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 Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Parts 410, 414, 416, 419, 421, 485, and 488
[CMS-1506-P; CMS-4125-P]
RIN 0938-AO15
 AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
 ACTION: Proposed rule.
 SUMMARY: This proposed rule would revise the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system, and to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, and the Deficit Reduction Act (DRA) of 2005. The proposed rule describes proposed changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes would be applicable to services furnished on or after January 1, 2007. In addition, this proposed rule would revise the current list of procedures that are approved when furnished in a Medicare-approved ambulatory surgical center (ASC), which would be applicable to services furnished on or after January 1, 2007. Further, this proposed rule would revise the ASC facility payment system to implement provisions of the MMA and other applicable statutory requirements, and update the ASC payment rates. Changes to the ASC facility payment system and the payment rates would be applicable to services furnished on or after January 1, 2008. This proposed rule would revise the emergency medical screening requirements for critical access hospitals (CAHs). In addition, this proposed rule would support implementation of a restructuring of the contracting entities responsibilities and functions that support the adjudication of Medicare fee-for-service (FFS) claims. This restructuring is directed by section 1874A of the Act, as added by section 911 of the MMA. The prior separate Medicare intermediary and Medicare carrier contracting authorities under Title XVIII of the Act have been replaced with the Medicare Administrative Contractor (MAC) authority. This proposed rule would also continue to implement the requirements of the DRA that require that we expand the “starter set” of 10 quality measures that we used in FY 2005 and FY 2006 for the hospital Inpatient Prospective Payment System (IPPS) Reporting Hospital Quality Data for the Annual Payment Update (RHQDAPU) program. We began to adopt expanded measures effective for payments beginning in FY 2007. We are proposing to add additional quality measures to the expanded set of measures for FY 2008 payment purposes. These measures include the HCAHPS® survey, as well as Surgical Care Improvement Project (SCIP, formerly Surgical Infection Prevention (SIP)), and Mortality quality measures.
 DATES: To be assured consideration, comments on all sections of the preamble of this proposed rule, except section XVIII. and section XXIII., must be received at one of the addresses provided in the 
                            **ADDRESSES**
                             section, no later than 5 p.m. October 10, 2006. To be assured consideration, comments on section XVIII. of this preamble relating to the proposed revised ASC payment system and the related regulation changes for implementation January 1, 2008, must be received at one of the addresses provided in the 
                            **ADDRESSES**
                             section, no later than 5 p.m. on November 6, 2006.
 ADDRESSES: In commenting on all provisions except those found in section XXIII. of the preamble, please refer to file code CMS-1506-P. In commenting on the provisions found in section XXIII. of the preamble for the FY 2008 IPPS RHQDAPU program, please refer to file code CMS-4125-P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. You may submit comments in one of four ways (no duplicates, please): 1. 
                            *Electronically.*
                             You may submit electronic comments on specific issues in this regulation to 
                            *http://www.cms.hhs.gov/​eRulemaking.*
                             Click on the link “Submit electronic comments on CMS regulations with an open comment period.” (Attachments should be in Microsoft Word, WordPerfect, or Excel; however, we prefer Microsoft Word.) 2. 
                            *By regular mail.*
                             You may mail written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1506-P, or CMS-4125-P, P.O. Box 8011, Baltimore, MD 21244-1850. Please allow sufficient time for mailed comments to be received before the close of the comment period. 3. 
                            *By express or overnight mail.*
                             You may send written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1506-P, or CMS-4125-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850. 4. 
                            *By hand or courier.*
                             If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) before the close of the comment period to one of the following addresses: Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security Boulevard, Baltimore, MD 21244-1850. If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786-7195 in advance to schedule your arrival with one of our staff members. (Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons without Federal Government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain proof of filing by stamping in and retaining an extra copy of the comments being filed.) Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period. *Submission of Comments on Paperwork Requirements.*
                             You may submit comments on this document's paperwork requirements by mailing your comments to the addresses provided at the end of the “Collection of Information Requirements” section in this document. For information on viewing public comments, see the beginning of the 
                            **SUPPLEMENTARY INFORMATION**
                             section.
 FOR FURTHER INFORMATION CONTACT: 
 
 Alberta Dwivedi, (410) 786-0378, Hospital outpatient prospective payment issues. Dana Burley, (410) 786-0378, Ambulatory surgery center issues. Suzanne Asplen, (410) 786-4558, Partial hospitalization and community mental health centers issues. Mary Collins, (410) 786-3189, Critical access hospital emergency medical planning issues. Sandra M. Clarke, (410) 786-6975, Medicare Administrative Contractors issues. Mark Zobel, (410) 786-6905, Medicare Administrative Contractors issues. Liz Goldstein, (410) 786-6665, FY 2008 IPPS RHQDAPU HCAHPS® issues. Bill Lehrman, (410) 786-1037, FY 2008 IPPS RHQDAPU HCAHPS® issues. Sheila Blackstock, (410) 786-3506, FY 2008 IPPS RHQDAPU SCIP and mortality issues.


SUPPLEMENTARY INFORMATION:  *Inspection of Public Comments:*
                         All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following Web site as soon as possible after they have been received: 
                        *http://www.cms.hhs.gov/​eRulemaking.*
                         Click on the link “Electronic Comments on CMS Regulations” on that Web site to view public comments. Comments received timely will also be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244, on Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone 1-800-743-3951. Electronic Access This 
                        **Federal Register**
                         document is also available from the 
                        **Federal Register**
                         online database through 
                        *GPO Access*, a service of the U.S. Government Printing Office. Free public access is available on a Wide Area Information Server (WAIS) through the Internet and via asynchronous dial-in. Internet users can access the database by using the World Wide Web; the Superintendent of Documents' home page address is 
                        *http://www.gpoaccess.gov/​index.html,*
                         by using local WAIS client software, or by telnet to 
                        *swais.access.gpo.gov,*
                         then login as guest (no password required). Dial-in users should use communications software and modem to call (202) 512-1661; type swais, then login as guest (no password required). Alphabetical List of Acronyms Appearing in the Proposed Rule ACEP American College of Emergency Physicians AHA American Hospital Association AHIMA American Health Information Management Association AMA American Medical Association APC Ambulatory payment classification AMP Average manufacturer price ASC Ambulatory Surgical Center ASP Average sales price AWP Average wholesale price BBA Balanced Budget Act of 1997, Pub. L. 105-33 BBRA Medicare, Medicaid, and SCHIP [State Children's Health Insurance Program] Balanced Budget Refinement Act of 1999, Pub. L. 106-113 BCA Blue Cross Association BCBSA Blue Cross and Blue Shield Association BIPA Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, Pub. L. 106-554 CAH Critical access hospital CBSA Core-Based Statistical Area CCR Cost-to-charge ratio CMHC Community mental health center CMS Centers for Medicare & Medicaid Services CNS Clinical nurse specialist CORF Comprehensive outpatient rehabilitation facility CPT [Physicians'] Current Procedural Terminology, Fourth Edition, 2006, copyrighted by the American Medical Association CRNA Certified registered nurse anesthetist CY Calendar year DMEPOS Durable medical equipment, prosthetics, orthotics, and supplies DMERC Durable medical equipment regional carrier DRA Deficit Reduction Act of 2005, Pub. L. 109-171 DSH Disproportionate share hospital EACH Essential Access Community Hospital E/M Evaluation and management EPO Erythropoietin ESRD End-stage renal disease FACA Federal Advisory Committee Act, Pub. L. 92-463 FAR Federal Acquisition Regulations FDA Food and Drug Administration FFS Fee-for-service FSS Federal Supply Schedule FY Federal fiscal year GAO Government Accountability Office HCPCS Healthcare Common Procedure Coding System HCRIS Hospital Cost Report Information System HHA Home health agency HIPAA Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191 ICD-9-CM International Classification of Diseases, Ninth Edition, Clinical Modification IDE Investigational device exemption IPPS [Hospital] Inpatient prospective payment system IVIG Intravenous immune globulin MAC Medicare Administrative Contractors MedPAC Medicare Payment Advisory Commission MDH Medicare-dependent, small rural hospital MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Pub. L. 108-173 MPFS Medicare Physician Fee Schedule MSA Metropolitan Statistical Area NCCI National Correct Coding Initiative NCD National Coverage Determination NTIOL New technology intraocular lens OCE Outpatient Code Editor OMB Office of Management and Budget OPD [Hospital] Outpatient department OPPS [Hospital] Outpatient prospective payment system PA Physician assistant PHP Partial hospitalization program PM Program memorandum PPI Producer Price Index PPS Prospective payment system PPV Pneumococcal pneumonia (virus) PRA Paperwork Reduction Act QIO Quality Improvement Organization RFA Regulatory Flexibility Act RHQDAPU Reporting hospital quality data for annual payment update RHHI Regional home health intermediary SBA Small Business Administration SCH Sole community hospital SDP Single Drug Pricer SI Status indicator TEFRA Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248 TOPS Transitional outpatient payments USPDI United States Pharmacopoeia Drug Information In this document, we address three payment systems under the Medicare program: the hospital outpatient prospective payment system (OPPS), the hospital inpatient prospective payment system (IPPS), and the ambulatory surgical center (ASC) payment system. The provisions relating to the OPPS are included in sections I. through XIII., XV., XVI., XX., XXIV., XXVI., and XXVII. of the preamble and in Addenda A, B, C (available on the Internet only; see section XXIV. of the preamble of this proposed rule), D1, D2, and E of this proposed rule. The provisions related to IPPS are included in sections XXIII., XXV. through XXVII. of the preamble. The provisions related to ASCs are 
                        ( print page 49508)
                        included in sections XVII,. XVIII., and XXIV. through XXVII. of the preamble and in Addenda AA, BB, and CC of the proposed rule. In addition, in this document, we address our proposed implementation of the Medicare contracting reform provisions of the MMA that replace the prior Medicare intermediary and carrier authorities formerly found in sections 1816 and 1842 of the Act with Medicare administrative contractor (MAC) authority under a new section 1874A of the Act. The provisions relating to MACs are included in sections XIX., XXVI., and XXVII.E. of this preamble. To assist readers in referencing sections contained in this document, we are providing the following table of contents: Table of Contents I. Background for the OPPS A. Legislative and Regulatory Authority for the Hospital Outpatient Prospective Payment System B. Excluded OPPS Services and Hospitals C. Prior Rulemaking D. APC Advisory Panel 1. Authority of the APC Panel 2. Establishment of the APC Panel 3. APC Panel Meetings and Organizational Structure E. Provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 1. Reduction in Threshold for Separate APCs for Drugs 2. Special Payment for Brachytherapy F. Provisions of the Deficit Reduction Act of 2005 1. 3-Year Transition of Hold Harmless Payments 2. Medicare Coverage of Ultrasound Screening for Abdominal Aortic Aneurysms G. Summary of the Major Contents of This Proposed Rule 1. Proposed Updates Affecting Payment for CY 2007 2. Proposed Ambulatory Payment Classification (APC) Group Policies 3. Proposed Payment Changes for Devices 4. Proposed Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals 5. Estimate of Transitional Pass-Through Spending in CY 2007 for Drugs, Biologicals, and Radiopharmaceuticals 6. Proposed Brachytherapy Payment Changes 7. Proposed Coding and Payment for Drug and Vaccine Administration 8. Proposed Hospital Coding for Evaluation and Management (E/M) Services 9. Proposed Payment for Blood and Blood Products 10. Proposed Payment for Observation Services 11. Procedures That Will Be Paid Only as Inpatient Services 12. Proposed Nonrecurring Policy Changes 13. Emergency Medical Screening in Critical Access Hospitals (CAHs) 14. Proposed OPPS Payment Status and Comment Indicator 15. OPPS Policy and Payment Recommendations 16. Proposed Policies Affecting Ambulatory Surgical Centers (ASCs) for CY 2007 17. Proposed Revised Ambulatory Surgical Center (ASC) Payment System for Implementation January 1, 2008 18. Medicare Provider Contractor Reform Mandate 19. Reporting Quality Data for Improved Quality and Costs under the OPPS 20. Promoting Effective Use of Health Information Technology 21. Health Care Information Transparency Initiative 22. Reporting Hospital Quality Data for Annual Payment Update under the IPPS 23. Impact Analysis II. Proposed Updates Affecting OPPS Payments for CY 2007 A. Proposed Recalibration of APC Relative Weights for CY 2007 1. Database Construction a. Database Source and Methodology b. Proposed Use of Single and Multiple Procedure Claims c. Proposed Revision to the Overall Cost-to-Charge Ratio (CCR) Calculation 2. Proposed Calculation of Median Costs for CY 2007 3. Proposed Calculation of Scaled OPPS Payment Weights 4. Proposed Changes to Packaged Services B. Proposed Payment for Partial Hospitalization 1. Background 2. Proposed PHP APC Update for CY 2007 3. Proposed Separate Threshold for Outlier Payments to CMHCs C. Proposed Conversion Factor Update for CY 2007 D. Proposed Wage Index Changes for CY 2007 E. Proposed Statewide Average Default CCRs F. OPPS Payments to Certain Rural Hospitals 1. Hold Harmless Transitional Payment Changes Made by Pub. L. 109-171 (DRA) 2. Proposed Adjustment for Rural SCHs Implemented in CY 2006 Related to Pub. L. 108-173 (MMA) G. Proposed CY 2007 Hospital Outpatient Outlier Payments H. Calculation of the Proposed OPPS National Unadjusted Medicare Payment I. Proposed Beneficiary Copayments for CY 2007 1. Background 2. Proposed Copayment for CY 2007 3. Calculation of a Proposed Adjusted Copayment Amount for an APC Group for CY 2007 III. Proposed OPPS Ambulatory Payment Classification (APC) Group Policies A. Proposed Treatment of New HCPCS and CPT Codes 1. Proposed Treatment of New HCPCS Codes Included in the Second and Third Quarterly OPPS Updates for CY 2006 2. Proposed Treatment of New CY 2007 Category I and III CPT Codes and Level II HCPCS Codes 3. Proposed Treatment of New Mid-Year CPT Codes B. Proposed Changes—Variations Within APCs 1. Background 2. Application of the 2 Times Rule 3. Exceptions to the 2 Times Rule C. New Technology APCs 1. Introduction 2. Proposed Movement of Procedures from New Technology APCs to Clinical APCs a. Nonmyocardial Positron Emission Tomography (PET) Scans b. PET/Computed Tomography (CT) Scans c. Stereotactic Radiosurgery (SRS) Treatment Delivery Services d. Magnetoencephalography (MEG) Services e. Other Services in New Technology APCs D. Proposed APC-Specific Policies 1. Skin Replacement Surgery and Skin Substitutes (APCs 0024, 0025 and 0027) 2. Treatment of Fracture/Dislocation (APC 0046) 3. Electrophysiologic Recording/Mapping (APC 0087) 4. Insertion of Mesh or Other Prosthesis (APC 0154) 5. Percutaneous Renal Cryoablation (APC 0163) 6. Keratoprosthesis (APC 0244) 7. Medication Therapy Management Services 8. Complex Interstitial Radiation Source Application (APC 0651) 9. Single Allergy Tests (APC 0381) 10. Hyperbaric Oxygen Therapy (APC 0659) 11. Myocardial Positron Emission Tomography (PET) Scans (APCs 0306, 0307) 12. Radiology Procedures (APCs 0333, 0662, and Other Imaging APCs) IV. Proposed OPPS Payment Changes for Devices A. Proposed Treatment of Device-Dependent APCs 1. Background 2. Proposed CY 2007 Payment Policy 3. Devices Billed in the Absence of an Appropriate Procedure Code 4. Proposed Payment Policy When Devices are Replaced Without Cost or Where Credit for a Replaced Device is Furnished to the Hospital B. Proposed Pass-Through Payments for Devices 1. Expiration of Transitional Pass-Through Payments for Certain Devices a. Background b. Proposed Policy for CY 2007 2. Provisions for Reducing Transitional Pass-Through Payments to Offset Costs Packaged Into APC Groups a. Background b. Proposed Policy for CY 2007 V. Proposed OPPS Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals A. Proposed Transitional Pass-Through Payment for Additional Costs of Drugs and Biologicals 1. Background 2. Expiration in CY 2006 of Pass-Through Status for Drugs and Biologicals 3. Drugs and Biologicals With Proposed Pass-Through Status in CY 2007
                            ( print page 49509) B. Proposed Payment for Drugs, Biologicals, and Radiopharmaceuticals Without Pass-Through Status 1. Background 2. Proposed Criteria for Packaging Payment for Drugs, Biologicals, and Radiopharmaceuticals 3. Proposed Payment for Drugs, Biologicals, and Radiopharmaceuticals Without Pass-Through Status That Are Not Packaged a. Proposed Payment for Specified Covered Outpatient Drugs b. Proposed CY 2007 Payment for Nonpass-Through Drugs, Biologicals, Radiopharmaceuticals With HCPCS Codes, But Without OPPS Hospital Claims Data VI. Proposed Estimate of OPPS Transitional Pass-Through Spending in CY 2007 for Drugs, Biologicals, Radiopharmaceuticals, and Devices A. Total Allowed Pass-Through Spending B. Proposed Estimate of Pass-Through Spending for CY 2007 VII. Proposed Brachytherapy Source Payment Changes A. Background B. Proposed Payments for Brachytherapy Sources in CY 2007 VIII. Proposed Changes to OPPS Drug Administration Coding and Payment for CY 2007 A. Background B. Proposed CY 2007 Drug Administration Coding Changes C. Proposed CY 2007 Drug Administration Payment Changes IX. Proposed Hospital Coding and Payment for Visits A. Background 1. Guidelines Based on the Number or Type of Staff Interventions 2. Guidelines Based on the Time Staff Spent With the Patient 3. Guidelines Based on a Point System Where a Certain Number of Points Are Assigned to Each Staff Intervention Based on the Time, Intensity, and Staff Type Required for the Intervention 4. Guidelines Based on Patient Complexity B. CY 2007 Proposed Coding 1. Clinic Visits 2. Emergency Department Visits 3. Critical Care Services C. CY 2007 Proposed Payment Policy D. CY 2007 Proposed Treatment of Guidelines 1. Background 2. Outstanding Concerns With the AHA/AHIMA Guidelines a. Three Versus Five Levels of Codes b. Lack of Clarity for Some Interventions c. Treatment of Separately Payable Services d. Some Interventions Appear Overvalued e. Concerns of Specialty Clinics f. American with Disabilities Act g. Differentiation Between New and Established Patients, and Between Standard Visits and Consultations h. Distinction Between Type A and Type B Emergency Departments X. Proposed Payment for Blood and Blood Products A. Background B. Proposed Policy Changes for CY 2007 XI. Proposed OPPS Payment for Observation Services XII. Proposed Procedures That Will Be Paid Only as Inpatient Procedures A. Background B. Proposed Changes to the Inpatient Only List C. Proposed CY 2007 Payment for Ancillary Outpatient Services When Patient Expires (-CA Modifier) 1. Background 2. Proposed Policy for CY 2007 XIII. Proposed OPPS Nonrecurring Policy Changes A. Removal of Comprehensive Outpatient Rehabilitation Facility (CORF) Services from the List of Services Paid under the OPPS B. Addition of Ultrasound Screening for Abdominal Aortic Aneurysms (AAAs) (Section 5112 of Pub. L. 109-171 (DRA)) 1. Background 2. Proposed Assignment of New HCPCS Code for Payment of Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) (Section 5112) 3. Handling of Comments Received in Response to This Proposal XIV. Emergency Medical Screening in Critical Access Hospitals (CAHs) A. Background B. Proposed Policy Change XV. Proposed OPPS Payment Status and Comment Indicators A. Proposed CY 2007 Status Indicator Definitions 1. Proposed Payment Status Indicators to Designate Services That Are Paid Under the OPPS 2. Proposed Payment Status Indicators to Designate Services That Are Paid Under a Payment System Other Than the OPPS 3. Proposed Payment Status Indicators to Designate Services That Are Not Recognized Under the OPPS But That May Be Recognized by Other Institutional Providers 4. Proposed Payment Status Indicators to Designate Services That Are Not Payable by Medicare B. Proposed CY 2007 Comment Indicator Definitions XVI. OPPS Policy and Payment Recommendations A. MedPAC Recommendations B. APC Panel Recommendations C. GAO Recommendations XVII. Proposed Policies Affecting Ambulatory Surgical Centers (ASCs) for CY 2007 A. ASC Background 1. Legislative History 2. Current Payment Method 3. Published Changes to the ASC List B. Proposed ASC List Update Effective for Services Furnished on or After January 1, 2007 1. Criteria for Additions to or Deletions from the ASC List 2. Response to Comments to the May 4, 2005 Interim Final Rule for the ASC Update 3. Procedures Proposed for Additions to the ASC List 4. Suggested Additions Not Accepted 5. Rationale for Payment Assignment 6. Other Comments on the May 4, 2005 Interim Final Rule C. Proposed Regulatory Changes for CY 2007 D. Implementation of Section 5103 of Pub. L. 109-171 (DRA) E. Proposal to Modify the Current ASC Process for Adjusting Payment for New Technology Intraocular Lenses (NTIOLs) 1. Background a. Current ASC Payment for Insertion of IOLs b. Classes of NTIOLs Approved for Payment Adjustment 2. Proposed Changes a. Process for Recognizing IOLs as Belonging to an Active IOL Class b. Public Notice and Comment Regarding Adjustments of NTIOL Payment Amounts c. Factors CMS Considers in Determining Whether a Payment Adjustment for Insertion of a New Class of IOL is Appropriate d. Proposal to Revise Content of a Request to Review e. Notice of CMS Determination f. Proposed Payment Adjustment XVIII. Proposed Revised ASC Payment System for Implementation January 1, 2008 A. Background 1. Provisions of Pub. L. 108-173 2. Other Factors Considered B. Procedures Proposed for Medicare Payment in ASCs Effective for Services Furnished on or After January 1, 2008 1. Proposed Payable Procedures a. Proposed Definition of Surgical Procedure b. Procedures Proposed for Exclusion from Payment Under the Revised ASC System 2. Proposed Treatment of Unlisted Procedure Codes and Procedures That Are Not Paid Separately Under the OPPS 3. Proposed Treatment of Office-Based Procedures 4. Listing of Surgical Procedures Proposed for Exclusion from Payment of an ASC Facility Fee Under the Revised Payment System C. Proposed Ratesetting Method 1. Overview of Current ASC Payment System 2. Proposal to Base ASC Relative Payment Weights on APC Groups and Relative Payment Weights Established Under the OPPS 3. Proposed Packaging Policy 4. Payment for Corneal Tissue Under the Revised ASC Payment System 5. Proposed Payment for Office-Based Procedures 6. Payment Policy for Multiple Procedure Discounting 7. Proposed Geographic Adjustment 8. Proposed Adjustment for Inflation 9. Proposed Beneficiary Coinsurance 10. Proposed to Phase in Implementation of Payment Rates Calculated Under the CY 2008 Revised ASC Payment System 11. Proposed Calculation of ASC Conversion Factor and Payment Rates for CY 2008 a. Overview b. Budget Neutrality Requirement 
                            ( print page 49510) c. Proposed Calculation of the ASC Payment Rates for CY 2008 d. Proposed Calculation of the ASC Payment Rates for CY 2009 and Future Years e. Alternative Option for Calculating the Budget Neutrality Adjustment Considered 12. Proposed Annual Updates D. Information in Addenda Related to the Revised CY 2008 ASC Payment System E. Technical Changes to 42 CFR Parts 414 and 416 XIX. Medicare Contracting Reform Mandate A. Background B. CMS's Vision for Medicare Fee-for-Service and MACs C. Provider Nomination and the Former Medicare Acquisition Authorities D. Summary of Changes Made to Sections 1816 of the Act E. Provisions of the Proposed Regulations 1. Definitions 2. Assignments of Providers and Suppliers to MACs 3. Other Proposed Technical and Conforming Changes a. Definition of “Intermediary” b. Intermediary Functions c. Options Available to Providers and CMS d. Nomination for Intermediary e. Notification of Actions on Nominations, Changes to Another Intermediary or to Director Payment, and Requirements for Approval of an Agreement f. Considerations Relating to the Effective and Efficient Administration of the Medicare Program g. Assignment and Reassignment of Providers by CMS h. Designation of National or Regional Intermediaries and Designation of Regional and Alternative Designated Regional Intermediaries for Home Health Agencies and Hospices i. Awarding of Experimental Contracts XX. Reporting Quality Data for Improved Quality and Costs under the OPPS XXI. Promoting Effective Use of Health Care Technology XXII. Health Care Information Transparency Initiative XXIII. Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update A. Background B. Proposed Additional Quality Measures for FY 2008 1. Introduction 2. HCAHPS® Survey and the Hospital Quality Initiative 3. Surgical Care Improvement Project (SCIP) Quality Measures 4. Mortality Outcome Measures C. General Procedures and Participation Requirements for the FY 2008 IPPS RHQDAPU Program D. HCAHPS® Procedures and Participation Requirements for the FY 2008 IPPS RHQDAPU Program 1. Introduction 2. HCAHPS® Hospital Pledge and Beginning Date for Data Collection 3. HCAHPS® Dry Run 4. HCAHPS® Data Collection Requirements 5. HCAHPS® Registration Requirements 6. HCAHPS® Additional Steps 7. HCAHPS® Survey Completion Requirements 8. HCAHPS® Public Reporting 9. Reporting HCAHPS® Results for Multi-Campus Hospitals E. SCIP & Mortality Measure Requirements for the FY 2008 RHQDAPU Program F. Conclusion XXIV. Files Available to the Public Via the Internet XXV. Collection of Information Requirements XXVI. Response to Comments XXVII. Regulatory Impact Analysis A. Overall Impact 1. Executive Order 12866 2. Regulatory Flexibility Act (RFA) 3. Small Rural Hospitals 4. Unfunded Mandates 5. Federalism B. Effects of Proposed OPPS Changes in This Proposed Rule 1. Alternatives Considered a. Alternatives Considered for CPT Coding and Payment Policy for Evaluation and Management Codes b. Options Considered for Brachytherapy Source Payments c. Options Considered for Payment of Radiopharmaceuticals 2. Limitation of Our Analysis 3. Estimated Impact of This Proposed Rule on Hospitals 4. Estimated Effect of This Proposed Rule on Beneficiaries 5. Accounting Statement 6. Conclusion C. Effects of Proposed Changes to the ASC Payment System for CY 2007 1. Alternatives Considered 2. Limitations on Our Analysis 3. Estimated Effects of This Proposed Rule on ASCs 4. Estimated Effects of This Proposed Rule on Beneficiaries 5. Conclusion 6. Accounting Statement D. Effects of the Proposed Revisions to the ASC Payment System for CY 2008 1. Alternatives Considered 2. Limitations on Our Analysis 3. Estimated Effects of This Proposed Rule on ASCs 4. Estimated Effects of This Proposed Rule on Beneficiaries 5. Conclusion E. Effects of the Medicare Contractor Reform Mandate F. Effects of Proposed Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for IPPS FY 2008 1. Alternatives Considered 2. Estimated Effects of This Proposed Rule a. Effects on Hospitals b. Effects on Other Providers c. Effects on the Medicare and Medicaid Program G. Executive Order 12866 Regulation Text Addenda Addendum A—OPPS Proposed List of Ambulatory Payment Classification (APCs) With Status Indicators (SI), Relative Weights, Payment Rates, and Copayment Amounts— CY 2007 Addendum AA—Proposed List of Medicare Approved ASC Procedures for CY 2007 With Additions and Payment Rates; Including Rates That Result From Implementation of Section 5103 of the DRA Addendum B—OPPS Proposed Payment Status by HCPCS Code and Related Information Calendar Year 2007 Addendum BB—Proposed List of Medicare Approved ASC Procedures for CY 2008 With Additions and Payment Rates Addendum CC—Proposed List of Procedures for CY 2008 Subject to Payment Limitation at the Medicare Physician Fee Schedule (MPFS) Nonfacility Amount Addendum D1—Proposed Payment Status Indicators Addendum D2—Proposed Comment Indicators Addendum E—Proposed CPT Codes That Are Paid Only as Inpatient Procedures I. Background for the OPPS A. Legislative and Regulatory Authority for the Hospital Outpatient Prospective Payment System When the Medicare statute was originally enacted, Medicare payment for hospital outpatient services was based on hospital-specific costs. In an effort to ensure that Medicare and its beneficiaries pay appropriately for services and to encourage more efficient delivery of care, the Congress mandated replacement of the reasonable cost-based payment methodology with a prospective payment system (PPS). The Balanced Budget Act (BBA) of 1997 (Pub. L. 105-33), added section 1833(t) to the Social Security Act (the Act) authorizing implementation of a PPS for hospital outpatient services (OPPS). The Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act (BBRA) of 1999 (Pub. L. 106-113), made major changes in the hospital OPPS. The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000 (Pub. L. 106-554), made further changes in the OPPS. Section 1833(t) of the Act was also amended by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Pub. L. 108-173). The Deficit Reduction Act (DRA) of 2005 (Pub. L. 109-171), enacted on February 8, 2006, made additional changes in the OPPS. A discussion of the provisions contained in Pub. L. 109-171 that are specific to the calendar year (CY) 2007 OPPS is included in section II.F. of this preamble. The OPPS was first implemented for services furnished on or after August 1, 2000. Implementing regulations for the OPPS are located at 42 CFR Part 419. Under the OPPS, we pay for hospital outpatient services on a rate-per-service 
                        ( print page 49511)
                        basis that varies according to the ambulatory payment classification (APC) group to which the service is assigned. We use Healthcare Common Procedure Coding System (HCPCS) codes (which include certain Current Procedural Terminology (CPT) codes) and descriptors to identify and group the services within each APC group. The OPPS includes payment for most hospital outpatient services, except those identified in section I.B. of this preamble. Section 1833(t)(1)(B)(ii) of the Act provides for Medicare payment under the OPPS for hospital outpatient services designated by the Secretary (which includes partial hospitalization services furnished by community mental health centers (CMHCs)) and hospital outpatient services that are furnished to inpatients who have exhausted their Part A benefits or who are otherwise not in a covered Part A stay. Section 611 of Pub. L. 108-173 added provisions for Medicare coverage of an initial preventive physical examination, subject to the applicable deductible and coinsurance, as an outpatient department service, payable under the OPPS. The OPPS rate is an unadjusted national payment amount that includes the Medicare payment and the beneficiary copayment. This rate is divided into a labor-related amount and a nonlabor-related amount. The labor-related amount is adjusted for area wage differences using the inpatient hospital wage index value for the locality in which the hospital or CMHC is located. All services and items within an APC group are comparable clinically and with respect to resource use (section 1833(t)(2)(B) of the Act). In accordance with section 1833(t)(2) of the Act, subject to certain exceptions, services and items within an APC group cannot be considered comparable with respect to the use of resources if the highest median (or mean cost, if elected by the Secretary) for an item or service in the APC group is more than 2 times greater than the lowest median cost for an item or service within the same APC group (referred to as the “2 times rule”). In implementing this provision, we use the median cost of the item or service assigned to an APC group. Special payments under the OPPS may be made for new technology items and services in one of two ways. Section 1833(t)(6) of the Act provides for temporary additional payments which we refer to as “transitional pass-through payments” for at least 2 but not more than 3 years for certain drugs, biological agents, brachytherapy devices used for the treatment of cancer, and categories of other medical devices. For new technology services that are not eligible for transitional pass-through payments and for which we lack sufficient data to appropriately assign them to a clinical APC group, we have established special APC groups based on costs, which we refer to as new technology APCs. These new technology APCs are designated by cost bands which allow us to provide appropriate and consistent payment for designated new procedures that are not yet reflected in our claims data. Similar to pass-through payments, an assignment to a new technology APC is temporary; that is, we retain a service within a new technology APC until we acquire sufficient data to assign it to a clinically appropriate APC group. B. Excluded OPPS Services and Hospitals Section 1833(t)(1)(B)(i) of the Act authorizes the Secretary to designate the hospital outpatient services that are paid under the OPPS. While most hospital outpatient services are payable under the OPPS, section 1833(t)(1)(B)(iv) of the Act excludes payment for ambulance, physical and occupational therapy, and speech-language pathology services, for which payment is made under a fee schedule. Section 614 of Pub. L. 108-173 amended section 1833(t)(1)(B)(iv) of the Act to exclude OPPS payment for screening and diagnostic mammography services. The Secretary exercised the authority granted under the statute to exclude from the OPPS those services that are paid under fee schedules or other payment systems. Such excluded services include, for example, the professional services of physicians and nonphysician practitioners paid under the Medicare Physician Fee Schedule (MPFS); laboratory services paid under the clinical diagnostic laboratory fee schedule; services for beneficiaries with end-stage renal disease (ESRD) that are paid under the ESRD composite rate; and, services and procedures that require an inpatient stay that are paid under the hospital inpatient prospective payment system (IPPS). We set forth the services that are excluded from payment under the OPPS in § 419.22 of the regulations. Under § 419.20(b) of the regulations, we specify the types of hospitals and entities that are excluded from payment under the OPPS. These excluded entities include Maryland hospitals, but only for services that are paid under a cost containment waiver in accordance with section 1814(b)(3) of the Act; critical access hospitals (CAHs); hospitals located outside of the 50 States, the District of Columbia, and Puerto Rico; and Indian Health Service hospitals. C. Prior Rulemaking On April 7, 2000, we published in the 
                        **Federal Register**
                         a final rule with comment period (65 FR 18434) to implement a prospective payment system for hospital outpatient services. The hospital OPPS was first implemented for services furnished on or after August 1, 2000. Section 1833(t)(9) of the Act requires the Secretary to review certain components of the OPPS not less often than annually and to revise the groups, relative payment weights, and other adjustments to take into account changes in medical practice, changes in technology, and the addition of new services, new cost data, and other relevant information and factors. Since initially implementing the OPPS, we have published final rules in the 
                        **Federal Register**
                         annually to implement statutory requirements and changes arising from our experience with this system. We last published such a document on November 10, 2005 (70 FR 68516). In that final rule with comment period, we revised the OPPS to update the payment weights and conversion factor for services payable under the CY 2006 OPPS on the basis of claims data from January 1, 2004, through December 31, 2004, and to implement certain provisions of Pub. L. 108-173. In addition, we responded to public comments received on the provisions of November 15, 2004 final rule with comment period pertaining to the APC assignment of HCPCS codes identified in Addendum B of that rule with the new interim (NI) comment indicators; and public comments received on the July 25, 2005 OPPS proposed rule for CY 2006 (70 FR 42674). We published a correction of the November 10, 2005 final rule with comment period on December 23, 2005 (70 FR 76176). This correction document corrected a number of technical errors that appeared in the November 10, 2005 final rule with comment period. D. APC Advisory Panel 1. Authority of the APC Panel Section 1833(t)(9)(A) of the Act, as amended by section 201(h) of the BBRA, requires that we consult with an outside panel of experts to review the clinical integrity of the payment groups and their weights under the OPPS. The Act further specifies that the panel will act in an advisory capacity. The Advisory Panel on Ambulatory Payment 
                        ( print page 49512)
                        Classification (APC) Groups (the APC Panel), discussed under section I.D.2. of this preamble, fulfills these requirements. The APC Panel is not restricted to using data compiled by CMS and may use data collected or developed by organizations outside the Department in conducting its review. 2. Establishment of the APC Panel On November 21, 2000, the Secretary signed the initial charter establishing the APC Panel. This expert panel, which may be composed of up to 15 representatives of providers subject to the OPPS (currently employed full-time, not as consultants, in their respective areas of expertise), reviews and advises CMS about the clinical integrity of the APC groups and their weights. For purposes of this Panel, consultants or independent contractors are not considered to be full-time employees. The APC Panel is technical in nature and is governed by the provisions of the Federal Advisory Committee Act (FACA). Since its initial chartering, the Secretary has twice renewed the APC Panel's charter: on November 1, 2002, and on November 1, 2004. The current charter indicates, among other requirements, that the APC Panel continues to be technical in nature; is governed by the provisions of the FACA; may convene up to three meetings per year; has a Designated Federal Officer (DFO); and is chaired by a Federal official who also serves as a CMS medical officer. The current APC Panel membership and other information pertaining to the Panel, including its charter, 
                        **Federal Register**
                         notices, meeting dates, agenda topics, and meeting reports can be viewed on the CMS Web site at 
                        *http://new.cms.hhs.gov/​FACA/​05_​AdvisoryPanelonAmbulatoryPaymentClassificationGroups.asp.* 3. APC Panel Meetings and Organizational Structure The APC Panel first met on February 27, February 28, and March 1, 2001. Since that initial meeting, the APC Panel has held nine subsequent meetings, with the last meeting taking place on March 1 and 2, 2006. (The APC Panel did not meet on March 3, 2006, as announced in the meeting notice published on December 23, 2005 (70 FR 76313).) Prior to each meeting, we publish a notice in the 
                        **Federal Register**
                         to announce the meeting and, when necessary, to solicit and announce nominations for APC Panel membership. The APC Panel has established an operational structure that, in part, includes the use of three subcommittees to facilitate its required APC review process. The three current subcommittees are the Data Subcommittee, the Observation Subcommittee, and the Packaging Subcommittee. The Data Subcommittee is responsible for studying the data issues confronting the APC Panel and for recommending options for resolving them. The Observation Subcommittee reviews and makes recommendations to the APC Panel on all issues pertaining to observation services paid under the OPPS, such as coding and operational issues. The Packaging Subcommittee studies and makes recommendations on issues pertaining to services that are not separately payable under the OPPS, but are bundled or packaged APC payments. Each of these subcommittees was established by a majority vote of the APC Panel during a scheduled APC Panel meeting. All subcommittee recommendations are discussed and voted upon by the full APC Panel. Discussions of the recommendations resulting from the APC Panel's March 2006 meeting are included in the sections of this preamble that are specific to each recommendation. For discussions of earlier APC Panel meetings and recommendations, we reference previous hospital OPPS final rules or the Web site mentioned earlier in this section. E. Provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, Pub. L. 108-173, made changes to the Act relating to the Medicare OPPS. In the January 6, 2004 interim final rule with comment period and the November 15, 2004 final rule with comment period, we implemented provisions of Pub. L. 108-173 relating to the OPPS that were effective for services provided in CY 2004 and CY 2005, respectively. In the November 10, 2005 final rule with comment period, we implemented provisions of Pub. L. 108-173 relating to the OPPS that went into effect for services provided in CY 2006 (70 FR 68521). We note below those provisions of Pub. L. 108-173 that will expire at the end of CY 2006. 1. Reduction in Threshold for Separate APCs for Drugs Section 621(a)(2) of Pub. L. 108-173 amended section 1833(t)(16) of the Act to set a $50 per administration threshold for the establishment of separate APCs for drugs and biologicals furnished from January 1, 2005, through December 31, 2006. Because this statutory provision will no longer be in effect for CY 2007, we have included a discussion of the proposed methodology that we would use for the drug administration threshold for CY 2007 in section V. of this preamble. 2. Special Payment for Brachytherapy Section 621(b)(1) of Pub. L. 108-173 amended section 1833(t)(16) of the Act to require that payment for brachytherapy devices consisting of a seed or seeds (or radioactive source) furnished on or after January 1, 2004, and before January 1, 2007, be paid based on the hospital's charge for each device furnished, adjusted to cost. Because this statutory provision will no longer be in effect for CY 2007, we discuss our proposed methodology for payment for brachytherapy devices for CY 2007 in section VII.B. of this preamble. F. Provisions of the Deficit Reduction Act of 2005 The Deficit Reduction Act (DRA) of 2005, Pub. L. 109-171, enacted on February 8, 2006, included three provisions affecting the OPPS, as discussed below. 1. 3-Year Transition of Hold Harmless Payments Section 5105 of Pub. L. 109-171 provides a 3-year transition of hold harmless OPPS payments for hospitals located in a rural area with not more than 100 beds that are not defined as sole community hospitals (SCHs). This provision provides an increased payment for such hospitals for covered OPD services furnished on or after January 1, 2006, and before January 1, 2009, if the OPPS payment they receive is less than the pre-BBA payment amount that they would have received for the same covered OPD services. This provision specifies that, in such cases, the amount of payment to the specified hospitals shall be increased by the applicable percentage of such difference. Section 5105 specifies the applicable percentage as 95 percent for CY 2006, 90 percent for CY 2007, and 85 percent for CY 2008. 2. Medicare Coverage of Ultrasound Screening for Abdominal Aortic Aneurysms Section 5112 of Pub. L. 109-171 amended section 1861 of the Act to include coverage of ultrasound screening for abdominal aortic aneurysms for certain individuals on or after January 1, 2007. The provision will apply to individuals (a) Who receive a referral for such an ultrasound screening as a result of an initial preventive physical examination; (b) who have not 
                        ( print page 49513)
                        been previously furnished with an ultrasound screening under Medicare; and (c) who have a family history of abdominal aortic aneurysm or manifest risk factors included in a beneficiary category recommended for screening (as determined by the United States Preventive Services Task Force). Ultrasound screening for abdominal aortic aneurysm will be included in the initial preventive physical examination. Section 5112 also added ultrasound screening for abdominal aortic aneurysm to the list of services for which the beneficiary deductible does not apply. These amendments apply to services furnished on or after January 1, 2007. G. Summary of the Major Content of This Proposed Rule In this proposed rule, we are setting forth proposed changes to the Medicare hospital OPPS for CY 2007. These changes would be effective for services furnished on or after January 1, 2007. We are setting forth proposed changes to the Medicare ASC program for CY 2007 and CY 2008. We are setting forth proposed changes to the way we process FFS claims under Medicare Part A and Part B. Some of these changes were effective on October 1, 2005 and all of the changes are to be fully implemented by October 1, 2011. Finally, we are setting forth a notice seeking comments on the RHQDAPU program under the Medicare hospital IPPS for FY 2008. These changes would be effective for payments beginning with FY 2008. The following is a summary of the major changes that we are proposing to make: 1. Proposed Updates Affecting Payments for CY 2007 In section II. of this preamble, we set forth— The methodology used to recalibrate the proposed APC relative payment weights and the proposed recalibration of the relative payment weights for CY 2007.
                    The proposed payment for partial hospitalization, including the proposed separate threshold for outlier payments for CMHCs.
                    The proposed update to the conversion factor used to determine payment rates under the OPPS for CY 2007.
                    The proposed retention of our current policy to apply the IPPS wage indices to wage adjust the APC median costs in determining the OPPS payment rate and the copayment standardized amount for CY 2007.
                    The proposed update of statewide average default cost-to-charge ratios.
                    Proposed changes relating to the expiring hold harmless payment provision.
                    Proposed changes to payment for rural sole community hospitals for CY 2007.
                    Proposed changes in the way we calculate hospital outpatient outlier payments for CY 2007.
                    Calculation of the proposed national unadjusted Medicare OPPS payment.
                    The proposed beneficiary copayment for OPPS services for CY 2007. 2. Proposed Ambulatory Payment Classification (APC) Group Policies In section III. of this preamble, we discuss the proposed additions of new procedure codes to the APCs; our proposal to establish a number of new APCs; and our proposal to make changes to the assignment of HCPCS codes under a number of existing APCs based on our analyses of Medicare claims data and recommendations of the APC Panel. We also discuss the application of the 2 times rule and proposed exceptions to it; proposed changes for specific APCs; the proposed refinement of the New Technology cost bands; and the proposed movement of procedures from the New Technology APCs. 3. Proposed Payment Changes for Devices In section IV. of this preamble, we discuss proposed changes to the device-dependent APCs, and to the pass-through payment for categories of devices. 4. Proposed Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals In section V. of this preamble, we discuss proposed changes for drugs, biologicals, and radiopharmaceuticals. 5. Estimate of Transitional Pass-Through Spending in CY 2007 for Drugs, Biologicals, and Devices In section VI. of this preamble, we discuss the proposed methodology for estimating total pass-through spending and whether there should be a pro rata reduction for transitional pass-through drugs, biologicals, radiopharmaceuticals, and categories of devices for CY 2007. 6. Proposed Brachytherapy Payment Changes In section VII. of this preamble, we discuss our proposal concerning coding and payment for the sources of brachytherapy. 7. Proposed Coding and Payment for Drug and Vaccine Administration In section VIII. of this preamble, we discuss our proposed coding and payment changes for drug and vaccine administration services. 8. Proposed Hospital Coding for Evaluation and Management (E/M) Services In section IX. of this preamble, we discuss our proposal for developing the coding guidelines for evaluation and management services. 9. Proposed Payment for Blood and Blood Products In section X. of this preamble, we discuss our proposed payment changes for blood and blood products. 10. Proposed Payment for Observation Services In section XI. of this preamble, we discuss our proposed criteria and coding changes for separately payable observation services. 11. Procedures That Will Be Paid Only as Inpatient Services In section XII. of this preamble, we discuss the procedures that we propose to remove from the inpatient list and assign to APCs. 12. Proposed Nonrecurring Policy Changes In section XIII. of this preamble, we discuss proposed changes to certain comprehensive outpatient rehabilitation facility (CORF) services paid under the OPPS. In this section, we also discuss proposed payment for ultrasound screening for abdominal aortic aneurysms (AAAs). 13. Emergency Medical Screening in Critical Access Hospitals (CAHs) In section XIV. of this preamble, we discuss proposed changes to a regulation governing emergency medical screening in critical access hospitals (CAHs). 14. Proposed OPPS Payment Status and Comment Indicator In section XV. of this preamble, we discuss proposed changes to the list of status indicators assigned to APCs and present our proposed comment indicators for the CY 2007 OPPS final rule. 15. OPPS Policy and Payment Recommendations In section XVI. of this preamble, we address recommendations made by MedPAC and the APC Panel regarding the OPPS for CY 2007.
                        ( print page 49514) 16. Proposed Policies Affecting Ambulatory Surgical Centers (ASCs) for CY 2007 In section XVII. of this preamble we discuss proposed payment changes affecting ASCs in CY 2007, the proposed list of updated ASC procedures, and proposed modification of the ASC payment adjustment process for new technology intraocular lenses (NTIOLs). 17. Proposed Revised Ambulatory Surgical Center (ASC) Payment System for Implementation January 1, 2008 In section XVIII. of this preamble, we discuss our proposal to implement a new ASC payment system for services furnished on or after January 1, 2008, and the regulatory changes related to the proposed new system. 18. Medicare Provider Contractor Reform Mandate In section XIX. of this preamble, we discuss proposed changes to the regulations under 42 CFR Part 421, Subpart B to conform them to the statutory changes required by section 911 of Public Law 108-173 related to Medicare contracting reform. 19. Reporting Quality Data for Improved Quality and Costs Under the OPPS In section XX. of this preamble, we discuss the expenditure growth in outpatient hospital services, invite comment on value-based purchasing specifically related to hospital outpatient departments, and discuss a value-based purchasing program proposal for the CY 2007 OPPS. 20. Promoting Effective Use of Health Information Technology In section XXI. of this preamble, we invite comments on promoting hospitals' effective use of health information technology. 21. Health Care Information Transparency Initiative In section XXII. of this preamble, we discuss HHS' major health information transparency initiative which we are launching in 2006. 22. Reporting Hospital Quality Data for Annual Payment Update Under the IPPS In section XXIII. of this preamble, we invite comment on our proposal for the FY 2008 IPPS annual payment update to add the HCAHPS® survey, measures from the Surgical Care Improvement Project (SCIP), and Mortality measures to the quality of care measures to be used in FY 2007 for purposes of the IPPS annual payment update. 23. Impact Analysis In section XXVII. of this preamble, we set forth an analysis of the impact that the proposed changes will have on affected entities and beneficiaries. II. Proposed Updates Affecting OPPS Payments for CY 2007 A. Proposed Recalibration of APC Relative Weights for CY 2007 (If you choose to comment on the issues in this section, please include the caption “APC Relative Weights” at the beginning of your comment.) 1. Database Construction a. Database Source and Methodology Section 1833(t)(9)(A) of the Act requires that the Secretary review and revise the relative payment weights for APCs at least annually. In the April 7, 2000 OPPS final rule with comment period (65 FR 18482), we explained in detail how we calculated the relative payment weights that were implemented on August 1, 2000, for each APC group. Except for some reweighting due to a small number of APC changes, these relative payment weights continued to be in effect for CY 2001. This policy is discussed in the November 13, 2000 interim final rule (65 FR 67824 through 67827). We are proposing to use the same basic methodology that we described in the April 7, 2000 final rule with comment period to recalibrate the APC relative payment weights for services furnished on or after January 1, 2007, and before January 1, 2008. That is, we would recalibrate the relative payment weights for each APC based on claims and cost report data for outpatient services. We are proposing to use the most recent available data to construct the database for calculating APC group weights. For the purpose of recalibrating APC relative payment weights in this proposed rule for CY 2007, we used approximately 131.9 million final action claims for hospital OPD services furnished on or after January 1, 2005, and before January 1, 2006. Of the 131.9 million final action claims for services provided in hospital outpatient settings, 102.9 million claims were of the type of bill potentially appropriate for use in setting rates for OPPS services (but did not necessarily contain services payable under the OPPS). Of the 102.9 million claims, approximately 48.5 million were not for services paid under the OPPS or were excluded as not appropriate for use (for example, erroneous cost-to-charge ratios or no HCPCS codes reported on the claim). We were able to use 50.7 million whole claims of the remaining 54.4 million claims to set the proposed OPPS APC relative weights for CY 2007 OPPS. From the 50.7 million whole claims, we created 91.4 million single records, of which 62.8 million were “pseudo” single claims (created from multiple procedure claims using the process we discuss in this section). The proposed APC relative weights and payments for CY 2007 in Addenda A and B to this proposed rule were calculated using claims from this period that had been processed before January 1, 2006. We selected claims for services paid under the OPPS and matched these claims to the most recent cost report filed by the individual hospitals represented in our claims data. We are proposing that the APC relative weights for CY 2007 continue to be based on the median hospital costs for services in the APC groups. For the CY 2007 OPPS final rule, we are proposing to base APC median costs on claims for services furnished in CY 2005 and processed before June 30, 2006. b. Proposed Use of Single and Multiple Procedure Claims For CY 2007, we are proposing to continue to use single procedure claims to set the medians on which the APC relative payment weights would be based. We have received many requests asking that we ensure that the data from claims that contain charges for multiple procedures are included in the data from which we calculate the relative payment weights. Requesters believe that relying solely on single procedure claims to recalibrate APC relative payment weights fails to take into account data for many frequently performed procedures, particularly those commonly performed in combination with other procedures. They believe that, by depending upon single procedure claims, we base relative payment weights on the least costly services, thereby introducing downward bias to the medians on which the weights are based. We agree that, optimally, it is desirable to use the data from as many claims as possible to recalibrate the APC relative payment weights, including those with multiple procedures. We generally use single procedure claims to set the median costs for APCs because we are, so far, unable to ensure that packaged costs can be appropriately allocated across multiple procedures performed on the same date of service. However, by bypassing specified codes that we believe do not have significant packaged costs, we are able to use more data from multiple procedure claims. In many cases, this enables us to create multiple “pseudo” single claims from claims that, as submitted, contained 
                        ( print page 49515)
                        multiple separately paid procedures on the same claim. For the CY 2007 OPPS, we are proposing to use the date of service on the claims and a list of codes to be bypassed to create “pseudo” single claims from multiple procedure claims, as we did in recalibrating the CY 2006 APC relative payment weights. We refer to these newly created single procedure claims as “pseudo” single claims because they were submitted by providers as multiple procedure claims. For CY 2003, we created “pseudo” single claims by bypassing HCPCS codes 93005 (Electrocardiogram, tracing), 71010 (Chest x-ray), and 71020 (Chest x-ray) on a submitted claim. However, we did not use claims data for the bypassed codes in the creation of the median costs for the APCs to which these three codes were assigned because the level of packaging that would have remained on the claim after we selected the bypass code was not apparent and, therefore, it was difficult to determine if the medians for these codes would be correct. For CY 2004, we created “pseudo” single claims by bypassing these three codes and also by bypassing an additional 269 HCPCS codes in APCs. We selected these codes based on a clinical review of the services and because it was presumed that these codes had only very limited packaging and could appropriately be bypassed for the purpose of creating “pseudo” single claims. The APCs to which these codes were assigned were varied and included mammography, cardiac rehabilitation, and Level I plain film x-rays. To derive more “pseudo” single claims, we also split the claims where there were dates of service for revenue code charges on that claim that could be matched to a single procedure code on the claim on the same date. For the CY 2004 OPPS, as in CY 2003, we did not include the claims data for the bypassed codes in the creation of the APCs to which the 269 codes were assigned because, again, we had not established that such an approach was appropriate and would aid in accurately estimating the median costs for those APCs. For CY 2004, from approximately 16.3 million otherwise unusable claims, we used approximately 9.5 million multiple procedure claims to create approximately 27 million “pseudo” single claims. For CY 2005, we identified 383 bypass codes and from approximately 24 million otherwise unusable claims, we used approximately 18 million multiple procedure claims to create approximately 52 million “pseudo” single claims. For CY 2005, we used the claims data for the bypass codes combined with the single procedure claims to set the median costs for the bypass codes. For CY 2006, we continued using the codes on the CY 2005 OPPS bypass list and expanded it to include 404 bypass codes, including 3 bladder catheterization codes (CPT codes 51701, 51702, and 51703), which did not meet the empirical criteria discussed below for the selection of bypass codes. We added these three codes to the CY 2006 bypass list because a decision to change their payment status from packaged to separately paid would have resulted in a reduction of the number of single bills on which we could base median costs for other major separately paid procedures that were billed on the same claim with these three procedure codes. That is, single bills which contained other procedures would have become multiple procedure claims when these bladder catheterization codes were converted to separately paid status. We believed and continue to believe that bypassing these three codes does not adversely affect the medians for other procedures because we believe that when these services are performed on the same day as another separately paid service, any packaging that appears on the claim would be appropriately associated with the other procedure and not with these codes. Consequently, for CY 2006, we identified 404 bypass codes for use in creating “pseudo” single claims and used some part of 90 percent of the total claims that were eligible for use in OPPS ratesetting and modeling in developing the final rule with comment period. This process enabled us to use, for CY 2006 OPPS, 88 million single bills for ratesetting: 55 million “pseudo” singles and 34 million “natural” single bills (bills that were submitted containing only one separately payable major HCPCS code). (These numbers do not sum to 88 million because more than 800,000 single bills were removed when we trimmed at the HCPCS level at +/−3 standard deviations from the geometric mean.) For CY 2007, we are proposing to continue using date-of-service matching as a tool for creation of “pseudo” single claims and to continue the use of a bypass list to create “pseudo” single claims. The process we are proposing for CY 2007 OPPS results in our being able to use some part of 94.8 percent of the total claims that are eligible for use in the OPPS ratesetting and modeling in developing this proposed rule. This process enabled us to use, for CY 2007, 62.8 million “pseudo” singles and 29.6 million “natural” single bills. We are proposing to bypass the 454 codes identified in Table 1 to create new single claims and to use the line-item costs associated with the bypass codes on these claims, together with the single procedure claims, in the creation of the median costs for the APCS into which they are assigned. Of the codes on this list, 404 codes were used for bypass in CY 2006. We are proposing to continue the use of the codes on the CY 2006 OPPS bypass list and to expand it by adding codes that, using data presented to the APC Panel at its March 2006 meeting, meet the same empirical criteria as those used in CY 2006 to create the bypass list, or which our clinicians believe would contain minimal packaging if the services were correctly coded (for example, ultrasound guidance). Our examination of the data against the criteria for inclusion on the bypass list, as discussed below for the addition of new codes, shows that the empirically selected codes used for bypass for the CY 2006 OPPS generally continue to meet the criteria or come very close to meeting the criteria, and we have received no comments against bypassing them. To facilitate comment, Table 1 indicates the list of codes we are proposing to bypass for creation of “pseudo” singles for CY 2007 OPPS. Bypass codes shown in Table 1 with an asterisk indicate the HCPCS codes we are proposing to add to the CY 2006 OPPS listed codes for bypass in CY 2007. The criteria we are proposing to use to determine the additional codes to add to the CY 2006 OPPS bypass list in order to create the bypass list for CY 2007 OPPS are discussed below. The following empirical criteria were developed by reviewing the frequency and magnitude of packaging in the single claims for payable codes other than drugs and biologicals. We assumed that the representation of packaging on the single claims for any given code is comparable to packaging for that code in the multiple claims: There were 100 or more single claims for the code. This number of single claims ensured that observed outcomes were sufficiently representative of packaging that might occur in the multiple claims.
                    Five percent or fewer of the single claims for the code had packaged costs on that single claim for the code. This criterion results in limiting the amount of packaging being redistributed to the payable procedure remaining on the claim after the bypass code is removed and ensures that the costs associated with the bypass code represent the cost of the bypassed service.( print page 49516)
                    The median cost of packaging observed in the single claim was equal to or less than $50. This limits the amount of error in redistributed costs.
                    The code is not a code for an unlisted service. In addition, we are proposing to add to the bypass list codes that our clinicians believe contain minimal packaging and codes for specified drug administration for which hospitals have requested separate payment but for which it is not possible to acquire median costs unless we add these codes to the bypass list. A more complete discussion of the effects of adding these drug administration codes to the bypass list is contained in the discussion of drug administration in section VIII.C. of this preamble. We specifically invite public comment on the “pseudo” single process, including the bypass list and the criteria. 
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
  
 
 c. Proposed Revision to the Overall Cost-to-Charge Ratio (CCR) Calculation We calculate both an overall CCR and cost center-specific cost-to-charge ratios (CCRs) for each hospital. For CY 2007 OPPS, we are proposing to change the methodology for calculating the overall CCR. The overall CCR is used in many components of the OPPS. We use the overall CCR to estimate costs from charges on a claim when we do not have an accurate cost center CCR. This does not happen very often. For the vast majority of services, we are able to use a cost center CCR to estimate costs from charges. However, we also use the overall CCR to identify the outlier threshold, to model payments for services that are paid at charges reduced to cost, and, during implementation, to determine outlier payments and payments for other services. We have discovered that the calculation of the overall CCR that the fiscal intermediaries are using to determine outlier payment and payment for services paid at charges reduced to cost differs from the overall CCR that we use to model the OPPS. In Program Transmittal A-03-04 on “Calculating Provider-Specific Outpatient Cost-to-Charge Ratios (CCRs) and Instructions on Cost Report Treatment of Hospital Outpatient Services Paid on a Reasonable Cost Basis” (January 17, 2003), we revised the overall CCR calculation that the fiscal intermediaries use in determining outlier and other cost payments. Until this point, each fiscal intermediary had used an overall CCR provided by CMS, or calculated an updated CCR at the provider's request using the same calculation. The calculation in Program Transmittal A-03-04, that is, the fiscal intermediary calculation, diverged from the “traditional” overall CCR that we used for modeling. It should be noted that the fiscal intermediary overall CCR calculation noted in Program Transmittal A-03-04 was created with feedback and input from the fiscal intermediaries. CMS' “traditional” calculation consists of summing the total costs from Worksheet B, Part I (Column 27), after removing the costs for nursing and paramedical education (Columns 21 and 24), for those ancillary cost centers that we believe contain most OPPS services, summing the total charges from Worksheet C, Part I (Columns 6 and 7) for the same set of ancillary cost centers, and dividing the former by the later. We exclude selected ancillary cost centers from our overall CCR calculation, such as 5700 Renal Dialysis, because we believe that the costs and charges in these cost centers are largely paid for under other payment systems. The specific list of ancillary cost centers, both standard and nonstandard, included in our overall CCR calculation is available on our Web site in the revenue center-to-cost center crosswalk workbook: 
                        *http://www.cms.hhs.gov/​HospitalOutpatientPPS.* The overall CCR calculation provided in Program Transmittal A-03-04, on the other hand, takes the CCRs from Worksheet C, Part I, Column 9, for each specified ancillary cost center; multiplies them by the Medicare Part B outpatient specific charges in each corresponding ancillary cost center from Worksheet D, Parts V and VI (Columns 2, 3, 4, and 5 and subscripts thereof); and then divides the sum of these costs by the sum of charges for the specified ancillary cost centers from Worksheet D, Parts V and VI (Columns 2, 3, 4, and 5 and subscripts thereof). Compared with our “traditional” overall CCR calculation that has been used for modeling OPPS and to calculate the median costs, this fiscal intermediary calculation of overall CCR fails to remove allied health costs and adds weighting by Medicare Part B charges. In comparing these two calculations, we discovered that, on average, the overall CCR calculation being used by the fiscal intermediary resulted in higher overall CCRs than under our “traditional” calculation. Using the most recent cost report data available for every provider with valid claims for CY 2004 as of November 2005, we estimated the median overall CCR using the traditional calculation to be 0.3040 (mean 0.3223) and the median overall CCR using the fiscal intermediary calculation to be 0.3309 (mean 0.3742). There also was much greater variability in the fiscal intermediary calculation of the overall CCR. The standard deviation under the “traditional” calculation was 0.1318, while the standard deviation using the fiscal intermediary's calculation was 0.2143. In part, the higher median estimate for the fiscal intermediary calculation is attributable to the inclusion of allied health costs for the over 700 hospitals with allied health programs. It is inappropriate to include these costs in the overall CCR calculation, because CMS already reimburses hospitals for the costs of these programs through cost report settlement. The higher median estimate and greater variability also is a function of the weighting by Medicare Part B charges. Because the fiscal intermediary overall CCR calculation is higher, on average, CMS has underestimated the outlier payment thresholds and, therefore, overpaid outlier payments. We also have underestimated spending for services paid at charges reduced to cost in our budget neutrality estimates. In examining the two different calculations, we decided that elements of each methodology had merit. Clearly, as noted above, allied health costs should not be included in an overall CCR calculation. However, weighting by Medicare Part B charges from Worksheet D, Parts V and VI, makes the overall CCR calculation more specific to OPPS. Therefore, we are proposing to adopt a single overall CCR calculation that incorporates weighting by Medicare Part B charges but excludes allied health costs for modeling and payment. Specifically, the proposed calculation removes allied health costs from cost center CCR calculations for specified ancillary cost centers, as discussed above, multiplies them by the Medicare Part B charges on Worksheet D, Parts V and VI, and sums these estimated Medicare costs. This sum is then divided by the sum of the same Medicare Part B charges for the same specified set of ancillary cost centers. Using the same cost report data, we estimated a median overall CCR for the proposed calculation of 0.3081 (mean 0.3389) with a standard deviation of 0.1583. The similarity to the median and standard deviation of the “traditional” overall CCR calculation noted above (median 0.3040 and standard deviation of 0.1318) masks some sizeable changes in overall CCR calculations for specific hospitals due largely to the inclusion of Medicare Part B weighting. In order to isolate the overall impact of adopting this methodology on APC medians, we used the first 9 months of CY 2005 claims data to estimate APC median costs varying only the two methods of determining overall CCR. We expected the impact to be limited because the majority of costs are estimated using a cost center-specific CCR and not the overall. As predicted, we observed minor changes in APC median costs from the adoption of the proposed overall CCR calculation. We largely observed differences of no more than 5 percent in either direction. The median overall percent change in APC cost estimates was -0.3 percent. We typically observe comparable changes in APC medians when we update our cost report data. The impact of the proposed CCR calculation on the outlier threshold is discussed further in section II. G. of this preamble. Using updated cost report data for the calculations in this proposed rule, we estimate a median overall CCR across all hospitals of 0.2999 using the proposed overall CCR calculation.
                        ( print page 49529) We believe that a single overall CCR calculation should be used for all components of the OPPS for both modeling and payment. Therefore, we are proposing to use the modified overall CCR calculation as discussed above when the hospital-specific overall CCR is used for any of the following calculations—in the CMS calculation of median costs for OPPS ratesetting, in the CMS calculation of the outlier threshold, in the fiscal intermediary calculation of outlier payments, in the CMS calculation of statewide CCRs, in the fiscal intermediary calculation of pass-through payments for devices, and for any other fiscal intermediary payment calculation in which the current hospital-specific overall CCR may be used now or in the future. If this proposal is finalized, we would issue a Medicare program instruction to fiscal intermediaries that would instruct them to recalculate and use the hospital-specific overall CCR as we are proposing for these purposes. 2. Proposed Calculation of Median Costs for CY 2007 In this section of the preamble, we discuss the use of claims to calculate the proposed OPPS payment rates for CY 2007. The hospital outpatient prospective payment page on the CMS Web site on which this proposed rule is posted provides an accounting of claims used in the development of the proposed rates: 
                        *http://www.cms.hhs.gov/​HospitalOutpatientPPS.*
                         The accounting of claims used in the development of this proposed rule is included on the Web site under supplemental materials for the CY 2007 proposed rule. That accounting provides additional detail regarding the number of claims derived at each stage of the process. In addition, below we discuss the files of claims that comprise the data sets that are available for purchase under a CMS data user contract. Our CMS Web site, 
                        *http://www.cms.hhs.gov/​HospitalOutpatientPPS*, includes information about purchasing the following two OPPS data files: “OPPS Limited Data Set” and “OPPS Identifiable Data Set.” We are proposing to use the following methodology to establish the relative weights to be used in calculating the proposed OPPS payment rates for CY 2007 shown in Addenda A and B to this proposed rule. This methodology is as follows: We used outpatient claims for the full CY 2005, processed before January 1, 2006, to set the relative weights for this proposed rule for CY 2007. To begin the calculation of the relative weights for CY 2007, we pulled all claims for outpatient services furnished in CY 2005 from the national claims history file. This is not the population of claims paid under the OPPS, but all outpatient claims (including, for example, CAH claims, and hospital claims for clinical laboratory services for persons who are neither inpatients nor outpatients of the hospital). We then excluded claims with condition codes 04, 20, 21, and 77. These are claims that providers submitted to Medicare knowing that no payment will be made. For example, providers submit claims with a condition code 21 to elicit an official denial notice from Medicare and document that a service is not covered. We then excluded claims for services furnished in Maryland, Guam, and the U.S. Virgin Islands because hospitals in those geographic areas are not paid under the OPPS. We divided the remaining claims into the three groups shown below. Groups 2 and 3 comprise the 103 million claims that contain hospital bill types paid under the OPPS. 1. Claims that were not bill types 12X, 13X, 14X (hospital bill types), or 76X (CMHC bill types). Other bill types are not paid under the OPPS and, therefore, these claims were not used to set OPPS payment. 2. Claims that were bill types 12X, 13X, or 14X (hospital bill types). These claims are hospital outpatient claims. 3. Claims that were bill type 76X (CMHC). (These claims are later combined with any claims in item 2 above with a condition code 41 to set the per diem partial hospitalization rate determined through a separate process.) For the CCR calculation process, we used the same general approach as we used in developing the final APC rates for CY 2006 (70 FR 68537), with a change to the development of the overall CCR as discussed above. That is, we first limited the population of cost reports to only those for hospitals that filed outpatient claims in CY 2005 before determining whether the CCRs for such hospitals were valid. We then calculated the CCRs at a cost center level and overall for each hospital for which we had claims data. We did this using hospital-specific data from the Healthcare Cost Report Information System (HCRIS). We used the most recent available cost report data, in most cases, cost reports for CY 2004. For this proposed rule, we used the most recent cost report available, whether submitted or settled. If the most recent available cost report was submitted but not settled, we looked at the last settled cost report to determine the ratio of submitted to settled cost using the overall CCR, and we then adjusted the most recent available submitted but not settled cost report using that ratio. We are proposing to use the most recently submitted cost reports to calculate the CCRs to be used to calculate median costs for the OPPS CY 2007 final rule. We calculated both an overall CCR and cost center-specific CCRs for each hospital. We used the proposed overall CCR calculation discussed in II.A.1.c. of this preamble for all purposes. We then flagged CAH claims, which are not paid under the OPPS, and claims from hospitals with invalid CCRs. The latter included claims from hospitals without a CCR; those from hospitals paid an all-inclusive rate; those from hospitals with obviously erroneous CCRs (greater than 90 or less than .0001); and those from hospitals with CCRs that were identified as outliers (3 standard deviations from the geometric mean after removing error CCRs). In addition, we trimmed the CCRs at the cost center level by removing the CCRs for each cost center as outliers if they exceeded +/-3 standard deviations from the geometric mean. This is the same methodology that we used in developing the final CY 2006 CCRs. For CY 2007, we are proposing to trim at the departmental CCR level to eliminate aberrant CCRs that, if found in high volume hospitals, could skew the medians. We used a four-tiered hierarchy of cost center CCRs to match a cost center to every possible revenue code appearing in the outpatient claims, with the top tier being the most common cost center and the last tier being the default CCR. If a hospital's cost center CCR was deleted by trimming, we set the CCR for that cost center to “missing,” so that another cost center CCR in the revenue center hierarchy could apply. If no other departmental CCR could apply to the revenue code on the claim, we used the hospital's overall CCR for the revenue code in question. For example, a visit reported under the clinic revenue code, but the hospital did not have a clinic cost center, we mapped the hospital-specific overall CCR to the clinic revenue code. The hierarchy of CCRs is available for inspection and comment at the CMS Web site: 
                        *http://www.cms.hhs.gov/​HospitalOutpatientPPS.* We then converted the charges to costs on each claim by applying the CCR that we believed was best suited to the revenue code indicated on the line with the charge. Table 2 below contains a list of the allowed revenue codes. Revenue codes not included in Table 2 are those 
                        ( print page 49530)
                        not allowed under the OPPS because their services cannot be paid under the OPPS (for example, inpatient room and board charges) and, thus charges with those revenue codes were not packaged for creation of the OPPS median costs. One exception is the calculation of median blood costs, as discussed in section X. of this preamble. Thus, we applied CCRs as described above to claims with bill types 12X, 13X, or 14X, excluding all claims from CAHs and hospitals in Maryland, Guam, and the U.S. Virgin Islands, and claims from all hospitals for which CCRs were flagged as invalid. We identified claims with condition code 41 as partial hospitalization services of hospitals and moved them to another file. These claims were combined with the 76X claims identified previously to calculate the partial hospitalization per diem rate. We then excluded claims without a HCPCS code. We also moved claims for observation services to another file. We moved to another file claims that contained nothing but flu and pneumococcal pneumonia (“PPV”) vaccine. Influenza and PPV vaccines are paid at reasonable cost and, therefore, these claims are not used to set OPPS rates. We note that the two above mentioned separate files containing partial hospitalization claims and the observation services claims are included in the files that are available for purchase as discussed above. We next copied line-item costs for drugs, blood, and devices (the lines stay on the claim, but are copied off onto another file) to a separate file. No claims were deleted when we copied these lines onto another file. These line-items are used to calculate a per unit mean and median and a per administration mean and median for drugs, radiopharmaceutical agents, blood and blood products, and devices, including but not limited to brachytherapy sources, as well as other information used to set payment rates, including a unit to day ratio for drugs. We then divided the remaining claims into the following five groups: 1. 
                        *Single Major Claims:*
                         Claims with a single separately payable procedure (that is, status indicator S, T, V, or X), all of which would be used in median setting. 2. 
                        *Multiple Major Claims:*
                         Claims with more than one separately payable procedure (that is, status indicator S, T, V, or X), or multiple units for one payable procedure. As discussed below, some of these can be used in median setting. 3. 
                        *Single Minor Claims:*
                         Claims with a single HCPCS code that is packaged (that is, status indicator N) and not separately payable. 4. 
                        *Multiple Minor Claims:*
                         Claims with multiple HCPCS codes that are packaged (that is, status indicator N) and not separately payable. 5. 
                        *Non-OPPS Claims:*
                         Claims that contain no services payable under the OPPS (that is, all status indicators other than S, T, V, X, or N). These claims are excluded from the files used for the OPPS. Non-OPPS claims have codes paid under other fee schedules, for example, durable medical equipment or clinical laboratory, and do not contain either a code for a separately paid service or a code for a packaged service. In previous years, we made a determination of whether each HCPCS code was a major code, or a minor code, or a code other than a major or minor code. We used those code specific determinations to sort claims into these five identified groups. For CY 2007 OPPS, we are proposing to use status indicators, as described above, to sort the claims into these groups. We believe that using status indicators is an appropriate way to sort the claims into these groups and also to make our process more transparent to the public. We further believe that this proposed method of sorting claims will enhance the public's ability to derive useful information and become a more informed commenter on this proposed rule. We note that the claims listed in numbers 1, 2, 3, and 4 above are included in the data files that can be purchased as described above. We set aside the single minor, multiple minor claims and the non-OPPS claims (numbers 3, 4, and 5 above) because we did not use these claims in calculating median cost. We then examined the multiple major claims for date of service to determine if we could break them into single procedure claims using the dates of service on all lines on the claim. If we could create claims with single major procedures by using date of service, we created a single procedure claim record for each separately paid procedure on a different date of service (that is, a “pseudo” single). We then used the “bypass codes” listed in Table 1 of this preamble and discussed in section II.A.1.b. to remove separately payable procedures that we determined contain limited costs or no packaged costs, or were otherwise suitable for inclusion on the bypass list, from a multiple procedure bill. When one of the two separately payable procedures on a multiple procedure claim was on the bypass code list, we split the claim into two single procedure claims records. The single procedure claim record that contained the bypass code did not retain packaged services. The single procedure claim record that contained the other separately payable procedure (but no bypass code) retained the packaged revenue code charges and the packaged HCPCS charges. We also removed lines that contained multiple units of codes on the bypass list and treated them as “pseudo” single claims by dividing the cost for the multiple units by the number of units on the line. Where one unit of a single separately paid procedure code remained on the claim after removal of the multiple units of the bypass code, we created a “pseudo” single claim from that residual claim record, which retained the costs of packaged revenue codes and packaged HCPCS codes. This enables us to use claims that would otherwise be multiple procedure claims and could not be used. We excluded those claims that we were not able to convert to singles even after applying all of the techniques for creation of “pseudo” singles. We then packaged the costs of packaged HCPCS codes (codes with status indicator “N” listed in Addendum B to this proposed rule) and packaged revenue codes into the cost of the single major procedure remaining on the claim. The list of packaged revenue codes is shown below in Table 2. After removing claims for hospitals with error CCRs, claims without HCPCS codes, claims for immunizations not covered under the OPPS, and claims for services not paid under the OPPS, 97.5 million claims were left. Of these 97.5 million claims, we were able to use some portion of 50.7 million whole claims (93.2 percent of the 54.4 million potentially usable claims) to create the 91.4 million single and “pseudo” single claims for use in the CY 2007 median payment ratesetting. Approximately 43 million claims were for services not paid under the OPPS. We also excluded (1) Claims that had zero costs after summing all costs on the claim and (2) claims containing payment flag 3. Effective for services furnished on or after July 1, 2004, the Outpatient Code Editor (OCE) assigns payment flag number 3 to claims on which hospitals submitted token charges for a service with status indicator “S” or “T” (a major separately paid service under OPPS) for which the fiscal intermediary is required to allocate the sum of charges for services with a status indicator equaling “S” or “T” based on the weight for the APC to which each code is assigned. We do not believe that these charges, which were token charges as submitted by the 
                        ( print page 49531)
                        hospital, are valid reflections of hospital resources. Therefore, we are proposing to delete these claims. We also deleted claims for which the charges equal the revenue center payment (that is, the Medicare payment) on the assumption that where the charge equals the payment, to apply a CCR to the charge would not yield a valid estimate of relative provider cost. For the remaining claims, we then standardized 60 percent of the costs of the claim (which we have previously determined to be the labor-related portion) for geographic differences in labor input costs. We made this adjustment by determining the wage index that applied to the hospital that furnished the service and dividing the cost for the separately paid HCPCS code furnished by the hospital by that wage index. As has been our policy since the inception of the OPPS, we are proposing to use the pre-reclassified wage indices for standardization because we believe that they better reflect the true costs of items and services in the area in which the hospital is located than the post-reclassification wage indices, and would result in the most accurate adjusted median costs. We also excluded claims that were outside 3 standard deviations from the geometric mean of units for each HCPCS code on the bypass list (because, as discussed above, we used claims that contain multiple units of the bypass codes). We then deleted 299,022 single bills reported with modifier 50 that were assigned to APCs that contained HCPCS codes that are considered to be conditional or independent bilateral procedures under the OPPS and that are subject to special payment provisions implemented through the OCE. Modifier 50 signifies that the procedure was performed bilaterally. Although these are apparently single claims for a separately payable service and although there is only one unit of the code reported on the claim, the presence of modifier 50 signifies that two services were furnished. Therefore, costs reported on these claims are for two procedures and not for a single procedure. Hence, we deleted these multiple procedure records, which we would have treated as single procedure claims in prior OPPS updates. We are seeking comments on the relative benefits of deleting these claims versus dividing the costs for the two procedures by two to create two “pseudo” single claims. We used the remaining claims to calculate median costs for each separately payable HCPCS code and each APC. The comparison of HCPCS and APC medians determines the applicability of the “2 times” rule. As stated previously, section 1833(t)(2) of the Act provides that, subject to certain exceptions, the items and services within an APC group cannot be considered comparable with respect to the use of resources if the highest median (or mean cost, if elected by the Secretary) for an item or service in the group is more than 2 times greater than the lowest median cost for an item or service within the same group (“the 2 times rule”). Finally, we reviewed the medians and reassigned HCPCS codes to different APCs as deemed appropriate. Section III.B. of this preamble includes a discussion of the HCPCS code assignment changes that resulted from examination of the medians and for other reasons. The APC medians were recalculated after we reassigned the affected HCPCS codes. Both the HCPCS medians and the APC medians were weighted to account for the inclusion of multiple units of the bypass codes in the creation of pseudo single bills. A detailed discussion of the proposed medians for blood and blood products is included in section X. of this preamble. A discussion of the proposed medians for APCs that require one or more devices when the service is performed is included in section IV.A. of this preamble. A discussion of the proposed median for observation services is included in section XI. of this preamble and a discussion of the proposed median for partial hospitalization is included below in section II.B. of this preamble. 
 
  
 
 3. Proposed Calculation of Scaled OPPS Payment Weights Using the median APC costs discussed previously, we calculated the proposed relative payment weights for each APC for CY 2007 shown in Addenda A and B of this proposed rule. In prior years, we scaled all the relative payment weights to APC 0601 (Mid Level Clinic Visit) because it is one of the most frequently performed services in the hospital outpatient setting. We assigned APC 0601 a relative payment weight of 1.00 and divided the median cost for each APC by the median cost for APC 0601 to derive the relative payment weight for each APC. For CY 2007 OPPS, we are proposing to scale all of the relative payment weights to APC 0606 (Level III Clinic Visits) because we are proposing to delete APC 0601 as part of the reconfiguration of the visit APCs. We chose APC 0606 as the scaling base because under our proposal to reconfigure the APCs where clinic visits are assigned for CY 2007, APC 0606 is the middle level clinic visit APC (that is, Level III of five levels). We have historically used the median cost of the middle level clinic visit APC (that is APC 0601 through CY 2006) to calculate unscaled weights because mid-level clinic visits are among the most frequently performed services in the hospital outpatient setting. Therefore, to maintain consistency in using as a median the most frequently used services, we are proposing to continue to use the median cost of the middle clinic level, proposed ASC 0606, to calculate unscaled weights. Following our standard methodology, but using the proposed CY 2007 median for APC 0606, we assigned APC 0606 a relative payment weight of 1.00 and divided the median cost of each APC by the median cost for APC 0606 to derive the unscaled relative payment weight for each APC. The choice of the APC on which to base the relative weights for all other APCs does not affect the payments made under the OPPS because we scale the weights for budget neutrality. Section 1833(t)(9)(B) of the Act requires that APC reclassification and recalibration changes, wage index changes, and other adjustments be made in a manner that assures that aggregate payments under the OPPS for CY 2007 are neither greater than nor less than the aggregate payments that would have been made without the changes. To comply with this requirement concerning the APC changes, we compared aggregate payments using the CY 2006 relative weights to aggregate payments using the CY 2007 proposed relative payment weights. Based on this comparison, we adjusted the relative weights for purposes of budget neutrality. The unscaled relative payment weights were adjusted by 1.354626473 for budget neutrality. We recognize the scaler, or weight scaling factor, for budget neutrality that we are proposing for CY 2007 is higher than any previous OPPS weight scaler as a result of our proposal to use APC 0606 as the base for calculation of relative weights. Our proposed use of the median cost for APC 0606 of $83.67 causes the unscaled weights to be lower than they would have been if we had chosen APC 0605 (Level 2 Clinic Visits; median $62.12) as the scaling base. The CY 2007 median cost of APC 0606 is significantly higher than the CY 2006 median cost of APC 0601 for mid-level clinic visits, which was used in CY 2006 and earlier years to calculate unscaled weights. Historically, the median cost for APC 0601 has been similar to the CY 2007 proposed median cost for APC 0605. In order to appropriately scale the total weight estimated for OPPS in CY 2007 to be similar to the total weight in OPPS for CY 2006, we calculated a scaler of 1.354626473, which is higher using APC 0606 as the base than it would be if we used APC 0605 as the base. In addition to adjusting for increases and decreases in weight due the recalibration of APC medians, the scaler also accounts for any change in the base. The proposed relative payment weights listed in Addenda A and B of this proposed rule incorporate the recalibration adjustments discussed in sections II.A.1. and 2. of this preamble. Section 1833(t)(14)(H) of the Act, as added by section 621(a)(1) of Pub. L. 108-173, states that “Additional expenditures resulting from this paragraph shall not be taken into account in establishing the conversion factor, weighting and other adjustment factors for 2004 and 2005 under paragraph (9) but shall be taken into account for subsequent years.” Section 1833(t)(14) of the Act provides the payment rates for certain “specified covered outpatient drugs.” Therefore, the cost of those specified covered outpatient drugs (as discussed in section V. of this preamble) is now included in the budget neutrality calculations for CY 2007 OPPS. Under section 1833(t)(16)(C) of the Act, as added by section 621(b)(1) of Pub. L. 108-173, payment for devices of brachytherapy consisting of a seed or seeds (or radioactive source) is to be made at charges adjusted to cost for services furnished on or after January 1, 2004, and before January 1, 2007. As we stated in our January 6, 2004 interim final rule, charges for the brachytherapy sources were not used in determining outlier payments, and payments for these items were excluded from budget neutrality calculations for the CY 2006 OPPS. We excluded these payments from budget neutrality calculations, in part, because of the challenge posed by estimating hospital-specific cost payment. For CY 2007, we are proposing a specific payment rate for brachytherapy sources, which will be subject to scaling for budget neutrality. (We provide a discussion of brachytherapy payment issues, including their continued exclusion from outlier payments, under section VII. of this preamble.) Therefore, the costs of brachytherapy sources are accounted for in the scaler of 1.354626473. 4. Proposed Changes to Packaged Services (If you choose to comment on the issues in this section, please include the caption “Packaged Services” at the beginning of your comment.) Payments for packaged services under the OPPS are bundled into the payments providers receive for separately payable services provided on the same day. Packaged services are identified by the status indicator “N.” Hospitals include charges for packaged services on their claims, and the costs associated with these packaged services are then bundled into the costs for separately payable procedures on those same claims in establishing payment rates for the separately payable services. This is consistent with the principles of a prospective payment system based upon groupings of services and in contrast to a fee schedule that provides individual payment for each service billed. Hospitals may use CPT codes to report any packaged services that were performed, consistent with CPT coding guidelines. As a result of requests from the public, a Packaging Subcommittee to the APC Panel was established to review all the procedural CPT codes with a status indicator of “N.” Providers have often suggested that many packaged services could be provided alone, without any other separately payable services on the claim, and requested that these codes not be assigned status indicator “N.” In deciding whether to package a service or pay for a code separately, we consider a variety of factors, including whether the service is normally provided separately or in conjunction with other services; how likely it is for the costs of the packaged code to be appropriately mapped to the separately payable codes 
                        ( print page 49534)
                        with which it was performed; and whether the expected cost of the service is relatively low. The Packaging Subcommittee identified areas for change for some packaged CPT codes that it believed could frequently be provided to patients as the sole service on a given date and that required significant hospital resources as determined from hospital claims data. Based on the comments received, additional issues, and new data that we shared with the Packaging Subcommittee concerning the packaging status of codes for CY 2007, the Packaging Subcommittee reviewed the packaging status of numerous HCPCS codes and reported its findings to the APC Panel at its March 2006 meeting. The APC Panel accepted the report of the Packaging Subcommittee, heard several presentations on certain packaged services, discussed the deliberations of the Packaging Subcommittee, and recommended that— CMS pay separately for HCPCS code 0069T (Acoustic heart sound recording and computer analysis only).
                    CMS maintain the packaged status of HCPCS code 0152T (Computer aided detection with further physician review for interpretation, with or without digitization of films radiographic images; chest radiograph(s)).
                    CMS maintain the packaged status of CPT code 36500 (venous catheterization for selective blood organ sampling).
                    CMS pay separately for CPT code 36540 (Collect blood, venous access device) if there are no separately payable OPPS services on the claim.
                    CMS pay separately for CPT code 36600 (Arterial puncture; withdrawal of blood for diagnosis) if there are no separately payable OPPS services on the claim.
                    CMS pay separately for CPT code 38792 (Sentinel node identification) if there are no separately payable OPPS services on the claim.
                    CMS maintain the packaged status of CPT codes 74328 (Endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation), 74329 (Endoscopic catheterization of the pancreatic ductal system, radiological supervision and interpretation), and 74330 (Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and interpretation).
                    CMS pay separately for CPT code 75893 (Venous sampling through catheter, with or without angiography, radiological supervision and interpretation) if there are no separately payable OPPS services on the claim.
                    CMS continue to separately pay for CPT code 76000 (Fluoroscopy, up to one hour physician time).
                    CMS maintain the packaged status of CPT codes 76001 (Fluoroscopy, physician time more than one hour), 76003 ((Fluoroscopic guidance for needle placement), and 76005 (Fluoroscopic guidance and localization of needle or catheter tip).
                    CMS maintain the packaged status of CPT codes 76937 (Ultrasound guidance for vascular access) and 75998 (Fluoroscopic guidance for central venous access device placement, replacement, or removal).
                    CMS provide separate payment for CPT codes 94760 (Noninvasive ear or pulse oximetry for oxygen saturation; single determination), 94761 (Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations), and 94762 (Noninvasive ear or pulse oximetry for oxygen saturation by continuous overnight monitoring) if there are no separately payable OPPS services on the claim.
                    CMS pay separately for CPT code 96523 (Irrigation of implanted venous access device) if there are no separately payable OPPS services on the claim.
                    CMS maintain the packaged status of HCPCS code G0269 (Placement of occlusive device into either a venous or arterial access site).
                    CMS pay separately for HCPCS code P9612 (Catheterization for collection of specimen, single patient) if there are no separately payable OPPS services on the claim.
                    CMS bring data to the next APC Panel meeting that show the following: (a) how the costs of packaged items and services are incorporated into the median costs of APCs and (b) how the costs of these packaged items and services influence payments for associated procedures.
                    The Packaging Subcommittee continue until the next APC Panel meeting. For CY 2007, we are proposing to maintain CPT code 0069T as a packaged service and not adopt the APC Panel's recommendation to pay separately for this code. The service uses signal processing technology to detect, interpret, and document acoustical activities of the heart through special sensors applied to a patient's chest. This code was a new Category III CPT code implemented in the CY 2005 OPPS and assigned a new interim status indicator of “N” in the CY 2005 OPPS final rule. The APC Panel recommended packaging CPT code 0069T for CY 2006, and we accepted that recommendation when we finalized the status indicator “N” assignment to 0069T for CY 2006. This code is indicated as an add-on code to an electrocardiography service, according to the AMA's CY 2006 CPT book. In its presentation to the APC Panel, the manufacturer requested that we pay separately for CPT code 0069T and assign it to APC 0099 (Electrocardiograms), based on its estimated cost and clinical characteristics. At the APC Panel meeting, the manufacturer stated that the acoustic heart sounds recording and analysis service may be provided with or without a separately reportable electrocardiogram. Members of the APC Panel engaged in extensive discussion of clinical scenarios as they considered whether CPT code 0069T could or could not be appropriately reported alone or in conjunction with several different procedure codes. We note that the parenthetical information following the AMA's code descriptor indicates that CPT code 0069T is to be reported in conjunction with CPT code 93005 (Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report). In addition, we do not believe that, based on its expected clinical uses as described by the manufacturer, CPT code 0069T would ever be performed as a sole service without other separately payable OPPS services and payment for CPT code 0069T could always be packaged into payments for those other services. Therefore, we believe that CPT code 0069T is appropriately packaged because it is closely linked to the performance of an ECG, should never be reported alone, and is estimated to require only modest hospital resources. Using CY 2005 claims, we had only 9 single claims for CPT code 0069T, with a median line-item cost of $1.93, consistent with its low expected cost. Packaging payment for CPT code 0069T is consistent with the principles of a prospective payment system that provides payments for groups of services. To the extent that the acoustic heart sounding recording service may be more frequently provided in the future in association with ECGs or other OPPS services as its clinical indications evolve, we expect that its cost would also be increasingly reflected in the median costs for those other services, particularly ECG procedures. For CY 2007, we are proposing to accept the APC Panel's recommendation to maintain the packaged status of CPT code 0152T. The service involves the application of computer algorithms and classification technologies to chest x-ray 
                        ( print page 49535)
                        images to acquire and display information regarding chest x-ray regions that may contain indications of cancer. This code was a new Category III CPT code implemented in the CY 2006 OPPS and assigned a new interim status indicator of “N” in the CY 2006 OPPS final rule with comment period. The code is indicated as an add-on code to chest x-ray CPT codes, according to the AMA's CY 2006 CPT book. In its presentation to the APC Panel, the manufacturer requested that we pay separately for this service and assign it to a New Technology APC with a payment rate of $15, based on its estimated cost, clinical considerations, and similarity to other image post-processing services that are paid separately. Under the OPPS we make payment for medically necessary services either separately or packaged into our payments for other services. We agree with the APC Panel that packaged payment for diagnostic chest x-ray computer-aided detection (CAD) under a prospective payment methodology for outpatient hospital services is appropriate because of the close relationship of chest x-ray CAD to chest x-ray services and its projected modest cost. Because 0152T is a new CPT code for CY 2006, we have no CY 2005 hospital claims data available for analysis. To the extent that CAD may be more frequently provided in the future to aid in the review of diagnostic chest x-rays as its clinical indications evolve, we expect that its cost would also be increasingly reflected in the median costs for chest x-ray procedures. For CY 2007, we are proposing to accept the recommendation of the APC Panel and maintain the packaged status of CPT code 36500. We note that several providers have commented that CPT code 36500 is sometimes billed only with its corresponding radiological supervision and interpretation code, 75893, but with no other separately payable OPPS services. In those cases, the provider would not receive any payment. For CY 2006, we accepted the APC Panel's recommendation to package both CPT codes 36500 and 75893 and to examine claims data. Our initial review of several clinical scenarios submitted by the public seemed to suggest that other separately payable procedures, such as venography, would likely be billed on the same claim. Our claims data indicate that there are usually separately payable codes that are billed on claims with CPT codes 36500 and 75893. However, we acknowledge that these two codes may occasionally be provided without any separately payable procedures. In these uncommon instances, the provider historically has not received any payment under the OPPS. We also understand that there is a cost associated with registering a patient and providing these services. For CY 2006, we have approximately 160 single claims for CPT code 75893, with a median cost of $269. Based on the proposal described below for “special” packaged codes, for CY 2007, when CPT codes 36500 and 75893 are billed on a claim with no separately payable OPPS services, CPT code 75893 would become separately payable and would receive payment for APC 0668. In this circumstance, payment for CPT code 36500 would be packaged into the separate payment for CPT code 75893. For CY 2007, we are proposing to accept the APC Panel's recommendation and pay separately for CPT codes 36540, 36600, 38792, 75893, 94762, and 96523 when any of these codes appear on a claim with no separately payable OPPS services also reported for the same date of service. We will refer to this subset of codes as “special” packaged codes. We acknowledge that there is a cost to the hospital associated with registering and treating a patient, regardless of whether the specific service provided requires minimal or significant hospital resources. While we continue to believe that these “special” packaged codes are almost always provided along with a separately payable service, our claims analyses indicate that there are rare instances when one of these services is provided without another separately payable OPPS service on the claim for the same date of service. In these instances, providers do not currently receive any payment. Therefore, we are proposing to provide payment for the “special” packaged codes listed above when they are billed on a claim without another separately payable OPPS service on the same date. When any of the “special” packaged codes are billed with other codes that are separately payable under the OPPS on the same date of service, the “special” packaged code would be treated as a packaged code, and the cost of the packaged code would be bundled into the costs of the other separately payable services on the claim. The payments that the provider receives for the separately payable services would include the bundled payment for the packaged code(s). We have heard concerns from the public stating that they are unable to submit claims to CMS that report only packaged codes. We note that although these claims are processed by the OCE and are ultimately rejected for payment, they are received by CMS, and we have cost data for packaged services based upon these claims. However, we recognize that the data used in our analyses to assess the frequencies with which packaged services are provided alone and their median costs are somewhat limited. It is possible that an unknown number of hospitals chose not to submit claims to CMS when a packaged code(s) was provided without other separately payable services on their claims, realizing that they would not receive payment for those claims. While we have been told that some hospitals may bill for a low-level visit if a packaged service only is provided so that they receive some payment for the encounter, we note that providers should bill a low-level visit code in such circumstances only if the hospital provides a significant, separately identifiable low-level visit in association with the packaged service. Through OCE logic, the PRICER would automatically assign payment for a “special” packaged service reported on a claim if there are no other services separately payable under the OPPS on the claim for the same date of service. In all other circumstances, the “special” packaged codes would be treated as packaged services. We are proposing to assign status indicator “Q” to these “special” packaged codes to indicate that they are usually packaged, except for special circumstances when they are separately payable. Through OCE logic, the status indicator of a “special” packaged code would be changed either to “N” or to the status indicator of the APC to which the code is assigned for separate payment, depending upon the presence or absence of other OPPS services also reported on the claim for the same date. Table 3 below lists the proposed status indicators and APC assignments for these “special” packaged codes when they are separately payable. We note that the payment for these “special” packaged codes is intended to make payment for all of the hospital costs, which may include patient registration and establishment of a medical record, in an outpatient hospital setting even when no separately payable services are provided to the patient on that day.
                        ( print page 49536) Table 3.—Proposed Status Indicators and APC Assignments for “Special” Packaged CPT Codes
CPT code
Descriptor
Proposed CY 2007 APC
Proposed status 
                                 indicator
Proposed CY 2007 APC 
                                 median36540
Collect blood, venous access device
0624
S
$32.9636600
Arterial puncture; withdrawal of blood for diagnosis
0035
T
12.4538792
Sentinel node identification
0389
S
86.9275893
Venous sampling through catheter, with or without angiography, radiological supervision and interpretation
0668
S
393.3594762
Noninvasive ear or pulse oximetry for oxygen saturation by continuous overnight monitoring
0443
X
61.3996523
Irrigation of implanted venous access device
0624
S
32.96
 In the case of a claim with two or more “special” packaged codes only reported on a single date of service, the PRICER would assign separate payment only to the “special” packaged code that would receive the highest payment. The other “special” codes would remain packaged and would not receive separate payment. We will monitor and analyze the claims frequency and claims detail for situations in which these codes are billed alone and then separately paid. This will allow us to determine both which providers are billing these codes most often and under what circumstances these codes are billed. We expect that hospitals scheduling and providing services efficiently to Medicare beneficiaries will continue to generally provide these minor services in conjunction with other medically necessary services. For CY 2007, we are proposing to accept the APC Panel's recommendation and maintain the packaged status of CPT codes 74328, 74329, and 74330. The AMA notes that these radiological supervision and interpretation codes should be reported with procedure codes 43260-43272. In fact, our data indicate that these supervision and interpretation codes are billed with 43260-43272 more than 90 percent of the time, indicating their routine use. We believe that some providers may be concerned that although the payment for the endoscopic procedure includes the bundled payment for the supervision and interpretation performed by the radiology department, the payment for the comprehensive service may be directed to the hospital department that performed the endoscopic procedure, rather than to the radiology department. While we understand this concern, the OPPS pays hospital for services provided, and we believe that hospitals are responsible for attributing payments to hospital departments as they believe appropriate. We do not believe that packaging these radiological supervision and interpretation codes leads to inaccurate payments for the full hospital resources associated with endoscopic retrograde cholangiopancreatography procedures. For CY 2007, we are proposing to accept the APC Panel's recommendation to continue to package CPT codes 76001, 76003, and 76005 and to continue to pay separately for CPT code 76000. We received a comment which stated that it was inconsistent to pay separately for CPT code 76000 (Fluoroscopy (separate procedure), up to one hour physician time) but to package CPT code 76001 (Fluoroscopy, physician time more than one hour) when CPT code 76001 appears to be a similar code, except that it is for a longer period of physician time. The Packaging Subcommittee believed that many of the claims that listed CPT code 76001 were erroneously billed, as many of the procedure codes that were billed with CPT code 76001 included fluoroscopy as an integral part of the procedure. In other cases, the Packaging Subcommittee noted that a procedure-specific fluoroscopy code should probably have been billed, instead of CPT code 76001. The Packaging Subcommittee believed that CPT code 76000 could often be provided as a sole service, with no other separately payable procedures. The Packaging Subcommittee recommended that CMS continue to pay separately for CPT code 76000, consistent with the AMA's definition of this code, which specifies that it is a separate procedure, and to continue to package CPT codes 76001, 76003, and 76005. For CY 2007, we are proposing to accept the APC Panel's recommendation to continue to package CPT codes 76937 and 75998. In the CY 2006 OPPS final rule with comment period (70 FR 68544 and 68545), we reviewed in detail the data related to these two codes and promised to share CY 2004 and early CY 2005 data with the Packaging Subcommittee. We reviewed current data with the Packaging Subcommittee, and it recommended that we continue to package these codes. In summary, we believe that these services would always be provided with another separately payable procedure, so their costs would be appropriately bundled with the definitive vascular access device procedures. The costs for these guidance procedures are relatively low compared to the CY 2007 proposed payment rates for the separately payable services they most frequently accompany. If we were to unpackage CPT codes 76937 and 75998, the single bills available to develop median costs for vascular access device insertion services would be significantly reduced. Therefore, we are proposing to continue to package both CPT codes 76937 and 75998 for CY 2007. For CY 2007, we are proposing to accept the APC Panel's recommendation to continue to package HCPCS code G0269. This code should never be billed without another separately payable procedure. Recent data indicate that 94 percent of the time HCPCS code G0269 was billed with either CPT code 93510 or 93526. In addition, the median cost of G0269 is low compared to the costs of the procedures with which it is typically associated. For CY 2007, we are proposing to continue packaging CPT codes 94760 (Noninvasive ear or pulse oximetry for oxygen saturation; single determination) and 94761 (Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations) and not adopt the APC Panel's recommendation to provide separate payment for these services if there are no other separately payable OPPS services on the claim for the same date of service. Our data review revealed that these services are very frequently provided in the OPPS, with over 1 million claims in CY 2005 for the single pulse oximetry determination service and over 400,000 claims for the multiple determinations service. These high frequencies may actually be understated as both of these services are packaged codes, and we have been told that some hospitals may not report the 
                        ( print page 49537)
                        HCPCS codes for services for which they receive no separate payments. Single and multiple pulse oximetry determinations are almost always provided in association with other services that are separately payable under the OPPS, into which their costs may be appropriately packaged. Specifically, OPPS hospital claims data revealed that out of the total instances of CPT code 94760 appearing on claims used for setting payment rates for this CY 2007 OPPS proposed rule, CPT code 94760 was billed only 4 percent of the time in association with no other separately payable OPPS services, with a median cost of $14. Using the same data, CPT code 94761 was billed only 7 percent of the time in association with no other separately payable OPPS services, with a median cost of $36. These pulse oximetry services have a relatively low cost compared with the OPPS services they frequently accompany. If we were to provide separate payment for these pulse oximetry determinations when performed as stand alone procedures by hospitals, we are concerned that hospitals would lose their incentive to provide these basic, low cost, and brief services as efficiently as possible, generally during the same encounters where they are providing other services to the same patients. We believe their appropriate provision as single services should be very rare. Therefore, for CY 2007 we are proposing not to include these codes on the list of “special” packaged codes, so their payment would remain packaged in all circumstances. For CY 2007, we are proposing to assign status indicator “A” to HCPCS code P9612 and reject the APC Panel's recommendation to pay separately under the OPPS for this code when it is billed without any separately payable OPPS services. This code is currently payable on the clinical lab fee schedule. Its status indicator of “A” would provide payment for the service whenever it is billed, regardless of the presence or absence of other reported services. In addition, for consistency we are proposing to assign status indicator “A” to HCPCS code P9615 as it is also payable on the clinical lab fee schedule. In general, when a code is payable on the clinical lab fee schedule, we defer to that fee schedule and do not assign payment under the OPPS. The APC Panel Packaging Subcommittee remains active, and additional issues and new data concerning the packaging status of codes will be shared for its consideration as information becomes available. We continue to encourage submission of common clinical scenarios involving currently packaged HCPCS codes to the Packaging Subcommittee for its ongoing review. Additional detailed suggestions for the Packaging Subcommittee should be submitted to 
                        *APCPanel@cms.hhs.gov,*
                         with “Packaging Subcommittee” in the subject line. B. Proposed Payment for Partial Hospitalization (If you choose to comment on issues in this section, please include the caption “Partial Hospitalization” at the beginning of your comment.) 1. Background Partial hospitalization is an intensive outpatient program of psychiatric services provided to patients as an alternative to inpatient psychiatric care for beneficiaries who have an acute mental illness. A partial hospitalization program (PHP) may be provided by a hospital to its outpatients or by a Medicare-certified community mental health center (CMHC). Section 1833(t)(1)(B)(i) of the Act provides the Secretary with the authority to designate the hospital outpatient services to be covered under the OPPS. The Medicare regulations at 42 CFR 419.21(c) that implement this provision specify that payments under the OPPS will be made for partial hospitalization services furnished by CMHCs. Section 1883(t)(2)(C) of the Act requires that we establish relative payment weights based on median (or mean, at the election of the Secretary) hospital costs determined by 1996 claims data and data from the most recent available cost reports. Payment to providers under the OPPS for PHPs represents the provider's overhead costs associated with the program. Because a day of care is the unit that defines the structure and scheduling of partial hospitalization services, we established a per diem payment methodology for the PHP APC, effective for services furnished on or after August 1, 2000. For a detailed discussion, we refer readers to the April 7, 2000 OPPS final rule with comment period (65 FR 18452). Historically, the median per diem cost for CMHCs has greatly exceeded the median per diem cost for hospital-based PHPs and has fluctuated significantly from year to year while the median per diem cost for hospital-based PHPs has remained relatively constant ($200-$225). We believe that CMHCs may have increased and decreased their charges in response to Medicare payment policies. As discussed in more detail in section II.B.2. of the preamble of this proposed rule and in the CY 2004 OPPS final rule with comment period (68 FR 63470), we believe that some CMHCs manipulated their charges in order to inappropriately receive outlier payments. In the CY 2003 OPPS update, the difference in median per diem cost for CMHCs and hospital-based PHPs was so great, $685 for CMHCs and $225 for hospital-based PHPs, that we applied an adjustment factor of .583 to CMHC costs to account for the difference between “as submitted” and “final settled” cost reports. By doing so, the CMHC median per diem cost was reduced to $384, resulting in a combined hospital-based and CMHC PHP median per diem cost of $273. As with all APCs in the OPPS, the median cost for each APC was scaled relative to the cost of a mid-level office visit and the conversion factor was applied. The resulting per diem rate for PHP for CY 2003 was $240.03. In the CY 2004 OPPS update, the median per diem cost for CMHCs grew to $1,038, while the median per diem cost for hospital-based PHPs was again $225. After applying the .583 adjustment factor in the CY 2004 proposed rule to the median CMHC per diem cost, the median CMHC per diem cost was $605. Because the CMHC median per diem cost exceeded the average per diem cost of inpatient psychiatric care, we proposed a per diem rate for CY 2004 based solely on hospital-based PHP data. The proposed PHP per diem for CY 2004, after scaling, was $208.95. However, by the time we published the OPPS final rule with comment period for CY 2004, we had received updated CCRs for CMHCs. Using the updated CCRs significantly lowered the CMHC median per diem cost to $440. As a result, we determined that the higher per diem cost for CMHCs was not due to the difference between “as submitted” and “final settled” cost reports, but was the result of excessive increases in charges which may have been done in order to receive higher outlier payments. Therefore, in calculating the PHP median per diem cost for CY 2004, we did not apply the .583 adjustment factor to CMHC costs to compute the PHP APC. Using the updated CCRs for CMHCs, the combined hospital-based and CMHC median per diem cost for PHP was $303. After scaling, we established the CY 2004 PHP APC of $286.82. For CY 2005, the PHP per diem amount was based on 12 months of hospital and CMHC PHP claims data (for services furnished from January 1, 2003, through December 31, 2003). We used data from all hospital bills reporting condition code 41, which identifies the claim as partial hospitalization, and all bills from CMHCs because CMHCs are Medicare 
                        ( print page 49538)
                        providers only for the purpose of providing partial hospitalization services. We used CCRs from the most recently available hospital and CMHC cost reports to convert each provider's line-item charges as reported on bills, to estimate the provider's cost for a day of PHP services. Per diem costs were then computed by summing the line-item costs on each bill and dividing by the number of days on the bill. In a Program Memorandum issued on January 17, 2003 (Transmittal A-03-004), we directed fiscal intermediaries to recalculate hospital and CMHC CCRs by April 30, 2003, using the most recently settled cost reports. Following the initial update of CCRs, fiscal intermediaries were further instructed to continue to update a provider's CCR and enter revised CCRs into the outpatient provider specific file. Therefore, for CMHCs, we used CCRs from the outpatient provider specific file. In the CY 2005 OPPS update, the CMHC median per diem cost was $310 and the hospital-based PHP median per diem cost was $215. No adjustments were determined to be necessary and, after scaling, the combined median per diem cost of $289 was reduced to $281.33. We believed that the reduction in the CMHC median per diem cost indicated that the use of updated CCRs had accounted for the previous increase in CMHC charges, and represented a more accurate estimate of CMHC per diem costs for PHP. For the CY 2006 OPPS final rule with comment period, we analyzed 12 months of the most current claims data available for hospital and CMHC PHP services furnished between January 1, 2004, and December 31, 2004. We also used the most currently available CCRs to estimate costs. The median per diem cost for CMHCs was $154, while the median per diem cost for hospital-based PHPs was $201. Based on the CY 2004 claims data, the average charge per day for CMHCs was $760, considerably greater than hospital-based per day costs but significantly lower than what it was in CY 2003 ($1,184). We believed that a combination of reduced charges and slightly lower CCRs for CMHCs resulted in a significant decline in the CMHC median per diem cost between CY 2003 and CY 2004. Following the methodology used for the CY 2005 OPPS update, the CY 2006 OPPS update combined hospital-based and CMHC median per diem cost was $161, a decrease of 44 percent compared to the CY 2005 combined median per diem amount. We believed that this amount was too low to cover the cost for all PHPs. Therefore, as stated in the CY 2006 OPPS final rule with comment period (70 FR 68548 and 68549), we considered the following three alternatives to our update methodology for the PHP APC for CY 2006 to mitigate this drastic reduction in payment for PHP services: (1) Base the PHP APC on hospital-based PHP data alone; (2) apply a different trimming methodology to CMHC costs in an effort to eliminate the effect of data for those CMHCs that appeared to have excessively increased their charges in order to receive outlier payments; and (3) apply a 15 percent reduction to the combined hospital-based and CMHC median per diem cost that was used to establish the CY 2005 PHP APC. (We refer readers to the CY 2006 OPPS final rule with comment period for a full discussion of the three alternatives (70 FR 68548).) After carefully considering these three alternatives and all comments received on them, we adopted the third alternative for CY 2006. We adopted this alternative because we believed and continue to believe that a reduction in the CY 2005 median per diem cost would strike an appropriate balance between using the best available data and providing adequate payment for a program that often spans 5-6 hours a day. We believe that 15 percent is an appropriate reduction because it recognizes decreases in median per diem costs in both the hospital data and the CMHC data, and also reduces the risk of any adverse impact on access to these services that might result from a large single-year rate reduction. However, we adopted this policy as a transitional measure, and stated in the CY 2006 OPPS final rule with comment period that we would continue to monitor CMHC costs and charges for these services and work with CMHCs to improve their reporting so that payments can be calculated based on better empirical data, consistent with the approach we have used to calculate payments in other areas of the OPPS (70 FR 68548). To apply this methodology for CY 2006, we reduced $289 (the CY 2005 combined unscaled hospital-based and CMHC median per diem cost) by 15 percent, resulting in a combined median per diem cost of $245.65 for CY 2006. 2. Proposed PHP APC Update for CY 2007 For CY 2007, we are proposing to calculate the CY 2007 PHP per diem payment rate using the same update methodology that we adopted in CY 2006. That is, we are proposing to apply an additional 15-percent reduction to the combined hospital-based and CMHC median per diem cost that was used to establish the CY 2006 per diem PHP payment. For CY 2007, we analyzed 12 months of data for hospital and CMHC PHP claims for services furnished between January 1, 2005 and December 31, 2005. We also used the most currently available CCRs to estimate costs. Using these CY 2005 claims data, the median per diem cost for CMHCs was $165 and the median per diem cost for hospital-based PHPs was $209. Following the methodology used for the CY 2005 update, the CY 2007 combined hospital-based and CMHC median per diem cost is $172. While the combined hospital-based and CMHC median per diem cost is about $10 higher using the CY 2005 data compared to the CY 2004 data ($172 compared to $161), we believe this amount is still too low to cover the cost for PHPs. We continue to believe that the policy we adopted for CY 2006—a 15-percent reduction applied to the current median cost—provides an appropriate decrease in median per diem costs for both the hospital and CMHC data. Therefore, for CY 2007, we are proposing an additional 15 percent reduction to the combined hospital-based and CMHC median per diem cost. We will continue to monitor and work with CMHCs to improve their reporting. If CMHC data continues to be a problem, we would consider using data from hospital-based PHPs only. To calculate the CY 2007 APC PHP per diem cost, we reduced $245.65 (the CY 2005 combined hospital-based and CMHC median per diem cost of $289 reduced by 15 percent) by 15 percent, which resulted in a combined median per diem cost of $208.80. 3. Proposed Separate Threshold for Outlier Payments to CMHCs In the November 7, 2003 final rule with comment period (68 FR 63469), we indicated that, given the difference in PHP charges between hospitals and CMHCs, we did not believe it was appropriate to make outlier payments to CMHCs using the outlier percentage target amount and threshold established for hospitals. There was a significant difference in the amount of outlier payments made to hospitals and CMHCs for PHP. In addition, further analysis indicated that using the same OPPS outlier threshold for both hospitals and CMHCs did not limit outlier payments to high cost cases and resulted in excessive outlier payments to CMHCs. Therefore, for CYs 2004, 2005, and 2006, we established a separate outlier threshold for CMHCs. For CYs 2004 and 2005, we designated a portion of the 
                        ( print page 49539)
                        estimated 2.0 percent outlier target amount specifically for CMHCs, consistent with the percentage of projected payments to CMHCs under the OPPS in each of those years, excluding outlier payments. For CY 2006, we set the estimated outlier target at 1.0 percent and allocated a portion of that 1.0 percent, 0.6 percent (or 0.006 percent of total OPPS payments), to CMHCs for PHP services. The CY 2006 CMHC outlier threshold is met when the cost of furnishing services by a CMHC exceeds 3.40 times the PHP APC payment amount. The CY 2006 OPPS outlier payment percentage is 50 percent of the amount of costs in excess of the threshold. The separate outlier threshold for CMHCs became effective January 1, 2004, and has resulted in more commensurate outlier payments. In CY 2004, the separate outlier threshold for CMHCs resulted in $1.8 million in outlier payments to CMHCs. In CY 2005, the separate outlier threshold for CMHCs resulted in $0.5 million in outlier payments to CMHCs. In contrast, in CY 2003, more than $30 million was paid to CMHCs in outlier payments. We believe this difference in outlier payments indicates that the separate outlier threshold for CMHCs has been successful in keeping outlier payments to CMHCs in line with the percentage of OPPS payments made to CMHCs. As discussed in section II.B.2. of this preamble, the CY 2005 CMHC data produce median per diem costs too low to use for the CY 2007 partial hospitalization payment rate. Due to the continued volatility of the CMHC charge data, we are proposing to maintain the existing outlier threshold for CMHCs for CY 2007 at 3.40 times the APC payment amount and the CY 2007 outlier payment percentage applicable to costs in excess of the threshold at 50 percent. As noted in section II.G. of this preamble, for CY 2007, we are proposing to continue our policy of setting aside 1.0 percent of the aggregate total payments under the OPPS for outlier payments. We are proposing that a portion of that 1.0 percent, an amount equal to 0.25 percent of outlier payments and 0.0025 percent of total OPPS payments would be allocated to CMHCs for PHP service outliers. As discussed in section II.G. of this preamble, we again are proposing to set a dollar threshold in addition to an APC multiplier threshold for OPPS outlier payments. However, because the PHP is the only APC for which CMHCs may receive payment under the OPPS, we would not expect to redirect outlier payments by imposing a dollar threshold. Therefore, we are not proposing to set a dollar threshold for CMHC outliers. As noted above, we are proposing to set the outlier threshold for CMHCs for CY 2007 at 3.40 percent times the APC payment amount and the CY 2007 outlier payment percentage applicable to costs in excess of the threshold at 50 percent. CMS and the Office of the Inspector General are continuing to monitor the excessive outlier payments to CMHCs. C. Proposed Conversion Factor Update for CY 2007 (If you choose to comment on issues in this section, please include the caption “Conversion Factor” at the beginning of your comment.) Section 1833(t)(3)(C)(ii) of the Act requires us to update the conversion factor used to determine payment rates under the OPPS on an annual basis. Section 1833(t)(3)(C)(iv) of the Act provides that, for CY 2007, the update is equal to the hospital inpatient market basket percentage increase applicable to hospital discharges under section 1886(b)(3)(B)(iii) of the Act. The forecast of the hospital market basket increase for FY 2007 published in the IPPS proposed rule on April 25, 2006 is 3.4 percent (71 FR 24148). To set the OPPS proposed conversion factor for CY 2007, we increased the CY 2006 conversion factor of $59.511, as specified in the November 10, 2005 final rule with comment period (70 FR 68551), by 3.4 percent. In accordance with section 1833(t)(9)(B) of the Act, we further adjusted the conversion factor for CY 2006 to ensure that the revisions we are making to our updates for a revised wage index and expanded rural adjustment are made on a budget neutral basis. We calculated a budget neutrality factor of 0.999908021 for wage index changes by comparing total payments from our simulation model using the FY 2007 IPPS proposed wage index values to those payments using the current (FY 2006) IPPS wage index values. To reflect the inclusion of essential access community hospitals (EACHs) as rural SCHs (discussed in section II.F. of this preamble), we calculated an additional budget neutrality factor of 0.999883468 for the rural adjustment, including EACHs. For CY 2007, we estimate that allowed pass-through spending would equal approximately $43.2 million, which represents 0.13 percent of total OPPS projected spending for CY 2007. The proposed conversion factor also is adjusted by the difference between the 0.17 percent pass-through dollars set-aside in CY 2006 and the 0.13 percent estimate for CY 2007 pass-through spending. Finally, proposed payments for outliers remain at 1.0 percent of total payments for CY 2007. The proposed market basket increase update factor of 3.4 percent for CY 2007, the required wage index budget neutrality adjustment of approximately 0.999908021, the return of 0.04 percent for the difference in the pass-through set-aside, and the proposed adjustment for the rural payment adjustment for rural SCHs, including rural EACHs, of 0.999883468 result in a proposed conversion factor for CY 2007 of $61.551. D. Proposed Wage Index Changes for CY 2007 (If you choose to comment on issues in this section, please include the caption “OPPS: Wage Indices” at the beginning of your comment.) Section 1833(t)(2)(D) of the Act requires the Secretary to determine a wage adjustment factor to adjust, for geographic wage differences, the portion of the OPPS payment rate and the copayment standardized amount attributable to labor and labor-related cost. This adjustment must be made in a budget neutral manner. As we have done in prior years, we are proposing to adopt the IPPS wage indices and extend these wage indices to hospitals that participate in the OPPS but not the IPPS (referred to in this section as “non-IPPS” hospitals). As discussed in section II.A. of this preamble, we standardize 60 percent of estimated costs (labor-related costs) for geographic area wage variation using the IPPS wage indices that are calculated prior to adjustments for reclassification to remove the effects of differences in area wage levels in determining the OPPS payment rate and the copayment standardized amount. As published in the original OPPS April 7, 2000 final rule with comment period (65 FR 18545), OPPS has consistently adopted the final IPPS wage indices as the wage indices for adjusting the OPPS standard payment amounts for labor market differences. Thus, the wage index that applies to a particular hospital under the IPPS will also apply to that hospital under the OPPS. As initially explained in the September 8, 1998 OPPS proposed rule, we believed and continue to believe that using the IPPS wage index as the source of an adjustment factor for OPPS is reasonable and logical, given the inseparable, subordinate status of the hospital outpatient within the hospital overall. In accordance with section 1886(d)(3)(E) of the Act, the IPPS wage index is updated annually. In this proposed rule, we are using the 
                        ( print page 49540)
                        proposed FY 2007 hospital IPPS wage indices published in the 
                        **Federal Register**
                         on April 25, 2006, which include the wage indices proposed to be in effect through March 31, 2007, and those proposed to be in effect on or after April 1, 2007, to accommodate the expiring reclassification provisions under section 508 of Pub. L. 108-173, to determine the wage adjustments for the OPPS payment rate and the copayment standardized amount for CY 2007. However, in accordance with our established policy, we are proposing to use the FY 2007 final version of these wage indices to determine the wage adjustments for the OPPS payment rate and copayment standardized amount that we will publish in our final rule for CY 2007. On May 17, 2006 (71 FR 28644), in response to a court order in 
                        *Bellevue Hosp. Ctr.*
                         v. 
                        *Leavitt,*
                         we published a second IPPS proposed rule that would revise the methodology for calculating the occupational mix adjustment for FY 2007. We proposed to replace in full the descriptions of the data and methodology that would be used in calculating the occupational mix adjustment discussed in the first FY 2007 IPPS proposed rule. The second proposed rule also states that, because of the collection of new occupational mix data, we would publish the FY 2007 occupational mix adjusted wage index tables and related impacts on the CMS Web site shortly after we publish the FY 2007 IPPS final rule, and in advance of October 1, 2006. The weights and factors would also be published on the CMS Web site after the FY 2007 IPPS final rule, but in advance of October 1, 2006. (71 FR 28650). Thus, for purposes of determining OPPS wage indices, readers are also directed to refer to the wage index tables that are published after the FY 2007 IPPS final rule. We note that the FY 2007 IPPS wage indices continue to reflect a number of changes implemented in FY 2005 as a result of the revised Office of Management and Budget (OMB) standards for defining geographic statistical areas, the implementation of an occupational mix adjustment as part of the wage index, and new wage adjustments provided for under Pub. L. 108-173. The following is a brief summary of the proposed changes in the FY 2005 IPPS wage indices, continued for FY 2007, and any adjustments that we are applying to the OPPS for CY 2007. We refer the reader to the FY 2007 IPPS proposed rule (71 FR 24074 through 24091) for a detailed discussion of the proposed changes to the wage indices. Readers should refer to our proposed rule published May 17, 2006, for proposed changes to the occupational mix adjustment and related issues (71 FR 28644-28653). In this proposed rule, we are not reprinting the proposed FY 2007 IPPS wage indices. We also refer readers to the CMS Web site for the OPPS at 
                        *http://www.cms.hhs.gov/​providers/​hopps.*
                         At this Web site, the reader will find a link to the proposed FY 2007 IPPS wage indices tables. (However, as noted above, these tables may change as a result of the May 17, 2006 occupational mix proposed rule discussed above.) 1. 
                        *The proposed continued use of the Core Based Statistical Areas (CBSAs) issued by the OMB as revised standards for designating geographical statistical areas based on the 2000 Census data, to define labor market areas for hospitals for purposes of the IPPS wage index.*
                         The OMB revised standards were published in the 
                        **Federal Register**
                         on December 27, 2000 (65 FR 82235), and OMB announced the new CBSAs on June 6, 2003, through an OMB bulletin. In the FY 2005 IPPS final rule, CMS adopted the new OMB definitions for wage index purposes. In the FY 2007 IPPS proposed rule, we again stated that hospitals located in MSAs will be urban and hospitals that are located in Micropolitan Areas or outside CBSAs will be rural. To help alleviate the decreased payments for previously urban hospitals that became rural under the new geographical definitions, we allowed these hospitals to maintain for the 3-year period from FY 2005 through FY 2007, the wage index of the MSA where they previously had been located. To be consistent with the IPPS, we will continue the policy we began in CY 2005 of applying the same urban-to-rural transition to non-IPPS hospitals paid under the OPPS. That is, we would maintain the wage index of the MSA where the hospital was previously located for purposes of determining a wage index for CY 2007. Beginning in FY 2008, the 3-year transition will end and these hospitals will receive their statewide rural wage index. However, hospitals paid under the IPPS will be eligible to apply for reclassification. For the occupational mix adjustment, we refer readers to CMS's May 17, 2006 occupational mix proposed rule discussed above. Under this proposed rule, wage indices would be adjusted 100 percent for occupational mix. In addition, as stated above, CMS plans that wage index tables and other adjustment factors would be published after publication of the FY 2007 IPPS final rule, but prior to October 1, 2006. As noted above, for purposes of estimating an adjustment for the OPPS payment rates to accommodate geographic differences in labor costs in this proposed rule, we have used the wage indices identified in the FY 2007 IPPS proposed rule. For the CY 2007 OPPS final rule, we plan to use the revised FY 2007 IPPS wage indices that will be fully adjusted for differences in occupational mix using the new survey data and available after October 1, 2006. In all cases, we will use the final FY 2007 IPPS wage indices, which include the wage indices to be in effect through March 31, 2007, and those to be in effect on or after April 1, 2007, with any subsequent corrections, for calculating OPPS payment in CY 2007. 2. 
                        *The reclassifications of hospitals to geographic areas for purposes of the wage index.*
                         For purposes of the OPPS wage index, we are proposing to adopt all of the IPPS reclassifications for FY 2007, including reclassifications that the Medicare Geographic Classification Review Board (MGCRB) approved under the one-time appeal process for hospitals under section 508 of Pub. L. 108-173. We note that section 508 reclassifications will terminate March 31, 2007, and that this expiration, along with the calendar year operating period of OPPS, impacts the calculation of the OPPS payment and the budget neutrality adjustment for the wage index. In the FY 2007 IPPS proposed rule (71 FR 24085 through 24087), we proposed procedural rules for hospitals that wished to reclassify for the second half of FY 2007 (April 1, 2007, through September 30, 2007) under section 1886(d)(10) of the Act. These rules essentially provided procedures for some hospitals to retain section 508 reclassifications for the first half of FY 2007 and also be eligible to maintain an approved reclassification under section 1886(d)(10) for the second half of FY 2007. Rather than calculating one wage index that reflected all final reclassification adjustments, we proposed two separate wage indices for FY 2007, one to be in effect October 1 through March 31, 2007, and one to be in effect April 1 through September 30, 2007. These procedural rules also impact a hospital's eligibility to receive the out-migration wage adjustment, discussed in greater detail in section III.I. of the FY 2007 IPPS proposed rule (71 FR 24087) and under section II.D.4. of this preamble. A hospital cannot receive an out-migration wage adjustment if it is reclassified under section 1886(d)(10) of the Act. Hospitals declining reclassification status for any part of the year become eligible to receive the out-migration wage adjustment if they are located in an adjustment county. 
                        ( print page 49541)
                        Because the OPPS operates on a calendar year (January 1 through December 31) and not a fiscal year, the expiring reclassification status under section 508 of Pub. L. 108-173 results in different wage indices for OPPS for the first quarter of CY 2007 (January 1, 2007, through March 31, 2007) and the last three quarters of CY 2007 (April 1, 2007, through December 31, 2007). 3. 
                        *The out-migration wage adjustment to the wage index.*
                         In FY 2007 IPPS proposed rule (71 FR 24087), we discussed the out-migration adjustment under section 505 of Pub. L. 109-173 for counties under this adjustment. Hospitals paid under the IPPS located in the qualifying section 505 “out-migration” counties receive a wage index increase unless they have already been otherwise reclassified. (See the IPPS FY 2007 proposed rule for further information on out-migration.) For OPPS purposes, we propose to continue our policy from CY 2006 to allow non-IPPS hospitals paid under the OPPS to qualify for out-migration adjustment if they are located in a section 505 out-migration county. Because non-IPPS hospitals cannot reclassify, they are eligible for the out-migration wage adjustment. Tables identifying counties eligible for the out-migration adjustment will be published after the FY 2007 IPPS final rule and CMS plans to publish them in advance of October 1, 2006. These tables will reflect updated county listing to reflect changes to the occupation mix adjustment made in response to 
                        *Bellevue*
                         court case discussed above. Because we are proposing to adopt the final FY 2007 IPPS wage index, we will adopt any changes in a hospital's classification status that would make them either eligible or ineligible for the out-migration wage adjustment both through March 31, 2007, and on or after April 1, 2007. With the exception of reclassifications resulting from the implementation of the one-time appeal process under section 508 of Pub. L. 108-173, all changes to the wage index resulting from geographic labor market area reclassifications or other adjustments must be incorporated in a budget neutral manner. Accordingly, in calculating the OPPS budget neutrality estimates for CY 2007, in this proposed rule, we have included the wage index changes that would result from MGCRB reclassifications, implementation of section 505 of Pub. L. 108-173, and other refinements made in the FY 2007 IPPS proposed rule, such as the hold harmless provision for hospitals changing status from urban to rural under the new CBSA geographic statistical area definitions. However, section 508 sets aside $900 million to implement the section 508 reclassifications. We considered the increased Medicare payments that the section 508 reclassifications would create in both the IPPS and OPPS when we determined the impact of the one-time appeal process. Because the increased OPPS payments already count against the $900 million limit, we did not consider these reclassifications when we calculated the proposed OPPS budget neutrality adjustment. Under the procedural rules described under section II.D.3. of this proposed rule above and in section III.H.5. of the FY 2007 IPPS proposed rule (71 FR 24085) regarding expiring section 508 reclassifications, different wage indices may be in effect for the first quarter of the calendar year and the last three quarters of the calendar year. These rules have implications for budget neutrality adjustments. Any additional payment attributable to reclassifications due to section 508 between January 1 and April 1, 2007, must be excluded from a budget neutrality adjustment, and all other adjustments to the wage index are subject to budget neutrality. Rather than calculating two different conversion factors, with different budget neutrality adjustments, we are proposing to calculate one budget neutrality adjustment that reflects the combined adjustments required for the first quarter and last three quarters of the calendar year, respectively. We followed the same approach in the FY 2007 IPPS proposed rule (71 FR 24087). E. Proposed Statewide Average Default CCRs (If you choose to comment on issues in this section, please include the caption “OPPS: Cost-to-Charge Ratios” at the beginning of your comment.) CMS uses CCRs to determine outlier payments, payments for pass-through devices, and monthly interim transitional corridor payments under the OPPS. Some hospitals do not have a valid CCR. These hospitals include, but are not limited to, hospitals that are new and have not yet submitted a cost report, hospitals that have a CCR that falls outside predetermined floor and ceiling thresholds for a valid CCR, or hospitals that have recently given up their all-inclusive rate status. Last year, we updated the default urban and rural CCRs for CY 2006 in our final rule, published on November 10, 2005 (70 FR 68553 through 68555). In this proposed rule, we are proposing to update the default ratios for CY 2007 using the most recent cost report data. We calculated the statewide default CCRs using the same overall CCRs that we use to adjust charges to costs on claims data. Please refer to section II.A.1.c. of this preamble for a discussion of our proposed revision to the overall CCR calculation. Table 4 lists the proposed CY 2007 default urban and rural CCRs by State and compares them to last year's default CCRs. These CCRs are the ratio of total costs to total charges from each provider's most recently submitted cost report, for those cost centers relevant to outpatient services weighted by Medicare Part B charges. We also adjusted these ratios to reflect final settled status by applying the differential between settled to submitted costs and charges from the most recent pair of settled to submitted cost reports. For this proposed rule, 81.79 percent of the submitted cost reports represented data for CY 2004. We only used valid CCRs to calculate these default ratios. That is, we removed the CCRs for all-inclusive hospitals, CAHs, and hospitals in Guam and the U.S. Virgin Islands because these entities are not paid under the OPPS, or in the case of all-inclusive hospitals, because their CCRs are suspect. We further identified and removed any obvious error CCRs and trimmed any outliers. We limited the hospitals used in the calculation of the default CCRs to those hospitals that billed for services under the OPPS during CY 2004. Finally, we calculated an overall average CCR, weighted by a measure of volume for CY 2004, for each State except Maryland. This measure of volume is the total lines on claims and is the same one that we use in our impact tables. For Maryland, we used an overall weighted average CCR for all hospitals in the Nation as a substitute for Maryland CCRs, which appear in Table 4. Very few providers in Maryland are eligible to receive payment under the OPPS, which limits the data available to calculate an accurate and representative CCR. The observed differences between last year's default statewide CCRs and the proposed CCRs are a combination of the general decline in the ratio between costs and charges widely observed in the cost report data and the change in the proposed overall CCR calculation. 
 
  
 
  
 
  
 
  As stated above, CMS uses default statewide CCRs for several groups of hospitals, including, but not limited to, hospitals that are new and have not yet submitted a cost report, hospitals that have a CCR that falls outside predetermined floor and ceiling thresholds for a valid CCR, and hospitals that have recently given up their all-inclusive rate status. Current OPPS policy also requires hospitals that experience a change of ownership, but that do not accept assignment of the previous hospital's provider agreement, to use the previous provider's CCR. For CY 2007, we are proposing to apply this treatment of using the default statewide CCR to include an entity that has not accepted assignment of an existing hospital's provider agreement in accordance with 42 CFR 489.18, and that has not yet submitted its first Medicare cost report. We are proposing that this policy be effective for hospitals experiencing a change of ownership on or after January 1, 2007. We believe that a hospital that has not accepted assignment of an existing hospital's provider agreement is similar to a new hospital that will establish its own costs and charges. We believe that the hospital that has chosen not to accept assignment may have different costs and charges than the existing hospital. Furthermore, we believe that the hospital should be provided time to establish its own costs and charges. Therefore, we are proposing to use the default statewide CCR to determine cost-based payments until the hospital has submitted its first Medicare cost report. F. OPPS Payments to Certain Rural Hospitals (If you choose to comment on issues in this section, please include the caption “OPPS: Rural Hospitals Hold Harmless Transitional Payments” at the beginning of your comment.) 1. Hold Harmless Transitional Payment Changes Made by Pub. L. 109-171 (DRA) When the OPPS was implemented, every provider was eligible to receive an additional payment adjustment (transitional corridor payment) if the payments it received for covered OPD services under the OPPS were less than the payments it would have received for the same services under the prior reasonable cost-based system. Section 1833(t)(7) of the Act provides that the transitional corridor payments are temporary payments for most providers, with two exceptions, to ease their transition from the prior reasonable cost-based payment system to the OPPS system. Cancer hospitals and children's hospitals receive the transitional corridor payments on a permanent basis. Section 1833(t)(7)(D)(i) of the Act originally provided for transitional corridor payments to rural hospitals with 100 or fewer beds for covered OPD services furnished before January 1, 2004. However, section 411 of Pub. L. 108-173 amended section 1833(t)(7)(D)(i) of the Act to extend these payments through December 31, 2005, for rural hospitals with 100 or fewer beds. Section 411 also extended the transitional corridor payments to sole community hospitals (SCHs) located in rural areas for services furnished during the period that begins with the provider's first cost reporting period beginning on or after January 1, 2004, and ends on December 31, 2005. Accordingly, the authority for making transitional corridor payments under section 1833(t)(7)(D)(i) of the Act, as amended by section 411 of Pub. L. 108-173, expired for rural hospitals having 100 or fewer beds and SCHs located in rural areas on December 31, 2005. Section 5105 of Pub. L. 109-171 reinstituted the hold harmless transitional outpatient payments (TOPs) for covered OPD services furnished on or after January 1, 2006, and before January 1, 2009, for rural hospitals having 100 or fewer beds that are not SCHs. When the OPPS payment is less than the payment the provider would have received under the previous reasonable cost-based system, the amount of payment is increased by 95 percent of the amount of the difference between those two payment systems for CY 2006, by 90 percent of the amount of that difference for CY 2007, and by 85 percent of the amount of that difference for CY 2008. For CY 2006, we have implemented section 5106 of Pub. L. 109-171 through Transmittal 877, issued on February 24, 2006. We did not specifically address whether TOPs payments apply to EACHs, which are considered to be SCHs under section 1886(d)(5)(D)(iii)(III) of the Act. Accordingly, under the statute, EACHs are treated as SCHs. Therefore, we believe that EACHs are not eligible for TOPs payment under Pub. L. 109-171. We are proposing to update § 419.70(d) 
                        ( print page 49546)
                        to reflect the requirements of Pub. L. 109-171. 2. Proposed Adjustment for Rural SCHs Implemented in CY 2006 Related to Pub. L. 108-173 (MMA) (If you choose to comment on issues in this section, please include the caption “OPPS: Rural SCH Payments” at the beginning of your comment.) In the CY 2006 OPPS final rule with comment period (70 FR 68556), we finalized a payment increase for rural SCHs of 7.1 percent for all services and procedures paid under the OPPS, excluding drugs, biologicals, brachytherapy seeds, and services paid under pass-through payment policy in accordance with section 1833(t)(13)(B) of the Act, as added by section 411 of Pub. L. 108-173. Section 411 gave the Secretary the authority to make an adjustment to OPPS payments for rural hospitals effective January 1, 2006 if justified by a study of the difference in costs by APC between hospitals in rural and urban areas. Our analysis showed a difference in costs only for rural SCHs and we implemented a payment adjustment for those hospitals beginning January 1, 2006. We recently became aware that we did not specifically address whether the adjustment applies to EACHs, which are considered to be SCHs pursuant to section 1886(d)(5)(D)(iii)(III) of the Act. Thus, under the statute, EACHs are treated as SCHs. Currently, fewer than 10 hospitals are classified as EACHs. As of CY 1998, under section 4201(c) of Pub. L. 105-33, a hospital can no longer become newly classified as an EACH. Therefore, for purposes of receiving this rural adjustment, we are clarifying that EACHs are treated as SCHs for purposes of receiving this adjustment, assuming these entities otherwise meet the rural adjustment criteria. This adjustment is budget neutral and applied before calculating outliers and coinsurance. We also stated that we would not reestablish the adjustment amount on an annual basis, but that we might review the adjustment in the future and, if appropriate, would revise the adjustment. For CY 2007, we are proposing to continue our current policy of a budget neutral 7.1 percent payment increase for rural SCHs for specified services. G. Proposed CY 2007 Hospital Outpatient Outlier Payments (If you choose to comment on issues in this section, please include the caption “Outlier Payments” at the beginning of your comment.) Currently, the OPPS pays outlier payments on a service-by-service basis. For CY 2006, the outlier threshold is met when the cost of furnishing a service or procedure by a hospital exceeds 1.75 times the APC payment amount and exceeds the APC payment rate plus a $1,250 fixed-dollar threshold. We introduced a fixed-dollar threshold in CY 2005 in addition to the traditional multiple threshold in order to better target outliers to those high cost and complex procedures where a very costly service could present a hospital with significant financial loss. If a provider meets both of these conditions, the multiple threshold and the fixed-dollar threshold, the outlier payment is calculated as 50 percent of the amount by which the cost of furnishing the service exceeds 1.75 times the APC payment rate. For a discussion on CMHC outliers, see section II.B.3. of the preamble to this proposed rule. As explained in our CY 2006 OPPS final rule with comment period (70 FR 68561), we set our projected target for aggregate outlier payments at 1.0 percent of aggregate total payments under the OPPS. Our outlier thresholds were set so that estimated CY 2006 aggregate outlier payments would equal 1.0 percent of aggregate total payments under the OPPS. In our CY 2006 OPPS final rule with comment period (70 FR 68563), we also published total outlier payments as a percent of total expenditures for past years. At this time, we do not have a complete set of CY 2005 claims in order to produce this number for CY 2005. We will report on CY 2005 outlier payments in our CY 2007 OPPS final rule. For CY 2007, we are proposing to continue our policy of setting aside 1.0 percent of aggregate total payments under the OPPS for outlier payments. A portion of that 1.0, an amount equal to 0.25 percent of outlier payments and 0.0025 percent of total OPPS payments would be allocated to CMHCs for partial hospitalization program service outliers. In order to ensure that estimated CY 2007 aggregate outlier payments would equal 1.0 percent of estimated aggregate total payments under the OPPS, we are proposing that the outlier threshold be set so that outlier payments are triggered when the cost of furnishing a service or procedure by a hospital exceeds 1.75 times the APC payment amount and exceeds the APC payment rate plus a $1,825 fixed-dollar threshold. We calculated the fixed-dollar threshold for this proposed rule using the same methodology as we did in CY 2006 except we used the revised overall CCR calculation discussed in section II.A.1.c. of this preamble. As discussed in section II.A.1.c. of this preamble, we discovered that the calculation of the overall CCR that the fiscal intermediaries are using to determine outlier payment and payment for services paid at charges reduced to cost differs from the overall CCR that we traditionally use to model the outlier thresholds. We discovered this during our calculations of the outlier threshold for our CY 2006 final rule with comment period, and we indicated in our preamble discussion for that rule, that we may revisit the threshold estimate in light of identified differences in the overall CCR calculation. Because, on average, the overall CCR calculation used by the fiscal intermediaries results in higher CCRs than those estimated using our “traditional” CCR sets, the outlier threshold is too low. The OPPS impact table in section XXVII. of this preamble demonstrates an estimated payment differential of 0.25 percent of total spending for hospital outlier payments in CY 2006 because of the differences in overall CCR calculations. The revised overall CCR calculation that we are proposing for CY 2007 aligns the two CCR calculations by removing allied and nursing health costs for those hospitals with paramedical education programs from the fiscal intermediary's CCR calculation and weighting our “traditional” calculation by total Medicare Part B charges. We expected this proposed change in the overall CCR calculation to raise the outlier threshold. The claims that we use to model each OPPS lag by 2 years. For this proposed rule, we used CY 2005 claims to model the CY 2007 OPPS. In order to estimate CY 2007 outlier payments for this proposed rule, we inflated the charges on the CY 2005 claims using the same inflation factor of 1.1515 that we used to estimate the IPPS fixed-dollar outlier threshold for the IPPS FY 2007 proposed rule. For 1 year, the inflation factor is 1.0757. The methodology for determining this charge inflation factor was discussed in the FY 2007 IPPS proposed rule (71 FR 24150). As we stated in our CY 2005 final rule with comment period, we believe that the use of this charge inflation factor is appropriate for OPPS because, with the exception of the routine service cost centers, hospitals use the same cost centers to capture costs and charges across inpatient and outpatient services (69 FR 65845, November 15, 2004). As also noted in the FY 2006 IPPS final rule, we believe that a charge inflation factor is more appropriate than an adjustment to costs because this methodology closely captures how 
                        ( print page 49547)
                        actual outlier payments are made and calculated (70 FR 47495, August 12, 2005). We then applied the revised overall CCR that we calculated from each hospital's most recent cost report (CMS-2552-96) and, if the cost report was not settled, we adjusted it by a settled-to-submitted ratio. We simulated aggregated outlier payments using these costs for several different fixed-dollar thresholds holding the 1.75 multiple constant until the total outlier payments equaled 1.0 percent of aggregated total OPPS payments. We estimate that a threshold of $1,825 combined with the multiple threshold of 1.75 times the APC payment rate would allocate 1.0 percent of aggregated total OPPS payments to outlier payments. For CMHCs, in CY 2007 we project the outlier threshold is met when the cost of furnishing a service or procedure by a CMHC exceeds 3.40 times the APC payment rate. If a CMHC provider meets this condition, the outlier payment is calculated as 50 percent of the amount by which the cost exceeds 3.40 times the APC payment rate. We are proposing to continue the same threshold policy for CY 2007 as we have established for CY 2006. An explanation for this proposed policy is discussed in section II.B.3. the preamble of this proposed rule. The following is an example of an outlier calculation for CY 2007 under our proposed policy. A hospital charges $20,000 for a procedure. The wage adjusted, and rural adjusted, if applicable, APC payment for the procedure is $3,500. Using the provider's CCR of 0.35, the estimated cost to the hospital is $7,000 (0.35 × $20,000). To determine whether this provider is eligible for outlier payments for this procedure, the provider must determine whether the cost for the service exceeds both the APC outlier cost threshold (1.75 × APC payment) and the fixed-dollar threshold ($1,825 + APC payment). In this example, the provider meets both criteria: (1) $7,000 exceeds $6,125 (1.75 × $3,500) (2) $7,000 exceeds $5,325 ($3,500 + $1,825) To calculate the outlier payment, which is 50 percent of the amount by which the cost of furnishing the service exceeds 1.75 times the APC rate, subtract $6,125 (1.75 × $3,500) from $7,000 (resulting in $825). The provider is eligible for 50 percent of the difference, in this case $437.50 ($825/2). The formula is (cost − (1.75 × APC payment rate))/2. H. Calculation of the Proposed OPPS National Unadjusted Medicare Payment (If you choose to comment on issues in this section, please include the caption “OPPS: National Unadjusted Medicare Payment” at the beginning of your comment.) The basic methodology for determining prospective payment rates for OPD services under the OPPS is set forth in existing regulations at § 419.31 and § 419.32. The payment rate for services and procedures for which payment is made under the OPPS is the product of the conversion factor calculated in accordance with section II.C. of this proposed rule and the relative weight determined under section II.A. of this proposed rule. Therefore, the national unadjusted payment rate for APCs contained in Addendum A to this proposed rule and for HCPCS codes to which payment under the OPPS has been assigned in Addendum B to this proposed rule (Addendum B is provided as a convenience for readers) was calculated by multiplying the proposed CY 2007 scaled weight for the APC by the proposed CY 2007 conversion factor. However, to determine the payment that will be made in a calendar year under the OPPS to a specific hospital for an APC for a service other than a drug, in a circumstance in which the multiple procedure discount does not apply, we take the following steps: *Step 1.*
                         Calculate 60 percent (the labor-related portion) of the national unadjusted payment rate. Since the initial implementation of the OPPS, we have used 60 percent to represent our estimate of that portion of costs attributable, on average, to labor. (Refer to the April 7, 2000 final rule with comment period (65 FR 18496 through 18497) for a detailed discussion of how we derived this percentage.) *Step 2.*
                         Determine the wage index area in which the hospital is located and identify the wage index level that applies to the specific hospital. The wage index values assigned to each area reflect the new geographic statistical areas as a result of revised OMB standards (urban and rural) to which hospitals are assigned for FY 2007 under the IPPS, reclassifications through the Medicare Classification Geographic Review Board, section 1866(d)(8)(B) “Lugar” hospitals, and section 401 of Pub. L. 108-173, and the reclassifications of hospitals under the one-time appeals process under section 508 of Pub. L. 108-173. The wage index values include the occupational mix adjustment described in section II.D. of this proposed rule that was developed for the proposed FY 2007 IPPS payment rates. We note that the original proposal for calculating the FY 2007 IPPS wage index has been recently changed. (Refer to the May 17, 2006 FY 2007 IPPS proposed rule, 71 FR 28644).) Final FY 2007 IPPS wage indices will be adjusted 100 percent for differences in occupational mix. Although we have not incorporated those changes in this proposed rule due to the availability of new survey data, as is our practice, we propose to adopt changes made to the FY 2007 IPPS wage index values after they have been finalized. *Step 3.*
                         Adjust the wage index of hospitals located in certain qualifying counties that have a relatively high percentage of hospital employees who reside in the county, but who work in a different county with a higher wage index, in accordance with section 505 of Pub. L. 108-173. Addendum L contains the qualifying counties and the proposed wage index increase developed for the FY 2007 IPPS. This step is to be followed only if the hospital has chosen not to accept reclassification under Step 2 above. *Step 4.*
                         Multiply the applicable wage index determined under Steps 2 and 3 by the amount determined under Step 1 that represents the labor-related portion of the national unadjusted payment rate. *Step 5.*
                         Calculate 40 percent (the nonlabor-related portion) of the national unadjusted payment rate and add that amount to the resulting product of Step 4. The result is the wage index adjusted payment rate for the relevant wage index area. *Step 6.*
                         If a provider is a SCH, as defined in § 419.92, and located in a rural area, as defined in § 412.63(b), or is treated as being located in a rural area under § 412.103 of the Act, multiply the wage index adjusted payment rate by 1.071 to calculate the total payment. I. Proposed Beneficiary Copayments for CY 2007 (If you choose to comment on issues in this section, please include the caption “OPPS: Beneficiary Copayments” at the beginning of your comment.) 1. Background Section 1833(t)(3)(B) of the Act requires the Secretary to set rules for determining copayment amounts to be paid by beneficiaries for covered OPD services. Section 1833(t)(8)(C)(ii) of the Act specifies that the Secretary must reduce the national unadjusted copayment amount for a covered OPD service (or group of such services) furnished in a year in a manner so that the effective copayment rate 
                        ( print page 49548)
                        (determined on a national unadjusted basis) for that service in the year does not exceed specified percentages. For all services paid under the OPPS in CY 2007, and in calendar years thereafter, the specified percentage is 40 percent of the APC payment rate (section 1833(t)(8)(C)(ii)(V) of the Act). Section 1833(t)(3)(B)(ii) of the Act provides that, for a covered OPD service (or group of such services) furnished in a year, the national unadjusted coinsurance amount cannot be less than 20 percent of the OPD fee schedule amount. 2. Proposed Copayment for CY 2007 For CY 2007, we are proposing to determine copayment amounts for new and revised APCs using the same methodology that we implemented for CY 2004 (Refer to the November 7, 2003 OPPS final rule with comment period, 68 FR 63458.) The proposed unadjusted copayment amounts for services payable under the OPPS that would be effective January 1, 2007, are shown in Addendum A and Addendum B of this proposed rule. 3. Calculation of a Proposed Adjusted Copayment Amount for an APC Group for CY 2007 To calculate the OPPS adjusted copayment amount for an APC group, take the following steps: *Step 1.*
                         Calculate the beneficiary payment percentage for the APC by dividing the APC's national unadjusted copayment by its payment rate. For example, using APC 0001, $7.00 is 23 percent of $30.14. *Step 2.*
                         Calculate the wage adjusted payment rate for the APC, for the provider in question, as indicated in section II.H. of this preamble. Calculate the rural adjustment for eligible providers as indicated in section II.H. of this preamble. *Step 3.*
                         Multiply the percentage calculated in Step 1 by the payment rate calculated in Step 2. The result is the wage-adjusted copayment amount for the APC. III. Proposed OPPS Ambulatory Payment Classification (APC) Group Policies A. Proposed Treatment of New HCPCS and CPT Codes (If you choose to comment on issues in this section, please include the caption “OPPS: New HCPCS and CPT Codes” at the beginning of your comment.) 1. Proposed Treatment of New HCPCS Codes Included in the Second and Third Quarterly OPPS Updates for CY 2006 During the second and third quarters of CY 2006, we created a total of four new Level II HCPCS codes that were not addressed in the November 10, 2005 final rule with comment period that updated the CY 2006 OPPS. We have designated the payment status of those codes and added them either through the April update (Transmittal 896, dated March 24, 2006) or the July update of the CY 2006 OPPS (Transmittal 970, dated May 30, 2006). In this proposed rule, we are soliciting public comments on the status indicators and APC assignments of these services, which are listed in Table 5. Because of the timing of this proposed rule, those codes implemented through the July 2006 OPPS update are not included in Addendum B of this proposed rule, while those codes based upon the April 2006 OPPS update are included in Addendum B. We intend to finalize the assignments for all of these services in the OPPS CY 2007 final rule. Table 5.—New HCPCS Codes Implemented in April or July 2006
HCPCS code
Description
Assigned status indicator
Assigned APC
Implementation dateC9227
Injection, micafungin sodium, per 1 mg
G
9227
April 1, 2006.C9228
Injection, tigecycline, per 1 mg
G
9228
April 1, 2006.C9229
Injection ibandronate sodium
G
9229
July 1, 2006.C9230
Injection, abatacept
G
9230
July 1, 2006.
 2. Proposed Treatment of New CY 2007 Category I and III CPT Codes and Level II HCPCS Codes As has been our practice in the past, we implement new Category I and III CPT codes and new Level II HCPCS codes, which are released in the fall of each year for annual updating, effective January 1 in the final rule updating the OPPS for the following calendar year. These codes are flagged with Comment Indicator “NI” in Addendum B of the OPPS final rule to indicate that we are assigning them an interim payment status which is subject to public comment following publication of the final rule that implements the annual OPPS update. (See the discussion immediately below concerning our modified policy for implementing new Category I and III mid-year CPT codes.) We are proposing to continue this recognition and process for CY 2007. New Category I and III CPT codes and new Level II HCPCS codes, effective January 1, 2007, will be designated in Addendum B of the CY 2007 OPPS final rule with Comment Indicator “NI.” The status indicator, the APC assignment, or both for all such codes flagged with Comment Indicator “NI,” will be open to public comment. We will respond to all comments received in a subsequent final rule. 3. Proposed Treatment of New Mid-Year CPT Codes Twice each year, the AMA issues Category III CPT codes, which the AMA defines as temporary codes for emerging technology, services, and procedures. (In addition, AMA issues mid-year Category I CPT codes for vaccines for which FDA approval is imminent, to ensure timely availability of a code.) The AMA establishes these codes to allow collection of data specific to the service described by the code, as these services could otherwise only be reported using a Category I CPT unlisted code. The AMA releases Category III CPT codes in January, for implementation beginning the following July, and in July, for implementation beginning the following January. Prior to CY 2006, we treated new Category III CPT codes implemented in July of the previous year or January of the OPPS update year in the same manner that new Category I CPT codes and new Level II HCPCS codes implemented in January of the OPPS update year are treated; that is, we provided APC and status indicator assignments or both in the final rule updating the OPPS for the following calendar year. New Category I and Category III CPT codes, as well as new Level II HCPCS codes, were flagged with Comment Indicator “NI” in Addendum B of the final rule to indicate that we were assigning them an 
                        ( print page 49549)
                        interim payment status which was subject to public comment following publication of the final rule that implemented the annual OPPS update. As stated in the CY 2006 OPPS final rule with comment period (70 FR 68567), we modified our process for implementing the Category III codes that the AMA releases each January for implementation in July to ensure timely collection of data pertinent to the services described by the codes; to ensure patient access to the services the codes describe; and to eliminate potential redundancy between Category III CPT codes and some of the C-codes, which are payable under the OPPS and created by us in response to applications for new technology services. Therefore, beginning on July 1, 2006, we implemented in the OPPS seven Category III CPT codes that the AMA released in January 2006 for implementation in July 2006. The codes are shown in Table 6. These codes are not included in Addendum B of this proposed rule, which is based upon the April 2006 OPPS update. In this proposed rule, we are soliciting public comments on the status indicators and, if applicable, the APC assignments of these services. We intend to finalize the assignments of these Category III CPT codes implemented in July 2006 in the CY 2007 OPPS final rule. Table 6.—Category III CPT Codes Implemented in July 2006
HCPCS code
Long descriptor
Status indicator
APC0155T
Laparoscopy, surgical, implantation or replacement of gastric stimulation electrodes, lesser curvature (i.e., morbid obesity)
T
01300156T
Laparoscopy, surgical, revision or removal of gastric stimulation electrodes, lesser curvature (i.e., morbid obesity)
T
01300157T
Laparotomy, implantation or replacement of gastric stimulation electrodes, lesser curvature (i.e., morbid obesity)
C0158T
Laparotomy, revision or removal of gastric stimulation electrodes, lesser curvature (i.e., morbid obesity)
C0159T
Computer aided detection, including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation, breast MRI
N0160T
Therapeutic repetitive transcranial magnetic stimulation treatment planning
X
03400161T
Therapeutic repetitive transcranial magnetic stimulation treatment delivery and management, per session
X
0340
 Some of the new Category III CPT codes describe services that we have determined to be similar in clinical characteristics and resource use to HCPCS codes in an existing APC. In these instances, we may assign the Category III CPT code to the appropriate clinical APC. Other Category III CPT codes describe services that we have determined are not compatible with an existing clinical APC, yet are appropriately provided in the hospital outpatient setting. In these cases, we may assign the Category III CPT code to what we estimate is an appropriately priced New Technology APC. In other cases, we may assign a Category III CPT code one of several nonseparately payable status indicators, including N, C, B, or E, which we believe is appropriate for the specific code. We expect that we will have received applications for new technology status for some of the services described by new Category III CPT codes, which may assist us in determining appropriate APC assignments. If the AMA establishes a Category III CPT code for a service for which an application has been submitted to CMS for new technology status, CMS may not have to issue a temporary Level II HCPCS code to describe the service, as has often been the case in the past when Category III CPT codes were only recognized by the OPPS on an annual basis. Therefore, for CY 2007, we are proposing to include in Addendum B of the OPPS CY 2007 final rule the new Category III CPT codes and the new Category I CPT codes for vaccines released in January 2006 for implementation on July 1, 2006 (through the OPPS quarterly update process) and the Category III and vaccine Category I CPT codes released in July 2006 for implementation on January 1, 2007. However, only those new Category III codes and the new vaccine codes implemented effective January 1, 2007, will be flagged with Comment Indicator “NI” in Addendum B of the CY 2007 final rule to indicate that we are assigning them an interim payment status which is subject to public comment. As discussed earlier, Category III codes and Category I vaccine codes implemented in July 2006, which are listed in Table 6, are subject to comment through this proposed rule and their status will be made final in the CY 2007 OPPS final rule. B. Proposed Changes—Variations Within APCs (If you choose to comment on issues in this section, please include the caption “OPPS: 2 Times Rule” at the beginning of your comment.) 1. Background Section 1833(t)(2)(A) of the Act requires the Secretary to develop a classification system for covered hospital outpatient services. Section 1833(t)(2)(B) of the Act provides that this classification system may be composed of groups of services, so that services within each group are comparable clinically and with respect to the use of resources. In accordance with these provisions, we developed a grouping classification system, referred to as the Ambulatory Payment Classification Groups (or APCs), as set forth in § 419.31 of the regulations. We use Level I and Level II HCPCS codes and descriptors to identify and group the services within each APC. The APCs are organized such that each group is homogeneous both clinically and in terms of resource use. Using this classification system, we have established distinct groups of surgical, diagnostic, and partial hospitalization services, as well as medical visits. We also have developed separate APC groups for certain medical devices, drugs, biologicals, radiopharmaceuticals, and brachytherapy devices. We have packaged into each procedure or service within an APC group the costs associated with those items or services that are directly related and integral to performing a procedure 
                        ( print page 49550)
                        or furnishing a service. Therefore, we do not make separate payment for packaged items or services. For example, packaged items and services include: (1) Use of an operating, treatment, or procedure room; (2) use of a recovery room; (3) most observation services; (4) anesthesia; (5) medical/surgical supplies; (6) pharmaceuticals (other than those for which separate payment may be allowed under the provisions discussed in section V of this preamble); and (7) incidental services such as venipuncture. Our packaging methodology is discussed in section II.A. of this proposed rule. Under the OPPS, we pay for hospital outpatient services on a rate-per-service basis that varies according to the APC group to which the service is assigned. Each APC weight represents the hospital median cost of the services included in that APC relative to the hospital median cost of the services included in APC 0606. The APC weights are scaled to APC 0606 because we are proposing it to be the middle level clinic visit APC (that is, where the Level III Clinic Visit HCPCS code of five proposed levels of clinic visits is assigned), and because middle level clinic visits are among the most frequently furnished services in the outpatient hospital setting. See section II.A.3. of this preamble for a complete discussion of the reasons for choosing APC 0606 as the basis for scaling the APC relative weights. Section 1833(t)(9)(A) of the Act requires the Secretary to review the components of the OPPS not less than annually and to revise the groups and relative payment weights and make other adjustments to take into account changes in medical practice, changes in technology, and the addition of new services, new cost data, and other relevant information and factors. Section 1833(t)(9)(A) of the Act, as amended by section 201(h) of the BBRA of 1999, also requires the Secretary, beginning in CY 2001, to consult with an outside panel of experts to review the APC groups and the relative payment weights (the APC Panel recommendations for specific services for CY 2007 OPPS and our responses to them are discussed in section III.D. of this preamble). Finally, as discussed earlier, section 1833(t)(2) of the Act provides that, subject to certain exceptions, the items and services within an APC group cannot be considered comparable with respect to the use of resources if the highest median (or mean cost, if elected by the Secretary) for an item or service in the group is more than 2 times greater than the lowest median cost for an item or service within the same group (referred to as the “2 times rule”). We use the median cost of the item or service in implementing this provision. The statute authorizes the Secretary to make exceptions to the 2 times rule in unusual cases, such as low-volume items and services. 2. Application of the 2 Times Rule In accordance with section 1833(t)(2) of the Act and § 419.31 of the regulations, we annually review the items and services within an APC group to determine, with respect to comparability of the use of resources, if the median of the highest cost item or service within an APC group is more than 2 times greater than the median of the lowest cost item or service within that same group (“2 times rule”). We make exceptions to this limit on the variation of costs within each APC group in unusual cases such as low-volume items and services. During the APC Panel's March 1-2, 2006 meeting, we presented median cost and utilization data for services furnished during the period of January 1, 2005, through September 30, 2005, about which we had concerns or about which the public had raised concerns regarding their APC assignments, status indicator assignments, or payment rates. The discussions of service-specific issues, the APC Panel recommendations if any, and our proposals for CY 2007 are contained in section III.D. of this preamble. In addition to the assignment of specific services to APCs which we discussed with the APC Panel, we also identified APCs with 2 times violations that were not specifically discussed with the APC Panel but for which we are proposing changes to their HCPCS codes' APC assignments in Addendum B of this proposed rule. In these cases, to eliminate a 2 times violation, we reassigned the codes to APCs that contained services that were similar with regard to both resource use and clinical homogeneity. We also are proposing changes to the status indicators for some codes that are not specifically and separately discussed in this proposed rule. In these cases, we changed the status indicators for some codes because we thought that another status indicator more accurately describes their payment status from an OPPS perspective based on our CY 2007 proposed policies. Addendum B of this proposed rule identifies with a comment indicator “CH” those HCPCS codes for which we are proposing a change to the APC assignment or status indicator as assigned in the January 2006 Addendum B. These proposed reassignments of APC or status indicator are subject to public comment under this proposed rule. 3. Exceptions to the 2 Times Rule As discussed earlier, we may make exceptions to the 2 times limit on the variation of costs within each APC group in unusual cases such as low-volume items and services. Taking into account the APC changes that we are proposing for CY 2007 based on the APC Panel recommendations discussed in section III.D. of this preamble, the proposed changes to status indicators and APC assignments as identified in Addendum B, and the use of CY 2005 claims data to calculate the median costs of procedures classified in the APCs, we reviewed all the APCs to determine which APCs would not satisfy the 2 times rule. We used the following criteria to decide whether to propose exceptions to the 2 times rule for affected APCs: Resource homogeneity
                    Clinical homogeneity
                    Hospital concentration
                    Frequency of service (volume)
                    Opportunity for upcoding and code fragments. For a detailed discussion of these criteria, refer to the April 7, 2000 OPPS final rule with comment period (65 FR 18457). Table 7 lists the APCs that we are proposing to exempt from the 2 times rule based on the criteria cited above. For cases in which a recommendation by the APC Panel appeared to result in or allow a violation of the 2 times rule, we generally accepted the APC Panel's recommendation because those recommendations were based on explicit consideration of resource use, clinical homogeneity, hospital specialization, and the quality of the data used to determine the APC payment rates that we are proposing for CY 2007. The median costs for hospital outpatient services for these and all other APCs which were used in development of this proposed rule can be found on the CMS Web site: 
                        *http://www.cms.hhs.gov.*( print page 49551) Table 7.—Proposed APC Exceptions to the 2 Times Rule for CY 2007
APC
APC description0007
Level II Incision & Drainage.0010
Level I Destruction of Lesion.0019
Level I Excision/Biopsy.0024
Level I Skin Repair.0031
Smoking Cessation Services.0040
Percutaneous Implantation of Neurostimulator Electrodes, Excluding Cranial Nerve.0043
Closed Treatment Fracture Finger/Toe/Trunk.0058
Level I Strapping and Cast Application.0060
Manipulation Therapy.0081
Non-Coronary Angioplasty or Atherectomy.0085
Level II Electrophysiologic Evaluation.0093
Vascular Reconstruction/Fistula Repair without Device.0105
Revision/Removal of Pacemakers, AICD, or Vascular.0111
Blood Product Exchange.0112
Apheresis, Photopheresis, and Plasmapheresis.0204
Level I Nerve Injections.0235
Level I Posterior Segment Eye Procedures.0245
Level I Cataract Procedures without IOL Insert.0251
Level I ENT Procedures.0252
Level II ENT Procedures.0274
Myelography.0303
Treatment Device Construction.0307
Myocardial Positron Emission Tomography (PET) Imaging.0312
Radioelement Applications.0323
Extended Individual Psychotherapy.0330
Dental Procedures.0409
Red Blood Cell Tests.0418
Insertion of Left Ventricular Pacing Elect.0432
Health and Behavior Services.0437
Level II Drug Administration.0604
Level I Clinic Visits.0664
Level I Proton Beam Radiation Therapy.
 C. New Technology APCs (If you choose to comment on issues in this section, please include the caption “New Technology APCs” at the beginning of your comment.) 1. Introduction In the November 30, 2001 final rule (66 FR 59903), we finalized changes to the time period a service was eligible for payment under a New Technology APC. Beginning in CY 2002, we retain services within New Technology APC groups until we gather sufficient claims data to enable us to assign the service to a clinically appropriate APC. This policy allows us to move a service from a New Technology APC in less than 2 years if sufficient data are available. It also allows us to retain a service in a New Technology APC for more than 3 years if sufficient data upon which to base a decision for reassignment have not been collected. We note that the cost bands for new technology APCs range from $0 to $50 in increments of $10, from $50 to $100 in an increment of $50, from $100 through $2,000 in intervals of $100, and from $2,000 through $6,000 in intervals of $500. These intervals, which are in two parallel sets of New Technology APCs, one with status indicator “S” and the other with status indicator “T,” allow us to price new technology services more appropriately and consistently. Every year we receive many requests for higher payment amounts for specific procedures under the OPPS because they require the use of expensive equipment. We are taking this opportunity to reiterate our response in general to the issue of hospitals' capital expenditures as they relate to the OPPS and Medicare. Under the OPPS, one of our goals is to make payments that are appropriate for the services that are necessary for treatment of Medicare beneficiaries. The OPPS like other Medicare payment systems is budget neutral and so, although we do not pay full hospital costs for procedures, we believe that our payment rates generally reflect the costs that are associated with providing care to Medicare beneficiaries in cost-efficient settings. Further, we believe that our rates are adequate to assure access to services for most beneficiaries. For many emerging technologies there is a transitional period during which utilization may be low, often because providers are first learning about the techniques and their clinical utility. Quite often, the requests for higher payment amounts are for new procedures in that transitional phase. These requests, and their accompanying estimates for expected Medicare beneficiary or total patient utilization, often reflect very low rates of patient use, resulting in high per use costs for which requesters believe Medicare should make full payment. Medicare does not, and we believe should not, assume responsibility for more than its share of the costs of procedures based on Medicare beneficiary projected utilization and does not set its payment rates based on initial projections of low utilization for services that require expensive capital equipment. For the OPPS, we rely on hospitals to make their business decisions regarding acquisition of high cost capital equipment taking into consideration their knowledge about their entire patient base (Medicare beneficiaries included) and an understanding of Medicare's and other payers' payment policies. We note that in a budget neutral environment, payments may not fully cover hospitals' costs, including those for the purchase and maintenance of capital equipment. We rely on providers to make their decisions regarding the acquisition of high cost equipment with the understanding that the Medicare 
                        ( print page 49552)
                        program must be careful to establish its initial payment rates for new services that lack hospital claims data based on realistic utilization projections for all such services delivered in cost-efficient hospital outpatient settings. As the OPPS acquires claims data regarding hospital costs associated with new procedures, we will regularly examine the claims data and any available new information regarding the clinical aspects of new procedures to confirm that our OPPS payments remain appropriate for procedures as they transition into mainstream medical practice. 2. Proposed Movement of Procedures From New Technology APCs to Clinical APCs As we explained in the November 30, 2001 final rule (66 FR 59897), we generally keep a procedure in the New Technology APC to which it is initially assigned until we have collected data sufficient to enable us to move the procedure to a clinically appropriate APC. However, in cases where we find that our original New Technology APC assignment was based on inaccurate or inadequate information, or where the New Technology APCs are restructured, we may, based on more recent resource utilization information (including claims data) or the availability of refined New Technology APC bands, reassign the procedure or service to a different New Technology APC that most appropriately reflects its cost. The procedures presented below represent services assigned to New Technology APCs for CY 2006 for which we believe we have sufficient data to reassign them to clinically appropriate APCs for CY 2007. Therefore, we are proposing to reassign them to clinically appropriate APCs as indicated specifically in our discussion and in Table 10. a. Nonmyocardial Positron Emission Tomography (PET) Scans Positron emission tomography (PET) is a noninvasive diagnostic imaging procedure that assesses the level of metabolic activity and perfusion in various organ systems of the human body. PET serves an important role in the clinical care of many Medicare beneficiaries. We recognize that PET is a useful technology in many instances and want to ensure that the technology remains available to Medicare beneficiaries when medically necessary. Since August 2000, nonmyocardial PET procedures have been assigned to a New Technology APC in the OPPS. As a result of our collection of 5 full years worth of hospital claims data, we believe that we have sufficient data to assign nonmyocardial PET scans to a clinically appropriate APC for CY 2007. Note that we assign a service to a New Technology APC only when we do not have adequate claims data upon which to determine the median cost of performing the procedure, and we expect that the service's clinical or resource characteristics will differ from all other procedures already assigned to clinical APCs. Each New Technology APC represents a particular cost band (for example, $1,400-1,500), and we assign procedures to these APCs based on our analysis of the procedures' costs. Payment for items assigned to a New Technology APC is the midpoint of the band (for example, $1,450). We move a service from a New Technology APC to a clinical APC when we have adequate claims data upon which to base its future payment rate. In the case of nonmyocardial PET services, we believe that we now have sufficient data to assign them to a clinically appropriate APC. We last proposed changes in payments for nonmyocardial PET procedures for CY 2005. At that time, while we had large numbers of single claims reflecting that the median cost of PET procedures was substantially lower than their CY 2004 payment rate of $1,450, we had some concerns that abruptly lowering the payment rate for nonmyocardial PET scans could hinder access to this technology. Therefore, we proposed three options to develop the CY 2005 payment rate for these procedures in the August 16, 2004 proposed rule (69 FR 50468). Specifically, we proposed the following options and invited comments on each of the options. Option 1: Continue in CY 2005 the CY 2004 assignment of the scans to New Technology APC 1516 prior to assigning to a clinical APC.
                    Option 2: Assign the PET scans to a clinically appropriate APC priced according to the median cost of the scans based on CY 2003 claims data. Under this option, we would assign PET scans to APC 0420, PET imaging.
                    Option 3: Transition assignment to a clinical APC in CY 2006 by setting payment in CY 2005 based on a 50/50 blend of the median cost of PET scans and their CY 2004 New Technology payment rate. We would assign the scans to New Technology APC 1513 for a blended transition payment. Based on comments received, we decided to set the CY 2005 payment rate for nonmyocardial PET scans based on option 3 at $1,150. We further stated in the November 15, 2004 final rule with comment period (69 FR 65716) that we believed there were sufficient claims data to assign nonmyocardial PET scans to a single clinical APC. However, to minimize any potential impact that a payment reduction resulting from this move might have had on beneficiary access to this technology, we set the CY 2005 OPPS payment rate for nonmyocardial PET scans based on a 50/50 blend of their median cost based on CY 2003 claims data and the payment rate of the CY 2004 New Technology APC to which they were assigned. Therefore, nonmyocardial PET scans were assigned to New Technology APC 1513 (New Technology—Level XIV ($1,000-$1,200) for a blended payment rate of $1,150 in CY 2005. In CY 2005, in the context of an expansion in Medicare coverage for PET procedures, we also simplified coding for PET services by instructing hospitals to bill several more general CPT codes in place of numerous disease-specific G-codes. We continued with these coding and payment methodologies in CY 2006. For CY 2007, we are proposing the assignment of nonmyocardial PET procedures to a clinically appropriate APC as we have several years of robust and stable claims data upon which to determine the median cost of performing these procedures. Based on analysis of our claims data, the median costs for nonmyocardial PET scans have ranged between approximately $852 and $924 for claims submitted from CY 2002 through CY 2005, yet our payment rates have been significantly higher than the median costs throughout this same time period. We have observed significant growth in the number of nonmyocardial PET scans performed on Medicare beneficiaries, from about 48,000 in CY 2002, to 68,000 in CY 2003, and once again to 121,000 in CY 2004, the year when we first reduced the OPPS nonmyocardial PET scan payment rates from $1,450 to $1,150. For the CY 2007 proposed rule, we have about 45,000 single PET claims from CY 2005, yielding a stable median cost for PET procedures of about $867. Although the CY 2005 claims data are not yet complete, the apparent decline in numbers of claims for nonmyocardial PET scans alone in the CY 2005 claims data is likely related to the large number of claims for PET/CT scans now observed in CY 2005, when codes for that combined service were first available for billing. In fact, the total number of PET scans provided to Medicare beneficiaries in CY 2005, defined as PET scans and PET/CT scans, continued to climb to almost 128,000 based upon the CY 2005 claims data available for this proposed rule, in 
                        ( print page 49553)
                        comparison to final claims for CY 2004 of approximately 121,000 for PET scans. Therefore, we are proposing to assign nonmyocardial PET scans, in particular, CPT codes 78608, 78811, 78812, and 78813, to new APC 0308 (Nonmyocardial PET Imaging) with a median cost of $865.30 for CY 2007. We are confident, in the face of our stable median costs for nonmyocardial PET scans over the past 4 years, that their additional 2-year period of receiving New Technology APC payments at the blended rate of $1,150 for CY 2005 and CY 2006 as we transitioned the services to a clinical APC should ensure continued availability of this technology now that its services will be paid through a clinical APC for CY 2007, like most other OPPS services. b. PET/Computed Tomography (CT) Scans Since August 2000, we have paid separately for PET and CT scans. In CY 2004, the payment rate for nonmyocardial PET scans was $1,450, while it was $193 for typical diagnostic CT scans. Prior to CY 2005, nonmyocardial PET and the PET portion of PET/CT scans were described by G-codes for billing to Medicare. Several commenters to the November 15, 2004 final rule with comment period (69 FR 65682) urged that we replace the G-codes for nonmyocardial PET and PET/CT scan procedures with the established CPT codes. These commenters stated that movement to the established CPT codes would greatly reduce the burden on hospitals of tracking and billing the G-codes which are not recognized by other payers and would allow for more uniform hospital billing of these scans. We agreed with the commenters that movement from the G-codes to the established CPT codes for nonmyocardial PET and PET/CT scans would allow for more uniform billing of these scans. As a result of a Medicare national coverage determination (Publication 100-3, Medicare Claims Processing Manual section 220.6) that was made effective January 28, 2005, we discontinued numerous G-codes that described myocardial PET and nonmyocardial PET procedures and replaced them with the established CPT codes. The CY 2005 payment rate for concurrent PET/CT scans using the CPT codes 78814, 78815, and 78816 was $1,250, which was $100 higher than the payment rate for PET scans alone. These PET/CT CPT codes were placed in New Technology APC 1514 (New Technology—Level XIV, $1,200-$1,300) for CY 2005. We continued with these coding and payment methodologies in CY 2006. For CY 2007, we are proposing the assignment of concurrent PET/CT scans, specifically CPT codes 78814, 78815, and 78816, to a clinically appropriate APC because we believe we have adequate claims data from CY 2005 upon which to determine the median cost of performing these procedures. Based on our analysis of CY 2005 single claims, the median cost of PET/CT scans is $865 from over almost 64,000 single claims. Comparison of the median cost of nonmyocardial PET procedures of $867 with the median cost of concurrent PET/CT scans demonstrates that the median costs of PET scans with or without concurrent CT scans for attenuation correction and anatomical localization are about the same. This result is not unexpected because many newer PET scanners also have the capability of rapidly acquiring CT images for attenuation correction and anatomical localization, sometimes with simultaneous image acquisition. To explore the possibility that the similarity in median costs for PET and PET/CT procedures could be related to different groups of hospitals billing the two types of PET services based on their available equipment, rather than the true comparability of hospital resources required for the two types of services, we analyzed claims from a subset of hospitals billing both PET and PET/CT scans in CY 2005. This analysis looked at 362 providers who billed a PET HCPCS code and a PET/CT CPT code at least one time each during CY 2005. The median cost from this subset of claims for nonmyocardial PET scans was $890, in comparison with $863 for the PET/CT scans. Thus, we observed the same close relationship between median costs of PET and PET/CT procedures from hospitals billing both sets of services as we did for all OPPS CY 2005 claims available for this proposed rule for these scans. We believe that our claims data accurately reflect the comparable hospital resources required to provide PET and PET/CT procedures, and the scans have obvious clinical similarity as well. Therefore, for CY 2007 we are proposing to assign the CPT codes for PET/CT scans, along with the CPT codes for PET scans, to the same new APC 0308 (Nonmyocardial PET Imaging) with a median cost of $865.30. We note that we have been paying separately for fluorodeoxyglucose (FDG), the radiopharmaceutical described by HCPCS code A9552 (F18 fdg), that is commonly administered during nonmyocardial PET and PET/CT procedures. For CY 2007, we are proposing to continue paying separately for FDG, according to the methodology described in section V. (Proposed OPPS Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals) of the preamble of this proposed rule. c. Stereotactic Radiosurgery (SRS) Treatment Delivery Services For the past several years, we have collected hospital costs associated with the planning and delivery of stereotactic radiosurgery services (hereafter referred to as SRS). As new technology emerged in the field of SRS, public commenters urged us to recognize cost differences associated with the various methods of SRS planning and delivery. Beginning in CY 2001, we established G-codes to capture any such cost variations associated with the various methods of planning and delivery of SRS. For CY 2004, based on comments received regarding the G-codes used for SRS, we made some modifications to the coding (68 FR 63431 and 63432). First, we received comments regarding the descriptors for HCPCS codes G0173 and G0251, indicating that these codes did not distinguish image-guided robotic SRS systems from other forms of linear accelerator-based SRS systems to account for the cost variation in delivering these services. In response, for CY 2004 we created two new G-codes (G0339 and G0340) to describe complete and fractionated image-guided robotic linear accelerator-based SRS treatment. We placed HCPCS code G0339 in APC 1528 at a payment rate of $5,250, and HCPCS code G0340 in APC 1525 at a payment rate of $3,750. Second, we received comments on HCPCS code G0242 which requested that we modify the code descriptor to avoid confusion and misuse of the code, and also to appropriately describe treatment planning for both linear accelerator-based and Cobalt 60-based SRS treatments. In response, for CY 2004, we created HCPCS code G0338 to distinguish linear accelerator-based SRS treatment planning from Cobalt 60-based SRS treatment planning. We placed HCPCS code G0338 in APC 1516 at a payment rate of $1,450. In CY 2005, there were no changes to the coding or New Technology APC payment rates for the SRS planning or treatment delivery codes from CY 2004. We stated in the CY 2005 OPPS final rule with comment period (69 FR 65711) that any SRS code changes would be premature without cost data to support a code restructuring. Therefore, we maintained HCPCS codes G0173, G0242, G0243, G0251, G0338, G0339, and G0340 in their respective New Technology APCs for CY 2005. We further stated that until we had completed an analysis of claims for these procedure codes, we would 
                        ( print page 49554)
                        continue to maintain HCPCS codes G0173, G0242, G0243, G0251, G0338, G0339, and G0340 in their respective New Technology APCs for CY 2005 as we considered the adoption of CPT codes to describe all SRS procedures for CY 2006. At its February 2005 meeting, the APC Panel discussed the clinical and resource cost similarities between planning for Cobalt 60-based and linear accelerator-based SRS. The APC Panel also discussed the use of CPT codes instead of specific G-codes to describe the services involved in SRS planning, noting the clinical similarities in radiation treatment planning regardless of the mode of treatment delivery. Given the APC Panel's thoughts about the possible need for CMS to separately track planning for SRS, the APC Panel eventually recommended that we create a single HCPCS code to encompass both Cobalt 60-based and linear accelerator-based SRS planning. Because we had no programmatic need to separately track SRS planning services, in the CY 2006 OPPS final rule with comment period (70 FR 68585) we discontinued HCPCS codes G0242 and G0338 for the reporting of charges for SRS planning and instructed hospitals to bill charges for SRS planning, regardless of the mode of treatment delivery, using all of the available CPT codes that most accurately reflect the services provided. Furthermore, the APC Panel recommended that we make no changes to the coding or APC placement of SRS treatment delivery HCPCS codes G0173, G0243, G0251, G0339, and G0340 for CY 2006. In addition, presenters to the APC Panel described ongoing deliberations among interested professional societies around the descriptions and coding for SRS. The APC Panel and presenters suggested that we wait for the outcome of these deliberations before making any significant changes to SRS delivery coding or payment rates. To date, we have received no report from participating professional societies as to the outcome of such deliberations. In response to comments for CY 2006 regarding the mature technology and stable median costs associated with Cobalt 60-based SRS treatment delivery described by G0243, we reassigned G0243 from a New Technology APC to new clinical APC 0127 (Stereotactic Radiosurgery) with a payment rate of $7,305 established based on the CY 2004 median cost of G0243. We made no changes for CY 2006 to the New Technology APC assignments of the other four SRS treatment codes, specifically, G0173, G0251, G0339, and G0340. Since we first established the full group of SRS treatment delivery codes in CY 2004, we now have 2 years of hospital claims data reflecting the costs of each of these services. Based on analysis of our claims data from CY 2004 and CY 2005, the median costs for linear accelerator-based SRS treatment delivery procedures as described by HCPCS codes G0173, G0251, G0339, and G0340 have been stable and generally lower than our New Technology APC payment rates in effect from CY 2004 through CY 2006. Specifically, the payment rate for HCPCS code G0173, a complete course of non-image guided, non-robotic linear accelerator-based SRS treatment, has been set at $5,250, yet our claims data indicate a median cost of $2,802 from CY 2004 claims and $3,665 from CY 2005 claims, based upon hundreds of single claims from each year. For HCPCS code G0251, fractionated non-image guided, non-robotic linear accelerator-based SRS treatment, the corresponding median costs have been $1,028 and $1,386 based upon over 1,000 single claims from each year, and relatively consistent with the procedure's New Technology APC payment of $1,150. With respect to the complete course of therapy in one session or first fraction of image-guided, robotic linear accelerator-based SRS, described by HCPCS code G0339, its median costs have been $4,917 and $4,809 for CY 2004 and CY 2005 respectively, based upon over 500 single bills in each year, in comparison with the procedure's payment rate of $5,250 for those years. Lastly, the median costs of HCPCS code G0340, the second through fifth sessions of image-guided, robotic linear accelerator-based SRS treatment, have been $2,502 for CY 2004 and $2,917 for CY 2005 as determined by over 1,000 single bills during each year, significantly lower than its payment rate of $3,750. Unquestionably, the claims data from CY 2004 and CY 2005 for linear accelerator-based SRS treatment delivery services reveal highly stable median costs from year to year based on significant claims volume. Based on the above findings, we believe that we have adequate claims data to assign the SRS treatment delivery procedures to clinically appropriate APCs, and we believe that such movement is appropriate. For CY 2007, we are proposing to create several new SRS clinical APCs of different levels to assign the HCPCS codes describing linear accelerator-based SRS treatment, G0173, G0251, G0339, and G0340, based on their clinical and hospital resource similarities and differences. In particular, we are proposing to assign HCPCS codes G0339 and G0173 to the same Level III SRS APC, because we believe these codes that describe the complete or first fraction of all types of linear accelerator-based SRS treatments have substantial hospital resource and clinical similarity, as observed in their median costs and recognized previously in their equivalent New Technology APC payments. The codes describing subsequent fractions of image-guided, robotic and non-image guided, non-robotic linear accelerator-based SRS treatments will each be assigned to their own clinical APCs, as they demonstrate significant differences in resource utilization as reflected in their median costs. Their previous assignments to different New Technology APCs anticipated these resource distinctions. We are proposing to continue our assignment of HCPCS code G0243 for Cobalt 60-based SRS treatment delivery to clinical APC 0127, renamed Level IV Stereotactic Radiosurgery. Our proposed reassignments of SRS services from New Technology APCs to clinical APCs are listed in Table 8 below. Table 8.—Proposed APC Reassignment for SRS Treatment Delivery Services for CY 2007
HCPCS code
Short descriptor
CY 2006 SI
CY 2006 APC
CY 2006 payment rate
Proposed CY 2007 SI
Proposed CY 2007 APC
Proposed CY 2007 APC median costG0173
Linear acc stereo radsur com
S
1528
$5,250.00
S
0067
$4,059.61G0251
Linear acc based stereo radio
S
1513
1,150.00
S
0065
1,386.20G0339
Robot lin-radsurg com, first
S
1528
5,250.00
S
0067
4,059.61G0340
Robot lin-radsurg fractx 2-5
S
1525
3,750.00
S
0066
2,916.68
 
 
 d. Magnetoencephalography (MEG) Services Magnetoencephalography (MEG) is a non-invasive diagnostic tool that assists surgeons presurgery by measuring and mapping brain activity. It may be used for epilepsy and brain tumor patients. Since CY 2002, the MEG procedures described by CPT codes 95965 (Meg, spontaneous), 95966 (Meg, evoked, single), and 95967 (Meg, evoked, each additional) have been assigned to New Technology APCs. In the July 25, 2005 proposed rule (70 FR 42709), we proposed to reassign MEG procedures to clinical APC 0430 using CY 2004 claims data to establish median costs on which the CY 2006 payment rates would be based. This proposal involved the reassignment of the three MEG procedures, specifically CPT codes 95965, 95966, and 95967, from three separate New Technology APCs into one new clinical APC with a status indicator of “T.” Commenters to this proposal believed that their assignment to clinical APC 0430 would be inappropriate because the proposed payment level of $674 was inadequate to cover the costs of the procedures, and because the procedures should not be assigned to only one level as their required hospital resources differ significantly. They further stated that our data did not represent the true costs of the procedures because MEG procedures are performed on very few Medicare patients. Analysis of our hospital data for claims submitted from CY 2002 through CY 2005 indicates that these procedures are rarely performed on Medicare beneficiaries. For claims submitted from CY 2002 through CY 2005, our single claims data show that there were annually only between 2 and 23 claims submitted for CPT code 95965, 3 and 7 claims for CPT code 95966, and only 1 for CPT code 95967. Additionally, the hospital claims median costs for these codes have varied widely, perhaps due to our small volume of claims. The median cost for CPT code 95965 has ranged from $332 using CY 2002 claims to $3,166 based upon CY 2005 claims. The median cost for CPT code 95966 has varied widely from CY 2002 to CY 2005. For single claims submitted during CY 2002, the median cost was $1,949, while it was $507 for CY 2003, $1,435 for CY 2004, and $701 from 3 single claims for CY 2005. The median cost for CPT code 95967 based upon 1 single claim from CY 2005 claims is $217. We have no hospital median cost data for CPT code 95967 prior to CY 2005. In the November 10, 2005 final rule with comment period (70 FR 68579), we stated that we carefully considered our claims data, information provided by the commenters, and the APC Panel recommendation for CY 2006 that we retain the MEG procedures in New Technology APCs. As a result of this analysis, we determined that using a 50/50 blend of the code specific median costs from our most recent CY 2004 hospital claims data and the CY 2005 New Technology APC code-specific payments amounts as the basis for assignment of the procedures for CY 2006 would be an appropriate way to recognize both the current payment rates for the procedures, which were originally based on the theoretical costs to hospitals of providing MEG services, and the median costs based upon our hospital claims data regarding actual MEG services provided to Medicare beneficiaries by hospitals. Therefore, CPT codes 95965, 95966, and 95967 were assigned to different New Technology APCs for CY 2006 based on this blended methodology, with payment rates of $2,750, $1,250, and $850 respectively. At the March 2006 APC Panel meeting, the Panel recommended that CMS move CPT codes 95965 (MEG, spontaneous), 95966 (MEG, evoked, single), and 95967 (MEG, evoked, each additional) from their CY 2006 New Technology APCs which were assigned based on the blended methodology described above to clinical APC(s) for CY 2007. Following that meeting, interested parties have provided us with CY 2005 charge and cost information from six hospitals that provided MEG services. These external data show wide variation in hospitals' costs and charges for MEG procedures, with generally higher values for CPT code 95965 and lower values for CPT codes 95966 and 95967 but no consistent proportionate relationship among those costs and charges. In some cases, the charges and costs for CPT codes 95966 and 95967 are quite similar for the two related services, one of which describes MEG for a single modality of evoked magnetic fields and the other that describes MEG for each additional modality of evoked magnetic fields. The individual hospital cost and charge data for specific services demonstrate significant variations of up to six fold across the hospitals, with an apparent inverse relationship between the numbers of services provided and the costs of the procedures. This finding is not unexpected, given the dependence of MEG procedures on the use of expensive capital equipment. As we have previously stated, our OPPS payment rates generally reflect the costs that are associated with providing care to Medicare beneficiaries in cost-efficient settings. For emerging technologies, we establish payment rates for new services that lack hospital claims data based on realistic utilization projections for all such services delivered in cost-efficient hospital outpatient settings. Given that we now have 4 years of hospital claims data for MEG procedures, because MEG is no longer a new technology, we do not believe these external data from 6 hospitals that performed MEG services in CY 2005 provide a better estimate of the hospital resources used in MEG procedures during the care of Medicare beneficiaries than our standard OPPS historical claims methodology. We agree with the APC Panel and are proposing to accept their recommendation to move the MEG CPT codes into clinical APCs for CY 2007. While the volumes for the MEG procedures are low, almost all procedures, including those with very low Medicare volume, are assigned to clinical APCs under the OPPS, with their payment rates based on the median costs of their assigned APCs. Therefore, we are proposing to assign CPT code 95965 to new clinical APC 0038 (Spontaneous MEG) with a proposed median cost of $3,166.30 and to assign both CPT codes 95966 and 95967 to APC 0209 (Level II MEG, Extended EEG Studies, and Sleep Studies) with a proposed median cost of $709.36. We believe that the assignment of CPT codes 95966 and 95967 to APC 0209 is appropriate because MEG studies are similar to EEGs and sleep studies in measuring activity of the brain over a significant time period, and our hospital claims data show that their hospital resources are also relatively comparable. MEG procedures and their CY 2007 proposed APC assignments are displayed in Table 9. 
                        ( print page 49556) Table 9.—Proposed CY 2007 APC Assignment for MEG
HCPCS Code
Short descriptor
CY 2006 SI
CY 2006 APC
CY 2006 payment rate
Proposed CY 2007 SI
Proposed CY 2007 APC
Proposed CY 2007 APC median cost95965
Meg, spontaneous
S
1523
$2,750.00
S
0038
$3,166.3095966
Meg, evoked, single
S
1514
1,250.00
S
0209
709.3695967
Meg, evoked, each additional
S
1510
850.00
S
0209
709.36
 As these procedures are performed on very few Medicare patients, we expect to continue to have small Medicare claims volumes for MEG services each year. However, we are confident that over time our claims data for these procedures will become more consistent and reflective of the full hospital resources used in MEG services, especially because only a small subset of hospitals provide MEG services. We have been told that hospitals performing MEG procedure recently have been paying increased attention to accurately reporting charges for all necessary hospital resources on their claims. We are optimistic that both increased public awareness of Medicare coding for these procedures and improved understanding of the standard OPPS methodology for establishing APC payment rates should result in improved claims data in the future that more accurately reflect the required hospital resources. e. Other Services in New Technology APCs (If you choose to comment on issues in this section, please include the caption “Other New Technology Services” at the beginning of your comment.) Other than the PET, PET/CT, and SRS new technology services discussed above, there are 23 procedures currently assigned to New Technology APCs for which we believe we also have data adequate to support their assignment to clinical APCs. For CY 2007, we are proposing to reassign these procedures to clinically appropriate APCs, applying their CY 2005 claims data to develop their clinical APC median costs on which payments would be based. These procedures and their proposed APC assignments are displayed in Table10. Table 10.—Proposed APC Reassignment of Other New Technology Procedures to Clinical APCs for CY 2007
HCPCS Code
Short descriptor
CY 2006 SI
CY 2006 APC
CY 2006 payment rate
Proposed CY 2007 SI
Proposed CY 2007 APC
Proposed CY 2007 APC median cost0003T
Cervicography
S
1492
$15.00
T
0191
$9.220101T
Extracorp shockwv tx,hi enrg
T
1547
850.00
T
0050
1,548.050102T
Extracorp shockwv tx,anesth
T
1547
850.00
T
0050
1,548.050133T
Esophageal implant injexn
T
1556
1,750.00
T
0422
1,704.8519296
Place po breast cath for rad
S
1524
3,250.00
T
0030
2,533.6219297
Place breast cath for rad
S
1523
2,750.00
T
0029
1,822.3820982
Ablate, bone tumor(s) perq
T
1557
1,850.00
T
0050
1,548.0528890
High energy eswt, plantar f
T
1547
850.00
T
0050
1,548.0536566
Insert tunneled cv cath
T
1564
4,750.00
T
0623
1,703.9777421
Stereoscopic x-ray guidance
S
1502
75.00
S
0257
88.3978804
Tumor imaging, whole body
S
1508
650.00
S
0408
308.8279403
Hematopoietic nuclear tx
S
1507
550.00
S
0413
315.1790473
Immune admin oral/nasal
S
1491
5.00
S
0436
10.7190474
Immune admin oral/nasal addl
S
1491
5.00
S
0436
10.7191035
G-esoph reflx tst w/electrod
S
1506
450.00
X
0361
242.86C9716
Radiofrequency energy to anu
S
1519
1,750.00
T
0150
1,818.31G0248
Demonstrate use home inr mon
S
1503
150.00
V
0604
49.45G0249
Provide test material,equipm
S
1503
150.00
V
0604
49.45G0293
Non-cov surg proc,clin trial
S
1505
350.00
X
0340
38.52G0294
Non-cov proc, clinical trial
S
1502
75.00
X
0340
38.52G0375
Smoke/tobacco counseling 3-10
S
1491
5.00
X
0031
10.60G0376
Smoke/tobacco counseling >10
S
1491
5.00
X
0031
10.60G3001
Admin + supply, tositumomab
S
1522
2,250.00
S
0442
1,515.80
 D. Proposed APC-Specific Policies 1. Skin Replacement Surgery and Skin Substitutes (APCs 0024, 0025, 0027) (If you choose to comment on issues in this section, please include the caption “Skin Replacement Surgery and Skin Substitutes” at the beginning of your comment.) For CY 2006, the American Medical Association (AMA) made comprehensive changes, including code additions, deletions, and revisions, accompanied by new and revised introductory language, parenthetical notes, subheadings and cross-references, to the Integumentary, Repair (Closure) subsection of surgery in the CPT book to facilitate more accurate reporting of skin grafts, skin replacements, skin substitutes, and local wound care. In particular, the section of the CPT book previously titled “Free Skin Grafts” and containing codes for skin replacement and skin substitute procedures was renamed, reorganized, and expanded. New and existing CPT codes related to skin replacement surgery and skin substitutes were organized into five subsections: Surgical Preparation, Autograft/Tissue Cultured Autograft, Acellular Dermal Replacement, Allograft/Tissue Cultured Allogeneic Skin Substitute, and Xenograft. 
                        ( print page 49557) As part of the CY 2006 CPT code update in the newly named “Skin Replacement Surgery and Skin Substitutes” section, certain codes were deleted that previously described skin allograft and tissue cultured and acellular skin substitute procedures, including CPT 15342 (Application of bilaminate skin substitute/neodermis; 25 sq cm); CPT 15343 (Application of bilaminate skin substitute/neodermis; each additional 25 sq cm); CPT 15350 (Application of allograft, skin; 100 sq cm or less), and CPT 15351 (Application of allograft, skin; each additional 100 sq cm). Thirty-seven new CPT codes were created in the “Skin Replacement Surgery and Skin Substitutes” section, and these codes received interim final status indicators and APC assignments in the CY 2006 final rule with comment period and were subject to comment. At its March 2006 meeting, the APC Panel heard several presentations on some of the new CY 2006 CPT codes for skin replacement and skin substitute procedures, and CMS has received additional information from the public regarding a number of these services. In particular, 18 new CPT codes that were created to more specifically describe skin allograft, skin replacement, and skin substitute procedures were the subject of the APC Panel discussion and recommendations. These codes are as follows: CPT 15170 (Acellular dermal replacement, trunk, arms, legs; first 100 sq cm or less, or one percent of body area of infants and children)
                    CPT 15171 (Acellular dermal replacement, trunk, arms, legs; each additional 100 sq cm, or each additional one percent of body area of infants and children, or part thereof)
                    CPT 15175 (Acellular dermal replacement, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or less, or one percent of body area of infants and children)
                    CPT 15176 (Acellular dermal replacement, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; each additional 100 sq cm, or each additional one percent of body area of infants and children, or part thereof)
                    CPT 15300 (Allograft skin for temporary wound closure, trunk, arms, legs; first 100 sq cm or less, or one percent of body area of infants and children)
                    CPT 15301 (Allograft skin for temporary wound closure; trunk, arms, legs; each additional 100 sq cm, or each additional one percent of body area of infants and children, or part thereof)
                    CPT 15320 (Allograft skin for temporary wound closure, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or less, or one percent of body area of infants and children)
                    CPT 15321 (Allograft skin for temporary wound closure, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; each additional 100 sq cm, or each additional one percent of body area of infants and children, or part thereof)
                    CPT 15340 (Tissue cultured allogeneic skin substitute; first 25 sq cm or less)
                    CPT 15341 (Tissue cultured allogeneic skin substitute; each additional 25 sq cm)
                    CPT 15360 (Tissue cultured allogeneic dermal substitute; trunk, arms, legs; first 100 sq cm or less, or one percent of body area of infants and children)
                    CPT 15361 (Tissue cultured allogeneic dermal substitute; trunk, arms, legs; each additional 100 sq cm, or each additional one percent of body area of infants and children, or part thereof)
                    CPT 15365 (Tissue cultured allogeneic dermal substitute, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or less, or one percent of body area of infants and children)
                    CPT 15366 (Tissue cultured allogeneic dermal substitute, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or less, or one percent of body area of infants and children)
                    CPT 15420 (Xenograft skin (dermal), for temporary wound closure, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or less, or one percent of body area of infants and children)
                    CPT 15421 (Xenograft skin (dermal), for temporary wound closure, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; each additional 100 sq cm, or each additional one percent of body area of infants and children, or part thereof)
                    CPT 15430 (Acellular xenograft implant; first 100 sq cm or less, or one percent of body area of infants and children)
                    CPT 15431 (Acellular xenograft implant; each additional 100 sq cm, or each additional one percent of body area of infants and children, or part thereof). The CY 2006 interim final APC assignments of these codes, the recommendations made by the APC Panel at its March 2006 meeting, and our proposed placement of the codes for CY 2007 are listed in Table 11 below. Note that in general, biological skin substitutes and replacements used in procedures described by these CPT codes are proposed for separate payment under the OPPS for CY 2007, according to the methodology outlined in section V. of the preamble of this proposed rule. Table 11.—CY 2007 Proposed Assignments of Skin Substitute and Skin Replacement Procedures
CPT code
Short descriptor
CY 2006 assignment
APC panel recommendation
CY 2007 proposed assignmentAPC
SI
APC median
APC
SI
APC median15170
Cell graft trunk/arm/legs
24
T
$92.22
27
25
T
$314.5815171
Cell graft t/arm/leg add-on
24
T
92.22
25
25
T
314.5815175
Acellular graft, f/n/hf/g
24
T
92.22
27
25
T
314.5815176
Acell graft, f/n/hf/g/add-on
24
T
92.22
25
25
T
314.5815300
Apply skin allograft, t/arm/lg
27
T
1081.66
N/A
25
T
314.5815301
Apply sknallograft t/a/l addl
25
T
315.37
N/A
25
T
314.5815320
Apply skin allogrft f/n/hf/g
25
T
315.37
27
25
T
314.5815321
Apply sknallogrft f/n/hfg add
25
T
315.37
25
25
T
314.5815340
Apply cult skin substitute
24
T
92.22
27
25
T
314.5815341
Apply cult skin sub add-on
24
T
92.22
25
25
T
314.5815360
Apply cult derm sub, t/a/l
24
T
92.22
27
25
T
314.58( print page 49558)15361
Aply cult derm sub t/a/l/ add-on
24
T
92.22
25
25
T
314.5815365
Apply cult derm sub f/n/hf/g
24
T
92.22
27
25
T
314.5815366
Apply cult derm f/hf/g add
24
T
92.22
25
25
T
314.5815420
Apply skin xgraft, f/n/hf/g
25
T
315.37
27
25
T
314.5815421
Apply skn xgraft, f/n/hf/g add
25
T
315.37
25
25
T
314.5815430
Apply acellular xenograft
25
T
315.37
27
25
T
314.5815431
Apply acellular xgraft add
25
T
315.37
25
25
T
314.58
 We reviewed the presentations to the APC Panel; the APC Panel's recommendations; the CPT code descriptors, introductory explanations, cross-references, and parenthetical notes; the clinical characteristic of the procedures; and the code-specific median costs for all related CPT codes available from our CY 2005 claims data. While we agree with the APC Panel that the codes currently placed in APC 0024 (Level I Skin Repair) should be assigned to an APC with a higher median cost for CY 2007, we disagree that these procedures should be placed in APC 0027 (Level IV Skin Repair). APC Panel presenters reasoned that some of the codes (CPTs 15170, 15175, 15320, 15340, 15360, 15365, 15420, and 15430) for the first increment of body surface area treated should be placed in APC 0027 because they are similar to CPT code 15300 (Allograft skin for temporary wound closure, trunk, arms, legs; first 100 sq cm or less, or one percent of body area of infants and children). Upon further review of the clinical and expected hospital resource characteristics of CPT code 15300, we believe that this procedure is not appropriately placed in APC 0027. Split-thickness and full thickness skin autograft procedures currently assigned to APC 0027 are likely to require greater hospital resources, including additional operating room time and special equipment, in comparison to application of a separately paid allograft skin product. Instead, for CY 2007 we are proposing to reassign CPT code 15300 to APC 0025 (Level II Skin Repair), with an APC median cost of $314.58. We agree, in principle, that other CPT codes for the first increment of body surface area treated with a skin replacement or skin substitute are similar clinically and from a hospital resource perspective to CPT code 15300 and are, therefore, proposing to assign these procedures to APC 0025 as well for CY 2007. Similarly, presenters reasoned that the related add-on codes (CPTs 15171, 15176, 15321, 15342, 15361, 15366, 15421, and 15431) for procedures to treat additional body surface areas are similar to CPT code 15301 (Allograft skin for temporary wound closure, trunk, arms, legs; each additional 100 sq cm, or each additional one percent of body area of infants and children, or part thereof) in terms of required hospital resources. CPT code 15301 is assigned to APC 0025 for CY 2006. We are proposing to maintain the assignment of CPT code 15301 to APC 0025 for CY 2007 and to reassign the other add-on codes to this APC. Note that APC 0025 has a status indicator of “T,” so that the add-on codes will experience the standard OPPS multiple surgical procedure reduction when properly billed with the first body surface area treatment codes that are assigned to the same clinical APC. We believe that this reduction in payment for the procedural resources associated with the add-on services is appropriate. 2. Treatment of Fracture/Dislocation (APC 0046) (If you choose to comment on issues in this section, please include the caption “Treatment of Fracture/Dislocation” at the beginning of your comment.) APC 0046 is a large clinical APC to which many procedures related to the percutaneous or open treatment of fractures and dislocations are assigned for CY 2006. Most of the approximately 100 procedures in the APC are relatively low volume, with even fewer single bills available for ratesetting. The median costs of the significant procedures in this APC as configured for CY 2006 range from a low of about $1,415 to a high of about $3,893. We received comments to the CY 2006 proposed rule (70 FR 42674) requesting that we distinguish procedures containing “with or without external fixation” in their descriptors to provide greater payments when external fixation is used to treat fractures. The commenters explained that when external fixation devices are used, the costs of the procedures increase, and, therefore, the current APC placement significantly underpays those procedures in those instances. In the CY 2006 final rule with comment period (70 FR 68607), we declined to reassign procedures that could include external fixation at that time but we acknowledged that we had treated APC 0046 as an exception to the 2 times rule for several years. For CY 2006, we again treated APC 0046 as an exception to the 2 times rule, but noted we would ask the APC Panel to consider whether this APC could be reconfigured to improve its clinical and resource homogeneity. At the March 2006 meeting of the APC Panel, we asked the Panel to consider a possible reconfiguration of APC 0046 based on partial year CY 2005 claims data. The reconfiguration would create three new APCs and would divide the codes in APC 0046 among them. The APC Panel recommended that CMS continue to evaluate the refinement of APC 0046 (Open/Percutaneous Treatment Fracture or Dislocation) into at least three APC levels, with consideration of a fourth level should data support this additional level. We are accepting the APC Panel's recommendation and are proposing for CY 2007 to split APC 0046 into three new APCs: APC 0062 (Level I Treatment Fracture/Dislocation); APC 0063 (Level II Treatment Fracture/Dislocation); and APC 0064 (Level III Treatment Fracture/Dislocation). To ensure clinical and resource homogeneity in the new APCs, their proposed configurations are based on the procedure code descriptors, clinical considerations specific to each procedure, and service-specific hospital resource utilization as shown in the claims data from CY 2005. Restructuring APC 0046 into these three new APCs eliminates 2 times rule violations in the Fracture/Dislocation series. 
                        ( print page 49559) We are not currently proposing a fourth APC level in the Fracture/Dislocation series because we do not believe our claims data are sufficiently robust and consistent from year to year to support differential payment for another service level. One code, CPT 27615 (Radical resection of tumor (e.g., malignant neoplasm), soft tissue of leg or ankle area), is not clinically coherent with the other procedures in APC 0046, and we are proposing to reassign this procedure outside of the Fracture/Dislocation series to APC 0050 (Level II Musculoskeletal Procedures Except Hand and Foot) for CY 2007.  
 
  
 
  3. Electrophysiologic Recording/Mapping (APC 0087) (If you choose to comment on issues in this section, please include the caption “Electrophysiologic Recording/Mapping” at the beginning of your comment.) At its March 2006 meeting, the APC Panel heard testimony from a presenter who asked that the Panel recommend that CPT codes 93609 (intraventricular and/or intra-atrial mapping of tachycardia, add-on), 93613 (intracardiac electrophysiologic 3-D mapping), and 93631 (intra-operative epicardial & endocardial pacing and mapping to localize zone of slow conduction for surgical correction) be removed from APC 0087. The presenter asked the APC Panel to recommend that these codes be placed in APC 0086 for improved clinical and resource alignment. The presenter indicated that the median costs for these CPT codes were more than two times the median cost of the least costly HCPCS code in APC 0087 and, therefore, constituted a 2 times violation. The presenter also indicated that the median cost of APC 0087 had declined in recent years, and argued that the payment rate for APC 0087 was too low to adequately compensate providers for these services. The APC Panel did not recommend that CMS move these codes from APC 0087 to APC 0086, but instead recommended that CMS maintain the three codes in APC 0087 for CY 2007. The APC Panel noted that, due to the low volume of these and other services assigned to APC 0087, under the CMS' rules there was no 2 times violation in APC 0087. Moreover, the APC Panel found that the services under discussion were cardiac electrophysiologic mapping services, like other procedures also assigned to APC 0087, and were, therefore, clinically coherent with other services in APC 0087. The APC Panel did not believe that these three cardiac electrophysiologic mapping procedures were similar clinically or from a resource perspective to the intracardiac catheter ablation procedures residing in APC 0086. We agree with the APC Panel's assessment and are accepting this APC Panel recommendation. Therefore, we are proposing that CPT codes 93609, 93613, and 93631 remain assigned to APC 0087 for CY 2007. 4. Insertion of Mesh or Other Prosthesis (APC 0154) (If you choose to comment on issues in this section, please include the caption “Insertion of Mesh or Other Prosthesis” at the beginning of your comment.) During the March 2006 APC Panel meeting, a presenter requested that we 
                        ( print page 49562)
                        reassign CPT code 57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (anterior, posterior compartment), vaginal approach) to a more clinically and resource-appropriate APC than its CY 2006 assignment to APC 0154 (Hernia/Hydrocele Procedures). The presenter expressed concern that the procedure is currently assigned to an APC with a “T” status indicator and stated that payment would be more accurate if it were assigned to an APC that has an “S” status indicator. The mesh insertion procedure is a CPT add-on code and is, by definition, performed at the same time as certain other procedures and will, therefore, be discounted every time it is performed. The presenter objected to our assignment of CPT code 57267 to an APC that is subject to the multiple procedure discount because it is always a secondary procedure, and the discounted payment amount is not adequate to pay even for the cost of the implantable mesh. The presenter also believed that its assignment to an APC where hernia and hydrocele procedures were also assigned was clinically inappropriate. The APC Panel recommended that CMS reassign CPT code 57267 to a more clinically and resource-appropriate APC. In the CY 2005 claims data, the median cost for CPT code 57267 is $529.14, the lowest by far for procedures in APC 0154, which has an APC median cost of $1,821 for CY 2007. However, the median cost of CPT code 57267 is based on only 6 single claims of the total 1,038 submitted for the service. Because the procedure always is performed in addition to other related procedures, we expect that claims for this service will be multiple claims. Therefore, we are not confident that the procedure's median cost based upon the six single claims is accurate. Therefore, in order to obtain more information about the cost of the procedure, we performed additional analyses of CY 2005 claims data in an attempt to specifically explore the cost of the mesh implant packaged into the payment for CPT code 57267. We believe that a significant portion of the procedural cost should be related to the cost of the mesh, based on information presented at the March 2006 APC Panel meeting. We looked at all claims that included charges for the HCPCS code for implantable mesh (C1781) and either CPT code 57267 or 49568 (Implantation of mesh or other prosthesis for incisional or ventral hernia repair). We examined the bills for CPT code 49568 in addition to those for CPT code 57267 because it is a high volume procedure that also uses implantable mesh, and we expected that the extra volume would improve our chances of identifying meaningful charge data. We found 210 claims with charges reported for both CPT code 57267 and HCPCS code C1781 on the same day and 6,345 claims with reported charges for both CPT code 49568 and HCPCS code C1781 on the same day. Costs developed from these two claims subsets included the cost of the implanted mesh device that was used in performing the procedure. Table 13 below displays the median costs from those claims. The costs shown in the column titled “Line-item Median Cost” are those we obtained by looking at all CY 2005 OPPS claims on which charges for both the procedure code (either CPT code 57267 or 49568) and the code for the implantable mesh (HCPCS code C1781) were reported. The costs shown in the column titled “Single Claims Median Cost” are the median costs calculated using only single procedure claims for the specific procedure that also included the C-code for the mesh. Our additional data analysis supports the APC Panel presenter's assertion that the cost of the mesh is greater than 50 percent of the total cost of CPT code 57267, but it also indicates that the mesh cost is far less than 50 percent of the payment amount for APC 0154. In CY 2006 the payment rate for APC 0154 is $1,704.59, and the payment when the multiple procedure discount is taken is $852.30, which is much greater than both the line-item median cost of the mesh and the median single claims cost of CPT code 57267 (which explicitly includes the implantable mesh) reflected in our claims data. Table 13.—Median Costs of HCPCS Code C1781 and Associated Procedures
HCPCS code
Short descriptor
Line-item 
                                 median cost
Single claims 
                                 median cost
CY 2006 APC 0154 payment amount
                                 (T status)57267
Insert mesh/pelvic flr add-on
$423.28
$529.14
$1,704.59C1781 (billed with 57267)
Mesh (implantable)
383.35
N/A
N/A49568
Hernia repair w/mesh
363.41
1,323.29
1,704.59C1781 (billed with 49568)
Mesh (implantable)
242.20
N/A
N/A
 We agree with the APC Panel that the procedure should be assigned to a more clinically appropriate APC, and therefore, we are proposing to accept its recommendation and reassign CPT code 57267 to APC 0195 (Level IX Female Reproductive Procedures), with status indicator “T” for CY 2007. The proposed median cost of APC 0195 is $1,777 for CY 2007, very comparable to the CY 2006 median cost of APC 0154, where CPT code 57267 is currently assigned. The median cost for the procedure remains very low in comparison with other procedures assigned to APC 0195, so that payment for the service when the multiple procedure reduction is applied should be appropriate. While not affecting the procedure's payment significantly, this reassignment improves the clinical homogeneity of APCs 0154 and 0195. 5. Percutaneous Renal Cryoablation (APC 0163) (If you choose to comment on issues in this section, please include the caption “Percutaneous Renal Cryoablation” at the beginning of your comment.) During the March 2006 APC Panel meeting, a presenter requested that we reassign CPT code 0135T (Ablation renal tumor(s), unilateral, percutaneous, cryotherapy) to APC 0423 (Level II Percutaneous Abdominal and Biliary Procedures). The presenter provided information about the costs of performing these procedures and compared the resource requirements for the procedures to those for CPT code 47382 (Ablation, one or more liver tumor(s), percutaneous, radiofrequency), which is currently assigned to APC 0423. The presenter proposed reassignment of CPT code 0135T to APC 0423 because that is where CPT code 47382 is assigned, and stated that the costs of the two procedures are very similar. 
                        ( print page 49563) The APC Panel recommended that we assign CPT code 0135T to APC 0423 for CY 2007. CPT code 0135T is new for CY 2006 and therefore, we have no claims data on which to base our APC assignment decision. The procedure currently has an interim assignment to APC 0163 (Level IV Cystourethroscopy and Other Genitourinary Procedures), with a CY 2006 payment amount of $1,999.35. We are proposing to accept the APC Panel's recommendation to reassign CPT code 0135T to APC 0423 for CY 2007. We believe that assignment of CPT code 0135T to APC 0423 is clinically appropriate, and that the CY 2007 median cost of APC 0423 of $2,410 is reasonably close to our expectations regarding the resource requirements for the renal cryoablation procedure. 6. Keratoprosthesis (APC 0244) (If you choose to comment on issues in this section, please include the caption “Keratophrosthesis” at the beginning of your comment.) CPT code 65770 is a surgical procedure for implantation of a keratoprosthesis, an artificial cornea. The keratoprosthesis device that is required for the implantation is described by HCPCS code C1818 (Integrated keratoprosthesis), a device category that received transitional pass-through payment under the OPPS from July 2003 through December 2005. When the device came off pass-through status for CY 2006 and its costs were packaged into the implantation procedure, CPT code 65770 continued to be assigned to APC 0244 (Corneal Transplant), with a payment rate of about $2,275, despite an increase in the median cost of the implantation procedure of about $1,200 associated with the packaging of the device. There is no 2 times violation in APC 0244 for CY 2006. At the March 2006 meeting of the APC Panel, following a presentation regarding the procedure to implant a keratoprosthesis that described the clinical and hospital resource characteristics of CPT code 65770, the Panel recommended moving CPT code 65770 to a more appropriate APC in order to make appropriate payment. We agree with the recommendation of the APC Panel. Claims data from CY 2005 demonstrate that the median cost for implantation of a keratoprosthesis of $3,127.51 remains significantly higher than the median costs of other procedures assigned to APC 0244, although there is no 2 times violation. In addition, CPT code 65770 contributes less than 1 percent of the single claims in the APC available for ratesetting, and it is likely to continue to be an uncommon procedure among Medicare beneficiaries, resulting in its persistent small contribution to the median cost of APC 0244. Therefore, for CY 2007 we are proposing to create a new APC 0293 (Level V Anterior Segment Eye Procedures) with a median cost of $3,127.51 and to move CPT code 65770 into that APC in order to more appropriately pay for the procedure and the related device. 7. Medication Therapy Management Services (If you choose to comment on issues in this section, please include the caption “Medication Therapy Management Services” at the beginning of your comment.) Following a presentation at its March 2006 meeting, the APC Panel made two recommendations regarding Category III CPT codes for pharmacist medication therapy management services that were new for CY 2006. These services include CPT codes 0115T (medication therapy management services provided by a pharmacist, individual, face-to-face with patient, initial 15 min., w/assessment and intervention if provided; initial encounter), 0116T (medication therapy management; subsequent encounter), and 0117T (medication therapy management; additional 15 min.). These codes were assigned status indicator “B” in the CY 2006 OPPS final rule with comment period, indicating that they are not recognized by the OPPS when submitted on an outpatient hospital Part B bill type, with comment indicator “NI” to identify them as subject to comment. The APC Panel recommended that we create a new APC, with a nominal payment, to which we would assign these codes; implement the assignment in July 2006, if possible, or otherwise in CY 2007; and provide guidance to hospitals on how and when these codes should be reported. We are not accepting the APC Panel's recommendations. Rather, we are proposing to continue to assign status indicator “B” to CPT codes 0115T, 0116T, and 0117T for CY 2007. According to the AMA, the purpose of Category III CPT codes is to facilitate data collection on and assessment of new services and procedures. Medication therapy management services are not new services in the OPPS, as they have been provided to patients by hospitals in the past as components of a wide variety of services provided by hospitals, including clinic and emergency room visits, procedures, and diagnostic tests. As such, we believe their associated hospital resource costs are already incorporated into the OPPS payments for these other services that are based on historical hospital claims data. The three Category III CPT codes specifically describe medication therapy management services provided by a pharmacist. We have no need to distinguish medication therapy management services provided by a pharmacist in a hospital from medication therapy management services provided by other hospital staff, as the OPPS only makes payments for services provided incident to physicians' services. Hospitals providing medication therapy management services incident to physicians' services may choose a variety of staffing configurations to provide those services, taking into account other relevant factors such as State and local laws and hospital policies. In general, we do not establish new clinical APCs for new codes and set payment rates for those APCs when we have no cost data for any services populating the APCs. New codes where we believe that there are no existing clinical APCs compatible with their expected clinical and hospital resource characteristics are often assigned to New Technology APCs until we have sufficient cost data to determine appropriate clinical APC assignments. However, these medication therapy management codes would not be eligible to map to New Technology APCs because they are not new services which are unrepresented in historical hospital claims data. As stated earlier, because we believe the costs of medication therapy management services are imbedded as a component within our claims data, we are confident that our claims data reflect the costs of pharmacist medication management services provided to hospital outpatients who are receiving hospital services. 8. Complex Interstitial Radiation Source Application (APC 0651) (If you choose to comment on issues in this section, please include the caption “Complex Interstitial Radiation Source Application” at the beginning of your comment.) APC 0651 (Complex Interstitial Radiation Source Application), contains only one code, CPT code 77778 (Complex interstitial application of brachytherapy sources). The coding, APC assignment, median cost, and resulting payment rate for CPT code 77778 have not been stable since the inception of the OPPS, and that instability has been a source of concern to hospitals that furnish the service and to specialty societies. The vast majority 
                        ( print page 49564)
                        of claims for interstitial brachytherapy are for the treatment of patients with a diagnosis of prostate cancer. The historical coding, APC assignments, and payment rates for CPT code 77778 and the related service CPT code 55859 (Transperitoneal placement of needles or catheters into the prostate for application of brachytherapy sources), are shown in Table 14. Table 14.—Historical Payment Rates for Complex Interstitial Application of Brachytherapy Sources
OPPS CY
Combination APC
CPT code 77778
APC for 77778
CPT code 55859
APC for 55859
Source2000
N/A
$198.31
APC 312
$848.04
APC 162
Pass-through.2001
N/A
205.495
APC 312
878.72
APC 162
Pass-through.2002
N/A
6344.67
APC 312
2068.23
APC 163
Pass-through with pro rata reduction.2003 (if prostate brachytherapy with iodine sources)
G0261, APC 648, $5154.34
N/A
N/A
N/A
N/A
Packaged.2003 (if prostate brachytherapy with palladium sources)
G0256, APC 649, $5998.24
N/A
N/A
N/A
N/A
Packaged.2003 (if not prostate brachytherapy, not including sources)
N/A
2853.58
APC 651
1479.60
APC 163
Separate payment based on scaled median cost per source.2004
N/A
558.24
APC 651
1848.55
APC 163
Cost.2005
N/A
1248.93
APC 651
2055.63
APC 163
Cost.2006
N/A
666.21
APC 651
1993.35
APC 163
Cost.
 We have frequently been told by the public that the instability in our payment rates for APC 0651 creates difficulty in planning and budgeting for hospitals. Moreover, we have been told that in this case reliance on single procedure claims results in use of only incorrectly coded claims for prostate brachytherapy because, for application to the prostate, which is estimated to be 85 percent of all occurrences of CPT code 77778, a correctly coded claim is a multiple procedure claim. Specifically, we are told that a correctly coded claim for prostate brachytherapy should include, for the same date of service, both CPT codes 55859 and 77778, brachytherapy sources reported with C-codes, and typically separately coded imaging and radiation therapy planning services. We are further advised that in the cases of complex interstitial brachytherapy where sources are placed in sites other than the prostate, the charges for both placing the needles or catheters and for applying the sources may be reported by CPT code 77778 alone because there are no other specific CPT codes for placement of needles or catheters in those sites. In other cases, the placement of needles or catheters may be reported with not otherwise classified codes specific to the treated body area. At the March 2006 APC Panel meeting, presenters urged the Panel to recommend that CMS use only single procedure claims that contain charges for brachytherapy sources on the same claim with CPT code 77778 to set the median cost for APC 0651. Presenters also urged that CMS adopt a process for using multiple procedure claims to set the median for APC 0651 that would sum the costs on multiple procedure claims containing CPT codes 77778 and 55859 (and no other separately payable services not on the bypass list) and, excluding the costs of sources, split the resulting aggregate median cost on the multiple procedure claim according to a preestablished attribution ratio between CPT codes 77778 and 55859. Presenters also urged that we provide hospital education on correct coding of brachytherapy services and devices of brachytherapy required to perform brachytherapy procedures. They indicated that any claim for a brachytherapy service that did not also report a brachytherapy source should be considered to be incorrectly coded and thus not reflective of the hospital resources required for the interstitial source application procedure. They believed that these claims should be excluded from use in establishing the median cost for APC 0651. They believed that hospitals which report the brachytherapy sources on their claims are more likely to report complete charges for the associated brachytherapy procedure than hospitals that do not report the separately payable brachytherapy sources. The APC Panel recommended that CMS reevaluate the proposed payment for brachytherapy services in APC 0651 for CY 2007. The APC Panel also recommended that CMS formally work with the Coalition for the Advancement of Brachytherapy, American Brachytherapy Society, and the American Society for Therapeutic Radiology and Oncology to evaluate the methodology for setting brachytherapy service payment rates in APC 0651. In response to the APC Panel recommendations, we are explicitly analyzing the standard OPPS methodology that we used in determining our proposed payment rate for APC 0651 in this proposed rule in the context of alternative multiple bill methodologies. In addition, we note that we routinely accept requests from interested organizations to discuss their views about OPPS payment policy issues. The organizations that the APC Panel asked us to work with have frequently brought their concerns to our attention through the rulemaking process and otherwise. We will consider the input of any individual or organization to the extent allowed by Federal law including the Administrative Procedure Act (APA) and the Federal Advisory Committee Act (FACA). We establish the OPPS rates through regulations. We are required to consider the timely comments of interested organizations, establish the payment policies for the forthcoming year, and respond to the timely comments of all public commenters in the final rule in which we establish the payments for the forthcoming year. For this proposed rule, we developed a median cost for APC 0651 using single procedure claims using the general OPPS process, but we also looked at multiple procedure claims that contain the most common combinations of codes used with APC 0651. Our single procedure claims process results in using 1,123 claims to calculate a median cost of $1028.93 for APC 0651. We have added CPT code 76965, a CPT code for ultrasound guidance that commonly appears on claims for complex 
                        ( print page 49565)
                        interstitial brachytherapy, to the bypass list for CY 2007 after close clinical review because we believe that it would typically have little associated packaging. We believe that this change, along with maintenance of CPT code 77290 for complex therapeutic radiology simulation-aided field setting on the bypass list, is responsible for the growth in single procedure claims from the 381 single bills on which the APC 0651 median cost was calculated for the CY 2006 OPPS final rule with comment period. However, only 6 of these 1,123 single and “pseudo” single claims also included brachytherapy sources used in complex interstitial brachytherapy source application, and the median cost for these 6 claims at $600.68 is significantly less than the median cost for all single claims. It is unclear why so many of these claims do not contain brachytherapy sources, which were separately paid at cost in CY 2005. Because we are proposing to pay separately for brachytherapy sources again for CY 2007, we see no reason to believe that these few claims for brachytherapy services that included sources, which also do not report CPT code 55859 for placement of needles or catheters into the prostate, are more correctly coded than those claims which do not separately report brachytherapy sources. We believe it is possible that hospitals billing CPT code 77778 and not the associated brachytherapy sources may have bundled their charges for the brachytherapy sources into their charge for CPT code 77778. We also identified multiple procedure claims that contained both CPT codes 77778 and 55859 and also included any one or more of the following procedure codes, which have repeatedly appeared as common procedures that are reported on the same claim with CPT codes 55859 and 77778: 76000, 76965, or 77290. We then calculated median costs for interstitial prostate brachytherapy in two different ways: (1) Bypassing the line item charges for these three ancillary codes; and (2) packaging the costs of these three ancillary codes. We applied this methodology both (1) to all claims that met these criteria with and without sources and (2) to claims that met the criteria and also separately reported brachytherapy sources that would be expected to be reported with CPT code 77778. See Tables 15 and 16 below for the results of this investigation. We found 10,571 multiple procedure claims with CPT codes 55859 and 77778 reported on the claim, including those both with and without separately reported sources. We found that 7,181 of the 10,571 claims contained any combination of the 3 ancillary codes (76000, 76965, or 77290). Table 15 shows the results of bypassing and packaging the line-item costs of the 3 ancillary procedures. Table 15.—Multiple Procedure Claims Including CPT Codes 55859 and 77778
Frequency
Minimum cost
Maximum cost
Mean cost
Median costAncillary Codes Packaged
* 7180
$828.46
$11,202.81
$3,326.50
$3,062.99Ancillary Codes Bypassed
7181
811.95
11,203.81
3,300.16
3,030.01* 1 lost to trimming.
 We found 9,791 multiple procedure claims with CPT codes 55859 and 77778 reported on the claim that also included brachytherapy sources that would be used with CPT code 77778. We found that 6,748 of the 9,791 claims contained any combination of the 3 ancillary codes. Table 16 shows the results of bypassing and packaging the line-item costs of the 3 ancillary procedures. Table 16.—Multiple Procedure Claims Including CPT Codes 55859 and 77778 and One or More Brachytherapy Sources
Frequency
Minimum cost
Maximum cost
Mean cost
Median costAncillary Codes Packaged
6748
$890.56
$10,224.17
$3,240.13
$3,026.62Ancillary Codes Bypassed
6748
912.81
10,307.37
3,215.75
2,992.60
 The claims containing CPT codes 55859 and 77778 and any combination of the three identified ancillary codes have mean and median costs that are very close to one another, regardless of whether the hospital billed separately for the brachytherapy sources on the claim with the procedure codes. Moreover, most of the multiple procedure claims we identified contained sources. This leads us to conclude that the presence of sources on the claim does not make a significant difference in the median cost of the combined service. Moreover, when we calculate the total median cost from single bills for the APCs for the two major procedures codes without regard to the separate payments that would be made for CPT codes 76000, 76965, and 77290, the sum of the CY 2007 proposed medians for APC 0651 and APC 0163 is $3,197.07, which is greater than the combination medians, even when the three ancillary services are packaged into the combination median. Under our proposed policies for CY 2007, hospitals would also be paid separately for brachytherapy sources, guidance services, and radiation therapy planning services that may be provided in support of services reported with CPT codes 55859 and 77778. Therefore, we believe that the summed median cost for APC 0651 and APC 0163 results in an appropriate level of full payment for the dominant type of service provided under APC 0651, interstitial prostate brachytherapy. We are proposing to use the median cost of $1,028.93, as derived from all single bills for APC 0651 according to our standard OPPS methodology, to establish the median for that APC. We recognize that prostate brachytherapy is not the sole use of CPT code 77778, although it is the predominant use. Costs attributable to the placement of needles and catheters and to the interstitial application of brachytherapy sources to sites other than the prostate may also be reported on claims whose data map to APC 0651. 
                        ( print page 49566)
                        This clinically driven variability in the claims data is difficult to assess without adding additional levels of complexity to the issue by considering diagnoses in establishing payments rates. However, recognizing that a PPS is a system based on averages and, to the extent that claims for all types of complex interstitial brachytherapy source application are included in the body of claims used to set the median cost for APC 0651, we believe that the payment for these services is appropriate. 9. Single Allergy Tests (APC 0381) (If you choose to comment on issues in this section, please include the caption “Allergy Testing” at the beginning of your comment.) We are proposing to continue with our methodology of differentiating single allergy tests (“per test”) from multiple allergy tests (“per visit”) by assigning these services to two different APCs to provide accurate payments for these tests in CY 2007. Multiple allergy tests are assigned to APC 0370, with a median cost calculated based on the standard OPPS methodology. We provided billing guidance in CY 2006 in Transmittal 804 (issued on January 3, 2006) specifically clarifying that hospitals should report charges for the CPT codes that describe single allergy tests to reflect charges “per test” rather than “per visit” and should bill the appropriate number of units of these CPT codes to describe all of the tests provided. However, our CY 2005 claims data available for the CY 2007 proposed rule do not yet reflect the improved and more consistent hospital billing practices of “per test” “for single allergy tests. Some claims for single allergy tests still appear to provide charges that represent a “per visit” charge, rather than a “per test” charge. Therefore, consistent with our payment policy for CY 2006, we are proposing to calculate a “per unit” median cost for APC 0381, based upon 349 claims containing multiple units or multiple occurrences of a single CPT code, where packaging on the claims is allocated equally to each unit of the CPT code. Using this methodology, we are proposing a median cost of $13.29 for APC 0381 for CY 2007. We are hopeful that the better and more accurate hospital reporting and charging practices for these single allergy test CPT codes beginning in CY 2006 will allow us to calculate the median cost of APC 0381 using the standard OPPS process in future OPPS updates. 10. Hyperbaric Oxygen Therapy (APC 0659) (If you choose to comment on issues in this section, please include the caption “Hyperbaric Oxygen Therapy” at the beginning of your comment.) When hyperbaric oxygen therapy (HBOT) is prescribed for promoting the healing of chronic wounds, it typically is prescribed for 90 minutes and billed using multiple units of HBOT on a single line or multiple occurrences of HBOT on a claim. In addition to the therapeutic time spent at full hyperbaric oxygen pressure, treatment involves additional time for achieving full pressure (descent), providing air breaks to prevent neurological and other complications from occurring during the course of treatment, and returning the patient to atmospheric pressure (ascent). The OPPS recognizes HCPCS code C1300 (Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval) for HBOT provided in the hospital outpatient setting. In the CY 2005 final rule with comment period (69 FR 65758 through 65759), we finalized a “per unit” median cost calculation for HBOT using only claims with multiple units or multiple occurrences of HCPCS code C1300 because delivery of a typical HBOT service requires more than 30 minutes. We observed that claims with only a single occurrence of the code were anomalies, either because they reflected terminated sessions or because they were incorrectly coded with a single unit. In the same rule, we also established that HBOT would not generally be furnished with additional services that might be packaged under the standard OPPS APC median cost methodology. This enabled us to use claims with multiple units or multiple occurrences. Finally, we also used each hospital's overall cost-to-charge ratio (CCR) to estimate costs for HCPCS code C1300 from billed charges rather than the CCR for the respiratory therapy cost center. Comments on the CY 2005 proposed rule effectively demonstrated that hospitals report the costs and charges for HBOT in a wide variety of cost centers. We used this methodology to estimate payment for HBOT in CYs 2005 and 2006. For CY 2007, we are proposing to continue using the same methodology to estimate a “per unit” median cost for HCPCS code C1300. Using 50,311 claims with multiple units or multiple occurrences, we estimate a median cost of $98.36. 11. Myocardial Positron Emission Tomography (PET) Scans (APCs 0306, 0307) (If you choose to comment on issues in this section, please include the caption “Myocardial PET Scans” at the beginning of your comment.) From August 2000 to December 31, 2005, under the OPPS we assigned to one clinical APC all myocardial positron emission tomography (PET) scan procedures, which were reported with multiple G-codes through March 31, 2005. Effective April 1, 2005, myocardial PET scans were reported with three CPT codes, specifically CPT codes 78459, 78491, and 78492, under the OPPS. Public comments to the CY 2006 OPPS proposed rule suggested that the HCPCS codes describing multiple myocardial PET scans should be assigned to a separate APC from single study codes because their hospital resource costs are significantly higher than single scans. Review of the CY 2004 claims data for myocardial PET scans revealed a median cost of $2,482 for the 9 G-codes that describe multiple myocardial PET scans, based upon 978 single claims of 2,001 total claims for multiple scan procedures. The CY 2004 claims data showed a median cost of $800 for the 6 G-codes describing single PET studies, based on 391 single claims of 575 total claims. A review of CY 2003 claims data showed a similar pattern of significantly higher hospital costs for multiple myocardial PET studies in comparison with single studies, although there were fewer claims for the procedures in CY 2003 in comparison with CY 2004. In response to the comments received and based on this claims information, myocardial PET services were assigned to two clinical APCs for the CY 2006 OPPS. HCPCS codes for single scans were assigned to APC 0306 with a payment rate of $800.55, and HCPCS codes for the multiple scan procedures were assigned to APC 0307 with a payment rate of $2,484.88. Analysis of the latest CY 2005 claims data for myocardial PET scans reveals that the APC median costs for the single and multiple myocardial PET codes are $836 and $680 respectively, based on 296 single claims for single studies and 1,150 single claims for multiple scan procedures. Despite more CY 2005 single claims for multiple scan procedures, the median cost of these procedures declined significantly from CY 2004 to CY 2005, dropping below the median cost of single studies. As indicated earlier, there was a significant coding change for myocardial PET services in CY 2005, with the reporting 
                        ( print page 49567)
                        of a single CPT code for multiple studies (CPT code 78492) for most of CY 2005, in comparison with nine G-codes in CY 2004. We examined the single bills for multiple scan procedures from CY 2004 and noted 17 hospitals were represented, with the majority of those claims from a single hospital. In contrast, in the CY 2005 claims, 25 hospitals were represented in the single bills for multiple scan procedures, and no single hospital contributed a majority of claims to the median cost calculation. We also examined differences in charges associated with G-codes versus the CPT code to determine if hospitals had adjusted the charge for the CPT code to reflect the termination of the multiple study G-codes. However, the individual charging practices of hospitals did not appear to vary with the use of a G-code versus the CPT code in either the CY 2004 or the CY 2005 claims. Greater volume of claims and consistent charging for both the G-codes and CPT code by hospitals suggest that the median appropriately captures the greater variability in relative hospital costs for multiple myocardial PET studies in the CY 2005 claims data. Based on our claims data, the use of myocardial PET scan technology has become more widely prevalent in hospitals, and as a result, we now have more data to support our proposed payment rates. We believe that the median costs from our CY 2005 claims data for myocardial PET scan services, calculated based upon our standard OPPS methodology and based on almost 1,500 single claims, for both the single and multiple scans, should be reflective of the hospital resources required to provide the services to Medicare beneficiaries in the outpatient hospital setting. Based on these data, the differential median costs of the single and multiple study procedures do not support the present two-level APC payment structure. Although we acknowledge that some people may believe that multiple scan procedures should require increased resources at some hospitals in comparison with single scans, particularly because of the longer scan times required for multiple studies, our data do not support a resource differential that would necessitate the placement of these single and multiple scan procedures into two separate APCs. As myocardial PET scans are being provided more frequently at a greater number of hospitals than in the past, it is possible that most hospitals performing multiple PET scans are particularly efficient in their delivery of higher volumes of these services and, therefore, incur hospital costs that are similar to those of single scans, which are provided less commonly. When all myocardial PET scan procedure codes are combined into a single clinical APC, as they were prior to CY 2006, the APC median cost for myocardial PET services is about $721, very similar to the $703 median cost of their single CY 2005 clinical APC. Therefore, for CY 2007, we are proposing to assign CPT codes 78459, 78491, and 78492 to a single APC, specifically, APC 0307 titled Myocardial Positron Emission Tomography (PET) Imaging, with a proposed median cost of $721. We believe that the assignment of these three CPT codes to APC 0307 is appropriate as the CY 2005 claims data reveal that more hospitals are providing multiple myocardial PET scan services, most myocardial PET scans are multiple studies, and the hospital resource costs of single and multiple studies are similar. We believe that the proposed median cost appropriately reflects the hospital resources associated with providing myocardial PET scans to Medicare beneficiaries in cost-efficient settings. Further, we believe that the proposed rates are adequate to ensure appropriate access to these services for Medicare beneficiaries. We are seeking comments on our proposal to provide a single payment rate for all myocardial PET scans in CY 2007. The myocardial PET scan CPT codes and their CY 2007 proposed APC assignments are displayed in Table 17. Table 17.—Proposed CY 2007 APC Assignment for Myocardial PET
HCPCS code
Short descriptor
CY 2006 SI
CY 2006 APC
CY 2006 payment rate
Proposed CY 2007 SI
Proposed CY 2007 APC
Proposed CY 2007 APC 
                                 median cost78459
Heart muscle imaging (PET)
S
0306
$800.55
S
0307
$721.2678491
Heart image (PET), single
S
0306
800.55
S
0307
721.2678492
Heart image (PET), multiple
S
0307
2,484.88
S
0307
721.26
 12. Radiology Procedures (APCs 0333, 0662, and Other Imaging APCs) (If you choose to comment on issues in this section, please include the caption “Radiology Procedures” at the beginning of your comment.) At its March 2006 meeting, the APC Panel made three recommendations regarding radiology services. These include the following: Reaffirming the CY 2005 recommendation that CMS postpone implementation of the multiple procedure reduction policy for imaging services as included in the CY 2006 OPPS proposed rule for CY 2007, to allow CMS to gather more data on the efficiencies associated with multiple imaging procedures that may already be reflected in OPPS payment rates for imaging services.
                    Recommending that CMS review payment rates for computed tomography (CT) and computed tomographic angiography (CTA) procedures to ensure that their payment rates are comparatively consistent and that they accurately reflect resource use.
                    Recommending that CMS invite comments on ways that hospitals can uniformly and consistently report charges and costs related to radiology services. In the CY 2006 OPPS final rule with comment period (70 FR 68707), we indicated that based on the APC Panel's recommendations and public comments received, we decided not to finalize our CY 2006 proposal to reduce OPPS payments for some second and subsequent diagnostic imaging procedures performed in the same session. Our analyses did not disprove the commenters' contentions that there are efficiencies already reflected in their hospital costs, and, therefore, their CCRs and the median costs for the procedures. Over the past 7 months, we have conducted additional studies of our hospital claims data for single and multiple diagnostic imaging procedures, and our analyses to date support continued deferral for CY 2007 of implementation of a multiple imaging procedure payment reduction policy in the OPPS. Therefore, we are accepting the APC Panel's recommendation to not adopt such a policy for CY 2007 pending the results of further analyses. Depending upon the findings from such studies, in a future rulemaking we may propose revisions to the structure of our 
                        ( print page 49568)
                        rates to further refine these rates in the context of additional study findings. We also are accepting the APC Panel's recommendation to review the CY 2007 proposed payment rates for CT and CTA procedures to ensure that their rates are comparatively consistent and accurately reflective of hospitals' resource costs. Presenters at the March 2006 APC Panel meeting indicated to the Panel that hospital resources for CTA procedures are similar to those for CT procedures that include scans without contrast followed by scans with contrast, but additional resources are required for the 3-dimensional reconstruction that is part of the CTA procedures. As a result of this image postprocessing, CTA scans display the vasculature in a 3-dimensional format rather than in the 2-dimensional cross-sectional images of conventional CT scans. Based upon CY 2005 claims data, the CY 2007 proposed median cost for APC 0333 for CT procedures that include scans without contrast material, followed by contrast scans to complete the studies is $309, and the CY 2007 proposed median cost for APC 0662 for CTA procedures is $304. As has been the case for the past several years, the median costs associated with these two APCs are virtually identical to one another and are also quite consistent with their historical costs from prior years of claims data. The CY 2007 proposed median costs for APCs 0333 and 0662 are based on about 500,000 and 150,000 single claims, respectively. The stability of these APC median costs, based on large numbers of single claims, is consistent with our belief that the median costs of these APCs accurately reflect hospitals' resource use. From CY 2004 to CY 2005 the number of CTA procedures performed in the outpatient department increased by 50 percent, whereas the number of CT procedures that included a scan without contrast followed by a scan with contrast to complete each full study increased by only about 1 percent. The large annual increases in the OPPS frequencies of CTA procedures through CY 2005 provide no evidence that Medicare beneficiaries are experiencing difficulty accessing these services in the hospital outpatient setting. CTA procedures are being more commonly performed for various clinical indications, likely resulting in more consistent and efficient use of the associated image postprocessing technology. Accordingly, it is not surprising that the hospital costs of typical CTA procedures in contemporary medical practice are very similar to the hospital costs of the more involved and resource-intensive complex CT services that, like CTA procedures, include scans without contrast material, followed by scans with contrast. Thus, we believe that our CY 2007 proposed payment rates for CT and CTA procedures are generally consistent with one another and accurately reflective of hospitals' resource costs. With respect to the APC Panel's recommendation regarding the reporting of costs and charges for radiology services, CMS requires hospitals to report their costs and charges through the cost report with sufficient specificity to support CMS' use of cost report data for monitoring and payment. Within generally accepted principles of cost accounting, we allow providers flexibility to accommodate the unique attributes of each institution's accounting systems. For example, providers must match the generally intended meaning of the line-item cost centers, both standard and nonstandard, to the unique configuration of department and service categories used by each hospital's accounting system. Also, while the cost report provides recommended bases of allocation for the general services cost centers, a provider is permitted, within specified guidelines, to use an alternative basis for a general service cost if it can justify to its fiscal intermediary that the alternative is more accurate than the recommended basis. This approach creates internal consistency between a hospital's accounting system and the cost report, but cannot guarantee the precise comparability of costs and charges for individual cost centers across institutions. However, we believe that achieving greater uniformity by, for example, specifying the exact components of individual cost centers, would be very burdensome for hospitals and auditors. Hospitals would need to tailor their internal accounting systems to reflect a national definition of a cost center. It is not clear that the marginal improvement in precision created by such a requirement would justify the additional administrative burden. The current hospital practice of matching costs to the general intended meaning of a cost center ensures that most services in the cost center will be comparable across providers, even if the precise composition of a cost center among hospitals differs. Further, every hospital provides a different mix of services. Even if CMS specified the components of each cost center, costs and charges on the cost report would continue to reflect each individual hospital's mix of services. At the same time, internal consistency is very important to the OPPS. Costs are estimated on claims by matching cost-to-charge ratios for a given hospital to their own claims data through a cost center-to-revenue code crosswalk. OPPS relative weights are based on the median cost for all services in an APC. The components resulting in CCRs for a given revenue code would have to be dramatically different for the providers contributing the majority of claims used to calculate an APC's median cost in order to impact relative weights. We are accepting the APC Panel's recommendation and specifically inviting comments on ways that hospitals can uniformly and consistently report charges and costs related to all cost centers, not just radiology, that also acknowledge the ubiquitous tradeoff between greater precision in developing CCRs and administrative burden associated with reduced flexibility in hospital accounting practices. IV. Proposed OPPS Payment Changes for Devices A. Proposed Treatment of Device-Dependent APCs (If you choose to comment on issues in this section, please include the caption “Device-Dependent APCs” at the beginning of your comment.) 1. Background Device-dependent APCs are populated by HCPCS codes that usually, but not always, require that a device be implanted or used to perform the procedure. For the CY 2002 OPPS, we used external data, in part, to establish the device-dependent APC medians used for weight setting. At that time, many devices were eligible for pass-through payment. For the CY 2002 OPPS, we estimated that the total amount of pass-through payments would far exceed the limit imposed by statute. To reduce the amount of a pro rata adjustment to all pass-through items, we packaged 75 percent of the cost of the devices, using external data furnished by commenters on the August 24, 2001 proposed rule and information furnished on applications for pass-through payment, into the median costs for the device-dependent APCs associated with these pass-through devices. The remaining 25 percent of the cost was considered to be pass-through payment. In the CY 2003 OPPS, we determined APC medians for device-dependent APCs using a three-pronged approach. First, we used only claims with device codes on the claim to set the medians for these APCs. Second, we used 
                        ( print page 49569)
                        external data, in part, to set the medians for selected device-dependent APCs by blending that external data with claims data to establish the APC medians. Finally, we also adjusted the median for any APC (whether device-dependent or not) that declined more than 15 percent. In addition, in the CY 2003 OPPS we deleted the device codes (“C” codes) from the HCPCS file in the belief that hospitals would include the charges for the devices on their claims, notwithstanding the absence of specific codes for devices used. In the CY 2004 OPPS, we used only claims containing device codes to set the medians for device-dependent APCs and again used external data in a 50/50 blend with claims data to adjust medians for a few device-dependent codes when it appeared that the adjustments were important to ensure access to care. However, hospital device code reporting was optional. In the CY 2005 OPPS, which was based on CY 2003 claims data, there were no device codes on the claims and, therefore, we could not use device-coded claims in median calculations as a proxy for completeness of the coding and charges on the claims. For the CY 2005 OPPS, we adjusted device-dependent APC medians for those device-dependent APCs for which the CY 2005 OPPS payment median was less than 95 percent of the CY 2004 OPPS payment median. In these cases, the CY 2005 OPPS payment median was adjusted to 95 percent of the CY 2004 OPPS payment median. We also reinstated the device codes and made the use of the device codes mandatory where an appropriate code exists to describe a device utilized in a procedure. We also implemented HCPCS code edits to facilitate complete reporting of the charges for the devices used in the procedures assigned to the device-dependent APCs. In the CY 2006 OPPS, which was based on CY 2004 claims data, we set the median costs for device-dependent APCs for CY 2006 at the highest of: (1) The median cost of all single bills; (2) the median cost calculated using only claims that contained pertinent device codes and for which the device cost is greater than $1; or (3) 90 percent of the payment median that was used to set the CY 2005 payment rates. We set 90 percent of the CY 2005 payment median as a floor rather than 85 percent as proposed, in consideration of public comments that stated that a 15-percent reduction from the CY 2005 payment median was too large of a transitional step. We noted in our CY 2006 proposed rule that we viewed our proposed 85-percent payment adjustment as a transitional step from the adjusted medians of past years to the use of unadjusted medians based solely on hospital claims data with device codes in future years (70 FR 42714). We also incorporated, as part of our CY 2006 methodology, the recommendation to base payment on medians that were calculated using only claims that passed the device edits. As stated in the CY 2006 OPPS final rule with comment period (70 FR 68620), we believed that this policy provided a reasonable transition to full use of claims data in CY 2007, which would include device coding and device editing, while better moderating the amount of decline from the CY 2005 OPPS payment rates. 2. Proposed CY 2007 Payment Policy For CY 2007, we are proposing to base the device-dependent APC medians on CY 2005 claims, the most current data available. As stated earlier, in CY 2005 we reinstated the use of device codes and made the reporting of device codes mandatory where an appropriate code exists to describe a device utilized. In CY 2005, we also implemented HCPCS code edits to facilitate complete reporting of the charges for the devices used in the procedures assigned to the device-dependent APCs. We implemented the first set of device edits on April 1, 2005, for those APCs for which the CY 2005 payment rate was based on an adjusted median cost. We continued to take public comment on the remaining device edits after April 1, 2005, and implemented device edits for the remaining device-dependent APCs on October 1, 2005. Subsequent to the implementation of the device edits, we received public comments that caused us to remove the requirement for edits for several APCs on the basis that the services in them do not always require the use of a device or there may be no suitable device codes available for reporting all devices that may be used to perform the procedures. For example, we removed the requirement for device codes for APC 0080 (Diagnostic Cardiac Catheterization) based on the information provided by hospitals that the codes assigned to this APC do not always require a device for which there is an appropriate HCPCS code. Therefore, we no longer consider this APC to be device dependent and have removed it from the list of device-dependent APCs. In the case of some procedures assigned to other device-dependent APCs, where we determined that no device was required to provide a particular service or where there were no HCPCS codes that described all devices that could be used to furnish the service, we removed the requirement for a device code for the individual procedure code but retained the device requirement for other procedure codes assigned to that device-dependent APC. In its February 2005 meeting, the APC Panel recommended that we consider calculating the median costs for APCs 0107 (Insertion of Cardioverter Defibrillator) and 0108 (Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads) by bypassing the line-item costs of CPT code 33241 (Subcutaneous removal of single or dual chamber pacing cardioverter-defibrillator pulse generator) and packaging the line item-costs of CPT codes 93640 (Electrophysiological evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement) and 93641 (Electrophysiological evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; with testing of single or dual chamber pacing cardioverter-defibrillator) when these codes, separately or in combination, are reported on the same claim with HCPCS codes G0297 (Insertion of single chamber pacing cardioverter defibrillator pulse generator), G0298 (Insertion of dual chamber pacing cardioverter defibrillator pulse generator), G0299 (Insertion or repositioning of electrode lead for single chamber pacing cardioverter defibrillator and insertion of pulse generator) and G0300 (Insertion or repositioning of electrode lead(s) for dual chamber pacing cardioverter defibrillator and insertion of pulse generator), which are assigned to APCs 0107 and 0108. The APC Panel recommended bypassing the line-item costs for CPT code 33241 because members believed that when a pacing cardioverter-defibrillator (ICD) pulse generator removal is performed in the same operative session as the insertion of a new pulse generator described by a procedure code assigned to APC 0107 or 0108, the packaging on the claim is appropriately assigned to the procedure code in APC 0107 or 0108. Moreover, CPT codes 93640 and 93641 may only be correctly coded when the electrophysiologic evaluation of ICD leads is performed at the time of initial implantation or replacement of an ICD 
                        ( print page 49570)
                        pulse generator and/or leads, with or without testing of the pulse generator. Thus, the APC Panel expected that the costs of the evaluations of the ICD leads (CPT codes 93640 and 93641) could be appropriately packaged with the procedure codes that describe the insertion of ICD generators, which are assigned to APCs 0107 and 0108, or the insertion of ICD leads assigned to APCs 0106 (Insertion/Replacement/Repair of Pacemaker and/or Electrodes), 0108, and 0418 (Insertion of Left Ventricular Pacing Elect). Because APCs 0107 and 0108 have typically had very few single bills on which the medians have been based, and because the APC Panel indicated that it believed that we could use many more claims if we bypassed CPT code 33241 and packaged CPT codes 93640 and 93641, we calculated median costs for APCs 0107 and 0108 using these rules. We excluded claims that did not meet the device edits, and we also excluded token claims. The effect of packaging CPT codes 93640 and 93641 into claims that both pass the device edits and also contain no token charges for devices are shown in Table 19 below. This affected APCs 0106, 0107, 0108, and 0418. Bypassing the line-item cost of CPT code 33241 could not be done for all claims on which this CPT code was reported because there are clinical circumstances in which the ICD pulse generator is removed and no new device is implanted. Therefore, the APC assignment for CPT code 33241 and the payment for that code need to reflect the packaging associated with the procedure when it is performed alone. Because of this problem with assigning packaging in all the circumstances in which the procedure may be reported, we decided against proposing to bypass CPT code 33241, either in general for all procedures or selectively, when it is reported with the procedures in APCs 0107 and 0108. However, CPT codes 93640 and 93641 are always performed during an operative procedure for ICD initial implantation or replacement or with implantation, revision or replacement of leads, and, therefore, it would be appropriate to package them into the surgical procedure with which they are performed. Moreover, as a result of the descriptors of the lead evaluation CPT codes, they should never be billed as single procedure claims and packaging them would also resolve the problem of setting their payment rates in part on the basis of claims that reflect erroneous coding. Packaging the costs of the intraoperative electrophysiologic testing of the ICD leads yields many more single bills on which to set median costs and also increases the median costs for APCs 0106, 0107, 0108, and 0418. Therefore, we are proposing to package CPT codes 93640 and 93641 for CY 2007. We calculated the median cost for device-dependent APCs using two different sets of claims. We first calculated a median cost using all single procedure claims for the procedure codes in those APCs. We also calculated a second median cost using only claims that contain allowed device codes and also for which charges for all device codes were in excess of $1.00 (nontoken charge device claims). We excluded claims for which the charge for a device was less than $1.01, in part, to recognize hospital charging practices due to a recall of cardioverter defibrillator and pacemaker pulse generators in CY 2005 for which the manufacturers provided replacement devices without cost to the beneficiary or hospital. We also found that there are other devices for which the charge was less than $1.01, and we removed those claims also. As expected, the median costs calculated using all single procedure bills, including both bills that lack appropriate device codes (where there are edits) and bills with token charges for devices, are, in many cases, less than the medians calculated using only claims that contain appropriate device codes and that have no token charges for devices. In some cases the medians are significantly different when claims either without device codes or which have only token device charges are removed. We believe that the claims that reflect the best estimated costs for these APCs, including the costs of the devices, are those claims that contain appropriate devices and which also have no token charges for devices. (See section IV.A.4. below for our discussion of payments when the hospital incurs no cost for the principal device required for the service.) When we compare the proposed median costs calculated using only CY 2005 claims that contain correct device codes and which do not contain token charges for devices to the unadjusted median costs that were derived from CY 2004 claims data, we find that the medians for only 2 APCs decline (6.3 percent for APC 0061 (Laminectomy or Incision for Implantation of Neurostimulator Electrodes, Excluding Cranial Nerve) and 2.78 percent for APC 0115 (Cannula/Access Device Procedures)). When we compared the proposed CY 2007 medians to the adjusted medians used to set the payment rates for CY 2006, only 6 APCs would decline more than 10 percent in median cost. This compares favorably to the data for the CY 2006 OPPS final rule with comment period in which 12 APCs declined more than 10 percent when the unadjusted median cost from the data for the CY 2006 OPPS final rule with comment period were compared to the adjusted median cost on which the CY 2005 OPPS payments were based. Some APC cost variation from year to year, whether increasing or decreasing, is to be expected. Therefore, we are proposing to base the payment rates for CY 2007 for these device-dependent APCs on median costs calculated using claims with appropriate device codes and which have no token charges for devices reported on the claim. We do not believe that adjustment of these median costs is necessary to provide adequate payment for these services, and, therefore, we are not proposing to adjust the median costs for these APCs to moderate any decreases in medians from CY 2006 to CY 2007. We recognize that, notwithstanding the device edits, it may continue to be necessary for purposes of median cost calculations to remove claims that do not contain devices because it is likely that there would be incidental occurrences of interrupted procedures in which a device is not used and does not appear on the claim. (The interrupted procedure modifier nullifies the device edit.) Moreover, there are likely to continue to be incidental occurrences of token charges for devices as a result of devices that are replaced without cost by the manufacturer. However, each of these circumstances could cause the procedure code median cost to underrepresent the cost of the complete procedure, including the device cost, where the hospital purchases the device. Hence, we believe that use of claims that meet the device edits and which do not contain token charges for devices are the appropriate claims to use to set the median costs for the device-dependent APCs, ensuring that the costs of the principal devices are included in the APC medians. In addition, we believe that, with our proposed changes to the OPPS packaging status of two codes for electrophysiologic evaluation of ICD leads, no special payment policies are needed to establish payment rates that correctly reflect the relative costs of these procedures to other procedures paid under the OPPS. 
 
