.57

30465 Repair nasal

stenosis T 0256 45.1286 "$3,132.83"

. $626.57

30520 Repair of nasal

septum T 0254 25.1379 "$1,745.07"

. $349.0230540 Repair nasal

defect T 0256 45.1286 "$3,132.83"

. $626.57

30545 Repair nasal

defect T 0256 45.1286 "$3,132.83"

. $626.57

30560 Release of nasal

adhesions T 0251 3.3531 $232.77

. $46.56

30580 Repair upper jaw

fistula T 0256 45.1286 "$3,132.83"

. $626.57

30600 Repair mouth/nose

fistula T 0256 45.1286 "$3,132.83"

. $626.57

30620 Intranasal

reconstruction T 0256 45.1286 "$3,132.83"

. $626.57

30630 Repair nasal septum

defect T 0254 25.1379 "$1,745.07"

. $349.02

30801 Ablate inf turbinate

superf T 0252 8.0353 $557.81

. $111.57

30802 Ablate inf turbinate

submuc T 0253 16.9180 "$1,174.45" $277.61 $234.89

30901 Control of

nosebleed T 0250 1.0875 $75.49 $24.28 $15.10

30903 Control of

nosebleed T 0250 1.0875 $75.49 $24.28 $15.10

30905 Control of

nosebleed T 0250 1.0875 $75.49 $24.28 $15.10

30906 Repeat control of

nosebleed T 0250 1.0875 $75.49 $24.28 $15.10

30915 Ligation nasal sinus

artery T 0092 26.9181 "$1,868.65"

. $373.73

30920 Ligation upper jaw

artery T 0092 26.9181 "$1,868.65"

. $373.73

30930 Ther fx nasal inf

turbinate T 0253 16.9180 "$1,174.45" $277.61 $234.89

30999 Nasal surgeryprocedure T 0250 1.0875 $75.49 $24.28 $15.10

31000 Irrigation maxillary

sinus T 0251 3.3531 $232.77

. $46.56

31002 Irrigation sphenoid

sinus T 0252 8.0353 $557.81

. $111.57

31020 Exploration maxillary

sinus T 0254 25.1379 "$1,745.07"

. $349.02

31030 Exploration maxillary

sinus T 0256 45.1286 "$3,132.83"

. $626.57

31032 Explore sinus remove

polyps T 0256 45.1286 "$3,132.83"

. $626.57

31040 Exploration behind upper

jaw T 0254 25.1379 "$1,745.07"

. $349.02

31050 Exploration sphenoid

sinus T 0256 45.1286 "$3,132.83"

. $626.57

31051 Sphenoid sinus

surgery T 0256 45.1286 "$3,132.83"

. $626.57

31070 Exploration of frontal

sinus T 0254 25.1379 "$1,745.07"

. $349.02

31075 Exploration of frontal

sinus T 0256 45.1286 "$3,132.83"

. $626.57

31080 Removal of frontal

sinus T 0256 45.1286 "$3,132.83"

. $626.57

31081 Removal of frontal

sinus T 0256 45.1286 "$3,132.83"

. $626.57

31084 Removal of frontal

sinus T 0256 45.1286 "$3,132.83"

. $626.57

31085 Removal of frontal

sinus T 0256 45.1286 "$3,132.83"

. $626.57

31086 Removal of frontal

sinus T 0256 45.1286 "$3,132.83"

. $626.57

31087 Removal of frontal

sinus T 0256 45.1286 "$3,132.83"

. $626.5731090 Exploration of

sinuses T 0256 45.1286 "$3,132.83"

. $626.57

31200 Removal of ethmoid

sinus T 0256 45.1286 "$3,132.83"

. $626.57

31201 Removal of ethmoid

sinus T 0256 45.1286 "$3,132.83"

. $626.57

31205 Removal of ethmoid

sinus T 0256 45.1286 "$3,132.83"

. $626.57

31225 Removal of upper

jaw C

31230 Removal of upper

jaw C

31231 Nasal endoscopy

dx T 0072 1.9475 $135.20

. $27.04

31233 Nasal/sinus endoscopy

dx T 0072 1.9475 $135.20

. $27.04

31235 Nasal/sinus endoscopy

dx T 0074 21.3691 "$1,483.44"

. $296.69

31237 Nasal/sinus endoscopy

surg T 0074 21.3691 "$1,483.44"

. $296.69

31238 Nasal/sinus endoscopy

surg T 0074 21.3691 "$1,483.44"

. $296.69

31239 Nasal/sinus endoscopy

surg T 0075 30.2222 "$2,098.03" $438.93 $419.61

31240 Nasal/sinus endoscopy

surg T 0074 21.3691 "$1,483.44"

. $296.69

31254 Revision of ethmoid

sinus T 0075 30.2222 "$2,098.03" $438.93 $419.61

31255 Removal of ethmoid

sinus T 0075 30.2222 "$2,098.03" $438.93 $419.61

31256 Exploration maxillary

sinus T 0075 30.2222 "$2,098.03" $438.93 $419.61

31267 Endoscopy maxillary

sinus T 0075 30.2222 "$2,098.03" $438.93 $419.6131276 Sinus endoscopy

surgical T 0075 30.2222 "$2,098.03" $438.93 $419.61

31287 Nasal/sinus endoscopy

surg T 0075 30.2222 "$2,098.03" $438.93 $419.61

31288 Nasal/sinus endoscopy

surg T 0075 30.2222 "$2,098.03" $438.93 $419.61

31290 Nasal/sinus endoscopy

surg C

31291 Nasal/sinus endoscopy

surg C

31292 Nasal/sinus endoscopy

surg T 0075 30.2222 "$2,098.03" $438.93 $419.61

31293 Nasal/sinus endoscopy

surg T 0075 30.2222 "$2,098.03" $438.93 $419.61

31294 Nasal/sinus endoscopy

surg T 0075 30.2222 "$2,098.03" $438.93 $419.61

31295 Sinus endo w/balloon

dil T 0075 30.2222 "$2,098.03" $438.93 $419.61

31296 Sinus endo w/balloon

dil T 0075 30.2222 "$2,098.03" $438.93 $419.61

31297 Sinus endo w/balloon

dil T 0075 30.2222 "$2,098.03" $438.93 $419.61

31299 Sinus surgery

procedure T 0250 1.0875 $75.49 $24.28 $15.10

31300 Removal of larynx

lesion T 0254 25.1379 "$1,745.07"

. $349.02

31320 Diagnostic incision

larynx T 0256 45.1286 "$3,132.83"

. $626.57

31360 Removal of

larynx C

31365 Removal of

larynx C

31367 Partial removal of

larynx C

31368 Partial removal of

larynx C31370 Partial removal of

larynx C

31375 Partial removal of

larynx C

31380 Partial removal of

larynx C

31382 Partial removal of

larynx C

31390 Removal of larynx &

pharynx C

31395 Reconstruct larynx &

pharynx C

31400 Revision of

larynx T 0256 45.1286 "$3,132.83"

. $626.57

31420 Removal of

epiglottis T 0256 45.1286 "$3,132.83"

. $626.57

31500 Insert emergency

airway S 0094 2.2773 $158.09 $44.32 $31.62

31502 Change of windpipe

airway S 0078 1.4008 $97.24

. $19.45

31505 Diagnostic

laryngoscopy T 0071 1.0521 $73.04

. $14.61

31510 Laryngoscopy with

biopsy T 0074 21.3691 "$1,483.44"

. $296.69

31511 Remove foreign body

larynx T 0072 1.9475 $135.20

. $27.04

31512 Removal of larynx

lesion T 0074 21.3691 "$1,483.44"

. $296.69

31513 Injection into vocal

cord T 0072 1.9475 $135.20

. $27.04

31515 Laryngoscopy for

aspiration T 0074 21.3691 "$1,483.44"

. $296.69

31520 Dx laryngoscopy

newborn T 0072 1.9475 $135.20

. $27.04

31525 Dx laryngoscopy excl

nb T 0074 21.3691 "$1,483.44"

. $296.6931526 Dx laryngoscopy w/oper

scope T 0074 21.3691 "$1,483.44"

. $296.69

31527 Laryngoscopy for

treatment T 0075 30.2222 "$2,098.03" $438.93 $419.61

31528 Laryngoscopy and

dilation T 0074 21.3691 "$1,483.44"

. $296.69

31529 Laryngoscopy and

dilation T 0074 21.3691 "$1,483.44"

. $296.69

31530 Laryngoscopy w/fb

removal T 0074 21.3691 "$1,483.44"

. $296.69

31531 Laryngoscopy w/fb & op

scope T 0074 21.3691 "$1,483.44"

. $296.69

31535 Laryngoscopy

w/biopsy T 0074 21.3691 "$1,483.44"

. $296.69

31536 Laryngoscopy w/bx & op

scope T 0074 21.3691 "$1,483.44"

. $296.69

31540 Laryngoscopy w/exc of

tumor T 0074 21.3691 "$1,483.44"

. $296.69

31541 Larynscop w/tumr exc +

scope T 0074 21.3691 "$1,483.44"

. $296.69

31545 Remove vc lesion

w/scope T 0075 30.2222 "$2,098.03" $438.93 $419.61

31546 Remove vc lesion

scope/graft T 0075 30.2222 "$2,098.03" $438.93 $419.61

31560 Laryngoscop

w/arytenoidectom T 0075 30.2222 "$2,098.03" $438.93 $419.61

31561 Larynscop remve cart +

scop T 0075 30.2222 "$2,098.03" $438.93 $419.61

31570 Laryngoscope w/vc

inj T 0074 21.3691 "$1,483.44"

. $296.69

31571 Laryngoscop w/vc inj +

scope T 0075 30.2222 "$2,098.03" $438.93 $419.61

31575 Diagnosticlaryngoscopy T 0072 1.9475 $135.20

. $27.04

31576 Laryngoscopy with

biopsy T 0074 21.3691 "$1,483.44"

. $296.69

31577 Remove foreign body

larynx T 0073 4.5122 $313.24 $67.83 $62.65

31578 Removal of larynx

lesion T 0075 30.2222 "$2,098.03" $438.93 $419.61

31579 Diagnostic

laryngoscopy T 0073 4.5122 $313.24 $67.83 $62.65

31580 Revision of

larynx T 0256 45.1286 "$3,132.83"

. $626.57

31582 Revision of

larynx T 0256 45.1286 "$3,132.83"

. $626.57

31584 Treat larynx

fracture C

31587 Revision of

larynx C

31588 Revision of

larynx T 0256 45.1286 "$3,132.83"

. $626.57

31590 Reinnervate

larynx T 0256 45.1286 "$3,132.83"

. $626.57

31595 Larynx nerve

surgery T 0256 45.1286 "$3,132.83"

. $626.57

31599 Larynx surgery

procedure T 0250 1.0875 $75.49 $24.28 $15.10

31600 Incision of

windpipe T 0254 25.1379 "$1,745.07"

. $349.02

31601 Incision of

windpipe T 0254 25.1379 "$1,745.07"

. $349.02

31603 Incision of

windpipe T 0252 8.0353 $557.81

. $111.57

31605 Incision of

windpipe T 0252 8.0353 $557.81

. $111.57

31610 Incision ofwindpipe T 0254 25.1379 "$1,745.07"

. $349.02

31611 Surgery/speech

prosthesis T 0254 25.1379 "$1,745.07"

. $349.02

31612 Puncture/clear

windpipe T 0254 25.1379 "$1,745.07"

. $349.02

31613 Repair windpipe

opening T 0254 25.1379 "$1,745.07"

. $349.02

31614 Repair windpipe

opening T 0256 45.1286 "$3,132.83"

. $626.57

31615 Visualization of

windpipe T 0252 8.0353 $557.81

. $111.57

31620 Endobronchial us add-on N

31622 Dx

bronchoscope/wash T 0076 10.4123 $722.82 $189.71 $144.57

31623 Dx

bronchoscope/brush T 0076 10.4123 $722.82 $189.71 $144.57

31624 Dx

bronchoscope/lavage T 0076 10.4123 $722.82 $189.71 $144.57

31625 Bronchoscopy

w/biopsy(s) T 0076 10.4123 $722.82 $189.71 $144.57

31626 Bronchoscopy

w/markers CH T 0415 29.1250 "$2,021.86" $459.92 $404.38

31627 Navigational bronchoscopy N

31628 Bronchoscopy/lung bx

each T 0076 10.4123 $722.82 $189.71 $144.57

31629 Bronchoscopy/needle bx

each T 0076 10.4123 $722.82 $189.71 $144.57

31630 Bronchoscopy dilate/fx

repr T 0415 29.1250 "$2,021.86" $459.92 $404.38

31631 Bronchoscopy dilate

w/stent T 0415 29.1250 "$2,021.86" $459.92 $404.38

31632 Bronchoscopy/lung bxaddl T 0076 10.4123 $722.82 $189.71 $144.57

31633 Bronchoscopy/needle bx

addl T 0076 10.4123 $722.82 $189.71 $144.57

31634 Bronch w/balloon

occlusion T 0076 10.4123 $722.82 $189.71 $144.57

31635 Bronchoscopy w/fb

removal T 0076 10.4123 $722.82 $189.71 $144.57

31636 Bronchoscopy bronch

stents T 0415 29.1250 "$2,021.86" $459.92 $404.38

31637 Bronchoscopy stent

add-on T 0076 10.4123 $722.82 $189.71 $144.57

31638 Bronchoscopy revise

stent T 0415 29.1250 "$2,021.86" $459.92 $404.38

31640 Bronchoscopy w/tumor

excise T 0415 29.1250 "$2,021.86" $459.92 $404.38

31641 Bronchoscopy treat

blockage T 0415 29.1250 "$2,021.86" $459.92 $404.38

31643 Diag

bronchoscope/catheter T 0076 10.4123 $722.82 $189.71 $144.57

31645 Bronchoscopy clear

airways T 0076 10.4123 $722.82 $189.71 $144.57

31646 Bronchoscopy reclear

airway T 0076 10.4123 $722.82 $189.71 $144.57

31656 Bronchoscopy inj for

x-ray T 0076 10.4123 $722.82 $189.71 $144.57

31715 Injection for bronchus

x-ray N

31717 Bronchial brush

biopsy T 0073 4.5122 $313.24 $67.83 $62.65

31720 Clearance of

airways S 0077 0.4224 $29.32 $7.74 $5.87

31725 Clearance of

airways C

31730 Intro windpipewire/tube T 0073 4.5122 $313.24 $67.83 $62.65

31750 Repair of

windpipe T 0256 45.1286 "$3,132.83"

. $626.57

31755 Repair of

windpipe T 0256 45.1286 "$3,132.83"

. $626.57

31760 Repair of

windpipe C

31766 Reconstruction of

windpipe C

31770 Repair/graft of

bronchus C

31775 Reconstruct

bronchus C

31780 Reconstruct

windpipe C

31781 Reconstruct

windpipe C

31785 Remove windpipe

lesion T 0254 25.1379 "$1,745.07"

. $349.02

31786 Remove windpipe

lesion C

31800 Repair of windpipe

injury C

31805 Repair of windpipe

injury C

31820 Closure of windpipe

lesion T 0254 25.1379 "$1,745.07"

. $349.02

31825 Repair of windpipe

defect T 0254 25.1379 "$1,745.07"

. $349.02

31830 Revise windpipe

scar T 0254 25.1379 "$1,745.07"

. $349.02

31899 Airways surgical

procedure T 0076 10.4123 $722.82 $189.71 $144.57

32035 Exploration of

chest C

32036 Exploration of

chest C

32095 Biopsy through chest

wall C32100 Exploration/biopsy of

chest C

32110 Explore/repair

chest C

32120 Re-exploration of

chest C

32124 Explore chest free

adhesions C

32140 Removal of lung

lesion(s) C

32141 Remove/treat lung

lesions C

32150 Removal of lung

lesion(s) C

32151 Remove lung foreign

body C

32160 Open chest heart

massage C

32200 Drain open lung

lesion C

32201 Drain percut lung

lesion T 0070 5.5572 $385.78

. $77.16

32215 Treat chest

lining C

32220 Release of

lung C

32225 Partial release of

lung C

32310 Removal of chest

lining C

32320 Free/remove chest

lining C

32400 Needle biopsy chest

lining T 0685 9.7281 $675.32

. $135.07

32402 Open biopsy chest

lining C

32405 Biopsy lung or

mediastinum T 0685 9.7281 $675.32

. $135.07

32420 Puncture/clear

lung T 0070 5.5572 $385.78

. $77.16

32421 Thoracentesis foraspiration T 0070 5.5572 $385.78

. $77.16

32422 Thoracentesis w/tube

insert T 0070 5.5572 $385.78

. $77.16

32440 Removal of

lung C

32442 Sleeve

pneumonectomy C

32445 Removal of

lung C

32480 Partial removal of

lung C

32482 Bilobectomy C

32484 Segmentectomy C

32486 Sleeve

lobectomy C

32488 Completion

pneumonectomy C

32491 Lung volume

reduction C

32500 Partial removal of

lung C

32501 Repair bronchus

add-on C

32503 Resect apical lung

tumor C

32504 Resect apical lung

tum/chest C

32540 Removal of lung

lesion C

32550 Insert pleural

cath T 0652 30.6257 "$2,126.04"

. $425.21

32551 Insertion of chest

tube T 0070 5.5572 $385.78

. $77.16

32552 Remove lung

catheter S 0078 1.4008 $97.24

. $19.45

32553 Ins mark thor for rt

perq X 0310 13.2460 $919.54 $322.74 $183.91

32560 Treat pleurodesis

w/agent T 0070 5.5572 $385.78

. $77.1632561 Lyse chest fibrin init

day T 0070 5.5572 $385.78

. $77.16

32562 Lyse chest fibrin subq

day T 0070 5.5572 $385.78

. $77.16

32601 Thoracoscopy

diagnostic T 0069 34.9007 "$2,422.81" $591.64 $484.57

32602 Thoracoscopy

diagnostic T 0069 34.9007 "$2,422.81" $591.64 $484.57

32603 Thoracoscopy

diagnostic T 0069 34.9007 "$2,422.81" $591.64 $484.57

32604 Thoracoscopy

diagnostic T 0069 34.9007 "$2,422.81" $591.64 $484.57

32605 Thoracoscopy

diagnostic T 0069 34.9007 "$2,422.81" $591.64 $484.57

32606 Thoracoscopy

diagnostic T 0069 34.9007 "$2,422.81" $591.64 $484.57

32650 Thoracoscopy

surgical C

32651 Thoracoscopy

surgical C

32652 Thoracoscopy

surgical C

32653 Thoracoscopy

surgical C

32654 Thoracoscopy

surgical C

32655 Thoracoscopy

surgical C

32656 Thoracoscopy

surgical C

32657 Thoracoscopy

surgical C

32658 Thoracoscopy

surgical C

32659 Thoracoscopy

surgical C

32660 Thoracoscopy

surgical C32661 Thoracoscopy

surgical C

32662 Thoracoscopy

surgical C

32663 Thoracoscopy

surgical C

32664 Thoracoscopy

surgical C

32665 Thoracoscopy

surgical C

32800 Repair lung

hernia C

32810 Close chest after

drainage C

32815 Close bronchial

fistula C

32820 Reconstruct injured

chest C

32850 Donor

pneumonectomy C

32851 Lung transplant

single C

32852 Lung transplant with

bypass C

32853 Lung transplant

double C

32854 Lung transplant with

bypass C

32855 Prepare donor lung

single C

32856 Prepare donor lung

double C

32900 Removal of

rib(s) C

32905 Revise & repair chest

wall C

32906 Revise & repair chest

wall C

32940 Revision of

lung C

32960 Therapeutic

pneumothorax T 0070 5.5572 $385.78

. $77.16

32997 Total lung

lavage C32998 Perq rf ablate tx pul

tumor T 0423 57.1703 "$3,968.76"

. $793.76

32999 Chest surgery

procedure T 0070 5.5572 $385.78

. $77.16

33010 Drainage of heart

sac T 0070 5.5572 $385.78

. $77.16

33011 Repeat drainage of heart

sac T 0070 5.5572 $385.78

. $77.16

33015 Incision of heart

sac C

33020 Incision of heart

sac C

33025 Incision of heart

sac C

33030 Partial removal of heart

sac C

33031 Partial removal of heart

sac C

33050 Removal of heart sac

lesion C

33120 Removal of heart

lesion C

33130 Removal of heart

lesion C

33140 Heart revascularize

(tmr) C

33141 Heart tmr w/other

procedure C

33202 Insert epicard eltrd

open C

33203 Insert epicard eltrd

endo C

33206 Insertion of heart

pacemaker T 0089 110.9465 "$7,701.91" "$1,620.86" "$1,540.39"

33207 Insertion of heart

pacemaker T 0089 110.9465 "$7,701.91" "$1,620.86" "$1,540.39"

33208 Insertion of heart

pacemaker T 0655 136.0608 "$9,445.34"

. "$1,889.07"

33210 Insertion of heartelectrode T 0106 48.5765 "$3,372.18"

. $674.44

33211 Insertion of heart

electrode T 0106 48.5765 "$3,372.18"

. $674.44

33212 Insertion of pulse

generator T 0090 93.4566 "$6,487.76" "$1,570.21" "$1,297.56"

33213 Insertion of pulse

generator T 0654 100.4629 "$6,974.13"

. "$1,394.83"

33214 Upgrade of pacemaker

system T 0655 136.0608 "$9,445.34"

. "$1,889.07"

33215 Reposition pacing-defib

lead T 0105 23.2424 "$1,613.49"

. $322.70

33216 Insert 1 electrode

pm-defib T 0106 48.5765 "$3,372.18"

. $674.44

33217 Insert 2 electrode

pm-defib T 0106 48.5765 "$3,372.18"

. $674.44

33218 Repair lead pace-defib

one T 0105 23.2424 "$1,613.49"

. $322.70

33220 Repair lead pace-defib

dual T 0105 23.2424 "$1,613.49"

. $322.70

33222 Revise pocket

pacemaker T 0136 17.2745 "$1,199.20"

. $239.84

33223 Revise pocket for

defib T 0136 17.2745 "$1,199.20"

. $239.84

33224 Insert pacing lead &

connect CH T 0655 136.0608 "$9,445.34"

. "$1,889.07"

33225 L ventric pacing lead add-on CH Q3

0108 379.7887 "$26,364.93"

. "$5,272.99"

33226 Reposition l ventric

lead T 0105 23.2424 "$1,613.49"

. $322.70

33233 Removal of pacemaker

system T 0105 23.2424 "$1,613.49"

. $322.70

33234 Removal of pacemaker

system T 0105 23.2424 "$1,613.49"

. $322.7033235 Removal pacemaker

electrode T 0105 23.2424 "$1,613.49"

. $322.70

33236 Remove

electrode/thoracotomy C

33237 Remove

electrode/thoracotomy C

33238 Remove

electrode/thoracotomy C

33240 Insert pulse generator T

0107 329.3230 "$22,861.60"

. "$4,572.32"

33241 Remove pulse

generator T 0105 23.2424 "$1,613.49"

. $322.70

33243 Remove

eltrd/thoracotomy C

33244 Remove eltrd

transven T 0105 23.2424 "$1,613.49"

. $322.70

33249 Eltrd/insert pace-defib CH Q3

0108 379.7887 "$26,364.93"

. "$5,272.99"

33250 Ablate heart dysrhythm

focus C

33251 Ablate heart dysrhythm

focus C

33254 Ablate atria

lmtd C

33255 Ablate atria w/o bypass

ext C

33256 Ablate atria w/bypass

exten C

33257 Ablate atria lmtd

add-on C

33258 Ablate atria x10sv

add-on C

33259 Ablate atria w/bypass

add-on C

33261 Ablate heart dysrhythm

focus C

33265 Ablate atria lmtd

endo C33266 Ablate atria x10sv

endo C

33282 Implant pat-active ht

record S 0680 78.4050 "$5,442.88"

. "$1,088.58"

33284 Remove pat-active ht

record T 0020 8.6164 $598.15

. $119.63

33300 Repair of heart

wound C

33305 Repair of heart

wound C

33310 Exploratory heart

surgery C

33315 Exploratory heart

surgery C

33320 Repair major blood

vessel(s) C

33321 Repair major

vessel C

33322 Repair major blood

vessel(s) C

33330 Insert major vessel

graft C

33332 Insert major vessel

graft C

33335 Insert major vessel

graft C

33400 Repair of aortic

valve C

33401 Valvuloplasty

open C

33403 Valvuloplasty w/cp

bypass C

33404 Prepare heart-aorta

conduit C

33405 Replacement of aortic

valve C

33406 Replacement of aortic

valve C

33410 Replacement of aortic

valve C

33411 Replacement of aortic

valve C

33412 Replacement of aorticvalve C

33413 Replacement of aortic

valve C

33414 Repair of aortic

valve C

33415 Revision subvalvular

tissue C

33416 Revise ventricle

muscle C

33417 Repair of aortic

valve C

33420 Revision of mitral

valve C

33422 Revision of mitral

valve C

33425 Repair of mitral

valve C

33426 Repair of mitral

valve C

33427 Repair of mitral

valve C

33430 Replacement of mitral

valve C

33460 Revision of tricuspid

valve C

33463 Valvuloplasty

tricuspid C

33464 Valvuloplasty

tricuspid C

33465 Replace tricuspid

valve C

33468 Revision of tricuspid

valve C

33470 Revision of pulmonary

valve C

33471 Valvotomy pulmonary

valve C

33472 Revision of pulmonary

valve C

33474 Revision of pulmonary

valve C

33475 Replacement pulmonary

valve C

33476 Revision of heartchamber C

33478 Revision of heart

chamber C

33496 Repair prosth valve

clot C

33500 Repair heart vessel

fistula C

33501 Repair heart vessel

fistula C

33502 Coronary artery

correction C

33503 Coronary artery

graft C

33504 Coronary artery

graft C

33505 Repair artery

w/tunnel C

33506 Repair artery

translocation C

33507 Repair art

intramural C

33508 Endoscopic vein

harvest N

33510 Cabg vein

single C

33511 Cabg vein

two C

33512 Cabg vein

three C

33513 Cabg vein

four C

33514 Cabg vein

five C

33516 Cabg vein six or

more C

33517 Cabg artery-vein

single C

33518 Cabg artery-vein

two C

33519 Cabg artery-vein

three C

33521 Cabg artery-vein

four C

33522 Cabg artery-veinfive C

33523 Cabg art-vein six or

more C

33530 Coronary artery

bypass/reop C

33533 Cabg arterial

single C

33534 Cabg arterial

two C

33535 Cabg arterial

three C

33536 Cabg arterial four or

more C

33542 Removal of heart

lesion C

33545 Repair of heart

damage C

33548 Restore/remodel

ventricle C

33572 Open coronary

endarterectomy C

33600 Closure of

valve C

33602 Closure of

valve C

33606 Anastomosis/artery-aorta C

33608 Repair anomaly

w/conduit C

33610 Repair by

enlargement C

33611 Repair double

ventricle C

33612 Repair double

ventricle C

33615 Repair modified

fontan C

33617 Repair single

ventricle C

33619 Repair single

ventricle C

33620 Apply r&l pulm art

bands C

33621 Transthor cath forstent C

33622 Redo compl cardiac

anomaly C

33641 Repair heart septum

defect C

33645 Revision of heart

veins C

33647 Repair heart septum

defects C

33660 Repair of heart

defects C

33665 Repair of heart

defects C

33670 Repair of heart

chambers C

33675 Close mult

vsd C

33676 Close mult vsd

w/resection C

33677 Cl mult vsd w/rem pul

band C

33681 Repair heart septum

defect C

33684 Repair heart septum

defect C

33688 Repair heart septum

defect C

33690 Reinforce pulmonary

artery C

33692 Repair of heart

defects C

33694 Repair of heart

defects C

33697 Repair of heart

defects C

33702 Repair of heart

defects C

33710 Repair of heart

defects C

33720 Repair of heart

defect C

33722 Repair of heart

defect C

33724 Repair venousanomaly C

33726 Repair pul venous

stenosis C

33730 Repair heart-vein

defect(s) C

33732 Repair heart-vein

defect C

33735 Revision of heart

chamber C

33736 Revision of heart

chamber C

33737 Revision of heart

chamber C

33750 Major vessel

shunt C

33755 Major vessel

shunt C

33762 Major vessel

shunt C

33764 Major vessel shunt &

graft C

33766 Major vessel

shunt C

33767 Major vessel

shunt C

33768 Cavopulmonary

shunting C

33770 Repair great vessels

defect C

33771 Repair great vessels

defect C

33774 Repair great vessels

defect C

33775 Repair great vessels

defect C

33776 Repair great vessels

defect C

33777 Repair great vessels

defect C

33778 Repair great vessels

defect C

33779 Repair great vessels

defect C

33780 Repair great vesselsdefect C

33781 Repair great vessels

defect C

33782 Nikaidoh

proc C

33783 Nikaidoh proc w/ostia

implt C

33786 Repair arterial

trunk C

33788 Revision of pulmonary

artery C

33800 Aortic

suspension C

33802 Repair vessel

defect C

33803 Repair vessel

defect C

33813 Repair septal

defect C

33814 Repair septal

defect C

33820 Revise major

vessel C

33822 Revise major

vessel C

33824 Revise major

vessel C

33840 Remove aorta

constriction C

33845 Remove aorta

constriction C

33851 Remove aorta

constriction C

33852 Repair septal

defect C

33853 Repair septal

defect C

33860 Ascending aortic

graft C

33863 Ascending aortic

graft C

33864 Ascending aortic

graft C

33870 Transverse aortic archgraft C

33875 Thoracic aortic

graft C

33877 Thoracoabdominal

graft C

33880 Endovasc taa repr incl

subcl C

33881 Endovasc taa repr w/o

subcl C

33883 Insert endovasc prosth

taa C

33884 Endovasc prosth taa

add-on C

33886 Endovasc prosth

delayed C

33889 Artery transpose/endovas

taa C

33891 Car-car bp grft/endovas

taa C

33910 Remove lung artery

emboli C

33915 Remove lung artery

emboli C

33916 Surgery of great

vessel C

33917 Repair pulmonary

artery C

33920 Repair pulmonary

atresia C

33922 Transect pulmonary

artery C

33924 Remove pulmonary

shunt C

33925 Rpr pul art unifocal w/o

cpb C

33926 Repr pul art unifocal

w/cpb C

33930 Removal of donor

heart/lung C

33933 Prepare donor

heart/lung C

33935 Transplantation

heart/lung C

33940 Removal of donorheart C

33944 Prepare donor

heart C

33945 Transplantation of

heart C

33960 External circulation

assist C

33961 External circulation

assist C

33967 Insert ia percut

device C

33968 Remove aortic assist

device C

33970 Aortic circulation

assist C

33971 Aortic circulation

assist C

33973 Insert balloon

device C

33974 Remove intra-aortic

balloon C

33975 Implant ventricular

device C

33976 Implant ventricular

device C

33977 Remove ventricular

device C

33978 Remove ventricular

device C

33979 Insert intracorporeal

device C

33980 Remove intracorporeal

device C

33981 Replace vad pump

ext C

33982 Replace vad intra w/o

bp C

33983 Replace vad intra

w/bp C

33999 Cardiac surgery

procedure T 0070 5.5572 $385.78

. $77.16

34001 Removal of artery

clot C34051 Removal of artery

clot C

34101 Removal of artery

clot T 0088 41.2260 "$2,861.91" $652.56 $572.39

34111 Removal of arm artery

clot T 0088 41.2260 "$2,861.91" $652.56 $572.39

34151 Removal of artery

clot C

34201 Removal of artery

clot T 0088 41.2260 "$2,861.91" $652.56 $572.39

34203 Removal of leg artery

clot T 0088 41.2260 "$2,861.91" $652.56 $572.39

34401 Removal of vein

clot C

34421 Removal of vein

clot T 0088 41.2260 "$2,861.91" $652.56 $572.39

34451 Removal of vein

clot C

34471 Removal of vein

clot T 0088 41.2260 "$2,861.91" $652.56 $572.39

34490 Removal of vein

clot T 0088 41.2260 "$2,861.91" $652.56 $572.39

34501 Repair valve femoral

vein T 0088 41.2260 "$2,861.91" $652.56 $572.39

34502 Reconstruct vena

cava C

34510 Transposition of vein

valve T 0088 41.2260 "$2,861.91" $652.56 $572.39

34520 Cross-over vein

graft T 0088 41.2260 "$2,861.91" $652.56 $572.39

34530 Leg vein

fusion T 0088 41.2260 "$2,861.91" $652.56 $572.39

34800 Endovas aaa repr w/sm

tube C

34802 Endovas aaa repr w/2-p

part C

34803 Endovas aaa repr w/3-ppart C

34804 Endovas aaa repr w/1-p

part C

34805 Endovas aaa repr w/long

tube C

34806 Aneurysm press sensor

add-on C

34808 Endovas iliac a device

addon C

34812 Xpose for endoprosth

femorl C

34813 Femoral endovas graft

add-on C

34820 Xpose for endoprosth

iliac C

34825 Endovasc extend prosth

init C

34826 Endovasc exten prosth

addl C

34830 Open aortic tube prosth

repr C

34831 Open aortoiliac prosth

repr C

34832 Open aortofemor prosth

repr C

34833 Xpose for endoprosth

iliac C

34834 Xpose endoprosth

brachial C

34900 Endovasc iliac repr

w/graft C

35001 Repair defect of

artery C

35002 Repair artery rupture

neck C

35005 Repair defect of

artery C

35011 Repair defect of

artery T 0653 43.1404 "$2,994.81"

. $598.97

35013 Repair artery rupture

arm C

35021 Repair defect of

artery C35022 Repair artery rupture

chest C

35045 Repair defect of arm

artery CH T 0093 30.7767 "$2,136.52"

. $427.31

35081 Repair defect of

artery C

35082 Repair artery rupture

aorta C

35091 Repair defect of

artery C

35092 Repair artery rupture

aorta C

35102 Repair defect of

artery C

35103 Repair artery rupture

groin C

35111 Repair defect of

artery C

35112 Repair artery rupture

spleen C

35121 Repair defect of

artery C

35122 Repair artery rupture

belly C

35131 Repair defect of

artery C

35132 Repair artery rupture

groin C

35141 Repair defect of

artery C

35142 Repair artery rupture

thigh C

35151 Repair defect of

artery C

35152 Repair artery rupture

knee C

35180 Repair blood vessel

lesion T 0093 30.7767 "$2,136.52"

. $427.31

35182 Repair blood vessel

lesion C

35184 Repair blood vessel

lesion T 0093 30.7767 "$2,136.52"

. $427.3135188 Repair blood vessel

lesion T 0088 41.2260 "$2,861.91" $652.56 $572.39

35189 Repair blood vessel

lesion C

35190 Repair blood vessel

lesion T 0093 30.7767 "$2,136.52"

. $427.31

35201 Repair blood vessel

lesion T 0093 30.7767 "$2,136.52"

. $427.31

35206 Repair blood vessel

lesion T 0093 30.7767 "$2,136.52"

. $427.31

35207 Repair blood vessel

lesion T 0088 41.2260 "$2,861.91" $652.56 $572.39

35211 Repair blood vessel

lesion C

35216 Repair blood vessel

lesion C

35221 Repair blood vessel

lesion C

35226 Repair blood vessel

lesion T 0020 8.6164 $598.15

. $119.63

35231 Repair blood vessel

lesion T 0093 30.7767 "$2,136.52"

. $427.31

35236 Repair blood vessel

lesion T 0093 30.7767 "$2,136.52"

. $427.31

35241 Repair blood vessel

lesion C

35246 Repair blood vessel

lesion C

35251 Repair blood vessel

lesion C

35256 Repair blood vessel

lesion T 0093 30.7767 "$2,136.52"

. $427.31

35261 Repair blood vessel

lesion T 0653 43.1404 "$2,994.81"

. $598.97

35266 Repair blood vessel

lesion T 0653 43.1404 "$2,994.81"

. $598.97

35271 Repair blood vessellesion C

35276 Repair blood vessel

lesion C

35281 Repair blood vessel

lesion C

35286 Repair blood vessel

lesion T 0653 43.1404 "$2,994.81"

. $598.97

35301 Rechanneling of

artery C

35302 Rechanneling of

artery C

35303 Rechanneling of

artery C

35304 Rechanneling of

artery C

35305 Rechanneling of

artery C

35306 Rechanneling of

artery C

35311 Rechanneling of

artery C

35321 Rechanneling of

artery T 0093 30.7767 "$2,136.52"

. $427.31

35331 Rechanneling of

artery C

35341 Rechanneling of

artery C

35351 Rechanneling of

artery C

35355 Rechanneling of

artery C

35361 Rechanneling of

artery C

35363 Rechanneling of

artery C

35371 Rechanneling of

artery C

35372 Rechanneling of

artery C

35390 Reoperation carotid

add-on C

35400 Angioscopy C35450 Repair arterial

blockage C

35452 Repair arterial

blockage C

35458 Repair arterial

blockage T 0083 65.1118 "$4,520.06"

. $904.02

35460 Repair venous

blockage T 0083 65.1118 "$4,520.06"

. $904.02

35471 Repair arterial

blockage T 0083 65.1118 "$4,520.06"

. $904.02

35472 Repair arterial

blockage T 0083 65.1118 "$4,520.06"

. $904.02

35475 Repair arterial

blockage T 0083 65.1118 "$4,520.06"

. $904.02

35476 Repair venous

blockage T 0083 65.1118 "$4,520.06"

. $904.02

35500 Harvest vein for

bypass T 0103 16.7686 "$1,164.08"

. $232.82

35501 Artery bypass

graft C

35506 Artery bypass

graft C

35508 Artery bypass

graft C

35509 Artery bypass

graft C

35510 Artery bypass

graft C

35511 Artery bypass

graft C

35512 Artery bypass

graft C

35515 Artery bypass

graft C

35516 Artery bypass

graft C

35518 Artery bypass

graft C

35521 Artery bypass

graft C35522 Artery bypass

graft C

35523 Artery bypass

graft C

35525 Artery bypass

graft C

35526 Artery bypass

graft C

35531 Artery bypass

graft C

35533 Artery bypass

graft C

35535 Artery bypass

graft C

35536 Artery bypass

graft C

35537 Artery bypass

graft C

35538 Artery bypass

graft C

35539 Artery bypass

graft C

35540 Artery bypass

graft C

35548 Artery bypass

graft C

35549 Artery bypass

graft C

35551 Artery bypass

graft C

35556 Artery bypass

graft C

35558 Artery bypass

graft C

35560 Artery bypass

graft C

35563 Artery bypass

graft C

35565 Artery bypass

graft C

35566 Artery bypass

graft C

35570 Artery bypass

graft C35571 Artery bypass

graft C

35572 Harvest femoropopliteal

vein N

35583 Vein bypass

graft C

35585 Vein bypass

graft C

35587 Vein bypass

graft C

35600 Harvest art for cabg

add-on C

35601 Artery bypass

graft C

35606 Artery bypass

graft C

35612 Artery bypass

graft C

35616 Artery bypass

graft C

35621 Artery bypass

graft C

35623 Bypass graft not

vein C

35626 Artery bypass

graft C

35631 Artery bypass

graft C

35632 Artery bypass

graft C

35633 Artery bypass

graft C

35634 Artery bypass

graft C

35636 Artery bypass

graft C

35637 Artery bypass

graft C

35638 Artery bypass

graft C

35642 Artery bypass

graft C

35645 Artery bypass

graft C35646 Artery bypass

graft C

35647 Artery bypass

graft C

35650 Artery bypass

graft C

35651 Artery bypass

graft C

35654 Artery bypass

graft C

35656 Artery bypass

graft C

35661 Artery bypass

graft C

35663 Artery bypass

graft C

35665 Artery bypass

graft C

35666 Artery bypass

graft C

35671 Artery bypass

graft C

35681 Composite bypass

graft C

35682 Composite bypass

graft C

35683 Composite bypass

graft C

35685 Bypass graft

patency/patch T 0093 30.7767 "$2,136.52"

. $427.31

35686 Bypass graft/av fist

patency T 0093 30.7767 "$2,136.52"

. $427.31

35691 Arterial

transposition C

35693 Arterial

transposition C

35694 Arterial

transposition C

35695 Arterial

transposition C

35697 Reimplant artery

each C35700 Reoperation bypass

graft C

35701 Exploration carotid

artery C

35721 Exploration femoral

artery C

35741 Exploration popliteal

artery C

35761 Exploration of

artery/vein T 0093 30.7767 "$2,136.52"

. $427.31

35800 Explore neck

vessels C

35820 Explore chest

vessels C

35840 Explore abdominal

vessels C

35860 Explore limb

vessels T 0093 30.7767 "$2,136.52"

. $427.31

35870 Repair vessel graft

defect C

35875 Removal of clot in

graft T 0088 41.2260 "$2,861.91" $652.56 $572.39

35876 Removal of clot in

graft T 0088 41.2260 "$2,861.91" $652.56 $572.39

35879 Revise graft

w/vein T 0088 41.2260 "$2,861.91" $652.56 $572.39

35881 Revise graft

w/vein T 0088 41.2260 "$2,861.91" $652.56 $572.39

35883 Revise graft w/nonauto

graft T 0088 41.2260 "$2,861.91" $652.56 $572.39

35884 Revise graft

w/vein T 0088 41.2260 "$2,861.91" $652.56 $572.39

35901 Excision graft

neck C

35903 Excision graft

extremity T 0093 30.7767 "$2,136.52"

. $427.31

35905 Excision graft

thorax C35907 Excision graft

abdomen C

36000 Place needle in

vein N

36002 Pseudoaneurysm injection

trt S 0267 2.1881 $151.90 $59.41 $30.38

36005 Injection ext

venography N

36010 Place catheter in

vein N

36011 Place catheter in

vein N

36012 Place catheter in

vein N

36013 Place catheter in

artery N

36014 Place catheter in

artery N

36015 Place catheter in

artery N

36100 Establish access to

artery N

36120 Establish access to

artery N

36140 Establish access to

artery N

36147 Access av dial grft for

eval CH T 0668 9.4312 $654.71

. $130.95

36148 Access av dial grft for

proc N

36160 Establish access to

aorta N

36200 Place catheter in

aorta N

36215 Place catheter in

artery N

36216 Place catheter in

artery N

36217 Place catheter in

artery N

36218 Place catheter in

artery N

36245 Place catheter inartery N

36246 Place catheter in

artery N

36247 Place catheter in

artery N

36248 Place catheter in

artery N

36260 Insertion of infusion

pump T 0623 30.2967 "$2,103.20"

. $420.64

36261 Revision of infusion

pump T 0105 23.2424 "$1,613.49"

. $322.70

36262 Removal of infusion

pump T 0105 23.2424 "$1,613.49"

. $322.70

36299 Vessel injection

procedure N

36400 Bl draw < 3 yrs

fem/jugular N

36405 Bl draw < 3 yrs scalp

vein N

36406 Bl draw < 3 yrs other

vein N

36410 Non-routine bl draw > 3

yrs N

36415 Routine

venipuncture A

36416 Capillary blood

draw N

36420 Vein access cutdown < 1 yr X

0035 0.2717 $18.86

. $3.78

36425 Vein access cutdown > 1 yr X

0035 0.2717 $18.86

. $3.78

36430 Blood transfusion

service S 0110 3.3671 $233.74

. $46.75

36440 Bl push transfuse 2 yr or

< S 0110 3.3671 $233.74

. $46.75

36450 Bl exchange/transfuse

nb S 0110 3.3671 $233.74

. $46.75

36455 Bl exchange/transfuse

non-nb S 0110 3.3671 $233.74

. $46.7536460 Transfusion service

fetal S 0110 3.3671 $233.74

. $46.75

36468 Injection(s) spider

veins T 0013 0.9786 $67.93

. $13.59

36469 Injection(s) spider

veins T 0013 0.9786 $67.93

. $13.59

36470 Injection therapy of

vein T 0013 0.9786 $67.93

. $13.59

36471 Injection therapy of

veins T 0013 0.9786 $67.93

. $13.59

36475 Endovenous rf 1st

vein T 0091 43.6864 "$3,032.71"

. $606.55

36476 Endovenous rf vein

add-on T 0092 26.9181 "$1,868.65"

. $373.73

36478 Endovenous laser 1st

vein T 0092 26.9181 "$1,868.65"

. $373.73

36479 Endovenous laser vein

addon T 0092 26.9181 "$1,868.65"

. $373.73

36481 Insertion of catheter

vein N

36500 Insertion of catheter

vein N

36510 Insertion of catheter

vein N

36511 Apheresis

wbc S 0111 11.7368 $814.77 $189.47 $162.96

36512 Apheresis

rbc S 0111 11.7368 $814.77 $189.47 $162.96

36513 Apheresis

platelets S 0111 11.7368 $814.77 $189.47 $162.96

36514 Apheresis

plasma S 0111 11.7368 $814.77 $189.47 $162.96

36515 Apheresis

adsorp/reinfuse S 0112 32.6016 "$2,263.20"

. $452.64

36516 Apheresisselective S 0112 32.6016 "$2,263.20"

. $452.64

36522 Photopheresis S 0112 32.6016 "$2,263.20"

. $452.64

36555 Insert non-tunnel cv

cath T 0621 11.1622 $774.88

. $154.98

36556 Insert non-tunnel cv

cath T 0621 11.1622 $774.88

. $154.98

36557 Insert tunneled cv

cath T 0622 25.1290 "$1,744.46"

. $348.90

36558 Insert tunneled cv

cath T 0622 25.1290 "$1,744.46"

. $348.90

36560 Insert tunneled cv

cath T 0623 30.2967 "$2,103.20"

. $420.64

36561 Insert tunneled cv

cath T 0623 30.2967 "$2,103.20"

. $420.64

36563 Insert tunneled cv

cath T 0623 30.2967 "$2,103.20"

. $420.64

36565 Insert tunneled cv

cath T 0623 30.2967 "$2,103.20"

. $420.64

36566 Insert tunneled cv

cath T 0623 30.2967 "$2,103.20"

. $420.64

36568 Insert picc

cath T 0621 11.1622 $774.88

. $154.98

36569 Insert picc

cath T 0621 11.1622 $774.88

. $154.98

36570 Insert picvad

cath T 0622 25.1290 "$1,744.46"

. $348.90

36571 Insert picvad

cath T 0622 25.1290 "$1,744.46"

. $348.90

36575 Repair tunneled cv

cath T 0121 6.3178 $438.58

. $87.72

36576 Repair tunneled cv

cath T 0621 11.1622 $774.88

. $154.9836578 Replace tunneled cv

cath T 0622 25.1290 "$1,744.46"

. $348.90

36580 Replace cvad

cath T 0621 11.1622 $774.88

. $154.98

36581 Replace tunneled cv

cath T 0622 25.1290 "$1,744.46"

. $348.90

36582 Replace tunneled cv

cath T 0623 30.2967 "$2,103.20"

. $420.64

36583 Replace tunneled cv

cath T 0623 30.2967 "$2,103.20"

. $420.64

36584 Replace picc

cath T 0621 11.1622 $774.88

. $154.98

36585 Replace picvad

cath T 0622 25.1290 "$1,744.46"

. $348.90

36589 Removal tunneled cv

cath T 0121 6.3178 $438.58

. $87.72

36590 Removal tunneled cv

cath T 0621 11.1622 $774.88

. $154.98

36591 Draw blood off venous

device Q1 0624 0.6235 $43.28 $12.56 $8.66

36592 Collect blood from

picc Q1 0624 0.6235 $43.28 $12.56 $8.66

36593 Declot vascular

device T 0676 2.3410 $162.51

. $32.51

36595 Mech remov tunneled cv

cath T 0622 25.1290 "$1,744.46"

. $348.90

36596 Mech remov tunneled cv

cath T 0621 11.1622 $774.88

. $154.98

36597 Reposition venous

catheter T 0621 11.1622 $774.88

. $154.98

36598 Inj w/fluor eval cv

device T 0676 2.3410 $162.51

. $32.51

36600 Withdrawal of arterial blood Q3

0035 0.2717 $18.86

. $3.7836620 Insertion catheter

artery N

36625 Insertion catheter

artery N

36640 Insertion catheter

artery T 0623 30.2967 "$2,103.20"

. $420.64

36660 Insertion catheter

artery C

36680 Insert needle bone

cavity T 0002 1.7462 $121.22

. $24.25

36800 Insertion of

cannula T 0115 36.8791 "$2,560.15"

. $512.03

36810 Insertion of

cannula T 0115 36.8791 "$2,560.15"

. $512.03

36815 Insertion of

cannula T 0115 36.8791 "$2,560.15"

. $512.03

36818 Av fuse uppr arm

cephalic T 0088 41.2260 "$2,861.91" $652.56 $572.39

36819 Av fuse uppr arm

basilic T 0088 41.2260 "$2,861.91" $652.56 $572.39

36820 Av fusion/forearm

vein T 0088 41.2260 "$2,861.91" $652.56 $572.39

36821 Av fusion direct any

site T 0088 41.2260 "$2,861.91" $652.56 $572.39

36822 Insertion of

cannula(s) C

36823 Insertion of

cannula(s) C

36825 Artery-vein

autograft T 0088 41.2260 "$2,861.91" $652.56 $572.39

36830 Artery-vein

nonautograft T 0088 41.2260 "$2,861.91" $652.56 $572.39

36831 Open thrombect av

fistula T 0088 41.2260 "$2,861.91" $652.56 $572.39

36832 Av fistula revision

open T 0088 41.2260 "$2,861.91" $652.56 $572.3936833 Av fistula

revision T 0088 41.2260 "$2,861.91" $652.56 $572.39

36835 Artery to vein

shunt T 0115 36.8791 "$2,560.15"

. $512.03

36838 Dist revas ligation

hemo T 0088 41.2260 "$2,861.91" $652.56 $572.39

36860 External cannula

declotting T 0676 2.3410 $162.51

. $32.51

36861 Cannula

declotting T 0115 36.8791 "$2,560.15"

. $512.03

36870 Percut thrombect av

fistula T 0653 43.1404 "$2,994.81"

. $598.97

37140 Revision of

circulation C

37145 Revision of

circulation C

37160 Revision of

circulation C

37180 Revision of

circulation C

37181 Splice spleen/kidney

veins C

37182 Insert hepatic shunt

(tips) C

37183 Remove hepatic shunt

(tips) T 0229 114.2626 "$7,932.11"

. "$1,586.43"

37184 Prim art mech

thrombectomy T 0088 41.2260 "$2,861.91" $652.56 $572.39

37185 Prim art m-thrombect

add-on T 0088 41.2260 "$2,861.91" $652.56 $572.39

37186 Sec art m-thrombect

add-on T 0088 41.2260 "$2,861.91" $652.56 $572.39

37187 Venous mech

thrombectomy T 0088 41.2260 "$2,861.91" $652.56 $572.39

37188 Venous m-thrombectomy

add-on T 0088 41.2260 "$2,861.91" $652.56 $572.3937195 Thrombolytic therapy

stroke T 0676 2.3410 $162.51

. $32.51

37200 Transcatheter

biopsy T 0623 30.2967 "$2,103.20"

. $420.64

37201 Transcatheter therapy

infuse T 0103 16.7686 "$1,164.08"

. $232.82

37202 Transcatheter therapy

infuse T 0103 16.7686 "$1,164.08"

. $232.82

37203 Transcatheter

retrieval T 0623 30.2967 "$2,103.20"

. $420.64

37204 Transcatheter

occlusion T 0082 104.8857 "$7,281.17"

. "$1,456.24"

37205 Transcath iv stent

percut T 0229 114.2626 "$7,932.11"

. "$1,586.43"

37206 Transcath iv stent/perc

addl T 0229 114.2626 "$7,932.11"

. "$1,586.43"

37207 Transcath iv stent

open T 0229 114.2626 "$7,932.11"

. "$1,586.43"

37208 Transcath iv stent/open

addl T 0229 114.2626 "$7,932.11"

. "$1,586.43"

37209 Change iv cath at thromb

tx T 0623 30.2967 "$2,103.20"

. $420.64

37210 Embolization uterine

fibroid T 0229 114.2626 "$7,932.11"

. "$1,586.43"

37215 Transcath stent cca

w/eps C

37216 Transcath stent cca w/o eps E

37220 Iliac

revasc T 0083 65.1118 "$4,520.06"

. $904.02

37221 Iliac revasc

w/stent CH T 0229 114.2626 "$7,932.11"

. "$1,586.43"

37222 Iliac revasc

add-on T 0083 65.1118 "$4,520.06"

. $904.0237223 Iliac revasc w/stent

add-on T 0083 65.1118 "$4,520.06"

. $904.02

37224 Fem/popl revas

w/tla T 0083 65.1118 "$4,520.06"

. $904.02

37225 Fem/popl revas

w/ather T 0229 114.2626 "$7,932.11"

. "$1,586.43"

37226 Fem/popl revasc

w/stent T 0229 114.2626 "$7,932.11"

. "$1,586.43"

37227 Fem/popl revasc stnt &

ather T 0319 202.3898 "$14,049.90" "$5,559.48" "$2,809.98"

37228 Tib/per revasc

w/tla T 0083 65.1118 "$4,520.06"

. $904.02

37229 Tib/per revasc

w/ather T 0229 114.2626 "$7,932.11"

. "$1,586.43"

37230 Tib/per revasc

w/stent T 0229 114.2626 "$7,932.11"

. "$1,586.43"

37231 Tib/per revasc stent &

ather T 0319 202.3898 "$14,049.90" "$5,559.48" "$2,809.98"

37232 Tib/per revasc

add-on T 0083 65.1118 "$4,520.06"

. $904.02

37233 Tibper revasc w/ather

add-on T 0229 114.2626 "$7,932.11"

. "$1,586.43"

37234 Revsc opn/prq tib/pero

stent T 0083 65.1118 "$4,520.06"

. $904.02

37235 Tib/per revasc stnt &

ather T 0083 65.1118 "$4,520.06"

. $904.02

37250 Iv us first vessel add-on N

37251 Iv us each add vessel add-on N

37500 Endoscopy ligate perf

veins T 0091 43.6864 "$3,032.71"

. $606.55

37501 Vascular endoscopy

procedure T 0092 26.9181 "$1,868.65"

. $373.7337565 Ligation of neck

vein T 0093 30.7767 "$2,136.52"

. $427.31

37600 Ligation of neck

artery T 0093 30.7767 "$2,136.52"

. $427.31

37605 Ligation of neck

artery T 0091 43.6864 "$3,032.71"

. $606.55

37606 Ligation of neck

artery T 0092 26.9181 "$1,868.65"

. $373.73

37607 Ligation of a-v

fistula T 0092 26.9181 "$1,868.65"

. $373.73

37609 Temporal artery

procedure T 0021 17.1909 "$1,193.39"

. $238.68

37615 Ligation of neck

artery T 0092 26.9181 "$1,868.65"

. $373.73

37616 Ligation of chest

artery C

37617 Ligation of abdomen

artery C

37618 Ligation of extremity

artery C

37620 Revision of major

vein T 0091 43.6864 "$3,032.71"

. $606.55

37650 Revision of major

vein T 0092 26.9181 "$1,868.65"

. $373.73

37660 Revision of major

vein C

37700 Revise leg

vein T 0092 26.9181 "$1,868.65"

. $373.73

37718 Ligate/strip short leg

vein T 0092 26.9181 "$1,868.65"

. $373.73

37722 Ligate/strip long leg

vein T 0091 43.6864 "$3,032.71"

. $606.55

37735 Removal of leg

veins/lesion T 0091 43.6864 "$3,032.71"

. $606.5537760 Ligate leg veins

radical T 0092 26.9181 "$1,868.65"

. $373.73

37761 Ligate leg veins

open T 0092 26.9181 "$1,868.65"

. $373.73

37765 Stab phleb veins xtr

10-20 T 0092 26.9181 "$1,868.65"

. $373.73

37766 Phleb veins - extrem

20+ T 0092 26.9181 "$1,868.65"

. $373.73

37780 Revision of leg

vein T 0092 26.9181 "$1,868.65"

. $373.73

37785 Ligate/divide/excise

vein T 0092 26.9181 "$1,868.65"

. $373.73

37788 Revascularization

penis C

37790 Penile venous

occlusion T 0181 34.3803 "$2,386.68" $598.48 $477.34

37799 Vascular surgery

procedure X 0624 0.6235 $43.28 $12.56 $8.66

38100 Removal of spleen

total C

38101 Removal of spleen

partial C

38102 Removal of spleen

total C

38115 Repair of ruptured

spleen C

38120 Laparoscopy

splenectomy T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

38129 Laparoscope proc

spleen T 0130 39.0865 "$2,713.38" $659.53 $542.68

38200 Injection for spleen

x-ray N

38204 Bl donor search management N

38205 Harvest allogenic stem

cells B

38206 Harvest auto stem

cells S 0111 11.7368 $814.77 $189.47 $162.9638207 Cryopreserve stem cells S

0110 3.3671 $233.74

. $46.75

38208 Thaw preserved stem cells S

0110 3.3671 $233.74

. $46.75

38209 Wash harvest stem cells S

0110 3.3671 $233.74

. $46.75

38210 T-cell depletion of harvest S

0393 6.3038 $437.61

. $87.53

38211 Tumor cell deplete of harvst S

0393 6.3038 $437.61

. $87.53

38212 Rbc depletion of harvest S

0393 6.3038 $437.61

. $87.53

38213 Platelet deplete of harvest S

0393 6.3038 $437.61

. $87.53

38214 Volume deplete of harvest S

0393 6.3038 $437.61

. $87.53

38215 Harvest stem cell concentrte S

0393 6.3038 $437.61

. $87.53

38220 Bone marrow

aspiration T 0003 3.9075 $271.26

. $54.26

38221 Bone marrow

biopsy T 0003 3.9075 $271.26

. $54.26

38230 Bone marrow

collection S 0112 32.6016 "$2,263.20"

. $452.64

38240 Bone marrow/stem

transplant S 0112 32.6016 "$2,263.20"

. $452.64

38241 Bone marrow/stem

transplant S 0112 32.6016 "$2,263.20"

. $452.64

38242 Lymphocyte infuse

transplant S 0111 11.7368 $814.77 $189.47 $162.96

38300 Drainage lymph node

lesion T 0007 13.4779 $935.64

. $187.1338305 Drainage lymph node

lesion T 0008 20.5401 "$1,425.89"

. $285.18

38308 Incision of lymph

channels T 0113 25.4874 "$1,769.34"

. $353.87

38380 Thoracic duct

procedure C

38381 Thoracic duct

procedure C

38382 Thoracic duct

procedure C

38500 Biopsy/removal lymph

nodes T 0113 25.4874 "$1,769.34"

. $353.87

38505 Needle biopsy lymph

nodes T 0005 8.1415 $565.18

. $113.04

38510 Biopsy/removal lymph

nodes T 0113 25.4874 "$1,769.34"

. $353.87

38520 Biopsy/removal lymph

nodes T 0113 25.4874 "$1,769.34"

. $353.87

38525 Biopsy/removal lymph

nodes T 0113 25.4874 "$1,769.34"

. $353.87

38530 Biopsy/removal lymph

nodes T 0113 25.4874 "$1,769.34"

. $353.87

38542 Explore deep node(s)

neck T 0114 51.2321 "$3,556.53"

. $711.31

38550 Removal neck/armpit

lesion T 0113 25.4874 "$1,769.34"

. $353.87

38555 Removal neck/armpit

lesion T 0113 25.4874 "$1,769.34"

. $353.87

38562 Removal pelvic lymph

nodes C

38564 Removal abdomen lymph

nodes C

38570 Laparoscopy lymph node

biop T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

38571 Laparoscopy

lymphadenectomy T 0132 71.0451 "$4,931.95" "$1,236.99" $986.3938572 Laparoscopy

lymphadenectomy T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

38589 Laparoscope proc

lymphatic T 0130 39.0865 "$2,713.38" $659.53 $542.68

38700 Removal of lymph nodes

neck T 0113 25.4874 "$1,769.34"

. $353.87

38720 Removal of lymph nodes

neck T 0113 25.4874 "$1,769.34"

. $353.87

38724 Removal of lymph nodes

neck C

38740 Remove armpit lymph

nodes T 0114 51.2321 "$3,556.53"

. $711.31

38745 Remove armpit lymph

nodes T 0114 51.2321 "$3,556.53"

. $711.31

38746 Remove thoracic lymph

nodes C

38747 Remove abdominal lymph

nodes C

38760 Remove groin lymph

nodes T 0113 25.4874 "$1,769.34"

. $353.87

38765 Remove groin lymph

nodes C

38770 Remove pelvis lymph

nodes C

38780 Remove abdomen lymph

nodes C

38790 Inject for lymphatic

x-ray N

38792 Identify sentinel node Q1

0392 2.5360 $176.05 $42.39 $35.21

38794 Access thoracic lymph

duct N

38900 Io map of sent lymph

node N

38999 Blood/lymph system

procedure S 0110 3.3671 $233.74

. $46.75

39000 Exploration of

chest C39010 Exploration of

chest C

39200 Removal chest

lesion C

39220 Removal chest

lesion C

39400 Visualization of

chest T 0069 34.9007 "$2,422.81" $591.64 $484.57

39499 Chest

procedure C

39501 Repair diaphragm

laceration C

39503 Repair of diaphragm

hernia C

39540 Repair of diaphragm

hernia C

39541 Repair of diaphragm

hernia C

39545 Revision of

diaphragm C

39560 Resect diaphragm

simple C

39561 Resect diaphragm

complex C

39599 Diaphragm surgery

procedure C

40490 Biopsy of

lip T 0251 3.3531 $232.77

. $46.56

40500 Partial excision of

lip T 0253 16.9180 "$1,174.45" $277.61 $234.89

40510 Partial excision of

lip T 0254 25.1379 "$1,745.07"

. $349.02

40520 Partial excision of

lip T 0253 16.9180 "$1,174.45" $277.61 $234.89

40525 Reconstruct lip with

flap T 0254 25.1379 "$1,745.07"

. $349.02

40527 Reconstruct lip with

flap T 0254 25.1379 "$1,745.07"

. $349.02

40530 Partial removal oflip T 0254 25.1379 "$1,745.07"

. $349.02

40650 Repair

lip T 0252 8.0353 $557.81

. $111.57

40652 Repair

lip T 0252 8.0353 $557.81

. $111.57

40654 Repair

lip T 0252 8.0353 $557.81

. $111.57

40700 Repair cleft

lip/nasal T 0256 45.1286 "$3,132.83"

. $626.57

40701 Repair cleft

lip/nasal T 0256 45.1286 "$3,132.83"

. $626.57

40702 Repair cleft

lip/nasal T 0256 45.1286 "$3,132.83"

. $626.57

40720 Repair cleft

lip/nasal T 0256 45.1286 "$3,132.83"

. $626.57

40761 Repair cleft

lip/nasal T 0256 45.1286 "$3,132.83"

. $626.57

40799 Lip surgery

procedure T 0250 1.0875 $75.49 $24.28 $15.10

40800 Drainage of mouth

lesion T 0006 1.4481 $100.53

. $20.11

40801 Drainage of mouth

lesion T 0252 8.0353 $557.81

. $111.57

40804 Removal foreign body

mouth X 0340 0.6739 $46.78

. $9.36

40805 Removal foreign body

mouth T 0252 8.0353 $557.81

. $111.57

40806 Incision of lip

fold T 0251 3.3531 $232.77

. $46.56

40808 Biopsy of mouth

lesion T 0251 3.3531 $232.77

. $46.56

40810 Excision of mouth

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.8940812 Excise/repair mouth

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

40814 Excise/repair mouth

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

40816 Excision of mouth

lesion T 0254 25.1379 "$1,745.07"

. $349.02

40818 Excise oral mucosa for

graft T 0251 3.3531 $232.77

. $46.56

40819 Excise lip or cheek

fold T 0252 8.0353 $557.81

. $111.57

40820 Treatment of mouth

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

40830 Repair mouth

laceration T 0251 3.3531 $232.77

. $46.56

40831 Repair mouth

laceration T 0252 8.0353 $557.81

. $111.57

40840 Reconstruction of

mouth T 0254 25.1379 "$1,745.07"

. $349.02

40842 Reconstruction of

mouth T 0254 25.1379 "$1,745.07"

. $349.02

40843 Reconstruction of

mouth T 0254 25.1379 "$1,745.07"

. $349.02

40844 Reconstruction of

mouth T 0256 45.1286 "$3,132.83"

. $626.57

40845 Reconstruction of

mouth T 0256 45.1286 "$3,132.83"

. $626.57

40899 Mouth surgery

procedure T 0250 1.0875 $75.49 $24.28 $15.10

41000 Drainage of mouth

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

41005 Drainage of mouth

lesion T 0251 3.3531 $232.77

. $46.56

41006 Drainage of mouthlesion T 0254 25.1379 "$1,745.07"

. $349.02

41007 Drainage of mouth

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

41008 Drainage of mouth

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

41009 Drainage of mouth

lesion T 0251 3.3531 $232.77

. $46.56

41010 Incision of tongue

fold T 0252 8.0353 $557.81

. $111.57

41015 Drainage of mouth

lesion T 0251 3.3531 $232.77

. $46.56

41016 Drainage of mouth

lesion T 0252 8.0353 $557.81

. $111.57

41017 Drainage of mouth

lesion T 0252 8.0353 $557.81

. $111.57

41018 Drainage of mouth

lesion T 0252 8.0353 $557.81

. $111.57

41019 Place needles h&n for

rt T 0254 25.1379 "$1,745.07"

. $349.02

41100 Biopsy of

tongue T 0252 8.0353 $557.81

. $111.57

41105 Biopsy of

tongue T 0253 16.9180 "$1,174.45" $277.61 $234.89

41108 Biopsy of floor of

mouth T 0019 4.8763 $338.51

. $67.71

41110 Excision of tongue

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

41112 Excision of tongue

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

41113 Excision of tongue

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

41114 Excision of tongue

lesion T 0254 25.1379 "$1,745.07"

. $349.0241115 Excision of tongue

fold T 0252 8.0353 $557.81

. $111.57

41116 Excision of mouth

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

41120 Partial removal of

tongue T 0254 25.1379 "$1,745.07"

. $349.02

41130 Partial removal of

tongue C

41135 Tongue and neck

surgery C

41140 Removal of

tongue C

41145 Tongue removal neck

surgery C

41150 Tongue mouth jaw

surgery C

41153 Tongue mouth neck

surgery C

41155 Tongue jaw & neck

surgery C

41250 Repair tongue

laceration T 0250 1.0875 $75.49 $24.28 $15.10

41251 Repair tongue

laceration T 0251 3.3531 $232.77

. $46.56

41252 Repair tongue

laceration T 0252 8.0353 $557.81

. $111.57

41500 Fixation of

tongue T 0254 25.1379 "$1,745.07"

. $349.02

41510 Tongue to lip

surgery T 0253 16.9180 "$1,174.45" $277.61 $234.89

41512 Tongue

suspension T 0252 8.0353 $557.81

. $111.57

41520 Reconstruction tongue

fold T 0252 8.0353 $557.81

. $111.57

41530 Tongue base vol

reduction T 0254 25.1379 "$1,745.07"

. $349.0241599 Tongue and mouth

surgery T 0250 1.0875 $75.49 $24.28 $15.10

41800 Drainage of gum

lesion T 0006 1.4481 $100.53

. $20.11

41805 Removal foreign body

gum T 0254 25.1379 "$1,745.07"

. $349.02

41806 Removal foreign body

jawbone T 0253 16.9180 "$1,174.45" $277.61 $234.89

41820 Excision gum each

quadrant T 0252 8.0353 $557.81

. $111.57

41821 Excision of gum

flap T 0252 8.0353 $557.81

. $111.57

41822 Excision of gum

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

41823 Excision of gum

lesion T 0254 25.1379 "$1,745.07"

. $349.02

41825 Excision of gum

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

41826 Excision of gum

lesion T 0254 25.1379 "$1,745.07"

. $349.02

41827 Excision of gum

lesion T 0254 25.1379 "$1,745.07"

. $349.02

41828 Excision of gum

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

41830 Removal of gum

tissue T 0253 16.9180 "$1,174.45" $277.61 $234.89

41850 Treatment of gum

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

41870 Gum

graft T 0254 25.1379 "$1,745.07"

. $349.02

41872 Repair

gum T 0253 16.9180 "$1,174.45" $277.61 $234.89

41874 Repair tooth

socket T 0254 25.1379 "$1,745.07"

. $349.0241899 Dental surgery

procedure T 0250 1.0875 $75.49 $24.28 $15.10

42000 Drainage mouth roof

lesion T 0251 3.3531 $232.77

. $46.56

42100 Biopsy roof of

mouth T 0252 8.0353 $557.81

. $111.57

42104 Excision lesion mouth

roof T 0253 16.9180 "$1,174.45" $277.61 $234.89

42106 Excision lesion mouth

roof T 0253 16.9180 "$1,174.45" $277.61 $234.89

42107 Excision lesion mouth

roof T 0254 25.1379 "$1,745.07"

. $349.02

42120 Remove

palate/lesion T 0256 45.1286 "$3,132.83"

. $626.57

42140 Excision of

uvula T 0252 8.0353 $557.81

. $111.57

42145 Repair palate

pharynx/uvula T 0254 25.1379 "$1,745.07"

. $349.02

42160 Treatment mouth roof

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

42180 Repair

palate T 0251 3.3531 $232.77

. $46.56

42182 Repair

palate T 0256 45.1286 "$3,132.83"

. $626.57

42200 Reconstruct cleft

palate T 0256 45.1286 "$3,132.83"

. $626.57

42205 Reconstruct cleft

palate T 0256 45.1286 "$3,132.83"

. $626.57

42210 Reconstruct cleft

palate T 0256 45.1286 "$3,132.83"

. $626.57

42215 Reconstruct cleft

palate T 0256 45.1286 "$3,132.83"

. $626.5742220 Reconstruct cleft

palate T 0256 45.1286 "$3,132.83"

. $626.57

42225 Reconstruct cleft

palate T 0256 45.1286 "$3,132.83"

. $626.57

42226 Lengthening of

palate T 0256 45.1286 "$3,132.83"

. $626.57

42227 Lengthening of

palate T 0256 45.1286 "$3,132.83"

. $626.57

42235 Repair

palate T 0253 16.9180 "$1,174.45" $277.61 $234.89

42260 Repair nose to lip

fistula T 0254 25.1379 "$1,745.07"

. $349.02

42280 Preparation palate

mold T 0251 3.3531 $232.77

. $46.56

42281 Insertion palate

prosthesis T 0253 16.9180 "$1,174.45" $277.61 $234.89

42299 Palate/uvula

surgery T 0250 1.0875 $75.49 $24.28 $15.10

42300 Drainage of salivary

gland T 0253 16.9180 "$1,174.45" $277.61 $234.89

42305 Drainage of salivary

gland T 0253 16.9180 "$1,174.45" $277.61 $234.89

42310 Drainage of salivary

gland T 0251 3.3531 $232.77

. $46.56

42320 Drainage of salivary

gland T 0251 3.3531 $232.77

. $46.56

42330 Removal of salivary

stone T 0253 16.9180 "$1,174.45" $277.61 $234.89

42335 Removal of salivary

stone T 0253 16.9180 "$1,174.45" $277.61 $234.89

42340 Removal of salivary

stone T 0253 16.9180 "$1,174.45" $277.61 $234.89

42400 Biopsy of salivary

gland T 0005 8.1415 $565.18

. $113.0442405 Biopsy of salivary

gland T 0254 25.1379 "$1,745.07"

. $349.02

42408 Excision of salivary

cyst T 0253 16.9180 "$1,174.45" $277.61 $234.89

42409 Drainage of salivary

cyst T 0253 16.9180 "$1,174.45" $277.61 $234.89

42410 Excise parotid

gland/lesion T 0256 45.1286 "$3,132.83"

. $626.57

42415 Excise parotid

gland/lesion T 0256 45.1286 "$3,132.83"

. $626.57

42420 Excise parotid

gland/lesion T 0256 45.1286 "$3,132.83"

. $626.57

42425 Excise parotid

gland/lesion T 0256 45.1286 "$3,132.83"

. $626.57

42426 Excise parotid

gland/lesion C

42440 Excise submaxillary

gland T 0256 45.1286 "$3,132.83"

. $626.57

42450 Excise sublingual

gland T 0254 25.1379 "$1,745.07"

. $349.02

42500 Repair salivary

duct T 0254 25.1379 "$1,745.07"

. $349.02

42505 Repair salivary

duct T 0256 45.1286 "$3,132.83"

. $626.57

42507 Parotid duct

diversion T 0256 45.1286 "$3,132.83"

. $626.57

42508 Parotid duct

diversion T 0256 45.1286 "$3,132.83"

. $626.57

42509 Parotid duct

diversion T 0256 45.1286 "$3,132.83"

. $626.57

42510 Parotid duct

diversion T 0256 45.1286 "$3,132.83"

. $626.57

42550 Injection for salivaryx-ray N

42600 Closure of salivary

fistula T 0253 16.9180 "$1,174.45" $277.61 $234.89

42650 Dilation of salivary

duct T 0252 8.0353 $557.81

. $111.57

42660 Dilation of salivary

duct T 0251 3.3531 $232.77

. $46.56

42665 Ligation of salivary

duct T 0254 25.1379 "$1,745.07"

. $349.02

42699 Salivary surgery

procedure T 0250 1.0875 $75.49 $24.28 $15.10

42700 Drainage of tonsil

abscess T 0251 3.3531 $232.77

. $46.56

42720 Drainage of throat

abscess T 0253 16.9180 "$1,174.45" $277.61 $234.89

42725 Drainage of throat

abscess T 0256 45.1286 "$3,132.83"

. $626.57

42800 Biopsy of

throat T 0252 8.0353 $557.81

. $111.57

42802 Biopsy of

throat T 0253 16.9180 "$1,174.45" $277.61 $234.89

42804 Biopsy of upper

nose/throat T 0253 16.9180 "$1,174.45" $277.61 $234.89

42806 Biopsy of upper

nose/throat T 0254 25.1379 "$1,745.07"

. $349.02

42808 Excise pharynx

lesion T 0254 25.1379 "$1,745.07"

. $349.02

42809 Remove pharynx foreign

body X 0340 0.6739 $46.78

. $9.36

42810 Excision of neck

cyst T 0254 25.1379 "$1,745.07"

. $349.02

42815 Excision of neck

cyst T 0256 45.1286 "$3,132.83"

. $626.5742820 Remove tonsils and

adenoids T 0254 25.1379 "$1,745.07"

. $349.02

42821 Remove tonsils and

adenoids T 0254 25.1379 "$1,745.07"

. $349.02

42825 Removal of

tonsils T 0254 25.1379 "$1,745.07"

. $349.02

42826 Removal of

tonsils T 0254 25.1379 "$1,745.07"

. $349.02

42830 Removal of

adenoids T 0254 25.1379 "$1,745.07"

. $349.02

42831 Removal of

adenoids T 0254 25.1379 "$1,745.07"

. $349.02

42835 Removal of

adenoids T 0254 25.1379 "$1,745.07"

. $349.02

42836 Removal of

adenoids T 0254 25.1379 "$1,745.07"

. $349.02

42842 Extensive surgery of

throat T 0254 25.1379 "$1,745.07"

. $349.02

42844 Extensive surgery of

throat T 0256 45.1286 "$3,132.83"

. $626.57

42845 Extensive surgery of

throat C

42860 Excision of tonsil

tags T 0254 25.1379 "$1,745.07"

. $349.02

42870 Excision of lingual

tonsil T 0254 25.1379 "$1,745.07"

. $349.02

42890 Partial removal of

pharynx T 0256 45.1286 "$3,132.83"

. $626.57

42892 Revision of pharyngeal

walls T 0256 45.1286 "$3,132.83"

. $626.57

42894 Revision of pharyngeal

walls C

42900 Repair throat

wound T 0252 8.0353 $557.81

. $111.5742950 Reconstruction of

throat T 0254 25.1379 "$1,745.07"

. $349.02

42953 Repair throat

esophagus C

42955 Surgical opening of

throat T 0254 25.1379 "$1,745.07"

. $349.02

42960 Control throat

bleeding T 0250 1.0875 $75.49 $24.28 $15.10

42961 Control throat

bleeding C

42962 Control throat

bleeding T 0256 45.1286 "$3,132.83"

. $626.57

42970 Control nose/throat

bleeding T 0250 1.0875 $75.49 $24.28 $15.10

42971 Control nose/throat

bleeding C

42972 Control nose/throat

bleeding T 0253 16.9180 "$1,174.45" $277.61 $234.89

42999 Throat surgery

procedure T 0250 1.0875 $75.49 $24.28 $15.10

43020 Incision of

esophagus T 0252 8.0353 $557.81

. $111.57

43030 Throat muscle

surgery T 0253 16.9180 "$1,174.45" $277.61 $234.89

43045 Incision of

esophagus C

43100 Excision of esophagus

lesion C

43101 Excision of esophagus

lesion C

43107 Removal of

esophagus C

43108 Removal of

esophagus C

43112 Removal of

esophagus C

43113 Removal of

esophagus C43116 Partial removal of

esophagus C

43117 Partial removal of

esophagus C

43118 Partial removal of

esophagus C

43121 Partial removal of

esophagus C

43122 Partial removal of

esophagus C

43123 Partial removal of

esophagus C

43124 Removal of

esophagus C

43130 Removal of esophagus

pouch T 0256 45.1286 "$3,132.83"

. $626.57

43135 Removal of esophagus

pouch C

43200 Esophagus

endoscopy T 0141 8.3787 $581.65 $136.33 $116.33

43201 Esoph scope w/submucous

inj CH T 0419 12.5693 $872.56 $204.51 $174.52

43202 Esophagus endoscopy

biopsy T 0141 8.3787 $581.65 $136.33 $116.33

43204 Esoph scope w/sclerosis

inj T 0141 8.3787 $581.65 $136.33 $116.33

43205 Esophagus

endoscopy/ligation CH T 0419 12.5693 $872.56 $204.51 $174.52

43215 Esophagus

endoscopy CH T 0419 12.5693 $872.56 $204.51 $174.52

43216 Esophagus

endoscopy/lesion T 0422 25.4890 "$1,769.45"

. $353.89

43217 Esophagus

endoscopy CH T 0419 12.5693 $872.56 $204.51 $174.52

43219 Esophagus

endoscopy T 0384 29.0233 "$2,014.80"

. $402.96

43220 Esoph endoscopy

dilation CH T 0419 12.5693 $872.56 $204.51 $174.5243226 Esoph endoscopy

dilation CH T 0419 12.5693 $872.56 $204.51 $174.52

43227 Esoph endoscopy

repair CH T 0419 12.5693 $872.56 $204.51 $174.52

43228 Esoph endoscopy

ablation T 0422 25.4890 "$1,769.45"

. $353.89

43231 Esoph endoscopy w/us

exam CH T 0419 12.5693 $872.56 $204.51 $174.52

43232 Esoph endoscopy w/us fn

bx CH T 0419 12.5693 $872.56 $204.51 $174.52

43234 Upper gi endoscopy

exam T 0141 8.3787 $581.65 $136.33 $116.33

43235 Uppr gi endoscopy

diagnosis T 0141 8.3787 $581.65 $136.33 $116.33

43236 Uppr gi scope w/submuc

inj T 0141 8.3787 $581.65 $136.33 $116.33

43237 Endoscopic us exam

esoph CH T 0419 12.5693 $872.56 $204.51 $174.52

43238 Uppr gi endoscopy w/us fn

bx CH T 0419 12.5693 $872.56 $204.51 $174.52

43239 Upper gi endoscopy

biopsy T 0141 8.3787 $581.65 $136.33 $116.33

43240 Esoph endoscope w/drain

cyst CH T 0419 12.5693 $872.56 $204.51 $174.52

43241 Upper GI endoscopy with

tube T 0141 8.3787 $581.65 $136.33 $116.33

43242 Uppr gi endoscopy w/us fn

bx CH T 0419 12.5693 $872.56 $204.51 $174.52

43243 Upper gi endoscopy &

inject T 0141 8.3787 $581.65 $136.33 $116.33

43244 Upper GI

endoscopy/ligation CH T 0419 12.5693 $872.56 $204.51 $174.5243245 Uppr gi scope dilate

strictr CH T 0419 12.5693 $872.56 $204.51 $174.52

43246 Place gastrostomy

tube CH T 0419 12.5693 $872.56 $204.51 $174.52

43247 Operative upper GI

endoscopy T 0141 8.3787 $581.65 $136.33 $116.33

43248 Uppr gi endoscopy/guide

wire T 0141 8.3787 $581.65 $136.33 $116.33

43249 Esoph endoscopy

dilation CH T 0419 12.5693 $872.56 $204.51 $174.52

43250 Upper GI

endoscopy/tumor CH T 0419 12.5693 $872.56 $204.51 $174.52

43251 Operative upper GI

endoscopy CH T 0419 12.5693 $872.56 $204.51 $174.52

43255 Operative upper GI

endoscopy CH T 0419 12.5693 $872.56 $204.51 $174.52

43256 Uppr gi endoscopy

w/stent T 0384 29.0233 "$2,014.80"

. $402.96

43257 Uppr gi scope w/thrml

txmnt T 0422 25.4890 "$1,769.45"

. $353.89

43258 Operative upper GI

endoscopy CH T 0419 12.5693 $872.56 $204.51 $174.52

43259 Endoscopic ultrasound

exam CH T 0419 12.5693 $872.56 $204.51 $174.52

43260 Endo

cholangiopancreatograph T 0151 24.4009 "$1,693.91"

. $338.79

43261 Endo

cholangiopancreatograph T 0151 24.4009 "$1,693.91"

. $338.79

43262 Endo

cholangiopancreatograph T 0151 24.4009 "$1,693.91"

. $338.79

43263 Endo

cholangiopancreatograph T 0151 24.4009 "$1,693.91"

. $338.79

43264 Endo

cholangiopancreatograph T 0151 24.4009 "$1,693.91"

. $338.7943265 Endo

cholangiopancreatograph T 0151 24.4009 "$1,693.91"

. $338.79

43267 Endo

cholangiopancreatograph T 0151 24.4009 "$1,693.91"

. $338.79

43268 Endo

cholangiopancreatograph T 0384 29.0233 "$2,014.80"

. $402.96

43269 Endo

cholangiopancreatograph T 0384 29.0233 "$2,014.80"

. $402.96

43271 Endo

cholangiopancreatograph T 0151 24.4009 "$1,693.91"

. $338.79

43272 Endo

cholangiopancreatograph T 0151 24.4009 "$1,693.91"

. $338.79

43273 Endoscopic

pancreatoscopy T 0151 24.4009 "$1,693.91"

. $338.79

43279 Lap myotomy

heller C

43280 Laparoscopy

fundoplasty T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

43281 Lap paraesophag hern

repair C

43282 Lap paraesoph her rpr

w/mesh C

43283 Lap esoph

lengthening C

43289 Laparoscope proc

esoph T 0130 39.0865 "$2,713.38" $659.53 $542.68

43300 Repair of

esophagus C

43305 Repair esophagus and

fistula C

43310 Repair of

esophagus C

43312 Repair esophagus and

fistula C

43313 Esophagoplasty

congenital C

43314 Tracheo-esophagoplastycong C

43320 Fuse esophagus &

stomach C

43325 Revise esophagus &

stomach C

43327 Esoph fundoplasty

lap C

43328 Esoph fundoplasty

thor C

43330 Esophagomyotomy

abdominal C

43331 Esophagomyotomy

thoracic C

43332 Transab esoph hiat hern

rpr C

43333 Transab esoph hiat hern

rpr C

43334 Transthor diaphrag hern

rpr C

43335 Transthor diaphrag hern

rpr C

43336 Thorabd diaphr hern

repair C

43337 Thorabd diaphr hern

repair C

43338 Esoph

lengthening C

43340 Fuse esophagus &

intestine C

43341 Fuse esophagus &

intestine C

43350 Surgical opening

esophagus C

43351 Surgical opening

esophagus C

43352 Surgical opening

esophagus C

43360 Gastrointestinal

repair C

43361 Gastrointestinal

repair C

43400 Ligate esophagus

veins C

43401 Esophagus surgery forveins C

43405 Ligate/staple

esophagus C

43410 Repair esophagus

wound C

43415 Repair esophagus

wound C

43420 Repair esophagus

opening T 0254 25.1379 "$1,745.07"

. $349.02

43425 Repair esophagus

opening C

43450 Dilate

esophagus T 0140 6.5430 $454.22

. $90.85

43453 Dilate

esophagus T 0140 6.5430 $454.22

. $90.85

43456 Dilate

esophagus T 0140 6.5430 $454.22

. $90.85

43458 Dilate esophagus CH

T 0419 12.5693 $872.56 $204.51 $174.52

43460 Pressure treatment

esophagus C

43496 Free jejunum flap

microvasc C

43499 Esophagus surgery

procedure T 0141 8.3787 $581.65 $136.33 $116.33

43500 Surgical opening of

stomach C

43501 Surgical repair of

stomach C

43502 Surgical repair of

stomach C

43510 Surgical opening of stomach CH

T 0141 8.3787 $581.65 $136.33 $116.33

43520 Incision of pyloric

muscle C

43605 Biopsy of

stomach C

43610 Excision of stomach

lesion C43611 Excision of stomach

lesion C

43620 Removal of

stomach C

43621 Removal of

stomach C

43622 Removal of

stomach C

43631 Removal of stomach

partial C

43632 Removal of stomach

partial C

43633 Removal of stomach

partial C

43634 Removal of stomach

partial C

43635 Removal of stomach

partial C

43640 Vagotomy & pylorus

repair C

43641 Vagotomy & pylorus

repair C

43644 Lap gastric

bypass/roux-en-y C

43645 Lap gastr bypass incl smll

i C

43647 Lap impl electrode

antrum S 0061 86.9786 "$6,038.05"

. "$1,207.61"

43648 Lap revise/remv eltrd

antrum T 0130 39.0865 "$2,713.38" $659.53 $542.68

43651 Laparoscopy vagus

nerve T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

43652 Laparoscopy vagus

nerve T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

43653 Laparoscopy

gastrostomy T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

43659 Laparoscope proc

stom T 0130 39.0865 "$2,713.38" $659.53 $542.68

43752 Nasal/orogastric

w/stent Q3 0272 1.2481 $86.64 $30.47 $17.3343753 Tx gastro intub

w/asp X 0340 0.6739 $46.78

. $9.36

43754 Dx gastr intub w/asp

spec X 0340 0.6739 $46.78

. $9.36

43755 Dx gastr intub w/asp

specs S 0097 0.9478 $65.80 $23.63 $13.16

43756 Dx duod intub w/asp

spec X 0272 1.2481 $86.64 $30.47 $17.33

43757 Dx duod intub w/asp

specs X 0272 1.2481 $86.64 $30.47 $17.33

43760 Change gastrostomy

tube T 0676 2.3410 $162.51

. $32.51

43761 Reposition gastrostomy

tube T 0141 8.3787 $581.65 $136.33 $116.33

43770 Lap place gastr adj

device C

43771 Lap revise gastr adj

device C

43772 Lap rmvl gastr adj

device C

43773 Lap replace gastr adj

device C

43774 Lap rmvl gastr adj all

parts C

43775 Lap sleeve

gastrectomy E

43800 Reconstruction of

pylorus C

43810 Fusion of stomach and

bowel C

43820 Fusion of stomach and

bowel C

43825 Fusion of stomach and

bowel C

43830 Place gastrostomy tube CH

T 0419 12.5693 $872.56 $204.51 $174.52

43831 Place gastrostomy

tube T 0141 8.3787 $581.65 $136.33 $116.3343832 Place gastrostomy

tube C

43840 Repair of stomach

lesion C

43842 V-band

gastroplasty E

43843 Gastroplasty w/o

v-band C

43845 Gastroplasty duodenal

switch C

43846 Gastric bypass for

obesity C

43847 Gastric bypass incl small

i C

43848 Revision

gastroplasty C

43850 Revise stomach-bowel

fusion C

43855 Revise stomach-bowel

fusion C

43860 Revise stomach-bowel

fusion C

43865 Revise stomach-bowel

fusion C

43870 Repair stomach

opening T 0422 25.4890 "$1,769.45"