  
 
  
 
  Table 19.—Effect of Packaging CPT Codes 93640 and 93641 on All Single Bills
APC
SI
APC group title
Post cost total frequency
Proposed CY 2007 single bill frequency 93640/93641 not packaged
Proposed CY 2007 single bill median 93640/93641 not packaged
Proposed CY 2007 single bill frequency 93640/93641 packaged
Proposed CY 2007 single bill median 93640/93641 packaged0106
T
Insertion/Replacement/Repair of Pacemaker and/or Electrodes
3819
457
$2,459.08
494
$2,549.700107
T
Insertion of Cardioverter-Defibrillator
16276
481
9,669.32
886
11,215.820108
T
Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads
9075
929
18,030.96
2950
22,362.680418
T
Insertion of Left Ventricular Pacing Elect
4824
142
5,098.03
225
9,696.51
 3. Devices Billed in the Absence of an Appropriate Procedure Code In the course of examining claims data for creation of the payment rates for this proposed rule, we identified circumstances in which hospitals billed a device code but failed to also bill any procedure code with which the device could be used correctly. These errors in billing lead to the costs of the device being packaged with an incorrect procedure code and also cause the hospital to be paid incorrectly for the service furnished if the device was appropriately reported. We discussed the billing of devices with incorrect procedure codes with the APC Panel at its March 2006 meeting, and the APC Panel recommended that we explore the extent to which it would be appropriate to establish edits for HCPCS device codes to ensure that hospitals also bill procedures in which the devices would be used on the same claim. We examined our CY 2005 claims data and found that incorrect billing occurs more often with some devices than with others. We are taking this opportunity to inform the public that we expect to implement device to procedure code edits for the specified devices and their associated procedures, which we believe must be reported on a claim with the specified device for the claim to be correctly coded and the device costs properly attributed to procedures with which they are used. The devices for which we expect to implement edits are shown below in Table 20 and are posted on the CMS outpatient hospital Web site, along with our initial draft of all the procedures with which they could be appropriately used and thus reported. We believe the establishment of claims edits reflects merely operational and administrative practice. However, as the public may assist in establishing appropriate edits, we, therefore, are asking that comments regarding the specific associations of device codes and procedure codes be provided to the following e-mail address: 
                        *OutpatientPPS@cms.hhs.gov*. This is the same e-mail address to which comments on the existing procedure to device edits should be directed. Comments submitted on this issue to this mail box are not comments on this proposed rule and we will not respond to them in the CY 2007 OPPS final rule. Table 20.—Devices Which Must Be Billed With Associated Procedure Codes
Device
DescriptionC1721
AICD, dual chamber.C1722
AICD, single chamber.C1767
Generator, neuro non-recharg.C1777
Lead, AICD, endo single coil.C1778
Lead, neurostimulator.( print page 49574)C1779
Lead, pmkr, transvenous VDD.C1785
Pmkr, dual, rate-resp.C1786
Pmkr, single, rate-resp.C1820
Generator, neuro rechg bat sys.C1882
AICD, other than sing/dual.C1895
Lead, AICD, endo dual coil.C1896
Lead, AICD, non sing/dual.C1897
Lead, neurostim test kit.C1898
Lead, pmkr, other than trans.C1899
Lead, pmkr/AICD combination.C1900
Lead, coronary venous.C2619
Pmkr, dual, non rate-resp.C2620
Pmkr, single, non rate-resp.C2621
Pmkr, other than sing/dual.
 4. Proposed Payment Policy When Devices are Replaced Without Cost or Where Credit for a Replaced Device Is Furnished to the Hospital As we discuss above in the context of the calculation of median costs for ICDs and pacemakers, in recent years there have been several field actions and recalls with regard to failure of these devices. In many of these cases, the manufacturers have offered replacement devices without cost to the hospital or credit for the device being replaced if the patient required a more expensive device. In some circumstances manufacturers have also offered, through a warranty package, to pay specified amounts for unreimbursed expenses to persons who had replacement devices implanted. In addition, we believe that incidental device failures that are covered by manufacturer warranties occur routinely. While we understand that some device malfunctions may be inevitable as medical technology grows increasingly sophisticated, we believe that early recognition of problems would reduce the number of people with the potential to be adversely affected by these device problems. The medical community needs heightened and early awareness of patterns of device failures, voluntary field actions, and recalls so that they can take appropriate action to care for our beneficiaries. Systematic efforts must be undertaken by all interested and involved parties, including manufacturers, insurers, and the medical community, to ensure that device problems are recognized and addressed as early as possible so that people's health is protected and high quality medical care is provided. We are taking several steps to assist in the early recognition and analysis of patterns of device problems to minimize the potential for harmful device-related effects on the health of Medicare beneficiaries and the public in general. In recent years, CMS has recognized the importance of data collection as a condition of Medicare coverage for selected services. In 2005, CMS issued a National Coverage Determination (NCD) that expanded coverage of ICDs and required registry participation when the devices were implanted for certain clinical indications. The NCD included this requirement in order to ensure that the care received by Medicare beneficiaries was reasonable and necessary and, therefore, appropriately reimbursed. Presently, the American College of Cardiology—National Cardiovascular Data Registry (ACC—NCDR) collects these data and maintains the registry. In addition to ensuring appropriate payment of claims, collection, and ongoing analysis of ICD implantation, data can speed public health action in the event of future device recalls. The systematic recording of device manufacturer and model number can enhance patient and provider notification. Analysis of registry data may uncover patterns in complication rates (for example, device malfunction, device-related infection, and early battery depletion) associated with particular devices that signify the need for a more specific investigation. Patterns found in registry data may identify problems earlier than the currently available mechanisms, which do not systematically collect such detailed information surrounding procedures. We encourage the medical community to work to develop additional registries for implantable devices, so that timely and comprehensive information is available regarding devices, recipients of those devices, and their health status and outcomes. While participation in an ICD registry is required as a condition of coverage for ICD implantation for certain clinical conditions, we believe that the potential benefits of registries extend well beyond their application in Medicare's specific national coverage determinations. As medical technology continues to swiftly advance, data collection regarding the short and long term outcomes of new technologies, and especially concerning implanted devices that may remain in the bodies of patients for their lifetimes, will be essential to the timely recognition of specific problems and patterns of complications. This information will facilitate early interventions to mitigate harm and improve the quality and efficiency of health care services. Moreover, data from registries may help further the development of high quality, evidence-based clinical practice guidelines for the care of patients who may receive device-intensive procedures. In turn, widespread use of evidence-based guidelines may reduce variation in medical practice, leading to improved personal and public health. Registry information may also contribute to the development of more comprehensive and refined quality metrics that may be used to systematically assess and then improve the safety and quality of health care. Such improvements in the quality of care that result in better personal health will require the sustained commitment of industry, payers, health care providers, and others towards that goal, along with excellent and open communication and rapid system-wide responses in a comprehensive effort to protect and enhance the health of the public. We look forward to further discussions with the public about new strategies to recognize device problems early and how to definitively address them, in order to minimize both the harmful health effects and increased health care costs that may result. In addition, we believe that the routine identification of Medicare claims where hospitals identify and then appropriately report selected services performed under the OPPS when devices are replaced without cost to the hospital or with full credit to the hospital for the cost of the replaced device, should provide comprehensive information regarding the outpatient hospital experiences of Medicare beneficiaries with certain devices that are being replaced. Because Medicare beneficiaries are common recipients of implanted devices, this claims information may be particularly helpful in identifying patterns of device problems early in their natural history so that appropriate strategies to reduce future problems may be developed. In addition to our concern for the public health, we also have a fiduciary responsibility to the Medicare trust fund to ensure that Medicare pays only for covered services. Therefore, we are proposing, effective for services furnished on or after January 1, 2007, to reduce the APC payment and beneficiary copayment for selected APCs in cases in which an implanted 
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                        device is replaced without cost to the hospital or with full credit for the removed device. Specifically, we are proposing to revise the existing regulations by adding new § 419.45, Payment and copayment reduction for replaced devices. This regulation is intended to cover certain devices for which credit for the replaced device is given or which are replaced as a result of or pursuant to a warranty, field action, voluntary recall, involuntary recall, and certain devices which are provided free of charge. It would provide for a reduction in the APC payment rate when we determine that the device is replaced without cost to the provider or beneficiary or when the provider receives full credit for the cost of a replaced device. The amount of the reduction to the APC payment rate would be calculated in the same manner as the offset amount that would be applied if the implanted device assigned to the APC had pass-through status as defined under § 419.66. The beneficiary's copayment amount would be calculated based on the reduced APC payment rate. We believe that this is appropriate because in these cases the full cost of the replaced device is not incurred and, therefore, we believe that an adjustment to the APC payment is necessary to remove the cost of the device. We believe that the averaging nature of the calculation of the amount of the adjustment causes it to be appropriately applied to cases of credit for the replaced device, regardless of whether there is a residual cost due to the implantation of a more expensive device. We also believe that the proposed adjustment is consistent with section 1862(a)(2) of the Act, which excludes from Medicare coverage an item or service for which neither the beneficiary nor anyone on his or her behalf has an obligation to pay. Payment of the full APC payment rate in these cases in which the device was replaced under warranty or in which there was a full credit for the price of the recalled or failed device effectively results in Medicare payment for a noncovered item. Moreover, it results in creation of a beneficiary liability for the copayment associated with the device for which the beneficiary has no liability. Therefore, we are proposing to adjust the APC payment rate in these circumstances under the authority of section 1833(t)(2)(E) of the Act, which permits us to make equitable adjustments to the OPPS payment rates. We recognize that in many cases, the packaged cost of the device is a relatively modest part of the APC payment for the procedure into which the device cost is packaged. In the case of devices of modest cost, we believe that the averaging nature of payments under the OPPS based on the conversion of charges to costs with CCRs would incorporate any significant savings from a warranty replacement, field action, or recall into the payment rate for the associated procedural APC and that no specific adjustment would be necessary or appropriate. However, in other cases, such as implantation of an ICD, the cost of the device is the majority of the cost of the APC and payment at the full payment rate for the procedural APC would pay the hospital much in excess of its incurred cost of the service. As we discuss above, we are proposing to set the APC payment rates for device-dependent APCs for the CY 2007 OPPS using only claims that contain appropriate devices to ensure that we make appropriate full payment when the hospital initially incurs the full cost of the device. Beginning in CY 2005, we required that device codes be billed for devices used and specifically required that hospitals bill certain device codes for some services. We are using the CY 2005 claims to set the payment rates for the CY 2007 OPPS. Currently, where the device is furnished without cost to the hospital, we have authorized hospitals to charge less than $1.01, although Medicare's longstanding policy has been that, in these cases, providers may not charge for the device furnished to them without cost. (See the Medicare Internet Only Manual, Medicare Benefit Policy Manual, Publication 100-02 Chapter 16, section 40.4.) We authorized this charge because the CMS device edits require that the hospital must report an appropriate device if they bill for certain codes that cannot be performed without a device or the claim will be returned. Moreover, the Fiscal Intermediary Standard System will not accept the claim unless there is a charge for each HCPCS code billed. In addition, we were seeking a means of identifying these recall cases in the data. Therefore, by authorizing hospitals to charge less than $1.01 for the device we enabled the claim to be paid and also provided a mechanism for identifying devices for which the hospital incurred no expense. Where we set the payment rates for these device-dependent APCs using only claims that contain the full costs of devices when they are purchased by hospitals and exclude claims for which there is no appropriate device code or a charge for the device of less than $1.01, the proposed APC payments into which the full costs of the devices have been packaged would result in excessive program payments and beneficiary copayments for the services being furnished if the devices were provided without cost to hospitals. To avoid excessive payments in these circumstances, as noted previously we are proposing to adjust the APC payment rates when implanted devices have been replaced without cost to the hospital or beneficiary or where full credit for such a device has been given because the replacement device is of greater cost than the originally implanted device. We are proposing that the adjustment would be limited to the APCs listed in Table 21, but only when the purpose of the procedure is to replace a device that is reported by a HCPCS code in Table 22 which was furnished without cost or at full credit by the manufacturer. We are proposing that the following three criteria must each be met for an APC to be subject to the adjustment. We selected the APCs in Table 21 on the basis of these three criteria. The first criterion is that all procedures assigned to the selected APCs must require implantable devices that would be reported if device replacement procedures were performed. Therefore, the device being replaced must be necessary for the service to be furnished and without the devices, the services assigned to the APCs could not be performed. For services, and, therefore, their assigned APCs, where a device is not needed or where it may or may not be needed to perform a procedure, we do not believe that reducing the payment for the APCs would be appropriate because the charges for the devices are unlikely to be a significant factor in establishing the rates for the APCs. The second criterion is that the required devices must be surgically inserted or implanted devices that remain in the patient's body after the conclusion of the procedures, at least temporarily. We believe this is necessary to establish that the replacement device is a direct replacement for the device being removed. In cases of failures of devices that are surgically inserted or implanted but do not remain in the patient's body after the conclusion of procedures, we believe that it is highly likely that the replacement device is not specifically used to care for the patient on whom the original defective device was used and that, where a defective device of this type is used, there is no savings to the hospital. For example, if a vascular catheter fails during a procedure, we believe that the physician will probably 
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                        use another similar catheter to finish the procedure. In these cases the hospital would correctly charge for the catheter that was used, and there would be no savings to the hospital from that procedure. The hospital would likely charge for both the defective device and the device used to complete the procedure because both catheters were used to provide the full service. We believe that if a replacement catheter is furnished to the hospital under warranty from the manufacturer, it would be used at a much later date on a different patient, it would most likely be charged to that patient account, and it would be unlikely to be specifically identified as being furnished without cost to the hospital. In these cases, we expect that any cost savings from the replacement devices such as these (for example, catheters) that are furnished without cost would be incorporated into the median costs for the procedures in the normal course of the data process through application of the CCRs generated from the cost reports. The third criterion is that the offset percent for the APC (that is, the median cost of the APC without device costs divided by the median cost of the APC with devices) must be significant. For this purpose, we are defining a significant offset percent as exceeding 40 percent. We believe that this percent is appropriate because our studies have shown that approximately 60 percent of the cost of OPPS services is wage-related, and that approximately 40 percent of the cost of OPPS services is not wage related. This is why we wage adjust 60 percent of the APC payment rates for all APCs, including APCs for which a greater percentage of the APC payment is for the cost of a device. We believe that once the device share of an APC exceeds the 40 percent we attribute to costs other than wage costs (for example, device costs, capital costs, plant costs, and supplies other than devices), the device cost is a significant part of the APC cost. Therefore, where the device costs in an APC exceed 40 percent, which is the average of all types of nonwage-related costs across all APCs, we are proposing to define the device costs as “significant” for purposes of this proposed policy. We recognize that it may be appropriate to define “significant” for this purpose at a different percentage of the APC cost because there are costs other than device costs (for example, capital costs and other supply costs) in the 40 percent of service costs to which the wage adjustment does not apply. We would reassess for future years whether it is appropriate to define “significant” for this purpose at a level other than 40 percent. For purposes of making the proposed adjustment, we would adapt the methodology that we have employed to establish an offset for the device costs incorporated into APCs in cases where a pass-through device is also being billed. We currently calculate the offset amount by first calculating a median including the device costs and then calculating a median excluding device costs using single bills that contain devices. We then divide the “without device” median by the “with device” median and subtract the percent from 100 to acquire the percent of cost attributable to devices in the APC. We apply this percent to the payment rate of the APC to determine the offset amount. For example, this is the methodology we used to calculate the offset amount for APC 0222 when current pass-through device C1820 (Generator, neuro rechg bat sys) is billed on the same claim. We believe that it is appropriate to apply this same methodology in circumstances when we need to remove the cost of the device from the APC payment, not because the device is being paid under pass-through but because the hospital is either not incurring the cost for the replaced device or has been given full credit for the replaced device. In both cases, the intent is to remove the cost of the device from the APC payment rate. Using this methodology, we calculated the proposed offset amounts in Table 21 by first calculating an APC median cost including device costs and then calculating a median cost excluding device costs, using only single bills that meet our device edits and do not have token charges for devices. We then divided the “without device” median cost by the “with device” median cost and subtracted the percent from 100 to acquire the percent of cost attributable to devices in the APC. We next applied this percent to the payment rate for the APC to determine the offset amount. The following is an example of the payment reduction in the case of replacement of an ICD under warranty. Where the cardioverter defibrillator pulse generator described by HCPCS code C1721 (AICD, dual chamber) is replaced under warranty during a procedure described by HCPCS code G0298 (Insertion of dual chamber pacing cardioverter defibrillator pulse generator), the hospital would report HCPCS code G0298 with a specified modifier and would also report HCPCS code C1721 with a token charge for the device. Assuming the hospital had a wage index of 1, the payment rate for APC 0107 after adjustment would be $1862.27. That is, the adjusted payment rate would equal the unadjusted payment rate for APC 0107 ($17,185.34) less the warranty reduction percentage in Table 21 of 89.13 percent ($15,317.29). Because the adjustment amount is set for the APC, the same adjustment amount would be removed if devices reported under HCPCS code C1722 or C1882 were reported with HCPCS code G0297. This is identical to the amount of adjustment that would apply to the payment for a pass-through device if there were, hypothetically, a new ICD to which we had given pass-through status (no ICD currently has pass-through status). We are proposing to both adjust the APC payment to remove payment for the device furnished without cost to the hospital or beneficiary and also to decrease the beneficiary copayment in proportion to the reduced APC payment so that the beneficiary would, in many but not all cases, share in the cost savings attributable to the provision of the device without cost by the manufacturer. We are proposing that when a device is replaced without cost to the hospital under warranty or recall or a credit is provided for the cost of a failed or recalled device (unlike cases of offset for a pass-through device), the beneficiary's copayment would be calculated based on the reduced APC payment rate, maintaining the same percentage copayment as applies to the unadjusted APC payment if the inpatient deductible is not exceeded. We believe that it is appropriate to reduce the beneficiary copayment in these cases because the device is being furnished or credited by the manufacturer without obligation on the part of the beneficiary. We note, however, that in the case of some high cost APCs, making the payment adjustment in a recall or warranty situation may not result in reduction of the copayment because the copayment, although based on the reduced payment rate, may continue to exceed the inpatient deductible and, therefore, would continue to be set at the inpatient deductible. In contrast, in the case of pass-through devices, the beneficiary is liable for the copayment on the full APC amount (which, in the case of high cost APCs, is limited to the Medicare inpatient deductible) but pays no copayment for the incremental cost of the pass-through device. This is appropriate in the case of payment for pass-through devices because the hospital incurs costs for both the service and the device, and Medicare pays for both the service through the full APC 
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                        payment and for the incremental cost of the pass-through device above the costs of associated devices already reflected in the APC payment at charges reduced to cost by a CCR. The pass-through payment amount is reduced only to prevent the program from making duplicate payment for a portion of the device, once as part of the APC payment and once through the pass-through payment. We are proposing to implement the adjustment through the use of an appropriate modifier specific to a device replacement without cost or crediting of the cost of a device by the manufacturer. Hospitals would be required to report the modifier appended to a specific procedure on claims for services when two conditions are met. The first condition is that the procedure is assigned to one of the APCs in Table 21. We have discussed above the criteria that we employed for selecting the APCs in Table 21. The second condition is that the device for which the manufacturer furnished a replacement device (or provided credit for the device being replaced) is one of the devices included in Table 22. We are restricting the devices to which the adjustment would apply to those included in Table 22 in order to ensure that the adjustment is not triggered by the replacement of an inexpensive device whose cost does not constitute a significant proportion of the total payment rate for an APC. The presence of the modifier would trigger the adjustment in payment for the APCs in Table 21. While we recognize that this creates a reporting burden for hospitals, we believe the reporting requirement is unavoidable. Only hospitals can report whether the circumstances for reduced payment as described above are met and, therefore, we see no option other than to have hospitals report this information to us. We recognize that the current FB modifier (“Item furnished without cost to provider, supplier or practitioner”) may not be appropriate in cases in which the replacement device is a more expensive device than the device being removed and may need to be changed to expand its use for all potential APC payment adjustment scenarios. Our proposed policy would accomplish three important goals. First and foremost, it would advise us of the extent to which devices are being replaced due to device failures so that, if patterns are identified, we can explore them to see if there are systemic problems with certain devices. The reporting of a specific modifier with certain procedure codes would allow us to examine patterns of delivery of specific hospital services when implanted devices are replaced without cost or with full credit for the cost of a device by the manufacturer, in comparison with publicly available information about problematic devices. Analysis of outpatient hospital claims would serve as an additional source of information to the medical community about patterns of device failures, voluntary field actions, and recalls, contributing to improved awareness and understanding of problems. Secondly, it would ensure equitable adjustment to the payments for surgical procedures to replace problematic devices by providing payments to hospitals only for the nondevice related procedural costs when a device is replaced without cost to the hospital for the device or with full credit for the removed device. Thirdly, it would also identify those claims that contain reduced device charges due to the full credit provided by the manufacturer for a replaced device so that in the future we can assess the impact of these claims on median costs for the services into which the device costs are packaged. This proposed policy would be effective for services furnished on or after January 1, 2007. We believe that this proposed policy is necessary to enable us to secure claims data that may be used to identify trends in device problems that lead to device replacements. It is also necessary to fulfill our fiduciary responsibility to the Medicare program by not providing payments for items that are excluded from coverage under Medicare law because neither the beneficiary nor any party on his or her behalf has an obligation to pay. Table 21.—Proposed Adjustment to APCs in Cases of Replacement of or Full Credit for Failed or Recalled Device
APC
SI
APC group title
CY 2007 proposed offset 
                                 percent0039
S
Level I Implantation of Neurostimulator
78.51%0040
S
Percutaneous Implantation of Neurostimulator Electrodes, Excluding Cranial Nerve
54.66%0061
S
Laminectomy or Incision for Implantation of Neurostimulator Electrodes, Excludin
60.59%0089
T
Insertion/Replacement of Permanent Pacemaker and Electrodes
77.14%0090
T
Insertion/Replacement of Pacemaker Pulse Generator
74.56%0106
T
Insertion/Replacement/Repair of Pacemaker and/or Electrodes
41.04%0107
T
Insertion of Cardioverter-Defibrillator
89.13%0108
T
Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads
89.15%0222
T
Implantation of Neurological Device
78.10%0225
S
Implantation of Neurostimulator Electrodes, Cranial Nerve
80.62%0226
T
Implantation of Drug Infusion Reservoir
62.21%0227
T
Implantation of Drug Infusion Device
81.50%0229
T
Transcatherter Placement of Intravascular Shunts
42.32%0259
T
Level VI ENT Procedures
84.03%0315
T
Level II Implantation of Neurostimulator
83.52%0385
S
Level I Prosthetic Urological Procedures
46.88%0386
S
Level II Prosthetic Urological Procedures
61.32%0418
T
Insertion of Left Ventricular Pacing Elect
86.11%0654
T
Insertion/Replacement of a permanent dual chamber pacemaker
76.73%0655
T
Insertion/Replacement/Conversion of a permanent dual chamber pacemaker
76.89%0680
S
Insertion of Patient Activated Event Recorders
77.03%0681
T
Knee Arthroplasty
73.26%
 
 
 Table 22.—Devices for Which the Proposed Modifier Must Be Reported With the Procedure Code When Furnished Without Cost or at Full Credit for a Replaced Device
Device
DescriptionC1721
AICD, dual chamber.C1722
AICD, single chamber.C1764
Event recorder, cardiac.C1767
Generator, neurostim, imp.C1771
Rep dev, urinary, w/sling.C1772
Infusion pump, programmable.C1776
Joint device (implantable).C1777
Lead, AICD, endo single coil.C1778
Lead, neurostimulator.C1779
Lead, pmkr, transvenous VDD.C1785
Pmkr, dual, rate-resp.C1786
Pmkr, single, rate-resp.C1813
Prosthesis, penile, inflatab.C1815
Pros, urinary sph, imp.C1820
Generator, neuro rechg bat sys.C1882
AICD, other than sing/dual.C1891
Infusion pump, non-prog, perm.C1895
Lead, AICD, endo dual coil.C1896
Lead, AICD, non sing/dual.C1897
Lead, neurostim, test kit.C1898
Lead, pmkr, other than trans.C1899
Lead, pmkr/AICD combination.C1900
Lead coronary venous.C2619
Pmkr, dual, non rate-resp.C2620
Pmkr, single, non rate-resp.C2621
Pmkr, other than sing/dual.C2622
Prosthesis, penile, non-inf.C2626
Infusion pump, non-prog, temp.C2631
Rep dev, urinary, w/o sling.L8614
Cochlear device/system.
 B. Proposed Pass-Through Payments for Devices (If you choose to comment on issues in this section, please include the caption “Pass-Through Devices” at the beginning of your comment.) 1. Expiration of Transitional Pass-Through Payments for Certain Devices a. Background Section 1833(t)(6)(B)(iii) of the Act requires that, under the OPPS, a category of devices be eligible for transitional pass-through payments for at least 2, but not more than 3, years. This period begins with the first date on which a transitional pass-through payment is made for any medical device that is described by the category. The device category codes became effective April 1, 2001, under the provisions of the BIPA. Prior to pass-through device categories, Medicare payments for pass-through devices under the OPPS were made on a brand-specific basis. All of the initial 97 category codes that were established as of April 1, 2001, have expired; 95 categories expired after CY 2002, and 2 categories expired after CY 2003. In addition, nine new categories have expired since their creation. We currently have no category codes for pass-through devices that will expire January 1, 2007. We created one new category effective January 1, 2006, for C1820 (Generator, neurostimulator (implantable), with rechargeable battery and charging system), which we are proposing to continue to pay under the pass-through provision in CY 2007 under the OPPS. This category was created after we published modifications to our criteria in the CY 2006 OPPS final rule with comment period on November 10, 2005 (70 FR 68628 through 68631) allowing CMS to refine previous pass-through category descriptions that would have prevented us from making pass-through payments for a new technology that otherwise met our criteria. These modifications amended the original criteria and process for creating additional device categories for pass-through payment that we published on November 2, 2001 (66 FR 55850 through 55857). Under our established policy, we base the expiration dates for the category codes on the date on which a category was first eligible for pass-through payment. In the November 1, 2002 OPPS final rule, we established a policy for payment of devices included in pass-through categories that are due to expire (67 FR 66763). For CY 2003 through CY 2006, we packaged the costs of the devices no longer eligible for pass-through payments into the costs of the procedures with which the devices were billed in the claims data used to set the payment rates for those years. Brachytherapy sources, which are now separately paid in accordance with section 1833(t)(2)(H) of the Act, are an exception to this established policy (with the exception of brachytherapy sources for prostate brachytherapy, which were packaged in the CY 2003 OPPS only). b. Proposed Policy for CY 2007 As we stated earlier, currently we have one effective device category for pass-through payment, C1820, which we created for pass-through payment effective January 1, 2006. We are proposing to continue to make payment under the pass-through provisions for category C1820 for CY 2007. We are proposing that this category would expire from pass-through payment after December 31, 2007. This would provide the category transitional pass-through payment status for a 2-year period, in accordance with the statutory requirement that no category be paid as a pass-through device for less than 2 years, nor more than 3 years. 2. Provisions for Reducing Transitional Pass-Through Payments To Offset Costs Packaged Into APC Groups a. Background In the November 30, 2001 OPPS final rule, we explained the methodology we used to estimate the portion of each APC payment rate that could reasonably be attributed to the cost of the associated devices that are eligible for pass-through payments (66 FR 59904). Beginning with the implementation of the CY 2002 OPPS quarterly update (April 1, 2002), we deducted from the pass-through payments for the identified devices an amount that reflected the portion of the APC payment amount that we determined was associated with the cost of the device, as required by section 1833(t)(6)(D)(ii) of the Act. In the November 1, 2002 interim final rule with comment period, we published the applicable offset amounts for CY 2003 (67 FR 66801). For the CY 2002 and CY 2003 OPPS updates, to estimate the portion of each APC payment rate that could reasonably be attributed to the cost of an associated device eligible for pass-through payment, we used claims data from the period used for recalibration of the APC rates. That is, for CY 2002 OPPS updating, we used CY 2000 claims data, and for CY 2003 OPPS updating, we used CY 2001 claims data. For CY 2002, we used median cost claims data based on specific revenue centers used for device-related costs because C-code cost data were not available until CY 2003. For CY 2003, we calculated a median cost for every APC without packaging the costs of associated C-codes for device categories that were billed with the APC. We then calculated a median cost for every APC with the costs of the associated device category C-codes that were billed with the APC packaged into the median. Comparing the median APC cost without device packaging to the median APC cost, including device packaging, enabled us to determine the percentage of the median APC cost that is attributable to the associated pass-through devices. By applying those percentages to the APC payment rates, we determined the applicable amount to be deducted from the pass-through payment, the ”offset” amount. We created an offset list comprised of any APC for which the device cost was at least 1 percent of the APC's cost. The offset list that we published for CY 2002 through CY 2004 was a list of offset amounts associated with those APCs with identified offset amounts developed using the methodology described above. As a rule, we do not 
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                        know in advance which procedures residing in certain APCs may be billed with new device categories. Therefore, an offset amount is applied only when a new device category is billed with a HCPCS procedure code that is assigned to an APC appearing on the offset list. For CY 2004, we modified our policy for applying offsets to device pass-through payments. Specifically, we indicated that we would apply an offset to a new device category only when we could determine that an APC contains costs associated with the device. We continued our existing methodology for determining the offset amount, described earlier. We were able to use this methodology to establish the device offset amounts for CY 2004 because providers reported device codes (C-codes) on the CY 2002 claims used for the CY 2004 OPPS update. For the CY 2005 update to the OPPS, our data consisted of CY 2003 claims that did not contain device codes and, therefore, for CY 2005, we utilized the device percentages as developed for CY 2004. In the CY 2004 OPPS update, we reviewed the device categories eligible for continuing pass-through payment in CY 2004 to determine whether the costs associated with the device categories are packaged into the existing APCs. Based on our review of the data for the device categories existing in CY 2004, we determined that there were no close or identifiable costs associated with the devices relating to the respective APCs that are normally billed with them. Therefore, for those device categories, we set the offset amount to $0 for CY 2004. We continued this policy of setting the offset amount to $0 for the device categories that continued to receive pass-through payment in CY 2005. For the CY 2006 OPPS update, CY 2004 hospital claims were available for analysis. Hospitals billed device C-codes in CY 2004 on a voluntary basis. We reviewed our CY 2004 data and found that the numbers of claims for services in many of the APCs for which we calculated device percentages using CY 2004 data were quite small. We also found that many of these APCs already had relatively few single claims available for median calculations compared with the total bill frequencies because of our inability to use many multiple bills in establishing median costs for all APCs. In addition, we found that our claims demonstrated that relatively few hospitals specifically coded for devices utilized in CY 2004. Thus, we were not confident that CY 2004 claims reporting C-codes represented the typical costs of all hospitals providing the services. Therefore, we did not use CY 2004 claims with device coding to calculate CY 2006 device offset amounts. In addition, we did not use the CY 2005 methodology, for which we utilized the device percentages as developed for CY 2004. Two years had passed since we developed the device offsets for CY 2004, and the device offsets originally calculated from CY 2002 hospitals' claims data may either have overestimated or underestimated the contributions of device costs to total procedural costs in the outpatient hospital environment of CY 2004. In addition, a number of the APCs on the CY 2004 and CY 2005 device offset percentage lists were either no longer in existence or were so significantly reconfigured that the past device offsets likely did not apply. For CY 2006, we reviewed the single new device category established thus far, C1820, to determine whether device costs associated with the new category are packaged into the existing APC structure. Under our established policy, if we determine that the device costs associated with the new category are closely identifiable to device costs packaged into existing APCs, we set the offset amount for the new category to an amount greater than $0. Our review of the service indicated that the median costs for the applicable APC 0222 (Implantation of Neurological Device) contained costs for neurostimulators similar to the costs of the new device category C1820. Therefore, we determined that a device offset would be appropriate. We announced an offset amount for that category in Program Transmittal No. 804, dated January 3, 2006. For CY 2006, we are using available partial year CY 2005 hospital claims data to calculate device percentages and potential offsets for CY 2006 applications for new device categories. Effective January 1, 2005, we require hospitals to report device C-codes and their costs when hospitals bill for services that utilize devices described by the existing C-codes. In addition, during CY 2005, we implemented device edits for many services that require devices and for which appropriate device C-codes exist. Therefore, we expected that the number of claims that include device codes and their respective costs to be much more robust and representative for CY 2005 than for CY 2004. We believe that use of the most current claims data to establish offset amounts when they are needed to ensure appropriate payment is consistent with our stated policy; therefore, we are proposing to continue to do so for the CY 2007 OPPS. Specifically, if we create a new device category for payment in CY 2007, to calculate potential offsets we are proposing to examine the most current available claims data, including device costs, to determine whether device costs associated with the new category are already packaged into the existing APC structure, as indicated earlier. If we conclude that some related device costs are packaged into existing APCs, we are proposing to use the methodology described earlier and first used for the CY 2003 OPPS to determine an appropriate device offset percentage for those APCs with which the new category would be reported. We did not publish a list of APCs with device percentages as a transitional policy for CY 2006 because of the previously discussed limitations of the CY 2004 OPPS data with respect to device costs associated with procedures. We stated in the CY 2006 final rule with comment period (70 FR 68628) that we expected to reexamine our previous methodology for calculating the device percentages and offset amounts for the CY 2007 OPPS update, which would be based on CY 2005 hospital claims data where device C-code reporting is required. b. Proposed Policy for CY 2007 For CY 2007, we are proposing to continue to review each new device category on a case-by-case basis as we have done in CY 2004, CY 2005, and CY 2006, to determine whether device costs associated with the new category are packaged into the existing APC structure. If we determine that, for any new device category, no device costs associated with the new category are packaged into existing APCs, we are proposing to continue our current policy of setting the offset amount for the new category to $0 for CY 2007. There is currently one new device category that would continue for pass-through payment in CY 2007. This category, described by HCPCS code C1820, currently has an offset amount of $8,647.81, which is applied to APC 0222. We are proposing to update this offset for CY 2007 based on the full year of claims data for CY 2005, the claims data year for our CY 2007 rate update. We are proposing an offset amount for C1820 of 78.1 percent of the proposed CY 2007 payment rate for APC 0222 based on the CY 2005 data used to calculate the proposed payment amount in this proposed rule. (See Addendum A of this proposed rule for a listing of the proposed CY 2007 APC payment rates.) We are proposing to continue our existing policy to establish new 
                        ( print page 49580)
                        categories in any quarter when we determine that the criteria for granting pass-through status for a device category are met. If we create a new device category and determine that our data contain a sufficient number of claims with identifiable costs associated with the new category of devices in any APC, we are proposing to adjust the APC payment if the offset amount is greater than $0. If we determine that a device offset greater than $0 is appropriate for any new category that we create, we are proposing to announce the offset amount in the program transmittal that announces the new category. In summary, for CY 2007, we are proposing to use CY 2005 hospital claims data to calculate device percentages and potential offsets for CY 2007 applications for new device categories. We are proposing to publish, through program transmittals, any new or updated offsets that we calculate for CY 2007, corresponding to newly created categories or existing categories, respectively. V. Proposed OPPS Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals A. Proposed Transitional Pass-Through Payment for Additional Costs of Drugs and Biologicals (If you choose to comment on issues in this section, please include the caption “Pass-Through Drugs” at the beginning of your comment.) 1. Background Section 1833(t)(6) of the Act provides for temporary additional payments or “transitional pass-through payments” for certain drugs and biological agents. As originally enacted by the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act (BBRA) of 1999 (Pub. L. 106-113), this provision requires the Secretary to make additional payments to hospitals for current orphan drugs, as designated under section 526 of the Federal Food, Drug, and Cosmetic Act (Pub. L. 107-186); current drugs and biological agents and brachytherapy sources used for the treatment of cancer; and current radiopharmaceutical drugs and biological products. For those drugs and biological agents referred to as “current,” the transitional pass-through payment began on the first date the hospital OPPS was implemented (before enactment of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act BIPA of 2000 (Pub. L. 106-554), on December 21, 2000). Transitional pass-through payments are also required for certain “new” drugs and biological agents that were not being paid for as a hospital outpatient department service as of December 31, 1996, and whose cost is “not insignificant” in relation to the OPPS payments for the procedures or services associated with the new drug or biological. Under the statute, transitional pass-through payments can be made for at least 2 years but not more than 3 years. In Addenda A and B of this proposed rule, proposed CY 2007 pass-through drugs and biological agents are identified by status indicator “G.” The process to apply for transitional pass-through payment for eligible drugs and biological agents can be found on our CMS Web site: 
                        *http://www.cms.hhs.gov.*
                         If we revise the application instructions in any way, we will post the revisions on our Web site and submit the changes to the Office of Management and Budget (OMB) for approval, as required under the Paperwork Reduction Act (PRA). Notification of new drugs and biologicals application processes is generally posted on the OPPS Web site at: 
                        *http://www.cms.hhs.gov/​providers/​hopps.* 2. Expiration in CY 2006 of Pass-Through Status for Drugs and Biologicals Section 1833(t)(6)(C)(i) of the Act specifies that the duration of transitional pass-through payments for drugs and biologicals must be no less than 2 years and no longer than 3 years. The 12 drugs and biologicals listed in Table 23, whose pass-through status will expire on December 31, 2006, meet that criterion. For all drugs and biologicals with pass-through status expiring on December 31, 2006, that are currently assigned temporary C-codes, if there is a permanent HCPCS code available for CY 2007 that describes the product, then we are proposing to delete the C-code and use the permanent HCPCS code for purposes of OPPS billing and payment for the product in CY 2007. Based on our review of the existing permanent HCPCS codes available at the time of this proposed rule, we have determined that HCPCS code J7344 (Nonmetabolic active tissue) appropriately describes the product reported under HCPCS code C9221 in the CY 2006 OPPS; therefore, we propose to delete C9221 and pay for this product using J7344 in CY 2007. The coding changes for the other products will depend on what the final HCPCS codes are for CY 2007, which will be included in the CY 2007 OPPS final rule. We specifically request comments on this proposed policy for CY 2007. Table 23.—Proposed List of Drugs and Biologicals for Which Pass-Through Status Expires December 31, 2006
HCPCS
APC
Short descriptorC9220
9220
Sodium hyaluronate.C9221
9221
Graftjacket Reg Matrix.C9222
9222
Graftjacket Sft Tis.J0128
9216
Abarelix injection.J0878
9124
Daptomycin injection.J2357
9300
Omalizumab injection.J2783
0738
Rasburicase.J2794
9125
Risperidone, long acting.J7518
9219
Mycophenolic acid.J9035
9214
Bevacizumab injection.J9055
9215
Cetuximab injection.J9305
9213
Pemetrexed injection.
 3. Drugs and Biologicals With Proposed Pass-Through Status in CY 2007 We are proposing to continue pass-through status in CY 2007 for nine drugs and biologicals. These items, which are listed in Table 24 below, were given pass-through status as of April 1, 2006. The APCs and HCPCS codes for drugs and biologicals that we are proposing to continue with pass-through status in CY 2007 are assigned status indicator “G” in Addenda A and B of this proposed rule. Section 1833(t)(6)(D)(i) of the Act sets the payment rate for pass-through eligible drugs (assuming that no pro rata reduction in pass-through payment is necessary) as the amount determined under section 1842(o) of the Act. We note that this section of the Act also states that if a drug or biological is covered under a competitive acquisition contract under section 1847B of the Act, the payment rate is equal to the average price for the drug or biological for all competitive acquisition areas and the year established as calculated and adjusted by the Secretary. Section 1847A of the Act, as added by section 303(c) of Pub. L. 108-173, establishes the use of the average sales price (ASP) methodology as the basis for payment of drugs and biologicals described in section 1842(o)(1)(C) of the Act and furnished on or after January 1, 2005. This payment methodology is set forth in § 419.64 of the regulations. Section 1847B of the Act, as added by section 303(d) of Pub. L. 108-173, establishes the payment methodology for drugs and biologicals under the competitive acquisition program. The competitive acquisition program was implemented as of July 1, 2006. The list of drugs and biologicals covered under this program can be found on 
                        *http://www.cms.hhs.gov/​CompetitiveAcquisforBios,*
                         along with 
                        ( print page 49581)
                        their payment rates and information on the program's methodology. Section 1833(t)(6)(D)(i) of the Act sets the payment rate for pass-through eligible drugs as the amount determined under section 1842(o) of the Act, or if a drug or biological is covered under a competitive acquisition contract under section 1847B of the Act, the payment rate is equal to the average price for the drug or biological for all competitive acquisition areas and the year established as calculated and adjusted by the Secretary. For CY 2007, under the OPPS we are proposing payment for drugs and biologicals with pass-through status that will also be covered under the competitive acquisition program to be based on the competitive acquisition program methodology. Similar to the payment policy established for pass-through drugs and biologicals in CY 2006, we are proposing to pay under the OPPS for all other drugs and biologicals with pass-through status in CY 2007 consistent with the provisions of section 1842(o) of the Act, as amended by section 621 of Pub. L. 108-173, at a rate that is equivalent to the payment these drugs and biologicals would receive in the physician office setting. Table 24 lists the drugs and biologicals for which we are proposing that pass-through status continue in CY 2007. Of these nine drugs and biologicals, only HCPCS codes J2503 (Pegaptanib sodium injection) and J9264 (Paclitaxel injection) are covered under the competitive acquisition program at the time of the development of this proposed rule. Therefore, in CY 2007, we are proposing to set payment for HCPCS codes J2503 and J9264 at the amounts determined under the competitive acquisition program, which will be a rate slightly different than the rate determined under the ASP methodology. Payment for all other drugs and biologicals would be equivalent to the payment these drugs and biologicals would receive in the physician office setting in CY 2007, where payment will be determined by the methodology described in § 419.904 and generally be equal to ASP+6 percent. In accordance with the ASP methodology, in the absence of ASP data, we are continuing the policy we implemented during CYs 2005 and 2006 of using the wholesale acquisition cost (WAC) for the product to establish the initial payment rate. We note, however, that if the WAC is also unavailable, then we would make payment at 95 percent of the product's most recent AWP. We adopted this interim payment methodology in order to be consistent with how we pay for new drugs, biologicals, and radiopharmaceuticals without HCPCS codes, as discussed in the CY 2006 OPPS final rule with comment period (70 FR 68669). We further note that with respect to items for which we currently do not have ASP data, once their ASP data become available in later quarter submissions, their payment rates under OPPS will be adjusted so that the rates are based on the ASP methodology and set to ASP+6 percent. Currently, there are no radiopharmaceuticals that would have pass-through status in CY 2007. In the event that a new radiopharmaceutical agent receives pass-through status in CY 2007, we propose to base its payment on the WAC for the product as ASP data for radiopharmaceuticals are not available. We note, however, that if the WAC is also unavailable, then we would calculate payment for the radiopharmaceutical at 95 percent of its most recent AWP. We are proposing to adopt this interim payment methodology in order to be consistent with how we pay for new drugs, biologicals, and radiopharmaceuticals without HCPCS codes, as discussed in the CY 2006 OPPS final rule with comment period (70 FR 68669). Section 1833(t)(6)(D)(i) of the Act also sets the amount of additional payment for pass-through eligible drugs and biologicals (the pass-through payment amount). The pass-through payment amount is the difference between the amount authorized under section 1842(o) of the Act (or under section 1847B of the Act, if the drug or biological is covered under a competitive acquisition contract), and the portion of the otherwise applicable fee schedule amount (that is, the APC payment rate) that the Secretary determines is associated with the drug or biological. We discuss in section V.B.3.b. of the preamble that we are proposing to make separate payment in CY 2007 for new drugs and biologicals with a HCPCS code, consistent with the provisions of section 1842(o) of the Act at a rate that is equivalent to the payment they would receive in a physician office setting (or under section 1847B of the Act, if the drug or biological is covered under a competitive acquisition contract), whether or not we have received a pass-through application for the item. Accordingly, in CY 2007 the pass-through payment amount would equal zero for those new drugs and biologicals that we determine have pass-through status. That is, when we subtract the amount to be paid for pass-through drugs and biologicals under section 1842(o) of the Act (or section 1847B of the Act, if the drug or biological is covered under a competitive acquisition contract), from the portion of the otherwise applicable fee schedule amount or the APC payment rate associated with the drug or biological that would be the amount paid for drugs and biologicals under section 1842(o) of the Act (or section 1847B of the Act, if the drug or biological is covered under a competitive acquisition contract), the resulting difference is equal to zero. We are proposing to use payment rates based on the ASP data from the fourth quarter of CY 2005 for budget neutrality estimates, impact analyses, and to complete Addenda A and B of this proposed rule because these are the most recent data available to us at this time. These payment rates are also the basis for drug payments in the physician office setting effective April 1, 2006. To be consistent with the ASP-based payments that would be made when these drugs and biologicals are furnished in physician offices, we are proposing to make any appropriate adjustments to the amounts shown in Addenda A and B of this proposed rule when we publish our CY 2007 OPPS final rule and also on a quarterly basis on our Web site during CY 2007 if later quarter ASP submissions (or more recent WACs or AWPs) indicate that adjustments to the payment rates for these pass-through drugs and biologicals are necessary. The payment rate for a radiopharmaceutical with pass-through status would also be adjusted accordingly. We also are proposing to make appropriate adjustments to the payment rates for these drugs and biologicals in the event that they become covered under the competitive acquisition program in the future. For drugs and biologicals that are currently covered under the competitive acquisition program, we are proposing to use the payment rates calculated under this program that are in effect as of July 1, 2006. We are proposing to update these payment rates if the rates change in the future. Table 24 lists the drugs and biologicals for which we are proposing that pass-through status continue in CY 2007. We assigned pass-through status to these drugs and biologicals as of April 1, 2006. We also have included in Addenda A and B of this proposed rule, the proposed CY 2007 APC payment rates for all pass-through drugs and biologicals, based on ASP data from the fourth quarter of CY 2005 (or if applicable, payment rates calculated under the competitive acquisition program) as described above. 
                        ( print page 49582) Table 24.—Proposed List of Drugs and Biologicals With Pass-Through Status in CY 2007
HCPCS
APC
Short descriptorC9225
9225
Fluocinolone acetonide.C9227
9227
Injection, micafungin sodium.C9228
9228
Injection, tigecycline.J2278
1694
Ziconotide injection.J2503
1697
Pegaptanib sodium injection.J8501
0868
Oral aprepitant.J9027
1710
Clofarabine injection.J9264
1712
Paclitaxel injection.Q4079
9126
Natalizumab injection.
 B. Proposed Payment for Drugs, Biologicals, and Radiopharmaceuticals Without Pass-Through Status (If you choose to comment on issues in this section, please include the caption “OPPS: Nonpass-Through Drugs, Biologicals, and Radiopharmaceuticals” at the beginning of your comment.) 1. Background Under the CY 2006 OPPS, we currently pay for drugs, biologicals, and radiopharmaceuticals that do not have pass-through status in one of two ways: packaged payment within the payment for the associated service or separate payment (individual APCs). We explained in the April 7, 2000 OPPS final rule with comment period (65 FR 18450) that we generally package the cost of drugs and radiopharmaceuticals into the APC payment rate for the procedure or treatment with which the products are usually furnished. Hospitals do not receive separate payment from Medicare for packaged items and supplies, and hospitals may not bill beneficiaries separately for any packaged items and supplies whose costs are recognized and paid within the national OPPS payment rate for the associated procedure or service. (Program Memorandum Transmittal A-01-133, issued on November 20, 2001, explains in greater detail the rules regarding separate payment for packaged services.) Packaging costs into a single aggregate payment for a service, procedure, or episode of care is a fundamental principle that distinguishes a prospective payment system from a fee schedule. In general, packaging the costs of items and services into the payment for the primary procedure or service with which they are associated encourages hospital efficiencies and also enables hospitals to manage their resources with maximum flexibility. Notwithstanding our commitment to package as many costs as possible, we are aware that packaging payments for certain drugs, biologicals, and radiopharmaceuticals, especially those that are particularly expensive or rarely used, might result in insufficient payments to hospitals, which could adversely affect beneficiary access to medically necessary services. Section 1833(t)(16)(B) of the Act, as added by section 621(a)(2) of Pub. L. 108-173, requires that the threshold for establishing separate APCs for drugs and biologicals be set at $50 per administration for CYs 2005 and 2006. However, this requirement for establishing the packaging threshold will expire at the end of CY 2006. For CY 2006, we finalized our policy to continue paying separately for drugs, biologicals, and radiopharmaceuticals whose per day cost exceeds $50 and packaging the costs of drugs, biologicals, and radiopharmaceuticals whose per day cost is less than $50 into the procedures with which they are billed. For CY 2006, we also continued an exception policy to our packaging rule for one particular class of drugs, the oral and injectable 5HT3 forms of anti-emetic treatments (70 FR 68635 through 68638). 2. Proposed Criteria for Packaging Payment for Drugs, Biologicals, and Radiopharmaceuticals During the March 2006 meeting of the APC Panel, the Panel recommended that CMS maintain the $50 packaging threshold or if the threshold is reevaluated, that CMS provide the Panel with data that indicate the costs of packaged drugs that are incorporated into drug administration payment rates. As indicated above, in accordance with section 1833(t)(16)(B) of the Act, the threshold for establishing separate APCs for drugs and biologicals was set to $50 per administration during CYs 2005 and 2006. Because this packaging threshold will expire at the end of CY 2006, we evaluated four options for packaging levels so that we could determine what the appropriate packaging threshold proposal for drugs, biologicals, and radiopharmaceuticals would be for the CY 2007 OPPS update. One of the packaging options we considered for the CY 2007 OPPS update was to pay separately for all drugs, biologicals, and radiopharmaceuticals with a HCPCS code. This would be a straightforward policy that would speed the creation of procedural APC medians. However, this policy would be inconsistent with OPPS packaging principles, reduce hospitals' incentives for economy and efficiency, and increase hospitals' administrative burden related to separate billing for more drugs, biologicals, and radiopharmaceuticals. The second option we considered for CY 2007 was to increase the packaging threshold to a level much higher than the current $50 threshold. This option would result in the packaging of more drugs, biologicals, and radiopharmaceuticals and would be more consistent with OPPS packaging principles. This option would also provide greater administrative simplicity for hospitals. However, implementation of this option might result, in some cases, in the drug administration payments being less than the cost of the packaged drugs. Relatively expensive drugs, biologicals, and radiopharmaceuticals could also be packaged under this option. The third packaging threshold option we evaluated was to maintain the packaging threshold at $50. We believe that this is a reasonable policy option that would provide stability to the payment system, as the packaging threshold has been set at $50 since CY 2004. This policy option would also be consistent with the APC Panel recommendation to maintain the packaging threshold at $50 in CY 2007; however, this policy would not take into account price inflation in determining the drug packaging threshold since the $50 threshold was initially established. Consequently, the fourth option we considered and are proposing for CY 2007 and subsequent years is to update the packaging threshold for inflation using an inflation adjustment factor based on the Producer Price Index (PPI) for prescription preparations. In order to update the packaging threshold for CY 2007 under this proposal, we used the four quarter moving average PPI levels for prescription preparations to trend the $50 threshold forward from the third quarter of CY 2005 (when the Pub. L. 108-173-mandated threshold became effective) to the third quarter of CY 2007. We are proposing that for each year beginning with CY 2007, we would adjust the packaging threshold by the PPI for prescription drugs, and the adjusted dollar amount would be rounded to the nearest $5 increment in order to determine the new threshold. The adjusted amount for CY 2007 was calculated to be $55.99, which we are rounding to $55. Therefore, for CY 2007, we are proposing to pay separately for drugs, biologicals, and radiopharmaceuticals whose per day cost exceeds $55 and packaging the costs of drugs, biologicals, and radiopharmaceuticals whose per day cost is less than or equal to $55 into the procedures with which they are billed. 
                        ( print page 49583) This proposed policy is consistent with the principle employed in many health care payment policy areas (and many other areas of government policy) of acknowledging the real costs by using an inflation adjustment instead of static dollar values. We believe that our proposed policy is consistent with the APC Panel's recommendation because we would be maintaining the $50 threshold in terms of its real value during the calendar year in which it would be in effect. Also, in the absence of a mechanism to update the threshold, we believe that current relatively inexpensive drugs would begin to receive separate payment over time. The PPI for prescription preparations reflects price changes at the wholesale or manufacturer stage. Because OPPS payment rates for drugs and biologicals are generally based on average sales price (ASP) data that are reported by their manufacturers, we believe that the PPI for prescription preparations would be an appropriate price index to use to update the packaging threshold for CY 2007 and beyond. For CY 2007, we are also proposing to continue our policy of exempting the oral and injectable 5HT3 anti-emetic products from our packaging rule (Table 25), thereby making separate payment for all of the 5HT3 anti-emetic products. As stated in the CY 2005 OPPS final rule with comment period (69 FR 65779 through 65780), chemotherapy is very difficult for many patients to tolerate, as the side effects are often debilitating. In order for Medicare beneficiaries to achieve the maximum therapeutic benefit from chemotherapy and other therapies with side effects of nausea and vomiting, anti-emetic use is often an integral part of the treatment regimen. We believe that we should continue to ensure that Medicare payment rules do not impede a beneficiary's access to the particular anti-emetic that is most effective for him or her as determined by the beneficiary and his or her physician. We solicit comments on these packaging proposals. Table 25.—Proposed Anti-Emetics To Exempt From Proposed $55 Packaging Requirement
HCPCS code
Short descriptionJ1260
Dolasetron mesylate.J1626
Granisetron HCl injection.J2405
Ondansetron HCl injection.J2469
Palonosetron HCl.Q0166
Granisetron HCl 1 mg oral.Q0179
Ondansetron HCl 8 mg oral.Q0180
Dolasetron mesylate oral.
 To determine their CY 2007 proposed packaging status, we calculated the per day cost of all drugs, biologicals, and radiopharmaceuticals that had a HCPCS code in CY 2005 and were paid (via packaged or separate payment) under the OPPS using claims data from January 1, 2005, to December 31, 2005. In CY 2005, multisource drugs and radiopharmaceuticals had two HCPCS codes that distinguished the innovator multisource (brand) drug or radiopharmaceutical from the noninnovator multisource (generic) drug or radiopharmaceutical. We aggregated claims for both the brand and generic HCPCS codes in our packaging analysis of these multisource products. In order to calculate the per day cost for drugs, biologicals, and radiopharmaceuticals to determine their packaging status in CY 2007, we are proposing to use the methodology that was described in detail in the CY 2006 OPPS proposed rule (70 FR 42723 through 42724) and finalized in the CY 2006 OPPS final rule with comment period (70 FR 68636 through 68638). However, in our calculation of per day costs for this proposed rule for the CY 2007 OPPS update, we used the payment rate for each drug and biological at its ASP+5 percent which was based on manufacturer-submitted ASP data from the fourth quarter of CY 2005. The ASP data from this period were also the basis for determining payments for drugs and biologicals in the physician office setting, effective April 1, 2006. The rationale for using ASP+5 percent as the payment for drugs and biologicals is described in section V.B.3.a.2. of this preamble. For items that did not have an ASP-based payment rate, we used their mean unit cost derived from the CY 2005 hospital claims data to determine their per day cost. We packaged the items with per day cost less than or equal to $55 and made items with per day cost greater than $55 separately payable. We are requesting comments on the methodology we are proposing to use to determine the per day cost of drugs, biologicals, and radiopharmaceuticals under the CY 2007 OPPS update. Our policy during previous cycles of the OPPS has been to use updated data for the final rules. For the CY 2007 OPPS final rule, we are proposing to use the ASP data from the first quarter of CY 2006, which would be the basis for calculating payment rates for drugs and biologicals in the physician office setting using the ASP methodology effective July 1, 2006, along with updated hospital claims data from CY 2005 to determine the final per day costs of drugs, biologicals, and radiopharmaceuticals and their packaging status in CY 2007. Subsequently, payment rates for CY 2007 separately payable drugs and biologicals will be updated to reflect applicable ASP-based rates effective in the physician office setting for services effective January 1, 2007. Because, for the CY 2007 OPPS final rule, we are proposing to use ASP data from the first quarter of CY 2006, which would be the basis for calculating payment rates for drugs and biologicals in the physician office setting using the ASP methodology, effective July 1, 2006, along with updated hospital claims data from CY 2005 to determine the final per day costs of drugs, biologicals, and radiopharmaceuticals, the packaging status of these items using the updated data may be different from their packaging status determined based on the data we are using for this proposed rule. Under such circumstances, we are proposing to apply the following policies to these drugs, biologicals, and radiopharmaceuticals whose relationship to the $55 threshold changes based on the final updated data: Drugs, biologicals, and radiopharmaceuticals that were paid separately in CY 2006 (which are proposed for separate payment in CY 2007), and then have per day costs less than $55 based on the updated ASPs and hospital claims data that would be used for the CY 2007 final rule with comment period, would continue to receive separate payment in CY 2007.
                    Drugs, biologicals, and radiopharmaceuticals that were packaged in CY 2006, (which are proposed for separate payment in CY 2007), and then have per day costs less than $55 based on the updated ASPs and hospital claims data that would be used for the CY 2007 final rule with comment period, would remain packaged in CY 2007.
                    Drugs, biologicals, and radiopharmaceuticals for which we propose packaged payment in CY 2007 but then have per day costs greater than $55 based on the updated ASPs and hospital claims data that would be used for the CY 2007 final rule with comment period, would receive separate payment in CY 2007. We are requesting specific comments on these proposed policies for CY 2007. 
                        ( print page 49584) 3. Proposed Payment for Drugs, Biologicals, and Radiopharmaceuticals Without Pass-Through Status That Are Not Packaged a. Proposed Payment for Specified Covered Outpatient Drugs (1) Background Section 1833(t)(14) of the Act, as added by section 621(a)(1) of Public Law 108-173, requires special classification of certain separately paid radiopharmaceuticals, drugs, and biologicals and mandates specific payments for these items. Under section 1833(t)(14)(B)(i) of the Act, a “specified covered outpatient drug” is a covered outpatient drug, as defined in section 1927(k)(2) of the Act, for which a separate APC exists and that either is a radiopharmaceutical agent or is a drug or biological for which payment was made on a pass-through basis on or before December 31, 2002. Under section 1833(t)(14)(B)(ii) of the Act, certain drugs and biologicals are designated as exceptions and are not included in the definition of “specified covered outpatient drugs.” These exceptions are— A drug or biological for which payment is first made on or after January 1, 2003, under the transitional pass-through payment provision in section 1833(t)(6) of the Act.
                    A drug or biological for which a temporary HCPCS code has not been assigned.
                    During CYs 2004 and 2005, an orphan drug (as designated by the Secretary). Section 1833(t)(14)(A)(iii) of the Act, as added by section 621(a)(1) of Pub. L. 108 173, requires that payment for specified covered outpatient drugs in CY 2006 and subsequent years be equal to the average acquisition cost for the drug for that year as determined by the Secretary subject to any adjustment for overhead costs and taking into account the hospital acquisition cost survey data collected by the Government Accountability Office (GAO) in CYs 2004 and 2005. If hospital acquisition cost data are not available, the law requires that payment be equal to payment rates established under the methodology described in section 1842(o), section 1847A, or section 1847B of the Act as calculated and adjusted by the Secretary as necessary. For CY 2006, we adopted a policy of paying for the acquisition and overhead costs of separately paid drugs and biologicals at a combined rate of ASP+6 percent. To calculate the ASP+6 percent payment rate, we evaluated the three data sources that were available to us for setting the CY 2006 payment rates for drugs and biologicals. As described in the CY 2006 OPPS final rule with comment period (70 FR 68639 through 68644), these data sources were the GAO reported average purchase prices for 55 specified covered outpatient drug categories for the period July 1, 2003 to June 30, 2004 collected via a survey of 1,400 acute care Medicare-certified hospitals; ASP data; and mean costs derived from CY 2004 hospital claims data used in developing the CY 2006 final rule with comment period. For the CY 2006 final rule with comment period, we used ASP data from the second quarter of CY 2005, which were used to set payment rates for drugs and biologicals in the physician office setting effective October 1, 2005. We also used updated claims data, reflecting all of the hospital claims data from CY 2004 and updated CCRs. In our data analysis for the CY 2006 OPPS final rule with comment period, we compared the payment rates for drugs and biologicals using data from all three sources described above. We estimated aggregate expenditures for all drugs and biologicals (excluding radiopharmaceuticals) that would be separately payable in CY 2006 and for the 55 drugs and biologicals reported by the GAO using mean costs from the claims data, the GAO mean purchase prices, and the ASP-based payment amounts (ASP+6 percent in most cases), and then calculated the equivalent average ASP-based payment rate under each of the three payment methodologies. The results based on updated ASP and claims data were published in Table 24 of the CY 2006 OPPS final rule with comment period. For a full discussion of our reasons for using these data, refer to section V.B.3.a. of the CY 2006 OPPS final rule with comment period (70 FR 68639 through 68644). As noted in the CY 2006 OPPS final rule with comment period, findings from a MedPAC survey of hospital charging practices indicated that hospitals set charges for drugs, biologicals, and radiopharmaceuticals high enough to reflect their pharmacy handling costs as well as their acquisition costs. Therefore, we believe the MedPAC survey indicated that payment for drugs and biologicals and pharmacy overhead at a combined ASP+6 percent rate would serve as the best proxy for the combined acquisition and overhead costs of each of these products. (2) Proposed Payment Policy for CY 2007 The provision in section 1833(t)(14)(A)(iii) of the Act, as described above, continues to be applicable to determining payments for specified covered outpatient drugs for CY 2007. Similar to CY 2006, this provision requires that in CY 2007 payment for specified covered outpatient drugs be equal to the average acquisition cost for the drug for that year as determined by the Secretary subject to any adjustment for overhead costs and taking into account the hospital acquisition cost survey data collected by the Government Accountability Office (GAO) in CYs 2004 and 2005. If hospital acquisition cost data are not available, the law requires that payment be equal to payment rates established under the methodology described in section 1842(o), section 1847A, or section 1847B of the Act as calculated and adjusted by the Secretary as necessary. Additionally, section 1833(t)(14)(E)(ii) authorizes the Secretary to adjust APC weights for specified covered outpatient drugs to take into account the MedPAC report relating to overhead and related expenses, such as pharmacy services and handling costs. For the CY 2007 proposed rule, we evaluated two data sources that we have available to us for setting the CY 2007 payment rates for drugs and biologicals. The first source of drug pricing information that we have is the ASP data from the fourth quarter of CY 2005, which were used to set payment rates for drugs and biologicals in the physician office setting effective April 1, 2006. We have ASP-based prices for approximately 500 drugs and biologicals (including contrast agents) payable under the OPPS; however, we currently do not have any ASP data on radiopharmaceuticals. Payments for most of the drugs and biologicals paid in the physician office setting are based on ASP+6 percent, and payments for items with no reported ASP are based on wholesale acquisition cost (WAC). The second source of cost data that we have for drugs, biologicals, and radiopharmaceuticals are the mean and median costs derived from the CY 2005 hospital claims data. As section 1833(t)(14)(A)(iii) of the Act clearly specifies that payment for specified covered outpatient drugs in CY 2007 be equal to the “average” acquisition cost for the drug, we limited our analysis to the mean costs of drugs determined using the hospital claims data, instead of using median costs. 
                        ( print page 49585) In our data analysis, we compared the payment rates for drugs and biologicals using data from both sources described above. We estimated aggregate expenditures for all drugs and biologicals (excluding radiopharmaceuticals) that would be separately payable in CY 2007 using mean costs from the hospital claims data and the ASP-based payment amounts (ASP+6 percent in most cases), and calculated the equivalent average ASP-based payment rate under both payment methodologies. The results of our data analysis indicate that using mean unit cost to set the payment rates for the drugs and biologicals that would be separately payable in CY 2007 would be equivalent to basing their payment rates, on average, at ASP+5 percent. As noted in the CY 2006 proposed and final rules, findings from a MedPAC survey of hospital charging practices indicated that hospitals set charges for drugs, biologicals, and radiopharmaceuticals high enough to reflect their pharmacy handling costs as well as their acquisition costs. Therefore, the mean costs calculated using charges from hospital claims data converted to costs are representative of hospital acquisition costs for these products, as well as their related pharmacy overhead costs. Our calculations indicate that using mean unit costs to set the payment rates for all separately payable drugs and biologicals would be equivalent to basing their payment rates on the ASP+5 percent, on average. Because pharmacy overhead costs are already built into the charges for drugs, biologicals, and radiopharmaceuticals, our current data therefore indicate that payment for drugs and biologicals and pharmacy overhead at a combined ASP+5 percent rate would serve as the best proxy for the combined acquisition and overhead costs of each of these products. Therefore, for CY 2007, we are proposing a policy of paying for the acquisition and overhead costs of separately paid drugs and biologicals at a combined rate of ASP+5 percent. In its final report on the hospital acquisition cost survey of specified covered outpatient drugs titled “Medicare Hospital Pharmaceuticals: Survey Shows Price Variation and Highlights Data Collection Lessons and Outpatient Rate-setting Challenges for CMS”, the GAO recommended that Secretary validate, on an occasional basis, manufacturers' reported drug ASPs as a measure of hospitals' acquisition costs using a survey of hospitals or other method that CMS determines to be similarly accurate and efficient. As we indicated in our written comments to the GAO on its draft report, we will continue to consider the best approach for setting payment rates for drugs and biologicals in light of this recommendation. We also indicated that we will continue to analyze the adequacy of ASP-based pricing in light of our hospital claims data, which for this CY 2007 OPPS proposed rule indicates that ASP+5 percent would be the best available proxy for hospitals' average acquisition and handling costs of drugs and biologicals in CY 2007. We note that ASP data are unavailable for some drugs and biologicals. For these few drugs and biologicals, we are proposing to use the mean costs from the CY 2005 hospital claims data to determine their packaging status for ratesetting. Until we receive ASP data for these items, payment will be based on their mean cost calculated from CY 2005 hospital claims data. The payment rates for separately payable drugs and biologicals shown in Addenda A and B to this proposed rule represent payments for their acquisition and overhead costs. Our proposal uses payment rates based on ASP data from the fourth quarter of 2005 because these are the most recent numbers available to us at this time. To be consistent with the ASP data that would be used to determine payments for these drugs and biologicals when furnished in physician offices, we propose to make any appropriate adjustments to the amounts shown in Addenda A and B to this proposed rule for those items on a quarterly basis as more recent ASP data become available and post the payment rate changes on our Web site during each quarter of CY 2007. We note that we would determine the packaging status of each drug or biological only once during the year during the update process; however, for the separately payable drugs and biologicals, we would update their ASP-based payment rates on a quarterly basis. During the March 2006 meeting of the APC Panel, the Panel recommended that CMS examine pharmacy overhead costs issues and work with appropriate associations to study how to measure pharmacy overhead costs. The Panel also recommended that CMS solicit feedback on how pharmacy overhead costs should be reimbursed in the future. In response to the APC Panel recommendations, we will continue to work on issues related to pharmacy overhead costs and request comments on other proposals that we can consider when establishing a future pharmacy overhead cost methodology. In addition, we note that we routinely accept requests from interested organizations to discuss their views about OPPS payment policy issues. We will consider the input of any individual or organization to the extent allowed by Federal law, including the Administrative Procedure Act (APA) and the Federal Advisory Committee Act (FACA). We establish the OPPS rates through regulations. We are required to consider the timely comments of interested organizations, establish the payment policies for the forthcoming year, and respond to the timely comments of all public commenters in the final rule in which we establish the payments for the forthcoming year. We are specifically requesting public comments on our proposal to pay for acquisition and overhead costs of drugs and biologicals under the OPPS at ASP+5 percent and the adequacy of the payment rates to account for actual acquisition and overhead costs incurred by hospitals for these items. In its October 31, 2005 letter of comment on proposed 2006 SCOD rates titled “Comments on Proposed 2006 SCOD Rates,” the GAO recommended that to better approximate hospitals' acquisition costs of SCODs the Secretary reconsider the level of proposed payment rates for drug SCODs, in relation to survey data on average purchase price, the role of rebates in determining acquisition costs, and the desirability of setting payment rates for SCODs at average acquisition costs. In the CY 2006 OPPS proposed rule (70 FR 42726), we noted that the comparison between the GAO purchase price data and the ASP data indicated that the GAO data on average were equivalent to ASP+3 percent. However, we also indicated that using mean unit cost from the CY 2004 hospital claims data to set the payment rates for the drugs and biologicals that would be separately payable in CY 2006 would be equivalent to basing their payment rates, on average, at ASP+8 percent. Therefore, we had proposed to establish payment for drugs and biologicals and their overhead costs at a combined rate of ASP+8 percent, where ASP+6 percent represented the acquisition cost of these items and 2 percent of ASP was for their overhead costs. For the CY 2006 OPPS final rule with comment period, where more recent ASP data, updated CCRs, and updated CY 2004 hospital claims data were available, we found that the comparison between the GAO purchase price data and the ASP data indicated that the GAO data on average were equivalent to ASP+4 percent, and using mean unit cost from hospital claims to set the payment rates for the drugs and 
                        ( print page 49586)
                        biologicals that would be separately payable in CY 2006 would be equivalent to basing their payment rates, on average, at ASP+6 percent. Because pharmacy overhead costs are already built into the charges for drugs, biologicals, and radiopharmaceuticals, we noted in the CY 2006 OPPS final rule with comment period that our claims data indicated that payment for drugs and biologicals and their pharmacy overhead at a combined ASP+6 percent rate served as the best proxy for the combined acquisition and overhead costs of each of these products. For the CY 2007 proposed rule, as indicated earlier in the preamble, we compared the CY 2005 hospital claims data with more recent ASP data and determined that using mean unit cost to set payment rates for separately payable drugs and biologicals in CY 2007 would be equivalent to basing their payment rates, on average, at ASP+5 percent. This is the policy we are proposing for CY 2007, and we believe that this payment level would serve as the best proxy for the combined acquisition and overhead costs of separately payable drugs and biologicals in CY 2007. In the CY 2006 OPPS final rule with comment period (70 FR 68661), we indicated that we will be paying for blood clotting factors at ASP+6 percent during CY 2006 under the OPPS and providing payment for the furnishing fee that is also a part of the payment for blood clotting factors furnished in physician offices under Medicare Part B. This furnishing fee will be updated each calendar year based on the consumer price index, and we will update the amount appropriately each year under the OPPS based upon the final amount noted in the Medicare Physician Fee Schedule final rule. In CY 2006, the furnishing fee is $0.146 per unit. For the CY 2007 OPPS, we are proposing to make payment for blood clotting factors at ASP+5 percent along with continuing payment for the furnishing fee using the updated amount for CY 2007. The proposed CY 2007 regulations establishing the ASP methodology and the furnishing fee for blood clotting factors under Medicare Part B can be found in the CY 2007 Medicare Physician Fee Schedule proposed rule. The updated furnishing fee amount for CY 2007 under the OPPS will be announced in the CY 2007 OPPS final rule. (3) CY 2007 Proposed Payment Policy for Radiopharmaceuticals Section 303(h) of Pub. L. 108-173 exempted radiopharmaceuticals from ASP pricing in the physician office setting where the fewer numbers (relative to the hospital outpatient setting) of radiopharmaceuticals are priced locally by Medicare contractors. Consequently, we do not have ASP data for radiopharmaceuticals. However, the law also requires us to make payments for specified covered outpatient drugs, including radiopharmaceuticals, equal to the average acquisition cost for the drug as determined by the Secretary and subject to any adjustment for overhead costs. We expect hospitals' different purchasing and preparation and handling practices for radiopharmaceuticals to be reflected in their charges. Therefore, for CY 2006, we calculated per day costs of radiopharmaceuticals using mean unit costs from the CY 2004 hospital claims data to determine the items' packaging status similar to the drugs and biologicals with no ASP data. For CY 2006, we implemented a 1-year temporary policy to pay for separately payable radiopharmaceuticals based on the hospital's charge for each radiopharmaceutical adjusted to cost. We clearly stated in our CY 2006 OPPS final rule with comment period that we did not intend to maintain the CY 2006 methodology permanently (70 FR 68656) and that we would actively seek other methodologies for setting payments for radiopharmaceuticals in CY 2007. During the March 2006 meeting of the APC Panel, the Panel recommended that CMS work with stakeholders to continue to develop a methodology to pay for radiopharmaceuticals. We note that we routinely accept requests from interested organizations to discuss their views about OPPS payment policy issues. We will consider the input of any individual or organization to the extent allowed by Federal law, including the Administrative Procedure Act (APA) and the Federal Advisory Committee Act (FACA). We establish OPPS rates through regulations. We are required to consider the timely comments of interested organizations, establish the payment policies for the forthcoming year, and respond to the timely comments of all public commenters in the final rule in which we establish the payments for the forthcoming year. We have considered comments and information from interested organizations in developing these policy options for CY 2007. Over this past year, despite reviews of the literature and numerous discussions with interested individuals and organizations from the radiopharmaceutical industry, we have received no specific suggestions from hospitals or industry regarding alternative prospective payment methodologies for radiopharmaceuticals that could be used in place of our CY 2006 cost-based payment methodology. However, in its final report on the hospital acquisition cost survey of specified covered outpatient drugs, titled “ Medicare Hospital Pharmaceuticals: Survey Shows Price Variations and Highlights Data Collection Lesson and Outpatient Rate-setting Challenges for CMS,” the GAO acknowledged that the distinctive nature of radiopharmaceuticals as compared with other drugs poses special challenges for collecting and interpreting hospital cost data. They discussed the challenges of balancing accuracy and efficiency in obtaining price data on radiopharmaceutical specified covered outpatient drugs. They concluded that the best option available to CMS, in terms of accuracy and efficiency, is for the Secretary to collect and use ready-to-use unit-dose prices paid by hospitals when available as the data source for setting and updating Medicare payment rates for radiopharmaceutical specified covered outpatient drugs. As we indicated in our written comments to the GAO on its draft report, we remain uncertain about whether a survey to collect unit-dose acquisition costs would be conducted as a survey of hospitals or manufacturers. We are also concerned about the level of expense and administrative burden that would be placed on the party reporting such information, based on the GAO's experience in surveying hospitals regarding radiopharmaceutical acquisition costs. The survey approach could lead to a very inefficient methodology for establishing payment rates. We also note that in conducting a survey to obtain ready-to-use unit-dose prices for radiopharmaceuticals, we would be able to collect this information for only a small number of radiopharmaceuticals that are purchased in unit-dose forms by hospitals; however, we believe that it is important to apply a consistent payment methodology to determine payments for all separately payable radiopharmaceuticals. Even though we are not proposing to adopt the GAO's recommendation for CY 2007, we will continue to explore this recommendation for future updates of the OPPS. In developing the payment policy proposal for separately payable radiopharmaceuticals for the CY 2007 proposed rule, we considered several additional policy options. The first option we considered proposing was to package additional 
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                        radiopharmaceuticals, either through packaging payments for all radiopharmaceuticals with payments for the services with which they are billed or increasing the packaging threshold for radiopharmaceuticals from a cost of $55 per day to a higher amount. In contrast to other separately payable drugs where the administration of many drugs is reported with only a few drug administration HCPCS codes, only a small number of specific radiopharmaceuticals may be appropriately provided in the performance of each particular nuclear medicine procedure. Because the provision of nuclear medicine procedures always requires one or more radiopharmaceuticals, packaging more radiopharmaceuticals effectively results in some increases in the costs of the associated nuclear medicine procedures to reflect the greater packaging of the radiopharmaceuticals. The specific increased procedural costs observed are dependent upon the volumes and costs of various radiopharmaceuticals used in the procedures and thus reflect an average cost across clinical scenarios where providers may choose among several radiopharmaceuticals for the procedures. A policy to package additional radiopharmaceuticals would be very consistent with OPPS packaging principles and payment policies which generally provide appropriate payment for the average service and would provide greater administrative simplicity for hospitals. Because we believe that radiopharmaceutical handling costs are included in hospitals charges for the radiopharmaceuticals themselves, payments for the nuclear medicine procedures would include payments for the handling costs of the radiopharmaceuticals used under this option. In examining our claims data for CY 2005, we noted that significant numbers of claims for nuclear medicine procedures included no HCPCS codes for radiopharmaceuticals. While it is possible that hospitals used packaged radiopharmaceuticals in some studies and therefore chose not to report them separately, it is also possible that some hospitals may have included charges for the required radiopharmaceuticals in their charges for the nuclear medicine procedures themselves. Packaging additional radiopharmaceuticals would be consistent with the charging practices of some hospitals that already may not be separately reporting radiopharmaceuticals, even when those radiopharmaceuticals would receive separate payment under the OPPS. Were we to package additional radiopharmaceuticals under the OPPS, consistent with our packaging policies for implantable devices, we might need to establish edits to ensure that radiopharmaceutical charges were always included on claims for nuclear medicine procedures, as has been suggested to us by interested organizations. However, under a policy of increased packaging of radiopharmaceuticals, payments for certain nuclear medicine procedures could potentially be less than the costs of some of the packaged radiopharmaceuticals and relatively expensive and high volume radiopharmaceuticals could become packaged. In addition, our payment policy could discourage selection of the most clinically appropriate radiopharmaceutical for a particular nuclear medicine procedure, especially if that radiopharmaceutical were expensive and not commonly used so that its costs were not fully reflected in the payment for the nuclear medicine procedure. In addition, the statutory definition of a “specified covered outpatient drug” for OPPS purposes that includes radiopharmaceutical agents appears more consistent with the treatment of radiopharmaceuticals like other drugs under the OPPS, at least when this is feasible. We solicit public comment on the merits of establishing a higher packaging threshold for radiopharmaceuticals, given their unique characteristics. The second option that we considered proposing was to continue the temporary CY 2006 methodology of paying for separately payable radiopharmaceuticals at charges reduced to cost, where payment would be determined using each hospital's overall CCR, and establishing our radiopharmaceutical packaging threshold at $55, as we are proposing for other drugs under the CY 2007 OPPS. This policy would provide stability to the payment methodology for radiopharmaceuticals from CY 2006 to CY 2007. As we indicated for CY 2007, this payment methodology provides an acceptable proxy for the average acquisition of the radiopharmaceutical along with its handling cost. However, as also indicated previously, we stated in the CY 2006 OPPS final rule with comment period that this payment policy was intended to be only a temporary policy, and that we would consider alternative methodologies to base radiopharmaceutical payments on for the CY 2007 OPPS update. We generally do not make payments under the OPPS for items and services at cost, particularly if we do not expect the costs of services to vary substantially and unpredictably over time and if we have hospital claims data available. Paying for radiopharmaceuticals at cost provides hospitals with no incentive to supply radiopharmaceuticals in the most efficient manner. In its comments on the CY 2006 OPPS proposed rule, the GAO expressed concern that this methodology would be likely to result in payments that exceed hospitals' acquisition costs for certain radiopharmaceuticals. Estimates of our CY 2006 payments for radiopharmaceuticals reveal variation from the 25th to 75th payment percentile of 2 to 9 fold, depending on the specific radiopharmaceutical. We do not believe that the radiopharmaceutical acquisition and handling costs for different hospitals to provide most radiopharmaceuticals should vary that greatly. In addition, using hospitals' overall CCRs to determine payments likely results in an overstatement of radiopharmaceutical costs, which are likely reported in several cost centers such as diagnostic radiology that have lower CCRs than hospitals' overall CCRs. The third option that we considered and are proposing for CY 2007 is to establish prospective payment rates for separately payable radiopharmaceuticals using mean costs derived from the CY 2005 claims data, where the costs are determined using our standard methodology of applying hospital-specific departmental CCRs to radiopharmaceutical charges, defaulting to hospital-specific overall CCRs only if appropriate departmental CCRs are unavailable. This proposal establishes our packaging threshold for radiopharmaceuticals at $55, as for other drugs under the CY 2007 OPPS. We believe this option provides us with the most consistent, accurate, and efficient methodology for prospectively establishing payment rates for separately payable radiopharmaceuticals. This is our preferred payment proposal for radiopharmaceuticals because this methodology is consistent with how payment rates for other services are determined under the OPPS and provides for prospective payments that serve as appropriate proxies for the average acquisition costs of the radiopharmaceuticals along with their handling costs. The MedPAC has indicated that hospitals currently include the charge for radiopharmaceutical handling in their charge for the radiopharmaceutical. In addition, this approach provides an average payment to hospitals, consistent 
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                        with the statutory requirement that we pay the average acquisition cost, in comparison with our CY 2006 cost-based policy which paid each hospital differently for each claim based on the claim's charges and the hospital's overall CCR. We believe that this methodology would likely pay more accurately for radiopharmaceuticals, and provide incentives for their efficient acquisition and preparation. Also, as discussed earlier, MedPAC indicated that hospitals include charges for handling costs in their charge for radiopharmaceuticals; therefore, mean costs based on our claims data would represent both the acquisition and overhead costs of the separately payable radiopharmaceuticals. We believe that this payment policy could also be an appropriate long-term radiopharmaceutical payment policy that would allow us to consistently establish prospective OPPS payment rates for the acquisition and overhead costs of separately payable radiopharmaceuticals. Because we will be paying separately for radiopharmaceuticals with mean costs per day greater than $55, without additional radiopharmaceutical packaging for CY 2007, we see no reason to establish edits for the presence of radiopharmaceutical codes on claims for nuclear medicine procedures as, in many cases, payments for the procedures do not include payments for the radiopharmaceuticals used. Under each of the payment options for radiopharmaceuticals, we considered that beginning with CY 2007 and going forward we would update the packaging threshold for inflation using an inflation adjustment factor based on the Producer Price Index (PPI) for prescription preparations. As discussed elsewhere in the preamble, the adjusted amount for CY 2007 was determined to be $55. In its October 31, 2005 letter of comment on proposed 2006 SCOD rates titled “Comments on Proposed 2006 SCOD Rates”, the GAO recommended that to better approximate hospitals' acquisition costs of SCODs that the Secretary reconsider the decision to base payment rates for radiopharmaceutical SCODs exclusively on estimated costs in light of the availability of data on actual prices paid for key radiopharmaceuticals. As we did not have ASPs for radiopharmaceuticals that best represent market prices, in the CY 2006 OPPS final rule with comment period, we finalized a temporary 1-year policy for CY 2006 to pay for radiopharmaceuticals that were separately payable in CY 2006 based on the hospital's charge for each radiopharmaceutical agent adjusted to cost. We noted that MedPAC has indicated that hospitals currently include the charge for pharmacy overhead costs in their charge for the radiopharmaceutical. Therefore, we believed that paying for these items on the basis of charges converted to cost would be the best available proxy for the average acquisition cost of the radiopharmaceutical along with its handling cost in CY 2006. We did not use the GAO hospital purchase prices as the basis for setting payments because when we examined differences between the CY 2005 payment rates for these nine radiopharmaceuticals and their GAO mean purchase prices, we found that the GAO purchase prices were substantially lower for several of these agents. We indicated that our intent was to maintain consistency, whenever possible, between the payment rates for these agents from CY 2005 to CY 2006. For CY 2007, however, we considered several payment options for radiopharmaceuticals that we discussed above and are proposing to establish prospective payment rates for separately payable radiopharmaceuticals using mean costs derived from the CY 2005 claims data. We note that the National HCPCS Panel changed the codes and the descriptors of many of the radiopharmaceutical products effective January 1, 2006, in some cases moving from prior code descriptors based upon units of radioactivity to new descriptors based on study doses. The hospital claims data we used for our analysis are based on radiopharmaceutical HCPCS codes that were in effect during CY 2005. Because there were significant changes in HCPCS code descriptors for several radiopharmaceuticals from CY 2005 to CY 2006, implementation of the proposed payment methodology for radiopharmaceuticals requires us to crosswalk the cost data for these radiopharmaceuticals that are in terms of the CY 2005 codes to the updated CY 2006 codes that we expect to be in effect during CY 2007. The mean cost data per unit of many CY 2005 codes can be directly crosswalked to the new CY 2006 codes because the products and units included in the code descriptors are essentially the same. However, there are several CY 2005 codes with descriptors specifying units of radioactivity that were changed to per study dose units in CY 2006. For these radiopharmaceuticals, we are proposing to calculate their per day costs based on the CY 2005 codes and use those per day costs as proxies for the per study dose costs of the CY 2006 codes. We believe that patients would generally receive one study dose of these radiopharmaceuticals each day, and our CY 2005 claims data show that they were most commonly billed with specific nuclear medicine procedures that normally include a single radiopharmaceutical dose on a given day. Therefore, the per day costs of these radiopharmaceuticals calculated based on claims reporting the CY 2005 codes should be an appropriate basis for determining the payment rates for the CY 2006 HCPCS codes. Out of the 39 radiopharmaceutical HCPCS codes that we are proposing to pay separately for in CY 2007, we are able to directly crosswalk the CY 2005 cost data to 31 of these codes. The descriptors for the remaining eight codes changed from per unit of radioactivity in CY 2005 to new descriptors based on per study doses in CY 2006. Therefore, we are proposing to use the per day costs based on the CY 2005 claims data as proxies for the per study dose costs for this subset of radiopharmaceutical HCPCS codes to be reported in CY 2007. There are three cases where two CY 2005 HCPCS codes were mapped to one new CY 2006 code that will be reported in CY 2007. These three CY 2006 HCPCS codes are A9550, A9553, and A9559. Because of the complicated nature of crosswalking the cost data for two predecessor HCPCS codes with different units in their descriptors to each of these new HCPCS codes, we are proposing to crosswalk the cost data only from the predecessor HCPCS codes with the most claims volume in CY 2005 to each of these three HCPCS codes to be reported for CY 2007. Table 26 below lists all of the CY 2007 separately payable radiopharmaceuticals and the predecessor HCPCS codes whose claims data were used to set the CY 2007 proposed payment rates and notes the crosswalk methodology used for the proposed rates. 
 
  
 
  
 
  
 
  
 
  We specifically request public comment on the radiopharmaceutical payment methodology that we are proposing for the CY 2007 OPPS update. We also seek public comment on the possibility of developing an alternative packaging threshold for radiopharmaceuticals to provide greater administrative simplicity for hospitals. Additionally, we request public comment on the crosswalk that we are proposing to use to determine the CY 2007 payment rates for separately payable radiopharmaceuticals. While payments for drugs, biologicals and radiopharmaceuticals are taken into account when calculating budget neutrality, we note that we are proposing to make payments for drugs, biologicals, and radiopharmaceuticals without scaling these payment amounts. 
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                        Section 1833(t)(14)(A)(iii)(I) requires that, beginning in CY 2006, we pay for a separately payable drug on the basis of “the average acquisition cost of the drug.” As we stated in the CY 2006 OPPS final rule with comment period (70 FR 42728), we believe that the best interpretation of the specific requirement that we pay for such drugs on the basis of average acquisition cost, is that these payments themselves should not be adjusted as part of meeting the statutory budget neutrality requirement. If we were to apply a budget neutrality scalar to these payments, we would no longer be paying the average acquisition cost, but rather an adjusted average acquisition cost, for separately payable drugs, biologicals, and radiopharmaceuticals. We believe that these amounts, without a budget neutrality scalar applied, are the best proxies we have for the aggregate average acquisition and pharmacy overhead and handling costs of drugs, biologicals, and radiopharmaceuticals. b. Proposed CY 2007 Payment for Nonpass-Through Drugs, Biologicals, and Radiopharmaceuticals With HCPCS Codes, But Without OPPS Hospital Claims Data Pub. L. 108-173 does not address the OPPS payment in CY 2005 and after for new drugs, biologicals, and radiopharmaceuticals that have assigned HCPCS codes, but that do not have a reference AWP or approval for payment as pass-through drugs or biologicals. Because there is no statutory provision that dictated payment for such drugs and biologicals in CY 2005, and because we had no hospital claims data to use in establishing a payment rate for them, we investigated several payment options for CY 2005 and discussed them in detail in the CY 2005 OPPS final rule with comment period (69 FR 65797 through 65799). For CYs 2005 and 2006, we finalized the policy to pay separately for new drugs, biologicals, and radiopharmaceuticals with HCPCS codes, but which did not have pass-through status at a rate that was equivalent to the payment they received in the physician office setting, which was established in accordance with the ASP methodology. For CY 2007, we are proposing to continue payment for these new drugs and biologicals with HCPCS codes as of January 1, 2007, but which do not have pass-through status, at a rate that is equivalent to the payment they would receive in the physician office setting, which would be established in accordance with the ASP methodology described in the CY 2006 Medicare Physician Fee Schedule final rule, where payment would generally be equal to ASP+6 percent. In accordance with the ASP methodology, in the absence of ASP data, we are continuing the policy we implemented during CYs 2005 and 2006 of using the wholesale acquisition cost (WAC) for the product to establish the initial payment rate. We note, however, that if the WAC is also unavailable, we would make payment at 95 percent of the product's most recent AWP. We are proposing to adopt this interim payment methodology in order to be consistent with how we pay for new drugs, biologicals, and radiopharmaceuticals without HCPCS codes, as discussed in the CY 2006 OPPS final rule with comment period (70 FR 68669). We further note that with respect to items for which we do not have ASP data, once their ASP data become available in later quarter submissions, their payment rates under OPPS will be adjusted so that the rates are based on the ASP methodology and set to ASP+6 percent. In the event that the drug or biological is covered under the competitive acquisition program, then we propose to pay for it at the payment rate calculated under this program consistent with the provisions in section 1847B of the Act. We propose to base payment for new radiopharmaceuticals with HCPCS codes as of January 1, 2007, but which do not have pass-through status, on the WACs for these products as ASP data for radiopharmaceuticals are not available. In addition, we note that if the WACs are also unavailable, then we would make payment for the radiopharmaceuticals at 95 percent of their most recent AWPs. We are proposing to adopt this interim payment methodology in order to be consistent with how we pay for new drugs, biologicals, and radiopharmaceuticals without HCPCS codes, as discussed in the CY 2006 OPPS final rule with comment period (70 FR 68669). To be consistent with the ASP-based payments that would be made when the new drugs and biologicals are furnished in physician offices, we are proposing to make any appropriate adjustments to their payment amounts in the CY 2007 OPPS final rule and also on a quarterly basis on our Web site during CY 2007 if later quarter ASP submissions (or more recent WACs or AWPs) indicate that adjustments to the payment rates for these drugs and biologicals are necessary. The payment rates for new radiopharmaceuticals would also be adjusted accordingly. We are also proposing to make appropriate adjustments to the payment rates for new drugs and biologicals in the event that they become covered under the competitive acquisition program in the future. As discussed in the CY 2005 OPPS final rule with comment period (69 FR 65797), and the CY 2006 OPPS final rule with comment period (70 FR 68666), new drugs, biologicals, and radiopharmaceuticals may be expensive, and we are concerned that packaging these new items might jeopardize beneficiary access to them. In addition, we do not want to delay separate payment for these items solely because a pass-through application was not submitted. The payment methodologies described above are the same as the methodologies that would be used to calculate the OPPS payment amount that pass-through drugs, biologicals, and radiopharmaceuticals would be paid in CY 2007. We refer readers to section V.A. of this preamble for a discussion of payment policies of pass-through drugs, biologicals, and radiopharmaceuticals under OPPS. Consequently, we are proposing to continue to treat new drugs, biologicals, and radiopharmaceuticals with newly established HCPCS codes the same, irrespective of whether pass-through status has been determined. We also are proposing to assign status indicator “K” to HCPCS codes for new drugs, biologicals, and radiopharmaceuticals for which we have not received a pass-through application. We specifically request comments on our proposed payment policies for new drugs, biologicals, and radiopharmaceuticals with HCPCS codes but which do not have pass-through status as of January 1, 2007. The new CY 2007 HCPCS codes for drugs, biologicals, and radiopharmaceuticals are not available at the time of the development of this proposed rule; however, they will be included in the CY 2007 OPPS final rule. There are several drugs, biologicals, and radiopharmaceuticals that were payable during CY 2005 or where HCPCS codes for products were created effective January 1, 2006, for which we do not have any CY 2005 hospital claims data. In order to determine the packaging status of these items for CY 2007, we calculated an estimate of the per day cost of each of these items by multiplying the payment rate for each product based on ASP+5 percent similar to other separately payable nonpass-through drugs and biologicals under the OPPS and, as determined using the ASP methodology as described in section V.B.3.a.2. of this preamble, by an estimated average number of units of each product that would typically be 
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                        furnished to a patient during one administration in the hospital outpatient setting. We are proposing to package items for which we estimate the per administration cost to be less than $55, which is the packaging threshold that we are proposing for drugs, biologicals, and radiopharmaceuticals in CY 2007, and pay separately for items with an estimated per administration cost greater than $55. We are proposing that the CY 2007 payment for separately payable items would be based on rates determined using the ASP methodology established in the physician office setting and set to ASP+5 percent, similar to other separately payable nonpass-through drugs and biologicals under the OPPS. In accordance with the ASP methodology used in the physician office setting, in the absence of ASP data, we would use the WAC for the product to establish the initial payment rate. We note, however, that if the WAC is also unavailable, then we would make payment at 95 percent of the most recent AWP available. We note that for radiopharmaceutical agents that do not have any CY 2005 hospital claims data, we propose to determine their packaging status and, if the items are separately payable, then establish their payment rates using the WACs for the products because ASP data are not available for any radiopharmaceuticals. We also note that if the WACs are unavailable, then we would use payment at 95 percent of the most recent AWPs to determine their packaging status and payment rates. In order to determine the packaging status and payment rates for these drugs, biologicals, and radiopharmaceuticals in this proposed rule, we used ASP data from the fourth quarter of 2005 or the most recent WAC or AWP data available at this time, as appropriate. Table 27 below lists all of the items without available CY 2005 claims data to which these policies would apply in CY 2007. There are three HCPCS codes for which we were not able to determine payment rates based on the ASP methodology. The HCPCS codes are 90393 (Vaccina ig, im), 90693 (Typhoid vaccine, akd, sc), and A9567 (Technitium TC-99m aerosol). Because we are unable to estimate the per administration cost of these items, we are proposing to package them in CY 2007. We are seeking comments on our proposed policies for determining the per administration cost of the drugs, biologicals, and radiopharmaceuticals that are payable under the OPPS, but do not have any CY 2005 claims data. Table 27.—Drugs, Biologicals, and Radiopharmaceuticals Without CY 2005 Claims Data
HCPCS code
Description
ASP-based 
                                 payment rate
Estimated average number of 
                                 units per  
                                 administration
CY 2007 proposed SI90714
Td vaccine no prsrv >/= 7 im
$18.09
1
N90727
Plague vaccine, im
150.00
1
KA9535
Injection, methylene blue
2.87
10
NJ0132
Acetylcysteine injection
1.86
210
KJ0200
Alatrofloxacin mesylate
16.03
2.5
NJ0278
Amikacin sulfate injection
1.33
5.25
NJ0288
Ampho b cholesteryl sulfate
12.00
35
KJ0350
Injection anistreplase 30 u
2,265.46
1
KJ0395
Arbutamine HCl injection
160.00
1
KJ1452
Intraocular Fomivirsen na
210.00
1
KJ2425
Palifermin injection
11.37
84
KJ2805
Sincalide injection
44.14
1
NJ2850
Inj secretin synthetic human
20.31
14
KJ3355
Urofollitropin, 75 iu
48.84
2
KJ3471
Ovine, up to 999 USP units
0.11
150
NJ3472
Ovine, 1000 USP units
133.77
1
KJ7341
Non-human, metabolic tissue
1.64
50
KJ8540
Oral dexamethasone
0.07
80
NJ9225
Histrelin implant
2,019.82
1
KQ9958
HOCM ≤ 149 mg/ml iodine, 1ml
0.06
100
NQ9959
HOCM 150-199mg/ml iodine,1ml
0.08
100
NQ9960
HOCM 200-249mg/ml iodine,1ml
0.09
100
NQ9961
HOCM 250-299mg/ml iodine,1ml
0.17
100
NQ9962
HOCM 300-349mg/ml iodine,1ml
0.14
100
NQ9963
HOCM 350-399mg/ml iodine,1ml
0.39
100
NQ9964
HOCM ≥ 400mg/ml iodine, 1ml
0.19
100
N
 VI. Proposed Estimate of OPPS Transitional Pass-Through Spending in CY 2007 for Drugs, Biologicals, Radiopharmaceuticals, and Devices (If you choose to comment on issues in this section, please include the caption “OPPS: Estimated Transitional Pass-Through Spending” at the beginning of your comment.) A. Total Allowed Pass-Through Spending Section 1833(t)(6)(E) of the Act limits the total projected amount of transitional pass-through payments for drugs, biologicals, radiopharmaceuticals, and categories of devices for a given year to an “applicable percentage” of projected total Medicare and beneficiary payments under the hospital OPPS. For a year before CY 2004, the applicable percentage was 2.5 percent; for CY 2004 and subsequent years, we specify the applicable percentage up to 2.0 percent. If we estimate before the beginning of the calendar year that the total amount of pass-through payments in that year would exceed the applicable percentage, section 1833(t)(6)(E)(iii) of the Act requires a uniform reduction in the amount of each of the transitional pass-through payments made in that year to ensure that the limit is not exceeded. We make an estimate of pass-through spending to determine not only whether 
                        ( print page 49596)
                        payments exceed the applicable percentage, but also to determine the appropriate reduction to the conversion factor for the projected level of pass-through spending in the following year. For devices, making an estimate of pass-through spending in CY 2007 entails estimating spending for two groups of items. The first group consists of those items for which we have claims data for procedures that we believe used devices that were eligible for pass-through status in CY 2005 and CY 2006 and that would continue to be eligible for pass-through payment in CY 2007. The second group consists of those items for which we have no direct claims data, that is, items that became, or would become, eligible in CY 2006 and would retain pass-through status in CY 2007, as well as items that would be newly eligible for pass-through payment beginning in CY 2007. B. Proposed Estimate of Pass-Through Spending for CY 2007 We are proposing to set the applicable percentage cap at 2.0 percent of the total OPPS projected payments for CY 2007. As we discuss in section IV.B. of this preamble, there is one device category receiving pass-through payment in CY 2006 that will continue for payment during CY 2007. Therefore, we estimate pass-through spending attributable to the first group of items described above to be $36.8 million. To estimate CY 2007 pass-through spending for device categories in the second group, that is, items for which we have no direct claims data, we used the following approach: For additional device categories that are approved for pass-through status after July 1, 2006, but before January 1, 2007, we are proposing to use price information from manufacturers and volume estimates based on claims for procedures that would most likely use the devices in question because we do not have any CY 2005 claims data upon which to base a spending estimate. We are proposing to project these data forward to CY 2007 using inflation and utilization factors based on total growth in OPPS services as projected by CMS' Office of the Actuary (OACT) to estimate CY 2007 pass-through spending for this group of device categories. We may use an alternate growth factor for any specific new device category based on our claims data or the device's clinical characteristics, or both. For device categories that become eligible for pass-through status in CY 2007, we are proposing to use the same methodology. We anticipate that any new categories for January 1, 2007, would be announced after the publication of this proposed rule, but before publication of the final rule with comment period. Therefore, the estimate of pass-through spending in the CY 2007 OPPS final rule with comment period would incorporate any pass-through spending for device categories made effective January 1, 2007, and during subsequent quarters of CY 2007. With respect to CY 2007 pass-through spending for drugs and biologicals, as we explain in section V.A.3. of this proposed rule, the pass-through payment amount for new drugs and biologicals that we determine have pass-through status will equal zero. Therefore, our estimate of pass-through spending for drugs and biologicals with pass-through status in CY 2007 equals zero. In the CY 2005 OPPS final rule with comment period (69 FR 65810), we indicated that we are accepting pass-through applications for new radiopharmaceuticals that are assigned a HCPCS code on or after January 1, 2005. (Prior to this date, radiopharmaceuticals were not included in the category of drugs paid under the OPPS, and therefore, were not eligible for pass-through status.) We have no new radiopharmaceuticals that were added for pass-through payment in CY 2005 or to this point in CY 2006, and we currently have no information identifying new radiopharmaceuticals to which a HCPCS code might be assigned on or after January 1, 2007, for which pass-through payment status would be sought. We also have no data regarding payment for new radiopharmaceuticals with pass-through status under the methodology that we specified in the CY 2005 OPPS final rule with comment period. However, we do not believe that pass-through spending for new radiopharmaceuticals in CY 2007 will be significant enough to materially affect our estimate of total pass-through spending in CY 2007. Therefore, we are not including radiopharmaceuticals in our estimate of pass-through spending for CY 2007. We discuss the methodology for determining the proposed CY 2007 payment amount for radiopharmaceuticals with pass-through status in section V.B.3.b. of this preamble. In accordance with the methodology described above, we estimate that total pass-through spending for both device categories that are continuing into CY 2007 and that first become eligible for pass-through status during CY 2007 would equal approximately $43.2 million, which represents 0.13 percent of total OPPS projected payments for CY 2007. This figure includes estimates for the current device category continuing into CY 2007, which equals $36.8 million, in addition to projections for categories that may become eligible after publication of this proposed rule but before the end of CY 2006, and for projections for new categories that may become eligible during CY 2007. Table 28.—Estimates for CY 2007 Transitional Pass-Through Spending for Current Pass-Through Categories Continuing Into CY 2007
HCPCS
APC
Existing pass-through device category
CY 2007 
                                 estimated  
                                 utilization
CY 2007 
                                 estimated  
                                 pass-through  
                                 paymentsC1820
1820
Generator, neurostimulator (implantable), with rechargeable battery and charging system
4,568
$36,766,720
 Because we estimate pass-through spending in CY 2007 will not amount to 2.0 percent of total projected OPPS CY 2007 spending, we are proposing to return 1.87 percent of the pass-through pool to adjust the conversion factor, as we discuss in section II.C. of this preamble. VII. Proposed Brachytherapy Source Payment Changes (If you choose to comment on issues in this section, please include the caption “OPPS: Brachytherapy” at the beginning of your comment.) A. Background Section 1833(t)(2)(H) of the Act, as added by section 621(b)(2)(C) of Pub. L. 108-173, mandated the creation of separate groups of covered OPD services that classify brachytherapy devices separately from other services or groups of services. The additional groups must 
                        ( print page 49597)
                        reflect the number, isotope, and radioactive intensity of the devices of brachytherapy furnished, including separate groups for Palladium-103 and Iodine-125 devices. In accordance with this provision, since CY 2004 we have established four new brachytherapy source codes and descriptors. Section 1833(t)(16)(C) of the Act, as added by section 621(b)(1) of Pub. L. 108-173, established payment for devices of brachytherapy consisting of a seed or seeds (or radioactive source) based on a hospital's charges for the service, adjusted to cost. The period of payment under this provision is for brachytherapy sources furnished from January 1, 2004, through December 31, 2006. Under section 1833(t)(16)(C) of the Act, charges for the brachytherapy devices may not be used in determining any outlier payments under the OPPS for that period of payment. Consistent with our practice under the OPPS to exclude items paid at cost from budget neutrality consideration, these items have been excluded from budget neutrality for that time period as well. In the OPPS interim final rule with comment period published on January 6, 2004 (69 FR 827), we implemented sections 621(b)(1) and (b)(2)(C) of Pub. L. 108-173. In that rule, we stated that we would pay for the brachytherapy sources listed in Table 4 of the interim final rule with comment period (69 FR 828) on a cost basis, as required by the statute. Since January 1, 2004, we have used status indicator “H” to denote nonpass-through brachytherapy sources paid on a cost basis, a policy that we finalized in the CY 2005 final rule with comment period (69 FR 65838). Furthermore, we adopted a standard policy for brachytherapy code descriptors, beginning January 1, 2005. We included “per source” in the HCPCS code descriptors for all those brachytherapy source descriptors for which units of payment were not already delineated. Section 621(b)(3) of Pub. L. 108-173 requires the Government Accountability Office (GAO) to conduct a study to determine appropriate payment amounts for devices of brachytherapy, and to submit a report on its study to the Congress and the Secretary, including recommendations. The GAO's final report, published at the end of July 2006, was not available in time to review and discuss in this proposed rule. We plan to discuss the report's findings and recommendations in the CY 2007 OPPS final rule with comment period. B. Proposed Payments for Brachytherapy Sources in CY 2007 As indicated above, the provision to pay for brachytherapy sources at charges reduced to cost expires after December 31, 2006, in accordance with section 1833(t)(16)(C) of the Act. However, under section 1833(t)(2)(H) of the Act, we are still required to create APC groupings that classify devices of brachytherapy separately from other services or groups of services in a manner reflecting the number, isotope, and radioactive intensity of the devices of brachytherapy furnished. We are proposing to pay separately for each of the sources listed in Table 29 below on a prospective basis for CY 2007, with payment rates to be determined using the CY 2005 claims-based median cost per source for each brachytherapy device. Consistent with our policy regarding APC payments made on a prospective basis, we are proposing that the cost of brachytherapy sources be subject to the outlier provisions of section 1833(t)(5) of the Act. As indicated in section II.A.2. of the preamble to this proposed rule, for CY 2007, we are proposing a specific payment rate for brachytherapy sources, which will be subject to scaling for budget neutrality. Table 29 includes a complete listing of the HCPCS codes, long descriptors, APC assignments, APC titles, and status indicators that we currently use for brachytherapy sources paid under the OPPS in CY 2006 and that we are proposing to use for CY 2007. The brachytherapy sources and related information in Table 29 are the same sources and information as those listed in Table 28 of the OPPS CY 2006 final rule with comment period (70 FR 68676). No additional brachytherapy sources have been added since the CY 2006 final rule with comment period. Table 29.—Proposed Separately Payable Brachytherapy Sources for CY 2007
HCPCS code
Long descriptor
APC
APC title
New status indicatorC1716
Brachytherapy source, Gold 198, per source
1716
Brachytx source, Gold 198
KC1717
Brachytherapy source, High Dose Rate Iridium 192, per source
1717
Brachytx source, HDR Ir-192
KC1718
Brachytherapy source, Iodine 125, per source
1718
Brachytx source, Iodine 125
KC1719
Brachytherapy source, Non-High Dose Rate Iridium 192, per source
1719
Brachytx source, Non-HDR Ir-192
KC1720
Brachytherapy source, Palladium 103, per source
1720
Brachytx source, Palladium 103
KC2616
Brachytherapy source, Yttrium-90, per source
2616
Brachytx source, Yttrium-90
KC2632
Brachytherapy solution, Iodine125, per mCi
2632
Brachytx sol, I-125, per mCi
KC2633
Brachytherapy source, Cesium-131, per source
2633
Brachytx source, Cesium-131
KC2634
Brachytherapy source, High Activity, Iodine-125, greater than 1.01 mCi (NIST), per source
2634
Brachytx source, HA, I-125
KC2635
Brachytherapy source, High Activity, Palladium-103, greater than 2.2 mCi (NIST), per source
2635
Brachytx source, HA, P-103
KC2636
Brachytherapy linear source, Palladium-103, per 1MM
2636
Brachytx linear source, P-103
KC2637
Brachytherapy source, Ytterbium-169, per source
2637
Brachytx, Ytterbium-169
K
 There are a number of advantages to this proposed payment method. The OPPS is a prospective payment system under which payment rates are generally established based on median costs from historical hospital claims. Therefore, under this payment method, brachytherapy sources would be paid using the same basic median cost methodology as the overall OPPS. The payment of sources would thus be an integral part of the OPPS, rather than a separate cost-based payment methodology within the OPPS. In addition, consistent and predictable prospectively established payment rates under the OPPS for brachytherapy sources are appropriate because we do not believe that the hospital resource costs associated with specific brachytherapy sources should vary 
                        ( print page 49598)
                        greatly across hospitals or across clinical conditions under treatment, other than through differences in the numbers of sources utilized, which are already accounted for in our per source payment methodology. This prospective payment methodology would promote efficiency in the provision of sources, while continuing to provide payments that reflect the wide clinical variation in the use of brachytherapy sources related to many factors, including tumor type and stage, patient anatomy, and planned brachytherapy dose. In addition, under this method, we would continue to pay for brachytherapy sources separately using the same C-codes and descriptors that hospitals have reported for the last several years. We note that High Dose Rate (HDR) Iridium-192 (C1717) is a reusable source, across treatment sessions and across patients. It is unclear whether hospitals are reporting the number of units provided accurately. Thus, while we are currently proposing that HDR Iridium be paid separately on the basis of the median cost per source as we are proposing to pay for the other brachytherapy sources, we invite comments on alternatives to using this methodology for this source, such as on the basis of median costs per treatment day on hospital claims. During the March 1-2, 2006 APC Panel meeting, we discussed median cost data for brachytherapy sources developed from the partial CY 2005 hospitals claims data available for analysis at the time of the meeting. While the APC Panel made no specific recommendations about a specific OPPS CY 2007 payment methodology for brachytherapy sources, the Panel reviewed the median costs for the sources of brachytherapy and generally commented that the median costs appeared reasonable for the commonly furnished brachytherapy sources. Because brachytherapy sources would no longer be paid on the basis of their charges reduced to costs, we are proposing to discontinue our use of payment status indicator “H” for APCs assigned to brachytherapy sources. We are proposing to use status indicator “K” for all brachytherapy source APCs for CY 2007. We are also proposing for CY 2007 to change the definition of status indicator “K” to ensure that “K” appropriately describes brachytherapy source APCs. Payment status indicators are discussed in section XV.A. of this preamble. There is one source for which we have no claims data or payment information. We added Ytterbium-169 (HCPCS code C2637) for payment effective October 1, 2005, because it met the requirements of section 1833(t)(2)(H) of the Act as a separate brachytherapy source. It is our understanding that this source, which is for use in high dose rate (HDR) brachytherapy, is not yet marketed by the manufacturer, although it has been approved by the Food and Drug Administration (FDA). Therefore, we have no claims data for this brachytherapy source in order to develop a prospective payment rate, as we do for the other brachytherapy sources for CY 2007. In addition, it is our understanding that no price for the product exists, as it has not yet been marketed. Thus, we also have no external information regarding the cost of this source to hospitals. We are weighing our payment options for CY 2007 for brachytherapy sources for which we have no payment or claims information, such as the present case with Ytterbium-169. This includes considering our CY 2007 payment options for other new brachytherapy sources that come to our attention, which historically have been newly recognized under the OPPS on a quarterly basis. One option for CY 2007 would be to pay for the currently existing HCPCS code C2637 at charges converted to costs. However, this would be inconsistent with our proposed policy with regard to payment for brachytherapy sources under prospectively established payment rates. We paid for all brachytherapy sources based upon charges converted to costs for CYs 2004 through 2006 because the law required us to do so. However, that provision will expire for the CY 2007 OPPS. In addition, this methodology would be inconsistent with the prospective payment methodologies we use to provide payments for other new items and services under the OPPS for which we do not yet have claims data. A second option would be to assign the code to its own APC or to a New Technology APC with a payment rate set at or near the lowest proposed payment rate for any source of brachytherapy paid on a per source basis (as opposed, for example, per mCi), for CY 2007. However, we have no claims data or other information regarding the cost of HCPCS code C2637 to hospitals. This payment policy would resemble our policy regarding the APC assignment of not otherwise classified codes, which are assigned to the lowest level APC in their clinically compatible series. However, HCPCS code C2637 is a specifically defined brachytherapy source, and such a payment rate would not recognize the clinical distinctions among brachytherapy sources, including their differences in isotopes, activity levels, and clinical uses in low dose rate (LDR) versus HDR brachytherapy. The solid brachytherapy source with the lowest proposed median cost for CY 2007 is HCPCS code C2634, for High Activity Iodine-125, with a median cost of $25.77 per source, which is implanted in LDR brachytherapy. A third option would be to assign HCPS code C2637 to its own APC or to a New Technology APC with a payment rate established at or near the proposed payment rate for HCPCS code C1717, which describes HDR Iridium-192. Like HCPCS code C2637, HCPCS code C1717 is used for HDR brachytherapy, and HCPCS code C1717 is the most commonly used source for HDR brachytherapy under the OPPS. However, this approach would not take into consideration significant differences in the two sources, including their radioactive isotopes and energy levels. The fourth option would be to assign HCPCS code C2637 to its own APC or to a New Technology APC with a prospective payment rate based on external data provided to us regarding the expected cost of the source to hospitals. If we were provided reliable and relevant cost information for the source, we could establish its payment rate based on that information and our review of other pertinent considerations, as we do for new technology services under the OPPS. Under this option, in the absence of external cost information, we would not recognize HCPCS code C2637 under the OPPS for CY 2007 until we received such information and could establish a payment rate in a quarterly OPPS update. CMS provided the brachytherapy source Ytterbium-169 a HCPCS code in CY 2005 at the manufacturer's request, based on the belief that the source would be marketed shortly. However, the product has not yet been marketed. Therefore, we currently have a recognized HCPCS code for an item that is not currently available to hospitals. We do not typically issue and maintain as payable a HCPCS code for an item that is not marketed. Under this option, if the source were marketed mid-quarter in CY 2007 and cost information was provided to us, there would be no payment available for the source until the next OPPS quarterly update, which would establish the payment rate for HCPCS code C2637 and its effective date. After weighing the above options, we are proposing the second option discussed, that is, to assign C2637 to its own APC or a New Technology APC with a payment rate set at or near the lowest proposed payment rate for any 
                        ( print page 49599)
                        source of brachytherapy paid on a per source basis. This option resembles our policy regarding the APC assignment of not otherwise classified codes, in the absence of any data currently available. Once we have claims data, or obtain external data, we can consider movement to another APC, if warranted. However, as we indicate below, we are interested in the public's comments on the four options we have presented. We are specifically inviting comments on how we should establish the CY 2007 payment amount for Ytterbium-169 (HCPCS code C2637), especially with consideration of the four options discussed above, and on how we should generally proceed on setting payment amounts for established or new brachytherapy sources eligible for separate payment under section 1833(t)(2)(H) of the Act, for which we have no claims-based cost data in the future. Note that under option 4, for a future new source we would need cost information regarding the source in order to establish a code for which we could set an appropriate OPPS payment rate. We intend to avoid routinely establishing HCPCS codes for brachytherapy sources which hospitals could not be using, and, therefore, for which payments would not be necessary. As we have consistently done in the past, we are inviting the public to submit recommendations for new codes to describe new brachytherapy sources in a manner reflecting the number, isotope, and radioactive intensity of the sources. We are requesting that commenters provide a detailed rationale to support recommended new sources and send recommendations to us. We will continue our endeavor to add new brachytherapy source codes and descriptors to our systems for payment on a quarterly basis. Such recommendations should be directed to the Division of Outpatient Care, Mail Stop C4-05-17, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244. We have considered the definition of the term “brachytherapy source” in the context of current medical practice, and in light of the language in section 1833(t)(2)(H) of the Act. We are proposing to define a device of brachytherapy eligible for separate payment under the OPPS as a “seed or seeds (or radioactive source)” as indicated in section 1833(t)(2)(H) of the Act, which refers to sources that are themselves radioactive, meaning that the sources contain a radioactive isotope. Therefore, for example, we do not consider specific devices that do not utilize radioactive isotopes to deliver radiation to be radioactive sources as envisioned by the statute. While the public may recommend any item that it wishes us to consider as a brachytherapy source, we remind the public of our interpretation of a device of brachytherapy eligible for separate payment under section 1833(t)(2)(H) of the Act. VIII. Proposed Changes to OPPS Drug Administration Coding and Payment for CY 2007 (If you choose to comment on issues in this section, please include the caption “OPPS: Drug Administration” at the beginning of your comment.) A. Background From the start of the OPPS until the end of CY 2004, three HCPCS codes were used to bill drug administration services provided in the hospital outpatient department: Q0081 (Infusion therapy, using other than chemotherapeutic drugs, per visit)
                    Q0083 (Chemotherapy administration by other than infusion technique only, per visit)
                    Q0084 (Chemotherapy administration by infusion technique only, per visit). A fourth OPPS drug administration HCPCS code, Q0085 (Administration of chemotherapy by both infusion and another route, per visit), was active from the beginning of the OPPS through the end of CY 2003. Each of these four HCPCS codes mapped to an APC (that is, Q0081 mapped to APC 0120, Q0083 mapped to APC 0116, Q0084 mapped to APC 0117, and Q0085 mapped to APC 0118), and the APC payment rates for these codes were made on a per-visit basis. The per-visit payment included payment for all hospital resources (except separately payable drugs) associated with the drug administration procedures. For CY 2004, we discontinued using HCPCS code Q0085 to identify drug administration services and moved to a combination of HCPCS codes Q0083 and Q0084 that allowed more accurate calculations when determining OPPS payment rates. In CY 2005, in response to the recommendations made by commenters and the hospital industry, OPPS transitioned to the use of CPT codes for drug administration services. These CPT codes allowed for more specific reporting of services, especially regarding the number of hours for an infusion, and provided consistency in coding between Medicare and other payers. However, we did not have any data to revise the CY 2005 per-visit APC payment structure for infusion services. In order to collect data for future ratesetting purposes, we implemented claims processing logic that collapsed payments for drug administration services and paid a single APC amount for those services for each visit, unless a modifier was used to identify drug administration services provided in a separate encounter on the same day. Hospitals were instructed to bill all applicable CPT codes for drug administration services provided in a hospital outpatient department, without regard to whether or not the CPT code would receive a separate APC payment during OPPS claims processing. While hospitals were just adopting CPT codes for outpatient drug administration services in CY 2005, physicians paid under the Medicare Physician Fee Schedule were using HCPCS G-codes in CY 2005 to report office-based drug administration services. These G-codes were developed in anticipation of substantial revisions to the drug administration CPT codes by the CPT Editorial Panel that were expected for CY 2006. In CY 2006, as anticipated, the CPT Editorial Panel revised its coding structure for drug administration services, incorporating new concepts such as initial, sequential, and concurrent services into a structure that previously distinguished services based on type of administration (chemotherapy/nonchemotherapy), method of administration (injection/infusion/push), and for infusion services, first hour and additional hours. For CY 2006, we proposed a crosswalk that mapped the expected CY 2006 CPT codes (represented by CY 2005 G-codes used in the physician office setting, the closest proxy at the time) to the APC payment structure implemented in CY 2005. Our crosswalk was reviewed by the APC Panel at both the February and August 2005 meetings, and was included in the CY 2006 OPPS proposed rule. During the proposed rule comment period, we received a number of comments that prompted several revisions to our proposed crosswalk, including the development of complex claims processing logic to assign correct payment for certain drug administration services that would vary based on other drug administration services provided during the same patient visit. These revisions were a result of the growing understanding, facilitated by the preview of CPT drug administration coding guidelines developed by the CPT Editorial Panel, in the hospital community of the multiple implications associated with adopting the newly 
                        ( print page 49600)
                        introduced CPT concepts of initial, sequential, and concurrent services. Upon review of the completed revisions to our proposed CY 2006 methodology, and following comprehensive assessment of all public comments, we implemented 20 of the 33 CY 2006 drug administration CPT codes that did not reflect the concepts of initial, sequential, and concurrent services, and we created 6 new HCPCS C-codes that generally paralleled the CY 2005 CPT codes for the same services. We chose not to implement the full set of CY 2006 CPT codes because of our concerns regarding the interface between the complex claims processing logic required for correct payments and hospitals' challenges in correctly coding their claims to receive accurate payments for these services. In addition, numerous commenters indicated that implementing certain CPT codes in a fashion consistent with the code descriptors would present hospitals with difficult operational and administrative challenges because concepts integral to the codes were inconsistent with the clinical patterns of drug administration services provided in hospital outpatient departments. In addition to coding changes, CY 2006 payment rates for drug administration services were updated based upon CY 2004 claims, and we continued the claims processing logic that required hospitals providing drug administration services to report all applicable drug administration HCPCS codes, despite some codes being collapsed into one APC for payment purposes. B. Proposed CY 2007 Drug Administration Coding Changes For the CY 2007 OPPS, we are proposing to continue the CY 2006 OPPS drug administration coding structure, which combines CPT codes with several C-codes. However, we welcome comments from hospitals regarding their experiences in implementing, for purposes of reporting to other payers, the CY 2006 CPT codes that incorporate the concepts of initial, sequential, and concurrent drug administration services. While we are not proposing to transition to the full set of CPT codes in CY 2007, we retain this as an option for the future. In addition, because of the discrepancies between APC payments (based on per-visit hospital claims data) and per-service CPT/HCPCS coding, we provided special instructions to hospitals in CY 2005 and CY 2006 regarding modifier 59 in order to ensure proper OPPS payments, consistent with our claims processing logic. As we do not expect any changes to our coding structure for CY 2007 and because we have updated service-specific claims data from CY 2005, we no longer have the need for specific drug administration instructions regarding modifier 59. Instead, for CY 2007 we are proposing that hospitals apply modifier 59 to drug administration services using the same correct coding principles that they generally use for other OPPS services. C. Proposed CY 2007 Drug Administration Payment Changes CY 2007 is the first year that we have more detailed claims data to inform our ratesetting process. Through CY 2006, payment for additional hours of drug infusion has always been packaged, although separate codes for reporting these hours have been used under the OPPS since CY 2005. Specifically, hospitals began reporting more precise CPT codes in CY 2005 that included separate coding for the first hour of infusion versus additional hours of infusion. In order to analyze these data, because we expected that additional hours of infusion codes would always be reported with codes for the first hour of infusion, thereby resulting in multiple bills for the additional hours of infusion CPT codes, we added the following three CY 2005 drug administration CPT codes to the bypass list utilized to create “pseudo” single claims: CPT codes 90781 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; each additional hour, up to eight (8) hours); 96412 (Chemotherapy administration, intravenous; infusion technique, one to 8 hours, each additional hour); and 96423 (Chemotherapy administration, intra-arterial; infusion technique, one to 8 hours, each additional hour). The standard OPPS methodology, as described in section II.A. of this proposed rule, was used to calculate HCPCS medians for these three drug administration codes. We then mapped all the data for the three additional hours of infusion CPT codes from the single and “pseudo” single claims to the APCs to which we are proposing to assign the CY 2005 claims data for these codes for purposes of calculating APC median costs. While bypassing these three CPT codes and developing additional “per unit” claims provide a methodology to calculate median costs for these previously packaged drug administration services and to attribute all of their cost data to their assigned APCs, we note that this methodology allocates all packaging on the claim related to drug administration to the associated first hour drug administration code. Because these additional hours of infusion codes are not reported alone in conjunction with other separately payable nondrug administration services, we would not expect that the packaging related to additional hours of infusion would be inappropriately assigned to nondrug administration services. While we realize that there are some packaged costs that truly are clinically related to the second and subsequent hours of infusion, especially for infusions of packaged drugs that span several hours, and would, therefore, be most appropriately allocated to the additional hours of infusion codes, we are not able at this time to accurately assign representative portions of packaging costs to multiple different services at this time due to the limitations of our claims data. We believe this proposed methodology takes into account all of the packaging on claims for drug administration services and provides a reasonable framework for developing median costs for drug administration services that are often provided in combination with one another. Upon review of the HCPCS median costs for all drug administration services, including injections and antigen therapy services, we created a comprehensive set of new APC groupings of CY 2005 HCPCS codes for drug administration services, with our assignments based both upon hospital resources utilized as reflected in HCPCS median costs and clinical coherence. The result of this analysis was the development of six proposed drug administration APC levels for the proposed CY 2007 payment rates, as shown in Table 30-1. 
 
  As shown above, the placement of HCPCS codes into the proposed six levels follows logical, clinically coherent principles and is consistent with both expected and observed differences in hospital resource costs, 
                        ( print page 49602)
                        both across levels and within each level. For example, the first hour of chemotherapy infusion is assigned to proposed Level VI, while additional hours of chemotherapy infusion are assigned to proposed Level III. This proposed structure is mirrored by the nonchemotherapy codes that show the first hour of nonchemotherapy infusion assigned to proposed Level V, while additional hours of nonchemotherapy infusion are assigned to proposed Level II. Using this structure as a base, the CY 2006 OPPS drug administration codes were assigned to the proposed 6-level APC structure based on their clinical and expected hospital resource characteristics, as seen in Table 30-2. This proposed structure was presented to the APC Panel during the March 2006 meeting. The Panel recommended using the bypass methodology as described above for the three additional hours of infusion codes to develop their median costs and supported separate payment for each additional hour of infusion for CY 2007, as shown in Table 30-2. 
 
  We are accepting the APC Panel's recommendation for CY 2007 to use the bypass and “per unit” methodology as described in proposing a drug administration payment structure that includes a methodology to pay for 
                        ( print page 49604)
                        infusion services by the hour. Therefore, we are proposing to assign HCPCS codes for CY 2007 to six new drug administration APCs, as listed in Table 30-2, with payment rates based on median costs for the APCs from CY 2005 claims data as assigned in Table 30-1. For CY 2007, the APC Panel also recommended that CMS reevaluate payment for IVIG administration, especially considering the resource intensity of IVIG infusions. We are accepting this APC Panel recommendation and believe that our proposed CY 2007 drug administration payment policy that would provide specific payment for each hour of infusion would provide more accurate and appropriate payment for lengthy infusions, including the administration of IVIG. IVIG administration in the outpatient hospital setting typically occurs over 3-6 hours, and under our proposal hospitals would receive separate payment for the first hour of infusion, along with payments for each of the additional 2-5 hours generally required for the IVIG infusion. Considerable hospital resources are used throughout the infusion period, including significant clinical staff time to monitor and adjust infusions based on patients' evolving conditions, so we believe separate payment for each additional hour is appropriate. With respect to separate payment for IVIG preadministration-related services, the APC Panel recommended that CMS maintain separate payment as long as it remains appropriate. For CY 2006 only, we created the temporary G-code G0332 (Preadministration-related services for intravenous infusion of immunoglobulin, per infusion encounter). We are accepting this APC Panel recommendation and have considered whether separate payment for IVIG preadministration-related services remains appropriate. Based upon our ongoing review of the IVIG marketplace and our CY 2007 proposed payment policies for items and services under the OPPS, we believe that separate payment for preadministration-related services specific to IVIG infusions would not be necessary in CY 2007 to ensure Medicare beneficiary access to IVIG. Hospitals' cooperation during CY 2005 in reporting all drug administration services, whether or not separate payments were made for all such services, has allowed us to develop robust median costs for individual services so that we have sufficient information to propose this more specific APC payment structure for drug administration services for CY 2007. We believe that this proposed structure would make appropriate payments for the hospital resources required to provide drug administration services, as we have large numbers of claims for many specific drug administration services that reveal significant and differential costs. In particular, using this proposed APC structure should allow us to make more accurate payments to hospitals for complex and lengthy drug administration services furnished to Medicare beneficiaries for many medical conditions, while also providing accurate payments for individual services when they are provided alone. IX. Proposed Hospital Coding and Payments for Visits (If you choose to comment on issues in this section, please include the caption “Visits” at the beginning of your comment.) A. Background Currently, CMS instructs hospitals to use the CY 2006 CPT codes used by physicians and listed in Table 31 to report clinic and emergency department visits and critical care services on claims paid under the OPPS. Table 31.—CY 2006 CPT Codes Used To Report Clinic and Emergency Department Visits and Critical Care Services
CPT code
Descriptor**CPT Evaluation and Management Codes**99201
Office or other outpatient visit for the evaluation and management of a new patient (Level 1).99202
Office or other outpatient visit for the evaluation and management of a new patient (Level 2).99203
Office or other outpatient visit for the evaluation and management of a new patient (Level 3).99204
Office or other outpatient visit for the evaluation and management of a new patient (Level 4).99205
Office or other outpatient visit for the evaluation and management of a new patient (Level 5).99211
Office or other outpatient visit for the evaluation and management of an established patient (Level 1).99212
Office or other outpatient visit for the evaluation and management of an established patient (Level 2).99213
Office or other outpatient visit for the evaluation and management of an established patient (Level 3).99214
Office or other outpatient visit for the evaluation and management of an established patient (Level 4).99215
Office or other outpatient visit for the evaluation and management of an established patient (Level 5).99241
Office consultation for a new or established patient (Level 1).99242
Office consultation for a new or established patient (Level 2).99243
Office consultation for a new or established patient (Level 3).99244
Office consultation for a new or established patient (Level 4).99245
Office consultation for a new or established patient (Level 5).**Emergency Department Visit CPT Codes**99281
Emergency department visit for the evaluation and management of a patient (Level 1).99282
Emergency department visit for the evaluation and management of a patient (Level 2).99283
Emergency department visit for the evaluation and management of a patient (Level 3).99284
Emergency department visit for the evaluation and management of a patient (Level 4).99285
Emergency department visit for the evaluation and management of a patient (Level 5).**Critical Care Services CPT Codes**99291
Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes.99292
Each additional 30 minutes.
 The majority of CPT code descriptors are applicable to both physician and facility resources associated with specific services. However, we have acknowledged from the beginning of the OPPS that we believe that CPT Evaluation and Management (E/M) 
                        ( print page 49605)
                        codes were defined to reflect the activities of physicians and do not describe well the range and mix of services provided by hospitals during visits of clinic and emergency department patients and critical care encounters. Presently, CPT indicates that office or other outpatient visit codes are used to report E/M services provided in the physician's office or in an outpatient or other ambulatory facility. For OPPS purposes, we refer to these as clinic visit codes. CPT also indicates that emergency department visit codes are used to report E/M services provided in the emergency department, defined as an “organized hospital-based facility for the provision of unscheduled episodic services to patients who present for immediate medical attention. The facility must be available 24 hours a day.” For OPPS purposes, we refer to these as emergency visit codes. CPT defines critical care services as the “direct delivery by a physician(s) of medical care for a critically ill or critically injured patient.” It also states that “critical care is usually, but not always, given in a critical care area, such as * * * the emergency care facility.” In the April 7, 2000 OPPS final rule (65 FR 18434), CMS instructed hospitals to report facility resources for clinic and emergency department visits using CPT E/M codes and to develop internal hospital guidelines to determine what level of visit to report for each patient. While awaiting the development of a national set of facility-specific codes and guidelines, we have advised that each hospital's internal guidelines should follow the intent of the CPT code descriptors, in that the guidelines should be designed to reasonably relate the intensity of hospital resources to the different levels of effort represented by the codes. During the January 2002 APC Panel meeting, the APC Panel recommended that CMS adopt the American College of Emergency Physicians (ACEP) intervention-based guidelines for facility coding of emergency department visits and develop guidelines for clinic visits that are modeled on the ACEP guidelines. In the August 9, 2002 OPPS proposed rule, we proposed 10 new G-codes (Levels 1-5 Facility Emergency Services and Levels 1-5 Facility Clinic Services) for use in the OPPS to report hospital visits. We also asked for public comments regarding national guidelines for hospital coding of emergency and clinic visits. We discussed various types of models, reflecting on the advantages and disadvantages of each. We reviewed in detail the considerations around various discrete types of specific guidelines, including guidelines based on staff interventions, based upon staff time spent with the patient, based on resource intensity point scoring, and based on severity acuity point scoring related to patient complexity. We note below our analysis of the various models. 1. Guidelines Based on the Number or Type of Staff Interventions Under this model, the level of service reported would be based on the number and/or type of interventions performed by nursing or ancillary staff. In the intervention model, baseline care (including registration, triage, initial nursing assessment, periodic vital signs as appropriate, simple discharge instructions, and exam room set up/clean up) and possibly a single minor intervention (for example, suture removal, rapid strep test, or visual acuity) would be reported by the lowest level of service. Higher levels of service would be reported as the number and/or complexity of staff interventions increased. The most commonly recommended intervention-based guidelines were the facility-coding guidelines developed by the ACEP. The ACEP model uses examples of interventions to illustrate appropriate coding. Coders extrapolate from these examples to determine the correct level of service to report. The ACEP model uses the types of interventions rather than the number of interventions to determine the appropriate level of service. This means that the single most complex intervention determines the level of service, whether it was the only service provided (in addition to baseline care), whether other similarly complex interventions were also provided, or whether other interventions of less complexity were also provided. The intervention model is based on emergency department/clinic resource use, is simple, reflects the care given to the patient, and does not require additional facility documentation. However, we expressed concern that the intervention model may provide an incentive to provide unnecessary services and that it is susceptible to upcoding. In addition, it is not particularly focused on measuring and appropriately reporting a code reflecting total hospital resources used in a visit. Furthermore, the ACEP model requires extrapolation from a set of examples that could make it prone to variability across hospitals. 2. Guidelines Based on the Time Staff Spent With the Patient Under this model, the level of service would be determined based on the amount of time hospital staff spent with a patient. The underlying assumption is that staff time spent with the patient is an appropriate proxy for total hospital resource consumption. In this model, if only baseline care (as described above) were provided, a Level 1 service would be reported. Higher levels of service would be reported based on increments of staff time beyond baseline care. For example, Level 2 could be reported for 11 to 20 minutes beyond baseline care, and Level 3 could be reported for 21 to 30 minutes beyond baseline care. This model is simple, correlates with total hospital resource use, and provides an objective standard for all hospitals to follow. However, we observed that this model would require additional, potentially burdensome documentation of staff time, could provide an incentive to work slowly or use less efficient personnel, and has the potential for upcoding and gaming. 3. Guidelines Based on a Point System Where a Certain Number of Points Are Assigned to Each Staff Intervention Based on the Time, Intensity, and Staff Type Required for the Intervention In this model, points or weights are assigned to each facility service and/or intervention provided to a patient in the clinic or emergency department. The level of service is determined by the sum of the points for all services/interventions provided. Commenters to the August 9, 2002 proposed rule recommended various approaches to a point system, including point systems that assigned points based on the amount of staff time spent with the patient, the number of activities performed during the visit, and a combination of patient condition and activities performed. A point system would correlate with facility resource consumption and provide an objective standard. In addition, it is not as easily gamed because time-based interventions can be assigned a set number of points. However, we noted that a point system could present a significant burden for hospitals in terms of requiring additional, clinically unnecessary documentation. Point systems that are complex could require dedicated staff to monitor and maintain them. 4. Guidelines Based on Patient Complexity Several variations were recommended in comments to the August 9, 2002 proposed rule, including assignment of 
                        ( print page 49606)
                        levels of service based on ICD-9-CM (International Classification of Diseases, Ninth Edition, Clinical Modification) diagnosis codes, based on complexity of medical decision making, or based on presenting complaint or medical problem. The premise for these guideline systems is that many emergency departments follow established protocols based on patients' presenting complaints and/or diagnoses. Therefore, assigning a level of service based on patient diagnosis should correlate with facility resource consumption. These systems may require the use of a coding “grid,” which lists more than 100 examples of patient conditions and diagnoses and assigns a level of service to each example. When the patient presents with a condition that does not appear on the grid, the coder must extrapolate from the grid to the individual patient. We expressed concern that these systems are extremely complex, demand significant interpretive work on the part of the coder (who may not have clinical experience), and are subject to variability across hospitals. While no clinically unnecessary documentation would be required because the system is based on diagnoses that are already reported on claims, there is a significant potential for upcoding and gaming. In the August 9, 2002 OPPS proposed rule, we also stated that we were concerned about counting separately paid services (for example, intravenous infusions, x-rays, electrocardiograms, and lab tests) as “interventions” or including their associated “staff time” in determining the level of service. We believed that the level of service should be determined by resource consumption that is not otherwise captured in payments for other separately payable services. We are now reconsidering this perspective and will discuss this further in section IX.D. of the preamble of this proposed rule. In the November 1, 2002 OPPS final rule, we specified that we would not create new codes to replace existing CPT E/M codes for reporting hospital visits until national guidelines have been developed, in response to commenters who were concerned about implementing code definitions without national guidelines. We noted that an independent panel of experts would be an appropriate forum to develop codes and guidelines that are simple to understand and implement, and that are compliant with the HIPAA requirements. We explained that organizations such as the American Hospital Associations (AHA) and the American Health Information Management Association (AHIMA) had such expertise and would be capable of creating hospital visit guidelines and providing ongoing education of providers. We also articulated a set of principles that any national guidelines for facility visit coding should satisfy, including that coding guidelines should be based on facility resources, should be clear to facilitate accurate payments and be usable for compliance purposes and audits, should meet the HIPAA requirements, should only require documentation that is clinically necessary for patient care, and should not facilitate upcoding or gaming. We stated that the distribution of codes should result in a normal curve. We concluded that we believed the most appropriate forum for development of code definitions and guidelines was an independent expert panel that would makes recommendations to CMS. The AHA and AHIMA originally supported the ACEP model for emergency visit coding, but we expressed concern that the ACEP guidelines allowed counting of separately payable services in determining a service level, which could result in the double counting of hospital resources in establishing visit payment rates and payment rates for those separately payable services. Subsequently, on their own initiative, the AHA and AHIMA formed an independent expert panel, the Hospital Evaluation and Management Coding Panel, comprised of members with coding, health information management, documentation, billing, nursing, finance, auditing, and medical experience. This panel included representatives from the AHA, AHIMA, ACEP, Emergency Nurses Association, and American Organization of Nurse Executives. CMS and AMA representatives observed the meetings. On June 24, 2003, the AHA and AHIMA submitted their recommended guidelines, hereafter referred to as the AHA/AHIMA guidelines, for reporting three levels of hospital clinic and emergency visits and a single level of critical care services to CMS, with the hope that CMS would publish the guidelines in the CY 2004 proposed rule. The AHA and AHIMA acknowledged that “continued refinement will be required as in all coding systems. The Panel * * * looks forward to working with CMS to incorporate any recommendations raised during the public comment period” (AHA/AHIMA guidelines report, page 9). The AHA and AHIMA indicated that the guidelines were field-tested several times by panel members at different stages of their development. The guidelines are based on an intervention model, where the levels are determined by the numbers and types of interventions performed by nursing or ancillary hospital staff. Higher levels of services are reported as the number and/or complexity of staff interventions increase. Although we did not publish the guidelines, the AHA and AHIMA released the guidelines through their Web sites. Consequently, we received numerous comments from providers and associations, some in favor and some opposed to the guidelines. We undertook a critical review of the recommendations from the AHA and AHIMA and made some modifications to the guidelines based on comments we received from outside hospitals and associations on the AHA/AHIMA guidelines, clinical review, and changing payment policies in the OPPS regarding some separately payable services. In an attempt to validate the modified AHA/AHIMA guidelines and examine the distribution of services that would result from their application to hospital clinic and emergency visits paid under the OPPS, we contracted a study that began in September 2004 and concluded in September 2005 to retrospectively code, under the modified AHA/AHIMA guidelines, hospital visits by reviewing hospital visit medical chart documentation gathered through the Comprehensive Error Rate Testing (CERT) work. While a review of documentation and assignment of visit levels based on the modified AHA/AHIMA guidelines to 12,500 clinic and emergency visits was initially planned, the study was terminated after a pilot review of only 750 visits. The contractor identified a number of elements in the guidelines that were difficult for coders to interpret, poorly defined, nonspecific, or regularly unavailable in the medical records. The contractor's coders were unable to determine any level for about 25 percent of the clinic cases and about 20 percent of the emergency cases reviewed. The only agreement observed between the levels reported on the claims and levels according to the modified AHA/AHIMA guidelines was the classification of Level 1 services, where the review supported the level on the claims 54-70 percent of the time. In addition, the vast majority of the clinic and emergency visits reviewed were assigned to Level 1 during the review. Based on these findings, we believed that it was not necessary to review additional records after the initial sample. The contractor advised that multiple terms in the guidelines required clearer definition and believed 
                        ( print page 49607)
                        that more examples would be helpful. Although we believe that all of the visit documentation for each case was available for the contractor's review, we were unable to determine definitively that this was the case. Thus, there is some possibility that the contractor's assignments would have differed if additional documentation from the medical records was available for the visits. In summary, while testing of the modified AHA/AHIMA guidelines was helpful in illuminating areas of the guidelines that would benefit from refinement, we were unable to draw conclusions about the relationship between the distribution of current hospital reporting of visits using CPT E/M codes that are assigned according to each hospital's internal guidelines and the distribution of coding under the AHA/AHIMA guidelines, nor were we able to demonstrate a normal distribution of visit levels under the modified AHA/AHIMA guidelines. B. CY 2007 Proposed Coding As discussed above, the majority of all CPT code descriptors are applicable to both physician and facility resources associated with specific services. However, we believe that CPT E/M codes were defined to reflect the activities of physicians and do not describe well the range and mix of services provided by hospitals during visits of clinic and emergency department patients and critical care encounters. While awaiting the development of a national set of facility-specific codes and guidelines, we have advised that each hospital's internal guidelines should follow the intent of the CPT code descriptors, in that the guidelines should be designed to reasonably relate the intensity of hospital resources to the different levels of effort represented by the codes. In the November 1, 2002 OPPS final rule, we specified that we would not create new codes to replace existing CPT E/M codes for reporting hospital visits until national guidelines have been developed, in response to commenters who were concerned about implementing code definitions without national guidelines. While we do not yet have a formal set of guidelines that we believe may be appropriately applied nationally to report different levels of hospital clinic and emergency department visit and to report critical care services, we have made significant progress in developing potential guidelines and, therefore, are proposing for CY 2007 the establishment of HCPCS codes to describe hospital clinic and emergency department visits and critical care services. Prior to our implementation of national guidelines for the new hospital visit HCPCS codes, we are proposing that hospitals may continue to use their existing internal guidelines to determine the visit levels to be reported with these codes. We anticipate that many providers would choose to use their existing guidelines for reporting visits with CPT codes. We do not expect a substantial workload for a provider that chooses to adjust its guidelines to reflect our proposed policies. We acknowledge that it can be burdensome for providers to bill G-codes rather than CPT codes. In this case, because current CPT E/M codes do not describe hospital visit resources, we have no alternative other than to create new G-codes. CPT has not yet created clinic and emergency department visit and critical care services codes that describe hospital resource utilization. It is important to note that G-codes may be recognized by other payers. 1. Clinic Visits For clinic visits, we are proposing five new codes, to replace hospitals' reporting of the CPT clinic visit E/M codes for new and established patients and consultations listed in Table 31. Providers have been reporting five levels of CPT codes through CY 2006, and we believe that it should be fairly easy to crosswalk current internal hospital guidelines to these five proposed new codes. Commenters to prior rules have stated that the hospital resources used for new and established patients to provide a specific level of service are very similar, and that it is unnecessary and burdensome from a coding perspective to distinguish between the two types of visits. The new codes are proposed in Table 32 below. Table 32.—Proposed CY 2007 HCPCS Codes To Be Used To Report Clinic Visits
HCPCS code
Short descriptor
Long descriptorGxxx1
Level 1 hosp clinic visit
Level 1 hospital clinic visit.Gxxx2
Level 2 hosp clinic visit
Level 2 hospital clinic visit.Gxxx3
Level 3 hosp clinic visit
Level 3 hospital clinic visit.Gxxx4
Level 4 hosp clinic visit
Level 4 hospital clinic visit.Gxxx5
Level 5 hosp clinic visit
Level 5 hospital clinic visit.
 2. Emergency Department Visits As described above, CPT defines an emergency department as “an organized hospital-based facility for the provision of unscheduled episodic services to patients who present for immediate medical attention. The facility must be available 24 hours a day.” Under the OPPS, we have restricted the billing of emergency department CPT codes to services furnished at facilities that meet this CPT definition. Facilities open less than 24 hours a day should not use the emergency department codes. Sections 1866(a)(1)(I), 1866(a)(1)(N), and 1867 of the Act impose specific obligations on Medicare-participating hospitals and critical access hospitals that offer emergency services. These obligations concern individuals who come to a hospital's dedicated emergency department (DED) and request examination or treatment for medical conditions, and apply to all of these individuals, regardless of whether or not they are beneficiaries of any program under the Act. Section 1867(h) of the Act specifically prohibits a delay in providing required screening or stabilization services in order to inquire about the individual's payment method or insurance status. Section 1867(d) of the Act provides for the imposition of civil monetary penalties on hospitals and physicians responsible for failing to meet the provisions listed above. These provisions, taken together, are frequently referred to as the Emergency Medical Treatment and Labor Act (EMTALA). EMTALA was passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act of 1985 Pub. L. 99-272 (COBRA). Section 489.24 of the EMTALA regulations defines “dedicated emergency department” as any department or facility of the hospital, regardless of whether it is located on or off the main hospital campus, that meets at least one of the following requirements: (1) It is licensed by the State in which it is located under applicable State law as an emergency room or emergency department; (2) It is 
                        ( print page 49608)
                        held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) During the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment. We believe that every emergency department that meets the CPT definition of emergency department also qualifies as a dedicated emergency department under EMTALA. However, we are aware that there are some departments or facilities of hospitals that meet the definition of a DED under the EMTALA regulations but that do not meet the more restrictive CPT definition of an emergency department. For example, a hospital department or facility that meets the definition of a DED may not be available 24 hours a day, 7 days a week. Nevertheless, hospitals with such departments or facilities incur EMTALA obligations with respect to an individual who presents to the department and requests, or has requested on his or her behalf, examination or treatment for an emergency medical condition. However, because they do not meet the CPT requirements for reporting emergency visit E/M codes, these facilities must bill clinic visit codes for the services they furnish. We have no way to distinguish in our hospital claims data the costs of visits provided in DEDs that do not meet the CPT definition of emergency department from the costs of clinic visits. Some hospitals have requested that they be permitted to bill emergency visit codes under the OPPS for services furnished in a facility that meets CPT's definition for reporting emergency visit E/M codes, except that they are not available 24 hours a day. These hospitals believe that their resource costs are more similar to those of emergency departments that meet the CPT definition than they are to the resource costs of clinics. Representatives of such facilities have argued that emergency department visit payments are more appropriate, on the grounds that their facilities treat patients with emergency conditions whose costs exceed the resources reflected in the clinic visit APC payments, even though these emergency departments are not available 24 hours per day. In addition, these hospital representatives indicated that their facilities have EMTALA obligations and should, therefore, be able to receive emergency visit payments. While these emergency departments may provide a broader range and intensity of hospital services and require significant resources to assure their availability and capabilities in comparison with typical hospital outpatient clinics, the fact that they do not operate with all capabilities full-time suggests that hospital resources associated with visits to emergency departments or facilities available less than 24 hours a day may not be as great as the resources associated with emergency departments or facilities that are available 24 hours a day and that fully meet the CPT definition. To determine whether visits to emergency departments or facilities (referred to as Type B emergency departments) that incur EMTALA obligations but do not meet more prescriptive expectations that are consistent with the CPT definition of an emergency department (referred to as Type A emergency departments) have different resource costs than visits to either clinics or Type A emergency departments, for CY 2007 we are proposing a set of five G-codes for use by all entities that meet the definition of a DED under the EMTALA regulations in § 489.24 but that are not Type A emergency departments, as described in Table 33 below. These codes will be called “Type B emergency visit codes.” Table 33.—Proposed CY 2007 HCPCS Codes To Be Used To Report Emergency Visits Provided in Type B Emergency Departments
HCPCS code
Short descriptor
Long descriptorGzzz1
Lev 1 hosp type B ED visit
Level 1 hospital emergency department visit provided in a Type B emergency department. (The ED must meet at least one of the following requirements: (1) It is licensed by the State in which it is located under applicable State law as an emergency room or emergency department; (2) It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) During the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment).Gzzz2
Lev 2 hosp type B ED visit
Level 2 hospital emergency department visit provided in a Type B emergency department. (The ED must meet at least one of the following requirements: (1) It is licensed by the State in which it is located under applicable State law as an emergency room or emergency department; (2) It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) During the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment).( print page 49609)Gzzz3
Lev 3 hosp type B ED visit
Level 3 hospital emergency department visit provided in a Type B emergency department. (The ED must meet at least one of the following requirements: (1) It is licensed by the State in which it is located under applicable State law as an emergency room or emergency department; (2) It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) During the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment).Gzzz4
Lev 4 hosp type B ED visit
Level 4 hospital emergency department visit provided in a Type B emergency department. (The ED must meet at least one of the following requirements: (1) It is licensed by the State in which it is located under applicable State law as an emergency room or emergency department; (2) It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) During the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment).Gzzz5
Lev 5 hosp type B ED visit
Level 5 hospital emergency department visit provided in a Type B emergency department. (The ED must meet at least one of the following requirements: (1) It is licensed by the State in which it is located under applicable State law as an emergency room or emergency department; (2) It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) During the calendar year immediately preceding the calendar year in which a determination under this section is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment).
 For CY 2007, we also are proposing to create five G-codes to be reported by the subset of provider-based emergency departments or facilities of the hospital, called Type A emergency departments, that are available to provide services 24 hours a day, 7 days per week and meet one or both of the following requirements related to the EMTALA definition of DED, specifically: (1) It is licensed by the State in which it is located under the applicable State law as an emergency room or emergency department; or (2) It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment. These codes will be called “Type A emergency visit codes” and would replace hospitals’ current reporting of the CPT emergency department visit E/M codes listed in Table 33. Our intention is to allow hospital-based emergency departments or facilities that are currently appropriately reporting CPT emergency department visit E/M codes to bill these new Type A emergency visit codes. We believe that this proposed definition of Type A emergency departments will neither narrow nor broaden the group of emergency departments or facilities that may bill the Type A emergency visit codes in comparison with those that are currently correctly billing CPT emergency department visit E/M codes. Rather, we are refining and clarifying the definition for use in the hospital context. We believe that because the concepts employed in the definition of a DED for EMTALA purposes are already familiar to hospitals, it is appropriate to employ those concepts, rather than the concepts employed in the CPT definition of emergency department, for purposes of defining these new G-codes. As we have previously noted, the CPT codes were defined to reflect the activities of physicians and do not always describe well the range and mix of services provided by hospitals during visits of emergency department patients. We believe that these new codes that we are proposing for reporting emergency visits to Type A emergency departments are more specific to the hospital context. For example, one feature that distinguishes Type A hospital emergency departments from other departments of the hospital is that Type A emergency departments do not generally provide scheduled care, but rather regularly operate to provide immediately available unscheduled services. The new codes that we are proposing for CY 2007 are listed in Table 34 below. 
                        ( print page 49610) Table 34.—Proposed CY 2007 HCPCS Codes To Be Used To Report Emergency Visits Provided in Type A Emergency Departments
HCPCS code
Short descriptor
Long descriptorGyyy1
Lev 1 hosp type A ED visit
Level 1 hospital emergency visit provided in a Type A hospital-based facility or department. (The facility or department must be open 24 hours a day, 7 days a week and meets at least one of the following requirements: (1) It is licensed by the State in which it is located under applicable State law as an emergency room or emergency department; or (2) It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment).Gyyy2
Lev 2 hosp type A ED visit
Level 2 hospital emergency visit provided in a Type A hospital-based facility or department. (The facility or department must be open 24 hours a day, 7 days a week and meets at least one of the following requirements: (1) It is licensed by the State in which it is located under applicable State law as an emergency room or emergency department; or (2) It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment).Gyyy3
Lev 3 hosp type A ED visit
Level 3 hospital emergency visit provided in a Type A hospital-based facility or department. (The facility or department must be open 24 hours a day, 7 days a week and meets at least one of the following requirements: (1) It is licensed by the State in which it is located under applicable State law as an emergency room or emergency department; or (2) It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment).Gyyy4
Lev 4 hosp type A ED visit
Level 4 hospital emergency visit provided in a Type A hospital-based facility or department. (The facility or department must be open 24 hours a day, 7 days a week and meets at least one of the following requirements: (1) It is licensed by the State in which it is located under applicable State law as an emergency room or emergency department; or (2) It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment).Gyyy5
Lev 5 hosp type A ED visit
Level 5 hospital emergency visit provided in a Type A hospital-based facility or department. (The facility or department must be open 24 hours a day, 7 days a week and meets at least one of the following requirements: (1) It is licensed by the State in which it is located under applicable State law as an emergency room or emergency department; or (2) It is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment).
 3. Critical Care Services For critical care services, we are proposing two new codes, to replace hospitals' reporting of the CPT E/M critical care codes listed in Table 31. Providers have been reporting two CPT codes through CY 2006, and we believe that it should be fairly easy to crosswalk current internal hospital guidelines to these two new proposed codes. The proposed new codes are listed in Table 35 below. Table 35.—Proposed CY 2007 HCPCS Codes To Be Used To Report Critical Care Services
HCPCS code
Short descriptor
Long descriptorGccc1
Hosp critical care, 30-74 min
Hospital critical care services, first 30-74 minutes.Gccc2
Hosp critical care, add 30 min
Hospital critical care services, each additional 30 minutes.
 C. CY 2007 Proposed Payment Policy Since the implementation of the OPPS, outpatient visits provided by hospitals have been paid at three payment levels for both clinic and emergency department visits, even though hospitals have been reporting five resource-based coding levels of clinic and emergency department visits using CPT E/M codes. Critical care services have been paid at one level, with separate payment for the first 30 to 74 minutes of care and bundling of payment for all additional 30 minute increments of critical care services into payment for the first 30-74 minutes. If the critical care service is less than 30 minutes in duration, then it is to be billed as either a clinic visit or an emergency visit CPT code. Because the three payment rates for clinic and emergency department visits are based on five levels of CPT codes as listed in Table 31, in general the two lowest levels of CPT codes (1 and 2) are assigned to the low-level visit APCs and the two highest levels of CPT codes (4 and 5) are assigned to the high-level visit APCs, with the single middle CPT level CPT code (3) assigned to the mid-level visit APCs. Hospital claims data indicate that the cost of providing a visit of the same level is generally significantly higher for emergency visits in comparison with clinic visits, with the differential increasing at higher levels of services. Based upon CY 2005 claims data processed through December 31, 2005, the median costs of clinic visit, emergency visit, and critical care APCs as configured for CY 2006 are listed below. 
                        ( print page 49611) Table 36.—Median Costs of Clinic and Emergency Visit and Critical Care APCs as Configured for CY 2006
APC title
APC 
                                 median
Levels of CPT codes assigned to APC**Clinic Visits**Low Level Clinic Visits
$53.94
Level 1 Clinic Visit, Level 2 Clinic Visit.Mid Level Clinic Visits
63.73
Level 3 Clinic Visit.High Level Clinic Visits
91.27
Level 4 Clinic Visit, Level 5 Clinic Visit.**Emergency Department Visits**Low Level Emergency Visits
76.43
Level 1 ED Visit, Level 2 ED Visit.Mid Level Emergency Visits
133.98
Level 3 ED Visit.High Level Emergency Visits
237.17
Level 4 ED Visit, Level 5 ED Visit.**Critical Care Services**Critical Care
495.16
Critical care, first hour.
 Historical hospitals claims data, however, have generally reflected significantly different median costs for the two levels of services assigned to the low and high level visit APCs. While the median costs of these services do not violate the 2 times rule within their assigned APCs, this may not be the most accurate method of payment for these very common hospital levels of visits which clearly demonstrate differential hospital resources. In particular, because of the relatively low volume of the highest levels of services in the clinic and emergency department, our payment rates may be especially low. Therefore, we are proposing five payment levels for clinic and emergency visits and one payment level for critical care services. As discussed in the previous section, we are proposing to create 17 new G-codes to replace the CPT E/M codes that hospitals are currently billing to report visits and critical care services. To determine appropriate payment rates for the new G-codes, we are proposing to map the data from the CY 2005 CPT E/M codes and other HCPCS codes currently assigned to the clinic visit APCs to 11 new APCs, 5 for clinic visits, 5 for emergency visits, and 1 for critical care services as shown in Table 37 to develop median costs for these APCs. We mapped the CPT E/M codes and other HCPCS codes to the new APCs based on median costs and clinical considerations. 
 
  In the case of the CPT E/M codes for emergency visits, the assignment of data from a single visit code to the new Type A Emergency Visit APC of the same level was straightforward. Similarly, the assignment of data from the only separately payable critical care CPT code to the new APC for critical care services was clear-cut. However, in some cases of the data for CPT clinic visit E/M codes, we assigned a code to 
                        ( print page 49613)
                        an appropriate clinic visit APC level based upon resource and clinical homogeneity considerations, and that APC assignment did not correspond to the visit level described by the code. For example, CPT 99213 is a level 3 clinic visit code for an established patient, which would seem to logically map to the Level 3 Clinic Visit APC. However, because CPT 99213 has a median cost of $63.04, it maps more appropriately to the Level 2 Clinic Visit APC, which has an overall median cost of $62.12. In general, CPT codes for established patient visits had lower median costs than new patient visit or consultation codes of the same E/M level, and that variability is reflected in their respective proposed APC data assignments for CY 2007. We believe that in CY 2007, when hospitals utilize their own internal guidelines to report clinic visits, without codes that differentiate among new, established, or consultation visits, they will report G-code levels that reflect their resources used. We expect that payments provided for G-codes of each level, based upon the CY 2005 claims data assignments as listed in Table 38, would provide appropriate resource-based payments for visits reported at each level. After the CY 2005 CPT E/M codes and other HCPCS codes were mapped to an appropriate new APC as shown in Table 38, the next step required was to assign an APC to each new G-code for which no data were available. We assigned these 16 new separately payable G-codes to an appropriate APC level based on the code level alone as shown in Table 38. For example, both the Level 1 Hospital Clinic Visit and Level 1 Hospital Type B ED visit codes are mapped to the Level 1 Hospital Clinic Visit APC, 0604. Similarly, the Level 1 Hospital Type A ED visit code is mapped to the Level 1 Type A Emergency Visit APC, 0609. We expect that this configuration would provide appropriate resource-based payments for visits reported at each level. We are proposing to assign status indicator “B” to the CPT E/M codes for CY 2007, with no APC assignment, because we are proposing new G-codes for the OPPS for CY 2007, as delineated in Table 38. Table 38 also removes codes that were deleted by CPT for CY 2007, and only includes codes that would be effective under the OPPS for CY 2007. 
 
  We are proposing to map the five new clinic visit G-codes to the five new Clinic Visit APCs, 0604, 0605, 0606, 0607, and 0608. We are proposing to assign the five new Type A emergency visit codes for services provided in a Type A emergency department to the five new Type A Emergency Visit APCs, 0609, 0613, 0614, 0615, and 0616. For CY 2007, we are proposing to assign the five new Type B emergency visit codes for services provided in a Type B emergency department to the five new Clinic Visit APCs, 0604, 0605, 0606, 0607, and 0608. This payment policy for Type B emergency visits is similar to our current policy which requires services furnished in emergency departments that have an EMTALA obligation but do not meet the CPT definition of emergency department to be reported using CPT clinic visit E/M codes, resulting in payments based upon clinic visit APCs. As mentioned above, CPT requires an emergency department to be open 24 hours per day in order for it to be eligible to bill emergency department E/M codes. While maintaining the same payment policy for Type B emergency department visits in CY 2007, the reporting of specific G-codes for emergency visits provided in Type B emergency departments will permit us to specifically collect and analyze the hospital resource costs of visits to these facilities in order to determine in the future whether a proposal of an alternative payment policy may be warranted. This approach to more refined data collection is similar to our approach to drug administration services under the OPPS over the past several years. We collected hospital claims data for specific detailed services using CPT and HCPCS codes for CYs 2005 and 2006, while making payments based on claims data available to us for the less specific HCPCS codes billed by hospitals prior to CY 2005. We recognize that reporting specific drug administration services for which hospitals received no separate or 
                        ( print page 49615)
                        additional payments created some additional administrative burden on hospitals for a period of time, but the resource information collected through the claims submissions has been critical to the development of our proposal of more refined drug administration payment policies. The hospital claims data based upon the CY 2005 drug administration coding structure now form the foundation of our CY 2007 proposal for drug administration services as described in section VIII.C. of the preamble to this proposed rule. Although we believe that our proposed payment policy for CY 2007 for Type B emergency department visits is consistent with our past policy regarding visits to emergency departments that do not meet the CPT definition of an emergency department, we are interested in public comments regarding this policy. The OPPS rulemaking cycle for CY 2009 will be the first year that we will have cost data for these new Type B emergency department HCPCS codes available for analysis. In the interim, we are particularly concerned with ensuring that necessary emergency department services are available to rural Medicare beneficiaries. We recognize that rural emergency departments may be disproportionately likely to offer essential emergency department services less than 24 hours per day, 7 days a week because of the limited demand for those services and the high costs and inefficiencies associated with providing full emergency department availability during times when few patients are present for emergency care. We believe that our OPPS payment policies for Type A and Type B emergency visits should support the ability of hospitals to provide their communities with essential and appropriate emergency department services efficiently and effectively. We also believe that the payment policies should present no payment incentive for hospitals to provide necessary emergency services less than 24 hours per day, 7 days per week, which could result in limited access to emergency services for Medicare beneficiaries, thereby leading to adverse effects on their health. We are proposing to map code Gccc1, the new proposed hospital critical care services code for the first 30-74 minutes of care, to the proposed new Critical Care APC 0617. We are proposing to assign status indicator “N” to proposed HCPCS code Gccc2, to indicate that the code is packaged, as the predecessor code to Gccc2 was also packaged. D. CY 2007 Proposed Treatment of Guidelines 1. Background As described in section IX.A. of the preamble of this proposed rule, since April 7, 2000 we have instructed hospitals to report facility resources for clinic and emergency department outpatient hospital visits using the CPT E/M codes and to develop internal hospital guidelines for reporting the appropriate visit level. In the CY 2003 OPPS final rule with comment period, we noted that an independent panel of experts would be an appropriate forum to develop codes and guidelines. In that final rule with comment period, we also articulated a set of principles that any national guidelines for facility visit coding should satisfy, including that coding guidelines should be based on facility resources, should be clear to facilitate accurate payments and be usable for compliance purposes and audits, should meet the HIPAA requirements, should only require documentation that is clinically necessary for patient care, and should not facilitate upcoding or gaming. We stated that the distribution of codes should result in a normal curve. Subsequently, as described above, the AHA and AHIMA formed an independent expert panel, the Hospital Evaluation and Management Coding Panel, and submitted the AHA/AHIMA guidelines for reporting three levels of hospital clinic and emergency visits and a single level of critical care services to CMS. The guidelines are based on an intervention model, where the levels are determined by the numbers and types of interventions performed by nursing or ancillary hospital staff. We undertook a critical review of the recommendations and made some modifications to the guidelines based on comments we received from outside hospitals and associations, clinical review, and changing payment policies in the OPPS regarding some separately payable services. In addition, as previously stated, we contracted a study to retrospectively code, under the modified AHA/AHIMA guidelines, hospital visits by reviewing hospital visit medical chart documentation gathered through CERT work. In summary, while the testing of the modified AHA/AHIMA guidelines was helpful in illuminating areas of the guidelines that would benefit from refinement, we were unable to draw conclusions about the relationship between the distribution of current hospital reporting of visits using CPT E/M codes that are assigned according to each hospital's internal guidelines and the distribution of code levels under the AHA/AHIMA guidelines, nor were we able to demonstrate a normal distribution of visit levels under the modified AHA/AHIMA guidelines. Despite the inconclusive findings from the validation study, after reviewing the AHA/AHIMA guidelines, as well as approximately a dozen other guidelines for outpatient visits submitted by various hospitals and hospital associations, we believe that the AHA/AHIMA guidelines are the most appropriate and well-developed guidelines for use in the OPPS of which we are aware. Our particular interest in these guidelines is based upon the broad-based input into their development, the need for CMS to move definitively to promulgate national outpatient hospital visit coding guidelines in the near future, and full consideration of the characteristics of alternative types of guidelines. We also think that hospitals will react favorably to guidelines developed and supported by the AHA and AHIMA, national organizations that have great interest in hospital coding and payment issues and possess significant medical, technical and practical expertise due to their broad membership, which includes hospitals and health information management professionals. Anecdotally, we have been told that a number of hospitals are successfully utilizing the AHA/AHIMA guidelines to report levels of hospital visits. However, other organizations have expressed concern that the AHA/AHIMA guidelines may result in a significant redistribution of hospital visits to higher levels, reducing the ability of the OPPS to discriminate among the hospital resources required for various different levels of visits. We, too, remain concerned about the potential redistributive effect on OPPS payments for other services or among levels of hospital visits when national guidelines for outpatient visit coding are adopted. We recognize that there may be difficulty crosswalking historical hospital claims data from current CPT E/M codes reported based on individual internal hospital guidelines to payments for any new coding system developed, in order to provide appropriate payment levels for hospital visits reported based on national guidelines in the future. There are several types of problems with the AHA/AHIMA guidelines that have been identified based upon extensive staff review and contractor use of the guidelines during the validation study. We believe the AHA/AHIMA guidelines require short-term refinement prior to their full adoption by the OPPS, as well as continued refinement over time after their 
                        ( print page 49616)
                        implementation. Our modified version of the AHA/AHIMA guidelines provides some possibilities for addressing certain issues. Our eight general areas of concern regarding the AHA/AHIMA model are listed below. In addition, we have posted to the CMS Web site both the original AHA/AHIMA guidelines and our modified draft version, and we are seeking public input before we adopt national guidelines. We continue to commit that we will provide a minimum of 6-12 months notice to hospitals prior to implementation of national guidelines to provide sufficient time for providers to make the necessary systems changes and educate their staff. 2. Outstanding Concerns With the AHA/AHIMA Guidelines a. Three Versus Five Levels of Codes The AHA/AHIMA guidelines describe three levels of codes for clinic and emergency visits, rather than the five levels of codes that we are proposing for clinic and Type A and Type B emergency visits. It would be impossible to pay at five levels using these guidelines, unless the guidelines were revised. As discussed above, our claims data indicate that five payment levels are justified for both clinic and Type A emergency visits, and, therefore, we are proposing five levels of G-codes so that providers may code at five visit levels and receive payments at five levels as well. In fact, the materials explaining the AHA/AHIMA guidelines state that one of the reasons that the model includes only three coding levels is because CMS only paid at three payment levels. We are now proposing to pay at five payment levels, and if our proposed CY 2007 payment policy is finalized, the AHA/AHIMA guidelines may need to be revised to reflect five visit levels. b. Lack of Clarity for Some Interventions Some interventions are vague, unclear, or nonspecific, without sufficient examples of documentation in the medical record that may support those interventions. For instance, it is unclear what documentation for the intervention stated as “Patient registration, room set up, patient use of room, room cleaning” and assigned in the AHA/AHIMA guidelines to a low-level clinic visit would be necessary to support all aspects of that intervention. In another case, the intervention “Frequent monitoring/assessment as evidenced by two sets of vital sign measurements or assessments” that is attributable to a mid-level emergency visit in the guidelines explains that this may include assessment of cardiovascular, pulmonary, or neurological status. However, it is unclear exactly what coders should look for in the medical record to support this intervention and whether narrative hospital staff descriptions of patient status would be considered to be assessments. These examples, and others, were identified by the contractor engaged in medical chart reviews as part of the guidelines validation study. The AHA/AHIMA guidelines may benefit from revisions to clarify some interventions and/or provide additional examples based upon questions that arose during field testing of the guidelines or that are raised by hospitals reviewing the AHA/AHIMA guidelines and the modified version posted on our Web site. c. Treatment of Separately Payable Services CMS and the APC Panel stated that separately payable services should be excluded from the guidelines because of their concern over the potential for double payment for hospital resources attributed to visit services when those resources were actually used to provide the separately payable services. Consistent with this policy, at the time of their development the AHA/AHIMA guidelines excluded all services separately payable under the OPPS from the list of interventions. For policy consistency, in our modified draft version of the guidelines, we removed interventions that have now become separately payable under the OPPS through CY 2006, such as bladder catheterizations and some wound care services. However, upon further reflection as we move forward to implement national guidelines, we are open to reconsidering whether the inclusion of some separately payable services in guidelines to determine visit levels could serve as a proxy for the resources that the patient will consume and that should be attributable to the hospital visit, not the separately payable services. In such cases, consideration of separately payable services in reporting visit levels may not result in double payment for components of those separately payable services. There may be hospital resources used in visits that are not captured in the AHA/AHIMA guidelines' limited number of interventions that are not separately payable. We believe that, in general, a patient with high medical acuity will consume more hospital resources in the visit than a patient with moderate acuity. However, when separately payable interventions are removed from the model, it may be difficult for the limited interventions remaining in the guidelines for each visit level to capture the acuity level of the patient. In addition, the list of HCPCS codes that are packaged can change annually. For example, in the CY 2006 OPPS, bladder catheterization services, which had been packaged in prior years, were first made separately payable. If the guidelines strictly excluded all separately payable services, then the guidelines could also change from year to year, possibly requiring additional education of hospital staff on an annual basis. An extremely ill emergency department patient who may need a significant number of separately payable procedures, but only one or two minor interventions that are not separately payable, may require significant time and attention from hospital staff that is unrelated to the hospital resources generally required for the separately payable procedures. The guidelines may indicate that a low level emergency department visit code should be billed, while in fact the patient may require significantly more hospital resources than a mildly ill patient who received the same two minor interventions. We are open to further discussion and welcome public comments on the exclusion of separately payable services from the national visit guidelines and whether their inclusion could pose a risk of attributing the same hospital resources to both visits and separately payable services, potentially resulting in duplicate payments for those resources. d. Some Interventions Appear Overvalued Several interventions that we believe may be minor are valued at a high level in the guidelines. This could result in visits with relatively less resource intensive interventions being coded as high level visits, leading to an overall visit distribution that was skewed toward the high end. Claims data then would fail to reflect the differential hospital resources associated with hospital visits of five levels. For example, the AHA/AHIMA guidelines consider oxygen administration, described as initiation and/or adjustment from a baseline oxygen regimen, to be a mid level emergency department intervention, while we believe that the associated hospital resources could be more consistent with its characterization as a low level emergency department intervention. In another example, the AHA/AHIMA guidelines consider specimen collection(s), other than venipuncture and other separately payable services, to be a mid level clinic intervention, while we believe this may be more consistent with other low level clinic 
                        ( print page 49617)
                        interventions, depending upon the numbers and types of different specimens collected. We encourage specific comments on the levels assigned to various interventions in the guidelines, with the goal of differentiating five levels of services in a normal distribution, based on their respective hospital resources. e. Concerns of Specialty Clinics The AHA/AHIMA guidelines are unlikely to sufficiently address the concerns of various specialty clinics (for example, pain management clinics, oncology clinics, and wound care centers). Anecdotally, we have heard that the interventions listed in the AHA/AHIMA guidelines do not include many of the interventions commonly performed in specialty clinics and that some of the interventions in the guidelines would never be performed in certain types of clinics. Currently, each provider has its own set of guidelines, and we believe that some specialty clinics have customized guidelines to facilitate coding their visits at different levels based upon the specific hospital resources commonly used in visits to their clinics. While we prefer to have one model that can be applied nationally to each level of clinic visit code for which we make a specific OPPS payment, we are unsure as to whether one model can adequately characterize visit levels for all types of clinics. For example, we have been told that the most appropriate proxy for facility resource consumption in cancer care is staff time due to the intensive staff interactions required to care for patients with cancer, regardless of the reasons for their clinic visits. We are interested in comments regarding the feasibility of applying national guidelines to specialty clinic visits while ensuring appropriate OPPS payments for those services and suggestions for revisions to the guideline models posted that could improve their utility in reporting such visits. f. Americans With Disabilities Act We are concerned that the AHA/AHIMA guidelines' intervention related to the special needs of certain patients may be in violation of the Americans with Disabilities Act, as it may increase the visit level reported, thereby increasing a patient's copayment. Even if additional hospital resources are required to treat patients with disabilities, patients must not have additional financial liability for those services based on their disabilities. g. Differentiation Between New and Established Patients, and Between Standard Visits and Consultations The AHA/AHIMA guidelines do not differentiate between new versus established patients or consultations versus standard visits for clinic visits. During the summer 2002 APC Panel meeting, the APC Panel recommended that CMS not differentiate among visit types, specifically new, established, and consultation visits, for the purposes of clinic visit facility coding. Therefore, in the August 9, 2002 OPPS proposed rule, we proposed to accept the APC Panel's recommendation to create five new G-codes to replace the CPT new and established clinic visit and consultation E/M codes. We did not finalize the codes for CY 2003 because of concerns then about creating new G-codes without national guidelines. During CY 2006 and earlier, there has not been a payment difference between new and established patient visits of the same level, as generally both were mapped to the same APC. The information describing the AHA/AHIMA guidelines indicates that only one set of guidelines was developed for five levels of codes for clinic visits, regardless of a patient's status as a new or established patient or the provision of a consultation visit. This approach may have been related to the lack of a payment differential for different types of clinic visits of the same level under the OPPS when those guidelines were developed. However, several years of hospital claims data regarding the median costs of the specific CPT clinic visit E/M codes consistently indicate that new patients generally are more resource intensive than existing patients across all visit levels, and that consultations are more resource intensive than standard visits. For example, based upon CY 2005 claims used by the OPPS for CY 2007 ratesetting, CPT code 99213, the level 3 clinic visit code for established patients, has a median cost of $63.04. CPT code 99203, the level 3 clinic visit code for new patients, has a median cost of $74.12. CPT code 99243, the level 3 consultation visit code, has a median cost of $84.14. Finally, CPT code 99273, the level 3 confirmatory consultation visit code which was deleted for CY 2006, had a median cost of $100.77. We encourage public comments that discuss the potential differences in hospital clinic resource consumption for new patient visits, established patient visits, and consultations. If there are significant additional hospital resources required to provide new patient visits or consultations, we are unsure whether the interventions in the AHA/AHIMA guidelines would reliably capture these additional resources. h. Distinction Between Type A and Type B Emergency Departments There are no AHA/AHIMA guidelines for the reporting of visits to Type B emergency departments that meet the EMTALA definition of a DED, but do not meet the proposed definition of a Type A emergency department, as discussed above. When the AHA and AHIMA created these guidelines, emergency departments that did not meet the CPT definition of emergency department were instructed to bill CPT clinic visit E/M codes. There was no distinction in reporting between emergency departments that, as DEDs, had an EMTALA obligation but did not meet the CPT definition of emergency department and outpatient hospital clinics that did not provide emergency services. If we finalize our proposal to create new G-codes for CY 2007 for Type B emergency departments to use in reporting visits, in the short run hospitals will use internal guidelines to determine their visit levels for Type B emergency department visits, as they will for visits to both clinics and Type A emergency departments. However, with the implementation of national hospital visit guidelines we will need to specify those guidelines to be used for the purposes of Type B emergency visit reporting. The AHA and AHIMA have not yet had the opportunity to consider the issue of Type B emergency visit reporting in their guidelines, and we welcome public comments to provide additional perspectives on the appropriate guidelines for reporting visit levels in these Type B emergency departments. The public comments that we receive on this guidelines section of this proposed rule will be publicly available to the AHA and AHIMA and their expert panel, along with comments that we receive on the two versions of the guidelines posted on our Web site. We hope to receive input from them over the upcoming months to address the eight areas of concern that are discussed above, as well as other issues brought to our attention by the public. We understand that some issues will not be able to be fully addressed by their expert panel until we finalize our CY 2007 payment policies for visits in the OPPS. We plan to communicate progress on the development of OPPS visit guidelines through updates to the OPPS Web site, and we may post other versions of draft guidelines in order to solicit additional public input during CY 2007. When we post additional 
                        ( print page 49618)
                        materials to the web for purposes of providing information or soliciting further comments regarding national guidelines, we will update the public through all means practically available to us, including communications with professional associations, list-serves, etc. While we understand the interest of some hospitals in our moving quickly to promulgate national guidelines that will assure standardized reporting of outpatient hospital visit levels, we believe that the issues we have identified and others that may arise are important and require serious consideration prior to the implementation of national guidelines. Because of our commitment to provide hospitals with 6-12 months notice prior to implementation of national guidelines, we expect that we will not implement national guidelines prior to CY 2008. We acknowledge that, once implemented, the guidelines will require periodic review and updating based on factors such as changing medical practices, hospital experiences in reporting the codes, new payment policies under the OPPS, and median costs for levels of services calculated from claims data. We are hopeful that the information received from the AHA, AHIMA and others on such reviews would permit us to effectively, and in a timely manner, address emerging guideline implementation issues, as well as develop desirable future modifications to the guidelines based on hospitals' experiences reporting commonly provided visits. We believe that this ongoing system should provide the most successful approach to ensuring that OPPS national visit guidelines continue to facilitate consistent and standardized reporting of outpatient hospital visits, in a manner that is resource-based and supportive of appropriate OPPS payments for the efficient and effective provision of visits in hospital outpatient settings. X. Proposed Payment for Blood and Blood Products A. Background (If you choose to comment on issues in this section, please include the caption “Blood and Blood Products” at the beginning of your comment.) Since the implementation of the OPPS in August 2000, separate payments have been made for blood and blood products through APCs rather than packaging them into payments for the procedures with which they were administered. Hospital payments for the costs of blood and blood products, as well as the costs of collecting, processing, and storing blood and blood products, are made through the OPPS payments for specific blood product APCs. On April 12, 2001, CMS issued the original billing guidance for blood products to hospitals (Program Transmittal A-01-50). In response to requests for clarification of these instructions, CMS issued Program Transmittal 496 on March 4, 2005. The comprehensive billing guidelines in the Program Transmittal also addressed specific concerns and issues related to billing for blood-related services, which the public had brought to our attention. In the CY 2000 OPPS, payments for blood and blood products were established based on external data provided by commenters due to limited Medicare claims data. From the CY 2000 OPPS to the CY 2002 OPPS, payment rates for blood and blood products were updated for inflation. For the CY 2003 OPPS, as described in the November 1, 2002 final rule with comment period (67 FR 66773), we applied a special adjustment methodology to blood and blood products that had significant reductions in payment rates from the CY 2002 OPPS to the CY 2003 OPPS, when median costs were first calculated from hospital claims. Using the adjustment methodology, we limited the decrease in payment rates for blood and blood products to approximately 15 percent. For the CY 2004 OPPS, as recommended by the APC Panel, we froze payment rates for blood and blood products at CY 2003 levels as we studied concerns raised by commenters and presenters at the August 2003 and February 2004 APC Panel meetings. For the CY 2005 OPPS, we established new APCs that allowed each blood product to be assigned to its own separate APC, as several of the previous blood product APCs contained multiple blood products with no clinical homogeneity or whose product-specific median costs may not have been similar. Some of the blood product HCPCS codes were reassigned to the new APCs (Table 34 of the November 15, 2004 final rule with comment period (69 FR 65819)). We also noted in the November 15, 2004 final rule with comment period, that public comments on previous OPPS rules had stated that the CCRs that were used to adjust charges to costs for blood products in past years were too low. Past commenters indicated that this approach resulted in an underestimation of the true hospital costs for blood and blood products. In response to these comments and APC Panel recommendations from its February 2004 and September 2004 meetings, we conducted a thorough analysis of the CY 2003 claims (used to calculate the CY 2005 APC payment rates) to compare CCRs between those hospitals reporting a blood-specific cost center and those hospitals defaulting to the overall hospital CCR in the conversion of their blood product charges to costs. As a result of this analysis, we observed a significant difference in CCRs utilized for conversion of blood product charges to costs for those hospitals with and without blood-specific cost centers. The median hospital blood-specific CCR was almost two times the median overall hospital CCR. As discussed in the November 15, 2004 final rule with comment period, we applied a methodology for hospitals not reporting a blood-specific cost center, which simulated a blood-specific CCR for each hospital that we then used to convert charges to costs for blood products. Thus, we developed simulated medians for all blood and blood products based on CY 2003 hospital claims data (69 FR 65816). For the CY 2005 OPPS, we also identified a subset of blood products that had less than 1,000 units billed in CY 2003. For these low-volume blood products, we based the CY 2005 OPPS payment rate on a 50/50 blend of the CY 2004 OPPS product-specific OPPS median costs and the CY 2005 OPPS simulated medians based on the application of blood-specific CCRs to all claims. We were concerned that, given the low frequency in which these products were billed, a few occurrences of coding or billing errors may have led to significant variability in the median calculation. The claims data may not have captured the complete costs of these products to hospitals as fully as possible. This low-volume adjustment methodology also allowed us to further study the issues raised by commenters and by presenters at the September 2004 APC Panel meeting, without putting beneficiary access to these low-volume blood products at risk. Overall, median costs from CY 2003 (used for the 2005 OPPS) to CY 2004 (used for the 2006 OPPS) were relatively stable, with a few significant increases and decreases from the CY 2005 adjusted median costs for some specific blood products. For the CY 2006 OPPS, we adopted a payment adjustment policy that limited significant decreases in APC payment rates for blood and blood products from the CY 2005 OPPS to the CY 2006 OPPS to not more than 5 percent. We applied this adjustment to 11 blood and blood product APCs for the CY 2006 OPPS, which we identified in Table 33 of the CY 2006 OPPS final rule with comment period. For the CY 2006 OPPS we set the final median costs for blood and blood products at the 
                        ( print page 49619)
                        greater of: (1) The simulated median costs calculated from the CY 2004 claims data; or (2) 95 percent of the CY 2005 OPPS adjusted median costs for these products, as reflected in Table 33 published in the CY 2006 OPPS final rule with comment period. B. Proposed Policy Changes for CY 2007 For the CY 2007 OPPS, we are proposing to establish payment rates for blood and blood products by using the same simulation methodology described in the November 15, 2004 final rule with comment period (69 FR 65816), which utilized hospital-specific actual or simulated CCRs for blood cost centers to convert hospital charges for blood and blood products to costs. We continue to believe that using blood-specific CCRs applied to hospital claims data will result in payments that more fully reflect hospitals' true costs of providing blood and blood products than our general methodology of defaulting to the overall hospital CCR when more specific CCRs are unavailable. The median costs for blood and blood products in this proposed rule are derived from the CY 2005 claims data and have the benefit of reflecting, in part, the clarifications about reporting that were provided through CMS Program Transmittal 496, which we issued on March 4, 2005. This instruction articulated and clarified many questions that had been raised by hospitals and others about how hospitals should report charges for blood and blood products. These instructions went into effect for services furnished on or after July 1, 2005, and therefore were in effect for the last 6 months of CY 2005. Thus, we expect that the reporting of charges and units for blood and blood products in CY 2005 has improved over past years, especially with respect to hospitals' inclusion of all charges related to the acquisition, processing, and handling of blood and blood products as specifically described in each of the relevant P-code descriptors. We believe that the median costs for blood and blood products from the CY 2005 claims data reflect this improved reporting of charges and units for these products, particularly with regard to the most commonly furnished blood and blood products. Of the 34 blood products, median costs per unit (calculated using the simulated blood CCR methodology) rise for 23 of them compared to the CY 2006 final rule with comment period unadjusted median unit costs. These 23 products account for 92.4 percent of all units of blood products furnished in our CY 2005 claims data. As has been the case in the past, the low volume products (which we define as fewer than 1,000 units) show the most volatility. Of the 12 low volume products, 6 products have increases in their unit costs compared to their CY 2006 unadjusted median unit costs, and 6 products show decreases in their median unit costs compared to their CY 2006 unadjusted median unit costs. The low-volume products for which the medians decline compared to their unadjusted median costs in CY 2006 represent only 0.29 percent of the total units of blood products furnished in the CY 2005 OPPS claims data. Fewer blood products increased in projected costs from CY 2006 to the proposed median costs for CY 2007 because we adjusted the CY 2006 median costs for blood and blood products. Of the 34 blood products, median costs rise for 19 of them compared to the CY 2006 OPPS adjusted median costs on which the CY 2006 payments were based (and which were adjusted to no less than 95 percent of the CY 2005 payment medians). These 19 products accounted for 91.6 percent of all units of blood products furnished in our CY 2005 claims data. Of the 12 low-volume products, 4 show increases in their median unit costs compared to the CY 2006 OPPS adjusted median unit costs, and 8 show decreases compared to their CY 2006 OPPS adjusted median unit costs. The low-volume products that show a decline in medians compared to their CY 2006 adjusted median costs represent only 0.4 percent of the total units of blood products reflected in the CY 2005 claims data. We are proposing to set the payment rates for blood and blood products for CY 2007 based on the unadjusted median costs for blood and blood products which are derived from the CY 2005 claims data as we have described. We believe that, in most cases, the unadjusted unit costs developed by this process are valid reflections of the estimated median costs of furnishing these specific blood products, and that no adjustment is required to result in appropriate payments for blood and blood products in CY 2007. Under this proposed policy, based on the CY 2005 claims data, the projected payments would rise for approximately 92 percent of the blood product units paid under OPPS if patterns of furnishing blood products in CY 2007 were similar to those in CY 2005. The low-volume products whose median costs decline compared to their CY 2006 unadjusted median costs are furnished very rarely and by very few providers because, in part, more commonly available products may be used for similar clinical indications. We have no reason to believe that the median costs for low-volume products are not valid reflections of the costs of furnishing these low-volume services, particularly given that so few providers furnish them and it is their claims data that is used to develop the medians. We note, as well, that the median costs of several low-volume blood products show a significant increase for CY 2007. We welcome public comments on this issue. Displayed in Table 39 is the list of blood product HCPCS codes with their proposed CY 2007 payment medians. Table 39.—Proposed CY 2007 Payment Medians for Blood and Blood Products
HCPCS code
SI
APC
Short description
Proposed CY 2007 units
Proposed CY 2007 OPPS median unit cost
CY 2006 unadjusted median cost
CY 2006 adjusted median costP9010
K
0950
Whole blood for transfusion, per unit
2060
$134.80
$117.91
$117.91P9011
K
0967
Blood split unit, specify amount
136
136.42
82.50
82.50P9012
K
0952
Cryoprecipitate each unit
4155
52.94
40.33
47.10P9016
K
0954
RBC leukocytes reduced, each unit
556100
177.51
163.16
163.16P9017
K
9508
Plasma 1 donor frz w/in 8 hr, each unit
40113
72.12
70.40
70.40P9019
K
0957
Platelets, each unit
25796
60.49
51.50
51.50P9020
K
0958
Platelet rich plasma unit
657
156.49
277.42
277.42P9021
K
0959
Red blood cells unit
145507
129.99
121.48
121.48P9022
K
0960
Washed red blood cells unit
2455
216.35
172.40
189.22P9023
K
0949
Frozen plasma, pooled, sd, each unit
388
55.96
60.38
76.15( print page 49620)P9031
K
1013
Platelets leukocytes reduced, each unit
19368
94.61
98.30
98.30P9032
K
9500
Platelets, irradiated, each unit
4579
129.45
73.46
86.55P9033
K
0968
Platelets leukoreduced irrad, each unit
4802
130.89
102.18
150.58P9034*
K
9507
Platelets, pheresis, each unit
9292
465.60
434.01
434.01P9035
K
9501
Platelet pheresis leukoreduced, each unit
40933
490.51
493.12
493.12P9036
K
9502
Platelet pheresis irradiated, each unit
1476
413.58
317.43
325.87P9037
K
1019
Plate pheresis leukoredu irrad, each unit
17766
616.68
581.01
581.01P9038
K
9505
RBC irradiated, each unit
4130
201.36
147.47
147.47P9039
K
9504
RBC deglycerolized, each unit
818
352.72
343.44
343.44P9040
K
0969
RBC leukoreduced irradiated, each unit
57857
228.76
218.04
218.04P9043
K
0956
Plasma protein fract, 5%, 50ml
430
24.81
67.94
67.94P9044
K
1009
Plasma, cryoprecipitate reduced, each unit
5868
80.23
74.52
74.52P9048
K
0966
Plasma protein fract, 5%, 250ml
398
193.39
127.36
315.70P9050
K
9506
Granulocytes, pheresis unit
495
253.43
245.14
994.64P9051
K
1010
Blood, l/r, cmv-neg, each unit
3364
135.83
207.72
207.72P9052
K
1011
Platelets, hla-m, l/r, unit
1809
649.06
609.48
609.48P9053
K
1020
Plt, pher, l/r cmv-neg, irr, each unit
895
722.82
654.13
654.13P9054
K
1016
Blood, l/r, froz/degly/wash, each unit
493
89.33
89.73
261.93P9055
K
1017
Plt, aph/pher, l/r, cmv-neg, each unit
534
379.91
526.00
526.00P9056
K
1018
Blood, l/r, irradiated, each unit
3720
134.43
162.42
178.37P9057
K
1021
RBC, frz/deg/wsh, l/r, irrad, each unit
71
427.35
345.53
345.53P9058
K
1022
RBC, l/r, cmv-neg, irrad, each unit
1965
264.47
256.76
266.89P9059
K
0955
Plasma, frz between 8-24hour, each unit
3118
73.28
74.70
74.70P9060
K
9503
Fr frz plasma donor retested, each unit
283
73.60
94.72
94.72*After removal of two claims with grossly excessive units.
 XI. Proposed OPPS Payment for Observation Services (If you choose to comment on issues in this section, please include the caption “OPPS: Observation Services” at the beginning of your comment.) Observation care is a well-defined set of specific, clinically appropriate services that include ongoing short-term treatment, assessment, and reassessment, before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital. Observation status is commonly assigned to patients with unexpectedly prolonged recovery after surgery and to patients who present to the emergency department and who then require a significant period of treatment or monitoring before a decision is made concerning their next placement. For CY 2006, we adopted two coding changes that affect how observation services are reported, and we made changes in the OCE to shift from individual providers to the OPPS claims processing systems the determination of whether or not observation services are separately payable or packaged. Observation services reported using HCPCS code G0378 (Hospital observation services, per hour) that are eligible for separate payment map to APC 0339 (Observation). The CY 2006 payment rate for APC 0339 is $425.08. The proposed CY 2007 median cost for APC 0339 is $442.16, reflecting relative stability in hospital costs for separately payable observation care. Direct admission to observation (G0379), when separately payable, is currently assigned for payment to APC 0600 (Low Level Clinic Visit) with a CY 2006 payment rate of $52.37. As discussed below, for CY 2007 we are proposing to assign direct admission to observation, when separately payable, to APC 0604 (Low Level Clinic Visit). The CY 2007 proposed median cost for APC 0604 is $49.93. As we stated in the November 10, 2005 OPPS final rule with comment period (70 FR 68688), the changes that we adopted for CY 2006 were intended to ensure more consistent hospital billing for observation services in order to guide our future analyses of payment for observation care and to simplify how observation services are reported and paid. We refer readers to the CY 2006 OPPS final rule with comment period for a detailed discussion of the G-codes for observation services and the OCE logic changes implemented for CY 2006 (70 FR 68688), and to Program Transmittal 787, issued on December 16, 2005, in which we updated Chapter 4, Section 290 of the Medicare Claims Processing Manual (Pub. 100-04) to reflect the CY 2006 changes and to provide additional guidance to contractors and hospitals. During the APC Panel's March 2006 meeting, the Observation Subcommittee did not make any recommendations to the Panel other than to request its review of additional data on observation services at the Panel's 2007 winter meeting. The APC Panel adopted the Observation Subcommittee's report and recommended no changes to the criteria for separate payment for observation services or to the coding and payment methodology for observation services. Therefore, for CY 2007, we are proposing to continue applying the criteria for separate payment for observation services and the coding and payment methodology for observation services that were implemented in CY 2006, with one exception. In section IX. of this preamble, we are proposing changes in coding and payment for clinic and emergency room visits. As part of these proposed changes, low level clinic visits would move from APC 0600 to APC 0604, with a CY 2007 proposed median cost of $49.93. Under the circumstances where direct admission to observation is separately payable, we are proposing to assign HCPCS code G0379 to APC 0604 consistent with its CY 2006 placement in the APC for Low Level Clinic Visits. As we stated in Program Transmittal A-02-129 released in January 2003, we 
                        ( print page 49621)
                        will continue to include in the October quarterly update of the OPPS any changes to the list of ICD-9-CM codes required for separate payment of HCPCS code G0378 resulting from the October 1 annual update of ICD-9-CM codes. The currently applicable ICD-9-CM codes are listed in Table 34 of the CY 2006 OPPS final rule with comment period (70 FR 68692), and any changes to that list will be included in the CY 2007 OPPS final rule with comment period. XII. Proposed Procedures That Will Be Paid Only as Inpatient Procedures A. Background Section 1833(t)(1)(B)(i) of the Act gives the Secretary broad authority to determine the services to be covered and paid for under the OPPS. Before implementation of the OPPS in August 2000, Medicare paid reasonable costs for services provided in the outpatient department. The claims submitted were subject to medical review by the fiscal intermediaries to determine the appropriateness of providing certain services in the outpatient setting. We did not specify in regulations those services that were appropriate to provide only in the inpatient setting and that, therefore, should be payable only when provided in that setting. In the April 7, 2000 final rule with comment period, we identified procedures that are typically provided only in an inpatient setting and, therefore, would not be paid by Medicare under the OPPS (65 FR 18455). These procedures comprise what is referred to as the “inpatient list.” The inpatient list specifies those services that are only paid when provided in an inpatient setting because of the nature of the procedure, the need for at least 24 hours of postoperative recovery time or monitoring before the patient can be safely discharged, or the underlying physical condition of the patient. As we discussed in the April 7, 2000 final rule with comment period (65 FR 18455) and the November 30, 2001 final rule (66 FR 59856), we use the following criteria when reviewing procedures to determine whether or not they should be moved from the inpatient list and assigned to an APC group for payment under the OPPS: Most outpatient departments are equipped to provide the services to the Medicare population.
                    The simplest procedure described by the code may be performed in most outpatient departments.
                    The procedure is related to codes that we have already removed from the inpatient list. In the November 1, 2002 final rule with comment period (67 FR 66741), we removed 43 procedures from the inpatient list for payment under OPPS. We also added the following criteria for use in reviewing procedures to determine whether they should be removed from the inpatient list and assigned to an APC group for payment under the OPPS: We have determined that the procedure is being performed in numerous hospitals on an outpatient basis; or
                    We have determined that the procedure can be appropriately and safely performed in an ambulatory surgical center (ASC) and is on the list of approved ASC procedures or proposed by us for addition to the ASC list. We believe that these additional criteria help us to identify procedures that are appropriate for removal from the inpatient list. B. Proposed Changes to the Inpatient Only List (If you choose to comment on issues in this section, please include the caption “Inpatient Only Procedures” at the beginning of your comment.) For CY 2007 OPPS, we used the same methodology as described in the November 15, 2004 final rule with comment period (69 FR 65835) to identify a subset of procedures currently on the inpatient list that are being widely performed on an outpatient basis. These procedures were then clinically reviewed for possible removal from the inpatient list. We solicited input from the APC Panel on the appropriateness of the removal of seven procedures from the inpatient list at the March 1, 2006 APC Panel meeting. During CY 2006, we have received no other candidate HCPCS codes for removal from the OPPS inpatient list based on recommendations from the public. The APC Panel recommended that one of the procedures (CPT code 21181, Reconstruction by contouring of benign tumor of cranial bones, extracranial) be removed from the list and that we solicit approval from the relevant physician specialty societies prior to proposing removal of the other procedures. Consistent with our established policy for removing procedures from the inpatient list, we rely on our utilization data and clinical staff input in determining which procedures are candidates for removal. We believe that our policy of proposing the procedures for removal and soliciting comments from the public, which includes physician specialty societies, is the most appropriate process to receive input from the public on this issue. Rather than solicit approval from a select group (for example, specific physician specialty societies), we believe that solicitation of comments from all interested parties is more consistent with meeting our obligation to the public regarding outpatient services provided by hospitals. The utilization data and clinical review findings for the eight procedures support our proposal to remove them from the inpatient list, and therefore, we are proposing to remove these procedures from the inpatient list and to assign them to clinically appropriate APCs, as shown in Table 40. The changes to the inpatient list would be effective for services furnished on or after January 1, 2007. Table 40.—Proposed Procedure Codes To Remove From Inpatient List and Proposed APC Assignments, Effective January 1, 2007
HCPCS code
Long descriptor
Proposed new APC assignment
Current status 
                                 indicator
Proposed new status indicator16035
Escharotomy; initial incision
0016
C
T21181
Reconstruction by contouring of benign tumor of cranial bones, extracranial
0254
C
T22851
Apply spine prosth device
0049
C
T57292
Construction of artificial vagina; with graft
0195
C
T57335
Vaginoplasty for intersex state
0195
C
T61720
Creation of lesion by stereotactic method, including burr holes and localizing and recording techniques, single of multiple stages; globus pallidus or thalamus
0221
C
T62000
Elevation of depressed skull fracture; simple extradural
0254
C
T( print page 49622)64804
Sympathectomy, cervicothoracic
0220
C
T
 C. Proposed CY 2007 Payment for Ancillary Outpatient Services When Patient Expires (-CA Modifier) (If you choose to comment on issues in this section, please include the caption “Ancillary Outpatient Services” at the beginning of your comment.) 1. Background In the November 1, 2002 final rule with comment period (67 FR 66798), we discussed the creation of a new HCPCS modifier -CA to address situations where a procedure on the OPPS inpatient list must be performed to resuscitate or stabilize a patient (whose status is that of an outpatient) with an emergent, life-threatening condition, and the patient dies before being admitted as an inpatient. In Transmittal A-02-129, issued on January 3, 2003, we instructed hospitals on the use of this modifier when submitting a claim on bill type 13x for a procedure that is on the inpatient list and assigned the payment status indicator (SI) “C” (to indicate inpatient services that are not paid under the OPPS). Conditions to be met for hospital payment for a claim reporting a service billed with modifier -CA include a patient with an emergent, life-threatening condition on whom a procedure on the inpatient list is performed on an emergency basis to resuscitate or stabilize the patient. For CY 2003, a single payment for otherwise payable outpatient services billed on a claim with a procedure appended with this new -CA modifier was made under APC 0977 (New Technology Level VIII, $1,000-$1,250), due to the lack of available claims data to establish a payment rate based on historical hospital costs. As discussed in the November 7, 2003 final rule with comment period, we created APC 0375 (Ancillary Outpatient Services When Patient Expires) to pay for services furnished on the same date as a procedure with SI “C” and billed with the modifier -CA (68 FR 63467) because we were concerned that payment under a New Technology APC would not result in an appropriate payment. Payment under a New Technology APC is a fixed amount that does not have a relative payment weight and, therefore, is not subject to recalibration based on hospital costs. In the absence of hospital claims data to determine costs, the clinical APC 0375 payment rate for CY 2004 was set at $1,150, which was the payment amount for the newly structured New Technology APC that replaced APC 0977. For CYs 2005 and 2006, the payment rates for APC 0375 for services billed on the same date as a “C” status procedure appended with modifier -CA were established in accordance with the same methodology we followed to set payment rates for the other procedural APCs in those years, based on the relative payment weight calculated for APC 0375. For APC 0375 specifically, we calculated the relative payment weight from all claims reporting a “C” status procedure appended with modifier -CA, using charge data from the relevant calendar year claims for line items with a HCPCS code and status indicator “V,” “S,” “T,” “X,” “N,” “K,” “G,” and “H,” in addition to charges for revenue codes without a HCPCS code. We continued to make one payment in CYs 2005 and 2006 under APC 0375 for the services that met the specific conditions discussed in previous rules for using modifier -CA. In the CY 2006 final rule with comment period (70 FR 68700) we discussed our concern about the large increase in the volume of hospital claims billed with modifier -CA from CY 2003 to CY 2004, growing from 18 to 300 claims over that 1-year time period. We acknowledged that because modifier -CA was first introduced for CY 2003, the use of the modifier in CYs 2003 and 2004 may have reflected such an increase due to hospitals' learning curve with respect to the modifier's appropriate use on claims for services payable under the OPPS. We also expressed some concern that numerous claims reflected unanticipated examples of “C” status procedures reported with modifier -CA that may not have been provided to patients with emergency life threatening conditions, where the inpatient procedure was performed on an emergency basis to resuscitate or stabilize the patient. We promised to monitor CY 2005 claims data for similar increases. Our review of the CY 2005 claims data revealed a decrease in the use of modifier -CA in comparison with CY 2004 claims. In CY 2005 there were only 210 claims submitted reporting modifier -CA. Because of the diverse individual clinical scenarios where modifier -CA may be appropriately reported, we expect some variation from year to year in the number of OPPS claims reporting the modifier. It would appear that the hospital learning curve regarding use of modifier -CA may have been completed over the past 3 year period, and that we may expect relatively consistent reporting of this modifier in future years. We wish to particularly note that not only was there no increase in the number of claims reporting modifier -CA in CY 2005, but there were also far fewer apparently inappropriate instances of use. Our CY 2005 claims data show the majority of reporting of modifier -CA was in association with what were likely to have been urgent interventions, including the insertion of intra-aortic balloon assist devices and exploratory laparotomies. We believe that the data support our speculation that much of the increase in reporting of the modifier observed in CY 2004 data was a result of hospitals' learning curve regarding the appropriate use of the modifier. 2. Proposed Policy for CY 2007 We do not propose any change to our policies regarding reporting of modifier -CA for CY 2007, or to our payment policy regarding APC 0375. Therefore, for CY 2007, we are proposing that hospitals continue reporting modifier -CA only under circumstances described in section VI. of Transmittal A-02-129, which provided specific billing guidance for the use of modifier -CA. In addition, we are proposing to continue to make one payment under APC 0375 for the services that meet the specific conditions discussed in previous rules for using modifier -CA, based on calculation of the relative payment weight for APC 0375 as described above. We applaud hospitals' improved billing practices and as before, will continue to monitor use of modifier -CA. The CY 2007 proposed APC 0375 median cost is $3,539, significantly increased from the $2,527 
                        ( print page 49623)
                        median cost proposed in the CY 2006 proposed rule. This variation in median costs, however, is expected because the specific cases that populate the claims data for APC 0375 likely exhibit only limited clinical and resource homogeneity among all the claims attributable to that APC in a given year and across different years for the same APC. The cost variation of APC 0375 from year to year could be expected because APC 0375 is unique in the OPPS and, by its definition, should always be limited in its use. XIII. Proposed Nonrecurring Policy Changes A. Removal of Comprehensive Outpatient Rehabilitation Facility (CORF) Services From the List of Services Paid under the OPPS (If you choose to comment on issues in this section, please include the caption “CORF Services” at the beginning of your comment.) We are proposing to make a technical change to the regulations at 42 CFR 419.21(d) to remove from the list of services paid under the OPPS certain services furnished by a comprehensive outpatient rehabilitation facility (CORF) when they are provided outside the patient's plan of care (for example, hepatitis B vaccine). Section 1834(k) of the Act, as added by section 4541(a) of Pub. L. 105-33 (BBA), requires that CORF services be paid using the lesser of actual charges or a fee schedule amount. We instructed fiscal intermediaries to use the Medicare Physician Fee Schedule (MPFS) for payments to CORFs. We have not required CORF cost reports, or paid CORFs under the OPPS, since 2001. The proposed revision of the regulation to delete certain CORF services from the list of specified services paid under the OPPS is necessary to conform the regulations to the statutory requirement. B. Addition of Ultrasound Screening for Abdominal Aortic Aneurysms (AAAs) (Section 5112 of Pub. 109-171 (DRA)) (If you choose to comment on the issues in this section, please include the caption “AAA Screening” at the beginning of your comment.) 1. Background Section 5112 of the Deficit Reduction Act of 2005, Pub. L. 109-171 (DRA), amended section 1861 and related provisions of the Act to provide for coverage under Part B of ultrasound screening for abdominal aortic aneurysms (AAAs), effective for services furnished on or after January 1, 2007, subject to certain eligibility and other limitations. The proposed rule governing this new Part B coverage will be established through a separate document, specifically the CY 2007 Medicare Physician Fee Schedule proposed rule. We refer readers to that document for a full and complete explanation of this coverage provision. 2. Proposed Assignment of New HCPCS Code for Payment of Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) (Section 5112) There is no current CPT code that specifically describes an ultrasound screening for AAA. Therefore, we are proposing to establish the following new HCPCS code, GXXXX (Ultrasound, B-scan and or real time with image documentation; for abdominal aortic aneurysm (AAA) screening) to be used to bill for the new service under both the Medicare Physician Fee Schedule and the OPPS. As required by the statute, Medicare will allow payment for a one-time only screening examination, and this screening test will be available even if the qualifying patient does not present signs or symptoms of disease or illness. In addition, this code does not include any other preventive services that are currently separately covered and paid under the Medicare Part B screening benefits. When these other preventive services are performed, they should be reported using the existing appropriate codes. We are proposing to base the payment for GXXXX on equivalent hospital resources and intensity to those contained in CPT code 76775, which is assigned to APC 0266 (Level II Diagnostic and Screening Ultrasound) under the OPPS for CY 2007. We believe that the hospital costs associated with the screening study are very similar to those of the limited retroperitoneal ultrasound diagnostic examination and, therefore, that the screening and diagnostic studies should be assigned to the same clinical APC for reasons of clinical and resource homogeneity. Thus, we are proposing to assign GXXXX to APC 0266 with a median cost of $98.59 for CY 2007. 3. Handling of Comments Received in Response to This Proposal We noted previously that ultrasound screening for AAAs is also addressed in detail in our proposed rule to update the Medicare Physician Fee Schedule for CY 2007. We will respond to all comments regarding the proposed elements required for the ultrasound screening for AAA, whether the examination is performed in a physician's office or an outpatient hospital setting, and the exception from the Part B annual deductible, in the final rule implementing the Medicare Physician Fee Schedule for CY 2007. We will respond to all comments regarding payment for GXXXX under the OPPS in the CY 2007 OPPS final rule. XIV. Emergency Medical Screening in Critical Access Hospitals (CAHs) (If you choose to comment on issues in this section, please include the caption “CAHs: Emergency Medical Screening” at the beginning of your comment.) A. Background Section 1820 of the Act, as amended by section 4201 of the Balanced Budget Act of 1997, provides for the establishment of Medicare Rural Hospital Flexibility Programs (MRHFPs), under which individual States may designate certain facilities as critical access hospitals (CAHs). Facilities that are so designated and meet the CAH conditions of participations (CoPs) under 42 CFR Part 485, Subpart F, will be certified as CAHs by CMS. The MRHFP replaced the Essential Access Community Hospital (EACH)/Rural Primary Care Hospital (RPCH) program. B. Proposed Policy Change Existing regulations governing CAHs at § 485.618(d) require on-call doctors and nonphysician practitioners who may be attending to urgent/acute medical problems in other areas of the CAH or outside the CAH to report to the CAH's emergency room within 30 minutes (60 minutes if the CAH is located in a frontier or remote area or permissible under the State's rural health care plan) to see a patient in the emergency room of a CAH. Often, these patients do not have emergency medical conditions. With changes to the regulations at § 489.24 that implement the Emergency Medical Treatment and Labor Act (EMTALA) over the past few years, some practitioners have noted to CMS that the requirements regarding who should respond to calls to see patients who present to the emergency department of a CAH are more stringent than for general hospitals. The provider community recently requested that we change the emergency on-call personnel requirements for CAHs to conform to the regulatory changes published in the FY 2005 IPPS final rule (69 FR 49271). In response to this request, we are proposing to revise the current CAH CoPs to align the emergency medical screening requirements in CAHs with those applicable to acute care hospitals. The 
                        ( print page 49624)
                        proposed change would allow registered nurses, in addition to the personnel currently required at § 485.618(d), to serve as qualified medical personnel to screen individuals who present to the CAH emergency room if the nature of the patient's request is within the registered nurse's scope of practice under State law and such screening is permitted by the CAH's bylaws. This proposed change would effectively eliminate the need for a doctor or mid-level practitioner to report to the emergency department to attend to a nonemergent request for medical care if a registered nurse is on site at the CAH and has made a determination that the care needed is of a non-emergent nature. The EMTALA statute at section 1867 of the Act states that a hospital in this context must provide an appropriate (suitable for the symptoms presented) medical screening examination within the capability of the hospital's emergency department to determine whether or not an emergency medical condition exists (section 1866(a)(1)(I) of the Act imposes the section 1867 requirements on a CAH). The EMTALA regulations at § 489.24(a) state that the examination must be conducted by qualified medical personnel. These qualified medical personnel designated to perform medical screening examinations must be determined qualified by the hospital's bylaws or rules and regulations and must be practicing within the scope of practice under State law. The regulations at § 489.24(c) relating to the use of dedicated emergency department for nonemergency services were added in September 2003 (68 FR 53262) to state that if an individual goes to a hospital's dedicated emergency department to request medical treatment, and the nature of the request makes it clear that the medical condition is not of an emergency nature, the hospital is required only to perform such screening as would be appropriate to determine that the individual does not have an emergency medical condition. Although EMTALA also applies to CAHs, the CoP for CAH emergency services (§ 485.618(d)) states that a physician, a physician assistant, a nurse practitioner, or a clinical nurse specialist with training or experience in emergency care must be on call and available onsite at a CAH within a specified timeframe. These are the CAH personnel who would be available to conduct an emergency medical screening under § 489.24(c). In contrast, the emergency services CoP for acute care hospitals at § 482.55 does not specify the type of personnel who must be available to provide emergency services and who would, therefore, perform assessments and screenings. The regulation states only that the services must be organized and supervised under the direction of a qualified member of the medical staff. Therefore, an acute care hospital may, if it chooses, have protocols that permit a registered nurse to conduct specific emergency medical screenings if the nature of the individual's request for examination and treatment is within the scope of practice of a registered nurse. For emergencies that are outside of a registered nurse's scope of practice, another qualified medical personnel (operating within his or her scope of practice under State law) would conduct the emergency medical screening. We are proposing to revise the CAH standard at § 485.618(d) to allow a CAH, if applicable, the flexibility of including a registered nurse, with training and experience in emergency care and who is on site at the CAH, as one of the qualified medical personnel available for emergency services, particularly emergency medical screenings, if the nature of the individual's request makes clear that the medical condition is not of an emergency nature and the individual's request for examination and treatment is within the registered nurse's scope of practice under State law. If the registered nurse begins the emergency medical screening and determines that the nature of the individual's conditions is outside his or her scope of practice under State law, the physician, physician assistant, nurse practitioner or a clinical nurse specialist must be contacted to see the patient within 30 or 60 minutes to conduct the emergency medical screening and provide stabilizing treatment. If the registered nurse knows initially that the medical screening for the presenting complaint is outside the applicable scope of practice under State law, the physician or other nonphysician practitioner must see the individual within the 30 or 60 minute timeframes (as currently specified in § 485.618(d)(1)). We recognize that not all CAHs will be able to utilize this flexibility. Some State licensure boards have stated that it is not within the authorized scope of practice for a registered nurse to independently perform an appropriate emergency medical screening for the purpose of determining if an emergency medical condition exists. However, the licensure boards in these States further maintain that it is within the scope of practice for a registered nurse to assess the health status of an individual to determine a nonemergent condition and to provide nursing care or to refer the individual to appropriate medical resources. Therefore, based on State law, some CAHs will not be able to designate registered nurses as qualified medical personnel under our proposed revision to the regulations governing CAHs. However, as we wish to provide flexibility to CAHs and to be consistent with existing EMTALA policy, we are proposing the revision to the regulation at § 485.618(d). XV. Proposed OPPS Payment Status and Comment Indicators A. Proposed CY 2007 Status Indicator Definitions (If you choose to comment on issues in this section, please include the caption “OPPS Status Indicator” at the beginning of your comment.) The OPPS payment status indicators (SIs) that we assign to HCPCS codes and APCs play an important role in determining payment for services under the OPPS. They indicate whether a service represented by a HCPCS code is payable under the OPPS or another payment system and also whether particular OPPS policies apply to the code. Our proposed CY 2007 status indicator assignments for APCs and HCPCS codes are shown in Addendum A and Addendum B, respectively. We are proposing to use the status indicators and definitions that are listed in Addendum D1, which we discuss below in greater detail: 1. Proposed Payment Status Indicators To Designate Services That Are Paid Under the OPPS Indicator
Item/code/service
OPPS payment statusG
Pass-Through Drugs and Biologicals
Paid under OPPS; Separate APC payment includes pass-through amount.H
(1) Pass-Through Device Categories
(1) Separate cost-based pass-through payment; Not subject to coinsurance.(2) Radiopharmaceutical Agents
(2) Separate cost-based non-pass-through payment.( print page 49625)K
(1) Non-Pass-Through Drugs and Biologicals
(1) Paid under OPPS; Separate APC payment.(2) Brachytherapy Sources
(2) Paid under OPPS; Separate APC payment.K
(3) Blood and Blood Products
(3) Paid under OPPS; Separate APC payment.N
Items and Services Packaged into APC Rates
Paid under OPPS; Payment is packaged into payment for other services, including outliers. Therefore, there is no separate APC payment.P
Partial Hospitalization
Paid under OPPS; Per diem APC payment.Q
Packaged Services Subject to Separate Payment Under OPPS Payment Criteria
Paid under OPPS; Addendum B displays APC assignments when services are separately payable. 
                                 (1) Separate APC payment based on OPPS payment criteria.  
                                 (2) If criteria are not met, payment is packaged into payment for other services, including outliers. Therefore, there is no separate APC payment.S
Significant Procedure, Not Discounted when Multiple
Paid under OPPS; Separate APC payment.T
Significant Procedure, Multiple Reduction Applies
Paid under OPPS; Separate APC payment.V
Clinic or Emergency Department Visit
Paid under OPPS; Separate APC payment.X
Ancillary Services
Paid under OPPS; Separate APC payment.
 2. Proposed Payment Status Indicators To Designate Services That Are Paid Under a Payment System Other Than the OPPS Indicator
Item/code/service
OPPS payment statusA
Services furnished to a hospital outpatient that are paid under a fee schedule or payment system other than OPPS, for example
Not paid under OPPS. Paid by fiscal intermediaries under a fee schedule or payment system other than OPPS.• Ambulance Services• Clinical Diagnostic Laboratory Services• Non-Implantable Prosthetic and Orthotic Devices• EPO for ESRD Patients• Physical, Occupational, and Speech Therapy• Routine Dialysis Services for ESRD Patients Provided in a Certified Dialysis Unit of a Hospital• Diagnostic Mammography• Screening MammographyC
Inpatient Procedures
Not paid under OPPS. Admit patient. Bill as inpatient.F
Corneal Tissue Acquisition; Certain CRNA Services; and Hepatitis B Vaccines
Not paid under OPPS. Paid at reasonable cost.L
Influenza Vaccine; Pneumococcal Pneumonia Vaccine
Not paid under OPPS. Paid at reasonable cost; Not subject to deductible or coinsurance.M
Items and Services Not Billable to the Fiscal Intermediary
Not paid under OPPS.Y
Non-Implantable Durable Medical Equipment
Not paid under OPPS. All institutional providers other than home health agencies bill to DMERC.
 3. Proposed Payment Status Indicators To Designate Services That Are Not Recognized Under the OPPS but That May Be Recognized by Other Institutional Providers Indicator
Item/code/service
OPPS payment statusB
Codes that are not recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x,13x, and 14x)
Not paid under OPPS. 
                                 • May be paid by intermediaries when submitted on a different bill type, for example, 75x (CORF), but not paid under OPPS.  
                                 • An alternate code that is recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x, 13x, and 14x) may be available.
 4. Proposed Payment Status Indicators to Designate Services That Are Not Payable by Medicare 
                        ( print page 49626) Indicator
Item/code/service
OPPS payment statusD
Discontinued Codes
Not paid under OPPS or any other Medicare payment system.E
Items, Codes, and Services:
Not paid under OPPS or any other Medicare payment system.• That are not covered by Medicare based on statutory exclusion• That are not covered by Medicare for reasons other than statutory exclusion• That are not recognized by Medicare but for which an alternate code for the same item or service may be available• For which separate payment is not provided by Medicare
 To make it more relevant to the proposed update of the OPPS, we are displaying in Addendum B of this proposed rule those HCPCS codes that describe items or services that are payable under the OPPS as well as nonpayable codes for which we are proposing a change in status. Status indicators for items and services that are payable under the OPPS are listed in section XV.A.1 of this preamble. A complete listing of HCPCS codes with OPPS payment status indicators and APC assignments proposed for CY 2007 is available electronically on the CMS Web site. B. Proposed CY 2007 Comment Indicator Definitions (If you choose to comment on issues in this section, please include the caption “OPPS Comment Indicator” at the beginning of your comment.) In the November 15, 2004 final rule with comment period (69 FR 65827 and 65828), we made final our policy to use three comment indicators to identify in an OPPS final rule the assignment status of a specific HCPCS code to an APC and the timeframe when comments on the HCPCS APC assignment will be accepted. These three comment indicators are listed below: “NF”—New code, final APC assignment; Comments were accepted on a proposed APC assignment in the Proposed Rule; APC assignment is no longer open to comment.
                    “NI”—New code, interim APC assignment; Comments will be accepted on the interim APC assignment for the new code. In the November 10, 2005 final rule with comment period (70 FR 68702 and 68703), we adopted a new comment indicator: “CH”—Active HCPCS codes in current and next calendar year; status indicator and/or APC assignment have changed. We implemented comment indicator “CH” to designate a change in payment status indicator and/or APC assignment for HCPCS codes in Addendum B of the CY 2006 final rule with comment period. We also stated that codes flagged with the “CH” indicator in that final rule would not be open to comment because the changes were previously subject to comment during the proposed rule comment period. We are proposing to continue that policy in the CY 2007 OPPS final rule. When used in an OPPS final rule, the “CH” indicator is only intended to facilitate the public's review of changes made from one calendar year to another. We are proposing to use the “CH” indicator in the CY 2007 final rule to indicate HCPCS codes for which the status indicator and/or APC assignment will change in CY 2007. However, only HCPCS codes with comment indicator “NI” in the CY 2007 OPPS final rule would be subject to comment during the final rule comment period. We also are proposing to use the “CH” indicator to call attention to changes in payment status indicator and/or APC assignment in this proposed rule to update the OPPS for CY 2007. We believe that using the “CH” indicator in this proposed rule will facilitate the public's review of the changes that we are proposing to make final in CY 2007. Use of the “CH” indicator in the proposed rule is significant because it highlights changes that are subject to comment during the proposed rule comment period. The three comment indicators that we are proposing to implement in CY 2007 and their definitions are listed in Addendum D2 of this proposed rule. XVI. OPPS Policy and Payment Recommendations (If you choose to comment on issues in this section, please include the caption “Policy and Payment Recommendations” at the beginning of your comment.) A. MedPAC Recommendations The Medicare Payment Advisory Commission (MedPAC) submits reports to Congress in March and June that summarize payment policy recommendations. The March 2006 MedPAC report included the following recommendation relating specifically to the hospital OPPS: Recommendation 2A: The Congress should increase payment rates for the acute inpatient and outpatient prospective payment systems in 2007 by the projected increase in the hospital market basket index less half of the Commission's expectation for productivity growth. A discussion regarding updates to the market basket is included in section II.C. (“Proposed OPPS Conversion Factor Update for 2007”) of this preamble. B. APC Panel Recommendations Recommendations made by the APC Panel are discussed in sections of this preamble that correspond to topics addressed by the APC Panel. Minutes of the APC Panel's March 1-2, 2006 meeting are available online at 
                        *http://www.cms.hhs.gov/​FACA/​05_​AdvisoryPanelonAmbulatoryPaymentClassificationGroups.asp.* C. GAO Recommendations A discussion of the October 31, 2005 GAO letter of comment on proposed 2006 specified covered outpatient drug (SCOD) rates (GAO-06-17R “Comments on Proposed 2006 SCOD Rates”) is contained in section V.3.B.a. of this preamble. A discussion of the April 2006 GAO report entitled “Medicare Hospital Pharmaceuticals: Survey Shows Price Variation and Highlights Data Collection Lessons and Outpatient Rate-setting Challenges for CMS” (GAO-06-372) is contained in section V.3.B.a. of this preamble. XVII. Proposed Policies Affecting Ambulatory Surgical Centers (ASCs) for CY 2007 A. ASC Background 1. Legislative History Section 1832(a)(2)(F)(i) of the Act provides that benefits under the Medicare Supplementary Medical Insurance program (Part B) include payment for facility services furnished in connection with surgical procedures the Secretary specifies which are performed in an ASC. To participate in the Medicare program as an ASC, a 
                        ( print page 49627)
                        facility must meet the standards specified in section 1832(a)(2)(F)(i) of the Act; in 42 CFR 416, subpart B of our regulations, which sets forth general conditions and requirements for ASCs; and in 42 CFR 416, subpart C of our regulations, which provides specific conditions for coverage for ASCs. The ASC services benefit was enacted by Congress through the Omnibus Reconciliation Act of 1980 (Pub. L. 96-499). For a detailed discussion of the legislative history related to ASCs, we refer readers to the June 12, 1998 proposed rule (63 FR 32291). Section 626(b) of Pub. L. 108-173, repealed the requirement formerly found in section 1833(i)(2)(A) of the Act that the Secretary conduct a survey of ASC costs for purposes of updating ASC payment rates and, instead, requires the Secretary to implement a revised ASC payment system, to be effective not later than January 1, 2008. Section XVIII. of this proposed rule contains our proposal for a revised ASC payment system that would be implemented on January 1, 2008. Section 5103 of Pub. L. 109-171, amended section 1833(i)(2) of the Act by adding a new subparagraph (E) to place a limitation on payments for surgical procedures in ASCs. If the standard overhead amount under section 1833(i)(2)(A) of the Act for a facility service for such procedure, without application of any geographic adjustment exceeds the Medicare OPPS payment amount for the service for that year, without application of any geographic adjustment, the Secretary shall substitute the OPPS payment amount for the ASC standard overhead amount. This provision applies to surgical procedures furnished in ASCs on or after January 1, 2007, and before the effective date of the revised ASC payment system. We discuss in section XVII.C. of this preamble, the regulatory changes that we are proposing for our current ASC payment system. In section XVII.D. of this proposed rule, we are addressing the changes in payment to ASCs mandated by section 5103 of Pub. L. 109-171, as well as additions to and deletions from the list of Medicare-approved ASC procedures to be implemented January 1, 2007, prior to implementation of the revised ASC payment system. In addition, in section XVII.E. of this preamble, we are proposing changes in the process to review payment adjustments for insertion of new technology intraocular lenses (NTIOLs). The CY 2007 OPPS final rule that we issue in the fall of 2006 will implement changes to the ASC list that will go into effect January 1, 2007. In section XVIII. of this preamble, we are proposing a revised payment system for ASCs to be implemented effective January 1, 2008, including revisions to the ASC list for CY 2008, the ratesetting method, and the applicable ASC regulations to incorporate the requirements and payments for ASC facility services under the proposed revised ASC system. We expect that a final rule implementing the revised ASC payment system will be published separately in the spring of 2007. 2. Current Payment Method There are two primary elements in the total cost of performing a surgical procedure: (a) The cost of the physician's professional services to perform the procedure and (b) the cost of items and services furnished by the facility where the procedure is performed (for example, surgical supplies, equipment, and nursing services). Payment for the first element is made under the Medicare physician fee schedule. This proposed rule addresses the second element, the payment of facility fees for ASC services. This proposed rule also addresses coverage of ASC services. Under the current ASC facility services payment system, the ASC payment rate is a standard overhead amount established on the basis of our estimate of a fee that takes into account the costs incurred by ASCs generally in providing facility services in connection with performing a specific procedure. The report of the Conference Committee accompanying section 934 of the Omnibus Reconciliation Act of 1980 (ORA), Pub. L. 96-499, which enacted the ASC benefit in December 1980, states that this overhead amount is expected to be calculated on a prospective basis using sample survey data and similar techniques to establish reasonable estimated overhead allowances, which take into account volume (within reasonable limits), for each of the listed procedures. (H.R. Rep. No. 96-1479, at 134-35 (1980)). To establish those reasonable estimated allowances for services furnished prior to implementation of the revised ASC payment system, section 626(b)(1) of Pub. L. 108-173 amended section 1833(i)(2)(A)(i) of the Act to require us to take into account the audited costs incurred by ASCs to perform a procedure, in accordance with a survey. Payment for ASC facility services is subject to the usual Medicare Part B deductible and coinsurance requirements and the amounts paid by Medicare must be 80 percent of the standard fee. Section 1833(i)(1) of the Act requires us to specify, in consultation with appropriate medical organizations, surgical procedures that are appropriately performed on an inpatient basis in a hospital but that can be safely performed in an ASC and to review and update the list of ASC procedures at least every 2 years. Section 141(b) of the Social Security Act Amendments of 1994, Pub. L. 103-432, requires us to establish a process for reviewing the appropriateness of the payment amount provided under section 1833(i)(2)(A)(iii) of the Act for intraocular lenses (IOLs) for a class of NTIOLs. That process was the subject of a separate final rule entitled “Adjustment in Payment Amounts for New Technology Intraocular Lenses Furnished by Ambulatory Surgical Centers,” published in the June 16, 1999 
                        **Federal Register**
                         (64 FR 32198). As stated earlier, in section XVII.E. of this proposed rule, we discuss the changes that we are proposing to that process. A summary of changes to ASC payment rates made prior to CY 1998 may be found in the June 12, 1998 proposed rule (63 FR 32292). The 1998 rule proposed to rebase the ASC payment rates using cost, charge, and utilization data collected by a 1994 survey of ASCs. In that proposed rule, we also proposed to refine the ratesetting methodology that was implemented in the February 8, 1990 
                        **Federal Register**
                         (55 FR 4577). However, the changes that were proposed for the ratesetting methodology were not implemented because of a combination of circumstances resulting in the delayed publication of a final rule. Those circumstances included several extensions to the comment period which ended July 30, 1999, Year 2000 (Y2K) Medicare systems compliancy considerations, and legislative changes required by the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA), Pub. L. 106-113 and the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), Pub. L. 106-554. Readers may refer to the March 28, 2003 ASC List Update final rule (68 FR 15269) for a detailed discussion of these circumstances and the legislative changes. 3. Published Changes to the ASC List Section 1833(i)(1)(A) of the Act requires the Secretary to specify surgical procedures that, although appropriately performed in an inpatient hospital setting, can also be performed safely on an ambulatory basis in an ASC, a CAH, or a hospital outpatient department. The report accompanying the legislation 
                        ( print page 49628)
                        explained that the Congress intended procedures currently performed on an ambulatory basis in a physician's office that do not generally require the more elaborate facilities of an ASC not be included in the list of ASC covered procedures (H.R. Rep. No. 96-1167, at 390-91, reprinted in 1980 U.S.C.C.A.N. 5526, 5753-54). In a final rule published August 5, 1982, in the 
                        **Federal Register**
                         (47 FR 34082), we established regulations that included criteria for specifying which surgical procedures were to be included for purposes of implementing the ASC facility benefit. Section 416.65(a) of the regulations specifies general standards for procedures on the ASC list. ASC procedures are those surgical and other medial procedures that are— Commonly performed on an inpatient basis but may be safely performed in an ASC;
                    Not of a type that are commonly performed or that may be safely performed in physicians' offices;
                    Limited to procedures requiring a dedicated operating room or suite and generally requiring a post-operative recovery room or short term (not overnight) convalescent room; and
                    Not otherwise excluded from Medicare coverage. Specific standards in § 416.65(b) limit covered ASC procedures to those that do not generally exceed 90 minutes operating time and a total of 4 hours recovery or convalescent time. If anesthesia is required, the anesthesia must be local or regional anesthesia, or general anesthesia of not more than 90 minutes duration. Section 416.65(b)(3) of the regulations excludes from the ASC list procedures that generally result in extensive blood loss, that require major or prolonged invasion of body cavities, that directly involve major blood vessels, or that are generally emergency or life-threatening in nature. A detailed history of published changes to the ASC list and ASC payment rates may be found in the June 12, 1998 proposed rule (63 FR 32292). Subsequently, in accordance with § 416.65(c), we published updates of the ASC list in the 
                        **Federal Register**
                         on March 28, 2003 (68 FR 15268) and May 4, 2005 (70 FR 23690). During years when we have not updated the ASC list in the 
                        **Federal Register**
                        , we have revised the list to be consistent with annual calendar year changes to HCPCS and CPT codes. These annual coding updates have been implemented through program instructions to the carriers that process ASC claims. The most recent update to the list to conform with CPT and HCPCS coding changes was published in Transmittal R-720-CP, Change Request 4082, on October 21, 2005. It may be found on our Web site at: 
                        *http://www.cms.hhs.gov/​Transmittals/​.* B. Proposed ASC List Update Effective for Services Furnished On or After January 1, 2007 1. Criteria for Additions to or Deletions From the ASC List In April 1987, we adopted quantitative criteria for identifying procedures that were commonly performed either in a hospital inpatient setting or in a physician's office. Collectively, commenters responding to a notice published on February 16, 1984 in the 
                        **Federal Register**
                         (49 FR 6023) had recommended that virtually every surgical CPT code be included on the ASC list. Consulting with other specialist physicians and medical organizations as appropriate, our medical staff reviewed the recommended additions to the list to determine which code or series of codes were appropriately performed on an ambulatory basis within the framework of the regulatory criteria in § 416.65. However, when we arrayed the proposed procedures by the site where they were most frequently performed according to our claims payment data files (1984 Part B Medicare Data (BMAD)), we found that many procedures were not commonly performed on an inpatient basis or were performed in a physician's office the majority of the time, and, thus, would not meet the standards in our regulations. Therefore, we decided that if a procedure was performed on an inpatient basis 20 percent of the time or less, or in a physician's office 50 percent of the time or more, it would be excluded from the ASC list. (April 21, 1987 (52 FR 13176)). At the time, we believed that these utilization thresholds best reflected the legislative objectives of moving procedures from the more expensive hospital inpatient setting to the less expensive ASC setting without encouraging the migration of procedures from the generally less expensive physician's office setting to the ASC. We applied these quantitative standards not only to codes proposed for addition to the ASC list, but also to the codes that were currently on the list, to delete codes that did not meet the thresholds. The trend towards performing surgery on an ambulatory or outpatient basis grew steadily and, by 1995, we discovered that a number of procedures that were on the ASC list at the time fell short of the 20 percent and 50 percent thresholds even though the procedures were obviously appropriate in the ASC setting. The most notable of these was cataract extraction with intraocular lens insertion that were already being performed predominately in outpatient settings by the early 1990s, although more than 20 percent were also performed as inpatient procedures. The thresholds would also have excluded from the ASC list certain newer procedures, such as CPT code 66825 (Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure)), that were rarely performed on a hospital inpatient basis but that were appropriate for the ASC setting. Strict adherence to the same 20 percent and 50 percent thresholds both to add and remove procedures did not provide latitude for minor fluctuations in utilization across settings or errors that could occur in the site-of-service data drawn from the National Claims History File that we were then using for analysis. In an effort to avoid these anomalies but still retain a relatively objective standard for determining which procedures should comprise the ASC list, we adopted in the 
                        **Federal Register**
                         notice with comment period published on January 26, 1995 (60 FR 5185), a modified standard for deleting procedures already on the list. We deleted from the list only those procedures whose combined inpatient, hospital outpatient, and ASC site-of-service volume was less than 46 percent of the procedure's total volume and that were either performed 50 percent of the time or more in the physician's office or 10 percent of the time or less in an inpatient hospital setting. We retained the 20 percent and 50 percent standard to determine which procedures would be appropriate additions to the ASC list. We are not proposing changes to the criteria for adding or deleting items from the ASC list effective January 1, 2007. However, please see section XVIII.B. of this proposed rule for a discussion of proposed changes in the context of developing a revised ASC payment system to be effective January 1, 2008. The proposed changes to the criteria result in the addition for CY 2008 of many procedures that do not meet the current criteria for addition to the list. 2. Response to Comments to May 4, 2005 Interim Final Rule for the ASC Update In accordance with section 1833(i)(1) of the Act, in this proposed rule, we are proposing to update the list of procedures that are covered when furnished in an ASC, effective January 
                        ( print page 49629)
                        1, 2007. In the process of determining which procedures to add to the list, we focused on requests we received from the public in their comments on our May 4, 2005 interim final rule (70 FR 23690). We evaluated codes for which we received requests from the public. The public comments include requests for addition and deletion of specific procedures and for assignment to higher payment groups for specific procedures. 3. Procedures Proposed for Addition to the ASC List Using the current criteria as described in section XVII.B.1. of this preamble, we identified 14 procedures that we are proposing to add to the ASC list effective January 1, 2007. The procedures would be assigned to one of the nine existing ASC payment groups as indicated in Table 41. Table 41.—Procedures Proposed for Addition to the ASC List Effective January 1, 2007
CPT
Short descriptor
ASC payment group13102
Repair wound/lesion add-on
113122
Repair wound/lesion add-on
113133
Repair wound/lesion add-on
119297
Place breast cath for rad
921356
Treat cheek bone fracture
322520
Percutaneous vertebroplasty, thor
922521
Percutaneous vertebroplasty, lumb
922522
Percutaneous vertebroplasty, add'l
135476
Repair venous blockage
936818
AV fuse, upper arm, cephalic
337205
Transcath IV stent, percutaneous
937206
Transcath IV stent/perc, add'l
143761
Reposition gastrostomy tube
146946
Ligation of hemorrhoids
1
 4. Suggested Additions Not Accepted There are a number of procedures for which we received requests for additions to the ASC list that we are not proposing to add to the ASC list because they do not meet the criteria set forth in section 416.65 of the CFR. Those procedures are listed in Tables 42 and 43 below. Our medical advisors believe that the procedures listed in Tables 42 and 43 may be of a type that: Are performed predominantly in the hospital inpatient or physician office setting;
                    Require an overnight or inpatient stay;
                    Require a total of 90 minutes of operating time or 4 hours or more of recovery time;
                    Require major or prolonged invasion of body cavities or involve major blood vessels;
                    Are generally emergent or life-threatening; or
                    Are of a type that result in extensive blood loss. We are not proposing to add 19 procedures for which we received requests for addition to the ASC list because they are procedures that are furnished predominantly in the physician office setting and according to the current criteria are not eligible for inclusion on the list. Those procedures are displayed in Table 42. One request was made that we add CPT code 66990 (Use of ophthalmic endoscope) to the list. As we stated in our May 5, 2005 interim final rule (70 FR 23704), this code is used to recognize the use of equipment that is integral to a surgical procedure and is not a surgical procedure. For this reason, we do not believe that it is an appropriate addition to the list. Table 42.—Procedures Not Proposed for Addition to 2007 ASC List Because They Are Predominantly Performed in the Physician's Office
CPT
Short descriptor31040
Exploration behind upper jaw.45300
Proctosigmoidoscopy dx.45303
Proctosigmoidoscopy dilate.45330
Diagnostic sigmoidoscopy.46221
Ligation of hemorrhoid(s).46604
Anoscopy and dilation.46614
Anoscopy, control bleeding.46900
Destruction, anal lesion(s).46910
Destruction, anal lesion(s).46916
Destruction, anal lesion(s).62367
Analyze spine infusion pump.62368
Analyze spine infusion pump.67028
Injection eye drug.67105
Repair detached retina.67110
Repair detached retina.67145
Treatment of retina.67210
Treatment of retinal lesion.67221
Ocular photodynamic ther.67228
Treatment of retinal lesion.
 We are proposing not to add to the ASC list 14 procedures for which we received requests because our medical advisors determined that those procedures do not meet the clinical criteria (§ 416.65) for addition. That is, the procedures either require more than 4 hours of recovery time, or may result in excessive blood loss, etc., making them ineligible for addition to the list of ASC procedures. Those procedures are displayed in Table 43. Table 43.—Procedures Not Added to the ASC List Because They Do Not Meet Current Clinical Criteria for Addition to the ASC List
CPT
Short descriptor27412
Autochondrocyte implant knee.27415
Osteochondral knee allograft.29866
Autgrft implnt, knee w/scope.29867
Allgrft implnt, knee w/scope.29868
Meniscal trnspl, knee w/scpe.35470
Repair arterial blockage.35475
Repair arterial blockage.47562
Laparoscopic cholecystectomy.47563
Laparo cholecystectomy/graph.47564
Laparo cholecystectomy/explr.63030
Low back disk surgery.63035
Spinal disk surgery add-on.63042
Laminotomy, single lumbar.63047
Removal of spinal lamina.
 5. Rationale for Payment Assignment Currently, procedures on the ASC list are assigned to one of nine payment groups based on our estimate of the costs incurred by the facility to perform the procedure. We are proposing no changes to those nine payment groups and are proposing to assign the additional procedures to one of those existing payment groups. The payment 
                        ( print page 49630)
                        group to which we propose each addition to the ASC list be classified is based on the payment group, which our medical advisors judged to be similar in terms of time and resource inputs to procedures currently on the list. The proposed list of procedures eligible for Medicare payment of a facility fee and the proposed rates are displayed in Addendum AA of this proposed rule. The procedures that are effected by the payment limit required by section 5103 of Pub. L. 109-171 are identified in that addendum along with their proposed rates. 6. Other Comments on the May 4, 2005 Interim Final Rule In the May 4, 2005 interim final rule (70 FR 23690), we also invited public comments on the payment assignments for specific procedure codes that we added to the ASC list in that rule that had not been proposed for addition to the ASC list in the November 26, 2004 proposed rule (69 FR 69178). We received comments on 14 of those newly-added procedures. A summary of those comments and our proposed treatment of them for CY 2007 is discussed below. Several comments requested that we delay adding to the ASC list CPT codes 33212 (Insertion or replacement of pacemaker pulse generator only; single chamber, atrial or ventricular), 33213 (Insertion or replacement of pacemaker pulse generator only; dual chamber), and 33233 (Removal of permanent pacemaker pulse generator) until we implement the new ASC payment system. We added these procedures to the ASC list in response to a request from a commenter. Our medical advisors evaluated the request and determined that these were appropriate procedures for performance in the ASC setting. We continue to believe that the procedures are appropriate for performance in the ASC and see no reason to remove them from the list at this time. Therefore, we are proposing to make no change in the ASC assignments for these three procedures. Two commenters requested that we reassign CPT codes 57155 (Insertion of uterine tandems and/or vaginal ovoids for clinical brachytherapy) and 58346 (Insertion of Heyman capsules for clinical brachytherapy) to the highest ASC payment group. The commenters believe that payment at a higher level is necessary in order to cover the costs of the equipment and supplies used in performing the procedures. We reviewed the OPPS cost data for these procedures and found that the median cost for CPT code 57155 is $506 and that for CPT code 58346 is $364. We do not have median cost data for the procedures performed in the ASC but the ASC payment amount for both services is $446, which is within the range of the median costs for those procedures in the generally more costly hospital outpatient setting. This leads us to believe that the $446 payment in the ASC is quite adequate. We are not proposing to assign the procedures to higher ASC payment groups. Several commenters wrote regarding CPT codes 36475 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein); 36476 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; second and subsequent veins in single extremity, each through separate access sites); 36478 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein); and 36479 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; second and subsequent veins treated in a single extremity, each through separate access sites). The commenters requested that we remove these procedures from the ASC list, and suggested that if we were unwilling to remove them from the list, that we assign the procedures to a higher payment group. They believe that these procedures require significantly more facility resources than other procedures with which they are currently grouped in payment level 3. The commenters explained that if the procedures were excluded from the list, more adequate payments would be made to physicians under the Medicare physician fee schedule for the required resources. We added these procedures to the list in response to public comments. We initially assigned the codes to ASC payment group 3, consistent with other procedures with similar clinical indications. We continue to believe that these procedures are appropriate for performance in the ASC setting and will not remove them from the list. However, we agree with the commenters' point that these procedures require significantly more facility resources than traditional vein removal procedures, and, therefore, we are proposing to reassign them to ASC payment group 9. We believe that this is an appropriate payment level that takes into consideration the costs of the required equipment and supplies. Two comments requested that we assign CPT code 46947 (Hemorrhoidopexy by stapling) to a higher ASC payment group. The commenters stated that due to the cost of the stapler used in the procedure, the resources required for this procedure are not similar to the other surgical procedures for the treatment of hemorrhoids that are also assigned to ASC payment group 3. The commenters suggested that it would be more appropriate to assign this procedure to ASC payment group 7. We agree with the commenters and are proposing to reassign this procedure to ASC payment group 7 for CY 2007. One commenter raised concern about payment for CPT code 49419 (Insertion of intraperitoneal cannula or catheter, with subcutaneous reservoir, permanent). The commenter reported that the catheter that is used in performing this procedure is billed separately under the DMEPOS fee schedule, and that Medicare carriers have discretion over whether or not to allow that payment. According to the commenter, in some areas, separate payment is not made for the catheter that is integral to the procedure. We believe that the commenter may be misinformed, because cannulas and catheters are not considered durable medical equipment, and they are not paid under the DMEPOS fee schedule. Rather, they are considered to be supplies. Payment for supplies furnished by an ASC in connection with a surgical procedure is bundled into the payment for the surgical procedure for which the supplies are required. One commenter requested that we allow separate payment for the material used as the sling in the procedure described by CPT code 51992 (Laparoscopy, surgical; sling operation for stress incontinence (e.g., fascia or synthetic)). The commenter stated that without separate payment for the sling material, the Medicare payment for performing the procedure is inadequate to cover the service. The commenter also stated that there is no specific HCPCS code to use for billing the synthetic sling material. We added CPT code 51992 to the ASC list in the last update in response to comments. We assigned CPT code 51992 to ASC payment group 5, the same ASC payment group to which other procedures to treat stress incontinence are assigned. We realize that the synthetic material for the sling may be costly, but there is no identifiable HCPCS code available for use in ASCs to report the material, and such material is not eligible for separate payment from Medicare in the ASC or 
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                        in any other setting. Further, CPT code 51992 describes a procedure that may be performed using synthetic material or fascia. As such, we cannot know whether the more costly synthetic material is used in any specific procedure and do not believe it is appropriate to fully incorporate the synthetic supply costs into the payment for all of the procedures performed. We continue to believe that ASC payment group 5 is an appropriate assignment for the procedure, and we are not proposing to change that assignment. One commenter requested that we make separate payment for the microinserts that are used in performing CPT code 58565 (Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants) even though there is no specific HCPCS code to describe the microinserts for billing, making separate payment impossible. We added CPT code 58565 to the ASC list in the last update in response to public comment. We assigned the procedure to ASC payment group 4 with other procedures with similar clinical indications. After further review, we are convinced that the procedure described by CPT code 58565 is significantly more resource-intensive than the other procedures in ASC payment group 4 and, therefore, we are proposing to reassign it to ASC payment group 9 for CY 2007. Several comments requested that CMS issue instructions to permit separate payment for the catheters that are inserted during the procedures described by CPT codes 19296 (Placement of radiotherapy afterloading balloon catheter into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; on date separate from partial mastectomy) and 19298 (Placement of radiotherapy afterloading brachytherapy catheters into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance). One commenter supported adding CPT code 19296 to the ASC list and assigning it to ASC payment group 9, but asserted that separate payment should also be provided for the balloon catheter inserted during the procedure. With regard to CPT code 19298, other commenters also stated that the payment level is inadequate and that separate payment should be allowed for the catheters inserted during the procedure. One of the commenters explained that the catheters used to perform the procedure described by CPT code 19298 are not high cost items (about $18.50 each) but these procedures typically use 30 catheters which makes the catheters a significant cost factor in performing the procedure. The catheters used in these procedures are classified as surgical supplies and as such, are not included on the DMEPOS fee schedule and are, therefore, not eligible for separate payment in the ASC. Payments for the costs of the catheters are packaged into the payments for performing the procedures. Currently CPT code 19298 is assigned to ASC payment group 1. Based on the information provided by the commenters we are persuaded that reassignment to a higher ASC payment group is warranted. Therefore, we are proposing to reassign CPT code 19298 to ASC payment group 9 for CY 2007. C. Proposed Regulatory Changes for CY 2007 As stated earlier, we are proposing a revised payment system for ASCs to be implemented effective January 1, 2008, including revisions to the ASC list for CY 2008, the ratesetting method, and the applicable ASC regulations to incorporate the requirements and payments for ASC facility services under the proposed revised ASC system. We expect that a final rule implementing the revised ASC payment system will be published separately in the spring of 2007. The revised ASC payment system will not take effect until January 1, 2008. However, we need to revise our current regulations at part 416, subparts D and E to ensure that the rules governing our current system are clearly distinguishable from those that would apply to the revised system beginning January 1, 2008. Therefore, we are proposing to revise subparts D and E to part 416 to reflect that these are the rules governing the APC payment system prior to January 1, 2008, and to redesignate the existing subpart F as subpart G under part 416 to codify the rules governing the ASC payment adjustment for NTIOLs. In addition, we are proposing to revise existing— § 416.1 (Basis and scope) to remove the obsolete reference to “a hospital outpatient department,” to add provisions of section 5103 ofPub. L. 109-171, and applicable provisions of Pub. L. 108-173.
                    § 416.65 (Covered surgical procedures) to modify the introductory text to clearly denote the section's application to covered surgical procedures furnished before January 1, 2008. In addition, we are proposing to remove the obsolete cross-reference in paragraph (a)(4) to § 405.310 and replace it with the correct cross-reference to § 411.15.
                    § 416.125 (ASC facility services payment rate) to incorporate the limitation on payment imposed by section 5103 ofPub. L. 109-171.
                    § 488.1 (Definitions) to correct a longstanding error by adding ambulatory surgical centers to the definition of a supplier in conformance with section 1861(d) of the Act. We also are proposing to add a new § 416.76 and § 416.121 to subparts D and E, respectively, to clearly state that the provisions of subparts D and E apply to services furnished before January 1, 2008. D. Implementation of Section 5103 of Pub. L. 109-171 (DRA) (If you choose to comment on issues in this section, please include the caption “Section 5103” at the beginning of your comments.) As noted in section XVII.A.1. of this preamble, section 5103 of Pub. L. 109-171 requires us to substitute the OPPS payment amount for the ASC standard overhead amount for surgical procedures performed at an ASC on or after January 1, 2007, but prior to the revised payment system when the ASC standard overhead amount exceeds the OPPS payment amount for the procedure. In Addendum AA of this proposed rule, we identify the HCPCS codes that we believe would be subject to section 5103 based on a comparison of the CY 2007 proposed OPPS payment rates and the ASC standard overhead amounts that are effective in CY 2007. We are proposing to add paragraph (c) to § 416.125 to reflect this change. E. Proposal To Modify the Current ASC Process for Adjusting Payment for New Technology Intraocular Lenses (NTIOLs) 1. Background (If you choose to comment on issues in this section, please include the caption “NTIOL” at the beginning of your comments.) At the inception of the ASC benefit on September 7, 1982, Medicare paid 80 percent of the reasonable charge for IOLs supplied for insertion concurrent with or following cataract surgery performed in an ASC (see 47 FR 34082, August 5, 1982). Section 4063(b) of OBRA 1987, Pub. L. 100-203, amended the Act to mandate that we include payment for an IOL furnished by an ASC for insertion during or following cataract surgery as part of the ASC facility fee for insertion of the IOL, and that the facility fee include payment that is reasonable and related to the cost of acquiring the class of lens involved in the procedure. Section 4151(c)(3) of the Omnibus Budget Reconciliation Act of 1990 
                        ( print page 49632)
                        (OBRA 1990), Pub. L. 101-508, froze the IOL payment amount at $200 for IOLs furnished by ASCs in conjunction with surgery performed during the period beginning November 5, 1990, and ending December 31, 1992. We continued paying an IOL allowance of $200 from January 1, 1993, through December 31, 1993. Section 13533 of the Omnibus Budget Reconciliation Act of 1993 (OBRA 1993), Pub. L. 103-66, mandated that payment for an IOL furnished by an ASC be equal to $150 beginning January 1, 1994, through December 31, 1998. Section 141(b)(1) of the Social Security Act Amendments of 1994 (SSAA 1994), Pub. L. 103-432, required us to develop and implement a process under which interested parties may request a review of the appropriateness of the payment amount for insertion of an IOL, to ensure that the facility fee for the procedure includes payment that is reasonable and related to the cost of acquiring a lens that belongs to a class of NTIOLs. In the February 8, 1990 
                        **Federal Register**
                         (55 FR 4526), we published a final notice entitled “Revision of Ambulatory Surgery Center Payment Rate Methodology,” which implemented Medicare payment for an IOL furnished at an ASC as part of the ASC facility fee for insertion of the IOL. In the June 16, 1999 
                        **Federal Register**
                         (64 FR 32198), we published a final rule entitled “Adjustment in Payment Amounts for New Technology Intraocular Lenses Furnished by Ambulatory Surgical Centers” to add a subpart F (§§ 416.180 through 416.200) to 42 CFR Part 416, which established a process for adjusting payment amounts for insertion of a class of NTIOLs furnished by ASCs. Our current regulations §§ 416.180 through 416.200 define the terms relevant to the process, establish the payment review process, and establish $50 as the payment adjustment amount that is added to the ASC facility fee for insertion of a lens that CMS determines is an NTIOL. Section 416.200 provides that the payment adjustment applies for a 5-year period that begins when we recognize the first lens that establishes a class of NTIOLs. In accordance with § 416.200(b), insertion of a lens that we subsequently recognize as belonging to an existing NTIOL class would receive the payment adjustment for the remainder of the 5-year period established for the class. Section 416.185(f)(2) provides that after July 16, 2002, we have the option of changing the $50 adjustment amount through proposed and final rulemaking in connection with ASC services. Since June 16, 1999, we have issued a series of 
                        **Federal Register**
                         notices to list lenses for which we received requests for a NTIOL payment adjustment and to solicit comments on those requests, or to announce the lenses that we have determined meet the criteria and definition of NTIOLs. We last published a 
                        **Federal Register**
                         notice pertaining to NTIOLs on April 28, 2006 (71 FR 25176). a. Current ASC Payment for Insertion of IOLs The current ASC payment groups, payment rates and procedural HCPCS codes for cataract extraction with IOL insertion are as follows: *Payment Group 6—$826 ($676 + $150 IOL Allowance)* CPT code 66985, Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal
                    CPT code 66986, Exchange of intraocular lens *Payment Group 8—$973 ($823 + $150 IOL allowance)* CPT code 66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (for example, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (for example, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage
                    CPT code 66983 Intracapsular cataract extraction with insertion of intraocular lens prosthesis (one stage procedure)
                    CPT code 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (for example, irrigation and aspiration or phacoemulsification) b. Classes of NTIOLs Approved for Payment Adjustment Since implementation of the process for adjustment of payment amounts for NTIOLs, that was established in the June 16, 1999 
                        **Federal Register**
                        , we have approved three classes of NTIOLs, as shown in the following table: NTIOL category
HCPCS 
                                 code
$50 approved for services furnished on or after
NTIOL 
                                 characteristic
IOLs eligible for adjustment1
Q1001
May 18, 2000, through May 18, 2005
Multifocal
Allergan AMO Array Multifocal lens, model SA40N.2
Q1002
May 18, 2000, through May 18, 2005
Reduction in Preexisting Astigmatism
STAAR Surgical Elastic Ultraviolet-Absorbing Silicone Posterior Chamber IOL with Toric Optic, models AA4203T, AA4203TF, and AA4203TL.3
Q1003
February 27, 2006, through February 26, 2011
Reduced Spherical Aberration
Advanced Medical Optics (AMO) Tecnis(®) IOL models Z9000, Z9001, and ZA9003; Alcon Acrysof IQ Model SN60WF.
 2. Proposed Changes a. Process for Recognizing IOLs as Belonging to an Active NTIOL Class Currently, we accept and review applications for inclusion in an active NTIOL class on a continuous basis throughout the year in accordance with §§ 416.180 through 416.200 of the regulations. We are proposing to continue this established process and to update and streamline it, as discussed below, to specify the request and comment review process, the information that a request must include to be accepted for review, the specific factors to be considered in evaluating requests, and the process to provide notification of determinations. As stated in section XVII.D. of this preamble, we are proposing to redesignate existing subpart F of part 416 as subpart G, which would include the regulations pertaining to the ASC payment adjustment for NTIOLs. In addition, we are proposing to revise redesignated subpart G to add new § 416.180, § 416.185, § 416.190, § 416.195, and § 416.200 to the regulations to reflect the changes that we are proposing to this process. One of the regulatory changes that we are proposing is to revise existing § 416.180 to establish the basis and 
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                        scope for this ASC payment adjustment. This proposal would eliminate the definitions currently included in that section for “Class of new technology intraocular lenses (IOLs),” “Interested party,” “New technology IOL,” and “New technology subset.” We do not believe that we need to retain these definitions because additional revisions that we are proposing to the regulations at part 416 would eliminate the term “interested party” from §§ 416.185(c) and 416.190 and the term “new technology subset” from §§ 416.185(g), 416.200(a), (b), and (c) and further clarify the terms “new technology IOL” and “class of new technology intraocular lenses (IOLs).” The other changes that we are proposing to part 416, pertaining to the ASC payment adjustment for NTIOLs, are discussed in this section. b. Public Notice and Comment Regarding Adjustments of NTIOL Payment Amounts We are proposing to update and streamline the process for determining whether an IOL that is to be inserted during or subsequent to cataract extraction qualifies for payment adjustment as a NTIOL, as set forth in existing § 416.185 of our regulations. The basis for the current NTIOL payment review process was enacted in 1994 and has been implemented through a series of separate 
                        **Federal Register**
                         notices specific to NTIOLs. We are proposing to modify the current process of using separate 
                        **Federal Register**
                         notices to notify the public of requests to review lenses for membership in new NTIOL classes, to solicit public comment on requests, and to notify the public of CMS determinations concerning new classes of NTIOLs for which an ASC payment adjustment would be made. We are proposing that these NTIOL-related notifications would be fully integrated into the annual notice and comment rulemaking for updating the ASC payment rates, the specific payment system in which NTIOL payment adjustments are made. Given that the NTIOL payment adjustments are applicable to ASC services and that the proposal for updating the new ASC payment system to be implemented in January 2008 anticipates an annual update process in coordination with notice and comment rulemaking on the OPPS, aligning the NTIOL process with this annual update would promote coordination and efficiency, thereby streamlining and expediting the NTIOL notification, comment, and review process. Specifically, we are proposing the following process: We would announce annually in the**Federal Register**
                         document that proposes the update of ASC payment rates for the following calendar year, a list of all requests to establish new NTIOL classes accepted for review during the calendar year in which the proposal is published and the deadline for submission of public comments regarding those requests. The deadline would be 30 days following publication of the list of requests.
                    In the**Federal Register**
                         document that finalizes the update of ASC payment rates for the following calendar year we would— + Provide a list of determinations made as a result of our review of all requests and public comments; and + Publish the deadline for submitting requests for review in the following calendar year. We believe that the coordination of public notice and comment regarding requests to establish new NTIOL classes with the update of ASC payment rates would facilitate judicious and comprehensive review and comment by interested parties, thereby resulting in more timely access to improved health technologies for Medicare beneficiaries. Accordingly, we are proposing to revise § 416.185 to reflect these proposed changes to the current process for publishing separate 
                        **Federal Register**
                         notices specific to NTIOLs. We note that we did not receive any review requests in response to the specific NTIOL April 28, 2006 notice (71 FR 25176) soliciting CY 2006 requests for review of the appropriateness of the payment amount for particular NTIOLs furnished in ASCs. c. Factors CMS Considers in Determining Whether an Adjustment of Payment for Insertion of a New Class of NTIOL Is Appropriate In determining whether a lens belongs to a new class of NTIOLs for which the ASC payment amount for insertion in conjunction with cataract surgery is appropriate, we expect that the insertion of the candidate IOL would result in significantly improved clinical outcomes compared to currently available IOLs. In addition, to establish a new NTIOL class, the candidate lens must be distinguishable from lenses already approved as members of active or expired classes of NTIOLs that share a predominant characteristic associated with improved clinical outcomes that was identified for each class. We are proposing to base our determinations on consideration of the following factors: The IOL must have been approved by the FDA and claims of specific clinical benefits and/or lens characteristics with established clinical relevance in comparison with currently available IOLs must have been approved by the FDA for use in labeling and advertising.
                    The IOL is not described by an active or expired NTIOL class; that is, it does not share the predominant, class-defining characteristic associated with improved clinical outcomes with designated members of an active or expired NTIOL class.
                    Evidence demonstrating that use of the IOL results in measurable, clinically meaningful, improved outcomes in comparison with use of currently available IOLs. According to the statute, and consistent with previous examples provided by CMS, superior outcomes that would be considered include the following: + Reduced risk of intraoperative or postoperative complication or trauma; + Accelerated postoperative recovery; + Reduced induced astigmatism; + Improved postoperative visual acuity; + More stable postoperative vision; + Other comparable clinical advantages, such as— ++ Reduced dependence on other eyewear (for example, spectacles, contact lenses, and reading glasses) ++ Decreased rate of subsequent diagnostic or therapeutic interventions, such as the need for YAG laser treatment. ++ Decreased incidence of subsequent IOL exchange. ++ Decreased blurred vision, glare, other quantifiable symptom or vision deficiency. In order to assess the clinical performance of a candidate IOL to establish a new NTIOL class, outcomes from use of the candidate lens would be compared with outcomes of use of currently available IOLs. Due to the rapid evolution of medical technology, we expect that the baseline of currently available IOLs for comparison would change from year to year. It is our expectation that the current ASC payment adjustment for active NTIOL classes should support the development and dissemination of new IOL technologies that would continue to improve the clinical outcomes of Medicare beneficiaries furnished IOLs after cataract extraction. Accordingly, we are proposing to revise our process for determining whether a lens belongs to a new class of NTIOLs for which an ASC payment adjustment is appropriate by setting forth the factors that we propose to 
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                        consider in making this determination. In addition, we are proposing to revise § 416.195 of the regulations to incorporate these proposed factors. Further, we are seeking public comments on the desirability of further interpreting the phrase “currently available lenses” for purposes of comparison and specific approaches to providing such clarifications. We believe that further interpretation could be helpful to requestors seeking to provide the most relevant, authoritative evidence concerning the clinical benefits of their lenses in comparison with those currently available lenses and to us as we review the information provided in requests to establish new NTIOL classes. However, we also believe that any clarifications should incorporate our expectations for technological progression of the baseline comparison lenses over time as we make future annual determinations regarding the establishment of new NTIOL classes. Therefore, we believe that the public's comments regarding practical and meaningful approaches to elaborating on the phrase “currently available lenses” would facilitate both requestors’ submission of complete requests for review and appropriate determinations by CMS regarding new NTIOL classes to receive the ASC payment adjustment. d. Proposal To Revise Content of a Request To Review To enable us to make a determination that the criteria for a payment adjustment for a new NTIOL class are met, we are proposing to require that a request include the information listed below. We are proposing to revise the content of a request (as currently set forth in § 416.195(a)) based on our experience in evaluating applications for OPPS pass-through status for new device categories over the past 6 years. We have found that the additional information allows our medical advisors to complete a more comprehensive evaluation, which would ensure that a payment adjustment is appropriate. We also have found that such information must be updated in a timely manner to ensure its relevancy to advancing technologies. Therefore, we also are proposing to post the information listed below on the CMS Web site at: 
                        *http://www.cms.hhs.gov/​center/​asc/​asp*
                         to provide easy access for updating rather than incorporating it in § 416.195(a) of the regulations. In addition, we are proposing to continue to require that a separate request would be required for each NTIOL for which a payment review as member of a new class is sought. We are proposing that a request that does not include all of the following information would be considered incomplete and could not be accepted for review until all information is furnished: Proposed name or description of a new class of NTIOLs.
                    Trade/brand name, manufacturer, and model number of the IOL for which the request to establish a new NTIOL class is being made. (Applications must include the name and description of at least one marketed IOL that would be placed in the proposed new NTIOL class.)
                    A list of all active or expired NTIOL classes that describe similar IOLs. For each active or expired class, provide a detailed explanation as to why that class would not describe the candidate IOL.
                    Detailed description of the FDA approved clinical indications for the candidate IOL.
                    Description of the IOL— + What is it? Provide a complete physical description of the IOL, including its components, for example, its composition; coating or covering; haptics; material; and construction. + What does it do? + How is it used? + What makes it different from other currently available IOLs? + What makes it superior to other currently available IOLs used for similar indications? + What are its clinical characteristics, for example, is it used for treatment of specific pathology; what is its life span; what are the complications associated with its use; and for what patient populations is it intended? + Submit relevant booklets, pamphlets, brochures, product catalogues, price lists, and/or package inserts that further describe and illuminate the nature of the IOL. If the candidate IOL replaces or improves upon an existing IOL, identify the trade/brand name and model of the existing IOL(s).
                    Full discussion of the clinically meaningful, improved outcomes that result from use of the candidate IOL compared to use of other currently available IOLs. This discussion must include evidence to demonstrate that use of the IOL results in measurable, clinically significant improvement over currently available IOLs in one or more of the following areas: + Reduced risk of intraoperative or postoperative complication or trauma. + Accelerated postoperative recovery. + Reduced induced astigmatism. + Improved postoperative visual acuity; + More stable postoperative vision. + Other comparable clinical advantages, such as— ++ Reduced dependence on other eyewear (for example, spectacles, contact lenses, and reading glasses); Decreased rate of subsequent diagnostic or therapeutic interventions, such as the need for YAG laser treatment; ++ Decreased incidence of subsequent IOL exchange; and ++ Decreased blurred vision, glare or other quantifiable symptom or vision deficiency. Provide the following information for the IOL(s) for which a new class is proposed: + Dates the candidate IOL was first marketed, reporting inside the United States and outside the United States separately. + Dates of sale of the first unit of the IOL, reporting inside the United States and outside the United States separately. + Number of IOLs that have been sold up to the date of the application. + A copy of the FDA's original approval notification. A copy of the labeling claims approved by the FDA for the IOL, indicating its clinical advantages and/or the lens characteristics with clinical relevance.
                    A copy of the FDA's summary of the IOL's safety and effectiveness.
                    Reports of modifications made after the original FDA approval. We strongly encourage and may give greater consideration for the submission of published, peer-reviewed literature and other materials that demonstrate substantial clinical improvement with use of the candidate IOL over use of currently available IOLs. Proposed § 416.190(d) provides that, in order for CMS to invoke the protection allowed under Exemption 4 of the Freedom of Information Act (5 U.S.C. 552(b)(4)) and, with respect to trade secrets, the Trade Secrets Act (18 U.S.C. 1905), the requestor must clearly identify all information that is to be characterized as confidential. For the stated reasons, we are proposing to revise § 416.190 to reflect these proposed changes to the content of a request for payment review of an IOL, to clarify when a request can be submitted and who may submit, and to also clarify the process for maintaining confidentiality of information included in a request. As stated earlier, we are not proposing to incorporate the list of proposed information required with each request in the regulations, but are proposing to post it on the CMS Web site to ensure that such information is updated in a timely manner and relevant to advancing IOL technologies. We are proposing to revise § 416.190 to 
                        ( print page 49635)
                        require that the content of each request for an IOL review must include all information as specified on the CMS Web for the request to be considered complete. e. Notice of CMS Determination We are proposing three possible outcomes from review of a request for determination of a new NTIOL class. As appropriate, for each completed request for a candidate IOL that is received by the established deadline, one of the following determinations would be announced annually in the final rule updating the ASC payment rates for the next calendar year: The request for a payment adjustment is approved for the IOL for 5 full years as a member of a new NTIOL class described by a new code.
                    The request for a payment adjustment is approved for the IOL for the balance of time remaining as a member of an active NTIOL class.
                    The request for a payment adjustment is not approved. We also are proposing to summarize briefly in the ASC final rule the evidence that was reviewed, the public comments, and the basis for our determination. When a new NTIOL class is established, we are proposing to identify the predominant characteristic of NTIOLs in that class that sets them apart from other IOLs (including those previously approved as members of other expired or active NTIOL classes) and is associated with improved clinical outcomes. The date of implementation of a payment adjustment in the case of approval of an IOL as a member of a new NTIOL class would be set prospectively as of 30 days after publication of the ASC payment update final rule, consistent with the statutory requirement. The date of implementation of a payment adjustment in the case of approval of a lens as a member of an active NTIOL class would be set prospectively as of the publication date of the ASC payment update final rule. f. Proposed Payment Adjustment The current payment adjustment for a 5-year period from the implementation date of a new NTIOL class is $50. We are not proposing to revise this payment adjustment for CY 2007. For CY 2007, we are proposing to revise § 416.200(a) through (c) to clarify how the IOL payment adjustment would be made and how an NTIOL would be paid after expiration of the payment adjustment. We also are proposing minor editorial changes to § 416.200(d). XVIII. Proposed Revised Ambulatory Surgical Center (ASC) Payment System for Implementation January 1, 2008 A. Background Generally, there are two primary elements in the total cost of performing a surgical procedure: the cost of the physician's professional services for performing the procedure and the cost of services furnished by the facility where the procedure is performed (for example, surgical supplies, equipment, nursing services, and overhead). The former is covered by the Medicare physician fee schedule. In 1980, a new Medicare benefit was enacted, authorizing payment of a fee to ASCs for facility services furnished in connection with performing certain surgical procedures. The statute requires us to specify surgical procedures that are appropriately and safely performed on an ambulatory basis in an ASC. Moreover, we are to review and update the list of these procedures not less often than every 2 years, in consultation with appropriate trade and professional associations. The ASC list was limited in 1982 to approximately 100 procedures. Currently, the list consists of more than 2,500 CPT codes encompassing a cross-section of surgical services, although 150 of these codes account for more than 90 percent of the approximately 4.5 million procedures paid for each year under the ASC Part B benefit. Eye, pain management, and gastrointestinal endoscopic procedures are the highest volume ASC surgeries under the present payment system. Medicare only allows payment to ASCs for procedures on the ASC list. Medicare pays 80 percent of the prospectively determined fee; the coinsurance rate is 20 percent for all procedures on the ASC list. In Pub. L. 108-173, the Congress mandated implementation of a revised payment system for ASC surgical services by no later than January 1, 2008. Pub. L. 108-173 sets forth several requirements for the revised payment system, but does not amend those provisions of the statute pertaining to the ASC list. In section XVIII. of this preamble, we describe the provisions of the revised ASC payment system that we are proposing to implement, as required by Pub. L.108-173, not later than January 1, 2008. Our proposal encompasses two components: first, our proposal for establishing and maintaining the ASC list of Medicare approved procedures under the revised payment system, and second, the method we are proposing to use to set payment rates for ASC facility services furnished in association with procedures on the ASC list. We also discuss in this section regulatory changes that we are proposing to 42 CFR parts 416 and 488 to incorporate the rules governing ASC facility payments under the revised payment system that would be applicable beginning in CY 2008. 1. Provisions of Pub. L. 108-173 Section 626(a) of Pub. L. 108-173 amended section 1833(i)(2)(C) of the Act, which requires the Secretary to update ASC payment rates using the Consumer Price Index for all urban consumers (U.S. City average) (CPI-U) if the Secretary has not otherwise updated the amounts under the revised ASC payment system. As amended by Pub. L. 108-173, this section requires that if the Secretary is required to apply the CPI-U increase, the CPI-U percentage increase is to be applied on a fiscal year basis beginning with FY 1986 through FY 2005 and on a calendar year basis beginning with 2006. Pub. L. 108-173 further amended section 1833(i)(2)(C) of the Act to require us in FY 2004, beginning April 1, 2004, to increase the ASC payment rates using the CPI-U as estimated for the 12-month period ending March 31, 2003, minus 3.0 percentage points. Pub. L. 108-173 also requires that the CPI adjustment factor equal zero percent in FY 2005, the last quarter of CY 2005, and each CY from 2006 through 2009. Section 626(b) of Pub. L. 108-173 repeals the requirement that CMS conduct a survey of ASC costs upon which to base a standard overhead payment amount for surgical services performed in ASCs, and adds section 1833(i)(2)(D)(iii) to the Act, which requires us to implement by no earlier than January 1, 2006, and not later than January 1, 2008, a revised ASC payment system. The revised payment system under section 1833(i)(2)(D)(i) of the Act is to take into account the recommendations contained in a Report to Congress that the GAO was required to submit by January 1, 2005. Section 1833(i)(2)(D)(ii) of the Act requires that the revised ASC payment system be designed to result in the same aggregate amount of expenditures for surgical services furnished in ASCs the year the system is implemented as would be made if the new system did not apply as estimated by the Secretary. This requirement is to take into account the limitation in ASC expenditures resulting from implementation of section 5103 of Pub. L. 109-171 beginning January 1, 2007, as we describe in section XVII.A.1 of this preamble. 
                        ( print page 49636) Section 1833(i)(2)(D)(iv) of the Act exempts the classification system, relative weights, payment amounts, and geographic adjustment factor (if any) under the revised ASC payment system from administrative and judicial review. Section 626(c) of Pub. L. 108-173 adds a conforming amendment to section 1833(a)(1) of the Act providing that the amounts paid under the revised ASC payment system shall equal 80 percent of the lesser of the actual charge for the services or the payment amount that we determine. 2. Other Factors Considered On August 2, 2005, we convened a listening session teleconference on revising the Medicare ASC payment system. Over 450 callers participated, including ASC staff, physicians, and representatives of industry trade associations. The listening session provided an opportunity for participants to identify the issues and concerns that they wanted us to address as we developed the revised ASC payment system. Callers encouraged us to foster beneficiary access to ASCs by creating incentives for physicians to use ASCs. The issues raised by participants included suggestions to expand or eliminate altogether the ASC list, recommendations to model payment on the hospital OPPS, and concerns about how we would propose to treat the geographic wage index adjustment and the annual ASC payment rate update. Several callers also raised concerns about ensuring adequate payment for supplies, ancillary services, and implantable devices under the new payment system, as well as developing a process to allow special payment for new technology. We have also met with representatives of the ASC industry over the past several years to discuss options for ratesetting other than conducting a survey, to discuss timely updates to the ASC list, and to listen to industry concerns related to the implementation of a new payment system. We appreciate the thoughtful suggestions that have been presented. We have carefully considered the concerns and issues brought to our attention, and a number of the proposals in this section for revising the ASC list and the method by which we set ASC payment rates take these concerns and issues into account. We look forward to receiving comments on the proposed changes set forth in this proposed rule and to continued input from representatives of industry associations and professional societies as we develop the final rule. B. Procedures Proposed for Medicare Payment in ASCs Effective for Services Furnished On or After January 1, 2008 1. Proposed Payable Procedures (If you choose to comment on issues in this section, please include the caption “ASC Payable Procedures” at the beginning of your comments.) In its March 2004 Report to the Congress, MedPAC recommended replacing the current “inclusive” list of procedures, which are the only procedures for which Medicare allows payment of an ASC facility fee, with an “exclusionary” list. That is, rather than limiting payment of an ASC facility fee to a list of procedures that CMS specifies, Medicare would allow payment to an ASC facility for any surgical procedure except those that CMS explicitly excludes from payment. MedPAC further recommended that clinical safety standards and the need for an overnight stay be the only criteria for excluding a procedure from payment of an ASC facility fee. MedPAC suggested that some of the criteria, such as site-of-service volume and time limits, which we have used in the past to identify procedures for the ASC list, are probably no longer clinically relevant. We have given careful consideration to MedPAC's recommendations and participated in considerable discussion and consultation with members of ASC trade associations and physicians who represent a variety of surgical specialties regarding the criteria that we would use to identify procedures that we would propose for payment under the new ASC payment system. We agree that adoption of a policy like that recommended by MedPAC would serve both to protect beneficiary safety and increase beneficiary access to procedures in appropriate clinical settings, recognizing the ASC industry's interest in obtaining Medicare payment for a much wider spectrum of services than is now allowed. Therefore, we are proposing that, under the revised ASC payment system for services furnished on or after January 1, 2008, Medicare would allow payment of an ASC facility fee for any surgical procedure performed at an ASC, except those surgical procedures that we determine are not payable under the ASC benefit. Further, we are proposing to establish beneficiary safety and the need for an overnight stay as the principal clinical considerations and factors in determining whether payment of an ASC facility fee would be allowed for a particular surgical procedure. As discussed in section XVIII.B.2 below, we also are proposing to exclude from payment under the ASC revised payment system those surgical procedures that are not eligible for separate payment under the OPPS and CPT surgical unlisted procedure codes. We discuss below the criteria that we are proposing as the basis for identifying procedures that would pose a significant safety risk to a Medicare beneficiary when performed in an ASC, or procedures following which we would expect a Medicare beneficiary to require overnight care. a. Proposed Definition of Surgical Procedure In order to delineate the scope of procedures that constitute “outpatient surgical procedures,” we must first clarify what we consider to be a “surgical” procedure. Under the current ASC payment system, we define as a surgical procedure any procedure described within the range of CPT Category I codes that the AMA defines as “surgery” (CPT codes 10000-69999) for purposes of the ASC payment system. Under the revised payment system, we are proposing to continue that standard. However, we seek comment on whether all services contained in this range are appropriately defined as “surgery.” For example, should procedures that are primarily office-based (see Addendum CC) or procedures that require relatively inexpensive resources to perform be excluded from the list? Within the CPT surgical code range, such procedures that either require very limited facility resources or are primarily performed in procedure rooms in physician offices could be considered not to be surgical procedures, in that they may not require typical surgical resources, such as a fully equipped operating room or significant postoperative recovery area, that are generally associated with surgical procedures that are predominantly performed in facility settings or have significant associated resource costs. Procedures that require relatively inexpensive resources to perform could be defined based on an ASC payment threshold, for example $100 or $200, such that procedures below this threshold would be excluded from the ASC list of procedures. We seek comment on what an appropriate payment threshold would be for defining procedures that require relatively inexpensive resources. In addition, we are proposing to include within the scope of surgical procedures payable in an ASC certain services that are described by HCPCS alphanumeric codes (Level II HCPCS codes) or by CPT Category III codes which directly crosswalk to or are 
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                        clinically similar to procedures in the CPT surgical range. We are proposing to include these three types of codes in our definition of surgical procedures because they all are eligible for payment under the OPPS and, to the extent it is reasonable to do so, we are proposing that the new ASC payment system parallel the OPPS in its policies. An example of a Level II HCPCS code that we believe represents a procedure that could be safely and appropriately performed in an ASC is HCPCS code G0297 (Insertion of single chamber pacing cardioverter defibrillator pulse generator). We developed this alphanumeric code for use in the OPPS because CPT code 33240, which describes the surgical insertion of cardioverter defibrillator pulse generators, does not distinguish insertion of a single chamber cardioverter defibrillator generator from insertion of a dual chamber cardioverter defibrillator generator. We were concerned that different facility resources could be required for the insertion of these two types of cardioverter defibrillator pulse generators, so we developed alternate codes to permit hospitals to more accurately report the resources required when these surgical procedures are performed for payment under the OPPS. In instances such as this, when an alphanumeric Level II HCPCS code is established as a substitute for a CPT surgical procedure code which does not adequately describe, from a facility perspective, the nature of a surgical service, we are proposing to allow payment for the alphanumeric code under the proposed new ASC payment system. We are proposing not to allow payment of an ASC facility fee for Level II HCPCS codes or Category III CPT codes that describe services which fall outside the scope of surgical procedures described by CPT codes 10000-69999. We recognize that continuing to use this definition of surgery would exclude from payment of an ASC facility fee certain invasive, “surgery-like” procedures, such as cardiac catheterization or certain radiation treatment services which are assigned codes outside the CPT surgical range. However, we believe that continuing to rely on the CPT definition of surgery would be administratively straightforward, uncontroversial, and consistent with our proposal to allow ASC payment for all outpatient surgical procedures. Since 1987, the ASC list has consisted of CPT codes that are defined as surgery by CPT. Given the number of other changes that we expect to be implemented as part of the proposed new payment system, along with the significant expansion of the ASC list that we are proposing, we believe that it would be prudent at the outset to continue to define surgery as it is defined by the CPT code set, which is used to report services for payment under both the Medicare Physician Fee Schedule (MPFS) and the OPPS. However, we are interested in commenters' opinions regarding the appropriateness of including primarily office-based procedures or including procedures that require relatively inexpensive resources to perform on the approved list of ASC procedures and we seek comment on this issue. That said, we have reviewed thousands of CPT codes in the surgical range (CPT codes 10000 through 69999), and we are proposing to not exclude payment for more than 750 additional surgical procedures, as well as continuing to not exclude payment for the more than 2,500 CPT codes on the current ASC list. If we were to consider CPT codes in the surgical range that were predominantly office-based to not be surgical procedures for purposes of the ASC payment system, the additions to the ASC list for CY 2008 would be limited to no more than about 300 other procedures. Similarly, if we were to define procedures requiring relatively inexpensive resources to not be surgical procedures, then additions to the ASC list for ASC payment would be more limited than under our current proposal. However, we are cognizant of the dynamic nature of ambulatory surgery, which has resulted in a dramatic shift of services from inpatient to outpatient settings over the past two decades. Therefore, we are soliciting comments regarding other services which are invasive and “surgery-like,” which could safely and appropriately be performed at an ASC, and which require the resources typical of an ASC, even though the procedures are described by codes that fall outside the range of CPT surgical codes. In particular, we would be interested in considering commenters' views of what constitutes a “surgical” procedure. b. Procedures Proposed for Exclusion From Payment Under the Revised ASC System As stated above, we are proposing to allow payment of an ASC facility fee for all procedures within the surgical range of CPT codes that do not pose a safety risk to Medicare beneficiaries or require an overnight stay. Having established what we would propose as constituting a “surgical procedure,” we next considered criteria that would enable us to identify procedures that could pose a significant safety risk when performed in an ASC or that would require an overnight stay within the bounds of prevailing medical practice. We discuss in this section how we propose to identify procedures that could pose a significant safety risk. (1) Significant Safety Risk First, we are proposing to exclude from payment of an ASC facility fee any procedure that is included on the current OPPS inpatient list. (See Addendum E to this proposed rule and section XII. of this preamble for a discussion of the OPPS inpatient list.) The procedures included on that list are typically performed in the inpatient hospital setting due to the nature of the procedure, the need for at least 24 hours of postoperative recovery time or monitoring before the patient can be safely discharged, or the underlying physical condition of the patient. We believe that any procedure for which we do not allow payment in the hospital outpatient setting due to safety concerns would not be safe to perform in an ASC. Second, we are proposing to exclude from payment of an ASC facility fee procedures that the CY 2005 Part B Extract Summary System (BESS) data indicate are performed 80 percent or more of the time in the hospital inpatient setting, even if those procedures are not included on the OPPS inpatient list. (See Table 4.) We selected an 80 percent threshold because we believe that an 80 percent level of inpatient performance is a fair indicator that a procedure is most appropriately performed on an inpatient basis and as such, would pose significant safety risks for Medicare beneficiaries if performed in an ASC. We find that procedures with inpatient utilization frequencies above this proposed threshold are complex and are likely to require a longer and more intensive level of care postoperatively than what is provided in a typical ASC. We believe that performing these procedures in an ASC, where immediate access to the full resources of an acute care hospital is not the norm, would pose a significant safety risk for beneficiaries. Third, we are proposing to retain the specific criteria for evaluating safety risks that are listed in § 416.65(b)(3). Procedures that involve major blood vessels; prolonged or extensive invasion of body cavities; extensive blood loss; or are emergent or life-threatening in nature could, by definition, pose a significant safety risk. Therefore, we are proposing to exclude from payment of an ASC facility fee, procedures that may be expected to involve any of these characteristics based on evaluation by 
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                        our medical advisors. We note that most of the procedures that our medical advisors identified as involving any of the characteristics listed currently in § 416.65(b)(3), also require overnight or inpatient stays, reinforcing their exclusion from being paid when performed in an ASC. Finally, we are proposing not to continue applying under our proposed revised system the current time-based prescriptive criteria at § 416.65(b)(1) and (2), which exclude from the ASC list procedures that exceed 90 minutes of operating time or 4 hours of recovery time or 90 minutes of anesthesia. We believe these criteria are no longer clinically appropriate for purposes of defining a significant safety risk for surgical procedures. In light of these proposed changes for evaluating procedures that pose a significant safety risk for beneficiaries under our proposed revised system, we believe that it would not be appropriate to apply the existing standard at § 416.65(a)(1), which states that covered surgical procedures are those that are commonly performed on an inpatient basis but may be safely performed in an ASC, because this standard is no longer relevant to prevailing medical practice in the realm of ambulatory or outpatient surgery. Similarly, we believe that it would not be appropriate to continue applying the existing standard at § 416.65(a)(2), which states that procedures performed in an ASC are not of a type that are commonly performed, or that may be performed in a physician's office. This standard is no longer relevant within the context of our proposal only to exclude from payment of an ASC facility fee under the revised payment system those surgical procedures that pose a safety risk or require an overnight stay. We would expect the types of procedures that are commonly performed or that may be performed in a physician's office to pose no significant safety risk and to require no overnight care. Therefore, we are proposing to add new subpart F to reflect coverage, scope and payment for ASC services under the revised payment system. Included in these changes will be new § 416.166 that will reflect these changes that we are proposing to our current policy for evaluating and identifying those procedures that would pose a significant safety risk for beneficiaries and would be excluded from our list of ASC covered procedures beginning January 1, 2008. To set apart the provisions that are applicable to our current ASC payment system from those that would apply to our proposed revised system, we are proposing to revise the section headings of subparts D and E to clearly denote the provisions that would govern covered surgical procedures furnished before January 1, 2008. We also will add new §§ 416.76 and 416.121 to clearly denote the effective dates of subparts D and E. (2) Overnight Stay A longstanding criterion for determining which procedures are appropriate for inclusion on the ASC list has been that the procedures on the list do not require an extended recovery time. Section 416.65(a)(3) of the regulations provides that ASC procedures “[a]re limited to those requiring a dedicated operating room (or suite), and generally requiring a post-operative recovery room or short-term (not overnight) convalescent room.” Under § 416.65(b)(1)(ii), we have considered procedures that require more than 4 hours recovery or convalescent time to be inappropriately performed in the ASC. We have heard many differing opinions as to what constitutes an “overnight” stay, ranging from “more than 24 hours” to time spent in recovery after sunset. After careful deliberation and consideration of several options, we are proposing to exclude from payment of an ASC facility fee any procedure for which prevailing medical practice dictates that the beneficiary will typically be expected to require active medical monitoring and care at midnight following the procedure. Our clinical staff evaluated each procedure using available claims and physician pricing data, as well as clinical judgment, to determine which procedures would be expected to require monitoring at midnight of the day on which the surgical procedure was performed. We are proposing to use midnight as the defining measure of an overnight stay for several reasons. First, a patient's location at midnight is a generally accepted standard for determining his or her status as a hospital inpatient or skilled nursing facility patient and as such, it seems reasonable to apply the same standard in the ASC setting. Second, overnight care is not within the scope of ASC facility services for which Medicare makes payment. The expectation is that procedures performed at an ASC are ambulatory in nature; that is, patients undergoing a procedure in an ASC will recover from anesthesia and return home on the same day that they report to the ASC for a scheduled procedure. Finally, the expected need for monitoring at midnight is a straightforward and easily understood definition of “overnight stay.” We are proposing to add the requirement that procedures not require an overnight stay to proposed new § 416.166. 2. Proposed Treatment of Unlisted Procedure Codes and Procedures That Are Not Paid Separately under the OPPS (If you choose to comment on issues in this section, please include the caption “ASC Unlisted Procedures” at the beginning of your comment.) Unlisted procedure CPT codes are used to report services and procedures that are not accurately described by any other, more specific CPT codes. An example of an unlisted CPT code is 33999 (Unlisted procedure, cardiac surgery). Within the surgical range of CPT codes, there are 91 such codes. None of the unlisted CPT codes in the surgical range is on the current ASC list of approved procedures. Under the OPPS, we assign unlisted CPT codes to the lowest weighted APC in the relevant clinical group regardless of the median cost for the unlisted procedure code, and we do not include the highly variable claims-based cost information for unlisted services in calculating APC median costs for purposes of establishing APC relative payment weights. Payment for unlisted CPT codes is made only at the discretion of the carrier under the MPFS. Because of concerns about the potential for safety risks when procedures that may only be reported with CPT unlisted procedure codes are performed, we are proposing to continue excluding unlisted procedure codes from payment of an ASC facility fee. For example, when CPT code 33999 is reported on a claim, we know only that some kind of cardiac surgery was performed. We have no other information about the procedure, and we have no way of knowing whether the procedure involved major blood vessels, prolonged or extensive invasion of body cavities, extensive blood loss, or was emergent or life-threatening in nature. Therefore, because of potential safety concerns, we are proposing to continue to exclude the unlisted surgical codes from payment of an ASC facility fee under the revised payment system. Prior to our evaluation of surgical procedure codes for their safety risk, we decided to propose that we would not make separate payment under the revised ASC payment system for CPT codes in the surgical range that are “packaged” under the OPPS. Packaged CPT codes under the OPPS are identified by status indicator ‘N' in Addendum B of this proposed rule. We are making this proposal for three reasons. First, we would not be able to 
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                        establish an ASC payment rate for packaged surgical procedures using the same method we are proposing for all other ASC procedures because packaged surgical codes have no relative payment weights under the OPPS upon which to base an ASC payment rate. Second, because we want an ASC system that is as similar to the OPPS as possible, we believe that surgical procedures whose costs we package under the OPPS should also be packaged in the ASC system. Finally, ASCs, just like hospitals, would receive payment for these surgical procedures because their costs are already packaged into the APC relative payment weights for associated separately payable procedures, for which we are proposing to pay a derivative ASC facility fee. 3. Proposed Treatment of Office-Based Procedures (If you choose to comment on issues in this section, please include the caption “ASC Office-Based Procedures” at the beginning of your comment.) According to the general standard in § 416.65(a)(2) of the regulations, procedures that “are commonly performed, or that may be safely performed, in physicians’ offices” are excluded from the ASC list. We are not proposing to continue to apply this provision under our revised system. Rather we are proposing to allow payment of an ASC facility fee for surgical procedures that are commonly and safely performed in the office setting. We reason that the types of procedures performed in physician offices would neither pose a significant safety risk nor require an overnight stay when performed in an ASC. However, we have concerns that allowing payment for office-based procedures under the ASC benefit may create an incentive for physicians inappropriately to convert their offices into ASCs or to move all their office surgery to an ASC. In section XVIII.C.5 below, to address this concern, we propose to limit payment for office-based procedures to help neutralize any such incentive. We also propose in new § 416.171(e) to set forth rules governing office-based procedures. We specifically invite comment regarding the effect on the Medicare program and on practice patterns for ambulatory surgery generally of our proposal to allow payment of an ASC facility fee for office-based procedures that historically have been excluded from the ASC list. As discussed elsewhere in this proposed rule, we are proposing to limit payment for office-based procedures in an attempt to mitigate potentially inappropriate migration of services from the physician office setting to the ASC. Alternatively, we could entirely exclude office-based procedures or procedures that require relatively inexpensive resources to perform from the approved ASC list of procedures. 4. Listing of Surgical Procedures Proposed for Exclusion From Payment of an ASC Facility Fee Under the Revised Payment System Tables 44 and 45 below, list the codes and short descriptors for surgical procedures that, in addition to the codes that comprise the inpatient list in Addendum E of this proposed rule, we are proposing to exclude from payment of an ASC facility fee for services furnished on or after January 1, 2008 because they pose a significant safety risk or require an overnight stay. We discuss in section XVIII.B.1.b.(1) above, our rationale for excluding the procedures in Table 44 from payment of an ASC facility fee. For many of the procedures listed in Table 45, several disqualifying criteria could be applicable, such as “requires inpatient stay” or “could potentially cause extensive blood loss” or “is emergent in nature.” Rather than list multiple disqualifying criteria for individual codes in Table 45, we have defaulted to the one characteristic that is common to all the codes listed. That is, we believe that, at a minimum, prevailing medical practice would dictate the provision of overnight care following each of the procedures listed in Table 45. We acknowledge that we had to exercise a degree of clinical judgment in identifying procedures for which we are proposing to exclude payment of an ASC facility fee. Therefore, we are soliciting comments on the appropriateness of excluding these procedures from payment of an ASC facility fee under the revised payment system. We request that commenters who disagree with a proposed exclusion from payment of an ASC facility fee submit clinical evidence that demonstrates that the criteria we are proposing in proposed new § 416.166 of the regulations are not factors when the procedure is performed in the majority of cases, including data to support that the preponderance of Medicare beneficiaries upon whom the procedure is performed do not require overnight care or monitoring following the surgery. Simply asserting that the procedure can be safely performed in an ASC without providing corroborative evidence and data does not furnish us with sufficient information upon which to make an informed decision. 
 
  
 
  
 
  
 
  
 
  
 
  
 
  C. Proposed Ratesetting Method 1. Overview of Current ASC Payment System (If you choose to comment on issues in this section, please include the caption “ASC Ratesetting” at the beginning of your comment.) The current ASC payment system consists of 9 standard overhead amounts ranging from $333 to $1339, based on data collected in a 1986 survey of ASC costs. An ASC payment “group” currently consists of all the procedures assigned to a particular standard overhead amount. ASC payment groups are heterogeneous in terms of clinical characteristics, cutting across all body systems and types of surgery. Medicare pays a $150 allowance for IOLs that are inserted during or subsequent to cataract surgery and an additional $50 for IOLs that we approved as NTIOLs. Medicare also makes separate payment for implantable prosthetic devices and implantable durable medical equipment surgically inserted at an ASC. Payment for all other facility services that are directly related to performing a surgical procedure is packaged into the prospectively determined ASC facility fee. The statute requires that ASC facility services amount be increased by the CPI-U in years when the amounts are not updated. However, since 1990, the Congress has frozen or reduced the update adjustment for periods of varying duration. ASC payment rates are currently frozen at their FY 2003 level. Carriers account for geographic wage variations when calculating individual ASC payments by applying the hospital IPPS wage index value established for the county in which the ASC is located to 34.45 percent of the national ASC standard overhead amount. The 1986 survey data are the basis for attributing 34.45 percent of ASC overhead costs to labor-related expenses. Medicare pays 80 percent of the standard overhead amount; the beneficiary coinsurance rate is 20 percent for all procedures on the list of Medicare approved ASC procedures. The standard overhead amounts for procedures on the ASC list were last rebased in 1990 using data collected in a 1986 survey of ASC costs. The process and methodology that we used to establish the current payment system are explained in the February 8, 1990 
                        **Federal Register**
                         (55 FR 4526). In the June 12, 1998 
                        **Federal Register**
                        , we issued a proposed rule to revise the ASC payment rates and ratesetting methodology based on data collected in a 1994 survey of ASC costs (63 FR 32290). In that proposed rule, we also proposed to expand the ASC list and establish payment groups similar to those being considered for the hospital OPPS, which was under development at the time, but which was not implemented until August 2000. Although we never implemented the revised ASC payment rates and ratesetting methodology proposed in 1998, we did make final some of the 1998 proposed additions to the ASC list in the March 28, 2003 final rule with comment period (68 FR 15268). In that rule, we explained in detail why we did not implement the ratesetting methodology and payment amounts proposed in the June 12, 1998 proposed rule. The ASC payment system that we are proposing in this proposed rule would implement requirements set forth in section 626 of Pub. L. 108-173. The revised payment system mandated by section 626(d) of Pub. L. 108-173 requires us to take into account recommendations in a report to Congress prepared by the GAO. The GAO recommendations are to be based on its study of the comparative relative costs of procedures furnished in ASCs and procedures furnished in hospital outpatient departments paid under the OPPS, and the extent to which the APCs reflect procedures performed in ASCs. Although the statutory due date for this report is January 1, 2005, CMS has not yet received the report or recommendations from the GAO. We are moving forward with our proposal for a revised ASC payment system without the benefit of GAO's recommendations because we are concerned that further delay would not give the public sufficient opportunity to review and comment on our proposed methodology, and the ASC industry and CMS would not have adequate time to prepare for changes scheduled for implementation January 1, 2008. 
                        ( print page 49647) 2. Proposal to Base ASC Relative Payment Weights on APC Groups and Relative Payment Weights Established Under the OPPS We considered several strategies and methodologies for setting ASC payment rates under a revised payment system. We could require ASCs to submit modified cost reports as a basis for establishing ASC costs. We could simply expand the number and payment range of the current ASC payment groups. We could base payments to ASCs on the relative weights for surgical services established under the MPFS. We could base payments to ASCs on the relative weights for surgical services established under the Medicare OPPS, as suggested in Pub. L. 108-173. We could base payments to ASCs on a flat percentage of the payment for the same services established under the OPPS, as advocated by representatives of several ASC associations. After carefully reviewing the advantages and disadvantages of each of these approaches, we are proposing, within the parameters of section 626 of Pub. L. 108-173, to use the APC groups and the relative payment weights for surgical procedures established under the OPPS as the basis of the payment groups and the relative payment weights for surgical procedures performed at ASCs. These payment weights would be multiplied by an ASC conversion factor in order to calculate the ASC payment rates. Several factors persuaded us to advance this proposal over the other approaches that we considered. First, in section 626(d) of Pub. L. 108-173, the Congress explicitly targets the OPPS for consideration by the GAO in its study of ASC payments. We believe it is reasonable to assume that Congress, by so doing, was highlighting the relative payment weights under the OPPS as a theoretical model for ASC relative payment weights under the revised payment system. Second, the ASC benefit provides payment for facility services associated with performing surgical procedures. The OPPS has equipped us with nearly a decade of experience in developing and refining a relative payment system for facility services furnished in connection with outpatient surgical procedures. Third, Pub. L. 108-173 applies for the first time a budget neutrality requirement to the ASC benefit. That is, in the year the revised system is implemented, the system is to be designed to result in the same aggregate amount of expenditures that would be made if the revised payment system were not implemented. Because the OPPS is also a prospective payment system for facility services that is subject to budget neutrality requirements, it provides useful parallels for a ratesetting methodology based on relative facility payment weights for surgical services under the revised ASC payment system. Fourth, in our analysis of the APC groups to which surgical procedures are assigned for payment under the OPPS, we found a significant overlap between surgical procedures furnished in the hospital outpatient setting and those performed in ASCs. Currently, of the 150 highest volume surgical procedures furnished in hospital outpatient departments, more than half (80) are also among the 150 highest volume procedures performed in ASCs. Finally, the ASC industry in numerous meetings with us over the past several years has frequently voiced its preference for a payment system that parallels the OPPS for the sake of promoting transparency across sites of service in the arena of outpatient surgery and to streamline and modernize how Medicare sets payments and determines what is payable under the ASC benefit. As we explain in sections I through XVI of this proposed rule, the OPPS payment rates are based on relative payment weights which are updated annually. APCs to which surgical procedures are assigned are generally homogeneous both in terms of clinical characteristics and resource requirements. The APCs have been continually refined over the past 6 years through the work of the APC Panel and as a result of comments received during the OPPS annual rulemaking cycles. Moreover, we believe that the APC groups and the relativity in resource utilization among APCs containing surgical procedures have matured so that they are reasonable and appropriate models for grouping outpatient surgical procedures and determining the relativity in the ASC payment weights in terms of clinical and resource homogeneity. For example, whether performed in a hospital outpatient department or in an ASC, we believe the time and facility resources required to perform a routine laparoscopic hernia repair (CY 2006 OPPS relative payment weight of 43.0498) are approximately 4 times higher than those required to perform a diagnostic colonoscopy (CY 2006 OPPS relative payment weight of 8.5588). Thus, we believe that the relative payment weights established under the OPPS for procedures performed in the outpatient hospital setting reasonably reflect the relative resources required for such procedures and do so with sufficient coherence to be applicable to other ambulatory sites of service. Taking all these factors into account, we are proposing to use the APCs as a “grouper” and the APC relative payment weights as the basis for ASC relative payment weights and for calculating ASC payment rates under the revised payment system. Accordingly, we are proposing to establish provisions in proposed new subpart F §§ 416.167, 416.169, and 416.171 to reflect these proposed changes for calculating the ASC payment rates beginning January 1, 2008. In the following sections, we focus on several additional basic assumptions that affect how we are proposing to calculate the ASC payment rates for implementation in January 2008. 3. Proposed Packaging Policy (If you choose to comment on issues in this section, please include the caption “ASC Packaging” at the beginning of your comment.) Payment for a surgical procedure under both the current OPPS and ASC payment systems represents payment for a package of various items and services, all of which are directly related and required in order to perform the procedure. In both systems, we package into a single facility fee the payment for a bundle of direct and indirect costs incurred by the facility to perform the procedure. These costs include, but are not limited to, use of the facility, including an operating suite or procedure room and recovery room; nursing, technician, and related services; administrative, recordkeeping and housekeeping items and services; medical and surgical supplies and equipment; surgical dressings; and materials for anesthesia. Medicare currently applies different rules under the ASC payment system and the OPPS system for determining whether payment for other items and services directly related to a surgical procedure is packaged into the facility payment for the associated surgical procedure or paid for separately. These other items and services include drugs, biologicals, contrast agents, implantable devices, and diagnostic services such as imaging. Currently, Medicare packages payment for the costs for all drugs, biologicals, and diagnostic services, including imaging, into the ASC standard overhead amount for the surgical procedure with which these items and services are associated. Under the OPPS, Medicare pays separately for some of these items and services, in addition to paying for the surgical procedure. 
                        ( print page 49648) ASCs currently receive separate payment for prosthetic implants and implantable durable medical equipment (DME). Conversely, under the OPPS, payment for prosthetic implants and implantable DME is packaged into the facility fee for the surgical procedure performed to insert the implants. Payment for IOLs and implantable surgical supplies, such as stents, mesh, guide wires, pins, and catheters is packaged into the associated surgical facility fee under both the OPPS and the ASC payment systems. We considered several packaging options for the revised ASC payment system. First, we considered making no change to the current policy regarding items and services for which payment is packaged into the ASC facility fee. That is, we would continue under the revised ASC payment system to package into the facility fee payment for overhead, payment for all drugs, biologicals, surgical dressings, supplies, splints, casts, and appliances and equipment directly related to the provision of surgical procedures; diagnostic or therapeutic services or items directly related to the provision of a surgical procedure; materials for anesthesia; and IOLs. In addition, we would continue to pay separately under other fee schedules for items and services such as NTIOLs, prosthetic implants and implantable DME surgically inserted at an ASC (DMEPOS fee schedule); laboratory services (clinical lab fee schedule); physician services (MPFS); and X-ray or diagnostic procedures other than those directly related to performance of the surgical procedure (MPFS). Section 416.164(a) addresses the services for which payment is included in the ASC facility fee, and § 416.164(b) addresses those services that are not included in the ASC facility fee. We also considered proposing to apply the OPPS packaging rules to the ASC payment system and to pay under the new ASC system the same way we pay under the OPPS for items and services directly related to a surgical procedure. If we adopted this option, payment for certain imaging procedures, drugs, biologicals, and contrast agents directly related to performing a surgical procedure would not be packaged into the facility fee for the procedure but would, instead, be paid separately. Conversely, payment for most surgically implanted devices and implantable DME 
                        *would*
                         be packaged. Each of the preceding two options have characteristics that are inconsistent with a fundamental principle of a prospective payment system, which is to base payment on large bundles of items and services so as to promote the efficient provision of services. To preserve as much as possible the elements of a prospective payment system within the revised ASC payment system, we are proposing a third option. That is, we are proposing to continue the current policy of packaging into the ASC facility fee payment all direct and indirect costs incurred by the facility to perform a surgical procedure. This would include payment for all drugs, biologicals, contrast agents, anesthesia materials, and imaging services, as well as the other items and services that are currently packaged into the ASC facility fee as listed in § 416.164(a). In addition, we are proposing to cease making separate payment for implantable prosthetic devices and implantable DME inserted surgically at an ASC. Instead, under the revised payment system, we are proposing to package into the ASC facility fee payment for implantable prosthetic devices and implantable DME when they are surgically inserted, as we do under the OPPS. However, we are proposing to continue excluding from payment as part of the ASC facility fee the other services addressed in § 416.164(b). That is, payment for items and services for which payment is made under other Part B fee schedules, with the exception of implantable prosthetic devices and implantable DME, would not be included in the ASC facility fee. Payment for items and services, such as physicians' professional services, for laboratory, X-ray or diagnostic procedures (other than those directly related to performance of the surgical procedure), nonimplantable prosthetic devices, ambulance services, leg, arm, back and neck braces, artificial limbs, and durable medical equipment for use in the patients' home would not be included in the ASC facility fee. We are proposing this option for a number of reasons. First, this approach to packaging is most consistent with the principles of a prospective payment system. Second, we believe that ASCs generally treat a less complex and severely ill patient case mix and, as a result, we believe that ASCs are less likely to provide on a regular basis many of the separately paid items and services that patients might receive more consistently in a hospital outpatient setting. Thus, we do not believe there is a need to pay for these services separately in ASCs, because that would unbundle some items and services that are currently packaged into the ASC facility fee, reduce incentives for cost-efficient delivery of services at ASCs, and increase the complexity of the revised ASC payment system. In addition, we believe it is critical to continue to focus the ASC payment system on appropriate payment for surgical services provided in ASCs. Moreover, after careful analysis of OPPS claims for surgical procedures, we were unable to identify ancillary items and services that are repeatedly and consistently reported separately in association with specific ambulatory surgical procedures. Rather, the OPPS claims for surgical procedures were of two types: one group showed a broad range of items and services that were provided on the same day that a surgical procedure was performed in the hospital outpatient department, only some of which were likely to be directly related to the surgical procedure; the second group of claims revealed that many surgical procedures are only infrequently associated with ancillary items and services paid separately under the OPPS. Therefore, we are proposing to reflect this proposed packaging policy in proposed new § 416.164. We are seeking comments from ASC clinical and administrative staff and from physicians who perform surgery at ASCs regarding nonsurgical ancillary services or items that are directly related to a surgical procedure that would be paid separately under the OPPS but that would be packaged under our proposal for the revised ASC payment system. We are specifically requesting that commenters provide data to indicate the frequency with which specific items and services are typically furnished in association with given procedures, the reasons why one patient might require the additional items and services whereas another patient would not, and the costs of those items and services relative to the other costs incurred to perform the associated surgery. 4. Payment for Corneal Tissue Under the Revised ASC Payment System (If you choose to comment on issues in this section, please include the caption “ASC Payment for Corneal Tissue” at the beginning of your comment.) In a memorandum dated May 21, 1992, CMS (known at the time as the Health Care Financing Administration or “HCFA”) notified Regional Administrators that carriers could pay corneal tissue acquisition costs when HCPCS code V2785 (Processing, preserving and transporting corneal tissue), is reported with corneal transplant procedures performed in an ASC. The memorandum indicated that payment for corneal tissue acquisition costs is subject to the usual copayment 
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                        and deductible requirements, and could be paid as an add-on to either the ASC facility fee or the physician's fee for corneal transplant surgery performed at an ASC. In the June 12, 1998 proposed rule to revise the ASC ratesetting methodology and payment rates, we proposed to package the costs incurred by an ASC to procure corneal tissue into the payment for the associated cornea transplant procedure rather than continue making separate payment for those costs (63 FR 32312 and 32313). We also proposed to package corneal tissue acquisition costs into the APC payment for corneal transplant procedures in the September 8, 1998 proposed rule to implement the OPPS (63 FR 47760). We received numerous comments from physicians, eye banks, and health care associations opposing both proposals. In the April 7, 2000 final rule with comment period, which implemented the OPPS, we summarize the comments that we received in response to the September 8, 1998 proposal, and we determined that we would not implement our proposal to package payment under the OPPS for corneal tissue costs but would, instead, make separate payment based on hospitals' reasonable costs to procure corneal tissue (65 FR 18448 and 18449). Because we never made final the changes in the ASC payment rates and ratesetting methodology that we proposed in the June 12, 1998 
                        **Federal Register**
                        , the policy issued in the June 1992 memorandum remains in effect, which allows carriers to make separate payment for the costs incurred to procure corneal tissue for transplant at an ASC. We are proposing under the revised ASC payment system to continue to pay ASCs separately, based on their invoiced costs, for the procurement of corneal tissue. We have no evidence to suggest that costs incurred to procure corneal tissue are any less variable now than they were in 1992, in 1998 or in 2000. If we were to package payment for the procurement of corneal tissue into the APC for corneal transplant procedures, we believe the resulting payment rate would continue to overpay those facilities that are able to acquire corneal tissue at little or no cost through philanthropic organizations and underpay those facilities that must pay for corneal tissue processing, testing, preservation, and transportation costs. Therefore, we are proposing to include in proposed new § 416.164, our proposal to exclude payment for corneal tissue furnished in an ASC on or after January 1, 2008, from the ASC facility payment rate. We invite comment and data that support or challenge this proposal to continue paying ASCs for corneal tissue on an acquisition cost basis. 5. Proposed Payment for Office-Based Procedures (If you choose to comment on issues in this section, please include the caption “ASC Payment for Office-Based Procedures” at the beginning of your comment.) Since the inception of the ASC benefit, procedures that are commonly performed or that can be safely performed in a physician's office have generally been excluded from the ASC list. For the sake of convenience, we refer to these procedures as “office-based” in this preamble discussion. Over the past 15 years, physicians and ASC associations have urged CMS to add office-based procedures to the ASC list or to retain on the ASC list procedures that were originally performed most commonly in an institutional setting, but that have subsequently moved to an office setting as surgical techniques and technology have advanced. Representatives of the ASC industry argue that although, for most patients, the office is an appropriate setting for most high volume office procedures, there are some patients for whom an ASC or another more resource-intensive setting is required. The physician may decide that a facility setting is necessary for individual patients for various clinical reasons, such as the need for more nursing staff, a sterile operating room, or a piece of equipment not typically available in the office setting. CPT code 52000 (Cystourethroscopy (separate procedure)) is a prime example of a high volume procedure that is performed more than 80 percent of the time in an office setting, but for which a small number of patients require resources usually available only at an ASC or hospital. Unless we make an exception to the criteria that currently govern which procedures comprise the ASC list and allow an office-based procedure to remain on the ASC list, as we have done with CPT code 52000, the hospital would be the only facility setting available as an alternative to the office setting. ASC industry commenters assert that this limitation is burdensome both to physicians and to beneficiaries and could, in some cases, limit beneficiary access to needed surgery. We generally interpret “office-based” or “commonly performed in a physician's office” to mean a surgical procedure that the most recent BESS data available indicate is performed more than 50 percent of the time in the physician's office setting. In section XVIII.B.1 of this preamble, we are proposing to expand the ASC list to allow payment for 
                        *all*
                         surgical procedures, except those procedures that pose a significant safety risk or require an overnight stay. Because office-based surgical procedures typically do not pose a significant safety risk and do not require an overnight stay, we are proposing not to exclude them from payment of an ASC facility fee under the revised ASC payment system. However, we are seeking comment on the appropriateness of excluding office-based procedures or procedures that require relatively inexpensive resources to perform from the approved ASC list of procedures. We recognize that paying an ASC facility fee for office-based procedures based on OPPS relative payment weights could have a significant impact on Medicare program costs. Approximately two-thirds of the additional procedures for which we propose to not exclude for payment beginning in CY 2008 are office-based, that is, they are performed in the physician office more than 50 percent of the time. The Medicare payment for many of these procedures under the MPFS would be lower than the payment for the same procedures when they are performed in an ASC where the facility fee is based on OPPS relative weights. The separate physician payment and facility payment when the procedures are performed in an ASC would exceed the combined payment when they are performed in the physician office. Therefore, ASC payment rates based on the OPPS relative payment weights could result in a significant program cost were these high volume procedures to shift from the office to the ASC setting. One reason why we are concerned if there were to be a sizable shift of office-based procedures to ASCs is the impact that would have on ASC payments in light of the statutory requirements that the revised ASC payment system be designed to result in the same aggregate amount of expenditures as would be made if the revised payment system were not implemented. (See section XVIII.A.1. of this preamble for a discussion of this requirement). An influx of high-volume, relatively low cost office-based procedures into the ASC setting under the revised payment system could lower the payment amounts for other procedures paid for in the ASC due to the constraints of budget neutrality. In other words, we would have to scale the ASC conversion factor downward in order for estimated 
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                        aggregate expenditures under the revised system to not exceed what they would have been if the new payment system were not implemented. Payment for procedures with relatively high payments would have to be reduced in order to offset increased aggregate costs resulting from an influx of relatively low cost, high volume office procedures shifting to ASCs. (See section XVIII.C.10. of this preamble for a detailed discussion of our proposal for calculating an ASC conversion factor.) We are committed to refining Medicare payment systems wherever possible to prevent payment incentives from inappropriately driving decisions about where to perform a surgical procedure when those decisions should be based on clinical considerations. We strive to promote value-based purchasing in all Medicare payment systems that leads to significant positive effects on the health of Medicare beneficiaries by improving quality and efficiency in the delivery of health services. We are also committed to ensuring Medicare payments that are efficient and reasonable. To mitigate the impact of office-based procedures migrating to the more expensive ASC setting if we were to implement our proposal not to exclude them from payment of an ASC facility fee under the revised ASC payment system, we are proposing to cap payment for office-based surgical procedures for which payment of an ASC facility fee would be allowed under the revised payment system as of January 1, 2008, at the lesser of the MPFS nonfacility practice expense payment or the ASC rate under the revised ASC payment system. We also are proposing to exempt procedures that are on the ASC list as of January 1, 2007, that meet our criterion for designation as office-based, from the payment limitation proposed for office-based procedures for which payment of an ASC facility fee would be allowed for the first time beginning January 1, 2008. Accordingly, we are proposing to incorporate in proposed new § 416.171(e) the limitation on payment for these procedures beginning January 1, 2008. As discussed elsewhere in this proposed rule, we are proposing to limit payment for office-based procedures in an attempt to mitigate potentially inappropriate migration of services from the physician office setting to the ASC. Alternatively, we could entirely exclude office-based procedures or procedures that require relatively inexpensive resources to perform from the approved ASC list of procedures, although this is not the approach we are advancing. In considering value-based purchasing, we seek comment concerning whether procedures that are currently primarily office-based or that require relatively inexpensive resources are most efficiently and effectively provided in the ASC facility setting, which typically possesses greater surgical capacity than such procedures would generally require. When we started to identify the codes that we would propose to classify as office-based beginning in CY 2008, we encountered some anomalous cases that required further refinement of our office-based criterion beyond strict application of a 50-percent utilization threshold. For example, we identified some CPT codes that meet the 50-percent office utilization threshold for which a nonfacility practice expense amount has not been developed under the MPFS. We are proposing to classify as office-based any surgical codes that our physician claims data indicate are performed more than 50 percent in an office setting, even if the codes lack a nonfacility practice expense RVU under the MPFS. We further propose to cap payment for these procedures, as appropriate, once a nonfacility practice expense RVU is established. Until that time, we are proposing to calculate payment for these office-based surgical CPT codes using the methodology we propose in sections XVIII.C.11.c. and d. below, for other surgical procedures. Similarly, until a national nonfacility practice expense RVU is established for office-based surgical CPT codes that are “carrier priced” under the MPFS, we are proposing to calculate the ASC facility payment using the same methodology that we are proposing for surgical procedures that are not office-based. Application of the cap to codes designated as office-based would be updated through rulemaking as part of the annual ASC payment update. In applying the data-based 50-percent threshold, we discovered some contradictions in the data that required us to further refine our definition of office-based. For example, we noted instances in which seemingly very similar procedures had inconsistent site of service utilization. The BESS data showed high levels of office utilization for some complex procedures which we expected to be performed infrequently in an office setting whereas simpler but related procedures showed lower levels of office utilization. We therefore undertook another, more detailed level of review and identified groups of CPT surgical codes related to procedures that are performed 50 percent or more of the time in the office setting to determine if there was a logical correlation between procedure complexity within a group of related procedures and the frequency with which those procedures were performed in the office setting. For example, according to CPT coding, the following three codes are related: 13120, Repair, complex, scalp arms and/or legs; 1.1cm to 2.5 cm 13121, Repair, complex, scalp arms and/or legs; 2.6 cm to 7.5 cm 13122, Repair, complex, scalp arms and/or legs; each additional 5 cm or less As is often the case for groups of related codes in the CPT coding system, the first of these codes is the least complex clinically and, in this example, the complexity of the procedure increases in proportion to the increase in the size of the area to be repaired. If utilization data indicated that CPT code 13122 was performed in the office 67 percent of the time in CY 2005, we would expect to find that both CPT codes 13120 and 13121 were also performed in the physician office more than 50 percent of the time during that year. Because the most complex procedure was provided in the office most of the time, logically, the less complex procedures would also have been performed in that site of service. However, the BESS data showed that this was not always the case. So, although our expectation was that, the less complex procedures within a group of related procedure codes would typically be performed most often in the office and the more complex procedures less often in the office, there are instances in which the less complex procedures with the code group were billed more often in an ASC or hospital outpatient department and the more complex procedures within the code billed in the office setting. In our analysis of the BESS site of service data, we also took into consideration the volume of cases represented in the data. There were a few instances in which we initially identified a procedure as office-based because the data indicated that 100 percent of the cases were performed in the physician office. However, closer inspection revealed that there was only one case reported for the procedure with physician's office as the site of service. We were concerned about using such low volume as the basis for identifying a procedure as office-based. Because of the unevenness of the data associated with some of the codes we initially classified as office-based, we conducted a code-by-code analysis to buttress inconclusive data with the clinical judgment of our medical advisors. As a result, on the basis of clinical judgement overriding inadequate or insufficient 
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                        claims data, there are some procedures that we deem meet the 50-percent threshold when taken in isolation from other closely related codes that we have designated as office-based. We are proposing to assess each year based on the most recent available BESS and other data available to us whether there are additional procedures that we would propose to classify as office-based. We would solicit comment on proposed classification of additional codes as office-based as part of the annual OPPS/ASC rulemaking cycle. In addition, we are proposing that once we identify a procedure as office-based, that classification would not change in future updates of the ASC payment system. We reason that once a procedure becomes safe enough to be performed in more than 50 percent of cases in the office setting, it would be improbable for it to revert to an institutional setting. To summarize, the list of codes that we propose as office-based in this rule takes into account the most recent available volume and utilization data for each individual procedure code and, if appropriate, the utilization and volume of related codes. While we are proposing to apply the office-based designation only to procedures that would no longer be excluded from payment of an ASC facility fee beginning in CY 2008, were we to exclude office-based services from ASC payments, we expect that the same approach to developing and updating the set of procedures in the CPT surgical code range that we consider to be office-based would be applicable. Finally, we are concerned that our proposal to allow payment of an ASC facility fee for office-based procedures, even if the ASC payment amount were capped at the lesser of the MPFS nonfacility practice expense payment or the revised ASC rate, would result in a downward adjustment to ASC payments overall, and would increase Medicare spending. We propose to exempt all procedures on the CY 2007 ASC list from application of the office-based classification. The procedures that we are proposing to designate as subject to the office-based payment limit are identified in new Addendum CC of this proposed rule. Those procedures for which the proposed CY 2008 payment would be based on the MPFS nonfacility practice expense RVU are flagged in Addendum BB. The ASC relative payment weight shown for procedures in Addendum BB that would be capped by the MPFS nonfacility practice expense RVU has been adjusted to reflect the capped payment amount. We remind readers that the ASC payment rates in Addendum BB of this proposed rule are based on proposed CY 2007 OPPS relative payment weights and proposed MPFS nonfacility practice expense RVUs. The final ASC relative weights and payment amounts for CY 2008 would be different from the rates published in this proposed rule because they would take into account the CY 2008 updates of both the OPPS and the MPFS. The proposed and final ASC relative weights and payment amounts for CY 2008 would be published in the 
                        **Federal Register**
                         during the proposed and final rulemaking cycles for the CY 2008 OPPS. 6. Payment Policy for Multiple Procedure Discounting We are proposing to mirror the OPPS policy for discounting when a beneficiary has more than one surgical procedure performed on the same day at an ASC. The current policy for multiple procedure discounting in the ASC, as specified in § 416.120(c)(2)(ii), is based on a simple count of procedures performed on the same day. The most costly procedure is paid the full amount and all other procedures are discounted by half. Under the OPPS, certain surgical procedures are not subject to the discounting policy. Generally, the procedures that are exempted are those performed to implant costly devices. They are not discounted even when performed in association with other surgical procedures because the cost of the implantable device does not change, so resource savings due to efficiencies would be minimal. Until now, there has been no reason to exempt any procedure from the multiple procedure discounting policy in ASCs because separate payments have been made for implantable devices. Thus, although the facility payment for the procedure may have been discounted, the cost of the device was paid outside of that rate and was unaffected by the multiple procedure discount. Under the revised ASC payment system, we are proposing to package into the payment for the procedure payment for implantable devices in the ASC, as in the OPPS. Because we are trying wherever possible to implement parallel payment policy across both systems, we are proposing to adopt the OPPS discounting policy that is applied more specifically to surgical procedures so that the costs of performing multiple procedures that require implantation of costly devices are taken into account. Thus, payment for the same set of multiple procedures in the OPPS and the ASC would be made using similar packaging and payment rules. Table 46 below lists the procedures that would be exempt from multiple procedure discounting. These exempt procedures are those surgical procedures proposed for payment of an ASC facility fee that are assigned a status indicator other than “T” under the OPPS, to indicate that a multiple surgical procedure reduction does not apply. We are proposing to update this list annually in the OPPS/ASC proposed rule, soliciting comment on the list. We are proposing to incorporate our proposed policy on multiple procedure discounts in proposed new § 416.172(e). 
 
  
 
  
 
  
 
 7. Proposed Geographic Adjustment (If you choose to comment on issues in this section, please include the caption “ASC Wage Index” at the beginning of your comment.) Currently, Medicare adjusts 34.45 percent of the national ASC payment rates using wage index values and localities that were established under the IPPS prior to implementation of the new Core Based Statistical Areas (CBSAs) issued by OMB in June 2003. Medicare currently adjusts 60 percent of national OPPS payment rates by the IPPS wage index value assigned to hospitals using the June 2003 OMB definitions for geographical statistical areas and wage adjustments required under Pub. L. 108-173. Since 1990, ASC payments have been adjusted for regional wage variations using the hospital IPPS wage index values. We believe that standardization continues to be appropriate in recognition of widely varying labor market costs tied to geographic localities. We also believe that it is advisable to maintain the consistency in locality designations between ASCs and hospitals and acknowledge parity of labor costs between ASCs and HOPDs that are competing for staff in the same locality. Therefore, we are proposing to apply to ASCs the IPPS pre-reclassification wage index values associated with the June 2003 OMB geographic localities, as recognized under the IPPS and OPPS, to adjust national ASC payment rates for geographic wage differences under the revised payment system. Although we have not collected new data to identify whether the current labor-related share is correct, the results of a 1994 survey of ASC costs supported the current 34.45 percent labor adjustment factor, and we have received no complaints from the ASC community about our continued use of the 34.45/65.55 ratio of labor to nonlabor costs for purposes of adjusting payments for regional wage differences. Moreover, we believe it is reasonable to expect ASCs to have a lower labor adjustment factor than that of a hospital. For example, most OPPS hospital outpatient departments are staffed 24 hours per day to provide emergency department services and observation care. Therefore, we are proposing to continue using 34.45 percent as the labor adjustment factor for regional wage differences under the ASC revised payment system, beginning in CY 2008. We are proposing to establish rules governing this proposed new § 416.172(c). 8. Proposed Adjustment for Inflation (If you choose to comment on issues in this section, please include the caption “ASC Inflation” at the beginning of your comment.) As noted above, section 1833(i)(2)(C)(iv) of the Act, as amended by section 626(a) of Pub. L. 108-173, requires the adjustment of ASC facility services amounts for inflation for FY 2005, the last quarter of CY 2005, and each of CYs 2006 through 2009, to equal zero percent. Otherwise, section 1833(i)(2)(C)(i) of the Act provides that ASC facility services amounts are to be adjusted by the percentage increase in the CPI-U during years when the ASC amounts are not updated. As explained in section II.C. of the preamble of this proposed rule, the OPPS conversion factor is updated annually using the hospital inpatient market basket percentage increase. Although section 626(d) of Pub. L. 108-173 suggests that the Congress found merit in linking the ASC payment system to the OPPS relative payment weights and APC groups, it did not require that the new ASC payment system be updated using the hospital market basket that is the basis for annual OPPS updates. However, we believe that an update of the ASC amount is performed through the annual relative ASC payment weight adjustments that we propose in section XVIII.C.11.d.(1) below, which obviates the requirement for the statutory CPI adjustment. Nonetheless, although we are not compelled to do so by the statute, we are proposing under the revised ASC payment system, beginning in CY 2008, to apply a CPI-U adjustment to update the ASC conversion factor for inflation on an annual basis, in accordance with the statutory formula. The CPI-U adjustment in CY 2008 and CY 2009 would equal zero. Beginning in CY 2010, we would update the ASC conversion factor by the percentage increase in the CPI-U (U.S. city average) as estimated for the 12-month period ending with the midpoint of the year involved. As we explain in section XVIII.C.11.d.(2) below, we are proposing to adjust the conversion factor for inflation annually to ensure that ASC payments keep up with cost increases attributable to inflation. Accordingly, we are proposing to establish rules in proposed new §§ 416.171 and 416.172 to reflect our proposed policies for standardizing labor-related costs, applying an inflationary adjustment, and calculating a conversion factor, respectively under the proposed new payment system beginning January 1, 2008. 9. Proposed Beneficiary Coinsurance (If you choose to comment on issues in this section, please include the caption “ASC Coinsurance” at the beginning of your comment.) Payment for ASC facility services is subject to the Medicare Part B deductible and coinsurance requirements. Currently, Medicare pays participating ASCs 80 percent of a prospectively determined rate, adjusted for regional wage variations. The beneficiary deductible and coinsurance make up the other 20 percent. Section 626(c) of Pub. L. 108-173 amended section 1833(a)(1) of the Act to provide that, beginning with the implementation date of the revised payment system, the Medicare program payment to ASCs shall equal 80 percent of the lesser of the actual charge for the services or the payment amount that we determine under the revised payment system for the services. We are proposing to make this change and to continue to maintain the beneficiary deductible and coinsurance at 20 percent. We are proposing to reflect this statutory requirement in proposed new § 416.172(b) and (d). 10. Proposal To Phase In Implementation of Payment Rates Calculated Under the CY 2008 Revised ASC Payment System (If you choose to comment on issues in this section, please include the caption “ASC Phase In” at the beginning of your comment.) We discuss in section XXVII.D. of this preamble our analysis of the impact the revised ASC payment system and estimated payment rates proposed for implementation in CY 2008 could have on certain ASCs that specialize in or perform high volumes of procedures for which payment under the new system would decrease. We want to ensure that the revised payment system does not cause a sudden, unwarranted migration of services from ASCs to other ambulatory settings, or the reverse; that ASCs would have an opportunity to balance their Medicare case mix between procedures whose rates decrease and procedures whose rates increase; and, that beneficiaries and their physicians would continue to have a robust choice of sites where important preventive and other surgical services are paid for by Medicare. Therefore, we propose to implement the revised ASC payment system in CY 2008 using transitional payment rates that would be based upon a 50/50 blend of the payment rate for procedures on the CY 
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                        2007 list of approved ASC procedures and the payment rate for that procedure calculated under the revised payment methodology described in the next section and reflected in proposed new § 416.171(c). (Procedures added for payment of an ASC facility fee beginning in CY 2008 would be paid the full amount calculated under the revised payment methodology for CY 2008 rather than a blended amount.) We further propose that, in CY 2009, we would fully implement the ASC payment rates calculated under the payment methodology proposed in the next section, discontinuing the blended transitional payment rate for services furnished beginning January 1, 2009. This is proposed in new § 416.171(d). 11. Proposed Calculation of ASC Conversion Factor and Payment Rates for CY 2008 (If you choose to comment on issues in this section, please include the caption “ASC Conversion Factor” at the beginning of your comment.) a. Overview In section XVIII.C.2 of this preamble, we are proposing to base ASC relative payment weights and rates under the revised system on APC groups and relative payment weights established under the OPPS. In section XVIII.C.4 of this preamble, we are proposing to set the ASC relative payment weight for certain office-based surgical procedures so that the national ASC payment rate does not exceed the MPFS nonfacility practice expense payment. The proposed ASC payment weights are multiplied by an ASC conversion factor to calculate the proposed ASC payment rates. For CY 2008, our current estimate of the budget neutral ASC conversion factor is $39.688. The final ASC conversion factor may be higher or lower than this figure for a number of reasons, including (1) The final OPPS relative payment weights for CY 2008, (2) the final physician fee schedule practice expense payments for CY 2008 and (3) updated utilization data. b. Budget Neutrality Requirement Section 626(b) of the MMA amended section 1833(i)(2) of the Act by adding subparagraph (D) to require that in the year the new system is implemented: “* * * [S]uch system shall be designed to result in the same aggregate amount of expenditures for such services as would be made if this subparagraph did not apply, as estimated by the Secretary * * *”. The ASC conversion factor is calculated so that aggregate expenditures under the new system are estimated to be the same as the aggregate expenditures for ASC facility services in CY 2008 that would have been paid had the ASC payment system not been revised, taking into consideration the cap on payments in CY 2007 as required under section 5103 of Pub. L. 109-171, which we discuss in section XVII.D., that is, the conversion factor is calculated so the new system is budget neutral. Note that we consider expenditures in the context of section 626(b) of the Pub. L. 108-173 budget neutrality requirement to mean expenditures from the Medicare Part B Trust Fund. We do not consider expenditures to include beneficiary coinsurance and copayments. We note, however, that the exclusion of beneficiary coinsurance payments does not impact the calculation of the ASC conversion factor under our proposed methodology. (See section XXVI.D. of this preamble for impacts of the revised ASC system on beneficiary coinsurance.) c. Proposed Calculation of the ASC Payment Rates for CY 2008 We are proposing to calculate the ASC payment rates for CY 2008 as follows: *Estimated payments under the current ASC system* *Step 1:*
                         To estimate the aggregate amount of expenditures that would be made in CY 2008 under the current ASC payment system, we first multiplied the estimated CY 2008 ASC volume for each CPT code on the current ASC list by the estimated CY 2008 ASC payment rate for the CPT code under the current ASC system. The estimated CY 2008 ASC payment rates are based on the proposed CY 2007 ASC payment rates, which are found in Addendum BB to take into account the OPPS cap on ASC services as required by section 5103 of Pub. L. 109-171 and to reflect the zero percent CY 2008 update for ASC services mandated by section 1833(i)(2)(C) of the Act. We then summed the results over all services on the current ASC list. *Estimated payments under the new ASC system* *Step 2:*
                         To estimate the aggregate amount of expenditures that would be made in CY 2008, we used estimated CY 2008 OPPS payment amounts instead of estimated CY 2008 ASC payment amounts under the current system, and we multiplied the estimated CY 2008 ASC volume for each CPT code on the current ASC list by the estimated CY 2008 OPPS payment rate for the CPT code. We summed the results over all services on the current ASC list. *Calculate the CY 2008 budget neutrality adjustment* *Step 3:*
                         To calculate the CY 2008 ASC budget neutrality adjustment, we divided the total expenditures calculated in Step 1 by the total expenditures calculated in Step 2. The result is 0.62. *Apply the CY 2008 budget neutrality adjustment to determine the CY 2008 ASC conversion factor* *Step 4:*
                         To determine the CY 2008 ASC conversion factor, we multiplied the estimated CY 2008 OPPS CF by the results in Step 3. Our current estimate of the CY 2008 OPPS CF is $64.013. Multiplying the estimated CY 2008 OPPS conversion factor by the 0.62 budget neutrality adjustment yields our current estimate of the CY 2008 ASC conversion factor: $39.688. *Calculate the CY 2008 ASC payment rate under the new ASC system* *Step 5:*
                         To determine the national ASC payment rate under the new system (including the beneficiary 20 percent coinsurance), we multiplied the ASC conversion factor from Step 4 by the ASC relative payment rate. The ASC relative payment weights are primarily based on the APC groups and relative payment weights established under the OPPS as described in section XVIII.C.2 of this preamble. However, as described in section XVIII.C.4 of this preamble, the ASC relative payment weights for certain office-based surgical procedures are set so that the national ASC payment rate does not exceed the MPFS nonfacility practice expense payment. As discussed elsewhere in this proposed rule, we are proposing to limit payment for office-based procedures in an attempt to mitigate potentially inappropriate migration of services from the physician office setting to the ASC. Alternatively, we could entirely exclude office-based procedures or procedures that require relatively inexpensive resources to perform from the approved ASC list of procedures, although this is not the approach we are advancing. The ASC relative payment weights are listed in Addendum BB of this proposed rule. *Calculate the CY 2008 ASC payment rate under the transition* *Step 6:*
                         As described in section XVIII.C.10. of this preamble, we are proposing under the revised payment system a 2-year transition to 100 percent implementation of the new ASC payment rates for procedures on the CY 2007 list of approved ASC procedures. In the first year of this transition, the payment rate would be based on 50 
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                        percent of the final CY 2007 ASC standard overhead amount and 50 percent of the final payment rate calculated under the revised payment methodology proposed in this section of the preamble. d. Proposed Calculation of the ASC Payment Rates for CY 2009 and Future Years (1) Updating the ASC Relative Payment Weights We are proposing to update the ASC relative payment weights each year using the national OPPS relative payment weights for that calendar year and, for the office-based procedures, the practice expense payments under the physician fee schedule for that calendar year. We further propose to uniformly scale the ASC relative payment weights each year so that estimated aggregate expenditures using updated ASC relative payment weights are the same as estimated aggregate expenditures using the current year ASC relative payment weights. That is, we propose to make the relative payment weights budget neutral to ensure that changes in the relative payment weights from year to year do not cause the estimated amount of expenditures to ASCs to increase or decrease as a function of those changes. For example, we propose to uniformly scale the ASC relative payment weights for CY 2009 so that estimated expenditures for CY 2009 using the updated CY 2009 ASC relative payment weights are the same as they would be using the CY 2008 ASC relative payment weights. We propose to uniformly scale the ASC relative payment weights for CY 2010 so that estimated expenditures for CY 2010 using the updated CY 2010 ASC relative payment weights are the same as they would be using the CY 2009 ASC relative payment weights. We are proposing to scale the relative payment weights annually because we believe that the purpose of using relative payment weights as part of the rate setting methodology under the revised ASC system is to establish appropriate relativity among surgical procedures paid for in an ASC. Scaling the relative payment weights each year would also serve as a buffer to protect ASCs from sudden changes that could occur under the OPPS. For example, by making the relative payment weights budget neutral under the revised ASC payment system, the ASC relative weights would not drop were there to be a sudden upsurge in costs associated with hospital outpatient emergency or clinic visits relative to outpatient surgical costs. Moreover, making the ASC relative weights budget neutral would shield the ASC payment system against the inadvertent impact of unrelated aggregate changes in OPPS expenditures. We propose to continue this methodology to update the ASC payment system in future years. (2) Updating the ASC Conversion Factor In section XVIII.11.d.1, above, we propose to scale the relativity among surgical procedures each year so that aggregate expenditures under the ASC are budget neutral notwithstanding changes in the relative payment weights. In section XVIII.11.c, above, we propose to calculate the ASC payment rates each year as the product of the ASC relative payment weight and the ASC conversion factor which have been adjusted for budget neutrality. Section 1833(i)(2)(C) of the Act requires that if the Secretary has not updated the ASC facility services amounts in a calendar year after CY 2009, the payment amounts shall be increased by the percentage increase in the CPI-U as estimated by the Secretary for the 12-month period ending with the midpoint of the year involved. Although we are only required to increase ASC payment rates by the percentage increase in the CPI-U in years when we do not update the ASC payment amounts, beginning with the CY 2008 revised ASC payment system, we propose to update the ASC conversion factor annually using the CPI-U. For example, for CY 2009, the statute requires a zero percent CPI-U increase for ASC services. Therefore, the CY 2009 conversion factor would be equal to the CY 2008 conversion factor. For CY 2010, we would increase the CY 2009 conversion factor by the estimated percent increase in the CPI-U for the 12-month period ending June 30, 2010; in CY 2011, we would increase the CY 2010 conversion factor by the estimated percent increase in the CPI-U for the 12-month period ending June 30, 2011, and so forth, each year thereafter. We propose to apply this adjustment annually to ensure that ASC payments keep up with cost increases attributable to inflation. Moreover, we propose to use the CPI-U to adjust the conversion factor for inflation because we have used the CPI-U to adjust payments to ASCs for inflation since July 1987, when we first updated the ASC payment rates in effect at the time by the projected increase in the CPI-U (52 FR 20467). This proposal is reflected in § 416.167 and § 416.171. e. Alternative Option for Calculating the Budget Neutrality Adjustment Considered We considered an alternative approach to calculating the budget neutrality adjustment under the new payment system, which would take into account the effects of the migration of procedures between ASCs, physicians' offices, and hospital outpatient departments that might be attributable to the new ASC payment system. In the following discussion the phrase “new ASC procedure” refers to a procedure not currently on the ASC list of approved procedures that we are proposing for inclusion on the ASC list of approved procedures beginning in CY 2008. Under this alternative, we assumed that 25 percent of the hospital outpatient department utilization for new ASC procedures would migrate to the ASC and we assumed that 15 percent of the physician office utilization for new ASC procedures would migrate to the ASC. We believe that our assumptions of a 25 percent and 15 percent migration from hospital outpatient departments and physician offices to ASCs, respectively, are reasonable given the general utilization relationships between these settings for services currently on the ASC list. For services on the current ASC list that are predominately performed in ASC and outpatient hospital department settings, they are on average performed 30 percent of the time in the ASC setting. For services on the current ASC list that are predominately performed in the ASC and physician office settings, they are on average performed 17 percent of the time in the physician office setting. We assumed that new ASC services would migrate at slightly lower rates in the first year of the revised ASC system, yielding our migration assumptions of 25 percent for the hospital outpatient department setting and 15 percent for the physician office setting. We also assumed that the net impact of migration on services currently on the ASC list is negligible. We note that payment rates for the current highest volume ASC procedures would generally decrease under the proposed new ASC system, and the lower volume ASC procedures would experience significant payment increases. We believe it is reasonable to assume that some of the higher volume services will migrate from ASCs to other settings, and some of the current lower volume procedures will migrate to the ASC setting as a result of the payment changes. 
                        ( print page 49658) In order to calculate the budget neutrality adjustment, first, we estimated expenditures that would occur if we did not revise the ASC payment system. We estimated CY 2008 expenditures if the ASC payment weights were not revised and the ASC list of approved procedures was not expanded. As described below (see Step 1). *Estimated payments under the current system* *Step 1:*
                         Hospital outpatient department migration valued using estimated CY 2008 OPPS payment rates (a) Assuming 25 percent of the outpatient hospital department utilization for new ASC procedures will migrate to the ASC, multiple 0.25 times the hospital outpatient department utilization for each new ASC procedure. (b) For each new ASC procedure, multiple the results of Step 1(a) by the estimated CY 2008 OPPS payment rate for the procedure. (c) Sum the results of Step 1(b) across all new ASC procedures. *Step 2:*
                         Physician office migration valued using estimated CY 2008 physician payment rates (a) Assuming 15 percent of the physician office utilization for new ASC procedures will migrate to the ASC, multiple 0.15 times the physician office utilization for each new ASC procedure. (b) For each new ASC procedure, multiple the results of Step 2(a) by the estimated CY 2008 physician office payment rate for the procedure. (c) Sum the results of Step 2(b) across all new ASC procedures. *Step 3:*
                         Current ASC services valued using the estimated CY 2008 ASC payment rates under the current ASC system (a) This is described under Step 1 in the Proposed Calculation of the ASC Conversion Factor section above. *Step 4:*
                         Sum the results of Steps 1-3. *Estimated payments under the new system* *Step 5:*
                         Hospital outpatient department migration valued using estimated CY 2008 OPPS payment rates (a) Same as Step 1 in this section. *Step 6:*
                         Identify new ASC procedures currently considered to be office-based (for example, insert examples and see Addendum BB) *Step 7:*
                         Physician office migration for new ASC procedures currently considered to be office based valued using the estimated CY 2008 OPPS payment rates capped at the estimated CY 2008 physician office payment rates (a) For each new ASC procedure considered to be office based, multiply the results of Step 2(a) by the lesser of: (1) The estimated CY 2008 OPPS rate for the procedure; and (2) The estimated CY 2008 physician fee schedule office rate for the procedure. (b) Sum the results of Step 7(a) across all new ASC procedures considered to be office-based. *Step 8:*
                         Physician office migration for new ASC procedures not currently considered office based valued using the estimated CY 2008 OPPS rates (a) For each new ASC procedure not considered to be office based, multiply the results of Step 2(a) by the estimated CY 2008 OPPS rate for the procedure. (b) Sum the results of Step 8(a) across all new ASC procedures not considered to be office based. *Step 9:*
                         Physician office migration valued using the estimated CY 2008 physician fee schedule out-of-office payment rate. (a) For each new ASC procedure, multiple the results of Step 2(a) by the estimated CY 2008 out of office physician rate for the procedure. (b) Sum the results of Step 9(a) across all new ASC procedures. *Step 10:*
                         Current ASC services valued using the estimated CY 2008 OPPS payment rates (a) This is described under Step 2 in this section. *Step 11:*
                         Sum the results of Steps 5, 7-10. *Calculate the budget neutrality adjustment* *Step 12:*
                         Divide the result of Step 4 by the result of Step 11. *Step 13:*
                         The application of the cap at the estimated CY 2008 physician office payment rates that occurs in Step 7 is dependent on the ASC conversion factor. The ASC budget neutrality adjustment resulting from Step 12 is calibrated to take into account the interactive nature of the ASC conversion factor and the physician office payment cap. The resulting budget neutrality adjustment is 0.62, indicating that under the migration assumptions described above the difference between our proposed budget neutrality adjustment without migration (0.62) and this alternative budget neutrality adjustment with migration (0.62) is equal rounded to the nearest hundredth. Discussion of the alternative calculation of the budget neutrality adjustment: We have chosen to propose calculation of the budget neutrality adjustment based on the CY 2007 final ASC list of approved services and current ASC utilization because we believe this is the most appropriate approach to estimating expenditures so as to result in a budget neutral payment system in CY 2008. We have no data which would enable us to precisely estimate the net potential migration of services between the ASC setting, the outpatient hospital setting, and the physician office setting that might result from implementation of the new ASC payment system. Moreover, basing our estimate of expenditures on current ASC utilization without including migration from other sites of service is consistent with how we estimate expenditures for purposes of maintaining budget neutrality in other Medicare payment systems. We expect that some commenters may believe it is more appropriate to estimate the ASC budget neutrality adjustment taking into account the potential migration of services between the ASC setting, the outpatient hospital setting, and the physician office setting. We welcome data supporting the use of specific migration assumptions in the calculation of the ASC budget neutrality adjustment. We describe above the budget neutrality calculation under the alternative approach based on our current best estimate of the potential migration of services between the different settings so as to facilitate and stimulate comment and to encourage the submission of pertinent quantitative evidence of surgical migration resulting from changes in payment rates. We welcome data on all of the migration assumptions under this alternative approach. We note again that under the reasonable migration assumptions described above, our proposed budget neutrality calculation without migration (0.62) and the alternative budget neutrality adjustment with migration (0.62) is equal rounded to the nearest hundredth. However, if we exclude office-based procedures from the approved list of procedures, under the alternative budget neutrality adjustment that takes into account migration across different practice settings, payment rates for the ASC services remaining on the list (those procedures that are not office-based) would be slightly higher due to the statutory budget neutrality requirement. 12. Proposed Annual Updates (If you choose to comment on issues in this section, please include the caption “ASC Updates” at the beginning of your comment.) Currently, we update the ASC list every 2 years through the notice and comment regulation process. We make additions to and deletions from the ASC list based on clinical judgment and data that are available regarding utilization of 
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                        care settings. The last update was published in the May 4, 2005 
                        **Federal Register**
                         (70 FR 23690) and the update for CY 2007 is proposed in section XVII of this preamble. The process we follow currently to update the ASC list is explained in section XVII of this preamble. Under the revised ASC payment system, which would be implemented effective January 1, 2008, we are proposing to update on an annual calendar year basis the ASC conversion factor, the relative payment weights and APC assignments, the ASC payment rates, and the list of procedures for which Medicare would not make payment of an ASC facility fee. To the extent possible under the rules and policies of the revised ASC payment system, we are proposing to maintain consistency between the OPPS and the ASC payment systems in the way we treat new and revised HCPCS and CPT codes for payment under the ASC payment system. We also are proposing to invite comment as part of the annual update cycle to determine if there are procedures that we exclude from payment in the ASC setting that merit reconsideration as a result of changes in clinical practice or innovations in technology. We are proposing to update the ASC list and payment system as part of the annual proposed and final rulemaking cycle updating the hospital OPPS. We believe that including the ASC update as part of the OPPS rulemaking cycle would ensure that updates of the ASC payment rates and the list of surgical procedures for which Medicare pays an ASC facility fee would be issued in a regular, predictable, and timely manner. Moreover, the ASC payment system would be updated concurrent with changes in the APC groups and the OPPS inpatient list, making it easier to predict changes in payment for particular services from year to year. In the first part of CY 2007, we are proposing to issue a final rule in which we would respond to comments submitted timely regarding the proposals set forth in this proposed rule and make final the policy and regulations for the revised ASC payment system for implementation effective January 1, 2008. We are proposing to include the CY 2008 ASC payment rates as part of the proposed and final rules for the CY 2008 OPPS update. We are proposing to evaluate each year all new CPT and alphanumeric HCPCS codes that describe surgical procedures to make preliminary determinations regarding whether or not they should be payable in the ASC setting and, if so, whether they are office-based procedures. In the absence of claims data that would indicate where procedures described by new codes are being performed, and resources required to perform them, we are proposing to use other available information, including our clinical advisors' judgment, predecessor CPT and HCPCS codes, information submitted by representatives of specialty societies and professional associations, and information submitted by commenters during the public comment period following publication of the final rule with comment period in the 
                        **Federal Register**
                        . We would publish in the annual OPPS/ASC payment update final rule those interim determinations for the new codes to be active January 1 of the update year. Those procedures would be open to comment on that final rule, and we would respond to comments about our determinations in the final rule for the following year, just as we currently respond to comments about our APC assignments for new codes in the OPPS final rule for the following year. After our review of public comments and in the absence of physicians' claims data, if our determination regarding the new codes is that they should reside on the ASC list as office-based procedures subject to the payment limitation, this determination would remain preliminary until there are adequate physicians' claims data available for these procedures to assess their predominant sites of service. Using those data, if we confirm our determination that the new codes are office-based because they were performed in the physician office setting more than 50 percent of the time, the codes would then be permanently assigned to the list of office-based procedures subject to the payment limitation. Accordingly, we are proposing to reflect this annual rulemaking and publication of revised payment methodologies and payment rates in new § 416.173 in proposed new subpart F. D. Information in Addenda Related to the Revised CY 2008 ASC Payment System (If you choose to comment on issues in this section, please include the caption “ASC Addenda” at the beginning of your comment.) The ASC payment rates, copayment amounts, and relative payment weights displayed in Addendum BB of this proposed rule are presented to model the ratesetting methodology that we are proposing for the revised ASC payment system required by Pub. L. 108-173. Actual payment rates proposed and made final for CY 2008 are dependent upon the final policies and regulations affecting the revised payment system that we would publish in a final rule in CY 2007; the proposed and final APC groups, APC relative payment weights, and MPFS nonfacility practice expense RVUs for CY 2008; and, the ASC conversion factor updated to reflect CY 2006 utilization data and CY 2007 ASC standard overhead payment amounts. E. Technical Changes to 42 CFR Parts 414 and 416 We are proposing to make the following technical change to 42 CFR 414: § 414.22 (Non-facility practice expense RVUs) is revised to conform to changes occurring under the ASC revised payment system. The change will be effective January 1, 2008. We are proposing to make the following technical changes to 42 CFR 416: § 416.65(a)(4) is revised to replace the obsolete cross-reference to § 405.310 with § 411.15.
                    § 416.120 is revised by replacing the incorrect cross-reference to “Part 413” with “Part 419.”
                    § 416.150 (Beneficiary appeals) is deleted because it does not conform with the appeals process provisions of42 CFR Part 405, subparts H and I. XIX. Medicare Contracting Reform Mandate A. Background Section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Pub. L. 108-173, amended Title XVIII of the Act to add section 1874A, Contracts with Medicare Administrative Contractors (MACs). Section 1874A of the Act replaces the prior Medicare intermediary and carrier contracting authorities formerly found in sections 1816 and 1842 of the Act, respectively. This reform (commonly referred to as “Medicare contracting reform” for Medicare fee-for-service) is intended to improve Medicare's administrative services to beneficiaries and health care providers and to bring standard contracting principles to Medicare, such as competition and performance incentives, which the government has long applied to other Federal programs under the Federal Acquisition Regulation (FAR). For Department of Health and Human Services acquisitions, the FAR is supplemented by the Department of Health and Human Services Acquisition Regulation (HHSAR) (48 CFR chapter 3). Using 
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                        competitive procedures, CMS will replace its current claims payment contractors (intermediaries and carriers) with new contract entities, MACs. Section 911(d)(1)(C) of Pub. L. 108-173 requires that CMS compete and transition all Medicare claims processing workloads to MACs by October 1, 2011. In accordance with section 911(e) of Pub. L. 108-173, on or after October 1, 2005, any reference to an “intermediary” or “carrier” in a regulation shall be deemed a reference to a MAC. The process of transition from intermediaries and carriers to MACs is not a single point-in-time occurrence, but rather necessarily happens over a multiyear period due to the size and nature of the claims workloads involved. Therefore, for the purposes of clarity, the term “intermediary” is used throughout this proposed rule to describe a Medicare contractor, pursuant to the authority of section 1816 of the Act, that has not yet transitioned to a MAC. In addition, for the purpose of clarity, the term “carrier” is used throughout this proposed rule to describe a Medicare contractor, pursuant to the authority of section 1842 of the Act, that has not yet transitioned to a MAC. B. CMS' Vision for Medicare Fee-for-Service and MACs CMS' vision for the Medicare fee-for-service (FFS) program is that of a premier health plan that allows for comprehensive, quality care and world-class beneficiary and provider service. Achieving this vision requires substantial improvement of CMS' current FFS administrative structure. Further information on CMS' plans to improve Medicare FFS may be obtained through the Medicare Contracting Reform Web site: 
                        *http://www.cms.hhs.gov/​medicarereform/​contractingreform/​.* In 2006, there are 24 intermediaries and 17 carriers that process FFS claims. Intermediaries process claims for Medicare Parts A and B relating to services furnished by health care facilities, including hospitals and SNFs. Carriers process claims for Medicare Part B, in particular, for physician, laboratory, and other nonfacility services. In addition, 4 intermediaries serve as regional home health intermediaries (RHHIs) and process Medicare claims for home health services and hospice services. (Section 1816 of the Act was amended in 1977 to allow the Secretary to designate regional or national intermediaries, which we refer to as RHHIs, to process claims for home health services. We have designated these RHHIs to serve both the home health agency (HHA) and the hospice provider communities.) For a complete listing of the current Medicare intermediaries and carriers, refer to the CMS Web site: 
                        *http://www.cms.hhs.gov/​contacts/​incardir.asp*. Although health care delivery in the United States has evolved with advances in modern technology, the contracting authorities relating to the Medicare FFS administrative structure did not substantially evolve between the enactment of the Medicare statute in 1965 and the enactment of Pub. L. 108-173. Prior to passage of Pub. L. 108-173, intermediary and carrier acquisition authorities did not permit full and open competition or unified processing of Medicare Part A and Part B claims. Medicare contracting was significantly hampered by the absence of performance-based incentives and cumbersome termination procedures. In an effort to achieve Congress' goal of a more efficient and effective Medicare operation, CMS developed a plan for most current Medicare Part A and Part B intermediary and carrier responsibilities to be integrated into a single contract entity to be administered by a single contractor in each area of the country. These new MACs will handle claims processing and related activities traditionally performed by intermediaries and carriers. Under Medicare contracting reform, the MACs will perform all the core claims processing operations for both Medicare Part A and Part B. CMS will ensure that MACs focus on providing a high level of customer service to providers and beneficiaries. MACs will be the providers' primary contact with Medicare, and CMS will hold the MACs accountable for overall provider and beneficiary satisfaction and correct claims payment. With respect to financial management, as was required of intermediaries and carriers, MACs will promote the fiscal integrity of the program and be accountable stewards of the Medicare Trust Fund dollars. The MACs will be required to pay claims timely, accurately, and in a reliable manner while promoting cost efficiency and the delivery of maximum value to the program. We recognize the potential for improving the efficiency and effectiveness of services to Medicare beneficiaries and providers through the Medicare contracting reform provisions contained in section 1874A of the Act. Through our implementation of these provisions, we expect to realize significant performance improvements. The future environment is designed to generate substantial savings both from an administrative and programmatic standpoint and will safeguard CMS' mission. C. Provider Nomination and the Former Medicare Acquisition Authorities As originally enacted in 1965 and until the enactment of Pub. L. 108-173, section 1816 of the Act afforded groups or associations and individual providers of services (as defined at section 1861(a) of the Act) the right to nominate (appoint) their intermediary. The intermediary agreements were governed by Medicare laws that diverge from the FAR in a number of important respects. Prior to Public Law 108-173, section 1816 of the Act precluded the Medicare program from competing intermediary functions on a full and open basis. Rather, institutional providers of services, such as hospitals and nursing facilities, nominated a particular intermediary to process and pay their Medicare Part A claims. In a significant historical development that took place shortly after Medicare's enactment in 1965, the American Hospital Association and other provider trade associations nominated the Blue Cross Association (BCA) to serve as the intermediary for their membership. The BCA merged with the Blue Shield Association in the 1970s to form today's Blue Cross and Blue Shield Association (BCBSA.) CMS and the BCBSA then entered into a prime contract, which continues to currently exist through the annual renewal process. In turn, the BCBSA subcontracted most operational intermediary functions to its member plans. The BCBSA assigned the majority of the nation's hospitals to its local Blue Cross plans. Some providers of services nominated commercial insurers to serve as their intermediaries. Most recently, section 911(b) of Pub. L. 108-173 amended section 1816 of the Act to remove the provider nomination authority. The section has been renamed: “Provisions Relating to the Administration of Part A.” Section 1816(a) of the Act, which authorized providers to select a contractor to perform claims payment and audit functions, has been amended. It now contains one sentence mandating the use of contracts with MACs to administer section 1816 of the Act. Sections 1816(e), (f), and (g), which authorized the Secretary to develop standards, criteria, and procedures for the assignment of providers to intermediaries and to reassign providers periodically, have been repealed. 
                        ( print page 49661) Section 911(d) of Pub. L. 108-173 permits the Secretary to transition the current intermediary and carrier functions to the MACs. More information about CMS' plans to implement Medicare contracting reform, including the Report to the Congress on this subject, can be obtained at the CMS Web site: 
                        *http://www.cms.hhs.gov/​medicarereform/​contractingreform/​*. MACs will perform all core claims processing operations for both Medicare Part A and Part B. The Part A and Part B MACs will operate in distinct, nonoverlapping geographic jurisdictions, which will form the basis of the Medicare claims processing operations. A transitional period runs between October 1, 2005, and October 1, 2011. During this period, any existing intermediary and carrier contracts could be maintained until replaced by a MAC contract. The statute requires that all intermediary and carrier contract functions are to be competed and awarded as MAC contracts by October 1, 2011. D. Summary of Changes Made to Section 1816 of the Act Substantial changes to section 1816 of the Act that were required by sections 911(b) and 911(c) of Pub. L. 108-173 took effect on October 1, 2005. The changes that we are proposing in this proposed rule to the regulations under 42 CFR part 421, subpart B (discussed under section XIX.E. of this preamble) are intended to conform the regulations to these statutory changes. Prior to the statutory developments directed by Pub. L. 108-173, section 1816 of the Act provided the foundation acquisition authority for agreements between CMS, acting for the Secretary, and intermediaries, for the purpose of administering benefits under Medicare Part A and making payments to providers of services. In particular, section 1816(a) of the Act formerly gave groups and associations of providers of services (which, under section 1861(u) of the Act, includes hospitals, critical access hospitals (CAHs), skilled nursing facilities (SNFs), comprehensive outpatient rehabilitation facilities (CORFs), HHAs, hospices, and, for the purposes of sections 1814(g) and 1835(e) of the Act, funds) the power to nominate their servicing intermediary to determine and make Medicare payments to their members. Under this provision, an intermediary could be a “national, state, or other public or private agency or organization.” As previously stated, under this provision, the American Hospital Association nominated the national Blue Cross Association to serve as the prime Medicare intermediary for its membership in 1965, an arrangement that continues to exist. Moreover, prior to the enactment of Pub. L. 108-173, section 1816(d) of the Act allowed individual providers and groups of providers to— Part with their group or association and nominate another entity to serve as their intermediary; and
                    Withdraw its/their nomination from an intermediary, and obtain services from another intermediary that had an agreement with the Secretary. Finally, section 1816(e) of the Act, as it formerly read, specified the substantial procedural requirements to be followed by the Secretary in the event that the Secretary desired to assign or reassign individual providers of services to any intermediary other than the nominated entity. This provision also gave limited authority to the Secretary to designate a regional or national intermediary for a particular “class” of providers of services. However, this authority was subject to substantial procedural requirements. Among these procedural requirements were: The Secretary had to promulgate standards, criteria and procedures for evaluating the performance of intermediaries under section 1816(f) of the Act;
                    The Secretary had to make a finding, after applying such standards, criteria, and procedures, that the reassignment of the individual provider and/or the designation of the regional or national intermediary would result in more efficient and effective administration of the Medicare program;
                    The Secretary had to provide a full explanation of his reasons for determining that the intermediary change would result in more efficient and effective administration; and
                    Affected agencies and organizations were given the right to a hearing, and any determinations of the Secretary on nominations and provider assignments were subject to judicial review. In the former sections 1816(e)(4) and 1816(e)(5) of the Act, the Secretary was given authority to establish regional intermediaries with respect to HHAs and hospice providers, although certain procedural requirements still had to be met. In summary, while under section 1816 of the Act, the Secretary was not required to accept all Medicare intermediary nominations, the Secretary had no independent authority to contract with any entity for Medicare intermediary services outside the nomination process. Moreover, while providers of services were given the opportunity to seek a reassignment to a new intermediary, the Secretary could not assign or reassign individual providers or classes of providers unless substantial procedural requirements were followed. The existing Medicare regulations under 42 CFR Part 421, particularly those within Subparts A and B, were substantially shaped by this statutory framework relating to provider nominations and the assignment or reassignment of providers of services to intermediaries. In particular, the following regulatory provisions have their basis in the statutory provisions of sections 1816(a), (d), and (e) of the Act (all are located within 42 CFR Part 421): § 421.1(c), which discusses criteria to be used in assigning and reassigning providers;
                    § 421.3, which provides exceptions to definitions to accommodate the designation of regional intermediaries for HHAs and intermediaries for hospices;
                    § 421.103, which identifies options available to providers for receiving Medicare payments;
                    § 421.104, which provides the procedural framework governing the administration of provider nominations for intermediaries;
                    § 421.105, which obligates CMS to provide notice as to its action on nominations;
                    § 421.106, which specifies the process to be used by a provider desiring a change of intermediary;
                    § 421.112, which provides the considerations to be taken into account by CMS when, among other things, it desires to assign or reassign a provider to an intermediary or designate a regional or national intermediary for a class of providers;
                    § 421.114, which governs the assignment or reassignment of individual providers;
                    § 421.116, which specifies the requirements for designating national or regional intermediaries consistent with sections 1816(e)(1) through (e)(3) of the Act; and
                    § 421.117, which specifies the parameters for assigning HHAs and hospice providers to regional intermediaries consistent with sections 1816(e)(4) and (e)(5) of the Act. In addition to the provisions discussed above that relate to provider nominations, prior to the enactment of Pub. L. 108-173, section 1816 of the Act also contained other provisions governing agreements with Medicare intermediaries that were not consistent with the mainstream of Federal acquisition and procurement 
                        ( print page 49662)
                        authorities, as this mainstream is reflected in the FAR. For instance— Section 1816(b) of the Act contains provisions that limited payment under all intermediary agreements to a cost-reimbursement basis only;
                    Section 1816(f) of the Act required the Secretary to publish his performance criteria and standards for intermediary agreements in the**Federal Register**
                        , and specified requirements relating to the application of such criteria and standards; and
                    Section 1816(g) afforded intermediaries the right to terminate their agreements with CMS, but limited the right of the Secretary to terminate the agreement; in particular, no provision was made for the normal right of the government to terminate for convenience. In section 911(b) of Pub. L. 108-173, Congress reiterated the requirement that CMS begin to move beyond the legacy nomination-based intermediary agreements during FY 2006. This was done by repealing outright or substantially modifying many of the provisions of section 1816 of the Act, effective October 1, 2005. In particular, section 911(b) of Pub. L. 108-173— Repealed the prior language of section 1816(a) of the Act, including the basic provider nomination provision, and replaced it with a statement indicating that Medicare Part A administrative functions would be contracted through section 1874A of the Act;
                    Repealed section 1816(b) of the Act in full, including its provisions limiting payment to cost reimbursement;
                    Repealed the contract-related provisions of section 1816(c) of the Act;
                    Repealed sections 1816(d), (e), (f), (g), (h), (i), and (l) of the Act; and
                    Made conforming changes to sections 1816(c), (j), and (k) of the Act. With these changes, section 1816 of the Act is no longer an acquisition authority, and there is no vestige of the former provider nomination provisions or the partial exceptions to those provisions relating to home health and hospice providers. While section 911(d)(1)(B) of Pub. L. 108-173 allows the Secretary to continue intermediary and carrier contracts in effect prior to October 1, 2005, under their terms and conditions until October 1, 2011, there was no similar extension for existing nomination arrangements. Section 911(d)(2)(A) of Pub. L. 108-173 provides the Secretary with authority to enter into intermediary agreements outside of the provider nomination process starting with the date of enactment of Pub. L. 108-173 (December 8, 2003). Therefore, while Congress specified that the Secretary should submit his plan for implementing section 911 at the start of FY 2005, the Secretary was authorized to contract outside of the section 1816 nomination provisions immediately and in advance of delivery of his report. This analysis requires that similar, conforming changes be made in our regulations as set forth in this proposed rule. E. Provisions of the Proposed Regulations As discussed under section XIX.A. of this preamble, based on the authority provided in sections 1874A(a) through (d) of the Act, as established by section 911(a)(1) of Pub. L. 108-173, we are proposing to establish regulations pertaining to MACs in a new Subpart E of 42 CFR Part 421. Moreover, based on the substantial changes to section 1816 of the Act, including the repeal of all of the section 1816 provisions relating to the ability of providers to nominate their servicing intermediary, as enacted by section 911(b) of Pub. L. 108-173, we also are proposing a number of changes to Subparts A and B of 42 CFR Part 421. In addition, we are proposing to change the title of Part 421 from “Intermediaries and Carriers” to “Medicare Contracting” and make conforming revisions to Subpart B of Part 421. As discussed earlier, section 911(b) of Pub. L. 108-173 either repealed outright or substantially modified sections 1816(a), (b), (c), (d), (e), (f), (g), (h), (i), and (l) of the Act, and made clear that the acquisition authority for Part A claims processing would, after October 1, 2005, be found in section 1874A of the Act. Among all these changes, each of the former “provider nomination” provisions within section 1816 of the Act was repealed. In addition, section 911(d)(2)(A) of Pub. L. 108-173 gave the Secretary authority to disregard the provider nomination provisions in his contracting, even prior to October 1, 2005. In accordance with these statutory changes, we are proposing to substantially modify or delete §§ 421.1(c), 421.3, 421.103, 421.104, 421.105, 421.106, 421.112, 421.114, 421.116, and 421.117 of the regulations. As discussed earlier, the amendment to title XVIII of the Act (to allow for the new section 1874A: “Contracts with Medicare Administrative Contractors”) requires CMS to contract with eligible entities to perform Medicare functions using the FAR. We are proposing to add regulations pertaining to MAC contracts in a new subpart E (Medicare Administrative Contractors) under Part 421 as follows: Subpart E—Medicare Administrative Contractors Sec. 421.400 Basis and scope. 421.401 Definitions. 421.404 Assignment of providers and suppliers to MACs. 1. Definitions Under proposed § 421.401, we define a “Medicare administrative contractor (MAC)” as an agency, organization, or other person with a contract to perform any or all of the functions set forth under section 1874A of the Act. With respect to the performance of a particular function in relation to an individual entitled to benefits under Medicare Part A or enrolled under Medicare Part B, or both, a specific provider of services or supplier (or class of such providers of services or suppliers), we are proposing to define an “appropriate MAC” as a MAC that has a contract to perform a Medicare administrative function in relation to a particular individual, provider of services, or supplier or class of providers. 2. Assignment of Providers and Suppliers to MACs We are proposing to establish a new § 421.404 to incorporate the rules governing the processing of claims submitted by providers and suppliers that enroll with and receive Medicare payment and other Medicare services. As a general rule, Medicare providers and suppliers will be assigned to the MAC that is contracted to administer the types of services (benefits) billed by the provider or supplier within the geographic locale in which the provider or supplier is physically located or furnishes health care services, respectively. One significant exception to this general rule pertains to suppliers of durable medical equipment, prosthetics, orthotics, and supplies. CMS would continue to allow these suppliers to bill to the contractor assigned to the locale in which the beneficiary receiving the items or supplies resides. In the past, under the provider nomination provisions that were repealed by section 911 of Pub. L. 108-173, CMS had considered (and occasionally approved) requests from certain classes of institutional providers covered by these section 1816 provisions, primarily, hospitals, SNFs, and CAHs, to bill an intermediary other than the one servicing providers in the geographic locale of the provider. The 
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                        process and criteria for making these determinations are set forth in detail in the existing regulations under 42 CFR part 421, subpart B (which we are proposing to remove in accordance with the changes effectuated by section 911(b) of Pub. L. 108-173. In particular, not automatically but on a fairly frequent basis, CMS approved requests from large multi-State groups of such providers under common ownership and control, called “chain providers,” to bill a single intermediary on behalf of all the individual providers in the chain through the headquarters office, or “home office,” of the chain provider. These chain providers were granted “single intermediary” status. The premise behind granting privileges to bill a single intermediary to such large multi-State chain providers was that this might reduce administrative billing expenses for the chain and reduce the administrative expenses of the Medicare program. In particular, assigning a large multi-State chain provider to a single intermediary facilitated the Medicare cost report audit and reimbursement functions, because findings with respect to the cost report of the chain's home office could affect the individual provider's cost report. Otherwise, these audit and reimbursement issues would need to be coordinated among multiple intermediaries. In addition to applying the relevant regulatory requirements in 42 CFR part 421, subpart B in our review of chain provider requests for single intermediary status, we applied additional criteria to focus our analysis and to ensure that the exception to our normal practice of assigning providers to their “local” intermediary was warranted. We advised the chain provider that it would have to demonstrate that having a single intermediary would be consistent with efficient and effective administration of the Medicare program, and that the intermediary would need to have sufficient capacity to effectively serve the chain (these elements were restatements of the regulatory criteria). In addition, we required the chain to meet the following requirements: Size—The provider chain had to be comprised of 10 participating facilities or 500 certified beds, or 5 facilities or 300 certified beds spread across 3 or more contiguous States.
                    Central Controls—The provider chain had to demonstrate that it exercised central controls, assuring substantial uniformity in operating procedures, utilization controls, personnel administration, and fiscal operations among the individual providers. The administrative efficiencies gained by both the large multi-State chain providers and the Medicare program by allowing single intermediary relationships to exist may not be as significant as they were formerly. Prior to the implementation of the Administration Simplification provisions of Part C of Title XI of the Act, the various intermediaries required providers to use somewhat divergent transaction and formatting standards in their electronic claims processing systems. A provider chain with centralized billing processes could make a good business case that it should be permitted to bill only one intermediary. Moreover, prior to the implementation of the many prospective payment systems required by the Balanced Budget Act of 1997 and subsequent public laws, a greater percentage of Medicare program payments hinged on the Medicare cost report audit and reimbursement process. In such an environment, there was potential benefit to both a chain provider and the government to minimize coordination issues. Finally, the former Medicare environment involved many intermediaries, so there were naturally more geographic boundaries among contractors that a multi-State chain could cross. We understand the provisions of section 1874A of the Act and, more particularly, the revisions to section 1816 of the Act made by section 911(b) of Pub. L. 108-173 to authorize the Secretary to assign all providers and suppliers, even the members of multi-State entities, to the geographically-based MACs based on their physical location. This action is consistent with CMS' vision, as articulated in the Secretary's Report to Congress on Medicare Contracting, of establishing a claims processing environment where most Medicare Part A and Part B claims involving a particular beneficiary are administered by the same contractor. However, as indicated in that Report (page V-4), we recognize that there may still be some legitimate business value to allowing large multi-State chains of providers that formerly were able to nominate their intermediary to bill on a consolidated basis to one MAC. While Congress has clearly mandated that the former provider nomination framework be abolished, we believe that allowing the practice of consolidated billing by large chains is within the discretion of the Secretary under section 911 of Pub. L. 108-173. Accordingly, in this proposed rule, we are proposing under § 421.404 that— Providers (as defined in42 CFR 400.202) will generally be assigned to the MAC with claims processing jurisdiction over the geographic locale in which the provider is physically located.
                    Large chain providers comprised of individual providers that were formerly permitted by CMS to “nominate” an intermediary, which we refer to as “qualified chain providers,” will be permitted to request opportunity to consolidate their Medicare billing activities to the MAC with jurisdiction over the geographic locale in which the chain's home office is located.
                    Qualified chain providers that were formerly granted single intermediary status do not need to re-request such privileges on behalf of the entire chain at this time.
                    CMS may grant other exceptions to the general rule for assigning providers to MACs, but only based on a finding that such an exception will support the implementation of the MACs or if CMS deems the exception to be in the compelling interest of the Medicare program. We are proposing to incorporate a definition of “qualified chain provider.” The criteria that constitute the proposed definition of a “qualified chain provider” mirror the elements that were historically applied. We believe these are appropriate criteria to employ in reviewing whether a chain provider should even be considered for consolidated billing. Less stringent criteria would clearly cut against the statutory mandate to establish MACs and end the provider nomination process. More stringent criteria might disrupt the operations of many entities that formerly were approved for single intermediary handling under the old criteria. Smaller chains of otherwise eligible providers (for example, hospitals, SNFs, and CAHs) might also desire consolidated billing, as well as other types of providers (for example, HHAs and hospices). In the latter case, the other types of providers (termed “ineligible providers” in this proposed rule) did not have the opportunity to request assignment to (nominate) a particular intermediary prior to October 1, 2005. In some cases, these other types of providers were assigned to regional intermediaries based on a nexus of statutory and administrative actions. In other cases, assignments were made through administrative action. In the case of smaller chains of otherwise eligible providers, we note that Pub. L. 108-173 clearly mandates the end of the provider nomination process and 
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                        appears to us to anticipate the use of regional contractors. We believe that our establishment of MACs that, in most cases, will administer claims from multiple States will largely resolve the concerns these other providers may have. Under our proposed approach, for instance, we believe that few chain providers will have to bill more than two MACs even if they fail to meet the tests for being a “qualified chain provider.” Finally, with respect to suppliers (as also defined in 42 CFR 400.202 of our regulations), we are proposing to assign suppliers (including physicians and other practitioners) to MACs based on the geographic jurisdiction in which they operate and furnish services. These requirements mirror the various Part B claims jurisdiction rules that have been in place. CMS may grant an exception to this policy only if CMS finds the exception will support the implementation of MACs or will serve some compelling interest of the Medicare program.. However, we do incorporate the current special billing requirements relating to suppliers of durable medical equipment, prosthetics, orthotics, and supplies under § 421.210 and § 421.212. As we move forward to implement MAC contracting in keeping with the statutory mandate of section 911 of Pub. L. 108-173 and the Secretary's Report to Congress, we invite public comments on the above issues, including our proposed definitions and criteria. (Once the MACs are initially implemented, we may propose more stringent criteria for consolidated billing status, in keeping with the overall thrust of section 911 of Pub. L. 108-173.) 3. Other Proposed Technical and Conforming Changes a. Definition of “Intermediary” (§ 421.3) We are proposing to revise the definition of the term “intermediary” under existing § 421.3 to delete reference to “alternative regional intermediaries.” CMS no longer allows HHAs and hospice care providers to select an alternative regional intermediary. Over the years, as the number of intermediaries in the program has decreased, the availability of alternative intermediaries for HHAs and hospices has declined. We have implemented the policy that all HHAs and hospice care facilities are to be assigned to the designated regional intermediary that serves their geographic jurisdiction. This is required for the efficient and effective administration of the Medicare program as the agency moves forward to implement the MACs. b. Intermediary Functions (§ 421.100) Section 1816(a) of the Act, which allowed providers to nominate an intermediary, required that only nominated intermediaries perform the functions of determining payment amounts and making payments to providers. Section 1874A of the Act, as added by section 911 of Pub. L. 108-173, eliminates the intermediary nomination process. All activities carried out under intermediary agreements will be transitioned to MAC contracts by September 30, 2011. During the transition period, CMS will still require regulations to support its intermediary agreements. We are proposing to amend § 421.100, concerning functions to be included in intermediary agreements, to address the dual intermediary responsibilities. We are proposing to revise existing § 421.100(i), Dual intermediary responsibilities, to delete the reference to § 421.117 from this section, as the statutory provision that made this necessary was repealed by Pub. L. 108-173. c. Options Available to Providers and CMS (§ 421.103) We are proposing to change the title of § 421.103 to “Payment to Providers” and to revise the contents of § 421.103 to clarify that, all providers must receive payments for covered services furnished to Medicare beneficiaries through an intermediary (under § 421.404) and eventually through a MAC (under § 421.404). We are proposing that this function must remain with the intermediaries. We would no longer allow providers to receive payments directly from CMS, nor would we allow providers to receive payments from alternative regional intermediaries. We believe the inclusion of this function is consistent with the effective and efficient administration of the Medicare program. d. Nomination for Intermediary (§ 421.104) We are proposing to change the title of § 421.104 to “Assignment of Providers of Services to Intermediaries During Transition to Medicare Administrative Contractors (MACs)” and to revise the contents of the section to provide that new providers that enter the Medicare program during the transition period will be assigned to the local designated intermediary that serves the jurisdiction in which the provider is located. We believe this change is necessary as we prepare to transition from intermediary agreements and carrier contracts to contracts with the MACs. In the MAC environment, providers will be assigned based on their geographic location to the MAC that has jurisdiction for their provider type. e. Notification of Actions on Nominations, Changes to Another Intermediary or to Direct Payment, and Requirements for Approval of an Agreement (§ 421.105 and § 421.106) We are proposing to remove § 421.105 and § 421.106 from the regulations, as the sections would no longer be applicable with implementation of the new Subpart E. f. Considerations Relating to the Effective and Efficient Administration of the Medicare Program (§ 421.112) We are proposing to revise § 421.112(a). As stated previously in this proposed rule, provider requests to be assigned or reassigned to a particular intermediary will no longer be considered. However, we may deem it necessary to reassign providers if we find it is necessary for the efficient and effective administration of the program. In addition, there will no longer be a national intermediary to serve a class of providers. g. Assignment and Reassignment of Providers by CMS (§ 421.114) We are proposing to revise § 421.114 to specify that we may consider it necessary to assign and reassign providers if the assignment or reassignment is in the best interest of the program. Before making these determinations, we will no longer review provider requests to be reassigned to another intermediary. This is consistent with the proposed policy to eliminate a provider request to change to another intermediary or to direct payment. Under Medicare contracting reform, we require increased flexibility to realign providers to geographical jurisdictions for effective implementation of the MACs. We reserve the right to reassign providers to other jurisdictions if we deem it to be in the best interest of the program. h. Designation of National or Regional Intermediaries (§ 421.116) and Designation of Regional and Alternative Designated Regional Intermediaries for Home Health Agencies and Hospices (§ 421.117) We are proposing to delete § 421.116, Designation of national or regional intermediaries, and § 421.117, Designation of regional and alternative designated regional intermediaries for 
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                        HHAs and hospices. The statutory provisions that made these regulations necessary were repealed by Pub. L. 108-173. Therefore, we no longer need these regulations. All providers will receive payment for covered services as described in § 421.103. i. Awarding of Experimental Contracts (§ 421.118) We are proposing to delete § 421.118, which specifies the provisions under which CMS may award a fixed price or performance incentive contract under the experimental authority contained in 42 U.S.C. 1395b-1 for performance of intermediary functions under § 421.100. The provisions of this section became obsolete with the enactment of section 911 of Pub. L. 108-173. XX. Reporting Quality Data for Improved Quality and Costs Under the OPPS (If you choose to comment of issues in this section, please include the caption “Hospital Quality Data” at the beginning of your comment.) As noted previously, CMS' Office of the Actuary currently projects that Medicare Part B expenditures will continue to grow at a significant rate, as a result of rapid growth in the use of both physician-related services and hospital outpatient services in the original Medicare fee-for-service program. Specifically, the actuaries project that the expenditures under the OPPS in CY 2007 will be approximately $32.540 billion. This represents approximately a 9.2 percent increase over our estimated expenditure of $29.809 billion for the OPPS in CY 2006, and reflects even more rapid spending growth in recent years. As the following table shows, implementation of the OPPS has not slowed outpatient spending growth; in fact, double-digit spending growth has been occurring. Table 47.—Growth in Expenditures Under OPPS From CY 2001 Through CY 2007 (Projected Expenditures for CY 2006 and CY 2007)
[in millions]
OPPS growth
CY 2001
CY 2002
CY 2003
CY 2004
CY 2005
CY 2006
CY 2007Incurred Cost
19,172
19,561
21,146
23,912
26,643
29,809
32,540Percent Increase

2.0
8.1
13.1
11.4
11.9
9.2Source: FY 2007 Mid-Session Review, Budget of the U.S. Government.
 The current rate of growth in expenditures for hospital outpatient services is of great concern to us. As with the other Medicare fee-for-service payment systems that are experiencing rapid spending growth, brisk growth in the intensity and utilization of services is the primary reason for the current rate of growth in the OPPS, rather than general price or enrollment changes. The table below illustrates the increases in the volume and intensity of outpatient hospital services over the last several years. Table 48.—Percent Increase in Volume/Intensity of Hospital Outpatient Services
CY 2002
CY 2003
CY 2004
CY 2005 (Est.)
CY 2006 (Est.)Percent Increase
3.0
2.0
8.0
8.0
10.0Source: FY 2007 Mid-Session Review, Budget of the U.S. Government.
 For outpatient hospital services, the volume and intensity for CY 2005 are estimated to continue to increase significantly at a rate of 8 percent, in excess of the long-term trend. This increase follows the 8 percent increase in CY 2004, and the growth is projected to be 10 percent in CY 2006. As we have stated repeatedly, this rapid growth in utilization of services in the OPPS shows that Medicare is paying mainly for more services each year, regardless of their quality or impact on beneficiary health. The program should promote higher quality services, so that Medicare spending is directed in the most efficient manner toward higher quality services. Medicare payments should encourage doctors and other providers in their efforts to achieve better health outcomes for Medicare beneficiaries at a lower cost. Therefore, we have been examining the concept of “value-based purchasing” in a number of payment systems. “Value-based purchasing” may use a range of incentives to achieve identified quality and efficiency goals, as a means of promoting better quality of care and more effective resource use in the Medicare payment systems. In developing the concept of value-based purchasing, we have been working closely with stakeholder partners, including health professionals and providers. In this proposed rule, we are seeking public comment on value-based purchasing as related specifically to hospital outpatient departments. As part of our overall goal of promoting value-based purchasing in outpatient payment, we also make one specific proposal in the OPPS for CY 2007. Section 1833(t)(2)(E) of the statute permits the Secretary to “establish, in a budget neutral manner, * * * adjustments as determined to be necessary to ensure equitable payments” under the OPPS. The absence of OPPS measures to promote high quality in the provision of services to Medicare beneficiaries creates an issue of payment equity. In general, payments to providers in Medicare's payment systems do not vary on the basis of quality or efficiency differences among the providers of services. As a result, Medicare's payment systems direct additional resources to hospitals that deliver care that is not of the highest quality. For that reason, each Medicare dollar spent does not result in the same quality and efficiency of care for Medicare beneficiaries. We believe that the collection and submission of performance data and the public reporting of comparative information about hospital performance can provide a strong incentive to encourage hospital accountability in general and quality improvement in particular. Measurement and reporting can focus the attention of hospitals and consumers on specific goals and on 
                        ( print page 49666)
                        hospitals' performance relative to those goals. Development and implementation of performance measurement and reporting by hospitals can thus produce quality improvement in actual health care delivery. Hospital performance measures may also provide a foundation for performance-based rather than volume-based payments, which are used in the OPPS today. We have obtained some evidence of the potential for improving quality of care in hospitals by means of the collection and submission of performance data from the Premier Hospital Quality Incentive Demonstration.[1]
                        
                         This demonstration was designed to test whether the quality of inpatient care for Medicare beneficiaries can improve when financial incentives are provided. Under the demonstration, about 270 hospitals of Premier, Inc., a nationwide alliance of not-for-profit hospitals, have been voluntarily providing data on 34 quality measures related to 5 clinical conditions: Heart attack, heart failure, pneumonia, coronary artery bypass graft, and hip and knee replacements. Using the quality measures, CMS identifies hospitals with the highest quality performance in each of the five clinical areas. Hospitals scoring in the top 10 percent in each clinical area receive a 2-percent bonus payment in addition to the regular Medicare DRG payment for the measured condition. Hospitals in the second highest 10 percent receive a 1-percent bonus payment. In the third year of the demonstration, if some hospitals do not achieve absolute improvements above the demonstration's first year composite score baseline (the lowest 20 percent) for that condition, then they will have their DRG payments reduced by one or two percent, depending on how far their performance is below the baseline. Following the first year of the demonstration (FY 2004), CMS awarded a total of $8.85 million to participating hospitals in the top two deciles for each clinical area. In the aggregate, quality of care improved in all five clinical areas that were measured. Preliminary information from the second year of the demonstration indicates that quality is continuing to improve, particularly for the hospitals that were initially poorest performing.[2]
                        
                         We believe that these results indicate that reporting of quality data may in and of itself lead to improved outcomes for Medicare beneficiaries. Since 2003, we have operated the Hospital Quality Initiative,[3]
                        
                         which is designed to stimulate improvements in inpatient hospital care by standardizing hospital performance measures and data transmission to ensure that all payers, hospitals, and oversight and accrediting entities use the same measures when publicly reporting on hospital performance. Section 501(b) of Pub. L. 108-173 authorized us to link the collection of data for an initial starter set of 10 quality measures to the hospital IPPS annual payment update. In order to implement this provision, we created the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program. For FYs 2005 and 2006, hospitals that met the RHQDAPU program's requirements received the full IPPS annual payment update, while hospitals that did not comply received an update that was reduced by 0.4 percentage points. For FY 2005, virtually every hospital in the country that was eligible to participate submitted data (98.3 percent), and approximately 96 percent of all participating hospitals met the requirements to receive the full update. The data regarding the starter set of 10 quality measures, as well as additional, voluntarily-reported data on other quality measures, are available to the public through the Hospital Compare Web site at: 
                        *http://www.hospitalcompare.hhs.gov.* The starter set of 10 quality measures that was established for the IPPS RHQDAPU as of November 1, 2003, are: Heart Attack (Acute Myocardial Infarction/AMI) Was aspirin given to the patient upon arrival to the hospital?
                    Was aspirin prescribed when the patient was discharged?
                    Was a beta-blocker given to the patient upon arrival to the hospital?
                    Was a beta-blocker prescribed when the patient was discharged?
                    Was an ACE inhibitor given for the patient with heart failure? Heart Failure (HF) Did the patient get an assessment of his or her heart function?
                    Was an ACE inhibitor given to the patient? Pneumonia (PNE) Was an antibiotic given to the patient in a timely way?
                    Had the patient received a pneumococcal vaccination?
                    Was the patient's oxygen level assessed? For FY 2007 and each subsequent year, section 5001(a) of Pub. L. 109-171 amended section 1886(b)(3)(B) of the Act and made changes to the program established under section 501(b) of Pub. L. 108-173. These changes require us to expand the number of measures for which data must be submitted, and to change the percentage point reduction in the annual payment update from 0.4 percentage points to 2.0 percentage points for IPPS hospitals that do not report the required quality measures in a form and manner, and at a time, specified by the Secretary. Effective for payments beginning with FY 2007, new section 1886(b)(3)(B)(viii)(IV) of the Act requires the Secretary to begin to adopt the expanded set of performance measures set forth in the IOM's 2005 report entitled, “Performance Measurement: Accelerating Improvement.” [4]
                        
                         Those measures include the HQA measures and the HCAHPS® patient perspective survey. Effective for payments beginning with FY 2008, the Secretary must add other measures that reflect consensus among affected parties and may replace existing measures as appropriate. New section 1886(b)(3)(B)(viii)(VII) of the Act requires the Secretary to post hospital quality data on these measures on the CMS Web site. A proposed list of expanded quality measures to be used for the FY 2007 update was included in the FY 2007 IPPS proposed rule (71 FR 24093). The final expanded set of 21 quality measures for the FY 2007 update, as listed in the FY 2007 IPPS final rule, is outlined below: Heart Failure (Acute Myocardial Infarction/AMI) Aspirin at arrival
                    Aspirin prescribed at discharge
                    ACE inhibitor (ACE-I) or Angiotensin Receptor Blocker (ARBs) for left ventricular systolic dysfunction
                    Beta blocker at arrival
                    Beta blocker prescribed at discharge
                    Thrombolytic agent received within 30 minutes of hospital arrival
                    Percutaneous Coronary Intervention (PCI) received within 120 minutes of hospital arrival( print page 49667)
                    Adult smoking cessation advice/counseling Heart Failure (HF) Left ventricular function assessment
                    ACE inhibitor (ACE-1) or Angiotensin Receptor Blocker (ARBs) for left ventricular systolic dysfunction
                    Discharge instructions
                    Adult smoking cessation advice/counseling Pneumonia (PNE) Initial antibiotic received within 4 hours of hospital arrival
                    Oxygenation assessment
                    Pneumococcal vaccination status
                    Blood culture performed before first antibiotic received in hospital
                    Adult smoking cessation advice/counseling
                    Appropriate initial antibiotic selection
                    Influenza vaccination status Surgical Care Improvement Project (SCIP) Prophylactic antibiotic received within 1 hour prior to surgical incision
                    Prophylactic antibiotics discontinued within 24 hours after surgery end time In order to receive the full FY 2007 IPPS update, hospitals are required to continue to collect data for all 10 starter set quality measures (or begin collecting such data, if newly participating in the program) and are required to provide a written pledge to submit data on the set of 21 expanded quality measures, in addition to completing several administrative tasks regarding quality reporting. All of the measures for the IPPS RHQDAPU program are to be reported on inpatient hospital discharges. We are proposing to employ our equitable adjustment authority under section 1833(t)(2)(E) of the Act to adapt the quality improvement mechanism provided by the IPPS RHQDAPU program for use in the OPPS. As we have discussed above, failure to account at all for quality in payment systems raises a fundamental issue of payment equity. In the absence of mechanisms that provide incentives for higher quality care, Medicare's payment systems can direct more resources to hospitals that do not deliver high quality care to Medicare beneficiaries. In this rule, we are proposing to initiate a Reporting Hospital Quality Data for Annual Payment Update under the OPPS, (OPPS RHQDAPU program) effective for payments beginning January 1, 2007. We propose to add a new § 419.43(h) to our regulations to implement this proposal. Under proposed new § 419.43(h)(1), we would initially implement an OPPS RHQDAPU program by reducing the OPPS conversion factor update in CY 2007 for those hospitals that are required to report quality data under the IPPS RHQDAPU program in order to receive the FY 2007 update, and fail to meet the requirements for receiving the full FY 2007 IPPS payment update. These hospitals would receive an update to the CY 2007 OPPS conversion factor that is reduced by 2.0 percentage points. Under proposed § 419.43(h)(2), any reduction would not affect a hospital's OPPS update in a subsequent calendar year. Hospitals that meet the IPPS RHQDAPU program's requirements for FY 2007 and receive the full IPPS annual payment update would also receive the full update to the conversion factor used to determine payments for CY 2007 under the OPPS. For this initial phase of implementing an OPPS RHQDAPU program in CY 2007, it will be necessary to provide an exception for certain hospital outpatient departments to the requirement that quality data be submitted under the IPPS RHQDAPU program in order to receive the full OPPS update. The quality data submission requirements of the IPPS RHQDAPU program apply only to “subsection (d)” hospitals. “Subsection (d)” hospitals are defined under section 1886(d)(1)(B) of the Act as hospitals that are located in the fifty states or the District of Columbia other than those categories of hospitals or hospital units that are specifically excluded from the IPPS, including psychiatric, rehabilitation, long-term care, children's, and cancer hospitals or hospital units. In other words, the provision does not apply to hospitals and hospital units excluded from the IPPS, or to hospitals located in Puerto Rico or the U.S. territories. For the initial stage of implementing the OPPS RHQDAPU program in CY 2007, hospitals that are paid under the OPPS but that do not qualify as “subsection (d)” hospitals will continue to receive the full update to the OPPS conversion factor. However, as we discuss below, our intention is to expand the OPPS RHQDAPU in the future program by requiring all hospitals that receive payment under the OPPS to participate in the program in order to receive a full update, by appropriate expansion, adaptation, and/or extension of quality performance measures and quality reporting mechanisms. We believe that it is fair and appropriate, for purposes of the initial phase of implementing an OPPS RHQDAPU program, to take timely and accurate reporting of IPPS RHQDAPU program quality measures into account under our equitable adjustment authority. We think that the 10 original quality measures and the expanded set of 21 process measures as reported for inpatient discharges for heart attack, heart failure, pneumonia, and surgical care reflect the quality of care in the outpatient department as well as the inpatient hospital, so they are appropriate for initial use in the OPPS as specific measures are being developed to reflect the quality of care for hospital outpatients. We believe that hospitals generally function as integrated systems that provide health care services to patients in both inpatient and outpatient settings for many of the same clinical conditions, while recognizing the different typical levels of acuity in the two settings. Hospital quality measures for multiple conditions reflect, in part, the systems of care established by hospitals in the outpatient setting such as the emergency department. Therefore, the well-developed quality measures reported for the FY 2007 IPPS regarding inpatient hospital discharges should reasonably represent the quality of care provided to hospital outpatients, so we are proposing their interim use for the CY 2007 OPPS while quality measures specific to hospital outpatients are being developed and refined. This use of multiple measures for several clinical conditions serves as a proxy for the quality of the systems of care established by hospitals. As we expand quality measurement for the hospital outpatient setting, we intend to move from measures that serve as proxies for the quality of care to actual performance measures for the outpatient setting. The discussion below focuses on the expanded list of 21 quality of care measures, as the 10 original measures continue to be included in the quality measurement expansion. There are 7 quality measures assessing the processes of care for patients presenting to the hospital with an acute myocardial infarction, focused on the care on arrival, the promptness of interventions, and discharge care. For the common urgent condition of a patient presenting to the hospital with chest pain that results in a clinical suspicion of acute myocardial infarction, in their effort to provide consistent, high quality care that is founded on evidence-based guidelines, hospitals often utilize clinical care pathways that are standardized for such patients presenting to the emergency room of the hospital. Such care pathways generally apply to patients with specific medical conditions who 
                        ( print page 49668)
                        present to the hospital initially as outpatients, regardless of their eventual discharge home from the outpatient department or inpatient admission. Thus, we believe that all 7 of these measures likely serve as reasonable proxies for the quality of care for patients presenting to the hospital outpatient department with chest pain related to a myocardial infarction, who commonly receive care along the continuum from outpatient to inpatient services in a hospital that provides such care in an integrated system. Similarly, there are 7 process measures related to the care of patients with pneumonia, who often present urgently to the hospital's emergency room with symptoms suggestive of the diagnosis of pneumonia. Because of the established clinical evidence regarding assessment and treatment activities that improve the quality of care for patients with pneumonia, most of the interventions that are measured, including oxygenation assessment, drawing of blood cultures, assessment of the patient's pneumococcal and influenza vaccine status, and selection and provision of an initial antibiotic in a timely manner, would generally be performed in the outpatient department, sometimes prior to a clinical decision about the patient's ultimate need for inpatient admission. In particular, the measures of vaccine status are quality measures that may be especially appropriate as hospital outpatient prevention measures. Their use in the hospital setting provides an opportunity for quality improvement in the hospital by encouraging assessment of immunization status and appropriate provision of immunizations, so we see no reason why their reporting on hospital inpatients is not also reflective of the quality of hospital outpatient care. While we acknowledge that in general the clinical picture of patients who are admitted to the hospital with pneumonia differs from that of patients who are not hospitalized, we expect there to be many common elements in their assessment, treatment, and counseling regarding the significance of smoking as the hospital provides their initial and subsequent care in the outpatient and/or inpatient settings. Therefore, we believe that all 7 of the measures related to the treatment of pneumonia are likely appropriately reflective of the quality of the care systems established by hospitals for outpatients with a diagnosis of pneumonia. There are 4 quality measures related to the treatment of patients with heart failure, including assessment of their cardiac function, use of certain medications in their treatment, counseling regarding smoking cessation, and provision of discharge instructions. Patients with heart failure, a common chronic medical condition, are seen frequently in hospital clinics and emergency departments with exacerbations of their symptoms. Once again, their initial treatment is often standardized and provided in the outpatient setting without consideration of their eventual discharge from the outpatient department or inpatient admission, a decision which ultimately depends on clinical considerations, including their response to treatment. Thus, we believe that all 4 of the inpatient quality measures regarding the treatment of patients with heart failure are reasonable surrogates for the quality of hospital systems of care for outpatients with heart failure. Likewise, under the expanded list of quality measures for the FY 2007 IPPS the surgical infection prevention quality measures indicating the provision of a prophylactic antibiotic within 1 hour prior to surgical incision and prophylactic antibiotics discontinued within 24 hours after surgery end time likely serve as a reasonable representation of the quality of surgical care for hospital outpatients. Many of the same surgical procedures are commonly performed on both hospital outpatients and inpatients, sometimes in the same operating room suites with attendance by the same clinical staff. Hospitals often have standardized protocols for providing antibiotics prior to surgery and postoperatively based on the types of procedures performed, rather than on the inpatient or outpatient status of the patient, and a decision to admit a patient may not even be made until after the completion of a procedure. Thus, we have no reason to believe that the preoperative and postoperative antibiotic experiences of a patient undergoing outpatient surgery would systemically vary from that of a hospital inpatient. In summary, we believe that quality improvement is usually a function of the entire institution as an integrated system that provides both inpatient and outpatient services to patients with an overlapping range of medical conditions. Quality improvement in a hospital inpatient department is likely to correlate with, and indeed to promote, similar quality improvement in the hospital's outpatient department and other sectors of the institution. Conversely, hospitals that fail to promote quality improvement in key sectors such as inpatient care are also unlikely to improve quality in the hospital outpatient department. We believe that the FY 2007 IPPS quality measures for multiple clinical conditions reflect the quality of hospitals' systems of care that customarily include key outpatient settings such as the emergency department. Therefore, as an interim measure while specific quality measures are being developed and refined for reporting on the quality of care to hospital outpatients, we are proposing that the initial CY 2007 OPPS RHQDAPU incorporate all of the quality measures that are applicable to the IPPS during FY 2007. We welcome public comments on the applicability to the OPPS of the various FY 2007 IPPS quality measures as proxies for the quality of care in hospital systems that include outpatient departments, with consideration of both the 10 starter set measures and the 11 new measures in the expanded set for FY 2007. Elsewhere in this proposed rule (section XXIII.), proposed additional quality measures for hospital reporting of quality data for the FY 2008 IPPS are discussed in detail. The proposed areas of expansion for the FY 2008 IPPS include the HCAHPS® survey, which incorporates questions measuring patients' perspectives on their hospital experiences; 3 additional measures related to the processes of surgical care to supplement the 2 initial Surgical Care Improvement Project (SCIP) measures to be implemented in FY 2007; and 3 risk-adjusted assessments of mortality within 30 days of hospital admission for acute myocardial infarction, heart failure, and pneumonia. For the same reasons detailed above for the FY 2007 IPPS SCIP measures, we believe that the additional surgical process of care measures are a reasonable interim proxy for the quality of surgical care for hospital outpatients. In addition, the questions on the hospital HCAHPS® survey assess aspects of the patient's hospital experience, including communication with doctors and nurses, responsiveness of the staff, pain management, and discharge information. These areas of questioning are all relevant to a hospital's care for its outpatients, who may be treated in the hospital outpatient department for an extended period of time, particularly if they are in observation status or recovering from a significant surgical procedure. As described above, because hospitals generally function as integrated systems, with both inpatients and outpatients with related medical conditions passing through the same departments and interacting with similar staff, we believe that this survey of patients who have 
                        ( print page 49669)
                        been admitted to the hospital may reasonably reflect hospital outpatients' perspectives on their care experiences as well. Finally, with respect to the 30-day mortality measures, these measures are linked to the same 3 medical conditions for which quality process measures have already been implemented in the IPPS RHQDAPU program, in order to expand the quality data to more fully reflect the true outcomes of care. These mortality measures are risk-adjusted based on historical medical care use, including inpatient and outpatient hospital care and physician offices visits, and reflect outcomes of care specifically for Medicare patients. Since we are proposing that the full set of FY 2007 IPPS process of care quality measures are acceptable proxies for the quality of care to hospital outpatients as previously discussed, and we believe that some of the value of health care process measures is their relative ease of measurement and their ultimate relationship to health outcomes, we believe that the 30-day mortality measures for inpatients may also reflect the quality of care to hospital outpatients with the same medical conditions. In addition, in view of the common clinical courses of acute myocardial infarction, heart failure, and pneumonia in Medicare beneficiaries, it is highly likely that hospital outpatient services may be provided to previously hospitalized patients within the measures' timeframe of 30 days after hospital discharge, thereby contributing to their care and health outcomes. Therefore, our intention is to adopt the full set of FY 2008 IPPS quality measures as proposed for the CY 2008 OPPS RHQDAPU program, while we continue to develop a set of specific quality measures for hospital outpatient care. We welcome public comments on the applicability of the FY 2008 IPPS additional quality measures that are proposed in this rule to the care of hospital outpatients. We also welcome public comments on alternative measures of quality of care, including measures of the cost or efficiency of care, that are suitable for adoption to reduce the incidence of lower-quality and high-cost outpatient hospital care for Medicare beneficiaries. We will formalize our proposal regarding the CY 2008 OPPS RHQDAPU program in the CY 2008 OPPS proposed rule, which may include proposing to adopt none, some, or all of the FY 2008 IPPS RHQDAPU measures, and may also reflect quality measures that are discussed in comments on this proposed rule. For purposes of computing the update to the conversion factor under the OPPS in CY 2007, therefore, we are proposing to reduce the update to the OPPS conversion factor by 2.0 percentage points for any hospital that is eligible to participate in the IPPS RHQDAPU program, but that has had its IPPS payment update reduced because it failed to comply with that program's requirements. Under this proposal, hospitals that fail to qualify for the full CY 2007 OPPS update would receive payments based on a conversion factor of $60.36, reflecting an update of 1.4 percent, in place of the conversion factor of $61.551 reflecting the full update of 3.4 percent. Under proposed § 419.43(h)(1), in order to avoid reduction to the CY 2007 OPPS update, hospitals that are eligible to participate in the IPPS RHQDAPU program must meet the requirements for receiving the full IPPS update for FY 2007. Updated procedures and requirements for the IPPS RHQDAPU program are included in the FY 2007 IPPS final rule. In addition to publication in the final rule, all revised procedures will be added to the “Reporting Hospital Quality Data for Annual Payment Update Reference Checklist” section of the QualityNet Exchange Web site (
                        *www.qnetexchange.org*). For purposes of determining which hospitals have not qualified to receive the full update under the OPPS for CY 2007, we will follow the determination for FY 2007 full IPPS payment update eligibility under the IPPS RHQDAPU program. These determinations will be released on or about September 1, 2006. As we noted above, we are undertaking this initiative under the authority granted by section 1833(t)(2)(E) of the Act, which authorizes the Secretary to “establish, in a budget neutral manner, * * * adjustments as determined to be necessary to ensure equitable payments” under the OPPS. Proposed § 419.43(h)(3) provides that the reduction to the CY 2007 update that we will implement for hospitals that fail to meet the requirements described above will be implemented in a budget neutral manner. Therefore, if we determine that some hospitals will receive a reduced update for CY 2007 as a result of failure to meet the requirements established under this initial phase of the OPPS RHQDAPU program, we will also make an adjustment to the OPPS conversion factor, so that estimated aggregate payments under the OPPS for CY 2007, taking into account the reduced update for some hospitals, equal the aggregate payments that we estimate would have been made in CY 2007 if all hospitals received the full update to the conversion factor. As we noted above, determinations concerning which hospitals fail to meet the requirements for receiving the full update to the OPPS conversion factor in CY 2007 will be available on or about September 1, 2006. We are therefore unable at this time to determine how many hospitals will receive a reduced update in CY 2007, or to determine the budget neutrality adjustment factor that will be necessary to ensure that estimated aggregate payments under the OPPS for CY 2007 do not change as a result of implementing the proposed OPPS RHQDAPU program. However, very few hospitals have failed to qualify for the full annual updates under the IPPS RHQDAPU program. We therefore anticipate that any further adjustment to the CY 2007 conversion factor to satisfy the budget neutrality requirement under section 1833(t)(2)(E) of the Act will be negligible. It is not our intention to maintain the specific requirements described above beyond a short initial phase of implementing an OPPS RHQDAPU program. Rather our intention is to develop this program beyond its initial stage in at least two ways. As we have stated previously, we believe that it is appropriate and fair during this initial phase of the OPPS RHQDAPU program, to take quality data reporting under the IPPS RHQDAPU program into consideration for purposes of determining the update for hospitals under the OPPS. However, it will be important for a fully developed OPPS RHQDAPU program to be based on reporting measures that are defined in terms of the quality considerations that are most appropriate and applicable in the hospital outpatient setting. In collaboration with health care stakeholders, we intend to begin work on a set of quality and cost of care measures specific to hospital outpatient departments for implementation in a later phase of the OPPS RHQDAPU program. We intend to implement a hospital outpatient-specific set of such quality and cost of care measures at the earliest possible date. Reporting of a more fully developed, outpatient-specific set of quality and cost of care measures may be effective for purposes of determining the update as early as CY 2009. However, in implementing the system we will allow adequate time for development of the appropriate measures; announcement of the quality and cost of care measures we have selected; consideration of comments from the hospital community, patient 
                        ( print page 49670)
                        advocates, and other stakeholders; establishment of the requisite mechanisms for reporting the measure; and initiation of actual reporting of the measures by hospitals. As we begin to develop such a set of hospital outpatient-specific quality and cost of care measures, we welcome comments on this issue. Specifically, we invite comments on the following (and related) questions: Which current quality and cost of care measures, such as IPPS quality measures (especially the measure set as expanded under the DRA), physician practice measures, HCAHPS®/ACAHPS®, etc., are most applicable in the hospital outpatient setting? What would be the characteristics of an ideal measure set of quality and cost of care measures for the outpatient setting? What quality and cost of care measures are currently available for the outpatient setting? What privately-led organizations or alliances are best suited to conduct needed development and consensus endorsement of outpatient quality measures? As we discussed above, for the initial stage of implementing the OPPS RHQDAPU program in CY 2007, hospitals that are paid under the OPPS but that do not qualify as “subsection (d)” hospitals will receive the full update to the OPPS conversion factor. However, we believe that it is essential to expand the requirements of the OPPS RHQDAPU program that we are proposing to all hospital outpatient departments paid under the OPPS. We will therefore also undertake to study, for CYs 2008 and beyond, approaches to adapting and expanding the current quality and cost of care measures under the IPPS RHQDAPU program for use in reporting on the quality of outpatient care in hospitals that are paid under the OPPS but that do not qualify as “subsection (d)” hospitals. We will also begin development of mechanisms by which these hospitals can report the requisite quality data in a timely and effective manner. We welcome comments on ways in which we can expand the proposed OPPS RHQDAPU program to all hospital outpatient departments that are paid under the OPPS, and on quality and cost of care measures that are specifically appropriate for reporting by hospital outpatient departments paid under the OPPS but that do not qualify as “subsection (d)” hospitals. Our ultimate goal is implementation of an OPPS RHQDAPU program that extends to all hospital outpatient departments that are paid under the OPPS, that is based on a set of quality and cost of care reporting measures that are specific to the hospital outpatient setting, and that is appropriately aligned with developments in quality reporting and value-based purchasing in other payment systems such as the IPPS. We will take into consideration issues related to the appropriate alignment of quality and cost of care reporting and value-based purchasing under the IPPS and OPPS during the planning process mandated by section 5001(b) of the DRA for implementation of inpatient value-based purchasing by FY 2009. We plan to include all hospital services, whether inpatient or outpatient, in the report on implementation of value-based purchasing. We have often heard from stakeholders that a more comprehensive, systematic approach to quality should be our focus. Quality reporting of inpatient and outpatient services is consistent with such comments, and will provide more comprehensive information about the quality of services provided by hospitals. We specifically request comments on the alignment of scope and other issues that should be considered during this planning process, including quality and cost of care reporting measures, data and program infrastructure, incentives, and public reporting of quality and cost of care measures under value-based purchasing. Finally, we request comments on the most effective use of our authority under section 1833(t)(2)(E) of the Act, in light of the concerning evidence of rapid and uneven payment growth in the OPPS with limited evidence of patient benefit. In particular, commenters who believe that the proposed quality reporting initiative is not the most effective use of this authority should consider submitting comments on alternative, more effective approaches to using this and related authorities available to CMS under the Act to promote higher quality, more equitable care. We do not believe that the status quo, with rapid and uneven growth in spending and limited evidence of its value, is consistent with a sustainable hospital outpatient payment program and affordable health care for Medicare beneficiaries, and we expect to take further steps to address this important concern. As we have noted elsewhere, continuing rapid growth in Medicare spending that is not addressed by effective payment reforms often results in across-the-board reductions in payment rates. In addition, we seek comment on whether section 1833(t)(2)(F) of the Act also supports the proposed use of quality reporting to determine a hospital's update under the OPPS. XXI. Promoting Effective Use of Health Information Technology (If you choose to comment on issues in this section, please include the caption “Health Information Technology” at the beginning of your comment.) We recognize the potential for health information technology (HIT) to facilitate improvements in the quality and efficiency of health care services. One recent RAND study found that broad adoption of electronic health records could save more than $81 billion annually and, at the same time, improve quality of care.[5]
                        
                         The largest potential savings that the study identified was in the hospital setting because of shorter hospital stays promoted by better coordinated care; less nursing time spent on administrative tasks; better use of medications in hospitals; and better utilization of drugs, laboratory services, and radiology services in hospital outpatient settings. The study also identified potential quality gains through enhanced patient safety, decision support tools for evidence-based medicine, and reminder mechanisms for screening and preventive care. Despite such large potential benefits, the study found that only about 20 to 25 percent of hospitals have adopted HIT systems. It is important to note the caveats to the RAND study. The projected savings are across the health care sector, and any Federal savings would be a reduced percentage. In addition, there are significant assumptions made in the RAND study. National savings are projected in some cases based on one or two small studies. Also, the study assumes patient compliance, in the form of participation in disease management programs and following medical advice. For these reasons, extreme caution should be used in interpreting these results. In summary, there are mixed signals about the potential of HIT to reduce costs. Some studies have indicated that HIT adoption does not necessarily lead to lower costs and improved quality. In addition, some industry experts have stated that factors such as an aging population, medical advances, and increasing provider expenses would make any projected savings impossible. 
                        ( print page 49671) In his 2004 State of the Union Address, President Bush announced a plan to ensure that most Americans have electronic health records within 10 years.[6]
                        
                         One part of this plan involves developing voluntary standards and promoting the adoption of interoperable HIT systems that use these standards. The 2007 Budget states that “The Administration supports the adoption of health information technology (IT) as a normal cost of doing business to ensure patients receive high quality care.” Over the past several years, CMS has undertaken several activities to promote the adoption and effective use of HIT in coordination with other Federal agencies and with the Office of the National Coordinator for Health Information Technology. One of those activities is promotion of data standards for clinical information, as well as for claims and administrative data. In addition, through our 8th Scope of Work contract with the QIOs, we are offering assistance to hospitals on how to adopt and redesign care processes to effectively use HIT to improve the quality of care for Medicare beneficiaries, including computerized physician order entry (CPOE) and bar coding systems. Finally, our Premier Hospital Quality Incentive Demonstration provides additional financial payments for hospitals that achieve improvements in quality, which effective HIT systems can facilitate. We are considering the role of interoperable HIT systems in increasing the quality of hospital services while avoiding unnecessary costs. As noted above, the Administration supports the adoption of HIT as a normal cost of doing business. While payments under the OPPS do not vary depending on the adoption and use of HIT, hospitals that leverage HIT to provide better quality services may more efficiently reap the reward of any resulting cost savings. In addition, the adoption and use of HIT may contribute to improved processes and outcomes of care, including shortened hospital stays and the avoidance of adverse drug reactions. We are seeking comments on our statutory authority to encourage the adoption and use of HIT. We also are seeking comments on the appropriate role of HIT in any value-based purchasing program, beyond the intrinsic incentives of the OPPS, to provide efficient care, encourage the avoidance of unnecessary costs, and increase quality of care. In addition, we are seeking comments on promotion of the use of effective HIT through hospital conditions of participation, perhaps by adding a requirement that hospitals use HIT that is compliant with and certified in its use of the HIT standards adopted by the Secretary. We anticipate that the American Health Information Community will provide advice to the Secretary on these issues. XXII. Health Care Information Transparency Initiative (If you choose to comment on issues in this section, please include the caption “Transparency of Health Care Information” at the beginning of your comment.) The United States (U.S.) faces a dilemma in health care. Although the rate of increase in health care spending slowed last year, costs are still growing at an unsustainable rate. The U.S. spends $1.9 trillion on health care, or 16 percent of the gross domestic product (GDP). By 2015, projections are that health care will consume 20 percent of GDP. The Medicare program alone consumes 3.4 percent of the GDP; by 2040, it will consume 8.1 percent of the GDP and by 2070, 14 percent of the GDP. Part of the reason health care costs are rising so quickly is that most consumers of health care—the patients—are frequently not aware of the actual cost of their care. Health insurance shields them from the full cost of services, and they have only limited information about the quality and costs of their care. Consequently, consumers do not have the incentive or means to carefully shop for providers offering the best value. Thus, providers of care are not subject to the competitive pressures that exist in other markets for offering quality services at the best possible price. Reducing the rate of increase in health care prices and avoiding health services of little value could help to stem the growth in health care spending, and potentially reduce the number of individuals who are unable to afford health insurance. Part of the President's health care agenda is to expand Health Savings Accounts (HSAs), which would provide consumers with greater financial incentives to compare providers in terms of price and quality, and choose those that offer the best value. In order to exercise those choices, consumers must have accessible and useful information on the price and quality of health care items and services. Typically, health care providers do not publicly quote or publish their prices. Moreover, list prices, or charges, generally differ from the actual prices negotiated and paid by different health plans. Thus, even if consumers were financially motivated to shop for the best price, it would be very difficult at the current time for them to access usable information. For these reasons, DHHS is launching a major health care information transparency initiative in 2006. This effort builds on steps taken by CMS to make quality and price information available. For example, Medicare has provided unprecedented information about drug prices in the Medicare drug benefit, and is now adding to these efforts in other areas. We recently posted Medicare payment information for common elective procedures and other common admissions for all hospitals by county on our Web site at 
                        *http://www.cms.hhs.gov/​HealthCareConInit/​01_​Overview.asp#TopOfPage.*
                         We will post geographically-based Medicare payment information for common elective procedures for ambulatory surgery centers this summer and for common hospital outpatient and physician services this fall. In addition, a number of tools providing usable health care information are already available to Medicare beneficiaries. Consumers can access “Compare” Web sites through 
                        *http://www.medicare.gov*
                         where they can evaluate important aspects of their health care options for care at a hospital, nursing home, home health agency, and dialysis facility, as well as compare their costs and coverage when choosing a prescription drug plan. CMS is developing a transparency initiative with the goals of providing more comprehensive information on quality and costs, including more complete measures of health outcomes, satisfaction, and volume of services that matter to consumers, and more comprehensive measures of costs for entire episodes of care, not just payments for particular services and admissions. We intend for the project to combine public and private health care data to provide cost and quality of care information at the physician and hospital levels. Quality, cost, pricing, and patient information will be reported to consumers and purchasers of health care in a meaningful and transparent way. In addition, we anticipate the project will provide a national template for performance measures and a payment structure that aligns payment and performance. 
                        ( print page 49672) XXIII. Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for the FY 2008 IPPS Annual Payment Update (If you choose to comment on issues in this section, please include the caption “FY 2008 IPPS RHQDAPU” at the beginning of your comments.) A. Background Section 5001(a) of the Deficit Reduction Act of 2005 (DRA) (Pub. L. 109-171) sets out new requirements for the IPPS Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program. The IPPS RHQDAPU program was established to implement section 501(b) of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) (Pub. L. 108-173). It builds on our ongoing voluntary Hospital Quality Initiative which is intended to empower consumers with quality of care information to make more informed decisions about their health care while also encouraging hospitals and clinicians to improve the quality of care. Section 5001(a) of Pub. L. 109-171 revises the mechanism used to update the standardized amount for payment for hospital inpatient operating costs. New sections 1886(b)(3)(B)(viii)(I) and (II) of the Act provide that the payment update for FY 2007 and each subsequent fiscal year will be reduced by 2.0 percentage points for any “subsection (d) hospital” that does not submit certain quality data in a form and manner, and at a time, specified by the Secretary. Under sections 1886(b)(3)(B)(viii)(III) and (IV) of the Act, we must expand the “starter set” of quality measures that we have used since FY 2005, and to begin to adopt the baseline set of performance measures as set forth in a 2005 report issued by the Institute of Medicine of the National Academy of Sciences (IOM) under section 238(b) of the MMA, effective for payments beginning with FY 2007. The 2005 IOM report's “baseline” quality measures include Hospital Quality Alliance (HQA)-approved clinical quality measures, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS®) patient perspective survey, and three structural measures. The structural measures are: (1) Implementation of computerized provider order entry for prescriptions, (2) staffing of intensive care units with intensivists, and (3) evidence-based hospital referrals. These measures originate from the Leapfrog Group's original “three leaps,” and are part of the NQF's 30 safe practices. In 2002, the Secretary of HHS initiated a partnership with several collaborators intended to promote hospital quality improvement and public reporting of hospital quality information. This collaboration is known as the Hospital Quality Alliance (HQA). The collaborators include the American Hospital Association, the Federation of American Hospitals, the Association of American Medical Colleges, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Quality Forum (NQF), the American Medical Association, the Consumer-Purchaser Disclosure Project, the American Association of Retired Persons, the American Federation of Labor Congress of Industrial Organizations, the Agency for Healthcare Research and Quality, as well as CMS, Quality Improvement Organizations (QIOs), and others. In the FY 2007 IPPS proposed rule, we proposed to add to our 10-measure “starter set” of quality measures, 11 HQA-approved measures for purposes of the FY 2007 update (71 FR 24093). Under section 1886(b)(3)(B)(viii)(V) of the Act, for payments beginning with FY 2008, we are required to add other measures that reflect consensus among affected parties and, to the extent feasible and practicable, must include measures set forth by one or more national consensus building entities. Commenters on the FY 2007 IPPS proposed rule requested that we notify the public as far in advance as possible of any proposed expansions of the measure set and program procedures to encourage broad collaboration and to give hospitals time to prepare for any anticipated changes. Other commenters requested that we adopt additional quality measures and that we do as soon as feasible. For example, several commenters urged that we adopt the HCAHPS® patient survey as a part of the IPPS RHQDAPU program, while others suggested that we adopt more of the IOM measures as well as more outcome measures, including mortality measures that were not included in the 2005 IOM report's “baseline” quality measures. In response to these comments and as part of our continuing efforts to strengthen the IPPS RHQDAPU program, we are seeking comments on this proposal to expand, for FY 2008, the measurement set beyond those measures we proposed to adopt for purposes of the FY 2007 update. This proposed expanded set would further broaden the scope of the IPPS RHQDAPU program by including the HCAHPS® patients' perspectives of care measures as well as surgical care and mortality outcome measures. B. Proposed Additional Quality Measures for FY 2008 1. Introduction For FY 2008, we propose to add the following categories to the measure set: *HCAHPS® Survey* HCAHPS® is also known as Hospital CAHPS or the CAHPS Hospital Survey. The HCAHPS® survey is composed of the following 27 questions: + 18 substantive questions that measure critical aspects of the hospital experience (communication with doctors; communication with nurses; responsiveness of hospital staff; cleanliness and quietness of hospital environment; pain management; communication about medicines; and discharge information). + 4 questions that direct patients to complete only those survey questions that apply to them. + 3 questions to be used to adjust the mix of patients across hospitals. + 2 questions that support Congressionally-mandated reports, the “National Healthcare Disparities Report,” and the “National Healthcare Quality Report.” *Surgical Care Improvement Project (SCIP)* + SCIP-VTE 1: Venous thromboembolism prophylaxis ordered for surgery patient + SCIP-VTE 2: VTE prophylaxis within 24 hours pre/post surgery + SCIP Infection 2: Prophylactic antibiotic selection for surgical patients *Mortality* + AMI 30-day mortality—Medicare patients + HF 30-day mortality—Medicare patients + Pneumonia 30-day mortality—Medicare patients We discuss these proposed measures in detail below. 2. HCAHPS® Survey and the Hospital Quality Initiative We have partnered with the Agency for Healthcare Research and Quality (AHRQ), another HHS agency, to develop HCAHPS®. The intent of the HCAHPS® initiative is to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives of hospital care. While many hospitals currently collect information on patients' satisfaction with care, there is currently no national standard for collecting or publicly reporting this information that would enable valid comparisons to be made across hospitals. To make the appropriate comparisons to support consumer choice, we believe it is necessary to 
                        ( print page 49673)
                        introduce a standard measurement approach. HCAHPS® can be viewed as a core set of questions that can be combined with a broader, customized set of hospital-specific items. HCAHPS® is intended to complement the data hospitals currently collect to support improvements in internal customer services and quality related initiatives within the hospital. Three broad goals have shaped HCAHPS®. The survey is designed to produce data on the patient's perspective on care that allows objective and meaningful comparisons between hospitals on issues that are important to consumers. In addition, public reporting of the survey results is designed to create incentives for hospitals to improve their quality of care. Also, public reporting will serve to enhance public accountability in health care by increasing the transparency of the quality of hospital care provided in return for the public investment. With these goals in mind, the HCAHPS® initiative has taken substantial steps to assure that the survey will be credible, useful, and practical. Throughout the HCAHPS® development process, AHRQ and CMS have solicited and received a great deal of public input. AHRQ published a 
                        **Federal Register**
                         notice that called for measures in July 2002 (67 FR 48477) and we solicited input on drafts of the HCAHPS® instrument and its implementation strategy (February 2003, June 2003, and December 2003—68 FR 5889, 68 FR 38346, 68 FR 68087). In addition to the public comments received, results from a 3-State Pilot Study were used to reduce the pool of 66 survey questions to 25 questions. In addition to the development and review processes, we submitted the 25-item version of the HCAHPS® instrument to the NQF. The NQF is a voluntary consensus standard-setting organization established to standardize health care quality measurement and reporting for its review and endorsement through its consensus development process. NQF endorsement represents the consensus of numerous health care providers, consumer groups, professional associations, purchasers, Federal agencies, and research and quality organizations. Following a thorough, multi-stage review process, HCAHPS® was endorsed by the NQF board in May 2005. In the process, NQF recommended a few modifications to the instrument. As a result of the recommendations of the NQF Consensus Development Process, questions regarding courtesy and respect were added to the survey. The NQF review committee believes that these questions are important to all patients, and may be particularly meaningful to patients who are members of racial and ethnic minority groups. Upon the recommendation of the NQF, we further examined the costs and benefits of the 27-item HCAHPS® survey. This cost-benefit analysis of HCAHPS® was conducted by Abt Associates, Inc. The report of this analysis can be found at 
                        *http://www.cms.hhs.gov/​HospitalQualityInits/​downloads/​HCAHPSCostsBenefits200512.pdf.* We published a 
                        **Federal Register**
                         notice soliciting comments on the draft 27-item HCAHPS® Survey in November 2005 (70 FR 67476). The HCAHPSreg; survey received approval by the Office of Management and Budget (OMB) on December 22, 2005. Shortly thereafter, we began final preparations for the voluntary national implementation (as a part of the Hospital Quality Initiative) with the support of the HQA. The HQA is a private/public partnership that includes the American Hospital Association, the Federation of American Hospitals, the Association of American Medical Colleges, JCHAO, NQF, American Association of Retired Persons (AARP), CMS, AHRQ, and other stakeholders who share a common interest in reporting on hospital quality. The HQA has been proactive in making performance data on hospitals accessible to the public, thereby improving patient care. We also offered training sessions for hospitals self-administering the survey and survey vendors acting on behalf of hospitals in February and April 2006. Since HCAHPS® was a new initiative, we decided that it was critical to hospitals, survey vendors, and CMS to acquire first-hand experience with data collection, including sampling and data submission to the QualityNet Exchange, prior to collecting data for public reporting. For hospitals participating in the national implementation of HCAHPS® on October 1, 2006, we required participation in a short dry run period of at least one month. A hospital could choose to sample and survey discharges in April, May, and/or June 2006. Data from this “dry run” are not publicly reported. National implementation begins October 2006 for this first set of hospitals and survey vendors that will be participating in the HCAHPS® voluntary initiative The initial public reporting period will cover nine months of patient discharges (October 2006 through June 2007). In late 2007, hospital results will be publicly reported on the CMS Hospital Compare Web site (
                        *http://www.hospitalcompare.hhs.gov*). After the initial implementation, the Web site will contain 12 months of HCAHPS® data and will be updated quarterly. The HCAHPS® survey is currently available in English and Spanish. During the HCAHPS® dry run and initial national implementation (discussed more fully below), we will be soliciting comments from participating hospitals and survey vendors regarding additional languages for HCAHPS®. This information can be submitted to our HCAHPS® mailbox, 
                        *CMSHOSPITALCAHPS@cms.hhs.gov*. From the information we receive, we will establish priorities for HCAHPS translation into additional languages. In order for the remaining hospitals to participate in HCAHPS®, future training sessions for hospital personnel and survey vendors will take place in early 2007. Hospitals may choose to self-administer HCAHPS®, or may choose to hire a vendor who has completed the training. A brief dry run of March 2007 discharges will allow newly participating hospitals and vendors to get “first-hand” experience with all phases of the data collection and submission process. Details about the HCAHPS® requirements, and the additional requirements proposed for HCAHPS® under the IPPS RHQDAPU program, are included in section XXIII.C. and XXIII.D. of this preamble. 3. Surgical Care Improvement Project (SCIP) Quality Measures The Surgical Care Improvement Project (SCIP) is a national quality partnership of organizations committed to improving the safety of surgical care through the reduction of post-operative complications. The primary goal of the partnership is to save lives by reducing the incidence of surgical complications by 25 percent by the year 2010.  Partners in SCIP believe that a meaningful reduction in complications requires a systems approach to our challenges, which means that surgeons, anesthesiologists, primary care physicians and internal medicine specialists, perioperative nurses, pharmacists, infection control professionals, and hospital executives must work together to make surgical care improvement a priority. SCIP partners coordinate their efforts through a steering committee that includes representatives of the American Hospital Association, the American College of Surgeons, the American Society of Anesthesiologists, the Association of Perioperative Registered Nurses, the JCAHO, the Institute of Healthcare Improvement, the 
                        ( print page 49674)
                        Department of Veterans Affair (VA), the Agency for Healthcare Research and Quality (AHRQ), CMS and the Centers for Disease Control and Prevention (CDC). SCIP is a comprehensive program, integrated into the quality improvement agenda of the CMS, JCAHO, the CDC, the American College of Surgeons, the Veterans Health Administration, as well as the other organizations that comprise the SCIP Steering Committee. There are a number of activities underway from these and other partnering organizations. 4. Mortality Outcome Measures CMS recognizes that the current set of hospital performance measures should be expanded to more fully reflect outcomes of care. The 30-day mortality measures for patients with acute myocardial infarction (AMI), heart failure (HF) and pneumonia are three separate claims-based, risk-adjusted assessments of mortality within 30 days of admission for each of the three conditions. The measures reflect outcomes of care for Medicare patients only, and rely on Medicare patients' historical medical care use, including inpatient and physician office visits and outpatient care 1 year before their hospitalizations, for the risk adjustment calculation. The 30-day mortality rate measures for AMI and HF were endorsed by the NQF in 2005 (see 
                        *http://www.qualityforum.org/​news/​tb3Hospspecsforweb02-10-06.pdf*). We anticipate that the 30-day mortality rate measure for pneumonia will also be endorsed by the NQF since it reflects the same underlying methodology as the other 30-day mortality measures. In contrast to the HCAHPS® and SCIP quality measures added to the measure set for FY 2008, no additional data collection from hospitals will be required to calculate the 30-day mortality measures. All three measures can be calculated based on Medicare inpatient and outpatient claims data that are already reported to the Medicare program for payment purposes. We anticipate that we will conduct a national dry run for the AMI and HF measures in late 2006 to test implementation and educate hospitals on the methodology. During this dry run, hospitals will be given the opportunity to examine their rates and other data associated with the measures, and to provide feedback to CMS on questions related to the calculation of the rates. The rates that will be developed for the dry run will be used for quality improvement purposes and will not be publicly reported to the Hospital Compare. More information about the dry run will be provided to hospitals through QualityNet Exchange Web site (
                        *http://www.qnetexchange.org*). We expect to calculate and publicly report 30-day mortality rates for the AMI and HF conditions in the June 2007 update of the Hospital Compare Web site. Rates for the 30-day pneumonia mortality measure will be posted as soon as possible after we receive NQF endorsement. As is currently the case for the other measures, hospitals will be provided a 30-day period in which they will be permitted to preview their rates before publication. As is currently the case for the “starter set” measures, hospitals that have pledged to submit data for full annual payment update for FY 2008 will not be permitted to suppress or withhold publication of the rates on the Hospital Compare Web site, except under highly limited circumstances. C. General Procedures and Participation Requirements for the FY 2008 IPPS RHQDAPU Program All revised procedures for FY 2008 also will be added to the “Reporting Hospital Quality Data for Annual Payment Update Reference Checklist” section of the QualityNet Exchange Web site. This checklist also links to all of the forms to be completed by hospitals participating in the program. To participate in the RHQDAPU program, we are proposing that hospitals must follow these steps: Complete all registration steps; this information can be found on “Reporting Hospital Quality Data for Annual Payment Update Reference Checklist” located on the QualityNet Exchange Web site.
                    Continue to collect data for all clinical quality measures that are currently part of the RHQDAPU program, and submit the data to the QIO Clinical Warehouse either using the CMS Abstraction & Reporting Tool (CART), the JCAHO ORYX® Core Measures Performance Measurement System, or another third-party vendor tool that has met specification requirements for data transmission to QualityNet Exchange. The submission must be done through QualityNet Exchange. Because the information in the QIO Clinical Warehouse is considered QIO information, it is subject to the stringent QIO confidentiality regulations in42 CFR Part 480. In addition, for purposes of the annual payment update, we will continue to require hospitals to pass our validation requirements. We originally set forth these requirements in the FY 2006 IPPS final rule (70 FR 47421), and we will continue to require that hospitals achieve an 80-percent reliability. We will also continue to post information related to validation requirements on the QualityNet Exchange Web site. In addition to these general procedures, the specific procedures below apply to these proposed additional measures. D. HCAHPS® Procedures and Participation Requirements for the FY 2008 IPPS RHQDAPU Program 1. Introduction Under sections 1886(b)(3)(B)(viii)(III) and (IV) of the Act, CMS must begin to adopt the baseline set of performance measurements as set forth in a 2005 report issued by the Institute of Medicine (IOM) of the National Academy of Sciences under section 238(b) of Pub. L. 108-173, effective for payments beginning with FY 2007. The 2005 IOM report recommends that we expand the “starter” measures by including the HCAHPS® patient perspective survey. We began to adopt the IOM measures in the FY 2007 IPPS final rule, in which we adopted 11 additional HQA-approved quality measures. In this proposed rule, we are proposing to expand the set of IOM measures hospitals will be required to report to receive the full IPPS market basket update for FY 2008. In addition, section 1886(b)(3)(B)(viii)(V) of the Act states that effective for payments beginning with FY 2008, we must add “other measures that reflect consensus among affected parties and, to the extent feasible and practicable,” include “measures set forth by one or more national consensus building entities.” Accordingly, we are proposing to add additional SCIP quality and measures and three 30-day mortality measures. 2. HCAHPS® Hospital Pledge and Beginning Date for Data Collection Under the FY 2008 RHQDAPU program, we are proposing that hospitals will need to submit HCAHPS® data to the QIO Clinical Warehouse beginning with discharges that occur in the third calendar quarter of 2007 (July through September discharges). In order to meet HCAHPS® requirements for the RHQDAPU program, we are proposing that all hospitals, including hospitals new to HCAHPS® and hospitals that have been collecting data since October 1, 2006, must submit a formal pledge to CMS by July 1, 2007 stating that they will collect and submit HCAHPS® data to the QIO Clinical Warehouse starting 
                        ( print page 49675)
                        with July 2007 discharges. We are proposing that to meet HCAHPS® requirements for the RHQDAPU program for FY 2008, all hospitals must submit this pledge to CMS. 3. HCAHPS® Dry Run We are proposing to require that hospitals that have not had experience collecting and submitting HCAHPS® data to the QIO Clinical Warehouse as a result of participating in the 2006 voluntary initiative must participate in a dry run of the survey in March 2007. We are proposing to require the submission of March 2007 dry run data to the QIO Clinical Warehouse by July 13, 2007 from those hospitals not yet collecting and submitting HCAHPS® data. 4. HCAHPS® Data Collection Requirements To collect HCAHPS® data, we are proposing that a hospital can either contract with an approved HCAHPS® survey vendor that will conduct the survey and submit data on the hospital's behalf to the QIO Clinical Warehouse, or a hospital can self-administer the survey without using a survey vendor provided that the hospital meets Minimum Survey Requirements as specified at (
                        *http://www.HCAHPSonline.org/​programapplication.asp*). A current list of approved HCAHPS® survey vendors can be found at 
                        *http://www.HCAHPSonline.org/​app_​vendor.asp.* 5. HCAHPS® Registration Requirements We are proposing that HCAHPS® registration requirements for the RHQDAPU program will include: + The hospital must be a registered user of QualityNet Exchange. Hospitals that are self-administering HCAHPS® or survey vendors hired by the hospitals must collect and submit HCAHPS® survey person-level data electronically to the QIO Clinical Warehouse via QualityNet Exchange, using prescribed file specifications that can be found at 
                        *http://www.HCAHPSonline.org/​techspecs.asp.* 6. Additional Steps for HCAHPS® Participation In order to participate in HCAHPS®, we are proposing that hospitals that self-administer the survey and survey vendors that collect and submit data on behalf of client hospitals must follow these steps: *Attend Hospital/Survey Vendor Training.*
                         Hospitals and survey vendors that intend to actually administer the survey must attend HCAHPS® training. Hospitals contracting with a survey vendor or another hospital to administer the survey on behalf of the hospital do not need to attend training. The next training session will be offered via Webinar in late January 2007. Please see 
                        *http://www.HCAHPSonline.org*
                         for updated information on training opportunities and registration. At a minimum, the hospital's or survey vendor's project manager must attend the HCAHPS® training for administering the survey. Hospitals and survey vendors that attended training in February or April 2006 and are participating in the voluntary HCAHPS data submission beginning October 2006 do not need to participate in the January 2007 training sessions. In addition, we may hold short refresher training sessions for all hospitals self-administering the survey and survey vendors in the spring of 2007.
                    *Review and follow the HCAHPS® Quality Assurance Guidelines and Updates.*
                         HCAHPS Quality Assurance Guidelines have been developed to standardize the survey data collection process and to ensure comparability of data reported through HCAHPS®. They are located on 
                        *http://www.hcahpsonline.org*
                         and will also be presented at the HCAHPS® hospital/survey vendor training. The HCAHPS® Quality Assurance Guidelines (the Guidelines) provide detailed information regarding: technical support; sampling protocols; the four allowed modes of survey administration; data specifications and coding; data preparation and submission; data reporting and the exceptions process. The Guidelines describe technical support that is available to hospitals and survey vendors administering HCAHPS® by using a toll-free number or by e-mail. It provides details regarding the protocol for sampling involving drawing a simple random sample each month from the sampling frame of eligible discharges. Sampling can be done at one time after the end of the month, or continuously throughout the month, as long as a simple random sample is generated for the month. The Guidelines include very specific information about the four allowed modes of survey administration: mail only, telephone only, a mixed methodology of mail with telephone follow up, and active interactive voice response (IVR). All modes of administration require following a standardized protocol. The Guidelines describe a standardized approach for the coding of all data from assigning the unique tracking number, the decision rules for capturing data, the file specifications, the file layout, the procedure for assigning disposition codes, the definition of a completed survey, and the procedure for calculating the total survey response rate. Data preparation and submission guidelines cover registration for data submission via the QualityNet Exchange, creation of data files, instructions for data submission via the QualityNet Exchange, and confirmation of accuracy of data. Data reporting covers internal and external reports; among them are the hospital preview reports and the public reports on CMS Hospital Compare. The Quality Assurance Guidelines describe the exceptions process to review requests for methodologies that vary from the standard HCAHPS® protocols and the appeals process if an exception is denied. For the initial implementation phase of the HCAHPS® survey, we are proposing that no exceptions to the four approved modes of survey administration will be allowed. In addition, hospitals/survey vendors must follow any updates that are posted on 
                        *http://www.HCAHPSonline.org.* *Develop Hospital/Survey Vendor HCAHPS® Quality Assurance Plan.*
                         Hospitals self-administering the survey and survey vendors must develop a Quality Assurance Plan for survey administration in accordance with the Quality Assurance Guidelines presented at the HCAHPS® hospital/survey vendor training and posted on 
                        *http://www.HCAHPS® online.org/programapplication.asp.*
                         The HCAHPS® Quality Assurance Plan should include the following: + Organizational chart + Work plan for survey implementation + Description of survey procedures and quality controls + Plans for quality assurance oversight of on-site work and of all subcontractors' work (including survey vendor, if used) + Confidentiality/Privacy and Security procedures in accordance with the Health Insurance Portability and Accountability Act (HIPAA). The hospital or survey vendor must make the HCAHPS ® Quality Assurance Plan available to the HCAHPS® project team upon request. The project team includes CMS, the Health Services Advisory Group (HSAG) that is helping CMS implement HCAHPS, and HSAG's subcontractors for this project. *Attest to the Accuracy of the Organization's Data Collection.*
                         Hospitals self-administering the survey and survey vendors must review and agree that the HCAHPS survey was administered in accordance with the HCAHPS® Quality Assurance Guidelines. 
                        ( print page 49676)
                    *Participate in HCAHPS® oversight activities.*
                         Hospitals and survey vendors must participate in a quality oversight process conducted by the HCAHPS® project team. Prior to July 2007, the purpose of the oversight activities will be to provide feedback to hospitals and survey vendors on data collection procedures. Starting in July 2007, CMS may ask hospitals/survey vendors to correct any problems that are found and provide follow-up documentation of corrections for review within a defined time period. If we find that the hospital has not made these corrections, CMS may determine that the hospital is not submitting appropriate HCAHPS® data for the RHQDAPU program. As part of these activities, HCAHPS® project staff will review and discuss with survey vendors and hospitals self-administering the survey their specific Quality Assurance Plans; survey management procedures; sampling and data collection protocols; and data preparation and submission. This review may take place in-person or through other means of communication. 7. HCAHPS® Survey Completion Requirements We are proposing that hospitals must submit complete HCAHPS® data in accordance with the HCAHPS® Quality Assurance Guidelines located at 
                        *http://www.HCAHPSonline.org*
                         and made available at the hospital/survey vendor training. These requirements specify that hospitals are required to survey a random sample of eligible discharges on a monthly basis. Hospitals should target to collect at least 300 completed surveys over the public reporting period. For the initial HCAHPS® national implementation, the public reporting period is 9 months, from October 2006 through June 2007. After this initial implementation, the public reporting period will be 12 months and hospitals should be targeting to collect at least 300 completed HCAHPS® surveys over a 12 month period. The initial public reporting period is 9 months, because of the broad interest of making HCAHPS results publicly available as quickly as possible. Smaller hospitals that cannot collect 300 completed HCAHPS® surveys during a public reporting period will only be required to collect as many completed surveys as possible. A small hospital is defined for the purposes of HCAHPS® as any hospital that cannot achieve 300 completed HCAHPS® surveys during a public reporting period, because of its dearth of eligible hospital discharges during that period. For those hospitals that cannot collect 300 completed HCAHPS® surveys, we plan to note this on 
                        *http://www.hospitalcompare.hhs.gov*
                         that the results for those hospitals are based on less than 100 completed HCAHPS® surveys or between 100 and 299 completed HCAHPS® surveys. 8. HCAHPS® Public Reporting We propose to display HCAHPS® data on our Web site for public viewing in accordance with section 1886(b)(3)(B)(viii)(VII) of the Act, which states that the Secretary must report quality measures that relate to patients' perspectives on care on our Web site. Before we display this information, hospitals will be permitted to review their data to be made public as we have recorded it. As we discussed above, there are 27 questions included in the HCAHPS® survey. The survey is comprised of substantive questions that directly pertain to seven domains of primary importance to the target audience: Doctor communication, nurse communication; cleanliness and quiet of the hospital environment; responsiveness of hospital staff; pain management; communication about medicines; and discharge information. It also includes two overall questions that measure the patient's overall satisfaction with the hospital and willingness to recommend the hospital. Each of the seven domains is constructed from two or three questions from the survey and is reported as a composite score. For public reporting purposes, the seven composite scores and two overall ratings will be displayed. There will be both national and state comparisons for each of the nine reported results. We are currently conducting testing with consumers to ensure that the HCAHPS® displays on 
                        *http://www.hospitalcompare.hhs.gov*
                         are consumer friendly. Generally, for CAHPS ® measures in other settings we display bar graphs with the top response categories, such as the percent of people surveyed that gave the hospital a “10” for a 0 to 10 rating, or the percent that said their doctors “always” communicate well. Users of the site can “drill down” to get more detailed information regarding the distribution for the response categories underlying the survey questions. 9. Reporting HCAHPS® Results for Multi-Campus Hospitals Currently, hospitals that share Medicare provider numbers combine their clinical data across campuses for submission and publication of their data. Our current plan for HCAHPS® is for these data to be combined across campuses. However, we are considering ways in which data could potentially be displayed by campus rather than by hospital system in the future. As a starting point, we are trying to determine a way to identify those hospitals that share Medicare provider numbers, which will allow CMS to denote that the measures are made up of multiple campuses on 
                        *http://www.hospitalcompare.hhs.gov.*
                         In the future, if feasible, we would like to move towards obtaining and reporting information at the campus level. We encourage comments regarding this issue. E. SCIP & Mortality Measure Requirements for the FY 2008 RHQDAPU Program We are proposing that hospitals be required to complete and return a written form on which they agree to participate in the RHQDAPU program for FY 2008.
                    For the SCIP measures, we are proposing to require hospitals to submit data starting with discharges that occur in CY 2007. Hospitals will be required to submit data on these measures to the QIO Clinical Warehouse beginning with discharges that occur in the first calendar year quarter of 2007 (January through March discharges). We are proposing that the deadline for hospitals to submit their data for first calendar quarter of 2007 will be August 15, 2007.
                    For the Mortality measures, we are proposing to use claims data that is already being collected for index hospitalizations to calculate the mortality rates, therefore, no additional data will need to be submitted by hospitals for these measures. Index hospitalization is the initial hospitalization for an episode of care. Claims data submitted to CMS for index hospitalizations occurring from July 2005 through June 2006 (3rd quarter CY 2005 through 2nd quarter CY 2006) will be used to calculate the mortality rates that will be used for FY 2008 annual payment determination. These rates will be posted on Hospital Compare in June 2007.
                    We are proposing to display on our Web site data collected on the SCIP and Mortality measures for public viewing in accordance with section 1886(b)(3)(B)(viii)(VII) of the Act. Before we display this information, hospitals will be permitted to review their data that are to be made public as we have recorded it. F. Conclusion We believe that our proposal to include HCAHPS®, SCIP and Mortality measures as part of the FY 2008 IPPS RHQDAPU program's reporting requirements meets the requirements of 
                        ( print page 49677)
                        section 1886(b)(3)(B)(viii)(III) of the Act. This provision states that we must expand for FY 2007 and each subsequent fiscal year, consistent with sections 1886(b)(3)(B)(viii)(IV) through 1886(b)(3)(viii)(VII) of the Act, the set of measures that the Secretary determines to be “appropriate” for the measurement of care furnished by hospitals in inpatient settings beyond the original 10-measure starter set of quality measures that applied in FY 2005 and FY 2006. Section 1886(b)(3)(B)(viii)(IV) of the Act requires us to begin to adopt the baseline set of performance measures set forth in the 2005 IOM report effective for payment beginning with FY 2007. We began to adopt these measures for FY 2007 and are now proposing to adopt additional measures, including several measures that are from this report. HCAHPS® and the SCIP Infection 2 measures are measures set forth in the 2005 IOM report. Thus, we believe our proposal to expand the measure set to include HCAHPS® and SCIP Infection 2 measures for the FY 2008 IPPS RHQDAPU program meets this requirement of the Act. Section 1886(b)(3)(B)(viii)(V) of the Act states that effective for payments beginning with fiscal year 2008, we must add “other measures that reflect consensus among affected parties and, to the extent feasible and practicable,” include “measures set forth by one or more national consensus building entities.” In addition to proposing to add additional measures from the baseline measures found in the 2005 IOM report, we are proposing to add additional SCIP quality measures and three 30-day mortality measures. In selecting these measures to adopt consistent with this section for the FY 2008 payment update and thereafter, CMS is proposing to add standardized quality measures that have been adopted or endorsed by a national consensus building entity that utilizes a national consensus building process that endorses measures based on (1) its consideration of issues such as the validity, reliability, impact and feasibility of the measures, and (2) input from a wide variety of stakeholders including, but not limited to, health care consumers and patients, clinicians and providers, purchasers, and researchers. We believe that adopting measures that have been endorsed as a result of this process achieves the type of consensus that Congress envisioned in enacting section 5001(a) of Pub. L. 109-171. The NQF is one consensus building entity that administers this process and takes these factors into account when endorsing measures. NQF is a voluntary consensus standard-setting organization established to standardize health care quality measurement and reporting, for its review and endorsement through its consensus development process. NQF endorsement, which occurs following a thorough, multi-stage review process, represents the consensus of numerous health care providers, consumer groups, professional associations, purchasers, Federal agencies, and research and quality organizations. We recognize that the 30-day Pneumonia mortality is not currently NQF-endorsed. We anticipate, however, that the NQF will endorse this measure soon. We do not plan to adopt the 30-day Pneumonia mortality measure unless it is endorsed by the NQF. The HQA is another such consensus building entity. The HQA is a public-private collaboration of numerous stakeholder groups. One goal of HQA is to identify a robust set of standardized and easy-to-understand hospital quality measures that would be used by all stakeholders in the health care system in order to improve quality of care and the ability of consumers to make informed health care choices. We also note that HQA currently relies on the NQF process as part of its process. CMS anticipates that other consensus building entities that take into account the issues of validity, reliability, impact and feasibility of the measures and involves a wide array of stakeholders may develop. XXIV. Files Available to the Public Via the Internet Addenda A and B to this proposed rule provide various data pertaining to the proposed CY 2007 payments for services under the OPPS. Addenda AA, BB, and CC to this proposed rule include various data pertaining the proposed ASC list of covered procedures and payment rates for procedures furnished in ASCs in CYs 2007 and 2008, respectively. To conserve resources and to make Addendum B more relevant to the OPPS, we are including in Addendum B of this proposed rule HCPCS codes (including CPT codes) for services that are assigned a payable status indicator under the OPPS and HCPCS codes for which we are proposing a change in status indicator and/or APC assignment for CY 2007. A list of all active HCPCS codes, regardless of their assigned payable status, is available to the public on the CMS Web site at: 
                        *http://www.cms.hhs.gov/​providers/​hopps.* For the convenience of the public, we are also including on this same CMS Web site a table that displays the HCPCS data in Addendum B sorted by APC assignment, identified as Addendum C. In addition, we are including on the CMS Web site, in a format that can be easily downloaded and manipulated, Addendum A. Similarly, we are including Addenda AA, BB, and CC on the CMS Web site at: 
                        *http://www.cms.hhs.gov/​center/​asc.asp.* We are not including as addenda in this proposed rule, reprints of wage index related tables from the FY 2007 IPPS proposed rule (71 FR 24235 through 24272) as they would be used for the OPPS for CY 2007. Rather, we are providing a link on the CMS Web site at: 
                        *http://www.cms.hhs.gov/​providers/​hopps*
                         to all of the proposed FY 2007 IPPS wage index related tables. For additional assistance, contact Anita Heygster, (410) 786-4486. XXV. Collection of Information Requirements Under the Paperwork Reduction Act of 1995 (PRA), we are required to provide 60-day notice in the 
                        **Federal Register**
                         and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues: The need for the information collection and its usefulness in carrying out the proper functions of our agency.
                    The accuracy of our estimate of the information collection burden.
                    The quality, utility, and clarity of the information to be collected.
                    Recommendations to minimize the information collection burden on the affected public, including automated collection techniques. The following information collection requirements included in this proposed rule and their associated burdens are subject to the PRA. We are soliciting public comment on each of the issues for the following section of this document that contain information collection requirements and are not currently approved by the OMB. Proposed Additional Quality Measures for FY 2008: Surgical Care Improvement Project (SCIP) Section 5001(a) of the Deficit Reduction Act of 2005 (DRA) (Pub. L. 109-171) sets out new requirements for the IPPS Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program. Under section 1886(b)(3)(B)(viii)(V) of the Act, for payments beginning with FY 2008, we 
                        ( print page 49678)
                        are required to add other measures that reflect consensus among affected parties and, to the extent feasible and practicable, must include measures set forth by one or more national consensus building entities. In this proposed rule, we are setting out the additional measures that we propose to require for FY 2008. The burden associated with this section is the time and effort associated with collecting, copying and submitting the data. As part of the 
                        *Surgical Care Improvement Project (SCIP)*, we estimate that there will be approximately 3,700 respondents per year. All of these hospitals must submit SCIP Infection 1 and 3 to receive the annual payment update covering FY 2007. Additional surgical procedures covering approximately 6,000,000 discharges annually will be sampled at a 10 percent rate per hospital, so an additional 600,000 discharges will be abstracted and submitted by hospitals for the additional SCIP measures (SCIP Infection 2 and VTE 1, 2). The 10 percent sampling rate is a minimum threshold specified in the most current version of the joint CMS/JCAHO Hospital Quality Measures Specifications Manual. We estimate that it will take 450,000 hours (3/4 hour per sampled discharge) to abstract and submit data for these additional sampled discharges. In addition, hospitals must abstract and submit additional information needed for the additional SCIP measures covering the surgical procedures already covered in SCIP Infection 1 and 3. We estimate that about 275,000 discharges will be sampled and abstracted covering these surgical procedures. We estimate that it will take an additional 137,500 hours (
                        1/2
                         hour per sampled discharge) for hospitals to abstract and submit this additional information. Both estimates include overhead. In total, we estimate that an additional 587,500 hours will be used by hospitals to abstract and submit the additional SCIP measures. This estimate includes overhead. Further, we note that there is no additional burden associated with the incorporation of mortality outcome measures, as this information is currently collected with claims data. We have submitted a copy of this proposed rule to the OMB for its review of the aforementioned information collection requirements. This proposed rule also includes associated information collections for which CMS has obtained the OMB's approval. The following is a discussion of these currently OMB approved collections. As discussed in section XXIII of this preamble, the IPPS RHQDAPU program expands upon the Hospital Quality Initiative which is intended to empower consumers with quality of care information to make more informed decisions about their health care while also encouraging hospitals and clinicians to improve the quality of care. The information collection associated with the IPPS RHQDAPU is the Hospital Quality Alliance (formerly known as the National Voluntary Hospital Reporting Initiative)—Hospital Quality Measures. The OMB approved this information collection under OMB control number 0938-0918, with an expiration date of December 31, 2008. As a result of the increase from 10 to 21 quality measures, CMS created a revised information collection request to include the new quality measures. CMS announced the revised information collection in a 60-day 
                        **Federal Register**
                         notice that published on June 9, 2006 (71 FR 33458). CMS will publish a 30-day 
                        **Federal Register**
                         notice prior to the submission of the revised information collection being proposed in this rule to OMB. Further, as discussed in section XXIII. of this preamble, for FY 2008, we are proposing to expand the IPPS RHQDAPU program to include the HCAHPS® Survey, also known as the Hospital CAHPS or the CAHPS Hospital Survey. The HCAHPS® Survey is composed of 27 questions: 18 substantive questions that encompass critical aspects of the hospital experience (communication with doctors, communication with nurses, responsiveness of hospital staff, cleanliness and quietness of hospital environment, pain management, communication about medicines, and discharge information); four questions to skip patients to appropriate questions; three questions to adjust for the mix of patients across hospitals; and two questions to support congressionally-mandated reports. As explained in section XXIII. of this preamble, CMS published a 
                        **Federal Register**
                         notice soliciting comments on the draft 27-item HCAHPS® Survey in November 2005 (70 FR 67476). The OMB approved the HCAHPS® Survey under OMB control number 0938-0981, with an expiration date of December 31, 2007. Proposed Revised § 416.190(c)—Request for Review of Payment Amount The collection of information requirements at 5 CFR 1320 are applicable to requirements affecting 10 or more entities. Proposed revised § 416.190(c) would require that a request for review of the ASC payment amount for insertion of an IOL must include all the information that CMS specifies on its Web site. While this section of the proposed rule contains information collection requirements, we estimate that less than 10 ASCs will be affected; therefore, we believe these collection requirements are exempt from OMB for review and approval, as specified at 5 CFR 1320.3(c)(4). Consequently, this section of the proposed rule need not be reviewed by the OMB under the authority of the PRA. If you comment on any of these information collection and record keeping requirements, please mail copies directly to the following: Centers for Medicare & Medicaid Services, Office of Strategic Operations and Regulatory Affairs,  Regulations Development Group,  Attn: Melissa Musotto, CMS-1506-P, Room C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850; and Office of Information and Regulatory Affairs,  Office of Management and Budget, Room 10235, New Executive Office Building, Washington, DC 20503,  Attn: Carolyn Lovett, CMS Desk Officer, (CMS-1506-P), 
                        *carolyn_lovett@omb.eop.gov.*
                         Fax (202) 395-6974. XXVI. Response to Comments Because of the large number of public comments we normally receive on 
                        **Federal Register**
                         documents, we are not able to acknowledge or respond to them individually. We will consider all comments we receive by the date and time specified in the 
                        **DATES**
                         section of this preamble, and, when we proceed with a subsequent document(s), we will respond to those comments in the preamble to that document(s). XXVII. Regulatory Impact Analysis (If you choose to comment on issues in this section, please include the caption “Impact” at the beginning of your comment.) A. Overall Impact We have examined the impacts of this proposed rule as required by Executive Order 12866 (September 1993, Regulatory Planning and Review), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354), section 1102(b) of the Social Security Act, the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132. 
                        ( print page 49679) 1. Executive Order 12866 Executive Order 12866 (as amended by Executive Order 13258, which merely reassigns responsibility of duties) directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). We estimate that the effects of the OPPS provisions that would be implemented by this proposed rule would result in expenditures exceeding $100 million in any 1 year. We estimate that adding 14 procedures to the ASC list and implementing section 5103 of Pub. L. 109-171) in CY 2007 would result in savings to the Medicare program of approximately $150 million. We further estimate that the revised ASC payment system and expanded list of payable ASC services which we are proposing to implement in CY 2008 would have no effect on Medicare expenditures compared to CY 2007. A more detailed discussion of the effects of the proposed changes to the ASC list of procedures for CY 2007 and the effects of proposed revisions to the ASC payment system in CY 2008 is provided in sections XXVII. C. and D. below. In addition, we estimate that the changes that we are proposing in section XIX. of this preamble to implement Medicare contracting reform mandated by section 911 of Pub. L. 108-173 have no economic effect on current Medicare payments in CY 2007. This aspect of our proposal would amend our current Medicare contractor regulations to conform them to the statutory changes mandated by Pub. L. 108-173 and in and of itself does not affect in any way Medicare's coverage or payment policies for hospital outpatient services or any other covered Medicare services. Accordingly, we believe that this provision has no immediate economic effect on Medicare payments in CY 2007. Further, we estimate that the changes that we are proposing in section XXIII. of this preamble to implement an expanded set of quality measures for the IPPS Reporting Hospital Quality Data for the Annual Payment Update (RHQDAPU) program in accordance with sections 1886(b)(3)(B)(viii)(III) and (IV) of the Act will not have a significant economic effect on Medicare payments to hospitals in CY 2007. A more detailed discussion of the effects of this proposal are included in section XXIII. of this preamble and section XXVII.F. below. However, we estimate the total increase (from changes in this proposed rule as well as enrollment, utilization, and case-mix changes) in expenditures under the OPPS for CY 2007 compared to CY 2006 to be approximately $2.98 billion. Therefore, this proposed rule is an economically significant rule under Executive Order 12866, and a major rule under 5 U.S.C. 804(2). 2. Regulatory Flexibility Act (RFA) The RFA requires agencies to determine whether a rule would have a significant economic impact on a substantial number of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and small governmental agencies. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of $6 million to $29 million in any 1 year (65 FR 69432). For purposes of the RFA, we have determined that approximately 37 percent of hospitals and 73 percent of ambulatory surgery centers would be considered small entities according to the Small Business Administration (SBA) size standards. We do not have data available to calculate the percentages of entities in the pharmaceutical preparation manufacturing, biological products, or medical instrument industries that would be considered to be small entities according to the SBA size standards. For the pharmaceutical preparation manufacturing industry (NAICS 325412), the size standard is 750 or fewer employees and $67.6 billion in annual sales (1997 business census). For biological products (except diagnostic) (NAICS 325414), with $5.7 billion in annual sales, and medical instruments (NAICS 339112), with $18.5 billion in annual sales, the standard is 50 or fewer employees (see the standards Web site at: 
                        *http://www.sba.gov/​regulations/​siccodes/​*). Individuals and States are not included in the definition of a small entity. Not for profit organizations are also considered to be small entities under the RFA. There are 2,163 voluntary hospitals that we consider to be not for profit organizations to which this proposed rule applies. 3. Small Rural Hospitals In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 603 of the RFA. With the exception of hospitals located in certain New England counties, for purposes of section 1102(b) of the Act, we previously defined a small rural hospital as a hospital with fewer than 100 beds that is located outside of a Metropolitan Statistical Area (MSA) (or New England County Metropolitan Area (NECMA)). However, under the new labor market definitions that we adopted in the November 15, 2004 final rule with comment period, for CY 2005 (consistent with the FY 2005 IPPS final rule), we no longer employ NECMAs to define urban areas in New England. Therefore, we now define a small rural hospital as a hospital with fewer than 100 beds that is located outside of an MSA. Section 601(g) of the Social Security Amendments of 1983 (Pub. L. 98-21) designated hospitals in certain New England counties as belonging to the adjacent NECMA. Thus, for purposes of the OPPS, we classify these hospitals as urban hospitals. We believe that the changes to the OPPS in this proposed rule would affect both a substantial number of rural hospitals as well as other classes of hospitals and that the effects on some may be significant although the proposed changes to the ASC payment system for CY 2007 and CY 2008 would have no effect on small rural hospitals. Therefore, we conclude that this proposed rule would have a significant impact on a substantial number of small entities. 4. Unfunded Mandates Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4) also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. That threshold level is currently approximately $120 million. The maximum nationwide cost to hospitals will be $16.9 million for HCAHPS® (Abt Report), $58.7 million in noncaptial costs for SCIP, and no cost for mortality measure. This proposed rule will not mandate any requirements for State, local, or tribal government, nor will it affect private sector costs. 5. Federalism Executive Order 13132 establishes certain requirements that an agency must meet when it publishes any rule (proposed or final) that imposes substantial direct costs on State and local governments, preempts State law, 
                        ( print page 49680)
                        or otherwise has Federalism implications. We have examined this proposed rule in accordance with Executive Order 13132, Federalism, and have determined that it would not have an impact on the rights, roles, and responsibilities of State, local or tribal governments. As reflected in Table 49 we estimate that OPPS payments to governmental hospitals (including State, local, and tribal governmental hospitals) would increase by 3.0 percent under this proposed rule. The proposals related to payments to ASCs in CYs 2007 and 2008 would not affect payments to government hospitals. In addition, the proposals related to MACs and HCAHPS would not affect payments to government hospitals. B. Effects of Proposed OPPS Changes in This Proposed Rule (If you choose to comment on issues in this section, please include the caption “OPPS Impact” at the beginning of your comment.) We are proposing several changes to the OPPS that are required by the statute. We are required under section 1833(t)(3)(C)(ii) of the Act to update annually the conversion factor used to determine the APC payment rates. We are also required under section 1833(t)(9)(A) of the Act to revise, not less often than annually, the wage index and other adjustments. In addition, we must review the clinical integrity of payment groups and weights at least annually. Accordingly, in this proposed rule, we are proposing to update the conversion factor and the wage index adjustment for hospital outpatient services furnished beginning January 1, 2007, as we discuss in sections II.C. and II.D., respectively, of this preamble. However, we are also proposing to reduce the update to the CY 2007 OPPS conversion factor by 2.0 percentage points for any hospital that is required to report quality data under the IPPS RHQDAPU for the FY 2007 update, and that fails to meet the requirements for receiving the full IPPS payment update in that payment year. We also are proposing to revise the relative APC payment weights using claims data from January 1, 2005, through December 31, 2005, and updated cost report information. In response to a provision in Pub. L. 108-173 that we analyze the cost of outpatient services in rural hospitals relative to urban hospitals, we are proposing to continue increased payments to rural SCHs, including EACHs. Section II.F. of this preamble provides greater detail on this rural adjustment. Finally, we are not proposing to remove any device categories from pass-through payment status in CY 2007. Under this proposed rule, the update change to the conversion factor as provided by statute would increase total OPPS payments by 3.4 percent in CY 2007. The update change to the OPPS conversion factor for any hospital that is required to report quality data under the IPPS RHQDAPU for the FY 2007 update, but fails to meet the requirements for receiving the full IPPS payment update in that payment year would increase OPPS payments by 1.4 percent in CY 2007. The expiration of the one-time wage reclassification under section 508 in April 2007 which is not budget neutral and an increase in the fixed-dollar outlier threshold to account for the under estimation of outlier payments in CY 2006 results in a net increase of 3.0 percent. The proposed changes to the APC weights, changes to the wage indices, the continuation of a payment adjustment for rural SCHs, and the proposed expansion of the rural adjustment to EACHs would not increase OPPS payments because these changes to the OPPS are budget neutral. However, these updates do change the distribution of payments within the budget neutral system as shown in Table 49 and described in more detail in this section. 1. Alternatives Considered Alternatives to the changes we are proposing to make and the reasons that we have chosen these options are discussed throughout this proposed rule. Some of the major issues discussed in this proposed rule and the options considered are discussed below. a. Alternatives Considered for CPT Coding and Payment Policy for Evaluation and Management Codes In section IX. of this preamble, we are proposing to create five new G-codes to replace CPT clinic E/M codes, five new G-codes for emergency visits provided in Type B emergency departments, five new G-codes for emergency visits provided in Type A emergency departments to replace CPT emergency department E/M codes, and two new G-codes to replace CPT critical care codes. CMS instructed hospitals to report facility resources for clinic and emergency department visits using CPT E/M codes and to develop internal hospital guidelines to determine what level of visit to report for each patient. However, since the beginning of the OPPS, we have acknowledged that the CPT E/M codes do not adequately describe the facility resources required to perform the services. Therefore, we are proposing G-codes to be used by hospitals to report clinic and emergency visits, and critical care services, which describe hospital resource use. We acknowledge that it can be burdensome for providers to bill G-codes rather than CPT codes. CPT has not yet created clinic and emergency department visit and critical care services codes that describe hospital resource utilization. In this case, because the current CPT E/M codes do not describe hospital visit resources, we have no alternative other than to create new G-codes. It is important to note that G-codes may be recognized by other payers. Some hospitals have requested that they be permitted to bill emergency visit codes under the OPPS for services furnished in a facility that meets CPT's definition for reporting emergency visit E/M codes, except that these hospitals are not available 24 hours a day. For CY 2007, we are proposing to establish a set of codes for visits provided in dedicated emergency departments that have an EMTALA obligation. These codes would be billed by Type B emergency departments, specifically those that do not meet the Type A requirements. We are also proposing to establish a separate set of codes for visits provided in a specific subset of dedicated emergency departments, called Type A emergency departments, that are open 24 hours per day, 7 days per week and/or that do not have an EMTALA obligation solely based on providing at least one-third of their outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment. An alternative to this policy is to continue to uphold past policy and allow only the Type A subset of dedicated emergency departments to bill emergency department codes. However, this would not allow us to determine whether visits to dedicated emergency departments or facilities that incur EMTALA obligations but do not meet more prescriptive expectations that are consistent with the CPT definition of an emergency department have different resource costs than visits to either clinics or the Type A subset of dedicated emergency departments that meet more prescriptive expectations, including 24 hours per day, 7 days per week availability. We must also establish payment rates for these new G-codes. For CY 2007, we are proposing to pay at five payment levels for both clinic and emergency department visits and one payment level for critical care services. We see meaningful differences among the median costs of five levels of clinic and emergency department codes that 
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                        suggest that five payment levels are more appropriate than three levels. In addition, providers have indicated that it is administratively burdensome to code for five levels, but receive payment at only three levels, as has been the historical policy in the OPPS. If future data indicate that three payment levels are more appropriate, we may revert back to three payment levels. An alternative to this policy is to continue paying at three payment levels for both clinic and emergency department visits and one payment level for critical care services. However, for the reasons described above, we are proposing to pay at five levels for clinic and emergency department visits for CY 2007 to ensure that payments more accurately reflect the median costs of the services provided. For CY 2007, we are proposing to pay emergency visits to Type B dedicated emergency departments that are not part of the specific subset identified as Type A emergency departments at the same rate as clinic visits, consistent with current policy. This payment policy is similar to our current policy that requires services furnished in emergency departments that have an EMTALA obligation but do not meet the CPT definition of emergency department to be reported using CPT clinic visit E/M codes, resulting in payments based upon clinic visit APCs. While maintaining the same payment policy for CY 2007, the reporting of specific G-codes for emergency visits provided in Type B dedicated emergency departments would permit us to specifically collect and analyze the hospital resource costs of visits to these facilities in order to determine whether a future proposal of an alternative payment policy may be warranted. An alternative would be to provide payment for services billed by Type B emergency departments at payment rates other than the clinic visit rates. However, we do not know what the hospital facility costs of these visits would be because we are unable to identify these services in our historical claims data. In some respects, their costs may resemble the costs of visits to clinics because they may not be available 24 hours per day or may not require the same high state of readiness as Type A emergency departments. In other respects, their costs may resemble the costs of visits to Type A emergency departments because they both provide predominantly unscheduled visits. Therefore, we currently would have no accurate methodology for establishing payment rates that are appropriate for visits to Type B emergency departments. Therefore, consistent with past payment policies for certain services, such as drug administration, in which we maintained current payment policies while gathering more detailed cost data, we are proposing to continue payment to Type B emergency departments at clinic visit rates while we gather hospital claims data specific to these visits to review their costs. b. Options Considered for Brachytherapy Source Payments Pursuant to sections 1833(t)(2)(H) and 1833(t)(16)(C) of the Act, we have paid for brachytherapy sources furnished on or after January 1, 2004, and before January 1, 2007, on a per source basis at an amount equal to the hospital's charge adjusted to cost by application of the hospital specific overall CCR. For CY 2007, we are proposing to pay for brachytherapy sources at a prospectively based rate for each source, which is assigned to a source-specific APC. We are proposing to convert the median cost to a relative weight by dividing it by the median for APC 0606, to scale the unscaled weight for budget neutrality, and to multiply the scaled weight by the conversion factor to calculate the payment rate per source. This is our standard OPPS methodology for using median costs to calculate the payment for each APC. We considered establishing a per day payment for brachytherapy sources based on our CY 2005 claims data. While this alternative would be consistent with the philosophy of a prospective payment system and would mitigate the effects on payment of inaccurate coding of the number of sources used, we believe that a per day payment may not provide source payment variation specifically addressed to the hospital resources used under the unique clinical circumstances of each individual treatment. There is considerable clinical variation in the number of sources used for brachytherapy services, and we believe a per day payment based on an average number of sources used may not as accurately reflect appropriate payment for an individual Medicare beneficiary's treatment as the per source payment methodology. Therefore, we are not proposing to set payments on a per day basis. We also considered continuing to make separate payment for sources of brachytherapy under the current methodology of hospital charges reduced to costs. Although hospitals are familiar with this methodology and this alternative is consistent with the requirement that sources be paid separately, we believe that to continue to pay on this basis would be inconsistent with the general methodology of a prospective payment system and would provide no incentive for a hospital to provide services efficiently and at the lowest cost. Therefore, for CY 2007, we are proposing to pay for each brachytherapy source on a per source rate that is calculated using our standard OPPS methodology. c. Options Considered for Payment of Radiopharmaceuticals In developing the payment policy proposal for separately payable radiopharmaceuticals for this CY 2007 proposed rule, we considered three policy options. The first option we considered was to propose packaging additional radiopharmaceuticals, either through packaging payments for all radiopharmaceuticals with payments for the services with which they are billed or increasing the packaging threshold for radiopharmaceuticals from a cost of $55 per day to a higher amount. In contrast to other separately payable drugs where the administration of many drugs is reported with only a few drug administration HCPCS codes, only a small number of specific radiopharmaceuticals may be appropriately provided in the performance of each particular nuclear medicine procedure. Because the provision of nuclear medicine procedures always requires one or more radiopharmaceuticals, packaging more radiopharmaceuticals effectively results in some increases in the costs of the associated nuclear medicine procedures to reflect the greater packaging of the radiopharmaceuticals. A policy to package additional radiopharmaceuticals would be very consistent with the OPPS packaging principles and payment policies which generally provide appropriate payment for the “average” service and would provide greater administrative simplicity for hospitals. However, under a policy of increased packaging of radiopharmaceuticals, payments for certain nuclear medicine procedures could potentially be less than the costs of some of the packaged radiopharmaceuticals and relatively expensive and high volume radiopharmaceuticals could become packaged. In addition, our payment policy could discourage selection of the most clinically appropriate radiopharmaceutical for a particular nuclear medicine procedure, especially if that radiopharmaceutical were expensive and not commonly used so that its costs were not fully reflected in 
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                        the payment for the nuclear medicine procedure. The second option that we considered was to propose to continue the temporary CY 2006 methodology of paying for separately payable radiopharmaceuticals at charges reduced to cost, where payment would be determined using each hospital's overall CCR, and establishing our radiopharmaceutical packaging threshold at $55, as we are proposing for other drugs for the CY 2007 OPPS. This policy would provide stability to the payment methodology for radiopharmaceuticals from CY 2006 to CY 2007. As we indicated for CY 2007, this payment methodology would provide an acceptable proxy for the average acquisition of the radiopharmaceutical along with its handling cost. However, as indicated previously, we stated in the CY 2006 final rule with comment period that this payment policy was intended to be only a temporary policy, and that we would consider alternative methodologies on which to base radiopharmaceutical payments for the CY 2007 OPPS update. Paying for radiopharmaceuticals at cost provides hospitals with no incentive to supply radiopharmaceuticals in the most efficient manner. In addition, using hospitals' overall CCRs to determine payments likely results in an overestimation of radiopharmaceutical cost, which are likely reported in several cost centers such as diagnostic radiology that have lower CCRs than hospitals' overall CCRs. The third option that we considered and are proposing for CY 2007 is to establish prospective payment rates for separately payable radiopharmaceuticals using mean costs derived from the CY 2005 claims data, where the costs are determined using our standard methodology of applying hospital-specific departmental CCRs to radiopharmaceutical charges and defaulting to hospital-specific overall CCRs only if appropriate departmental CCRs are unavailable. This proposal establishes our packaging threshold for radiopharmaceuticals at $55, as proposed for other drugs under the CY 2007 OPPS. We believe this option provides us with the most consistent, accurate, and efficient methodology for prospectively establishing payment rates for separately payable radiopharmaceuticals; in addition, this proposed methodology is consistent with how payment rates for other services are determined under the OPPS and provides for prospective payments that serve as appropriate proxies for the average acquisition costs of the radiopharmaceuticals along with their handling costs. 2. Limitations of Our Analysis The distributional impacts presented here are the projected effects of the policy changes, as well as the statutory changes that would be effective for CY 2007, on various hospital groups. We estimate the effects of individual policy changes by estimating payments per service while holding all other payment policies constant. We use the best data available but do not attempt to predict behavioral responses to our policy changes. In addition, we do not make adjustments for future changes in variables such as service volume, service-mix, or number of encounters. As we have done in previous proposed rules, we are soliciting comments and information about the anticipated effect of these proposed changes on hospitals and our methodology for estimating them. One limitation of our analysis in this proposed rule is that we are unable at this time to estimate the impact of our proposal to reduce the update to the CY 2007 OPPS conversion factor by 2.0 percentage points for any hospital that is required to report quality data under the IPPS RHQDAPU for the FY 2007 update, and that fails to meet the requirements for receiving the full IPPS payment update in that payment year. As we discuss in section XXIII of the preamble of this proposed rule, we are unable at this time to determine how many hospitals will receive a reduced update in CY 2007. Determinations concerning which hospitals have failed to meet the requirements for receiving the full update to the OPPS conversion factor in CY 2007 will only become available on or about September 1, 2006. Experience with mandatory reporting of quality data under the IPPS RHQAPU indicates that only a small number of hospitals have failed to meet the requirements to receive the full update to their payments under the IPPS. However, the statute requires that the reduction to the update for those IPPS hospitals that fail to meet the quality reporting requirement will increase from 0.4 percentage point to 2.0 percentage points for purposes of payment in FY 2007. This increase in the size of the update reduction significantly increases the already strong incentive to submit quality data. We therefore believe that the already small number of hospitals that fail to meet the requirements for receiving the full update may actually decrease significantly. We expect that only very few, if any, hospitals will fail to receive the full update to the OPPS conversion factor in CY 2007. However, due to the uncertainty concerning the degree to which the increased incentive to report quality data will affect hospital behavior, we are unable to predict with any confidence the number of hospitals that will receive the reduced update under the OPPS RHQDAPU, or to incorporate any specific data concerning the impact of this proposal into impact Table 49 below. We are also unable to determine the budget neutrality adjustment factor that will be necessary to ensure that estimated aggregate payments under the OPPS for CY 2007 do not change as a result of implementing the proposed OPPS RHQDAPU. We also expect, however, that the distributional impact of the proposal will be quite minimal. We also expect that any budget neutrality adjustment that we determine to be necessary once the determinations concerning compliance with the quality data reporting requirements become available will be correspondingly negligible. At the same time, any hospital that has reason to believe that it will not meet the requirements for receiving a full update under our proposal should be able to assess the potential impact of receiving the reduced update, simply by estimating the payments that the hospital will receive using the reduced conversion factor of $60.36, reflecting an update of 1.4 percent, in place of the conversion factor of $61.551 reflecting the full proposed update of 3.4 percent. Over time, the proposed OPPS RHQDAPU may have a discernible, positive impact on the quality of care available to Medicare beneficiaries in hospital outpatient departments. Meanwhile, the impact analysis below assumes that there will be full compliance with the requirements of the proposed OPPS RHQDAPU for purposes of receiving the full update in CY 2007, that all OPPS outpatient departments will therefore receive payments reflecting the full update in CY 2007, and that no additional adjustment to the OPP conversion factor will be necessary to ensure budget neutrality in CY 2007. 3. Estimated Impacts of This Proposed Rule on Hospitals The estimated increase in the total payments made under the OPPS is limited by the increase to the conversion factor set under the methodology in the statute. The distributional impacts presented do not include assumptions about changes in volume and service-mix. The enactment of Pub. L. 108-173 on December 8, 2003, provided for the additional payment outside of the budget 
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                        neutrality requirement for wage indices for specific hospitals reclassified under section 508 through CY 2007. Table 49 shows the estimated redistribution of hospital payments among providers as a result of a new APC structure, wage indices, and proposed adjustment for rural SCHs and EACHs, which are budget neutral; the estimated distribution of increased payments in CY 2007 resulting from the combined impact of the proposed APC recalibration, wage effects, the rural SCH and EACH adjustment, and the proposed market basket update to the conversion factor; and, finally, estimated payments considering all proposed payments for CY 2007 relative to all payments for CY 2006, including the impact of expiring wage provisions and changes in the outlier threshold. Because updates to the conversion factor, including the update of the market basket and the addition of money not dedicated to pass-through payments are applied uniformly, observed redistributions of payments in the impact table largely depends on the mix of services furnished by a hospital (for example, how the APCs for the hospital's most frequently furnished services would change), the impact of the wage index changes on the hospital, and the impact of the payment adjustment for rural SCHs, including EACHs. However, total payments made under this system and the extent to which this proposed rule would redistribute money during implementation also would depend on changes in volume, practice patterns, and the mix of services billed between CY 2006 and CY 2007, which CMS cannot forecast. Overall, the proposed OPPS rates for CY 2007 would have a positive effect for all hospitals paid under the OPPS. Proposed changes would result in a 3.0 percent increase in Medicare payments to all hospitals, exclusive of transitional pass-through payments. Removing cancer and children's hospitals because their payments are held harmless to the pre-BBA ratio between payment and cost suggests that proposed changes would result in a 3.1 percent increase in Medicare payments to all other hospitals. To illustrate the impact of the proposed CY 2007 changes, our analysis begins with a baseline simulation model that uses the final CY 2006 weights, the FY 2006 final post-reclassification IPPS wage indices without additional increases resulting from section 508 reclassifications, and the final CY 2006 conversion factor. Column 2 in Table 49 reflects the independent effects of the proposed APC reclassification and recalibration changes. Column 3 reflects the effects of updated wage indices, and the adjustment for rural SCHs and EACHs. The clarification that the rural adjustment applies to EACHs is not shown separately because there are so few EACHs that the overall impact cannot be observed when payments are aggregated by type of hospital. These effects are budget neutral, which is apparent in the overall zero impact in payment for all hospitals in the top row. Column 2 shows the independent effect of changes resulting from the proposed reclassification of services codes among APC groups and the proposed recalibration of APC weights based on a complete year of CY 2005 hospital OPPS claims data and more recent cost report data. We modeled the independent effect of APC recalibration by varying only the weights, the final CY 2006 weights versus the proposed CY 2007 weights, in our baseline model, and calculating the percent difference in payments. Column 3 shows the impact of updating the wage index used to calculate payment by applying the proposed FY 2007 IPPS wage index, combined with the impact of the proposed 7.1 percent rural adjustment for SCHs and EACHs for services other than drugs, biologicals, brachytherapy sources, and those receiving pass-through payments. The OPPS wage index used in Column 3 does not include changes to the wage index for hospitals reclassified under section 508 of Pub. L. 108-173. We modeled the independent effect of updating the wage index and the rural adjustment by varying only the wage index and the inclusion of EACHs, using the proposed CY 2007 scaled weights, and a CY 2006 conversion factor that included a budget neutrality adjustment for changes in wage effects and the rural adjustment between CY 2006 and CY 2007. Column 4 demonstrates the combined “budget neutral” impact of proposed APC recalibration, the wage index update, and the proposed rural adjustment for rural SCHs and EACHs on various classes of hospitals, as well as the impact of updating the conversion factor with the market basket update. We modeled the independent effect of proposed budget neutrality adjustments and the market basket update by using the weights and wage indices for each year, and using a CY 2006 conversion factor that included the proposed market basket update and budget neutrality adjustments for differences in wages and the adjustment for rural SCHs and EACHs. Finally, Column 5 depicts the full impact of the proposed CY 2007 policy on each hospital group by including the effect of all the proposed changes for CY 2007 and comparing them to all estimated payments in CY 2006, including those required by Pub. L. 108-173. Column 5 shows the combined budget neutral effects of Columns 2 through 4, plus the impact of increasing the outlier threshold after realigning the overall CCR calculation used to model the outlier threshold with the one used by the fiscal intermediary for payment, the impact of changing the percentage of total payments dedicated to transitional pass-through payments to 0.13 percent, and the expiration of payment for wage index increases for hospitals reclassified under section 508 of Pub. L. 108-173 in April 2007. As noted in section II.D. of this preamble, because section 508 expires in April 2007 and OPPS operates on a calendar year basis, we used a blended wage index consisting of 25 percent of the IPPS wage index with section 508 and 75 percent of the IPPS wage index after section 508 expires. We modeled the independent effect of all changes in Column 5 using the final weights for CY 2006 and the proposed weights for CY 2007. The wage indices in each year include wage index increases for hospitals eligible for reclassification under section 508 of Pub. L. 108-173, and in 2007, these provisions expire in April 2007. We used the final conversion factor for CY 2006 of $59.511 and the proposed CY 2007 conversion factor of $61.551. Column 5 also contains simulated outlier payments for each year. We used the charge inflation factor used in the proposed FY 2007 IPPS rule of 7.57 percent (1.0757) to increase individual costs on the CY 2005 claims to reflect CY 2006 dollars, and we used the most recent overall CCR for each hospital as calculated for the APC median setting process. Using the CY 2005 claims and a 7.57 percent charge inflation factor, we currently estimate that actual outlier payments for CY 2006, using a multiple threshold of 1.75 and a fixed-dollar threshold of $1,250 would be 1.25 percent of total payments, which is 0.25 percent higher than the 1.0 percent that we projected in setting outlier policies for CY 2006, due to the differences in the calculation of the overall CCR, as discussed in section II.A.1.c. of this preamble. Outlier payments of 1.25 percent appear in the CY 2006 comparison in Column 5. We used the same set of claims and a charge inflation factor of 15.15 percent (1.1515) to model the CY 2007 outliers at 1.0 percent of total payments using a multiple 
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                        threshold of 1.75 and a proposed fixed-dollar threshold of $1,825. Column 1: Total Number of Hospitals Column 1 in Table 49 shows the total number of hospital providers (3,922) for which we were able to use CY 2005 hospital outpatient claims to model CY 2006 and CY 2007 payments by classes of hospitals. We excluded all hospitals for which we could not accurately estimate CY 2006 or CY 2007 payment and entities that are not paid under the OPPS. The latter entities include CAHs, all-inclusive hospitals, and hospitals located in Guam, the U.S. Virgin Islands, Northern Marianas, American Samoa, and the State of Maryland. This process is discussed in greater detail in section II.A. of this preamble. At this time, we are unable to calculate a disproportionate share (DSH) variable for hospitals not participating in the IPPS. Hospitals for which we do not have a DSH variable are grouped separately and generally include psychiatric hospitals, rehabilitation hospitals, and LTCHs. Finally, section 1833(t)(7)(D) of the Act permanently holds harmless cancer hospitals and children's hospitals to the proportion of their pre-BBA payment relative to their costs. Because this proposed rule would not impact these hospitals negatively, we removed them from our impact analyses. We show the total number (3,864) of OPPS hospitals, excluding the hold-harmless cancer hospitals and children's hospitals, on the second line of the table. Column 2: APC Recalibration The combined effect of the proposed APC reclassification and recalibration, in Column 2 are typical for APC recalibration. Overall, these changes have no impact on all urban hospitals, which show no projected change in payments, although some classes of urban hospitals experience decreases in payments. However, changes to the APC structure for CY 2007 tend to favor, slightly, urban hospitals that are not located in large urban areas. We estimate that large urban hospitals would experience a decline of 0.1 percent, while “other” urban hospitals experience an increase of 0.1 percent. Urban hospitals with between 0 and 299 beds experience increases, while the largest urban hospitals, those with beds greater than 299 experience decreases of 0.1 to 0.2 percent. With regard to volume, all urban hospitals except those with volume less than 11,000 lines, experience increases in payments. The lowest volume hospitals experience the largest decrease of 7.1 percent, largely as a result of decreases in payment for partial hospitalization and psychotherapy services. Urban hospitals providing the highest volume of services demonstrate no projected change as a result of APC recalibration. Estimated decreases in payment for urban hospitals are also concentrated in some regions, specifically, Middle Atlantic, West North Central, and Pacific, with decreases of 0.3, 0.4, and 0.2 percent respectively. On the other hand, most other regions experience moderate increases and urban hospitals in the East South Central and New England experience no change as a result of APC recalibration. Overall, rural hospitals show a modest 0.1 percent increase as a result of changes to the APC structure, and this 0.1 percent increase appears to be concentrated in rural hospitals that are not rural SCHs, which experience a 0.2 percent increase. Notwithstanding a modest overall increase in payments, there is substantial variation among classes of rural hospitals. Specifically, rural hospitals with more than 199 beds experience a decrease of 0.1 percent and rural hospitals with 150-199 beds experience the largest increase of 0.3 percent. With regard to volume, all rural hospitals, except those with the lowest volume, experience increases in payments. The lowest volume hospitals experience the largest decrease of 3.5 percent. Rural hospitals with greater than 5,000 lines of volume demonstrate projected increases of 0.1 to 0.4 percent as a result of APC recalibration. Increases ranging from 0.2 to 0.5 percent occur for rural hospitals in every region except New England, the Middle Atlantic, and the West North Central. The largest decreases are observed in New England (−0.5 percent), Middle Atlantic (−0.5), West North Central (−0.2 percent) regions. Among other classes of hospitals, the largest observed impacts resulting from APC recalibration include an increase of 0.1 percent for nonteaching hospitals and a decrease of 0.3 percent for major teaching hospitals. Urban hospitals that are treating DSH patients and are also teaching hospitals experience decreases of 0.1 percent. We project that hospitals for which a DSH percentage is not available, including psychiatric hospitals, rehabilitation hospitals, and long-term care hospitals would experience decreases in payments of 8.9 percent, and for the urban subset, 9.2 percent, largely as a result of proposed changes to partial hospitalization and psychotherapy payments. Classifying hospitals by type of ownership suggests that proprietary hospitals would gain 0.4 percent, while governmental and voluntary hospitals would experience neither gains nor losses (0.0 percent change). Column 3: New Wage Indices and the Effect of the Rural Adjustment Changes introduced by the proposed FY 2007 IPPS wage indices together with the effect of including EACHs in the rural adjustment would have a modest impact in CY 2007, decreasing payments to rural hospitals other than SCHs slightly and having no effect overall on urban hospitals. We estimate that rural SCHs would experience an increase in payments of 0.1 percent, while all other rural hospitals experience a decrease of 0.2 percent. With respect to volume, rural hospitals with moderate volume experience decreases of 0.2 percent. For both facility size and volume, no category of rural hospitals experiences an increase greater than 0.2 percent. Examining hospitals by region reveals slightly greater variability. We estimate that rural hospitals in several regions would experience decreases in payment up to 0.7 percent due to wage changes, including New England, East South Central, South Atlantic, Mountain, and West South Central regions. However, rural hospitals in the remaining regions experience increases. We estimate that the Pacific region would see the largest increase of 0.6 percent. Overall, urban hospitals experience no change in payments as a result of the new wage indices and the rural adjustment. With respect to facility size, we estimate that urban hospitals with less than 100 and greater than 499 beds would experience a decrease in payments of 0.1 percent. Urban hospitals with 100-299 beds experience no change. Urban hospitals with between 300-499 beds have the largest increase of 0.1 percent. When categorized by volume, urban hospitals with the largest volume experience no change in payment as a result of changes to the wage index and the presence of the rural adjustment, and urban hospitals with the lowest volume experience a 0.2 percent increase in payment. We estimate that urban hospitals in the South Atlantic, East South Central, and West South Central regions would experience modest decreases due to wage changes and the effect of the rural adjustment of no more than 0.3 percent (except for urban hospitals in Puerto Rico, with a decrease of 1.8 percent). Urban hospitals in all other regions (except New England) would experience an increase of 0.1 to 0.7 percent. Urban hospitals in the New England region would experience no change in payments. 
                        ( print page 49685) Looking across other categories of hospitals, we estimate that updating the wage index and continuing the rural adjustment would lead major teaching hospitals to gain 0.1 percent and hospitals without graduate medical education programs are estimated to lose 0.1 percent. Hospitals serving 23-35 percent low-income patients are estimated to gain 0.1 percent. Hospitals serving no low-income patients, for which the percent of low-income patients cannot be determined and those serving more than 35 percent low-income patients lose 0.1 percent, whereas hospitals serving other percentages of low-income patients experience no change. Voluntary hospitals as classes would experience no change in payment due to wage changes and the effect of the rural adjustment. Governmental and proprietary hospitals would lose 0.1 percent. Column 4: All Budget Neutrality Changes and Market Basket Update The addition of the market basket update alleviates any negative impacts on payments for CY 2007 created by the budget neutrality adjustments made in Columns 2, and 3, with the exception of urban hospitals with the lowest volume of services and hospitals not paid under IPPS, including psychiatric hospitals, rehabilitation hospitals, and LTCHs (DSH not available). In many instances, the redistribution of payments created by proposed APC recalibration offset those introduced by updating the wage indices. However, in a few instances, negative APC recalibration changes compound a reduction in payment from updating the wage index. We estimate that the cumulative impact of the budget neutrality adjustments and the addition of the market basket update would result in an increase in payments for urban hospitals of 3.4 percent, which is equal to the market basket update of 3.4 percent. Large urban hospitals would experience an increase of 3.3 percent and other urban hospitals would experience an increase of 3.6 percent. Urban hospitals with the lowest volume experience a negative market basket update, which is largely a function of the 7.1 percent decrease in payments attributable to changes to the APC structure. Urban hospitals with moderate volume have an increase of 2.3 percent while urban hospitals with volumes greater than 10,999 lines have increases of 3.4 to 3.5 percent. When we examine the impact of the cumulative effect of APC changes, wage index and rural adjustment changes, and the market basket on urban hospitals by region, we see that urban hospitals in five regions (New England, East North Central, West South Central, Mountain, and Pacific) would experience an increase that is equal to or higher than the market basket increase. Hospitals in the remaining five regions (Middle Atlantic, South Atlantic, East South Central, West North Central, and Puerto Rico) receive an increase that is less than the market basket. We estimate that the cumulative impact of budget neutrality adjustments and the market basket update would result in an overall increase for rural hospitals of 3.4 percent, with rural SCHs experiencing an update of 3.4 percent and other rural hospitals also experiencing an update of 3.4 percent. In general, rural hospitals with less than 200 beds and rural hospitals with more than 5,000 lines of volume experience increases equal to or greater than the market basket update of 3.4 percent. We estimate that low-volume rural hospitals would experience no change (0.0 percent). Rural hospitals demonstrate variability by region. We estimate that four regions (East North Central, West North Central, West South Central, and Pacific) would experience increases larger than the market basket update. We also estimate that rural hospitals in the five remaining regions (New England, Middle Atlantic, South Atlantic, East South Central, and Mountain) would receive increases that would be less than the market basket increase. The changes across columns for other classes of hospitals are fairly moderate and most show updates relatively close to the market basket update with the exception of hospitals not paid under the IPPS. These hospitals show negative payment updates as a result of changes to payment rates for partial hospitalization and psychotherapy services. Voluntary, proprietary and governmental hospitals also show an increase equal to or greater than the market basket. Column 5: All Proposed Changes for CY 2007 Column 5 compares all proposed changes for CY 2007 to final payment for CY 2006 and includes any additional dollars resulting from provisions in Pub. L. 108-173 in both years, changes in outlier payment percentages and thresholds, and the difference in pass-through estimates. Overall, we estimate that hospitals would gain 3.0 percent under this proposed rule in CY 2007 relative to total spending in CY 2006. When we excluded cancer and children's hospitals, which are held harmless, the gain is 3.1 percent. While hospitals would receive the 3.4 percent increase due to the market basket update appearing in Column 4 and the additional 0.04 percent for the reduction in the pass-through estimate between CY 2006 and CY 2007, we estimate that hospitals also experience a 0.25 percent loss due to outlier payments as a result of the increased threshold and the change to the overall CCR that is used to estimate outlier payments. In addition, there is a loss of 0.17 percent as a result of the expiration of the section 508 wage adjustment. In general, urban hospitals appear to experience the largest negative impacts from the combined effects of these factors. We estimate that hospitals in large urban areas would gain 3.0 percent in CY 2007 and hospitals in other urban areas would gain 3.1 percent. We estimate that low-volume urban hospitals would experience a decrease in total payments of 3.2 percent between CY 2006 and CY 2007, largely as a result of changes to payment for partial hospitalization, psychotherapy and radiation therapy services. Hospitals reporting 5,000 to 10,999 lines of volume show an increase of 1.9 percent but all hospitals with volume larger than 10,999 lines have increases equal to or greater than 3.1 percent. Urban hospitals in all regions other than the Mountain region have overall increases that are less than the market basket increase and which range from 2.5 to 3.3 percent. Urban hospitals in the Mountain region are estimated to receive the largest increases for urban hospitals of 4.1 percent. Overall, rural hospitals experience increases similar to those observed for urban hospitals. Overall, we estimate that rural hospitals would experience an increase in payments of 3.1 percent, which is identical to the 3.1 percent increase we project for all hospitals when we exclude the 58 hospitals that are held harmless under the law. However, we also estimate that rural SCHs would experience an increase of 2.8 percent, and that the other rural hospitals would only experience an increase of 3.3 percent. No category of rural hospitals experiences a decrease in payments between CY 2006 and CY 2007, and rural hospitals in a few regions show increases comparable to, or better than, the market basket. Rural hospitals with fewer than 150 beds and rural hospitals with volumes greater than 4,999 lines experience increases of at least 3.0 percent, the national average overall increase for all hospitals. Across the regions, rural hospitals in five regions (South Atlantic, East North Central, East South Central, West South Central, and Pacific) are projected to 
                        ( print page 49686)
                        receive increases equal to or greater than the projected 3.0 percent increase for all hospitals. Rural hospitals in four regions (New England, Middle Atlantic, West North Central, and Mountain) are projected to receive overall increases that are less than the projected increase for all hospitals. We project that low-volume rural hospitals would experience the lowest increase in overall payment of 0.8 percent (due largely to changes in payment for partial hospitalization, psychotherapy, and radiation therapy services). Among other classes of hospitals, we estimate that hospitals not paid under the IPPS (DSH Not Available) would experience decreases in payments between CY 2006 and CY 2007 of 5.4 percent. We estimate that major teaching hospitals would experience an increase of 2.6 percent and that nonteaching hospitals would experience an increase of 3.2 percent. 
 