. $353.89

43880 Repair stomach-bowel

fistula C

43881 Impl/redo electrd

antrum C

43882 Revise/remove electrd

antrum C

43886 Revise gastric port

open T 0137 21.8041 "$1,513.64"

. $302.73

43887 Remove gastric port

open T 0135 5.1973 $360.80

. $72.16

43888 Change gastric port

open T 0137 21.8041 "$1,513.64"

. $302.73

43999 Stomach surgery

procedure T 0141 8.3787 $581.65 $136.33 $116.3344005 Freeing of bowel

adhesion C

44010 Incision of small

bowel C

44015 Insert needle cath

bowel C

44020 Explore small

intestine C

44021 Decompress small

bowel C

44025 Incision of large

bowel C

44050 Reduce bowel

obstruction C

44055 Correct malrotation of

bowel C

44100 Biopsy of

bowel CH T 0419 12.5693 $872.56 $204.51 $174.52

44110 Excise intestine

lesion(s) C

44111 Excision of bowel

lesion(s) C

44120 Removal of small

intestine C

44121 Removal of small

intestine C

44125 Removal of small

intestine C

44126 Enterectomy w/o taper

cong C

44127 Enterectomy w/taper

cong C

44128 Enterectomy cong

add-on C

44130 Bowel to bowel

fusion C

44132 Enterectomy cadaver

donor C

44133 Enterectomy live

donor C

44135 Intestine transplnt

cadaver C

44136 Intestine transplant

live C44137 Remove intestinal

allograft C

44139 Mobilization of

colon C

44140 Partial removal of

colon C

44141 Partial removal of

colon C

44143 Partial removal of

colon C

44144 Partial removal of

colon C

44145 Partial removal of

colon C

44146 Partial removal of

colon C

44147 Partial removal of

colon C

44150 Removal of

colon C

44151 Removal of

colon/ileostomy C

44155 Removal of

colon/ileostomy C

44156 Removal of

colon/ileostomy C

44157 Colectomy w/ileoanal

anast C

44158 Colectomy w/neo-rectum

pouch C

44160 Removal of

colon C

44180 Lap

enterolysis T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

44186 Lap

jejunostomy T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

44187 Lap

ileo/jejuno-stomy C

44188 Lap

colostomy C

44202 Lap

enterectomy C44203 Lap resect s/intestine

addl C

44204 Laparo partial

colectomy C

44205 Lap colectomy part

w/ileum C

44206 Lap part colectomy

w/stoma T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

44207 L

colectomy/coloproctostomy T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

44208 L

colectomy/coloproctostomy T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

44210 Laparo total

proctocolectomy C

44211 Lap colectomy

w/proctectomy C

44212 Laparo total

proctocolectomy C

44213 Lap mobil splenic fl

add-on T 0130 39.0865 "$2,713.38" $659.53 $542.68

44227 Lap close

enterostomy C

44238 Laparoscope proc

intestine T 0130 39.0865 "$2,713.38" $659.53 $542.68

44300 Open bowel to

skin C

44310 Ileostomy/jejunostomy C

44312 Revision of

ileostomy T 0137 21.8041 "$1,513.64"

. $302.73

44314 Revision of

ileostomy C

44316 Devise bowel

pouch C

44320 Colostomy C

44322 Colostomy with

biopsies C

44340 Revision of

colostomy T 0137 21.8041 "$1,513.64"

. $302.7344345 Revision of

colostomy C

44346 Revision of

colostomy C

44360 Small bowel

endoscopy T 0142 10.1643 $705.61 $152.78 $141.13

44361 Small bowel

endoscopy/biopsy T 0142 10.1643 $705.61 $152.78 $141.13

44363 Small bowel

endoscopy T 0142 10.1643 $705.61 $152.78 $141.13

44364 Small bowel

endoscopy CH T 0424 15.8412 "$1,099.70" $239.49 $219.94

44365 Small bowel

endoscopy CH T 0424 15.8412 "$1,099.70" $239.49 $219.94

44366 Small bowel

endoscopy CH T 0424 15.8412 "$1,099.70" $239.49 $219.94

44369 Small bowel

endoscopy CH T 0424 15.8412 "$1,099.70" $239.49 $219.94

44370 Small bowel

endoscopy/stent T 0384 29.0233 "$2,014.80"

. $402.96

44372 Small bowel

endoscopy CH T 0424 15.8412 "$1,099.70" $239.49 $219.94

44373 Small bowel

endoscopy CH T 0424 15.8412 "$1,099.70" $239.49 $219.94

44376 Small bowel

endoscopy T 0142 10.1643 $705.61 $152.78 $141.13

44377 Small bowel

endoscopy/biopsy T 0142 10.1643 $705.61 $152.78 $141.13

44378 Small bowel

endoscopy CH T 0424 15.8412 "$1,099.70" $239.49 $219.94

44379 S bowel endoscope

w/stent T 0384 29.0233 "$2,014.80"

. $402.96

44380 Small bowel

endoscopy T 0142 10.1643 $705.61 $152.78 $141.1344382 Small bowel

endoscopy T 0142 10.1643 $705.61 $152.78 $141.13

44383 Ileoscopy

w/stent T 0384 29.0233 "$2,014.80"

. $402.96

44385 Endoscopy of bowel

pouch T 0143 9.3183 $646.88 $186.06 $129.38

44386 Endoscopy bowel

pouch/biop T 0143 9.3183 $646.88 $186.06 $129.38

44388 Colonoscopy T 0143 9.3183 $646.88 $186.06 $129.38

44389 Colonoscopy with

biopsy T 0143 9.3183 $646.88 $186.06 $129.38

44390 Colonoscopy for foreign

body T 0143 9.3183 $646.88 $186.06 $129.38

44391 Colonoscopy for

bleeding T 0143 9.3183 $646.88 $186.06 $129.38

44392 Colonoscopy &

polypectomy T 0143 9.3183 $646.88 $186.06 $129.38

44393 Colonoscopy lesion

removal T 0143 9.3183 $646.88 $186.06 $129.38

44394 Colonoscopy

w/snare T 0143 9.3183 $646.88 $186.06 $129.38

44397 Colonoscopy

w/stent T 0384 29.0233 "$2,014.80"

. $402.96

44500 Intro gastrointestinal

tube T 0121 6.3178 $438.58

. $87.72

44602 Suture small

intestine C

44603 Suture small

intestine C

44604 Suture large

intestine C

44605 Repair of bowel

lesion C

44615 Intestinal

stricturoplasty C44620 Repair bowel

opening C

44625 Repair bowel

opening C

44626 Repair bowel

opening C

44640 Repair bowel-skin

fistula C

44650 Repair bowel

fistula C

44660 Repair bowel-bladder

fistula C

44661 Repair bowel-bladder

fistula C

44680 Surgical revision

intestine C

44700 Suspend bowel

w/prosthesis C

44701 Intraop colon lavage

add-on N

44715 Prepare donor

intestine C

44720 Prep donor

intestine/venous C

44721 Prep donor

intestine/artery C

44799 Unlisted procedure

intestine T 0153 26.6476 "$1,849.88" $375.24 $369.98

44800 Excision of bowel

pouch C

44820 Excision of mesentery

lesion C

44850 Repair of

mesentery C

44899 Bowel surgery

procedure C

44900 Drain app abscess

open C

44901 Drain app abscess

percut T 0037 15.3594 "$1,066.25" $225.55 $213.25

44950 Appendectomy T 0153 26.6476 "$1,849.88" $375.24 $369.98

44955 Appendectomyadd-on T 0153 26.6476 "$1,849.88" $375.24 $369.98

44960 Appendectomy C

44970 Laparoscopy

appendectomy T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

44979 Laparoscope proc

app T 0130 39.0865 "$2,713.38" $659.53 $542.68

45000 Drainage of pelvic abscess CH

T 0149 24.4472 "$1,697.12"

. $339.43

45005 Drainage of rectal abscess CH

T 0149 24.4472 "$1,697.12"

. $339.43

45020 Drainage of rectal

abscess T 0155 16.0235 "$1,112.35"

. $222.47

45100 Biopsy of

rectum T 0149 24.4472 "$1,697.12"

. $339.43

45108 Removal of anorectal

lesion T 0149 24.4472 "$1,697.12"

. $339.43

45110 Removal of

rectum C

45111 Partial removal of

rectum C

45112 Removal of

rectum C

45113 Partial

proctectomy C

45114 Partial removal of

rectum C

45116 Partial removal of

rectum C

45119 Remove rectum

w/reservoir C

45120 Removal of

rectum C

45121 Removal of rectum and

colon C

45123 Partial

proctectomy C

45126 Pelvic

exenteration C45130 Excision of rectal

prolapse C

45135 Excision of rectal

prolapse C

45136 Excise ileoanal

reservior C

45150 Excision of rectal

stricture T 0149 24.4472 "$1,697.12"

. $339.43

45160 Excision of rectal

lesion T 0149 24.4472 "$1,697.12"

. $339.43

45171 Exc rect tum transanal part CH

T 0149 24.4472 "$1,697.12"

. $339.43

45172 Exc rect tum transanal

full T 0149 24.4472 "$1,697.12"

. $339.43

45190 Destruction rectal

tumor T 0149 24.4472 "$1,697.12"

. $339.43

45300 Proctosigmoidoscopy

dx T 0146 6.3038 $437.61

. $87.53

45303 Proctosigmoidoscopy

dilate T 0147 11.0219 $765.14

. $153.03

45305 Proctosigmoidoscopy

w/bx T 0147 11.0219 $765.14

. $153.03

45307 Proctosigmoidoscopy

fb T 0428 23.9719 "$1,664.13"

. $332.83

45308 Proctosigmoidoscopy

removal T 0147 11.0219 $765.14

. $153.03

45309 Proctosigmoidoscopy

removal T 0147 11.0219 $765.14

. $153.03

45315 Proctosigmoidoscopy

removal T 0147 11.0219 $765.14

. $153.03

45317 Proctosigmoidoscopy

bleed T 0147 11.0219 $765.14

. $153.03

45320 Proctosigmoidoscopy

ablate T 0428 23.9719 "$1,664.13"

. $332.83

45321 Proctosigmoidoscopyvolvul T 0428 23.9719 "$1,664.13"

. $332.83

45327 Proctosigmoidoscopy

w/stent T 0384 29.0233 "$2,014.80"

. $402.96

45330 Diagnostic

sigmoidoscopy T 0146 6.3038 $437.61

. $87.53

45331 Sigmoidoscopy and

biopsy T 0146 6.3038 $437.61

. $87.53

45332 Sigmoidoscopy w/fb

removal T 0146 6.3038 $437.61

. $87.53

45333 Sigmoidoscopy & polypectomy CH

T 0146 6.3038 $437.61

. $87.53

45334 Sigmoidoscopy for

bleeding T 0147 11.0219 $765.14

. $153.03

45335 Sigmoidoscopy w/submuc

inj T 0146 6.3038 $437.61

. $87.53

45337 Sigmoidoscopy &

decompress T 0146 6.3038 $437.61

. $87.53

45338 Sigmoidoscopy w/tumr remove CH

T 0146 6.3038 $437.61

. $87.53

45339 Sigmoidoscopy w/ablate

tumr T 0147 11.0219 $765.14

. $153.03

45340 Sig w/balloon

dilation T 0147 11.0219 $765.14

. $153.03

45341 Sigmoidoscopy w/ultrasound CH

T 0146 6.3038 $437.61

. $87.53

45342 Sigmoidoscopy w/us guide

bx T 0147 11.0219 $765.14

. $153.03

45345 Sigmoidoscopy

w/stent T 0384 29.0233 "$2,014.80"

. $402.96

45355 Surgical

colonoscopy T 0143 9.3183 $646.88 $186.06 $129.38

45378 Diagnostic

colonoscopy T 0143 9.3183 $646.88 $186.06 $129.3845379 Colonoscopy w/fb

removal T 0143 9.3183 $646.88 $186.06 $129.38

45380 Colonoscopy and

biopsy T 0143 9.3183 $646.88 $186.06 $129.38

45381 Colonoscopy submucous

inj T 0143 9.3183 $646.88 $186.06 $129.38

45382 Colonoscopy/control

bleeding T 0143 9.3183 $646.88 $186.06 $129.38

45383 Lesion removal

colonoscopy T 0143 9.3183 $646.88 $186.06 $129.38

45384 Lesion remove

colonoscopy T 0143 9.3183 $646.88 $186.06 $129.38

45385 Lesion removal

colonoscopy T 0143 9.3183 $646.88 $186.06 $129.38

45386 Colonoscopy dilate

stricture T 0143 9.3183 $646.88 $186.06 $129.38

45387 Colonoscopy

w/stent T 0384 29.0233 "$2,014.80"

. $402.96

45391 Colonoscopy w/endoscope

us T 0143 9.3183 $646.88 $186.06 $129.38

45392 Colonoscopy w/endoscopic

fnb T 0143 9.3183 $646.88 $186.06 $129.38

45395 Lap removal of

rectum C

45397 Lap remove rectum

w/pouch C

45400 Laparoscopic

proc C

45402 Lap proctopexy w/sig

resect C

45499 Laparoscope proc

rectum T 0130 39.0865 "$2,713.38" $659.53 $542.68

45500 Repair of

rectum T 0149 24.4472 "$1,697.12"

. $339.43

45505 Repair ofrectum T 0150 32.9730 "$2,288.99"

. $457.80

45520 Treatment of rectal

prolapse T 0013 0.9786 $67.93

. $13.59

45540 Correct rectal

prolapse C

45541 Correct rectal

prolapse T 0150 32.9730 "$2,288.99"

. $457.80

45550 Repair rectum/remove

sigmoid C

45560 Repair of

rectocele T 0150 32.9730 "$2,288.99"

. $457.80

45562 Exploration/repair of

rectum C

45563 Exploration/repair of

rectum C

45800 Repair rect/bladder

fistula C

45805 Repair fistula

w/colostomy C

45820 Repair rectourethral

fistula C

45825 Repair fistula

w/colostomy C

45900 Reduction of rectal

prolapse T 0148 6.1052 $423.82

. $84.77

45905 Dilation of anal

sphincter T 0149 24.4472 "$1,697.12"

. $339.43

45910 Dilation of rectal

narrowing T 0149 24.4472 "$1,697.12"

. $339.43

45915 Remove rectal

obstruction T 0155 16.0235 "$1,112.35"

. $222.47

45990 Surg dx exam

anorectal T 0149 24.4472 "$1,697.12"

. $339.43

45999 Rectum surgery

procedure T 0148 6.1052 $423.82

. $84.77

46020 Placement of

seton T 0149 24.4472 "$1,697.12"

. $339.4346030 Removal of rectal

marker T 0148 6.1052 $423.82

. $84.77

46040 Incision of rectal

abscess T 0149 24.4472 "$1,697.12"

. $339.43

46045 Incision of rectal

abscess T 0149 24.4472 "$1,697.12"

. $339.43

46050 Incision of anal

abscess CH T 0148 6.1052 $423.82

. $84.77

46060 Incision of rectal

abscess T 0149 24.4472 "$1,697.12"

. $339.43

46070 Incision of anal

septum T 0155 16.0235 "$1,112.35"

. $222.47

46080 Incision of anal

sphincter T 0149 24.4472 "$1,697.12"

. $339.43

46083 Incise external

hemorrhoid T 0164 2.0973 $145.59

. $29.12

46200 Removal of anal

fissure T 0149 24.4472 "$1,697.12"

. $339.43

46220 Excise anal ext

tag/papilla T 0155 16.0235 "$1,112.35"

. $222.47

46221 Ligation of

hemorrhoid(s) T 0148 6.1052 $423.82

. $84.77

46230 Removal of anal

tags T 0149 24.4472 "$1,697.12"

. $339.43

46250 Remove ext hem groups

2+ T 0149 24.4472 "$1,697.12"

. $339.43

46255 Remove int/ext hem 1

group T 0149 24.4472 "$1,697.12"

. $339.43

46257 Remove in/ex hem grp &

fiss T 0149 24.4472 "$1,697.12"

. $339.43

46258 Remove in/ex hem grp

w/fistu T 0149 24.4472 "$1,697.12"

. $339.43

46260 Remove in/ex hem groups2+ T 0149 24.4472 "$1,697.12"

. $339.43

46261 Remove in/ex hem grps &

fiss T 0149 24.4472 "$1,697.12"

. $339.43

46262 Remove in/ex hem grps

w/fist T 0149 24.4472 "$1,697.12"

. $339.43

46270 Remove anal fist

subq T 0149 24.4472 "$1,697.12"

. $339.43

46275 Remove anal fist

inter T 0149 24.4472 "$1,697.12"

. $339.43

46280 Remove anal fist

complex T 0149 24.4472 "$1,697.12"

. $339.43

46285 Remove anal fist 2

stage T 0149 24.4472 "$1,697.12"

. $339.43

46288 Repair anal

fistula T 0149 24.4472 "$1,697.12"

. $339.43

46320 Removal of hemorrhoid

clot T 0149 24.4472 "$1,697.12"

. $339.43

46500 Injection into hemorrhoid(s) CH

T 0148 6.1052 $423.82

. $84.77

46505 Chemodenervation anal

musc T 0149 24.4472 "$1,697.12"

. $339.43

46600 Diagnostic

anoscopy X 0340 0.6739 $46.78

. $9.36

46604 Anoscopy and

dilation T 0147 11.0219 $765.14

. $153.03

46606 Anoscopy and

biopsy T 0146 6.3038 $437.61

. $87.53

46608 Anoscopy remove for body CH

T 0146 6.3038 $437.61

. $87.53

46610 Anoscopy remove

lesion T 0428 23.9719 "$1,664.13"

. $332.83

46611 Anoscopy T 0147 11.0219 $765.14

. $153.0346612 Anoscopy remove

lesions T 0428 23.9719 "$1,664.13"

. $332.83

46614 Anoscopy control

bleeding T 0146 6.3038 $437.61

. $87.53

46615 Anoscopy T 0428 23.9719 "$1,664.13"

. $332.83

46700 Repair of anal

stricture T 0149 24.4472 "$1,697.12"

. $339.43

46705 Repair of anal

stricture C

46706 Repr of anal fistula

w/glue T 0150 32.9730 "$2,288.99"

. $457.80

46707 Repair anorectal fist

w/plug T 0150 32.9730 "$2,288.99"

. $457.80

46710 Repr per/vag pouch sngl

proc C

46712 Repr per/vag pouch dbl

proc C

46715 Rep perf anoper

fistu C

46716 Rep perf anoper/vestib

fistu C

46730 Construction of absent

anus C

46735 Construction of absent

anus C

46740 Construction of absent

anus C

46742 Repair of imperforated

anus C

46744 Repair of cloacal

anomaly C

46746 Repair of cloacal

anomaly C

46748 Repair of cloacal

anomaly C

46750 Repair of anal

sphincter T 0150 32.9730 "$2,288.99"

. $457.80

46751 Repair of anal

sphincter C46753 Reconstruction of

anus T 0149 24.4472 "$1,697.12"

. $339.43

46754 Removal of suture from

anus T 0149 24.4472 "$1,697.12"

. $339.43

46760 Repair of anal

sphincter T 0150 32.9730 "$2,288.99"

. $457.80

46761 Repair of anal

sphincter T 0150 32.9730 "$2,288.99"

. $457.80

46762 Implant artificial

sphincter T 0150 32.9730 "$2,288.99"

. $457.80

46900 Destruction anal

lesion(s) T 0016 2.8248 $196.10

. $39.22

46910 Destruction anal

lesion(s) T 0017 22.0631 "$1,531.62"

. $306.33

46916 Cryosurgery anal

lesion(s) T 0015 1.4936 $103.69

. $20.74

46917 Laser surgery anal

lesions T 0017 22.0631 "$1,531.62"

. $306.33

46922 Excision of anal

lesion(s) T 0017 22.0631 "$1,531.62"

. $306.33

46924 Destruction anal

lesion(s) T 0017 22.0631 "$1,531.62"

. $306.33

46930 Destroy internal

hemorrhoids T 0148 6.1052 $423.82

. $84.77

46940 Treatment of anal

fissure T 0149 24.4472 "$1,697.12"

. $339.43

46942 Treatment of anal

fissure T 0148 6.1052 $423.82

. $84.77

46945 Remove by ligat int hem grp CH

T 0149 24.4472 "$1,697.12"

. $339.43

46946 Remove by ligat int hem grps CH

T 0149 24.4472 "$1,697.12"

. $339.43

46947 Hemorrhoidopexy by

stapling T 0150 32.9730 "$2,288.99"

. $457.8046999 Anus surgery

procedure T 0148 6.1052 $423.82

. $84.77

47000 Needle biopsy of

liver T 0685 9.7281 $675.32

. $135.07

47001 Needle biopsy liver

add-on N

47010 Open drainage liver

lesion C

47011 Percut drain liver

lesion T 0037 15.3594 "$1,066.25" $225.55 $213.25

47015 Inject/aspirate liver

cyst C

47100 Wedge biopsy of

liver C

47120 Partial removal of

liver C

47122 Extensive removal of

liver C

47125 Partial removal of

liver C

47130 Partial removal of

liver C

47133 Removal of donor

liver C

47135 Transplantation of

liver C

47136 Transplantation of

liver C

47140 Partial removal donor

liver C

47141 Partial removal donor

liver C

47142 Partial removal donor

liver C

47143 Prep donor liver

whole C

47144 Prep donor liver

3-segment C

47145 Prep donor liver lobe

split C

47146 Prep donorliver/venous C

47147 Prep donor

liver/arterial C

47300 Surgery for liver

lesion C

47350 Repair liver

wound C

47360 Repair liver

wound C

47361 Repair liver

wound C

47362 Repair liver

wound C

47370 Laparo ablate liver tumor

rf T 0174 107.5115 "$7,463.45" "$1,962.55" "$1,492.69"

47371 Laparo ablate liver

cryosurg T 0174 107.5115 "$7,463.45" "$1,962.55" "$1,492.69"

47379 Laparoscope procedure

liver T 0130 39.0865 "$2,713.38" $659.53 $542.68

47380 Open ablate liver tumor

rf C

47381 Open ablate liver tumor

cryo C

47382 Percut ablate liver

rf T 0423 57.1703 "$3,968.76"

. $793.76

47399 Liver surgery

procedure T 0004 4.5956 $319.03

. $63.81

47400 Incision of liver

duct C

47420 Incision of bile

duct C

47425 Incision of bile

duct C

47460 Incise bile duct

sphincter C

47480 Incision of

gallbladder C

47490 Incision of

gallbladder T 0152 31.2779 "$2,171.31"

. $434.27

47500 Injection for liverx-rays N

47505 Injection for liver

x-rays N

47510 Insert catheter bile

duct T 0152 31.2779 "$2,171.31"

. $434.27

47511 Insert bile duct

drain T 0152 31.2779 "$2,171.31"

. $434.27

47525 Change bile duct

catheter T 0427 16.2153 "$1,125.67"

. $225.14

47530 Revise/reinsert bile

tube T 0427 16.2153 "$1,125.67"

. $225.14

47550 Bile duct endoscopy

add-on C

47552 Biliary endoscopy thru

skin T 0152 31.2779 "$2,171.31"

. $434.27

47553 Biliary endoscopy thru

skin T 0152 31.2779 "$2,171.31"

. $434.27

47554 Biliary endoscopy thru

skin T 0152 31.2779 "$2,171.31"

. $434.27

47555 Biliary endoscopy thru

skin T 0152 31.2779 "$2,171.31"

. $434.27

47556 Biliary endoscopy thru

skin T 0152 31.2779 "$2,171.31"

. $434.27

47560 Laparoscopy

w/cholangio T 0130 39.0865 "$2,713.38" $659.53 $542.68

47561 Laparo

w/cholangio/biopsy T 0130 39.0865 "$2,713.38" $659.53 $542.68

47562 Laparoscopic

cholecystectomy T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

47563 Laparo

cholecystectomy/graph T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

47564 Laparo

cholecystectomy/explr T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

47570 Laparo

cholecystoenterostomy C47579 Laparoscope proc

biliary T 0130 39.0865 "$2,713.38" $659.53 $542.68

47600 Removal of

gallbladder C

47605 Removal of

gallbladder C

47610 Removal of

gallbladder C

47612 Removal of

gallbladder C

47620 Removal of

gallbladder C

47630 Remove bile duct

stone T 0152 31.2779 "$2,171.31"

. $434.27

47700 Exploration of bile

ducts C

47701 Bile duct

revision C

47711 Excision of bile duct

tumor C

47712 Excision of bile duct

tumor C

47715 Excision of bile duct

cyst C

47720 Fuse gallbladder &

bowel C

47721 Fuse upper gi

structures C

47740 Fuse gallbladder &

bowel C

47741 Fuse gallbladder &

bowel C

47760 Fuse bile ducts and

bowel C

47765 Fuse liver ducts &

bowel C

47780 Fuse bile ducts and

bowel C

47785 Fuse bile ducts and

bowel C

47800 Reconstruction of bile

ducts C47801 Placement bile duct

support C

47802 Fuse liver duct &

intestine C

47900 Suture bile duct

injury C

47999 Bile tract surgery

procedure T 0152 31.2779 "$2,171.31"

. $434.27

48000 Drainage of

abdomen C

48001 Placement of drain

pancreas C

48020 Removal of pancreatic

stone C

48100 Biopsy of pancreas

open C

48102 Needle biopsy

pancreas T 0685 9.7281 $675.32

. $135.07

48105 Resect/debride

pancreas C

48120 Removal of pancreas

lesion C

48140 Partial removal of

pancreas C

48145 Partial removal of

pancreas C

48146 Pancreatectomy C

48148 Removal of pancreatic

duct C

48150 Partial removal of

pancreas C

48152 Pancreatectomy C

48153 Pancreatectomy C

48154 Pancreatectomy C

48155 Removal of

pancreas C

48160 Pancreas

removal/transplant E48400 Injection intraop

add-on C

48500 Surgery of pancreatic

cyst C

48510 Drain pancreatic

pseudocyst C

48511 Drain pancreatic

pseudocyst T 0037 15.3594 "$1,066.25" $225.55 $213.25

48520 Fuse pancreas cyst and

bowel C

48540 Fuse pancreas cyst and

bowel C

48545 Pancreatorrhaphy C

48547 Duodenal

exclusion C

48548 Fuse pancreas and

bowel C

48550 Donor

pancreatectomy E

48551 Prep donor

pancreas C

48552 Prep donor

pancreas/venous C

48554 Transpl allograft

pancreas C

48556 Removal allograft

pancreas C

48999 Pancreas surgery

procedure T 0004 4.5956 $319.03

. $63.81

49000 Exploration of

abdomen C

49002 Reopening of

abdomen C

49010 Exploration behind

abdomen C

49020 Drain abdominal

abscess C

49021 Drain abdominal

abscess T 0037 15.3594 "$1,066.25" $225.55 $213.25

49040 Drain open abdom

abscess C49041 Drain percut abdom

abscess T 0037 15.3594 "$1,066.25" $225.55 $213.25

49060 Drain open retrop

abscess C

49061 Drain percut retroper

absc T 0037 15.3594 "$1,066.25" $225.55 $213.25

49062 Drain to peritoneal

cavity C

49080 Puncture peritoneal

cavity T 0070 5.5572 $385.78

. $77.16

49081 Removal of abdominal

fluid T 0070 5.5572 $385.78

. $77.16

49180 Biopsy abdominal

mass T 0685 9.7281 $675.32

. $135.07

49203 Exc abd tum 5 cm or

less C

49204 Exc abd tum over 5

cm C

49205 Exc abd tum over 10

cm C

49215 Excise sacral spine

tumor C

49220 Multiple surgery

abdomen C

49250 Excision of

umbilicus T 0153 26.6476 "$1,849.88" $375.24 $369.98

49255 Removal of

omentum C

49320 Diag laparo separate

proc T 0130 39.0865 "$2,713.38" $659.53 $542.68

49321 Laparoscopy

biopsy T 0130 39.0865 "$2,713.38" $659.53 $542.68

49322 Laparoscopy

aspiration T 0130 39.0865 "$2,713.38" $659.53 $542.68

49323 Laparo drain

lymphocele T 0130 39.0865 "$2,713.38" $659.53 $542.68

49324 Lap insert tunnel ip

cath T 0130 39.0865 "$2,713.38" $659.53 $542.6849325 Lap revision perm ip

cath T 0130 39.0865 "$2,713.38" $659.53 $542.68

49326 Lap w/omentopexy

add-on T 0130 39.0865 "$2,713.38" $659.53 $542.68

49327 Lap ins device for

rt T 0130 39.0865 "$2,713.38" $659.53 $542.68

49329 Laparo proc

abdm/per/oment T 0130 39.0865 "$2,713.38" $659.53 $542.68

49400 Air injection into

abdomen N

49402 Remove foreign body

adbomen T 0153 26.6476 "$1,849.88" $375.24 $369.98

49411 Ins mark abd/pel for rt

perq X 0310 13.2460 $919.54 $322.74 $183.91

49412 Ins device for rt guide open C

49418 Insert tun ip cath

perc T 0652 30.6257 "$2,126.04"

. $425.21

49419 Insert tun ip cath

w/port T 0115 36.8791 "$2,560.15"

. $512.03

49421 Ins tun ip cath for dial

opn T 0652 30.6257 "$2,126.04"

. $425.21

49422 Remove tunneled ip

cath T 0105 23.2424 "$1,613.49"

. $322.70

49423 Exchange drainage

catheter T 0427 16.2153 "$1,125.67"

. $225.14

49424 Assess cyst contrast

inject N

49425 Insert abdomen-venous

drain C

49426 Revise abdomen-venous

shunt T 0153 26.6476 "$1,849.88" $375.24 $369.98

49427 Injection abdominal

shunt N

49428 Ligation ofshunt C

49429 Removal of

shunt T 0105 23.2424 "$1,613.49"

. $322.70

49435 Insert subq exten to ip

cath T 0427 16.2153 "$1,125.67"

. $225.14

49436 Embedded ip cath

exit-site T 0427 16.2153 "$1,125.67"

. $225.14

49440 Place gastrostomy tube

perc CH T 0419 12.5693 $872.56 $204.51 $174.52

49441 Place duod/jej tube

perc CH T 0419 12.5693 $872.56 $204.51 $174.52

49442 Place cecostomy tube

perc CH T 0149 24.4472 "$1,697.12"

. $339.43

49446 Change g-tube to g-j

perc CH T 0419 12.5693 $872.56 $204.51 $174.52

49450 Replace g/c tube

perc T 0121 6.3178 $438.58

. $87.72

49451 Replace duod/jej tube

perc T 0121 6.3178 $438.58

. $87.72

49452 Replace g-j tube

perc T 0121 6.3178 $438.58

. $87.72

49460 Fix g/colon tube

w/device T 0121 6.3178 $438.58

. $87.72

49465 Fluoro exam of g/colon

tube Q1 0277 2.0083 $139.42 $52.93 $27.89

49491 Rpr hern preemie

reduc T 0154 32.9744 "$2,289.08" $464.85 $457.82

49492 Rpr ing hern premie

blocked T 0154 32.9744 "$2,289.08" $464.85 $457.82

49495 Rpr ing hernia baby

reduc T 0154 32.9744 "$2,289.08" $464.85 $457.82

49496 Rpr ing hernia baby

blocked T 0154 32.9744 "$2,289.08" $464.85 $457.8249500 Rpr ing hernia init

reduce T 0154 32.9744 "$2,289.08" $464.85 $457.82

49501 Rpr ing hernia init

blocked T 0154 32.9744 "$2,289.08" $464.85 $457.82

49505 Prp i/hern init reduc >5

yr T 0154 32.9744 "$2,289.08" $464.85 $457.82

49507 Prp i/hern init block >5

yr T 0154 32.9744 "$2,289.08" $464.85 $457.82

49520 Rerepair ing hernia

reduce T 0154 32.9744 "$2,289.08" $464.85 $457.82

49521 Rerepair ing hernia

blocked T 0154 32.9744 "$2,289.08" $464.85 $457.82

49525 Repair ing hernia

sliding T 0154 32.9744 "$2,289.08" $464.85 $457.82

49540 Repair lumbar

hernia T 0154 32.9744 "$2,289.08" $464.85 $457.82

49550 Rpr rem hernia init

reduce T 0154 32.9744 "$2,289.08" $464.85 $457.82

49553 Rpr fem hernia init

blocked T 0154 32.9744 "$2,289.08" $464.85 $457.82

49555 Rerepair fem hernia

reduce T 0154 32.9744 "$2,289.08" $464.85 $457.82

49557 Rerepair fem hernia

blocked T 0154 32.9744 "$2,289.08" $464.85 $457.82

49560 Rpr ventral hern init

reduc T 0154 32.9744 "$2,289.08" $464.85 $457.82

49561 Rpr ventral hern init

block T 0154 32.9744 "$2,289.08" $464.85 $457.82

49565 Rerepair ventrl hern

reduce T 0154 32.9744 "$2,289.08" $464.85 $457.82

49566 Rerepair ventrl hern

block T 0154 32.9744 "$2,289.08" $464.85 $457.82

49568 Hernia repair

w/mesh T 0154 32.9744 "$2,289.08" $464.85 $457.8249570 Rpr epigastric hern

reduce T 0154 32.9744 "$2,289.08" $464.85 $457.82

49572 Rpr epigastric hern

blocked T 0154 32.9744 "$2,289.08" $464.85 $457.82

49580 Rpr umbil hern reduc < 5

yr T 0154 32.9744 "$2,289.08" $464.85 $457.82

49582 Rpr umbil hern block < 5

yr T 0154 32.9744 "$2,289.08" $464.85 $457.82

49585 Rpr umbil hern reduc > 5

yr T 0154 32.9744 "$2,289.08" $464.85 $457.82

49587 Rpr umbil hern block > 5

yr T 0154 32.9744 "$2,289.08" $464.85 $457.82

49590 Repair spigelian

hernia T 0154 32.9744 "$2,289.08" $464.85 $457.82

49600 Repair umbilical

lesion T 0154 32.9744 "$2,289.08" $464.85 $457.82

49605 Repair umbilical

lesion C

49606 Repair umbilical

lesion C

49610 Repair umbilical

lesion C

49611 Repair umbilical

lesion C

49650 Lap ing hernia repair

init T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

49651 Lap ing hernia repair

recur T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

49652 Lap vent/abd hernia

repair T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

49653 Lap vent/abd hern proc

comp T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

49654 Lap inc hernia

repair T 0132 71.0451 "$4,931.95" "$1,236.99" $986.3949655 Lap inc hern repair

comp T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

49656 Lap inc hernia repair

recur T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

49657 Lap inc hern recur

comp T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

49659 Laparo proc hernia

repair T 0130 39.0865 "$2,713.38" $659.53 $542.68

49900 Repair of abdominal

wall C

49904 Omental flap

extra-abdom C

49905 Omental flap

intra-abdom C

49906 Free omental flap

microvasc C

49999 Abdomen surgery

procedure T 0153 26.6476 "$1,849.88" $375.24 $369.98

50010 Exploration of

kidney C

50020 Renal abscess open

drain T 0162 26.2690 "$1,823.59"

. $364.72

50021 Renal abscess percut

drain T 0037 15.3594 "$1,066.25" $225.55 $213.25

50040 Drainage of

kidney C

50045 Exploration of

kidney C

50060 Removal of kidney

stone C

50065 Incision of

kidney C

50070 Incision of

kidney C

50075 Removal of kidney

stone C

50080 Removal of kidney

stone T 0429 45.8647 "$3,183.93"

. $636.79

50081 Removal of kidneystone T 0429 45.8647 "$3,183.93"

. $636.79

50100 Revise kidney blood

vessels C

50120 Exploration of

kidney C

50125 Explore and drain

kidney C

50130 Removal of kidney

stone C

50135 Exploration of

kidney C

50200 Renal biopsy

perq T 0685 9.7281 $675.32

. $135.07

50205 Renal biopsy

open C

50220 Remove kidney

open C

50225 Removal kidney open

complex C

50230 Removal kidney open

radical C

50234 Removal of kidney &

ureter C

50236 Removal of kidney &

ureter C

50240 Partial removal of

kidney C

50250 Cryoablate renal mass

open C

50280 Removal of kidney

lesion C

50290 Removal of kidney

lesion C

50300 Remove cadaver donor

kidney C

50320 Remove kidney living

donor C

50323 Prep cadaver renal

allograft C

50325 Prep donor renal

graft C

50327 Prep renal

graft/venous C50328 Prep renal

graft/arterial C

50329 Prep renal

graft/ureteral C

50340 Removal of

kidney C

50360 Transplantation of

kidney C

50365 Transplantation of

kidney C

50370 Remove transplanted

kidney C

50380 Reimplantation of

kidney C

50382 Change ureter stent

percut T 0162 26.2690 "$1,823.59"

. $364.72

50384 Remove ureter stent

percut T 0161 17.6738 "$1,226.92"

. $245.39

50385 Change stent via

transureth T 0162 26.2690 "$1,823.59"

. $364.72

50386 Remove stent via

transureth T 0160 7.3594 $510.89

. $102.18

50387 Change ext/int ureter

stent T 0427 16.2153 "$1,125.67"

. $225.14

50389 Remove renal tube

w/fluoro T 0160 7.3594 $510.89

. $102.18

50390 Drainage of kidney

lesion T 0685 9.7281 $675.32

. $135.07

50391 Instll rx agnt into rnal

tub T 0126 1.1699 $81.21

. $16.25

50392 Insert kidney

drain T 0161 17.6738 "$1,226.92"

. $245.39

50393 Insert ureteral

tube T 0162 26.2690 "$1,823.59"

. $364.72

50394 Injection for kidney

x-ray N

50395 Create passage tokidney T 0162 26.2690 "$1,823.59"

. $364.72

50396 Measure kidney

pressure T 0164 2.0973 $145.59

. $29.12

50398 Change kidney

tube T 0427 16.2153 "$1,125.67"

. $225.14

50400 Revision of

kidney/ureter C

50405 Revision of

kidney/ureter C

50500 Repair of kidney

wound C

50520 Close kidney-skin

fistula C

50525 Repair renal-abdomen

fistula C

50526 Repair renal-abdomen

fistula C

50540 Revision of horseshoe

kidney C

50541 Laparo ablate renal

cyst T 0130 39.0865 "$2,713.38" $659.53 $542.68

50542 Laparo ablate renal

mass T 0174 107.5115 "$7,463.45" "$1,962.55" "$1,492.69"

50543 Laparo partial

nephrectomy T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

50544 Laparoscopy pyeloplasty CH

T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

50545 Laparo radical

nephrectomy C

50546 Laparoscopic

nephrectomy C

50547 Laparo removal donor

kidney C

50548 Laparo remove

w/ureter C

50549 Laparoscope proc

renal T 0130 39.0865 "$2,713.38" $659.53 $542.68

50551 Kidney

endoscopy T 0160 7.3594 $510.89

. $102.1850553 Kidney

endoscopy T 0162 26.2690 "$1,823.59"

. $364.72

50555 Kidney endoscopy &

biopsy T 0160 7.3594 $510.89

. $102.18

50557 Kidney endoscopy &

treatment T 0162 26.2690 "$1,823.59"

. $364.72

50561 Kidney endoscopy &

treatment T 0162 26.2690 "$1,823.59"

. $364.72

50562 Renal scope w/tumor

resect T 0160 7.3594 $510.89

. $102.18

50570 Kidney

endoscopy T 0160 7.3594 $510.89

. $102.18

50572 Kidney

endoscopy T 0160 7.3594 $510.89

. $102.18

50574 Kidney endoscopy &

biopsy T 0160 7.3594 $510.89

. $102.18

50575 Kidney

endoscopy T 0163 36.9605 "$2,565.80"

. $513.16

50576 Kidney endoscopy &

treatment T 0161 17.6738 "$1,226.92"

. $245.39

50580 Kidney endoscopy &

treatment T 0161 17.6738 "$1,226.92"

. $245.39

50590 Fragmenting of kidney

stone T 0169 51.4038 "$3,568.45" $997.74 $713.69

50592 Perc rf ablate renal

tumor T 0423 57.1703 "$3,968.76"

. $793.76

50593 Perc cryo ablate renal

tum T 0423 57.1703 "$3,968.76"

. $793.76

50600 Exploration of

ureter C

50605 Insert ureteral

support C

50610 Removal of ureter

stone C50620 Removal of ureter

stone C

50630 Removal of ureter

stone C

50650 Removal of

ureter C

50660 Removal of

ureter C

50684 Injection for ureter

x-ray N

50686 Measure ureter

pressure T 0126 1.1699 $81.21

. $16.25

50688 Change of ureter

tube/stent T 0427 16.2153 "$1,125.67"

. $225.14

50690 Injection for ureter

x-ray N

50700 Revision of

ureter C

50715 Release of

ureter C

50722 Release of

ureter C

50725 Release/revise

ureter C

50727 Revise

ureter T 0165 20.1960 "$1,402.01"

. $280.41

50728 Revise

ureter C

50740 Fusion of ureter &

kidney C

50750 Fusion of ureter &

kidney C

50760 Fusion of

ureters C

50770 Splicing of

ureters C

50780 Reimplant ureter in

bladder C

50782 Reimplant ureter in

bladder C

50783 Reimplant ureter in

bladder C50785 Reimplant ureter in

bladder C

50800 Implant ureter in

bowel C

50810 Fusion of ureter &

bowel C

50815 Urine shunt to

intestine C

50820 Construct bowel

bladder C

50825 Construct bowel

bladder C

50830 Revise urine

flow C

50840 Replace ureter by

bowel C

50845 Appendico-vesicostomy C

50860 Transplant ureter to

skin C

50900 Repair of

ureter C

50920 Closure ureter/skin

fistula C

50930 Closure ureter/bowel

fistula C

50940 Release of

ureter C

50945 Laparoscopy

ureterolithotomy T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

50947 Laparo new

ureter/bladder T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

50948 Laparo new

ureter/bladder T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

50949 Laparoscope proc

ureter T 0130 39.0865 "$2,713.38" $659.53 $542.68

50951 Endoscopy of

ureter T 0160 7.3594 $510.89

. $102.18

50953 Endoscopy of

ureter T 0160 7.3594 $510.89

. $102.1850955 Ureter endoscopy &

biopsy T 0162 26.2690 "$1,823.59"

. $364.72

50957 Ureter endoscopy &

treatment T 0162 26.2690 "$1,823.59"

. $364.72

50961 Ureter endoscopy &

treatment T 0162 26.2690 "$1,823.59"

. $364.72

50970 Ureter

endoscopy T 0160 7.3594 $510.89

. $102.18

50972 Ureter endoscopy &

catheter T 0160 7.3594 $510.89

. $102.18

50974 Ureter endoscopy &

biopsy T 0161 17.6738 "$1,226.92"

. $245.39

50976 Ureter endoscopy &

treatment T 0161 17.6738 "$1,226.92"

. $245.39

50980 Ureter endoscopy &

treatment T 0162 26.2690 "$1,823.59"

. $364.72

51020 Incise & treat

bladder T 0162 26.2690 "$1,823.59"

. $364.72

51030 Incise & treat

bladder T 0162 26.2690 "$1,823.59"

. $364.72

51040 Incise & drain

bladder T 0162 26.2690 "$1,823.59"

. $364.72

51045 Incise bladder/drain

ureter T 0160 7.3594 $510.89

. $102.18

51050 Removal of bladder

stone T 0162 26.2690 "$1,823.59"

. $364.72

51060 Removal of ureter

stone T 0163 36.9605 "$2,565.80"

. $513.16

51065 Remove ureter

calculus T 0162 26.2690 "$1,823.59"

. $364.72

51080 Drainage of bladder

abscess T 0008 20.5401 "$1,425.89"

. $285.18

51100 Drain bladder byneedle T 0164 2.0973 $145.59

. $29.12

51101 Drain bladder by

trocar/cath T 0126 1.1699 $81.21

. $16.25

51102 Drain bl w/cath

insertion T 0165 20.1960 "$1,402.01"

. $280.41

51500 Removal of bladder

cyst T 0154 32.9744 "$2,289.08" $464.85 $457.82

51520 Removal of bladder

lesion T 0162 26.2690 "$1,823.59"

. $364.72

51525 Removal of bladder

lesion C

51530 Removal of bladder

lesion C

51535 Repair of ureter

lesion T 0162 26.2690 "$1,823.59"

. $364.72

51550 Partial removal of

bladder C

51555 Partial removal of

bladder C

51565 Revise bladder &

ureter(s) C

51570 Removal of

bladder C

51575 Removal of bladder &

nodes C

51580 Remove bladder/revise

tract C

51585 Removal of bladder &

nodes C

51590 Remove bladder/revise

tract C

51595 Remove bladder/revise

tract C

51596 Remove bladder/create

pouch C

51597 Removal of pelvic

structures C

51600 Injection for bladder

x-ray N

51605 Preparation for bladderxray N

51610 Injection for bladder

x-ray N

51700 Irrigation of

bladder T 0164 2.0973 $145.59

. $29.12

51701 Insert bladder

catheter X 0340 0.6739 $46.78

. $9.36

51702 Insert temp bladder

cath X 0340 0.6739 $46.78

. $9.36

51703 Insert bladder cath

complex T 0126 1.1699 $81.21

. $16.25

51705 Change of bladder

tube T 0164 2.0973 $145.59

. $29.12

51710 Change of bladder

tube T 0121 6.3178 $438.58

. $87.72

51715 Endoscopic

injection/implant T 0168 32.1043 "$2,228.68"

. $445.74

51720 Treatment of bladder

lesion T 0156 3.1976 $221.98

. $44.40

51725 Simple

cystometrogram T 0156 3.1976 $221.98

. $44.40

51726 Complex

cystometrogram T 0156 3.1976 $221.98

. $44.40

51727 Cystometrogram

w/up T 0156 3.1976 $221.98

. $44.40

51728 Cystometrogram

w/vp T 0156 3.1976 $221.98

. $44.40

51729 Cystometrogram

w/vp&up T 0156 3.1976 $221.98

. $44.40

51736 Urine flow

measurement X 0340 0.6739 $46.78

. $9.36

51741 Electro-uroflowmetry

first T 0126 1.1699 $81.21

. $16.25

51784 Anal/urinary musclestudy T 0126 1.1699 $81.21

. $16.25

51785 Anal/urinary muscle

study T 0164 2.0973 $145.59

. $29.12

51792 Urinary reflex

study T 0126 1.1699 $81.21

. $16.25

51797 Intraabdominal pressure

test T 0164 2.0973 $145.59

. $29.12

51798 Us urine capacity

measure X 0340 0.6739 $46.78

. $9.36

51800 Revision of

bladder/urethra C

51820 Revision of urinary

tract C

51840 Attach

bladder/urethra C

51841 Attach

bladder/urethra C

51845 Repair bladder

neck T 0202 45.5816 "$3,164.27" $981.50 $632.86

51860 Repair of bladder

wound T 0162 26.2690 "$1,823.59"

. $364.72

51865 Repair of bladder

wound C

51880 Repair of bladder

opening T 0162 26.2690 "$1,823.59"

. $364.72

51900 Repair bladder/vagina

lesion C

51920 Close bladder-uterus

fistula C

51925 Hysterectomy/bladder

repair C

51940 Correction of bladder

defect C

51960 Revision of bladder &

bowel C

51980 Construct bladder

opening C

51990 Laparo urethral

suspension T 0131 47.7164 "$3,312.47" "$1,001.89" $662.5051992 Laparo sling

operation T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

51999 Laparoscope proc

bla T 0130 39.0865 "$2,713.38" $659.53 $542.68

52000 Cystoscopy T 0160 7.3594 $510.89

. $102.18

52001 Cystoscopy removal of

clots T 0161 17.6738 "$1,226.92"

. $245.39

52005 Cystoscopy & ureter

catheter T 0162 26.2690 "$1,823.59"

. $364.72

52007 Cystoscopy and

biopsy T 0162 26.2690 "$1,823.59"

. $364.72

52010 Cystoscopy & duct

catheter T 0160 7.3594 $510.89

. $102.18

52204 Cystoscopy

w/biopsy(s) T 0162 26.2690 "$1,823.59"

. $364.72

52214 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.72

52224 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.72

52234 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.72

52235 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.72

52240 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.72

52250 Cystoscopy and

radiotracer T 0162 26.2690 "$1,823.59"

. $364.72

52260 Cystoscopy and

treatment T 0161 17.6738 "$1,226.92"

. $245.39

52265 Cystoscopy and

treatment T 0160 7.3594 $510.89

. $102.18

52270 Cystoscopy & reviseurethra T 0161 17.6738 "$1,226.92"

. $245.39

52275 Cystoscopy & revise

urethra T 0162 26.2690 "$1,823.59"

. $364.72

52276 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.72

52277 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.72

52281 Cystoscopy and

treatment T 0161 17.6738 "$1,226.92"

. $245.39

52282 Cystoscopy implant

stent T 0163 36.9605 "$2,565.80"

. $513.16

52283 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.72

52285 Cystoscopy and

treatment T 0161 17.6738 "$1,226.92"

. $245.39

52290 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.72

52300 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.72

52301 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.72

52305 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.72

52310 Cystoscopy and

treatment T 0161 17.6738 "$1,226.92"

. $245.39

52315 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.72

52317 Remove bladder

stone T 0162 26.2690 "$1,823.59"

. $364.72

52318 Remove bladder

stone T 0162 26.2690 "$1,823.59"

. $364.72

52320 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.7252325 Cystoscopy stone

removal T 0162 26.2690 "$1,823.59"

. $364.72

52327 Cystoscopy inject

material T 0163 36.9605 "$2,565.80"

. $513.16

52330 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.72

52332 Cystoscopy and

treatment T 0162 26.2690 "$1,823.59"

. $364.72

52334 Create passage to

kidney T 0162 26.2690 "$1,823.59"

. $364.72

52341 Cysto w/ureter stricture

tx T 0162 26.2690 "$1,823.59"

. $364.72

52342 Cysto w/up stricture

tx T 0162 26.2690 "$1,823.59"

. $364.72

52343 Cysto w/renal stricture

tx T 0162 26.2690 "$1,823.59"

. $364.72

52344 Cysto/uretero stricture

tx T 0162 26.2690 "$1,823.59"

. $364.72

52345 Cysto/uretero w/up

stricture T 0162 26.2690 "$1,823.59"

. $364.72

52346 Cystouretero w/renal

strict T 0162 26.2690 "$1,823.59"

. $364.72

52351 Cystouretero & or

pyeloscope T 0162 26.2690 "$1,823.59"

. $364.72

52352 Cystouretero w/stone

remove T 0162 26.2690 "$1,823.59"

. $364.72

52353 Cystouretero

w/lithotripsy T 0163 36.9605 "$2,565.80"

. $513.16

52354 Cystouretero

w/biopsy T 0162 26.2690 "$1,823.59"

. $364.72

52355 Cystouretero w/excise

tumor T 0162 26.2690 "$1,823.59"

. $364.72

52400 Cystouretero w/congenrepr T 0162 26.2690 "$1,823.59"

. $364.72

52402 Cystourethro cut ejacul

duct T 0162 26.2690 "$1,823.59"

. $364.72

52450 Incision of

prostate T 0162 26.2690 "$1,823.59"

. $364.72

52500 Revision of bladder

neck T 0162 26.2690 "$1,823.59"

. $364.72

52601 Prostatectomy

(TURP) T 0163 36.9605 "$2,565.80"

. $513.16

52630 Remove prostate

regrowth T 0163 36.9605 "$2,565.80"

. $513.16

52640 Relieve bladder

contracture T 0162 26.2690 "$1,823.59"

. $364.72

52647 Laser surgery of

prostate T 0429 45.8647 "$3,183.93"

. $636.79

52648 Laser surgery of

prostate T 0429 45.8647 "$3,183.93"

. $636.79

52649 Prostate laser

enucleation T 0429 45.8647 "$3,183.93"

. $636.79

52700 Drainage of prostate

abscess T 0162 26.2690 "$1,823.59"

. $364.72

53000 Incision of

urethra T 0166 20.7987 "$1,443.85"

. $288.77

53010 Incision of

urethra T 0166 20.7987 "$1,443.85"

. $288.77

53020 Incision of

urethra T 0166 20.7987 "$1,443.85"

. $288.77

53025 Incision of

urethra T 0166 20.7987 "$1,443.85"

. $288.77

53040 Drainage of urethra

abscess T 0166 20.7987 "$1,443.85"

. $288.77

53060 Drainage of urethra

abscess T 0166 20.7987 "$1,443.85"

. $288.7753080 Drainage of urinary

leakage T 0166 20.7987 "$1,443.85"

. $288.77

53085 Drainage of urinary

leakage T 0166 20.7987 "$1,443.85"

. $288.77

53200 Biopsy of

urethra T 0166 20.7987 "$1,443.85"

. $288.77

53210 Removal of

urethra T 0168 32.1043 "$2,228.68"

. $445.74

53215 Removal of

urethra T 0166 20.7987 "$1,443.85"

. $288.77

53220 Treatment of urethra

lesion T 0168 32.1043 "$2,228.68"

. $445.74

53230 Removal of urethra

lesion T 0168 32.1043 "$2,228.68"

. $445.74

53235 Removal of urethra

lesion T 0166 20.7987 "$1,443.85"

. $288.77

53240 Surgery for urethra

pouch T 0168 32.1043 "$2,228.68"

. $445.74

53250 Removal of urethra

gland T 0166 20.7987 "$1,443.85"

. $288.77

53260 Treatment of urethra

lesion T 0166 20.7987 "$1,443.85"

. $288.77

53265 Treatment of urethra

lesion T 0166 20.7987 "$1,443.85"

. $288.77

53270 Removal of urethra

gland T 0166 20.7987 "$1,443.85"

. $288.77

53275 Repair of urethra

defect T 0166 20.7987 "$1,443.85"

. $288.77

53400 Revise urethra stage

1 T 0168 32.1043 "$2,228.68"

. $445.74

53405 Revise urethra stage

2 T 0168 32.1043 "$2,228.68"

. $445.74

53410 Reconstruction ofurethra T 0168 32.1043 "$2,228.68"

. $445.74

53415 Reconstruction of

urethra C

53420 Reconstruct urethra stage

1 T 0168 32.1043 "$2,228.68"

. $445.74

53425 Reconstruct urethra stage

2 T 0168 32.1043 "$2,228.68"

. $445.74

53430 Reconstruction of

urethra T 0168 32.1043 "$2,228.68"

. $445.74

53431 Reconstruct

urethra/bladder T 0168 32.1043 "$2,228.68"

. $445.74

53440 Male sling

procedure S 0385 103.8680 "$7,210.52"

. "$1,442.11"

53442 Remove/revise male

sling T 0168 32.1043 "$2,228.68"

. $445.74

53444 Insert tandem

cuff S 0385 103.8680 "$7,210.52"

. "$1,442.11"

53445 Insert uro/ves nck

sphincter S 0386 168.5335 "$11,699.60"

. "$2,339.92"

53446 Remove uro

sphincter T 0168 32.1043 "$2,228.68"

. $445.74

53447 Remove/replace ur

sphincter S 0386 168.5335 "$11,699.60"

. "$2,339.92"

53448 Remov/replc ur sphinctr

comp C

53449 Repair uro

sphincter T 0168 32.1043 "$2,228.68"

. $445.74

53450 Revision of

urethra T 0168 32.1043 "$2,228.68"

. $445.74

53460 Revision of

urethra T 0166 20.7987 "$1,443.85"

. $288.77

53500 Urethrlys transvag w/

scope T 0168 32.1043 "$2,228.68"

. $445.74

53502 Repair of urethrainjury T 0166 20.7987 "$1,443.85"

. $288.77

53505 Repair of urethra

injury T 0168 32.1043 "$2,228.68"

. $445.74

53510 Repair of urethra

injury T 0166 20.7987 "$1,443.85"

. $288.77

53515 Repair of urethra

injury T 0168 32.1043 "$2,228.68"

. $445.74

53520 Repair of urethra

defect T 0168 32.1043 "$2,228.68"

. $445.74

53600 Dilate urethra

stricture T 0156 3.1976 $221.98

. $44.40

53601 Dilate urethra

stricture T 0126 1.1699 $81.21

. $16.25

53605 Dilate urethra

stricture T 0161 17.6738 "$1,226.92"

. $245.39

53620 Dilate urethra

stricture T 0165 20.1960 "$1,402.01"

. $280.41

53621 Dilate urethra

stricture T 0164 2.0973 $145.59

. $29.12

53660 Dilation of

urethra T 0126 1.1699 $81.21

. $16.25

53661 Dilation of

urethra T 0126 1.1699 $81.21

. $16.25

53665 Dilation of

urethra T 0166 20.7987 "$1,443.85"

. $288.77

53850 Prostatic microwave

thermotx T 0429 45.8647 "$3,183.93"

. $636.79

53852 Prostatic rf

thermotx T 0429 45.8647 "$3,183.93"

. $636.79

53855 Insert prost urethral

stent T 0164 2.0973 $145.59

. $29.12

53860 Transurethral rf

treatment T 0165 20.1960 "$1,402.01"

. $280.4153899 Urology surgery

procedure T 0126 1.1699 $81.21

. $16.25

54000 Slitting of

prepuce T 0166 20.7987 "$1,443.85"

. $288.77

54001 Slitting of

prepuce T 0166 20.7987 "$1,443.85"

. $288.77

54015 Drain penis

lesion T 0008 20.5401 "$1,425.89"

. $285.18

54050 Destruction penis

lesion(s) T 0013 0.9786 $67.93

. $13.59

54055 Destruction penis

lesion(s) T 0017 22.0631 "$1,531.62"

. $306.33

54056 Cryosurgery penis

lesion(s) T 0013 0.9786 $67.93

. $13.59

54057 Laser surg penis

lesion(s) T 0017 22.0631 "$1,531.62"

. $306.33

54060 Excision of penis

lesion(s) T 0017 22.0631 "$1,531.62"

. $306.33

54065 Destruction penis

lesion(s) T 0017 22.0631 "$1,531.62"

. $306.33

54100 Biopsy of

penis T 0021 17.1909 "$1,193.39"

. $238.68

54105 Biopsy of

penis T 0022 23.4169 "$1,625.60" $350.05 $325.12

54110 Treatment of penis

lesion T 0181 34.3803 "$2,386.68" $598.48 $477.34

54111 Treat penis lesion

graft T 0181 34.3803 "$2,386.68" $598.48 $477.34

54112 Treat penis lesion

graft T 0181 34.3803 "$2,386.68" $598.48 $477.34

54115 Treatment of penis

lesion T 0008 20.5401 "$1,425.89"

. $285.18

54120 Partial removal ofpenis T 0181 34.3803 "$2,386.68" $598.48 $477.34

54125 Removal of

penis C

54130 Remove penis &

nodes C

54135 Remove penis &

nodes C

54150 Circumcision w/regionl

block T 0183 23.7235 "$1,646.89"

. $329.38

54160 Circumcision

neonate T 0183 23.7235 "$1,646.89"

. $329.38

54161 Circum 28 days or

older T 0183 23.7235 "$1,646.89"

. $329.38

54162 Lysis penil circumic

lesion T 0183 23.7235 "$1,646.89"

. $329.38

54163 Repair of

circumcision T 0183 23.7235 "$1,646.89"

. $329.38

54164 Frenulotomy of

penis T 0183 23.7235 "$1,646.89"

. $329.38

54200 Treatment of penis

lesion T 0164 2.0973 $145.59

. $29.12

54205 Treatment of penis

lesion T 0181 34.3803 "$2,386.68" $598.48 $477.34

54220 Treatment of penis

lesion T 0164 2.0973 $145.59

. $29.12

54230 Prepare penis

study N

54231 Dynamic

cavernosometry T 0165 20.1960 "$1,402.01"

. $280.41

54235 Penile

injection CH T 0164 2.0973 $145.59

. $29.12

54240 Penis

study T 0126 1.1699 $81.21

. $16.25

54250 Penis

study T 0164 2.0973 $145.59

. $29.1254300 Revision of

penis T 0181 34.3803 "$2,386.68" $598.48 $477.34

54304 Revision of

penis T 0181 34.3803 "$2,386.68" $598.48 $477.34

54308 Reconstruction of

urethra T 0181 34.3803 "$2,386.68" $598.48 $477.34

54312 Reconstruction of

urethra T 0181 34.3803 "$2,386.68" $598.48 $477.34

54316 Reconstruction of

urethra T 0181 34.3803 "$2,386.68" $598.48 $477.34

54318 Reconstruction of

urethra T 0181 34.3803 "$2,386.68" $598.48 $477.34

54322 Reconstruction of

urethra T 0181 34.3803 "$2,386.68" $598.48 $477.34

54324 Reconstruction of

urethra T 0181 34.3803 "$2,386.68" $598.48 $477.34

54326 Reconstruction of

urethra T 0181 34.3803 "$2,386.68" $598.48 $477.34

54328 Revise

penis/urethra T 0181 34.3803 "$2,386.68" $598.48 $477.34

54332 Revise

penis/urethra T 0181 34.3803 "$2,386.68" $598.48 $477.34

54336 Revise

penis/urethra T 0181 34.3803 "$2,386.68" $598.48 $477.34

54340 Secondary urethral

surgery T 0181 34.3803 "$2,386.68" $598.48 $477.34

54344 Secondary urethral

surgery T 0181 34.3803 "$2,386.68" $598.48 $477.34

54348 Secondary urethral

surgery T 0181 34.3803 "$2,386.68" $598.48 $477.34

54352 Reconstruct

urethra/penis T 0181 34.3803 "$2,386.68" $598.48 $477.34

54360 Penis plasticsurgery T 0181 34.3803 "$2,386.68" $598.48 $477.34

54380 Repair

penis T 0181 34.3803 "$2,386.68" $598.48 $477.34

54385 Repair

penis T 0181 34.3803 "$2,386.68" $598.48 $477.34

54390 Repair penis and

bladder C

54400 Insert semi-rigid

prosthesis S 0385 103.8680 "$7,210.52"

. "$1,442.11"

54401 Insert self-contd

prosthesis S 0386 168.5335 "$11,699.60"

. "$2,339.92"

54405 Insert multi-comp penis

pros S 0386 168.5335 "$11,699.60"

. "$2,339.92"

54406 Remove muti-comp penis

pros T 0181 34.3803 "$2,386.68" $598.48 $477.34

54408 Repair multi-comp penis

pros T 0181 34.3803 "$2,386.68" $598.48 $477.34

54410 Remove/replace penis

prosth S 0386 168.5335 "$11,699.60"

. "$2,339.92"

54411 Remov/replc penis pros

comp C

54415 Remove self-contd penis

pros T 0181 34.3803 "$2,386.68" $598.48 $477.34

54416 Remv/repl penis contain

pros S 0386 168.5335 "$11,699.60"

. "$2,339.92"

54417 Remv/replc penis pros

compl C

54420 Revision of

penis T 0181 34.3803 "$2,386.68" $598.48 $477.34

54430 Revision of

penis C

54435 Revision of

penis T 0181 34.3803 "$2,386.68" $598.48 $477.34

54440 Repair of

penis T 0181 34.3803 "$2,386.68" $598.48 $477.3454450 Preputial

stretching T 0156 3.1976 $221.98

. $44.40

54500 Biopsy of

testis T 0037 15.3594 "$1,066.25" $225.55 $213.25

54505 Biopsy of

testis T 0183 23.7235 "$1,646.89"

. $329.38

54512 Excise lesion

testis T 0183 23.7235 "$1,646.89"

. $329.38

54520 Removal of

testis T 0183 23.7235 "$1,646.89"

. $329.38

54522 Orchiectomy

partial T 0183 23.7235 "$1,646.89"

. $329.38

54530 Removal of

testis T 0154 32.9744 "$2,289.08" $464.85 $457.82

54535 Extensive testis

surgery T 0181 34.3803 "$2,386.68" $598.48 $477.34

54550 Exploration for

testis T 0154 32.9744 "$2,289.08" $464.85 $457.82

54560 Exploration for

testis T 0183 23.7235 "$1,646.89"

. $329.38

54600 Reduce testis

torsion T 0183 23.7235 "$1,646.89"

. $329.38

54620 Suspension of

testis T 0183 23.7235 "$1,646.89"

. $329.38

54640 Suspension of

testis T 0154 32.9744 "$2,289.08" $464.85 $457.82

54650 Orchiopexy

(Fowler-Stephens) CH T 0154 32.9744 "$2,289.08" $464.85 $457.82

54660 Revision of

testis T 0183 23.7235 "$1,646.89"

. $329.38

54670 Repair testis

injury T 0183 23.7235 "$1,646.89"

. $329.38

54680 Relocation oftestis(es) T 0183 23.7235 "$1,646.89"

. $329.38

54690 Laparoscopy

orchiectomy T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

54692 Laparoscopy

orchiopexy T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

54699 Laparoscope proc

testis T 0130 39.0865 "$2,713.38" $659.53 $542.68

54700 Drainage of

scrotum T 0183 23.7235 "$1,646.89"

. $329.38

54800 Biopsy of

epididymis T 0004 4.5956 $319.03

. $63.81

54830 Remove epididymis

lesion T 0183 23.7235 "$1,646.89"

. $329.38

54840 Remove epididymis

lesion T 0183 23.7235 "$1,646.89"

. $329.38

54860 Removal of

epididymis T 0183 23.7235 "$1,646.89"

. $329.38

54861 Removal of

epididymis T 0183 23.7235 "$1,646.89"

. $329.38

54865 Explore

epididymis T 0183 23.7235 "$1,646.89"

. $329.38

54900 Fusion of spermatic

ducts T 0183 23.7235 "$1,646.89"

. $329.38

54901 Fusion of spermatic

ducts T 0183 23.7235 "$1,646.89"

. $329.38

55000 Drainage of

hydrocele T 0004 4.5956 $319.03

. $63.81

55040 Removal of

hydrocele T 0154 32.9744 "$2,289.08" $464.85 $457.82

55041 Removal of

hydroceles T 0154 32.9744 "$2,289.08" $464.85 $457.82

55060 Repair of

hydrocele T 0183 23.7235 "$1,646.89"

. $329.3855100 Drainage of scrotum

abscess T 0007 13.4779 $935.64

. $187.13

55110 Explore

scrotum T 0183 23.7235 "$1,646.89"

. $329.38

55120 Removal of scrotum

lesion T 0183 23.7235 "$1,646.89"

. $329.38

55150 Removal of

scrotum T 0183 23.7235 "$1,646.89"

. $329.38

55175 Revision of

scrotum T 0183 23.7235 "$1,646.89"

. $329.38

55180 Revision of

scrotum T 0183 23.7235 "$1,646.89"

. $329.38

55200 Incision of sperm

duct T 0183 23.7235 "$1,646.89"

. $329.38

55250 Removal of sperm

duct(s) T 0183 23.7235 "$1,646.89"

. $329.38

55300 Prepare sperm duct

x-ray N

55400 Repair of sperm

duct T 0183 23.7235 "$1,646.89"

. $329.38

55450 Ligation of sperm

duct T 0183 23.7235 "$1,646.89"

. $329.38

55500 Removal of

hydrocele T 0183 23.7235 "$1,646.89"

. $329.38

55520 Removal of sperm cord

lesion T 0183 23.7235 "$1,646.89"

. $329.38

55530 Revise spermatic cord

veins T 0183 23.7235 "$1,646.89"

. $329.38

55535 Revise spermatic cord

veins T 0154 32.9744 "$2,289.08" $464.85 $457.82

55540 Revise hernia & sperm

veins T 0154 32.9744 "$2,289.08" $464.85 $457.82

55550 Laparo ligate spermatic

vein T 0131 47.7164 "$3,312.47" "$1,001.89" $662.5055559 Laparo proc spermatic

cord T 0130 39.0865 "$2,713.38" $659.53 $542.68

55600 Incise sperm duct

pouch T 0183 23.7235 "$1,646.89"

. $329.38

55605 Incise sperm duct

pouch C

55650 Remove sperm duct

pouch C

55680 Remove sperm pouch

lesion T 0183 23.7235 "$1,646.89"

. $329.38

55700 Biopsy of

prostate T 0184 14.2476 $989.07

. $197.82

55705 Biopsy of

prostate T 0184 14.2476 $989.07

. $197.82

55706 Prostate saturation

sampling T 0184 14.2476 $989.07

. $197.82

55720 Drainage of prostate

abscess T 0162 26.2690 "$1,823.59"

. $364.72

55725 Drainage of prostate

abscess T 0162 26.2690 "$1,823.59"

. $364.72

55801 Removal of

prostate C

55810 Extensive prostate

surgery C

55812 Extensive prostate

surgery C

55815 Extensive prostate

surgery C

55821 Removal of

prostate C

55831 Removal of

prostate C

55840 Extensive prostate

surgery C

55842 Extensive prostate

surgery C

55845 Extensive prostate

surgery C55860 Surgical exposure

prostate T 0165 20.1960 "$1,402.01"

. $280.41

55862 Extensive prostate

surgery C

55865 Extensive prostate

surgery C

55866 Laparo radical

prostatectomy C

55870 Electroejaculation T 0189 3.6121 $250.75

. $50.15

55873 Cryoablate

prostate T 0674 111.0864 "$7,711.62"

. "$1,542.33"

55875 Transperi needle place

pros Q3 0163 36.9605 "$2,565.80"

. $513.16

55876 Place rt device/marker pros X

0310 13.2460 $919.54 $322.74 $183.91

55899 Genital surgery

procedure T 0126 1.1699 $81.21

. $16.25

55920 Place needles pelvic for

rt T 0153 26.6476 "$1,849.88" $375.24 $369.98

55970 Sex transformation m to

f E

55980 Sex transformation f to

m E

56405 I & D of

vulva/perineum T 0188 1.6099 $111.76

. $22.36

56420 Drainage of gland

abscess T 0188 1.6099 $111.76

. $22.36

56440 Surgery for vulva

lesion T 0193 20.7771 "$1,442.35"

. $288.47

56441 Lysis of labial

lesion(s) T 0193 20.7771 "$1,442.35"

. $288.47

56442 Hymenotomy T 0193 20.7771 "$1,442.35"

. $288.47

56501 Destroy vulva lesions

sim T 0017 22.0631 "$1,531.62"

. $306.3356515 Destroy vulva lesion/s

compl T 0017 22.0631 "$1,531.62"

. $306.33

56605 Biopsy of

vulva/perineum T 0189 3.6121 $250.75

. $50.15

56606 Biopsy of

vulva/perineum T 0188 1.6099 $111.76

. $22.36

56620 Partial removal of

vulva T 0193 20.7771 "$1,442.35"

. $288.47

56625 Complete removal of

vulva T 0193 20.7771 "$1,442.35"

. $288.47

56630 Extensive vulva

surgery C

56631 Extensive vulva

surgery C

56632 Extensive vulva

surgery C

56633 Extensive vulva

surgery C

56634 Extensive vulva

surgery C

56637 Extensive vulva

surgery C

56640 Extensive vulva

surgery C

56700 Partial removal of

hymen T 0193 20.7771 "$1,442.35"

. $288.47

56740 Remove vagina gland

lesion T 0193 20.7771 "$1,442.35"

. $288.47

56800 Repair of

vagina T 0193 20.7771 "$1,442.35"

. $288.47

56805 Repair

clitoris T 0193 20.7771 "$1,442.35"

. $288.47

56810 Repair of

perineum T 0193 20.7771 "$1,442.35"

. $288.47

56820 Exam of vulva

w/scope T 0188 1.6099 $111.76

. $22.36

56821 Exam/biopsy of vulvaw/scope T 0188 1.6099 $111.76

. $22.36

57000 Exploration of

vagina T 0193 20.7771 "$1,442.35"

. $288.47

57010 Drainage of pelvic

abscess T 0193 20.7771 "$1,442.35"

. $288.47

57020 Drainage of pelvic

fluid T 0192 7.0332 $488.24

. $97.65

57022 I & d vaginal hematoma

pp T 0007 13.4779 $935.64

. $187.13

57023 I & d vag hematoma

non-ob T 0008 20.5401 "$1,425.89"

. $285.18

57061 Destroy vag lesions

simple T 0193 20.7771 "$1,442.35"

. $288.47

57065 Destroy vag lesions

complex T 0193 20.7771 "$1,442.35"

. $288.47

57100 Biopsy of

vagina T 0192 7.0332 $488.24

. $97.65

57105 Biopsy of

vagina T 0193 20.7771 "$1,442.35"

. $288.47

57106 Remove vagina wall

partial T 0193 20.7771 "$1,442.35"

. $288.47

57107 Remove vagina tissue

part T 0195 35.9320 "$2,494.40"

. $498.88

57109 Vaginectomy partial

w/nodes T 0195 35.9320 "$2,494.40"

. $498.88

57110 Remove vagina wall

complete C

57111 Remove vagina tissue

compl C

57112 Vaginectomy w/nodes

compl C

57120 Closure of

vagina T 0195 35.9320 "$2,494.40"

. $498.88

57130 Remove vagina

lesion T 0193 20.7771 "$1,442.35"

. $288.4757135 Remove vagina

lesion T 0193 20.7771 "$1,442.35"

. $288.47

57150 Treat vagina

infection T 0188 1.6099 $111.76

. $22.36

57155 Insert uteri

tandems/ovoids T 0192 7.0332 $488.24

. $97.65

57156 Ins vag brachytx

device T 0189 3.6121 $250.75

. $50.15

57160 Insert pessary/other

device T 0188 1.6099 $111.76

. $22.36

57170 Fitting of

diaphragm/cap T 0191 0.1274 $8.84 $1.85 $1.77

57180 Treat vaginal

bleeding T 0188 1.6099 $111.76

. $22.36

57200 Repair of

vagina T 0193 20.7771 "$1,442.35"

. $288.47

57210 Repair

vagina/perineum T 0193 20.7771 "$1,442.35"

. $288.47

57220 Revision of

urethra T 0202 45.5816 "$3,164.27" $981.50 $632.86

57230 Repair of urethral

lesion T 0195 35.9320 "$2,494.40"

. $498.88

57240 Repair bladder &

vagina T 0195 35.9320 "$2,494.40"

. $498.88

57250 Repair rectum &

vagina T 0195 35.9320 "$2,494.40"

. $498.88

57260 Repair of

vagina T 0195 35.9320 "$2,494.40"

. $498.88

57265 Extensive repair of

vagina T 0202 45.5816 "$3,164.27" $981.50 $632.86

57267 Insert mesh/pelvic flr

addon T 0195 35.9320 "$2,494.40"

. $498.8857268 Repair of bowel

bulge T 0195 35.9320 "$2,494.40"

. $498.88

57270 Repair of bowel

pouch C

57280 Suspension of

vagina C

57282 Colpopexy

extraperitoneal T 0202 45.5816 "$3,164.27" $981.50 $632.86

57283 Colpopexy

intraperitoneal T 0202 45.5816 "$3,164.27" $981.50 $632.86

57284 Repair paravag defect

open T 0202 45.5816 "$3,164.27" $981.50 $632.86

57285 Repair paravag defect

vag T 0202 45.5816 "$3,164.27" $981.50 $632.86

57287 Revise/remove sling

repair T 0195 35.9320 "$2,494.40"

. $498.88

57288 Repair bladder

defect T 0202 45.5816 "$3,164.27" $981.50 $632.86

57289 Repair bladder &

vagina T 0195 35.9320 "$2,494.40"

. $498.88

57291 Construction of

vagina T 0195 35.9320 "$2,494.40"

. $498.88

57292 Construct vagina with

graft T 0195 35.9320 "$2,494.40"

. $498.88

57295 Revise vag graft via

vagina T 0193 20.7771 "$1,442.35"

. $288.47

57296 Revise vag graft open

abd C

57300 Repair rectum-vagina

fistula T 0195 35.9320 "$2,494.40"

. $498.88

57305 Repair rectum-vagina

fistula C

57307 Fistula repair &

colostomy C

57308 Fistula repair

transperine C57310 Repair urethrovaginal

lesion T 0202 45.5816 "$3,164.27" $981.50 $632.86

57311 Repair urethrovaginal

lesion C

57320 Repair bladder-vagina

lesion T 0195 35.9320 "$2,494.40"

. $498.88

57330 Repair bladder-vagina

lesion T 0195 35.9320 "$2,494.40"

. $498.88

57335 Repair

vagina T 0195 35.9320 "$2,494.40"

. $498.88

57400 Dilation of

vagina T 0193 20.7771 "$1,442.35"

. $288.47

57410 Pelvic

examination T 0193 20.7771 "$1,442.35"

. $288.47

57415 Remove vaginal foreign

body T 0193 20.7771 "$1,442.35"

. $288.47

57420 Exam of vagina

w/scope T 0189 3.6121 $250.75

. $50.15

57421 Exam/biopsy of vag

w/scope T 0189 3.6121 $250.75

. $50.15

57423 Repair paravag defect

lap T 0202 45.5816 "$3,164.27" $981.50 $632.86

57425 Laparoscopy surg colpopexy CH

T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

57426 Revise prosth vag graft

lap T 0193 20.7771 "$1,442.35"

. $288.47

57452 Exam of cervix

w/scope T 0188 1.6099 $111.76

. $22.36

57454 Bx/curett of cervix

w/scope T 0189 3.6121 $250.75

. $50.15

57455 Biopsy of cervix

w/scope T 0189 3.6121 $250.75

. $50.15

57456 Endocerv curettage

w/scope T 0189 3.6121 $250.75

. $50.1557460 Bx of cervix w/scope

leep T 0193 20.7771 "$1,442.35"

. $288.47

57461 Conz of cervix w/scope

leep T 0193 20.7771 "$1,442.35"

. $288.47

57500 Biopsy of

cervix T 0192 7.0332 $488.24

. $97.65

57505 Endocervical

curettage T 0192 7.0332 $488.24

. $97.65

57510 Cauterization of

cervix T 0193 20.7771 "$1,442.35"

. $288.47

57511 Cryocautery of

cervix T 0188 1.6099 $111.76

. $22.36

57513 Laser surgery of

cervix T 0193 20.7771 "$1,442.35"

. $288.47

57520 Conization of

cervix T 0193 20.7771 "$1,442.35"

. $288.47

57522 Conization of

cervix T 0193 20.7771 "$1,442.35"

. $288.47

57530 Removal of

cervix T 0195 35.9320 "$2,494.40"

. $498.88

57531 Removal of cervix

radical C

57540 Removal of residual

cervix C

57545 Remove cervix/repair

pelvis C

57550 Removal of residual

cervix T 0195 35.9320 "$2,494.40"

. $498.88

57555 Remove cervix/repair

vagina T 0195 35.9320 "$2,494.40"

. $498.88

57556 Remove cervix repair

bowel T 0202 45.5816 "$3,164.27" $981.50 $632.86

57558 D&c of cervical

stump T 0193 20.7771 "$1,442.35"

. $288.4757700 Revision of

cervix T 0193 20.7771 "$1,442.35"

. $288.47

57720 Revision of

cervix T 0193 20.7771 "$1,442.35"

. $288.47

57800 Dilation of cervical

canal T 0193 20.7771 "$1,442.35"

. $288.47

58100 Biopsy of uterus

lining T 0188 1.6099 $111.76

. $22.36

58110 Bx done w/colposcopy add-on N

58120 Dilation and

curettage T 0193 20.7771 "$1,442.35"

. $288.47

58140 Myomectomy abdom

method C

58145 Myomectomy vag

method T 0195 35.9320 "$2,494.40"

. $498.88

58146 Myomectomy abdom

complex C

58150 Total

hysterectomy C

58152 Total

hysterectomy C

58180 Partial

hysterectomy C

58200 Extensive

hysterectomy C

58210 Extensive

hysterectomy C

58240 Removal of pelvis

contents C

58260 Vaginal hysterectomy T

0195 35.9320 "$2,494.40"

. $498.88

58262 Vag hyst including t/o T

0195 35.9320 "$2,494.40"

. $498.88

58263 Vag hyst w/t/o & vag repair T

0195 35.9320 "$2,494.40"

. $498.88

58267 Vag hyst w/urinary

repair C58270 Vag hyst w/enterocele repair T

0195 35.9320 "$2,494.40"

. $498.88

58275 Hysterectomy/revise

vagina C

58280 Hysterectomy/revise

vagina C

58285 Extensive

hysterectomy C

58290 Vag hyst complex T

0202 45.5816 "$3,164.27" $981.50 $632.86

58291 Vag hyst incl t/o complex T

0202 45.5816 "$3,164.27" $981.50 $632.86

58292 Vag hyst t/o & repair compl T

0202 45.5816 "$3,164.27" $981.50 $632.86

58293 Vag hyst w/uro repair

compl C

58294 Vag hyst w/enterocele compl T

0202 45.5816 "$3,164.27" $981.50 $632.86

58300 Insert intrauterine

device E

58301 Remove intrauterine

device T 0188 1.6099 $111.76

. $22.36

58321 Artificial

insemination T 0189 3.6121 $250.75

. $50.15

58322 Artificial

insemination T 0189 3.6121 $250.75

. $50.15

58323 Sperm

washing T 0189 3.6121 $250.75

. $50.15

58340 Catheter for

hysterography N

58345 Reopen fallopian

tube T 0193 20.7771 "$1,442.35"

. $288.47

58346 Insert heyman uteri

capsule T 0193 20.7771 "$1,442.35"

. $288.47

58350 Reopen fallopian

tube T 0195 35.9320 "$2,494.40"

. $498.8858353 Endometr ablate

thermal T 0195 35.9320 "$2,494.40"

. $498.88

58356 Endometrial

cryoablation T 0202 45.5816 "$3,164.27" $981.50 $632.86

58400 Suspension of

uterus C

58410 Suspension of

uterus C

58520 Repair of ruptured

uterus C

58540 Revision of

uterus C

58541 Lsh uterus 250 g or

less T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

58542 Lsh w/t/o ut 250 g or

less T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

58543 Lsh uterus above 250

g T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

58544 Lsh w/t/o uterus above 250

g T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

58545 Laparoscopic

myomectomy T 0130 39.0865 "$2,713.38" $659.53 $542.68

58546 Laparo-myomectomy

complex T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

58548 Lap radical

hyst C

58550 Laparo-asst vag

hysterectomy T 0132 71.0451 "$4,931.95" "$1,236.99" $986.39

58552 Laparo-vag hyst incl

t/o T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

58553 Laparo-vag hyst

complex T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

58554 Laparo-vag hyst w/t/o

compl T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

58555 Hysteroscopy dx sep

proc T 0190 23.1868 "$1,609.63" $424.28 $321.9358558 Hysteroscopy

biopsy T 0190 23.1868 "$1,609.63" $424.28 $321.93

58559 Hysteroscopy

lysis T 0190 23.1868 "$1,609.63" $424.28 $321.93

58560 Hysteroscopy resect

septum T 0387 37.9124 "$2,631.88" $650.74 $526.38

58561 Hysteroscopy remove

myoma T 0387 37.9124 "$2,631.88" $650.74 $526.38

58562 Hysteroscopy remove

fb T 0190 23.1868 "$1,609.63" $424.28 $321.93

58563 Hysteroscopy

ablation T 0387 37.9124 "$2,631.88" $650.74 $526.38

58565 Hysteroscopy

sterilization T 0202 45.5816 "$3,164.27" $981.50 $632.86

58570 Tlh uterus 250 g or

less T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

58571 Tlh w/t/o 250 g or

less T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

58572 Tlh uterus over 250

g T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

58573 Tlh w/t/o uterus over 250

g T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

58578 Laparo proc

uterus T 0130 39.0865 "$2,713.38" $659.53 $542.68

58579 Hysteroscope

procedure T 0190 23.1868 "$1,609.63" $424.28 $321.93

58600 Division of fallopian

tube T 0195 35.9320 "$2,494.40"

. $498.88

58605 Division of fallopian

tube C

58611 Ligate oviduct(s)

add-on C

58615 Occlude fallopian

tube(s) T 0193 20.7771 "$1,442.35"

. $288.4758660 Laparoscopy

lysis T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

58661 Laparoscopy remove

adnexa T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

58662 Laparoscopy excise

lesions T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

58670 Laparoscopy tubal

cautery T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

58671 Laparoscopy tubal

block T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

58672 Laparoscopy

fimbrioplasty T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

58673 Laparoscopy

salpingostomy T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

58679 Laparo proc

oviduct-ovary T 0130 39.0865 "$2,713.38" $659.53 $542.68

58700 Removal of fallopian

tube C

58720 Removal of

ovary/tube(s) C

58740 Adhesiolysis tube

ovary C

58750 Repair

oviduct C

58752 Revise ovarian

tube(s) C

58760 Fimbrioplasty C

58770 Create new tubal

opening T 0195 35.9320 "$2,494.40"

. $498.88

58800 Drainage of ovarian

cyst(s) T 0193 20.7771 "$1,442.35"

. $288.47

58805 Drainage of ovarian

cyst(s) T 0195 35.9320 "$2,494.40"

. $498.88

58820 Drain ovary abscess

open T 0195 35.9320 "$2,494.40"

. $498.8858822 Drain ovary abscess

percut C

58823 Drain pelvic abscess

percut T 0193 20.7771 "$1,442.35"

. $288.47

58825 Transposition

ovary(s) C

58900 Biopsy of

ovary(s) T 0193 20.7771 "$1,442.35"

. $288.47

58920 Partial removal of

ovary(s) T 0195 35.9320 "$2,494.40"

. $498.88

58925 Removal of ovarian

cyst(s) T 0195 35.9320 "$2,494.40"

. $498.88

58940 Removal of

ovary(s) C

58943 Removal of

ovary(s) C

58950 Resect ovarian

malignancy C

58951 Resect ovarian

malignancy C

58952 Resect ovarian

malignancy C

58953 Tah rad dissect for

debulk C

58954 Tah rad debulk/lymph

remove C

58956 Bso omentectomy

w/tah C

58957 Resect recurrent gyn

mal C

58958 Resect recur gyn mal

w/lym C

58960 Exploration of

abdomen C

58970 Retrieval of

oocyte T 0189 3.6121 $250.75

. $50.15

58974 Transfer of

embryo T 0189 3.6121 $250.75

. $50.15

58976 Transfer of

embryo T 0189 3.6121 $250.75

. $50.1558999 Genital surgery

procedure T 0191 0.1274 $8.84 $1.85 $1.77

59000 Amniocentesis

diagnostic T 0189 3.6121 $250.75

. $50.15

59001 Amniocentesis

therapeutic T 0192 7.0332 $488.24

. $97.65

59012 Fetal cord puncture

prenatal T 0189 3.6121 $250.75

. $50.15

59015 Chorion

biopsy T 0189 3.6121 $250.75

. $50.15

59020 Fetal contract stress

test T 0188 1.6099 $111.76

. $22.36

59025 Fetal non-stress

test T 0188 1.6099 $111.76

. $22.36

59030 Fetal scalp blood

sample T 0189 3.6121 $250.75

. $50.15

59050 Fetal monitor w/report M

59051 Fetal monitor/interpret

only B

59070 Transabdom amnioinfus

w/us T 0188 1.6099 $111.76

. $22.36

59072 Umbilical cord occlud

w/us T 0189 3.6121 $250.75

. $50.15

59074 Fetal fluid drainage

w/us T 0189 3.6121 $250.75

. $50.15

59076 Fetal shunt placement

w/us T 0189 3.6121 $250.75

. $50.15

59100 Remove uterus

lesion T 0195 35.9320 "$2,494.40"

. $498.88

59120 Treat ectopic

pregnancy C

59121 Treat ectopic

pregnancy C

59130 Treat ectopicpregnancy C

59135 Treat ectopic

pregnancy C

59136 Treat ectopic

pregnancy C

59140 Treat ectopic

pregnancy C

59150 Treat ectopic

pregnancy T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

59151 Treat ectopic

pregnancy T 0131 47.7164 "$3,312.47" "$1,001.89" $662.50

59160 D & c after

delivery T 0193 20.7771 "$1,442.35"

. $288.47

59200 Insert cervical

dilator T 0188 1.6099 $111.76

. $22.36

59300 Episiotomy or vaginal

repair T 0193 20.7771 "$1,442.35"

. $288.47

59320 Revision of

cervix T 0193 20.7771 "$1,442.35"

. $288.47

59325 Revision of

cervix C

59350 Repair of

uterus C

59400 Obstetrical

care B

59409 Obstetrical

care T 0193 20.7771 "$1,442.35"

. $288.47

59410 Obstetrical

care B

59412 Antepartum

manipulation T 0193 20.7771 "$1,442.35"

. $288.47

59414 Deliver

placenta T 0193 20.7771 "$1,442.35"

. $288.47

59425 Antepartum care

only B

59426 Antepartum care

only B

59430 Care afterdelivery B

59510 Cesarean

delivery B

59514 Cesarean delivery

only C

59515 Cesarean

delivery B

59525 Remove uterus after

cesarean C

59610 Vbac

delivery B

59612 Vbac delivery

only T 0193 20.7771 "$1,442.35"

. $288.47

59614 Vbac care after

delivery B

59618 Attempted vbac

delivery B

59620 Attempted vbac delivery

only C

59622 Attempted vbac after

care B

59812 Treatment of

miscarriage T 0193 20.7771 "$1,442.35"

. $288.47

59820 Care of

miscarriage T 0193 20.7771 "$1,442.35"

. $288.47

59821 Treatment of

miscarriage T 0193 20.7771 "$1,442.35"

. $288.47

59830 Treat uterus

infection C

59840 Abortion T 0193 20.7771 "$1,442.35"

. $288.47

59841 Abortion T 0193 20.7771 "$1,442.35"

. $288.47

59850 Abortion C

59851 Abortion C

59852 Abortion C

59855 Abortion C

59856 Abortion C

59857 Abortion C59866 Abortion

(mpr) T 0189 3.6121 $250.75

. $50.15

59870 Evacuate mole of

uterus T 0193 20.7771 "$1,442.35"

. $288.47

59871 Remove cerclage

suture T 0193 20.7771 "$1,442.35"

. $288.47

59897 Fetal invas px

w/us T 0191 0.1274 $8.84 $1.85 $1.77

59898 Laparo proc ob

care/deliver T 0130 39.0865 "$2,713.38" $659.53 $542.68

59899 Maternity care

procedure T 0191 0.1274 $8.84 $1.85 $1.77

60000 Drain thyroid/tongue

cyst T 0252 8.0353 $557.81

. $111.57

60100 Biopsy of

thyroid T 0004 4.5956 $319.03

. $63.81

60200 Remove thyroid

lesion T 0114 51.2321 "$3,556.53"

. $711.31

60210 Partial thyroid

excision T 0114 51.2321 "$3,556.53"

. $711.31

60212 Partial thyroid

excision T 0114 51.2321 "$3,556.53"

. $711.31

60220 Partial removal of

thyroid T 0114 51.2321 "$3,556.53"

. $711.31

60225 Partial removal of

thyroid T 0114 51.2321 "$3,556.53"

. $711.31

60240 Removal of

thyroid T 0114 51.2321 "$3,556.53"

. $711.31

60252 Removal of

thyroid T 0256 45.1286 "$3,132.83"

. $626.57

60254 Extensive thyroid

surgery C

60260 Repeat thyroid

surgery T 0256 45.1286 "$3,132.83"

. $626.5760270 Removal of

thyroid C

60271 Removal of

thyroid T 0256 45.1286 "$3,132.83"

. $626.57

60280 Remove thyroid duct

lesion T 0114 51.2321 "$3,556.53"

. $711.31

60281 Remove thyroid duct

lesion T 0114 51.2321 "$3,556.53"

. $711.31

60300 Aspir/inj thyroid

cyst T 0004 4.5956 $319.03

. $63.81

60500 Explore parathyroid

glands T 0256 45.1286 "$3,132.83"

. $626.57

60502 Re-explore

parathyroids T 0256 45.1286 "$3,132.83"

. $626.57

60505 Explore parathyroid

glands C

60512 Autotransplant

parathyroid T 0022 23.4169 "$1,625.60" $350.05 $325.12

60520 Removal of thymus

gland T 0256 45.1286 "$3,132.83"

. $626.57

60521 Removal of thymus

gland C

60522 Removal of thymus

gland C

60540 Explore adrenal

gland C

60545 Explore adrenal

gland C

60600 Remove carotid body

lesion C

60605 Remove carotid body

lesion C

60650 Laparoscopy

adrenalectomy C

60659 Laparo proc

endocrine T 0130 39.0865 "$2,713.38" $659.53 $542.68

60699 Endocrine surgery

procedure T 0114 51.2321 "$3,556.53"

. $711.3161000 Remove cranial cavity

fluid T 0207 7.5480 $523.98

. $104.80

61001 Remove cranial cavity

fluid T 0207 7.5480 $523.98

. $104.80

61020 Remove brain cavity

fluid T 0207 7.5480 $523.98

. $104.80

61026 Injection into brain

canal T 0207 7.5480 $523.98

. $104.80

61050 Remove brain canal

fluid T 0207 7.5480 $523.98

. $104.80

61055 Injection into brain

canal T 0207 7.5480 $523.98

. $104.80

61070 Brain canal shunt

procedure T 0121 6.3178 $438.58

. $87.72

61105 Twist drill

hole C

61107 Drill skull for

implantation C

61108 Drill skull for

drainage C

61120 Burr hole for

puncture C

61140 Pierce skull for

biopsy C

61150 Pierce skull for

drainage C

61151 Pierce skull for

drainage C

61154 Pierce skull & remove

clot C

61156 Pierce skull for

drainage C

61210 Pierce skull implant

device C

61215 Insert brain-fluid

device T 0224 42.5188 "$2,951.66"

. $590.34

61250 Pierce skull &

explore C61253 Pierce skull &

explore C

61304 Open skull for

exploration C

61305 Open skull for

exploration C

61312 Open skull for

drainage C

61313 Open skull for

drainage C

61314 Open skull for

drainage C

61315 Open skull for

drainage C

61316 Implt cran bone flap to

abdo C

61320 Open skull for

drainage C

61321 Open skull for

drainage C

61322 Decompressive

craniotomy C

61323 Decompressive

lobectomy C

61330 Decompress eye

socket T 0256 45.1286 "$3,132.83"

. $626.57

61332 Explore/biopsy eye

socket C

61333 Explore orbit/remove

lesion C

61334 Explore orbit/remove

object T 0256 45.1286 "$3,132.83"

. $626.57

61340 Subtemporal

decompression C

61343 Incise skull (press

relief) C

61345 Relieve cranial

pressure C

61440 Incise skull for

surgery C

61450 Incise skull for

surgery C61458 Incise skull for brain

wound C

61460 Incise skull for

surgery C

61470 Incise skull for

surgery C

61480 Incise skull for

surgery C

61490 Incise skull for

surgery C

61500 Removal of skull

lesion C

61501 Remove infected skull

bone C

61510 Removal of brain

lesion C

61512 Remove brain lining

lesion C

61514 Removal of brain

abscess C

61516 Removal of brain

lesion C

61517 Implt brain chemotx

add-on C

61518 Removal of brain

lesion C

61519 Remove brain lining

lesion C

61520 Removal of brain

lesion C

61521 Removal of brain

lesion C

61522 Removal of brain

abscess C

61524 Removal of brain

lesion C

61526 Removal of brain

lesion C

61530 Removal of brain

lesion C

61531 Implant brain

electrodes C

61533 Implant brain

electrodes C61534 Removal of brain

lesion C

61535 Remove brain

electrodes C

61536 Removal of brain

lesion C

61537 Removal of brain

tissue C

61538 Removal of brain

tissue C

61539 Removal of brain

tissue C

61540 Removal of brain

tissue C

61541 Incision of brain

tissue C

61542 Removal of brain

tissue C

61543 Removal of brain

tissue C

61544 Remove & treat brain

lesion C

61545 Excision of brain

tumor C

61546 Removal of pituitary

gland C

61548 Removal of pituitary

gland C

61550 Release of skull

seams C

61552 Release of skull

seams C

61556 Incise

skull/sutures C

61557 Incise

skull/sutures C

61558 Excision of

skull/sutures C

61559 Excision of

skull/sutures C

61563 Excision of skull

tumor C

61564 Excision of skull

tumor C61566 Removal of brain

tissue C

61567 Incision of brain

tissue C

61570 Remove foreign body

brain C

61571 Incise skull for brain

wound C

61575 Skull base/brainstem

surgery C

61576 Skull base/brainstem

surgery C

61580 Craniofacial approach

skull C

61581 Craniofacial approach

skull C

61582 Craniofacial approach

skull C

61583 Craniofacial approach

skull C

61584 Orbitocranial

approach/skull C

61585 Orbitocranial

approach/skull C

61586 Resect nasopharynx

skull C

61590 Infratemporal

approach/skull C

61591 Infratemporal

approach/skull C

61592 Orbitocranial

approach/skull C

61595 Transtemporal

approach/skull C

61596 Transcochlear

approach/skull C

61597 Transcondylar

approach/skull C

61598 Transpetrosal

approach/skull C

61600 Resect/excise cranial

lesion C

61601 Resect/excise cranial

lesion C61605 Resect/excise cranial

lesion C

61606 Resect/excise cranial

lesion C

61607 Resect/excise cranial

lesion C

61608 Resect/excise cranial

lesion C

61609 Transect artery

sinus C

61610 Transect artery

sinus C

61611 Transect artery

sinus C

61612 Transect artery

sinus C

61613 Remove aneurysm

sinus C

61615 Resect/excise lesion

skull C

61616 Resect/excise lesion

skull C

61618 Repair

dura C

61619 Repair

dura C

61623 Endovasc tempory vessel

occl T 0082 104.8857 "$7,281.17"

. "$1,456.24"

61624 Transcath occlusion

cns C

61626 Transcath occlusion

non-cns T 0082 104.8857 "$7,281.17"

. "$1,456.24"

61630 Intracranial

angioplasty C

61635 Intracran angioplsty

w/stent C

61640 Dilate ic vasospasm init E

61641 Dilate ic vasospasm add-on E

61642 Dilate ic vasospasm add-on E

61680 Intracranial vesselsurgery C

61682 Intracranial vessel

surgery C

61684 Intracranial vessel

surgery C

61686 Intracranial vessel

surgery C

61690 Intracranial vessel

surgery C

61692 Intracranial vessel

surgery C

61697 Brain aneurysm repr

complx C

61698 Brain aneurysm repr

complx C

61700 Brain aneurysm repr

simple C

61702 Inner skull vessel

surgery C

61703 Clamp neck

artery C

61705 Revise circulation to

head C

61708 Revise circulation to

head C

61710 Revise circulation to

head C

61711 Fusion of skull

arteries C

61720 Incise skull/brain

surgery T 0221 37.4067 "$2,596.77"

. $519.36

61735 Incise skull/brain

surgery C

61750 Incise skull/brain

biopsy C

61751 Brain biopsy w/ct/mr

guide C

61760 Implant brain

electrodes C

61770 Incise skull for

treatment T 0221 37.4067 "$2,596.77"

. $519.36

61781 Scan proc cranial

intra N61782 Scan proc cranial

extra N

61783 Scan proc

spinal N

61790 Treat trigeminal

nerve T 0220 19.0626 "$1,323.33"

. $264.67

61791 Treat trigeminal

tract T 0203 12.9066 $895.98

. $179.20

61796 Srs cranial lesion

simple B

61797 Srs cran les simple

addl B

61798 Srs cranial lesion

complex B

61799 Srs cran les complex

addl B

61800 Apply srs headframe

add-on B

61850 Implant

neuroelectrodes C

61860 Implant

neuroelectrodes C

61863 Implant

neuroelectrode C

61864 Implant neuroelectrde

addl C

61867 Implant

neuroelectrode C

61868 Implant neuroelectrde

addl C

61870 Implant

neuroelectrodes C

61875 Implant

neuroelectrodes C

61880 Revise/remove

neuroelectrode T 0687 20.7466 "$1,440.23" $382.52 $288.05

61885 Insrt/redo neurostim 1

array S 0039 209.6958 "$14,557.08"

. "$2,911.42"

61886 Implant neurostim arrays S

0315 284.8462 "$19,774.02"

. "$3,954.81"61888 Revise/remove

neuroreceiver T 0688 31.3873 "$2,178.91" $768.94 $435.79

62000 Treat skull

fracture T 0254 25.1379 "$1,745.07"

. $349.02

62005 Treat skull

fracture C

62010 Treatment of head

injury C

62100 Repair brain fluid

leakage C

62115 Reduction of skull

defect C

62116 Reduction of skull

defect C

62117 Reduction of skull

defect C

62120 Repair skull cavity

lesion C

62121 Incise skull

repair C

62140 Repair of skull

defect C

62141 Repair of skull

defect C

62142 Remove skull

plate/flap C

62143 Replace skull

plate/flap C

62145 Repair of skull &

brain C

62146 Repair of skull with

graft C

62147 Repair of skull with

graft C

62148 Retr bone flap to fix

skull C

62160 Neuroendoscopy add-on N

62161 Dissect brain

w/scope C

62162 Remove colloid cyst

w/scope C

62163 Neuroendoscopy w/fbremoval C

62164 Remove brain tumor

w/scope C

62165 Remove pituit tumor

w/scope C

62180 Establish brain cavity

shunt C

62190 Establish brain cavity

shunt C

62192 Establish brain cavity

shunt C

62194 Replace/irrigate

catheter T 0207 7.5480 $523.98

. $104.80

62200 Establish brain cavity

shunt C

62201 Brain cavity shunt

w/scope C

62220 Establish brain cavity

shunt C

62223 Establish brain cavity

shunt C

62225 Replace/irrigate

catheter T 0427 16.2153 "$1,125.67"

. $225.14

62230 Replace/revise brain

shunt T 0224 42.5188 "$2,951.66"

. $590.34

62252 Csf shunt

reprogram S 0691 2.4153 $167.67

. $33.54

62256 Remove brain cavity

shunt C

62258 Replace brain cavity

shunt C

62263 Epidural lysis mult sessions CH

T 0203 12.9066 $895.98

. $179.20

62264 Epidural lysis on single

day T 0203 12.9066 $895.98

. $179.20

62267 Interdiscal perq aspir

dx T 0004 4.5956 $319.03

. $63.81

62268 Drain spinal cord

cyst T 0207 7.5480 $523.98

. $104.8062269 Needle biopsy spinal

cord T 0685 9.7281 $675.32

. $135.07

62270 Spinal fluid tap

diagnostic T 0206 3.9371 $273.31

. $54.67

62272 Drain cerebro spinal

fluid T 0206 3.9371 $273.31

. $54.67

62273 Inject epidural

patch T 0207 7.5480 $523.98

. $104.80

62280 Treat spinal cord

lesion T 0207 7.5480 $523.98

. $104.80

62281 Treat spinal cord lesion CH

T 0203 12.9066 $895.98

. $179.20

62282 Treat spinal canal lesion CH

T 0203 12.9066 $895.98

. $179.20

62284 Injection for

myelogram N

62287 Percutaneous

diskectomy T 0221 37.4067 "$2,596.77"

. $519.36

62290 Inject for spine disk

x-ray N

62291 Inject for spine disk

x-ray N

62292 Injection into disk

lesion T 0207 7.5480 $523.98

. $104.80

62294 Injection into spinal

artery T 0207 7.5480 $523.98

. $104.80

62310 Inject spine

c/t T 0207 7.5480 $523.98

. $104.80

62311 Inject spine l/s

(cd) T 0207 7.5480 $523.98

. $104.80

62318 Inject spine w/cath

c/t T 0207 7.5480 $523.98

. $104.80

62319 Inject spine w/cath l/s

(cd) T 0203 12.9066 $895.98

. $179.2062350 Implant spinal canal

cath T 0224 42.5188 "$2,951.66"

. $590.34

62351 Implant spinal canal

cath T 0208 51.1173 "$3,548.56"

. $709.72

62355 Remove spinal canal

catheter T 0203 12.9066 $895.98

. $179.20

62360 Insert spine infusion

device T 0224 42.5188 "$2,951.66"

. $590.34

62361 Implant spine infusion

pump T 0227 190.0513 "$13,193.36"

. "$2,638.68"

62362 Implant spine infusion

pump T 0227 190.0513 "$13,193.36"

. "$2,638.68"

62365 Remove spine infusion

device T 0221 37.4067 "$2,596.77"

. $519.36

62367 Analyze spine infusion

pump S 0691 2.4153 $167.67

. $33.54

62368 Analyze spine infusion

pump S 0691 2.4153 $167.67

. $33.54

63001 Removal of spinal

lamina T 0208 51.1173 "$3,548.56"

. $709.72

63003 Removal of spinal

lamina T 0208 51.1173 "$3,548.56"

. $709.72

63005 Removal of spinal

lamina T 0208 51.1173 "$3,548.56"

. $709.72

63011 Removal of spinal

lamina T 0208 51.1173 "$3,548.56"

. $709.72

63012 Removal of spinal

lamina T 0208 51.1173 "$3,548.56"

. $709.72

63015 Removal of spinal

lamina T 0208 51.1173 "$3,548.56"

. $709.72

63016 Removal of spinal

lamina T 0208 51.1173 "$3,548.56"

. $709.72

63017 Removal of spinal

lamina T 0208 51.1173 "$3,548.56"

. $709.7263020 Neck spine disk

surgery T 0208 51.1173 "$3,548.56"

. $709.72

63030 Low back disk

surgery T 0208 51.1173 "$3,548.56"

. $709.72

63035 Spinal disk surgery

add-on T 0208 51.1173 "$3,548.56"

. $709.72

63040 Laminotomy single

cervical T 0208 51.1173 "$3,548.56"

. $709.72

63042 Laminotomy single

lumbar T 0208 51.1173 "$3,548.56"

. $709.72

63043 Laminotomy addl

cervical C

63044 Laminotomy addl

lumbar C

63045 Removal of spinal

lamina T 0208 51.1173 "$3,548.56"

. $709.72

63046 Removal of spinal

lamina T 0208 51.1173 "$3,548.56"

. $709.72

63047 Removal of spinal

lamina T 0208 51.1173 "$3,548.56"

. $709.72

63048 Remove spinal lamina

add-on T 0208 51.1173 "$3,548.56"

. $709.72

63050 Cervical

laminoplasty C

63051 C-laminoplasty

w/graft/plate C

63055 Decompress spinal

cord T 0208 51.1173 "$3,548.56"

. $709.72

63056 Decompress spinal

cord T 0208 51.1173 "$3,548.56"

. $709.72

63057 Decompress spine cord

add-on T 0208 51.1173 "$3,548.56"

. $709.72

63064 Decompress spinal

cord T 0208 51.1173 "$3,548.56"

. $709.7263066 Decompress spine cord

add-on T 0208 51.1173 "$3,548.56"

. $709.72

63075 Neck spine disk

surgery T 0208 51.1173 "$3,548.56"

. $709.72

63076 Neck spine disk

surgery T 0208 51.1173 "$3,548.56"

. $709.72

63077 Spine disk surgery

thorax C

63078 Spine disk surgery

thorax C

63081 Removal of vertebral

body C

63082 Remove vertebral body

add-on C

63085 Removal of vertebral

body C

63086 Remove vertebral body

add-on C

63087 Removal of vertebral

body C

63088 Remove vertebral body

add-on C

63090 Removal of vertebral

body C

63091 Remove vertebral body

add-on C

63101 Removal of vertebral

body C

63102 Removal of vertebral

body C

63103 Remove vertebral body

add-on C

63170 Incise spinal cord

tract(s) C

63172 Drainage of spinal

cyst C

63173 Drainage of spinal

cyst C

63180 Revise spinal cord

ligaments C

63182 Revise spinal cord

ligaments C63185 Incise spinal

column/nerves C

63190 Incise spinal

column/nerves C

63191 Incise spinal

column/nerves C

63194 Incise spinal column &

cord C

63195 Incise spinal column &

cord C

63196 Incise spinal column &

cord C

63197 Incise spinal column &

cord C

63198 Incise spinal column &

cord C

63199 Incise spinal column &

cord C

63200 Release of spinal

cord C

63250 Revise spinal cord

vessels C

63251 Revise spinal cord

vessels C

63252 Revise spinal cord

vessels C

63265 Excise intraspinal

lesion C

63266 Excise intraspinal

lesion C

63267 Excise intraspinal

lesion C

63268 Excise intraspinal

lesion C

63270 Excise intraspinal

lesion C

63271 Excise intraspinal

lesion C

63272 Excise intraspinal

lesion C

63273 Excise intraspinal

lesion C

63275 Biopsy/excise spinal

tumor C63276 Biopsy/excise spinal

tumor C

63277 Biopsy/excise spinal

tumor C

63278 Biopsy/excise spinal

tumor C

63280 Biopsy/excise spinal

tumor C

63281 Biopsy/excise spinal

tumor C

63282 Biopsy/excise spinal

tumor C

63283 Biopsy/excise spinal

tumor C

63285 Biopsy/excise spinal

tumor C

63286 Biopsy/excise spinal

tumor C

63287 Biopsy/excise spinal

tumor C

63290 Biopsy/excise spinal

tumor C

63295 Repair of laminectomy

defect C

63300 Removal of vertebral

body C

63301 Removal of vertebral

body C

63302 Removal of vertebral

body C

63303 Removal of vertebral

body C

63304 Removal of vertebral

body C

63305 Removal of vertebral

body C

63306 Removal of vertebral

body C

63307 Removal of vertebral

body C

63308 Remove vertebral body

add-on C

63600 Remove spinal cord

lesion T 0220 19.0626 "$1,323.33"

. $264.6763610 Stimulation of spinal

cord T 0220 19.0626 "$1,323.33"

. $264.67

63615 Remove lesion of spinal

cord T 0220 19.0626 "$1,323.33"

. $264.67

63620 Srs spinal

lesion B

63621 Srs spinal lesion

addl B

63650 Implant

neuroelectrodes S 0040 62.7889 "$4,358.81"

. $871.77

63655 Implant

neuroelectrodes S 0061 86.9786 "$6,038.05"

. "$1,207.61"

63661 Remove spine eltrd perq

aray T 0687 20.7466 "$1,440.23" $382.52 $288.05

63662 Remove spine eltrd

plate T 0687 20.7466 "$1,440.23" $382.52 $288.05

63663 Revise spine eltrd perq aray CH

T 0040 62.7889 "$4,358.81"

. $871.77

63664 Revise spine eltrd plate CH

T 0040 62.7889 "$4,358.81"

. $871.77

63685 Insrt/redo spine n generator S

0039 209.6958 "$14,557.08"

. "$2,911.42"

63688 Revise/remove

neuroreceiver T 0688 31.3873 "$2,178.91" $768.94 $435.79

63700 Repair of spinal

herniation C

63702 Repair of spinal

herniation C

63704 Repair of spinal

herniation C

63706 Repair of spinal

herniation C

63707 Repair spinal fluid

leakage C

63709 Repair spinal fluid

leakage C

63710 Graft repair of spinedefect C

63740 Install spinal

shunt C

63741 Install spinal

shunt T 0224 42.5188 "$2,951.66"

. $590.34

63744 Revision of spinal

shunt T 0224 42.5188 "$2,951.66"

. $590.34

63746 Removal of spinal

shunt T 0203 12.9066 $895.98

. $179.20

64400 N block inj

trigeminal T 0204 2.7693 $192.24 $40.13 $38.45

64402 N block inj

facial T 0204 2.7693 $192.24 $40.13 $38.45

64405 N block inj

occipital T 0206 3.9371 $273.31

. $54.67

64408 N block inj

vagus CH T 0204 2.7693 $192.24 $40.13 $38.45

64410 N block inj

phrenic CH T 0204 2.7693 $192.24 $40.13 $38.45

64412 N block inj spinal

accessor CH T 0206 3.9371 $273.31

. $54.67

64413 N block inj cervical

plexus T 0206 3.9371 $273.31

. $54.67

64415 N block inj brachial

plexus T 0206 3.9371 $273.31

. $54.67

64416 N block cont infuse b

plex T 0207 7.5480 $523.98

. $104.80

64417 N block inj

axillary T 0206 3.9371 $273.31

. $54.67

64418 N block inj

suprascapular T 0206 3.9371 $273.31

. $54.67

64420 N block inj intercost

sng T 0206 3.9371 $273.31

. $54.67

64421 N block inj intercostmlt T 0207 7.5480 $523.98

. $104.80

64425 N block inj

ilio-ing/hypogi T 0206 3.9371 $273.31

. $54.67

64430 N block inj

pudendal T 0207 7.5480 $523.98

. $104.80

64435 N block inj

paracervical T 0206 3.9371 $273.31

. $54.67

64445 N block inj sciatic

sng T 0207 7.5480 $523.98

. $104.80

64446 N blk inj sciatic cont

inf T 0207 7.5480 $523.98

. $104.80

64447 N block inj fem

single T 0206 3.9371 $273.31

. $54.67

64448 N block inj fem cont

inf T 0207 7.5480 $523.98

. $104.80

64449 N block inj lumbar

plexus T 0207 7.5480 $523.98

. $104.80

64450 N block other

peripheral T 0206 3.9371 $273.31

. $54.67

64455 N block inj plantar

digit T 0204 2.7693 $192.24 $40.13 $38.45

64479 Inj foramen epidural

c/t T 0207 7.5480 $523.98

. $104.80

64480 Inj foramen epidural

add-on T 0206 3.9371 $273.31

. $54.67

64483 Inj foramen epidural

l/s T 0207 7.5480 $523.98

. $104.80

64484 Inj foramen epidural

add-on T 0206 3.9371 $273.31

. $54.67

64490 Inj paravert f jnt c/t 1

lev T 0207 7.5480 $523.98

. $104.80

64491 Inj paravert f jnt c/t 2

lev T 0204 2.7693 $192.24 $40.13 $38.4564492 Inj paravert f jnt c/t 3

lev T 0204 2.7693 $192.24 $40.13 $38.45

64493 Inj paravert f jnt l/s 1

lev T 0207 7.5480 $523.98

. $104.80

64494 Inj paravert f jnt l/s 2

lev T 0204 2.7693 $192.24 $40.13 $38.45

64495 Inj paravert f jnt l/s 3

lev T 0204 2.7693 $192.24 $40.13 $38.45

64505 N block spenopalatine

gangl T 0204 2.7693 $192.24 $40.13 $38.45

64508 N block carotid sinus

s/p T 0204 2.7693 $192.24 $40.13 $38.45

64510 N block stellate

ganglion T 0207 7.5480 $523.98

. $104.80

64517 N block inj hypogas

plxs T 0207 7.5480 $523.98

. $104.80

64520 N block

lumbar/thoracic T 0207 7.5480 $523.98

. $104.80

64530 N block inj celiac

pelus T 0207 7.5480 $523.98

. $104.80

64550 Apply

neurostimulator A

64553 Implant

neuroelectrodes S 0040 62.7889 "$4,358.81"

. $871.77

64555 Implant

neuroelectrodes S 0040 62.7889 "$4,358.81"

. $871.77

64560 Implant

neuroelectrodes S 0040 62.7889 "$4,358.81"

. $871.77

64561 Implant

neuroelectrodes S 0040 62.7889 "$4,358.81"

. $871.77

64565 Implant

neuroelectrodes S 0040 62.7889 "$4,358.81"

. $871.77

64566 Neuroeltrd stim post

tibial T 0204 2.7693 $192.24 $40.13 $38.4564568 Inc for vagus n elect

impl S 0318 337.4240 "$23,423.97" "$9,121.76" "$4,684.80"

64569 Revise/repl vagus n

eltrd T 0687 20.7466 "$1,440.23" $382.52 $288.05

64570 Remove vagus n

eltrd T 0221 37.4067 "$2,596.77"

. $519.36

64575 Implant

neuroelectrodes S 0061 86.9786 "$6,038.05"

. "$1,207.61"

64577 Implant

neuroelectrodes S 0061 86.9786 "$6,038.05"

. "$1,207.61"

64580 Implant

neuroelectrodes S 0061 86.9786 "$6,038.05"

. "$1,207.61"

64581 Implant

neuroelectrodes S 0061 86.9786 "$6,038.05"

. "$1,207.61"

64585 Revise/remove

neuroelectrode T 0687 20.7466 "$1,440.23" $382.52 $288.05

64590 Insrt/redo pn/gastr stimul S

0039 209.6958 "$14,557.08"

. "$2,911.42"

64595 Revise/rmv pn/gastr

stimul T 0688 31.3873 "$2,178.91" $768.94 $435.79

64600 Injection treatment of

nerve T 0203 12.9066 $895.98

. $179.20

64605 Injection treatment of

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64610 Injection treatment of

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64611 Chemodenerv saliv

glands T 0204 2.7693 $192.24 $40.13 $38.45

64612 Destroy nerve face

muscle T 0204 2.7693 $192.24 $40.13 $38.45

64613 Destroy nerve neck

muscle T 0206 3.9371 $273.31

. $54.6764614 Destroy nerve extrem

musc T 0206 3.9371 $273.31

. $54.67

64620 Injection treatment of

nerve CH T 0203 12.9066 $895.98

. $179.20

64622 Destr paravertebrl nerve

l/s T 0203 12.9066 $895.98

. $179.20

64623 Destr paravertebral n

add-on T 0207 7.5480 $523.98

. $104.80

64626 Destr paravertebrl nerve

c/t CH T 0203 12.9066 $895.98

. $179.20

64627 Destr paravertebral n

add-on T 0204 2.7693 $192.24 $40.13 $38.45

64630 Injection treatment of

nerve T 0207 7.5480 $523.98

. $104.80

64632 N block inj common

digit T 0204 2.7693 $192.24 $40.13 $38.45

64640 Injection treatment of

nerve T 0207 7.5480 $523.98

. $104.80

64650 Chemodenerv eccrine

glands T 0204 2.7693 $192.24 $40.13 $38.45

64653 Chemodenerv eccrine

glands T 0204 2.7693 $192.24 $40.13 $38.45

64680 Injection treatment of

nerve CH T 0203 12.9066 $895.98

. $179.20

64681 Injection treatment of

nerve T 0203 12.9066 $895.98

. $179.20

64702 Revise finger/toe

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64704 Revise hand/foot

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64708 Revise arm/leg

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64712 Revision of sciatic

nerve T 0220 19.0626 "$1,323.33"

. $264.6764713 Revision of arm

nerve(s) T 0220 19.0626 "$1,323.33"

. $264.67

64714 Revise low back

nerve(s) T 0220 19.0626 "$1,323.33"

. $264.67

64716 Revision of cranial

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64718 Revise ulnar nerve at

elbow T 0220 19.0626 "$1,323.33"

. $264.67

64719 Revise ulnar nerve at

wrist T 0220 19.0626 "$1,323.33"

. $264.67

64721 Carpal tunnel

surgery T 0220 19.0626 "$1,323.33"

. $264.67

64722 Relieve pressure on

nerve(s) T 0220 19.0626 "$1,323.33"

. $264.67

64726 Release foot/toe

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64727 Internal nerve

revision T 0220 19.0626 "$1,323.33"

. $264.67

64732 Incision of brow

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64734 Incision of cheek

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64736 Incision of chin

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64738 Incision of jaw

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64740 Incision of tongue

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64742 Incision of facial

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64744 Incise nerve back of

head T 0220 19.0626 "$1,323.33"

. $264.6764746 Incise diaphragm

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64752 Incision of vagus

nerve C

64755 Incision of stomach

nerves C

64760 Incision of vagus

nerve C

64761 Incision of pelvis

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64763 Incise hip/thigh

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64766 Incise hip/thigh

nerve T 0221 37.4067 "$2,596.77"

. $519.36

64771 Sever cranial

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64772 Incision of spinal

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64774 Remove skin nerve

lesion T 0220 19.0626 "$1,323.33"

. $264.67

64776 Remove digit nerve

lesion T 0220 19.0626 "$1,323.33"

. $264.67

64778 Digit nerve surgery

add-on T 0220 19.0626 "$1,323.33"

. $264.67

64782 Remove limb nerve

lesion T 0220 19.0626 "$1,323.33"

. $264.67

64783 Limb nerve surgery

add-on T 0220 19.0626 "$1,323.33"

. $264.67

64784 Remove nerve

lesion T 0220 19.0626 "$1,323.33"

. $264.67

64786 Remove sciatic nerve

lesion T 0221 37.4067 "$2,596.77"

. $519.36

64787 Implant nerve

end T 0220 19.0626 "$1,323.33"

. $264.67

64788 Remove skin nervelesion T 0220 19.0626 "$1,323.33"

. $264.67

64790 Removal of nerve

lesion T 0220 19.0626 "$1,323.33"

. $264.67

64792 Removal of nerve

lesion T 0221 37.4067 "$2,596.77"

. $519.36

64795 Biopsy of

nerve T 0220 19.0626 "$1,323.33"

. $264.67

64802 Remove sympathetic

nerves T 0220 19.0626 "$1,323.33"

. $264.67

64804 Remove sympathetic

nerves T 0220 19.0626 "$1,323.33"

. $264.67

64809 Remove sympathetic

nerves C

64818 Remove sympathetic

nerves C

64820 Remove sympathetic

nerves T 0220 19.0626 "$1,323.33"

. $264.67

64821 Remove sympathetic

nerves T 0054 29.0181 "$2,014.44"

. $402.89

64822 Remove sympathetic

nerves T 0054 29.0181 "$2,014.44"

. $402.89

64823 Remove sympathetic

nerves T 0054 29.0181 "$2,014.44"

. $402.89

64831 Repair of digit

nerve T 0221 37.4067 "$2,596.77"

. $519.36

64832 Repair nerve

add-on T 0221 37.4067 "$2,596.77"

. $519.36

64834 Repair of hand or foot

nerve T 0221 37.4067 "$2,596.77"

. $519.36

64835 Repair of hand or foot

nerve T 0221 37.4067 "$2,596.77"

. $519.36

64836 Repair of hand or foot

nerve T 0221 37.4067 "$2,596.77"

. $519.36

64837 Repair nerveadd-on T 0221 37.4067 "$2,596.77"

. $519.36

64840 Repair of leg

nerve T 0221 37.4067 "$2,596.77"

. $519.36

64856 Repair/transpose

nerve T 0221 37.4067 "$2,596.77"

. $519.36

64857 Repair arm/leg

nerve T 0221 37.4067 "$2,596.77"

. $519.36

64858 Repair sciatic

nerve T 0221 37.4067 "$2,596.77"

. $519.36

64859 Nerve

surgery T 0221 37.4067 "$2,596.77"

. $519.36

64861 Repair of arm

nerves T 0221 37.4067 "$2,596.77"

. $519.36

64862 Repair of low back

nerves T 0221 37.4067 "$2,596.77"

. $519.36

64864 Repair of facial

nerve T 0221 37.4067 "$2,596.77"

. $519.36

64865 Repair of facial

nerve T 0221 37.4067 "$2,596.77"

. $519.36

64866 Fusion of facial/other

nerve C

64868 Fusion of facial/other

nerve C

64870 Fusion of facial/other

nerve T 0221 37.4067 "$2,596.77"

. $519.36

64872 Subsequent repair of

nerve T 0221 37.4067 "$2,596.77"

. $519.36

64874 Repair & revise nerve

add-on T 0221 37.4067 "$2,596.77"

. $519.36

64876 Repair nerve/shorten

bone T 0221 37.4067 "$2,596.77"

. $519.36

64885 Nerve graft head or

neck T 0221 37.4067 "$2,596.77"

. $519.36

64886 Nerve graft head orneck T 0221 37.4067 "$2,596.77"

. $519.36

64890 Nerve graft hand or

foot T 0221 37.4067 "$2,596.77"

. $519.36

64891 Nerve graft hand or

foot T 0221 37.4067 "$2,596.77"

. $519.36

64892 Nerve graft arm or

leg T 0221 37.4067 "$2,596.77"

. $519.36

64893 Nerve graft arm or

leg T 0221 37.4067 "$2,596.77"

. $519.36

64895 Nerve graft hand or

foot T 0221 37.4067 "$2,596.77"

. $519.36

64896 Nerve graft hand or

foot T 0221 37.4067 "$2,596.77"

. $519.36

64897 Nerve graft arm or

leg T 0221 37.4067 "$2,596.77"

. $519.36

64898 Nerve graft arm or

leg T 0221 37.4067 "$2,596.77"

. $519.36

64901 Nerve graft

add-on T 0221 37.4067 "$2,596.77"

. $519.36

64902 Nerve graft

add-on T 0221 37.4067 "$2,596.77"

. $519.36

64905 Nerve pedicle

transfer T 0221 37.4067 "$2,596.77"

. $519.36

64907 Nerve pedicle

transfer T 0221 37.4067 "$2,596.77"

. $519.36

64910 Nerve repair

w/allograft T 0221 37.4067 "$2,596.77"

. $519.36

64911 Neurorraphy w/vein

autograft T 0221 37.4067 "$2,596.77"

. $519.36

64999 Nervous system

surgery T 0204 2.7693 $192.24 $40.13 $38.45

65091 Revise

eye T 0242 40.9376 "$2,841.89" $597.36 $568.3865093 Revise eye with

implant T 0242 40.9376 "$2,841.89" $597.36 $568.38

65101 Removal of

eye T 0242 40.9376 "$2,841.89" $597.36 $568.38

65103 Remove eye/insert

implant T 0242 40.9376 "$2,841.89" $597.36 $568.38

65105 Remove eye/attach

implant T 0242 40.9376 "$2,841.89" $597.36 $568.38

65110 Removal of

eye T 0242 40.9376 "$2,841.89" $597.36 $568.38

65112 Remove eye/revise

socket T 0242 40.9376 "$2,841.89" $597.36 $568.38

65114 Remove eye/revise

socket T 0242 40.9376 "$2,841.89" $597.36 $568.38

65125 Revise ocular

implant T 0241 27.0493 "$1,877.76" $383.45 $375.56

65130 Insert ocular

implant T 0241 27.0493 "$1,877.76" $383.45 $375.56

65135 Insert ocular

implant T 0241 27.0493 "$1,877.76" $383.45 $375.56

65140 Attach ocular

implant T 0242 40.9376 "$2,841.89" $597.36 $568.38

65150 Revise ocular

implant T 0241 27.0493 "$1,877.76" $383.45 $375.56

65155 Reinsert ocular

implant T 0242 40.9376 "$2,841.89" $597.36 $568.38

65175 Removal of ocular

implant T 0240 20.3065 "$1,409.68" $296.20 $281.94

65205 Remove foreign body from

eye S 0698 1.4030 $97.40

. $19.48

65210 Remove foreign body from

eye S 0698 1.4030 $97.40

. $19.48

65220 Remove foreign body fromeye S 0698 1.4030 $97.40

. $19.48

65222 Remove foreign body from

eye S 0698 1.4030 $97.40

. $19.48

65235 Remove foreign body from

eye T 0233 16.8777 "$1,171.65"

. $234.33

65260 Remove foreign body from

eye T 0235 4.9132 $341.07

. $68.22

65265 Remove foreign body from

eye T 0237 22.7865 "$1,581.84"

. $316.37

65270 Repair of eye

wound T 0240 20.3065 "$1,409.68" $296.20 $281.94

65272 Repair of eye

wound T 0234 25.2649 "$1,753.89" $511.31 $350.78

65273 Repair of eye

wound C

65275 Repair of eye

wound T 0234 25.2649 "$1,753.89" $511.31 $350.78

65280 Repair of eye

wound T 0237 22.7865 "$1,581.84"

. $316.37

65285 Repair of eye

wound T 0672 41.3248 "$2,868.77"

. $573.76

65286 Repair of eye

wound T 0255 7.8512 $545.03 $124.97 $109.01

65290 Repair of eye socket

wound T 0243 25.2851 "$1,755.29" $415.27 $351.06

65400 Removal of eye

lesion T 0233 16.8777 "$1,171.65"

. $234.33

65410 Biopsy of

cornea T 0233 16.8777 "$1,171.65"

. $234.33

65420 Removal of eye

lesion T 0233 16.8777 "$1,171.65"

. $234.33

65426 Removal of eye

lesion T 0234 25.2649 "$1,753.89" $511.31 $350.7865430 Corneal

smear S 0698 1.4030 $97.40

. $19.48

65435 Curette/treat

cornea T 0239 8.3090 $576.81

. $115.37

65436 Curette/treat

cornea T 0233 16.8777 "$1,171.65"

. $234.33

65450 Treatment of corneal

lesion S 0231 2.3088 $160.28

. $32.06

65600 Revision of

cornea T 0240 20.3065 "$1,409.68" $296.20 $281.94

65710 Corneal

transplant T 0244 38.4709 "$2,670.65" $800.09 $534.13

65730 Corneal

transplant T 0244 38.4709 "$2,670.65" $800.09 $534.13

65750 Corneal

transplant T 0244 38.4709 "$2,670.65" $800.09 $534.13

65755 Corneal

transplant T 0244 38.4709 "$2,670.65" $800.09 $534.13

65756 Corneal trnspl

endothelial T 0244 38.4709 "$2,670.65" $800.09 $534.13

65757 Prep corneal endo

allograft N

65760 Revision of

cornea E

65765 Revision of

cornea E

65767 Corneal tissue

transplant E

65770 Revise cornea with

implant T 0293 117.7956 "$8,177.37"

. "$1,635.48"

65771 Radial

keratotomy E

65772 Correction of

astigmatism T 0233 16.8777 "$1,171.65"

. $234.33

65775 Correction of

astigmatism T 0233 16.8777 "$1,171.65"

. $234.3365778 Cover eye

w/membrane CH Q2 0233 16.8777 "$1,171.65"

. $234.33

65779 Cover eye w/membrane

suture CH T 0233 16.8777 "$1,171.65"

. $234.33

65780 Ocular reconst

transplant T 0244 38.4709 "$2,670.65" $800.09 $534.13

65781 Ocular reconst

transplant T 0244 38.4709 "$2,670.65" $800.09 $534.13

65782 Ocular reconst

transplant T 0244 38.4709 "$2,670.65" $800.09 $534.13

65800 Drainage of

eye T 0255 7.8512 $545.03 $124.97 $109.01

65805 Drainage of

eye CH T 0234 25.2649 "$1,753.89" $511.31 $350.78

65810 Drainage of

eye T 0234 25.2649 "$1,753.89" $511.31 $350.78

65815 Drainage of

eye T 0234 25.2649 "$1,753.89" $511.31 $350.78

65820 Relieve inner eye

pressure T 0234 25.2649 "$1,753.89" $511.31 $350.78

65850 Incision of

eye T 0234 25.2649 "$1,753.89" $511.31 $350.78

65855 Laser surgery of

eye T 0247 5.5801 $387.37 $104.31 $77.48

65860 Incise inner eye

adhesions T 0247 5.5801 $387.37 $104.31 $77.48

65865 Incise inner eye

adhesions T 0233 16.8777 "$1,171.65"

. $234.33

65870 Incise inner eye

adhesions T 0234 25.2649 "$1,753.89" $511.31 $350.78

65875 Incise inner eye

adhesions T 0234 25.2649 "$1,753.89" $511.31 $350.78

65880 Incise inner eyeadhesions T 0233 16.8777 "$1,171.65"

. $234.33

65900 Remove eye

lesion T 0232 2.9435 $204.34 $42.27 $40.87

65920 Remove implant of

eye T 0234 25.2649 "$1,753.89" $511.31 $350.78

65930 Remove blood clot from

eye T 0234 25.2649 "$1,753.89" $511.31 $350.78

66020 Injection treatment of

eye T 0233 16.8777 "$1,171.65"

. $234.33

66030 Injection treatment of

eye T 0233 16.8777 "$1,171.65"

. $234.33

66130 Remove eye

lesion T 0234 25.2649 "$1,753.89" $511.31 $350.78

66150 Glaucoma

surgery T 0234 25.2649 "$1,753.89" $511.31 $350.78

66155 Glaucoma

surgery T 0234 25.2649 "$1,753.89" $511.31 $350.78

66160 Glaucoma

surgery T 0234 25.2649 "$1,753.89" $511.31 $350.78

66165 Glaucoma

surgery T 0234 25.2649 "$1,753.89" $511.31 $350.78

66170 Glaucoma

surgery T 0234 25.2649 "$1,753.89" $511.31 $350.78

66172 Incision of

eye T 0234 25.2649 "$1,753.89" $511.31 $350.78

66174 Translum dil eye

canal T 0673 41.7832 "$2,900.59" $632.65 $580.12

66175 Trnslum dil eye canal

w/stnt T 0673 41.7832 "$2,900.59" $632.65 $580.12

66180 Implant eye

shunt T 0673 41.7832 "$2,900.59" $632.65 $580.12

66185 Revise eye

shunt T 0234 25.2649 "$1,753.89" $511.31 $350.7866220 Repair eye

lesion T 0672 41.3248 "$2,868.77"

. $573.76

66225 Repair/graft eye

lesion T 0673 41.7832 "$2,900.59" $632.65 $580.12

66250 Follow-up surgery of

eye T 0233 16.8777 "$1,171.65"

. $234.33

66500 Incision of

iris T 0232 2.9435 $204.34 $42.27 $40.87

66505 Incision of

iris T 0255 7.8512 $545.03 $124.97 $109.01

66600 Remove iris and

lesion T 0234 25.2649 "$1,753.89" $511.31 $350.78

66605 Removal of

iris T 0234 25.2649 "$1,753.89" $511.31 $350.78

66625 Removal of

iris T 0255 7.8512 $545.03 $124.97 $109.01

66630 Removal of

iris T 0234 25.2649 "$1,753.89" $511.31 $350.78

66635 Removal of

iris T 0234 25.2649 "$1,753.89" $511.31 $350.78

66680 Repair iris & ciliary

body T 0234 25.2649 "$1,753.89" $511.31 $350.78

66682 Repair iris & ciliary

body T 0234 25.2649 "$1,753.89" $511.31 $350.78

66700 Destruction ciliary

body T 0233 16.8777 "$1,171.65"

. $234.33

66710 Ciliary transsleral

therapy T 0233 16.8777 "$1,171.65"

. $234.33

66711 Ciliary endoscopic

ablation T 0233 16.8777 "$1,171.65"

. $234.33

66720 Destruction ciliary

body T 0233 16.8777 "$1,171.65"

. $234.33

66740 Destruction ciliarybody T 0234 25.2649 "$1,753.89" $511.31 $350.78

66761 Revision of

iris T 0247 5.5801 $387.37 $104.31 $77.48

66762 Revision of

iris T 0247 5.5801 $387.37 $104.31 $77.48

66770 Removal of inner eye

lesion T 0247 5.5801 $387.37 $104.31 $77.48

66820 Incision secondary

cataract T 0255 7.8512 $545.03 $124.97 $109.01

66821 After cataract laser

surgery T 0247 5.5801 $387.37 $104.31 $77.48

66825 Reposition intraocular

lens T 0234 25.2649 "$1,753.89" $511.31 $350.78

66830 Removal of lens

lesion T 0255 7.8512 $545.03 $124.97 $109.01

66840 Removal of lens

material T 0245 15.2776 "$1,060.57"

. $212.12

66850 Removal of lens

material T 0249 30.7811 "$2,136.82" $516.99 $427.37

66852 Removal of lens

material T 0249 30.7811 "$2,136.82" $516.99 $427.37

66920 Extraction of

lens T 0249 30.7811 "$2,136.82" $516.99 $427.37

66930 Extraction of

lens T 0249 30.7811 "$2,136.82" $516.99 $427.37

66940 Extraction of

lens T 0245 15.2776 "$1,060.57"

. $212.12

66982 Cataract surgery

complex T 0246 24.0158 "$1,667.18" $488.94 $333.44

66983 Cataract surg w/iol 1

stage T 0246 24.0158 "$1,667.18" $488.94 $333.44

66984 Cataract surg w/iol 1

stage T 0246 24.0158 "$1,667.18" $488.94 $333.4466985 Insert lens

prosthesis T 0246 24.0158 "$1,667.18" $488.94 $333.44

66986 Exchange lens

prosthesis T 0246 24.0158 "$1,667.18" $488.94 $333.44

66990 Ophthalmic endoscope

add-on N

66999 Eye surgery

procedure T 0232 2.9435 $204.34 $42.27 $40.87

67005 Partial removal of eye

fluid T 0237 22.7865 "$1,581.84"

. $316.37

67010 Partial removal of eye

fluid T 0672 41.3248 "$2,868.77"

. $573.76

67015 Release of eye

fluid T 0672 41.3248 "$2,868.77"

. $573.76

67025 Replace eye

fluid T 0672 41.3248 "$2,868.77"

. $573.76

67027 Implant eye drug

system T 0672 41.3248 "$2,868.77"

. $573.76

67028 Injection eye

drug T 0238 3.3278 $231.02

. $46.21

67030 Incise inner eye

strands T 0237 22.7865 "$1,581.84"

. $316.37

67031 Laser surgery eye

strands T 0247 5.5801 $387.37 $104.31 $77.48

67036 Removal of inner eye

fluid T 0672 41.3248 "$2,868.77"

. $573.76

67039 Laser treatment of

retina T 0672 41.3248 "$2,868.77"

. $573.76

67040 Laser treatment of

retina T 0672 41.3248 "$2,868.77"

. $573.76

67041 Vit for macular

pucker T 0672 41.3248 "$2,868.77"

. $573.76

67042 Vit for macular

hole T 0672 41.3248 "$2,868.77"

. $573.7667043 Vit for membrane

dissect T 0672 41.3248 "$2,868.77"

. $573.76

67101 Repair detached

retina T 0237 22.7865 "$1,581.84"

. $316.37

67105 Repair detached

retina T 0247 5.5801 $387.37 $104.31 $77.48

67107 Repair detached

retina T 0672 41.3248 "$2,868.77"

. $573.76

67108 Repair detached

retina T 0672 41.3248 "$2,868.77"

. $573.76

67110 Repair detached

retina T 0237 22.7865 "$1,581.84"

. $316.37

67112 Rerepair detached

retina T 0672 41.3248 "$2,868.77"

. $573.76

67113 Repair retinal detach

cplx T 0672 41.3248 "$2,868.77"

. $573.76

67115 Release encircling

material T 0237 22.7865 "$1,581.84"

. $316.37

67120 Remove eye implant

material T 0237 22.7865 "$1,581.84"

. $316.37

67121 Remove eye implant

material T 0672 41.3248 "$2,868.77"

. $573.76

67141 Treatment of

retina T 0235 4.9132 $341.07

. $68.22

67145 Treatment of

retina T 0247 5.5801 $387.37 $104.31 $77.48

67208 Treatment of retinal

lesion T 0235 4.9132 $341.07

. $68.22

67210 Treatment of retinal

lesion T 0247 5.5801 $387.37 $104.31 $77.48

67218 Treatment of retinal

lesion T 0237 22.7865 "$1,581.84"

. $316.3767220 Treatment of choroid

lesion T 0235 4.9132 $341.07

. $68.22

67221 Ocular photodynamic

ther T 0235 4.9132 $341.07

. $68.22

67225 Eye photodynamic ther

add-on T 0235 4.9132 $341.07

. $68.22

67227 Treatment of retinal

lesion T 0237 22.7865 "$1,581.84"

. $316.37

67228 Treatment of retinal

lesion T 0247 5.5801 $387.37 $104.31 $77.48

67229 Tr retinal les preterm

inf T 0247 5.5801 $387.37 $104.31 $77.48

67250 Reinforce eye

wall T 0240 20.3065 "$1,409.68" $296.20 $281.94

67255 Reinforce/graft eye

wall T 0237 22.7865 "$1,581.84"

. $316.37

67299 Eye surgery

procedure T 0235 4.9132 $341.07

. $68.22

67311 Revise eye

muscle T 0243 25.2851 "$1,755.29" $415.27 $351.06

67312 Revise two eye

muscles T 0243 25.2851 "$1,755.29" $415.27 $351.06

67314 Revise eye

muscle T 0243 25.2851 "$1,755.29" $415.27 $351.06

67316 Revise two eye

muscles T 0243 25.2851 "$1,755.29" $415.27 $351.06

67318 Revise eye

muscle(s) T 0243 25.2851 "$1,755.29" $415.27 $351.06

67320 Revise eye muscle(s)

add-on T 0243 25.2851 "$1,755.29" $415.27 $351.06

67331 Eye surgery follow-up

add-on T 0243 25.2851 "$1,755.29" $415.27 $351.06

67332 Rerevise eye muscles

add-on T 0243 25.2851 "$1,755.29" $415.27 $351.0667334 Revise eye muscle

w/suture T 0243 25.2851 "$1,755.29" $415.27 $351.06

67335 Eye suture during

surgery T 0243 25.2851 "$1,755.29" $415.27 $351.06

67340 Revise eye muscle

add-on T 0243 25.2851 "$1,755.29" $415.27 $351.06

67343 Release eye

tissue T 0243 25.2851 "$1,755.29" $415.27 $351.06

67345 Destroy nerve of eye

muscle T 0238 3.3278 $231.02

. $46.21

67346 Biopsy eye

muscle T 0699 15.6140 "$1,083.92"

. $216.79

67399 Eye muscle surgery

procedure T 0243 25.2851 "$1,755.29" $415.27 $351.06

67400 Explore/biopsy eye

socket T 0240 20.3065 "$1,409.68" $296.20 $281.94

67405 Explore/drain eye

socket T 0241 27.0493 "$1,877.76" $383.45 $375.56

67412 Explore/treat eye

socket T 0240 20.3065 "$1,409.68" $296.20 $281.94

67413 Explore/treat eye

socket T 0241 27.0493 "$1,877.76" $383.45 $375.56

67414 Explr/decompress eye

socket T 0242 40.9376 "$2,841.89" $597.36 $568.38

67415 Aspiration orbital

contents T 0240 20.3065 "$1,409.68" $296.20 $281.94

67420 Explore/treat eye

socket T 0242 40.9376 "$2,841.89" $597.36 $568.38

67430 Explore/treat eye

socket T 0242 40.9376 "$2,841.89" $597.36 $568.38

67440 Explore/drain eye

socket T 0242 40.9376 "$2,841.89" $597.36 $568.3867445 Explr/decompress eye

socket T 0242 40.9376 "$2,841.89" $597.36 $568.38

67450 Explore/biopsy eye

socket T 0242 40.9376 "$2,841.89" $597.36 $568.38

67500 Inject/treat eye

socket S 0231 2.3088 $160.28

. $32.06

67505 Inject/treat eye

socket T 0238 3.3278 $231.02

. $46.21

67515 Inject/treat eye

socket T 0238 3.3278 $231.02

. $46.21

67550 Insert eye socket

implant T 0242 40.9376 "$2,841.89" $597.36 $568.38

67560 Revise eye socket

implant T 0241 27.0493 "$1,877.76" $383.45 $375.56

67570 Decompress optic

nerve T 0242 40.9376 "$2,841.89" $597.36 $568.38

67599 Orbit surgery

procedure T 0238 3.3278 $231.02

. $46.21

67700 Drainage of eyelid

abscess T 0238 3.3278 $231.02

. $46.21

67710 Incision of

eyelid T 0239 8.3090 $576.81

. $115.37

67715 Incision of eyelid

fold T 0240 20.3065 "$1,409.68" $296.20 $281.94

67800 Remove eyelid

lesion T 0238 3.3278 $231.02

. $46.21

67801 Remove eyelid

lesions T 0239 8.3090 $576.81

. $115.37

67805 Remove eyelid

lesions T 0238 3.3278 $231.02

. $46.21

67808 Remove eyelid

lesion(s) T 0240 20.3065 "$1,409.68" $296.20 $281.94

67810 Biopsy of

eyelid T 0238 3.3278 $231.02

. $46.2167820 Revise

eyelashes S 0698 1.4030 $97.40

. $19.48

67825 Revise

eyelashes T 0238 3.3278 $231.02

. $46.21

67830 Revise

eyelashes T 0239 8.3090 $576.81

. $115.37

67835 Revise

eyelashes T 0240 20.3065 "$1,409.68" $296.20 $281.94

67840 Remove eyelid

lesion T 0239 8.3090 $576.81

. $115.37

67850 Treat eyelid

lesion T 0239 8.3090 $576.81

. $115.37

67875 Closure of eyelid by

suture T 0239 8.3090 $576.81

. $115.37

67880 Revision of

eyelid T 0233 16.8777 "$1,171.65"

. $234.33

67882 Revision of

eyelid T 0240 20.3065 "$1,409.68" $296.20 $281.94

67900 Repair brow

defect T 0241 27.0493 "$1,877.76" $383.45 $375.56

67901 Repair eyelid

defect T 0240 20.3065 "$1,409.68" $296.20 $281.94

67902 Repair eyelid

defect T 0241 27.0493 "$1,877.76" $383.45 $375.56

67903 Repair eyelid

defect T 0240 20.3065 "$1,409.68" $296.20 $281.94

67904 Repair eyelid

defect T 0240 20.3065 "$1,409.68" $296.20 $281.94

67906 Repair eyelid

defect T 0240 20.3065 "$1,409.68" $296.20 $281.94

67908 Repair eyelid

defect T 0240 20.3065 "$1,409.68" $296.20 $281.9467909 Revise eyelid

defect T 0240 20.3065 "$1,409.68" $296.20 $281.94

67911 Revise eyelid

defect T 0240 20.3065 "$1,409.68" $296.20 $281.94

67912 Correction eyelid

w/implant T 0240 20.3065 "$1,409.68" $296.20 $281.94

67914 Repair eyelid

defect T 0240 20.3065 "$1,409.68" $296.20 $281.94

67915 Repair eyelid

defect T 0240 20.3065 "$1,409.68" $296.20 $281.94

67916 Repair eyelid

defect T 0240 20.3065 "$1,409.68" $296.20 $281.94

67917 Repair eyelid

defect T 0240 20.3065 "$1,409.68" $296.20 $281.94

67921 Repair eyelid

defect T 0240 20.3065 "$1,409.68" $296.20 $281.94

67922 Repair eyelid

defect T 0240 20.3065 "$1,409.68" $296.20 $281.94

67923 Repair eyelid

defect T 0240 20.3065 "$1,409.68" $296.20 $281.94

67924 Repair eyelid

defect T 0240 20.3065 "$1,409.68" $296.20 $281.94

67930 Repair eyelid

wound T 0240 20.3065 "$1,409.68" $296.20 $281.94

67935 Repair eyelid

wound T 0240 20.3065 "$1,409.68" $296.20 $281.94

67938 Remove eyelid foreign

body S 0231 2.3088 $160.28

. $32.06

67950 Revision of

eyelid T 0240 20.3065 "$1,409.68" $296.20 $281.94

67961 Revision of

eyelid T 0240 20.3065 "$1,409.68" $296.20 $281.94

67966 Revision of

eyelid T 0240 20.3065 "$1,409.68" $296.20 $281.9467971 Reconstruction of

eyelid T 0240 20.3065 "$1,409.68" $296.20 $281.94

67973 Reconstruction of

eyelid T 0241 27.0493 "$1,877.76" $383.45 $375.56

67974 Reconstruction of

eyelid T 0240 20.3065 "$1,409.68" $296.20 $281.94

67975 Reconstruction of

eyelid T 0240 20.3065 "$1,409.68" $296.20 $281.94

67999 Revision of

eyelid T 0238 3.3278 $231.02

. $46.21

68020 Incise/drain eyelid

lining T 0238 3.3278 $231.02

. $46.21

68040 Treatment of eyelid

lesions S 0698 1.4030 $97.40

. $19.48

68100 Biopsy of eyelid lining CH

T 0239 8.3090 $576.81

. $115.37

68110 Remove eyelid lining

lesion T 0699 15.6140 "$1,083.92"

. $216.79

68115 Remove eyelid lining

lesion T 0240 20.3065 "$1,409.68" $296.20 $281.94

68130 Remove eyelid lining

lesion T 0233 16.8777 "$1,171.65"

. $234.33

68135 Remove eyelid lining

lesion T 0239 8.3090 $576.81

. $115.37

68200 Treat eyelid by

injection CH S 0230 0.6929 $48.10

. $9.62

68320 Revise/graft eyelid

lining T 0241 27.0493 "$1,877.76" $383.45 $375.56

68325 Revise/graft eyelid

lining T 0241 27.0493 "$1,877.76" $383.45 $375.56

68326 Revise/graft eyelid

lining T 0240 20.3065 "$1,409.68" $296.20 $281.9468328 Revise/graft eyelid

lining T 0241 27.0493 "$1,877.76" $383.45 $375.56

68330 Revise eyelid

lining T 0234 25.2649 "$1,753.89" $511.31 $350.78

68335 Revise/graft eyelid

lining T 0241 27.0493 "$1,877.76" $383.45 $375.56

68340 Separate eyelid

adhesions T 0240 20.3065 "$1,409.68" $296.20 $281.94

68360 Revise eyelid

lining T 0234 25.2649 "$1,753.89" $511.31 $350.78

68362 Revise eyelid

lining T 0234 25.2649 "$1,753.89" $511.31 $350.78

68371 Harvest eye tissue

alograft CH T 0234 25.2649 "$1,753.89" $511.31 $350.78

68399 Eyelid lining

surgery T 0238 3.3278 $231.02

. $46.21

68400 Incise/drain tear

gland T 0238 3.3278 $231.02

. $46.21

68420 Incise/drain tear

sac T 0240 20.3065 "$1,409.68" $296.20 $281.94

68440 Incise tear duct

opening T 0238 3.3278 $231.02

. $46.21

68500 Removal of tear

gland T 0241 27.0493 "$1,877.76" $383.45 $375.56

68505 Partial removal tear

gland T 0241 27.0493 "$1,877.76" $383.45 $375.56

68510 Biopsy of tear

gland T 0240 20.3065 "$1,409.68" $296.20 $281.94

68520 Removal of tear

sac T 0241 27.0493 "$1,877.76" $383.45 $375.56

68525 Biopsy of tear

sac T 0240 20.3065 "$1,409.68" $296.20 $281.94

68530 Clearance of tear

duct T 0238 3.3278 $231.02

. $46.2168540 Remove tear gland

lesion T 0240 20.3065 "$1,409.68" $296.20 $281.94

68550 Remove tear gland

lesion T 0241 27.0493 "$1,877.76" $383.45 $375.56

68700 Repair tear

ducts T 0240 20.3065 "$1,409.68" $296.20 $281.94

68705 Revise tear duct

opening T 0238 3.3278 $231.02

. $46.21

68720 Create tear sac

drain T 0241 27.0493 "$1,877.76" $383.45 $375.56

68745 Create tear duct

drain T 0241 27.0493 "$1,877.76" $383.45 $375.56

68750 Create tear duct

drain T 0241 27.0493 "$1,877.76" $383.45 $375.56

68760 Close tear duct

opening T 0238 3.3278 $231.02

. $46.21

68761 Close tear duct

opening T 0238 3.3278 $231.02

. $46.21

68770 Close tear system

fistula T 0241 27.0493 "$1,877.76" $383.45 $375.56

68801 Dilate tear duct

opening S 0698 1.4030 $97.40

. $19.48

68810 Probe nasolacrimal

duct T 0238 3.3278 $231.02

. $46.21

68811 Probe nasolacrimal

duct T 0240 20.3065 "$1,409.68" $296.20 $281.94

68815 Probe nasolacrimal

duct T 0240 20.3065 "$1,409.68" $296.20 $281.94

68816 Probe nl duct

w/balloon T 0240 20.3065 "$1,409.68" $296.20 $281.94

68840 Explore/irrigate tear

ducts S 0231 2.3088 $160.28

. $32.0668850 Injection for tear sac

x-ray N

68899 Tear duct system

surgery T 0238 3.3278 $231.02

. $46.21

69000 Drain external ear

lesion T 0006 1.4481 $100.53

. $20.11

69005 Drain external ear

lesion T 0008 20.5401 "$1,425.89"

. $285.18

69020 Drain outer ear canal

lesion T 0006 1.4481 $100.53

. $20.11

69090 Pierce

earlobes E

69100 Biopsy of external

ear T 0251 3.3531 $232.77

. $46.56

69105 Biopsy of external ear

canal T 0253 16.9180 "$1,174.45" $277.61 $234.89

69110 Remove external ear

partial T 0021 17.1909 "$1,193.39"

. $238.68

69120 Removal of external

ear T 0254 25.1379 "$1,745.07"

. $349.02

69140 Remove ear canal

lesion(s) T 0254 25.1379 "$1,745.07"

. $349.02

69145 Remove ear canal

lesion(s) T 0021 17.1909 "$1,193.39"

. $238.68

69150 Extensive ear canal

surgery T 0252 8.0353 $557.81

. $111.57

69155 Extensive ear/neck

surgery C

69200 Clear outer ear

canal X 0340 0.6739 $46.78

. $9.36

69205 Clear outer ear

canal T 0022 23.4169 "$1,625.60" $350.05 $325.12

69210 Remove impacted ear

wax X 0340 0.6739 $46.78

. $9.36

69220 Clean out mastoidcavity T 0013 0.9786 $67.93

. $13.59

69222 Clean out mastoid

cavity T 0253 16.9180 "$1,174.45" $277.61 $234.89

69300 Revise external

ear T 0254 25.1379 "$1,745.07"

. $349.02

69310 Rebuild outer ear

canal T 0256 45.1286 "$3,132.83"

. $626.57

69320 Rebuild outer ear

canal T 0256 45.1286 "$3,132.83"

. $626.57

69399 Outer ear surgery

procedure T 0250 1.0875 $75.49 $24.28 $15.10

69400 Inflate middle ear

canal T 0251 3.3531 $232.77

. $46.56

69401 Inflate middle ear

canal T 0251 3.3531 $232.77

. $46.56

69405 Catheterize middle ear

canal T 0252 8.0353 $557.81

. $111.57

69420 Incision of

eardrum T 0251 3.3531 $232.77

. $46.56

69421 Incision of

eardrum T 0253 16.9180 "$1,174.45" $277.61 $234.89

69424 Remove ventilating

tube T 0253 16.9180 "$1,174.45" $277.61 $234.89

69433 Create eardrum

opening T 0252 8.0353 $557.81

. $111.57

69436 Create eardrum

opening T 0253 16.9180 "$1,174.45" $277.61 $234.89

69440 Exploration of middle

ear T 0254 25.1379 "$1,745.07"

. $349.02

69450 Eardrum

revision T 0256 45.1286 "$3,132.83"

. $626.57

69501 Mastoidectomy T 0256 45.1286 "$3,132.83"

. $626.5769502 Mastoidectomy T 0254 25.1379 "$1,745.07"

. $349.02

69505 Remove mastoid

structures T 0256 45.1286 "$3,132.83"

. $626.57

69511 Extensive mastoid

surgery T 0256 45.1286 "$3,132.83"

. $626.57

69530 Extensive mastoid

surgery T 0256 45.1286 "$3,132.83"

. $626.57

69535 Remove part of temporal

bone C

69540 Remove ear

lesion T 0253 16.9180 "$1,174.45" $277.61 $234.89

69550 Remove ear

lesion T 0256 45.1286 "$3,132.83"

. $626.57

69552 Remove ear

lesion T 0256 45.1286 "$3,132.83"

. $626.57

69554 Remove ear

lesion C

69601 Mastoid surgery

revision T 0256 45.1286 "$3,132.83"

. $626.57

69602 Mastoid surgery

revision T 0256 45.1286 "$3,132.83"

. $626.57

69603 Mastoid surgery

revision T 0256 45.1286 "$3,132.83"

. $626.57

69604 Mastoid surgery

revision T 0256 45.1286 "$3,132.83"

. $626.57

69605 Mastoid surgery

revision T 0256 45.1286 "$3,132.83"

. $626.57

69610 Repair of

eardrum T 0254 25.1379 "$1,745.07"

. $349.02

69620 Repair of

eardrum T 0254 25.1379 "$1,745.07"

. $349.02

69631 Repair eardrum

structures T 0256 45.1286 "$3,132.83"

. $626.57

69632 Rebuild eardrumstructures T 0256 45.1286 "$3,132.83"

. $626.57

69633 Rebuild eardrum

structures T 0256 45.1286 "$3,132.83"

. $626.57

69635 Repair eardrum

structures T 0256 45.1286 "$3,132.83"

. $626.57

69636 Rebuild eardrum

structures T 0256 45.1286 "$3,132.83"

. $626.57

69637 Rebuild eardrum

structures T 0256 45.1286 "$3,132.83"

. $626.57

69641 Revise middle ear &

mastoid T 0256 45.1286 "$3,132.83"

. $626.57

69642 Revise middle ear &

mastoid T 0256 45.1286 "$3,132.83"

. $626.57

69643 Revise middle ear &

mastoid T 0256 45.1286 "$3,132.83"

. $626.57

69644 Revise middle ear &

mastoid T 0256 45.1286 "$3,132.83"

. $626.57

69645 Revise middle ear &

mastoid T 0256 45.1286 "$3,132.83"

. $626.57

69646 Revise middle ear &

mastoid T 0256 45.1286 "$3,132.83"

. $626.57

69650 Release middle ear

bone T 0254 25.1379 "$1,745.07"

. $349.02

69660 Revise middle ear

bone T 0256 45.1286 "$3,132.83"

. $626.57

69661 Revise middle ear

bone T 0256 45.1286 "$3,132.83"

. $626.57

69662 Revise middle ear

bone T 0256 45.1286 "$3,132.83"

. $626.57

69666 Repair middle ear

structures T 0256 45.1286 "$3,132.83"

. $626.57

69667 Repair middle ear

structures T 0256 45.1286 "$3,132.83"

. $626.5769670 Remove mastoid air

cells T 0256 45.1286 "$3,132.83"

. $626.57

69676 Remove middle ear

nerve T 0256 45.1286 "$3,132.83"

. $626.57

69700 Close mastoid

fistula T 0256 45.1286 "$3,132.83"

. $626.57

69710 Implant/replace hearing

aid E

69711 Remove/repair hearing

aid T 0256 45.1286 "$3,132.83"

. $626.57

69714 Implant temple bone

w/stimul T 0425 130.4476 "$9,055.67"

. "$1,811.14"

69715 Temple bne implnt

w/stimulat T 0425 130.4476 "$9,055.67"

. "$1,811.14"

69717 Temple bone implant

revision T 0425 130.4476 "$9,055.67"

. "$1,811.14"

69718 Revise temple bone

implant T 0425 130.4476 "$9,055.67"

. "$1,811.14"

69720 Release facial

nerve T 0256 45.1286 "$3,132.83"

. $626.57

69725 Release facial

nerve T 0256 45.1286 "$3,132.83"

. $626.57

69740 Repair facial

nerve T 0256 45.1286 "$3,132.83"

. $626.57

69745 Repair facial

nerve T 0256 45.1286 "$3,132.83"

. $626.57

69799 Middle ear surgery

procedure T 0250 1.0875 $75.49 $24.28 $15.10

69801 Incise inner

ear T 0253 16.9180 "$1,174.45" $277.61 $234.89

69802 Incise inner

ear T 0254 25.1379 "$1,745.07"

. $349.02

69805 Explore inner

ear T 0256 45.1286 "$3,132.83"

. $626.5769806 Explore inner

ear T 0256 45.1286 "$3,132.83"

. $626.57

69820 Establish inner ear

window T 0256 45.1286 "$3,132.83"

. $626.57

69840 Revise inner ear

window T 0256 45.1286 "$3,132.83"

. $626.57

69905 Remove inner

ear T 0256 45.1286 "$3,132.83"

. $626.57

69910 Remove inner ear &

mastoid T 0256 45.1286 "$3,132.83"

. $626.57

69915 Incise inner ear

nerve T 0256 45.1286 "$3,132.83"

. $626.57

69930 Implant cochlear

device T 0259 395.1320 "$27,430.06" "$7,545.06" "$5,486.02"

69949 Inner ear surgery

procedure T 0250 1.0875 $75.49 $24.28 $15.10

69950 Incise inner ear

nerve C

69955 Release facial

nerve T 0256 45.1286 "$3,132.83"

. $626.57

69960 Release inner ear

canal T 0256 45.1286 "$3,132.83"

. $626.57

69970 Remove inner ear

lesion T 0256 45.1286 "$3,132.83"

. $626.57

69979 Temporal bone

surgery T 0250 1.0875 $75.49 $24.28 $15.10

69990 Microsurgery

add-on N

70010 Contrast x-ray of

brain Q2 0274 6.9677 $483.70

. $96.74

70015 Contrast x-ray of

brain Q2 0274 6.9677 $483.70

. $96.74

70030 X-ray eye for foreign

body X 0260 0.6418 $44.55

. $8.9170100 X-ray exam of

jaw X 0260 0.6418 $44.55

. $8.91

70110 X-ray exam of

jaw X 0260 0.6418 $44.55

. $8.91

70120 X-ray exam of

mastoids X 0260 0.6418 $44.55

. $8.91

70130 X-ray exam of

mastoids X 0260 0.6418 $44.55

. $8.91

70134 X-ray exam of middle

ear X 0261 1.0831 $75.19

. $15.04

70140 X-ray exam of facial

bones X 0260 0.6418 $44.55

. $8.91

70150 X-ray exam of facial

bones X 0260 0.6418 $44.55

. $8.91

70160 X-ray exam of nasal

bones X 0260 0.6418 $44.55

. $8.91

70170 X-ray exam of tear

duct Q2 0263 3.3928 $235.53

. $47.11

70190 X-ray exam of eye

sockets X 0260 0.6418 $44.55

. $8.91

70200 X-ray exam of eye

sockets X 0260 0.6418 $44.55

. $8.91

70210 X-ray exam of

sinuses X 0260 0.6418 $44.55

. $8.91

70220 X-ray exam of

sinuses X 0260 0.6418 $44.55

. $8.91

70240 X-ray exam pituitary

saddle X 0260 0.6418 $44.55

. $8.91

70250 X-ray exam of

skull X 0260 0.6418 $44.55

. $8.91

70260 X-ray exam of

skull X 0261 1.0831 $75.19

. $15.0470300 X-ray exam of

teeth X 0262 0.4650 $32.28

. $6.46

70310 X-ray exam of

teeth X 0262 0.4650 $32.28

. $6.46

70320 Full mouth x-ray of

teeth X 0262 0.4650 $32.28

. $6.46

70328 X-ray exam of jaw

joint X 0260 0.6418 $44.55

. $8.91

70330 X-ray exam of jaw

joints X 0260 0.6418 $44.55

. $8.91

70332 X-ray exam of jaw joint Q2

0275 3.9868 $276.76 $68.90 $55.36

70336 Magnetic image jaw

joint Q3 0336 4.8219 $334.74 $131.90 $66.95

70350 X-ray head for

orthodontia X 0260 0.6418 $44.55

. $8.91

70355 Panoramic x-ray of

jaws X 0262 0.4650 $32.28

. $6.46

70360 X-ray exam of

neck X 0260 0.6418 $44.55

. $8.91

70370 Throat x-ray &

fluoroscopy X 0272 1.2481 $86.64 $30.47 $17.33

70371 Speech evaluation

complex X 0272 1.2481 $86.64 $30.47 $17.33

70373 Contrast x-ray of

larynx Q2 0263 3.3928 $235.53

. $47.11

70380 X-ray exam of salivary

gland X 0260 0.6418 $44.55

. $8.91

70390 X-ray exam of salivary duct Q2

0263 3.3928 $235.53

. $47.11

70450 Ct head/brain w/o

dye Q3 0332 2.7424 $190.38 $73.61 $38.08

70460 Ct head/brain

w/dye Q3 0283 4.2806 $297.16 $95.77 $59.4470470 Ct head/brain w/o &

w/dye Q3 0333 4.7716 $331.24 $115.09 $66.25

70480 Ct orbit/ear/fossa w/o

dye Q3 0332 2.7424 $190.38 $73.61 $38.08

70481 Ct orbit/ear/fossa

w/dye Q3 0283 4.2806 $297.16 $95.77 $59.44

70482 Ct orbit/ear/fossa

w/o&w/dye Q3 0333 4.7716 $331.24 $115.09 $66.25

70486 Ct maxillofacial w/o

dye Q3 0332 2.7424 $190.38 $73.61 $38.08

70487 Ct maxillofacial

w/dye Q3 0283 4.2806 $297.16 $95.77 $59.44

70488 Ct maxillofacial w/o &

w/dye Q3 0333 4.7716 $331.24 $115.09 $66.25

70490 Ct soft tissue neck w/o

dye Q3 0332 2.7424 $190.38 $73.61 $38.08

70491 Ct soft tissue neck

w/dye Q3 0283 4.2806 $297.16 $95.77 $59.44

70492 Ct sft tsue nck w/o &

w/dye Q3 0333 4.7716 $331.24 $115.09 $66.25

70496 Ct angiography

head Q3 0662 4.8432 $336.21 $113.59 $67.25

70498 Ct angiography

neck Q3 0662 4.8432 $336.21 $113.59 $67.25

70540 Mri orbit/face/neck w/o

dye Q3 0336 4.8219 $334.74 $131.90 $66.95

70542 Mri orbit/face/neck

w/dye Q3 0284 6.1872 $429.52 $144.34 $85.91

70543 Mri orbt/fac/nck w/o &

w/dye Q3 0337 7.6393 $530.32 $196.43 $106.07

70544 Mr angiography head w/o

dye Q3 0336 4.8219 $334.74 $131.90 $66.9570545 Mr angiography head

w/dye Q3 0284 6.1872 $429.52 $144.34 $85.91

70546 Mr angiograph head

w/o&w/dye Q3 0337 7.6393 $530.32 $196.43 $106.07

70547 Mr angiography neck w/o

dye Q3 0336 4.8219 $334.74 $131.90 $66.95

70548 Mr angiography neck

w/dye Q3 0284 6.1872 $429.52 $144.34 $85.91

70549 Mr angiograph neck

w/o&w/dye Q3 0337 7.6393 $530.32 $196.43 $106.07

70551 Mri brain w/o

dye Q3 0336 4.8219 $334.74 $131.90 $66.95

70552 Mri brain

w/dye Q3 0284 6.1872 $429.52 $144.34 $85.91

70553 Mri brain w/o &

w/dye Q3 0337 7.6393 $530.32 $196.43 $106.07

70554 Fmri brain by

tech Q3 0336 4.8219 $334.74 $131.90 $66.95

70555 Fmri brain by

phys/psych S 0336 4.8219 $334.74 $131.90 $66.95

70557 Mri brain w/o

dye S 0336 4.8219 $334.74 $131.90 $66.95

70558 Mri brain

w/dye S 0284 6.1872 $429.52 $144.34 $85.91

70559 Mri brain w/o &

w/dye S 0337 7.6393 $530.32 $196.43 $106.07

71010 Chest

x-ray Q3 0260 0.6418 $44.55

. $8.91

71015 Chest

x-ray Q3 0260 0.6418 $44.55

. $8.91

71020 Chest

x-ray Q3 0260 0.6418 $44.55

. $8.91

71021 Chest

x-ray X 0260 0.6418 $44.55

. $8.9171022 Chest

x-ray X 0260 0.6418 $44.55

. $8.91

71023 Chest x-ray and

fluoroscopy X 0272 1.2481 $86.64 $30.47 $17.33

71030 Chest

x-ray X 0260 0.6418 $44.55

. $8.91

71034 Chest x-ray and

fluoroscopy X 0272 1.2481 $86.64 $30.47 $17.33

71035 Chest

x-ray X 0260 0.6418 $44.55

. $8.91

71040 Contrast x-ray of bronchi Q2

0263 3.3928 $235.53

. $47.11

71060 Contrast x-ray of bronchi Q2

0263 3.3928 $235.53

. $47.11

71090 X-ray & pacemaker insertion N

71100 X-ray exam of

ribs X 0260 0.6418 $44.55

. $8.91

71101 X-ray exam of

ribs/chest X 0260 0.6418 $44.55

. $8.91

71110 X-ray exam of

ribs X 0260 0.6418 $44.55

. $8.91

71111 X-ray exam of

ribs/chest X 0261 1.0831 $75.19

. $15.04

71120 X-ray exam of

breastbone X 0260 0.6418 $44.55

. $8.91

71130 X-ray exam of

breastbone X 0260 0.6418 $44.55

. $8.91

71250 Ct thorax w/o

dye Q3 0332 2.7424 $190.38 $73.61 $38.08

71260 Ct thorax

w/dye Q3 0283 4.2806 $297.16 $95.77 $59.44

71270 Ct thorax w/o &w/dye Q3 0333 4.7716 $331.24 $115.09 $66.25

71275 Ct angiography

chest Q3 0662 4.8432 $336.21 $113.59 $67.25

71550 Mri chest w/o

dye Q3 0336 4.8219 $334.74 $131.90 $66.95

71551 Mri chest

w/dye Q3 0284 6.1872 $429.52 $144.34 $85.91

71552 Mri chest w/o &

w/dye Q3 0337 7.6393 $530.32 $196.43 $106.07

71555 Mri angio chest w or w/o

dye B

72010 X-ray exam of

spine X 0261 1.0831 $75.19

. $15.04

72020 X-ray exam of

spine X 0260 0.6418 $44.55

. $8.91

72040 X-ray exam of neck

spine X 0260 0.6418 $44.55

. $8.91

72050 X-ray exam of neck

spine X 0261 1.0831 $75.19

. $15.04

72052 X-ray exam of neck

spine X 0261 1.0831 $75.19

. $15.04

72069 X-ray exam of trunk

spine X 0260 0.6418 $44.55

. $8.91

72070 X-ray exam of thoracic

spine X 0260 0.6418 $44.55

. $8.91

72072 X-ray exam of thoracic

spine X 0260 0.6418 $44.55

. $8.91

72074 X-ray exam of thoracic

spine X 0260 0.6418 $44.55

. $8.91

72080 X-ray exam of trunk

spine X 0260 0.6418 $44.55

. $8.91

72090 X-ray exam of trunk

spine X 0261 1.0831 $75.19

. $15.0472100 X-ray exam of lower

spine X 0260 0.6418 $44.55

. $8.91

72110 X-ray exam of lower

spine X 0261 1.0831 $75.19

. $15.04

72114 X-ray exam of lower

spine X 0261 1.0831 $75.19

. $15.04

72120 X-ray exam of lower

spine X 0260 0.6418 $44.55

. $8.91

72125 Ct neck spine w/o

dye Q3 0332 2.7424 $190.38 $73.61 $38.08

72126 Ct neck spine

w/dye Q3 0283 4.2806 $297.16 $95.77 $59.44

72127 Ct neck spine w/o &

w/dye Q3 0333 4.7716 $331.24 $115.09 $66.25

72128 Ct chest spine w/o

dye Q3 0332 2.7424 $190.38 $73.61 $38.08

72129 Ct chest spine

w/dye Q3 0283 4.2806 $297.16 $95.77 $59.44

72130 Ct chest spine w/o &

w/dye Q3 0333 4.7716 $331.24 $115.09 $66.25

72131 Ct lumbar spine w/o

dye Q3 0332 2.7424 $190.38 $73.61 $38.08

72132 Ct lumbar spine

w/dye Q3 0283 4.2806 $297.16 $95.77 $59.44

72133 Ct lumbar spine w/o &

w/dye Q3 0333 4.7716 $331.24 $115.09 $66.25

72141 Mri neck spine w/o

dye Q3 0336 4.8219 $334.74 $131.90 $66.95

72142 Mri neck spine

w/dye Q3 0284 6.1872 $429.52 $144.34 $85.91

72146 Mri chest spine w/o

dye Q3 0336 4.8219 $334.74 $131.90 $66.95

72147 Mri chest spine

w/dye Q3 0284 6.1872 $429.52 $144.34 $85.9172148 Mri lumbar spine w/o

dye Q3 0336 4.8219 $334.74 $131.90 $66.95

72149 Mri lumbar spine

w/dye Q3 0284 6.1872 $429.52 $144.34 $85.91

72156 Mri neck spine w/o &

w/dye Q3 0337 7.6393 $530.32 $196.43 $106.07

72157 Mri chest spine w/o &

w/dye Q3 0337 7.6393 $530.32 $196.43 $106.07

72158 Mri lumbar spine w/o &

w/dye Q3 0337 7.6393 $530.32 $196.43 $106.07

72159 Mr angio spine

w/o&w/dye B

72170 X-ray exam of

pelvis X 0260 0.6418 $44.55

. $8.91

72190 X-ray exam of

pelvis X 0260 0.6418 $44.55

. $8.91

72191 Ct angiograph pelv

w/o&w/dye Q3 0662 4.8432 $336.21 $113.59 $67.25

72192 Ct pelvis w/o

dye Q3 0332 2.7424 $190.38 $73.61 $38.08

72193 Ct pelvis

w/dye Q3 0283 4.2806 $297.16 $95.77 $59.44

72194 Ct pelvis w/o &

w/dye Q3 0333 4.7716 $331.24 $115.09 $66.25

72195 Mri pelvis w/o

dye Q3 0336 4.8219 $334.74 $131.90 $66.95

72196 Mri pelvis

w/dye Q3 0284 6.1872 $429.52 $144.34 $85.91

72197 Mri pelvis w/o &

w/dye Q3 0337 7.6393 $530.32 $196.43 $106.07

72198 Mr angio pelvis w/o &

w/dye B

72200 X-ray exam sacroiliac

joints X 0260 0.6418 $44.55

. $8.9172202 X-ray exam sacroiliac

joints X 0260 0.6418 $44.55

. $8.91

72220 X-ray exam of

tailbone X 0260 0.6418 $44.55

. $8.91

72240 Contrast x-ray of neck spine Q2

0274 6.9677 $483.70

. $96.74

72255 Contrast x-ray thorax spine Q2

0274 6.9677 $483.70

. $96.74

72265 Contrast x-ray lower spine Q2

0274 6.9677 $483.70

. $96.74

72270 Contrast x-ray spine Q2

0274 6.9677 $483.70

. $96.74

72275 Epidurography N

72285 X-ray c/t spine disk Q2

0388 23.0551 "$1,600.49"