  
 
  4. Estimated Effect of This Proposed Rule on Beneficiaries For services for which the beneficiary pays a copayment of 20 percent of the payment rate, the beneficiary share of payment would increase for services for which OPPS payments would rise and would decrease for services for which OPPS payments would fall. For example, for an electrocardiogram (APC 0099), the minimum unadjusted copayment in CY 2006 was $4.49. In this proposed rule, the minimum unadjusted copayment for APC 0099 is $4.72 because the OPPS payment for the service would increase under this proposed rule. In another example, for a Level IV Needle Biopsy (APC 0037), in the CY 2006 OPPS, the national unadjusted copayment in CY 2006 was $228.76, and the minimum unadjusted copayment was $114.38. In this 
                        ( print page 49689)
                        proposed rule, the national unadjusted copayment for APC 0037 is $228.76. The minimum unadjusted copayment for APC 0037 is $126.32, or 20 percent of the proposed payment for APC 0037. In all cases, the statute limits beneficiary liability for copayment for a service to the inpatient hospital deductible for the applicable year. For 2006, the inpatient deductible is $962. In order to better understand the impact of changes in copayment on beneficiaries, we modeled the percent change in total copayment liability using CY 2005 claims. We estimate, using the claims of the 3,922 hospitals on which our modeling is based, that total beneficiary liability for copayments would decline as an overall percentage of total payments from 27.5 percent in CY 2006 (revised from 29 percent that we estimated for CY 2006 in the November 1, 2005 final rule with comment period 70 FR 68727) to 26.3 percent in CY 2007. This estimated decline in beneficiary liability is a consequence of the APC recalibration and reconfiguration we are proposing for CY 2007. In particular, the proposed changes to the emergency department visit APCs would set the copayments for these high volume services to 20 percent of the proposed payment rates, resulting in a significant reduction in beneficiary copayments. 5. Accounting Statement As required by OMB Circular A-4 (available at 
                        *http://www.whitehousegov/​omb/​circulars/​a004/​a-4.pdf*, in Table 50 below, we have prepared an accounting statement showing the classification of the expenditures associated with the OPPS provisions of this proposed rule. This table provides our best estimate of the increase in Medicare payments under the OPPS as a result of the changes presented in this proposed rule on the data for 3,922 hospitals. All expenditures are classified as transfers to Medicare providers (that is, OPPS). Table 50.—Accounting Statement: Classification of Estimated Expenditures From CY 2006 to CY 2007
Category
TransfersAnnualized Monetized Transfers
$1.0 Billion.From Whom to Whom
Federal Government to OPPS Medicare Providers.Category
Transfers.Annualized Monetized Transfer
$250 Million.From Whom to Whom
Increase in Premium Payments from Beneficiaries to Federal Government.Total
$750 Million.
 6. Conclusion The changes in this proposed rule would affect all classes of hospitals. Some hospitals experience significant gains and others less significant gains, but almost all hospitals would experience positive updates in OPPS payments in CY 2007. Table 49 demonstrates the estimated distributional impact of the OPPS budget neutrality requirements and an additional 3.0 percent increase in payments for CY 2007, after considering the proposed market basket increase, the cost of outliers, changes to the pass-through estimate and the elimination of the section 508 adjustment of Pub. L. 108-173. The accompanying discussion, in combination with the rest of this proposed rule,2 constitutes a regulatory impact analysis. C. Effects of Proposed Changes to the ASC Payment System for CY 2007 (If you choose to comment on issues in the section, please include the caption “CY 2007 ASC Impact” at the beginning of your comment.) We are proposing to add 14 surgical procedures to the Medicare list of ASC payable services and to implement section 5103 of Pub. L. 109-171, which requires the Secretary to substitute the OPPS payment amount for the ASC standard overhead amount if the standard overhead amount for facility services for surgical procedures performed in an ASC, without application of any geographic adjustment, exceeds the Medicare OPPS payment amount for the service for that year, without application of any geographic adjustment. This provision applies to surgical procedures furnished in ASCs on or after January 1, 2007, and before the effective date of the revised ASC payment system. Except for the payment changes required under section 5103 of Pub. L. 109-171, we are proposing no changes in CY 2007 to the ASC payment rates that are currently in effect. The Office of the Actuary estimates that adding the 14 procedures we are proposing in section XVII. of this preamble and implementing the Pub. L. 109-171 mandate would result in a savings to the Medicare program of approximately $150 million in CY 2007. 1. Alternatives Considered We are issuing this proposed rule to meet a statutory requirement that we update the list of approved ASC procedures at least every two years. We implement the biennial update of the list through notice and comment in the 
                        **Federal Register**
                         to give interested parties an opportunity to review and comment on proposed additions to and deletions from the ASC list. The last update of the ASC list through notice and comment was effective July 5, 2005. However, the statute requires us to update the list at least every 2 years, which means we must update the list by July 2007. 2. Limitations of Our Analysis Without datasets related to classes of ASCs which parallel the data maintained in the Medicare provider-specific files for hospitals, we cannot model distributional impacts of the proposed CY 2007 changes in the ASC list and ASC payments similar to those we prepare for our OPPS impact analysis (see Table 49). The actuarial estimate of Medicare program costs or savings resulting from the update of the ASC list and implementation of section 5103 of Pub. L. 109-171 in CY 2007 is based on estimated CY 2007 utilization. As we have done in previous proposed rules, we are soliciting comments and information about the anticipated effect of these changes that we are proposing for CY 2007 to gauge their impact on individual ASCs. 3. Estimated Effects of This Proposed Rule on ASCs The CMS Office of the Actuary estimates that approximately 25 percent of the cases currently reported by hospitals using the 14 codes we are proposing to add to the ASC list would shift to the ASC setting in CY 2007. It estimates that the shift of these procedures to the less costly ASC setting 
                        ( print page 49690)
                        would result in modest savings for the Medicare program. Savings would also be realized because section 5103 of the Pub. L. 109-171 would impose a payment limit for 81 procedures on the current ASC list. The Office of the Actuary estimates that adding 14 surgical procedures to the ASC list and capping payment for 81 procedures on the current ASC list would result in a combined savings to the Medicare program of approximately $150 million in CY 2007. We have not estimated the impact of our proposed changes for CY 2007 on Medicare expenditures in subsequent years because we are proposing to implement an entirely revised payment system in CY 2008. Our analysis of the impact of that proposed payment system is discussed in section XXVII.D. Currently, Medicare pays a facility fee to ASCs only for those procedures that have been approved for the ASC list. The addition of 14 surgical procedures to the ASC list would be beneficial to ASCs by making it possible for them to offer more surgical procedures to Medicare beneficiaries. We believe that approximately 25 percent of the annual hospital outpatient volume of the 14 procedures proposed for addition to the ASC list would move to the ASC setting in CY 2007. To the extent that hospital outpatient utilization decreases and ASC utilization increases in CY 2007, the Medicare program would realize a savings because the ASC standard overhead amount for all procedures, including the proposed additions to the ASC list, would be equal to or lower than the payment rate for the same procedures under the OPPS. Because hospitals perform a much higher volume of ambulatory surgeries overall than are performed in ASCs, we do not expect significant hospital revenue losses to result from migration of procedures that we are proposing for addition to the ASC list to the ASC setting. 4. Estimated Effects of This Proposed Rule on Beneficiaries The proposed changes for CY 2007 would be positive for beneficiaries in at least two respects. First, for the procedures we are proposing to add to the ASC list in CY 2007, the beneficiary copayment amount would be lower when these procedures are performed in an ASC than if they were performed in a hospital outpatient department. The difference in copayment amounts is attributable to the difference in the coinsurance rate between the ASC payment system and the OPPS. That is, the coinsurance rate for all surgical procedures payable under the ASC benefit is 20 percent of the standard overhead amount, whereas the coinsurance rate for the same surgical procedures performed in a hospital outpatient setting ranges from 20 percent to 40 percent under the OPPS. In addition, in accordance with section 5103 of Pub. L. 109-171, no ASC payment rate in CY 2007 may be greater than the OPPS rate for a given procedure. Thus, due to the limitations on the ASC facility rate required by Pub. L. 109-171, beneficiaries will be assured a lower ASC copayment amount for procedures in CY 2007 than in previous years. The only exceptions would be when the ASC copayment amount exceeds the inpatient deductible. The statute requires that copayment amounts under the OPPS not exceed the inpatient deductible. Second, beneficiary access to services would be expanded by the proposed addition of 14 surgical procedures to the ASC list. Beneficiaries would have an additional setting from which to choose were it necessary for them to undergo one of the surgical procedures that we are proposing to add the ASC list in CY 2007. 5. Conclusion The impact on ASCs of proposed changes to the ASC payment system for CY 2007 would depend on an individual ASC's mix of patients and its payers, specifically, the proportion of its patients who are Medicare beneficiaries, whether or not the ASC chooses to perform the procedures proposed for addition to the ASC list, and whether or not the ASC provides services that will be affected by the payment limits imposed by section 5103 of Pub. L. 109-171. Overall, the Office of the Actuary estimates that the Medicare program would realize a $35 million savings as a result of implementing the changes proposed for CY 2007. 6. Accounting Statement As required by OMB Circular A-4 (available at 
                        *http://www.whitehousegov/​omb/​circulars/​a004/​a-4.pdf*), in Table 51 below, we have prepared an accounting statement showing the classification of the expenditures associated with the CY 2007 ASC provisions of this proposed rule. This table provides our best estimate of the reduction in Medicare payments under the ASC payment system as a result of the changes presented in this proposed rule for CY 2007. All expenditures are classified as transfers to Medicare providers (that is, ASC). Table 51.—Accounting Statement: Classification of Estimated ASC Expenditures From CY 2006 to CY 2007
Category
TransfersAnnualized Monetized Transfers
$150 million savings.From Whom to Whom
Medicare ASC Suppliers to the Federal Government.Annualized Monetized Transfer
$50 Million Impact.From Whom to Whom
Decrease in Premium from Beneficiaries to Federal Government.Total
$100 million savings.
 D. Effects of Proposed Revisions to the ASC Payment System for CY 2008 (If you choose to comment on issues in this section, please include the caption “CY 2008 ASC Impact” at the beginning of your comment.) In CY 2008, we are proposing to implement a completely revised Medicare ASC payment system that could have a far-reaching effect on the provision of outpatient surgical services for a number of years to come. First, we are proposing to greatly expand the list of procedures that would be eligible for payment of an ASC facility fee. Second, we also are proposing to move from a limited fee schedule based on nine disparate payment groups to a payment system incorporating relative payment weights and APC groups, which are key elements of the hospital OPPS. Implementation by January 1, 2008 of a revised ASC payment system designed to result in budget neutrality is mandated by section 626 of Pub. L. 108-173. To set ASC payment rates for CY 2008 under the revised system, we are proposing to multiply ASC relative payment weights for surgical procedures by an ASC conversion factor that we would calculate to result in the same aggregate expenditures for ASC services 
                        ( print page 49691)
                        in CY 2008 that we estimate would have been made if the revised payment system were not implemented. The effects of the expanded ASC list combined with significant changes in payment rates for ASC facility services would vary across ASCs, depending on whether or not the ASC limits its services to those in a particular surgical specialty area, the volume of specific services provided by the ASC, and the percentage of its patients that are Medicare beneficiaries. The Office of the Actuary estimates that the revised payment system proposed in section XVIII. of this preamble would result in neither savings nor costs for the Medicare program. That is, because it is designed to be budget neutral, the revised ASC payment system proposed for implementation in CY 2008 would neither increase nor decrease expenditures under Part B of Medicare. The Office of the Actuary further estimates that beneficiaries would save approximately $30 million under the revised ASC payment system proposed for implementation in CY 2008 because ASC payment rates would in all cases be lower than OPPS payment rates for the same services, and because beneficiary coinsurance for ASC services is a strict 20 percent rather than the 20-40 percent coinsurance rates allowed under the OPPS. (The only exceptions would be when the copayment amount for a procedure under the revised ASC payment system exceeds the hospital inpatient deductible. Section 1833(t)(8)(C)(i) of the Act provides that the copayment amount for a procedure paid under the OPPS cannot exceed the inpatient deductible established for the year in which the procedure is performed.) 1. Alternatives Considered We are issuing this proposal to meet a statutory requirement to implement, no later than January 1, 2008, a revised payment system for ASCs. We are proposing to implement the revised payment system and expanded list through rulemaking in the 
                        **Federal Register**
                         to afford interested parties an opportunity to comment on revisions we are proposing to the policies and rules for identifying surgical procedures that would be approved for payment of an ASC facility fee and the revisions we are proposing to the ASC ratesetting methodology and payment policies and regulations under the revised ASC payment system. Throughout section XVIII. of this preamble, we discuss the various options we considered as we developed proposals to redesign the ASC payment system in broad terms, and specific policies, such as those affecting payment for ancillary services related to surgical procedures, the definition of a surgical procedure, criteria for identifying procedures that are not safely or appropriately performed in an ASC, and so forth. Although we propose in section XVIII. of this preamble to phase in the new ASC payment rates under the revised payment system over a 2-year period, we initially considered fully implementing the new rates for ASC services furnished on or after January 1, 2008. However, as we discuss below, our analysis of the effect that the change in payments might have on ASCs led us to propose implementation of payment rates in CY 2008 that would be based upon a 50/50 blend of the estimated current payment rate with the new payment rate. We believe that allowing a blended rate in the first year is appropriate in light of the adverse financial impact that some ASCs could potentially experience if they perform a high volume of procedures whose rates would significantly decrease under the revised system. We want to emphasize that our proposed blended payment is but one of the numerous provisions we propose in section XVIII. of this preamble as comprising the revised ASC payment system. That is, our proposal to make payment for a surgical procedure in the first year we implement the revised payment system of only 50 percent of the payment rate determined in accordance with the current payment system, would be built into and considered integral to full implementation of the revised ASC payment system proposed for CY 2008. 2. Limitations of Our Analysis Without datasets related to classes of ASCs which parallel the data maintained in the Medicare provider-specific files for hospitals, we cannot model distributional impacts of the proposed CY 2007 changes in the ASC list and ASC payments similar to those that we prepare in our impact analysis for the OPPS (see Table 49 in section XXVII.B. above). The impacts presented here are the projected effects of the policy and statutory changes that would be effective for CY 2008, on aggregate ASC utilization and Medicare payments. We can only infer the effects of the revised payment system on different types of ASCs, for example, single or multispecialty, high or low volume, urban or nonurban ASCs, based on an overall comparison of procedure volume and facility payments between the current and the proposed payment system. Moreover, because ASCs are not required to file Medicare cost reports, we do not have those as a source of data to help evaluate whether or not the payments for ASC services are appropriate, taking into account the resources required by ASCs to perform different surgical procedures. Because the aggregated impact tables below are based upon a methodology that assumes no changes in service mix or volumes with respect to the most recent CY 2005 ASC data, our estimates of the percent change in allowed charges based on the revised payment system for CY 2008 are necessarily limited. We believe it is likely that the volumes and service mix of procedures provided in ASCs would change significantly in CY 2008 under the revised payment system, although we are unable to accurately project these changes. At this point, our data do not enable us to confidently estimate the net potential for migration of services among ambulatory care settings that might result from implementation of the proposed revised ASC payment system. As we have done in previous proposed rules, we rely on comments and information from stakeholders to mitigate the limitations in the data available to us for analysis of the impact these proposed changes would have on individual ASCs, on classes of specialty ASCs, on hospitals, on physicians and on beneficiaries. 3. Estimated Effect of This Proposed Rule on ASCs Some ASCs are multispecialty facilities that perform the gamut of surgical procedures from excision of lesions to hernia repair to cataract extraction; others focus on a single specialty and perform only a limited range of surgical procedures, such as eye procedures or gastrointestinal procedures or orthopedic surgery. The combined effect on an individual ASC of the proposed revised CY 2008 payment system and the proposed expanded list of procedures would depend on a number of factors including, but not limited to, the mix of services the ASC provides, the volume of specific services provided by the ASC, and the percentage of its patients who are Medicare beneficiaries. An individual ASC's revenues from non-Medicare sources might or might not be affected by the Medicare payment changes depending on the mix of services it provides to its non-Medicare patients and the extent to which revenues from other payors are influenced by the Medicare payment rates. To estimate changes in Medicare payments for current ASC services, we 
                        ( print page 49692)
                        compared estimated payment rates for CY 2008 under the current system with the estimated proposed payment rates for CY 2008 under the revised system. In analyzing these comparisons, we became concerned about the significant negative effect the new payment rates might have on Medicare revenues for certain surgical procedures that are frequently performed in ASCs. We also became concerned about the impact of the revised payment rates on ASCs that specialize in a limited number of surgical procedures for which payment would decrease under the new system. We do not want the revised payment system to cause procedures currently performed in high volume in ASCs to migrate to hospital outpatient departments in response to sudden payment reductions. On the contrary, we want to encourage procedures that are being frequently performed in ASCs at the present time to continue being performed in ASCs because, in all likelihood, the ASC has become an extremely efficient setting for high volume procedures, such as cataract extraction and colonoscopies. Moreover, we believe one of the positive outcomes of the revised ASC payment system could be to expand beneficiary and physician choice when it comes to selecting an appropriate site for ambulatory surgical services as a consequence of the expansion of surgical services available in the ASC setting and revised payment rates that pay more appropriately for ASC facility services. Therefore, to give ASCs additional time to reconfigure their case mix so that they can focus on achieving more efficient delivery of a broader range of services, we are proposing during the first year of the revised payment system (CY 2008) to pay ASCs using a blended rate, 50 percent of the CY 2007 ASC rate for surgical procedures on the CY 2007 ASC list added to 50 percent of the CY 2008 proposed ASC rate. Table 52 shows the impact at the APC group level, sorted by APC group, of the revised payment system if we were to apply a 50/50 blend of the old ASC payment rate and the new ASC payment within the particular APC group. The APC groups shown in this table are those for which we estimate CY 2008 allowed charges under the revised payment system would exceed $5 million. Procedures assigned to these APCs account for the highest aggregate allowed charges under the current payment system. The following is an explanation of the information represented in Table 52: Column 1—*APC Group*
                         indicates the APC classification of procedures to which the ASC expenditures are attributed. For a listing of the individual HCPCS codes assigned to the APC groups, see Addendum C of this proposed rule, which can be found on the CMS Web site.
                    Column 2—*Allowed Charges*
                         are the Medicare payment amounts for covered ASC surgical procedures. Allowed charges include both Medicare program payments and coinsurance and deductibles, which are the financial responsibility of the beneficiary. These amounts have been summed across all procedures provided within the particular APC by ASCs. The allowed charges are expressed in millions of dollars.
                    Column 3—*CY 2008 Percent Change*
                         (under 50/50 Blend): The CY 2008 impact of the revised ASC payment system under the transition is the percentage increase or decrease in allowed charges attributable to changes in the ASC payment rates for CY 2008 under a 50/50 blend of the old ASC payment rate and the new ASC payment within the particular APC group. Table 52.—Estimated CY 2008 Impact of the Proposed Revised ASC Payment System on Aggregate Allowed Charges Under the 50/50 Blend, by APC Group
APC group
Allowed charges
                                 (in millions)
CY 2008 percent change 
                                 (under 50/50 Blend)0021—Level III Excision/ Biopsy
$7
200022—Level IV Excision/ Biopsy
12
340027—Level IV Skin Repair
6
330028—Level I Breast Surgery
7
250041—Level I Arthroscopy
56
350042—Level II Arthroscopy
14
1080051—Level III Musculoskeletal Procedures Except Hand and Foot
17
550053—Level I Hand Musculoskeletal Procedures
20
170054—Level II Hand Musculoskeletal Procedures
6
390055—Level I Foot Musculoskeletal Procedures
36
280057—Bunion Procedures
9
600075—Level V Endoscopy Upper Airway
14
270140—Esophageal Dilation without Endoscopy
10
−180141—Level I Upper GI Procedures
233
−120143—Lower GI Endoscopy
427
−110154—Hernia/Hydrocele Procedures
15
310158—Colorectal Cancer Screening: Colonoscopy
63
−150160—Level I Cystourethroscopy and other Genitourinary Procedures
26
−110161—Level II Cystourethroscopy and other Genitourinary Procedures
14
350162—Level III Cystourethroscopy and other Genitourinary Procedures
11
510163—Level IV Cystourethroscopy and other Genitourinary Procedures
5
200184—Prostate Biopsy
8
−180203—Level IV Nerve Injections
9
250206—Level II Nerve Injections
58
−170207—Level III Nerve Injections
209
−120220—Level I Nerve Procedures
22
300233—Level II Anterior Segment Eye Procedures
8
170234—Level III Anterior Segment Eye Procedures
17
230240—Level III Repair and Plastic Eye Procedures
47
70244—Corneal Transplant
7
27( print page 49693)0246—Cataract Procedures with IOL Insert
1,100
−20247—Laser Eye Procedures Except Retinal
97
−180254—Level IV ENT Procedures
6
310672—Level IV Posterior Segment Eye Procedures
23
410686—Level III Skin Repair
54
−5All Other (APC categories less than $5 million)
110
25Total
2,785
0
 Table 53 below shows the impact of the revised payment system on total payments for selected high volume procedures during the first year the revised payment system is implemented (CY 2008). These are the most frequently performed procedures at ASCs under the current Medicare payment system. The HCPCS codes are sorted in descending order by estimated allowed charges. The percent change in this table again compares payment rates for CY 2008 under the current system with our estimate of the proposed payment rates for CY 2008, incorporating a 50/50 blend of the ASC payment under the current system and the ASC payment under the revised system. Table 53.—Estimated CY 2008 Impact of Revised ASC Payment System on Aggregate Payments for Selected High Volume Procedures under the 50/50 Blend
HCPCS Code
Description
Allowed charges 
                                 (in millions)
CY 2008 percent change 
                                 (50/50 Blend)66984
Cataract surg w/iol, 1 stage
$1,062
−243239
Upper gi endoscopy, biopsy
166
−1345378
Diagnostic colonoscopy
147
−1145380
Colonoscopy and biopsy
112
−1145385
Lesion removal colonoscopy
108
−1166821
After cataract laser surgery
97
−1862311
Inject spine l/s (cd)
78
−1245384
Lesion remove colonoscopy
45
−1164483
Inj foramen epidural l/s
42
−1264476
Inj paravertebral l/s add-on
39
−17G0121
Colon ca scrn; not high rsk
37
−1566982
Cataract surgery, complex
32
−215823
Revision of upper eyelid
29
−1343235
Uppr gi endoscopy, diagnosis
28
−1G0105
Colorectal scrn; hi risk ind
26
−1564475
Inj paravertebral l/s
25
−1252000
Cystoscopy
24
−1064484
Inj foramen epidural add-on
20
−1267904
Repair eyelid defect
18
443248
Uppr gi endoscopy/guide wire
18
−1364721
Carpal tunnel surgery
17
3029881
Knee arthroscopy/surgery
17
4128285
Repair of hammertoe
15
2964623
Destr paravertebral n add-on
15
−1262310
Inject spine c/t
13
−1229880
Knee arthroscopy/surgery
12
4126055
Incise finger tendon sheath
11
22
 Over time, we believe the current ASC payment system has served as an incentive to ASCs to focus on providing procedures for which they determine Medicare payments are adequate to support the ASC's continued operation. In our analyses of the effects of the new payment rates, we found that the ASC payment rates for many of the procedures performed most frequently in ASCs are equal to or greater than the OPPS rates for the same procedures. Conversely, procedures for which the current ASC payment rates are lower than the OPPS rates for the same procedures tend to be performed less frequently in ASCs. We believe the proposed revised payment system represents a major stride towards encouraging greater efficiency in ASCs and promoting a significant increase in the scope and breadth of surgical procedures performed in ASCs because it would more appropriately distribute 
                        ( print page 49694)
                        payments across the entire spectrum of surgical procedures, based on a coherent system of relative payment weights. As a consequence, we expect that there would be changes in the mix of procedures provided in ASCs under the proposed revised payment system because the revised payment system would encourage ASCs to expand their service mix beyond the handful of the most lucrative procedures which comprise the bulk of ASC utilization under the current Medicare payment system. There are also some procedures for which the current ASC and OPPS rates are roughly equivalent. Under the proposed revised payment system, those services would be paid a significantly lower amount than they are currently. We believe that in some cases the payment under the current ASC system is generous relative to ASC costs, so ASCs would in all likelihood continue performing those procedures under the proposed revised payment system. To the extent that ASCs determine that the new rates for specific services or types of procedures are inadequate relative to the costs of those services, we would expect a change in the mix of services the ASC provides. Table 53 identifies a number of high volume procedures for which ASC payments would decrease under the revised system, although payments would increase significantly for other high volume procedures. What Table 53 does not show are the hundreds of other procedures currently on the ASC list that have very low volume, which we believe correlates with the low payment rates currently set for those procedures. Under the revised system, payment rates would increase significantly for numerous procedures that are currently underpaid when compared with payments for the same services under the OPPS. While an ASC may earn less from providing a service that has been its highest volume (and best paid) procedure under the current system because the payment rate for that procedure is lower under the revised payment system, that ASC may more than offset the reduction in revenues by beginning to perform other services for which the proposed rates under the revised system are significantly higher. The procedures displayed in Table 53 (current high volume procedures) are the highest volume procedures under the current system but we expect that other procedures will become high volume procedures under the revised system. While Table 52 suggests that payment for some types of procedures would decrease and others would increase, considering multiple procedures as a clinically related group generally moderates some of the extreme increases and decreases in payments displayed in Table 53 for selected high volume procedures that are members of those groups. ASCs with particular capabilities for specializing in urological or gastrointestinal procedures could shift their focus to other related procedures in the same taxonomy whose payment rates were more favorable. Those specialty ASCs could potentially continue to draw upon their experiences and resources to perform other related services. The tables above show how payment for high volume procedures currently on the ASC list would be affected by changes in payment using the ASC relative payment weights and rate setting methodology proposed under the new payment system. We also propose to add in CY 2008 hundreds of surgical procedures to the already extensive list of services for which Medicare allows payment of an ASC facility fee, creating new opportunities for ASCs to expand their range of Medicare-approved surgical procedures. Table 54 suggests some of the potential for growth that ASCs could realize under the revised payment system. The codes in this table are selected high volume procedures currently performed predominantly in the office and/or hospital outpatient setting. We believe the payment rates for these procedures under the proposed revised system would make them attractive additions to the existing surgical choices that ASCs currently offer Medicare beneficiaries in the areas of gastroenterology, urology, and pain management. Note that we have included columns to show the MPFS nonfacility rate, office volume, and a column entitled “OPPS Rate Adjusted to CY 2008 ASC Rate” that shows the proposed blended CY 2008 payment rate for each procedures that is compared to the MPFS nonfacility rate to determine which is the proposed CY 2008 rate. The procedures that are on the office-based list and, are therefore, subject to payment limitation (the lesser of the ASC rate or the MPFS nonfacility rate) are denoted with an asterisk. We have also denoted with an asterisk, those proposed CY 2008 ASC payments that are limited by the nonfacility rate. Table 54.—Selected High Volume Procedures Proposed for ASC Payment for CY 2008
CPT code
Short descriptor
Proposed CY 2007 OPPS payment rate
Proposed CY 2008 MPFS nonfacilty rate
Proposed CY 2008 ASC payment rate
OPPS or physician office volume
Payment for office-based procedure if no payment cap45300*
Proctosigmoidoscopy dx
$295.48
$60.03
$60.03
39524
$183.1945330*
Diagnostic sigmoidoscopy
295.48
81.86
81.86
42684
183.1946600*
Diagnostic anoscopy
38.23
51.50
23.70
80577
23.7046934
Destruction of hemorrhoids
792.64
177.36
177.36
34423
491.4347562
Laparoscopic cholecystectomy
2,678.23
N/A
1,660.48
30,029
1,660.4847563
Laparo cholecystectomy/graph
2,678.23
N/A
1,660.48
13,979
1,660.4850590
Fragmenting of kidney stone
2,734.57
N/A
1,683.45
26,549.00
1,683.4553850*
Prostatic microwave thermotx
2,604.69
2,459.51
1,653.04
31796
1,653.0453852*
Prostatic rf thermotx
2,604.69
2,320.01
1,653.04
8574
1,653.0461795
Brain surgery using computer
338.56
N/A
209.90
1,067
209.9062368*
Analyze spine infusion pump
173.90
21.83
21.83
122336
107.8264450*
N block, other peripheral
138.43
42.29
42.29
132194
85.8364612*
Destroy nerve, face muscle
138.43
68.90
68.90
35679
85.8364640*
Injection treatment of nerve
341.23
189.09
189.09
79126
211.56
 
 
 Unlike hospital outpatient departments, ASCs typically provide only a select set of procedures, and those procedures are generally performed on a scheduled, elective basis, affording ASCs much greater control over their case mix and costs than is possible for a typical hospital outpatient department. We expect that, as a result of implementation of the changes proposed under the revised ASC payment system, some procedures for which payment would decrease could migrate to other ambulatory settings. Conversely, we expect ASC volume to increase for those procedures for which payment rates go up under the revised payment system. These decisions will be made at the individual ASC level, depending on its physician staff, types of patients and its payors, and other considerations. 4. Estimated Effects of This Proposed Rule on Beneficiaries We estimate that the proposed changes for CY 2008 would be positive for beneficiaries in at least two respects. The ASC coinsurance rate is set at 20 percent rather than between 20 percent and 40 percent as is the case under the OPPS. Because ASC payment rates under the revised payment system are lower than payment rates for the same procedures under the OPPS, the beneficiary copayment amount under the ASC payment system would generally be less than the OPPS copayment amount for like services. (The only exceptions would be when the ASC copayment amount exceeds the inpatient deductible. The statute requires that copayment amounts under the OPPS not exceed the inpatient deductible.) In addition to the potential for reduced copayments, beneficiary access to services could be expanded as a result of the addition of the proposed 763 surgical procedures to the ASC list of services eligible for Medicare payment. We expect that ASCs would provide a broader range of surgical services under the revised system and that beneficiaries would benefit from having access to a greater variety of surgical procedures in ASCs. 5. Conclusion The proposed changes to the ASC payment system for CY 2008 would affect each of the more than 4,000 ASCs currently approved for participation in the Medicare program. The effect on an individual ASC will depend on the ASC's mix of patients, the proportion of their patients that are Medicare beneficiaries, the degree to which the payments for the procedures offered by the ASC are changed under the proposed revised system, and the degree to which the ASC chooses to provide a different set of procedures. The revised payment system is designed to result in the same aggregate amount of expenditures that would be made under the ASC benefit if the revised system were not implemented. The budget neutrality of the new payment system would not be affected by the proposed two year transition to full implementation of the new payment rates. E. Effects of the Medicare Contracting Reform Mandate (If you choose to comment on issues in this section, please include the caption “Medicare Contracting Reform Impact” at the beginning of your comment.) In section XIX. of this preamble, we discuss our proposal to revise the regulations under 42 CFR Part 421, Subpart B for Medicare intermediaries and carriers to conform the regulations to the statutory changes mandated by section 1874A of the Act as added by section 911 of Pub. L. 108-173, which took effect on October 1, 2005. As discussed in section XIX. of this preamble, section 1874A of the Act is intended to improve Medicare's administrative services to beneficiaries and health care providers and to bring standard contracting principles to Medicare, such as competition and performance incentives, which the government has long applied to other Federal programs under the FAR. This provision requires that CMS replace its current claims payment contractors by October 1, 2011 with new contract entities referred to as MACs. We believe that this provision has no immediate economic effect on Medicare payments in CY 2007 because it is administrative in nature and does not change Medicare's coverage and reimbursement policies for hospital outpatient services or any other covered Medicare services. F. Effects of Proposed Additional Quality Measures and Procedures for Hospital Reporting of Quality Data for IPPS FY 2008 We have tried to minimize the costs of HCAHPS®, including minimizing the impact on small/rural hospitals. While there are no capital or operational/maintenance costs associated with the implementation of HCAHPS®, there are costs for collecting the data. The nationwide cost of conducting the HCAHPS® survey are estimated to be between $3.6 million and $16.9 million per year assuming approximately 3,700 hospitals (see Abt Associates, Inc. report, 
                        *http://www.cms.hhs.gov/​HospitalQualityInits/​downloads/​HCAHPSCostsBenefits200512.pdf*). We have reduced the burden for small/rural hospitals by making it possible to conduct the HCAHPS® survey without hiring a survey vendor; we have provided a free online data entry tool to simplify submission for reporting; we have required significantly fewer completed surveys of small hospitals than of larger hospitals; and we have permitted four different modes of survey administration, which will allow hospitals to administer the survey in the manner most familiar to them. In addition, hospitals that are self-administering the survey (or their survey vendor, if the hospital chooses to employ one) beginning in 2007 will participate in free HCAHPS® training offered via Webinar in January 2007. All hospitals that join in 2007 will be required to participate in a month-long dry run in March 2007. Hospitals that chose not to participate in HCAHPS® will not meet the HCAHPS® requirements necessary to receive the full market basket update for FY 2008. The costs of collecting HCAHPS® patient survey data will vary across hospitals depending on the method used to collect patient survey data, the number of patients surveyed, and whether HCAHPS® is incorporated into their existing patient satisfaction surveys. While hospitals may choose to administer HCAHPS® as a stand-alone survey, there are significant cost savings associated with combining HCAHPS® with existing surveys. Hospitals will have a financial incentive to administer a single survey that includes both HCAHPS® and information necessary to support quality improvement activities. We have cited a cost/benefit report showing that the costs of conducting HCAHPS® would be as follows. HCAHPS® collected as a separate survey is between $11.00 and $15.25 per complete survey ($3,300 to $4,575 per hospital), assuming that 80-85 percent of hospitals collect HCAHPS® by mail and the remainder by phone or active IVR. It would be considerably less expensive to combine HCAHPS® with existing surveys. In a combined survey, it is estimated that it would cost only $3.26 per complete survey (or $978 per hospital) to incorporate the 27-item HCAHPS® instrument into existing surveys. Depending on the proportion of hospitals that incorporate HCAHPS® into existing surveys, it is therefore estimated that the costs of HCAHPS® is between $3.6 million and $16.9 million per year (Abt Associates, Inc. report, 
                        *http://www.cms.hhs.gov/​
                            ( print page 49696)
                            HospitalQualityInits/​downloads/​HCAHPSCostsBenefits200512.pdf*). We have made provisions to reduce the burden of the HCAHPS® initiative for small/rural hospitals. As a cost savings provisions for all hospitals (but one that is particularly useful for small hospitals), a free on-line tool for data entry is available to hospitals choosing to conduct data entry themselves in lieu of contracting with a survey vendor for this service. The sample size requirements are reduced for small hospitals unable to achieve 300 completed surveys. For all hospitals, we are allowing four modes of survey administration (mail, telephone, combination of mail and telephone, and active interactive voice recognition), and we are allowing for hospitals to either use a vendor or conduct the survey on their own. Additionally, we are allowing hospitals to integrate the HCAHPS® survey with their own patient satisfaction surveys. This option provides significant cost savings to conduct HCAHPS® annually: for the mail mode, it is estimated to cost $603 per hospital; and for the telephone mode, it is estimated to be $2,478 per hospital. For hospitals collecting 100 completed surveys, it costs about $326 annually per hospital. CMS is providing free HCAHPS® training and materials and the cost of reporting HCAHPS® results to CMS is minimal. The benefits of public reporting for hospitals are great. There are multiple reports of hospitals being motivated by these data and using them for improvement. Not only is there more consistent evidence regarding hospital impact, but there are also several well-designed studies that have found at least some impact on hospital clinical performance (Abt report). HCAHPS® provides many benefits to hospitals and also to society at-large. The HCAHPS® initiative has taken substantial steps to assure that the survey will be credible, useful, and practical. First, the survey is designed to produce comparable data on the patient's perspective on care that allows objective and meaningful comparisons between hospitals on domains that are important to consumers. Second, public reporting of the survey results is designed to create incentives for hospitals to improve their quality of care. Third, public reporting will serve to enhance public accountability in health care by increasing the transparency of the quality of hospital care provided in return for the public investment. For the public at-large, there is the potential benefit of improved health through improvements in hospital care. The intent of having the HCAHPS® initiative that resulted in a unique hospital survey is to provide one standardized instrument and accompanying data collection methodology that is in the public domain for measuring patients' perspectives on hospital care. While many hospitals currently collect information on patients' satisfaction with care, there is no one national standard for collecting or publicly reporting this information that would enable valid comparisons to be made across all hospitals. In order to make “apples to apples” comparisons to support consumer choice, it is necessary to introduce a standard measurement approach. HCAHPS® can be viewed as a core set of questions that can be combined with a broader, customized set of hospital-specific items. HCAHPS® is meant to complement the data hospitals currently collect to support improvements in internal customer services and quality related activities. • SCIP While there are no capital or operational/maintenance costs associated with the implementation of SCIP, our pilot study concluded that there will be costs associated with the collection of the data. The data collection costs have been calculated as follows: SCIP collection as additional measures has been calculated to be $75.00 and $100.00 per additional hour of data abstraction (approximately $16,000 per hospital). Depending on the proportion of hospitals that already collect these measures, it is estimated that the costs of collecting the additional measures is approximately $58.7 million dollars per year. For a detailed discussion of the data collection burden (burden hours) associated with these costs, please refer to the information collection section of the preamble. • Mortality The 30-day mortality measures for AMI, HF and Pneumonia are each individually calculated solely on administrative data already submitted to CMS for other purposes, such as claims submitted for payment by the hospitals. As no new or additional data will be required from hospitals to calculate the rates for these measures, we believe that there will be no measurable impact on the hospitals as a result of the inclusion of any or all of these measures in the RHQDAPU set. 1. Alternatives Considered The HCAHPS® survey and the SCIP and mortality measures are a subset of CMS's larger Quality Initiative for both the Medicare and Medicaid programs. The Hospital Quality Initiative was established nationally in November 2002 for nursing homes, and was expanded in 2003 to the nation's home health care agencies and hospitals. The Hospital Quality Initiative supports significant improvement in the quality of hospital care that is integral to both the Medicare and Medicaid programs. This initiative aims to improve hospital's quality of care by distributing objective and easy to understand data on hospital performance. The public availability of this information will encourage consumers and their physicians to discuss and make better informed decisions on how to get the best hospital care, create incentives for hospitals to improve care, and support public accountability. In all, improved care equates to the improvement of health for Medicare and Medicaid beneficiaries. HCAHPS®, SCIP and Mortality measures parallel the trend in both the federal and many state governments to make hospital performance information (generally clinical processes or outcomes of care) publicly available. The goals of HCAHPS® are to (1) Produce comparable data on the patient's perspective on care to allow objective and meaningful comparisons between hospitals on domains that are important to consumer decision-making, (2) to have these data publicly reported to create incentives for hospitals to improve their quality of care, and (3) to enhance public accountability by providers by increasing the transparency of the quality of hospital care provided in return for the public investment. HCAHPS®, SCIP and Mortality measures fit into a larger context of performance reporting developed by the Strategic Framework Board of the National Quality Forum. This is based on the assumption that consumers take value (both cost and quality) into account in any major purchasing decision. Public reporting of both the clinical measures and HCAHPS® is vital to the value-based healthcare purchasing approach. Patient perspectives of care encompasses an important CMS priority, as indicated by the Agency's support for programs related to the Institute of Medicine's (IOM) call for public reporting, the Hospital Quality Initiative (HQI) and the Hospital Quality Alliance (HQA), a public-private measurement and reporting collaborative. The HCAHPS® survey has been endorsed by the Hospital Quality Alliance. Implementing this survey fulfills the requirements 
                        ( print page 49697)
                        1886(b)(3)(B)(viii)(III) and (IV) of the Act that require CMS to expand the starter set of 10 quality measures used since FY 2005. In expanding these measures, we must begin to adopt the baseline set of performance measures as set forth in a 2005 report issued by the Institute of Medicine (IOM) of the National Academy of Sciences under section 238(b) of Pub. L. 108-173, effective for payments beginning with FY 2007. The IOM measures include the Hospital Quality Alliance (HQA) measures, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS®) patient perspective survey, and three structural measures. No alternatives were discussed for the SCIP and mortality measures. 2. Estimated Effects of This Proposed Rule a. Effects on Hospitals Hospitals will benefit from the information that the HCAHPS® survey and the SCIP and Mortality measures data collection will provide. Hospitals are an essential part of the National Quality Forum's Strategic Framework Board. We have made provisions that reduce the burden of the HCAHPS® initiative, especially for small/rural hospitals. The public reporting of HCAHPS® results and additional quality measures may stimulate improvements in hospital quality of care in several ways. Hospitals can use the publicly reported data to benchmark their performance with other institutions. Consumers/patients would potentially seek care in hospitals that are publicly reported to perform well. CMS does not plan to make major revisions to the HCAHPS® survey itself or to its implementation procedures soon after HCAHPS® national implementation. With the core set of HCAHPS® measures, hospitals will have the beginnings of a benchmark for trending of their hospital results over time. To promote its wide and rapid adoption, HCAHPS® has been carefully designed to fit within the framework of patient satisfaction surveying that hospitals currently employ. Still, CMS fully understands that participation in the HCAHPS® initiative will require some effort and expense on the part of hospitals that volunteer to take part. b. Effects on Other Providers Physicians will benefit by learning what surveyed consumers/patients answered about their quality of care during their hospital stays, as well as become informed about surgical care improvement and mortality rates. Studies indicate that providers are potentially affected by public reporting. They may be motivated to improve the quality of care they deliver with the availability of performance information. Primary care physicians are also users of this information during the referral process of patients to hospitals. Studies indicate that the public reporting of hospital quality indicators may spur internal hospital quality improvement and lead to changes in physician behavior within the hospital environment. c. Effects on the Medicare and Medicaid Programs Some potential benefits of publicly reporting quality information has been described in the literature as pertaining to consumers, providers and purchasers. Consumers (beneficiaries) could incorporate the quality information into their decision-making about hospital choices, and benefit from better care resulting from the additional measures as well as the questions asked by HCAHPS®, such as questions about communication with providers (fewer medical errors due to patient feedback about medication effect) and discharge planning (fewer readmissions due to better patient awareness about what to expect when discharged) and the reporting of clinical measures. Providers could potentially be motivated to improve the quality of care they provide for results of more effective and efficient hospital operation. Providers could also use the information internally to improve communication and improve performance, use the information to justify the need to increase staff ratios, use the measures in choices about practitioner practice locales, use the information to improve their ratings on patient perspectives and potentially compete with one another in the area of improving accreditation results, and use the information to choose hospitals on the basis of quality of care for their patients. Purchasers could potentially benefit from this information for supporting shorter lengths of stay, availability of benchmarks, and availability of information to support purchasing decisions. G. Executive Order 12866 In accordance with the provisions of Executive Order 12866, this proposed rule was reviewed by the OMB. List of Subjects 42 CFR Part 410 Health facilities
Health professions
Laboratories
Medicare
Rural areas
X-rays 42 CFR Part 414 Administrative practice and procedure
Health facilities
Health professions
Kidney diseases
Medicare
Reporting and recordkeeping requirements 42 CFR Part 416 Health facilities
Kidney diseases
Medicare
Reporting and recordkeeping requirements 42 CFR Part 419 Hospitals
Medicare
Reporting and recordkeeping requirements 42 CFR Part 421 Administrative practice and procedure
Health facilities
Health professions
Medicare
Reporting and recordkeeping requirements 42 CFR Part 485 Grant program-health
Health facilities
Medicaid
Medicare
Reporting and recordkeeping requirements 42 CFR Part 488 Administrative practice and procedure
Health facilities
Medicare
Reporting and recordkeeping requirements
 For reasons stated in the preamble of this proposed rule, the Centers for Medicare  Medicaid Services is proposing to amend 42 CFR Chapter IV as set forth below: PART 410—SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS 1. The authority citation for part 410 continues to read as follows: Authority:
                            Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). 2. Section 410.152 is amended by revising paragraph (i) to read as follows: § 410.152
  
 (i) 
                                *Amount of Payment: ASC facility services.*
                                 (1) For ASC facility services furnished on or after July 1, 1987 and before January 1, 2008, in connection with the surgical procedures specified in part 416 of this chapter, Medicare Part B pays 80 percent of a standard overhead amount as specified in § 416.120(c) of this chapter. (2) For ASC facility services furnished on or after January 1, 2008, in connection with the surgical procedures specified in part 416 of this chapter, Medicare Part B pays the lesser of 80 percent of the actual charge, 80 percent of the prospective payment amount as 
                                ( print page 49698)
                                determined under Subpart F of Part 416 of this chapter, or, under the limitation described in § 416.167(b)(3), the amount determined under Subpart B of Part 414 of this chapter.
 PART 414—PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES 3. The authority citation for Part 414 continues to read as follows: Authority:
                            Secs. 1102, 1871, and 1834(l) of the Social Security Act (42 U.S.C. 1302, 1395hh, and 1395m(l)). 4. Section 414.22 is amended by revising paragraph (b)(5)(i)(B) to read as follows: § 414.22
  
 (b) 
                                *Practice Expense RVUs.* 
 (5) * * * (i) * * * (B) 
                                *Non-facility practice expense RVUs.*
                                 The higher non-facility practice expense RVUs apply to services performed in a physician's office, a patient's home, an ASC if the physician is performing a procedure for which an ASC facility fee is not paid under Part 416, a nursing facility, or a facility or institution other than a hospital or skilled nursing facility, community mental health center, or ASC performing an ASC approved procedure.
 PART 416—AMBULATORY SURGICAL SERVICES 5. The authority citation for part 416 continues to read as follows: Authority:
                            Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). 6. Section 416.1 is amended by— a. Revising paragraph (a)(2). b. Revising paragraph (a)(3). c. Adding new paragraphs (a)(4) and (a)(5). The revisions and additions read as follows: § 416.1
  (a) * * * (2) Section 1833(i)(1)(A) of the Act requires the Secretary to specify the surgical procedures that can be performed safely on an ambulatory basis in an ambulatory surgical center. (3) Sections 1833(i)(2)(A) and (D), and 1833(a)(1)(G) of the Act specify the amounts to be paid for facility services furnished in connection with the specified surgical procedures when they are performed in an ASC. (4) Section 1833(i)(2)(C) of the Act provides that if the Secretary has not updated amounts for ASC facility services furnished during a fiscal year through 2005 or a calendar year beginning with 2006, the amounts shall be increased by the percentage increase in the Consumer Price Index for all urban consumers as estimated by the Secretary for the 12-month period ending with the midpoint of the year involved, except that, in fiscal year 2005, the last quarter of calendar year 2005, and each of the calendar years 2006 through 2009, the increase shall be zero percent. (5) Section 1833(i)(2)(E) of the act provides that with respect to surgical procedures furnished on or after January 1, 2007, and before the effective date of the implementation of a revised payment system, the payment amount shall be the lesser of the ASC payment rate established under section 1833(i)(2) (A) of the act or the prospective payment rate for hospital outpatient department services established under section 1833(t)(3)(D). The lesser payment amount shall be determined prior to application of any geographic adjustment. 
 7. Section 416.2 is amended by— a. Republishing the introductory test preceding the definitions b. Revising the definitions of “Covered surgical procedures” and “Facility services.” The republished introductory text preceding the definitions and revised definitions read as follows:
 § 416.2
  As used in this part: 
 *Covered surgical procedures*
                                 means those surgical procedures that meet the criteria specified in §§ 416.65 or 416.166, as applicable, and are published in the 
                                **Federal Register**
                                . *Facility services*
                                 means services that are furnished in connection with covered surgical procedures performed in an ASC. 8. The heading for Subpart D is revised to read as follows:
 Subpart D—Scope of Benefits for Services Furnished Before January 1, 2008
 9. Section 416.65 is amended by— a. Revising the introductory text. b. Revising paragraph (a)(4). The revisions read as follows: § 416.65
  Effective for services furnished before January 1, 2008, covered surgical procedures are those procedures that meet the standards described in paragraphs (a) and (b) of this section and are included in the list published in accordance with paragraph (c) of this section. (a) * * * (4) Are not otherwise excluded under § 411.15 of this chapter. 
 10. A new § 416.76 is added to read as follows:
 § 416.76
  The provisions of this subpart apply to facility services furnished before January 1, 2008. 11. The heading for Subpart E is revised to read as follows:
 Subpart E—Prospective Payment System For Facility Services Furnished Before January 1, 2008 § 416.120
  12. In paragraph (a) of § 416.120, the cross-reference “Part 413” is removed and the cross-reference “Part 419” added in its place. 13. A new § 416.121 is added to read as follows:
 § 416.121
  The provisions of this subpart apply to facility services furnished before January 1, 2008. 14. Section 416.125 is amended by adding a new paragraph (c) to read as follows:
 § 416.125
  
 (c) For services furnished on or after January 1, 2007, and before the effective date of implementation of a revised payment system, the ASC payment rate for a surgical procedure shall be the lesser of the ASC payment rate established under paragraph (a) of this section or the prospective payment rate for the procedure established under section 419.32. The lesser payment amount shall be determined prior to application of any geographic adjustment.
 § 416.150
  15. Section 416.150 is removed.
 Subpart F—[Redesignated as Subpart G]
 16. Existing Subpart F is redesignated Subpart G 17. A new Subpart F is added to read as follows: Subpart F—Coverage, Scope of ASC Facility Services, and Prospective Payment System For Facility Services Furnished On Or After January 1, 2008
 416.160
                            Basis and scope.
                            416.161
                            Applicability.
                            416.163
                            General rules.
                            416.164
                            Scope of ASC facility services.
                            416.166
                            Covered surgical procedures.
                            416.167
                            Basis of payment.
                            416.171
                            Calculation of prospective payment rates for ASC services.
                            416.172
                            Adjustments to national payment rates.
                            416.173
                            Publication of revised payment methodologies and payment rates.
                            416.178
                            Limitations on administrative and judicial review.
 § 416.160
  (a) 
                                *Statutory basis.*
                                 (1) Section 1833(a)(1)(G) of the Act provides that, beginning with the implementation date of a revised payment system for ASC facility services furnished in connection with a surgical procedure pursuant to section 1833(i)(1)(A) of the Act, the amount paid shall be 80 percent of the lesser of the actual charge for such services or the amount determined by the Secretary under the revised payment system. (2) Section 1833(i)(1)(A) of the Act requires the Secretary to specify the surgical procedures that can be performed safely on an ambulatory basis in an ASC. (3) Section 1833(i)(2)(D) of the Act requires the Secretary to implement a revised payment system for payment of surgical services furnished in ASCs. The statute requires that, in the year such system is implemented, the system shall be designed to result in the same amount of aggregate expenditures for such services as would be made if there were no requirement for a revised payment system. The revised payment system shall be implemented no earlier than January 1, 2006, and no later than January 1, 2008. There shall be no administrative or judicial review under section 1869 of the Act, section 1878 of the Act, or otherwise of the classification system, the relative weights, payment amounts, and the geographic adjustment factor, if any, of the revised payment system. (b) 
                                *Scope.*
                                 This subpart sets forth— (1) The scope of ASC facility services and the criteria for determining the procedures for which Medicare pays an ASC facility fee; and (2) The methodologies by which Medicare determines payment amounts for ASC facility services.
 § 416.161
  The provisions of this subpart apply to ASC facility services furnished on or after January 1, 2008.
 § 416.163
  (a) The services for which payment is made under this subpart are ASC facility services as specified in § 416.164(a) furnished to Medicare beneficiaries by a participating ASC in connection with covered surgical procedures as determined by the Secretary in accordance with § 416.166. (b) Physician services, including surgical procedures and all preoperative and post-operative services that are performed by a physician, are paid in accordance with Part 414 of this chapter. (c) Items and services as specified in § 416.164(b) for which payment may be made under other provisions of Part 410 of this chapter are not included in the payment amount for ASC facility services.
 § 416.164
  (a) 
                                *Included services.*
                                 ASC facility services include, but are not limited to— (1) Nursing, technician, and related services; (2) Use of the facility where the surgical procedures are performed; (3) Items and services directly related to the pre-operative preparation of patients upon their admission to the ASC for surgery, to the performance of a surgical procedure(s) and to the post-operative and post-anesthesia care of patients prior to their discharge from the ASC. This includes, but is not limited to: Any laboratory testing performed under a Clinical Laboratory Improvement Amendments of 1988 (CLIA) certificate of waiver; drugs and biologicals; medical and surgical supplies and equipment; surgical dressings; implanted prosthetic devices, accessories and supplies including intraocular lenses (IOLs); implanted DME, accessories and supplies; splints and casts and related devices; and imaging services or other diagnostic tests or interpretive services directly related to a surgical procedure; (4) Administrative, recordkeeping and housekeeping items and services; (5) Materials, including supplies and equipment for the administration and monitoring of anesthesia; and (6) Supervision of the services of an anesthetist by the operating surgeon. (b) 
                                *Excluded services.*
                                 Facility services do not include costs incurred to procure corneal tissue or items and services for which payment may be made under other provisions of Parts 410 and 414 of this chapter, such as physicians' services; X-ray or diagnostic procedures (other than those directly related to performance of the surgical procedure); ambulance services; leg, arm, back and neck braces other than those that serve the function of a cast or splint; artificial limbs; non-implantable prosthetic devices and durable medical equipment. In addition, they do not include anesthetist services furnished on or after January 1, 1989.
 § 416.166
  (a) 
                                *Covered surgical procedures.*
                                 Effective for services furnished on or after January 1, 2008, covered surgical procedures are those procedures that meet the general standards described in paragraph (b) of this section (whether commonly furnished in an ASC or a physician's office) and are not excluded under paragraph (c) of this section. (b) 
                                *General standards.*
                                 Subject to the exclusions in paragraph (c) of this section, covered surgical procedures are surgical procedures specified by the Secretary that would not be expected to pose a significant safety risk to a Medicare beneficiary when performed in an ASC. (c) 
                                *General exclusions.*
                                 Notwithstanding paragraph (b) of this section, covered surgical procedures do not include those surgical and other medical procedures that— (1) Generally result in extensive blood loss; (2) Require major or prolonged invasion of body cavities; (3) Directly involve major blood vessels; (4) Are generally emergent or life-threatening in nature; (5) Standard medical practice dictates that the beneficiary will typically be expected to require active medical monitoring and care at midnight following the procedure; or, (6) Are otherwise excluded under § 411.15 of this chapter.
 § 416.167
  (a) 
                                *Unit of payment.*
                                 Under the ASC prospective payment system, prospectively determined amounts are paid for facility services furnished to Medicare beneficiaries in connection with designated surgical procedures. Surgical procedures are identified by codes established under the Centers for Medicare  Medicaid Services Common Procedure Coding System (HCPCS). The prospective payment rate for each procedure for which payment is allowed under the ASC payment system is determined according to the methodology described in § 416.171. The manner in which the Medicare 
                                ( print page 49700)
                                payment amount and the beneficiary copayment amount for each procedure are determined is described in § 416.172. (b) 
                                *Ambulatory payment classification (APC) groups and payment weights* (1) ASC covered surgical procedures are classified using the APC groups described in § 419.31 of this chapter. An APC group consists of outpatient services and procedures that are comparable clinically and in terms of resources. (2) For purposes of calculating ASC national payment rates under the methodology described in § 416.171, except as specified in paragraph (b)(3), of this section, an ASC covered surgical procedure is assigned the applicable APC relative payment weight described in § 419.31 of this chapter. (3) Notwithstanding paragraph (b)(2) of this section, the relative payment weights for procedures paid in accordance with § 416.171(e) are determined so that the national ASC payment rate does not exceed the MPFS nonfacility amount paid for such procedures under Subpart B of Part 414 of this chapter.
 § 416.171
  (a) 
                                *Conversion factor for calendar year 2008.*
                                 CMS calculates a conversion factor so that payment for ASC services furnished in 2008 would result in the same aggregate amount of expenditures as would be made if the provisions in Subpart F did not apply. (b) 
                                *Conversion factor for calendar year 2009 and subsequent years.*
                                 The conversion factor for a calendar year is equal to the conversion factor calculated for the previous year adjusted as follows: (1) For calendar year 2009, the increase shall equal zero percent. (2) For calendar year 2010 and subsequent years, by the Consumer Price Index for all urban consumers (U.S. city average) as estimated by the Secretary for the 12-month period ending with the midpoint of the year involved. (c) 
                                *Transitional payment rates for calendar year 2008.*
                                 ASC payment rates for 2008 are a transitional blend of 50 percent of the CY 2007 ASC payment rate for a surgical procedure on the CY 2007 ASC list of surgical procedures and 50 percent of the payment rate for the procedure calculated under the methodology described in paragraph (d) of this section. (d) 
                                *Payment rates for calendar year 2009 and subsequent years.*
                                 The national ASC payment rate for a covered surgical procedure designated in accordance with § 416.166 is the product of the conversion factor calculated under paragraph (a) or paragraph (b) of this section and the relative weight determined under § 416.167(b). (e) 
                                *Limitation on payment for certain ASC procedures.*
                                 Notwithstanding the provisions of paragraph (c) and paragraph (d) of this section, if CMS determines that a covered procedure under § 416.166 of this part is commonly performed in physicians' offices, payment for ASC facility services for such procedure shall be the lesser of the amount determined under paragraph (c) or paragraph (d) of this section or the amount paid for such procedure under Subpart B of Part 414 of this chapter. (f) 
                                *Budget neutrality.*
                                 (1) For calendar year 2008, CMS adjusts the conversion factor in accordance with paragraph (a) to result in budget neutrality as estimated by CMS. (2) For calendar year 2009 and subsequent years, CMS adjusts the ASC relative payment weights under § 416.167(b)(2) as needed so that any updates and adjustments made under § 419.50(a) of this chapter are budget neutral as estimated by CMS.
 § 416.172
  (a) 
                                *General rule.*
                                 CMS establishes national prospective payment rates for ASC facility services to which certain adjustments are applied to determine Medicare program payment and beneficiary copayment amounts. (b) 
                                *Lesser of actual charge or prospective rate.*
                                 Payments to ASCs shall equal the lesser of 80 percent of: (1) the actual charge for the service; or, (2) the prospective rate determined under this subpart. (c) 
                                *Geographic adjustment.*
                                 National ASC payment rates established under § 416.171 for covered surgical procedures are adjusted for variations in ASC labor costs across geographic areas using wage index values, labor and non-labor percentages, and localities specified by the Secretary. (d) 
                                *Deductibles and coinsurance.*
                                 Part B deductible and coinsurance amounts apply as specified in § 410.152(a) and (i) of this chapter. (e) 
                                *Payment reductions for multiple surgical procedures.*
                                 (1) 
                                *General rule.*
                                 Except as provided in paragraph (e)(2) of this section, when more than one surgical procedure for which payment is made under the ASC prospective payment system is performed during an operative session, the Medicare program payment amount and the beneficiary copayment amount are based on— (i) The full amounts for the procedure with the highest APC payment rate; and (ii) One-half of the full program and the beneficiary payment amounts for all other covered procedures. (2) 
                                *Exception.*
                                 The Secretary may apply any policies or procedures used with respect to multiple procedures under the prospective payment system for hospital outpatient department services under part 419 of this chapter as may be consistent with the equitable and efficient administration of part 416.
 § 416.173
  CMS will publish annually through notice and comment rulemaking in the 
                                **Federal Register**
                                , the payment methodologies, payment rates and surgical procedures for which CMS will make an ASC facility payment, and other revisions as appropriate.
 § 416.178
  There is no administrative or judicial review under sections 1869 of the Act, section 1878 of the Act or otherwise of the following: (a) The APC classification system; (b) Relative payment weights; (c) Payment amounts; or (d) Geographic adjustment factors. 18. Redesignated Subpart G is revised to read as follows:
 Subpart G—Adjustment in Payment Amounts for New Technology Intraocular Lenses Furnished by Ambulatory Service Centers
 416.180
                            Basis and scope.
                            416.185
                            Process for establishing a new class of new technology IOLs.
                            416.190
                            Request for review of payment amount.
                            416.195
                            Determination of membership in new classes of new technology IOLs.
                            416.200
                            Payment adjustment.
 § 416.180
  (a) 
                                *Basis.*
                                 This subpart implements section 141 of Public Law 103-432, which provides for adjustments to payment amounts for new technology intraocular lenses (IOLs) furnished at ambulatory surgical centers (ASCs). (b) 
                                *Scope.*
                                 This subpart sets forth— (1) The process for interested parties to request that CMS review the appropriateness of the ASC facility fee for insertion of an IOL. This process includes a review of whether that payment is reasonable and related to the cost of acquiring a lens determined by CMS as belonging to a class of new technology IOLs; 
                                ( print page 49701) (2) Factors that CMS considers for determination of a new class of new technology IOLs; and (3) Application of the payment adjustment.
 § 416.185
  (a) 
                                *Announcement of deadline for requests for review.*
                                 CMS announces the deadline for each year's requests for review of a new class of new technology IOLs in the final rule updating the ASC payment rates for that calendar year. (b) 
                                *Announcement of new classes of new technology IOLs for which review requests have been made and solicitation of public comments.*
                                 CMS announces the requests for review received in a calendar year and the deadline for public comments regarding the requests in the proposed rule updating the ASC payment rates for the following calendar year. The deadline for submission of public comments is 30 days following the date of the publication of the proposed rule. (c) 
                                *Announcement of determinations regarding requests for review.*
                                 CMS announces its determinations for a calendar year in the final rule updating the ASC payment rates for the following calendar year. CMS publishes the codes and effective dates allowed for those lenses recognized by CMS as belonging to a class of new technology IOLs. New classes of new technology IOLs are effective 30 days following the date of publication of the final rule.
 § 416.190
  (a) 
                                *When requests can be submitted.*
                                 A request for review of the appropriateness of ASC payment for insertion of an IOL that might qualify for a payment adjustment as belonging to a new class of new technology IOLs must be submitted to CMS in accordance with the annual published deadline. (b) 
                                *Who may submit a request.*
                                 Any individual, partnership, corporation, association, society, scientific or academic establishment, or professional or trade organization able to furnish the information required in paragraph(c) of this section may request that CMS review the appropriateness of the payment amount provided under section 1833(i)(2)(A)(iii) of the Act with respect to an IOL that meets the criteria of a new technology IOL under § 416.195. (c) 
                                *Content of a request.*
                                 In order to be accepted by CMS for review, a request for review of the ASC payment amount for insertion of an IOL must include all the information as specified by CMS. (d) 
                                *Confidential information.*
                                 In order for CMS to invoke the protection allowed under Exemption 4 of the Freedom of Information Act (5 U.S.C. 552(b)(4)) and, with respect to trade secrets, the Trade Secrets Act (18 U.S.C. 1905), the requestor must clearly identify all information that is to be characterized as confidential.
 § 416.195
  (a) 
                                *Factors to be considered.*
                                 CMS uses the following criteria to determine whether an IOL qualifies for a payment adjustment as a member of a new class of new technology IOLs when inserted at an ASC. (1) The IOL is approved by the FDA. (2) Claims of specific clinical benefits and/or lens characteristics with established clinical relevance in comparison to currently available IOLs are approved by the FDA for use in labeling and advertising. (3) The IOL is not described by an active or expired class of new technology IOLs; that is, it does not share a predominant, class-defining characteristic associated with improved clinical outcomes with members of an active or expired class. (4) Evidence demonstrated that use of the IOL results in measurable, clinically meaningful, improved outcomes in comparison with use of currently available IOLs. Superior outcomes include: (i) Reduced risk of intraoperative or postoperative complication or trauma; (ii) Accelerated postoperative recovery; (iii) Reduced induced astigmatism; (iv) Improved postoperative visual acuity; (v) More stable postoperative vision; (vi) Other comparable clinical advantages. (b) 
                                *CMS determination of eligibility for payment adjustment.*
                                 CMS reviews the information submitted with a completed request for review, public comments submitted timely, and other pertinent information and makes a determination as follows: (1) The IOL is eligible for a payment adjustment as a member of a new class of new technology IOLs. (2) The IOL is a member of an active class of new technology IOLs and is eligible for a payment adjustment for the remainder of the period established for that class. (3) The IOL does not meet the criteria for designation as a new technology IOL and a payment adjustment is not appropriate.
 § 416.200
  (a) CMS establishes the amount of the payment adjustment for classes of new technology IOLs through proposed and final rulemaking in connection with ASC center services. (b) CMS adjusts the payment for insertion of an IOL approved as belonging to a class of new technology IOLs for the 5-year period of time established for that class. (c) Upon expiration of the 5-year period of the payment adjustment, payment reverts to the standard rate for IOL insertion procedures performed in ASCs. (d) ASCs that furnish an IOL designated by CMS as belonging to a class of new technology IOLs must submit claims using billing codes specified by CMS to receive the new technology IOL payment adjustment.
 PART 419—PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES 19. The authority citation for part 419 continues to read as follows: Authority:
                            Secs. 1102, 1833(t), and 1871 of the Social Security Act (42 U.S.C. 1302, 1395l(t), and 1395hh). 20. Section 419.21 is amended by revising the introductory text of paragraph (d) to read as follows: § 419.21
  
 (d) The following medical and other health services furnished by a home health agency (HHA) to patients who are not under an HHA plan or treatment or by a hospice program furnishing services to patients outside the hospice benefit: 
 21. Section 419.43 is amended by adding a new paragraph (h) to read as follows:
 § 419.43
  
 (h) 
                                *Applicable adjustments to conversion factor for CY 2007 and for subsequent calendar years.* (1) 
                                *General rule.*
                                 For CY 2007, the applicable adjustment to the conversion factor specified in § 419.32(b)(iv) is reduced by 2.0 percentage points for any hospital that has its annual percentage change reduced under § 412.64(d)(2) of this chapter for the corresponding fiscal year. For subsequent years, the applicable adjustment to the conversion factor is reduced for any hospital that 
                                ( print page 49702)
                                fails to satisfy quality reporting requirements as designated by CMS. (2) 
                                *Limitation.*
                                 Any reduction to a hospital's adjustment to its conversion factor specified in § 419.32(b)(iv) which occurs as a result of paragraph (h)(1) of this section will apply only to the calendar year involved and will not be taken into account in computing that hospital's applicable adjustment for a subsequent calendar year. (3) 
                                *Budget neutrality.*
                                 For CY 2007 and for each subsequent calendar year, CMS makes an adjustment to the conversion factor, so that estimated aggregate payments under the OPPS for such calendar year are not affected by any reductions to hospital adjustments which occur as a result of paragraph (h)(1) of this section. 22. A new section 419.45 is added to read as follows:
 § 419.45
  (a) 
                                *General rule.*
                                 CMS reduces the amount of payment for an implanted device made under the hospital outpatient prospective payment system in accordance with § 419.66 for which CMS determines that a significant portion of the payment is attributable to the cost of an implanted device, when one of the following situations occur: (1) The device is replaced without cost to the provider or the beneficiary; or (2) The provider receives full credit for the cost of a replaced device. (b) 
                                *Amount of reduction to the APC payment.*
                                 The amount of the reduction to the APC payment made under paragraph (a) of this section is calculated in the same manner as the offset amount that would be applied if the device implanted in a procedure assigned to the APC had transitional pass-through status under § 419.66. (c) 
                                *Amount of beneficiary copayment.*
                                 The beneficiary copayment is calculated based on the APC payment after application of the reduction under paragraph (b) of this section. 23. Section 419.70 is amended by— a. Revising paragraph (d)(1). b. Redesignating paragraphs (d)(2) and (d)(3) as paragraphs (d)(3) and (d)(4), respectively. c. Adding a new paragraph (d)(2). The revisions and addition read as follows:
 § 419.70
  
 (d) 
                                *Hold harmless provisions.*
                                —(1) 
                                *Temporary treatment for small rural hospitals before January 1, 2006.*
                                 For covered hospital outpatient services furnished in a calendar year before January 1, 2006, for which the prospective payment system amount is less than the pre-BBA amount, the amount of payment under this part is increased by the amount of that difference if the hospital— (i) Is located in a rural area as defined in § 412.63(b) of this chapter or is treated as being located in a rural area under section 1886(d)(8)(E) of the Act; and (ii) Has 100 or fewer beds as defined in § 412.105(b) of this chapter. (2) 
                                *Temporary treatment for small rural hospitals on or after January 1, 2006.*
                                 For covered hospital outpatient services furnished in a calendar year from January 1, 2006, through December 31, 2008, for which the prospective payment system amount is less than the pre-BBA amount, the amount of payment under this paragraph is increased by 95 percent of that difference for services furnished during 2006, 90 percent of that difference for services furnished during 2007, and 85 percent of that difference for services furnished during 2008 if the hospital— (i) Is located in a rural area as defined in § 412.63(b) of this chapter or is treated as being located in a rural area under section 1886(d)(8)(E) of the Act; (ii) Has 100 or fewer beds as defined in § 412.105(b) of this chapter; (iii) Is not a sole community hospital as defined in § 412.92 of this chapter; and (iv) Is not an essential access community hospital under § 412.109 of this chapter.
 PART 421—MEDICARE CONTRACTING 24. The heading of part 421 is revised to read as set out above. 25. The authority citation for part 421 continues to read as follows: Authority:
                            Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). 26. Section 421.3 is revised to read as follows: § 421.3
  As used in this part— *Intermediary*
                                 means an entity that has a contract with CMS (under statutory provisions in effect prior to October 1, 2005) to determine and make Medicare payments for Part A or Part B benefits payable on a cost basis (or under the prospective payment system for hospitals) and to perform other related functions. For purposes of applying the performance criteria in § 421.120 and the performance standards in § 421.122 and any adverse action resulting from that application, the term “intermediary” also means a Blue Cross plan that has entered into a subcontract approved by CMS with the Blue Cross and Blue Shield Association to perform intermediary functions. 27. Section 421.100 is amended by revising paragraph (i) to read as follows:
 § 421.100
  
 (i) 
                                *Dual intermediary responsibilities.*
                                 Regarding the responsibility for service to provider-based HHAs and provider-based hospices, where the HHA or the hospice and its parent provider will be served by different intermediaries, the designated regional intermediary will process bills, make coverage determinations, and make payments to the HHAs and the hospices. The intermediary serving the parent provider will perform all fiscal functions, including audits and settlement of the Medicare cost reports and the HHA and hospice supplement worksheets. 28. Section 421.103 is revised to read as follows:
 § 421.103
  Providers are assigned to intermediaries in accordance with § 421.104. As the Medicare Administrative Contractors (MACs) are implemented, providers are reassigned from intermediaries to MACs in accordance with § 412.404. 29. Section 421.104 is revised to read as follows:
 § 421.104
  (a) Beginning October 1, 2005, CMS assigns providers of services and other entities that may bill Part A benefits to intermediaries in a manner that will best support the transition to Medicare administrative contractors (MACs) under section 1874A of the Act in accordance with Subpart E of this part. (b) These providers of services and other entities must continue to bill the intermediary that they were billing prior to October 1, 2005, until one of the following events occurs: (1) The intermediary's agreement with CMS ends, and the provider or entity is directed by CMS to bill another CMS contractor. (2) The provider or entity is assigned to a MAC that has begun to administer claims within the geographic locale of the provider or entity. (3) CMS directs the provider or entity to begin billing another CMS contractor in order to support the implementation 
                                ( print page 49703)
                                of MACs under section 1874A of the Act and Subpart E of this part. (c) New providers of services and new entities will be assigned to the intermediary serving their geographic locale if no MAC has begun to administer Medicare claims in the locale. These providers or entities must continue to bill the intermediary until one of the events in paragraph (b) of this section occurs. (d) Providers or entities will only be granted exceptions to the provisions of paragraphs (b) or (c) of this section if CMS deems the exception to be in the compelling interest of the Medicare program. (e) CMS will notify the provider or entity, the outgoing intermediary, and the newly assigned intermediary of assignment or reassignment decisions.
 § 421.105
  30. Section 421.105 is removed.
 § 421.106
  31. Section 421.106 is removed. 32. Section 421.112 is amended by— a. Revising paragraph (a). b. Revising paragraph (b). The revisions read as follows:
 § 421.112
  (a) In order to accomplish the most effective and efficient administration of the Medicare program, the Secretary may make determinations with respect to the termination of an intermediary agreement, and CMS may make determinations with respect to renewal of an intermediary agreement under § 421.110. (b) When taking the actions specified in paragraph (a) of this section, the Secretary or CMS will consider the performance of the individual intermediary in its Medicare operations using the factors contained in the performance criteria specified in § 421.120 and the performance standards specified in section § 421.122. 
 33. Section 421.114 is revised to read as follows:
 § 421.114
  CMS may assign or reassign any provider to any intermediary if it determines that the assignment or reassignment will be in the best interests of the Medicare program.
 § 421.116
  34. Section 421.116 is removed.
 § 421.117
  35. Section 421.117 is removed.
 § 421.118
  36. Section 421.118 is removed. 37. Reserve Subpart D and add a new Subpart E to Part 421 to read as follows:
 Subpart E—Medicare Administrative Contractors (MACs)
 421.400
                            Statutory basis and scope.
                            421.401
                            Definitions.
                            421.404
                            Assignment of providers and suppliers to MACs.
 § 421.400
  (a) 
                                *Statutory basis.*
                                 This subpart implements section 1874A of the Act, which provides for the transition of the claims processing functions and operations for both Medicare Part A and Part B intermediaries and carriers to Medicare administrative contractors (MACs). The transition will occur between October 1, 2005, and October 1, 2011. MACs will be fully operational in distinct, nonoverlapping geographic jurisdictions by October 1, 2011. (b) 
                                *Scope.*
                                 This subpart specifies the requirements under which providers and suppliers will be assigned to MACs.
 § 421.401
  For purposes of this subpart— *Appropriate MAC*
                                 means a MAC that has a contract under section 1874A of the Act to perform a particular Medicare administrative function in relation to: (1) A particular individual entitled to benefits under Part A or enrolled under Part B, or both; (2) A specific provider of services or supplier; or (3) A class of providers of services or suppliers. *Medicare administrative contractor*
                                 (MAC) means an agency, organization, or other person with a contract under section 1874A of the Act.
 § 421.404
  (a) 
                                *Definitions.*
                                 As used in this section— *Chain provider*
                                 means a group of two or more providers under common ownership or control. *Common control*
                                 exists when an individual, a group of individuals, or an organization has the power, directly or indirectly, to significantly influence or direct the actions or policies of the group of suppliers or eligible providers. *Common ownership*
                                 exists when an individual, a group of individuals, or an organization possesses significant equity in the group of suppliers or eligible providers. *Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)*
                                 means the types of services specified in § 421.210(b). *Eligible provider*
                                 means a hospital, skilled nursing facility, or critical access hospital that meets the definition of a provider under § 400.202 of this chapter. *Home office*
                                 means the entity that provides centralized management and administrative services to the individual providers or suppliers under common ownership and common control, such as centralized accounting, purchasing, personnel services, management direction and control, and other similar services. *Ineligible provider*
                                 means a provider under § 400.202 of this chapter that is not an eligible provider. *Medicare benefit category*
                                 means a category of covered benefits under Part A or Part B of the Medicare program (for example, inpatient hospital services, post-hospital extended care services, and physicians' services). *Provider*
                                 has the same meaning as specified under § 400.202 of this chapter. *Qualified chain provider*
                                 means a chain provider comprised of— (1) 10 or more eligible providers collectively totaling 500 or more certified beds; or (2) 5 or more eligible providers collectively totaling 300 or more certified beds, with eligible providers in 3 or more continuous States. *Supplier*
                                 has the same meaning as specified in § 400.202 of this chapter. (b) 
                                *Assignment of providers to MACs.*
                                 (1) Providers enroll with and receive Medicare payment and other Medicare services from the MAC contracted by CMS to administer claims for the Medicare benefit category applicable to the provider's covered services for the geographic locale in which the provider is physically located. (2) Qualified chain providers may request and receive an exception from the requirement of paragraph (b)(1) of this section from CMS. Upon CMS' approval, a qualified chain provider may enroll with and bill on behalf of the eligible providers under its common ownership or common control to the MAC contracted by CMS to administer claims for the Medicare benefit category applicable to the eligible providers' covered services for the geographic locale in which the qualified chain provider's home office is physically located. (3) As MAC contractors become available, qualified chain providers, granted approval by CMS to enroll with and bill a single intermediary on behalf of their eligible member providers prior to October 1, 2005, will be assigned at an appropriate time to the MAC contracted by CMS to administer claims 
                                ( print page 49704)
                                for the applicable Medicare benefit category for the geographic locale in which the chain provider's home office is physically located. The qualified chain provider will not need to request an exception to the requirement of paragraph (b)(1) of this section in order for this assignment to take effect. (4) CMS may grant an exception to the requirement of paragraph (b)(1) of this section to eligible providers that are not under the common ownership or common control of a qualified chain provider, as well as ineligible providers, only if CMS finds the exception will support the implementation of MACs or will serve some other compelling interest of the Medicare program. (c) 
                                *Assignment of suppliers to MACs.*
                                 (1) Suppliers, including physicians and other practitioners, but excluding suppliers of DMEPOS, enroll with and receive Medicare payment and other Medicare services from the MAC contracted by CMS to administer claims for the Medicare benefit category applicable to the supplier's covered services for the geographic locale in which the supplier furnished such services. (2) Suppliers of DMEPOS receive Medicare payment and other Medicare services from the MAC assigned to administer claims for DMEPOS for the regional area in which the beneficiary receiving the DMEPOS resides. The terms of §§ 421.210 and 421.212 continue to apply to suppliers of DMEPOS. (3) CMS may allow a group of ESRD suppliers under common ownership and common control to enroll with the MAC contracted by CMS to administer ESRD claims for the geographic locale in which the group's home office is located only if— (i) The group of ESRD suppliers requests such privileges; and (ii) CMS finds the exception will support the implementation of MACs or will serve some other compelling interest of the Medicare program.
 PART 485—CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS 38. The authority citation for Part 485 continues to read as follows: Authority:
                            Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). 39. Section 485.618 is amended by— a. Revising paragraph (d)(1) introductory text. b. Redesignating paragraphs (d)(2) and (d)(3) as paragraphs (d)(3) and (d)(4), respectively. c. Adding a new paragraph (d)(2). d. In redesignated paragraph (d)(3)(iv), removing the cross-reference “paragraph (d)(2)(iii)” and adding the cross-reference “paragraph (d)(3)(iii)” in its place. e. In redesignated paragraph (d)(4), removing the cross-reference “paragraph (d)(2)(iii)” and adding the cross-reference “paragraph (d)(3)(iii)” in its place. The revisions and additions read as follows: § 485.618
  
 (d) 
                                *Standard: Personnel.* (1) Except as specified in paragraph (d)(3) of this section, there must be a doctor of medicine or osteopathy, a physician assistant, a nurse practitioner, or a clinical nurse specialist, with training or experience in emergency care, on call and immediately available by telephone or radio contact, and available onsite within the following timeframes: 
 (2) A registered nurse with training and experience in emergency care can be utilized to conduct specific medical screening examinations only if— (i) The registered nurse is on site and immediately available at the CAH when a patient requests medical care; and (ii) The nature of the patient's request for medical care is within the scope of practice of a registered nurse and consistent with applicable State laws.
 PART 488—SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES 40. The authority citation for part 488 continues to read as follows: Authority:
                            Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). 41. In § 488.1, the definition of “supplier” is revised to read as follows: § 488.1
  
 *Supplier*
                                 means any of the following: Independent laboratory; portable X-ray services; physical therapist in independent practice; ESRD facility; rural health clinic; Federally qualified health center; chiropractor; or ambulatory surgical center. 
 (Catalog of Federal Domestic Assistance Program No. 93.778, Medical Assistance Program) (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program)
 Dated: July 28, 2006. Mark B. McClellan, Administrator, Centers for Medicare  Medicaid Services. Dated: August 7, 2006. Michael O. Leavitt, Secretary.
 
 
 Addendum A.—OPPS Proposed List of Ambulatory Payment Classifications (APCs) With Status Indicators (SI), Relative Weights, Payment Rates, and Copayment Amounts Calendar Year 2007
APC
Group title
SI
Relative weight
Payment rate
National unadjusted copayment
Minimum unadjusted copyment0001
Level I Photochemotherapy
S
0.4896
30.14
7.00
6.030002
Level I Fine Needle Biopsy/Aspiration
T
1.0948
67.39

13.480003
Bone Marrow Biopsy/Aspiration
T
2.4295
149.54

29.910004
Level I Needle Biopsy/ Aspiration Except Bone Marrow
T
2.0863
128.41

25.680005
Level II Needle Biopsy/Aspiration Except Bone Marrow
T
3.8051
234.21
71.59
46.840006
Level I Incision  Drainage
T
1.4821
91.22
21.76
18.240007
Level II Incision  Drainage
T
10.9184
672.04

134.410008
Level III Incision and Drainage
T
17.4686
1,075.21

215.040009
Nail Procedures
T
0.6803
41.87

8.370010
Level I Destruction of Lesion
T
0.4829
29.72
8.14
5.940011
Level II Destruction of Lesion
T
2.6478
162.97

32.590012
Level I Debridement  Destruction
T
0.8076
49.71
10.30
9.940013
Level II Debridement  Destruction
T
1.0876
66.94

13.390015
Level III Debridement  Destruction
T
1.6062
98.86
20.13
19.770016
Level IV Debridement  Destruction
T
2.6253
161.59
32.68
32.320017
Level VI Debridement  Destruction
T
17.7392
1,091.87
227.84
218.370018
Biopsy of Skin/Puncture of Lesion
T
1.0534
64.84
15.87
12.970019
Level I Excision/ Biopsy
T
4.0123
246.96
71.87
49.390020
Level II Excision/ Biopsy
T
6.5128
400.87
98.57
80.170021
Level III Excision/ Biopsy
T
14.9563
920.58
219.48
184.120022
Level IV Excision/ Biopsy
T
19.9760
1,229.54
354.45
245.910023
Exploration Penetrating Wound
T
4.1133
253.18

50.640024
Level I Skin Repair
T
1.4924
91.86
30.08
18.370025
Level II Skin Repair
T
5.0931
313.49
95.46
62.700027
Level IV Skin Repair
T
21.2645
1,308.85
329.72
261.770028
Level I Breast Surgery
T
19.2250
1,183.32
303.74
236.660029
Level II Breast Surgery
T
28.1505
1,732.69

346.540030
Level III Breast Surgery
T
40.7495
2,508.17
763.55
501.630031
Smoking Cessation Services
X
0.1716
10.56

2.110033
Partial Hospitalization
P
3.3837
208.27

41.650035
Arterial/Venous Puncture
T
0.2016
12.41

2.480036
Level II Fine Needle Biopsy/Aspiration
T
2.0147
124.01

24.800037
Level IV Needle Biopsy/Aspiration Except Bone Marrow
T
10.2616
631.61
228.76
126.320038
Spontaneous MEG
S
51.2627
3,155.27

631.050039
Level I Implantation of Neurostimulator
S
175.9328
10,828.84

2,165.770040
Percutaneous Implantation of Neurostimulator Electrodes, Excluding Cranial Nerve
S
56.3855
3,470.58

694.120041
Level I Arthroscopy
T
28.6279
1,762.08

352.420042
Level II Arthroscopy
T
45.0637
2,773.72
804.74
554.740043
Closed Treatment Fracture Finger/Toe/Trunk
T
1.6914
104.11

20.820045
Bone/Joint Manipulation Under Anesthesia
T
14.5502
895.58
268.47
179.120047
Arthroplasty without Prosthesis
T
32.7543
2,016.06
537.03
403.210048
Level I Arthroplasty with Prosthesis
T
47.1644
2,903.02

580.600049
Level I Musculoskeletal Procedures Except Hand and Foot
T
20.8214
1,281.58

256.320050
Level II Musculoskeletal Procedures Except Hand and Foot
T
25.0600
1,542.47

308.490051
Level III Musculoskeletal Procedures Except Hand and Foot
T
41.2543
2,539.24

507.850052
Level IV Musculoskeletal Procedures Except Hand and Foot
T
65.8846
4,055.26

811.050053
Level I Hand Musculoskeletal Procedures
T
16.0343
986.93
253.49
197.390054
Level II Hand Musculoskeletal Procedures
T
25.8425
1,590.63

318.130055
Level I Foot Musculoskeletal Procedures
T
20.2255
1,244.90
355.34
248.980056
Level II Foot Musculoskeletal Procedures
T
41.2239
2,537.37

507.470057
Bunion Procedures
T
28.0970
1,729.40
475.91
345.880058
Level I Strapping and Cast Application
S
1.0504
64.65

12.930060
Manipulation Therapy
S
0.4904
30.18

6.040061
Laminectomy or Incision for Implantation of Neurostimulator Electrodes, Excluding Cranial Nerve
S
84.2373
5,184.89

1,036.980062
Level I Treatment Fracture/Dislocation
T
25.6702
1,580.03
375.46
316.010063
Level II Treatment Fracture/Dislocation
T
37.5680
2,312.35
549.49
462.470064
Level III Treatment Fracture/Dislocation
T
56.4195
3,472.68
825.22
694.540065
Level I Stereotactic Radiosurgery
S
22.4428
1,381.38

276.280066
Level II Stereotactic Radiosurgery
S
47.2213
2,906.52

581.300067
Level III Stereotactic Radiosurgery
S
65.7255
4,045.47

809.090068
CPAP Initiation
S
1.3718
84.44
29.48
16.890069
Thoracoscopy
T
31.5464
1,941.71
591.64
388.340070
Thoracentesis/Lavage Procedures
T
3.6425
224.20

44.840071
Level I Endoscopy Upper Airway
T
0.7572
46.61
11.03
9.320072
Level II Endoscopy Upper Airway
T
1.4038
86.41
21.27
17.280073
Level III Endoscopy Upper Airway
T
3.8737
238.43
69.72
47.690074
Level IV Endoscopy Upper Airway
T
15.1300
931.27
295.70
186.25( print page 49706)0075
Level V Endoscopy Upper Airway
T
21.8010
1,341.87
445.92
268.370076
Level I Endoscopy Lower Airway
T
9.3905
577.99
189.82
115.600077
Level I Pulmonary Treatment
S
0.3383
20.82
7.74
4.160078
Level II Pulmonary Treatment
S
1.0381
63.90
14.55
12.780079
Ventilation Initiation and Management
S
2.7732
170.69

34.140080
Diagnostic Cardiac Catheterization
T
37.1008
2,283.59
838.92
456.720081
Non-Coronary Angioplasty or Atherectomy
T
42.8894
2,639.89

527.980082
Coronary Atherectomy
T
76.2006
4,690.22
1,008.90
938.040083
Coronary Angioplasty and Percutaneous Valvuloplasty
T
57.4937
3,538.79

707.760084
Level I Electrophysiologic Evaluation
S
9.9197
610.57

122.110085
Level II Electrophysiologic Evaluation
T
34.7086
2,136.35

427.270086
Ablate Heart Dysrhythm Focus
T
47.1472
2,901.96
812.36
580.390087
Cardiac Electrophysiologic Recording/Mapping
T
32.8298
2,020.71

404.140088
Thrombectomy
T
37.9652
2,336.80
655.22
467.360089
Insertion/Replacement of Permanent Pacemaker and Electrodes
T
121.9402
7,505.54
1,682.28
1,501.110090
Insertion/Replacement of Pacemaker Pulse Generator
T
97.8357
6,021.89
1,612.80
1,204.380091
Level II Vascular Ligation
T
34.6279
2,131.38

426.280092
Level I Vascular Ligation
T
24.5817
1,513.03
306.56
302.610093
Vascular Reconstruction/Fistula Repair without Device
T
21.9703
1,352.29

270.460094
Level I Resuscitation and Cardioversion
S
2.4630
151.60
46.29
30.320095
Cardiac Rehabilitation
S
0.5792
35.65
13.86
7.130096
Non-Invasive Vascular Studies
S
1.5727
96.80
38.13
19.360097
Cardiac and Ambulatory Blood Pressure Monitoring
X
1.0245
63.06
23.79
12.610098
Injection of Sclerosing Solution
T
1.1035
67.92

13.580099
Electrocardiograms
S
0.3835
23.60

4.720100
Cardiac Stress Tests
X
2.5352
156.04
41.44
31.210101
Tilt Table Evaluation
S
4.3122
265.42
100.24
53.080103
Miscellaneous Vascular Procedures
T
17.0436
1,049.05
223.63
209.810104
Transcatheter Placement of Intracoronary Stents
T
87.9808
5,415.31

1,083.060105
Revision/Removal of Pacemakers, AICD, or Vascular
T
23.4666
1,444.39
370.40
288.880106
Insertion/Replacement/Repair of Pacemaker and/or Electrodes
T
44.7574
2,754.86

550.970107
Insertion of Cardioverter-Defibrillator
T
279.2049
17,185.34

3,437.070108
Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads
T
370.5535
22,807.94

4,561.590109
Removal of Implanted Devices
T
10.9541
674.24

134.850110
Transfusion
S
3.4570
212.78

42.560111
Blood Product Exchange
S
11.7005
720.18
198.40
144.040112
Apheresis, Photopheresis, and Plasmapheresis
S
30.6602
1,887.17
433.29
377.430113
Excision Lymphatic System
T
21.3673
1,315.18

263.040114
Thyroid/Lymphadenectomy Procedures
T
37.1283
2,285.28
461.19
457.060115
Cannula/Access Device Procedures
T
29.4757
1,814.26
378.68
362.850121
Level I Tube changes and Repositioning
T
2.3431
144.22
43.80
28.840122
Level II Tube changes and Repositioning
T
7.2859
448.45

89.690123
Bone Marrow Harvesting and Bone Marrow/Stem Cell Transplant
S
23.2490
1,431.00

286.200125
Refilling of Infusion Pump
T
2.2200
136.64

27.330126
Level I Urinary and Anal Procedures
T
1.0844
66.75
16.40
13.350127
Level IV Stereotactic Radiosurgery
S
126.8566
7,808.15

1,561.630130
Level I Laparoscopy
T
31.9353
1,965.65
659.53
393.130131
Level II Laparoscopy
T
43.5124
2,678.23
1,001.89
535.650132
Level III Laparoscopy
T
70.8854
4,363.07
1,239.22
872.610140
Esophageal Dilation without Endoscopy
T
5.3134
327.05
91.40
65.410141
Level I Upper GI Procedures
T
8.3070
511.30
143.38
102.260142
Small Intestine Endoscopy
T
9.3878
577.83
152.78
115.570143
Lower GI Endoscopy
T
8.8143
542.53
186.06
108.510146
Level I Sigmoidoscopy and Anoscopy
T
4.8005
295.48
64.40
59.100147
Level II Sigmoidoscopy and Anoscopy
T
8.5644
527.15

105.430148
Level I Anal/Rectal Procedures
T
4.8970
301.42

60.280149
Level III Anal/Rectal Procedures
T
22.2336
1,368.50
293.06
273.700150
Level IV Anal/Rectal Procedures
T
29.4386
1,811.98
437.12
362.400151
Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
T
19.8125
1,219.48
245.46
243.900152
Level I Percutaneous Abdominal and Biliary Procedures
T
19.4515
1,197.26

239.450153
Peritoneal and Abdominal Procedures
T
22.1758
1,364.94
397.95
272.990154
Hernia/Hydrocele Procedures
T
29.1491
1,794.16
464.85
358.830155
Level II Anal/Rectal Procedures
T
12.8778
792.64

158.530156
Level III Urinary and Anal Procedures
T
3.5688
219.66

43.930157
Colorectal Cancer Screening: Barium Enema
S
2.4974
153.72

30.740158
Colorectal Cancer Screening: Colonoscopy
T
7.8134
480.92

120.230159
Colorectal Cancer Screening: Flexible Sigmoidoscopy
S
3.8973
239.88

59.970160
Level I Cystourethroscopy and other Genitourinary Procedures
T
6.7325
414.39
105.06
82.880161
Level II Cystourethroscopy and other Genitourinary Procedures
T
19.2766
1,186.49
249.36
237.30( print page 49707)0162
Level III Cystourethroscopy and other Genitourinary Procedures
T
23.8562
1,468.37

293.670163
Level IV Cystourethroscopy and other Genitourinary Procedures
T
35.1024
2,160.59

432.120164
Level II Urinary and Anal Procedures
T
2.1159
130.24

26.050165
Level IV Urinary and Anal Procedures
T
18.2333
1,122.28

224.460166
Level I Urethral Procedures
T
18.5138
1,139.54

227.910168
Level II Urethral Procedures
T
28.5971
1,760.18
388.16
352.040169
Lithotripsy
T
44.1144
2,715.29
1,009.47
543.060170
Dialysis
S
6.8096
419.14

83.830171
Level V Anal/Rectal Procedures
T
37.2425
2,292.31
705.28
458.460180
Circumcision
T
20.7418
1,276.68
304.87
255.340181
Penile Procedures
T
32.9991
2,031.13
621.82
406.230183
Testes/Epididymis Procedures
T
23.7072
1,459.20

291.840184
Prostate Biopsy
T
5.9892
368.64
96.27
73.730188
Level II Female Reproductive Proc
T
1.4050
86.48

17.300189
Level III Female Reproductive Proc
T
2.9902
184.05

36.810190
Level I Hysteroscopy
T
21.4199
1,318.42
424.28
263.680191
Level I Female Reproductive Proc
T
0.1501
9.24

1.850192
Level IV Female Reproductive Proc
T
6.9265
426.33

85.270193
Level V Female Reproductive Proc
T
14.7958
910.70

182.140194
Level VIII Female Reproductive Proc
T
20.5113
1,262.49
397.84
252.500195
Level IX Female Reproductive Proc
T
28.7410
1,769.04
483.80
353.810196
Dilation and Curettage
T
17.7635
1,093.36
338.23
218.670197
Infertility Procedures
T
4.4108
271.49

54.300198
Pregnancy and Neonatal Care Procedures
T
1.4026
86.33
32.19
17.270200
Level VII Female Reproductive Proc
T
17.2607
1,062.41
248.39
212.480201
Level VI Female Reproductive Proc
T
18.5251
1,140.24
329.65
228.050202
Level X Female Reproductive Proc
T
42.8756
2,639.04
981.50
527.810203
Level IV Nerve Injections
T
12.4432
765.89
240.33
153.180204
Level I Nerve Injections
T
2.2491
138.43
40.13
27.690206
Level II Nerve Injections
T
5.5439
341.23
75.55
68.250207
Level III Nerve Injections
T
6.3788
392.62
86.92
78.520208
Laminotomies and Laminectomies
T
43.9030
2,702.27

540.450209
Level II MEG, Extended EEG Studies and Sleep Studies
S
11.4847
706.89
268.73
141.380212
Nervous System Injections
T
3.0383
187.01
65.96
37.400213
Level I MEG, Extended EEG Studies and Sleep Studies
S
2.3133
142.39
53.58
28.480214
Electroencephalogram
S
1.2353
76.03
28.24
15.210215
Level I Nerve and Muscle Tests
S
0.5760
35.45

7.090216
Level III Nerve and Muscle Tests
S
2.6729
164.52

32.900218
Level II Nerve and Muscle Tests
S
1.1993
73.82

14.760220
Level I Nerve Procedures
T
17.7609
1,093.20

218.640221
Level II Nerve Procedures
T
33.3035
2,049.86
463.62
409.970222
Implantation of Neurological Device
T
178.1307
10,964.12

2,192.820223
Implantation or Revision of Pain Management Catheter
T
29.2931
1,803.02

360.600224
Implantation of Reservoir/Pump/Shunt
T
45.6712
2,811.11

562.220225
Implantation of Neurostimulator Electrodes, Cranial Nerve
S
234.1628
14,412.95

2,882.590226
Implantation of Drug Infusion Reservoir
T
112.0147
6,894.62

1,378.920227
Implantation of Drug Infusion Device
T
183.1974
11,275.98

2,255.200228
Creation of Lumbar Subarachnoid Shunt
T
36.1603
2,225.70

445.140229
Transcatherter Placement of Intravascular Shunts
T
66.0804
4,067.31

813.460230
Level I Eye Tests  Treatments
S
0.8126
50.02
14.97
10.000231
Level III Eye Tests  Treatments
S
2.1934
135.01

27.000232
Level I Anterior Segment Eye Procedures
T
5.9800
368.07
92.21
73.610233
Level II Anterior Segment Eye Procedures
T
14.9969
923.07
266.33
184.610234
Level III Anterior Segment Eye Procedures
T
22.9479
1,412.47
511.31
282.490235
Level I Posterior Segment Eye Procedures
T
4.0750
250.82
61.14
50.160236
Level II Posterior Segment Eye Procedures
T
16.3433
1,005.95

201.190237
Level III Posterior Segment Eye Procedures
T
26.9305
1,657.60

331.520238
Level I Repair and Plastic Eye Procedures
T
2.8099
172.95

34.590239
Level II Repair and Plastic Eye Procedures
T
6.9354
426.88

85.380240
Level III Repair and Plastic Eye Procedures
T
17.0126
1,047.14
307.90
209.430241
Level IV Repair and Plastic Eye Procedures
T
24.8502
1,529.55
384.47
305.910242
Level V Repair and Plastic Eye Procedures
T
35.5217
2,186.40
597.36
437.280243
Strabismus/Muscle Procedures
T
21.2885
1,310.33
431.09
262.070244
Corneal Transplant
T
37.9446
2,335.53
803.26
467.110245
Level I Cataract Procedures without IOL Insert
T
14.5427
895.12
217.05
179.020246
Cataract Procedures with IOL Insert
T
23.5664
1,450.54
495.96
290.110247
Laser Eye Procedures Except Retinal
T
5.1266
315.55
104.31
63.110248
Laser Retinal Procedures
T
5.0285
309.51
95.08
61.900249
Level II Cataract Procedures without IOL Insert
T
28.5043
1,754.47
524.67
350.89( print page 49708)0250
Nasal Cauterization/Packing
T
1.2021
73.99
25.50
14.800251
Level I ENT Procedures
T
2.3768
146.29

29.260252
Level II ENT Procedures
T
7.7261
475.55
111.84
95.110253
Level III ENT Procedures
T
16.4494
1,012.48
282.29
202.500254
Level IV ENT Procedures
T
23.1564
1,425.30
321.35
285.060256
Level V ENT Procedures
T
37.7719
2,324.90

464.980257
Level I Therapeutic Radiologic Procedures
S
0.9770
60.14

12.030258
Tonsil and Adenoid Procedures
T
22.7757
1,401.87
437.25
280.370259
Level VI ENT Procedures
T
406.8232
25,040.37
8,698.43
5,008.070260
Level I Plain Film Except Teeth
X
0.7276
44.78

8.960261
Level II Plain Film Except Teeth Including Bone Density Measurement
X
1.2515
77.03

15.410262
Plain Film of Teeth
X
0.5818
35.81

7.160263
Level I Miscellaneous Radiology Procedures
X
1.7120
105.38
23.77
21.080264
Level II Miscellaneous Radiology Procedures
X
2.9791
183.37
70.84
36.670265
Level I Diagnostic and Screening Ultrasound
S
1.0145
62.44
23.63
12.490266
Level II Diagnostic and Screening Ultrasound
S
1.5947
98.16
37.80
19.630267
Level III Diagnostic and Screening Ultrasound
S
2.5166
154.90
60.80
30.980268
Level I Ultrasound Guidance Procedures
S
1.1967
73.66

14.730269
Level II Echocardiogram Except Transesophageal
S
3.2432
199.62
75.60
39.920270
Transesophageal Echocardiogram
S
6.2689
385.86
141.32
77.170272
Fluoroscopy
X
1.2985
79.92
31.64
15.980274
Myelography
S
2.6182
161.15
64.46
32.230275
Arthrography
S
3.7021
227.87
69.09
45.570276
Level I Digestive Radiology
S
1.4519
89.37
34.97
17.870277
Level II Digestive Radiology
S
2.2764
140.11
54.63
28.020278
Diagnostic Urography
S
2.4721
152.16
60.84
30.430279
Level II Angiography and Venography
S
9.6539
594.21
150.03
118.840280
Level III Angiography and Venography
S
20.9479
1,289.36
353.85
257.870282
Miscellaneous Computerized Axial Tomography
S
1.5552
95.72
37.92
19.140283
Computerized Axial Tomography with Contrast Material
S
4.1858
257.64
102.17
51.530284
Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contras
S
6.2589
385.24
148.40
77.050288
Bone Density:Axial Skeleton
S
1.2005
73.89

14.780293
Level V Anterior Segment Eye Procedures
T
50.6347
3,116.62
1,100.34
623.320296
Level II Therapeutic Radiologic Procedures
S
2.7106
166.84
53.99
33.370297
Level III Therapeutic Radiologic Procedures
S
3.6483
224.56
89.82
44.910298
Level IV Therapeutic Radiologic Procedures
S
8.4904
522.59
209.02
104.520299
Miscellaneous Radiation Treatment
S
6.0322
371.29

74.260300
Level I Radiation Therapy
S
1.5004
92.35

18.470301
Level II Radiation Therapy
S
2.2670
139.54

27.910302
Computer Assisted Navigational Procedures
S
5.5005
338.56
105.94
67.710303
Treatment Device Construction
X
2.9637
182.42
66.95
36.480304
Level I Therapeutic Radiation Treatment Preparation
X
1.6062
98.86
39.54
19.770305
Level II Therapeutic Radiation Treatment Preparation
X
4.0232
247.63
91.38
49.530307
Myocardial Positron Emission Tomography (PET) imaging
S
11.6773
718.75
287.49
143.750308
Non-Myocardial Positron Emission Tomography (PET) imaging
S
14.0093
862.29

172.460309
Level II Ultrasound Guidance Procedures
S
2.1284
131.01

26.200310
Level III Therapeutic Radiation Treatment Preparation
X
14.0578
865.27
325.27
173.050312
Radioelement Applications
S
5.0185
308.89

61.780313
Brachytherapy
S
13.3939
824.41

164.880314
Hyperthermic Therapies
S
3.6583
225.17
66.65
45.030315
Level II Implantation of Neurostimulator
T
235.5774
14,500.02

2,900.000320
Electroconvulsive Therapy
S
5.5017
338.64
80.06
67.730321
Biofeedback and Other Training
S
1.3693
84.28
21.72
16.860322
Brief Individual Psychotherapy
S
1.1749
72.32

14.460323
Extended Individual Psychotherapy
S
1.7170
105.68

21.140324
Family Psychotherapy
S
2.2087
135.95

27.190325
Group Psychotherapy
S
1.0787
66.40
14.51
13.280330
Dental Procedures
S
9.5891
590.22

118.040332
Computerized Axial Tomography and Computerized Angiography without Contras
S
3.1631
194.69
75.24
38.940333
Computerized Axial Tomography and Computerized Angiography without Contrast followed by Contrast
S
5.0020
307.88
121.52
61.580335
Magnetic Resonance Imaging, Miscellaneous
S
4.6629
287.01
114.80
57.400336
Magnetic Resonance Imaging and Magnetic Resonance Angiography without Cont
S
5.8500
360.07
139.68
72.010337
MRI and Magnetic Resonance Angiography without Contrast Material followed
S
8.3423
513.48
202.50
102.700339
Observation
S
7.1587
440.63

88.13( print page 49709)0340
Minor Ancillary Procedures
X
0.6211
38.23

7.650341
Skin Tests
X
0.0914
5.63
2.25
1.130342
Level I Pathology
X
0.0813
5.00
2.00
1.000343
Level III Pathology
X
0.5309
32.68
10.84
6.540344
Level IV Pathology
X
0.8107
49.90
15.66
9.980345
Level I Transfusion Laboratory Procedures
X
0.2218
13.65
2.87
2.730346
Level II Transfusion Laboratory Procedures
X
0.3494
21.51
4.39
4.300347
Level III Transfusion Laboratory Procedures
X
0.7394
45.51
11.24
9.100348
Fertility Laboratory Procedures
X
0.8928
54.95

10.990350
Administration of flu and PPV vaccine
S
0.4107
25.28
0.00
0.000360
Level I Alimentary Tests
X
1.3789
84.87
33.88
16.970361
Level II Alimentary Tests
X
3.9319
242.01
83.23
48.400362
Contact Lens and Spectacle Services
X
0.5328
32.79

6.560363
Level I Otorhinolaryngologic Function Tests
X
0.8534
52.53
17.44
10.510364
Level I Audiometry
X
0.4637
28.54
7.06
5.710365
Level II Audiometry
X
1.2467
76.74
18.52
15.350366
Level III Audiometry
X
1.8175
111.87
26.14
22.370367
Level I Pulmonary Test
X
0.6253
38.49
14.64
7.700368
Level II Pulmonary Tests
X
0.9568
58.89
22.77
11.780369
Level III Pulmonary Tests
X
2.8329
174.37
44.18
34.870370
Allergy Tests
X
1.0769
66.28

13.260372
Therapeutic Phlebotomy
X
0.5814
35.79
10.09
7.160373
Level I Neuropsychological Testing
X
1.6262
100.09

20.020374
Monitoring Psychiatric Drugs
X
1.1509
70.84

14.170375
Ancillary Outpatient Services When Patient Expires
S
57.3014
3,526.96

705.390376
Level II Cardiac Imaging
S
4.9770
306.34
119.77
61.270377
Level III Cardiac Imaging
S
6.7443
415.12
158.84
83.020378
Level II Pulmonary Imaging
S
5.2084
320.58
128.23
64.120379
Injection adenosine 6 MG
K

29.90

5.980381
Single Allergy Tests
X
0.2151
13.24

2.650382
Level II Neuropsychological Testing
X
2.7541
169.52
67.80
33.900384
GI Procedures with Stents
T
22.6777
1,395.84
292.31
279.170385
Level I Prosthetic Urological Procedures
S
79.3730
4,885.49

977.100386
Level II Prosthetic Urological Procedures
S
135.7295
8,354.29

1,670.860387
Level II Hysteroscopy
T
33.3029
2,049.83
655.55
409.970388
Discography
S
14.2706
878.37
289.72
175.670389
Level I Non-imaging Nuclear Medicine
S
1.4072
86.61
33.98
17.320390
Level I Endocrine Imaging
S
2.3732
146.07
58.42
29.210391
Level II Endocrine Imaging
S
2.7556
169.61
66.18
33.920392
Level II Non-imaging Nuclear Medicine
S
2.0849
128.33
51.33
25.670393
Red Cell/Plasma Studies
S
3.5902
220.98
82.04
44.200394
Hepatobiliary Imaging
S
4.4705
275.16
102.61
55.030395
GI Tract Imaging
S
3.6937
227.35
89.73
45.470396
Bone Imaging
S
4.0166
247.23
95.02
49.450397
Vascular Imaging
S
2.2521
138.62
49.58
27.720398
Level I Cardiac Imaging
S
4.2511
261.66
100.06
52.330399
Nuclear Medicine Add-on Imaging
S
1.5282
94.06
35.80
18.810400
Hematopoietic Imaging
S
3.9304
241.92
93.22
48.380401
Level I Pulmonary Imaging
S
3.2013
197.04
78.81
39.410402
Brain Imaging
S
4.8596
299.11
119.64
59.820403
CSF Imaging
S
3.4867
214.61
83.35
42.920404
Renal and Genitourinary Studies Level I
S
3.4235
210.72
84.28
42.140405
Renal and Genitourinary Studies Level II
S
4.1056
252.70
98.77
50.540406
Level I Tumor/Infection Imaging
S
3.9386
242.42
96.96
48.480407
Level I Radionuclide Therapy
S
3.1506
193.92
77.56
38.780408
Level II Tumor/Infection Imaging
S
4.9998
307.74

61.550409
Red Blood Cell Tests
X
0.1237
7.61
2.20
1.520411
Respiratory Procedures
S
0.3793
23.35

4.670412
IMRT Treatment Delivery
S
5.5021
338.66

67.730413
Level II Radionuclide Therapy
S
5.1026
314.07

62.810415
Level II Endoscopy Lower Airway
T
21.8803
1,346.75
459.92
269.350416
Level I Intravascular and Intracardiac Ultrasound and Flow Reserve
S
32.2182
1,983.06

396.610417
Computerized Reconstruction
S
3.1140
191.67

38.330418
Insertion of Left Ventricular Pacing Elect.
T
267.8870
16,488.71

3,297.740421
Prolonged Physiologic Monitoring
X
1.6486
101.47

20.290422
Level II Upper GI Procedures
T
27.5493
1,695.69
448.81
339.140423
Level II Percutaneous Abdominal and Biliary Procedures
T
39.0235
2,401.94

480.390425
Level II Arthroplasty with Prosthesis
T
105.1666
6,473.11
1,378.01
1,294.620426
Level II Strapping and Cast Application
S
2.2728
139.89

27.98( print page 49710)0427
Level III Tube Changes and Repositioning
T
11.5220
709.19

141.840428
Level III Sigmoidoscopy and Anoscopy
T
20.4902
1,261.19

252.240429
Level V Cystourethroscopy and other Genitourinary Procedures
T
42.9327
2,642.55

528.510432
Health and Behavior Services
S
0.6006
36.97

7.390433
Level II Pathology
X
0.2571
15.82
5.93
3.160434
Cardiac Defect Repair
T
87.3424
5,376.01

1,075.200436
Level I Drug Administration
S
0.1769
10.89

2.180437
Level II Drug Administration
S
0.4107
25.28

5.060438
Level III Drug Administration
S
0.7892
48.58

9.720439
Level IV Drug Administration
S
1.5841
97.50

19.500440
Level V Drug Administration
S
1.8285
112.55

22.510441
Level VI Drug Administration
S
2.5071
154.31

30.860442
Dosimetric Drug Administration
S
24.5410
1,510.52

302.100443
Overnight Pulse Oximetry
X
0.9939
61.18
24.47
12.240604
Level 1 Clinic Visits
V
0.8083
49.75

9.950605
Level 2 Clinic Visits
V
1.0057
61.90

12.380606
Level 3 Clinic Visits
V
1.3546
83.38

16.680607
Level 4 Clinic Visits
V
1.7080
105.13

21.030608
Level 5 Clinic Visits
V
2.1226
130.65

26.130609
Level 1 Type A Emergency Visits
V
0.8323
51.23

10.250613
Level 2 Type A Emergency Visits
V
1.3728
84.50

16.900614
Level 3 Type A Emergency Visits
V
2.1692
133.52

26.700615
Level 4 Type A Emergency Visits
V
3.4790
214.14

42.830616
Level 5 Type A Emergency Visits
V
5.3773
330.98

66.200617
Critical Care
S
8.0167
493.44

98.690621
Level I Vascular Access Procedures
T
8.7841
540.67

108.130622
Level II Vascular Access Procedures
T
22.6984
1,397.11

279.420623
Level III Vascular Access Procedures
T
28.4646
1,752.02

350.400624
Minor Vascular Access Device Procedures
X
0.5336
32.84
13.13
6.570648
Breast Reconstruction with Prosthesis
T
48.7796
3,002.43

600.490651
Complex Interstitial Radiation Source Application
S
16.6585
1,025.35

205.070652
Insertion of Intraperitoneal and Pleural Catheters
T
29.2259
1,798.88

359.780653
Vascular Reconstruction/Fistula Repair with Device
T
31.0004
1,908.11

381.620654
Insertion/Replacement of a permanent dual chamber pacemaker
T
112.2347
6,908.16

1,381.630655
Insertion/Replacement/Conversion of a permanent dual chamber pacemaker
T
153.1524
9,426.68

1,885.340656
Transcatheter Placement of Intracoronary Drug-Eluting Stents
T
106.8902
6,579.20

1,315.840657
Placement of Tissue Clips
S
1.7625
108.48

21.700658
Percutaneous Breast Biopsies
T
6.4482
396.89

79.380659
Hyperbaric Oxygen
S
1.5925
98.02

19.600660
Level II Otorhinolaryngologic Function Tests
X
1.4988
92.25
29.07
18.450661
Level V Pathology
X
2.6066
160.44
64.17
32.090662
CT Angiography
S
4.9203
302.85
118.88
60.570663
Level I Electronic Analysis of Neurostimulator Pulse Generators
S
1.0752
66.18
16.96
13.240664
Level I Proton Beam Radiation Therapy
S
18.4698
1,136.83

227.370665
Bone Density:AppendicularSkeleton
S
0.5569
34.28

6.860667
Level II Proton Beam Radiation Therapy
S
22.0972
1,360.10

272.020668
Level I Angiography and Venography
S
6.3684
391.98
88.26
78.400670
Level II Intravascular and Intracardiac Ultrasound and Flow Reserve
S
29.7322
1,830.05
536.10
366.010672
Level IV Posterior Segment Eye Procedures
T
36.8820
2,270.12

454.020673
Level IV Anterior Segment Eye Procedures
T
37.3057
2,296.20
649.56
459.240674
Prostate Cryoablation
T
107.8298
6,637.03

1,327.410675
Prostatic Thermotherapy
T
42.3176
2,604.69

520.940676
Thrombolysis and Thrombectomy
T
2.0612
126.87

25.370678
External Counterpulsation
T
1.7263
106.26

21.250679
Level II Resuscitation and Cardioversion
S
5.5435
341.21
95.30
68.240680
Insertion of Patient Activated Event Recorders
S
74.8877
4,609.41

921.880681
Knee Arthroplasty
T
173.0706
10,652.67

2,130.530682
Level V Debridement  Destruction
T
6.7529
415.65
158.65
83.130683
Level II Photochemotherapy
S
2.6902
165.58

33.120685
Level III Needle Biopsy/Aspiration Except Bone Marrow
T
6.0729
373.79
115.47
74.760686
Level III Skin Repair
T
13.3433
821.29

164.260687
Revision/Removal of Neurostimulator Electrodes
T
17.1830
1,057.63
423.05
211.530688
Revision/Removal of Neurostimulator Pulse Generator Receiver
T
33.9521
2,089.79
835.91
417.960689
Electronic Analysis of Cardioverter-defibrillators
S
0.5400
33.24

6.650690
Electronic Analysis of Pacemakers and other Cardiac Devices
S
0.3628
22.33
8.67
4.470691
Electronic Analysis of Programmable Shunts/Pumps
S
2.8253
173.90
60.61
34.780692
Level II Electronic Analysis of Neurostimulator Pulse Generators
S
1.9519
120.14
30.16
24.030693
Breast Reconstruction
T
37.4843
2,307.20
731.74
461.44( print page 49711)0694
Mohs Surgery
T
3.4844
214.47
58.14
42.890695
Level VII Debridement  Destruction
T
20.5802
1,266.73
266.59
253.350697
Level I Echocardiogram Except Transesophageal
S
1.6002
98.49
35.99
19.700698
Level II Eye Tests  Treatments
S
1.2244
75.36
16.52
15.070699
Level IV Eye Tests  Treatments
T
13.9509
858.69

171.740700
Antepartum Manipulation
T
2.8011
172.41

34.480701
Sr89 strontium
K

533.58

106.720702
Sm 153 lexidronm
K

1,316.41

263.280704
In111 satumomab
K

192.12

38.420705
Tc99m tetrofosmin
K

73.81

14.760722
Tc99m pentetate
K

56.77

11.350723
Co57/58
K

149.44

29.890724
Co57 cyano
K

63.74

12.750726
Dexrazoxane HCl injection
K

179.62

35.920728
Filgrastim 300 mcg injection
K

182.53

36.510730
Pamidronate disodium /30 MG
K

29.31

5.860731
Sargramostim injection
K

23.12

4.620732
Mesna injection
K

7.87

1.570735
Ampho b cholesteryl sulfate
K

12.00

2.400736
Amphotericin b liposome inj
K

17.40

3.480737
Nitrogen N-13 ammonia
K

230.77

46.150738
Rasburicase
K

110.36

22.070739
Tc99m depreotide
K

67.91

13.580740
Tc99m gluceptate
K

236.53

47.310741
Cr51 chromate
K

167.62

33.520742
Tc99m labeled rbc
K

132.95

26.590743
Tc99m mertiatide
K

180.08

36.020744
Plague vaccine, im
K

150.00

30.000750
Dolasetron mesylate
K

6.76

1.350763
Dolasetron mesylate oral
K

47.52

9.500764
Granisetron HCl injection
K

6.80

1.360765
Granisetron HCl 1 mg oral
K

37.08

7.420768
Ondansetron hcl injection
K

3.69

0.740769
Ondansetron HCl 8mg oral
K

34.21

6.840800
Leuprolide acetate /3.75 MG
K

440.36

88.070802
Etoposide oral 50 MG
K

32.73

6.550807
Aldesleukin/single use vial
K

734.10

146.820809
Bcg live intravesical vac
K

110.48

22.100810
Goserelin acetate implant
K

197.59

39.520811
Carboplatin injection
K

13.74

2.750812
Carmus bischl nitro inj
K

139.66

27.930814
Asparaginase injection
K

53.66

10.730820
Daunorubicin
K

23.36

4.670821
Daunorubicin citrate liposom
K

55.72

11.140823
Docetaxel
K

294.48

58.900827
Floxuridine injection
K

62.61

12.520828
Gemcitabine HCl
K

116.59

23.320830
Irinotecan injection
K

125.28

25.060831
Ifosfomide injection
K

54.19

10.840832
Idarubicin hcl injection
K

265.53

53.110834
Interferon alfa-2a inj
K

33.53

6.710835
Inj cosyntropin per 0.25 MG
K

63.55

12.710836
Interferon alfa-2b inj
K

13.54

2.710838
Interferon gamma 1-b inj
K

289.87

57.970840
Inj melphalan hydrochl 50 MG
K

1,190.81

238.160842
Fludarabine phosphate inj
K

230.11

46.020843
Pegaspargase/singl dose vial
K

1,596.00

319.200844
Pentostatin injection
K

2,000.96

400.190849
Rituximab cancer treatment
K

465.23

93.050850
Streptozocin injection
K

147.45

29.490851
Thiotepa injection
K

45.38

9.080852
Topotecan
K

780.54

156.110855
Vinorelbine tartrate/10 mg
K

22.04

4.410856
Porfimer sodium
K

2,481.76

496.350858
Inj cladribine per 1 MG
K

38.28

7.660860
Plicamycin (mithramycin) inj
K

173.66

34.730861
Leuprolide acetate injeciton
K

7.86

1.570862
Mitomycin 5 MG inj
K

18.82

3.760863
Paclitaxel injection
K

15.44

3.09( print page 49712)0864
Mitoxantrone hydrochl / 5 MG
K

336.76

67.350865
Interferon alfa-n3 inj
K

50.33

10.070868
Oral aprepitant
G

4.63

0.930876
Caffeine citrate injection
K

3.34

0.670884
Rho d immune globulin inj
K

97.11

19.420887
Azathioprine parenteral
K

48.73

9.750888
Cyclosporine oral 100 mg
K

3.88

0.780890
Lymphocyte immune globulin
K

295.38

59.080891
Tacrolimus oral per 1 MG
K

3.40

0.680892
Edetate calcium disodium inj
K

39.80

7.960895
Deferoxamine mesylate inj
K

14.77

2.950900
Alglucerase injection
K

38.85

7.770901
Alpha 1 proteinase inhibitor
K

3.21

0.640902
Botulinum toxin a per unit
K

4.85

0.970903
Cytomegalovirus imm IV /vial
K

755.79

151.160906
RSV-ivig
K

16.02

3.200910
Interferon beta-1b / .25 MG
K

91.34

18.270911
Inj streptokinase /250000 IU
K

78.75

15.750912
Interferon alfacon-1
K

3.92

0.780913
Ganciclovir long act implant
K

4,200.00

840.000916
Injection imiglucerase /unit
K

3.87

0.770917
Adenosine injection
K

69.41

13.880925
Factor viii
K

0.68

0.140926
Factor VIII (porcine)
K

0.66

0.130927
Factor viii recombinant
K

1.05

0.210928
Factor ix complex
K

0.63

0.130929
Anti-inhibitor
K

1.29

0.260930
Antithrombin iii injection
K

1.62

0.320931
Factor IX non-recombinant
K

0.88

0.180932
Factor IX recombinant
K

0.98

0.200935
Clonidine hydrochloride
K

62.71

12.540949
Frozen plasma, pooled, sd
K
0.9060
55.77

11.150950
Whole blood for transfusion
K
2.1824
134.33

26.870952
Cryoprecipitate each unit
K
0.8571
52.76

10.550954
RBC leukocytes reduced
K
2.8738
176.89

35.380955
Plasma, frz between 8-24 hour
K
1.1864
73.02

14.600956
Plasma protein fract,5%,50ml
K
0.4016
24.72

4.940957
Platelets, each unit
K
0.9794
60.28

12.060958
Plaelet rich plasma unit
K
2.5336
155.95

31.190959
Red blood cells unit
K
2.1045
129.53

25.910960
Washed red blood cells unit
K
3.5028
215.60

43.120961
Albumin (human),5%, 50ml
K

25.48

5.100963
Albumin (human), 5%, 250 ml
K

72.09

14.420964
Albumin (human), 25%, 20 ml
K

26.79

5.360965
Albumin (human), 25%, 50ml
K

61.77

12.350966
Plasmaprotein fract,5%,250ml
K
3.1309
192.71

38.540967
Blood split unit
K
2.2087
135.95

27.190968
Platelets leukoreduced irrad
K
2.1192
130.44

26.090969
RBC leukoreduced irradiated
K
3.7037
227.97

45.591009
Cryoprecipitatereducedplasma
K
1.2990
79.95

15.991010
Blood, l/r, cmv-neg
K
2.1991
135.36

27.071011
Platelets, hla-m, l/r, unit
K
10.5084
646.80

129.361013
Platelets leukocytes reduced
K
1.5318
94.28

18.861016
Blood, l/r, froz/degly/wash
K
1.4462
89.02

17.801017
Plt, aph/pher, l/r, cmv-neg
K
6.1508
378.59

75.721018
Blood, l/r, irradiated
K
2.1765
133.97

26.791019
Plate pheres leukoredu irrad
K
9.9841
614.53

122.911020
Plt, pher, l/r cmv-neg, irr
K
11.7025
720.30

144.061021
RBC, frz/deg/wsh, l/r, irrad
K
6.9189
425.87

85.171022
RBC, l/r, cmv-neg, irrad
K
4.2818
263.55

52.711045
I131 iodobenguate, dx
K

429.55

85.911052
Injection, voriconazole
K

4.55

0.911064
Th I131 so iodide cap millic
K

14.54

2.911083
Adalimumab injection
K

304.40

60.881084
Denileukin diftitox, 300 mcg
K

1,391.05

278.211086
Temozolomide
K

7.16

1.431088
Iodine I-131 iodide cap, dx
K

24.86

4.971096
Tc99m exametazime
K

317.07

63.411150
I131 iodide sol, rx
K

12.60

2.52( print page 49713)1166
Cytarabine liposome
K

374.75

74.951167
Inj, epirubicin hcl, 2 mg
K

24.47

4.891178
BUSULFAN IV, 6 Mg
K

24.87

4.971203
Verteporfin injection
K

8.89

1.781207
Octreotide injection, depot
K

89.50

17.901280
Corticotropin injection
K

108.85

21.771330
Ergonovine maleate injection
K

27.56

5.511436
Etidronate disodium inj
K

70.73

14.151491
New Technology—Level IA ($0-$10)
S

5.00

1.001492
New Technology—Level IB ($10-$20)
S

15.00

3.001493
New Technology—Level IC ($20-$30)
S

25.00

5.001494
New Technology—Level ID ($30-$40)
S

35.00

7.001495
New Technology—Level IE ($40-$50)
S

45.00

9.001496
New Technology—Level IA ($0-$10)
T

5.00

1.001497
New Technology—Level IB($10-$20)
T

15.00

3.001498
New Technology—Level IC ($20-$30)
T

25.00

5.001499
New Technology—Level ID($30-$40)
T

35.00

7.001500
New Technology—Level IE ($40-$50)
T

45.00

9.001502
New Technology—Level II ($50-$100)
S

75.00

15.001503
New Technology—Level III ($100-$200)
S

150.00

30.001504
New Technology—Level IV ($200-$300)
S

250.00

50.001505
New Technology—Level V ($300-$400)
S

350.00

70.001506
New Technology—Level VI ($400-$500)
S

450.00

90.001507
New Technology—Level VII ($500-$600)
S

550.00

110.001508
New Technology—Level VIII ($600-$700)
S

650.00

130.001509
New Technology—Level IX ($700-$800)
S

750.00

150.001510
New Technology—Level X ($800-$900)
S

850.00

170.001511
New Technology—Level XI ($900-$1000)
S

950.00

190.001512
New Technology—Level XII ($1000-$1100)
S

1,050.00

210.001513
New Technology—Level XIII ($1100-$1200)
S

1,150.00

230.001514
New Technology—Level XIV ($1200-$1300)
S

1,250.00

250.001515
New Technology—Level XV ($1300-$1400)
S

1,350.00

270.001516
New Technology—Level XVI ($1400-$1500)
S

1,450.00

290.001517
New Technology—Level XVII ($1500-$1600)
S

1,550.00

310.001518
New Technology—Level XVIII ($1600-$1700)
S

1,650.00

330.001519
New Technology—Level IXX ($1700-$1800)
S

1,750.00

350.001520
New Technology—Level XX ($1800-$1900)
S

1,850.00

370.001521
New Technology—Level XXI ($1900-$2000)
S

1,950.00

390.001522
New Technology—Level XXII ($2000-$2500)
S

2,250.00

450.001523
New Technology—Level XXIII ($2500-$3000)
S

2,750.00

550.001524
New Technology—Level XIV ($3000-$3500)
S

3,250.00

650.001525
New Technology—Level XXV ($3500-$4000)
S

3,750.00

750.001526
New Technology—Level XXVI ($4000-$4500)
S

4,250.00

850.001527
New Technology—Level XXVII ($4500-$5000)
S

4,750.00

950.001528
New Technology—Level XXVIII ($5000-$5500)
S

5,250.00

1,050.001529
New Technology—Level XXIX ($5500-$6000)
S

5,750.00

1,150.001530
New Technology—Level XXX ($6000-$6500)
S

6,250.00

1,250.001531
New Technology—Level XXXI ($6500-$7000)
S

6,750.00

1,350.001532
New Technology—Level XXXII ($7000-$7500)
S

7,250.00

1,450.001533
New Technology—Level XXXIII ($7500-$8000)
S

7,750.00

1,550.001534
New Technology—Level XXXIV ($8000-$8500)
S

8,250.00

1,650.001535
New Technology—Level XXXV ($8500-$9000)
S

8,750.00

1,750.001536
New Technology—Level XXXVI ($9000-$9500)
S

9,250.00

1,850.001537
New Technology—Level XXXVII ($9500-$10000)
S

9,750.00

1,950.001539
New Technology—Level II ($50-$100)
T

75.00

15.001540
New Technology—Level III ($100-$200)
T

150.00

30.001541
New Technology—Level IV ($200-$300)
T

250.00

50.001542
New Technology—Level V ($300-$400)
T

350.00

70.001543
New Technology—Level VI ($400-$500)
T

450.00

90.001544
New Technology—Level VII ($500—$600)
T

550.00

110.001545
New Technology—Level VIII ($600-$700)
T

650.00

130.001546
New Technology—Level IX ($700-$800)
T

750.00

150.001547
New Technology—Level X ($800-$900)
T

850.00

170.001548
New Technology—Level XI ($900-$1000)
T

950.00

190.001549
New Technology—Level XII ($1000-$1100)
T

1,050.00

210.001550
New Technology—Level XIII ($1100-$1200)
T

1,150.00

230.001551
New Technology—Level XIV ($1200-$1300)
T

1,250.00

250.001552
New Technology—Level XV ($1300-$1400)
T

1,350.00

270.001553
New Technology—Level XVI ($1400-$1500)
T

1,450.00

290.00( print page 49714)1554
New Technology—Level XVII ($1500-$1600)
T

1,550.00

310.001555
New Technology—Level XVIII ($1600-$1700)
T

1,650.00

330.001556
New Technology—Level XIX ($1700-$1800)
T

1,750.00

350.001557
New Technology—Level XX ($1800-$1900)
T

1,850.00

370.001558
New Technology—Level XXI ($1900-$2000)
T

1,950.00

390.001559
New Technology—Level XXII ($2000-$2500)
T

2,250.00

450.001560
New Technology—Level XXIII ($2500-$3000)
T

2,750.00

550.001561
New Technology—Level XXIV ($3000-$3500)
T

3,250.00

650.001562
New Technology—Level XXV ($3500-$4000)
T

3,750.00

750.001563
New Technology—Level XXVI ($4000-$4500)
T

4,250.00

850.001564
New Technology—Level XXVII ($4500-$5000)
T

4,750.00

950.001565
New Technology—Level XXVIII ($5000-$5500)
T

5,250.00

1,050.001566
New Technology—Level XXIX ($5500-$6000)
T

5,750.00

1,150.001567
New Technology—Level XXX ($6000-$6500)
T

6,250.00

1,250.001568
New Technology—Level XXXI ($6500-$7000)
T

6,750.00

1,350.001569
New Technology—Level XXXII ($7000-$7500)
T

7,250.00

1,450.001570
New Technology—Level XXXIII ($7500-$8000)
T

7,750.00

1,550.001571
New Technology—Level XXXIV ($8000-$8500)
T

8,250.00

1,650.001572
New Technology—Level XXXV ($8500-$9000)
T

8,750.00

1,750.001573
New Technology—Level XXXVI ($9000-$9500)
T

9,250.00

1,850.001574
New Technology—Level XXXVII ($9500-$10000)
T

9,750.00

1,950.001600
Tc99m sestamibi
K

82.58

16.521603
TL201 thallium
K

27.18

5.441604
In111 capromab
K

928.19

185.641605
Abciximab injection
K

452.96

90.591606
Injection anistreplase 30 u
K

2,265.46

453.091607
Eptifibatide injection
K

13.31

2.661608
Etanercept injection
K

154.12

30.821609
Rho(D) immune globulin h, sd
K

13.57

2.711611
Hylan G-F 20 injection
K

196.99

39.401612
Daclizumab, parenteral
K

345.07

69.011613
Trastuzumab
K

54.59

10.921629
Nonmetabolic act d/e tissue
K

15.20

3.041630
Hep b ig, im
K

118.61

23.721631
Baclofen intrathecal trial
K

70.20

14.041632
Metabolic active D/E tissue
K

27.56

5.511633
Alefacept
K

26.03

5.211642
In111 ibritumomab, dx
K

1,344.34

268.871643
Y90 ibritumomab, rx
K

12,130.20

2,426.041644
I131 tositumomab, dx
K

1,368.17

273.631645
I131 tositumomab, rx
K

11,868.78

2,373.761646
In111 oxyquinoline
K

306.51

61.301647
In111 pentetate
K

262.81

52.561648
Tc99m arcitumomab
K

255.95

51.191650
Tc99m succimer
K

84.79

16.961651
F18 fdg
K

235.56

47.111654
Rb82 rubidium
K

239.83

47.971655
Tinzaparin sodium injection
K

2.18

0.441670
Tetanus immune globulin inj
K

90.71

18.141671
Ga67 gallium
K

22.73

4.551672
Tc99m bicisate
K

254.46

50.891675
P32 Na phosphate
K

117.11

23.421676
P32 chromic phosphate
K

222.35

44.471677
In111 pentetreotide
K

185.60

37.121678
Tc99m fanolesomab
K

527.31

105.461680
Acetylcysteine injection
K

1.86

0.371682
Aprotonin, 10,000 kiu
K

2.32

0.461683
Basiliximab
K

1,388.81

277.761684
Corticorelin ovine triflutal
K

4.22

0.841685
Darbepoetin alfa, non-esrd
K

3.00

0.601686
Epoetin alfa, non-esrd
K

9.25

1.851687
Digoxin immune fab (ovine)
K

527.46

105.491688
Ethanolamine oleate
K

71.57

14.311689
Fomepizole
K

11.82

2.361690
Hemin
K

6.59

1.321691
Iron dextran 165 injection
K

12.30

2.461692
Iron dextran 267 injection
K

10.17

2.031693
Lepirudin
K

146.38

29.281694
Ziconotide injection
G

6.20

1.24( print page 49715)1695
Nesiritide injection
K

29.72

5.941696
Palifermin injection
K

11.37

2.271697
Pegaptanib sodium injection
G

1,107.54

221.511700
Inj secretin synthetic human
K

20.31

4.061701
Treprostinil injection
K

53.51

10.701703
Ovine, 1000 USP units
K

133.77

26.751704
Inj Vonwillebrand factor iu
K

0.87

0.171705
Factor viia
K

1.08

0.221707
Non-human, metabolic tissue
K

1.64

0.331709
Azacitidine injection
K

4.09

0.821710
Clofarabine injection
G

116.68

23.341711
Histrelin implant
K

2,019.82

403.961712
Paclitaxel injection
G

8.73

1.751713
Inj Fe-based MR contrast,1ml
K

30.12

6.021716
Brachytx source, Gold 198
K
0.4493
27.65

5.531717
Brachytx source, HDR Ir-192
K
2.1922
134.93

26.991718
Brachytx source, Iodine 125
K
0.5754
35.42

7.081719
Brachytx sour, Non-HDR Ir-192
K
0.5108
31.44

6.291720
Brachytx sour, Palladium 103
K
0.7945
48.90

9.781738
Oxaliplatin
K

8.47

1.691739
Pegademase bovine, 25 iu
K

164.50

32.901740
Diazoxide injection
K

110.88

22.181741
Urofollitropin, 75 iu
K

48.84

9.771820
Generator neuro rechg bat sys
H2210
Methyldopate hcl injection
K

9.86

1.972616
Brachytx source, Yttrium-90
K
272.7710
16,789.33

3,357.872632
Brachytx sol, I-125, per mCi
K
0.3139
19.32

3.862633
Brachytx source, Cesium-131
K
1.4622
90.00

18.002634
Brachytx source, HA, I-125
K
0.4172
25.68

5.142635
Brachytx source, HA, P-103
K
0.8820
54.29

10.862636
Brachytx linear source, P-103
K
0.6360
39.15

7.832637
Brachytx, Ytterbium-169
K
0.4172
25.68

5.142731
Immune globulin, powder
K

22.05

4.412732
Immune globulin, liquid
K

28.82

5.762770
Quinupristin/dalfopristin
K

108.03

21.612940
Somatrem injection
K

583.74

116.753030
Sumatriptan succinate / 6 MG
K

51.75

10.353032
Dtp/hib vaccine, im
K

68.91

13.783038
Inj biperiden lactate/5 mg
K

88.36

17.673039
Inj metaraminol bitartrate
K

17.68

3.543040
Penicillin g benzathine inj
K

67.86

13.573041
Bivalirudin
K

1.62

0.323042
Foscarnet sodium injection
K

10.69

2.143043
Gamma globulin 1 CC inj
K

10.59

2.123045
Meropenem
K

3.76

0.753046
Octreotide inj, non-depot
K

4.34

0.873047
Melphalan oral 2 MG
K

4.39

0.883048
Doxorubic hcl 10 MG vl chemo
K

6.23

1.253049
Cyclophosphamide lyophilized
K

5.47

1.093050
Sermorelin acetate injection
K

1.73

0.357000
Amifostine
K

448.41

89.687005
Gonadorelin hydroch/ 100 mcg
K

178.59

35.727011
Oprelvekin injection
K

243.39

48.687015
Oral busulfan
K

1.95

0.397028
Fosphenytoin, 50 mg
K

5.18

1.047034
Somatropin injection
K

43.73

8.757035
Teniposide, 50 mg
K

264.26

52.857036
Urokinase 250,000 IU inj
K

453.41

90.687038
Monoclonal antibodies
K

860.94

172.197041
Tirofiban HCl
K

7.61

1.527042
Capecitabine, oral, 150 mg
K

3.60

0.727043
Infliximab injection
K

53.73

10.757045
Inj trimetrexate glucoronate
K

144.39

28.887046
Doxorubicin hcl liposome inj
K

367.56

73.517048
Alteplase recombinant
K

31.06

6.217049
Filgrastim 480 mcg injection
K

289.59

57.927051
Leuprolide acetate implant
K

2,157.81

431.567308
Aminolevulinic acid hcl top
K

99.92

19.987316
Sodium hyaluronate injection
K

112.04

22.41( print page 49716)9001
Linezolid injection
K

23.50

4.709002
Tenecteplase injection
K

2,059.01

411.809003
Palivizumab, per 50 mg
K

609.62

121.929004
Gemtuzumab ozogamicin
K

2,265.57

453.119005
Reteplase injection
K

754.71

150.949006
Tacrolimus injection
K

135.17

27.039012
Arsenic trioxide
K

32.92

6.589015
Mycophenolate mofetil oral
K

2.50

0.509018
Botulinum toxin type B
K

7.85

1.579019
Caspofungin acetate
K

32.19

6.449020
Sirolimus, oral
K

6.84

1.379022
IM inj interferon beta 1-a
K

97.99

19.609023
Rho d immune globulin 50 mcg
K

14.13

2.839024
Amphotericin b lipid complex
K

11.10

2.229031
Arbutamine HCl injection
K

160.00

32.009032
Baclofen 10 MG injection
K

191.50

38.309033
Cidofovir injection
K

757.03

151.419038
Inj estrogen conjugate 25 MG
K

57.78

11.569040
Intraocular Fomivirsen na
K

210.00

42.009042
Glucagon hydrochloride/1 MG
K

62.42

12.489044
Ibutilide fumarate injection
K

249.01

49.809046
Iron sucrose injection
K

0.36

0.079047
Itraconazole injection
K

36.23

7.259051
Urea injection
K

69.10

13.829054
Metabolically active tissue
K

15.01

3.009100
I131 serum albumin, dx
K

36.78

7.369104
Antithymocyte globuln rabbit
K

301.48

60.309108
Thyrotropin injection
K

766.61

153.329110
Alemtuzumab injection
K

525.75

105.159112
Inj perflutren lip micros,ml
K

61.25

12.259115
Zoledronic acid
K

200.82

40.169119
Injection, pegfilgrastim 6mg
K

2,142.79

428.569120
Injection, Fulvestrant
K

80.31

16.069121
Injection, argatroban
K

16.40

3.289122
Triptorelin pamoate
K

300.90

60.189124
Daptomycin injection
K

0.31

0.069125
Risperidone, long acting
K

4.73

0.959126
Natalizumab injection
G

6.39

1.289133
Rabies ig, im/sc
K

63.98

12.809134
Rabies ig, heat treated
K

68.58

13.729135
Varicella-zoster ig, im
K

149.08

29.829137
Bcg vaccine, percut
K

115.46

23.099139
Rabies vaccine, im
K

155.25

31.059140
Rabies vaccine, id
K

118.49

23.709141
Measles-rubella vaccine, sc
K

44.62

8.929142
Chicken pox vaccine, sc
K

66.84

13.379143
Meningococcal vaccine, sc
K

84.46

16.899144
Encephalitis vaccine, sc
K

99.15

19.839145
Meningococcal vaccine, im
K

143.12

28.629148
I123 iodide cap, dx
K

27.44

5.499156
Nonmetabolic active tissue
K

66.39

13.289157
LOCM  = 149 mg/ml iodine, 1ml
K

0.30

0.069158
LOCM 150-199mg/ml iodine,1ml
K

1.84

0.379159
LOCM 200-249mg/ml iodine,1ml
K

1.25

0.259160
LOCM 250-299mg/ml iodine,1ml
K

0.32

0.069161
LOCM 300-349mg/ml iodine,1ml
K

0.34

0.079162
LOCM 350-399mg/ml iodine,1ml
K

0.21

0.049163
LOCM  = 400 mg/ml iodine,1ml
K

0.30

0.069164
Inj Gad-base MR contrast,1ml
K

2.88

0.589165
Oral MR contrast
K

8.87

1.779167
Valrubicin
K

76.03

15.219202
Inj octafluoropropane mic,ml
K

40.75

8.159203
Inj perflexane lip micros,ml
K

8.22

1.649207
Bortezomib injection
K

29.81

5.969208
Agalsidase beta injection
K

126.00

25.209209
Laronidase injection
K

23.64

4.739210
Palonosetron HCl
K

17.51

3.509213
Pemetrexed injection
K

40.90

8.189214
Bevacizumab injection
K

56.36

11.27( print page 49717)9215
Cetuximab injection
K

49.39

9.889216
Abarelix injection
K

66.20

13.249217
Leuprolide acetate suspnsion
K

242.99

48.609219
Mycophenolic acid
K

2.15

0.439220
Sodium hyaluronate
K

197.62

39.529222
Graftjacket SftTis
K

883.78

176.769224
Injection, galsulfase
K

1,503.23

300.659225
Fluocinolone acetonide
G

19,345.00

3,869.009227
Injection, micafungin sodium
G

1.98

0.409228
Injection, tigecycline
G

0.96

0.199300
Omalizumab injection
K

16.34

3.279500
Platelets, irradiated
K
2.0957
128.99

25.809501
Platelet pheres leukoreduced
K
7.9414
488.80

97.769502
Platelet pheresis irradiated
K
6.6959
412.14

82.439503
Fr frz plasma donor retested
K
1.1915
73.34

14.679504
RBC deglycerolized
K
5.7106
351.49

70.309505
RBC irradiated
K
3.2600
200.66

40.139506
Granulocytes, pheresis unit
K
4.1030
252.54

50.519507
Platelets, pheresis
K
7.5381
463.98

92.809508
Plasma 1 donor frz w/in 8 hr
K
1.1677
71.87

14.37
 Addendum AA.—Proposed List of Medicare Approved ASC Procedures for CY 2007 With Additions and Payment Rates;  Including Rates That Result From Implementation of  Section 5103 of the DRA
HCPCS
Short Descriptor
ASC Payment Group
OPPS Payment Rate
ASC Payment Rate
DRA Cap
ASC Copayment Amount10121
Remove foreign body
2
$920.58
$446.00

$89.2010180
Complex drainage, wound
2
$1,075.21
$446.00

$89.2011010
Debride skin, fx
2
$246.96
$246.96
Y
$49.3911011
Debride skin/muscle, fx
2
$246.96
$246.96
Y
$49.3911012
Debride skin/muscle/bone, fx
2
$246.96
$246.96
Y
$49.3911042
Debride skin/tissue
2
$161.59
$161.59
Y
$32.3211043
Debride tissue/muscle
2
$161.59
$161.59
Y
$32.3211044
Debride tissue/muscle/bone
2
$415.65
$415.65
Y
$83.1311404
Exc tr-ext b9+marg 3.1-4 cm
1
$920.58
$333.00

$66.6011406
Exc tr-ext b9+marg  4.0 cm
2
$920.58
$446.00

$89.2011424
Exc h-f-nk-sp b9+marg 3.1-4
2
$920.58
$446.00

$89.2011426
Exc h-f-nk-sp b9+marg  4 cm
2
$1,229.54
$446.00

$89.2011444
Exc face-mm b9+marg 3.1-4 cm
1
$400.87
$333.00

$66.6011446
Exc face-mm b9+marg  4 cm
2
$1,229.54
$446.00

$89.2011450
Removal, sweat gland lesion
2
$1,229.54
$446.00

$89.2011451
Removal, sweat gland lesion
2
$1,229.54
$446.00

$89.2011462
Removal, sweat gland lesion
2
$1,229.54
$446.00

$89.2011463
Removal, sweat gland lesion
2
$1,229.54
$446.00

$89.2011470
Removal, sweat gland lesion
2
$1,229.54
$446.00

$89.2011471
Removal, sweat gland lesion
2
$1,229.54
$446.00

$89.2011604
Exc tr-ext mlg+marg 3.1-4 cm
2
$400.87
$400.87
Y
$80.1711606
Exc tr-ext mlg+marg  4 cm
2
$920.58
$446.00

$89.2011624
Exc h-f-nk-sp mlg+marg 3.1-4
2
$920.58
$446.00

$89.2011626
Exc h-f-nk-sp mlg+mar  4 cm
2
$1,229.54
$446.00

$89.2011644
Exc face-mm malig+marg 3.1-4
2
$920.58
$446.00

$89.2011646
Exc face-mm mlg+marg  4 cm
2
$1,229.54
$446.00

$89.2011770
Removal of pilonidal lesion
3
$1,229.54
$510.00

$102.0011771
Removal of pilonidal lesion
3
$1,229.54
$510.00

$102.0011772
Removal of pilonidal lesion
3
$1,229.54
$510.00

$102.0011960
Insert tissue expander(s)
2
$1,308.85
$446.00

$89.2011970
Replace tissue expander
3
$2,539.24
$510.00

$102.0011971
Remove tissue expander(s)
1
$1,229.54
$333.00

$66.6012005
Repair superficial wound(s)
2
$91.86
$91.86
Y
$18.3712006
Repair superficial wound(s)
2
$91.86
$91.86
Y
$18.3712007
Repair superficial wound(s)
2
$91.86
$91.86
Y
$18.3712016
Repair superficial wound(s)
2
$91.86
$91.86
Y
$18.3712017
Repair superficial wound(s)
2
$91.86
$91.86
Y
$18.3712018
Repair superficial wound(s)
2
$91.86
$91.86
Y
$18.3712020
Closure of split wound
1
$91.86
$91.86
Y
$18.3712021
Closure of split wound
1
$91.86
$91.86
Y
$18.37( print page 49718)12034
Layer closure of wound(s)
2
$91.86
$91.86
Y
$18.3712035
Layer closure of wound(s)
2
$91.86
$91.86
Y
$18.3712036
Layer closure of wound(s)
2
$91.86
$91.86
Y
$18.3712037
Layer closure of wound(s)
2
$313.49
$313.49
Y
$62.7012044
Layer closure of wound(s)
2
$91.86
$91.86
Y
$18.3712045
Layer closure of wound(s)
2
$91.86
$91.86
Y
$18.3712046
Layer closure of wound(s)
2
$91.86
$91.86
Y
$18.3712047
Layer closure of wound(s)
2
$313.49
$313.49
Y
$62.7012054
Layer closure of wound(s)
2
$91.86
$91.86
Y
$18.3712055
Layer closure of wound(s)
2
$91.86
$91.86
Y
$18.3712056
Layer closure of wound(s)
2
$91.86
$91.86
Y
$18.3712057
Layer closure of wound(s)
2
$313.49
$313.49
Y
$62.7013100
Repair of wound or lesion
2
$313.49
$313.49
Y
$62.7013101
Repair of wound or lesion
3
$313.49
$313.49
Y
$62.7013102
Repair wound/lesion add-on
1
$91.86
$91.86
Y
$18.3713120
Repair of wound or lesion
2
$91.86
$91.86
Y
$18.3713121
Repair of wound or lesion
3
$91.86
$91.86
Y
$18.3713122
Repair wound/lesion add-on
1
$91.86
$91.86
Y
$18.3713131
Repair of wound or lesion
2
$91.86
$91.86
Y
$18.3713132
Repair of wound or lesion
3
$91.86
$91.86
Y
$18.3713133
Repair wound/lesion add-on
1
$91.86
$91.86
Y
$18.3713150
Repair of wound or lesion
3
$313.49
$313.49
Y
$62.7013151
Repair of wound or lesion
3
$91.86
$91.86
Y
$18.3713152
Repair of wound or lesion
3
$313.49
$313.49
Y
$62.7013160
Late closure of wound
2
$1,308.85
$446.00

$89.2014000
Skin tissue rearrangement
2
$821.29
$446.00

$89.2014001
Skin tissue rearrangement
3
$1,308.85
$510.00

$102.0014020
Skin tissue rearrangement
3
$821.29
$510.00

$102.0014021
Skin tissue rearrangement
3
$821.29
$510.00

$102.0014040
Skin tissue rearrangement
2
$821.29
$446.00

$89.2014041
Skin tissue rearrangement
3
$821.29
$510.00

$102.0014060
Skin tissue rearrangement
3
$821.29
$510.00

$102.0014061
Skin tissue rearrangement
3
$821.29
$510.00

$102.0014300
Skin tissue rearrangement
4
$1,308.85
$630.00

$126.0014350
Skin tissue rearrangement
3
$1,308.85
$510.00

$102.0015000
Wound prep, 1st 100 sq cm
2
$313.49
$313.49
Y
$62.7015001
Wound prep, addl 100 sq cm
1
$313.49
$313.49
Y
$62.7015040
Harvest cultured skin graft
2
$91.86
$91.86
Y
$18.3715050
Skin pinch graft
2
$313.49
$313.49
Y
$62.7015100
Skin splt grft, trnk/arm/leg
2
$1,308.85
$446.00

$89.2015101
Skin splt grft t/a/l, add-on
3
$1,308.85
$510.00

$102.0015110
Epidrm autogrft trnk/arm/leg
2
$1,308.85
$446.00

$89.2015111
Epidrm autogrft t/a/l add-on
1
$1,308.85
$333.00

$66.6015115
Epidrm a-grft face/nck/hf/g
2
$1,308.85
$446.00

$89.2015116
Epidrm a-grft f/n/hf/g addl
1
$1,308.85
$333.00

$66.6015120
Skn splt a-grft fac/nck/hf/g
2
$1,308.85
$446.00

$89.2015121
Skn splt a-grft f/n/hf/g add
3
$1,308.85
$510.00

$102.0015130
Derm autograft, trnk/arm/leg
2
$1,308.85
$446.00

$89.2015131
Derm autograft t/a/l add-on
1
$1,308.85
$333.00

$66.6015135
Derm autograft face/nck/hf/g
2
$1,308.85
$446.00

$89.2015136
Derm autograft, f/n/hf/g add
1
$1,308.85
$333.00

$66.6015150
Cult epiderm grft t/arm/leg
2
$1,308.85
$446.00

$89.2015151
Cult epiderm grft t/a/l addl
1
$1,308.85
$333.00

$66.6015152
Cult epiderm graft t/a/l +%
1
$1,308.85
$333.00

$66.6015155
Cult epiderm graft, f/n/hf/g
2
$1,308.85
$446.00

$89.2015156
Cult epidrm grft f/n/hfg add
1
$1,308.85
$333.00

$66.6015157
Cult epiderm grft f/n/hfg +%
1
$1,308.85
$333.00

$66.6015200
Skin full graft, trunk
3
$821.29
$510.00

$102.0015201
Skin full graft trunk add-on
2
$313.49
$313.49
Y
$62.7015220
Skin full graft sclp/arm/leg
2
$821.29
$446.00

$89.2015221
Skin full graft add-on
2
$313.49
$313.49
Y
$62.7015240
Skin full grft face/genit/hf
3
$821.29
$510.00

$102.0015241
Skin full graft add-on
3
$313.49
$313.49
Y
$62.7015260
Skin full graft een  lips
2
$821.29
$446.00

$89.2015261
Skin full graft add-on
2
$313.49
$313.49
Y
$62.7015300
Apply skinallogrft, t/arm/lg
2
$313.49
$313.49
Y
$62.7015301
Apply sknallogrft t/a/l addl
1
$313.49
$313.49
Y
$62.7015320
Apply skin allogrft f/n/hf/g
2
$313.49
$313.49
Y
$62.7015321
Aply sknallogrft f/n/hfg add
1
$313.49
$313.49
Y
$62.70( print page 49719)15330
Aply acell alogrft t/arm/leg
2
$313.49
$313.49
Y
$62.7015331
Aply acell grft t/a/l add-on
1
$313.49
$313.49
Y
$62.7015335
Apply acell graft, f/n/hf/g
2
$313.49
$313.49
Y
$62.7015336
Aply acell grft f/n/hf/g add
1
$313.49
$313.49
Y
$62.7015400
Apply skin xenograft, t/a/l
2
$313.49
$313.49
Y
$62.7015401
Apply skn xenogrft t/a/l add
2
$313.49
$313.49
Y
$62.7015420
Apply skin xgraft, f/n/hf/g
2
$313.49
$313.49
Y
$62.7015421
Apply skn xgrft f/n/hf/g add
1
$313.49
$313.49
Y
$62.7015430
Apply acellular xenograft
2
$313.49
$313.49
Y
$62.7015431
Apply acellular xgraft add
1
$313.49
$313.49
Y
$62.7015570
Form skin pedicle flap
3
$1,308.85
$510.00

$102.0015572
Form skin pedicle flap
3
$1,308.85
$510.00

$102.0015574
Form skin pedicle flap
3
$1,308.85
$510.00

$102.0015576
Form skin pedicle flap
3
$821.29
$510.00

$102.0015600
Skin graft
3
$1,308.85
$510.00

$102.0015610
Skin graft
3
$1,308.85
$510.00

$102.0015620
Skin graft
4
$1,308.85
$630.00

$126.0015630
Skin graft
3
$1,308.85
$510.00

$102.0015650
Transfer skin pedicle flap
5
$1,308.85
$717.00

$143.4015732
Muscle-skin graft, head/neck
3
$1,308.85
$510.00

$102.0015734
Muscle-skin graft, trunk
3
$1,308.85
$510.00

$102.0015736
Muscle-skin graft, arm
3
$1,308.85
$510.00

$102.0015738
Muscle-skin graft, leg
3
$1,308.85
$510.00

$102.0015740
Island pedicle flap graft
2
$821.29
$446.00

$89.2015750
Neurovascular pedicle graft
2
$1,308.85
$446.00

$89.2015760
Composite skin graft
2
$1,308.85
$446.00

$89.2015770
Derma-fat-fascia graft
3
$1,308.85
$510.00

$102.0015775
Hair transplant punch grafts
3
$313.49
$313.49
Y
$62.7015776
Hair transplant punch grafts
3
$313.49
$313.49
Y
$62.7015820
Revision of lower eyelid
3
$1,308.85
$510.00

$102.0015821
Revision of lower eyelid
3
$1,308.85
$510.00

$102.0015822
Revision of upper eyelid
3
$1,308.85
$510.00

$102.0015823
Revision of upper eyelid
5
$821.29
$717.00

$143.4015824
Removal of forehead wrinkles
3
$1,308.85
$510.00

$102.0015825
Removal of neck wrinkles
3
$1,308.85
$510.00

$102.0015826
Removal of brow wrinkles
3
$1,308.85
$510.00

$102.0015828
Removal of face wrinkles
3
$1,308.85
$510.00

$102.0015829
Removal of skin wrinkles
5
$1,308.85
$717.00

$143.4015831
Excise excessive skin tissue
3
$1,229.54
$510.00

$102.0015832
Excise excessive skin tissue
3
$1,229.54
$510.00

$102.0015833
Excise excessive skin tissue
3
$1,229.54
$510.00

$102.0015834
Excise excessive skin tissue
3
$1,229.54
$510.00

$102.0015835
Excise excessive skin tissue
3
$313.49
$313.49
Y
$62.7015836
Excise excessive skin tissue
3
$920.58
$510.00

$102.0015839
Excise excessive skin tissue
3
$920.58
$510.00

$102.0015840
Graft for face nerve palsy
4
$1,308.85
$630.00

$126.0015841
Graft for face nerve palsy
4
$1,308.85
$630.00

$126.0015845
Skin and muscle repair, face
4
$1,308.85
$630.00

$126.0015876
Suction assisted lipectomy
3
$1,308.85
$510.00

$102.0015877
Suction assisted lipectomy
3
$1,308.85
$510.00

$102.0015878
Suction assisted lipectomy
3
$821.29
$510.00

$102.0015879
Suction assisted lipectomy
3
$1,308.85
$510.00

$102.0015920
Removal of tail bone ulcer
3
$246.96
$246.96
Y
$49.3915922
Removal of tail bone ulcer
4
$1,308.85
$630.00

$126.0015931
Remove sacrum pressure sore
3
$1,229.54
$510.00

$102.0015933
Remove sacrum pressure sore
3
$1,229.54
$510.00

$102.0015934
Remove sacrum pressure sore
3
$1,308.85
$510.00

$102.0015935
Remove sacrum pressure sore
4
$1,308.85
$630.00

$126.0015936
Remove sacrum pressure sore
4
$1,308.85
$630.00

$126.0015937
Remove sacrum pressure sore
4
$1,308.85
$630.00

$126.0015940
Remove hip pressure sore
3
$1,229.54
$510.00

$102.0015941
Remove hip pressure sore
3
$1,229.54
$510.00

$102.0015944
Remove hip pressure sore
3
$1,308.85
$510.00

$102.0015945
Remove hip pressure sore
4
$1,308.85
$630.00

$126.0015946
Remove hip pressure sore
4
$1,308.85
$630.00

$126.0015950
Remove thigh pressure sore
3
$1,229.54
$510.00

$102.0015951
Remove thigh pressure sore
4
$1,229.54
$630.00

$126.0015952
Remove thigh pressure sore
3
$1,308.85
$510.00

$102.0015953
Remove thigh pressure sore
4
$1,308.85
$630.00

$126.00( print page 49720)15956
Remove thigh pressure sore
3
$1,308.85
$510.00

$102.0015958
Remove thigh pressure sore
4
$1,308.85
$630.00

$126.0016025
Dress/debrid p-thick burn, m
2
$66.94
$66.94
Y
$13.3916030
Dress/debrid p-thick burn, l
2
$98.86
$98.86
Y
$19.7719020
Incision of breast lesion
2
$1,075.21
$446.00

$89.2019100
Bx breast percut w/o image
1
$234.21
$234.21
Y
$46.8419101
Biopsy of breast, open
2
$1,183.32
$446.00

$89.2019102
Bx breast percut w/image
2
$234.21
$234.21
Y
$46.8419103
Bx breast percut w/device
2
$396.89
$396.89
Y
$79.3819110
Nipple exploration
2
$1,183.32
$446.00

$89.2019112
Excise breast duct fistula
3
$1,183.32
$510.00

$102.0019120
Removal of breast lesion
3
$1,183.32
$510.00

$102.0019125
Excision, breast lesion
3
$1,183.32
$510.00

$102.0019126
Excision, addl breast lesion
3
$1,183.32
$510.00

$102.0019140
Removal of breast tissue
4
$1,183.32
$630.00

$126.0019160
Partial mastectomy
3
$1,183.32
$510.00

$102.0019162
P-mastectomy w/ln removal
7
$2,307.20
$995.00

$199.0019180
Removal of breast
4
$1,732.69
$630.00

$126.0019182
Removal of breast
4
$1,732.69
$630.00

$126.0019296
Place po breast cath for rad
9
$2,508.17
$1,339.00

$267.8019297
Place breast cath for rad
9
$1,732.69
$1,339.00

$267.8019298
Place breast rad tube/caths
9
$3,250.00
$1,339.00

$267.8019316
Suspension of breast
4
$1,732.69
$630.00

$126.0019318
Reduction of large breast
4
$2,307.20
$630.00

$126.0019324
Enlarge breast
4
$2,307.20
$630.00

$126.0019325
Enlarge breast with implant
9
$3,002.43
$1,339.00

$267.8019328
Removal of breast implant
1
$1,732.69
$333.00

$66.6019330
Removal of implant material
1
$1,732.69
$333.00

$66.6019340
Immediate breast prosthesis
2
$2,508.17
$446.00

$89.2019342
Delayed breast prosthesis
3
$3,002.43
$510.00

$102.0019350
Breast reconstruction
4
$1,183.32
$630.00

$126.0019355
Correct inverted nipple(s)
4
$1,732.69
$630.00

$126.0019357
Breast reconstruction
5
$3,002.43
$717.00

$143.4019366
Breast reconstruction
5
$1,732.69
$717.00

$143.4019370
Surgery of breast capsule
4
$1,732.69
$630.00

$126.0019371
Removal of breast capsule
4
$1,732.69
$630.00

$126.0019380
Revise breast reconstruction
5
$2,508.17
$717.00

$143.4020005
Incision of deep abscess
2
$1,281.58
$446.00

$89.2020200
Muscle biopsy
2
$920.58
$446.00

$89.2020205
Deep muscle biopsy
3
$920.58
$510.00

$102.0020206
Needle biopsy, muscle
1
$234.21
$234.21
Y
$46.8420220
Bone biopsy, trocar/needle
1
$246.96
$246.96
Y
$49.3920225
Bone biopsy, trocar/needle
2
$400.87
$400.87
Y
$80.1720240
Bone biopsy, excisional
2
$1,229.54
$446.00

$89.2020245
Bone biopsy, excisional
3
$1,229.54
$510.00

$102.0020250
Open bone biopsy
3
$1,281.58
$510.00

$102.0020251
Open bone biopsy
3
$1,281.58
$510.00

$102.0020525
Removal of foreign body
3
$1,229.54
$510.00

$102.0020650
Insert and remove bone pin
3
$1,281.58
$510.00

$102.0020670
Removal of support implant
1
$920.58
$333.00

$66.6020680
Removal of support implant
3
$1,229.54
$510.00

$102.0020690
Apply bone fixation device
2
$1,542.47
$446.00

$89.2020692
Apply bone fixation device
3
$1,542.47
$510.00

$102.0020693
Adjust bone fixation device
3
$1,281.58
$510.00

$102.0020694
Remove bone fixation device
1
$1,281.58
$333.00

$66.6020900
Removal of bone for graft
3
$1,542.47
$510.00

$102.0020902
Removal of bone for graft
4
$1,542.47
$630.00

$126.0020910
Remove cartilage for graft
3
$1,308.85
$510.00

$102.0020912
Remove cartilage for graft
3
$1,308.85
$510.00

$102.0020920
Removal of fascia for graft
4
$821.29
$630.00

$126.0020922
Removal of fascia for graft
3
$1,308.85
$510.00

$102.0020924
Removal of tendon for graft
4
$1,542.47
$630.00

$126.0020926
Removal of tissue for graft
4
$821.29
$630.00

$126.0020975
Electrical bone stimulation
2
$38.23
$38.23
Y
$7.6521010
Incision of jaw joint
2
$1,425.30
$446.00

$89.2021015
Resection of facial tumor
3
$1,012.48
$510.00

$102.0021025
Excision of bone, lower jaw
2
$2,324.90
$446.00

$89.2021026
Excision of facial bone(s)
2
$2,324.90
$446.00

$89.2021029
Contour of face bone lesion
2
$2,324.90
$446.00

$89.20( print page 49721)21034
Excise max/zygoma mlg tumor
3
$2,324.90
$510.00

$102.0021040
Excise mandible lesion
2
$1,425.30
$446.00

$89.2021044
Removal of jaw bone lesion
2
$2,324.90
$446.00

$89.2021046
Remove mandible cyst complex
2
$2,324.90
$446.00

$89.2021047
Excise lwr jaw cyst w/repair
2
$2,324.90
$446.00

$89.2021050
Removal of jaw joint
3
$2,324.90
$510.00

$102.0021060
Remove jaw joint cartilage
2
$2,324.90
$446.00

$89.2021070
Remove coronoid process
3
$2,324.90
$510.00

$102.0021100
Maxillofacial fixation
2
$2,324.90
$446.00

$89.2021120
Reconstruction of chin
7
$1,425.30
$995.00

$199.0021121
Reconstruction of chin
7
$1,425.30
$995.00

$199.0021122
Reconstruction of chin
7
$1,425.30
$995.00

$199.0021123
Reconstruction of chin
7
$1,425.30
$995.00

$199.0021125
Augmentation, lower jaw bone
7
$1,425.30
$995.00

$199.0021127
Augmentation, lower jaw bone
9
$2,324.90
$1,339.00

$267.8021181
Contour cranial bone lesion
7
$1,425.30
$995.00

$199.0021206
Reconstruct upper jaw bone
5
$2,324.90
$717.00

$143.4021208
Augmentation of facial bones
7
$2,324.90
$995.00

$199.0021209
Reduction of facial bones
5
$2,324.90
$717.00

$143.4021210
Face bone graft
7
$2,324.90
$995.00

$199.0021215
Lower jaw bone graft
7
$2,324.90
$995.00

$199.0021230
Rib cartilage graft
7
$2,324.90
$995.00

$199.0021235
Ear cartilage graft
7
$1,425.30
$995.00

$199.0021240
Reconstruction of jaw joint
4
$2,324.90
$630.00

$126.0021242
Reconstruction of jaw joint
5
$2,324.90
$717.00

$143.4021243
Reconstruction of jaw joint
5
$2,324.90
$717.00

$143.4021244
Reconstruction of lower jaw
7
$2,324.90
$995.00

$199.0021245
Reconstruction of jaw
7
$2,324.90
$995.00

$199.0021246
Reconstruction of jaw
7
$2,324.90
$995.00

$199.0021248
Reconstruction of jaw
7
$2,324.90
$995.00

$199.0021249
Reconstruction of jaw
7
$2,324.90
$995.00

$199.0021267
Revise eye sockets
7
$2,324.90
$995.00

$199.0021270
Augmentation, cheek bone
5
$2,324.90
$717.00

$143.4021275
Revision, orbitofacial bones
7
$2,324.90
$995.00

$199.0021280
Revision of eyelid
5
$2,324.90
$717.00

$143.4021282
Revision of eyelid
5
$1,012.48
$717.00

$143.4021295
Revision of jaw muscle/bone
1
$475.55
$333.00

$66.6021296
Revision of jaw muscle/bone
1
$1,425.30
$333.00

$66.6021300
Treatment of skull fracture
2
$1,012.48
$446.00

$89.2021310
Treatment of nose fracture
2
$146.29
$146.29
Y
$29.2621315
Treatment of nose fracture
2
$146.29
$146.29
Y
$29.2621320
Treatment of nose fracture
2
$475.55
$446.00

$89.2021325
Treatment of nose fracture
4
$1,425.30
$630.00

$126.0021330
Treatment of nose fracture
5
$1,425.30
$717.00

$143.4021335
Treatment of nose fracture
7
$1,425.30
$995.00

$199.0021336
Treat nasal septal fracture
4
$2,312.35
$630.00

$126.0021337
Treat nasal septal fracture
2
$1,012.48
$446.00

$89.2021338
Treat nasoethmoid fracture
4
$1,425.30
$630.00

$126.0021339
Treat nasoethmoid fracture
5
$1,425.30
$717.00

$143.4021340
Treatment of nose fracture
4
$2,324.90
$630.00

$126.0021345
Treat nose/jaw fracture
7
$1,425.30
$995.00

$199.0021355
Treat cheek bone fracture
3
$2,324.90
$510.00

$102.0021356
Treat cheek bone fracture
3
$1,425.30
$510.00

$102.0021400
Treat eye socket fracture
2
$475.55
$446.00

$89.2021401
Treat eye socket fracture
3
$1,012.48
$510.00

$102.0021421
Treat mouth roof fracture
4
$1,425.30
$630.00

$126.0021445
Treat dental ridge fracture
4
$1,425.30
$630.00

$126.0021450
Treat lower jaw fracture
3
$146.29
$146.29
Y
$29.2621451
Treat lower jaw fracture
4
$475.55
$475.55
Y
$95.1121452
Treat lower jaw fracture
2
$1,012.48
$446.00

$89.2021453
Treat lower jaw fracture
3
$2,324.90
$510.00

$102.0021454
Treat lower jaw fracture
5
$1,425.30
$717.00

$143.4021461
Treat lower jaw fracture
4
$2,324.90
$630.00

$126.0021462
Treat lower jaw fracture
5
$2,324.90
$717.00

$143.4021465
Treat lower jaw fracture
4
$2,324.90
$630.00

$126.0021480
Reset dislocated jaw
1
$146.29
$146.29
Y
$29.2621485
Reset dislocated jaw
2
$1,012.48
$446.00

$89.2021490
Repair dislocated jaw
3
$2,324.90
$510.00

$102.0021497
Interdental wiring
2
$1,012.48
$446.00

$89.20( print page 49722)21501
Drain neck/chest lesion
2
$1,075.21
$446.00

$89.2021502
Drain chest lesion
2
$1,281.58
$446.00

$89.2021555
Remove lesion, neck/chest
2
$1,229.54
$446.00

$89.2021556
Remove lesion, neck/chest
2
$1,229.54
$446.00

$89.2021600
Partial removal of rib
2
$1,542.47
$446.00

$89.2021610
Partial removal of rib
2
$1,542.47
$446.00

$89.2021700
Revision of neck muscle
2
$1,281.58
$446.00

$89.2021720
Revision of neck muscle
3
$1,281.58
$510.00

$102.0021725
Revision of neck muscle
3
$91.22
$91.22
Y
$18.2421800
Treatment of rib fracture
1
$104.11
$104.11
Y
$20.8221805
Treatment of rib fracture
2
$1,580.03
$446.00

$89.2021820
Treat sternum fracture
1
$104.11
$104.11
Y
$20.8221925
Biopsy soft tissue of back
2
$1,229.54
$446.00

$89.2021930
Remove lesion, back or flank
2
$1,229.54
$446.00

$89.2021935
Remove tumor, back
3
$1,229.54
$510.00

$102.0022305
Treat spine process fracture
1
$104.11
$104.11
Y
$20.8222310
Treat spine fracture
1
$104.11
$104.11
Y
$20.8222315
Treat spine fracture
2
$104.11
$104.11
Y
$20.8222505
Manipulation of spine
2
$895.58
$446.00

$89.2022520
Percutaneous vertebroplasty,
9
$1,542.47
$1339.00

$267.8022521
Percutaneous vertebroplasty,
9
$1,542.47
$1339.00

$267.8022522
Percutaneous vertebroplasty,
1
$1,542.47
$373.00

$66.0022900
Remove abdominal wall lesion
4
$1,229.54
$630.00

$126.0023000
Removal of calcium deposits
2
$920.58
$446.00

$89.2023020
Release shoulder joint
2
$2,539.24
$446.00

$89.2023030
Drain shoulder lesion
1
$1,075.21
$333.00

$66.6023031
Drain shoulder bursa
3
$1,075.21
$510.00

$102.0023035
Drain shoulder bone lesion
3
$1,281.58
$510.00

$102.0023040
Exploratory shoulder surgery
3
$1,542.47
$510.00

$102.0023044
Exploratory shoulder surgery
4
$1,542.47
$630.00

$126.0023066
Biopsy shoulder tissues
2
$1,229.54
$446.00

$89.2023075
Removal of shoulder lesion
2
$920.58
$446.00

$89.2023076
Removal of shoulder lesion
2
$1,229.54
$446.00

$89.2023077
Remove tumor of shoulder
3
$1,229.54
$510.00

$102.0023100
Biopsy of shoulder joint
2
$1,281.58
$446.00

$89.2023101
Shoulder joint surgery
7
$1,542.47
$995.00

$199.0023105
Remove shoulder joint lining
4
$1,542.47
$630.00

$126.0023106
Incision of collarbone joint
4
$1,542.47
$630.00

$126.0023107
Explore treat shoulder joint
4
$1,542.47
$630.00

$126.0023120
Partial removal, collar bone
5
$2,539.24
$717.00

$143.4023125
Removal of collar bone
5
$2,539.24
$717.00

$143.4023130
Remove shoulder bone, part
5
$2,539.24
$717.00

$143.4023140
Removal of bone lesion
4
$1,281.58
$630.00

$126.0023145
Removal of bone lesion
5
$1,542.47
$717.00

$143.4023146
Removal of bone lesion
5
$1,542.47
$717.00

$143.4023150
Removal of humerus lesion
4
$1,542.47
$630.00

$126.0023155
Removal of humerus lesion
5
$1,542.47
$717.00

$143.4023156
Removal of humerus lesion
5
$1,542.47
$717.00

$143.4023170
Remove collar bone lesion
2
$1,542.47
$446.00

$89.2023172
Remove shoulder blade lesion
2
$1,542.47
$446.00

$89.2023174
Remove humerus lesion
2
$1,542.47
$446.00

$89.2023180
Remove collar bone lesion
4
$1,542.47
$630.00

$126.0023182
Remove shoulder blade lesion
4
$1,542.47
$630.00

$126.0023184
Remove humerus lesion
4
$1,542.47
$630.00

$126.0023190
Partial removal of scapula
4
$1,542.47
$630.00

$126.0023195
Removal of head of humerus
5
$1,542.47
$717.00

$143.4023330
Remove shoulder foreign body
1
$400.87
$333.00

$66.6023331
Remove shoulder foreign body
1
$1,229.54
$333.00

$66.6023395
Muscle transfer,shoulder/arm
5
$2,539.24
$717.00

$143.4023397
Muscle transfers
7
$4,055.26
$995.00

$199.0023400
Fixation of shoulder blade
7
$1,542.47
$995.00

$199.0023405
Incision of tendon  muscle
2
$1,542.47
$446.00

$89.2023406
Incise tendon(s)  muscle(s)
2
$1,542.47
$446.00

$89.2023410
Repair rotator cuff, acute
5
$2,539.24
$717.00

$143.4023412
Repair rotator cuff, chronic
7
$2,539.24
$995.00

$199.0023415
Release of shoulder ligament
5
$2,539.24
$717.00

$143.4023420
Repair of shoulder
7
$2,539.24
$995.00

$199.0023430
Repair biceps tendon
4
$2,539.24
$630.00

$126.0023440
Remove/transplant tendon
4
$2,539.24
$630.00

$126.00( print page 49723)23450
Repair shoulder capsule
5
$4,055.26
$717.00

$143.4023455
Repair shoulder capsule
7
$4,055.26
$995.00

$199.0023460
Repair shoulder capsule
5
$4,055.26
$717.00

$143.4023462
Repair shoulder capsule
7
$2,539.24
$995.00

$199.0023465
Repair shoulder capsule
5
$4,055.26
$717.00

$143.4023466
Repair shoulder capsule
7
$2,539.24
$995.00

$199.0023480
Revision of collar bone
4
$2,539.24
$630.00

$126.0023485
Revision of collar bone
7
$4,055.26
$995.00

$199.0023490
Reinforce clavicle
3
$2,539.24
$510.00

$102.0023491
Reinforce shoulder bones
3
$4,055.26
$510.00

$102.0023500
Treat clavicle fracture
1
$104.11
$104.11
Y
$20.8223505
Treat clavicle fracture
1
$104.11
$104.11
Y
$20.8223515
Treat clavicle fracture
3
$3,472.68
$510.00

$102.0023520
Treat clavicle dislocation
1
$104.11
$104.11
Y
$20.8223525
Treat clavicle dislocation
1
$104.11
$104.11
Y
$20.8223530
Treat clavicle dislocation
3
$2,312.35
$510.00

$102.0023532
Treat clavicle dislocation
4
$1,580.03
$630.00

$126.0023540
Treat clavicle dislocation
1
$104.11
$104.11
Y
$20.8223545
Treat clavicle dislocation
1
$104.11
$104.11
Y
$20.8223550
Treat clavicle dislocation
3
$2,312.35
$510.00

$102.0023552
Treat clavicle dislocation
4
$2,312.35
$630.00

$126.0023570
Treat shoulder blade fx
1
$104.11
$104.11
Y
$20.8223575
Treat shoulder blade fx
1
$104.11
$104.11
Y
$20.8223585
Treat scapula fracture
3
$3,472.68
$510.00

$102.0023605
Treat humerus fracture
2
$104.11
$104.11
Y
$20.8223615
Treat humerus fracture
4
$3,472.68
$630.00

$126.0023616
Treat humerus fracture
4
$3,472.68
$630.00

$126.0023625
Treat humerus fracture
2
$104.11
$104.11
Y
$20.8223630
Treat humerus fracture
5
$3,472.68
$717.00

$143.4023650
Treat shoulder dislocation
1
$104.11
$104.11
Y
$20.8223655
Treat shoulder dislocation
1
$895.58
$333.00

$66.6023660
Treat shoulder dislocation
3
$2,312.35
$510.00

$102.0023665
Treat dislocation/fracture
2
$104.11
$104.11
Y
$20.8223670
Treat dislocation/fracture
3
$3,472.68
$510.00

$102.0023675
Treat dislocation/fracture
2
$104.11
$104.11
Y
$20.8223680
Treat dislocation/fracture
3
$2,312.35
$510.00

$102.0023700
Fixation of shoulder
1
$895.58
$333.00

$66.6023800
Fusion of shoulder joint
4
$4,055.26
$630.00

$126.0023802
Fusion of shoulder joint
7
$2,539.24
$995.00

$199.0023921
Amputation follow-up surgery
3
$313.49
$313.49
Y
$62.7023930
Drainage of arm lesion
1
$1,075.21
$333.00

$66.6023931
Drainage of arm bursa
2
$1,075.21
$446.00

$89.2023935
Drain arm/elbow bone lesion
2
$1,281.58
$446.00

$89.2024000
Exploratory elbow surgery
4
$1,542.47
$630.00

$126.0024006
Release elbow joint
4
$1,542.47
$630.00

$126.0024066
Biopsy arm/elbow soft tissue
2
$920.58
$446.00

$89.2024075
Remove arm/elbow lesion
2
$920.58
$446.00

$89.2024076
Remove arm/elbow lesion
2
$1,229.54
$446.00

$89.2024077
Remove tumor of arm/elbow
3
$1,229.54
$510.00

$102.0024100
Biopsy elbow joint lining
1
$1,281.58
$333.00

$66.6024101
Explore/treat elbow joint
4
$1,542.47
$630.00

$126.0024102
Remove elbow joint lining
4
$1,542.47
$630.00

$126.0024105
Removal of elbow bursa
3
$1,281.58
$510.00

$102.0024110
Remove humerus lesion
2
$1,281.58
$446.00

$89.2024115
Remove/graft bone lesion
3
$1,542.47
$510.00

$102.0024116
Remove/graft bone lesion
3
$1,542.47
$510.00

$102.0024120
Remove elbow lesion
3
$1,281.58
$510.00

$102.0024125
Remove/graft bone lesion
3
$1,542.47
$510.00

$102.0024126
Remove/graft bone lesion
3
$1,542.47
$510.00

$102.0024130
Removal of head of radius
3
$1,542.47
$510.00

$102.0024134
Removal of arm bone lesion
2
$1,542.47
$446.00

$89.2024136
Remove radius bone lesion
2
$1,542.47
$446.00

$89.2024138
Remove elbow bone lesion
2
$1,542.47
$446.00

$89.2024140
Partial removal of arm bone
3
$1,542.47
$510.00

$102.0024145
Partial removal of radius
3
$1,542.47
$510.00

$102.0024147
Partial removal of elbow
2
$1,542.47
$446.00

$89.2024155
Removal of elbow joint
3
$2,539.24
$510.00

$102.0024160
Remove elbow joint implant
2
$1,542.47
$446.00

$89.2024164
Remove radius head implant
3
$1,542.47
$510.00

$102.00( print page 49724)24201
Removal of arm foreign body
2
$920.58
$446.00

$89.2024301
Muscle/tendon transfer
4
$1,542.47
$630.00

$126.0024305
Arm tendon lengthening
4
$1,542.47
$630.00

$126.0024310
Revision of arm tendon
3
$1,281.58
$510.00

$102.0024320
Repair of arm tendon
3
$2,539.24
$510.00

$102.0024330
Revision of arm muscles
3
$4,055.26
$510.00

$102.0024331
Revision of arm muscles
3
$2,539.24
$510.00

$102.0024340
Repair of biceps tendon
3
$2,539.24
$510.00

$102.0024341
Repair arm tendon/muscle
3
$2,539.24
$510.00

$102.0024342
Repair of ruptured tendon
3
$2,539.24
$510.00

$102.0024345
Repr elbw med ligmnt w/tissu
2
$1,542.47
$446.00

$89.2024350
Repair of tennis elbow
3
$1,542.47
$510.00

$102.0024351
Repair of tennis elbow
3
$1,542.47
$510.00

$102.0024352
Repair of tennis elbow
3
$1,542.47
$510.00

$102.0024354
Repair of tennis elbow
3
$1,542.47
$510.00

$102.0024356
Revision of tennis elbow
3
$1,542.47
$510.00

$102.0024360
Reconstruct elbow joint
5
$2,016.06
$717.00

$143.4024361
Reconstruct elbow joint
5
$6,473.11
$717.00

$143.4024362
Reconstruct elbow joint
5
$2,903.02
$717.00

$143.4024363
Replace elbow joint
7
$6,473.11
$995.00

$199.0024365
Reconstruct head of radius
5
$2,016.06
$717.00

$143.4024366
Reconstruct head of radius
5
$6,473.11
$717.00

$143.4024400
Revision of humerus
4
$1,542.47
$630.00

$126.0024410
Revision of humerus
4
$1,542.47
$630.00

$126.0024420
Revision of humerus
3
$2,539.24
$510.00

$102.0024430
Repair of humerus
3
$4,055.26
$510.00

$102.0024435
Repair humerus with graft
4
$4,055.26
$630.00

$126.0024470
Revision of elbow joint
3
$2,539.24
$510.00

$102.0024495
Decompression of forearm
2
$1,542.47
$446.00

$89.2024498
Reinforce humerus
3
$4,055.26
$510.00

$102.0024500
Treat humerus fracture
1
$104.11
$104.11
Y
$20.8224505
Treat humerus fracture
1
$104.11
$104.11
Y
$20.8224515
Treat humerus fracture
4
$3,472.68
$630.00

$126.0024516
Treat humerus fracture
4
$3,472.68
$630.00

$126.0024530
Treat humerus fracture
1
$104.11
$104.11
Y
$20.8224535
Treat humerus fracture
1
$104.11
$104.11
Y
$20.8224538
Treat humerus fracture
2
$1,580.03
$446.00

$89.2024545
Treat humerus fracture
4
$3,472.68
$630.00

$126.0024546
Treat humerus fracture
5
$3,472.68
$717.00

$143.4024560
Treat humerus fracture
1
$104.11
$104.11
Y
$20.8224565
Treat humerus fracture
2
$104.11
$104.11
Y
$20.8224566
Treat humerus fracture
2
$1,580.03
$446.00

$89.2024575
Treat humerus fracture
3
$3,472.68
$510.00

$102.0024576
Treat humerus fracture
1
$104.11
$104.11
Y
$20.8224577
Treat humerus fracture
1
$104.11
$104.11
Y
$20.8224579
Treat humerus fracture
3
$3,472.68
$510.00

$102.0024582
Treat humerus fracture
2
$1,580.03
$446.00

$89.2024586
Treat elbow fracture
4
$3,472.68
$630.00

$126.0024587
Treat elbow fracture
5
$3,472.68
$717.00

$143.4024600
Treat elbow dislocation
1
$104.11
$104.11
Y
$20.8224605
Treat elbow dislocation
2
$895.58
$446.00

$89.2024615
Treat elbow dislocation
3
$3,472.68
$510.00

$102.0024620
Treat elbow fracture
2
$104.11
$104.11
Y
$20.8224635
Treat elbow fracture
3
$3,472.68
$510.00

$102.0024655
Treat radius fracture
1
$104.11
$104.11
Y
$20.8224665
Treat radius fracture
4
$2,312.35
$630.00

$126.0024666
Treat radius fracture
4
$3,472.68
$630.00

$126.0024670
Treat ulnar fracture
1
$104.11
$104.11
Y
$20.8224675
Treat ulnar fracture
1
$104.11
$104.11
Y
$20.8224685
Treat ulnar fracture
3
$2,312.35
$510.00

$102.0024800
Fusion of elbow joint
4
$2,539.24
$630.00

$126.0024802
Fusion/graft of elbow joint
5
$2,539.24
$717.00

$143.4024925
Amputation follow-up surgery
3
$1,281.58
$510.00

$102.0025000
Incision of tendon sheath
3
$1,281.58
$510.00

$102.0025020
Decompress forearm 1 space
3
$1,281.58
$510.00

$102.0025023
Decompress forearm 1 space
3
$1,542.47
$510.00

$102.0025024
Decompress forearm 2 spaces
3
$1,542.47
$510.00

$102.0025025
Decompress forearm 2 spaces
3
$1,542.47
$510.00

$102.0025028
Drainage of forearm lesion
1
$1,281.58
$333.00

$66.60( print page 49725)25031
Drainage of forearm bursa
2
$1,281.58
$446.00

$89.2025035
Treat forearm bone lesion
2
$1,281.58
$446.00

$89.2025040
Explore/treat wrist joint
5
$1,542.47
$717.00

$143.4025066
Biopsy forearm soft tissues
2
$1,229.54
$446.00

$89.2025075
Removal forearm lesion subcu
2
$920.58
$446.00

$89.2025076
Removal forearm lesion deep
3
$1,229.54
$510.00

$102.0025077
Remove tumor, forearm/wrist
3
$1,229.54
$510.00

$102.0025085
Incision of wrist capsule
3
$1,281.58
$510.00

$102.0025100
Biopsy of wrist joint
2
$1,281.58
$446.00

$89.2025101
Explore/treat wrist joint
3
$1,542.47
$510.00

$102.0025105
Remove wrist joint lining
4
$1,542.47
$630.00

$126.0025107
Remove wrist joint cartilage
3
$1,542.47
$510.00

$102.0025110
Remove wrist tendon lesion
3
$1,281.58
$510.00

$102.0025111
Remove wrist tendon lesion
3
$986.93
$510.00

$102.0025112
Reremove wrist tendon lesion
4
$986.93
$630.00

$126.0025115
Remove wrist/forearm lesion
4
$1,281.58
$630.00

$126.0025116
Remove wrist/forearm lesion
4
$1,281.58
$630.00

$126.0025118
Excise wrist tendon sheath
2
$1,542.47
$446.00

$89.2025119
Partial removal of ulna
3
$1,542.47
$510.00

$102.0025120
Removal of forearm lesion
3
$1,542.47
$510.00

$102.0025125
Remove/graft forearm lesion
3
$1,542.47
$510.00

$102.0025126
Remove/graft forearm lesion
3
$1,542.47
$510.00

$102.0025130
Removal of wrist lesion
3
$1,542.47
$510.00

$102.0025135
Remove  graft wrist lesion
3
$1,542.47
$510.00

$102.0025136
Remove  graft wrist lesion
3
$1,542.47
$510.00

$102.0025145
Remove forearm bone lesion
2
$1,542.47
$446.00

$89.2025150
Partial removal of ulna
2
$1,542.47
$446.00

$89.2025151
Partial removal of radius
2
$1,542.47
$446.00

$89.2025210
Removal of wrist bone
3
$1,590.63
$510.00

$102.0025215
Removal of wrist bones
4
$1,590.63
$630.00

$126.0025230
Partial removal of radius
4
$1,542.47
$630.00

$126.0025240
Partial removal of ulna
4
$1,542.47
$630.00

$126.0025248
Remove forearm foreign body
2
$1,281.58
$446.00

$89.2025250
Removal of wrist prosthesis
1
$1,542.47
$333.00

$66.6025251
Removal of wrist prosthesis
1
$1,542.47
$333.00

$66.6025260
Repair forearm tendon/muscle
4
$1,542.47
$630.00

$126.0025263
Repair forearm tendon/muscle
2
$1,542.47
$446.00

$89.2025265
Repair forearm tendon/muscle
3
$1,542.47
$510.00

$102.0025270
Repair forearm tendon/muscle
4
$1,542.47
$630.00

$126.0025272
Repair forearm tendon/muscle
3
$1,542.47
$510.00

$102.0025274
Repair forearm tendon/muscle
4
$1,542.47
$630.00

$126.0025275
Repair forearm tendon sheath
4
$1,542.47
$630.00

$126.0025280
Revise wrist/forearm tendon
4
$1,542.47
$630.00

$126.0025290
Incise wrist/forearm tendon
3
$1,542.47
$510.00

$102.0025295
Release wrist/forearm tendon
3
$1,281.58
$510.00

$102.0025300
Fusion of tendons at wrist
3
$1,542.47
$510.00

$102.0025301
Fusion of tendons at wrist
3
$1,542.47
$510.00

$102.0025310
Transplant forearm tendon
3
$2,539.24
$510.00

$102.0025312
Transplant forearm tendon
4
$2,539.24
$630.00

$126.0025315
Revise palsy hand tendon(s)
3
$2,539.24
$510.00

$102.0025316
Revise palsy hand tendon(s)
3
$4,055.26
$510.00

$102.0025320
Repair/revise wrist joint
3
$2,539.24
$510.00

$102.0025332
Revise wrist joint
5
$2,016.06
$717.00

$143.4025335
Realignment of hand
3
$2,539.24
$510.00

$102.0025337
Reconstruct ulna/radioulnar
5
$2,539.24
$717.00

$143.4025350
Revision of radius
3
$4,055.26
$510.00

$102.0025355
Revision of radius
3
$2,539.24
$510.00

$102.0025360
Revision of ulna
3
$1,542.47
$510.00

$102.0025365
Revise radius  ulna
3
$1,542.47
$510.00

$102.0025370
Revise radius or ulna
3
$2,539.24
$510.00

$102.0025375
Revise radius  ulna
4
$2,539.24
$630.00

$126.0025390
Shorten radius or ulna
3
$1,542.47
$510.00

$102.0025391
Lengthen radius or ulna
4
$2,539.24
$630.00

$126.0025392
Shorten radius  ulna
3
$1,542.47
$510.00

$102.0025393
Lengthen radius  ulna
4
$2,539.24
$630.00

$126.0025400
Repair radius or ulna
3
$1,542.47
$510.00

$102.0025405
Repair/graft radius or ulna
4
$1,542.47
$630.00

$126.0025415
Repair radius  ulna
3
$1,542.47
$510.00

$102.0025420
Repair/graft radius  ulna
4
$4,055.26
$630.00

$126.00( print page 49726)25425
Repair/graft radius or ulna
3
$2,539.24
$510.00

$102.0025426
Repair/graft radius  ulna
4
$2,539.24
$630.00

$126.0025440
Repair/graft wrist bone
4
$4,055.26
$630.00

$126.0025441
Reconstruct wrist joint
5
$6,473.11
$717.00

$143.4025442
Reconstruct wrist joint
5
$6,473.11
$717.00

$143.4025443
Reconstruct wrist joint
5
$2,903.02
$717.00

$143.4025444
Reconstruct wrist joint
5
$2,903.02
$717.00

$143.4025445
Reconstruct wrist joint
5
$2,903.02
$717.00

$143.4025446
Wrist replacement
7
$6,473.11
$995.00

$199.0025447
Repair wrist joint(s)
5
$2,016.06
$717.00

$143.4025449
Remove wrist joint implant
5
$2,016.06
$717.00

$143.4025450
Revision of wrist joint
3
$2,539.24
$510.00

$102.0025455
Revision of wrist joint
3
$2,539.24
$510.00

$102.0025490
Reinforce radius
3
$2,539.24
$510.00

$102.0025491
Reinforce ulna
3
$2,539.24
$510.00

$102.0025492
Reinforce radius and ulna
3
$2,539.24
$510.00

$102.0025505
Treat fracture of radius
1
$104.11
$104.11
Y
$20.8225515
Treat fracture of radius
3
$2,312.35
$510.00

$102.0025520
Treat fracture of radius
1
$104.11
$104.11
Y
$20.8225525
Treat fracture of radius
4
$2,312.35
$630.00

$126.0025526
Treat fracture of radius
5
$2,312.35
$717.00

$143.4025535
Treat fracture of ulna
1
$104.11
$104.11
Y
$20.8225545
Treat fracture of ulna
3
$2,312.35
$510.00

$102.0025565
Treat fracture radius  ulna
2
$104.11
$104.11
Y
$20.8225574
Treat fracture radius  ulna
3
$3,472.68
$510.00

$102.0025575
Treat fracture radius/ulna
3
$3,472.68
$510.00

$102.0025605
Treat fracture radius/ulna
3
$104.11
$104.11
Y
$20.8225611
Treat fracture radius/ulna
3
$1,580.03
$510.00

$102.0025620
Treat fracture radius/ulna
5
$3,472.68
$717.00

$143.4025624
Treat wrist bone fracture
2
$104.11
$104.11
Y
$20.8225628
Treat wrist bone fracture
3
$2,312.35
$510.00

$102.0025635
Treat wrist bone fracture
1
$104.11
$104.11
Y
$20.8225645
Treat wrist bone fracture
3
$2,312.35
$510.00

$102.0025660
Treat wrist dislocation
1
$104.11
$104.11
Y
$20.8225670
Treat wrist dislocation
3
$1,580.03
$510.00

$102.0025671
Pin radioulnar dislocation
1
$1,580.03
$333.00

$66.6025675
Treat wrist dislocation
1
$104.11
$104.11
Y
$20.8225676
Treat wrist dislocation
2
$1,580.03
$446.00

$89.2025680
Treat wrist fracture
2
$104.11
$104.11
Y
$20.8225685
Treat wrist fracture
3
$1,580.03
$510.00

$102.0025690
Treat wrist dislocation
1
$104.11
$104.11
Y
$20.8225695
Treat wrist dislocation
2
$1,580.03
$446.00

$89.2025800
Fusion of wrist joint
4
$4,055.26
$630.00

$126.0025805
Fusion/graft of wrist joint
5
$2,539.24
$717.00

$143.4025810
Fusion/graft of wrist joint
5
$4,055.26
$717.00

$143.4025820
Fusion of hand bones
4
$986.93
$630.00

$126.0025825
Fuse hand bones with graft
5
$1,590.63
$717.00

$143.4025830
Fusion, radioulnar jnt/ulna
5
$4,055.26
$717.00

$143.4025907
Amputation follow-up surgery
3
$1,281.58
$510.00

$102.0025922
Amputate hand at wrist
3
$1,281.58
$510.00

$102.0025929
Amputation follow-up surgery
3
$821.29
$510.00

$102.0026011
Drainage of finger abscess
1
$672.04
$333.00

$66.6026020
Drain hand tendon sheath
2
$986.93
$446.00

$89.2026025
Drainage of palm bursa
1
$986.93
$333.00

$66.6026030
Drainage of palm bursa(s)
2
$986.93
$446.00

$89.2026034
Treat hand bone lesion
2
$986.93
$446.00

$89.2026040
Release palm contracture
4
$1,590.63
$630.00

$126.0026045
Release palm contracture
3
$1,590.63
$510.00

$102.0026055
Incise finger tendon sheath
2
$986.93
$446.00

$89.2026060
Incision of finger tendon
2
$986.93
$446.00

$89.2026070
Explore/treat hand joint
2
$986.93
$446.00

$89.2026075
Explore/treat finger joint
4
$986.93
$630.00

$126.0026080
Explore/treat finger joint
4
$986.93
$630.00

$126.0026100
Biopsy hand joint lining
2
$986.93
$446.00

$89.2026105
Biopsy finger joint lining
1
$986.93
$333.00

$66.6026110
Biopsy finger joint lining
1
$986.93
$333.00

$66.6026115
Removal hand lesion subcut
2
$1,229.54
$446.00

$89.2026116
Removal hand lesion, deep
2
$1,229.54
$446.00

$89.2026117
Remove tumor, hand/finger
3
$1,229.54
$510.00

$102.00( print page 49727)26121
Release palm contracture
4
$1,590.63
$630.00

$126.0026123
Release palm contracture
4
$1,590.63
$630.00

$126.0026125
Release palm contracture
4
$986.93
$630.00

$126.0026130
Remove wrist joint lining
3
$986.93
$510.00

$102.0026135
Revise finger joint, each
4
$1,590.63
$630.00

$126.0026140
Revise finger joint, each
2
$986.93
$446.00

$89.2026145
Tendon excision, palm/finger
3
$986.93
$510.00

$102.0026160
Remove tendon sheath lesion
3
$986.93
$510.00

$102.0026170
Removal of palm tendon, each
3
$986.93
$510.00

$102.0026180
Removal of finger tendon
3
$986.93
$510.00

$102.0026185
Remove finger bone
4
$986.93
$630.00

$126.0026200
Remove hand bone lesion
2
$986.93
$446.00

$89.2026205
Remove/graft bone lesion
3
$1,590.63
$510.00

$102.0026210
Removal of finger lesion
2
$986.93
$446.00

$89.2026215
Remove/graft finger lesion
3
$986.93
$510.00

$102.0026230
Partial removal of hand bone
7
$986.93
$986.93
Y
$197.3926235
Partial removal, finger bone
3
$986.93
$510.00

$102.0026236
Partial removal, finger bone
3
$986.93
$510.00

$102.0026250
Extensive hand surgery
3
$986.93
$510.00

$102.0026255
Extensive hand surgery
3
$1,590.63
$510.00

$102.0026260
Extensive finger surgery
3
$986.93
$510.00

$102.0026261
Extensive finger surgery
3
$986.93
$510.00

$102.0026262
Partial removal of finger
2
$986.93
$446.00

$89.2026320
Removal of implant from hand
2
$920.58
$446.00

$89.2026350
Repair finger/hand tendon
1
$1,590.63
$333.00

$66.6026352
Repair/graft hand tendon
4
$1,590.63
$630.00

$126.0026356
Repair finger/hand tendon
4
$1,590.63
$630.00

$126.0026357
Repair finger/hand tendon
4
$1,590.63
$630.00

$126.0026358
Repair/graft hand tendon
4
$1,590.63
$630.00

$126.0026370
Repair finger/hand tendon
4
$1,590.63
$630.00

$126.0026372
Repair/graft hand tendon
4
$1,590.63
$630.00

$126.0026373
Repair finger/hand tendon
3
$1,590.63
$510.00

$102.0026390
Revise hand/finger tendon
4
$1,590.63
$630.00

$126.0026392
Repair/graft hand tendon
3
$1,590.63
$510.00

$102.0026410
Repair hand tendon
3
$986.93
$510.00

$102.0026412
Repair/graft hand tendon
3
$1,590.63
$510.00

$102.0026415
Excision, hand/finger tendon
4
$1,590.63
$630.00

$126.0026416
Graft hand or finger tendon
3
$1,590.63
$510.00

$102.0026418
Repair finger tendon
4
$986.93
$630.00

$126.0026420
Repair/graft finger tendon
4
$1,590.63
$630.00

$126.0026426
Repair finger/hand tendon
3
$1,590.63
$510.00

$102.0026428
Repair/graft finger tendon
3
$1,590.63
$510.00

$102.0026432
Repair finger tendon
3
$986.93
$510.00

$102.0026433
Repair finger tendon
3
$986.93
$510.00

$102.0026434
Repair/graft finger tendon
3
$1,590.63
$510.00

$102.0026437
Realignment of tendons
3
$986.93
$510.00

$102.0026440
Release palm/finger tendon
3
$986.93
$510.00

$102.0026442
Release palm  finger tendon
3
$1,590.63
$510.00

$102.0026445
Release hand/finger tendon
3
$986.93
$510.00

$102.0026449
Release forearm/hand tendon
3
$1,590.63
$510.00

$102.0026450
Incision of palm tendon
3
$986.93
$510.00

$102.0026455
Incision of finger tendon
3
$986.93
$510.00

$102.0026460
Incise hand/finger tendon
3
$986.93
$510.00

$102.0026471
Fusion of finger tendons
2
$986.93
$446.00

$89.2026474
Fusion of finger tendons
2
$986.93
$446.00

$89.2026476
Tendon lengthening
1
$986.93
$333.00

$66.6026477
Tendon shortening
1
$986.93
$333.00

$66.6026478
Lengthening of hand tendon
1
$986.93
$333.00

$66.6026479
Shortening of hand tendon
1
$986.93
$333.00

$66.6026480
Transplant hand tendon
3
$1,590.63
$510.00

$102.0026483
Transplant/graft hand tendon
3
$1,590.63
$510.00

$102.0026485
Transplant palm tendon
2
$1,590.63
$446.00

$89.2026489
Transplant/graft palm tendon
3
$1,590.63
$510.00

$102.0026490
Revise thumb tendon
3
$1,590.63
$510.00

$102.0026492
Tendon transfer with graft
3
$1,590.63
$510.00

$102.0026494
Hand tendon/muscle transfer
3
$1,590.63
$510.00

$102.0026496
Revise thumb tendon
3
$1,590.63
$510.00

$102.0026497
Finger tendon transfer
3
$1,590.63
$510.00

$102.0026498
Finger tendon transfer
4
$1,590.63
$630.00

$126.00( print page 49728)26499
Revision of finger
3
$1,590.63
$510.00

$102.0026500
Hand tendon reconstruction
4
$986.93
$630.00

$126.0026502
Hand tendon reconstruction
4
$1,590.63
$630.00

$126.0026504
Hand tendon reconstruction
4
$1,590.63
$630.00

$126.0026508
Release thumb contracture
3
$986.93
$510.00

$102.0026510
Thumb tendon transfer
3
$1,590.63
$510.00

$102.0026516
Fusion of knuckle joint
1
$1,590.63
$333.00

$66.6026517
Fusion of knuckle joints
3
$1,590.63
$510.00

$102.0026518
Fusion of knuckle joints
3
$1,590.63
$510.00

$102.0026520
Release knuckle contracture
3
$986.93
$510.00

$102.0026525
Release finger contracture
3
$986.93
$510.00

$102.0026530
Revise knuckle joint
3
$2,016.06
$510.00

$102.0026531
Revise knuckle with implant
7
$2,903.02
$995.00

$199.0026535
Revise finger joint
5
$2,016.06
$717.00

$143.4026536
Revise/implant finger joint
5
$2,903.02
$717.00

$143.4026540
Repair hand joint
4
$986.93
$630.00

$126.0026541
Repair hand joint with graft
7
$1,590.63
$995.00

$199.0026542
Repair hand joint with graft
4
$986.93
$630.00

$126.0026545
Reconstruct finger joint
4
$1,590.63
$630.00

$126.0026546
Repair nonunion hand
4
$1,590.63
$630.00

$126.0026548
Reconstruct finger joint
4
$1,590.63
$630.00

$126.0026550
Construct thumb replacement
2
$1,590.63
$446.00

$89.2026555
Positional change of finger
3
$1,590.63
$510.00

$102.0026560
Repair of web finger
2
$986.93
$446.00

$89.2026561
Repair of web finger
3
$1,590.63
$510.00

$102.0026562
Repair of web finger
4
$1,590.63
$630.00

$126.0026565
Correct metacarpal flaw
5
$1,590.63
$717.00

$143.4026567
Correct finger deformity
5
$1,590.63
$717.00

$143.4026568
Lengthen metacarpal/finger
3
$1,590.63
$510.00

$102.0026580
Repair hand deformity
5
$986.93
$717.00

$143.4026587
Reconstruct extra finger
5
$986.93
$717.00

$143.4026590
Repair finger deformity
5
$986.93
$717.00

$143.4026591
Repair muscles of hand
3
$1,590.63
$510.00

$102.0026593
Release muscles of hand
3
$986.93
$510.00

$102.0026596
Excision constricting tissue
2
$986.93
$446.00

$89.2026605
Treat metacarpal fracture
2
$104.11
$104.11
Y
$20.8226607
Treat metacarpal fracture
2
$104.11
$104.11
Y
$20.8226608
Treat metacarpal fracture
4
$1,580.03
$630.00

$126.0026615
Treat metacarpal fracture
4
$2,312.35
$630.00

$126.0026645
Treat thumb fracture
1
$104.11
$104.11
Y
$20.8226650
Treat thumb fracture
2
$1,580.03
$446.00

$89.2026665
Treat thumb fracture
4
$2,312.35
$630.00

$126.0026675
Treat hand dislocation
2
$104.11
$104.11
Y
$20.8226676
Pin hand dislocation
2
$1,580.03
$446.00

$89.2026685
Treat hand dislocation
3
$2,312.35
$510.00

$102.0026686
Treat hand dislocation
3
$3,472.68
$510.00

$102.0026705
Treat knuckle dislocation
2
$104.11
$104.11
Y
$20.8226706
Pin knuckle dislocation
2
$104.11
$104.11
Y
$20.8226715
Treat knuckle dislocation
4
$2,312.35
$630.00

$126.0026727
Treat finger fracture, each
7
$1,580.03
$995.00

$199.0026735
Treat finger fracture, each
4
$2,312.35
$630.00

$126.0026742
Treat finger fracture, each
2
$104.11
$104.11
Y
$20.8226746
Treat finger fracture, each
5
$2,312.35
$717.00

$143.4026756
Pin finger fracture, each
2
$1,580.03
$446.00

$89.2026765
Treat finger fracture, each
4
$2,312.35
$630.00

$126.0026776
Pin finger dislocation
2
$1,580.03
$446.00

$89.2026785
Treat finger dislocation
2
$1,580.03
$446.00

$89.2026820
Thumb fusion with graft
5
$1,590.63
$717.00

$143.4026841
Fusion of thumb
4
$1,590.63
$630.00

$126.0026842
Thumb fusion with graft
4
$1,590.63
$630.00

$126.0026843
Fusion of hand joint
3
$1,590.63
$510.00

$102.0026844
Fusion/graft of hand joint
3
$1,590.63
$510.00

$102.0026850
Fusion of knuckle
4
$1,590.63
$630.00

$126.0026852
Fusion of knuckle with graft
4
$1,590.63
$630.00

$126.0026860
Fusion of finger joint
3
$1,590.63
$510.00

$102.0026861
Fusion of finger jnt, add-on
2
$1,590.63
$446.00

$89.2026862
Fusion/graft of finger joint
4
$1,590.63
$630.00

$126.0026863
Fuse/graft added joint
3
$1,590.63
$510.00

$102.0026910
Amputate metacarpal bone
3
$1,590.63
$510.00

$102.00( print page 49729)26951
Amputation of finger/thumb
2
$986.93
$446.00

$89.2026952
Amputation of finger/thumb
4
$986.93
$630.00

$126.0026990
Drainage of pelvis lesion
1
$1,281.58
$333.00

$66.6026991
Drainage of pelvis bursa
1
$1,281.58
$333.00

$66.6027000
Incision of hip tendon
2
$1,281.58
$446.00

$89.2027001
Incision of hip tendon
3
$1,542.47
$510.00

$102.0027003
Incision of hip tendon
3
$1,542.47
$510.00

$102.0027033
Exploration of hip joint
3
$2,539.24
$510.00

$102.0027035
Denervation of hip joint
4
$2,539.24
$630.00

$126.0027040
Biopsy of soft tissues
1
$400.87
$333.00

$66.6027041
Biopsy of soft tissues
2
$400.87
$400.87
Y
$80.1727047
Remove hip/pelvis lesion
2
$1,229.54
$446.00

$89.2027048
Remove hip/pelvis lesion
3
$1,229.54
$510.00

$102.0027049
Remove tumor, hip/pelvis
3
$1,229.54
$510.00

$102.0027050
Biopsy of sacroiliac joint
3
$1,281.58
$510.00

$102.0027052
Biopsy of hip joint
3
$1,281.58
$510.00

$102.0027060
Removal of ischial bursa
5
$1,281.58
$717.00

$143.4027062
Remove femur lesion/bursa
5
$1,281.58
$717.00

$143.4027065
Removal of hip bone lesion
5
$1,281.58
$717.00

$143.4027066
Removal of hip bone lesion
5
$1,542.47
$717.00

$143.4027067
Remove/graft hip bone lesion
5
$1,542.47
$717.00

$143.4027080
Removal of tail bone
2
$1,542.47
$446.00

$89.2027086
Remove hip foreign body
1
$400.87
$333.00

$66.6027087
Remove hip foreign body
3
$1,281.58
$510.00

$102.0027097
Revision of hip tendon
3
$1,542.47
$510.00

$102.0027098
Transfer tendon to pelvis
3
$1,542.47
$510.00

$102.0027100
Transfer of abdominal muscle
4
$2,539.24
$630.00

$126.0027105
Transfer of spinal muscle
4
$2,539.24
$630.00

$126.0027110
Transfer of iliopsoas muscle
4
$2,539.24
$630.00

$126.0027111
Transfer of iliopsoas muscle
4
$2,539.24
$630.00

$126.0027193
Treat pelvic ring fracture
1
$104.11
$104.11
Y
$20.8227194
Treat pelvic ring fracture
2
$895.58
$446.00

$89.2027202
Treat tail bone fracture
2
$2,312.35
$446.00

$89.2027230
Treat thigh fracture
1
$104.11
$104.11
Y
$20.8227238
Treat thigh fracture
1
$104.11
$104.11
Y
$20.8227246
Treat thigh fracture
1
$104.11
$104.11
Y
$20.8227250
Treat hip dislocation
1
$104.11
$104.11
Y
$20.8227252
Treat hip dislocation
2
$895.58
$446.00

$89.2027257
Treat hip dislocation
3
$895.58
$510.00

$102.0027265
Treat hip dislocation
1
$104.11
$104.11
Y
$20.8227266
Treat hip dislocation
2
$895.58
$446.00

$89.2027275
Manipulation of hip joint
2
$895.58
$446.00

$89.2027301
Drain thigh/knee lesion
3
$1,075.21
$510.00

$102.0027305
Incise thigh tendon  fascia
2
$1,281.58
$446.00

$89.2027306
Incision of thigh tendon
3
$1,281.58
$510.00

$102.0027307
Incision of thigh tendons
3
$1,281.58
$510.00

$102.0027310
Exploration of knee joint
4
$1,542.47
$630.00

$126.0027315
Partial removal, thigh nerve
2
$1,093.20
$446.00

$89.2027320
Partial removal, thigh nerve
2
$1,093.20
$446.00

$89.2027323
Biopsy, thigh soft tissues
1
$400.87
$333.00

$66.6027324
Biopsy, thigh soft tissues
1
$1,229.54
$333.00

$66.6027327
Removal of thigh lesion
2
$1,229.54
$446.00

$89.2027328
Removal of thigh lesion
3
$1,229.54
$510.00

$102.0027329
Remove tumor, thigh/knee
4
$1,229.54
$630.00

$126.0027330
Biopsy, knee joint lining
4
$1,542.47
$630.00

$126.0027331
Explore/treat knee joint
4
$1,542.47
$630.00

$126.0027332
Removal of knee cartilage
4
$1,542.47
$630.00

$126.0027333
Removal of knee cartilage
4
$1,542.47
$630.00

$126.0027334
Remove knee joint lining
4
$1,542.47
$630.00

$126.0027335
Remove knee joint lining
4
$1,542.47
$630.00

$126.0027340
Removal of kneecap bursa
3
$1,281.58
$510.00

$102.0027345
Removal of knee cyst
4
$1,281.58
$630.00

$126.0027347
Remove knee cyst
4
$1,281.58
$630.00

$126.0027350
Removal of kneecap
4
$1,542.47
$630.00

$126.0027355
Remove femur lesion
3
$1,542.47
$510.00

$102.0027356
Remove femur lesion/graft
4
$1,542.47
$630.00

$126.0027357
Remove femur lesion/graft
5
$1,542.47
$717.00

$143.4027358
Remove femur lesion/fixation
5
$1,542.47
$717.00

$143.4027360
Partial removal, leg bone(s)
5
$1,542.47
$717.00

$143.40( print page 49730)27372
Removal of foreign body
7
$1,229.54
$995.00

$199.0027380
Repair of kneecap tendon
1
$1,281.58
$333.00

$66.6027381
Repair/graft kneecap tendon
3
$1,281.58
$510.00

$102.0027385
Repair of thigh muscle
3
$1,281.58
$510.00

$102.0027386
Repair/graft of thigh muscle
3
$1,281.58
$510.00

$102.0027390
Incision of thigh tendon
1
$1,281.58
$333.00

$66.6027391
Incision of thigh tendons
2
$1,281.58
$446.00

$89.2027392
Incision of thigh tendons
3
$1,281.58
$510.00

$102.0027393
Lengthening of thigh tendon
2
$1,542.47
$446.00

$89.2027394
Lengthening of thigh tendons
3
$1,542.47
$510.00

$102.0027395
Lengthening of thigh tendons
3
$2,539.24
$510.00

$102.0027396
Transplant of thigh tendon
3
$1,542.47
$510.00

$102.0027397
Transplants of thigh tendons
3
$2,539.24
$510.00

$102.0027400
Revise thigh muscles/tendons
3
$2,539.24
$510.00

$102.0027403
Repair of knee cartilage
4
$1,542.47
$630.00

$126.0027405
Repair of knee ligament
4
$2,539.24
$630.00

$126.0027407
Repair of knee ligament
4
$4,055.26
$630.00

$126.0027409
Repair of knee ligaments
4
$2,539.24
$630.00

$126.0027418
Repair degenerated kneecap
3
$2,539.24
$510.00

$102.0027420
Revision of unstable kneecap
3
$2,539.24
$510.00

$102.0027422
Revision of unstable kneecap
7
$2,539.24
$995.00

$199.0027424
Revision/removal of kneecap
3
$2,539.24
$510.00

$102.0027425
Lat retinacular release open
7
$1,542.47
$995.00

$199.0027427
Reconstruction, knee
3
$2,539.24
$510.00

$102.0027428
Reconstruction, knee
4
$4,055.26
$630.00

$126.0027429
Reconstruction, knee
4
$4,055.26
$630.00

$126.0027430
Revision of thigh muscles
4
$2,539.24
$630.00

$126.0027435
Incision of knee joint
4
$2,539.24
$630.00

$126.0027437
Revise kneecap
4
$2,016.06
$630.00

$126.0027438
Revise kneecap with implant
5
$2,903.02
$717.00

$143.4027441
Revision of knee joint
5
$2,016.06
$717.00

$143.4027442
Revision of knee joint
5
$2,016.06
$717.00

$143.4027443
Revision of knee joint
5
$2,016.06
$717.00

$143.4027496
Decompression of thigh/knee
5
$1,281.58
$717.00

$143.4027497
Decompression of thigh/knee
3
$1,281.58
$510.00

$102.0027498
Decompression of thigh/knee
3
$1,281.58
$510.00

$102.0027499
Decompression of thigh/knee
3
$1,281.58
$510.00

$102.0027500
Treatment of thigh fracture
1
$104.11
$104.11
Y
$20.8227501
Treatment of thigh fracture
2
$104.11
$104.11
Y
$20.8227502
Treatment of thigh fracture
2
$104.11
$104.11
Y
$20.8227503
Treatment of thigh fracture
3
$104.11
$104.11
Y
$20.8227508
Treatment of thigh fracture
1
$104.11
$104.11
Y
$20.8227509
Treatment of thigh fracture
3
$1,580.03
$510.00

$102.0027510
Treatment of thigh fracture
1
$104.11
$104.11
Y
$20.8227516
Treat thigh fx growth plate
1
$104.11
$104.11
Y
$20.8227517
Treat thigh fx growth plate
1
$104.11
$104.11
Y
$20.8227520
Treat kneecap fracture
1
$104.11
$104.11
Y
$20.8227530
Treat knee fracture
1
$104.11
$104.11
Y
$20.8227532
Treat knee fracture
1
$104.11
$104.11
Y
$20.8227538
Treat knee fracture(s)
1
$104.11
$104.11
Y
$20.8227550
Treat knee dislocation
1
$104.11
$104.11
Y
$20.8227552
Treat knee dislocation
1
$895.58
$333.00

$66.6027560
Treat kneecap dislocation
1
$104.11
$104.11
Y
$20.8227562
Treat kneecap dislocation
1
$895.58
$333.00

$66.6027566
Treat kneecap dislocation
2
$2,312.35
$446.00

$89.2027570
Fixation of knee joint
1
$895.58
$333.00

$66.6027594
Amputation follow-up surgery
3
$1,281.58
$510.00

$102.0027600
Decompression of lower leg
3
$1,281.58
$510.00

$102.0027601
Decompression of lower leg
3
$1,281.58
$510.00

$102.0027602
Decompression of lower leg
3
$1,281.58
$510.00

$102.0027603
Drain lower leg lesion
2
$1,075.21
$446.00

$89.2027604
Drain lower leg bursa
2
$1,281.58
$446.00

$89.2027605
Incision of achilles tendon
1
$1,244.90
$333.00

$66.6027606
Incision of achilles tendon
1
$1,281.58
$333.00

$66.6027607
Treat lower leg bone lesion
2
$1,281.58
$446.00

$89.2027610
Explore/treat ankle joint
2
$1,542.47
$446.00

$89.2027612
Exploration of ankle joint
3
$1,542.47
$510.00

$102.0027614
Biopsy lower leg soft tissue
2
$1,229.54
$446.00

$89.2027615
Remove tumor, lower leg
3
$1,542.47
$510.00

$102.00( print page 49731)27618
Remove lower leg lesion
2
$920.58
$446.00

$89.2027619
Remove lower leg lesion
3
$1,229.54
$510.00

$102.0027620
Explore/treat ankle joint
4
$1,542.47
$630.00

$126.0027625
Remove ankle joint lining
4
$1,542.47
$630.00

$126.0027626
Remove ankle joint lining
4
$1,542.47
$630.00

$126.0027630
Removal of tendon lesion
3
$1,281.58
$510.00

$102.0027635
Remove lower leg bone lesion
3
$1,542.47
$510.00

$102.0027637
Remove/graft leg bone lesion
3
$1,542.47
$510.00

$102.0027638
Remove/graft leg bone lesion
3
$1,542.47
$510.00

$102.0027640
Partial removal of tibia
2
$2,539.24
$446.00

$89.2027641
Partial removal of fibula
2
$1,542.47
$446.00

$89.2027647
Extensive ankle/heel surgery
3
$2,539.24
$510.00

$102.0027650
Repair achilles tendon
3
$2,539.24
$510.00

$102.0027652
Repair/graft achilles tendon
3
$4,055.26
$510.00

$102.0027654
Repair of achilles tendon
3
$2,539.24
$510.00

$102.0027656
Repair leg fascia defect
2
$1,281.58
$446.00

$89.2027658
Repair of leg tendon, each
1
$1,281.58
$333.00

$66.6027659
Repair of leg tendon, each
2
$1,281.58
$446.00

$89.2027664
Repair of leg tendon, each
2
$1,281.58
$446.00

$89.2027665
Repair of leg tendon, each
2
$1,542.47
$446.00

$89.2027675
Repair lower leg tendons
2
$1,281.58
$446.00

$89.2027676
Repair lower leg tendons
3
$1,542.47
$510.00

$102.0027680
Release of lower leg tendon
3
$1,542.47
$510.00

$102.0027681
Release of lower leg tendons
2
$1,542.47
$446.00

$89.2027685
Revision of lower leg tendon
3
$1,542.47
$510.00

$102.0027686
Revise lower leg tendons
3
$1,542.47
$510.00

$102.0027687
Revision of calf tendon
3
$1,542.47
$510.00

$102.0027690
Revise lower leg tendon
4
$2,539.24
$630.00

$126.0027691
Revise lower leg tendon
4
$2,539.24
$630.00

$126.0027692
Revise additional leg tendon
3
$2,539.24
$510.00

$102.0027695
Repair of ankle ligament
2
$1,542.47
$446.00

$89.2027696
Repair of ankle ligaments
2
$1,542.47
$446.00

$89.2027698
Repair of ankle ligament
2
$1,542.47
$446.00

$89.2027700
Revision of ankle joint
5
$2,016.06
$717.00

$143.4027704
Removal of ankle implant
2
$1,281.58
$446.00

$89.2027705
Incision of tibia
2
$2,539.24
$446.00

$89.2027707
Incision of fibula
2
$1,281.58
$446.00

$89.2027709
Incision of tibia  fibula
2
$1,542.47
$446.00

$89.2027730
Repair of tibia epiphysis
2
$1,542.47
$446.00

$89.2027732
Repair of fibula epiphysis
2
$1,542.47
$446.00

$89.2027734
Repair lower leg epiphyses
2
$1,542.47
$446.00

$89.2027740
Repair of leg epiphyses
2
$1,542.47
$446.00

$89.2027742
Repair of leg epiphyses
2
$2,539.24
$446.00

$89.2027745
Reinforce tibia
3
$4,055.26
$510.00

$102.0027750
Treatment of tibia fracture
1
$104.11
$104.11
Y
$20.8227752
Treatment of tibia fracture
1
$104.11
$104.11
Y
$20.8227756
Treatment of tibia fracture
3
$1,580.03
$510.00

$102.0027758
Treatment of tibia fracture
4
$2,312.35
$630.00

$126.0027759
Treatment of tibia fracture
4
$3,472.68
$630.00

$126.0027760
Treatment of ankle fracture
1
$104.11
$104.11
Y
$20.8227762
Treatment of ankle fracture
1
$104.11
$104.11
Y
$20.8227766
Treatment of ankle fracture
3
$2,312.35
$510.00

$102.0027780
Treatment of fibula fracture
1
$104.11
$104.11
Y
$20.8227781
Treatment of fibula fracture
1
$104.11
$104.11
Y
$20.8227784
Treatment of fibula fracture
3
$2,312.35
$510.00

$102.0027786
Treatment of ankle fracture
1
$104.11
$104.11
Y
$20.8227788
Treatment of ankle fracture
1
$104.11
$104.11
Y
$20.8227792
Treatment of ankle fracture
3
$2,312.35
$510.00

$102.0027808
Treatment of ankle fracture
1
$104.11
$104.11
Y
$20.8227810
Treatment of ankle fracture
1
$104.11
$104.11
Y
$20.8227814
Treatment of ankle fracture
3
$2,312.35
$510.00

$102.0027816
Treatment of ankle fracture
1
$104.11
$104.11
Y
$20.8227818
Treatment of ankle fracture
1
$104.11
$104.11
Y
$20.8227822
Treatment of ankle fracture
3
$2,312.35
$510.00

$102.0027823
Treatment of ankle fracture
3
$3,472.68
$510.00

$102.0027824
Treat lower leg fracture
1
$104.11
$104.11
Y
$20.8227825
Treat lower leg fracture
2
$104.11
$104.11
Y
$20.8227826
Treat lower leg fracture
3
$2,312.35
$510.00

$102.0027827
Treat lower leg fracture
3
$3,472.68
$510.00

$102.00( print page 49732)27828
Treat lower leg fracture
4
$3,472.68
$630.00

$126.0027829
Treat lower leg joint
2
$2,312.35
$446.00

$89.2027830
Treat lower leg dislocation
1
$104.11
$104.11
Y
$20.8227831
Treat lower leg dislocation
1
$104.11
$104.11
Y
$20.8227832
Treat lower leg dislocation
2
$2,312.35
$446.00

$89.2027840
Treat ankle dislocation
1
$104.11
$104.11
Y
$20.8227842
Treat ankle dislocation
1
$895.58
$333.00

$66.6027846
Treat ankle dislocation
3
$2,312.35
$510.00

$102.0027848
Treat ankle dislocation
3
$2,312.35
$510.00

$102.0027860
Fixation of ankle joint
1
$895.58
$333.00

$66.6027870
Fusion of ankle joint, open
4
$4,055.26
$630.00

$126.0027871
Fusion of tibiofibular joint
4
$4,055.26
$630.00

$126.0027884
Amputation follow-up surgery
3
$1,281.58
$510.00

$102.0027889
Amputation of foot at ankle
3
$1,542.47
$510.00

$102.0027892
Decompression of leg
3
$1,281.58
$510.00

$102.0027893
Decompression of leg
3
$1,281.58
$510.00

$102.0027894
Decompression of leg
3
$1,281.58
$510.00

$102.0028002
Treatment of foot infection
3
$1,281.58
$510.00

$102.0028003
Treatment of foot infection
3
$1,281.58
$510.00

$102.0028005
Treat foot bone lesion
3
$1,244.90
$510.00

$102.0028008
Incision of foot fascia
3
$1,244.90
$510.00

$102.0028011
Incision of toe tendons
3
$1,244.90
$510.00

$102.0028020
Exploration of foot joint
2
$1,244.90
$446.00

$89.2028022
Exploration of foot joint
2
$1,244.90
$446.00

$89.2028024
Exploration of toe joint
2
$1,244.90
$446.00

$89.2028030
Removal of foot nerve
4
$1,093.20
$630.00

$126.0028035
Decompression of tibia nerve
4
$1,093.20
$630.00

$126.0028043
Excision of foot lesion
2
$1,229.54
$446.00

$89.2028045
Excision of foot lesion
3
$1,244.90
$510.00

$102.0028046
Resection of tumor, foot
3
$1,244.90
$510.00

$102.0028050
Biopsy of foot joint lining
2
$1,244.90
$446.00

$89.2028052
Biopsy of foot joint lining
2
$1,244.90
$446.00

$89.2028054
Biopsy of toe joint lining
2
$1,244.90
$446.00

$89.2028060
Partial removal, foot fascia
2
$1,244.90
$446.00

$89.2028062
Removal of foot fascia
3
$1,244.90
$510.00

$102.0028070
Removal of foot joint lining
3
$1,244.90
$510.00

$102.0028072
Removal of foot joint lining
3
$1,244.90
$510.00

$102.0028080
Removal of foot lesion
3
$1,244.90
$510.00

$102.0028086
Excise foot tendon sheath
2
$1,244.90
$446.00

$89.2028088
Excise foot tendon sheath
2
$1,244.90
$446.00

$89.2028090
Removal of foot lesion
3
$1,244.90
$510.00

$102.0028092
Removal of toe lesions
3
$1,244.90
$510.00

$102.0028100
Removal of ankle/heel lesion
2
$1,244.90
$446.00

$89.2028102
Remove/graft foot lesion
3
$2,537.37
$510.00

$102.0028103
Remove/graft foot lesion
3
$2,537.37
$510.00

$102.0028104
Removal of foot lesion
2
$1,244.90
$446.00

$89.2028106
Remove/graft foot lesion
3
$2,537.37
$510.00

$102.0028107
Remove/graft foot lesion
3
$2,537.37
$510.00

$102.0028108
Removal of toe lesions
2
$1,244.90
$446.00

$89.2028110
Part removal of metatarsal
3
$1,244.90
$510.00

$102.0028111
Part removal of metatarsal
3
$1,244.90
$510.00

$102.0028112
Part removal of metatarsal
3
$1,244.90
$510.00

$102.0028113
Part removal of metatarsal
3
$1,244.90
$510.00

$102.0028114
Removal of metatarsal heads
3
$1,244.90
$510.00

$102.0028116
Revision of foot
3
$1,244.90
$510.00

$102.0028118
Removal of heel bone
4
$1,244.90
$630.00

$126.0028119
Removal of heel spur
4
$1,244.90
$630.00

$126.0028120
Part removal of ankle/heel
7
$1,244.90
$995.00

$199.0028122
Partial removal of foot bone
3
$1,244.90
$510.00

$102.0028126
Partial removal of toe
3
$1,244.90
$510.00

$102.0028130
Removal of ankle bone
3
$1,244.90
$510.00

$102.0028140
Removal of metatarsal
3
$1,244.90
$510.00

$102.0028150
Removal of toe
3
$1,244.90
$510.00

$102.0028153
Partial removal of toe
3
$1,244.90
$510.00

$102.0028160
Partial removal of toe
3
$1,244.90
$510.00

$102.0028171
Extensive foot surgery
3
$1,244.90
$510.00

$102.0028173
Extensive foot surgery
3
$1,244.90
$510.00

$102.0028175
Extensive foot surgery
3
$1,244.90
$510.00

$102.0028192
Removal of foot foreign body
2
$920.58
$446.00

$89.20( print page 49733)28193
Removal of foot foreign body
4
$400.87
$400.87
Y
$80.1728200
Repair of foot tendon
3
$1,244.90
$510.00

$102.0028202
Repair/graft of foot tendon
3
$1,244.90
$510.00

$102.0028208
Repair of foot tendon
3
$1,244.90
$510.00

$102.0028210
Repair/graft of foot tendon
3
$2,537.37
$510.00

$102.0028222
Release of foot tendons
1
$1,244.90
$333.00

$66.6028225
Release of foot tendon
1
$1,244.90
$333.00

$66.6028226
Release of foot tendons
1
$1,244.90
$333.00

$66.6028234
Incision of foot tendon
2
$1,244.90
$446.00

$89.2028238
Revision of foot tendon
3
$2,537.37
$510.00

$102.0028240
Release of big toe
2
$1,244.90
$446.00

$89.2028250
Revision of foot fascia
3
$1,244.90
$510.00

$102.0028260
Release of midfoot joint
3
$1,244.90
$510.00

$102.0028261
Revision of foot tendon
3
$1,244.90
$510.00

$102.0028262
Revision of foot and ankle
4
$1,244.90
$630.00

$126.0028264
Release of midfoot joint
1
$2,537.37
$333.00

$66.6028270
Release of foot contracture
3
$1,244.90
$510.00

$102.0028280
Fusion of toes
2
$1,244.90
$446.00

$89.2028285
Repair of hammertoe
3
$1,244.90
$510.00

$102.0028286
Repair of hammertoe
4
$1,244.90
$630.00

$126.0028288
Partial removal of foot bone
3
$1,244.90
$510.00

$102.0028289
Repair hallux rigidus
3
$1,244.90
$510.00

$102.0028290
Correction of bunion
2
$1,729.40
$446.00

$89.2028292
Correction of bunion
2
$1,729.40
$446.00

$89.2028293
Correction of bunion
3
$1,729.40
$510.00

$102.0028294
Correction of bunion
3
$1,729.40
$510.00

$102.0028296
Correction of bunion
3
$1,729.40
$510.00

$102.0028297
Correction of bunion
3
$1,729.40
$510.00

$102.0028298
Correction of bunion
3
$1,729.40
$510.00

$102.0028299
Correction of bunion
5
$1,729.40
$717.00

$143.4028300
Incision of heel bone
2
$2,537.37
$446.00

$89.2028302
Incision of ankle bone
2
$1,244.90
$446.00

$89.2028304
Incision of midfoot bones
2
$2,537.37
$446.00

$89.2028305
Incise/graft midfoot bones
3
$2,537.37
$510.00

$102.0028306
Incision of metatarsal
4
$1,244.90
$630.00

$126.0028307
Incision of metatarsal
4
$1,244.90
$630.00

$126.0028308
Incision of metatarsal
2
$1,244.90
$446.00

$89.2028309
Incision of metatarsals
4
$2,537.37
$630.00

$126.0028310
Revision of big toe
3
$1,244.90
$510.00

$102.0028312
Revision of toe
3
$1,244.90
$510.00

$102.0028313
Repair deformity of toe
2
$1,244.90
$446.00

$89.2028315
Removal of sesamoid bone
4
$1,244.90
$630.00

$126.0028320
Repair of foot bones
4
$2,537.37
$630.00

$126.0028322
Repair of metatarsals
4
$2,537.37
$630.00

$126.0028340
Resect enlarged toe tissue
4
$1,244.90
$630.00

$126.0028341
Resect enlarged toe
4
$1,244.90
$630.00

$126.0028344
Repair extra toe(s)
4
$1,244.90
$630.00

$126.0028345
Repair webbed toe(s)
4
$1,244.90
$630.00

$126.0028400
Treatment of heel fracture
1
$104.11
$104.11
Y
$20.8228405
Treatment of heel fracture
2
$104.11
$104.11
Y
$20.8228406
Treatment of heel fracture
2
$1,580.03
$446.00

$89.2028415
Treat heel fracture
3
$2,312.35
$510.00

$102.0028420
Treat/graft heel fracture
4
$2,312.35
$630.00

$126.0028435
Treatment of ankle fracture
2
$104.11
$104.11
Y
$20.8228436
Treatment of ankle fracture
2
$1,580.03
$446.00

$89.2028445
Treat ankle fracture
3
$2,312.35
$510.00

$102.0028456
Treat midfoot fracture
2
$1,580.03
$446.00

$89.2028465
Treat midfoot fracture, each
3
$2,312.35
$510.00

$102.0028476
Treat metatarsal fracture
2
$1,580.03
$446.00

$89.2028485
Treat metatarsal fracture
4
$2,312.35
$630.00

$126.0028496
Treat big toe fracture
2
$1,580.03
$446.00

$89.2028505
Treat big toe fracture
3
$2,312.35
$510.00

$102.0028525
Treat toe fracture
3
$2,312.35
$510.00

$102.0028531
Treat sesamoid bone fracture
3
$2,312.35
$510.00

$102.0028545
Treat foot dislocation
1
$1,580.03
$333.00

$66.6028546
Treat foot dislocation
2
$1,580.03
$446.00

$89.2028555
Repair foot dislocation
2
$2,312.35
$446.00

$89.2028575
Treat foot dislocation
1
$104.11
$104.11
Y
$20.8228576
Treat foot dislocation
3
$1,580.03
$510.00

$102.00( print page 49734)28585
Repair foot dislocation
3
$2,312.35
$510.00

$102.0028605
Treat foot dislocation
1
$104.11
$104.11
Y
$20.8228606
Treat foot dislocation
2
$1,580.03
$446.00

$89.2028615
Repair foot dislocation
3
$2,312.35
$510.00

$102.0028635
Treat toe dislocation
1
$895.58
$333.00

$66.6028636
Treat toe dislocation
3
$1,580.03
$510.00

$102.0028645
Repair toe dislocation
3
$2,312.35
$510.00

$102.0028665
Treat toe dislocation
1
$895.58
$333.00

$66.6028666
Treat toe dislocation
3
$1,580.03
$510.00

$102.0028675
Repair of toe dislocation
3
$2,312.35
$510.00

$102.0028705
Fusion of foot bones
4
$2,537.37
$630.00

$126.0028715
Fusion of foot bones
4
$2,537.37
$630.00

$126.0028725
Fusion of foot bones
4
$2,537.37
$630.00

$126.0028730
Fusion of foot bones
4
$2,537.37
$630.00

$126.0028735
Fusion of foot bones
4
$2,537.37
$630.00

$126.0028737
Revision of foot bones
5
$2,537.37
$717.00

$143.4028740
Fusion of foot bones
4
$2,537.37
$630.00

$126.0028750
Fusion of big toe joint
4
$2,537.37
$630.00

$126.0028755
Fusion of big toe joint
4
$1,244.90
$630.00

$126.0028760
Fusion of big toe joint
4
$2,537.37
$630.00

$126.0028810
Amputation toe  metatarsal
2
$1,244.90
$446.00

$89.2028820
Amputation of toe
2
$1,244.90
$446.00

$89.2028825
Partial amputation of toe
2
$1,244.90
$446.00

$89.2029800
Jaw arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029804
Jaw arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029805
Shoulder arthroscopy, dx
3
$1,762.08
$510.00

$102.0029806
Shoulder arthroscopy/surgery
3
$2,773.72
$510.00

$102.0029807
Shoulder arthroscopy/surgery
3
$2,773.72
$510.00

$102.0029819
Shoulder arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029820
Shoulder arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029821
Shoulder arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029822
Shoulder arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029823
Shoulder arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029824
Shoulder arthroscopy/surgery
5
$1,762.08
$717.00

$143.4029825
Shoulder arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029826
Shoulder arthroscopy/surgery
3
$2,773.72
$510.00

$102.0029827
Arthroscop rotator cuff repr
5
$2,773.72
$717.00

$143.4029830
Elbow arthroscopy
3
$1,762.08
$510.00

$102.0029834
Elbow arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029835
Elbow arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029836
Elbow arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029837
Elbow arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029838
Elbow arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029840
Wrist arthroscopy
3
$1,762.08
$510.00

$102.0029843
Wrist arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029844
Wrist arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029845
Wrist arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029846
Wrist arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029847
Wrist arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029848
Wrist endoscopy/surgery
9
$1,762.08
$1,339.00

$267.8029850
Knee arthroscopy/surgery
4
$1,762.08
$630.00

$126.0029851
Knee arthroscopy/surgery
4
$2,773.72
$630.00

$126.0029855
Tibial arthroscopy/surgery
4
$2,773.72
$630.00

$126.0029856
Tibial arthroscopy/surgery
4
$1,762.08
$630.00

$126.0029860
Hip arthroscopy, dx
4
$1,762.08
$630.00

$126.0029861
Hip arthroscopy/surgery
4
$1,762.08
$630.00

$126.0029862
Hip arthroscopy/surgery
9
$2,773.72
$1,339.00

$267.8029863
Hip arthroscopy/surgery
4
$2,773.72
$630.00

$126.0029870
Knee arthroscopy, dx
3
$1,762.08
$510.00

$102.0029871
Knee arthroscopy/drainage
3
$1,762.08
$510.00

$102.0029873
Knee arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029874
Knee arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029875
Knee arthroscopy/surgery
4
$1,762.08
$630.00

$126.0029876
Knee arthroscopy/surgery
4
$1,762.08
$630.00

$126.0029877
Knee arthroscopy/surgery
4
$1,762.08
$630.00

$126.0029879
Knee arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029880
Knee arthroscopy/surgery
4
$1,762.08
$630.00

$126.0029881
Knee arthroscopy/surgery
4
$1,762.08
$630.00

$126.0029882
Knee arthroscopy/surgery
3
$1,762.08
$510.00

$102.00( print page 49735)29883
Knee arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029884
Knee arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029885
Knee arthroscopy/surgery
3
$2,773.72
$510.00

$102.0029886
Knee arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029887
Knee arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029888
Knee arthroscopy/surgery
3
$2,773.72
$510.00

$102.0029889
Knee arthroscopy/surgery
3
$2,773.72
$510.00

$102.0029891
Ankle arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029892
Ankle arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029893
Scope, plantar fasciotomy
9
$1,244.90
$1,244.90
Y
$248.9829894
Ankle arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029895
Ankle arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029897
Ankle arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029898
Ankle arthroscopy/surgery
3
$1,762.08
$510.00

$102.0029899
Ankle arthroscopy/surgery
3
$2,773.72
$510.00

$102.0029900
Mcp joint arthroscopy, dx
3
$986.93
$510.00

$102.0029901
Mcp joint arthroscopy, surg
3
$986.93
$510.00

$102.0029902
Mcp joint arthroscopy, surg
3
$986.93
$510.00

$102.0030115
Removal of nose polyp(s)
2
$1,012.48
$446.00

$89.2030117
Removal of intranasal lesion
3
$1,012.48
$510.00

$102.0030118
Removal of intranasal lesion
3
$1,425.30
$510.00

$102.0030120
Revision of nose
1
$1,012.48
$333.00

$66.6030125
Removal of nose lesion
2
$2,324.90
$446.00

$89.2030130
Excise inferior turbinate
3
$1,012.48
$510.00

$102.0030140
Resect inferior turbinate
2
$1,425.30
$446.00

$89.2030150
Partial removal of nose
3
$2,324.90
$510.00

$102.0030160
Removal of nose
4
$2,324.90
$630.00

$126.0030220
Insert nasal septal button
3
$475.55
$475.55
Y
$95.1130310
Remove nasal foreign body
1
$1,012.48
$333.00

$66.6030320
Remove nasal foreign body
2
$1,012.48
$446.00

$89.2030400
Reconstruction of nose
4
$2,324.90
$630.00

$126.0030410
Reconstruction of nose
5
$2,324.90
$717.00

$143.4030420
Reconstruction of nose
5
$2,324.90
$717.00

$143.4030430
Revision of nose
3
$1,425.30
$510.00

$102.0030435
Revision of nose
5
$2,324.90
$717.00

$143.4030450
Revision of nose
7
$2,324.90
$995.00

$199.0030460
Revision of nose
7
$2,324.90
$995.00

$199.0030462
Revision of nose
9
$2,324.90
$1,339.00

$267.8030465
Repair nasal stenosis
9
$2,324.90
$1,339.00

$267.8030520
Repair of nasal septum
4
$1,425.30
$630.00

$126.0030540
Repair nasal defect
5
$2,324.90
$717.00

$143.4030545
Repair nasal defect
5
$2,324.90
$717.00

$143.4030560
Release of nasal adhesions
2
$146.29
$146.29
Y
$29.2630580
Repair upper jaw fistula
4
$2,324.90
$630.00

$126.0030600
Repair mouth/nose fistula
4
$2,324.90
$630.00

$126.0030620
Intranasal reconstruction
7
$2,324.90
$995.00

$199.0030630
Repair nasal septum defect
7
$1,425.30
$995.00

$199.0030801
Ablate inf turbinate, superf
1
$475.55
$333.00

$66.6030802
Cauterization, inner nose
1
$475.55
$333.00

$66.6030903
Control of nosebleed
1
$73.99
$73.99
Y
$14.8030905
Control of nosebleed
1
$73.99
$73.99
Y
$14.8030906
Repeat control of nosebleed
1
$73.99
$73.99
Y
$14.8030915
Ligation, nasal sinus artery
2
$1,513.03
$446.00

$89.2030920
Ligation, upper jaw artery
3
$1,513.03
$510.00

$102.0030930
Ther fx, nasal inf turbinate
4
$1,012.48
$630.00

$126.0031020
Exploration, maxillary sinus
2
$1,425.30
$446.00

$89.2031030
Exploration, maxillary sinus
3
$2,324.90
$510.00

$102.0031032
Explore sinus, remove polyps
4
$2,324.90
$630.00

$126.0031050
Exploration, sphenoid sinus
2
$2,324.90
$446.00

$89.2031051
Sphenoid sinus surgery
4
$2,324.90
$630.00

$126.0031070
Exploration of frontal sinus
2
$1,425.30
$446.00

$89.2031075
Exploration of frontal sinus
4
$2,324.90
$630.00

$126.0031080
Removal of frontal sinus
4
$2,324.90
$630.00

$126.0031081
Removal of frontal sinus
4
$2,324.90
$630.00

$126.0031084
Removal of frontal sinus
4
$2,324.90
$630.00

$126.0031085
Removal of frontal sinus
4
$2,324.90
$630.00

$126.0031086
Removal of frontal sinus
4
$2,324.90
$630.00

$126.0031087
Removal of frontal sinus
4
$2,324.90
$630.00

$126.0031090
Exploration of sinuses
5
$2,324.90
$717.00

$143.40( print page 49736)31200
Removal of ethmoid sinus
2
$2,324.90
$446.00

$89.2031201
Removal of ethmoid sinus
5
$2,324.90
$717.00

$143.4031205
Removal of ethmoid sinus
3
$2,324.90
$510.00

$102.0031233
Nasal/sinus endoscopy, dx
2
$86.41
$86.41
Y
$17.2831235
Nasal/sinus endoscopy, dx
1
$931.27
$333.00

$66.6031237
Nasal/sinus endoscopy, surg
2
$931.27
$446.00

$89.2031238
Nasal/sinus endoscopy, surg
1
$931.27
$333.00

$66.6031239
Nasal/sinus endoscopy, surg
4
$1,341.87
$630.00

$126.0031240
Nasal/sinus endoscopy, surg
2
$931.27
$446.00

$89.2031254
Revision of ethmoid sinus
3
$1,341.87
$510.00

$102.0031255
Removal of ethmoid sinus
5
$1,341.87
$717.00

$143.4031256
Exploration maxillary sinus
3
$1,341.87
$510.00

$102.0031267
Endoscopy, maxillary sinus
3
$1,341.87
$510.00

$102.0031276
Sinus endoscopy, surgical
3
$1,341.87
$510.00

$102.0031287
Nasal/sinus endoscopy, surg
3
$1,341.87
$510.00

$102.0031288
Nasal/sinus endoscopy, surg
3
$1,341.87
$510.00

$102.0031300
Removal of larynx lesion
5
$1,425.30
$717.00

$143.4031320
Diagnostic incision, larynx
2
$2,324.90
$446.00

$89.2031400
Revision of larynx
2
$2,324.90
$446.00

$89.2031420
Removal of epiglottis
2
$2,324.90
$446.00

$89.2031510
Laryngoscopy with biopsy
2
$931.27
$446.00

$89.2031511
Remove foreign body, larynx
2
$86.41
$86.41
Y
$17.2831512
Removal of larynx lesion
2
$931.27
$446.00

$89.2031513
Injection into vocal cord
2
$86.41
$86.41
Y
$17.2831515
Laryngoscopy for aspiration
1
$931.27
$333.00

$66.6031525
Dx laryngoscopy excl nb
1
$931.27
$333.00

$66.6031526
Dx laryngoscopy w/oper scope
2
$1,341.87
$446.00

$89.2031527
Laryngoscopy for treatment
1
$1,341.87
$333.00

$66.6031528
Laryngoscopy and dilation
2
$931.27
$446.00

$89.2031529
Laryngoscopy and dilation
2
$931.27
$446.00

$89.2031530
Laryngoscopy w/fb removal
2
$1,341.87
$446.00

$89.2031531
Laryngoscopy w/fb  op scope
3
$1,341.87
$510.00

$102.0031535
Laryngoscopy w/biopsy
2
$1,341.87
$446.00

$89.2031536
Laryngoscopy w/bx  op scope
3
$1,341.87
$510.00

$102.0031540
Laryngoscopy w/exc of tumor
3
$1,341.87
$510.00

$102.0031541
Larynscop w/tumr exc + scope
4
$1,341.87
$630.00

$126.0031545
Remove vc lesion w/scope
4
$1,341.87
$630.00

$126.0031546
Remove vc lesion scope/graft
4
$1,341.87
$630.00

$126.0031560
Laryngoscop w/arytenoidectom
5
$1,341.87
$717.00

$143.4031561
Larynscop, remve cart + scop
5
$1,341.87
$717.00

$143.4031570
Laryngoscope w/vc inj
2
$931.27
$446.00

$89.2031571
Laryngoscop w/vc inj + scope
2
$1,341.87
$446.00

$89.2031576
Laryngoscopy with biopsy
2
$1,341.87
$446.00

$89.2031577
Remove foreign body, larynx
2
$238.43
$238.43
Y
$47.6931578
Removal of larynx lesion
2
$1,341.87
$446.00

$89.2031580
Revision of larynx
5
$2,324.90
$717.00

$143.4031582
Revision of larynx
5
$2,324.90
$717.00

$143.4031588
Revision of larynx
5
$2,324.90
$717.00

$143.4031590
Reinnervate larynx
5
$2,324.90
$717.00

$143.4031595
Larynx nerve surgery
2
$2,324.90
$446.00

$89.2031603
Incision of windpipe
1
$475.55
$333.00

$66.6031611
Surgery/speech prosthesis
3
$1,425.30
$510.00

$102.0031612
Puncture/clear windpipe
1
$1,425.30
$333.00

$66.6031613
Repair windpipe opening
2
$1,425.30
$446.00

$89.2031614
Repair windpipe opening
2
$2,324.90
$446.00

$89.2031615
Visualization of windpipe
1
$577.99
$333.00

$66.6031622
Dx bronchoscope/wash
1
$577.99
$333.00

$66.6031623
Dx bronchoscope/brush
2
$577.99
$446.00

$89.2031624
Dx bronchoscope/lavage
2
$577.99
$446.00

$89.2031625
Bronchoscopy w/biopsy(s)
2
$577.99
$446.00

$89.2031628
Bronchoscopy/lung bx, each
2
$577.99
$446.00

$89.2031629
Bronchoscopy/needle bx, each
2
$577.99
$446.00

$89.2031630
Bronchoscopy dilate/fx repr
2
$1,346.75
$446.00

$89.2031631
Bronchoscopy, dilate w/stent
2
$1,346.75
$446.00

$89.2031635
Bronchoscopy w/fb removal
2
$577.99
$446.00

$89.2031636
Bronchoscopy, bronch stents
2
$1,346.75
$446.00

$89.2031637
Bronchoscopy, stent add-on
1
$577.99
$333.00

$66.6031638
Bronchoscopy, revise stent
2
$1,346.75
$446.00

$89.2031640
Bronchoscopy w/tumor excise
2
$1,346.75
$446.00

$89.20( print page 49737)31641
Bronchoscopy, treat blockage
2
$1,346.75
$446.00

$89.2031643
Diag bronchoscope/catheter
2
$577.99
$446.00

$89.2031645
Bronchoscopy, clear airways
1
$577.99
$333.00

$66.6031646
Bronchoscopy, reclear airway
1
$577.99
$333.00

$66.6031656
Bronchoscopy, inj for x-ray
1
$577.99
$333.00

$66.6031700
Insertion of airway catheter
1
$86.41
$86.41
Y
$17.2831717
Bronchial brush biopsy
1
$238.43
$238.43
Y
$47.6931720
Clearance of airways
1
$46.61
$46.61
Y
$9.3231730
Intro, windpipe wire/tube
1
$238.43
$238.43
Y
$47.6931750
Repair of windpipe
5
$2,324.90
$717.00

$143.4031755
Repair of windpipe
2
$2,324.90
$446.00

$89.2031820
Closure of windpipe lesion
1
$1,012.48
$333.00

$66.6031825
Repair of windpipe defect
2
$1,425.30
$446.00

$89.2031830
Revise windpipe scar
2
$1,425.30
$446.00

$89.2032000
Drainage of chest
1
$224.20
$224.20
Y
$44.8432400
Needle biopsy chest lining
1
$373.79
$333.00

$66.6032405
Biopsy, lung or mediastinum
1
$373.79
$333.00

$66.6032420
Puncture/clear lung
1
$224.20
$224.20
Y
$44.8433010
Drainage of heart sac
2
$224.20
$224.20
Y
$44.8433011
Repeat drainage of heart sac
2
$224.20
$224.20
Y
$44.8433212
Insertion of pulse generator
3
$6,021.89
$510.00

$102.0033213
Insertion of pulse generator
3
$6,908.16
$510.00

$102.0033222
Revise pocket, pacemaker
2
$1,308.85
$446.00

$89.2033223
Revise pocket, pacing-defib
2
$1,308.85
$446.00

$89.2033233
Removal of pacemaker system
2
$1,444.39
$446.00

$89.2035188
Repair blood vessel lesion
4
$2,336.80
$630.00

$126.0035207
Repair blood vessel lesion
4
$2,336.80
$630.00

$126.0035476
Repair venous blockage
9
$2,639.89
$1,339.00

$267.8035875
Removal of clot in graft
9
$2,336.80
$1,339.00

$267.8035876
Removal of clot in graft
9
$2,336.80
$1,339.00

$267.8036260
Insertion of infusion pump
3
$1,752.02
$510.00

$102.0036261
Revision of infusion pump
2
$1,752.02
$446.00

$89.2036262
Removal of infusion pump
1
$1,397.11
$333.00

$66.6036475
Endovenous rf, 1st vein
8
$2,131.38
$973.00

$194.6036476
Endovenous rf, vein add-on
8
$2,131.38
$973.00

$194.6036478
Endovenous laser, 1st vein
8
$1,513.03
$973.00

$194.6036479
Endovenous laser vein addon
8
$1,513.03
$973.00

$194.6036555
Insert non-tunnel cv cath
1
$540.67
$333.00

$66.6036556
Insert non-tunnel cv cath
1
$540.67
$333.00

$66.6036557
Insert tunneled cv cath
2
$1,397.11
$446.00

$89.2036558
Insert tunneled cv cath
2
$1,397.11
$446.00

$89.2036560
Insert tunneled cv cath
3
$1,752.02
$510.00

$102.0036561
Insert tunneled cv cath
3
$1,752.02
$510.00

$102.0036563
Insert tunneled cv cath
3
$1,752.02
$510.00

$102.0036565
Insert tunneled cv cath
3
$1,752.02
$510.00

$102.0036566
Insert tunneled cv cath
3
$1,752.02
$510.00

$102.0036568
Insert picc cath
1
$540.67
$333.00

$66.6036569
Insert picc cath
1
$540.67
$333.00

$66.6036570
Insert picvad cath
3
$1,397.11
$510.00

$102.0036571
Insert picvad cath
3
$1,397.11
$510.00

$102.0036575
Repair tunneled cv cath
2
$540.67
$446.00

$89.2036576
Repair tunneled cv cath
2
$540.67
$446.00

$89.2036578
Replace tunneled cv cath
2
$1,397.11
$446.00

$89.2036580
Replace cvad cath
1
$540.67
$333.00

$66.6036581
Replace tunneled cv cath
2
$1,397.11
$446.00

$89.2036582
Replace tunneled cv cath
3
$1,752.02
$510.00

$102.0036583
Replace tunneled cv cath
3
$1,752.02
$510.00

$102.0036584
Replace picc cath
1
$540.67
$333.00

$66.6036585
Replace picvad cath
3
$1,397.11
$510.00

$102.0036589
Removal tunneled cv cath
1
$540.67
$333.00

$66.6036590
Removal tunneled cv cath
1
$540.67
$333.00

$66.6036640
Insertion catheter, artery
1
$1,752.02
$333.00

$66.6036800
Insertion of cannula
3
$1,814.26
$510.00

$102.0036810
Insertion of cannula
3
$1,814.26
$510.00

$102.0036815
Insertion of cannula
3
$1,814.26
$510.00

$102.0036818
AV fuse, upper arm, cephalic
3
$2,336.80
$510.00

$102.0036819
Av fuse, uppr arm, basilic
3
$2,336.80
$510.00

$102.0036820
Av fusion/forearm vein
3
$2,336.80
$510.00

$102.0036821
Av fusion direct any site
3
$2,336.80
$510.00

$102.00( print page 49738)36825
Artery-vein autograft
4
$2,336.80
$630.00

$126.0036830
Artery-vein nonautograft
4
$2,336.80
$630.00

$126.0036831
Open thrombect av fistula
9
$2,336.80
$1,339.00

$267.8036832
Av fistula revision, open
4
$2,336.80
$630.00

$126.0036833
Av fistula revision
4
$2,336.80
$630.00

$126.0036834
Repair a-v aneurysm
3
$2,336.80
$510.00

$102.0036835
Artery to vein shunt
4
$1,814.26
$630.00

$126.0036860
External cannula declotting
2
$126.87
$126.87
Y
$25.3736861
Cannula declotting
3
$1,814.26
$510.00