. $320.10

72291 Perq verte/sacroplsty fluor N

72292 Perq verte/sacroplsty ct N

72295 X-ray of lower spine disk Q2

0388 23.0551 "$1,600.49"

. $320.10

73000 X-ray exam of collar

bone X 0260 0.6418 $44.55

. $8.91

73010 X-ray exam of shoulder

blade X 0260 0.6418 $44.55

. $8.91

73020 X-ray exam of

shoulder X 0260 0.6418 $44.55

. $8.91

73030 X-ray exam of

shoulder X 0260 0.6418 $44.55

. $8.91

73040 Contrast x-ray of shoulder Q2

0275 3.9868 $276.76 $68.90 $55.36

73050 X-ray exam of

shoulders X 0260 0.6418 $44.55

. $8.9173060 X-ray exam of

humerus X 0260 0.6418 $44.55

. $8.91

73070 X-ray exam of

elbow X 0260 0.6418 $44.55

. $8.91

73080 X-ray exam of

elbow X 0260 0.6418 $44.55

. $8.91

73085 Contrast x-ray of elbow Q2

0275 3.9868 $276.76 $68.90 $55.36

73090 X-ray exam of

forearm X 0260 0.6418 $44.55

. $8.91

73092 X-ray exam of arm

infant X 0260 0.6418 $44.55

. $8.91

73100 X-ray exam of

wrist X 0260 0.6418 $44.55

. $8.91

73110 X-ray exam of

wrist X 0260 0.6418 $44.55

. $8.91

73115 Contrast x-ray of wrist Q2

0275 3.9868 $276.76 $68.90 $55.36

73120 X-ray exam of

hand X 0260 0.6418 $44.55

. $8.91

73130 X-ray exam of

hand X 0260 0.6418 $44.55

. $8.91

73140 X-ray exam of

finger(s) X 0260 0.6418 $44.55

. $8.91

73200 Ct upper extremity w/o

dye Q3 0332 2.7424 $190.38 $73.61 $38.08

73201 Ct upper extremity

w/dye Q3 0283 4.2806 $297.16 $95.77 $59.44

73202 Ct uppr extremity

w/o&w/dye Q3 0333 4.7716 $331.24 $115.09 $66.25

73206 Ct angio upr extrm

w/o&w/dye Q3 0662 4.8432 $336.21 $113.59 $67.25

73218 Mri upper extremity w/odye Q3 0336 4.8219 $334.74 $131.90 $66.95

73219 Mri upper extremity

w/dye Q3 0284 6.1872 $429.52 $144.34 $85.91

73220 Mri uppr extremity

w/o&w/dye Q3 0337 7.6393 $530.32 $196.43 $106.07

73221 Mri joint upr extrem w/o

dye Q3 0336 4.8219 $334.74 $131.90 $66.95

73222 Mri joint upr extrem

w/dye Q3 0284 6.1872 $429.52 $144.34 $85.91

73223 Mri joint upr extr

w/o&w/dye Q3 0337 7.6393 $530.32 $196.43 $106.07

73225 Mr angio upr extr

w/o&w/dye B

73500 X-ray exam of

hip X 0260 0.6418 $44.55

. $8.91

73510 X-ray exam of

hip X 0260 0.6418 $44.55

. $8.91

73520 X-ray exam of

hips X 0260 0.6418 $44.55

. $8.91

73525 Contrast x-ray of hip Q2

0275 3.9868 $276.76 $68.90 $55.36

73530 X-ray exam of hip N

73540 X-ray exam of pelvis &

hips X 0260 0.6418 $44.55

. $8.91

73542 X-ray exam sacroiliac joint Q2

0275 3.9868 $276.76 $68.90 $55.36

73550 X-ray exam of

thigh X 0260 0.6418 $44.55

. $8.91

73560 X-ray exam of knee 1 or

2 X 0260 0.6418 $44.55

. $8.91

73562 X-ray exam of knee

3 X 0260 0.6418 $44.55

. $8.91

73564 X-ray exam knee 4 ormore X 0260 0.6418 $44.55

. $8.91

73565 X-ray exam of

knees X 0260 0.6418 $44.55

. $8.91

73580 Contrast x-ray of knee joint Q2

0275 3.9868 $276.76 $68.90 $55.36

73590 X-ray exam of lower

leg X 0260 0.6418 $44.55

. $8.91

73592 X-ray exam of leg

infant X 0260 0.6418 $44.55

. $8.91

73600 X-ray exam of

ankle X 0260 0.6418 $44.55

. $8.91

73610 X-ray exam of

ankle X 0260 0.6418 $44.55

. $8.91

73615 Contrast x-ray of ankle Q2

0275 3.9868 $276.76 $68.90 $55.36

73620 X-ray exam of

foot X 0260 0.6418 $44.55

. $8.91

73630 X-ray exam of

foot X 0260 0.6418 $44.55

. $8.91

73650 X-ray exam of

heel X 0260 0.6418 $44.55

. $8.91

73660 X-ray exam of

toe(s) X 0260 0.6418 $44.55

. $8.91

73700 Ct lower extremity w/o

dye Q3 0332 2.7424 $190.38 $73.61 $38.08

73701 Ct lower extremity

w/dye Q3 0283 4.2806 $297.16 $95.77 $59.44

73702 Ct lwr extremity

w/o&w/dye Q3 0333 4.7716 $331.24 $115.09 $66.25

73706 Ct angio lwr extr

w/o&w/dye Q3 0662 4.8432 $336.21 $113.59 $67.25

73718 Mri lower extremity w/o

dye Q3 0336 4.8219 $334.74 $131.90 $66.9573719 Mri lower extremity

w/dye Q3 0284 6.1872 $429.52 $144.34 $85.91

73720 Mri lwr extremity

w/o&w/dye Q3 0337 7.6393 $530.32 $196.43 $106.07

73721 Mri jnt of lwr extre w/o

dye Q3 0336 4.8219 $334.74 $131.90 $66.95

73722 Mri joint of lwr extr

w/dye Q3 0284 6.1872 $429.52 $144.34 $85.91

73723 Mri joint lwr extr

w/o&w/dye Q3 0337 7.6393 $530.32 $196.43 $106.07

73725 Mr ang lwr ext w or w/o

dye B

74000 X-ray exam of

abdomen X 0260 0.6418 $44.55

. $8.91

74010 X-ray exam of

abdomen X 0260 0.6418 $44.55

. $8.91

74020 X-ray exam of

abdomen X 0260 0.6418 $44.55

. $8.91

74022 X-ray exam series

abdomen X 0261 1.0831 $75.19

. $15.04

74150 Ct abdomen w/o

dye Q3 0332 2.7424 $190.38 $73.61 $38.08

74160 Ct abdomen

w/dye Q3 0283 4.2806 $297.16 $95.77 $59.44

74170 Ct abdomen w/o &

w/dye Q3 0333 4.7716 $331.24 $115.09 $66.25

74175 Ct angio abdom w/o &

w/dye Q3 0662 4.8432 $336.21 $113.59 $67.25

74176 Ct abd & pelvis w/o

contrast CH Q3 0331 5.8040 $402.91 $155.78 $80.59

74177 Ct abdomen&pelvis

w/contrast CH Q3 0334 8.2338 $571.59 $184.21 $114.32

74178 Ct abd&pelv 1+

section/regns CH Q3 0334 8.2338 $571.59 $184.21 $114.3274181 Mri abdomen w/o

dye Q3 0336 4.8219 $334.74 $131.90 $66.95

74182 Mri abdomen

w/dye Q3 0284 6.1872 $429.52 $144.34 $85.91

74183 Mri abdomen w/o &

w/dye Q3 0337 7.6393 $530.32 $196.43 $106.07

74185 Mri angio abdom w orw/o

dye B

74190 X-ray exam of peritoneum Q2

0263 3.3928 $235.53

. $47.11

74210 Contrst x-ray exam of

throat S 0276 1.2290 $85.32 $33.87 $17.07

74220 Contrast x-ray

esophagus S 0276 1.2290 $85.32 $33.87 $17.07

74230 Cine/vid x-ray

throat/esoph S 0276 1.2290 $85.32 $33.87 $17.07

74235 Remove esophagus obstruction N

74240 X-ray exam upper gi

tract S 0276 1.2290 $85.32 $33.87 $17.07

74241 X-ray exam upper gi

tract S 0276 1.2290 $85.32 $33.87 $17.07

74245 X-ray exam upper gi

tract S 0277 2.0083 $139.42 $52.93 $27.89

74246 Contrst x-ray uppr gi

tract S 0276 1.2290 $85.32 $33.87 $17.07

74247 Contrst x-ray uppr gi

tract S 0276 1.2290 $85.32 $33.87 $17.07

74249 Contrst x-ray uppr gi

tract S 0277 2.0083 $139.42 $52.93 $27.89

74250 X-ray exam of small

bowel S 0276 1.2290 $85.32 $33.87 $17.07

74251 X-ray exam of small

bowel S 0277 2.0083 $139.42 $52.93 $27.8974260 X-ray exam of small

bowel S 0276 1.2290 $85.32 $33.87 $17.07

74261 Ct colonography

dx Q3 0332 2.7424 $190.38 $73.61 $38.08

74262 Ct colonography dx

w/dye Q3 0283 4.2806 $297.16 $95.77 $59.44

74263 Ct colonography

screening E

74270 Contrast x-ray exam of

colon S 0276 1.2290 $85.32 $33.87 $17.07

74280 Contrast x-ray exam of

colon S 0277 2.0083 $139.42 $52.93 $27.89

74283 Contrast x-ray exam of

colon S 0276 1.2290 $85.32 $33.87 $17.07

74290 Contrast x-ray

gallbladder S 0276 1.2290 $85.32 $33.87 $17.07

74291 Contrast x-rays

gallbladder S 0276 1.2290 $85.32 $33.87 $17.07

74300 X-ray bile ducts/pancreas N

74301 X-rays at surgery add-on N

74305 X-ray bile ducts/pancreas Q2

0263 3.3928 $235.53

. $47.11

74320 Contrast x-ray of bile ducts Q2

0317 6.2675 $435.09

. $87.02

74327 X-ray bile stone removal N

74328 X-ray bile duct

endoscopy N

74329 X-ray for pancreas

endoscopy N

74330 X-ray bile/panc

endoscopy N

74340 X-ray guide for GI

tube N74355 X-ray guide intestinal

tube N

74360 X-ray guide gi

dilation N

74363 X-ray bile duct

dilation N

74400 Contrst x-ray urinary

tract S 0278 2.5896 $179.77 $58.44 $35.96

74410 Contrst x-ray urinary

tract S 0278 2.5896 $179.77 $58.44 $35.96

74415 Contrst x-ray urinary

tract S 0278 2.5896 $179.77 $58.44 $35.96

74420 Contrst x-ray urinary

tract S 0278 2.5896 $179.77 $58.44 $35.96

74425 Contrst x-ray urinary tract Q2

0278 2.5896 $179.77 $58.44 $35.96

74430 Contrast x-ray bladder Q2

0278 2.5896 $179.77 $58.44 $35.96

74440 X-ray male genital tract Q2

0278 2.5896 $179.77 $58.44 $35.96

74445 X-ray exam of penis Q2

0278 2.5896 $179.77 $58.44 $35.96

74450 X-ray urethra/bladder Q2

0278 2.5896 $179.77 $58.44 $35.96

74455 X-ray urethra/bladder Q2

0278 2.5896 $179.77 $58.44 $35.96

74470 X-ray exam of kidney lesion Q2

0263 3.3928 $235.53

. $47.11

74475 X-ray control cath insert Q2

0161 17.6738 "$1,226.92"

. $245.39

74480 X-ray control cath insert Q2

0161 17.6738 "$1,226.92"

. $245.39

74485 X-ray guide gu dilation Q2

0161 17.6738 "$1,226.92"

. $245.39

74710 X-ray measurement ofpelvis X 0261 1.0831 $75.19

. $15.04

74740 X-ray female genital tract Q2

0263 3.3928 $235.53

. $47.11

74742 X-ray fallopian tube N

74775 X-ray exam of

perineum S 0278 2.5896 $179.77 $58.44 $35.96

75557 Cardiac mri for

morph Q3 0336 4.8219 $334.74 $131.90 $66.95

75559 Cardiac mri w/stress

img Q3 0336 4.8219 $334.74 $131.90 $66.95

75561 Cardiac mri for morph

w/dye Q3 0337 7.6393 $530.32 $196.43 $106.07

75563 Card mri w/stress img &

dye Q3 0337 7.6393 $530.32 $196.43 $106.07

75565 Card mri veloc flow mapping N

75571 Ct hrt w/o dye w/ca

test X 0340 0.6739 $46.78

. $9.36

75572 Ct hrt w/3d

image S 0383 3.7294 $258.89

. $51.78

75573 Ct hrt w/3d image

congen S 0383 3.7294 $258.89

. $51.78

75574 Ct angio hrt w/3d

image S 0383 3.7294 $258.89

. $51.78

75600 Contrast x-ray exam of aorta Q2

0279 29.6734 "$2,059.93"

. $411.99

75605 Contrast x-ray exam of aorta Q2

0279 29.6734 "$2,059.93"

. $411.99

75625 Contrast x-ray exam of aorta Q2

0279 29.6734 "$2,059.93"

. $411.99

75630 X-ray aorta leg arteries Q2

0279 29.6734 "$2,059.93"

. $411.99

75635 Ct angio abdominal arteries Q20662 4.8432 $336.21 $113.59 $67.25

75650 Artery x-rays head & neck Q2

0280 49.6711 "$3,448.17"

. $689.64

75658 Artery x-rays arm Q2

0279 29.6734 "$2,059.93"

. $411.99

75660 Artery x-rays head & neck Q2

0280 49.6711 "$3,448.17"

. $689.64

75662 Artery x-rays head & neck Q2

0280 49.6711 "$3,448.17"

. $689.64

75665 Artery x-rays head & neck Q2

0279 29.6734 "$2,059.93"

. $411.99

75671 Artery x-rays head & neck Q2

0280 49.6711 "$3,448.17"

. $689.64

75676 Artery x-rays neck Q2

0279 29.6734 "$2,059.93"

. $411.99

75680 Artery x-rays neck Q2

0279 29.6734 "$2,059.93"

. $411.99

75685 Artery x-rays spine Q2

0279 29.6734 "$2,059.93"

. $411.99

75705 Artery x-rays spine Q2

0279 29.6734 "$2,059.93"

. $411.99

75710 Artery x-rays arm/leg Q2

0279 29.6734 "$2,059.93"

. $411.99

75716 Artery x-rays arms/legs Q2

0279 29.6734 "$2,059.93"

. $411.99

75722 Artery x-rays kidney Q2

0279 29.6734 "$2,059.93"

. $411.99

75724 Artery x-rays kidneys Q2

0279 29.6734 "$2,059.93"

. $411.99

75726 Artery x-rays abdomen Q2

0279 29.6734 "$2,059.93"

. $411.99

75731 Artery x-rays adrenal gland Q2

0279 29.6734 "$2,059.93"

. $411.9975733 Artery x-rays adrenals Q2

0279 29.6734 "$2,059.93"

. $411.99

75736 Artery x-rays pelvis Q2

0279 29.6734 "$2,059.93"

. $411.99

75741 Artery x-rays lung Q2

0279 29.6734 "$2,059.93"

. $411.99

75743 Artery x-rays lungs Q2

0279 29.6734 "$2,059.93"

. $411.99

75746 Artery x-rays lung Q2

0668 9.4312 $654.71

. $130.95

75756 Artery x-rays chest Q2

0668 9.4312 $654.71

. $130.95

75774 Artery x-ray each vessel N

75791 Av dialysis shunt

imaging CH Q2 0668 9.4312 $654.71

. $130.95

75801 Lymph vessel x-ray arm/leg Q2

0317 6.2675 $435.09

. $87.02

75803 Lymph vessel x-ray arms/legs Q2

0317 6.2675 $435.09

. $87.02

75805 Lymph vessel x-ray trunk Q2

0317 6.2675 $435.09

. $87.02

75807 Lymph vessel x-ray trunk Q2

0317 6.2675 $435.09

. $87.02

75809 Nonvascular shunt x-ray Q2

0261 1.0831 $75.19

. $15.04

75810 Vein x-ray spleen/liver Q2

0279 29.6734 "$2,059.93"

. $411.99

75820 Vein x-ray arm/leg Q2

0668 9.4312 $654.71

. $130.95

75822 Vein x-ray arms/legs Q2

0668 9.4312 $654.71

. $130.95

75825 Vein x-ray trunk Q2

0279 29.6734 "$2,059.93"

. $411.9975827 Vein x-ray chest Q2

0668 9.4312 $654.71

. $130.95

75831 Vein x-ray kidney Q2

0279 29.6734 "$2,059.93"

. $411.99

75833 Vein x-ray kidneys Q2

0279 29.6734 "$2,059.93"

. $411.99

75840 Vein x-ray adrenal gland Q2

0279 29.6734 "$2,059.93"

. $411.99

75842 Vein x-ray adrenal glands Q2

0279 29.6734 "$2,059.93"

. $411.99

75860 Vein x-ray neck Q2

0668 9.4312 $654.71

. $130.95

75870 Vein x-ray skull Q2

0668 9.4312 $654.71

. $130.95

75872 Vein x-ray skull Q2

0668 9.4312 $654.71

. $130.95

75880 Vein x-ray eye socket Q2

0668 9.4312 $654.71

. $130.95

75885 Vein x-ray liver Q2

0279 29.6734 "$2,059.93"

. $411.99

75887 Vein x-ray liver Q2

0668 9.4312 $654.71

. $130.95

75889 Vein x-ray liver Q2

0279 29.6734 "$2,059.93"

. $411.99

75891 Vein x-ray liver Q2

0279 29.6734 "$2,059.93"

. $411.99

75893 Venous sampling by catheter Q2

0279 29.6734 "$2,059.93"

. $411.99

75894 X-rays transcath

therapy N

75896 X-rays transcath

therapy N

75898 Follow-up angiography Q1

0261 1.0831 $75.19

. $15.0475900 Intravascular cath

exchange C

75901 Remove cva device obstruct N

75902 Remove cva lumen obstruct N

75940 X-ray placement vein filter N

75945 Intravascular us Q2

0267 2.1881 $151.90 $59.41 $30.38

75946 Intravascular us add-on N

75952 Endovasc repair abdom

aorta C

75953 Abdom aneurysm endovas

rpr C

75954 Iliac aneurysm endovas

rpr C

75956 Xray endovasc thor ao

repr C

75957 Xray endovasc thor ao

repr C

75958 Xray place prox ext thor

ao C

75959 Xray place dist ext thor

ao C

75960 Transcath iv stent rs&i N

75961 Retrieval broken catheter N

75962 Repair arterial blockage Q2

0083 65.1118 "$4,520.06"

. $904.02

75964 Repair artery blockage each N

75966 Repair arterial blockage Q2

0083 65.1118 "$4,520.06"

. $904.02

75968 Repair artery blockage each N

75970 Vascular biopsy N

75978 Repair venous blockage Q20093 30.7767 "$2,136.52"

. $427.31

75980 Contrast xray exam bile duct N

75982 Contrast xray exam bile duct N

75984 Xray control catheter change N

75989 Abscess drainage under

x-ray N

76000 Fluoroscope examination Q1

0272 1.2481 $86.64 $30.47 $17.33

76001 Fluoroscope exam

extensive N

76010 X-ray nose to

rectum X 0260 0.6418 $44.55

. $8.91

76080 X-ray exam of fistula Q2

0263 3.3928 $235.53

. $47.11

76098 X-ray exam breast specimen Q2

0317 6.2675 $435.09

. $87.02

76100 X-ray exam of body

section X 0261 1.0831 $75.19

. $15.04

76101 Complex body section

x-ray X 0263 3.3928 $235.53

. $47.11

76102 Complex body section

x-rays X 0263 3.3928 $235.53

. $47.11

76120 Cine/video

x-rays X 0272 1.2481 $86.64 $30.47 $17.33

76125 Cine/video x-rays add-on N

76140 X-ray

consultation E

76376 3d render w/o postprocess N

76377 3d rendering w/postprocess N

76380 CAT scan follow-up

study S 0282 1.5453 $107.27 $35.74 $21.4676390 Mr

spectroscopy E

76496 Fluoroscopic

procedure X 0272 1.2481 $86.64 $30.47 $17.33

76497 Ct

procedure S 0282 1.5453 $107.27 $35.74 $21.46

76498 Mri

procedure S 0336 4.8219 $334.74 $131.90 $66.95

76499 Radiographic

procedure X 0260 0.6418 $44.55

. $8.91

76506 Echo exam of

head S 0265 0.8995 $62.44 $22.26 $12.49

76510 Ophth us b & quant

a T 0232 2.9435 $204.34 $42.27 $40.87

76511 Ophth us quant a

only S 0266 1.3711 $95.18 $36.80 $19.04

76512 Ophth us b w/non-quant

a S 0266 1.3711 $95.18 $36.80 $19.04

76513 Echo exam of eye water

bath S 0266 1.3711 $95.18 $36.80 $19.04

76514 Echo exam of eye thickness X

0035 0.2717 $18.86

. $3.78

76516 Echo exam of

eye S 0265 0.8995 $62.44 $22.26 $12.49

76519 Echo exam of

eye S 0266 1.3711 $95.18 $36.80 $19.04

76529 Echo exam of

eye S 0265 0.8995 $62.44 $22.26 $12.49

76536 Us exam of head and

neck S 0266 1.3711 $95.18 $36.80 $19.04

76604 Us exam

chest Q3 0265 0.8995 $62.44 $22.26 $12.49

76645 Us exam

breast(s) S 0265 0.8995 $62.44 $22.26 $12.4976700 Us exam abdom

complete Q3 0266 1.3711 $95.18 $36.80 $19.04

76705 Echo exam of

abdomen Q3 0266 1.3711 $95.18 $36.80 $19.04

76770 Us exam abdo back wall

comp Q3 0266 1.3711 $95.18 $36.80 $19.04

76775 Us exam abdo back wall

lim Q3 0266 1.3711 $95.18 $36.80 $19.04

76776 Us exam k transpl

w/doppler Q3 0266 1.3711 $95.18 $36.80 $19.04

76800 Us exam spinal

canal S 0266 1.3711 $95.18 $36.80 $19.04

76801 Ob us < 14 wks single

fetus S 0266 1.3711 $95.18 $36.80 $19.04

76802 Ob us < 14 wks addl

fetus S 0265 0.8995 $62.44 $22.26 $12.49

76805 Ob us >/= 14 wks sngl

fetus S 0266 1.3711 $95.18 $36.80 $19.04

76810 Ob us >/= 14 wks addl

fetus S 0266 1.3711 $95.18 $36.80 $19.04

76811 Ob us detailed sngl

fetus S 0267 2.1881 $151.90 $59.41 $30.38

76812 Ob us detailed addl

fetus S 0265 0.8995 $62.44 $22.26 $12.49

76813 Ob us nuchal meas 1

gest S 0265 0.8995 $62.44 $22.26 $12.49

76814 Ob us nuchal meas

add-on S 0265 0.8995 $62.44 $22.26 $12.49

76815 Ob us limited

fetus(s) S 0265 0.8995 $62.44 $22.26 $12.49

76816 Ob us follow-up per

fetus S 0265 0.8995 $62.44 $22.26 $12.49

76817 Transvaginal us

obstetric S 0265 0.8995 $62.44 $22.26 $12.4976818 Fetal biophys profile

w/nst S 0266 1.3711 $95.18 $36.80 $19.04

76819 Fetal biophys profil w/o

nst S 0266 1.3711 $95.18 $36.80 $19.04

76820 Umbilical artery

echo S 0265 0.8995 $62.44 $22.26 $12.49

76821 Middle cerebral artery

echo S 0265 0.8995 $62.44 $22.26 $12.49

76825 Echo exam of fetal heart CH

S 0697 3.1535 $218.92

. $43.79

76826 Echo exam of fetal heart CH

S 0697 3.1535 $218.92

. $43.79

76827 Echo exam of fetal

heart S 0265 0.8995 $62.44 $22.26 $12.49

76828 Echo exam of fetal

heart S 0265 0.8995 $62.44 $22.26 $12.49

76830 Transvaginal us

non-ob S 0266 1.3711 $95.18 $36.80 $19.04

76831 Echo exam

uterus Q3 0267 2.1881 $151.90 $59.41 $30.38

76856 Us exam pelvic

complete Q3 0266 1.3711 $95.18 $36.80 $19.04

76857 Us exam pelvic

limited Q3 0265 0.8995 $62.44 $22.26 $12.49

76870 Us exam

scrotum Q3 0266 1.3711 $95.18 $36.80 $19.04

76872 Us

transrectal S 0266 1.3711 $95.18 $36.80 $19.04

76873 Echograp trans r pros

study S 0266 1.3711 $95.18 $36.80 $19.04

76881 Us xtr non-vasc

complete S 0266 1.3711 $95.18 $36.80 $19.0476882 Us xtr non-vasc

lmtd S 0265 0.8995 $62.44 $22.26 $12.49

76885 Us exam infant hips

dynamic S 0265 0.8995 $62.44 $22.26 $12.49

76886 Us exam infant hips

static S 0265 0.8995 $62.44 $22.26 $12.49

76930 Echo guide cardiocentesis N

76932 Echo guide for heart biopsy N

76936 Echo guide for artery

repair S 0096 1.5324 $106.38 $36.83 $21.28

76937 Us guide vascular

access N

76940 Us guide tissue

ablation N

76941 Echo guide for

transfusion N

76942 Echo guide for

biopsy N

76945 Echo guide villus

sampling N

76946 Echo guide for

amniocentesis N

76948 Echo guide ova

aspiration N

76950 Echo guidance

radiotherapy N

76965 Echo guidance

radiotherapy N

76970 Ultrasound exam

follow-up S 0265 0.8995 $62.44 $22.26 $12.49

76975 GI endoscopic ultrasound Q2

0267 2.1881 $151.90 $59.41 $30.38

76977 Us bone density

measure X 0340 0.6739 $46.78 $0.00 $0.00

76998 Us guide intraop N

76999 Echo examination

procedure S 0265 0.8995 $62.44 $22.26 $12.4977001 Fluoroguide for vein device N

77002 Needle localization by xray N

77003 Fluoroguide for spine inject N

77011 Ct scan for localization N

77012 Ct scan for needle biopsy N

77013 Ct guide for tissue ablation N

77014 Ct scan for therapy guide N

77021 Mr guidance for needle place N

77022 Mri for tissue ablation N

77031 Stereotact guide for brst bx N

77032 Guidance for needle breast N

77051 Computer dx mammogram

add-on A

77052 Comp screen mammogram

add-on A

77053 X-ray of mammary duct Q2

0263 3.3928 $235.53

. $47.11

77054 X-ray of mammary ducts Q2

0263 3.3928 $235.53

. $47.11

77055 Mammogram one

breast A

77056 Mammogram both

breasts A

77057 Mammogram

screening A

77058 Mri one

breast B

77059 Mri both

breasts B

77071 X-ray stress view X

0260 0.6418 $44.55

. $8.9177072 X-rays for bone age X

0260 0.6418 $44.55

. $8.91

77073 X-rays bone length studies X

0260 0.6418 $44.55

. $8.91

77074 X-rays bone survey limited X

0261 1.0831 $75.19

. $15.04

77075 X-rays bone survey complete X

0261 1.0831 $75.19

. $15.04

77076 X-rays bone survey infant X

0261 1.0831 $75.19

. $15.04

77077 Joint survey single view X

0260 0.6418 $44.55

. $8.91

77078 Ct bone density

axial S 0288 1.0215 $70.91 $0.00 $0.00

77079 Ct bone density

peripheral S 0282 1.5453 $107.27 $0.00 $0.00

77080 Dxa bone density

axial S 0288 1.0215 $70.91 $0.00 $0.00

77081 Dxa bone

density/peripheral S 0665 0.4570 $31.72 $0.00 $0.00

77082 Dxa bone density vert fx X

0260 0.6418 $44.55

. $8.91

77083 Radiographic absorptiometry X

0261 1.0831 $75.19 $0.00 $0.00

77084 Magnetic image bone marrow S

0336 4.8219 $334.74 $131.90 $66.95

77261 Radiation therapy

planning B

77262 Radiation therapy

planning B

77263 Radiation therapy

planning B

77280 Set radiation therapy

field X 0304 1.4946 $103.76 $34.39 $20.76

77285 Set radiation therapy

field X 0305 3.7009 $256.92 $86.44 $51.3977290 Set radiation therapy

field X 0305 3.7009 $256.92 $86.44 $51.39

77295 Set radiation therapy

field X 0310 13.2460 $919.54 $322.74 $183.91

77299 Radiation therapy

planning X 0304 1.4946 $103.76 $34.39 $20.76

77300 Radiation therapy dose

plan X 0304 1.4946 $103.76 $34.39 $20.76

77301 Radiotherapy dose plan

imrt X 0310 13.2460 $919.54 $322.74 $183.91

77305 Teletx isodose plan

simple X 0304 1.4946 $103.76 $34.39 $20.76

77310 Teletx isodose plan

intermed X 0304 1.4946 $103.76 $34.39 $20.76

77315 Teletx isodose plan

complex X 0305 3.7009 $256.92 $86.44 $51.39

77321 Special teletx port

plan X 0305 3.7009 $256.92 $86.44 $51.39

77326 Brachytx isodose calc

simp X 0304 1.4946 $103.76 $34.39 $20.76

77327 Brachytx isodose calc

interm X 0305 3.7009 $256.92 $86.44 $51.39

77328 Brachytx isodose plan

compl X 0305 3.7009 $256.92 $86.44 $51.39

77331 Special radiation

dosimetry X 0304 1.4946 $103.76 $34.39 $20.76

77332 Radiation treatment

aid(s) X 0303 2.7910 $193.75 $64.95 $38.75

77333 Radiation treatment

aid(s) X 0303 2.7910 $193.75 $64.95 $38.75

77334 Radiation treatment

aid(s) X 0303 2.7910 $193.75 $64.95 $38.75

77336 Radiation physics

consult X 0304 1.4946 $103.76 $34.39 $20.7677338 Design mlc device for

imrt CH X 0305 3.7009 $256.92 $86.44 $51.39

77370 Radiation physics

consult X 0304 1.4946 $103.76 $34.39 $20.76

77371 Srs

multisource S 0127 106.1294 "$7,367.50"

. "$1,473.50"

77372 Srs linear

based B

77373 Sbrt

delivery B

77399 External radiation

dosimetry X 0304 1.4946 $103.76 $34.39 $20.76

77401 Radiation treatment

delivery S 0300 1.3628 $94.61

. $18.93

77402 Radiation treatment

delivery S 0300 1.3628 $94.61

. $18.93

77403 Radiation treatment

delivery S 0300 1.3628 $94.61

. $18.93

77404 Radiation treatment

delivery S 0300 1.3628 $94.61

. $18.93

77406 Radiation treatment

delivery S 0300 1.3628 $94.61

. $18.93

77407 Radiation treatment

delivery S 0300 1.3628 $94.61

. $18.93

77408 Radiation treatment

delivery CH S 0301 2.3680 $164.39

. $32.88

77409 Radiation treatment

delivery CH S 0301 2.3680 $164.39

. $32.88

77411 Radiation treatment

delivery S 0301 2.3680 $164.39

. $32.88

77412 Radiation treatment

delivery S 0301 2.3680 $164.39

. $32.88

77413 Radiation treatment

delivery S 0301 2.3680 $164.39

. $32.8877414 Radiation treatment

delivery S 0301 2.3680 $164.39

. $32.88

77416 Radiation treatment

delivery S 0301 2.3680 $164.39

. $32.88

77417 Radiology port film(s) N

77418 Radiation tx delivery

imrt S 0412 6.4422 $447.22

. $89.45

77421 Stereoscopic x-ray

guidance N

77422 Neutron beam tx

simple S 0301 2.3680 $164.39

. $32.88

77423 Neutron beam tx

complex S 0301 2.3680 $164.39

. $32.88

77427 Radiation tx management

x5 B

77431 Radiation therapy

management B

77432 Stereotactic radiation

trmt B

77435 Sbrt management N

77470 Special radiation

treatment S 0299 5.6094 $389.40

. $77.88

77499 Radiation therapy

management B

77520 Proton trmt simple w/o

comp S 0664 14.2952 $992.37

. $198.48

77522 Proton trmt simple

w/comp S 0664 14.2952 $992.37

. $198.48

77523 Proton trmt

intermediate S 0667 18.7001 "$1,298.16"

. $259.64

77525 Proton treatment

complex S 0667 18.7001 "$1,298.16"

. $259.64

77600 Hyperthermia

treatment S 0299 5.6094 $389.40

. $77.8877605 Hyperthermia

treatment S 0299 5.6094 $389.40

. $77.88

77610 Hyperthermia

treatment S 0299 5.6094 $389.40

. $77.88

77615 Hyperthermia

treatment S 0299 5.6094 $389.40

. $77.88

77620 Hyperthermia

treatment S 0299 5.6094 $389.40

. $77.88

77750 Infuse radioactive

materials S 0301 2.3680 $164.39

. $32.88

77761 Apply intrcav radiat

simple S 0312 4.7014 $326.37

. $65.28

77762 Apply intrcav radiat

interm S 0312 4.7014 $326.37

. $65.28

77763 Apply intrcav radiat

compl S 0312 4.7014 $326.37

. $65.28

77776 Apply interstit radiat

simpl S 0312 4.7014 $326.37

. $65.28

77777 Apply interstit radiat

inter S 0312 4.7014 $326.37

. $65.28

77778 Apply interstit radiat

compl Q3 0651 12.4760 $866.08

. $173.22

77785 Hdr brachytx 1

channel S 0313 9.8659 $684.89 $258.98 $136.98

77786 Hdr brachytx 2-12

channel S 0313 9.8659 $684.89 $258.98 $136.98

77787 Hdr brachytx over 12

chan S 0313 9.8659 $684.89 $258.98 $136.98

77789 Apply surface

radiation S 0300 1.3628 $94.61

. $18.93

77790 Radiation

handling N

77799 Radium/radioisotope

therapy S 0312 4.7014 $326.37

. $65.2878000 Thyroid single

uptake S 0389 1.5133 $105.05 $26.88 $21.01

78001 Thyroid multiple

uptakes S 0389 1.5133 $105.05 $26.88 $21.01

78003 Thyroid

suppress/stimul S 0389 1.5133 $105.05 $26.88 $21.01

78006 Thyroid imaging with

uptake S 0391 3.1750 $220.41 $65.46 $44.09

78007 Thyroid image mult

uptakes S 0391 3.1750 $220.41 $65.46 $44.09

78010 Thyroid

imaging S 0390 1.8660 $129.54 $46.52 $25.91

78011 Thyroid imaging with

flow S 0390 1.8660 $129.54 $46.52 $25.91

78015 Thyroid met

imaging S 0406 4.0374 $280.28 $85.03 $56.06

78016 Thyroid met

imaging/studies S 0406 4.0374 $280.28 $85.03 $56.06

78018 Thyroid met imaging

body S 0406 4.0374 $280.28 $85.03 $56.06

78020 Thyroid met uptake N

78070 Parathyroid nuclear

imaging S 0391 3.1750 $220.41 $65.46 $44.09

78075 Adrenal nuclear

imaging CH S 0414 6.9811 $484.63

. $96.93

78099 Endocrine nuclear

procedure S 0390 1.8660 $129.54 $46.52 $25.91

78102 Bone marrow imaging

ltd S 0400 3.7132 $257.77 $91.24 $51.56

78103 Bone marrow imaging

mult S 0400 3.7132 $257.77 $91.24 $51.56

78104 Bone marrow imagingbody S 0400 3.7132 $257.77 $91.24 $51.56

78110 Plasma volume

single S 0393 6.3038 $437.61

. $87.53

78111 Plasma volume

multiple S 0393 6.3038 $437.61

. $87.53

78120 Red cell mass

single S 0393 6.3038 $437.61

. $87.53

78121 Red cell mass

multiple S 0393 6.3038 $437.61

. $87.53

78122 Blood

volume S 0393 6.3038 $437.61

. $87.53

78130 Red cell survival

study S 0393 6.3038 $437.61

. $87.53

78135 Red cell survival

kinetics S 0393 6.3038 $437.61

. $87.53

78140 Red cell

sequestration S 0393 6.3038 $437.61

. $87.53

78185 Spleen

imaging S 0400 3.7132 $257.77 $91.24 $51.56

78190 Platelet survival

kinetics S 0392 2.5360 $176.05 $42.39 $35.21

78191 Platelet

survival S 0392 2.5360 $176.05 $42.39 $35.21

78195 Lymph system

imaging S 0400 3.7132 $257.77 $91.24 $51.56

78199 Blood/lymph nuclear

exam S 0400 3.7132 $257.77 $91.24 $51.56

78201 Liver

imaging S 0394 4.1587 $288.70 $90.78 $57.74

78202 Liver imaging with

flow S 0394 4.1587 $288.70 $90.78 $57.74

78205 Liver imaging

(3D) S 0394 4.1587 $288.70 $90.78 $57.7478206 Liver image (3d) with

flow S 0394 4.1587 $288.70 $90.78 $57.74

78215 Liver and spleen

imaging S 0394 4.1587 $288.70 $90.78 $57.74

78216 Liver & spleen

image/flow S 0394 4.1587 $288.70 $90.78 $57.74

78220 Liver function

study S 0394 4.1587 $288.70 $90.78 $57.74

78223 Hepatobiliary

imaging S 0394 4.1587 $288.70 $90.78 $57.74

78230 Salivary gland

imaging S 0395 3.4576 $240.03 $87.01 $48.01

78231 Serial salivary

imaging S 0395 3.4576 $240.03 $87.01 $48.01

78232 Salivary gland function

exam S 0395 3.4576 $240.03 $87.01 $48.01

78258 Esophageal motility

study S 0395 3.4576 $240.03 $87.01 $48.01

78261 Gastric mucosa

imaging S 0395 3.4576 $240.03 $87.01 $48.01

78262 Gastroesophageal reflux

exam S 0395 3.4576 $240.03 $87.01 $48.01

78264 Gastric emptying

study S 0395 3.4576 $240.03 $87.01 $48.01

78267 Breath tst attain/anal

c-14 A

78268 Breath test analysis

c-14 A

78270 Vit B-12 absorption

exam S 0392 2.5360 $176.05 $42.39 $35.21

78271 Vit b-12 absrp exam int

fac S 0392 2.5360 $176.05 $42.39 $35.21

78272 Vit b-12 absorp

combined S 0392 2.5360 $176.05 $42.39 $35.2178278 Acute GI blood loss

imaging S 0395 3.4576 $240.03 $87.01 $48.01

78282 GI protein loss

exam S 0395 3.4576 $240.03 $87.01 $48.01

78290 Meckels divert

exam S 0395 3.4576 $240.03 $87.01 $48.01

78291 Leveen/shunt patency

exam S 0395 3.4576 $240.03 $87.01 $48.01

78299 GI nuclear

procedure S 0395 3.4576 $240.03 $87.01 $48.01

78300 Bone imaging limited

area S 0396 3.5140 $243.94 $93.91 $48.79

78305 Bone imaging multiple

areas S 0396 3.5140 $243.94 $93.91 $48.79

78306 Bone imaging whole

body S 0396 3.5140 $243.94 $93.91 $48.79

78315 Bone imaging 3

phase S 0396 3.5140 $243.94 $93.91 $48.79

78320 Bone imaging

(3D) S 0396 3.5140 $243.94 $93.91 $48.79

78350 Bone mineral single

photon E

78351 Bone mineral dual

photon E

78399 Musculoskeletal nuclear

exam S 0396 3.5140 $243.94 $93.91 $48.79

78414 Non-imaging heart

function S 0398 4.2252 $293.31 $93.33 $58.67

78428 Cardiac shunt

imaging S 0398 4.2252 $293.31 $93.33 $58.67

78445 Vascular flow

imaging S 0397 2.4220 $168.14 $38.85 $33.63

78451 Ht muscle image spect

sing S 0377 9.7483 $676.73

. $135.3578452 Ht muscle image spect

mult S 0377 9.7483 $676.73

. $135.35

78453 Ht muscle image planar

sing S 0377 9.7483 $676.73

. $135.35

78454 Ht musc image planar

mult S 0377 9.7483 $676.73

. $135.35

78456 Acute venous thrombus

image S 0397 2.4220 $168.14 $38.85 $33.63

78457 Venous thrombosis

imaging S 0397 2.4220 $168.14 $38.85 $33.63

78458 Ven thrombosis images

bilat S 0397 2.4220 $168.14 $38.85 $33.63

78459 Heart muscle imaging

(PET) S 0307 13.2711 $921.28

. $184.26

78466 Heart infarct

image S 0398 4.2252 $293.31 $93.33 $58.67

78468 Heart infarct image

(ef) S 0398 4.2252 $293.31 $93.33 $58.67

78469 Heart infarct image

(3D) S 0398 4.2252 $293.31 $93.33 $58.67

78472 Gated heart planar

single S 0398 4.2252 $293.31 $93.33 $58.67

78473 Gated heart

multiple S 0398 4.2252 $293.31 $93.33 $58.67

78481 Heart first pass

single S 0398 4.2252 $293.31 $93.33 $58.67

78483 Heart first pass

multiple S 0398 4.2252 $293.31 $93.33 $58.67

78491 Heart image (pet)

single S 0307 13.2711 $921.28

. $184.26

78492 Heart image (pet)

multiple S 0307 13.2711 $921.28

. $184.26

78494 Heart imagespect S 0398 4.2252 $293.31 $93.33 $58.67

78496 Heart first pass add-on N

78499 Cardiovascular nuclear

exam S 0398 4.2252 $293.31 $93.33 $58.67

78580 Lung perfusion

imaging S 0401 2.8425 $197.33 $71.16 $39.47

78584 Lung V/Q image single

breath S 0378 4.5059 $312.80 $120.71 $62.56

78585 Lung V/Q

imaging S 0378 4.5059 $312.80 $120.71 $62.56

78586 Aerosol lung image

single S 0401 2.8425 $197.33 $71.16 $39.47

78587 Aerosol lung image

multiple S 0401 2.8425 $197.33 $71.16 $39.47

78588 Perfusion lung

image S 0378 4.5059 $312.80 $120.71 $62.56

78591 Vent image 1 breath 1

proj S 0401 2.8425 $197.33 $71.16 $39.47

78593 Vent image 1 proj

gas S 0401 2.8425 $197.33 $71.16 $39.47

78594 Vent image mult proj

gas S 0401 2.8425 $197.33 $71.16 $39.47

78596 Lung differential

function S 0378 4.5059 $312.80 $120.71 $62.56

78599 Respiratory nuclear

exam S 0401 2.8425 $197.33 $71.16 $39.47

78600 Brain image < 4

views S 0403 3.3656 $233.64 $70.43 $46.73

78601 Brain image w/flow < 4

views S 0402 8.7081 $604.52

. $120.91

78605 Brain image 4+

views S 0403 3.3656 $233.64 $70.43 $46.7378606 Brain image w/flow 4 +

views S 0402 8.7081 $604.52

. $120.91

78607 Brain imaging

(3D) S 0402 8.7081 $604.52

. $120.91

78608 Brain imaging

(PET) S 0308 14.6171 "$1,014.72"

. $202.95

78609 Brain imaging

(PET) E

78610 Brain flow imaging

only S 0403 3.3656 $233.64 $70.43 $46.73

78630 Cerebrospinal fluid

scan S 0402 8.7081 $604.52

. $120.91

78635 CSF

ventriculography S 0402 8.7081 $604.52

. $120.91

78645 CSF shunt

evaluation S 0403 3.3656 $233.64 $70.43 $46.73

78647 Cerebrospinal fluid

scan S 0402 8.7081 $604.52

. $120.91

78650 CSF leakage

imaging S 0402 8.7081 $604.52

. $120.91

78660 Nuclear exam of tear

flow S 0403 3.3656 $233.64 $70.43 $46.73

78699 Nervous system nuclear

exam S 0403 3.3656 $233.64 $70.43 $46.73

78700 Kidney imaging

morphol S 0404 4.5715 $317.35 $81.14 $63.47

78701 Kidney imaging with

flow S 0404 4.5715 $317.35 $81.14 $63.47

78707 K flow/funct image w/o

drug S 0404 4.5715 $317.35 $81.14 $63.47

78708 K flow/funct image

w/drug S 0404 4.5715 $317.35 $81.14 $63.47

78709 K flow/funct image

multiple S 0404 4.5715 $317.35 $81.14 $63.4778710 Kidney imaging

(3D) S 0404 4.5715 $317.35 $81.14 $63.47

78725 Kidney function

study S 0392 2.5360 $176.05 $42.39 $35.21

78730 Urinary bladder

retention S 0389 1.5133 $105.05 $26.88 $21.01

78740 Ureteral reflux

study S 0404 4.5715 $317.35 $81.14 $63.47

78761 Testicular imaging

w/flow S 0404 4.5715 $317.35 $81.14 $63.47

78799 Genitourinary nuclear

exam S 0404 4.5715 $317.35 $81.14 $63.47

78800 Tumor imaging limited

area S 0406 4.0374 $280.28 $85.03 $56.06

78801 Tumor imaging mult

areas S 0414 6.9811 $484.63

. $96.93

78802 Tumor imaging whole

body S 0414 6.9811 $484.63

. $96.93

78803 Tumor imaging

(3D) S 0414 6.9811 $484.63

. $96.93

78804 Tumor imaging whole

body S 0408 13.7263 $952.88

. $190.58

78805 Abscess imaging ltd

area S 0414 6.9811 $484.63

. $96.93

78806 Abscess imaging whole

body S 0414 6.9811 $484.63

. $96.93

78807 Nuclear

localization/abscess S 0414 6.9811 $484.63

. $96.93

78808 Iv inj ra drug dx study Q1

0392 2.5360 $176.05 $42.39 $35.21

78811 Pet image ltd

area S 0308 14.6171 "$1,014.72"

. $202.95

78812 Pet imageskull-thigh S 0308 14.6171 "$1,014.72"

. $202.95

78813 Pet image full

body S 0308 14.6171 "$1,014.72"

. $202.95

78814 Pet image w/ct

lmtd S 0308 14.6171 "$1,014.72"

. $202.95

78815 Pet image w/ct

skull-thigh S 0308 14.6171 "$1,014.72"

. $202.95

78816 Pet image w/ct full

body S 0308 14.6171 "$1,014.72"