$102.0036870
Percut thrombect av fistula
9
$1,908.11
$1,339.00

$267.8037205
Transcath IV stent, percutan
9
$4,067.31
$1,339.00

$267.8037206
Transcath IV stent/perc, add
1
$4,067.31
$333.00

$66.6037500
Endoscopy ligate perf veins
3
$2,131.38
$510.00

$102.0037607
Ligation of a-v fistula
3
$1,513.03
$510.00

$102.0037609
Temporal artery procedure
2
$920.58
$446.00

$89.2037650
Revision of major vein
2
$1,513.03
$446.00

$89.2037700
Revise leg vein
2
$2,131.38
$446.00

$89.2037718
Ligate/strip short leg vein
3
$2,131.38
$510.00

$102.0037722
Ligate/strip long leg vein
3
$2,131.38
$510.00

$102.0037735
Removal of leg veins/lesion
3
$2,131.38
$510.00

$102.0037760
Ligation, leg veins, open
3
$1,513.03
$510.00

$102.0037780
Revision of leg vein
3
$1,513.03
$510.00

$102.0037785
Ligate/divide/excise vein
3
$1,513.03
$510.00

$102.0037790
Penile venous occlusion
3
$2,031.13
$510.00

$102.0038300
Drainage, lymph node lesion
1
$672.04
$333.00

$66.6038305
Drainage, lymph node lesion
2
$1,075.21
$446.00

$89.2038308
Incision of lymph channels
2
$1,315.18
$446.00

$89.2038500
Biopsy/removal, lymph nodes
2
$1,315.18
$446.00

$89.2038505
Needle biopsy, lymph nodes
1
$234.21
$234.21
Y
$46.8438510
Biopsy/removal, lymph nodes
2
$1,315.18
$446.00

$89.2038520
Biopsy/removal, lymph nodes
2
$1,315.18
$446.00

$89.2038525
Biopsy/removal, lymph nodes
2
$1,315.18
$446.00

$89.2038530
Biopsy/removal, lymph nodes
2
$1,315.18
$446.00

$89.2038542
Explore deep node(s), neck
2
$2,285.28
$446.00

$89.2038550
Removal, neck/armpit lesion
3
$1,315.18
$510.00

$102.0038555
Removal, neck/armpit lesion
4
$1,315.18
$630.00

$126.0038570
Laparoscopy, lymph node biop
9
$2,678.23
$1,339.00

$267.8038571
Laparoscopy, lymphadenectomy
9
$4,363.07
$1,339.00

$267.8038572
Laparoscopy, lymphadenectomy
9
$2,678.23
$1,339.00

$267.8038740
Remove armpit lymph nodes
2
$2,285.28
$446.00

$89.2038745
Remove armpit lymph nodes
4
$2,285.28
$630.00

$126.0038760
Remove groin lymph nodes
2
$1,315.18
$446.00

$89.2040500
Partial excision of lip
2
$1,012.48
$446.00

$89.2040510
Partial excision of lip
2
$1,425.30
$446.00

$89.2040520
Partial excision of lip
2
$1,012.48
$446.00

$89.2040525
Reconstruct lip with flap
2
$1,425.30
$446.00

$89.2040527
Reconstruct lip with flap
2
$1,425.30
$446.00

$89.2040530
Partial removal of lip
2
$1,425.30
$446.00

$89.2040650
Repair lip
3
$475.55
$475.55
Y
$95.1140652
Repair lip
3
$475.55
$475.55
Y
$95.1140654
Repair lip
3
$475.55
$475.55
Y
$95.1140700
Repair cleft lip/nasal
7
$2,324.90
$995.00

$199.0040701
Repair cleft lip/nasal
7
$2,324.90
$995.00

$199.0040720
Repair cleft lip/nasal
7
$2,324.90
$995.00

$199.0040761
Repair cleft lip/nasal
3
$2,324.90
$510.00

$102.0040801
Drainage of mouth lesion
2
$475.55
$446.00

$89.2040814
Excise/repair mouth lesion
2
$1,012.48
$446.00

$89.2040816
Excision of mouth lesion
2
$1,425.30
$446.00

$89.2040818
Excise oral mucosa for graft
1
$146.29
$146.29
Y
$29.2640819
Excise lip or cheek fold
1
$475.55
$333.00

$66.6040831
Repair mouth laceration
1
$475.55
$333.00

$66.6040840
Reconstruction of mouth
2
$1,425.30
$446.00

$89.2040842
Reconstruction of mouth
3
$1,425.30
$510.00

$102.0040843
Reconstruction of mouth
3
$1,425.30
$510.00

$102.0040844
Reconstruction of mouth
5
$2,324.90
$717.00

$143.4040845
Reconstruction of mouth
5
$2,324.90
$717.00

$143.4041005
Drainage of mouth lesion
1
$146.29
$146.29
Y
$29.2641006
Drainage of mouth lesion
1
$1,425.30
$333.00

$66.6041007
Drainage of mouth lesion
1
$1,012.48
$333.00

$66.60( print page 49739)41008
Drainage of mouth lesion
1
$1,012.48
$333.00

$66.6041009
Drainage of mouth lesion
1
$146.29
$146.29
Y
$29.2641010
Incision of tongue fold
1
$475.55
$333.00

$66.6041015
Drainage of mouth lesion
1
$146.29
$146.29
Y
$29.2641016
Drainage of mouth lesion
1
$475.55
$333.00

$66.6041017
Drainage of mouth lesion
1
$475.55
$333.00

$66.6041018
Drainage of mouth lesion
1
$475.55
$333.00

$66.6041112
Excision of tongue lesion
2
$1,012.48
$446.00

$89.2041113
Excision of tongue lesion
2
$1,012.48
$446.00

$89.2041114
Excision of tongue lesion
2
$1,425.30
$446.00

$89.2041116
Excision of mouth lesion
1
$1,012.48
$333.00

$66.6041120
Partial removal of tongue
5
$1,425.30
$717.00

$143.4041250
Repair tongue laceration
2
$146.29
$146.29
Y
$29.2641251
Repair tongue laceration
2
$146.29
$146.29
Y
$29.2641252
Repair tongue laceration
2
$475.55
$446.00

$89.2041500
Fixation of tongue
1
$1,425.30
$333.00

$66.6041510
Tongue to lip surgery
1
$1,012.48
$333.00

$66.6041520
Reconstruction, tongue fold
2
$475.55
$446.00

$89.2041800
Drainage of gum lesion
1
$91.22
$91.22
Y
$18.2441827
Excision of gum lesion
2
$1,425.30
$446.00

$89.2042000
Drainage mouth roof lesion
2
$146.29
$146.29
Y
$29.2642107
Excision lesion, mouth roof
2
$1,425.30
$446.00

$89.2042120
Remove palate/lesion
4
$2,324.90
$630.00

$126.0042140
Excision of uvula
2
$475.55
$446.00

$89.2042145
Repair palate, pharynx/uvula
5
$1,425.30
$717.00

$143.4042180
Repair palate
1
$146.29
$146.29
Y
$29.2642182
Repair palate
2
$2,324.90
$446.00

$89.2042200
Reconstruct cleft palate
5
$2,324.90
$717.00

$143.4042205
Reconstruct cleft palate
5
$2,324.90
$717.00

$143.4042210
Reconstruct cleft palate
5
$2,324.90
$717.00

$143.4042215
Reconstruct cleft palate
7
$2,324.90
$995.00

$199.0042220
Reconstruct cleft palate
5
$2,324.90
$717.00

$143.4042226
Lengthening of palate
5
$2,324.90
$717.00

$143.4042235
Repair palate
5
$1,012.48
$717.00

$143.4042260
Repair nose to lip fistula
4
$1,425.30
$630.00

$126.0042300
Drainage of salivary gland
1
$1,012.48
$333.00

$66.6042305
Drainage of salivary gland
2
$1,012.48
$446.00

$89.2042310
Drainage of salivary gland
1
$146.29
$146.29
Y
$29.2642320
Drainage of salivary gland
1
$146.29
$146.29
Y
$29.2642340
Removal of salivary stone
2
$1,012.48
$446.00

$89.2042405
Biopsy of salivary gland
2
$1,012.48
$446.00

$89.2042408
Excision of salivary cyst
3
$1,012.48
$510.00

$102.0042409
Drainage of salivary cyst
3
$1,012.48
$510.00

$102.0042410
Excise parotid gland/lesion
3
$2,324.90
$510.00

$102.0042415
Excise parotid gland/lesion
7
$2,324.90
$995.00

$199.0042420
Excise parotid gland/lesion
7
$2,324.90
$995.00

$199.0042425
Excise parotid gland/lesion
7
$2,324.90
$995.00

$199.0042440
Excise submaxillary gland
3
$2,324.90
$510.00

$102.0042450
Excise sublingual gland
2
$1,425.30
$446.00

$89.2042500
Repair salivary duct
3
$1,425.30
$510.00

$102.0042505
Repair salivary duct
4
$2,324.90
$630.00

$126.0042507
Parotid duct diversion
3
$2,324.90
$510.00

$102.0042508
Parotid duct diversion
4
$2,324.90
$630.00

$126.0042509
Parotid duct diversion
4
$2,324.90
$630.00

$126.0042510
Parotid duct diversion
4
$2,324.90
$630.00

$126.0042600
Closure of salivary fistula
1
$1,012.48
$333.00

$66.6042665
Ligation of salivary duct
7
$1,425.30
$995.00

$199.0042700
Drainage of tonsil abscess
1
$146.29
$146.29
Y
$29.2642720
Drainage of throat abscess
1
$1,012.48
$333.00

$66.6042725
Drainage of throat abscess
2
$2,324.90
$446.00

$89.2042802
Biopsy of throat
1
$1,012.48
$333.00

$66.6042804
Biopsy of upper nose/throat
1
$1,012.48
$333.00

$66.6042806
Biopsy of upper nose/throat
2
$1,425.30
$446.00

$89.2042808
Excise pharynx lesion
2
$1,012.48
$446.00

$89.2042810
Excision of neck cyst
3
$1,425.30
$510.00

$102.0042815
Excision of neck cyst
5
$2,324.90
$717.00

$143.4042820
Remove tonsils and adenoids
3
$1,401.87
$510.00

$102.0042821
Remove tonsils and adenoids
5
$1,401.87
$717.00

$143.4042825
Removal of tonsils
4
$1,401.87
$630.00

$126.00( print page 49740)42826
Removal of tonsils
4
$1,401.87
$630.00

$126.0042830
Removal of adenoids
4
$1,401.87
$630.00

$126.0042831
Removal of adenoids
4
$1,401.87
$630.00

$126.0042835
Removal of adenoids
4
$1,401.87
$630.00

$126.0042836
Removal of adenoids
4
$1,401.87
$630.00

$126.0042860
Excision of tonsil tags
3
$1,401.87
$510.00

$102.0042870
Excision of lingual tonsil
3
$1,401.87
$510.00

$102.0042890
Partial removal of pharynx
7
$2,324.90
$995.00

$199.0042892
Revision of pharyngeal walls
7
$2,324.90
$995.00

$199.0042900
Repair throat wound
1
$475.55
$333.00

$66.6042950
Reconstruction of throat
2
$1,425.30
$446.00

$89.2042955
Surgical opening of throat
2
$1,425.30
$446.00

$89.2042960
Control throat bleeding
1
$73.99
$73.99
Y
$14.8042962
Control throat bleeding
2
$2,324.90
$446.00

$89.2042972
Control nose/throat bleeding
3
$1,012.48
$510.00

$102.0043200
Esophagus endoscopy
1
$511.30
$333.00

$66.6043201
Esoph scope w/submucous inj
1
$511.30
$333.00

$66.6043202
Esophagus endoscopy, biopsy
1
$511.30
$333.00

$66.6043204
Esoph scope w/sclerosis inj
1
$511.30
$333.00

$66.6043205
Esophagus endoscopy/ligation
1
$511.30
$333.00

$66.6043215
Esophagus endoscopy
1
$511.30
$333.00

$66.6043216
Esophagus endoscopy/lesion
1
$511.30
$333.00

$66.6043217
Esophagus endoscopy
1
$511.30
$333.00

$66.6043219
Esophagus endoscopy
1
$1,395.84
$333.00

$66.6043220
Esoph endoscopy, dilation
1
$511.30
$333.00

$66.6043226
Esoph endoscopy, dilation
1
$511.30
$333.00

$66.6043227
Esoph endoscopy, repair
2
$511.30
$446.00

$89.2043228
Esoph endoscopy, ablation
2
$1,695.69
$446.00

$89.2043231
Esoph endoscopy w/us exam
2
$511.30
$446.00

$89.2043232
Esoph endoscopy w/us fn bx
2
$511.30
$446.00

$89.2043234
Upper gi endoscopy, exam
1
$511.30
$333.00

$66.6043235
Uppr gi endoscopy, diagnosis
1
$511.30
$333.00

$66.6043236
Uppr gi scope w/submuc inj
2
$511.30
$446.00

$89.2043237
Endoscopic us exam, esoph
2
$511.30
$446.00

$89.2043238
Uppr gi endoscopy w/us fn bx
2
$511.30
$446.00

$89.2043239
Upper gi endoscopy, biopsy
2
$511.30
$446.00

$89.2043240
Esoph endoscope w/drain cyst
2
$511.30
$446.00

$89.2043241
Upper gi endoscopy with tube
2
$511.30
$446.00

$89.2043242
Uppr gi endoscopy w/us fn bx
2
$511.30
$446.00

$89.2043243
Upper gi endoscopy  inject
2
$511.30
$446.00

$89.2043244
Upper gi endoscopy/ligation
2
$511.30
$446.00

$89.2043245
Uppr gi scope dilate strictr
2
$511.30
$446.00

$89.2043246
Place gastrostomy tube
2
$511.30
$446.00

$89.2043247
Operative upper gi endoscopy
2
$511.30
$446.00

$89.2043248
Uppr gi endoscopy/guide wire
2
$511.30
$446.00

$89.2043249
Esoph endoscopy, dilation
2
$511.30
$446.00

$89.2043250
Upper gi endoscopy/tumor
2
$511.30
$446.00

$89.2043251
Operative upper gi endoscopy
2
$511.30
$446.00

$89.2043255
Operative upper gi endoscopy
2
$511.30
$446.00

$89.2043256
Uppr gi endoscopy w/stent
3
$1,395.84
$510.00

$102.0043258
Operative upper gi endoscopy
3
$511.30
$510.00

$102.0043259
Endoscopic ultrasound exam
3
$511.30
$510.00

$102.0043260
Endo cholangiopancreatograph
2
$1,219.48
$446.00

$89.2043261
Endo cholangiopancreatograph
2
$1,219.48
$446.00

$89.2043262
Endo cholangiopancreatograph
2
$1,219.48
$446.00

$89.2043263
Endo cholangiopancreatograph
2
$1,219.48
$446.00

$89.2043264
Endo cholangiopancreatograph
2
$1,219.48
$446.00

$89.2043265
Endo cholangiopancreatograph
2
$1,219.48
$446.00

$89.2043267
Endo cholangiopancreatograph
2
$1,219.48
$446.00

$89.2043268
Endo cholangiopancreatograph
2
$1,395.84
$446.00

$89.2043269
Endo cholangiopancreatograph
2
$1,395.84
$446.00

$89.2043271
Endo cholangiopancreatograph
2
$1,219.48
$446.00

$89.2043272
Endo cholangiopancreatograph
2
$1,219.48
$446.00

$89.2043450
Dilate esophagus
1
$327.05
$327.05
Y
$65.4143453
Dilate esophagus
1
$327.05
$327.05
Y
$65.4143456
Dilate esophagus
2
$327.05
$327.05
Y
$65.4143458
Dilate esophagus
2
$327.05
$327.05
Y
$65.4143600
Biopsy of stomach
1
$511.30
$333.00

$66.6043653
Laparoscopy, gastrostomy
9
$2,678.23
$1,339.00

$267.80( print page 49741)43750
Place gastrostomy tube
2
$511.30
$446.00

$89.2043760
Change gastrostomy tube
1
$144.22
$144.22
Y
$28.8443761
Reposition gastrostomy tube
1
$448.45
$333.00

$66.6043870
Repair stomach opening
1
$511.30
$333.00

$66.6044100
Biopsy of bowel
1
$511.30
$333.00

$66.6044312
Revision of ileostomy
1
$1,308.85
$333.00

$66.6044340
Revision of colostomy
3
$1,308.85
$510.00

$102.0044360
Small bowel endoscopy
2
$577.83
$446.00

$89.2044361
Small bowel endoscopy/biopsy
2
$577.83
$446.00

$89.2044363
Small bowel endoscopy
2
$577.83
$446.00

$89.2044364
Small bowel endoscopy
2
$577.83
$446.00

$89.2044365
Small bowel endoscopy
2
$577.83
$446.00

$89.2044366
Small bowel endoscopy
2
$577.83
$446.00

$89.2044369
Small bowel endoscopy
2
$577.83
$446.00

$89.2044370
Small bowel endoscopy/stent
9
$1,395.84
$1,339.00

$267.8044372
Small bowel endoscopy
2
$577.83
$446.00

$89.2044373
Small bowel endoscopy
2
$577.83
$446.00

$89.2044376
Small bowel endoscopy
2
$577.83
$446.00

$89.2044377
Small bowel endoscopy/biopsy
2
$577.83
$446.00

$89.2044378
Small bowel endoscopy
2
$577.83
$446.00

$89.2044379
Sbowel endoscope w/stent
9
$1,395.84
$1,339.00

$267.8044380
Small bowel endoscopy
1
$577.83
$333.00

$66.6044382
Small bowel endoscopy
1
$577.83
$333.00

$66.6044383
Ileoscopy w/stent
9
$1,395.84
$1,339.00

$267.8044385
Endoscopy of bowel pouch
1
$542.53
$333.00

$66.6044386
Endoscopy, bowel pouch/biop
1
$542.53
$333.00

$66.6044388
Colonoscopy
1
$542.53
$333.00

$66.6044389
Colonoscopy with biopsy
1
$542.53
$333.00

$66.6044390
Colonoscopy for foreign body
1
$542.53
$333.00

$66.6044391
Colonoscopy for bleeding
1
$542.53
$333.00

$66.6044392
Colonoscopy  polypectomy
1
$542.53
$333.00

$66.6044393
Colonoscopy, lesion removal
1
$542.53
$333.00

$66.6044394
Colonoscopy w/snare
1
$542.53
$333.00

$66.6044397
Colonoscopy w/stent
1
$1,395.84
$333.00

$66.6045000
Drainage of pelvic abscess
1
$301.42
$301.42
Y
$60.2845005
Drainage of rectal abscess
2
$792.64
$446.00

$89.2045020
Drainage of rectal abscess
2
$792.64
$446.00

$89.2045100
Biopsy of rectum
1
$1,368.50
$333.00

$66.6045108
Removal of anorectal lesion
2
$1,368.50
$446.00

$89.2045150
Excision of rectal stricture
2
$1,368.50
$446.00

$89.2045160
Excision of rectal lesion
2
$1,368.50
$446.00

$89.2045170
Excision of rectal lesion
2
$1,368.50
$446.00

$89.2045190
Destruction, rectal tumor
9
$1,368.50
$1,339.00

$267.8045305
Proctosigmoidoscopy w/bx
1
$527.15
$333.00

$66.6045307
Proctosigmoidoscopy fb
1
$1,261.19
$333.00

$66.6045308
Proctosigmoidoscopy removal
1
$527.15
$333.00

$66.6045309
Proctosigmoidoscopy removal
1
$527.15
$333.00

$66.6045315
Proctosigmoidoscopy removal
1
$527.15
$333.00

$66.6045317
Proctosigmoidoscopy bleed
1
$527.15
$333.00

$66.6045320
Proctosigmoidoscopy ablate
1
$1,261.19
$333.00

$66.6045321
Proctosigmoidoscopy volvul
1
$1,261.19
$333.00

$66.6045327
Proctosigmoidoscopy w/stent
1
$1,395.84
$333.00

$66.6045331
Sigmoidoscopy and biopsy
1
$295.48
$295.48
Y
$59.1045332
Sigmoidoscopy w/fb removal
1
$295.48
$295.48
Y
$59.1045333
Sigmoidoscopy  polypectomy
1
$527.15
$333.00

$66.6045334
Sigmoidoscopy for bleeding
1
$527.15
$333.00

$66.6045335
Sigmoidoscopy w/submuc inj
1
$295.48
$295.48
Y
$59.1045337
Sigmoidoscopy  decompress
1
$295.48
$295.48
Y
$59.1045338
Sigmoidoscopy w/tumr remove
1
$527.15
$333.00

$66.6045339
Sigmoidoscopy w/ablate tumr
1
$527.15
$333.00

$66.6045340
Sig w/balloon dilation
1
$527.15
$333.00

$66.6045341
Sigmoidoscopy w/ultrasound
1
$527.15
$333.00

$66.6045342
Sigmoidoscopy w/us guide bx
1
$527.15
$333.00

$66.6045345
Sigmoidoscopy w/stent
1
$1,395.84
$333.00

$66.6045355
Surgical colonoscopy
1
$542.53
$333.00

$66.6045378
Diagnostic colonoscopy
2
$542.53
$446.00

$89.2045379
Colonoscopy w/fb removal
2
$542.53
$446.00

$89.2045380
Colonoscopy and biopsy
2
$542.53
$446.00

$89.2045381
Colonoscopy, submucous inj
2
$542.53
$446.00

$89.20( print page 49742)45382
Colonoscopy/control bleeding
2
$542.53
$446.00

$89.2045383
Lesion removal colonoscopy
2
$542.53
$446.00

$89.2045384
Lesion remove colonoscopy
2
$542.53
$446.00

$89.2045385
Lesion removal colonoscopy
2
$542.53
$446.00

$89.2045386
Colonoscopy dilate stricture
2
$542.53
$446.00

$89.2045387
Colonoscopy w/stent
1
$1,395.84
$333.00

$66.6045391
Colonoscopy w/endoscope us
2
$542.53
$446.00

$89.2045392
Colonoscopy w/endoscopic fnb
2
$542.53
$446.00

$89.2045500
Repair of rectum
2
$1,368.50
$446.00

$89.2045505
Repair of rectum
2
$1,811.98
$446.00

$89.2045560
Repair of rectocele
2
$1,811.98
$446.00

$89.2045900
Reduction of rectal prolapse
1
$301.42
$301.42
Y
$60.2845905
Dilation of anal sphincter
1
$1,368.50
$333.00

$66.6045910
Dilation of rectal narrowing
1
$1,368.50
$333.00

$66.6045915
Remove rectal obstruction
1
$301.42
$301.42
Y
$60.2845990
Surg dx exam, anorcctal
2
$301.42
$301.42
Y
$60.2846020
Placement of seton
3
$1,368.50
$510.00

$102.0046030
Removal of rectal marker
1
$301.42
$301.42
Y
$60.2846040
Incision of rectal abscess
3
$1,368.50
$510.00

$102.0046045
Incision of rectal abscess
2
$1,368.50
$446.00

$89.2046050
Incision of anal abscess
1
$301.42
$301.42
Y
$60.2846060
Incision of rectal abscess
2
$1,368.50
$446.00

$89.2046080
Incision of anal sphincter
3
$1,368.50
$510.00

$102.0046200
Removal of anal fissure
2
$1,368.50
$446.00

$89.2046210
Removal of anal crypt
2
$1,368.50
$446.00

$89.2046211
Removal of anal crypts
2
$1,368.50
$446.00

$89.2046220
Removal of anal tag
1
$1,368.50
$333.00

$66.6046230
Removal of anal tags
1
$1,368.50
$333.00

$66.6046250
Hemorrhoidectomy
3
$1,368.50
$510.00

$102.0046255
Hemorrhoidectomy
3
$1,368.50
$510.00

$102.0046257
Remove hemorrhoids  fissure
3
$1,368.50
$510.00

$102.0046258
Remove hemorrhoids  fistula
3
$1,368.50
$510.00

$102.0046260
Hemorrhoidectomy
3
$1,368.50
$510.00

$102.0046261
Remove hemorrhoids  fissure
4
$1,368.50
$630.00

$126.0046262
Remove hemorrhoids  fistula
4
$1,368.50
$630.00

$126.0046270
Removal of anal fistula
3
$1,368.50
$510.00

$102.0046275
Removal of anal fistula
3
$1,368.50
$510.00

$102.0046280
Removal of anal fistula
4
$1,368.50
$630.00

$126.0046285
Removal of anal fistula
1
$1,368.50
$333.00

$66.6046288
Repair anal fistula
4
$1,368.50
$630.00

$126.0046608
Anoscopy, remove for body
1
$527.15
$333.00

$66.6046610
Anoscopy, remove lesion
1
$1,261.19
$333.00

$66.6046611
Anoscopy
1
$527.15
$333.00

$66.6046612
Anoscopy, remove lesions
1
$1,261.19
$333.00

$66.6046615
Anoscopy
2
$1,261.19
$446.00

$89.2046700
Repair of anal stricture
3
$1,368.50
$510.00

$102.0046706
Repr of anal fistula w/glue
1
$1,811.98
$333.00

$66.6046750
Repair of anal sphincter
3
$2,292.31
$510.00

$102.0046753
Reconstruction of anus
3
$1,368.50
$510.00

$102.0046754
Removal of suture from anus
2
$1,368.50
$446.00

$89.2046760
Repair of anal sphincter
2
$2,292.31
$446.00

$89.2046761
Repair of anal sphincter
3
$2,292.31
$510.00

$102.0046762
Implant artificial sphincter
7
$2,292.31
$995.00

$199.0046917
Laser surgery, anal lesions
1
$1,266.73
$333.00

$66.6046922
Excision of anal lesion(s)
1
$1,266.73
$333.00

$66.6046924
Destruction, anal lesion(s)
1
$1,266.73
$333.00

$66.6046937
Cryotherapy of rectal lesion
2
$1,368.50
$446.00

$89.2046938
Cryotherapy of rectal lesion
2
$1,811.98
$446.00

$89.2046946
Ligation of hemorrhoids
1
$792.64
$333.00

$66.6046947
Hemorrhoidopexy by stapling
7
$1,811.98
$995.00

$199.0047000
Needle biopsy of liver
1
$373.79
$333.00

$66.6047510
Insert catheter, bile duct
2
$1,197.26
$446.00

$89.2047511
Insert bile duct drain
9
$1,197.26
$1,197.26
Y
$239.4547525
Change bile duct catheter
1
$709.19
$333.00

$66.6047530
Revise/reinsert bile tube
1
$709.19
$333.00

$66.6047552
Biliary endoscopy thru skin
2
$1,197.26
$446.00

$89.2047553
Biliary endoscopy thru skin
3
$1,197.26
$510.00

$102.0047554
Biliary endoscopy thru skin
3
$1,197.26
$510.00

$102.0047555
Biliary endoscopy thru skin
3
$1,197.26
$510.00

$102.00( print page 49743)47556
Biliary endoscopy thru skin
9
$1,197.26
$1,197.26
Y
$239.4547560
Laparoscopy w/cholangio
3
$1,965.65
$510.00

$102.0047561
Laparo w/cholangio/biopsy
3
$1,965.65
$510.00

$102.0047630
Remove bile duct stone
3
$1,197.26
$510.00

$102.0048102
Needle biopsy, pancreas
1
$373.79
$333.00

$66.6049080
Puncture, peritoneal cavity
2
$224.20
$224.20
Y
$44.8449081
Removal of abdominal fluid
2
$224.20
$224.20
Y
$44.8449085
Remove abdomen foreign body
2
$1,364.94
$446.00

$89.2049180
Biopsy, abdominal mass
1
$373.79
$333.00

$66.6049250
Excision of umbilicus
4
$1,364.94
$630.00

$126.0049320
Diag laparo separate proc
3
$1,965.65
$510.00

$102.0049321
Laparoscopy, biopsy
4
$1,965.65
$630.00

$126.0049322
Laparoscopy, aspiration
4
$1,965.65
$630.00

$126.0049419
Insrt abdom cath for chemotx
1
$1,814.26
$333.00

$66.6049420
Insert abdom drain, temp
1
$1,798.88
$333.00

$66.6049421
Insert abdom drain, perm
1
$1,798.88
$333.00

$66.6049422
Remove perm cannula/catheter
1
$1,444.39
$333.00

$66.6049426
Revise abdomen-venous shunt
2
$1,364.94
$446.00

$89.2049495
Rpr ing hernia baby, reduc
4
$1,794.16
$630.00

$126.0049496
Rpr ing hernia baby, blocked
4
$1,794.16
$630.00

$126.0049500
Rpr ing hernia, init, reduce
4
$1,794.16
$630.00

$126.0049501
Rpr ing hernia, init blocked
9
$1,794.16
$1,339.00

$267.8049505
Prp i/hern init reduc  5 yr
4
$1,794.16
$630.00

$126.0049507
Prp i/hern init block  5 yr
9
$1,794.16
$1,339.00

$267.8049520
Rerepair ing hernia, reduce
7
$1,794.16
$995.00

$199.0049521
Rerepair ing hernia, blocked
9
$1,794.16
$1,339.00

$267.8049525
Repair ing hernia, sliding
4
$1,794.16
$630.00

$126.0049540
Repair lumbar hernia
2
$1,794.16
$446.00

$89.2049550
Rpr rem hernia, init, reduce
5
$1,794.16
$717.00

$143.4049553
Rpr fem hernia, init blocked
9
$1,794.16
$1,339.00

$267.8049555
Rerepair fem hernia, reduce
5
$1,794.16
$717.00

$143.4049557
Rerepair fem hernia, blocked
9
$1,794.16
$1,339.00

$267.8049560
Rpr ventral hern init, reduc
4
$1,794.16
$630.00

$126.0049561
Rpr ventral hern init, block
9
$1,794.16
$1,339.00

$267.8049565
Rerepair ventrl hern, reduce
4
$1,794.16
$630.00

$126.0049566
Rerepair ventrl hern, block
9
$1,794.16
$1,339.00

$267.8049568
Hernia repair w/mesh
7
$1,794.16
$995.00

$199.0049570
Rpr epigastric hern, reduce
4
$1,794.16
$630.00

$126.0049572
Rpr epigastric hern, blocked
9
$1,794.16
$1,339.00

$267.8049580
Rpr umbil hern, reduc   5 yr
4
$1,794.16
$630.00

$126.0049582
Rpr umbil hern, block   5 yr
9
$1,794.16
$1,339.00

$267.8049585
Rpr umbil hern, reduc  5 yr
4
$1,794.16
$630.00

$126.0049587
Rpr umbil hern, block  5 yr
9
$1,794.16
$1,339.00

$267.8049590
Repair spigelian hernia
3
$1,794.16
$510.00

$102.0049600
Repair umbilical lesion
4
$1,794.16
$630.00

$126.0049650
Laparo hernia repair initial
4
$2,678.23
$630.00

$126.0049651
Laparo hernia repair recur
7
$2,678.23
$995.00

$199.0050200
Biopsy of kidney
1
$373.79
$333.00

$66.6050390
Drainage of kidney lesion
1
$373.79
$333.00

$66.6050392
Insert kidney drain
1
$1,186.49
$333.00

$66.6050393
Insert ureteral tube
1
$1,186.49
$333.00

$66.6050395
Create passage to kidney
1
$1,186.49
$333.00

$66.6050396
Measure kidney pressure
1
$130.24
$130.24
Y
$26.0550398
Change kidney tube
1
$448.45
$333.00

$66.6050551
Kidney endoscopy
1
$414.39
$333.00

$66.6050553
Kidney endoscopy
1
$1,186.49
$333.00

$66.6050555
Kidney endoscopy  biopsy
1
$414.39
$333.00

$66.6050557
Kidney endoscopy  treatment
1
$1,468.37
$333.00

$66.6050561
Kidney endoscopy  treatment
1
$1,186.49
$333.00

$66.6050688
Change of ureter tube/stent
1
$448.45
$333.00

$66.6050947
Laparo new ureter/bladder
9
$2,678.23
$1,339.00

$267.8050948
Laparo new ureter/bladder
9
$2,678.23
$1,339.00

$267.8050951
Endoscopy of ureter
1
$414.39
$333.00

$66.6050953
Endoscopy of ureter
1
$414.39
$333.00

$66.6050955
Ureter endoscopy  biopsy
1
$1,186.49
$333.00

$66.6050957
Ureter endoscopy  treatment
1
$1,186.49
$333.00

$66.6050961
Ureter endoscopy  treatment
1
$1,186.49
$333.00

$66.6050970
Ureter endoscopy
1
$414.39
$333.00

$66.6050972
Ureter endoscopy  catheter
1
$414.39
$333.00

$66.60( print page 49744)50974
Ureter endoscopy  biopsy
1
$1,186.49
$333.00

$66.6050976
Ureter endoscopy  treatment
1
$1,186.49
$333.00

$66.6050980
Ureter endoscopy  treatment
1
$1,186.49
$333.00

$66.6051010
Drainage of bladder
1
$1,122.28
$333.00

$66.6051020
Incise  treat bladder
4
$1,468.37
$630.00

$126.0051030
Incise  treat bladder
4
$1,468.37
$630.00

$126.0051040
Incise  drain bladder
4
$1,468.37
$630.00

$126.0051045
Incise bladder/drain ureter
4
$414.39
$414.39
Y
$82.8851050
Removal of bladder stone
4
$1,468.37
$630.00

$126.0051065
Remove ureter calculus
4
$1,468.37
$630.00

$126.0051080
Drainage of bladder abscess
1
$1,075.21
$333.00

$66.6051500
Removal of bladder cyst
4
$1,794.16
$630.00

$126.0051520
Removal of bladder lesion
4
$1,468.37
$630.00

$126.0051710
Change of bladder tube
1
$448.45
$333.00

$66.6051715
Endoscopic injection/implant
3
$1,760.18
$510.00

$102.0051726
Complex cystometrogram
1
$219.66
$219.66
Y
$43.9351772
Urethra pressure profile
1
$130.24
$130.24
Y
$26.0551785
Anal/urinary muscle study
1
$66.75
$66.75
Y
$13.3551880
Repair of bladder opening
1
$1,468.37
$333.00

$66.6051992
Laparo sling operation
5
$2,678.23
$717.00

$143.4052000
Cystoscopy
1
$414.39
$333.00

$66.6052001
Cystoscopy, removal of clots
2
$414.39
$414.39
Y
$82.8852005
Cystoscopy  ureter catheter
2
$1,186.49
$446.00

$89.2052007
Cystoscopy and biopsy
2
$1,186.49
$446.00

$89.2052010
Cystoscopy  duct catheter
2
$414.39
$414.39
Y
$82.8852204
Cystoscopy
2
$1,186.49
$446.00

$89.2052214
Cystoscopy and treatment
2
$1,468.37
$446.00

$89.2052224
Cystoscopy and treatment
2
$1,468.37
$446.00

$89.2052234
Cystoscopy and treatment
2
$1,468.37
$446.00

$89.2052235
Cystoscopy and treatment
3
$1,468.37
$510.00

$102.0052240
Cystoscopy and treatment
3
$1,468.37
$510.00

$102.0052250
Cystoscopy and radiotracer
4
$1,468.37
$630.00

$126.0052260
Cystoscopy and treatment
2
$1,186.49
$446.00

$89.2052270
Cystoscopy  revise urethra
2
$1,186.49
$446.00

$89.2052275
Cystoscopy  revise urethra
2
$1,186.49
$446.00

$89.2052276
Cystoscopy and treatment
3
$1,186.49
$510.00

$102.0052277
Cystoscopy and treatment
2
$1,468.37
$446.00

$89.2052281
Cystoscopy and treatment
2
$1,186.49
$446.00

$89.2052282
Cystoscopy, implant stent
9
$2,160.59
$1,339.00

$267.8052283
Cystoscopy and treatment
2
$1,186.49
$446.00

$89.2052285
Cystoscopy and treatment
2
$1,186.49
$446.00

$89.2052290
Cystoscopy and treatment
2
$1,186.49
$446.00

$89.2052300
Cystoscopy and treatment
2
$1,186.49
$446.00

$89.2052301
Cystoscopy and treatment
3
$1,186.49
$510.00

$102.0052305
Cystoscopy and treatment
2
$1,186.49
$446.00

$89.2052310
Cystoscopy and treatment
2
$414.39
$414.39
Y
$82.8852315
Cystoscopy and treatment
2
$1,186.49
$446.00

$89.2052317
Remove bladder stone
1
$1,468.37
$333.00

$66.6052318
Remove bladder stone
2
$1,468.37
$446.00

$89.2052320
Cystoscopy and treatment
5
$1,468.37
$717.00

$143.4052325
Cystoscopy, stone removal
4
$1,468.37
$630.00

$126.0052327
Cystoscopy, inject material
2
$1,468.37
$446.00

$89.2052330
Cystoscopy and treatment
2
$1,468.37
$446.00

$89.2052332
Cystoscopy and treatment
2
$1,468.37
$446.00

$89.2052334
Create passage to kidney
3
$1,468.37
$510.00

$102.0052341
Cysto w/ureter stricture tx
3
$1,468.37
$510.00

$102.0052342
Cysto w/up stricture tx
3
$1,468.37
$510.00

$102.0052343
Cysto w/renal stricture tx
3
$1,468.37
$510.00

$102.0052344
Cysto/uretero, stricture tx
3
$1,468.37
$510.00

$102.0052345
Cysto/uretero w/up stricture
3
$1,468.37
$510.00

$102.0052346
Cystouretero w/renal strict
3
$1,468.37
$510.00

$102.0052351
Cystouretero  or pyeloscope
3
$1,186.49
$510.00

$102.0052352
Cystouretero w/stone remove
4
$1,468.37
$630.00

$126.0052353
Cystouretero w/lithotripsy
4
$2,160.59
$630.00

$126.0052354
Cystouretero w/biopsy
4
$1,468.37
$630.00

$126.0052355
Cystouretero w/excise tumor
4
$1,468.37
$630.00

$126.0052400
Cystouretero w/congen repr
3
$1,468.37
$510.00

$102.0052402
Cystourethro cut ejacul duct
3
$1,468.37
$510.00

$102.0052450
Incision of prostate
3
$1,468.37
$510.00

$102.00( print page 49745)52500
Revision of bladder neck
3
$1,468.37
$510.00

$102.0052510
Dilation prostatic urethra
3
$1,186.49
$510.00

$102.0052601
Prostatectomy (turp)
4
$2,160.59
$630.00

$126.0052606
Control postop bleeding
1
$1,468.37
$333.00

$66.6052612
Prostatectomy, first stage
2
$2,160.59
$446.00

$89.2052614
Prostatectomy, second stage
1
$2,160.59
$333.00

$66.6052620
Remove residual prostate
1
$2,160.59
$333.00

$66.6052630
Remove prostate regrowth
2
$2,160.59
$446.00

$89.2052640
Relieve bladder contracture
2
$1,468.37
$446.00

$89.2052647
Laser surgery of prostate
9
$2,642.55
$1,339.00

$267.8052648
Laser surgery of prostate
9
$2,642.55
$1,339.00

$267.8052700
Drainage of prostate abscess
2
$1,468.37
$446.00

$89.2053000
Incision of urethra
1
$1,139.54
$333.00

$66.6053010
Incision of urethra
1
$1,139.54
$333.00

$66.6053020
Incision of urethra
1
$1,139.54
$333.00

$66.6053040
Drainage of urethra abscess
2
$1,139.54
$446.00

$89.2053080
Drainage of urinary leakage
3
$1,139.54
$510.00

$102.0053200
Biopsy of urethra
1
$1,139.54
$333.00

$66.6053210
Removal of urethra
5
$1,760.18
$717.00

$143.4053215
Removal of urethra
5
$1,139.54
$717.00

$143.4053220
Treatment of urethra lesion
2
$1,760.18
$446.00

$89.2053230
Removal of urethra lesion
2
$1,760.18
$446.00

$89.2053235
Removal of urethra lesion
3
$1,139.54
$510.00

$102.0053240
Surgery for urethra pouch
2
$1,760.18
$446.00

$89.2053250
Removal of urethra gland
2
$1,139.54
$446.00

$89.2053260
Treatment of urethra lesion
2
$1,139.54
$446.00

$89.2053265
Treatment of urethra lesion
2
$1,139.54
$446.00

$89.2053270
Removal of urethra gland
2
$1,139.54
$446.00

$89.2053275
Repair of urethra defect
2
$1,139.54
$446.00

$89.2053400
Revise urethra, stage 1
3
$1,760.18
$510.00

$102.0053405
Revise urethra, stage 2
2
$1,760.18
$446.00

$89.2053410
Reconstruction of urethra
2
$1,760.18
$446.00

$89.2053420
Reconstruct urethra, stage 1
3
$1,760.18
$510.00

$102.0053425
Reconstruct urethra, stage 2
2
$1,760.18
$446.00

$89.2053430
Reconstruction of urethra
2
$1,760.18
$446.00

$89.2053431
Reconstruct urethra/bladder
2
$1,760.18
$446.00

$89.2053440
Male sling procedure
2
$4,885.49
$446.00

$89.2053442
Remove/revise male sling
1
$1,760.18
$333.00

$66.6053444
Insert tandem cuff
2
$4,885.49
$446.00

$89.2053445
Insert uro/ves nck sphincter
1
$8,354.29
$333.00

$66.6053446
Remove uro sphincter
1
$1,760.18
$333.00

$66.6053447
Remove/replace ur sphincter
1
$8,354.29
$333.00

$66.6053449
Repair uro sphincter
1
$1,760.18
$333.00

$66.6053450
Revision of urethra
1
$1,760.18
$333.00

$66.6053460
Revision of urethra
1
$1,139.54
$333.00

$66.6053502
Repair of urethra injury
2
$1,139.54
$446.00

$89.2053505
Repair of urethra injury
2
$1,760.18
$446.00

$89.2053510
Repair of urethra injury
2
$1,139.54
$446.00

$89.2053515
Repair of urethra injury
2
$1,760.18
$446.00

$89.2053520
Repair of urethra defect
2
$1,760.18
$446.00

$89.2053605
Dilate urethra stricture
2
$1,186.49
$446.00

$89.2053665
Dilation of urethra
1
$1,139.54
$333.00

$66.6054000
Slitting of prepuce
2
$1,139.54
$446.00

$89.2054001
Slitting of prepuce
2
$1,139.54
$446.00

$89.2054015
Drain penis lesion
4
$1,075.21
$630.00

$126.0054057
Laser surg, penis lesion(s)
1
$1,091.87
$333.00

$66.6054060
Excision of penis lesion(s)
1
$1,091.87
$333.00

$66.6054065
Destruction, penis lesion(s)
1
$1,266.73
$333.00

$66.6054100
Biopsy of penis
1
$920.58
$333.00

$66.6054105
Biopsy of penis
1
$1,229.54
$333.00

$66.6054110
Treatment of penis lesion
2
$2,031.13
$446.00

$89.2054111
Treat penis lesion, graft
2
$2,031.13
$446.00

$89.2054112
Treat penis lesion, graft
2
$2,031.13
$446.00

$89.2054115
Treatment of penis lesion
1
$1,075.21
$333.00

$66.6054120
Partial removal of penis
2
$2,031.13
$446.00

$89.2054150
Circumcision
1
$1,276.68
$333.00

$66.6054152
Circumcision
1
$1,276.68
$333.00

$66.6054160
Circumcision
2
$1,276.68
$446.00

$89.2054161
Circumcision
2
$1,276.68
$446.00

$89.20( print page 49746)54162
Lysis penil circumic lesion
2
$1,276.68
$446.00

$89.2054163
Repair of circumcision
2
$1,276.68
$446.00

$89.2054164
Frenulotomy of penis
2
$1,276.68
$446.00

$89.2054205
Treatment of penis lesion
4
$2,031.13
$630.00

$126.0054220
Treatment of penis lesion
1
$130.24
$130.24
Y
$26.0554300
Revision of penis
3
$2,031.13
$510.00

$102.0054304
Revision of penis
3
$2,031.13
$510.00

$102.0054308
Reconstruction of urethra
3
$2,031.13
$510.00

$102.0054312
Reconstruction of urethra
3
$2,031.13
$510.00

$102.0054316
Reconstruction of urethra
3
$2,031.13
$510.00

$102.0054318
Reconstruction of urethra
3
$2,031.13
$510.00

$102.0054322
Reconstruction of urethra
3
$2,031.13
$510.00

$102.0054324
Reconstruction of urethra
3
$2,031.13
$510.00

$102.0054326
Reconstruction of urethra
3
$2,031.13
$510.00

$102.0054328
Revise penis/urethra
3
$2,031.13
$510.00

$102.0054340
Secondary urethral surgery
3
$2,031.13
$510.00

$102.0054344
Secondary urethral surgery
3
$2,031.13
$510.00

$102.0054348
Secondary urethral surgery
3
$2,031.13
$510.00

$102.0054352
Reconstruct urethra/penis
3
$2,031.13
$510.00

$102.0054360
Penis plastic surgery
3
$2,031.13
$510.00

$102.0054380
Repair penis
3
$2,031.13
$510.00

$102.0054385
Repair penis
3
$2,031.13
$510.00

$102.0054400
Insert semi-rigid prosthesis
3
$4,885.49
$510.00

$102.0054401
Insert self-contd prosthesis
3
$8,354.29
$510.00

$102.0054405
Insert multi-comp penis pros
3
$8,354.29
$510.00

$102.0054406
Remove muti-comp penis pros
3
$2,031.13
$510.00

$102.0054408
Repair multi-comp penis pros
3
$2,031.13
$510.00

$102.0054410
Remove/replace penis prosth
3
$8,354.29
$510.00

$102.0054415
Remove self-contd penis pros
3
$2,031.13
$510.00

$102.0054416
Remv/repl penis contain pros
3
$8,354.29
$510.00

$102.0054420
Revision of penis
4
$2,031.13
$630.00

$126.0054435
Revision of penis
4
$2,031.13
$630.00

$126.0054440
Repair of penis
4
$2,031.13
$630.00

$126.0054450
Preputial stretching
1
$219.66
$219.66
Y
$43.9354500
Biopsy of testis
1
$631.61
$333.00

$66.6054505
Biopsy of testis
1
$1,459.20
$333.00

$66.6054512
Excise lesion testis
2
$1,459.20
$446.00

$89.2054520
Removal of testis
3
$1,459.20
$510.00

$102.0054522
Orchiectomy, partial
3
$1,459.20
$510.00

$102.0054530
Removal of testis
4
$1,794.16
$630.00

$126.0054550
Exploration for testis
4
$1,794.16
$630.00

$126.0054600
Reduce testis torsion
4
$1,459.20
$630.00

$126.0054620
Suspension of testis
3
$1,459.20
$510.00

$102.0054640
Suspension of testis
4
$1,794.16
$630.00

$126.0054660
Revision of testis
2
$1,459.20
$446.00

$89.2054670
Repair testis injury
3
$1,459.20
$510.00

$102.0054680
Relocation of testis(es)
3
$1,459.20
$510.00

$102.0054690
Laparoscopy, orchiectomy
9
$2,678.23
$1,339.00

$267.8054700
Drainage of scrotum
2
$1,459.20
$446.00

$89.2054800
Biopsy of epididymis
1
$128.41
$128.41
Y
$25.6854820
Exploration of epididymis
1
$1,459.20
$333.00

$66.6054830
Remove epididymis lesion
3
$1,459.20
$510.00

$102.0054840
Remove epididymis lesion
4
$1,459.20
$630.00

$126.0054860
Removal of epididymis
3
$1,459.20
$510.00

$102.0054861
Removal of epididymis
4
$1,459.20
$630.00

$126.0054900
Fusion of spermatic ducts
4
$1,459.20
$630.00

$126.0054901
Fusion of spermatic ducts
4
$1,459.20
$630.00

$126.0055040
Removal of hydrocele
3
$1,794.16
$510.00

$102.0055041
Removal of hydroceles
5
$1,794.16
$717.00

$143.4055060
Repair of hydrocele
4
$1,459.20
$630.00

$126.0055100
Drainage of scrotum abscess
1
$672.04
$333.00

$66.6055110
Explore scrotum
2
$1,459.20
$446.00

$89.2055120
Removal of scrotum lesion
2
$1,459.20
$446.00

$89.2055150
Removal of scrotum
1
$1,459.20
$333.00

$66.6055175
Revision of scrotum
1
$1,459.20
$333.00

$66.6055180
Revision of scrotum
2
$1,459.20
$446.00

$89.2055200
Incision of sperm duct
2
$1,459.20
$446.00

$89.2055250
Removal of sperm duct(s)
2
$1,459.20
$446.00

$89.2055400
Repair of sperm duct
1
$1,459.20
$333.00

$66.60( print page 49747)55500
Removal of hydrocele
3
$1,459.20
$510.00

$102.0055520
Removal of sperm cord lesion
4
$1,459.20
$630.00

$126.0055530
Revise spermatic cord veins
4
$1,459.20
$630.00

$126.0055535
Revise spermatic cord veins
4
$1,794.16
$630.00

$126.0055540
Revise hernia  sperm veins
5
$1,794.16
$717.00

$143.4055550
Laparo ligate spermatic vein
9
$2,678.23
$1,339.00

$267.8055680
Remove sperm pouch lesion
1
$1,459.20
$333.00

$66.6055700
Biopsy of prostate
2
$368.64
$368.64
Y
$73.7355705
Biopsy of prostate
2
$368.64
$368.64
Y
$73.7355720
Drainage of prostate abscess
1
$1,468.37
$333.00

$66.6055725
Drainage of prostate abscess
2
$1,468.37
$446.00

$89.2055859
Percut/needle insert, pros
9
$2,160.59
$1,339.00

$267.8055873
Cryoablate prostate
9
$6,637.03
$1,339.00

$267.8056440
Surgery for vulva lesion
2
$1,262.49
$446.00

$89.2056441
Lysis of labial lesion(s)
1
$910.70
$333.00

$66.6056515
Destroy vulva lesion/s compl
3
$1,266.73
$510.00

$102.0056620
Partial removal of vulva
5
$1,769.04
$717.00

$143.4056625
Complete removal of vulva
7
$1,769.04
$995.00

$199.0056700
Partial removal of hymen
1
$1,262.49
$333.00

$66.6056720
Incision of hymen
1
$910.70
$333.00

$66.6056740
Remove vagina gland lesion
3
$1,262.49
$510.00

$102.0056800
Repair of vagina
3
$1,262.49
$510.00

$102.0056810
Repair of perineum
5
$1,262.49
$717.00

$143.4057000
Exploration of vagina
1
$910.70
$333.00

$66.6057010
Drainage of pelvic abscess
2
$910.70
$446.00

$89.2057020
Drainage of pelvic fluid
2
$426.33
$426.33
Y
$85.2757023
I d vag hematoma, non-ob
1
$1,075.21
$333.00

$66.6057065
Destroy vag lesions, complex
1
$1,262.49
$333.00

$66.6057105
Biopsy of vagina
2
$1,262.49
$446.00

$89.2057130
Remove vagina lesion
2
$1,262.49
$446.00

$89.2057135
Remove vagina lesion
2
$1,262.49
$446.00

$89.2057155
Insert uteri tandems/ovoids
2
$426.33
$426.33
Y
$85.2757180
Treat vaginal bleeding
1
$184.05
$184.05
Y
$36.8157200
Repair of vagina
1
$1,262.49
$333.00

$66.6057210
Repair vagina/perineum
2
$1,262.49
$446.00

$89.2057220
Revision of urethra
3
$2,639.04
$510.00

$102.0057230
Repair of urethral lesion
3
$1,769.04
$510.00

$102.0057240
Repair bladder  vagina
5
$1,769.04
$717.00

$143.4057250
Repair rectum  vagina
5
$1,769.04
$717.00

$143.4057260
Repair of vagina
5
$1,769.04
$717.00

$143.4057265
Extensive repair of vagina
7
$2,639.04
$995.00

$199.0057268
Repair of bowel bulge
3
$1,769.04
$510.00

$102.0057288
Repair bladder defect
5
$2,639.04
$717.00

$143.4057289
Repair bladder  vagina
5
$1,769.04
$717.00

$143.4057291
Construction of vagina
5
$1,769.04
$717.00

$143.4057300
Repair rectum-vagina fistula
3
$1,769.04
$510.00

$102.0057400
Dilation of vagina
2
$1,262.49
$446.00

$89.2057410
Pelvic examination
2
$910.70
$446.00

$89.2057415
Remove vaginal foreign body
2
$1,262.49
$446.00

$89.2057513
Laser surgery of cervix
2
$910.70
$446.00

$89.2057520
Conization of cervix
2
$1,262.49
$446.00

$89.2057522
Conization of cervix
2
$1,769.04
$446.00

$89.2057530
Removal of cervix
3
$1,769.04
$510.00

$102.0057550
Removal of residual cervix
3
$1,769.04
$510.00

$102.0057556
Remove cervix, repair bowel
5
$2,639.04
$717.00

$143.4057700
Revision of cervix
1
$1,262.49
$333.00

$66.6057720
Revision of cervix
3
$1,262.49
$510.00

$102.0057820
D c of residual cervix
3
$1,093.36
$510.00

$102.0058120
Dilation and curettage
2
$1,093.36
$446.00

$89.2058145
Myomectomy vag method
5
$1,769.04
$717.00

$143.4058346
Insert heyman uteri capsule
2
$910.70
$446.00

$89.2058350
Reopen fallopian tube
3
$1,769.04
$510.00

$102.0058353
Endometr ablate, thermal
4
$1,769.04
$630.00

$126.0058545
Laparoscopic myomectomy
9
$1,965.65
$1,339.00

$267.8058546
Laparo-myomectomy, complex
9
$2,678.23
$1,339.00

$267.8058550
Laparo-asst vag hysterectomy
9
$4,363.07
$1,339.00

$267.8058555
Hysteroscopy, dx, sep proc
1
$1,318.42
$333.00

$66.6058558
Hysteroscopy, biopsy
3
$1,318.42
$510.00

$102.0058559
Hysteroscopy, lysis
2
$1,318.42
$446.00

$89.20( print page 49748)58560
Hysteroscopy, resect septum
3
$2,049.83
$510.00

$102.0058561
Hysteroscopy, remove myoma
3
$2,049.83
$510.00

$102.0058562
Hysteroscopy, remove fb
3
$1,318.42
$510.00

$102.0058563
Hysteroscopy, ablation
4
$2,049.83
$630.00

$126.0058565
Hysteroscopy, sterilization
9
$2,639.04
$1,339.00

$267.8058660
Laparoscopy, lysis
5
$2,678.23
$717.00

$143.4058661
Laparoscopy, remove adnexa
5
$2,678.23
$717.00

$143.4058662
Laparoscopy, excise lesions
5
$2,678.23
$717.00

$143.4058670
Laparoscopy, tubal cautery
3
$2,678.23
$510.00

$102.0058671
Laparoscopy, tubal block
3
$2,678.23
$510.00

$102.0058672
Laparoscopy, fimbrioplasty
5
$2,678.23
$717.00

$143.4058673
Laparoscopy, salpingostomy
5
$2,678.23
$717.00

$143.4058800
Drainage of ovarian cyst(s)
3
$910.70
$510.00

$102.0058820
Drain ovary abscess, open
3
$1,769.04
$510.00

$102.0058900
Biopsy of ovary(s)
3
$910.70
$510.00

$102.0058970
Retrieval of oocyte
1
$271.49
$271.49
Y
$54.3058974
Transfer of embryo
1
$271.49
$271.49
Y
$54.3058976
Transfer of embryo
1
$271.49
$271.49
Y
$54.3059160
D c after delivery
3
$1,093.36
$510.00

$102.0059320
Revision of cervix
1
$1,262.49
$333.00

$66.6059812
Treatment of miscarriage
5
$1,140.24
$717.00

$143.4059820
Care of miscarriage
5
$1,140.24
$717.00

$143.4059821
Treatment of miscarriage
5
$1,140.24
$717.00

$143.4059840
Abortion
5
$1,062.41
$717.00

$143.4059841
Abortion
5
$1,062.41
$717.00

$143.4059870
Evacuate mole of uterus
5
$1,140.24
$717.00

$143.4059871
Remove cerclage suture
5
$1,262.49
$717.00

$143.4060000
Drain thyroid/tongue cyst
1
$475.55
$333.00

$66.6060200
Remove thyroid lesion
2
$2,285.28
$446.00

$89.2060280
Remove thyroid duct lesion
4
$2,285.28
$630.00

$126.0060281
Remove thyroid duct lesion
4
$2,285.28
$630.00

$126.0061020
Remove brain cavity fluid
1
$187.01
$187.01
Y
$37.4061026
Injection into brain canal
1
$187.01
$187.01
Y
$37.4061050
Remove brain canal fluid
1
$187.01
$187.01
Y
$37.4061055
Injection into brain canal
1
$187.01
$187.01
Y
$37.4061070
Brain canal shunt procedure
1
$187.01
$187.01
Y
$37.4061215
Insert brain-fluid device
3
$2,811.11
$510.00

$102.0061790
Treat trigeminal nerve
3
$1,093.20
$510.00

$102.0061791
Treat trigeminal tract
3
$341.23
$341.23
Y
$68.2561885
Insrt/redo neurostim 1 array
2
$10,828.84
$446.00

$89.2061886
Implant neurostim arrays
3
$14,500.02
$510.00

$102.0061888
Revise/remove neuroreceiver
1
$2,089.79
$333.00

$66.6062194
Replace/irrigate catheter
1
$709.19
$333.00

$66.6062225
Replace/irrigate catheter
1
$709.19
$333.00

$66.6062230
Replace/revise brain shunt
2
$2,811.11
$446.00

$89.2062263
Epidural lysis mult sessions
1
$765.89
$333.00

$66.6062264
Epidural lysis on single day
1
$765.89
$333.00

$66.6062268
Drain spinal cord cyst
1
$187.01
$187.01
Y
$37.4062269
Needle biopsy, spinal cord
1
$373.79
$333.00

$66.6062270
Spinal fluid tap, diagnostic
1
$138.43
$138.43
Y
$27.6962272
Drain cerebro spinal fluid
1
$138.43
$138.43
Y
$27.6962273
Inject epidural patch
1
$341.23
$333.00

$66.6062280
Treat spinal cord lesion
1
$392.62
$333.00

$66.6062281
Treat spinal cord lesion
1
$392.62
$333.00

$66.6062282
Treat spinal canal lesion
1
$392.62
$333.00

$66.6062287
Percutaneous diskectomy
9
$2,049.86
$1,339.00

$267.8062294
Injection into spinal artery
3
$187.01
$187.01
Y
$37.4062310
Inject spine c/t
1
$392.62
$333.00

$66.6062311
Inject spine l/s (cd)
1
$392.62
$333.00

$66.6062318
Inject spine w/cath, c/t
1
$392.62
$333.00

$66.6062319
Inject spine w/cath l/s (cd)
1
$392.62
$333.00

$66.6062350
Implant spinal canal cath
2
$1,803.02
$446.00

$89.2062355
Remove spinal canal catheter
2
$765.89
$446.00

$89.2062360
Insert spine infusion device
2
$6,894.62
$446.00

$89.2062361
Implant spine infusion pump
2
$11,275.98
$446.00

$89.2062362
Implant spine infusion pump
2
$11,275.98
$446.00

$89.2062365
Remove spine infusion device
2
$2,049.86
$446.00

$89.2063600
Remove spinal cord lesion
2
$1,093.20
$446.00

$89.2063610
Stimulation of spinal cord
1
$1,093.20
$333.00

$66.60( print page 49749)63650
Implant neuroelectrodes
2
$3,470.58
$446.00

$89.2063660
Revise/remove neuroelectrode
1
$1,057.63
$333.00

$66.6063685
Insrt/redo spine n generator
2
$10,964.12
$446.00

$89.2063688
Revise/remove neuroreceiver
1
$2,089.79
$333.00

$66.6063744
Revision of spinal shunt
3
$2,225.70
$510.00

$102.0063746
Removal of spinal shunt
2
$674.24
$446.00

$89.2064410
Nblock inj, phrenic
1
$341.23
$333.00

$66.6064415
Nblock inj, brachial plexus
1
$138.43
$138.43
Y
$27.6964417
Nblock inj, axillary
1
$138.43
$138.43
Y
$27.6964420
Nblock inj, intercost, sng
1
$138.43
$138.43
Y
$27.6964421
Nblock inj, intercost, mlt
1
$341.23
$333.00

$66.6064430
Nblock inj, pudendal
1
$138.43
$138.43
Y
$27.6964470
Inj paravertebral c/t
1
$392.62
$333.00

$66.6064472
Inj paravertebral c/t add-on
1
$341.23
$333.00

$66.6064475
Inj paravertebral l/s
1
$392.62
$333.00

$66.6064476
Inj paravertebral l/s add-on
1
$341.23
$333.00

$66.6064479
Inj foramen epidural c/t
1
$392.62
$333.00

$66.6064480
Inj foramen epidural add-on
1
$392.62
$333.00

$66.6064483
Inj foramen epidural l/s
1
$392.62
$333.00

$66.6064484
Inj foramen epidural add-on
1
$392.62
$333.00

$66.6064510
Nblock, stellate ganglion
1
$392.62
$333.00

$66.6064517
Nblock inj, hypogas plxs
2
$138.43
$138.43
Y
$27.6964520
Nblock, lumbar/thoracic
1
$392.62
$333.00

$66.6064530
Nblock inj, celiac pelus
1
$392.62
$333.00

$66.6064553
Implant neuroelectrodes
1
$14,412.95
$333.00

$66.6064561
Implant neuroelectrodes
3
$3,470.58
$510.00

$102.0064573
Implant neuroelectrodes
1
$14,412.95
$333.00

$66.6064575
Implant neuroelectrodes
1
$5,184.89
$333.00

$66.6064577
Implant neuroelectrodes
1
$5,184.89
$333.00

$66.6064580
Implant neuroelectrodes
1
$5,184.89
$333.00

$66.6064581
Implant neuroelectrodes
3
$5,184.89
$510.00

$102.0064585
Revise/remove neuroelectrode
1
$1,057.63
$333.00

$66.6064590
Insrt/redo perph n generator
2
$10,964.12
$446.00

$89.2064595
Revise/remove neuroreceiver
1
$2,089.79
$333.00

$66.6064600
Injection treatment of nerve
1
$765.89
$333.00

$66.6064605
Injection treatment of nerve
1
$765.89
$333.00

$66.6064610
Injection treatment of nerve
1
$765.89
$333.00

$66.6064620
Injection treatment of nerve
1
$765.89
$333.00

$66.6064622
Destr paravertebrl nerve l/s
1
$765.89
$333.00

$66.6064623
Destr paravertebral n add-on
1
$392.62
$333.00

$66.6064626
Destr paravertebrl nerve c/t
1
$765.89
$333.00

$66.6064627
Destr paravertebral n add-on
1
$392.62
$333.00

$66.6064630
Injection treatment of nerve
2
$341.23
$341.23
Y
$68.2564680
Injection treatment of nerve
2
$392.62
$392.62
Y
$78.5264681
Injection treatment of nerve
2
$765.89
$446.00

$89.2064702
Revise finger/toe nerve
1
$1,093.20
$333.00

$66.6064704
Revise hand/foot nerve
1
$1,093.20
$333.00

$66.6064708
Revise arm/leg nerve
2
$1,093.20
$446.00

$89.2064712
Revision of sciatic nerve
2
$1,093.20
$446.00

$89.2064713
Revision of arm nerve(s)
2
$1,093.20
$446.00

$89.2064714
Revise low back nerve(s)
2
$1,093.20
$446.00

$89.2064716
Revision of cranial nerve
3
$1,093.20
$510.00

$102.0064718
Revise ulnar nerve at elbow
2
$1,093.20
$446.00

$89.2064719
Revise ulnar nerve at wrist
2
$1,093.20
$446.00

$89.2064721
Carpal tunnel surgery
2
$1,093.20
$446.00

$89.2064722
Relieve pressure on nerve(s)
1
$1,093.20
$333.00

$66.6064726
Release foot/toe nerve
1
$1,093.20
$333.00

$66.6064727
Internal nerve revision
1
$1,093.20
$333.00

$66.6064732
Incision of brow nerve
2
$1,093.20
$446.00

$89.2064734
Incision of cheek nerve
2
$1,093.20
$446.00

$89.2064736
Incision of chin nerve
2
$1,093.20
$446.00

$89.2064738
Incision of jaw nerve
2
$1,093.20
$446.00

$89.2064740
Incision of tongue nerve
2
$1,093.20
$446.00

$89.2064742
Incision of facial nerve
2
$1,093.20
$446.00

$89.2064744
Incise nerve, back of head
2
$1,093.20
$446.00

$89.2064746
Incise diaphragm nerve
2
$1,093.20
$446.00

$89.2064771
Sever cranial nerve
2
$1,093.20
$446.00

$89.2064772
Incision of spinal nerve
2
$1,093.20
$446.00

$89.2064774
Remove skin nerve lesion
2
$1,093.20
$446.00

$89.20( print page 49750)64776
Remove digit nerve lesion
3
$1,093.20
$510.00

$102.0064778
Digit nerve surgery add-on
2
$1,093.20
$446.00

$89.2064782
Remove limb nerve lesion
3
$1,093.20
$510.00

$102.0064783
Limb nerve surgery add-on
2
$1,093.20
$446.00

$89.2064784
Remove nerve lesion
3
$1,093.20
$510.00

$102.0064786
Remove sciatic nerve lesion
3
$2,049.86
$510.00

$102.0064787
Implant nerve end
2
$1,093.20
$446.00

$89.2064788
Remove skin nerve lesion
3
$1,093.20
$510.00

$102.0064790
Removal of nerve lesion
3
$1,093.20
$510.00

$102.0064792
Removal of nerve lesion
3
$2,049.86
$510.00

$102.0064795
Biopsy of nerve
2
$1,093.20
$446.00

$89.2064802
Remove sympathetic nerves
2
$1,093.20
$446.00

$89.2064821
Remove sympathetic nerves
4
$1,590.63
$630.00

$126.0064831
Repair of digit nerve
4
$2,049.86
$630.00

$126.0064832
Repair nerve add-on
1
$2,049.86
$333.00

$66.6064834
Repair of hand or foot nerve
2
$2,049.86
$446.00

$89.2064835
Repair of hand or foot nerve
3
$2,049.86
$510.00

$102.0064836
Repair of hand or foot nerve
3
$2,049.86
$510.00

$102.0064837
Repair nerve add-on
1
$2,049.86
$333.00

$66.6064840
Repair of leg nerve
2
$2,049.86
$446.00

$89.2064856
Repair/transpose nerve
2
$2,049.86
$446.00

$89.2064857
Repair arm/leg nerve
2
$2,049.86
$446.00

$89.2064858
Repair sciatic nerve
2
$2,049.86
$446.00

$89.2064859
Nerve surgery
1
$2,049.86
$333.00

$66.6064861
Repair of arm nerves
3
$2,049.86
$510.00

$102.0064862
Repair of low back nerves
3
$2,049.86
$510.00

$102.0064864
Repair of facial nerve
3
$2,049.86
$510.00

$102.0064865
Repair of facial nerve
4
$2,049.86
$630.00

$126.0064870
Fusion of facial/other nerve
4
$2,049.86
$630.00

$126.0064872
Subsequent repair of nerve
2
$2,049.86
$446.00

$89.2064874
Repair  revise nerve add-on
3
$2,049.86
$510.00

$102.0064876
Repair nerve/shorten bone
3
$2,049.86
$510.00

$102.0064885
Nerve graft, head or neck
2
$2,049.86
$446.00

$89.2064886
Nerve graft, head or neck
2
$2,049.86
$446.00

$89.2064890
Nerve graft, hand or foot
2
$2,049.86
$446.00

$89.2064891
Nerve graft, hand or foot
2
$2,049.86
$446.00

$89.2064892
Nerve graft, arm or leg
2
$2,049.86
$446.00

$89.2064893
Nerve graft, arm or leg
2
$2,049.86
$446.00

$89.2064895
Nerve graft, hand or foot
3
$2,049.86
$510.00

$102.0064896
Nerve graft, hand or foot
3
$2,049.86
$510.00

$102.0064897
Nerve graft, arm or leg
3
$2,049.86
$510.00

$102.0064898
Nerve graft, arm or leg
3
$2,049.86
$510.00

$102.0064901
Nerve graft add-on
2
$2,049.86
$446.00

$89.2064902
Nerve graft add-on
2
$2,049.86
$446.00

$89.2064905
Nerve pedicle transfer
2
$2,049.86
$446.00

$89.2064907
Nerve pedicle transfer
1
$2,049.86
$333.00

$66.6065091
Revise eye
3
$2,186.40
$510.00

$102.0065093
Revise eye with implant
3
$2,186.40
$510.00

$102.0065101
Removal of eye
3
$2,186.40
$510.00

$102.0065103
Remove eye/insert implant
3
$2,186.40
$510.00

$102.0065105
Remove eye/attach implant
4
$2,186.40
$630.00

$126.0065110
Removal of eye
5
$2,186.40
$717.00

$143.4065112
Remove eye/revise socket
7
$2,186.40
$995.00

$199.0065114
Remove eye/revise socket
7
$2,186.40
$995.00

$199.0065130
Insert ocular implant
3
$1,529.55
$510.00

$102.0065135
Insert ocular implant
2
$1,529.55
$446.00

$89.2065140
Attach ocular implant
3
$2,186.40
$510.00

$102.0065150
Revise ocular implant
2
$1,529.55
$446.00

$89.2065155
Reinsert ocular implant
3
$2,186.40
$510.00

$102.0065175
Removal of ocular implant
1
$1,047.14
$333.00

$66.6065235
Remove foreign body from eye
2
$923.07
$446.00

$89.2065260
Remove foreign body from eye
3
$1,005.95
$510.00

$102.0065265
Remove foreign body from eye
4
$1,657.60
$630.00

$126.0065270
Repair of eye wound
2
$1,047.14
$446.00

$89.2065272
Repair of eye wound
2
$1,412.47
$446.00

$89.2065275
Repair of eye wound
4
$1,412.47
$630.00

$126.0065280
Repair of eye wound
4
$1,005.95
$630.00

$126.0065285
Repair of eye wound
4
$2,270.12
$630.00

$126.0065290
Repair of eye socket wound
3
$1,310.33
$510.00

$102.00( print page 49751)65400
Removal of eye lesion
1
$923.07
$333.00

$66.6065410
Biopsy of cornea
2
$923.07
$446.00

$89.2065420
Removal of eye lesion
2
$923.07
$446.00

$89.2065426
Removal of eye lesion
5
$1,412.47
$717.00

$143.4065710
Corneal transplant
7
$2,335.53
$995.00

$199.0065730
Corneal transplant
7
$2,335.53
$995.00

$199.0065750
Corneal transplant
7
$2,335.53
$995.00

$199.0065755
Corneal transplant
7
$2,335.53
$995.00

$199.0065770
Revise cornea with implant
7
$3,116.62
$995.00

$199.0065772
Correction of astigmatism
4
$923.07
$630.00

$126.0065775
Correction of astigmatism
4
$923.07
$630.00

$126.0065780
Ocular reconst, transplant
5
$2,335.53
$717.00

$143.4065781
Ocular reconst, transplant
5
$2,335.53
$717.00

$143.4065782
Ocular reconst, transplant
5
$2,335.53
$717.00

$143.4065800
Drainage of eye
1
$923.07
$333.00

$66.6065805
Drainage of eye
1
$923.07
$333.00

$66.6065810
Drainage of eye
3
$1,412.47
$510.00

$102.0065815
Drainage of eye
2
$1,412.47
$446.00

$89.2065820
Relieve inner eye pressure
1
$368.07
$333.00

$66.6065850
Incision of eye
4
$1,412.47
$630.00

$126.0065865
Incise inner eye adhesions
1
$923.07
$333.00

$66.6065870
Incise inner eye adhesions
4
$1,412.47
$630.00

$126.0065875
Incise inner eye adhesions
4
$1,412.47
$630.00

$126.0065880
Incise inner eye adhesions
4
$923.07
$630.00

$126.0065900
Remove eye lesion
5
$923.07
$717.00

$143.4065920
Remove implant of eye
7
$1,412.47
$995.00

$199.0065930
Remove blood clot from eye
5
$1,412.47
$717.00

$143.4066020
Injection treatment of eye
1
$923.07
$333.00

$66.6066030
Injection treatment of eye
1
$368.07
$333.00

$66.6066130
Remove eye lesion
7
$1,412.47
$995.00

$199.0066150
Glaucoma surgery
4
$1,412.47
$630.00

$126.0066155
Glaucoma surgery
4
$1,412.47
$630.00

$126.0066160
Glaucoma surgery
2
$1,412.47
$446.00

$89.2066165
Glaucoma surgery
4
$1,412.47
$630.00

$126.0066170
Glaucoma surgery
4
$1,412.47
$630.00

$126.0066172
Incision of eye
4
$1,412.47
$630.00

$126.0066180
Implant eye shunt
5
$2,296.20
$717.00

$143.4066185
Revise eye shunt
2
$2,296.20
$446.00

$89.2066220
Repair eye lesion
3
$2,270.12
$510.00

$102.0066225
Repair/graft eye lesion
4
$2,296.20
$630.00

$126.0066250
Follow-up surgery of eye
2
$923.07
$446.00

$89.2066500
Incision of iris
1
$368.07
$333.00

$66.6066505
Incision of iris
1
$368.07
$333.00

$66.6066600
Remove iris and lesion
3
$1,412.47
$510.00

$102.0066605
Removal of iris
3
$1,412.47
$510.00

$102.0066625
Removal of iris
3
$368.07
$368.07
Y
$73.6166630
Removal of iris
3
$1,412.47
$510.00

$102.0066635
Removal of iris
3
$1,412.47
$510.00

$102.0066680
Repair iris  ciliary body
3
$1,412.47
$510.00

$102.0066682
Repair iris  ciliary body
2
$1,412.47
$446.00

$89.2066700
Destruction, ciliary body
2
$923.07
$446.00

$89.2066710
Ciliary transsleral therapy
2
$923.07
$446.00

$89.2066711
Ciliary endoscopic ablation
2
$923.07
$446.00

$89.2066720
Destruction, ciliary body
2
$923.07
$446.00

$89.2066740
Destruction, ciliary body
2
$1,412.47
$446.00

$89.2066821
After cataract laser surgery
2
$315.55
$315.55
Y
$63.1166825
Reposition intraocular lens
4
$1,412.47
$630.00

$126.0066830
Removal of lens lesion
4
$368.07
$368.07
Y
$73.6166840
Removal of lens material
4
$895.12
$630.00

$126.0066850
Removal of lens material
7
$1,754.47
$995.00

$199.0066852
Removal of lens material
4
$1,754.47
$630.00

$126.0066920
Extraction of lens
4
$1,754.47
$630.00

$126.0066930
Extraction of lens
5
$1,754.47
$717.00

$143.4066940
Extraction of lens
5
$895.12
$717.00

$143.4066982
Cataract surgery, complex
8
$1,450.54
$973.00

$194.6066983
Cataract surg w/iol, 1 stage
8
$1,450.54
$973.00

$194.6066984
Cataract surg w/iol, 1 stage
8
$1,450.54
$973.00

$194.6066985
Insert lens prosthesis
6
$1,450.54
$826.00

$165.2066986
Exchange lens prosthesis
6
$1,450.54
$826.00

$165.20( print page 49752)67005
Partial removal of eye fluid
4
$1,657.60
$630.00

$126.0067010
Partial removal of eye fluid
4
$1,657.60
$630.00

$126.0067015
Release of eye fluid
1
$1,657.60
$333.00

$66.6067025
Replace eye fluid
1
$1,657.60
$333.00

$66.6067027
Implant eye drug system
4
$2,270.12
$630.00

$126.0067030
Incise inner eye strands
1
$1,005.95
$333.00

$66.6067031
Laser surgery, eye strands
2
$315.55
$315.55
Y
$63.1167036
Removal of inner eye fluid
4
$2,270.12
$630.00

$126.0067038
Strip retinal membrane
5
$2,270.12
$717.00

$143.4067039
Laser treatment of retina
7
$2,270.12
$995.00

$199.0067040
Laser treatment of retina
7
$2,270.12
$995.00

$199.0067107
Repair detached retina
5
$2,270.12
$717.00

$143.4067108
Repair detached retina
7
$2,270.12
$995.00

$199.0067112
Rerepair detached retina
7
$2,270.12
$995.00

$199.0067115
Release encircling material
2
$1,005.95
$446.00

$89.2067120
Remove eye implant material
2
$1,005.95
$446.00

$89.2067121
Remove eye implant material
2
$1,657.60
$446.00

$89.2067141
Treatment of retina
2
$250.82
$250.82
Y
$50.1667218
Treatment of retinal lesion
5
$1,005.95
$717.00

$143.4067227
Treatment of retinal lesion
1
$1,657.60
$333.00

$66.6067250
Reinforce eye wall
3
$1,047.14
$510.00

$102.0067255
Reinforce/graft eye wall
3
$1,657.60
$510.00

$102.0067311
Revise eye muscle
3
$1,310.33
$510.00

$102.0067312
Revise two eye muscles
4
$1,310.33
$630.00

$126.0067314
Revise eye muscle
4
$1,310.33
$630.00

$126.0067316
Revise two eye muscles
4
$1,310.33
$630.00

$126.0067318
Revise eye muscle(s)
4
$1,310.33
$630.00

$126.0067320
Revise eye muscle(s) add-on
4
$1,310.33
$630.00

$126.0067331
Eye surgery follow-up add-on
4
$1,310.33
$630.00

$126.0067332
Rerevise eye muscles add-on
4
$1,310.33
$630.00

$126.0067334
Revise eye muscle w/suture
4
$1,310.33
$630.00

$126.0067335
Eye suture during surgery
4
$1,310.33
$630.00

$126.0067340
Revise eye muscle add-on
4
$1,310.33
$630.00

$126.0067343
Release eye tissue
7
$1,310.33
$995.00

$199.0067350
Biopsy eye muscle
1
$858.69
$333.00

$66.6067400
Explore/biopsy eye socket
3
$1,529.55
$510.00

$102.0067405
Explore/drain eye socket
4
$1,529.55
$630.00

$126.0067412
Explore/treat eye socket
5
$1,529.55
$717.00

$143.4067413
Explore/treat eye socket
5
$1,529.55
$717.00

$143.4067415
Aspiration, orbital contents
1
$1,047.14
$333.00

$66.6067420
Explore/treat eye socket
5
$2,186.40
$717.00

$143.4067430
Explore/treat eye socket
5
$2,186.40
$717.00

$143.4067440
Explore/drain eye socket
5
$2,186.40
$717.00

$143.4067445
Explr/decompress eye socket
5
$2,186.40
$717.00

$143.4067450
Explore/biopsy eye socket
5
$2,186.40
$717.00

$143.4067550
Insert eye socket implant
4
$2,186.40
$630.00

$126.0067560
Revise eye socket implant
2
$1,529.55
$446.00

$89.2067570
Decompress optic nerve
4
$2,186.40
$630.00

$126.0067715
Incision of eyelid fold
1
$1,047.14
$333.00

$66.6067808
Remove eyelid lesion(s)
2
$1,047.14
$446.00

$89.2067830
Revise eyelashes
2
$426.88
$426.88
Y
$85.3867835
Revise eyelashes
2
$1,047.14
$446.00

$89.2067880
Revision of eyelid
3
$923.07
$510.00

$102.0067882
Revision of eyelid
3
$1,047.14
$510.00

$102.0067900
Repair brow defect
4
$1,047.14
$630.00

$126.0067901
Repair eyelid defect
5
$1,047.14
$717.00

$143.4067902
Repair eyelid defect
5
$1,047.14
$717.00

$143.4067903
Repair eyelid defect
4
$1,047.14
$630.00

$126.0067904
Repair eyelid defect
4
$1,047.14
$630.00

$126.0067906
Repair eyelid defect
5
$1,047.14
$717.00

$143.4067908
Repair eyelid defect
4
$1,047.14
$630.00

$126.0067909
Revise eyelid defect
4
$1,047.14
$630.00

$126.0067911
Revise eyelid defect
3
$1,047.14
$510.00

$102.0067912
Correction eyelid w/implant
3
$1,047.14
$510.00

$102.0067914
Repair eyelid defect
3
$1,047.14
$510.00

$102.0067916
Repair eyelid defect
4
$1,047.14
$630.00

$126.0067917
Repair eyelid defect
4
$1,047.14
$630.00

$126.0067921
Repair eyelid defect
3
$1,047.14
$510.00

$102.0067923
Repair eyelid defect
4
$1,047.14
$630.00

$126.00( print page 49753)67924
Repair eyelid defect
4
$1,047.14
$630.00

$126.0067935
Repair eyelid wound
2
$1,047.14
$446.00

$89.2067950
Revision of eyelid
2
$1,047.14
$446.00

$89.2067961
Revision of eyelid
3
$1,047.14
$510.00

$102.0067966
Revision of eyelid
3
$1,047.14
$510.00

$102.0067971
Reconstruction of eyelid
3
$1,529.55
$510.00

$102.0067973
Reconstruction of eyelid
3
$1,529.55
$510.00

$102.0067974
Reconstruction of eyelid
3
$1,529.55
$510.00

$102.0067975
Reconstruction of eyelid
3
$1,047.14
$510.00

$102.0068115
Remove eyelid lining lesion
2
$1,047.14
$446.00

$89.2068130
Remove eyelid lining lesion
2
$923.07
$446.00

$89.2068320
Revise/graft eyelid lining
4
$1,047.14
$630.00

$126.0068325
Revise/graft eyelid lining
4
$1,529.55
$630.00

$126.0068326
Revise/graft eyelid lining
4
$1,529.55
$630.00

$126.0068328
Revise/graft eyelid lining
4
$1,529.55
$630.00

$126.0068330
Revise eyelid lining
4
$1,412.47
$630.00

$126.0068335
Revise/graft eyelid lining
4
$1,529.55
$630.00

$126.0068340
Separate eyelid adhesions
4
$1,047.14
$630.00

$126.0068360
Revise eyelid lining
2
$1,412.47
$446.00

$89.2068362
Revise eyelid lining
2
$1,412.47
$446.00

$89.2068371
Harvest eye tissue, alograft
2
$923.07
$446.00

$89.2068500
Removal of tear gland
3
$1,529.55
$510.00

$102.0068505
Partial removal, tear gland
3
$1,529.55
$510.00

$102.0068510
Biopsy of tear gland
1
$1,047.14
$333.00

$66.6068520
Removal of tear sac
3
$1,529.55
$510.00

$102.0068525
Biopsy of tear sac
1
$1,047.14
$333.00

$66.6068540
Remove tear gland lesion
3
$1,529.55
$510.00

$102.0068550
Remove tear gland lesion
3
$1,529.55
$510.00

$102.0068700
Repair tear ducts
2
$1,529.55
$446.00

$89.2068720
Create tear sac drain
4
$1,529.55
$630.00

$126.0068745
Create tear duct drain
4
$1,529.55
$630.00

$126.0068750
Create tear duct drain
4
$1,529.55
$630.00

$126.0068770
Close tear system fistula
4
$1,047.14
$630.00

$126.0068810
Probe nasolacrimal duct
1
$135.01
$135.01
Y
$27.0068811
Probe nasolacrimal duct
2
$1,047.14
$446.00

$89.2068815
Probe nasolacrimal duct
2
$1,047.14
$446.00

$89.2069110
Remove external ear, partial
1
$920.58
$333.00

$66.6069120
Removal of external ear
2
$1,425.30
$446.00

$89.2069140
Remove ear canal lesion(s)
2
$1,425.30
$446.00

$89.2069145
Remove ear canal lesion(s)
2
$920.58
$446.00

$89.2069150
Extensive ear canal surgery
3
$475.55
$475.55
Y
$95.1169205
Clear outer ear canal
1
$1,229.54
$333.00

$66.6069300
Revise external ear
3
$1,425.30
$510.00

$102.0069310
Rebuild outer ear canal
3
$2,324.90
$510.00

$102.0069320
Rebuild outer ear canal
7
$2,324.90
$995.00

$199.0069421
Incision of eardrum
3
$1,012.48
$510.00

$102.0069436
Create eardrum opening
3
$1,012.48
$510.00

$102.0069440
Exploration of middle ear
3
$1,425.30
$510.00

$102.0069450
Eardrum revision
1
$2,324.90
$333.00

$66.6069501
Mastoidectomy
7
$2,324.90
$995.00

$199.0069502
Mastoidectomy
7
$1,425.30
$995.00

$199.0069505
Remove mastoid structures
7
$2,324.90
$995.00

$199.0069511
Extensive mastoid surgery
7
$2,324.90
$995.00

$199.0069530
Extensive mastoid surgery
7
$2,324.90
$995.00

$199.0069550
Remove ear lesion
5
$2,324.90
$717.00

$143.4069552
Remove ear lesion
7
$2,324.90
$995.00

$199.0069601
Mastoid surgery revision
7
$2,324.90
$995.00

$199.0069602
Mastoid surgery revision
7
$2,324.90
$995.00

$199.0069603
Mastoid surgery revision
7
$2,324.90
$995.00

$199.0069604
Mastoid surgery revision
7
$2,324.90
$995.00

$199.0069605
Mastoid surgery revision
7
$2,324.90
$995.00

$199.0069620
Repair of eardrum
2
$1,425.30
$446.00

$89.2069631
Repair eardrum structures
5
$2,324.90
$717.00

$143.4069632
Rebuild eardrum structures
5
$2,324.90
$717.00

$143.4069633
Rebuild eardrum structures
5
$2,324.90
$717.00

$143.4069635
Repair eardrum structures
7
$2,324.90
$995.00

$199.0069636
Rebuild eardrum structures
7
$2,324.90
$995.00

$199.0069637
Rebuild eardrum structures
7
$2,324.90
$995.00

$199.0069641
Revise middle ear  mastoid
7
$2,324.90
$995.00

$199.00( print page 49754)69642
Revise middle ear  mastoid
7
$2,324.90
$995.00

$199.0069643
Revise middle ear  mastoid
7
$2,324.90
$995.00

$199.0069644
Revise middle ear  mastoid
7
$2,324.90
$995.00

$199.0069645
Revise middle ear  mastoid
7
$2,324.90
$995.00

$199.0069646
Revise middle ear  mastoid
7
$2,324.90
$995.00

$199.0069650
Release middle ear bone
7
$1,425.30
$995.00

$199.0069660
Revise middle ear bone
5
$2,324.90
$717.00

$143.4069661
Revise middle ear bone
5
$2,324.90
$717.00

$143.4069662
Revise middle ear bone
5
$2,324.90
$717.00

$143.4069666
Repair middle ear structures
4
$2,324.90
$630.00

$126.0069667
Repair middle ear structures
4
$2,324.90
$630.00

$126.0069670
Remove mastoid air cells
3
$2,324.90
$510.00

$102.0069676
Remove middle ear nerve
3
$2,324.90
$510.00

$102.0069700
Close mastoid fistula
3
$2,324.90
$510.00

$102.0069711
Remove/repair hearing aid
1
$2,324.90
$333.00

$66.6069714
Implant temple bone w/stimul
9
$2,324.90
$1,339.00

$267.8069715
Temple bne implnt w/stimulat
9
$2,324.90
$1,339.00

$267.8069717
Temple bone implant revision
9
$2,324.90
$1,339.00

$267.8069718
Revise temple bone implant
9
$2,324.90
$1,339.00

$267.8069720
Release facial nerve
5
$2,324.90
$717.00

$143.4069740
Repair facial nerve
5
$2,324.90
$717.00

$143.4069745
Repair facial nerve
5
$2,324.90
$717.00

$143.4069801
Incise inner ear
5
$2,324.90
$717.00

$143.4069802
Incise inner ear
7
$2,324.90
$995.00

$199.0069805
Explore inner ear
7
$2,324.90
$995.00

$199.0069806
Explore inner ear
7
$2,324.90
$995.00

$199.0069820
Establish inner ear window
5
$2,324.90
$717.00

$143.4069840
Revise inner ear window
5
$2,324.90
$717.00

$143.4069905
Remove inner ear
7
$2,324.90
$995.00

$199.0069910
Remove inner ear  mastoid
7
$2,324.90
$995.00

$199.0069915
Incise inner ear nerve
7
$2,324.90
$995.00

$199.0069930
Implant cochlear device
7
$25,040.37
$995.00

$199.00G0105
Colorectal scrn; hi risk ind
2
$480.92
$446.00

$89.20G0121
Colon ca scrn; not high rsk
2
$480.92
$446.00

$89.20G0260
Inj for sacroiliac jt anesth
1
$341.23
$333.00

$66.60
 Addendum B.—Payment Status by HCPCS Code and Related Information Calendar Year 2007
CPT/HCPCS
Description
CI
SI
APC
Relative weight
Payment rate
National unadjusted copayment
Minimum unadjusted copayment00100
Anesth, salivary gland

N00102
Anesth, repair of cleft lip

N00103
Anesth, blepharoplasty

N00104
Anesth, electroshock

N00120
Anesth, ear surgery

N00124
Anesth, ear exam

N00126
Anesth, tympanotomy

N00140
Anesth, procedures on eye

N00142
Anesth, lens surgery

N00144
Anesth, corneal transplant

N00145
Anesth, vitreoretinal surg

N00147
Anesth, iridectomy

N00148
Anesth, eye exam

N00160
Anesth, nose/sinus surgery

N00162
Anesth, nose/sinus surgery

N00164
Anesth, biopsy of nose

N00170
Anesth, procedure on mouth

N00172
Anesth, cleft palate repair

N00174
Anesth, pharyngeal surgery

N00190
Anesth, face/skull bone surg

N00210
Anesth, open head surgery

N00212
Anesth, skull drainage

N00216
Anesth, head vessel surgery

N00218
Anesth, special head surgery

N00220
Anesth, intrcrn nerve

N00222
Anesth, head nerve surgery

N( print page 49755)00300
Anesth, head/neck/ptrunk

N00320
Anesth, neck organ, 1  over

N00322
Anesth, biopsy of thyroid

N00326
Anesth, larynx/trach,  1 yr

N00350
Anesth, neck vessel surgery

N00352
Anesth, neck vessel surgery

N00400
Anesth, skin, ext/per/atrunk

N00402
Anesth, surgery of breast

N00410
Anesth, correct heart rhythm

N00450
Anesth, surgery of shoulder

N00454
Anesth, collar bone biopsy

N00470
Anesth, removal of rib

N00472
Anesth, chest wall repair

N00500
Anesth, esophageal surgery

N00520
Anesth, chest procedure

N00522
Anesth, chest lining biopsy

N00528
Anesth, chest partition view

N00529
Anesth, chest partition view

N00530
Anesth, pacemaker insertion

N00532
Anesth, vascular access

N00534
Anesth, cardioverter/defib

N00537
Anesth, cardiac electrophys

N00539
Anesth, trach-bronch reconst

N00541
Anesth, one lung ventilation

N00548
Anesth, trachea,bronchi surg

N00550
Anesth, sternal debridement

N00563
Anesth, heart surg w/arrest

N00566
Anesth, cabg w/o pump

N00600
Anesth, spine, cord surgery

N00620
Anesth, spine, cord surgery

N00630
Anesth, spine, cord surgery

N00634
Anesth for chemonucleolysis

N00635
Anesth, lumbar puncture

N00640
Anesth, spine manipulation

N00700
Anesth, abdominal wall surg

N00702
Anesth, for liver biopsy

N00730
Anesth, abdominal wall surg

N00740
Anesth, upper gi visualize

N00750
Anesth, repair of hernia

N00752
Anesth, repair of hernia

N00754
Anesth, repair of hernia

N00756
Anesth, repair of hernia

N00770
Anesth, blood vessel repair

N00790
Anesth, surg upper abdomen

N00797
Anesth, surgery for obesity

N00800
Anesth, abdominal wall surg

N00810
Anesth, low intestine scope

N00820
Anesth, abdominal wall surg

N00830
Anesth, repair of hernia

N00832
Anesth, repair of hernia

N00834
Anesth, hernia repair  1 yr

N00836
Anesth hernia repair preemie

N00840
Anesth, surg lower abdomen

N00842
Anesth, amniocentesis

N00851
Anesth, tubal ligation

N00860
Anesth, surgery of abdomen

N00862
Anesth, kidney/ureter surg

N00870
Anesth, bladder stone surg

N00872
Anesth kidney stone destruct

N00873
Anesth kidney stone destruct

N00880
Anesth, abdomen vessel surg

N00902
Anesth, anorectal surgery

N00906
Anesth, removal of vulva

N00910
Anesth, bladder surgery

N00912
Anesth, bladder tumor surg

N00914
Anesth, removal of prostate

N00916
Anesth, bleeding control

N00918
Anesth, stone removal

N00920
Anesth, genitalia surgery

N00921
Anesth, vasectomy

N( print page 49756)00922
Anesth, sperm duct surgery

N00924
Anesth, testis exploration

N00926
Anesth, removal of testis

N00928
Anesth, removal of testis

N00930
Anesth, testis suspension

N00938
Anesth, insert penis device

N00940
Anesth, vaginal procedures

N00942
Anesth, surg on vag/urethral

N00948
Anesth, repair of cervix

N00950
Anesth, vaginal endoscopy

N00952
Anesth, hysteroscope/graph

N01112
Anesth, bone aspirate/bx

N01120
Anesth, pelvis surgery

N01130
Anesth, body cast procedure

N01160
Anesth, pelvis procedure

N01170
Anesth, pelvis surgery

N01173
Anesth, fx repair, pelvis

N01180
Anesth, pelvis nerve removal

N01190
Anesth, pelvis nerve removal

N01200
Anesth, hip joint procedure

N01202
Anesth, arthroscopy of hip

N01210
Anesth, hip joint surgery

N01215
Anesth, revise hip repair

N01220
Anesth, procedure on femur

N01230
Anesth, surgery of femur

N01250
Anesth, upper leg surgery

N01260
Anesth, upper leg veins surg

N01270
Anesth, thigh arteries surg

N01320
Anesth, knee area surgery

N01340
Anesth, knee area procedure

N01360
Anesth, knee area surgery

N01380
Anesth, knee joint procedure

N01382
Anesth, dx knee arthroscopy

N01390
Anesth, knee area procedure

N01392
Anesth, knee area surgery

N01400
Anesth, knee joint surgery

N01420
Anesth, knee joint casting

N01430
Anesth, knee veins surgery

N01432
Anesth, knee vessel surg

N01440
Anesth, knee arteries surg

N01462
Anesth, lower leg procedure

N01464
Anesth, ankle/ft arthroscopy

N01470
Anesth, lower leg surgery

N01472
Anesth, achilles tendon surg

N01474
Anesth, lower leg surgery

N01480
Anesth, lower leg bone surg

N01482
Anesth, radical leg surgery

N01484
Anesth, lower leg revision

N01490
Anesth, lower leg casting

N01500
Anesth, leg arteries surg

N01520
Anesth, lower leg vein surg

N01522
Anesth, lower leg vein surg

N01610
Anesth, surgery of shoulder

N01620
Anesth, shoulder procedure

N01622
Anes dx shoulder arthroscopy

N01630
Anesth, surgery of shoulder

N01650
Anesth, shoulder artery surg

N01670
Anesth, shoulder vein surg

N01680
Anesth, shoulder casting

N01682
Anesth, airplane cast

N01710
Anesth, elbow area surgery

N01712
Anesth, uppr arm tendon surg

N01714
Anesth, uppr arm tendon surg

N01716
Anesth, biceps tendon repair

N01730
Anesth, uppr arm procedure

N01732
Anesth, dx elbow arthroscopy

N01740
Anesth, upper arm surgery

N01742
Anesth, humerus surgery

N01744
Anesth, humerus repair

N01758
Anesth, humeral lesion surg

N( print page 49757)01760
Anesth, elbow replacement

N01770
Anesth, uppr arm artery surg

N01772
Anesth, uppr arm embolectomy

N01780
Anesth, upper arm vein surg

N01782
Anesth, uppr arm vein repair

N01810
Anesth, lower arm surgery

N01820
Anesth, lower arm procedure

N01829
Anesth, dx wrist arthroscopy

N01830
Anesth, lower arm surgery

N01832
Anesth, wrist replacement

N01840
Anesth, lwr arm artery surg

N01842
Anesth, lwr arm embolectomy

N01844
Anesth, vascular shunt surg

N01850
Anesth, lower arm vein surg

N01852
Anesth, lwr arm vein repair

N01860
Anesth, lower arm casting

N01905
Anes, spine inject, x-ray/re

N01916
Anesth, dx arteriography

N01920
Anesth, catheterize heart

N01922
Anesth, cat or MRI scan

N01924
Anes, ther interven rad, art

N01925
Anes, ther interven rad, car

N01926
Anes, tx interv rad hrt/cran

N01930
Anes, ther interven rad, vei

N01931
Anes, ther interven rad, tip

N01932
Anes, tx interv rad, th vein

N01933
Anes, tx interv rad, cran v

N01951
Anesth, burn, less 4 percent

N01952
Anesth, burn, 4-9 percent

N01953
Anesth, burn, each 9 percent

N01958
Anesth, antepartum manipul

N01960
Anesth, vaginal delivery

N01961
Anesth, cs delivery

N01962
Anesth, emer hysterectomy

N01963
Anesth, cs hysterectomy

N01965
Anesth, inc/missed ab proc

N01966
Anesth, induced ab procedure

N01967
Anesth/analg, vag delivery

N01968
Anes/analg cs deliver add-on

N01969
Anesth/analg cs hyst add-on

N01991
Anesth, nerve block/inj

N01992
Anesth, n block/inj, prone

N01995
Regional anesthesia limb

N01996
Hosp manage cont drug admin

N01999
Unlisted anesth procedure

N10021
Fna w/o image

T
0002
1.0948
67.39

13.4810022
Fna w/image

T
0036
2.0147
124.01

24.8010040
Acne surgery

T
0010
0.4829
29.72
8.14
5.9410060
Drainage of skin abscess

T
0006
1.4821
91.22
21.76
18.2410061
Drainage of skin abscess

T
0006
1.4821
91.22
21.76
18.2410080
Drainage of pilonidal cyst

T
0006
1.4821
91.22
21.76
18.2410081
Drainage of pilonidal cyst

T
0007
10.9184
672.04

134.4110120
Remove foreign body

T
0006
1.4821
91.22
21.76
18.2410121
Remove foreign body

T
0021
14.9563
920.58
219.48
184.1210140
Drainage of hematoma/fluid

T
0007
10.9184
672.04

134.4110160
Puncture drainage of lesion

T
0018
1.0534
64.84
15.87
12.9710180
Complex drainage, wound

T
0008
17.4686
1,075.21

215.0411000
Debride infected skin

T
0013
1.0876
66.94

13.3911001
Debride infected skin add-on

T
0012
0.8076
49.71
10.30
9.9411010
Debride skin, fx

T
0019
4.0123
246.96
71.87
49.3911011
Debride skin/muscle, fx

T
0019
4.0123
246.96
71.87
49.3911012
Debride skin/muscle/bone, fx

T
0019
4.0123
246.96
71.87
49.3911040
Debride skin, partial

T
0015
1.6062
98.86
20.13
19.7711041
Debride skin, full

T
0015
1.6062
98.86
20.13
19.7711042
Debride skin/tissue

T
0016
2.6253
161.59
32.68
32.3211043
Debride tissue/muscle

T
0016
2.6253
161.59
32.68
32.3211044
Debride tissue/muscle/bone

T
0682
6.7529
415.65
158.65
83.1311055
Trim skin lesion

T
0012
0.8076
49.71
10.30
9.9411056
Trim skin lesions, 2 to 4

T
0012
0.8076
49.71
10.30
9.9411057
Trim skin lesions, over 4

T
0013
1.0876
66.94

13.39( print page 49758)11100
Biopsy, skin lesion

T
0018
1.0534
64.84
15.87
12.9711101
Biopsy, skin add-on

T
0018
1.0534
64.84
15.87
12.9711200
Removal of skin tags

T
0013
1.0876
66.94

13.3911201
Remove skin tags add-on

T
0015
1.6062
98.86
20.13
19.7711300
Shave skin lesion

T
0012
0.8076
49.71
10.30
9.9411301
Shave skin lesion

T
0012
0.8076
49.71
10.30
9.9411302
Shave skin lesion

T
0013
1.0876
66.94

13.3911303
Shave skin lesion

T
0015
1.6062
98.86
20.13
19.7711305
Shave skin lesion

T
0013
1.0876
66.94

13.3911306
Shave skin lesion

T
0013
1.0876
66.94

13.3911307
Shave skin lesion

T
0013
1.0876
66.94

13.3911308
Shave skin lesion

T
0013
1.0876
66.94

13.3911310
Shave skin lesion

T
0013
1.0876
66.94

13.3911311
Shave skin lesion

T
0013
1.0876
66.94

13.3911312
Shave skin lesion

T
0013
1.0876
66.94

13.3911313
Shave skin lesion

T
0016
2.6253
161.59
32.68
32.3211400
Exc tr-ext b9+marg 0.5  cm

T
0019
4.0123
246.96
71.87
49.3911401
Exc tr-ext b9+marg 0.6-1 cm

T
0019
4.0123
246.96
71.87
49.3911402
Exc tr-ext b9+marg 1.1-2 cm

T
0019
4.0123
246.96
71.87
49.3911403
Exc tr-ext b9+marg 2.1-3 cm

T
0020
6.5128
400.87
98.57
80.1711404
Exc tr-ext b9+marg 3.1-4 cm

T
0021
14.9563
920.58
219.48
184.1211406
Exc tr-ext b9+marg  4.0 cm

T
0021
14.9563
920.58
219.48
184.1211420
Exc h-f-nk-sp b9+marg 0.5

T
0020
6.5128
400.87
98.57
80.1711421
Exc h-f-nk-sp b9+marg 0.6-1

T
0020
6.5128
400.87
98.57
80.1711422
Exc h-f-nk-sp b9+marg 1.1-2

T
0020
6.5128
400.87
98.57
80.1711423
Exc h-f-nk-sp b9+marg 2.1-3

T
0021
14.9563
920.58
219.48
184.1211424
Exc h-f-nk-sp b9+marg 3.1-4

T
0021
14.9563
920.58
219.48
184.1211426
Exc h-f-nk-sp b9+marg  4 cm

T
0022
19.9760
1,229.54
354.45
245.9111440
Exc face-mm b9+marg 0.5  cm

T
0019
4.0123
246.96
71.87
49.3911441
Exc face-mm b9+marg 0.6-1 cm

T
0019
4.0123
246.96
71.87
49.3911442
Exc face-mm b9+marg 1.1-2 cm

T
0020
6.5128
400.87
98.57
80.1711443
Exc face-mm b9+marg 2.1-3 cm

T
0020
6.5128
400.87
98.57
80.1711444
Exc face-mm b9+marg 3.1-4 cm

T
0020
6.5128
400.87
98.57
80.1711446
Exc face-mm b9+marg  4 cm

T
0022
19.9760
1,229.54
354.45
245.9111450
Removal, sweat gland lesion

T
0022
19.9760
1,229.54
354.45
245.9111451
Removal, sweat gland lesion

T
0022
19.9760
1,229.54
354.45
245.9111462
Removal, sweat gland lesion

T
0022
19.9760
1,229.54
354.45
245.9111463
Removal, sweat gland lesion

T
0022
19.9760
1,229.54
354.45
245.9111470
Removal, sweat gland lesion

T
0022
19.9760
1,229.54
354.45
245.9111471
Removal, sweat gland lesion

T
0022
19.9760
1,229.54
354.45
245.9111600
Exc tr-ext mlg+marg 0.5  cm

T
0019
4.0123
246.96
71.87
49.3911601
Exc tr-ext mlg+marg 0.6-1 cm

T
0019
4.0123
246.96
71.87
49.3911602
Exc tr-ext mlg+marg 1.1-2 cm

T
0019
4.0123
246.96
71.87
49.3911603
Exc tr-ext mlg+marg 2.1-3 cm

T
0020
6.5128
400.87
98.57
80.1711604
Exc tr-ext mlg+marg 3.1-4 cm

T
0020
6.5128
400.87
98.57
80.1711606
Exc tr-ext mlg+marg  4 cm

T
0021
14.9563
920.58
219.48
184.1211620
Exc h-f-nk-sp mlg+marg 0.5

T
0020
6.5128
400.87
98.57
80.1711621
Exc h-f-nk-sp mlg+marg 0.6-1

T
0019
4.0123
246.96
71.87
49.3911622
Exc h-f-nk-sp mlg+marg 1.1-2

T
0020
6.5128
400.87
98.57
80.1711623
Exc h-f-nk-sp mlg+marg 2.1-3

T
0021
14.9563
920.58
219.48
184.1211624
Exc h-f-nk-sp mlg+marg 3.1-4

T
0021
14.9563
920.58
219.48
184.1211626
Exc h-f-nk-sp mlg+mar  4 cm

T
0022
19.9760
1,229.54
354.45
245.9111640
Exc face-mm malig+marg 0.5

T
0020
6.5128
400.87
98.57
80.1711641
Exc face-mm malig+marg 0.6-1

T
0020
6.5128
400.87
98.57
80.1711642
Exc face-mm malig+marg 1.1-2

T
0020
6.5128
400.87
98.57
80.1711643
Exc face-mm malig+marg 2.1-3

T
0020
6.5128
400.87
98.57
80.1711644
Exc face-mm malig+marg 3.1-4

T
0021
14.9563
920.58
219.48
184.1211646
Exc face-mm mlg+marg  4 cm

T
0022
19.9760
1,229.54
354.45
245.9111719
Trim nail(s)

T
0009
0.6803
41.87

8.3711720
Debride nail, 1-5

T
0009
0.6803
41.87

8.3711721
Debride nail, 6 or more

T
0009
0.6803
41.87

8.3711730
Removal of nail plate

T
0013
1.0876
66.94

13.3911732
Remove nail plate, add-on

T
0012
0.8076
49.71
10.30
9.9411740
Drain blood from under nail

T
0009
0.6803
41.87

8.3711750
Removal of nail bed

T
0019
4.0123
246.96
71.87
49.3911752
Remove nail bed/finger tip

T
0022
19.9760
1,229.54
354.45
245.9111755
Biopsy, nail unit

T
0019
4.0123
246.96
71.87
49.3911760
Repair of nail bed

T
0024
1.4924
91.86
30.08
18.3711762
Reconstruction of nail bed

T
0024
1.4924
91.86
30.08
18.3711765
Excision of nail fold, toe

T
0015
1.6062
98.86
20.13
19.77( print page 49759)11770
Removal of pilonidal lesion

T
0022
19.9760
1,229.54
354.45
245.9111771
Removal of pilonidal lesion

T
0022
19.9760
1,229.54
354.45
245.9111772
Removal of pilonidal lesion

T
0022
19.9760
1,229.54
354.45
245.9111900
Injection into skin lesions

T
0012
0.8076
49.71
10.30
9.9411901
Added skin lesions injection

T
0012
0.8076
49.71
10.30
9.9411920
Correct skin color defects

T
0024
1.4924
91.86
30.08
18.3711921
Correct skin color defects

T
0024
1.4924
91.86
30.08
18.3711922
Correct skin color defects

T
0024
1.4924
91.86
30.08
18.3711950
Therapy for contour defects

T
0024
1.4924
91.86
30.08
18.3711951
Therapy for contour defects

T
0024
1.4924
91.86
30.08
18.3711952
Therapy for contour defects

T
0024
1.4924
91.86
30.08
18.3711954
Therapy for contour defects

T
0024
1.4924
91.86
30.08
18.3711960
Insert tissue expander(s)

T
0027
21.2645
1,308.85
329.72
261.7711970
Replace tissue expander
CH
T
0051
41.2543
2,539.24

507.8511971
Remove tissue expander(s)

T
0022
19.9760
1,229.54
354.45
245.9111976
Removal of contraceptive cap

T
0019
4.0123
246.96
71.87
49.3911980
Implant hormone pellet(s)

X
0340
0.6211
38.23

7.6511981
Insert drug implant device

X
0340
0.6211
38.23

7.6511982
Remove drug implant device

X
0340
0.6211
38.23

7.6511983
Remove/insert drug implant

X
0340
0.6211
38.23

7.6512001
Repair superficial wound(s)

T
0024
1.4924
91.86
30.08
18.3712002
Repair superficial wound(s)

T
0024
1.4924
91.86
30.08
18.3712004
Repair superficial wound(s)

T
0024
1.4924
91.86
30.08
18.3712005
Repair superficial wound(s)

T
0024
1.4924
91.86
30.08
18.3712006
Repair superficial wound(s)

T
0024
1.4924
91.86
30.08
18.3712007
Repair superficial wound(s)

T
0024
1.4924
91.86
30.08
18.3712011
Repair superficial wound(s)

T
0024
1.4924
91.86
30.08
18.3712013
Repair superficial wound(s)

T
0024
1.4924
91.86
30.08
18.3712014
Repair superficial wound(s)

T
0024
1.4924
91.86
30.08
18.3712015
Repair superficial wound(s)

T
0024
1.4924
91.86
30.08
18.3712016
Repair superficial wound(s)

T
0024
1.4924
91.86
30.08
18.3712017
Repair superficial wound(s)

T
0024
1.4924
91.86
30.08
18.3712018
Repair superficial wound(s)

T
0024
1.4924
91.86
30.08
18.3712020
Closure of split wound

T
0024
1.4924
91.86
30.08
18.3712021
Closure of split wound

T
0024
1.4924
91.86
30.08
18.3712031
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712032
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712034
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712035
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712036
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712037
Layer closure of wound(s)

T
0025
5.0931
313.49
95.46
62.7012041
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712042
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712044
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712045
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712046
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712047
Layer closure of wound(s)

T
0025
5.0931
313.49
95.46
62.7012051
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712052
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712053
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712054
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712055
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712056
Layer closure of wound(s)

T
0024
1.4924
91.86
30.08
18.3712057
Layer closure of wound(s)

T
0025
5.0931
313.49
95.46
62.7013100
Repair of wound or lesion

T
0025
5.0931
313.49
95.46
62.7013101
Repair of wound or lesion

T
0025
5.0931
313.49
95.46
62.7013102
Repair wound/lesion add-on

T
0024
1.4924
91.86
30.08
18.3713120
Repair of wound or lesion

T
0024
1.4924
91.86
30.08
18.3713121
Repair of wound or lesion

T
0024
1.4924
91.86
30.08
18.3713122
Repair wound/lesion add-on

T
0024
1.4924
91.86
30.08
18.3713131
Repair of wound or lesion

T
0024
1.4924
91.86
30.08
18.3713132
Repair of wound or lesion

T
0024
1.4924
91.86
30.08
18.3713133
Repair wound/lesion add-on

T
0024
1.4924
91.86
30.08
18.3713150
Repair of wound or lesion

T
0025
5.0931
313.49
95.46
62.7013151
Repair of wound or lesion

T
0024
1.4924
91.86
30.08
18.3713152
Repair of wound or lesion

T
0025
5.0931
313.49
95.46
62.7013153
Repair wound/lesion add-on

T
0024
1.4924
91.86
30.08
18.3713160
Late closure of wound

T
0027
21.2645
1,308.85
329.72
261.7714000
Skin tissue rearrangement

T
0686
13.3433
821.29

164.2614001
Skin tissue rearrangement

T
0027
21.2645
1,308.85
329.72
261.77( print page 49760)14020
Skin tissue rearrangement

T
0686
13.3433
821.29

164.2614021
Skin tissue rearrangement
CH
T
0686
13.3433
821.29

164.2614040
Skin tissue rearrangement

T
0686
13.3433
821.29

164.2614041
Skin tissue rearrangement
CH
T
0686
13.3433
821.29

164.2614060
Skin tissue rearrangement
CH
T
0686
13.3433
821.29

164.2614061
Skin tissue rearrangement

T
0686
13.3433
821.29

164.2614300
Skin tissue rearrangement

T
0027
21.2645
1,308.85
329.72
261.7714350
Skin tissue rearrangement

T
0027
21.2645
1,308.85
329.72
261.7715000
Wound prep, 1st 100 sq cm

T
0025
5.0931
313.49
95.46
62.7015001
Wound prep, addl 100 sq cm

T
0025
5.0931
313.49
95.46
62.7015040
Harvest cultured skin graft

T
0024
1.4924
91.86
30.08
18.3715050
Skin pinch graft

T
0025
5.0931
313.49
95.46
62.7015100
Skin splt grft, trnk/arm/leg

T
0027
21.2645
1,308.85
329.72
261.7715101
Skin splt grft t/a/l, add-on

T
0027
21.2645
1,308.85
329.72
261.7715110
Epidrm autogrft trnk/arm/leg

T
0027
21.2645
1,308.85
329.72
261.7715111
Epidrm autogrft t/a/l add-on

T
0027
21.2645
1,308.85
329.72
261.7715115
Epidrm a-grft face/nck/hf/g

T
0027
21.2645
1,308.85
329.72
261.7715116
Epidrm a-grft f/n/hf/g addl

T
0027
21.2645
1,308.85
329.72
261.7715120
Skn splt a-grft fac/nck/hf/g

T
0027
21.2645
1,308.85
329.72
261.7715121
Skn splt a-grft f/n/hf/g add

T
0027
21.2645
1,308.85
329.72
261.7715130
Derm autograft, trnk/arm/leg

T
0027
21.2645
1,308.85
329.72
261.7715131
Derm autograft t/a/l add-on

T
0027
21.2645
1,308.85
329.72
261.7715135
Derm autograft face/nck/hf/g

T
0027
21.2645
1,308.85
329.72
261.7715136
Derm autograft, f/n/hf/g add

T
0027
21.2645
1,308.85
329.72
261.7715150
Cult epiderm grft t/arm/leg

T
0027
21.2645
1,308.85
329.72
261.7715151
Cult epiderm grft t/a/l addl

T
0027
21.2645
1,308.85
329.72
261.7715152
Cult epiderm graft t/a/l +%

T
0027
21.2645
1,308.85
329.72
261.7715155
Cult epiderm graft, f/n/hf/g

T
0027
21.2645
1,308.85
329.72
261.7715156
Cult epidrm grft f/n/hfg add

T
0027
21.2645
1,308.85
329.72
261.7715157
Cult epiderm grft f/n/hfg +%

T
0027
21.2645
1,308.85
329.72
261.7715170
Acell graft trunk/arms/legs
CH
T
0025
5.0931
313.49
95.46
62.7015171
Acell graft t/arm/leg add-on
CH
T
0025
5.0931
313.49
95.46
62.7015175
Acellular graft, f/n/hf/g
CH
T
0025
5.0931
313.49
95.46
62.7015176
Acell graft, f/n/hf/g add-on
CH
T
0025
5.0931
313.49
95.46
62.7015200
Skin full graft, trunk
CH
T
0686
13.3433
821.29

164.2615201
Skin full graft trunk add-on

T
0025
5.0931
313.49
95.46
62.7015220
Skin full graft sclp/arm/leg
CH
T
0686
13.3433
821.29

164.2615221
Skin full graft add-on

T
0025
5.0931
313.49
95.46
62.7015240
Skin full grft face/genit/hf

T
0686
13.3433
821.29

164.2615241
Skin full graft add-on

T
0025
5.0931
313.49
95.46
62.7015260
Skin full graft eenlips

T
0686
13.3433
821.29

164.2615261
Skin full graft add-on

T
0025
5.0931
313.49
95.46
62.7015300
Apply skinallogrft, t/arm/lg
CH
T
0025
5.0931
313.49
95.46
62.7015301
Apply sknallogrft t/a/l addl

T
0025
5.0931
313.49
95.46
62.7015320
Apply skin allogrft f/n/hf/g

T
0025
5.0931
313.49
95.46
62.7015321
Aply sknallogrft f/n/hfg add

T
0025
5.0931
313.49
95.46
62.7015330
Aply acell alogrft t/arm/leg

T
0025
5.0931
313.49
95.46
62.7015331
Aply acell grft t/a/l add-on

T
0025
5.0931
313.49
95.46
62.7015335
Apply acell graft, f/n/hf/g

T
0025
5.0931
313.49
95.46
62.7015336
Aply acell grft f/n/hf/g add

T
0025
5.0931
313.49
95.46
62.7015340
Apply cult skin substitute
CH
T
0025
5.0931
313.49
95.46
62.7015341
Apply cult skin sub add-on
CH
T
0025
5.0931
313.49
95.46
62.7015360
Apply cult derm sub, t/a/l
CH
T
0025
5.0931
313.49
95.46
62.7015361
Aply cult derm sub t/a/l add
CH
T
0025
5.0931
313.49
95.46
62.7015365
Apply cult derm sub f/n/hf/g
CH
T
0025
5.0931
313.49
95.46
62.7015366
Apply cult derm f/hf/g add
CH
T
0025
5.0931
313.49
95.46
62.7015400
Apply skin xenograft, t/a/l

T
0025
5.0931
313.49
95.46
62.7015401
Apply skn xenogrft t/a/l add

T
0025
5.0931
313.49
95.46
62.7015420
Apply skin xgraft, f/n/hf/g

T
0025
5.0931
313.49
95.46
62.7015421
Apply skn xgrft f/n/hf/g add

T
0025
5.0931
313.49
95.46
62.7015430
Apply acellular xenograft

T
0025
5.0931
313.49
95.46
62.7015431
Apply acellular xgraft add

T
0025
5.0931
313.49
95.46
62.7015570
Form skin pedicle flap

T
0027
21.2645
1,308.85
329.72
261.7715572
Form skin pedicle flap

T
0027
21.2645
1,308.85
329.72
261.7715574
Form skin pedicle flap

T
0027
21.2645
1,308.85
329.72
261.7715576
Form skin pedicle flap

T
0686
13.3433
821.29

164.2615600
Skin graft

T
0027
21.2645
1,308.85
329.72
261.7715610
Skin graft

T
0027
21.2645
1,308.85
329.72
261.7715620
Skin graft

T
0027
21.2645
1,308.85
329.72
261.7715630
Skin graft

T
0027
21.2645
1,308.85
329.72
261.77( print page 49761)15650
Transfer skin pedicle flap

T
0027
21.2645
1,308.85
329.72
261.7715732
Muscle-skin graft, head/neck

T
0027
21.2645
1,308.85
329.72
261.7715734
Muscle-skin graft, trunk

T
0027
21.2645
1,308.85
329.72
261.7715736
Muscle-skin graft, arm

T
0027
21.2645
1,308.85
329.72
261.7715738
Muscle-skin graft, leg

T
0027
21.2645
1,308.85
329.72
261.7715740
Island pedicle flap graft

T
0686
13.3433
821.29

164.2615750
Neurovascular pedicle graft

T
0027
21.2645
1,308.85
329.72
261.7715760
Composite skin graft

T
0027
21.2645
1,308.85
329.72
261.7715770
Derma-fat-fascia graft

T
0027
21.2645
1,308.85
329.72
261.7715775
Hair transplant punch grafts

T
0025
5.0931
313.49
95.46
62.7015776
Hair transplant punch grafts

T
0025
5.0931
313.49
95.46
62.7015780
Abrasion treatment of skin

T
0022
19.9760
1,229.54
354.45
245.9115781
Abrasion treatment of skin

T
0019
4.0123
246.96
71.87
49.3915782
Abrasion treatment of skin

T
0019
4.0123
246.96
71.87
49.3915783
Abrasion treatment of skin

T
0016
2.6253
161.59
32.68
32.3215786
Abrasion, lesion, single

T
0013
1.0876
66.94

13.3915787
Abrasion, lesions, add-on

T
0013
1.0876
66.94

13.3915788
Chemical peel, face, epiderm

T
0012
0.8076
49.71
10.30
9.9415789
Chemical peel, face, dermal

T
0015
1.6062
98.86
20.13
19.7715792
Chemical peel, nonfacial

T
0013
1.0876
66.94

13.3915793
Chemical peel, nonfacial

T
0012
0.8076
49.71
10.30
9.9415819
Plastic surgery, neck

T
0025
5.0931
313.49
95.46
62.7015820
Revision of lower eyelid

T
0027
21.2645
1,308.85
329.72
261.7715821
Revision of lower eyelid

T
0027
21.2645
1,308.85
329.72
261.7715822
Revision of upper eyelid

T
0027
21.2645
1,308.85
329.72
261.7715823
Revision of upper eyelid
CH
T
0686
13.3433
821.29

164.2615824
Removal of forehead wrinkles

T
0027
21.2645
1,308.85
329.72
261.7715825
Removal of neck wrinkles

T
0027
21.2645
1,308.85
329.72
261.7715826
Removal of brow wrinkles

T
0027
21.2645
1,308.85
329.72
261.7715828
Removal of face wrinkles

T
0027
21.2645
1,308.85
329.72
261.7715829
Removal of skin wrinkles

T
0027
21.2645
1,308.85
329.72
261.7715831
Excise excessive skin tissue

T
0022
19.9760
1,229.54
354.45
245.9115832
Excise excessive skin tissue

T
0022
19.9760
1,229.54
354.45
245.9115833
Excise excessive skin tissue

T
0022
19.9760
1,229.54
354.45
245.9115834
Excise excessive skin tissue

T
0022
19.9760
1,229.54
354.45
245.9115835
Excise excessive skin tissue

T
0025
5.0931
313.49
95.46
62.7015836
Excise excessive skin tissue

T
0021
14.9563
920.58
219.48
184.1215837
Excise excessive skin tissue

T
0021
14.9563
920.58
219.48
184.1215838
Excise excessive skin tissue

T
0021
14.9563
920.58
219.48
184.1215839
Excise excessive skin tissue

T
0021
14.9563
920.58
219.48
184.1215840
Graft for face nerve palsy

T
0027
21.2645
1,308.85
329.72
261.7715841
Graft for face nerve palsy

T
0027
21.2645
1,308.85
329.72
261.7715842
Flap for face nerve palsy

T
0686
13.3433
821.29

164.2615845
Skin and muscle repair, face

T
0027
21.2645
1,308.85
329.72
261.7715850
Removal of sutures

T
0016
2.6253
161.59
32.68
32.3215851
Removal of sutures

T
0016
2.6253
161.59
32.68
32.3215852
Dressing change not for burn

X
0340
0.6211
38.23

7.6515860
Test for blood flow in graft
CH
X
0340
0.6211
38.23

7.6515876
Suction assisted lipectomy

T
0027
21.2645
1,308.85
329.72
261.7715877
Suction assisted lipectomy

T
0027
21.2645
1,308.85
329.72
261.7715878
Suction assisted lipectomy

T
0686
13.3433
821.29

164.2615879
Suction assisted lipectomy

T
0027
21.2645
1,308.85
329.72
261.7715920
Removal of tail bone ulcer

T
0019
4.0123
246.96
71.87
49.3915922
Removal of tail bone ulcer

T
0027
21.2645
1,308.85
329.72
261.7715931
Remove sacrum pressure sore

T
0022
19.9760
1,229.54
354.45
245.9115933
Remove sacrum pressure sore

T
0022
19.9760
1,229.54
354.45
245.9115934
Remove sacrum pressure sore

T
0027
21.2645
1,308.85
329.72
261.7715935
Remove sacrum pressure sore

T
0027
21.2645
1,308.85
329.72
261.7715936
Remove sacrum pressure sore

T
0027
21.2645
1,308.85
329.72
261.7715937
Remove sacrum pressure sore

T
0027
21.2645
1,308.85
329.72
261.7715940
Remove hip pressure sore

T
0022
19.9760
1,229.54
354.45
245.9115941
Remove hip pressure sore

T
0022
19.9760
1,229.54
354.45
245.9115944
Remove hip pressure sore

T
0027
21.2645
1,308.85
329.72
261.7715945
Remove hip pressure sore

T
0027
21.2645
1,308.85
329.72
261.7715946
Remove hip pressure sore

T
0027
21.2645
1,308.85
329.72
261.7715950
Remove thigh pressure sore

T
0022
19.9760
1,229.54
354.45
245.9115951
Remove thigh pressure sore

T
0022
19.9760
1,229.54
354.45
245.9115952
Remove thigh pressure sore

T
0027
21.2645
1,308.85
329.72
261.7715953
Remove thigh pressure sore

T
0027
21.2645
1,308.85
329.72
261.7715956
Remove thigh pressure sore

T
0027
21.2645
1,308.85
329.72
261.77( print page 49762)15958
Remove thigh pressure sore

T
0027
21.2645
1,308.85
329.72
261.7715999
Removal of pressure sore

T
0019
4.0123
246.96
71.87
49.3916000
Initial treatment of burn(s)

T
0012
0.8076
49.71
10.30
9.9416020
Dress/debrid p-thick burn, s

T
0013
1.0876
66.94

13.3916025
Dress/debrid p-thick burn, m

T
0013
1.0876
66.94

13.3916030
Dress/debrid p-thick burn, l

T
0015
1.6062
98.86
20.13
19.7716035
Incision of burn scab, initi
CH
T
0016
2.6253
161.59
32.68
32.3217000
Destroy benign/premlg lesion

T
0010
0.4829
29.72
8.14
5.9417003
Destroy lesions, 2-14

T
0010
0.4829
29.72
8.14
5.9417004
Destroy lesions, 15 or more

T
0011
2.6478
162.97

32.5917106
Destruction of skin lesions

T
0011
2.6478
162.97

32.5917107
Destruction of skin lesions

T
0011
2.6478
162.97

32.5917108
Destruction of skin lesions

T
0011
2.6478
162.97

32.5917110
Destruct lesion, 1-14
CH
T
0012
0.8076
49.71
10.30
9.9417111
Destruct lesion, 15 or more

T
0013
1.0876
66.94

13.3917250
Chemical cautery, tissue

T
0013
1.0876
66.94

13.3917260
Destruction of skin lesions

T
0015
1.6062
98.86
20.13
19.7717261
Destruction of skin lesions

T
0015
1.6062
98.86
20.13
19.7717262
Destruction of skin lesions

T
0015
1.6062
98.86
20.13
19.7717263
Destruction of skin lesions

T
0015
1.6062
98.86
20.13
19.7717264
Destruction of skin lesions

T
0015
1.6062
98.86
20.13
19.7717266
Destruction of skin lesions

T
0016
2.6253
161.59
32.68
32.3217270
Destruction of skin lesions

T
0015
1.6062
98.86
20.13
19.7717271
Destruction of skin lesions

T
0013
1.0876
66.94

13.3917272
Destruction of skin lesions

T
0015
1.6062
98.86
20.13
19.7717273
Destruction of skin lesions

T
0015
1.6062
98.86
20.13
19.7717274
Destruction of skin lesions

T
0016
2.6253
161.59
32.68
32.3217276
Destruction of skin lesions

T
0016
2.6253
161.59
32.68
32.3217280
Destruction of skin lesions

T
0015
1.6062
98.86
20.13
19.7717281
Destruction of skin lesions

T
0015
1.6062
98.86
20.13
19.7717282
Destruction of skin lesions

T
0015
1.6062
98.86
20.13
19.7717283
Destruction of skin lesions

T
0015
1.6062
98.86
20.13
19.7717284
Destruction of skin lesions

T
0016
2.6253
161.59
32.68
32.3217286
Destruction of skin lesions

T
0015
1.6062
98.86
20.13
19.7717304
1 stage mohs, up to 5 spec

T
0694
3.4844
214.47
58.14
42.8917305
2 stage mohs, up to 5 spec

T
0694
3.4844
214.47
58.14
42.8917306
3 stage mohs, up to 5 spec

T
0694
3.4844
214.47
58.14
42.8917307
Mohs addl stage up to 5 spec

T
0694
3.4844
214.47
58.14
42.8917310
Mohs any stage  5 spec each

T
0694
3.4844
214.47
58.14
42.8917340
Cryotherapy of skin
CH
T
0016
2.6253
161.59
32.68
32.3217360
Skin peel therapy

T
0013
1.0876
66.94

13.3917380
Hair removal by electrolysis

T
0013
1.0876
66.94

13.3917999
Skin tissue procedure
CH
T
0012
0.8076
49.71
10.30
9.9419000
Drainage of breast lesion

T
0004
2.0863
128.41

25.6819001
Drain breast lesion add-on
CH
T
0002
1.0948
67.39

13.4819020
Incision of breast lesion

T
0008
17.4686
1,075.21

215.0419030
Injection for breast x-ray

N19100
Bx breast percut w/o image

T
0005
3.8051
234.21
71.59
46.8419101
Biopsy of breast, open

T
0028
19.2250
1,183.32
303.74
236.6619102
Bx breast percut w/image

T
0005
3.8051
234.21
71.59
46.8419103
Bx breast percut w/device

T
0658
6.4482
396.89

79.3819110
Nipple exploration

T
0028
19.2250
1,183.32
303.74
236.6619112
Excise breast duct fistula

T
0028
19.2250
1,183.32
303.74
236.6619120
Removal of breast lesion

T
0028
19.2250
1,183.32
303.74
236.6619125
Excision, breast lesion

T
0028
19.2250
1,183.32
303.74
236.6619126
Excision, addl breast lesion

T
0028
19.2250
1,183.32
303.74
236.6619140
Removal of breast tissue

T
0028
19.2250
1,183.32
303.74
236.6619160
Partial mastectomy

T
0028
19.2250
1,183.32
303.74
236.6619162
P-mastectomy w/ln removal

T
0693
37.4843
2,307.20
731.74
461.4419180
Removal of breast

T
0029
28.1505
1,732.69

346.5419182
Removal of breast

T
0029
28.1505
1,732.69

346.5419240
Removal of breast

T
0030
40.7495
2,508.17
763.55
501.6319260
Removal of chest wall lesion

T
0021
14.9563
920.58
219.48
184.1219290
Place needle wire, breast

N19291
Place needle wire, breast

N19295
Place breast clip, percut

S
0657
1.7625
108.48

21.7019296
Place po breast cath for rad
CH
T
0030
40.7495
2,508.17
763.55
501.6319297
Place breast cath for rad
CH
T
0029
28.1505
1,732.69

346.5419298
Place breast rad tube/caths

S
1524

3,250.00

650.0019316
Suspension of breast

T
0029
28.1505
1,732.69

346.54( print page 49763)19318
Reduction of large breast

T
0693
37.4843
2,307.20
731.74
461.4419324
Enlarge breast

T
0693
37.4843
2,307.20
731.74
461.4419325
Enlarge breast with implant

T
0648
48.7796
3,002.43

600.4919328
Removal of breast implant

T
0029
28.1505
1,732.69

346.5419330
Removal of implant material

T
0029
28.1505
1,732.69

346.5419340
Immediate breast prosthesis

T
0030
40.7495
2,508.17
763.55
501.6319342
Delayed breast prosthesis

T
0648
48.7796
3,002.43

600.4919350
Breast reconstruction

T
0028
19.2250
1,183.32
303.74
236.6619355
Correct inverted nipple(s)

T
0029
28.1505
1,732.69

346.5419357
Breast reconstruction

T
0648
48.7796
3,002.43

600.4919366
Breast reconstruction

T
0029
28.1505
1,732.69

346.5419370
Surgery of breast capsule

T
0029
28.1505
1,732.69

346.5419371
Removal of breast capsule

T
0029
28.1505
1,732.69

346.5419380
Revise breast reconstruction

T
0030
40.7495
2,508.17
763.55
501.6319396
Design custom breast implant

T
0029
28.1505
1,732.69

346.5419499
Breast surgery procedure

T
0028
19.2250
1,183.32
303.74
236.6620000
Incision of abscess

T
0006
1.4821
91.22
21.76
18.2420005
Incision of deep abscess

T
0049
20.8214
1,281.58

256.3220100
Explore wound, neck

T
0023
4.1133
253.18

50.6420101
Explore wound, chest

T
0027
21.2645
1,308.85
329.72
261.7720102
Explore wound, abdomen

T
0027
21.2645
1,308.85
329.72
261.7720103
Explore wound, extremity

T
0023
4.1133
253.18

50.6420150
Excise epiphyseal bar

T
0051
41.2543
2,539.24

507.8520200
Muscle biopsy

T
0021
14.9563
920.58
219.48
184.1220205
Deep muscle biopsy

T
0021
14.9563
920.58
219.48
184.1220206
Needle biopsy, muscle

T
0005
3.8051
234.21
71.59
46.8420220
Bone biopsy, trocar/needle

T
0019
4.0123
246.96
71.87
49.3920225
Bone biopsy, trocar/needle

T
0020
6.5128
400.87
98.57
80.1720240
Bone biopsy, excisional

T
0022
19.9760
1,229.54
354.45
245.9120245
Bone biopsy, excisional

T
0022
19.9760
1,229.54
354.45
245.9120250
Open bone biopsy

T
0049
20.8214
1,281.58

256.3220251
Open bone biopsy

T
0049
20.8214
1,281.58

256.3220500
Injection of sinus tract

T
0251
2.3768
146.29

29.2620501
Inject sinus tract for x-ray

N20520
Removal of foreign body

T
0019
4.0123
246.96
71.87
49.3920525
Removal of foreign body

T
0022
19.9760
1,229.54
354.45
245.9120526
Ther injection, carp tunnel

T
0204
2.2491
138.43
40.13
27.6920550
Inj tendon sheath/ligament

T
0204
2.2491
138.43
40.13
27.6920551
Inj tendon origin/insertion

T
0204
2.2491
138.43
40.13
27.6920552
Inj trigger point, 1/2 muscl

T
0204
2.2491
138.43
40.13
27.6920553
Inject trigger points, =/ 3

T
0204
2.2491
138.43
40.13
27.6920600
Drain/inject, joint/bursa

T
0204
2.2491
138.43
40.13
27.6920605
Drain/inject, joint/bursa

T
0204
2.2491
138.43
40.13
27.6920610
Drain/inject, joint/bursa

T
0204
2.2491
138.43
40.13
27.6920612
Aspirate/inj ganglion cyst

T
0204
2.2491
138.43
40.13
27.6920615
Treatment of bone cyst

T
0004
2.0863
128.41

25.6820650
Insert and remove bone pin

T
0049
20.8214
1,281.58

256.3220662
Application of pelvis brace

T
0049
20.8214
1,281.58

256.3220663
Application of thigh brace

T
0049
20.8214
1,281.58

256.3220665
Removal of fixation device

X
0340
0.6211
38.23

7.6520670
Removal of support implant

T
0021
14.9563
920.58
219.48
184.1220680
Removal of support implant

T
0022
19.9760
1,229.54
354.45
245.9120690
Apply bone fixation device

T
0050
25.0600
1,542.47

308.4920692
Apply bone fixation device

T
0050
25.0600
1,542.47

308.4920693
Adjust bone fixation device

T
0049
20.8214
1,281.58

256.3220694
Remove bone fixation device

T
0049
20.8214
1,281.58

256.3220822
Replantation digit, complete

T
0054
25.8425
1,590.63

318.1320900
Removal of bone for graft

T
0050
25.0600
1,542.47

308.4920902
Removal of bone for graft

T
0050
25.0600
1,542.47

308.4920910
Remove cartilage for graft

T
0027
21.2645
1,308.85
329.72
261.7720912
Remove cartilage for graft

T
0027
21.2645
1,308.85
329.72
261.7720920
Removal of fascia for graft

T
0686
13.3433
821.29

164.2620922
Removal of fascia for graft

T
0027
21.2645
1,308.85
329.72
261.7720924
Removal of tendon for graft

T
0050
25.0600
1,542.47

308.4920926
Removal of tissue for graft

T
0686
13.3433
821.29

164.2620950
Fluid pressure, muscle

T
0006
1.4821
91.22
21.76
18.2420972
Bone/skin graft, metatarsal

T
0056
41.2239
2,537.37

507.4720973
Bone/skin graft, great toe

T
0056
41.2239
2,537.37

507.4720975
Electrical bone stimulation

X
0340
0.6211
38.23

7.6520982
Ablate, bone tumor(s) perq
CH
T
0050
25.0600
1,542.47

308.49( print page 49764)20999
Musculoskeletal surgery

T
0049
20.8214
1,281.58

256.3221010
Incision of jaw joint

T
0254
23.1564
1,425.30
321.35
285.0621015
Resection of facial tumor

T
0253
16.4494
1,012.48
282.29
202.5021025
Excision of bone, lower jaw

T
0256
37.7719
2,324.90

464.9821026
Excision of facial bone(s)

T
0256
37.7719
2,324.90

464.9821029
Contour of face bone lesion

T
0256
37.7719
2,324.90

464.9821030
Excise max/zygoma b9 tumor

T
0254
23.1564
1,425.30
321.35
285.0621031
Remove exostosis, mandible

T
0254
23.1564
1,425.30
321.35
285.0621032
Remove exostosis, maxilla

T
0254
23.1564
1,425.30
321.35
285.0621034
Excise max/zygoma mlg tumor

T
0256
37.7719
2,324.90

464.9821040
Excise mandible lesion

T
0254
23.1564
1,425.30
321.35
285.0621044
Removal of jaw bone lesion

T
0256
37.7719
2,324.90

464.9821046
Remove mandible cyst complex

T
0256
37.7719
2,324.90

464.9821047
Excise lwr jaw cyst w/repair

T
0256
37.7719
2,324.90

464.9821048
Remove maxilla cyst complex

T
0256
37.7719
2,324.90

464.9821049
Excis uppr jaw cyst w/repair

T
0256
37.7719
2,324.90

464.9821050
Removal of jaw joint

T
0256
37.7719
2,324.90

464.9821060
Remove jaw joint cartilage

T
0256
37.7719
2,324.90

464.9821070
Remove coronoid process

T
0256
37.7719
2,324.90

464.9821076
Prepare face/oral prosthesis

T
0254
23.1564
1,425.30
321.35
285.0621077
Prepare face/oral prosthesis

T
0256
37.7719
2,324.90

464.9821079
Prepare face/oral prosthesis

T
0256
37.7719
2,324.90

464.9821080
Prepare face/oral prosthesis

T
0256
37.7719
2,324.90

464.9821081
Prepare face/oral prosthesis

T
0256
37.7719
2,324.90

464.9821082
Prepare face/oral prosthesis

T
0256
37.7719
2,324.90

464.9821083
Prepare face/oral prosthesis

T
0256
37.7719
2,324.90

464.9821084
Prepare face/oral prosthesis

T
0256
37.7719
2,324.90

464.9821085
Prepare face/oral prosthesis

T
0253
16.4494
1,012.48
282.29
202.5021086
Prepare face/oral prosthesis

T
0256
37.7719
2,324.90

464.9821087
Prepare face/oral prosthesis

T
0256
37.7719
2,324.90

464.9821088
Prepare face/oral prosthesis

T
0256
37.7719
2,324.90

464.9821089
Prepare face/oral prosthesis

T
0251
2.3768
146.29

29.2621100
Maxillofacial fixation

T
0256
37.7719
2,324.90

464.9821110
Interdental fixation

T
0252
7.7261
475.55
111.84
95.1121116
Injection, jaw joint x-ray

N21120
Reconstruction of chin

T
0254
23.1564
1,425.30
321.35
285.0621121
Reconstruction of chin

T
0254
23.1564
1,425.30
321.35
285.0621122
Reconstruction of chin

T
0254
23.1564
1,425.30
321.35
285.0621123
Reconstruction of chin

T
0254
23.1564
1,425.30
321.35
285.0621125
Augmentation, lower jaw bone

T
0254
23.1564
1,425.30
321.35
285.0621127
Augmentation, lower jaw bone

T
0256
37.7719
2,324.90

464.9821137
Reduction of forehead

T
0254
23.1564
1,425.30
321.35
285.0621138
Reduction of forehead

T
0256
37.7719
2,324.90

464.9821139
Reduction of forehead

T
0256
37.7719
2,324.90

464.9821150
Reconstruct midface, lefort

T
0256
37.7719
2,324.90

464.9821175
Reconstruct orbit/forehead

T
0256
37.7719
2,324.90

464.9821181
Contour cranial bone lesion

T
0254
23.1564
1,425.30
321.35
285.0621195
Reconst lwr jaw w/o fixation

T
0256
37.7719
2,324.90

464.9821198
Reconstr lwr jaw segment

T
0256
37.7719
2,324.90

464.9821199
Reconstr lwr jaw w/advance

T
0256
37.7719
2,324.90

464.9821206
Reconstruct upper jaw bone

T
0256
37.7719
2,324.90

464.9821208
Augmentation of facial bones

T
0256
37.7719
2,324.90

464.9821209
Reduction of facial bones

T
0256
37.7719
2,324.90

464.9821210
Face bone graft

T
0256
37.7719
2,324.90

464.9821215
Lower jaw bone graft

T
0256
37.7719
2,324.90

464.9821230
Rib cartilage graft

T
0256
37.7719
2,324.90

464.9821235
Ear cartilage graft

T
0254
23.1564
1,425.30
321.35
285.0621240
Reconstruction of jaw joint

T
0256
37.7719
2,324.90

464.9821242
Reconstruction of jaw joint

T
0256
37.7719
2,324.90

464.9821243
Reconstruction of jaw joint

T
0256
37.7719
2,324.90

464.9821244
Reconstruction of lower jaw

T
0256
37.7719
2,324.90

464.9821245
Reconstruction of jaw

T
0256
37.7719
2,324.90

464.9821246
Reconstruction of jaw

T
0256
37.7719
2,324.90

464.9821248
Reconstruction of jaw

T
0256
37.7719
2,324.90

464.9821249
Reconstruction of jaw

T
0256
37.7719
2,324.90

464.9821260
Revise eye sockets

T
0256
37.7719
2,324.90

464.9821261
Revise eye sockets

T
0256
37.7719
2,324.90

464.9821263
Revise eye sockets

T
0256
37.7719
2,324.90

464.9821267
Revise eye sockets

T
0256
37.7719
2,324.90

464.9821270
Augmentation, cheek bone

T
0256
37.7719
2,324.90

464.98( print page 49765)21275
Revision, orbitofacial bones

T
0256
37.7719
2,324.90

464.9821280
Revision of eyelid

T
0256
37.7719
2,324.90

464.9821282
Revision of eyelid

T
0253
16.4494
1,012.48
282.29
202.5021295
Revision of jaw muscle/bone

T
0252
7.7261
475.55
111.84
95.1121296
Revision of jaw muscle/bone

T
0254
23.1564
1,425.30
321.35
285.0621299
Cranio/maxillofacial surgery

T
0251
2.3768
146.29

29.2621300
Treatment of skull fracture

T
0253
16.4494
1,012.48
282.29
202.5021310
Treatment of nose fracture

T
0251
2.3768
146.29

29.2621315
Treatment of nose fracture

T
0251
2.3768
146.29

29.2621320
Treatment of nose fracture

T
0252
7.7261
475.55
111.84
95.1121325
Treatment of nose fracture

T
0254
23.1564
1,425.30
321.35
285.0621330
Treatment of nose fracture

T
0254
23.1564
1,425.30
321.35
285.0621335
Treatment of nose fracture

T
0254
23.1564
1,425.30
321.35
285.0621336
Treat nasal septal fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4721337
Treat nasal septal fracture

T
0253
16.4494
1,012.48
282.29
202.5021338
Treat nasoethmoid fracture

T
0254
23.1564
1,425.30
321.35
285.0621339
Treat nasoethmoid fracture

T
0254
23.1564
1,425.30
321.35
285.0621340
Treatment of nose fracture

T
0256
37.7719
2,324.90

464.9821345
Treat nose/jaw fracture

T
0254
23.1564
1,425.30
321.35
285.0621355
Treat cheek bone fracture

T
0256
37.7719
2,324.90

464.9821356
Treat cheek bone fracture

T
0254
23.1564
1,425.30
321.35
285.0621390
Treat eye socket fracture

T
0256
37.7719
2,324.90

464.9821400
Treat eye socket fracture

T
0252
7.7261
475.55
111.84
95.1121401
Treat eye socket fracture

T
0253
16.4494
1,012.48
282.29
202.5021406
Treat eye socket fracture

T
0256
37.7719
2,324.90

464.9821407
Treat eye socket fracture

T
0256
37.7719
2,324.90

464.9821408
Treat eye socket fracture

T
0256
37.7719
2,324.90

464.9821421
Treat mouth roof fracture

T
0254
23.1564
1,425.30
321.35
285.0621440
Treat dental ridge fracture

T
0254
23.1564
1,425.30
321.35
285.0621445
Treat dental ridge fracture

T
0254
23.1564
1,425.30
321.35
285.0621450
Treat lower jaw fracture

T
0251
2.3768
146.29

29.2621451
Treat lower jaw fracture

T
0252
7.7261
475.55
111.84
95.1121452
Treat lower jaw fracture

T
0253
16.4494
1,012.48
282.29
202.5021453
Treat lower jaw fracture

T
0256
37.7719
2,324.90

464.9821454
Treat lower jaw fracture

T
0254
23.1564
1,425.30
321.35
285.0621461
Treat lower jaw fracture

T
0256
37.7719
2,324.90

464.9821462
Treat lower jaw fracture

T
0256
37.7719
2,324.90

464.9821465
Treat lower jaw fracture

T
0256
37.7719
2,324.90

464.9821470
Treat lower jaw fracture

T
0256
37.7719
2,324.90

464.9821480
Reset dislocated jaw

T
0251
2.3768
146.29

29.2621485
Reset dislocated jaw

T
0253
16.4494
1,012.48
282.29
202.5021490
Repair dislocated jaw

T
0256
37.7719
2,324.90

464.9821495
Treat hyoid bone fracture

T
0253
16.4494
1,012.48
282.29
202.5021497
Interdental wiring

T
0253
16.4494
1,012.48
282.29
202.5021499
Head surgery procedure

T
0251
2.3768
146.29

29.2621501
Drain neck/chest lesion

T
0008
17.4686
1,075.21

215.0421502
Drain chest lesion

T
0049
20.8214
1,281.58

256.3221550
Biopsy of neck/chest
CH
T
0020
6.5128
400.87
98.57
80.1721555
Remove lesion, neck/chest

T
0022
19.9760
1,229.54
354.45
245.9121556
Remove lesion, neck/chest

T
0022
19.9760
1,229.54
354.45
245.9121557
Remove tumor, neck/chest

T
0022
19.9760
1,229.54
354.45
245.9121600
Partial removal of rib

T
0050
25.0600
1,542.47

308.4921610
Partial removal of rib

T
0050
25.0600
1,542.47

308.4921685
Hyoid myotomysuspension

T
0252
7.7261
475.55
111.84
95.1121700
Revision of neck muscle

T
0049
20.8214
1,281.58

256.3221720
Revision of neck muscle

T
0049
20.8214
1,281.58

256.3221725
Revision of neck muscle

T
0006
1.4821
91.22
21.76
18.2421742
Repair stern/nuss w/o scope

T
0051
41.2543
2,539.24

507.8521743
Repair sternum/nuss w/scope

T
0051
41.2543
2,539.24

507.8521800
Treatment of rib fracture

T
0043
1.6914
104.11

20.8221805
Treatment of rib fracture
CH
T
0062
25.6702
1,580.03
375.46
316.0121820
Treat sternum fracture

T
0043
1.6914
104.11

20.8221899
Neck/chest surgery procedure

T
0251
2.3768
146.29

29.2621920
Biopsy soft tissue of back

T
0020
6.5128
400.87
98.57
80.1721925
Biopsy soft tissue of back

T
0022
19.9760
1,229.54
354.45
245.9121930
Remove lesion, back or flank

T
0022
19.9760
1,229.54
354.45
245.9121935
Remove tumor, back

T
0022
19.9760
1,229.54
354.45
245.9122100
Remove part of neck vertebra

T
0208
43.9030
2,702.27

540.4522101
Remove part, thorax vertebra

T
0208
43.9030
2,702.27

540.4522102
Remove part, lumbar vertebra

T
0208
43.9030
2,702.27

540.45( print page 49766)22103
Remove extra spine segment

T
0208
43.9030
2,702.27

540.4522222
Revision of thorax spine

T
0208
43.9030
2,702.27

540.4522305
Treat spine process fracture

T
0043
1.6914
104.11

20.8222310
Treat spine fracture

T
0043
1.6914
104.11

20.8222315
Treat spine fracture

T
0043
1.6914
104.11

20.8222505
Manipulation of spine

T
0045
14.5502
895.58
268.47
179.1222520
Percut vertebroplasty thor

T
0050
25.0600
1,542.47

308.4922521
Percut vertebroplasty lumb

T
0050
25.0600
1,542.47

308.4922522
Percut vertebroplasty add'l

T
0050
25.0600
1,542.47

308.4922523
Percut kyphoplasty, thor

T
0052
65.8846
4,055.26

811.0522524
Percut kyphoplasty, lumbar

T
0052
65.8846
4,055.26

811.0522525
Percut kyphoplasty, add-on

T
0052
65.8846
4,055.26

811.0522612
Lumbar spine fusion

T
0208
43.9030
2,702.27

540.4522614
Spine fusion, extra segment

T
0208
43.9030
2,702.27

540.4522851
Apply spine prosth device
CH
T
0049
20.8214
1,281.58

256.3222899
Spine surgery procedure
CH
T
0049
20.8214
1,281.58

256.3222900
Remove abdominal wall lesion

T
0022
19.9760
1,229.54
354.45
245.9122999
Abdomen surgery procedure
CH
T
0049
20.8214
1,281.58

256.3223000
Removal of calcium deposits

T
0021
14.9563
920.58
219.48
184.1223020
Release shoulder joint

T
0051
41.2543
2,539.24

507.8523030
Drain shoulder lesion

T
0008
17.4686
1,075.21

215.0423031
Drain shoulder bursa

T
0008
17.4686
1,075.21

215.0423035
Drain shoulder bone lesion

T
0049
20.8214
1,281.58

256.3223040
Exploratory shoulder surgery

T
0050
25.0600
1,542.47

308.4923044
Exploratory shoulder surgery

T
0050
25.0600
1,542.47

308.4923065
Biopsy shoulder tissues
CH
T
0020
6.5128
400.87
98.57
80.1723066
Biopsy shoulder tissues

T
0022
19.9760
1,229.54
354.45
245.9123075
Removal of shoulder lesion

T
0021
14.9563
920.58
219.48
184.1223076
Removal of shoulder lesion

T
0022
19.9760
1,229.54
354.45
245.9123077
Remove tumor of shoulder

T
0022
19.9760
1,229.54
354.45
245.9123100
Biopsy of shoulder joint

T
0049
20.8214
1,281.58

256.3223101
Shoulder joint surgery

T
0050
25.0600
1,542.47

308.4923105
Remove shoulder joint lining

T
0050
25.0600
1,542.47

308.4923106
Incision of collarbone joint

T
0050
25.0600
1,542.47

308.4923107
Explore treat shoulder joint

T
0050
25.0600
1,542.47

308.4923120
Partial removal, collar bone

T
0051
41.2543
2,539.24

507.8523125
Removal of collar bone

T
0051
41.2543
2,539.24

507.8523130
Remove shoulder bone, part

T
0051
41.2543
2,539.24

507.8523140
Removal of bone lesion

T
0049
20.8214
1,281.58

256.3223145
Removal of bone lesion

T
0050
25.0600
1,542.47

308.4923146
Removal of bone lesion

T
0050
25.0600
1,542.47

308.4923150
Removal of humerus lesion

T
0050
25.0600
1,542.47

308.4923155
Removal of humerus lesion

T
0050
25.0600
1,542.47

308.4923156
Removal of humerus lesion

T
0050
25.0600
1,542.47

308.4923170
Remove collar bone lesion

T
0050
25.0600
1,542.47

308.4923172
Remove shoulder blade lesion

T
0050
25.0600
1,542.47

308.4923174
Remove humerus lesion

T
0050
25.0600
1,542.47

308.4923180
Remove collar bone lesion

T
0050
25.0600
1,542.47

308.4923182
Remove shoulder blade lesion

T
0050
25.0600
1,542.47

308.4923184
Remove humerus lesion

T
0050
25.0600
1,542.47

308.4923190
Partial removal of scapula

T
0050
25.0600
1,542.47

308.4923195
Removal of head of humerus

T
0050
25.0600
1,542.47

308.4923330
Remove shoulder foreign body

T
0020
6.5128
400.87
98.57
80.1723331
Remove shoulder foreign body

T
0022
19.9760
1,229.54
354.45
245.9123350
Injection for shoulder x-ray

N23395
Muscle transfer,shoulder/arm

T
0051
41.2543
2,539.24

507.8523397
Muscle transfers

T
0052
65.8846
4,055.26

811.0523400
Fixation of shoulder blade

T
0050
25.0600
1,542.47

308.4923405
Incision of tendonmuscle

T
0050
25.0600
1,542.47

308.4923406
Incise tendon(s)muscle(s)

T
0050
25.0600
1,542.47

308.4923410
Repair rotator cuff, acute
CH
T
0051
41.2543
2,539.24

507.8523412
Repair rotator cuff, chronic
CH
T
0051
41.2543
2,539.24

507.8523415
Release of shoulder ligament

T
0051
41.2543
2,539.24

507.8523420
Repair of shoulder
CH
T
0051
41.2543
2,539.24

507.8523430
Repair biceps tendon
CH
T
0051
41.2543
2,539.24

507.8523440
Remove/transplant tendon
CH
T
0051
41.2543
2,539.24

507.8523450
Repair shoulder capsule

T
0052
65.8846
4,055.26

811.0523455
Repair shoulder capsule

T
0052
65.8846
4,055.26

811.0523460
Repair shoulder capsule

T
0052
65.8846
4,055.26

811.0523462
Repair shoulder capsule
CH
T
0051
41.2543
2,539.24

507.85( print page 49767)23465
Repair shoulder capsule

T
0052
65.8846
4,055.26

811.0523466
Repair shoulder capsule
CH
T
0051
41.2543
2,539.24

507.8523470
Reconstruct shoulder joint

T
0425
105.1666
6,473.11
1,378.01
1,294.6223480
Revision of collar bone

T
0051
41.2543
2,539.24

507.8523485
Revision of collar bone
CH
T
0052
65.8846
4,055.26

811.0523490
Reinforce clavicle

T
0051
41.2543
2,539.24

507.8523491
Reinforce shoulder bones
CH
T
0052
65.8846
4,055.26

811.0523500
Treat clavicle fracture

T
0043
1.6914
104.11

20.8223505
Treat clavicle fracture

T
0043
1.6914
104.11

20.8223515
Treat clavicle fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5423520
Treat clavicle dislocation

T
0043
1.6914
104.11

20.8223525
Treat clavicle dislocation

T
0043
1.6914
104.11

20.8223530
Treat clavicle dislocation
CH
T
0063
37.5680
2,312.35
549.49
462.4723532
Treat clavicle dislocation
CH
T
0062
25.6702
1,580.03
375.46
316.0123540
Treat clavicle dislocation

T
0043
1.6914
104.11

20.8223545
Treat clavicle dislocation

T
0043
1.6914
104.11

20.8223550
Treat clavicle dislocation
CH
T
0063
37.5680
2,312.35
549.49
462.4723552
Treat clavicle dislocation
CH
T
0063
37.5680
2,312.35
549.49
462.4723570
Treat shoulder blade fx

T
0043
1.6914
104.11

20.8223575
Treat shoulder blade fx

T
0043
1.6914
104.11

20.8223585
Treat scapula fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5423600
Treat humerus fracture

T
0043
1.6914
104.11

20.8223605
Treat humerus fracture

T
0043
1.6914
104.11

20.8223615
Treat humerus fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5423616
Treat humerus fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5423620
Treat humerus fracture

T
0043
1.6914
104.11

20.8223625
Treat humerus fracture

T
0043
1.6914
104.11

20.8223630
Treat humerus fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5423650
Treat shoulder dislocation

T
0043
1.6914
104.11

20.8223655
Treat shoulder dislocation

T
0045
14.5502
895.58
268.47
179.1223660
Treat shoulder dislocation
CH
T
0063
37.5680
2,312.35
549.49
462.4723665
Treat dislocation/fracture

T
0043
1.6914
104.11

20.8223670
Treat dislocation/fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5423675
Treat dislocation/fracture

T
0043
1.6914
104.11

20.8223680
Treat dislocation/fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4723700
Fixation of shoulder

T
0045
14.5502
895.58
268.47
179.1223800
Fusion of shoulder joint
CH
T
0052
65.8846
4,055.26

811.0523802
Fusion of shoulder joint

T
0051
41.2543
2,539.24

507.8523921
Amputation follow-up surgery

T
0025
5.0931
313.49
95.46
62.7023929
Shoulder surgery procedure

T
0043
1.6914
104.11

20.8223930
Drainage of arm lesion

T
0008
17.4686
1,075.21

215.0423931
Drainage of arm bursa

T
0008
17.4686
1,075.21

215.0423935
Drain arm/elbow bone lesion

T
0049
20.8214
1,281.58

256.3224000
Exploratory elbow surgery

T
0050
25.0600
1,542.47

308.4924006
Release elbow joint

T
0050
25.0600
1,542.47

308.4924065
Biopsy arm/elbow soft tissue

T
0021
14.9563
920.58
219.48
184.1224066
Biopsy arm/elbow soft tissue

T
0021
14.9563
920.58
219.48
184.1224075
Remove arm/elbow lesion

T
0021
14.9563
920.58
219.48
184.1224076
Remove arm/elbow lesion

T
0022
19.9760
1,229.54
354.45
245.9124077
Remove tumor of arm/elbow

T
0022
19.9760
1,229.54
354.45
245.9124100
Biopsy elbow joint lining

T
0049
20.8214
1,281.58

256.3224101
Explore/treat elbow joint

T
0050
25.0600
1,542.47

308.4924102
Remove elbow joint lining

T
0050
25.0600
1,542.47

308.4924105
Removal of elbow bursa

T
0049
20.8214
1,281.58

256.3224110
Remove humerus lesion

T
0049
20.8214
1,281.58

256.3224115
Remove/graft bone lesion

T
0050
25.0600
1,542.47

308.4924116
Remove/graft bone lesion

T
0050
25.0600
1,542.47

308.4924120
Remove elbow lesion

T
0049
20.8214
1,281.58

256.3224125
Remove/graft bone lesion

T
0050
25.0600
1,542.47

308.4924126
Remove/graft bone lesion

T
0050
25.0600
1,542.47

308.4924130
Removal of head of radius

T
0050
25.0600
1,542.47

308.4924134
Removal of arm bone lesion

T
0050
25.0600
1,542.47

308.4924136
Remove radius bone lesion

T
0050
25.0600
1,542.47

308.4924138
Remove elbow bone lesion

T
0050
25.0600
1,542.47

308.4924140
Partial removal of arm bone

T
0050
25.0600
1,542.47

308.4924145
Partial removal of radius

T
0050
25.0600
1,542.47

308.4924147
Partial removal of elbow

T
0050
25.0600
1,542.47

308.4924149
Radical resection of elbow

T
0050
25.0600
1,542.47

308.4924150
Extensive humerus surgery
CH
T
0051
41.2543
2,539.24

507.8524151
Extensive humerus surgery

T
0052
65.8846
4,055.26

811.05( print page 49768)24152
Extensive radius surgery
CH
T
0051
41.2543
2,539.24

507.8524153
Extensive radius surgery

T
0052
65.8846
4,055.26

811.0524155
Removal of elbow joint

T
0051
41.2543
2,539.24

507.8524160
Remove elbow joint implant

T
0050
25.0600
1,542.47

308.4924164
Remove radius head implant

T
0050
25.0600
1,542.47

308.4924200
Removal of arm foreign body

T
0019
4.0123
246.96
71.87
49.3924201
Removal of arm foreign body

T
0021
14.9563
920.58
219.48
184.1224220
Injection for elbow x-ray

N24300
Manipulate elbow w/anesth

T
0045
14.5502
895.58
268.47
179.1224301
Muscle/tendon transfer

T
0050
25.0600
1,542.47

308.4924305
Arm tendon lengthening

T
0050
25.0600
1,542.47

308.4924310
Revision of arm tendon

T
0049
20.8214
1,281.58

256.3224320
Repair of arm tendon

T
0051
41.2543
2,539.24

507.8524330
Revision of arm muscles
CH
T
0052
65.8846
4,055.26

811.0524331
Revision of arm muscles

T
0051
41.2543
2,539.24

507.8524332
Tenolysis, triceps

T
0049
20.8214
1,281.58

256.3224340
Repair of biceps tendon

T
0051
41.2543
2,539.24

507.8524341
Repair arm tendon/muscle

T
0051
41.2543
2,539.24

507.8524342
Repair of ruptured tendon

T
0051
41.2543
2,539.24

507.8524343
Repr elbow lat ligmnt w/tiss

T
0050
25.0600
1,542.47

308.4924344
Reconstruct elbow lat ligmnt
CH
T
0052
65.8846
4,055.26

811.0524345
Repr elbw med ligmnt w/tissu

T
0050
25.0600
1,542.47

308.4924346
Reconstruct elbow med ligmnt

T
0051
41.2543
2,539.24

507.8524350
Repair of tennis elbow

T
0050
25.0600
1,542.47

308.4924351
Repair of tennis elbow

T
0050
25.0600
1,542.47

308.4924352
Repair of tennis elbow

T
0050
25.0600
1,542.47

308.4924354
Repair of tennis elbow

T
0050
25.0600
1,542.47

308.4924356
Revision of tennis elbow

T
0050
25.0600
1,542.47

308.4924360
Reconstruct elbow joint

T
0047
32.7543
2,016.06
537.03
403.2124361
Reconstruct elbow joint

T
0425
105.1666
6,473.11
1,378.01
1,294.6224362
Reconstruct elbow joint

T
0048
47.1644
2,903.02

580.6024363
Replace elbow joint

T
0425
105.1666
6,473.11
1,378.01
1,294.6224365
Reconstruct head of radius

T
0047
32.7543
2,016.06
537.03
403.2124366
Reconstruct head of radius

T
0425
105.1666
6,473.11
1,378.01
1,294.6224400
Revision of humerus

T
0050
25.0600
1,542.47

308.4924410
Revision of humerus

T
0050
25.0600
1,542.47

308.4924420
Revision of humerus

T
0051
41.2543
2,539.24

507.8524430
Repair of humerus
CH
T
0052
65.8846
4,055.26

811.0524435
Repair humerus with graft
CH
T
0052
65.8846
4,055.26

811.0524470
Revision of elbow joint

T
0051
41.2543
2,539.24

507.8524495
Decompression of forearm

T
0050
25.0600
1,542.47

308.4924498
Reinforce humerus
CH
T
0052
65.8846
4,055.26

811.0524500
Treat humerus fracture

T
0043
1.6914
104.11

20.8224505
Treat humerus fracture

T
0043
1.6914
104.11

20.8224515
Treat humerus fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5424516
Treat humerus fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5424530
Treat humerus fracture

T
0043
1.6914
104.11

20.8224535
Treat humerus fracture

T
0043
1.6914
104.11

20.8224538
Treat humerus fracture
CH
T
0062
25.6702
1,580.03
375.46
316.0124545
Treat humerus fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5424546
Treat humerus fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5424560
Treat humerus fracture

T
0043
1.6914
104.11

20.8224565
Treat humerus fracture

T
0043
1.6914
104.11

20.8224566
Treat humerus fracture
CH
T
0062
25.6702
1,580.03
375.46
316.0124575
Treat humerus fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5424576
Treat humerus fracture

T
0043
1.6914
104.11

20.8224577
Treat humerus fracture

T
0043
1.6914
104.11

20.8224579
Treat humerus fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5424582
Treat humerus fracture
CH
T
0062
25.6702
1,580.03
375.46
316.0124586
Treat elbow fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5424587
Treat elbow fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5424600
Treat elbow dislocation

T
0043
1.6914
104.11

20.8224605
Treat elbow dislocation

T
0045
14.5502
895.58
268.47
179.1224615
Treat elbow dislocation
CH
T
0064
56.4195
3,472.68
825.22
694.5424620
Treat elbow fracture

T
0043
1.6914
104.11

20.8224635
Treat elbow fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5424640
Treat elbow dislocation

T
0043
1.6914
104.11

20.8224650
Treat radius fracture

T
0043
1.6914
104.11

20.8224655
Treat radius fracture

T
0043
1.6914
104.11

20.8224665
Treat radius fracture
CH
T
0063
37.5680
2,312.35
549.49
462.47( print page 49769)24666
Treat radius fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5424670
Treat ulnar fracture

T
0043
1.6914
104.11

20.8224675
Treat ulnar fracture

T
0043
1.6914
104.11

20.8224685
Treat ulnar fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4724800
Fusion of elbow joint

T
0051
41.2543
2,539.24

507.8524802
Fusion/graft of elbow joint

T
0051
41.2543
2,539.24

507.8524925
Amputation follow-up surgery

T
0049
20.8214
1,281.58

256.3224935
Revision of amputation

T
0052
65.8846
4,055.26

811.0524999
Upper arm/elbow surgery

T
0043
1.6914
104.11

20.8225000
Incision of tendon sheath

T
0049
20.8214
1,281.58

256.3225001
Incise flexor carpi radialis

T
0049
20.8214
1,281.58

256.3225020
Decompress forearm 1 space

T
0049
20.8214
1,281.58

256.3225023
Decompress forearm 1 space

T
0050
25.0600
1,542.47

308.4925024
Decompress forearm 2 spaces

T
0050
25.0600
1,542.47

308.4925025
Decompress forearm 2 spaces

T
0050
25.0600
1,542.47

308.4925028
Drainage of forearm lesion

T
0049
20.8214
1,281.58

256.3225031
Drainage of forearm bursa

T
0049
20.8214
1,281.58

256.3225035
Treat forearm bone lesion

T
0049
20.8214
1,281.58

256.3225040
Explore/treat wrist joint

T
0050
25.0600
1,542.47

308.4925065
Biopsy forearm soft tissues
CH
T
0020
6.5128
400.87
98.57
80.1725066
Biopsy forearm soft tissues

T
0022
19.9760
1,229.54
354.45
245.9125075
Removal forearm lesion subcu

T
0021
14.9563
920.58
219.48
184.1225076
Removal forearm lesion deep

T
0022
19.9760
1,229.54
354.45
245.9125077
Remove tumor, forearm/wrist

T
0022
19.9760
1,229.54
354.45
245.9125085
Incision of wrist capsule

T
0049
20.8214
1,281.58

256.3225100
Biopsy of wrist joint

T
0049
20.8214
1,281.58

256.3225101
Explore/treat wrist joint

T
0050
25.0600
1,542.47

308.4925105
Remove wrist joint lining

T
0050
25.0600
1,542.47

308.4925107
Remove wrist joint cartilage

T
0050
25.0600
1,542.47

308.4925110
Remove wrist tendon lesion

T
0049
20.8214
1,281.58

256.3225111
Remove wrist tendon lesion

T
0053
16.0343
986.93
253.49
197.3925112
Reremove wrist tendon lesion

T
0053
16.0343
986.93
253.49
197.3925115
Remove wrist/forearm lesion

T
0049
20.8214
1,281.58

256.3225116
Remove wrist/forearm lesion

T
0049
20.8214
1,281.58

256.3225118
Excise wrist tendon sheath

T
0050
25.0600
1,542.47

308.4925119
Partial removal of ulna

T
0050
25.0600
1,542.47

308.4925120
Removal of forearm lesion

T
0050
25.0600
1,542.47

308.4925125
Remove/graft forearm lesion

T
0050
25.0600
1,542.47

308.4925126
Remove/graft forearm lesion

T
0050
25.0600
1,542.47

308.4925130
Removal of wrist lesion

T
0050
25.0600
1,542.47

308.4925135
Removegraft wrist lesion

T
0050
25.0600
1,542.47

308.4925136
Removegraft wrist lesion

T
0050
25.0600
1,542.47

308.4925145
Remove forearm bone lesion

T
0050
25.0600
1,542.47

308.4925150
Partial removal of ulna

T
0050
25.0600
1,542.47

308.4925151
Partial removal of radius

T
0050
25.0600
1,542.47

308.4925170
Extensive forearm surgery
CH
T
0051
41.2543
2,539.24

507.8525210
Removal of wrist bone

T
0054
25.8425
1,590.63

318.1325215
Removal of wrist bones

T
0054
25.8425
1,590.63

318.1325230
Partial removal of radius

T
0050
25.0600
1,542.47

308.4925240
Partial removal of ulna

T
0050
25.0600
1,542.47

308.4925246
Injection for wrist x-ray

N25248
Remove forearm foreign body

T
0049
20.8214
1,281.58

256.3225250
Removal of wrist prosthesis

T
0050
25.0600
1,542.47

308.4925251
Removal of wrist prosthesis

T
0050
25.0600
1,542.47

308.4925259
Manipulate wrist w/anesthes

T
0043
1.6914
104.11

20.8225260
Repair forearm tendon/muscle

T
0050
25.0600
1,542.47

308.4925263
Repair forearm tendon/muscle

T
0050
25.0600
1,542.47

308.4925265
Repair forearm tendon/muscle

T
0050
25.0600
1,542.47

308.4925270
Repair forearm tendon/muscle

T
0050
25.0600
1,542.47

308.4925272
Repair forearm tendon/muscle

T
0050
25.0600
1,542.47

308.4925274
Repair forearm tendon/muscle

T
0050
25.0600
1,542.47

308.4925275
Repair forearm tendon sheath

T
0050
25.0600
1,542.47

308.4925280
Revise wrist/forearm tendon

T
0050
25.0600
1,542.47

308.4925290
Incise wrist/forearm tendon

T
0050
25.0600
1,542.47

308.4925295
Release wrist/forearm tendon

T
0049
20.8214
1,281.58

256.3225300
Fusion of tendons at wrist

T
0050
25.0600
1,542.47

308.4925301
Fusion of tendons at wrist

T
0050
25.0600
1,542.47

308.4925310
Transplant forearm tendon

T
0051
41.2543
2,539.24

507.8525312
Transplant forearm tendon

T
0051
41.2543
2,539.24

507.8525315
Revise palsy hand tendon(s)

T
0051
41.2543
2,539.24

507.85( print page 49770)25316
Revise palsy hand tendon(s)
CH
T
0052
65.8846
4,055.26

811.0525320
Repair/revise wrist joint

T
0051
41.2543
2,539.24

507.8525332
Revise wrist joint

T
0047
32.7543
2,016.06
537.03
403.2125335
Realignment of hand

T
0051
41.2543
2,539.24

507.8525337
Reconstruct ulna/radioulnar

T
0051
41.2543
2,539.24

507.8525350
Revision of radius
CH
T
0052
65.8846
4,055.26

811.0525355
Revision of radius

T
0051
41.2543
2,539.24

507.8525360
Revision of ulna

T
0050
25.0600
1,542.47

308.4925365
Revise radiusulna

T
0050
25.0600
1,542.47

308.4925370
Revise radius or ulna

T
0051
41.2543
2,539.24

507.8525375
Revise radiusulna

T
0051
41.2543
2,539.24

507.8525390
Shorten radius or ulna

T
0050
25.0600
1,542.47

308.4925391
Lengthen radius or ulna

T
0051
41.2543
2,539.24

507.8525392
Shorten radiusulna

T
0050
25.0600
1,542.47

308.4925393
Lengthen radiusulna

T
0051
41.2543
2,539.24

507.8525394
Repair carpal bone, shorten

T
0053
16.0343
986.93
253.49
197.3925400
Repair radius or ulna

T
0050
25.0600
1,542.47

308.4925405
Repair/graft radius or ulna

T
0050
25.0600
1,542.47

308.4925415
Repair radiusulna

T
0050
25.0600
1,542.47

308.4925420
Repair/graft radiusulna
CH
T
0052
65.8846
4,055.26

811.0525425
Repair/graft radius or ulna

T
0051
41.2543
2,539.24

507.8525426
Repair/graft radiusulna

T
0051
41.2543
2,539.24

507.8525430
Vasc graft into carpal bone

T
0054
25.8425
1,590.63

318.1325431
Repair nonunion carpal bone

T
0054
25.8425
1,590.63

318.1325440
Repair/graft wrist bone
CH
T
0052
65.8846
4,055.26

811.0525441
Reconstruct wrist joint

T
0425
105.1666
6,473.11
1,378.01
1,294.6225442
Reconstruct wrist joint

T
0425
105.1666
6,473.11
1,378.01
1,294.6225443
Reconstruct wrist joint

T
0048
47.1644
2,903.02

580.6025444
Reconstruct wrist joint

T
0048
47.1644
2,903.02

580.6025445
Reconstruct wrist joint

T
0048
47.1644
2,903.02

580.6025446
Wrist replacement

T
0425
105.1666
6,473.11
1,378.01
1,294.6225447
Repair wrist joint(s)

T
0047
32.7543
2,016.06
537.03
403.2125449
Remove wrist joint implant

T
0047
32.7543
2,016.06
537.03
403.2125450
Revision of wrist joint

T
0051
41.2543
2,539.24

507.8525455
Revision of wrist joint

T
0051
41.2543
2,539.24

507.8525490
Reinforce radius

T
0051
41.2543
2,539.24

507.8525491
Reinforce ulna

T
0051
41.2543
2,539.24

507.8525492
Reinforce radius and ulna

T
0051
41.2543
2,539.24

507.8525500
Treat fracture of radius

T
0043
1.6914
104.11

20.8225505
Treat fracture of radius

T
0043
1.6914
104.11

20.8225515
Treat fracture of radius
CH
T
0063
37.5680
2,312.35
549.49
462.4725520
Treat fracture of radius

T
0043
1.6914
104.11

20.8225525
Treat fracture of radius
CH
T
0063
37.5680
2,312.35
549.49
462.4725526
Treat fracture of radius
CH
T
0063
37.5680
2,312.35
549.49
462.4725530
Treat fracture of ulna

T
0043
1.6914
104.11

20.8225535
Treat fracture of ulna

T
0043
1.6914
104.11

20.8225545
Treat fracture of ulna
CH
T
0063
37.5680
2,312.35
549.49
462.4725560
Treat fracture radiusulna

T
0043
1.6914
104.11

20.8225565
Treat fracture radiusulna

T
0043
1.6914
104.11

20.8225574
Treat fracture radiusulna
CH
T
0064
56.4195
3,472.68
825.22
694.5425575
Treat fracture radius/ulna
CH
T
0064
56.4195
3,472.68
825.22
694.5425600
Treat fracture radius/ulna

T
0043
1.6914
104.11

20.8225605
Treat fracture radius/ulna

T
0043
1.6914
104.11

20.8225611
Treat fracture radius/ulna
CH
T
0062
25.6702
1,580.03
375.46
316.0125620
Treat fracture radius/ulna
CH
T
0064
56.4195
3,472.68
825.22
694.5425622
Treat wrist bone fracture

T
0043
1.6914
104.11

20.8225624
Treat wrist bone fracture

T
0043
1.6914
104.11

20.8225628
Treat wrist bone fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4725630
Treat wrist bone fracture

T
0043
1.6914
104.11

20.8225635
Treat wrist bone fracture

T
0043
1.6914
104.11

20.8225645
Treat wrist bone fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4725650
Treat wrist bone fracture

T
0043
1.6914
104.11

20.8225651
Pin ulnar styloid fracture
CH
T
0062
25.6702
1,580.03
375.46
316.0125652
Treat fracture ulnar styloid
CH
T
0063
37.5680
2,312.35
549.49
462.4725660
Treat wrist dislocation

T
0043
1.6914
104.11

20.8225670
Treat wrist dislocation
CH
T
0062
25.6702
1,580.03
375.46
316.0125671
Pin radioulnar dislocation
CH
T
0062
25.6702
1,580.03
375.46
316.0125675
Treat wrist dislocation

T
0043
1.6914
104.11

20.8225676
Treat wrist dislocation
CH
T
0062
25.6702
1,580.03
375.46
316.0125680
Treat wrist fracture

T
0043
1.6914
104.11

20.82( print page 49771)25685
Treat wrist fracture
CH
T
0062
25.6702
1,580.03
375.46
316.0125690
Treat wrist dislocation

T
0043
1.6914
104.11

20.8225695
Treat wrist dislocation
CH
T
0062
25.6702
1,580.03
375.46
316.0125800
Fusion of wrist joint
CH
T
0052
65.8846
4,055.26

811.0525805
Fusion/graft of wrist joint

T
0051
41.2543
2,539.24

507.8525810
Fusion/graft of wrist joint
CH
T
0052
65.8846
4,055.26

811.0525820
Fusion of hand bones

T
0053
16.0343
986.93
253.49
197.3925825
Fuse hand bones with graft

T
0054
25.8425
1,590.63

318.1325830
Fusion, radioulnar jnt/ulna
CH
T
0052
65.8846
4,055.26

811.0525907
Amputation follow-up surgery

T
0049
20.8214
1,281.58

256.3225922
Amputate hand at wrist

T
0049
20.8214
1,281.58

256.3225929
Amputation follow-up surgery

T
0686
13.3433
821.29

164.2625999
Forearm or wrist surgery

T
0043
1.6914
104.11

20.8226010
Drainage of finger abscess

T
0006
1.4821
91.22
21.76
18.2426011
Drainage of finger abscess

T
0007
10.9184
672.04

134.4126020
Drain hand tendon sheath

T
0053
16.0343
986.93
253.49
197.3926025
Drainage of palm bursa

T
0053
16.0343
986.93
253.49
197.3926030
Drainage of palm bursa(s)

T
0053
16.0343
986.93
253.49
197.3926034
Treat hand bone lesion

T
0053
16.0343
986.93
253.49
197.3926035
Decompress fingers/hand

T
0053
16.0343
986.93
253.49
197.3926037
Decompress fingers/hand

T
0053
16.0343
986.93
253.49
197.3926040
Release palm contracture

T
0054
25.8425
1,590.63

318.1326045
Release palm contracture

T
0054
25.8425
1,590.63

318.1326055
Incise finger tendon sheath

T
0053
16.0343
986.93
253.49
197.3926060
Incision of finger tendon

T
0053
16.0343
986.93
253.49
197.3926070
Explore/treat hand joint

T
0053
16.0343
986.93
253.49
197.3926075
Explore/treat finger joint

T
0053
16.0343
986.93
253.49
197.3926080
Explore/treat finger joint

T
0053
16.0343
986.93
253.49
197.3926100
Biopsy hand joint lining

T
0053
16.0343
986.93
253.49
197.3926105
Biopsy finger joint lining

T
0053
16.0343
986.93
253.49
197.3926110
Biopsy finger joint lining

T
0053
16.0343
986.93
253.49
197.3926115
Removal hand lesion subcut

T
0022
19.9760
1,229.54
354.45
245.9126116
Removal hand lesion, deep

T
0022
19.9760
1,229.54
354.45
245.9126117
Remove tumor, hand/finger

T
0022
19.9760
1,229.54
354.45
245.9126121
Release palm contracture

T
0054
25.8425
1,590.63

318.1326123
Release palm contracture

T
0054
25.8425
1,590.63

318.1326125
Release palm contracture

T
0053
16.0343
986.93
253.49
197.3926130
Remove wrist joint lining

T
0053
16.0343
986.93
253.49
197.3926135
Revise finger joint, each

T
0054
25.8425
1,590.63

318.1326140
Revise finger joint, each

T
0053
16.0343
986.93
253.49
197.3926145
Tendon excision, palm/finger

T
0053
16.0343
986.93
253.49
197.3926160
Remove tendon sheath lesion

T
0053
16.0343
986.93
253.49
197.3926170
Removal of palm tendon, each

T
0053
16.0343
986.93
253.49
197.3926180
Removal of finger tendon

T
0053
16.0343
986.93
253.49
197.3926185
Remove finger bone

T
0053
16.0343
986.93
253.49
197.3926200
Remove hand bone lesion

T
0053
16.0343
986.93
253.49
197.3926205
Remove/graft bone lesion

T
0054
25.8425
1,590.63

318.1326210
Removal of finger lesion

T
0053
16.0343
986.93
253.49
197.3926215
Remove/graft finger lesion

T
0053
16.0343
986.93
253.49
197.3926230
Partial removal of hand bone

T
0053
16.0343
986.93
253.49
197.3926235
Partial removal, finger bone

T
0053
16.0343
986.93
253.49
197.3926236
Partial removal, finger bone

T
0053
16.0343
986.93
253.49
197.3926250
Extensive hand surgery

T
0053
16.0343
986.93
253.49
197.3926255
Extensive hand surgery

T
0054
25.8425
1,590.63

318.1326260
Extensive finger surgery

T
0053
16.0343
986.93
253.49
197.3926261
Extensive finger surgery

T
0053
16.0343
986.93
253.49
197.3926262
Partial removal of finger

T
0053
16.0343
986.93
253.49
197.3926320
Removal of implant from hand

T
0021
14.9563
920.58
219.48
184.1226340
Manipulate finger w/anesth

T
0043
1.6914
104.11

20.8226350
Repair finger/hand tendon

T
0054
25.8425
1,590.63

318.1326352
Repair/graft hand tendon

T
0054
25.8425
1,590.63

318.1326356
Repair finger/hand tendon

T
0054
25.8425
1,590.63

318.1326357
Repair finger/hand tendon

T
0054
25.8425
1,590.63

318.1326358
Repair/graft hand tendon

T
0054
25.8425
1,590.63

318.1326370
Repair finger/hand tendon

T
0054
25.8425
1,590.63

318.1326372
Repair/graft hand tendon

T
0054
25.8425
1,590.63

318.1326373
Repair finger/hand tendon

T
0054
25.8425
1,590.63

318.1326390
Revise hand/finger tendon

T
0054
25.8425
1,590.63

318.1326392
Repair/graft hand tendon

T
0054
25.8425
1,590.63

318.1326410
Repair hand tendon

T
0053
16.0343
986.93
253.49
197.39( print page 49772)26412
Repair/graft hand tendon

T
0054
25.8425
1,590.63

318.1326415
Excision, hand/finger tendon

T
0054
25.8425
1,590.63

318.1326416
Graft hand or finger tendon

T
0054
25.8425
1,590.63

318.1326418
Repair finger tendon

T
0053
16.0343
986.93
253.49
197.3926420
Repair/graft finger tendon

T
0054
25.8425
1,590.63

318.1326426
Repair finger/hand tendon

T
0054
25.8425
1,590.63

318.1326428
Repair/graft finger tendon

T
0054
25.8425
1,590.63

318.1326432
Repair finger tendon

T
0053
16.0343
986.93
253.49
197.3926433
Repair finger tendon

T
0053
16.0343
986.93
253.49
197.3926434
Repair/graft finger tendon

T
0054
25.8425
1,590.63

318.1326437
Realignment of tendons

T
0053
16.0343
986.93
253.49
197.3926440
Release palm/finger tendon

T
0053
16.0343
986.93
253.49
197.3926442
Release palmfinger tendon

T
0054
25.8425
1,590.63

318.1326445
Release hand/finger tendon

T
0053
16.0343
986.93
253.49
197.3926449
Release forearm/hand tendon

T
0054
25.8425
1,590.63

318.1326450
Incision of palm tendon

T
0053
16.0343
986.93
253.49
197.3926455
Incision of finger tendon

T
0053
16.0343
986.93
253.49
197.3926460
Incise hand/finger tendon

T
0053
16.0343
986.93
253.49
197.3926471
Fusion of finger tendons

T
0053
16.0343
986.93
253.49
197.3926474
Fusion of finger tendons

T
0053
16.0343
986.93
253.49
197.3926476
Tendon lengthening

T
0053
16.0343
986.93
253.49
197.3926477
Tendon shortening

T
0053
16.0343
986.93
253.49
197.3926478
Lengthening of hand tendon

T
0053
16.0343
986.93
253.49
197.3926479
Shortening of hand tendon

T
0053
16.0343
986.93
253.49
197.3926480
Transplant hand tendon

T
0054
25.8425
1,590.63

318.1326483
Transplant/graft hand tendon

T
0054
25.8425
1,590.63

318.1326485
Transplant palm tendon

T
0054
25.8425
1,590.63

318.1326489
Transplant/graft palm tendon

T
0054
25.8425
1,590.63

318.1326490
Revise thumb tendon

T
0054
25.8425
1,590.63

318.1326492
Tendon transfer with graft

T
0054
25.8425
1,590.63

318.1326494
Hand tendon/muscle transfer

T
0054
25.8425
1,590.63

318.1326496
Revise thumb tendon

T
0054
25.8425
1,590.63

318.1326497
Finger tendon transfer

T
0054
25.8425
1,590.63

318.1326498
Finger tendon transfer

T
0054
25.8425
1,590.63

318.1326499
Revision of finger

T
0054
25.8425
1,590.63

318.1326500
Hand tendon reconstruction

T
0053
16.0343
986.93
253.49
197.3926502
Hand tendon reconstruction

T
0054
25.8425
1,590.63

318.1326504
Hand tendon reconstruction

T
0054
25.8425
1,590.63

318.1326508
Release thumb contracture

T
0053
16.0343
986.93
253.49
197.3926510
Thumb tendon transfer

T
0054
25.8425
1,590.63

318.1326516
Fusion of knuckle joint

T
0054
25.8425
1,590.63

318.1326517
Fusion of knuckle joints

T
0054
25.8425
1,590.63

318.1326518
Fusion of knuckle joints

T
0054
25.8425
1,590.63

318.1326520
Release knuckle contracture

T
0053
16.0343
986.93
253.49
197.3926525
Release finger contracture

T
0053
16.0343
986.93
253.49
197.3926530
Revise knuckle joint

T
0047
32.7543
2,016.06
537.03
403.2126531
Revise knuckle with implant

T
0048
47.1644
2,903.02

580.6026535
Revise finger joint

T
0047
32.7543
2,016.06
537.03
403.2126536
Revise/implant finger joint

T
0048
47.1644
2,903.02

580.6026540
Repair hand joint

T
0053
16.0343
986.93
253.49
197.3926541
Repair hand joint with graft

T
0054
25.8425
1,590.63

318.1326542
Repair hand joint with graft

T
0053
16.0343
986.93
253.49
197.3926545
Reconstruct finger joint

T
0054
25.8425
1,590.63

318.1326546
Repair nonunion hand

T
0054
25.8425
1,590.63

318.1326548
Reconstruct finger joint

T
0054
25.8425
1,590.63

318.1326550
Construct thumb replacement

T
0054
25.8425
1,590.63

318.1326555
Positional change of finger

T
0054
25.8425
1,590.63

318.1326560
Repair of web finger

T
0053
16.0343
986.93
253.49
197.3926561
Repair of web finger

T
0054
25.8425
1,590.63

318.1326562
Repair of web finger

T
0054
25.8425
1,590.63

318.1326565
Correct metacarpal flaw

T
0054
25.8425
1,590.63

318.1326567
Correct finger deformity

T
0054
25.8425
1,590.63

318.1326568
Lengthen metacarpal/finger

T
0054
25.8425
1,590.63

318.1326580
Repair hand deformity

T
0053
16.0343
986.93
253.49
197.3926587
Reconstruct extra finger

T
0053
16.0343
986.93
253.49
197.3926590
Repair finger deformity

T
0053
16.0343
986.93
253.49
197.3926591
Repair muscles of hand

T
0054
25.8425
1,590.63

318.1326593
Release muscles of hand

T
0053
16.0343
986.93
253.49
197.3926596
Excision constricting tissue

T
0053
16.0343
986.93
253.49
197.3926600
Treat metacarpal fracture

T
0043
1.6914
104.11

20.82( print page 49773)26605
Treat metacarpal fracture

T
0043
1.6914
104.11

20.8226607
Treat metacarpal fracture

T
0043
1.6914
104.11

20.8226608
Treat metacarpal fracture
CH
T
0062
25.6702
1,580.03
375.46
316.0126615
Treat metacarpal fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4726641
Treat thumb dislocation

T
0043
1.6914
104.11

20.8226645
Treat thumb fracture

T
0043
1.6914
104.11

20.8226650
Treat thumb fracture
CH
T
0062
25.6702
1,580.03
375.46
316.0126665
Treat thumb fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4726670
Treat hand dislocation

T
0043
1.6914
104.11

20.8226675
Treat hand dislocation

T
0043
1.6914
104.11

20.8226676
Pin hand dislocation
CH
T
0062
25.6702
1,580.03
375.46
316.0126685
Treat hand dislocation
CH
T
0063
37.5680
2,312.35
549.49
462.4726686
Treat hand dislocation
CH
T
0064
56.4195
3,472.68
825.22
694.5426700
Treat knuckle dislocation

T
0043
1.6914
104.11

20.8226705
Treat knuckle dislocation

T
0043
1.6914
104.11

20.8226706
Pin knuckle dislocation

T
0043
1.6914
104.11

20.8226715
Treat knuckle dislocation
CH
T
0063
37.5680
2,312.35
549.49
462.4726720
Treat finger fracture, each

T
0043
1.6914
104.11

20.8226725
Treat finger fracture, each

T
0043
1.6914
104.11

20.8226727
Treat finger fracture, each
CH
T
0062
25.6702
1,580.03
375.46
316.0126735
Treat finger fracture, each
CH
T
0063
37.5680
2,312.35
549.49
462.4726740
Treat finger fracture, each

T
0043
1.6914
104.11

20.8226742
Treat finger fracture, each

T
0043
1.6914
104.11

20.8226746
Treat finger fracture, each
CH
T
0063
37.5680
2,312.35
549.49
462.4726750
Treat finger fracture, each

T
0043
1.6914
104.11

20.8226755
Treat finger fracture, each

T
0043
1.6914
104.11

20.8226756
Pin finger fracture, each
CH
T
0062
25.6702
1,580.03
375.46
316.0126765
Treat finger fracture, each
CH
T
0063
37.5680
2,312.35
549.49
462.4726770
Treat finger dislocation

T
0043
1.6914
104.11

20.8226775
Treat finger dislocation

T
0045
14.5502
895.58
268.47
179.1226776
Pin finger dislocation
CH
T
0062
25.6702
1,580.03
375.46
316.0126785
Treat finger dislocation
CH
T
0062
25.6702
1,580.03
375.46
316.0126820
Thumb fusion with graft

T
0054
25.8425
1,590.63

318.1326841
Fusion of thumb

T
0054
25.8425
1,590.63

318.1326842
Thumb fusion with graft

T
0054
25.8425
1,590.63

318.1326843
Fusion of hand joint

T
0054
25.8425
1,590.63

318.1326844
Fusion/graft of hand joint

T
0054
25.8425
1,590.63

318.1326850
Fusion of knuckle

T
0054
25.8425
1,590.63

318.1326852
Fusion of knuckle with graft

T
0054
25.8425
1,590.63

318.1326860
Fusion of finger joint

T
0054
25.8425
1,590.63

318.1326861
Fusion of finger jnt, add-on

T
0054
25.8425
1,590.63

318.1326862
Fusion/graft of finger joint

T
0054
25.8425
1,590.63

318.1326863
Fuse/graft added joint

T
0054
25.8425
1,590.63

318.1326910
Amputate metacarpal bone

T
0054
25.8425
1,590.63

318.1326951
Amputation of finger/thumb

T
0053
16.0343
986.93
253.49
197.3926952
Amputation of finger/thumb

T
0053
16.0343
986.93
253.49
197.3926989
Hand/finger surgery

T
0043
1.6914
104.11

20.8226990
Drainage of pelvis lesion

T
0049
20.8214
1,281.58

256.3226991
Drainage of pelvis bursa

T
0049
20.8214
1,281.58

256.3227000
Incision of hip tendon

T
0049
20.8214
1,281.58

256.3227001
Incision of hip tendon

T
0050
25.0600
1,542.47

308.4927003
Incision of hip tendon

T
0050
25.0600
1,542.47

308.4927033
Exploration of hip joint

T
0051
41.2543
2,539.24

507.8527035
Denervation of hip joint
CH
T
0051
41.2543
2,539.24

507.8527040
Biopsy of soft tissues

T
0020
6.5128
400.87
98.57
80.1727041
Biopsy of soft tissues

T
0020
6.5128
400.87
98.57
80.1727047
Remove hip/pelvis lesion

T
0022
19.9760
1,229.54
354.45
245.9127048
Remove hip/pelvis lesion

T
0022
19.9760
1,229.54
354.45
245.9127049
Remove tumor, hip/pelvis

T
0022
19.9760
1,229.54
354.45
245.9127050
Biopsy of sacroiliac joint

T
0049
20.8214
1,281.58

256.3227052
Biopsy of hip joint

T
0049
20.8214
1,281.58

256.3227060
Removal of ischial bursa

T
0049
20.8214
1,281.58

256.3227062
Remove femur lesion/bursa

T
0049
20.8214
1,281.58

256.3227065
Removal of hip bone lesion

T
0049
20.8214
1,281.58

256.3227066
Removal of hip bone lesion

T
0050
25.0600
1,542.47

308.4927067
Remove/graft hip bone lesion

T
0050
25.0600
1,542.47

308.4927080
Removal of tail bone

T
0050
25.0600
1,542.47

308.4927086
Remove hip foreign body

T
0020
6.5128
400.87
98.57
80.1727087
Remove hip foreign body

T
0049
20.8214
1,281.58

256.3227093
Injection for hip x-ray

N( print page 49774)27095
Injection for hip x-ray

N27097
Revision of hip tendon

T
0050
25.0600
1,542.47

308.4927098
Transfer tendon to pelvis

T
0050
25.0600
1,542.47

308.4927100
Transfer of abdominal muscle

T
0051
41.2543
2,539.24

507.8527105
Transfer of spinal muscle

T
0051
41.2543
2,539.24

507.8527110
Transfer of iliopsoas muscle

T
0051
41.2543
2,539.24

507.8527111
Transfer of iliopsoas muscle

T
0051
41.2543
2,539.24

507.8527193
Treat pelvic ring fracture

T
0043
1.6914
104.11

20.8227194
Treat pelvic ring fracture

T
0045
14.5502
895.58
268.47
179.1227200
Treat tail bone fracture

T
0043
1.6914
104.11

20.8227202
Treat tail bone fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4727216
Treat pelvic ring fracture

T
0050
25.0600
1,542.47

308.4927220
Treat hip socket fracture

T
0043
1.6914
104.11

20.8227230
Treat thigh fracture

T
0043
1.6914
104.11

20.8227235
Treat thigh fracture

T
0050
25.0600
1,542.47

308.4927238
Treat thigh fracture

T
0043
1.6914
104.11

20.8227246
Treat thigh fracture

T
0043
1.6914
104.11

20.8227250
Treat hip dislocation

T
0043
1.6914
104.11

20.8227252
Treat hip dislocation

T
0045
14.5502
895.58
268.47
179.1227256
Treat hip dislocation

T
0043
1.6914
104.11

20.8227257
Treat hip dislocation

T
0045
14.5502
895.58
268.47
179.1227265
Treat hip dislocation

T
0043
1.6914
104.11

20.8227266
Treat hip dislocation

T
0045
14.5502
895.58
268.47
179.1227275
Manipulation of hip joint

T
0045
14.5502
895.58
268.47
179.1227299
Pelvis/hip joint surgery

T
0043
1.6914
104.11

20.8227301
Drain thigh/knee lesion

T
0008
17.4686
1,075.21

215.0427305
Incise thigh tendonfascia

T
0049
20.8214
1,281.58

256.3227306
Incision of thigh tendon

T
0049
20.8214
1,281.58

256.3227307
Incision of thigh tendons

T
0049
20.8214
1,281.58

256.3227310
Exploration of knee joint

T
0050
25.0600
1,542.47

308.4927315
Partial removal, thigh nerve

T
0220
17.7609
1,093.20

218.6427320
Partial removal, thigh nerve

T
0220
17.7609
1,093.20

218.6427323
Biopsy, thigh soft tissues
CH
T
0020
6.5128
400.87
98.57
80.1727324
Biopsy, thigh soft tissues

T
0022
19.9760
1,229.54
354.45
245.9127327
Removal of thigh lesion

T
0022
19.9760
1,229.54
354.45
245.9127328
Removal of thigh lesion

T
0022
19.9760
1,229.54
354.45
245.9127329
Remove tumor, thigh/knee

T
0022
19.9760
1,229.54
354.45
245.9127330
Biopsy, knee joint lining

T
0050
25.0600
1,542.47

308.4927331
Explore/treat knee joint

T
0050
25.0600
1,542.47

308.4927332
Removal of knee cartilage

T
0050
25.0600
1,542.47

308.4927333
Removal of knee cartilage

T
0050
25.0600
1,542.47

308.4927334
Remove knee joint lining

T
0050
25.0600
1,542.47

308.4927335
Remove knee joint lining

T
0050
25.0600
1,542.47

308.4927340
Removal of kneecap bursa

T
0049
20.8214
1,281.58

256.3227345
Removal of knee cyst

T
0049
20.8214
1,281.58

256.3227347
Remove knee cyst

T
0049
20.8214
1,281.58

256.3227350
Removal of kneecap

T
0050
25.0600
1,542.47

308.4927355
Remove femur lesion

T
0050
25.0600
1,542.47

308.4927356
Remove femur lesion/graft

T
0050
25.0600
1,542.47

308.4927357
Remove femur lesion/graft

T
0050
25.0600
1,542.47

308.4927358
Remove femur lesion/fixation

T
0050
25.0600
1,542.47

308.4927360
Partial removal, leg bone(s)

T
0050
25.0600
1,542.47

308.4927370
Injection for knee x-ray

N27372
Removal of foreign body

T
0022
19.9760
1,229.54
354.45
245.9127380
Repair of kneecap tendon

T
0049
20.8214
1,281.58

256.3227381
Repair/graft kneecap tendon

T
0049
20.8214
1,281.58

256.3227385
Repair of thigh muscle

T
0049
20.8214
1,281.58

256.3227386
Repair/graft of thigh muscle

T
0049
20.8214
1,281.58

256.3227390
Incision of thigh tendon

T
0049
20.8214
1,281.58

256.3227391
Incision of thigh tendons

T
0049
20.8214
1,281.58

256.3227392
Incision of thigh tendons

T
0049
20.8214
1,281.58

256.3227393
Lengthening of thigh tendon

T
0050
25.0600
1,542.47

308.4927394
Lengthening of thigh tendons

T
0050
25.0600
1,542.47

308.4927395
Lengthening of thigh tendons

T
0051
41.2543
2,539.24

507.8527396
Transplant of thigh tendon

T
0050
25.0600
1,542.47

308.4927397
Transplants of thigh tendons

T
0051
41.2543
2,539.24

507.8527400
Revise thigh muscles/tendons

T
0051
41.2543
2,539.24

507.8527403
Repair of knee cartilage

T
0050
25.0600
1,542.47

308.4927405
Repair of knee ligament

T
0051
41.2543
2,539.24

507.8527407
Repair of knee ligament
CH
T
0052
65.8846
4,055.26

811.05( print page 49775)27409
Repair of knee ligaments

T
0051
41.2543
2,539.24

507.8527412
Autochondrocyte implant knee

T
0042
45.0637
2,773.72
804.74
554.7427415
Osteochondral knee allograft

T
0042
45.0637
2,773.72
804.74
554.7427418
Repair degenerated kneecap

T
0051
41.2543
2,539.24

507.8527420
Revision of unstable kneecap

T
0051
41.2543
2,539.24

507.8527422
Revision of unstable kneecap

T
0051
41.2543
2,539.24

507.8527424
Revision/removal of kneecap

T
0051
41.2543
2,539.24

507.8527425
Lat retinacular release open

T
0050
25.0600
1,542.47

308.4927427
Reconstruction, knee
CH
T
0051
41.2543
2,539.24

507.8527428
Reconstruction, knee

T
0052
65.8846
4,055.26

811.0527429
Reconstruction, knee

T
0052
65.8846
4,055.26

811.0527430
Revision of thigh muscles

T
0051
41.2543
2,539.24

507.8527435
Incision of knee joint

T
0051
41.2543
2,539.24

507.8527437
Revise kneecap

T
0047
32.7543
2,016.06
537.03
403.2127438
Revise kneecap with implant

T
0048
47.1644
2,903.02

580.6027440
Revision of knee joint

T
0047
32.7543
2,016.06
537.03
403.2127441
Revision of knee joint

T
0047
32.7543
2,016.06
537.03
403.2127442
Revision of knee joint

T
0047
32.7543
2,016.06
537.03
403.2127443
Revision of knee joint

T
0047
32.7543
2,016.06
537.03
403.2127446
Revision of knee joint

T
0681
173.0706
10,652.67

2,130.5327475
Surgery to stop leg growth

T
0050
25.0600
1,542.47

308.4927496
Decompression of thigh/knee

T
0049
20.8214
1,281.58

256.3227497
Decompression of thigh/knee

T
0049
20.8214
1,281.58

256.3227498
Decompression of thigh/knee

T
0049
20.8214
1,281.58

256.3227499
Decompression of thigh/knee

T
0049
20.8214
1,281.58

256.3227500
Treatment of thigh fracture

T
0043
1.6914
104.11

20.8227501
Treatment of thigh fracture

T
0043
1.6914
104.11

20.8227502
Treatment of thigh fracture

T
0043
1.6914
104.11

20.8227503
Treatment of thigh fracture

T
0043
1.6914
104.11

20.8227508
Treatment of thigh fracture

T
0043
1.6914
104.11

20.8227509
Treatment of thigh fracture
CH
T
0062
25.6702
1,580.03
375.46
316.0127510
Treatment of thigh fracture

T
0043
1.6914
104.11

20.8227516
Treat thigh fx growth plate

T
0043
1.6914
104.11

20.8227517
Treat thigh fx growth plate

T
0043
1.6914
104.11

20.8227520
Treat kneecap fracture

T
0043
1.6914
104.11

20.8227524
Treat kneecap fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4727530
Treat knee fracture

T
0043
1.6914
104.11

20.8227532
Treat knee fracture

T
0043
1.6914
104.11

20.8227538
Treat knee fracture(s)

T
0043
1.6914
104.11

20.8227550
Treat knee dislocation

T
0043
1.6914
104.11

20.8227552
Treat knee dislocation

T
0045
14.5502
895.58
268.47
179.1227560
Treat kneecap dislocation

T
0043
1.6914
104.11

20.8227562
Treat kneecap dislocation

T
0045
14.5502
895.58
268.47
179.1227566
Treat kneecap dislocation
CH
T
0063
37.5680
2,312.35
549.49
462.4727570
Fixation of knee joint

T
0045
14.5502
895.58
268.47
179.1227594
Amputation follow-up surgery

T
0049
20.8214
1,281.58

256.3227599
Leg surgery procedure

T
0043
1.6914
104.11

20.8227600
Decompression of lower leg

T
0049
20.8214
1,281.58

256.3227601
Decompression of lower leg

T
0049
20.8214
1,281.58

256.3227602
Decompression of lower leg

T
0049
20.8214
1,281.58

256.3227603
Drain lower leg lesion

T
0008
17.4686
1,075.21

215.0427604
Drain lower leg bursa

T
0049
20.8214
1,281.58

256.3227605
Incision of achilles tendon

T
0055
20.2255
1,244.90
355.34
248.9827606
Incision of achilles tendon

T
0049
20.8214
1,281.58

256.3227607
Treat lower leg bone lesion

T
0049
20.8214
1,281.58

256.3227610
Explore/treat ankle joint

T
0050
25.0600
1,542.47

308.4927612
Exploration of ankle joint

T
0050
25.0600
1,542.47

308.4927613
Biopsy lower leg soft tissue

T
0020
6.5128
400.87
98.57
80.1727614
Biopsy lower leg soft tissue

T
0022
19.9760
1,229.54
354.45
245.9127615
Remove tumor, lower leg
CH
T
0050
25.0600
1,542.47

308.4927618
Remove lower leg lesion

T
0021
14.9563
920.58
219.48
184.1227619
Remove lower leg lesion

T
0022
19.9760
1,229.54
354.45
245.9127620
Explore/treat ankle joint

T
0050
25.0600
1,542.47

308.4927625
Remove ankle joint lining

T
0050
25.0600
1,542.47

308.4927626
Remove ankle joint lining

T
0050
25.0600
1,542.47

308.4927630
Removal of tendon lesion

T
0049
20.8214
1,281.58

256.3227635
Remove lower leg bone lesion

T
0050
25.0600
1,542.47

308.4927637
Remove/graft leg bone lesion

T
0050
25.0600
1,542.47

308.4927638
Remove/graft leg bone lesion

T
0050
25.0600
1,542.47

308.4927640
Partial removal of tibia

T
0051
41.2543
2,539.24

507.85( print page 49776)27641
Partial removal of fibula

T
0050
25.0600
1,542.47

308.4927647
Extensive ankle/heel surgery

T
0051
41.2543
2,539.24

507.8527648
Injection for ankle x-ray

N27650
Repair achilles tendon

T
0051
41.2543
2,539.24

507.8527652
Repair/graft achilles tendon
CH
T
0052
65.8846
4,055.26

811.0527654
Repair of achilles tendon

T
0051
41.2543
2,539.24

507.8527656
Repair leg fascia defect

T
0049
20.8214
1,281.58

256.3227658
Repair of leg tendon, each

T
0049
20.8214
1,281.58

256.3227659
Repair of leg tendon, each

T
0049
20.8214
1,281.58

256.3227664
Repair of leg tendon, each

T
0049
20.8214
1,281.58

256.3227665
Repair of leg tendon, each

T
0050
25.0600
1,542.47

308.4927675
Repair lower leg tendons

T
0049
20.8214
1,281.58

256.3227676
Repair lower leg tendons

T
0050
25.0600
1,542.47

308.4927680
Release of lower leg tendon

T
0050
25.0600
1,542.47

308.4927681
Release of lower leg tendons

T
0050
25.0600
1,542.47

308.4927685
Revision of lower leg tendon

T
0050
25.0600
1,542.47

308.4927686
Revise lower leg tendons

T
0050
25.0600
1,542.47

308.4927687
Revision of calf tendon

T
0050
25.0600
1,542.47

308.4927690
Revise lower leg tendon

T
0051
41.2543
2,539.24

507.8527691
Revise lower leg tendon

T
0051
41.2543
2,539.24

507.8527692
Revise additional leg tendon

T
0051
41.2543
2,539.24

507.8527695
Repair of ankle ligament

T
0050
25.0600
1,542.47

308.4927696
Repair of ankle ligaments

T
0050
25.0600
1,542.47

308.4927698
Repair of ankle ligament

T
0050
25.0600
1,542.47

308.4927700
Revision of ankle joint

T
0047
32.7543
2,016.06
537.03
403.2127704
Removal of ankle implant

T
0049
20.8214
1,281.58

256.3227705
Incision of tibia

T
0051
41.2543
2,539.24

507.8527707
Incision of fibula

T
0049
20.8214
1,281.58

256.3227709
Incision of tibiafibula

T
0050
25.0600
1,542.47

308.4927730
Repair of tibia epiphysis

T
0050
25.0600
1,542.47

308.4927732
Repair of fibula epiphysis

T
0050
25.0600
1,542.47

308.4927734
Repair lower leg epiphyses

T
0050
25.0600
1,542.47

308.4927740
Repair of leg epiphyses

T
0050
25.0600
1,542.47

308.4927742
Repair of leg epiphyses

T
0051
41.2543
2,539.24

507.8527745
Reinforce tibia
CH
T
0052
65.8846
4,055.26

811.0527750
Treatment of tibia fracture

T
0043
1.6914
104.11

20.8227752
Treatment of tibia fracture

T
0043
1.6914
104.11

20.8227756
Treatment of tibia fracture
CH
T
0062
25.6702
1,580.03
375.46
316.0127758
Treatment of tibia fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4727759
Treatment of tibia fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5427760
Treatment of ankle fracture

T
0043
1.6914
104.11

20.8227762
Treatment of ankle fracture

T
0043
1.6914
104.11

20.8227766
Treatment of ankle fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4727780
Treatment of fibula fracture

T
0043
1.6914
104.11

20.8227781
Treatment of fibula fracture

T
0043
1.6914
104.11

20.8227784
Treatment of fibula fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4727786
Treatment of ankle fracture

T
0043
1.6914
104.11

20.8227788
Treatment of ankle fracture

T
0043
1.6914
104.11

20.8227792
Treatment of ankle fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4727808
Treatment of ankle fracture

T
0043
1.6914
104.11

20.8227810
Treatment of ankle fracture

T
0043
1.6914
104.11

20.8227814
Treatment of ankle fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4727816
Treatment of ankle fracture

T
0043
1.6914
104.11

20.8227818
Treatment of ankle fracture

T
0043
1.6914
104.11

20.8227822
Treatment of ankle fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4727823
Treatment of ankle fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5427824
Treat lower leg fracture

T
0043
1.6914
104.11

20.8227825
Treat lower leg fracture

T
0043
1.6914
104.11

20.8227826
Treat lower leg fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4727827
Treat lower leg fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5427828
Treat lower leg fracture
CH
T
0064
56.4195
3,472.68
825.22
694.5427829
Treat lower leg joint
CH
T
0063
37.5680
2,312.35
549.49
462.4727830
Treat lower leg dislocation

T
0043
1.6914
104.11

20.8227831
Treat lower leg dislocation

T
0043
1.6914
104.11

20.8227832
Treat lower leg dislocation
CH
T
0063
37.5680
2,312.35
549.49
462.4727840
Treat ankle dislocation

T
0043
1.6914
104.11

20.8227842
Treat ankle dislocation

T
0045
14.5502
895.58
268.47
179.1227846
Treat ankle dislocation
CH
T
0063
37.5680
2,312.35
549.49
462.4727848
Treat ankle dislocation
CH
T
0063
37.5680
2,312.35
549.49
462.4727860
Fixation of ankle joint

T
0045
14.5502
895.58
268.47
179.12( print page 49777)27870
Fusion of ankle joint, open
CH
T
0052
65.8846
4,055.26

811.0527871
Fusion of tibiofibular joint
CH
T
0052
65.8846
4,055.26

811.0527884
Amputation follow-up surgery

T
0049
20.8214
1,281.58

256.3227889
Amputation of foot at ankle

T
0050
25.0600
1,542.47

308.4927892
Decompression of leg

T
0049
20.8214
1,281.58

256.3227893
Decompression of leg

T
0049
20.8214
1,281.58

256.3227894
Decompression of leg

T
0049
20.8214
1,281.58

256.3227899
Leg/ankle surgery procedure

T
0043
1.6914
104.11

20.8228001
Drainage of bursa of foot

T
0007
10.9184
672.04

134.4128002
Treatment of foot infection

T
0049
20.8214
1,281.58

256.3228003
Treatment of foot infection

T
0049
20.8214
1,281.58

256.3228005
Treat foot bone lesion

T
0055
20.2255
1,244.90
355.34
248.9828008
Incision of foot fascia

T
0055
20.2255
1,244.90
355.34
248.9828010
Incision of toe tendon

T
0055
20.2255
1,244.90
355.34
248.9828011
Incision of toe tendons

T
0055
20.2255
1,244.90
355.34
248.9828020
Exploration of foot joint

T
0055
20.2255
1,244.90
355.34
248.9828022
Exploration of foot joint

T
0055
20.2255
1,244.90
355.34
248.9828024
Exploration of toe joint

T
0055
20.2255
1,244.90
355.34
248.9828030
Removal of foot nerve

T
0220
17.7609
1,093.20

218.6428035
Decompression of tibia nerve

T
0220
17.7609
1,093.20

218.6428043
Excision of foot lesion
CH
T
0022
19.9760
1,229.54
354.45
245.9128045
Excision of foot lesion

T
0055
20.2255
1,244.90
355.34
248.9828046
Resection of tumor, foot

T
0055
20.2255
1,244.90
355.34
248.9828050
Biopsy of foot joint lining

T
0055
20.2255
1,244.90
355.34
248.9828052
Biopsy of foot joint lining

T
0055
20.2255
1,244.90
355.34
248.9828054
Biopsy of toe joint lining

T
0055
20.2255
1,244.90
355.34
248.9828060
Partial removal, foot fascia

T
0055
20.2255
1,244.90
355.34
248.9828062
Removal of foot fascia

T
0055
20.2255
1,244.90
355.34
248.9828070
Removal of foot joint lining

T
0055
20.2255
1,244.90
355.34
248.9828072
Removal of foot joint lining

T
0055
20.2255
1,244.90
355.34
248.9828080
Removal of foot lesion

T
0055
20.2255
1,244.90
355.34
248.9828086
Excise foot tendon sheath

T
0055
20.2255
1,244.90
355.34
248.9828088
Excise foot tendon sheath

T
0055
20.2255
1,244.90
355.34
248.9828090
Removal of foot lesion

T
0055
20.2255
1,244.90
355.34
248.9828092
Removal of toe lesions

T
0055
20.2255
1,244.90
355.34
248.9828100
Removal of ankle/heel lesion

T
0055
20.2255
1,244.90
355.34
248.9828102
Remove/graft foot lesion

T
0056
41.2239
2,537.37

507.4728103
Remove/graft foot lesion

T
0056
41.2239
2,537.37

507.4728104
Removal of foot lesion

T
0055
20.2255
1,244.90
355.34
248.9828106
Remove/graft foot lesion

T
0056
41.2239
2,537.37

507.4728107
Remove/graft foot lesion

T
0056
41.2239
2,537.37

507.4728108
Removal of toe lesions

T
0055
20.2255
1,244.90
355.34
248.9828110
Part removal of metatarsal

T
0055
20.2255
1,244.90
355.34
248.9828111
Part removal of metatarsal

T
0055
20.2255
1,244.90
355.34
248.9828112
Part removal of metatarsal

T
0055
20.2255
1,244.90
355.34
248.9828113
Part removal of metatarsal

T
0055
20.2255
1,244.90
355.34
248.9828114
Removal of metatarsal heads

T
0055
20.2255
1,244.90
355.34
248.9828116
Revision of foot

T
0055
20.2255
1,244.90
355.34
248.9828118
Removal of heel bone

T
0055
20.2255
1,244.90
355.34
248.9828119
Removal of heel spur

T
0055
20.2255
1,244.90
355.34
248.9828120
Part removal of ankle/heel

T
0055
20.2255
1,244.90
355.34
248.9828122
Partial removal of foot bone

T
0055
20.2255
1,244.90
355.34
248.9828124
Partial removal of toe

T
0055
20.2255
1,244.90
355.34
248.9828126
Partial removal of toe

T
0055
20.2255
1,244.90
355.34
248.9828130
Removal of ankle bone

T
0055
20.2255
1,244.90
355.34
248.9828140
Removal of metatarsal

T
0055
20.2255
1,244.90
355.34
248.9828150
Removal of toe

T
0055
20.2255
1,244.90
355.34
248.9828153
Partial removal of toe

T
0055
20.2255
1,244.90
355.34
248.9828160
Partial removal of toe

T
0055
20.2255
1,244.90
355.34
248.9828171
Extensive foot surgery

T
0055
20.2255
1,244.90
355.34
248.9828173
Extensive foot surgery

T
0055
20.2255
1,244.90
355.34
248.9828175
Extensive foot surgery

T
0055
20.2255
1,244.90
355.34
248.9828190
Removal of foot foreign body

T
0019
4.0123
246.96
71.87
49.3928192
Removal of foot foreign body

T
0021
14.9563
920.58
219.48
184.1228193
Removal of foot foreign body

T
0020
6.5128
400.87
98.57
80.1728200
Repair of foot tendon

T
0055
20.2255
1,244.90
355.34
248.9828202
Repair/graft of foot tendon

T
0055
20.2255
1,244.90
355.34
248.9828208
Repair of foot tendon

T
0055
20.2255
1,244.90
355.34
248.9828210
Repair/graft of foot tendon

T
0056
41.2239
2,537.37

507.4728220
Release of foot tendon

T
0055
20.2255
1,244.90
355.34
248.98( print page 49778)28222
Release of foot tendons

T
0055
20.2255
1,244.90
355.34
248.9828225
Release of foot tendon

T
0055
20.2255
1,244.90
355.34
248.9828226
Release of foot tendons

T
0055
20.2255
1,244.90
355.34
248.9828230
Incision of foot tendon(s)

T
0055
20.2255
1,244.90
355.34
248.9828232
Incision of toe tendon

T
0055
20.2255
1,244.90
355.34
248.9828234
Incision of foot tendon

T
0055
20.2255
1,244.90
355.34
248.9828238
Revision of foot tendon

T
0056
41.2239
2,537.37

507.4728240
Release of big toe

T
0055
20.2255
1,244.90
355.34
248.9828250
Revision of foot fascia

T
0055
20.2255
1,244.90
355.34
248.9828260
Release of midfoot joint

T
0055
20.2255
1,244.90
355.34
248.9828261
Revision of foot tendon

T
0055
20.2255
1,244.90
355.34
248.9828262
Revision of foot and ankle

T
0055
20.2255
1,244.90
355.34
248.9828264
Release of midfoot joint

T
0056
41.2239
2,537.37

507.4728270
Release of foot contracture

T
0055
20.2255
1,244.90
355.34
248.9828272
Release of toe joint, each

T
0055
20.2255
1,244.90
355.34
248.9828280
Fusion of toes

T
0055
20.2255
1,244.90
355.34
248.9828285
Repair of hammertoe

T
0055
20.2255
1,244.90
355.34
248.9828286
Repair of hammertoe

T
0055
20.2255
1,244.90
355.34
248.9828288
Partial removal of foot bone

T
0055
20.2255
1,244.90
355.34
248.9828289
Repair hallux rigidus

T
0055
20.2255
1,244.90
355.34
248.9828290
Correction of bunion

T
0057
28.0970
1,729.40
475.91
345.8828292
Correction of bunion

T
0057
28.0970
1,729.40
475.91
345.8828293
Correction of bunion

T
0057
28.0970
1,729.40
475.91
345.8828294
Correction of bunion

T
0057
28.0970
1,729.40
475.91
345.8828296
Correction of bunion

T
0057
28.0970
1,729.40
475.91
345.8828297
Correction of bunion

T
0057
28.0970
1,729.40
475.91
345.8828298
Correction of bunion

T
0057
28.0970
1,729.40
475.91
345.8828299
Correction of bunion

T
0057
28.0970
1,729.40
475.91
345.8828300
Incision of heel bone

T
0056
41.2239
2,537.37

507.4728302
Incision of ankle bone

T
0055
20.2255
1,244.90
355.34
248.9828304
Incision of midfoot bones

T
0056
41.2239
2,537.37

507.4728305
Incise/graft midfoot bones

T
0056
41.2239
2,537.37

507.4728306
Incision of metatarsal

T
0055
20.2255
1,244.90
355.34
248.9828307
Incision of metatarsal

T
0055
20.2255
1,244.90
355.34
248.9828308
Incision of metatarsal

T
0055
20.2255
1,244.90
355.34
248.9828309
Incision of metatarsals

T
0056
41.2239
2,537.37

507.4728310
Revision of big toe

T
0055
20.2255
1,244.90
355.34
248.9828312
Revision of toe

T
0055
20.2255
1,244.90
355.34
248.9828313
Repair deformity of toe

T
0055
20.2255
1,244.90
355.34
248.9828315
Removal of sesamoid bone

T
0055
20.2255
1,244.90
355.34
248.9828320
Repair of foot bones

T
0056
41.2239
2,537.37

507.4728322
Repair of metatarsals

T
0056
41.2239
2,537.37

507.4728340
Resect enlarged toe tissue

T
0055
20.2255
1,244.90
355.34
248.9828341
Resect enlarged toe

T
0055
20.2255
1,244.90
355.34
248.9828344
Repair extra toe(s)

T
0055
20.2255
1,244.90
355.34
248.9828345
Repair webbed toe(s)

T
0055
20.2255
1,244.90
355.34
248.9828360
Reconstruct cleft foot

T
0056
41.2239
2,537.37

507.4728400
Treatment of heel fracture

T
0043
1.6914
104.11

20.8228405
Treatment of heel fracture

T
0043
1.6914
104.11

20.8228406
Treatment of heel fracture
CH
T
0062
25.6702
1,580.03
375.46
316.0128415
Treat heel fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4728420
Treat/graft heel fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4728430
Treatment of ankle fracture

T
0043
1.6914
104.11

20.8228435
Treatment of ankle fracture

T
0043
1.6914
104.11

20.8228436
Treatment of ankle fracture
CH
T
0062
25.6702
1,580.03
375.46
316.0128445
Treat ankle fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4728450
Treat midfoot fracture, each

T
0043
1.6914
104.11

20.8228455
Treat midfoot fracture, each

T
0043
1.6914
104.11

20.8228456
Treat midfoot fracture
CH
T
0062
25.6702
1,580.03
375.46
316.0128465
Treat midfoot fracture, each
CH
T
0063
37.5680
2,312.35
549.49
462.4728470
Treat metatarsal fracture

T
0043
1.6914
104.11

20.8228475
Treat metatarsal fracture

T
0043
1.6914
104.11

20.8228476
Treat metatarsal fracture
CH
T
0062
25.6702
1,580.03
375.46
316.0128485
Treat metatarsal fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4728490
Treat big toe fracture

T
0043
1.6914
104.11

20.8228495
Treat big toe fracture

T
0043
1.6914
104.11

20.8228496
Treat big toe fracture
CH
T
0062
25.6702
1,580.03
375.46
316.0128505
Treat big toe fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4728510
Treatment of toe fracture

T
0043
1.6914
104.11

20.8228515
Treatment of toe fracture

T
0043
1.6914
104.11

20.82( print page 49779)28525
Treat toe fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4728530
Treat sesamoid bone fracture

T
0043
1.6914
104.11

20.8228531
Treat sesamoid bone fracture
CH
T
0063
37.5680
2,312.35
549.49
462.4728540
Treat foot dislocation

T
0043
1.6914
104.11

20.8228545
Treat foot dislocation
CH
T
0062
25.6702
1,580.03
375.46
316.0128546
Treat foot dislocation
CH
T
0062
25.6702
1,580.03
375.46
316.0128555
Repair foot dislocation
CH
T
0063
37.5680
2,312.35
549.49
462.4728570
Treat foot dislocation

T
0043
1.6914
104.11

20.8228575
Treat foot dislocation

T
0043
1.6914
104.11

20.8228576
Treat foot dislocation
CH
T
0062
25.6702
1,580.03
375.46
316.0128585
Repair foot dislocation
CH
T
0063
37.5680
2,312.35
549.49
462.4728600
Treat foot dislocation

T
0043
1.6914
104.11

20.8228605
Treat foot dislocation

T
0043
1.6914
104.11

20.8228606
Treat foot dislocation
CH
T
0062
25.6702
1,580.03
375.46
316.0128615
Repair foot dislocation
CH
T
0063
37.5680
2,312.35
549.49
462.4728630
Treat toe dislocation

T
0043
1.6914
104.11

20.8228635
Treat toe dislocation

T
0045
14.5502
895.58
268.47
179.1228636
Treat toe dislocation
CH
T
0062
25.6702
1,580.03
375.46
316.0128645
Repair toe dislocation
CH
T
0063
37.5680
2,312.35
549.49
462.4728660
Treat toe dislocation

T
0043
1.6914
104.11

20.8228665
Treat toe dislocation

T
0045
14.5502
895.58
268.47
179.1228666
Treat toe dislocation
CH
T
0062
25.6702
1,580.03
375.46
316.0128675
Repair of toe dislocation
CH
T
0063
37.5680
2,312.35
549.49
462.4728705
Fusion of foot bones

T
0056
41.2239
2,537.37

507.4728715
Fusion of foot bones

T
0056
41.2239
2,537.37

507.4728725
Fusion of foot bones

T
0056
41.2239
2,537.37

507.4728730
Fusion of foot bones

T
0056
41.2239
2,537.37

507.4728735
Fusion of foot bones

T
0056
41.2239
2,537.37

507.4728737
Revision of foot bones

T
0056
41.2239
2,537.37

507.4728740
Fusion of foot bones

T
0056
41.2239
2,537.37

507.4728750
Fusion of big toe joint

T
0056
41.2239
2,537.37

507.4728755
Fusion of big toe joint

T
0055
20.2255
1,244.90
355.34
248.9828760
Fusion of big toe joint

T
0056
41.2239
2,537.37

507.4728810
Amputation toemetatarsal

T
0055
20.2255
1,244.90
355.34
248.9828820
Amputation of toe

T
0055
20.2255
1,244.90
355.34
248.9828825
Partial amputation of toe

T
0055
20.2255
1,244.90
355.34
248.9828890
High energy eswt, plantar f
CH
T
0050
25.0600
1,542.47

308.4928899
Foot/toes surgery procedure

T
0043
1.6914
104.11

20.8229000
Application of body cast

S
0058
1.0504
64.65

12.9329010
Application of body cast

S
0426
2.2728
139.89

27.9829015
Application of body cast

S
0426
2.2728
139.89

27.9829020
Application of body cast

S
0058
1.0504
64.65

12.9329025
Application of body cast

S
0058
1.0504
64.65

12.9329035
Application of body cast

S
0426
2.2728
139.89

27.9829040
Application of body cast

S
0058
1.0504
64.65

12.9329044
Application of body cast

S
0426
2.2728
139.89

27.9829046
Application of body cast

S
0426
2.2728
139.89

27.9829049
Application of figure eight

S
0058
1.0504
64.65

12.9329055
Application of shoulder cast

S
0426
2.2728
139.89

27.9829058
Application of shoulder cast

S
0058
1.0504
64.65

12.9329065
Application of long arm cast

S
0426
2.2728
139.89

27.9829075
Application of forearm cast

S
0426
2.2728
139.89

27.9829085
Apply hand/wrist cast

S
0058
1.0504
64.65

12.9329086
Apply finger cast

S
0058
1.0504
64.65

12.9329105
Apply long arm splint

S
0058
1.0504
64.65

12.9329125
Apply forearm splint

S
0058
1.0504
64.65

12.9329126
Apply forearm splint

S
0058
1.0504
64.65

12.9329130
Application of finger splint

S
0058
1.0504
64.65

12.9329131
Application of finger splint

S
0058
1.0504
64.65

12.9329200
Strapping of chest

S
0058
1.0504
64.65

12.9329220
Strapping of low back

S
0058
1.0504
64.65

12.9329240
Strapping of shoulder

S
0058
1.0504
64.65

12.9329260
Strapping of elbow or wrist

S
0058
1.0504
64.65

12.9329280
Strapping of hand or finger

S
0058
1.0504
64.65

12.9329305
Application of hip cast

S
0426
2.2728
139.89

27.9829325
Application of hip casts

S
0426
2.2728
139.89

27.9829345
Application of long leg cast

S
0426
2.2728
139.89

27.9829355
Application of long leg cast

S
0426
2.2728
139.89

27.9829358
Apply long leg cast brace

S
0426
2.2728
139.89

27.9829365
Application of long leg cast

S
0426
2.2728
139.89

27.98( print page 49780)29405
Apply short leg cast

S
0426
2.2728
139.89

27.9829425
Apply short leg cast

S
0426
2.2728
139.89

27.9829435
Apply short leg cast

S
0426
2.2728
139.89

27.9829440
Addition of walker to cast

S
0058
1.0504
64.65

12.9329445
Apply rigid leg cast

S
0426
2.2728
139.89

27.9829450
Application of leg cast

S
0058
1.0504
64.65

12.9329505
Application, long leg splint

S
0058
1.0504
64.65

12.9329515
Application lower leg splint

S
0058
1.0504
64.65

12.9329520
Strapping of hip

S
0058
1.0504
64.65

12.9329530
Strapping of knee

S
0058
1.0504
64.65

12.9329540
Strapping of ankle and/or ft

S
0058
1.0504
64.65

12.9329550
Strapping of toes

S
0058
1.0504
64.65

12.9329580
Application of paste boot

S
0058
1.0504
64.65

12.9329590
Application of foot splint

S
0058
1.0504
64.65

12.9329700
Removal/revision of cast

S
0058
1.0504
64.65

12.9329705
Removal/revision of cast

S
0058
1.0504
64.65

12.9329710
Removal/revision of cast

S
0426
2.2728
139.89

27.9829715
Removal/revision of cast

S
0058
1.0504
64.65

12.9329720
Repair of body cast

S
0058
1.0504
64.65

12.9329730
Windowing of cast

S
0058
1.0504
64.65

12.9329740
Wedging of cast

S
0058
1.0504
64.65

12.9329750
Wedging of clubfoot cast

S
0058
1.0504
64.65

12.9329799
Casting/strapping procedure

S
0058
1.0504
64.65

12.9329800
Jaw arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229804
Jaw arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229805
Shoulder arthroscopy, dx

T
0041
28.6279
1,762.08

352.4229806
Shoulder arthroscopy/surgery

T
0042
45.0637
2,773.72
804.74
554.7429807
Shoulder arthroscopy/surgery

T
0042
45.0637
2,773.72
804.74
554.7429819
Shoulder arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229820
Shoulder arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229821
Shoulder arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229822
Shoulder arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229823
Shoulder arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229824
Shoulder arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229825
Shoulder arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229826
Shoulder arthroscopy/surgery

T
0042
45.0637
2,773.72
804.74
554.7429827
Arthroscop rotator cuff repr

T
0042
45.0637
2,773.72
804.74
554.7429830
Elbow arthroscopy

T
0041
28.6279
1,762.08

352.4229834
Elbow arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229835
Elbow arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229836
Elbow arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229837
Elbow arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229838
Elbow arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229840
Wrist arthroscopy

T
0041
28.6279
1,762.08

352.4229843
Wrist arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229844
Wrist arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229845
Wrist arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229846
Wrist arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229847
Wrist arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229848
Wrist endoscopy/surgery

T
0041
28.6279
1,762.08

352.4229850
Knee arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229851
Knee arthroscopy/surgery

T
0042
45.0637
2,773.72
804.74
554.7429855
Tibial arthroscopy/surgery

T
0042
45.0637
2,773.72
804.74
554.7429856
Tibial arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229860
Hip arthroscopy, dx

T
0041
28.6279
1,762.08

352.4229861
Hip arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229862
Hip arthroscopy/surgery

T
0042
45.0637
2,773.72
804.74
554.7429863
Hip arthroscopy/surgery

T
0042
45.0637
2,773.72
804.74
554.7429866
Autgrft implnt, knee w/scope

T
0042
45.0637
2,773.72
804.74
554.7429867
Allgrft implnt, knee w/scope

T
0042
45.0637
2,773.72
804.74
554.7429868
Meniscal trnspl, knee w/scpe

T
0042
45.0637
2,773.72
804.74
554.7429870
Knee arthroscopy, dx

T
0041
28.6279
1,762.08

352.4229871
Knee arthroscopy/drainage

T
0041
28.6279
1,762.08

352.4229873
Knee arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229874
Knee arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229875
Knee arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229876
Knee arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229877
Knee arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229879
Knee arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229880
Knee arthroscopy/surgery

T
0041
28.6279
1,762.08

352.42( print page 49781)29881
Knee arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229882
Knee arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229883
Knee arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229884
Knee arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229885
Knee arthroscopy/surgery

T
0042
45.0637
2,773.72
804.74
554.7429886
Knee arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229887
Knee arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229888
Knee arthroscopy/surgery

T
0042
45.0637
2,773.72
804.74
554.7429889
Knee arthroscopy/surgery

T
0042
45.0637
2,773.72
804.74
554.7429891
Ankle arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229892
Ankle arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229893
Scope, plantar fasciotomy

T
0055
20.2255
1,244.90
355.34
248.9829894
Ankle arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229895
Ankle arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229897
Ankle arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229898
Ankle arthroscopy/surgery

T
0041
28.6279
1,762.08

352.4229899
Ankle arthroscopy/surgery

T
0042
45.0637
2,773.72
804.74
554.7429900
Mcp joint arthroscopy, dx

T
0053
16.0343
986.93
253.49
197.3929901
Mcp joint arthroscopy, surg

T
0053
16.0343
986.93
253.49
197.3929902
Mcp joint arthroscopy, surg

T
0053
16.0343
986.93
253.49
197.3929999
Arthroscopy of joint

T
0252
7.7261
475.55
111.84
95.1130110
Removal of nose polyp(s)

T
0253
16.4494
1,012.48
282.29
202.5030115
Removal of nose polyp(s)

T
0253
16.4494
1,012.48
282.29
202.5030117
Removal of intranasal lesion

T
0253
16.4494
1,012.48
282.29
202.5030118
Removal of intranasal lesion

T
0254
23.1564
1,425.30
321.35
285.0630120
Revision of nose

T
0253
16.4494
1,012.48
282.29
202.5030124
Removal of nose lesion

T
0252
7.7261
475.55
111.84
95.1130125
Removal of nose lesion

T
0256
37.7719
2,324.90

464.9830130
Excise inferior turbinate

T
0253
16.4494
1,012.48
282.29
202.5030140
Resect inferior turbinate

T
0254
23.1564
1,425.30
321.35
285.0630150
Partial removal of nose

T
0256
37.7719
2,324.90

464.9830160
Removal of nose

T
0256
37.7719
2,324.90

464.9830200
Injection treatment of nose

T
0252
7.7261
475.55
111.84
95.1130210
Nasal sinus therapy

T
0252
7.7261
475.55
111.84
95.1130220
Insert nasal septal button

T
0252
7.7261
475.55
111.84
95.1130300
Remove nasal foreign body

X
0340
0.6211
38.23

7.6530310
Remove nasal foreign body

T
0253
16.4494
1,012.48
282.29
202.5030320
Remove nasal foreign body

T
0253
16.4494
1,012.48
282.29
202.5030400
Reconstruction of nose

T
0256
37.7719
2,324.90

464.9830410
Reconstruction of nose

T
0256
37.7719
2,324.90

464.9830420
Reconstruction of nose

T
0256
37.7719
2,324.90

464.9830430
Revision of nose

T
0254
23.1564
1,425.30
321.35
285.0630435
Revision of nose

T
0256
37.7719
2,324.90

464.9830450
Revision of nose

T
0256
37.7719
2,324.90

464.9830460
Revision of nose

T
0256
37.7719
2,324.90

464.9830462
Revision of nose

T
0256
37.7719
2,324.90

464.9830465
Repair nasal stenosis

T
0256
37.7719
2,324.90

464.9830520
Repair of nasal septum

T
0254
23.1564
1,425.30
321.35
285.0630540
Repair nasal defect

T
0256
37.7719
2,324.90

464.9830545
Repair nasal defect

T
0256
37.7719
2,324.90

464.9830560
Release of nasal adhesions

T
0251
2.3768
146.29

29.2630580
Repair upper jaw fistula

T
0256
37.7719
2,324.90

464.9830600
Repair mouth/nose fistula

T
0256
37.7719
2,324.90

464.9830620
Intranasal reconstruction

T
0256
37.7719
2,324.90

464.9830630
Repair nasal septum defect

T
0254
23.1564
1,425.30
321.35
285.0630801
Ablate inf turbinate, superf

T
0252
7.7261
475.55
111.84
95.1130802
Cauterization, inner nose

T
0252
7.7261
475.55
111.84
95.1130901
Control of nosebleed

T
0250
1.2021
73.99
25.50
14.8030903
Control of nosebleed

T
0250
1.2021
73.99
25.50
14.8030905
Control of nosebleed

T
0250
1.2021
73.99
25.50
14.8030906
Repeat control of nosebleed

T
0250
1.2021
73.99
25.50
14.8030915
Ligation, nasal sinus artery
CH
T
0092
24.5817
1,513.03
306.56
302.6130920
Ligation, upper jaw artery

T
0092
24.5817
1,513.03
306.56
302.6130930
Ther fx, nasal inf turbinate

T
0253
16.4494
1,012.48
282.29
202.5030999
Nasal surgery procedure

T
0251
2.3768
146.29

29.2631000
Irrigation, maxillary sinus

T
0251
2.3768
146.29

29.2631002
Irrigation, sphenoid sinus

T
0252
7.7261
475.55
111.84
95.1131020
Exploration, maxillary sinus

T
0254
23.1564
1,425.30
321.35
285.0631030
Exploration, maxillary sinus

T
0256
37.7719
2,324.90

464.9831032
Explore sinus, remove polyps

T
0256
37.7719
2,324.90

464.98( print page 49782)31040
Exploration behind upper jaw

T
0254
23.1564
1,425.30
321.35
285.0631050
Exploration, sphenoid sinus

T
0256
37.7719
2,324.90

464.9831051
Sphenoid sinus surgery

T
0256
37.7719
2,324.90

464.9831070
Exploration of frontal sinus

T
0254
23.1564
1,425.30
321.35
285.0631075
Exploration of frontal sinus

T
0256
37.7719
2,324.90

464.9831080
Removal of frontal sinus

T
0256
37.7719
2,324.90

464.9831081
Removal of frontal sinus

T
0256
37.7719
2,324.90

464.9831084
Removal of frontal sinus

T
0256
37.7719
2,324.90

464.9831085
Removal of frontal sinus

T
0256
37.7719
2,324.90

464.9831086
Removal of frontal sinus

T
0256
37.7719
2,324.90

464.9831087
Removal of frontal sinus

T
0256
37.7719
2,324.90

464.9831090
Exploration of sinuses

T
0256
37.7719
2,324.90

464.9831200
Removal of ethmoid sinus

T
0256
37.7719
2,324.90

464.9831201
Removal of ethmoid sinus

T
0256
37.7719
2,324.90

464.9831205
Removal of ethmoid sinus

T
0256
37.7719
2,324.90

464.9831231
Nasal endoscopy, dx

T
0072
1.4038
86.41
21.27
17.2831233
Nasal/sinus endoscopy, dx

T
0072
1.4038
86.41
21.27
17.2831235
Nasal/sinus endoscopy, dx

T
0074
15.1300
931.27
295.70
186.2531237
Nasal/sinus endoscopy, surg
CH
T
0074
15.1300
931.27
295.70
186.2531238
Nasal/sinus endoscopy, surg

T
0074
15.1300
931.27
295.70
186.2531239
Nasal/sinus endoscopy, surg

T
0075
21.8010
1,341.87
445.92
268.3731240
Nasal/sinus endoscopy, surg

T
0074
15.1300
931.27
295.70
186.2531254
Revision of ethmoid sinus

T
0075
21.8010
1,341.87
445.92
268.3731255
Removal of ethmoid sinus

T
0075
21.8010
1,341.87
445.92
268.3731256
Exploration maxillary sinus

T
0075
21.8010
1,341.87
445.92
268.3731267
Endoscopy, maxillary sinus

T
0075
21.8010
1,341.87
445.92
268.3731276
Sinus endoscopy, surgical

T
0075
21.8010
1,341.87
445.92
268.3731287
Nasal/sinus endoscopy, surg

T
0075
21.8010
1,341.87
445.92
268.3731288
Nasal/sinus endoscopy, surg

T
0075
21.8010
1,341.87
445.92
268.3731292
Nasal/sinus endoscopy, surg

T
0075
21.8010
1,341.87
445.92
268.3731293
Nasal/sinus endoscopy, surg

T
0075
21.8010
1,341.87
445.92
268.3731294
Nasal/sinus endoscopy, surg

T
0075
21.8010
1,341.87
445.92
268.3731299
Sinus surgery procedure

T
0251
2.3768
146.29

29.2631300
Removal of larynx lesion

T
0254
23.1564
1,425.30
321.35
285.0631320
Diagnostic incision, larynx

T
0256
37.7719
2,324.90

464.9831400
Revision of larynx

T
0256
37.7719
2,324.90

464.9831420
Removal of epiglottis

T
0256
37.7719
2,324.90

464.9831500
Insert emergency airway

S
0094
2.4630
151.60
46.29
30.3231502
Change of windpipe airway

T
0121
2.3431
144.22
43.80
28.8431505
Diagnostic laryngoscopy

T
0071
0.7572
46.61
11.03
9.3231510
Laryngoscopy with biopsy

T
0074
15.1300
931.27
295.70
186.2531511
Remove foreign body, larynx

T
0072
1.4038
86.41
21.27
17.2831512
Removal of larynx lesion

T
0074
15.1300
931.27
295.70
186.2531513
Injection into vocal cord

T
0072
1.4038
86.41
21.27
17.2831515
Laryngoscopy for aspiration

T
0074
15.1300
931.27
295.70
186.2531520
Dx laryngoscopy, newborn

T
0072
1.4038
86.41
21.27
17.2831525
Dx laryngoscopy excl nb

T
0074
15.1300
931.27
295.70
186.2531526
Dx laryngoscopy w/oper scope

T
0075
21.8010
1,341.87
445.92
268.3731527
Laryngoscopy for treatment

T
0075
21.8010
1,341.87
445.92
268.3731528
Laryngoscopy and dilation

T
0074
15.1300
931.27
295.70
186.2531529
Laryngoscopy and dilation

T
0074
15.1300
931.27
295.70
186.2531530
Laryngoscopy w/fb removal

T
0075
21.8010
1,341.87
445.92
268.3731531
Laryngoscopy w/fbop scope

T
0075
21.8010
1,341.87
445.92
268.3731535
Laryngoscopy w/biopsy

T
0075
21.8010
1,341.87
445.92
268.3731536
Laryngoscopy w/bxop scope

T
0075
21.8010
1,341.87
445.92
268.3731540
Laryngoscopy w/exc of tumor

T
0075
21.8010
1,341.87
445.92
268.3731541
Larynscop w/tumr exc + scope

T
0075
21.8010
1,341.87
445.92
268.3731545
Remove vc lesion w/scope

T
0075
21.8010
1,341.87
445.92
268.3731546
Remove vc lesion scope/graft

T
0075
21.8010
1,341.87
445.92
268.3731560
Laryngoscop w/arytenoidectom

T
0075
21.8010
1,341.87
445.92
268.3731561
Larynscop, remve cart + scop

T
0075
21.8010
1,341.87
445.92
268.3731570
Laryngoscope w/vc inj

T
0074
15.1300
931.27
295.70
186.2531571
Laryngoscop w/vc inj + scope

T
0075
21.8010
1,341.87
445.92
268.3731575
Diagnostic laryngoscopy

T
0072
1.4038
86.41
21.27
17.2831576
Laryngoscopy with biopsy

T
0075
21.8010
1,341.87
445.92
268.3731577
Remove foreign body, larynx

T
0073
3.8737
238.43
69.72
47.6931578
Removal of larynx lesion

T
0075
21.8010
1,341.87
445.92
268.3731579
Diagnostic laryngoscopy

T
0073
3.8737
238.43
69.72
47.6931580
Revision of larynx

T
0256
37.7719
2,324.90

464.9831582
Revision of larynx

T
0256
37.7719
2,324.90

464.98( print page 49783)31588
Revision of larynx

T
0256
37.7719
2,324.90

464.9831590
Reinnervate larynx

T
0256
37.7719
2,324.90

464.9831595
Larynx nerve surgery

T
0256
37.7719
2,324.90

464.9831599
Larynx surgery procedure

T
0251
2.3768
146.29

29.2631600
Incision of windpipe

T
0254
23.1564
1,425.30
321.35
285.0631601
Incision of windpipe

T
0254
23.1564
1,425.30
321.35
285.0631603
Incision of windpipe

T
0252
7.7261
475.55
111.84
95.1131605
Incision of windpipe

T
0252
7.7261
475.55
111.84
95.1131610
Incision of windpipe

T
0254
23.1564
1,425.30
321.35
285.0631611
Surgery/speech prosthesis

T
0254
23.1564
1,425.30
321.35
285.0631612
Puncture/clear windpipe

T
0254
23.1564
1,425.30
321.35
285.0631613
Repair windpipe opening

T
0254
23.1564
1,425.30
321.35
285.0631614
Repair windpipe opening

T
0256
37.7719
2,324.90

464.9831615
Visualization of windpipe

T
0076
9.3905
577.99
189.82
115.6031620
Endobronchial us add-on

S
0670
29.7322
1,830.05
536.10
366.0131622
Dx bronchoscope/wash

T
0076
9.3905
577.99
189.82
115.6031623
Dx bronchoscope/brush

T
0076
9.3905
577.99
189.82
115.6031624
Dx bronchoscope/lavage

T
0076
9.3905
577.99
189.82
115.6031625
Bronchoscopy w/biopsy(s)

T
0076
9.3905
577.99
189.82
115.6031628
Bronchoscopy/lung bx, each

T
0076
9.3905
577.99
189.82
115.6031629
Bronchoscopy/needle bx, each

T
0076
9.3905
577.99
189.82
115.6031630
Bronchoscopy dilate/fx repr

T
0415
21.8803
1,346.75
459.92
269.3531631
Bronchoscopy, dilate w/stent

T
0415
21.8803
1,346.75
459.92
269.3531632
Bronchoscopy/lung bx, add'l

T
0076
9.3905
577.99
189.82
115.6031633
Bronchoscopy/needle bx add'l

T
0076
9.3905
577.99
189.82
115.6031635
Bronchoscopy w/fb removal

T
0076
9.3905
577.99
189.82
115.6031636
Bronchoscopy, bronch stents

T
0415
21.8803
1,346.75
459.92
269.3531637
Bronchoscopy, stent add-on

T
0076
9.3905
577.99
189.82
115.6031638
Bronchoscopy, revise stent

T
0415
21.8803
1,346.75
459.92
269.3531640
Bronchoscopy w/tumor excise

T
0415
21.8803
1,346.75
459.92
269.3531641
Bronchoscopy, treat blockage

T
0415
21.8803
1,346.75
459.92
269.3531643
Diag bronchoscope/catheter

T
0076
9.3905
577.99
189.82
115.6031645
Bronchoscopy, clear airways

T
0076
9.3905
577.99
189.82
115.6031646
Bronchoscopy, reclear airway

T
0076
9.3905
577.99
189.82
115.6031656
Bronchoscopy, inj for x-ray

T
0076
9.3905
577.99
189.82
115.6031700
Insertion of airway catheter

T
0072
1.4038
86.41
21.27
17.2831708
Instill airway contrast dye

N31710
Insertion of airway catheter

N31715
Injection for bronchus x-ray

N31717
Bronchial brush biopsy

T
0073
3.8737
238.43
69.72
47.6931720
Clearance of airways

T
0071
0.7572
46.61
11.03
9.3231730
Intro, windpipe wire/tube

T
0073
3.8737
238.43
69.72
47.6931750
Repair of windpipe

T
0256
37.7719
2,324.90

464.9831755
Repair of windpipe

T
0256
37.7719
2,324.90

464.9831785
Remove windpipe lesion

T
0254
23.1564
1,425.30
321.35
285.0631820
Closure of windpipe lesion

T
0253
16.4494
1,012.48
282.29
202.5031825
Repair of windpipe defect

T
0254
23.1564
1,425.30
321.35
285.0631830
Revise windpipe scar

T
0254
23.1564
1,425.30
321.35
285.0631899
Airways surgical procedure

T
0076
9.3905
577.99
189.82
115.6032000
Drainage of chest

T
0070
3.6425
224.20

44.8432002
Treatment of collapsed lung

T
0070
3.6425
224.20

44.8432005
Treat lung lining chemically

T
0070
3.6425
224.20

44.8432019
Insert pleural catheter
CH
T
0652
29.2259
1,798.88

359.7832020
Insertion of chest tube

T
0070
3.6425
224.20

44.8432201
Drain, percut, lung lesion

T
0070
3.6425
224.20

44.8432400
Needle biopsy chest lining

T
0685
6.0729
373.79
115.47
74.7632405
Biopsy, lung or mediastinum

T
0685
6.0729
373.79
115.47
74.7632420
Puncture/clear lung

T
0070
3.6425
224.20

44.8432601
Thoracoscopy, diagnostic

T
0069
31.5464
1,941.71
591.64
388.3432602
Thoracoscopy, diagnostic

T
0069
31.5464
1,941.71
591.64
388.3432603
Thoracoscopy, diagnostic

T
0069
31.5464
1,941.71
591.64
388.3432604
Thoracoscopy, diagnostic

T
0069
31.5464
1,941.71
591.64
388.3432605
Thoracoscopy, diagnostic

T
0069
31.5464
1,941.71
591.64
388.3432606
Thoracoscopy, diagnostic

T
0069
31.5464
1,941.71
591.64
388.3432960
Therapeutic pneumothorax

T
0070
3.6425
224.20

44.8432999
Chest surgery procedure

T
0070
3.6425
224.20

44.8433010
Drainage of heart sac

T
0070
3.6425
224.20

44.8433011
Repeat drainage of heart sac

T
0070
3.6425
224.20

44.8433206
Insertion of heart pacemaker

T
0089
121.9402
7,505.54
1,682.28
1,501.1133207
Insertion of heart pacemaker

T
0089
121.9402
7,505.54
1,682.28
1,501.11( print page 49784)33208
Insertion of heart pacemaker

T
0655
153.1524
9,426.68

1,885.3433210
Insertion of heart electrode

T
0106
44.7574
2,754.86

550.9733211
Insertion of heart electrode

T
0106
44.7574
2,754.86

550.9733212
Insertion of pulse generator

T
0090
97.8357
6,021.89
1,612.80
1,204.3833213
Insertion of pulse generator

T
0654
112.2347
6,908.16

1,381.6333214
Upgrade of pacemaker system

T
0655
153.1524
9,426.68

1,885.3433215
Reposition pacing-defib lead

T
0105
23.4666
1,444.39
370.40
288.8833216
Insert lead pace-defib, one

T
0106
44.7574
2,754.86

550.9733217
Insert lead pace-defib, dual

T
0106
44.7574
2,754.86

550.9733218
Repair lead pace-defib, one

T
0106
44.7574
2,754.86

550.9733220
Repair lead pace-defib, dual

T
0106
44.7574
2,754.86

550.9733222
Revise pocket, pacemaker

T
0027
21.2645
1,308.85
329.72
261.7733223
Revise pocket, pacing-defib

T
0027
21.2645
1,308.85
329.72
261.7733224
Insert pacing leadconnect

T
0418
267.8870
16,488.71

3,297.7433225
L ventric pacing lead add-on

T
0418
267.8870
16,488.71

3,297.7433226
Reposition l ventric lead

T
0105
23.4666
1,444.39
370.40
288.8833233
Removal of pacemaker system

T
0105
23.4666
1,444.39
370.40
288.8833234
Removal of pacemaker system

T
0105
23.4666
1,444.39
370.40
288.8833235
Removal pacemaker electrode

T
0105
23.4666
1,444.39
370.40
288.8833241
Remove pulse generator

T
0105
23.4666
1,444.39
370.40
288.8833244
Remove eltrd, transven

T
0105
23.4666
1,444.39
370.40
288.8833282
Implant pat-active ht record

S
0680
74.8877
4,609.41

921.8833284
Remove pat-active ht record

T
0109
10.9541
674.24

134.8533508
Endoscopic vein harvest

N33999
Cardiac surgery procedure

T
0070
3.6425
224.20

44.8434101
Removal of artery clot

T
0088
37.9652
2,336.80
655.22
467.3634111
Removal of arm artery clot

T
0088
37.9652
2,336.80
655.22
467.3634201
Removal of artery clot

T
0088
37.9652
2,336.80
655.22
467.3634203
Removal of leg artery clot

T
0088
37.9652
2,336.80
655.22
467.3634421
Removal of vein clot

T
0088
37.9652
2,336.80
655.22
467.3634471
Removal of vein clot

T
0088
37.9652
2,336.80
655.22
467.3634490
Removal of vein clot

T
0088
37.9652
2,336.80
655.22
467.3634501
Repair valve, femoral vein

T
0088
37.9652
2,336.80
655.22
467.3634510
Transposition of vein valve

T
0088
37.9652
2,336.80
655.22
467.3634520
Cross-over vein graft

T
0088
37.9652
2,336.80
655.22
467.3634530
Leg vein fusion

T
0088
37.9652
2,336.80
655.22
467.3635011
Repair defect of artery

T
0653
31.0004
1,908.11

381.6235180
Repair blood vessel lesion

T
0093
21.9703
1,352.29

270.4635184
Repair blood vessel lesion

T
0093
21.9703
1,352.29

270.4635188
Repair blood vessel lesion

T
0088
37.9652
2,336.80
655.22
467.3635190
Repair blood vessel lesion

T
0093
21.9703
1,352.29

270.4635201
Repair blood vessel lesion

T
0093
21.9703
1,352.29

270.4635206
Repair blood vessel lesion

T
0093
21.9703
1,352.29

270.4635207
Repair blood vessel lesion

T
0088
37.9652
2,336.80
655.22
467.3635226
Repair blood vessel lesion

T
0093
21.9703
1,352.29

270.4635231
Repair blood vessel lesion

T
0093
21.9703
1,352.29

270.4635236
Repair blood vessel lesion

T
0093
21.9703
1,352.29

270.4635256
Repair blood vessel lesion

T
0093
21.9703
1,352.29

270.4635261
Repair blood vessel lesion

T
0653
31.0004
1,908.11

381.6235266
Repair blood vessel lesion

T
0653
31.0004
1,908.11

381.6235286
Repair blood vessel lesion

T
0653
31.0004
1,908.11

381.6235321
Rechanneling of artery

T
0093
21.9703
1,352.29

270.4635458
Repair arterial blockage

T
0081
42.8894
2,639.89

527.9835459
Repair arterial blockage

T
0081
42.8894
2,639.89

527.9835460
Repair venous blockage

T
0081
42.8894
2,639.89

527.9835470
Repair arterial blockage

T
0081
42.8894
2,639.89

527.9835471
Repair arterial blockage

T
0081
42.8894
2,639.89

527.9835472
Repair arterial blockage

T
0081
42.8894
2,639.89

527.9835473
Repair arterial blockage

T
0081
42.8894
2,639.89

527.9835474
Repair arterial blockage

T
0081
42.8894
2,639.89

527.9835475
Repair arterial blockage

T
0081
42.8894
2,639.89

527.9835476
Repair venous blockage

T
0081
42.8894
2,639.89

527.9835484
Atherectomy, open

T
0081
42.8894
2,639.89

527.9835485
Atherectomy, open

T
0081
42.8894
2,639.89

527.9835490
Atherectomy, percutaneous

T
0081
42.8894
2,639.89

527.9835491
Atherectomy, percutaneous

T
0081
42.8894
2,639.89

527.9835492
Atherectomy, percutaneous

T
0081
42.8894
2,639.89

527.9835493
Atherectomy, percutaneous

T
0081
42.8894
2,639.89

527.9835494
Atherectomy, percutaneous

T
0081
42.8894
2,639.89

527.9835495
Atherectomy, percutaneous

T
0081
42.8894
2,639.89

527.98( print page 49785)35500
Harvest vein for bypass

T
0081
42.8894
2,639.89

527.9835572
Harvest femoropopliteal vein

N35685
Bypass graft patency/patch

T
0093
21.9703
1,352.29

270.4635686
Bypass graft/av fist patency

T
0093
21.9703
1,352.29

270.4635761
Exploration of artery/vein

T
0115
29.4757
1,814.26
378.68
362.8535860
Explore limb vessels

T
0093
21.9703
1,352.29

270.4635875
Removal of clot in graft

T
0088
37.9652
2,336.80
655.22
467.3635876
Removal of clot in graft

T
0088
37.9652
2,336.80
655.22
467.3635879
Revise graft w/vein

T
0088
37.9652
2,336.80
655.22
467.3635881
Revise graft w/vein

T
0088
37.9652
2,336.80
655.22
467.3635903
Excision, graft, extremity

T
0115
29.4757
1,814.26
378.68
362.8536000
Place needle in vein

N36002
Pseudoaneurysm injection trt

S
0267
2.5166
154.90
60.80
30.9836005
Injection ext venography

N36010
Place catheter in vein

N36011
Place catheter in vein

N36012
Place catheter in vein

N36013
Place catheter in artery

N36014
Place catheter in artery

N36015
Place catheter in artery

N36100
Establish access to artery

N36120
Establish access to artery

N36140
Establish access to artery

N36145
Artery to vein shunt

N36160
Establish access to aorta

N36200
Place catheter in aorta

N36215
Place catheter in artery

N36216
Place catheter in artery

N36217
Place catheter in artery

N36218
Place catheter in artery

N36245
Place catheter in artery

N36246
Place catheter in artery

N36247
Place catheter in artery

N36248
Place catheter in artery

N36260
Insertion of infusion pump

T
0623
28.4646
1,752.02

350.4036261
Revision of infusion pump

T
0623
28.4646
1,752.02

350.4036262
Removal of infusion pump

T
0622
22.6984
1,397.11

279.4236299
Vessel injection procedure

N36400
Bl draw  3 yrs fem/jugular

N36405
Bl draw  3 yrs scalp vein

N36406
Bl draw  3 yrs other vein

N36410
Non-routine bl draw  3 yrs

N36416
Capillary blood draw

N36420
Vein access cutdown  1 yr

T
0035
0.2016
12.41

2.4836425
Vein access cutdown  1 yr

T
0035
0.2016
12.41

2.4836430
Blood transfusion service

S
0110
3.4570
212.78

42.5636440
Bl push transfuse, 2 yr or

S
0110
3.4570
212.78

42.5636450
Bl exchange/transfuse, nb

S
0110
3.4570
212.78

42.5636455
Bl exchange/transfuse non-nb

S
0110
3.4570
212.78

42.5636460
Transfusion service, fetal

S
0110
3.4570
212.78

42.5636468
Injection(s), spider veins

T
0098
1.1035
67.92

13.5836469
Injection(s), spider veins

T
0098
1.1035
67.92

13.5836470
Injection therapy of vein

T
0098
1.1035
67.92

13.5836471
Injection therapy of veins

T
0098
1.1035
67.92

13.5836475
Endovenous rf, 1st vein

T
0091
34.6279
2,131.38

426.2836476
Endovenous rf, vein add-on

T
0091
34.6279
2,131.38

426.2836478
Endovenous laser, 1st vein
CH
T
0092
24.5817
1,513.03
306.56
302.6136479
Endovenous laser vein addon
CH
T
0092
24.5817
1,513.03
306.56
302.6136481
Insertion of catheter, vein

N36500
Insertion of catheter, vein

N36510
Insertion of catheter, vein

N36511
Apheresis wbc

S
0111
11.7005
720.18
198.40
144.0436512
Apheresis rbc

S
0111
11.7005
720.18
198.40
144.0436513
Apheresis platelets

S
0111
11.7005
720.18
198.40
144.0436514
Apheresis plasma

S
0111
11.7005
720.18
198.40
144.0436515
Apheresis, adsorp/reinfuse

S
0112
30.6602
1,887.17
433.29
377.4336516
Apheresis, selective

S
0112
30.6602
1,887.17
433.29
377.4336522
Photopheresis

S
0112
30.6602
1,887.17
433.29
377.4336540
Collect blood venous device
CH
Q
0624
0.5336
32.84
13.13
6.5736550
Declot vascular device

T
0676
2.0612
126.87

25.37( print page 49786)36555
Insert non-tunnel cv cath

T
0621
8.7841
540.67

108.1336556
Insert non-tunnel cv cath

T
0621
8.7841
540.67

108.1336557
Insert tunneled cv cath

T
0622
22.6984
1,397.11

279.4236558
Insert tunneled cv cath

T
0622
22.6984
1,397.11

279.4236560
Insert tunneled cv cath

T
0623
28.4646
1,752.02

350.4036561
Insert tunneled cv cath

T
0623
28.4646
1,752.02

350.4036563
Insert tunneled cv cath

T
0623
28.4646
1,752.02

350.4036565
Insert tunneled cv cath

T
0623
28.4646
1,752.02

350.4036566
Insert tunneled cv cath
CH
T
0623
28.4646
1,752.02

350.4036568
Insert picc cath

T
0621
8.7841
540.67

108.1336569
Insert picc cath

T
0621
8.7841
540.67

108.1336570
Insert picvad cath

T
0622
22.6984
1,397.11

279.4236571
Insert picvad cath

T
0622
22.6984
1,397.11

279.4236575
Repair tunneled cv cath

T
0621
8.7841
540.67

108.1336576
Repair tunneled cv cath

T
0621
8.7841
540.67

108.1336578
Replace tunneled cv cath

T
0622
22.6984
1,397.11

279.4236580
Replace cvad cath

T
0621
8.7841
540.67

108.1336581
Replace tunneled cv cath

T
0622
22.6984
1,397.11

279.4236582
Replace tunneled cv cath

T
0623
28.4646
1,752.02

350.4036583
Replace tunneled cv cath

T
0623
28.4646
1,752.02

350.4036584
Replace picc cath

T
0621
8.7841
540.67

108.1336585
Replace picvad cath

T
0622
22.6984
1,397.11

279.4236589
Removal tunneled cv cath

T
0621
8.7841
540.67

108.1336590
Removal tunneled cv cath

T
0621
8.7841
540.67

108.1336595
Mech remov tunneled cv cath

T
0622
22.6984
1,397.11

279.4236596
Mech remov tunneled cv cath

T
0621
8.7841
540.67

108.1336597
Reposition venous catheter

T
0621
8.7841
540.67

108.1336598
Inj w/fluor, eval cv device

X
0340
0.6211
38.23

7.6536600
Withdrawal of arterial blood
CH
Q
0035
0.2016
12.41

2.4836620
Insertion catheter, artery

N36625
Insertion catheter, artery

N36640
Insertion catheter, artery

T
0623
28.4646
1,752.02

350.4036680
Insert needle, bone cavity

T
0002
1.0948
67.39

13.4836800
Insertion of cannula

T
0115
29.4757
1,814.26
378.68
362.8536810
Insertion of cannula

T
0115
29.4757
1,814.26
378.68
362.8536815
Insertion of cannula

T
0115
29.4757
1,814.26
378.68
362.8536818
Av fuse, uppr arm, cephalic

T
0088
37.9652
2,336.80
655.22
467.3636819
Av fuse, uppr arm, basilic

T
0088
37.9652
2,336.80
655.22
467.3636820
Av fusion/forearm vein

T
0088
37.9652
2,336.80
655.22
467.3636821
Av fusion direct any site

T
0088
37.9652
2,336.80
655.22
467.3636825
Artery-vein autograft

T
0088
37.9652
2,336.80
655.22
467.3636830
Artery-vein nonautograft

T
0088
37.9652
2,336.80
655.22
467.3636831
Open thrombect av fistula

T
0088
37.9652
2,336.80
655.22
467.3636832
Av fistula revision, open

T
0088
37.9652
2,336.80
655.22
467.3636833
Av fistula revision

T
0088
37.9652
2,336.80
655.22
467.3636834
Repair A-V aneurysm

T
0088
37.9652
2,336.80
655.22
467.3636835
Artery to vein shunt

T
0115
29.4757
1,814.26
378.68
362.8536838
Dist revas ligation, hemo

T
0088
37.9652
2,336.80
655.22
467.3636860
External cannula declotting

T
0676
2.0612
126.87

25.3736861
Cannula declotting

T
0115
29.4757
1,814.26
378.68
362.8536870
Percut thrombect av fistula

T
0653
31.0004
1,908.11

381.6237183
Remove hepatic shunt (tips)

T
0229
66.0804
4,067.31

813.4637184
Prim art mech thrombectomy

T
0653
31.0004
1,908.11

381.6237185
Prim art m-thrombect add-on

T
0103
17.0436
1,049.05
223.63
209.8137186
Sec art m-thrombect add-on

T
0103
17.0436
1,049.05
223.63
209.8137187
Venous mech thrombectomy

T
0653
31.0004
1,908.11

381.6237188
Venous m-thrombectomy add-on

T
0653
31.0004
1,908.11

381.6237195
Thrombolytic therapy, stroke

T
0676
2.0612
126.87

25.3737200
Transcatheter biopsy

T
0685
6.0729
373.79
115.47
74.7637201
Transcatheter therapy infuse

T
0676
2.0612
126.87

25.3737202
Transcatheter therapy infuse

T
0676
2.0612
126.87

25.3737203
Transcatheter retrieval

T
0103
17.0436
1,049.05
223.63
209.8137204
Transcatheter occlusion

T
0115
29.4757
1,814.26
378.68
362.8537205
Transcath iv stent, percut

T
0229
66.0804
4,067.31

813.4637206
Transcath iv stent/perc addl

T
0229
66.0804
4,067.31

813.4637207
Transcath iv stent, open

T
0229
66.0804
4,067.31

813.4637208
Transcath iv stent/open addl

T
0229
66.0804
4,067.31

813.4637209
Change iv cath at thromb tx

T
0103
17.0436
1,049.05
223.63
209.8137250
Iv us first vessel add-on

S
0416
32.2182
1,983.06

396.6137251
Iv us each add vessel add-on

S
0416
32.2182
1,983.06

396.61( print page 49787)37500
Endoscopy ligate perf veins
CH
T
0091
34.6279
2,131.38

426.2837501
Vascular endoscopy procedure

T
0092
24.5817
1,513.03
306.56
302.6137565
Ligation of neck vein

T
0093
21.9703
1,352.29

270.4637600
Ligation of neck artery

T
0093
21.9703
1,352.29

270.4637605
Ligation of neck artery

T
0091
34.6279
2,131.38

426.2837606
Ligation of neck artery
CH
T
0092
24.5817
1,513.03
306.56
302.6137607
Ligation of a-v fistula

T
0092
24.5817
1,513.03
306.56
302.6137609
Temporal artery procedure

T
0021
14.9563
920.58
219.48
184.1237615
Ligation of neck artery
CH
T
0092
24.5817
1,513.03
306.56
302.6137620
Revision of major vein

T
0091
34.6279
2,131.38

426.2837650
Revision of major vein
CH
T
0092
24.5817
1,513.03
306.56
302.6137700
Revise leg vein

T
0091
34.6279
2,131.38

426.2837718
Ligate/strip short leg vein
CH
T
0091
34.6279
2,131.38

426.2837722
Ligate/strip long leg vein
CH
T
0091
34.6279
2,131.38

426.2837735
Removal of leg veins/lesion
CH
T
0091
34.6279
2,131.38

426.2837760
Ligation, leg veins, open
CH
T
0092
24.5817
1,513.03
306.56
302.6137765
Phleb veins - extrem - to 20
CH
T
0092
24.5817
1,513.03
306.56
302.6137766
Phleb veins - extrem 20+
CH
T
0092
24.5817
1,513.03
306.56
302.6137780
Revision of leg vein
CH
T
0092
24.5817
1,513.03
306.56
302.6137785
Ligate/divide/excise vein
CH
T
0092
24.5817
1,513.03
306.56
302.6137790
Penile venous occlusion

T
0181
32.9991
2,031.13
621.82
406.2337799
Vascular surgery procedure

T
0103
17.0436
1,049.05
223.63
209.8138120
Laparoscopy, splenectomy

T
0131
43.5124
2,678.23
1,001.89
535.6538129
Laparoscope proc, spleen

T
0130
31.9353
1,965.65
659.53
393.1338200
Injection for spleen x-ray

N38204
Bl donor search management

N38205
Harvest allogenic stem cells

S
0111
11.7005
720.18
198.40
144.0438206
Harvest auto stem cells

S
0111
11.7005
720.18
198.40
144.0438220
Bone marrow aspiration

T
0003
2.4295
149.54

29.9138221
Bone marrow biopsy

T
0003
2.4295
149.54

29.9138230
Bone marrow collection

S
0123
23.2490
1,431.00

286.2038240
Bone marrow/stem transplant

S
0123
23.2490
1,431.00

286.2038241
Bone marrow/stem transplant

S
0123
23.2490
1,431.00

286.2038242
Lymphocyte infuse transplant

S
0111
11.7005
720.18
198.40
144.0438300
Drainage, lymph node lesion

T
0007
10.9184
672.04

134.4138305
Drainage, lymph node lesion

T
0008
17.4686
1,075.21

215.0438308
Incision of lymph channels

T
0113
21.3673
1,315.18

263.0438500
Biopsy/removal, lymph nodes

T
0113
21.3673
1,315.18

263.0438505
Needle biopsy, lymph nodes

T
0005
3.8051
234.21
71.59
46.8438510
Biopsy/removal, lymph nodes

T
0113
21.3673
1,315.18

263.0438520
Biopsy/removal, lymph nodes

T
0113
21.3673
1,315.18

263.0438525
Biopsy/removal, lymph nodes

T
0113
21.3673
1,315.18

263.0438530
Biopsy/removal, lymph nodes

T
0113
21.3673
1,315.18

263.0438542
Explore deep node(s), neck

T
0114
37.1283
2,285.28
461.19
457.0638550
Removal, neck/armpit lesion

T
0113
21.3673
1,315.18

263.0438555
Removal, neck/armpit lesion

T
0113
21.3673
1,315.18

263.0438570
Laparoscopy, lymph node biop

T
0131
43.5124
2,678.23
1,001.89
535.6538571
Laparoscopy, lymphadenectomy

T
0132
70.8854
4,363.07
1,239.22
872.6138572
Laparoscopy, lymphadenectomy

T
0131
43.5124
2,678.23
1,001.89
535.6538589
Laparoscope proc, lymphatic

T
0130
31.9353
1,965.65
659.53
393.1338700
Removal of lymph nodes, neck

T
0113
21.3673
1,315.18

263.0438720
Removal of lymph nodes, neck

T
0113
21.3673
1,315.18

263.0438740
Remove armpit lymph nodes

T
0114
37.1283
2,285.28
461.19
457.0638745
Remove armpit lymph nodes

T
0114
37.1283
2,285.28
461.19
457.0638760
Remove groin lymph nodes

T
0113
21.3673
1,315.18

263.0438790
Inject for lymphatic x-ray

N38792
Identify sentinel node
CH
Q
0389
1.4072
86.61
33.98
17.3238794
Access thoracic lymph duct

N38999
Blood/lymph system procedure

S
0110
3.4570
212.78

42.5639400
Visualization of chest

T
0069
31.5464
1,941.71
591.64
388.3440490
Biopsy of lip

T
0251
2.3768
146.29

29.2640500
Partial excision of lip

T
0253
16.4494
1,012.48
282.29
202.5040510
Partial excision of lip

T
0254
23.1564
1,425.30
321.35
285.0640520
Partial excision of lip

T
0253
16.4494
1,012.48
282.29
202.5040525
Reconstruct lip with flap

T
0254
23.1564
1,425.30
321.35
285.0640527
Reconstruct lip with flap

T
0254
23.1564
1,425.30
321.35
285.0640530
Partial removal of lip

T
0254
23.1564
1,425.30
321.35
285.0640650
Repair lip

T
0252
7.7261
475.55
111.84
95.1140652
Repair lip

T
0252
7.7261
475.55
111.84
95.1140654
Repair lip

T
0252
7.7261
475.55
111.84
95.11( print page 49788)40700
Repair cleft lip/nasal

T
0256
37.7719
2,324.90

464.9840701
Repair cleft lip/nasal

T
0256
37.7719
2,324.90

464.9840702
Repair cleft lip/nasal

T
0256
37.7719
2,324.90

464.9840720
Repair cleft lip/nasal

T
0256
37.7719
2,324.90

464.9840761
Repair cleft lip/nasal

T
0256
37.7719
2,324.90

464.9840799
Lip surgery procedure

T
0251
2.3768
146.29

29.2640800
Drainage of mouth lesion
CH
T
0006
1.4821
91.22
21.76
18.2440801
Drainage of mouth lesion

T
0252
7.7261
475.55
111.84
95.1140804
Removal, foreign body, mouth

X
0340
0.6211
38.23

7.6540805
Removal, foreign body, mouth

T
0252
7.7261
475.55
111.84
95.1140806
Incision of lip fold

T
0251
2.3768
146.29

29.2640808
Biopsy of mouth lesion

T
0251
2.3768
146.29

29.2640810
Excision of mouth lesion

T
0253
16.4494
1,012.48
282.29
202.5040812
Excise/repair mouth lesion

T
0253
16.4494
1,012.48
282.29
202.5040814
Excise/repair mouth lesion

T
0253
16.4494
1,012.48
282.29
202.5040816
Excision of mouth lesion

T
0254
23.1564
1,425.30
321.35
285.0640818
Excise oral mucosa for graft

T
0251
2.3768
146.29

29.2640819
Excise lip or cheek fold

T
0252
7.7261
475.55
111.84
95.1140820
Treatment of mouth lesion

T
0253
16.4494
1,012.48
282.29
202.5040830
Repair mouth laceration

T
0251
2.3768
146.29

29.2640831
Repair mouth laceration

T
0252
7.7261
475.55
111.84
95.1140840
Reconstruction of mouth

T
0254
23.1564
1,425.30
321.35
285.0640842
Reconstruction of mouth

T
0254
23.1564
1,425.30
321.35
285.0640843
Reconstruction of mouth

T
0254
23.1564
1,425.30
321.35
285.0640844
Reconstruction of mouth

T
0256
37.7719
2,324.90

464.9840845
Reconstruction of mouth

T
0256
37.7719
2,324.90

464.9840899
Mouth surgery procedure

T
0251
2.3768
146.29

29.2641000
Drainage of mouth lesion

T
0253
16.4494
1,012.48
282.29
202.5041005
Drainage of mouth lesion

T
0251
2.3768
146.29

29.2641006
Drainage of mouth lesion

T
0254
23.1564
1,425.30
321.35
285.0641007
Drainage of mouth lesion

T
0253
16.4494
1,012.48
282.29
202.5041008
Drainage of mouth lesion

T
0253
16.4494
1,012.48
282.29
202.5041009
Drainage of mouth lesion

T
0251
2.3768
146.29

29.2641010
Incision of tongue fold

T
0252
7.7261
475.55
111.84
95.1141015
Drainage of mouth lesion

T
0251
2.3768
146.29

29.2641016
Drainage of mouth lesion

T
0252
7.7261
475.55
111.84
95.1141017
Drainage of mouth lesion

T
0252
7.7261
475.55
111.84
95.1141018
Drainage of mouth lesion

T
0252
7.7261
475.55
111.84
95.1141100
Biopsy of tongue

T
0252
7.7261
475.55
111.84
95.1141105
Biopsy of tongue

T
0253
16.4494
1,012.48
282.29
202.5041108
Biopsy of floor of mouth

T
0252
7.7261
475.55
111.84
95.1141110
Excision of tongue lesion

T
0253
16.4494
1,012.48
282.29
202.5041112
Excision of tongue lesion

T
0253
16.4494
1,012.48
282.29
202.5041113
Excision of tongue lesion

T
0253
16.4494
1,012.48
282.29
202.5041114
Excision of tongue lesion

T
0254
23.1564
1,425.30
321.35
285.0641115
Excision of tongue fold

T
0252
7.7261
475.55
111.84
95.1141116
Excision of mouth lesion

T
0253
16.4494
1,012.48
282.29
202.5041120
Partial removal of tongue

T
0254
23.1564
1,425.30
321.35
285.0641250
Repair tongue laceration

T
0251
2.3768
146.29

29.2641251
Repair tongue laceration

T
0251
2.3768
146.29

29.2641252
Repair tongue laceration

T
0252
7.7261
475.55
111.84
95.1141500
Fixation of tongue

T
0254
23.1564
1,425.30
321.35
285.0641510
Tongue to lip surgery

T
0253
16.4494
1,012.48
282.29
202.5041520
Reconstruction, tongue fold

T
0252
7.7261
475.55
111.84
95.1141599
Tongue and mouth surgery

T
0251
2.3768
146.29

29.2641800
Drainage of gum lesion
CH
T
0006
1.4821
91.22
21.76
18.2441805
Removal foreign body, gum

T
0254
23.1564
1,425.30
321.35
285.0641806
Removal foreign body,jawbone

T
0253
16.4494
1,012.48
282.29
202.5041820
Excision, gum, each quadrant

T
0252
7.7261
475.55
111.84
95.1141821
Excision of gum flap

T
0252
7.7261
475.55
111.84
95.1141822
Excision of gum lesion

T
0253
16.4494
1,012.48
282.29
202.5041823
Excision of gum lesion

T
0254
23.1564
1,425.30
321.35
285.0641825
Excision of gum lesion

T
0253
16.4494
1,012.48
282.29
202.5041826
Excision of gum lesion

T
0253
16.4494
1,012.48
282.29
202.5041827
Excision of gum lesion

T
0254
23.1564
1,425.30
321.35
285.0641828
Excision of gum lesion

T
0253
16.4494
1,012.48
282.29
202.5041830
Removal of gum tissue

T
0253
16.4494
1,012.48
282.29
202.5041850
Treatment of gum lesion

T
0253
16.4494
1,012.48
282.29
202.5041870
Gum graft

T
0254
23.1564
1,425.30
321.35
285.0641872
Repair gum

T
0253
16.4494
1,012.48
282.29
202.50( print page 49789)41874
Repair tooth socket

T
0254
23.1564
1,425.30
321.35
285.0641899
Dental surgery procedure

T
0251
2.3768
146.29

29.2642000
Drainage mouth roof lesion

T
0251
2.3768
146.29

29.2642100
Biopsy roof of mouth

T
0252
7.7261
475.55
111.84
95.1142104
Excision lesion, mouth roof

T
0253
16.4494
1,012.48
282.29
202.5042106
Excision lesion, mouth roof

T
0253
16.4494
1,012.48
282.29
202.5042107
Excision lesion, mouth roof

T
0254
23.1564
1,425.30
321.35
285.0642120
Remove palate/lesion

T
0256
37.7719
2,324.90

464.9842140
Excision of uvula

T
0252
7.7261
475.55
111.84
95.1142145
Repair palate, pharynx/uvula

T
0254
23.1564
1,425.30
321.35
285.0642160
Treatment mouth roof lesion

T
0253
16.4494
1,012.48
282.29
202.5042180
Repair palate

T
0251
2.3768
146.29

29.2642182
Repair palate

T
0256
37.7719
2,324.90

464.9842200
Reconstruct cleft palate

T
0256
37.7719
2,324.90

464.9842205
Reconstruct cleft palate

T
0256
37.7719
2,324.90

464.9842210
Reconstruct cleft palate

T
0256
37.7719
2,324.90

464.9842215
Reconstruct cleft palate

T
0256
37.7719
2,324.90

464.9842220
Reconstruct cleft palate

T
0256
37.7719
2,324.90

464.9842225
Reconstruct cleft palate

T
0256
37.7719
2,324.90

464.9842226
Lengthening of palate

T
0256
37.7719
2,324.90

464.9842227
Lengthening of palate

T
0256
37.7719
2,324.90

464.9842235
Repair palate

T
0253
16.4494
1,012.48
282.29
202.5042260
Repair nose to lip fistula

T
0254
23.1564
1,425.30
321.35
285.0642280
Preparation, palate mold

T
0251
2.3768
146.29

29.2642281
Insertion, palate prosthesis

T
0253
16.4494
1,012.48
282.29
202.5042299
Palate/uvula surgery

T
0251
2.3768
146.29

29.2642300
Drainage of salivary gland

T
0253
16.4494
1,012.48
282.29
202.5042305
Drainage of salivary gland

T
0253
16.4494
1,012.48
282.29
202.5042310
Drainage of salivary gland

T
0251
2.3768
146.29

29.2642320
Drainage of salivary gland

T
0251
2.3768
146.29

29.2642330
Removal of salivary stone

T
0253
16.4494
1,012.48
282.29
202.5042335
Removal of salivary stone

T
0253
16.4494
1,012.48
282.29
202.5042340
Removal of salivary stone

T
0253
16.4494
1,012.48
282.29
202.5042400
Biopsy of salivary gland

T
0005
3.8051
234.21
71.59
46.8442405
Biopsy of salivary gland

T
0253
16.4494
1,012.48
282.29
202.5042408
Excision of salivary cyst

T
0253
16.4494
1,012.48
282.29
202.5042409
Drainage of salivary cyst

T
0253
16.4494
1,012.48
282.29
202.5042410
Excise parotid gland/lesion

T
0256
37.7719
2,324.90

464.9842415
Excise parotid gland/lesion

T
0256
37.7719
2,324.90

464.9842420
Excise parotid gland/lesion

T
0256
37.7719
2,324.90

464.9842425
Excise parotid gland/lesion

T
0256
37.7719
2,324.90

464.9842440
Excise submaxillary gland

T
0256
37.7719
2,324.90

464.9842450
Excise sublingual gland

T
0254
23.1564
1,425.30
321.35
285.0642500
Repair salivary duct

T
0254
23.1564
1,425.30
321.35
285.0642505
Repair salivary duct

T
0256
37.7719
2,324.90

464.9842507
Parotid duct diversion

T
0256
37.7719
2,324.90

464.9842508
Parotid duct diversion

T
0256
37.7719
2,324.90

464.9842509
Parotid duct diversion

T
0256
37.7719
2,324.90

464.9842510
Parotid duct diversion

T
0256
37.7719
2,324.90

464.9842550
Injection for salivary x-ray

N42600
Closure of salivary fistula

T
0253
16.4494
1,012.48
282.29
202.5042650
Dilation of salivary duct

T
0252
7.7261
475.55
111.84
95.1142660
Dilation of salivary duct

T
0251
2.3768
146.29

29.2642665
Ligation of salivary duct

T
0254
23.1564
1,425.30
321.35
285.0642699
Salivary surgery procedure

T
0251
2.3768
146.29

29.2642700
Drainage of tonsil abscess

T
0251
2.3768
146.29

29.2642720
Drainage of throat abscess

T
0253
16.4494
1,012.48
282.29
202.5042725
Drainage of throat abscess

T
0256
37.7719
2,324.90

464.9842800
Biopsy of throat
CH
T
0252
7.7261
475.55
111.84
95.1142802
Biopsy of throat

T
0253
16.4494
1,012.48
282.29
202.5042804
Biopsy of upper nose/throat

T
0253
16.4494
1,012.48
282.29
202.5042806
Biopsy of upper nose/throat

T
0254
23.1564
1,425.30
321.35
285.0642808
Excise pharynx lesion

T
0253
16.4494
1,012.48
282.29
202.5042809
Remove pharynx foreign body

X
0340
0.6211
38.23

7.6542810
Excision of neck cyst

T
0254
23.1564
1,425.30
321.35
285.0642815
Excision of neck cyst

T
0256
37.7719
2,324.90

464.9842820
Remove tonsils and adenoids

T
0258
22.7757
1,401.87
437.25
280.3742821
Remove tonsils and adenoids

T
0258
22.7757
1,401.87
437.25
280.3742825
Removal of tonsils

T
0258
22.7757
1,401.87
437.25
280.3742826
Removal of tonsils

T
0258
22.7757
1,401.87
437.25
280.37( print page 49790)42830
Removal of adenoids

T
0258
22.7757
1,401.87
437.25
280.3742831
Removal of adenoids

T
0258
22.7757
1,401.87
437.25
280.3742835
Removal of adenoids

T
0258
22.7757
1,401.87
437.25
280.3742836
Removal of adenoids

T
0258
22.7757
1,401.87
437.25
280.3742842
Extensive surgery of throat

T
0254
23.1564
1,425.30
321.35
285.0642844
Extensive surgery of throat

T
0256
37.7719
2,324.90

464.9842860
Excision of tonsil tags

T
0258
22.7757
1,401.87
437.25
280.3742870
Excision of lingual tonsil

T
0258
22.7757
1,401.87
437.25
280.3742890
Partial removal of pharynx

T
0256
37.7719
2,324.90

464.9842892
Revision of pharyngeal walls

T
0256
37.7719
2,324.90

464.9842900
Repair throat wound

T
0252
7.7261
475.55
111.84
95.1142950
Reconstruction of throat

T
0254
23.1564
1,425.30
321.35
285.0642955
Surgical opening of throat

T
0254
23.1564
1,425.30
321.35
285.0642960
Control throat bleeding

T
0250
1.2021
73.99
25.50
14.8042962
Control throat bleeding

T
0256
37.7719
2,324.90

464.9842970
Control nose/throat bleeding

T
0250
1.2021
73.99
25.50
14.8042972
Control nose/throat bleeding

T
0253
16.4494
1,012.48
282.29
202.5042999
Throat surgery procedure

T
0251
2.3768
146.29

29.2643020
Incision of esophagus

T
0252
7.7261
475.55
111.84
95.1143030
Throat muscle surgery

T
0253
16.4494
1,012.48
282.29
202.5043130
Removal of esophagus pouch
CH
T
0256
37.7719
2,324.90

464.9843200
Esophagus endoscopy

T
0141
8.3070
511.30
143.38
102.2643201
Esoph scope w/submucous inj

T
0141
8.3070
511.30
143.38
102.2643202
Esophagus endoscopy, biopsy

T
0141
8.3070
511.30
143.38
102.2643204
Esoph scope w/sclerosis inj

T
0141
8.3070
511.30
143.38
102.2643205
Esophagus endoscopy/ligation

T
0141
8.3070
511.30
143.38
102.2643215
Esophagus endoscopy

T
0141
8.3070
511.30
143.38
102.2643216
Esophagus endoscopy/lesion

T
0141
8.3070
511.30
143.38
102.2643217
Esophagus endoscopy

T
0141
8.3070
511.30
143.38
102.2643219
Esophagus endoscopy

T
0384
22.6777
1,395.84
292.31
279.1743220
Esoph endoscopy, dilation

T
0141
8.3070
511.30
143.38
102.2643226
Esoph endoscopy, dilation

T
0141
8.3070
511.30
143.38
102.2643227
Esoph endoscopy, repair

T
0141
8.3070
511.30
143.38
102.2643228
Esoph endoscopy, ablation

T
0422
27.5493
1,695.69
448.81
339.1443231
Esoph endoscopy w/us exam

T
0141
8.3070
511.30
143.38
102.2643232
Esoph endoscopy w/us fn bx

T
0141
8.3070
511.30
143.38
102.2643234
Upper GI endoscopy, exam

T
0141
8.3070
511.30
143.38
102.2643235
Uppr gi endoscopy, diagnosis

T
0141
8.3070
511.30
143.38
102.2643236
Uppr gi scope w/submuc inj

T
0141
8.3070
511.30
143.38
102.2643237
Endoscopic us exam, esoph

T
0141
8.3070
511.30
143.38
102.2643238
Uppr gi endoscopy w/us fn bx

T
0141
8.3070
511.30
143.38
102.2643239
Upper GI endoscopy, biopsy

T
0141
8.3070
511.30
143.38
102.2643240
Esoph endoscope w/drain cyst

T
0141
8.3070
511.30
143.38
102.2643241
Upper GI endoscopy with tube

T
0141
8.3070
511.30
143.38
102.2643242
Uppr gi endoscopy w/us fn bx

T
0141
8.3070
511.30
143.38
102.2643243
Upper gi endoscopyinject

T
0141
8.3070
511.30
143.38
102.2643244
Upper GI endoscopy/ligation

T
0141
8.3070
511.30
143.38
102.2643245
Uppr gi scope dilate strictr

T
0141
8.3070
511.30
143.38
102.2643246
Place gastrostomy tube

T
0141
8.3070
511.30
143.38
102.2643247
Operative upper GI endoscopy

T
0141
8.3070
511.30
143.38
102.2643248
Uppr gi endoscopy/guide wire

T
0141
8.3070
511.30
143.38
102.2643249
Esoph endoscopy, dilation

T
0141
8.3070
511.30
143.38
102.2643250
Upper GI endoscopy/tumor

T
0141
8.3070
511.30
143.38
102.2643251
Operative upper GI endoscopy

T
0141
8.3070
511.30
143.38
102.2643255
Operative upper GI endoscopy

T
0141
8.3070
511.30
143.38
102.2643256
Uppr gi endoscopy w/stent

T
0384
22.6777
1,395.84
292.31
279.1743257
Uppr gi scope w/thrml txmnt

T
0422
27.5493
1,695.69
448.81
339.1443258
Operative upper GI endoscopy

T
0141
8.3070
511.30
143.38
102.2643259
Endoscopic ultrasound exam

T
0141
8.3070
511.30
143.38
102.2643260
Endo cholangiopancreatograph

T
0151
19.8125
1,219.48
245.46
243.9043261
Endo cholangiopancreatograph

T
0151
19.8125
1,219.48
245.46
243.9043262
Endo cholangiopancreatograph

T
0151
19.8125
1,219.48
245.46
243.9043263
Endo cholangiopancreatograph

T
0151
19.8125
1,219.48
245.46
243.9043264
Endo cholangiopancreatograph

T
0151
19.8125
1,219.48
245.46
243.9043265
Endo cholangiopancreatograph

T
0151
19.8125
1,219.48
245.46
243.9043267
Endo cholangiopancreatograph

T
0151
19.8125
1,219.48
245.46
243.9043268
Endo cholangiopancreatograph

T
0384
22.6777
1,395.84
292.31
279.1743269
Endo cholangiopancreatograph

T
0384
22.6777
1,395.84
292.31
279.1743271
Endo cholangiopancreatograph

T
0151
19.8125
1,219.48
245.46
243.9043272
Endo cholangiopancreatograph

T
0151
19.8125
1,219.48
245.46
243.90( print page 49791)43280
Laparoscopy, fundoplasty

T
0132
70.8854
4,363.07
1,239.22
872.6143289
Laparoscope proc, esoph

T
0130
31.9353
1,965.65
659.53
393.1343450
Dilate esophagus

T
0140
5.3134
327.05
91.40
65.4143453
Dilate esophagus

T
0140
5.3134
327.05
91.40
65.4143456
Dilate esophagus

T
0140
5.3134
327.05
91.40
65.4143458
Dilate esophagus

T
0140
5.3134
327.05
91.40
65.4143499
Esophagus surgery procedure

T
0141
8.3070
511.30
143.38
102.2643510
Surgical opening of stomach

T
0141
8.3070
511.30
143.38
102.2643600
Biopsy of stomach

T
0141
8.3070
511.30
143.38
102.2643651
Laparoscopy, vagus nerve

T
0132
70.8854
4,363.07
1,239.22
872.6143652
Laparoscopy, vagus nerve

T
0132
70.8854
4,363.07
1,239.22
872.6143653
Laparoscopy, gastrostomy

T
0131
43.5124
2,678.23
1,001.89
535.6543659
Laparoscope proc, stom

T
0130
31.9353
1,965.65
659.53
393.1343750
Place gastrostomy tube

T
0141
8.3070
511.30
143.38
102.2643752
Nasal/orogastric w/stent

X
0272
1.2985
79.92
31.64
15.9843760
Change gastrostomy tube

T
0121
2.3431
144.22
43.80
28.8443761
Reposition gastrostomy tube

T
0122
7.2859
448.45

89.6943830
Place gastrostomy tube

T
0422
27.5493
1,695.69
448.81
339.1443831
Place gastrostomy tube

T
0141
8.3070
511.30
143.38
102.2643870
Repair stomach opening

T
0141
8.3070
511.30
143.38
102.2643886
Revise gastric port, open

T
0025
5.0931
313.49
95.46
62.7043887
Remove gastric port, open

T
0025
5.0931
313.49
95.46
62.7043888
Change gastric port, open

T
0686
13.3433
821.29

164.2643999
Stomach surgery procedure

T
0141
8.3070
511.30
143.38
102.2644100
Biopsy of bowel

T
0141
8.3070
511.30
143.38
102.2644180
Lap, enterolysis

T
0131
43.5124
2,678.23
1,001.89
535.6544186
Lap, jejunostomy

T
0131
43.5124
2,678.23
1,001.89
535.6544206
Lap part colectomy w/stoma

T
0132
70.8854
4,363.07
1,239.22
872.6144207
L colectomy/coloproctostomy

T
0132
70.8854
4,363.07
1,239.22
872.6144208
L colectomy/coloproctostomy

T
0132
70.8854
4,363.07
1,239.22
872.6144213
Lap, mobil splenic fl add-on

T
0130
31.9353
1,965.65
659.53
393.1344238
Laparoscope proc, intestine

T
0130
31.9353
1,965.65
659.53
393.1344312
Revision of ileostomy

T
0027
21.2645
1,308.85
329.72
261.7744340
Revision of colostomy

T
0027
21.2645
1,308.85
329.72
261.7744360
Small bowel endoscopy

T
0142
9.3878
577.83
152.78
115.5744361
Small bowel endoscopy/biopsy

T
0142
9.3878
577.83
152.78
115.5744363
Small bowel endoscopy

T
0142
9.3878
577.83
152.78
115.5744364
Small bowel endoscopy

T
0142
9.3878
577.83
152.78
115.5744365
Small bowel endoscopy

T
0142
9.3878
577.83
152.78
115.5744366
Small bowel endoscopy

T
0142
9.3878
577.83
152.78
115.5744369
Small bowel endoscopy

T
0142
9.3878
577.83
152.78
115.5744370
Small bowel endoscopy/stent

T
0384
22.6777
1,395.84
292.31
279.1744372
Small bowel endoscopy

T
0142
9.3878
577.83
152.78
115.5744373
Small bowel endoscopy

T
0142
9.3878
577.83
152.78
115.5744376
Small bowel endoscopy

T
0142
9.3878
577.83
152.78
115.5744377
Small bowel endoscopy/biopsy

T
0142
9.3878
577.83
152.78
115.5744378
Small bowel endoscopy

T
0142
9.3878
577.83
152.78
115.5744379
S bowel endoscope w/stent

T
0384
22.6777
1,395.84
292.31
279.1744380
Small bowel endoscopy

T
0142
9.3878
577.83
152.78
115.5744382
Small bowel endoscopy

T
0142
9.3878
577.83
152.78
115.5744383
Ileoscopy w/stent

T
0384
22.6777
1,395.84
292.31
279.1744385
Endoscopy of bowel pouch

T
0143
8.8143
542.53
186.06
108.5144386
Endoscopy, bowel pouch/biop

T
0143
8.8143
542.53
186.06
108.5144388
Colonoscopy

T
0143
8.8143
542.53
186.06
108.5144389
Colonoscopy with biopsy

T
0143
8.8143
542.53
186.06
108.5144390
Colonoscopy for foreign body

T
0143
8.8143
542.53
186.06
108.5144391
Colonoscopy for bleeding

T
0143
8.8143
542.53
186.06
108.5144392
Colonoscopypolypectomy

T
0143
8.8143
542.53
186.06
108.5144393
Colonoscopy, lesion removal

T
0143
8.8143
542.53
186.06
108.5144394
Colonoscopy w/snare

T
0143
8.8143
542.53
186.06
108.5144397
Colonoscopy w/stent

T
0384
22.6777
1,395.84
292.31
279.1744500
Intro, gastrointestinal tube

T
0121
2.3431
144.22
43.80
28.8444701
Intraop colon lavage add-on

N44799
Unlisted procedure intestine
CH
T
0153
22.1758
1,364.94
397.95
272.9944901
Drain app abscess, percut

T
0037
10.2616
631.61
228.76
126.3244970
Laparoscopy, appendectomy

T
0131
43.5124
2,678.23
1,001.89
535.6544979
Laparoscope proc, app

T
0130
31.9353
1,965.65
659.53
393.1345000
Drainage of pelvic abscess

T
0148
4.8970
301.42

60.2845005
Drainage of rectal abscess

T
0155
12.8778
792.64

158.5345020
Drainage of rectal abscess

T
0155
12.8778
792.64

158.53( print page 49792)45100
Biopsy of rectum

T
0149
22.2336
1,368.50
293.06
273.7045108
Removal of anorectal lesion
CH
T
0149
22.2336
1,368.50
293.06
273.7045150
Excision of rectal stricture

T
0149
22.2336
1,368.50
293.06
273.7045160
Excision of rectal lesion
CH
T
0149
22.2336
1,368.50
293.06
273.7045170
Excision of rectal lesion
CH
T
0149
22.2336
1,368.50
293.06
273.7045190
Destruction, rectal tumor
CH
T
0149
22.2336
1,368.50
293.06
273.7045300
Proctosigmoidoscopy dx

T
0146
4.8005
295.48
64.40
59.1045303
Proctosigmoidoscopy dilate

T
0147
8.5644
527.15

105.4345305
Proctosigmoidoscopy w/bx

T
0147
8.5644
527.15

105.4345307
Proctosigmoidoscopy fb

T
0428
20.4902
1,261.19

252.2445308
Proctosigmoidoscopy removal

T
0147
8.5644
527.15

105.4345309
Proctosigmoidoscopy removal

T
0147
8.5644
527.15

105.4345315
Proctosigmoidoscopy removal

T
0147
8.5644
527.15

105.4345317
Proctosigmoidoscopy bleed

T
0147
8.5644
527.15

105.4345320
Proctosigmoidoscopy ablate

T
0428
20.4902
1,261.19

252.2445321
Proctosigmoidoscopy volvul

T
0428
20.4902
1,261.19

252.2445327
Proctosigmoidoscopy w/stent

T
0384
22.6777
1,395.84
292.31
279.1745330
Diagnostic sigmoidoscopy

T
0146
4.8005
295.48
64.40
59.1045331
Sigmoidoscopy and biopsy

T
0146
4.8005
295.48
64.40
59.1045332
Sigmoidoscopy w/fb removal

T
0146
4.8005
295.48
64.40
59.1045333
Sigmoidoscopypolypectomy

T
0147
8.5644
527.15

105.4345334
Sigmoidoscopy for bleeding

T
0147
8.5644
527.15

105.4345335
Sigmoidoscopy w/submuc inj

T
0146
4.8005
295.48
64.40
59.1045337
Sigmoidoscopydecompress

T
0146
4.8005
295.48
64.40
59.1045338
Sigmoidoscopy w/tumr remove

T
0147
8.5644
527.15

105.4345339
Sigmoidoscopy w/ablate tumr

T
0147
8.5644
527.15

105.4345340
Sig w/balloon dilation

T
0147
8.5644
527.15

105.4345341
Sigmoidoscopy w/ultrasound

T
0147
8.5644
527.15

105.4345342
Sigmoidoscopy w/us guide bx

T
0147
8.5644
527.15

105.4345345
Sigmoidoscopy w/stent

T
0384
22.6777
1,395.84
292.31
279.1745355
Surgical colonoscopy

T
0143
8.8143
542.53
186.06
108.5145378
Diagnostic colonoscopy

T
0143
8.8143
542.53
186.06
108.5145379
Colonoscopy w/fb removal

T
0143
8.8143
542.53
186.06
108.5145380
Colonoscopy and biopsy

T
0143
8.8143
542.53
186.06
108.5145381
Colonoscopy, submucous inj

T
0143
8.8143
542.53
186.06
108.5145382
Colonoscopy/control bleeding

T
0143
8.8143
542.53
186.06
108.5145383
Lesion removal colonoscopy

T
0143
8.8143
542.53
186.06
108.5145384
Lesion remove colonoscopy

T
0143
8.8143
542.53
186.06
108.5145385
Lesion removal colonoscopy

T
0143
8.8143
542.53
186.06
108.5145386
Colonoscopy dilate stricture

T
0143
8.8143
542.53
186.06
108.5145387
Colonoscopy w/stent

T
0384
22.6777
1,395.84
292.31
279.1745391
Colonoscopy w/endoscope us

T
0143
8.8143
542.53
186.06
108.5145392
Colonoscopy w/endoscopic fnb

T
0143
8.8143
542.53
186.06
108.5145499
Laparoscope proc, rectum

T
0130
31.9353
1,965.65
659.53
393.1345500
Repair of rectum

T
0149
22.2336
1,368.50
293.06
273.7045505
Repair of rectum

T
0150
29.4386
1,811.98
437.12
362.4045520
Treatment of rectal prolapse

T
0098
1.1035
67.92

13.5845541
Correct rectal prolapse

T
0150
29.4386
1,811.98
437.12
362.4045560
Repair of rectocele

T
0150
29.4386
1,811.98
437.12
362.4045900
Reduction of rectal prolapse

T
0148
4.8970
301.42

60.2845905
Dilation of anal sphincter

T
0149
22.2336
1,368.50
293.06
273.7045910
Dilation of rectal narrowing

T
0149
22.2336
1,368.50
293.06
273.7045915
Remove rectal obstruction

T
0148
4.8970
301.42

60.2845990
Surg dx exam, anorectal

T
0148
4.8970
301.42

60.2845999
Rectum surgery procedure

T
0148
4.8970
301.42

60.2846020
Placement of seton
CH
T
0149
22.2336
1,368.50
293.06
273.7046030
Removal of rectal marker

T
0148
4.8970
301.42

60.2846040
Incision of rectal abscess

T
0149
22.2336
1,368.50
293.06
273.7046045
Incision of rectal abscess
CH
T
0149
22.2336
1,368.50
293.06
273.7046050
Incision of anal abscess

T
0148
4.8970
301.42

60.2846060
Incision of rectal abscess
CH
T
0149
22.2336
1,368.50
293.06
273.7046070
Incision of anal septum

T
0155
12.8778
792.64

158.5346080
Incision of anal sphincter

T
0149
22.2336
1,368.50
293.06
273.7046083
Incise external hemorrhoid
CH
T
0164
2.1159
130.24

26.0546200
Removal of anal fissure
CH
T
0149
22.2336
1,368.50
293.06
273.7046210
Removal of anal crypt

T
0149
22.2336
1,368.50
293.06
273.7046211
Removal of anal crypts
CH
T
0149
22.2336
1,368.50
293.06
273.7046220
Removal of anal tag

T
0149
22.2336
1,368.50
293.06
273.7046221
Ligation of hemorrhoid(s)

T
0148
4.8970
301.42

60.2846230
Removal of anal tags

T
0149
22.2336
1,368.50
293.06
273.70( print page 49793)46250
Hemorrhoidectomy
CH
T
0149
22.2336
1,368.50
293.06
273.7046255
Hemorrhoidectomy
CH
T
0149
22.2336
1,368.50
293.06
273.7046257
Remove hemorrhoidsfissure
CH
T
0149
22.2336
1,368.50
293.06
273.7046258
Remove hemorrhoidsfistula
CH
T
0149
22.2336
1,368.50
293.06
273.7046260
Hemorrhoidectomy
CH
T
0149
22.2336
1,368.50
293.06
273.7046261
Remove hemorrhoidsfissure
CH
T
0149
22.2336
1,368.50
293.06
273.7046262
Remove hemorrhoidsfistula
CH
T
0149
22.2336
1,368.50
293.06
273.7046270
Removal of anal fistula
CH
T
0149
22.2336
1,368.50
293.06
273.7046275
Removal of anal fistula
CH
T
0149
22.2336
1,368.50
293.06
273.7046280
Removal of anal fistula
CH
T
0149
22.2336
1,368.50
293.06
273.7046285
Removal of anal fistula
CH
T
0149
22.2336
1,368.50
293.06
273.7046288
Repair anal fistula
CH
T
0149
22.2336
1,368.50
293.06
273.7046320
Removal of hemorrhoid clot
CH
T
0155
12.8778
792.64

158.5346500
Injection into hemorrhoid(s)

T
0155
12.8778
792.64

158.5346505
Chemodenervation anal musc

T
0148
4.8970
301.42

60.2846600
Diagnostic anoscopy

X
0340
0.6211
38.23

7.6546604
Anoscopy and dilation

T
0147
8.5644
527.15

105.4346606
Anoscopy and biopsy

T
0146
4.8005
295.48
64.40
59.1046608
Anoscopy, remove for body

T
0147
8.5644
527.15

105.4346610
Anoscopy, remove lesion

T
0428
20.4902
1,261.19

252.2446611
Anoscopy

T
0147
8.5644
527.15

105.4346612
Anoscopy, remove lesions

T
0428
20.4902
1,261.19

252.2446614
Anoscopy, control bleeding

T
0146
4.8005
295.48
64.40
59.1046615
Anoscopy

T
0428
20.4902
1,261.19

252.2446700
Repair of anal stricture
CH
T
0149
22.2336
1,368.50
293.06
273.7046706
Repr of anal fistula w/glue

T
0150
29.4386
1,811.98
437.12
362.4046750
Repair of anal sphincter
CH
T
0171
37.2425
2,292.31
705.28
458.4646753
Reconstruction of anus
CH
T
0149
22.2336
1,368.50
293.06
273.7046754
Removal of suture from anus

T
0149
22.2336
1,368.50
293.06
273.7046760
Repair of anal sphincter
CH
T
0171
37.2425
2,292.31
705.28
458.4646761
Repair of anal sphincter
CH
T
0171
37.2425
2,292.31
705.28
458.4646762
Implant artificial sphincter
CH
T
0171
37.2425
2,292.31
705.28
458.4646900
Destruction, anal lesion(s)

T
0016
2.6253
161.59
32.68
32.3246910
Destruction, anal lesion(s)

T
0017
17.7392
1,091.87
227.84
218.3746916
Cryosurgery, anal lesion(s)

T
0013
1.0876
66.94

13.3946917
Laser surgery, anal lesions

T
0695
20.5802
1,266.73
266.59
253.3546922
Excision of anal lesion(s)

T
0695
20.5802
1,266.73
266.59
253.3546924
Destruction, anal lesion(s)

T
0695
20.5802
1,266.73
266.59
253.3546934
Destruction of hemorrhoids

T
0155
12.8778
792.64

158.5346935
Destruction of hemorrhoids

T
0155
12.8778
792.64

158.5346936
Destruction of hemorrhoids

T
0149
22.2336
1,368.50
293.06
273.7046937
Cryotherapy of rectal lesion

T
0149
22.2336
1,368.50
293.06
273.7046938
Cryotherapy of rectal lesion

T
0150
29.4386
1,811.98
437.12
362.4046940
Treatment of anal fissure

T
0149
22.2336
1,368.50
293.06
273.7046942
Treatment of anal fissure

T
0148
4.8970
301.42

60.2846945
Ligation of hemorrhoids

T
0155
12.8778
792.64

158.5346946
Ligation of hemorrhoids

T
0155
12.8778
792.64

158.5346947
Hemorrhoidopexy by stapling

T
0150
29.4386
1,811.98
437.12
362.4046999
Anus surgery procedure

T
0148
4.8970
301.42

60.2847000
Needle biopsy of liver

T
0685
6.0729
373.79
115.47
74.7647001
Needle biopsy, liver add-on

N47011
Percut drain, liver lesion

T
0037
10.2616
631.61
228.76
126.3247370
Laparo ablate liver tumor rf

T
0132
70.8854
4,363.07
1,239.22
872.6147371
Laparo ablate liver cryosurg

T
0131
43.5124
2,678.23
1,001.89
535.6547379
Laparoscope procedure, liver

T
0130
31.9353
1,965.65
659.53
393.1347382
Percut ablate liver rf

T
0423
39.0235
2,401.94

480.3947399
Liver surgery procedure
CH
T
0004
2.0863
128.41

25.6847490
Incision of gallbladder

T
0152
19.4515
1,197.26

239.4547500
Injection for liver x-rays

N47505
Injection for liver x-rays

N47510
Insert catheter, bile duct

T
0152
19.4515
1,197.26

239.4547511
Insert bile duct drain

T
0152
19.4515
1,197.26

239.4547525
Change bile duct catheter

T
0427
11.5220
709.19

141.8447530
Revise/reinsert bile tube

T
0427
11.5220
709.19

141.8447552
Biliary endoscopy thru skin

T
0152
19.4515
1,197.26

239.4547553
Biliary endoscopy thru skin

T
0152
19.4515
1,197.26

239.4547554
Biliary endoscopy thru skin

T
0152
19.4515
1,197.26

239.4547555
Biliary endoscopy thru skin

T
0152
19.4515
1,197.26

239.4547556
Biliary endoscopy thru skin

T
0152
19.4515
1,197.26

239.4547560
Laparoscopy w/cholangio

T
0130
31.9353
1,965.65
659.53
393.13( print page 49794)47561
Laparo w/cholangio/biopsy

T
0130
31.9353
1,965.65
659.53
393.1347562
Laparoscopic cholecystectomy

T
0131
43.5124
2,678.23
1,001.89
535.6547563
Laparo cholecystectomy/graph

T
0131
43.5124
2,678.23
1,001.89
535.6547564
Laparo cholecystectomy/explr

T
0131
43.5124
2,678.23
1,001.89
535.6547579
Laparoscope proc, biliary

T
0130
31.9353
1,965.65
659.53
393.1347630
Remove bile duct stone

T
0152
19.4515
1,197.26

239.4547999
Bile tract surgery procedure

T
0152
19.4515
1,197.26

239.4548102
Needle biopsy, pancreas

T
0685
6.0729
373.79
115.47
74.7648511
Drain pancreatic pseudocyst

T
0037
10.2616
631.61
228.76
126.3248999
Pancreas surgery procedure

T
0004
2.0863
128.41

25.6849021
Drain abdominal abscess

T
0037
10.2616
631.61
228.76
126.3249041
Drain, percut, abdom abscess

T
0037
10.2616
631.61
228.76
126.3249061
Drain, percut, retroper absc

T
0037
10.2616
631.61
228.76
126.3249080
Puncture, peritoneal cavity

T
0070
3.6425
224.20

44.8449081
Removal of abdominal fluid

T
0070
3.6425
224.20

44.8449085
Remove abdomen foreign body

T
0153
22.1758
1,364.94
397.95
272.9949180
Biopsy, abdominal mass

T
0685
6.0729
373.79
115.47
74.7649200
Removal of abdominal lesion

T
0130
31.9353
1,965.65
659.53
393.1349250
Excision of umbilicus

T
0153
22.1758
1,364.94
397.95
272.9949320
Diag laparo separate proc

T
0130
31.9353
1,965.65
659.53
393.1349321
Laparoscopy, biopsy

T
0130
31.9353
1,965.65
659.53
393.1349322
Laparoscopy, aspiration

T
0130
31.9353
1,965.65
659.53
393.1349323
Laparo drain lymphocele

T
0130
31.9353
1,965.65
659.53
393.1349329
Laparo proc, abdm/per/oment

T
0130
31.9353
1,965.65
659.53
393.1349400
Air injection into abdomen

N49419
Insrt abdom cath for chemotx

T
0115
29.4757
1,814.26
378.68
362.8549420
Insert abdom drain, temp

T
0652
29.2259
1,798.88

359.7849421
Insert abdom drain, perm

T
0652
29.2259
1,798.88

359.7849422
Remove perm cannula/catheter

T
0105
23.4666
1,444.39
370.40
288.8849423
Exchange drainage catheter

T
0427
11.5220
709.19

141.8449424
Assess cyst, contrast inject

N49426
Revise abdomen-venous shunt

T
0153
22.1758
1,364.94
397.95
272.9949427
Injection, abdominal shunt

N49429
Removal of shunt

T
0105
23.4666
1,444.39
370.40
288.8849491
Rpr hern preemie reduc

T
0154
29.1491
1,794.16
464.85
358.8349492
Rpr ing hern premie, blocked

T
0154
29.1491
1,794.16
464.85
358.8349495
Rpr ing hernia baby, reduc

T
0154
29.1491
1,794.16
464.85
358.8349496
Rpr ing hernia baby, blocked

T
0154
29.1491
1,794.16
464.85
358.8349500
Rpr ing hernia, init, reduce

T
0154
29.1491
1,794.16
464.85
358.8349501
Rpr ing hernia, init blocked

T
0154
29.1491
1,794.16
464.85
358.8349505
Prp i/hern init reduc 5 yr

T
0154
29.1491
1,794.16
464.85
358.8349507
Prp i/hern init block 5 yr

T
0154
29.1491
1,794.16
464.85
358.8349520
Rerepair ing hernia, reduce

T
0154
29.1491
1,794.16
464.85
358.8349521
Rerepair ing hernia, blocked

T
0154
29.1491
1,794.16
464.85
358.8349525
Repair ing hernia, sliding

T
0154
29.1491
1,794.16
464.85
358.8349540
Repair lumbar hernia

T
0154
29.1491
1,794.16
464.85
358.8349550
Rpr rem hernia, init, reduce

T
0154
29.1491
1,794.16
464.85
358.8349553
Rpr fem hernia, init blocked

T
0154
29.1491
1,794.16
464.85
358.8349555
Rerepair fem hernia, reduce

T
0154
29.1491
1,794.16
464.85
358.8349557
Rerepair fem hernia, blocked

T
0154
29.1491
1,794.16
464.85
358.8349560
Rpr ventral hern init, reduc

T
0154
29.1491
1,794.16
464.85
358.8349561
Rpr ventral hern init, block

T
0154
29.1491
1,794.16
464.85
358.8349565
Rerepair ventrl hern, reduce

T
0154
29.1491
1,794.16
464.85
358.8349566
Rerepair ventrl hern, block

T
0154
29.1491
1,794.16
464.85
358.8349568
Hernia repair w/mesh

T
0154
29.1491
1,794.16
464.85
358.8349570
Rpr epigastric hern, reduce

T
0154
29.1491
1,794.16
464.85
358.8349572
Rpr epigastric hern, blocked

T
0154
29.1491
1,794.16
464.85
358.8349580
Rpr umbil hern, reduc  5 yr

T
0154
29.1491
1,794.16
464.85
358.8349582
Rpr umbil hern, block  5 yr

T
0154
29.1491
1,794.16
464.85
358.8349585
Rpr umbil hern, reduc  5 yr

T
0154
29.1491
1,794.16
464.85
358.8349587
Rpr umbil hern, block  5 yr

T
0154
29.1491
1,794.16
464.85
358.8349590
Repair spigelian hernia

T
0154
29.1491
1,794.16
464.85
358.8349600
Repair umbilical lesion

T
0154
29.1491
1,794.16
464.85
358.8349650
Laparo hernia repair initial

T
0131
43.5124
2,678.23
1,001.89
535.6549651
Laparo hernia repair recur

T
0131
43.5124
2,678.23
1,001.89
535.6549659
Laparo proc, hernia repair

T
0130
31.9353
1,965.65
659.53
393.1349999
Abdomen surgery procedure

T
0153
22.1758
1,364.94
397.95
272.9950020
Renal abscess, open drain

T
0162
23.8562
1,468.37

293.6750021
Renal abscess, percut drain

T
0037
10.2616
631.61
228.76
126.3250080
Removal of kidney stone

T
0429
42.9327
2,642.55

528.51( print page 49795)50081
Removal of kidney stone

T
0429
42.9327
2,642.55

528.5150200
Biopsy of kidney

T
0685
6.0729
373.79
115.47
74.7650382
Change ureter stent, percut

T
0161
19.2766
1,186.49
249.36
237.3050384
Remove ureter stent, percut

T
0161
19.2766
1,186.49
249.36
237.3050387
Change ext/int ureter stent

T
0122
7.2859
448.45

89.6950389
Remove renal tube w/fluoro

T
0156
3.5688
219.66

43.9350390
Drainage of kidney lesion

T
0685
6.0729
373.79
115.47
74.7650391
Instll rx agnt into rnal tub
CH
T
0126
1.0844
66.75
16.40
13.3550392
Insert kidney drain

T
0161
19.2766
1,186.49
249.36
237.3050393
Insert ureteral tube

T
0161
19.2766
1,186.49
249.36
237.3050394
Injection for kidney x-ray

N50395
Create passage to kidney

T
0161
19.2766
1,186.49
249.36
237.3050396
Measure kidney pressure

T
0164
2.1159
130.24

26.0550398
Change kidney tube

T
0122
7.2859
448.45

89.6950541
Laparo ablate renal cyst

T
0130
31.9353
1,965.65
659.53
393.1350542
Laparo ablate renal mass

T
0132
70.8854
4,363.07
1,239.22
872.6150543
Laparo partial nephrectomy

T
0131
43.5124
2,678.23
1,001.89
535.6550544
Laparoscopy, pyeloplasty

T
0130
31.9353
1,965.65
659.53
393.1350549
Laparoscope proc, renal

T
0130
31.9353
1,965.65
659.53
393.1350551
Kidney endoscopy

T
0160
6.7325
414.39
105.06
82.8850553
Kidney endoscopy

T
0161
19.2766
1,186.49
249.36
237.3050555
Kidney endoscopybiopsy

T
0160
6.7325
414.39
105.06
82.8850557
Kidney endoscopytreatment

T
0162
23.8562
1,468.37

293.6750561
Kidney endoscopytreatment

T
0161
19.2766
1,186.49
249.36
237.3050562
Renal scope w/tumor resect

T
0160
6.7325
414.39
105.06
82.8850570
Kidney endoscopy

T
0160
6.7325
414.39
105.06
82.8850572
Kidney endoscopy

T
0160
6.7325
414.39
105.06
82.8850574
Kidney endoscopybiopsy

T
0160
6.7325
414.39
105.06
82.8850575
Kidney endoscopy

T
0163
35.1024
2,160.59

432.1250576
Kidney endoscopytreatment

T
0161
19.2766
1,186.49
249.36
237.3050590
Fragmenting of kidney stone

T
0169
44.1144
2,715.29
1,009.47
543.0650592
Perc rf ablate renal tumor

T
0423
39.0235
2,401.94

480.3950684
Injection for ureter x-ray

N50686
Measure ureter pressure
CH
T
0126
1.0844
66.75
16.40
13.3550688
Change of ureter tube/stent

T
0122
7.2859
448.45

89.6950690
Injection for ureter x-ray

N50945
Laparoscopy ureterolithotomy

T
0131
43.5124
2,678.23
1,001.89
535.6550947
Laparo new ureter/bladder

T
0131
43.5124
2,678.23
1,001.89
535.6550948
Laparo new ureter/bladder

T
0131
43.5124
2,678.23
1,001.89
535.6550949
Laparoscope proc, ureter

T
0130
31.9353
1,965.65
659.53
393.1350951
Endoscopy of ureter

T
0160
6.7325
414.39
105.06
82.8850953
Endoscopy of ureter

T
0160
6.7325
414.39
105.06
82.8850955
Ureter endoscopybiopsy

T
0161
19.2766
1,186.49
249.36
237.3050957
Ureter endoscopytreatment

T
0161
19.2766
1,186.49
249.36
237.3050961
Ureter endoscopytreatment

T
0161
19.2766
1,186.49
249.36
237.3050970
Ureter endoscopy

T
0160
6.7325
414.39
105.06
82.8850972
Ureter endoscopycatheter

T
0160
6.7325
414.39
105.06
82.8850974
Ureter endoscopybiopsy

T
0161
19.2766
1,186.49
249.36
237.3050976
Ureter endoscopytreatment

T
0161
19.2766
1,186.49
249.36
237.3050980
Ureter endoscopytreatment

T
0161
19.2766
1,186.49
249.36
237.3051000
Drainage of bladder

T
0164
2.1159
130.24

26.0551005
Drainage of bladder
CH
T
0126
1.0844
66.75
16.40
13.3551010
Drainage of bladder

T
0165
18.2333
1,122.28

224.4651020
Incisetreat bladder

T
0162
23.8562
1,468.37

293.6751030
Incisetreat bladder

T
0162
23.8562
1,468.37

293.6751040
Incisedrain bladder

T
0162
23.8562
1,468.37

293.6751045
Incise bladder/drain ureter

T
0160
6.7325
414.39
105.06
82.8851050
Removal of bladder stone

T
0162
23.8562
1,468.37

293.6751065
Remove ureter calculus

T
0162
23.8562
1,468.37

293.6751080
Drainage of bladder abscess

T
0008
17.4686
1,075.21

215.0451500
Removal of bladder cyst

T
0154
29.1491
1,794.16
464.85
358.8351520
Removal of bladder lesion

T
0162
23.8562
1,468.37

293.6751600
Injection for bladder x-ray

N51605
Preparation for bladder xray

N51610
Injection for bladder x-ray

N51700
Irrigation of bladder

T
0164
2.1159
130.24

26.0551701
Insert bladder catheter

X
0340
0.6211
38.23

7.6551702
Insert temp bladder cath

X
0340
0.6211
38.23

7.6551703
Insert bladder cath, complex
CH
T
0126
1.0844
66.75
16.40
13.3551705
Change of bladder tube

T
0121
2.3431
144.22
43.80
28.84( print page 49796)51710
Change of bladder tube

T
0122
7.2859
448.45

89.6951715
Endoscopic injection/implant

T
0168
28.5971
1,760.18
388.16
352.0451720
Treatment of bladder lesion
CH
T
0164
2.1159
130.24

26.0551725
Simple cystometrogram
CH
T
0164
2.1159
130.24

26.0551726
Complex cystometrogram

T
0156
3.5688
219.66

43.9351736
Urine flow measurement
CH
T
0126
1.0844
66.75
16.40
13.3551741
Electro-uroflowmetry, first
CH
T
0126
1.0844
66.75
16.40
13.3551772
Urethra pressure profile
CH
T
0164
2.1159
130.24

26.0551784
Anal/urinary muscle study
CH
T
0126
1.0844
66.75
16.40
13.3551785
Anal/urinary muscle study
CH
T
0126
1.0844
66.75
16.40
13.3551792
Urinary reflex study
CH
T
0126
1.0844
66.75
16.40
13.3551795
Urine voiding pressure study

T
0164
2.1159
130.24

26.0551797
Intraabdominal pressure test

T
0164
2.1159
130.24

26.0551798
Us urine capacity measure

X
0340
0.6211
38.23

7.6551880
Repair of bladder opening

T
0162
23.8562
1,468.37

293.6751990
Laparo urethral suspension

T
0131
43.5124
2,678.23
1,001.89
535.6551992
Laparo sling operation
CH
T
0131
43.5124
2,678.23
1,001.89
535.6551999
Laparoscope proc, bladder

T
0130
31.9353
1,965.65
659.53
393.1352000
Cystoscopy

T
0160
6.7325
414.39
105.06
82.8852001
Cystoscopy, removal of clots

T
0160
6.7325
414.39
105.06
82.8852005
Cystoscopyureter catheter

T
0161
19.2766
1,186.49
249.36
237.3052007
Cystoscopy and biopsy

T
0161
19.2766
1,186.49
249.36
237.3052010
Cystoscopyduct catheter

T
0160
6.7325
414.39
105.06
82.8852204
Cystoscopy

T
0161
19.2766
1,186.49
249.36
237.3052214
Cystoscopy and treatment

T
0162
23.8562
1,468.37

293.6752224
Cystoscopy and treatment

T
0162
23.8562
1,468.37

293.6752234
Cystoscopy and treatment

T
0162
23.8562
1,468.37

293.6752235
Cystoscopy and treatment

T
0162
23.8562
1,468.37

293.6752240
Cystoscopy and treatment

T
0162
23.8562
1,468.37

293.6752250
Cystoscopy and radiotracer

T
0162
23.8562
1,468.37

293.6752260
Cystoscopy and treatment

T
0161
19.2766
1,186.49
249.36
237.3052265
Cystoscopy and treatment

T
0160
6.7325
414.39
105.06
82.8852270
Cystoscopyrevise urethra

T
0161
19.2766
1,186.49
249.36
237.3052275
Cystoscopyrevise urethra

T
0161
19.2766
1,186.49
249.36
237.3052276
Cystoscopy and treatment

T
0161
19.2766
1,186.49
249.36
237.3052277
Cystoscopy and treatment

T
0162
23.8562
1,468.37

293.6752281
Cystoscopy and treatment

T
0161
19.2766
1,186.49
249.36
237.3052282
Cystoscopy, implant stent

T
0163
35.1024
2,160.59

432.1252283
Cystoscopy and treatment

T
0161
19.2766
1,186.49
249.36
237.3052285
Cystoscopy and treatment

T
0161
19.2766
1,186.49
249.36
237.3052290
Cystoscopy and treatment

T
0161
19.2766
1,186.49
249.36
237.3052300
Cystoscopy and treatment

T
0161
19.2766
1,186.49
249.36
237.3052301
Cystoscopy and treatment

T
0161
19.2766
1,186.49
249.36
237.3052305
Cystoscopy and treatment

T
0161
19.2766
1,186.49
249.36
237.3052310
Cystoscopy and treatment

T
0160
6.7325
414.39
105.06
82.8852315
Cystoscopy and treatment

T
0161
19.2766
1,186.49
249.36
237.3052317
Remove bladder stone

T
0162
23.8562
1,468.37

293.6752318
Remove bladder stone

T
0162
23.8562
1,468.37

293.6752320
Cystoscopy and treatment

T
0162
23.8562
1,468.37

293.6752325
Cystoscopy, stone removal

T
0162
23.8562
1,468.37

293.6752327
Cystoscopy, inject material

T
0162
23.8562
1,468.37

293.6752330
Cystoscopy and treatment

T
0162
23.8562
1,468.37

293.6752332
Cystoscopy and treatment

T
0162
23.8562
1,468.37

293.6752334
Create passage to kidney

T
0162
23.8562
1,468.37

293.6752341
Cysto w/ureter stricture tx

T
0162
23.8562
1,468.37

293.6752342
Cysto w/up stricture tx

T
0162
23.8562
1,468.37

293.6752343
Cysto w/renal stricture tx

T
0162
23.8562
1,468.37

293.6752344
Cysto/uretero, stricture tx

T
0162
23.8562
1,468.37

293.6752345
Cysto/uretero w/up stricture

T
0162
23.8562
1,468.37

293.6752346
Cystouretero w/renal strict

T
0162
23.8562
1,468.37

293.6752351
Cystoureteroor pyeloscope

T
0161
19.2766
1,186.49
249.36
237.3052352
Cystouretero w/stone remove

T
0162
23.8562
1,468.37

293.6752353
Cystouretero w/lithotripsy

T
0163
35.1024
2,160.59

432.1252354
Cystouretero w/biopsy

T
0162
23.8562
1,468.37

293.6752355
Cystouretero w/excise tumor

T
0162
23.8562
1,468.37

293.6752400
Cystouretero w/congen repr

T
0162
23.8562
1,468.37

293.6752402
Cystourethro cut ejacul duct

T
0162
23.8562
1,468.37

293.6752450
Incision of prostate

T
0162
23.8562
1,468.37

293.6752500
Revision of bladder neck

T
0162
23.8562
1,468.37

293.6752510
Dilation prostatic urethra

T
0161
19.2766
1,186.49
249.36
237.30( print page 49797)52601
Prostatectomy (TURP)

T
0163
35.1024
2,160.59

432.1252606
Control postop bleeding

T
0162
23.8562
1,468.37

293.6752612
Prostatectomy, first stage

T
0163
35.1024
2,160.59

432.1252614
Prostatectomy, second stage

T
0163
35.1024
2,160.59

432.1252620
Remove residual prostate

T
0163
35.1024
2,160.59

432.1252630
Remove prostate regrowth

T
0163
35.1024
2,160.59

432.1252640
Relieve bladder contracture

T
0162
23.8562
1,468.37

293.6752647
Laser surgery of prostate

T
0429
42.9327
2,642.55

528.5152648
Laser surgery of prostate

T
0429
42.9327
2,642.55

528.5152700
Drainage of prostate abscess

T
0162
23.8562
1,468.37

293.6753000
Incision of urethra

T
0166
18.5138
1,139.54

227.9153010
Incision of urethra

T
0166
18.5138
1,139.54

227.9153020
Incision of urethra

T
0166
18.5138
1,139.54

227.9153025
Incision of urethra

T
0166
18.5138
1,139.54

227.9153040
Drainage of urethra abscess

T
0166
18.5138
1,139.54

227.9153060
Drainage of urethra abscess

T
0166
18.5138
1,139.54

227.9153080
Drainage of urinary leakage

T
0166
18.5138
1,139.54

227.9153085
Drainage of urinary leakage

T
0166
18.5138
1,139.54

227.9153200
Biopsy of urethra

T
0166
18.5138
1,139.54

227.9153210
Removal of urethra

T
0168
28.5971
1,760.18
388.16
352.0453215
Removal of urethra

T
0166
18.5138
1,139.54

227.9153220
Treatment of urethra lesion

T
0168
28.5971
1,760.18
388.16
352.0453230
Removal of urethra lesion

T
0168
28.5971
1,760.18
388.16
352.0453235
Removal of urethra lesion

T
0166
18.5138
1,139.54

227.9153240
Surgery for urethra pouch

T
0168
28.5971
1,760.18
388.16
352.0453250
Removal of urethra gland

T
0166
18.5138
1,139.54

227.9153260
Treatment of urethra lesion

T
0166
18.5138
1,139.54

227.9153265
Treatment of urethra lesion

T
0166
18.5138
1,139.54

227.9153270
Removal of urethra gland

T
0166
18.5138
1,139.54

227.9153275
Repair of urethra defect

T
0166
18.5138
1,139.54

227.9153400
Revise urethra, stage 1

T
0168
28.5971
1,760.18
388.16
352.0453405
Revise urethra, stage 2

T
0168
28.5971
1,760.18
388.16
352.0453410
Reconstruction of urethra

T
0168
28.5971
1,760.18
388.16
352.0453420
Reconstruct urethra, stage 1

T
0168
28.5971
1,760.18
388.16
352.0453425
Reconstruct urethra, stage 2

T
0168
28.5971
1,760.18
388.16
352.0453430
Reconstruction of urethra

T
0168
28.5971
1,760.18
388.16
352.0453431
Reconstruct urethra/bladder

T
0168
28.5971
1,760.18
388.16
352.0453440
Male sling procedure

S
0385
79.3730
4,885.49

977.1053442
Remove/revise male sling

T
0168
28.5971
1,760.18
388.16
352.0453444
Insert tandem cuff

S
0385
79.3730
4,885.49

977.1053445
Insert uro/ves nck sphincter

S
0386
135.7295
8,354.29

1,670.8653446
Remove uro sphincter

T
0168
28.5971
1,760.18
388.16
352.0453447
Remove/replace ur sphincter

S
0386
135.7295
8,354.29

1,670.8653449
Repair uro sphincter

T
0168
28.5971
1,760.18
388.16
352.0453450
Revision of urethra

T
0168
28.5971
1,760.18
388.16
352.0453460
Revision of urethra

T
0166
18.5138
1,139.54

227.9153500
Urethrlys, transvag w/scope

T
0168
28.5971
1,760.18
388.16
352.0453502
Repair of urethra injury

T
0166
18.5138
1,139.54

227.9153505
Repair of urethra injury

T
0168
28.5971
1,760.18
388.16
352.0453510
Repair of urethra injury

T
0166
18.5138
1,139.54

227.9153515
Repair of urethra injury

T
0168
28.5971
1,760.18
388.16
352.0453520
Repair of urethra defect

T
0168
28.5971
1,760.18
388.16
352.0453600
Dilate urethra stricture

T
0156
3.5688
219.66

43.9353601
Dilate urethra stricture
CH
T
0126
1.0844
66.75
16.40
13.3553605
Dilate urethra stricture

T
0161
19.2766
1,186.49
249.36
237.3053620
Dilate urethra stricture

T
0165
18.2333
1,122.28

224.4653621
Dilate urethra stricture

T
0164
2.1159
130.24

26.0553660
Dilation of urethra
CH
T
0126
1.0844
66.75
16.40
13.3553661
Dilation of urethra
CH
T
0126
1.0844
66.75
16.40
13.3553665
Dilation of urethra

T
0166
18.5138
1,139.54

227.9153850
Prostatic microwave thermotx

T
0675
42.3176
2,604.69

520.9453852
Prostatic rf thermotx

T
0675
42.3176
2,604.69

520.9453853
Prostatic water thermother

T
0162
23.8562
1,468.37

293.6753899
Urology surgery procedure
CH
T
0126
1.0844
66.75
16.40
13.3554000
Slitting of prepuce

T
0166
18.5138
1,139.54

227.9154001
Slitting of prepuce

T
0166
18.5138
1,139.54

227.9154015
Drain penis lesion

T
0008
17.4686
1,075.21

215.0454050
Destruction, penis lesion(s)

T
0013
1.0876
66.94

13.3954055
Destruction, penis lesion(s)

T
0017
17.7392
1,091.87
227.84
218.3754056
Cryosurgery, penis lesion(s)

T
0012
0.8076
49.71
10.30
9.94( print page 49798)54057
Laser surg, penis lesion(s)

T
0017
17.7392
1,091.87
227.84
218.3754060
Excision of penis lesion(s)

T
0017
17.7392
1,091.87
227.84
218.3754065
Destruction, penis lesion(s)

T
0695
20.5802
1,266.73
266.59
253.3554100
Biopsy of penis

T
0021
14.9563
920.58
219.48
184.1254105
Biopsy of penis

T
0022
19.9760
1,229.54
354.45
245.9154110
Treatment of penis lesion

T
0181
32.9991
2,031.13
621.82
406.2354111
Treat penis lesion, graft

T
0181
32.9991
2,031.13
621.82
406.2354112
Treat penis lesion, graft

T
0181
32.9991
2,031.13
621.82
406.2354115
Treatment of penis lesion

T
0008
17.4686
1,075.21

215.0454120
Partial removal of penis

T
0181
32.9991
2,031.13
621.82
406.2354150
Circumcision

T
0180
20.7418
1,276.68
304.87
255.3454152
Circumcision

T
0180
20.7418
1,276.68
304.87
255.3454160
Circumcision

T
0180
20.7418
1,276.68
304.87
255.3454161
Circumcision

T
0180
20.7418
1,276.68
304.87
255.3454162
Lysis penil circumic lesion

T
0180
20.7418
1,276.68
304.87
255.3454163
Repair of circumcision

T
0180
20.7418
1,276.68
304.87
255.3454164
Frenulotomy of penis

T
0180
20.7418
1,276.68
304.87
255.3454200
Treatment of penis lesion
CH
T
0164
2.1159
130.24

26.0554205
Treatment of penis lesion

T
0181
32.9991
2,031.13
621.82
406.2354220
Treatment of penis lesion
CH
T
0164
2.1159
130.24

26.0554230
Prepare penis study

N54231
Dynamic cavernosometry

T
0165
18.2333
1,122.28

224.4654235
Penile injection

T
0164
2.1159
130.24

26.0554240
Penis study
CH
T
0126
1.0844
66.75
16.40
13.3554250
Penis study

T
0164
2.1159
130.24

26.0554300
Revision of penis

T
0181
32.9991
2,031.13
621.82
406.2354304
Revision of penis

T
0181
32.9991
2,031.13
621.82
406.2354308
Reconstruction of urethra

T
0181
32.9991
2,031.13
621.82
406.2354312
Reconstruction of urethra

T
0181
32.9991
2,031.13
621.82
406.2354316
Reconstruction of urethra

T
0181
32.9991
2,031.13
621.82
406.2354318
Reconstruction of urethra

T
0181
32.9991
2,031.13
621.82
406.2354322
Reconstruction of urethra

T
0181
32.9991
2,031.13
621.82
406.2354324
Reconstruction of urethra

T
0181
32.9991
2,031.13
621.82
406.2354326
Reconstruction of urethra

T
0181
32.9991
2,031.13
621.82
406.2354328
Revise penis/urethra

T
0181
32.9991
2,031.13
621.82
406.2354340
Secondary urethral surgery

T
0181
32.9991
2,031.13
621.82
406.2354344
Secondary urethral surgery

T
0181
32.9991
2,031.13
621.82
406.2354348
Secondary urethral surgery

T
0181
32.9991
2,031.13
621.82
406.2354352
Reconstruct urethra/penis

T
0181
32.9991
2,031.13
621.82
406.2354360
Penis plastic surgery

T
0181
32.9991
2,031.13
621.82
406.2354380
Repair penis

T
0181
32.9991
2,031.13
621.82
406.2354385
Repair penis

T
0181
32.9991
2,031.13
621.82
406.2354400
Insert semi-rigid prosthesis

S
0385
79.3730
4,885.49

977.1054401
Insert self-contd prosthesis

S
0386
135.7295
8,354.29

1,670.8654405
Insert multi-comp penis pros

S
0386
135.7295
8,354.29

1,670.8654406
Remove muti-comp penis pros

T
0181
32.9991
2,031.13
621.82
406.2354408
Repair multi-comp penis pros

T
0181
32.9991
2,031.13
621.82
406.2354410
Remove/replace penis prosth

S
0386
135.7295
8,354.29

1,670.8654415
Remove self-contd penis pros

T
0181
32.9991
2,031.13
621.82
406.2354416
Remv/repl penis contain pros

S
0386
135.7295
8,354.29

1,670.8654420
Revision of penis

T
0181
32.9991
2,031.13
621.82
406.2354435
Revision of penis

T
0181
32.9991
2,031.13
621.82
406.2354440
Repair of penis

T
0181
32.9991
2,031.13
621.82
406.2354450
Preputial stretching

T
0156
3.5688
219.66

43.9354500
Biopsy of testis

T
0037
10.2616
631.61
228.76
126.3254505
Biopsy of testis

T
0183
23.7072
1,459.20

291.8454512
Excise lesion testis

T
0183
23.7072
1,459.20

291.8454520
Removal of testis

T
0183
23.7072
1,459.20

291.8454522
Orchiectomy, partial

T
0183
23.7072
1,459.20

291.8454530
Removal of testis

T
0154
29.1491
1,794.16
464.85
358.8354550
Exploration for testis

T
0154
29.1491
1,794.16
464.85
358.8354560
Exploration for testis

T
0183
23.7072
1,459.20

291.8454600
Reduce testis torsion

T
0183
23.7072
1,459.20

291.8454620
Suspension of testis

T
0183
23.7072
1,459.20

291.8454640
Suspension of testis

T
0154
29.1491
1,794.16
464.85
358.8354660
Revision of testis

T
0183
23.7072
1,459.20

291.8454670
Repair testis injury

T
0183
23.7072
1,459.20

291.8454680
Relocation of testis(es)

T
0183
23.7072
1,459.20

291.8454690
Laparoscopy, orchiectomy

T
0131
43.5124
2,678.23
1,001.89
535.6554692
Laparoscopy, orchiopexy

T
0132
70.8854
4,363.07
1,239.22
872.61( print page 49799)54699
Laparoscope proc, testis

T
0130
31.9353
1,965.65
659.53
393.1354700
Drainage of scrotum

T
0183
23.7072
1,459.20

291.8454800
Biopsy of epididymis

T
0004
2.0863
128.41

25.6854820
Exploration of epididymis

T
0183
23.7072
1,459.20

291.8454830
Remove epididymis lesion

T
0183
23.7072
1,459.20

291.8454840
Remove epididymis lesion

T
0183
23.7072
1,459.20

291.8454860
Removal of epididymis

T
0183
23.7072
1,459.20

291.8454861
Removal of epididymis

T
0183
23.7072
1,459.20

291.8454900
Fusion of spermatic ducts

T
0183
23.7072
1,459.20

291.8454901
Fusion of spermatic ducts

T
0183
23.7072
1,459.20

291.8455000
Drainage of hydrocele

T
0004
2.0863
128.41

25.6855040
Removal of hydrocele

T
0154
29.1491
1,794.16
464.85
358.8355041
Removal of hydroceles

T
0154
29.1491
1,794.16
464.85
358.8355060
Repair of hydrocele

T
0183
23.7072
1,459.20

291.8455100
Drainage of scrotum abscess
CH
T
0007
10.9184
672.04

134.4155110
Explore scrotum

T
0183
23.7072
1,459.20

291.8455120
Removal of scrotum lesion

T
0183
23.7072
1,459.20

291.8455150
Removal of scrotum

T
0183
23.7072
1,459.20

291.8455175
Revision of scrotum

T
0183
23.7072
1,459.20

291.8455180
Revision of scrotum

T
0183
23.7072
1,459.20

291.8455200
Incision of sperm duct

T
0183
23.7072
1,459.20

291.8455250
Removal of sperm duct(s)

T
0183
23.7072
1,459.20

291.8455300
Prepare, sperm duct x-ray

N55400
Repair of sperm duct

T
0183
23.7072
1,459.20

291.8455450
Ligation of sperm duct

T
0183
23.7072
1,459.20

291.8455500
Removal of hydrocele

T
0183
23.7072
1,459.20

291.8455520
Removal of sperm cord lesion

T
0183
23.7072
1,459.20

291.8455530
Revise spermatic cord veins

T
0183
23.7072
1,459.20

291.8455535
Revise spermatic cord veins

T
0154
29.1491
1,794.16
464.85
358.8355540
Revise herniasperm veins

T
0154
29.1491
1,794.16
464.85
358.8355550
Laparo ligate spermatic vein

T
0131
43.5124
2,678.23
1,001.89
535.6555559
Laparo proc, spermatic cord

T
0130
31.9353
1,965.65
659.53
393.1355600
Incise sperm duct pouch

T
0183
23.7072
1,459.20

291.8455680
Remove sperm pouch lesion

T
0183
23.7072
1,459.20

291.8455700
Biopsy of prostate

T
0184
5.9892
368.64
96.27
73.7355705
Biopsy of prostate

T
0184
5.9892
368.64
96.27
73.7355720
Drainage of prostate abscess

T
0162
23.8562
1,468.37

293.6755725
Drainage of prostate abscess

T
0162
23.8562
1,468.37

293.6755859
Percut/needle insert, pros

T
0163
35.1024
2,160.59

432.1255860
Surgical exposure, prostate

T
0165
18.2333
1,122.28

224.4655870
Electroejaculation

T
0197
4.4108
271.49

54.3055873
Cryoablate prostate

T
0674
107.8298
6,637.03

1,327.4155899
Genital surgery procedure
CH
T
0126
1.0844
66.75
16.40
13.3556405
ID of vulva/perineum

T
0189
2.9902
184.05

36.8156420
Drainage of gland abscess
CH
T
0188
1.4050
86.48

17.3056440
Surgery for vulva lesion

T
0194
20.5113
1,262.49
397.84
252.5056441
Lysis of labial lesion(s)

T
0193
14.7958
910.70

182.1456501
Destroy, vulva lesions, sim

T
0017
17.7392
1,091.87
227.84
218.3756515
Destroy vulva lesion/s compl

T
0695
20.5802
1,266.73
266.59
253.3556605
Biopsy of vulva/perineum

T
0019
4.0123
246.96
71.87
49.3956606
Biopsy of vulva/perineum

T
0019
4.0123
246.96
71.87
49.3956620
Partial removal of vulva

T
0195
28.7410
1,769.04
483.80
353.8156625
Complete removal of vulva

T
0195
28.7410
1,769.04
483.80
353.8156700
Partial removal of hymen

T
0194
20.5113
1,262.49
397.84
252.5056720
Incision of hymen

T
0193
14.7958
910.70

182.1456740
Remove vagina gland lesion

T
0194
20.5113
1,262.49
397.84
252.5056800
Repair of vagina

T
0194
20.5113
1,262.49
397.84
252.5056805
Repair clitoris

T
0193
14.7958
910.70

182.1456810
Repair of perineum

T
0194
20.5113
1,262.49
397.84
252.5056820
Exam of vulva w/scope

T
0188
1.4050
86.48

17.3056821
Exam/biopsy of vulva w/scope

T
0189
2.9902
184.05

36.8157000
Exploration of vagina

T
0193
14.7958
910.70

182.1457010
Drainage of pelvic abscess

T
0193
14.7958
910.70

182.1457020
Drainage of pelvic fluid

T
0192
6.9265
426.33

85.2757022
Id vaginal hematoma, pp

T
0007
10.9184
672.04

134.4157023
Id vag hematoma, non-ob

T
0008
17.4686
1,075.21

215.0457061
Destroy vag lesions, simple

T
0194
20.5113
1,262.49
397.84
252.5057065
Destroy vag lesions, complex

T
0194
20.5113
1,262.49
397.84
252.5057100
Biopsy of vagina

T
0192
6.9265
426.33

85.2757105
Biopsy of vagina

T
0194
20.5113
1,262.49
397.84
252.50( print page 49800)57106
Remove vagina wall, partial

T
0194
20.5113
1,262.49
397.84
252.5057107
Remove vagina tissue, part

T
0195
28.7410
1,769.04
483.80
353.8157109
Vaginectomy partial w/nodes

T
0195
28.7410
1,769.04
483.80
353.8157120
Closure of vagina

T
0195
28.7410
1,769.04
483.80
353.8157130
Remove vagina lesion

T
0194
20.5113
1,262.49
397.84
252.5057135
Remove vagina lesion

T
0194
20.5113
1,262.49
397.84
252.5057150
Treat vagina infection

T
0191
0.1501
9.24

1.8557155
Insert uteri tandems/ovoids

T
0192
6.9265
426.33

85.2757160
Insert pessary/other device

T
0188
1.4050
86.48

17.3057170
Fitting of diaphragm/cap

T
0191
0.1501
9.24

1.8557180
Treat vaginal bleeding

T
0189
2.9902
184.05

36.8157200
Repair of vagina

T
0194
20.5113
1,262.49
397.84
252.5057210
Repair vagina/perineum

T
0194
20.5113
1,262.49
397.84
252.5057220
Revision of urethra

T
0202
42.8756
2,639.04
981.50
527.8157230
Repair of urethral lesion

T
0195
28.7410
1,769.04
483.80
353.8157240
Repair bladdervagina

T
0195
28.7410
1,769.04
483.80
353.8157250
Repair rectumvagina

T
0195
28.7410
1,769.04
483.80
353.8157260
Repair of vagina

T
0195
28.7410
1,769.04
483.80
353.8157265
Extensive repair of vagina

T
0202
42.8756
2,639.04
981.50
527.8157267
Insert mesh/pelvic flr addon
CH
T
0195
28.7410
1,769.04
483.80
353.8157268
Repair of bowel bulge

T
0195
28.7410
1,769.04
483.80
353.8157284
Repair paravaginal defect

T
0202
42.8756
2,639.04
981.50
527.8157287
Revise/remove sling repair
CH
T
0195
28.7410
1,769.04
483.80
353.8157288
Repair bladder defect

T
0202
42.8756
2,639.04
981.50
527.8157289
Repair bladdervagina

T
0195
28.7410
1,769.04
483.80
353.8157291
Construction of vagina

T
0195
28.7410
1,769.04
483.80
353.8157292
Construct vagina with graft
CH
T
0195
28.7410
1,769.04
483.80
353.8157295
Change vaginal graft

T
0194
20.5113
1,262.49
397.84
252.5057300
Repair rectum-vagina fistula

T
0195
28.7410
1,769.04
483.80
353.8157310
Repair urethrovaginal lesion

T
0202
42.8756
2,639.04
981.50
527.8157320
Repair bladder-vagina lesion

T
0195
28.7410
1,769.04
483.80
353.8157330
Repair bladder-vagina lesion

T
0195
28.7410
1,769.04
483.80
353.8157335
Repair vagina
CH
T
0195
28.7410
1,769.04
483.80
353.8157400
Dilation of vagina

T
0194
20.5113
1,262.49
397.84
252.5057410
Pelvic examination

T
0193
14.7958
910.70

182.1457415
Remove vaginal foreign body

T
0194
20.5113
1,262.49
397.84
252.5057420
Exam of vagina w/scope

T
0189
2.9902
184.05

36.8157421
Exam/biopsy of vag w/scope

T
0189
2.9902
184.05

36.8157425
Laparoscopy, surg, colpopexy

T
0130
31.9353
1,965.65
659.53
393.1357452
Exam of cervix w/scope
CH
T
0188
1.4050
86.48

17.3057454
Bx/curett of cervix w/scope

T
0189
2.9902
184.05

36.8157455
Biopsy of cervix w/scope

T
0189
2.9902
184.05

36.8157456
Endocerv curettage w/scope

T
0189
2.9902
184.05

36.8157460
Bx of cervix w/scope, leep

T
0193
14.7958
910.70

182.1457461
Conz of cervix w/scope, leep

T
0194
20.5113
1,262.49
397.84
252.5057500
Biopsy of cervix
CH
T
0189
2.9902
184.05

36.8157505
Endocervical curettage

T
0189
2.9902
184.05

36.8157510
Cauterization of cervix

T
0193
14.7958
910.70

182.1457511
Cryocautery of cervix
CH
T
0188
1.4050
86.48

17.3057513
Laser surgery of cervix

T
0193
14.7958
910.70

182.1457520
Conization of cervix

T
0194
20.5113
1,262.49
397.84
252.5057522
Conization of cervix

T
0195
28.7410
1,769.04
483.80
353.8157530
Removal of cervix

T
0195
28.7410
1,769.04
483.80
353.8157550
Removal of residual cervix

T
0195
28.7410
1,769.04
483.80
353.8157555
Remove cervix/repair vagina

T
0195
28.7410
1,769.04
483.80
353.8157556
Remove cervix, repair bowel

T
0202
42.8756
2,639.04
981.50
527.8157700
Revision of cervix

T
0194
20.5113
1,262.49
397.84
252.5057720
Revision of cervix

T
0194
20.5113
1,262.49
397.84
252.5057800
Dilation of cervical canal

T
0193
14.7958
910.70

182.1457820
Dc of residual cervix

T
0196
17.7635
1,093.36
338.23
218.6758100
Biopsy of uterus lining

T
0188
1.4050
86.48

17.3058110
Bx done w/colposcopy add-on

T
0188
1.4050
86.48

17.3058120
Dilation and curettage

T
0196
17.7635
1,093.36
338.23
218.6758145
Myomectomy vag method

T
0195
28.7410
1,769.04
483.80
353.8158301
Remove intrauterine device
CH
T
0188
1.4050
86.48

17.3058321
Artificial insemination

T
0197
4.4108
271.49

54.3058322
Artificial insemination

T
0197
4.4108
271.49

54.3058323
Sperm washing

T
0197
4.4108
271.49

54.3058340
Catheter for hysterography

N58345
Reopen fallopian tube

T
0193
14.7958
910.70

182.14( print page 49801)58346
Insert heyman uteri capsule

T
0193
14.7958
910.70

182.1458350
Reopen fallopian tube

T
0195
28.7410
1,769.04
483.80
353.8158353
Endometr ablate, thermal

T
0195
28.7410
1,769.04
483.80
353.8158356
Endometrial cryoablation

T
0202
42.8756
2,639.04
981.50
527.8158545
Laparoscopic myomectomy

T
0130
31.9353
1,965.65
659.53
393.1358546
Laparo-myomectomy, complex

T
0131
43.5124
2,678.23
1,001.89
535.6558550
Laparo-asst vag hysterectomy

T
0132
70.8854
4,363.07
1,239.22
872.6158552
Laparo-vag hyst incl t/o

T
0131
43.5124
2,678.23
1,001.89
535.6558553
Laparo-vag hyst, complex

T
0131
43.5124
2,678.23
1,001.89
535.6558554
Laparo-vag hyst w/t/o, compl

T
0131
43.5124
2,678.23
1,001.89
535.6558555
Hysteroscopy, dx, sep proc

T
0190
21.4199
1,318.42
424.28
263.6858558
Hysteroscopy, biopsy

T
0190
21.4199
1,318.42
424.28
263.6858559
Hysteroscopy, lysis

T
0190
21.4199
1,318.42
424.28
263.6858560
Hysteroscopy, resect septum

T
0387
33.3029
2,049.83
655.55
409.9758561
Hysteroscopy, remove myoma

T
0387
33.3029
2,049.83
655.55
409.9758562
Hysteroscopy, remove fb

T
0190
21.4199
1,318.42
424.28
263.6858563
Hysteroscopy, ablation

T
0387
33.3029
2,049.83
655.55
409.9758565
Hysteroscopy, sterilization

T
0202
42.8756
2,639.04
981.50
527.8158578
Laparo proc, uterus

T
0130
31.9353
1,965.65
659.53
393.1358579
Hysteroscope procedure

T
0190
21.4199
1,318.42
424.28
263.6858600
Division of fallopian tube

T
0195
28.7410
1,769.04
483.80
353.8158615
Occlude fallopian tube(s)

T
0194
20.5113
1,262.49
397.84
252.5058660
Laparoscopy, lysis

T
0131
43.5124
2,678.23
1,001.89
535.6558661
Laparoscopy, remove adnexa

T
0131
43.5124
2,678.23
1,001.89
535.6558662
Laparoscopy, excise lesions

T
0131
43.5124
2,678.23
1,001.89
535.6558670
Laparoscopy, tubal cautery

T
0131
43.5124
2,678.23
1,001.89
535.6558671
Laparoscopy, tubal block

T
0131
43.5124
2,678.23
1,001.89
535.6558672
Laparoscopy, fimbrioplasty

T
0131
43.5124
2,678.23
1,001.89
535.6558673
Laparoscopy, salpingostomy

T
0131
43.5124
2,678.23
1,001.89
535.6558679
Laparo proc, oviduct-ovary

T
0130
31.9353
1,965.65
659.53
393.1358770
Create new tubal opening

T
0195
28.7410
1,769.04
483.80
353.8158800
Drainage of ovarian cyst(s)

T
0193
14.7958
910.70

182.1458820
Drain ovary abscess, open

T
0195
28.7410
1,769.04
483.80
353.8158823
Drain pelvic abscess, percut

T
0193
14.7958
910.70

182.1458900
Biopsy of ovary(s)

T
0193
14.7958
910.70

182.1458920
Partial removal of ovary(s)

T
0195
28.7410
1,769.04
483.80
353.8158925
Removal of ovarian cyst(s)

T
0195
28.7410
1,769.04
483.80
353.8158970
Retrieval of oocyte

T
0197
4.4108
271.49

54.3058974
Transfer of embryo

T
0197
4.4108
271.49

54.3058976
Transfer of embryo

T
0197
4.4108
271.49

54.3058999
Genital surgery procedure

T
0191
0.1501
9.24

1.8559000
Amniocentesis, diagnostic

T
0198
1.4026
86.33
32.19
17.2759001
Amniocentesis, therapeutic

T
0192
6.9265
426.33

85.2759012
Fetal cord puncture,prenatal

T
0198
1.4026
86.33
32.19
17.2759015
Chorion biopsy

T
0198
1.4026
86.33
32.19
17.2759020
Fetal contract stress test
CH
T
0189
2.9902
184.05

36.8159025
Fetal non-stress test

T
0198
1.4026
86.33
32.19
17.2759030
Fetal scalp blood sample

T
0198
1.4026
86.33
32.19
17.2759070
Transabdom amnioinfus w/us

T
0198
1.4026
86.33
32.19
17.2759072
Umbilical cord occlud w/us

T
0198
1.4026
86.33
32.19
17.2759074
Fetal fluid drainage w/us

T
0198
1.4026
86.33
32.19
17.2759076
Fetal shunt placement, w/us

T
0198
1.4026
86.33
32.19
17.2759100
Remove uterus lesion

T
0195
28.7410
1,769.04
483.80
353.8159150
Treat ectopic pregnancy

T
0131
43.5124
2,678.23
1,001.89
535.6559151
Treat ectopic pregnancy

T
0131
43.5124
2,678.23
1,001.89
535.6559160
Dc after delivery

T
0196
17.7635
1,093.36
338.23
218.6759200
Insert cervical dilator

T
0189
2.9902
184.05

36.8159300
Episiotomy or vaginal repair

T
0193
14.7958
910.70

182.1459320
Revision of cervix

T
0194
20.5113
1,262.49
397.84
252.5059409
Obstetrical care

T
0194
20.5113
1,262.49
397.84
252.5059412
Antepartum manipulation

T
0700
2.8011
172.41

34.4859414
Deliver placenta

T
0193
14.7958
910.70

182.1459612
Vbac delivery only

T
0194
20.5113
1,262.49
397.84
252.5059812
Treatment of miscarriage

T
0201
18.5251
1,140.24
329.65
228.0559820
Care of miscarriage

T
0201
18.5251
1,140.24
329.65
228.0559821
Treatment of miscarriage

T
0201
18.5251
1,140.24
329.65
228.0559840
Abortion

T
0200
17.2607
1,062.41
248.39
212.4859841
Abortion

T
0200
17.2607
1,062.41
248.39
212.4859866
Abortion (mpr)

T
0198
1.4026
86.33
32.19
17.2759870
Evacuate mole of uterus

T
0201
18.5251
1,140.24
329.65
228.05( print page 49802)59871
Remove cerclage suture

T
0194
20.5113
1,262.49
397.84
252.5059897
Fetal invas px w/us

T
0198
1.4026
86.33
32.19
17.2759898
Laparo proc, ob care/deliver

T
0130
31.9353
1,965.65
659.53
393.1359899
Maternity care procedure

T
0198
1.4026
86.33
32.19
17.2760000
Drain thyroid/tongue cyst

T
0252
7.7261
475.55
111.84
95.1160001
Aspirate/inject thyriod cyst

T
0004
2.0863
128.41

25.6860100
Biopsy of thyroid

T
0004
2.0863
128.41

25.6860200
Remove thyroid lesion

T
0114
37.1283
2,285.28
461.19
457.0660210
Partial thyroid excision

T
0114
37.1283
2,285.28
461.19
457.0660212
Partial thyroid excision

T
0114
37.1283
2,285.28
461.19
457.0660220
Partial removal of thyroid

T
0114
37.1283
2,285.28
461.19
457.0660225
Partial removal of thyroid

T
0114
37.1283
2,285.28
461.19
457.0660240
Removal of thyroid

T
0114
37.1283
2,285.28
461.19
457.0660252
Removal of thyroid

T
0256
37.7719
2,324.90

464.9860260
Repeat thyroid surgery

T
0256
37.7719
2,324.90

464.9860280
Remove thyroid duct lesion

T
0114
37.1283
2,285.28
461.19
457.0660281
Remove thyroid duct lesion

T
0114
37.1283
2,285.28
461.19
457.0660500
Explore parathyroid glands

T
0256
37.7719
2,324.90

464.9860512
Autotransplant parathyroid

T
0022
19.9760
1,229.54
354.45
245.9160659
Laparo proc, endocrine

T
0130
31.9353
1,965.65
659.53
393.1360699
Endocrine surgery procedure

T
0114
37.1283
2,285.28
461.19
457.0661000
Remove cranial cavity fluid

T
0212
3.0383
187.01
65.96
37.4061001
Remove cranial cavity fluid

T
0212
3.0383
187.01
65.96
37.4061020
Remove brain cavity fluid

T
0212
3.0383
187.01
65.96
37.4061026
Injection into brain canal

T
0212
3.0383
187.01
65.96
37.4061050
Remove brain canal fluid

T
0212
3.0383
187.01
65.96
37.4061055
Injection into brain canal

T
0212
3.0383
187.01
65.96
37.4061070
Brain canal shunt procedure

T
0212
3.0383
187.01
65.96
37.4061215
Insert brain-fluid device

T
0224
45.6712
2,811.11

562.2261330
Decompress eye socket

T
0256
37.7719
2,324.90

464.9861334
Explore orbit/remove object

T
0256
37.7719
2,324.90

464.9861623
Endovasc tempory vessel occl

T
0081
42.8894
2,639.89

527.9861626
Transcath occlusion, non-cns

T
0081
42.8894
2,639.89

527.9861720
Incise skull/brain surgery
CH
T
0221
33.3035
2,049.86
463.62
409.9761790
Treat trigeminal nerve

T
0220
17.7609
1,093.20

218.6461791
Treat trigeminal tract

T
0206
5.5439
341.23
75.55
68.2561795
Brain surgery using computer

S
0302
5.5005
338.56
105.94
67.7161880
Revise/remove neuroelectrode

T
0687
17.1830
1,057.63
423.05
211.5361885
Insrt/redo neurostim 1 array

S
0039
175.9328
10,828.84

2,165.7761886
Implant neurostim arrays

T
0315
235.5774
14,500.02

2,900.0061888
Revise/remove neuroreceiver

T
0688
33.9521
2,089.79
835.91
417.9662000
Treat skull fracture
CH
T
0254
23.1564
1,425.30
321.35
285.0662160
Neuroendoscopy add-on

T
0122
7.2859
448.45

89.6962194
Replace/irrigate catheter

T
0427
11.5220
709.19

141.8462225
Replace/irrigate catheter

T
0427
11.5220
709.19

141.8462230
Replace/revise brain shunt

T
0224
45.6712
2,811.11

562.2262252
Csf shunt reprogram

S
0691
2.8253
173.90
60.61
34.7862263
Epidural lysis mult sessions

T
0203
12.4432
765.89
240.33
153.1862264
Epidural lysis on single day

T
0203
12.4432
765.89
240.33
153.1862268
Drain spinal cord cyst

T
0212
3.0383
187.01
65.96
37.4062269
Needle biopsy, spinal cord

T
0685
6.0729
373.79
115.47
74.7662270
Spinal fluid tap, diagnostic

T
0204
2.2491
138.43
40.13
27.6962272
Drain cerebro spinal fluid

T
0204
2.2491
138.43
40.13
27.6962273
Inject epidural patch

T
0206
5.5439
341.23
75.55
68.2562280
Treat spinal cord lesion

T
0207
6.3788
392.62
86.92
78.5262281
Treat spinal cord lesion

T
0207
6.3788
392.62
86.92
78.5262282
Treat spinal canal lesion

T
0207
6.3788
392.62
86.92
78.5262284
Injection for myelogram

N62287
Percutaneous diskectomy

T
0221
33.3035
2,049.86
463.62
409.9762290
Inject for spine disk x-ray

N62291
Inject for spine disk x-ray

N62292
Injection into disk lesion

T
0212
3.0383
187.01
65.96
37.4062294
Injection into spinal artery

T
0212
3.0383
187.01
65.96
37.4062310
Inject spine c/t

T
0207
6.3788
392.62
86.92
78.5262311
Inject spine l/s (cd)

T
0207
6.3788
392.62
86.92
78.5262318
Inject spine w/cath, c/t

T
0207
6.3788
392.62
86.92
78.5262319
Inject spine w/cath l/s (cd)

T
0207
6.3788
392.62
86.92
78.5262350
Implant spinal canal cath

T
0223
29.2931
1,803.02

360.6062351
Implant spinal canal cath

T
0208
43.9030
2,702.27

540.4562355
Remove spinal canal catheter

T
0203
12.4432
765.89
240.33
153.18( print page 49803)62360
Insert spine infusion device

T
0226
112.0147
6,894.62

1,378.9262361
Implant spine infusion pump

T
0227
183.1974
11,275.98

2,255.2062362
Implant spine infusion pump

T
0227
183.1974
11,275.98

2,255.2062365
Remove spine infusion device

T
0221
33.3035
2,049.86
463.62
409.9762367
Analyze spine infusion pump

S
0691
2.8253
173.90
60.61
34.7862368
Analyze spine infusion pump

S
0691
2.8253
173.90
60.61
34.7863001
Removal of spinal lamina

T
0208
43.9030
2,702.27

540.4563003
Removal of spinal lamina

T
0208
43.9030
2,702.27

540.4563005
Removal of spinal lamina

T
0208
43.9030
2,702.27

540.4563011
Removal of spinal lamina

T
0208
43.9030
2,702.27

540.4563012
Removal of spinal lamina

T
0208
43.9030
2,702.27

540.4563015
Removal of spinal lamina

T
0208
43.9030
2,702.27

540.4563016
Removal of spinal lamina

T
0208
43.9030
2,702.27

540.4563017
Removal of spinal lamina

T
0208
43.9030
2,702.27

540.4563020
Neck spine disk surgery

T
0208
43.9030
2,702.27

540.4563030
Low back disk surgery

T
0208
43.9030
2,702.27

540.4563035
Spinal disk surgery add-on

T
0208
43.9030
2,702.27

540.4563040
Laminotomy, single cervical

T
0208
43.9030
2,702.27

540.4563042
Laminotomy, single lumbar

T
0208
43.9030
2,702.27

540.4563045
Removal of spinal lamina

T
0208
43.9030
2,702.27

540.4563046
Removal of spinal lamina

T
0208
43.9030
2,702.27

540.4563047
Removal of spinal lamina

T
0208
43.9030
2,702.27

540.4563048
Remove spinal lamina add-on

T
0208
43.9030
2,702.27

540.4563055
Decompress spinal cord

T
0208
43.9030
2,702.27

540.4563056
Decompress spinal cord

T
0208
43.9030
2,702.27

540.4563057
Decompress spine cord add-on

T
0208
43.9030
2,702.27

540.4563064
Decompress spinal cord

T
0208
43.9030
2,702.27

540.4563066
Decompress spine cord add-on

T
0208
43.9030
2,702.27

540.4563075
Neck spine disk surgery

T
0208
43.9030
2,702.27

540.4563600
Remove spinal cord lesion

T
0220
17.7609
1,093.20

218.6463610
Stimulation of spinal cord

T
0220
17.7609
1,093.20

218.6463615
Remove lesion of spinal cord

T
0220
17.7609
1,093.20

218.6463650
Implant neuroelectrodes

S
0040
56.3855
3,470.58

694.1263655
Implant neuroelectrodes

S
0061
84.2373
5,184.89

1,036.9863660
Revise/remove neuroelectrode

T
0687
17.1830
1,057.63
423.05
211.5363685
Insrt/redo spine n generator

T
0222
178.1307
10,964.12

2,192.8263688
Revise/remove neuroreceiver

T
0688
33.9521
2,089.79
835.91
417.9663741
Install spinal shunt

T
0228
36.1603
2,225.70

445.1463744
Revision of spinal shunt

T
0228
36.1603
2,225.70

445.1463746
Removal of spinal shunt

T
0109
10.9541
674.24

134.8564400
N block inj, trigeminal

T
0204
2.2491
138.43
40.13
27.6964402
N block inj, facial

T
0204
2.2491
138.43
40.13
27.6964405
N block inj, occipital

T
0204
2.2491
138.43
40.13
27.6964408
N block inj, vagus

T
0204
2.2491
138.43
40.13
27.6964410
N block inj, phrenic

T
0206
5.5439
341.23
75.55
68.2564412
N block inj, spinal accessor

T
0206
5.5439
341.23
75.55
68.2564413
N block inj, cervical plexus

T
0204
2.2491
138.43
40.13
27.6964415
N block inj, brachial plexus

T
0204
2.2491
138.43
40.13
27.6964416
N block cont infuse, b plex

T
0204
2.2491
138.43
40.13
27.6964417
N block inj, axillary

T
0204
2.2491
138.43
40.13
27.6964418
N block inj, suprascapular

T
0204
2.2491
138.43
40.13
27.6964420
N block inj, intercost, sng

T
0204
2.2491
138.43
40.13
27.6964421
N block inj, intercost, mlt

T
0206
5.5439
341.23
75.55
68.2564425
N block inj, ilio-ing/hypogi

T
0204
2.2491
138.43
40.13
27.6964430
N block inj, pudendal

T
0204
2.2491
138.43
40.13
27.6964435
N block inj, paracervical

T
0204
2.2491
138.43
40.13
27.6964445
N block inj, sciatic, sng

T
0204
2.2491
138.43
40.13
27.6964446
N blk inj, sciatic, cont inf

T
0206
5.5439
341.23
75.55
68.2564447
N block inj fem, single

T
0204
2.2491
138.43
40.13
27.6964448
N block inj fem, cont inf

T
0204
2.2491
138.43
40.13
27.6964449
N block inj, lumbar plexus

T
0204
2.2491
138.43
40.13
27.6964450
N block, other peripheral

T
0204
2.2491
138.43
40.13
27.6964470
Inj paravertebral c/t

T
0207
6.3788
392.62
86.92
78.5264472
Inj paravertebral c/t add-on

T
0206
5.5439
341.23
75.55
68.2564475
Inj paravertebral l/s

T
0207
6.3788
392.62
86.92
78.5264476
Inj paravertebral l/s add-on

T
0206
5.5439
341.23
75.55
68.2564479
Inj foramen epidural c/t

T
0207
6.3788
392.62
86.92
78.5264480
Inj foramen epidural add-on

T
0207
6.3788
392.62
86.92
78.5264483
Inj foramen epidural l/s

T
0207
6.3788
392.62
86.92
78.5264484
Inj foramen epidural add-on

T
0207
6.3788
392.62
86.92
78.52( print page 49804)64505
N block, spenopalatine gangl

T
0204
2.2491
138.43
40.13
27.6964508
N block, carotid sinus s/p

T
0204
2.2491
138.43
40.13
27.6964510
N block, stellate ganglion

T
0207
6.3788
392.62
86.92
78.5264517
N block inj, hypogas plxs

T
0204
2.2491
138.43
40.13
27.6964520
N block, lumbar/thoracic

T
0207
6.3788
392.62
86.92
78.5264530
N block inj, celiac pelus

T
0207
6.3788
392.62
86.92
78.5264553
Implant neuroelectrodes

S
0225
234.1628
14,412.95

2,882.5964555
Implant neuroelectrodes

S
0040
56.3855
3,470.58

694.1264560
Implant neuroelectrodes

S
0040
56.3855
3,470.58

694.1264561
Implant neuroelectrodes

S
0040
56.3855
3,470.58

694.1264565
Implant neuroelectrodes

S
0040
56.3855
3,470.58

694.1264573
Implant neuroelectrodes

S
0225
234.1628
14,412.95

2,882.5964575
Implant neuroelectrodes

S
0061
84.2373
5,184.89

1,036.9864577
Implant neuroelectrodes

S
0061
84.2373
5,184.89

1,036.9864580
Implant neuroelectrodes

S
0061
84.2373
5,184.89

1,036.9864581
Implant neuroelectrodes

S
0061
84.2373
5,184.89

1,036.9864585
Revise/remove neuroelectrode

T
0687
17.1830
1,057.63
423.05
211.5364590
Insrt/redo perph n generator

T
0222
178.1307
10,964.12

2,192.8264595
Revise/remove neuroreceiver

T
0688
33.9521
2,089.79
835.91
417.9664600
Injection treatment of nerve

T
0203
12.4432
765.89
240.33
153.1864605
Injection treatment of nerve

T
0203
12.4432
765.89
240.33
153.1864610
Injection treatment of nerve

T
0203
12.4432
765.89
240.33
153.1864612
Destroy nerve, face muscle

T
0204
2.2491
138.43
40.13
27.6964613
Destroy nerve, neck muscle

T
0204
2.2491
138.43
40.13
27.6964614
Destroy nerve, extrem musc

T
0204
2.2491
138.43
40.13
27.6964620
Injection treatment of nerve

T
0203
12.4432
765.89
240.33
153.1864622
Destr paravertebrl nerve l/s

T
0203
12.4432
765.89
240.33
153.1864623
Destr paravertebral n add-on

T
0207
6.3788
392.62
86.92
78.5264626
Destr paravertebrl nerve c/t

T
0203
12.4432
765.89
240.33
153.1864627
Destr paravertebral n add-on

T
0207
6.3788
392.62
86.92
78.5264630
Injection treatment of nerve

T
0206
5.5439
341.23
75.55
68.2564640
Injection treatment of nerve

T
0206
5.5439
341.23
75.55
68.2564650
Chemodenerv eccrine glands

T
0204
2.2491
138.43
40.13
27.6964653
Chemodenerv eccrine glands

T
0204
2.2491
138.43
40.13
27.6964680
Injection treatment of nerve

T
0207
6.3788
392.62
86.92
78.5264681
Injection treatment of nerve

T
0203
12.4432
765.89
240.33
153.1864702
Revise finger/toe nerve

T
0220
17.7609
1,093.20

218.6464704
Revise hand/foot nerve

T
0220
17.7609
1,093.20

218.6464708
Revise arm/leg nerve

T
0220
17.7609
1,093.20

218.6464712
Revision of sciatic nerve

T
0220
17.7609
1,093.20

218.6464713
Revision of arm nerve(s)

T
0220
17.7609
1,093.20

218.6464714
Revise low back nerve(s)

T
0220
17.7609
1,093.20

218.6464716
Revision of cranial nerve

T
0220
17.7609
1,093.20

218.6464718
Revise ulnar nerve at elbow

T
0220
17.7609
1,093.20

218.6464719
Revise ulnar nerve at wrist

T
0220
17.7609
1,093.20

218.6464721
Carpal tunnel surgery

T
0220
17.7609
1,093.20

218.6464722
Relieve pressure on nerve(s)

T
0220
17.7609
1,093.20

218.6464726
Release foot/toe nerve

T
0220
17.7609
1,093.20

218.6464727
Internal nerve revision

T
0220
17.7609
1,093.20

218.6464732
Incision of brow nerve

T
0220
17.7609
1,093.20

218.6464734
Incision of cheek nerve

T
0220
17.7609
1,093.20

218.6464736
Incision of chin nerve

T
0220
17.7609
1,093.20

218.6464738
Incision of jaw nerve

T
0220
17.7609
1,093.20

218.6464740
Incision of tongue nerve

T
0220
17.7609
1,093.20

218.6464742
Incision of facial nerve

T
0220
17.7609
1,093.20

218.6464744
Incise nerve, back of head

T
0220
17.7609
1,093.20

218.6464746
Incise diaphragm nerve

T
0220
17.7609
1,093.20

218.6464761
Incision of pelvis nerve

T
0220
17.7609
1,093.20

218.6464763
Incise hip/thigh nerve

T
0220
17.7609
1,093.20

218.6464766
Incise hip/thigh nerve

T
0221
33.3035
2,049.86
463.62
409.9764771
Sever cranial nerve

T
0220
17.7609
1,093.20

218.6464772
Incision of spinal nerve

T
0220
17.7609
1,093.20

218.6464774
Remove skin nerve lesion

T
0220
17.7609
1,093.20

218.6464776
Remove digit nerve lesion

T
0220
17.7609
1,093.20

218.6464778
Digit nerve surgery add-on

T
0220
17.7609
1,093.20

218.6464782
Remove limb nerve lesion

T
0220
17.7609
1,093.20

218.6464783
Limb nerve surgery add-on

T
0220
17.7609
1,093.20

218.6464784
Remove nerve lesion

T
0220
17.7609
1,093.20

218.6464786
Remove sciatic nerve lesion

T
0221
33.3035
2,049.86
463.62
409.9764787
Implant nerve end

T
0220
17.7609
1,093.20

218.64( print page 49805)64788
Remove skin nerve lesion

T
0220
17.7609
1,093.20

218.6464790
Removal of nerve lesion

T
0220
17.7609
1,093.20

218.6464792
Removal of nerve lesion

T
0221
33.3035
2,049.86
463.62
409.9764795
Biopsy of nerve

T
0220
17.7609
1,093.20

218.6464802
Remove sympathetic nerves

T
0220
17.7609
1,093.20

218.6464804
Remove sympathetic nerves
CH
T
0220
17.7609
1,093.20

218.6464820
Remove sympathetic nerves

T
0220
17.7609
1,093.20

218.6464821
Remove sympathetic nerves

T
0054
25.8425
1,590.63

318.1364822
Remove sympathetic nerves

T
0054
25.8425
1,590.63

318.1364823
Remove sympathetic nerves

T
0054
25.8425
1,590.63

318.1364831
Repair of digit nerve

T
0221
33.3035
2,049.86
463.62
409.9764832
Repair nerve add-on

T
0221
33.3035
2,049.86
463.62
409.9764834
Repair of hand or foot nerve

T
0221
33.3035
2,049.86
463.62
409.9764835
Repair of hand or foot nerve

T
0221
33.3035
2,049.86
463.62
409.9764836
Repair of hand or foot nerve

T
0221
33.3035
2,049.86
463.62
409.9764837
Repair nerve add-on

T
0221
33.3035
2,049.86
463.62
409.9764840
Repair of leg nerve

T
0221
33.3035
2,049.86
463.62
409.9764856
Repair/transpose nerve

T
0221
33.3035
2,049.86
463.62
409.9764857
Repair arm/leg nerve

T
0221
33.3035
2,049.86
463.62
409.9764858
Repair sciatic nerve

T
0221
33.3035
2,049.86
463.62
409.9764859
Nerve surgery

T
0221
33.3035
2,049.86
463.62
409.9764861
Repair of arm nerves

T
0221
33.3035
2,049.86
463.62
409.9764862
Repair of low back nerves

T
0221
33.3035
2,049.86
463.62
409.9764864
Repair of facial nerve

T
0221
33.3035
2,049.86
463.62
409.9764865
Repair of facial nerve

T
0221
33.3035
2,049.86
463.62
409.9764870
Fusion of facial/other nerve

T
0221
33.3035
2,049.86
463.62
409.9764872
Subsequent repair of nerve

T
0221
33.3035
2,049.86
463.62
409.9764874
Repairrevise nerve add-on

T
0221
33.3035
2,049.86
463.62
409.9764876
Repair nerve/shorten bone

T
0221
33.3035
2,049.86
463.62
409.9764885
Nerve graft, head or neck

T
0221
33.3035
2,049.86
463.62
409.9764886
Nerve graft, head or neck

T
0221
33.3035
2,049.86
463.62
409.9764890
Nerve graft, hand or foot

T
0221
33.3035
2,049.86
463.62
409.9764891
Nerve graft, hand or foot

T
0221
33.3035
2,049.86
463.62
409.9764892
Nerve graft, arm or leg

T
0221
33.3035
2,049.86
463.62
409.9764893
Nerve graft, arm or leg

T
0221
33.3035
2,049.86
463.62
409.9764895
Nerve graft, hand or foot

T
0221
33.3035
2,049.86
463.62
409.9764896
Nerve graft, hand or foot

T
0221
33.3035
2,049.86
463.62
409.9764897
Nerve graft, arm or leg

T
0221
33.3035
2,049.86
463.62
409.9764898
Nerve graft, arm or leg

T
0221
33.3035
2,049.86
463.62
409.9764901
Nerve graft add-on

T
0221
33.3035
2,049.86
463.62
409.9764902
Nerve graft add-on

T
0221
33.3035
2,049.86
463.62
409.9764905
Nerve pedicle transfer

T
0221
33.3035
2,049.86
463.62
409.9764907
Nerve pedicle transfer

T
0221
33.3035
2,049.86
463.62
409.9764999
Nervous system surgery

T
0204
2.2491
138.43
40.13
27.6965091
Revise eye

T
0242
35.5217
2,186.40
597.36
437.2865093
Revise eye with implant
CH
T
0242
35.5217
2,186.40
597.36
437.2865101
Removal of eye

T
0242
35.5217
2,186.40
597.36
437.2865103
Remove eye/insert implant

T
0242
35.5217
2,186.40
597.36
437.2865105
Remove eye/attach implant

T
0242
35.5217
2,186.40
597.36
437.2865110
Removal of eye

T
0242
35.5217
2,186.40
597.36
437.2865112
Remove eye/revise socket

T
0242
35.5217
2,186.40
597.36
437.2865114
Remove eye/revise socket

T
0242
35.5217
2,186.40
597.36
437.2865125
Revise ocular implant

T
0240
17.0126
1,047.14
307.90
209.4365130
Insert ocular implant

T
0241
24.8502
1,529.55
384.47
305.9165135
Insert ocular implant

T
0241
24.8502
1,529.55
384.47
305.9165140
Attach ocular implant

T
0242
35.5217
2,186.40
597.36
437.2865150
Revise ocular implant

T
0241
24.8502
1,529.55
384.47
305.9165155
Reinsert ocular implant

T
0242
35.5217
2,186.40
597.36
437.2865175
Removal of ocular implant

T
0240
17.0126
1,047.14
307.90
209.4365205
Remove foreign body from eye

S
0698
1.2244
75.36
16.52
15.0765210
Remove foreign body from eye

S
0698
1.2244
75.36
16.52
15.0765220
Remove foreign body from eye

S
0698
1.2244
75.36
16.52
15.0765222
Remove foreign body from eye

S
0698
1.2244
75.36
16.52
15.0765235
Remove foreign body from eye

T
0233
14.9969
923.07
266.33
184.6165260
Remove foreign body from eye

T
0236
16.3433
1,005.95

201.1965265
Remove foreign body from eye

T
0237
26.9305
1,657.60

331.5265270
Repair of eye wound

T
0240
17.0126
1,047.14
307.90
209.4365272
Repair of eye wound

T
0234
22.9479
1,412.47
511.31
282.4965275
Repair of eye wound

T
0234
22.9479
1,412.47
511.31
282.4965280
Repair of eye wound

T
0236
16.3433
1,005.95

201.19( print page 49806)65285
Repair of eye wound

T
0672
36.8820
2,270.12

454.0265286
Repair of eye wound

T
0232
5.9800
368.07
92.21
73.6165290
Repair of eye socket wound

T
0243
21.2885
1,310.33
431.09
262.0765400
Removal of eye lesion

T
0233
14.9969
923.07
266.33
184.6165410
Biopsy of cornea

T
0233
14.9969
923.07
266.33
184.6165420
Removal of eye lesion

T
0233
14.9969
923.07
266.33
184.6165426
Removal of eye lesion

T
0234
22.9479
1,412.47
511.31
282.4965430
Corneal smear

S
0698
1.2244
75.36
16.52
15.0765435
Curette/treat cornea

T
0239
6.9354
426.88

85.3865436
Curette/treat cornea

T
0233
14.9969
923.07
266.33
184.6165450
Treatment of corneal lesion

S
0231
2.1934
135.01

27.0065600
Revision of cornea

T
0240
17.0126
1,047.14
307.90
209.4365710
Corneal transplant

T
0244
37.9446
2,335.53
803.26
467.1165730
Corneal transplant

T
0244
37.9446
2,335.53
803.26
467.1165750
Corneal transplant

T
0244
37.9446
2,335.53
803.26
467.1165755
Corneal transplant

T
0244
37.9446
2,335.53
803.26
467.1165770
Revise cornea with implant
CH
T
0293
50.6347
3,116.62
1,100.34
623.3265772
Correction of astigmatism

T
0233
14.9969
923.07
266.33
184.6165775
Correction of astigmatism

T
0233
14.9969
923.07
266.33
184.6165780
Ocular reconst, transplant

T
0244
37.9446
2,335.53
803.26
467.1165781
Ocular reconst, transplant

T
0244
37.9446
2,335.53
803.26
467.1165782
Ocular reconst, transplant

T
0244
37.9446
2,335.53
803.26
467.1165800
Drainage of eye

T
0233
14.9969
923.07
266.33
184.6165805
Drainage of eye

T
0233
14.9969
923.07
266.33
184.6165810
Drainage of eye

T
0234
22.9479
1,412.47
511.31
282.4965815
Drainage of eye

T
0234
22.9479
1,412.47
511.31
282.4965820
Relieve inner eye pressure

T
0232
5.9800
368.07
92.21
73.6165850
Incision of eye

T
0234
22.9479
1,412.47
511.31
282.4965855
Laser surgery of eye

T
0247
5.1266
315.55
104.31
63.1165860
Incise inner eye adhesions

T
0247
5.1266
315.55
104.31
63.1165865
Incise inner eye adhesions

T
0233
14.9969
923.07
266.33
184.6165870
Incise inner eye adhesions

T
0234
22.9479
1,412.47
511.31
282.4965875
Incise inner eye adhesions

T
0234
22.9479
1,412.47
511.31
282.4965880
Incise inner eye adhesions

T
0233
14.9969
923.07
266.33
184.6165900
Remove eye lesion

T
0233
14.9969
923.07
266.33
184.6165920
Remove implant of eye

T
0234
22.9479
1,412.47
511.31
282.4965930
Remove blood clot from eye

T
0234
22.9479
1,412.47
511.31
282.4966020
Injection treatment of eye

T
0233
14.9969
923.07
266.33
184.6166030
Injection treatment of eye

T
0232
5.9800
368.07
92.21
73.6166130
Remove eye lesion

T
0234
22.9479
1,412.47
511.31
282.4966150
Glaucoma surgery

T
0234
22.9479
1,412.47
511.31
282.4966155
Glaucoma surgery

T
0234
22.9479
1,412.47
511.31
282.4966160
Glaucoma surgery

T
0234
22.9479
1,412.47
511.31
282.4966165
Glaucoma surgery

T
0234
22.9479
1,412.47
511.31
282.4966170
Glaucoma surgery

T
0234
22.9479
1,412.47
511.31
282.4966172
Incision of eye
CH
T
0234
22.9479
1,412.47
511.31
282.4966180
Implant eye shunt

T
0673
37.3057
2,296.20
649.56
459.2466185
Revise eye shunt

T
0673
37.3057
2,296.20
649.56
459.2466220
Repair eye lesion

T
0672
36.8820
2,270.12

454.0266225
Repair/graft eye lesion

T
0673
37.3057
2,296.20
649.56
459.2466250
Follow-up surgery of eye

T
0233
14.9969
923.07
266.33
184.6166500
Incision of iris

T
0232
5.9800
368.07
92.21
73.6166505
Incision of iris

T
0232
5.9800
368.07
92.21
73.6166600
Remove iris and lesion

T
0234
22.9479
1,412.47
511.31
282.4966605
Removal of iris

T
0234
22.9479
1,412.47
511.31
282.4966625
Removal of iris

T
0232
5.9800
368.07
92.21
73.6166630
Removal of iris

T
0234
22.9479
1,412.47
511.31
282.4966635
Removal of iris

T
0234
22.9479
1,412.47
511.31
282.4966680
Repair irisciliary body

T
0234
22.9479
1,412.47
511.31
282.4966682
Repair irisciliary body

T
0234
22.9479
1,412.47
511.31
282.4966700
Destruction, ciliary body

T
0233
14.9969
923.07
266.33
184.6166710
Ciliary transsleral therapy

T
0233
14.9969
923.07
266.33
184.6166711
Ciliary endoscopic ablation

T
0233
14.9969
923.07
266.33
184.6166720
Destruction, ciliary body

T
0233
14.9969
923.07
266.33
184.6166740
Destruction, ciliary body

T
0234
22.9479
1,412.47
511.31
282.4966761
Revision of iris

T
0247
5.1266
315.55
104.31
63.1166762
Revision of iris

T
0247
5.1266
315.55
104.31
63.1166770
Removal of inner eye lesion

T
0247
5.1266
315.55
104.31
63.1166820
Incision, secondary cataract

T
0232
5.9800
368.07
92.21
73.6166821
After cataract laser surgery

T
0247
5.1266
315.55
104.31
63.11( print page 49807)66825
Reposition intraocular lens

T
0234
22.9479
1,412.47
511.31
282.4966830
Removal of lens lesion

T
0232
5.9800
368.07
92.21
73.6166840
Removal of lens material

T
0245
14.5427
895.12
217.05
179.0266850
Removal of lens material

T
0249
28.5043
1,754.47
524.67
350.8966852
Removal of lens material

T
0249
28.5043
1,754.47
524.67
350.8966920
Extraction of lens

T
0249
28.5043
1,754.47
524.67
350.8966930
Extraction of lens

T
0249
28.5043
1,754.47
524.67
350.8966940
Extraction of lens

T
0245
14.5427
895.12
217.05
179.0266982
Cataract surgery, complex

T
0246
23.5664
1,450.54
495.96
290.1166983
Cataract surg w/iol, 1 stage

T
0246
23.5664
1,450.54
495.96
290.1166984
Cataract surg w/iol, 1 stage

T
0246
23.5664
1,450.54
495.96
290.1166985
Insert lens prosthesis

T
0246
23.5664
1,450.54
495.96
290.1166986
Exchange lens prosthesis

T
0246
23.5664
1,450.54
495.96
290.1166990
Ophthalmic endoscope add-on

N66999
Eye surgery procedure

T
0232
5.9800
368.07
92.21
73.6167005
Partial removal of eye fluid

T
0237
26.9305
1,657.60

331.5267010
Partial removal of eye fluid

T
0237
26.9305
1,657.60

331.5267015
Release of eye fluid

T
0237
26.9305
1,657.60

331.5267025
Replace eye fluid

T
0237
26.9305
1,657.60

331.5267027
Implant eye drug system

T
0672
36.8820
2,270.12

454.0267028
Injection eye drug

T
0235
4.0750
250.82
61.14
50.1667030
Incise inner eye strands

T
0236
16.3433
1,005.95

201.1967031
Laser surgery, eye strands

T
0247
5.1266
315.55
104.31
63.1167036
Removal of inner eye fluid

T
0672
36.8820
2,270.12

454.0267038
Strip retinal membrane

T
0672
36.8820
2,270.12

454.0267039
Laser treatment of retina

T
0672
36.8820
2,270.12

454.0267040
Laser treatment of retina

T
0672
36.8820
2,270.12

454.0267101
Repair detached retina

T
0236
16.3433
1,005.95

201.1967105
Repair detached retina

T
0248
5.0285
309.51
95.08
61.9067107
Repair detached retina

T
0672
36.8820
2,270.12

454.0267108
Repair detached retina

T
0672
36.8820
2,270.12

454.0267110
Repair detached retina

T
0236
16.3433
1,005.95

201.1967112
Rerepair detached retina

T
0672
36.8820
2,270.12

454.0267115
Release encircling material

T
0236
16.3433
1,005.95

201.1967120
Remove eye implant material

T
0236
16.3433
1,005.95

201.1967121
Remove eye implant material

T
0237
26.9305
1,657.60

331.5267141
Treatment of retina

T
0235
4.0750
250.82
61.14
50.1667145
Treatment of retina

T
0248
5.0285
309.51
95.08
61.9067208
Treatment of retinal lesion

T
0236
16.3433
1,005.95

201.1967210
Treatment of retinal lesion

T
0248
5.0285
309.51
95.08
61.9067218
Treatment of retinal lesion

T
0236
16.3433
1,005.95

201.1967220
Treatment of choroid lesion

T
0235
4.0750
250.82
61.14
50.1667221
Ocular photodynamic ther

T
0235
4.0750
250.82
61.14
50.1667225
Eye photodynamic ther add-on

T
0235
4.0750
250.82
61.14
50.1667227
Treatment of retinal lesion
CH
T
0237
26.9305
1,657.60

331.5267228
Treatment of retinal lesion

T
0248
5.0285
309.51
95.08
61.9067250
Reinforce eye wall

T
0240
17.0126
1,047.14
307.90
209.4367255
Reinforce/graft eye wall

T
0237
26.9305
1,657.60

331.5267299
Eye surgery procedure

T
0235
4.0750
250.82
61.14
50.1667311
Revise eye muscle

T
0243
21.2885
1,310.33
431.09
262.0767312
Revise two eye muscles

T
0243
21.2885
1,310.33
431.09
262.0767314
Revise eye muscle

T
0243
21.2885
1,310.33
431.09
262.0767316
Revise two eye muscles

T
0243
21.2885
1,310.33
431.09
262.0767318
Revise eye muscle(s)

T
0243
21.2885
1,310.33
431.09
262.0767320
Revise eye muscle(s) add-on

T
0243
21.2885
1,310.33
431.09
262.0767331
Eye surgery follow-up add-on

T
0243
21.2885
1,310.33
431.09
262.0767332
Rerevise eye muscles add-on

T
0243
21.2885
1,310.33
431.09
262.0767334
Revise eye muscle w/suture

T
0243
21.2885
1,310.33
431.09
262.0767335
Eye suture during surgery

T
0243
21.2885
1,310.33
431.09
262.0767340
Revise eye muscle add-on

T
0243
21.2885
1,310.33
431.09
262.0767343
Release eye tissue

T
0243
21.2885
1,310.33
431.09
262.0767345
Destroy nerve of eye muscle

T
0238
2.8099
172.95

34.5967350
Biopsy eye muscle

T
0699
13.9509
858.69

171.7467399
Eye muscle surgery procedure

T
0243
21.2885
1,310.33
431.09
262.0767400
Explore/biopsy eye socket

T
0241
24.8502
1,529.55
384.47
305.9167405
Explore/drain eye socket

T
0241
24.8502
1,529.55
384.47
305.9167412
Explore/treat eye socket

T
0241
24.8502
1,529.55
384.47
305.9167413
Explore/treat eye socket

T
0241
24.8502
1,529.55
384.47
305.9167414
Explr/decompress eye socket

T
0242
35.5217
2,186.40
597.36
437.2867415
Aspiration, orbital contents

T
0240
17.0126
1,047.14
307.90
209.43( print page 49808)67420
Explore/treat eye socket

T
0242
35.5217
2,186.40
597.36
437.2867430
Explore/treat eye socket

T
0242
35.5217
2,186.40
597.36
437.2867440
Explore/drain eye socket

T
0242
35.5217
2,186.40
597.36
437.2867445
Explr/decompress eye socket

T
0242
35.5217
2,186.40
597.36
437.2867450
Explore/biopsy eye socket

T
0242
35.5217
2,186.40
597.36
437.2867500
Inject/treat eye socket

S
0231
2.1934
135.01

27.0067505
Inject/treat eye socket

T
0238
2.8099
172.95

34.5967515
Inject/treat eye socket

T
0238
2.8099
172.95

34.5967550
Insert eye socket implant

T
0242
35.5217
2,186.40
597.36
437.2867560
Revise eye socket implant

T
0241
24.8502
1,529.55
384.47
305.9167570
Decompress optic nerve

T
0242
35.5217
2,186.40
597.36
437.2867599
Orbit surgery procedure

T
0238
2.8099
172.95

34.5967700
Drainage of eyelid abscess

T
0238
2.8099
172.95

34.5967710
Incision of eyelid

T
0239
6.9354
426.88

85.3867715
Incision of eyelid fold

T
0240
17.0126
1,047.14
307.90
209.4367800
Remove eyelid lesion

T
0238
2.8099
172.95

34.5967801
Remove eyelid lesions

T
0239
6.9354
426.88

85.3867805
Remove eyelid lesions

T
0238
2.8099
172.95

34.5967808
Remove eyelid lesion(s)

T
0240
17.0126
1,047.14
307.90
209.4367810
Biopsy of eyelid

T
0238
2.8099
172.95

34.5967820
Revise eyelashes

S
0698
1.2244
75.36
16.52
15.0767825
Revise eyelashes

T
0238
2.8099
172.95

34.5967830
Revise eyelashes

T
0239
6.9354
426.88

85.3867835
Revise eyelashes

T
0240
17.0126
1,047.14
307.90
209.4367840
Remove eyelid lesion

T
0239
6.9354
426.88

85.3867850
Treat eyelid lesion

T
0239
6.9354
426.88

85.3867875
Closure of eyelid by suture

T
0239
6.9354
426.88

85.3867880
Revision of eyelid

T
0233
14.9969
923.07
266.33
184.6167882
Revision of eyelid

T
0240
17.0126
1,047.14
307.90
209.4367900
Repair brow defect

T
0240
17.0126
1,047.14
307.90
209.4367901
Repair eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367902
Repair eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367903
Repair eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367904
Repair eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367906
Repair eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367908
Repair eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367909
Revise eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367911
Revise eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367912
Correction eyelid w/implant

T
0240
17.0126
1,047.14
307.90
209.4367914
Repair eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367915
Repair eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367916
Repair eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367917
Repair eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367921
Repair eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367922
Repair eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367923
Repair eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367924
Repair eyelid defect

T
0240
17.0126
1,047.14
307.90
209.4367930
Repair eyelid wound

T
0240
17.0126
1,047.14
307.90
209.4367935
Repair eyelid wound

T
0240
17.0126
1,047.14
307.90
209.4367938
Remove eyelid foreign body

S
0698
1.2244
75.36
16.52
15.0767950
Revision of eyelid

T
0240
17.0126
1,047.14
307.90
209.4367961
Revision of eyelid

T
0240
17.0126
1,047.14
307.90
209.4367966
Revision of eyelid

T
0240
17.0126
1,047.14
307.90
209.4367971
Reconstruction of eyelid

T
0241
24.8502
1,529.55
384.47
305.9167973
Reconstruction of eyelid

T
0241
24.8502
1,529.55
384.47
305.9167974
Reconstruction of eyelid

T
0241
24.8502
1,529.55
384.47
305.9167975
Reconstruction of eyelid

T
0240
17.0126
1,047.14
307.90
209.4367999
Revision of eyelid

T
0238
2.8099
172.95

34.5968020
Incise/drain eyelid lining

T
0240
17.0126
1,047.14
307.90
209.4368040
Treatment of eyelid lesions

S
0698
1.2244
75.36
16.52
15.0768100
Biopsy of eyelid lining

T
0232
5.9800
368.07
92.21
73.6168110
Remove eyelid lining lesion

T
0699
13.9509
858.69

171.7468115
Remove eyelid lining lesion

T
0240
17.0126
1,047.14
307.90
209.4368130
Remove eyelid lining lesion

T
0233
14.9969
923.07
266.33
184.6168135
Remove eyelid lining lesion

T
0239
6.9354
426.88

85.3868200
Treat eyelid by injection

S
0230
0.8126
50.02
14.97
10.0068320
Revise/graft eyelid lining

T
0240
17.0126
1,047.14
307.90
209.4368325
Revise/graft eyelid lining
CH
T
0241
24.8502
1,529.55
384.47
305.9168326
Revise/graft eyelid lining

T
0241
24.8502
1,529.55
384.47
305.9168328
Revise/graft eyelid lining

T
0241
24.8502
1,529.55
384.47
305.91( print page 49809)68330
Revise eyelid lining

T
0234
22.9479
1,412.47
511.31
282.4968335
Revise/graft eyelid lining

T
0241
24.8502
1,529.55
384.47
305.9168340
Separate eyelid adhesions

T
0240
17.0126
1,047.14
307.90
209.4368360
Revise eyelid lining

T
0234
22.9479
1,412.47
511.31
282.4968362
Revise eyelid lining

T
0234
22.9479
1,412.47
511.31
282.4968371
Harvest eye tissue, alograft

T
0233
14.9969
923.07
266.33
184.6168399
Eyelid lining surgery

T
0238
2.8099
172.95

34.5968400
Incise/drain tear gland

T
0238
2.8099
172.95

34.5968420
Incise/drain tear sac

T
0240
17.0126
1,047.14
307.90
209.4368440
Incise tear duct opening

T
0238
2.8099
172.95

34.5968500
Removal of tear gland

T
0241
24.8502
1,529.55
384.47
305.9168505
Partial removal, tear gland

T
0241
24.8502
1,529.55
384.47
305.9168510
Biopsy of tear gland

T
0240
17.0126
1,047.14
307.90
209.4368520
Removal of tear sac

T
0241
24.8502
1,529.55
384.47
305.9168525
Biopsy of tear sac

T
0240
17.0126
1,047.14
307.90
209.4368530
Clearance of tear duct

T
0240
17.0126
1,047.14
307.90
209.4368540
Remove tear gland lesion

T
0241
24.8502
1,529.55
384.47
305.9168550
Remove tear gland lesion
CH
T
0241
24.8502
1,529.55
384.47
305.9168700
Repair tear ducts

T
0241
24.8502
1,529.55
384.47
305.9168705
Revise tear duct opening

T
0238
2.8099
172.95

34.5968720
Create tear sac drain
CH
T
0241
24.8502
1,529.55
384.47
305.9168745
Create tear duct drain

T
0241
24.8502
1,529.55
384.47
305.9168750
Create tear duct drain
CH
T
0241
24.8502
1,529.55
384.47
305.9168760
Close tear duct opening
CH
S
0231
2.1934
135.01

27.0068761
Close tear duct opening

S
0231
2.1934
135.01

27.0068770
Close tear system fistula

T
0240
17.0126
1,047.14
307.90
209.4368801
Dilate tear duct opening

S
0698
1.2244
75.36
16.52
15.0768810
Probe nasolacrimal duct

S
0231
2.1934
135.01

27.0068811
Probe nasolacrimal duct

T
0240
17.0126
1,047.14
307.90
209.4368815
Probe nasolacrimal duct

T
0240
17.0126
1,047.14
307.90
209.4368840
Explore/irrigate tear ducts
CH
S
0698
1.2244
75.36
16.52
15.0768850
Injection for tear sac x-ray

N68899
Tear duct system surgery
CH
T
0238
2.8099
172.95

34.5969000
Drain external ear lesion

T
0006
1.4821
91.22
21.76
18.2469005
Drain external ear lesion

T
0008
17.4686
1,075.21

215.0469020
Drain outer ear canal lesion

T
0006
1.4821
91.22
21.76
18.2469100
Biopsy of external ear

T
0019
4.0123
246.96
71.87
49.3969105
Biopsy of external ear canal

T
0253
16.4494
1,012.48
282.29
202.5069110
Remove external ear, partial

T
0021
14.9563
920.58
219.48
184.1269120
Removal of external ear

T
0254
23.1564
1,425.30
321.35
285.0669140
Remove ear canal lesion(s)

T
0254
23.1564
1,425.30
321.35
285.0669145
Remove ear canal lesion(s)

T
0021
14.9563
920.58
219.48
184.1269150
Extensive ear canal surgery

T
0252
7.7261
475.55
111.84
95.1169200
Clear outer ear canal

X
0340
0.6211
38.23

7.6569205
Clear outer ear canal

T
0022
19.9760
1,229.54
354.45
245.9169210
Remove impacted ear wax

X
0340
0.6211
38.23

7.6569220
Clean out mastoid cavity

T
0012
0.8076
49.71
10.30
9.9469222
Clean out mastoid cavity
CH
T
0252
7.7261
475.55
111.84
95.1169300
Revise external ear

T
0254
23.1564
1,425.30
321.35
285.0669310
Rebuild outer ear canal

T
0256
37.7719
2,324.90

464.9869320
Rebuild outer ear canal

T
0256
37.7719
2,324.90

464.9869399
Outer ear surgery procedure

T
0251
2.3768
146.29

29.2669400
Inflate middle ear canal

T
0251
2.3768
146.29

29.2669401
Inflate middle ear canal

T
0251
2.3768
146.29

29.2669405
Catheterize middle ear canal

T
0252
7.7261
475.55
111.84
95.1169420
Incision of eardrum

T
0251
2.3768
146.29

29.2669421
Incision of eardrum

T
0253
16.4494
1,012.48
282.29
202.5069424
Remove ventilating tube

T
0252
7.7261
475.55
111.84
95.1169433
Create eardrum opening

T
0252
7.7261
475.55
111.84
95.1169436
Create eardrum opening

T
0253
16.4494
1,012.48
282.29
202.5069440
Exploration of middle ear

T
0254
23.1564
1,425.30
321.35
285.0669450
Eardrum revision

T
0256
37.7719
2,324.90

464.9869501
Mastoidectomy

T
0256
37.7719
2,324.90

464.9869502
Mastoidectomy

T
0254
23.1564
1,425.30
321.35
285.0669505
Remove mastoid structures

T
0256
37.7719
2,324.90

464.9869511
Extensive mastoid surgery

T
0256
37.7719
2,324.90

464.9869530
Extensive mastoid surgery

T
0256
37.7719
2,324.90

464.9869540
Remove ear lesion

T
0253
16.4494
1,012.48
282.29
202.5069550
Remove ear lesion

T
0256
37.7719
2,324.90

464.9869552
Remove ear lesion

T
0256
37.7719
2,324.90

464.98( print page 49810)69601
Mastoid surgery revision

T
0256
37.7719
2,324.90

464.9869602
Mastoid surgery revision

T
0256
37.7719
2,324.90

464.9869603
Mastoid surgery revision

T
0256
37.7719
2,324.90

464.9869604
Mastoid surgery revision

T
0256
37.7719
2,324.90

464.9869605
Mastoid surgery revision

T
0256
37.7719
2,324.90

464.9869610
Repair of eardrum

T
0254
23.1564
1,425.30
321.35
285.0669620
Repair of eardrum

T
0254
23.1564
1,425.30
321.35
285.0669631
Repair eardrum structures

T
0256
37.7719
2,324.90

464.9869632
Rebuild eardrum structures

T
0256
37.7719
2,324.90

464.9869633
Rebuild eardrum structures

T
0256
37.7719
2,324.90

464.9869635
Repair eardrum structures

T
0256
37.7719
2,324.90

464.9869636
Rebuild eardrum structures

T
0256
37.7719
2,324.90

464.9869637
Rebuild eardrum structures

T
0256
37.7719
2,324.90

464.9869641
Revise middle earmastoid

T
0256
37.7719
2,324.90

464.9869642
Revise middle earmastoid

T
0256
37.7719
2,324.90

464.9869643
Revise middle earmastoid

T
0256
37.7719
2,324.90

464.9869644
Revise middle earmastoid

T
0256
37.7719
2,324.90

464.9869645
Revise middle earmastoid

T
0256
37.7719
2,324.90

464.9869646
Revise middle earmastoid

T
0256
37.7719
2,324.90

464.9869650
Release middle ear bone

T
0254
23.1564
1,425.30
321.35
285.0669660
Revise middle ear bone

T
0256
37.7719
2,324.90

464.9869661
Revise middle ear bone

T
0256
37.7719
2,324.90

464.9869662
Revise middle ear bone

T
0256
37.7719
2,324.90

464.9869666
Repair middle ear structures

T
0256
37.7719
2,324.90

464.9869667
Repair middle ear structures

T
0256
37.7719
2,324.90

464.9869670
Remove mastoid air cells

T
0256
37.7719
2,324.90

464.9869676
Remove middle ear nerve

T
0256
37.7719
2,324.90

464.9869700
Close mastoid fistula

T
0256
37.7719
2,324.90

464.9869711
Remove/repair hearing aid

T
0256
37.7719
2,324.90

464.9869714
Implant temple bone w/stimul

T
0256
37.7719
2,324.90

464.9869715
Temple bne implnt w/stimulat

T
0256
37.7719
2,324.90

464.9869717
Temple bone implant revision

T
0256
37.7719
2,324.90

464.9869718
Revise temple bone implant

T
0256
37.7719
2,324.90

464.9869720
Release facial nerve

T
0256
37.7719
2,324.90

464.9869725
Release facial nerve

T
0256
37.7719
2,324.90

464.9869740
Repair facial nerve

T
0256
37.7719
2,324.90

464.9869745
Repair facial nerve

T
0256
37.7719
2,324.90

464.9869799
Middle ear surgery procedure

T
0251
2.3768
146.29

29.2669801
Incise inner ear

T
0256
37.7719
2,324.90

464.9869802
Incise inner ear

T
0256
37.7719
2,324.90

464.9869805
Explore inner ear

T
0256
37.7719
2,324.90

464.9869806
Explore inner ear

T
0256
37.7719
2,324.90

464.9869820
Establish inner ear window

T
0256
37.7719
2,324.90

464.9869840
Revise inner ear window

T
0256
37.7719
2,324.90

464.9869905
Remove inner ear

T
0256
37.7719
2,324.90

464.9869910
Remove inner earmastoid

T
0256
37.7719
2,324.90

464.9869915
Incise inner ear nerve

T
0256
37.7719
2,324.90

464.9869930
Implant cochlear device

T
0259
406.8232
25,040.37
8,698.43
5,008.0769949
Inner ear surgery procedure

T
0251
2.3768
146.29

29.2669955
Release facial nerve

T
0256
37.7719
2,324.90

464.9869960
Release inner ear canal

T
0256
37.7719
2,324.90

464.9869979
Temporal bone surgery

T
0251
2.3768
146.29

29.2669990
Microsurgery add-on

N70010
Contrast x-ray of brain

S
0274
2.6182
161.15
64.46
32.2370015
Contrast x-ray of brain

S
0274
2.6182
161.15
64.46
32.2370030
X-ray eye for foreign body

X
0260
0.7276
44.78

8.9670100
X-ray exam of jaw

X
0260
0.7276
44.78

8.9670110
X-ray exam of jaw

X
0260
0.7276
44.78

8.9670120
X-ray exam of mastoids

X
0260
0.7276
44.78

8.9670130
X-ray exam of mastoids

X
0260
0.7276
44.78

8.9670134
X-ray exam of middle ear

X
0261
1.2515
77.03

15.4170140
X-ray exam of facial bones

X
0260
0.7276
44.78

8.9670150
X-ray exam of facial bones

X
0260
0.7276
44.78

8.9670160
X-ray exam of nasal bones

X
0260
0.7276
44.78

8.9670170
X-ray exam of tear duct

X
0264
2.9791
183.37
70.84
36.6770190
X-ray exam of eye sockets

X
0260
0.7276
44.78

8.9670200
X-ray exam of eye sockets

X
0260
0.7276
44.78

8.9670210
X-ray exam of sinuses

X
0260
0.7276
44.78

8.9670220
X-ray exam of sinuses

X
0260
0.7276
44.78

8.9670240
X-ray exam, pituitary saddle

X
0260
0.7276
44.78

8.96( print page 49811)70250
X-ray exam of skull

X
0260
0.7276
44.78

8.9670260
X-ray exam of skull

X
0261
1.2515
77.03

15.4170300
X-ray exam of teeth

X
0262
0.5818
35.81

7.1670310
X-ray exam of teeth

X
0262
0.5818
35.81

7.1670320
Full mouth x-ray of teeth

X
0262
0.5818
35.81

7.1670328
X-ray exam of jaw joint

X
0260
0.7276
44.78

8.9670330
X-ray exam of jaw joints

X
0260
0.7276
44.78

8.9670332
X-ray exam of jaw joint

S
0275
3.7021
227.87
69.09
45.5770336
Magnetic image, jaw joint

S
0335
4.6629
287.01
114.80
57.4070350
X-ray head for orthodontia

X
0260
0.7276
44.78

8.9670355
Panoramic x-ray of jaws

X
0260
0.7276
44.78

8.9670360
X-ray exam of neck

X
0260
0.7276
44.78

8.9670370
Throat x-rayfluoroscopy

X
0272
1.2985
79.92
31.64
15.9870371
Speech evaluation, complex

X
0272
1.2985
79.92
31.64
15.9870373
Contrast x-ray of larynx

X
0263
1.7120
105.38
23.77
21.0870380
X-ray exam of salivary gland

X
0260
0.7276
44.78

8.9670390
X-ray exam of salivary duct

X
0263
1.7120
105.38
23.77
21.0870450
Ct head/brain w/o dye

S
0332
3.1631
194.69
75.24
38.9470460
Ct head/brain w/dye

S
0283
4.1858
257.64
102.17
51.5370470
Ct head/brain w/ow/dye

S
0333
5.0020
307.88
121.52
61.5870480
Ct orbit/ear/fossa w/o dye

S
0332
3.1631
194.69
75.24
38.9470481
Ct orbit/ear/fossa w/dye

S
0283
4.1858
257.64
102.17
51.5370482
Ct orbit/ear/fossa w/ow/dye

S
0333
5.0020
307.88
121.52
61.5870486
Ct maxillofacial w/o dye

S
0332
3.1631
194.69
75.24
38.9470487
Ct maxillofacial w/dye

S
0283
4.1858
257.64
102.17
51.5370488
Ct maxillofacial w/ow/dye

S
0333
5.0020
307.88
121.52
61.5870490
Ct soft tissue neck w/o dye

S
0332
3.1631
194.69
75.24
38.9470491
Ct soft tissue neck w/dye

S
0283
4.1858
257.64
102.17
51.5370492
Ct sft tsue nck w/ow/dye

S
0333
5.0020
307.88
121.52
61.5870496
Ct angiography, head

S
0662
4.9203
302.85
118.88
60.5770498
Ct angiography, neck

S
0662
4.9203
302.85
118.88
60.5770540
Mri orbit/face/neck w/o dye

S
0336
5.8500
360.07
139.68
72.0170542
Mri orbit/face/neck w/dye

S
0284
6.2589
385.24
148.40
77.0570543
Mri orbt/fac/nck w/ow/dye

S
0337
8.3423
513.48
202.50
102.7070544
Mr angiography head w/o dye

S
0336
5.8500
360.07
139.68
72.0170545
Mr angiography head w/dye

S
0284
6.2589
385.24
148.40
77.0570546
Mr angiograph head w/ow/dye

S
0337
8.3423
513.48
202.50
102.7070547
Mr angiography neck w/o dye

S
0336
5.8500
360.07
139.68
72.0170548
Mr angiography neck w/dye

S
0284
6.2589
385.24
148.40
77.0570549
Mr angiograph neck w/ow/dye

S
0337
8.3423
513.48
202.50
102.7070551
Mri brain w/o dye

S
0336
5.8500
360.07
139.68
72.0170552
Mri brain w/dye

S
0284
6.2589
385.24
148.40
77.0570553
Mri brain w/ow/dye

S
0337
8.3423
513.48
202.50
102.7070557
Mri brain w/o dye

S
0336
5.8500
360.07
139.68
72.0170558
Mri brain w/dye

S
0284
6.2589
385.24
148.40
77.0570559
Mri brain w/ow/dye

S
0337
8.3423
513.48
202.50
102.7071010
Chest x-ray

X
0260
0.7276
44.78

8.9671015
Chest x-ray

X
0260
0.7276
44.78

8.9671020
Chest x-ray

X
0260
0.7276
44.78

8.9671021
Chest x-ray

X
0260
0.7276
44.78

8.9671022
Chest x-ray

X
0260
0.7276
44.78

8.9671023
Chest x-ray and fluoroscopy

X
0272
1.2985
79.92
31.64
15.9871030
Chest x-ray

X
0260
0.7276
44.78

8.9671034
Chest x-ray and fluoroscopy

X
0272
1.2985
79.92
31.64
15.9871035
Chest x-ray

X
0260
0.7276
44.78

8.9671040
Contrast x-ray of bronchi

X
0263
1.7120
105.38
23.77
21.0871060
Contrast x-ray of bronchi

X
0263
1.7120
105.38
23.77
21.0871090
X-raypacemaker insertion

X
0272
1.2985
79.92
31.64
15.9871100
X-ray exam of ribs

X
0260
0.7276
44.78

8.9671101
X-ray exam of ribs/chest

X
0260
0.7276
44.78

8.9671110
X-ray exam of ribs

X
0260
0.7276
44.78

8.9671111
X-ray exam of ribs/chest

X
0261
1.2515
77.03

15.4171120
X-ray exam of breastbone

X
0260
0.7276
44.78

8.9671130
X-ray exam of breastbone

X
0260
0.7276
44.78

8.9671250
Ct thorax w/o dye

S
0332
3.1631
194.69
75.24
38.9471260
Ct thorax w/dye

S
0283
4.1858
257.64
102.17
51.5371270
Ct thorax w/ow/dye

S
0333
5.0020
307.88
121.52
61.5871275
Ct angiography, chest

S
0662
4.9203
302.85
118.88
60.5771550
Mri chest w/o dye

S
0336
5.8500
360.07
139.68
72.0171551
Mri chest w/dye

S
0284
6.2589
385.24
148.40
77.05( print page 49812)71552
Mri chest w/ow/dye

S
0337
8.3423
513.48
202.50
102.7072010
X-ray exam of spine

X
0260
0.7276
44.78

8.9672020
X-ray exam of spine

X
0260
0.7276
44.78

8.9672040
X-ray exam of neck spine

X
0260
0.7276
44.78

8.9672050
X-ray exam of neck spine

X
0261
1.2515
77.03

15.4172052
X-ray exam of neck spine

X
0261
1.2515
77.03

15.4172069
X-ray exam of trunk spine

X
0260
0.7276
44.78

8.9672070
X-ray exam of thoracic spine

X
0260
0.7276
44.78

8.9672072
X-ray exam of thoracic spine

X
0260
0.7276
44.78

8.9672074
X-ray exam of thoracic spine

X
0260
0.7276
44.78

8.9672080
X-ray exam of trunk spine

X
0260
0.7276
44.78

8.9672090
X-ray exam of trunk spine

X
0261
1.2515
77.03

15.4172100
X-ray exam of lower spine

X
0260
0.7276
44.78

8.9672110
X-ray exam of lower spine

X
0261
1.2515
77.03

15.4172114
X-ray exam of lower spine

X
0261
1.2515
77.03

15.4172120
X-ray exam of lower spine

X
0261
1.2515
77.03

15.4172125
Ct neck spine w/o dye

S
0332
3.1631
194.69
75.24
38.9472126
Ct neck spine w/dye

S
0283
4.1858
257.64
102.17
51.5372127
Ct neck spine w/ow/dye

S
0333
5.0020
307.88
121.52
61.5872128
Ct chest spine w/o dye

S
0332
3.1631
194.69
75.24
38.9472129
Ct chest spine w/dye

S
0283
4.1858
257.64
102.17
51.5372130
Ct chest spine w/ow/dye

S
0333
5.0020
307.88
121.52
61.5872131
Ct lumbar spine w/o dye

S
0332
3.1631
194.69
75.24
38.9472132
Ct lumbar spine w/dye

S
0283
4.1858
257.64
102.17
51.5372133
Ct lumbar spine w/ow/dye

S
0333
5.0020
307.88
121.52
61.5872141
Mri neck spine w/o dye

S
0336
5.8500
360.07
139.68
72.0172142
Mri neck spine w/dye

S
0284
6.2589
385.24
148.40
77.0572146
Mri chest spine w/o dye

S
0336
5.8500
360.07
139.68
72.0172147
Mri chest spine w/dye

S
0284
6.2589
385.24
148.40
77.0572148
Mri lumbar spine w/o dye

S
0336
5.8500
360.07
139.68
72.0172149
Mri lumbar spine w/dye

S
0284
6.2589
385.24
148.40
77.0572156
Mri neck spine w/ow/dye

S
0337
8.3423
513.48
202.50
102.7072157
Mri chest spine w/ow/dye

S
0337
8.3423
513.48
202.50
102.7072158
Mri lumbar spine w/ow/dye

S
0337
8.3423
513.48
202.50
102.7072170
X-ray exam of pelvis

X
0260
0.7276
44.78

8.9672190
X-ray exam of pelvis

X
0260
0.7276
44.78

8.9672191
Ct angiograph pelv w/ow/dye

S
0662
4.9203
302.85
118.88
60.5772192
Ct pelvis w/o dye

S
0332
3.1631
194.69
75.24
38.9472193
Ct pelvis w/dye

S
0283
4.1858
257.64
102.17
51.5372194
Ct pelvis w/ow/dye

S
0333
5.0020
307.88
121.52
61.5872195
Mri pelvis w/o dye

S
0336
5.8500
360.07
139.68
72.0172196
Mri pelvis w/dye

S
0284
6.2589
385.24
148.40
77.0572197
Mri pelvis w/ow/dye

S
0337
8.3423
513.48
202.50
102.7072200
X-ray exam sacroiliac joints

X
0260
0.7276
44.78

8.9672202
X-ray exam sacroiliac joints

X
0260
0.7276
44.78

8.9672220
X-ray exam of tailbone

X
0260
0.7276
44.78

8.9672240
Contrast x-ray of neck spine

S
0274
2.6182
161.15
64.46
32.2372255
Contrast x-ray, thorax spine

S
0274
2.6182
161.15
64.46
32.2372265
Contrast x-ray, lower spine

S
0274
2.6182
161.15
64.46
32.2372270
Contrast x-ray, spine

S
0274
2.6182
161.15
64.46
32.2372275
Epidurography

S
0274
2.6182
161.15
64.46
32.2372285
X-ray c/t spine disk

S
0388
14.2706
878.37
289.72
175.6772295
X-ray of lower spine disk

S
0388
14.2706
878.37
289.72
175.6773000
X-ray exam of collar bone

X
0260
0.7276
44.78

8.9673010
X-ray exam of shoulder blade

X
0260
0.7276
44.78

8.9673020
X-ray exam of shoulder

X
0260
0.7276
44.78

8.9673030
X-ray exam of shoulder

X
0260
0.7276
44.78

8.9673040
Contrast x-ray of shoulder

S
0275
3.7021
227.87
69.09
45.5773050
X-ray exam of shoulders

X
0260
0.7276
44.78

8.9673060
X-ray exam of humerus

X
0260
0.7276
44.78

8.9673070
X-ray exam of elbow

X
0260
0.7276
44.78

8.9673080
X-ray exam of elbow

X
0260
0.7276
44.78

8.9673085
Contrast x-ray of elbow

S
0275
3.7021
227.87
69.09
45.5773090
X-ray exam of forearm

X
0260
0.7276
44.78

8.9673092
X-ray exam of arm, infant

X
0260
0.7276
44.78

8.9673100
X-ray exam of wrist

X
0260
0.7276
44.78

8.9673110
X-ray exam of wrist

X
0260
0.7276
44.78

8.9673115
Contrast x-ray of wrist

S
0275
3.7021
227.87
69.09
45.5773120
X-ray exam of hand

X
0260
0.7276
44.78

8.9673130
X-ray exam of hand

X
0260
0.7276
44.78

8.96( print page 49813)73140
X-ray exam of finger(s)

X
0260
0.7276
44.78

8.9673200
Ct upper extremity w/o dye

S
0332
3.1631
194.69
75.24
38.9473201
Ct upper extremity w/dye

S
0283
4.1858
257.64
102.17
51.5373202
Ct uppr extremity w/ow/dye

S
0333
5.0020
307.88
121.52
61.5873206
Ct angio upr extrm w/ow/dye

S
0662
4.9203
302.85
118.88
60.5773218
Mri upper extremity w/o dye

S
0336
5.8500
360.07
139.68
72.0173219
Mri upper extremity w/dye

S
0284
6.2589
385.24
148.40
77.0573220
Mri uppr extremity w/ow/dye

S
0337
8.3423
513.48
202.50
102.7073221
Mri joint upr extrem w/o dye

S
0336
5.8500
360.07
139.68
72.0173222
Mri joint upr extrem w/dye

S
0284
6.2589
385.24
148.40
77.0573223
Mri joint upr extr w/ow/dye

S
0337
8.3423
513.48
202.50
102.7073500
X-ray exam of hip

X
0260
0.7276
44.78

8.9673510
X-ray exam of hip

X
0260
0.7276
44.78

8.9673520
X-ray exam of hips

X
0261
1.2515
77.03

15.4173525
Contrast x-ray of hip

S
0275
3.7021
227.87
69.09
45.5773530
X-ray exam of hip

X
0261
1.2515
77.03

15.4173540
X-ray exam of pelviships

X
0260
0.7276
44.78

8.9673542
X-ray exam, sacroiliac joint

S
0275
3.7021
227.87
69.09
45.5773550
X-ray exam of thigh

X
0260
0.7276
44.78

8.9673560
X-ray exam of knee, 1 or 2

X
0260
0.7276
44.78

8.9673562
X-ray exam of knee, 3

X
0260
0.7276
44.78

8.9673564
X-ray exam, knee, 4 or more

X
0260
0.7276
44.78

8.9673565
X-ray exam of knees

X
0260
0.7276
44.78

8.9673580
Contrast x-ray of knee joint

S
0275
3.7021
227.87
69.09
45.5773590
X-ray exam of lower leg

X
0260
0.7276
44.78

8.9673592
X-ray exam of leg, infant

X
0260
0.7276
44.78

8.9673600
X-ray exam of ankle

X
0260
0.7276
44.78

8.9673610
X-ray exam of ankle

X
0260
0.7276
44.78

8.9673615
Contrast x-ray of ankle

S
0275
3.7021
227.87
69.09
45.5773620
X-ray exam of foot

X
0260
0.7276
44.78

8.9673630
X-ray exam of foot

X
0260
0.7276
44.78

8.9673650
X-ray exam of heel

X
0260
0.7276
44.78

8.9673660
X-ray exam of toe(s)

X
0260
0.7276
44.78

8.9673700
Ct lower extremity w/o dye

S
0332
3.1631
194.69
75.24
38.9473701
Ct lower extremity w/dye

S
0283
4.1858
257.64
102.17
51.5373702
Ct lwr extremity w/ow/dye

S
0333
5.0020
307.88
121.52
61.5873706
Ct angio lwr extr w/ow/dye

S
0662
4.9203
302.85
118.88
60.5773718
Mri lower extremity w/o dye

S
0336
5.8500
360.07
139.68
72.0173719
Mri lower extremity w/dye

S
0284
6.2589
385.24
148.40
77.0573720
Mri lwr extremity w/ow/dye

S
0337
8.3423
513.48
202.50
102.7073721
Mri jnt of lwr extre w/o dye

S
0336
5.8500
360.07
139.68
72.0173722
Mri joint of lwr extr w/dye

S
0284
6.2589
385.24
148.40
77.0573723
Mri joint lwr extr w/ow/dye

S
0337
8.3423
513.48
202.50
102.7074000
X-ray exam of abdomen

X
0260
0.7276
44.78

8.9674010
X-ray exam of abdomen

X
0260
0.7276
44.78

8.9674020
X-ray exam of abdomen

X
0260
0.7276
44.78

8.9674022
X-ray exam series, abdomen

X
0261
1.2515
77.03

15.4174150
Ct abdomen w/o dye

S
0332
3.1631
194.69
75.24
38.9474160
Ct abdomen w/dye

S
0283
4.1858
257.64
102.17
51.5374170
Ct abdomen w/ow/dye

S
0333
5.0020
307.88
121.52
61.5874175
Ct angio abdom w/ow/dye

S
0662
4.9203
302.85
118.88
60.5774181
Mri abdomen w/o dye

S
0336
5.8500
360.07
139.68
72.0174182
Mri abdomen w/dye

S
0284
6.2589
385.24
148.40
77.0574183
Mri abdomen w/ow/dye

S
0337
8.3423
513.48
202.50
102.7074190
X-ray exam of peritoneum

X
0264
2.9791
183.37
70.84
36.6774210
Contrst x-ray exam of throat

S
0276
1.4519
89.37
34.97
17.8774220
Contrast x-ray, esophagus

S
0276
1.4519
89.37
34.97
17.8774230
Cine/vid x-ray, throat/esoph

S
0276
1.4519
89.37
34.97
17.8774235
Remove esophagus obstruction
CH
S
0257
0.9770
60.14

12.0374240
X-ray exam, upper gi tract

S
0276
1.4519
89.37
34.97
17.8774241
X-ray exam, upper gi tract

S
0276
1.4519
89.37
34.97
17.8774245
X-ray exam, upper gi tract

S
0277
2.2764
140.11
54.63
28.0274246
Contrst x-ray uppr gi tract

S
0276
1.4519
89.37
34.97
17.8774247
Contrst x-ray uppr gi tract

S
0276
1.4519
89.37
34.97
17.8774249
Contrst x-ray uppr gi tract

S
0277
2.2764
140.11
54.63
28.0274250
X-ray exam of small bowel

S
0276
1.4519
89.37
34.97
17.8774251
X-ray exam of small bowel

S
0277
2.2764
140.11
54.63
28.0274260
X-ray exam of small bowel
CH
S
0276
1.4519
89.37
34.97
17.8774270
Contrast x-ray exam of colon

S
0276
1.4519
89.37
34.97
17.8774280
Contrast x-ray exam of colon

S
0277
2.2764
140.11
54.63
28.02( print page 49814)74283
Contrast x-ray exam of colon

S
0276
1.4519
89.37
34.97
17.8774290
Contrast x-ray, gallbladder

S
0276
1.4519
89.37
34.97
17.8774291
Contrast x-rays, gallbladder

S
0276
1.4519
89.37
34.97
17.8774300
X-ray bile ducts/pancreas

X
0263
1.7120
105.38
23.77
21.0874301
X-rays at surgery add-on

X
0263
1.7120
105.38
23.77
21.0874305
X-ray bile ducts/pancreas

X
0263
1.7120
105.38
23.77
21.0874320
Contrast x-ray of bile ducts

X
0264
2.9791
183.37
70.84
36.6774327
X-ray bile stone removal

S
0296
2.7106
166.84
53.99
33.3774328
X-ray bile duct endoscopy

N74329
X-ray for pancreas endoscopy

N74330
X-ray bile/panc endoscopy

N74340
X-ray guide for GI tube

X
0272
1.2985
79.92
31.64
15.9874350
X-ray guide, stomach tube

X
0263
1.7120
105.38
23.77
21.0874355
X-ray guide, intestinal tube

X
0263
1.7120
105.38
23.77
21.0874360
X-ray guide, GI dilation
CH
S
0257
0.9770
60.14

12.0374363
X-ray, bile duct dilation

S
0297
3.6483
224.56
89.82
44.9174400
Contrst x-ray, urinary tract

S
0278
2.4721
152.16
60.84
30.4374410
Contrst x-ray, urinary tract

S
0278
2.4721
152.16
60.84
30.4374415
Contrst x-ray, urinary tract

S
0278
2.4721
152.16
60.84
30.4374420
Contrst x-ray, urinary tract

S
0278
2.4721
152.16
60.84
30.4374425
Contrst x-ray, urinary tract

S
0278
2.4721
152.16
60.84
30.4374430
Contrast x-ray, bladder

S
0278
2.4721
152.16
60.84
30.4374440
X-ray, male genital tract

S
0278
2.4721
152.16
60.84
30.4374445
X-ray exam of penis

S
0278
2.4721
152.16
60.84
30.4374450
X-ray, urethra/bladder

S
0278
2.4721
152.16
60.84
30.4374455
X-ray, urethra/bladder

S
0278
2.4721
152.16
60.84
30.4374470
X-ray exam of kidney lesion

X
0263
1.7120
105.38
23.77
21.0874475
X-ray control, cath insert

S
0297
3.6483
224.56
89.82
44.9174480
X-ray control, cath insert

S
0296
2.7106
166.84
53.99
33.3774485
X-ray guide, GU dilation

S
0296
2.7106
166.84
53.99
33.3774710
X-ray measurement of pelvis

X
0261
1.2515
77.03

15.4174740
X-ray, female genital tract

X
0264
2.9791
183.37
70.84
36.6774742
X-ray, fallopian tube

X
0264
2.9791
183.37
70.84
36.6774775
X-ray exam of perineum

S
0278
2.4721
152.16
60.84
30.4375552
Heart mri for morph w/o dye

S
0336
5.8500
360.07
139.68
72.0175553
Heart mri for morph w/dye

S
0284
6.2589
385.24
148.40
77.0575554
Cardiac MRI/function

S
0336
5.8500
360.07
139.68
72.0175555
Cardiac MRI/limited study

S
0336
5.8500
360.07
139.68
72.0175600
Contrast x-ray exam of aorta

S
0280
20.9479
1,289.36
353.85
257.8775605
Contrast x-ray exam of aorta

S
0280
20.9479
1,289.36
353.85
257.8775625
Contrast x-ray exam of aorta

S
0280
20.9479
1,289.36
353.85
257.8775630
X-ray aorta, leg arteries

S
0280
20.9479
1,289.36
353.85
257.8775635
Ct angio abdominal arteries

S
0662
4.9203
302.85
118.88
60.5775650
Artery x-rays, headneck

S
0280
20.9479
1,289.36
353.85
257.8775658
Artery x-rays, arm

S
0279
9.6539
594.21
150.03
118.8475660
Artery x-rays, headneck

S
0668
6.3684
391.98
88.26
78.4075662
Artery x-rays, headneck

S
0280
20.9479
1,289.36
353.85
257.8775665
Artery x-rays, headneck

S
0280
20.9479
1,289.36
353.85
257.8775671
Artery x-rays, headneck

S
0280
20.9479
1,289.36
353.85
257.8775676
Artery x-rays, neck

S
0280
20.9479
1,289.36
353.85
257.8775680
Artery x-rays, neck

S
0280
20.9479
1,289.36
353.85
257.8775685
Artery x-rays, spine

S
0280
20.9479
1,289.36
353.85
257.8775705
Artery x-rays, spine

S
0668
6.3684
391.98
88.26
78.4075710
Artery x-rays, arm/leg

S
0280
20.9479
1,289.36
353.85
257.8775716
Artery x-rays, arms/legs

S
0280
20.9479
1,289.36
353.85
257.8775722
Artery x-rays, kidney

S
0280
20.9479
1,289.36
353.85
257.8775724
Artery x-rays, kidneys

S
0280
20.9479
1,289.36
353.85
257.8775726
Artery x-rays, abdomen

S
0280
20.9479
1,289.36
353.85
257.8775731
Artery x-rays, adrenal gland

S
0280
20.9479
1,289.36
353.85
257.8775733
Artery x-rays, adrenals

S
0668
6.3684
391.98
88.26
78.4075736
Artery x-rays, pelvis

S
0280
20.9479
1,289.36
353.85
257.8775741
Artery x-rays, lung

S
0279
9.6539
594.21
150.03
118.8475743
Artery x-rays, lungs

S
0280
20.9479
1,289.36
353.85
257.8775746
Artery x-rays, lung

S
0279
9.6539
594.21
150.03
118.8475756
Artery x-rays, chest

S
0279
9.6539
594.21
150.03
118.8475774
Artery x-ray, each vessel

S
0279
9.6539
594.21
150.03
118.8475790
Visualize A-V shunt

S
0279
9.6539
594.21
150.03
118.8475801
Lymph vessel x-ray, arm/leg

X
0264
2.9791
183.37
70.84
36.6775803
Lymph vessel x-ray,arms/legs

X
0264
2.9791
183.37
70.84
36.6775805
Lymph vessel x-ray, trunk

X
0264
2.9791
183.37
70.84
36.67( print page 49815)75807
Lymph vessel x-ray, trunk

X
0264
2.9791
183.37
70.84
36.6775809
Nonvascular shunt, x-ray

X
0263
1.7120
105.38
23.77
21.0875810
Vein x-ray, spleen/liver

S
0279
9.6539
594.21
150.03
118.8475820
Vein x-ray, arm/leg

S
0668
6.3684
391.98
88.26
78.4075822
Vein x-ray, arms/legs

S
0668
6.3684
391.98
88.26
78.4075825
Vein x-ray, trunk

S
0279
9.6539
594.21
150.03
118.8475827
Vein x-ray, chest

S
0279
9.6539
594.21
150.03
118.8475831
Vein x-ray, kidney

S
0279
9.6539
594.21
150.03
118.8475833
Vein x-ray, kidneys

S
0279
9.6539
594.21
150.03
118.8475840
Vein x-ray, adrenal gland

S
0280
20.9479
1,289.36
353.85
257.8775842
Vein x-ray, adrenal glands

S
0280
20.9479
1,289.36
353.85
257.8775860
Vein x-ray, neck

S
0668
6.3684
391.98
88.26
78.4075870
Vein x-ray, skull

S
0668
6.3684
391.98
88.26
78.4075872
Vein x-ray, skull

S
0279
9.6539
594.21
150.03
118.8475880
Vein x-ray, eye socket

S
0668
6.3684
391.98
88.26
78.4075885
Vein x-ray, liver

S
0280
20.9479
1,289.36
353.85
257.8775887
Vein x-ray, liver

S
0279
9.6539
594.21
150.03
118.8475889
Vein x-ray, liver

S
0280
20.9479
1,289.36
353.85
257.8775891
Vein x-ray, liver

S
0279
9.6539
594.21
150.03
118.8475893
Venous sampling by catheter
CH
Q
0668
6.3684
391.98
88.26
78.4075894
X-rays, transcath therapy
CH
S
0298
8.4904
522.59
209.02
104.5275896
X-rays, transcath therapy
CH
S
0298
8.4904
522.59
209.02
104.5275898
Follow-up angiography

X
0263
1.7120
105.38
23.77
21.0875901
Remove cva device obstruct

X
0263
1.7120
105.38
23.77
21.0875902
Remove cva lumen obstruct

X
0263
1.7120
105.38
23.77
21.0875940
X-ray placement, vein filter
CH
S
0298
8.4904
522.59
209.02
104.5275945
Intravascular us

S
0267
2.5166
154.90
60.80
30.9875946
Intravascular us add-on

S
0266
1.5947
98.16
37.80
19.6375960
Transcath iv stent rsi

S
0668
6.3684
391.98
88.26
78.4075961
Retrieval, broken catheter

S
0668
6.3684
391.98
88.26
78.4075962
Repair arterial blockage

S
0668
6.3684
391.98
88.26
78.4075964
Repair artery blockage, each

S
0668
6.3684
391.98
88.26
78.4075966
Repair arterial blockage

S
0668
6.3684
391.98
88.26
78.4075968
Repair artery blockage, each

S
0668
6.3684
391.98
88.26
78.4075970
Vascular biopsy

S
0668
6.3684
391.98
88.26
78.4075978
Repair venous blockage

S
0668
6.3684
391.98
88.26
78.4075980
Contrast xray exam bile duct

S
0297
3.6483
224.56
89.82
44.9175982
Contrast xray exam bile duct

S
0297
3.6483
224.56
89.82
44.9175984
Xray control catheter change

X
0263
1.7120
105.38
23.77
21.0875989
Abscess drainage under x-ray

N75992
Atherectomy, x-ray exam
CH
S
0668
6.3684
391.98
88.26
78.4075993
Atherectomy, x-ray exam
CH
S
0668
6.3684
391.98
88.26
78.4075994
Atherectomy, x-ray exam
CH
S
0668
6.3684
391.98
88.26
78.4075995
Atherectomy, x-ray exam
CH
S
0668
6.3684
391.98
88.26
78.4075996
Atherectomy, x-ray exam
CH
S
0668
6.3684
391.98
88.26
78.4075998
Fluoroguide for vein device

N76000
Fluoroscope examination

X
0272
1.2985
79.92
31.64
15.9876001
Fluoroscope exam, extensive

N76003
Needle localization by x-ray

N76005
Fluoroguide for spine inject

N76006
X-ray stress view

X
0260
0.7276
44.78

8.9676010
X-ray, nose to rectum

X
0260
0.7276
44.78

8.9676012
Percut vertebroplasty fluor

S
0274
2.6182
161.15
64.46
32.2376013
Percut vertebroplasty, ct

S
0274
2.6182
161.15
64.46
32.2376020
X-rays for bone age

X
0260
0.7276
44.78

8.9676040
X-rays, bone evaluation
CH
X
0260
0.7276
44.78

8.9676061
X-rays, bone survey

X
0261
1.2515
77.03

15.4176062
X-rays, bone survey

X
0261
1.2515
77.03

15.4176065
X-rays, bone evaluation
CH
X
0260
0.7276
44.78

8.9676066
Joint survey, single view

X
0260
0.7276
44.78

8.9676070
Ct bone density, axial

S
0288
1.2005
73.89

14.7876071
Ct bone density, peripheral

S
0282
1.5552
95.72
37.92
19.1476075
Dxa bone density,  axial

S
0288
1.2005
73.89

14.7876076
Dxa bone density/peripheral

S
0665
0.5569
34.28

6.8676077
Dxa bone density/v-fracture

X
0260
0.7276
44.78

8.9676078
Radiographic absorptiometry
CH
X
0261
1.2515
77.03

15.4176080
X-ray exam of fistula

X
0263
1.7120
105.38
23.77
21.0876086
X-ray of mammary duct

X
0263
1.7120
105.38
23.77
21.0876088
X-ray of mammary ducts

X
0263
1.7120
105.38
23.77
21.0876095
Stereotactic breast biopsy

X
0264
2.9791
183.37
70.84
36.67( print page 49816)76096
X-ray of needle wire, breast

X
0263
1.7120
105.38
23.77
21.0876098
X-ray exam, breast specimen

X
0260
0.7276
44.78

8.9676100
X-ray exam of body section

X
0261
1.2515
77.03

15.4176101
Complex body section x-ray

X
0263
1.7120
105.38
23.77
21.0876102
Complex body section x-rays

X
0264
2.9791
183.37
70.84
36.6776120
Cine/video x-rays

X
0272
1.2985
79.92
31.64
15.9876125
Cine/video x-rays add-on

X
0260
0.7276
44.78

8.9676150
X-ray exam, dry process

X
0260
0.7276
44.78

8.9676350
Special x-ray contrast study

N76355
Ct scan for localization

S
0283
4.1858
257.64
102.17
51.5376360
Ct scan for needle biopsy

S
0283
4.1858
257.64
102.17
51.5376362
Ct guide for tissue ablation

S
0333
5.0020
307.88
121.52
61.5876370
Ct scan for therapy guide

S
0282
1.5552
95.72
37.92
19.1476376
3d render w/o postprocess

X
0340
0.6211
38.23

7.6576377
3d rendering w/postprocess

S
0282
1.5552
95.72
37.92
19.1476380
CAT scan follow-up study

S
0282
1.5552
95.72
37.92
19.1476393
Mr guidance for needle place

S
0335
4.6629
287.01
114.80
57.4076394
Mri for tissue ablation

S
0335
4.6629
287.01
114.80
57.4076400
Magnetic image, bone marrow

S
0335
4.6629
287.01
114.80
57.4076496
Fluoroscopic procedure

X
0272
1.2985
79.92
31.64
15.9876497
Ct procedure

S
0282
1.5552
95.72
37.92
19.1476498
Mri procedure

S
0335
4.6629
287.01
114.80
57.4076499
Radiographic procedure

X
0260
0.7276
44.78

8.9676506
Echo exam of head

S
0265
1.0145
62.44
23.63
12.4976510
Ophth us, bquant a

S
0266
1.5947
98.16
37.80
19.6376511
Ophth us, quant a only

S
0266
1.5947
98.16
37.80
19.6376512
Ophth us, b w/non-quant a

S
0266
1.5947
98.16
37.80
19.6376513
Echo exam of eye, water bath

S
0266
1.5947
98.16
37.80
19.6376514
Echo exam of eye, thickness

X
0340
0.6211
38.23

7.6576516
Echo exam of eye

S
0265
1.0145
62.44
23.63
12.4976519
Echo exam of eye

S
0266
1.5947
98.16
37.80
19.6376529
Echo exam of eye

S
0265
1.0145
62.44
23.63
12.4976536
Us exam of head and neck

S
0266
1.5947
98.16
37.80
19.6376604
Us exam, chest, b-scan
CH
S
0265
1.0145
62.44
23.63
12.4976645
Us exam, breast(s)

S
0265
1.0145
62.44
23.63
12.4976700
Us exam, abdom, complete

S
0266
1.5947
98.16
37.80
19.6376705
Echo exam of abdomen

S
0266
1.5947
98.16
37.80
19.6376770
Us exam abdo back wall, comp

S
0266
1.5947
98.16
37.80
19.6376775
Us exam abdo back wall, lim

S
0266
1.5947
98.16
37.80
19.6376778
Us exam kidney transplant

S
0266
1.5947
98.16
37.80
19.6376800
Us exam, spinal canal

S
0266
1.5947
98.16
37.80
19.6376801
Ob us  14 wks, single fetus

S
0266
1.5947
98.16
37.80
19.6376802
Ob us  14 wks, add'l fetus

S
0265
1.0145
62.44
23.63
12.4976805
Ob us /= 14 wks, sngl fetus

S
0266
1.5947
98.16
37.80
19.6376810
Ob us /= 14 wks, addl fetus

S
0266
1.5947
98.16
37.80
19.6376811
Ob us, detailed, sngl fetus

S
0267
2.5166
154.90
60.80
30.9876812
Ob us, detailed, addl fetus
CH
S
0265
1.0145
62.44
23.63
12.4976815
Ob us, limited, fetus(s)

S
0265
1.0145
62.44
23.63
12.4976816
Ob us, follow-up, per fetus

S
0265
1.0145
62.44
23.63
12.4976817
Transvaginal us, obstetric
CH
S
0265
1.0145
62.44
23.63
12.4976818
Fetal biophys profile w/nst

S
0266
1.5947
98.16
37.80
19.6376819
Fetal biophys profil w/o nst

S
0266
1.5947
98.16
37.80
19.6376820
Umbilical artery echo

S
0096
1.5727
96.80
38.13
19.3676821
Middle cerebral artery echo

S
0096
1.5727
96.80
38.13
19.3676825
Echo exam of fetal heart
CH
S
0697
1.6002
98.49
35.99
19.7076826
Echo exam of fetal heart

S
0697
1.6002
98.49
35.99
19.7076827
Echo exam of fetal heart
CH
S
0697
1.6002
98.49
35.99
19.7076828
Echo exam of fetal heart

S
0697
1.6002
98.49
35.99
19.7076830
Transvaginal us, non-ob

S
0266
1.5947
98.16
37.80
19.6376831
Echo exam, uterus

S
0267
2.5166
154.90
60.80
30.9876856
Us exam, pelvic, complete

S
0266
1.5947
98.16
37.80
19.6376857
Us exam, pelvic, limited

S
0265
1.0145
62.44
23.63
12.4976870
Us exam, scrotum

S
0266
1.5947
98.16
37.80
19.6376872
Us, transrectal

S
0266
1.5947
98.16
37.80
19.6376873
Echograp trans r, pros study

S
0266
1.5947
98.16
37.80
19.6376880
Us exam, extremity

S
0266
1.5947
98.16
37.80
19.6376885
Us exam infant hips, dynamic

S
0265
1.0145
62.44
23.63
12.4976886
Us exam infant hips, static
CH
S
0265
1.0145
62.44
23.63
12.4976930
Echo guide, cardiocentesis

S
0268
1.1967
73.66

14.7376932
Echo guide for heart biopsy
CH
S
0309
2.1284
131.01

26.20( print page 49817)76936
Echo guide for artery repair
CH
S
0309
2.1284
131.01

26.2076937
Us guide, vascular access

N76940
Us guide, tissue ablation

S
0268
1.1967
73.66

14.7376941
Echo guide for transfusion

S
0268
1.1967
73.66

14.7376942
Echo guide for biopsy

S
0268
1.1967
73.66

14.7376945
Echo guide, villus sampling

S
0268
1.1967
73.66

14.7376946
Echo guide for amniocentesis

S
0268
1.1967
73.66

14.7376948
Echo guide, ova aspiration
CH
S
0309
2.1284
131.01

26.2076950
Echo guidance radiotherapy

S
0268
1.1967
73.66

14.7376965
Echo guidance radiotherapy
CH
S
0309
2.1284
131.01

26.2076970
Ultrasound exam follow-up

S
0265
1.0145
62.44
23.63
12.4976975
GI endoscopic ultrasound

S
0266
1.5947
98.16
37.80
19.6376977
Us bone density measure

X
0340
0.6211
38.23

7.6576986
Ultrasound guide intraoper

S
0266
1.5947
98.16
37.80
19.6376999
Echo examination procedure

S
0265
1.0145
62.44
23.63
12.4977280
Set radiation therapy field

X
0304
1.6062
98.86
39.54
19.7777285
Set radiation therapy field

X
0305
4.0232
247.63
91.38
49.5377290
Set radiation therapy field

X
0305
4.0232
247.63
91.38
49.5377295
Set radiation therapy field

X
0310
14.0578
865.27
325.27
173.0577299
Radiation therapy planning

X
0304
1.6062
98.86
39.54
19.7777300
Radiation therapy dose plan

X
0304
1.6062
98.86
39.54
19.7777301
Radiotherapy dose plan, imrt

X
0310
14.0578
865.27
325.27
173.0577305
Teletx isodose plan simple

X
0304
1.6062
98.86
39.54
19.7777310
Teletx isodose plan intermed

X
0305
4.0232
247.63
91.38
49.5377315
Teletx isodose plan complex

X
0305
4.0232
247.63
91.38
49.5377321
Special teletx port plan

X
0305
4.0232
247.63
91.38
49.5377326
Brachytx isodose calc simp

X
0304
1.6062
98.86
39.54
19.7777327
Brachytx isodose calc interm

X
0305
4.0232
247.63
91.38
49.5377328
Brachytx isodose plan compl

X
0305
4.0232
247.63
91.38
49.5377331
Special radiation dosimetry

X
0304
1.6062
98.86
39.54
19.7777332
Radiation treatment aid(s)

X
0303
2.9637
182.42
66.95
36.4877333
Radiation treatment aid(s)

X
0303
2.9637
182.42
66.95
36.4877334
Radiation treatment aid(s)

X
0303
2.9637
182.42
66.95
36.4877336
Radiation physics consult

X
0304
1.6062
98.86
39.54
19.7777370
Radiation physics consult

X
0304
1.6062
98.86
39.54
19.7777399
External radiation dosimetry

X
0304
1.6062
98.86
39.54
19.7777401
Radiation treatment delivery

S
0300
1.5004
92.35

18.4777402
Radiation treatment delivery

S
0300
1.5004
92.35

18.4777403
Radiation treatment delivery

S
0300
1.5004
92.35

18.4777404
Radiation treatment delivery

S
0300
1.5004
92.35

18.4777406
Radiation treatment delivery

S
0300
1.5004
92.35

18.4777407
Radiation treatment delivery

S
0300
1.5004
92.35

18.4777408
Radiation treatment delivery

S
0300
1.5004
92.35

18.4777409
Radiation treatment delivery

S
0300
1.5004
92.35

18.4777411
Radiation treatment delivery

S
0301
2.2670
139.54

27.9177412
Radiation treatment delivery

S
0301
2.2670
139.54

27.9177413
Radiation treatment delivery

S
0301
2.2670
139.54

27.9177414
Radiation treatment delivery

S
0301
2.2670
139.54

27.9177416
Radiation treatment delivery

S
0301
2.2670
139.54

27.9177417
Radiology port film(s)

X
0260
0.7276
44.78

8.9677418
Radiation tx delivery, imrt

S
0412
5.5021
338.66

67.7377421
Stereoscopic x-ray guidance
CH
S
0257
0.9770
60.14

12.0377422
Neutron beam tx, simple

S
0301
2.2670
139.54

27.9177423
Neutron beam tx, complex

S
0301
2.2670
139.54

27.9177470
Special radiation treatment

S
0299
6.0322
371.29

74.2677520
Proton trmt, simple w/o comp

S
0664
18.4698
1,136.83

227.3777522
Proton trmt, simple w/comp

S
0664
18.4698
1,136.83

227.3777523
Proton trmt, intermediate

S
0667
22.0972
1,360.10

272.0277525
Proton treatment, complex

S
0667
22.0972
1,360.10

272.0277600
Hyperthermia treatment

S
0314
3.6583
225.17
66.65
45.0377605
Hyperthermia treatment

S
0314
3.6583
225.17
66.65
45.0377610
Hyperthermia treatment

S
0314
3.6583
225.17
66.65
45.0377615
Hyperthermia treatment

S
0314
3.6583
225.17
66.65
45.0377620
Hyperthermia treatment

S
0314
3.6583
225.17
66.65
45.0377750
Infuse radioactive materials

S
0301
2.2670
139.54

27.9177761
Apply intrcav radiat simple

S
0312
5.0185
308.89

61.7877762
Apply intrcav radiat interm

S
0312
5.0185
308.89

61.7877763
Apply intrcav radiat compl

S
0312
5.0185
308.89

61.7877776
Apply interstit radiat simpl

S
0312
5.0185
308.89

61.7877777
Apply interstit radiat inter

S
0312
5.0185
308.89

61.78( print page 49818)77778
Apply interstit radiat compl

S
0651
16.6585
1,025.35

205.0777781
High intensity brachytherapy

S
0313
13.3939
824.41

164.8877782
High intensity brachytherapy

S
0313
13.3939
824.41

164.8877783
High intensity brachytherapy

S
0313
13.3939
824.41

164.8877784
High intensity brachytherapy

S
0313
13.3939
824.41

164.8877789
Apply surface radiation

S
0300
1.5004
92.35

18.4777790
Radiation handling

N77799
Radium/radioisotope therapy
CH
S
0312
5.0185
308.89

61.7878000
Thyroid, single uptake

S
0389
1.4072
86.61
33.98
17.3278001
Thyroid, multiple uptakes

S
0389
1.4072
86.61
33.98
17.3278003
Thyroid suppress/stimul

S
0392
2.0849
128.33
51.33
25.6778006
Thyroid imaging with uptake

S
0390
2.3732
146.07
58.42
29.2178007
Thyroid image, mult uptakes

S
0391
2.7556
169.61
66.18
33.9278010
Thyroid imaging

S
0390
2.3732
146.07
58.42
29.2178011
Thyroid imaging with flow

S
0390
2.3732
146.07
58.42
29.2178015
Thyroid met imaging

S
0406
3.9386
242.42
96.96
48.4878016
Thyroid met imaging/studies

S
0406
3.9386
242.42
96.96
48.4878018
Thyroid met imaging, body

S
0406
3.9386
242.42
96.96
48.4878020
Thyroid met uptake

S
0399
1.5282
94.06
35.80
18.8178070
Parathyroid nuclear imaging

S
0391
2.7556
169.61
66.18
33.9278075
Adrenal nuclear imaging

S
0391
2.7556
169.61
66.18
33.9278099
Endocrine nuclear procedure

S
0390
2.3732
146.07
58.42
29.2178102
Bone marrow imaging, ltd

S
0400
3.9304
241.92
93.22
48.3878103
Bone marrow imaging, mult

S
0400
3.9304
241.92
93.22
48.3878104
Bone marrow imaging, body

S
0400
3.9304
241.92
93.22
48.3878110
Plasma volume, single

S
0393
3.5902
220.98
82.04
44.2078111
Plasma volume, multiple

S
0393
3.5902
220.98
82.04
44.2078120
Red cell mass, single

S
0393
3.5902
220.98
82.04
44.2078121
Red cell mass, multiple

S
0393
3.5902
220.98
82.04
44.2078122
Blood volume

S
0393
3.5902
220.98
82.04
44.2078130
Red cell survival study

S
0393
3.5902
220.98
82.04
44.2078135
Red cell survival kinetics

S
0393
3.5902
220.98
82.04
44.2078140
Red cell sequestration

S
0393
3.5902
220.98
82.04
44.2078185
Spleen imaging

S
0400
3.9304
241.92
93.22
48.3878190
Platelet survival, kinetics

S
0392
2.0849
128.33
51.33
25.6778191
Platelet survival

S
0392
2.0849
128.33
51.33
25.6778195
Lymph system imaging

S
0400
3.9304
241.92
93.22
48.3878199
Blood/lymph nuclear exam

S
0400
3.9304
241.92
93.22
48.3878201
Liver imaging

S
0394
4.4705
275.16
102.61
55.0378202
Liver imaging with flow

S
0394
4.4705
275.16
102.61
55.0378205
Liver imaging (3D)

S
0394
4.4705
275.16
102.61
55.0378206
Liver image (3d) with flow

S
0394
4.4705
275.16
102.61
55.0378215
Liver and spleen imaging

S
0394
4.4705
275.16
102.61
55.0378216
Liverspleen image/flow

S
0394
4.4705
275.16
102.61
55.0378220
Liver function study

S
0394
4.4705
275.16
102.61
55.0378223
Hepatobiliary imaging

S
0394
4.4705
275.16
102.61
55.0378230
Salivary gland imaging

S
0395
3.6937
227.35
89.73
45.4778231
Serial salivary imaging

S
0395
3.6937
227.35
89.73
45.4778232
Salivary gland function exam

S
0395
3.6937
227.35
89.73
45.4778258
Esophageal motility study

S
0395
3.6937
227.35
89.73
45.4778261
Gastric mucosa imaging

S
0395
3.6937
227.35
89.73
45.4778262
Gastroesophageal reflux exam

S
0395
3.6937
227.35
89.73
45.4778264
Gastric emptying study

S
0395
3.6937
227.35
89.73
45.4778270
Vit B-12 absorption exam

S
0392
2.0849
128.33
51.33
25.6778271
Vit b-12 absrp exam, int fac

S
0392
2.0849
128.33
51.33
25.6778272
Vit B-12 absorp, combined

S
0392
2.0849
128.33
51.33
25.6778278
Acute GI blood loss imaging

S
0395
3.6937
227.35
89.73
45.4778282
GI protein loss exam

S
0395
3.6937
227.35
89.73
45.4778290
Meckel's divert exam

S
0395
3.6937
227.35
89.73
45.4778291
Leveen/shunt patency exam

S
0395
3.6937
227.35
89.73
45.4778299
GI nuclear procedure

S
0395
3.6937
227.35
89.73
45.4778300
Bone imaging, limited area

S
0396
4.0166
247.23
95.02
49.4578305
Bone imaging, multiple areas

S
0396
4.0166
247.23
95.02
49.4578306
Bone imaging, whole body

S
0396
4.0166
247.23
95.02
49.4578315
Bone imaging, 3 phase

S
0396
4.0166
247.23
95.02
49.4578320
Bone imaging (3D)

S
0396
4.0166
247.23
95.02
49.4578350
Bone mineral, single photon

X
0260
0.7276
44.78

8.9678399
Musculoskeletal nuclear exam

S
0396
4.0166
247.23
95.02
49.4578414
Non-imaging heart function

S
0398
4.2511
261.66
100.06
52.3378428
Cardiac shunt imaging

S
0398
4.2511
261.66
100.06
52.33( print page 49819)78445
Vascular flow imaging

S
0397
2.2521
138.62
49.58
27.7278456
Acute venous thrombus image

S
0397
2.2521
138.62
49.58
27.7278457
Venous thrombosis imaging

S
0397
2.2521
138.62
49.58
27.7278458
Ven thrombosis images, bilat

S
0397
2.2521
138.62
49.58
27.7278459
Heart muscle imaging (PET)
CH
S
0307
11.6773
718.75
287.49
143.7578460
Heart muscle blood, single

S
0398
4.2511
261.66
100.06
52.3378461
Heart muscle blood, multiple

S
0377
6.7443
415.12
158.84
83.0278464
Heart image (3d), single

S
0398
4.2511
261.66
100.06
52.3378465
Heart image (3d), multiple

S
0377
6.7443
415.12
158.84
83.0278466
Heart infarct image

S
0398
4.2511
261.66
100.06
52.3378468
Heart infarct image (ef)

S
0398
4.2511
261.66
100.06
52.3378469
Heart infarct image (3D)

S
0398
4.2511
261.66
100.06
52.3378472
Gated heart, planar, single

S
0398
4.2511
261.66
100.06
52.3378473
Gated heart, multiple

S
0376
4.9770
306.34
119.77
61.2778478
Heart wall motion add-on

S
0399
1.5282
94.06
35.80
18.8178480
Heart function add-on

S
0399
1.5282
94.06
35.80
18.8178481
Heart first pass, single

S
0398
4.2511
261.66
100.06
52.3378483
Heart first pass, multiple

S
0376
4.9770
306.34
119.77
61.2778491
Heart image (pet), single
CH
S
0307
11.6773
718.75
287.49
143.7578492
Heart image (pet), multiple

S
0307
11.6773
718.75
287.49
143.7578494
Heart image, spect

S
0398
4.2511
261.66
100.06
52.3378496
Heart first pass add-on

S
0399
1.5282
94.06
35.80
18.8178499
Cardiovascular nuclear exam

S
0398
4.2511
261.66
100.06
52.3378580
Lung perfusion imaging

S
0401
3.2013
197.04
78.81
39.4178584
Lung V/Q image single breath

S
0378
5.2084
320.58
128.23
64.1278585
Lung V/Q imaging

S
0378
5.2084
320.58
128.23
64.1278586
Aerosol lung image, single

S
0401
3.2013
197.04
78.81
39.4178587
Aerosol lung image, multiple

S
0401
3.2013
197.04
78.81
39.4178588
Perfusion lung image

S
0378
5.2084
320.58
128.23
64.1278591
Vent image, 1 breath, 1 proj

S
0401
3.2013
197.04
78.81
39.4178593
Vent image, 1 proj, gas

S
0401
3.2013
197.04
78.81
39.4178594
Vent image, mult proj, gas

S
0401
3.2013
197.04
78.81
39.4178596
Lung differential function

S
0378
5.2084
320.58
128.23
64.1278599
Respiratory nuclear exam

S
0401
3.2013
197.04
78.81
39.4178600
Brain imaging, ltd static

S
0402
4.8596
299.11
119.64
59.8278601
Brain imaging, ltd w/flow

S
0402
4.8596
299.11
119.64
59.8278605
Brain imaging, complete

S
0402
4.8596
299.11
119.64
59.8278606
Brain imaging, compl w/flow

S
0402
4.8596
299.11
119.64
59.8278607
Brain imaging (3D)

S
0402
4.8596
299.11
119.64
59.8278608
Brain imaging (PET)
CH
S
0308
14.0093
862.29

172.4678610
Brain flow imaging only

S
0402
4.8596
299.11
119.64
59.8278615
Cerebral vascular flow image

S
0402
4.8596
299.11
119.64
59.8278630
Cerebrospinal fluid scan

S
0403
3.4867
214.61
83.35
42.9278635
CSF ventriculography

S
0403
3.4867
214.61
83.35
42.9278645
CSF shunt evaluation

S
0403
3.4867
214.61
83.35
42.9278647
Cerebrospinal fluid scan

S
0403
3.4867
214.61
83.35
42.9278650
CSF leakage imaging

S
0403
3.4867
214.61
83.35
42.9278660
Nuclear exam of tear flow

S
0403
3.4867
214.61
83.35
42.9278699
Nervous system nuclear exam

S
0402
4.8596
299.11
119.64
59.8278700
Kidney imaging, static

S
0404
3.4235
210.72
84.28
42.1478701
Kidney imaging with flow

S
0404
3.4235
210.72
84.28
42.1478704
Imaging renogram

S
0404
3.4235
210.72
84.28
42.1478707
Kidney flow/function image

S
0404
3.4235
210.72
84.28
42.1478708
Kidney flow/function image

S
0405
4.1056
252.70
98.77
50.5478709
Kidney flow/function image

S
0405
4.1056
252.70
98.77
50.5478710
Kidney imaging (3D)

S
0404
3.4235
210.72
84.28
42.1478715
Renal vascular flow exam

S
0404
3.4235
210.72
84.28
42.1478725
Kidney function study

S
0389
1.4072
86.61
33.98
17.3278730
Urinary bladder retention

X
0340
0.6211
38.23

7.6578740
Ureteral reflux study

S
0404
3.4235
210.72
84.28
42.1478760
Testicular imaging

S
0404
3.4235
210.72
84.28
42.1478761
Testicular imaging/flow

S
0404
3.4235
210.72
84.28
42.1478799
Genitourinary nuclear exam

S
0404
3.4235
210.72
84.28
42.1478800
Tumor imaging, limited area

S
0406
3.9386
242.42
96.96
48.4878801
Tumor imaging, mult areas

S
0406
3.9386
242.42
96.96
48.4878802
Tumor imaging, whole body

S
0406
3.9386
242.42
96.96
48.4878803
Tumor imaging (3D)

S
0406
3.9386
242.42
96.96
48.4878804
Tumor imaging, whole body
CH
S
0408
4.9998
307.74

61.5578805
Abscess imaging, ltd area

S
0406
3.9386
242.42
96.96
48.4878806
Abscess imaging, whole body
CH
S
0408
4.9998
307.74

61.55( print page 49820)78807
Nuclear localization/abscess

S
0406
3.9386
242.42
96.96
48.4878811
Tumor imaging (pet), limited
CH
S
0308
14.0093
862.29

172.4678812
Tumor image (pet)/skul-thigh
CH
S
0308
14.0093
862.29

172.4678813
Tumor image (pet) full body
CH
S
0308
14.0093
862.29

172.4678814
Tumor image pet/ct, limited
CH
S
0308
14.0093
862.29

172.4678815
Tumorimage pet/ct skul-thigh
CH
S
0308
14.0093
862.29

172.4678816
Tumor image pet/ct full body
CH
S
0308
14.0093
862.29

172.4678890
Nuclear medicine data proc

N78891
Nuclear med data proc

N78999
Nuclear diagnostic exam

S
0389
1.4072
86.61
33.98
17.3279005
Nuclear rx, oral admin

S
0407
3.1506
193.92
77.56
38.7879101
Nuclear rx, iv admin

S
0407
3.1506
193.92
77.56
38.7879200
Nuclear rx, intracav admin
CH
S
0413
5.1026
314.07

62.8179300
Nuclr rx, interstit colloid

S
0407
3.1506
193.92
77.56
38.7879403
Hematopoietic nuclear tx
CH
S
0413
5.1026
314.07

62.8179440
Nuclear rx, intra-articular
CH
S
0413
5.1026
314.07

62.8179445
Nuclear rx, intra-arterial

S
0407
3.1506
193.92
77.56
38.7879999
Nuclear medicine therapy

S
0407
3.1506
193.92
77.56
38.7880103
Drug analysis, tissue prep

N80500
Lab pathology consultation

X
0433
0.2571
15.82
5.93
3.1680502
Lab pathology consultation

X
0342
0.0813
5.00
2.00
1.0085097
Bone marrow interpretation

X
0343
0.5309
32.68
10.84
6.5485396
Clotting assay, whole blood

N86077
Physician blood bank service

X
0433
0.2571
15.82
5.93
3.1686078
Physician blood bank service

X
0343
0.5309
32.68
10.84
6.5486079
Physician blood bank service

X
0433
0.2571
15.82
5.93
3.1686485
Skin test, candida

X
0341
0.0914
5.63
2.25
1.1386490
Coccidioidomycosis skin test

X
0341
0.0914
5.63
2.25
1.1386510
Histoplasmosis skin test

X
0341
0.0914
5.63
2.25
1.1386580
TB intradermal test

X
0341
0.0914
5.63
2.25
1.1386850
RBC antibody screen

X
0345
0.2218
13.65
2.87
2.7386860
RBC antibody elution

X
0346
0.3494
21.51
4.39
4.3086870
RBC antibody identification

X
0346
0.3494
21.51
4.39
4.3086880
Coombs test, direct

X
0409
0.1237
7.61
2.20
1.5286885
Coombs test, indirect, qual

X
0409
0.1237
7.61
2.20
1.5286886
Coombs test, indirect, titer

X
0409
0.1237
7.61
2.20
1.5286890
Autologous blood process

X
0347
0.7394
45.51
11.24
9.1086891
Autologous blood, op salvage

X
0346
0.3494
21.51
4.39
4.3086900
Blood typing, ABO

X
0409
0.1237
7.61
2.20
1.5286901
Blood typing, Rh (D)

X
0409
0.1237
7.61
2.20
1.5286903
Blood typing, antigen screen

X
0345
0.2218
13.65
2.87
2.7386904
Blood typing, patient serum

X
0346
0.3494
21.51
4.39
4.3086905
Blood typing, RBC antigens

X
0345
0.2218
13.65
2.87
2.7386906
Blood typing, Rh phenotype

X
0345
0.2218
13.65
2.87
2.7386920
Compatibility test, spin

X
0346
0.3494
21.51
4.39
4.3086921
Compatibility test, incubate

X
0345
0.2218
13.65
2.87
2.7386922
Compatibility test, antiglob

X
0346
0.3494
21.51
4.39
4.3086923
Compatibility test, electric

X
0345
0.2218
13.65
2.87
2.7386927
Plasma, fresh frozen

X
0345
0.2218
13.65
2.87
2.7386930
Frozen blood prep

X
0347
0.7394
45.51
11.24
9.1086931
Frozen blood thaw

X
0347
0.7394
45.51
11.24
9.1086932
Frozen blood freeze/thaw

X
0347
0.7394
45.51
11.24
9.1086945
Blood product/irradiation

X
0345
0.2218
13.65
2.87
2.7386950
Leukacyte transfusion

X
0345
0.2218
13.65
2.87
2.7386960
Vol reduction of blood/prod

X
0345
0.2218
13.65
2.87
2.7386965
Pooling blood platelets
CH
X
0346
0.3494
21.51
4.39
4.3086970
RBC pretreatment

X
0345
0.2218
13.65
2.87
2.7386971
RBC pretreatment

X
0345
0.2218
13.65
2.87
2.7386972
RBC pretreatment

X
0346
0.3494
21.51
4.39
4.3086975
RBC pretreatment, serum
CH
X
0346
0.3494
21.51
4.39
4.3086976
RBC pretreatment, serum

X
0345
0.2218
13.65
2.87
2.7386977
RBC pretreatment, serum
CH
X
0346
0.3494
21.51
4.39
4.3086978
RBC pretreatment, serum
CH
X
0346
0.3494
21.51
4.39
4.3086985
Split blood or products

X
0345
0.2218
13.65
2.87
2.7386999
Transfusion procedure

X
0345
0.2218
13.65
2.87
2.7388104
Cytopathology, fluids

X
0433
0.2571
15.82
5.93
3.1688106
Cytopathology, fluids

X
0433
0.2571
15.82
5.93
3.1688107
Cytopathology, fluids

X
0433
0.2571
15.82
5.93
3.1688108
Cytopath, concentrate tech

X
0433
0.2571
15.82
5.93
3.1688112
Cytopath, cell enhance tech

X
0343
0.5309
32.68
10.84
6.54( print page 49821)88125
Forensic cytopathology
CH
X
0433
0.2571
15.82
5.93
3.1688141
Cytopath, c/v, interpret

N88160
Cytopath smear, other source

X
0433
0.2571
15.82
5.93
3.1688161
Cytopath smear, other source

X
0433
0.2571
15.82
5.93
3.1688162
Cytopath smear, other source

X
0433
0.2571
15.82
5.93
3.1688172
Cytopathology eval of fna

X
0343
0.5309
32.68
10.84
6.5488173
Cytopath eval, fna, report

X
0343
0.5309
32.68
10.84
6.5488182
Cell marker study
CH
X
0343
0.5309
32.68
10.84
6.5488184
Flowcytometry/tc, 1 marker
CH
X
0433
0.2571
15.82
5.93
3.1688185
Flowcytometry/tc, add-on
CH
X
0433
0.2571
15.82
5.93
3.1688187
Flowcytometry/read, 2-8

X
0433
0.2571
15.82
5.93
3.1688188
Flowcytometry/read, 9-15

X
0433
0.2571
15.82
5.93
3.1688189
Flowcytometry/read, 16

X
0343
0.5309
32.68
10.84
6.5488299
Cytogenetic study

X
0342
0.0813
5.00
2.00
1.0088300
Surgical path, gross

X
0433
0.2571
15.82
5.93
3.1688302
Tissue exam by pathologist

X
0433
0.2571
15.82
5.93
3.1688304
Tissue exam by pathologist

X
0343
0.5309
32.68
10.84
6.5488305
Tissue exam by pathologist

X
0343
0.5309
32.68
10.84
6.5488307
Tissue exam by pathologist

X
0344
0.8107
49.90
15.66
9.9888309
Tissue exam by pathologist

X
0344
0.8107
49.90
15.66
9.9888311
Decalcify tissue
CH
X
0433
0.2571
15.82
5.93
3.1688312
Special stains

X
0433
0.2571
15.82
5.93
3.1688313
Special stains

X
0433
0.2571
15.82
5.93
3.1688314
Histochemical stain

X
0342
0.0813
5.00
2.00
1.0088318
Chemical histochemistry

X
0433
0.2571
15.82
5.93
3.1688319
Enzyme histochemistry

X
0343
0.5309
32.68
10.84
6.5488321
Microslide consultation

X
0433
0.2571
15.82
5.93
3.1688323
Microslide consultation

X
0343
0.5309
32.68
10.84
6.5488325
Comprehensive review of data

X
0344
0.8107
49.90
15.66
9.9888329
Path consult introp

X
0433
0.2571
15.82
5.93
3.1688331
Path consult intraop, 1 bloc

X
0343
0.5309
32.68
10.84
6.5488332
Path consult intraop, add'l

X
0433
0.2571
15.82
5.93
3.1688333
Intraop cyto path consult, 1

X
0343
0.5309
32.68
10.84
6.5488334
Intraop cyto path consult, 2

X
0433
0.2571
15.82
5.93
3.1688342
Immunohistochemistry

X
0343
0.5309
32.68
10.84
6.5488346
Immunofluorescent study

X
0343
0.5309
32.68
10.84
6.5488347
Immunofluorescent study

X
0343
0.5309
32.68
10.84
6.5488348
Electron microscopy

X
0661
2.6066
160.44
64.17
32.0988349
Scanning electron microscopy

X
0661
2.6066
160.44
64.17
32.0988355
Analysis, skeletal muscle

X
0343
0.5309
32.68
10.84
6.5488356
Analysis, nerve

X
0344
0.8107
49.90
15.66
9.9888358
Analysis, tumor

X
0344
0.8107
49.90
15.66
9.9888360
Tumor immunohistochem/manual
CH
X
0343
0.5309
32.68
10.84
6.5488361
Tumor immunohistochem/comput

X
0344
0.8107
49.90
15.66
9.9888362
Nerve teasing preparations

X
0344
0.8107
49.90
15.66
9.9888365
Insitu hybridization (fish)

X
0344
0.8107
49.90
15.66
9.9888367
Insitu hybridization, auto

X
0344
0.8107
49.90
15.66
9.9888368
Insitu hybridization, manual

X
0344
0.8107
49.90
15.66
9.9888380
Microdissection

N88384
Eval molecular probes, 11-50

X
0433
0.2571
15.82
5.93
3.1688385
Eval  molecul probes, 51-250

X
0343
0.5309
32.68
10.84
6.5488386
Eval molecul probes, 251-500

X
0344
0.8107
49.90
15.66
9.9889049
Chct for mal hyperthermia

X
0343
0.5309
32.68
10.84
6.5489100
Sample intestinal contents

X
0360
1.3789
84.87
33.88
16.9789105
Sample intestinal contents

X
0360
1.3789
84.87
33.88
16.9789130
Sample stomach contents

X
0360
1.3789
84.87
33.88
16.9789132
Sample stomach contents

X
0360
1.3789
84.87
33.88
16.9789135
Sample stomach contents

X
0360
1.3789
84.87
33.88
16.9789136
Sample stomach contents

X
0360
1.3789
84.87
33.88
16.9789140
Sample stomach contents

X
0360
1.3789
84.87
33.88
16.9789141
Sample stomach contents

X
0360
1.3789
84.87
33.88
16.9789220
Sputum specimen collection

X
0343
0.5309
32.68
10.84
6.5489230
Collect sweat for test

X
0433
0.2571
15.82
5.93
3.1689250
Cultr oocyte/embryo 4 days

X
0348
0.8928
54.95

10.9989251
Cultr oocyte/embryo 4 days

X
0348
0.8928
54.95

10.9989253
Embryo hatching

X
0348
0.8928
54.95

10.9989254
Oocyte identification

X
0348
0.8928
54.95

10.9989255
Prepare embryo for transfer

X
0348
0.8928
54.95

10.9989257
Sperm identification

X
0348
0.8928
54.95

10.9989258
Cryopreservation; embryo(s)

X
0348
0.8928
54.95

10.99( print page 49822)89259
Cryopreservation, sperm

X
0348
0.8928
54.95

10.9989260
Sperm isolation, simple

X
0348
0.8928
54.95

10.9989261
Sperm isolation, complex

X
0348
0.8928
54.95

10.9989264
Identify sperm tissue

X
0348
0.8928
54.95

10.9989268
Insemination of oocytes

X
0348
0.8928
54.95

10.9989272
Extended culture of oocytes

X
0348
0.8928
54.95

10.9989280
Assist oocyte fertilization

X
0348
0.8928
54.95

10.9989281
Assist oocyte fertilization

X
0348
0.8928
54.95

10.9989290
Biopsy, oocyte polar body

X
0348
0.8928
54.95

10.9989291
Biopsy, oocyte polar body

X
0348
0.8928
54.95

10.9989335
Cryopreserve testicular tiss

X
0348
0.8928
54.95

10.9989342
Storage/year; embryo(s)

X
0348
0.8928
54.95

10.9989343
Storage/year; sperm/semen

X
0348
0.8928
54.95

10.9989344
Storage/year; reprod tissue

X
0348
0.8928
54.95

10.9989346
Storage/year; oocyte(s)

X
0348
0.8928
54.95

10.9989352
Thawing cryopresrved; embryo

X
0348
0.8928
54.95

10.9989353
Thawing cryopresrved; sperm

X
0348
0.8928
54.95

10.9989354
Thaw cryoprsvrd; reprod tiss

X
0348
0.8928
54.95

10.9989356
Thawing cryopresrved; oocyte

X
0348
0.8928
54.95

10.9990296
Diphtheria antitoxin

N90371
Hep b ig, im

K
1630

118.61

23.7290375
Rabies ig, im/sc

K
9133

63.98

12.8090376
Rabies ig, heat treated

K
9134

68.58

13.7290385
Rh ig, minidose, im

N90393
Vaccina ig, im

N90396
Varicella-zoster ig, im

K
9135

149.08

29.8290471
Immunization admin
CH
S
0437
0.4107
25.28

5.0690472
Immunization admin, each add
CH
S
0436
0.1769
10.89

2.1890473
Immune admin oral/nasal
CH
S
0436
0.1769
10.89

2.1890474
Immune admin oral/nasal addl
CH
S
0436
0.1769
10.89

2.1890476
Adenovirus vaccine, type 4
CH
N90477
Adenovirus vaccine, type 7

N90581
Anthrax vaccine, sc
CH
N90585
Bcg vaccine, percut

K
9137

115.46

23.0990632
Hep a vaccine, adult im

N90633
Hep a vacc, ped/adol, 2 dose

N90634
Hep a vacc, ped/adol, 3 dose

N90636
Hep a/hep b vacc, adult im
CH
N90645
Hib vaccine, hboc, im

N90646
Hib vaccine, prp-d, im

N90647
Hib vaccine, prp-omp, im

N90648
Hib vaccine, prp-t, im

N90665
Lyme disease vaccine, im
CH
N90675
Rabies vaccine, im

K
9139

155.25

31.0590676
Rabies vaccine, id

K
9140

118.49

23.7090680
Rotovirus vacc 3 dose, oral

N90690
Typhoid vaccine, oral

N90691
Typhoid vaccine, im

N90692
Typhoid vaccine, h-p, sc/id

N90693
Typhoid vaccine, akd, sc

N90698
Dtap-hib-ip vaccine, im

N90700
Dtap vaccine,  7 yrs, im

N90701
Dtp vaccine, im

N90702
Dt vaccine  7, im

N90703
Tetanus vaccine, im

N90704
Mumps vaccine, sc

N90705
Measles vaccine, sc

N90706
Rubella vaccine, sc

N90707
Mmr vaccine, sc

N90708
Measles-rubella vaccine, sc

K
9141

44.62

8.9290710
Mmrv vaccine, sc

N90712
Oral poliovirus vaccine

N90713
Poliovirus, ipv, sc/im

N90714
Td vaccine no prsrv /= 7 im
CH
N90715
Tdap vaccine 7 im

N90716
Chicken pox vaccine, sc

K
9142

66.84

13.3790717
Yellow fever vaccine, sc
CH
N90718
Td vaccine  7, im

N90719
Diphtheria vaccine, im

N90720
Dtp/hib vaccine, im
CH
K
3032

68.91

13.78( print page 49823)90721
Dtap/hib vaccine, im

N90725
Cholera vaccine, injectable

N90727
Plague vaccine, im
CH
K
0744

150.00

30.0090733
Meningococcal vaccine, sc

K
9143

84.46

16.8990734
Meningococcal vaccine, im

K
9145

143.12

28.6290735
Encephalitis vaccine, sc

K
9144

99.15

19.8390749
Vaccine toxoid

N90772
Ther/proph/diag inj, sc/im
CH
S
0437
0.4107
25.28

5.0690773
Ther/proph/diag inj, ia
CH
S
0438
0.7892
48.58

9.7290779
Ther/prop/diag inj/inf proc
CH
S
0436
0.1769
10.89

2.1890801
Psy dx interview

S
0323
1.7170
105.68

21.1490802
Intac psy dx interview

S
0323
1.7170
105.68

21.1490804
Psytx, office, 20-30 min

S
0322
1.1749
72.32

14.4690805
Psytx, off, 20-30 min w/em

S
0322
1.1749
72.32

14.4690806
Psytx, off, 45-50 min

S
0323
1.7170
105.68

21.1490807
Psytx, off, 45-50 min w/em

S
0323
1.7170
105.68

21.1490808
Psytx, office, 75-80 min

S
0323
1.7170
105.68

21.1490809
Psytx, off, 75-80, w/em

S
0323
1.7170
105.68

21.1490810
Intac psytx, off, 20-30 min

S
0322
1.1749
72.32

14.4690811
Intac psytx, 20-30, w/em

S
0322
1.1749
72.32

14.4690812
Intac psytx, off, 45-50 min

S
0323
1.7170
105.68

21.1490813
Intac psytx, 45-50 min w/em

S
0323
1.7170
105.68

21.1490814
Intac psytx, off, 75-80 min

S
0323
1.7170
105.68

21.1490815
Intac psytx, 75-80 w/em

S
0323
1.7170
105.68

21.1490816
Psytx, hosp, 20-30 min

S
0322
1.1749
72.32

14.4690817
Psytx, hosp, 20-30 min w/em

S
0322
1.1749
72.32

14.4690818
Psytx, hosp, 45-50 min

S
0323
1.7170
105.68

21.1490819
Psytx, hosp, 45-50 min w/em

S
0323
1.7170
105.68

21.1490821
Psytx, hosp, 75-80 min

S
0323
1.7170
105.68

21.1490822
Psytx, hosp, 75-80 min w/em

S
0323
1.7170
105.68

21.1490823
Intac psytx, hosp, 20-30 min

S
0322
1.1749
72.32

14.4690824
Intac psytx, hsp 20-30 w/em

S
0322
1.1749
72.32

14.4690826
Intac psytx, hosp, 45-50 min

S
0323
1.7170
105.68

21.1490827
Intac psytx, hsp 45-50 w/em

S
0323
1.7170
105.68

21.1490828
Intac psytx, hosp, 75-80 min

S
0323
1.7170
105.68

21.1490829
Intac psytx, hsp 75-80 w/em

S
0323
1.7170
105.68

21.1490845
Psychoanalysis

S
0323
1.7170
105.68

21.1490846
Family psytx w/o patient

S
0324
2.2087
135.95

27.1990847
Family psytx w/patient

S
0324
2.2087
135.95

27.1990849
Multiple family group psytx

S
0325
1.0787
66.40
14.51
13.2890853
Group psychotherapy

S
0325
1.0787
66.40
14.51
13.2890857
Intac group psytx

S
0325
1.0787
66.40
14.51
13.2890862
Medication management

X
0374
1.1509
70.84

14.1790865
Narcosynthesis

S
0323
1.7170
105.68

21.1490870
Electroconvulsive therapy

S
0320
5.5017
338.64
80.06
67.7390880
Hypnotherapy

S
0323
1.7170
105.68

21.1490885
Psy evaluation of records

N90887
Consultation with family

N90889
Preparation of report

N90899
Psychiatric service/therapy

S
0322
1.1749
72.32

14.4690911
Biofeedback peri/uro/rectal

S
0321
1.3693
84.28
21.72
16.8690935
Hemodialysis, one evaluation

S
0170
6.8096
419.14

83.8390940
Hemodialysis access study

N90945
Dialysis, one evaluation

S
0170
6.8096
419.14

83.8391000
Esophageal intubation

X
0361
3.9319
242.01
83.23
48.4091010
Esophagus motility study

X
0361
3.9319
242.01
83.23
48.4091011
Esophagus motility study

X
0361
3.9319
242.01
83.23
48.4091012
Esophagus motility study

X
0361
3.9319
242.01
83.23
48.4091020
Gastric motility studies

X
0361
3.9319
242.01
83.23
48.4091022
Duodenal motility study

X
0361
3.9319
242.01
83.23
48.4091030
Acid perfusion of esophagus

X
0361
3.9319
242.01
83.23
48.4091034
Gastroesophageal reflux test

X
0361
3.9319
242.01
83.23
48.4091035
G-esoph reflx tst w/electrod
CH
X
0361
3.9319
242.01
83.23
48.4091037
Esoph imped function test

X
0361
3.9319
242.01
83.23
48.4091038
Esoph imped funct test  1h

X
0361
3.9319
242.01
83.23
48.4091040
Esoph balloon distension tst

X
0360
1.3789
84.87
33.88
16.9791052
Gastric analysis test

X
0361
3.9319
242.01
83.23
48.4091055
Gastric intubation for smear

X
0360
1.3789
84.87
33.88
16.9791060
Gastric saline load test

X
0360
1.3789
84.87
33.88
16.9791065
Breath hydrogen test

X
0360
1.3789
84.87
33.88
16.97( print page 49824)91100
Pass intestine bleeding tube

X
0360
1.3789
84.87
33.88
16.9791105
Gastric intubation treatment

X
0360
1.3789
84.87
33.88
16.9791110
Gi tract capsule endoscopy

T
0142
9.3878
577.83
152.78
115.5791120
Rectal sensation test
CH
T
0126
1.0844
66.75
16.40
13.3591122
Anal pressure record
CH
T
0164
2.1159
130.24

26.0591123
Irrigate fecal impaction

N91132
Electrogastrography

X
0360
1.3789
84.87
33.88
16.9791133
Electrogastrography w/test

X
0360
1.3789
84.87
33.88
16.9791299
Gastroenterology procedure

X
0360
1.3789
84.87
33.88
16.9792002
Eye exam, new patient
CH
V
0605
1.0057
61.90

12.3892004
Eye exam, new patient
CH
V
0606
1.3546
83.38

16.6892012
Eye exam established pat
CH
V
0604
0.8083
49.75

9.9592014
Eye examtreatment
CH
V
0605
1.0057
61.90

12.3892018
New eye examtreatment

T
0699
13.9509
858.69

171.7492019
Eye examtreatment

T
0699
13.9509
858.69

171.7492020
Special eye evaluation

S
0230
0.8126
50.02
14.97
10.0092060
Special eye evaluation

S
0230
0.8126
50.02
14.97
10.0092065
Orthoptic/pleoptic training
CH
S
0230
0.8126
50.02
14.97
10.0092070
Fitting of contact lens

N92081
Visual field examination(s)

S
0230
0.8126
50.02
14.97
10.0092082
Visual field examination(s)

S
0230
0.8126
50.02
14.97
10.0092083
Visual field examination(s)

S
0230
0.8126
50.02
14.97
10.0092100
Serial tonometry exam(s)

N92120
Tonographyeye evaluation

S
0230
0.8126
50.02
14.97
10.0092130
Water provocation tonography

S
0230
0.8126
50.02
14.97
10.0092135
Opthalmic dx imaging

S
0230
0.8126
50.02
14.97
10.0092136
Ophthalmic biometry

S
0698
1.2244
75.36
16.52
15.0792140
Glaucoma provocative tests
CH
S
0230
0.8126
50.02
14.97
10.0092225
Special eye exam, initial
CH
S
0230
0.8126
50.02
14.97
10.0092226
Special eye exam, subsequent
CH
S
0230
0.8126
50.02
14.97
10.0092230
Eye exam with photos
CH
S
0231
2.1934
135.01

27.0092235
Eye exam with photos

S
0231
2.1934
135.01

27.0092240
Icg angiography

S
0231
2.1934
135.01

27.0092250
Eye exam with photos

S
0230
0.8126
50.02
14.97
10.0092260
Ophthalmoscopy/dynamometry
CH
S
0230
0.8126
50.02
14.97
10.0092265
Eye muscle evaluation

S
0230
0.8126
50.02
14.97
10.0092270
Electro-oculography

S
0230
0.8126
50.02
14.97
10.0092275
Electroretinography

S
0231
2.1934
135.01

27.0092283
Color vision examination

S
0230
0.8126
50.02
14.97
10.0092284
Dark adaptation eye exam

S
0698
1.2244
75.36
16.52
15.0792285
Eye photography

S
0230
0.8126
50.02
14.97
10.0092286
Internal eye photography

S
0698
1.2244
75.36
16.52
15.0792287
Internal eye photography

S
0698
1.2244
75.36
16.52
15.0792311
Contact lens fitting

X
0362
0.5328
32.79

6.5692312
Contact lens fitting

X
0362
0.5328
32.79

6.5692313
Contact lens fitting

X
0362
0.5328
32.79

6.5692315
Prescription of contact lens

X
0362
0.5328
32.79

6.5692316
Prescription of contact lens

X
0362
0.5328
32.79

6.5692317
Prescription of contact lens

X
0362
0.5328
32.79

6.5692325
Modification of contact lens

X
0362
0.5328
32.79

6.5692326
Replacement of contact lens

X
0362
0.5328
32.79

6.5692352
Special spectacles fitting

X
0362
0.5328
32.79

6.5692353
Special spectacles fitting

X
0362
0.5328
32.79

6.5692354
Special spectacles fitting

X
0362
0.5328
32.79

6.5692355
Special spectacles fitting

X
0362
0.5328
32.79

6.5692358
Eye prosthesis service

X
0362
0.5328
32.79

6.5692371
Repairadjust spectacles

X
0362
0.5328
32.79

6.5692499
Eye service or procedure

S
0230
0.8126
50.02
14.97
10.0092502
Ear and throat examination

T
0251
2.3768
146.29

29.2692504
Ear microscopy examination

N92511
Nasopharyngoscopy

T
0071
0.7572
46.61
11.03
9.3292512
Nasal function studies

X
0363
0.8534
52.53
17.44
10.5192516
Facial nerve function test

X
0660
1.4988
92.25
29.07
18.4592520
Laryngeal function studies

X
0660
1.4988
92.25
29.07
18.4592531
Spontaneous nystagmus study

N92532
Positional nystagmus test

N92533
Caloric vestibular test

N92534
Optokinetic nystagmus test

N92541
Spontaneous nystagmus test

X
0363
0.8534
52.53
17.44
10.5192542
Positional nystagmus test

X
0363
0.8534
52.53
17.44
10.51( print page 49825)92543
Caloric vestibular test

X
0660
1.4988
92.25
29.07
18.4592544
Optokinetic nystagmus test

X
0363
0.8534
52.53
17.44
10.5192545
Oscillating tracking test

X
0363
0.8534
52.53
17.44
10.5192546
Sinusoidal rotational test

X
0660
1.4988
92.25
29.07
18.4592547
Supplemental electrical test

X
0363
0.8534
52.53
17.44
10.5192548
Posturography

X
0660
1.4988
92.25
29.07
18.4592552
Pure tone audiometry, air

X
0364
0.4637
28.54
7.06
5.7192553
Audiometry, airbone

X
0365
1.2467
76.74
18.52
15.3592555
Speech threshold audiometry

X
0364
0.4637
28.54
7.06
5.7192556
Speech audiometry, complete

X
0364
0.4637
28.54
7.06
5.7192557
Comprehensive hearing test

X
0365
1.2467
76.74
18.52
15.3592561
Bekesy audiometry, diagnosis

X
0364
0.4637
28.54
7.06
5.7192562
Loudness balance test

X
0364
0.4637
28.54
7.06
5.7192563
Tone decay hearing test

X
0364
0.4637
28.54
7.06
5.7192564
Sisi hearing test

X
0364
0.4637
28.54
7.06
5.7192565
Stenger test, pure tone

X
0364
0.4637
28.54
7.06
5.7192567
Tympanometry

X
0364
0.4637
28.54
7.06
5.7192568
Acoustic refl threshold tst

X
0364
0.4637
28.54
7.06
5.7192569
Acoustic reflex decay test

X
0364
0.4637
28.54
7.06
5.7192571
Filtered speech hearing test

X
0364
0.4637
28.54
7.06
5.7192572
Staggered spondaic word test

X
0366
1.8175
111.87
26.14
22.3792573
Lombard test

X
0364
0.4637
28.54
7.06
5.7192575
Sensorineural acuity test

X
0364
0.4637
28.54
7.06
5.7192576
Synthetic sentence test

X
0364
0.4637
28.54
7.06
5.7192577
Stenger test, speech

X
0366
1.8175
111.87
26.14
22.3792579
Visual audiometry (vra)

X
0365
1.2467
76.74
18.52
15.3592582
Conditioning play audiometry

X
0365
1.2467
76.74
18.52
15.3592583
Select picture audiometry

X
0364
0.4637
28.54
7.06
5.7192584
Electrocochleography

X
0660
1.4988
92.25
29.07
18.4592585
Auditor evoke potent, compre

S
0216
2.6729
164.52

32.9092586
Auditor evoke potent, limit

S
0218
1.1993
73.82

14.7692587
Evoked auditory test

X
0363
0.8534
52.53
17.44
10.5192588
Evoked auditory test

X
0660
1.4988
92.25
29.07
18.4592596
Ear protector evaluation

X
0364
0.4637
28.54
7.06
5.7192601
Cochlear implt f/up exam  7

X
0366
1.8175
111.87
26.14
22.3792602
Reprogram cochlear implt  7

X
0366
1.8175
111.87
26.14
22.3792603
Cochlear implt f/up exam 7

X
0366
1.8175
111.87
26.14
22.3792604
Reprogram cochlear implt 7

X
0366
1.8175
111.87
26.14
22.3792620
Auditory function, 60 min

X
0365
1.2467
76.74
18.52
15.3592621
Auditory function, + 15 min

N92625
Tinnitus assessment

X
0365
1.2467
76.74
18.52
15.3592626
Eval aud rehab status

X
0365
1.2467
76.74
18.52
15.3592627
Eval aud status rehab add-on

N92700
Ent procedure/service

X
0364
0.4637
28.54
7.06
5.7192950
Heart/lung resuscitation cpr

S
0094
2.4630
151.60
46.29
30.3292953
Temporary external pacing

S
0094
2.4630
151.60
46.29
30.3292960
Cardioversion electric, ext

S
0679
5.5435
341.21
95.30
68.2492961
Cardioversion, electric, int

S
0679
5.5435
341.21
95.30
68.2492973
Percut coronary thrombectomy

T
0088
37.9652
2,336.80
655.22
467.3692974
Cath place, cardio brachytx

T
0103
17.0436
1,049.05
223.63
209.8192977
Dissolve clot, heart vessel

T
0676
2.0612
126.87

25.3792978
Intravasc us, heart add-on

S
0670
29.7322
1,830.05
536.10
366.0192979
Intravasc us, heart add-on

S
0416
32.2182
1,983.06

396.6192980
Insert intracoronary stent

T
0104
87.9808
5,415.31

1,083.0692981
Insert intracoronary stent

T
0104
87.9808
5,415.31

1,083.0692982
Coronary artery dilation

T
0083
57.4937
3,538.79

707.7692984
Coronary artery dilation

T
0083
57.4937
3,538.79

707.7692986
Revision of aortic valve

T
0083
57.4937
3,538.79

707.7692987
Revision of mitral valve

T
0083
57.4937
3,538.79

707.7692990
Revision of pulmonary valve

T
0083
57.4937
3,538.79

707.7692995
Coronary atherectomy

T
0082
76.2006
4,690.22
1,008.90
938.0492996
Coronary atherectomy add-on

T
0082
76.2006
4,690.22
1,008.90
938.0492997
Pul art balloon repr, percut

T
0081
42.8894
2,639.89

527.9892998
Pul art balloon repr, percut

T
0081
42.8894
2,639.89

527.9893005
Electrocardiogram, tracing

S
0099
0.3835
23.60

4.7293012
Transmission of ecg

N93017
Cardiovascular stress test

X
0100
2.5352
156.04
41.44
31.2193024
Cardiac drug stress test

X
0100
2.5352
156.04
41.44
31.2193025
Microvolt t-wave assess

X
0100
2.5352
156.04
41.44
31.2193041
Rhythm ECG, tracing

S
0099
0.3835
23.60

4.72( print page 49826)93225
ECG monitor/record, 24 hrs

X
0097
1.0245
63.06
23.79
12.6193226
ECG monitor/report, 24 hrs

X
0097
1.0245
63.06
23.79
12.6193231
Ecg monitor/record, 24 hrs

X
0097
1.0245
63.06
23.79
12.6193232
ECG monitor/report, 24 hrs

X
0097
1.0245
63.06
23.79
12.6193236
ECG monitor/report, 24 hrs

X
0097
1.0245
63.06
23.79
12.6193270
ECG recording

X
0097
1.0245
63.06
23.79
12.6193271
Ecg/monitoring and analysis

X
0097
1.0245
63.06
23.79
12.6193278
ECG/signal-averaged

S
0099
0.3835
23.60

4.7293303
Echo transthoracic

S
0269
3.2432
199.62
75.60
39.9293304
Echo transthoracic

S
0697
1.6002
98.49
35.99
19.7093307
Echo exam of heart

S
0269
3.2432
199.62
75.60
39.9293308
Echo exam of heart

S
0697
1.6002
98.49
35.99
19.7093312
Echo transesophageal

S
0270
6.2689
385.86
141.32
77.1793313
Echo transesophageal

S
0270
6.2689
385.86
141.32
77.1793314
Echo transesophageal

N93315
Echo transesophageal

S
0270
6.2689
385.86
141.32
77.1793316
Echo transesophageal

S
0270
6.2689
385.86
141.32
77.1793317
Echo transesophageal

N93318
Echo transesophageal intraop

S
0270
6.2689
385.86
141.32
77.1793320
Doppler echo exam, heart
CH
S
0697
1.6002
98.49
35.99
19.7093321
Doppler echo exam, heart