. $202.95

78999 Nuclear diagnostic

exam S 0389 1.5133 $105.05 $26.88 $21.01

79005 Nuclear rx oral

admin S 0407 3.2808 $227.75 $78.13 $45.55

79101 Nuclear rx iv

admin S 0407 3.2808 $227.75 $78.13 $45.55

79200 Nuclear rx intracav

admin S 0413 4.0894 $283.89

. $56.78

79300 Nuclr rx interstit

colloid S 0407 3.2808 $227.75 $78.13 $45.55

79403 Hematopoietic nuclear

tx S 0413 4.0894 $283.89

. $56.78

79440 Nuclear rx

intra-articular S 0413 4.0894 $283.89

. $56.78

79445 Nuclear rx

intra-arterial S 0407 3.2808 $227.75 $78.13 $45.55

79999 Nuclear medicine

therapy S 0407 3.2808 $227.75 $78.13 $45.55

80047 Metabolic panel ionized

ca A

80048 Metabolic panel total

ca A

80050 General health

panel E

80051 Electrolyte

panel A80053 Comprehen metabolic

panel A

80055 Obstetric

panel E

80061 Lipid

panel A

80069 Renal function

panel A

80074 Acute hepatitis

panel A

80076 Hepatic function

panel A

80100 Drug screen

qualitate/multi E

80101 Drug screen

single E

80102 Drug

confirmation A

80103 Drug analysis tissue

prep N

80104 Drug scrn 1+ class

nonchromo E

80150 Assay of

amikacin A

80152 Assay of

amitriptyline A

80154 Assay of

benzodiazepines A

80156 Assay carbamazepine

total A

80157 Assay carbamazepine

free A

80158 Assay of

cyclosporine A

80160 Assay of

desipramine A

80162 Assay of

digoxin A

80164 Assay dipropylacetic

acid A

80166 Assay of

doxepin A

80168 Assay of

ethosuximide A80170 Assay of

gentamicin A

80172 Assay of

gold A

80173 Assay of

haloperidol A

80174 Assay of

imipramine A

80176 Assay of

lidocaine A

80178 Assay of

lithium A

80182 Assay of

nortriptyline A

80184 Assay of

phenobarbital A

80185 Assay of phenytoin

total A

80186 Assay of phenytoin

free A

80188 Assay of

primidone A

80190 Assay of

procainamide A

80192 Assay of

procainamide A

80194 Assay of

quinidine A

80195 Assay of

sirolimus A

80196 Assay of

salicylate A

80197 Assay of

tacrolimus A

80198 Assay of

theophylline A

80200 Assay of

tobramycin A

80201 Assay of

topiramate A

80202 Assay of

vancomycin A

80299 Quantitative assay

drug A80400 Acth stimulation

panel A

80402 Acth stimulation

panel A

80406 Acth stimulation

panel A

80408 Aldosterone suppression

eval A

80410 Calcitonin stimul

panel A

80412 CRH stimulation

panel A

80414 Testosterone

response A

80415 Estradiol response

panel A

80416 Renin stimulation

panel A

80417 Renin stimulation

panel A

80418 Pituitary evaluation

panel A

80420 Dexamethasone

panel A

80422 Glucagon tolerance

panel A

80424 Glucagon tolerance

panel A

80426 Gonadotropin hormone

panel A

80428 Growth hormone

panel A

80430 Growth hormone

panel A

80432 Insulin suppression

panel A

80434 Insulin tolerance

panel A

80435 Insulin tolerance

panel A

80436 Metyrapone

panel A

80438 TRH stimulation

panel A80439 TRH stimulation

panel A

80440 TRH stimulation

panel A

80500 Lab pathology

consultation CH X 0342 0.1639 $11.38

. $2.28

80502 Lab pathology

consultation X 0342 0.1639 $11.38

. $2.28

81000 Urinalysis nonauto

w/scope A

81001 Urinalysis auto

w/scope A

81002 Urinalysis nonauto w/o

scope A

81003 Urinalysis auto w/o

scope A

81005 Urinalysis A

81007 Urine screen for

bacteria A

81015 Microscopic exam of

urine A

81020 Urinalysis glass

test A

81025 Urine pregnancy

test A

81050 Urinalysis volume

measure A

81099 Urinalysis test

procedure A

82000 Assay of blood

acetaldehyde A

82003 Assay of

acetaminophen A

82009 Test for

acetone/ketones A

82010 Acetone

assay A

82013 Acetylcholinesterase

assay A

82016 Acylcarnitines

qual A

82017 Acylcarnitinesquant A

82024 Assay of

acth A

82030 Assay of adp &

amp A

82040 Assay of serum

albumin A

82042 Assay of urine

albumin A

82043 Microalbumin

quantitative A

82044 Microalbumin

semiquant A

82045 Albumin ischemia

modified A

82055 Assay of

ethanol A

82075 Assay of breath

ethanol A

82085 Assay of

aldolase A

82088 Assay of

aldosterone A

82101 Assay of urine

alkaloids A

82103 Alpha-1-antitrypsin

total A

82104 Alpha-1-antitrypsin

pheno A

82105 Alpha-fetoprotein

serum A

82106 Alpha-fetoprotein

amniotic A

82107 Alpha-fetoprotein

l3 A

82108 Assay of

aluminum A

82120 Amines vaginal fluid

qual A

82127 Amino acid single

qual A

82128 Amino acids mult

qual A

82131 Amino acids singlequant A

82135 Assay aminolevulinic

acid A

82136 Amino acids quant

2-5 A

82139 Amino acids quan 6 or

more A

82140 Assay of

ammonia A

82143 Amniotic fluid

scan A

82145 Assay of

amphetamines A

82150 Assay of

amylase A

82154 Androstanediol

glucuronide A

82157 Assay of

androstenedione A

82160 Assay of

androsterone A

82163 Assay of angiotensin

II A

82164 Angiotensin I enzyme

test A

82172 Assay of

apolipoprotein A

82175 Assay of

arsenic A

82180 Assay of ascorbic

acid A

82190 Atomic

absorption A

82205 Assay of

barbiturates A

82232 Assay of beta-2

protein A

82239 Bile acids

total A

82240 Bile acids

cholylglycine A

82247 Bilirubin

total A

82248 Bilirubindirect A

82252 Fecal bilirubin

test A

82261 Assay of

biotinidase A

82270 Occult blood

feces A

82271 Occult blood other

sources A

82272 Occult bld feces 1-3

tests A

82274 Assay test for blood

fecal A

82286 Assay of

bradykinin A

82300 Assay of

cadmium A

82306 Vitamin d 25

hydroxy A

82308 Assay of

calcitonin A

82310 Assay of

calcium A

82330 Assay of

calcium A

82331 Calcium infusion

test A

82340 Assay of calcium in

urine A

82355 Calculus analysis

qual A

82360 Calculus assay

quant A

82365 Calculus

spectroscopy A

82370 X-ray assay

calculus A

82373 Assay c-d transfer

measure A

82374 Assay blood carbon

dioxide A

82375 Assay carboxyhb

quant A

82376 Assay carboxyhbqual A

82378 Carcinoembryonic

antigen A

82379 Assay of

carnitine A

82380 Assay of

carotene A

82382 Assay urine

catecholamines A

82383 Assay blood

catecholamines A

82384 Assay three

catecholamines A

82387 Assay of

cathepsin-d A

82390 Assay of

ceruloplasmin A

82397 Chemiluminescent

assay A

82415 Assay of

chloramphenicol A

82435 Assay of blood

chloride A

82436 Assay of urine

chloride A

82438 Assay other fluid

chlorides A

82441 Test for

chlorohydrocarbons A

82465 Assay bld/serum

cholesterol A

82480 Assay serum

cholinesterase A

82482 Assay rbc

cholinesterase A

82485 Assay chondroitin

sulfate A

82486 Gas/liquid

chromatography A

82487 Paper

chromatography A

82488 Paper

chromatography A

82489 Thin layerchromatography A

82491 Chromotography quant

sing A

82492 Chromotography quant

mult A

82495 Assay of

chromium A

82507 Assay of

citrate A

82520 Assay of

cocaine A

82523 Collagen

crosslinks A

82525 Assay of

copper A

82528 Assay of

corticosterone A

82530 Cortisol

free A

82533 Total

cortisol A

82540 Assay of

creatine A

82541 Column chromotography

qual A

82542 Column chromotography

quant A

82543 Column

chromotograph/isotope A

82544 Column

chromotograph/isotope A

82550 Assay of ck

(cpk) A

82552 Assay of cpk in

blood A

82553 Creatine mb

fraction A

82554 Creatine

isoforms A

82565 Assay of

creatinine A

82570 Assay of urine

creatinine A82575 Creatinine clearance

test A

82585 Assay of

cryofibrinogen A

82595 Assay of

cryoglobulin A

82600 Assay of

cyanide A

82607 Vitamin

B-12 A

82608 B-12 binding

capacity A

82610 Cystatin

c A

82615 Test for urine

cystines A

82626 Dehydroepiandrosterone A

82627 Dehydroepiandrosterone A

82633 Desoxycorticosterone A

82634 Deoxycortisol A

82638 Assay of dibucaine

number A

82646 Assay of

dihydrocodeinone A

82649 Assay of

dihydromorphinone A

82651 Assay of

dihydrotestosterone A

82652 Vit d 1

25-dihydroxy A

82654 Assay of

dimethadione A

82656 Pancreatic elastase

fecal A

82657 Enzyme cell

activity A

82658 Enzyme cell activity

ra A

82664 Electrophoretic

test A82666 Assay of

epiandrosterone A

82668 Assay of

erythropoietin A

82670 Assay of

estradiol A

82671 Assay of

estrogens A

82672 Assay of

estrogen A

82677 Assay of

estriol A

82679 Assay of

estrone A

82690 Assay of

ethchlorvynol A

82693 Assay of ethylene

glycol A

82696 Assay of

etiocholanolone A

82705 Fats/lipids feces

qual A

82710 Fats/lipids feces

quant A

82715 Assay of fecal

fat A

82725 Assay of blood fatty

acids A

82726 Long chain fatty

acids A

82728 Assay of

ferritin A

82731 Assay of fetal

fibronectin A

82735 Assay of

fluoride A

82742 Assay of

flurazepam A

82746 Blood folic acid

serum A

82747 Assay of folic acid

rbc A

82757 Assay of semen

fructose A82759 Assay of rbc

galactokinase A

82760 Assay of

galactose A

82775 Assay galactose

transferase A

82776 Galactose transferase

test A

82784 Assay iga/igd/igg/igm

each A

82785 Assay of

ige A

82787 Igg 1 2 3 or 4

each A

82800 Blood

pH A

82803 Blood gases any

combination A

82805 Blood gases w/o2

saturation A

82810 Blood gases o2 sat

only A

82820 Hemoglobin-oxygen

affinity A

82930 Gastric analy w/ph ea

spec A

82938 Gastrin

test A

82941 Assay of

gastrin A

82943 Assay of

glucagon A

82945 Glucose other

fluid A

82946 Glucagon tolerance

test A

82947 Assay glucose blood

quant A

82948 Reagent strip/blood

glucose A

82950 Glucose

test A

82951 Glucose tolerance test

(GTT) A82952 GTT-added

samples A

82953 Glucose-tolbutamide

test A

82955 Assay of g6pd

enzyme A

82960 Test for G6PD

enzyme A

82962 Glucose blood

test A

82963 Assay of

glucosidase A

82965 Assay of gdh

enzyme A

82975 Assay of

glutamine A

82977 Assay of

GGT A

82978 Assay of

glutathione A

82979 Assay rbc

glutathione A

82980 Assay of

glutethimide A

82985 Glycated

protein A

83001 Gonadotropin

(FSH) A

83002 Gonadotropin

(LH) A

83003 Assay growth hormone

(hgh) A

83008 Assay of

guanosine A

83009 H pylori (c-13)

blood A

83010 Assay of haptoglobin

quant A

83012 Assay of

haptoglobins A

83013 H pylori (c-13)

breath A

83014 H pylori drug

admin A83015 Heavy metal

screen A

83018 Quantitative screen

metals A

83020 Hemoglobin

electrophoresis A

83021 Hemoglobin

chromotography A

83026 Hemoglobin copper

sulfate A

83030 Fetal hemoglobin

chemical A

83033 Fetal hemoglobin assay

qual A

83036 Glycosylated hemoglobin

test A

83037 Glycosylated hb home

device A

83045 Blood methemoglobin

test A

83050 Blood methemoglobin

assay A

83051 Assay of plasma

hemoglobin A

83055 Blood sulfhemoglobin

test A

83060 Blood sulfhemoglobin

assay A

83065 Assay of hemoglobin

heat A

83068 Hemoglobin stability

screen A

83069 Assay of urine

hemoglobin A

83070 Assay of hemosiderin

qual A

83071 Assay of hemosiderin

quant A

83080 Assay of b

hexosaminidase A

83088 Assay of

histamine A

83090 Assay of

homocystine A83150 Assay of for

hva A

83491 Assay of

corticosteroids A

83497 Assay of

5-hiaa A

83498 Assay of

progesterone A

83499 Assay of

progesterone A

83500 Assay free

hydroxyproline A

83505 Assay total

hydroxyproline A

83516 Immunoassay

nonantibody A

83518 Immunoassay

dipstick A

83519 Ria

nonantibody A

83520 Immunoassay quant nos

nonab A

83525 Assay of

insulin A

83527 Assay of

insulin A

83528 Assay of intrinsic

factor A

83540 Assay of

iron A

83550 Iron binding

test A

83570 Assay of idh

enzyme A

83582 Assay of ketogenic

steroids A

83586 Assay 17-

ketosteroids A

83593 Fractionation

ketosteroids A

83605 Assay of lactic

acid A

83615 Lactate (LD) (LDH)

enzyme A83625 Assay of ldh

enzymes A

83630 Lactoferrin fecal

(qual) A

83631 Lactoferrin fecal

(quant) A

83632 Placental

lactogen A

83633 Test urine for

lactose A

83634 Assay of urine for

lactose A

83655 Assay of

lead A

83661 L/s ratio fetal

lung A

83662 Foam stability fetal

lung A

83663 Fluoro polarize fetal

lung A

83664 Lamellar bdy fetal

lung A

83670 Assay of lap

enzyme A

83690 Assay of

lipase A

83695 Assay of

lipoprotein(a) A

83698 Assay lipoprotein

pla2 A

83700 Lipopro bld

electrophoretic A

83701 Lipoprotein bld hr

fraction A

83704 Lipoprotein bld by

nmr A

83718 Assay of

lipoprotein A

83719 Assay of blood

lipoprotein A

83721 Assay of blood

lipoprotein A

83727 Assay of lrh

hormone A83735 Assay of

magnesium A

83775 Assay of md

enzyme A

83785 Assay of

manganese A

83788 Mass spectrometry

qual A

83789 Mass spectrometry

quant A

83805 Assay of

meprobamate A

83825 Assay of

mercury A

83835 Assay of

metanephrines A

83840 Assay of

methadone A

83857 Assay of

methemalbumin A

83858 Assay of

methsuximide A

83861 Microfluid analy

tears A

83864 Mucopolysaccharides A

83866 Mucopolysaccharides

screen A

83872 Assay synovial fluid

mucin A

83873 Assay of csf

protein A

83874 Assay of

myoglobin A

83876 Assay

myeloperoxidase A

83880 Natriuretic

peptide A

83883 Assay nephelometry not

spec A

83885 Assay of

nickel A

83887 Assay of

nicotine A83890 Molecule

isolate A

83891 Molecule isolate

nucleic A

83892 Molecular

diagnostics A

83893 Molecule

dot/slot/blot A

83894 Molecule gel

electrophor A

83896 Molecular

diagnostics A

83897 Molecule nucleic

transfer A

83898 Molecule nucleic ampli

each A

83900 Molecule nucleic ampli 2

seq A

83901 Molecule nucleic ampli

addon A

83902 Molecular

diagnostics A

83903 Molecule mutation

scan A

83904 Molecule mutation

identify A

83905 Molecule mutation

identify A

83906 Molecule mutation

identify A

83907 Lyse cells for nucleic

ext A

83908 Nucleic acid signal

ampli A

83909 Nucleic acid high

resolute A

83912 Genetic

examination A

83913 Molecular rna

stabilization A

83914 Mutation ident

ola/sbce/aspe A

83915 Assay of

nucleotidase A83916 Oligoclonal

bands A

83918 Organic acids total

quant A

83919 Organic acids qual

each A

83921 Organic acid single

quant A

83925 Assay of

opiates A

83930 Assay of blood

osmolality A

83935 Assay of urine

osmolality A

83937 Assay of

osteocalcin A

83945 Assay of

oxalate A

83950 Oncoprotein

her-2/neu A

83951 Oncoprotein

dcp A

83970 Assay of

parathormone A

83986 Assay ph body fluid

nos A

83987 Exhaled breath

condensate A

83992 Assay for

phencyclidine A

83993 Assay for calprotectin

fecal A

84022 Assay of

phenothiazine A

84030 Assay of blood

pku A

84035 Assay of

phenylketones A

84060 Assay acid

phosphatase A

84061 Phosphatase forensic

exam A

84066 Assay prostate

phosphatase A84075 Assay alkaline

phosphatase A

84078 Assay alkaline

phosphatase A

84080 Assay alkaline

phosphatases A

84081 Amniotic fluid enzyme

test A

84085 Assay of rbc pg6d

enzyme A

84087 Assay phosphohexose

enzymes A

84100 Assay of

phosphorus A

84105 Assay of urine

phosphorus A

84106 Test for

porphobilinogen A

84110 Assay of

porphobilinogen A

84112 Placenta alpha micro ig

c/v A

84119 Test urine for

porphyrins A

84120 Assay of urine

porphyrins A

84126 Assay of feces

porphyrins A

84127 Assay of feces

porphyrins A

84132 Assay of serum

potassium A

84133 Assay of urine

potassium A

84134 Assay of

prealbumin A

84135 Assay of

pregnanediol A

84138 Assay of

pregnanetriol A

84140 Assay of

pregnenolone A

84143 Assay of

17-hydroxypregneno A84144 Assay of

progesterone A

84145 Procalcitonin

(pct) A

84146 Assay of

prolactin A

84150 Assay of

prostaglandin A

84152 Assay of psa

complexed A

84153 Assay of psa

total A

84154 Assay of psa

free A

84155 Assay of protein

serum A

84156 Assay of protein

urine A

84157 Assay of protein

other A

84160 Assay of protein any

source A

84163 Pappa

serum A

84165 Protein e-phoresis

serum A

84166 Protein

e-phoresis/urine/csf A

84181 Western blot

test A

84182 Protein western blot

test A

84202 Assay RBC

protoporphyrin A

84203 Test RBC

protoporphyrin A

84206 Assay of

proinsulin A

84207 Assay of vitamin

b-6 A

84210 Assay of

pyruvate A

84220 Assay of pyruvate

kinase A84228 Assay of

quinine A

84233 Assay of

estrogen A

84234 Assay of

progesterone A

84235 Assay of endocrine

hormone A

84238 Assay nonendocrine

receptor A

84244 Assay of

renin A

84252 Assay of vitamin

b-2 A

84255 Assay of

selenium A

84260 Assay of

serotonin A

84270 Assay of sex hormone

globul A

84275 Assay of sialic

acid A

84285 Assay of

silica A

84295 Assay of serum

sodium A

84300 Assay of urine

sodium A

84302 Assay of sweat

sodium A

84305 Assay of

somatomedin A

84307 Assay of

somatostatin A

84311 Spectrophotometry A

84315 Body fluid specific

gravity A

84375 Chromatogram assay

sugars A

84376 Sugars single

qual A

84377 Sugars multiple

qual A84378 Sugars single

quant A

84379 Sugars multiple

quant A

84392 Assay of urine

sulfate A

84402 Assay of

testosterone A

84403 Assay of total

testosterone A

84425 Assay of vitamin

b-1 A

84430 Assay of

thiocyanate A

84431 Thromboxane

urine A

84432 Assay of

thyroglobulin A

84436 Assay of total

thyroxine A

84437 Assay of neonatal

thyroxine A

84439 Assay of free

thyroxine A

84442 Assay of thyroid

activity A

84443 Assay thyroid stim

hormone A

84445 Assay of

tsi A

84446 Assay of vitamin

e A

84449 Assay of

transcortin A

84450 Transferase (AST)

(SGOT) A

84460 Alanine amino (ALT)

(SGPT) A

84466 Assay of

transferrin A

84478 Assay of

triglycerides A

84479 Assay of thyroid (t3 or

t4) A84480 Assay triiodothyronine

(t3) A

84481 Free assay

(FT-3) A

84482 T3

reverse A

84484 Assay of troponin

quant A

84485 Assay duodenal fluid

trypsin A

84488 Test feces for

trypsin A

84490 Assay of feces for

trypsin A

84510 Assay of

tyrosine A

84512 Assay of troponin

qual A

84520 Assay of urea

nitrogen A

84525 Urea nitrogen

semi-quant A

84540 Assay of

urine/urea-n A

84545 Urea-N clearance

test A

84550 Assay of blood/uric

acid A

84560 Assay of urine/uric

acid A

84577 Assay of

feces/urobilinogen A

84578 Test urine

urobilinogen A

84580 Assay of urine

urobilinogen A

84583 Assay of urine

urobilinogen A

84585 Assay of urine

vma A

84586 Assay of

vip A

84588 Assay of

vasopressin A84590 Assay of vitamin

a A

84591 Assay of nos

vitamin A

84597 Assay of vitamin

k A

84600 Assay of

volatiles A

84620 Xylose tolerance

test A

84630 Assay of

zinc A

84681 Assay of

c-peptide A

84702 Chorionic gonadotropin

test A

84703 Chorionic gonadotropin

assay A

84704 Hcg free betachain

test A

84830 Ovulation

tests A

84999 Clinical chemistry

test A

85002 Bleeding time

test A

85004 Automated diff wbc

count A

85007 Bl smear w/diff wbc

count A

85008 Bl smear w/o diff wbc

count A

85009 Manual diff wbc count

b-coat A

85013 Spun

microhematocrit A

85014 Hematocrit A

85018 Hemoglobin A

85025 Complete cbc w/auto diff

wbc A

85027 Complete cbc

automated A

85032 Manual cell counteach A

85041 Automated rbc

count A

85044 Manual reticulocyte

count A

85045 Automated reticulocyte

count A

85046 Reticyte/hgb

concentrate A

85048 Automated leukocyte

count A

85049 Automated platelet

count A

85055 Reticulated platelet

assay A

85060 Blood smear

interpretation B

85097 Bone marrow

interpretation X 0343 0.5225 $36.27 $10.78 $7.26

85130 Chromogenic substrate

assay A

85170 Blood clot

retraction A

85175 Blood clot lysis

time A

85210 Blood clot factor II

test A

85220 Blood clot factor V

test A

85230 Blood clot factor VII

test A

85240 Blood clot factor VIII

test A

85244 Blood clot factor VIII

test A

85245 Blood clot factor VIII

test A

85246 Blood clot factor VIII

test A

85247 Blood clot factor VIII

test A

85250 Blood clot factor IX

test A85260 Blood clot factor X

test A

85270 Blood clot factor XI

test A

85280 Blood clot factor XII

test A

85290 Blood clot factor XIII

test A

85291 Blood clot factor XIII

test A

85292 Blood clot factor

assay A

85293 Blood clot factor

assay A

85300 Antithrombin III

test A

85301 Antithrombin III

test A

85302 Blood clot inhibitor

antigen A

85303 Blood clot inhibitor

test A

85305 Blood clot inhibitor

assay A

85306 Blood clot inhibitor

test A

85307 Assay activated protein

c A

85335 Factor inhibitor

test A

85337 Thrombomodulin A

85345 Coagulation

time A

85347 Coagulation

time A

85348 Coagulation

time A

85360 Euglobulin

lysis A

85362 Fibrin degradation

products A

85366 Fibrinogen

test A85370 Fibrinogen

test A

85378 Fibrin degrade

semiquant A

85379 Fibrin degradation

quant A

85380 Fibrin degradation

vte A

85384 Fibrinogen A

85385 Fibrinogen A

85390 Fibrinolysins

screen A

85396 Clotting assay whole

blood N

85397 Clotting funct

activity A

85400 Fibrinolytic

plasmin A

85410 Fibrinolytic

antiplasmin A

85415 Fibrinolytic

plasminogen A

85420 Fibrinolytic

plasminogen A

85421 Fibrinolytic

plasminogen A

85441 Heinz bodies

direct A

85445 Heinz bodies

induced A

85460 Hemoglobin

fetal A

85461 Hemoglobin

fetal A

85475 Hemolysin A

85520 Heparin

assay A

85525 Heparin

neutralization A

85530 Heparin-protamine

tolerance A

85536 Iron stain peripheral

blood A85540 Wbc alkaline

phosphatase A

85547 RBC mechanical

fragility A

85549 Muramidase A

85555 RBC osmotic

fragility A

85557 RBC osmotic

fragility A

85576 Blood platelet

aggregation A

85597 Phospholipid pltlt

neutraliz A

85598 Hexagnal phosph pltlt

neutrl A

85610 Prothrombin

time A

85611 Prothrombin

test A

85612 Viper venom prothrombin

time A

85613 Russell viper venom

diluted A

85635 Reptilase

test A

85651 Rbc sed rate

nonautomated A

85652 Rbc sed rate

automated A

85660 RBC sickle cell

test A

85670 Thrombin time

plasma A

85675 Thrombin time

titer A

85705 Thromboplastin

inhibition A

85730 Thromboplastin time

partial A

85732 Thromboplastin time

partial A

85810 Blood viscosity

examination A

85999 Hematologyprocedure A

86000 Agglutinins

febrile A

86001 Allergen specific

igg A

86003 Allergen specific

IgE A

86005 Allergen specific

IgE A

86021 WBC antibody

identification A

86022 Platelet

antibodies A

86023 Immunoglobulin

assay A

86038 Antinuclear

antibodies A

86039 Antinuclear antibodies

(ANA) A

86060 Antistreptolysin o

titer A

86063 Antistreptolysin o

screen A

86077 Physician blood bank

service CH X 0342 0.1639 $11.38

. $2.28

86078 Physician blood bank

service X 0343 0.5225 $36.27 $10.78 $7.26

86079 Physician blood bank

service CH X 0342 0.1639 $11.38

. $2.28

86140 C-reactive

protein A

86141 C-reactive protein

hs A

86146 Glycoprotein

antibody A

86147 Cardiolipin

antibody A

86148 Phospholipid

antibody A

86155 Chemotaxis

assay A

86156 Cold agglutininscreen A

86157 Cold agglutinin

titer A

86160 Complement

antigen A

86161 Complement/function

activity A

86162 Complement total

(ch50) A

86171 Complement fixation

each A

86185 Counterimmunoelectrophoresis A

86200 Ccp

antibody A

86215 Deoxyribonuclease

antibody A

86225 DNA

antibody A

86226 Dna antibody single

strand A

86235 Nuclear antigen

antibody A

86243 Fc

receptor A

86255 Fluorescent antibody

screen A

86256 Fluorescent antibody

titer A

86277 Growth hormone

antibody A

86280 Hemagglutination

inhibition A

86294 Immunoassay tumor

qual A

86300 Immunoassay tumor ca

15-3 A

86301 Immunoassay tumor ca

19-9 A

86304 Immunoassay tumor ca

125 A

86305 Human epididymis protein

4 A

86308 Heterophileantibodies A

86309 Heterophile

antibodies A

86310 Heterophile

antibodies A

86316 Immunoassay tumor

other A

86317 Immunoassay infectious

agent A

86318 Immunoassay infectious

agent A

86320 Serum

immunoelectrophoresis A

86325 Other

immunoelectrophoresis A

86327 Immunoelectrophoresis

assay A

86329 Immunodiffusion A

86331 Immunodiffusion

ouchterlony A

86332 Immune complex

assay A

86334 Immunofix e-phoresis

serum A

86335 Immunfix

e-phorsis/urine/csf A

86336 Inhibin

A A

86337 Insulin

antibodies A

86340 Intrinsic factor

antibody A

86341 Islet cell

antibody A

86343 Leukocyte histamine

release A

86344 Leukocyte

phagocytosis A

86352 Cell function assay

w/stim A

86353 Lymphocyte

transformation A86355 B cells total

count A

86356 Mononuclear cell

antigen A

86357 Nk cells total

count A

86359 T cells total

count A

86360 T cell absolute

count/ratio A

86361 T cell absolute

count A

86367 Stem cells total

count A

86376 Microsomal

antibody A

86378 Migration inhibitory

factor A

86382 Neutralization test

viral A

86384 Nitroblue tetrazolium

dye A

86403 Particle agglutination

test A

86406 Particle agglutination

test A

86430 Rheumatoid factor

test A

86431 Rheumatoid factor

quant A

86480 Tb test cell immun

measure A

86481 Tb ag response t-cell

susp A

86485 Skin test

candida X 0341 0.0776 $5.39 $2.02 $1.08

86486 Skin test nos

antigen X 0341 0.0776 $5.39 $2.02 $1.08

86490 Coccidioidomycosis skin

test X 0341 0.0776 $5.39 $2.02 $1.08

86510 Histoplasmosis skin

test X 0341 0.0776 $5.39 $2.02 $1.0886580 TB intradermal

test X 0341 0.0776 $5.39 $2.02 $1.08

86590 Streptokinase

antibody A

86592 Syphilis test non-trep

qual A

86593 Syphilis test non-trep

quant A

86602 Antinomyces

antibody A

86603 Adenovirus

antibody A

86606 Aspergillus

antibody A

86609 Bacterium

antibody A

86611 Bartonella

antibody A

86612 Blastomyces

antibody A

86615 Bordetella

antibody A

86617 Lyme disease

antibody A

86618 Lyme disease

antibody A

86619 Borrelia

antibody A

86622 Brucella

antibody A

86625 Campylobacter

antibody A

86628 Candida

antibody A

86631 Chlamydia

antibody A

86632 Chlamydia igm

antibody A

86635 Coccidioides

antibody A

86638 Q fever

antibody A86641 Cryptococcus

antibody A

86644 CMV

antibody A

86645 Cmv antibody

igm A

86648 Diphtheria

antibody A

86651 Encephalitis

antibody A

86652 Encephalitis

antibody A

86653 Encephalitis

antibody A

86654 Encephalitis

antibody A

86658 Enterovirus

antibody A

86663 Epstein-barr

antibody A

86664 Epstein-barr

antibody A

86665 Epstein-barr

antibody A

86666 Ehrlichia

antibody A

86668 Francisella

tularensis A

86671 Fungus

antibody A

86674 Giardia lamblia

antibody A

86677 Helicobacter

pylori A

86682 Helminth

antibody A

86684 Hemophilus

influenza A

86687 Htlv-i

antibody A

86688 Htlv-ii

antibody A

86689 HTLV/HIV confirmatory

test A86692 Hepatitis delta

agent A

86694 Herpes simplex

test A

86695 Herpes simplex

test A

86696 Herpes simplex type

2 A

86698 Histoplasma A

86701 HIV-1 A

86702 HIV-2 A

86703 Hiv-1/hiv-2 single

assay A

86704 Hep b core antibody

total A

86705 Hep b core antibody

igm A

86706 Hep b surface

antibody A

86707 Hep be

antibody A

86708 Hep a antibody

total A

86709 Hep a antibody

igm A

86710 Influenza virus

antibody A

86713 Legionella

antibody A

86717 Leishmania

antibody A

86720 Leptospira

antibody A

86723 Listeria monocytogenes

ab A

86727 Lymph choriomeningitis

ab A

86729 Lympho venereum

antibody A

86732 Mucormycosis

antibody A

86735 Mumps

antibody A86738 Mycoplasma

antibody A

86741 Neisseria

meningitidis A

86744 Nocardia

antibody A

86747 Parvovirus

antibody A

86750 Malaria

antibody A

86753 Protozoa antibody

nos A

86756 Respiratory virus

antibody A

86757 Rickettsia

antibody A

86759 Rotavirus

antibody A

86762 Rubella

antibody A

86765 Rubeola

antibody A

86768 Salmonella

antibody A

86771 Shigella

antibody A

86774 Tetanus

antibody A

86777 Toxoplasma

antibody A

86778 Toxoplasma antibody

igm A

86780 Treponema

pallidum A

86784 Trichinella

antibody A

86787 Varicella-zoster

antibody A

86788 West nile virus ab

igm A

86789 West nile virus

antibody A

86790 Virus antibody

nos A86793 Yersinia

antibody A

86800 Thyroglobulin

antibody A

86803 Hepatitis c ab

test A

86804 Hep c ab test

confirm A

86805 Lymphocytotoxicity

assay A

86806 Lymphocytotoxicity

assay A

86807 Cytotoxic antibody

screening A

86808 Cytotoxic antibody

screening A

86812 Hla typing a b or

c A

86813 Hla typing a b or

c A

86816 Hla typing

dr/dq A

86817 Hla typing

dr/dq A

86821 Lymphocyte culture

mixed A

86822 Lymphocyte culture

primed A

86825 Hla x-math

non-cytotoxic A

86826 Hla x-match noncytotoxc

addl A

86849 Immunology

procedure A

86850 RBC antibody

screen X 0345 0.2109 $14.64

. $2.93

86860 RBC antibody

elution X 0346 0.3580 $24.85

. $4.97

86870 RBC antibody

identification X 0346 0.3580 $24.85

. $4.97

86880 Coombs test

direct X 0409 0.1103 $7.66 $2.16 $1.5486885 Coombs test indirect

qual X 0409 0.1103 $7.66 $2.16 $1.54

86886 Coombs test indirect

titer X 0409 0.1103 $7.66 $2.16 $1.54

86890 Autologous blood

process X 0347 0.6541 $45.41

. $9.09

86891 Autologous blood op

salvage X 0345 0.2109 $14.64

. $2.93

86900 Blood typing

abo X 0409 0.1103 $7.66 $2.16 $1.54

86901 Blood typing rh

(d) X 0409 0.1103 $7.66 $2.16 $1.54

86902 Blood type antigen donor

ea X 0345 0.2109 $14.64

. $2.93

86904 Blood typing patient

serum X 0345 0.2109 $14.64

. $2.93

86905 Blood typing rbc

antigens X 0345 0.2109 $14.64

. $2.93

86906 Blood typing rh

phenotype X 0345 0.2109 $14.64

. $2.93

86910 Blood typing paternity

test E

86911 Blood typing antigen

system E

86920 Compatibility test

spin X 0345 0.2109 $14.64

. $2.93

86921 Compatibility test

incubate X 0345 0.2109 $14.64

. $2.93

86922 Compatibility test

antiglob X 0346 0.3580 $24.85

. $4.97

86923 Compatibility test

electric X 0345 0.2109 $14.64

. $2.93

86927 Plasma fresh

frozen X 0345 0.2109 $14.64

. $2.9386930 Frozen blood

prep X 0347 0.6541 $45.41

. $9.09

86931 Frozen blood

thaw X 0347 0.6541 $45.41

. $9.09

86932 Frozen blood

freeze/thaw X 0347 0.6541 $45.41

. $9.09

86940 Hemolysins/agglutinins

auto A

86941 Hemolysins/agglutinins A

86945 Blood

product/irradiation X 0345 0.2109 $14.64

. $2.93

86950 Leukacyte

transfusion X 0345 0.2109 $14.64

. $2.93

86960 Vol reduction of

blood/prod X 0345 0.2109 $14.64

. $2.93

86965 Pooling blood

platelets X 0346 0.3580 $24.85

. $4.97

86970 RBC

pretreatment X 0345 0.2109 $14.64

. $2.93

86971 RBC

pretreatment X 0345 0.2109 $14.64

. $2.93

86972 RBC

pretreatment X 0345 0.2109 $14.64

. $2.93

86975 Rbc pretreatment

serum X 0346 0.3580 $24.85

. $4.97

86976 Rbc pretreatment

serum X 0345 0.2109 $14.64

. $2.93

86977 Rbc pretreatment

serum X 0347 0.6541 $45.41

. $9.09

86978 Rbc pretreatment

serum X 0346 0.3580 $24.85

. $4.97

86985 Split blood or

products X 0345 0.2109 $14.64

. $2.9386999 Transfusion

procedure X 0345 0.2109 $14.64

. $2.93

87001 Small animal

inoculation A

87003 Small animal

inoculation A

87015 Specimen

concentration A

87040 Blood culture for

bacteria A

87045 Feces culture

bacteria A

87046 Stool cultr bacteria

each A

87070 Culture bacteria

other A

87071 Culture bacteri aerobic

othr A

87073 Culture bacteria

anaerobic A

87075 Cultr bacteria except

blood A

87076 Culture anaerobe ident

each A

87077 Culture aerobic

identify A

87081 Culture screen

only A

87084 Culture of specimen by

kit A

87086 Urine culture/colony

count A

87088 Urine bacteria

culture A

87101 Skin fungi

culture A

87102 Fungus isolation

culture A

87103 Blood fungus

culture A

87106 Fungi identification

yeast A

87107 Fungi identificationmold A

87109 Mycoplasma A

87110 Chlamydia

culture A

87116 Mycobacteria

culture A

87118 Mycobacteric

identification A

87140 Culture type

immunofluoresc A

87143 Culture typing

glc/hplc A

87147 Culture type

immunologic A

87149 Dna/rna direct

probe A

87150 Dna/rna amplified

probe A

87152 Culture type pulse field

gel A

87153 Dna/rna

sequencing A

87158 Culture typing added

method A

87164 Dark field

examination A

87166 Dark field

examination A

87168 Macroscopic exam

arthropod A

87169 Macroscopic exam

parasite A

87172 Pinworm

exam A

87176 Tissue homogenization

cultr A

87177 Ova and parasites

smears A

87181 Microbe susceptible

diffuse A

87184 Microbe susceptible

disk A

87185 Microbe susceptible

enzyme A87186 Microbe susceptible

mic A

87187 Microbe susceptible

mlc A

87188 Microbe suscept

macrobroth A

87190 Microbe suscept

mycobacteri A

87197 Bactericidal level

serum A

87205 Smear gram

stain A

87206 Smear fluorescent/acid

stai A

87207 Smear special

stain A

87209 Smear complex

stain A

87210 Smear wet mount

saline/ink A

87220 Tissue exam for

fungi A

87230 Assay toxin or

antitoxin A

87250 Virus inoculate

eggs/animal A

87252 Virus inoculation

tissue A

87253 Virus inoculate tissue

addl A

87254 Virus inoculation shell

via A

87255 Genet virus isolate

hsv A

87260 Adenovirus ag

if A

87265 Pertussis ag

if A

87267 Enterovirus antibody

dfa A

87269 Giardia ag

if A

87270 Chlamydia trachomatis ag

if A87271 Cytomegalovirus

dfa A

87272 Cryptosporidium ag

if A

87273 Herpes simplex 2 ag

if A

87274 Herpes simplex 1 ag

if A

87275 Influenza b ag

if A

87276 Influenza a ag

if A

87277 Legionella micdadei ag

if A

87278 Legion pneumophilia ag

if A

87279 Parainfluenza ag

if A

87280 Respiratory syncytial ag

if A

87281 Pneumocystis carinii ag

if A

87283 Rubeola ag

if A

87285 Treponema pallidum ag

if A

87290 Varicella zoster ag

if A

87299 Antibody detection nos

if A

87300 Ag detection polyval

if A

87301 Adenovirus ag

eia A

87305 Aspergillus ag

eia A

87320 Chylmd trach ag

eia A

87324 Clostridium ag

eia A

87327 Cryptococcus neoform ag

eia A

87328 Cryptosporidium ag

eia A87329 Giardia ag

eia A

87332 Cytomegalovirus ag

eia A

87335 E coli 0157 ag

eia A

87336 Entamoeb hist dispr ag

eia A

87337 Entamoeb hist group ag

eia A

87338 Hpylori stool

eia A

87339 H pylori ag

eia A

87340 Hepatitis b surface ag

eia A

87341 Hepatitis b surface ag

eia A

87350 Hepatitis be ag

eia A

87380 Hepatitis delta ag

eia A

87385 Histoplasma capsul ag

eia A

87390 Hiv-1 ag

eia A

87391 Hiv-2 ag

eia A

87400 Influenza a/b ag

eia A

87420 Resp syncytial ag

eia A

87425 Rotavirus ag

eia A

87427 Shiga-like toxin ag

eia A

87430 Strep a ag

eia A

87449 Ag detect nos eia

mult A

87450 Ag detect nos eia

single A

87451 Ag detect polyval eia

mult A87470 Bartonella dna dir

probe A

87471 Bartonella dna amp

probe A

87472 Bartonella dna

quant A

87475 Lyme dis dna dir

probe A

87476 Lyme dis dna amp

probe A

87477 Lyme dis dna

quant A

87480 Candida dna dir

probe A

87481 Candida dna amp

probe A

87482 Candida dna

quant A

87485 Chylmd pneum dna dir

probe A

87486 Chylmd pneum dna amp

probe A

87487 Chylmd pneum dna

quant A

87490 Chylmd trach dna dir

probe A

87491 Chylmd trach dna amp

probe A

87492 Chylmd trach dna

quant A

87493 C diff amplified

probe A

87495 Cytomeg dna dir

probe A

87496 Cytomeg dna amp

probe A

87497 Cytomeg dna

quant A

87498 Enterovirus dna amp

probe A

87500 Vanomycin dna amp

probe A

87501 Influenza dna amp prob

1+ A87502 Influenza dna amp

probe A

87503 Influenza dna amp prob

addl A

87510 Gardner vag dna dir

probe A

87511 Gardner vag dna amp

probe A

87512 Gardner vag dna

quant A

87515 Hepatitis b dna dir

probe A

87516 Hepatitis b dna amp

probe A

87517 Hepatitis b dna

quant A

87520 Hepatitis c rna dir

probe A

87521 Hepatitis c rna amp

probe A

87522 Hepatitis c rna

quant A

87525 Hepatitis g dna dir

probe A

87526 Hepatitis g dna amp

probe A

87527 Hepatitis g dna

quant A

87528 Hsv dna dir

probe A

87529 Hsv dna amp

probe A

87530 Hsv dna

quant A

87531 Hhv-6 dna dir

probe A

87532 Hhv-6 dna amp

probe A

87533 Hhv-6 dna

quant A

87534 Hiv-1 dna dir

probe A

87535 Hiv-1 dna amp

probe A87536 Hiv-1 dna

quant A

87537 Hiv-2 dna dir

probe A

87538 Hiv-2 dna amp

probe A

87539 Hiv-2 dna

quant A

87540 Legion pneumo dna dir

prob A

87541 Legion pneumo dna amp

prob A

87542 Legion pneumo dna

quant A

87550 Mycobacteria dna dir

probe A

87551 Mycobacteria dna amp

probe A

87552 Mycobacteria dna

quant A

87555 M.tuberculo dna dir

probe A

87556 M.tuberculo dna amp

probe A

87557 M.tuberculo dna

quant A

87560 M.avium-intra dna dir

prob A

87561 M.avium-intra dna amp

prob A

87562 M.avium-intra dna

quant A

87580 M.pneumon dna dir

probe A

87581 M.pneumon dna amp

probe A

87582 M.pneumon dna

quant A

87590 N.gonorrhoeae dna dir

prob A

87591 N.gonorrhoeae dna amp

prob A

87592 N.gonorrhoeae dna

quant A87620 Hpv dna dir

probe A

87621 Hpv dna amp

probe A

87622 Hpv dna

quant A

87640 Staph a dna amp

probe A

87641 Mr-staph dna amp

probe A

87650 Strep a dna dir

probe A

87651 Strep a dna amp

probe A

87652 Strep a dna

quant A

87653 Strep b dna amp

probe A

87660 Trichomonas vagin dir

probe A

87797 Detect agent nos dna

dir A

87798 Detect agent nos dna

amp A

87799 Detect agent nos dna

quant A

87800 Detect agnt mult dna

direc A

87801 Detect agnt mult dna

ampli A

87802 Strep b assay

w/optic A

87803 Clostridium toxin a

w/optic A

87804 Influenza assay

w/optic A

87807 Rsv assay

w/optic A

87808 Trichomonas assay

w/optic A

87809 Adenovirus assay

w/optic A

87810 Chylmd trach assay

w/optic A87850 N. gonorrhoeae assay

w/optic A

87880 Strep a assay

w/optic A

87899 Agent nos assay

w/optic A

87900 Phenotype infect agent

drug A

87901 Genotype dna hiv reverse

t A

87902 Genotype dna hepatitis

c A

87903 Phenotype dna hiv

w/culture A

87904 Phenotype dna hiv w/clt

add A

87905 Sialidase enzyme

assay A

87906 Genotype dna hiv reverse

t A

87999 Microbiology

procedure A

88000 Autopsy (necropsy)

gross E

88005 Autopsy (necropsy)

gross E

88007 Autopsy (necropsy)

gross E

88012 Autopsy (necropsy)

gross E

88014 Autopsy (necropsy)

gross E

88016 Autopsy (necropsy)

gross E

88020 Autopsy (necropsy)

complete E

88025 Autopsy (necropsy)

complete E

88027 Autopsy (necropsy)

complete E

88028 Autopsy (necropsy)

complete E

88029 Autopsy (necropsy)

complete E88036 Limited

autopsy E

88037 Limited

autopsy E

88040 Forensic autopsy

(necropsy) E

88045 Coroners autopsy

(necropsy) E

88099 Necropsy (autopsy)

procedure E

88104 Cytopath fl nongyn

smears X 0433 0.2464 $17.11 $5.17 $3.43

88106 Cytopath fl nongyn

filter X 0433 0.2464 $17.11 $5.17 $3.43

88107 Cytopath fl nongyn

sm/fltr CH X 0433 0.2464 $17.11 $5.17 $3.43

88108 Cytopath concentrate

tech X 0433 0.2464 $17.11 $5.17 $3.43

88112 Cytopath cell enhance

tech X 0343 0.5225 $36.27 $10.78 $7.26

88120 Cytp urne 3-5 probes ea

spec X 0344 0.8204 $56.95 $15.56 $11.39

88121 Cytp urine 3-5 probes

cmptr X 0344 0.8204 $56.95 $15.56 $11.39

88125 Forensic

cytopathology X 0433 0.2464 $17.11 $5.17 $3.43

88130 Sex chromatin

identification A

88140 Sex chromatin

identification A

88141 Cytopath c/v

interpret N

88142 Cytopath c/v thin

layer A

88143 Cytopath c/v thin layer

redo A

88147 Cytopath c/v

automated A88148 Cytopath c/v auto

rescreen A

88150 Cytopath c/v

manual A

88152 Cytopath c/v auto

redo A

88153 Cytopath c/v

redo A

88154 Cytopath c/v

select A

88155 Cytopath c/v index

add-on A

88160 Cytopath smear other

source X 0433 0.2464 $17.11 $5.17 $3.43

88161 Cytopath smear other

source X 0433 0.2464 $17.11 $5.17 $3.43

88162 Cytopath smear other

source X 0343 0.5225 $36.27 $10.78 $7.26

88164 Cytopath tbs c/v

manual A

88165 Cytopath tbs c/v

redo A

88166 Cytopath tbs c/v auto

redo A

88167 Cytopath tbs c/v

select A

88172 Cytp dx eval fna 1st ea

site X 0433 0.2464 $17.11 $5.17 $3.43

88173 Cytopath eval fna

report X 0343 0.5225 $36.27 $10.78 $7.26

88174 Cytopath c/v auto in

fluid A

88175 Cytopath c/v auto fluid

redo A

88177 Cytp c/v auto thin lyr

addl X 0342 0.1639 $11.38

. $2.28

88182 Cell marker

study X 0343 0.5225 $36.27 $10.78 $7.26

88184 Flowcytometry/ tc 1

marker X 0433 0.2464 $17.11 $5.17 $3.4388185 Flowcytometry/tc

add-on X 0433 0.2464 $17.11 $5.17 $3.43

88187 Flowcytometry/read

2-8 X 0342 0.1639 $11.38

. $2.28

88188 Flowcytometry/read

9-15 X 0343 0.5225 $36.27 $10.78 $7.26

88189 Flowcytometry/read 16 &

> X 0343 0.5225 $36.27 $10.78 $7.26

88199 Cytopathology

procedure X 0342 0.1639 $11.38

. $2.28

88230 Tissue culture

lymphocyte A

88233 Tissue culture

skin/biopsy A

88235 Tissue culture

placenta A

88237 Tissue culture bone

marrow A

88239 Tissue culture

tumor A

88240 Cell

cryopreserve/storage A

88241 Frozen cell

preparation A

88245 Chromosome analysis

20-25 A

88248 Chromosome analysis

50-100 A

88249 Chromosome analysis

100 A

88261 Chromosome analysis

5 A

88262 Chromosome analysis

15-20 A

88263 Chromosome analysis

45 A

88264 Chromosome analysis

20-25 A

88267 Chromosome analysplacenta A

88269 Chromosome analys

amniotic A

88271 Cytogenetics dna

probe A

88272 Cytogenetics

3-5 A

88273 Cytogenetics

10-30 A

88274 Cytogenetics

25-99 A

88275 Cytogenetics

100-300 A

88280 Chromosome karyotype

study A

88283 Chromosome banding

study A

88285 Chromosome count

additional A

88289 Chromosome study

additional A

88291 Cyto/molecular

report M

88299 Cytogenetic

study X 0342 0.1639 $11.38

. $2.28

88300 Surgical path

gross CH X 0342 0.1639 $11.38

. $2.28

88302 Tissue exam by

pathologist X 0433 0.2464 $17.11 $5.17 $3.43

88304 Tissue exam by

pathologist X 0343 0.5225 $36.27 $10.78 $7.26

88305 Tissue exam by

pathologist X 0343 0.5225 $36.27 $10.78 $7.26

88307 Tissue exam by

pathologist X 0344 0.8204 $56.95 $15.56 $11.39

88309 Tissue exam by

pathologist X 0344 0.8204 $56.95 $15.56 $11.39

88311 Decalcify

tissue X 0342 0.1639 $11.38

. $2.2888312 Special stains group

1 X 0433 0.2464 $17.11 $5.17 $3.43

88313 Special stains group

2 X 0433 0.2464 $17.11 $5.17 $3.43

88314 Histochemical stains

add-on X 0433 0.2464 $17.11 $5.17 $3.43

88318 Chemical

histochemistry X 0433 0.2464 $17.11 $5.17 $3.43

88319 Enzyme

histochemistry X 0343 0.5225 $36.27 $10.78 $7.26

88321 Microslide

consultation X 0433 0.2464 $17.11 $5.17 $3.43

88323 Microslide

consultation X 0343 0.5225 $36.27 $10.78 $7.26

88325 Comprehensive review of

data X 0344 0.8204 $56.95 $15.56 $11.39

88329 Path consult

introp X 0433 0.2464 $17.11 $5.17 $3.43

88331 Path consult intraop 1

bloc X 0343 0.5225 $36.27 $10.78 $7.26

88332 Path consult intraop

addl CH X 0342 0.1639 $11.38

. $2.28

88333 Intraop cyto path consult

1 X 0433 0.2464 $17.11 $5.17 $3.43

88334 Intraop cyto path consult

2 X 0433 0.2464 $17.11 $5.17 $3.43

88342 Immunohistochemistry X 0343 0.5225 $36.27 $10.78 $7.26

88346 Immunofluorescent

study X 0343 0.5225 $36.27 $10.78 $7.26

88347 Immunofluorescent

study X 0343 0.5225 $36.27 $10.78 $7.26

88348 Electron

microscopy X 0661 2.3755 $164.91

. $32.9988349 Scanning electron

microscopy X 0661 2.3755 $164.91

. $32.99

88355 Analysis skeletal

muscle X 0343 0.5225 $36.27 $10.78 $7.26

88356 Analysis

nerve X 0344 0.8204 $56.95 $15.56 $11.39

88358 Analysis

tumor X 0343 0.5225 $36.27 $10.78 $7.26

88360 Tumor

immunohistochem/manual X 0343 0.5225 $36.27 $10.78 $7.26

88361 Tumor

immunohistochem/comput X 0344 0.8204 $56.95 $15.56 $11.39

88362 Nerve teasing

preparations X 0344 0.8204 $56.95 $15.56 $11.39

88363 Xm archive tissue molec

anal X 0342 0.1639 $11.38

. $2.28

88365 Insitu hybridization

(fish) X 0344 0.8204 $56.95 $15.56 $11.39

88367 Insitu hybridization

auto X 0343 0.5225 $36.27 $10.78 $7.26

88368 Insitu hybridization

manual X 0344 0.8204 $56.95 $15.56 $11.39

88371 Protein western blot

tissue A

88372 Protein analysis

w/probe A

88380 Microdissection

laser N

88381 Microdissection

manual N

88384 Eval molecular probes

11-50 X 0433 0.2464 $17.11 $5.17 $3.43

88385 Eval molecul probes

51-250 X 0343 0.5225 $36.27 $10.78 $7.2688386 Eval molecul probes

251-500 X 0344 0.8204 $56.95 $15.56 $11.39

88387 Tiss exam molecular

study N

88388 Tiss ex molecul study

add-on N

88399 Surgical pathology

procedure X 0342 0.1639 $11.38

. $2.28

88720 Bilirubin total

transcut A

88738 Hgb quant

transcutaneous A

88740 Transcutaneous

carboxyhb A

88741 Transcutaneous

methb A

88749 In vivo lab

service A

89049 Chct for mal

hyperthermia X 0342 0.1639 $11.38

. $2.28

89050 Body fluid cell

count A

89051 Body fluid cell

count A

89055 Leukocyte assessment

fecal A

89060 Exam synovial fluid

crystals A

89125 Specimen fat

stain A

89160 Exam feces for meat

fibers A

89190 Nasal smear for

eosinophils A

89220 Sputum specimen

collection X 0433 0.2464 $17.11 $5.17 $3.43

89230 Collect sweat for

test X 0343 0.5225 $36.27 $10.78 $7.26

89240 Pathology lab procedure X

0342 0.1639 $11.38

. $2.28

89250 Cultr oocyte/embryo <4days X 0344 0.8204 $56.95 $15.56 $11.39

89251 Cultr oocyte/embryo <4

days X 0344 0.8204 $56.95 $15.56 $11.39

89253 Embryo

hatching X 0344 0.8204 $56.95 $15.56 $11.39

89254 Oocyte

identification X 0344 0.8204 $56.95 $15.56 $11.39

89255 Prepare embryo for

transfer X 0344 0.8204 $56.95 $15.56 $11.39

89257 Sperm

identification X 0343 0.5225 $36.27 $10.78 $7.26

89258 Cryopreservation

embryo(s) X 0344 0.8204 $56.95 $15.56 $11.39

89259 Cryopreservation

sperm CH X 0433 0.2464 $17.11 $5.17 $3.43

89260 Sperm isolation

simple X 0343 0.5225 $36.27 $10.78 $7.26

89261 Sperm isolation

complex X 0343 0.5225 $36.27 $10.78 $7.26

89264 Identify sperm

tissue X 0344 0.8204 $56.95 $15.56 $11.39

89268 Insemination of

oocytes X 0344 0.8204 $56.95 $15.56 $11.39

89272 Extended culture of

oocytes X 0344 0.8204 $56.95 $15.56 $11.39

89280 Assist oocyte

fertilization X 0344 0.8204 $56.95 $15.56 $11.39

89281 Assist oocyte

fertilization X 0344 0.8204 $56.95 $15.56 $11.39

89290 Biopsy oocyte polar

body X 0344 0.8204 $56.95 $15.56 $11.39

89291 Biopsy oocyte polar

body X 0344 0.8204 $56.95 $15.56 $11.3989300 Semen analysis

w/huhner A

89310 Semen analysis

w/count A

89320 Semen anal

vol/count/mot A

89321 Semen anal sperm

detection A

89322 Semen anal strict

criteria A

89325 Sperm antibody

test A

89329 Sperm evaluation

test A

89330 Evaluation cervical

mucus A

89331 Retrograde ejaculation

anal A

89335 Cryopreserve testicular

tiss X 0344 0.8204 $56.95 $15.56 $11.39

89342 Storage/year

embryo(s) X 0344 0.8204 $56.95 $15.56 $11.39

89343 Storage/year

sperm/semen X 0344 0.8204 $56.95 $15.56 $11.39

89344 Storage/year reprod

tissue X 0344 0.8204 $56.95 $15.56 $11.39

89346 Storage/year

oocyte(s) X 0344 0.8204 $56.95 $15.56 $11.39

89352 Thawing cryopresrved

embryo X 0344 0.8204 $56.95 $15.56 $11.39

89353 Thawing cryopresrved

sperm X 0344 0.8204 $56.95 $15.56 $11.39

89354 Thaw cryoprsvrd reprod

tiss X 0344 0.8204 $56.95 $15.56 $11.39

89356 Thawing cryopresrved

oocyte X 0344 0.8204 $56.95 $15.56 $11.39

89398 Unlisted reprod med lab

proc X 0342 0.1639 $11.38

. $2.2890281 Human ig

im E

90283 Human ig

iv E

90284 Human ig

sc E

90287 Botulinum

antitoxin E

90288 Botulism ig

iv E

90291 Cmv ig

iv E

90296 Diphtheria

antitoxin E

90371 Hep b ig

im K 1630 $112.16

. $22.44

90375 Rabies ig

im/sc K 9133 $159.86

. $31.98

90376 Rabies ig heat

treated K 9134 $154.18

. $30.84

90378 Rsv mab im 50mg CH

N

90384 Rh ig full-dose

im E

90385 Rh ig minidose

im N

90386 Rh ig

iv E

90389 Tetanus ig

im E

90393 Vaccina ig

im E

90396 Varicella-zoster ig

im K 9135 $129.48

. $25.90

90399 Immune

globulin E

90460 Imadm any route 1st

vac/tox B

90461 Inadm any route addl

vac/tox B90471 Immunization

admin S 0436 0.3780 $26.24

. $5.25

90472 Immunization admin each

add S 0436 0.3780 $26.24

. $5.25

90473 Immune admin

oral/nasal S 0436 0.3780 $26.24

. $5.25

90474 Immune admin oral/nasal

addl S 0436 0.3780 $26.24

. $5.25

90476 Adenovirus vaccine type 4 CH

N

90477 Adenovirus vaccine type 7 E

90581 Anthrax vaccine sc E

90585 Bcg vaccine

percut K 9137 $112.46

. $22.50

90586 Bcg vaccine

intravesical B

90632 Hep a vaccine adult

im N

90633 Hep a vacc ped/adol 2

dose N

90634 Hep a vacc ped/adol 3

dose N

90636 Hep a/hep b vacc adult

im N

90644 Meningoccl hib vac 4 dose

im E

90645 Hib vaccine hboc

im N

90646 Hib vaccine prp-d

im N

90647 Hib vaccine prp-omp

im N

90648 Hib vaccine prp-t

im N

90649 Hpv vaccine 4 valent

im M

90650 Hpv vaccine 2 valent

im M

90654 "Flu vaccine no preserv, ID" E90655 Flu vaccine no preserv

6-35m L

90656 Flu vaccine no preserv 3 &

> L

90657 Flu vaccine 3 yrs

im L

90658 Flu vaccine 3 yrs & > im E

90660 Flu vaccine

nasal L

90661 Flu vacc cell cult prsv free E

90662 Flu vacc prsv free inc

antig L

90664 Flu vacc pandemic

intranasal E

90665 Lyme disease vaccine

im N

90666 Flu vac pandem prsrv free

im E

90667 Flu vac pandemic adjuvant

im E

90668 Flu vac pandemic splt

im E

90669 Pneumococcal vacc 7 val im L

90670 Pneumococcal vacc 13 val im L

90675 Rabies vaccine

im K 9139 $190.82

. $38.17

90676 Rabies vaccine

id K 9140 $107.83

. $21.57

90680 Rotovirus vacc 3 dose oral CH

N

90681 Rotavirus vacc 2 dose

oral K 1239 $100.56

. $20.12

90690 Typhoid vaccine

oral N

90691 Typhoid vaccine im N

90692 Typhoid vaccine h-psc/id N

90693 Typhoid vaccine akd

sc B

90696 Dtap-ipv vacc 4-6 yr

im N

90698 Dtap-hib-ip vaccine

im N

90700 Dtap vaccine < 7 yrs

im N

90701 Dtp vaccine

im N

90702 Dt vaccine < 7

im N

90703 Tetanus vaccine

im N

90704 Mumps vaccine

sc N

90705 Measles vaccine

sc N

90706 Rubella vaccine

sc N

90707 Mmr vaccine

sc N

90708 Measles-rubella vaccine

sc N

90710 Mmrv vaccine sc N

90712 Oral poliovirus

vaccine N

90713 Poliovirus ipv

sc/im N

90714 Td vaccine no prsrv >/= 7

im N

90715 Tdap vaccine >7

im N

90716 Chicken pox vaccine

sc M

90717 Yellow fever vaccine

sc N

90718 Td vaccine > 7

im N

90719 Diphtheria vaccine

im N

90720 Dtp/hib vaccineim N

90721 Dtap/hib vaccine

im N

90723 Dtap-hep b-ipv vaccine

im E

90725 Cholera vaccine

injectable E

90727 Plague vaccine im E

90732 Pneumococcal

vaccine L

90733 Meningococcal vaccine sc K

9143 $104.49

. $20.90

90734 Meningococcal vaccine

im K 9145 $83.39

. $16.68

90735 Encephalitis vaccine

sc K 9144 $100.16

. $20.04

90736 Zoster vacc sc M

90738 Inactivated je vacc im M

90740 Hepb vacc ill pat 3 dose

im F

90743 Hep b vacc adol 2 dose

im F

90744 Hepb vacc ped/adol 3 dose

im F

90746 Hep b vaccine adult

im F

90747 Hepb vacc ill pat 4 dose

im F

90748 Hep b/hib vaccine

im E

90749 Vaccine

toxoid N

90801 Psy dx

interview Q3 0323 1.5885 $110.27

. $22.06

90802 Intac psy dx

interview Q3 0323 1.5885 $110.27

. $22.06

90804 Psytx office 20-30

min Q3 0322 1.0957 $76.06

. $15.2290805 Psytx off 20-30 min

w/e&m Q3 0322 1.0957 $76.06

. $15.22

90806 Psytx off 45-50

min Q3 0323 1.5885 $110.27

. $22.06

90807 Psytx off 45-50 min

w/e&m Q3 0323 1.5885 $110.27

. $22.06

90808 Psytx office 75-80

min Q3 0323 1.5885 $110.27

. $22.06

90809 Psytx off 75-80

w/e&m Q3 0323 1.5885 $110.27

. $22.06

90810 Intac psytx off 20-30

min Q3 0322 1.0957 $76.06

. $15.22

90811 Intac psytx 20-30

w/e&m Q3 0322 1.0957 $76.06

. $15.22

90812 Intac psytx off 45-50

min Q3 0323 1.5885 $110.27

. $22.06

90813 Intac psytx 45-50 min

w/e&m Q3 0323 1.5885 $110.27

. $22.06

90814 Intac psytx off 75-80

min Q3 0323 1.5885 $110.27

. $22.06

90815 Intac psytx 75-80

w/e&m Q3 0323 1.5885 $110.27

. $22.06

90816 Psytx hosp 20-30

min P

90817 Psytx hosp 20-30 min

w/e&m P

90818 Psytx hosp 45-50

min P

90819 Psytx hosp 45-50 min

w/e&m P

90821 Psytx hosp 75-80

min P

90822 Psytx hosp 75-80 min

w/e&m P

90823 Intac psytx hosp 20-30

min P

90824 Intac psytx hsp 20-30w/e&m P

90826 Intac psytx hosp 45-50

min P

90827 Intac psytx hsp 45-50

w/e&m P

90828 Intac psytx hosp 75-80

min P

90829 Intac psytx hsp 75-80

w/e&m P

90845 Psychoanalysis Q3 0323 1.5885 $110.27

. $22.06

90846 Family psytx w/o

patient Q3 0324 1.8739 $130.09

. $26.02

90847 Family psytx

w/patient Q3 0324 1.8739 $130.09

. $26.02

90849 Multiple family group

psytx Q3 0325 0.7798 $54.13 $11.54 $10.83

90853 Group

psychotherapy Q3 0325 0.7798 $54.13 $11.54 $10.83

90857 Intac group

psytx Q3 0325 0.7798 $54.13 $11.54 $10.83

90862 Medication

management Q3 0605 1.0430 $72.41

. $14.49

90865 Narcosynthesis Q3 0323 1.5885 $110.27

. $22.06

90867 Tcranial magn stim tx

plan S 0216 2.6231 $182.10

. $36.42

90868 Tcranial magn stim tx

deli S 0216 2.6231 $182.10

. $36.42

90870 Electroconvulsive

therapy S 0320 5.9679 $414.29

. $82.86

90875 Psychophysiological

therapy E

90876 Psychophysiological

therapy E

90880 Hypnotherapy Q3 0323 1.5885 $110.27

. $22.06

90882 Environmentalmanipulation E

90885 Psy evaluation of

records N

90887 Consultation with

family N

90889 Preparation of

report N

90899 Psychiatric

service/therapy Q3 0322 1.0957 $76.06

. $15.22

90901 Biofeedback train any

meth A

90911 Biofeedback peri/uro/rectal T

0126 1.1699 $81.21

. $16.25

90935 Hemodialysis one

evaluation S 0170 5.9462 $412.79

. $82.56

90937 Hemodialysis repeated eval B

90940 Hemodialysis access

study N

90945 Dialysis one

evaluation V 0608 2.4718 $171.59

. $34.32

90947 Dialysis repeated

eval B

90951 Esrd serv 4 visits p mo

<2 M

90952 Esrd serv 2-3 vsts p mo

<2 M

90953 Esrd serv 1 visit p mo

<2 M

90954 Esrd serv 4 vsts p mo

2-11 M

90955 Esrd srv 2-3 vsts p mo

2-11 M

90956 Esrd srv 1 visit p mo

2-11 M

90957 Esrd srv 4 vsts p mo

12-19 M

90958 Esrd srv 2-3 vsts p mo

12-19 M

90959 Esrd serv 1 vst p mo

12-19 M90960 Esrd srv 4 visits p mo

20+ M

90961 Esrd srv 2-3 vsts p mo

20+ M

90962 Esrd serv 1 visit p mo

20+ M

90963 Esrd home pt serv p mo

<2 M

90964 Esrd home pt serv p mo

2-11 M

90965 Esrd home pt serv p mo

12-19 M

90966 Esrd home pt serv p mo

20+ M

90967 Esrd home pt serv p day

<2 M

90968 Esrd home pt srv p day

2-11 M

90969 Esrd home pt srv p day

12-19 M

90970 Esrd home pt serv p day

20+ M

90989 Dialysis training

complete B

90993 Dialysis training

incompl B

90997 Hemoperfusion B

90999 Dialysis

procedure B

91010 Esophagus motility

study X 0361 4.1026 $284.80 $83.23 $56.96

91013 Esophgl motil

w/stim/perfus X 0361 4.1026 $284.80 $83.23 $56.96

91020 Gastric motility

studies X 0361 4.1026 $284.80 $83.23 $56.96

91022 Duodenal motility

study X 0361 4.1026 $284.80 $83.23 $56.96

91030 Acid perfusion of

esophagus X 0361 4.1026 $284.80 $83.23 $56.96

91034 Gastroesophageal refluxtest X 0361 4.1026 $284.80 $83.23 $56.96

91035 G-esoph reflx tst

w/electrod X 0361 4.1026 $284.80 $83.23 $56.96

91037 Esoph imped function

test X 0360 1.7147 $119.03 $33.57 $23.81

91038 Esoph imped funct test >

1h X 0361 4.1026 $284.80 $83.23 $56.96

91040 Esoph balloon distension

tst X 0360 1.7147 $119.03 $33.57 $23.81

91065 Breath hydrogen

test X 0360 1.7147 $119.03 $33.57 $23.81

91110 Gi tract capsule

endoscopy T 0142 10.1643 $705.61 $152.78 $141.13

91111 Esophageal capsule

endoscopy CH T 0419 12.5693 $872.56 $204.51 $174.52

91117 Colon motility 6 hr

study T 0156 3.1976 $221.98

. $44.40

91120 Rectal sensation

test T 0126 1.1699 $81.21

. $16.25

91122 Anal pressure

record T 0156 3.1976 $221.98

. $44.40

91132 Electrogastrography X 0360 1.7147 $119.03 $33.57 $23.81

91133 Electrogastrography

w/test X 0360 1.7147 $119.03 $33.57 $23.81

91299 Gastroenterology

procedure X 0360 1.7147 $119.03 $33.57 $23.81

92002 Eye exam new

patient V 0606 1.4647 $101.68

. $20.34

92004 Eye exam new

patient V 0606 1.4647 $101.68

. $20.34

92012 Eye exam established

pat V 0605 1.0430 $72.41

. $14.4992014 Eye exam &

treatment V 0605 1.0430 $72.41

. $14.49

92015 Refraction E

92018 New eye exam &

treatment T 0699 15.6140 "$1,083.92"

. $216.79

92019 Eye exam &

treatment T 0699 15.6140 "$1,083.92"

. $216.79

92020 Special eye

evaluation S 0230 0.6929 $48.10

. $9.62

92025 Corneal

topography CH S 0230 0.6929 $48.10

. $9.62

92060 Special eye

evaluation CH S 0230 0.6929 $48.10

. $9.62

92065 Orthoptic/pleoptic

training CH S 0230 0.6929 $48.10

. $9.62

92070 Fitting of contact

lens N

92081 Visual field

examination(s) S 0230 0.6929 $48.10

. $9.62

92082 Visual field

examination(s) CH S 0230 0.6929 $48.10

. $9.62

92083 Visual field

examination(s) CH S 0230 0.6929 $48.10

. $9.62

92100 Serial tonometry

exam(s) N

92120 Tonography & eye

evaluation CH S 0230 0.6929 $48.10

. $9.62

92130 Water provocation

tonography S 0230 0.6929 $48.10

. $9.62

92132 Cmptr ophth dx img ant

segmt S 0230 0.6929 $48.10

. $9.62

92133 Cmptr ophth img optic

nerve S 0230 0.6929 $48.10

. $9.62

92134 Cptr ophth dx img post

segmt S 0230 0.6929 $48.10

. $9.6292136 Ophthalmic

biometry CH S 0230 0.6929 $48.10

. $9.62

92140 Glaucoma provocative

tests S 0230 0.6929 $48.10

. $9.62

92225 Special eye exam

initial S 0230 0.6929 $48.10

. $9.62

92226 Special eye exam

subsequent CH S 0230 0.6929 $48.10

. $9.62

92227 Remote dx retinal

imaging X 0035 0.2717 $18.86

. $3.78

92228 Remote retinal imaging

mgmt X 0035 0.2717 $18.86

. $3.78

92230 Eye exam with photos CH

S 0698 1.4030 $97.40

. $19.48

92235 Eye exam with

photos S 0231 2.3088 $160.28

. $32.06

92240 Icg

angiography S 0231 2.3088 $160.28

. $32.06

92250 Eye exam with

photos CH S 0230 0.6929 $48.10

. $9.62

92260 Ophthalmoscopy/dynamometry S 0230 0.6929 $48.10

. $9.62

92265 Eye muscle

evaluation CH S 0230 0.6929 $48.10

. $9.62

92270 Electro-oculography S 0230 0.6929 $48.10

. $9.62

92275 Electroretinography S 0231 2.3088 $160.28

. $32.06

92283 Color vision

examination S 0230 0.6929 $48.10

. $9.62

92284 Dark adaptation eye

exam CH S 0230 0.6929 $48.10

. $9.62

92285 Eye

photography CH S 0230 0.6929 $48.10

. $9.6292286 Internal eye photography CH

S 0698 1.4030 $97.40

. $19.48

92287 Internal eye photography CH

S 0698 1.4030 $97.40

. $19.48

92310 Contact lens

fitting E

92311 Contact lens

fitting S 0698 1.4030 $97.40

. $19.48

92312 Contact lens

fitting CH S 0230 0.6929 $48.10

. $9.62

92313 Contact lens

fitting S 0230 0.6929 $48.10

. $9.62

92314 Prescription of contact

lens E

92315 Prescription of contact

lens S 0230 0.6929 $48.10

. $9.62

92316 Prescription of contact

lens S 0698 1.4030 $97.40

. $19.48

92317 Prescription of contact

lens S 0230 0.6929 $48.10

. $9.62

92325 Modification of contact

lens S 0230 0.6929 $48.10

. $9.62

92326 Replacement of contact

lens CH S 0230 0.6929 $48.10

. $9.62

92340 Fitting of

spectacles E

92341 Fitting of

spectacles E

92342 Fitting of

spectacles E

92352 Special spectacles

fitting S 0698 1.4030 $97.40

. $19.48

92353 Special spectacles

fitting S 0230 0.6929 $48.10

. $9.62

92354 Special spectacles

fitting S 0230 0.6929 $48.10

. $9.6292355 Special spectacles

fitting S 0230 0.6929 $48.10

. $9.62

92358 Eye prosthesis

service S 0230 0.6929 $48.10

. $9.62

92370 Repair & adjust

spectacles E

92371 Repair & adjust

spectacles S 0230 0.6929 $48.10

. $9.62

92499 Eye service or

procedure S 0230 0.6929 $48.10

. $9.62

92502 Ear and throat

examination T 0251 3.3531 $232.77

. $46.56

92504 Ear microscopy

examination N

92506 Speech/hearing

evaluation A

92507 Speech/hearing

therapy A

92508 Speech/hearing

therapy A

92511 Nasopharyngoscopy T 0071 1.0521 $73.04

. $14.61

92512 Nasal function

studies X 0363 0.9462 $65.69 $17.10 $13.14

92516 Facial nerve function

test X 0660 1.8827 $130.70 $27.10 $26.14

92520 Laryngeal function

studies X 0660 1.8827 $130.70 $27.10 $26.14

92526 Oral function

therapy A

92531 Spontaneous nystagmus

study N

92532 Positional nystagmus

test N

92533 Caloric vestibular

test N

92534 Optokinetic nystagmus

test N92540 Basic vestibular

evaluation X 0660 1.8827 $130.70 $27.10 $26.14

92541 Spontaneous nystagmus

test X 0363 0.9462 $65.69 $17.10 $13.14

92542 Positional nystagmus

test X 0363 0.9462 $65.69 $17.10 $13.14

92543 Caloric vestibular

test X 0660 1.8827 $130.70 $27.10 $26.14

92544 Optokinetic nystagmus

test X 0363 0.9462 $65.69 $17.10 $13.14

92545 Oscillating tracking

test X 0363 0.9462 $65.69 $17.10 $13.14

92546 Sinusoidal rotational

test X 0660 1.8827 $130.70 $27.10 $26.14

92547 Supplemental electrical test N

92548 Posturography X 0660 1.8827 $130.70 $27.10 $26.14

92550 Tympanometry & reflex

thresh X 0364 0.4896 $33.99 $7.06 $6.80

92551 Pure tone hearing test

air E

92552 Pure tone audiometry

air X 0364 0.4896 $33.99 $7.06 $6.80

92553 Audiometry air &

bone X 0365 1.2340 $85.66 $18.14 $17.14

92555 Speech threshold

audiometry X 0364 0.4896 $33.99 $7.06 $6.80

92556 Speech audiometry

complete X 0364 0.4896 $33.99 $7.06 $6.80

92557 Comprehensive hearing

test X 0365 1.2340 $85.66 $18.14 $17.14

92559 Group audiometric

testing E

92560 Bekesy audiometryscreen E

92561 Bekesy audiometry

diagnosis CH X 0365 1.2340 $85.66 $18.14 $17.14

92562 Loudness balance

test X 0364 0.4896 $33.99 $7.06 $6.80

92563 Tone decay hearing

test X 0364 0.4896 $33.99 $7.06 $6.80

92564 Sisi hearing

test X 0364 0.4896 $33.99 $7.06 $6.80

92565 Stenger test pure

tone X 0364 0.4896 $33.99 $7.06 $6.80

92567 Tympanometry X 0364 0.4896 $33.99 $7.06 $6.80

92568 Acoustic refl threshold

tst X 0364 0.4896 $33.99 $7.06 $6.80

92570 Acoustic immitance

testing CH X 0365 1.2340 $85.66 $18.14 $17.14

92571 Filtered speech hearing

test X 0364 0.4896 $33.99 $7.06 $6.80

92572 Staggered spondaic word

test X 0366 1.6976 $117.85 $23.61 $23.57

92575 Sensorineural acuity

test X 0364 0.4896 $33.99 $7.06 $6.80

92576 Synthetic sentence

test X 0364 0.4896 $33.99 $7.06 $6.80

92577 Stenger test

speech X 0366 1.6976 $117.85 $23.61 $23.57

92579 Visual audiometry

(vra) X 0365 1.2340 $85.66 $18.14 $17.14

92582 Conditioning play

audiometry X 0365 1.2340 $85.66 $18.14 $17.14

92583 Select picture

audiometry X 0364 0.4896 $33.99 $7.06 $6.80

92584 Electrocochleography S 0216 2.6231 $182.10

. $36.4292585 Auditor evoke potent

compre S 0216 2.6231 $182.10

. $36.42

92586 Auditor evoke potent

limit S 0218 1.1945 $82.92

. $16.59

92587 Evoked auditory

test X 0363 0.9462 $65.69 $17.10 $13.14

92588 Evoked auditory

test X 0363 0.9462 $65.69 $17.10 $13.14

92590 Hearing aid exam one

ear E

92591 Hearing aid exam both

ears E

92592 Hearing aid check one

ear E

92593 Hearing aid check both

ears E

92594 Electro hearng aid test

one E

92595 Electro hearng aid tst

both E

92596 Ear protector

evaluation X 0364 0.4896 $33.99 $7.06 $6.80

92597 Oral speech device

eval A

92601 Cochlear implt f/up exam <

7 X 0366 1.6976 $117.85 $23.61 $23.57

92602 Reprogram cochlear implt <

7 X 0366 1.6976 $117.85 $23.61 $23.57

92603 Cochlear implt f/up exam 7

> X 0366 1.6976 $117.85 $23.61 $23.57

92604 Reprogram cochlear implt 7

> X 0366 1.6976 $117.85 $23.61 $23.57

92605 Eval for nonspeech device

rx A

92606 Non-speech device

service A

92607 Ex for speech device rx1hr A

92608 Ex for speech device rx

addl A

92609 Use of speech device

service A

92610 Evaluate swallowing

function A

92611 Motion

fluoroscopy/swallow A

92612 Endoscopy swallow tst

(fees) A

92613 Endoscopy swallow tst (fees) B

92614 Laryngoscopic sensory

test A

92615 Eval laryngoscopy sense

tst E

92616 Fees w/laryngeal sense

test A

92617 Interprt fees/laryngeal

test E

92620 Auditory function 60

min X 0365 1.2340 $85.66 $18.14 $17.14

92621 Auditory function + 15

min N

92625 Tinnitus

assessment X 0365 1.2340 $85.66 $18.14 $17.14

92626 Eval aud rehab

status X 0366 1.6976 $117.85 $23.61 $23.57

92627 Eval aud status rehab

add-on N

92630 Aud rehab pre-ling hear

loss E

92633 Aud rehab postling hear

loss E

92640 Aud brainstem implt

programg X 0365 1.2340 $85.66 $18.14 $17.14

92700 Ent

procedure/service X 0364 0.4896 $33.99 $7.06 $6.80

92950 Heart/lung resuscitation

cpr S 0094 2.2773 $158.09 $44.32 $31.6292953 Temporary external

pacing Q3 0094 2.2773 $158.09 $44.32 $31.62

92960 Cardioversion electric

ext S 0679 5.3123 $368.78 $94.48 $73.76

92961 Cardioversion electric

int S 0679 5.3123 $368.78 $94.48 $73.76

92970 Cardioassist

internal C

92971 Cardioassist

external C

92973 Percut coronary

thrombectomy T 0088 41.2260 "$2,861.91" $652.56 $572.39

92974 Cath place cardio

brachytx T 0103 16.7686 "$1,164.08"

. $232.82

92975 Dissolve clot heart

vessel C

92977 Dissolve clot heart

vessel T 0676 2.3410 $162.51

. $32.51

92978 Intravasc us heart

add-on N

92979 Intravasc us heart

add-on N

92980 Insert intracoronary

stent T 0104 79.9047 "$5,546.98"

. "$1,109.40"

92981 Insert intracoronary

stent T 0104 79.9047 "$5,546.98"

. "$1,109.40"

92982 Coronary artery

dilation T 0083 65.1118 "$4,520.06"

. $904.02

92984 Coronary artery

dilation T 0083 65.1118 "$4,520.06"

. $904.02

92986 Revision of aortic

valve T 0083 65.1118 "$4,520.06"

. $904.02

92987 Revision of mitral

valve T 0083 65.1118 "$4,520.06"

. $904.02

92990 Revision of pulmonaryvalve T 0083 65.1118 "$4,520.06"

. $904.02

92992 Revision of heart

chamber C

92993 Revision of heart

chamber C

92995 Coronary

atherectomy T 0082 104.8857 "$7,281.17"

. "$1,456.24"

92996 Coronary atherectomy

add-on T 0082 104.8857 "$7,281.17"

. "$1,456.24"

92997 Pul art balloon repr

percut T 0083 65.1118 "$4,520.06"

. $904.02

92998 Pul art balloon repr

percut T 0083 65.1118 "$4,520.06"

. $904.02

93000 Electrocardiogram complete M

93005 Electrocardiogram

tracing S 0099 0.3895 $27.04

. $5.41

93010 Electrocardiogram

report B

93015 Cardiovascular stress

test B

93016 Cardiovascular stress

test B

93017 Cardiovascular stress

test X 0100 2.5348 $175.97 $40.87 $35.20

93018 Cardiovascular stress

test B

93024 Cardiac drug stress

test X 0100 2.5348 $175.97 $40.87 $35.20

93025 Microvolt t-wave

assess X 0100 2.5348 $175.97 $40.87 $35.20

93040 Rhythm ECG with

report B

93041 Rhythm ecg

tracing X 0035 0.2717 $18.86

. $3.78

93042 Rhythm ecg

report B93224 Ecg monit/reprt up to 48

hrs M

93225 Ecg monit/reprt up to 48

hrs S 0097 0.9478 $65.80 $23.63 $13.16

93226 Ecg monit/reprt up to 48

hrs S 0097 0.9478 $65.80 $23.63 $13.16

93227 Ecg monit/reprt up to 48

hrs M

93228 Remote 30 day ecg

rev/report M

93229 Remote 30 day ecg tech

supp S 0209 11.3894 $790.65 $268.73 $158.13

93268 ECG

record/review M

93270 Remote 30 day ecg

rev/report S 0097 0.9478 $65.80 $23.63 $13.16

93271 Ecg/monitoring and analysis S

0692 1.6659 $115.65

. $23.13

93272 Ecg/review interpret

only M

93278 ECG/signal-averaged X 0035 0.2717 $18.86

. $3.78

93279 Pm device progr eval

sngl S 0690 0.5148 $35.74 $8.67 $7.15

93280 Pm device progr eval

dual S 0690 0.5148 $35.74 $8.67 $7.15

93281 Pm device progr eval

multi S 0690 0.5148 $35.74 $8.67 $7.15

93282 Icd device prog eval 1

sngl S 0690 0.5148 $35.74 $8.67 $7.15

93283 Icd device progr eval

dual S 0690 0.5148 $35.74 $8.67 $7.15

93284 Icd device progr eval

mult S 0690 0.5148 $35.74 $8.67 $7.15

93285 Ilr device eval

progr S 0690 0.5148 $35.74 $8.67 $7.1593286 Pre-op pm device

eval N

93287 Pre-op icd device

eval N

93288 Pm device eval in

person S 0690 0.5148 $35.74 $8.67 $7.15

93289 Icd device

interrogate S 0690 0.5148 $35.74 $8.67 $7.15

93290 Icm device eval X

0035 0.2717 $18.86

. $3.78

93291 Ilr device

interrogate S 0690 0.5148 $35.74 $8.67 $7.15

93292 Wcd device

interrogate S 0690 0.5148 $35.74 $8.67 $7.15

93293 Pm phone r-strip device

eval S 0690 0.5148 $35.74 $8.67 $7.15

93294 Pm device interrogate remote M

93295 Icd device interrogat remote M

93296 Pm/icd remote tech

serv S 0690 0.5148 $35.74 $8.67 $7.15

93297 Icm device interrogat remote M

93298 Ilr device interrogat remote M

93299 Icm/ilr remote tech

serv CH S 0690 0.5148 $35.74 $8.67 $7.15

93303 Echo

transthoracic S 0270 8.1675 $566.99 $133.61 $113.40

93304 Echo

transthoracic S 0269 5.5306 $383.93

. $76.79

93306 Tte w/doppler

complete S 0269 5.5306 $383.93

. $76.79

93307 Tte w/o doppler

complete S 0269 5.5306 $383.93

. $76.79

93308 Tte f-up orlmtd S 0697 3.1535 $218.92

. $43.79

93312 Echo

transesophageal S 0270 8.1675 $566.99 $133.61 $113.40

93313 Echo

transesophageal S 0269 5.5306 $383.93

. $76.79

93314 Echo

transesophageal N

93315 Echo transesophageal CH

S 0269 5.5306 $383.93

. $76.79

93316 Echo

transesophageal S 0270 8.1675 $566.99 $133.61 $113.40

93317 Echo

transesophageal N

93318 Echo transesophageal

intraop S 0270 8.1675 $566.99 $133.61 $113.40

93320 Doppler echo exam heart N

93321 Doppler echo exam heart N

93325 Doppler color flow add-on N

93350 Stress tte

only S 0269 5.5306 $383.93

. $76.79

93351 Stress tte

complete S 0270 8.1675 $566.99 $133.61 $113.40

93352 Admin ecg contrast agent M

93451 Right heart

cath T 0080 39.2392 "$2,723.99" $838.04 $544.80

93452 Left hrt cath

w/ventrclgrphy T 0080 39.2392 "$2,723.99" $838.04 $544.80

93453 R&l hrt cath

w/ventriclgrphy T 0080 39.2392 "$2,723.99" $838.04 $544.80

93454 Coronary artery angio

s&i T 0080 39.2392 "$2,723.99" $838.04 $544.80

93455 Coronary art/grft angios&i T 0080 39.2392 "$2,723.99" $838.04 $544.80

93456 R hrt coronary artery

angio T 0080 39.2392 "$2,723.99" $838.04 $544.80

93457 R hrt art/grft

angio T 0080 39.2392 "$2,723.99" $838.04 $544.80

93458 L hrt artery/ventricle

angio T 0080 39.2392 "$2,723.99" $838.04 $544.80

93459 L hrt art/grft

angio T 0080 39.2392 "$2,723.99" $838.04 $544.80

93460 R&l hrt art/ventricle

angio T 0080 39.2392 "$2,723.99" $838.04 $544.80

93461 R&l hrt art/ventricle

angio T 0080 39.2392 "$2,723.99" $838.04 $544.80

93462 L hrt cath trnsptl

puncture T 0080 39.2392 "$2,723.99" $838.04 $544.80

93463 Drug admin & hemodynmic

meas N

93464 Exercise w/hemodynamic

meas N

93503 Insert/place heart

catheter T 0103 16.7686 "$1,164.08"

. $232.82

93505 Biopsy of heart

lining T 0103 16.7686 "$1,164.08"

. $232.82

93530 Rt heart cath

congenital T 0080 39.2392 "$2,723.99" $838.04 $544.80

93531 R & l heart cath

congenital T 0080 39.2392 "$2,723.99" $838.04 $544.80

93532 R & l heart cath

congenital T 0080 39.2392 "$2,723.99" $838.04 $544.80

93533 R & l heart cath

congenital T 0080 39.2392 "$2,723.99" $838.04 $544.80

93561 Cardiac output

measurement N

93562 Cardiac output

measurement N93563 Inject congenital card

cath N

93564 Inject hrt congntl

art/grft N

93565 Inject l ventr/atrial

angio N

93566 Inject r ventr/atrial

angio N

93567 Inject suprvlv

aortography N

93568 Inject pulm art hrt

cath N

93571 Heart flow reserve

measure N

93572 Heart flow reserve

measure N

93580 Transcath closure of

asd T 0434 166.2005 "$11,537.64"

. "$2,307.53"

93581 Transcath closure of

vsd T 0434 166.2005 "$11,537.64"

. "$2,307.53"

93600 Bundle of His

recording S 0084 9.6404 $669.24

. $133.85

93602 Intra-atrial

recording S 0084 9.6404 $669.24

. $133.85

93603 Right ventricular

recording S 0084 9.6404 $669.24

. $133.85

93609 Map tachycardia add-on N

93610 Intra-atrial

pacing S 0084 9.6404 $669.24

. $133.85

93612 Intraventricular

pacing S 0084 9.6404 $669.24

. $133.85

93613 Electrophys map 3d add-on N

93615 Esophageal

recording S 0084 9.6404 $669.24

. $133.85

93616 Esophageal

recording S 0084 9.6404 $669.24

. $133.8593618 Heart rhythm

pacing S 0084 9.6404 $669.24

. $133.85

93619 Electrophysiology

evaluation Q3 0085 52.8540 "$3,669.12"

. $733.83

93620 Electrophysiology

evaluation Q3 0085 52.8540 "$3,669.12"

. $733.83

93621 Electrophysiology evaluation N

93622 Electrophysiology evaluation N

93623 Stimulation pacing heart N

93624 Electrophysiologic

study T 0085 52.8540 "$3,669.12"

. $733.83

93631 Heart pacing mapping N

93640 Evaluation heart device N

93641 Electrophysiology evaluation N

93642 Electrophysiology

evaluation S 0084 9.6404 $669.24

. $133.85

93650 Ablate heart dysrhythm

focus Q3 0085 52.8540 "$3,669.12"

. $733.83

93651 Ablate heart dysrhythm

focus Q3 0086 133.7624 "$9,285.79"

. "$1,857.16"

93652 Ablate heart dysrhythm

focus Q3 0086 133.7624 "$9,285.79"

. "$1,857.16"

93660 Tilt table

evaluation S 0101 4.2610 $295.80 $100.24 $59.16

93662 Intracardiac ecg (ice) N

93668 Peripheral vascular

rehab E

93701 Bioimpedance cv

analysis S 0099 0.3895 $27.04

. $5.41

93720 Total bodyplethysmography B

93721 Plethysmography

tracing CH X 0367 0.7369 $51.16 $13.76 $10.24

93722 Plethysmography

report B

93724 Analyze pacemaker

system S 0690 0.5148 $35.74 $8.67 $7.15

93740 Temperature gradient

studies CH X 0367 0.7369 $51.16 $13.76 $10.24

93745 Set-up

cardiovert-defibrill S 0690 0.5148 $35.74 $8.67 $7.15

93750 Interrogation vad in

person S 0692 1.6659 $115.65

. $23.13

93770 Measure venous

pressure N

93784 Ambulatory BP

monitoring E

93786 Ambulatory BP

recording S 0097 0.9478 $65.80 $23.63 $13.16

93788 Ambulatory BP

analysis S 0097 0.9478 $65.80 $23.63 $13.16

93790 Review/report BP recording M

93797 Cardiac

rehab S 0095 0.9648 $66.98 $13.49 $13.40

93798 Cardiac

rehab/monitor S 0095 0.9648 $66.98 $13.49 $13.40

93799 Cardiovascular

procedure S 0097 0.9478 $65.80 $23.63 $13.16

93875 Extracranial

study S 0096 1.5324 $106.38 $36.83 $21.28

93880 Extracranial

study S 0267 2.1881 $151.90 $59.41 $30.38

93882 Extracranial

study S 0267 2.1881 $151.90 $59.41 $30.3893886 Intracranial

study S 0267 2.1881 $151.90 $59.41 $30.38

93888 Intracranial

study S 0265 0.8995 $62.44 $22.26 $12.49

93890 Tcd vasoreactivity

study S 0266 1.3711 $95.18 $36.80 $19.04

93892 Tcd emboli detect w/o

inj S 0266 1.3711 $95.18 $36.80 $19.04

93893 Tcd emboli detect

w/inj S 0266 1.3711 $95.18 $36.80 $19.04

93922 Upr/l xtremity art 2

levels S 0097 0.9478 $65.80 $23.63 $13.16

93923 Upr/lxtr art stdy 3+

lvls S 0096 1.5324 $106.38 $36.83 $21.28

93924 Lwr xtr vasc stdy

bilat S 0096 1.5324 $106.38 $36.83 $21.28

93925 Lower extremity

study S 0267 2.1881 $151.90 $59.41 $30.38

93926 Lower extremity

study S 0266 1.3711 $95.18 $36.80 $19.04

93930 Upper extremity

study S 0267 2.1881 $151.90 $59.41 $30.38

93931 Upper extremity

study S 0266 1.3711 $95.18 $36.80 $19.04

93965 Extremity

study S 0096 1.5324 $106.38 $36.83 $21.28

93970 Extremity

study S 0267 2.1881 $151.90 $59.41 $30.38

93971 Extremity

study S 0266 1.3711 $95.18 $36.80 $19.04

93975 Vascular

study S 0267 2.1881 $151.90 $59.41 $30.38

93976 Vascular

study S 0267 2.1881 $151.90 $59.41 $30.3893978 Vascular

study S 0267 2.1881 $151.90 $59.41 $30.38

93979 Vascular

study S 0266 1.3711 $95.18 $36.80 $19.04

93980 Penile vascular

study S 0267 2.1881 $151.90 $59.41 $30.38

93981 Penile vascular

study S 0267 2.1881 $151.90 $59.41 $30.38

93982 Aneurysm pressure sens

study S 0097 0.9478 $65.80 $23.63 $13.16

93990 Doppler flow

testing S 0266 1.3711 $95.18 $36.80 $19.04

94002 Vent mgmt inpat init

day Q3 0079 3.0221 $209.79

. $41.96

94003 Vent mgmt inpat subq

day Q3 0079 3.0221 $209.79

. $41.96

94004 Vent mgmt nf per

day B

94005 Home vent mgmt supervision M

94010 Breathing capacity

test CH X 0367 0.7369 $51.16 $13.76 $10.24

94011 Spirometry up to 2 yrs

old CH X 0367 0.7369 $51.16 $13.76 $10.24

94012 Spirmtry w/brnchdil inf-2

yr CH X 0367 0.7369 $51.16 $13.76 $10.24

94013 Meas lung vol thru 2

yrs X 0369 2.6420 $183.41 $37.27 $36.69

94014 Patient recorded

spirometry X 0367 0.7369 $51.16 $13.76 $10.24

94015 Patient recorded

spirometry X 0367 0.7369 $51.16 $13.76 $10.24

94016 Review patient

spirometry A94060 Evaluation of wheezing S

0078 1.4008 $97.24

. $19.45

94070 Evaluation of

wheezing X 0369 2.6420 $183.41 $37.27 $36.69

94150 Vital capacity

test X 0367 0.7369 $51.16 $13.76 $10.24

94200 Lung function test

(MBC/MVV) X 0367 0.7369 $51.16 $13.76 $10.24

94240 Residual lung

capacity X 0368 0.8927 $61.97 $20.93 $12.40

94250 Expired gas

collection X 0367 0.7369 $51.16 $13.76 $10.24

94260 Thoracic gas

volume CH X 0367 0.7369 $51.16 $13.76 $10.24

94350 Lung nitrogen washout

curve CH X 0367 0.7369 $51.16 $13.76 $10.24

94360 Measure airflow

resistance X 0367 0.7369 $51.16 $13.76 $10.24

94370 Breath airway closing

volume CH X 0367 0.7369 $51.16 $13.76 $10.24

94375 Respiratory flow volume

loop CH X 0367 0.7369 $51.16 $13.76 $10.24

94400 CO2 breathing response

curve X 0367 0.7369 $51.16 $13.76 $10.24

94450 Hypoxia response

curve X 0368 0.8927 $61.97 $20.93 $12.40

94452 Hast

w/report X 0368 0.8927 $61.97 $20.93 $12.40

94453 Hast w/oxygen

titrate CH X 0367 0.7369 $51.16 $13.76 $10.24

94610 Surfactant admin thru tube S

0077 0.4224 $29.32 $7.74 $5.87

94620 Pulmonary stresstest/simple X 0368 0.8927 $61.97 $20.93 $12.40

94621 Pulm stress

test/complex X 0369 2.6420 $183.41 $37.27 $36.69

94640 Airway inhalation

treatment S 0077 0.4224 $29.32 $7.74 $5.87

94642 Aerosol inhalation

treatment S 0078 1.4008 $97.24

. $19.45

94644 Cbt 1st

hour X 0340 0.6739 $46.78

. $9.36

94645 Cbt each addl

hour X 0340 0.6739 $46.78

. $9.36

94660 Pos airway pressure

cpap Q3 0078 1.4008 $97.24

. $19.45

94662 Neg press ventilation

cnp Q3 0079 3.0221 $209.79

. $41.96

94664 Evaluate pt use of

inhaler S 0077 0.4224 $29.32 $7.74 $5.87

94667 Chest wall

manipulation S 0077 0.4224 $29.32 $7.74 $5.87

94668 Chest wall

manipulation S 0077 0.4224 $29.32 $7.74 $5.87

94680 Exhaled air analysis

o2 X 0368 0.8927 $61.97 $20.93 $12.40

94681 Exhaled air analysis

o2/co2 CH X 0369 2.6420 $183.41 $37.27 $36.69

94690 Exhaled air

analysis X 0367 0.7369 $51.16 $13.76 $10.24

94720 Monoxide diffusing

capacity X 0368 0.8927 $61.97 $20.93 $12.40

94725 Membrane diffusion

capacity CH X 0367 0.7369 $51.16 $13.76 $10.24

94750 Pulmonary compliance

study X 0367 0.7369 $51.16 $13.76 $10.2494760 Measure blood oxygen

level N

94761 Measure blood oxygen

level N

94762 Measure blood oxygen

level Q3 0097 0.9478 $65.80 $23.63 $13.16

94770 Exhaled carbon dioxide

test X 0368 0.8927 $61.97 $20.93 $12.40

94772 Breath recording

infant X 0369 2.6420 $183.41 $37.27 $36.69

94774 Ped home apnea rec compl B

94775 Ped home apnea rec

hk-up S 0097 0.9478 $65.80 $23.63 $13.16

94776 Ped home apnea rec

downld S 0097 0.9478 $65.80 $23.63 $13.16

94777 Ped home apnea rec report B

94799 Pulmonary

service/procedure X 0367 0.7369 $51.16 $13.76 $10.24

95004 Percut allergy skin

tests X 0381 0.4731 $32.84

. $6.57

95010 Percut allergy titrate

test X 0381 0.4731 $32.84

. $6.57

95012 Exhaled nitric oxide

meas X 0367 0.7369 $51.16 $13.76 $10.24

95015 Id allergy

titrate-drug/bug X 0381 0.4731 $32.84

. $6.57

95024 Id allergy test

drug/bug X 0381 0.4731 $32.84

. $6.57

95027 Id allergy

titrate-airborne X 0381 0.4731 $32.84

. $6.57

95028 Id allergy test-delayed

type X 0381 0.4731 $32.84

. $6.57

95044 Allergy patchtests X 0381 0.4731 $32.84

. $6.57

95052 Photo patch

test X 0381 0.4731 $32.84

. $6.57

95056 Photosensitivity

tests X 0370 1.3506 $93.76

. $18.76

95060 Eye allergy

tests X 0370 1.3506 $93.76

. $18.76

95065 Nose allergy

test X 0381 0.4731 $32.84

. $6.57

95070 Bronchial allergy

tests X 0369 2.6420 $183.41 $37.27 $36.69

95071 Bronchial allergy

tests CH X 0368 0.8927 $61.97 $20.93 $12.40

95075 Ingestion challenge

test X 0361 4.1026 $284.80 $83.23 $56.96

95115 Immunotherapy one

injection S 0436 0.3780 $26.24

. $5.25

95117 Immunotherapy injections S

0436 0.3780 $26.24

. $5.25

95120 Immunotherapy one injection E

95125 Immunotherapy many antigens E

95130 Immunotherapy insect venom E

95131 Immunotherapy insect venoms E

95132 Immunotherapy insect venoms E

95133 Immunotherapy insect venoms E

95134 Immunotherapy insect venoms E

95144 Antigen therapy

services S 0437 0.5280 $36.65

. $7.33

95145 Antigen therapy

services S 0437 0.5280 $36.65

. $7.3395146 Antigen therapy

services S 0438 1.0547 $73.22

. $14.65

95147 Antigen therapy

services S 0438 1.0547 $73.22

. $14.65

95148 Antigen therapy

services S 0437 0.5280 $36.65

. $7.33

95149 Antigen therapy

services S 0437 0.5280 $36.65

. $7.33

95165 Antigen therapy

services S 0436 0.3780 $26.24

. $5.25

95170 Antigen therapy

services S 0437 0.5280 $36.65

. $7.33

95180 Rapid

desensitization X 0370 1.3506 $93.76

. $18.76

95199 Allergy immunology

services X 0381 0.4731 $32.84

. $6.57

95250 Glucose monitoring

cont V 0607 1.9242 $133.58

. $26.72

95251 Gluc monitor cont phys

i&r B

95800 Slp stdy

unattended S 0213 2.3958 $166.32 $53.48 $33.27

95801 Slp stdy unatnd

w/anal S 0213 2.3958 $166.32 $53.48 $33.27

95803 Actigraphy

testing S 0218 1.1945 $82.92

. $16.59

95805 Multiple sleep latency

test S 0209 11.3894 $790.65 $268.73 $158.13

95806 Sleep study unatt&resp

efft S 0213 2.3958 $166.32 $53.48 $33.27

95807 Sleep study

attended S 0209 11.3894 $790.65 $268.73 $158.13

95808 Polysomnography

1-3 S 0209 11.3894 $790.65 $268.73 $158.1395810 Polysomnography 4 or

more S 0209 11.3894 $790.65 $268.73 $158.13

95811 Polysomnography

w/cpap S 0209 11.3894 $790.65 $268.73 $158.13

95812 Eeg 41-60

minutes S 0213 2.3958 $166.32 $53.48 $33.27

95813 Eeg over 1

hour S 0213 2.3958 $166.32 $53.48 $33.27

95816 Eeg awake and

drowsy S 0213 2.3958 $166.32 $53.48 $33.27

95819 Eeg awake and

asleep S 0213 2.3958 $166.32 $53.48 $33.27

95822 Eeg coma or sleep

only S 0213 2.3958 $166.32 $53.48 $33.27

95824 Eeg cerebral death

only S 0216 2.6231 $182.10

. $36.42

95827 Eeg all night

recording S 0213 2.3958 $166.32 $53.48 $33.27

95829 Surgery electrocorticogram N

95830 Insert electrodes for

EEG B

95831 Limb muscle testing

manual A

95832 Hand muscle testing

manual A

95833 Body muscle testing

manual A

95834 Body muscle testing

manual A

95851 Range of motion

measurements A

95852 Range of motion

measurements A

95857 Cholinesterase

challenge S 0218 1.1945 $82.92

. $16.5995860 Muscle test one

limb S 0218 1.1945 $82.92

. $16.59

95861 Muscle test 2

limbs S 0218 1.1945 $82.92

. $16.59

95863 Muscle test 3

limbs S 0218 1.1945 $82.92

. $16.59

95864 Muscle test 4

limbs S 0218 1.1945 $82.92

. $16.59

95865 Muscle test

larynx S 0218 1.1945 $82.92

. $16.59

95866 Muscle test

hemidiaphragm S 0218 1.1945 $82.92

. $16.59

95867 Muscle test cran nerv

unilat S 0218 1.1945 $82.92

. $16.59

95868 Muscle test cran nerve

bilat S 0218 1.1945 $82.92

. $16.59

95869 Muscle test thor

paraspinal S 0215 0.6352 $44.10

. $8.82

95870 Muscle test

nonparaspinal S 0215 0.6352 $44.10

. $8.82

95872 Muscle test one

fiber S 0218 1.1945 $82.92

. $16.59

95873 Guide nerv destr elec stim N

95874 Guide nerv destr needle emg N

95875 Limb exercise

test S 0218 1.1945 $82.92

. $16.59

95900 Motor nerve conduction

test S 0215 0.6352 $44.10

. $8.82

95903 Motor nerve conduction

test S 0215 0.6352 $44.10

. $8.82

95904 Sense nerve conduction

test S 0215 0.6352 $44.10

. $8.8295905 Motor/sens nrve conduct

test S 0215 0.6352 $44.10

. $8.82

95920 Intraop nerve test add-on N

95921 Autonomic nerv function

test S 0218 1.1945 $82.92

. $16.59

95922 Autonomic nerv function

test S 0218 1.1945 $82.92

. $16.59

95923 Autonomic nerv function

test S 0218 1.1945 $82.92

. $16.59

95925 Somatosensory

testing S 0216 2.6231 $182.10

. $36.42

95926 Somatosensory

testing S 0216 2.6231 $182.10

. $36.42

95927 Somatosensory

testing S 0216 2.6231 $182.10

. $36.42

95928 C motor evoked uppr

limbs S 0218 1.1945 $82.92

. $16.59

95929 C motor evoked lwr

limbs S 0218 1.1945 $82.92

. $16.59

95930 Visual evoked potential

test S 0216 2.6231 $182.10

. $36.42

95933 Blink reflex

test S 0215 0.6352 $44.10

. $8.82

95934 H-reflex

test S 0215 0.6352 $44.10

. $8.82

95936 H-reflex

test S 0215 0.6352 $44.10

. $8.82

95937 Neuromuscular junction

test S 0218 1.1945 $82.92

. $16.59

95950 Ambulatory eeg

monitoring S 0209 11.3894 $790.65 $268.73 $158.13

95951 EEG

monitoring/videorecord S 0209 11.3894 $790.65 $268.73 $158.1395953 EEG

monitoring/computer S 0209 11.3894 $790.65 $268.73 $158.13

95954 EEG monitoring/giving

drugs S 0218 1.1945 $82.92

. $16.59

95955 EEG during surgery N

95956 Eeg monitor technol

attended S 0209 11.3894 $790.65 $268.73 $158.13

95957 EEG digital analysis N

95958 EEG monitoring/function

test S 0213 2.3958 $166.32 $53.48 $33.27

95961 Electrode stimulation

brain S 0216 2.6231 $182.10

. $36.42

95962 Electrode stim brain

add-on S 0216 2.6231 $182.10

. $36.42

95965 Meg spontaneous S

0067 46.8279 "$3,250.79"

. $650.16

95966 Meg evoked single S

0065 12.4513 $864.37

. $172.88

95967 Meg evoked each addl S

0065 12.4513 $864.37

. $172.88

95970 Analyze neurostim no

prog S 0218 1.1945 $82.92

. $16.59

95971 Analyze neurostim

simple S 0692 1.6659 $115.65

. $23.13

95972 Analyze neurostim

complex S 0692 1.6659 $115.65

. $23.13

95973 Analyze neurostim

complex S 0692 1.6659 $115.65

. $23.13

95974 Cranial neurostim

complex S 0692 1.6659 $115.65

. $23.13

95975 Cranial neurostim

complex S 0692 1.6659 $115.65

. $23.1395978 Analyze neurostim

brain/1h S 0692 1.6659 $115.65

. $23.13

95979 Analyz neurostim brain

addon S 0692 1.6659 $115.65

. $23.13

95980 Io anal gast n-stim

init N

95981 Io anal gast n-stim

subsq S 0218 1.1945 $82.92

. $16.59

95982 Io ga n-stim subsq

w/reprog S 0692 1.6659 $115.65

. $23.13

95990 Spin/brain pump refil &

main S 0439 1.9117 $132.71

. $26.55

95991 Spin/brain pump refil &

main S 0439 1.9117 $132.71

. $26.55

95992 Canalith repositioning

proc A

95999 Neurological

procedure S 0215 0.6352 $44.10

. $8.82

96000 Motion analysis

video/3d S 0216 2.6231 $182.10

. $36.42

96001 Motion test w/ft press

meas S 0216 2.6231 $182.10

. $36.42

96002 Dynamic surface

emg S 0218 1.1945 $82.92

. $16.59

96003 Dynamic fine wire

emg S 0218 1.1945 $82.92

. $16.59

96004 Phys review of motion tests B

96020 Functional brain mapping N

96040 Genetic counseling 30 min B

96101 Psycho testing by

psych/phys Q3 0382 2.6658 $185.06

. $37.02

96102 Psycho testing by

technician Q3 0382 2.6658 $185.06

. $37.0296103 Psycho testing admin by

comp Q3 0373 1.3767 $95.57

. $19.12

96105 Assessment of

aphasia A

96110 Developmental test

lim Q3 0373 1.3767 $95.57

. $19.12

96111 Developmental test

extend Q3 0373 1.3767 $95.57

. $19.12

96116 Neurobehavioral status

exam Q3 0382 2.6658 $185.06

. $37.02

96118 Neuropsych tst by

psych/phys Q3 0382 2.6658 $185.06

. $37.02

96119 Neuropsych testing by

tec Q3 0382 2.6658 $185.06

. $37.02

96120 Neuropsych tst admin

w/comp Q3 0382 2.6658 $185.06

. $37.02

96125 Cognitive test by hc pro A

96150 Assess hlth/behave

init Q3 0432 0.4940 $34.29

. $6.86

96151 Assess hlth/behave

subseq Q3 0432 0.4940 $34.29

. $6.86

96152 Intervene hlth/behave

indiv Q3 0432 0.4940 $34.29

. $6.86

96153 Intervene hlth/behave

group Q3 0432 0.4940 $34.29

. $6.86

96154 Interv hlth/behav fam

w/pt Q3 0432 0.4940 $34.29

. $6.86

96155 Interv hlth/behav fam no

pt E

96360 Hydration iv infusion

init S 0438 1.0547 $73.22

. $14.65

96361 Hydrate iv infusion

add-on S 0436 0.3780 $26.24

. $5.2596365 Ther/proph/diag iv inf

init S 0439 1.9117 $132.71

. $26.55

96366 Ther/proph/diag iv inf

addon S 0436 0.3780 $26.24

. $5.25

96367 Tx/proph/dg addl seq iv

inf S 0437 0.5280 $36.65

. $7.33

96368 Ther/diag concurrent

inf N

96369 Sc ther infusion up to 1

hr S 0439 1.9117 $132.71

. $26.55

96370 Sc ther infusion addl

hr S 0437 0.5280 $36.65

. $7.33

96371 Sc ther infusion reset

pump S 0436 0.3780 $26.24

. $5.25

96372 Ther/proph/diag inj

sc/im S 0436 0.3780 $26.24

. $5.25

96373 Ther/proph/diag inj

ia S 0437 0.5280 $36.65

. $7.33

96374 Ther/proph/diag inj iv

push S 0437 0.5280 $36.65

. $7.33

96375 Tx/pro/dx inj new drug

addon S 0437 0.5280 $36.65

. $7.33

96376 Tx/pro/dx inj same drug

adon N

96379 Ther/prop/diag inj/inf

proc S 0436 0.3780 $26.24

. $5.25

96401 Chemo anti-neopl

sq/im S 0437 0.5280 $36.65

. $7.33

96402 Chemo hormon antineopl

sq/im S 0437 0.5280 $36.65

. $7.33

96405 Chemo intralesional up to

7 S 0437 0.5280 $36.65

. $7.33

96406 Chemo intralesional over

7 S 0439 1.9117 $132.71

. $26.5596409 Chemo iv push sngl drug S

0439 1.9117 $132.71

. $26.55

96411 Chemo iv push addl drug S

0438 1.0547 $73.22

. $14.65

96413 Chemo iv infusion 1 hr S

0440 3.0395 $211.00

. $42.20

96415 Chemo iv infusion addl

hr S 0437 0.5280 $36.65

. $7.33

96416 Chemo prolong infuse

w/pump S 0440 3.0395 $211.00

. $42.20

96417 Chemo iv infus each addl

seq S 0438 1.0547 $73.22

. $14.65

96420 Chemo ia push

tecnique S 0438 1.0547 $73.22

. $14.65

96422 Chemo ia infusion up to 1

hr S 0440 3.0395 $211.00

. $42.20

96423 Chemo ia infuse each addl hr S

0438 1.0547 $73.22

. $14.65

96425 Chemotherapy infusion

method S 0440 3.0395 $211.00

. $42.20

96440 Chemotherapy

intracavitary S 0439 1.9117 $132.71

. $26.55

96446 Chemotx admn prtl

cavity S 0439 1.9117 $132.71

. $26.55

96450 Chemotherapy into

cns S 0440 3.0395 $211.00

. $42.20

96521 Refill/maint portable

pump S 0439 1.9117 $132.71

. $26.55

96522 Refill/maint pump/resvr

syst S 0439 1.9117 $132.71

. $26.55

96523 Irrig drug delivery device Q1

0624 0.6235 $43.28 $12.56 $8.66

96542 Chemotherapyinjection S 0438 1.0547 $73.22

. $14.65

96549 Chemotherapy

unspecified S 0436 0.3780 $26.24

. $5.25

96567 Photodynamic tx

skin T 0015 1.4936 $103.69

. $20.74

96570 Photodynmc tx 30 min

add-on T 0015 1.4936 $103.69

. $20.74

96571 Photodynamic tx addl 15

min T 0015 1.4936 $103.69

. $20.74

96900 Ultraviolet light

therapy S 0001 0.5025 $34.88

. $6.98

96902 Trichogram N

96904 Whole body

photography N

96910 Photochemotherapy with

UV-B S 0001 0.5025 $34.88

. $6.98

96912 Photochemotherapy with

UV-A S 0001 0.5025 $34.88

. $6.98

96913 Photochemotherapy uv-a or

b S 0683 2.9704 $206.21

. $41.25

96920 Laser tx skin < 250 sq

cm T 0015 1.4936 $103.69

. $20.74

96921 Laser tx skin 250-500 sq

cm T 0015 1.4936 $103.69

. $20.74

96922 Laser tx skin > 500 sq

cm T 0015 1.4936 $103.69

. $20.74

96999 Dermatological

procedure T 0012 0.4047 $28.09

. $5.62

97001 Pt

evaluation A

97002 Pt

re-evaluation A

97003 Ot

evaluation A

97004 Otre-evaluation A

97005 Athletic train

eval E

97006 Athletic train

reeval E

97010 Hot or cold packs

therapy A

97012 Mechanical traction

therapy A

97014 Electric stimulation

therapy E

97016 Vasopneumatic device

therapy A

97018 Paraffin bath

therapy A

97022 Whirlpool

therapy A

97024 Diathermy eg

microwave A

97026 Infrared

therapy A

97028 Ultraviolet

therapy A

97032 Electrical

stimulation A

97033 Electric current

therapy A

97034 Contrast bath

therapy A

97035 Ultrasound

therapy A

97036 Hydrotherapy A

97039 Physical therapy

treatment A

97110 Therapeutic

exercises A

97112 Neuromuscular

reeducation A

97113 Aquatic

therapy/exercises A

97116 Gait training

therapy A

97124 Massage

therapy A97139 Physical medicine

procedure A

97140 Manual

therapy A

97150 Group therapeutic

procedures A

97530 Therapeutic

activities A

97532 Cognitive skills

development A

97533 Sensory

integration A

97535 Self care mngment

training A

97537 Community/work

reintegration A

97542 Wheelchair mngment

training A

97545 Work

hardening A

97546 Work hardening

add-on A

97597 Rmvl devital tis 20

cm/< T 0015 1.4936 $103.69

. $20.74

97598 Rmvl devital tis addl 20

cm< T 0015 1.4936 $103.69

. $20.74

97602 Wound(s) care

non-selective T 0013 0.9786 $67.93

. $13.59

97605 Neg press wound tx < 50

cm T 0013 0.9786 $67.93

. $13.59

97606 Neg press wound tx > 50

cm T 0015 1.4936 $103.69

. $20.74

97750 Physical performance

test A

97755 Assistive technology

assess A

97760 Orthotic mgmt and

training A

97761 Prosthetic

training A97762 C/o for orthotic/prosth

use A

97799 Physical medicine

procedure A

97802 Medical nutrition indiv

in A

97803 Med nutrition indiv

subseq A

97804 Medical nutrition

group A

97810 Acupunct w/o stimul 15

min E

97811 Acupunct w/o stimul addl

15m E

97813 Acupunct w/stimul 15

min E

97814 Acupunct w/stimul addl

15m E

98925 Osteopathic

manipulation S 0060 0.3234 $22.45

. $4.49

98926 Osteopathic

manipulation S 0060 0.3234 $22.45

. $4.49

98927 Osteopathic

manipulation S 0060 0.3234 $22.45

. $4.49

98928 Osteopathic

manipulation S 0060 0.3234 $22.45

. $4.49

98929 Osteopathic

manipulation S 0060 0.3234 $22.45

. $4.49

98940 Chiropractic

manipulation S 0060 0.3234 $22.45

. $4.49

98941 Chiropractic

manipulation S 0060 0.3234 $22.45

. $4.49

98942 Chiropractic

manipulation S 0060 0.3234 $22.45

. $4.49

98943 Chiropractic

manipulation E

98960 Self-mgmt educ & train 1

pt E

98961 Self-mgmt educ/train 2-4pt E

98962 Self-mgmt educ/train 5-8

pt E

98966 Hc pro phone call 5-10

min E

98967 Hc pro phone call 11-20

min E

98968 Hc pro phone call 21-30

min E

98969 Online service by hc

pro E

99000 Specimen handling E

99001 Specimen handling E

99002 Device

handling B

99024 Postop follow-up

visit B

99026 In-hospital on call

service E

99027 Out-of-hosp on call

service E

99050 Medical services after

hrs B

99051 Med serv

eve/wkend/holiday B

99053 Med serv 10pm-8am 24 hr

fac B

99056 Med service out of

office B

99058 Office emergency

care B

99060 Out of office emerg med

serv B

99070 Special

supplies B

99071 Patient education

materials B

99075 Medical

testimony E

99078 Group health

education N

99080 Special reports orforms B

99082 Unusual physician

travel B

99090 Computer data

analysis B

99091 Collect/review data from

pt N

99100 Special anesthesia

service B

99116 Anesthesia with

hypothermia B

99135 Special anesthesia

procedure B

99140 Emergency

anesthesia B

99143 Mod cs by same phys < 5

yrs N

99144 Mod cs by same phys 5 yrs

+ N

99145 Mod cs by same phys

add-on N

99148 Mod cs diff phys < 5

yrs N

99149 Mod cs diff phys 5 yrs

+ N

99150 Mod cs diff phys

add-on N

99170 Anogenital exam

child T 0191 0.1274 $8.84 $1.85 $1.77

99172 Ocular function

screen E

99173 Visual acuity

screen E

99174 Ocular

photoscreening E

99175 Induction of

vomiting N

99183 Hyperbaric oxygen

therapy B

99190 Special pump

services C

99191 Special pump

services C99192 Special pump

services C

99195 Phlebotomy X 0624 0.6235 $43.28 $12.56 $8.66

99199 Special

service/proc/report B

99201 Office/outpatient visit

new V 0604 0.6941 $48.18

. $9.64

99202 Office/outpatient visit

new V 0605 1.0430 $72.41

. $14.49

99203 Office/outpatient visit

new V 0606 1.4647 $101.68

. $20.34

99204 Office/outpatient visit

new V 0607 1.9242 $133.58

. $26.72

99205 Office/outpatient visit new Q3

0608 2.4718 $171.59

. $34.32

99211 Office/outpatient visit

est V 0604 0.6941 $48.18

. $9.64

99212 Office/outpatient visit

est V 0605 1.0430 $72.41

. $14.49

99213 Office/outpatient visit

est V 0605 1.0430 $72.41

. $14.49

99214 Office/outpatient visit

est V 0606 1.4647 $101.68

. $20.34

99215 Office/outpatient visit est Q3

0607 1.9242 $133.58

. $26.72

99217 Observation care

discharge B

99218 Initial observation

care B

99219 Initial observation

care B

99220 Initial observation

care B

99221 Initial hospital care B

99222 Initial hospital care B99223 Initial hospital care B

99224 Subsequent observation care B

99225 Subsequent observation care B

99226 Subsequent observation care B

99231 Subsequent hospital care B

99232 Subsequent hospital care B

99233 Subsequent hospital care B

99234 Observ/hosp same

date B

99235 Observ/hosp same

date B

99236 Observ/hosp same

date B

99238 Hospital discharge day B

99239 Hospital discharge day B

99241 Office

consultation E

99242 Office

consultation E

99243 Office

consultation E

99244 Office

consultation E

99245 Office

consultation E

99251 Inpatient

consultation E

99252 Inpatient

consultation E

99253 Inpatient

consultation E

99254 Inpatient

consultation E

99255 Inpatient

consultation E99281 Emergency dept

visit V 0609 0.7290 $50.61 $12.12 $10.13

99282 Emergency dept

visit V 0613 1.2424 $86.25 $20.73 $17.25

99283 Emergency dept

visit V 0614 1.9769 $137.24 $33.86 $27.45

99284 Emergency dept visit Q3

0615 3.1815 $220.86 $48.11 $44.18

99285 Emergency dept visit Q3

0616 4.7283 $328.24 $72.57 $65.65

99288 Direct advanced life

support B

99291 Critical care first hour Q3

0617 6.8172 $473.25 $104.95 $94.65

99292 Critical care addl 30

min N

99304 Nursing facility care

init B

99305 Nursing facility care

init B

99306 Nursing facility care

init B

99307 Nursing fac care

subseq B

99308 Nursing fac care

subseq B

99309 Nursing fac care

subseq B

99310 Nursing fac care

subseq B

99315 Nursing fac discharge

day B

99316 Nursing fac discharge

day B

99318 Annual nursing fac

assessmnt B

99324 Domicil/r-home visit new

pat B

99325 Domicil/r-home visit new

pat B99326 Domicil/r-home visit new

pat B

99327 Domicil/r-home visit new

pat B

99328 Domicil/r-home visit new

pat B

99334 Domicil/r-home visit est

pat B

99335 Domicil/r-home visit est

pat B

99336 Domicil/r-home visit est

pat B

99337 Domicil/r-home visit est

pat B

99339 Domicil/r-home care

supervis B

99340 Domicil/r-home care

supervis B

99341 Home visit new

patient B

99342 Home visit new

patient B

99343 Home visit new

patient B

99344 Home visit new

patient B

99345 Home visit new

patient B

99347 Home visit est

patient B

99348 Home visit est

patient B

99349 Home visit est

patient B

99350 Home visit est

patient B

99354 Prolonged service

office N

99355 Prolonged service

office N

99356 Prolonged service

inpatient C

99357 Prolonged service

inpatient C99358 Prolong service w/o

contact N

99359 Prolong serv w/o contact

add N

99360 Physician standby

services B

99363 Anticoag mgmt

init B

99364 Anticoag mgmt

subseq B

99366 Team conf w/pat by hc

pro N

99367 Team conf w/o pat by

phys N

99368 Team conf w/o pat by hc

pro N

99374 Home health care

supervision B

99375 Home health care

supervision E

99377 Hospice care

supervision B

99378 Hospice care

supervision E

99379 Nursing fac care

supervision B

99380 Nursing fac care

supervision B

99381 Init pm e/m new pat

inf E

99382 Init pm e/m new pat 1-4

yrs E

99383 Prev visit new age

5-11 E

99384 Prev visit new age

12-17 E

99385 Prev visit new age

18-39 E

99386 Prev visit new age

40-64 E

99387 Init pm e/m new pat 65+

yrs E

99391 Per pm reeval est pat

inf E99392 Prev visit est age

1-4 E

99393 Prev visit est age

5-11 E

99394 Prev visit est age

12-17 E

99395 Prev visit est age

18-39 E

99396 Prev visit est age

40-64 E

99397 Per pm reeval est pat 65+

yr E

99401 Preventive counseling

indiv E

99402 Preventive counseling

indiv E

99403 Preventive counseling

indiv E

99404 Preventive counseling

indiv E

99406 Behav chng smoking 3-10

min X 0031 0.2941 $20.42

. $4.09

99407 Behav chng smoking > 10

min X 0031 0.2941 $20.42

. $4.09

99408 Audit/dast 15-30 min E

99409 Audit/dast over 30

min E

99411 Preventive counseling

group E

99412 Preventive counseling

group E

99420 Health risk assessment

test E

99429 Unlisted preventive

service E

99441 Phone e/m by phys 5-10

min E

99442 Phone e/m by phys 11-20

min E

99443 Phone e/m by phys 21-30

min E99444 Online e/m by

phys E

99450 Basic life disability

exam E

99455 Work related disability

exam B

99456 Disability

examination B

99460 Init nb em per day

hosp V 0605 1.0430 $72.41

. $14.49

99461 Init nb em per day

non-fac M

99462 Sbsq nb em per day

hosp C

99463 Same day nb

discharge V 0605 1.0430 $72.41

. $14.49

99464 Attendance at

delivery N

99465 Nb

resuscitation S 0094 2.2773 $158.09 $44.32 $31.62

99466 Ped crit care

transport N

99467 Ped crit care transport

addl N

99468 Neonate crit care

initial C

99469 Neonate crit care

subsq C

99471 Ped critical care

initial C

99472 Ped critical care

subsq C

99475 Ped crit care age 2-5

init C

99476 Ped crit care age 2-5

subsq C

99477 Init day hosp neonate

care C

99478 Ic lbw inf < 1500 gm

subsq C

99479 Ic lbw inf 1500-2500 g

subsq C99480 Ic inf pbw 2501-5000 g

subsq C

99499 Unlisted e&m

service B

99500 Home visit

prenatal E

99501 Home visit

postnatal E

99502 Home visit nb

care E

99503 Home visit resp

therapy E

99504 Home visit mech

ventilator E

99505 Home visit stoma

care E

99506 Home visit im

injection E

99507 Home visit cath

maintain E

99509 Home visit day life

activity E

99510 Home visit sing/m/fam

couns E

99511 Home visit fecal/enema

mgmt E

99512 Home visit for

hemodialysis E

99600 Home visit

nos E

99601 Home infusion/visit 2

hrs E

99602 Home infusion each addtl

hr E

99605 Mtms by pharm np 15

min E

99606 Mtms by pharm est 15

min E

99607 Mtms by pharm addl 15

min E

0001F Heart failure

composite E

0005F Osteoarthritis

composite E0012F Cap bacterial

assess E

0014F Comp preop assess cat

surg E

0015F Melan follow-up

complete E

0019T Extracorp shock wv tx ms nos A

0030T Antiprothrombin

antibody A

0042T Ct perfusion w/contrast

cbf N

0048T Implant ventricular

device C

0050T Removal circulation

assist C

0051T Implant total heart

system C

0052T Replace component heart

syst C

0053T Replace component heart

syst C

0054T Bone surgery using

computer N

0055T Bone surgery using

computer N

0058T Cryopreservation ovary

tiss X 0344 0.8204 $56.95 $15.56 $11.39

0059T Cryopreservation

oocyte X 0344 0.8204 $56.95 $15.56 $11.39

0071T U/s leiomyomata ablate

<200 S 0067 46.8279 "$3,250.79"

. $650.16

0072T U/s leiomyomata ablate

>200 S 0067 46.8279 "$3,250.79"

. $650.16

0073T Delivery comp

imrt S 0412 6.4422 $447.22

. $89.45

0075T Perq stent/chest vert

art C

0076T S&i stent/chest vert

art C

0078T Endovasc aort reprw/device C

0079T Endovasc visc extnsn

repr C

0080T Endovasc aort repr rad

s&i C

0081T Endovasc visc extnsn

s&i C

0085T Breath test heart

reject E

0092T Artific disc

addl C

0095T Artific diskectomy addl C

0098T Rev artific disc

addl C

0099T Implant corneal

ring CH T 0234 25.2649 "$1,753.89" $511.31 $350.78

0100T Prosth retina

receive&gen T 0672 41.3248 "$2,868.77"