S
0697
1.6002
98.49
35.99
19.7093325
Doppler color flow add-on

S
0697
1.6002
98.49
35.99
19.7093350
Echo transthoracic

S
0269
3.2432
199.62
75.60
39.9293501
Right heart catheterization

T
0080
37.1008
2,283.59
838.92
456.7293503
Insert/place heart catheter

T
0103
17.0436
1,049.05
223.63
209.8193505
Biopsy of heart lining

T
0103
17.0436
1,049.05
223.63
209.8193508
Cath placement, angiography

T
0080
37.1008
2,283.59
838.92
456.7293510
Left heart catheterization

T
0080
37.1008
2,283.59
838.92
456.7293511
Left heart catheterization

T
0080
37.1008
2,283.59
838.92
456.7293514
Left heart catheterization

T
0080
37.1008
2,283.59
838.92
456.7293524
Left heart catheterization

T
0080
37.1008
2,283.59
838.92
456.7293526
RtLt heart catheters

T
0080
37.1008
2,283.59
838.92
456.7293527
RtLt heart catheters

T
0080
37.1008
2,283.59
838.92
456.7293528
RtLt heart catheters

T
0080
37.1008
2,283.59
838.92
456.7293529
Rt, lt heart catheterization

T
0080
37.1008
2,283.59
838.92
456.7293530
Rt heart cath, congenital

T
0080
37.1008
2,283.59
838.92
456.7293531
Rl heart cath, congenital

T
0080
37.1008
2,283.59
838.92
456.7293532
Rl heart cath, congenital

T
0080
37.1008
2,283.59
838.92
456.7293533
Rl heart cath, congenital

T
0080
37.1008
2,283.59
838.92
456.7293539
Injection, cardiac cath

N93540
Injection, cardiac cath

N93541
Injection for lung angiogram

N93542
Injection for heart x-rays

N93543
Injection for heart x-rays

N93544
Injection for aortography

N93545
Inject for coronary x-rays

N93555
Imaging, cardiac cath

N93556
Imaging, cardiac cath

N93561
Cardiac output measurement

N93562
Cardiac output measurement

N93571
Heart flow reserve measure

S
0670
29.7322
1,830.05
536.10
366.0193572
Heart flow reserve measure

S
0416
32.2182
1,983.06

396.6193580
Transcath closure of asd

T
0434
87.3424
5,376.01

1,075.2093581
Transcath closure of vsd

T
0434
87.3424
5,376.01

1,075.2093600
Bundle of His recording

T
0087
32.8298
2,020.71

404.1493602
Intra-atrial recording

T
0087
32.8298
2,020.71

404.1493603
Right ventricular recording

T
0087
32.8298
2,020.71

404.1493609
Map tachycardia, add-on

T
0087
32.8298
2,020.71

404.1493610
Intra-atrial pacing

T
0087
32.8298
2,020.71

404.1493612
Intraventricular pacing

T
0087
32.8298
2,020.71

404.1493613
Electrophys map 3d, add-on

T
0087
32.8298
2,020.71

404.1493615
Esophageal recording

T
0087
32.8298
2,020.71

404.1493616
Esophageal recording

T
0087
32.8298
2,020.71

404.1493618
Heart rhythm pacing

T
0087
32.8298
2,020.71

404.1493619
Electrophysiology evaluation

T
0085
34.7086
2,136.35

427.2793620
Electrophysiology evaluation

T
0085
34.7086
2,136.35

427.2793621
Electrophysiology evaluation

T
0085
34.7086
2,136.35

427.2793622
Electrophysiology evaluation

T
0085
34.7086
2,136.35

427.2793623
Stimulation, pacing heart

T
0087
32.8298
2,020.71

404.1493624
Electrophysiologic study

T
0085
34.7086
2,136.35

427.27( print page 49827)93631
Heart pacing, mapping

T
0087
32.8298
2,020.71

404.1493640
Evaluation heart device
CH
N93641
Electrophysiology evaluation
CH
N93642
Electrophysiology evaluation

S
0084
9.9197
610.57

122.1193650
Ablate heart dysrhythm focus

T
0086
47.1472
2,901.96
812.36
580.3993651
Ablate heart dysrhythm focus

T
0086
47.1472
2,901.96
812.36
580.3993652
Ablate heart dysrhythm focus

T
0086
47.1472
2,901.96
812.36
580.3993660
Tilt table evaluation

S
0101
4.3122
265.42
100.24
53.0893662
Intracardiac ecg (ice)

S
0670
29.7322
1,830.05
536.10
366.0193701
Bioimpedance, thoracic

S
0099
0.3835
23.60

4.7293721
Plethysmography tracing

X
0368
0.9568
58.89
22.77
11.7893724
Analyze pacemaker system

S
0690
0.3628
22.33
8.67
4.4793727
Analyze ilr system

S
0690
0.3628
22.33
8.67
4.4793731
Analyze pacemaker system

S
0690
0.3628
22.33
8.67
4.4793732
Analyze pacemaker system

S
0690
0.3628
22.33
8.67
4.4793733
Telephone analy, pacemaker

S
0690
0.3628
22.33
8.67
4.4793734
Analyze pacemaker system

S
0690
0.3628
22.33
8.67
4.4793735
Analyze pacemaker system

S
0690
0.3628
22.33
8.67
4.4793736
Telephonic analy, pacemaker

S
0690
0.3628
22.33
8.67
4.4793740
Temperature gradient studies

X
0368
0.9568
58.89
22.77
11.7893741
Analyze ht pace device sngl

S
0689
0.5400
33.24

6.6593742
Analyze ht pace device sngl

S
0689
0.5400
33.24

6.6593743
Analyze ht pace device dual

S
0689
0.5400
33.24

6.6593744
Analyze ht pace device dual

S
0689
0.5400
33.24

6.6593745
Set-up cardiovert-defibrill

S
0689
0.5400
33.24

6.6593770
Measure venous pressure

N93786
Ambulatory BP recording

X
0097
1.0245
63.06
23.79
12.6193788
Ambulatory BP analysis

X
0097
1.0245
63.06
23.79
12.6193797
Cardiac rehab

S
0095
0.5792
35.65
13.86
7.1393798
Cardiac rehab/monitor

S
0095
0.5792
35.65
13.86
7.1393799
Cardiovascular procedure
CH
X
0097
1.0245
63.06
23.79
12.6193875
Extracranial study

S
0096
1.5727
96.80
38.13
19.3693880
Extracranial study

S
0267
2.5166
154.90
60.80
30.9893882
Extracranial study

S
0267
2.5166
154.90
60.80
30.9893886
Intracranial study

S
0267
2.5166
154.90
60.80
30.9893888
Intracranial study
CH
S
0265
1.0145
62.44
23.63
12.4993890
Tcd, vasoreactivity study

S
0266
1.5947
98.16
37.80
19.6393892
Tcd, emboli detect w/o inj

S
0266
1.5947
98.16
37.80
19.6393893
Tcd, emboli detect w/inj

S
0266
1.5947
98.16
37.80
19.6393922
Extremity study

S
0096
1.5727
96.80
38.13
19.3693923
Extremity study

S
0096
1.5727
96.80
38.13
19.3693924
Extremity study

S
0096
1.5727
96.80
38.13
19.3693925
Lower extremity study

S
0267
2.5166
154.90
60.80
30.9893926
Lower extremity study

S
0266
1.5947
98.16
37.80
19.6393930
Upper extremity study

S
0267
2.5166
154.90
60.80
30.9893931
Upper extremity study

S
0266
1.5947
98.16
37.80
19.6393965
Extremity study

S
0096
1.5727
96.80
38.13
19.3693970
Extremity study

S
0267
2.5166
154.90
60.80
30.9893971
Extremity study

S
0266
1.5947
98.16
37.80
19.6393975
Vascular study

S
0267
2.5166
154.90
60.80
30.9893976
Vascular study

S
0267
2.5166
154.90
60.80
30.9893978
Vascular study

S
0266
1.5947
98.16
37.80
19.6393979
Vascular study

S
0266
1.5947
98.16
37.80
19.6393980
Penile vascular study

S
0267
2.5166
154.90
60.80
30.9893981
Penile vascular study

S
0266
1.5947
98.16
37.80
19.6393990
Doppler flow testing

S
0266
1.5947
98.16
37.80
19.6394010
Breathing capacity test

X
0368
0.9568
58.89
22.77
11.7894014
Patient recorded spirometry

X
0367
0.6253
38.49
14.64
7.7094015
Patient recorded spirometry

X
0367
0.6253
38.49
14.64
7.7094060
Evaluation of wheezing

X
0368
0.9568
58.89
22.77
11.7894070
Evaluation of wheezing

X
0369
2.8329
174.37
44.18
34.8794150
Vital capacity test

X
0367
0.6253
38.49
14.64
7.7094200
Lung function test (MBC/MVV)

X
0367
0.6253
38.49
14.64
7.7094240
Residual lung capacity

X
0368
0.9568
58.89
22.77
11.7894250
Expired gas collection

X
0367
0.6253
38.49
14.64
7.7094260
Thoracic gas volume
CH
X
0368
0.9568
58.89
22.77
11.7894350
Lung nitrogen washout curve
CH
X
0368
0.9568
58.89
22.77
11.7894360
Measure airflow resistance

X
0367
0.6253
38.49
14.64
7.7094370
Breath airway closing volume

X
0367
0.6253
38.49
14.64
7.7094375
Respiratory flow volume loop

X
0367
0.6253
38.49
14.64
7.70( print page 49828)94400
CO2 breathing response curve

X
0367
0.6253
38.49
14.64
7.7094450
Hypoxia response curve

X
0368
0.9568
58.89
22.77
11.7894452
Hast w/report

X
0368
0.9568
58.89
22.77
11.7894453
Hast w/oxygen titrate
CH
X
0367
0.6253
38.49
14.64
7.7094620
Pulmonary stress test/simple

X
0368
0.9568
58.89
22.77
11.7894621
Pulm stress test/complex

X
0369
2.8329
174.37
44.18
34.8794640
Airway inhalation treatment

S
0077
0.3383
20.82
7.74
4.1694642
Aerosol inhalation treatment

S
0078
1.0381
63.90
14.55
12.7894656
Initial ventilator mgmt

S
0079
2.7732
170.69

34.1494657
Continued ventilator mgmt

S
0079
2.7732
170.69

34.1494660
Pos airway pressure, CPAP

S
0068
1.3718
84.44
29.48
16.8994662
Neg press ventilation, cnp

S
0079
2.7732
170.69

34.1494664
Evaluate pt use of inhaler

S
0077
0.3383
20.82
7.74
4.1694667
Chest wall manipulation

S
0077
0.3383
20.82
7.74
4.1694668
Chest wall manipulation

S
0077
0.3383
20.82
7.74
4.1694680
Exhaled air analysis, o2

X
0367
0.6253
38.49
14.64
7.7094681
Exhaled air analysis, o2/co2

X
0368
0.9568
58.89
22.77
11.7894690
Exhaled air analysis
CH
X
0367
0.6253
38.49
14.64
7.7094720
Monoxide diffusing capacity

X
0368
0.9568
58.89
22.77
11.7894725
Membrane diffusion capacity

X
0368
0.9568
58.89
22.77
11.7894750
Pulmonary compliance study
CH
X
0367
0.6253
38.49
14.64
7.7094760
Measure blood oxygen level

N94761
Measure blood oxygen level

N94762
Measure blood oxygen level
CH
Q
0443
0.9939
61.18
24.47
12.2494770
Exhaled carbon dioxide test

X
0367
0.6253
38.49
14.64
7.7094772
Breath recording, infant

X
0369
2.8329
174.37
44.18
34.8794799
Pulmonary service/procedure

X
0367
0.6253
38.49
14.64
7.7095004
Percut allergy skin tests

X
0381
0.2151
13.24

2.6595010
Percut allergy titrate test

X
0381
0.2151
13.24

2.6595015
Id allergy titrate-drug/bug

X
0381
0.2151
13.24

2.6595024
Id allergy test, drug/bug

X
0381
0.2151
13.24

2.6595027
Id allergy titrate-airborne

X
0381
0.2151
13.24

2.6595028
Id allergy test-delayed type

X
0381
0.2151
13.24

2.6595044
Allergy patch tests

X
0381
0.2151
13.24

2.6595052
Photo patch test

X
0381
0.2151
13.24

2.6595056
Photosensitivity tests

X
0370
1.0769
66.28

13.2695060
Eye allergy tests

X
0370
1.0769
66.28

13.2695065
Nose allergy test

X
0381
0.2151
13.24

2.6595070
Bronchial allergy tests

X
0369
2.8329
174.37
44.18
34.8795071
Bronchial allergy tests

X
0369
2.8329
174.37
44.18
34.8795075
Ingestion challenge test

X
0361
3.9319
242.01
83.23
48.4095078
Provocative testing

X
0370
1.0769
66.28

13.2695115
Immunotherapy, one injection
CH
S
0436
0.1769
10.89

2.1895117
Immunotherapy injections
CH
S
0437
0.4107
25.28

5.0695144
Antigen therapy services
CH
S
0437
0.4107
25.28

5.0695145
Antigen therapy services
CH
S
0437
0.4107
25.28

5.0695146
Antigen therapy services
CH
S
0437
0.4107
25.28

5.0695147
Antigen therapy services
CH
S
0437
0.4107
25.28

5.0695148
Antigen therapy services
CH
S
0437
0.4107
25.28

5.0695149
Antigen therapy services
CH
S
0437
0.4107
25.28

5.0695165
Antigen therapy services
CH
S
0437
0.4107
25.28

5.0695170
Antigen therapy services
CH
S
0437
0.4107
25.28

5.0695180
Rapid desensitization

X
0370
1.0769
66.28

13.2695199
Allergy immunology services
CH
X
0381
0.2151
13.24

2.6595250
Glucose monitoring, cont

X
0421
1.6486
101.47

20.2995805
Multiple sleep latency test

S
0209
11.4847
706.89
268.73
141.3895806
Sleep study, unattended

S
0213
2.3133
142.39
53.58
28.4895807
Sleep study, attended

S
0209
11.4847
706.89
268.73
141.3895808
Polysomnography, 1-3

S
0209
11.4847
706.89
268.73
141.3895810
Polysomnography, 4 or more

S
0209
11.4847
706.89
268.73
141.3895811
Polysomnography w/cpap

S
0209
11.4847
706.89
268.73
141.3895812
Eeg, 41-60 minutes

S
0213
2.3133
142.39
53.58
28.4895813
Eeg, over 1 hour

S
0213
2.3133
142.39
53.58
28.4895816
Eeg, awake and drowsy

S
0213
2.3133
142.39
53.58
28.4895819
Eeg, awake and asleep

S
0213
2.3133
142.39
53.58
28.4895822
Eeg, coma or sleep only

S
0213
2.3133
142.39
53.58
28.4895824
Eeg, cerebral death only

S
0214
1.2353
76.03
28.24
15.2195827
Eeg, all night recording

S
0213
2.3133
142.39
53.58
28.4895829
Surgery electrocorticogram

S
0214
1.2353
76.03
28.24
15.2195857
Tensilon test

S
0218
1.1993
73.82

14.76( print page 49829)95860
Muscle test, one limb

S
0218
1.1993
73.82

14.7695861
Muscle test, 2 limbs

S
0218
1.1993
73.82

14.7695863
Muscle test, 3 limbs

S
0218
1.1993
73.82

14.7695864
Muscle test, 4 limbs

S
0218
1.1993
73.82

14.7695865
Muscle test, larynx

S
0218
1.1993
73.82

14.7695866
Muscle test, hemidiaphragm

S
0218
1.1993
73.82

14.7695867
Muscle test cran nerv unilat

S
0218
1.1993
73.82

14.7695868
Muscle test cran nerve bilat

S
0218
1.1993
73.82

14.7695869
Muscle test, thor paraspinal

S
0215
0.5760
35.45

7.0995870
Muscle test, nonparaspinal

S
0215
0.5760
35.45

7.0995872
Muscle test, one fiber

S
0218
1.1993
73.82

14.7695873
Guide nerv destr, elec stim

S
0215
0.5760
35.45

7.0995874
Guide nerv destr, needle emg

S
0215
0.5760
35.45

7.0995875
Limb exercise test

S
0215
0.5760
35.45

7.0995900
Motor nerve conduction test

S
0215
0.5760
35.45

7.0995903
Motor nerve conduction test

S
0215
0.5760
35.45

7.0995904
Sense nerve conduction test

S
0215
0.5760
35.45

7.0995920
Intraop nerve test add-on

S
0216
2.6729
164.52

32.9095921
Autonomic nerv function test
CH
S
0215
0.5760
35.45

7.0995922
Autonomic nerv function test
CH
S
0215
0.5760
35.45

7.0995923
Autonomic nerv function test
CH
S
0215
0.5760
35.45

7.0995925
Somatosensory testing

S
0216
2.6729
164.52

32.9095926
Somatosensory testing

S
0216
2.6729
164.52

32.9095927
Somatosensory testing

S
0216
2.6729
164.52

32.9095928
C motor evoked, uppr limbs

S
0218
1.1993
73.82

14.7695929
C motor evoked, lwr limbs

S
0218
1.1993
73.82

14.7695930
Visual evoked potential test

S
0216
2.6729
164.52

32.9095933
Blink reflex test

S
0215
0.5760
35.45

7.0995934
H-reflex test

S
0215
0.5760
35.45

7.0995936
H-reflex test

S
0215
0.5760
35.45

7.0995937
Neuromuscular junction test
CH
S
0215
0.5760
35.45

7.0995950
Ambulatory eeg monitoring

S
0209
11.4847
706.89
268.73
141.3895951
EEG monitoring/videorecord

S
0209
11.4847
706.89
268.73
141.3895953
EEG monitoring/computer

S
0209
11.4847
706.89
268.73
141.3895954
EEG monitoring/giving drugs

S
0214
1.2353
76.03
28.24
15.2195955
EEG during surgery

S
0213
2.3133
142.39
53.58
28.4895956
Eeg monitoring, cable/radio

S
0209
11.4847
706.89
268.73
141.3895957
EEG digital analysis

S
0214
1.2353
76.03
28.24
15.2195958
EEG monitoring/function test

S
0213
2.3133
142.39
53.58
28.4895961
Electrode stimulation, brain

S
0216
2.6729
164.52

32.9095962
Electrode stim, brain add-on

S
0216
2.6729
164.52

32.9095965
Meg, spontaneous
CH
S
0038
51.2627
3,155.27

631.0595966
Meg, evoked, single
CH
S
0209
11.4847
706.89
268.73
141.3895967
Meg, evoked, each add'l
CH
S
0209
11.4847
706.89
268.73
141.3895970
Analyze neurostim, no prog

S
0218
1.1993
73.82

14.7695971
Analyze neurostim, simple

S
0692
1.9519
120.14
30.16
24.0395972
Analyze neurostim, complex

S
0692
1.9519
120.14
30.16
24.0395973
Analyze neurostim, complex
CH
S
0663
1.0752
66.18
16.96
13.2495974
Cranial neurostim, complex

S
0692
1.9519
120.14
30.16
24.0395975
Cranial neurostim, complex

S
0692
1.9519
120.14
30.16
24.0395978
Analyze neurostim brain/1h

S
0692
1.9519
120.14
30.16
24.0395979
Analyz neurostim brain addon
CH
S
0663
1.0752
66.18
16.96
13.2495990
Spin/brain pump refilmain

T
0125
2.2200
136.64

27.3395991
Spin/brain pump refilmain

T
0125
2.2200
136.64

27.3395999
Neurological procedure

S
0215
0.5760
35.45

7.0996000
Motion analysis, video/3d

S
0216
2.6729
164.52

32.9096001
Motion test w/ft press meas

S
0216
2.6729
164.52

32.9096002
Dynamic surface emg

S
0218
1.1993
73.82

14.7696003
Dynamic fine wire emg

S
0215
0.5760
35.45

7.0996101
Psycho testing by psych/phys

X
0373
1.6262
100.09

20.0296102
Psycho testing by technician

X
0382
2.7541
169.52
67.80
33.9096103
Psycho testing admin by comp

X
0373
1.6262
100.09

20.0296110
Developmental test, lim

X
0373
1.6262
100.09

20.0296111
Developmental test, extend

X
0373
1.6262
100.09

20.0296116
Neurobehavioral status exam

X
0373
1.6262
100.09

20.0296118
Neuropsych tst by psych/phys

X
0373
1.6262
100.09

20.0296119
Neuropsych testing by tech

X
0382
2.7541
169.52
67.80
33.9096120
Neuropsych tst admin w/comp

X
0373
1.6262
100.09

20.0296150
Assess hlth/behave, init

S
0432
0.6006
36.97

7.3996151
Assess hlth/behave, subseq

S
0432
0.6006
36.97

7.39( print page 49830)96152
Intervene hlth/behave, indiv

S
0432
0.6006
36.97

7.3996153
Intervene hlth/behave, group

S
0432
0.6006
36.97

7.3996154
Interv hlth/behav, fam w/pt

S
0432
0.6006
36.97

7.3996401
Chemo, anti-neopl, sq/im
CH
S
0438
0.7892
48.58

9.7296402
Chemo hormon antineopl sq/im
CH
S
0438
0.7892
48.58

9.7296405
Chemo intralesional, up to 7
CH
S
0438
0.7892
48.58

9.7296406
Chemo intralesional over 7
CH
S
0438
0.7892
48.58

9.7296416
Chemo prolong infuse w/pump
CH
S
0441
2.5071
154.31

30.8696420
Chemo, ia, push tecnique
CH
S
0439
1.5841
97.50

19.5096422
Chemo ia infusion up to 1 hr
CH
S
0441
2.5071
154.31

30.8696423
Chemo ia infuse each addl hr
CH
S
0438
0.7892
48.58

9.7296425
Chemotherapy,infusion method
CH
S
0441
2.5071
154.31

30.8696440
Chemotherapy, intracavitary
CH
S
0439
1.5841
97.50

19.5096445
Chemotherapy, intracavitary
CH
S
0439
1.5841
97.50

19.5096450
Chemotherapy, into CNS
CH
S
0441
2.5071
154.31

30.8696521
Refill/maint, portable pump
CH
S
0440
1.8285
112.55

22.5196522
Refill/maint pump/resvr syst
CH
S
0440
1.8285
112.55

22.5196523
Irrig drug delivery device
CH
Q
0624
0.5336
32.84
13.13
6.5796542
Chemotherapy injection
CH
S
0438
0.7892
48.58

9.7296549
Chemotherapy, unspecified
CH
S
0436
0.1769
10.89

2.1896567
Photodynamic tx, skin

T
0016
2.6253
161.59
32.68
32.3296570
Photodynamic tx, 30 min

T
0015
1.6062
98.86
20.13
19.7796571
Photodynamic tx, addl 15 min

T
0015
1.6062
98.86
20.13
19.7796900
Ultraviolet light therapy

S
0001
0.4896
30.14
7.00
6.0396902
Trichogram

N96910
Photochemotherapy with UV-B

S
0001
0.4896
30.14
7.00
6.0396912
Photochemotherapy with UV-A

S
0001
0.4896
30.14
7.00
6.0396913
Photochemotherapy, UV-A or B

S
0683
2.6902
165.58

33.1296920
Laser tx, skin  250 sq cm

T
0013
1.0876
66.94

13.3996921
Laser tx, skin 250-500 sq cm

T
0013
1.0876
66.94

13.3996922
Laser tx, skin  500 sq cm

T
0013
1.0876
66.94

13.3996999
Dermatological procedure

T
0010
0.4829
29.72
8.14
5.9497597
Active wound care/20 cm or

T
0012
0.8076
49.71
10.30
9.9497598
Active wound care  20 cm

T
0013
1.0876
66.94

13.3997602
Wound(s) care non-selective

X
0340
0.6211
38.23

7.6597605
Neg press wound tx,  50 cm

T
0012
0.8076
49.71
10.30
9.9497606
Neg press wound tx,  50 cm

T
0013
1.0876
66.94

13.3998925
Osteopathic manipulation

S
0060
0.4904
30.18

6.0498926
Osteopathic manipulation

S
0060
0.4904
30.18

6.0498927
Osteopathic manipulation

S
0060
0.4904
30.18

6.0498928
Osteopathic manipulation

S
0060
0.4904
30.18

6.0498929
Osteopathic manipulation

S
0060
0.4904
30.18

6.0498940
Chiropractic manipulation

S
0060
0.4904
30.18

6.0498941
Chiropractic manipulation

S
0060
0.4904
30.18

6.0498942
Chiropractic manipulation

S
0060
0.4904
30.18

6.0499078
Group health education

N99091
Collect/review data from pt

N99143
Mod cs by same phys,  5 yrs

N99144
Mod cs by same phys, 5 yrs +

N99145
Mod cs by same phys add-on

N99148
Mod cs diff phys  5 yrs

N99149
Mod cs diff phys 5 yrs +

N99150
Mod cs diff phys add-on

N99170
Anogenital exam, child

T
0191
0.1501
9.24

1.8599175
Induction of vomiting

N99185
Regional hypothermia

N99186
Total body hypothermia

N99195
Phlebotomy

X
0372
0.5814
35.79
10.09
7.1699201
Office/outpatient visit, new
CH
B99202
Office/outpatient visit, new
CH
B99203
Office/outpatient visit, new
CH
B99204
Office/outpatient visit, new
CH
B99205
Office/outpatient visit, new
CH
B99211
Office/outpatient visit, est
CH
B99212
Office/outpatient visit, est
CH
B99213
Office/outpatient visit, est
CH
B99214
Office/outpatient visit, est
CH
B99215
Office/outpatient visit, est
CH
B99241
Office consultation
CH
B99242
Office consultation
CH
B( print page 49831)99243
Office consultation
CH
B99244
Office consultation
CH
B99245
Office consultation
CH
B99281
Emergency dept visit
CH
B99282
Emergency dept visit
CH
B99283
Emergency dept visit
CH
B99284
Emergency dept visit
CH
B99285
Emergency dept visit
CH
B99289
Ped crit care transport

N99290
Ped crit care transport addl

N99291
Critical care, first hour
CH
B99292
Critical care, add'l 30 min
CH
B99300
Ic, infant pbw 2501-5000 gm

N99354
Prolonged service, office

N99355
Prolonged service, office

N99358
Prolonged serv, w/o contact

N99359
Prolonged serv, w/o contact

N99361
Physician/team conference

N99362
Physician/team conference

N99431
Initial care, normal newborn
CH
V
0605
1.0057
61.90

12.3899432
Newborn care, not in hosp

N99436
Attendance, birth

N99440
Newborn resuscitation

S
0094
2.4630
151.60
46.29
30.320003T
Cervicography
CH
T
0191
0.1501
9.24

1.850008T
Upper gi endoscopy w/suture

T
0422
27.5493
1,695.69
448.81
339.140016T
Thermotx choroid vasc lesion

T
0235
4.0750
250.82
61.14
50.160017T
Photocoagulat macular drusen

T
0235
4.0750
250.82
61.14
50.160018T
Transcranial magnetic stimul

S
0215
0.5760
35.45

7.090027T
Endoscopic epidural lysis

T
0220
17.7609
1,093.20

218.640028T
Dexa body composition study

N0031T
Speculoscopy

N0032T
Speculoscopy w/direct sample

N0042T
Ct perfusion w/contrast, cbf

N0044T
Whole body photography

N0045T
Whole body photography

N0046T
Cath lavage, mammary duct(s

T
0021
14.9563
920.58
219.48
184.120047T
Cath lavage, mammary duct(s)

T
0021
14.9563
920.58
219.48
184.120054T
Bone surgery using computer

S
0302
5.5005
338.56
105.94
67.710055T
Bone surgery using computer

S
0302
5.5005
338.56
105.94
67.710056T
Bone surgery using computer

S
0302
5.5005
338.56
105.94
67.710058T
Cryopreservation, ovary tiss

X
0348
0.8928
54.95

10.990059T
Cryopreservation, oocyte

X
0348
0.8928
54.95

10.990062T
Rep intradisc annulus;1 lev

T
0050
25.0600
1,542.47

308.490063T
Rep intradisc annulus;1lev

T
0050
25.0600
1,542.47

308.490064T
Spectroscop eval expired gas

X
0367
0.6253
38.49
14.64
7.700067T
Ct colonography;dx

S
0333
5.0020
307.88
121.52
61.580069T
Analysis only heart sound

N0070T
Interp only heart sound

N0071T
U/s leiomyomata ablate 200

T
0195
28.7410
1,769.04
483.80
353.810072T
U/s leiomyomata ablate 200

T
0202
42.8756
2,639.04
981.50
527.810073T
Delivery, comp imrt

S
0412
5.5021
338.66

67.730083T
Stereotactic rad tx mngmt

N0084T
Temp prostate urethral stent

T
0164
2.1159
130.24

26.050085T
Breath test heart reject

X
0340
0.6211
38.23

7.650086T
L ventricle fill pressure

N0087T
Sperm eval hyaluronan

X
0348
0.8928
54.95

10.990088T
Rf tongue base vol reduxn

T
0253
16.4494
1,012.48
282.29
202.500089T
Actigraphy testing, 3-day

S
0218
1.1993
73.82

14.760099T
Implant corneal ring

T
0233
14.9969
923.07
266.33
184.610100T
Prosth retina receivegen

T
0672
36.8820
2,270.12

454.020101T
Extracorp shockwv tx,hi enrg
CH
T
0050
25.0600
1,542.47

308.490102T
Extracorp shockwv tx,anesth
CH
T
0050
25.0600
1,542.47

308.490106T
Touch quant sensory test

X
0341
0.0914
5.63
2.25
1.130107T
Vibrate quant sensory test

X
0341
0.0914
5.63
2.25
1.130108T
Cool quant sensory test

X
0341
0.0914
5.63
2.25
1.130109T
Heat quant sensory test

X
0341
0.0914
5.63
2.25
1.130110T
Nos quant sensory test

X
0341
0.0914
5.63
2.25
1.130120T
Fibroadenoma cryoablate, ea

T
0029
28.1505
1,732.69

346.540123T
Scleral fistulization

T
0234
22.9479
1,412.47
511.31
282.490124T
Conjunctival drug placement

T
0232
5.9800
368.07
92.21
73.61( print page 49832)0126T
Chd risk imt study

N0133T
Esophageal implant injexn
CH
T
0422
27.5493
1,695.69
448.81
339.140135T
Perq cryoablate renal tumor
CH
T
0423
39.0235
2,401.94

480.390137T
Prostate saturation sampling

T
0184
5.9892
368.64
96.27
73.730144T
CT heart wo dye; qual calc

S
0398
4.2511
261.66
100.06
52.330145T
CT heart w/wo dye funct

S
0376
4.9770
306.34
119.77
61.270146T
CCTA w/wo dye

S
0376
4.9770
306.34
119.77
61.270147T
CCTA w/wo, quan calcium

S
0376
4.9770
306.34
119.77
61.270148T
CCTA w/wo, strxr

S
0377
6.7443
415.12
158.84
83.020149T
CCTA w/wo, strxr quan calc

S
0377
6.7443
415.12
158.84
83.020150T
CCTA w/wo, disease strxr

S
0398
4.2511
261.66
100.06
52.330151T
CT heart funct add-on

S
0282
1.5552
95.72
37.92
19.140152T
Computer chest add-on

N0154T
Implant aneur sensor study

X
0097
1.0245
63.06
23.79
12.61A0800
Amb trans 7pm-7am
CH
EA4218
Sterile saline or water

NA4220
Infusion pump refill kit

NA4248
Chlorhexidine antisept

NA4262
Temporary tear duct plug

NA4263
Permanent tear duct plug

NA4270
Disposable endoscope sheath

NA4300
Cath impl vasc access portal

NA4301
Implantable access syst perc

NA4561
Pessary rubber, any type

NA4562
Pessary, non rubber,any type

NA4641
Radiopharm dx agent noc

NA4642
In111 satumomab
CH
K
0704

192.12

38.42A9500
Tc99m sestamibi
CH
K
1600

82.58

16.52A9502
Tc99m tetrofosmin
CH
K
0705

73.81

14.76A9503
Tc99m medronate

NA9504
Tc99m apcitide
CH
NA9505
TL201 thallium
CH
K
1603

27.18

5.44A9507
In111 capromab
CH
K
1604

928.19

185.64A9508
I131 iodobenguate, dx
CH
K
1045

429.55

85.91A9510
Tc99m disofenin
CH
NA9512
Tc99m pertechnetate

NA9516
I123 iodide cap, dx
CH
K
9148

27.44

5.49A9517
I131 iodide cap, rx
CH
K
1064

14.54

2.91A9521
Tc99m exametazime
CH
K
1096

317.07

63.41A9524
I131 serum albumin, dx
CH
K
9100

36.78

7.36A9526
Nitrogen N-13 ammonia
CH
K
0737

230.77

46.15A9528
Iodine I-131 iodide cap, dx
CH
K
1088

24.86

4.97A9529
I131 iodide sol, dx
CH
NA9530
I131 iodide sol, rx
CH
K
1150

12.60

2.52A9531
I131 max 100uCi
CH
NA9532
I125 serum albumin, dx
CH
NA9535
Injection, methylene blue
CH
NA9536
Tc99m depreotide
CH
K
0739

67.91

13.58A9537
Tc99m mebrofenin

NA9538
Tc99m pyrophosphate

NA9539
Tc99m pentetate
CH
K
0722

56.77

11.35A9540
Tc99m MAA

NA9541
Tc99m sulfur colloid

NA9542
In111 ibritumomab, dx
CH
K
1642

1,344.34

268.87A9543
Y90 ibritumomab, rx
CH
K
1643

12,130.20

2,426.04A9544
I131 tositumomab, dx
CH
K
1644

1,368.17

273.63A9545
I131 tositumomab, rx
CH
K
1645

11,868.78

2,373.76A9546
Co57/58
CH
K
0723

149.44

29.89A9547
In111 oxyquinoline
CH
K
1646

306.51

61.30A9548
In111 pentetate
CH
K
1647

262.81

52.56A9549
Tc99m arcitumomab
CH
K
1648

255.95

51.19A9550
Tc99m gluceptate
CH
K
0740

236.53

47.31A9551
Tc99m succimer
CH
K
1650

84.79

16.96A9552
F18 fdg
CH
K
1651

235.56

47.11A9553
Cr51 chromate
CH
K
0741

167.62

33.52A9554
I125 iothalamate, dx
CH
NA9555
Rb82 rubidium
CH
K
1654

239.83

47.97A9556
Ga67 gallium
CH
K
1671

22.73

4.55A9557
Tc99m bicisate
CH
K
1672

254.46

50.89A9558
Xe133 xenon 10mci

N( print page 49833)A9559
Co57 cyano
CH
K
0724

63.74

12.75A9560
Tc99m labeled rbc
CH
K
0742

132.95

26.59A9561
Tc99m oxidronate

NA9562
Tc99m mertiatide
CH
K
0743

180.08

36.02A9563
P32 Na phosphate
CH
K
1675

117.11

23.42A9564
P32 chromic phosphate
CH
K
1676

222.35

44.47A9565
In111 pentetreotide
CH
K
1677

185.60

37.12A9566
Tc99m fanolesomab
CH
K
1678

527.31

105.46A9567
Technetium TC-99m aerosol
CH
NA9600
Sr89 strontium
CH
K
0701

533.58

106.72A9605
Sm 153 lexidronm
CH
K
0702

1,316.41

263.28A9698
Non-rad contrast materialNOC

NA9699
Radiopharm rx agent noc

NC1178
BUSULFAN IV, 6 Mg

K
1178

24.87

4.97C1300
HYPERBARIC Oxygen

S
0659
1.5925
98.02

19.60C1713
Anchor/screw bn/bn,tis/bn

NC1714
Cath, trans atherectomy, dir

NC1715
Brachytherapy needle

NC1716
Brachytx source, Gold 198
CH
K
1716
0.4493
27.65

5.53C1717
Brachytx source, HDR Ir-192
CH
K
1717
2.1922
134.93

26.99C1718
Brachytx source, Iodine 125
CH
K
1718
0.5754
35.42

7.08C1719
Brachytx sour,Non-HDR Ir-192
CH
K
1719
0.5108
31.44

6.29C1720
Brachytx sour, Palladium 103
CH
K
1720
0.7945
48.90

9.78C1721
AICD, dual chamber

NC1722
AICD, single chamber

NC1724
Cath, trans atherec,rotation

NC1725
Cath, translumin non-laser

NC1726
Cath, bal dil, non-vascular

NC1727
Cath, bal tis dis, non-vas

NC1728
Cath, brachytx seed adm

NC1729
Cath, drainage

NC1730
Cath, EP, 19 or few elect

NC1731
Cath, EP, 20 or more elec

NC1732
Cath, EP, diag/abl, 3D/vect

NC1733
Cath, EP, othr than cool-tip

NC1750
Cath, hemodialysis,long-term

NC1751
Cath, inf, per/cent/midline

NC1752
Cath,hemodialysis,short-term

NC1753
Cath, intravas ultrasound

NC1754
Catheter, intradiscal

NC1755
Catheter, intraspinal

NC1756
Cath, pacing, transesoph

NC1757
Cath, thrombectomy/embolect

NC1758
Catheter, ureteral

NC1759
Cath, intra echocardiography

NC1760
Closure dev, vasc

NC1762
Conn tiss, human(inc fascia)

NC1763
Conn tiss, non-human

NC1764
Event recorder, cardiac

NC1765
Adhesion barrier

NC1766
Intro/sheath,strble,non-peel

NC1767
Generator, neuro non-recharg

NC1768
Graft, vascular

NC1769
Guide wire

NC1770
Imaging coil, MR, insertable

NC1771
Rep dev, urinary, w/sling

NC1772
Infusion pump, programmable

NC1773
Ret dev, insertable

NC1776
Joint device (implantable)

NC1777
Lead, AICD, endo single coil

NC1778
Lead, neurostimulator

NC1779
Lead, pmkr, transvenous VDD

NC1780
Lens, intraocular (new tech)

NC1781
Mesh (implantable)

NC1782
Morcellator

NC1783
Ocular imp, aqueous drain de

NC1784
Ocular dev, intraop, det ret

NC1785
Pmkr, dual, rate-resp

NC1786
Pmkr, single, rate-resp

NC1787
Patient progr, neurostim

N( print page 49834)C1788
Port, indwelling, imp

NC1789
Prosthesis, breast, imp

NC1813
Prosthesis, penile, inflatab

NC1814
Retinal tamp, silicone oil

NC1815
Pros, urinary sph, imp

NC1816
Receiver/transmitter, neuro

NC1817
Septal defect imp sys

NC1818
Integrated keratoprosthesis

NC1819
Tissue localization-excision

NC1820
Generator neuro rechg bat sy

H
1820C1874
Stent, coated/cov w/del sys

NC1875
Stent, coated/cov w/o del sy

NC1876
Stent, non-coa/non-cov w/del

NC1877
Stent, non-coat/cov w/o del

NC1878
Matrl for vocal cord

NC1879
Tissue marker, implantable

NC1880
Vena cava filter

NC1881
Dialysis access system

NC1882
AICD, other than sing/dual

NC1883
Adapt/ext, pacing/neuro lead

NC1884
Embolization Protect syst

NC1885
Cath, translumin angio laser

NC1887
Catheter, guiding

NC1888
Endovas non-cardiac abl cath

NC1891
Infusion pump,non-prog, perm

NC1892
Intro/sheath,fixed,peel-away

NC1893
Intro/sheath, fixed,non-peel

NC1894
Intro/sheath, non-laser

NC1895
Lead, AICD, endo dual coil

NC1896
Lead, AICD, non sing/dual

NC1897
Lead, neurostim test kit

NC1898
Lead, pmkr, other than trans

NC1899
Lead, pmkr/AICD combination

NC1900
Lead, coronary venous

NC2614
Probe, perc lumb disc

NC2615
Sealant, pulmonary, liquid

NC2616
Brachytx source, Yttrium-90
CH
K
2616
272.7710
16,789.33

3,357.87C2617
Stent, non-cor, tem w/o del

NC2618
Probe, cryoablation

NC2619
Pmkr, dual, non rate-resp

NC2620
Pmkr, single, non rate-resp

NC2621
Pmkr, other than sing/dual

NC2622
Prosthesis, penile, non-inf

NC2625
Stent, non-cor, tem w/del sy

NC2626
Infusion pump, non-prog,temp

NC2627
Cath, suprapubic/cystoscopic

NC2628
Catheter, occlusion

NC2629
Intro/sheath, laser

NC2630
Cath, EP, cool-tip

NC2631
Rep dev, urinary, w/o sling

NC2632
Brachytx sol, I-125, per mCi
CH
K
2632
0.3139
19.32

3.86C2633
Brachytx source, Cesium-131
CH
K
2633
1.4622
90.00

18.00C2634
Brachytx source, HA, I-125
CH
K
2634
0.4172
25.68

5.14C2635
Brachytx source, HA, P-103
CH
K
2635
0.8820
54.29

10.86C2636
Brachytx linear source,P-103
CH
K
2636
0.6360
39.15

7.83C2637
Brachytx, Ytterbium-169
CH
K
2637
0.4172
25.68

5.14C8900
MRA w/cont, abd

S
0284
6.2589
385.24
148.40
77.05C8901
MRA w/o cont, abd

S
0336
5.8500
360.07
139.68
72.01C8902
MRA w/o fol w/cont, abd

S
0337
8.3423
513.48
202.50
102.70C8903
MRI w/cont, breast,  uni

S
0284
6.2589
385.24
148.40
77.05C8904
MRI w/o cont, breast, uni

S
0336
5.8500
360.07
139.68
72.01C8905
MRI w/o fol w/cont, brst, un

S
0337
8.3423
513.48
202.50
102.70C8906
MRI w/cont, breast,  bi

S
0284
6.2589
385.24
148.40
77.05C8907
MRI w/o cont, breast, bi

S
0336
5.8500
360.07
139.68
72.01C8908
MRI w/o fol w/cont, breast,

S
0337
8.3423
513.48
202.50
102.70C8909
MRA w/cont, chest

S
0284
6.2589
385.24
148.40
77.05C8910
MRA w/o cont, chest

S
0336
5.8500
360.07
139.68
72.01C8911
MRA w/o fol w/cont, chest

S
0337
8.3423
513.48
202.50
102.70C8912
MRA w/cont, lwr ext

S
0284
6.2589
385.24
148.40
77.05C8913
MRA w/o cont, lwr ext

S
0336
5.8500
360.07
139.68
72.01( print page 49835)C8914
MRA w/o fol w/cont, lwr ext

S
0337
8.3423
513.48
202.50
102.70C8918
MRA w/cont, pelvis

S
0284
6.2589
385.24
148.40
77.05C8919
MRA w/o cont, pelvis

S
0336
5.8500
360.07
139.68
72.01C8920
MRA w/o fol w/cont, pelvis

S
0337
8.3423
513.48
202.50
102.70C8950
IV inf, tx/dx, up to 1 hr
CH
S
0440
1.8285
112.55

22.51C8951
IV inf, tx/dx, each addl hr
CH
S
0437
0.4107
25.28

5.06C8952
Tx, prophy, dx IV push
CH
S
0438
0.7892
48.58

9.72C8953
Chemotx adm, IV push
CH
S
0439
1.5841
97.50

19.50C8954
Chemotx adm, IV inf up to 1h
CH
S
0441
2.5071
154.31

30.86C8955
Chemotx adm, IV inf, addl hr
CH
S
0438
0.7892
48.58

9.72C8957
Prolonged IV inf, req pump
CH
S
0441
2.5071
154.31

30.86C9003
Palivizumab, per 50 mg

K
9003

609.62

121.92C9113
Inj pantoprazole sodium, via

NC9121
Injection, argatroban

K
9121

16.40

3.28C9220
Sodium hyaluronate
CH
K
9220

197.62

39.52C9221
Graftjacket Reg Matrix
CH
BC9222
Graftjacket SftTis
CH
K
9222

883.78

176.76C9224
Injection, galsulfase

K
9224

1,503.23

300.65C9225
Fluocinolone acetonide

G
9225

19,345.00

3,869.00C9227
Injection, micafungin sodium

G
9227

1.98

0.40C9228
Injection, tigecycline

G
9228

0.96

0.19C9716
Radiofrequency energy to anu
CH
T
0150
29.4386
1,811.98
437.12
362.40C9723
Dyn IR Perf Img

S
1502

75.00

15.00C9724
EPS gast cardia plic

T
0422
27.5493
1,695.69
448.81
339.14C9725
Place endorectal app

S
1507

550.00

110.00C9726
Rxt breast appl place/remov

S
1508

650.00

130.00D0150
Comprehensve oral evaluation

S
0330
9.5891
590.22

118.04D0240
Intraoral occlusal film

S
0330
9.5891
590.22

118.04D0250
Extraoral first film

S
0330
9.5891
590.22

118.04D0260
Extraoral ea additional film

S
0330
9.5891
590.22

118.04D0270
Dental bitewing single film

S
0330
9.5891
590.22

118.04D0272
Dental bitewings two films

S
0330
9.5891
590.22

118.04D0274
Dental bitewings four films

S
0330
9.5891
590.22

118.04D0277
Vert bitewings-sev to eight

S
0330
9.5891
590.22

118.04D0460
Pulp vitality test

S
0330
9.5891
590.22

118.04D1510
Space maintainer fxd unilat

S
0330
9.5891
590.22

118.04D1515
Fixed bilat space maintainer

S
0330
9.5891
590.22

118.04D1520
Remove unilat space maintain

S
0330
9.5891
590.22

118.04D1525
Remove bilat space maintain

S
0330
9.5891
590.22

118.04D1550
Recement space maintainer

S
0330
9.5891
590.22

118.04D2999
Dental unspec restorative pr

S
0330
9.5891
590.22

118.04D3460
Endodontic endosseous implan

S
0330
9.5891
590.22

118.04D3999
Endodontic procedure

S
0330
9.5891
590.22

118.04D4260
Osseous surgery per quadrant

S
0330
9.5891
590.22

118.04D4263
Bone replce graft first site

S
0330
9.5891
590.22

118.04D4264
Bone replce graft each add

S
0330
9.5891
590.22

118.04D4268
Surgical revision procedure

S
0330
9.5891
590.22

118.04D4270
Pedicle soft tissue graft pr

S
0330
9.5891
590.22

118.04D4271
Free soft tissue graft proc

S
0330
9.5891
590.22

118.04D4273
Subepithelial tissue graft

S
0330
9.5891
590.22

118.04D4355
Full mouth debridement

S
0330
9.5891
590.22

118.04D4381
Localized delivery antimicro

S
0330
9.5891
590.22

118.04D5911
Facial moulage sectional

S
0330
9.5891
590.22

118.04D5912
Facial moulage complete

S
0330
9.5891
590.22

118.04D5983
Radiation applicator

S
0330
9.5891
590.22

118.04D5984
Radiation shield

S
0330
9.5891
590.22

118.04D5985
Radiation cone locator

S
0330
9.5891
590.22

118.04D5987
Commissure splint

S
0330
9.5891
590.22

118.04D6920
Dental connector bar

S
0330
9.5891
590.22

118.04D7111
Extraction coronal remnants

S
0330
9.5891
590.22

118.04D7140
Extraction erupted tooth/exr

S
0330
9.5891
590.22

118.04D7210
Rem imp tooth w mucoper flp

S
0330
9.5891
590.22

118.04D7220
Impact tooth remov soft tiss

S
0330
9.5891
590.22

118.04D7230
Impact tooth remov part bony

S
0330
9.5891
590.22

118.04D7240
Impact tooth remov comp bony

S
0330
9.5891
590.22

118.04D7241
Impact tooth rem bony w/comp

S
0330
9.5891
590.22

118.04D7250
Tooth root removal

S
0330
9.5891
590.22

118.04D7260
Oral antral fistula closure

S
0330
9.5891
590.22

118.04D7261
Primary closure sinus perf

S
0330
9.5891
590.22

118.04D7291
Transseptal fiberotomy

S
0330
9.5891
590.22

118.04( print page 49836)D7940
Reshaping bone orthognathic

S
0330
9.5891
590.22

118.04D9110
Tx dental pain minor proc

ND9230
Analgesia

ND9248
Sedation (non-iv)

ND9630
Other drugs/medicaments

S
0330
9.5891
590.22

118.04D9930
Treatment of complications

S
0330
9.5891
590.22

118.04D9940
Dental occlusal guard

S
0330
9.5891
590.22

118.04D9950
Occlusion analysis

S
0330
9.5891
590.22

118.04D9951
Limited occlusal adjustment

S
0330
9.5891
590.22

118.04D9952
Complete occlusal adjustment

S
0330
9.5891
590.22

118.04E0616
Cardiac event recorder

NE0749
Elec osteogen stim implanted

NE0782
Non-programble infusion pump

NE0783
Programmable infusion pump

NE0785
Replacement impl pump cathet

NE0786
Implantable pump replacement

NE0830
Ambulatory traction device

NE1399
Durable medical equipment mi

NG0008
Admin influenza virus vac
CH
S
0350
0.4107
25.28
0.00
0.00G0009
Admin pneumococcal vaccine
CH
S
0350
0.4107
25.28
0.00
0.00G0101
CA screen;pelvic/breast exam
CH
V
0604
0.8083
49.75

9.95G0102
Prostate ca screening; dre

NG0104
CA screen;flexi sigmoidscope

S
0159
3.8973
239.88

59.97G0105
Colorectal scrn; hi risk ind

T
0158
7.8134
480.92

120.23G0106
Colon CA screen;barium enema

S
0157
2.4974
153.72

30.74G0117
Glaucoma scrn hgh risk direc

S
0230
0.8126
50.02
14.97
10.00G0118
Glaucoma scrn hgh risk direc

S
0230
0.8126
50.02
14.97
10.00G0120
Colon ca scrn; barium enema

S
0157
2.4974
153.72

30.74G0121
Colon ca scrn not hi rsk ind

T
0158
7.8134
480.92

120.23G0127
Trim nail(s)

T
0009
0.6803
41.87

8.37G0129
Partial hosp prog service

P
0033
3.3837
208.27

41.65G0130
Single energy x-ray study

X
0260
0.7276
44.78

8.96G0166
Extrnl counterpulse, per tx

T
0678
1.7263
106.26

21.25G0173
Linear acc stereo radsur com
CH
S
0067
65.7255
4,045.47

809.09G0175
OPPS Service,sched team conf
CH
V
0608
2.1226
130.65

26.13G0176
OPPS/PHP;activity therapy

P
0033
3.3837
208.27

41.65G0177
OPPS/PHP; traineduc serv

P
0033
3.3837
208.27

41.65G0186
Dstry eye lesn,fdr vssl tech

T
0235
4.0750
250.82
61.14
50.16G0237
Therapeutic procd strg endur

S
0411
0.3793
23.35

4.67G0238
Oth resp proc, indiv

S
0411
0.3793
23.35

4.67G0239
Oth resp proc, group

S
0411
0.3793
23.35

4.67G0243
Multisour photon stero treat

S
0127
126.8566
7,808.15

1,561.63G0245
Initial foot exam pt lops
CH
V
0604
0.8083
49.75

9.95G0246
Followup eval of foot pt lop
CH
V
0605
1.0057
61.90

12.38G0247
Routine footcare pt w lops

T
0009
0.6803
41.87

8.37G0248
Demonstrate use home inr mon
CH
V
0604
0.8083
49.75

9.95G0249
Provide test material,equipm
CH
V
0604
0.8083
49.75

9.95G0251
Linear acc based stero radio
CH
S
0065
22.4428
1,381.38

276.28G0257
Unsched dialysis ESRD pt hos

S
0170
6.8096
419.14

83.83G0259
Inject for sacroiliac joint

NG0260
Inj for sacroiliac jt anesth

T
0206
5.5439
341.23
75.55
68.25G0267
Bone marrow or psc harvest

S
0110
3.4570
212.78

42.56G0268
Removal of impacted wax md

X
0340
0.6211
38.23

7.65G0269
Occlusive device in vein art

NG0275
Renal angio, cardiac cath

NG0278
Iliac art angio,cardiac cath

NG0288
Recon, CTA for surg plan

S
0417
3.1140
191.67

38.33G0289
Arthro, loose body + chondro

NG0290
Drug-eluting stents, single

T
0656
106.8902
6,579.20

1,315.84G0291
Drug-eluting stents,each add

T
0656
106.8902
6,579.20

1,315.84G0293
Non-cov surg proc,clin trial
CH
X
0340
0.6211
38.23

7.65G0294
Non-cov proc, clinical trial
CH
X
0340
0.6211
38.23

7.65G0297
Insert single chamber/cd

T
0107
279.2049
17,185.34

3,437.07G0298
Insert dual chamber/cd

T
0107
279.2049
17,185.34

3,437.07G0299
Inser/repos single icd+leads

T
0108
370.5535
22,807.94

4,561.59G0300
Insert reposit lead dual+gen

T
0108
370.5535
22,807.94

4,561.59G0302
Pre-op service LVRS complete

S
1509

750.00

150.00G0303
Pre-op service LVRS 10-15dos

S
1507

550.00

110.00G0304
Pre-op service LVRS 1-9 dos

S
1504

250.00

50.00G0305
Post op service LVRS min 6

S
1504

250.00

50.00( print page 49837)G0332
Preadmin IV immunoglobulin
CH
BG0339
Robot lin-radsurg com, first
CH
S
0067
65.7255
4,045.47

809.09G0340
Robt lin-radsurg fractx 2-5
CH
S
0066
47.2213
2,906.52

581.30G0344
Initial preventive exam
CH
V
0605
1.0057
61.90

12.38G0364
Bone marrow aspirate biopsy
CH
T
0002
1.0948
67.39

13.48G0365
Vessel mapping hemo access

S
0267
2.5166
154.90
60.80
30.98G0367
EKG tracing for initial prev

S
0099
0.3835
23.60

4.72G0375
Smoke/tobacco counselng 3-10
CH
X
0031
0.1716
10.56

2.11G0376
Smoke/tobacco counseling 10
CH
X
0031
0.1716
10.56

2.11G0378
Hospital observation per hr

Q
0339
7.1587
440.63

88.13G0379
Direct admit hospital observ
CH
Q
0604
0.8083
49.75

9.95G3001
Admin + supply, tositumomab
CH
S
0442
24.5410
1,510.52

302.10J0120
Tetracyclin injection

NJ0128
Abarelix injection
CH
K
9216

66.20

13.24J0130
Abciximab injection

K
1605

452.96

90.59J0132
Acetylcysteine injection

K
1680

1.86

0.37J0133
Acyclovir injection

NJ0135
Adalimumab injection

K
1083

304.40

60.88J0150
Injection adenosine 6 MG

K
0379

29.90

5.98J0152
Adenosine injection

K
0917

69.41

13.88J0170
Adrenalin epinephrin inject

NJ0180
Agalsidase beta injection

K
9208

126.00

25.20J0190
Inj biperiden lactate/5 mg
CH
K
3038

88.36

17.67J0200
Alatrofloxacin mesylate

NJ0205
Alglucerase injection

K
0900

38.85

7.77J0207
Amifostine

K
7000

448.41

89.68J0210
Methyldopate hcl injection

K
2210

9.86

1.97J0215
Alefacept

K
1633

26.03

5.21J0256
Alpha 1 proteinase inhibitor

K
0901

3.21

0.64J0278
Amikacin sulfate injection
CH
NJ0280
Aminophyllin 250 MG inj

NJ0282
Amiodarone HCl

NJ0285
Amphotericin B
CH
NJ0287
Amphotericin b lipid complex

K
9024

11.10

2.22J0288
Ampho b cholesteryl sulfate

K
0735

12.00

2.40J0289
Amphotericin b liposome inj

K
0736

17.40

3.48J0290
Ampicillin 500 MG inj

NJ0295
Ampicillin sodium per 1.5 gm

NJ0300
Amobarbital 125 MG inj

NJ0330
Succinycholine chloride inj

NJ0350
Injection anistreplase 30 u

K
1606

2,265.46

453.09J0360
Hydralazine hcl injection

NJ0365
Aprotonin, 10,000 kiu

K
1682

2.32

0.46J0380
Inj metaraminol bitartrate
CH
K
3039

17.68

3.54J0390
Chloroquine injection

NJ0395
Arbutamine HCl injection

K
9031

160.00

32.00J0456
Azithromycin

NJ0460
Atropine sulfate injection

NJ0470
Dimecaprol injection
CH
NJ0475
Baclofen 10 MG injection

K
9032

191.50

38.30J0476
Baclofen intrathecal trial

K
1631

70.20

14.04J0480
Basiliximab

K
1683

1,388.81

277.76J0500
Dicyclomine injection

NJ0515
Inj benztropine mesylate

NJ0520
Bethanechol chloride inject

NJ0530
Penicillin g benzathine inj

NJ0540
Penicillin g benzathine inj

NJ0550
Penicillin g benzathine inj

NJ0560
Penicillin g benzathine inj

NJ0570
Penicillin g benzathine inj

NJ0580
Penicillin g benzathine inj
CH
K
3040

67.86

13.57J0583
Bivalirudin
CH
K
3041

1.62

0.32J0585
Botulinum toxin a per unit

K
0902

4.85

0.97J0587
Botulinum toxin type B

K
9018

7.85

1.57J0592
Buprenorphine hydrochloride

NJ0595
Butorphanol tartrate 1 mg

NJ0600
Edetate calcium disodium inj

K
0892

39.80

7.96J0610
Calcium gluconate injection

NJ0620
Calcium glycerlact/10 ML

NJ0630
Calcitonin salmon injection
CH
N( print page 49838)J0636
Inj calcitriol per 0.1 mcg

NJ0637
Caspofungin acetate

K
9019

32.19

6.44J0640
Leucovorin calcium injection

NJ0670
Inj mepivacaine HCL/10 ml

NJ0690
Cefazolin sodium injection

NJ0692
Cefepime HCl for injection

NJ0694
Cefoxitin sodium injection

NJ0696
Ceftriaxone sodium injection

NJ0697
Sterile cefuroxime injection

NJ0698
Cefotaxime sodium injection

NJ0702
Betamethasone acetsod phosp

NJ0704
Betamethasone sod phosp/4 MG

NJ0706
Caffeine citrate injection

K
0876

3.34

0.67J0710
Cephapirin sodium injection

NJ0713
Inj ceftazidime per 500 mg

NJ0715
Ceftizoxime sodium/500 MG

NJ0720
Chloramphenicol sodium injec

NJ0725
Chorionic gonadotropin/1000u

NJ0735
Clonidine hydrochloride

K
0935

62.71

12.54J0740
Cidofovir injection

K
9033

757.03

151.41J0743
Cilastatin sodium injection

NJ0744
Ciprofloxacin iv

NJ0745
Inj codeine phosphate/30 MG

NJ0760
Colchicine injection

NJ0770
Colistimethate sodium inj

NJ0780
Prochlorperazine injection

NJ0795
Corticorelin ovine triflutal

K
1684

4.22

0.84J0800
Corticotropin injection

K
1280

108.85

21.77J0835
Inj cosyntropin per 0.25 MG

K
0835

63.55

12.71J0850
Cytomegalovirus imm IV/vial

K
0903

755.79

151.16J0878
Daptomycin injection
CH
K
9124

0.31

0.06J0881
Darbepoetin alfa, non-esrd

K
1685

3.00

0.60J0882
Darbepoetin alfa, esrd use
CH
AJ0885
Epoetin alfa, non-esrd

K
1686

9.25

1.85J0886
Epoetin alfa, esrd
CH
AJ0895
Deferoxamine mesylate inj

K
0895

14.77

2.95J0900
Testosterone enanthate inj

NJ0945
Brompheniramine maleate inj

NJ0970
Estradiol valerate injection

NJ1000
Depo-estradiol cypionate inj

NJ1020
Methylprednisolone 20 MG inj

NJ1030
Methylprednisolone 40 MG inj

NJ1040
Methylprednisolone 80 MG inj

NJ1051
Medroxyprogesterone inj

NJ1060
Testosterone cypionate 1 ML

NJ1070
Testosterone cypionat 100 MG

NJ1080
Testosterone cypionat 200 MG

NJ1094
Inj dexamethasone acetate

NJ1100
Dexamethasone sodium phos

NJ1110
Inj dihydroergotamine mesylt
CH
NJ1120
Acetazolamid sodium injectio

NJ1160
Digoxin injection

NJ1162
Digoxin immune fab (ovine)

K
1687

527.46

105.49J1165
Phenytoin sodium injection

NJ1170
Hydromorphone injection

NJ1180
Dyphylline injection
CH
NJ1190
Dexrazoxane HCl injection

K
0726

179.62

35.92J1200
Diphenhydramine hcl injectio

NJ1205
Chlorothiazide sodium inj

NJ1212
Dimethyl sulfoxide 50% 50 ML

NJ1230
Methadone injection

NJ1240
Dimenhydrinate injection

NJ1245
Dipyridamole injection

NJ1250
Inj dobutamine HCL/250 mg

NJ1260
Dolasetron mesylate

K
0750

6.76

1.35J1265
Dopamine injection

NJ1270
Injection, doxercalciferol

NJ1320
Amitriptyline injection

NJ1325
Epoprostenol injection

NJ1327
Eptifibatide injection

K
1607

13.31

2.66( print page 49839)J1330
Ergonovine maleate injection

K
1330

27.56

5.51J1335
Ertapenem injection

NJ1364
Erythro lactobionate/500 MG

NJ1380
Estradiol valerate 10 MG inj

NJ1390
Estradiol valerate 20 MG inj

NJ1410
Inj estrogen conjugate 25 MG

K
9038

57.78

11.56J1430
Ethanolamine oleate 100 mg

K
1688

71.57

14.31J1435
Injection estrone per 1 MG

NJ1436
Etidronate disodium inj

K
1436

70.73

14.15J1438
Etanercept injection

K
1608

154.12

30.82J1440
Filgrastim 300 mcg injection

K
0728

182.53

36.51J1441
Filgrastim 480 mcg injection

K
7049

289.59

57.92J1450
Fluconazole

NJ1451
Fomepizole, 15 mg

K
1689

11.82

2.36J1452
Intraocular Fomivirsen na

K
9040

210.00

42.00J1455
Foscarnet sodium injection
CH
K
3042

10.69

2.14J1457
Gallium nitrate injection
CH
NJ1460
Gamma globulin 1 CC inj
CH
K
3043

10.59

2.12J1565
RSV-ivig

K
0906

16.02

3.20J1566
Immune globulin, powder

K
2731

22.05

4.41J1567
Immune globulin, liquid

K
2732

28.82

5.76J1570
Ganciclovir sodium injection

NJ1580
Garamycin gentamicin inj

NJ1590
Gatifloxacin injection

NJ1595
Injection glatiramer acetate

NJ1600
Gold sodium thiomaleate inj

NJ1610
Glucagon hydrochloride/1 MG

K
9042

62.42

12.48J1620
Gonadorelin hydroch/100 mcg

K
7005

178.59

35.72J1626
Granisetron HCl injection

K
0764

6.80

1.36J1630
Haloperidol injection

NJ1631
Haloperidol decanoate inj

NJ1640
Hemin, 1 mg

K
1690

6.59

1.32J1642
Inj heparin sodium per 10 u

NJ1644
Inj heparin sodium per 1000u

NJ1645
Dalteparin sodium

NJ1650
Inj enoxaparin sodium

NJ1652
Fondaparinux sodium

NJ1655
Tinzaparin sodium injection

K
1655

2.18

0.44J1670
Tetanus immune globulin inj

K
1670

90.71

18.14J1700
Hydrocortisone acetate inj

NJ1710
Hydrocortisone sodium ph inj

NJ1720
Hydrocortisone sodium succ i

NJ1730
Diazoxide injection

K
1740

110.88

22.18J1742
Ibutilide fumarate injection

K
9044

249.01

49.80J1745
Infliximab injection

K
7043

53.73

10.75J1751
Iron dextran 165 injection

K
1691

12.30

2.46J1752
Iron dextran 267 injection

K
1692

10.17

2.03J1756
Iron sucrose injection

K
9046

0.36

0.07J1785
Injection imiglucerase/unit

K
0916

3.87

0.77J1790
Droperidol injection

NJ1800
Propranolol injection

NJ1815
Insulin injection

NJ1817
Insulin for insulin pump use

NJ1830
Interferon beta-1b/.25 MG

K
0910

91.34

18.27J1835
Itraconazole injection

K
9047

36.23

7.25J1840
Kanamycin sulfate 500 MG inj

NJ1850
Kanamycin sulfate 75 MG inj

NJ1885
Ketorolac tromethamine inj

NJ1890
Cephalothin sodium injection

NJ1931
Laronidase injection

K
9209

23.64

4.73J1940
Furosemide injection

NJ1945
Lepirudin

K
1693

146.38

29.28J1950
Leuprolide acetate/3.75 MG

K
0800

440.36

88.07J1956
Levofloxacin injection

NJ1960
Levorphanol tartrate inj

NJ1980
Hyoscyamine sulfate inj

NJ1990
Chlordiazepoxide injection

NJ2001
Lidocaine injection

NJ2010
Lincomycin injection

NJ2020
Linezolid injection

K
9001

23.50

4.70( print page 49840)J2060
Lorazepam injection

NJ2150
Mannitol injection

NJ2175
Meperidine hydrochl/100 MG

NJ2180
Meperidine/promethazine inj

NJ2185
Meropenem
CH
K
3045

3.76

0.75J2210
Methylergonovin maleate inj

NJ2250
Inj midazolam hydrochloride

NJ2260
Inj milrinone lactate/5 MG

NJ2270
Morphine sulfate injection

NJ2271
Morphine so4 injection 100mg

NJ2275
Morphine sulfate injection

NJ2278
Ziconotide injection

G
1694

6.20

1.24J2280
Inj, moxifloxacin 100 mg

NJ2300
Inj nalbuphine hydrochloride

NJ2310
Inj naloxone hydrochloride

NJ2320
Nandrolone decanoate 50 MG

NJ2321
Nandrolone decanoate 100 MG

NJ2322
Nandrolone decanoate 200 MG

NJ2325
Nesiritide injection

K
1695

29.72

5.94J2353
Octreotide injection, depot

K
1207

89.50

17.90J2354
Octreotide inj, non-depot
CH
K
3046

4.34

0.87J2355
Oprelvekin injection

K
7011

243.39

48.68J2357
Omalizumab injection
CH
K
9300

16.34

3.27J2360
Orphenadrine injection

NJ2370
Phenylephrine hcl injection

NJ2400
Chloroprocaine hcl injection

NJ2405
Ondansetron hcl injection

K
0768

3.69

0.74J2410
Oxymorphone hcl injection

NJ2425
Palifermin injection

K
1696

11.37

2.27J2430
Pamidronate disodium/30 MG

K
0730

29.31

5.86J2440
Papaverin hcl injection

NJ2460
Oxytetracycline injection

NJ2469
Palonosetron HCl

K
9210

17.51

3.50J2501
Paricalcitol

NJ2503
Pegaptanib sodium injection

G
1697

1,107.54

221.51J2504
Pegademase bovine, 25 iu

K
1739

164.50

32.90J2505
Injection, pegfilgrastim 6mg

K
9119

2,142.79

428.56J2510
Penicillin g procaine inj

NJ2513
Pentastarch 10% solution
CH
NJ2515
Pentobarbital sodium inj

NJ2540
Penicillin g potassium inj

NJ2543
Piperacillin/tazobactam

NJ2550
Promethazine hcl injection

NJ2560
Phenobarbital sodium inj

NJ2590
Oxytocin injection

NJ2597
Inj desmopressin acetate

NJ2650
Prednisolone acetate inj

NJ2670
Totazoline hcl injection

NJ2675
Inj progesterone per 50 MG

NJ2680
Fluphenazine decanoate 25 MG

NJ2690
Procainamide hcl injection

NJ2700
Oxacillin sodium injeciton
CH
NJ2710
Neostigmine methylslfte inj

NJ2720
Inj protamine sulfate/10 MG

NJ2725
Inj protirelin per 250 mcg

NJ2730
Pralidoxime chloride inj
CH
NJ2760
Phentolaine mesylate inj

NJ2765
Metoclopramide hcl injection

NJ2770
Quinupristin/dalfopristin

K
2770

108.03

21.61J2780
Ranitidine hydrochloride inj

NJ2783
Rasburicase
CH
K
0738

110.36

22.07J2788
Rho d immune globulin 50 mcg

K
9023

14.13

2.83J2790
Rho d immune globulin inj

K
0884

97.11

19.42J2792
Rho(D) immune globulin h, sd

K
1609

13.57

2.71J2794
Risperidone, long acting
CH
K
9125

4.73

0.95J2795
Ropivacaine HCl injection

NJ2800
Methocarbamol injection

NJ2805
Sincalide injection
CH
NJ2810
Inj theophylline per 40 MG

NJ2820
Sargramostim injection

K
0731

23.12

4.62( print page 49841)J2850
Inj secretin synthetic human

K
1700

20.31

4.06J2910
Aurothioglucose injeciton
CH
NJ2912
Sodium chloride injection

NJ2916
Na ferric gluconate complex

NJ2920
Methylprednisolone injection

NJ2930
Methylprednisolone injection

NJ2940
Somatrem injection

K
2940

583.74

116.75J2941
Somatropin injection

K
7034

43.73

8.75J2950
Promazine hcl injection

NJ2993
Reteplase injection

K
9005

754.71

150.94J2995
Inj streptokinase/250000 IU

K
0911

78.75

15.75J2997
Alteplase recombinant

K
7048

31.06

6.21J3000
Streptomycin injection

NJ3010
Fentanyl citrate injeciton

NJ3030
Sumatriptan succinate/6 MG

K
3030

51.75

10.35J3070
Pentazocine injection

NJ3100
Tenecteplase injection

K
9002

2,059.01

411.80J3105
Terbutaline sulfate inj

NJ3120
Testosterone enanthate inj

NJ3130
Testosterone enanthate inj

NJ3140
Testosterone suspension inj

NJ3150
Testosteron propionate inj

NJ3230
Chlorpromazine hcl injection

NJ3240
Thyrotropin injection

K
9108

766.61

153.32J3246
Tirofiban HCl

K
7041

7.61

1.52J3250
Trimethobenzamide hcl inj

NJ3260
Tobramycin sulfate injection

NJ3265
Injection torsemide 10 mg/ml

NJ3280
Thiethylperazine maleate inj

NJ3285
Treprostinil injection

K
1701

53.51

10.70J3301
Triamcinolone acetonide inj

NJ3302
Triamcinolone diacetate inj

NJ3303
Triamcinolone hexacetonl inj

NJ3305
Inj trimetrexate glucoronate

K
7045

144.39

28.88J3310
Perphenazine injeciton

NJ3315
Triptorelin pamoate

K
9122

300.90

60.18J3320
Spectinomycn di-hcl inj

NJ3350
Urea injection

K
9051

69.10

13.82J3355
Urofollitropin, 75 iu

K
1741

48.84

9.77J3360
Diazepam injection

NJ3364
Urokinase 5000 IU injection

NJ3365
Urokinase 250,000 IU inj

K
7036

453.41

90.68J3370
Vancomycin hcl injection

NJ3396
Verteporfin injection

K
1203

8.89

1.78J3400
Triflupromazine hcl inj

NJ3410
Hydroxyzine hcl injection

NJ3411
Thiamine hcl 100 mg

NJ3415
Pyridoxine hcl 100 mg

NJ3420
Vitamin b12 injection

NJ3430
Vitamin k phytonadione inj

NJ3465
Injection, voriconazole

K
1052

4.55

0.91J3470
Hyaluronidase injection
CH
NJ3471
Ovine, up to 999 USP units
CH
NJ3472
Ovine, 1000 USP units

K
1703

133.77

26.75J3475
Inj magnesium sulfate

NJ3480
Inj potassium chloride

NJ3485
Zidovudine

NJ3486
Ziprasidone mesylate

NJ3487
Zoledronic acid

K
9115

200.82

40.16J3490
Drugs unclassified injection

NJ3530
Nasal vaccine inhalation

NJ3590
Unclassified biologics

NJ7030
Normal saline solution infus

NJ7040
Normal saline solution infus

NJ7042
5% dextrose/normal saline

NJ7050
Normal saline solution infus

NJ7060
5% dextrose/water

NJ7070
D5w infusion

NJ7100
Dextran 40 infusion

NJ7110
Dextran 75 infusion

N( print page 49842)J7120
Ringers lactate infusion

NJ7130
Hypertonic saline solution

NJ7188
Inj Vonwillebrand factor iu

K
1704

0.87

0.17J7189
Factor viia

K
1705

1.08

0.22J7190
Factor viii

K
0925

0.68

0.14J7191
Factor VIII (porcine)

K
0926

0.66

0.13J7192
Factor viii recombinant

K
0927

1.05

0.21J7193
Factor IX non-recombinant

K
0931

0.88

0.18J7194
Factor ix complex

K
0928

0.63

0.13J7195
Factor IX recombinant

K
0932

0.98

0.20J7197
Antithrombin iii injection

K
0930

1.62

0.32J7198
Anti-inhibitor

K
0929

1.29

0.26J7308
Aminolevulinic acid hcl top

K
7308

99.92

19.98J7310
Ganciclovir long act implant

K
0913

4,200.00

840.00J7317
Sodium hyaluronate injection

K
7316

112.04

22.41J7320
Hylan G-F 20 injection

K
1611

196.99

39.40J7340
Metabolic active D/E tissue

K
1632

27.56

5.51J7341
Non-human, metabolic tissue

K
1707

1.64

0.33J7342
Metabolically active tissue

K
9054

15.01

3.00J7343
Nonmetabolic act d/e tissue

K
1629

15.20

3.04J7344
Nonmetabolic active tissue

K
9156

66.39

13.28J7350
Injectable human tissue
CH
NJ7500
Azathioprine oral 50mg

NJ7501
Azathioprine parenteral

K
0887

48.73

9.75J7502
Cyclosporine oral 100 mg

K
0888

3.88

0.78J7504
Lymphocyte immune globulin

K
0890

295.38

59.08J7505
Monoclonal antibodies

K
7038

860.94

172.19J7506
Prednisone oral

NJ7507
Tacrolimus oral per 1 MG

K
0891

3.40

0.68J7509
Methylprednisolone oral

NJ7510
Prednisolone oral per 5 mg

NJ7511
Antithymocyte globuln rabbit

K
9104

301.48

60.30J7513
Daclizumab, parenteral

K
1612

345.07

69.01J7515
Cyclosporine oral 25 mg
CH
NJ7516
Cyclosporin parenteral 250mg

NJ7517
Mycophenolate mofetil oral

K
9015

2.50

0.50J7518
Mycophenolic acid
CH
K
9219

2.15

0.43J7520
Sirolimus, oral

K
9020

6.84

1.37J7525
Tacrolimus injection

K
9006

135.17

27.03J7599
Immunosuppressive drug noc

NJ7674
Methacholine chloride, neb

NJ7799
Non-inhalation drug for DME

NJ8501
Oral aprepitant

G
0868

4.63

0.93J8510
Oral busulfan

K
7015

1.95

0.39J8520
Capecitabine, oral, 150 mg

K
7042

3.60

0.72J8530
Cyclophosphamide oral 25 MG

NJ8540
Oral dexamethasone
CH
NJ8560
Etoposide oral 50 MG

K
0802

32.73

6.55J8597
Antiemetic drug oral NOS

NJ8600
Melphalan oral 2 MG
CH
K
3047

4.39

0.88J8610
Methotrexate oral 2.5 MG

NJ8700
Temozolomide

K
1086

7.16

1.43J9000
Doxorubic hcl 10 MG vl chemo
CH
K
3048

6.23

1.25J9001
Doxorubicin hcl liposome inj

K
7046

367.56

73.51J9010
Alemtuzumab injection

K
9110

525.75

105.15J9015
Aldesleukin/single use vial

K
0807

734.10

146.82J9017
Arsenic trioxide

K
9012

32.92

6.58J9020
Asparaginase injection

K
0814

53.66

10.73J9025
Azacitidine injection

K
1709

4.09

0.82J9027
Clofarabine injection

G
1710

116.68

23.34J9031
Bcg live intravesical vac

K
0809

110.48

22.10J9035
Bevacizumab injection
CH
K
9214

56.36

11.27J9040
Bleomycin sulfate injection
CH
NJ9041
Bortezomib injection

K
9207

29.81

5.96J9045
Carboplatin injection

K
0811

13.74

2.75J9050
Carmus bischl nitro inj

K
0812

139.66

27.93J9055
Cetuximab injection
CH
K
9215

49.39

9.88J9060
Cisplatin 10 MG injection

NJ9065
Inj cladribine per 1 MG

K
0858

38.28

7.66J9070
Cyclophosphamide 100 MG inj

N( print page 49843)J9093
Cyclophosphamide lyophilized
CH
K
3049

5.47

1.09J9098
Cytarabine liposome

K
1166

374.75

74.95J9100
Cytarabine hcl 100 MG inj

NJ9120
Dactinomycin actinomycin d

NJ9130
Dacarbazine 100 mg inj
CH
NJ9150
Daunorubicin

K
0820

23.36

4.67J9151
Daunorubicin citrate liposom

K
0821

55.72

11.14J9160
Denileukin diftitox, 300 mcg

K
1084

1,391.05

278.21J9165
Diethylstilbestrol injection

NJ9170
Docetaxel

K
0823

294.48

58.90J9175
Elliotts b solution per ml

NJ9178
Inj, epirubicin hcl, 2 mg

K
1167

24.47

4.89J9181
Etoposide 10 MG inj

NJ9185
Fludarabine phosphate inj

K
0842

230.11

46.02J9190
Fluorouracil injection

NJ9200
Floxuridine injection

K
0827

62.61

12.52J9201
Gemcitabine HCl

K
0828

116.59

23.32J9202
Goserelin acetate implant

K
0810

197.59

39.52J9206
Irinotecan injection

K
0830

125.28

25.06J9208
Ifosfomide injection

K
0831

54.19

10.84J9209
Mesna injection

K
0732

7.87

1.57J9211
Idarubicin hcl injection

K
0832

265.53

53.11J9212
Interferon alfacon-1

K
0912

3.92

0.78J9213
Interferon alfa-2a inj

K
0834

33.53

6.71J9214
Interferon alfa-2b inj

K
0836

13.54

2.71J9215
Interferon alfa-n3 inj

K
0865

50.33

10.07J9216
Interferon gamma 1-b inj

K
0838

289.87

57.97J9217
Leuprolide acetate suspnsion

K
9217

242.99

48.60J9218
Leuprolide acetate injeciton

K
0861

7.86

1.57J9219
Leuprolide acetate implant

K
7051

2,157.81

431.56J9225
Histrelin implant

K
1711

2,019.82

403.96J9230
Mechlorethamine hcl inj

NJ9245
Inj melphalan hydrochl 50 MG

K
0840

1,190.81

238.16J9250
Methotrexate sodium inj

NJ9263
Oxaliplatin

K
1738

8.47

1.69J9264
Paclitaxel injection

G
1712

8.73

1.75J9265
Paclitaxel injection

K
0863

15.44

3.09J9266
Pegaspargase/singl dose vial

K
0843

1,596.00

319.20J9268
Pentostatin injection

K
0844

2,000.96

400.19J9270
Plicamycin (mithramycin) inj

K
0860

173.66

34.73J9280
Mitomycin 5 MG inj

K
0862

18.82

3.76J9293
Mitoxantrone hydrochl/5 MG

K
0864

336.76

67.35J9300
Gemtuzumab ozogamicin

K
9004

2,265.57

453.11J9305
Pemetrexed injection
CH
K
9213

40.90

8.18J9310
Rituximab cancer treatment

K
0849

465.23

93.05J9320
Streptozocin injection

K
0850

147.45

29.49J9340
Thiotepa injection

K
0851

45.38

9.08J9350
Topotecan

K
0852

780.54

156.11J9355
Trastuzumab

K
1613

54.59

10.92J9357
Valrubicin, 200 mg

K
9167

76.03

15.21J9360
Vinblastine sulfate inj

NJ9370
Vincristine sulfate 1 MG inj

NJ9390
Vinorelbine tartrate/10 mg

K
0855

22.04

4.41J9395
Injection, Fulvestrant

K
9120

80.31

16.06J9600
Porfimer sodium

K
0856

2,481.76

496.35J9999
Chemotherapy drug

NL8600
Implant breast silicone/eq

NL8603
Collagen imp urinary 2.5 ml

NL8606
Synthetic implnt urinary 1ml

NL8609
Artificial cornea

NL8610
Ocular implant

NL8612
Aqueous shunt prosthesis

NL8613
Ossicular implant

NL8614
Cochlear device/system

NL8630
Metacarpophalangeal implant

NL8631
MCP joint repl 2 pc or more

NL8641
Metatarsal joint implant

NL8642
Hallux implant

NL8658
Interphalangeal joint spacer

NL8659
Interphalangeal joint repl

N( print page 49844)L8670
Vascular graft, synthetic

NL8682
Implt neurostim radiofq rec

NL8699
Prosthetic implant NOS

NM0064
Visit for drug monitoring

X
0374
1.1509
70.84

14.17P9010
Whole blood for transfusion

K
0950
2.1824
134.33

26.87P9011
Blood split unit

K
0967
2.2087
135.95

27.19P9012
Cryoprecipitate each unit

K
0952
0.8571
52.76

10.55P9016
RBC leukocytes reduced

K
0954
2.8738
176.89

35.38P9017
Plasma 1 donor frz w/in 8 hr

K
9508
1.1677
71.87

14.37P9019
Platelets, each unit

K
0957
0.9794
60.28

12.06P9020
Plaelet rich plasma unit

K
0958
2.5336
155.95

31.19P9021
Red blood cells unit

K
0959
2.1045
129.53

25.91P9022
Washed red blood cells unit

K
0960
3.5028
215.60

43.12P9023
Frozen plasma, pooled, sd

K
0949
0.9060
55.77

11.15P9031
Platelets leukocytes reduced

K
1013
1.5318
94.28

18.86P9032
Platelets, irradiated

K
9500
2.0957
128.99

25.80P9033
Platelets leukoreduced irrad

K
0968
2.1192
130.44

26.09P9034
Platelets, pheresis

K
9507
7.5381
463.98

92.80P9035
Platelet pheres leukoreduced

K
9501
7.9414
488.80

97.76P9036
Platelet pheresis irradiated

K
9502
6.6959
412.14

82.43P9037
Plate pheres leukoredu irrad

K
1019
9.9841
614.53

122.91P9038
RBC irradiated

K
9505
3.2600
200.66

40.13P9039
RBC deglycerolized

K
9504
5.7106
351.49

70.30P9040
RBC leukoreduced irradiated

K
0969
3.7037
227.97

45.59P9041
Albumin (human),5%, 50ml

K
0961

25.48

5.10P9043
Plasma protein fract,5%,50ml

K
0956
0.4016
24.72

4.94P9044
Cryoprecipitatereducedplasma

K
1009
1.2990
79.95

15.99P9045
Albumin (human), 5%, 250 ml

K
0963

72.09

14.42P9046
Albumin (human), 25%, 20 ml

K
0964

26.79

5.36P9047
Albumin (human), 25%, 50ml

K
0965

61.77

12.35P9048
Plasmaprotein fract,5%,250ml

K
0966
3.1309
192.71

38.54P9050
Granulocytes, pheresis unit

K
9506
4.1030
252.54

50.51P9051
Blood, l/r, cmv-neg

K
1010
2.1991
135.36

27.07P9052
Platelets, hla-m, l/r, unit

K
1011
10.5084
646.80

129.36P9053
Plt, pher, l/r cmv-neg, irr

K
1020
11.7025
720.30

144.06P9054
Blood, l/r, froz/degly/wash

K
1016
1.4462
89.02

17.80P9055
Plt, aph/pher, l/r, cmv-neg

K
1017
6.1508
378.59

75.72P9056
Blood, l/r, irradiated

K
1018
2.1765
133.97

26.79P9057
RBC, frz/deg/wsh, l/r, irrad

K
1021
6.9189
425.87

85.17P9058
RBC, l/r, cmv-neg, irrad

K
1022
4.2818
263.55

52.71P9059
Plasma, frz between 8-24hour

K
0955
1.1864
73.02

14.60P9060
Fr frz plasma donor retested

K
9503
1.1915
73.34

14.67P9612
Catheterize for urine spec
CH
AP9615
Urine specimen collect mult

NQ0035
Cardiokymography

X
0100
2.5352
156.04
41.44
31.21Q0091
Obtaining screen pap smear

T
0191
0.1501
9.24

1.85Q0092
Set up port xray equipment

NQ0163
Diphenhydramine HCl 50mg

NQ0164
Prochlorperazine maleate 5mg

NQ0166
Granisetron HCl 1 mg oral

K
0765

37.08

7.42Q0167
Dronabinol 2.5mg oral

NQ0169
Promethazine HCl 12.5mg oral

NQ0171
Chlorpromazine HCl 10mg oral

NQ0173
Trimethobenzamide HCl 250mg

NQ0174
Thiethylperazine maleate10mg

NQ0175
Perphenazine 4mg oral

NQ0177
Hydroxyzine pamoate 25mg

NQ0179
Ondansetron HCl 8mg oral

K
0769

34.21

6.84Q0180
Dolasetron mesylate oral

K
0763

47.52

9.50Q0512
Px sup fee anti-can sub pres
CH
BQ0515
Sermorelin acetate injection
CH
K
3050

1.73

0.35Q1003
Ntiol category 3

NQ1004
Ntiol category 4

NQ1005
Ntiol category 5

NQ2004
Bladder calculi irrig sol

NQ2009
Fosphenytoin, 50 mg

K
7028

5.18

1.04Q2017
Teniposide, 50 mg

K
7035

264.26

52.85Q3019
ALS emer trans no ALS serv
CH
EQ3020
ALS nonemer trans no ALS ser
CH
EQ3025
IM inj interferon beta 1-a

K
9022

97.99

19.60( print page 49845)Q3031
Collagen skin test

NQ4079
Natalizumab injection

G
9126

6.39

1.28Q9945
LOCM =149 mg/ml iodine, 1ml

K
9157

0.30

0.06Q9946
LOCM 150-199mg/ml iodine,1ml

K
9158

1.84

0.37Q9947
LOCM 200-249mg/ml iodine,1ml

K
9159

1.25

0.25Q9948
LOCM 250-299mg/ml iodine,1ml

K
9160

0.32

0.06Q9949
LOCM 300-349mg/ml iodine,1ml

K
9161

0.34

0.07Q9950
LOCM 350-399mg/ml iodine,1ml

K
9162

0.21

0.04Q9951
LOCM = 400 mg/ml iodine,1ml

K
9163

0.30

0.06Q9952
Inj Gad-base MR contrast,1ml

K
9164

2.88

0.58Q9953
Inj Fe-based MR contrast,1ml

K
1713

30.12

6.02Q9954
Oral MR contrast, 100 ml

K
9165

8.87

1.77Q9955
Inj perflexane lip micros,ml

K
9203

8.22

1.64Q9956
Inj octafluoropropane mic,ml

K
9202

40.75

8.15Q9957
Inj perflutren lip micros,ml

K
9112

61.25

12.25Q9958
HOCM =149 mg/ml iodine, 1ml
CH
NQ9959
HOCM 150-199mg/ml iodine,1ml

NQ9960
HOCM 200-249mg/ml iodine,1ml
CH
NQ9961
HOCM 250-299mg/ml iodine,1ml
CH
NQ9962
HOCM 300-349mg/ml iodine,1ml
CH
NQ9963
HOCM 350-399mg/ml iodine,1ml
CH
NQ9964
HOCM= 400mg/ml iodine, 1ml
CH
NV2630
Anter chamber intraocul lens

NV2631
Iris support intraoclr lens

NV2632
Post chmbr intraocular lens

NV2790
Amniotic membrane

N
 Addendum BB.—Proposed List of Medicare Approved ASC Procedures For CY 2008 With Additions and Payment Rates
HCPCS
Short Description
New 2008 ASC approved procedure
Designated as office based
Payment capped at MPFS rate
CY 08 ASC relative payment weight
CY 08 payment without 50/50 transition
CY 08 payment with 50/50 transition
CY 08 copayment without 50/50 transition
CY 08 copayment with 50/50 transition10021
Fna w/o image
Y
Y

1.0948
$43.45
$43.45
$8.69
$8.6910022
Fna w/image
Y


2.0147
$79.96
$79.96
$15.99
$15.9910040
Acne surgery
Y
Y

0.4829
$19.17
$19.17
$3.83
$3.8310060
Drainage of skin abscess
Y
Y
Y
1.1457
$45.47
$45.47
$9.09
$9.0910061
Drainage of skin abscess
Y
Y

1.4821
$58.82
$58.82
$11.76
$11.7610080
Drainage of pilonidal cyst
Y
Y

1.4821
$58.82
$58.82
$11.76
$11.7610081
Drainage of pilonidal cyst
Y
Y
Y
3.2148
$127.59
$127.59
$25.52
$25.5210120
Remove foreign body
Y
Y

1.4821
$58.82
$58.82
$11.76
$11.7610121
Remove foreign body



14.9563
$593.59
$519.79
$118.72
$103.9610140
Drainage of hematoma/fluid
Y
Y
Y
1.7090
$67.83
$67.83
$13.57
$13.5710160
Puncture drainage of lesion
Y
Y

1.0534
$41.81
$41.81
$8.36
$8.3610180
Complex drainage, wound



17.4686
$693.30
$569.65
$138.66
$113.9311000
Debride infected skin
Y
Y
Y
0.5503
$21.84
$21.84
$4.37
$4.3711001
Debride infected skin add-on
Y
Y
Y
0.1942
$7.71
$7.71
$1.54
$1.5411010
Debride skin, fx



4.0123
$159.24
$203.10
$31.85
$40.6211011
Debride skin/muscle, fx



4.0123
$159.24
$203.10
$31.85
$40.6211012
Debride skin/muscle/bone, fx



4.0123
$159.24
$203.10
$31.85
$40.6211040
Debride skin, partial
Y
Y
Y
0.5040
$20.00
$20.00
$4.00
$4.00( print page 49846)11041
Debride skin, full
Y
Y
Y
0.6042
$23.98
$23.98
$4.80
$4.8011042
Debride skin/tissue



2.6253
$104.19
$132.89
$20.84
$26.5811043
Debride tissue/muscle



2.6253
$104.19
$132.89
$20.84
$26.5811044
Debride tissue/muscle/bone



6.7529
$268.01
$341.83
$53.60
$68.3711055
Trim skin lesion
Y
Y
Y
0.5762
$22.87
$22.87
$4.57
$4.5711056
Trim skin lesions, 2 to 4
Y
Y
Y
0.6403
$25.41
$25.41
$5.08
$5.0811057
Trim skin lesions, over 4
Y
Y
Y
0.7268
$28.85
$28.85
$5.77
$5.7711100
Biopsy, skin lesion
Y
Y

1.0534
$41.81
$41.81
$8.36
$8.3611101
Biopsy, skin add-on
Y
Y
Y
0.3217
$12.77
$12.77
$2.55
$2.5511200
Removal of skin tags
Y
Y
Y
0.9713
$38.55
$38.55
$7.71
$7.7111201
Remove skin tags add-on
Y
Y
Y
0.1365
$5.42
$5.42
$1.08
$1.0811300
Shave skin lesion
Y
Y

0.8076
$32.05
$32.05
$6.41
$6.4111301
Shave skin lesion
Y
Y

0.8076
$32.05
$32.05
$6.41
$6.4111302
Shave skin lesion
Y
Y

1.0876
$43.16
$43.16
$8.63
$8.6311303
Shave skin lesion
Y
Y
Y
1.5547
$61.70
$61.70
$12.34
$12.3411305
Shave skin lesion
Y
Y
Y
0.8112
$32.20
$32.20
$6.44
$6.4411306
Shave skin lesion
Y
Y
Y
1.0789
$42.82
$42.82
$8.56
$8.5611307
Shave skin lesion
Y
Y

1.0876
$43.16
$43.16
$8.63
$8.6311308
Shave skin lesion
Y
Y

1.0876
$43.16
$43.16
$8.63
$8.6311310
Shave skin lesion
Y
Y
Y
1.0785
$42.80
$42.80
$8.56
$8.5611311
Shave skin lesion
Y
Y

1.0876
$43.16
$43.16
$8.63
$8.6311312
Shave skin lesion
Y
Y

1.0876
$43.16
$43.16
$8.63
$8.6311313
Shave skin lesion
Y
Y
Y
1.7299
$68.66
$68.66
$13.73
$13.7311400
Removal of skin lesion
Y
Y
Y
1.6618
$65.96
$65.96
$13.19
$13.1911401
Removal of skin lesion
Y
Y
Y
1.8178
$72.14
$72.14
$14.43
$14.4311402
Removal of skin lesion
Y
Y
Y
1.9768
$78.45
$78.45
$15.69
$15.6911403
Removal of skin lesion
Y
Y
Y
2.1118
$83.81
$83.81
$16.76
$16.7611404
Exc tr-ext b9+marg 3.1-4 cm



14.9563
$593.59
$463.29
$118.72
$92.6611406
Exc tr-ext b9+marg  4.0 cm



14.9563
$593.59
$519.79
$118.72
$103.9611420
Removal of skin lesion
Y
Y
Y
1.5323
$60.81
$60.81
$12.16
$12.1611421
Removal of skin lesion
Y
Y
Y
1.8294
$72.61
$72.61
$14.52
$14.5211422
Removal of skin lesion
Y
Y
Y
1.9996
$79.36
$79.36
$15.87
$15.8711423
Removal of skin lesion
Y
Y
Y
2.2405
$88.92
$88.92
$17.78
$17.78( print page 49847)11424
Exc h-f-nk-sp b9+marg 3.1-4



14.9563
$593.59
$519.79
$118.72
$103.9611426
Exc h-f-nk-sp b9+marg  4 cm



19.9760
$792.81
$619.40
$158.56
$123.8811440
Removal of skin lesion
Y
Y
Y
1.8212
$72.28
$72.28
$14.46
$14.4611441
Removal of skin lesion
Y
Y
Y
2.0319
$80.64
$80.64
$16.13
$16.1311442
Removal of skin lesion
Y
Y
Y
2.2205
$88.13
$88.13
$17.63
$17.6311443
Removal of skin lesion
Y
Y
Y
2.4880
$98.75
$98.75
$19.75
$19.7511444
Exc face-mm b9+marg 3.1-4 cm



6.5128
$258.48
$295.74
$51.70
$59.1511446
Exc face-mm b9+marg  4 cm



19.9760
$792.81
$619.40
$158.56
$123.8811450
Removal, sweat gland lesion



19.9760
$792.81
$619.40
$158.56
$123.8811451
Removal, sweat gland lesion



19.9760
$792.81
$619.40
$158.56
$123.8811462
Removal, sweat gland lesion



19.9760
$792.81
$619.40
$158.56
$123.8811463
Removal, sweat gland lesion



19.9760
$792.81
$619.40
$158.56
$123.8811470
Removal, sweat gland lesion



19.9760
$792.81
$619.40
$158.56
$123.8811471
Removal, sweat gland lesion



19.9760
$792.81
$619.40
$158.56
$123.8811600
Removal of skin lesion
Y
Y
Y
2.2612
$89.74
$89.74
$17.95
$17.9511601
Removal of skin lesion
Y
Y
Y
2.5980
$103.11
$103.11
$20.62
$20.6211602
Removal of skin lesion
Y
Y
Y
2.8188
$111.87
$111.87
$22.37
$22.3711603
Removal of skin lesion
Y
Y
Y
3.0099
$119.46
$119.46
$23.89
$23.8911604
Exc tr-ext mlg+marg 3.1-4 cm



6.5128
$258.48
$329.68
$51.70
$65.9411606
Exc tr-ext mlg+marg  4 cm



14.9563
$593.59
$519.79
$118.72
$103.9611620
Removal of skin lesion
Y
Y
Y
2.2902
$90.89
$90.89
$18.18
$18.1811621
Removal of skin lesion
Y
Y
Y
2.6216
$104.05
$104.05
$20.81
$20.8111622
Removal of skin lesion
Y
Y
Y
2.9059
$115.33
$115.33
$23.07
$23.0711623
Removal of skin lesion
Y
Y
Y
3.1563
$125.27
$125.27
$25.05
$25.0511624
Exc h-f-nk-sp mlg+marg 3.1-4



14.9563
$593.59
$519.79
$118.72
$103.9611626
Exc h-f-nk-sp mlg+mar  4 cm



19.9760
$792.81
$619.40
$158.56
$123.8811640
Removal of skin lesion
Y
Y
Y
2.4089
$95.60
$95.60
$19.12
$19.1211641
Removal of skin lesion
Y
Y
Y
2.8188
$111.87
$111.87
$22.37
$22.3711642
Removal of skin lesion
Y
Y
Y
3.1554
$125.23
$125.23
$25.05
$25.0511643
Removal of skin lesion
Y
Y
Y
3.4305
$136.15
$136.15
$27.23
$27.23( print page 49848)11644
Exc face-mm malig+marg 3.1-4



14.9563
$593.59
$519.79
$118.72
$103.9611646
Exc face-mm mlg+marg  4 cm



19.9760
$792.81
$619.40
$158.56
$123.8811719
Trim nail(s)
Y
Y
Y
0.2643
$10.49
$10.49
$2.10
$2.1011720
Debride nail, 1-5
Y
Y
Y
0.3393
$13.47
$13.47
$2.69
$2.6911721
Debride nail, 6 or more
Y
Y
Y
0.4134
$16.41
$16.41
$3.28
$3.2811730
Removal of nail plate
Y
Y
Y
0.9967
$39.56
$39.56
$7.91
$7.9111732
Remove nail plate, add-on
Y
Y
Y
0.4138
$16.42
$16.42
$3.28
$3.2811740
Drain blood from under nail
Y
Y
Y
0.5675
$22.52
$22.52
$4.50
$4.5011750
Removal of nail bed
Y
Y
Y
2.1520
$85.41
$85.41
$17.08
$17.0811752
Remove nail bed/finger tip
Y
Y
Y
3.0179
$119.78
$119.78
$23.96
$23.9611755
Biopsy, nail unit
Y
Y
Y
1.5236
$60.47
$60.47
$12.09
$12.0911760
Repair of nail bed
Y


1.4924
$59.23
$59.23
$11.85
$11.8511762
Reconstruction of nail bed
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8511765
Excision of nail fold, toe
Y
Y

1.6062
$63.75
$63.75
$12.75
$12.7511770
Removal of pilonidal lesion



19.9760
$792.81
$651.40
$158.56
$130.2811771
Removal of pilonidal lesion



19.9760
$792.81
$651.40
$158.56
$130.2811772
Removal of pilonidal lesion



19.9760
$792.81
$651.40
$158.56
$130.2811900
Injection into skin lesions
Y
Y
Y
0.6789
$26.94
$26.94
$5.39
$5.3911901
Added skin lesions injection
Y
Y
Y
0.7259
$28.81
$28.81
$5.76
$5.7611920
Correct skin color defects
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8511921
Correct skin color defects
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8511922
Correct skin color defects
Y
Y
Y
0.8864
$35.18
$35.18
$7.04
$7.0411950
Therapy for contour defects
Y
Y
Y
0.8811
$34.97
$34.97
$6.99
$6.9911951
Therapy for contour defects
Y
Y
Y
1.1485
$45.58
$45.58
$9.12
$9.1211952
Therapy for contour defects
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8511954
Therapy for contour defects
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8511960
Insert tissue expander(s)



21.2645
$843.95
$644.97
$168.79
$128.9911970
Replace tissue expander



41.2543
$1,637.30
$1,073.65
$327.46
$214.7311971
Remove tissue expander(s)



19.9760
$792.81
$562.90
$158.56
$112.5811976
Removal of contraceptive cap
Y
Y
Y
1.4625
$58.04
$58.04
$11.61
$11.61( print page 49849)11980
Implant hormone pellet(s)
Y
Y

0.6211
$24.65
$24.65
$4.93
$4.9311981
Insert drug implant device
Y
Y

0.6211
$24.65
$24.65
$4.93
$4.9311982
Remove drug implant device
Y
Y

0.6211
$24.65
$24.65
$4.93
$4.9311983
Remove/insert drug implant
Y
Y

0.6211
$24.65
$24.65
$4.93
$4.9312001
Repair superficial wound(s)
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8512002
Repair superficial wound(s)
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8512004
Repair superficial wound(s)
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8512005
Repair superficial wound(s)



1.4924
$59.23
$75.55
$11.85
$15.1112006
Repair superficial wound(s)



1.4924
$59.23
$75.55
$11.85
$15.1112007
Repair superficial wound(s)



1.4924
$59.23
$75.55
$11.85
$15.1112011
Repair superficial wound(s)
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8512013
Repair superficial wound(s)
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8512014
Repair superficial wound(s)
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8512015
Repair superficial wound(s)
Y


1.4924
$59.23
$59.23
$11.85
$11.8512016
Repair superficial wound(s)



1.4924
$59.23
$75.55
$11.85
$15.1112017
Repair superficial wound(s)



1.4924
$59.23
$75.55
$11.85
$15.1112018
Repair superficial wound(s)



1.4924
$59.23
$75.55
$11.85
$15.1112020
Closure of split wound



1.4924
$59.23
$75.55
$11.85
$15.1112021
Closure of split wound



1.4924
$59.23
$75.55
$11.85
$15.1112031
Layer closure of wound(s)
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8512032
Layer closure of wound(s)
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8512034
Layer closure of wound(s)



1.4924
$59.23
$75.55
$11.85
$15.1112035
Layer closure of wound(s)



1.4924
$59.23
$75.55
$11.85
$15.1112036
Layer closure of wound(s)



1.4924
$59.23
$75.55
$11.85
$15.1112037
Layer closure of wound(s)



5.0931
$202.14
$257.81
$40.43
$51.5612041
Layer closure of wound(s)
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8512042
Layer closure of wound(s)
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.85( print page 49850)12044
Layer closure of wound(s)



1.4924
$59.23
$75.55
$11.85
$15.1112045
Layer closure of wound(s)



1.4924
$59.23
$75.55
$11.85
$15.1112046
Layer closure of wound(s)



1.4924
$59.23
$75.55
$11.85
$15.1112047
Layer closure of wound(s)



5.0931
$202.14
$257.81
$40.43
$51.5612051
Layer closure of wound(s)
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8512052
Layer closure of wound(s)
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8512053
Layer closure of wound(s)
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8512054
Layer closure of wound(s)



1.4924
$59.23
$75.55
$11.85
$15.1112055
Layer closure of wound(s)



1.4924
$59.23
$75.55
$11.85
$15.1112056
Layer closure of wound(s)



1.4924
$59.23
$75.55
$11.85
$15.1112057
Layer closure of wound(s)



5.0931
$202.14
$257.81
$40.43
$51.5613100
Repair of wound or lesion



5.0931
$202.14
$257.81
$40.43
$51.5613101
Repair of wound or lesion



5.0931
$202.14
$257.81
$40.43
$51.5613102
Repair wound/lesion add-on
Y


1.4924
$59.23
$59.23
$11.85
$11.8513120
Repair of wound or lesion



1.4924
$59.23
$75.55
$11.85
$15.1113121
Repair of wound or lesion



1.4924
$59.23
$75.55
$11.85
$15.1113122
Repair wound/lesion add-on
Y


1.4924
$59.23
$59.23
$11.85
$11.8513131
Repair of wound or lesion



1.4924
$59.23
$75.55
$11.85
$15.1113132
Repair of wound or lesion



1.4924
$59.23
$75.55
$11.85
$15.1113133
Repair wound/lesion add-on
Y
Y

1.4924
$59.23
$59.23
$11.85
$11.8513150
Repair of wound or lesion



5.0931
$202.14
$257.81
$40.43
$51.5613151
Repair of wound or lesion



1.4924
$59.23
$75.55
$11.85
$15.1113152
Repair of wound or lesion



5.0931
$202.14
$257.81
$40.43
$51.5613153
Repair wound/lesion add-on
Y


1.4924
$59.23
$59.23
$11.85
$11.8513160
Late closure of wound



21.2645
$843.95
$644.97
$168.79
$128.9914000
Skin tissue rearrangement



13.3433
$529.57
$487.79
$105.91
$97.5614001
Skin tissue rearrangement



21.2645
$843.95
$676.97
$168.79
$135.3914020
Skin tissue rearrangement



13.3433
$529.57
$519.79
$105.91
$103.9614021
Skin tissue rearrangement



13.3433
$529.57
$519.79
$105.91
$103.9614040
Skin tissue rearrangement



13.3433
$529.57
$487.79
$105.91
$97.5614041
Skin tissue rearrangement



13.3433
$529.57
$519.79
$105.91
$103.9614060
Skin tissue rearrangement



13.3433
$529.57
$519.79
$105.91
$103.9614061
Skin tissue rearrangement



13.3433
$529.57
$519.79
$105.91
$103.9614300
Skin tissue rearrangement



21.2645
$843.95
$736.97
$168.79
$147.39( print page 49851)14350
Skin tissue rearrangement



21.2645
$843.95
$676.97
$168.79
$135.3915000
Wound prep, 1st 100 sq cm



5.0931
$202.14
$257.81
$40.43
$51.5615001
Wound prep, addl 100 sq cm



5.0931
$202.14
$257.81
$40.43
$51.5615040
Harvest cultured skin graft



1.4924
$59.23
$75.55
$11.85
$15.1115050
Skin pinch graft



5.0931
$202.14
$257.81
$40.43
$51.5615100
Skin splt grft, trnk/arm/leg



21.2645
$843.95
$644.97
$168.79
$128.9915101
Skin splt grft t/a/l, add-on



21.2645
$843.95
$676.97
$168.79
$135.3915110
Epidrm autogrft trnk/arm/leg



21.2645
$843.95
$644.97
$168.79
$128.9915111
Epidrm autogrft t/a/l add-on



21.2645
$843.95
$588.47
$168.79
$117.6915115
Epidrm a-grft face/nck/hf/g



21.2645
$843.95
$644.97
$168.79
$128.9915116
Epidrm a-grft f/n/hf/g addl



21.2645
$843.95
$588.47
$168.79
$117.6915120
Skn splt a-grft fac/nck/hf/g



21.2645
$843.95
$644.97
$168.79
$128.9915121
Skn splt a-grft f/n/hf/g add



21.2645
$843.95
$676.97
$168.79
$135.3915130
Derm autograft, trnk/arm/leg



21.2645
$843.95
$644.97
$168.79
$128.9915131
Derm autograft t/a/l add-on



21.2645
$843.95
$588.47
$168.79
$117.6915135
Derm autograft face/nck/hf/g



21.2645
$843.95
$644.97
$168.79
$128.9915136
Derm autograft, f/n/hf/g add



21.2645
$843.95
$588.47
$168.79
$117.6915150
Cult epiderm grft t/arm/leg



21.2645
$843.95
$644.97
$168.79
$128.9915151
Cult epiderm grft t/a/l addl



21.2645
$843.95
$588.47
$168.79
$117.6915152
Cult epiderm graft t/a/l +%



21.2645
$843.95
$588.47
$168.79
$117.6915155
Cult epiderm graft, f/n/hf/g



21.2645
$843.95
$644.97
$168.79
$128.9915156
Cult epidrm grft f/n/hfg add



21.2645
$843.95
$588.47
$168.79
$117.6915157
Cult epiderm grft f/n/hfg +%



21.2645
$843.95
$588.47
$168.79
$117.6915200
Skin full graft, trunk



13.3433
$529.57
$519.79
$105.91
$103.9615201
Skin full graft trunk add-on



5.0931
$202.14
$257.81
$40.43
$51.5615220
Skin full graft sclp/arm/leg



13.3433
$529.57
$487.79
$105.91
$97.5615221
Skin full graft add-on



5.0931
$202.14
$257.81
$40.43
$51.5615240
Skin full grft face/genit/hf



13.3433
$529.57
$519.79
$105.91
$103.9615241
Skin full graft add-on



5.0931
$202.14
$257.81
$40.43
$51.5615260
Skin full graft een  lips



13.3433
$529.57
$487.79
$105.91
$97.5615261
Skin full graft add-on



5.0931
$202.14
$257.81
$40.43
$51.5615300
Apply skinallogrft, t/arm/lg



5.0931
$202.14
$257.81
$40.43
$51.5615301
Apply sknallogrft t/a/l addl



5.0931
$202.14
$257.81
$40.43
$51.56( print page 49852)15320
Apply skin allogrft f/n/hf/g



5.0931
$202.14
$257.81
$40.43
$51.5615321
Aply sknallogrft f/n/hfg add



5.0931
$202.14
$257.81
$40.43
$51.5615330
Aply acell alogrft t/arm/leg



5.0931
$202.14
$257.81
$40.43
$51.5615331
Aply acell grft t/a/l add-on



5.0931
$202.14
$257.81
$40.43
$51.5615335
Apply acell graft, f/n/hf/g



5.0931
$202.14
$257.81
$40.43
$51.5615336
Aply acell grft f/n/hf/g add



5.0931
$202.14
$257.81
$40.43
$51.5615340
Apply cult skin substitute
Y
Y
Y
3.2865
$130.44
$130.44
$26.09
$26.0915341
Apply cult skin sub add-on
Y


5.0931
$202.14
$202.14
$40.43
$40.4315360
Apply cult derm sub, t/a/l
Y


5.0931
$202.14
$202.14
$40.43
$40.4315361
Aply cult derm sub t/a/l add
Y


5.0931
$202.14
$202.14
$40.43
$40.4315365
Apply cult derm sub f/n/hf/g
Y


5.0931
$202.14
$202.14
$40.43
$40.4315366
Apply cult derm f/hf/g add
Y


5.0931
$202.14
$202.14
$40.43
$40.4315400
Apply skin xenograft, t/a/l



5.0931
$202.14
$257.81
$40.43
$51.5615401
Apply skn xenogrft t/a/l add



5.0931
$202.14
$257.81
$40.43
$51.5615420
Apply skin xgraft, f/n/hf/g



5.0931
$202.14
$257.81
$40.43
$51.5615421
Apply skn xgrft f/n/hf/g add



5.0931
$202.14
$257.81
$40.43
$51.5615430
Apply acellular xenograft



5.0931
$202.14
$257.81
$40.43
$51.5615431
Apply acellular xgraft add



5.0931
$202.14
$257.81
$40.43
$51.5615570
Form skin pedicle flap



21.2645
$843.95
$676.97
$168.79
$135.3915572
Form skin pedicle flap



21.2645
$843.95
$676.97
$168.79
$135.3915574
Form skin pedicle flap



21.2645
$843.95
$676.97
$168.79
$135.3915576
Form skin pedicle flap



13.3433
$529.57
$519.79
$105.91
$103.9615600
Skin graft



21.2645
$843.95
$676.97
$168.79
$135.3915610
Skin graft



21.2645
$843.95
$676.97
$168.79
$135.3915620
Skin graft



21.2645
$843.95
$736.97
$168.79
$147.3915630
Skin graft



21.2645
$843.95
$676.97
$168.79
$135.3915650
Transfer skin pedicle flap



21.2645
$843.95
$780.47
$168.79
$156.0915732
Muscle-skin graft, head/neck



21.2645
$843.95
$676.97
$168.79
$135.3915734
Muscle-skin graft, trunk



21.2645
$843.95
$676.97
$168.79
$135.3915736
Muscle-skin graft, arm



21.2645
$843.95
$676.97
$168.79
$135.3915738
Muscle-skin graft, leg



21.2645
$843.95
$676.97
$168.79
$135.3915740
Island pedicle flap graft



13.3433
$529.57
$487.79
$105.91
$97.5615750
Neurovascular pedicle graft



21.2645
$843.95
$644.97
$168.79
$128.9915760
Composite skin graft



21.2645
$843.95
$644.97
$168.79
$128.99( print page 49853)15770
Derma-fat-fascia graft



21.2645
$843.95
$676.97
$168.79
$135.3915775
Hair transplant punch grafts



5.0931
$202.14
$257.81
$40.43
$51.5615776
Hair transplant punch grafts



5.0931
$202.14
$257.81
$40.43
$51.5615780
Abrasion treatment of skin
Y
Y
Y
10.0118
$397.35
$397.35
$79.47
$79.4715781
Abrasion treatment of skin
Y
Y

4.0123
$159.24
$159.24
$31.85
$31.8515782
Dressing change not for burn
Y
Y

4.0123
$159.24
$159.24
$31.85
$31.8515783
Abrasion treatment of skin
Y
Y

2.6253
$104.19
$104.19
$20.84
$20.8415786
Abrasion, lesion, single
Y
Y

1.0876
$43.16
$43.16
$8.63
$8.6315787
Abrasion, lesions, add-on
Y
Y
Y
0.8221
$32.63
$32.63
$6.53
$6.5315788
Chemical peel, face, epiderm
Y
Y

0.8076
$32.05
$32.05
$6.41
$6.4115789
Chemical peel, face, dermal
Y
Y

1.6062
$63.75
$63.75
$12.75
$12.7515792
Chemical peel, nonfacial
Y
Y

1.0876
$43.16
$43.16
$8.63
$8.6315793
Chemical peel, nonfacial
Y
Y

0.8076
$32.05
$32.05
$6.41
$6.4115819
Plastic surgery, neck
Y


5.0931
$202.14
$202.14
$40.43
$40.4315820
Revision of lower eyelid



21.2645
$843.95
$676.97
$168.79
$135.3915821
Revision of lower eyelid



21.2645
$843.95
$676.97
$168.79
$135.3915822
Revision of upper eyelid



21.2645
$843.95
$676.97
$168.79
$135.3915823
Revision of upper eyelid



13.3433
$529.57
$623.29
$105.91
$124.6615824
Removal of forehead wrinkles



21.2645
$843.95
$676.97
$168.79
$135.3915825
Removal of neck wrinkles



21.2645
$843.95
$676.97
$168.79
$135.3915826
Removal of brow wrinkles



21.2645
$843.95
$676.97
$168.79
$135.3915828
Removal of face wrinkles



21.2645
$843.95
$676.97
$168.79
$135.3915829
Removal of skin wrinkles



21.2645
$843.95
$780.47
$168.79
$156.0915831
Excise excessive skin tissue



19.9760
$792.81
$651.40
$158.56
$130.2815832
Excise excessive skin tissue



19.9760
$792.81
$651.40
$158.56
$130.2815833
Excise excessive skin tissue



19.9760
$792.81
$651.40
$158.56
$130.2815834
Excise excessive skin tissue



19.9760
$792.81
$651.40
$158.56
$130.2815835
Excise excessive skin tissue



5.0931
$202.14
$257.81
$40.43
$51.5615836
Excise excessive skin tissue



14.9563
$593.59
$551.79
$118.72
$110.36( print page 49854)15837
Excise excessive skin tissue
Y


14.9563
$593.59
$593.59
$118.72
$118.7215838
Excise excessive skin tissue
Y


14.9563
$593.59
$593.59
$118.72
$118.7215839
Excise excessive skin tissue



14.9563
$593.59
$551.79
$118.72
$110.3615840
Graft for face nerve palsy



21.2645
$843.95
$736.97
$168.79
$147.3915841
Graft for face nerve palsy



21.2645
$843.95
$736.97
$168.79
$147.3915845
Skin and muscle repair, face



21.2645
$843.95
$736.97
$168.79
$147.3915850
Removal of sutures
Y


2.6253
$104.19
$104.19
$20.84
$20.8415851
Removal of sutures
Y
Y
Y
1.2829
$50.92
$50.92
$10.18
$10.1815852
Dressing change not for burn
Y


0.6211
$24.65
$24.65
$4.93
$4.9315860
Test for blood flow in graft
Y


0.6211
$24.65
$24.65
$4.93
$4.9315876
Suction assisted lipectomy



21.2645
$843.95
$676.97
$168.79
$135.3915877
Suction assisted lipectomy



21.2645
$843.95
$676.97
$168.79
$135.3915878
Suction assisted lipectomy



13.3433
$529.57
$519.79
$105.91
$103.9615879
Suction assisted lipectomy



21.2645
$843.95
$676.97
$168.79
$135.3915920
Removal of tail bone ulcer



4.0123
$159.24
$203.10
$31.85
$40.6215922
Removal of tail bone ulcer



21.2645
$843.95
$736.97
$168.79
$147.3915931
Remove sacrum pressure sore



19.9760
$792.81
$651.40
$158.56
$130.2815933
Remove sacrum pressure sore



19.9760
$792.81
$651.40
$158.56
$130.2815934
Remove sacrum pressure sore



21.2645
$843.95
$676.97
$168.79
$135.3915935
Remove sacrum pressure sore



21.2645
$843.95
$736.97
$168.79
$147.3915936
Remove sacrum pressure sore



21.2645
$843.95
$736.97
$168.79
$147.3915937
Remove sacrum pressure sore



21.2645
$843.95
$736.97
$168.79
$147.3915940
Remove hip pressure sore



19.9760
$792.81
$651.40
$158.56
$130.2815941
Remove hip pressure sore



19.9760
$792.81
$651.40
$158.56
$130.2815944
Remove hip pressure sore



21.2645
$843.95
$676.97
$168.79
$135.3915945
Remove hip pressure sore



21.2645
$843.95
$736.97
$168.79
$147.3915946
Remove hip pressure sore



21.2645
$843.95
$736.97
$168.79
$147.3915950
Remove thigh pressure sore



19.9760
$792.81
$651.40
$158.56
$130.2815951
Remove thigh pressure sore



19.9760
$792.81
$711.40
$158.56
$142.2815952
Remove thigh pressure sore



21.2645
$843.95
$676.97
$168.79
$135.3915953
Remove thigh pressure sore



21.2645
$843.95
$736.97
$168.79
$147.39( print page 49855)15956
Remove thigh pressure sore



21.2645
$843.95
$676.97
$168.79
$135.3915958
Remove thigh pressure sore



21.2645
$843.95
$736.97
$168.79
$147.3916000
Initial treatment of burn(s)
Y
Y
Y
0.6709
$26.63
$26.63
$5.33
$5.3316020
Treatment of burn(s)
Y
Y
Y
1.0167
$40.35
$40.35
$8.07
$8.0716025
Dress/debrid p-thick burn, m



1.0876
$43.16
$55.05
$8.63
$11.0116030
Dress/debrid p-thick burn, l



1.6062
$63.75
$81.30
$12.75
$16.2617000
Destroy benign/premlg lesion
Y
Y

0.4829
$19.17
$19.17
$3.83
$3.8317003
Destroy lesions, 2-14
Y
Y
Y
0.0928
$3.68
$3.68
$0.74
$0.7417004
Destroy lesions, 15 or more
Y
Y
Y
2.0221
$80.25
$80.25
$16.05
$16.0517106
Destruction of skin lesions
Y
Y

2.6478
$105.09
$105.09
$21.02
$21.0217107
Destruction of skin lesions
Y
Y

2.6478
$105.09
$105.09
$21.02
$21.0217108
Destruction of skin lesions
Y
Y

2.6478
$105.09
$105.09
$21.02
$21.0217110
Destruct lesion, 1-14
Y
Y

0.8076
$32.05
$32.05
$6.41
$6.4117111
Destruct lesion, 15 or more
Y
Y

1.0876
$43.16
$43.16
$8.63
$8.6317250
Chemical cautery, tissue
Y
Y
Y
1.0812
$42.91
$42.91
$8.58
$8.5817260
Destruction of skin lesions
Y
Y
Y
1.1651
$46.24
$46.24
$9.25
$9.2517261
Destruction of skin lesions
Y
Y

1.6062
$63.75
$63.75
$12.75
$12.7517262
Destruction of skin lesions
Y
Y

1.6062
$63.75
$63.75
$12.75
$12.7517263
Destruction of skin lesions
Y
Y

1.6062
$63.75
$63.75
$12.75
$12.7517264
Destruction of skin lesions
Y
Y

1.6062
$63.75
$63.75
$12.75
$12.7517266
Destruction of skin lesions
Y
Y
Y
2.6129
$103.70
$103.70
$20.74
$20.7417270
Destruction of skin lesions
Y
Y

1.6062
$63.75
$63.75
$12.75
$12.7517271
Destruction of skin lesions
Y
Y

1.0876
$43.16
$43.16
$8.63
$8.6317272
Destruction of skin lesions
Y
Y

1.6062
$63.75
$63.75
$12.75
$12.7517273
Destruction of skin lesions
Y
Y

1.6062
$63.75
$63.75
$12.75
$12.7517274
Destruction of skin lesions
Y
Y

2.6253
$104.19
$104.19
$20.84
$20.8417276
Destruction of skin lesions
Y
Y

2.6253
$104.19
$104.19
$20.84
$20.8417280
Destruction of skin lesions
Y
Y

1.6062
$63.75
$63.75
$12.75
$12.7517281
Destruction of skin lesions
Y
Y

1.6062
$63.75
$63.75
$12.75
$12.7517282
Destruction of skin lesions
Y
Y

1.6062
$63.75
$63.75
$12.75
$12.7517283
Destruction of skin lesions
Y
Y

1.6062
$63.75
$63.75
$12.75
$12.7517284
Destruction of skin lesions
Y
Y

2.6253
$104.19
$104.19
$20.84
$20.8417286
Destruction of skin lesions
Y
Y

1.6062
$63.75
$63.75
$12.75
$12.7517304
1 stage mohs, up to 5 spec
Y
Y

3.4844
$138.29
$138.29
$27.66
$27.66( print page 49856)17305
2 stage mohs, up to 5 spec
Y
Y

3.4844
$138.29
$138.29
$27.66
$27.6617306
3 stage mohs, up to 5 spec
Y
Y

3.4844
$138.29
$138.29
$27.66
$27.6617307
Mohs addl stage up to 5 spec
Y
Y

3.4844
$138.29
$138.29
$27.66
$27.6617310
Mohs any stage  5 spec each
Y
Y
Y
1.5657
$62.14
$62.14
$12.43
$12.4317340
Cryotherapy of skin
Y
Y
Y
0.3096
$12.29
$12.29
$2.46
$2.4617360
Skin peel therapy
Y
Y

1.0876
$43.16
$43.16
$8.63
$8.6317380
Hair removal by electrolysis
Y
Y

1.0876
$43.16
$43.16
$8.63
$8.6319000
Drainage of breast lesion
Y
Y
Y
1.7129
$67.98
$67.98
$13.60
$13.6019001
Drain breast lesion add-on
Y
Y
Y
0.2210
$8.77
$8.77
$1.75
$1.7519020
Incision of breast lesion



17.4686
$693.30
$569.65
$138.66
$113.9319100
Bx breast percut w/o image



3.8051
$151.02
$192.61
$30.20
$38.5219101
Biopsy of breast, open



19.2250
$763.00
$604.50
$152.60
$120.9019102
Bx breast percut w/image



3.8051
$151.02
$192.61
$30.20
$38.5219103
Bx breast percut w/device



6.4482
$255.92
$326.40
$51.18
$65.2819110
Nipple exploration



19.2250
$763.00
$604.50
$152.60
$120.9019112
Excise breast duct fistula



19.2250
$763.00
$636.50
$152.60
$127.3019120
Removal of breast lesion



19.2250
$763.00
$636.50
$152.60
$127.3019125
Excision, breast lesion



19.2250
$763.00
$636.50
$152.60
$127.3019126
Excision, addl breast lesion



19.2250
$763.00
$636.50
$152.60
$127.3019140
Removal of breast tissue



19.2250
$763.00
$696.50
$152.60
$139.3019160
Partial mastectomy



19.2250
$763.00
$636.50
$152.60
$127.3019162
P-mastectomy w/ln removal



37.4843
$1,487.68
$1,241.34
$297.54
$248.2719180
Removal of breast



28.1505
$1,117.24
$873.62
$223.45
$174.7219182
Removal of breast



28.1505
$1,117.24
$873.62
$223.45
$174.7219295
Place breast clip, percut
Y


1.7625
$69.95
$69.95
$13.99
$13.9919296
Place po breast cath for rad



40.7495
$1,617.27
$1,478.13
$323.45
$295.6319297
Place breast cath for rad
Y


28.1505
$1,117.24
$1,117.24
$223.45
$223.4519298
Place breast rad tube/caths



-
$   -
$166.50
$    -
$33.3019316
Suspension of breast



28.1505
$1,117.24
$873.62
$223.45
$174.7219318
Reduction of large breast



37.4843
$1,487.68
$1,058.84
$297.54
$211.7719324
Enlarge breast



37.4843
$1,487.68
$1,058.84
$297.54
$211.7719325
Enlarge breast with implant



48.7796
$1,935.97
$1,637.48
$387.19
$327.5019328
Removal of breast implant



28.1505
$1,117.24
$725.12
$223.45
$145.0219330
Removal of implant material



28.1505
$1,117.24
$725.12
$223.45
$145.02( print page 49857)19340
Immediate breast prosthesis



40.7495
$1,617.27
$1,031.63
$323.45
$206.3319342
Delayed breast prosthesis



48.7796
$1,935.97
$1,222.98
$387.19
$244.6019350
Breast reconstruction



19.2250
$763.00
$696.50
$152.60
$139.3019355
Correct inverted nipple(s)



28.1505
$1,117.24
$873.62
$223.45
$174.7219357
Breast reconstruction



48.7796
$1,935.97
$1,326.48
$387.19
$265.3019366
Breast reconstruction



28.1505
$1,117.24
$917.12
$223.45
$183.4219370
Surgery of breast capsule



28.1505
$1,117.24
$873.62
$223.45
$174.7219371
Removal of breast capsule



28.1505
$1,117.24
$873.62
$223.45
$174.7219380
Revise breast reconstruction



40.7495
$1,617.27
$1,167.13
$323.45
$233.4319396
Design custom breast implant
Y


28.1505
$1,117.24
$1,117.24
$223.45
$223.4520000
Incision of abscess
Y
Y

1.4821
$58.82
$58.82
$11.76
$11.7620005
Incision of deep abscess



20.8214
$826.36
$636.18
$165.27
$127.2420103
Explore wound, extremity
Y


4.1133
$163.25
$163.25
$32.65
$32.6520150
Excise epiphyseal bar
Y


41.2543
$1,637.30
$1,637.30
$327.46
$327.4620200
Muscle biopsy



14.9563
$593.59
$519.79
$118.72
$103.9620205
Deep muscle biopsy



14.9563
$593.59
$551.79
$118.72
$110.3620206
Needle biopsy, muscle



3.8051
$151.02
$192.61
$30.20
$38.5220220
Bone biopsy, trocar/needle



4.0123
$159.24
$203.10
$31.85
$40.6220225
Bone biopsy, trocar/needle



6.5128
$258.48
$329.68
$51.70
$65.9420240
Bone biopsy, excisional



19.9760
$792.81
$619.40
$158.56
$123.8820245
Bone biopsy, excisional



19.9760
$792.81
$651.40
$158.56
$130.2820250
Open bone biopsy



20.8214
$826.36
$668.18
$165.27
$133.6420251
Open bone biopsy



20.8214
$826.36
$668.18
$165.27
$133.6420500
Injection of sinus tract
Y
Y
Y
1.5496
$61.50
$61.50
$12.30
$12.3020520
Removal of foreign body
Y
Y
Y
2.3536
$93.41
$93.41
$18.68
$18.6820525
Removal of foreign body



19.9760
$792.81
$651.40
$158.56
$130.2820526
Ther injection, carp tunnel
Y
Y
Y
0.7740
$30.72
$30.72
$6.14
$6.1420550
Inject tendon/ligament/cyst
Y
Y
Y
0.5718
$22.69
$22.69
$4.54
$4.5420551
Inj tendon origin/insertion
Y
Y
Y
0.5635
$22.37
$22.37
$4.47
$4.4720552
Inj trigger point, 1/2 muscl
Y
Y
Y
0.5564
$22.08
$22.08
$4.42
$4.4220553
Inject trigger points,  3
Y
Y
Y
0.6242
$24.77
$24.77
$4.95
$4.9520600
Drain/inject, joint/bursa
Y
Y
Y
0.5622
$22.31
$22.31
$4.46
$4.46( print page 49858)20605
Drain/inject, joint/bursa
Y
Y
Y
0.6427
$25.51
$25.51
$5.10
$5.1020610
Drain/inject, joint/bursa
Y
Y
Y
0.8759
$34.76
$34.76
$6.95
$6.9520612
Aspirate/inj ganglion cyst
Y
Y
Y
0.6035
$23.95
$23.95
$4.79
$4.7920615
Treatment of bone cyst
Y
Y

2.0863
$82.80
$82.80
$16.56
$16.5620650
Insert and remove bone pin



20.8214
$826.36
$668.18
$165.27
$133.6420662
Application of pelvis brace
Y
Y
Y
4.4737
$177.55
$177.55
$35.51
$35.5120663
Application of thigh brace
Y
Y
Y
4.2278
$167.79
$167.79
$33.56
$33.5620665
Removal of fixation device
Y


0.6211
$24.65
$24.65
$4.93
$4.9320670
Removal of support implant



14.9563
$593.59
$463.29
$118.72
$92.6620680
Removal of support implant



19.9760
$792.81
$651.40
$158.56
$130.2820690
Apply bone fixation device



25.0600
$994.58
$720.29
$198.92
$144.0620692
Apply bone fixation device



25.0600
$994.58
$752.29
$198.92
$150.4620693
Adjust bone fixation device



20.8214
$826.36
$668.18
$165.27
$133.6420694
Remove bone fixation device



20.8214
$826.36
$579.68
$165.27
$115.9420822
Replantation digit, complete
Y


25.8425
$1,025.64
$1,025.64
$205.13
$205.1320900
Removal of bone for graft



25.0600
$994.58
$752.29
$198.92
$150.4620902
Removal of bone for graft



25.0600
$994.58
$812.29
$198.92
$162.4620910
Remove cartilage for graft



21.2645
$843.95
$676.97
$168.79
$135.3920912
Remove cartilage for graft



21.2645
$843.95
$676.97
$168.79
$135.3920920
Removal of fascia for graft



13.3433
$529.57
$579.79
$105.91
$115.9620922
Removal of fascia for graft



21.2645
$843.95
$676.97
$168.79
$135.3920924
Removal of tendon for graft



25.0600
$994.58
$812.29
$198.92
$162.4620926
Removal of tissue for graft



13.3433
$529.57
$579.79
$105.91
$115.9620972
Bone/skin graft, metatarsal
Y


41.2239
$1,636.10
$1,636.10
$327.22
$327.2220973
Bone/skin graft, great toe
Y
Y
Y
16.9974
$674.60
$674.60
$134.92
$134.9220975
Electrical bone stimulation



0.6211
$24.65
$31.44
$4.93
$6.2920982
Ablate, bone tumor(s) perq
Y


25.0600
$994.58
$994.58
$198.92
$198.9221010
Incision of jaw joint



23.1564
$919.03
$682.52
$183.81
$136.5021015
Resection of facial tumor



16.4494
$652.85
$581.42
$130.57
$116.2821025
Excision of bone, lower jaw



37.7719
$1,499.09
$972.55
$299.82
$194.5121026
Excision of facial bone(s)



37.7719
$1,499.09
$972.55
$299.82
$194.5121029
Contour of face bone lesion



37.7719
$1,499.09
$972.55
$299.82
$194.51( print page 49859)21030
Removal of face bone lesion
Y
Y
Y
5.9541
$236.31
$236.31
$47.26
$47.2621031
Remove exostosis, mandible
Y
Y
Y
4.9253
$195.47
$195.47
$39.09
$39.0921032
Remove exostosis, maxilla
Y
Y
Y
5.0435
$200.17
$200.17
$40.03
$40.0321034
Excise max/zygoma mlg tumor



37.7719
$1,499.09
$1,004.55
$299.82
$200.9121040
Excise mandible lesion



23.1564
$919.03
$682.52
$183.81
$136.5021044
Removal of jaw bone lesion



37.7719
$1,499.09
$972.55
$299.82
$194.5121046
Remove mandible cyst complex



37.7719
$1,499.09
$972.55
$299.82
$194.5121047
Excise lwr jaw cyst w/repair



37.7719
$1,499.09
$972.55
$299.82
$194.5121048
Remove maxilla cyst complex
Y
Y
Y
10.3744
$411.74
$411.74
$82.35
$82.3521050
Removal of jaw joint



37.7719
$1,499.09
$1,004.55
$299.82
$200.9121060
Remove jaw joint cartilage



37.7719
$1,499.09
$972.55
$299.82
$194.5121070
Remove coronoid process



37.7719
$1,499.09
$1,004.55
$299.82
$200.9121076
Prepare face/oral prosthesis
Y
Y
Y
8.9380
$354.73
$354.73
$70.95
$70.9521077
Prepare face/oral prosthesis
Y
Y
Y
21.8677
$867.89
$867.89
$173.58
$173.5821079
Prepare face/oral prosthesis
Y
Y
Y
15.4101
$611.60
$611.60
$122.32
$122.3221080
Prepare face/oral prosthesis
Y
Y
Y
17.6321
$699.78
$699.78
$139.96
$139.9621081
Prepare face/oral prosthesis
Y
Y
Y
16.1148
$639.56
$639.56
$127.91
$127.9121082
Prepare face/oral prosthesis
Y
Y
Y
14.8249
$588.37
$588.37
$117.67
$117.6721083
Prepare face/oral prosthesis
Y
Y
Y
14.5513
$577.51
$577.51
$115.50
$115.5021084
Prepare face/oral prosthesis
Y
Y
Y
16.8041
$666.92
$666.92
$133.38
$133.3821085
Prepare face/oral prosthesis
Y
Y
Y
6.5587
$260.30
$260.30
$52.06
$52.0621086
Prepare face/oral prosthesis
Y
Y
Y
16.0903
$638.59
$638.59
$127.72
$127.7221087
Prepare face/oral prosthesis
Y
Y
Y
15.9673
$633.71
$633.71
$126.74
$126.7421088
Prepare face/oral prosthesis
Y
Y

37.7719
$1,499.09
$1,499.09
$299.82
$299.8221100
Maxillofacial fixation



37.7719
$1,499.09
$972.55
$299.82
$194.51( print page 49860)21110
Interdental fixation
Y
Y

7.7261
$306.63
$306.63
$61.33
$61.3321120
Reconstruction of chin



23.1564
$919.03
$957.02
$183.81
$191.4021121
Reconstruction of chin



23.1564
$919.03
$957.02
$183.81
$191.4021122
Reconstruction of chin



23.1564
$919.03
$957.02
$183.81
$191.4021123
Reconstruction of chin



23.1564
$919.03
$957.02
$183.81
$191.4021125
Augmentation, lower jaw bone



23.1564
$919.03
$957.02
$183.81
$191.4021127
Augmentation, lower jaw bone



37.7719
$1,499.09
$1,419.05
$299.82
$283.8121137
Reduction of forehead
Y


23.1564
$919.03
$919.03
$183.81
$183.8121138
Reduction of forehead
Y


37.7719
$1,499.09
$1,499.09
$299.82
$299.8221139
Reduction of forehead
Y


37.7719
$1,499.09
$1,499.09
$299.82
$299.8221150
Reconstruct midface, lefort
Y


37.7719
$1,499.09
$1,499.09
$299.82
$299.8221181
Contour cranial bone lesion



23.1564
$919.03
$957.02
$183.81
$191.4021198
Reconstr lwr jaw segment
Y


37.7719
$1,499.09
$1,499.09
$299.82
$299.8221199
Reconstr lwr jaw w/advance
Y


37.7719
$1,499.09
$1,499.09
$299.82
$299.8221206
Reconstruct upper jaw bone



37.7719
$1,499.09
$1,108.05
$299.82
$221.6121208
Augmentation of facial bones



37.7719
$1,499.09
$1,247.05
$299.82
$249.4121209
Reduction of facial bones



37.7719
$1,499.09
$1,108.05
$299.82
$221.6121210
Face bone graft



37.7719
$1,499.09
$1,247.05
$299.82
$249.4121215
Lower jaw bone graft



37.7719
$1,499.09
$1,247.05
$299.82
$249.4121230
Rib cartilage graft



37.7719
$1,499.09
$1,247.05
$299.82
$249.4121235
Ear cartilage graft



23.1564
$919.03
$957.02
$183.81
$191.4021240
Reconstruction of jaw joint



37.7719
$1,499.09
$1,064.55
$299.82
$212.9121242
Reconstruction of jaw joint



37.7719
$1,499.09
$1,108.05
$299.82
$221.6121243
Reconstruction of jaw joint



37.7719
$1,499.09
$1,108.05
$299.82
$221.6121244
Reconstruction of lower jaw



37.7719
$1,499.09
$1,247.05
$299.82
$249.4121245
Reconstruction of jaw



37.7719
$1,499.09
$1,247.05
$299.82
$249.4121246
Reconstruction of jaw



37.7719
$1,499.09
$1,247.05
$299.82
$249.4121248
Reconstruction of jaw



37.7719
$1,499.09
$1,247.05
$299.82
$249.4121249
Reconstruction of jaw



37.7719
$1,499.09
$1,247.05
$299.82
$249.4121260
Revise eye sockets
Y


37.7719
$1,499.09
$1,499.09
$299.82
$299.8221267
Revise eye sockets



37.7719
$1,499.09
$1,247.05
$299.82
$249.4121270
Augmentation, cheek bone



37.7719
$1,499.09
$1,108.05
$299.82
$221.61( print page 49861)21275
Revision, orbitofacial bones



37.7719
$1,499.09
$1,247.05
$299.82
$249.4121280
Revision of eyelid



37.7719
$1,499.09
$1,108.05
$299.82
$221.6121282
Revision of eyelid



16.4494
$652.85
$684.92
$130.57
$136.9821295
Revision of jaw muscle/bone



7.7261
$306.63
$319.82
$61.33
$63.9621296
Revision of jaw muscle/bone



23.1564
$919.03
$626.02
$183.81
$125.2021300
Treatment of skull fracture



16.4494
$652.85
$549.42
$130.57
$109.8821310
Treatment of nose fracture



2.3768
$94.33
$120.31
$18.87
$24.0621315
Treatment of nose fracture



2.3768
$94.33
$120.31
$18.87
$24.0621320
Treatment of nose fracture



7.7261
$306.63
$376.32
$61.33
$75.2621325
Treatment of nose fracture



23.1564
$919.03
$774.52
$183.81
$154.9021330
Treatment of nose fracture



23.1564
$919.03
$818.02
$183.81
$163.6021335
Treatment of nose fracture



23.1564
$919.03
$957.02
$183.81
$191.4021336
Treat nasal septal fracture



37.5680
$1,491.00
$1,060.50
$298.20
$212.1021337
Treat nasal septal fracture



16.4494
$652.85
$549.42
$130.57
$109.8821338
Treat nasoethmoid fracture



23.1564
$919.03
$774.52
$183.81
$154.9021339
Treat nasoethmoid fracture



23.1564
$919.03
$818.02
$183.81
$163.6021340
Treatment of nose fracture



37.7719
$1,499.09
$1,064.55
$299.82
$212.9121345
Treat nose/jaw fracture



23.1564
$919.03
$957.02
$183.81
$191.4021355
Treat cheek bone fracture



37.7719
$1,499.09
$1,004.55
$299.82
$200.9121356
Treat cheek bone fracture
Y


23.1564
$919.03
$919.03
$183.81
$183.8121390
Treat eye socket fracture
Y


37.7719
$1,499.09
$1,499.09
$299.82
$299.8221400
Treat eye socket fracture



7.7261
$306.63
$376.32
$61.33
$75.2621401
Treat eye socket fracture



16.4494
$652.85
$581.42
$130.57
$116.2821406
Treat eye socket fracture
Y


37.7719
$1,499.09
$1,499.09
$299.82
$299.8221407
Treat eye socket fracture
Y


37.7719
$1,499.09
$1,499.09
$299.82
$299.8221421
Treat mouth roof fracture



23.1564
$919.03
$774.52
$183.81
$154.9021440
Treat dental ridge fracture
Y
Y
Y
7.6734
$304.54
$304.54
$60.91
$60.9121445
Treat dental ridge fracture



23.1564
$919.03
$774.52
$183.81
$154.9021450
Treat lower jaw fracture



2.3768
$94.33
$120.31
$18.87
$24.0621451
Treat lower jaw fracture



7.7261
$306.63
$391.09
$61.33
$78.2221452
Treat lower jaw fracture



16.4494
$652.85
$549.42
$130.57
$109.8821453
Treat lower jaw fracture



37.7719
$1,499.09
$1,004.55
$299.82
$200.91( print page 49862)21454
Treat lower jaw fracture



23.1564
$919.03
$818.02
$183.81
$163.6021461
Treat lower jaw fracture



37.7719
$1,499.09
$1,064.55
$299.82
$212.9121462
Treat lower jaw fracture



37.7719
$1,499.09
$1,108.05
$299.82
$221.6121465
Treat lower jaw fracture



37.7719
$1,499.09
$1,064.55
$299.82
$212.9121480
Reset dislocated jaw



2.3768
$94.33
$120.31
$18.87
$24.0621485
Reset dislocated jaw



16.4494
$652.85
$549.42
$130.57
$109.8821490
Repair dislocated jaw



37.7719
$1,499.09
$1,004.55
$299.82
$200.9121495
Treat hyoid bone fracture
Y


16.4494
$652.85
$652.85
$130.57
$130.5721497
Interdental wiring



16.4494
$652.85
$549.42
$130.57
$109.8821501
Drain neck/chest lesion



17.4686
$693.30
$569.65
$138.66
$113.9321502
Drain chest lesion



20.8214
$826.36
$636.18
$165.27
$127.2421550
Biopsy of neck/chest
Y


6.5128
$258.48
$258.48
$51.70
$51.7021555
Remove lesion, neck/chest



19.9760
$792.81
$619.40
$158.56
$123.8821556
Remove lesion, neck/chest



19.9760
$792.81
$619.40
$158.56
$123.8821557
Remove tumor, neck/chest
Y


19.9760
$792.81
$792.81
$158.56
$158.5621600
Partial removal of rib



25.0600
$994.58
$720.29
$198.92
$144.0621610
Partial removal of rib



25.0600
$994.58
$720.29
$198.92
$144.0621685
Hyoid myotomy  suspension
Y


7.7261
$306.63
$306.63
$61.33
$61.3321700
Revision of neck muscle



20.8214
$826.36
$636.18
$165.27
$127.2421720
Revision of neck muscle



20.8214
$826.36
$668.18
$165.27
$133.6421725
Revision of neck muscle



1.4821
$58.82
$75.02
$11.76
$15.0021800
Treatment of rib fracture



1.6914
$67.13
$85.62
$13.43
$17.1221805
Treatment of rib fracture



25.6702
$1,018.80
$732.40
$203.76
$146.4821820
Treat sternum fracture



1.6914
$67.13
$85.62
$13.43
$17.1221920
Biopsy soft tissue of back
Y
Y
Y
3.3341
$132.32
$132.32
$26.46
$26.4621925
Biopsy soft tissue of back



19.9760
$792.81
$619.40
$158.56
$123.8821930
Remove lesion, back or flank



19.9760
$792.81
$619.40
$158.56
$123.8821935
Remove tumor, back



19.9760
$792.81
$651.40
$158.56
$130.2822102
Remove part, lumbar vertebra
Y


43.9030
$1,742.43
$1,742.43
$348.49
$348.4922103
Remove extra spine segment
Y


43.9030
$1,742.43
$1,742.43
$348.49
$348.4922305
Treat spine process fracture



1.6914
$67.13
$85.62
$13.43
$17.1222310
Treat spine fracture



1.6914
$67.13
$85.62
$13.43
$17.12( print page 49863)22315
Treat spine fracture



1.6914
$67.13
$85.62
$13.43
$17.1222505
Manipulation of spine



14.5502
$577.47
$511.73
$115.49
$102.3522520
Percut vertebroplasty thor
Y


25.0600
$994.58
$994.58
$198.92
$198.9222521
Percut vertebroplasty lumb
Y


25.0600
$994.58
$994.58
$198.92
$198.9222522
Percut vertebroplasty add'l
Y


25.0600
$994.58
$994.58
$198.92
$198.9222523
Percut kyphoplasty, thor
Y


65.8846
$2,614.83
$2,614.83
$522.97
$522.9722524
Percut kyphoplasty, lumbar
Y


65.8846
$2,614.83
$2,614.83
$522.97
$522.9722525
Percut kyphoplasty, add-on
Y


65.8846
$2,614.83
$2,614.83
$522.97
$522.9722900
Remove abdominal wall lesion



19.9760
$792.81
$711.40
$158.56
$142.2823000
Removal of calcium deposits



14.9563
$593.59
$519.79
$118.72
$103.9623020
Release shoulder joint



41.2543
$1,637.30
$1,041.65
$327.46
$208.3323030
Drain shoulder lesion



17.4686
$693.30
$513.15
$138.66
$102.6323031
Drain shoulder bursa



17.4686
$693.30
$601.65
$138.66
$120.3323035
Drain shoulder bone lesion



20.8214
$826.36
$668.18
$165.27
$133.6423040
Exploratory shoulder surgery



25.0600
$994.58
$752.29
$198.92
$150.4623044
Exploratory shoulder surgery



25.0600
$994.58
$812.29
$198.92
$162.4623065
Biopsy shoulder tissues
Y
Y
Y
2.3504
$93.28
$93.28
$18.66
$18.6623066
Biopsy shoulder tissues



19.9760
$792.81
$619.40
$158.56
$123.8823075
Removal of shoulder lesion



14.9563
$593.59
$519.79
$118.72
$103.9623076
Removal of shoulder lesion



19.9760
$792.81
$619.40
$158.56
$123.8823077
Remove tumor of shoulder



19.9760
$792.81
$651.40
$158.56
$130.2823100
Biopsy of shoulder joint



20.8214
$826.36
$636.18
$165.27
$127.2423101
Shoulder joint surgery



25.0600
$994.58
$994.79
$198.92
$198.9623105
Remove shoulder joint lining



25.0600
$994.58
$812.29
$198.92
$162.4623106
Incision of collarbone joint



25.0600
$994.58
$812.29
$198.92
$162.4623107
Explore treat shoulder joint



25.0600
$994.58
$812.29
$198.92
$162.4623120
Partial removal, collar bone



41.2543
$1,637.30
$1,177.15
$327.46
$235.4323125
Removal of collar bone



41.2543
$1,637.30
$1,177.15
$327.46
$235.43( print page 49864)23130
Remove shoulder bone, part



41.2543
$1,637.30
$1,177.15
$327.46
$235.4323140
Removal of bone lesion



20.8214
$826.36
$728.18
$165.27
$145.6423145
Removal of bone lesion



25.0600
$994.58
$855.79
$198.92
$171.1623146
Removal of bone lesion



25.0600
$994.58
$855.79
$198.92
$171.1623150
Removal of humerus lesion



25.0600
$994.58
$812.29
$198.92
$162.4623155
Removal of humerus lesion



25.0600
$994.58
$855.79
$198.92
$171.1623156
Removal of humerus lesion



25.0600
$994.58
$855.79
$198.92
$171.1623170
Remove collar bone lesion



25.0600
$994.58
$720.29
$198.92
$144.0623172
Remove shoulder blade lesion



25.0600
$994.58
$720.29
$198.92
$144.0623174
Remove humerus lesion



25.0600
$994.58
$720.29
$198.92
$144.0623180
Remove collar bone lesion



25.0600
$994.58
$812.29
$198.92
$162.4623182
Remove shoulder blade lesion



25.0600
$994.58
$812.29
$198.92
$162.4623184
Remove humerus lesion



25.0600
$994.58
$812.29
$198.92
$162.4623190
Partial removal of scapula



25.0600
$994.58
$812.29
$198.92
$162.4623195
Removal of head of humerus



25.0600
$994.58
$855.79
$198.92
$171.1623330
Remove shoulder foreign body



6.5128
$258.48
$295.74
$51.70
$59.1523331
Remove shoulder foreign body



19.9760
$792.81
$562.90
$158.56
$112.5823395
Muscle transfer,shoulder/arm



41.2543
$1,637.30
$1,177.15
$327.46
$235.4323397
Muscle transfers



65.8846
$2,614.83
$1,804.92
$522.97
$360.9823400
Fixation of shoulder blade



25.0600
$994.58
$994.79
$198.92
$198.9623405
Incision of tendon  muscle



25.0600
$994.58
$720.29
$198.92
$144.0623406
Incise tendon(s)  muscle(s)



25.0600
$994.58
$720.29
$198.92
$144.0623410
Repair rotator cuff, acute



41.2543
$1,637.30
$1,177.15
$327.46
$235.4323412
Repair rotator cuff, chronic



41.2543
$1,637.30
$1,316.15
$327.46
$263.2323415
Release of shoulder ligament



41.2543
$1,637.30
$1,177.15
$327.46
$235.4323420
Repair of shoulder



41.2543
$1,637.30
$1,316.15
$327.46
$263.2323430
Repair biceps tendon



41.2543
$1,637.30
$1,133.65
$327.46
$226.7323440
Remove/transplant tendon



41.2543
$1,637.30
$1,133.65
$327.46
$226.7323450
Repair shoulder capsule



65.8846
$2,614.83
$1,665.92
$522.97
$333.1823455
Repair shoulder capsule



65.8846
$2,614.83
$1,804.92
$522.97
$360.98( print page 49865)23460
Repair shoulder capsule



65.8846
$2,614.83
$1,665.92
$522.97
$333.1823462
Repair shoulder capsule



41.2543
$1,637.30
$1,316.15
$327.46
$263.2323465
Repair shoulder capsule



65.8846
$2,614.83
$1,665.92
$522.97
$333.1823466
Repair shoulder capsule



41.2543
$1,637.30
$1,316.15
$327.46
$263.2323480
Revision of collar bone



41.2543
$1,637.30
$1,133.65
$327.46
$226.7323485
Revision of collar bone



65.8846
$2,614.83
$1,804.92
$522.97
$360.9823490
Reinforce clavicle



41.2543
$1,637.30
$1,073.65
$327.46
$214.7323491
Reinforce shoulder bones



65.8846
$2,614.83
$1,562.42
$522.97
$312.4823500
Treat clavicle fracture



1.6914
$67.13
$85.62
$13.43
$17.1223505
Treat clavicle fracture



1.6914
$67.13
$85.62
$13.43
$17.1223515
Treat clavicle fracture



56.4195
$2,239.18
$1,374.59
$447.84
$274.9223520
Treat clavicle dislocation



1.6914
$67.13
$85.62
$13.43
$17.1223525
Treat clavicle dislocation



1.6914
$67.13
$85.62
$13.43
$17.1223530
Treat clavicle dislocation



37.5680
$1,491.00
$1,000.50
$298.20
$200.1023532
Treat clavicle dislocation



25.6702
$1,018.80
$824.40
$203.76
$164.8823540
Treat clavicle dislocation



1.6914
$67.13
$85.62
$13.43
$17.1223545
Treat clavicle dislocation



1.6914
$67.13
$85.62
$13.43
$17.1223550
Treat clavicle dislocation



37.5680
$1,491.00
$1,000.50
$298.20
$200.1023552
Treat clavicle dislocation



37.5680
$1,491.00
$1,060.50
$298.20
$212.1023570
Treat shoulder blade fx



1.6914
$67.13
$85.62
$13.43
$17.1223575
Treat shoulder blade fx



1.6914
$67.13
$85.62
$13.43
$17.1223585
Treat scapula fracture



56.4195
$2,239.18
$1,374.59
$447.84
$274.9223600
Treat humerus fracture
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4323605
Treat humerus fracture



1.6914
$67.13
$85.62
$13.43
$17.1223615
Treat humerus fracture



56.4195
$2,239.18
$1,434.59
$447.84
$286.9223616
Treat humerus fracture



56.4195
$2,239.18
$1,434.59
$447.84
$286.9223620
Treat humerus fracture
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4323625
Treat humerus fracture



1.6914
$67.13
$85.62
$13.43
$17.1223630
Treat humerus fracture



56.4195
$2,239.18
$1,478.09
$447.84
$295.6223650
Treat shoulder dislocation



1.6914
$67.13
$85.62
$13.43
$17.1223655
Treat shoulder dislocation



14.5502
$577.47
$455.23
$115.49
$91.0523660
Treat shoulder dislocation



37.5680
$1,491.00
$1,000.50
$298.20
$200.1023665
Treat dislocation/fracture



1.6914
$67.13
$85.62
$13.43
$17.1223670
Treat dislocation/fracture



56.4195
$2,239.18
$1,374.59
$447.84
$274.92( print page 49866)23675
Treat dislocation/fracture



1.6914
$67.13
$85.62
$13.43
$17.1223680
Treat dislocation/fracture



37.5680
$1,491.00
$1,000.50
$298.20
$200.1023700
Fixation of shoulder



14.5502
$577.47
$455.23
$115.49
$91.0523800
Fusion of shoulder joint



65.8846
$2,614.83
$1,622.42
$522.97
$324.4823802
Fusion of shoulder joint



41.2543
$1,637.30
$1,316.15
$327.46
$263.2323921
Amputation follow-up surgery



5.0931
$202.14
$257.81
$40.43
$51.5623930
Drainage of arm lesion



17.4686
$693.30
$513.15
$138.66
$102.6323931
Drainage of arm bursa



17.4686
$693.30
$569.65
$138.66
$113.9323935
Drain arm/elbow bone lesion



20.8214
$826.36
$636.18
$165.27
$127.2424000
Exploratory elbow surgery



25.0600
$994.58
$812.29
$198.92
$162.4624006
Release elbow joint



25.0600
$994.58
$812.29
$198.92
$162.4624065
Biopsy arm/elbow soft tissue
Y
Y
Y
3.1861
$126.45
$126.45
$25.29
$25.2924066
Biopsy arm/elbow soft tissue



14.9563
$593.59
$519.79
$118.72
$103.9624075
Remove arm/elbow lesion



14.9563
$593.59
$519.79
$118.72
$103.9624076
Remove arm/elbow lesion



19.9760
$792.81
$619.40
$158.56
$123.8824077
Remove tumor of arm/elbow



19.9760
$792.81
$651.40
$158.56
$130.2824100
Biopsy elbow joint lining



20.8214
$826.36
$579.68
$165.27
$115.9424101
Explore/treat elbow joint



25.0600
$994.58
$812.29
$198.92
$162.4624102
Remove elbow joint lining



25.0600
$994.58
$812.29
$198.92
$162.4624105
Removal of elbow bursa



20.8214
$826.36
$668.18
$165.27
$133.6424110
Remove humerus lesion



20.8214
$826.36
$636.18
$165.27
$127.2424115
Remove/graft bone lesion



25.0600
$994.58
$752.29
$198.92
$150.4624116
Remove/graft bone lesion



25.0600
$994.58
$752.29
$198.92
$150.4624120
Remove elbow lesion



20.8214
$826.36
$668.18
$165.27
$133.6424125
Remove/graft bone lesion



25.0600
$994.58
$752.29
$198.92
$150.4624126
Remove/graft bone lesion



25.0600
$994.58
$752.29
$198.92
$150.4624130
Removal of head of radius



25.0600
$994.58
$752.29
$198.92
$150.4624134
Removal of arm bone lesion



25.0600
$994.58
$720.29
$198.92
$144.0624136
Remove radius bone lesion



25.0600
$994.58
$720.29
$198.92
$144.0624138
Remove elbow bone lesion



25.0600
$994.58
$720.29
$198.92
$144.0624140
Partial removal of arm bone



25.0600
$994.58
$752.29
$198.92
$150.4624145
Partial removal of radius



25.0600
$994.58
$752.29
$198.92
$150.46( print page 49867)24147
Partial removal of elbow



25.0600
$994.58
$720.29
$198.92
$144.0624149
Radical resection of elbow
Y


25.0600
$994.58
$994.58
$198.92
$198.9224152
Extensive radius surgery
Y


41.2543
$1,637.30
$1,637.30
$327.46
$327.4624153
Extensive radius surgery
Y


65.8846
$2,614.83
$2,614.83
$522.97
$522.9724155
Removal of elbow joint



41.2543
$1,637.30
$1,073.65
$327.46
$214.7324160
Remove elbow joint implant



25.0600
$994.58
$720.29
$198.92
$144.0624164
Remove radius head implant



25.0600
$994.58
$752.29
$198.92
$150.4624200
Removal of arm foreign body
Y
Y
Y
2.6370
$104.66
$104.66
$20.93
$20.9324201
Removal of arm foreign body



14.9563
$593.59
$519.79
$118.72
$103.9624300
Manipulate elbow w/anesth
Y


14.5502
$577.47
$577.47
$115.49
$115.4924301
Muscle/tendon transfer



25.0600
$994.58
$812.29
$198.92
$162.4624305
Arm tendon lengthening



25.0600
$994.58
$812.29
$198.92
$162.4624310
Revision of arm tendon



20.8214
$826.36
$668.18
$165.27
$133.6424320
Repair of arm tendon



41.2543
$1,637.30
$1,073.65
$327.46
$214.7324330
Revision of arm muscles



65.8846
$2,614.83
$1,562.42
$522.97
$312.4824331
Revision of arm muscles



41.2543
$1,637.30
$1,073.65
$327.46
$214.7324332
Tenolysis, triceps
Y


20.8214
$826.36
$826.36
$165.27
$165.2724340
Repair of biceps tendon



41.2543
$1,637.30
$1,073.65
$327.46
$214.7324341
Repair arm tendon/muscle



41.2543
$1,637.30
$1,073.65
$327.46
$214.7324342
Repair of ruptured tendon



41.2543
$1,637.30
$1,073.65
$327.46
$214.7324343
Repr elbow lat ligmnt w/tiss
Y


25.0600
$994.58
$994.58
$198.92
$198.9224344
Reconstruct elbow lat ligmnt
Y


65.8846
$2,614.83
$2,614.83
$522.97
$522.9724345
Repr elbw med ligmnt w/tissu



25.0600
$994.58
$720.29
$198.92
$144.0624346
Reconstruct elbow med ligmnt
Y


41.2543
$1,637.30
$1,637.30
$327.46
$327.4624350
Repair of tennis elbow



25.0600
$994.58
$752.29
$198.92
$150.4624351
Repair of tennis elbow



25.0600
$994.58
$752.29
$198.92
$150.4624352
Repair of tennis elbow



25.0600
$994.58
$752.29
$198.92
$150.4624354
Repair of tennis elbow



25.0600
$994.58
$752.29
$198.92
$150.4624356
Revision of tennis elbow



25.0600
$994.58
$752.29
$198.92
$150.4624360
Reconstruct elbow joint



32.7543
$1,299.96
$1,008.48
$259.99
$201.7024361
Reconstruct elbow joint



105.1666
$4,173.86
$2,445.43
$834.77
$489.0924362
Reconstruct elbow joint



47.1644
$1,871.86
$1,294.43
$374.37
$258.89( print page 49868)24363
Replace elbow joint



105.1666
$4,173.86
$2,584.43
$834.77
$516.8924365
Reconstruct head of radius



32.7543
$1,299.96
$1,008.48
$259.99
$201.7024366
Reconstruct head of radius



105.1666
$4,173.86
$2,445.43
$834.77
$489.0924400
Revision of humerus



25.0600
$994.58
$812.29
$198.92
$162.4624410
Revision of humerus



25.0600
$994.58
$812.29
$198.92
$162.4624420
Revision of humerus



41.2543
$1,637.30
$1,073.65
$327.46
$214.7324430
Repair of humerus



65.8846
$2,614.83
$1,562.42
$522.97
$312.4824435
Repair humerus with graft



65.8846
$2,614.83
$1,622.42
$522.97
$324.4824470
Revision of elbow joint



41.2543
$1,637.30
$1,073.65
$327.46
$214.7324495
Decompression of forearm



25.0600
$994.58
$720.29
$198.92
$144.0624498
Reinforce humerus



65.8846
$2,614.83
$1,562.42
$522.97
$312.4824500
Treat humerus fracture



1.6914
$67.13
$85.62
$13.43
$17.1224505
Treat humerus fracture



1.6914
$67.13
$85.62
$13.43
$17.1224515
Treat humerus fracture



56.4195
$2,239.18
$1,434.59
$447.84
$286.9224516
Treat humerus fracture



56.4195
$2,239.18
$1,434.59
$447.84
$286.9224530
Treat humerus fracture



1.6914
$67.13
$85.62
$13.43
$17.1224535
Treat humerus fracture



1.6914
$67.13
$85.62
$13.43
$17.1224538
Treat humerus fracture



25.6702
$1,018.80
$732.40
$203.76
$146.4824545
Treat humerus fracture



56.4195
$2,239.18
$1,434.59
$447.84
$286.9224546
Treat humerus fracture



56.4195
$2,239.18
$1,478.09
$447.84
$295.6224560
Treat humerus fracture



1.6914
$67.13
$85.62
$13.43
$17.1224565
Treat humerus fracture



1.6914
$67.13
$85.62
$13.43
$17.1224566
Treat humerus fracture



25.6702
$1,018.80
$732.40
$203.76
$146.4824575
Treat humerus fracture



56.4195
$2,239.18
$1,374.59
$447.84
$274.9224576
Treat humerus fracture



1.6914
$67.13
$85.62
$13.43
$17.1224577
Treat humerus fracture



1.6914
$67.13
$85.62
$13.43
$17.1224579
Treat humerus fracture



56.4195
$2,239.18
$1,374.59
$447.84
$274.9224582
Treat humerus fracture



25.6702
$1,018.80
$732.40
$203.76
$146.4824586
Treat elbow fracture



56.4195
$2,239.18
$1,434.59
$447.84
$286.9224587
Treat elbow fracture



56.4195
$2,239.18
$1,478.09
$447.84
$295.6224600
Treat elbow dislocation



1.6914
$67.13
$85.62
$13.43
$17.1224605
Treat elbow dislocation



14.5502
$577.47
$511.73
$115.49
$102.3524615
Treat elbow dislocation



56.4195
$2,239.18
$1,374.59
$447.84
$274.92( print page 49869)24620
Treat elbow fracture



1.6914
$67.13
$85.62
$13.43
$17.1224635
Treat elbow fracture



56.4195
$2,239.18
$1,374.59
$447.84
$274.9224640
Treat elbow dislocation
Y


1.6914
$67.13
$67.13
$13.43
$13.4324650
Treat radius fracture
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4324655
Treat radius fracture



1.6914
$67.13
$85.62
$13.43
$17.1224665
Treat radius fracture



37.5680
$1,491.00
$1,060.50
$298.20
$212.1024666
Treat radius fracture



56.4195
$2,239.18
$1,434.59
$447.84
$286.9224670
Treat ulnar fracture



1.6914
$67.13
$85.62
$13.43
$17.1224675
Treat ulnar fracture



1.6914
$67.13
$85.62
$13.43
$17.1224685
Treat ulnar fracture



37.5680
$1,491.00
$1,000.50
$298.20
$200.1024800
Fusion of elbow joint



41.2543
$1,637.30
$1,133.65
$327.46
$226.7324802
Fusion/graft of elbow joint



41.2543
$1,637.30
$1,177.15
$327.46
$235.4324925
Amputation follow-up surgery



20.8214
$826.36
$668.18
$165.27
$133.6425000
Incision of tendon sheath



20.8214
$826.36
$668.18
$165.27
$133.6425001
Incise flexor carpi radialis
Y


20.8214
$826.36
$826.36
$165.27
$165.2725020
Decompress forearm 1 space



20.8214
$826.36
$668.18
$165.27
$133.6425023
Decompress forearm 1 space



25.0600
$994.58
$752.29
$198.92
$150.4625024
Decompress forearm 2 spaces



25.0600
$994.58
$752.29
$198.92
$150.4625025
Decompress forearm 2 spaces



25.0600
$994.58
$752.29
$198.92
$150.4625028
Drainage of forearm lesion



20.8214
$826.36
$579.68
$165.27
$115.9425031
Drainage of forearm bursa



20.8214
$826.36
$636.18
$165.27
$127.2425035
Treat forearm bone lesion



20.8214
$826.36
$636.18
$165.27
$127.2425040
Explore/treat wrist joint



25.0600
$994.58
$855.79
$198.92
$171.1625065
Biopsy forearm soft tissues
Y
Y
Y
3.2509
$129.02
$129.02
$25.80
$25.8025066
Biopsy forearm soft tissues



19.9760
$792.81
$619.40
$158.56
$123.8825075
Removal forearm lesion subcu



14.9563
$593.59
$519.79
$118.72
$103.9625076
Removal forearm lesion deep



19.9760
$792.81
$651.40
$158.56
$130.2825077
Remove tumor, forearm/wrist



19.9760
$792.81
$651.40
$158.56
$130.2825085
Incision of wrist capsule



20.8214
$826.36
$668.18
$165.27
$133.6425100
Biopsy of wrist joint



20.8214
$826.36
$636.18
$165.27
$127.24( print page 49870)25101
Explore/treat wrist joint



25.0600
$994.58
$752.29
$198.92
$150.4625105
Remove wrist joint lining



25.0600
$994.58
$812.29
$198.92
$162.4625107
Remove wrist joint cartilage



25.0600
$994.58
$752.29
$198.92
$150.4625110
Remove wrist tendon lesion



20.8214
$826.36
$668.18
$165.27
$133.6425111
Remove wrist tendon lesion



16.0343
$636.37
$573.19
$127.27
$114.6425112
Reremove wrist tendon lesion



16.0343
$636.37
$633.19
$127.27
$126.6425115
Remove wrist/forearm lesion



20.8214
$826.36
$728.18
$165.27
$145.6425116
Remove wrist/forearm lesion



20.8214
$826.36
$728.18
$165.27
$145.6425118
Excise wrist tendon sheath



25.0600
$994.58
$720.29
$198.92
$144.0625119
Partial removal of ulna



25.0600
$994.58
$752.29
$198.92
$150.4625120
Removal of forearm lesion



25.0600
$994.58
$752.29
$198.92
$150.4625125
Remove/graft forearm lesion



25.0600
$994.58
$752.29
$198.92
$150.4625126
Remove/graft forearm lesion



25.0600
$994.58
$752.29
$198.92
$150.4625130
Removal of wrist lesion



25.0600
$994.58
$752.29
$198.92
$150.4625135
Remove  graft wrist lesion



25.0600
$994.58
$752.29
$198.92
$150.4625136
Remove  graft wrist lesion



25.0600
$994.58
$752.29
$198.92
$150.4625145
Remove forearm bone lesion



25.0600
$994.58
$720.29
$198.92
$144.0625150
Partial removal of ulna



25.0600
$994.58
$720.29
$198.92
$144.0625151
Partial removal of radius



25.0600
$994.58
$720.29
$198.92
$144.0625210
Removal of wrist bone



25.8425
$1,025.64
$767.82
$205.13
$153.5625215
Removal of wrist bones



25.8425
$1,025.64
$827.82
$205.13
$165.5625230
Partial removal of radius



25.0600
$994.58
$812.29
$198.92
$162.4625240
Partial removal of ulna



25.0600
$994.58
$812.29
$198.92
$162.4625248
Remove forearm foreign body



20.8214
$826.36
$636.18
$165.27
$127.2425250
Removal of wrist prosthesis



25.0600
$994.58
$663.79
$198.92
$132.7625251
Removal of wrist prosthesis



25.0600
$994.58
$663.79
$198.92
$132.7625259
Manipulate wrist w/anesthes
Y


1.6914
$67.13
$67.13
$13.43
$13.4325260
Repair forearm tendon/muscle



25.0600
$994.58
$812.29
$198.92
$162.4625263
Repair forearm tendon/muscle



25.0600
$994.58
$720.29
$198.92
$144.0625265
Repair forearm tendon/muscle



25.0600
$994.58
$752.29
$198.92
$150.46( print page 49871)25270
Repair forearm tendon/muscle



25.0600
$994.58
$812.29
$198.92
$162.4625272
Repair forearm tendon/muscle



25.0600
$994.58
$752.29
$198.92
$150.4625274
Repair forearm tendon/muscle



25.0600
$994.58
$812.29
$198.92
$162.4625275
Repair forearm tendon sheath



25.0600
$994.58
$812.29
$198.92
$162.4625280
Revise wrist/forearm tendon



25.0600
$994.58
$812.29
$198.92
$162.4625290
Incise wrist/forearm tendon



25.0600
$994.58
$752.29
$198.92
$150.4625295
Release wrist/forearm tendon



20.8214
$826.36
$668.18
$165.27
$133.6425300
Fusion of tendons at wrist



25.0600
$994.58
$752.29
$198.92
$150.4625301
Fusion of tendons at wrist



25.0600
$994.58
$752.29
$198.92
$150.4625310
Transplant forearm tendon



41.2543
$1,637.30
$1,073.65
$327.46
$214.7325312
Transplant forearm tendon



41.2543
$1,637.30
$1,133.65
$327.46
$226.7325315
Revise palsy hand tendon(s)



41.2543
$1,637.30
$1,073.65
$327.46
$214.7325316
Revise palsy hand tendon(s)



65.8846
$2,614.83
$1,562.42
$522.97
$312.4825320
Repair/revise wrist joint



41.2543
$1,637.30
$1,073.65
$327.46
$214.7325332
Revise wrist joint



32.7543
$1,299.96
$1,008.48
$259.99
$201.7025335
Realignment of hand



41.2543
$1,637.30
$1,073.65
$327.46
$214.7325337
Reconstruct ulna/radioulnar



41.2543
$1,637.30
$1,177.15
$327.46
$235.4325350
Revision of radius



65.8846
$2,614.83
$1,562.42
$522.97
$312.4825355
Revision of radius



41.2543
$1,637.30
$1,073.65
$327.46
$214.7325360
Revision of ulna



25.0600
$994.58
$752.29
$198.92
$150.4625365
Revise radius  ulna



25.0600
$994.58
$752.29
$198.92
$150.4625370
Revise radius or ulna



41.2543
$1,637.30
$1,073.65
$327.46
$214.7325375
Revise radius  ulna



41.2543
$1,637.30
$1,133.65
$327.46
$226.7325390
Shorten radius or ulna



25.0600
$994.58
$752.29
$198.92
$150.4625391
Lengthen radius or ulna



41.2543
$1,637.30
$1,133.65
$327.46
$226.7325392
Shorten radius  ulna



25.0600
$994.58
$752.29
$198.92
$150.4625393
Lengthen radius  ulna



41.2543
$1,637.30
$1,133.65
$327.46
$226.7325394
Repair carpal bone, shorten
Y


16.0343
$636.37
$636.37
$127.27
$127.2725400
Repair radius or ulna



25.0600
$994.58
$752.29
$198.92
$150.4625405
Repair/graft radius or ulna



25.0600
$994.58
$812.29
$198.92
$162.46( print page 49872)25415
Repair radius  ulna



25.0600
$994.58
$752.29
$198.92
$150.4625420
Repair/graft radius  ulna



65.8846
$2,614.83
$1,622.42
$522.97
$324.4825425
Repair/graft radius or ulna



41.2543
$1,637.30
$1,073.65
$327.46
$214.7325426
Repair/graft radius  ulna



41.2543
$1,637.30
$1,133.65
$327.46
$226.7325430
Vasc graft into carpal bone
Y


25.8425
$1,025.64
$1,025.64
$205.13
$205.1325431
Repair nonunion carpal bone
Y


25.8425
$1,025.64
$1,025.64
$205.13
$205.1325440
Repair/graft wrist bone



65.8846
$2,614.83
$1,622.42
$522.97
$324.4825441
Reconstruct wrist joint



105.1666
$4,173.86
$2,445.43
$834.77
$489.0925442
Reconstruct wrist joint



105.1666
$4,173.86
$2,445.43
$834.77
$489.0925443
Reconstruct wrist joint



47.1644
$1,871.86
$1,294.43
$374.37
$258.8925444
Reconstruct wrist joint



47.1644
$1,871.86
$1,294.43
$374.37
$258.8925445
Reconstruct wrist joint



47.1644
$1,871.86
$1,294.43
$374.37
$258.8925446
Wrist replacement



105.1666
$4,173.86
$2,584.43
$834.77
$516.8925447
Repair wrist joint(s)



32.7543
$1,299.96
$1,008.48
$259.99
$201.7025449
Remove wrist joint implant



32.7543
$1,299.96
$1,008.48
$259.99
$201.7025450
Revision of wrist joint



41.2543
$1,637.30
$1,073.65
$327.46
$214.7325455
Revision of wrist joint



41.2543
$1,637.30
$1,073.65
$327.46
$214.7325490
Reinforce radius



41.2543
$1,637.30
$1,073.65
$327.46
$214.7325491
Reinforce ulna



41.2543
$1,637.30
$1,073.65
$327.46
$214.7325492
Reinforce radius and ulna



41.2543
$1,637.30
$1,073.65
$327.46
$214.7325500
Treat fracture of radius
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4325505
Treat fracture of radius



1.6914
$67.13
$85.62
$13.43
$17.1225515
Treat fracture of radius



37.5680
$1,491.00
$1,000.50
$298.20
$200.1025520
Treat fracture of radius



1.6914
$67.13
$85.62
$13.43
$17.1225525
Treat fracture of radius



37.5680
$1,491.00
$1,060.50
$298.20
$212.1025526
Treat fracture of radius



37.5680
$1,491.00
$1,104.00
$298.20
$220.8025530
Treat fracture of ulna
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4325535
Treat fracture of ulna



1.6914
$67.13
$85.62
$13.43
$17.1225545
Treat fracture of ulna



37.5680
$1,491.00
$1,000.50
$298.20
$200.1025560
Treat fracture radius  ulna
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4325565
Treat fracture radius  ulna



1.6914
$67.13
$85.62
$13.43
$17.1225574
Treat fracture radius  ulna



56.4195
$2,239.18
$1,374.59
$447.84
$274.9225575
Treat fracture radius/ulna



56.4195
$2,239.18
$1,374.59
$447.84
$274.9225600
Treat fracture radius/ulna
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4325605
Treat fracture radius/ulna



1.6914
$67.13
$85.62
$13.43
$17.12( print page 49873)25611
Treat fracture radius/ulna



25.6702
$1,018.80
$764.40
$203.76
$152.8825620
Treat fracture radius/ulna



56.4195
$2,239.18
$1,478.09
$447.84
$295.6225622
Treat wrist bone fracture
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4325624
Treat wrist bone fracture



1.6914
$67.13
$85.62
$13.43
$17.1225628
Treat wrist bone fracture



37.5680
$1,491.00
$1,000.50
$298.20
$200.1025630
Treat wrist bone fracture
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4325635
Treat wrist bone fracture



1.6914
$67.13
$85.62
$13.43
$17.1225645
Treat wrist bone fracture



37.5680
$1,491.00
$1,000.50
$298.20
$200.1025650
Treat wrist bone fracture
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4325651
Pin ulnar styloid fracture
Y


25.6702
$1,018.80
$1,018.80
$203.76
$203.7625652
Treat fracture ulnar styloid
Y


37.5680
$1,491.00
$1,491.00
$298.20
$298.2025660
Treat wrist dislocation



1.6914
$67.13
$85.62
$13.43
$17.1225670
Treat wrist dislocation



25.6702
$1,018.80
$764.40
$203.76
$152.8825671
Pin radioulnar dislocation



25.6702
$1,018.80
$675.90
$203.76
$135.1825675
Treat wrist dislocation



1.6914
$67.13
$85.62
$13.43
$17.1225676
Treat wrist dislocation



25.6702
$1,018.80
$732.40
$203.76
$146.4825680
Treat wrist fracture



1.6914
$67.13
$85.62
$13.43
$17.1225685
Treat wrist fracture



25.6702
$1,018.80
$764.40
$203.76
$152.8825690
Treat wrist dislocation



1.6914
$67.13
$85.62
$13.43
$17.1225695
Treat wrist dislocation



25.6702
$1,018.80
$732.40
$203.76
$146.4825800
Fusion of wrist joint



65.8846
$2,614.83
$1,622.42
$522.97
$324.4825805
Fusion/graft of wrist joint



41.2543
$1,637.30
$1,177.15
$327.46
$235.4325810
Fusion/graft of wrist joint



65.8846
$2,614.83
$1,665.92
$522.97
$333.1825820
Fusion of hand bones



16.0343
$636.37
$633.19
$127.27
$126.6425825
Fuse hand bones with graft



25.8425
$1,025.64
$871.32
$205.13
$174.2625830
Fusion, radioulnar jnt/ulna



65.8846
$2,614.83
$1,665.92
$522.97
$333.1825907
Amputation follow-up surgery



20.8214
$826.36
$668.18
$165.27
$133.6425922
Amputate hand at wrist



20.8214
$826.36
$668.18
$165.27
$133.6425929
Amputation follow-up surgery



13.3433
$529.57
$519.79
$105.91
$103.9626010
Drainage of finger abscess
Y
Y

1.4821
$58.82
$58.82
$11.76
$11.7626011
Drainage of finger abscess



10.9184
$433.33
$383.17
$86.67
$76.6326020
Drain hand tendon sheath



16.0343
$636.37
$541.19
$127.27
$108.24( print page 49874)26025
Drainage of palm bursa



16.0343
$636.37
$484.69
$127.27
$96.9426030
Drainage of palm bursa(s)



16.0343
$636.37
$541.19
$127.27
$108.2426034
Treat hand bone lesion



16.0343
$636.37
$541.19
$127.27
$108.2426035
Decompress fingers/hand
Y


16.0343
$636.37
$636.37
$127.27
$127.2726040
Release palm contracture



25.8425
$1,025.64
$827.82
$205.13
$165.5626045
Release palm contracture



25.8425
$1,025.64
$767.82
$205.13
$153.5626055
Incise finger tendon sheath



16.0343
$636.37
$541.19
$127.27
$108.2426060
Incision of finger tendon



16.0343
$636.37
$541.19
$127.27
$108.2426070
Explore/treat hand joint



16.0343
$636.37
$541.19
$127.27
$108.2426075
Explore/treat finger joint



16.0343
$636.37
$633.19
$127.27
$126.6426080
Explore/treat finger joint



16.0343
$636.37
$633.19
$127.27
$126.6426100
Biopsy hand joint lining



16.0343
$636.37
$541.19
$127.27
$108.2426105
Biopsy finger joint lining



16.0343
$636.37
$484.69
$127.27
$96.9426110
Biopsy finger joint lining



16.0343
$636.37
$484.69
$127.27
$96.9426115
Removal hand lesion subcut



19.9760
$792.81
$619.40
$158.56
$123.8826116
Removal hand lesion, deep



19.9760
$792.81
$619.40
$158.56
$123.8826117
Remove tumor, hand/finger



19.9760
$792.81
$651.40
$158.56
$130.2826121
Release palm contracture



25.8425
$1,025.64
$827.82
$205.13
$165.5626123
Release palm contracture



25.8425
$1,025.64
$827.82
$205.13
$165.5626125
Release palm contracture



16.0343
$636.37
$633.19
$127.27
$126.6426130
Remove wrist joint lining



16.0343
$636.37
$573.19
$127.27
$114.6426135
Revise finger joint, each



25.8425
$1,025.64
$827.82
$205.13
$165.5626140
Revise finger joint, each



16.0343
$636.37
$541.19
$127.27
$108.2426145
Tendon excision, palm/finger



16.0343
$636.37
$573.19
$127.27
$114.6426160
Remove tendon sheath lesion



16.0343
$636.37
$573.19
$127.27
$114.6426170
Removal of palm tendon, each



16.0343
$636.37
$573.19
$127.27
$114.6426180
Removal of finger tendon



16.0343
$636.37
$573.19
$127.27
$114.6426185
Remove finger bone



16.0343
$636.37
$633.19
$127.27
$126.6426200
Remove hand bone lesion



16.0343
$636.37
$541.19
$127.27
$108.2426205
Remove/graft bone lesion



25.8425
$1,025.64
$767.82
$205.13
$153.5626210
Removal of finger lesion



16.0343
$636.37
$541.19
$127.27
$108.2426215
Remove/graft finger lesion



16.0343
$636.37
$573.19
$127.27
$114.6426230
Partial removal of hand bone



16.0343
$636.37
$811.65
$127.27
$162.33( print page 49875)26235
Partial removal, finger bone



16.0343
$636.37
$573.19
$127.27
$114.6426236
Partial removal, finger bone



16.0343
$636.37
$573.19
$127.27
$114.6426250
Extensive hand surgery



16.0343
$636.37
$573.19
$127.27
$114.6426255
Extensive hand surgery



25.8425
$1,025.64
$767.82
$205.13
$153.5626260
Extensive finger surgery



16.0343
$636.37
$573.19
$127.27
$114.6426261
Extensive finger surgery



16.0343
$636.37
$573.19
$127.27
$114.6426262
Partial removal of finger



16.0343
$636.37
$541.19
$127.27
$108.2426320
Removal of implant from hand



14.9563
$593.59
$519.79
$118.72
$103.9626340
Manipulate finger w/anesth
Y


1.6914
$67.13
$67.13
$13.43
$13.4326350
Repair finger/hand tendon



25.8425
$1,025.64
$679.32
$205.13
$135.8626352
Repair/graft hand tendon



25.8425
$1,025.64
$827.82
$205.13
$165.5626356
Repair finger/hand tendon



25.8425
$1,025.64
$827.82
$205.13
$165.5626357
Repair finger/hand tendon



25.8425
$1,025.64
$827.82
$205.13
$165.5626358
Repair/graft hand tendon



25.8425
$1,025.64
$827.82
$205.13
$165.5626370
Repair finger/hand tendon



25.8425
$1,025.64
$827.82
$205.13
$165.5626372
Repair/graft hand tendon



25.8425
$1,025.64
$827.82
$205.13
$165.5626373
Repair finger/hand tendon



25.8425
$1,025.64
$767.82
$205.13
$153.5626390
Revise hand/finger tendon



25.8425
$1,025.64
$827.82
$205.13
$165.5626392
Repair/graft hand tendon



25.8425
$1,025.64
$767.82
$205.13
$153.5626410
Repair hand tendon



16.0343
$636.37
$573.19
$127.27
$114.6426412
Repair/graft hand tendon



25.8425
$1,025.64
$767.82
$205.13
$153.5626415
Excision, hand/finger tendon



25.8425
$1,025.64
$827.82
$205.13
$165.5626416
Graft hand or finger tendon



25.8425
$1,025.64
$767.82
$205.13
$153.5626418
Repair finger tendon



16.0343
$636.37
$633.19
$127.27
$126.6426420
Repair/graft finger tendon



25.8425
$1,025.64
$827.82
$205.13
$165.5626426
Repair finger/hand tendon



25.8425
$1,025.64
$767.82
$205.13
$153.5626428
Repair/graft finger tendon



25.8425
$1,025.64
$767.82
$205.13
$153.5626432
Repair finger tendon



16.0343
$636.37
$573.19
$127.27
$114.6426433
Repair finger tendon



16.0343
$636.37
$573.19
$127.27
$114.6426434
Repair/graft finger tendon



25.8425
$1,025.64
$767.82
$205.13
$153.5626437
Realignment of tendons



16.0343
$636.37
$573.19
$127.27
$114.6426440
Release palm/finger tendon



16.0343
$636.37
$573.19
$127.27
$114.6426442
Release palm  finger tendon



25.8425
$1,025.64
$767.82
$205.13
$153.56( print page 49876)26445
Release hand/finger tendon



16.0343
$636.37
$573.19
$127.27
$114.6426449
Release forearm/hand tendon



25.8425
$1,025.64
$767.82
$205.13
$153.5626450
Incision of palm tendon



16.0343
$636.37
$573.19
$127.27
$114.6426455
Incision of finger tendon



16.0343
$636.37
$573.19
$127.27
$114.6426460
Incise hand/finger tendon



16.0343
$636.37
$573.19
$127.27
$114.6426471
Fusion of finger tendons



16.0343
$636.37
$541.19
$127.27
$108.2426474
Fusion of finger tendons



16.0343
$636.37
$541.19
$127.27
$108.2426476
Tendon lengthening



16.0343
$636.37
$484.69
$127.27
$96.9426477
Tendon shortening



16.0343
$636.37
$484.69
$127.27
$96.9426478
Lengthening of hand tendon



16.0343
$636.37
$484.69
$127.27
$96.9426479
Shortening of hand tendon



16.0343
$636.37
$484.69
$127.27
$96.9426480
Transplant hand tendon



25.8425
$1,025.64
$767.82
$205.13
$153.5626483
Transplant/graft hand tendon



25.8425
$1,025.64
$767.82
$205.13
$153.5626485
Transplant palm tendon



25.8425
$1,025.64
$735.82
$205.13
$147.1626489
Transplant/graft palm tendon



25.8425
$1,025.64
$767.82
$205.13
$153.5626490
Revise thumb tendon



25.8425
$1,025.64
$767.82
$205.13
$153.5626492
Tendon transfer with graft



25.8425
$1,025.64
$767.82
$205.13
$153.5626494
Hand tendon/muscle transfer



25.8425
$1,025.64
$767.82
$205.13
$153.5626496
Revise thumb tendon



25.8425
$1,025.64
$767.82
$205.13
$153.5626497
Finger tendon transfer



25.8425
$1,025.64
$767.82
$205.13
$153.5626498
Finger tendon transfer



25.8425
$1,025.64
$827.82
$205.13
$165.5626499
Revision of finger



25.8425
$1,025.64
$767.82
$205.13
$153.5626500
Hand tendon reconstruction



16.0343
$636.37
$633.19
$127.27
$126.6426502
Hand tendon reconstruction



25.8425
$1,025.64
$827.82
$205.13
$165.5626504
Hand tendon reconstruction



25.8425
$1,025.64
$827.82
$205.13
$165.5626508
Release thumb contracture



16.0343
$636.37
$573.19
$127.27
$114.6426510
Thumb tendon transfer



25.8425
$1,025.64
$767.82
$205.13
$153.5626516
Fusion of knuckle joint



25.8425
$1,025.64
$679.32
$205.13
$135.8626517
Fusion of knuckle joints



25.8425
$1,025.64
$767.82
$205.13
$153.5626518
Fusion of knuckle joints



25.8425
$1,025.64
$767.82
$205.13
$153.5626520
Release knuckle contracture



16.0343
$636.37
$573.19
$127.27
$114.6426525
Release finger contracture



16.0343
$636.37
$573.19
$127.27
$114.6426530
Revise knuckle joint



32.7543
$1,299.96
$904.98
$259.99
$181.00( print page 49877)26531
Revise knuckle with implant



47.1644
$1,871.86
$1,433.43
$374.37
$286.6926535
Revise finger joint



32.7543
$1,299.96
$1,008.48
$259.99
$201.7026536
Revise/implant finger joint



47.1644
$1,871.86
$1,294.43
$374.37
$258.8926540
Repair hand joint



16.0343
$636.37
$633.19
$127.27
$126.6426541
Repair hand joint with graft



25.8425
$1,025.64
$1,010.32
$205.13
$202.0626542
Repair hand joint with graft



16.0343
$636.37
$633.19
$127.27
$126.6426545
Reconstruct finger joint



25.8425
$1,025.64
$827.82
$205.13
$165.5626546
Repair nonunion hand



25.8425
$1,025.64
$827.82
$205.13
$165.5626548
Reconstruct finger joint



25.8425
$1,025.64
$827.82
$205.13
$165.5626550
Construct thumb replacement



25.8425
$1,025.64
$735.82
$205.13
$147.1626555
Positional change of finger



25.8425
$1,025.64
$767.82
$205.13
$153.5626560
Repair of web finger



16.0343
$636.37
$541.19
$127.27
$108.2426561
Repair of web finger



25.8425
$1,025.64
$767.82
$205.13
$153.5626562
Repair of web finger



25.8425
$1,025.64
$827.82
$205.13
$165.5626565
Correct metacarpal flaw



25.8425
$1,025.64
$871.32
$205.13
$174.2626567
Correct finger deformity



25.8425
$1,025.64
$871.32
$205.13
$174.2626568
Lengthen metacarpal/finger



25.8425
$1,025.64
$767.82
$205.13
$153.5626580
Repair hand deformity



16.0343
$636.37
$676.69
$127.27
$135.3426587
Reconstruct extra finger



16.0343
$636.37
$676.69
$127.27
$135.3426590
Repair finger deformity



16.0343
$636.37
$676.69
$127.27
$135.3426591
Repair muscles of hand



25.8425
$1,025.64
$767.82
$205.13
$153.5626593
Release muscles of hand



16.0343
$636.37
$573.19
$127.27
$114.6426596
Excision constricting tissue



16.0343
$636.37
$541.19
$127.27
$108.2426600
Treat metacarpal fracture
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4326605
Treat metacarpal fracture



1.6914
$67.13
$85.62
$13.43
$17.1226607
Treat metacarpal fracture



1.6914
$67.13
$85.62
$13.43
$17.1226608
Treat metacarpal fracture



25.6702
$1,018.80
$824.40
$203.76
$164.8826615
Treat metacarpal fracture



37.5680
$1,491.00
$1,060.50
$298.20
$212.1026641
Treat thumb dislocation
Y


1.6914
$67.13
$67.13
$13.43
$13.4326645
Treat thumb fracture



1.6914
$67.13
$85.62
$13.43
$17.1226650
Treat thumb fracture



25.6702
$1,018.80
$732.40
$203.76
$146.48( print page 49878)26665
Treat thumb fracture



37.5680
$1,491.00
$1,060.50
$298.20
$212.1026670
Treat hand dislocation
Y


1.6914
$67.13
$67.13
$13.43
$13.4326675
Treat hand dislocation



1.6914
$67.13
$85.62
$13.43
$17.1226676
Pin hand dislocation



25.6702
$1,018.80
$732.40
$203.76
$146.4826685
Treat hand dislocation



37.5680
$1,491.00
$1,000.50
$298.20
$200.1026686
Treat hand dislocation



56.4195
$2,239.18
$1,374.59
$447.84
$274.9226700
Treat knuckle dislocation
Y


1.6914
$67.13
$67.13
$13.43
$13.4326705
Treat knuckle dislocation



1.6914
$67.13
$85.62
$13.43
$17.1226706
Pin knuckle dislocation



1.6914
$67.13
$85.62
$13.43
$17.1226715
Treat knuckle dislocation



37.5680
$1,491.00
$1,060.50
$298.20
$212.1026720
Treat finger fracture, each
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4326725
Treat finger fracture, each
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4326727
Treat finger fracture, each



25.6702
$1,018.80
$1,006.90
$203.76
$201.3826735
Treat finger fracture, each



37.5680
$1,491.00
$1,060.50
$298.20
$212.1026740
Treat finger fracture, each
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4326742
Treat finger fracture, each



1.6914
$67.13
$85.62
$13.43
$17.1226746
Treat finger fracture, each



37.5680
$1,491.00
$1,104.00
$298.20
$220.8026750
Treat finger fracture, each
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4326755
Treat finger fracture, each
Y


1.6914
$67.13
$67.13
$13.43
$13.4326756
Pin finger fracture, each



25.6702
$1,018.80
$732.40
$203.76
$146.4826765
Treat finger fracture, each



37.5680
$1,491.00
$1,060.50
$298.20
$212.1026770
Treat finger dislocation
Y


1.6914
$67.13
$67.13
$13.43
$13.4326775
Treat finger dislocation
Y


14.5502
$577.47
$577.47
$115.49
$115.4926776
Pin finger dislocation



25.6702
$1,018.80
$732.40
$203.76
$146.4826785
Treat finger dislocation



25.6702
$1,018.80
$732.40
$203.76
$146.4826820
Thumb fusion with graft



25.8425
$1,025.64
$871.32
$205.13
$174.2626841
Fusion of thumb



25.8425
$1,025.64
$827.82
$205.13
$165.5626842
Thumb fusion with graft



25.8425
$1,025.64
$827.82
$205.13
$165.5626843
Fusion of hand joint



25.8425
$1,025.64
$767.82
$205.13
$153.5626844
Fusion/graft of hand joint



25.8425
$1,025.64
$767.82
$205.13
$153.5626850
Fusion of knuckle



25.8425
$1,025.64
$827.82
$205.13
$165.5626852
Fusion of knuckle with graft



25.8425
$1,025.64
$827.82
$205.13
$165.5626860
Fusion of finger joint



25.8425
$1,025.64
$767.82
$205.13
$153.5626861
Fusion of finger jnt, add-on



25.8425
$1,025.64
$735.82
$205.13
$147.16( print page 49879)26862
Fusion/graft of finger joint



25.8425
$1,025.64
$827.82
$205.13
$165.5626863
Fuse/graft added joint



25.8425
$1,025.64
$767.82
$205.13
$153.5626910
Amputate metacarpal bone



25.8425
$1,025.64
$767.82
$205.13
$153.5626951
Amputation of finger/thumb



16.0343
$636.37
$541.19
$127.27
$108.2426952
Amputation of finger/thumb



16.0343
$636.37
$633.19
$127.27
$126.6426990
Drainage of pelvis lesion



20.8214
$826.36
$579.68
$165.27
$115.9426991
Drainage of pelvis bursa



20.8214
$826.36
$579.68
$165.27
$115.9427000
Incision of hip tendon



20.8214
$826.36
$636.18
$165.27
$127.2427001
Incision of hip tendon



25.0600
$994.58
$752.29
$198.92
$150.4627003
Incision of hip tendon



25.0600
$994.58
$752.29
$198.92
$150.4627033
Exploration of hip joint



41.2543
$1,637.30
$1,073.65
$327.46
$214.7327035
Denervation of hip joint



41.2543
$1,637.30
$1,133.65
$327.46
$226.7327040
Biopsy of soft tissues



6.5128
$258.48
$295.74
$51.70
$59.1527041
Biopsy of soft tissues



6.5128
$258.48
$329.68
$51.70
$65.9427047
Remove hip/pelvis lesion



19.9760
$792.81
$619.40
$158.56
$123.8827048
Remove hip/pelvis lesion



19.9760
$792.81
$651.40
$158.56
$130.2827049
Remove tumor, hip/pelvis



19.9760
$792.81
$651.40
$158.56
$130.2827050
Biopsy of sacroiliac joint



20.8214
$826.36
$668.18
$165.27
$133.6427052
Biopsy of hip joint



20.8214
$826.36
$668.18
$165.27
$133.6427060
Removal of ischial bursa



20.8214
$826.36
$771.68
$165.27
$154.3427062
Remove femur lesion/bursa



20.8214
$826.36
$771.68
$165.27
$154.3427065
Removal of hip bone lesion



20.8214
$826.36
$771.68
$165.27
$154.3427066
Removal of hip bone lesion



25.0600
$994.58
$855.79
$198.92
$171.1627067
Remove/graft hip bone lesion



25.0600
$994.58
$855.79
$198.92
$171.1627080
Removal of tail bone



25.0600
$994.58
$720.29
$198.92
$144.0627086
Remove hip foreign body



6.5128
$258.48
$295.74
$51.70
$59.1527087
Remove hip foreign body



20.8214
$826.36
$668.18
$165.27
$133.6427097
Revision of hip tendon



25.0600
$994.58
$752.29
$198.92
$150.4627098
Transfer tendon to pelvis



25.0600
$994.58
$752.29
$198.92
$150.4627100
Transfer of abdominal muscle



41.2543
$1,637.30
$1,133.65
$327.46
$226.7327105
Transfer of spinal muscle



41.2543
$1,637.30
$1,133.65
$327.46
$226.7327110
Transfer of iliopsoas muscle



41.2543
$1,637.30
$1,133.65
$327.46
$226.73( print page 49880)27111
Transfer of iliopsoas muscle



41.2543
$1,637.30
$1,133.65
$327.46
$226.7327193
Treat pelvic ring fracture



1.6914
$67.13
$85.62
$13.43
$17.1227194
Treat pelvic ring fracture



14.5502
$577.47
$511.73
$115.49
$102.3527200
Treat tail bone fracture
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4327202
Treat tail bone fracture



37.5680
$1,491.00
$968.50
$298.20
$193.7027230
Treat thigh fracture



1.6914
$67.13
$85.62
$13.43
$17.1227238
Treat thigh fracture



1.6914
$67.13
$85.62
$13.43
$17.1227246
Treat thigh fracture



1.6914
$67.13
$85.62
$13.43
$17.1227250
Treat hip dislocation



1.6914
$67.13
$85.62
$13.43
$17.1227252
Treat hip dislocation



14.5502
$577.47
$511.73
$115.49
$102.3527256
Treat hip dislocation
Y


1.6914
$67.13
$67.13
$13.43
$13.4327257
Treat hip dislocation



14.5502
$577.47
$543.73
$115.49
$108.7527265
Treat hip dislocation



1.6914
$67.13
$85.62
$13.43
$17.1227266
Treat hip dislocation



14.5502
$577.47
$511.73
$115.49
$102.3527275
Manipulation of hip joint



14.5502
$577.47
$511.73
$115.49
$102.3527301
Drain thigh/knee lesion



17.4686
$693.30
$601.65
$138.66
$120.3327305
Incise thigh tendon  fascia



20.8214
$826.36
$636.18
$165.27
$127.2427306
Incision of thigh tendon



20.8214
$826.36
$668.18
$165.27
$133.6427307
Incision of thigh tendons



20.8214
$826.36
$668.18
$165.27
$133.6427310
Exploration of knee joint



25.0600
$994.58
$812.29
$198.92
$162.4627315
Partial removal, thigh nerve



17.7609
$704.90
$575.45
$140.98
$115.0927320
Partial removal, thigh nerve



17.7609
$704.90
$575.45
$140.98
$115.0927323
Biopsy, thigh soft tissues



6.5128
$258.48
$295.74
$51.70
$59.1527324
Biopsy, thigh soft tissues



19.9760
$792.81
$562.90
$158.56
$112.5827327
Removal of thigh lesion



19.9760
$792.81
$619.40
$158.56
$123.8827328
Removal of thigh lesion



19.9760
$792.81
$651.40
$158.56
$130.2827329
Remove tumor, thigh/knee



19.9760
$792.81
$711.40
$158.56
$142.2827330
Biopsy, knee joint lining



25.0600
$994.58
$812.29
$198.92
$162.4627331
Explore/treat knee joint



25.0600
$994.58
$812.29
$198.92
$162.4627332
Removal of knee cartilage



25.0600
$994.58
$812.29
$198.92
$162.4627333
Removal of knee cartilage



25.0600
$994.58
$812.29
$198.92
$162.4627334
Remove knee joint lining



25.0600
$994.58
$812.29
$198.92
$162.4627335
Remove knee joint lining



25.0600
$994.58
$812.29
$198.92
$162.46( print page 49881)27340
Removal of kneecap bursa



20.8214
$826.36
$668.18
$165.27
$133.6427345
Removal of knee cyst



20.8214
$826.36
$728.18
$165.27
$145.6427347
Remove knee cyst



20.8214
$826.36
$728.18
$165.27
$145.6427350
Removal of kneecap



25.0600
$994.58
$812.29
$198.92
$162.4627355
Remove femur lesion



25.0600
$994.58
$752.29
$198.92
$150.4627356
Remove femur lesion/graft



25.0600
$994.58
$812.29
$198.92
$162.4627357
Remove femur lesion/graft



25.0600
$994.58
$855.79
$198.92
$171.1627358
Remove femur lesion/fixation



25.0600
$994.58
$855.79
$198.92
$171.1627360
Partial removal, leg bone(s)



25.0600
$994.58
$855.79
$198.92
$171.1627372
Removal of foreign body



19.9760
$792.81
$893.90
$158.56
$178.7827380
Repair of kneecap tendon



20.8214
$826.36
$579.68
$165.27
$115.9427381
Repair/graft kneecap tendon



20.8214
$826.36
$668.18
$165.27
$133.6427385
Repair of thigh muscle



20.8214
$826.36
$668.18
$165.27
$133.6427386
Repair/graft of thigh muscle



20.8214
$826.36
$668.18
$165.27
$133.6427390
Incision of thigh tendon



20.8214
$826.36
$579.68
$165.27
$115.9427391
Incision of thigh tendons



20.8214
$826.36
$636.18
$165.27
$127.2427392
Incision of thigh tendons



20.8214
$826.36
$668.18
$165.27
$133.6427393
Lengthening of thigh tendon



25.0600
$994.58
$720.29
$198.92
$144.0627394
Lengthening of thigh tendons



25.0600
$994.58
$752.29
$198.92
$150.4627395
Lengthening of thigh tendons



41.2543
$1,637.30
$1,073.65
$327.46
$214.7327396
Transplant of thigh tendon



25.0600
$994.58
$752.29
$198.92
$150.4627397
Transplants of thigh tendons



41.2543
$1,637.30
$1,073.65
$327.46
$214.7327400
Revise thigh muscles/tendons



41.2543
$1,637.30
$1,073.65
$327.46
$214.7327403
Repair of knee cartilage



25.0600
$994.58
$812.29
$198.92
$162.4627405
Repair of knee ligament



41.2543
$1,637.30
$1,133.65
$327.46
$226.7327407
Repair of knee ligament



65.8846
$2,614.83
$1,622.42
$522.97
$324.4827409
Repair of knee ligaments



41.2543
$1,637.30
$1,133.65
$327.46
$226.7327418
Repair degenerated kneecap



41.2543
$1,637.30
$1,073.65
$327.46
$214.7327420
Revision of unstable kneecap



41.2543
$1,637.30
$1,073.65
$327.46
$214.7327422
Revision of unstable kneecap



41.2543
$1,637.30
$1,316.15
$327.46
$263.23( print page 49882)27424
Revision/removal of kneecap



41.2543
$1,637.30
$1,073.65
$327.46
$214.7327425
Lat retinacular release open



25.0600
$994.58
$994.79
$198.92
$198.9627427
Reconstruction, knee



41.2543
$1,637.30
$1,073.65
$327.46
$214.7327428
Reconstruction, knee



65.8846
$2,614.83
$1,622.42
$522.97
$324.4827429
Reconstruction, knee



65.8846
$2,614.83
$1,622.42
$522.97
$324.4827430
Revision of thigh muscles



41.2543
$1,637.30
$1,133.65
$327.46
$226.7327435
Incision of knee joint



41.2543
$1,637.30
$1,133.65
$327.46
$226.7327437
Revise kneecap



32.7543
$1,299.96
$964.98
$259.99
$193.0027438
Revise kneecap with implant



47.1644
$1,871.86
$1,294.43
$374.37
$258.8927441
Revision of knee joint



32.7543
$1,299.96
$1,008.48
$259.99
$201.7027442
Revision of knee joint



32.7543
$1,299.96
$1,008.48
$259.99
$201.7027443
Revision of knee joint



32.7543
$1,299.96
$1,008.48
$259.99
$201.7027496
Decompression of thigh/knee



20.8214
$826.36
$771.68
$165.27
$154.3427497
Decompression of thigh/knee



20.8214
$826.36
$668.18
$165.27
$133.6427498
Decompression of thigh/knee



20.8214
$826.36
$668.18
$165.27
$133.6427499
Decompression of thigh/knee



20.8214
$826.36
$668.18
$165.27
$133.6427500
Treatment of thigh fracture



1.6914
$67.13
$85.62
$13.43
$17.1227501
Treatment of thigh fracture



1.6914
$67.13
$85.62
$13.43
$17.1227502
Treatment of thigh fracture



1.6914
$67.13
$85.62
$13.43
$17.1227503
Treatment of thigh fracture



1.6914
$67.13
$85.62
$13.43
$17.1227508
Treatment of thigh fracture



1.6914
$67.13
$85.62
$13.43
$17.1227509
Treatment of thigh fracture



25.6702
$1,018.80
$764.40
$203.76
$152.8827510
Treatment of thigh fracture



1.6914
$67.13
$85.62
$13.43
$17.1227516
Treat thigh fx growth plate



1.6914
$67.13
$85.62
$13.43
$17.1227517
Treat thigh fx growth plate



1.6914
$67.13
$85.62
$13.43
$17.1227520
Treat kneecap fracture



1.6914
$67.13
$85.62
$13.43
$17.1227530
Treat knee fracture



1.6914
$67.13
$85.62
$13.43
$17.1227532
Treat knee fracture



1.6914
$67.13
$85.62
$13.43
$17.1227538
Treat knee fracture(s)



1.6914
$67.13
$85.62
$13.43
$17.1227550
Treat knee dislocation



1.6914
$67.13
$85.62
$13.43
$17.1227552
Treat knee dislocation



14.5502
$577.47
$455.23
$115.49
$91.0527560
Treat kneecap dislocation



1.6914
$67.13
$85.62
$13.43
$17.1227562
Treat kneecap dislocation



14.5502
$577.47
$455.23
$115.49
$91.0527566
Treat kneecap dislocation



37.5680
$1,491.00
$968.50
$298.20
$193.70( print page 49883)27570
Fixation of knee joint



14.5502
$577.47
$455.23
$115.49
$91.0527594
Amputation follow-up surgery



20.8214
$826.36
$668.18
$165.27
$133.6427600
Decompression of lower leg



20.8214
$826.36
$668.18
$165.27
$133.6427601
Decompression of lower leg



20.8214
$826.36
$668.18
$165.27
$133.6427602
Decompression of lower leg



20.8214
$826.36
$668.18
$165.27
$133.6427603
Drain lower leg lesion



17.4686
$693.30
$569.65
$138.66
$113.9327604
Drain lower leg bursa



20.8214
$826.36
$636.18
$165.27
$127.2427605
Incision of achilles tendon



20.2255
$802.71
$567.86
$160.54
$113.5727606
Incision of achilles tendon



20.8214
$826.36
$579.68
$165.27
$115.9427607
Treat lower leg bone lesion



20.8214
$826.36
$636.18
$165.27
$127.2427610
Explore/treat ankle joint



25.0600
$994.58
$720.29
$198.92
$144.0627612
Exploration of ankle joint



25.0600
$994.58
$752.29
$198.92
$150.4627613
Biopsy lower leg soft tissue
Y
Y
Y
3.0423
$120.74
$120.74
$24.15
$24.1527614
Biopsy lower leg soft tissue



19.9760
$792.81
$619.40
$158.56
$123.8827615
Remove tumor, lower leg



25.0600
$994.58
$752.29
$198.92
$150.4627618
Remove lower leg lesion



14.9563
$593.59
$519.79
$118.72
$103.9627619
Remove lower leg lesion



19.9760
$792.81
$651.40
$158.56
$130.2827620
Explore/treat ankle joint



25.0600
$994.58
$812.29
$198.92
$162.4627625
Remove ankle joint lining



25.0600
$994.58
$812.29
$198.92
$162.4627626
Remove ankle joint lining



25.0600
$994.58
$812.29
$198.92
$162.4627630
Removal of tendon lesion



20.8214
$826.36
$668.18
$165.27
$133.6427635
Remove lower leg bone lesion



25.0600
$994.58
$752.29
$198.92
$150.4627637
Remove/graft leg bone lesion



25.0600
$994.58
$752.29
$198.92
$150.4627638
Remove/graft leg bone lesion



25.0600
$994.58
$752.29
$198.92
$150.4627640
Partial removal of tibia



41.2543
$1,637.30
$1,041.65
$327.46
$208.3327641
Partial removal of fibula



25.0600
$994.58
$720.29
$198.92
$144.0627647
Extensive ankle/heel surgery



41.2543
$1,637.30
$1,073.65
$327.46
$214.7327650
Repair achilles tendon



41.2543
$1,637.30
$1,073.65
$327.46
$214.7327652
Repair/graft achilles tendon



65.8846
$2,614.83
$1,562.42
$522.97
$312.4827654
Repair of achilles tendon



41.2543
$1,637.30
$1,073.65
$327.46
$214.7327656
Repair leg fascia defect



20.8214
$826.36
$636.18
$165.27
$127.24( print page 49884)27658
Repair of leg tendon, each



20.8214
$826.36
$579.68
$165.27
$115.9427659
Repair of leg tendon, each



20.8214
$826.36
$636.18
$165.27
$127.2427664
Repair of leg tendon, each



20.8214
$826.36
$636.18
$165.27
$127.2427665
Repair of leg tendon, each



25.0600
$994.58
$720.29
$198.92
$144.0627675
Repair lower leg tendons



20.8214
$826.36
$636.18
$165.27
$127.2427676
Repair lower leg tendons



25.0600
$994.58
$752.29
$198.92
$150.4627680
Release of lower leg tendon



25.0600
$994.58
$752.29
$198.92
$150.4627681
Release of lower leg tendons



25.0600
$994.58
$720.29
$198.92
$144.0627685
Revision of lower leg tendon



25.0600
$994.58
$752.29
$198.92
$150.4627686
Revise lower leg tendons



25.0600
$994.58
$752.29
$198.92
$150.4627687
Revision of calf tendon



25.0600
$994.58
$752.29
$198.92
$150.4627690
Revise lower leg tendon



41.2543
$1,637.30
$1,133.65
$327.46
$226.7327691
Revise lower leg tendon



41.2543
$1,637.30
$1,133.65
$327.46
$226.7327692
Revise additional leg tendon



41.2543
$1,637.30
$1,073.65
$327.46
$214.7327695
Repair of ankle ligament



25.0600
$994.58
$720.29
$198.92
$144.0627696
Repair of ankle ligaments



25.0600
$994.58
$720.29
$198.92
$144.0627698
Repair of ankle ligament



25.0600
$994.58
$720.29
$198.92
$144.0627700
Revision of ankle joint



32.7543
$1,299.96
$1,008.48
$259.99
$201.7027704
Removal of ankle implant



20.8214
$826.36
$636.18
$165.27
$127.2427705
Incision of tibia



41.2543
$1,637.30
$1,041.65
$327.46
$208.3327707
Incision of fibula



20.8214
$826.36
$636.18
$165.27
$127.2427709
Incision of tibia  fibula



25.0600
$994.58
$720.29
$198.92
$144.0627730
Repair of tibia epiphysis



25.0600
$994.58
$720.29
$198.92
$144.0627732
Repair of fibula epiphysis



25.0600
$994.58
$720.29
$198.92
$144.0627734
Repair lower leg epiphyses



25.0600
$994.58
$720.29
$198.92
$144.0627740
Repair of leg epiphyses



25.0600
$994.58
$720.29
$198.92
$144.0627742
Repair of leg epiphyses



41.2543
$1,637.30
$1,041.65
$327.46
$208.3327745
Reinforce tibia



65.8846
$2,614.83
$1,562.42
$522.97
$312.4827750
Treatment of tibia fracture



1.6914
$67.13
$85.62
$13.43
$17.1227752
Treatment of tibia fracture



1.6914
$67.13
$85.62
$13.43
$17.1227756
Treatment of tibia fracture



25.6702
$1,018.80
$764.40
$203.76
$152.8827758
Treatment of tibia fracture



37.5680
$1,491.00
$1,060.50
$298.20
$212.1027759
Treatment of tibia fracture



56.4195
$2,239.18
$1,434.59
$447.84
$286.92( print page 49885)27760
Treatment of ankle fracture



1.6914
$67.13
$85.62
$13.43
$17.1227762
Treatment of ankle fracture



1.6914
$67.13
$85.62
$13.43
$17.1227766
Treatment of ankle fracture



37.5680
$1,491.00
$1,000.50
$298.20
$200.1027780
Treatment of fibula fracture



1.6914
$67.13
$85.62
$13.43
$17.1227781
Treatment of fibula fracture



1.6914
$67.13
$85.62
$13.43
$17.1227784
Treatment of fibula fracture



37.5680
$1,491.00
$1,000.50
$298.20
$200.1027786
Treatment of ankle fracture



1.6914
$67.13
$85.62
$13.43
$17.1227788
Treatment of ankle fracture



1.6914
$67.13
$85.62
$13.43
$17.1227792
Treatment of ankle fracture



37.5680
$1,491.00
$1,000.50
$298.20
$200.1027808
Treatment of ankle fracture



1.6914
$67.13
$85.62
$13.43
$17.1227810
Treatment of ankle fracture



1.6914
$67.13
$85.62
$13.43
$17.1227814
Treatment of ankle fracture



37.5680
$1,491.00
$1,000.50
$298.20
$200.1027816
Treatment of ankle fracture



1.6914
$67.13
$85.62
$13.43
$17.1227818
Treatment of ankle fracture



1.6914
$67.13
$85.62
$13.43
$17.1227822
Treatment of ankle fracture



37.5680
$1,491.00
$1,000.50
$298.20
$200.1027823
Treatment of ankle fracture



56.4195
$2,239.18
$1,374.59
$447.84
$274.9227824
Treat lower leg fracture



1.6914
$67.13
$85.62
$13.43
$17.1227825
Treat lower leg fracture



1.6914
$67.13
$85.62
$13.43
$17.1227826
Treat lower leg fracture



37.5680
$1,491.00
$1,000.50
$298.20
$200.1027827
Treat lower leg fracture



56.4195
$2,239.18
$1,374.59
$447.84
$274.9227828
Treat lower leg fracture



56.4195
$2,239.18
$1,434.59
$447.84
$286.9227829
Treat lower leg joint



37.5680
$1,491.00
$968.50
$298.20
$193.7027830
Treat lower leg dislocation



1.6914
$67.13
$85.62
$13.43
$17.1227831
Treat lower leg dislocation



1.6914
$67.13
$85.62
$13.43
$17.1227832
Treat lower leg dislocation



37.5680
$1,491.00
$968.50
$298.20
$193.7027840
Treat ankle dislocation



1.6914
$67.13
$85.62
$13.43
$17.1227842
Treat ankle dislocation



14.5502
$577.47
$455.23
$115.49
$91.0527846
Treat ankle dislocation



37.5680
$1,491.00
$1,000.50
$298.20
$200.1027848
Treat ankle dislocation



37.5680
$1,491.00
$1,000.50
$298.20
$200.1027860
Fixation of ankle joint



14.5502
$577.47
$455.23
$115.49
$91.0527870
Fusion of ankle joint, open



65.8846
$2,614.83
$1,622.42
$522.97
$324.4827871
Fusion of tibiofibular joint



65.8846
$2,614.83
$1,622.42
$522.97
$324.4827884
Amputation follow-up surgery



20.8214
$826.36
$668.18
$165.27
$133.64( print page 49886)27889
Amputation of foot at ankle



25.0600
$994.58
$752.29
$198.92
$150.4627892
Decompression of leg



20.8214
$826.36
$668.18
$165.27
$133.6427893
Decompression of leg



20.8214
$826.36
$668.18
$165.27
$133.6427894
Decompression of leg



20.8214
$826.36
$668.18
$165.27
$133.6428001
Drainage of bursa of foot
Y
Y
Y
2.9456
$116.90
$116.90
$23.38
$23.3828002
Treatment of foot infection



20.8214
$826.36
$668.18
$165.27
$133.6428003
Treatment of foot infection



20.8214
$826.36
$668.18
$165.27
$133.6428005
Treat foot bone lesion



20.2255
$802.71
$656.36
$160.54
$131.2728008
Incision of foot fascia



20.2255
$802.71
$656.36
$160.54
$131.2728010
Incision of toe tendon
Y
Y
Y
2.2064
$87.57
$87.57
$17.51
$17.5128011
Incision of toe tendons



20.2255
$802.71
$656.36
$160.54
$131.2728020
Exploration of foot joint



20.2255
$802.71
$624.36
$160.54
$124.8728022
Exploration of foot joint



20.2255
$802.71
$624.36
$160.54
$124.8728024
Exploration of toe joint



20.2255
$802.71
$624.36
$160.54
$124.8728030
Removal of foot nerve



17.7609
$704.90
$667.45
$140.98
$133.4928035
Decompression of tibia nerve



17.7609
$704.90
$667.45
$140.98
$133.4928043
Excision of foot lesion



19.9760
$792.81
$619.40
$158.56
$123.8828045
Excision of foot lesion



20.2255
$802.71
$656.36
$160.54
$131.2728046
Resection of tumor, foot



20.2255
$802.71
$656.36
$160.54
$131.2728050
Biopsy of foot joint lining



20.2255
$802.71
$624.36
$160.54
$124.8728052
Biopsy of foot joint lining



20.2255
$802.71
$624.36
$160.54
$124.8728054
Biopsy of toe joint lining



20.2255
$802.71
$624.36
$160.54
$124.8728060
Partial removal, foot fascia



20.2255
$802.71
$624.36
$160.54
$124.8728062
Removal of foot fascia



20.2255
$802.71
$656.36
$160.54
$131.2728070
Removal of foot joint lining



20.2255
$802.71
$656.36
$160.54
$131.2728072
Removal of foot joint lining



20.2255
$802.71
$656.36
$160.54
$131.2728080
Removal of foot lesion



20.2255
$802.71
$656.36
$160.54
$131.2728086
Excise foot tendon sheath



20.2255
$802.71
$624.36
$160.54
$124.8728088
Excise foot tendon sheath



20.2255
$802.71
$624.36
$160.54
$124.8728090
Removal of foot lesion



20.2255
$802.71
$656.36
$160.54
$131.2728092
Removal of toe lesions



20.2255
$802.71
$656.36
$160.54
$131.2728100
Removal of ankle/heel lesion



20.2255
$802.71
$624.36
$160.54
$124.8728102
Remove/graft foot lesion



41.2239
$1,636.10
$1,073.05
$327.22
$214.61( print page 49887)28103
Remove/graft foot lesion



41.2239
$1,636.10
$1,073.05
$327.22
$214.6128104
Removal of foot lesion



20.2255
$802.71
$624.36
$160.54
$124.8728106
Remove/graft foot lesion



41.2239
$1,636.10
$1,073.05
$327.22
$214.6128107
Remove/graft foot lesion



41.2239
$1,636.10
$1,073.05
$327.22
$214.6128108
Removal of toe lesions



20.2255
$802.71
$624.36
$160.54
$124.8728110
Part removal of metatarsal



20.2255
$802.71
$656.36
$160.54
$131.2728111
Part removal of metatarsal



20.2255
$802.71
$656.36
$160.54
$131.2728112
Part removal of metatarsal



20.2255
$802.71
$656.36
$160.54
$131.2728113
Part removal of metatarsal



20.2255
$802.71
$656.36
$160.54
$131.2728114
Removal of metatarsal heads



20.2255
$802.71
$656.36
$160.54
$131.2728116
Revision of foot



20.2255
$802.71
$656.36
$160.54
$131.2728118
Removal of heel bone



20.2255
$802.71
$716.36
$160.54
$143.2728119
Removal of heel spur



20.2255
$802.71
$716.36
$160.54
$143.2728120
Part removal of ankle/heel



20.2255
$802.71
$898.86
$160.54
$179.7728122
Partial removal of foot bone



20.2255
$802.71
$656.36
$160.54
$131.2728124
Partial removal of toe
Y
Y
Y
4.9541
$196.62
$196.62
$39.32
$39.3228126
Partial removal of toe



20.2255
$802.71
$656.36
$160.54
$131.2728130
Removal of ankle bone



20.2255
$802.71
$656.36
$160.54
$131.2728140
Removal of metatarsal



20.2255
$802.71
$656.36
$160.54
$131.2728150
Removal of toe



20.2255
$802.71
$656.36
$160.54
$131.2728153
Partial removal of toe



20.2255
$802.71
$656.36
$160.54
$131.2728160
Partial removal of toe



20.2255
$802.71
$656.36
$160.54
$131.2728171
Extensive foot surgery



20.2255
$802.71
$656.36
$160.54
$131.2728173
Extensive foot surgery



20.2255
$802.71
$656.36
$160.54
$131.2728175
Extensive foot surgery



20.2255
$802.71
$656.36
$160.54
$131.2728190
Removal of foot foreign body
Y
Y
Y
3.1309
$124.26
$124.26
$24.85
$24.8528192
Removal of foot foreign body



14.9563
$593.59
$519.79
$118.72
$103.9628193
Removal of foot foreign body



6.5128
$258.48
$329.68
$51.70
$65.9428200
Repair of foot tendon



20.2255
$802.71
$656.36
$160.54
$131.2728202
Repair/graft of foot tendon



20.2255
$802.71
$656.36
$160.54
$131.2728208
Repair of foot tendon



20.2255
$802.71
$656.36
$160.54
$131.2728210
Repair/graft of foot tendon



41.2239
$1,636.10
$1,073.05
$327.22
$214.6128220
Release of foot tendon
Y
Y
Y
4.6712
$185.39
$185.39
$37.08
$37.0828222
Release of foot tendons



20.2255
$802.71
$567.86
$160.54
$113.57( print page 49888)28225
Release of foot tendon



20.2255
$802.71
$567.86
$160.54
$113.5728226
Release of foot tendons



20.2255
$802.71
$567.86
$160.54
$113.5728230
Incision of foot tendon(s)
Y
Y
Y
4.6363
$184.00
$184.00
$36.80
$36.8028232
Incision of toe tendon
Y
Y
Y
4.4311
$175.86
$175.86
$35.17
$35.1728234
Incision of foot tendon



20.2255
$802.71
$624.36
$160.54
$124.8728238
Revision of foot tendon



41.2239
$1,636.10
$1,073.05
$327.22
$214.6128240
Release of big toe



20.2255
$802.71
$624.36
$160.54
$124.8728250
Revision of foot fascia



20.2255
$802.71
$656.36
$160.54
$131.2728260
Release of midfoot joint



20.2255
$802.71
$656.36
$160.54
$131.2728261
Revision of foot tendon



20.2255
$802.71
$656.36
$160.54
$131.2728262
Revision of foot and ankle



20.2255
$802.71
$716.36
$160.54
$143.2728264
Release of midfoot joint



41.2239
$1,636.10
$984.55
$327.22
$196.9128270
Release of foot contracture



20.2255
$802.71
$656.36
$160.54
$131.2728272
Release of toe joint, each
Y
Y
Y
4.2127
$167.19
$167.19
$33.44
$33.4428280
Fusion of toes



20.2255
$802.71
$624.36
$160.54
$124.8728285
Repair of hammertoe



20.2255
$802.71
$656.36
$160.54
$131.2728286
Repair of hammertoe



20.2255
$802.71
$716.36
$160.54
$143.2728288
Partial removal of foot bone



20.2255
$802.71
$656.36
$160.54
$131.2728289
Repair hallux rigidus



20.2255
$802.71
$656.36
$160.54
$131.2728290
Correction of bunion



28.0970
$1,115.12
$780.56
$223.02
$156.1128292
Correction of bunion



28.0970
$1,115.12
$780.56
$223.02
$156.1128293
Correction of bunion



28.0970
$1,115.12
$812.56
$223.02
$162.5128294
Correction of bunion



28.0970
$1,115.12
$812.56
$223.02
$162.5128296
Correction of bunion



28.0970
$1,115.12
$812.56
$223.02
$162.5128297
Correction of bunion



28.0970
$1,115.12
$812.56
$223.02
$162.5128298
Correction of bunion



28.0970
$1,115.12
$812.56
$223.02
$162.5128299
Correction of bunion



28.0970
$1,115.12
$916.06
$223.02
$183.2128300
Incision of heel bone



41.2239
$1,636.10
$1,041.05
$327.22
$208.2128302
Incision of ankle bone



20.2255
$802.71
$624.36
$160.54
$124.8728304
Incision of midfoot bones



41.2239
$1,636.10
$1,041.05
$327.22
$208.2128305
Incise/graft midfoot bones



41.2239
$1,636.10
$1,073.05
$327.22
$214.6128306
Incision of metatarsal



20.2255
$802.71
$716.36
$160.54
$143.2728307
Incision of metatarsal



20.2255
$802.71
$716.36
$160.54
$143.2728308
Incision of metatarsal



20.2255
$802.71
$624.36
$160.54
$124.87( print page 49889)28309
Incision of metatarsals



41.2239
$1,636.10
$1,133.05
$327.22
$226.6128310
Revision of big toe



20.2255
$802.71
$656.36
$160.54
$131.2728312
Revision of toe



20.2255
$802.71
$656.36
$160.54
$131.2728313
Repair deformity of toe



20.2255
$802.71
$624.36
$160.54
$124.8728315
Removal of sesamoid bone



20.2255
$802.71
$716.36
$160.54
$143.2728320
Repair of foot bones



41.2239
$1,636.10
$1,133.05
$327.22
$226.6128322
Repair of metatarsals



41.2239
$1,636.10
$1,133.05
$327.22
$226.6128340
Resect enlarged toe tissue



20.2255
$802.71
$716.36
$160.54
$143.2728341
Resect enlarged toe



20.2255
$802.71
$716.36
$160.54
$143.2728344
Repair extra toe(s)



20.2255
$802.71
$716.36
$160.54
$143.2728345
Repair webbed toe(s)



20.2255
$802.71
$716.36
$160.54
$143.2728400
Treatment of heel fracture



1.6914
$67.13
$85.62
$13.43
$17.1228405
Treatment of heel fracture



1.6914
$67.13
$85.62
$13.43
$17.1228406
Treatment of heel fracture



25.6702
$1,018.80
$732.40
$203.76
$146.4828415
Treat heel fracture



37.5680
$1,491.00
$1,000.50
$298.20
$200.1028420
Treat/graft heel fracture



37.5680
$1,491.00
$1,060.50
$298.20
$212.1028430
Treatment of ankle fracture
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4328435
Treatment of ankle fracture



1.6914
$67.13
$85.62
$13.43
$17.1228436
Treatment of ankle fracture



25.6702
$1,018.80
$732.40
$203.76
$146.4828445
Treat ankle fracture



37.5680
$1,491.00
$1,000.50
$298.20
$200.1028450
Treat midfoot fracture, each
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4328455
Treat midfoot fracture, each
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4328456
Treat midfoot fracture



25.6702
$1,018.80
$732.40
$203.76
$146.4828465
Treat midfoot fracture, each



37.5680
$1,491.00
$1,000.50
$298.20
$200.1028470
Treat metatarsal fracture
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4328475
Treat metatarsal fracture
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4328476
Treat metatarsal fracture



25.6702
$1,018.80
$732.40
$203.76
$146.4828485
Treat metatarsal fracture



37.5680
$1,491.00
$1,060.50
$298.20
$212.1028490
Treat big toe fracture
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4328495
Treat big toe fracture
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4328496
Treat big toe fracture



25.6702
$1,018.80
$732.40
$203.76
$146.4828505
Treat big toe fracture



37.5680
$1,491.00
$1,000.50
$298.20
$200.1028510
Treatment of toe fracture
Y
Y
Y
1.3651
$54.18
$54.18
$10.84
$10.8428515
Treatment of toe fracture
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.43( print page 49890)28525
Treat toe fracture



37.5680
$1,491.00
$1,000.50
$298.20
$200.1028530
Treat sesamoid bone fracture
Y
Y
Y
1.3078
$51.90
$51.90
$10.38
$10.3828531
Treat sesamoid bone fracture



37.5680
$1,491.00
$1,000.50
$298.20
$200.1028540
Treat foot dislocation
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4328545
Treat foot dislocation



25.6702
$1,018.80
$675.90
$203.76
$135.1828546
Treat foot dislocation



25.6702
$1,018.80
$732.40
$203.76
$146.4828555
Repair foot dislocation



37.5680
$1,491.00
$968.50
$298.20
$193.7028570
Treat foot dislocation
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4328575
Treat foot dislocation



1.6914
$67.13
$85.62
$13.43
$17.1228576
Treat foot dislocation



25.6702
$1,018.80
$764.40
$203.76
$152.8828585
Repair foot dislocation



37.5680
$1,491.00
$1,000.50
$298.20
$200.1028600
Treat foot dislocation
Y
Y

1.6914
$67.13
$67.13
$13.43
$13.4328605
Treat foot dislocation



1.6914
$67.13
$85.62
$13.43
$17.1228606
Treat foot dislocation



25.6702
$1,018.80
$732.40
$203.76
$146.4828615
Repair foot dislocation



37.5680
$1,491.00
$1,000.50
$298.20
$200.1028630
Treat toe dislocation
Y


1.6914
$67.13
$67.13
$13.43
$13.4328635
Treat toe dislocation



14.5502
$577.47
$455.23
$115.49
$91.0528636
Treat toe dislocation



25.6702
$1,018.80
$764.40
$203.76
$152.8828645
Repair toe dislocation



37.5680
$1,491.00
$1,000.50
$298.20
$200.1028660
Treat toe dislocation
Y


1.6914
$67.13
$67.13
$13.43
$13.4328665
Treat toe dislocation



14.5502
$577.47
$455.23
$115.49
$91.0528666
Treat toe dislocation



25.6702
$1,018.80
$764.40
$203.76
$152.8828675
Repair of toe dislocation



37.5680
$1,491.00
$1,000.50
$298.20
$200.1028705
Fusion of foot bones



41.2239
$1,636.10
$1,133.05
$327.22
$226.6128715
Fusion of foot bones



41.2239
$1,636.10
$1,133.05
$327.22
$226.6128725
Fusion of foot bones



41.2239
$1,636.10
$1,133.05
$327.22
$226.6128730
Fusion of foot bones



41.2239
$1,636.10
$1,133.05
$327.22
$226.6128735
Fusion of foot bones



41.2239
$1,636.10
$1,133.05
$327.22
$226.6128737
Revision of foot bones



41.2239
$1,636.10
$1,176.55
$327.22
$235.3128740
Fusion of foot bones



41.2239
$1,636.10
$1,133.05
$327.22
$226.6128750
Fusion of big toe joint



41.2239
$1,636.10
$1,133.05
$327.22
$226.6128755
Fusion of big toe joint



20.2255
$802.71
$716.36
$160.54
$143.2728760
Fusion of big toe joint



41.2239
$1,636.10
$1,133.05
$327.22
$226.6128810
Amputation toe  metatarsal



20.2255
$802.71
$624.36
$160.54
$124.87( print page 49891)28820
Amputation of toe



20.2255
$802.71
$624.36
$160.54
$124.8728825
Partial amputation of toe



20.2255
$802.71
$624.36
$160.54
$124.8728890
High energy eswt, plantar f
Y


25.0600
$994.58
$994.58
$198.92
$198.9229010
Application of body cast
Y
Y

2.2728
$90.20
$90.20
$18.04
$18.0429015
Application of body cast
Y
Y

2.2728
$90.20
$90.20
$18.04
$18.0429020
Application of body cast
Y


1.0504
$41.69
$41.69
$8.34
$8.3429025
Application of body cast
Y
Y

1.0504
$41.69
$41.69
$8.34
$8.3429035
Application of body cast
Y


2.2728
$90.20
$90.20
$18.04
$18.0429040
Application of body cast
Y


1.0504
$41.69
$41.69
$8.34
$8.3429044
Application of body cast
Y
Y

2.2728
$90.20
$90.20
$18.04
$18.0429049
Application of figure eight
Y
Y

1.0504
$41.69
$41.69
$8.34
$8.3429055
Application of shoulder cast
Y
Y

2.2728
$90.20
$90.20
$18.04
$18.0429058
Application of shoulder cast
Y
Y

1.0504
$41.69
$41.69
$8.34
$8.3429065
Application of long arm cast
Y
Y
Y
1.1406
$45.27
$45.27
$9.05
$9.0529075
Application of forearm cast
Y
Y
Y
1.0379
$41.19
$41.19
$8.24
$8.2429085
Apply hand/wrist cast
Y
Y

1.0504
$41.69
$41.69
$8.34
$8.3429086
Apply finger cast
Y
Y
Y
0.8720
$34.61
$34.61
$6.92
$6.9229105
Apply long arm splint
Y
Y
Y
1.0024
$39.78
$39.78
$7.96
$7.9629125
Apply forearm splint
Y
Y
Y
0.8527
$33.84
$33.84
$6.77
$6.7729126
Apply forearm splint
Y
Y
Y
0.9572
$37.99
$37.99
$7.60
$7.6029130
Application of finger splint
Y
Y
Y
0.3862
$15.33
$15.33
$3.07
$3.0729131
Application of finger splint
Y
Y
Y
0.5869
$23.29
$23.29
$4.66
$4.6629200
Strapping of chest
Y
Y
Y
0.5597
$22.21
$22.21
$4.44
$4.4429220
Strapping of low back
Y
Y
Y
0.5669
$22.50
$22.50
$4.50
$4.5029240
Strapping of shoulder
Y
Y
Y
0.6464
$25.66
$25.66
$5.13
$5.1329260
Strapping of elbow or wrist
Y
Y
Y
0.5940
$23.58
$23.58
$4.72
$4.7229280
Strapping of hand or finger
Y
Y
Y
0.6225
$24.70
$24.70
$4.94
$4.9429305
Application of hip cast
Y


2.2728
$90.20
$90.20
$18.04
$18.0429325
Application of hip casts
Y


2.2728
$90.20
$90.20
$18.04
$18.0429345
Application of long leg cast
Y
Y
Y
1.5007
$59.56
$59.56
$11.91
$11.9129355
Application of long leg cast
Y
Y
Y
1.4561
$57.79
$57.79
$11.56
$11.5629358
Apply long leg cast brace
Y
Y
Y
1.7938
$71.19
$71.19
$14.24
$14.2429365
Application of long leg cast
Y
Y
Y
1.4129
$56.08
$56.08
$11.22
$11.2229405
Apply short leg cast
Y
Y
Y
1.0527
$41.78
$41.78
$8.36
$8.36( print page 49892)29425
Apply short leg cast
Y
Y
Y
1.0639
$42.22
$42.22
$8.44
$8.4429435
Apply short leg cast
Y
Y
Y
1.3502
$53.59
$53.59
$10.72
$10.7229440
Addition of walker to cast
Y
Y
Y
0.5600
$22.23
$22.23
$4.45
$4.4529445
Apply rigid leg cast
Y
Y
Y
1.4713
$58.39
$58.39
$11.68
$11.6829450
Application of leg cast
Y
Y

1.0504
$41.69
$41.69
$8.34
$8.3429505
Application, long leg splint
Y


1.0504
$41.69
$41.69
$8.34
$8.3429515
Application lower leg splint
Y


1.0504
$41.69
$41.69
$8.34
$8.3429520
Strapping of hip
Y
Y
Y
0.6469
$25.67
$25.67
$5.13
$5.1329530
Strapping of knee
Y
Y
Y
0.6104
$24.23
$24.23
$4.85
$4.8529540
Strapping of ankle and/or ft
Y
Y
Y
0.4057
$16.10
$16.10
$3.22
$3.2229550
Strapping of toes
Y
Y
Y
0.4128
$16.38
$16.38
$3.28
$3.2829580
Application of paste boot
Y
Y
Y
0.5844
$23.19
$23.19
$4.64
$4.6429590
Application of foot splint
Y
Y
Y
0.4639
$18.41
$18.41
$3.68
$3.6829700
Removal/revision of cast
Y
Y
Y
0.7997
$31.74
$31.74
$6.35
$6.3529705
Removal/revision of cast
Y
Y
Y
0.6912
$27.43
$27.43
$5.49
$5.4929710
Removal/revision of cast
Y
Y
Y
1.3029
$51.71
$51.71
$10.34
$10.3429715
Removal/revision of cast
Y
Y
Y
1.0504
$41.69
$41.69
$8.34
$8.3429720
Repair of body cast
Y
Y
Y
1.0084
$40.02
$40.02
$8.00
$8.0029730
Windowing of cast
Y
Y
Y
0.6775
$26.89
$26.89
$5.38
$5.3829740
Wedging of cast
Y
Y
Y
0.9533
$37.83
$37.83
$7.57
$7.5729750
Wedging of clubfoot cast
Y
Y
Y
0.8453
$33.55
$33.55
$6.71
$6.7129800
Jaw arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229804
Jaw arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229805
Shoulder arthroscopy, dx



28.6279
$1,136.19
$823.09
$227.24
$164.6229806
Shoulder arthroscopy/surgery



45.0637
$1,788.49
$1,149.25
$357.70
$229.8529807
Shoulder arthroscopy/surgery



45.0637
$1,788.49
$1,149.25
$357.70
$229.8529819
Shoulder arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229820
Shoulder arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229821
Shoulder arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229822
Shoulder arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.62( print page 49893)29823
Shoulder arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229824
Shoulder arthroscopy/surgery



28.6279
$1,136.19
$926.59
$227.24
$185.3229825
Shoulder arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229826
Shoulder arthroscopy/surgery



45.0637
$1,788.49
$1,149.25
$357.70
$229.8529827
Arthroscop rotator cuff repr



45.0637
$1,788.49
$1,252.75
$357.70
$250.5529830
Elbow arthroscopy



28.6279
$1,136.19
$823.09
$227.24
$164.6229834
Elbow arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229835
Elbow arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229836
Elbow arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229837
Elbow arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229838
Elbow arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229840
Wrist arthroscopy



28.6279
$1,136.19
$823.09
$227.24
$164.6229843
Wrist arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229844
Wrist arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229845
Wrist arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229846
Wrist arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229847
Wrist arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229848
Wrist endoscopy/surgery



28.6279
$1,136.19
$1,237.59
$227.24
$247.5229850
Knee arthroscopy/surgery



28.6279
$1,136.19
$883.09
$227.24
$176.6229851
Knee arthroscopy/surgery



45.0637
$1,788.49
$1,209.25
$357.70
$241.8529855
Tibial arthroscopy/surgery



45.0637
$1,788.49
$1,209.25
$357.70
$241.8529856
Tibial arthroscopy/surgery



28.6279
$1,136.19
$883.09
$227.24
$176.6229860
Hip arthroscopy, dx



28.6279
$1,136.19
$883.09
$227.24
$176.6229861
Hip arthroscopy/surgery



28.6279
$1,136.19
$883.09
$227.24
$176.6229862
Hip arthroscopy/surgery



45.0637
$1,788.49
$1,563.75
$357.70
$312.7529863
Hip arthroscopy/surgery



45.0637
$1,788.49
$1,209.25
$357.70
$241.8529866
Autgrft implnt, knee w/scope
Y


45.0637
$1,788.49
$1,788.49
$357.70
$357.7029870
Knee arthroscopy, dx



28.6279
$1,136.19
$823.09
$227.24
$164.6229871
Knee arthroscopy/drainage



28.6279
$1,136.19
$823.09
$227.24
$164.6229873
Knee arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229874
Knee arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229875
Knee arthroscopy/surgery



28.6279
$1,136.19
$883.09
$227.24
$176.62( print page 49894)29876
Knee arthroscopy/surgery



28.6279
$1,136.19
$883.09
$227.24
$176.6229877
Knee arthroscopy/surgery



28.6279
$1,136.19
$883.09
$227.24
$176.6229879
Knee arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229880
Knee arthroscopy/surgery



28.6279
$1,136.19
$883.09
$227.24
$176.6229881
Knee arthroscopy/surgery



28.6279
$1,136.19
$883.09
$227.24
$176.6229882
Knee arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229883
Knee arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229884
Knee arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229885
Knee arthroscopy/surgery



45.0637
$1,788.49
$1,149.25
$357.70
$229.8529886
Knee arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229887
Knee arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229888
Knee arthroscopy/surgery



45.0637
$1,788.49
$1,149.25
$357.70
$229.8529889
Knee arthroscopy/surgery



45.0637
$1,788.49
$1,149.25
$357.70
$229.8529891
Ankle arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229892
Ankle arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229893
Scope, plantar fasciotomy



20.2255
$802.71
$1,023.81
$160.54
$204.7629894
Ankle arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229895
Ankle arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229897
Ankle arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229898
Ankle arthroscopy/surgery



28.6279
$1,136.19
$823.09
$227.24
$164.6229899
Ankle arthroscopy/surgery



45.0637
$1,788.49
$1,149.25
$357.70
$229.8529900
Mcp joint arthroscopy, dx



16.0343
$636.37
$573.19
$127.27
$114.6429901
Mcp joint arthroscopy, surg



16.0343
$636.37
$573.19
$127.27
$114.6429902
Mcp joint arthroscopy, surg



16.0343
$636.37
$573.19
$127.27
$114.6430000
Drainage of nose lesion
Y
Y

2.3768
$94.33
$94.33
$18.87
$18.8730020
Drainage of nose lesion
Y
Y

2.3768
$94.33
$94.33
$18.87
$18.8730100
Intranasal biopsy
Y
Y
Y
1.9302
$76.60
$76.60
$15.32
$15.3230110
Removal of nose polyp(s)
Y
Y
Y
3.0207
$119.89
$119.89
$23.98
$23.9830115
Removal of nose polyp(s)



16.4494
$652.85
$549.42
$130.57
$109.8830117
Removal of intranasal lesion



16.4494
$652.85
$581.42
$130.57
$116.2830118
Removal of intranasal lesion



23.1564
$919.03
$714.52
$183.81
$142.9030120
Revision of nose



16.4494
$652.85
$492.92
$130.57
$98.58( print page 49895)30124
Removal of nose lesion
Y
Y
Y
3.1426
$124.72
$124.72
$24.94
$24.9430125
Removal of nose lesion



37.7719
$1,499.09
$972.55
$299.82
$194.5130130
Excise inferior turbinate



16.4494
$652.85
$581.42
$130.57
$116.2830140
Resect inferior turbinate



23.1564
$919.03
$682.52
$183.81
$136.5030150
Partial removal of nose



37.7719
$1,499.09
$1,004.55
$299.82
$200.9130160
Removal of nose



37.7719
$1,499.09
$1,064.55
$299.82
$212.9130200
Injection treatment of nose
Y
Y
Y
1.5377
$61.03
$61.03
$12.21
$12.2130210
Nasal sinus therapy
Y
Y
Y
1.9430
$77.11
$77.11
$15.42
$15.4230220
Insert nasal septal button



7.7261
$306.63
$391.09
$61.33
$78.2230300
Remove nasal foreign body
Y
Y

0.6211
$24.65
$24.65
$4.93
$4.9330310
Remove nasal foreign body



16.4494
$652.85
$492.92
$130.57
$98.5830320
Remove nasal foreign body



16.4494
$652.85
$549.42
$130.57
$109.8830400
Reconstruction of nose



37.7719
$1,499.09
$1,064.55
$299.82
$212.9130410
Reconstruction of nose



37.7719
$1,499.09
$1,108.05
$299.82
$221.6130420
Reconstruction of nose



37.7719
$1,499.09
$1,108.05
$299.82
$221.6130430
Revision of nose



23.1564
$919.03
$714.52
$183.81
$142.9030435
Revision of nose



37.7719
$1,499.09
$1,108.05
$299.82
$221.6130450
Revision of nose



37.7719
$1,499.09
$1,247.05
$299.82
$249.4130460
Revision of nose



37.7719
$1,499.09
$1,247.05
$299.82
$249.4130462
Revision of nose



37.7719
$1,499.09
$1,419.05
$299.82
$283.8130465
Repair nasal stenosis



37.7719
$1,499.09
$1,419.05
$299.82
$283.8130520
Repair of nasal septum



23.1564
$919.03
$774.52
$183.81
$154.9030540
Repair nasal defect



37.7719
$1,499.09
$1,108.05
$299.82
$221.6130545
Repair nasal defect



37.7719
$1,499.09
$1,108.05
$299.82
$221.6130560
Release of nasal adhesions



2.3768
$94.33
$120.31
$18.87
$24.0630580
Repair upper jaw fistula



37.7719
$1,499.09
$1,064.55
$299.82
$212.9130600
Repair mouth/nose fistula



37.7719
$1,499.09
$1,064.55
$299.82
$212.9130620
Intranasal reconstruction



37.7719
$1,499.09
$1,247.05
$299.82
$249.4130630
Repair nasal septum defect



23.1564
$919.03
$957.02
$183.81
$191.4030801
Ablate inf turbinate, superf



7.7261
$306.63
$319.82
$61.33
$63.9630802
Cauterization, inner nose



7.7261
$306.63
$319.82
$61.33
$63.9630901
Control of nosebleed
Y
Y
Y
1.1029
$43.77
$43.77
$8.75
$8.7530903
Control of nosebleed



1.2021
$47.71
$60.85
$9.54
$12.17( print page 49896)30905
Control of nosebleed



1.2021
$47.71
$60.85
$9.54
$12.1730906
Repeat control of nosebleed



1.2021
$47.71
$60.85
$9.54
$12.1730915
Ligation, nasal sinus artery



24.5817
$975.60
$710.80
$195.12
$142.1630920
Ligation, upper jaw artery



24.5817
$975.60
$742.80
$195.12
$148.5630930
Ther fx, nasal inf turbinate



16.4494
$652.85
$641.42
$130.57
$128.2831000
Irrigation, maxillary sinus
Y
Y

2.3768
$94.33
$94.33
$18.87
$18.8731002
Irrigation, sphenoid sinus
Y
Y
Y
2.4899
$98.82
$98.82
$19.76
$19.7631020
Exploration, maxillary sinus



23.1564
$919.03
$682.52
$183.81
$136.5031030
Exploration, maxillary sinus



37.7719
$1,499.09
$1,004.55
$299.82
$200.9131032
Explore sinus, remove polyps



37.7719
$1,499.09
$1,064.55
$299.82
$212.9131040
Exploration behind upper jaw
Y
Y
Y
7.3501
$291.71
$291.71
$58.34
$58.3431050
Exploration, sphenoid sinus



37.7719
$1,499.09
$972.55
$299.82
$194.5131051
Sphenoid sinus surgery



37.7719
$1,499.09
$1,064.55
$299.82
$212.9131070
Exploration of frontal sinus



23.1564
$919.03
$682.52
$183.81
$136.5031075
Exploration of frontal sinus



37.7719
$1,499.09
$1,064.55
$299.82
$212.9131080
Removal of frontal sinus



37.7719
$1,499.09
$1,064.55
$299.82
$212.9131081
Removal of frontal sinus



37.7719
$1,499.09
$1,064.55
$299.82
$212.9131084
Removal of frontal sinus



37.7719
$1,499.09
$1,064.55
$299.82
$212.9131085
Removal of frontal sinus



37.7719
$1,499.09
$1,064.55
$299.82
$212.9131086
Removal of frontal sinus



37.7719
$1,499.09
$1,064.55
$299.82
$212.9131087
Removal of frontal sinus



37.7719
$1,499.09
$1,064.55
$299.82
$212.9131090
Exploration of sinuses



37.7719
$1,499.09
$1,108.05
$299.82
$221.6131200
Removal of ethmoid sinus



37.7719
$1,499.09
$972.55
$299.82
$194.5131201
Removal of ethmoid sinus



37.7719
$1,499.09
$1,108.05
$299.82
$221.6131205
Removal of ethmoid sinus



37.7719
$1,499.09
$1,004.55
$299.82
$200.9131231
Nasal endoscopy, dx
Y
Y

1.4038
$55.71
$55.71
$11.14
$11.1431233
Nasal/sinus endoscopy, dx



1.4038
$55.71
$71.06
$11.14
$14.2131235
Nasal/sinus endoscopy, dx



15.1300
$600.48
$466.74
$120.10
$93.3531237
Nasal/sinus endoscopy, surg



15.1300
$600.48
$523.24
$120.10
$104.6531238
Nasal/sinus endoscopy, surg



15.1300
$600.48
$466.74
$120.10
$93.3531239
Nasal/sinus endoscopy, surg



21.8010
$865.24
$747.62
$173.05
$149.52( print page 49897)31240
Nasal/sinus endoscopy, surg



15.1300
$600.48
$523.24
$120.10
$104.6531254
Revision of ethmoid sinus



21.8010
$865.24
$687.62
$173.05
$137.5231255
Removal of ethmoid sinus



21.8010
$865.24
$791.12
$173.05
$158.2231256
Exploration maxillary sinus



21.8010
$865.24
$687.62
$173.05
$137.5231267
Endoscopy, maxillary sinus



21.8010
$865.24
$687.62
$173.05
$137.5231276
Sinus endoscopy, surgical



21.8010
$865.24
$687.62
$173.05
$137.5231287
Nasal/sinus endoscopy, surg



21.8010
$865.24
$687.62
$173.05
$137.5231288
Nasal/sinus endoscopy, surg



21.8010
$865.24
$687.62
$173.05
$137.5231300
Removal of larynx lesion



23.1564
$919.03
$818.02
$183.81
$163.6031320
Diagnostic incision, larynx



37.7719
$1,499.09
$972.55
$299.82
$194.5131400
Revision of larynx



37.7719
$1,499.09
$972.55
$299.82
$194.5131420
Removal of epiglottis



37.7719
$1,499.09
$972.55
$299.82
$194.5131502
Change of windpipe airway
Y


2.3431
$92.99
$92.99
$18.60
$18.6031505
Diagnostic laryngoscopy
Y
Y

0.7572
$30.05
$30.05
$6.01
$6.0131510
Laryngoscopy with biopsy



15.1300
$600.48
$523.24
$120.10
$104.6531511
Remove foreign body, larynx



1.4038
$55.71
$71.06
$11.14
$14.2131512
Removal of larynx lesion



15.1300
$600.48
$523.24
$120.10
$104.6531513
Injection into vocal cord



1.4038
$55.71
$71.06
$11.14
$14.2131515
Laryngoscopy for aspiration



15.1300
$600.48
$466.74
$120.10
$93.3531520
Diagnostic laryngoscopy
Y


1.4038
$55.71
$55.71
$11.14
$11.1431525
Dx laryngoscopy excl nb



15.1300
$600.48
$466.74
$120.10
$93.3531526
Dx laryngoscopy w/oper scope



21.8010
$865.24
$655.62
$173.05
$131.1231527
Laryngoscopy for treatment



21.8010
$865.24
$599.12
$173.05
$119.8231528
Laryngoscopy and dilation



15.1300
$600.48
$523.24
$120.10
$104.6531529
Laryngoscopy and dilation



15.1300
$600.48
$523.24
$120.10
$104.6531530
Laryngoscopy w/fb removal



21.8010
$865.24
$655.62
$173.05
$131.1231531
Laryngoscopy w/fb  op scope



21.8010
$865.24
$687.62
$173.05
$137.5231535
Laryngoscopy w/biopsy



21.8010
$865.24
$655.62
$173.05
$131.1231536
Laryngoscopy w/bx  op scope



21.8010
$865.24
$687.62
$173.05
$137.5231540
Laryngoscopy w/exc of tumor



21.8010
$865.24
$687.62
$173.05
$137.52( print page 49898)31541
Larynscop w/tumr exc + scope