. $573.76

0101T Extracorp shockwv tx hi

enrg T 0050 32.4101 "$2,249.91"

. $449.99

0102T Extracorp shockwv tx

anesth T 0050 32.4101 "$2,249.91"

. $449.99

0103T Holotranscobalamin A

0106T Touch quant sensory test X

0341 0.0776 $5.39 $2.02 $1.08

0107T Vibrate quant sensory test X

0341 0.0776 $5.39 $2.02 $1.08

0108T Cool quant sensory test X

0341 0.0776 $5.39 $2.02 $1.08

0109T Heat quant sensory test X

0341 0.0776 $5.39 $2.02 $1.08

0110T Nos quant sensory

test X 0341 0.0776 $5.39 $2.02 $1.08

0111T Rbc membranes fatty

acids A

0123T Scleralfistulization T 0234 25.2649 "$1,753.89" $511.31 $350.78

0124T Conjunctival drug

placement T 0232 2.9435 $204.34 $42.27 $40.87

0126T Chd risk imt

study Q1 0340 0.6739 $46.78

. $9.36

0141T Perq islet

transplant E

0142T Open islet

transplant E

0143T Laparoscopic islet

transplnt E

0155T Lap impl gast curve

electrd T 0130 39.0865 "$2,713.38" $659.53 $542.68

0156T Lap remv gast curve

electrd T 0130 39.0865 "$2,713.38" $659.53 $542.68

0157T Open impl gast curve

electrd C

0158T Open remv gast curve

electrd C

0159T Cad breast

mri N

0163T Lumb artif diskectomy

addl C

0164T Remove lumb artif disc

addl C

0165T Revise lumb artif disc

addl C

0166T Tcath vsd close w/o

bypass C

0167T Tcath vsd close

w/bypass C

0168T Rhinophototx light app bilat T

0251 3.3531 $232.77

. $46.56

0169T Place stereo cath

brain C

0171T Lumbar spine proces

distract T 0052 87.5671 "$6,078.91"

. "$1,215.79"

0172T Lumbar spine process

addl T 0052 87.5671 "$6,078.91"

. "$1,215.79"0173T Iop monit io

pressure N

0174T Cad cxr with

interp N

0175T Cad cxr

remote N

0178T 64 lead ecg w/i&r B

0179T 64 lead ecg

w/tracing X 0100 2.5348 $175.97 $40.87 $35.20

0180T 64 lead ecg w/i&r only B

0181T Corneal

hysteresis S 0230 0.6929 $48.10

. $9.62

0182T Hdr elect

brachytherapy S 0313 9.8659 $684.89 $258.98 $136.98

0183T Wound

ultrasound T 0015 1.4936 $103.69

. $20.74

0184T Exc rectal tumor

endoscopic C

0185T Comptr probability

analysis N

0186T Suprachoroidal drug

delivery T 0237 22.7865 "$1,581.84"

. $316.37

0188T Videoconf crit care 74

min M

0189T Videoconf crit care addl

30 M

0190T Place intraoc radiation

src T 0237 22.7865 "$1,581.84"

. $316.37

0191T Insert ant segment drain

int T 0673 41.7832 "$2,900.59" $632.65 $580.12

0192T Insert ant segment drain

ext T 0673 41.7832 "$2,900.59" $632.65 $580.12

0195T Arthrod presac

interbody C

0196T Arthrod presac interbody

eac C0197T Intrafraction track

motion N

0198T Ocular blood flow

measure S 0230 0.6929 $48.10

. $9.62

0199T Physiologic tremor

record S 0215 0.6352 $44.10

. $8.82

0200T Perq sacral augmt unilat inj CH

T 0050 32.4101 "$2,249.91"

. $449.99

0201T Perq sacral augmt bilat

inj T 0050 32.4101 "$2,249.91"

. $449.99

0202T Post vert arthrplst 1

lumbar C

0205T Inirs each vessel

add-on N

0206T Remote algorithm analys

ecg Q1 0340 0.6739 $46.78

. $9.36

0207T Clear eyelid gland

w/heat S 0230 0.6929 $48.10

. $9.62

0208T Audiometry air

only X 0035 0.2717 $18.86

. $3.78

0209T Audiometry air &

bone X 0035 0.2717 $18.86

. $3.78

0210T Speech audiometry

threshold X 0035 0.2717 $18.86

. $3.78

0211T Speech audiom thresh &

recog X 0035 0.2717 $18.86

. $3.78

0212T Compre audiometry

evaluation CH X 0365 1.2340 $85.66 $18.14 $17.14

0213T Njx paravert w/us

cer/thor T 0207 7.5480 $523.98

. $104.80

0214T Njx paravert w/us

cer/thor T 0204 2.7693 $192.24 $40.13 $38.45

0215T Njx paravert w/us

cer/thor T 0204 2.7693 $192.24 $40.13 $38.45

0216T Njx paravert w/uslumb/sac T 0207 7.5480 $523.98

. $104.80

0217T Njx paravert w/us

lumb/sac T 0204 2.7693 $192.24 $40.13 $38.45

0218T Njx paravert w/us

lumb/sac T 0204 2.7693 $192.24 $40.13 $38.45

0219T Plmt post facet implt

cerv C

0220T Plmt post facet implt

thor C

0221T Plmt post facet implt

lumb T 0050 32.4101 "$2,249.91"

. $449.99

0222T Plmt post facet implt

addl T 0050 32.4101 "$2,249.91"

. $449.99

0223T Acoustic ecg

w/i&r S 0099 0.3895 $27.04

. $5.41

0224T Acoustic ecg 1+

analysis S 0690 0.5148 $35.74 $8.67 $7.15

0225T Acoustic ecg analy &

reprog S 0690 0.5148 $35.74 $8.67 $7.15

0226T Anoscopy hra w/spec

collect X 0340 0.6739 $46.78

. $9.36

0227T Anoscopy hra

w/biopsy T 0146 6.3038 $437.61

. $87.53

0228T Njx tfrml eprl w/us

cer/thor T 0207 7.5480 $523.98

. $104.80

0229T Njx tfrml eprl w/us

cer/thor T 0206 3.9371 $273.31

. $54.67

0230T Njx tfrml eprl w/us

lumb/sac T 0207 7.5480 $523.98

. $104.80

0231T Njx tfrml eprl w/us

lumb/sac T 0206 3.9371 $273.31

. $54.67

0232T Njx platelet

plasma X 0340 0.6739 $46.78

. $9.36

0233T Skin glycationspectroscopy A

0234T Trluml perip athrc renal

art T 0082 104.8857 "$7,281.17"

. "$1,456.24"

0235T Trluml perip athrc

visceral C

0236T Trluml perip athrc abd

aorta T 0082 104.8857 "$7,281.17"

. "$1,456.24"

0237T Trluml perip athrc

brchiocph T 0082 104.8857 "$7,281.17"

. "$1,456.24"

0238T Trluml perip athrc iliac

art T 0082 104.8857 "$7,281.17"

. "$1,456.24"

0239T Bioimpedance

spectroscopy S 0099 0.3895 $27.04

. $5.41

0240T Esoph motility 3d

topography X 0361 4.1026 $284.80 $83.23 $56.96

0241T Esoph motility

w/stim/perf X 0361 4.1026 $284.80 $83.23 $56.96

0242T Gi tract transit & pres

meas X 0361 4.1026 $284.80 $83.23 $56.96

0243T Intm msr bronchodil

wheeze S 0078 1.4008 $97.24

. $19.45

0244T Cont msr bronchodil

wheeze X 0369 2.6420 $183.41 $37.27 $36.69

0245T Opn tx rib fx 1-2

ribs T 0062 26.2376 "$1,821.41" $371.33 $364.29

0246T Opn tx rib fx 3-4

ribs T 0062 26.2376 "$1,821.41" $371.33 $364.29

0247T Opn tx rib fx 5-6

ribs T 0062 26.2376 "$1,821.41" $371.33 $364.29

0248T Opn tx rib fx 7+

ribs T 0062 26.2376 "$1,821.41" $371.33 $364.29

0249T Ligation hemorrhoid

w/us T 0155 16.0235 "$1,112.35"

. $222.47

0250T Insert bronchialvalve T 0415 29.1250 "$2,021.86" $459.92 $404.38

0251T Remov bronchial valve

addl T 0076 10.4123 $722.82 $189.71 $144.57

0252T Bronchscpc rmvl bronch

valve T 0076 10.4123 $722.82 $189.71 $144.57

0253T Insert aqueous drain

device T 0234 25.2649 "$1,753.89" $511.31 $350.78

0254T Evasc rpr iliac art

bifur C

0255T Evasc rpr iliac art bifr

s&i C

0256T Evasc aortic hrt

valve C

0257T Opn tthrc aortic hrt

valve C

0258T Aortic hrt valv w/o card

byp C

0259T Aortic hrt valve w/card

byp C

0260T Hypthrm bdy neonate

28d/< N

0261T Hypthrm head neonate

28d/< N

0500F Initial prenatal care

visit E

0501F Prenatal flow

sheet E

0502F Subsequent prenatal

care E

0503F Postpartum care

visit E

0505F Hemodialysis plan docd M

0507F Periton dialysis plan docd M

0509F Urine incon plan docd M

0513F Elev bp plan of care docd M

0514F Care plan hgb docd esa pt M0516F Anemia plan of care

docd E

0517F Glaucoma plan of care docd M

0518F Fall plan of care docd M

0519F Pland chemo docd b/4

txmnt E

0520F Rad dos limts b/4 3d rad M

0521F Plan of care 4 pain docd M

0525F Initial visit for

episode E

0526F Subs visit for episode M

0528F Rcmnd flw-up 10 yrs

docd E

0529F Intrvl 3+yrs pts clnscp docd M

0535F Dyspnea mngmnt plan

docd E

0540F Gluco mngmnt plan docd M

0545F Follow up care plan mdd

docd E

0575F HIV rna plan care docd M

1000F Tobacco use

assessed E

1002F Assess anginal symptom/level M

1003F Level of activity

assess E

1004F Clin symp vol ovrld

assess E

1005F Asthma symptoms evaluate M

1006F Osteoarthritis assess M

1007F Anti-inflm/anlgsc otc assess M

1008F Gi/renal risk

assess E1015F Copd symptoms

assess E

1018F Assess dyspnea not

present E

1019F Assess dyspnea

present E

1022F Pneumo imm status

assess E

1026F Co-morbid condition

assess E

1030F Influenza imm status

assess E

1034F Current tobacco

smoker E

1035F Smokeless tobacco

user E

1036F Tobacco non-user M

1038F Persistent asthma M

1039F Intermittent asthma M

1040F Dsm-iv info mdd docd M

1050F History of mole

changes E

1055F Visual funct status

assess E

1060F Doc perm/cont/parox atr

fib E

1061F Doc lack perm+cont+parox

fib E

1065F Ischm stroke symp lt3

hrsb/4 E

1066F Ischm stroke symp ge3

hrsb/4 E

1070F Alarm symp

assessed-absent E

1071F Alarm symp assessed-1+

prsnt E

1090F Pres/absn urine incon assess M

1091F Urine incon characterized M1100F Ptfalls assess-docd ge2+/yr M

1101F Pt falls assess-docd le1/yr M

1110F Pt lft inpt fac w/in 60 days M

1111F Dschrg med/current med merge M

1116F Auric/peri pain assessed M

1118F GERD symps assessed 12

month E

1119F Init eval for condition M

1121F Subs eval for condition M

1123F Acp discuss/dscn mkr docd M

1124F Acp discuss-no dscnmkr docd M

1125F Amnt pain noted pain prsnt M

1126F Amnt pain noted none prsnt M

1130F Bk pain + fxn assessed M

1134F Epsd bk pain for =< 6

wks E

1135F Epsd bk pain for > 6

wks E

1136F Epsd bk pain for <= 12

wks E

1137F Epsd bk pain for > 12

wks E

1150F Doc pt rsk death w/in

1yr E

1151F Doc no pt rsk death w/in

1yr E

1152F Doc advncd dis comfort

1st E

1153F Doc advncd dis cmfrt not

1st E

1157F Advnc care plan in

rcrd E1158F Advnc care plan tlk docd M

1159F Med list docd in

rcrd E

1160F Rvw meds by rx/dr in

rcrd E

1170F Fxnl status assessed M

1180F Thromboemb risk

assessed E

1200F Seizure type& frequ

docd E

1205F EPI etiol synd rvwd and

docd E

1220F Pt screened for

depression E

1400F Prkns diag

rviewed E

2000F Blood pressure measure M

2001F Weight

record E

2002F Clin sign vol ovrld

assess E

2004F Initial exam involved

joints E

2010F Vital signs recorded M

2014F Mental status assess M

2018F Hydration status

assess E

2019F Dilated macul exam done M

2020F Dilated fundus eval

done E

2021F Dilat macul+ exam done M

2022F Dil retina exam interp rev M

2024F 7 field photo interp doc rev M

2026F Eye image valid to dx rev M2027F Optic nerve head eval done M

2028F Foot exam performed M

2029F Complete phys skin exam

done E

2030F H2o stat docd

normal E

2031F H2o stat docd

dehydrated E

2035F Tymp memb motion examd M

2040F Bk pn xm on init visit date M

2044F Doc mntl tst b/4 bk

trxmnt E

2050F Wound char size etc docd E

2060F Pt talk eval hlthwkr re

mdd E

3006F Cxr doc

rev E

3008F Body mass index

docd E

3011F Lipid panel doc

rev E

3014F Screen mammo doc rev M

3015F Cerv cancer screen

docd E

3016F Pt scrnd unhlthy OH use M

3017F Colorectal ca screen doc rev M

3018F Pre-prxd rsk et al docd E

3020F Lvf assess M

3021F Lvef mod/sever deprs syst M

3022F Lvef >=40% systolic M

3023F Spirom doc rev M3025F Spirom fev/fvc<70% w/copd M

3027F Spirom fev/fvc>=70%/w/o copd M

3028F O2 saturation doc rev M

3035F O2 saturation<=88% /pao<=55 E

3037F O2 saturation> 88% /pao>55 E

3038F Pulm fx w/in 12 mon b/4 surg M

3040F Fev<40% predicted value E

3042F Fev>=40% predicted value E

3044F Hg a1c level lt 7.0% M

3045F Hg a1c level 7.0-9.0% M

3046F Hemoglobin a1c level > 9.0% M

3048F Ldl-c <100 mg/dl M

3049F Ldl-c 100-129 mg/dl M

3050F Ldl-c >= 130 mg/dl M

3060F Pos microalbuminuria rev M

3061F Neg microalbuminuria rev M

3062F Pos macroalbuminuria rev M

3066F Nephropathy doc tx M

3072F Low risk for retinopathy M

3073F Pre-surg eye measures docd E

3074F Syst bp lt 130 mm hg M

3075F Syst bp ge 130 - 139mm hg M3077F Syst bp >= 140 mm hg M

3078F Diast bp < 80 mm hg M

3079F Diast bp 80-89 mm hg M

3080F Diast bp >= 90 mm hg M

3082F Kt/v <1.2 M

3083F Kt/v > 1.2 <1.7 M

3084F Kt/v ge 1.7 M

3085F Suicide risk assessed M

3088F Mdd mild E

3089F Mdd moderate E

3090F Mdd severe w/o psych E

3091F Mdd severe w/psych E

3092F Mdd in remission M

3093F Doc new diag 1st/addl mdd E

3095F Central dexa results docd M

3096F Central dexa ordered M

3100F Image test ref carot diam M

3110F Pres/absn hmrhg/lesion docd M

3111F Ct/mri brain done w/in 24hrs M

3112F Ct/mri brain done >24 hrs M

3120F 12-lead ecg performed M

3130F Upper gi endoscopy performed E3132F Doc ref upper gi endoscopy E

3140F Upper gi endo shows barrtts E

3141F Upper gi endo not barrtts E

3142F Barium swallow test ordered E

3150F Forceps esoph biopsy done E

3155F Cytogen test marrow b/4 tx M

3160F Doc fe+ stores b/4 epo thx M

3170F Flow cyto done b/4 tx M

3200F Barium swallow test not req E

3210F Grp a strep test performed M

3215F Pt immunity to hep a docd M

3216F Pt immunity to hep b docd M

3218F Rna tstng hep c docd done M

3220F Hep c quant rna tstng docd M

3230F Note hring tst w/in 6 mon E

3250F Nonprim loc anat bx site tum M

3260F Pt cat/pn cat/hist grd docd M

3265F Rna tstng hepc vir ord/docd M

3266F Hepc gn tstng docd b/4txmnt M

3268F Psa/t/glsc docd b/4 txmnt E

3269F Bone scn b/4 txmnt/aftr Dx M

3270F No bone scn b/4 txmnt/aftrDx M3271F Low risk prostate cancer M

3272F Med risk prostate cancer M

3273F High risk prostate cancer M

3274F Prost Cncr rsk not lw/md/hgh M

3278F Serum lvls CA/iPTH/lpd ord M

3279F Hgb lvl >/= 13 g/dl M

3280F Hgb lvl 11-12.9 g/dL M

3281F Hgb lvl < 11 g/dl M

3284F Iop down >15% of pre-svc lvl M

3285F IOP down <15% of pre-svc lvl M

3288F Fall risk assessment docd M

3290F Pt=D(Rh)- and unsensitized E

3291F Pt=d(rh)+ or sensitized E

3292F Hiv tstng asked/docd/revwd E

3293F Abo rh blood typing

docd E

3294F Grp b strep screening

docd E

3300F AJCC stage docd b/4 thxpy M

3301F Cancer stage docd metast M

3315F Er+ or pr+ breast cancer M

3316F ER- or PR- breast cancer M

3317F Path rpt malig cancer docd E

3318F Path rpt malig cancer docd E3319F X-ray/ct/ultrsnd et al ord M

3320F No xray/ct/ et al ordd M

3321F AJCC cncr 0/IA melan docd M

3322F Melanoma>ajcc stage 0 or ia M

3323F Clin node stgng docdb/4 surg M

3324F Mri ct scan ord rvwd

rqstd E

3325F Preop asses 4 cataract surg E

3328F Prfrmnc docd 2 wks b/4 surg M

3330F Imaging study ordered (bkp) E

3331F Bk imaging tst not ordered E

3340F Mammo assess inc xray docd M

3341F Mammo assess negative docd M

3342F Mammo assess bengn docd M

3343F Mammo probably bengn docd M

3344F Mammo assess susp docd M

3345F Mammo assess hghlymalig doc M

3350F Mammo bx proven malig docd M

3351F Neg scrn dep symp by

deptool E

3352F No sig dep symp by dep

tool E

3353F Mild-mod dep symp by

deptool E

3354F Clin sig dep sym by dep

tool E

3370F AJCC brst cncr stage 0 docd M3372F Ajcc brst cncr stage 1 docd M

3374F Ajcc brst cncr stage 1 docd M

3376F AJCC brstcncr stage 2 docd M

3378F AJCC brstcncr stage 3 docd M

3380F AJCC brstcncr stage 4 docd M

3382F AJCC cln cncr stage 0 docd M

3384F AJCC cln cncr stage 1 docd M

3386F AJCC cln cncr stage 2 docd M

3388F AJCC cln cncr stage 3 docd M

3390F AJCC cln cncr stage 4 docd M

3450F Dyspnea scrnd no-mild dysp E

3451F Dyspnea scrnd mod-high dysp E

3452F Dyspnea not screened E

3455F TB scrng done-interpd 6mon M

3470F Ra disease activity low M

3471F Ra disease activity mod M

3472F Ra disease activity high M

3475F Disease progn RA poor docd M

3476F Disease progn RA good docd M

3490F History aids-defining cond M

3491F HIV unsure baby of HIV+moms E

3492F History cd4+ cell count <350 M3493F No hist cd4+ cell count<350 M

3494F CD4+cell count <200cells/mm3 M

3495F Cd4+cell cnt 200-499 cells M

3496F Cd4+ cell count + 500 cells M

3497F CD4+ cell percentage <15% E

3498F Cd4+ cell % >=15% (hiv) E

3500F Cd4+cell cnt/% docd as done M

3502F HIV rna vrl ld <lmts quantif M

3503F HIV rna vrl ldnot<lmts quntf M

3510F Doc tb scrng-rslts interpd E

3511F Chlmyd/gonrh tsts docd done M

3512F Syph scrng docd as done M

3513F Hep B scrng docd as done E

3514F Hep C scrng docd as done E

3515F Pt has docd immun to hep C E

3550F Low rsk thromboembolism E

3551F Intrmed rsk thromboembolism E

3552F Hgh risk for thromboembolism E

3555F Pt inr measurement performed E

3570F Rprt bone scint xref w xray M

3572F Pt consid poss risk fx E

3573F Pt not consid poss risk fx E3650F Eeg ordered rvwd reqstd E

3700F Psych disorders assessed E

3720F Cognit impairment assessed E

4000F Tobacco use txmnt counseling M

4001F Tobacco use txmnt pharmacol M

4002F Statin therapy rx M

4003F Pt ed write/oral pts w/ hf M

4004F Pt tobacco screen rcvd tlk M

4005F Pharm thx for op rxd M

4006F Beta-blocker therapy rx M

4009F Ace/arb inhibitor therapy rx M

4011F Oral antiplatelet therapy rx M

4012F Warfarin therapy rx M

4014F Written discharge instr prvd E

4015F Persist asthma medicine ctrl M

4016F Anti-inflm/anlgsc agent rx E

4017F Gi prophylaxis for nsaid rx E

4018F Therapy exercise joint rx E

4019F Doc recpt counsl vit d/calc+ E

4025F Inhaled bronchodilator rx M

4030F Oxygen therapy rx E

4033F Pulmonary rehab rec E4035F Influenza imm rec E

4037F Influenza imm order/admin M

4040F Pneumoc vac/admin/rcvd M

4041F Doc order cefazolin/cefurox M

4042F Doc antibio not given M

4043F Doc order given stop antibio M

4044F Doc order given vte prophylx M

4045F Empiric antibiotic rx M

4046F Doc antibio given b/4 surg M

4047F Doc antibio given b/4 surg M

4048F Doc antibio given b/4 surg M

4049F Doc order given stop antibio M

4050F Ht care plan doc M

4051F Referred for an AV fistula M

4052F Hemodialysis via AV fistula E

4053F Hemodialysis via AV graft E

4054F Hemodialysis via catheter E

4055F Pt rcvng periton dialysis E

4056F Approp oral rehyd recommd E

4058F Ped gastro ed given caregvr E

4060F Psych svcs provided E

4062F Pt referral psych docd E4063F Antidepres rxthxpy not

rxd E

4064F Antidepressant rx E

4065F Antipsychotic rx E

4066F ECT provided E

4067F Pt referral for ect docd E

4070F Dvt prophylx recvd day 2 M

4073F Oral antiplat thx rx dischrg M

4075F Anticoag thx rx at dischrg M

4077F Doc t-pa admin considered E

4079F Doc rehab svcs considered M

4084F Aspirin recvd w/in 24 hrs M

4090F Pt rcvng epo thxpy M

4095F Pt not rcvng epo thxpy M

4100F Biphos thxpy vein ord/recvd M

4110F Int mam art used for cabg M

4115F Beta blckr admin w/in 24 hrs M

4120F Antibiot rxd/given M

4124F Antibiot not rxd/given M

4130F Topical prep rx aoe M

4131F Syst antimicrobial thx rx M

4132F No syst antimicrobial thx rx M

4133F Antihist/decong rx/recom E4134F No antihist/decong rx/recom E

4135F Systemic corticosteroids rx E

4136F Syst corticosteroids not rx E

4148F Hep A vac injxn admin/recvd M

4149F Hep B vac injxn admin/recvd M

4150F Pt recvng antivir txmnt hepc M

4151F Pt not recvng antiv hep c M

4153F Combo pegintf/rib rx M

4155F Hep A vac series prev recvd E

4157F Hep B vac series prev recvd E

4158F Pt edu re alcoh drnkng done M

4159F Contrcp talk b/4 antiv txmnt M

4163F Pt couns 4 txmnt opt prost E

4164F Adjv hrmnl thxpy rxd M

4165F 3d-crt/imrt received M

4167F Hd bed tilted 1st day vent E

4168F Pt care icu&vent w/in 24hrs E

4169F No pt care ICU/vent in 24hrs E

4171F Pt rcvng esa thxpy M

4172F Pt not rcvng esa thxpy M

4174F Couns potent glauc impct E

4175F Vis of >= 20/40 w/in 90 days M4176F Talk re uv light pt/crgvr E

4177F Talk pt/crgvr re areds prev M

4178F Antid glbln rcvd w/in 26wks E

4179F Tamoxifen/AI prescribed M

4180F Adjv thxpyrxd/rcvd colon ca M

4181F Conformal radn thxpy rcvd E

4182F No conformal radn thxpy E

4185F Continuous ppi or h2ra rcvd E

4186F No cont ppi or h2ra rcvd E

4187F Anti rheum drugthxpyrxd/gvn M

4188F Approp ACE/ARB tstng done E

4189F Approp digoxin tstng done E

4190F Approp diuretic tstng done E

4191F Approp anticonvuls tstng E

4192F Pt not rcvng glucoco thxpy M

4193F Pt rcvng<10mg daily predniso M

4194F Pt rcvng>10mg daily predniso M

4195F Pt rcvng anti-rheum thxpy RA M

4196F Ptnot rcvng anti-rhm thxpyRA M

4200F External beam to prost only M

4201F Extrnl beam other than prost M

4210F ACE/ARB thxpy for >= 6 mons E4220F Digoxin thxpy for >= 6 mons E

4221F Diuretic thxpy for >= 6 mons E

4230F Anticonv thxpy for >= 6 mons E

4240F Instr xrcz 4bk pn >12 weeks E

4242F Sprvsd xrcz bk pn >12 weeks E

4245F Pt instr nrml lifest M

4248F Pt instr no bd rest>= 4 days M

4250F Wrmng 4 surg normothermia M

4255F Anesth 60+ min as docd M

4256F Anesthe <60 min as docd M

4260F Wound srfc culturetech used E

4261F Tech other than surfc cultr E

4265F Wet-dry dressings rx recmd E

4266F No wet-dry drssings rx recmd E

4267F Comprssion thxpy prescribed M

4268F Pt ed re comp thxpy rcvd E

4269F Appropos mthd offloading Rxd E

4270F Pt rcvng anti r-viral thxpy M

4271F Pt rcvng anti r-viral thxpy M

4274F Flu immuno admind rcvd M

4275F Hep b vac inj admin/rcvd E

4276F Potent antivir thxpy Rxd M4279F PCP prophylaxis Rxd E

4280F PCP prophylax Rxd 3mon low % M

4290F Pt scrned for inj drug use M

4293F Pt scrnd hgh-risk sex behav M

4300F Pt rcvng warf thxpy E

4301F Pt not rcvng warf thxpy E

4305F Pt ed re ft care inspct rcvd E

4306F Pt tlk psych & Rx opd addic E

4320F Pt talk psychsoc&rx oh dpnd E

4324F Pt queried prkns complic E

4325F Med txmnt options rvwd w/pt E

4326F Pt asked re symp auto dysfxn E

4328F Pt asked re sleep disturb E

4330F Cnslng epi spec sfty

issues E

4340F Cnslng chldbrng women

epi E

4400F Rehab thxpy options w/pt E

5005F Pt counsld on exam for moles E

5010F Macul result to phy mng dm M

5015F Doc fx & test/txmnt for op M

5020F Txmnts 2 main Dr by 1 mon E

5050F Plan 2 main dr by 1 month M

5060F Fndngs mammo 2pt w/in 3 days E5062F Mammo result com to pt 5 day E

5100F Rsk fx ref w/n 24 hrs xray E

5200F Eval appros surg thxpy

epi E

6005F Care level rationale doc E

6010F Dysphag test done b/4 eating M

6015F Dysphag test done b/4 eating M

6020F Npo (nothing-mouth) ordered M

6030F Max sterile barriers follwd M

6040F Appro rad ds dvcs techs docd E

6045F Radxps in end rprt4fluro pxd M

6070F Pt asked/cnsld aed

effects E

6080F Pt/caregiver queried falls E

6090F Pt/caregiver counsel safety E

7010F Pt info into recall system M

7020F Mammo assess cat in dbase E

7025F Pt infosys alarm 4 nxt mammo M

A0021 Outside state ambulance

serv E

A0080 Noninterest escort in non

er E

A0090 Interest escort in non

er E

A0100 Nonemergency transport

taxi E

A0110 Nonemergency transport

bus E

A0120 Noner transport

mini-bus EA0130 Noner transport wheelch

van E

A0140 Nonemergency transport

air E

A0160 Noner transport case

worker E

A0170 Transport parking

fees/tolls E

A0180 Noner transport lodgng

recip E

A0190 Noner transport meals

recip E

A0200 Noner transport lodgng

escrt E

A0210 Noner transport meals

escort E

A0225 Neonatal emergency

transport E

A0380 Basic life support

mileage E

A0382 Basic support routine

suppls A

A0384 Bls defibrillation

supplies A

A0390 Advanced life support

mileag E

A0392 Als defibrillation

supplies A

A0394 Als IV drug therapy

supplies A

A0396 Als esophageal intub

suppls A

A0398 Als routine disposble

suppls A

A0420 Ambulance waiting 1/2

hr A

A0422 Ambulance 02 life

sustaining A

A0424 Extra ambulance

attendant A

A0425 Ground

mileage A

A0426 Als

1 AA0427 ALS1-emergency A

A0428 bls A

A0429 BLS-emergency A

A0430 Fixed wing air

transport A

A0431 Rotary wing air

transport A

A0432 PI volunteer ambulance

co A

A0433 als

2 A

A0434 Specialty care

transport A

A0435 Fixed wing air

mileage A

A0436 Rotary wing air

mileage A

A0888 Noncovered ambulance

mileage E

A0998 Ambulance

response/treatment E

A0999 Unlisted ambulance

service A

A4206 1 CC sterile

syringe&needle E

A4207 2 CC sterile

syringe&needle E

A4208 3 CC sterile

syringe&needle E

A4209 5+ CC sterile

syringe&needle E

A4210 Nonneedle injection

device E

A4211 Supp for self-adm injections E

A4212 Non coring needle or

stylet B

A4213 20+ CC syringe

only E

A4215 Sterile

needle E

A4216 "Sterile water/saline, 10

ml" AA4217 "Sterile water/saline, 500

ml" A

A4218 Sterile saline or water N

A4220 Infusion pump refill

kit N

A4221 Maint drug infus cath per

wk Y

A4222 Infusion supplies with

pump Y

A4223 Infusion supplies w/o

pump E

A4230 Infus insulin pump non needl N

A4231 Infusion insulin pump needle N

A4232 Syringe w/needle insulin

3cc E

A4233 Alkalin batt for glucose

mon Y

A4234 J-cell batt for glucose

mon Y

A4235 Lithium batt for glucose

mon Y

A4236 Silvr oxide batt glucose

mon Y

A4244 Alcohol or peroxide per

pint E

A4245 Alcohol wipes per

box E

A4246 Betadine/phisohex

solution E

A4247 Betadine/iodine

swabs/wipes E

A4248 Chlorhexidine

antisept N

A4250 Urine reagent

strips/tablets E

A4252 Blood ketone test or

strip E

A4253 Blood glucose/reagent

strips Y

A4255 Glucose monitor

platforms YA4256 Calibrator

solution/chips Y

A4257 Replace Lensshield

Cartridge Y

A4258 Lancet device

each Y

A4259 Lancets per

box Y

A4261 Cervical cap

contraceptive E

A4262 Temporary tear duct

plug N

A4263 Permanent tear duct

plug N

A4264 Intratubal occlusion

device E

A4265 Paraffin Y

A4266 Diaphragm E

A4267 Male

condom E

A4268 Female

condom E

A4269 Spermicide E

A4270 Disposable endoscope sheath N

A4280 Brst prsths adhsv

attchmnt A

A4281 Replacement breastpump

tube E

A4282 Replacement breastpump

adpt E

A4283 Replacement breastpump

cap E

A4284 Replcmnt breast pump

shield E

A4285 Replcmnt breast pump

bottle E

A4286 Replcmnt breastpump lok

ring E

A4290 Sacral nerve stim test

lead B

A4300 Cath impl vasc access

portal NA4301 Implantable access syst

perc N

A4305 Drug delivery system >=50

ML N

A4306 Drug delivery system <=50

ml N

A4310 Insert tray w/o

bag/cath A

A4311 Catheter w/o bag 2-way

latex A

A4312 Cath w/o bag 2-way

silicone A

A4313 Catheter w/bag

3-way A

A4314 Cath w/drainage 2-way

latex A

A4315 Cath w/drainage 2-way

silcne A

A4316 Cath w/drainage

3-way A

A4320 Irrigation

tray A

A4321 Cath therapeutic irrig

agent A

A4322 Irrigation

syringe A

A4326 Male external

catheter A

A4327 Fem urinary collect dev

cup A

A4328 Fem urinary collect

pouch A

A4330 Stool collection

pouch A

A4331 Extension drainage

tubing A

A4332 Lube sterile

packet A

A4333 Urinary cath anchor

device A

A4334 Urinary cath leg

strap A

A4335 Incontinence

supply AA4336 Urethral

insert A

A4338 Indwelling catheter

latex A

A4340 Indwelling catheter

special A

A4344 Cath indw foley 2 way

silicn A

A4346 Cath indw foley 3

way A

A4349 Disposable male external

cat A

A4351 Straight tip urine

catheter A

A4352 Coude tip urinary

catheter A

A4353 Intermittent urinary

cath A

A4354 Cath insertion tray

w/bag A

A4355 Bladder irrigation

tubing A

A4356 Ext ureth clmp or compr

dvc A

A4357 Bedside drainage

bag A

A4358 Urinary leg or abdomen

bag A

A4360 Disposable ext urethral

dev A

A4361 Ostomy face

plate A

A4362 Solid skin

barrier A

A4363 "Ostomy clamp,

replacement" A

A4364 "Adhesive, liquid or

equal" A

A4366 Ostomy

vent A

A4367 Ostomy

belt A

A4368 Ostomy

filter AA4369 Skin barrier liquid per

oz A

A4371 Skin barrier powder per

oz A

A4372 Skin barrier solid 4x4

equiv A

A4373 Skin barrier with

flange A

A4375 Drainable plastic pch w

fcpl A

A4376 Drainable rubber pch w

fcplt A

A4377 Drainable plstic pch w/o

fp A

A4378 Drainable rubber pch w/o

fp A

A4379 Urinary plastic pouch w

fcpl A

A4380 Urinary rubber pouch w

fcplt A

A4381 Urinary plastic pouch w/o

fp A

A4382 Urinary hvy plstc pch w/o

fp A

A4383 Urinary rubber pouch w/o

fp A

A4384 Ostomy faceplt/silicone

ring A

A4385 Ost skn barrier sld ext

wear A

A4387 Ost clsd pouch w att st

barr A

A4388 Drainable pch w ex wear

barr A

A4389 Drainable pch w st wear

barr A

A4390 Drainable pch ex wear

convex A

A4391 Urinary pouch w ex wear

barr A

A4392 Urinary pouch w st wear

barr A

A4393 Urine pch w ex wear bar

conv AA4394 Ostomy pouch liq

deodorant A

A4395 Ostomy pouch solid

deodorant A

A4396 Peristomal hernia supprt

blt A

A4397 Irrigation supply

sleeve A

A4398 Ostomy irrigation

bag A

A4399 Ostomy irrig cone/cath w

brs A

A4400 Ostomy irrigation

set A

A4402 Lubricant per

ounce A

A4404 Ostomy ring

each A

A4405 Nonpectin based ostomy

paste A

A4406 Pectin based ostomy

paste A

A4407 "Ext wear ost skn barr

<=4sq""" A

A4408 "Ext wear ost skn barr

>4sq""" A

A4409 Ost skn barr convex <=4 sq

i A

A4410 Ost skn barr extnd >4

sq A

A4411 Ost skn barr extnd

=4sq A

A4412 Ost pouch drain high

output A

A4413 2 pc drainable ost

pouch A

A4414 Ost sknbar w/o conv<=4 sq

in A

A4415 Ost skn barr w/o conv >4

sqi A

A4416 Ost pch clsd w

barrier/filtr A

A4417 Ost pch w

bar/bltinconv/fltr AA4418 Ost pch clsd w/o bar w

filtr A

A4419 Ost pch for bar w

flange/flt A

A4420 Ost pch clsd for bar w lk

fl A

A4421 Ostomy supply

misc E

A4422 Ost pouch absorbent

material A

A4423 Ost pch for bar w lk

fl/fltr A

A4424 Ost pch drain w bar &

filter A

A4425 Ost pch drain for barrier

fl A

A4426 Ost pch drain 2 piece

system A

A4427 Ost pch drain/barr lk

flng/f A

A4428 Urine ost pouch w

faucet/tap A

A4429 Urine ost pouch w

bltinconv A

A4430 Ost urine pch w b/bltin

conv A

A4431 Ost pch urine w

barrier/tapv A

A4432 Os pch urine w

bar/fange/tap A

A4433 Urine ost pch bar w lock

fln A

A4434 Ost pch urine w lock

flng/ft A

A4450 Non-waterproof

tape A

A4452 Waterproof

tape A

A4455 Adhesive remover per

ounce A

A4456 "Adhesive remover,

wipes" A

A4458 Reusable enema

bag EA4461 Surgicl dress hold

non-reuse A

A4463 Surgical dress holder

reuse A

A4465 Non-elastic extremity

binder N

A4466 Elastic

garment/covering E

A4470 Gravlee jet

washer N

A4480 Vabra

aspirator N

A4481 Tracheostoma

filter A

A4483 Moisture

exchanger A

A4490 Above knee surgical

stocking E

A4495 Thigh length surg

stocking E

A4500 Below knee surgical

stocking E

A4510 Full length surg

stocking E

A4520 Incontinence garment

anytype E

A4550 Surgical

trays B

A4554 Disposable

underpads E

A4556 "Electrodes,

pair" Y

A4557 "Lead wires,

pair" Y

A4558 Conductive gel or

paste Y

A4559 Coupling gel or

paste Y

A4561 "Pessary rubber, any

type" N

A4562 "Pessary, non rubber,any

type" N

A4565 Slings NA4566 Should

sling/vest/abrestrain E

A4570 Splint E

A4575 Hyperbaric o2 chamber

disps E

A4580 Cast supplies

(plaster) E

A4590 Special casting

material E

A4595 TENS suppl 2 lead per

month Y

A4600 "Sleeve, inter limb comp

dev" Y

A4601 "Lith ion batt, non-pros use

" Y

A4604 Tubing with heating

element Y

A4605 Trach suction cath close

sys Y

A4606 Oxygen probe used w

oximeter A

A4608 Transtracheal oxygen

cath Y

A4611 Heavy duty

battery Y

A4612 Battery

cables Y

A4613 Battery charger Y

A4614 Hand-held PEFR meter Y

A4615 Cannula

nasal Y

A4616 Tubing (oxygen) per

foot Y

A4617 Mouth

piece Y

A4618 Breathing

circuits Y

A4619 Face

tent Y

A4620 Variable concentration

mask YA4623 Tracheostomy inner

cannula A

A4624 Tracheal suction

tube Y

A4625 Trach care kit for new

trach A

A4626 Tracheostomy cleaning

brush A

A4627 Spacer

bag/reservoir E

A4628 Oropharyngeal suction

cath Y

A4629 Tracheostomy care

kit A

A4630 Repl bat t.e.n.s. own by

pt Y

A4633 Uvl replacement

bulb Y

A4634 Replacement bulb th

lightbox A

A4635 Underarm crutch

pad Y

A4636 Handgrip for cane

etc Y

A4637 Repl tip

cane/crutch/walker Y

A4638 Repl batt pulse gen

sys Y

A4639 Infrared ht sys replcmnt

pad Y

A4640 Alternating pressure

pad Y

A4641 Radiopharm dx agent

noc N

A4642 In111

satumomab N

A4648 Implantable tissue

marker N

A4649 Surgical

supplies N

A4650 Implant radiation

dosimeter N

A4651 Calibrated microcap

tube AA4652 Microcapillary tube

sealant A

A4653 PD catheter anchor

belt A

A4657 Syringe w/wo

needle N

A4660 Sphyg/bp app w cuff and

stet N

A4663 Dialysis blood pressure

cuff N

A4670 "Automatic bp monitor,

dial" E

A4671 Disposable cycler

set B

A4672 "Drainage ext line,

dialysis" B

A4673 Ext line w easy lock

connect B

A4674 "Chem/antisept solution,

8oz" B

A4680 "Activated carbon filter,

ea" N

A4690 "Dialyzer,

each" N

A4706 Bicarbonate conc sol per

gal N

A4707 Bicarbonate conc pow per

pac N

A4708 Acetate conc sol per

gallon N

A4709 Acid conc sol per

gallon N

A4714 Treated water per

gallon N

A4719 """Y set""

tubing" N

A4720 Dialysat sol fld vol >

249cc N

A4721 Dialysat sol fld vol >

999cc N

A4722 Dialys sol fld vol >

1999cc N

A4723 Dialys sol fld vol >

2999cc NA4724 Dialys sol fld vol >

3999cc N

A4725 Dialys sol fld vol >

4999cc N

A4726 Dialys sol fld vol >

5999cc N

A4728 "Dialysate solution,

non-dex" B

A4730 "Fistula cannulation set,

ea" N

A4736 "Topical anesthetic, per

gram" N

A4737 Inj anesthetic per 10

ml N

A4740 Shunt

accessory N

A4750 Art or venous blood

tubing N

A4755 Comb art/venous blood

tubing N

A4760 "Dialysate sol test kit,

each" N

A4765 Dialysate conc pow per

pack N

A4766 Dialysate conc sol add 10

ml N

A4770 Blood collection

tube/vacuum N

A4771 Serum clotting time

tube N

A4772 Blood glucose test

strips N

A4773 Occult blood test

strips N

A4774 Ammonia test

strips N

A4802 Protamine sulfate per 50

mg N

A4860 Disposable catheter

tips N

A4870 Plumb/elec wk hm hemo

equip N

A4890 Repair/maint cont hemo

equip NA4911 Drain

bag/bottle N

A4913 Misc dialysis supplies

noc N

A4918 Venous pressure

clamp N

A4927 Non-sterile

gloves N

A4928 Surgical

mask N

A4929 "Tourniquet for dialysis,

ea" N

A4930 "Sterile, gloves per

pair" N

A4931 Reusable oral

thermometer N

A4932 Reusable rectal

thermometer E

A5051 Pouch clsd w barr

attached A

A5052 Clsd ostomy pouch w/o

barr A

A5053 Clsd ostomy pouch

faceplate A

A5054 Clsd ostomy pouch

w/flange A

A5055 Stoma

cap A

A5061 Pouch drainable w barrier

at A

A5062 Drnble ostomy pouch w/o

barr A

A5063 Drain ostomy pouch

w/flange A

A5071 Urinary pouch

w/barrier A

A5072 Urinary pouch w/o

barrier A

A5073 Urinary pouch on barr

w/flng A

A5081 Continent stoma

plug A

A5082 Continent stoma

catheter AA5083 Stoma absorptive

cover A

A5093 Ostomy accessory convex

inse A

A5102 Bedside drain btl w/wo

tube A

A5105 Urinary

suspensory A

A5112 Urinary leg

bag A

A5113 Latex leg

strap A

A5114 Foam/fabric leg

strap A

A5120 "Skin barrier, wipe or

swab" A

A5121 Solid skin barrier

6x6 A

A5122 Solid skin barrier

8x8 A

A5126 Disk/foam pad +oradhesive A

A5131 Appliance

cleaner A

A5200 Percutaneous catheter

anchor A

A5500 Diab shoe for density

insert Y

A5501 Diabetic custom molded

shoe Y

A5503 Diabetic shoe

w/roller/rockr Y

A5504 Diabetic shoe with

wedge Y

A5505 Diab shoe w/metatarsal

bar Y

A5506 Diabetic shoe w/off set

heel Y

A5507 Modification diabetic

shoe Y

A5508 Diabetic deluxe

shoe Y

A5510 Compression form shoe

insert EA5512 Multi den insert direct form Y

A5513 Multi den insert custom mold Y

A6000 Wound warming wound

cover E

A6010 Collagen based wound

filler A

A6011 Collagen gel/paste wound

fil A

A6021 Collagen dressing <=16 sq

in A

A6022 Collagen drsg>16<=48 sq

in A

A6023 Collagen dressing >48 sq

in A

A6024 Collagen dsg wound

filler A

A6025 "Silicone gel sheet,

each" E

A6154 Wound pouch

each A

A6196 Alginate dressing <=16 sq

in A

A6197 Alginate drsg >16 <=48 sq

in A

A6198 alginate dressing > 48 sq

in A

A6199 Alginate drsg wound

filler A

A6203 Composite drsg <= 16 sq

in A

A6204 Composite drsg >16<=48 sq

in A

A6205 Composite drsg > 48 sq

in A

A6206 Contact layer <= 16 sq

in A

A6207 Contact layer >16<= 48 sq

in A

A6208 Contact layer > 48 sq

in A

A6209 Foam drsg <=16 sq in w/o

bdr AA6210 Foam drg >16<=48 sq in w/o

b A

A6211 Foam drg > 48 sq in w/o

brdr A

A6212 Foam drg <=16 sq in

w/border A

A6213 Foam drg >16<=48 sq in

w/bdr A

A6214 Foam drg > 48 sq in

w/border A

A6215 Foam dressing wound

filler A

A6216 Non-sterile gauze<=16 sq

in A

A6217 Non-sterile gauze>16<=48

sq A

A6218 Non-sterile gauze > 48 sq

in A

A6219 Gauze <= 16 sq in

w/border A

A6220 Gauze >16 <=48 sq in

w/bordr A

A6221 Gauze > 48 sq in

w/border A

A6222 Gauze <=16 in no w/sal w/o

b A

A6223 Gauze >16<=48 no w/sal w/o

b A

A6224 Gauze > 48 in no w/sal w/o

b A

A6228 Gauze <= 16 sq in

water/sal A

A6229 Gauze >16<=48 sq in

watr/sal A

A6230 Gauze > 48 sq in

water/salne A

A6231 Hydrogel dsg<=16 sq

in A

A6232 Hydrogel dsg>16<=48 sq

in A

A6233 Hydrogel dressing >48 sq

in A

A6234 Hydrocolld drg <=16 w/o

bdr AA6235 Hydrocolld drg >16<=48 w/o

b A

A6236 Hydrocolld drg > 48 in w/o

b A

A6237 Hydrocolld drg <=16 in

w/bdr A

A6238 Hydrocolld drg >16<=48

w/bdr A

A6239 Hydrocolld drg > 48 in

w/bdr A

A6240 Hydrocolld drg filler

paste A

A6241 Hydrocolloid drg filler

dry A

A6242 Hydrogel drg <=16 in w/o

bdr A

A6243 Hydrogel drg >16<=48 w/o

bdr A

A6244 Hydrogel drg >48 in w/o

bdr A

A6245 Hydrogel drg <= 16 in

w/bdr A

A6246 Hydrogel drg >16<=48 in

w/b A

A6247 Hydrogel drg > 48 sq in

w/b A

A6248 Hydrogel drsg gel

filler A

A6250 Skin seal protect

moisturizr A

A6251 Absorpt drg <=16 sq in w/o

b A

A6252 Absorpt drg >16 <=48 w/o

bdr A

A6253 Absorpt drg > 48 sq in w/o

b A

A6254 Absorpt drg <=16 sq in

w/bdr A

A6255 Absorpt drg >16<=48 in

w/bdr A

A6256 Absorpt drg > 48 sq in

w/bdr A

A6257 Transparent film <= 16 sq

in AA6258 Transparent film >16<=48

in A

A6259 Transparent film > 48 sq

in A

A6260 Wound cleanser any

type/size A

A6261 Wound filler gel/paste

/oz A

A6262 Wound filler dry form /

gram A

A6266 Impreg gauze no

h20/sal/yard A

A6402 Sterile gauze <= 16 sq

in A

A6403 Sterile gauze>16 <= 48 sq

in A

A6404 Sterile gauze > 48 sq

in A

A6407 "Packing strips,

non-impreg" A

A6410 Sterile eye

pad A

A6411 Non-sterile eye

pad A

A6412 Occlusive eye

patch A

A6413 "Adhesive bandage, first-aid" E

A6441 "Pad band w>=3""

<5""/yd" A

A6442 "Conform band n/s

w<3""/yd" A

A6443 "Conform band n/s

w>=3""<5""/yd" A

A6444 "Conform band n/s

w>=5""/yd" A

A6445 "Conform band s w

<3""/yd" A

A6446 "Conform band s w>=3""

<5""/yd" A

A6447 "Conform band s w

>=5""/yd" A

A6448 "Lt compres band

<3""/yd" AA6449 "Lt compres band >=3""

<5""/yd" A

A6450 "Lt compres band

>=5""/yd" A

A6451 "Mod compres band

w>=3""<5""/yd" A

A6452 "High compres band

w>=3""<5""yd" A

A6453 "Self-adher band w

<3""/yd" A

A6454 "Self-adher band w>=3""

<5""/yd" A

A6455 "Self-adher band

>=5""/yd" A

A6456 "Zinc paste band w

>=3""<5""/yd" A

A6457 Tubular

dressing A

A6501 Compres burngarment

bodysuit A

A6502 Compres burngarment

chinstrp A

A6503 Compres burngarment

facehood A

A6504 Cmprsburngarment

glove-wrist A

A6505 Cmprsburngarment

glove-elbow A

A6506 Cmprsburngrmnt

glove-axilla A

A6507 Cmprs burngarment

foot-knee A

A6508 Cmprs burngarment

foot-thigh A

A6509 Compres burn garment

jacket A

A6510 Compres burn garment

leotard A

A6511 Compres burn garment

panty A

A6512 "Compres burn garment,

noc" A

A6513 Compress burn mask

face/neck BA6530 Compression stocking

BK18-30 E

A6531 Compression stocking

BK30-40 A

A6532 Compression stocking

BK40-50 A

A6533 Gc stocking thighlngth

18-30 E

A6534 Gc stocking thighlngth

30-40 E

A6535 Gc stocking thighlngth

40-50 E

A6536 Gc stocking full lngth

18-30 E

A6537 Gc stocking full lngth

30-40 E

A6538 Gc stocking full lngth

40-50 E

A6539 Gc stocking waistlngth

18-30 E

A6540 Gc stocking waistlngth

30-40 E

A6541 Gc stocking waistlngth

40-50 E

A6544 Gc stocking garter

belt E

A6545 Grad comp non-elastic

BK A

A6549 G compression

stocking E

A6550 Neg pres wound ther drsg

set Y

A7000 Disposable canister for

pump Y

A7001 Nondisposable pump

canister Y

A7002 Tubing used w suction

pump Y

A7003 Nebulizer administration

set Y

A7004 Disposable nebulizer sml

vol Y

A7005 Nondisposable nebulizer

set YA7006 Filtered nebulizer admin

set Y

A7007 Lg vol nebulizer

disposable Y

A7008 Disposable nebulizer

prefill Y

A7009 Nebulizer reservoir

bottle Y

A7010 Disposable corrugated

tubing Y

A7011 Nondispos corrugated

tubing Y

A7012 Nebulizer water collec

devic Y

A7013 Disposable compressor

filter Y

A7014 Compressor nondispos

filter Y

A7015 Aerosol mask used w

nebulize Y

A7016 Nebulizer dome &

mouthpiece Y

A7017 Nebulizer not used w

oxygen Y

A7018 Water distilled

w/nebulizer Y

A7020 "Interface, cough stim

device" Y

A7025 Replace chest compress

vest Y

A7026 Replace chst cmprss sys

hose Y

A7027 Combination oral/nasal

mask Y

A7028 Repl oral cushion combo

mask Y

A7029 Repl nasal pillow comb

mask Y

A7030 CPAP full face

mask Y

A7031 Replacement facemask

interfa Y

A7032 Replacement nasal

cushion YA7033 Replacement nasal

pillows Y

A7034 Nasal application

device Y

A7035 Pos airway press

headgear Y

A7036 Pos airway press

chinstrap Y

A7037 Pos airway pressure

tubing Y

A7038 Pos airway pressure

filter Y

A7039 "Filter, non disposable w

pap" Y

A7040 One way chest drain

valve A

A7041 Water seal drain

container A

A7042 Implanted pleural

catheter N

A7043 Vacuum

drainagebottle/tubing A

A7044 PAP oral

interface Y

A7045 Repl exhalation port for

PAP Y

A7046 "Repl water chamber, PAP

dev" Y

A7501 Tracheostoma valve w

diaphra A

A7502 Replacement

diaphragm/fplate A

A7503 HMES filter holder or

cap A

A7504 Tracheostoma HMES

filter A

A7505 HMES or trach valve

housing A

A7506 HMES/trachvalve

adhesivedisk A

A7507 Integrated filter &

holder A

A7508 Housing & Integrated

Adhesiv AA7509 Heat & moisture exchange

sys A

A7520 Trach/laryn tube

non-cuffed A

A7521 Trach/laryn tube

cuffed A

A7522 Trach/laryn tube

stainless A

A7523 Tracheostomy shower

protect A

A7524 Tracheostoma

stent/stud/bttn A

A7525 Tracheostomy

mask A

A7526 Tracheostomy tube

collar A

A7527 Trach/laryn tube

plug/stop A

A8000 Soft protect helmet prefab Y

A8001 Hard protect helmet prefab Y

A8002 Soft protect helmet custom Y

A8003 Hard protect helmet custom Y

A8004 "Repl soft interface, helmet" Y

A9150 Misc/exper non-prescript

dru B

A9152 Single vitamin

nos E

A9153 Multi-vitamin

nos E

A9155 Artificial saliva B

A9180 "Lice treatment,

topical" E

A9270 Non-covered item or

service E

A9273 Hot/cold h2obot/cap/col/wrap Y

A9274 Ext amb insulin delivery

sys EA9275 Disp home glucose monitor

E

A9276 "Disposable sensor, CGM

sys" E

A9277 "External transmitter,

CGM" E

A9278 "External receiver, CGM

sys" E

A9279 Monitoring

feature/deviceNOC E

A9280 "Alert device,

noc" E

A9281 Reaching/grabbing

device E

A9282 Wig any

type E

A9283 Foot press off load supp

dev E

A9284 Non-electronic

spirometer N

A9300 Exercise

equipment E

A9500 Tc99m

sestamibi N

A9501 Technetium TC-99m

teboroxime N

A9502 Tc99m

tetrofosmin N

A9503 Tc99m

medronate N

A9504 Tc99m

apcitide N

A9505 TL201

thallium N

A9507 In111

capromab N

A9508 "I131 iodobenguate,

dx" N

A9509 Iodine I-123 sod iodide

mil N

A9510 Tc99m disofenin N

A9512 Tc99m

pertechnetate NA9516 Iodine I-123 sod iodide

mic N

A9517 "I131 iodide cap, rx" K

1064 $17.58

. $3.52

A9521 Tc99m

exametazime N

A9524 "I131 serum albumin,

dx" N

A9526 Nitrogen N-13

ammonia N

A9527 Iodine I-125 sodium

iodide U 2632 0.2868 $19.91

. $3.99

A9528 "Iodine I-131 iodide cap,

dx" N

A9529 "I131 iodide sol, dx" N

A9530 "I131 iodide sol, rx" K

1150 $13.26

. $2.66

A9531 I131 max 100uCi N

A9532 "I125 serum albumin, dx" N

A9536 Tc99m depreotide N

A9537 Tc99m

mebrofenin N

A9538 Tc99m

pyrophosphate N

A9539 Tc99m pentetate N

A9540 Tc99m

MAA N

A9541 Tc99m sulfur

colloid N

A9542 "In111 ibritumomab, dx" N

A9543 "Y90 ibritumomab, rx" K

1643 "$32,078.39"

. "$6,415.68"

A9544 "I131 tositumomab, dx" N

A9545 "I131 tositumomab, rx" K

1645 "$29,460.02"

. "$5,892.01"A9546 Co57/58 N

A9547 In111 oxyquinoline N

A9548 In111 pentetate N

A9550 Tc99m gluceptate N

A9551 Tc99m succimer N

A9552 F18 fdg N

A9553 Cr51 chromate N

A9554 "I125 iothalamate, dx" N

A9555 Rb82 rubidium N

A9556 Ga67 gallium N

A9557 Tc99m bicisate N

A9558 Xe133 xenon 10mci N

A9559 Co57

cyano N

A9560 Tc99m labeled

rbc N

A9561 Tc99m oxidronate N

A9562 Tc99m mertiatide N

A9563 P32 Na phosphate K

1675 $162.87

. $32.58

A9564 P32 chromic phosphate K

1676 $154.15

. $30.83

A9566 Tc99m fanolesomab N

A9567 Technetium TC-99m

aerosol N

A9568 Technetium tc99m

arcitumomab N

A9569 Technetium TC-99m auto

WBC NA9570 Indium In-111 auto

WBC N

A9571 Indium IN-111 auto

platelet N

A9572 Indium In-111

pentetreotide N

A9576 Inj prohance

multipack N

A9577 Inj

multihance N

A9578 Inj multihance

multipack N

A9579 "Gad-base MR contrast NOS,1ml

" N

A9580 Sodium fluoride

F-18 N

A9581 Gadoxetate disodium

inj N

A9582 Iodine I-123

iobenguane CH N

A9583 Gadofosveset trisodium

inj CH N

A9600 Sr89 strontium K

0701 $641.83

. $128.37

A9604 Sm 153

lexidronam K 1295 "$7,555.71"

. "$1,511.15"

A9698 Non-rad contrast

materialNOC N

A9699 Radiopharm rx agent

noc N

A9700 Echocardiography

Contrast B

A9900 Supply/accessory/service Y

A9901 Delivery/set

up/dispensing A

A9999 "DME supply or accessory,

nos" Y

B4034 Enter feed supkit syr by

day Y

B4035 Enteral feed supp pump per

d Y

B4036 Enteral feed sup kit gravby Y

B4081 Enteral ng tubing w/

stylet Y

B4082 Enteral ng tubing w/o

stylet Y

B4083 Enteral stomach tube

levine Y

B4087 "Gastro/jejuno tube,

std" A

B4088 "Gastro/jejuno tube,

low-pro" A

B4100 Food thickener

oral E

B4102 EF adult fluids and

electro Y

B4103 EF ped fluid and

electrolyte Y

B4104 Additive for enteral

formula E

B4149 EF blenderized

foods Y

B4150 EF complet w/intact

nutrient Y

B4152 EF calorie

dense>/=1.5Kcal Y

B4153 EF hydrolyzed/amino

acids Y

B4154 EF spec metabolic

noninherit Y

B4155 EF

incomplete/modular Y

B4157 EF special metabolic

inherit Y

B4158 EF ped complete intact

nut Y

B4159 EF ped complete soy

based Y

B4160 EF ped caloric

dense>/=0.7kc Y

B4161 EF ped hydrolyzed/amino

acid Y

B4162 EF ped specmetabolic

inherit Y

B4164 Parenteral 50% dextrosesolu Y

B4168 Parenteral sol amino acid

3. Y

B4172 Parenteral sol amino acid

5. Y

B4176 Parenteral sol amino acid

7- Y

B4178 Parenteral sol amino acid

> Y

B4180 Parenteral sol carb >

50% Y

B4185 Parenteral sol 10 gm

lipids B

B4189 Parenteral sol amino acid & Y

B4193 Parenteral sol 52-73 gm prot Y

B4197 Parenteral sol 74-100 gm pro Y

B4199 Parenteral sol > 100gm prote Y

B4216 Parenteral nutrition additiv Y

B4220 Parenteral supply kit premix Y

B4222 Parenteral supply kit homemi Y

B4224 Parenteral administration ki Y

B5000 Parenteral sol renal-amirosy Y

B5100 Parenteral sol hepatic-fream Y

B5200 Parenteral sol stres-brnch c Y

B9000 Enter infusion pump w/o alrm Y

B9002 Enteral infusion pump w/ ala Y

B9004 Parenteral infus pump portab Y

B9006 Parenteral infus pump statio Y

B9998 Enteral supp not otherwise c YB9999 Parenteral supp not othrws c Y

C1300 HYPERBARIC

Oxygen S 0659 1.4834 $102.98

. $20.60

C1713 "Anchor/screw

bn/bn,tis/bn" N

C1714 "Cath, trans atherectomy,

dir" N

C1715 Brachytherapy

needle N

C1716 "Brachytx, non-str,

Gold-198" U 1716 1.0120 $70.25

. $14.05

C1717 "Brachytx, non-str,HDR

Ir-192" U 1717 3.1681 $219.93

. $43.99

C1719 "Brachytx, NS,

Non-HDRIr-192" U 1719 0.4486 $31.14

. $6.23

C1721 "AICD, dual

chamber" N

C1722 "AICD, single

chamber" N

C1724 "Cath, trans

atherec,rotation" N

C1725 "Cath, translumin

non-laser" N

C1726 "Cath, bal dil,

non-vascular" N

C1727 "Cath, bal tis dis,

non-vas" N

C1728 "Cath, brachytx seed

adm" N

C1729 "Cath,

drainage" N

C1730 "Cath, EP, 19 or few

elect" N

C1731 "Cath, EP, 20 or more

elec" N

C1732 "Cath, EP, diag/abl,

3D/vect" N

C1733 "Cath, EP, othr than

cool-tip" NC1749 "Endo, colon, retro

imaging" H 1749

C1750 "Cath,

hemodialysis,long-term" N

C1751 "Cath, inf,

per/cent/midline" N

C1752 "Cath,hemodialysis,short-term" N

C1753 "Cath, intravas

ultrasound" N

C1754 "Catheter,

intradiscal" N

C1755 "Catheter,

intraspinal" N

C1756 "Cath, pacing,

transesoph" N

C1757 "Cath,

thrombectomy/embolect" N

C1758 "Catheter,

ureteral" N

C1759 "Cath, intra

echocardiography" N

C1760 "Closure dev,

vasc" N

C1762 "Conn tiss, human(inc

fascia)" N

C1763 "Conn tiss,

non-human" N

C1764 "Event recorder,

cardiac" N

C1765 Adhesion

barrier N

C1766 "Intro/sheath,strble,non-peel" N

C1767 "Generator, neuro

non-recharg" N

C1768 "Graft,

vascular" N

C1769 Guide

wire N

C1770 "Imaging coil, MR,

insertable" N

C1771 "Rep dev, urinary,w/sling" N

C1772 "Infusion pump,

programmable" N

C1773 "Ret dev,

insertable" N

C1776 Joint device

(implantable) N

C1777 "Lead, AICD, endo single

coil" N

C1778 "Lead,

neurostimulator" N

C1779 "Lead, pmkr, transvenous

VDD" N

C1780 "Lens, intraocular (new

tech)" N

C1781 Mesh

(implantable) N

C1782 Morcellator N

C1783 "Ocular imp, aqueous drain

de" N

C1784 "Ocular dev, intraop, det

ret" N

C1785 "Pmkr, dual,

rate-resp" N

C1786 "Pmkr, single,

rate-resp" N

C1787 "Patient progr,

neurostim" N

C1788 "Port, indwelling,

imp" N

C1789 "Prosthesis, breast,

imp" N

C1813 "Prosthesis, penile,

inflatab" N

C1814 "Retinal tamp, silicone

oil" N

C1815 "Pros, urinary sph,

imp" N

C1816 "Receiver/transmitter,

neuro" N

C1817 Septal defect imp

sys N

C1818 Integrated

keratoprosthesis NC1819 Tissue

localization-excision N

C1820 Generator neuro rechg bat sy N

C1821 Interspinous implant N

C1874 "Stent, coated/cov w/del

sys" N

C1875 "Stent, coated/cov w/o del

sy" N

C1876 "Stent, non-coa/non-cov

w/del" N

C1877 "Stent, non-coat/cov w/o

del" N

C1878 Matrl for vocal

cord N

C1879 "Tissue marker,

implantable" N

C1880 Vena cava

filter N

C1881 Dialysis access

system N

C1882 "AICD, other than

sing/dual" N

C1883 "Adapt/ext, pacing/neuro

lead" N

C1884 Embolization Protect

syst N

C1885 "Cath, translumin angio

laser" N

C1887 "Catheter,

guiding" N

C1888 Endovas non-cardiac abl

cath N

C1891 "Infusion pump,non-prog,

perm" N

C1892 "Intro/sheath,fixed,peel-away" N

C1893 "Intro/sheath,

fixed,non-peel" N

C1894 "Intro/sheath,

non-laser" N

C1895 "Lead, AICD, endo dualcoil" N

C1896 "Lead, AICD, non

sing/dual" N

C1897 "Lead, neurostim test

kit" N

C1898 "Lead, pmkr, other than

trans" N

C1899 "Lead, pmkr/AICD

combination" N

C1900 "Lead, coronary

venous" N

C2614 "Probe, perc lumb

disc" N

C2615 "Sealant, pulmonary,

liquid" N

C2616 "Brachytx,

non-str,Yttrium-90" U 2616 232.3017 "$16,126.38"

. "$3,225.28"

C2617 "Stent, non-cor, tem w/o

del" N

C2618 "Probe,

cryoablation" N

C2619 "Pmkr, dual, non

rate-resp" N

C2620 "Pmkr, single, non

rate-resp" N

C2621 "Pmkr, other than

sing/dual" N

C2622 "Prosthesis, penile,

non-inf" N

C2625 "Stent, non-cor, tem w/del

sy" N

C2626 "Infusion pump,

non-prog,temp" N

C2627 "Cath,

suprapubic/cystoscopic" N

C2628 "Catheter,

occlusion" N

C2629 "Intro/sheath,

laser" N

C2630 "Cath, EP,

cool-tip" N

C2631 "Rep dev, urinary, w/o

sling" NC2634 "Brachytx, non-str, HA,

I-125" U 2634 0.7908 $54.90

. $10.98

C2635 "Brachytx, non-str, HA,

P-103" U 2635 0.3438 $23.87

. $4.78

C2636 "Brachy linear,

non-str,P-103" U 2636 0.5112 $35.49

. $7.10

C2637 "Brachy,non-str,Ytterbium-169" B

C2638 "Brachytx, stranded,

I-125" U 2638 0.6225 $43.21

. $8.65

C2639 "Brachytx,

non-stranded,I-125" U 2639 0.4992 $34.65

. $6.93

C2640 "Brachytx, stranded,

P-103" U 2640 1.0610 $73.65

. $14.73

C2641 "Brachytx,

non-stranded,P-103" U 2641 0.9263 $64.30

. $12.86

C2642 "Brachytx, stranded,

C-131" U 2642 1.6922 $117.47

. $23.50

C2643 "Brachytx,

non-stranded,C-131" U 2643 1.0735 $74.52

. $14.91

C2698 "Brachytx, stranded,

NOS" U 2698 0.6225 $43.21

. $8.65

C2699 "Brachytx, non-stranded,

NOS" U 2699 0.3438 $23.87

. $4.78

C8900 "MRA w/cont,

abd" Q3 0284 6.1872 $429.52 $144.34 $85.91

C8901 "MRA w/o cont,

abd" Q3 0336 4.8219 $334.74 $131.90 $66.95

C8902 "MRA w/o fol w/cont,

abd" Q3 0337 7.6393 $530.32 $196.43 $106.07

C8903 "MRI w/cont, breast,

uni" Q3 0284 6.1872 $429.52 $144.34 $85.91

C8904 "MRI w/o cont, breast,

uni" Q3 0336 4.8219 $334.74 $131.90 $66.95C8905 "MRI w/o fol w/cont, brst,

un" Q3 0337 7.6393 $530.32 $196.43 $106.07

C8906 "MRI w/cont, breast,

bi" Q3 0284 6.1872 $429.52 $144.34 $85.91

C8907 "MRI w/o cont, breast,

bi" Q3 0336 4.8219 $334.74 $131.90 $66.95

C8908 "MRI w/o fol w/cont,

breast," Q3 0337 7.6393 $530.32 $196.43 $106.07

C8909 "MRA w/cont,

chest" Q3 0284 6.1872 $429.52 $144.34 $85.91

C8910 "MRA w/o cont,

chest" Q3 0336 4.8219 $334.74 $131.90 $66.95

C8911 "MRA w/o fol w/cont,

chest" Q3 0337 7.6393 $530.32 $196.43 $106.07

C8912 "MRA w/cont, lwr

ext" Q3 0284 6.1872 $429.52 $144.34 $85.91

C8913 "MRA w/o cont, lwr

ext" Q3 0336 4.8219 $334.74 $131.90 $66.95

C8914 "MRA w/o fol w/cont, lwr

ext" Q3 0337 7.6393 $530.32 $196.43 $106.07

C8918 "MRA w/cont,

pelvis" Q3 0284 6.1872 $429.52 $144.34 $85.91

C8919 "MRA w/o cont,

pelvis" Q3 0336 4.8219 $334.74 $131.90 $66.95

C8920 "MRA w/o fol w/cont,

pelvis" Q3 0337 7.6393 $530.32 $196.43 $106.07

C8921 "TTE w or w/o fol w/cont,

com" S 0128 8.1207 $563.74 $166.16 $112.75

C8922 "TTE w or w/o fol w/cont,

f/u" S 0128 8.1207 $563.74 $166.16 $112.75

C8923 "2D TTE w or w/o fol

w/con,co" S 0128 8.1207 $563.74 $166.16 $112.75C8924 "2D TTE w or w/o fol

w/con,fu" S 0128 8.1207 $563.74 $166.16 $112.75

C8925 "2D TEE w or w/o fol

w/con,in" S 0128 8.1207 $563.74 $166.16 $112.75

C8926 "TEE w or w/o fol

w/cont,cong" S 0128 8.1207 $563.74 $166.16 $112.75

C8927 "TEE w or w/o fol w/cont,

mon" S 0128 8.1207 $563.74 $166.16 $112.75

C8928 "TTE w or w/o fol

w/con,stres" S 0128 8.1207 $563.74 $166.16 $112.75

C8929 "TTE w or wo fol

wcon,Doppler" S 0128 8.1207 $563.74 $166.16 $112.75

C8930 "TTE w or w/o contr, cont

ECG" S 0128 8.1207 $563.74 $166.16 $112.75

C8931 "MRA, w/dye, spinal

canal" Q3 0284 6.1872 $429.52 $144.34 $85.91

C8932 "MRA, w/o dye, spinal canal

" Q3 0336 4.8219 $334.74 $131.90 $66.95

C8933 "MRA, w/o&w/dye, spinal

canal" Q3 0337 7.6393 $530.32 $196.43 $106.07

C8934 "MRA, w/dye, upper

extremity" Q3 0284 6.1872 $429.52 $144.34 $85.91

C8935 "MRA, w/o dye, upper

extr" Q3 0336 4.8219 $334.74 $131.90 $66.95

C8936 "MRA, w/o&w/dye, upper

extr" Q3 0337 7.6393 $530.32 $196.43 $106.07

C8957 "Prolonged IV inf, req

pump" S 0440 3.0395 $211.00

. $42.20

C9113 "Inj pantoprazole sodium,

via" N

C9121 "Injection,

argatroban" K 9121 $18.71

. $3.75

C9248 "Inj, clevidipine

butyrate" K 9248 $6.03

. $1.21C9250 Artiss fibrin

sealant CH K 9250 $121.80

. $24.36

C9254 "Injection,

lacosamide" K 9254 $0.15

. $0.03

C9257 Bevacizumab

injection K 1281 $1.47

. $0.30

C9270 Gammaplex

IVIG G 9270 $37.29

. $7.39

C9272 "Inj,

denosumab" G 9272 $14.52

. $2.88

C9273 "Sipuleucel-T, per

infusion" G 9273 "$32,860.00"

. "$6,510.00"

C9274 Crotalidae Poly Immune

Fab G 9274 "$2,111.36"

. $418.29

C9275 Hexaminolevulinate

HCl G 9275 $636.00 $0.00 $0.00

C9276 Cabazitaxel

injection G 9276 $135.05

. $26.76

C9277 "Lumizyme, 1

mg" G 9277 $14.83

. $2.94

C9279 "Injection,

ibuprofen" G 9279 $1.39

. $0.28

C9280 "Injection, eribulin

mesylate" G 9280 $901.00

. $178.50

C9281 "Injection, pegloticase

" G 9281 $304.75

. $60.38

C9282 "Injection, ceftaroline fosamil

" G 9282 $0.72

. $0.14

C9352 "Neuragen nerve guide, per cm" N

C9353 "Neurawrap nerve protector,cm" N

C9354 "Veritas collagen matrix, cm2" N

C9355 "Neuromatrix nerve cuff, cm" NC9356 "TenoGlide tendon prot, cm2" N

C9358 "SurgiMend,

fetal" K 9358 $11.09

. $2.22

C9359 "Implnt,bon void filler-putty" N

C9360 "SurgiMend,

neonatal" CH K 9360 $11.59

. $2.32

C9361 NeuroMend nerve wrap CH N

C9362 "Implnt,bon void filler-strip" CH N

C9363 Integra Meshed Bil Wound

Mat CH K 9363 $19.17

. $3.84

C9364 "Porcine implant, Permacol" CH N

C9367 Endoform Dermal

Template G 9367 $4.35

. $0.86

C9399 Unclassified drugs or

biolog A

C9716 Radiofrequency energy to

anu T 0150 32.9730 "$2,288.99"

. $457.80

C9724 EPS gast cardia

plic T 0422 25.4890 "$1,769.45"

. $353.89

C9725 Place endorectal

app T 0148 6.1052 $423.82

. $84.77

C9726 Rxt breast appl

place/remov T 0028 25.8383 "$1,793.69"

. $358.74

C9727 Insert palate implants T

0252 8.0353 $557.81

. $111.57

C9728 "Place device/marker, non pro" X

0310 13.2460 $919.54 $322.74 $183.91

C9729 Percut lumbar

lami T 0208 51.1173 "$3,548.56"

. $709.72

C9800 Dermal filler inj px/suppl T

0135 5.1973 $360.80

. $72.16C9898 Inpnt stay radiolabeled

item N

C9899 "Inpt implant pros dev,no

cov" A

D0120 Periodic oral

evaluation E

D0140 Limit oral eval problm

focus E

D0145 "Oral evaluation, pt < 3yrs" E

D0150 Comprehensve oral

evaluation S 0330 9.5583 $663.54

. $132.71

D0160 Extensv oral eval prob

focus E

D0170 "Re-eval,est pt,problem

focus" E

D0180 Comp periodontal

evaluation E

D0210 Intraor complete film

series E

D0220 Intraoral periapical first

f E

D0230 Intraoral periapical ea

add E

D0240 Intraoral occlusal

film S 0330 9.5583 $663.54

. $132.71

D0250 Extraoral first

film S 0330 9.5583 $663.54

. $132.71

D0260 Extraoral ea additional

film S 0330 9.5583 $663.54

. $132.71

D0270 Dental bitewing single

film S 0330 9.5583 $663.54

. $132.71

D0272 Dental bitewings two

films S 0330 9.5583 $663.54

. $132.71

D0273 Bitewings - three films E

D0274 Dental bitewings four

films S 0330 9.5583 $663.54

. $132.71

D0277 Vert bitewings-sev to

eight S 0330 9.5583 $663.54

. $132.71D0290 Dental film skull/facial

bon E

D0310 Dental

saliography E

D0320 Dental tmj arthrogram incl

i E

D0321 Dental other tmj

films E

D0322 Dental tomographic

survey E

D0330 Dental panoramic

film E

D0340 Dental cephalometric

film E

D0350 Oral/facial photo

images E

D0360 Cone beam

ct E

D0362 "Cone beam, two

dimensional" E

D0363 "Cone beam, three

dimensional" E

D0415 Collection of

microorganisms E

D0416 Viral

culture B

D0417 Collect & prep saliva

sample E

D0418 Analysis of saliva

sample E

D0421 Gen tst suscept oral

disease B

D0425 Caries susceptibility

test E

D0431 Diag tst detect mucos

abnorm B

D0460 Pulp vitality

test S 0330 9.5583 $663.54

. $132.71

D0470 Diagnostic

casts E

D0472 "Gross exam, prep &

report" BD0473 "Micro exam, prep &

report" B

D0474 Micro w exam of surg

margins B

D0475 Decalcification

procedure B

D0476 Spec stains for

microorganis B

D0477 Spec stains not for

microorg B

D0478 Immunohistochemical

stains B

D0479 Tissue in-situ

hybridization B

D0480 Cytopath smear prep &

report B

D0481 Electron microscopy

diagnost B

D0482 Direct

immunofluorescence B

D0483 Indirect

immunofluorescence B

D0484 Consult slides prep

elsewher B

D0485 Consult inc prep of

slides B

D0486 Access of transep cytol samp E

D0502 Other oral pathology

procedu B

D0999 Unspecified diagnostic

proce B

D1110 Dental prophylaxis

adult E

D1120 Dental prophylaxis

child E

D1203 Topical app fluoride

child E

D1204 Topical app fluoride

adult E

D1206 Topical fluoride

varnish E

D1310 Nutri counsel-control

caries ED1320 Tobacco

counseling E

D1330 Oral hygiene

instruction E

D1351 Dental sealant per

tooth E

D1352 "Prev resin rest, perm

tooth" E

D1510 Space maintainer fxd

unilat S 0330 9.5583 $663.54

. $132.71

D1515 Fixed bilat space

maintainer S 0330 9.5583 $663.54

. $132.71

D1520 Remove unilat space

maintain S 0330 9.5583 $663.54

. $132.71

D1525 Remove bilat space

maintain S 0330 9.5583 $663.54

. $132.71

D1550 Recement space

maintainer S 0330 9.5583 $663.54

. $132.71

D1555 Remove fix space

maintainer E

D2140 Amalgam one surface

permanen E

D2150 Amalgam two surfaces

permane E

D2160 Amalgam three surfaces

perma E

D2161 Amalgam 4 or > surfaces

perm E

D2330 Resin one

surface-anterior E

D2331 Resin two

surfaces-anterior E

D2332 Resin three

surfaces-anterio E

D2335 Resin 4/> surf or w incis

an E

D2390 Ant resin-based cmpst

crown E

D2391 Post 1 srfc resinbased

cmpst E

D2392 Post 2 srfc resinbasedcmpst E

D2393 Post 3 srfc resinbased

cmpst E

D2394 Post >=4srfc resinbase

cmpst E

D2410 Dental gold foil one

surface E

D2420 Dental gold foil two

surface E

D2430 Dental gold foil three

surfa E

D2510 Dental inlay metalic 1

surf E

D2520 Dental inlay metallic 2

surf E

D2530 Dental inlay metl 3/more

sur E

D2542 Dental onlay metallic 2

surf E

D2543 Dental onlay metallic 3

surf E

D2544 Dental onlay metl 4/more

sur E

D2610 Inlay porcelain/ceramic 1

su E

D2620 Inlay porcelain/ceramic 2

su E

D2630 Dental onlay porc 3/more

sur E

D2642 Dental onlay porcelin 2

surf E

D2643 Dental onlay porcelin 3

surf E

D2644 Dental onlay porc 4/more

sur E

D2650 Inlay composite/resin one

su E

D2651 Inlay composite/resin two

su E

D2652 Dental inlay resin 3/mre

sur E

D2662 Dental onlay resin 2

surface E

D2663 Dental onlay resin 3surface E

D2664 Dental onlay resin 4/mre

sur E

D2710 Crown resin-based

indirect E

D2712 Crown 3/4 resin-based

compos E

D2720 Crown resin w/ high noble

me E

D2721 Crown resin w/ base

metal E

D2722 Crown resin w/ noble

metal E

D2740 Crown porcelain/ceramic

subs E

D2750 Crown porcelain w/ h noble

m E

D2751 Crown porcelain fused base

m E

D2752 Crown porcelain w/ noble

met E

D2780 Crown 3/4 cast hi noble

met E

D2781 Crown 3/4 cast base

metal E

D2782 Crown 3/4 cast noble

metal E

D2783 Crown 3/4

porcelain/ceramic E

D2790 Crown full cast high noble

m E

D2791 Crown full cast base

metal E

D2792 Crown full cast noble

metal E

D2794 Crown-titanium E

D2799 Provisional

crown E

D2910 Recement inlay onlay or

part E

D2915 Recement cast or prefab

post E

D2920 Dental recementcrown E

D2930 Prefab stnlss steel crwn

pri E

D2931 Prefab stnlss steel crown

pe E

D2932 Prefabricated resin

crown E

D2933 Prefab stainless steel

crown E

D2934 Prefab steel crown

primary E

D2940 Protective

restoration E

D2950 Core build-up incl any

pins E

D2951 Tooth pin

retention E

D2952 Post and core cast +

crown E

D2953 Each addtnl cast

post E

D2954 Prefab post/core +

crown E

D2955 Post

removal E

D2957 Each addtnl prefab

post E

D2960 Laminate labial

veneer E

D2961 Lab labial veneer

resin E

D2962 Lab labial veneer

porcelain E

D2970 Temp crown (fractured tooth) E

D2971 Add proc construct new

crown E

D2975 Coping E

D2980 Crown

repair E

D2999 Dental unspec restorative

pr S 0330 9.5583 $663.54

. $132.71

D3110 Pulp capdirect E

D3120 Pulp cap

indirect E

D3220 Therapeutic

pulpotomy E

D3221 Gross pulpal

debridement E

D3222 Part pulp for

apexogenesis E

D3230 Pulpal therapy anterior

prim E

D3240 Pulpal therapy posterior

pri E

D3310 "End thxpy, anterior

tooth" E

D3320 "End thxpy, bicuspid

tooth" E

D3330 "End thxpy,

molar" E

D3331 Non-surg tx root canal

obs E

D3332 Incomplete endodontic

tx E

D3333 Internal root

repair E

D3346 Retreat root canal

anterior E

D3347 Retreat root canal

bicuspid E

D3348 Retreat root canal

molar E

D3351 Apexification/recalc

initial E

D3352 Apexification/recalc

interim E

D3353 Apexification/recalc

final E

D3354 Pulpal regeneration

E

D3410 Apicoect/perirad surg

anter E

D3421 Root surgery

bicuspid E

D3425 Root surgerymolar E

D3426 Root surgery ea add

root E

D3430 Retrograde

filling E

D3450 Root

amputation E

D3460 Endodontic endosseous

implan S 0330 9.5583 $663.54

. $132.71

D3470 Intentional

replantation E

D3910 Isolation- tooth w rubb

dam E

D3920 Tooth

splitting E

D3950 Canal prep/fitting of

dowel E

D3999 Endodontic

procedure S 0330 9.5583 $663.54

. $132.71

D4210 Gingivectomy/plasty per

quad E

D4211 Gingivectomy/plasty per

toot E

D4230 Ana crown exp 4 or> per

quad E

D4231 Ana crown exp 1-3 per

quad E

D4240 Gingival flap proc w/

planin E

D4241 Gngvl flap w rootplan 1-3

th E

D4245 Apically positioned

flap E

D4249 Crown lengthen hard

tissue E

D4260 Osseous surgery per

quadrant S 0330 9.5583 $663.54

. $132.71

D4261 Osseous

surgl-3teethperquad E

D4263 Bone replce graft first

site S 0330 9.5583 $663.54

. $132.71D4264 Bone replce graft each

add S 0330 9.5583 $663.54

. $132.71

D4265 Bio mtrls to aid soft/os

reg E

D4266 Guided tiss regen

resorble E

D4267 Guided tiss regen

nonresorb E

D4268 Surgical revision

procedure S 0330 9.5583 $663.54

. $132.71

D4270 Pedicle soft tissue graft

pr S 0330 9.5583 $663.54

. $132.71

D4271 Free soft tissue graft

proc S 0330 9.5583 $663.54

. $132.71

D4273 Subepithelial tissue

graft S 0330 9.5583 $663.54

. $132.71

D4274 Distal/proximal wedge

proc E

D4275 Soft tissue

allograft E

D4276 Con tissue w dble ped

graft E

D4320 Provision splnt

intracoronal E

D4321 Provisional splint

extracoro E

D4341 Periodontal scaling &

root E

D4342 Periodontal scaling

1-3teeth E

D4355 Full mouth

debridement S 0330 9.5583 $663.54

. $132.71

D4381 Localized delivery

antimicro S 0330 9.5583 $663.54

. $132.71

D4910 Periodontal maint

procedures E

D4920 Unscheduled dressing

change E

D4999 Unspecified periodontal

proc ED5110 Dentures complete

maxillary E

D5120 Dentures complete

mandible E

D5130 Dentures immediat

maxillary E

D5140 Dentures immediat

mandible E

D5211 Dentures maxill part

resin E

D5212 Dentures mand part

resin E

D5213 Dentures maxill part

metal E

D5214 Dentures mandibl part

metal E

D5225 Maxillary part denture

flex E

D5226 Mandibular part denture

flex E

D5281 Removable partial

denture E

D5410 Dentures adjust cmplt

maxil E

D5411 Dentures adjust cmplt

mand E

D5421 Dentures adjust part

maxill E

D5422 Dentures adjust part

mandbl E

D5510 Dentur repr broken compl

bas E

D5520 Replace denture teeth

complt E

D5610 Dentures repair resin

base E

D5620 Rep part denture cast

frame E

D5630 Rep partial denture

clasp E

D5640 Replace part denture

teeth E

D5650 Add tooth to partial

denture ED5660 Add clasp to partial

denture E

D5670 Replc tth&acrlc on mtl

frmwk E

D5671 Replc tth&acrlc

mandibular E

D5710 Dentures rebase cmplt

maxil E

D5711 Dentures rebase cmplt

mand E

D5720 Dentures rebase part

maxill E

D5721 Dentures rebase part

mandbl E

D5730 Denture reln cmplt maxil

ch E

D5731 Denture reln cmplt mand

chr E

D5740 Denture reln part maxil

chr E

D5741 Denture reln part mand

chr E

D5750 Denture reln cmplt max

lab E

D5751 Denture reln cmplt mand

lab E

D5760 Denture reln part maxil

lab E

D5761 Denture reln part mand

lab E

D5810 Denture interm cmplt

maxill E

D5811 Denture interm cmplt

mandbl E

D5820 Denture interm part

maxill E

D5821 Denture interm part

mandbl E

D5850 Denture tiss conditn

maxill E

D5851 Denture tiss condtin

mandbl E

D5860 Overdenture

complete ED5861 Overdenture

partial E

D5862 Precision

attachment E

D5867 Replacement of precision

att E

D5875 Prosthesis

modification E

D5899 Removable prosthodontic

proc E

D5911 Facial moulage

sectional S 0330 9.5583 $663.54

. $132.71

D5912 Facial moulage

complete S 0330 9.5583 $663.54

. $132.71

D5913 Nasal

prosthesis E

D5914 Auricular

prosthesis E

D5915 Orbital

prosthesis E

D5916 Ocular

prosthesis E

D5919 Facial

prosthesis E

D5922 Nasal septal

prosthesis E

D5923 Ocular prosthesis

interim E

D5924 Cranial

prosthesis E

D5925 Facial augmentation

implant E

D5926 Replacement nasal

prosthesis E

D5927 Auricular

replacement E

D5928 Orbital

replacement E

D5929 Facial

replacement E

D5931 Surgical

obturator ED5932 Postsurgical

obturator E

D5933 Refitting of

obturator E

D5934 Mandibular flange

prosthesis E

D5935 Mandibular denture

prosth E

D5936 Temp obturator

prosthesis E

D5937 Trismus

appliance E

D5951 Feeding

aid E

D5952 Pediatric speech

aid E

D5953 Adult speech

aid E

D5954 Superimposed

prosthesis E

D5955 Palatal lift

prosthesis E

D5958 Intraoral con def inter

plt E

D5959 Intraoral con def mod

palat E

D5960 Modify speech aid

prosthesis E

D5982 Surgical

stent E

D5983 Radiation

applicator S 0330 9.5583 $663.54

. $132.71

D5984 Radiation

shield S 0330 9.5583 $663.54

. $132.71

D5985 Radiation cone

locator S 0330 9.5583 $663.54

. $132.71

D5986 Fluoride

applicator E

D5987 Commissure

splint S 0330 9.5583 $663.54

. $132.71

D5988 Surgical

splint ED5991 Topical medicament

carrier E

D5992 Adjust max prost appliance

E

D5993 Main/clean max prosthesis

E

D5999 Maxillofacial

prosthesis E

D6010 Odontics endosteal

implant E

D6012 Endosteal

implant E

D6040 Odontics eposteal

implant E

D6050 Odontics transosteal

implnt E

D6053 Implnt/abtmnt spprt remv

dnt E

D6054 Implnt/abtmnt spprt

remvprtl E

D6055 Implant connecting

bar E

D6056 Prefabricated

abutment E

D6057 Custom

abutment E

D6058 Abutment supported

crown E

D6059 Abutment supported mtl

crown E

D6060 Abutment supported mtl

crown E

D6061 Abutment supported mtl

crown E

D6062 Abutment supported mtl

crown E

D6063 Abutment supported mtl

crown E

D6064 Abutment supported mtl

crown E

D6065 Implant supported

crown E

D6066 Implant supported mtl

crown ED6067 Implant supported mtl

crown E

D6068 Abutment supported

retainer E

D6069 Abutment supported

retainer E

D6070 Abutment supported

retainer E

D6071 Abutment supported

retainer E

D6072 Abutment supported

retainer E

D6073 Abutment supported

retainer E

D6074 Abutment supported

retainer E

D6075 Implant supported

retainer E

D6076 Implant supported

retainer E

D6077 Implant supported

retainer E

D6078 Implnt/abut suprtd fixd

dent E

D6079 Implnt/abut suprtd fixd

dent E

D6080 Implant

maintenance E

D6090 Repair

implant E

D6091 Repl semi/precision

attach E

D6092 Recement supp

crown E

D6093 Recement supp part

denture E

D6094 Abut support crown

titanium E

D6095 Odontics repr

abutment E

D6100 Removal of

implant E

D6190 Radio/surgical implant

index ED6194 Abut support retainer

titani E

D6199 Implant

procedure E

D6205 Pontic-indirect resin

based E

D6210 Prosthodont high noble

metal E

D6211 Bridge base metal

cast E

D6212 Bridge noble metal

cast E

D6214 Pontic

titanium E

D6240 Bridge porcelain high

noble E

D6241 Bridge porcelain base

metal E

D6242 Bridge porcelain nobel

metal E

D6245 Bridge

porcelain/ceramic E

D6250 Bridge resin w/high

noble E

D6251 Bridge resin base

metal E

D6252 Bridge resin w/noble

metal E

D6253 Provisional

pontic E

D6254 Interim pontic

E

D6545 Dental retainr cast

metl E

D6548 Porcelain/ceramic

retainer E

D6600 Porcelain/ceramic inlay

2srf E

D6601 Porc/ceram inlay >= 3

surfac E

D6602 Cst hgh nble mtl inlay 2

srf E

D6603 Cst hgh nble mtl inlay

>=3sr ED6604 Cst bse mtl inlay 2

surfaces E

D6605 Cst bse mtl inlay >= 3

surfa E

D6606 Cast noble metal inlay 2

sur E

D6607 Cst noble mtl inlay >=3

surf E

D6608 Onlay porc/crmc 2

surfaces E

D6609 Onlay porc/crmc >=3

surfaces E

D6610 Onlay cst hgh nbl mtl 2

srfc E

D6611 Onlay cst hgh nbl mtl

>=3srf E

D6612 Onlay cst base mtl 2

surface E

D6613 Onlay cst base mtl >=3

surfa E

D6614 Onlay cst nbl mtl 2

surfaces E

D6615 Onlay cst nbl mtl >=3

surfac E

D6624 Inlay

titanium E

D6634 Onlay

titanium E

D6710 Crown-indirect resin

based E

D6720 Retain crown resin w hi

nble E

D6721 Crown resin w/base

metal E

D6722 Crown resin w/noble

metal E

D6740 Crown

porcelain/ceramic E

D6750 Crown porcelain high

noble E

D6751 Crown porcelain base

metal E

D6752 Crown porcelain noble

metal ED6780 Crown 3/4 high noble

metal E

D6781 Crown 3/4 cast based

metal E

D6782 Crown 3/4 cast noble

metal E

D6783 Crown 3/4

porcelain/ceramic E

D6790 Crown full high noble

metal E

D6791 Crown full base metal

cast E

D6792 Crown full noble metal

cast E

D6793 Provisional retainer

crown E

D6794 Crown

titanium E

D6795 Interim retainer crown

E

D6920 Dental connector

bar S 0330 9.5583 $663.54

. $132.71

D6930 Dental recement

bridge E

D6940 Stress

breaker E

D6950 Precision

attachment E

D6970 Post & core plus

retainer E

D6972 Prefab post & core plus

reta E

D6973 Core build up for

retainer E

D6975 Coping

metal E

D6976 Each addtnl cast

post E

D6977 Each addtl prefab

post E

D6980 Bridge

repair E

D6985 Pediatric partial denturefx E

D6999 Fixed prosthodontic

proc E

D7111 Extraction coronal

remnants S 0330 9.5583 $663.54

. $132.71

D7140 Extraction erupted

tooth/exr S 0330 9.5583 $663.54

. $132.71

D7210 Rem imp tooth w mucoper

flp S 0330 9.5583 $663.54

. $132.71

D7220 Impact tooth remov soft

tiss S 0330 9.5583 $663.54

. $132.71

D7230 Impact tooth remov part

bony S 0330 9.5583 $663.54

. $132.71

D7240 Impact tooth remov comp

bony S 0330 9.5583 $663.54

. $132.71

D7241 Impact tooth rem bony

w/comp S 0330 9.5583 $663.54

. $132.71

D7250 Tooth root

removal S 0330 9.5583 $663.54

. $132.71

D7251 Coronectomy E

D7260 Oral antral fistula

closure S 0330 9.5583 $663.54

. $132.71

D7261 Primary closure sinus

perf S 0330 9.5583 $663.54

. $132.71

D7270 Tooth

reimplantation E

D7272 Tooth

transplantation E

D7280 Exposure impact tooth

orthod E

D7282 Mobilize erupted/malpos

toot E

D7283 Place device impacted

tooth B

D7285 Biopsy of oral tissue

hard E

D7286 Biopsy of oral tissuesoft E

D7287 Exfoliative cytolog

collect E

D7288 Brush

biopsy B

D7290 Repositioning of

teeth E

D7291 Transseptal

fiberotomy S 0330 9.5583 $663.54

. $132.71

D7292 Screw retained

plate E

D7293 Temp anchorage dev w

flap E

D7294 Temp anchorage dev w/o

flap E

D7295 "Bone harvest,auto graft proc

" E

D7310 Alveoplasty w/

extraction E

D7311 Alveoloplasty w/extract

1-3 E

D7320 Alveoplasty w/o

extraction E

D7321 Alveoloplasty not

w/extracts B

D7340 Vestibuloplasty ridge

extens E

D7350 Vestibuloplasty exten

graft E

D7410 Rad exc lesion up to 1.25

cm E

D7411 Excision benign

lesion>1.25c E

D7412 Excision benign lesion

compl E

D7413 Excision malig

lesion<=1.25c E

D7414 Excision malig

lesion>1.25cm E

D7415 Excision malig les

complicat E

D7440 Malig tumor exc to 1.25

cm ED7441 Malig tumor > 1.25

cm E

D7450 Rem odontogen cyst to

1.25cm E

D7451 Rem odontogen cyst > 1.25

cm E

D7460 Rem nonodonto cyst to

1.25cm E

D7461 Rem nonodonto cyst > 1.25

cm E

D7465 Lesion

destruction E

D7471 Rem exostosis any

site E

D7472 Removal of torus

palatinus E

D7473 Remove torus

mandibularis E

D7485 Surg reduct

osseoustuberosit E

D7490 Maxilla or mandible

resectio E

D7510 I&d absc intraoral soft

tiss E

D7511 Incision/drain abscess

intra B

D7520 I&d abscess

extraoral E

D7521 Incision/drain abscess

extra B

D7530 Removal fb skin/areolar

tiss E

D7540 Removal of fb

reaction E

D7550 Removal of sloughed off

bone E

D7560 Maxillary

sinusotomy E

D7610 Maxilla open reduct

simple E

D7620 Clsd reduct simpl maxilla

fx E

D7630 Open red simpl mandible

fx ED7640 Clsd red simpl mandible

fx E

D7650 Open red simp malar/zygom

fx E

D7660 Clsd red simp malar/zygom

fx E

D7670 Closd rductn splint

alveolus E

D7671 Alveolus open

reduction E

D7680 Reduct simple facial bone

fx E

D7710 Maxilla open reduct

compound E

D7720 Clsd reduct compd maxilla

fx E

D7730 Open reduct compd mandble

fx E

D7740 Clsd reduct compd mandble

fx E

D7750 Open red comp malar/zygma

fx E

D7760 Clsd red comp malar/zygma

fx E

D7770 Open reduc compd alveolus

fx E

D7771 Alveolus clsd reduc stblz

te E

D7780 Reduct compnd facial bone

fx E

D7810 Tmj open

reduct-dislocation E

D7820 Closed tmp

manipulation E

D7830 Tmj manipulation under

anest E

D7840 Removal of tmj

condyle E

D7850 Tmj

meniscectomy E

D7852 Tmj repair of joint

disc E

D7854 Tmj excisn of joint

membrane ED7856 Tmj cutting of a

muscle E

D7858 Tmj

reconstruction E

D7860 Tmj cutting into

joint E

D7865 Tmj reshaping

components E

D7870 Tmj aspiration joint

fluid E

D7871 Lysis + lavage w

catheters E

D7872 Tmj diagnostic

arthroscopy E

D7873 Tmj arthroscopy lysis

adhesn E

D7874 Tmj arthroscopy disc

reposit E

D7875 Tmj arthroscopy

synovectomy E

D7876 Tmj arthroscopy

discectomy E

D7877 Tmj arthroscopy

debridement E

D7880 Occlusal orthotic

appliance E

D7899 Tmj unspecified

therapy E

D7910 Dent sutur recent wnd to

5cm E

D7911 Dental suture wound to 5

cm E

D7912 Suture complicate wnd > 5

cm E

D7920 Dental skin

graft E

D7940 Reshaping bone

orthognathic S 0330 9.5583 $663.54

. $132.71

D7941 Bone cutting ramus

closed E

D7943 Cutting ramus open

w/graft E

D7944 Bone cutting

segmented ED7945 Bone cutting body

mandible E

D7946 Reconstruction maxilla

total E

D7947 Reconstruct maxilla

segment E

D7948 Reconstruct midface no

graft E

D7949 Reconstruct midface

w/graft E

D7950 Mandible

graft E

D7951 Sinus aug w bone/bone

sup E

D7953 Bone replacement

graft E

D7955 Repair maxillofacial

defects E

D7960 Frenulectomy/frenectomy E

D7963 Frenuloplasty E

D7970 Excision hyperplastic

tissue E

D7971 Excision pericoronal

gingiva E

D7972 Surg redct fibrous

tuberosit E

D7980 Sialolithotomy E

D7981 Excision of salivary

gland E

D7982 Sialodochoplasty E

D7983 Closure of salivary

fistula E

D7990 Emergency

tracheotomy E

D7991 Dental

coronoidectomy E

D7995 Synthetic graft facial

bones E

D7996 Implant mandible for

augment ED7997 Appliance

removal E

D7998 Intraoral place of fix

dev E

D7999 Oral surgery

procedure E

D8010 Limited dental tx

primary E

D8020 Limited dental tx

transition E

D8030 Limited dental tx

adolescent E

D8040 Limited dental tx

adult E

D8050 Intercep dental tx

primary E

D8060 Intercep dental tx

transitn E

D8070 Compre dental tx

transition E

D8080 Compre dental tx

adolescent E

D8090 Compre dental tx

adult E

D8210 Orthodontic rem appliance

tx E

D8220 Fixed appliance therapy

habt E

D8660 Preorthodontic tx

visit E

D8670 Periodic orthodontc tx

visit E

D8680 Orthodontic

retention E

D8690 Orthodontic

treatment E

D8691 Repair ortho

appliance E

D8692 Replacement

retainer E

D8693 Rebond/cement/repair

retain E

D8999 Orthodontic

procedure ED9110 Tx dental pain minor

proc N

D9120 Fix partial denture

section E

D9210 Dent anesthesia w/o

surgery E

D9211 Regional block

anesthesia E

D9212 Trigeminal block

anesthesia E

D9215 Local

anesthesia E

D9220 General

anesthesia E

D9221 General anesthesia ea ad

15m E

D9230 Analgesia N

D9241 Intravenous

sedation E

D9242 IV sedation ea ad 30

m E

D9248 Sedation

(non-iv) N

D9310 Dental

consultation E

D9410 Dental house

call E

D9420 Hospital/ASC

call E

D9430 Office visit during

hours E

D9440 Office visit after

hours E

D9450 Case presentation tx

plan E

D9610 Dent therapeutic drug

inject E

D9612 Thera par drugs 2 or >

admin E

D9630 Other

drugs/medicaments S 0330 9.5583 $663.54

. $132.71

D9910 Dent appl desensitizing

med ED9911 Appl desensitizing

resin E

D9920 Behavior

management E

D9930 Treatment of

complications S 0330 9.5583 $663.54

. $132.71

D9940 Dental occlusal

guard S 0330 9.5583 $663.54

. $132.71

D9941 Fabrication athletic

guard E

D9942 Repair/reline occlusal

guard E

D9950 Occlusion

analysis S 0330 9.5583 $663.54

. $132.71

D9951 Limited occlusal

adjustment S 0330 9.5583 $663.54

. $132.71

D9952 Complete occlusal

adjustment S 0330 9.5583 $663.54

. $132.71

D9970 Enamel

microabrasion E

D9971 Odontoplasty 1-2

teeth E

D9972 Extrnl bleaching per

arch E

D9973 Extrnl bleaching per

tooth E

D9974 Intrnl bleaching per

tooth E

D9999 Adjunctive

procedure E

E0100 Cane adjust/fixed with

tip Y

E0105 Cane adjust/fixed quad/3

pro Y

E0110 Crutch forearm

pair Y

E0111 Crutch forearm

each Y

E0112 Crutch underarm pair

wood Y

E0113 Crutch underarm eachwood Y

E0114 Crutch underarm pair no

wood Y

E0116 Crutch underarm each no

wood Y

E0117 Underarm springassist

crutch Y

E0118 Crutch

substitute E

E0130 Walker rigid adjust/fixed

ht Y

E0135 Walker folding

adjust/fixed Y

E0140 Walker w trunk

support Y

E0141 Rigid wheeled walker

adj/fix Y

E0143 Walker folding wheeled w/o

s Y

E0144 Enclosed walker w rear

seat Y

E0147 Walker variable wheel

resist Y

E0148 Heavyduty walker no

wheels Y

E0149 Heavy duty wheeled

walker Y

E0153 Forearm crutch platform

atta Y

E0154 Walker platform

attachment Y

E0155 "Walker wheel

attachment,pair" Y

E0156 Walker seat

attachment Y

E0157 Walker crutch

attachment Y

E0158 Walker leg extenders set

of4 Y

E0159 Brake for wheeled

walker Y

E0160 Sitz type bath or

equipment Y

E0161 Sitz bath/equipmentw/faucet Y

E0162 Sitz bath

chair Y

E0163 Commode chair with fixed

arm Y

E0165 Commode chair with

detacharm Y

E0167 Commode chair pail or

pan Y

E0168 Heavyduty/wide commode

chair Y

E0170 Commode chair

electric Y

E0171 Commode chair

non-electric Y

E0172 Seat lift mechanism

toilet E

E0175 Commode chair foot

rest Y

E0181 Press pad alternating w/

pum Y

E0182 "Replace pump, alt press

pad" Y

E0184 Dry pressure

mattress Y

E0185 Gel pressure mattress

pad Y

E0186 Air pressure

mattress Y

E0187 Water pressure

mattress Y

E0188 Synthetic sheepskin

pad Y

E0189 Lambswool sheepskin

pad Y

E0190 Positioning

cushion E

E0191 Protector heel or

elbow Y

E0193 Powered air flotation

bed Y

E0194 Air fluidized

bed Y

E0196 Gel pressuremattress Y

E0197 Air pressure pad for

mattres Y

E0198 Water pressure pad for

mattr Y

E0199 Dry pressure pad for

mattres Y

E0200 Heat lamp without

stand Y

E0202 Phototherapy light w/

photom Y

E0203 Therapeutic lightbox tabletp E

E0205 Heat lamp with

stand Y

E0210 Electric heat pad

standard Y

E0215 Electric heat pad

moist Y

E0217 Water circ heat pad w

pump Y

E0218 Water circ cold pad w

pump Y

E0221 Infrared heating pad

system Y

E0225 Hydrocollator

unit Y

E0231 Wound warming

device E

E0232 Warming card for

NWT E

E0235 Paraffin bath unit

portable Y

E0236 Pump for water circulating

p Y

E0239 Hydrocollator unit

portable Y

E0240 Bath/shower

chair E

E0241 Bath tub wall

rail E

E0242 Bath tub rail

floor E

E0243 Toiletrail E

E0244 Toilet seat

raised E

E0245 Tub stool or

bench E

E0246 Transfer tub rail

attachment E

E0247 Trans bench w/wo comm

open E

E0248 HDtrans bench w/wo comm

open E

E0249 Pad water circulating heat

u Y

E0250 Hosp bed fixed ht w/

mattres Y

E0251 Hosp bed fixd ht w/o

mattres Y

E0255 Hospital bed var ht w/

mattr Y

E0256 Hospital bed var ht w/o

matt Y

E0260 Hosp bed semi-electr w/

matt Y

E0261 Hosp bed semi-electr w/o

mat Y

E0265 Hosp bed total electr w/

mat Y

E0266 Hosp bed total elec w/o

matt Y

E0270 Hospital bed institutional

t E

E0271 Mattress

innerspring Y

E0272 Mattress foam

rubber Y

E0273 Bed

board E

E0274 Over-bed

table E

E0275 Bed pan

standard Y

E0276 Bed pan

fracture Y

E0277 Powered pres-redu airmattrs Y

E0280 Bed

cradle Y

E0290 Hosp bed fx ht w/o rails

w/m Y

E0291 Hosp bed fx ht w/o rail

w/o Y

E0292 Hosp bed var ht w/o rail

w/o Y

E0293 Hosp bed var ht w/o rail

w/ Y

E0294 Hosp bed semi-elect w/

mattr Y

E0295 Hosp bed semi-elect w/o

matt Y

E0296 Hosp bed total elect w/

matt Y

E0297 Hosp bed total elect w/o

mat Y

E0300 Enclosed ped crib hosp

grade Y

E0301 "HD hosp bed, 350-600

lbs" Y

E0302 Ex hd hosp bed > 600

lbs Y

E0303 Hosp bed hvy dty xtra

wide Y

E0304 Hosp bed xtra hvy dty x

wide Y

E0305 Rails bed side half

length Y

E0310 Rails bed side full

length Y

E0315 Bed accessory

brd/tbl/supprt E

E0316 Bed safety

enclosure Y

E0325 Urinal male

jug-type Y

E0326 Urinal female

jug-type Y

E0328 "Ped hospital bed,

manual" Y

E0329 Ped hospital bedsemi/elect Y

E0350 Control unit bowel

system E

E0352 Disposable pack w/bowel

syst E

E0370 Air elevator for

heel E

E0371 Nonpower mattress

overlay Y

E0372 Powered air mattress

overlay Y

E0373 Nonpowered pressure

mattress Y

E0424 Stationary compressed gas

02 Y

E0425 Gas system stationary

compre E

E0430 Oxygen system gas

portable E

E0431 Portable gaseous

02 Y

E0433 Portable liquid oxygen

sys Y

E0434 Portable liquid

02 Y

E0435 Oxygen system liquid

portabl E

E0439 Stationary liquid

02 Y

E0440 Oxygen system liquid

station E

E0441 "Stationary O2 contents,

gas" Y

E0442 "Stationary O2 contents,

liq" Y

E0443 "Portable 02 contents,

gas" Y

E0444 "Portable 02 contents,

liquid" Y

E0445 Oximeter

non-invasive N

E0446 "Topical Ox Deliver sys,

nos" E

E0450 Vol control vent invasivint Y

E0455 Oxygen tent excl croup/ped

t Y

E0457 Chest

shell Y

E0459 Chest

wrap Y

E0460 Neg press vent

portabl/statn Y

E0461 Vol control vent noninv

int Y

E0462 Rocking bed w/ or w/o side

r Y

E0463 Press supp vent invasive

int Y

E0464 Press supp vent noninv

int Y

E0470 RAD w/o backup non-inv

intfc Y

E0471 RAD w/backup non inv

intrfc Y

E0472 RAD w backup invasive

intrfc Y

E0480 Percussor elect/pneum home

m Y

E0481 Intrpulmnry percuss vent

sys E

E0482 Cough stimulating

device Y

E0483 Chest compression gen

system Y

E0484 Non-elec oscillatory pep

dvc Y

E0485 Oral device/appliance

prefab Y

E0486 Oral device/appliance

cusfab Y

E0487 Electronic spirometer

N

E0500 Ippb all

types Y

E0550 Humidif extens supple w

ippb Y

E0555 Humidifier for use w/regula Y

E0560 Humidifier supplemental w/

i Y

E0561 Humidifier nonheated w

PAP Y

E0562 Humidifier heated used w

PAP Y

E0565 Compressor air power

source Y

E0570 Nebulizer with

compression Y

E0571 Aerosol compressor for

svneb Y

E0572 Aerosol compressor adjust

pr Y

E0574 Ultrasonic generator w

svneb Y

E0575 Nebulizer

ultrasonic Y

E0580 Nebulizer for use w/

regulat Y

E0585 Nebulizer w/ compressor &

he Y

E0600 Suction pump portab hom

modl Y

E0601 Cont airway pressure

device Y

E0602 Manual breast

pump Y

E0603 Electric breast

pump N

E0604 Hosp grade elec breast

pump A

E0605 Vaporizer room

type Y

E0606 Drainage board

postural Y

E0607 Blood glucose monitor

home Y

E0610 Pacemaker monitr

audible/vis Y

E0615 Pacemaker monitr

digital/vis Y

E0616 Cardiac eventrecorder N

E0617 Automatic ext

defibrillator Y

E0618 Apnea

monitor Y

E0619 Apnea monitor w

recorder Y

E0620 Cap bld skin piercing

laser Y

E0621 Patient lift sling or

seat Y

E0625 Patient lift bathroom or

toi E

E0627 Seat lift incorp

lift-chair Y

E0628 Seat lift for pt

furn-electr Y

E0629 Seat lift for pt

furn-non-el Y

E0630 Patient lift

hydraulic Y

E0635 Patient lift

electric Y

E0636 PT support & positioning

sys Y

E0637 Combination sit to stand

sys E

E0638 Standing frame

sys E

E0639 Moveable patient lift

system E

E0640 Fixed patient lift

system E

E0641 Multi-position stnd fram

sys E

E0642 Dynamic standing

frame E

E0650 Pneuma compresor

non-segment Y

E0651 Pneum compressor

segmental Y

E0652 Pneum compres w/cal

pressure Y

E0655 Pneumatic appliance halfarm Y

E0656 Segmental pneumatic

trunk Y

E0657 Segmental pneumatic

chest Y

E0660 Pneumatic appliance full

leg Y

E0665 Pneumatic appliance full

arm Y

E0666 Pneumatic appliance half

leg Y

E0667 Seg pneumatic appl full

leg Y

E0668 Seg pneumatic appl full

arm Y

E0669 Seg pneumatic appli half

leg Y

E0671 Pressure pneum appl full

leg Y

E0672 Pressure pneum appl full

arm Y

E0673 Pressure pneum appl half

leg Y

E0675 Pneumatic compression

device Y

E0676 Inter limb compress dev

NOS Y

E0691 Uvl pnl 2 sq ft or

less Y

E0692 Uvl sys panel 4

ft Y

E0693 Uvl sys panel 6

ft Y

E0694 Uvl md cabinet sys 6

ft Y

E0700 Safety

equipment E

E0705 Transfer

device B

E0710 Restraints any

type E

E0720 Tens two

lead Y

E0730 Tens fourlead Y

E0731 Conductive garment for

tens/ Y

E0740 Incontinence treatment

systm Y

E0744 Neuromuscular stim for

scoli Y

E0745 Neuromuscular stim for

shock Y

E0746 Electromyograph

biofeedback N

E0747 Elec osteogen stim not

spine Y

E0748 Elec osteogen stim

spinal Y

E0749 Elec osteogen stim

implanted N

E0755 Electronic salivary reflex

s E

E0760 Osteogen ultrasound

stimltor Y

E0761 Nontherm electromgntc

device E

E0762 Trans elec jt stim dev

sys B

E0764 Functional

neuromuscularstim Y

E0765 Nerve stimulator for tx

n&v Y

E0769 Electric wound treatment

dev B

E0770 Functional electric stim

NOS Y

E0776 Iv

pole Y

E0779 Amb infusion pump

mechanical Y

E0780 Mech amb infusion pump

<8hrs Y

E0781 External ambulatory infus

pu Y

E0782 Non-programble infusion

pump N

E0783 Programmable infusionpump N

E0784 Ext amb infusn pump

insulin Y

E0785 Replacement impl pump

cathet N

E0786 Implantable pump

replacement N

E0791 Parenteral infusion pump

sta Y

E0830 Ambulatory traction

device N

E0840 Tract frame attach

headboard Y

E0849 Cervical pneum trac

equip Y

E0850 Traction stand free

standing Y

E0855 Cervical traction

equipment Y

E0856 Cervic collar w air

bladder Y

E0860 Tract equip cervical

tract Y

E0870 Tract frame attach

footboard Y

E0880 Trac stand free stand

extrem Y

E0890 Traction frame attach

pelvic Y

E0900 Trac stand free stand

pelvic Y

E0910 Trapeze bar attached to

bed Y

E0911 HD trapeze bar attach to

bed Y

E0912 HD trapeze bar free

standing Y

E0920 Fracture frame attached to

b Y

E0930 Fracture frame free

standing Y

E0935 Cont pas motion exercise

dev Y

E0936 "CPM device, other thanknee" E

E0940 Trapeze bar free

standing Y

E0941 Gravity assisted traction

de Y

E0942 Cervical head

harness/halter Y

E0944 Pelvic

belt/harness/boot Y

E0945 Belt/harness

extremity Y

E0946 Fracture frame dual w

cross Y

E0947 Fracture frame attachmnts

pe Y

E0948 Fracture frame attachmnts

ce Y

E0950 Tray Y

E0951 Loop

heel Y

E0952 "Toe loop/holder,

each" Y

E0955 Cushioned

headrest Y

E0956 W/c lateral trunk/hip

suppor Y

E0957 W/c medial thigh

support Y

E0958 Whlchr att- conv 1 arm

drive Y

E0959 Amputee

adapter B

E0960 W/c shoulder

harness/straps Y

E0961 Wheelchair brake

extension B

E0966 Wheelchair head rest

extensi B

E0967 Manual wc hand rim w

project Y

E0968 Wheelchair commode

seat Y

E0969 Wheelchair narrowing

device YE0970 Wheelchair no. 2 footplates E

E0971 Wheelchair anti-tipping

devi B

E0973 W/Ch access det adj

armrest B

E0974 W/Ch access

anti-rollback B

E0978 "W/C acc,saf belt pelv

strap" B

E0980 Wheelchair safety

vest Y

E0981 "Seat upholstery,

replacement" Y

E0982 "Back upholstery,

replacement" Y

E0983 Add pwr

joystick Y

E0984 Add pwr

tiller Y

E0985 W/c seat lift

mechanism Y

E0986 Man w/c push-rim pow

assist Y

E0990 Wheelchair elevating leg

res B

E0992 Wheelchair solid seat

insert B

E0994 Wheelchair arm

rest Y

E0995 Wheelchair calf

rest B

E1002 Pwr seat

tilt Y

E1003 Pwr seat

recline Y

E1004 Pwr seat recline

mech Y

E1005 Pwr seat recline

pwr Y

E1006 Pwr seat combo w/o

shear Y

E1007 Pwr seat combo

w/shear YE1008 Pwr seat combo pwr

shear Y

E1009 Add mech leg

elevation Y

E1010 Add pwr leg

elevation Y

E1011 Ped wc modify width

adjustm Y

E1014 Reclining back add ped

w/c Y

E1015 Shock absorber for man

w/c Y

E1016 Shock absorber for power

w/c Y

E1017 HD shck absrbr for hd man

wc Y

E1018 HD shck absrber for hd

powwc Y

E1020 Residual limb support

system Y

E1028 W/c manual

swingaway Y

E1029 W/c vent tray

fixed Y

E1030 W/c vent tray

gimbaled Y

E1031 Rollabout chair with

casters Y

E1035 Patient transfer system

<300 Y

E1036 Patient transfer system

>300 Y

E1037 "Transport chair, ped

size" Y

E1038 Transport chair pt

wt<=300lb Y

E1039 Transport chair pt wt

>300lb Y

E1050 Whelchr fxd full length

arms Y

E1060 Wheelchair detachable

arms Y

E1070 Wheelchair detachable foot

r YE1083 Hemi-wheelchair fixed

arms Y

E1084 Hemi-wheelchair detachable

a Y

E1085 Hemi-wheelchair fixed arms E

E1086 Hemi-wheelchair detachable a E

E1087 Wheelchair lightwt fixed

arm Y

E1088 Wheelchair lightweight det

a Y

E1089 Wheelchair lightwt fixed arm E

E1090 Wheelchair lightweight det a E

E1092 Wheelchair wide w/ leg

rests Y

E1093 Wheelchair wide w/ foot

rest Y

E1100 Whchr s-recl fxd arm leg

res Y

E1110 Wheelchair semi-recl

detach Y

E1130 Whlchr stand fxd arm ft rest E

E1140 Wheelchair standard detach a E

E1150 Wheelchair standard w/ leg

r Y

E1160 Wheelchair fixed

arms Y

E1161 Manual adult wc w

tiltinspac Y

E1170 Whlchr ampu fxd arm leg

rest Y

E1171 Wheelchair amputee w/o leg

r Y

E1172 Wheelchair amputee detach

ar Y

E1180 Wheelchair amputee w/ foot

r Y

E1190 Wheelchair amputee w/ leg

re YE1195 Wheelchair amputee heavy

dut Y

E1200 Wheelchair amputee fixed

arm Y

E1220 Whlchr special

size/constrc Y

E1221 Wheelchair spec size w

foot Y

E1222 Wheelchair spec size w/

leg Y

E1223 Wheelchair spec size w

foot Y

E1224 Wheelchair spec size w/

leg Y

E1225 Manual semi-reclining

back Y

E1226 Manual fully reclining

back B

E1227 Wheelchair spec sz spec ht

a Y

E1228 Wheelchair spec sz spec ht

b Y

E1229 Pediatric wheelchair

NOS Y

E1230 Power operated

vehicle Y

E1231 Rigid ped w/c

tilt-in-space Y

E1232 Folding ped wc

tilt-in-space Y

E1233 Rig ped wc tltnspc w/o

seat Y

E1234 Fld ped wc tltnspc w/o

seat Y

E1235 Rigid ped wc

adjustable Y

E1236 Folding ped wc

adjustable Y

E1237 Rgd ped wc adjstabl w/o

seat Y

E1238 Fld ped wc adjstabl w/o

seat Y

E1239 Ped power wheelchair NOS YE1240 Whchr litwt det arm leg

rest Y

E1250 Wheelchair lightwt fixed arm E

E1260 Wheelchair lightwt foot rest E

E1270 Wheelchair lightweight leg

r Y

E1280 Whchr h-duty det arm leg

res Y

E1285 Wheelchair heavy duty fixed E

E1290 Wheelchair hvy duty detach a E

E1295 Wheelchair heavy duty

fixed Y

E1296 Wheelchair special seat

heig Y

E1297 Wheelchair special seat

dept Y

E1298 Wheelchair spec seat

depth/w Y

E1300 Whirlpool

portable E

E1310 Whirlpool

non-portable Y

E1353 Oxygen supplies

regulator Y

E1354 "Wheeled cart, port

cyl/conc" Y

E1355 Oxygen supplies

stand/rack Y

E1356 "Batt pack/cart, port

conc" Y

E1357 "Battery charger, port

conc" Y

E1358 "DC power adapter, port

conc" Y

E1372 Oxy suppl heater for

nebuliz Y

E1390 Oxygen

concentrator Y

E1391 "Oxygen concentrator,

dual" YE1392 Portable oxygen

concentrator Y

E1399 Durable medical equipment

mi Y

E1405 O2/water vapor enrich

w/heat Y

E1406 O2/water vapor enrich w/o

he Y

E1500 Centrifuge A

E1510 Kidney dialysate delivry

sys A

E1520 Heparin infusion

pump A

E1530 Replacement air bubble

detec A

E1540 Replacement pressure

alarm A

E1550 Bath conductivity

meter A

E1560 Replace blood leak

detector A

E1570 Adjustable chair for esrd

pt A

E1575 Transducer protect/fld

bar A

E1580 Unipuncture control

system A

E1590 Hemodialysis

machine A

E1592 Auto interm peritoneal

dialy A

E1594 Cycler dialysis

machine A

E1600 Deli/install chrg hemo

equip A

E1610 Reverse osmosis h2o puri

sys A

E1615 Deionizer H2O puri

system A

E1620 Replacement blood

pump A

E1625 Water softening

system AE1630 Reciprocating peritoneal

dia A

E1632 Wearable artificial

kidney A

E1634 Peritoneal dialysis

clamp B

E1635 Compact travel

hemodialyzer A

E1636 Sorbent cartridges per

10 A

E1637 "Hemostats for dialysis,

each" A

E1639 Dialysis

scale A

E1699 Dialysis equipment

noc A

E1700 Jaw motion rehab

system Y

E1701 Repl cushions for jaw

motion Y

E1702 Repl measr scales jaw

motion Y

E1800 Adjust elbow ext/flex

device Y

E1801 SPS elbow

device Y

E1802 Adjst forearm pro/sup

device Y

E1805 Adjust wrist ext/flex

device Y

E1806 SPS wrist

device Y

E1810 Adjust knee ext/flex

device Y

E1811 SPS knee

device Y

E1812 Knee ext/flex w act res

ctrl Y

E1815 Adjust ankle ext/flex

device Y

E1816 SPS ankle

device Y

E1818 SPS forearm

device YE1820 Soft interface

material Y

E1821 Replacement interface

SPSD Y

E1825 Adjust finger ext/flex

devc Y

E1830 Adjust toe ext/flex

device Y

E1831 Static str toe dev

ext/flex Y

E1840 Adj shoulder ext/flex

device Y

E1841 Static str shldr dev rom

adj Y

E1902 AAC non-electronic

board Y

E2000 Gastric suction pump hme

mdl Y

E2100 Bld glucose monitor w

voice Y

E2101 Bld glucose monitor w

lance Y

E2120 Pulse gen sys tx endolymp

fl Y

E2201 "Man w/ch acc seat

w>=20""<24""" Y

E2202 Seat width 24-27

in Y

E2203 Frame depth less than 22

in Y

E2204 Frame depth 22 to 25

in Y

E2205 "Manual wc accessory,

handrim" Y

E2206 Complete wheel lock

assembly Y

E2207 Crutch and cane

holder Y

E2208 Cylinder tank

carrier Y

E2209 Arm trough

each Y

E2210 Wheelchair

bearings YE2211 Pneumatic propulsion

tire Y

E2212 Pneumatic prop tire

tube Y

E2213 Pneumatic prop tire

insert Y

E2214 Pneumatic caster tire

each Y

E2215 Pneumatic caster tire

tube Y

E2216 Foam filled propulsion

tire Y

E2217 Foam filled caster tire

each Y

E2218 Foam propulsion tire

each Y

E2219 Foam caster tire any size

ea Y

E2220 Solid propulsion tire

each Y

E2221 Solid caster tire

each Y

E2222 Solid caster integrated

whl Y

E2224 Propulsion whl excludes

tire Y

E2225 Caster wheel excludes

tire Y

E2226 Caster fork replacement

only Y

E2227 Gear reduction drive

wheel Y

E2228 "Mwc acc, wheelchair

brake" Y

E2230 Manual standing

system E

E2231 Solid seat support

base Y

E2291 Planar back for ped size

wc Y

E2292 Planar seat for ped size

wc Y

E2293 Contour back for ped size

wc YE2294 Contour seat for ped size

wc Y

E2295 Ped dynamic seating

frame Y

E2300 Pwr seat elevation

sys Y

E2301 Pwr

standing Y

E2310 Electro connect btw

control Y

E2311 Electro connect btw 2

sys Y

E2312 Mini-prop remote

joystick Y

E2313 "PWC harness, expand

control" Y

E2321 Hand interface

joystick Y

E2322 Mult mech

switches Y

E2323 Special joystick

handle Y

E2324 Chin cup

interface Y

E2325 Sip and puff

interface Y

E2326 Breath tube

kit Y

E2327 Head control interface

mech Y

E2328 Head/extremity control

inter Y

E2329 Head control

nonproportional Y

E2330 Head control proximity

switc Y

E2331 Attendant

control Y

E2340 W/c wdth 20-23 in seat

frame Y

E2341 W/c wdth 24-27 in seat

frame Y

E2342 W/c dpth 20-21 in seat

frame YE2343 W/c dpth 22-25 in seat

frame Y

E2351 Electronic SGD

interface Y

E2360 22nf nonsealed

leadacid Y

E2361 22nf sealed leadacid

battery Y

E2362 Gr24 nonsealed

leadacid Y

E2363 Gr24 sealed leadacid

battery Y

E2364 U1nonsealed leadacid

battery Y

E2365 U1 sealed leadacid

battery Y

E2366 "Battery charger, single

mode" Y

E2367 "Battery charger, dual

mode" Y

E2368 Power wc motor

replacement Y

E2369 Pwr wc gear box

replacement Y

E2370 Pwr wc motor/gear box

combo Y

E2371 Gr27 sealed leadacid

battery Y

E2372 Gr27 non-sealed

leadacid Y

E2373 Hand/chin ctrl spec

joystick Y

E2374 Hand/chin ctrl std

joystick Y

E2375 Non-expandable

controller Y

E2376 "Expandable controller,

repl" Y

E2377 "Expandable controller,

initl" Y

E2381 Pneum drive wheel

tire Y

E2382 "Tube, pneum wheel drive

tire" YE2383 "Insert, pneum wheel drive

" Y

E2384 Pneumatic caster

tire Y

E2385 "Tube, pneumatic caster

tire" Y

E2386 Foam filled drive wheel

tire Y

E2387 Foam filled caster

tire Y

E2388 Foam drive wheel

tire Y

E2389 Foam caster

tire Y

E2390 Solid drive wheel

tire Y

E2391 Solid caster

tire Y

E2392 "Solid caster tire,

integrate" Y

E2394 Drive wheel excludes

tire Y

E2395 Caster wheel excludes

tire Y

E2396 Caster

fork Y

E2397 "Pwc acc, lith-based

battery" Y

E2402 Neg press wound therapy

pump Y

E2500 SGD digitized pre-rec

<=8min Y

E2502 SGD prerec msg >8min

<=20min Y

E2504 SGD prerec msg>20min

<=40min Y

E2506 SGD prerec msg > 40

min Y

E2508 SGD spelling phys

contact Y

E2510 SGD w multi methods

msg/accs Y

E2511 SGD sftwre prgrm for

PC/PDA YE2512 "SGD accessory, mounting

sys" Y

E2599 SGD accessory

noc Y

E2601 Gen w/c cushion wdth < 22

in Y

E2602 Gen w/c cushion wdth >=22

in Y

E2603 Skin protect wc cus wd

<22in Y

E2604 Skin protect wc cus

wd>=22in Y

E2605 Position wc cush wdth <22

in Y

E2606 Position wc cush wdth>=22

in Y

E2607 Skin pro/pos wc cus wd

<22in Y

E2608 Skin pro/pos wc cus

wd>=22in Y

E2609 Custom fabricate w/c

cushion Y

E2610 Powered w/c

cushion B

E2611 Gen use back cush wdth

<22in Y

E2612 Gen use back cush

wdth>=22in Y

E2613 Position back cush wd

<22in Y

E2614 Position back cush

wd>=22in Y

E2615 Pos back post/lat wdth

<22in Y

E2616 Pos back post/lat

wdth>=22in Y

E2617 Custom fab w/c back

cushion Y

E2619 Replace cover w/c seat

cush Y

E2620 WC planar back cush wd

<22in Y

E2621 WC planar back cush

wd>=22in YE2622 Adj skin pro w/c cus

wd<22in Y

E2623 Adj skin pro wc cus

wd>=22in Y

E2624 Adj skin pro/pos

cus<22in Y

E2625 Adj skin pro/pos wc

cus>=22 Y

E8000 Posterior gait

trainer E

E8001 Upright gait

trainer E

E8002 Anterior gait

trainer E

G0008 Admin influenza virus vac S

0350 0.3780 $26.24 $0.00 $0.00

G0009 Admin pneumococcal vaccine S

0350 0.3780 $26.24 $0.00 $0.00

G0010 Admin hepatitis b

vaccine S 0436 0.3780 $26.24 $0.00 $0.00

G0027 Semen

analysis A

G0101 CA screen;pelvic/breast

exam V 0604 0.6941 $48.18 $0.00 $0.00

G0102 Prostate ca screening;

dre N

G0103 PSA screening

A

G0104 CA screen;flexi

sigmoidscope S 0159 5.4345 $377.26 $0.00 $0.00

G0105 Colorectal scrn; hi risk

ind T 0158 8.3174 $577.39 $0.00 $0.00

G0106 Colon CA screen;barium

enema S 0157 2.2553 $156.56

. $31.32

G0108 Diab manage trn per

indiv A

G0109 Diab manage trn

ind/group A

G0117 Glaucoma scrn hgh risk

direc S 0698 1.4030 $97.40

. $19.48G0118 Glaucoma scrn hgh risk

direc S 0230 0.6929 $48.10

. $9.62

G0120 Colon ca scrn; barium

enema S 0157 2.2553 $156.56

. $31.32

G0121 Colon ca scrn not hi rsk

ind T 0158 8.3174 $577.39 $0.00 $0.00

G0122 Colon ca scrn; barium

enema E

G0123 Screen cerv/vag thin

layer A

G0124 Screen c/v thin layer by MD B

G0127 Trim

nail(s) T 0012 0.4047 $28.09

. $5.62

G0128 CORF skilled nursing

service B

G0129 Partial hosp prog

service P

G0130 Single energy x-ray

study X 0260 0.6418 $44.55 $0.00 $0.00

G0141 "Scr c/v cyto,autosys and md" B

G0143 "Scr c/v

cyto,thinlayer,rescr" A

G0144 "Scr c/v

cyto,thinlayer,rescr" A

G0145 "Scr c/v

cyto,thinlayer,rescr" A

G0147 "Scr c/v cyto, automated

sys" A

G0148 "Scr c/v cyto, autosys,

rescr" A

G0151 "HHCP-serv of pt,ea 15

min" B

G0152 "HHCP-serv of ot,ea 15

min" B

G0153 "HHCP-svs of s/l path,ea

15mn" BG0154 "HHCP-svs of rn,ea 15

min" B

G0155 "HHCP-svs of csw,ea 15

min" B

G0156 "HHCP-svs of aide,ea 15

min" B

G0157 HHC PT assistant ea 15

B

G0158 HHC OT assistant ea

15 B

G0159 HHC PT maint ea 15

min B

G0160 HHC Occup Therapy ea

15 B

G0161 HHC SLP ea 15

min B

G0162 "HHC RN E&M plan svs, 15

min" B

G0163 HHC LPN/RN obs/asses ea

15 B

G0164 HHC lis nurse train ea

15 B

G0166 "Extrnl counterpulse, per

tx" T 0678 1.3160 $91.36

. $18.28

G0168 Wound closure by adhesive B

G0173 Linear acc stereo radsur

com S 0067 46.8279 "$3,250.79"

. $650.16

G0175 "OPPS Service,sched team

conf" V 0607 1.9242 $133.58

. $26.72

G0176 OPPS/PHP;activity

therapy P

G0177 OPPS/PHP; train & educ serv N

G0179 MD recertification HHA PT M

G0180 MD certification HHA patient M

G0181 Home health care supervision M

G0182 Hospice care supervision MG0186 "Dstry eye lesn,fdr vssl

tech" T 0235 4.9132 $341.07

. $68.22

G0202 Screeningmammographydigital A

G0204 Diagnosticmammographydigital A

G0206 Diagnosticmammographydigital A

G0219 PET img wholbod melano

nonco E

G0235 PET not otherwise

specified E

G0237 Therapeutic procd strg

endur S 0077 0.4224 $29.32 $7.74 $5.87

G0238 "Oth resp proc,

indiv" S 0077 0.4224 $29.32 $7.74 $5.87

G0239 "Oth resp proc,

group" S 0077 0.4224 $29.32 $7.74 $5.87

G0245 Initial foot exam pt

lops V 0604 0.6941 $48.18

. $9.64

G0246 Followup eval of foot pt

lop V 0605 1.0430 $72.41

. $14.49

G0247 Routine footcare pt w

lops T 0013 0.9786 $67.93

. $13.59

G0248 Demonstrate use home inr

mon V 0607 1.9242 $133.58

. $26.72

G0249 Provide INR test

mater/equip V 0607 1.9242 $133.58

. $26.72

G0250 MD INR test revie inter

mgmt M

G0251 Linear acc based stero

radio S 0065 12.4513 $864.37

. $172.88

G0252 PET imaging initial

dx E

G0255 Current percep threshold

tst E

G0257 Unsched dialysis ESRD pthos S 0170 5.9462 $412.79

. $82.56

G0259 Inject for sacroiliac

joint N

G0260 Inj for sacroiliac jt

anesth T 0207 7.5480 $523.98

. $104.80

G0268 Removal of impacted wax md N

G0269 Occlusive device in vein

art N

G0270 MNT subs tx for change

dx A

G0271 Group MNT 2 or more 30

mins A

G0275 "Renal angio, cardiac

cath" N

G0278 "Iliac art angio,cardiac

cath" N

G0281 Elec stim unattend for

press A

G0282 Elect stim wound care not

pd E

G0283 Elec stim other than

wound A

G0288 "Recon, CTA for surg

plan" N

G0289 "Arthro, loose body +

chondro" N

G0290 "Drug-eluting stents,

single" T 0656 104.4584 "$7,251.50"

. "$1,450.30"

G0291 "Drug-eluting stents,each

add" T 0656 104.4584 "$7,251.50"

. "$1,450.30"

G0293 "Non-cov surg proc,clin trial" X

0340 0.6739 $46.78

. $9.36

G0294 "Non-cov proc, clinical trial" X

0340 0.6739 $46.78

. $9.36

G0295 Electromagnetic therapy

onc E

G0302 Pre-op service LVRS

complete S 0209 11.3894 $790.65 $268.73 $158.13

G0303 Pre-op service LVRS

10-15dos S 0209 11.3894 $790.65 $268.73 $158.13G0304 Pre-op service LVRS 1-9

dos S 0213 2.3958 $166.32 $53.48 $33.27

G0305 Post op service LVRS min

6 S 0213 2.3958 $166.32 $53.48 $33.27

G0306 CBC/diffwbc w/o

platelet A

G0307 CBC without

platelet A

G0328 Fecal blood scrn

immunoassay A

G0329 Electromagntic tx for

ulcers A

G0333 Dispense fee initial 30

day M

G0337 Hospice evaluation

preelecti B

G0339 "Robot lin-radsurg com,

first" S 0067 46.8279 "$3,250.79"

. $650.16

G0340 Robt lin-radsurg fractx

2-5 S 0066 35.2457 "$2,446.76"

. $489.36

G0341 Percutaneous islet

celltrans C

G0342 Laparoscopy islet cell

trans C

G0343 Laparotomy islet cell

transp C

G0364 Bone marrow aspirate &biopsy X

0340 0.6739 $46.78

. $9.36

G0365 Vessel mapping hemo

access S 0267 2.1881 $151.90 $59.41 $30.38

G0372 MD service required for

PMD M

G0378 Hospital observation per hr

N

G0379 Direct refer hospital

observ Q3 0604 0.6941 $48.18

. $9.64

G0380 Lev 1 hosp type B ED visit V

0626 0.5673 $39.38

. $7.88

G0381 Lev 2 hosp type B ED visit V0627 0.8183 $56.81

. $11.37

G0382 Lev 3 hosp type B ED visit V

0628 1.3027 $90.43

. $18.09

G0383 Lev 4 hosp type B ED visit V

0629 1.9652 $136.42

. $27.29

G0384 Lev 5 hosp type B ED

visit Q3 0630 3.7640 $261.30

. $52.26

G0389 Ultrasound exam AAA

screen S 0266 1.3711 $95.18 $0.00 $0.00

G0390 Trauma Respons w/hosp

criti S 0618 11.6401 $808.06

. $161.62

G0396 Alcohol/subs interv 15-30mn S

0432 0.4940 $34.29

. $6.86

G0397 Alcohol/subs interv >30 min S

0432 0.4940 $34.29

. $6.86

G0398 Home sleep test/type 2 Porta S

0213 2.3958 $166.32 $53.48 $33.27

G0399 Home sleep test/type 3 Porta S

0213 2.3958 $166.32 $53.48 $33.27

G0400 Home sleep test/type 4 Porta S

0213 2.3958 $166.32 $53.48 $33.27

G0402 Initial preventive

exam V 0606 1.4647 $101.68 $0.00 $0.00

G0403 EKG for initial prevent

exam M

G0404 EKG tracing for initial prev

S 0099 0.3895 $27.04

. $5.41

G0405 EKG interpret & report preve B

G0406 Telhealth inpt consult

15min C

G0407 Telheath inpt consult

25min C

G0408 Telhealth inpt consult

35min C

G0409 CORF related serv 15 mins

ea MG0410 Grp psych partial hosp

45-50 P

G0411 Inter active grp psych

parti P

G0412 Open tx iliac spine

uni/bil C

G0413 Pelvic ring fracture uni/bil T

0050 32.4101 "$2,249.91"

. $449.99

G0414 Pelvic ring fx treat int

fix C

G0415 Open tx post pelvic

fxcture C

G0416 Sat biopsy prostate 1-20

spc X 0661 2.3755 $164.91

. $32.99

G0417 Sat biopsy prostate

21-40 CH S 1505 $350.00

. $70.00

G0418 Sat biopsy prostate

41-60 CH S 1506 $450.00

. $90.00

G0419 Sat biopsy prostate:

>60 CH S 1508 $650.00

. $130.00

G0420 Ed svc CKD ind per

session A

G0421 Ed svc CKD grp per

session A

G0422 Intens cardiac rehab

w/exerc S 0095 0.9648 $66.98 $13.49 $13.40

G0423 Intens cardiac rehab no

exer S 0095 0.9648 $66.98 $13.49 $13.40

G0424 Pulmonary rehab w

exer S 0102 0.5308 $36.85

. $7.37

G0425 Inpt telehealth consult

30m C

G0426 Inpt telehealth consult

50m C

G0427 Inpt telehealth con

70/>m C

G0428 Collagen Meniscus

Implant EG0429 Dermal filler injection(s) B

G0431 drug screen multiple

class A

G0432 EIA HIV-1/HIV-2

screen A

G0433 ELISA HIV-1/HIV-2

screen A

G0434 Drug screen multi drug

class A

G0435 Oral HIV-1/HIV-2

screen A

G0436 Tobacco-use counsel 3-10

min X 0031 0.2941 $20.42 $0.00 $0.00

G0437 Tobacco-use

counsel>10min X 0031 0.2941 $20.42 $0.00 $0.00

G0438 "PPPS, initial

visit" A

G0439 "PPPS, subseq

visit" A

G0440 Skin/dermal subs init 25or< B

G0441 Skin/dermal subs each addition B

G3001 "Admin + supply,

tositumomab" S 0442 22.9208 "$1,591.16"

. $318.24

G8126 Pt treat

w/antidepress12wks M

G8127 Pt not treat

w/antidepres12w M

G8128 Pt inelig for antidepres

med M

G8395 LVEF>=40% doc normal or mild M

G8396 LVEF not performed M

G8397 Dil macula/fundus exam/w doc M

G8398 Dil macular/fundus not perfo M

G8399 Pt w/DXA document or order MG8400 Pt w/DXA no document or orde M

G8401 Pt inelig osteo screen measu M

G8404 Low extemity neur exam docum M

G8405 Low extemity neur not perfor M

G8406 Pt inelig lower extrem neuro M

G8410 Eval on foot documented M

G8415 Eval on foot not performed M

G8416 Pt inelig footwear evaluatio M

G8417 Calc BMI abv up param f/u M

G8418 Calc BMI blw low param f/u M

G8419 Calc BMI out nrm param nof/u M

G8420 Calc BMI norm parameters M

G8421 BMI not calculated M

G8422 Pt inelig BMI calculation M

G8427 Doc cur meds by prov M

G8428 Cur meds not document M

G8430 Pt inelig med check M

G8431 Pos clin depres scrn f/u doc M

G8432 Clin depression screen not d M

G8433 Pt inelig; scrn clin dep M

G8440 Pain assess f/u pln document M

G8441 No document of pain assess MG8442 Pt inelig pain assessment M

G8447 Pt vis doc use EHR cer ATCB M

G8448 Pt vis doc w/PQRI qual EHR M

G8450 Beta-bloc rx pt w/abn lvef M

G8451 Pt w/abn lvef inelig b-bloc M

G8452 Pt w/abn lvef b-bloc no rx M

G8458 Pt inelig geno no antvir tx M

G8459 Doc pt rec antivir treat M

G8460 Pt inelig RNA no antvir tx M

G8461 Pt rec antivir treat hep c M

G8462 Pt inelig couns no antvir tx M

G8463 Pt rec antiviral treat doc M

G8464 Pt inelig; lo to no dter rsk M

G8465 High risk recurrence pro ca M

G8468 ACE/ARB rx pt w/abn lvef M

G8469 Pt w/abn lvef inelig ACE/ARB M

G8470 Pt w/ normal lvef M

G8471 LVEF not performed/doc M

G8472 ACE/ARB no rx pt w/abn lvef M

G8473 ACE/ARB thxpy rx'd M

G8474 ACE/ARB not rx'd; doc reas M

G8475 ACE/ARB thxpy not rx'd MG8476 BP sys <130 and dias <80 M

G8477 BP sys>=130 and/or dias >=80 M

G8478 BP not performed/doc M

G8482 Flu immunize order/admin M

G8483 Flu imm no ord/admin doc rea M

G8484 Flu immunize no order/admin M

G8485 "Report, Diabetes measures" M

G8486 "Report, Prev Care Measures" M

G8487 Report CKD Measures M

G8489 CAD measures grp M

G8490 RA measures grp M

G8491 HIV/AIDS measures grp M

G8492 Periop Care measures grp M

G8493 Back pain measures grp M

G8494 DM meas qual act perform M

G8495 CKD meas qual act perform M

G8496 Prev Care MG qual act perfrm M

G8497 CABG meas qual act perform M

G8498 CAD meas qual act perform M

G8499 RA meas qual act perform M

G8500 HIV meas qual act perform M

G8501 Perio meas qual act perform MG8502 Back Pain MG qual act perfrm M

G8506 Pt rec ACE/ARB M

G8508 Pt inelig; pain asses no f/u M

G8509 Pain assess no f/u pln doc M

G8510 Pt inelig neg scrn depres M

G8511 Clin depres scrn no f/u doc M

G8524 Patch closure conv CEA M

G8525 No patch closure CEA M

G8526 No patch closure conv CEA M

G8530 Auto AV fistula recd M

G8531 Pt inelig; auto AV fistula M

G8532 No auto AV fistula; no reas M

G8534 Doc elder mal scrn f/u plan M

G8535 Pt inelig no eld mal scrn M

G8536 No doc elder mal scrn M

G8537 Pt inelig eldmal scrn no f/u M

G8538 Eld mal scrn no f/u pln M

G8539 Cur funct assess & care pln M

G8540 Pt inelig funct assess M

G8541 No doc cur funct assess M

G8542 Pt inelig func asses no pln M

G8543 Cur funct asses; no care pln MG8544 CABG measures grp M

G8545 HepC measures grp M

G8546 CAP measures grp M

G8547 IVD measures grp M

G8548 HF measures grp M

G8549 HepC MG qual act perform M

G8550 CAP MG qual act perform M

G8551 HF MG qual act perform M

G8552 IVD MG qual act perform M

G8553 1 Rx via qualified eRx sys M

G8556 Ref to doc otolog eval M

G8557 Pt inelig ref otolog eval M

G8558 No ref to doc otolog eval M

G8559 Pt ref doc oto eval M

G8560 Pt hx act drain prev 90 days M

G8561 Pt inelig for ref oto eval M

G8562 Pt no hx act drain 90 d M

G8563 Pt no ref oto reas no spec M

G8564 Pt ref oto eval M

G8565 Ver doc hear loss M

G8566 Pt inelig ref oto eval M

G8567 Pt no doc hear loss MG8568 Pt no ref otolo no spec M

G8569 Prol intubation req M

G8570 No prol intub req M

G8571 Ster wd ifx 30 d postop M

G8572 No ster wd ifx M

G8573 Stk/CVA CABG M

G8574 No strk/CVA CABG M

G8575 Postop ren insuf M

G8576 No postop ren insuf M

G8577 Reop req bld grft oth M

G8578 No reop req bld grft oth M

G8579 Antplt med disch M

G8580 Antplt med contraind M

G8581 no antplt med disch M

G8582 Bblock disch M

G8583 Bblock contraind M

G8584 No bblock disch M

G8585 Antilipid treat disch M

G8586 Antlip disch contra M

G8587 No antlipid treat disch M

G8588 Sys BP <140 M

G8589 Sys BP >= 140 MG8590 Dia BP < 90 M

G8591 Dia BP >= 90 M

G8592 No BP measure M

G8593 Lipid pn results M

G8594 No lipid prof perf M

G8595 Ldl < 100 M

G8596 No LDL perf M

G8597 Ldl >= 100 M

G8598 Asp therp used M

G8599 No asp therp used M

G8600 tPA initi w/in 3 hrs M

G8601 No elig tPA init w/in 3 hrs M

G8602 No tPA init w/in 3 hrs M

G8603 Spok lang comp score M

G8604 No high score spok lang M

G8605 No spok lang comp score M

G8606 Attention score M

G8607 No high score attention M

G8608 No attention score M

G8609 Memory score M

G8610 No high score memory M

G8611 No memory score MG8612 Moto speech score M

G8613 No high score moto speech M

G8614 No moto speech score M

G8615 Reading score M

G8616 No high score reading M

G8617 No reading score M

G8618 Spok lang exp score M

G8619 No high score spok lang exp M

G8620 No spok lang exp score M

G8621 Writing score M

G8622 No high score writing M

G8623 No writing score M

G8624 Swallowing score M

G8625 No high score swallowing M

G8626 No swallowing score M

G8627 Surg proc w/in 30 days M

G8628 No surg proc w/in 30 days M

G8629 Doc antibio order b/4 surg M

G8630 Doc antibio given b/4 surg M

G8631 Pt no elg 4 order antbi give M

G8632 Doc no antibi order b/4 surg M

G8633 Pharm ther osteo rx MG8634 Pt no elg phar ther osteo M

G8635 No pharm ther osteo rx M

G8636 Flu immun admin/prev rec M

G8637 Pt no elg receiv flu immun M

G8638 Flu immun no admin/prev rec M

G8639 Flu immun admin or prev rec M

G8640 Pt no elg rec flu immun M

G8641 Flu immun not admin/pre rec M

G8642 Hrdshp rural w/o internet M

G8643 Hrdshp w/o suff pharm w/eRx M

G8644 EP no prescribe priv M

G8645 Asthma measures grp M

G8646 Asthma MG qual act perform M

G8647 Fun stat score knee >= 0 M

G8648 Fun stat score knee < 0 M

G8649 Fun stat score knee pt noelg M

G8650 Fun stat score knee not done M

G8651 Fun stat score hip >= 0 M

G8652 Fun stat score hip < 0 M

G8653 Fun stat score hip pt no elg M

G8654 Fun stat score hip not done M

G8655 Fun stat score LE >= 0 MG8656 Fun stat score LE < 0 M

G8657 Fun stat score LE pt no elg M

G8658 Fun stat score LE not done M

G8659 Fun stat score LS >= 0 M

G8660 Fun stat score LS < 0 M

G8661 Fun stat score LS pt no elg M

G8662 Fun stat score LS not done M

G8663 Fun stat score shdl >=0 M

G8664 Fun stat score shdl < 0 M

G8665 Fun stat score shdl pt no elg M

G8666 Fun stat score shdl not done M

G8667 Fun stat score UE >=0 M

G8668 Fun stat score UE < 0 M

G8669 Fun stat score UE pt no elg M

G8670 Fun stat score UE not done M

G8671 Fun stat score neck/TS >=0 M

G8672 Fun stat score neck/TS < 0 M

G8673 Fun stat scor nek/TS pt no elg M

G8674 Fun stat scor nek/TS not don M

G8675 BP Syst >= 140 mmHg M

G8676 BP Diast >= 90 mmHg M

G8677 BP Syst < 130 mmHg MG8678 BP Syst >=130 - 139 mmHg M

G8679 BP Diast < 80 mmHg M

G8680 BP Diast 80-89 mmHg M

G8681 Pt hosp w/HF M

G8682 LVG test perf M

G8683 Pt not elig for LVF test M

G8684 Pt not hosp w/HF M

G8685 LVF test not perf M

G8686 Toba smkr curr or 2 hand exp M

G8687 No tob smkr cur no 2 hnd exp M

G8688 Smkls tob cur; no 2 hnd exp M

G8689 Toba use not assess M

G8690 Curr toba smkr or 2 hand exp M

G8691 No cur tob smkr no 2 hnd exp M

G8692 Curr smkls tob; no 2 hnd exp M

G8693 Tobacco no assess M

G9001 "MCCD, initial

rate" B

G9002 "MCCD,maintenance

rate" B

G9003 "MCCD, risk adj hi,

initial" B

G9004 "MCCD, risk adj lo,

initial" B

G9005 "MCCD, risk adj,

maintenance" B

G9006 "MCCD, Home

monitoring" BG9007 "MCCD, sch team

conf" B

G9008 "Mccd,phys coor-care

ovrsght" B

G9009 "MCCD, risk adj, level

3" B

G9010 "MCCD, risk adj, level

4" B

G9011 "MCCD, risk adj, level

5" B

G9012 Other Specified Case

Mgmt B

G9013 ESRD demo bundle level

I E

G9014 ESRD demo bundle-level

II E

G9016 Demo-smoking cessation

coun E

G9017 Amantadine HCL 100mg

oral A

G9018 "Zanamivir,inhalation pwd

10m" A

G9019 Oseltamivir phosphate

75mg A

G9020 Rimantadine HCL 100mg

oral A

G9033 Amantadine HCL oral

brand A

G9034 "Zanamivir, inh pwdr,

brand" A

G9035 "Oseltamivir phosp,

brand" A

G9036 "Rimantadine HCL,

brand" A

G9041 Low vision rehab occupationa A

G9042 Low vision rehab orient/mobi A

G9043 Low vision lowvision therapi A

G9044 Low vision rehabilate teache A

G9050 Oncology work-up evaluation EG9051 Oncology tx decision-mgmt E

G9052 Onc surveillance for disease E

G9053 Onc expectant management pt E

G9054 Onc supervision palliative E

G9055 Onc visit unspecified NOS E

G9056 Onc prac mgmt adheres guide E

G9057 Onc pract mgmt differs trial E

G9058 Onc prac mgmt disagree w/gui E

G9059 Onc prac mgmt pt opt alterna E

G9060 Onc prac mgmt dif pt comorb E

G9061 Onc prac cond noadd by guide E

G9062 Onc prac guide differs nos E

G9063 Onc dx nsclc stgI no progres M

G9064 Onc dx nsclc stg2 no progres M

G9065 Onc dx nsclc stg3A no progre M

G9066 Onc dx nsclc stg3B-4 metasta M

G9067 Onc dx nsclc dx unknown nos M

G9068 Onc dx sclc/nsclc limited M

G9069 Onc dx sclc/nsclc ext at dx M

G9070 Onc dx sclc/nsclc ext unknwn M

G9071 "Onc dx brst stg1-2B HR,nopro" M

G9072 Onc dx brst stg1-2 noprogres MG9073 "Onc dx brst stg3-HR, no pro" M

G9074 Onc dx brst stg3-noprogress M

G9075 Onc dx brst metastic/ recur M

G9077 Onc dx prostate T1no progres M

G9078 Onc dx prostate T2no progres M

G9079 Onc dx prostate T3b-T4noprog M

G9080 Onc dx prostate w/rise PSA M

G9083 Onc dx prostate unknwn nos M

G9084 "Onc dx colon t1-3,n1-2,no pr" M

G9085 "Onc dx colon T4, N0 w/o prog" M

G9086 Onc dx colon T1-4 no dx prog M

G9087 Onc dx colon metas evid dx M

G9088 Onc dx colon metas noevid dx M

G9089 Onc dx colon extent unknown M

G9090 Onc dx rectal T1-2 no progr M

G9091 Onc dx rectal T3 N0 no prog M

G9092 "Onc dx rectal T1-3,N1-2noprg" M

G9093 "Onc dx rectal T4,N,M0 no prg" M

G9094 Onc dx rectal M1 w/mets prog M

G9095 Onc dx rectal extent unknwn M

G9096 Onc dx esophag T1-T3 noprog M

G9097 Onc dx esophageal T4 no prog MG9098 Onc dx esophageal mets recur M

G9099 Onc dx esophageal unknown M

G9100 Onc dx gastric no recurrence M

G9101 Onc dx gastric p R1-R2noprog M

G9102 Onc dx gastric unresectable M

G9103 Onc dx gastric recurrent M

G9104 Onc dx gastric unknown NOS M

G9105 Onc dx pancreatc p R0 res no M

G9106 Onc dx pancreatc p R1/R2 no M

G9107 Onc dx pancreatic unresectab M

G9108 Onc dx pancreatic unknwn NOS M

G9109 Onc dx head/neck T1-T2no prg M

G9110 Onc dx head/neck T3-4 noprog M

G9111 Onc dx head/neck M1 mets rec M

G9112 Onc dx head/neck ext unknown M

G9113 Onc dx ovarian stg1A-B no pr M

G9114 Onc dx ovarian stg1A-B or 2 M

G9115 Onc dx ovarian stg3/4 noprog M

G9116 Onc dx ovarian recurrence M

G9117 Onc dx ovarian unknown NOS M

G9123 Onc dx CML chronic phase M

G9124 Onc dx CML acceler phase MG9125 Onc dx CML blast phase M

G9126 Onc dx CML remission M

G9128 Onc dx multi myeloma stage I M

G9129 Onc dx mult myeloma stg2 hig M

G9130 Onc dx multi myeloma unknown M

G9131 Onc dx brst unknown NOS M

G9132 Onc dx prostate mets no cast M

G9133 Onc dx prostate clinical met M

G9134 Onc NHLstg 1-2 no relap no M

G9135 Onc dx NHL stg 3-4 not relap M

G9136 Onc dx NHL trans to lg Bcell M

G9137 Onc dx NHL relapse/refractor M

G9138 Onc dx NHL stg unknown M

G9139 Onc dx CML dx status unknown M

G9140 Frontier extended stay demo A

G9141 "Influenza A H1N1,admin w

cou" S 0350 0.3780 $26.24 $0.00 $0.00

G9142 "Influenza A H1N1,

vaccine" E

G9143 Warfarin respon genetic test A

G9147 Outpt IV insulin tx any

mea E

J0120 Tetracyclin injection N

J0129 Abatacept injection K

9230 $20.26

. $4.06

J0130 Abciximab

injection K 1605 $515.32

. $103.07J0132 Acetylcysteine

injection K 1272 $2.67

. $0.54

J0133 Acyclovir injection N

J0135 Adalimumab

injection K 1083 $394.16

. $78.84

J0150 Injection adenosine 6 MG N

J0152 Adenosine

injection K 0917 $89.99

. $18.00

J0171 Adrenalin epinephrine

inject N

J0180 Agalsidase beta

injection K 9208 $133.65

. $26.73

J0190 Inj biperiden lactate/5

mg E

J0200 Alatrofloxacin

mesylate N

J0205 Alglucerase

injection K 0900 $41.19

. $8.24

J0207 Amifostine K 7000 $314.05

. $62.81

J0210 Methyldopate hcl

injection K 2210 $39.24

. $7.85

J0215 Alefacept K

1633 $35.86

. $7.18

J0220 Alglucosidase alfa injection K

9234 $155.84

. $31.17

J0256 Alpha 1 proteinase

inhibitor K 0901 $3.79

. $0.76

J0270 Alprostadil for

injection B

J0275 Alprostadil urethral

suppos B

J0278 Amikacin sulfate injection N

J0280 Aminophyllin 250 MG

inj NJ0282 Amiodarone

HCl N

J0285 Amphotericin B N

J0287 Amphotericin b lipid

complex K 9024 $8.76

. $1.76

J0288 Ampho b cholesteryl

sulfate K 0735 $13.74

. $2.75

J0289 Amphotericin b liposome

inj K 0736 $14.77

. $2.96

J0290 Ampicillin 500 MG

inj N

J0295 Ampicillin sodium per 1.5

gm N

J0300 Amobarbital 125 MG inj CH

K 1341 $23.38

. $4.68

J0330 Succinycholine chloride

inj N

J0348 Anidulafungin

injection K 1349 $1.29

. $0.26

J0350 Injection anistreplase 30 u E

J0360 Hydralazine hcl

injection N

J0364 Apomorphine

hydrochloride N

J0365 "Aprotonin, 10,000

kiu" N

J0380 Inj metaraminol bitartrate N

J0390 Chloroquine

injection N

J0395 Arbutamine hcl injection E

J0400 Aripiprazole injection N

J0456 Azithromycin N

J0461 Atropine sulfate

injection N

J0470 Dimecaprol

injection N

J0475 Baclofen 10 MGinjection K 9032 $200.54

. $40.11

J0476 Baclofen intrathecal trial K

1631 $72.18

. $14.44

J0480 Basiliximab K

1683 "$2,027.27"

. $405.46

J0500 Dicyclomine

injection N

J0515 Inj benztropine mesylate CH

N

J0520 Bethanechol chloride

inject N

J0558 PenG benzathine/procaine

inj N

J0561 Penicillin g benzathine

inj N

J0583 Bivalirudin K

3041 $2.54

. $0.51

J0585 "Injection,onabotulinumtoxinA" K 0902 $5.38

. $1.08

J0586 AbobotulinumtoxinA K 1289 $7.41

. $1.49

J0587 "Inj,

rimabotulinumtoxinB" K 9018 $10.33

. $2.07

J0592 Buprenorphine

hydrochloride N

J0594 Busulfan

injection K 1178 $16.29

. $3.26

J0595 Butorphanol tartrate 1

mg N

J0597 "C-1 esterase,

berinert" G 9269 $27.53

. $5.45

J0598 "C-1 esterase,

cinryze" CH K 9251 $43.78

. $8.76

J0600 Edetate calcium disodium

inj K 1274 $192.07

. $38.42

J0610 Calcium gluconate

injection N

J0620 Calcium glycer & lact/10

ML NJ0630 Calcitonin salmon

injection CH N

J0636 Inj calcitriol per 0.1

mcg N

J0637 Caspofungin

acetate K 9019 $12.13

. $2.43

J0638 Canakinumab

injection K 1311 $87.45

. $17.49

J0640 Leucovorin calcium

injection N

J0641 Levoleucovorin

injection CH K 1236 $1.78

. $0.36

J0670 Inj mepivacaine HCL/10

ml N

J0690 Cefazolin sodium

injection N

J0692 Cefepime HCl for

injection N

J0694 Cefoxitin sodium

injection N

J0696 Ceftriaxone sodium

injection N

J0697 Sterile cefuroxime

injection N

J0698 Cefotaxime sodium

injection N

J0702 Betamethasone acet&sod

phosp N

J0706 Caffeine citrate injection N

J0710 Cephapirin sodium

injection N

J0713 Inj ceftazidime per 500

mg N

J0715 Ceftizoxime sodium / 500

MG N

J0718 Certolizumab pegol inj CH

K 9249 $3.99

. $0.80

J0720 Chloramphenicol sodium

injec N

J0725 Chorionic

gonadotropin/1000u NJ0735 Clonidine hydrochloride CH

N

J0740 Cidofovir

injection K 9033 $740.09

. $148.02

J0743 Cilastatin sodium

injection N

J0744 Ciprofloxacin

iv N

J0745 Inj codeine phosphate /30

MG N

J0760 Colchicine

injection N

J0770 Colistimethate sodium

inj N

J0775 "Collagenase, clost hist

inj" G 1340 $37.51

. $7.43

J0780 Prochlorperazine

injection N

J0795 Corticorelin ovine triflutal K

1684 $5.06

. $1.02

J0800 Corticotropin

injection K 1280 "$2,395.22"

. $479.05

J0833 Cosyntropin injection

NOS K 0835 $99.76

. $19.96

J0834 Cosyntropin cortrosyn

inj CH N

J0850 Cytomegalovirus imm IV

/vial K 0903 $922.07

. $184.42

J0878 Daptomycin

injection K 9124 $0.45

. $0.09

J0881 "Darbepoetin alfa, non-esrd" K

1685 $2.98

. $0.60

J0882 "Darbepoetin alfa, esrd

use" A

J0885 "Epoetin alfa, non-esrd" K

1686 $9.57

. $1.92

J0886 Epoetin alfa 1000 units

ESRD A

J0894 Decitabine injection K

9231 $30.71

. $6.15J0895 Deferoxamine mesylate inj N

J0900 Testosterone enanthate

inj N

J0945 Brompheniramine maleate inj CH

N

J1000 Depo-estradiol cypionate

inj N

J1020 Methylprednisolone 20 MG

inj N

J1030 Methylprednisolone 40 MG

inj N

J1040 Methylprednisolone 80 MG

inj N

J1051 Medroxyprogesterone

inj N

J1055 Medrxyprogester acetate

inj E

J1056 MA/EC

contraceptiveinjection E

J1060 Testosterone cypionate 1

ML N

J1070 Testosterone cypionat 100

MG N

J1080 Testosterone cypionat 200

MG N

J1094 Inj dexamethasone

acetate N

J1100 Dexamethasone sodium

phos N

J1110 Inj dihydroergotamine

mesylt N

J1120 Acetazolamid sodium

injectio N

J1160 Digoxin

injection N

J1162 Digoxin immune fab (ovine) K

1687 $583.90

. $116.78

J1165 Phenytoin sodium

injection N

J1170 Hydromorphone

injection N

J1180 Dyphylline

injection NJ1190 Dexrazoxane HCl

injection K 0726 $274.42

. $54.89

J1200 Diphenhydramine hcl

injectio N

J1205 Chlorothiazide sodium inj K

0747 $272.64

. $54.53

J1212 Dimethyl sulfoxide 50% 50 ML K

1221 $82.68

. $16.54

J1230 Methadone

injection N

J1240 Dimenhydrinate

injection N

J1245 Dipyridamole

injection N

J1250 Inj dobutamine HCL/250

mg N

J1260 Dolasetron

mesylate N

J1265 Dopamine injection N

J1267 Doripenem injection N

J1270 "Injection,

doxercalciferol" N

J1290 Ecallantide

injection G 9263 $275.28

. $54.54

J1300 Eculizumab

injection K 9236 $183.71

. $36.75

J1320 Amitriptyline

injection N

J1324 Enfuvirtide

injection N

J1325 Epoprostenol

injection N

J1327 Eptifibatide

injection K 1607 $20.31

. $4.07

J1330 Ergonovine maleate injection N

J1335 Ertapenem

injection N

J1364 Erythro lactobionate /500MG N

J1380 Estradiol valerate 10 MG

inj N

J1410 Inj estrogen conjugate 25

MG K 9038 $94.03

. $18.81

J1430 Ethanolamine oleate 100 mg K

1688 $147.14

. $29.43

J1435 Injection estrone per 1

MG E

J1436 Etidronate disodium

inj N

J1438 Etanercept

injection K 1608 $203.01

. $40.61

J1440 Filgrastim 300 mcg

injection K 0728 $238.72

. $47.75

J1441 Filgrastim 480 mcg

injection K 7049 $376.20

. $75.24

J1450 Fluconazole N

J1451 "Fomepizole, 15 mg" K

1689 $6.76

. $1.36

J1452 Intraocular Fomivirsen

na E

J1453 Fosaprepitant injection K

9242 $1.71

. $0.35

J1455 Foscarnet sodium injection CH K

1359 $13.06

. $2.62

J1457 Gallium nitrate injection CH

N

J1458 Galsulfase injection K

9224 $338.26

. $67.66

J1459 Inj IVIG privigen 500 mg K

1214 $34.45

. $6.89

J1460 Gamma globulin 1 CC inj K

3043 $17.91

. $3.59

J1559 Hizentra injection K

1312 $7.15

. $1.43

J1560 Gamma globulin > 10 CC inj K

0933 $179.06

. $35.82

J1561 Gamunex injection K

0948 $36.91

. $7.39

J1562 "Vivaglobin, inj" K

1275 $7.11

. $1.43J1566 "Immune globulin,

powder" K 2731 $30.62

. $6.13

J1568 Octagam

injection K 0943 $55.80

. $11.16

J1569 Gammagard liquid

injection K 0944 $37.67

. $7.54

J1570 Ganciclovir sodium injection CH

K 1343 $62.51

. $12.51

J1571 Hepagam b im

injection K 0946 $57.07

. $11.42

J1572 Flebogamma

injection K 0947 $35.04

. $7.01

J1573 "Hepagam b intravenous,

inj" K 1138 $57.07

. $11.42

J1580 Garamycin gentamicin

inj N

J1590 Gatifloxacin

injection N

J1595 Injection glatiramer acetate K

1015 $95.57

. $19.12

J1599 "Ivig non-lyophilized,

NOS" N

J1600 Gold sodium thiomaleate

inj N

J1610 Glucagon hydrochloride/1

MG K 9042 $95.59

. $19.12

J1620 Gonadorelin hydroch/ 100 mcg CH

K 1344 $94.82

. $18.97

J1626 Granisetron hcl

injection N

J1630 Haloperidol

injection N

J1631 Haloperidol decanoate

inj N

J1640 "Hemin, 1 mg" K

1690 $8.33

. $1.67

J1642 Inj heparin sodium per 10

u N

J1644 Inj heparin sodium per

1000u NJ1645 Dalteparin

sodium N

J1650 Inj enoxaparin

sodium N

J1652 Fondaparinux

sodium N

J1655 Tinzaparin sodium

injection N

J1670 Tetanus immune globulin

inj K 1670 $222.97

. $44.60

J1675 Histrelin

acetate B

J1680 Human fibrinogen conc

inj CH K 1290 $71.52

. $14.31

J1700 Hydrocortisone acetate

inj N

J1710 Hydrocortisone sodium ph

inj N

J1720 Hydrocortisone sodium succ

i N

J1730 Diazoxide injection CH

N

J1740 Ibandronate sodium

injection K 9229 $144.36

. $28.88

J1742 Ibutilide fumarate

injection K 9044 $129.32

. $25.87

J1743 Idursulfase

injection K 9232 $446.45

. $89.29

J1745 Infliximab

injection K 7043 $58.90

. $11.78

J1750 Inj iron

dextran K 1237 $11.59

. $2.32

J1756 Iron sucrose injection CH

N

J1786 Imuglucerase

injection K 1327 $41.19

. $8.24

J1790 Droperidol

injection NJ1800 Propranolol

injection N

J1810 Droperidol/fentanyl

inj E

J1815 Insulin

injection N

J1817 Insulin for insulin pump

use N

J1826 Interferon Beta-1A

inj E

J1830 Interferon beta-1b / .25

MG K 0910 $197.14

. $39.43

J1835 Itraconazole injection CH

K 1355 $359.59

. $71.92

J1840 Kanamycin sulfate 500 MG

inj N

J1850 Kanamycin sulfate 75 MG

inj N

J1885 Ketorolac tromethamine

inj N

J1890 Cephalothin sodium

injection N

J1930 Lanreotide

injection K 9237 $29.92

. $5.99

J1931 Laronidase

injection K 9209 $25.08

. $5.02

J1940 Furosemide

injection N

J1945 Lepirudin K

1693 $299.56

. $59.92

J1950 Leuprolide acetate /3.75

MG K 0800 $547.54

. $109.51

J1953 Levetiracetam

injection N

J1955 Inj levocarnitine per 1

gm B

J1956 Levofloxacin

injection N

J1960 Levorphanol tartrate

inj N

J1980 Hyoscyamine sulfate

inj NJ1990 Chlordiazepoxide

injection N

J2001 Lidocaine

injection N

J2010 Lincomycin

injection N

J2020 Linezolid

injection K 9001 $33.99

. $6.80

J2060 Lorazepam

injection N

J2150 Mannitol

injection N

J2170 Mecasermin

injection K 1308 $20.18

. $4.04

J2175 Meperidine hydrochl /100

MG N

J2180 Meperidine/promethazine

inj N

J2185 Meropenem N

J2210 Methylergonovin maleate

inj N

J2248 Micafungin sodium injection K

9227 $1.02

. $0.21

J2250 Inj midazolam

hydrochloride N

J2260 Inj milrinone lactate / 5

MG N

J2270 Morphine sulfate

injection N

J2271 Morphine so4 injection

100mg N

J2275 Morphine sulfate

injection N

J2278 Ziconotide injection K

1694 $6.48

. $1.30

J2280 "Inj, moxifloxacin 100

mg" N

J2300 Inj nalbuphine

hydrochloride N

J2310 Inj naloxone

hydrochloride N

J2315 "Naltrexone, depot form" K0759 $2.77

. $0.56

J2320 Nandrolone decanoate 50 MG CH

N

J2323 Natalizumab injection K

9126 $9.88

. $1.98

J2325 Nesiritide injection K

1695 $43.93

. $8.79

J2353 "Octreotide injection,

depot" K 1207 $113.48

. $22.70

J2354 "Octreotide inj, non-depot" N

J2355 Oprelvekin

injection K 7011 $240.88

. $48.18

J2357 Omalizumab

injection K 9300 $20.64

. $4.13

J2358 Olanzapine long-acting

inj K 1331 $2.70

. $0.54

J2360 Orphenadrine

injection N

J2370 Phenylephrine hcl

injection N

J2400 Chloroprocaine hcl

injection N

J2405 Ondansetron hcl

injection N

J2410 Oxymorphone hcl

injection N

J2425 Palifermin injection K

1696 $11.15

. $2.23

J2426 Paliperidone palmitate inj CH K

9255 $6.45

. $1.29

J2430 Pamidronate disodium /30

MG N

J2440 Papaverin hcl

injection N

J2460 Oxytetracycline

injection E

J2469 Palonosetron

hcl K 9210 $18.51

. $3.71

J2501 Paricalcitol N

J2503 Pegaptanib sodium

injection K 1697 "$1,002.20"

. $200.44J2504 "Pegademase bovine, 25 iu" K

1739 $242.67

. $48.54

J2505 "Injection, pegfilgrastim

6mg" K 9119 "$2,527.87"

. $505.58

J2510 Penicillin g procaine inj CH

N

J2513 Pentastarch 10%

solution K 1222 $158.76

. $31.76

J2515 Pentobarbital sodium

inj N

J2540 Penicillin g potassium

inj N

J2543 Piperacillin/tazobactam N

J2545 Pentamidine non-comp

unit B

J2550 Promethazine hcl

injection N

J2560 Phenobarbital sodium

inj N

J2562 Plerixafor

injection CH K 9252 $278.36

. $55.68

J2590 Oxytocin

injection N

J2597 Inj desmopressin

acetate CH K 1356 $3.93

. $0.79

J2650 Prednisolone acetate

inj N

J2670 Totazoline hcl

injection N

J2675 Inj progesterone per 50

MG N

J2680 Fluphenazine decanoate 25

MG N

J2690 Procainamide hcl

injection N

J2700 Oxacillin sodium

injeciton CH N

J2710 Neostigmine methylslfte

inj NJ2720 Inj protamine sulfate/10

MG N

J2724 Protein c

concentrate K 1139 $12.50

. $2.50

J2725 Inj protirelin per 250

mcg CH K 1357 $27.03

. $5.41

J2730 Pralidoxime chloride inj K

1023 $88.57

. $17.72

J2760 Phentolaine mesylate inj CH K

1358 $56.35

. $11.27

J2765 Metoclopramide hcl

injection N

J2770 Quinupristin/dalfopristin K 2770 $157.23

. $31.45

J2778 Ranibizumab

injection K 9233 $398.10

. $79.62

J2780 Ranitidine hydrochloride

inj N

J2783 Rasburicase K 0738 $183.08

. $36.62

J2785 Regadenoson

injection K 9244 $51.36

. $10.28

J2788 Rho d immune globulin 50

mcg K 9023 $24.81

. $4.97

J2790 Rho d immune globulin

inj K 0884 $82.16

. $16.44

J2791 Rhophylac

injection K 0945 $5.09

. $1.02

J2792 "Rho(D) immune globulin h,

sd" K 1609 $18.83

. $3.77

J2793 Rilonacept

injection K 1291 $23.63

. $4.73

J2794 "Risperidone, long

acting" K 9125 $4.93

. $0.99

J2795 Ropivacaine HCl

injection N

J2796 Romiplostim

injection K 9245 $44.84

. $8.97J2800 Methocarbamol

injection N

J2805 Sincalide injection CH

N

J2810 Inj theophylline per 40

MG N

J2820 Sargramostim

injection K 0731 $23.62

. $4.73

J2850 Inj secretin synthetic human K

1700 $26.97

. $5.40

J2910 Aurothioglucose

injeciton N

J2916 Na ferric gluconate

complex N

J2920 Methylprednisolone

injection N

J2930 Methylprednisolone

injection N

J2940 Somatrem injection CH

E

J2941 Somatropin

injection K 7034 $56.09

. $11.22

J2950 Promazine hcl

injection N

J2993 Reteplase

injection K 9005 "$1,332.35"