21.8010
$865.24
$747.62
$173.05
$149.5231545
Remove vc lesion w/scope



21.8010
$865.24
$747.62
$173.05
$149.5231546
Remove vc lesion scope/graft



21.8010
$865.24
$747.62
$173.05
$149.5231560
Laryngoscop w/arytenoidectom



21.8010
$865.24
$791.12
$173.05
$158.2231561
Larynscop, remve cart + scop



21.8010
$865.24
$791.12
$173.05
$158.2231570
Laryngoscope w/vc inj



15.1300
$600.48
$523.24
$120.10
$104.6531571
Laryngoscop w/vc inj + scope



21.8010
$865.24
$655.62
$173.05
$131.1231575
Diagnostic laryngoscopy
Y
Y

1.4038
$55.71
$55.71
$11.14
$11.1431576
Laryngoscopy with biopsy



21.8010
$865.24
$655.62
$173.05
$131.1231577
Remove foreign body, larynx



3.8737
$153.74
$196.08
$30.75
$39.2231578
Removal of larynx lesion



21.8010
$865.24
$655.62
$173.05
$131.1231579
Diagnostic laryngoscopy
Y
Y
Y
2.8542
$113.28
$113.28
$22.66
$22.6631580
Revision of larynx



37.7719
$1,499.09
$1,108.05
$299.82
$221.6131582
Revision of larynx



37.7719
$1,499.09
$1,108.05
$299.82
$221.6131588
Revision of larynx



37.7719
$1,499.09
$1,108.05
$299.82
$221.6131590
Reinnervate larynx



37.7719
$1,499.09
$1,108.05
$299.82
$221.6131595
Larynx nerve surgery



37.7719
$1,499.09
$972.55
$299.82
$194.5131603
Incision of windpipe



7.7261
$306.63
$319.82
$61.33
$63.9631605
Incision of windpipe
Y


7.7261
$306.63
$306.63
$61.33
$61.3331611
Surgery/speech prosthesis



23.1564
$919.03
$714.52
$183.81
$142.9031612
Puncture/clear windpipe



23.1564
$919.03
$626.02
$183.81
$125.2031613
Repair windpipe opening



23.1564
$919.03
$682.52
$183.81
$136.5031614
Repair windpipe opening



37.7719
$1,499.09
$972.55
$299.82
$194.5131615
Visualization of windpipe



9.3905
$372.69
$352.85
$74.54
$70.5731620
Endobronchial us add-on
Y


29.7322
$1,180.01
$1,180.01
$236.00
$236.0031622
Dx bronchoscope/wash



9.3905
$372.69
$352.85
$74.54
$70.5731623
Dx bronchoscope/brush



9.3905
$372.69
$409.35
$74.54
$81.8731624
Dx bronchoscope/lavage



9.3905
$372.69
$409.35
$74.54
$81.8731625
Bronchoscopy w/biopsy(s)



9.3905
$372.69
$409.35
$74.54
$81.8731628
Bronchoscopy/lung bx, each



9.3905
$372.69
$409.35
$74.54
$81.8731629
Bronchoscopy/needle bx, each



9.3905
$372.69
$409.35
$74.54
$81.87( print page 49899)31630
Bronchoscopy dilate/fx repr



21.8803
$868.39
$657.19
$173.68
$131.4431631
Bronchoscopy, dilate w/stent



21.8803
$868.39
$657.19
$173.68
$131.4431632
Bronchoscopy/lung bx, add'l
Y


9.3905
$372.69
$372.69
$74.54
$74.5431633
Bronchoscopy/needle bx add'l
Y


9.3905
$372.69
$372.69
$74.54
$74.5431635
Bronchoscopy w/fb removal



9.3905
$372.69
$409.35
$74.54
$81.8731636
Bronchoscopy, bronch stents



21.8803
$868.39
$657.19
$173.68
$131.4431637
Bronchoscopy, stent add-on



9.3905
$372.69
$352.85
$74.54
$70.5731638
Bronchoscopy, revise stent



21.8803
$868.39
$657.19
$173.68
$131.4431640
Bronchoscopy w/tumor excise



21.8803
$868.39
$657.19
$173.68
$131.4431641
Bronchoscopy, treat blockage



21.8803
$868.39
$657.19
$173.68
$131.4431643
Diag bronchoscope/catheter



9.3905
$372.69
$409.35
$74.54
$81.8731645
Bronchoscopy, clear airways



9.3905
$372.69
$352.85
$74.54
$70.5731646
Bronchoscopy, reclear airway



9.3905
$372.69
$352.85
$74.54
$70.5731656
Bronchoscopy, inj for x-ray



9.3905
$372.69
$352.85
$74.54
$70.5731700
Insertion of airway catheter



1.4038
$55.71
$71.06
$11.14
$14.2131717
Bronchial brush biopsy



3.8737
$153.74
$196.08
$30.75
$39.2231720
Clearance of airways



0.7572
$30.05
$38.33
$6.01
$7.6731730
Intro, windpipe wire/tube



3.8737
$153.74
$196.08
$30.75
$39.2231750
Repair of windpipe



37.7719
$1,499.09
$1,108.05
$299.82
$221.6131755
Repair of windpipe



37.7719
$1,499.09
$972.55
$299.82
$194.5131820
Closure of windpipe lesion



16.4494
$652.85
$492.92
$130.57
$98.5831825
Repair of windpipe defect



23.1564
$919.03
$682.52
$183.81
$136.5031830
Revise windpipe scar



23.1564
$919.03
$682.52
$183.81
$136.5032000
Drainage of chest



3.6425
$144.56
$184.38
$28.91
$36.8832002
Treatment of collapsed lung
Y


3.6425
$144.56
$144.56
$28.91
$28.9132019
Insert pleural catheter
Y


29.2259
$1,159.92
$1,159.92
$231.98
$231.9832020
Tube thoracostomy
Y


3.6425
$144.56
$144.56
$28.91
$28.9132400
Needle biopsy chest lining



6.0729
$241.02
$287.01
$48.20
$57.4032405
Biopsy, lung or mediastinum



6.0729
$241.02
$287.01
$48.20
$57.4032420
Puncture/clear lung



3.6425
$144.56
$184.38
$28.91
$36.8832960
Therapeutic pneumothorax
Y


3.6425
$144.56
$144.56
$28.91
$28.9133010
Drainage of heart sac



3.6425
$144.56
$184.38
$28.91
$36.88( print page 49900)33011
Repeat drainage of heart sac



3.6425
$144.56
$184.38
$28.91
$36.8833206
Insertion of heart pacemaker
Y


121.9402
$4,839.57
$4,839.57
$967.91
$967.9133212
Insertion of pulse generator



97.8357
$3,882.91
$2,196.46
$776.58
$439.2933213
Insertion of pulse generator



112.2347
$4,454.38
$2,482.19
$890.88
$496.4433214
Upgrade of pacemaker system
Y


153.1524
$6,078.33
$6,078.33
$1,215.67
$1,215.6733215
Reposition pacing-defib lead
Y


23.4666
$931.34
$931.34
$186.27
$186.2733216
Insert lead pace-defib, one
Y


44.7574
$1,776.34
$1,776.34
$355.27
$355.2733217
Insert lead pace-defib, dual
Y


44.7574
$1,776.34
$1,776.34
$355.27
$355.2733218
Repair lead pace-defib, one
Y


44.7574
$1,776.34
$1,776.34
$355.27
$355.2733220
Repair lead pace-defib, dual
Y


44.7574
$1,776.34
$1,776.34
$355.27
$355.2733222
Revise pocket, pacemaker



21.2645
$843.95
$644.97
$168.79
$128.9933223
Revise pocket, pacing-defib



21.2645
$843.95
$644.97
$168.79
$128.9933224
Insert pacing lead  connect
Y


267.8870
$10,631.92
$10,631.92
$2,126.38
$2,126.3833225
L ventric pacing lead add-on
Y


267.8870
$10,631.92
$10,631.92
$2,126.38
$2,126.3833226
Reposition l ventric lead
Y


23.4666
$931.34
$931.34
$186.27
$186.2733233
Removal of pacemaker system



23.4666
$931.34
$688.67
$186.27
$137.7333234
Removal of pacemaker system
Y


23.4666
$931.34
$931.34
$186.27
$186.2733241
Remove pulse generator
Y


23.4666
$931.34
$931.34
$186.27
$186.2733282
Implant pat-active ht record
Y


74.8877
$2,972.15
$2,972.15
$594.43
$594.4333284
Remove pat-active ht record
Y


10.9541
$434.75
$434.75
$86.95
$86.9535188
Repair blood vessel lesion



37.9652
$1,506.77
$1,068.38
$301.35
$213.6835207
Repair blood vessel lesion



37.9652
$1,506.77
$1,068.38
$301.35
$213.6835473
Repair arterial blockage
Y


42.8894
$1,702.20
$1,702.20
$340.44
$340.4435474
Repair arterial blockage
Y


42.8894
$1,702.20
$1,702.20
$340.44
$340.4435476
Repair venous blockage
Y


42.8894
$1,702.20
$1,702.20
$340.44
$340.4435492
Atherectomy, percutaneous
Y


42.8894
$1,702.20
$1,702.20
$340.44
$340.4435761
Exploration of artery/vein
Y


29.4757
$1,169.83
$1,169.83
$233.97
$233.9735875
Removal of clot in graft



37.9652
$1,506.77
$1,422.88
$301.35
$284.58( print page 49901)35876
Removal of clot in graft



37.9652
$1,506.77
$1,422.88
$301.35
$284.5836002
Pseudoaneurysm injection trt
Y


2.5166
$99.88
$99.88
$19.98
$19.9836260
Insertion of infusion pump



28.4646
$1,129.71
$819.85
$225.94
$163.9736261
Revision of infusion pump



28.4646
$1,129.71
$787.85
$225.94
$157.5736262
Removal of infusion pump



22.6984
$900.86
$616.93
$180.17
$123.3936420
Vein access cutdown  1 yr
Y


0.2016
$8.00
$8.00
$1.60
$1.6036425
Vein access cutdown  1 yr
Y
Y
Y
0.1841
$7.31
$7.31
$1.46
$1.4636430
Blood transfusion service
Y
Y
Y
0.8269
$32.82
$32.82
$6.56
$6.5636440
Bl push transfuse, 2 yr or
Y
Y
Y
0.3133
$12.43
$12.43
$2.49
$2.4936450
Bl exchange/transfuse, nb
Y
Y

0.6213
$24.66
$24.66
$4.93
$4.9336468
Injection(s), spider veins
Y
Y

1.1035
$43.80
$43.80
$8.76
$8.7636469
Injection(s), spider veins
Y


1.1035
$43.80
$43.80
$8.76
$8.7636470
Injection therapy of vein
Y
Y

1.1035
$43.80
$43.80
$8.76
$8.7636471
Injection therapy of veins
Y
Y

1.1035
$43.80
$43.80
$8.76
$8.7636475
Endovenous rf, 1st vein



34.6279
$1,374.32
$942.16
$274.86
$188.4336476
Endovenous rf, vein add-on



34.6279
$1,374.32
$942.16
$274.86
$188.4336478
Endovenous laser, 1st vein



24.5817
$975.60
$742.80
$195.12
$148.5636479
Endovenous laser vein addon



24.5817
$975.60
$742.80
$195.12
$148.5636511
Apheresis wbc
Y


11.7005
$464.37
$464.37
$92.87
$92.8736512
Apheresis rbc
Y


11.7005
$464.37
$464.37
$92.87
$92.8736513
Apheresis platelets
Y


11.7005
$464.37
$464.37
$92.87
$92.8736514
Apheresis plasma
Y


11.7005
$464.37
$464.37
$92.87
$92.8736515
Apheresis, adsorp/reinfuse
Y


30.6602
$1,216.84
$1,216.84
$243.37
$243.3736516
Apheresis, selective
Y


30.6602
$1,216.84
$1,216.84
$243.37
$243.3736522
Photopheresis
Y


30.6602
$1,216.84
$1,216.84
$243.37
$243.3736550
Declot vascular device
Y
Y
Y
0.5176
$20.54
$20.54
$4.11
$4.1136555
Insert non-tunnel cv cath



8.7841
$348.62
$340.81
$69.72
$68.1636556
Insert non-tunnel cv cath



8.7841
$348.62
$340.81
$69.72
$68.1636557
Insert tunneled cv cath



22.6984
$900.86
$673.43
$180.17
$134.6936558
Insert tunneled cv cath



22.6984
$900.86
$673.43
$180.17
$134.6936560
Insert tunneled cv cath



28.4646
$1,129.71
$819.85
$225.94
$163.9736561
Insert tunneled cv cath



28.4646
$1,129.71
$819.85
$225.94
$163.9736563
Insert tunneled cv cath



28.4646
$1,129.71
$819.85
$225.94
$163.97( print page 49902)36565
Insert tunneled cv cath



28.4646
$1,129.71
$819.85
$225.94
$163.9736566
Insert tunneled cv cath



28.4646
$1,129.71
$819.85
$225.94
$163.9736568
Insert picc cath



8.7841
$348.62
$340.81
$69.72
$68.1636569
Insert picc cath



8.7841
$348.62
$340.81
$69.72
$68.1636570
Insert picvad cath



22.6984
$900.86
$705.43
$180.17
$141.0936571
Insert picvad cath



22.6984
$900.86
$705.43
$180.17
$141.0936575
Repair tunneled cv cath



8.7841
$348.62
$397.31
$69.72
$79.4636576
Repair tunneled cv cath



8.7841
$348.62
$397.31
$69.72
$79.4636578
Replace tunneled cv cath



22.6984
$900.86
$673.43
$180.17
$134.6936580
Replace cvad cath



8.7841
$348.62
$340.81
$69.72
$68.1636581
Replace tunneled cv cath



22.6984
$900.86
$673.43
$180.17
$134.6936582
Replace tunneled cv cath



28.4646
$1,129.71
$819.85
$225.94
$163.9736583
Replace tunneled cv cath



28.4646
$1,129.71
$819.85
$225.94
$163.9736584
Replace picc cath



8.7841
$348.62
$340.81
$69.72
$68.1636585
Replace picvad cath



22.6984
$900.86
$705.43
$180.17
$141.0936589
Removal tunneled cv cath



8.7841
$348.62
$340.81
$69.72
$68.1636590
Removal tunneled cv cath



8.7841
$348.62
$340.81
$69.72
$68.1636595
Mech remov tunneled cv cath
Y


22.6984
$900.86
$900.86
$180.17
$180.1736596
Mech remov tunneled cv cath
Y


8.7841
$348.62
$348.62
$69.72
$69.7236598
Inj w/fluor, eval cv device
Y
Y

0.6211
$24.65
$24.65
$4.93
$4.9336640
Insertion catheter, artery



28.4646
$1,129.71
$731.35
$225.94
$146.2736680
Insert needle, bone cavity
Y


1.0948
$43.45
$43.45
$8.69
$8.6936800
Insertion of cannula



29.4757
$1,169.83
$839.92
$233.97
$167.9836810
Insertion of cannula



29.4757
$1,169.83
$839.92
$233.97
$167.9836815
Insertion of cannula



29.4757
$1,169.83
$839.92
$233.97
$167.9836818
Av fuse, uppr arm, cephalic
Y


37.9652
$1,506.77
$1,506.77
$301.35
$301.3536819
Av fuse, uppr arm, basilic



37.9652
$1,506.77
$1,008.38
$301.35
$201.6836820
Av fusion/forearm vein



37.9652
$1,506.77
$1,008.38
$301.35
$201.6836821
Av fusion direct any site



37.9652
$1,506.77
$1,008.38
$301.35
$201.6836825
Artery-vein autograft



37.9652
$1,506.77
$1,068.38
$301.35
$213.6836830
Artery-vein nonautograft



37.9652
$1,506.77
$1,068.38
$301.35
$213.6836831
Open thrombect av fistula



37.9652
$1,506.77
$1,422.88
$301.35
$284.5836832
Av fistula revision, open



37.9652
$1,506.77
$1,068.38
$301.35
$213.6836833
Av fistula revision



37.9652
$1,506.77
$1,068.38
$301.35
$213.68( print page 49903)36834
Repair a-v aneurysm



37.9652
$1,506.77
$1,008.38
$301.35
$201.6836835
Artery to vein shunt



29.4757
$1,169.83
$899.92
$233.97
$179.9836860
External cannula declotting



2.0612
$81.81
$104.34
$16.36
$20.8736861
Cannula declotting



29.4757
$1,169.83
$839.92
$233.97
$167.9836870
Percut thrombect av fistula



31.0004
$1,230.35
$1,284.67
$246.07
$256.9337184
Prim art mech thrombectomy
Y


31.0004
$1,230.35
$1,230.35
$246.07
$246.0737185
Prim art m-thrombect add-on
Y


17.0436
$676.43
$676.43
$135.29
$135.2937186
Sec art m-thrombect add-on
Y


17.0436
$676.43
$676.43
$135.29
$135.2937187
Venous mech thrombectomy
Y


31.0004
$1,230.35
$1,230.35
$246.07
$246.0737188
Venous m-thrombectomy add-on
Y


31.0004
$1,230.35
$1,230.35
$246.07
$246.0737200
Transcatheter biopsy
Y


6.0729
$241.02
$241.02
$48.20
$48.2037203
Transcatheter retrieval
Y


17.0436
$676.43
$676.43
$135.29
$135.2937205
Transcath iv stent, percut
Y


66.0804
$2,622.60
$2,622.60
$524.52
$524.5237250
Iv us first vessel add-on
Y


32.2182
$1,278.68
$1,278.68
$255.74
$255.7437251
Iv us each add vessel add-on
Y


32.2182
$1,278.68
$1,278.68
$255.74
$255.7437500
Endoscopy ligate perf veins



34.6279
$1,374.32
$942.16
$274.86
$188.4337607
Ligation of a-v fistula



24.5817
$975.60
$742.80
$195.12
$148.5637609
Temporal artery procedure



14.9563
$593.59
$519.79
$118.72
$103.9637650
Revision of major vein



24.5817
$975.60
$710.80
$195.12
$142.1637700
Revise leg vein



34.6279
$1,374.32
$910.16
$274.86
$182.0337718
Ligate/strip short leg vein



34.6279
$1,374.32
$942.16
$274.86
$188.4337722
Ligate/strip long leg vein



34.6279
$1,374.32
$942.16
$274.86
$188.4337735
Removal of leg veins/lesion



34.6279
$1,374.32
$942.16
$274.86
$188.4337760
Ligation, leg veins, open



24.5817
$975.60
$742.80
$195.12
$148.5637765
Phleb veins - extrem - to 20
Y
Y
Y
3.5230
$139.82
$139.82
$27.96
$27.9637766
Phleb veins - extrem 20+
Y
Y
Y
4.0582
$161.06
$161.06
$32.21
$32.2137780
Revision of leg vein



24.5817
$975.60
$742.80
$195.12
$148.5637785
Ligate/divide/excise vein



24.5817
$975.60
$742.80
$195.12
$148.5637790
Penile venous occlusion



32.9991
$1,309.67
$909.84
$261.93
$181.9738205
Harvest allogenic stem cells
Y


11.7005
$464.37
$464.37
$92.87
$92.8738206
Harvest auto stem cells
Y


11.7005
$464.37
$464.37
$92.87
$92.87( print page 49904)38220
Bone marrow aspiration
Y
Y

2.4295
$96.42
$96.42
$19.28
$19.2838221
Bone marrow biopsy
Y
Y

2.4295
$96.42
$96.42
$19.28
$19.2838230
Bone marrow collection
Y


23.2490
$922.71
$922.71
$184.54
$184.5438241
Bone marrow/stem transplant
Y


23.2490
$922.71
$922.71
$184.54
$184.5438242
Lymphocyte infuse transplant
Y
Y
Y
0.6143
$24.38
$24.38
$4.88
$4.8838300
Drainage, lymph node lesion



10.9184
$433.33
$383.17
$86.67
$76.6338305
Drainage, lymph node lesion



17.4686
$693.30
$569.65
$138.66
$113.9338308
Incision of lymph channels



21.3673
$848.03
$647.01
$169.61
$129.4038500
Biopsy/removal, lymph nodes



21.3673
$848.03
$647.01
$169.61
$129.4038505
Needle biopsy, lymph nodes



3.8051
$151.02
$192.61
$30.20
$38.5238510
Biopsy/removal, lymph nodes



21.3673
$848.03
$647.01
$169.61
$129.4038520
Biopsy/removal, lymph nodes



21.3673
$848.03
$647.01
$169.61
$129.4038525
Biopsy/removal, lymph nodes



21.3673
$848.03
$647.01
$169.61
$129.4038530
Biopsy/removal, lymph nodes



21.3673
$848.03
$647.01
$169.61
$129.4038542
Explore deep node(s), neck



37.1283
$1,473.55
$959.78
$294.71
$191.9638550
Removal, neck/armpit lesion



21.3673
$848.03
$679.01
$169.61
$135.8038555
Removal, neck/armpit lesion



21.3673
$848.03
$739.01
$169.61
$147.8038570
Laparoscopy, lymph node biop



43.5124
$1,726.92
$1,532.96
$345.38
$306.5938571
Laparoscopy, lymphadenectomy



70.8854
$2,813.31
$2,076.15
$562.66
$415.2338572
Laparoscopy, lymphadenectomy



43.5124
$1,726.92
$1,532.96
$345.38
$306.5938700
Removal of lymph nodes, neck
Y


21.3673
$848.03
$848.03
$169.61
$169.6138740
Remove armpit lymph nodes



37.1283
$1,473.55
$959.78
$294.71
$191.9638745
Remove armpit lymph nodes



37.1283
$1,473.55
$1,051.78
$294.71
$210.3638760
Remove groin lymph nodes



21.3673
$848.03
$647.01
$169.61
$129.4040490
Biopsy of lip
Y
Y
Y
1.6094
$63.87
$63.87
$12.77
$12.7740500
Partial excision of lip



16.4494
$652.85
$549.42
$130.57
$109.8840510
Partial excision of lip



23.1564
$919.03
$682.52
$183.81
$136.5040520
Partial excision of lip



16.4494
$652.85
$549.42
$130.57
$109.8840525
Reconstruct lip with flap



23.1564
$919.03
$682.52
$183.81
$136.5040527
Reconstruct lip with flap



23.1564
$919.03
$682.52
$183.81
$136.5040530
Partial removal of lip



23.1564
$919.03
$682.52
$183.81
$136.50( print page 49905)40650
Repair lip



7.7261
$306.63
$391.09
$61.33
$78.2240652
Repair lip



7.7261
$306.63
$391.09
$61.33
$78.2240654
Repair lip



7.7261
$306.63
$391.09
$61.33
$78.2240700
Repair cleft lip/nasal



37.7719
$1,499.09
$1,247.05
$299.82
$249.4140701
Repair cleft lip/nasal



37.7719
$1,499.09
$1,247.05
$299.82
$249.4140702
Repair cleft lip/nasal
Y
Y
Y
6.6019
$262.02
$262.02
$52.40
$52.4040720
Repair cleft lip/nasal



37.7719
$1,499.09
$1,247.05
$299.82
$249.4140761
Repair cleft lip/nasal



37.7719
$1,499.09
$1,004.55
$299.82
$200.9140800
Drainage of mouth lesion
Y
Y

1.4821
$58.82
$58.82
$11.76
$11.7640801
Drainage of mouth lesion



7.7261
$306.63
$376.32
$61.33
$75.2640804
Removal, foreign body, mouth
Y
Y

0.6211
$24.65
$24.65
$4.93
$4.9340805
Removal, foreign body, mouth
Y
Y
Y
4.1994
$166.66
$166.66
$33.33
$33.3340806
Incision of lip fold
Y
Y
Y
1.8622
$73.91
$73.91
$14.78
$14.7840808
Biopsy of mouth lesion
Y
Y

2.3768
$94.33
$94.33
$18.87
$18.8740810
Excision of mouth lesion
Y
Y
Y
2.8430
$112.83
$112.83
$22.57
$22.5740812
Excise/repair mouth lesion
Y
Y
Y
3.6275
$143.97
$143.97
$28.79
$28.7940814
Excise/repair mouth lesion



16.4494
$652.85
$549.42
$130.57
$109.8840816
Excision of mouth lesion



23.1564
$919.03
$682.52
$183.81
$136.5040818
Excise oral mucosa for graft



2.3768
$94.33
$120.31
$18.87
$24.0640819
Excise lip or cheek fold



7.7261
$306.63
$319.82
$61.33
$63.9640820
Treatment of mouth lesion
Y
Y
Y
3.9656
$157.39
$157.39
$31.48
$31.4840830
Repair mouth laceration
Y


2.3768
$94.33
$94.33
$18.87
$18.8740831
Repair mouth laceration



7.7261
$306.63
$319.82
$61.33
$63.9640840
Reconstruction of mouth



23.1564
$919.03
$682.52
$183.81
$136.5040842
Reconstruction of mouth



23.1564
$919.03
$714.52
$183.81
$142.9040843
Reconstruction of mouth



23.1564
$919.03
$714.52
$183.81
$142.9040844
Reconstruction of mouth



37.7719
$1,499.09
$1,108.05
$299.82
$221.6140845
Reconstruction of mouth



37.7719
$1,499.09
$1,108.05
$299.82
$221.6141000
Drainage of mouth lesion
Y
Y
Y
2.1048
$83.53
$83.53
$16.71
$16.7141005
Drainage of mouth lesion



2.3768
$94.33
$120.31
$18.87
$24.0641006
Drainage of mouth lesion



23.1564
$919.03
$626.02
$183.81
$125.2041007
Drainage of mouth lesion



16.4494
$652.85
$492.92
$130.57
$98.5841008
Drainage of mouth lesion



16.4494
$652.85
$492.92
$130.57
$98.5841009
Drainage of mouth lesion



2.3768
$94.33
$120.31
$18.87
$24.06( print page 49906)41010
Incision of tongue fold



7.7261
$306.63
$319.82
$61.33
$63.9641015
Drainage of mouth lesion



2.3768
$94.33
$120.31
$18.87
$24.0641016
Drainage of mouth lesion



7.7261
$306.63
$319.82
$61.33
$63.9641017
Drainage of mouth lesion



7.7261
$306.63
$319.82
$61.33
$63.9641018
Drainage of mouth lesion



7.7261
$306.63
$319.82
$61.33
$63.9641100
Biopsy of tongue
Y
Y
Y
2.1907
$86.95
$86.95
$17.39
$17.3941105
Biopsy of tongue
Y
Y
Y
2.1418
$85.00
$85.00
$17.00
$17.0041108
Biopsy of floor of mouth
Y
Y
Y
1.9697
$78.17
$78.17
$15.63
$15.6341110
Excision of tongue lesion
Y
Y
Y
2.8336
$112.46
$112.46
$22.49
$22.4941112
Excision of tongue lesion



16.4494
$652.85
$549.42
$130.57
$109.8841113
Excision of tongue lesion



16.4494
$652.85
$549.42
$130.57
$109.8841114
Excision of tongue lesion



23.1564
$919.03
$682.52
$183.81
$136.5041115
Excision of tongue fold
Y
Y
Y
3.3338
$132.31
$132.31
$26.46
$26.4641116
Excision of mouth lesion



16.4494
$652.85
$492.92
$130.57
$98.5841120
Partial removal of tongue



23.1564
$919.03
$818.02
$183.81
$163.6041250
Repair tongue laceration



2.3768
$94.33
$120.31
$18.87
$24.0641251
Repair tongue laceration



2.3768
$94.33
$120.31
$18.87
$24.0641252
Repair tongue laceration



7.7261
$306.63
$376.32
$61.33
$75.2641500
Fixation of tongue



23.1564
$919.03
$626.02
$183.81
$125.2041510
Tongue to lip surgery



16.4494
$652.85
$492.92
$130.57
$98.5841520
Reconstruction, tongue fold



7.7261
$306.63
$376.32
$61.33
$75.2641800
Drainage of gum lesion



1.4821
$58.82
$75.02
$11.76
$15.0041805
Removal foreign body, gum
Y
Y
Y
3.2618
$129.45
$129.45
$25.89
$25.8941806
Removal foreign body,jawbone
Y
Y
Y
4.1774
$165.79
$165.79
$33.16
$33.1641820
Excision, gum, each quadrant
Y
Y

7.7261
$306.63
$306.63
$61.33
$61.3341821
Excision of gum flap
Y


7.7261
$306.63
$306.63
$61.33
$61.3341822
Excision of gum lesion
Y
Y
Y
3.7793
$149.99
$149.99
$30.00
$30.0041823
Excision of gum lesion
Y
Y
Y
5.3407
$211.96
$211.96
$42.39
$42.3941825
Excision of gum lesion
Y
Y
Y
2.9473
$116.97
$116.97
$23.39
$23.3941826
Excision of gum lesion
Y
Y
Y
3.3501
$132.96
$132.96
$26.59
$26.5941827
Excision of gum lesion



23.1564
$919.03
$682.52
$183.81
$136.5041828
Excision of gum lesion
Y
Y
Y
3.4999
$138.90
$138.90
$27.78
$27.7841830
Removal of gum tissue
Y
Y
Y
4.8590
$192.84
$192.84
$38.57
$38.57( print page 49907)41850
Treatment of gum lesion
Y
Y

16.4494
$652.85
$652.85
$130.57
$130.5741870
Gum graft
Y


23.1564
$919.03
$919.03
$183.81
$183.8141872
Repair gum
Y
Y
Y
1.6239
$64.45
$64.45
$12.89
$12.8941874
Repair tooth socket
Y
Y
Y
4.6763
$185.59
$185.59
$37.12
$37.1242000
Drainage mouth roof lesion



2.3768
$94.33
$120.31
$18.87
$24.0642100
Biopsy roof of mouth
Y
Y
Y
1.8757
$74.44
$74.44
$14.89
$14.8942104
Excision lesion, mouth roof
Y
Y
Y
2.6328
$104.49
$104.49
$20.90
$20.9042106
Excision lesion, mouth roof
Y
Y
Y
3.3670
$133.63
$133.63
$26.73
$26.7342107
Excision lesion, mouth roof



23.1564
$919.03
$682.52
$183.81
$136.5042120
Remove palate/lesion



37.7719
$1,499.09
$1,064.55
$299.82
$212.9142140
Excision of uvula



7.7261
$306.63
$376.32
$61.33
$75.2642145
Repair palate, pharynx/uvula



23.1564
$919.03
$818.02
$183.81
$163.6042160
Treatment mouth roof lesion
Y
Y
Y
3.4534
$137.06
$137.06
$27.41
$27.4142180
Repair palate



2.3768
$94.33
$120.31
$18.87
$24.0642182
Repair palate



37.7719
$1,499.09
$972.55
$299.82
$194.5142200
Reconstruct cleft palate



37.7719
$1,499.09
$1,108.05
$299.82
$221.6142205
Reconstruct cleft palate



37.7719
$1,499.09
$1,108.05
$299.82
$221.6142210
Reconstruct cleft palate



37.7719
$1,499.09
$1,108.05
$299.82
$221.6142215
Reconstruct cleft palate



37.7719
$1,499.09
$1,247.05
$299.82
$249.4142220
Reconstruct cleft palate



37.7719
$1,499.09
$1,108.05
$299.82
$221.6142226
Lengthening of palate



37.7719
$1,499.09
$1,108.05
$299.82
$221.6142235
Repair palate



16.4494
$652.85
$684.92
$130.57
$136.9842260
Repair nose to lip fistula



23.1564
$919.03
$774.52
$183.81
$154.9042280
Preparation, palate mold
Y
Y
Y
1.8635
$73.96
$73.96
$14.79
$14.7942281
Insertion, palate prosthesis
Y


16.4494
$652.85
$652.85
$130.57
$130.5742300
Drainage of salivary gland



16.4494
$652.85
$492.92
$130.57
$98.5842305
Drainage of salivary gland



16.4494
$652.85
$549.42
$130.57
$109.8842310
Drainage of salivary gland



2.3768
$94.33
$120.31
$18.87
$24.0642320
Drainage of salivary gland



2.3768
$94.33
$120.31
$18.87
$24.0642330
Removal of salivary stone
Y
Y
Y
2.7864
$110.59
$110.59
$22.12
$22.1242335
Removal of salivary stone
Y
Y
Y
4.5522
$180.67
$180.67
$36.13
$36.1342340
Removal of salivary stone



16.4494
$652.85
$549.42
$130.57
$109.8842400
Biopsy of salivary gland
Y
Y
Y
1.5674
$62.21
$62.21
$12.44
$12.4442405
Biopsy of salivary gland



16.4494
$652.85
$549.42
$130.57
$109.8842408
Excision of salivary cyst



16.4494
$652.85
$581.42
$130.57
$116.2842409
Drainage of salivary cyst



16.4494
$652.85
$581.42
$130.57
$116.28( print page 49908)42410
Excise parotid gland/lesion



37.7719
$1,499.09
$1,004.55
$299.82
$200.9142415
Excise parotid gland/lesion



37.7719
$1,499.09
$1,247.05
$299.82
$249.4142420
Excise parotid gland/lesion



37.7719
$1,499.09
$1,247.05
$299.82
$249.4142425
Excise parotid gland/lesion



37.7719
$1,499.09
$1,247.05
$299.82
$249.4142440
Excise submaxillary gland



37.7719
$1,499.09
$1,004.55
$299.82
$200.9142450
Excise sublingual gland



23.1564
$919.03
$682.52
$183.81
$136.5042500
Repair salivary duct



23.1564
$919.03
$714.52
$183.81
$142.9042505
Repair salivary duct



37.7719
$1,499.09
$1,064.55
$299.82
$212.9142507
Parotid duct diversion



37.7719
$1,499.09
$1,004.55
$299.82
$200.9142508
Parotid duct diversion



37.7719
$1,499.09
$1,064.55
$299.82
$212.9142509
Parotid duct diversion



37.7719
$1,499.09
$1,064.55
$299.82
$212.9142510
Parotid duct diversion



37.7719
$1,499.09
$1,064.55
$299.82
$212.9142600
Closure of salivary fistula



16.4494
$652.85
$492.92
$130.57
$98.5842650
Dilation of salivary duct
Y
Y
Y
1.0121
$40.17
$40.17
$8.03
$8.0342660
Dilation of salivary duct
Y
Y
Y
1.2294
$48.79
$48.79
$9.76
$9.7642665
Ligation of salivary duct



23.1564
$919.03
$957.02
$183.81
$191.4042700
Drainage of tonsil abscess



2.3768
$94.33
$120.31
$18.87
$24.0642720
Drainage of throat abscess



16.4494
$652.85
$492.92
$130.57
$98.5842725
Drainage of throat abscess



37.7719
$1,499.09
$972.55
$299.82
$194.5142800
Biopsy of throat
Y
Y
Y
1.9620
$77.87
$77.87
$15.57
$15.5742802
Biopsy of throat



16.4494
$652.85
$492.92
$130.57
$98.5842804
Biopsy of upper nose/throat



16.4494
$652.85
$492.92
$130.57
$98.5842806
Biopsy of upper nose/throat



23.1564
$919.03
$682.52
$183.81
$136.5042808
Excise pharynx lesion



16.4494
$652.85
$549.42
$130.57
$109.8842809
Remove pharynx foreign body
Y


0.6211
$24.65
$24.65
$4.93
$4.9342810
Excision of neck cyst



23.1564
$919.03
$714.52
$183.81
$142.9042815
Excision of neck cyst



37.7719
$1,499.09
$1,108.05
$299.82
$221.6142820
Remove tonsils and adenoids



22.7757
$903.92
$706.96
$180.78
$141.3942821
Remove tonsils and adenoids



22.7757
$903.92
$810.46
$180.78
$162.0942825
Removal of tonsils



22.7757
$903.92
$766.96
$180.78
$153.3942826
Removal of tonsils



22.7757
$903.92
$766.96
$180.78
$153.3942830
Removal of adenoids



22.7757
$903.92
$766.96
$180.78
$153.3942831
Removal of adenoids



22.7757
$903.92
$766.96
$180.78
$153.39( print page 49909)42835
Removal of adenoids



22.7757
$903.92
$766.96
$180.78
$153.3942836
Removal of adenoids



22.7757
$903.92
$766.96
$180.78
$153.3942860
Excision of tonsil tags



22.7757
$903.92
$706.96
$180.78
$141.3942870
Excision of lingual tonsil



22.7757
$903.92
$706.96
$180.78
$141.3942890
Partial removal of pharynx



37.7719
$1,499.09
$1,247.05
$299.82
$249.4142892
Revision of pharyngeal walls



37.7719
$1,499.09
$1,247.05
$299.82
$249.4142900
Repair throat wound



7.7261
$306.63
$319.82
$61.33
$63.9642950
Reconstruction of throat



23.1564
$919.03
$682.52
$183.81
$136.5042955
Surgical opening of throat



23.1564
$919.03
$682.52
$183.81
$136.5042960
Control throat bleeding



1.2021
$47.71
$60.85
$9.54
$12.1742962
Control throat bleeding



37.7719
$1,499.09
$972.55
$299.82
$194.5142970
Control nose/throat bleeding
Y
Y

1.2021
$47.71
$47.71
$9.54
$9.5442972
Control nose/throat bleeding



16.4494
$652.85
$581.42
$130.57
$116.2843030
Throat muscle surgery
Y


16.4494
$652.85
$652.85
$130.57
$130.5743200
Esophagus endoscopy



8.3070
$329.69
$331.34
$65.94
$66.2743201
Esoph scope w/submucous inj



8.3070
$329.69
$331.34
$65.94
$66.2743202
Esophagus endoscopy, biopsy



8.3070
$329.69
$331.34
$65.94
$66.2743204
Esoph scope w/sclerosis inj



8.3070
$329.69
$331.34
$65.94
$66.2743205
Esophagus endoscopy/ligation



8.3070
$329.69
$331.34
$65.94
$66.2743215
Esophagus endoscopy



8.3070
$329.69
$331.34
$65.94
$66.2743216
Esophagus endoscopy/lesion



8.3070
$329.69
$331.34
$65.94
$66.2743217
Esophagus endoscopy



8.3070
$329.69
$331.34
$65.94
$66.2743219
Esophagus endoscopy



22.6777
$900.03
$616.52
$180.01
$123.3043220
Esoph endoscopy, dilation



8.3070
$329.69
$331.34
$65.94
$66.2743226
Esoph endoscopy, dilation



8.3070
$329.69
$331.34
$65.94
$66.2743227
Esoph endoscopy, repair



8.3070
$329.69
$387.84
$65.94
$77.5743228
Esoph endoscopy, ablation



27.5493
$1,093.38
$769.69
$218.68
$153.9443231
Esoph endoscopy w/us exam



8.3070
$329.69
$387.84
$65.94
$77.5743232
Esoph endoscopy w/us fn bx



8.3070
$329.69
$387.84
$65.94
$77.5743234
Upper gi endoscopy, exam



8.3070
$329.69
$331.34
$65.94
$66.27( print page 49910)43235
Uppr gi endoscopy, diagnosis



8.3070
$329.69
$331.34
$65.94
$66.2743236
Uppr gi scope w/submuc inj



8.3070
$329.69
$387.84
$65.94
$77.5743237
Endoscopic us exam, esoph



8.3070
$329.69
$387.84
$65.94
$77.5743238
Uppr gi endoscopy w/us fn bx



8.3070
$329.69
$387.84
$65.94
$77.5743239
Upper gi endoscopy, biopsy



8.3070
$329.69
$387.84
$65.94
$77.5743240
Esoph endoscope w/drain cyst



8.3070
$329.69
$387.84
$65.94
$77.5743241
Upper gi endoscopy with tube



8.3070
$329.69
$387.84
$65.94
$77.5743242
Uppr gi endoscopy w/us fn bx



8.3070
$329.69
$387.84
$65.94
$77.5743243
Upper gi endoscopy  inject



8.3070
$329.69
$387.84
$65.94
$77.5743244
Upper gi endoscopy/ligation



8.3070
$329.69
$387.84
$65.94
$77.5743245
Uppr gi scope dilate strictr



8.3070
$329.69
$387.84
$65.94
$77.5743246
Place gastrostomy tube



8.3070
$329.69
$387.84
$65.94
$77.5743247
Operative upper gi endoscopy



8.3070
$329.69
$387.84
$65.94
$77.5743248
Uppr gi endoscopy/guide wire



8.3070
$329.69
$387.84
$65.94
$77.5743249
Esoph endoscopy, dilation



8.3070
$329.69
$387.84
$65.94
$77.5743250
Upper gi endoscopy/tumor



8.3070
$329.69
$387.84
$65.94
$77.5743251
Operative upper gi endoscopy



8.3070
$329.69
$387.84
$65.94
$77.5743255
Operative upper gi endoscopy



8.3070
$329.69
$387.84
$65.94
$77.5743256
Uppr gi endoscopy w/stent



22.6777
$900.03
$705.02
$180.01
$141.0043257
Uppr gi scope w/thrml txmnt
Y


27.5493
$1,093.38
$1,093.38
$218.68
$218.6843258
Operative upper gi endoscopy



8.3070
$329.69
$419.84
$65.94
$83.9743259
Endoscopic ultrasound exam



8.3070
$329.69
$419.84
$65.94
$83.9743260
Endo cholangiopancreatograph



19.8125
$786.32
$616.16
$157.26
$123.2343261
Endo cholangiopancreatograph



19.8125
$786.32
$616.16
$157.26
$123.2343262
Endo cholangiopancreatograph



19.8125
$786.32
$616.16
$157.26
$123.2343263
Endo cholangiopancreatograph



19.8125
$786.32
$616.16
$157.26
$123.2343264
Endo cholangiopancreatograph



19.8125
$786.32
$616.16
$157.26
$123.23( print page 49911)43265
Endo cholangiopancreatograph



19.8125
$786.32
$616.16
$157.26
$123.2343267
Endo cholangiopancreatograph



19.8125
$786.32
$616.16
$157.26
$123.2343268
Endo cholangiopancreatograph



22.6777
$900.03
$673.02
$180.01
$134.6043269
Endo cholangiopancreatograph



22.6777
$900.03
$673.02
$180.01
$134.6043271
Endo cholangiopancreatograph



19.8125
$786.32
$616.16
$157.26
$123.2343272
Endo cholangiopancreatograph



19.8125
$786.32
$616.16
$157.26
$123.2343450
Dilate esophagus



5.3134
$210.88
$268.96
$42.18
$53.7943453
Dilate esophagus



5.3134
$210.88
$268.96
$42.18
$53.7943456
Dilate esophagus



5.3134
$210.88
$268.96
$42.18
$53.7943458
Dilate esophagus



5.3134
$210.88
$268.96
$42.18
$53.7943600
Biopsy of stomach



8.3070
$329.69
$331.34
$65.94
$66.2743653
Laparoscopy, gastrostomy



43.5124
$1,726.92
$1,532.96
$345.38
$306.5943750
Place gastrostomy tube



8.3070
$329.69
$387.84
$65.94
$77.5743760
Change gastrostomy tube



2.3431
$92.99
$118.61
$18.60
$23.7243761
Reposition gastrostomy tube
Y


7.2859
$289.16
$289.16
$57.83
$57.8343870
Repair stomach opening



8.3070
$329.69
$331.34
$65.94
$66.2743886
Revise gastric port, open
Y


5.0931
$202.14
$202.14
$40.43
$40.4343887
Remove gastric port, open
Y


5.0931
$202.14
$202.14
$40.43
$40.4343888
Change gastric port, open
Y


13.3433
$529.57
$529.57
$105.91
$105.9144100
Biopsy of bowel



8.3070
$329.69
$331.34
$65.94
$66.2744312
Revision of ileostomy



21.2645
$843.95
$588.47
$168.79
$117.6944340
Revision of colostomy



21.2645
$843.95
$676.97
$168.79
$135.3944360
Small bowel endoscopy



9.3878
$372.58
$409.29
$74.52
$81.8644361
Small bowel endoscopy/biopsy



9.3878
$372.58
$409.29
$74.52
$81.8644363
Small bowel endoscopy



9.3878
$372.58
$409.29
$74.52
$81.8644364
Small bowel endoscopy



9.3878
$372.58
$409.29
$74.52
$81.8644365
Small bowel endoscopy



9.3878
$372.58
$409.29
$74.52
$81.8644366
Small bowel endoscopy



9.3878
$372.58
$409.29
$74.52
$81.8644369
Small bowel endoscopy



9.3878
$372.58
$409.29
$74.52
$81.8644370
Small bowel endoscopy/stent



22.6777
$900.03
$1,119.52
$180.01
$223.9044372
Small bowel endoscopy



9.3878
$372.58
$409.29
$74.52
$81.86( print page 49912)44373
Small bowel endoscopy



9.3878
$372.58
$409.29
$74.52
$81.8644376
Small bowel endoscopy



9.3878
$372.58
$409.29
$74.52
$81.8644377
Small bowel endoscopy/biopsy



9.3878
$372.58
$409.29
$74.52
$81.8644378
Small bowel endoscopy



9.3878
$372.58
$409.29
$74.52
$81.8644379
Sbowel endoscope w/stent



22.6777
$900.03
$1,119.52
$180.01
$223.9044380
Small bowel endoscopy



9.3878
$372.58
$352.79
$74.52
$70.5644382
Small bowel endoscopy



9.3878
$372.58
$352.79
$74.52
$70.5644383
Ileoscopy w/stent



22.6777
$900.03
$1,119.52
$180.01
$223.9044385
Endoscopy of bowel pouch



8.8143
$349.82
$341.41
$69.96
$68.2844386
Endoscopy, bowel pouch/biop



8.8143
$349.82
$341.41
$69.96
$68.2844388
Colonoscopy



8.8143
$349.82
$341.41
$69.96
$68.2844389
Colonoscopy with biopsy



8.8143
$349.82
$341.41
$69.96
$68.2844390
Colonoscopy for foreign body



8.8143
$349.82
$341.41
$69.96
$68.2844391
Colonoscopy for bleeding



8.8143
$349.82
$341.41
$69.96
$68.2844392
Colonoscopy  polypectomy



8.8143
$349.82
$341.41
$69.96
$68.2844393
Colonoscopy, lesion removal



8.8143
$349.82
$341.41
$69.96
$68.2844394
Colonoscopy w/snare



8.8143
$349.82
$341.41
$69.96
$68.2844397
Colonoscopy w/stent



22.6777
$900.03
$616.52
$180.01
$123.3045000
Drainage of pelvic abscess



4.8970
$194.35
$247.89
$38.87
$49.5845005
Drainage of rectal abscess



12.8778
$511.10
$478.55
$102.22
$95.7145020
Drainage of rectal abscess



12.8778
$511.10
$478.55
$102.22
$95.7145100
Biopsy of rectum



22.2336
$882.41
$607.70
$176.48
$121.5445108
Removal of anorectal lesion



22.2336
$882.41
$664.20
$176.48
$132.8445150
Excision of rectal stricture



22.2336
$882.41
$664.20
$176.48
$132.8445160
Excision of rectal lesion



22.2336
$882.41
$664.20
$176.48
$132.8445170
Excision of rectal lesion



22.2336
$882.41
$664.20
$176.48
$132.8445190
Destruction, rectal tumor



22.2336
$882.41
$1,110.70
$176.48
$222.1445300
Proctosigmoidoscopy dx
Y
Y
Y
1.5109
$59.96
$59.96
$11.99
$11.9945303
Proctosigmoidoscopy dilate
Y
Y

8.5644
$339.90
$339.90
$67.98
$67.9845305
Proctosigmoidoscopy w/bx



8.5644
$339.90
$336.45
$67.98
$67.2945307
Proctosigmoidoscopy fb



20.4902
$813.22
$573.11
$162.64
$114.6245308
Proctosigmoidoscopy removal



8.5644
$339.90
$336.45
$67.98
$67.29( print page 49913)45309
Proctosigmoidoscopy removal



8.5644
$339.90
$336.45
$67.98
$67.2945315
Proctosigmoidoscopy removal



8.5644
$339.90
$336.45
$67.98
$67.2945317
Proctosigmoidoscopy bleed



8.5644
$339.90
$336.45
$67.98
$67.2945320
Proctosigmoidoscopy ablate



20.4902
$813.22
$573.11
$162.64
$114.6245321
Proctosigmoidoscopy volvul



20.4902
$813.22
$573.11
$162.64
$114.6245327
Proctosigmoidoscopy w/stent



22.6777
$900.03
$616.52
$180.01
$123.3045330
Diagnostic sigmoidoscopy
Y
Y
Y
2.0624
$81.85
$81.85
$16.37
$16.3745331
Sigmoidoscopy and biopsy



4.8005
$190.52
$243.00
$38.10
$48.6045332
Sigmoidoscopy w/fb removal



4.8005
$190.52
$243.00
$38.10
$48.6045333
Sigmoidoscopy  polypectomy



8.5644
$339.90
$336.45
$67.98
$67.2945334
Sigmoidoscopy for bleeding



8.5644
$339.90
$336.45
$67.98
$67.2945335
Sigmoidoscopy w/submuc inj



4.8005
$190.52
$243.00
$38.10
$48.6045337
Sigmoidoscopy  decompress



4.8005
$190.52
$243.00
$38.10
$48.6045338
Sigmoidoscopy w/tumr remove



8.5644
$339.90
$336.45
$67.98
$67.2945339
Sigmoidoscopy w/ablate tumr



8.5644
$339.90
$336.45
$67.98
$67.2945340
Sig w/balloon dilation



8.5644
$339.90
$336.45
$67.98
$67.2945341
Sigmoidoscopy w/ultrasound



8.5644
$339.90
$336.45
$67.98
$67.2945342
Sigmoidoscopy w/us guide bx



8.5644
$339.90
$336.45
$67.98
$67.2945345
Sigmoidoscopy w/stent



22.6777
$900.03
$616.52
$180.01
$123.3045355
Surgical colonoscopy



8.8143
$349.82
$341.41
$69.96
$68.2845378
Diagnostic colonoscopy



8.8143
$349.82
$397.91
$69.96
$79.5845379
Colonoscopy w/fb removal



8.8143
$349.82
$397.91
$69.96
$79.5845380
Colonoscopy and biopsy



8.8143
$349.82
$397.91
$69.96
$79.5845381
Colonoscopy, submucous inj



8.8143
$349.82
$397.91
$69.96
$79.5845382
Colonoscopy/control bleeding



8.8143
$349.82
$397.91
$69.96
$79.5845383
Lesion removal colonoscopy



8.8143
$349.82
$397.91
$69.96
$79.5845384
Lesion remove colonoscopy



8.8143
$349.82
$397.91
$69.96
$79.5845385
Lesion removal colonoscopy



8.8143
$349.82
$397.91
$69.96
$79.5845386
Colonoscopy dilate stricture



8.8143
$349.82
$397.91
$69.96
$79.5845387
Colonoscopy w/stent



22.6777
$900.03
$616.52
$180.01
$123.30( print page 49914)45391
Colonoscopy w/endoscope us



8.8143
$349.82
$397.91
$69.96
$79.5845392
Colonoscopy w/endoscopic fnb



8.8143
$349.82
$397.91
$69.96
$79.5845500
Repair of rectum



22.2336
$882.41
$664.20
$176.48
$132.8445505
Repair of rectum



29.4386
$1,168.36
$807.18
$233.67
$161.4445520
Treatment of rectal prolapse
Y
Y

1.1035
$43.80
$43.80
$8.76
$8.7645560
Repair of rectocele



29.4386
$1,168.36
$807.18
$233.67
$161.4445900
Reduction of rectal prolapse



4.8970
$194.35
$247.89
$38.87
$49.5845905
Dilation of anal sphincter



22.2336
$882.41
$607.70
$176.48
$121.5445910
Dilation of rectal narrowing



22.2336
$882.41
$607.70
$176.48
$121.5445915
Remove rectal obstruction



4.8970
$194.35
$247.89
$38.87
$49.5845990
Surg dx exam, anorectal



4.8970
$194.35
$247.89
$38.87
$49.5846020
Placement of seton



22.2336
$882.41
$696.20
$176.48
$139.2446030
Removal of rectal marker



4.8970
$194.35
$247.89
$38.87
$49.5846040
Incision of rectal abscess



22.2336
$882.41
$696.20
$176.48
$139.2446045
Incision of rectal abscess



22.2336
$882.41
$664.20
$176.48
$132.8446050
Incision of anal abscess



4.8970
$194.35
$247.89
$38.87
$49.5846060
Incision of rectal abscess



22.2336
$882.41
$664.20
$176.48
$132.8446070
Incision of anal septum
Y


12.8778
$511.10
$511.10
$102.22
$102.2246080
Incision of anal sphincter



22.2336
$882.41
$696.20
$176.48
$139.2446083
Incise external hemorrhoid
Y
Y
Y
2.0708
$82.18
$82.18
$16.44
$16.4446200
Removal of anal fissure



22.2336
$882.41
$664.20
$176.48
$132.8446210
Removal of anal crypt



22.2336
$882.41
$664.20
$176.48
$132.8446211
Removal of anal crypts



22.2336
$882.41
$664.20
$176.48
$132.8446220
Removal of anal tag



22.2336
$882.41
$607.70
$176.48
$121.5446221
Ligation of hemorrhoid(s)
Y
Y
Y
2.7306
$108.37
$108.37
$21.67
$21.6746230
Removal of anal tags



22.2336
$882.41
$607.70
$176.48
$121.5446250
Hemorrhoidectomy



22.2336
$882.41
$696.20
$176.48
$139.2446255
Hemorrhoidectomy



22.2336
$882.41
$696.20
$176.48
$139.2446257
Remove hemorrhoids  fissure



22.2336
$882.41
$696.20
$176.48
$139.2446258
Remove hemorrhoids  fistula



22.2336
$882.41
$696.20
$176.48
$139.2446260
Hemorrhoidectomy



22.2336
$882.41
$696.20
$176.48
$139.24( print page 49915)46261
Remove hemorrhoids  fissure



22.2336
$882.41
$756.20
$176.48
$151.2446262
Remove hemorrhoids  fistula



22.2336
$882.41
$756.20
$176.48
$151.2446270
Removal of anal fistula



22.2336
$882.41
$696.20
$176.48
$139.2446275
Removal of anal fistula



22.2336
$882.41
$696.20
$176.48
$139.2446280
Removal of anal fistula



22.2336
$882.41
$756.20
$176.48
$151.2446285
Removal of anal fistula



22.2336
$882.41
$607.70
$176.48
$121.5446288
Repair anal fistula



22.2336
$882.41
$756.20
$176.48
$151.2446320
Removal of hemorrhoid clot
Y
Y
Y
1.9331
$76.72
$76.72
$15.34
$15.3446500
Injection into hemorrhoid(s)
Y
Y
Y
2.4529
$97.35
$97.35
$19.47
$19.4746505
Chemodenervation anal musc
Y


4.8970
$194.35
$194.35
$38.87
$38.8746600
Diagnostic anoscopy
Y
Y

0.6211
$24.65
$24.65
$4.93
$4.9346604
Anoscopy and dilation
Y
Y

8.5644
$339.90
$339.90
$67.98
$67.9846606
Anoscopy and biopsy
Y
Y
Y
3.3278
$132.07
$132.07
$26.41
$26.4146608
Anoscopy, remove for body



8.5644
$339.90
$336.45
$67.98
$67.2946610
Anoscopy, remove lesion



20.4902
$813.22
$573.11
$162.64
$114.6246611
Anoscopy



8.5644
$339.90
$336.45
$67.98
$67.2946612
Anoscopy, remove lesions



20.4902
$813.22
$573.11
$162.64
$114.6246614
Anoscopy, control bleeding
Y
Y
Y
2.1904
$86.93
$86.93
$17.39
$17.3946615
Anoscopy



20.4902
$813.22
$629.61
$162.64
$125.9246700
Repair of anal stricture



22.2336
$882.41
$696.20
$176.48
$139.2446706
Repr of anal fistula w/glue



29.4386
$1,168.36
$750.68
$233.67
$150.1446750
Repair of anal sphincter



37.2425
$1,478.08
$994.04
$295.62
$198.8146753
Reconstruction of anus



22.2336
$882.41
$696.20
$176.48
$139.2446754
Removal of suture from anus



22.2336
$882.41
$664.20
$176.48
$132.8446760
Repair of anal sphincter



37.2425
$1,478.08
$962.04
$295.62
$192.4146761
Repair of anal sphincter



37.2425
$1,478.08
$994.04
$295.62
$198.8146762
Implant artificial sphincter



37.2425
$1,478.08
$1,236.54
$295.62
$247.3146900
Destruction, anal lesion(s)
Y
Y

2.6253
$104.19
$104.19
$20.84
$20.8446910
Destruction, anal lesion(s)
Y
Y
Y
2.9131
$115.62
$115.62
$23.12
$23.1246916
Cryosurgery, anal lesion(s)
Y
Y

1.0876
$43.16
$43.16
$8.63
$8.6346917
Laser surgery, anal lesions



20.5802
$816.79
$574.89
$163.36
$114.9846922
Excision of anal lesion(s)



20.5802
$816.79
$574.89
$163.36
$114.98( print page 49916)46924
Destruction, anal lesion(s)



20.5802
$816.79
$574.89
$163.36
$114.9846934
Destruction of hemorrhoids
Y
Y
Y
4.4793
$177.78
$177.78
$35.56
$35.5646935
Destruction of hemorrhoids
Y
Y
Y
3.0462
$120.90
$120.90
$24.18
$24.1846936
Destruction of hemorrhoids
Y
Y
Y
4.7722
$189.40
$189.40
$37.88
$37.8846937
Cryotherapy of rectal lesion



22.2336
$882.41
$664.20
$176.48
$132.8446938
Cryotherapy of rectal lesion



29.4386
$1,168.36
$807.18
$233.67
$161.4446940
Treatment of anal fissure
Y
Y
Y
2.0705
$82.17
$82.17
$16.43
$16.4346942
Treatment of anal fissure
Y
Y
Y
1.9967
$79.25
$79.25
$15.85
$15.8546945
Ligation of hemorrhoids
Y
Y
Y
3.4793
$138.09
$138.09
$27.62
$27.6246946
Ligation of hemorrhoids
Y
Y
Y
3.6051
$143.08
$143.08
$28.62
$28.6246947
Hemorrhoidopexy by stapling



29.4386
$1,168.36
$839.18
$233.67
$167.8447000
Needle biopsy of liver



6.0729
$241.02
$287.01
$48.20
$57.4047382
Percut ablate liver rf
Y


39.0235
$1,548.77
$1,548.77
$309.75
$309.7547510
Insert catheter, bile duct



19.4515
$771.99
$609.00
$154.40
$121.8047511
Insert bile duct drain



19.4515
$771.99
$984.63
$154.40
$196.9347525
Change bile duct catheter



11.5220
$457.29
$395.14
$91.46
$79.0347530
Revise/reinsert bile tube



11.5220
$457.29
$395.14
$91.46
$79.0347552
Biliary endoscopy thru skin



19.4515
$771.99
$609.00
$154.40
$121.8047553
Biliary endoscopy thru skin



19.4515
$771.99
$641.00
$154.40
$128.2047554
Biliary endoscopy thru skin



19.4515
$771.99
$641.00
$154.40
$128.2047555
Biliary endoscopy thru skin



19.4515
$771.99
$641.00
$154.40
$128.2047556
Biliary endoscopy thru skin



19.4515
$771.99
$984.63
$154.40
$196.9347560
Laparoscopy w/cholangio



31.9353
$1,267.45
$888.73
$253.49
$177.7547561
Laparo w/cholangio/biopsy



31.9353
$1,267.45
$888.73
$253.49
$177.7547562
Laparoscopic cholecystectomy
Y


43.5124
$1,726.92
$1,726.92
$345.38
$345.3847563
Laparo cholecystectomy/graph
Y


43.5124
$1,726.92
$1,726.92
$345.38
$345.3847630
Remove bile duct stone



19.4515
$771.99
$641.00
$154.40
$128.2048102
Needle biopsy, pancreas



6.0729
$241.02
$287.01
$48.20
$57.4049080
Puncture, peritoneal cavity



3.6425
$144.56
$184.38
$28.91
$36.8849081
Removal of abdominal fluid



3.6425
$144.56
$184.38
$28.91
$36.8849085
Remove abdomen foreign body



22.1758
$880.12
$663.06
$176.02
$132.6149180
Biopsy, abdominal mass



6.0729
$241.02
$287.01
$48.20
$57.40( print page 49917)49250
Excision of umbilicus



22.1758
$880.12
$755.06
$176.02
$151.0149320
Diag laparo separate proc



31.9353
$1,267.45
$888.73
$253.49
$177.7549321
Laparoscopy, biopsy



31.9353
$1,267.45
$948.73
$253.49
$189.7549322
Laparoscopy, aspiration



31.9353
$1,267.45
$948.73
$253.49
$189.7549419
Insrt abdom cath for chemotx



29.4757
$1,169.83
$751.42
$233.97
$150.2849420
Insert abdom drain, temp



29.2259
$1,159.92
$746.46
$231.98
$149.2949421
Insert abdom drain, perm



29.2259
$1,159.92
$746.46
$231.98
$149.2949422
Remove perm cannula/catheter



23.4666
$931.34
$632.17
$186.27
$126.4349423
Exchange drainage catheter
Y


11.5220
$457.29
$457.29
$91.46
$91.4649426
Revise abdomen-venous shunt



22.1758
$880.12
$663.06
$176.02
$132.6149429
Removal of shunt
Y


23.4666
$931.34
$931.34
$186.27
$186.2749495
Rpr ing hernia baby, reduc



29.1491
$1,156.87
$893.44
$231.37
$178.6949496
Rpr ing hernia baby, blocked



29.1491
$1,156.87
$893.44
$231.37
$178.6949500
Rpr ing hernia, init, reduce



29.1491
$1,156.87
$893.44
$231.37
$178.6949501
Rpr ing hernia, init blocked



29.1491
$1,156.87
$1,247.94
$231.37
$249.5949505
Prp i/hern init reduc 5 yr



29.1491
$1,156.87
$893.44
$231.37
$178.6949507
Prp i/hern init block 5 yr



29.1491
$1,156.87
$1,247.94
$231.37
$249.5949520
Rerepair ing hernia, reduce



29.1491
$1,156.87
$1,075.94
$231.37
$215.1949521
Rerepair ing hernia, blocked



29.1491
$1,156.87
$1,247.94
$231.37
$249.5949525
Repair ing hernia, sliding



29.1491
$1,156.87
$893.44
$231.37
$178.6949540
Repair lumbar hernia



29.1491
$1,156.87
$801.44
$231.37
$160.2949550
Rpr rem hernia, init, reduce



29.1491
$1,156.87
$936.94
$231.37
$187.3949553
Rpr fem hernia, init blocked



29.1491
$1,156.87
$1,247.94
$231.37
$249.5949555
Rerepair fem hernia, reduce



29.1491
$1,156.87
$936.94
$231.37
$187.3949557
Rerepair fem hernia, blocked



29.1491
$1,156.87
$1,247.94
$231.37
$249.5949560
Rpr ventral hern init, reduc



29.1491
$1,156.87
$893.44
$231.37
$178.6949561
Rpr ventral hern init, block



29.1491
$1,156.87
$1,247.94
$231.37
$249.5949565
Rerepair ventrl hern, reduce



29.1491
$1,156.87
$893.44
$231.37
$178.6949566
Rerepair ventrl hern, block



29.1491
$1,156.87
$1,247.94
$231.37
$249.5949568
Hernia repair w/mesh



29.1491
$1,156.87
$1,075.94
$231.37
$215.19( print page 49918)49570
Rpr epigastric hern, reduce



29.1491
$1,156.87
$893.44
$231.37
$178.6949572
Rpr epigastric hern, blocked



29.1491
$1,156.87
$1,247.94
$231.37
$249.5949580
Rpr umbil hern, reduc  5 yr



29.1491
$1,156.87
$893.44
$231.37
$178.6949582
Rpr umbil hern, block  5 yr



29.1491
$1,156.87
$1,247.94
$231.37
$249.5949585
Rpr umbil hern, reduc  5 yr



29.1491
$1,156.87
$893.44
$231.37
$178.6949587
Rpr umbil hern, block  5 yr



29.1491
$1,156.87
$1,247.94
$231.37
$249.5949590
Repair spigelian hernia



29.1491
$1,156.87
$833.44
$231.37
$166.6949600
Repair umbilical lesion



29.1491
$1,156.87
$893.44
$231.37
$178.6949650
Laparo hernia repair initial



43.5124
$1,726.92
$1,178.46
$345.38
$235.6949651
Laparo hernia repair recur



43.5124
$1,726.92
$1,360.96
$345.38
$272.1950200
Biopsy of kidney



6.0729
$241.02
$287.01
$48.20
$57.4050382
Change ureter stent, percut
Y


19.2766
$765.05
$765.05
$153.01
$153.0150384
Remove ureter stent, percut
Y


19.2766
$765.05
$765.05
$153.01
$153.0150387
Change ext/int ureter stent
Y


7.2859
$289.16
$289.16
$57.83
$57.8350389
Remove renal tube w/fluoro
Y


3.5688
$141.64
$141.64
$28.33
$28.3350390
Drainage of kidney lesion



6.0729
$241.02
$287.01
$48.20
$57.4050391
Instll rx agnt into rnal tub
Y
Y

1.0844
$43.04
$43.04
$8.61
$8.6150392
Insert kidney drain



19.2766
$765.05
$549.03
$153.01
$109.8150393
Insert ureteral tube



19.2766
$765.05
$549.03
$153.01
$109.8150395
Create passage to kidney



19.2766
$765.05
$549.03
$153.01
$109.8150396
Measure kidney pressure



2.1159
$83.98
$107.11
$16.80
$21.4250398
Change kidney tube



7.2859
$289.16
$311.08
$57.83
$62.2250551
Kidney endoscopy



6.7325
$267.20
$300.10
$53.44
$60.0250553
Kidney endoscopy



19.2766
$765.05
$549.03
$153.01
$109.8150555
Kidney endoscopy  biopsy



6.7325
$267.20
$300.10
$53.44
$60.0250557
Kidney endoscopy  treatment



23.8562
$946.81
$639.90
$189.36
$127.9850561
Kidney endoscopy  treatment



19.2766
$765.05
$549.03
$153.01
$109.8150562
Renal scope w/tumor resect
Y


6.7325
$267.20
$267.20
$53.44
$53.4450570
Kidney endoscopy
Y


6.7325
$267.20
$267.20
$53.44
$53.4450572
Kidney endoscopy
Y


6.7325
$267.20
$267.20
$53.44
$53.4450574
Kidney endoscopy  biopsy
Y


6.7325
$267.20
$267.20
$53.44
$53.4450575
Kidney endoscopy
Y


35.1024
$1,393.15
$1,393.15
$278.63
$278.6350576
Kidney endoscopy  treatment
Y


19.2766
$765.05
$765.05
$153.01
$153.01( print page 49919)50590
Fragmenting of kidney stone
Y


44.1144
$1,750.82
$1,750.82
$350.16
$350.1650592
Perc rf ablate renal tumor
Y


39.0235
$1,548.77
$1,548.77
$309.75
$309.7550686
Measure ureter pressure
Y
Y

1.0844
$43.04
$43.04
$8.61
$8.6150688
Change of ureter tube/stent



7.2859
$289.16
$311.08
$57.83
$62.2250947
Laparo new ureter/bladder



43.5124
$1,726.92
$1,532.96
$345.38
$306.5950948
Laparo new ureter/bladder



43.5124
$1,726.92
$1,532.96
$345.38
$306.5950951
Endoscopy of ureter



6.7325
$267.20
$300.10
$53.44
$60.0250953
Endoscopy of ureter



6.7325
$267.20
$300.10
$53.44
$60.0250955
Ureter endoscopy  biopsy



19.2766
$765.05
$549.03
$153.01
$109.8150957
Ureter endoscopy  treatment



19.2766
$765.05
$549.03
$153.01
$109.8150961
Ureter endoscopy  treatment



19.2766
$765.05
$549.03
$153.01
$109.8150970
Ureter endoscopy



6.7325
$267.20
$300.10
$53.44
$60.0250972
Ureter endoscopy  catheter



6.7325
$267.20
$300.10
$53.44
$60.0250974
Ureter endoscopy  biopsy



19.2766
$765.05
$549.03
$153.01
$109.8150976
Ureter endoscopy  treatment



19.2766
$765.05
$549.03
$153.01
$109.8150980
Ureter endoscopy  treatment



19.2766
$765.05
$549.03
$153.01
$109.8151000
Drainage of bladder
Y
Y
Y
1.2446
$49.40
$49.40
$9.88
$9.8851005
Drainage of bladder
Y
Y

1.0844
$43.04
$43.04
$8.61
$8.6151010
Drainage of bladder



18.2333
$723.64
$528.32
$144.73
$105.6651020
Incise  treat bladder



23.8562
$946.81
$788.40
$189.36
$157.6851030
Incise  treat bladder



23.8562
$946.81
$788.40
$189.36
$157.6851040
Incise  drain bladder



23.8562
$946.81
$788.40
$189.36
$157.6851045
Incise bladder/drain ureter



6.7325
$267.20
$340.80
$53.44
$68.1651050
Removal of bladder stone



23.8562
$946.81
$788.40
$189.36
$157.6851065
Remove ureter calculus



23.8562
$946.81
$788.40
$189.36
$157.6851080
Drainage of bladder abscess



17.4686
$693.30
$513.15
$138.66
$102.6351500
Removal of bladder cyst



29.1491
$1,156.87
$893.44
$231.37
$178.6951520
Removal of bladder lesion



23.8562
$946.81
$788.40
$189.36
$157.6851700
Irrigation of bladder
Y
Y
Y
1.3433
$53.31
$53.31
$10.66
$10.6651701
Insert bladder catheter
Y
Y

0.6211
$24.65
$24.65
$4.93
$4.9351702
Insert temp bladder cath
Y
Y

0.6211
$24.65
$24.65
$4.93
$4.93( print page 49920)51703
Insert bladder cath, complex
Y
Y

1.0844
$43.04
$43.04
$8.61
$8.6151705
Change of bladder tube
Y
Y
Y
1.8609
$73.85
$73.85
$14.77
$14.7751710
Change of bladder tube



7.2859
$289.16
$311.08
$57.83
$62.2251715
Endoscopic injection/implant



28.5971
$1,134.96
$822.48
$226.99
$164.5051720
Treatment of bladder lesion
Y
Y
Y
1.4579
$57.86
$57.86
$11.57
$11.5751725
Simple cystometrogram
Y
Y

2.1159
$83.98
$83.98
$16.80
$16.8051726
Complex cystometrogram



3.5688
$141.64
$180.65
$28.33
$36.1351736
Urine flow measurement
Y
Y
Y
0.6370
$25.28
$25.28
$5.06
$5.0651741
Electro-uroflowmetry, first
Y
Y
Y
0.8854
$35.14
$35.14
$7.03
$7.0351772
Urethra pressure profile



2.1159
$83.98
$107.11
$16.80
$21.4251784
Anal/urinary muscle study
Y
Y

1.0844
$43.04
$43.04
$8.61
$8.6151785
Anal/urinary muscle study



1.0844
$43.04
$54.89
$8.61
$10.9851792
Urinary reflex study
Y
Y

1.0844
$43.04
$43.04
$8.61
$8.6151795
Urine voiding pressure study
Y
Y

2.1159
$83.98
$83.98
$16.80
$16.8051797
Intraabdominal pressure test
Y
Y

2.1159
$83.98
$83.98
$16.80
$16.8051798
Us urine capacity measure
Y
Y
Y
0.4057
$16.10
$16.10
$3.22
$3.2251880
Repair of bladder opening



23.8562
$946.81
$639.90
$189.36
$127.9851992
Laparo sling operation



43.5124
$1,726.92
$1,221.96
$345.38
$244.3952000
Cystoscopy



6.7325
$267.20
$300.10
$53.44
$60.0252001
Cystoscopy, removal of clots



6.7325
$267.20
$340.80
$53.44
$68.1652005
Cystoscopy  ureter catheter



19.2766
$765.05
$605.53
$153.01
$121.1152007
Cystoscopy and biopsy



19.2766
$765.05
$605.53
$153.01
$121.1152010
Cystoscopy  duct catheter



6.7325
$267.20
$340.80
$53.44
$68.1652204
Cystoscopy



19.2766
$765.05
$605.53
$153.01
$121.1152214
Cystoscopy and treatment



23.8562
$946.81
$696.40
$189.36
$139.2852224
Cystoscopy and treatment



23.8562
$946.81
$696.40
$189.36
$139.2852234
Cystoscopy and treatment



23.8562
$946.81
$696.40
$189.36
$139.2852235
Cystoscopy and treatment



23.8562
$946.81
$728.40
$189.36
$145.6852240
Cystoscopy and treatment



23.8562
$946.81
$728.40
$189.36
$145.6852250
Cystoscopy and radiotracer



23.8562
$946.81
$788.40
$189.36
$157.6852260
Cystoscopy and treatment



19.2766
$765.05
$605.53
$153.01
$121.1152265
Cystoscopy and treatment
Y
Y

6.7325
$267.20
$267.20
$53.44
$53.44( print page 49921)52270
Cystoscopy  revise urethra



19.2766
$765.05
$605.53
$153.01
$121.1152275
Cystoscopy  revise urethra



19.2766
$765.05
$605.53
$153.01
$121.1152276
Cystoscopy and treatment



19.2766
$765.05
$637.53
$153.01
$127.5152277
Cystoscopy and treatment



23.8562
$946.81
$696.40
$189.36
$139.2852281
Cystoscopy and treatment



19.2766
$765.05
$605.53
$153.01
$121.1152282
Cystoscopy, implant stent



35.1024
$1,393.15
$1,366.07
$278.63
$273.2152283
Cystoscopy and treatment



19.2766
$765.05
$605.53
$153.01
$121.1152285
Cystoscopy and treatment



19.2766
$765.05
$605.53
$153.01
$121.1152290
Cystoscopy and treatment



19.2766
$765.05
$605.53
$153.01
$121.1152300
Cystoscopy and treatment



19.2766
$765.05
$605.53
$153.01
$121.1152301
Cystoscopy and treatment



19.2766
$765.05
$637.53
$153.01
$127.5152305
Cystoscopy and treatment



19.2766
$765.05
$605.53
$153.01
$121.1152310
Cystoscopy and treatment



6.7325
$267.20
$340.80
$53.44
$68.1652315
Cystoscopy and treatment



19.2766
$765.05
$605.53
$153.01
$121.1152317
Remove bladder stone



23.8562
$946.81
$639.90
$189.36
$127.9852318
Remove bladder stone



23.8562
$946.81
$696.40
$189.36
$139.2852320
Cystoscopy and treatment



23.8562
$946.81
$831.90
$189.36
$166.3852325
Cystoscopy, stone removal



23.8562
$946.81
$788.40
$189.36
$157.6852327
Cystoscopy, inject material



23.8562
$946.81
$696.40
$189.36
$139.2852330
Cystoscopy and treatment



23.8562
$946.81
$696.40
$189.36
$139.2852332
Cystoscopy and treatment



23.8562
$946.81
$696.40
$189.36
$139.2852334
Create passage to kidney



23.8562
$946.81
$728.40
$189.36
$145.6852341
Cysto w/ureter stricture tx



23.8562
$946.81
$728.40
$189.36
$145.6852342
Cysto w/up stricture tx



23.8562
$946.81
$728.40
$189.36
$145.6852343
Cysto w/renal stricture tx



23.8562
$946.81
$728.40
$189.36
$145.6852344
Cysto/uretero, stricture tx



23.8562
$946.81
$728.40
$189.36
$145.6852345
Cysto/uretero w/up stricture



23.8562
$946.81
$728.40
$189.36
$145.6852346
Cystouretero w/renal strict



23.8562
$946.81
$728.40
$189.36
$145.6852351
Cystouretero  or pyeloscope



19.2766
$765.05
$637.53
$153.01
$127.5152352
Cystouretero w/stone remove



23.8562
$946.81
$788.40
$189.36
$157.6852353
Cystouretero w/lithotripsy



35.1024
$1,393.15
$1,011.57
$278.63
$202.3152354
Cystouretero w/biopsy



23.8562
$946.81
$788.40
$189.36
$157.6852355
Cystouretero w/excise tumor



23.8562
$946.81
$788.40
$189.36
$157.6852400
Cystouretero w/congen repr



23.8562
$946.81
$728.40
$189.36
$145.68( print page 49922)52402
Cystourethro cut ejacul duct



23.8562
$946.81
$728.40
$189.36
$145.6852450
Incision of prostate



23.8562
$946.81
$728.40
$189.36
$145.6852500
Revision of bladder neck



23.8562
$946.81
$728.40
$189.36
$145.6852510
Dilation prostatic urethra



19.2766
$765.05
$637.53
$153.01
$127.5152601
Prostatectomy (turp)



35.1024
$1,393.15
$1,011.57
$278.63
$202.3152606
Control postop bleeding



23.8562
$946.81
$639.90
$189.36
$127.9852612
Prostatectomy, first stage



35.1024
$1,393.15
$919.57
$278.63
$183.9152614
Prostatectomy, second stage



35.1024
$1,393.15
$863.07
$278.63
$172.6152620
Remove residual prostate



35.1024
$1,393.15
$863.07
$278.63
$172.6152630
Remove prostate regrowth



35.1024
$1,393.15
$919.57
$278.63
$183.9152640
Relieve bladder contracture



23.8562
$946.81
$696.40
$189.36
$139.2852647
Laser surgery of prostate



42.9327
$1,703.92
$1,521.46
$340.78
$304.2952648
Laser surgery of prostate



42.9327
$1,703.92
$1,521.46
$340.78
$304.2952700
Drainage of prostate abscess



23.8562
$946.81
$696.40
$189.36
$139.2853000
Incision of urethra



18.5138
$734.78
$533.89
$146.96
$106.7853010
Incision of urethra



18.5138
$734.78
$533.89
$146.96
$106.7853020
Incision of urethra



18.5138
$734.78
$533.89
$146.96
$106.7853025
Incision of urethra
Y
Y
Y
0.3551
$14.09
$14.09
$2.82
$2.8253040
Drainage of urethra abscess



18.5138
$734.78
$590.39
$146.96
$118.0853060
Drainage of urethra abscess
Y
Y
Y
1.7500
$69.45
$69.45
$13.89
$13.8953080
Drainage of urinary leakage



18.5138
$734.78
$622.39
$146.96
$124.4853085
Drainage of urinary leakage
Y


18.5138
$734.78
$734.78
$146.96
$146.9653200
Biopsy of urethra



18.5138
$734.78
$533.89
$146.96
$106.7853210
Removal of urethra



28.5971
$1,134.96
$925.98
$226.99
$185.2053215
Removal of urethra



18.5138
$734.78
$725.89
$146.96
$145.1853220
Treatment of urethra lesion



28.5971
$1,134.96
$790.48
$226.99
$158.1053230
Removal of urethra lesion



28.5971
$1,134.96
$790.48
$226.99
$158.1053235
Removal of urethra lesion



18.5138
$734.78
$622.39
$146.96
$124.4853240
Surgery for urethra pouch



28.5971
$1,134.96
$790.48
$226.99
$158.1053250
Removal of urethra gland



18.5138
$734.78
$590.39
$146.96
$118.0853260
Treatment of urethra lesion



18.5138
$734.78
$590.39
$146.96
$118.0853265
Treatment of urethra lesion



18.5138
$734.78
$590.39
$146.96
$118.0853270
Removal of urethra gland



18.5138
$734.78
$590.39
$146.96
$118.08( print page 49923)53275
Repair of urethra defect



18.5138
$734.78
$590.39
$146.96
$118.0853400
Revise urethra, stage 1



28.5971
$1,134.96
$822.48
$226.99
$164.5053405
Revise urethra, stage 2



28.5971
$1,134.96
$790.48
$226.99
$158.1053410
Reconstruction of urethra



28.5971
$1,134.96
$790.48
$226.99
$158.1053420
Reconstruct urethra, stage 1



28.5971
$1,134.96
$822.48
$226.99
$164.5053425
Reconstruct urethra, stage 2



28.5971
$1,134.96
$790.48
$226.99
$158.1053430
Reconstruction of urethra



28.5971
$1,134.96
$790.48
$226.99
$158.1053431
Reconstruct urethra/bladder



28.5971
$1,134.96
$790.48
$226.99
$158.1053440
Male sling procedure



79.3730
$3,150.16
$1,798.08
$630.03
$359.6253442
Remove/revise male sling



28.5971
$1,134.96
$733.98
$226.99
$146.8053444
Insert tandem cuff



79.3730
$3,150.16
$1,798.08
$630.03
$359.6253445
Insert uro/ves nck sphincter



135.7295
$5,386.84
$2,859.92
$1,077.37
$571.9853446
Remove uro sphincter



28.5971
$1,134.96
$733.98
$226.99
$146.8053447
Remove/replace ur sphincter



135.7295
$5,386.84
$2,859.92
$1,077.37
$571.9853449
Repair uro sphincter



28.5971
$1,134.96
$733.98
$226.99
$146.8053450
Revision of urethra



28.5971
$1,134.96
$733.98
$226.99
$146.8053460
Revision of urethra



18.5138
$734.78
$533.89
$146.96
$106.7853502
Repair of urethra injury



18.5138
$734.78
$590.39
$146.96
$118.0853505
Repair of urethra injury



28.5971
$1,134.96
$790.48
$226.99
$158.1053510
Repair of urethra injury



18.5138
$734.78
$590.39
$146.96
$118.0853515
Repair of urethra injury



28.5971
$1,134.96
$790.48
$226.99
$158.1053520
Repair of urethra defect



28.5971
$1,134.96
$790.48
$226.99
$158.1053600
Dilate urethra stricture
Y
Y
Y
0.9900
$39.29
$39.29
$7.86
$7.8653601
Dilate urethra stricture
Y
Y

1.0844
$43.04
$43.04
$8.61
$8.6153605
Dilate urethra stricture



19.2766
$765.05
$605.53
$153.01
$121.1153620
Dilate urethra stricture
Y
Y
Y
1.6003
$63.51
$63.51
$12.70
$12.7053621
Dilate urethra stricture
Y
Y
Y
1.6839
$66.83
$66.83
$13.37
$13.3753660
Dilation of urethra
Y
Y

1.0844
$43.04
$43.04
$8.61
$8.6153661
Dilation of urethra
Y
Y

1.0844
$43.04
$43.04
$8.61
$8.6153665
Dilation of urethra



18.5138
$734.78
$533.89
$146.96
$106.7853850
Prostatic microwave thermotx
Y
Y

42.3176
$1,679.50
$1,679.50
$335.90
$335.9053852
Prostatic rf thermotx
Y
Y

42.3176
$1,679.50
$1,679.50
$335.90
$335.90( print page 49924)53853
Prostatic water thermother
Y
Y

23.8562
$946.81
$946.81
$189.36
$189.3654000
Slitting of prepuce



18.5138
$734.78
$590.39
$146.96
$118.0854001
Slitting of prepuce



18.5138
$734.78
$590.39
$146.96
$118.0854015
Drain penis lesion



17.4686
$693.30
$661.65
$138.66
$132.3354050
Destruction, penis lesion(s)
Y
Y

1.0876
$43.16
$43.16
$8.63
$8.6354055
Destruction, penis lesion(s)
Y
Y
Y
1.5372
$61.01
$61.01
$12.20
$12.2054056
Cryosurgery, penis lesion(s)
Y
Y

0.8076
$32.05
$32.05
$6.41
$6.4154057
Laser surg, penis lesion(s)



17.7392
$704.03
$518.52
$140.81
$103.7054060
Excision of penis lesion(s)



17.7392
$704.03
$518.52
$140.81
$103.7054065
Destruction, penis lesion(s)



20.5802
$816.79
$574.89
$163.36
$114.9854100
Biopsy of penis



14.9563
$593.59
$463.29
$118.72
$92.6654105
Biopsy of penis



19.9760
$792.81
$562.90
$158.56
$112.5854110
Treatment of penis lesion



32.9991
$1,309.67
$877.84
$261.93
$175.5754111
Treat penis lesion, graft



32.9991
$1,309.67
$877.84
$261.93
$175.5754112
Treat penis lesion, graft



32.9991
$1,309.67
$877.84
$261.93
$175.5754115
Treatment of penis lesion



17.4686
$693.30
$513.15
$138.66
$102.6354120
Partial removal of penis



32.9991
$1,309.67
$877.84
$261.93
$175.5754150
Circumcision



20.7418
$823.20
$578.10
$164.64
$115.6254152
Circumcision



20.7418
$823.20
$578.10
$164.64
$115.6254160
Circumcision



20.7418
$823.20
$634.60
$164.64
$126.9254161
Circumcision



20.7418
$823.20
$634.60
$164.64
$126.9254162
Lysis penil circumic lesion



20.7418
$823.20
$634.60
$164.64
$126.9254163
Repair of circumcision



20.7418
$823.20
$634.60
$164.64
$126.9254164
Frenulotomy of penis



20.7418
$823.20
$634.60
$164.64
$126.9254200
Treatment of penis lesion
Y
Y
Y
1.6501
$65.49
$65.49
$13.10
$13.1054205
Treatment of penis lesion



32.9991
$1,309.67
$969.84
$261.93
$193.9754220
Treatment of penis lesion



2.1159
$83.98
$107.11
$16.80
$21.4254231
Dynamic cavernosometry
Y
Y
Y
1.3889
$55.12
$55.12
$11.02
$11.0254235
Penile injection
Y
Y
Y
1.0170
$40.36
$40.36
$8.07
$8.0754240
Penis study
Y
Y
Y
1.0844
$43.04
$43.04
$8.61
$8.6154250
Penis study
Y
Y
Y
0.9079
$36.03
$36.03
$7.21
$7.2154300
Revision of penis



32.9991
$1,309.67
$909.84
$261.93
$181.9754304
Revision of penis



32.9991
$1,309.67
$909.84
$261.93
$181.9754308
Reconstruction of urethra



32.9991
$1,309.67
$909.84
$261.93
$181.97( print page 49925)54312
Reconstruction of urethra



32.9991
$1,309.67
$909.84
$261.93
$181.9754316
Reconstruction of urethra



32.9991
$1,309.67
$909.84
$261.93
$181.9754318
Reconstruction of urethra



32.9991
$1,309.67
$909.84
$261.93
$181.9754322
Reconstruction of urethra



32.9991
$1,309.67
$909.84
$261.93
$181.9754324
Reconstruction of urethra



32.9991
$1,309.67
$909.84
$261.93
$181.9754326
Reconstruction of urethra



32.9991
$1,309.67
$909.84
$261.93
$181.9754328
Revise penis/urethra



32.9991
$1,309.67
$909.84
$261.93
$181.9754340
Secondary urethral surgery



32.9991
$1,309.67
$909.84
$261.93
$181.9754344
Secondary urethral surgery



32.9991
$1,309.67
$909.84
$261.93
$181.9754348
Secondary urethral surgery



32.9991
$1,309.67
$909.84
$261.93
$181.9754352
Reconstruct urethra/penis



32.9991
$1,309.67
$909.84
$261.93
$181.9754360
Penis plastic surgery



32.9991
$1,309.67
$909.84
$261.93
$181.9754380
Repair penis



32.9991
$1,309.67
$909.84
$261.93
$181.9754385
Repair penis



32.9991
$1,309.67
$909.84
$261.93
$181.9754400
Insert semi-rigid prosthesis



79.3730
$3,150.16
$1,830.08
$630.03
$366.0254401
Insert self-contd prosthesis



135.7295
$5,386.84
$2,948.42
$1,077.37
$589.6854405
Insert multi-comp penis pros



135.7295
$5,386.84
$2,948.42
$1,077.37
$589.6854406
Remove muti-comp penis pros



32.9991
$1,309.67
$909.84
$261.93
$181.9754408
Repair multi-comp penis pros



32.9991
$1,309.67
$909.84
$261.93
$181.9754410
Remove/replace penis prosth



135.7295
$5,386.84
$2,948.42
$1,077.37
$589.6854415
Remove self-contd penis pros



32.9991
$1,309.67
$909.84
$261.93
$181.9754416
Remv/repl penis contain pros



135.7295
$5,386.84
$2,948.42
$1,077.37
$589.6854420
Revision of penis



32.9991
$1,309.67
$969.84
$261.93
$193.9754435
Revision of penis



32.9991
$1,309.67
$969.84
$261.93
$193.9754440
Repair of penis



32.9991
$1,309.67
$969.84
$261.93
$193.9754450
Preputial stretching



3.5688
$141.64
$180.65
$28.33
$36.1354500
Biopsy of testis



10.2616
$407.26
$370.13
$81.45
$74.0354505
Biopsy of testis



23.7072
$940.89
$636.95
$188.18
$127.3954512
Excise lesion testis



23.7072
$940.89
$693.45
$188.18
$138.6954520
Removal of testis



23.7072
$940.89
$725.45
$188.18
$145.0954522
Orchiectomy, partial



23.7072
$940.89
$725.45
$188.18
$145.0954530
Removal of testis



29.1491
$1,156.87
$893.44
$231.37
$178.6954550
Exploration for testis



29.1491
$1,156.87
$893.44
$231.37
$178.69( print page 49926)54560
Exploration for testis
Y


23.7072
$940.89
$940.89
$188.18
$188.1854600
Reduce testis torsion



23.7072
$940.89
$785.45
$188.18
$157.0954620
Suspension of testis



23.7072
$940.89
$725.45
$188.18
$145.0954640
Suspension of testis



29.1491
$1,156.87
$893.44
$231.37
$178.6954660
Revision of testis



23.7072
$940.89
$693.45
$188.18
$138.6954670
Repair testis injury



23.7072
$940.89
$725.45
$188.18
$145.0954680
Relocation of testis(es)



23.7072
$940.89
$725.45
$188.18
$145.0954690
Laparoscopy, orchiectomy



43.5124
$1,726.92
$1,532.96
$345.38
$306.5954700
Drainage of scrotum



23.7072
$940.89
$693.45
$188.18
$138.6954800
Biopsy of epididymis



2.0863
$82.80
$105.61
$16.56
$21.1254820
Exploration of epididymis



23.7072
$940.89
$636.95
$188.18
$127.3954830
Remove epididymis lesion



23.7072
$940.89
$725.45
$188.18
$145.0954840
Remove epididymis lesion



23.7072
$940.89
$785.45
$188.18
$157.0954860
Removal of epididymis



23.7072
$940.89
$725.45
$188.18
$145.0954861
Removal of epididymis



23.7072
$940.89
$785.45
$188.18
$157.0954900
Fusion of spermatic ducts



23.7072
$940.89
$785.45
$188.18
$157.0954901
Fusion of spermatic ducts



23.7072
$940.89
$785.45
$188.18
$157.0955000
Drainage of hydrocele
Y
Y
Y
1.6905
$67.09
$67.09
$13.42
$13.4255040
Removal of hydrocele



29.1491
$1,156.87
$833.44
$231.37
$166.6955041
Removal of hydroceles



29.1491
$1,156.87
$936.94
$231.37
$187.3955060
Repair of hydrocele



23.7072
$940.89
$785.45
$188.18
$157.0955100
Drainage of scrotum abscess



10.9184
$433.33
$383.17
$86.67
$76.6355110
Explore scrotum



23.7072
$940.89
$693.45
$188.18
$138.6955120
Removal of scrotum lesion



23.7072
$940.89
$693.45
$188.18
$138.6955150
Removal of scrotum



23.7072
$940.89
$636.95
$188.18
$127.3955175
Revision of scrotum



23.7072
$940.89
$636.95
$188.18
$127.3955180
Revision of scrotum



23.7072
$940.89
$693.45
$188.18
$138.6955200
Incision of sperm duct



23.7072
$940.89
$693.45
$188.18
$138.6955250
Removal of sperm duct(s)



23.7072
$940.89
$693.45
$188.18
$138.6955400
Repair of sperm duct



23.7072
$940.89
$636.95
$188.18
$127.3955450
Ligation of sperm duct
Y
Y
Y
5.6047
$222.44
$222.44
$44.49
$44.4955500
Removal of hydrocele



23.7072
$940.89
$725.45
$188.18
$145.0955520
Removal of sperm cord lesion



23.7072
$940.89
$785.45
$188.18
$157.09( print page 49927)55530
Revise spermatic cord veins



23.7072
$940.89
$785.45
$188.18
$157.0955535
Revise spermatic cord veins



29.1491
$1,156.87
$893.44
$231.37
$178.6955540
Revise hernia  sperm veins



29.1491
$1,156.87
$936.94
$231.37
$187.3955550
Laparo ligate spermatic vein



43.5124
$1,726.92
$1,532.96
$345.38
$306.5955559
Laparo proc, spermatic cord
Y


31.9353
$1,267.45
$1,267.45
$253.49
$253.4955600
Incise sperm duct pouch
Y
Y
Y
3.5462
$140.74
$140.74
$28.15
$28.1555680
Remove sperm pouch lesion



23.7072
$940.89
$636.95
$188.18
$127.3955700
Biopsy of prostate



5.9892
$237.70
$303.17
$47.54
$60.6355705
Biopsy of prostate



5.9892
$237.70
$303.17
$47.54
$60.6355720
Drainage of prostate abscess



23.8562
$946.81
$639.90
$189.36
$127.9855725
Drainage of prostate abscess



23.8562
$946.81
$696.40
$189.36
$139.2855859
Percut/needle insert, pros



35.1024
$1,393.15
$1,366.07
$278.63
$273.2155860
Surgical exposure, prostate
Y


18.2333
$723.64
$723.64
$144.73
$144.7355870
Electroejaculation
Y
Y
Y
1.7213
$68.32
$68.32
$13.66
$13.6655873
Cryoablate prostate



107.8298
$4,279.56
$2,809.28
$855.91
$561.8656405
I  D of vulva/perineum
Y
Y
Y
1.0685
$42.41
$42.41
$8.48
$8.4856420
Drainage of gland abscess
Y
Y

1.4050
$55.76
$55.76
$11.15
$11.1556440
Surgery for vulva lesion



20.5113
$814.05
$630.03
$162.81
$126.0156441
Lysis of labial lesion(s)



14.7958
$587.22
$460.11
$117.44
$92.0256501
Destroy, vulva lesions, sim
Y
Y
Y
1.4690
$58.30
$58.30
$11.66
$11.6656515
Destroy vulva lesion/s compl



20.5802
$816.79
$663.39
$163.36
$132.6856605
Biopsy of vulva/perineum
Y
Y
Y
0.8450
$33.54
$33.54
$6.71
$6.7156606
Biopsy of vulva/perineum
Y
Y
Y
0.3647
$14.47
$14.47
$2.89
$2.8956620
Partial removal of vulva



28.7410
$1,140.68
$928.84
$228.14
$185.7756625
Complete removal of vulva



28.7410
$1,140.68
$1,067.84
$228.14
$213.5756700
Partial removal of hymen



20.5113
$814.05
$573.53
$162.81
$114.7156720
Incision of hymen



14.7958
$587.22
$460.11
$117.44
$92.0256740
Remove vagina gland lesion



20.5113
$814.05
$662.03
$162.81
$132.4156800
Repair of vagina



20.5113
$814.05
$662.03
$162.81
$132.4156810
Repair of perineum



20.5113
$814.05
$765.53
$162.81
$153.11( print page 49928)56820
Exam of vulva w/scope
Y
Y
Y
1.0682
$42.39
$42.39
$8.48
$8.4856821
Exam/biopsy of vulva w/scope
Y
Y
Y
1.4089
$55.92
$55.92
$11.18
$11.1857000
Exploration of vagina



14.7958
$587.22
$460.11
$117.44
$92.0257010
Drainage of pelvic abscess



14.7958
$587.22
$516.61
$117.44
$103.3257020
Drainage of pelvic fluid



6.9265
$274.90
$350.61
$54.98
$70.1257022
I  d vaginal hematoma, pp
Y


10.9184
$433.33
$433.33
$86.67
$86.6757023
I d vag hematoma, non-ob



17.4686
$693.30
$513.15
$138.66
$102.6357061
Destroy vag lesions, simple
Y
Y
Y
1.3555
$53.80
$53.80
$10.76
$10.7657065
Destroy vag lesions, complex



20.5113
$814.05
$573.53
$162.81
$114.7157100
Biopsy of vagina
Y
Y
Y
0.8573
$34.02
$34.02
$6.80
$6.8057105
Biopsy of vagina



20.5113
$814.05
$630.03
$162.81
$126.0157130
Remove vagina lesion



20.5113
$814.05
$630.03
$162.81
$126.0157135
Remove vagina lesion



20.5113
$814.05
$630.03
$162.81
$126.0157150
Treat vagina infection
Y
Y

0.1501
$5.96
$5.96
$1.19
$1.1957155
Insert uteri tandems/ovoids



6.9265
$274.90
$350.61
$54.98
$70.1257160
Insert pessary/other device
Y
Y
Y
0.8815
$34.98
$34.98
$7.00
$7.0057170
Fitting of diaphragm/cap
Y
Y

0.1501
$5.96
$5.96
$1.19
$1.1957180
Treat vaginal bleeding



2.9902
$118.68
$151.36
$23.74
$30.2757200
Repair of vagina



20.5113
$814.05
$573.53
$162.81
$114.7157210
Repair vagina/perineum



20.5113
$814.05
$630.03
$162.81
$126.0157220
Revision of urethra



42.8756
$1,701.65
$1,105.83
$340.33
$221.1757230
Repair of urethral lesion



28.7410
$1,140.68
$825.34
$228.14
$165.0757240
Repair bladder  vagina



28.7410
$1,140.68
$928.84
$228.14
$185.7757250
Repair rectum  vagina



28.7410
$1,140.68
$928.84
$228.14
$185.7757260
Repair of vagina



28.7410
$1,140.68
$928.84
$228.14
$185.7757265
Extensive repair of vagina



42.8756
$1,701.65
$1,348.33
$340.33
$269.6757268
Repair of bowel bulge



28.7410
$1,140.68
$825.34
$228.14
$165.0757287
Revise/remove sling repair
Y


28.7410
$1,140.68
$1,140.68
$228.14
$228.1457288
Repair bladder defect



42.8756
$1,701.65
$1,209.33
$340.33
$241.8757289
Repair bladder  vagina



28.7410
$1,140.68
$928.84
$228.14
$185.7757291
Construction of vagina



28.7410
$1,140.68
$928.84
$228.14
$185.7757300
Repair rectum-vagina fistula



28.7410
$1,140.68
$825.34
$228.14
$165.0757320
Repair bladder-vagina lesion
Y


28.7410
$1,140.68
$1,140.68
$228.14
$228.14( print page 49929)57400
Dilation of vagina



20.5113
$814.05
$630.03
$162.81
$126.0157410
Pelvic examination



14.7958
$587.22
$516.61
$117.44
$103.3257415
Remove vaginal foreign body



20.5113
$814.05
$630.03
$162.81
$126.0157420
Exam of vagina w/scope
Y
Y
Y
1.1018
$43.73
$43.73
$8.75
$8.7557421
Exam/biopsy of vag w/scope
Y
Y
Y
1.4710
$58.38
$58.38
$11.68
$11.6857452
Examination of vagina
Y
Y
Y
1.0518
$41.75
$41.75
$8.35
$8.3557454
Vagina examination  biopsy
Y
Y
Y
1.2983
$51.53
$51.53
$10.31
$10.3157455
Biopsy of cervix w/scope
Y
Y
Y
1.3775
$54.67
$54.67
$10.93
$10.9357456
Endocerv curettage w/scope
Y
Y
Y
1.3315
$52.85
$52.85
$10.57
$10.5757460
Cervix excision
Y
Y
Y
4.3623
$173.13
$173.13
$34.63
$34.6357461
Conz of cervix w/scope, leep
Y
Y
Y
4.6015
$182.62
$182.62
$36.52
$36.5257500
Biopsy of cervix
Y
Y
Y
1.9587
$77.74
$77.74
$15.55
$15.5557505
Endocervical curettage
Y
Y
Y
1.1880
$47.15
$47.15
$9.43
$9.4357510
Cauterization of cervix
Y
Y
Y
1.2257
$48.65
$48.65
$9.73
$9.7357511
Cryocautery of cervix
Y
Y

1.4050
$55.76
$55.76
$11.15
$11.1557513
Laser surgery of cervix



14.7958
$587.22
$516.61
$117.44
$103.3257520
Conization of cervix



20.5113
$814.05
$630.03
$162.81
$126.0157522
Conization of cervix



28.7410
$1,140.68
$793.34
$228.14
$158.6757530
Removal of cervix



28.7410
$1,140.68
$825.34
$228.14
$165.0757550
Removal of residual cervix



28.7410
$1,140.68
$825.34
$228.14
$165.0757556
Remove cervix, repair bowel



42.8756
$1,701.65
$1,209.33
$340.33
$241.8757700
Revision of cervix



20.5113
$814.05
$573.53
$162.81
$114.7157720
Revision of cervix



20.5113
$814.05
$662.03
$162.81
$132.4157800
Dilation of cervical canal
Y
Y
Y
0.6280
$24.92
$24.92
$4.98
$4.9857820
D c of residual cervix



17.7635
$705.00
$607.50
$141.00
$121.5058100
Biopsy of uterus lining
Y
Y
Y
1.0495
$41.65
$41.65
$8.33
$8.3358110
Bx done w/colposcopy add-on
Y
Y
Y
0.4041
$16.04
$16.04
$3.21
$3.2158120
Dilation and curettage



17.7635
$705.00
$575.50
$141.00
$115.1058145
Myomectomy vag method



28.7410
$1,140.68
$928.84
$228.14
$185.7758301
Remove intrauterine device
Y
Y
Y
1.0140
$40.24
$40.24
$8.05
$8.0558321
Artificial insemination
Y
Y
Y
0.9178
$36.42
$36.42
$7.28
$7.2858322
Artificial insemination
Y
Y
Y
0.9612
$38.15
$38.15
$7.63
$7.6358323
Sperm washing
Y
Y
Y
0.2946
$11.69
$11.69
$2.34
$2.3458345
Reopen fallopian tube
Y
Y
Y
1.9449
$77.19
$77.19
$15.44
$15.44( print page 49930)58346
Insert heyman uteri capsule



14.7958
$587.22
$516.61
$117.44
$103.3258350
Reopen fallopian tube



28.7410
$1,140.68
$825.34
$228.14
$165.0758353
Endometr ablate, thermal



28.7410
$1,140.68
$885.34
$228.14
$177.0758356
Endometrial cryoablation
Y
Y

42.8756
$1,701.65
$1,701.65
$340.33
$340.3358545
Laparoscopic myomectomy



31.9353
$1,267.45
$1,303.23
$253.49
$260.6558546
Laparo-myomectomy, complex



43.5124
$1,726.92
$1,532.96
$345.38
$306.5958550
Laparo-asst vag hysterectomy



70.8854
$2,813.31
$2,076.15
$562.66
$415.2358552
Laparo-vag hyst incl t/o
Y


43.5124
$1,726.92
$1,726.92
$345.38
$345.3858555
Hysteroscopy, dx, sep proc



21.4199
$850.11
$591.56
$170.02
$118.3158558
Hysteroscopy, biopsy



21.4199
$850.11
$680.06
$170.02
$136.0158559
Hysteroscopy, lysis



21.4199
$850.11
$648.06
$170.02
$129.6158560
Hysteroscopy, resect septum



33.3029
$1,321.73
$915.86
$264.35
$183.1758561
Hysteroscopy, remove myoma



33.3029
$1,321.73
$915.86
$264.35
$183.1758562
Hysteroscopy, remove fb



21.4199
$850.11
$680.06
$170.02
$136.0158563
Hysteroscopy, ablation



33.3029
$1,321.73
$975.86
$264.35
$195.1758565
Hysteroscopy, sterilization



42.8756
$1,701.65
$1,165.83
$340.33
$233.1758600
Division of fallopian tube
Y


28.7410
$1,140.68
$1,140.68
$228.14
$228.1458615
Occlude fallopian tube(s)
Y


20.5113
$814.05
$814.05
$162.81
$162.8158660
Laparoscopy, lysis



43.5124
$1,726.92
$1,221.96
$345.38
$244.3958661
Laparoscopy, remove adnexa



43.5124
$1,726.92
$1,221.96
$345.38
$244.3958662
Laparoscopy, excise lesions



43.5124
$1,726.92
$1,221.96
$345.38
$244.3958670
Laparoscopy, tubal cautery



43.5124
$1,726.92
$1,118.46
$345.38
$223.6958671
Laparoscopy, tubal block



43.5124
$1,726.92
$1,118.46
$345.38
$223.6958672
Laparoscopy, fimbrioplasty



43.5124
$1,726.92
$1,221.96
$345.38
$244.3958673
Laparoscopy, salpingostomy



43.5124
$1,726.92
$1,221.96
$345.38
$244.3958800
Drainage of ovarian cyst(s)



14.7958
$587.22
$548.61
$117.44
$109.7258820
Drain ovary abscess, open



28.7410
$1,140.68
$825.34
$228.14
$165.0758900
Biopsy of ovary(s)



14.7958
$587.22
$548.61
$117.44
$109.7258970
Retrieval of oocyte



4.4108
$175.06
$223.27
$35.01
$44.6558974
Transfer of embryo



4.4108
$175.06
$223.27
$35.01
$44.6558976
Transfer of embryo



4.4108
$175.06
$223.27
$35.01
$44.6559000
Amniocentesis, diagnostic
Y
Y

1.4026
$55.67
$55.67
$11.13
$11.13( print page 49931)59001
Amniocentesis, therapeutic
Y
Y
Y
1.0624
$42.16
$42.16
$8.43
$8.4359012
Fetal cord puncture,prenatal
Y


1.4026
$55.67
$55.67
$11.13
$11.1359015
Chorion biopsy
Y
Y
Y
1.2728
$50.52
$50.52
$10.10
$10.1059020
Fetal contract stress test
Y
Y
Y
0.7961
$31.60
$31.60
$6.32
$6.3259025
Fetal non-stress test
Y
Y
Y
0.4581
$18.18
$18.18
$3.64
$3.6459070
Transabdom amnioinfus w/us
Y


1.4026
$55.67
$55.67
$11.13
$11.1359072
Umbilical cord occlud w/us
Y


1.4026
$55.67
$55.67
$11.13
$11.1359076
Fetal shunt placement, w/us
Y


1.4026
$55.67
$55.67
$11.13
$11.1359100
Remove uterus lesion
Y
Y
Y
5.2552
$208.57
$208.57
$41.71
$41.7159150
Treat ectopic pregnancy
Y


43.5124
$1,726.92
$1,726.92
$345.38
$345.3859151
Treat ectopic pregnancy
Y


43.5124
$1,726.92
$1,726.92
$345.38
$345.3859160
D c after delivery



17.7635
$705.00
$607.50
$141.00
$121.5059200
Insert cervical dilator
Y
Y
Y
0.9139
$36.27
$36.27
$7.25
$7.2559300
Episiotomy or vaginal repair
Y
Y
Y
1.8766
$74.48
$74.48
$14.90
$14.9059320
Revision of cervix



20.5113
$814.05
$573.53
$162.81
$114.7159412
Antepartum manipulation
Y


2.8011
$111.17
$111.17
$22.23
$22.2359812
Treatment of miscarriage



18.5251
$735.23
$726.11
$147.05
$145.2259820
Care of miscarriage



18.5251
$735.23
$726.11
$147.05
$145.2259821
Treatment of miscarriage



18.5251
$735.23
$726.11
$147.05
$145.2259840
Abortion



17.2607
$685.04
$701.02
$137.01
$140.2059841
Abortion



17.2607
$685.04
$701.02
$137.01
$140.2059866
Abortion (mpr)
Y


1.4026
$55.67
$55.67
$11.13
$11.1359870
Evacuate mole of uterus



18.5251
$735.23
$726.11
$147.05
$145.2259871
Remove cerclage suture



20.5113
$814.05
$765.53
$162.81
$153.1160000
Drain thyroid/tongue cyst



7.7261
$306.63
$319.82
$61.33
$63.9660001
Aspirate/inject thyriod cyst
Y
Y
Y
1.4633
$58.08
$58.08
$11.62
$11.6260100
Biopsy of thyroid
Y
Y
Y
1.1901
$47.23
$47.23
$9.45
$9.4560200
Remove thyroid lesion



37.1283
$1,473.55
$959.78
$294.71
$191.9660280
Remove thyroid duct lesion



37.1283
$1,473.55
$1,051.78
$294.71
$210.3660281
Remove thyroid duct lesion



37.1283
$1,473.55
$1,051.78
$294.71
$210.3661000
Remove cranial cavity fluid
Y
Y
Y
0.9167
$36.38
$36.38
$7.28
$7.2861001
Remove cranial cavity fluid
Y
Y
Y
0.9655
$38.32
$38.32
$7.66
$7.6661020
Remove brain cavity fluid



3.0383
$120.58
$153.80
$24.12
$30.7661026
Injection into brain canal



3.0383
$120.58
$153.80
$24.12
$30.76( print page 49932)61050
Remove brain canal fluid



3.0383
$120.58
$153.80
$24.12
$30.7661055
Injection into brain canal



3.0383
$120.58
$153.80
$24.12
$30.7661070
Brain canal shunt procedure



3.0383
$120.58
$153.80
$24.12
$30.7661215
Insert brain-fluid device



45.6712
$1,812.60
$1,161.30
$362.52
$232.2661330
Decompress eye socket
Y


37.7719
$1,499.09
$1,499.09
$299.82
$299.8261334
Explore orbit/remove object
Y


37.7719
$1,499.09
$1,499.09
$299.82
$299.8261790
Treat trigeminal nerve



17.7609
$704.90
$607.45
$140.98
$121.4961791
Treat trigeminal tract



5.5439
$220.03
$280.63
$44.01
$56.1361795
Brain surgery using computer
Y


5.5005
$218.30
$218.30
$43.66
$43.6661880
Revise/remove neuroelectrode
Y


17.1830
$681.96
$681.96
$136.39
$136.3961885
Insrt/redo neurostim 1 array



175.9328
$6,982.44
$3,714.22
$1,396.49
$742.8461886
Implant neurostim arrays



235.5774
$9,349.62
$4,929.81
$1,869.92
$985.9661888
Revise/remove neuroreceiver



33.9521
$1,347.49
$840.25
$269.50
$168.0562194
Replace/irrigate catheter



11.5220
$457.29
$395.14
$91.46
$79.0362225
Replace/irrigate catheter



11.5220
$457.29
$395.14
$91.46
$79.0362230
Replace/revise brain shunt



45.6712
$1,812.60
$1,129.30
$362.52
$225.8662252
Csf shunt reprogram
Y
Y
Y
1.1258
$44.68
$44.68
$8.94
$8.9462263
Epidural lysis mult sessions



12.4432
$493.85
$413.42
$98.77
$82.6862264
Epidural lysis on single day



12.4432
$493.85
$413.42
$98.77
$82.6862268
Drain spinal cord cyst



3.0383
$120.58
$153.80
$24.12
$30.7662269
Needle biopsy, spinal cord



6.0729
$241.02
$287.01
$48.20
$57.4062270
Spinal fluid tap, diagnostic



2.2491
$89.26
$113.85
$17.85
$22.7762272
Drain cerebro spinal fluid



2.2491
$89.26
$113.85
$17.85
$22.7762273
Inject epidural patch



5.5439
$220.03
$276.51
$44.01
$55.3062280
Treat spinal cord lesion



6.3788
$253.16
$293.08
$50.63
$58.6262281
Treat spinal cord lesion



6.3788
$253.16
$293.08
$50.63
$58.6262282
Treat spinal canal lesion



6.3788
$253.16
$293.08
$50.63
$58.6262287
Percutaneous diskectomy



33.3035
$1,321.75
$1,330.38
$264.35
$266.0862292
Injection into disk lesion
Y


3.0383
$120.58
$120.58
$24.12
$24.1262294
Injection into spinal artery



3.0383
$120.58
$153.80
$24.12
$30.7662310
Inject spine c/t



6.3788
$253.16
$293.08
$50.63
$58.6262311
Inject spine l/s (cd)



6.3788
$253.16
$293.08
$50.63
$58.62( print page 49933)62318
Inject spine w/cath, c/t



6.3788
$253.16
$293.08
$50.63
$58.6262319
Inject spine w/cath l/s (cd)



6.3788
$253.16
$293.08
$50.63
$58.6262350
Implant spinal canal cath



29.2931
$1,162.59
$804.29
$232.52
$160.8662355
Remove spinal canal catheter



12.4432
$493.85
$469.92
$98.77
$93.9862360
Insert spine infusion device



112.0147
$4,445.65
$2,445.82
$889.13
$489.1662361
Implant spine infusion pump



183.1974
$7,270.75
$3,858.38
$1,454.15
$771.6862362
Implant spine infusion pump



183.1974
$7,270.75
$3,858.38
$1,454.15
$771.6862365
Remove spine infusion device



33.3035
$1,321.75
$883.88
$264.35
$176.7862367
Analyze spine infusion pump
Y
Y
Y
0.4369
$17.34
$17.34
$3.47
$3.4762368
Analyze spine infusion pump
Y
Y
Y
0.5519
$21.90
$21.90
$4.38
$4.3863600
Remove spinal cord lesion



17.7609
$704.90
$575.45
$140.98
$115.0963610
Stimulation of spinal cord



17.7609
$704.90
$518.95
$140.98
$103.7963615
Remove lesion of spinal cord
Y
Y
Y
6.2719
$248.92
$248.92
$49.78
$49.7863650
Implant neuroelectrodes



56.3855
$2,237.83
$1,341.92
$447.57
$268.3863655
Implant neuroelectrodes
Y


84.2373
$3,343.22
$3,343.22
$668.64
$668.6463660
Revise/remove neuroelectrode



17.1830
$681.96
$507.48
$136.39
$101.5063685
Insrt/redo spine n generator



178.1307
$7,069.67
$3,757.83
$1,413.93
$751.5763688
Revise/remove neuroreceiver



33.9521
$1,347.49
$840.25
$269.50
$168.0563744
Revision of spinal shunt



36.1603
$1,435.13
$972.57
$287.03
$194.5163746
Removal of spinal shunt



10.9541
$434.75
$440.37
$86.95
$88.0764400
N block inj, trigeminal
Y
Y
Y
1.4194
$56.33
$56.33
$11.27
$11.2764402
N block inj, facial
Y
Y
Y
1.3219
$52.46
$52.46
$10.49
$10.4964405
N block inj, occipital
Y
Y
Y
1.1245
$44.63
$44.63
$8.93
$8.9364408
N block inj, vagus
Y
Y
Y
1.3388
$53.13
$53.13
$10.63
$10.6364410
Nblock inj, phrenic



5.5439
$220.03
$276.51
$44.01
$55.3064412
N block inj, spinal accessor
Y
Y
Y
2.0074
$79.67
$79.67
$15.93
$15.9364413
N block inj, cervical plexus
Y
Y
Y
1.3483
$53.51
$53.51
$10.70
$10.7064415
Nblock inj, brachial plexus



2.2491
$89.26
$113.85
$17.85
$22.7764416
N block cont infuse, b plex
Y


2.2491
$89.26
$89.26
$17.85
$17.8564417
Nblock inj, axillary



2.2491
$89.26
$113.85
$17.85
$22.7764418
N block inj, suprascapular
Y
Y
Y
1.9395
$76.98
$76.98
$15.40
$15.40( print page 49934)64420
Nblock inj, intercost, sng



2.2491
$89.26
$113.85
$17.85
$22.7764421
Nblock inj, intercost, mlt



5.5439
$220.03
$276.51
$44.01
$55.3064425
N block inj ilio-ing/hypogi
Y
Y
Y
1.2794
$50.78
$50.78
$10.16
$10.1664430
Nblock inj, pudendal



2.2491
$89.26
$113.85
$17.85
$22.7764435
N block inj, paracervical
Y
Y
Y
1.9447
$77.18
$77.18
$15.44
$15.4464445
Injection for nerve block
Y
Y
Y
1.8559
$73.66
$73.66
$14.73
$14.7364450
N block, other peripheral
Y
Y
Y
1.0671
$42.35
$42.35
$8.47
$8.4764470
Inj paravertebral c/t



6.3788
$253.16
$293.08
$50.63
$58.6264472
Inj paravertebral c/t add-on



5.5439
$220.03
$276.51
$44.01
$55.3064475
Inj paravertebral l/s



6.3788
$253.16
$293.08
$50.63
$58.6264476
Inj paravertebral l/s add-on



5.5439
$220.03
$276.51
$44.01
$55.3064479
Inj foramen epidural c/t



6.3788
$253.16
$293.08
$50.63
$58.6264480
Inj foramen epidural add-on



6.3788
$253.16
$293.08
$50.63
$58.6264483
Inj foramen epidural l/s



6.3788
$253.16
$293.08
$50.63
$58.6264484
Inj foramen epidural add-on



6.3788
$253.16
$293.08
$50.63
$58.6264505
N block, spenopalatine gangl
Y
Y
Y
1.0101
$40.09
$40.09
$8.02
$8.0264508
N block, carotid sinus s/p
Y
Y
Y
2.2491
$89.26
$89.26
$17.85
$17.8564510
Nblock, stellate ganglion



6.3788
$253.16
$293.08
$50.63
$58.6264517
Nblock inj, hypogas plxs



2.2491
$89.26
$113.85
$17.85
$22.7764520
Nblock, lumbar/thoracic



6.3788
$253.16
$293.08
$50.63
$58.6264530
Nblock inj, celiac pelus



6.3788
$253.16
$293.08
$50.63
$58.6264553
Implant neuroelectrodes



234.1628
$9,293.47
$4,813.24
$1,858.69
$962.6564555
Implant neuroelectrodes
Y
Y
Y
2.4298
$96.44
$96.44
$19.29
$19.2964560
Implant neuroelectrodes
Y


56.3855
$2,237.83
$2,237.83
$447.57
$447.5764561
Implant neuroelectrodes



56.3855
$2,237.83
$1,373.92
$447.57
$274.7864565
Implant neuroelectrodes
Y
Y
Y
2.4267
$96.31
$96.31
$19.26
$19.2664573
Implant neuroelectrodes



234.1628
$9,293.47
$4,813.24
$1,858.69
$962.6564575
Implant neuroelectrodes



84.2373
$3,343.22
$1,838.11
$668.64
$367.6264577
Implant neuroelectrodes



84.2373
$3,343.22
$1,838.11
$668.64
$367.62( print page 49935)64580
Implant neuroelectrodes



84.2373
$3,343.22
$1,838.11
$668.64
$367.6264581
Implant neuroelectrodes



84.2373
$3,343.22
$1,926.61
$668.64
$385.3264585
Revise/remove neuroelectrode



17.1830
$681.96
$507.48
$136.39
$101.5064590
Insrt/redo perph n generator



178.1307
$7,069.67
$3,757.83
$1,413.93
$751.5764595
Revise/remove neuroreceiver



33.9521
$1,347.49
$840.25
$269.50
$168.0564600
Injection treatment of nerve



12.4432
$493.85
$413.42
$98.77
$82.6864605
Injection treatment of nerve



12.4432
$493.85
$413.42
$98.77
$82.6864610
Injection treatment of nerve



12.4432
$493.85
$413.42
$98.77
$82.6864612
Destroy nerve, face muscle
Y
Y
Y
1.7396
$69.04
$69.04
$13.81
$13.8164613
Destroy nerve, spine muscle
Y
Y
Y
1.8356
$72.85
$72.85
$14.57
$14.5764614
Destroy nerve, extrem musc
Y
Y
Y
2.0569
$81.63
$81.63
$16.33
$16.3364620
Injection treatment of nerve



12.4432
$493.85
$413.42
$98.77
$82.6864622
Destr paravertebrl nerve l/s



12.4432
$493.85
$413.42
$98.77
$82.6864623
Destr paravertebral n add-on



6.3788
$253.16
$293.08
$50.63
$58.6264626
Destr paravertebrl nerve c/t



12.4432
$493.85
$413.42
$98.77
$82.6864627
Destr paravertebral n add-on



6.3788
$253.16
$293.08
$50.63
$58.6264630
Injection treatment of nerve



5.5439
$220.03
$280.63
$44.01
$56.1364640
Injection treatment of nerve
Y
Y
Y
2.8054
$111.34
$111.34
$22.27
$22.2764650
Chemodenerv eccrine glands
Y


2.2491
$89.26
$89.26
$17.85
$17.8564653
Chemodenerv eccrine glands
Y


2.2491
$89.26
$89.26
$17.85
$17.8564680
Injection treatment of nerve



6.3788
$253.16
$322.89
$50.63
$64.5864681
Injection treatment of nerve



12.4432
$493.85
$469.92
$98.77
$93.9864702
Revise finger/toe nerve



17.7609
$704.90
$518.95
$140.98
$103.7964704
Revise hand/foot nerve



17.7609
$704.90
$518.95
$140.98
$103.7964708
Revise arm/leg nerve



17.7609
$704.90
$575.45
$140.98
$115.0964712
Revision of sciatic nerve



17.7609
$704.90
$575.45
$140.98
$115.0964713
Revision of arm nerve(s)



17.7609
$704.90
$575.45
$140.98
$115.0964714
Revise low back nerve(s)



17.7609
$704.90
$575.45
$140.98
$115.0964716
Revision of cranial nerve



17.7609
$704.90
$607.45
$140.98
$121.49( print page 49936)64718
Revise ulnar nerve at elbow



17.7609
$704.90
$575.45
$140.98
$115.0964719
Revise ulnar nerve at wrist



17.7609
$704.90
$575.45
$140.98
$115.0964721
Carpal tunnel surgery



17.7609
$704.90
$575.45
$140.98
$115.0964722
Relieve pressure on nerve(s)



17.7609
$704.90
$518.95
$140.98
$103.7964726
Release foot/toe nerve



17.7609
$704.90
$518.95
$140.98
$103.7964727
Internal nerve revision



17.7609
$704.90
$518.95
$140.98
$103.7964732
Incision of brow nerve



17.7609
$704.90
$575.45
$140.98
$115.0964734
Incision of cheek nerve



17.7609
$704.90
$575.45
$140.98
$115.0964736
Incision of chin nerve



17.7609
$704.90
$575.45
$140.98
$115.0964738
Incision of jaw nerve



17.7609
$704.90
$575.45
$140.98
$115.0964740
Incision of tongue nerve



17.7609
$704.90
$575.45
$140.98
$115.0964742
Incision of facial nerve



17.7609
$704.90
$575.45
$140.98
$115.0964744
Incise nerve, back of head



17.7609
$704.90
$575.45
$140.98
$115.0964746
Incise diaphragm nerve



17.7609
$704.90
$575.45
$140.98
$115.0964761
Incision of pelvis nerve
Y


17.7609
$704.90
$704.90
$140.98
$140.9864763
Incise hip/thigh nerve
Y


17.7609
$704.90
$704.90
$140.98
$140.9864766
Incise hip/thigh nerve
Y


33.3035
$1,321.75
$1,321.75
$264.35
$264.3564771
Sever cranial nerve



17.7609
$704.90
$575.45
$140.98
$115.0964772
Incision of spinal nerve



17.7609
$704.90
$575.45
$140.98
$115.0964774
Remove skin nerve lesion



17.7609
$704.90
$575.45
$140.98
$115.0964776
Remove digit nerve lesion



17.7609
$704.90
$607.45
$140.98
$121.4964778
Digit nerve surgery add-on



17.7609
$704.90
$575.45
$140.98
$115.0964782
Remove limb nerve lesion



17.7609
$704.90
$607.45
$140.98
$121.4964783
Limb nerve surgery add-on



17.7609
$704.90
$575.45
$140.98
$115.0964784
Remove nerve lesion



17.7609
$704.90
$607.45
$140.98
$121.4964786
Remove sciatic nerve lesion



33.3035
$1,321.75
$915.88
$264.35
$183.1864787
Implant nerve end



17.7609
$704.90
$575.45
$140.98
$115.0964788
Remove skin nerve lesion



17.7609
$704.90
$607.45
$140.98
$121.4964790
Removal of nerve lesion



17.7609
$704.90
$607.45
$140.98
$121.4964792
Removal of nerve lesion



33.3035
$1,321.75
$915.88
$264.35
$183.1864795
Biopsy of nerve



17.7609
$704.90
$575.45
$140.98
$115.0964802
Remove sympathetic nerves



17.7609
$704.90
$575.45
$140.98
$115.0964820
Remove sympathetic nerves
Y


17.7609
$704.90
$704.90
$140.98
$140.98( print page 49937)64821
Remove sympathetic nerves



25.8425
$1,025.64
$827.82
$205.13
$165.5664822
Remove sympathetic nerves
Y


25.8425
$1,025.64
$1,025.64
$205.13
$205.1364823
Remove sympathetic nerves
Y


25.8425
$1,025.64
$1,025.64
$205.13
$205.1364831
Repair of digit nerve



33.3035
$1,321.75
$975.88
$264.35
$195.1864832
Repair nerve add-on



33.3035
$1,321.75
$827.38
$264.35
$165.4864834
Repair of hand or foot nerve



33.3035
$1,321.75
$883.88
$264.35
$176.7864835
Repair of hand or foot nerve



33.3035
$1,321.75
$915.88
$264.35
$183.1864836
Repair of hand or foot nerve



33.3035
$1,321.75
$915.88
$264.35
$183.1864837
Repair nerve add-on



33.3035
$1,321.75
$827.38
$264.35
$165.4864840
Repair of leg nerve



33.3035
$1,321.75
$883.88
$264.35
$176.7864856
Repair/transpose nerve



33.3035
$1,321.75
$883.88
$264.35
$176.7864857
Repair arm/leg nerve



33.3035
$1,321.75
$883.88
$264.35
$176.7864858
Repair sciatic nerve



33.3035
$1,321.75
$883.88
$264.35
$176.7864859
Nerve surgery



33.3035
$1,321.75
$827.38
$264.35
$165.4864861
Repair of arm nerves



33.3035
$1,321.75
$915.88
$264.35
$183.1864862
Repair of low back nerves



33.3035
$1,321.75
$915.88
$264.35
$183.1864864
Repair of facial nerve



33.3035
$1,321.75
$915.88
$264.35
$183.1864865
Repair of facial nerve



33.3035
$1,321.75
$975.88
$264.35
$195.1864870
Fusion of facial/other nerve



33.3035
$1,321.75
$975.88
$264.35
$195.1864872
Subsequent repair of nerve



33.3035
$1,321.75
$883.88
$264.35
$176.7864874
Repair  revise nerve add-on



33.3035
$1,321.75
$915.88
$264.35
$183.1864876
Repair nerve/shorten bone



33.3035
$1,321.75
$915.88
$264.35
$183.1864885
Nerve graft, head or neck



33.3035
$1,321.75
$883.88
$264.35
$176.7864886
Nerve graft, head or neck



33.3035
$1,321.75
$883.88
$264.35
$176.7864890
Nerve graft, hand or foot



33.3035
$1,321.75
$883.88
$264.35
$176.7864891
Nerve graft, hand or foot



33.3035
$1,321.75
$883.88
$264.35
$176.7864892
Nerve graft, arm or leg



33.3035
$1,321.75
$883.88
$264.35
$176.7864893
Nerve graft, arm or leg



33.3035
$1,321.75
$883.88
$264.35
$176.7864895
Nerve graft, hand or foot



33.3035
$1,321.75
$915.88
$264.35
$183.1864896
Nerve graft, hand or foot



33.3035
$1,321.75
$915.88
$264.35
$183.1864897
Nerve graft, arm or leg



33.3035
$1,321.75
$915.88
$264.35
$183.1864898
Nerve graft, arm or leg



33.3035
$1,321.75
$915.88
$264.35
$183.1864901
Nerve graft add-on



33.3035
$1,321.75
$883.88
$264.35
$176.7864902
Nerve graft add-on



33.3035
$1,321.75
$883.88
$264.35
$176.78( print page 49938)64905
Nerve pedicle transfer



33.3035
$1,321.75
$883.88
$264.35
$176.7864907
Nerve pedicle transfer



33.3035
$1,321.75
$827.38
$264.35
$165.4865091
Revise eye



35.5217
$1,409.79
$959.89
$281.96
$191.9865093
Revise eye with implant



35.5217
$1,409.79
$959.89
$281.96
$191.9865101
Removal of eye



35.5217
$1,409.79
$959.89
$281.96
$191.9865103
Remove eye/insert implant



35.5217
$1,409.79
$959.89
$281.96
$191.9865105
Remove eye/attach implant



35.5217
$1,409.79
$1,019.89
$281.96
$203.9865110
Removal of eye



35.5217
$1,409.79
$1,063.39
$281.96
$212.6865112
Remove eye/revise socket



35.5217
$1,409.79
$1,202.39
$281.96
$240.4865114
Remove eye/revise socket



35.5217
$1,409.79
$1,202.39
$281.96
$240.4865125
Revise ocular implant
Y


17.0126
$675.20
$675.20
$135.04
$135.0465130
Insert ocular implant



24.8502
$986.26
$748.13
$197.25
$149.6365135
Insert ocular implant



24.8502
$986.26
$716.13
$197.25
$143.2365140
Attach ocular implant



35.5217
$1,409.79
$959.89
$281.96
$191.9865150
Revise ocular implant



24.8502
$986.26
$716.13
$197.25
$143.2365155
Reinsert ocular implant



35.5217
$1,409.79
$959.89
$281.96
$191.9865175
Removal of ocular implant



17.0126
$675.20
$504.10
$135.04
$100.8265205
Remove foreign body from eye
Y
Y
Y
0.5328
$21.15
$21.15
$4.23
$4.2365210
Remove foreign body from eye
Y
Y
Y
0.6756
$26.81
$26.81
$5.36
$5.3665220
Remove foreign body from eye
Y


1.2244
$48.59
$48.59
$9.72
$9.7265222
Remove foreign body from eye
Y
Y
Y
0.7394
$29.35
$29.35
$5.87
$5.8765235
Remove foreign body from eye



14.9969
$595.20
$520.60
$119.04
$104.1265260
Remove foreign body from eye



16.3433
$648.63
$579.32
$129.73
$115.8665265
Remove foreign body from eye



26.9305
$1,068.82
$849.41
$213.76
$169.8865270
Repair of eye wound



17.0126
$675.20
$560.60
$135.04
$112.1265272
Repair of eye wound



22.9479
$910.76
$678.38
$182.15
$135.6865275
Repair of eye wound



22.9479
$910.76
$770.38
$182.15
$154.0865280
Repair of eye wound



16.3433
$648.63
$639.32
$129.73
$127.8665285
Repair of eye wound



36.8820
$1,463.78
$1,046.89
$292.76
$209.3865286
Repair of eye wound
Y
Y

5.9800
$237.33
$237.33
$47.47
$47.4765290
Repair of eye socket wound



21.2885
$844.90
$677.45
$168.98
$135.4965400
Removal of eye lesion



14.9969
$595.20
$464.10
$119.04
$92.82( print page 49939)65410
Biopsy of cornea



14.9969
$595.20
$520.60
$119.04
$104.1265420
Removal of eye lesion



14.9969
$595.20
$520.60
$119.04
$104.1265426
Removal of eye lesion



22.9479
$910.76
$813.88
$182.15
$162.7865430
Corneal smear
Y
Y
Y
1.0593
$42.04
$42.04
$8.41
$8.4165435
Curette/treat cornea
Y
Y
Y
0.8260
$32.78
$32.78
$6.56
$6.5665436
Curette/treat cornea
Y


14.9969
$595.20
$595.20
$119.04
$119.0465450
Treatment of corneal lesion
Y


2.1934
$87.05
$87.05
$17.41
$17.4165600
Revision of cornea
Y
Y
Y
4.1704
$165.51
$165.51
$33.10
$33.1065710
Corneal transplant



37.9446
$1,505.95
$1,250.47
$301.19
$250.0965730
Corneal transplant



37.9446
$1,505.95
$1,250.47
$301.19
$250.0965750
Corneal transplant



37.9446
$1,505.95
$1,250.47
$301.19
$250.0965755
Corneal transplant



37.9446
$1,505.95
$1,250.47
$301.19
$250.0965770
Revise cornea with implant



50.6347
$2,009.59
$1,502.30
$401.92
$300.4665772
Correction of astigmatism



14.9969
$595.20
$612.60
$119.04
$122.5265775
Correction of astigmatism



14.9969
$595.20
$612.60
$119.04
$122.5265780
Ocular reconst, transplant



37.9446
$1,505.95
$1,111.47
$301.19
$222.2965781
Ocular reconst, transplant



37.9446
$1,505.95
$1,111.47
$301.19
$222.2965782
Ocular reconst, transplant



37.9446
$1,505.95
$1,111.47
$301.19
$222.2965800
Drainage of eye



14.9969
$595.20
$464.10
$119.04
$92.8265805
Drainage of eye



14.9969
$595.20
$464.10
$119.04
$92.8265810
Drainage of eye



22.9479
$910.76
$710.38
$182.15
$142.0865815
Drainage of eye



22.9479
$910.76
$678.38
$182.15
$135.6865820
Relieve inner eye pressure



5.9800
$237.33
$285.17
$47.47
$57.0365850
Incision of eye



22.9479
$910.76
$770.38
$182.15
$154.0865855
Laser surgery of eye
Y
Y
Y
3.4882
$138.44
$138.44
$27.69
$27.6965860
Incise inner eye adhesions
Y
Y
Y
3.2701
$129.78
$129.78
$25.96
$25.9665865
Incise inner eye adhesions



14.9969
$595.20
$464.10
$119.04
$92.8265870
Incise inner eye adhesions



22.9479
$910.76
$770.38
$182.15
$154.0865875
Incise inner eye adhesions



22.9479
$910.76
$770.38
$182.15
$154.0865880
Incise inner eye adhesions



14.9969
$595.20
$612.60
$119.04
$122.5265900
Remove eye lesion



14.9969
$595.20
$656.10
$119.04
$131.2265920
Remove implant of eye



22.9479
$910.76
$952.88
$182.15
$190.5865930
Remove blood clot from eye



22.9479
$910.76
$813.88
$182.15
$162.7866020
Injection treatment of eye



14.9969
$595.20
$464.10
$119.04
$92.8266030
Injection treatment of eye



5.9800
$237.33
$285.17
$47.47
$57.0366130
Remove eye lesion



22.9479
$910.76
$952.88
$182.15
$190.5866150
Glaucoma surgery



22.9479
$910.76
$770.38
$182.15
$154.08( print page 49940)66155
Glaucoma surgery



22.9479
$910.76
$770.38
$182.15
$154.0866160
Glaucoma surgery



22.9479
$910.76
$678.38
$182.15
$135.6866165
Glaucoma surgery



22.9479
$910.76
$770.38
$182.15
$154.0866170
Glaucoma surgery



22.9479
$910.76
$770.38
$182.15
$154.0866172
Incision of eye



22.9479
$910.76
$770.38
$182.15
$154.0866180
Implant eye shunt



37.3057
$1,480.59
$1,098.80
$296.12
$219.7666185
Revise eye shunt



37.3057
$1,480.59
$963.30
$296.12
$192.6666220
Repair eye lesion



36.8820
$1,463.78
$986.89
$292.76
$197.3866225
Repair/graft eye lesion



37.3057
$1,480.59
$1,055.30
$296.12
$211.0666250
Follow-up surgery of eye



14.9969
$595.20
$520.60
$119.04
$104.1266500
Incision of iris



5.9800
$237.33
$285.17
$47.47
$57.0366505
Incision of iris



5.9800
$237.33
$285.17
$47.47
$57.0366600
Remove iris and lesion



22.9479
$910.76
$710.38
$182.15
$142.0866605
Removal of iris



22.9479
$910.76
$710.38
$182.15
$142.0866625
Removal of iris



5.9800
$237.33
$302.70
$47.47
$60.5466630
Removal of iris



22.9479
$910.76
$710.38
$182.15
$142.0866635
Removal of iris



22.9479
$910.76
$710.38
$182.15
$142.0866680
Repair iris  ciliary body



22.9479
$910.76
$710.38
$182.15
$142.0866682
Repair iris  ciliary body



22.9479
$910.76
$678.38
$182.15
$135.6866700
Destruction, ciliary body



14.9969
$595.20
$520.60
$119.04
$104.1266710
Ciliary transsleral therapy



14.9969
$595.20
$520.60
$119.04
$104.1266711
Ciliary endoscopic ablation



14.9969
$595.20
$520.60
$119.04
$104.1266720
Destruction, ciliary body



14.9969
$595.20
$520.60
$119.04
$104.1266740
Destruction, ciliary body



22.9479
$910.76
$678.38
$182.15
$135.6866761
Revision of iris
Y
Y
Y
4.6821
$185.82
$185.82
$37.16
$37.1666762
Revision of iris
Y
Y
Y
4.7458
$188.35
$188.35
$37.67
$37.6766770
Removal of inner eye lesion
Y
Y
Y
5.1266
$203.46
$203.46
$40.69
$40.6966820
Incision, secondary cataract
Y


5.9800
$237.33
$237.33
$47.47
$47.4766821
After cataract laser surgery



5.1266
$203.46
$259.51
$40.69
$51.9066825
Reposition intraocular lens



22.9479
$910.76
$770.38
$182.15
$154.0866830
Removal of lens lesion



5.9800
$237.33
$302.70
$47.47
$60.5466840
Removal of lens material



14.5427
$577.17
$603.59
$115.43
$120.7266850
Removal of lens material



28.5043
$1,131.28
$1,063.14
$226.26
$212.6366852
Removal of lens material



28.5043
$1,131.28
$880.64
$226.26
$176.1366920
Extraction of lens



28.5043
$1,131.28
$880.64
$226.26
$176.1366930
Extraction of lens



28.5043
$1,131.28
$924.14
$226.26
$184.83( print page 49941)66940
Extraction of lens



14.5427
$577.17
$647.09
$115.43
$129.4266982
Cataract surgery, complex



23.5664
$935.31
$954.15
$187.06
$190.8366983
Cataract surg w/iol, 1 stage



23.5664
$935.31
$954.15
$187.06
$190.8366984
Cataract surg w/iol, 1 stage



23.5664
$935.31
$954.15
$187.06
$190.8366985
Insert lens prosthesis



23.5664
$935.31
$880.65
$187.06
$176.1366986
Exchange lens prosthesis



23.5664
$935.31
$880.65
$187.06
$176.1367005
Partial removal of eye fluid



26.9305
$1,068.82
$849.41
$213.76
$169.8867010
Partial removal of eye fluid



26.9305
$1,068.82
$849.41
$213.76
$169.8867015
Release of eye fluid



26.9305
$1,068.82
$700.91
$213.76
$140.1867025
Replace eye fluid



26.9305
$1,068.82
$700.91
$213.76
$140.1867027
Implant eye drug system



36.8820
$1,463.78
$1,046.89
$292.76
$209.3867028
Injection eye drug
Y
Y
Y
2.1499
$85.32
$85.32
$17.06
$17.0667030
Incise inner eye strands



16.3433
$648.63
$490.82
$129.73
$98.1667031
Laser surgery, eye strands



5.1266
$203.46
$259.51
$40.69
$51.9067036
Removal of inner eye fluid



36.8820
$1,463.78
$1,046.89
$292.76
$209.3867038
Strip retinal membrane



36.8820
$1,463.78
$1,090.39
$292.76
$218.0867039
Laser treatment of retina



36.8820
$1,463.78
$1,229.39
$292.76
$245.8867040
Laser treatment of retina



36.8820
$1,463.78
$1,229.39
$292.76
$245.8867101
Repair detached retina
Y
Y
Y
7.7847
$308.96
$308.96
$61.79
$61.7967105
Repair detached retina
Y
Y

5.0285
$199.57
$199.57
$39.91
$39.9167107
Repair detached retina



36.8820
$1,463.78
$1,090.39
$292.76
$218.0867108
Repair detached retina



36.8820
$1,463.78
$1,229.39
$292.76
$245.8867110
Repair detached retina
Y
Y
Y
8.4635
$335.90
$335.90
$67.18
$67.1867112
Rerepair detached retina



36.8820
$1,463.78
$1,229.39
$292.76
$245.8867115
Release encircling material



16.3433
$648.63
$547.32
$129.73
$109.4667120
Remove eye implant material



16.3433
$648.63
$547.32
$129.73
$109.4667121
Remove eye implant material



26.9305
$1,068.82
$757.41
$213.76
$151.4867141
Treatment of retina



4.0750
$161.73
$206.27
$32.35
$41.2567145
Treatment of retina
Y
Y
Y
4.8836
$193.82
$193.82
$38.76
$38.7667208
Treatment of retinal lesion
Y
Y
Y
5.2064
$206.63
$206.63
$41.33
$41.3367210
Treatment of retinal lesion
Y
Y

5.0285
$199.57
$199.57
$39.91
$39.9167218
Treatment of retinal lesion



16.3433
$648.63
$682.82
$129.73
$136.5667220
Treatment of choroid lesion
Y
Y

4.0750
$161.73
$161.73
$32.35
$32.35( print page 49942)67221
Ocular photodynamic ther
Y
Y
Y
3.3107
$131.39
$131.39
$26.28
$26.2867225
Eye photodynamic ther add-on
Y
Y
Y
0.2131
$8.46
$8.46
$1.69
$1.6967227
Treatment of retinal lesion



26.9305
$1,068.82
$700.91
$213.76
$140.1867228
Treatment of retinal lesion
Y
Y

5.0285
$199.57
$199.57
$39.91
$39.9167250
Reinforce eye wall



17.0126
$675.20
$592.60
$135.04
$118.5267255
Reinforce/graft eye wall



26.9305
$1,068.82
$789.41
$213.76
$157.8867311
Revise eye muscle



21.2885
$844.90
$677.45
$168.98
$135.4967312
Revise two eye muscles



21.2885
$844.90
$737.45
$168.98
$147.4967314
Revise eye muscle



21.2885
$844.90
$737.45
$168.98
$147.4967316
Revise two eye muscles



21.2885
$844.90
$737.45
$168.98
$147.4967318
Revise eye muscle(s)



21.2885
$844.90
$737.45
$168.98
$147.4967320
Revise eye muscle(s) add-on



21.2885
$844.90
$737.45
$168.98
$147.4967331
Eye surgery follow-up add-on



21.2885
$844.90
$737.45
$168.98
$147.4967332
Rerevise eye muscles add-on



21.2885
$844.90
$737.45
$168.98
$147.4967334
Revise eye muscle w/suture



21.2885
$844.90
$737.45
$168.98
$147.4967335
Eye suture during surgery



21.2885
$844.90
$737.45
$168.98
$147.4967340
Revise eye muscle add-on



21.2885
$844.90
$737.45
$168.98
$147.4967343
Release eye tissue



21.2885
$844.90
$919.95
$168.98
$183.9967345
Destroy nerve of eye muscle
Y
Y
Y
2.1183
$84.07
$84.07
$16.81
$16.8167350
Biopsy eye muscle



13.9509
$553.68
$443.34
$110.74
$88.6767400
Explore/biopsy eye socket



24.8502
$986.26
$748.13
$197.25
$149.6367405
Explore/drain eye socket



24.8502
$986.26
$808.13
$197.25
$161.6367412
Explore/treat eye socket



24.8502
$986.26
$851.63
$197.25
$170.3367413
Explore/treat eye socket



24.8502
$986.26
$851.63
$197.25
$170.3367414
Explr/decompress eye socket
Y


35.5217
$1,409.79
$1,409.79
$281.96
$281.9667415
Aspiration, orbital contents



17.0126
$675.20
$504.10
$135.04
$100.8267420
Explore/treat eye socket



35.5217
$1,409.79
$1,063.39
$281.96
$212.6867430
Explore/treat eye socket



35.5217
$1,409.79
$1,063.39
$281.96
$212.6867440
Explore/drain eye socket



35.5217
$1,409.79
$1,063.39
$281.96
$212.6867445
Explr/decompress eye socket



35.5217
$1,409.79
$1,063.39
$281.96
$212.68( print page 49943)67450
Explore/biopsy eye socket



35.5217
$1,409.79
$1,063.39
$281.96
$212.6867500
Inject/treat eye socket
Y


2.1934
$87.05
$87.05
$17.41
$17.4167505
Inject/treat eye socket
Y


2.8099
$111.52
$111.52
$22.30
$22.3067515
Inject/treat eye socket
Y
Y
Y
0.6151
$24.41
$24.41
$4.88
$4.8867550
Insert eye socket implant



35.5217
$1,409.79
$1,019.89
$281.96
$203.9867560
Revise eye socket implant



24.8502
$986.26
$716.13
$197.25
$143.2367570
Decompress optic nerve



35.5217
$1,409.79
$1,019.89
$281.96
$203.9867700
Drainage of eyelid abscess
Y
Y

2.8099
$111.52
$111.52
$22.30
$22.3067710
Incision of eyelid
Y
Y
Y
4.0013
$158.80
$158.80
$31.76
$31.7667715
Incision of eyelid fold



17.0126
$675.20
$504.10
$135.04
$100.8267800
Remove eyelid lesion
Y
Y
Y
1.3373
$53.08
$53.08
$10.62
$10.6267801
Remove eyelid lesions
Y
Y
Y
1.6194
$64.27
$64.27
$12.85
$12.8567805
Remove eyelid lesions
Y
Y
Y
2.0923
$83.04
$83.04
$16.61
$16.6167808
Remove eyelid lesion(s)



17.0126
$675.20
$560.60
$135.04
$112.1267810
Biopsy of eyelid
Y
Y

2.8099
$111.52
$111.52
$22.30
$22.3067820
Revise eyelashes
Y
Y
Y
0.4905
$19.47
$19.47
$3.89
$3.8967825
Revise eyelashes
Y
Y
Y
1.3893
$55.14
$55.14
$11.03
$11.0367830
Revise eyelashes



6.9354
$275.25
$351.07
$55.05
$70.2167835
Revise eyelashes



17.0126
$675.20
$560.60
$135.04
$112.1267840
Remove eyelid lesion
Y
Y
Y
4.1405
$164.33
$164.33
$32.87
$32.8767850
Treat eyelid lesion
Y
Y
Y
2.9051
$115.30
$115.30
$23.06
$23.0667875
Closure of eyelid by suture
Y


6.9354
$275.25
$275.25
$55.05
$55.0567880
Revision of eyelid



14.9969
$595.20
$552.60
$119.04
$110.5267882
Revision of eyelid



17.0126
$675.20
$592.60
$135.04
$118.5267900
Repair brow defect



17.0126
$675.20
$652.60
$135.04
$130.5267901
Repair eyelid defect



17.0126
$675.20
$696.10
$135.04
$139.2267902
Repair eyelid defect



17.0126
$675.20
$696.10
$135.04
$139.2267903
Repair eyelid defect



17.0126
$675.20
$652.60
$135.04
$130.5267904
Repair eyelid defect



17.0126
$675.20
$652.60
$135.04
$130.5267906
Repair eyelid defect



17.0126
$675.20
$696.10
$135.04
$139.2267908
Repair eyelid defect



17.0126
$675.20
$652.60
$135.04
$130.5267909
Revise eyelid defect



17.0126
$675.20
$652.60
$135.04
$130.5267911
Revise eyelid defect



17.0126
$675.20
$592.60
$135.04
$118.52( print page 49944)67912
Correction eyelid w/implant



17.0126
$675.20
$592.60
$135.04
$118.5267914
Repair eyelid defect



17.0126
$675.20
$592.60
$135.04
$118.5267915
Repair eyelid defect
Y
Y
Y
4.5979
$182.48
$182.48
$36.50
$36.5067916
Repair eyelid defect



17.0126
$675.20
$652.60
$135.04
$130.5267917
Repair eyelid defect



17.0126
$675.20
$652.60
$135.04
$130.5267921
Repair eyelid defect



17.0126
$675.20
$592.60
$135.04
$118.5267922
Repair eyelid defect
Y
Y
Y
4.5261
$179.63
$179.63
$35.93
$35.9367923
Repair eyelid defect



17.0126
$675.20
$652.60
$135.04
$130.5267924
Repair eyelid defect



17.0126
$675.20
$652.60
$135.04
$130.5267930
Repair eyelid wound
Y
Y
Y
4.4580
$176.93
$176.93
$35.39
$35.3967935
Repair eyelid wound



17.0126
$675.20
$560.60
$135.04
$112.1267938
Remove eyelid foreign body
Y
Y

1.2244
$48.59
$48.59
$9.72
$9.7267950
Revision of eyelid



17.0126
$675.20
$560.60
$135.04
$112.1267961
Revision of eyelid



17.0126
$675.20
$592.60
$135.04
$118.5267966
Revision of eyelid



17.0126
$675.20
$592.60
$135.04
$118.5267971
Reconstruction of eyelid



24.8502
$986.26
$748.13
$197.25
$149.6367973
Reconstruction of eyelid



24.8502
$986.26
$748.13
$197.25
$149.6367974
Reconstruction of eyelid



24.8502
$986.26
$748.13
$197.25
$149.6367975
Reconstruction of eyelid



17.0126
$675.20
$592.60
$135.04
$118.5268020
Incise/drain eyelid lining
Y
Y
Y
1.1738
$46.59
$46.59
$9.32
$9.3268040
Treatment of eyelid lesions
Y
Y
Y
0.5826
$23.12
$23.12
$4.62
$4.6268100
Biopsy of eyelid lining
Y
Y
Y
2.4727
$98.14
$98.14
$19.63
$19.6368110
Remove eyelid lining lesion
Y
Y
Y
3.1702
$125.82
$125.82
$25.16
$25.1668115
Remove eyelid lining lesion



17.0126
$675.20
$560.60
$135.04
$112.1268130
Remove eyelid lining lesion



14.9969
$595.20
$520.60
$119.04
$104.1268135
Remove eyelid lining lesion
Y
Y
Y
1.5122
$60.01
$60.01
$12.00
$12.0068200
Treat eyelid by injection
Y
Y
Y
0.4396
$17.45
$17.45
$3.49
$3.4968320
Revise/graft eyelid lining



17.0126
$675.20
$652.60
$135.04
$130.5268325
Revise/graft eyelid lining



24.8502
$986.26
$808.13
$197.25
$161.6368326
Revise/graft eyelid lining



24.8502
$986.26
$808.13
$197.25
$161.6368328
Revise/graft eyelid lining



24.8502
$986.26
$808.13
$197.25
$161.6368330
Revise eyelid lining



22.9479
$910.76
$770.38
$182.15
$154.0868335
Revise/graft eyelid lining



24.8502
$986.26
$808.13
$197.25
$161.6368340
Separate eyelid adhesions



17.0126
$675.20
$652.60
$135.04
$130.52( print page 49945)68360
Revise eyelid lining



22.9479
$910.76
$678.38
$182.15
$135.6868362
Revise eyelid lining



22.9479
$910.76
$678.38
$182.15
$135.6868371
Harvest eye tissue, alograft



14.9969
$595.20
$520.60
$119.04
$104.1268400
Incise/drain tear gland
Y
Y

2.8099
$111.52
$111.52
$22.30
$22.3068420
Incise/drain tear sac
Y
Y
Y
4.7254
$187.54
$187.54
$37.51
$37.5168440
Incise tear duct opening
Y
Y
Y
1.4355
$56.97
$56.97
$11.39
$11.3968500
Removal of tear gland



24.8502
$986.26
$748.13
$197.25
$149.6368505
Partial removal, tear gland



24.8502
$986.26
$748.13
$197.25
$149.6368510
Biopsy of tear gland



17.0126
$675.20
$504.10
$135.04
$100.8268520
Removal of tear sac



24.8502
$986.26
$748.13
$197.25
$149.6368525
Biopsy of tear sac



17.0126
$675.20
$504.10
$135.04
$100.8268530
Clearance of tear duct
Y
Y
Y
6.0445
$239.89
$239.89
$47.98
$47.9868540
Remove tear gland lesion



24.8502
$986.26
$748.13
$197.25
$149.6368550
Remove tear gland lesion



24.8502
$986.26
$748.13
$197.25
$149.6368700
Repair tear ducts



24.8502
$986.26
$716.13
$197.25
$143.2368705
Revise tear duct opening
Y
Y

2.8099
$111.52
$111.52
$22.30
$22.3068720
Create tear sac drain



24.8502
$986.26
$808.13
$197.25
$161.6368745
Create tear duct drain



24.8502
$986.26
$808.13
$197.25
$161.6368750
Create tear duct drain



24.8502
$986.26
$808.13
$197.25
$161.6368760
Close tear duct opening
Y
Y

2.1934
$87.05
$87.05
$17.41
$17.4168761
Close tear duct opening
Y
Y
Y
1.8117
$71.90
$71.90
$14.38
$14.3868770
Close tear system fistula



17.0126
$675.20
$652.60
$135.04
$130.5268801
Dilate tear duct opening
Y
Y

1.2244
$48.59
$48.59
$9.72
$9.7268810
Probe nasolacrimal duct



2.1934
$87.05
$111.03
$17.41
$22.2168811
Probe nasolacrimal duct



17.0126
$675.20
$560.60
$135.04
$112.1268815
Probe nasolacrimal duct



17.0126
$675.20
$560.60
$135.04
$112.1268840
Explore/irrigate tear ducts
Y
Y

1.2244
$48.59
$48.59
$9.72
$9.7269000
Drain external ear lesion
Y
Y

1.4821
$58.82
$58.82
$11.76
$11.7669005
Drain external ear lesion
Y
Y
Y
2.4802
$98.44
$98.44
$19.69
$19.6969020
Drain outer ear canal lesion
Y
Y

1.4821
$58.82
$58.82
$11.76
$11.7669100
Biopsy of external ear
Y
Y
Y
1.5436
$61.26
$61.26
$12.25
$12.2569105
Biopsy of external ear canal
Y
Y
Y
2.1216
$84.20
$84.20
$16.84
$16.84( print page 49946)69110
Remove external ear, partial



14.9563
$593.59
$463.29
$118.72
$92.6669120
Removal of external ear



23.1564
$919.03
$682.52
$183.81
$136.5069140
Remove ear canal lesion(s)



23.1564
$919.03
$682.52
$183.81
$136.5069145
Remove ear canal lesion(s)



14.9563
$593.59
$519.79
$118.72
$103.9669150
Extensive ear canal surgery



7.7261
$306.63
$391.09
$61.33
$78.2269200
Clear outer ear canal
Y
Y

0.6211
$24.65
$24.65
$4.93
$4.9369205
Clear outer ear canal



19.9760
$792.81
$562.90
$158.56
$112.5869210
Remove impacted ear wax
Y
Y
Y
0.5077
$20.15
$20.15
$4.03
$4.0369220
Clean out mastoid cavity
Y
Y

0.8076
$32.05
$32.05
$6.41
$6.4169222
Clean out mastoid cavity
Y
Y
Y
3.3054
$131.19
$131.19
$26.24
$26.2469300
Revise external ear



23.1564
$919.03
$714.52
$183.81
$142.9069310
Rebuild outer ear canal



37.7719
$1,499.09
$1,004.55
$299.82
$200.9169320
Rebuild outer ear canal



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169400
Inflate middle ear canal
Y
Y
Y
2.1026
$83.45
$83.45
$16.69
$16.6969401
Inflate middle ear canal
Y
Y
Y
1.1906
$47.25
$47.25
$9.45
$9.4569405
Catheterize middle ear canal
Y
Y
Y
3.0530
$121.17
$121.17
$24.23
$24.2369420
Incision of eardrum
Y
Y

2.3768
$94.33
$94.33
$18.87
$18.8769421
Incision of eardrum



16.4494
$652.85
$581.42
$130.57
$116.2869424
Remove ventilating tube
Y
Y
Y
1.9136
$75.95
$75.95
$15.19
$15.1969433
Create eardrum opening
Y
Y
Y
2.7076
$107.46
$107.46
$21.49
$21.4969436
Create eardrum opening



16.4494
$652.85
$581.42
$130.57
$116.2869440
Exploration of middle ear



23.1564
$919.03
$714.52
$183.81
$142.9069450
Eardrum revision



37.7719
$1,499.09
$916.05
$299.82
$183.2169501
Mastoidectomy



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169502
Mastoidectomy



23.1564
$919.03
$957.02
$183.81
$191.4069505
Remove mastoid structures



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169511
Extensive mastoid surgery



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169530
Extensive mastoid surgery



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169540
Remove ear lesion
Y
Y
Y
3.2334
$128.33
$128.33
$25.67
$25.6769550
Remove ear lesion



37.7719
$1,499.09
$1,108.05
$299.82
$221.6169552
Remove ear lesion



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169601
Mastoid surgery revision



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169602
Mastoid surgery revision



37.7719
$1,499.09
$1,247.05
$299.82
$249.41( print page 49947)69603
Mastoid surgery revision



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169604
Mastoid surgery revision



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169605
Mastoid surgery revision



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169610
Repair of eardrum
Y
Y
Y
4.4163
$175.28
$175.28
$35.06
$35.0669620
Repair of eardrum



23.1564
$919.03
$682.52
$183.81
$136.5069631
Repair eardrum structures



37.7719
$1,499.09
$1,108.05
$299.82
$221.6169632
Rebuild eardrum structures



37.7719
$1,499.09
$1,108.05
$299.82
$221.6169633
Rebuild eardrum structures



37.7719
$1,499.09
$1,108.05
$299.82
$221.6169635
Repair eardrum structures



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169636
Rebuild eardrum structures



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169637
Rebuild eardrum structures



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169641
Revise middle ear  mastoid



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169642
Revise middle ear  mastoid



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169643
Revise middle ear  mastoid



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169644
Revise middle ear  mastoid



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169645
Revise middle ear  mastoid



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169646
Revise middle ear  mastoid



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169650
Release middle ear bone



23.1564
$919.03
$957.02
$183.81
$191.4069660
Revise middle ear bone



37.7719
$1,499.09
$1,108.05
$299.82
$221.6169661
Revise middle ear bone



37.7719
$1,499.09
$1,108.05
$299.82
$221.6169662
Revise middle ear bone



37.7719
$1,499.09
$1,108.05
$299.82
$221.6169666
Repair middle ear structures



37.7719
$1,499.09
$1,064.55
$299.82
$212.9169667
Repair middle ear structures



37.7719
$1,499.09
$1,064.55
$299.82
$212.9169670
Remove mastoid air cells



37.7719
$1,499.09
$1,004.55
$299.82
$200.9169676
Remove middle ear nerve



37.7719
$1,499.09
$1,004.55
$299.82
$200.9169700
Close mastoid fistula



37.7719
$1,499.09
$1,004.55
$299.82
$200.9169711
Remove/repair hearing aid



37.7719
$1,499.09
$916.05
$299.82
$183.2169714
Implant temple bone w/stimul



37.7719
$1,499.09
$1,419.05
$299.82
$283.8169715
Temple bne implnt w/stimulat



37.7719
$1,499.09
$1,419.05
$299.82
$283.8169717
Temple bone implant revision



37.7719
$1,499.09
$1,419.05
$299.82
$283.8169718
Revise temple bone implant



37.7719
$1,499.09
$1,419.05
$299.82
$283.81( print page 49948)69720
Release facial nerve



37.7719
$1,499.09
$1,108.05
$299.82
$221.6169740
Repair facial nerve



37.7719
$1,499.09
$1,108.05
$299.82
$221.6169745
Repair facial nerve



37.7719
$1,499.09
$1,108.05
$299.82
$221.6169801
Incise inner ear



37.7719
$1,499.09
$1,108.05
$299.82
$221.6169802
Incise inner ear



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169805
Explore inner ear



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169806
Explore inner ear



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169820
Establish inner ear window



37.7719
$1,499.09
$1,108.05
$299.82
$221.6169840
Revise inner ear window



37.7719
$1,499.09
$1,108.05
$299.82
$221.6169905
Remove inner ear



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169910
Remove inner ear  mastoid



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169915
Incise inner ear nerve



37.7719
$1,499.09
$1,247.05
$299.82
$249.4169930
Implant cochlear device



406.8232
$16,146.03
$8,570.52
$3,229.21
$1,714.10G0104
CA screen;flexi sigmoidscope
Y
Y

1.7292
$68.63
$68.63
$13.73
$13.73G0105
Colorectal scrn; hi risk ind



7.8134
$310.10
$378.05
$62.02
$75.61G0121
Colon ca scrn; not high rsk



7.8134
$310.10
$378.05
$62.02
$75.61G0127
Trim nail(s)
Y
Y

0.2665
$10.58
$10.58
$2.12
$2.12G0186
Dstry eye lesn,fdr vssl tech
Y
Y

4.0750
$161.73
$161.73
$32.35
$32.35G0260
Inj for sacroiliac jt anesth



5.5439
$220.03
$276.51
$44.01
$55.30G0268
Removal of impacted wax md
Y
Y

0.5409
$21.47
$21.47
$4.29
$4.29G0364
Bone marrow aspirate  biops
Y
Y

0.1293
$5.13
$5.13
$1.03
$1.03
 ADDENDUM CC.—Proposed List of Procedures for CY 2008 Subject to Payment Limitation at the MPFS Nonfacility AMOUNT
HCPCS
Short Description10021
Fna w/o image10040
Acne surgery10060
Drainage of skin abscess10061
Drainage of skin abscess10080
Drainage of pilonidal cyst10081
Drainage of pilonidal cyst10120
Remove foreign body10140
Drainage of hematoma/fluid10160
Puncture drainage of lesion11000
Debride infected skin11001
Debride infected skin add-on11040
Debride skin, partial11041
Debride skin, full11055
Trim skin lesion11056
Trim skin lesions, 2 to 411057
Trim skin lesions, over 411100
Biopsy, skin lesion11101
Biopsy, skin add-on11200
Removal of skin tags11201
Remove skin tags add-on11300
Shave skin lesion11301
Shave skin lesion11302
Shave skin lesion11303
Shave skin lesion11305
Shave skin lesion11306
Shave skin lesion11307
Shave skin lesion11308
Shave skin lesion11310
Shave skin lesion11311
Shave skin lesion11312
Shave skin lesion11313
Shave skin lesion11400
Exc tr-ext b9+marg 0.5   cm11401
Exc tr-ext b9+marg 0.6-1 cm11402
Exc tr-ext b9+marg 1.1-2 cm11403
Exc tr-ext b9+marg 2.1-3 cm11420
Exc h-f-nk-sp b9+marg 0.511421
Exc h-f-nk-sp b9+marg 0.6-111422
Exc h-f-nk-sp b9+marg 1.1-211423
Exc h-f-nk-sp b9+marg 2.1-311440
Exc face-mm b9+marg 0.5  cm11441
Exc face-mm b9+marg 0.6-1 cm11442
Exc face-mm b9+marg 1.1-2 cm11443
Exc face-mm b9+marg 2.1-3 cm11600
Exc tr-ext mlg+marg 0.5  cm( print page 49949)11601
Exc tr-ext mlg+marg 0.6-1 cm11602
Exc tr-ext mlg+marg 1.1-2 cm11603
Exc tr-ext mlg+marg 2.1-3 cm11620
Exc h-f-nk-sp mlg+marg 0.511621
Exc h-f-nk-sp mlg+marg 0.6-111622
Exc h-f-nk-sp mlg+marg 1.1-211623
Exc h-f-nk-sp mlg+marg 2.1-311640
Exc face-mm malig+marg 0.511641
Exc face-mm malig+marg 0.6-111642
Exc face-mm malig+marg 1.1-211643
Exc face-mm malig+marg 2.1-311719
Trim nail(s)11720
Debride nail, 1-511721
Debride nail, 6 or more11730
Removal of nail plate11732
Remove nail plate, add-on11740
Drain blood from under nail11750
Removal of nail bed11752
Remove nail bed/finger tip11755
Biopsy, nail unit11762
Reconstruction of nail bed11765
Excision of nail fold, toe11900
Injection into skin lesions11901
Added skin lesions injection11920
Correct skin color defects11921
Correct skin color defects11922
Correct skin color defects11950
Therapy for contour defects11951
Therapy for contour defects11952
Therapy for contour defects11954
Therapy for contour defects11976
Removal of contraceptive cap11980
Implant hormone pellet(s)11981
Insert drug implant device11982
Remove drug implant device11983
Remove/insert drug implant12001
Repair superficial wound(s)12002
Repair superficial wound(s)12004
Repair superficial wound(s)12011
Repair superficial wound(s)12013
Repair superficial wound(s)12014
Repair superficial wound(s)12031
Layer closure of wound(s)12032
Layer closure of wound(s)12041
Layer closure of wound(s)12042
Layer closure of wound(s)12051
Layer closure of wound(s)12052
Layer closure of wound(s)12053
Layer closure of wound(s)13133
Repair wound/lesion add-on15340
Apply cult skin substitute15780
Abrasion treatment of skin15781
Abrasion treatment of skin15782
Abrasion treatment of skin15783
Abrasion treatment of skin15786
Abrasion, lesion, single15787
Abrasion, lesions, add-on15788
Chemical peel, face, epiderm15789
Chemical peel, face, dermal15792
Chemical peel, nonfacial15793
Chemical peel, nonfacial15851
Removal of sutures16000
Initial treatment of burn(s)16020
Dress/debrid p-thick burn, s17000
Destroy benign/premlg lesion17003
Destroy lesions, 2-1417004
Destroy lesions, 15 or more17106
Destruction of skin lesions17107
Destruction of skin lesions17108
Destruction of skin lesions17110
Destruct lesion, 1-1417111
Destruct lesion, 15 or more17250
Chemical cautery, tissue17260
Destruction of skin lesions17261
Destruction of skin lesions17262
Destruction of skin lesions17263
Destruction of skin lesions17264
Destruction of skin lesions17266
Destruction of skin lesions17270
Destruction of skin lesions17271
Destruction of skin lesions17272
Destruction of skin lesions17273
Destruction of skin lesions17274
Destruction of skin lesions17276
Destruction of skin lesions17280
Destruction of skin lesions17281
Destruction of skin lesions17282
Destruction of skin lesions17283
Destruction of skin lesions17284
Destruction of skin lesions17286
Destruction of skin lesions17304
1 stage mohs, up to 5 spec17305
2 stage mohs, up to 5 spec17306
3 stage mohs, up to 5 spec17307
Mohs addl stage up to 5 spec17310
Mohs any stage  5 spec each17340
Cryotherapy of skin17360
Skin peel therapy17380
Hair removal by electrolysis19000
Drainage of breast lesion19001
Drain breast lesion add-on20000
Incision of abscess20500
Injection of sinus tract20520
Removal of foreign body20526
Ther injection, carp tunnel20550
Inj tendon sheath/ligament20551
Inj tendon origin/insertion20552
Inj trigger point, 1/2 muscl20553
Inject trigger points, =/ 320600
Drain/inject, joint/bursa20605
Drain/inject, joint/bursa20610
Drain/inject, joint/bursa20612
Aspirate/inj ganglion cyst20615
Treatment of bone cyst20662
Application of pelvis brace20663
Application of thigh brace20973
Bone/skin graft, great toe20974
Electrical bone stimulation20979
Us bone stimulation21030
Excise max/zygoma b9 tumor21031
Remove exostosis, mandible21032
Remove exostosis, maxilla21048
Remove maxilla cyst complex21076
Prepare face/oral prosthesis21077
Prepare face/oral prosthesis21079
Prepare face/oral prosthesis21080
Prepare face/oral prosthesis21081
Prepare face/oral prosthesis21082
Prepare face/oral prosthesis21083
Prepare face/oral prosthesis21084
Prepare face/oral prosthesis21085
Prepare face/oral prosthesis21086
Prepare face/oral prosthesis21087
Prepare face/oral prosthesis21088
Prepare face/oral prosthesis21089
Prepare face/oral prosthesis21110
Interdental fixation21440
Treat dental ridge fracture21920
Biopsy soft tissue of back23065
Biopsy shoulder tissues23600
Treat humerus fracture23620
Treat humerus fracture24065
Biopsy arm/elbow soft tissue24200
Removal of arm foreign body24650
Treat radius fracture25065
Biopsy forearm soft tissues25500
Treat fracture of radius25530
Treat fracture of ulna25560
Treat fracture radiusamp; ulna25600
Treat fracture radius/ulna25622
Treat wrist bone fracture25630
Treat wrist bone fracture25650
Treat wrist bone fracture26010
Drainage of finger abscess26600
Treat metacarpal fracture26720
Treat finger fracture, each26725
Treat finger fracture, each26740
Treat finger fracture, each26750
Treat finger fracture, each27200
Treat tail bone fracture27613
Biopsy lower leg soft tissue28001
Drainage of bursa of foot28010
Incision of toe tendon28124
Partial removal of toe28190
Removal of foot foreign body28220
Release of foot tendon28230
Incision of foot tendon(s)28232
Incision of toe tendon28272
Release of toe joint, each28430
Treatment of ankle fracture28450
Treat midfoot fracture, each28455
Treat midfoot fracture, each28470
Treat metatarsal fracture28475
Treat metatarsal fracture28490
Treat big toe fracture28495
Treat big toe fracture28510
Treatment of toe fracture28515
Treatment of toe fracture28530
Treat sesamoid bone fracture28540
Treat foot dislocation28570
Treat foot dislocation28600
Treat foot dislocation29010
Application of body cast29015
Application of body cast29025
Application of body cast29049
Application of figure eight29055
Application of shoulder cast29058
Application of shoulder cast29065
Application of long arm cast29075
Application of forearm cast29085
Apply hand/wrist cast29086
Apply finger cast29105
Apply long arm splint29125
Apply forearm splint29126
Apply forearm splint29130
Application of finger splint29131
Application of finger splint29200
Strapping of chest29220
Strapping of low back29240
Strapping of shoulder29260
Strapping of elbow or wrist( print page 49950)29280
Strapping of hand or finger29345
Application of long leg cast29355
Application of long leg cast29358
Apply long leg cast brace29365
Application of long leg cast29405
Apply short leg cast29425
Apply short leg cast29435
Apply short leg cast29440
Addition of walker to cast29445
Apply rigid leg cast29450
Application of leg cast29520
Strapping of hip29530
Strapping of knee29540
Strapping of ankle and/or ft29550
Strapping of toes29580
Application of paste boot29590
Application of foot splint29700
Removal/revision of cast29705
Removal/revision of cast29710
Removal/revision of cast29715
Removal/revision of cast29720
Repair of body cast29730
Windowing of cast29740
Wedging of cast29750
Wedging of clubfoot cast30000
Drainage of nose lesion30020
Drainage of nose lesion30100
Intranasal biopsy30110
Removal of nose polyp(s)30124
Removal of nose lesion30200
Injection treatment of nose30210
Nasal sinus therapy30300
Remove nasal foreign body30901
Control of nosebleed31000
Irrigation, maxillary sinus31002
Irrigation, sphenoid sinus31040
Exploration behind upper jaw31231
Nasal endoscopy, dx31505
Diagnostic laryngoscopy31575
Diagnostic laryngoscopy31579
Diagnostic laryngoscopy36425
Vein access cutdown  1 yr36430
Blood transfusion service36440
Bl push transfuse, 2 yr or lgt;36468
Injection(s), spider veins36470
Injection therapy of vein36471
Injection therapy of veins36550
Declot vascular device36598
Inj w/fluor, eval cv device37765
Phleb veins - extrem - to 2037766
Phleb veins - extrem 20+38220
Bone marrow aspiration38221
Bone marrow biopsy38242
Lymphocyte infuse transplant40490
Biopsy of lip40702
Repair cleft lip/nasal40800
Drainage of mouth lesion40804
Removal, foreign body, mouth40805
Removal, foreign body, mouth40806
Incision of lip fold40808
Biopsy of mouth lesion40810
Excision of mouth lesion40812
Excise/repair mouth lesion40820
Treatment of mouth lesion41000
Drainage of mouth lesion41100
Biopsy of tongue41105
Biopsy of tongue41108
Biopsy of floor of mouth41110
Excision of tongue lesion41115
Excision of tongue fold41805
Removal foreign body, gum41806
Removal foreign body,jawbone41820
Excision, gum, each quadrant41822
Excision of gum lesion41823
Excision of gum lesion41825
Excision of gum lesion41826
Excision of gum lesion41828
Excision of gum lesion41830
Removal of gum tissue41850
Treatment of gum lesion41872
Repair gum41874
Repair tooth socket42100
Biopsy roof of mouth42104
Excision lesion, mouth roof42106
Excision lesion, mouth roof42160
Treatment mouth roof lesion42280
Preparation, palate mold42330
Removal of salivary stone42335
Removal of salivary stone42400
Biopsy of salivary gland42650
Dilation of salivary duct42660
Dilation of salivary duct42800
Biopsy of throat42970
Control nose/throat bleeding45300
Proctosigmoidoscopy dx45303
Proctosigmoidoscopy dilate45330
Diagnostic sigmoidoscopy45520
Treatment of rectal prolapse46083
Incise external hemorrhoid46221
Ligation of hemorrhoid(s)46320
Removal of hemorrhoid clot46500
Injection into hemorrhoid(s)46600
Diagnostic anoscopy46604
Anoscopy and dilation46606
Anoscopy and biopsy46614
Anoscopy, control bleeding46900
Destruction, anal lesion(s)46910
Destruction, anal lesion(s)46916
Cryosurgery, anal lesion(s)46934
Destruction of hemorrhoids46935
Destruction of hemorrhoids46936
Destruction of hemorrhoids46940
Treatment of anal fissure46942
Treatment of anal fissure46945
Ligation of hemorrhoids46946
Ligation of hemorrhoids50391
Instll rx agnt into rnal tub50686
Measure ureter pressure51000
Drainage of bladder51005
Drainage of bladder51700
Irrigation of bladder51701
Insert bladder catheter51702
Insert temp bladder cath51703
Insert bladder cath, complex51705
Change of bladder tube51720
Treatment of bladder lesion51725
Simple cystometrogram51736
Urine flow measurement51741
Electro-uroflowmetry, first51784
Anal/urinary muscle study51792
Urinary reflex study51795
Urine voiding pressure study51797
Intraabdominal pressure test51798
Us urine capacity measure52265
Cystoscopy and treatment53025
Incision of urethra53060
Drainage of urethra abscess53600
Dilate urethra stricture53601
Dilate urethra stricture53620
Dilate urethra stricture53621
Dilate urethra stricture53660
Dilation of urethra53661
Dilation of urethra53850
Prostatic microwave thermotx53852
Prostatic rf thermotx53853
Prostatic water thermother54050
Destruction, penis lesion(s)54055
Destruction, penis lesion(s)54056
Cryosurgery, penis lesion(s)54200
Treatment of penis lesion54231
Dynamic cavernosometry54235
Penile injection54240
Penis study54250
Penis study55000
Drainage of hydrocele55450
Ligation of sperm duct55600
Incise sperm duct pouch55870
Electroejaculation56405
I  D of vulva/perineum56420
Drainage of gland abscess56501
Destroy, vulva lesions, sim56605
Biopsy of vulva/perineum56606
Biopsy of vulva/perineum56820
Exam of vulva w/scope56821
Exam/biopsy of vulva w/scope57061
Destroy vag lesions, simple57100
Biopsy of vagina57150
Treat vagina infection57160
Insert pessary/other device57170
Fitting of diaphragm/cap57420
Exam of vagina w/scope57421
Exam/biopsy of vag w/scope57452
Exam of cervix w/scope57454
Bx/curett of cervix w/scope57455
Biopsy of cervix w/scope57456
Endocerv curettage w/scope57460
Bx of cervix w/scope, leep57461
Conz of cervix w/scope, leep57500
Biopsy of cervix57505
Endocervical curettage57510
Cauterization of cervix57511
Cryocautery of cervix57800
Dilation of cervical canal58100
Biopsy of uterus lining58110
Bx done w/colposcopy add-on58300
Insert intrauterine device58301
Remove intrauterine device58321
Artificial insemination58322
Artificial insemination58323
Sperm washing58345
Reopen fallopian tube58356
Endometrial cryoablation59000
Amniocentesis, diagnostic59001
Amniocentesis, therapeutic59015
Chorion biopsy59020
Fetal contract stress test59025
Fetal non-stress test59100
Remove uterus lesion59200
Insert cervical dilator59300
Episiotomy or vaginal repair60001
Aspirate/inject thyriod cyst( print page 49951)60100
Biopsy of thyroid61000
Remove cranial cavity fluid61001
Remove cranial cavity fluid62252
Csf shunt reprogram62367
Analyze spine infusion pump62368
Analyze spine infusion pump63615
Remove lesion of spinal cord64400
N block inj, trigeminal64402
N block inj, facial64405
N block inj, occipital64408
N block inj, vagus64412
N block inj, spinal accessor64413
N block inj, cervical plexus64418
N block inj, suprascapular64425
N block inj, ilio-ing/hypogi64435
N block inj, paracervical64445
N block inj, sciatic, sng64450
N block, other peripheral64505
N block, spenopalatine gangl64508
N block, carotid sinus s/p64550
Apply neurostimulator64555
Implant neuroelectrodes64565
Implant neuroelectrodes64612
Destroy nerve, face muscle64613
Destroy nerve, neck muscle64614
Destroy nerve, extrem musc64640
Injection treatment of nerve65205
Remove foreign body from eye65210
Remove foreign body from eye65222
Remove foreign body from eye65286
Repair of eye wound65430
Corneal smear65435
Curette/treat cornea65600
Revision of cornea65855
Laser surgery of eye65860
Incise inner eye adhesions66761
Revision of iris66762
Revision of iris66770
Removal of inner eye lesion67028
Injection eye drug67101
Repair detached retina67105
Repair detached retina67110
Repair detached retina67145
Treatment of retina67208
Treatment of retinal lesion67210
Treatment of retinal lesion67220
Treatment of choroid lesion67221
Ocular photodynamic ther67225
Eye photodynamic ther add-on67228
Treatment of retinal lesion67345
Destroy nerve of eye muscle67515
Inject/treat eye socket67700
Drainage of eyelid abscess67710
Incision of eyelid67800
Remove eyelid lesion67801
Remove eyelid lesions67805
Remove eyelid lesions67810
Biopsy of eyelid67820
Revise eyelashes67825
Revise eyelashes67840
Remove eyelid lesion67850
Treat eyelid lesion67915
Repair eyelid defect67922
Repair eyelid defect67930
Repair eyelid wound67938
Remove eyelid foreign body68020
Incise/drain eyelid lining68040
Treatment of eyelid lesions68100
Biopsy of eyelid lining68110
Remove eyelid lining lesion68135
Remove eyelid lining lesion68200
Treat eyelid by injection68400
Incise/drain tear gland68420
Incise/drain tear sac68440
Incise tear duct opening68530
Clearance of tear duct68705
Revise tear duct opening68760
Close tear duct opening68761
Close tear duct opening68801
Dilate tear duct opening68840
Explore/irrigate tear ducts69000
Drain external ear lesion69005
Drain external ear lesion69020
Drain outer ear canal lesion69100
Biopsy of external ear69105
Biopsy of external ear canal69200
Clear outer ear canal69210
Remove impacted ear wax69220
Clean out mastoid cavity69222
Clean out mastoid cavity69399
Outer ear surgery procedure69400
Inflate middle ear canal69401
Inflate middle ear canal69405
Catheterize middle ear canal69410
Inset middle ear (baffle)69420
Incision of eardrum69424
Remove ventilating tube69433
Create eardrum opening69540
Remove ear lesion69610
Repair of eardrum
 Addendum D1.—Proposed Payment Status Indicators
Indicator
Item/code/service
OPPS payment statusA
Services furnished to a hospital outpatient that are paid under a fee schedule or payment system other than OPPS, for example: 
                                     • Ambulance Services  
                                     • Clinical Diagnostic Laboratory Services  
                                     • Non-Implantable Prosthetic and Orthotic Devices
Not paid under OPPS. Paid by fiscal intermediaries under a fee schedule or payment system other than OPPS.• EPO for ESRD Patients 
                                     • Physical, Occupational, and Speech Therapy  
                                     • Routine Dialysis Services for ESRD Patients Provided in a Certified Dialysis Unit of a Hospital  
                                     • Diagnostic Mammography  
                                     • Screening MammographyB
Codes that are not recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x and 13x)
Not paid under OPPS. 
                                     • May be paid by intermediaries when submitted on a different bill type, for example, 75x (CORF), but not paid under OPPS.  
                                     • An alternate code that is recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x and 13x) may be available.C
Inpatient Procedures
Not paid under OPPS. Admit patient. Bill as inpatient.D
Discontinued Codes
Not paid under OPPS or any other Medicare payment system.E
Items, Codes, and Services: 
                                     • That are not covered by Medicare based on statutory exclusion  
                                     • That are not covered by Medicare for reasons other than statutory exclusion
Not paid under OPPS or any other Medicare payment system.• That are not recognized by Medicare but for which an alternate code for the same item or service may be available 
                                     • For which separate payment is not provided by Medicare.( print page 49952)F
Corneal Tissue Acquisition; Certain CRNA Services; and Hepatitis B Vaccines
Not paid under OPPS. Paid at reasonable cost.G
Pass-Through Drugs and Biologicals
Paid under OPPS; Separate APC payment includes pass-through amount.H
Pass-Through Device Categories
Separate cost-based pass-through payment; Not subject to coinsurance.K
(1) Non-Pass-Through Drugs and Biologicals, and Radiopharmaceutical Agents
(1) Paid under OPPS; Separate APC payment.(2) Brachytherapy Sources
(2) Paid under OPPS; Separate APC payment.(3) Blood and Blood Products
(3) Paid under OPPS; Separate APC payment.L
Influenza Vaccine; Pneumococcal Pneumonia Vaccine
Not paid under OPPS. Paid at reasonable cost; Not subject to deductible or coinsurance.M
Items and Services Not Billable to the Fiscal Intermediary
Not paid under OPPS.N
Items and Services Packaged into APC Rates
Paid under OPPS; Payment is packaged into payment for other services, including outliers. Therefore, there is no separate APC payment.P
Partial Hospitalization
Paid under OPPS; Per diem APC payment.Q
Packaged Services Subject to Separate Payment Under OPPS Payment Criteria
Paid under OPPS; Addendum B displays APC assignments when services are separately payable. 
                                     (1) Separate APC payment based on OPPS payment criteria.  
                                     (2) If criteria are not met, payment is packaged into payment for other services, including outliers. Therefore, there is no separate APC payment.S
Significant Procedure, Not Discounted when Multiple
Paid under OPPS; Separate APC payment.T
Significant Procedure, Multiple Reduction Applies
Paid under OPPS; Separate APC payment.V
Clinic or Emergency Department Visit
Paid under OPPS; Separate APC payment.Y
Non-Implantable Durable Medical Equipment
Not paid under OPPS. All institutional providers other than home health agencies bill to DMERC.X
Ancillary Services
Paid under OPPS; Separate APC payment.
 Addendum D2.—Proposed Comment Indicators
Comment indicator
DescriptorNF
New code, final APC assignment; Comments were accepted on a proposed APC assignment in the Proposed Rule; APC assignment is no longer open to comment.NI
New code, interim APC assignment; Comments will be accepted on the interim APC assignment for the new code.CH
Active HCPCS codes in current year and next calendar year; status indicator and/or APC assignment have changed.
 Addendum E.—CPT Codes That Are Paid Only as Inpatient Procedures
CPT/HCPCS
Description
CY 2007 Proposed Rule 
                                     Status  
                                     Indicator00176
Anesth, pharyngeal surgery
C00192
Anesth, facial bone surgery
C00214
Anesth, skull drainage
C00215
Anesth, skull repair/fract
C00404
Anesth, surgery of breast
C00406
Anesth, surgery of breast
C00452
Anesth, surgery of shoulder
C00474
Anesth, surgery of rib(s)
C00524
Anesth, chest drainage
C00540
Anesth, chest surgery
C00542
Anesth, release of lung
C00546
Anesth, lung, chest wall surg
C00560
Anesth, heart surg w/o pump
C00561
Anesth, heart surgry  age 1
C00562
Anesth, heart surg w/pump
C00580
Anesth, heart/lung transplnt
C00604
Anesth, sitting procedure
C00622
Anesth, removal of nerves
C00632
Anesth, removal of nerves
C00670
Anesth, spine, cord surgery
C00792
Anesth, hemorr/excise liver
C00794
Anesth, pancreas removal
C00796
Anesth, for liver transplant
C( print page 49953)00802
Anesth, fat layer removal
C00844
Anesth, pelvis surgery
C00846
Anesth, hysterectomy
C00848
Anesth, pelvic organ surg
C00864
Anesth, removal of bladder
C00865
Anesth, removal of prostate
C00866
Anesth, removal of adrenal
C00868
Anesth, kidney transplant
C00882
Anesth, major vein ligation
C00904
Anesth, perineal surgery
C00908
Anesth, removal of prostate
C00932
Anesth, amputation of penis
C00934
Anesth, penis, nodes removal
C00936
Anesth, penis, nodes removal
C00944
Anesth, vaginal hysterectomy
C01140
Anesth, amputation at pelvis
C01150
Anesth, pelvic tumor surgery
C01212
Anesth, hip disarticulation
C01214
Anesth, hip arthroplasty
C01232
Anesth, amputation of femur
C01234
Anesth, radical femur surg
C01272
Anesth, femoral artery surg
C01274
Anesth, femoral embolectomy
C01402
Anesth, knee arthroplasty
C01404
Anesth, amputation at knee
C01442
Anesth, knee artery surg
C01444
Anesth, knee artery repair
C01486
Anesth, ankle replacement
C01502
Anesth, lwr leg embolectomy
C01632
Anesth, surgery of shoulder
C01634
Anesth, shoulder joint amput
C01636
Anesth, forequarter amput
C01638
Anesth, shoulder replacement
C01652
Anesth, shoulder vessel surg
C01654
Anesth, shoulder vessel surg
C01656
Anesth, arm-leg vessel surg
C01756
Anesth, radical humerus surg
C01990
Support for organ donor
C11004
Debride genitalia  perineum
C11005
Debride abdom wall
C11006
Debride genit/per/abdom wall
C11008
Remove mesh from abd wall
C15756
Free myo/skin flap microvasc
C15757
Free skin flap, microvasc
C15758
Free fascial flap, microvasc
C16036
Escharotomy; add'l incision
C19200
Removal of breast
C19220
Removal of breast
C19271
Revision of chest wall
C19272
Extensive chest wall surgery
C19361
Breast reconstruction
C19364
Breast reconstruction
C19367
Breast reconstruction
C19368
Breast reconstruction
C19369
Breast reconstruction
C20660
Apply, rem fixation device
C20661
Application of head brace
C20664
Halo brace application
C20802
Replantation, arm, complete
C20805
Replant forearm, complete
C20808
Replantation hand, complete
C20816
Replantation digit, complete
C20824
Replantation thumb, complete
C20827
Replantation thumb, complete
C20838
Replantation foot, complete
C20930
Spinal bone allograft
C20931
Spinal bone allograft
C20936
Spinal bone autograft
C( print page 49954)20937
Spinal bone autograft
C20938
Spinal bone autograft
C20955
Fibula bone graft, microvasc
C20956
Iliac bone graft, microvasc
C20957
Mt bone graft, microvasc
C20962
Other bone graft, microvasc
C20969
Bone/skin graft, microvasc
C20970
Bone/skin graft, iliac crest
C21045
Extensive jaw surgery
C21141
Reconstruct midface, lefort
C21142
Reconstruct midface, lefort
C21143
Reconstruct midface, lefort
C21145
Reconstruct midface, lefort
C21146
Reconstruct midface, lefort
C21147
Reconstruct midface, lefort
C21151
Reconstruct midface, lefort
C21154
Reconstruct midface, lefort
C21155
Reconstruct midface, lefort
C21159
Reconstruct midface, lefort
C21160
Reconstruct midface, lefort
C21172
Reconstruct orbit/forehead
C21179
Reconstruct entire forehead
C21180
Reconstruct entire forehead
C21182
Reconstruct cranial bone
C21183
Reconstruct cranial bone
C21184
Reconstruct cranial bone
C21188
Reconstruction of midface
C21193
Reconst lwr jaw w/o graft
C21194
Reconst lwr jaw w/graft
C21196
Reconst lwr jaw w/fixation
C21247
Reconstruct lower jaw bone
C21255
Reconstruct lower jaw bone
C21256
Reconstruction of orbit
C21268
Revise eye sockets
C21343
Treatment of sinus fracture
C21344
Treatment of sinus fracture
C21346
Treat nose/jaw fracture
C21347
Treat nose/jaw fracture
C21348
Treat nose/jaw fracture
C21360
Treat cheek bone fracture
C21365
Treat cheek bone fracture
C21366
Treat cheek bone fracture
C21385
Treat eye socket fracture
C21386
Treat eye socket fracture
C21387
Treat eye socket fracture
C21395
Treat eye socket fracture
C21422
Treat mouth roof fracture
C21423
Treat mouth roof fracture
C21431
Treat craniofacial fracture
C21432
Treat craniofacial fracture
C21433
Treat craniofacial fracture
C21435
Treat craniofacial fracture
C21436
Treat craniofacial fracture
C21510
Drainage of bone lesion
C21615
Removal of rib
C21616
Removal of rib and nerves
C21620
Partial removal of sternum
C21627
Sternal debridement
C21630
Extensive sternum surgery
C21632
Extensive sternum surgery
C21705
Revision of neck muscle/rib
C21740
Reconstruction of sternum
C21750
Repair of sternum separation
C21810
Treatment of rib fracture(s)
C21825
Treat sternum fracture
C22010
Id, p-spine, c/t/cerv-thor
C22015
Id, p-spine, l/s/ls
C22110
Remove part of neck vertebra
C( print page 49955)22112
Remove part, thorax vertebra
C22114
Remove part, lumbar vertebra
C22116
Remove extra spine segment
C22210
Revision of neck spine
C22212
Revision of thorax spine
C22214
Revision of lumbar spine
C22216
Revise, extra spine segment
C22220
Revision of neck spine
C22224
Revision of lumbar spine
C22226
Revise, extra spine segment
C22318
Treat odontoid fx w/o graft
C22319
Treat odontoid fx w/graft
C22325
Treat spine fracture
C22326
Treat neck spine fracture
C22327
Treat thorax spine fracture
C22328
Treat each add spine fx
C22532
Lat thorax spine fusion
C22533
Lat lumbar spine fusion
C22534
Lat thor/lumb, add'l seg
C22548
Neck spine fusion
C22554
Neck spine fusion
C22556
Thorax spine fusion
C22558
Lumbar spine fusion
C22585
Additional spinal fusion
C22590
Spine  skull spinal fusion
C22595
Neck spinal fusion
C22600
Neck spine fusion
C22610
Thorax spine fusion
C22630
Lumbar spine fusion
C22632
Spine fusion, extra segment
C22800
Fusion of spine
C22802
Fusion of spine
C22804
Fusion of spine
C22808
Fusion of spine
C22810
Fusion of spine
C22812
Fusion of spine
C22818
Kyphectomy, 1-2 segments
C22819
Kyphectomy, 3 or more
C22830
Exploration of spinal fusion
C22840
Insert spine fixation device
C22841
Insert spine fixation device
C22842
Insert spine fixation device
C22843
Insert spine fixation device
C22844
Insert spine fixation device
C22845
Insert spine fixation device
C22846
Insert spine fixation device
C22847
Insert spine fixation device
C22848
Insert pelv fixation device
C22849
Reinsert spinal fixation
C22850
Remove spine fixation device
C22851
Apply spine prosth device
C22852
Remove spine fixation device
C22855
Remove spine fixation device
C23200
Removal of collar bone
C23210
Removal of shoulder blade
C23220
Partial removal of humerus
C23221
Partial removal of humerus
C23222
Partial removal of humerus
C23332
Remove shoulder foreign body
C23472
Reconstruct shoulder joint
C23900
Amputation of arm  girdle
C23920
Amputation at shoulder joint
C24900
Amputation of upper arm
C24920
Amputation of upper arm
C24930
Amputation follow-up surgery
C24931
Amputate upper arm  implant
C24940
Revision of upper arm
C25900
Amputation of forearm
C( print page 49956)25905
Amputation of forearm
C25909
Amputation follow-up surgery
C25915
Amputation of forearm
C25920
Amputate hand at wrist
C25924
Amputation follow-up surgery
C25927
Amputation of hand
C25931
Amputation follow-up surgery
C26551
Great toe-hand transfer
C26553
Single transfer, toe-hand
C26554
Double transfer, toe-hand
C26556
Toe joint transfer
C26992
Drainage of bone lesion
C27005
Incision of hip tendon
C27006
Incision of hip tendons
C27025
Incision of hip/thigh fascia
C27030
Drainage of hip joint
C27036
Excision of hip joint/muscle
C27054
Removal of hip joint lining
C27070
Partial removal of hip bone
C27071
Partial removal of hip bone
C27075
Extensive hip surgery
C27076
Extensive hip surgery
C27077
Extensive hip surgery
C27078
Extensive hip surgery
C27079
Extensive hip surgery
C27090
Removal of hip prosthesis
C27091
Removal of hip prosthesis
C27120
Reconstruction of hip socket
C27122
Reconstruction of hip socket
C27125
Partial hip replacement
C27130
Total hip arthroplasty
C27132
Total hip arthroplasty
C27134
Revise hip joint replacement
C27137
Revise hip joint replacement
C27138
Revise hip joint replacement
C27140
Transplant femur ridge
C27146
Incision of hip bone
C27147
Revision of hip bone
C27151
Incision of hip bones
C27156
Revision of hip bones
C27158
Revision of pelvis
C27161
Incision of neck of femur
C27165
Incision/fixation of femur
C27170
Repair/graft femur head/neck
C27175
Treat slipped epiphysis
C27176
Treat slipped epiphysis
C27177
Treat slipped epiphysis
C27178
Treat slipped epiphysis
C27179
Revise head/neck of femur
C27181
Treat slipped epiphysis
C27185
Revision of femur epiphysis
C27187
Reinforce hip bones
C27215
Treat pelvic fracture(s)
C27217
Treat pelvic ring fracture
C27218
Treat pelvic ring fracture
C27222
Treat hip socket fracture
C27226
Treat hip wall fracture
C27227
Treat hip fracture(s)
C27228
Treat hip fracture(s)
C27232
Treat thigh fracture
C27236
Treat thigh fracture
C27240
Treat thigh fracture
C27244
Treat thigh fracture
C27245
Treat thigh fracture
C27248
Treat thigh fracture
C27253
Treat hip dislocation
C27254
Treat hip dislocation
C27258
Treat hip dislocation
C( print page 49957)27259
Treat hip dislocation
C27280
Fusion of sacroiliac joint
C27282
Fusion of pubic bones
C27284
Fusion of hip joint
C27286
Fusion of hip joint
C27290
Amputation of leg at hip
C27295
Amputation of leg at hip
C27303
Drainage of bone lesion
C27365
Extensive leg surgery
C27445
Revision of knee joint
C27447
Total knee arthroplasty
C27448
Incision of thigh
C27450
Incision of thigh
C27454
Realignment of thigh bone
C27455
Realignment of knee
C27457
Realignment of knee
C27465
Shortening of thigh bone
C27466
Lengthening of thigh bone
C27468
Shorten/lengthen thighs
C27470
Repair of thigh
C27472
Repair/graft of thigh
C27477
Surgery to stop leg growth
C27479
Surgery to stop leg growth
C27485
Surgery to stop leg growth
C27486
Revise/replace knee joint
C27487
Revise/replace knee joint
C27488
Removal of knee prosthesis
C27495
Reinforce thigh
C27506
Treatment of thigh fracture
C27507
Treatment of thigh fracture
C27511
Treatment of thigh fracture
C27513
Treatment of thigh fracture
C27514
Treatment of thigh fracture
C27519
Treat thigh fx growth plate
C27535
Treat knee fracture
C27536
Treat knee fracture
C27540
Treat knee fracture
C27556
Treat knee dislocation
C27557
Treat knee dislocation
C27558
Treat knee dislocation
C27580
Fusion of knee
C27590
Amputate leg at thigh
C27591
Amputate leg at thigh
C27592
Amputate leg at thigh
C27596
Amputation follow-up surgery
C27598
Amputate lower leg at knee
C27645
Extensive lower leg surgery
C27646
Extensive lower leg surgery
C27702
Reconstruct ankle joint
C27703
Reconstruction, ankle joint
C27712
Realignment of lower leg
C27715
Revision of lower leg
C27720
Repair of tibia
C27722
Repair/graft of tibia
C27724
Repair/graft of tibia
C27725
Repair of lower leg
C27727
Repair of lower leg
C27880
Amputation of lower leg
C27881
Amputation of lower leg
C27882
Amputation of lower leg
C27886
Amputation follow-up surgery
C27888
Amputation of foot at ankle
C28800
Amputation of midfoot
C28805
Amputation thru metatarsal
C31225
Removal of upper jaw
C31230
Removal of upper jaw
C31290
Nasal/sinus endoscopy, surg
C31291
Nasal/sinus endoscopy, surg
C( print page 49958)31360
Removal of larynx
C31365
Removal of larynx
C31367
Partial removal of larynx
C31368
Partial removal of larynx
C31370
Partial removal of larynx
C31375
Partial removal of larynx
C31380
Partial removal of larynx
C31382
Partial removal of larynx
C31390
Removal of larynx  pharynx
C31395
Reconstruct larynx  pharynx
C31584
Treat larynx fracture
C31587
Revision of larynx
C31725
Clearance of airways
C31760
Repair of windpipe
C31766
Reconstruction of windpipe
C31770
Repair/graft of bronchus
C31775
Reconstruct bronchus
C31780
Reconstruct windpipe
C31781
Reconstruct windpipe
C31786
Remove windpipe lesion
C31800
Repair of windpipe injury
C31805
Repair of windpipe injury
C32035
Exploration of chest
C32036
Exploration of chest
C32095
Biopsy through chest wall
C32100
Exploration/biopsy of chest
C32110
Explore/repair chest
C32120
Re-exploration of chest
C32124
Explore chest free adhesions
C32140
Removal of lung lesion(s)
C32141
Remove/treat lung lesions
C32150
Removal of lung lesion(s)
C32151
Remove lung foreign body
C32160
Open chest heart massage
C32200
Drain, open, lung lesion
C32215
Treat chest lining
C32220
Release of lung
C32225
Partial release of lung
C32310
Removal of chest lining
C32320
Free/remove chest lining
C32402
Open biopsy chest lining
C32440
Removal of lung
C32442
Sleeve pneumonectomy
C32445
Removal of lung
C32480
Partial removal of lung
C32482
Bilobectomy
C32484
Segmentectomy
C32486
Sleeve lobectomy
C32488
Completion pneumonectomy
C32491
Lung volume reduction
C32500
Partial removal of lung
C32501
Repair bronchus add-on
C32503
Resect apical lung tumor
C32504
Resect apical lung tum/chest
C32540
Removal of lung lesion
C32650
Thoracoscopy, surgical
C32651
Thoracoscopy, surgical
C32652
Thoracoscopy, surgical
C32653
Thoracoscopy, surgical
C32654
Thoracoscopy, surgical
C32655
Thoracoscopy, surgical
C32656
Thoracoscopy, surgical
C32657
Thoracoscopy, surgical
C32658
Thoracoscopy, surgical
C32659
Thoracoscopy, surgical
C32660
Thoracoscopy, surgical
C32661
Thoracoscopy, surgical
C32662
Thoracoscopy, surgical
C( print page 49959)32663
Thoracoscopy, surgical
C32664
Thoracoscopy, surgical
C32665
Thoracoscopy, surgical
C32800
Repair lung hernia
C32810
Close chest after drainage
C32815
Close bronchial fistula
C32820
Reconstruct injured chest
C32850
Donor pneumonectomy
C32851
Lung transplant, single
C32852
Lung transplant with bypass
C32853
Lung transplant, double
C32854
Lung transplant with bypass
C32855
Prepare donor lung, single
C32856
Prepare donor lung, double
C32900
Removal of rib(s)
C32905
Revise  repair chest wall
C32906
Revise  repair chest wall
C32940
Revision of lung
C32997
Total lung lavage
C33015
Incision of heart sac
C33020
Incision of heart sac
C33025
Incision of heart sac
C33030
Partial removal of heart sac
C33031
Partial removal of heart sac
C33050
Removal of heart sac lesion
C33120
Removal of heart lesion
C33130
Removal of heart lesion
C33140
Heart revascularize (tmr)
C33141
Heart tmr w/other procedure
C33200
Insertion of heart pacemaker
C33201
Insertion of heart pacemaker
C33236
Remove electrode/thoracotomy
C33237
Remove electrode/thoracotomy
C33238
Remove electrode/thoracotomy
C33243
Remove eltrd/thoracotomy
C33245
Insert epic eltrd pace-defib
C33246
Insert epic eltrd/generator
C33250
Ablate heart dysrhythm focus
C33251
Ablate heart dysrhythm focus
C33253
Reconstruct atria
C33261
Ablate heart dysrhythm focus
C33300
Repair of heart wound
C33305
Repair of heart wound
C33310
Exploratory heart surgery
C33315
Exploratory heart surgery
C33320
Repair major blood vessel(s)
C33321
Repair major vessel
C33322
Repair major blood vessel(s)
C33330
Insert major vessel graft
C33332
Insert major vessel graft
C33335
Insert major vessel graft
C33400
Repair of aortic valve
C33401
Valvuloplasty, open
C33403
Valvuloplasty, w/cp bypass
C33404
Prepare heart-aorta conduit
C33405
Replacement of aortic valve
C33406
Replacement of aortic valve
C33410
Replacement of aortic valve
C33411
Replacement of aortic valve
C33412
Replacement of aortic valve
C33413
Replacement of aortic valve
C33414
Repair of aortic valve
C33415
Revision, subvalvular tissue
C33416
Revise ventricle muscle
C33417
Repair of aortic valve
C33420
Revision of mitral valve
C33422
Revision of mitral valve
C33425
Repair of mitral valve
C( print page 49960)33426
Repair of mitral valve
C33427
Repair of mitral valve
C33430
Replacement of mitral valve
C33460
Revision of tricuspid valve
C33463
Valvuloplasty, tricuspid
C33464
Valvuloplasty, tricuspid
C33465
Replace tricuspid valve
C33468
Revision of tricuspid valve
C33470
Revision of pulmonary valve
C33471
Valvotomy, pulmonary valve
C33472
Revision of pulmonary valve
C33474
Revision of pulmonary valve
C33475
Replacement, pulmonary valve
C33476
Revision of heart chamber
C33478
Revision of heart chamber
C33496
Repair, prosth valve clot
C33500
Repair heart vessel fistula
C33501
Repair heart vessel fistula
C33502
Coronary artery correction
C33503
Coronary artery graft
C33504
Coronary artery graft
C33505
Repair artery w/tunnel
C33506
Repair artery, translocation
C33507
Repair art, intramural
C33510
CABG, vein, single
C33511
CABG, vein, two
C33512
CABG, vein, three
C33513
CABG, vein, four
C33514
CABG, vein, five
C33516
Cabg, vein, six or more
C33517
CABG, artery-vein, single
C33518
CABG, artery-vein, two
C33519
CABG, artery-vein, three
C33521
CABG, artery-vein, four
C33522
CABG, artery-vein, five
C33523
Cabg, art-vein, six or more
C33530
Coronary artery, bypass/reop
C33533
CABG, arterial, single
C33534
CABG, arterial, two
C33535
CABG, arterial, three
C33536
Cabg, arterial, four or more
C33542
Removal of heart lesion
C33545
Repair of heart damage
C33548
Restore/remodel, ventricle
C33572
Open coronary endarterectomy
C33600
Closure of valve
C33602
Closure of valve
C33606
Anastomosis/artery-aorta
C33608
Repair anomaly w/conduit
C33610
Repair by enlargement
C33611
Repair double ventricle
C33612
Repair double ventricle
C33615
Repair, modified fontan
C33617
Repair single ventricle
C33619
Repair single ventricle
C33641
Repair heart septum defect
C33645
Revision of heart veins
C33647
Repair heart septum defects
C33660
Repair of heart defects
C33665
Repair of heart defects
C33670
Repair of heart chambers
C33681
Repair heart septum defect
C33684
Repair heart septum defect
C33688
Repair heart septum defect
C33690
Reinforce pulmonary artery
C33692
Repair of heart defects
C33694
Repair of heart defects
C33697
Repair of heart defects
C( print page 49961)33702
Repair of heart defects
C33710
Repair of heart defects
C33720
Repair of heart defect
C33722
Repair of heart defect
C33730
Repair heart-vein defect(s)
C33732
Repair heart-vein defect
C33735
Revision of heart chamber
C33736
Revision of heart chamber
C33737
Revision of heart chamber
C33750
Major vessel shunt
C33755
Major vessel shunt
C33762
Major vessel shunt
C33764
Major vessel shunt  graft
C33766
Major vessel shunt
C33767
Major vessel shunt
C33768
Cavopulmonary shunting
C33770
Repair great vessels defect
C33771
Repair great vessels defect
C33774
Repair great vessels defect
C33775
Repair great vessels defect
C33776
Repair great vessels defect
C33777
Repair great vessels defect
C33778
Repair great vessels defect
C33779
Repair great vessels defect
C33780
Repair great vessels defect
C33781
Repair great vessels defect
C33786
Repair arterial trunk
C33788
Revision of pulmonary artery
C33800
Aortic suspension
C33802
Repair vessel defect
C33803
Repair vessel defect
C33813
Repair septal defect
C33814
Repair septal defect
C33820
Revise major vessel
C33822
Revise major vessel
C33824
Revise major vessel
C33840
Remove aorta constriction
C33845
Remove aorta constriction
C33851
Remove aorta constriction
C33852
Repair septal defect
C33853
Repair septal defect
C33860
Ascending aortic graft
C33861
Ascending aortic graft
C33863
Ascending aortic graft
C33870
Transverse aortic arch graft
C33875
Thoracic aortic graft
C33877
Thoracoabdominal graft
C33880
Endovasc taa repr incl subcl
C33881
Endovasc taa repr w/o subcl
C33883
Insert endovasc prosth, taa
C33884
Endovasc prosth, taa, add-on
C33886
Endovasc prosth, delayed
C33889
Artery transpose/endovas taa
C33891
Car-car bp grft/endovas taa
C33910
Remove lung artery emboli
C33915
Remove lung artery emboli
C33916
Surgery of great vessel
C33917
Repair pulmonary artery
C33920
Repair pulmonary atresia
C33922
Transect pulmonary artery
C33924
Remove pulmonary shunt
C33925
Rpr pul art unifocal w/o cpb
C33926
Repr pul art, unifocal w/cpb
C33930
Removal of donor heart/lung
C33933
Prepare donor heart/lung
C33935
Transplantation, heart/lung
C33940
Removal of donor heart
C33944
Prepare donor heart
C( print page 49962)33945
Transplantation of heart
C33960
External circulation assist
C33961
External circulation assist
C33967
Insert ia percut device
C33968
Remove aortic assist device
C33970
Aortic circulation assist
C33971
Aortic circulation assist
C33973
Insert balloon device
C33974
Remove intra-aortic balloon
C33975
Implant ventricular device
C33976
Implant ventricular device
C33977
Remove ventricular device
C33978
Remove ventricular device
C33979
Insert intracorporeal device
C33980
Remove intracorporeal device
C34001
Removal of artery clot
C34051
Removal of artery clot
C34151
Removal of artery clot
C34401
Removal of vein clot
C34451
Removal of vein clot
C34502
Reconstruct vena cava
C34800
Endovas aaa repr w/sm tube
C34802
Endovas aaa repr w/2-p part
C34803
Endovas aaa repr w/3-p part
C34804
Endovas aaa repr w/1-p part
C34805
Endovas aaa repr w/long tube
C34808
Endovas iliac a device addon
C34812
Xpose for endoprosth, femorl
C34813
Femoral endovas graft add-on
C34820
Xpose for endoprosth, iliac
C34825
Endovasc extend prosth, init
C34826
Endovasc exten prosth, add'l
C34830
Open aortic tube prosth repr
C34831
Open aortoiliac prosth repr
C34832
Open aortofemor prosth repr
C34833
Xpose for endoprosth, iliac
C34834
Xpose, endoprosth, brachial
C34900
Endovasc iliac repr w/graft
C35001
Repair defect of artery
C35002
Repair artery rupture, neck
C35005
Repair defect of artery
C35013
Repair artery rupture, arm
C35021
Repair defect of artery
C35022
Repair artery rupture, chest
C35045
Repair defect of arm artery
C35081
Repair defect of artery
C35082
Repair artery rupture, aorta
C35091
Repair defect of artery
C35092
Repair artery rupture, aorta
C35102
Repair defect of artery
C35103
Repair artery rupture, groin
C35111
Repair defect of artery
C35112
Repair artery rupture,spleen
C35121
Repair defect of artery
C35122
Repair artery rupture, belly
C35131
Repair defect of artery
C35132
Repair artery rupture, groin
C35141
Repair defect of artery
C35142
Repair artery rupture, thigh
C35151
Repair defect of artery
C35152
Repair artery rupture, knee
C35182
Repair blood vessel lesion
C35189
Repair blood vessel lesion
C35211
Repair blood vessel lesion
C35216
Repair blood vessel lesion
C35221
Repair blood vessel lesion
C35241
Repair blood vessel lesion
C35246
Repair blood vessel lesion
C( print page 49963)35251
Repair blood vessel lesion
C35271
Repair blood vessel lesion
C35276
Repair blood vessel lesion
C35281
Repair blood vessel lesion
C35301
Rechanneling of artery
C35311
Rechanneling of artery
C35331
Rechanneling of artery
C35341
Rechanneling of artery
C35351
Rechanneling of artery
C35355
Rechanneling of artery
C35361
Rechanneling of artery
C35363
Rechanneling of artery
C35371
Rechanneling of artery
C35372
Rechanneling of artery
C35381
Rechanneling of artery
C35390
Reoperation, carotid add-on
C35400
Angioscopy
C35450
Repair arterial blockage
C35452
Repair arterial blockage
C35454
Repair arterial blockage
C35456
Repair arterial blockage
C35480
Atherectomy, open
C35481
Atherectomy, open
C35482
Atherectomy, open
C35483
Atherectomy, open
C35501
Artery bypass graft
C35506
Artery bypass graft
C35507
Artery bypass graft
C35508
Artery bypass graft
C35509
Artery bypass graft
C35510
Artery bypass graft
C35511
Artery bypass graft
C35512
Artery bypass graft
C35515
Artery bypass graft
C35516
Artery bypass graft
C35518
Artery bypass graft
C35521
Artery bypass graft
C35522
Artery bypass graft
C35525
Artery bypass graft
C35526
Artery bypass graft
C35531
Artery bypass graft
C35533
Artery bypass graft
C35536
Artery bypass graft
C35541
Artery bypass graft
C35546
Artery bypass graft
C35548
Artery bypass graft
C35549
Artery bypass graft
C35551
Artery bypass graft
C35556
Artery bypass graft
C35558
Artery bypass graft
C35560
Artery bypass graft
C35563
Artery bypass graft
C35565
Artery bypass graft
C35566
Artery bypass graft
C35571
Artery bypass graft
C35583
Vein bypass graft
C35585
Vein bypass graft
C35587
Vein bypass graft
C35600
Harvest artery for cabg
C35601
Artery bypass graft
C35606
Artery bypass graft
C35612
Artery bypass graft
C35616
Artery bypass graft
C35621
Artery bypass graft
C35623
Bypass graft, not vein
C35626
Artery bypass graft
C35631
Artery bypass graft
C35636
Artery bypass graft
C( print page 49964)35641
Artery bypass graft
C35642
Artery bypass graft
C35645
Artery bypass graft
C35646
Artery bypass graft
C35647
Artery bypass graft
C35650
Artery bypass graft
C35651
Artery bypass graft
C35654
Artery bypass graft
C35656
Artery bypass graft
C35661
Artery bypass graft
C35663
Artery bypass graft
C35665
Artery bypass graft
C35666
Artery bypass graft
C35671
Artery bypass graft
C35681
Composite bypass graft
C35682
Composite bypass graft
C35683
Composite bypass graft
C35691
Arterial transposition
C35693
Arterial transposition
C35694
Arterial transposition
C35695
Arterial transposition
C35697
Reimplant artery each
C35700
Reoperation, bypass graft
C35701
Exploration, carotid artery
C35721
Exploration, femoral artery
C35741
Exploration popliteal artery
C35800
Explore neck vessels
C35820
Explore chest vessels
C35840
Explore abdominal vessels
C35870
Repair vessel graft defect
C35901
Excision, graft, neck
C35905
Excision, graft, thorax
C35907
Excision, graft, abdomen
C36660
Insertion catheter, artery
C36822
Insertion of cannula(s)
C36823
Insertion of cannula(s)
C37140
Revision of circulation
C37145
Revision of circulation
C37160
Revision of circulation
C37180
Revision of circulation
C37181
Splice spleen/kidney veins
C37182
Insert hepatic shunt (tips)
C37215
Transcath stent, cca w/eps
C37216
Transcath stent, cca w/o eps
C37616
Ligation of chest artery
C37617
Ligation of abdomen artery
C37618
Ligation of extremity artery
C37660
Revision of major vein
C37788
Revascularization, penis
C38100
Removal of spleen, total
C38101
Removal of spleen, partial
C38102
Removal of spleen, total
C38115
Repair of ruptured spleen
C38380
Thoracic duct procedure
C38381
Thoracic duct procedure
C38382
Thoracic duct procedure
C38562
Removal, pelvic lymph nodes
C38564
Removal, abdomen lymph nodes
C38724
Removal of lymph nodes, neck
C38746
Remove thoracic lymph nodes
C38747
Remove abdominal lymph nodes
C38765
Remove groin lymph nodes
C38770
Remove pelvis lymph nodes
C38780
Remove abdomen lymph nodes
C39000
Exploration of chest
C39010
Exploration of chest
C39200
Removal chest lesion
C39220
Removal chest lesion
C( print page 49965)39499
Chest procedure
C39501
Repair diaphragm laceration
C39502
Repair paraesophageal hernia
C39503
Repair of diaphragm hernia
C39520
Repair of diaphragm hernia
C39530
Repair of diaphragm hernia
C39531
Repair of diaphragm hernia
C39540
Repair of diaphragm hernia
C39541
Repair of diaphragm hernia
C39545
Revision of diaphragm
C39560
Resect diaphragm, simple
C39561
Resect diaphragm, complex
C39599
Diaphragm surgery procedure
C41130
Partial removal of tongue
C41135
Tongue and neck surgery
C41140
Removal of tongue
C41145
Tongue removal, neck surgery
C41150
Tongue, mouth, jaw surgery
C41153
Tongue, mouth, neck surgery
C41155
Tongue, jaw,  neck surgery
C42426
Excise parotid gland/lesion
C42845
Extensive surgery of throat
C42894
Revision of pharyngeal walls
C42953
Repair throat, esophagus
C42961
Control throat bleeding
C42971
Control nose/throat bleeding
C43045
Incision of esophagus
C43100
Excision of esophagus lesion
C43101
Excision of esophagus lesion
C43107
Removal of esophagus
C43108
Removal of esophagus
C43112
Removal of esophagus
C43113
Removal of esophagus
C43116
Partial removal of esophagus
C43117
Partial removal of esophagus
C43118
Partial removal of esophagus
C43121
Partial removal of esophagus
C43122
Partial removal of esophagus
C43123
Partial removal of esophagus
C43124
Removal of esophagus
C43135
Removal of esophagus pouch
C43300
Repair of esophagus
C43305
Repair esophagus and fistula
C43310
Repair of esophagus
C43312
Repair esophagus and fistula
C43313
Esophagoplasty congenital
C43314
Tracheo-esophagoplasty cong
C43320
Fuse esophagus  stomach
C43324
Revise esophagus  stomach
C43325
Revise esophagus  stomach
C43326
Revise esophagus  stomach
C43330
Repair of esophagus
C43331
Repair of esophagus
C43340
Fuse esophagus  intestine
C43341
Fuse esophagus  intestine
C43350
Surgical opening, esophagus
C43351
Surgical opening, esophagus
C43352
Surgical opening, esophagus
C43360
Gastrointestinal repair
C43361
Gastrointestinal repair
C43400
Ligate esophagus veins
C43401
Esophagus surgery for veins
C43405
Ligate/staple esophagus
C43410
Repair esophagus wound
C43415
Repair esophagus wound
C43420
Repair esophagus opening
C43425
Repair esophagus opening
C43460
Pressure treatment esophagus
C( print page 49966)43496
Free jejunum flap, microvasc
C43500
Surgical opening of stomach
C43501
Surgical repair of stomach
C43502
Surgical repair of stomach
C43520
Incision of pyloric muscle
C43605
Biopsy of stomach
C43610
Excision of stomach lesion
C43611
Excision of stomach lesion
C43620
Removal of stomach
C43621
Removal of stomach
C43622
Removal of stomach
C43631
Removal of stomach, partial
C43632
Removal of stomach, partial
C43633
Removal of stomach, partial
C43634
Removal of stomach, partial
C43635
Removal of stomach, partial
C43640
Vagotomy  pylorus repair
C43641
Vagotomy  pylorus repair
C43644
Lap gastric bypass/roux-en-y
C43645
Lap gastr bypass incl smll i
C43770
Lap, place gastr adjust band
C43771
Lap, revise adjust gast band
C43772
Lap, remove adjust gast band
C43773
Lap, change adjust gast band
C43774
Lap remov adj gast band/port
C43800
Reconstruction of pylorus
C43810
Fusion of stomach and bowel
C43820
Fusion of stomach and bowel
C43825
Fusion of stomach and bowel
C43832
Place gastrostomy tube
C43840
Repair of stomach lesion
C43842
V-band gastroplasty
C43843
Gastroplasty w/o v-band
C43845
Gastroplasty duodenal switch
C43846
Gastric bypass for obesity
C43847
Gastric bypass incl small i
C43848
Revision gastroplasty
C43850
Revise stomach-bowel fusion
C43855
Revise stomach-bowel fusion
C43860
Revise stomach-bowel fusion
C43865
Revise stomach-bowel fusion
C43880
Repair stomach-bowel fistula
C44005
Freeing of bowel adhesion
C44010
Incision of small bowel
C44015
Insert needle cath bowel
C44020
Explore small intestine
C44021
Decompress small bowel
C44025
Incision of large bowel
C44050
Reduce bowel obstruction
C44055
Correct malrotation of bowel
C44110
Excise intestine lesion(s)
C44111
Excision of bowel lesion(s)
C44120
Removal of small intestine
C44121
Removal of small intestine
C44125
Removal of small intestine
C44126
Enterectomy w/o taper, cong
C44127
Enterectomy w/taper, cong
C44128
Enterectomy cong, add-on
C44130
Bowel to bowel fusion
C44132
Enterectomy, cadaver donor
C44133
Enterectomy, live donor
C44135
Intestine transplnt, cadaver
C44136
Intestine transplant, live
C44137
Remove intestinal allograft
C44139
Mobilization of colon
C44140
Partial removal of colon
C44141
Partial removal of colon
C44143
Partial removal of colon
C( print page 49967)44144
Partial removal of colon
C44145
Partial removal of colon
C44146
Partial removal of colon
C44147
Partial removal of colon
C44150
Removal of colon
C44151
Removal of colon/ileostomy
C44152
Removal of colon/ileostomy
C44153
Removal of colon/ileostomy
C44155
Removal of colon/ileostomy
C44156
Removal of colon/ileostomy
C44160
Removal of colon
C44187
Lap, ileo/jejuno-stomy
C44188
Lap, colostomy
C44202
Lap, enterectomy
C44203
Lap resect s/intestine, addl
C44204
Laparo partial colectomy
C44205
Lap colectomy part w/ileum
C44210
Laparo total proctocolectomy
C44211
Laparo total proctocolectomy
C44212
Laparo total proctocolectomy
C44227
Lap, close enterostomy
C44300
Open bowel to skin
C44310
Ileostomy/jejunostomy
C44314
Revision of ileostomy
C44316
Devise bowel pouch
C44320
Colostomy
C44322
Colostomy with biopsies
C44345
Revision of colostomy
C44346
Revision of colostomy
C44602
Suture, small intestine
C44603
Suture, small intestine
C44604
Suture, large intestine
C44605
Repair of bowel lesion
C44615
Intestinal stricturoplasty
C44620
Repair bowel opening
C44625
Repair bowel opening
C44626
Repair bowel opening
C44640
Repair bowel-skin fistula
C44650
Repair bowel fistula
C44660
Repair bowel-bladder fistula
C44661
Repair bowel-bladder fistula
C44680
Surgical revision, intestine
C44700
Suspend bowel w/prosthesis
C44715
Prepare donor intestine
C44720
Prep donor intestine/venous
C44721
Prep donor intestine/artery
C44800
Excision of bowel pouch
C44820
Excision of mesentery lesion
C44850
Repair of mesentery
C44899
Bowel surgery procedure
C44900
Drain app abscess, open
C44950
Appendectomy
C44955
Appendectomy add-on
C44960
Appendectomy
C45110
Removal of rectum
C45111
Partial removal of rectum
C45112
Removal of rectum
C45113
Partial proctectomy
C45114
Partial removal of rectum
C45116
Partial removal of rectum
C45119
Remove rectum w/reservoir
C45120
Removal of rectum
C45121
Removal of rectum and colon
C45123
Partial proctectomy
C45126
Pelvic exenteration
C45130
Excision of rectal prolapse
C45135
Excision of rectal prolapse
C45136
Excise ileoanal reservior
C( print page 49968)45395
Lap, removal of rectum
C45397
Lap, remove rectum w/pouch
C45400
Laparoscopic proctopexy
C45402
Lap proctopexy w/sig resect
C45540
Correct rectal prolapse
C45550
Repair rectum/remove sigmoid
C45562
Exploration/repair of rectum
C45563
Exploration/repair of rectum
C45800
Repair rect/bladder fistula
C45805
Repair fistula w/colostomy
C45820
Repair rectourethral fistula
C45825
Repair fistula w/colostomy
C46705
Repair of anal stricture
C46710
Repr per/vag pouch sngl proc
C46712
Repr per/vag pouch dbl proc
C46715
Rep perf anoper fistu
C46716
Rep perf anoper/vestib fistu
C46730
Construction of absent anus
C46735
Construction of absent anus
C46740
Construction of absent anus
C46742
Repair of imperforated anus
C46744
Repair of cloacal anomaly
C46746
Repair of cloacal anomaly
C46748
Repair of cloacal anomaly
C46751
Repair of anal sphincter
C47010
Open drainage, liver lesion
C47015
Inject/aspirate liver cyst
C47100
Wedge biopsy of liver
C47120
Partial removal of liver
C47122
Extensive removal of liver
C47125
Partial removal of liver
C47130
Partial removal of liver
C47133
Removal of donor liver
C47135
Transplantation of liver
C47136
Transplantation of liver
C47140
Partial removal, donor liver
C47141
Partial removal, donor liver
C47142
Partial removal, donor liver
C47143
Prep donor liver, whole
C47144
Prep donor liver, 3-segment
C47145
Prep donor liver, lobe split
C47146
Prep donor liver/venous
C47147
Prep donor liver/arterial
C47300
Surgery for liver lesion
C47350
Repair liver wound
C47360
Repair liver wound
C47361
Repair liver wound
C47362
Repair liver wound
C47380
Open ablate liver tumor rf
C47381
Open ablate liver tumor cryo
C47400
Incision of liver duct
C47420
Incision of bile duct
C47425
Incision of bile duct
C47460
Incise bile duct sphincter
C47480
Incision of gallbladder
C47550
Bile duct endoscopy add-on
C47570
Laparo cholecystoenterostomy
C47600
Removal of gallbladder
C47605
Removal of gallbladder
C47610
Removal of gallbladder
C47612
Removal of gallbladder
C47620
Removal of gallbladder
C47700
Exploration of bile ducts
C47701
Bile duct revision
C47711
Excision of bile duct tumor
C47712
Excision of bile duct tumor
C47715
Excision of bile duct cyst
C47716
Fusion of bile duct cyst
C( print page 49969)47720
Fuse gallbladder  bowel
C47721
Fuse upper gi structures
C47740
Fuse gallbladder  bowel
C47741
Fuse gallbladder  bowel
C47760
Fuse bile ducts and bowel
C47765
Fuse liver ducts  bowel
C47780
Fuse bile ducts and bowel
C47785
Fuse bile ducts and bowel
C47800
Reconstruction of bile ducts
C47801
Placement, bile duct support
C47802
Fuse liver duct  intestine
C47900
Suture bile duct injury
C48000
Drainage of abdomen
C48001
Placement of drain, pancreas
C48005
Resect/debride pancreas
C48020
Removal of pancreatic stone
C48100
Biopsy of pancreas, open
C48120
Removal of pancreas lesion
C48140
Partial removal of pancreas
C48145
Partial removal of pancreas
C48146
Pancreatectomy
C48148
Removal of pancreatic duct
C48150
Partial removal of pancreas
C48152
Pancreatectomy
C48153
Pancreatectomy
C48154
Pancreatectomy
C48155
Removal of pancreas
C48180
Fuse pancreas and bowel
C48400
Injection, intraop add-on
C48500
Surgery of pancreatic cyst
C48510
Drain pancreatic pseudocyst
C48520
Fuse pancreas cyst and bowel
C48540
Fuse pancreas cyst and bowel
C48545
Pancreatorrhaphy
C48547
Duodenal exclusion
C48551
Prep donor pancreas
C48552
Prep donor pancreas/venous
C48554
Transpl allograft pancreas
C48556
Removal, allograft pancreas
C49000
Exploration of abdomen
C49002
Reopening of abdomen
C49010
Exploration behind abdomen
C49020
Drain abdominal abscess
C49040
Drain, open, abdom abscess
C49060
Drain, open, retrop abscess
C49062
Drain to peritoneal cavity
C49201
Remove abdom lesion, complex
C49215
Excise sacral spine tumor
C49220
Multiple surgery, abdomen
C49255
Removal of omentum
C49425
Insert abdomen-venous drain
C49428
Ligation of shunt
C49605
Repair umbilical lesion
C49606
Repair umbilical lesion
C49610
Repair umbilical lesion
C49611
Repair umbilical lesion
C49900
Repair of abdominal wall
C49904
Omental flap, extra-abdom
C49905
Omental flap, intra-abdom
C49906
Free omental flap, microvasc
C50010
Exploration of kidney
C50040
Drainage of kidney
C50045
Exploration of kidney
C50060
Removal of kidney stone
C50065
Incision of kidney
C50070
Incision of kidney
C50075
Removal of kidney stone
C50100
Revise kidney blood vessels
C( print page 49970)50120
Exploration of kidney
C50125
Explore and drain kidney
C50130
Removal of kidney stone
C50135
Exploration of kidney
C50205
Biopsy of kidney
C50220
Remove kidney, open
C50225
Removal kidney open, complex
C50230
Removal kidney open, radical
C50234
Removal of kidney  ureter
C50236
Removal of kidney  ureter
C50240
Partial removal of kidney
C50250
Cryoablate renal mass open
C50280
Removal of kidney lesion
C50290
Removal of kidney lesion
C50300
Remove cadaver donor kidney
C50320
Remove kidney, living donor
C50323
Prep cadaver renal allograft
C50325
Prep donor renal graft
C50327
Prep renal graft/venous
C50328
Prep renal graft/arterial
C50329
Prep renal graft/ureteral
C50340
Removal of kidney
C50360
Transplantation of kidney
C50365
Transplantation of kidney
C50370
Remove transplanted kidney
C50380
Reimplantation of kidney
C50400
Revision of kidney/ureter
C50405
Revision of kidney/ureter
C50500
Repair of kidney wound
C50520
Close kidney-skin fistula
C50525
Repair renal-abdomen fistula
C50526
Repair renal-abdomen fistula
C50540
Revision of horseshoe kidney
C50545
Laparo radical nephrectomy
C50546
Laparoscopic nephrectomy
C50547
Laparo removal donor kidney
C50548
Laparo remove w/ureter
C50580
Kidney endoscopy  treatment
C50600
Exploration of ureter
C50605
Insert ureteral support
C50610
Removal of ureter stone
C50620
Removal of ureter stone
C50630
Removal of ureter stone
C50650
Removal of ureter
C50660
Removal of ureter
C50700
Revision of ureter
C50715
Release of ureter
C50722
Release of ureter
C50725
Release/revise ureter
C50727
Revise ureter
C50728
Revise ureter
C50740
Fusion of ureter  kidney
C50750
Fusion of ureter  kidney
C50760
Fusion of ureters
C50770
Splicing of ureters
C50780
Reimplant ureter in bladder
C50782
Reimplant ureter in bladder
C50783
Reimplant ureter in bladder
C50785
Reimplant ureter in bladder
C50800
Implant ureter in bowel
C50810
Fusion of ureter  bowel
C50815
Urine shunt to intestine
C50820
Construct bowel bladder
C50825
Construct bowel bladder
C50830
Revise urine flow
C50840
Replace ureter by bowel
C50845
Appendico-vesicostomy
C50860
Transplant ureter to skin
C( print page 49971)50900
Repair of ureter
C50920
Closure ureter/skin fistula
C50930
Closure ureter/bowel fistula
C50940
Release of ureter
C51060
Removal of ureter stone
C51525
Removal of bladder lesion
C51530
Removal of bladder lesion
C51535
Repair of ureter lesion
C51550
Partial removal of bladder
C51555
Partial removal of bladder
C51565
Revise bladder  ureter(s)
C51570
Removal of bladder
C51575
Removal of bladder  nodes
C51580
Remove bladder/revise tract
C51585
Removal of bladder  nodes
C51590
Remove bladder/revise tract
C51595
Remove bladder/revise tract
C51596
Remove bladder/create pouch
C51597
Removal of pelvic structures
C51800
Revision of bladder/urethra
C51820
Revision of urinary tract
C51840
Attach bladder/urethra
C51841
Attach bladder/urethra
C51845
Repair bladder neck
C51860
Repair of bladder wound
C51865
Repair of bladder wound
C51900
Repair bladder/vagina lesion
C51920
Close bladder-uterus fistula
C51925
Hysterectomy/bladder repair
C51940
Correction of bladder defect
C51960
Revision of bladder  bowel
C51980
Construct bladder opening
C53415
Reconstruction of urethra
C53448
Remov/replc ur sphinctr comp
C54125
Removal of penis
C54130
Remove penis  nodes
C54135
Remove penis  nodes
C54332
Revise penis/urethra
C54336
Revise penis/urethra
C54390
Repair penis and bladder
C54411
Remov/replc penis pros, comp
C54417
Remv/replc penis pros, compl
C54430
Revision of penis
C54535
Extensive testis surgery
C54650
Orchiopexy (Fowler-Stephens)
C55605
Incise sperm duct pouch
C55650
Remove sperm duct pouch
C55801
Removal of prostate
C55810
Extensive prostate surgery
C55812
Extensive prostate surgery
C55815
Extensive prostate surgery
C55821
Removal of prostate
C55831
Removal of prostate
C55840
Extensive prostate surgery
C55842
Extensive prostate surgery
C55845
Extensive prostate surgery
C55862
Extensive prostate surgery
C55865
Extensive prostate surgery
C55866
Laparo radical prostatectomy
C56630
Extensive vulva surgery
C56631
Extensive vulva surgery
C56632
Extensive vulva surgery
C56633
Extensive vulva surgery
C56634
Extensive vulva surgery
C56637
Extensive vulva surgery
C56640
Extensive vulva surgery
C57110
Remove vagina wall, complete
C57111
Remove vagina tissue, compl
C( print page 49972)57112
Vaginectomy w/nodes, compl
C57270
Repair of bowel pouch
C57280
Suspension of vagina
C57282
Colpopexy, extraperitoneal
C57283
Colpopexy, intraperitoneal
C57305
Repair rectum-vagina fistula
C57307
Fistula repair  colostomy
C57308
Fistula repair, transperine
C57311
Repair urethrovaginal lesion
C57531
Removal of cervix, radical
C57540
Removal of residual cervix
C57545
Remove cervix/repair pelvis
C58140
Myomectomy abdom method
C58146
Myomectomy abdom complex
C58150
Total hysterectomy
C58152
Total hysterectomy
C58180
Partial hysterectomy
C58200
Extensive hysterectomy
C58210
Extensive hysterectomy
C58240
Removal of pelvis contents
C58260
Vaginal hysterectomy
C58262
Vag hyst including t/o
C58263
Vag hyst w/t/o  vag repair
C58267
Vag hyst w/urinary repair
C58270
Vag hyst w/enterocele repair
C58275
Hysterectomy/revise vagina
C58280
Hysterectomy/revise vagina
C58285
Extensive hysterectomy
C58290
Vag hyst complex
C58291
Vag hyst incl t/o, complex
C58292
Vag hyst t/o  repair, compl
C58293
Vag hyst w/uro repair, compl
C58294
Vag hyst w/enterocele, compl
C58400
Suspension of uterus
C58410
Suspension of uterus
C58520
Repair of ruptured uterus
C58540
Revision of uterus
C58605
Division of fallopian tube
C58611
Ligate oviduct(s) add-on
C58700
Removal of fallopian tube
C58720
Removal of ovary/tube(s)
C58740
Revise fallopian tube(s)
C58750
Repair oviduct
C58752
Revise ovarian tube(s)
C58760
Remove tubal obstruction
C58805
Drainage of ovarian cyst(s)
C58822
Drain ovary abscess, percut
C58825
Transposition, ovary(s)
C58940
Removal of ovary(s)
C58943
Removal of ovary(s)
C58950
Resect ovarian malignancy
C58951
Resect ovarian malignancy
C58952
Resect ovarian malignancy
C58953
Tah, rad dissect for debulk
C58954
Tah rad debulk/lymph remove
C58956
Bso, omentectomy w/tah
C58960
Exploration of abdomen
C59120
Treat ectopic pregnancy
C59121
Treat ectopic pregnancy
C59130
Treat ectopic pregnancy
C59135
Treat ectopic pregnancy
C59136
Treat ectopic pregnancy
C59140
Treat ectopic pregnancy
C59325
Revision of cervix
C59350
Repair of uterus
C59514
Cesarean delivery only
C59525
Remove uterus after cesarean
C59620
Attempted vbac delivery only
C( print page 49973)59830
Treat uterus infection
C59850
Abortion
C59851
Abortion
C59852
Abortion
C59855
Abortion
C59856
Abortion
C59857
Abortion
C60254
Extensive thyroid surgery
C60270
Removal of thyroid
C60271
Removal of thyroid
C60502
Re-explore parathyroids
C60505
Explore parathyroid glands
C60520
Removal of thymus gland
C60521
Removal of thymus gland
C60522
Removal of thymus gland
C60540
Explore adrenal gland
C60545
Explore adrenal gland
C60600
Remove carotid body lesion
C60605
Remove carotid body lesion
C60650
Laparoscopy adrenalectomy
C61105
Twist drill hole
C61107
Drill skull for implantation
C61108
Drill skull for drainage
C61120
Burr hole for puncture
C61140
Pierce skull for biopsy
C61150
Pierce skull for drainage
C61151
Pierce skull for drainage
C61154
Pierce skull  remove clot
C61156
Pierce skull for drainage
C61210
Pierce skull, implant device
C61250
Pierce skull  explore
C61253
Pierce skull  explore
C61304
Open skull for exploration
C61305
Open skull for exploration
C61312
Open skull for drainage
C61313
Open skull for drainage
C61314
Open skull for drainage
C61315
Open skull for drainage
C61316
Implt cran bone flap to abdo
C61320
Open skull for drainage
C61321
Open skull for drainage
C61322
Decompressive craniotomy
C61323
Decompressive lobectomy
C61332
Explore/biopsy eye socket
C61333
Explore orbit/remove lesion
C61340
Subtemporal decompression
C61343
Incise skull (press relief)
C61345
Relieve cranial pressure
C61440
Incise skull for surgery
C61450
Incise skull for surgery
C61458
Incise skull for brain wound
C61460
Incise skull for surgery
C61470
Incise skull for surgery
C61480
Incise skull for surgery
C61490
Incise skull for surgery
C61500
Removal of skull lesion
C61501
Remove infected skull bone
C61510
Removal of brain lesion
C61512
Remove brain lining lesion
C61514
Removal of brain abscess
C61516
Removal of brain lesion
C61517
Implt brain chemotx add-on
C61518
Removal of brain lesion
C61519
Remove brain lining lesion
C61520
Removal of brain lesion
C61521
Removal of brain lesion
C61522
Removal of brain abscess
C61524
Removal of brain lesion
C( print page 49974)61526
Removal of brain lesion
C61530
Removal of brain lesion
C61531
Implant brain electrodes
C61533
Implant brain electrodes
C61534
Removal of brain lesion
C61535
Remove brain electrodes
C61536
Removal of brain lesion
C61537
Removal of brain tissue
C61538
Removal of brain tissue
C61539
Removal of brain tissue
C61540
Removal of brain tissue
C61541
Incision of brain tissue
C61542
Removal of brain tissue
C61543
Removal of brain tissue
C61544
Remove  treat brain lesion
C61545
Excision of brain tumor
C61546
Removal of pituitary gland
C61548
Removal of pituitary gland
C61550
Release of skull seams
C61552
Release of skull seams
C61556
Incise skull/sutures
C61557
Incise skull/sutures
C61558
Excision of skull/sutures
C61559
Excision of skull/sutures
C61563
Excision of skull tumor
C61564
Excision of skull tumor
C61566
Removal of brain tissue
C61567
Incision of brain tissue
C61570
Remove foreign body, brain
C61571
Incise skull for brain wound
C61575
Skull base/brainstem surgery
C61576
Skull base/brainstem surgery
C61580
Craniofacial approach, skull
C61581
Craniofacial approach, skull
C61582
Craniofacial approach, skull
C61583
Craniofacial approach, skull
C61584
Orbitocranial approach/skull
C61585
Orbitocranial approach/skull
C61586
Resect nasopharynx, skull
C61590
Infratemporal approach/skull
C61591
Infratemporal approach/skull
C61592
Orbitocranial approach/skull
C61595
Transtemporal approach/skull
C61596
Transcochlear approach/skull
C61597
Transcondylar approach/skull
C61598
Transpetrosal approach/skull
C61600
Resect/excise cranial lesion
C61601
Resect/excise cranial lesion
C61605
Resect/excise cranial lesion
C61606
Resect/excise cranial lesion
C61607
Resect/excise cranial lesion
C61608
Resect/excise cranial lesion
C61609
Transect artery, sinus
C61610
Transect artery, sinus
C61611
Transect artery, sinus
C61612
Transect artery, sinus
C61613
Remove aneurysm, sinus
C61615
Resect/excise lesion, skull
C61616
Resect/excise lesion, skull
C61618
Repair dura
C61619
Repair dura
C61624
Transcath occlusion, cns
C61680
Intracranial vessel surgery
C61682
Intracranial vessel surgery
C61684
Intracranial vessel surgery
C61686
Intracranial vessel surgery
C61690
Intracranial vessel surgery
C61692
Intracranial vessel surgery
C( print page 49975)61697
Brain aneurysm repr, complx
C61698
Brain aneurysm repr, complx
C61700
Brain aneurysm repr, simple
C61702
Inner skull vessel surgery
C61703
Clamp neck artery
C61705
Revise circulation to head
C61708
Revise circulation to head
C61710
Revise circulation to head
C61711
Fusion of skull arteries
C61735
Incise skull/brain surgery
C61750
Incise skull/brain biopsy
C61751
Brain biopsy w/ct/mr guide
C61760
Implant brain electrodes
C61770
Incise skull for treatment
C61850
Implant neuroelectrodes
C61860
Implant neuroelectrodes
C61863
Implant neuroelectrode
C61864
Implant neuroelectrde, addl
C61867
Implant neuroelectrode
C61868
Implant neuroelectrde, add'l
C61870
Implant neuroelectrodes
C61875
Implant neuroelectrodes
C62005
Treat skull fracture
C62010
Treatment of head injury
C62100
Repair brain fluid leakage
C62115
Reduction of skull defect
C62116
Reduction of skull defect
C62117
Reduction of skull defect
C62120
Repair skull cavity lesion
C62121
Incise skull repair
C62140
Repair of skull defect
C62141
Repair of skull defect
C62142
Remove skull plate/flap
C62143
Replace skull plate/flap
C62145
Repair of skull  brain
C62146
Repair of skull with graft
C62147
Repair of skull with graft
C62148
Retr bone flap to fix skull
C62161
Dissect brain w/scope
C62162
Remove colloid cyst w/scope
C62163
Neuroendoscopy w/fb removal
C62164
Remove brain tumor w/scope
C62165
Remove pituit tumor w/scope
C62180
Establish brain cavity shunt
C62190
Establish brain cavity shunt
C62192
Establish brain cavity shunt
C62200
Establish brain cavity shunt
C62201
Brain cavity shunt w/scope
C62220
Establish brain cavity shunt
C62223
Establish brain cavity shunt
C62256
Remove brain cavity shunt
C62258
Replace brain cavity shunt
C63043
Laminotomy, add'l cervical
C63044
Laminotomy, add'l lumbar
C63050
Cervical laminoplasty
C63051
C-laminoplasty w/graft/plate
C63076
Neck spine disk surgery
C63077
Spine disk surgery, thorax
C63078
Spine disk surgery, thorax
C63081
Removal of vertebral body
C63082
Remove vertebral body add-on
C63085
Removal of vertebral body
C63086
Remove vertebral body add-on
C63087
Removal of vertebral body
C63088
Remove vertebral body add-on
C63090
Removal of vertebral body
C63091
Remove vertebral body add-on
C63101
Removal of vertebral body
C( print page 49976)63102
Removal of vertebral body
C63103
Remove vertebral body add-on
C63170
Incise spinal cord tract(s)
C63172
Drainage of spinal cyst
C63173
Drainage of spinal cyst
C63180
Revise spinal cord ligaments
C63182
Revise spinal cord ligaments
C63185
Incise spinal column/nerves
C63190
Incise spinal column/nerves
C63191
Incise spinal column/nerves
C63194
Incise spinal column  cord
C63195
Incise spinal column  cord
C63196
Incise spinal column  cord
C63197
Incise spinal column  cord
C63198
Incise spinal column  cord
C63199
Incise spinal column  cord
C63200
Release of spinal cord
C63250
Revise spinal cord vessels
C63251
Revise spinal cord vessels
C63252
Revise spinal cord vessels
C63265
Excise intraspinal lesion
C63266
Excise intraspinal lesion
C63267
Excise intraspinal lesion
C63268
Excise intraspinal lesion
C63270
Excise intraspinal lesion
C63271
Excise intraspinal lesion
C63272
Excise intraspinal lesion
C63273
Excise intraspinal lesion
C63275
Biopsy/excise spinal tumor
C63276
Biopsy/excise spinal tumor
C63277
Biopsy/excise spinal tumor
C63278
Biopsy/excise spinal tumor
C63280
Biopsy/excise spinal tumor
C63281
Biopsy/excise spinal tumor
C63282
Biopsy/excise spinal tumor
C63283
Biopsy/excise spinal tumor
C63285
Biopsy/excise spinal tumor
C63286
Biopsy/excise spinal tumor
C63287
Biopsy/excise spinal tumor
C63290
Biopsy/excise spinal tumor
C63295
Repair of laminectomy defect
C63300
Removal of vertebral body
C63301
Removal of vertebral body
C63302
Removal of vertebral body
C63303
Removal of vertebral body
C63304
Removal of vertebral body
C63305
Removal of vertebral body
C63306
Removal of vertebral body
C63307
Removal of vertebral body
C63308
Remove vertebral body add-on
C63700
Repair of spinal herniation
C63702
Repair of spinal herniation
C63704
Repair of spinal herniation
C63706
Repair of spinal herniation
C63707
Repair spinal fluid leakage
C63709
Repair spinal fluid leakage
C63710
Graft repair of spine defect
C63740
Install spinal shunt
C64752
Incision of vagus nerve
C64755
Incision of stomach nerves
C64760
Incision of vagus nerve
C64809
Remove sympathetic nerves
C64818
Remove sympathetic nerves
C64866
Fusion of facial/other nerve
C64868
Fusion of facial/other nerve
C65273
Repair of eye wound
C69155
Extensive ear/neck surgery
C69535
Remove part of temporal bone
C( print page 49977)69554
Remove ear lesion
C69950
Incise inner ear nerve
C69970
Remove inner ear lesion
C75900
Intravascular cath exchange
C75952
Endovasc repair abdom aorta
C75953
Abdom aneurysm endovas rpr
C75954
Iliac aneurysm endovas rpr
C75956
Xray, endovasc thor ao repr
C75957
Xray, endovasc thor ao repr
C75958
Xray, place prox ext thor ao
C75959
Xray, place dist ext thor ao
C92970
Cardioassist, internal
C92971
Cardioassist, external
C92975
Dissolve clot, heart vessel
C92992
Revision of heart chamber
C92993
Revision of heart chamber
C99190
Special pump services
C99191
Special pump services
C99192
Special pump services
C99251
Initial inpatient consult
C99252
Initial inpatient consult
C99253
Initial inpatient consult
C99254
Initial inpatient consult
C99255
Initial inpatient consult
C99293
Ped critical care, initial
C99294
Ped critical care, subseq
C99295
Neonate crit care, initial
C99296
Neonate critical care subseq
C99298
Ic for lbw infant  1500 gm
C99299
Ic, lbw infant 1500-2500 gm
C99356
Prolonged service, inpatient
C99357
Prolonged service, inpatient
C99433
Normal newborn care/hospital
C0021T
Fetal oximetry, trnsvag/cerv
C0024T
Transcath cardiac reduction
C0048T
Implant ventricular device
C0049T
External circulation assist
C0050T
Removal circulation assist
C0051T
Implant total heart system
C0052T
Replace component heart syst
C0053T
Replace component heart syst
C0075T
Perq stent/chest vert art
C0076T
Si stent/chest vert art
C0077T
Cereb therm perfusion probe
C0078T
Endovasc aort repr w/device
C0079T
Endovasc visc extnsn repr
C0080T
Endovasc aort repr rad si
C0081T
Endovasc visc extnsn si
C0090T
Cervical artific disc
C0091T
Lumbar artific disc
C0092T
Artific disc addl
C0093T
Cervical artific diskectomy
C0094T
Lumbar artific diskectomy
C0095T
Artific diskectomy addl
C0096T
Rev cervical artific disc
C0097T
Rev lumbar artific disc
C0098T
Rev artific disc addl
C0153T
Implant aneur sensor add-on
CG0341
Percutaneous islet celltrans
CG0342
Laparoscopy islet cell trans
CG0343
Laparotomy islet cell transp
C


# Footnotes

1.
    
                             The Premier Hospital Quality Incentive Demonstration was authorized under section 402 of Pub. L 90-248, Social Security Amendments of 1967 (42 U.S.C. 1395b-1). This section authorizes certain types of demonstration projects that waive compliance with the regular payment methods used in the Medicare program. Back to Citation
 2.
    
                             Additional information on the Premier Hospital Quality Incentive Demonstration is available on the CMS Web site at: 
                            *http://www.cms.hhs.gov/​HospitalQualityInits/​35_​HospitalPremier.asp.* Back to Citation
 3.
    
                             Additional information on CMS' Hospital Quality Initiative is available on the CMS Web site at: 
                            *http://www.cms.hhs.gov/​HospitalQualityInits/​.* Back to Citation
 4.
    
                             Institute of Medicine, “Performance Measurement: Accelerating Improvement,” December 1, 2005, available at 
                            *http://www.iom.edu/​CMS/​3809/​19805/​31310.aspx*. Back to Citation
 5.
    
                             RAND News Release: RAND Study Says Computerizing Medical Records Could Save $81 Billion Annually and Improve the Quality of Medical Care, September 14, 2005, available at: 
                            *http://rand.org/​news/​press.05/​09.14.html.* Back to Citation
 6.
    
                             Transforming Health Care: The President's Health Information Technology Plan, available at: 
                            *http://www.whitehouse.gov/​infocus/​technology/​economic_​policy200404/​chap3.html.* Back to Citation


BILLING CODE 4120-01-P BILLING CODE 4120-01-C [FR Doc. 06-6846 Filed 8-8-06; 4:15 pm]