. $266.47

J2995 Inj streptokinase /250000

IU K 1226 $47.57

. $9.52

J2997 Alteplase

recombinant K 7048 $39.22

. $7.85

J3000 Streptomycin

injection N

J3010 Fentanyl citrate

injeciton N

J3030 Sumatriptan succinate / 6

MG N

J3070 Pentazocine

injection N

J3095 Telavancin

injection G 9258 $1.96

. $0.39

J3101 Tenecteplaseinjection K 9002 $51.95

. $10.39

J3105 Terbutaline sulfate

inj N

J3110 Teriparatide

injection B

J3120 Testosterone enanthate

inj N

J3130 Testosterone enanthate

inj N

J3140 Testosterone suspension

inj N

J3150 Testosteron propionate

inj N

J3230 Chlorpromazine hcl

injection N

J3240 Thyrotropin

injection K 9108 "$1,034.03"

. $206.81

J3243 Tigecycline

injection K 9228 $1.22

. $0.25

J3246 Tirofiban

HCl K 7041 $8.83

. $1.77

J3250 Trimethobenzamide hcl

inj N

J3260 Tobramycin sulfate

injection N

J3262 Tocilizumab

injection G 9264 $3.47

. $0.69

J3265 Injection torsemide 10

mg/ml N

J3280 Thiethylperazine maleate

inj N

J3285 Treprostinil injection K

1701 $60.08

. $12.02

J3300 Triamcinolone A inj PRS-free K

1253 $3.17

. $0.64

J3301 Triamcinolone acet inj

NOS N

J3302 Triamcinolone diacetate

inj N

J3303 Triamcinolone hexacetonl

inj NJ3305 Inj trimetrexate glucoronate CH

E

J3310 Perphenazine

injeciton K 1304 $30.91

. $6.19

J3315 Triptorelin

pamoate K 9122 $193.59

. $38.72

J3320 Spectinomycn di-hcl

inj E

J3350 Urea

injection K 1306 $82.18

. $16.44

J3355 "Urofollitropin, 75 iu" K

1741 $63.60

. $12.72

J3357 Ustekinumab

injection G 9261 $112.30

. $22.25

J3360 Diazepam

injection N

J3364 Urokinase 5000 IU

injection N

J3365 "Urokinase 250,000 IU

inj" K 7036 $449.09

. $89.82

J3370 Vancomycin hcl

injection N

J3385 Velaglucerase

alfa G 9271 $349.88

. $69.32

J3396 Verteporfin

injection K 1203 $9.55

. $1.91

J3400 Triflupromazine hcl

inj E

J3410 Hydroxyzine hcl

injection N

J3411 Thiamine hcl 100

mg N

J3415 Pyridoxine hcl 100

mg N

J3420 Vitamin b12

injection N

J3430 Vitamin k phytonadione

inj N

J3465 "Injection,

voriconazole" K 1052 $6.02

. $1.21J3470 Hyaluronidase

injection N

J3471 "Ovine, up to 999 USP

units" N

J3472 "Ovine, 1000 USP

units" N

J3473 Hyaluronidase

recombinant N

J3475 Inj magnesium

sulfate N

J3480 Inj potassium

chloride N

J3485 Zidovudine N

J3486 Ziprasidone

mesylate N

J3487 Zoledronic

acid K 9115 $219.00

. $43.80

J3488 Reclast

injection K 0951 $218.47

. $43.70

J3490 Drugs unclassified

injection N

J3520 Edetate disodium per 150

mg E

J3530 Nasal vaccine

inhalation N

J3535 Metered dose inhaler

drug E

J3570 Laetrile amygdalin vit

B17 E

J3590 Unclassified

biologics N

J7030 Normal saline solution

infus N

J7040 Normal saline solution

infus N

J7042 5% dextrose/normal

saline N

J7050 Normal saline solution

infus N

J7060 5%

dextrose/water NJ7070 D5w

infusion N

J7100 Dextran 40

infusion N

J7110 Dextran 75

infusion N

J7120 Ringers lactate

infusion N

J7130 Hypertonic saline

solution N

J7184 Wilate

injection G 9267 $70.14

. $13.90

J7185 Xyntha

inj K 1268 $1.05

. $0.21

J7186 Antihemophilic viii/vwf comp K

1213 $0.90

. $0.18

J7187 "Humate-P, inj" K

1704 $0.87

. $0.18

J7189 Factor viia K

1705 $1.50

. $0.30

J7190 Factor

viii K 0925 $0.87

. $0.18

J7191 Factor VIII

(porcine) K 1279 $1.17

. $0.24

J7192 Factor viii recombinant

NOS K 0927 $1.09

. $0.22

J7193 Factor IX

non-recombinant K 0931 $0.88

. $0.18

J7194 Factor ix

complex K 0928 $0.85

. $0.17

J7195 Factor IX

recombinant K 0932 $1.13

. $0.23

J7196 Antithrombin

recombinant K 1332 $101.40

. $20.28

J7197 Antithrombin iii

injection K 1263 $2.48

. $0.50

J7198 Anti-inhibitor K 0929 $1.57

. $0.32

J7199 Hemophilia clot factor

noc BJ7300 Intraut copper

contraceptive E

J7302 Levonorgestrel iu

contracept E

J7303 Contraceptive vaginal

ring E

J7304 Contraceptive hormone

patch E

J7306 Levonorgestrel implant

sys E

J7307 Etonogestrel implant

system E

J7308 Aminolevulinic acid hcl

top K 7308 $138.70

. $27.74

J7309 "Methyl aminolevulinate,

top" K 1338 $68.27

. $13.66

J7310 Ganciclovir long act

implant K 0913 "$16,640.00"

. "$3,328.00"

J7311 Fluocinolone acetonide

implt K 9225 "$18,980.00"

. "$3,796.00"

J7312 Dexamethasone intra

implant CH K 9256 $194.17

. $38.84

J7321 Hyalgan/supartz inj per

dose K 0873 $88.80

. $17.76

J7323 Euflexxa inj per

dose K 0875 $147.16

. $29.44

J7324 Orthovisc inj per

dose K 0877 $167.00

. $33.40

J7325 Synvisc or

Synvisc-One K 0874 $11.81

. $2.37

J7330 Cultured chondrocytes

implnt B

J7335 Capsaicin 8%

patch G 9268 $25.55

. $5.06

J7500 Azathioprine oral

50mg N

J7501 Azathioprineparenteral K 0887 $104.77

. $20.96

J7502 Cyclosporine oral 100

mg N

J7504 Lymphocyte immune

globulin K 0890 $542.36

. $108.48

J7505 Monoclonal

antibodies K 7038 "$1,112.14"

. $222.43

J7506 Prednisone

oral N

J7507 Tacrolimus oral per 1

MG N

J7509 Methylprednisolone

oral N

J7510 Prednisolone oral per 5

mg N

J7511 Antithymocyte globuln

rabbit K 9104 $387.17

. $77.44

J7513 "Daclizumab,

parenteral" K 1612 $516.41

. $103.29

J7515 Cyclosporine oral 25

mg N

J7516 Cyclosporin parenteral

250mg N

J7517 Mycophenolate mofetil

oral N

J7518 Mycophenolic acid N

J7520 "Sirolimus, oral" N

J7525 Tacrolimus

injection K 9006 $136.85

. $27.37

J7599 Immunosuppressive drug

noc N

J7604 Acetylcysteine comp unit M

J7605 Arformoterol non-comp unit M

J7606 "Formoterol fumarate, inh" M

J7607 Levalbuterol comp con MJ7608 Acetylcysteine non-comp unit M

J7609 Albuterol comp unit M

J7610 Albuterol comp con M

J7611 Albuterol non-comp con M

J7612 Levalbuterol non-comp con M

J7613 Albuterol non-comp unit M

J7614 Levalbuterol non-comp unit M

J7615 Levalbuterol comp unit M

J7620 Albuterol ipratrop non-comp M

J7622 Beclomethasone comp unit M

J7624 Betamethasone comp unit M

J7626 Budesonide non-comp unit M

J7627 Budesonide comp unit M

J7628 Bitolterol mesylate comp con M

J7629 Bitolterol mesylate comp unt M

J7631 Cromolyn sodium noncomp unit M

J7632 Cromolyn sodium comp unit M

J7633 Budesonide non-comp con M

J7634 Budesonide comp con M

J7635 Atropine comp con M

J7636 Atropine comp unit M

J7637 Dexamethasone comp con MJ7638 Dexamethasone comp unit M

J7639 Dornase alfa non-comp unit M

J7640 Formoterol comp unit

E

J7641 Flunisolide comp unit M

J7642 Glycopyrrolate comp con M

J7643 Glycopyrrolate comp unit M

J7644 Ipratropium bromide non-comp M

J7645 Ipratropium bromide comp M

J7647 Isoetharine comp con M

J7648 Isoetharine non-comp con M

J7649 Isoetharine non-comp unit M

J7650 Isoetharine comp unit M

J7657 Isoproterenol comp con M

J7658 Isoproterenol non-comp con M

J7659 Isoproterenol non-comp unit M

J7660 Isoproterenol comp unit M

J7667 Metaproterenol comp con M

J7668 Metaproterenol non-comp con M

J7669 Metaproterenol non-comp unit M

J7670 Metaproterenol comp unit M

J7674 "Methacholine chloride,

neb" N

J7676 Pentamidine comp unit dose MJ7680 Terbutaline sulf comp con M

J7681 Terbutaline sulf comp unit M

J7682 Tobramycin non-comp unit M

J7683 Triamcinolone comp con M

J7684 Triamcinolone comp unit M

J7685 Tobramycin comp unit M

J7686 "Treprostinil, non-comp

unit" M

J7699 Inhalation solution for DME M

J7799 Non-inhalation drug for DME N

J8498 Antiemetic rectal/supp

NOS B

J8499 Oral prescrip drug non

chemo E

J8501 Oral

aprepitant K 0868 $5.90

. $1.18

J8510 Oral

busulfan K 1307 $3.59

. $0.72

J8515 "Cabergoline, oral

0.25mg" E

J8520 "Capecitabine, oral, 150

mg" K 7042 $6.81

. $1.37

J8521 "Capecitabine, oral, 500

mg" K 0934 $22.48

. $4.50

J8530 Cyclophosphamide oral 25

MG N

J8540 Oral

dexamethasone N

J8560 Etoposide oral 50

MG K 0802 $34.34

. $6.87

J8562 Oral fludarabine

phosphate G 1339 $79.44

. $15.74

J8565 Gefitiniboral E

J8597 Antiemetic drug oral

NOS N

J8600 Melphalan oral 2

MG N

J8610 Methotrexate oral 2.5

MG N

J8650 Nabilone oral CH

E

J8700 Temozolomide K 1086 $9.31

. $1.87

J8705 Topotecan oral CH

K 1238 $76.40

. $15.28

J8999 Oral prescription drug

chemo B

J9000 Doxorubicin hcl injection N

J9001 Doxorubicin hcl liposome

inj K 7046 $504.27

. $100.86

J9010 Alemtuzumab

injection K 9110 $577.60

. $115.52

J9015 Aldesleukin

injection K 0807 $915.45

. $183.09

J9017 Arsenic trioxide

injection K 9012 $40.13

. $8.03

J9020 Asparaginase

injection K 0814 $62.07

. $12.42

J9025 Azacitidine

injection K 1709 $5.16

. $1.04

J9027 Clofarabine

injection K 1710 $114.37

. $22.88

J9031 Bcg live intravesical

vac K 0809 $114.38

. $22.88

J9033 Bendamustine

injection K 9243 $18.15

. $3.63

J9035 Bevacizumab

injection K 9214 $58.72

. $11.75J9040 Bleomycin sulfate injection N

J9041 Bortezomib

injection K 9207 $39.60

. $7.92

J9045 Carboplatin injection N

J9050 Carmustine

injection K 0812 $172.56

. $34.52

J9055 Cetuximab

injection K 9215 $49.52

. $9.91

J9060 Cisplatin 10 MG

injection N

J9065 Inj cladribine per 1

MG K 0858 $23.59

. $4.72

J9070 Cyclophosphamide 100 MG

inj N

J9098 Cytarabine liposome

inj K 1166 $479.02

. $95.81

J9100 Cytarabine hcl 100 MG

inj N

J9120 Dactinomycin injection K

0752 $529.42

. $105.89

J9130 Dacarbazine 100 mg inj N

J9150 Daunorubicin

injection K 0820 $13.16

. $2.64

J9151 Daunorubicin citrate

inj K 0821 $56.58

. $11.32

J9155 Degarelix injection CH

K 1296 $2.79

. $0.56

J9160 Denileukin diftitox

inj K 1084 "$1,559.54"

. $311.91

J9165 Diethylstilbestrol injection CH

E

J9171 Docetaxel

injection K 0823 $20.84

. $4.17

J9175 Elliotts b solution per ml N

J9178 "Inj, epirubicin hcl, 2mg" K 1167 $1.87

. $0.38

J9181 Etoposide injection N

J9185 Fludarabine phosphate inj CH N

J9190 Fluorouracil

injection N

J9200 Floxuridine

injection K 0827 $36.60

. $7.32

J9201 Gemcitabine hcl

injection K 0828 $111.40

. $22.28

J9202 Goserelin acetate

implant K 0810 $195.16

. $39.04

J9206 Irinotecan injection CH

N

J9207 Ixabepilone

injection K 9240 $62.53

. $12.51

J9208 Ifosfomide

injection K 0831 $31.21

. $6.25

J9209 Mesna

injection N

J9211 Idarubicin hcl

injection K 0832 $46.43

. $9.29

J9212 Interferon alfacon-1 inj CH

N

J9213 Interferon alfa-2a inj CH

E

J9214 Interferon alfa-2b

inj K 0836 $16.19

. $3.24

J9215 Interferon alfa-n3

inj K 0865 $20.87

. $4.18

J9216 Interferon gamma 1-b

inj K 0838 $549.62

. $109.93

J9217 Leuprolide acetate

suspnsion K 9217 $210.96

. $42.20

J9218 Leuprolide acetate

injeciton K 0861 $4.88

. $0.98

J9219 Leuprolide acetateimplant K 7051 "$4,728.88"

. $945.78

J9225 Vantas

implant K 1711 "$3,223.57"

. $644.72

J9226 Supprelin LA

implant K 1142 "$15,184.53"

. "$3,036.91"

J9230 Mechlorethamine hcl

inj K 0751 $154.88

. $30.98

J9245 Inj melphalan hydrochl 50

MG K 0840 "$1,272.01"

. $254.41

J9250 Methotrexate sodium

inj N

J9260 Methotrexate sodium

inj N

J9261 Nelarabine injection

K 0825 $110.19

. $22.04

J9263 Oxaliplatin K 1738 $8.36

. $1.68

J9264 Paclitaxel protein

bound K 1712 $9.21

. $1.85

J9265 Paclitaxel injection CH

N

J9266 Pegaspargase injection

K 0843 "$2,675.40"

. $535.08

J9268 Pentostatin

injection K 0844 "$1,068.16"

. $213.64

J9270 Plicamycin (mithramycin)

inj N

J9280 Mitomycin 5 MG

inj K 1232 $20.36

. $4.08

J9293 Mitoxantrone hydrochl / 5

MG K 0864 $33.95

. $6.79

J9300 Gemtuzumab ozogamicin

inj K 9004 "$2,637.02"

. $527.41

J9302 Ofatumumab

injection G 9260 $45.41

. $9.00

J9303 Panitumumab

injection K 9235 $85.62

. $17.13J9305 Pemetrexed

injection K 9213 $51.37

. $10.28

J9307 Pralatrexate

injection G 9259 $165.63

. $32.81

J9310 Rituximab

injection K 0849 $599.16

. $119.84

J9315 Romidepsin

injection G 9265 $219.30

. $43.45

J9320 Streptozocin

injection K 0850 $264.81

. $52.97

J9328 Temozolomide

injection CH K 9253 $4.86

. $0.98

J9330 Temsirolimus

injection K 1168 $49.87

. $9.98

J9340 Thiotepa

injection K 0851 $106.54

. $21.31

J9351 Topotecan

injection K 1350 $19.30

. $3.86

J9355 Trastuzumab

injection K 1613 $69.06

. $13.82

J9357 Valrubicin

injection K 1235 $946.64

. $189.33

J9360 Vinblastine sulfate

inj N

J9370 Vincristine sulfate 1 MG

inj N

J9390 Vinorelbine tartrate

inj N

J9395 "Injection,

Fulvestrant" K 9120 $81.81

. $16.37

J9600 Porfimer sodium

injection K 0856 "$3,017.82"

. $603.57

J9999 Chemotherapy

drug N

K0001 Standardwheelchair Y

K0002 Stnd hemi (low seat)

whlchr Y

K0003 Lightweight

wheelchair Y

K0004 High strength ltwt

whlchr Y

K0005 Ultralightweight

wheelchair Y

K0006 Heavy duty

wheelchair Y

K0007 Extra heavy duty

wheelchair Y

K0009 Other manual

wheelchair/base Y

K0010 Stnd wt frame power

whlchr Y

K0011 Stnd wt pwr whlchr w

control Y

K0012 Ltwt portbl power

whlchr Y

K0014 Other power whlchr

base Y

K0015 Detach non-adjus hght

armrst Y

K0017 Detach adjust armrest

base Y

K0018 Detach adjust armrst

upper Y

K0019 Arm pad

each Y

K0020 Fixed adjust armrest

pair Y

K0037 High mount flip-up

footrest Y

K0038 Leg strap

each Y

K0039 Leg strap h style

each Y

K0040 Adjustable angle

footplate Y

K0041 Large size footplate

each Y

K0042 Standard size footplateeach Y

K0043 Ftrst lower extension

tube Y

K0044 Ftrst upper hanger

bracket Y

K0045 Footrest complete

assembly Y

K0046 Elevat legrst low

extension Y

K0047 Elevat legrst up hangr

brack Y

K0050 Ratchet

assembly Y

K0051 Cam relese assem

ftrst/lgrst Y

K0052 Swingaway detach

footrest Y

K0053 Elevate footrest

articulate Y

K0056 Seat ht <17 or >=21 ltwt

wc Y

K0065 Spoke

protectors Y

K0069 Rear whl complete solid

tire Y

K0070 Rear whl compl pneum

tire Y

K0071 Front castr compl pneum

tire Y

K0072 Frnt cstr cmpl sem-pneum

tir Y

K0073 Caster pin lock

each Y

K0077 Front caster assem

complete Y

K0098 Drive belt power

wheelchair Y

K0105 Iv hanger Y

K0108 W/c component-accessory

NOS Y

K0195 Elevating whlchair leg

rests Y

K0455 Pump uninterruptedinfusion Y

K0462 Temporary replacement

eqpmnt Y

K0552 Supply/ext inf pump syr

type Y

K0601 Repl batt silver oxide 1.5

v Y

K0602 Repl batt silver oxide 3 v

Y

K0603 Repl batt alkaline 1.5

v Y

K0604 Repl batt lithium 3.6

v Y

K0605 Repl batt lithium 4.5

v Y

K0606 AED garment w elec

analysis Y

K0607 Repl batt for

AED Y

K0608 Repl garment for

AED Y

K0609 Repl electrode for

AED Y

K0669 Seat/back cus no dmepdac

ver Y

K0672 Removable soft interface LE A

K0730 Ctrl dose inh drug deliv sys Y

K0733 12-24hr sealed lead acid Y

K0738 Portable gas oxygen system Y

K0739 Repair/svc DME non-oxygen eq Y

K0740 Repair/svc oxygen

equipment E

K0800 POV group 1 std up to 300lbs Y

K0801 POV group 1 hd 301-450 lbs Y

K0802 POV group 1 vhd 451-600 lbs Y

K0806 POV group 2 std up to 300lbs YK0807 POV group 2 hd 301-450 lbs Y

K0808 POV group 2 vhd 451-600 lbs Y

K0812 Power operated vehicle NOC Y

K0813 PWC gp 1 std port seat/back Y

K0814 PWC gp 1 std port cap chair Y

K0815 PWC gp 1 std seat/back Y

K0816 PWC gp 1 std cap chair Y

K0820 PWC gp 2 std port seat/back Y

K0821 PWC gp 2 std port cap chair Y

K0822 PWC gp 2 std seat/back Y

K0823 PWC gp 2 std cap chair Y

K0824 PWC gp 2 hd seat/back Y

K0825 PWC gp 2 hd cap chair Y

K0826 PWC gp 2 vhd seat/back Y

K0827 PWC gp vhd cap chair Y

K0828 PWC gp 2 xtra hd seat/back Y

K0829 PWC gp 2 xtra hd cap chair Y

K0830 PWC gp2 std seat elevate s/b Y

K0831 PWC gp2 std seat elevate cap Y

K0835 PWC gp2 std sing pow opt s/b Y

K0836 PWC gp2 std sing pow opt cap Y

K0837 PWC gp 2 hd sing pow opt s/b YK0838 PWC gp 2 hd sing pow opt cap Y

K0839 PWC gp2 vhd sing pow opt s/b Y

K0840 PWC gp2 xhd sing pow opt s/b Y

K0841 PWC gp2 std mult pow opt s/b Y

K0842 PWC gp2 std mult pow opt cap Y

K0843 PWC gp2 hd mult pow opt s/b Y

K0848 PWC gp 3 std seat/back Y

K0849 PWC gp 3 std cap chair Y

K0850 PWC gp 3 hd seat/back Y

K0851 PWC gp 3 hd cap chair Y

K0852 PWC gp 3 vhd seat/back Y

K0853 PWC gp 3 vhd cap chair Y

K0854 PWC gp 3 xhd seat/back Y

K0855 PWC gp 3 xhd cap chair Y

K0856 PWC gp3 std sing pow opt s/b Y

K0857 PWC gp3 std sing pow opt cap Y

K0858 PWC gp3 hd sing pow opt s/b Y

K0859 PWC gp3 hd sing pow opt cap Y

K0860 PWC gp3 vhd sing pow opt s/b Y

K0861 PWC gp3 std mult pow opt s/b Y

K0862 PWC gp3 hd mult pow opt s/b Y

K0863 PWC gp3 vhd mult pow opt s/b YK0864 PWC gp3 xhd mult pow opt s/b Y

K0868 PWC gp 4 std seat/back Y

K0869 PWC gp 4 std cap chair Y

K0870 PWC gp 4 hd seat/back Y

K0871 PWC gp 4 vhd seat/back Y

K0877 PWC gp4 std sing pow opt s/b Y

K0878 PWC gp4 std sing pow opt cap Y

K0879 PWC gp4 hd sing pow opt s/b Y

K0880 PWC gp4 vhd sing pow opt s/b Y

K0884 PWC gp4 std mult pow opt s/b Y

K0885 PWC gp4 std mult pow opt cap Y

K0886 PWC gp4 hd mult pow s/b Y

K0890 PWC gp5 ped sing pow opt s/b Y

K0891 PWC gp5 ped mult pow opt s/b Y

K0898 Power wheelchair NOC Y

K0899 Pow mobil dev no dmepdac Y

L0112 Cranial cervical

orthosis A

L0113 Cranial cervical

torticollis A

L0120 Cerv flexible

non-adjustable A

L0130 Flex thermoplastic collar

mo A

L0140 Cervical semi-rigid

adjustab A

L0150 Cerv semi-rig adj moldedchn A

L0160 Cerv semi-rig wire

occ/mand A

L0170 Cervical collar molded to

pt A

L0172 Cerv col thermplas foam 2

pi A

L0174 Cerv col foam 2 piece w

thor A

L0180 Cer post col occ/man sup

adj A

L0190 Cerv collar supp adj cerv

ba A

L0200 Cerv col supp adj bar &

thor A

L0220 Thor rib belt custom

fabrica A

L0430 Dewall posture

protector A

L0450 TLSO flex prefab

thoracic A

L0452 tlso flex custom fab

thoraci A

L0454 TLSO flex prefab

sacrococ-T9 A

L0456 TLSO flex

prefab A

L0458 TLSO 2Mod symphis-xipho

pre A

L0460 TLSO2Mod symphysis-stern

pre A

L0462 TLSO 3Mod sacro-scap

pre A

L0464 TLSO 4Mod sacro-scap

pre A

L0466 TLSO rigid frame pre soft

ap A

L0468 TLSO rigid frame prefab

pelv A

L0470 TLSO rigid frame pre

subclav A

L0472 TLSO rigid frame hyperex

pre A

L0480 TLSO rigid plastic customfa A

L0482 TLSO rigid lined custom

fab A

L0484 TLSO rigid plastic cust

fab A

L0486 TLSO rigidlined cust fab

two A

L0488 TLSO rigid lined pre one

pie A

L0490 TLSO rigid plastic pre

one A

L0491 TLSO 2 piece rigid

shell A

L0492 TLSO 3 piece rigid

shell A

L0621 SIO flex pelvisacral

prefab A

L0622 SIO flex pelvisacral

custom A

L0623 SIO panel

prefab A

L0624 SIO panel

custom A

L0625 LO flexibl L1-below L5

pre A

L0626 LO sag stays/panels

pre-fab A

L0627 LO sagitt rigid panel

prefab A

L0628 LO flex w/o rigid stays

pre A

L0629 LSO flex w/rigid stays

cust A

L0630 LSO post rigid panel

pre A

L0631 LSO sag-coro rigid frame

pre A

L0632 LSO sag rigid frame

cust A

L0633 LSO flexion control

prefab A

L0634 LSO flexion control

custom A

L0635 LSO sagit rigid panelprefab A

L0636 LSO sagittal rigid panel

cus A

L0637 LSO sag-coronal panel

prefab A

L0638 LSO sag-coronal panel

custom A

L0639 LSO s/c shell/panel

prefab A

L0640 LSO s/c shell/panel

custom A

L0700 Ctlso a-p-l control

molded A

L0710 Ctlso a-p-l control w/

inter A

L0810 Halo cervical into jckt

vest A

L0820 Halo cervical into body

jack A

L0830 Halo cerv into milwaukee

typ A

L0859 MRI compatible

system A

L0861 Halo repl

liner/interface A

L0970 Tlso corset

front A

L0972 Lso corset

front A

L0974 Tlso full

corset A

L0976 Lso full

corset A

L0978 Axillary crutch

extension A

L0980 Peroneal straps

pair A

L0982 Stocking supp grips set of

f A

L0984 Protective body sock

each A

L0999 Add to spinal orthosis

NOS A

L1000 Ctlso milwauke initialmodel A

L1001 CTLSO infant

immobilizer A

L1005 Tension based scoliosis

orth A

L1010 Ctlso axilla

sling A

L1020 Kyphosis

pad A

L1025 Kyphosis pad

floating A

L1030 Lumbar bolster

pad A

L1040 Lumbar or lumbar rib

pad A

L1050 Sternal

pad A

L1060 Thoracic

pad A

L1070 Trapezius

sling A

L1080 Outrigger A

L1085 Outrigger bil w/ vert

extens A

L1090 Lumbar

sling A

L1100 Ring flange

plastic/leather A

L1110 Ring flange plas/leather

mol A

L1120 Covers for upright

each A

L1200 Furnsh initial orthosis

only A

L1210 Lateral thoracic

extension A

L1220 Anterior thoracic

extension A

L1230 Milwaukee type

superstructur A

L1240 Lumbar derotation

pad A

L1250 Anterior asis

pad AL1260 Anterior thoracic

derotation A

L1270 Abdominal

pad A

L1280 Rib gusset (elastic)

each A

L1290 Lateral trochanteric

pad A

L1300 Body jacket mold to

patient A

L1310 Post-operative body

jacket A

L1499 Spinal orthosis

NOS A

L1500 Thkao mobility

frame A

L1510 Thkao standing

frame A

L1520 Thkao swivel

walker A

L1600 Abduct hip flex frejka w

cvr A

L1610 Abduct hip flex frejka

covr A

L1620 Abduct hip flex pavlik

harne A

L1630 Abduct control hip

semi-flex A

L1640 Pelv band/spread bar thigh

c A

L1650 HO abduction hip

adjustable A

L1652 HO bi thighcuffs w sprdr

bar A

L1660 HO abduction static

plastic A

L1680 Pelvic & hip control thigh

c A

L1685 Post-op hip abduct custom

fa A

L1686 HO post-op hip

abduction A

L1690 Combination bilateral

HO AL1700 Leg perthes orth toronto

typ A

L1710 Legg perthes orth

newington A

L1720 Legg perthes orthosis

trilat A

L1730 Legg perthes orth scottish

r A

L1755 Legg perthes patten bottom

t A

L1810 Ko elastic with

joints A

L1820 Ko elas w/ condyle pads &

jo A

L1830 Ko immobilizer canvas

longit A

L1831 Knee orth pos locking

joint A

L1832 KO adj jnt pos rigid

support A

L1834 Ko w/0 joint rigid molded

to A

L1836 Rigid KO wo

joints A

L1840 Ko derot ant cruciate

custom A

L1843 KO single upright custom

fit A

L1844 Ko w/adj jt rot cntrl

molded A

L1845 Ko w/ adj flex/ext rotat

cus A

L1846 Ko w adj flex/ext rotat

mold A

L1847 KO adjustable w air

chambers A

L1850 Ko swedish

type A

L1860 Ko supracondylar socket

mold A

L1900 Afo sprng wir drsflx calf

bd A

L1902 Afo ankle

gauntlet AL1904 Afo molded ankle

gauntlet A

L1906 Afo multiligamentus ankle

su A

L1907 AFO supramalleolar

custom A

L1910 Afo sing bar clasp attach

sh A

L1920 Afo sing upright w/ adjust

s A

L1930 Afo

plastic A

L1932 Afo rig ant tib prefab

TCF/= A

L1940 Afo molded to patient

plasti A

L1945 Afo molded plas rig ant

tib A

L1950 Afo spiral molded to pt

plas A

L1951 AFO spiral

prefabricated A

L1960 Afo pos solid ank plastic

mo A

L1970 Afo plastic molded w/ankle

j A

L1971 "AFO w/ankle joint,

prefab" A

L1980 Afo sing solid stirrup

calf A

L1990 Afo doub solid stirrup

calf A

L2000 Kafo sing fre stirr

thi/calf A

L2005 KAFO sng/dbl mechanical

act A

L2010 Kafo sng solid stirrup w/o

j A

L2020 Kafo dbl solid stirrup

band/ A

L2030 Kafo dbl solid stirrup w/o

j A

L2034 KAFO pla sin up w/wo k/a

cus AL2035 KAFO plastic pediatric

size A

L2036 Kafo plas doub free knee

mol A

L2037 Kafo plas sing free knee

mol A

L2038 Kafo w/o joint multi-axis

an A

L2040 Hkafo torsion bil rot

straps A

L2050 Hkafo torsion cable hip

pelv A

L2060 Hkafo torsion ball bearing

j A

L2070 Hkafo torsion unilat rot

str A

L2080 Hkafo unilat torsion

cable A

L2090 Hkafo unilat torsion ball

br A

L2106 Afo tib fx cast plaster

mold A

L2108 Afo tib fx cast molded to

pt A

L2112 Afo tibial fracture

soft A

L2114 Afo tib fx

semi-rigid A

L2116 Afo tibial fracture

rigid A

L2126 Kafo fem fx cast

thermoplas A

L2128 Kafo fem fx cast molded to

p A

L2132 Kafo femoral fx cast

soft A

L2134 Kafo fem fx cast

semi-rigid A

L2136 Kafo femoral fx cast

rigid A

L2180 Plas shoe insert w ank

joint A

L2182 Drop lock

knee AL2184 Limited motion knee

joint A

L2186 Adj motion knee jnt lerman

t A

L2188 Quadrilateral

brim A

L2190 Waist

belt A

L2192 Pelvic band & belt thigh

fla A

L2200 Limited ankle motion ea

jnt A

L2210 Dorsiflexion assist each

joi A

L2220 Dorsi & plantar flex

ass/res A

L2230 Split flat caliper stirr &

p A

L2232 "Rocker bottom, contact

AFO" A

L2240 Round caliper and plate

atta A

L2250 Foot plate molded stirrup

at A

L2260 Reinforced solid

stirrup A

L2265 Long tongue

stirrup A

L2270 Varus/valgus strap

padded/li A

L2275 Plastic mod low ext

pad/line A

L2280 Molded inner

boot A

L2300 Abduction bar jointed

adjust A

L2310 Abduction

bar-straight A

L2320 Non-molded

lacer A

L2330 Lacer molded to patient

mode A

L2335 Anterior swing

band AL2340 Pre-tibial shell molded to

p A

L2350 Prosthetic type socket

molde A

L2360 Extended steel

shank A

L2370 Patten

bottom A

L2375 Torsion ank & half solid

sti A

L2380 Torsion straight knee

joint A

L2385 Straight knee joint heavy

du A

L2387 Add LE poly knee custom

KAFO A

L2390 Offset knee joint

each A

L2395 Offset knee joint heavy

duty A

L2397 Suspension sleeve lower

ext A

L2405 Knee joint drop lock ea

jnt A

L2415 Knee joint cam lock each

joi A

L2425 Knee disc/dial lock/adj

flex A

L2430 Knee jnt ratchet lock ea

jnt A

L2492 Knee lift loop drop lock

rin A

L2500 Thi/glut/ischia wgt

bearing A

L2510 Th/wght bear quad-lat brim

m A

L2520 Th/wght bear quad-lat brim

c A

L2525 Th/wght bear nar m-l brim

mo A

L2526 Th/wght bear nar m-l brim

cu A

L2530 Thigh/wght bear lacer

non-mo AL2540 Thigh/wght bear lacer

molded A

L2550 Thigh/wght bear high roll

cu A

L2570 Hip clevis type 2 posit

jnt A

L2580 Pelvic control pelvic

sling A

L2600 Hip clevis/thrust bearing

fr A

L2610 Hip clevis/thrust bearing

lo A

L2620 Pelvic control hip heavy

dut A

L2622 Hip joint adjustable

flexion A

L2624 Hip adj flex ext abduct

cont A

L2627 Plastic mold recipro hip &

c A

L2628 Metal frame recipro hip &

ca A

L2630 Pelvic control band & belt

u A

L2640 Pelvic control band & belt

b A

L2650 Pelv & thor control

gluteal A

L2660 Thoracic control thoracic

ba A

L2670 Thorac cont paraspinal

uprig A

L2680 Thorac cont lat support

upri A

L2750 Plating chrome/nickel pr

bar A

L2755 Carbon graphite

lamination A

L2760 Extension per extension

per A

L2768 Ortho sidebar

disconnect A

L2780 Non-corrosive

finish AL2785 Drop lock retainer

each A

L2795 Knee control full

kneecap A

L2800 Knee cap medial or lateral

p A

L2810 Knee control condylar

pad A

L2820 Soft interface below knee

se A

L2830 Soft interface above knee

se A

L2840 Tibial length sock fx or

equ A

L2850 Femoral lgth sock fx or

equa A

L2861 Torsion mechanism

knee/ankle E

L2999 Lower extremity orthosis

NOS A

L3000 Ft insert ucb berkeley

shell A

L3001 Foot insert remov molded

spe A

L3002 Foot insert plastazote or

eq A

L3003 Foot insert silicone gel

eac A

L3010 Foot longitudinal arch

suppo A

L3020 Foot longitud/metatarsal

sup A

L3030 Foot arch support remov

prem A

L3031 Foot lamin/prepreg

composite A

L3040 Ft arch suprt premold

longit A

L3050 Foot arch supp premold

metat A

L3060 Foot arch supp

longitud/meta A

L3070 Arch suprt att to sho

longit AL3080 Arch supp att to shoe

metata A

L3090 Arch supp att to shoe

long/m A

L3100 Hallus-valgus nght dynamic

s A

L3140 Abduction rotation bar

shoe A

L3150 Abduct rotation bar w/o

shoe A

L3160 Shoe styled positioning

dev A

L3170 Foot plastic heel

stabilizer A

L3201 Oxford w supinat/pronat

inf A

L3202 Oxford w/ supinat/pronator

c A

L3203 Oxford w/

supinator/pronator A

L3204 Hightop w/ supp/pronator

inf A

L3206 Hightop w/ supp/pronator

chi A

L3207 Hightop w/ supp/pronator

jun A

L3208 Surgical boot each

infant A

L3209 Surgical boot each

child A

L3211 Surgical boot each

junior A

L3212 Benesch boot pair

infant A

L3213 Benesch boot pair

child A

L3214 Benesch boot pair

junior A

L3215 Orthopedic ftwear ladies oxf E

L3216 Orthoped ladies shoes dpth i E

L3217 Ladies shoes hightop depth i EL3219 Orthopedic mens shoes oxford E

L3221 Orthopedic mens shoes dpth i E

L3222 Mens shoes hightop depth inl E

L3224 Woman's shoe oxford

brace A

L3225 Man's shoe oxford

brace A

L3230 Custom shoes depth inlay A

L3250 Custom mold shoe remov prost A

L3251 Shoe molded to pt silicone s A

L3252 Shoe molded plastazote cust A

L3253 Shoe molded plastazote cust A

L3254 Orth foot non-stndard size/w A

L3255 Orth foot non-standard size/ A

L3257 Orth foot add charge split s A

L3260 Ambulatory surgical boot

eac E

L3265 Plastazote sandal each A

L3300 Sho lift taper to metatarsal A

L3310 Shoe lift elev heel/sole neo A

L3320 Shoe lift elev heel/sole cor A

L3330 Lifts elevation metal extens A

L3332 Shoe lifts tapered to one-ha A

L3334 Shoe lifts elevation heel /i A

L3340 Shoe wedge sach AL3350 Shoe heel wedge A

L3360 Shoe sole wedge outside sole A

L3370 Shoe sole wedge between sole A

L3380 Shoe clubfoot wedge A

L3390 Shoe outflare wedge A

L3400 Shoe metatarsal bar wedge ro A

L3410 Shoe metatarsal bar between A

L3420 Full sole/heel wedge btween A

L3430 Sho heel count plast reinfor A

L3440 Heel leather reinforced A

L3450 Shoe heel sach cushion type A

L3455 Shoe heel new leather standa A

L3460 Shoe heel new rubber standar A

L3465 Shoe heel thomas with wedge A

L3470 Shoe heel thomas extend to b A

L3480 Shoe heel pad & depress for A

L3485 Shoe heel pad removable for A

L3500 Ortho shoe add leather insol A

L3510 Orthopedic shoe add rub insl A

L3520 O shoe add felt w leath insl A

L3530 Ortho shoe add half sole A

L3540 Ortho shoe add full sole AL3550 O shoe add standard toe tap A

L3560 O shoe add horseshoe toe tap A

L3570 O shoe add instep extension A

L3580 O shoe add instep velcro clo A

L3590 O shoe convert to sof counte A

L3595 Ortho shoe add march bar A

L3600 Trans shoe calip plate exist A

L3610 Trans shoe caliper plate new A

L3620 Trans shoe solid stirrup exi A

L3630 Trans shoe solid stirrup new A

L3640 Shoe dennis browne splint bo A

L3649 Orthopedic shoe modifica NOS A

L3650 Shlder fig 8 abduct

restrain A

L3660 Abduct restrainer

canvas&web A

L3670 Acromio/clavicular

canvas&we A

L3671 SO cap design w/o jnts

CF A

L3674 SO airplane w/wo joint

CF A

L3675 Canvas vest

SO A

L3677 SO hard plastic

stabilizer A

L3702 EO w/o joints

CF A

L3710 Elbow elastic with metal

joi A

L3720 Forearm/arm cuffs free

motio AL3730 Forearm/arm cuffs ext/flex

a A

L3740 Cuffs adj lock w/ active

con A

L3760 "EO withjoint,

Prefabricated" A

L3762 Rigid EO wo

joints A

L3763 EWHO rigid w/o jnts

CF A

L3764 EWHO w/joint(s)

CF A

L3765 EWHFO rigid w/o jnts

CF A

L3766 EWHFO w/joint(s)

CF A

L3806 WHFO w/joint(s) custom

fab A

L3807 "WHFO,no joint,

prefabricated" A

L3808 "WHFO, rigid w/o

joints" A

L3891 Torsion mechanism

wrist/elbo E

L3900 Hinge extension/flex

wrist/f A

L3901 Hinge ext/flex wrist

finger A

L3904 Whfo electric custom

fitted A

L3905 WHO w/nontorsion jnt(s)

CF A

L3906 WHO w/o joints

CF A

L3908 Wrist cock-up

non-molded A

L3912 Flex glove w/elastic

finger A

L3913 HFO w/o joints

CF A

L3915 WHO w nontor jnt(s)

prefab A

L3917 Prefab metacarpl fx

orthosis AL3919 HO w/o joints

CF A

L3921 HFO w/joint(s)

CF A

L3923 HFO w/o joints

PF A

L3925 FO pip/dip with

joint/spring A

L3927 FO pip/dip w/o

joint/spring A

L3929 "HFO nontorsion joint,

prefab" A

L3931 WHFO nontorsion joint

prefab A

L3933 FO w/o joints

CF A

L3935 FO nontorsion joint

CF A

L3956 Add joint upper ext

orthosis A

L3960 Sewho airplan desig abdu

pos A

L3961 SEWHO cap design w/o jnts

CF A

L3962 Sewho erbs palsey design

abd A

L3964 Seo mobile arm sup att to

wc Y

L3965 Arm supp att to wc rancho

ty Y

L3966 Mobile arm supports

reclinin Y

L3967 SEWHO airplane w/o jnts

CF A

L3968 Friction dampening arm

supp Y

L3969 Monosuspension arm/hand

supp Y

L3970 Elevat proximal arm

support Y

L3971 SEWHO cap design w/jnt(s)

CF A

L3972 Offset/lat rocker arm w/

ela YL3973 SEWHO airplane w/jnt(s)

CF A

L3974 Mobile arm support

supinator Y

L3975 SEWHFO cap design w/o jnt

CF A

L3976 SEWHFO airplane w/o jnts

CF A

L3977 SEWHFO cap desgn w/jnt(s)

CF A

L3978 SEWHFO airplane w/jnt(s)

CF A

L3980 Upp ext fx orthosis

humeral A

L3982 Upper ext fx orthosis

rad/ul A

L3984 Upper ext fx orthosis

wrist A

L3995 Sock fracture or equal

each A

L3999 Upper limb orthosis

NOS A

L4000 Repl girdle milwaukee

orth A

L4002 "Replace strap, any

orthosis" A

L4010 Replace trilateral socket

br A

L4020 Replace quadlat socket

brim A

L4030 Replace socket brim cust

fit A

L4040 Replace molded thigh

lacer A

L4045 Replace non-molded thigh

lac A

L4050 Replace molded calf

lacer A

L4055 Replace non-molded calf

lace A

L4060 Replace high roll

cuff A

L4070 Replace prox & dist

upright AL4080 Repl met band kafo-afo

prox A

L4090 Repl met band kafo-afo

calf/ A

L4100 Repl leath cuff kafo prox

th A

L4110 Repl leath cuff kafo-afo

cal A

L4130 Replace pretibial

shell A

L4205 Ortho dvc repair per 15

min A

L4210 Orth dev repair/repl minor

p A

L4350 Ankle control orthosi

prefab A

L4360 Pneumati walking boot

prefab A

L4370 Pneumatic full leg

splint A

L4380 Pneumatic knee

splint A

L4386 Non-pneum walk boot

prefab A

L4392 Replace AFO soft

interface A

L4394 Replace foot drop

spint A

L4396 Static

AFO A

L4398 Foot drop splint

recumbent A

L4631 "Afo, walk boot type, cus

fab" A

L5000 Sho insert w arch toe

filler A

L5010 Mold socket ank hgt w/ toe

f A

L5020 Tibial tubercle hgt w/ toe

f A

L5050 Ank symes mold sckt sach

ft A

L5060 Symes met fr leath socket

ar AL5100 Molded socket shin sach

foot A

L5105 Plast socket jts/thgh

lacer A

L5150 Mold sckt ext knee shin

sach A

L5160 Mold socket bent knee shin

s A

L5200 Kne sing axis fric shin

sach A

L5210 No knee/ankle joints w/ ft

b A

L5220 No knee joint with artic

ali A

L5230 Fem focal defic constant

fri A

L5250 Hip canad sing axi cons

fric A

L5270 Tilt table locking hip

sing A

L5280 Hemipelvect canad sing

axis A

L5301 BK mold socket SACH ft

endo A

L5311 "Knee disart, SACH ft,

endo" A

L5321 AK open end

SACH A

L5331 Hip disart canadian SACH

ft A

L5341 Hemipelvectomy canadian

SACH A

L5400 Postop dress & 1 cast chg

bk A

L5410 Postop dsg bk ea add cast

ch A

L5420 Postop dsg & 1 cast chg

ak/d A

L5430 Postop dsg ak ea add cast

ch A

L5450 Postop app non-wgt bear

dsg A

L5460 Postop app non-wgt bear

dsg AL5500 Init bk ptb plaster

direct A

L5505 Init ak ischal plstr

direct A

L5510 Prep BK ptb plaster

molded A

L5520 Perp BK ptb thermopls

direct A

L5530 Prep BK ptb thermopls

molded A

L5535 Prep BK ptb open end

socket A

L5540 Prep BK ptb laminated

socket A

L5560 Prep AK ischial plast

molded A

L5570 Prep AK ischial direct

form A

L5580 Prep AK ischial thermo

mold A

L5585 Prep AK ischial open

end A

L5590 Prep AK ischial

laminated A

L5595 Hip disartic sach

thermopls A

L5600 Hip disart sach laminat

mold A

L5610 Above knee

hydracadence A

L5611 Ak 4 bar link w/fric

swing A

L5613 Ak 4 bar ling w/hydraul

swig A

L5614 4-bar link above knee

w/swng A

L5616 Ak univ multiplex sys

frict A

L5617 AK/BK self-aligning unit

ea A

L5618 Test socket

symes A

L5620 Test socket below

knee AL5622 Test socket knee

disarticula A

L5624 Test socket above

knee A

L5626 Test socket hip

disarticulat A

L5628 Test socket

hemipelvectomy A

L5629 Below knee acrylic

socket A

L5630 Syme typ expandabl wall

sckt A

L5631 Ak/knee disartic acrylic

soc A

L5632 Symes type ptb brim design

s A

L5634 Symes type poster opening

so A

L5636 Symes type medial opening

so A

L5637 Below knee total

contact A

L5638 Below knee leather

socket A

L5639 Below knee wood

socket A

L5640 Knee disarticulat leather

so A

L5642 Above knee leather

socket A

L5643 Hip flex inner socket ext

fr A

L5644 Above knee wood

socket A

L5645 Bk flex inner socket ext

fra A

L5646 Below knee cushion

socket A

L5647 Below knee suction

socket A

L5648 Above knee cushion

socket A

L5649 Isch containmt/narrow m-l

so AL5650 Tot contact ak/knee disart

s A

L5651 Ak flex inner socket ext

fra A

L5652 Suction susp ak/knee

disart A

L5653 Knee disart expand wall

sock A

L5654 Socket insert

symes A

L5655 Socket insert below

knee A

L5656 Socket insert knee

articulat A

L5658 Socket insert above

knee A

L5661 Multi-durometer

symes A

L5665 Multi-durometer below

knee A

L5666 Below knee cuff

suspension A

L5668 Socket insert w/o lock

lower A

L5670 Bk molded supracondylar

susp A

L5671 BK/AK locking

mechanism A

L5672 Bk removable medial brim

sus A

L5673 Socket insert w lock

mech A

L5676 Bk knee joints single axis

p A

L5677 Bk knee joints polycentric

p A

L5678 Bk joint covers

pair A

L5679 Socket insert w/o lock

mech A

L5680 Bk thigh lacer

non-molded A

L5681 Intl custm cong/latyp

insert AL5682 Bk thigh lacer glut/ischia

m A

L5683 Initial custom socket

insert A

L5684 Bk fork

strap A

L5685 Below knee sus/seal

sleeve A

L5686 Bk back

check A

L5688 Bk waist belt

webbing A

L5690 Bk waist belt padded and

lin A

L5692 Ak pelvic control belt

light A

L5694 Ak pelvic control belt

pad/l A

L5695 Ak sleeve susp

neoprene/equa A

L5696 Ak/knee disartic pelvic

join A

L5697 Ak/knee disartic pelvic

band A

L5698 Ak/knee disartic silesian

ba A

L5699 Shoulder

harness A

L5700 Replace socket below

knee A

L5701 Replace socket above

knee A

L5702 Replace socket

hip A

L5703 Symes ankle w/o (SACH)

foot A

L5704 Custom shape cover

BK A

L5705 Custom shape cover

AK A

L5706 Custom shape cvr knee

disart A

L5707 Custom shape cvr hip

disart AL5710 Kne-shin exo sng axi mnl

loc A

L5711 Knee-shin exo mnl lock

ultra A

L5712 Knee-shin exo frict swg &

st A

L5714 Knee-shin exo variable

frict A

L5716 Knee-shin exo mech stance

ph A

L5718 Knee-shin exo frct swg &

sta A

L5722 Knee-shin pneum swg frct

exo A

L5724 Knee-shin exo fluid swing

ph A

L5726 Knee-shin ext jnts fld swg

e A

L5728 Knee-shin fluid swg &

stance A

L5780 Knee-shin pneum/hydra

pneum A

L5781 Lower limb pros vacuum

pump A

L5782 HD low limb pros vacuum

pump A

L5785 Exoskeletal bk ultralt

mater A

L5790 Exoskeletal ak ultra-light

m A

L5795 Exoskel hip ultra-light

mate A

L5810 Endoskel knee-shin mnl

lock A

L5811 Endo knee-shin mnl lck

ultra A

L5812 Endo knee-shin frct swg &

st A

L5814 Endo knee-shin hydral swg

ph A

L5816 Endo knee-shin polyc mch

sta A

L5818 Endo knee-shin frct swg &

st AL5822 Endo knee-shin pneum swg

frc A

L5824 Endo knee-shin fluid swing

p A

L5826 Miniature knee

joint A

L5828 Endo knee-shin fluid

swg/sta A

L5830 Endo knee-shin pneum/swg

pha A

L5840 Multi-axial knee/shin

system A

L5845 Knee-shin sys stance

flexion A

L5848 Knee-shin sys hydraul

stance A

L5850 Endo ak/hip knee extens

assi A

L5855 Mech hip extension

assist A

L5856 Elec knee-shin

swing/stance A

L5857 Elec knee-shin swing

only A

L5858 Stance phase

only A

L5910 Endo below knee alignable

sy A

L5920 Endo ak/hip alignable

system A

L5925 Above knee manual

lock A

L5930 High activity knee

frame A

L5940 Endo bk ultra-light

material A

L5950 Endo ak ultra-light

material A

L5960 Endo hip ultra-light

materia A

L5961 "Endo poly hip,

pneu/hyd/rot" A

L5962 Below knee flex cover

system AL5964 Above knee flex cover

system A

L5966 Hip flexible cover

system A

L5968 Multiaxial ankle w

dorsiflex A

L5970 Foot external keel sach

foot A

L5971 "SACH foot,

replacement" A

L5972 Flexible keel

foot A

L5973 Ank-foot sys dors-plant

flex A

L5974 Foot single axis

ankle/foot A

L5975 Combo ankle/foot

prosthesis A

L5976 Energy storing

foot A

L5978 Ft prosth multiaxial

ankl/ft A

L5979 Multi-axial ankle/ft

prosth A

L5980 Flex foot

system A

L5981 Flex-walk sys low ext

prosth A

L5982 Exoskeletal axial rotation

u A

L5984 Endoskeletal axial

rotation A

L5985 Lwr ext dynamic prosth

pylon A

L5986 Multi-axial rotation

unit A

L5987 Shank ft w vert load

pylon A

L5988 Vertical shock reducing

pylo A

L5990 User adjustable heel

height A

L5999 Lowr extremity prosthes

NOS AL6000 Par hand robin-aids thum

rem A

L6010 Hand robin-aids

little/ring A

L6020 Part hand robin-aids no

fing A

L6025 Part hand disart

myoelectric A

L6050 Wrst MLd sck flx hng tri

pad A

L6055 Wrst mold sock w/exp

interfa A

L6100 Elb mold sock flex hinge

pad A

L6110 Elbow mold sock suspension

t A

L6120 Elbow mold doub splt soc

ste A

L6130 Elbow stump activated lock

h A

L6200 Elbow mold outsid lock

hinge A

L6205 Elbow molded w/ expand

inter A

L6250 Elbow inter loc elbow

forarm A

L6300 Shlder disart int lock

elbow A

L6310 Shoulder passive restor

comp A

L6320 Shoulder passive restor

cap A

L6350 Thoracic intern lock

elbow A

L6360 Thoracic passive restor

comp A

L6370 Thoracic passive restor

cap A

L6380 Postop dsg cast chg

wrst/elb A

L6382 Postop dsg cast chg elb

dis/ A

L6384 Postop dsg cast chg

shlder/t AL6386 Postop ea cast chg &

realign A

L6388 Postop applicat rigid dsg

on A

L6400 Below elbow prosth tiss

shap A

L6450 Elb disart prosth tiss

shap A

L6500 Above elbow prosth tiss

shap A

L6550 Shldr disar prosth tiss

shap A

L6570 Scap thorac prosth tiss

shap A

L6580 Wrist/elbow bowden cable

mol A

L6582 Wrist/elbow bowden cbl dir

f A

L6584 Elbow fair lead cable

molded A

L6586 Elbow fair lead cable dir

fo A

L6588 Shdr fair lead cable

molded A

L6590 Shdr fair lead cable

direct A

L6600 Polycentric hinge

pair A

L6605 Single pivot hinge

pair A

L6610 Flexible metal hinge

pair A

L6611 "Additional switch, ext

power" A

L6615 Disconnect locking wrist

uni A

L6616 Disconnect insert locking

wr A

L6620 Flexion/extension wrist

unit A

L6621 Flex/ext wrist w/wo

friction A

L6623 Spring-ass rot wrst w/

latch AL6624 Flex/ext/rotation wrist

unit A

L6625 Rotation wrst w/ cable

lock A

L6628 Quick disconn hook adapter

o A

L6629 Lamination collar w/

couplin A

L6630 Stainless steel any

wrist A

L6632 Latex suspension sleeve

each A

L6635 Lift assist for

elbow A

L6637 Nudge control elbow

lock A

L6638 Elec lock on manual pw

elbow A

L6640 Shoulder abduction joint

pai A

L6641 Excursion amplifier pulley

t A

L6642 Excursion amplifier lever

ty A

L6645 Shoulder flexion-abduction

j A

L6646 Multipo locking shoulder

jnt A

L6647 Shoulder lock

actuator A

L6648 Ext pwrd shlder

lock/unlock A

L6650 Shoulder universal

joint A

L6655 Standard control cable

extra A

L6660 Heavy duty control

cable A

L6665 Teflon or equal cable

lining A

L6670 Hook to hand cable

adapter A

L6672 Harness chest/shlder

saddle AL6675 Harness figure of 8 sing

con A

L6676 Harness figure of 8 dual

con A

L6677 UE triple control

harness A

L6680 Test sock wrist disart/bel

e A

L6682 Test sock elbw

disart/above A

L6684 Test socket shldr

disart/tho A

L6686 Suction

socket A

L6687 Frame typ socket bel

elbow/w A

L6688 Frame typ sock above

elb/dis A

L6689 Frame typ socket shoulder

di A

L6690 Frame typ sock

interscap-tho A

L6691 Removable insert

each A

L6692 Silicone gel insert or

equal A

L6693 Lockingelbow forearm

cntrbal A

L6694 Elbow socket ins use

w/lock A

L6695 Elbow socket ins use w/o

lck A

L6696 Cus elbo skt in for

con/atyp A

L6697 Cus elbo skt in not

con/atyp A

L6698 Below/above elbow lock

mech A

L6703 "Term dev, passive hand mitt

" A

L6704 "Term dev, sport/rec/work

att" A

L6706 Term dev mech hook vol open AL6707 Term dev mech hook vol

close A

L6708 Term dev mech hand vol

open A

L6709 Term dev mech hand vol

close A

L6711 "Ped term dev, hook, vol

open" A

L6712 "Ped term dev, hook, vol

clos" A

L6713 "Ped term dev, hand, vol

open" A

L6714 "Ped term dev, hand, vol

clos" A

L6721 "Hook/hand, hvy dty, vol

open" A

L6722 "Hook/hand, hvy dty, vol

clos" A

L6805 Term dev modifier wrist

unit A

L6810 Term dev precision pinch

dev A

L6881 Term dev auto grasp

feature A

L6882 Microprocessor control

uplmb A

L6883 Replc sockt below e/w

disa A

L6884 Replc sockt above elbow

disa A

L6885 Replc sockt shldr

dis/interc A

L6890 Prefab glove for term

device A

L6895 Custom glove for term

device A

L6900 Hand restorat thumb/1

finger A

L6905 Hand restoration multiple

fi A

L6910 Hand restoration no

fingers A

L6915 Hand restoration replacmnt

g AL6920 Wrist disarticul switch

ctrl A

L6925 Wrist disart myoelectronic

c A

L6930 Below elbow switch

control A

L6935 Below elbow myoelectronic

ct A

L6940 Elbow disarticulation

switch A

L6945 Elbow disart myoelectronic

c A

L6950 Above elbow switch

control A

L6955 Above elbow myoelectronic

ct A

L6960 Shldr disartic switch

contro A

L6965 Shldr disartic

myoelectronic A

L6970 Interscapular-thor switch

ct A

L6975 Interscap-thor

myoelectronic A

L7007 Adult electric

hand A

L7008 Pediatric electric

hand A

L7009 Adult electric

hook A

L7040 Prehensile

actuator A

L7045 Pediatric electric

hook A

L7170 Electronic elbow hosmer

swit A

L7180 Electronic elbow

sequential A

L7181 Electronic elbo

simultaneous A

L7185 Electron elbow adolescent

sw A

L7186 Electron elbow child

switch AL7190 Elbow adolescent

myoelectron A

L7191 Elbow child myoelectronic

ct A

L7260 Electron wrist rotator

otto A

L7261 Electron wrist rotator

utah A

L7266 Servo control steeper or

equ A

L7272 Analogue control unb or

equa A

L7274 Proportional ctl 12 volt

uta A

L7360 Six volt bat otto bock/eq

ea A

L7362 Battery chrgr six volt

otto A

L7364 Twelve volt battery

utah/equ A

L7366 Battery chrgr 12 volt

utah/e A

L7367 Replacemnt lithium

ionbatter A

L7368 Lithium ion battery

charger A

L7400 "Add UE prost be/wd,

ultlite" A

L7401 Add UE prost a/e ultlite

mat A

L7402 Add UE prost s/d ultlite

mat A

L7403 Add UE prost b/e

acrylic A

L7404 Add UE prost a/e

acrylic A

L7405 Add UE prost s/d

acrylic A

L7499 Upper extremity prosthes

NOS A

L7500 Prosthetic dvc repair

hourly A

L7510 Prosthetic device repair

rep AL7520 Repair prosthesis per 15

min A

L7600 Prosthetic donning sleeve E

L7900 Male vacuum erection

system A

L8000 Mastectomy

bra A

L8001 Breast prosthesis bra &

form A

L8002 Brst prsth bra & bilat

form A

L8010 Mastectomy

sleeve A

L8015 Ext breastprosthesis

garment A

L8020 Mastectomy

form A

L8030 Breast prosthes w/o

adhesive A

L8031 Breast prosthesis w

adhesive A

L8032 Reusable nipple

prosthesis A

L8035 Custom breast

prosthesis A

L8039 Breast prosthesis

NOS A

L8040 Nasal

prosthesis A

L8041 Midfacial

prosthesis A

L8042 Orbital

prosthesis A

L8043 Upper facial

prosthesis A

L8044 Hemi-facial

prosthesis A

L8045 Auricular

prosthesis A

L8046 Partial facial

prosthesis A

L8047 Nasal septal

prosthesis AL8048 Unspec maxillofacial

prosth A

L8049 Repair maxillofacial

prosth A

L8300 Truss single w/ standard

pad A

L8310 Truss double w/ standard

pad A

L8320 Truss addition to std pad

wa A

L8330 Truss add to std pad

scrotal A

L8400 Sheath below

knee A

L8410 Sheath above

knee A

L8415 Sheath upper

limb A

L8417 Pros sheath/sock w gel

cushn A

L8420 Prosthetic sock multi ply

BK A

L8430 Prosthetic sock multi ply

AK A

L8435 Pros sock multi ply upper

lm A

L8440 Shrinker below

knee A

L8460 Shrinker above

knee A

L8465 Shrinker upper

limb A

L8470 Pros sock single ply

BK A

L8480 Pros sock single ply

AK A

L8485 Pros sock single ply upper

l A

L8499 Unlisted misc prosthetic

ser A

L8500 Artificial

larynx A

L8501 Tracheostomy speaking

valve AL8505 "Artificial larynx,

accessory" A

L8507 Trach-esoph voice pros pt

in A

L8509 Trach-esoph voice pros md

in A

L8510 Voice

amplifier A

L8511 Indwelling trach

insert A

L8512 Gel cap for trach voice

pros A

L8513 Trach pros cleaning

device A

L8514 Repl trach puncture

dilator A

L8515 Gel cap app device for

trach A

L8600 Implant breast

silicone/eq N

L8603 Collagen imp urinary 2.5

ml N

L8604 Dextranomer/hyaluronic

acid N

L8606 Synthetic implnt urinary

1ml N

L8609 Artificial

cornea N

L8610 Ocular

implant N

L8612 Aqueous shunt

prosthesis N

L8613 Ossicular

implant N

L8614 Cochlear

device N

L8615 Coch implant headset

replace A

L8616 Coch implant microphone

repl A

L8617 Coch implant trans coil

repl A

L8618 Coch implant tran cable

repl AL8619 Coch imp ext proc/contr

rplc A

L8621 Repl zinc air

battery A

L8622 Repl alkaline

battery A

L8623 "Lith ion batt

CID,non-earlvl" A

L8624 "Lith ion batt CID, ear

level" A

L8627 CID ext speech process

repl A

L8628 CID ext controller

repl A

L8629 CID transmit coil and

cable A

L8630 Metacarpophalangeal

implant N

L8631 MCP joint repl 2 pc or

more N

L8641 Metatarsal joint

implant N

L8642 Hallux

implant N

L8658 Interphalangeal joint

spacer N

L8659 Interphalangeal joint

repl N

L8670 "Vascular graft,

synthetic" N

L8680 Implt neurostim elctr

each N

L8681 Pt prgrm for implt

neurostim A

L8682 Implt neurostim radiofq

rec N

L8683 Radiofq trsmtr for implt

neu A

L8684 Radiof trsmtr implt scrl

neu A

L8685 Implt nrostm pls gen sng rec N

L8686 Implt nrostm pls gen sng non NL8687 Implt nrostm pls gen dua rec N

L8688 Implt nrostm pls gen dua non N

L8689 External recharg sys

intern A

L8690 "Aud osseo dev, int/ext

comp" N

L8691 Osseointegrated snd proc

rpl A

L8692 Non-osseointegrated snd

proc E

L8693 "Aud osseo dev,

abutment" A

L8695 External recharg sys

extern A

L8699 Prosthetic implant

NOS N

L9900 O&P

supply/accessory/service N

M0064 Visit for drug

monitoring Q3 0607 1.9242 $133.58

. $26.72

M0075 Cellular

therapy E

M0076 Prolotherapy E

M0100 Intragastric

hypothermia E

M0300 IV

chelationtherapy E

M0301 Fabric wrapping of

aneurysm E

P2028 Cephalin floculation

test A

P2029 Congo red blood

test A

P2031 Hair

analysis E

P2033 Blood thymol

turbidity A

P2038 Blood

mucoprotein A

P3000 Screen pap by tech w mdsupv A

P3001 Screening pap smear by

phys B

P7001 Culture bacterial

urine E

P9010 Whole blood for transfusion R

0950 2.7926 $193.86

. $38.78

P9011 Blood split unit R

0967 2.2455 $155.88

. $31.18

P9012 Cryoprecipitate each unit R

0952 1.0975 $76.19

. $15.24

P9016 RBC leukocytes reduced R

0954 2.8046 $194.70

. $38.94

P9017 Plasma 1 donor frz w/in 8 hr R

9508 1.0927 $75.86

. $15.18

P9019 "Platelets, each unit" R

0957 1.2522 $86.93

. $17.39

P9020 Plaelet rich plasma unit R

0958 1.9703 $136.78

. $27.36

P9021 Red blood cells unit R

0959 2.1382 $148.43

. $29.69

P9022 Washed red blood cells unit R

0960 4.0969 $284.41

. $56.89

P9023 "Frozen plasma, pooled, sd" R

0949 1.0221 $70.95

. $14.19

P9031 Platelets leukocytes reduced R

1013 1.7459 $121.20

. $24.24

P9032 "Platelets, irradiated" R

9500 2.1768 $151.11

. $30.23

P9033 Platelets leukoreduced irrad R

0968 2.0418 $141.74

. $28.35

P9034 "Platelets, pheresis" R

9507 6.0636 $420.94

. $84.19

P9035 Platelet pheres leukoreduced R

9501 7.5524 $524.29

. $104.86P9036 Platelet pheresis irradiated R

9502 7.5964 $527.34

. $105.47

P9037 Plate pheres leukoredu irrad R

1019 9.9046 $687.58

. $137.52

P9038 RBC irradiated R

9505 3.3729 $234.15

. $46.83

P9039 RBC deglycerolized R

9504 3.4728 $241.08

. $48.22

P9040 RBC leukoreduced irradiated R

0969 3.7077 $257.39

. $51.48

P9041 "Albumin (human),5%,

50ml" K 0961 $20.37

. $4.08

P9043 "Plasma protein fract,5%,50ml" R

0956 0.2513 $17.45

. $3.49

P9044 Cryoprecipitatereducedplasma R

1009 1.1839 $82.19

. $16.44

P9045 "Albumin (human), 5%, 250

ml" K 0963 $67.07

. $13.42

P9046 "Albumin (human), 25%, 20

ml" K 0964 $29.16

. $5.84

P9047 "Albumin (human), 25%,

50ml" K 0965 $70.39

. $14.08

P9048 "Plasmaprotein fract,5%,250ml" R

0966 1.2214 $84.79

. $16.96

P9050 "Granulocytes, pheresis unit" R

9506 22.1451 "$1,537.31"

. $307.47

P9051 "Blood, l/r, cmv-neg" R

1010 2.7475 $190.73

. $38.15

P9052 "Platelets, hla-m, l/r, unit" R

1011 11.4189 $792.70

. $158.54

P9053 "Plt, pher, l/r cmv-neg, irr" R

1020 8.6696 $601.84

. $120.37

P9054 "Blood, l/r, froz/degly/wash" R

1016 1.8650 $129.47

. $25.90P9055 "Plt, aph/pher, l/r, cmv-neg" R

1017 5.7123 $396.55

. $79.31

P9056 "Blood, l/r, irradiated" R

1018 2.1603 $149.97

. $30.00

P9057 "RBC, frz/deg/wsh, l/r, irrad" R

1021 6.2606 $434.61

. $86.93

P9058 "RBC, l/r, cmv-neg, irrad" R

1022 4.0635 $282.09

. $56.42

P9059 "Plasma, frz between 8-24hour" R

0955 1.0092 $70.06

. $14.02

P9060 Fr frz plasma donor retested R

9503 1.2624 $87.64

. $17.53

P9603 One-way allow prorated

miles A

P9604 One-way allow prorated

trip A

P9612 Catheterize for urine spec A

P9615 Urine specimen collect

mult N

Q0035 Cardiokymography X 0100 2.5348 $175.97 $40.87 $35.20

Q0081 Infusion ther other than che B

Q0083 Chemo by other than infusion B

Q0084 Chemotherapy by infusion B

Q0085 Chemo by both infusion and

o B

Q0091 Obtaining screen pap

smear T 0191 0.1274 $8.84 $0.00 $0.00

Q0092 Set up port xray

equipment N

Q0111 Wet mounts/ w

preparations A

Q0112 Potassium hydroxide

preps AQ0113 Pinworm

examinations A

Q0114 Fern

test A

Q0115 Post-coital mucous

exam A

Q0138 "Ferumoxytol, non-esrd" CH K

1297 $0.69

. $0.14

Q0139 "Ferumoxytol, esrd

use" A

Q0144 "Azithromycin dihydrate,

oral" E

Q0163 Diphenhydramine HCl

50mg N

Q0164 Prochlorperazine maleate

5mg N

Q0165 Prochlorperazine

maleate10mg N

Q0166 Granisetron hcl 1 mg

oral N

Q0167 Dronabinol 2.5mg

oral N

Q0168 Dronabinol 5mg

oral N

Q0169 Promethazine HCl 12.5mg

oral N

Q0170 Promethazine HCl 25 mg

oral N

Q0171 Chlorpromazine HCl 10mg

oral N

Q0172 Chlorpromazine HCl 25mg

oral N

Q0173 Trimethobenzamide HCl

250mg N

Q0174 Thiethylperazine

maleate10mg E

Q0175 Perphenazine 4mg

oral N

Q0176 Perphenazine 8mg

oral N

Q0177 Hydroxyzine pamoate

25mg N

Q0178 Hydroxyzine pamoate

50mg NQ0179 Ondansetron hcl 8 mg

oral N

Q0180 Dolasetron mesylate

oral N

Q0181 Unspecified oral

anti-emetic E

Q0478 "Power adapter, combo

vad" A

Q0479 "Power module combo vad,

rep" A

Q0480 "Driver pneumatic vad,

rep" A

Q0481 "Microprcsr cu elec vad,

rep" A

Q0482 "Microprcsr cu combo vad,

rep" A

Q0483 "Monitor elec vad,

rep" A

Q0484 Monitor elec or comb vad

rep A

Q0485 "Monitor cable elec vad,

rep" A

Q0486 Mon cable elec/pneum vad

rep A

Q0487 "Leads any type vad, rep

only" A

Q0488 "Pwr pack base elec vad,

rep" A

Q0489 "Pwr pck base combo vad,

rep" A

Q0490 "Emr pwr source elec vad,

rep" A

Q0491 Emr pwr source combo vad

rep A

Q0492 "Emr pwr cbl elec vad,

rep" A

Q0493 "Emr pwr cbl combo vad,

rep" A

Q0494 "Emr hd pmp elec/combo,

rep" A

Q0495 "Charger elec/combo vad,

rep" A

Q0496 "Battery elec/combo vad,

rep" AQ0497 "Bat clps elec/comb vad,

rep" A

Q0498 "Holster elec/combo vad,

rep" A

Q0499 Belt/vest elec/combo vad

rep A

Q0500 "Filters elec/combo vad,

rep" A

Q0501 "Shwr cov elec/combo vad,

rep" A

Q0502 "Mobility cart pneum vad,

rep" A

Q0503 Battery pneum vad

replacemnt A

Q0504 "Pwr adpt pneum vad, rep

veh" A

Q0505 Miscl supply/accessory

vad A

Q0506 Lith-ion batt elec/pneum

VAD A

Q0510 Dispens fee

immunosupressive B

Q0511 "Sup fee

antiem,antica,immuno" B

Q0512 Px sup fee anti-can sub

pres B

Q0513 Disp fee inhal drugs/30

days B

Q0514 Disp fee inhal drugs/90

days B

Q0515 Sermorelin acetate injection K

3050 $1.76

. $0.36

Q1004 Ntiol category 4 E

Q1005 Ntiol category 5 E

Q2004 Bladder calculi irrig

sol N

Q2009 Fosphenytoin inj

PE N

Q2017 "Teniposide, 50

mg" K 7035 $316.52

. $63.31

Q2026 Radiesseinjection B

Q2027 Sculptra

injection B

Q2035 "Afluria vacc, 3 yrs & >,

im" L

Q2036 "Flulaval vacc, 3 yrs & >,

im" L

Q2037 "Fluvirin vacc, 3 yrs & >,

im" L

Q2038 "Fluzone vacc, 3 yrs & >,

im" L

Q2039 "NOS flu vacc, 3 yrs & >,

im" L

Q2040 Incobotulinumtoxin

A G 9278 $5.57

. $1.10

Q3001 Brachytherapy

Radioelements B

Q3014 Telehealth facility

fee A

Q3025 IM inj interferon beta

1-a K 9022 $220.75

. $44.15

Q3026 Subc inj interferon

beta-1a E

Q3031 Collagen skin

test N

Q4001 Cast sup body cast

plaster B

Q4002 Cast sup body cast

fiberglas B

Q4003 Cast sup shoulder cast

plstr B

Q4004 Cast sup shoulder cast

fbrgl B

Q4005 Cast sup long arm adult

plst B

Q4006 Cast sup long arm adult

fbrg B

Q4007 Cast sup long arm ped

plster B

Q4008 Cast sup long arm ped

fbrgls B

Q4009 Cast sup sht arm adult

plstr BQ4010 Cast sup sht arm adult

fbrgl B

Q4011 Cast sup sht arm ped

plaster B

Q4012 Cast sup sht arm ped

fbrglas B

Q4013 Cast sup gauntlet

plaster B

Q4014 Cast sup gauntlet

fiberglass B

Q4015 Cast sup gauntlet ped

plster B

Q4016 Cast sup gauntlet ped

fbrgls B

Q4017 Cast sup lng arm splint

plst B

Q4018 Cast sup lng arm splint

fbrg B

Q4019 Cast sup lng arm splnt ped

p B

Q4020 Cast sup lng arm splnt ped

f B

Q4021 Cast sup sht arm splint

plst B

Q4022 Cast sup sht arm splint

fbrg B

Q4023 Cast sup sht arm splnt ped

p B

Q4024 Cast sup sht arm splnt ped

f B

Q4025 Cast sup hip spica

plaster B

Q4026 Cast sup hip spica

fiberglas B

Q4027 Cast sup hip spica ped

plstr B

Q4028 Cast sup hip spica ped

fbrgl B

Q4029 Cast sup long leg

plaster B

Q4030 Cast sup long leg

fiberglass B

Q4031 Cast sup lng leg ped

plaster BQ4032 Cast sup lng leg ped

fbrgls B

Q4033 Cast sup lng leg cylinder

pl B

Q4034 Cast sup lng leg cylinder

fb B

Q4035 Cast sup lngleg cylndr ped

p B

Q4036 Cast sup lngleg cylndr ped

f B

Q4037 Cast sup shrt leg

plaster B

Q4038 Cast sup shrt leg

fiberglass B

Q4039 Cast sup shrt leg ped

plster B

Q4040 Cast sup shrt leg ped

fbrgls B

Q4041 Cast sup lng leg splnt

plstr B

Q4042 Cast sup lng leg splnt

fbrgl B

Q4043 Cast sup lng leg splnt ped

p B

Q4044 Cast sup lng leg splnt ped

f B

Q4045 Cast sup sht leg splnt

plstr B

Q4046 Cast sup sht leg splnt

fbrgl B

Q4047 Cast sup sht leg splnt ped

p B

Q4048 Cast sup sht leg splnt ped

f B

Q4049 "Finger splint,

static" B

Q4050 Cast supplies

unlisted B

Q4051 Splint supplies

misc B

Q4074 Iloprost non-comp unit

dose Y

Q4081 "Epoetin alfa, 100 units ESRD " AQ4082 Drug/bio NOC part B drug CAP B

Q4100 "Skin substitute,

NOS" N

Q4101 Apligraf K 1240 $34.06

. $6.82

Q4102 Oasis wound

matrix K 1241 $4.68

. $0.94

Q4103 Oasis burn

matrix CH N

Q4104 Integra

BMWD K 1243 $15.45

. $3.09

Q4105 Integra

DRT K 1244 $10.95

. $2.19

Q4106 Dermagraft K 1245 $39.39

. $7.88

Q4107 Graftjacket K 1246 $92.79

. $18.56

Q4108 Integra

matrix K 1247 $20.95

. $4.19

Q4110 Primatrix K 1248 $31.67

. $6.34

Q4111 Gammagraft K 1252 $7.17

. $1.44

Q4112 Cymetra

injectable K 1249 $334.07

. $66.82

Q4113 Graftjacket

xpress K 1250 $334.07

. $66.82

Q4114 Integra flowable wound

matri K 1251 $972.75

. $194.55

Q4115 Alloskin K 1287 $6.07

. $1.22

Q4116 Alloderm K 1270 $31.11

. $6.23

Q4117 Hyalomatrix E

Q4118 Matristem

micromatrix K 1342 $3.13

. $0.63

Q4119 Matristem wound

matrix K 1351 $6.04

. $1.21Q4120 Matristem burn

matrix E

Q4121 Theraskin K 1345 $20.32

. $4.07

Q5001 Hospice in patient home B

Q5002 Hospice in assisted living B

Q5003 Hospice in LT/non-skilled NF B

Q5004 Hospice in SNF B

Q5005 "Hospice, inpatient hospital" B

Q5006 Hospice in hospice facility B

Q5007 Hospice in LTCH B

Q5008 Hospice in inpatient psych B

Q5009 "Hospice care, NOS" B

Q5010 Hospice home care in hospice B

Q9951 "LOCM >= 400 mg/ml iodine,1ml" N

Q9953 "Inj Fe-based MR contrast,1ml" N

Q9954 "Oral MR contrast, 100 ml" N

Q9955 "Inj perflexane lip micros,ml " N

Q9956 "Inj octafluoropropane mic,ml" N

Q9957 "Inj perflutren lip micros,ml" N

Q9958 "HOCM <=149 mg/ml iodine,

1ml" N

Q9959 "HOCM 150-199mg/ml iodine,1ml" N

Q9960 "HOCM 200-249mg/ml iodine,1ml" N

Q9961 "HOCM 250-299mg/ml iodine,1ml" NQ9962 "HOCM 300-349mg/ml iodine,1ml" N

Q9963 "HOCM 350-399mg/ml iodine,1ml" N

Q9964 "HOCM>= 400mg/ml iodine, 1ml" N

Q9965 "LOCM 100-199mg/ml

iodine,1ml" N

Q9966 "LOCM 200-299mg/ml

iodine,1ml" N

Q9967 "LOCM 300-399mg/ml

iodine,1ml" N

Q9968 Visualization

adjunct CH N

R0070 Transport portable x-ray B

R0075 Transport port x-ray multipl B

R0076 Transport portable EKG B

V2020 Vision svcs frames

purchases A

V2025 Eyeglasses delux

frames E

V2100 Lens spher single plano

4.00 A

V2101 Single visn sphere

4.12-7.00 A

V2102 Singl visn sphere

7.12-20.00 A

V2103 Spherocylindr

4.00d/12-2.00d A

V2104 Spherocylindr

4.00d/2.12-4d A

V2105 Spherocylinder

4.00d/4.25-6d A

V2106 Spherocylinder

4.00d/>6.00d A

V2107 Spherocylinder

4.25d/12-2d A

V2108 Spherocylinder

4.25d/2.12-4d A

V2109 Spherocylinder

4.25d/4.25-6d AV2110 Spherocylinder 4.25d/over

6d A

V2111 Spherocylindr

7.25d/.25-2.25 A

V2112 Spherocylindr

7.25d/2.25-4d A

V2113 Spherocylindr

7.25d/4.25-6d A

V2114 Spherocylinder over

12.00d A

V2115 Lens lenticular

bifocal A

V2118 Lens aniseikonic

single A

V2121 "Lenticular lens,

single" A

V2199 Lens single vision not oth

c A

V2200 Lens spher bifoc plano

4.00d A

V2201 Lens sphere bifocal

4.12-7.0 A

V2202 Lens sphere bifocal

7.12-20. A

V2203 Lens sphcyl bifocal

4.00d/.1 A

V2204 Lens sphcy bifocal

4.00d/2.1 A

V2205 Lens sphcy bifocal

4.00d/4.2 A

V2206 Lens sphcy bifocal

4.00d/ove A

V2207 Lens sphcy bifocal

4.25-7d/. A

V2208 Lens sphcy bifocal

4.25-7/2. A

V2209 Lens sphcy bifocal

4.25-7/4. A

V2210 Lens sphcy bifocal 4.25-7/ov A

V2211 Lens sphcy bifo

7.25-12/.25- A

V2212 Lens sphcyl bifo

7.25-12/2.2 AV2213 Lens sphcyl bifo

7.25-12/4.2 A

V2214 Lens sphcyl bifocal over

12. A

V2215 Lens lenticular

bifocal A

V2218 Lens aniseikonic

bifocal A

V2219 Lens bifocal seg width

over A

V2220 Lens bifocal add over

3.25d A

V2221 "Lenticular lens,

bifocal" A

V2299 Lens bifocal

speciality A

V2300 Lens sphere trifocal

4.00d A

V2301 Lens sphere trifocal

4.12-7. A

V2302 Lens sphere trifocal

7.12-20 A

V2303 Lens sphcy trifocal

4.0/.12- A

V2304 Lens sphcy trifocal

4.0/2.25 A

V2305 Lens sphcy trifocal

4.0/4.25 A

V2306 Lens sphcyl trifocal

4.00/>6 A

V2307 Lens sphcy trifocal

4.25-7/. A

V2308 Lens sphc trifocal

4.25-7/2. A

V2309 Lens sphc trifocal

4.25-7/4. A

V2310 Lens sphc trifocal

4.25-7/>6 A

V2311 Lens sphc trifo

7.25-12/.25- A

V2312 Lens sphc trifo

7.25-12/2.25 A

V2313 Lens sphc trifo

7.25-12/4.25 AV2314 Lens sphcyl trifocal over

12 A

V2315 Lens lenticular

trifocal A

V2318 Lens aniseikonic

trifocal A

V2319 Lens trifocal seg width >

28 A

V2320 Lens trifocal add over

3.25d A

V2321 "Lenticular lens,

trifocal" A

V2399 Lens trifocal

speciality A

V2410 Lens variab asphericity

sing A

V2430 Lens variable asphericity

bi A

V2499 Variable asphericity

lens A

V2500 Contact lens pmma

spherical A

V2501 Cntct lens

pmma-toric/prism A

V2502 Contact lens pmma

bifocal A

V2503 Cntct lens pmma color

vision A

V2510 Cntct gas permeable

sphericl A

V2511 Cntct toric prism

ballast A

V2512 Cntct lens gas permbl

bifocl A

V2513 Contact lens extended

wear A

V2520 Contact lens

hydrophilic A

V2521 Cntct lens hydrophilic

toric A

V2522 Cntct lens hydrophil

bifocl A

V2523 Cntct lens hydrophil

extend AV2530 Contact lens gas

impermeable A

V2531 Contact lens gas

permeable A

V2599 Contact lens/es other

type A

V2600 Hand held low vision

aids A

V2610 Single lens spectacle

mount A

V2615 Telescop/othr compound

lens A

V2623 Plastic eye prosth

custom A

V2624 Polishing artifical

eye A

V2625 Enlargemnt of eye

prosthesis A

V2626 Reduction of eye

prosthesis A

V2627 Scleral cover

shell A

V2628 Fabrication &

fitting A

V2629 Prosthetic eye other

type A

V2630 Anter chamber intraocul

lens N

V2631 Iris support intraoclr

lens N

V2632 Post chmbr intraocular

lens N

V2700 Balance

lens A

V2702 Deluxe lens

feature E

V2710 Glass/plastic slab off

prism A

V2715 Prism

lens/es A

V2718 Fresnell prism press-on

lens A

V2730 Special base

curve AV2744 Tint photochromatic

lens/es A

V2745 "Tint, any

color/solid/grad" A

V2750 Anti-reflective

coating A

V2755 UV

lens/es A

V2756 Eye glass

case E

V2760 Scratch resistant

coating A

V2761 Mirror

coating B

V2762 "Polarization, any

lens" A

V2770 Occluder

lens/es A

V2780 Oversize

lens/es A

V2781 Progressive lens per

lens B

V2782 "Lens, 1.54-1.65

p/1.60-1.79g" A

V2783 "Lens, >= 1.66 p/>=1.80

g" A

V2784 Lens polycarb or

equal A

V2785 Corneal tissue

processing F

V2786 Occupational multifocal

lens A

V2787 Astigmatism-correct

function E

V2788 Presbyopia-correct

function E

V2790 Amniotic

membrane N

V2797 Vis item/svc in other

code A

V2799 Miscellaneous vision

service A

V5008 Hearing

screening EV5010 Assessment for hearing

aid E

V5011 Hearing aid

fitting/checking E

V5014 Hearing aid

repair/modifying E

V5020 Conformity

evaluation E

V5030 Body-worn hearing aid

air E

V5040 Body-worn hearing aid

bone E

V5050 Hearing aid monaural in

ear E

V5060 Behind ear hearing

aid E

V5070 Glasses air

conduction E

V5080 Glasses bone

conduction E

V5090 Hearing aid dispensing

fee E

V5095 Implant mid ear hearing

pros E

V5100 Body-worn bilat hearing

aid E

V5110 Hearing aid dispensing

fee E

V5120 Body-worn binaur hearing

aid E

V5130 In ear binaural hearing

aid E

V5140 Behind ear binaur hearing

ai E

V5150 Glasses binaural hearing

aid E

V5160 Dispensing fee

binaural E

V5170 Within ear cros hearing

aid E

V5180 Behind ear cros hearing

aid E

V5190 Glasses cros hearing

aid EV5200 Cros hearing aid dispens

fee E

V5210 In ear bicros hearing

aid E

V5220 Behind ear bicros hearing

ai E

V5230 Glasses bicros hearing

aid E

V5240 Dispensing fee

bicros E

V5241 "Dispensing fee,

monaural" E

V5242 "Hearing aid, monaural,

cic" E

V5243 "Hearing aid, monaural,

itc" E

V5244 "Hearing aid, prog, mon,

cic" E

V5245 "Hearing aid, prog, mon,

itc" E

V5246 "Hearing aid, prog, mon,

ite" E

V5247 "Hearing aid, prog, mon,

bte" E

V5248 "Hearing aid, binaural,

cic" E

V5249 "Hearing aid, binaural,

itc" E

V5250 "Hearing aid, prog, bin,

cic" E

V5251 "Hearing aid, prog, bin,

itc" E

V5252 "Hearing aid, prog, bin,

ite" E

V5253 "Hearing aid, prog, bin,

bte" E

V5254 "Hearing id, digit, mon,

cic" E

V5255 "Hearing aid, digit, mon,

itc" E

V5256 "Hearing aid, digit, mon,

ite" E

V5257 "Hearing aid, digit, mon,

bte" EV5258 "Hearing aid, digit, bin,

cic" E

V5259 "Hearing aid, digit, bin,

itc" E

V5260 "Hearing aid, digit, bin,

ite" E

V5261 "Hearing aid, digit, bin,

bte" E

V5262 "Hearing aid, disp,

monaural" E

V5263 "Hearing aid, disp,

binaural" E

V5264 Ear

mold/insert E

V5265 "Ear mold/insert,

disp" E

V5266 Battery for hearing

device E

V5267 Hearing aid

supply/accessory E

V5268 ALD Telephone

Amplifier E

V5269 "Alerting device, any

type" E

V5270 "ALD, TV amplifier, any

type" E

V5271 "ALD, TV caption

decoder" E

V5272 Tdd E

V5273 ALD for cochlear

implant E

V5274 ALD

unspecified E

V5275 Ear

impression E

V5298 Hearing aid

noc E

V5299 Hearing

service B

V5336 Repair communication

device E

V5362 Speech

screening EV5363 Language

screening E

V5364 Dysphagia

screening E